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Journal Watch 22/2/2024

Updated: Feb 28

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 the benefit of early RYGB to manage patients with obesity and T2DM, LSG with same-day discharge outcomes, HRQL and patient satisfaction with appearance after body contouring surgery, cost implications for post-bariatric body contouring surgery and sleeve gastrectomy reduces the need for liver transplantation, and more (please note, log-in maybe required to access the full paper).

Preoperative duration of type 2 diabetes mellitus and remission after Roux-en-Y gastric bypass: A single center long-term cohort study

There is a potential benefit of early Roux-en-Y gastric bypass (RYGB) to manage patients with obesity and T2DM, according to researchers from the Mayo Clinic Rochester, MN.

Reporting in the International Journal of Surgery, they note that RYGB has resulted in excellent glycaemic control and type 2 diabetes mellitus (T2DM) remission for patients with obesity and T2DM. Importantly, the exact timing to offer surgical intervention during the course of the disease is not known.

Therefore, they performed a retrospective cohort study to establish the exact relationship between duration of T2DM and remission after RYGB. They cohort were divided into quartiles of preoperative disease duration to quantify the change in remission rates for each year of delay between T2DM diagnosis and RYGB. they also compared the average time to remission and changes in glycaemic control parameters.

The cohort included 519 patients (67.2% female; age 53.4±10.7 y; BMI 46.6±8.4 kg/m2) with a follow-up period of 6.6±3.8 years. Remission was demonstrated in 51% of patients and they found that the longer duration of T2DM was a significant negative predictor of remission with an estimated decrease in remission rates of 7% for each year of delay (p<0.001).

Compared to patients with <3 years of T2DM, remission decreased by 37% for patients with 3-6 years, 64% for those with 7-12 years and 81% for patients with more than 12 years (p<0.001). Half of the patients reached T2DM remission after 0.5 and 1.1 years respectively for the first and second quartiles, while patients in the other quartiles never reached 50% remission.

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Safety and cost of performing laparoscopic sleeve gastrectomy with same day discharge at a large academic hospital

Laparoscopic sleeve gastrectomy (LSG) with same-day discharge (SDD) can safely be performed at large academic surgery centres without increased morbidity or need for additional services in the perioperative period, according to investigators from Massachusetts General Hospital, Boston, MA.

Reporting in Surgical Endoscopy, 75 patients were enrolled in the LSG with SDD program during the study period, with 62 (82.7%) having a successful immediate postoperative discharge. Reasons for cancelation of planned SDD included anxiety (n=5), pain (n=3), nausea (n=2) and one patient each with hypotension, urinary retention and bleeding. After propensity matching (1:1 to those with planned inpatient recovery based on age, BMI and ASA classification), the authors found no differences in age, BMI or ASA classification in a comparison group of patients with planned inpatient recovery, and no differences in perioperative complications. There were no readmissions or requirements for outpatient intravenous fluids among patients with SDD, compared to n=3 (4.0%) and n=2 (2.7%) in the inpatient cohort, respectively.

The total perioperative cost for patients undergoing LSG with planned SDD was 6.8% less than those with inpatient recovery. The authors concluded that SDD may also be associated with decreased costs and allows for more efficient hospital bed allocation.

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Body Contouring Surgery after Bariatric Surgery Improves Long-term Health-related Quality of Life and Satisfaction with Appearance - An International Longitudinal Cohort Study Using the BODY-Q

Patients who underwent body contouring surgery (BCS) maintained the improvement in health-related quality of life (HRQL) and satisfaction with appearance in contrast to patients who only underwent BS, an international team of researchers has reported.

Writing in the Annals of Surgery, they compared patients’ HRQL and satisfaction with appearance in patients who have undergone bariatric surgery with or without subsequent BCS in relation to the general population normative for the BODY-Q (a PROM developed to measure changes in HRQL and satisfaction with appearance in patients with surgery and BCS) data from six European countries (Denmark, Netherlands, Finland, Germany, Italy and Poland).

The study included 24,604 assessments from 5,620 patients. They reported that surgery initially led to improved HRQL and appearance scores throughout the first post-bariatric year, followed by a gradual decrease. However, patients who underwent subsequent BCS after surgery experienced a sustained improvement in HRQL and appearance or remained relatively stable for up to ten-years post-operatively.

The authors stated that the results “emphasise the pivotal role that BCS plays in the completion of the weight loss trajectory.”

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The Financial Toxicity of Post-Bariatric Body Contouring Surgery: A Survey Study of an Urban Tertiary Care Center’s Patients

Researchers from Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, have reported significant financial implications for patients undergoing with post-bariatric body contouring surgery (BCS).

Writing in SOARD, the study sought to characterise the financial impact of treatment on all patients who received bariatric surgery compared to those receiving only bariatric surgery and those with post-bariatric BCS.

The patient survey included COST-FACIT (a patient-reported outcome measure that describes the financial distress experienced by cancer patients) and was sent to 105 patients with a history of bariatric surgery (n=86) or post-bariatric BCS (n=19).

The outcomes showed that patients with post-bariatric BCS had slightly higher COST scores than those receiving bariatric surgery only, but this difference was not significant (15.6 versus 17.8, p=0.23). Most patients (76%) did not have an awareness of BCS or BCS cost prior to bariatric surgery, and many (68%) had more loose skin than anticipated.

Crucially, survey respondents noted a gap between patient education and expectations around loose skin and body contouring that can be addressed through improved presurgical counselling.

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Sleeve Gastrectomy Reduces the Need for Liver Transplantation in Patients with Obesity and Non-Alcoholic Steatohepatitis: a Predictive Model

Weight loss following sleeve gastrectomy (SG) is associated with a reduction in the progression of Non-Alcoholic Steatohepatitis (NASH) and reducing the need for liver transplantation (LT), according to a team of US researchers.

Writing in Obesity Surgery,  the researchers performed a Markov decision analysis to simulate the lives of 20,000 patients with obesity and concomitant NASH who were deemed ineligible to be waitlisted for LT unless they achieved a body mass index <35kg/m2. Life expectancy following medical weight management (MWM) and sleeve gastrectomy (SG) were estimated. Patients were defined as having NASH without fibrosis and a pre-intervention BMI45kg/m2.

The simulated base case analysis patients who underwent SG gained 14.3 years of life vs. patients who underwent MWM. One year after weight loss intervention, 9% of simulated MWM patients required LT vs. 5% of SG patients. The survival benefit for SG was >BMI32.2kg/m2.

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