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Background: Currently, there is no nationally accepted protocol for addressing weight regain or inadequate weight loss after MBS. Objectives: To devise, implement, and evaluate a protocol targeting weight regain or inadequate weight loss in MBS patients at our institution. Setting: Vanderbilt University Medical Center, Nashville, TN, United States Methods: Patients at least 6 months following primary sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) who achieved or were trending toward <50% excess body weight loss or who regained ≥10% of their lowest postoperative weight, were identified and referred for medical weight loss (MWL) intervention. Exclusion criteria were body mass index (BMI) ≤ 27 kg/m2, treatment with adjustable gastric banding, and conversion from SG to RYGB. Results: 2274 patients who were >6 months out from surgery were evaluated over 12 months. 93 patients (86% female) met criteria for inclusion. 69 (74%) patients agreed to intervention and were followed for an average of 165 days (SD 106.89 days), demonstrating a mean weight change of −5.11 kg (SD 6.86 kg), and BMI change of −1.81 kg/m2 (SD 2.37 kg/m2). Patients who spent <90 days in a MWL program demonstrated less average weight loss (1.75 kg vs 6.48 kg) (P =.0042), and less change in BMI (−.63 kg/m2 vs −2.29 kg/m2) (P =.0037) when compared to patients who spent >90 days in the MWL intervention. Conclusions: This study identifies criteria for intervention in patients suffering weight regain or inadequate weight loss after MBS and demonstrates that standardized identification and referral for treatment results in modest weight loss. [ABSTRACT FROM AUTHOR]

The feasibility and safety of unselectively applying an enhanced recovery after surgery (ERAS) protocol in a low-volume bariatric unit were determined. Retrospectively, review patients undergoing bariatric surgeries between 2015 and 2018 were included, and those receiving non-primary procedures or with BMI <32.5 kg/m2 were excluded. Demographics and 30-day outcomes were collected and compared between the ERAS (2017-2018) and control (2015-2016) groups. 62 (40.8%) were treated before and 90 (59.2%) were treated after ERAS. No differences in baseline demographics, except ERAS group had more Roux-en-Y gastric bypass procedures (58.9% vs. 12.9%). A markedly reduced operation time (101 min vs. 147 min) and shortened length of stay (2.6 days vs. 3.3 days) were observed with no increment of ER visits, readmissions (1.1% vs. 4.8%), or total complications between the groups (5.5% vs. 9.7%). Unselective ERAS implementation in low-volume units is feasible and safe, with significantly reduced operation times and shortened LOS without increased complications. [ABSTRACT FROM AUTHOR]

Introduction: One-anastomosis gastric bypass (OAGB) complication, such as leakage, can be dangerous and should be managed properly, yet little data exist in the literature regarding the management of leaks after OAGB, and there are no guidelines to date. Methods: The authors performed a systematic review and meta-analysis of the literature and 46 studies, examining 44 318 patients were included. Results: There were 410 leaks reported in 44 318 patients of OAGB published in the literature, which represents a prevalence of 1% of leaks after OAGB. The surgical strategy was very variable among all the different studies; 62.1% of patients with leaks had to undergo another surgery due to the leak. The most commonly performed procedure was peritoneal washout and drainage (with or without T-tube placement) in 30.8% of patients, followed by conversion to Roux-en-Y gastric bypass in 9.6% of patients. Medical treatment with antibiotics, with or without total parenteral nutrition alone, was conducted in 13.6% of patients. Among the patients with the leak, the mortality rate related to the leak was 1.95%, and the mortality due to the leak in the population of OAGB was 0.02%. Conclusion: The management of leaks following OAGB requires a multidisciplinary approach. OAGB is a safe operation with a low leak risk rate, and the leaks can be managed successfully if detected in a timely fashion. [ABSTRACT FROM AUTHOR]

BackgroundOpioid analgesics are often prescribed to manage pain after bariatric surgery, which may develop into chronic prescription opioid use (CPOU) in opioid-naïve patients. Bariatric surgery may affect opioid use in those with or without presurgical CPOU.ObjectiveTo compare CPOU persistence and incidence in a large multisite cohort of veterans undergoing bariatric surgery (open Roux-en-Y gastric bypass, laparoscopic RYGB, or laparoscopic sleeve gastrectomy) and matched nonsurgical controls.SettingVeterans Administration hospitals.MethodsIn a retrospective cohort study, we matched 1117 surgical patients with baseline CPOU to 9531 nonsurgical controls, and 2822 surgical patients without CPOU at baseline to 26,392 nonsurgical controls using sequential stratification. CPOU persistence in veterans with baseline CPOU was estimated using generalized estimating equations by procedure type. CPOU incidence in veterans without baseline CPOU was estimated in Cox regression models by procedure type because postoperative pain, complications, and absorption may differ by procedure.ResultsIn veterans with baseline CPOU, postsurgical CPOU declined over time for each surgical procedure; these trends did not differ between surgical patients and nonsurgical controls. In veterans without baseline CPOU, compared with nonsurgical controls, bariatric patients had higher CPOU incidence within 5 years after open Roux-en-Y gastric bypass (hazard ratio = 1.19; 95% confidence interval: 1.06-1.34) or laparoscopic open Roux-en-Y gastric bypass (hazard ratio = 1.22, 95% confidence interval: 1.06-1.41). Veterans undergoing laparoscopic sleeve gastrectomy had higher CPOU incidence 1 to 5 years after surgery (hazard ratio = 1.28; 95% confidence interval: 1.05-1.56) than nonsurgical controls.ConclusionsBariatric surgery was associated with greater risk of CPOU incidence in patients without baseline CPOU but was not associated with greater CPOU persistence.

Creating a metric in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) to assess Black-versus-White disparities is critical if we are to ensure equitable care for all. To investigate Black-versus-White disparities while replicating MBSAQIP methodology with regard to covariates and modeling so that the results can serve as the foundation to create a benchmarked site-level Disparities Metric for MBSAQIP. United States and Canada. Across the 2015–2019 MBSAQIP cohorts, 543,976 adults underwent primary or revision sleeve gastrectomy or Roux-en-Y gastric bypass and were reported as either White or Black. Using a set of covariates derived from published MBSAQIP performance models, we performed multivariable logistic modeling with 10-fold cross-validation for the 11 outcomes evaluated in MBSAQIP Semiannual Reports, plus venous thromboembolism (VTE) and death. We analyzed primary and revision cases separately. After risk adjustment, Black patients experienced higher odds of all-occurrence morbidity (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.19–1.25; P <.001), serious events (OR, 1.08; 95% CI, 1.04–1.13; P <.001), all-cause intervention (OR, 1.31; 95% CI, 1.24–1.37; P <.001), related intervention (OR, 1.29; 95% CI, 1.22–1.37; P <.001), all-cause readmission (OR, 1.37; 95% CI, 1.33–1.41; P <.001), related readmission (OR, 1.41; 95% CI, 1.36–1.46; P <.001), venous thromboembolism (OR, 1.49; 95% CI, 1.34–1.65; P <.001), and death (OR, 1.59; 95% CI, 1.34–1.89; P <.001) after primary procedures. Black patients experienced lower odds of morbidity (OR,.94; 95% CI,.91–.98; P =.004) and surgical-site infection (OR,.72; 95% CI,.66–.78; P <.001). Black patients experienced a higher risk for serious complications and required more readmissions, reoperations, and postoperative interventions. This study supports the creation of a site-level Disparities Metric for the MBSAQIP and provides the framework to do so. [ABSTRACT FROM AUTHOR]

Inadequate access to public bariatric surgical services has favoured the growth of bariatric tourism. This study analysed data extracted from bariatric surgical centres that care for patients travelling from abroad. The research highlights apparent deficits in accreditation, communication, perioperative care, and travel health advice. An international registry of accredited bariatric tourism providers and patient education may be indicated. [ABSTRACT FROM AUTHOR]

Background : The COVID-19 pandemic was initially responsible for a global restricted access to healthcare resources including the follow-up of at-risk populations such as bariatric patients. We substituted face-to-face bariatric follow-up outpatient clinics (FTFC) with teleclinics (TC) during the lockdown. Material and Methods: We retrospectively reviewed data collected on all patients scheduled for TC during the French lockdown period (March 15 to May 15, 2020) (N = 87). Our aims were to present the patients' outcomes at one and 2 years post-TC implementation and describe patient/practitioner satisfaction. Results: Seven (8%) patients required FTFC, and 80 (92%) underwent TC (study population) for preoperative bariatric assessment (N = 3) and postoperative follow-up (N = 77) after 23.6 ± 29 months following surgery. TC was performed with video and audio (N = 46; 57.5%) or audio alone when video was impossible (N = 34; 42.5%). Sixteen (20%) patients presented at least one complication identified at the first TC and were managed accordingly. There were no readmissions at 30/90 days post-TC. At 1-year after the first TC, overall follow-up rate was 94.9% (TC: 73% vs FTFC: 27%). Patients surveyed on the main advantages of TC over FTFC (N = 46) cited: saving time (97.8%) at a mean 3.9 ± 6.4 h saved per TC, work-advantages (94.3%), and comparable relevance of TC (84.8%). At 2 years post-TC implementation, follow-up rate was 93.5% and satisfaction rate was 80%, with 33% of patients preferring to return to FTFC. Conclusions: TC is a satisfactory substitute for FTFC, enabling continued bariatric follow-up during and beyond the pandemic setting without compromising patient safety. However, the modest satisfaction outcomes at 2 years highlight a need to discuss follow-up preferences in order to achieve optimal outcomes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the quality of surgical guidelines on bariatric/metabolic surgery. Methods: Four independent reviewers used the AGREE II (The Appraisal of Guidelines for Research and Evaluation II) tool to assess the methodological quality of the included guidelines and conducted a comparative analysis of the main recommendations for surgical methods of these guidelines. Results: Nine surgical guidelines were included in this study. Five articles with AGREE II scores over 60% are worthy of clinical recommendation. The field of rigor of development was relatively low, with an average score of 50.82%. Among 15 key recommendations and the corresponding best evidence in the guidelines, only 4 key recommendations were grade A recommendations. Conclusions: The quality of metabolic and bariatric guidelines is uneven, and there is much room for improvement. [ABSTRACT FROM AUTHOR]

Background and Aim: Roux-En-Y gastric bypass (RYGB) is associated with risk of alcohol use disorder. The impact of RYGB among patients with alcohol-associated liver disease (ALD) remains unknown. Methods: A retrospective cohort from National Inpatient Sample (01/2006–09/2015) database on 421,156 admissions with alcohol-associated cirrhosis (AC) was stratified for non-primary discharge diagnosis of previous RYGB. Admissions with RYGB (cases) were matched 1:3 to without RYGB (controls) based on propensity score on demographics, calendar year, socioeconomic status (insurance and zip code income quartile), obesity, diabetes, anxiety, and alcohol use disorder. Primary outcome was concomitant discharge diagnosis of alcoholic hepatitis (AH) or development of acute on chronic liver failure (ACLF). Results: Of 10,168 admissions (mean age 49 yrs., 75% females, 79% whites), cases (N = 2542) vs. controls had higher prevalence of concomitant AH (18.8 vs. 17%, P = 0.032), hepatic encephalopathy (31 vs. 25%), infection (28 vs. 24%), and grade 3 ACLF (13 vs. 5%), P < 0.001. Conditional logistic regression models showed higher odds for AH, hepatic encephalopathy, and infection among cases. In-hospital mortality of 6.3% (43% in ACLF) was lower in cases, but similar in the sub-cohorts of AH (N = 1768) or ACLF (N = 768). Results were similar in a sensitivity analysis of matched cohort of 2016 hospitalizations (504 cases) with primary discharge diagnosis of AC. Conclusion: Among patients with AC, previous RYGB is associated with increased likelihood of concomitant AH, hepatic encephalopathy, and infection, but similar in-hospital mortality. Prospective studies are needed to validate, determine causality, and understand mechanisms of these findings among patients with alcohol-associated cirrhosis. [ABSTRACT FROM AUTHOR]

Background: Hospital readmission (HR) rates following metabolic/bariatric surgery (MBS) are used as a surrogate for quality outcomes and are increasingly tied to reimbursement rates. There are limited data concerning predictors of HR rates with regard to type of bariatric procedure. Methods: This study is a retrospective review of prospectively collected data from patients who underwent MBS from January 2014 to December 2019 at Brigham and Women's Hospital in Boston, Massachusetts. The causes of all HRs and reoperations within 30 days of the original discharge were analyzed. Statistical significance was determined using Chi Squared test and T test. Results: 2815 patients underwent MBS. 2373 patients (84.3%) had primary procedures, while 442 patients (15.7%) had secondary or revisional procedures. The overall 30-day readmission rate was 5.7%, with no significant difference for patients who underwent primary vs. secondary MBS. Among primary procedures, the readmission rate was higher for Roux-en-Y Gastric Bypass (RYGB) than laparoscopic sleeve gastrectomy (SG) (10.32% vs. 4.77%). Readmissions were most often due to nontechnical causes. The overall reoperation rate was 1.14% and was higher for patients undergoing secondary vs. primary procedures (2.94% vs 0.80%). Conclusions: Readmission rate was similar to that in existing literature. Revisional/secondary surgery did not lead to increased readmissions, although was associated with a higher reoperation rate. Most HRs were due to nontechnical causes. Optimization of postoperative care, such as fluid status, may reduce the incidence of postoperative complications. [ABSTRACT FROM AUTHOR]

Nutritional deficiencies following malabsorptive surgeries are a major concern. Purpose: To present clinical-based, mid-term nutritional outcomes in single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) patients using a nutritional supplement based on the American Society for Metabolic & Bariatric Surgery (ASMBS) guidelines. Setting: Single private institute, Australia. Materials and Methods: Data from 196 patients who underwent a primary SADI-S by a single surgeon from January 2017 through March 2022 were retrospectively analysed. All patients received either original or altered formulated nutritional supplementation throughout the study. In total, three formulae, slightly different from each other, were used at three different time points to formulate the supplement. Results: In total, 196 patients were included. The average age and preoperative body mass index were 44.9 ± 6.7 years and 43.6 ± 22.5 kg/m2, respectively. Nutritional follow-up was available on 77.5%, 73.2%, 73.4%, and 59.7% of patients at 12, 24, 36, and 48 months, respectively. At baseline, 48.3%, 30%, 14.9%, 13.3%, 12.4%, 3.8%, 2.3%, and 0.5% of the patients had vitamin D, calcium, folic acid, total protein, iron, vitamin B12, copper, and vitamin A deficiencies, respectively. Postoperatively, mild to moderate vitamin deficiencies were noted in 14.2% of the patients in the first 18 months; however, at 4 years, the cohort had zero nutritional deficiencies. There were no long-term complications, revisions/conversions, or mortalities related to nutritional deficiencies. Conclusion: Factors, like preoperative and postoperative early, aggressive correction of nutritional deficiencies, regular laboratory monitoring and follow-ups with the multidisciplinary team, and adherence to our formulated nutritional supplement, have contributed to favourable nutritional outcomes at 4 years. [ABSTRACT FROM AUTHOR]

Introduction: The use of social media as a medical information tool parallels rising obesity rates. TikTok, the popular video-sharing platform, contains nearly 99,000 videos hashtagged "weightloss." Prior studies have analyzed the quality of medical information on TikTok in other areas of medicine. However, the quality of videos regarding weight loss procedures has not yet been determined. Methods: Hashtags encompassing three weight loss modalities were searched using TikTok's algorithm. The first 50 videos meeting inclusion criteria for each modality were considered. Two independent reviewers categorized videos and assessed their content quality using DISCERN. Quality scores and popularity were compared between videos sources, modalities, and content categories. Results: Of 150 videos included, 20.7% were created by physicians versus 79.3% by non-physicians (p < 0.001). The average DISCERN score for physician-created content was significantly higher than that of non-physicians (p < 0.001), despite significantly less popularity (p < 0.002). The 50 most popular videos had significantly lower DISCERN scores than the 50 least popular (p < 0.02). The average DISCERN score for endoscopic sleeve gastroplasty (ESG) videos were significantly higher than videos related to Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) (p < 0.001). VSG-related videos were significantly more popular than RYGB- and ESG-related videos (p < 0.001 and p < 0.001). Finally, educational videos had significantly higher DISCERN scores than weight loss transformation and personal experience videos (p < 0.001). Conclusion: Videos on TikTok related to weight loss procedures are poor, and greater popularity trends with lower quality. Assessment of content can encourage viewers to seek better information and allow providers to improve patient information tools. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate associations of ghrelin, glucagon-like peptide 1 (GLP-1), and peptide YY 3–36 (PYY3-36) with weight change after bariatric arterial embolization (BAE). Materials and Methods: Subgroup analysis of data collected during the BEAT Obesity Trial involving 7 participants with BMI > 40 who were embolized with 300- to 500-μm Embosphere Microspheres. Three participants were characterized as "responders" (top tertile of weight loss at each visit) and 4 as "non-responders" (bottom tertile of weight loss at each visit). Mean ± standard deviation participant age was 44 ± 11 years, and 6 of 7 participants were women. Participants were evaluated at baseline, 2 weeks, and 1, 3, 6, and 12 months after BAE. After fasting, participants consumed a mixed meal test at each visit; blood samples were collected at 0, 15, 30, 60, 120, 180, and 240 min. Study outcome measures were changes in weight from baseline and plasma serum hormone levels. Results: Percentage change in ghrelin decreased significantly in non-responders at 60 and 120 min at 1 and 12 months (estimated difference between 60 vs. 0 min at 1 month: 69% [95% CI − 126%, − 13%]; estimated difference between 120 vs. 0 min at 12 months: − 131% (95% CI − 239%, − 23%]). Responders had significantly lower ghrelin and greater weight loss than non-responders at 6 and 12 months. GLP-1 and PYY3-36 levels did not differ between groups. Conclusion: Participants with consistent weight loss throughout follow-up had lower ghrelin than non-responders, supporting decreased ghrelin as a mechanism underlying BAE-induced weight loss. Level of Evidence I: High-quality randomized trial or prospective study; testing of previously developed diagnostic criteria on consecutive patients; sensible costs and alternatives; values obtained from many studies with multiway sensitivity analyses; systematic review of Level I RCTs and Level I studies. [ABSTRACT FROM AUTHOR]

Background: A better understanding of the influence of restricted dietary intake on circulating ketone concentrations might help to explain heterogeneity in the amount of weight lost in dietary interventions. We sought to determine the association between the magnitude of weight loss and changes in fasting serum ketone concentrations in adults with severe obesity completing a meal replacement programme. Methods: In this single-centre prospective cohort study, adults with severe and complicated obesity attending our regional bariatric service underwent an eight-week, milk-based, low-energy meal replacement programme. Fasting serum beta-hydroxybutyrate levels were measured with a spectrophotometric assay at baseline and after two- and eight weeks of follow-up. Results: Of 120 patients who started the programme, 74 (62%) completed eight weeks. Of these, 60% were female, mean age was 49.2 ± 11.9 (range 18–75.1) years, mean body mass index was 51.2 ± 10.5 kg−2. The median [IQR] total weight loss percentage after eight weeks was 10.2 [8.6, 12.2] %. Fasting serum ketones increased between zero and eight weeks from a median of 95 [70, 140] to 185 [130, 320] μmoL/l (p

Obesity is a serious metabolic disease that significantly increases cardiovascular risks and other health complications. Sarcopenia is an independent risk factor for morbidity and mortality in patients suffering from obesity that increases the health risks and is associated with cardiac, respiratory and other diseases. Bariatric and metabolic surgery (BMS) leads to significant changes in body composition. Our pilot study showed that bariatric patients are at risk of sarcopenia after BMS. This finding resulted in a hypothesis that an exercise plan in the experimental group will lead to postural stabilization and a lower decline in muscle homotopy, further leading to a greater reduction in fat mass and a positive effect of exercise on skeletal muscle volume and strength and endocrine-metabolic function. The aim of the present study is to determine the effect of programmed aerobic and strength training on muscle function, volume, and morphology in patients after BMS. The study is a single-center, randomized clinical trial after sleeve gastrectomy focused on muscle tissue. The experimental group will perform targeted physical activity once a week for 12 months and the training plan will include anaerobic and aerobic components. Magnetic resonance imaging of skeletal muscles will be correlated with the values of densitometry examination and changes in body composition, certain blood parameters of myokines, biomechanical analysis of movement abnormalities, and behavioral and dietary counseling. This study will address the research questions about the effect of programmed training on muscle tissue and muscular functions after BMS.

This study investigates the effects of adolescent bariatric surgery among young adults approximately 10 years post-surgery. Participants were recruited from a hospital-based bariatric registry. We used an exploratory, qualitatively-driven mixed methods design. Findings were integrated with medical chart data and the SF-36, Body QoL, and the Transition Readiness Assessment Questionnaire. Of the 22 participants who completed surveys (14 females and 8 males), 20 participants also completed a phone interview. Median participant age was 25 years (range = 19–30). Median weight-loss was 23% (6.0%‒58%). Four themes emerged: taking control, weight loss challenges, body image adjustment, and growing up. Participants reported physical benefits of surgery yet were challenged by eating habits, body image, and interpersonal relationships. Participants were indifferent to preventative healthcare, despite the potential for vitamin deficiencies and the return of weight-related comorbidities. Clinicians can facilitate the transition to young adulthood by providing continued mental support, education, and medical monitoring. [ABSTRACT FROM AUTHOR]

Introduction An alternative to the gold standard Roux-en-Y gastric bypass is the one-anastomosis gastric bypass procedure. Although the safety and effectiveness of this method are widely recognized, there arestillmanyunansweredissuesabouttheprospectivelongterm dangers owing to biliary reflux and its potential complications. However, problems from the mini-gastric bypass (MGB) surgery have drawn attention, particularly the reflux of jejunal contents, including bile and pancreatic secretions, into the gastric tube or even the esophagus, a condition known as bile reflux in the literature. Aim To determine whether the incidence of bile reflux differs between anterior and posterior gastrojejunostomies. Patients and methods A total of 50 patients without gastroesophageal reflux disease symptoms or a hiatus hernia who were scheduled for MGB surgery at our facility between August 2021 and April 2022 were included in the research. Patients received hepatobiliary scintigraphy 6 months following the procedure. The patients were divided into two groups: group A consisted of 25 patients who underwent anterior antecolic gastrojejunostomy, and group B consisted of 25 patients who underwent posterior retrocolic gastrojejunostomy. Results After being divided into two groups randomly, 50 patients were recruited in the study. The included patients had a meanage of 38.55 years, a mean weight of 125.36kg, anda mean BMI of 50.1 kg/m², with 86% of them being females. In 24 (48%) individuals with Bile reflux scintigraphy (BRS), there was no evidence of bile reflux into the stomach or esophageal pouch. In group A with an anterior antecolic gastrojejunostomy, 14 (28%) patients had a positive BRS, whereas in group B with a posterior retrocolic gastrojejunostomy, 12 (24%) patients showed bile reflux activity. Conclusion Our findings show that temporary bile reflux after MGB occurs often in the gastric tube and maybe in the esophagus and that the location of the gastrojejunostomy has no bearing on the presence of bile reflux. [ABSTRACT FROM AUTHOR]

Overweight and obesity are one of public health's major problems in the world. Conservative treatment with exercise, diet and pharmacotherapy is often ineffective, especially in the long term. Bariatric surgery is the gold standard method for a sustained long-term weight loss. Recently the endovascular technique of bariatric artery embolization (BAE) has been studied as an obesity and overweight treatment, with promising results. The goal of this article is to analyze the rationale behind BAE and to provide an up-todate analysis of its strengths and limitation in comparison with bariatric surgery as a treatment for obesity. [ABSTRACT FROM AUTHOR]

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Purpose: A shared decision-making (SDM) process centered on the patient perspective may increase understanding and treatment satisfaction. This study aimed to investigate whether SDM would increase the acceptance of bariatric/metabolic surgeries, change treatment decisions, and affect 1-year results. Materials and methods: This retrospective analysis enrolled 315 consecutive patients with a body mass index between 32.5 and 50 kg/m2 and aged 20–65 years who underwent consultation for a primary bariatric/metabolic procedure within 2 years before (pre-SDM) or after (post-SDM) SDM program implementation to assist in the decision to undergo Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) surgery. Consent rate, procedure choice, weight loss, comorbidity remission, etc., were compared between periods and procedures. Statistical tests were two-sided, with p < 0.05 considered significant. Results: More eligible patients underwent metabolic/bariatric procedures post-SDM than pre-SDM (115/159 [72%] vs. 106/156 [68%]; p = 0.395), and a stronger preference for RYGB post-SDM was observed (71% vs. 62%; p = 0.153). Significantly more patients with diabetes (28 [34.1%] vs. 5 [15.2%]; p = 0.041) chose RYGB over SG post-SDM. Patients who underwent RYGB had a higher diabetes remission rate both pre-SDM (70.0% vs. 58.3%; p = 0.571) and post-SDM (76.2% vs. 66.7%; p = 0.712) than those who underwent SG. While 1-year weight loss was similar between procedures, adherence to nutritional supplementation did not appear to be broadly enhanced post-SDM. Conclusion: SDM influenced procedure selection toward RYGB, which was more popular than SG among patients with diabetes. Higher diabetes remission was achieved with RYGB, although the results of other effects deserve further study. [ABSTRACT FROM AUTHOR]

Purpose: Laparoscopic sleeve gastrectomy (SG) is the most popular bariatric surgery. Nonetheless, only a few studies have reported its long-term outcomes. This study aimed to evaluate changes in weight and body mass index (BMI) parameters, resolution of comorbidities, and frequency of re-operations in a follow-up period of at least 10 years. Materials and Methods: Data was available from 180 patients' records who underwent SG between 2008 and 2011 in the Tel Aviv Sourasky Medical Center. Eighty patients agreed to partake in a follow-up assessment that was completed via a phone call questionnaire and hospital computed registry. Results: Patients' mean preoperative BMI was 43.86 ± 6.36 kg/m2 which was significantly higher when compared to mean nadir BMI and last follow-up BMI (29.44 ± 7.12 and 36.34 ± 9.7; p < 0.001). Mean percentage of excess weight loss (%EWL) at 10 years was 42.65 ± 36.02% and mean percentage of total weight loss was 19.33 ± 16.73%. Twenty-eight patients (35%) maintained at least 50% EWL. Twenty-seven (33.75%) patients underwent at least one surgical procedure following SG. Eleven patients (13.75%) underwent a conversion to Roux-en-Y gastric bypass and six patients (7.5%) underwent conversion to one anastomosis gastric bypass. Resolution of type 2 diabetes (T2D), hypertension, and hypercholesterolemia occurred in 47%, 43.7%, and 48.4%, respectively. De-novo cases of gastroesophageal reflux (GERD) were present in 40%. Conclusion: SG shows high long-term failure rates. One of every three patients will undergo another surgical procedure within a 10-year period. [ABSTRACT FROM AUTHOR]

Background: Patient-centred care models for acutely hospitalised people living with obesity are poorly understood and the quality of evidence low. Objective: The aim of this study was to explore and better understand the lived experience of people living with obesity, in the inpatient hospital context. Design: A qualitative methodology using Interpretative Phenomenological Analysis (IPA) was used. Data were collected via a single semi-structured interview with each participant. Setting and participants: The study was completed at a metropolitan public health service. Ten previously hospitalised patients who live with obesity were included. Results: Three main themes emerged: meeting physical care needs of people with obesity on hospital wards, interpersonal interactions between patients and healthcare professionals, and the psychosocial impact of being obese in the hospital setting. Priorities included timely provision of appropriate equipment and infrastructure design to meet care needs and facilitate better wellbeing. To improve patient experience, an emphasis on basic principles of quality care provision to enhance interpersonal interactions, along with improved awareness of the impact of weight bias and obesity stigma in healthcare are supported. Participants found hospitalisation stressful, but valued support from healthcare professionals regarding weight loss. Discussion: These data provide new insights in to the lived experience of people living with obesity in the hospital setting. Items which are low cost, such as appropriately sized chairs and gowns, as well facilitators to independent mobility such as electric wheelchairs are suggested to improve both experience and care outcomes. Interpersonal interactions demonstrated obesity stigma in the hospital setting, with participants expressing the desire for more appropriate communication. People living with obesity self-reflected in the inpatient setting, suggesting that staff should be trained to utilise the opportunity to provide weight loss advice. Conclusions: The themes identified in this study provide insight into the lived experience of people with obesity in hospital. This understanding provides direction for the development of improved models of care for people living with obesity in this setting and beyond. [ABSTRACT FROM AUTHOR]

The article presents the discussion on management of youth with different types of diabetes undergoing surgery. Topics include young people with diabetes having a diabetes consultation prior to all types of surgery or anesthesia; and surgery being preferably scheduled as the first case of the day or on the surgical list.

Background: Obesity is an independent risk factor for chronic kidney disease (CKD) and is the strongest known modifiable risk factor for hyperuricemia and gout. We aimed to discover the outcome of serum uric acid (SUA), gouty arthritis, and kidney function in obese patients after bariatric surgery and possible links with BMI variations. Methods: Retrospective study has been performed in National Hospital in Riyadh, KSA, between Jan. 2018 to Jan. 2020. We studied only 98 patients who met our inclusion criteria. Patients followed-up at 1 month (for gouty attack only) postoperative, 3 months postoperative, and 6 months postoperative for body mass index (BMI), serum creatinine, dipstick urinalysis, SUA, and estimated glomerular filtration rate (eGFR). Radiological studies, medical history, follow up radiological studies, and clinical follow up were obtained from the hospital data system. Results: A total of 98 patients with mean eGFR were 90.65 ± 29.34 ml/min/1.73 m2, mean SUA 5.56 ± 1.84 mg/dl, and mean BMI was 45.28 ± 7.25 kg/m2, at surgery. Mean BMI had decreased significantly to 38.52 ± 6.05 kg/m2 at 3 months and to 34.61 ± 5.35 kg/m2 at 6 months (P < 0.001). The mean GFR had improved significantly (99.14 ± 23.32 ml/min/1.73 m2) at 6 months (P < 0.001). Interestingly, proteinuria had resolved in 17 patients out of 23 patients at 6 months. Number of gouty attacks was decreased during the first month post-surgery (P < 0.001). SUA level was significantly decreased (4.32 ± 1.27 mg/dl) (P < 0.001). SUA showed significant negative correlations with eGFR at 3 months and positively significant correlations with BMI at 3 and 6 months. By multinomial logistic regression, BMI and initial eGFR were the independent predictive variables for the outcome of eGFR at 6 months, while male gender and initial SUA were the independent predictive variables on the outcome of SUA at 6 months. Postoperatively in gouty arthritis patients, the number of joints affected, patient global VAS assessment, and number of gouty attacks were significantly reduced (P < 0.001). Conclusion: Bariatric surgery has been associated with reduction of BMI and subsequently reduction of SUA levels, gouty attacks, and improvement of eGFR. [ABSTRACT FROM AUTHOR]

Nowadays, non-alcoholic fatty liver disease is one of the first causes of liver transplant worldwide; many efforts have been done to find the perfect drug for this multifactorial disease. Presently we just have a few drugs that could be used in specific and limited clinical scenarios. Current evidence suggests that bariatric endoscopic and surgical therapies could be strategies with optimal outcomes, with high impact in quality of life, decrease of cardiovascular risk, and improvement in metabolic profile, despite being considered expensive procedures. This review proposes to consider these therapies early together with liver fibrosis evaluation, with long term cost-effectiveness benefits in the absence of response to lifestyle modifications and pharmacological treatments. [ABSTRACT FROM AUTHOR]

Background: A better understanding of the influence of genetic factors on the response to lifestyle interventions in people with obesity may allow the development of more personalised, effective and efficient therapeutic strategies. We sought to determine the influence of six obesity-related genetic risk scores on the magnitude of weight lost by patients with severe obesity who completed a dietary intervention. Methods: In this single-centre prospective cohort study, participants with severe and complicated obesity who completed a 24-week, milk-based meal replacement programme were genotyped to detect the frequency of common risk alleles for obesity and type 2 diabetes-related traits. Genetic risk scores (GRS) for six of these traits were derived. Participants with a potentially deleterious monogenic gene variant were excluded from the analysis. Results: In 93 patients completing the programme who were not carrying a known obesity-related gene mutation, 35.5% had diabetes, 53.8% were female, mean age was 51.4 ± 11 years, mean body mass index was 51.5 ± 8.7 and mean total weight loss percent at 24 weeks was 16 ± 6.3%. The waist–hip ratio (WHR) GRS was inversely associated with percentage total weight loss at 24 weeks (adjusted β for one standard deviation increase in WHR GRS −11.6 [−23.0, −0.3], p = 0.045), and patients in the lowest tertile of WHR GRS lost more weight. Conclusions: Patients with severe and complicated obesity with a genetic predisposition to central fat accumulation had less weight loss in a 24-week milk-based meal replacement programme, but there was no evidence for influence from the five other obesity-related genetic risk scores on the response to dietary restriction. [ABSTRACT FROM AUTHOR]

Purpose: Depression is a multifaceted psychiatric condition that has been associated with suboptimal weight loss following bariatric surgery. Previous variations of Beck Depression Inventory-Second Edition (BDI-II) subscales been proposed, including those identified within bariatric populations; however, it is unclear whether the BDI-II items contained within these subscales would remain consistent after the procedure considering the physical and lifestyle changes that occur following bariatric surgery. Materials and Methods: A two-step analytic approach that comprised of exploratory (EFA) and confirmatory factor analyses (CFA) that aimed to identify a stable factor structure using pre- and 6-month post-surgical BDI-II responses. Baseline BDI-II responses of 149 patients (Group 1) were used to identify an initial EFA model. Five BDI-II models underwent CFA using BDI-II responses of a comparable pre-surgical group (Group 2; n = 142), and 6-month post-surgical data from Group 1. Results: EFA generated a two-factor solution. Of the five CFA models performed, the three-factor model that was initially identified by Hayes (2015) among patients undergoing bariatric surgery demonstrated superior fit across time and between groups. Conclusions: Although the EFA initially identified a two-factor model, CFA determined that a previously defined three-factor model reliably fit both pre- and post-surgical BDI-II responses. This study supports using the Hayes (2015) subscales when monitoring pre- and post-bariatric surgery facets of depression specific to this population. Being able to accurately and reliably monitor depressive symptoms of patients that are undergoing bariatric surgery will allow for the provision and monitoring of targeted interventions aimed at improving their mental and physical health outcomes. [ABSTRACT FROM AUTHOR]

Overweight and obesity are one of public health’s major problems in the world. Conservative treatment with exercise, diet and pharmacotherapy is often ineffective, especially in the long term. Bariatric surgery is the gold standard method for a sustained long-term weight loss. Recently the endovascular technique of bariatric artery embolization (BAE) has been studied as an obesity and overweight treatment, with promising results. The goal of this article is to analyze the rationale behind BAE and to provide an up-to-date analysis of its strengths and limitation in comparison with bariatric surgery as a treatment for obesity.

Background: The introduction of the robotic platform to bariatric surgery has brought forth a novel approach. The purpose of this research was to study the advantages and disadvantages of the combination modes of the robotic arm and laparoscopic instruments in robot-assisted sleeve gastrectomy (RASG). Methods: 9 The clinical data of 12 patients who underwent RASG in the first affiliated hospital of shandong first medical university from December 2019 to September 2020 were analyzed. According to the different combination modes of laparoscopic instruments and robotic arms, they were divided into two groups: the “4 ​+ ​1″ group (n ​= ​6) and the “3 ​+ ​2” group (n ​= ​6). Results: This study evaluated a total of 12 patients. There were no statistically significant differences in patient demographics characteristics and co-morbid disease. The mean operating time (125.3 ​± ​6.5min in 4 ​+ ​1 versus 127 ​± ​8.3min in 3 ​+ ​2, P ​= ​0.601), length of hospital stay (6.3 ​± ​1.0 ​d in 4 ​+ ​1 versus 5.6 ​± ​1.9 ​d in 3 ​+ ​2, P ​= ​0.221),intraoperative blood loss (31.6 ​± ​9.8 ​ml in 4 ​+ ​1 versus 28.3 ​± ​11.7 ​ml in 3 ​+ ​2, P ​= ​0.713), hospital costs (72487.6 ​± ​1135.1 yuan in 4 ​+ ​1 versus 73433.8 ​± ​5301.5 yuan in 3 ​+ ​2, P ​= ​0.12), excess Weight Loss (EWL)% at 1 month after operation (12.4 ​± ​1.9 in 4 ​+ ​1 versus 13.3 ​± ​2.4 in 3 ​+ ​2, P ​= ​0.634)did not differ between the two groups. Conclusions: Two modes are both feasible and safe for RASG. The surgeon can choose one mode to perform the operation according to the situation of his team.

Abstract Background Individuals with obesity are at higher risk of experiencing complications during their pregnancy and may also experience infertility, requiring assisted reproductive technologies (ART) to conceive. The current body of literature demonstrates that bariatric surgery decreases an individual’s risk of developing a variety of obesity-related obstetrical conditions during and after pregnancy. However, the effects of bariatric surgery on ART outcomes are not well understood. Therefore, the paucity in the literature warrants a need to determine these effects. Methods We will search electronic databases, including MEDLINE, Embase, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL), as well as the gray literature and the reference lists of included articles. We will screen all studies published between January 1978 and the present day that explore the impact of bariatric surgery on ART outcomes for women and men. We will include observational studies. Two independent reviewers will assess the studies for inclusion and extract data for each article. The main outcome that will be analyzed is live birth rate. Secondary outcomes such as time to conception, number of rounds of ART, type of bariatric surgery, and length of time between bariatric surgery and initiation of ART will also be recorded. Risk of bias will be conducted using the National Institutes of Health Study Quality Assessment Tools. A random effects model will be used to account for statistical analysis and results will be pooled with forest plots. In the event of statistical and reporting heterogeneity, we will provide a qualitative synthesis and narrative review of the results. Discussion This review will provide information on the outcomes of ART following bariatric surgery and may help healthcare professionals make informed decisions about the length of time between bariatric surgery and initiation of ART. The study findings may be of interest to various stakeholders including patients, bariatric surgeons, obstetricians, and gynecologists, and those who specialize in obesity medicine and reproductive endocrinology and infertility. We plan to disseminate our findings through presentations, publications, and social media releases to individuals who are navigating infertility and are interested in undergoing or have undergone bariatric surgery, healthcare professionals, policymakers, and researchers. Systematic review registration PROSPERO CRD42021252561

Abstract Background Obesity is an independent risk factor for chronic kidney disease (CKD) and is the strongest known modifiable risk factor for hyperuricemia and gout. We aimed to discover the outcome of serum uric acid (SUA), gouty arthritis, and kidney function in obese patients after bariatric surgery and possible links with BMI variations. Methods Retrospective study has been performed in National Hospital in Riyadh, KSA, between Jan. 2018 to Jan. 2020. We studied only 98 patients who met our inclusion criteria. Patients followed-up at 1 month (for gouty attack only) postoperative, 3 months postoperative, and 6 months postoperative for body mass index (BMI), serum creatinine, dipstick urinalysis, SUA, and estimated glomerular filtration rate (eGFR). Radiological studies, medical history, follow up radiological studies, and clinical follow up were obtained from the hospital data system. Results A total of 98 patients with mean eGFR were 90.65 ± 29.34 ml/min/1.73 m2, mean SUA 5.56 ± 1.84 mg/dl, and mean BMI was 45.28 ± 7.25 kg/m2, at surgery. Mean BMI had decreased significantly to 38.52 ± 6.05 kg/m2 at 3 months and to 34.61 ± 5.35 kg/m2 at 6 months (P < 0.001). The mean GFR had improved significantly (99.14 ± 23.32 ml/min/1.73 m2) at 6 months (P < 0.001). Interestingly, proteinuria had resolved in 17 patients out of 23 patients at 6 months. Number of gouty attacks was decreased during the first month post-surgery (P < 0.001). SUA level was significantly decreased (4.32 ± 1.27 mg/dl) (P < 0.001). SUA showed significant negative correlations with eGFR at 3 months and positively significant correlations with BMI at 3 and 6 months. By multinomial logistic regression, BMI and initial eGFR were the independent predictive variables for the outcome of eGFR at 6 months, while male gender and initial SUA were the independent predictive variables on the outcome of SUA at 6 months. Postoperatively in gouty arthritis patients, the number of joints affected, patient global VAS assessment, and number of gouty attacks were significantly reduced (P < 0.001). Conclusion Bariatric surgery has been associated with reduction of BMI and subsequently reduction of SUA levels, gouty attacks, and improvement of eGFR.

Context: The importance of upper gastrointestinal (UGI) contrast study following sleeve gastrectomy (SG) is equivocal. It can, however, yield anatomical and functional details, the significance of which mostly remains unknown. Settings and Design: This prospective, single-center study included SG patients between January 2018 and January 2019. Materials and Methods: UGI contrast study was done on post-operative day 1. The findings of the study namely gastroesophageal junction (GEJ) holdup time, presence of fundus, gastroduodenal emptying (GDE) time, and sleeve shape were compared with weight loss, improvement of glycosylated hemoglobin (HbA1c) and gastroesophageal reflux disease (GERD) symptoms at 3, 6, and 12 months follow-up. Results: There were 138 patients with 100% follow-up. Radiological sleeve patterns observed were: tubular (62.3%), superior (16.0%), and inferior (21.7%) pouches. GEJ holdup time had no effect on percentage total weight loss (%TWL) (P = 0.09) or HbA1c improvement (P = 0.077). The absence of fundus led to greater %TWL at 6 months (P = 0.048). GDE time

Abstract Background Patients with Class III obesity pose unique challenges to health care staff and organisations. Care requirements of this population are unique and require specialised equipment and knowledge to meet these needs, maintain the quality of care, as well as the safety of patients and staff. Aim To synthesise the evidence on the nursing care of Class III obese patients in acute care settings. Methods A scoping review informed by JBI. CINAHL Plus, Medline, Scopus, Proquest Central, Web of Science and Embase were searched for primary research articles about the nursing management of people classified as Class III obese in acute care. Methodological quality of included studies was assessed; data extracted and synthesised into themes. Results Fourteen studies were included in the review. The synthesis generated three themes: Access to equipment, knowledge and training, patient care, and opportunities to improve care. Conclusions A paucity of high-quality evidence informs the nursing care of people with Class III obesity in acute care. Access to appropriate equipment dominated the findings of this review. Adequate provision of equipment and education on its use are required. Education to promote engagement with patients, adapting clinical practice and promotion of self-care could improve care and outcomes.

Nowadays, non-alcoholic fatty liver disease is one of the first causes of liver transplant worldwide; many efforts have been done to find the perfect drug for this multifactorial disease. Presently we just have a few drugs that could be used in specific and limited clinical scenarios. Current evidence suggests that bariatric endoscopic and surgical therapies could be strategies with optimal outcomes, with high impact in quality of life, decrease of cardiovascular risk, and improvement in metabolic profile, despite being considered expensive procedures. This review proposes to consider these therapies early together with liver fibrosis evaluation, with long term cost-effectiveness benefits in the absence of response to lifestyle modifications and pharmacological treatments.