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Journal Watch 17/08/2022

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 an Italian ERAS bariatric consensus statement, a comparison of the Endo GIA Tri-Staple technology and AEON Endostapler, bariatric surgery for Prader-Willi Syndrome patients, association between primary care physicians’ knowledge and a obesity treatments, and Chinese researchers say there is a need to improve and increase multicentre and multidisciplinary cooperation within the bariatric specialty (please note, log-in maybe required to access the full paper)

Enhanced recovery after bariatric surgery: an Italian consensus statement

The Italian Society for the Surgery of Obesity and Metabolic Diseases and the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care have concluded that enhanced recovery after bariatric surgery (ERABS) is an effective and safe approach in a consensus statement.

Published in Surgical Endoscopy, the 13-member expert task force of surgeons and anaesthesiologists assessed the effectiveness and safety of ERABS and developed evidence-based recommendations with regard to pre-, intra-, and post-operative care for patients with obesity undergoing ERABS.

The found that compared to the conventional approach, ERABS reduces the length of hospital stay and does not heighten the risk of major post-operative complications, re-operations, and hospital re-admissions, nor does it increase the overall surgical costs. A total of 25 recommendations were proposed, covering pre-operative evaluation and care (7 items), intra-operative management (1 item, 11 sub-items), and post-operative care and discharge (6 items).

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Prospective Randomized Comparison of Linear Endostaplers During Laparoscopic Sleeve Gastrectomy

Researchers from Holyoke Medical Center, Holyoke, MA, who compared two laparoscopic linear endostaplers (LLES) - Medtronic’s Endo GIA Tri-Staple technology to Lexington Medical’s AEON Endostapler in patients undergoing laparoscopic sleeve gastrectomy (LSG) – have reported both devices were equally safe and effective in terms of LLES and specimen characteristics, patient symptoms, hospital stay and adverse events (AEs). However, bleeding VAS scores were significantly lower, favouring the AEON LLES.

In total, 60 patients were prospectively randomised to undergo LSG with either LLES. Intraoperative bleeding was evaluated using five laparoscopic and corresponding endoscopic images of staple line before clip application, compared with a 1–5 Visual Analogue Scale (VAS), assessed by an independent bariatric surgeon who was blinded to the LLES used. Images of all cases were reviewed on the same day to increase test–retest reliability.

Published in Obesity Surgery, the authors noted that both groups were similar in patient demographics. Compared to MTS, AEON LLES group had significantly lower bleeding VAS scores in 4/5 laparoscopic images (pre-pyloric: 1.7±0.7 vs. 2.36±0.76, p=0.0007, mid-sleeve: 1.46±0.62 vs. 1.86±0.68, p=0.019, proximal sleeve: 1.6±0.77 vs. 2.0±0.83, p=0.038, gastro-oesophageal junction: 1.43±0.67 vs. 1.86±0.77, p=0.014) and 3/5 endoscopic images (pre-pyloric: 1.56±0.56 vs. 2.36±0.76, p=0.006, incisura: 1.66±0.54 vs. 2.0±0.52, p=0.021, mid-sleeve: 1.63±0.49 vs. 2.0±0.45, p=0.005). There was no statistical difference in other parameters.

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Effects of Restrictive Bariatric Surgery on Congenital Prader-Willi Syndrome: A Case Report

Researchers from Shifa International Hospital, Islamabad, Pakistan, have concluded that laparoscopic sleeve gastrectomy can be offered to patients with Prader-Willi syndrome until there is a better alternative.

Writing in Cureus, their case report concerned a 19-year-old male child with Prader-Willi syndrome presented with morbid obesity, obstructive sleep apnoea, and impaired glycaemic control. The patient had complained of hyperphagia since early childhood, but food intake increased aggressively in the last few years, which resulted in morbid obesity.

The patient was treated with laparoscopic sleeve gastrectomy, and the residual stomach volume was 100 ml. The intervention resulted in a 37.1% weight reduction after one year of surgery with well-controlled blood sugar levels. The patient also reported improved overall quality of life, mood, and functionality.

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Primary care physicians’ knowledge and attitudes about obesity, adherence to treatment guidelines and association with confidence to treat obesity: a Swedish survey study

Swedish researchers have confirmed there was a positive association between Swedish primary care physicians’ knowledge and adherence to obesity guidelines and being more confident to suggest obesity treatment.

Writing in BMC Primary Care, the authors sent a questionnaire to 1,642 primary care physicians in four regions in Sweden. The survey focused on the physicians’ knowledge, attitudes towards obesity, confidence in obesity management, adherence to obesity guidelines and barriers to optimal care. We created different statistical indices for knowledge, attitudes and adherence.

Replies from 235 primary care physicians yielded a response rate of 14.3%. Most physicians answered correctly that obesity is a disease (91%), that obesity regulation sits in the hypothalamus (70%) and that obesity is due to disorders of appetite regulation (69%). However, 44% of the physicians thought that the most effective weight reduction method for severe obesity was lifestyle changes; 47% believed that obesity is due to lack of self-control, 14% mentioned lack of motivation and 22% stated laziness.

Although 97% believed that physicians can help individuals with obesity and 56% suggested that obesity treatment should be prioritised, 87% of the physicians expressed that losing weight is the patients’ responsibility.

While 99% of the physicians felt confident to discuss lifestyle changes, 67% and 81% were confident to suggest medication or bariatric surgery, respectively. Respondents perceived that the greatest barrier in obesity management was lack of time (69%) and resources (49%).

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Visual Analysis of Nutrient Deficiency and Treatment Protocols in Bariatric Surgery Based on VOSviewer

Chinese researchers have said there is an urgent need for bariatric surgery institutions and authors to strengthen cross-institutional, cross-team, and multicentre and multidisciplinary cooperation.

Published in BioMed Research International, the researchers analysed the literature on nutritional deficiencies in bariatric surgery and discussed the current status of research, research hotspots and new development trend and treatment of nutritional deficiency in bariatric surgery.

The reported that there were 1,015 relevant publications and the overall trend of literature published was on the rise. Keyword analysis showed that “bariatric surgery” and “nutritional deficiencies” are the hot topics of research in this field.

The authors said there was an urgent need for multicentre and multidisciplinary cooperation, to promote and facilitate the exchange and cooperation in the field of bariatric surgery between developed countries in Europe and America and developing countries in Asia, Africa, and Latin America, to draw the attention of developing countries to the health problems caused by obesity, and to encourage and support the development of developing countries in this field.

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