Journal Watch 21/5/2025

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 tighter stoma results in greater weight loss, hypoalbuminemia is not a factor for major complications, comparing RYGB and LSG risk factors and reoperation rates, soaring insurance costs risks future of Australian BMS, medications as adjunctive therapy post-BMS, the importance of preop patient education, and more (please note, log-in maybe required to access the full paper).

The tighter the stoma, the greater the loss: A narrower gastrojejunostomy is more beneficial for weight loss following roux-en-Y gastric bypass

Iranian researchers have concluded that performing a gastrojejunostomy (GJ) with a 30mm stapler, compared to a 45mm stapler increases weight loss in LRYGB patients.

Writing in Clinical Obesity, their study investigated the influence of linear-stapled GJ size in long-term LRYGB weight reduction results. Their retrospective analysis included 100 patients who underwent LRYGB surgery between January and July 2021. The patients were divided into two 50-patient groups based on the size of their linear-stapled GJ, either 30 or 45 mm.

After 24 months, the 30mm group reduced their BMI by an average of 19.23, compared with the 16.43 kg/m2 of the 45mm group (p<0.001). Overall, repeated measures ANOVA showed a beneficial weight loss pattern for the 30mm group in all four categories (weight, BMI, EWL, and TWL).

Upon adjusting for age, biliopancreatic length, alimentary length, sex, history of diabetes, and a history of hypertension in repeated measures ANOVA, this difference remained significantly in favour of the 30mm GJ.

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Use of Preoperative Hypoalbuminemia as Independent Predictor of Post-Conversion and Revisional Bariatric Surgery Outcomes: MBSAQIP Registry Analysis

After adjusting for confounding patient factors, hypoalbuminemia alone did not arise as an independent predictive factor for the 30-day major complications, such as leak, reoperation, or reintervention after revisional and anastomotic conversion MBS, although there may be an increase in surgical site infection and readmission rates, US researchers report.

Writing in the Journal of the American College of Surgeons, this study investigated whether hypoalbuminemia is a risk factor for postoperative morbidity in revisional and conversion metabolic and bariatric surgery (MBS).

Using MBSAQIP registry data from 58,327 MBS revisions and anastomotic conversions from 2020 to 2022, they used a preoperative albumin level of 3.5 g/dL as a threshold to identify patients with hypoalbuminemia.

Although univariate analyses illustrated an association between hypoalbuminemia and postoperative morbidity, multivariable regression and 1:1 matched analysis showed hypoalbuminemia is not an independently significant driver of 30-day overall postoperative complications (including leaks), reoperation or reintervention. However, 1:1 matched analysis demonstrated significantly increased odds of 30-day postoperative superficial surgical site infection (p=0.049) and readmission (p=0.045) associated with albumin levels lower than 3.5 g/dL.

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Comparing risk factors and reoperation rates for laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass

Researchers from Morristown Medical Center, Morristown, NJ, have stated that surgeons choosing to utilise an LRYGB procedure over an LSG should do so while carefully considering the increased risk of reoperation.

Writing in Clinical Obesity, they used MBSAQIP registry data they divided patients in each operation cohort into those who underwent reoperation within 30 days and those who did not. Patients who underwent a RYGB experienced higher rates of reoperation (1.84%) compared to those undergoing an LSG (0.65%). Comorbidities such as diabetes, sleep apnoea and gastroesophageal reflux disease were associated with higher rates of reoperation.

“As the prevalence of obesity increases worldwide, it is vital to understand the risk factors and complications associated with different types of MBS,” they concluded.

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Professional indemnity insurance rates for metabolic bariatric surgeons in Australia: survey results

An alarming number of Australian bariatric surgeons are considering shutting their clinics because of skyrocketing insurance costs and growing malpractice claims, according to a survey by the University of Notre Dame Australia, Flinders University and the Australian and New Zealand Metabolic and Obesity Surgical Society.

In Australia, 97 per cent of bariatric surgery operations are performed in the private sector, and private surgeons must have professional indemnity insurance (PII) to practice. To gain an understanding of PII rates for metabolic bariatric surgeons and trends around malpractice claims in Australia, a cross-sectional online survey was developed by the Medicolegal Subcommittee and Board of the Australian and New Zealand Metabolic and Obesity Surgical Society (ANZMOSS).

Reporting in the ANZ Journal of Surgery, they found 37 per cent of bariatric surgeons were considering quitting the practice because of soaring indemnity insurance premiums, with professional indemnity insurance premiums rising by 35 per cent in the past year, with an average annual cost of about AUS$70,000. The mean reported annual cost (all costs in Australian dollars) of PII in 2022/23 was $51,748 ± $34,687 (range $4000–$230,000). The mean annual cost of PII in 2023/24 was $69,933 ± $60,181 (range $5500–$500,000).

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Obesity medications in patients with recurrent weight gain or suboptimal clinical response following bariatric surgery: a meta-analysis

Obesity medications may be an effective adjunctive therapy to maintain weight loss post-bariatric surgery, according to Iranian researchers.

Writing in the International Journal of Obesity, the meta-anaylsis identified 26 relevant studies and demonstrated that glucagon-like peptide-1 (GLP-1) receptor agonists reduced weight by 8.38 kg and BMI by 3.76 kg/m². The overall %TWL was 9.94%. After subgroup analysis, they found that the effect of semaglutide on %TWL was significantly greater than that of liraglutide.

In terms of non-GLP-1 receptor agonists, patients achieved a weight loss of 2.97 kg, a BMI loss of 1.41 kg/m² and a % TWL of 4.50%. The subgroup analysis suggested that combination therapy had more pronounced effects on outcomes than monotherapy.

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Trends and Practices in Bariatric Surgery in Egypt: Insights on Esophagogastroduodenoscopy (EGD) Utilization and Surgical Volumes

A survey of Egyptian metabolic and bariatric surgeons (MBS) has revealed that procedural volumes are increasing, although economic constraints remain the predominant barrier to routine esophagogastroduodenoscopy (EGD) use, despite its potential to improve surgical outcomes by identifying incidental pathologies, according to the study by the Collaborative Egyptian National Survey Group.

Published in Obesity Surgery, the survey found that the volume of bariatric procedures increased from 2021 to 2023, with significant growth in sleeve gastrectomy (SG) and single-anastomosis sleeve ileal (SASI) bypasses/bipartition. Revisional surgeries were most commonly Roux-en-Y gastric bypass (RYGB). Despite this growth, EGD utilization remained limited. Pre-operatively, only 12.5% of surgeons performed EGD routinely for all patients, while 67.5% used it selectively based on patient or procedural factors.

“Enhancing patient care requires establishing a national registry, upgrading training programs, and implementing observerships to align with international standards are pivotal in advancing bariatric care in Egypt and guaranteeing high-calibre, evidence-based patient care,” they concluded.

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The Practice of Preoperative Patient Education in Metabolic Bariatric Surgery: Results of a National Survey

US researchers have reported preoperative MBS patient education (PE) offers opportunities for clinicians to reflect on, incorporate recommended practice changes, and research patient education practices using educational constructs of content, delivery methods, knowledge measurement, and clinical outcomes.

Writing in SOARD, their survey divided responses (n=269) into two groups: nurses (65.8%) and Other Integrated Health Professionals [OIHP] (34.2%). Over 74% in both groups rated 15 education content areas as “very important” or “extremely important”. Content areas were developed “most of time” or “always” (by nurses and OIHP) utilising clinical experience (79.0% and 75.0%), implementing information from literature (69.3% and 75.3%), and theory (55.4% and 76.1%).

A majority perceived preoperative MBS-PE to be moderately or highly related to surgical outcomes.

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