Journal Watch 23/4/2025

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 15 years banded one anastomosis gastric bypass results, OAGB is a feasible and effective revisional procedure after failed open VBG, comparing three BMS procedures in adolescents, systematic review of dumping syndrome post-OAGB, robotic BMS does not eliminate first assistant in bariatric surgery compared to laparoscopy, and more (please note, log-in maybe required to access the full paper).

Banded One Anastomosis Gastric Bypass: 15 Year Results from a Single Centre

Banded one anastomosis gastric bypass (BOAGB) using a silastic ring continues to show good results as an effective operation at 15 years, with a high %EWL and %TWL, low conversion rate, and significant reduction in medication use for hypertension, hyperlipidaemia and T2DM, according to researchers from New Zealand.

Reporting in Obesity Surgery, the study including 156 patients from a single centre between 2005–2008 who underwent a BOAGB. A questionnaire, blood test results and electronic records were utilised at 15 years post-operatively to identify patient outcomes.

At 15 years, the average was 82.0%, the average %TWL was 35.9% and the average BMI had reduced from 46.3 kg/m2 to 29.7 kg/m2. In total, 106/114 (93.0%) patients had adequate weight loss at 15 years. 27/114 (23.7%) of patients had recurrent weight gain at 15 years. Antihypertensives, lipid lowering therapy and hypoglycaemic medications were all reduced, but proton pump inhibitor medications had increased. There were 11 (7.1%) deaths by 15 years, none were directly related to the initial operation. Silastic rings were removed in 12 patients (7.7%) with 21 (13.5%) patients having a conversion to a Roux-en-Y gastric bypass over 15 years, of which 14 (9.0%) were due to reflux. There were no conversions for malnutrition. Patient satisfaction was high, with an average Likert satisfaction score of 8.4.

The authors concluded that this operation is durable and weight loss remains excellent and the addition of a silastic ring is effective in reducing long-term recurrent weight gain.

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Laparoscopic One Anastomosis Gastric Bypass as a Revisional Procedure After Failed Vertical Banded Gastroplasty: Our Center Experience

Investigators from the Mansoura University, Mansoura, Egypt, have concluded that OAGB is a feasible and effective revisional procedure after failed open VBG.

Writing in the Journal of Obesity, 71 patients who underwent revisional OAGB after failed open VBG between February 2014 and February 202. EBWL % after revisional OAGB was 68.2 ± 9.4%, 65.9 ± 2.5%, and 59.6 ± 7.4% after one, two and three years, respectively. The mean BMI before revisional surgery was 41.8 ± 3.7 kg/m2, which decreased to 31.9 ± 4.2 kg/m2 three years after the revisional surgery. After one year, the remission of T2DM was 85.7% and hypertension was 80%. Remission of other comorbidities was also observed. Bile reflux was encountered in six cases (8.5%), two of them required surgical intervention.

The authors noted that the risk of bile reflux should be considered to justify these findings and further prospective randomised controlled trials are required.

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Outcomes of Bariatric Surgery in Adolescents: A Meta-Analysis Comparing Three Surgical Techniques

An international team of researchers, who performed a meta-analysis comparing three BMS techniques have found that RYGB is the most effective bariatric procedure for weight loss in adolescents, although SG is much safer.

Reporting in The American Journal of Surgery, their analysis included 14 studies (13,994 patients) and compared outcomes between RYGB, LSG and LAGB in adolescents (age ≤ 21 years). On subgroup analyses, SG (MD: -15.95 kg; -13.76%) and RYGB (MD: -23.86 kg; -11.36%) demonstrated a significantly greater absolute change in weight and percentage change in BMI than AGB, respectively.

RYGB demonstrated a significantly greater absolute (MD: −1.68 kg/m) and percentage change in BMI (MD: -3.01%) than SG. However, RYGB was associated with a greater risk of post-operative complications than both SG (RR: 2.09) and AGB (RR: 3.51).

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Dumping Syndrome After One Anastomosis Gastric Bypass—A Systematic Review

Investigators from Iran University of Medical Sciences, Tehran, Iran, have found that dumping syndrome seems to be a rare long-term complication after OAGB and revisional/conversional interventions might not be needed.

Writing in Obesity Surgery, their systematic identified 17 studies (3,420 patients) were included. The mean postoperative follow-up was 11.91 ± 1.5 months. The incidence of dumping syndrome was reported between 9 to 42.9% and 0.5% to 27.8% in studies using the Sigstad dumping score and patients’ self-reported dumping syndrome, respectively.

Treatment of dumping syndrome after OAGB included mainly dietary changes and medications.

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Robotic approach does not eliminate first assistant in bariatric surgery compared to laparoscopy

Researchers from Geisinger Health System, Danville, PA, have reported that robotic surgery failed to show a reduction in the need for an assistant in RYGB procedures but did lead to a decrease in the number of assistants required in SG.

Reporting in Surgical Endoscopy, this retrospective analysis of the MBSAQIP database from 2015 to 2019 to determine the prevalence of Attending Surgeon involvement in robotic-assisted, laparoscopic RYGB and SG procedures, in comparison to non-physician surgical First Assistants (FAs).

A total of 12,480 patients had robotic RYGB. After a 1:1 match, attending-level FAs were involved in 25.9% of LRYGB cases, mid-level FAs in 55.6% and no assistants in 18.5%. In contrast, RRYGB cases utilised attending-level FAs in 13.7% of cases, mid-level FAs in 68.4% and had no assistants in 17.9% of cases (p<0.0001).

In LSG, attending-level FAs were present in 28.1% of cases, mid-level FAs in 51.6% and no assistants in 20.3%. In comparison, robotic SG cases had attending-level FAs in 16.1%, mid-level FAs in 55.6% and no assistants in 28.3% of cases (p<0.0001).

Mid-level assistance was necessary for the majority of robotic and laparoscopic bariatric metabolic cases. The robotic platform was associated with an approximate 12% reduction in the requirement for attending-level assistance in robotic procedures.

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