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Journal Watch 27/09/2023

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 long-term LSG outcomes, racial differences after bariatric surgery, impact of robotic assistance on complications in bariatric surgery, post-op vitamin D and Semaglutide in patients with heart failure, and more (please note, log-in maybe required to access the full paper).

Long-Term Results of Laparoscopic Sleeve Gastrectomy: a Review of Studies Reporting 10+ Years Outcomes

Researchers from Italy and Israel have reported rates of de novo GERD and revisional surgery at ten years after laparoscopic sleeve gastrectomy (LSG).

Writing in Obesity Surgery, they identified 11 studies including 1,020 patients that met the inclusion criteria. Overall weighted mean %TWL was 24.4% (17–36.9%), and remission rates from TD2M to HTN were 45.6% (0–94.7%) and 41.4% (0–78.4%), respectively. De novo GERD had an overall prevalence of 32.3% (21.4–58.4%), and five cases (0.5%) of Barrett’s disease were reported. Revisional surgery was required for 19.2% (1–49.5%) of patients, Roux-en-Y gastric bypass being the most common secondary procedure.

“Long-term outcomes of the sleeve gastrectomy on TD2M should be further investigated by prospective trials,” the researchers concluded. “Even if one third of patients may develop new onset GERD, less than 20% of individuals requires revisional surgery within ten years from LSG.”

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Racial Differences After Bariatric Surgery: 24-Month Follow-up of a Randomized Controlled Trial for Post-operative Loss-of-Control Eating

A study led by Yale School of Medicine researchers, published in SOARD, has found non-White patients with loss-of-control (LOC)-eating post-bariatric surgery, attain less percent excess weight loss than White patients but have comparable or better outcomes in LOC-eating, associated eating-disorder psychopathology, and depression over time.

The prospective study examined and extended initial short-term findings regarding racial differences in post-bariatric surgery LOC-eating and weight-loss to longer-term outcomes through 24-month follow-ups. In total, 140 patients (46.4% non-white) were enrolled in a three-month randomised controlled trial for LOC-eating performed about six months post-bariatric surgery. Participants were reassessed at six-, 12-, 18-, and 24-months after treatment ended (about 33-months post-surgery).

White patients had significantly greater percent excess weight loss at all follow-ups than non-White patients (ps<0.03). White patients reported significantly greater LOC-eating at 12- (p=0.004) and 24-month (p=0.02) follow-ups, and significantly greater eating-disorder psychopathology at 12-month follow-up (p<0.03). Racial groups did not differ significantly in eating-disorder psychopathology at 24-month follow-up, or in BDI-II depression scores at any follow-ups.

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Impact of Robotic Assistance on Complications in Bariatric Surgery at Expert Laparoscopic Surgery Centers

Robotic assistance reduced the length of stay but did not statistically significantly reduce postoperative complications (Clavien score≥3) following either sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB), according to research led by Lille University Hospital CHU Lille, Lille, France.

Writing in the Annals of Surgery, they investigated the way robotic assistance affected rate of complications in bariatric surgery at expert robotic and laparoscopic surgery facilities. The study included 35,043 patients (24,428 SGs 10,452 RYGBs; 163 single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S)), with 938 operated on with robotic assistance (801 SG; 134 RYGB; 3 SADI-S), among 142 centres.

They reported found no benefit of robotic assistance regarding the risk of complications (average treatment effect= −0.05, p=0.794), with no difference in the RYGB+SADI group (p=0.322) but a negative trend in the SG group (more complications, p=0.060). Length of hospital stay was decreased in the robot group (3.7±11.1 vs 4.0±9.0 days, p<0.001).

They noted that the tendency toward an elevated risk of complications following SG requires more supporting studies.

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Vitamin D Concentration Changes after Bariatric Surgery

Brazilian researchers have found that Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) result in similar body composition and postsurgical vitamin D levels, with significant differences only for parathyroid (PTH), bone mineral density (BMD) and insulin variables, demonstrating that both procedures are effective in reducing fat mass.

The aim of the study was to evaluate the vitamin D levels and body composition of 120 patients who had one of the procedures.

There was a significant difference between groups only for PTH, total BMD, and insulin variables. A significant intragroup difference was found in the variables’ BMI and vitamin D for the vertical sleeve gastrectomy group and BMI for the RYGB group.

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Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity

An international team of researchers has reported that patients with heart failure with preserved ejection fraction and obesity, who were treatment with semaglutide (2.4mg) led to larger reductions in symptoms and physical limitations, greater improvements in exercise function, and greater weight loss than placebo.

Reporting in the New England Journal of Medicine, they randomly assigned 529 patients who had heart failure with preserved ejection fraction and a BMI>30 to receive once-weekly semaglutide (2.4mg) or placebo for 52 weeks. The dual primary end points were the change from baseline in the Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS; scores range from 0 to 100, with higher scores indicating fewer symptoms and physical limitations) and the change in body weight.

The mean change in the KCCQ-CSS was 16.6 points with semaglutide and 8.7 points with placebo (p<0.001), and the mean percentage change in body weight was −13.3% with semaglutide and −2.6% with placebo (p<0.001). The mean change in the 6-minute walk distance was 21.5m with semaglutide and 1.2m with placebo (p<0.001). In the analysis of the hierarchical composite end point, semaglutide produced more wins than placebo (p<0.001). The mean percentage change in the CRP level was –43.5% with semaglutide and –7.3% with placebo (p<0.001). Serious adverse events were reported in 35 participants (13.3%) in the semaglutide group and 71 (26.7%) in the placebo group.

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