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Journal watch 24/05/2023

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 the early outcomes from a linear magnetic compression anastomosis device, 5 year outcomes from Medicaid SG and RYGB, complications after robotic bariatric surgery, bariatric revisional surgery in Italy and the needs of health care providers working with adolescents, and more (please note, log-in maybe required to access the full paper).

Side-to-side magnet anastomosis system duodeno-ileostomy with sleeve gastrectomy: early multi-center results

An international team of researchers has reported side-to-side Magnet System duodeno-ileostomy with sleeve gastrectomy (SG) in adults with class III obesity appeared feasible, safe and effective for weight loss and and type 2 diabetes (T2D) resolution in the short term.

Writing in Surgical Endoscopy, the multi-centre study evaluated the feasibility, safety and preliminary effectiveness of a novel linear magnetic compression anastomosis device, the Magnet System (MS), to form a side-to-side duodeno-ileostomy (DI) diversion for weight loss and type 2 diabetes (T2D) resolution.

They recruited 24 patients with class II and III obesity (body mass index [BMI, kg/m2] ≥ 35.0– ≤ 50.0 with/without T2D [HbA1C > 6.5%]) and two linear MS magnets were delivered endoscopically to the duodenum and ileum with laparoscopic assistance and aligned, initiating DI; SG was added. There were no bowel incisions or retained sutures/staples. Fused magnets were expelled naturally. Adverse events (AEs) were graded by Clavien-Dindo Classification (CDC).

The magnets were expelled at a median 48.5 days and the respective mean BMI, total weight loss, and excess weight loss at six months (n=24): 32.0 ± 0.8, 28.1 ± 1.0%, and 66.2 ± 3.4%; at 12 months (n=5), 29.3 ± 1.5, 34.0 ± 1.4%, and 80.2 ± 6.6%. Group mean respective mean HbA1C and glucose levels dropped to 1.1 ± 0.4% and 24.8 ± 6.6 mg/dL (6 months); 2.0 ± 1.1% and 53.8 ± 6.3 mg/dL (12 months). There were 0 device-related AEs, three procedure-related serious AEs. No anastomotic bleeding, leakage, stricture or mortality.

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Comparative Safety of Sleeve Gastrectomy and Gastric Bypass up to 5 Years After Surgery in Patients With Medicaid

Investigators led by University of Michigan, Ann Arbor, MI, have reported that among patients with Medicaid undergoing bariatric surgery, sleeve gastrectomy was associated with a lower risk of mortality, complications, hospitalization, ED use, and reoperations, but a higher risk of revision compared with gastric bypass.

Using Medicaid claims, they performed a retrospective cohort study of adult patients who underwent sleeve gastrectomy or gastric bypass from January 2012 to December 2018. Instrumental variables survival analysis was used to estimate the cumulative incidence and heterogeneity of outcomes up to five years after surgery.

From 132,788 patients with Medicaid, 84,717 (63.8%) underwent sleeve gastrectomy and 48,071 (36.2%) underwent gastric bypass. A total of 69,225 (52.1%) patients were White, 33,833 (25.5%) were Black, and 29,730 (22.4%) were Hispanic. Compared with gastric bypass, sleeve gastrectomy was associated with a lower five-year cumulative incidence of mortality (1.29% vs 2.15%), complications (11.5% vs 16.2%), hospitalization (43.7% vs 53.7%), emergency department (ED) use (61.6% vs 68.2%) and reoperation (18.5% vs 22.8%), but a higher cumulative incidence of revision (3.3% vs 2.0%).

Writing in the Annals of Surgery, they concluded that although the difference between sleeve and bypass was generally similar among White, Black, and Hispanic patients, the magnitude of this difference was smaller among Black patients for ED use and Hispanic patients for reoperation.

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Robotic-Assisted Bariatric Surgery Is Associated with Increased Postoperative Complications Compared to Laparoscopic: a Nationwide Readmissions Database Study

Researchers from Creighton University, Omaha, NE, have found robotic-assisted (RA) bariatric surgery is associated with 13% higher odds of complication, 10% higher odds of readmission and 31% hospital costs.

Writing in Obesity Surgery, they compared intra- and post-operative complications and 30- and 90-day all-cause readmissions between robotic and laparoscopic assisted surgery using the Nationwide Readmissions Database (NRD).

A total of 1,371,778 hospitalizations met inclusion criteria with 7.1% using RA. Patient demographic and clinical characteristics were mostly similar between groups. Adjusted odds of complication were 13% higher for RA (adjusted odds ratio [aOR]: 1.13, 95% CI: 1.03–1.23 p=0.008). The most common complications included nausea/vomiting, acute blood loss anaemia, incisional hernia and transfusion. Adjusted odds of 30- and 90-day readmission were 10% higher for RA, LOS was similar (1.6 vs. 1.6 days, p=0.253); although, hospital costs were 31.1% higher for RA ($15,806 vs. $12,056, p<0.001).

They researchers added subsequent studies are required using databases that can include additional patient-, facility-, surgery-, and surgeon-specific characteristics.

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Trends and safety of bariatric revisional surgery in Italy: multicenter, prospective, observational study

Researchers from the University “La Sapienza” of Rome, Italy, have concluded that current Italian trends show a shift towards SG being the most revised procedure and RYGB the most used as revisional procedure.

Reporting in SOARD, this prospective, observational, multi-centre enrolled 220 patients between January 2021 and March 2022 who were compared with 560 control-group patients (patients undergoing RBS between 2016-2020).

The mortality was 0.45% vs 0.35% with an overall of 0.25%, while open surgery or conversion to open surgery registered in 1%. No differences were found for mortality, morbidity, complications, readmission (1.3%) and reoperation rates (2.2%). IWL/WR was the most frequent cause, followed by GERD. Roux-en-Y gastric bypass RYGB was the most used revisional procedure (56%), whilst sleeve gastrectomy SG was the most revised procedure in the study-group, compared to gastric banding in the control-group. RBS represents up to 9% of the total BS in the Italian participating centres.

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A qualitative exploration on the needs of health care providers working with adolescents who are undergoing bariatric surgery

Canadian researchers have reported that there needs to be improvements for HCPs in appropriate resources for adolescent patient education, as well as pre- and post-operative preparation.

Writing in Obesity Pillars, they investigated the resource needs of HCPs working with adolescents living with severe obesity who are undergoing bariatric surgery by interviewing seven HCPs from an adolescent bariatric programme using a semi-structured interview guide.

They identified four data-generated themes highlighting the perceived needs and challenges faced by HCPs including: (1) gaps in patient education materials on the subject of the bariatric surgery process, obesity as a chronic disease and mental health, (2) the need for designing resources that are teen-friendly, adaptable, and accessible, (3) the need for resources to facilitate decision-making and patient evaluation delivering more streamlined care and; (4) challenges to addressing resource needs due to limited clinical time and budgets.

“The hope is that HCPs can improve quality of care delivered and positively impact surgical outcomes in their patients,” they concluded.

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