Journal Watch 30/4/2025

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 10-year RYGB outcomes, senior surgical residents vs bariatric surgeons, 30-day outcomes for ESG vs LSG, opioid-free anaesthesia in bariatric surgery, the BARIREF study, factors influencing patients’ choice of obesity treatment, and more (please note, log-in maybe required to access the full paper).

Ten-year Results After Primary Gastric Bypass: Real-world Data from A Swedish Nationwide Registry

Researchers from Sweden have reported patients undergoing primary RYGB in Sweden demonstrate lasting weight loss and substantial remission of obesity-related diseases at ten years post-operation.

Writing in the Annals of Surgery, they included data from the Scandinavian Obesity Surgery Registry, a national Swedish quality registry of MBS. In total,  29,578 individuals (mean age 41.0±11.0 y, 75.6% females) had a RYGB in Sweden 2007-2012. At ten years, mean body weight was reduced from 112.7 kg to 91.4 kg, corresponding to a total body weight loss of 24.6%.

They also found a significant complete remission rate persisted in type 2 diabetes (29.7%), hypertension (15.1%) and dyslipidaemia (8.8%), while the use of antidepressants increased by 38.6%, (p<0.001 for all). The use of continuous positive airway pressure for sleep apnoea decreased from 9.8% to 4.1%. New-onset disease was in general associated to age, low weight loss and presence of other comorbidities.

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Outcomes of laparoscopic sleeve gastrectomy performed by senior surgical residents as compared to bariatric surgeons

Researchers from Rehovot and the Hebrew University Medical School, Jerusalem, Israel, have reported that LSG can be safely performed using senior surgical residents (SSR) with appropriate supervision, with no detrimental impact on the outcomes - highlighting the feasibility of involving residents in LSG while maintaining a high standard of care.

Reporting in Surgical Endoscopy, they retrospectively analysed 480 patients who underwent LSG. The consultant group (SBS) surgery performed 350 procedures and the  Supervised resident group (SSR), under the supervision of SBS, performed 130 procedures. Data collected included demographics, body mass index (BMI), excessive body weight loss (EBWL), complications, and follow-up results.

Operative times were longer in supervised resident group (104.13 min) than in consultant group (82.63 min, p<0.001). Early complications occurred in 3.1% of the cases, with no significant difference between the groups. Postoperative BMI and EBWL showed slightly better short-term results in supervised resident group, although differences diminished in the long term.

The authors concluded that these findings support the integration of LSG training into surgical residency programmes.

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Comparing Endoscopic Sleeve Gastroplasty (ESG) and Laparoscopic Sleeve Gastrectomy (LSG) 30-Day Outcomes and Healthcare Utilization: A Multi-Centered Retrospective Cohort Study of 506,597 Patients

Thirty-day outcomes from a large multi-institutional database demonstrates that ESG does not confer additional risk of 30-day serious complications compared to LSG, and has lower odds off post-procedural ED utilisation in the same comparison, according to researchers from the University of Virginia, Charlottesville and the Cleveland Clinic, Cleveland.

Writing in Obesity Surgery, they used multivariable logistic regression modelling to identify predictors of serious complications and outpatient emergency department (ED) visits from both procedures.

A total of 506,597 patients met inclusion criteria (2,285 ESG and 504,312 LSG). ESG patients were younger (42.6 ± 11.8 years versus 45.1 ± 10.7 years, p < 0.0001), had a lower BMI (39.5 ± 7.5 kg/m2 versus 44.9 ± 7.7 kg/m2, p < 0.0001), and were primarily female (86.2% versus 81.5%, p < 0.0001). Multivariable regression modelling revealed no differences in serious complications between ESG and LSG. ESG was protective against ED visits (OR 0.66; 95% 0.54–0.80; p < 0.0001). There were no other differences with respect to mortality or other healthcare metrics, such as outpatient rehydration, between procedures.

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Opioid-free anesthesia in bariatric surgery: a prospective randomized controlled trial

Opioid-Free Anesthesia (OFA reduces postoperative morphine consumption and improves pain management without compromising hemodynamic stability or increasing sedation,according to investigators from Saint-Joseph University, Beirut, Lebanon.

Writing in the European Journal of Medical Research, the study included 58 patients: 32 received Opioid-Based Anesthesia (OBA) and 26 received OFA. The OFA regimen included lidocaine, ketamine, magnesium sulfate, dexmedetomidine, and dexamethasone.

The reported that OFA significantly reduced postoperative morphine consumption (median dose of 8 mg vs.19 mg, p = 0.000) and Visual analogue scale  scores for pain at rest, during movement, and during coughing were significantly lower in the OFA group. Both groups were hemodynamically stable perioperatively. There was no significant difference in PONV incidence or sedation levels between the groups in the PACU, 24 and 48 h after surgery. Patient satisfaction was higher in the OFA group, with 65% reporting a satisfaction score of ≥ 8/10 compared to 28% in the OBA group.

These findings support the use of OFA in bariatric surgery, despite the need for further studies with larger sample sizes, they added.

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The BARIREF Study: BARIatric Surgery Complications in Patients with Prior REFlux Surgery in a Large National Cohort

Researcher from France and Switzerland have concluded that prior fundoplication increased postoperative complications after SG but not after RYGB, and therefore RYGB appears to be the safer bariatric procedure in patients with prior fundoplication.

Reporting in the Annals of Surgery, they conducted a retrospective analysis of a national French database of patients undergoing RYGB and SG between 2013 and 2023. Patients were grouped according to prior fundoplication (PriorF) or no fundoplication (NoF).

Among 372,464 patients, 337 (0.1%) had prior fundoplication. PriorF patients had higher rates of severe postoperative complications (Dindo ≥IIIa: 8.9% vs. 3.7%, P < 0.001), longer hospital stays (4.5 ± 4.9 vs. 3.7 ± 2.9 d, P < 0.001), and higher readmission rates (17.8% vs. 10.6%, P < 0.001).

In addition, a multivariate analysis for RYGB showed no significant association between prior fundoplication and complications (OR 1.71, 95% CI 1.00–2.74, P=0.051). Prior fundoplication was independently associated with increased complications after SG (OR 2.54, 95% CI 1.37–4.32, P < 0.001).

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Factors influencing patients to choose one obesity treatment over another: a qualitative study

An international team of researchers  have identified four main themes - 1) structural factors, 2) physical and emotional impact, 3) knowledge (of healthcare professionals and patients) and 4) support – that influences patients when choosing one obesity treatment over another.

Writing in the International Journal of Obesity, they sought to identify factors affecting patient preferences and subsequent obesity treatment preferences among those seeking treatment for obesity-related disorders.

Using a participatory action research design, they conducted World Café focus groups as part of a triangulation process with previously collected individual interviews and photovoice. Using purposive sampling, 12 patients with obesity complications of chronic kidney disease, type 2 diabetes, and metabolic dysfunction-associated steatotic liver disease took part.

Five themes emerged from the World Café on what influences patient treatment choice, which were 1) lack of resources, 2) healthcare professionals’ knowledge gaps, 3) lack of understanding, 4) emotional impact, and 5) support from family, friends, and HCPs.

“This study demonstrates the importance of ensuring access to all treatment options by developing effective treatment plans with clear information for patients,” they concluded.

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