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Journal Watch 11/10/2023

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 fixing the alimentary limb (AL) length during a duodenal switch can improved glycaemic control, concomitant cholecystectomy (CC) during sleeve gastrectomy (SG) and gastric bypass (GBP) should be avoided, bariatric surgery in preteens is safe and efficacious when performed at specialized centres and that age criteria may not be required, bariatric surgery is able to cure urinary incontinence in one of three women and a significant improvement was obtained in more than two-thirds of the patients, and post-op changes in bodyweight were determined by age, pre-operation status of bodyweight and HbA1C, and more (please note, log-in maybe required to access the full paper).


Remission of Type II Diabetes Mellitus after Duodenal Switch: the Contribution of Common Channel Length

Researcher from the UNC Rex Healthcare, Raleigh, NC, have concluded that when the length of the alimentary limb (AL) is fixed, during a duodenal switch (DS) and shortening common channel lengths results in improved glycaemic control and remission of DM in patients with the need for insulin preoperatively.


Writing in Obesity Surgery, they retrospectively reviewed 341 consecutive patients with DM undergoing DS with one of three different common channel (CC) lengths (100 cm, 150 cm, and 200 cm), each with a fixed 300 cm alimentary limb (AL). Patients were stratified by insulin dependence (IDDM) versus non-insulin dependent diabetes (NIDDM).


The NIDDM group had a similar average HbA1c at last follow-up for each of the CC lengths. However, the IDDM group had lower average HbA1c with shorter CC lengths (100cm = 5.4%, 150cm = 6%, 200cm = 6.4%, p<0.05). Shorter CC lengths resulted in a greater proportion of patients achieving remission in the IDDM group (66%, 50%, 32% in the 100cm, 150cm, and 200cm CC, respectively, p<0.01).


Rates of nutritional deficiencies were higher in shorter common channel lengths. Revision for malnutrition was similar between common channel lengths (100cm group: 3.7%; 150cm group: 1.8%; 200cm group: 0%, p=NS).


In addition, the noted milder forms of DM are treated well with any of the CC lengths.


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Risk-Benefit Balance of Simultaneous Gastric Bypass or Sleeve Gastrectomy and Concomitant Cholecystectomy - A Comprehensive Nationwide Cohort of 289,627 Patients

Researchers from Lille University Hospital CHU Lille, Lille, France, have reported concomitant cholecystectomy (CC) during sleeve gastrectomy (SG) and gastric bypass (GBP) should be avoided.


Writing in the Annals of Surgery, the nationwide retrospective cohort research was conducted in two parts using information from a national administrative database (PMSI): The 90-day morbidity of MBS with or without CC was first compared in a matched trial (propensity score), and medium-term biliary complication following MBS when no CC had been performed during MBS up to nine years after MBS (minimum 18 months).


Between 2013 and 2020, 289,627 patients had a SG (70%) or a GBP (30%) and the principal indications of CC were symptomatic cholelithiasis (79.5%) or acute cholecystitis (3.6%). Prophylactic CC occurred only in 15.5% of the cases. In their matched-group analysis, they included 9,323 patients in each arm. The complication rate at day 90 after surgery was greater in the CC arm (p<0.001], independently of the reason of the CC. At 18 months, there was a 0.1% risk of symptomatic gallstone migration and a 0.08% risk of biliary pancreatitis. At 9 years, 20.5±0.52% of patients underwent an interval cholecystectomy. The likelihood of interval cholecystectomy decreased from 5.4% per year to 1.7% per year after the first 18 months the whole cohort, risk at 18 months of symptomatic gallstone migration was 0.1%, of pancreatitis 0.08% and of angiocholitis 0.1%.


The researchers concluded that in the case of asymptomatic gallstones after bariatric surgery, prophylactic cholecystectomy should not be recommended.


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Outcomes after metabolic and bariatric surgery in preteens versus teens using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database and center-specific data

US researchers, reporting in Obesity, have concluded that bariatric surgery in preteens is safe and efficacious when performed at specialized centres, and that age criteria may not be required.


The American Academy of Pediatrics (AAP) recently released clinical guidelines for the treatment of childhood obesity, including surgery being appropriate for children 13 years of age and older. The use of this age cut-off was due to a lack of data for children younger than 13. To address this knowledge gap, the researchers used the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database to compare outcomes in preteens to teens after bariatric surgery, hypothesising that there would be no difference in outcomes between the two groups.


A total of 4755 patients were identified, 47 of whom were <13 years of age. Preteens had similar sex distribution (66% vs. 75% female), were more likely to be Black (27.7% vs. 18.3%) or Hispanic (21.3% vs. 7.6%) race, and weighed less (274 ± 58 vs. 293 ± 85 lb, p = 0.01), but they had similar BMI (46.9 ± 7 vs. 47 ± 13 kg/m2) as their teen counterparts. Preteens were more likely to suffer from sleep apnoea (34% vs. 19%, p<0.01) and insulin-dependent type 2 diabetes (10.6% vs. 1.8%, p<0.01). There were no complications in the preteens compared to teens (0% vs. 0.5%), and they did not undergo any unplanned readmissions (0% vs. 2.9%) or reoperations (0% vs. 0.8%) within 30 days of surgery. There were also no mortalities reported in preteens (0% vs. 0.1%). The risk-adjusted decrease in BMI between preteens and teens was also comparable at 30 days (4.2 [95% CI: 3.0–5.4] vs. 4.6 [95% CI: 4.4–4.7], p=0.6).


The AAP and others are encouraged to include age cut-offs in their guidelines for children with obesity and bariatric surgery, only when data are available to support their inclusion.


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Is Surgical Treatment for Obesity Able to Cure Urinary Incontinence in Women?—A Prospective Single-Center Study

Investigators from the “Carol Davila” University of Medicine and Pharmacy, in Bucharest, Romania, have that bariatric surgery is able to cure urinary incontinence in one of three women and a significant improvement was obtained in more than two-thirds of the patients, regardless of the type of incontinence.


Published in MDPI, they performed a prospective study on 54 female patients with obesity before and after bariatric surgery, over a period of nine years. The ICIQ score improved from 13.31 ± 5.18 before surgery to 8.30 ± 4.49 points after surgery (p<0.0001). Before surgery, 38 patients (70%) described severe incontinence compared to only 20 patients (37%) after surgery. A total of 16 women (31%) reported complete cure of urinary incontinence after bariatric surgery.


Data from the VAS questionnaire show improvement in 46 cases (85%). Pad usage improved from 7.04 ± 2.79 to 3.42 ± 2.77 (p<0.001) per day. The number of patients using more than one pad per day decreased from 35 (65%) to 9 (17%). The type of incontinence did not seem to be relevant, but they explained that the study’s sample size was too small to lead to statistically significant results. There was no impact on the outcome of incontinence of number/type of delivery, age or BMI.

“For an obese female with urinary incontinence, treatment for obesity should prevail and incontinence should be treated only if symptoms remain,” they concluded.


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The Rapid Changes in Bodyweight and Glycemic Control Are Determined by Pre-status After Bariatric Surgery in Both Genders in Young Chinese Individuals

Researchers from Shanghai Pudong Hospital, Shanghai, China, have reported that changes in bodyweight were determined by age, pre-operation status of bodyweight and HbA1C in young Chinese people with obesity.


Published in Cureus, the investigators sought to identify the factors associated with rapid glycaemic, bodyweight, and lipid profile remission in 131 patients following bariatric surgery. They followed up the patients at 1 month, 3 months, 6 months and 12 months.


They showed that bodyweight, hypertension, fasting plasma glucose (FPG), HbA1c, and triglyceride (TG) levels decreased significantly in one to three months following surgery in both male and female patients (p<0.05). They demonstrated that age and the pre-operation HbA1c levels were independent predictors of HbA1c reduction in both young obese male and female patients in three months after surgery. For body weight loss, age and pre-operation bodyweight were the predictors in females, but only pre-operation body weight was the independent predictor in obese young male patients.


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