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Journal Watch 29/05/2024

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 Marginal ulcers post-OAGB vs RYGB, banded vs. non-banded RYGB, six-year analysis of same-day discharge, COVID-19 and post-bariatric outcomes, and revision of restrictive bariatric procedures in elderly patients, and more (please note, log-in maybe required to access the full paper).

Similar Rates of Symptomatic Marginal Ulcers After One-Anastomosis-Gastric Bypass Compared to Roux-en-Y Gastric Bypass

The risk of developing a marginal ulcer (MU) is similar between patients who underwent one-anastomosis-gastric-bypass (OAGB) and Roux-en-Y gastric bypass (RYGB), according to researchers from the Hebrew University of Jerusalem, Jerusalem, Israel.

Writing in Obesity Surgery, the investigators compared the incidence, presentation, and management of MU between the two surgeries to examined whether concerns among surgeons that MUs are more common after OAGB due to the constant and extensive exposure of the anastomosis to bile.

They report that symptomatic MUs were present in 23/372 OAGB patients (6.2%) and 35/491 RYGB patients (7.1%) (p=0.58). The MU diagnosis time was shorter in OAGB patients (12±11 vs. 22±17 months, p<0.01). Approximately 15% of ulcers presented with perforation upon admission (17% vs.11.4%, p=0.7) and re-operation was required in 5/23 OAGB (21.7%) and 6/36 RYGB (17%) patients (p=0.11)> The remining Mus were managed non-operatively.

The researchers concluded that the data indicates that OAGB patients with MU present earlier, although the clinical presentation is similar to RYGB patients.

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Banded versus Non-Banded Roux-en-Y Gastric Bypass: Short, Mid, and Long-Term Surgical Outcomes - a systematic review and meta-analysis

Patients who underwent banded-RYGB surgery showed a statistically significant increase in the %EWL at one-, two- and five-years postoperatively vs non-banded RYGB, according to a systematic review and meta-analysis by researchers from France and Italy.

Reporting in SOARD, the systematic review identified13 comparative studies (3,230 patients banded-RYGB and 5,302 RYGB). Four studies reported data on one-year postoperative percent excess weight loss (%EWL), demonstrating a significant increase of 6.03 %EWL in patients who underwent banded-RYGB. A further four studies reported the two-year postoperative %EWL, showing that banded patients had a 5.32 greater %EWL vs RYGB patients (not statistically significant).

At five-years, the average %EWL difference was 7.6 in favour of banded-RYGB. However, patients in the banded group presented a non-significant 1.45 OR of developing postoperative complications vs. RYGB patients.

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Safety of Same-Day Discharge after Bariatric Surgery: Retrospective 6-Year North American Analysis

A six-year analysis of same-day discharge (SDD) bariatric surgery has reported that it is associated with a significantly higher mortality rate and a higher risk of complications for RYGB vs. sleeve gastrectomy, according to investigators from Brigham and Women’s Hospital, Boston, MA.

Reporting in the Journal of the American College of Surgeons, the study sought to determine the national trends, safety profile, and risk factors for complications of SDD for minimally invasive bariatric surgery. Using the MBSAQIP database, multivariate logistic regression was performed on preoperative patient characteristics predictive of increased complications associated with SDD. Postoperative outcomes within 30 days and propensity score matching for patient demographics and preoperative comorbidities was conducted.

They report SDD increased from 2.4% in 2016 to 7.4% in 2021. Major preoperative factors associated with increased complications for SDD included Black race, history of MI, renal insufficiency, deep vein thrombosis and smoking. SDD for RYGB had 72% increased risk of postoperative complications vs. sleeve gastrectomy. The overall major complications were lower in SDD cohort vs admission cohort (p<0.01), but there was a significant increase in deaths within 30 days (p=0.01), cardiac arrest (p<0.01) and dehydration requiring treatment (p<0.01) in SDD cohort vs the admission cohort.

Given the outcomes, the researchers called for further studies to appropriately select patients for whom bariatric surgery can be safely performed as an outpatient.

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The Impact of COVID-19 Pandemic on Patient Selection and Access to Care, Approach Type, and Postoperative Outcomes in Bariatric Surgery

Patients who underwent bariatric surgery during the COVID-19 pandemic appeared to be healthier with fewer comorbidities and experienced fewer adverse postoperative outcomes vs. those who had pre-pandemic surgery, according to investigators from the University of Arizona College of Medicine, Tucson, AZ.

Reporting in SOARD, the study examined how the COVID-19 pandemic influenced patient selection, approach type and postoperative outcomes in elective bariatric surgery. Using data from the MBSAQIP database, a total of 741,620 patients underwent robotic and laparoscopic sleeve gastrectomy and Roux-en-Y gastric-bypass. The procedures carried out in 2020 showed lower comorbidities and postoperative complications vs. pre-pandemic years, regardless of the approach type. Interestingly, the proportion of White patients decreased during the pandemic, but there was an increase in the number of African American and Hispanic patients having bariatric surgery.

They authors concluded that this study highlights the limited access to bariatric surgery for high-risk patients during the pandemic.

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Revision of restrictive bariatric procedures in elderly patients: results at a 5-year follow-up

Revisional Bariatric Surgery (RBS) in elderly patients (over 65 years old) is effective and with a reasonable complication rate and with long-lasting weight loss and improvements in obesity associated medical problems, according to researchers from Tel Aviv University, Tel Aviv, Israel.

Writing in Updates in Surgery, 39 patients undergoing RBS were included in the comparative analysis − 23 patients (57.5%) after adjustable gastric banding (LAGB) and 16 patients (40%) after Sleeve Gastrectomy (SG). The mean age and body mass index (BMI) of patients were comparable (67.2±2.8 years and 38.3±7.4, respectively).

They found no difference in associated medical problems except reflux which was higher in SG (68% vs. 13%; p<0.001). The revisional surgeries included one anastomosis gastric bypass (n=22), SG (n=8) and Roux-en-y gastric bypass (n=9). Early major complication rates were comparable (4.3% and 12.5%; p=0.36) and readmission rate was higher in patients SG (p=0.03). The mean BMI and total weight loss was 29.2 and 20.3%, respectively with no difference between groups. The rate of patients with associated medical problems at last follow-up was significantly reduced. Five patients (12.5%) underwent revisional surgery due to complications during follow-up.

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