Search

On August 9-10, 2017, the American College of Surgeons hosted a symposium on metabolic surgery, with 12 follow-on papers published serially in the Bulletin of the College. The current synopsis outlines the varied contents of these papers, often in the original words of their authors, who are cited within their topic sections. Topics covered include the following: history and definition of metabolic surgery, bariatric surgery, international bariatric surgery, mechanisms of metabolic surgery, diabetes and the metabolic syndrome, frontiers of metabolic surgery, institutional collaborations, accreditations and quality initiatives, professional training, the role of the National Institutes of Health, and advocacy. Based on these insights, an enthusiastic affirmation for the future of metabolic surgery is warranted.

The article presents abstracts on several on medical topics which include Mexican bariatric surgery, inflammation of subcutaneous tissues after laparoscopic gastric bypass and surgery of patients with prader willi syndrome.

Lack of standard definitions of primary and secondary (non)responders after RYGB and SG makes it impossible to compare the literature. The aim was to analyze the different definitions used. MEDLINE® was searched for literature published between 01-07-2014 and 01-07-2017 concerning (1) patients who received a primary RYGB or SG and (2) the outcomes of primary and secondary (non)responders. One hundred twelve out of 650 papers were eligible. Forty out of 47 papers described a definition of weight loss success. Sixty-seven out of 112 papers mentioned weight loss failure of which 42 described a definition, in total 23 different definitions. Weight regain was mentioned in 77 papers; only 21 papers provided a definition. The recent literature regarding definitions of these outcomes is highly inconsistent. To compare the literature international consensus is required. [ABSTRACT FROM AUTHOR]

Roux-en-Y gastric bypass (RYGB) is an effective treatment for severe obesity and obesity-related comorbidities. Postprandial hypoglycemia may occur as a long-term complication after RYGB. This study reviews the literature on surgical treatment for intractable post-RYGB hypoglycemia to provide updated information. A search was performed in Embase and PubMed, and 25 papers were identified. Thirteen papers on reversal were included. Resolution of postprandial hypoglycemic symptoms occurred in 42/48 (88%) patients after reversal. Twelve papers on pancreatectomy were included. Resolution occurred in 27/50 (54%) patients after pancreatectomy. The optimal surgical treatment for intractable post-RYGB hypoglycemia has not been defined, but reversal of RYGB seems to be more effective than other treatments. Further research on etiology and long-term evaluation of surgical outcomes may refine treatment options. [ABSTRACT FROM AUTHOR]

During this time, Dr. Sarwer also provided clinical supervision and mentoring to approximately 10 Ph.D. candidates, as well as five junior faculty members from CWED, on the psychosocial evaluation and management of bariatric surgery patients. Building on his work with plastic surgery patients, Dr. Sarwer's first studies were on the body image and appearance concerns of women with obesity. Graph David B. Sarwer, Ph.D., was born in Skokie, Illinois, on January 4, 1968, and was raised by his adoptive parents, Rivian and Sam Sarwer, along with his sister, Linda, in Mt. Prospect, Illinois. Dr. Sarwer has published several empirical papers, reviews, and book chapters on the psychosocial issues in persons with extreme obesity who undergo bariatric surgery and then present to plastic surgeons for body contouring procedures. [Extracted from the article]

Dear Editor, We thank Dr Ali Kagan Coskun for his interest in our paper on early bleeding after laparoscopic Roux-en-Y gastric bypass (RYGB) published recently in Obesity Surgery [[1]] and for his kind comments on our findings and conclusions. Dr Kagan Coskun refers to other potential risk factors for post-operative hemorrhage after RYGB, such as diabetes, renal insufficiency, smoking, history of pulmonary embolism, and prior foregut surgery. In their recent papers, neither Pereira et al. [[3]], who studied 340 patients after RYGB, nor Golzarand et al. [[4]], who reported on 430 and 1830 patients after RYGB and sleeve gastrectomy respectively, found an association between the presence of diabetes and post-operative bleeding. [Extracted from the article]

Background: Weight regain after Roux-en-Y gastric bypass (RYGB) is a nightmare for the patients and the surgeons and is mostly regarded as "irreversible." However, conversions to duodenal switch (DS) have been done previously with promising success. The current paper reports a single center's mid-to-long-term follow-up outcomes. Methods: The data from all patients undergoing a conversion of RYGB (and one anastomosis gastric bypass (OAGB)) to DS were reviewed retrospectively. The demographic, operative, and weight loss parameters were analyzed, including age, duration of surgery, weight loss, body mass index (BMI), and morbidity/mortality. Results: Seventeen patients were operated on between January 2013 and December 2021. The mean BMI was 45 kg/m2 (33–70) before conversion. The overall average %EWL was 74.4%, the least was 52% at 6 months, and the most was 91% at 24 and 36 months. All comorbidities resolved after conversion. One patient had a gastro-gastrostomy leak needing prompt surgical repair on the same day of diagnosis. Three patients had other complications: a duodenal stump leak, an intrabdominal abscess, and an ileus. All resolved without surgery. One sudden death happened on the 5th postoperative day. Conclusion: Laparoscopic conversion of gastric bypass operations to DS is a complicated procedure that may have severe complications despite excessive patience and expertise but can be performed in a single step. The mid-to-long-term outcomes are promising for weight loss and control of associated co-morbidities. [ABSTRACT FROM AUTHOR]

Background: Obesity affects 1.5 billion people worldwide, yet few are treated effectively and considerable variability exists in its management. In 2020, a joint International Federation of Surgery for Obesity and Metabolic Diseases (IFSO) and World Gastroenterology Organization (WGO) advisory committee initiated the drafting of consensus guidelines on obesity management, to be based on detailed literature reviews and the results of an extensive multi-disciplinary survey of intercontinental experts. This paper reports on the latter. The objective of this study is to identify areas of consensus and non-consensus among intercontinental, inter-disciplinary experts in obesity management. Methods: Guided by an international consensus-survey expert, a three-round online Delphi survey was conducted in the summer of 2021 of international obesity-management experts spanning the fields of medicine, bariatric endoscopy and surgery, psychology, and nutrition. Issues like epidemiology and risk factors, patient selection for metabolic and bariatric surgery (ASMBS-Clinical-Issues-Committee, Surg Obes Relat Dis : Off J Am Soc Bariatric Surg. 8:e27-32, 1), psychological issues, patient preparation for MBS, bariatric endoscopy, and outcomes and follow-up were addressed. Results: Ninety-four experts from six continents voted on 180 statements, with consensus reached on 158, including consensus agreement with 96 and disagreement with 24 statements (38 had other response options besides agree/disagree). Among unanimous opinions were the need for all medical societies to work together to address obesity, for regular regional and national obesity surveillance, for multi-disciplinary management, to recognize the increasing impact of childhood and adolescent obesity, to accept some weight regain as normal after MBS, and for life-long follow-up of MBS patients. Conclusions: Obesity is a major health issue that requires aggressive surveillance and thoughtful multidisciplinary management. [ABSTRACT FROM AUTHOR]

This letter is a critique of a scientific paper that evaluates the safety of intragastric balloons (IGBs) for weight loss. The author raises concerns about the paper's conclusions, pointing out limitations in the data analysis and methodology. They argue that comparing adverse event rates between different types of balloons is scientifically flawed and that the authors failed to consider important factors such as implantation time. The author also disputes the recommendation to revise the Spatz3 balloon, stating that it is baseless and lacks scientific validity. Overall, the author suggests that the paper's conclusions should be viewed with caution due to the limitations of the retrospective data analysis. [Extracted from the article]

Purpose: Endoscopic sleeve gastroplasty (ESG) has grown in popularity as a potential minimally invasive bariatric procedure with acceptable short- and medium-term outcomes. This review aims to assess the safety and weight loss outcomes of ESG and compare it with laparoscopic sleeve gastrectomy (LSG). Material and Methods: A comprehensive search of MEDLINE, EMBASE, Cochrane and World Wide Web was conducted. Results: Five studies were reviewed, three ESG cohort studies and two case-matched cohort studies comparing ESG with LSG. Total unique ESG and LSG patients were 1451 and 203, respectively. All papers demonstrated a modest short-term total body weight loss (TBWL%) at 6 months ranging from 13.7 to 15.2% for ESG. Comparably, the two LSG papers demonstrated a superior TBWL% of 23.5 and 23.6% at 6 months, with one paper reporting a 12-month TBWL% of 29.3%. Two ESG papers reported medium-term results at 18 and 24 months of 14.8% and 18.6%, respectively. Excluding Clavien-Dindo 1 complications, ESG had a complication rate between 2.0 and 2.7%, while comparatively, LSG had a complication rate between 9.2 and 16.9% (current literature reported as 8.7%). In both procedures, there were no grade IV or V complications. Conclusion: ESG when compared with LSG has lower short-term weight loss outcomes with fewer complications. Weight loss results for ESG appear to plateau after the 1-year mark. The future and uptake of ESG as a minimally invasive bariatric procedure will be determined by its long-term data on potential weight loss sustainability. [ABSTRACT FROM AUTHOR]

Purpose: Laparoscopic bariatric surgeries can cause intense postoperative pain. Opioid medication can alleviate the pain but can have harmful side effects especially in patients with obstructive sleep apnea. To promote early recovery, enhanced recovery after surgery guideline advises minimizing opioid use and opting for alternative analgesics. This paper aims to investigate the effect of regional anesthesia techniques through a systematic review and network meta-analysis. Primary outcome is postoperative morphine equivalent consumption at 24 h. Methods: Search was conducted in the following databases: PubMed, CENTRAL, Scopus, and EMBASE, from the inception until 10 January 2023. The eligibility criteria were determined by PICOS, including postoperative opioid consumption, pain scores, time to ambulate, use of additional analgesics, and adverse events. The quality assessment was performed using the Risk of Bias 2 Tool, and the certainty of evidence was assessed using the GRADE approach. Funnel plots were used to evaluate publication bias. Results: We included 22 studies in quantitative synthesis. A review of 12 studies found that all techniques had a lower mean consumption of opioids compared to placebo or no intervention, with TAP block having the greatest reduction. The quality of evidence for postoperative pain, PONV, time to deambulate, and use of rescue analgesics, was rated as moderate, with TAP block being the most effective intervention. There was no publication bias in any outcome. Conclusions: TAP block is superior to other regional anesthesia techniques in reducing opioid consumption, pain, PONV, and use of rescue analgesics in bariatric surgery. However, further research is needed. [ABSTRACT FROM AUTHOR]

Background: The clinical significance of sleeve gastrectomy (SG) as a primary bariatric intervention is still under debate. This article aims to systematically analyze excessive weight loss (EWL) in patients after SG. Methods: A systematic literature search on SG from the period January 2003 to December 2010 was performed. Data described from systematic reviews dealing with gastric bypass procedures was used as comparator. Results: The final study included 123 papers describing 12,129 patients. Most of the papers describe EWL at 12 months (43.9% of all papers). For SG, the maximum EWL occurred 24 and 36 months postoperatively with a mean EWL of 64.3% (minimum 46.1%, maximum 75.0%) and 66.0% (minimum 60.0%, maximum 77.5%), respectively. At 12 months, the mean EWL in patients receiving SG was significantly lower when compared to patients who underwent gastric bypass (SG 56.1%, gastric bypass 68.3%; p < 0.01, two-sided Wilcoxon test). Although patients with gastric bypass still had higher EWL rates at 24 months compared to patients after SG, these differences were not significant (SG 61.3%, gastric bypass 69.6%; p = 0.09, two-sided Wilcoxon rank-sum test). Reoperations after SG are necessary in 6.8% (range 0.7-25%) of cases with patients receiving SG as a stand alone procedure and in 9.6-28.5% of cases with patients undergoing SG as a planned first stage procedure. Conclusions: SG is an effective bariatric procedure with a lasting effect on EWL. Compared with gastric bypasses, there is no difference in EWL at the time point of 24 months. [ABSTRACT FROM AUTHOR]

This document is a reply to a letter to the editor regarding a paper titled "Diabetes Remission After LRYGBP With and Without Fundus Resection: a Randomized Clinical Trial." The authors thank the commentator for their comments and address each of them. The paper discusses the use of gastric fundus resection as a tool for improving glycemic control in patients with type 2 diabetes mellitus (T2DM) undergoing laparoscopic Roux-en-Y gastric bypass (LRYGBP). The authors hypothesized that fundectomy would enhance diabetic control in patients with a BMI ≥ 40 kg/m2 and T2DM with a duration shorter than 8 years. The study evaluated various glycemic parameters and gastrointestinal hormones to investigate the mechanisms affecting glucose homeostasis. The authors acknowledge the need for larger sample sizes and longer follow-up to confirm their findings. They caution against recommending fundus resection for short-term improvement of glycemic control and suggest interpreting the greater BMI reduction after LRYGBP with fundus resection with caution. [Extracted from the article]

Introduction: Obesity has become an epidemic in the Arabian Gulf, with the prevalence of obesity according to the latest report from the World Health Organization (WHO) showing the gulf region to be countries with the highest incidence of obesity in the 30% plus group. This study aims to examine publications on bariatric surgery and compare them with the other countries with a high incidence of obesity in the world. Methods: A literature review on bariatric surgery published from the earliest detected year of publication up until March 2016 using SCOPUS, PubMed, Ovid, and Google Scholar was conducted. Individual papers were assessed for types of surgery, preoperative measures, names of journals, authors, and outcomes. The data was analyzed using Endnote library and SPSS. Key words used in the search included 'Bariatric Surgery,' 'Arabian Gulf,' 'Kuwait,' 'Qatar,' 'Saudi Arabia,' 'United Arab Emirates,' 'Oman,' 'USA,' 'Australia,' 'weight loss surgery,' 'sleeve gastrectomy,' 'gastric bypass,' 'gastric band,' 'mini-gastric bypass,' 'biliropancreatic diversion,' 'duodenal switch,' and 'intragastric balloon.' Original papers, systematic reviews and case reports were included. Results: From our review, the gastric sleeve proved to be the most popular published on procedure in the Arabian Gulf, whereas the USA had the highest percentage of gastric bypass surgeries and Australia had equivalent numbers when it came to gastric bypass and band. The numbers of studies from Saudi Arabia, Kuwait, UAE, Bahrain, Qatar, and Oman were 70, 44, 20, 7, 6, and 0, respectively. The mean impact factor of the published articles was 2.53 +/− 1.76 SD. Most of the publications were published in Obesity Surgery (29%), Surgery for Obesity and Related Diseases (5%), and Surgical Endoscopy (5%). Conclusion: The Arabian Gulf has both the highest percentage of bariatric procedures performed as well as the highest prevalence of obesity. However, they have the lowest number of publications and research when compared to their western counterparts; therefore, more research and publications are needed in the Arabian Gulf region, as well as the possibility of producing a regional registry to be able to have a good overview of bariatric surgery in the region. [ABSTRACT FROM AUTHOR]

Introduction: Obesity is associated with a higher prevalence of various comorbidities including erectile dysfunction (ED). Bariatric surgery leads to weight loss and remission of weight-related diseases. The exact influence of bariatric treatment on ED is yet to be established; however, the number of papers on the subject is growing. Methodology: A systematic review with meta-analysis comparing erectile dysfunction before and after surgery was conducted according to PRISMA guidelines with a literature search performed in June 2022. Inclusion criteria involved (1) ED assessment using the International International Index of Erectile Function (IIEF) and (2) longitudinal study design. Secondary endpoints involved hormonal changes and specific fields of IIEF. Results: An initial search yielded 878 records. Fourteen studies were included in the meta-analysis involving 508 patients. The quality of analyzed studies was moderate. Analysis showed significant differences in IIEF before and after surgery (Std. MD = 1.19, 95% CI 0.72 to 1.66, p<0.0001). Testosterone after surgery is higher by 156.32 pg/ml (95% CI 84.78 to 227.86, p<0.0001). There were differences in erectile function (MD:4.86, p < 0.0001), desire (MD: 1.21, p < 0.0001), intercourse satisfaction (MD: 2.16, p < 0.0001), and overall satisfaction (MD: 1.21, p = 0.003). There were no differences in terms of orgasms (MD: 0.65, p = 0.06). Conclusion: There are differences in ED before and after bariatric surgery. Patients achieve 19% more in the IIEF questionnaire showing improvement. Further studies, including multivariate regression models on large cohorts, are required to determine whether the surgery is an independent factor in alleviating ED. [ABSTRACT FROM AUTHOR]

Introduction: Obesity increases the risk of pelvic floor disorders in individuals with obesity, including faecal incontinence. Faecal incontinence (FI) is a condition with important clinical and psychosocial consequences. Though it is associated with obesity, the effect of bariatric surgery on the prevalence and severity of FI is not well reported. Objective: To assess the effect of bariatric surgery on the prevalence and severity of FI in adult patients with obesity. Methods: This systematic review was conducted in accordance with the PRISMA statement. Two independent reviewers performed a literature search in MEDLINE, PubMed, Cochrane and Embase from 1 January 1980 to 12 January 2019. We included published English-language randomized control trials and observational studies assessing pre- and post-bariatric surgery prevalence or severity of FI. Random-effects models with DerSimonian and Laird's variance estimator were used for meta-analysis. Results: Thirteen studies were included, eight assessing prevalence (678 patients) and 11 assessing severity of FI (992 patients). There was no significant difference in prevalence post-operatively overall, though it trended towards a reduction [pooled OR=0.55; =0.075]. There was a significant reduction of FI prevalence in women post-bariatric surgery [95% CI 0.22 to 0.94, p=0.034]. There was a statistically significant reduction in FI prevalence following Roux-en-Y gastric bypass and one anastomosis gastric bypass [0.46, 95% CI 0.26 to 0.81; p=0.007]. There was no significant reduction of incontinence episodes post-operatively [pooled mean difference =−0.17, 95% CI −0.90 to 0.56; p=0.65]. Quality of life (QOL) was not significantly improved post-bariatric surgery [mean differences for the following facets of QOL: behaviour −0.35, 95% CI −0.94 to 0.24; depression 0.04, 95% CI −0.12 to 0.2; lifestyle −0.33, 95% CI −0.98 to 0.33; p values of 0.25, 0.61 and 0.33, respectively]. Discussion: There was a significant reduction in FI prevalence in women and those who underwent Roux-en-Y or one anastomosis gastric bypass. Our results for FI prevalence overall, FI severity and impact on quality of life were not statistically significant. Larger studies are needed in this under-researched area to determine the true effect of bariatric surgery on FI. [ABSTRACT FROM AUTHOR]

Gastroesophageal reflux disease (GERD) is a common concern following laparoscopic sleeve gastrectomy (LSG). This paper aimed to assess the incidence of reflux disease following these bariatric procedures. A literature search was conducted to identify observational studies and clinical trials reporting patients developed GERD disease after LSG. Twenty-two studies included in the analysis, involve 20,495 participants, indicated that the estimated proportion of patients who developed post-surgery GERD was 0.35 (95% CI 0.30–0.41). Subgroup analysis revealed a proportion of 0.33 (95% CI 0.27–0.38) in observational studies and 0.58 (95% CI 0.39–0.75) in clinical trials. High heterogeneity was noted across studies (I2 = 98%). Sensitivity analyses and publication bias assessments were performed to enhance the robustness of the results. Our findings highlight a moderate to high risk of developing GERD following LSG surgery. [ABSTRACT FROM AUTHOR]