Published in October 2014 Issue             

Risk Prediction of Complications of Metabolic Syndrome Before and 6 Years After Gastric Bypass (SOARD)

Six years following laparoscopic gastric bypass, patients experience remarkable control of diabetes, dyslipidemia, and hypertension, and significant reduction in predicted risk of major complications, including nephropathy, retinopathy and cardiovascular disease and mortality. Cleveland Clinic researchers followed 131 diabetic patients for a median postsurgical follow-up time of 6 years (range, 5–9). Sixty-one percent (61%) of patients saw remission of their diabetes and, on average, achieved a 60.7% excess weight loss. At a long-term follow-up, the levels of glycated hemoglobin, low density lipoprotein, and blood pressure were within the recommended American Diabetes Association’s goals in 85%, 73% and 63% of patients respectively. RYGB was associated with a relative risk reduction of 27% for 10-year overall risk of coronary heart disease, stroke and peripheral vascular disease.

Early Morbidity and Mortality of Laparoscopic Sleeve Gastrectomy and Gastric Bypass in the Elderly: A NSQIP Analysis (SOARD)

Study compared 30-day morbidity and mortality in 1,005 elderly patients age 65 and over who underwent laparoscopic gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (SG) between 2010 and 2011. Patients were selected from the National Surgical Quality Improvement Program database and had a BMI of 44+7. Diabetes was more frequent in the RYGB group (43% vs 55.6%). At 30-day follow-up, SG was not associated with significantly different outcomes compared to RYGB, and both procedures have acceptably low morbidity (5.2% vs. 5.6%) and mortality (0.6% vs. 0.6%) rates.

Anemia, Iron and Vitamin B12 Deficiencies After Sleeve Gastrectomy compared to Roux-en-Y Gastric Bypas: A Meta-analysis (SOARD)

A meta-analysis including nine studies with a duration of >12 months, comparing SG with RYGB for outcome data of postoperative anemia, iron and vitamin B12 deficiencies were reviewed. Results suggest SG is more beneficial than RYGB with regard to postoperative vitamin B12 deficiency. However, both procedures are comparable with regard to risk of postoperative anemia and iron deficiency. Postoperative prophylactic iron and B12 supplementation, in addition to general multivitamins and mineral supplementation
is recommended.

How People View Their Own Weight Influences Bariatric Surgery Success
(Obesity Surgery)

The study examined internalized weight bias in relation to post-surgical weight loss success in adults. It showed negative feelings about one’s own weight influence success after bariatric surgery. Geisinger Health System researchers measured the degree to which participants internalized weight bias by developing negative self-attributions as a result of these biases. On average, most participants were white females with a preoperative mean BMI of 47.8 kg/m˛ and a postoperative BMI of 32.5±6.1 kg/m˛ twelve months after surgery. As ratings of internalized weight bias before surgery increased, weight loss success twelve months after surgery decreased. No differences were found in ratings of bias between participants’ race or geographic location, but researchers identified high levels of internal negative thoughts and feelings in about 40% of preoperative participants. In addition, greater weight bias was associated with greater depression.

Access to Care for Adolescents Seeking Weight Loss Surgery (Obesity)

Less than half of adolescents with clinical indications for surgery received approval for the procedure on the first request. In a retrospective review, researchers evaluated clinical data of 57 teens and found only 47% of patients were granted approval of their initial letter of medical necessity. Reasons for denial included being under 18-years-old, the type of procedure requested, insufficient duration of medically-supervised weight loss, lack of medical necessity and psychological concern. Subsequently 80% were approved on appeal and 11% were never approved.