Published in January 2014 Issue             

A Call to Arms: Obese Men with More Severe Comorbid Disease and Underutilization of Bariatric Operations

Although men typically make up less than 20 percent of bariatric surgery patients, they may actually have more to gain from these operations, according to a study in the December 2013 edition of Surgical Endoscopy. Data were prospectively collected from 1,368 consecutive patients evaluated for bariatric surgery over a 4-year period. Male patients tended to be older (44.5 ± 9.5 vs. 42.6 ± 9.6 years, p = 0.0044) and had higher BMI (48.7 ± 7.8 vs. 46.6 ± 7.4 kg/m2, p < 0.0001). On average, more men had diabetes (36.4% vs. 28.9%), hypertension (68.8% vs. 55.3%), obstructive sleep apnea (71.9% vs. 45.7%). Researchers concluded that men present later in life, with more advanced obesity, and with more complicated comorbidities and that such findings "mandate more research and resources to investigate barriers to treatment and to provide the morbidly obese male with the surgical care he clearly needs."

Revisional Bariatric Surgery is More Effective for Improving Obesity-Related Comorbidities than it is for Re-inducing Major Weight Loss

According to a study in SOARD (online, December 30, 2013), revision of a failed RYGB or conversion of VBG to RYGB improves co-morbid conditions, despite resulting in less weight loss and a higher complication rate than primary RYGB. Seventy-eight patients (22 RYGB and 56 VBG) who had procedures between 2005 and 2012 were identified from a patient database. Researchers found a revision bariatric operation resulted in significant reductions in diabetes (VBG: 100%, RYGB: 85.7%), GERD (VBG: 94.4%, RYGB: 80%), and hypertension (VBG: 74.2%, RYGB: 60%) post surgery. The amount of excess weight loss was 35.8 percent for RYGB patients and 46.2 percent for VBG patients. The morbidity rate after revisional bariatric surgery was 31.8 percent for RYGB and 51.8 percent prior to a revision.

A Systematic Review of Gastric Plication for the Treatment of Obesity

A systemic review of laparoscopic gastric plication (LGP) at the University Hospital in China found the restrictive bariatric procedure is durable in the short-term in treating obesity. Researchers examined 14 studies (1,450 LGP patients, 80.8% female). No mortality was reported in the studies. The average rate of major complications requiring reoperation was 3.7 percent (ranging from 0% to 15.4%). Mean preoperative BMI ranged from 31.2 to 44.5 kg/m2. Excessive weight loss for LGP varied from 31.8 percent to 74.4 percent at six months to 24 months post surgery. Authors conclude early reports with LGP are promising, "however, it remains unclear if weight loss following LGP is durable in the long term. Additional prospective comparative trials and long-term follow-up are needed to further define the role of LGP in the surgical management of obesity." Published in SOARD (online, December 16, 2013).

Mid-term Results of Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass in Adolescent Patients

Laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB) may be safe and effective operations in adolescents with severe obesity, according to a study published in the online edition of Obesity Surgery (January 5). Cleveland Clinic Florida conducted a retrospective review of 18 adolescent patients (mean age 17.5 years) who underwent LSG and RYGB between 2002 and 2011. The average weight was 293.1 pounds with an average BMI of 47.2 kg/m2 before surgery. Fifteen of the patients were available for follow-up. After surgery, the weight at 4.6 years follow-up was 188.4 pounds and average BMI was 30.1 kg/m2. Eighty-one percent of the patients who were available for follow-up saw their co-morbid conditions in remission following rapid weight loss.

Bariatric Emergencies: Current Evidence and Strategies of Management

A study published in the online edition of World Journal of Emergency Surgery (December 29) found postoperative bariatric surgery complications are preventable. A PubMed and Google search of the current outcomes of bariatric surgery emergencies resulted in 6,358 articles. Ninety papers were selected based on complications and emergency treatment of 830,998 bariatric patients. Results showed emergencies mostly occurred in the Accident and Emergency departments, where serious outcomes were reported after complex operations such as gastric bypass. Complications were also found after gastric band. Technical errors, suboptimal evaluation, failure of effective communication with bariatric teams who performed the initial operation, patient factors, and delay in the presentation were the reported causes. The mortality post bariatric surgery was less than that of control group of obese patients, where mortality ranged from 0.14 percent to 2.2 percent. Revisional surgery increased to 6.5 percent. Study authors conclude awareness of bariatric emergencies and its effective management are the gold standards for best outcomes. An algorithm is suggested and needs further evaluation.

Diabetes and Weight in Comparative Studies of Bariatric Surgery vs. Conventional Medical Therapy: A Systematic Review and Meta-Analysis

A meta-analysis of randomized controlled trials and observational studies found bariatric surgery was significantly more effective than conventional medical therapy in achieving weight loss and the remission of type 2 diabetes. The overall type 2 diabetes remission rate for surgery was 63.5 percent vs. 15.6 percent for the medical group. Researchers identified 515 articles, narrowing their search to 16 studies based on relevancy of their findings. The outcomes of 3,076 bariatric surgery patients and 3,055 patients who received conventional or no weight loss therapy were compared with ≥12-month follow-up. Ninety-four percent of the studies demonstrated a significant statistical advantage in favor of the surgery. The study was published in the December 28 online edition of Obesity Surgery.