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Journal Watch 27/3/2024

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 intensive pre-operative information course results in less weight recurrence, laparoscopic versus robotic-assisted bariatric surgery, surgery alleviates electrocardiographic abnormalities, short peptide-based vs complex protein-based supplements in preventing early post-bariatric fat-free mass loss and body fat percentage changes determine diabetes remission after bariatric surgery, and more (please note, log-in maybe required to access the full paper).

Intensive pre-operative information course (IPIC) and pre-operative weight loss results in long-term sustained weight loss following bariatric surgery: 11 years results from a tertiary referral centre

Intensive pre-operative information course (IPIC) and higher pre-operative weight loss improve weight loss post-bariatric surgery and reduce the likelihood of weight regain during long-term follow-up, according to researchers from the Royal Infirmary Edinburgh, Edinburgh, UK.

Writing in Surgical Endoscopy, their regional bariatric service introduced a 12-week intensive pre-operative information course (IPIC) to optimise pre-operative weight loss and provide education prior to bariatric surgery in 2008.

In total 339 patients (median age, 49 years; median follow-up, 7 years [0.5–11 years]; median EWL%, 49.6%.) were evaluated, including 158 gastric sleeve and 161 gastric bypass. During follow-up 273 patients (80.5%) and 196 patients (53.1%) achieved EWL ≥ 50% and ≥ 70%, respectively.

In multivariate survival analyses, pre-operative weight loss through IPIC, both <10.5% and >10.5% EWL, were positively associated with EWL ≥ 50% (HR 2.23, p<0.001) and EWL ≥70% (HR 3.24, p<0.001), respectively. After a median of 6.5 years after achieving EWL50% or EWL70%, 56.8% (154/271) had sustained EWL50% and 50.6% (85/168) sustained EWL70%. Higher pre-operative weight loss through IPIC increased the likelihood of sustained EWL ≥50% (OR, 2.36; p=0.013) and EWL ≥ 0% (OR, 2.03; p=0.011) at the end of follow-up.

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Laparoscopic versus robotic-assisted primary bariatric-metabolic surgery. Are we still expecting to overcome the learning curve? A propensity score-matched analysis of the MBSAQIP database

Robotic-assisted bariatric-metabolic surgery results in a higher readmission, reoperation rate and higher morbidity at 30 days postoperatively vs conventional laparoscopy, investigators from Cleveland Clinic, Florida have reported.

Writing in SOARD they evaluated readmission and reoperation rates after bariatric-metabolic surgery performed by conventional laparoscopy versus robotic-assisted from 2015-2021 using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).

Of 1,065,272 cases meeting inclusion criteria, 87% were conventional laparoscopic bariatric-metabolic surgeries, which were matched 1:1 with robotic-assisted cases (13%). Reoperation (OR(95% CI) 1.28(1.20-1.37), p<0.0001), postoperative morbidity (OR(95% CI) 1.19(1.13-1.25), p<0.0001), readmission (OR(95% CI) 1.21(1.17-1.26), p<0.0001), emergency room visits (OR(95% CI) 1.07(1.03-1.10), p<0.0001) and cumulative hospital stay >5 days (OR(95% CI) 1.14(1.08-1.21), p<0.0001) at 30 days postoperatively were significantly higher for robotic-assisted cases.

The benefits of laparoscopic surgery over robotic-assisted surgery seem more evident in SG and BPD/DS than RYGB. Robotic-assisted cases had a similar mortality rate at 30 days postoperatively vs conventional laparoscopic cases. Similar results were observed in cases from 2020-2021, except for emergency room visits, which showed no difference between groups.

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Bariatric surgery mitigated electrocardiographic abnormalities in patients with morbid obesity

Bariatric surgeries can correct abnormal R wave progression and resolve QT dispersion in morbidly obese patients, according to researchers led by a team from the Mother and Child Hospital in Shiraz, Iran.

Reporting in Scientific Reports, they analysed the relationships between weight loss, type of surgery and electrocardiographic alterations in 200 patients.

They found that bariatric procedures significantly improved R wave progression (60 versus 27, p<0.001), corrected RVH (63 versus 18, p<0.001), reduced QTc dispersion (139 versus 35, p<0.001), shortened the QTc interval (443.9 versus 409.7, p<0.001) and increased the Sokolow-Lyon score (15 versus 17.17, p<0.001).

The findings suggest that weight loss achieved through bariatric surgery significantly shortened the QTc duration, improved QTc dispersion and RVH and corrected R wave progression.

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Protein Supplements with Short Peptides Are Better than Complex Protein-Based Supplements on Improving Early Fat-Free Mass Loss Following Bariatric Surgery: A Retrospective Cohort Study

Short peptide-based (SPB) supplements may be more effective in preventing early fat-free mass (FFM) loss after bariatric surgery, compared to complex protein-based (CPB) supplements, according to researchers from the Affiliated Hospital of Southwest Jiaotong University, Chengdu, China.

Writing in Obesity Surgery, their study included 138 patients (69.6% were female, with a mean age of 33.3 years) who underwent BS other than RYGB and who were divided into two groups based on their consumption of protein supplements after surgery: SPB group and CPB group. Multiple linear regressions separated by sex were employed to examine the associations between SPB supplements and FFM loss and percentage of FFM (%FFM) loss, respectively.

In multiple linear regression analyses, SPB supplements were significantly and positively associated with a lower FFM loss in both female p=0.047) and male (p=0.024), and were positively associated with a lower %FFM loss in both female and male, but was only significant in male (p=0.049).

They recommended SPB supplements for patients undergoing surgery although further research is needed to validate these findings.

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Associations of change in body fat percentage with baseline body composition and diabetes remission after bariatric surgery

Body fat percentage (BFP) changes determine diabetes remission after bariatric surgery, and baseline fat-free mass index (FFMI) is crucial for BFP changes, according to researchers from Tong University School of Medicine, Shanghai, China.

Reporting in the Obesity journal, they analysed 203 patients with type 2 diabetes who underwent RYGB. They verified the results in a laparoscopic sleeve gastrectomy cohort with 311 patients.

Compared with non-remission patients in the RYGB cohort, those who achieved DR showed a higher baseline fat-free mass index (FFMI) and experienced the most significant changes in BFP (p<0.001). In comparative analyses, BFP changes were significantly better than BMI changes in identifying short- and long-term DR.

Baseline BMI was positively correlated with changes in BFP but negatively correlated with changes in FFMI. These findings were replicated in the laparoscopic sleeve gastrectomy cohort.

Interestingly, a lower initial BMI is associated with a smaller BFP reduction and greater FFMI loss after bariatric surgery.

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