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Journal Watch 16/08/2023

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 a paper reporting that there were differences in key outcome measures in robotic versus laparoscopic gastric bypass, the estimated impact of semaglutide on 93 million US adults, a trial reporting BPD/DS has superior outcomes to RYGB, the burden of abdominal pain after bariatric surgery, and surgery in patients older than 65 years, and more (please note, log-in maybe required to access the full paper).

Robotic versus laparoscopic gastric bypass in bariatric surgery: A systematic review and meta-analysis on perioperative outcomes

A systematic review and meta-analysis by Australian researchers has revealed that there was no significant difference in key outcome measures in robotic versus laparoscopic gastric bypass.

Robotic-assisted surgery has emerged as a compelling approach to bariatric surgery. However, current literature has not demonstrated superior outcomes to laparoscopic bariatric surgery consistently to justify its higher cost. With its mechanical advantages, the potential gains from the robotic surgical platform are likely to be apparent in more complex cases such as gastric bypass especially revisional cases.

Published in SOARD, this systematic review and meta-analysis included 28 eligible studies (82,155 patients: 9,051 robotic bariatric surgery (RBS) versus 73,104 laparoscopic bariatric surgery). All included studies compared Roux-en-Y gastric bypass. Robotic surgery had a higher re-operation rate within 30 days - 4.4% versus 3.4% (p=0.027) than laparoscopic surgery. There were no differences report in complication rate, anastomotic leak, anastomotic stricture, surgical site infections, hospital readmission, length of stay, operative time, conversion rate and mortality.

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US Population Eligibility and Estimated Impact of Semaglutide Treatment on Obesity Prevalence and Cardiovascular Disease Events

Researchers from the University of California, Irvine, have determined that semaglutide treatment in eligible US adults may substantially reduce obesity prevalence and CVD events, which may dramatically impact associated healthcare costs.

Writing in Cardiovascular Drugs and Therapy, they estimated the US population eligibility for semaglutide 2.4 mg (based on the weight management indication) and the impact on obesity and CVD events. They applied STEP 1 trial eligibility criteria to US adults aged ≥ 18 years in the US National Health and Nutrition Examination Survey (NHANES) 2015-2018 to estimate the US eligible population.

They identified 3,999 US adults weighted to an estimated population size of 93.0 million (38% of US adults) who fit STEP 1 eligibility criteria. Applying STEP 1 treatment effects on weight loss resulted in an estimated 69.1% (64.3 million) and 50.5% (47.0 million) showing ≥ 10% and ≥ 15% weight reductions, respectively, translating to a 46.1% (43.0 million) reduction in obesity (BMI ≥ 30 kg/m2) prevalence. Among those without CVD, estimated 10-year CVD risks were 10.15% “before” and 8.34% “after” semaglutide “treatment” reflecting a 1.81% absolute (and 17.8% relative) risk reduction translating to 1.50 million preventable CVD events over ten years.

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Long-term Follow-up 15 Years After Duodenal Switch or Gastric Bypass for Super Obesity: a Randomized Controlled Trial

When compared to Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD/DS) results in superior weight loss and metabolic control as well as superior Bariatric Analysis and Reporting Outcome System (BAROS) score, however, at the cost of more adverse events, according to researchers from the Uppsala University, Uppsala, Sweden.

Writing in Obesity Surgery, this randomised controlled trial compared the long-term outcome of BPD/DS, and RYGB in patients with super obesity, i.e., body mass index (BMI) >50kg/m2. The single-centre, single-blinded trial included 47 patients (BMI > 48 and eligible for bariatric surgery) who were randomised 1:1 to BPD/DS and RYGB (25 men, 24 BPD/DS, 39.1 ± 9.9 years, BMI 54.5 ± 6.1 kg/m2). The primary outcome was weight loss.

Thirty-four (18 BPD/DS) of the living 42 patients (81.0%) participated. BPD/DS resulted in higher BMI loss (20.4 ± 7.9 vs. 12.4 ± 8.6, p=0.008) and higher percent of total body weight loss (37.5% ± 12.2 vs. 22.8% ± 14.8, p=0.004). BPD/DS was associated with lower fasting glucose, glycated haemoglobin (HbA1c), and low-density lipoprotein (LDL) as well as lower haemoglobin. Adverse events were more common after BPD/DS (2.7 vs. 0.9 per patient, p=0.004). BAROS demonstrated superior scores for BPD/DS (p=0.047).

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The burden of abdominal pain after bariatric surgery in terms of diagnostic testing the OPERATE study

According to researchers from Spaarne Gasthuis, Hoofddorp, the Netherlands, the diagnostic burden in patients with abdominal pain following bariatric surgery is high. The most frequently performed diagnostic test is abdominal CT, yielding the highest number of diagnosis in these patients.

Writing in SOARD, they sought to quantify type and number of diagnostic tests performed in patients with abdominal pain after bariatric surgery and evaluate the burden and their yield in the diagnostic process.

In total, 441 patients were included (401 (90.9%) were female, median time after BS 37.0 months (IQR 11.0-66.0) and mean percentage total weight loss was 31.41 (SD 10.53)) and there were 715 diagnostic tests performed of which 355 abdominal CT scans, 155 ultrasounds and 106 gastroscopies. These tests yielded a possible explanation for the pain in 40.2%, 45.3% and 34.7%, respectively.

The diagnoses internal herniation, ileus and nephrolithiasis generally required only one diagnostic test, whereas patients with ACNES, IBS and constipation required several until diagnosis. Even after several negative tests, a diagnosis was still found in the subsequent test: 86.7% of patients with five or more tests had a definitive diagnoses. Reoperations were performed in 37.2% of patients.

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Bariatric and Metabolic Surgery in Patients Older than 65 Years – a Multicenter Study

Bariatric surgery appears to be a safe and effective method of treatment of obesity in patients over 65 years of age, according to Polish researchers, who noted OAGB seems to have better results in weight loss than SG, RYGB and AGB in older patients.

Writing in Obesity Surgery, this retrospective study analysed 284 patients (173 women, 60.9%) over 65 years who underwent laparoscopic bariatric procedures in Poland from 2008 to 2022. The efficacy endpoints were percentage of excess weight loss (EWL%), percentage of total weight loss (%TWL), improvement in obesity-related diseases.

The mean follow-up was 47.5 months. The mean BMI before surgery was 43.1 kg/m2. 146 (51.4%) patients had T2D, and 244 (85.9%) had HT. The most common procedure was sleeve gastrectomy (82.0%). The mean EWL% after surgery was 50.9%, and the mean TWL% after surgery was 20.6%.

There was the statistically significant difference between AGB vs OAGB, SG vs OAGB in %EWL (p=0.0116, p=0.009, respectively) and RYGB vs OAGB in %TWL (p=0.0291). After surgery, 93 patients (63.7%) had complete or partial remission of T2D, and 112 patients (45.9%) had complete or partial remission of HT.

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