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Journal Watch 02/08/2023

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 marginal ulcers post OAGB, pre-operative orlistat and OAGB, post-RYGB and -LSG perinatal outcomes and Patient-Reported Outcomes in Obesity (PROS), and more (please note, log-in maybe required to access the full paper).

Marginal Ulcers Following One-Anastomosis Gastric Bypass: a Systematic Review and Meta-analysis

UK researchers, writing in Obesity Surgery, have report marginal ulcers are an uncommon complication following OAGB with the majority of patients are treated conservatively with proton-pump inhibitors (PPIs).

The systematic review and meta-analysis, which sought to understand the incidence rates, risk factors and management of marginal ulcers following OAGB, included 32 studies involving 8,868 patients. The incidence of marginal ulcers was 2.59% of which 53 patients presented within 12 months, 24 patients presented after 31 months, and five patients after six years. One hundred forty-six patients did not have presentation time documented. Sixty-five patients were described to have marginal ulcers diagnosed on endoscopy, of which 54 were symptomatic and 11 were asymptomatic. The authors did not specify the choice of investigation for the remaining 163 patients. Of patients, 89.7% were treated conservatively with PPIs, whilst 10.3% had surgery to treat their marginal ulcer.

They concluded that larger, well-designed studies reporting on risk factors, investigation and management of marginal ulcers following OAGB are warranted.

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Effectiveness of a preoperative orlistat-based weight management plan and its impact on the results of one-anastomosis gastric bypass: A retrospective study

Researchers at the Taipei Medical University, Taipei, Taiwan, have reported that pre-operative orlistat-regimen benefitted two-thirds of patients who subsequently underwent one-anastomosis gastric bypass (OAGB).

The aim was to first investigate the efficacy of a preoperative weight management program centered on orlistat, and then assess its impact on the results of OAGB. Eligible patients who adhered to a 10–14 day orlistat regimen as part of a 4–6-week diet/lifestyle modification plan preceding surgery were stratified into weight reduction (Group 1) and weight gain (Group 2) groups post treatment. The correlation between pre- and postoperative weight loss and perioperative outcomes was assessed.

Of 62 eligible patients, 55 met the inclusion criteria and complied with treatment; 35 (64%) patients in Group 1 lost a median of 2.0 kg, and Group 2 had a median weight gain of 2.9 kg. There was no difference in the incidence of 30-day complications. Weight loss did not differ between the groups at 24 months.

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Adverse perinatal outcomes after Roux-en-Y Gastric Bypass vs. Sleeve Gastrectomy: a systematic review

Investigators from Lund University and Skåne University Hospital, Malmö, Sweden, have reported that their systematic review found no major differences in BMI, mode of delivery, birthweight, gestational age, or rates of intrauterine death between women having undergone RYGB vs. SG.

Writing in BMC Pregnancy and Childbirth, they compared adverse perinatal outcomes in pregnant women following RYGB and SG. They noted a higher incidence of both small for gestational age (SGA - 22.9%, 11.9%, 14.2%) and large for gestational age (LGA - 4.2%, 4.8%, 1.7%) in SG compared to Roux-en-Y (SGA: 8.8%, 7.7%, 11.5%, 8.3% and LGA: 3.4%, 0.7%). SG had a shorter surgery to conception interval as compared to RYGB.

Future studies are indicated to counsel women of reproductive age on the most appropriate type of bariatric surgery that is associated with the best perinatal outcomes, they concluded.

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Sensitivity for Change Analyses of the Patient-Reported Outcomes in Obesity (PROS) Questionnaire: A Prospective Cohort Study

Researchers from Western Norway University of Applied Sciences, Førde, Norway, have concluded that the Patient-Reported Outcomes in Obesity (PROS) is sensitive to change over time and may be used as a brief, easy to administer tool to facilitate a conversation about obesity-specific quality of life in clinical consultations.

The PROS was developed to address patients’ health-related quality of life (HRQOL) concerns during clinical consultations and facilitate meaningful dialogue. The present study aimed to explore its sensitivity to change and 38 patients responded to items on the PROS and the Obesity-related Problems Scale (OP) before surgery and three, 12 and 24 months after surgery.

They noted a significant change over time was detected for the PROS with the largest effect size at 24 months (effect size − 1.34, p˂0.001), while the corresponding effect size for the OP was − 1.32 (p˂0.001). In all items of the PROS, the majority of patients responded not bothered at 24 months. The items physical activity, pain, sleep and self-esteem showed the largest change in the percentage of patients reporting not bothered from baseline to 24 months after surgery.

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