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Journal Watch 30/11/2022

Updated: Dec 1, 2022

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 bariatric surgery helps decrease risk of acute ischemic stroke in patients with history of transient ischemic attack, the long-term LSG outcomes, outcomes of once-weekly semaglutide 2.4mg on C-reactive protein in adults with overweight or obesity (STEP 1, 2, and 3 studies), learning curve of laparoscopic inguinal hernia repair and USPSTF recommendation for obstructive sleep apnoea screening in adults (please note, log-in maybe required to access the full paper).

Does Bariatric Surgery Change the Risk of Acute Ischemic Stroke in Patients with History of Transient Ischemic Attack? A Nationwide Analysis

Researchers from the Cleveland Clinic Florida, FL, have reported that conclude bariatric surgery helps decrease risk of acute ischemic stroke (AIS) in patients with history of transient ischemic attack (TIA).

Writing in SOARD, the researchers sought to determine risk of AIS in individuals with obesity with history of TIA, compared to patients with history of bariatric surgery. Using the Nationwide Inpatient Sample (NIS) database from 2010 to 2015, they retrospectively identified patients with obesity and past medical history of TIA and divided them in two groups: a treatment group of patients who underwent bariatric surgery, and a control group of patients with obesity.

They found that the rate of AIS in the treatment group was significantly lower compared to control group (2.8% vs. 4.2%, p<0.0001). After adjusting for covariables, the risk difference of AIS was still significant between control and treatment groups (OR=1.33, p<0.0001), showing that patients in treatment group were less likely to have an AIS compared to control group.

The authors acknowledge that this comparison is limited by the nature of the database and further studies are needed to better understand these results.

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Long-term Reported Outcomes Following Primary Laparoscopic Sleeve Gastrectomy

Authors from the Assuta Medical Center, Tel Aviv, Israel, have reported that in the long term primary LSG was associated with satisfactory weight and health outcomes. However, weight regain was notable.

Reporting in Obesity Surgery, they examined the outcomes and subjective experience of 578 patients who underwent primary LSG with long-term follow-up. The mean baseline age and body mass index (BMI) were 41.9 ± 10.6 years and 42.5 ± 5.5 kg/m2, respectively. BMI at nadir was 27.5 ± 4.9 kg/m2, corresponding to a mean excess weight loss (EWL) of 86.9 ± 22.8%. However, the proportion of patients with weight regain, defined as nadir ≥50.0% EWL, but at follow-up < 50.0% EWL, was 34.6% (n=200) and the mean weight regain from nadir was 13.3 ± 11.1 kg.

The report that the main reasons for weight regain given by patients included “not following guidelines,” “lack of exercise,” “subjective impression of being able to ingest larger quantities of food in a meal,” and “not meeting with the dietitian.” Resolution of obesity-related conditions at follow-up was reported for hypertension (51.7%), dyslipidaemia (58.1%) and type 2 diabetes (72.2%). The majority of patients (62.3%) reported satisfaction with LSG.

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Effects of once-weekly semaglutide 2.4 mg on C-reactive protein in adults with overweight or obesity (STEP 1, 2, and 3): Exploratory analyses of three randomised, double-blind, placebo-controlled, phase 3 trials

An international team of researchers, reporting in eClinicalMedicine, have found that once-weekly semaglutide 2.4 mg and 1.0 mg reduced C-reactive protein (CRP) concentration irrespective of baseline BMI/bodyweight/glycaemic status compared with placebo, suggesting a potential anti-inflammatory role of semaglutide in obesity.

STEP 1, 2, and 3 were 68-week, placebo-controlled trials of semaglutide for weight management in participants with overweight/obesity, with (STEP 2) or without (STEP 1 and 3) type 2 diabetes. Change in serum CRP from baseline to week 68 was assessed as a prespecified secondary endpoint for semaglutide 2.4 mg versus placebo (STEP 1, 2, and 3) and versus semaglutide 1.0 mg (STEP 2).

In all trials, semaglutide 2.4 mg reduced CRP at week 68 versus placebo (estimated treatment difference [ETD; 95% CI] −44% [–49 to −39] in STEP 1, –39% [–46 to −30] in STEP 2, and –48% [–55 to −39] in STEP 3; all p < 0.05). In STEP 2, CRP reductions were greater with semaglutide 2.4 mg (−49%) than with 1.0 mg (−42%) but the difference did not reach statistical significance (ETD [95% CI] −12% [–23 to 1]; p = 0.06). Reductions in CRP occurred in parallel with bodyweight loss and were consistent regardless of baseline BMI/bodyweight/glycaemic status.

More semaglutide-treated participants had reductions in CRP-defined cardiovascular risk versus those on placebo. Reductions in CRP were positively correlated with reductions in bodyweight, waist circumference, fasting plasma glucose, fasting serum insulin and HOMA-IR.

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Learning curve of laparoscopic inguinal hernia repair: systematic review, meta-analysis, and meta-regression

Researchers from the Royal Melbourne Hospital, Melbourne, Australia, writing in Surgical Endoscopy, have reported that laparoscopic inguinal hernia repair has a well-defined learning curve and while learning surgeons demonstrated reasonable outcomes, supervision during this period may be appropriate given the increased risk of conversion to open surgery.

For their study, the researchers evaluated published literature relating to the learning curve of laparoscopic inguinal hernia repair and identify the number of cases required for proficiency. They also compared outcomes between surgeons before and after this learning curve threshold had been attained.

Their systematic literature review found that there was a non-linear trend in the number of cases required to achieve surgical proficiency, with a 2.7% year-on-year decrease. The predicted number of cases to achieve surgical proficiency in 2020 was 32.5 (p<0.01). The meta-analysis determined that surgeons in their learning phase may experience a higher rate of conversions to open (OR 4.43, 95% CI 1.65, 11.88), postoperative complications (OR 1.61, 95% CI 1.07, 2.42), and recurrences (OR 1.32, 95% CI 0.40, 4.30).

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USPSTF Updates Recommendation for Obstructive Sleep Apnea Screening in Adults

Researchers from Henry Ford Health, Detroit, MI, writing in JAMA Otolaryngology Head & Neck Surgery, have updated the US Preventive Services Task Force (USPSTF) obstructive sleep apnoea (OSA) screening recommendations.

These latest updates 2 applies to asymptomatic adults 18 years or older and to adults with unrecognized symptoms of OSA but does not apply to persons presenting with symptoms (eg, snoring, witnessed apnoea, excessive daytime sleepiness, impaired cognition, mood changes, gasping or choking while asleep) or concerns about OSA, persons who have been referred for evaluation or treatment of suspected OSA, or persons who have acute conditions that could trigger the onset of OSA (eg, stroke).

The risk factors associated with OSA were male sex, older age (40-70 years), postmenopausal status, higher body mass index, and craniofacial and upper airway abnormalities (eg, enlarged tonsils or long upper airway).

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