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 impact of parental bariatric surgery on LSG outcomes in adolescents, outcomes from the PACT Study, a Malaysian study looking at abdominoplasty vs non-abdominoplasty on weight loss, bariatric surgery reduces cancers risk, and a RCT trial comparing the outcomes of two methods of LOAGB (please note, log-in maybe required to access the full paper).
The impact of parental bariatric surgery and patient age on laparoscopic sleeve gastrectomy outcomes in adolescents
US researchers has reported that patient age should not be a barrier to weight loss surgery, especially among patients with a parental history of obesity.
Writing in Surgical Endoscopy, the study sought to evaluate the effects of parental history of bariatric surgery, as well as age at time of operation, on adolescents who underwent laparoscopic sleeve gastrectomy (LSG). The investigators performed a retrospective review of patients, aged ten to 19 years, who had LSG from January 2010 to December 2019. The adolescent bariatric surgical dataset used to obtain patient demographics, weight, body mass index (BMI) and parental history of bariatric surgery.
From 328 patients, 76 (23.2%) had parents who had previously undergone bariatric surgery. These patients were significantly heavier by weight (p=0.012) at the time of operation but had no difference in postoperative weight loss. When all patients were compared by age at operation (<16 years, n=102, ≥ 16 years, n=226), there were few differences in outcomes.
The authors added that intervening at a younger age, the metabolic sequelae of obesity may be reduced.
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Global variations in preoperative practices concerning patients seeking primary bariatric and metabolic surgery (PACT Study): A survey of 634 bariatric healthcare professionals
Investigators from the PACT Study collaborative aimed to capture global variations in preoperative practices concerning patients planned for BMS. A 41-item questionnaire-based survey was designed and the survey link was freely distributed on social and scientific media platforms, email groups and circulated through personal connections of authors.
In total, 634 bariatric healthcare professionals from 76 countries/regions completed the survey. Of these, n=310 (48.9%) were from public hospitals, n=466 (73.5%) were surgeons, and the rest were multidisciplinary professionals. More than half of respondents reported using local society/association guidelines in their practice (n=310, 61.6%).
The majority of respondents routinely recommend nutritional screening preoperatively (n=385, 77.5%), mandatory preoperative diets for liver size reduction (n=220, 53.1%), routine screening for T2DM (n=371, 90.7%), and mandate a glycaemic control target before BMS in patients with T2DM (n=203, 55.6%).
However, less than half (n = 183, 43.9%) recommend mandatory preoperative weight loss to all patients. Most respondents (n = 296, 77.1%) recommend psychological intervention before surgery for patients diagnosed with psychological conditions. Variations were also identified in laboratory investigations and optimisation; and in the aspects of decision making, education and consent.
“This survey identified significant global variations in preoperative practices concerning patients seeking primary BMS,” the authors concluded in the International Journal of Obesity. “Our findings could facilitate future research for the determination of best practice in these areas of variations, and consensus-building to guide clinical practice while we wait for that evidence to emerge.”
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The Impact of Abdominoplasty vs Non-abdominoplasty on Weight Loss in Bariatric and Non-bariatric Malaysian Patients: A Multicentre Retrospective Study
Researchers from the Universiti Sains Malaysia School of Medical Sciences, Kubang Kerian, Malaysia, have evaluated the relationship between weight loss in pre- and post-abdominoplasty and compared the weight loss of those who do not undergo abdominoplasty in bariatric and non-bariatric patients.
This study measured weight changes at designated time points in four different groups (total 98 patients): abdominoplasty after bariatric surgery (group A), patients with abdominoplasty alone (B), bariatric surgery alone (group C) and diet alone (group D).
Patients in groups A and B (patients who had abdominoplasty regardless with or without bariatric surgery) had a significant weight loss after six months (mean difference=10.70kg, 95% CI=4.05, 17.34, p<0.001), compared to pre abdominoplasty weight. Patients in group B were statistically significant (mean difference=4.01kg, 95% CI=0.92, 7.10, p=0.007) with 3.60kg weight reduction (4.59%).
Patients in group A had clinically significant weight reduction (4.45kg, 5.14%) but it was not statistically significant (p>0.05) and had no significant additional weight reduction, compared to non-abdominoplasty (group C) patients (p=0.650). Patients in group C had a statistically significant difference from those in group D (F [1.00, 48.00] = 8.56, p=0.005) with an average weight loss of 3.60kg (4.59%) vs 2.56kg (2.8%), respectively.
“All patients with abdominoplasty had significant weight loss after six months,” the authors concluded in the journal Cureus. “Bariatric patients did not experience significant additional weight loss with abdominoplasty. Weight reduction after abdominoplasty alone was greater than diet alone.”
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Evaluating the Correlation of Bariatric Surgery and the Prevalence of Cancers in Obese Patients: A Study of the National Inpatient Sample (NIS) Database
Researchers from the US, who evaluated the correlation of bariatric surgery in patients with morbid obesity, have concluded that the odds of developing breast, oesophageal, prostate, renal and colorectal cancers are significantly lower in these patients who undergo bariatric surgery.
The study included 7,672,508 patients who were divided into those who did and did not undergo bariatric surgery, and studied for the prevalence of obesity-associated cancers.
The mean age of cases who underwent bariatric surgery was younger when compared to those who did not undergo the procedure (43.89±25.16 vs. 54.90±36.40, p-value <0.0001). The highest bariatric surgery rate was seen in the Northeast (5.57%), followed by the West (4.15%), South (3.02%) and Midwest (2.96%) (p-value <0.0001).
Overall, the odds of patients with morbid obesity who underwent bariatric surgery and developed cancer are: oesophageal cancer 0.19 (0.1218-0.3078, p<0.0001), colorectal cancer 0.0368 (0.0275- 0.0493, p<0.0001), endometrial cancer 0.0155 (0.0099-0.0244, <0.0001), breast cancer 0.0712 (0.0582-0.0871, p<0.0001), prostate cancer 0.0285 (0.0199-0.0408, p<0.0001) and renal cancer 0.0182 (0.0106-0.0314, p<0.0001).
The odds of cancer post-bariatric surgery remained significantly lower even after matching certain confounding factors.
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A laparoscopic one anastomosis gastric bypass with wrapping versus nonwrapping fundus of the excluded part of the stomach to treat obese patients (FundoRingOAGB trial): study protocol for a randomized controlled trial
Researchers from the Society of Bariatric and Metabolic Surgeons of Kazakhstan have described the design and protocol of a randomised controlled trial comparing the outcomes of two methods of laparoscopic one anastomosis gastric bypass (LOAGB): experimental method with wrapping versus standard method non-wrapping fundus of the excluded part of the stomach to prevent weight regain and biliary reflux after LOAGB.
Writing in BMC Trials, the authors note that this is a single-centre prospective, interventional, randomised controlled trial. The study will recruit 100 patients with obesity and the endpoints include body mass index, bile reflux in the oesophagus, other reflux symptoms, which will be assessed presurgery and at 12, 24 and 36 months.
The authors believe that this RCT will provide important data on the impact of wrapping the fundus of the excluded part of the stomach to prevent weight regain and biliary reflux after LOAGB.
For further information, please visit: ClinicalTrials.govNCT04834635.
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