Journal watch - review of the latest clinical papers 13/10/2021

Updated: 6 days ago

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 access to bariatric surgery after the Affordable Care Act, the use of ursodeoxycholic acid (UDCA) to reduce gallstones after bariatric surgery, the latest findings from the Tehran Obesity Treatment Study, defining global benchmarks in revisional surgery and the outcomes from the total left-side surgical approach to treat hiatal hernia (please note, log-in maybe required to access the full paper).


Examination of Elective Bariatric Surgery Rates Before and After US Affordable Care Act Medicaid Expansion

Access to bariatric surgery increased by 31% annually for lower-income Medicaid-covered and uninsured white adults age 26 to 64 but not for Hispanic and Black adults after the expansion of the Affordable Care Act (ACA) Medicaid, according to researchers at Wake Forest School of Medicine.


The study, published in JAMA Health Forum, examined the association between Medicaid expansion and the rate of inpatient elective bariatric surgery among lower-income individuals aged 26 to 64. Researchers analysed data from 637,557 bariatric surgeries from 2010 to 2017 from 11 states that expanded Medicaid and six states that did not.


The study showed that before the ACA's Medicaid expansion, lack of insurance may have been a major barrier for many lower-income patients eligible for bariatric surgery. However, insurance alone, while a necessary step toward improving bariatric surgery access, was not sufficient for Black and Hispanic patients in the study.


The study investigators said future studies could examine, for example, whether lower-income Hispanic and Black patients are less likely to be referred by their primary care physicians for surgical evaluation or more likely to be excluded during the pre-approval process.


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The impact of ursodeoxycholic acid on gallstone disease after bariatric surgery: a meta-analysis of randomised control trials

Researchers led by University Hospital, Dublin, Ireland, report ursodeoxycholic acid (UDCA) significantly reduces the risk of both asymptomatic and symptomatic gallstones after bariatric surgery, according to their meta-analysis of randomised control trials (RCTs).


Their analysis, published in SOARD, included ten RCTs with 2,583 patients, with 1,772 patients (68.6%) receiving UDCA and 811 (31.4%) receiving placebo. They found that there was a significant reduction in gallstone formation in patients who received UDCA post-operatively (p=<0.00001). The overall prevalence of gallstone formation was 24.7% in the control group vs 7.3% in the UDCA group. A daily dose of ≤600mg had a significantly reduced risk of gallstone formation vs placebo (p<0.001).


The authors concluded that UDCA should be considered part of a standard post-operative care bundle after bariatric surgery.


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Body Composition Changes Following Sleeve Gastrectomy Vs. One-Anastomosis Gastric Bypass: Tehran Obesity Treatment Study (TOTS)

Authors from Shahid Beheshti University of Medical Sciences, in Tehran, Iran, has reported that fat-free mass loss (FFML) FFML was greater, after sleeve gastrectomy (SG) compared to one-anastomosis gastric bypass (OAGB).


The study, published in Obesity Surgery, evaluated body composition changes and the determinants of FFML up to three years after the two procedures and included 3,864 patients. The results showed a better FFM preservation and a greater FM loss over time in the OAGB group compared to the SG group. FFML during the first three months was greater in the SG vs. the OAGB group (p<0.001). SG surgery, higher preoperative BMI and female gender were associated with greater FFML/WL%.


The researchers said the outcomes emphasise the need for therapeutic interventions such as regular exercise programs and dietary intake modifications.


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Defining Global Benchmarks in Elective Secondary Bariatric Surgery Comprising Conversional, Revisional, and Reversal Procedures

An international team of researchers has found that revisional bariatric surgery is safe, although postoperative morbidity exceeds the established benchmarks for primary surgery.


The study, published in the Annals of Surgery, included 44,884 bariatric procedures performed in 18 high-volume centres from four continents with, 5,349 (12%) revisional bariatric surgery identified. Twenty-one outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of centres.


The benchmark cohort included 3,143 cases, mainly females (85%), aged 43.8±10 years, 8.4±5.3 years after primary surgery, with a BMI 35.2±7 kg/m2. The main indications were insufficient weight loss (43%) and gastro-oesophageal reflux disease/dysphagia (25%). Ninety-days postoperatively, 14.6% of benchmark patients presented ≥1 complication, mortality was 0.06% (n=2). Significantly higher morbidity was observed in non-benchmark cases and after conversional/reversal or revisional procedures with gastrointestinal suture/stapling.


The authors concluded that the considerable rate of tertiary bariatric surgery warrants expertise and future research to optimise the management of non-success after surgery.


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A new technique for treating hiatal hernia with gastroesophageal reflux disease: the laparoscopic total left-side surgical approach

Investigators from Capital Medical University, Beijing, China, have reported the that total left-side surgical approach (TLSA) to treat hiatal hernia (HH) with gastroesophageal reflux disease (GERD) can result in a less trauma and rapid recovery, compared to the traditional bilateral surgical approach.


The small study, published in BMC Surgery, included five patients and found that gastrointestinal function recovered within four days of surgery in all the patients and the six-month follow-up gastroscopy examination showed well-established gastroesophageal flap valves. In addition, compared with the baseline results, the six-month follow-up results showed lower values for the total GerdQ score (12.4 vs. 6.2) and the total oesophageal acid exposure time (3.48% vs. 0.38%).


The researchers concluded that the initial results were positive however, long-term results from a larger clinical trial are needed to validate these findings.


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