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Journal Watch 3/05/2023

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 redo fundoplication, long-term value of bariatric surgery, surgery improves cognitive function in older adults, T2DM remission in BMI>50 patients and sleeve gastrectomy in adolescent patients, and more (please note, log-in maybe required to access the full paper).

Redo fundoplication vs. Roux-en-Y gastric bypass conversion for failed anti-reflux surgery: which is better?

Conversion to Roux-en-Y gastric bypass (RYGB) may offer superior resolution of reflux than redo fundoplication (RF) especially for obese patients, according to researchers from the Mayo Clinic, Jacksonville, FL.

Writing in Surgical Endoscopy, they compared the outcomes of different revisional techniques for failed anti-reflux surgery by retrospectively analysing patients who underwent RF or RYGB conversion after a failed fundoplication. A total of 165 patients were included, RF was performed in 120 (73 Toupet and 47 Nissen), RYGB in 3, and 7 patients had fundoplication takedown alone.

The RYGB group had a significantly higher BMI, and more prior revisional surgeries compared to the other groups. Median operative time and length of stay were longer for RYGB. Twenty (12.1%) patients experienced postoperative complications, with the highest incidence in the RYGB group. Reflux and dysphagia improved significantly for the whole cohort, with the greatest improvement noted with reflux in the RYGB group (89.5% with preoperative reflux vs. 10.5% with postoperative reflux, p=<0.001). On multivariable regression, they found that prior re-operative surgery was associated with persistent reflux and dysphagia, whereas RYGB conversion was protective against reflux.

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The Long-term Value of Bariatric Surgery Interventions for American Adults With Type 2 Diabetes Mellitus

Diabetes remission after bariatric surgery improves healthy life expectancy and provides net social benefit despite high procedural costs, investigators from the RAND Corporation and the University of Southern California have found.

Reporting in the Annals of Surgery, they estimated the individual-level net social value benefits of diabetes remission through bariatric surgery and compares the population-level effects of expanding eligibility alone versus improving utilisation for currently eligible individuals.

The per capita net social value of bariatric surgery-related diabetes remission was $264,670 ($234,527–294,814) under current and $227,114 ($205,300–248,928) under expanded eligibility, an 11.1% and 9.16% improvement over conventional management. Quality-adjusted life expectancy represented the largest gains (current: $194,706; expanded: $169,002); followed by earnings ($51,395 and $46,466), and medical savings ($41,769 and $34,866) balanced against the surgery cost ($23,200). Doubling surgical utilisation for currently eligible patients provides higher population gains ($34.9B) than only expanding eligibility at current utilization ($29.0B).

The per capita benefits appear greater among currently eligible individuals and policies that increase utilization may produce larger societal value than expanding eligibility criteria alone, they concluded.

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Diabetes Mellitus Remission in Patients with BMI > 50 kg/m2 after Bariatric Surgeries: A Real-World Multi-Centered Study

In patients with BMI≥50, RYGB and SG demonstrated significant and similar long-term T2DM remission rates and weight loss outcomes, according to a team of US researchers, writing in Obesity Surgery.

This retrospective study included all patients with BMI ≥50, T2DM and who had RYGB or SG at three tertiary referral centres in the US.

A total of 279 patients with T2DM (65% females, mean age 51.0±11.7 years, 89% white, BMI 56.6±5.9kg/m2) were analysed. Long-term T2DM remission (≥ 5 years) was demonstrated in 47% of patients. The duration of T2DM (p<0.0001), number of T2DM medications (p=0.003) and weight loss (p=0.048) were the only independent factors for long-term T2DM remission.

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Effects of Bariatric Surgery on Cognitive Function in Older Adults: A Prospective Longitudinal Study

Bariatric Surgery improves cognitive function in older adults, according to a study by a team from Iran University of Medical Sciences (IUMS), Tehran, Iran.

Writing in SOARD, they assessed cognitive function in 24 older Iranian patients before and after bariatric surgery using the Digit Span Test (DGS), the computerized version of the Wisconsin Card Sorting Test-64 (WCST-64), and the paper-and-pencil versions of the Trail Making Test (TMT), parts A and B, spanning the four cognitive domains of attention, working memory, processing speed, and executive functioning.

The bariatric surgery group was compared to a waiting list control group. At four months of follow-up, comparisons between the groups revealed that the surgical group performed significantly better than the control group on the forward DGS, WCST, and TMT parts A and B.

However, there was no significant difference between groups on the backward DGS. Further within-group comparisons demonstrated significant improvements from baseline in forward DGS, WCST, and TMT components A and B. The same variables did not alter significantly over time in the control group.

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Long-term Outcomes of Sleeve Gastrectomy in Adolescent Patients: The Effect of Weight Loss in Younger Years to Outcomes in Adulthood

Researchers from Kuwait have reported sleeve gastrectomy has been found to be an effective and safe weight loss tool, with sustained long-term weight maintenance and resolution of early comorbidities in adolescent patients.

Writing in BMC Surgery, they included 164 adolescent patients (mean age 19) who underwent LSG. A majority (71%) of patients were female, while the mean weight at surgery was 128.6 kg, equating to a BMI of 47.8 - 32% of patients had a starting BMI more than 50, while 6.7% had a BMI over 60.

The highest weight loss was achieved at 18 months post-op, corresponding to an EWL of 82.66%.

On long-term follow-up, weight loss was maintained over the 13 years post-op. Obstructive sleep apnea resolved in 75% of the patients while hypertension persisted in the 2 patients who were diagnosed with it pre-op. Twenty-one patients developed gastro-esophageal reflux disease 5.7 years post-op, while 20 patients were treated for gall bladder stones 4.4 years post-op.

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