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Journal Watch 11/05/2023

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 MBSAQIP assessment of post-operative leaks, revisional banded vs non banded sleeve, GLP-1 analogues and anticancer immune cells, abdominal scars after Vinci robot-assisted gastrectomy and DJBLs are superior to optimal medical management, and more (please note, log-in maybe required to access the full paper).

When Do Leaks Occur? An Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program

US researcher, writing in SOARD, have reported that the length of time for sleeve gastrectomy (SG) leak presentation was more delayed than Roux-en-Y gastric bypasses (RYGB) leak presentation and surgeons should be vigilant for leaks for at least three weeks after surgery.

The study authors used data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) to evaluate the rate and timing of leaks. From 370,369 SGs and 159,280 RYGBs, they identified 598 (0.16%) SG leaks with an average time to presentation of 13.2±7.8 days, compared to RYGB with 520 leaks (0.32%) and the average time to presentation was 9.5±7.4 days. Both procedures with a leak had a higher relative risk (RR) of Grade 4 and 5 Clavien-Dindo complication rates.

RR of mortality rates in SG patients with leak was 35.2 (confidence interval (CI): 20-61) vs. RYGB with leak was 31.4 (CI: 19-50).

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Two-Year Results of the Banded Versus Non-banded Re-sleeve Gastrectomy as a Secondary Weight Loss Procedure After the Failure of Primary Sleeve Gastrectomy: a Randomized Controlled Trial

Both banded (BLSG) and non-banded re-sleeve gastrectomy (NBLSG) are feasible and safe with satisfactory outcomes in patients with weight regain after LSG who have gastric dilatation without reflux esophagitis, investigators from the Alexandria University and Madina Women’s Hospital, Alexandria, Egypt, have reported.

Their randomised controlled trial aimed to compare the outcomes and two-year follow-up results of BLSG and NBLSG after weight regain following primary LSG. Writing in Obesity Surgery, they reported that both groups (25 patients each) achieved similar %EWL and %TWL at six months, one year, and two years postoperatively (%EWL 46.9 vs. 43.6, 83.7 vs. 86.3, and 85.7 vs. 83.9) (p=>0.151) (%TWL 23.9 vs. 21.8, 43.1 vs .43.3, 44.2 vs. 42.2) (p=>0.342), respectively. However, the body mass index was significantly lower with BLSG (24.9 vs. NBLSG, 26.9). No significant differences were observed regarding improvement of the associated medical problems after the first and two years after revisional LSG or the postoperative complications between both groups.

The BLSG tends to have a more stable weight loss after two years with a significantly lower BMI, lower stomach volume, and less weight regain, and food tolerance decreased in both groups but reduced more in the BLSG group, they concluded.

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Glucagon-like peptide-1 therapy in people with obesity restores natural killer cell metabolism and effector function

Researchers from Ireland have reported that glucagon-like peptide (GLP-1) analogues, can actually restore anticancer immune cells, ‘Natural Killer (NK)’, function in the body including its ability to kill cancerous cells.

The study investigated whether therapy with long-acting GLP-1 analogues, which are an effective treatment for obesity, could restore NK cell functionality in people with obesity. Twenty patients who received six months of once weekly GLP-1 therapy (semaglutide) had improved NK cell function, as measured by cytotoxicity and interferon-γ/granzyme B production.

The research also shows that the restored cancer-killing effect of NK cells is independent of the GLP-1's main weight loss function, so it appears the treatment is directly kick-starting the NK cells' engine.

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The effect of double W tension-reduced suture technique on the abdominal scars following the da Vinci robot-assisted gastrectomy for severely obese patients

Employing a ‘Double W tension-reduced suture technique’ could significantly improve the appearance and reduce comorbidities of scars following the da Vinci robot-assisted gastrectomy for patients with severe obese, according to a team from China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China.

Reporting in BMC Surgery, they analysed the effect of this new type of tension-reduced suture on the 40 abdominal scars: 20 incisions were closed by the conventional full-thickness surgical suture as the control group, and 20 incisions were sewn up by double W tension-reduced suture as the double W group. The scars were assessed at one-month follow-up using the Vancouver scar scale (VSS), ultrasound and patient satisfaction.

The VSS score was 6.80 ± 2.16 in the control group vs. 2.60 ± 1.89 in the double W group (p<0.05). Ultrasound revealed fibres of subcutaneous tissue in the double W group were arranged neatly, the ultrasonic signal intensity was relatively uniform. Finally, more patients were satisfied and very satisfied with scars in the double W group.

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Duodenal–jejunal bypass liners are superior to optimal medical management in ameliorating metabolic dysfunction: A systematic review and meta-analysis

Duodenal–jejunal bypass liners (DJBLs) provide significant metabolic and anthropometric improvements for patients with obesity vs optimal medical management, according to a A systematic review and meta-analysis by researchers from the University of Alberta, Edmonton, Alberta, Canada.

Reporting in Obesity Reviews, their study included 28 studies (1,229 patients) undergoing DJBL treatment. When compared to medical management, DJBLs provided superior reductions in HbA1c (p<0.0001), FPG (p=0.0009), BMI (p<0.0001) and weight (p=0.01).

They concluded that although DJBLs provide significant metabolic and anthropometric improvements uncertainty about the extent to which improvements are maintained after device removal.

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