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Study Roundup

Published in November Issue             

Safety of Revision Sleeve Gastrectomy Compared to Roux-Y Gastric Bypass After Failed Gastric Banding: Analysis of the MBSAQIP  (Annals of Surgery)

To assess the safety of revisional surgery, both preoperative characteristics and 30-day outcomes were evaluated from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database were selected for all patients who underwent a 1-stage conversion of laparoscopic adjustable gastric banding (LAGB) to laparoscopic sleeve gastrectomy (conv-LSG) or Roux-Y gastric bypass (conv-LRYGB).
Cases were matched 1:1 by age, BMI and comorbidities including diabetes, hypertension, hyperlipidemia, venous stasis, and sleep apnea. A total of 2,708 patients were included and no mortalities occured. The mean operative time in conv-LRYGB was significantly longer in comparison to conv-LSG patients (151 ± 58 vs 113 ± 45 minutes). Patients after conv-LRYGB had a clinically increased anastomotic leakage rate (2.07% vs 1.18%) and significantly increased bleed rate (2.66% vs 0.44%). Thirty-day readmission rate was significantly higher in conv-LRYGB patients (7.46% vs 3.69%), as was 30-day reoperation rate (3.25% vs 1.26%). The length of hospital stay was longer in conv-LRYGB. Researchers concluded that a single-stage conversion of failed LAGB leads to greater morbidity and higher complication rates when converted to LRYGB versus LSG, particularly in regards to bleed events, 30-day reoperation, 30-day readmission, operative time, and hospital stay.

Bariatric Surgery as an Efficient Treatment for Non-Alcoholic Fatty Liver Disease in a Prospective Study with 1-Year Follow-up (Obesity Surgery)

To evaluate the improvement of non-alcoholic fatty liver disease (NAFLD) after laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB), 100 patients were evaluated preoperatively and postoperatively with liver stiffness measurements. There were significant improvements in BMI, total weight loss and excess weight loss. Liver stiffness was significantly improved from pre- to postoperative (12.9 ± 10.4 vs. 7.1 ± 3.7 kPa) at median follow-up of 12.5 months. There were also significant improvements of liver fibrosis scores (aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio 0.8 ± 0.3 vs. 1.1 ± 0.4; NAFLD fibrosis score - 1.0 ± 1.8 vs. - 1.7 ± 1.3; APRI score 0.3 ± 0.2 vs. 0.3 ± 0.1; BARD score 2.3 ± 1.2 vs. 2.8 ± 1.1) and laboratory parameters. After adjustment for baseline liver stiffness, RYGB showed higher improvements than LSG, and there was no gender difference. Improvement of liver stiffness was not correlated to improvement of BMI, %TWL or %EWL. Researchers concluded the findings highlight the potential of bariatric surgery for successful treatment

Revisional Gastric Bypass for Failed Restrictive Procedures: Comparison of Single-Anastomosis (Mini-) and Roux-en-Y Gastric Bypass (Obesity Surgery)

Study evaluated two different bypass techniques, laparoscopic RY gastric bypass (RYGB) versus single-anastomosis (mini-) gastric bypass (SAGB) (both one-stage) as a revision option (R-RYGB and R-SAGB) for failed restrictive bariatric operations. From May 2001 to December 2015, a total of 116 patients with failed restrictive bariatric operations underwent laparoscopic revisional bypass surgery (81 R-SAGB and 35 R-RYGB). Among them, 81 were failed after vertical banded gastroplasty and 35 were after adjustable gastric band. Revision surgery was performed, on average, at 58.8 months from the primary surgery. Main reasons for the revisions included weight regain (50.9%), inadequate weight loss (31%), and intolerance (18.1%). R-RYGB had significantly longer operative times than R-SAGB. Major complication occurred in 12 (10%) patients without significant difference between R-SAGB group and R-RYGB group. At 1 year follow-up, weight loss was better in R-SAGB than R-RYGB (76.8 vs. 32.9% EWL). At 5 year follow-up, a significantly lower hemoglobin level was found in R-SAGB group. While both SAGB and RYGB are safe options for revising a restrictive bariatric operation, R-SAGB was shown to be a simpler procedure with better weight reduction.

Problematic Alcohol Use and Associated Characteristics Following Bariatric Surgery
(Obesity Surgery)

To provide descriptive information of a sample of adults with self-identified alcohol use problems following bariatric surgery, the study examined (1) alcohol and substance use symptoms using standardized assessments, (2) current and past psychiatric comorbidity,
(3) subjective changes in alcohol sensitivity following surgery, and (4) specific patterns of alcohol use prior to and following bariatric surgery. Twenty-six patients who had undergone gastric bypass or sleeve gastrectomy completed a series of structured diagnostic interviews and self-report assessments by telephone 1 to 4 years following surgery. All participants met objective criteria for current problematic alcohol use, reported increased subjective sensitivity to alcohol following surgery, and demonstrated significant current and past psychiatric comorbidities, most notably previous major depression (45.5%). Approximately one third of participants demonstrated new-onset Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) alcohol use or dependence following surgery. Preoperative drinking frequencies and quantities were similar to those reported during the period of the heaviest postoperative alcohol use.

Improvement in Quality of Life after Bariatric Surgery: Sleeve Versus Bypass (SOARD)

Researchers used the RAND 36-item Health Survey to assess differences in improvement of quality of life (QoL) for laparoscopic sleeve gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (RYGB). Patients who underwent a primary operation from January 2012 until January 2017 completed the QoL questionnaire preoperatively and 1-year postoperatively.
A total of 1184 patients were included of which 666 patients underwent SG and 518 patients underwent RYGB. Patients significantly differed in BMI, weight, waist circumference, prevalence of gastroesophageal reflux disease, obstructive sleep apnea syndrome, and hypertension. Patients completed QoL questionnaire preoperatively and 1-year postoperative. Results showed all QoL domains greatly improved after bariatric surgery.
The improvement was comparable after SG and RYGB, except for more increase in physical functioning after RYGB.

Medium to Long-Term Outcomes of Bariatric Surgery in Older Adults with Super Obesity (SOARD)

A single-center retrospective study evaluated the safety and medium to long-term outcomes of bariatric surgery in older adults aged >=60 years with morbid obesity. Between January 2006 and December 2014, 104 patients underwent 115 procedures including sleeve gastrectomy (SG, 74%), Roux-en-Y gastric bypass (RYGB, 16%) or biliopancreatic diversion with duodenal switch (BPD/DS, %). Mean age and BMI were 63.3±2.6 years and 51.7±8.1kg/m2, respectively. Sixty-six patients were categorized as having super obesity (BMI >50kg/m2). Average follow-up time was 42±19 months. At baseline, 78% had hypertension, 60% had type 2 diabetes and 31% had obstructive sleep apnea. There was no 30-day mortality. Complication rate was 14%. Mean percent excess weight loss at 2 years was 52.2±23.8. Remission rates of hypertension, type 2 diabetes and obstructive sleep apnea were 26%, 44% and 38%, respectively. Researchers concluded that bariatric surgery is safe and effective in improving obesity-related comorbidities in older patients with morbid obesity and age alone should not preclude patients from getting the best bariatric procedure for obesity and related comorbidities.