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Journal Watch 05/07/2023

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 bleeding after bariatric surgery, Oseberg trial outcomes, one-year outcomes from a magnet anastomosis system, robotic assistance during bariatric surgery and more (please note, log-in maybe required to access the full paper).

Timing and management of bleeding after bariatric surgery

Researchers from the Renaissance School of Medicine, Stony Brook, NY, have reported that patients after sleeve gastrectomy (SG) who experience bleeding are more likely to undergo reoperation than Roux-en-Y gastric bypass (RYGB) patients.

Writing in Surgical Endoscopy, they identified 6,251 patients from the Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) database with bleeding after SG or RYGB.

In total, 2,653 patients underwent subsequent procedures (n=1,375 [51.83%] RYGB index procedure, n=1,278 [48.17%] SG index procedure) – 1,892 (71.32%) and 761 (28.68%) patients had reoperation and non-operative intervention, respectively. For patients who developed bleeding, SG was associated with significantly higher reoperation risk, while RYGB was associated with significantly higher risk of non-operative intervention. Early bleeding was associated with significantly increased risk of reoperation and decreased risk of non-operative intervention, regardless of initial procedure.

They also noted that patients with bleeding after RYGB are more likely to undergo non-operative intervention, compared to SG patients. The initial approach did not play a role in the total number of subsequent reoperations/non-operative interventions, they concluded.

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Patient-reported outcomes, weight loss, and remission of type 2 diabetes 3 years after gastric bypass and sleeve gastrectomy (Oseberg); a single-centre, randomised controlled trial

Three years outcomes from the Oseberg trial have revealed gastric bypass was superior to sleeve gastrectomy in patients with type 2 diabetes and obesity regarding weight related quality of life, reflux symptoms, weight loss, and remission of diabetes, researchers from Norway have found.

Writing in The Lancet Diabetes & Endocrinology, the trial was a single-centre, parallel-group, randomised trial, in which 109 patients were enrolled and randomly assigned to sleeve gastrectomy (n=55) or gastric bypass (n=54). In total, 93 (85%) patients completed the three-year follow-up.

Compared with sleeve gastrectomy, gastric bypass was associated with a greater improvement in weight-related quality of life, less reflux symptoms, greater total bodyweight loss (8% difference, 25% vs 17%),and a higher probability of diabetes remission (67% vs 33%).

They reported that symptoms of abdominal pain, indigestion, diarrhoea, dumping, depression and binge eating did not differ between groups.

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First-in-Human Side-to-Side Magnetic Compression Duodeno-ileostomy with the Magnet Anastomosis System

An international team of researchers, writing in Obesity Surgery, has reported the first outcomes from a study that evaluated the feasibility and safety of the novel magnet anastomosis system (MS) to create a side-to-side duodeno-ileal (DI) diversion for weight loss and T2DM resolution.

Five female patients underwent a side-to-side MS DI diversion, with a standard sleeve gastrectomy. A linear magnet was delivered by flexible endoscopy to a point 250 cm proximal to the ileocecal valve; a second magnet was positioned in the first part of the duodenum; the bowel segments containing magnets were apposed, initiating gradual anastomosis formation. They reported that all magnets were successfully placed, formed patent durable anastomoses and expelled without re-intervention.

The total weight loss at 12 months was 34.0±1.4% (SEM); excess weight loss, 80.2±6.6% and mean HbA1C (%) dropped from 6.8 ± 0.8 to 4.8 ± 0.2 (glucose (mg/dL), from 134.3 ± 17.9 to 87.3 ± 6.3 (mean reduction, 47.0 mg/dL)). There was no anastomotic bleeding, leakage, obstruction or infection and no mortality.

They concluded that procedure in adults with severe obesity was feasible and safe, achieved excellent weight loss, and resolved type 2 diabetes at one-year follow-up.

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Impact of Robotic Assistance on Complications in Bariatric Surgery at Expert Laparoscopic Surgery Centers. A Retrospective Comparative Study With Propensity Score

French researchers, writing in the Annals of Surgery, have reported robotic assistance during bariatric surgery reduced the length of stay, but did not statistically significantly reduce postoperative complications following either GBP or SG.

This retrospective study compared the serious complication rate (defined as a Clavien score ≥3) in patients undergoing metabolic bariatric surgery with or without robotic assistance. The study included 35,043 patients with 938 operated on with robotic assistance (801 SG; 134 RYGB; 3 SADI-S).

They found no benefit of robotic assistance regarding the risk of complications (p=0.794), with no difference in the RYGB+SADI group (p=0.322) but a negative trend in the SG group (more complications, p=0.060). However, length of hospital stay was decreased in the robot group (p<0.001).

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