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Journal Watch 29/11/2023

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 cancer incidence after surgery, surgery and cardiac function, OAGB outcomes based by gender, factors influencing delayed discharge, maternal cardiometabolic status post-surgery and trocar entry site hernias in LSG, and more (please note, log-in maybe required to access the full paper).

Incidence of cancer for patients after bariatric surgery: evidence from 33 cohort studies

A systematic review and meta-analysis has concluded that bariatric surgery could reduce the incidence of cancer significantly, according to researchers led by Sichuan University, Chengdu, China.

Published in SOARD, the meta-analysis sought to evaluate the pooled effect and further implemented subgroup analysis stratified by cancer type, bariatric operation type and sex.

All cohort studies were included in their meta-analysis from 18,216 studies. The overall cancer incidence showed a significant decrease in the group with bariatric surgery (p=0.000, 95% CI 0.46 to 0.68). In subgroup analysis, similar decrease effect was found in nine cancers. Furthermore, the incidence of cancer decreased significantly in male (p=0.001, 95% CI 0.51 to 0.85) and female (p=0.000, 95% CI 0.57 to 0.69) patients and patients undergoing gastric bypass (p=0.000, 95% CI 0.33 to 0.63) or sleeve gastrectomy (p=0.001, 95% CI 0.27 to 0.70).

The added that further large-scale well-matched studies are needed to verify the protective effect of bariatric surgery on cancer incidence.

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The effects of bariatric surgery on cardiac function: a systematic review and meta-analysis

Bariatric surgery leads to reverse remodelling and improvement in cardiac geometry and function driven by metabolic and haemodynamic factors, researchers from Imperial College Healthcare NHS Foundation Trust, London, UK, have reported.

Writing in the International Journal of Obesity, they conducted a systematic review and meta-analysis of studies reporting pre- and post-operative cardiac structure and function parameters on cardiac imaging in patients undergoing bariatric surgery.

The study included 80 studies (3,332 patients) and found bariatric surgery is associated with a statistically significant improvement in cardiac geometry and function including a decrease of 12.2% (95% CI 0.096–0.149; p<0.001) in left ventricular (LV) mass index and an increase of 0.155 (95% CI 0.106–0.205; p<0.001) in E/A ratio.

They also reported a decrease of 2.012 mm (95% CI 1.356–2.699; p<0.001) in left atrial diameter, a decrease of 1.16 mm (95% CI 0.62–1.69; p<0.001) in LV diastolic dimension and an increase of 1.636% (95% CI 0.706–2.566; p<0.001) in LV ejection fraction after surgery.

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Gender Comparisons of Surgical Outcomes in Patients Undergoing One Anastomosis Gastric Bypass (OAGB): a Historical Cohort Study

One Anastomosis Gastric Bypass (OAGB) surgery results in better quality of life (QOL) outcomes for male than for female patients as measured by the BAROS, despite a similar BMI reduction, and with no difference in complications, according to a study published in Obesity Surgery.

Investigators from Soroka University Medical Center, Beer-Sheva, Israel, assessed the gender-oriented results from OAGB and specifically QOL parameters using the Bariatric Analysis and Reporting Outcome System (BAROS).

In total, 152 patients were included; of these, 51 (33.6%) were males, with an average follow-up period of 4.1 (±1.3) years post-surgery. There were no significant pre- or post-surgery differences between males and females, except for pre-op weight (which as expected was higher for males). Males had a higher overall BAROS score than females (3.8±2.1 vs. 2.6±2.1, p<0.001).

They noted that gender-specific outcomes are one of the variables that one should be aware of in optimizing patient selection and pre-operative patient counselling.

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Patient and operative factors influence delayed discharge following bariatric surgery in an enhanced recovery setting

Patient length of stay is independent of BMI, operation and comorbidities and these factors do not need special consideration in Enhanced Recovery After Surgery (ERAS) bariatric surgery programmes, researchers from Luton and Dunstable University Hospital, Luton, UK.

Published in SOARD, the investigators wanted to predict which patients would deviate from the ERAS programme as early identification of these patients could allow for more tailored protocols to be implemented pre-operatively, thereby improving patient outcomes. Therefore, they examined the factors which preclude discharge by comparing patients who were successfully discharged by the end of the first post-operative day (POD 0/1) to those who stayed longer, including revisional surgery.

The conducted a retrospective analysis for of all patients who had bariatric surgery in their centre in one year (288 bariatric operations, 78% RYGB and 22% LSG), 13% were revisional operations. Four patients returned to theatre on the index admission. 81% of patients were discharged by POD 0/1. A re-presentation within 30 days was seen in 6% of patients.

There was no significant difference in length of stay for the type of operation performed (p=0.86) or primary or revisional procedures. Length of stay was also independent of age, BMI and comorbidities. Caucasian patients were more likely to be discharged on POD 0/1 than those of other ethnicities (90% vs 78%; p=0.02) and operations performed by trainee surgeons, under consultant supervision, were significantly more likely to be discharged on POD 0/1 (p=0.03).

However, a logistic regression analysis was unable to predict patients who had a prolonged stay and they concluded that the impact of individual patient factor, and their interaction, is complex and cannot predict overstay.

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Impact of maternal cardiometabolic status after bariatric surgery on the association between telomere length and adiposity in offspring

Researchers from the Université Laval, Quebec, Canada, have reported that the influence of maternal metabolic status on the association between telomere length and markers of adiposity in children suggests a putative modulating effect of bariatric surgery on the cardiometabolic risk in offspring.

Writing in Scientific Reports, they compared the telomere length of children born before versus after maternal bariatric surgery as a surrogate to test the influence of the mother’s metabolic status on children’s telomere length.

They estimated DNA methylation telomere length (DNAmTL) from Methylation-EPIC BeadChip array data from a total of 24 children born before and after maternal bariatric surgery in the greater Quebec City area. They found DNAmTL was inversely associated with chronological age in children (r =−0.80, p<0.001) and significant differences were observed on age-adjusted DNAmTL between children born before versus after the maternal bariatric surgery.

The associations found between BMI and body fat percentage with DNAmTL in children born after the surgery were influenced by maternal triglycerides, TG/HDL-C ratio and TyG index.

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Trocar Entry Site Hernias in Laparoscopic Sleeve Gastrectomy Patients: A Retrospective Cross-Sectional Study

Istanbul Medeniyet University, Goztepe and Yalcin City Hospital, Istanbul, Turkey, have reported that in LSG, repair of the trocar port closure is not always necessary and the rates of hernia at port entry sites were similar between cases with and without fascial repair.

Writing in Cureus, their retrospective study aimed to identify the incidence and risk factors for hernia development in 284 patients who did not undergo fascia repair at trocar entry sites. The patient’s weight, BMI, percentage of excess weight loss (%EWL), percentage of total weight loss (%TWL), comorbidities and the occurrence of complications were recorded at one, six, 12, 18, and 24 months after surgery.

All patients underwent a 24-month follow-up, during which four patients developed trocar site hernias, resulting in an overall prevalence of 1.4%. Of the total hernias, two occurred within the first 30 days. A single patient required surgical intervention for an incarcerated hernia on the 18th day. Before undergoing LSG, the mean weight and BMI of the participants were 124.2±16.7 kg and 43.4±5.7 kg/m², respectively. After one year, the participants experienced a mean percentage of excess weight loss (EWL) of 77.1±12.2% and a mean total weight loss (TWL) of 33.2±6.2%.

They found that hernia formation was associated with both T2DM and female gender.

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