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Journal Watch 10/08/2022

Updated: Aug 11, 2022

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 management of post-operative bleeding, the impact of BPD-DS on the normalisation of glycaemic metabolism, Bariatric surgery and post-op decreases in bone mineral density, concurrent bioabsorbable mesh and bariatric surgery, obesity stigma in healthcare and prior incisional hernia repair with after common abdominal operations (please note, log-in maybe required to access the full paper).

Early Bleeding After Laparoscopic Roux-en-Y Gastric Bypass: Incidence, Risk Factors, and Management — a 21-Year Experience

Researchers from the Lausanne University Hospital (CHUV), Lausanne, Switzerland, have reported that postoperative bleeding (POB) is most frequently managed with conservative measures however, treatment should be tailored depending on suspected location of bleeding and hemodynamic stability.

From 2,639 patients 253 (9.5%) presented at least one postoperative complication (the first 30 days) and the most common complications were POB (2.7%), leak (1.1%) and wound infection (1.1%) followed by intestinal obstruction without haemorrhage (0.8%), intra-abdominal infection (0.8%), and respiratory infection and/or pleural effusion (0.8%).

When the researcher compared patients with and without POB, POB was associated with male sex (37.5% vs 23.6%, p=0.01), older age (44.9 vs 42.1 years, p=0.04) and pre-existing high blood pressure (59.7% vs 46.9%, p=0.04). After multivariate analysis, only male sex (p = 0.01) remained an independent risk factor. Length of stay was significantly longer in patients who developed POB (8.3 vs 3.8 days, p<0.01).

A majority of patients (79.2%) presented POB within the first three postoperative days, whereas seven patients (10%) needed readmission for POB. Tachycardia was the most frequent symptom (45 patients, 63%) and abdominal pain was more frequent with ILB compared with ELB (50% vs. 20%, p=0.02).

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Long-term Remission of Type 2 Diabetes and Patient Survival After Biliopancreatic Diversion with Duodenal Switch

Writing in Obesity Surgery, German researchers have found that biliopancreatic diversion with duodenal switch (BPD-DS) causes a rapid and long-lasting normalisation of glycaemic metabolism in patients with advanced T2DM.

The study included 91 patients with advanced T2DM were included, 62 were available for follow-up (rate of 77%). Patients were stratified according to preoperative diabetes severity into four groups (group 1: oral antidiabetic drugs only; group 2: insulin < 5 years; group 3: insulin 5–10 years; group 4: insulin > 10 years).

Glycated haemoglobin (HbA1c) levels were 9.4 ± 2.0% before surgery and decreased to 5.1 ± 0.8% after one year and 5.4 ± 1.0% after six–12 years. Insulin discontinuation rate after surgery as well as the rate of long-term remission decreased steadily from groups 1 to 4, while long-term mortality increased. T2DM remission rates were 93%, 88%, 45%, and 40% in groups 1, 2, 3, and 4, respectively.

The authors concluded that T2DM remission rate after six–12 years varies significantly (from 40% to more than 90%) and is highly dependent on preoperative diabetes severity.

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Changes in bone mineral density after bariatric surgery in patients of different ages or patients with different postoperative periods: a systematic review and meta-analysis

Bariatric surgery decreases bone mineral density (BMD) at different body sites, specifically in the femoral neck and lumbar spine in adults over 40 years old and at postoperative periods greater than 12 months, according to researchers from Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.

They identified 22 studies/articles for their systematic review and meta-analysis (3,250 people were included, 733 in the surgery group and 2,517 in the control group). Thirteen articles reported on the relationship between bariatric surgery and femoral neck BMD and showed that the bone density of the surgery group significantly decreased more compared to the control group (p=0.03).

Fifteen [articles examined the relationship between bariatric surgery and lumbar spine BMD and found that the bone density of the surgery group was lower vs. the control group (p=0.26), but there was no significant difference. Four articles reported the relationship between bariatric surgery and total body BMD and showed the bone density of the surgical group was 0.03g/cm2 lower than that of the control group (p<0.00001).

The authors concluded that longer follow-up studies are still needed to determine whether bone mass changes or stabilises.

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Does the use of bioabsorbable mesh for hiatal hernia repair at the time of bariatric surgery reduce recurrence rates? A meta-analysis

US investigators have reported that Repair with bioabsorbable mesh at the time of the index bariatric surgery is more effective at reducing the recurrence rate of hiatal hernia than suture cruroplasty.

Writing in SOARD, they identified 12 studies with 1,351 patients. Four studies had both a mesh group (MG) and a non-mesh group (NM). There were 668 patients in the MG and 683 patients in the NM.

Hernia size noted in NM (7 cm2) compared to MG (6.5 cm2) (95%CI 3.89 – 9.14; p=0.86). The MG had less recurrence compared to NM (Effect Size: 2% vs. 14%; 95% CI -0.26– -0.02; p=0.027). The average follow-up was 28.8 months for the MG group and 32.8 for the NM group.

Further studies investigating the long-term outcomes of bioabsorbable mesh placed at the time of bariatric surgery are needed.

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Effective strategies in ending weight stigma in healthcare

There is an urgent need to better educate medical professionals on weight stigma to help tackle the UK's obesity crisis, according to the conclusions of a large-scale review led by University College London (UCL) researchers.

Published in Obesity Reviews, UCL researchers conducted a review to evaluate weight stigma reduction strategies in health care practice and health care education, with a view to provide recommendations for interventions, learning, and research.

They identified that weight-inclusive approaches to education in health care were effective in challenging stereotypes and improving attitudes. Such methods included ethics seminars discussing patient experiences, embedding virtual story-telling of patient case studies, or empathy evoking activities in the curriculum, such as following a calorie restricted diet or participation in clinical encounters with patients living with overweight and obesity. However, other methods such as video presentations and short lectures were not equally effective in improving attitudes in the long term.

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Reoperation Through a Prosthetic-Reinforced Abdominal Wall and Its Association With Postoperative Outcomes and Longitudinal Health Care Utilization

Researchers from the University of Pennsylvania, Philadelphia, have reported reoperation through a previously prosthetic-reinforced abdominal wall was associated with increased surgical complications and healthcare utilisation.

Reporting in JAMA Network, the authors investigated the association of prior incisional hernia repair with mesh (IHRWM) with postoperative outcomes and healthcare utilisation after common abdominal operations.

In total 914,105 patients undergoing common abdominal surgical procedures (including 81,123 bariatric patients [8.9%]) with prior IHRWM were matched to patients without a history of abdominal surgical procedures. After matching, prior IHRWM was associated with increased overall complications, surgical complications, length of hospital stay (p<0.001), index admission charges (p<0.001) and 1-year unplanned readmissions (p=0.002).

They noted that this trend persisted even when comparing matched patients with prior IHRWM to patients with a history of abdominal surgical procedures, and the treatment outcome disappeared when comparing patients with prior IHRWOM to those without a previous abdominal operation.

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