STUDY ROUNDUP

Published in March 2015 Issue             


Five-Year Outcomes After Laparoscopic Gastric Bypass and Laparoscopic Duodenal Switch in Patients With Body Mass Index of 50 to 60 (JAMA Surgery)


In a randomized clinical open-label trial biliopancreatic diversion with duodenal switch appeared to lead to greater weight loss than traditional gastric bypass surgery, and results in a significantly greater drop in cholesterol, tryglycerides and blood sugar levels 5 years following surgery. Sixty patients with a BMI of 50 to 60 underwent gastric bypass (n = 31) or duodenal switch (n = 29). Five years after surgery, the mean reductions in BMI were 13.6 and 22.1 after gastric bypass and duodenal switch, respectively. However, duodenal switch was associated with more gastrointestinal adverse effects, with patients undergoing more surgical procedures related to the initial surgery. Additionally, duodenal switch patients had significantly more hospital admissions compared with gastric bypass patients.


Infections Most Common Cause of Readmissions After Surgery (JAMA)


The unplanned readmission rate for the 498 875 operations was 5.7%, which varied by procedure from 3.8% for hysterectomy to 14.9% for lower extremity vascular bypass. The most common reason for unplanned readmission was surgical site infection overall (19.5%) and also after colectomy or proctectomy (25.8%), ventral hernia repair (26.5%), hysterectomy (28.8%), arthroplasty (18.8%), and lower extremity vascular bypass (36.4%). Obstruction or ileus was the most common reason for readmission after bariatric surgery (24.5%) and the second most common reason overall (10.3%), after colectomy or proctectomy (18.1%), ventral hernia repair (16.7%), and hysterectomy (13.4%).


Outcomes of Pregnancy after Bariatric Surgery (NEJM)


The study shows bariatric surgery is associated with reduced risks of gestational diabetes and excessive fetal growth, shorter gestation, an increased risk of small-for-gestational-age infants, and possibly increased mortality. Using the Swedish Medical Birth Register, 670 pregnant women who had bariatric surgery between 2006 through 2011 were identified. Researchers assessed the risks of gestational diabetes, “large-for-gestational-age” and “small-for-gestational-age” infants, preterm birth, stillbirth, neonatal death, and major congenital malformations. Pregnancies after bariatric surgery, as compared the controls, were associated with lower gestational diabetes (1.9% vs. 6.8%, respectively) and large-for-gestational-age infants (8.6% vs. 22.4%). In contrast, they were associated with a higher risk of small-for-gestational-age infants (15.6% vs. 7.6%) and shorter gestation (273.0 vs. 277.5 days), although the risk of preterm birth was not significantly different (10.0% vs. 7.5%). The risk of stillbirth or neonatal death was 1.7% vs 0.7%.


Laparoscopic Sleeve Gastrectomy Leads The U.S. Utilization of Bariatric Surgery at Academic Medical Centers (SOARD)


To examine the trend in utilization of LSG performed at academic medical centers in the U.S., clinical data was obtained from the University HealthSystem Consortium database for 54,953 bariatric procedures performed between October 1, 2011 and June 30, 2014. LSG increased from 23.7% during 4th quarter of 2011 to 60.7% for the 2nd quarter of 2014. For the same time periods, RYGB decreased from 62.2% to 37.0%. Utilization of LSG surpassed that of RYGB in the 2nd quarter of 2013 (50.6% vs. 45.8% respectively). During the same time period, utilization of open gastric bypass fell from 6.6% to 1.5% and the use of laparoscopic adjustable gastric banding decreased from 7.5% to 0.8%. Results demonstrate that within the context of U.S. academic medical centers, there has been a significant increase in utilization of LSG that has surpassed that of RYGB since 2013.


Effectiveness of Laparoscopic Gastric Bypass on Obese Class I Type 2 Diabetes Mellitus Patients (SOARD)


A single center prospective study compare the effectiveness of RYGB in type 2 diabetes mellitus (T2DM) patients with class I obesity, with T2DM patients suffering from class II and III obesity. From March 2010 to July 2011, 42 patients undergoing RYGB were identified. After 36 months, metabolic parameters significantly improved in both groups. Partial remission rates between the two groups at each time point (12 months, 24 months and 36 months) were comparable. Obese class II and III patients had higher complete remission rates at 12 months and 24 months, but no difference was observed at 36 months. Obese class II and III patients had a higher complete remission rate than obese class I patients.


Bariatric Surgery in the Cognitively Impaired (SOARD)


Researchers from the Cleveland Clinic’s Bariatric and Metabolic Institute conducted a case series of 6 patients with non-acquired cognitive impairment who underwent bariatric surgery and found the procedure can be performed with minimal morbidity after intensive multidisciplinary management. However, the retrospective analysis also concluded that patients in this population might lose less weight than what is reported for patients without cognitive delay.


Inequity to the Utilization of Bariatric Surgery: a Systematic Review and Meta-Analysis (Obesity Surgery)


Patients who received bariatric surgery were significantly more likely to be white versus non-white, female versus male, and have private versus government or public insurance. Electronic databases were searched for population-based studies that explored the relationship between sociodemographic characteristics of patients eligible for bariatric surgery to those who actually received the procedure. Nine retrospective cohort studies were pooled using a random effects model.