Journal Watch 23/12/2022

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 laparoscopic sleeve gastrectomy is a durable intervention for weight reduction in adolescents, RYGB results in marked and sustained improvements in obesity-related comorbidities in patients >60 years, both pre- and post-transplant bariatric surgery are effective and safe however, bariatric surgery lowered the rates of documented spinal disorders and procedures, and a report on Intrathoracic Pouch Migration in One-Anastomosis Gastric Bypass (please note, log-in maybe required to access the full paper).

Laparoscopic Sleeve Gastrectomy in Adolescents: Ten-Years Follow-up

Investigators from Tel Aviv University, Israel, have concluded that laparoscopic sleeve gastrectomy (LSG) is a durable intervention for weight reduction in adolescents.


Reporting in Obesity Surgery, their retrospective analysis included 46 patients who underwent LSG, 31 of them (67.39%) completed long-term follow-up and were included in the study. Mean follow-up time was 10.84 ± 2.35 years. Mean body-mass index (BMI) was 44.94±4.33kg/m2 and 30.11±7.10, before and ten-year following surgery, respectively, a reduction of 33.24% (p< 0.001). Long-term TWL% was 32.31 ± 12.02.


Following weight reduction, resolution of hypertension was noted in 8 patients (88.9%, p<0.001). Frequent long-term side effects of surgery were gastrointestinal reflux disease (GERD) and alopecia in 22.58% and 48.39%, respectively.


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Impact of Age on Obesity-related Comorbidity After Gastric Bypass - A Cohort Study From the Scandinavian Obesity Surgery Registry (SOReg)

There are marked and sustained improvements in obesity-related comorbidities are seen after gastric bypass in patients >60 years, indicating that age should not be considered an exclusion criterion for RYGB by itself, according to Swedish researchers.


Reporting in the Annals of Surgery, the researchers sought to evaluate the resolution of obesity-related comorbidities after gastric bypass in relation to age. Data on 57,215 patients operated with primary gastric bypass between May 2007 and December 2018 was extracted from the Scandinavian Obesity Surgery Registry. Follow-up rates in all eligible patients were 89%, 69%, and 59% at 1, 2, and 5 years, respectively, and 64% in patients >60 years at 5 years.


In this group of patients, the preoperative prevalence of diabetes, hypertension, dyslipidaemia and obstructive sleep apnoea syndrome was reduced at 5years by 45%, 10%, 24%, and 62%, respectively. Compared to all patients, the odds ratio (95% confidence interval) for resolution of these comorbidities in patients above 60 years at five years were 0.70 (0.57–0.86) 0.45 (0.37–0.53), 0.80 (0.63–1.01), and 0.54 (0.40–0.72).


Although to somewhat lower rates compared to younger patients, marked and sustained improvements in obesity-related comorbidities are seen after gastric bypass in patients >60 years, the authors concluded.


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Bariatric surgery before and after kidney transplantation: a propensity score-matched analysis

Researchers from the Erasmus Medical Center and the University Medical Center Groningen, in The Netherlands, have found that both pre- and post-transplant bariatric surgery are effective and safe however, different conditions of each transplant candidate should be considered in detail to determine the optimal timing of surgery.


Writing in SOARD, the authors look at the short- and long-term outcomes of patients who underwent both surgery and kidney transplantation (KT) to determine the optimal timing of bariatric surgery.


Twenty-two patients were included in the KT first group and 34 in the BS first group. Death-uncensored graft survival in the KT first group was significantly higher than the BS first group (90.9% vs. 71.4%, p=0.009), without significant difference in patient survival and death-censored graft survival (100% vs. 90.5%, P=0.082; and 90.9% vs. 81.0%, p=0.058).


In addition, there was no significant difference in one-year total weight loss (1y TWL: median [IQR], 36.0 [28.0-42.0] vs. 29.6 [21.5-40.6] kg, P=0.424), one-year percentage of excess weight loss (1y %EWL: median [IQR], 74.9 [54.1-99.0] vs. 57.9 [47.5-79.4], P=0.155), and the incidence of postoperative complications (36.4% vs. 50.0%, P=0.316) between the KT first and BS first groups.


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Bariatric Surgery Lowers Rates of Spinal Symptoms and Spinal Surgery in a Morbidly Obese Population

Bariatric surgery lowered the rates of documented spinal disorders and procedures, as well as reducing the overall rate of healthcare encounters for patients with morbid obesity, according to US researchers.


The study, published in Clinical Spine Surgery, assess the rates of spinal diagnoses and procedures in patients with morbid obesity before and after bariatric surgery. A total of 73,046 bariatric patients were included in the study included (age 67.88±17.66, 56.1% female) and for regression analysis, 299,504 non-bariatric patient with morbid obesity were included (age 53.45±16.52, 65.6% female). The most common bariatric surgeries performed were gastrectomy (73.9%), laparoscopic sleeve gastrectomy (65.9%), and gastric band with gastric bypass (19.9%).


Overall, rates of spinal symptoms decreased following surgery (7.40%–5.14%, P<0.001). Cervical, thoracic, lumbar spine diagnoses rates dropped from 3.28% to 2.99%, 2.91% to 2.57%, and 5.39% to 3.92% (all p<0.001), respectively. The most marked reductions were reported in cervical spontaneous compression fractures, cervical disc herniation, thoracic radicular pain, spontaneous lumbar compression fractures, lumbar spinal stenosis and lumbar spondylosis.


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Intrathoracic Pouch Migration in One-Anastomosis Gastric Bypass with and without Hiatoplasty – A 3D-CT Volumetry Study

Investigators from the Medical University of Vienna, Vienna, Austria, have reported that in primary One-Anastomosis Gastric Bypass (OAGB), an additional hiatoplasty was not associated with higher rates of intrathoracic pouch migration (ITM) or gastro-esophageal reflux disease (GERD), nevertheless the length of ITM was higher after hiatoplasty. They concluded, in SOARD, that If ITM occurs, patients have a risk developing GERD.


The study, which sought to discover whether OAGB or OAGB combined with hiatoplasty carries a higher risk of ITM and therefore also GERD, included 50 patients (group 1: 25x primary OAGB; group 2: 25x primary OAGB with hiatoplasty). History of weight, GERD, and quality of life were recorded in patient interviews and pouch volume and ITM were evaluated using 3D-CT volumetry

The researchers found no differences in terms of patient characteristics, history of weight, pouch volume or quality of life between both groups. ITM was found in group 1 in 60% (n=15) and group 2 in 76% (n=19) of all patients (p=0.152). The ITM mean length was significantly lower in group 1 with 0.9 ±1.1cm than in group 2 with 1.8 ±1.2cm (p=0.007).


For GERD, there was no difference between both groups, but significantly more patients with ITM (38.2%; n=13) were suffering from GERD, compared to patients without ITM (6.3%; n=1).


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