Search

Author(s): Valentin Mocanu [sup.1] , Zhengxiao Zhang [sup.2] [sup.3] , Edward C. Deehan [sup.2] , Dina H. Kao [sup.4] , Naomi Hotte [sup.2] , Shahzeer Karmali [sup.1] , Daniel W. [...], Fecal microbial transplantation (FMT) from lean donors to patients with obesity has been associated with metabolic benefits, yet results so far have been inconsistent. In this study, we tested the application of daily fiber supplementation as an adjunct to FMT therapy to modulate cardiometabolic outcomes. We performed a double-blind randomized trial in patients with severe obesity and metabolic syndrome receiving oral FMT, to test high-fermentable (HF) and low-fermentable (LF) fiber supplements (NCT03477916). Seventy participants were randomized to the FMT-HF (n = 17), FMT-LF (n = 17), HF (n = 17) and LF (n = 19) groups. The primary outcome was the assessment of change in insulin sensitivity from baseline to 6 weeks using the homeostatic model assessment (HOMA2-IR/IS). After 6 weeks, only patients in the FMT-LF group had significant improvements in HOMA2-IR (3.16 [plus or minus] 3.01 at 6 weeks versus 3.77 [plus or minus] 3.57 at baseline; P = 0.02). No difference in HOMA2-IR was observed over this period for those in the FMT-HF group (3.25 [plus or minus] 1.70 at 6 weeks versus 3.17 [plus or minus] 1.72 at baseline; P = 0.8), the HF group (3.49 [plus or minus] 1.43 at 6 weeks versus 3.26 [plus or minus] 1.33 at baseline; P = 0.8) or the LF group (3.76 [plus or minus] 2.01 at 6 weeks versus 3.56 [plus or minus] 1.81 at baseline; P = 0.8). Interventions were safe and well-tolerated with no treatment-attributed serious adverse events. We provide proof of concept for the use of a single-dose oral FMT combined with daily low-fermentable fiber supplementation to improve insulin sensitivity in patients with severe obesity and metabolic syndrome. Results from a phase 2 randomized controlled trial demonstrate improved insulin sensitivity in patients with severe obesity and metabolic syndrome following single-dose fecal microbial transplantation and daily supplementation with low-fermentable fiber for 6 weeks.

Background: The use of a single anastomosis duodeno-ileal bypass (SADI) as a revisional procedure in patients with pre-operative GERD is not well understood. Thirty-day outcomes in patients with pre-existing GERD undergoing revision with an SADI have not been previously reported. Methods: The Metabolic and Bariatric Accreditation and Quality Improvement Program registry was consulted to identify patients undergoing revisional bariatric surgery with an SADI between 2020 and 2021. Our analysis sought to determine if preoperative GERD had significant impact on thirty-day outcomes. Bivariate and multivariable logistic regression analyses were used to identify independent predictors of 30-day morbidity. Results: Preoperative GERD was seen in 342 patients (36.7%). Preoperative GERD was not associated with anastomotic leak (2.5% non-GERD cohort vs. 1.2% GERD cohort; p = 0.2) nor bleeding (1% non-GERD cohort vs. 1.8% GERD cohort; p = 0.33). There was no difference in thirty-day readmission (5.6% vs. 5.9%, p = 0.9), reintervention (2.4% vs. 1.2%, p = 0.2), or reoperation (3.6% vs. 2.05%; p = 0.19) rates. The multivariable regression analysis revealed that a history of myocardial infarction was associated with a significantly elevated risk of serious complication (OR 12.2; 95% CI 2.79–53.23; p = 0.001), as was dyslipidemia (OR 2.2; 95% CI 1.04–4.56; p = 0.04). Conclusions: Pre-operative GERD does not have any association with anastomotic leak, bleeding, thirty-day readmission, reintervention, or reoperation in patients undergoing revisional bariatric surgery to SADI. A history of myocardial infarction and dyslipidemia are independent predictors of post-operative thirty-day morbidity, irrespective of the presence of preoperative GERD. [ABSTRACT FROM AUTHOR]

Obesity has become a global epidemic. (1) The prevalence of obesity in Canada is nearing 30%, (2) and the health care costs associated with obesity in this country are now [...], Background: Hospital readmissions after bariatric surgery can significantly increase health care costs. Rates of readmission after bariatric surgery have ranged from 0.6% to 11.3%, but the rate of complications and the factors that predict readmission have not been well characterized in Canada. The objective of this study was to characterize readmission rates and the factors that predict 30-day readmission in a Canadian centre. Methods: A retrospective study was performed on all patients who underwent bariatric surgery between 2010 and 2015 in a single Canadian centre. Procedures included laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB). Prospectively collected data were extracted from an administrative database. Multivariable logistic regression analysis was performed to determine which factors predict 30-day readmission. Results: A total of 1468 patients had bariatric surgery (51.0% LRYGB, 40.5% LSG, 8.6% LAGB) during the 6-year study period, with an overall 30-day readmission rate of 7.5%. LRYGB was associated with a higher readmission rate (11.4%) than LSG (3.7%) or LAGB (1.6%). Common reasons for readmission were infection (24.8%), pain (17.4%) and nausea or vomiting (10.1%). Multivariable analysis identified 3 factors that independently predicted readmission: length of stay greater than 4 days (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.03-4.63, p = 0.042), LRYGB (OR 5.21, 95% CI 1.19-22.73, p = 0.028) and acute renal failure (OR 14.10, 95% CI 1.07-186.29, p = 0.045). Conclusion: Readmissions after bariatric surgery were most commonly caused by potentially preventable factors, such as pain, nausea or vomiting. Strategies to identify and address factors associated with readmission may reduce readmissions and health care costs after bariatric surgery in a publicly funded health care system. Contexte : Les readmissions hospitalieres apres la chirurgie bariatrique peuvent accroitre significativement le cout des soins de sante. Les taux de ces readmissions ont varie de 0,6 % a 11,3 %, mais le taux de complications et les facteurs de prediction des readmissions n'ont pas ete bien caracterises au Canada. L'objectif de cette etude est de caracteriser les taux de readmissions et les facteurs qui permettent de predire une readmission a 30 jours dans un centre canadien. Methodes : Nous avons etudie retrospectivement tous les cas de chirurgie bari atrique effectues entre 2010 et 2015 dans un etablissement canadien. Les interventions incluaient la derivation gastrique Roux-en-Y laparoscopique (DGRYL), la gastrectomie en manchon laparoscopique (GML) et la gastroplastie laparoscopique avec anneau ajustable (GLAA). Les donnees recueillies de maniere prospective ont ete extraites d'une base de donnees administrative. Nous avons procede a une analyse de regression logistique multivariee pour determiner quels facteurs permettaient de predire la readmission a 30 jours. Resultats : En tout, 1468 patients ont subi une chirurgie bariatrique (51,0 % DGRYL, 40,5 % GML et 8,6 % GLAA) durant les 6 annees de l'etude, avec un taux global de readmission a 30 jours de 7,5 %. La DGRYL a ete associee un taux de readmission plus eleve (11,4 %) que la GML (3,7 %) ou la GLAA (1,6 %). Les raisons de readmission les plus frequentes ont ete infection (24,8 %), douleur (17,4 %) et nausees ou vomissements (10,1 %). L'analyse multivariee a permis de degager 3 facteurs independants de readmission, soit sejour de plus de 4 jours (rapport des cotes [RR] 2,18, intervalle de confance [IC] de 95 % 1,03-4,63, p = 0,042), DGRYL (RC 5,21, IC de 95 % 1,19-22,73, p = 0,028) et insuffsance renale aigue (RC 14,10, IC de 95 % 1,07-186,29, p = 0,045). Conclusion : Les readmissions apres la chirurgie bariatrique ont le plus souvent ete dues a des facteurs evitables, tels que douleur, nausees et vomissements. Des strategies visant a identifer et a corriger les facteurs de readmission pourraient reduire ces dernieres et le cout des soins de sante apres la chirurgie bariatrique dans un systeme de sante public.