Journal Watch 27/04/2022

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 antireflux medication in RYGB vs LSG patients, early postoperative bleeding predictors after bariatric surgery, the information needs of patients undergoing bariatric surgery, quality of life scores following bariatric surgery and bariatric surgery improves the retinal microvascular phenotype (please note, log-in maybe required to access the full paper).


Long-Term Comparative Effectiveness of Gastric Bypass and Sleeve Gastrectomy on Use of Antireflux Medication: A Difference-in-Differences Analysis

Researchers from the University of Michigan, Ann Arbor, MI, who compared the long-term effectiveness of RYGB and LSG on use of antireflux medication have concluded that while use of antireflux medication decreased following both procedures, RYGB was associated with a greater reduction in antireflux medication use five years after surgery vs LSG.


In this retrospective study of Medicare beneficiaries undergoing both procedures, they performed a difference-in-differences analysis to evaluate the differential change in antireflux medication use between groups before and after surgery.


In total, 16,640 patients underwent RYGB and 26,724 patients underwent LSG. Before surgery, GERD medication use was higher among patients undergoing RYGB (62.4%) compared to patients undergoing LSG (60.1%). Five years after surgery, gastroesophageal reflux (GERD) medication use was lower in patients who underwent gastric bypass (47.8%) vs. patients who underwent sleeve gastrectomy (53.7%). The differential decrease from baseline GERD medication use was greater for patients who underwent gastric bypass at two-, three-, four- and five-years post-surgery.


Writing in SOARD, the authors conclude that understanding the long-term comparative effectiveness of these two common bariatric operations may better inform treatment decisions among patients and surgeons.


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Prediction Factors of Early Postoperative Bleeding after Bariatric Surgery

Investigators in Iran who sort to determine early postoperative bleeding predictors after bariatric surgery, have concluded that a positive association between type of procedure, history of intragastric balloon (IGB), and oral non-aspirin NSIADs use, as well as an inverse relationship between staple line oversewing and the odds of bleeding after bariatric surgery.


Published in Obesity Surgery, the retrospective study included 2,260 patients who underwent bariatric surgery. They diagnosed early postoperative bleeding by the following symptoms: abdominal pain, hypotension, tachycardia, hematemesis, melena, decreased haemoglobin level, the need for at least two units of packed red blood cells (PRBCs) transfusion, and reoperation within the first 48 hours after surgery.


The results showed the odds of early postoperative bleeding were higher in LRYGB patients vs LSG patients. They also found that prior IGB and oral non-aspirin non-steroidal anti-inflammatory drugs were positively associated with the occurrence of postoperative bleeding. In contrast, there was an inverse relationship between staple line oversewing and the odds of postoperative. Following stratification data based on the type of the surgery, the positive association between IGB and the odds of bleeding was constant in the LRYGB group. In the LSG group, use of non-aspirin NSAIDs was linked to a higher incidence of postoperative bleeding, while oversewing of the staple line lowered the incidence of this event.


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Information needs of patients undergoing bariatric surgery in Germany: a qualitative study

Germany investigators, writing in BMC Health Services Research, who wanted to identify the information needs of patients undergoing bariatric surgery and to explore the information provision within the healthcare process of bariatric surgery in Germany – have found that there were unmet information needs.


For the study, they conducted a qualitative study (n=14 single, semi-structured telephone interviews) between April 2018 and April 2019. The interview consisted of four main sections (demographic information, pre-/postoperative healthcare provision, information needs).


They report that patients felt well informed concerning general information. However, it was pointed out that it was not possible to provide complete information preoperatively, as the need for information only arises when there are postoperative (specific) problems.

In addition, they report that there seems to be a high demand for specific postoperative information regarding nutrition and nutrition-related problems. However, patients reported that:

  • postoperative nutritional counselling is not reimbursed by health insurance funds

  • information conveyed in support groups and the exchange of experiences are highly valued by patients.

  • the information provided within the support groups as unfiltered, frightening or exaggerated

The authors conclude that reimbursement by health insurance funds could increase the use of postoperative nutritional counselling and thus serve existing information needs, and that support groups enable an exchange of experiences and therefore offer low-barrier access to information.


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Post-Bariatric Surgery Patients: A Quality of Life Assessment in Saudi Arabia

Saudi Arabian authors, writing in Cureus, have found that quality of life scores following bariatric surgery was mostly reported to be fair or average.


The study was designed to assess the quality of life and its associated factors following bariatric surgery in the country. In total, 400 adult patients (160 (40%) were males and 240 (60%) were females) who had undergone bariatric surgery were recruited from different regions in Saudi Arabia between December 2021 and February 2022.


Of the 400 participants, 160 (40%) were males and 240 (60%) were females. Post-surgery, most of the participants (35%) had a fair quality of life, 25% had very poor quality, 20% had very good quality, 15% had good quality, and 5% had poor quality of life. A statistically significant association (p<0.001) was found with the following factors: gender, age, nationality, educational level, marital status, and history of chronic diseases.


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Longitudinal Effect of Bariatric Surgery on Retinal Microcirculation and Target Organ Damage: the BASTOD Study

Researchers from France, reporting in Obesity Surgery, have found that bariatric surgery improved the retinal microvascular phenotype during the first year after bariatric surgery, with decreased central retinal vein equivalent (CRVE) and increased arteriole-to-venule ratio (AVR).


The study recorded biologic features, vessel stiffness, echocardiograph variables and retinal calibre at baseline and six and 12 poster-surgery. They study included 88 patients (75 women).

Mean changes in the first year after BS were − 5.1 µm in CRVE (p<0.0001), + 0.02 in AVR (p<0.0001), − 1.4 mmol/L in glycaemia (p<0.0001), − 1.0 mg/L in natural logarithm of C-reactive protein (p<0.0001), and − 54.0 g in left ventricular mass (p=0.0005). There was no significant improvement in arterial stiffness markers. Predictors of improvement in CRVE were high baseline weight (p=0.030), male sex (p=0.025), and no diabetes history (p Dynamic links between variations =0.047).


The investigators reported that the factors associated with retinal microvascular plasticity were male sex, high baseline weight, and absence of diabetes. They note that longitudinal assessment of retinal vascular calibres may offer new insights into the pathophysiology of subclinical vascular processes.


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