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Journal Watch 17/05/2023

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 a RCT reporting long-term reduced risk of small bowel obstruction (SBO) after mesenteric defects closure in LRYGB, four-year outcomes from single-anastomosis sleeve ileal, SG impact on PCOS, sugammadex can reduce the incidence and severity of postoperative nausea and vomiting, and patients did not have healthy dietary quality intake one year after surgery, and more (please note, log-in maybe required to access the full paper).

Long-term Safety and Efficacy of Closure of Mesenteric Defects in Laparoscopic Gastric Bypass Surgery A Randomized Clinical Trial

Swedish researchers have reported the outcomes from a randomised clinical trial that found long-term reduced risk of small bowel obstruction (SBO) after mesenteric defects closure in laparoscopic Roux-en-Y gastric bypass (LRYGB).

Writing in JAMA Surgery, a total of 2,507 patients (1863 female [74.3%]) were randomly assigned to closure of mesenteric defects beneath the jejunojejunostomy and at the Petersen space using nonabsorbable running sutures during LRYGB (n=1,259) or nonclosure (n=1,248), with ten years of follow-up after the intervention. The primary outcome was reoperation for SBO.

After ten yearsa reoperation for SBO from day 31 to 10 years after surgery was performed in 185 patients with nonclosure vs 98 patients with closure. New incident chronic opioid use was seen among 175 of 863 opioid-naive patients with nonclosure and 166 of 895 opioid-naive patients with closure.

The authors said the findings suggest that routine use of this procedure during LRYGB should be considered.

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Mid-term outcomes after single anastomosis sleeve ileal (SASI) bypass in treatment of morbid obesity

Norwegian researchers have found single-anastomosis sleeve ileal (SASI) bypass appears to be safe, and one of the most effective bariatric procedures regarding weight loss and obesity related comorbidities out to four years.

Reporting in Surgical Endoscopy, the study included 366 patients with morbid obesity who underwent primary SASI bypass from January 2018 to February 2022. After four years, mean percentage excess weight loss was 93.3% and total weight loss was 41.2%. Remission of comorbidities was 93% for type 2 diabetes mellitus, 73% for hypertension, 83% for hyperlipidaemia, 79% for sleep apnoea and 25% for gastroesophageal reflux disease (GERD).

The authors write that the double-outlet created in this procedure seems to minimise nutritional complications.

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Effects of Sleeve Gastrectomy on Patients with Obesity and Polycystic Ovary Syndrome: a Meta-analysis

Chinese investigators have reported that patients who had a sleeve gastrectomy (SG) had significant improvements in menstrual irregularity, testosterone and sex hormone-binding globulin (SHBG) levels, glycolipid metabolism indicators and BMI.

Writing in Obesity Surgery, the meta-analysis was performed on menstrual irregularity, total testosterone, SHBG, anti-Mullerian hormone, glucolipid metabolism indicators and BMI post-SG.

From six studies (218 patients) they found post-SG menstrual irregularity significantly decreased as well as total testosterone levels and BMI. A significant increase was observed in the levels of SHBG and high-density lipoprotein after SG.

The authors suggested that SG may be considered as a new option for the clinical treatment of patients with obesity and polycystic ovary syndrome.

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Use of sugammadex is associated with reduced incidence and severity of postoperative nausea and vomiting in adult patients with obesity undergoing laparoscopic bariatric surgery: a post-hoc analysis

Chinese investigators have reported that sugammadex can reduce the incidence and severity of postoperative nausea and vomiting (PONV), increase postoperative water intake and shorten the time to first flatus in bariatric patients during postoperative inpatient hospitalisation, compared with neostigmine.

Writing in BMC Anesthesiology, the researchers performed a randomised controlled trial with 205 patients who underwent laparoscopic bariatric surgery. The primary outcome was the incidence of PONV within 48h after surgery.

The incidence of PONV was 43.4% (89/205) within the first 48 h after LBS. A multivariable analysi found sugammadex use was an independent protective factor of PONV. After inverse probability of treatment weighting adjustment, sugammadex use was associated with lower incidence of PONV, postoperative nausea and postoperative vomiting within postoperative 48h. The severity of PON as well as the incidence and severity of POV within the first 24 h were also lower in the sugammadex group (all p<0.05). Reduced need for rescue antiemetic therapy within the first 24h, increased water intake for both periods and earlier first passage of flatus were observed in the sugammadex group (all p<0.05).

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Diet quality and anthropometric indices of patients undergone bariatric surgery: the prospective Tehran obesity treatment study

Investigators from Shahid Beheshti University of Medical Sciences, Tehran, Iran, have reported that patients did not have healthy dietary quality intake one year after bariatric surgery.

Their study assessed dietary quality and food group components in patients one year after surgery, the relationship between dietary quality score and anthropometric indices, and evaluated the trend of BMI three years after surgery.

A total of 160 patients had a sleeve gastrectomy (SG) (n=108) or gastric bypass (GB) (n=52), and were assessed for dietary intakes using three 24-hour dietary recalls one year after surgery. Writing in BMC Surgery, they reported that the mean total healthy eating index (HEI) score was 64±12 out of 100. More than %60 of participants exceeded the recommendations for saturated fat and sodium. The HEI score did not show significant relationship with anthropometric indices. The mean of BMI in SG group increased over three years of follow up, while in GB group, there were no significant differences in BMI during three years of follow up.

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