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Journal Watch 20/12/2023

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 sleeve gastrectomy plus fundoplication, comparison of laparoscopic and robotic approaches, long-term bariatric outcomes, post-op ursodeoxycholic acid prophylaxis for gallstones and outcomes the randomised controlled trial of mazdutide, and more (please note, log-in maybe required to access the full paper).

Effectiveness of Sleeve Gastrectomy Plus Fundoplication versus Sleeve Gastrectomy alone for Treatment of Severe Obesity: A Systematic Review and Meta-analysis

Laparoscopic sleeve gastrectomy (SG) plus fundoplication achieved better GERD remission, but is associated with lesser weight loss and increased postoperative complications compared to SG alone, according to a systematic review and meta-analysis by researchers from Singapore.


Reporting in SOARD, the researchers sought to compare the efficacy and safety of SG) plus fundoplication with SG alone for the treatment of severe obesity (≥35 kg/m2). They identified five studies with 539 subjects (212 SG + F and 327 SG alone) were included.


They found that the mean pre-operative BMI was 42.6kg/m2. SG + F achieved higher remission of GERD compared to LSG. In addition, %TWL was lower in the SG + F group, although there was no difference in %EWL. There were higher postoperative complications in SG + F, but no difference in operative time or length of stay between the two groups.


They concluded that further studies are required to ascertain the overall clinical benefit of SG + F for patients with severe obesity.


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First Assistant In Bariatric Surgery: A Comparison Between Laparoscopic And Robotic Approaches: A 4-Year Analysis of the MBSAQIP Database (2016–2019)

Investigators from the University of Arizona College of Medicine, Tucson, AZ, who assessed the relationship between the type of first assistant (FA) and operative time (OT) and postoperative outcomes comparing robotic and laparoscopic approaches in bariatric surgery, have reported FA was associated with a decreased variability in OT in the robotic cohort compared to the laparoscopic group with no significant difference in complication rates.


Writing in Obesity Surgery, the acquired data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data from 2016–2019. In total, 691789 patients who underwent robotic (R), and laparoscopic (L) sleeve gastrectomy (SG), Roux-en-Y gastric-bypass (RYGB), and duodenal switch (DS) were included.


They found that the percentage variation of OT was higher in the laparoscopic group (L-SG: 8.18%, L-RYGB: 9.88%, and L-DS: 15.00%) versus the robotic group (R-SG: 2.43%, R-RYGB: 5.76%, and R-DS: 0.80%). However, there was not a significant difference in 30-day outcomes between laparoscopic and robotic approaches for the same procedures.


These results suggest that the robotic approach may decrease the need for skilled FAs in bariatric procedures, they concluded.


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Long term outcomes of metabolic/bariatric surgery in adults

US researchers, who performed a comprehensive overview of the long-term outcomes of metabolic/bariatric surgery, have concluded that surgery results in durable and significant weight loss and improvements in comorbid conditions, including type 2 diabetes.


Reporting in the BMJ, they noted that observational studies and randomised controlled trials have reported a broad range of long term outcomes, including a lower incidence of cardiovascular events, cancer and death. Although weight regain is a risk in a small number of patients and there is an association between surgery and an increased risk of developing substance and alcohol use disorders, suicidal ideation/attempts and accidental death.


In addition, patients need lifelong follow-up to help to reduce the risk of these complications and other nutritional deficiencies. They also highlighted that different surgical procedures have important differences in risks and benefits, and a clear need exists for more long-term research about less invasive and emerging procedures.


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Ursodeoxycholic Acid Prophylaxis and the Reduction of Gallstone Formation After Bariatric Surgery: An Updated Meta-Analysis of Randomized Controlled Trials

A systematic review and meta-analysis of randomized controlled trials supports the efficacy of ursodeoxycholic acid (UDCA) prophylaxis in preventing gallstone formation after bariatric surgery, according to researchers from the Jordanian Royal Medical Services, Amman, Jordan. The findings suggest that UDCA administration not only lowers overall gallstone incidence but also reduces the occurrence of symptomatic cholelithiasis and mitigates the need for cholecystectomy.


Reporting in Cureus, the authors assessed the efficacy of UDCA in preventing gallstone formation after bariatric surgery and identified 12 randomized controlled trials (RCTs) incorporating 2,767 patients who underwent diverse bariatric procedures.


Patients receiving UDCA demonstrated a significantly lower overall incidence of gallstones post-bariatric surgery (p<0.0001), with a subgroup analyses confirming reduced gallstone incidence at three months (p=0.04), six months (p<0.00001) and one year (p<0.00001) with UDCA prophylaxis. Symptomatic cholelithiasis incidence was also lower in the UDCA group (p< 0.00001) and cholecystectomy rates were also significantly reduced (p=0.002).


However, the authors cautioned that due to heterogeneity, diverse surgical procedures and limited long-term follow-up in the included studies, further research with standardised protocols and extended observational periods is recommended to strengthen the evidence base and guide clinical practice.


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A phase 2 randomised controlled trial of mazdutide in Chinese overweight adults or adults with obesity

Overweight adults or adults with obesity, 24-week treatment with mazdutide - a once-weekly glucagon-like peptide-1 (GLP-1) and glucagon receptor dual agonist - up to 6mg was safe and led to robust and clinically meaningful body weight reduction, according to Chinese researchers.


Reporting in Nature Communications, 248 overweight adults (body-mass index [BMI] ≥24 kg/m2) accompanied by hyperphagia and/or at least one obesity-related comorbidity or adults with obesity (BMI ≥ 28 kg/m2) were randomly assigned (3:1:3:1:3:1) to once-weekly mazdutide 3mg (n=62), 4.5mg (n=63), 6mg (n=61) or placebo (n=62) at 20 hospitals in China.


 The mean percentage changes from baseline to week 24 in body weight were −6.7% (SE 0.7) with mazdutide 3mg, −10.4% (0.7) with 4.5mg, −11.3% (0.7) with 6mg and 1.0% (0.7) with placebo, with treatment difference versus placebo ranging from −7.7% to −12.3% (all p < 0.0001). All mazdutide doses were well tolerated and the most common adverse events included diarrhoea, nausea and upper respiratory tract infection.


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