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 the mechanism of staple line leak after sleeve gastrectomy via isobaric pressurisation, outcomes from the DAYSLEEVE RCT, outcomes of the first consensus meeting standardise PROMS in obesity treatment research, the changes in cognitive function following bariatric surgery and a paper reporting on the relationship between early weight loss and weight loss maintenance with naltrexone-bupropion therapy (please note, log-in maybe required to access the full paper).
Mechanism of Staple Line Leak After Sleeve Gastrectomy via Isobaric Pressurisation Concentrating Stress Forces at the Proximal Staple Line
Investigators from Monash University, Melbourne, Australia, writing in Obesity Surgery, have reported how high-pressure events could translate stress to the luminal wall and precipitate a gastric leak post-LSG.
Although staple line leak post-LSG has been hypothesised to be related to hyperpressurisation in the proximal stomach, they noted that there is little objective evidence demonstrating how these forces could be transmitted to the luminal wall. Therefore, the authors sought to define conditions in the proximal stomach and simulate the transmission of stress forces in the post-operative stomach using a finite element analysis (FEA).
For their study, the manometry of 14 post-LSG patients was compared to ten controls. Manometry, boundary conditions and volumetric CT were integrated to develop six models. These models delineated luminal wall stress in the proximal stomach.
The found that the LSG patients had a significantly higher peak intragastric isobaric pressures 31.58±2.1 vs. 13.49±1.3mmHg (p=0.0002). Regions of stress were clustered at the staple line near the GOJ and peak stress was observed there in 67% of models. A uniform greater curvature did not fail or concentrate stress under maximal pressurisation. Geometric variation demonstrated that a larger triangulated apex increased stress by 17% (255 kPa versus 218 kPa), with a 37% increase at the GOJ (203kPA versus 148kPA). A wider incisura reduced stress at the GOJ by 9.9% (128 kPa versus 142 kPa).
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Laparoscopic Sleeve Gastrectomy as Day Case Surgery vs Conventional Hospitalization: Results of the DAYSLEEVE Randomized Clinical Trial
Researchers from the New You Medical Center, Riyadh, Saudi Arabia, have concluded that LSG is feasible as a day case procedure with comparable outcomes to conventional hospitalisation.
The DAYSLEEVE clinical trial compared the feasibility, perioperative outcomes and weight loss of ambulatory LSG with same-day discharge (DC LSG) vs conventional hospitalisation with next-day discharge (CH LSG), in patients who satisfied low acuity criteria. The primary outcomes were 30-day adverse events, hospitalizations, reoperations and readmissions, and the secondary outcome was weight loss during the first year.
Writing in SOARD, the reported that 1,544 patients were randomised in the study (n=777 in each group. Eighteen (2.3%) patients in the DC LSG were transferred to the hospital for overnight stay. Additionally, 13 (1.7%) patients requested additional stay without a medical indication for a total overnight stay rate of 4%. One DC LSG (0.1%) patient was readmitted, and two CH LSG (0.3%) patients stayed for an extra day. Seventeen percent of DC LSG patients had unscheduled consultations during the first postoperative week compared to 6% of the CH LSG patients (p<0.001).
There were no reoperations or mortality in either group, and weight loss results were similar; At one year follow-up, DC LSG %excess weight loss was 87±17% compared to 85±17% in the CH LSG group. The follow-up rate was 100%.
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Outcomes of the first global multidisciplinary consensus meeting including persons living with obesity to standardize patient-reported outcome measurement in obesity treatment research
An international team of researchers, writing in Obesity Reviews, have reported the outcomes of the first global multidisciplinary consensus meeting to standardize patient-reported outcome measurement in obesity treatment research.
The S.Q.O.T. initiative was founded to Standardize Quality of life measurement in Obesity Treatment and the first face-to-face, international, multidisciplinary consensus meeting was conducted to identify the key PROs and preferred PROMs for obesity treatment research. It comprised of 35 people living with obesity (PLWO) and healthcare providers (HCPs).
The following eight PROs were considered important: self-esteem, physical health/functioning, mental/psychological health, social health, eating, stigma, body image, and excess skin. Self-esteem was considered the most important PRO, particularly for PLWO, while physical health was perceived to be the most important among HCPs. For each PRO, one or more PROMs were selected, except for stigma. This consensus meeting was a first step toward standardizing PROs (what to measure) and PROMs (how to measure) in obesity treatment research.
It provides an overview of the key PROs and a first selection of the PROMs that can be used to evaluate these PROs, the authors concluded.
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The changes in cognitive function following bariatric surgery considering the function of gut microbiome
An international team of authors, writing in Obesity Pillars, have reported that there is a possible correlation between cognitive dysfunction and increased risk of cognitive dysfunction in people with a BMI>40kg/m2.
In their review article, the authors discuss the association of obesity, cognitive impairment and physiological changes after bariatric surgery. They noted that bariatric surgery has a series of physiological benefits which may lead to an improvement in cognitive functions in individuals who are prone to later developing Alzheimer's disease. Also, taxonomical change in the gut microbiome profile provides a healthy condition for living with better levels of cognition without neuropathological damages in older ages.
They concluded that bariatric surgery may increase neurotransmitters and improve the gut bacteria, leading to a significant reduction in the risk of Alzheimer's disease.
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The relationship between early weight loss and weight loss maintenance with naltrexone-bupropion therapy
An international team of researchers, wiring in eClinicalMedicine, have reported that naltrexone/bupropion (NB) could be used as part of long-term, comprehensive weight loss and weight loss maintenance strategies.
They conducted a post-hoc analysis of four phase III, randomized, double-blind, placebo-controlled, 56-week studies (COR-I, COR-II, COR-BMOD, and COR-DM), the placebo-controlled cardiovascular outcomes trial LIGHT (208 weeks), and the randomized, open-label trial IGNITE (78 weeks).
Included subjects were treated with NB 32mg/360mg or placebo, with baseline, week 16, and final time point data. The primary outcome was Kaplan-Meier-estimated weight loss maintenance in each study for up to 204 weeks.
The analysis included data from 10,198 participants (NB=5,412; placebo=4,786). Proportions of patients with ≥5% or ≥10% weight loss maintenance were numerically higher for NB vs. placebo in all studies and time points. Differences were statistically significant for ≥5% weight loss maintenance in COR-BMOD and COR-I/-II at weeks 52 and 56 and the LIGHT study at weeks 52, 104, and 208. For ≥10% weight loss maintenance, differences were statistically significant in COR-I/COR-II at weeks 52 and 56.
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