Welcome to our weekly round-up of the latest bariatric and obesity-related papers published in the medical literature. As ever, we have looked far and wide to give you an overview of papers including rheumatic diseases after BMS, Koala Sleeve for GERD control, BMS and liver fibrosis in T2DM patients, myocardial mechanical changes before and after BMS, intraoperative methadone use for post-op pain and simulation training with haptic feedback during live robot-assisted sleeve gastrectomy, and more (please note, log-in maybe required to access the full paper).
Rheumatic Diseases Following Metabolic and Bariatric Surgery: A Systematic Review and Meta-Analysis
In a meta-analysis, researchers from Brazil found a significant decrease in the prevalence of rheumatic diseases, improvements in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and reduced medication use among patients undergoing BMS.
Writing in Obesity Surgery, they conducted a random-effects meta-analysis from 28 studies including 43,421 patients with 13,347 patients with rheumatic diseases. The prevalence of osteoarthritis (OA), rheumatoid arthritis, and psoriatic arthritis was significantly reduced after BMS
(OR 0.20; 95% CI 0.12 to 0.33; p=0.01).
The WOMAC index for patients with OA had a statistically significant overall reduction after BMS at 6 months (p<0.01) and at 12 months (p<0.01). Medication use significantly decreased after BMS, both at the follow-up beyond two years (p<0.01) and up to two years (p<0.01).
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Koala Sleeve: innovative technique for enhanced GERD control without sacrificing weight loss
Investigators from the Hospital de Pedro Hispano, Matosinhos, Portugal, have reported that sleeve gastrectomy (SG) with horizontal gastroplasty appears to be a promising, simple, and safe option for patients with gastroesophageal reflux disease (GERD) undergoing SG.
Reporting in Surgical Endoscopy, they examined the outcomes of a novel modification to SG, combining it with horizontal gastroplasty to address GERD symptoms without compromising weight loss outcomes. The procedure involves a standard SG with complete fundus resection, followed by the creation of a horizontal valve at the gastroesophageal junction using three horizontal mattress sutures.
Seven patients with preoperative GERD were selected for this technique. Post-operative outcomes were assessed, including weight loss and GERD symptom resolution. The mean operative time was 76 min, with no procedure-related complications. Three months postoperatively, the average percentage of excess weight loss (%EWL) was 68%. Importantly, none of the patients reported GERD symptoms, indicating effective reflux control.
“This technique may offer a viable alternative to RYGB for managing GERD in bariatric patients. Further studies are needed to validate these initial findings and assess long-term outcomes, they concluded.
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Impact of bariatric surgery on liver fibrosis indices among type 2 diabetes patients in a national cohort
Iranian researchers have reported BMS significantly improves non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) and cause alterations in aspartate aminotransferase (AST) to platelet ratio index (APRI) and Fibrosis-4 (FIB-4) index levels without increasing the risk of liver cirrhosis development among patients with T2D and obesity.
Writing in Scientific Reports, they evaluated the effect of BMS on the association between liver fibrosis indices and obesity. This is a retrospective cohort, evaluating 1,205 individuals diagnosed with type 2 diabetes (T2D) and living with obesity, who experienced bariatric surgery. These patients living with T2D and obesity were monitored after bariatric surgery for two years.
There was an initial increase in FIB-4 index observed at the three-months visit, followed by a decline up to one year with a slight increase at the last follow-up (p<0.001), the mean FIB-4 in patients with FIB-4 ≥ 1.3 (pre-operation) did not exceed the value of 2.00, which is lower than the cut-off value of high risk for liver cirrhosis (FIB-4 ≥ 2.67). In addition, the NAFLD fibrosis score (NFS) demonstrated a substantial decline from −0.32±1.32 pre-operation to -0.86±1.15 at the two-year mark (p<0.001).
Finally, APRI decreased from 0.27±0.20 pre-operation to 0.23±0.12 at the 12-month follow-up.
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Myocardial mechanical changes before and after bariatric surgery in individuals with obesity and diabetes: a 1-year follow-up study
Individuals with obesity can benefit from bariatric surgery, which includes improved heart function and delayed disease progression, according to investigators from the Shanxi Bethune Hospital, Shanxi, China.
Writing in Scientific Reports, two-dimensional speckle-tracking echocardiography was applied to evaluate the changes of left ventricular myocardial mechanics in individuals with obesity and diabetes before and after BMS. A total of 58 individuals with obesity were divided into an obesity-only group (30 patients) and an obesity + diabetes group (28 patients). Routine echocardiographic parameters and left ventricular global longitudinal strain (GLS) were compared between the two groups at baseline and 6 and 12 months postoperatively.
At all three time points, GLS was lower in the obesity + diabetes group than in the obesity-only group. In both groups, the GLS increased successively at 6 and 12 months postoperatively. The change in GLS (∆GLS) from baseline to 6 months was higher than the △GLS from 6 to 12 months in both groups. The △GLS from baseline to 6 months was lower in the obesity + diabetes group than in the obesity-only group.
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Intraoperative Use of Methadone for Postoperative Pain Control in Bariatric Surgery: A Randomized, Double-Blind, Controlled Clinical Trial
Brazilian investigators have found intravenous methadone single dose in laparoscopic bariatric surgery was safe, achieving better postoperative pain outcomes.
Writing in Cureus, they aimed to assess postoperative pain in patients who received a single dose of methadone during the anesthetic-surgical procedure, as well as to evaluate adverse effects in a randomised, double-blind, clinical trial with patients undergoing video laparoscopic bariatric surgery.
Immediately after anaesthesia induction, the methadone group (MG, n=16) received 10mg of methadone diluted in 100ml of 0.9% saline, and the Control group (CG, n=18) received only 100ml of 0.9% saline (without methadone in this group). The assessment of pain was made using the visual analog scale (VAS), 10 minutes after extubation in the post-anaesthesia care unit (PACU) and six, 12, and 24 hours after surgery. The presence of nausea and vomiting, respiratory depression, and the need for postoperative rescue opioids were analysed.
The MG showed a lower average of pain scores on the VAS over 24 hours, with a significant difference in the first 10 minutes postoperatively. Furthermore, it showed a greater decrease in VAS pain scores over 24 hours (p<0.001) compared to the CG. In the postoperative period, no significant difference was found between the groups regarding rescue morphine use within the first 24 hours (p=0,469), except during the PACU period, the rescue morphine use was higher in the CG (p=0,005). There was no significant difference regarding the presence of nausea and vomiting (p=0.372).
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Simulation training with haptic feedback of instrument vibrations reduces resident workload during live robot-assisted sleeve gastrectomy
Haptic feedback of instrument vibrations provided during robotic surgical simulation reduces trainee workload during both simulation and live OR cases, according to an in international team of researchers
Writing in Surgical Endoscopy, they conducted a single-blinded study with 12 general surgery residents (third and seventh post-graduate year, PGY) randomised into haptic and control groups. Participants performed five simulated bariatric surgeries on a custom inanimate simulator followed by live robot-assisted sleeve gastrectomies (RASGs) using da Vinci robots. The haptic group received naturalistic haptic feedback of instrument vibrations during their first four simulated procedures. Participants completed pre-/post-procedure STAI and post-procedure NASA-TLX questionnaires in both simulation and the operating room (OR).
Higher PGY level (simulation: p<0.001, OR p=0.004), shorter operative time (simulation: p<0.001, OR p=0.003) and lower pre-procedure STAI (simulation: p=0.003, OR p<0.001) were significantly associated with lower self-reported overall workload in both operative settings; PGY-7 s reported about 10% lower workload than PGY-3 s.
The haptic group had significantly lower overall covariate-adjusted NASA-TLX during the fourth (p=0.03) and fifth (p=0.04) simulated procedures and across all OR procedures (p=0.047), though not for only the first three OR procedures. Haptic feedback reduced physical demand (simulation: p<0.001, OR p=0.001) and increased perceived performance (simulation: p=0.031, OR p<0.001) in both settings.
They concluded that the implications of workload reduction and its potential effects on patient safety warrant further investigation.
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