Bariatric Surgery Worldwide: Baseline Demographic Description and One-Year Outcomes from the Fourth IFSO Global Registry Report 2018

Laparoscopic sleeve gastrectomy (LSG) is currently the most performed bariatric procedure in the world. The 4th International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Global registry report (2014-18) estimates 87,015 procedures, equal to 45.9% of all bariatric procedures. Initially performed as the first step of the duodenals witch (biliopancreatic diversion with duodenal switch (BPD-DS)), a very complex malabsorptive procedure invented by a Canadian Surgeon P. Marceau as an evolution of the BPD, invented by N. Scopinaro, an Italian surgeon, LSG established itself in the early 2000s as a stand alone procedure, especially following the observations of Michael Gagner, pioneer of bariatric surgery. Over the years LSG has grown rapidly. The reasons for this popularity are the relative technical simplicity compared to other procedures, efficacy, good quality. For these reasons there has been a real explosion of bariatric surgery: many surgeons, driven by the relative simplicity of the procedure (longitudinal gastrectomy on the guide of a probe), begun to propose this procedure. So is LSG really an effective simple procedure that is good for all patients? Absolutely not. Performing a longitudinal gastrectomy can be simple; performing a good LSG is not.

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Type 2 diabetes remission one year after bariatric surgery - a comparison between vertical sleeve gastrectomy and gastric bypass

Endocrine Abstracts ◽

10.1530/endoabs.56.gp102 ◽

2018 ◽

Author(s):

Ines Ferreira Barros ◽

Silvia Paredes ◽

Fernando Manso ◽

Costa Jose Manuel Maia da ◽

Aline Fernandes ◽

...

Keyword(s):

Type 2 Diabetes ◽

Bariatric Surgery ◽

Gastric Bypass ◽

Sleeve Gastrectomy ◽

Diabetes Remission ◽

Vertical Sleeve Gastrectomy ◽

Type 2 Diabetes Remission ◽

One Year

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National Bariatric Surgery Registries: an International Comparison

Obesity Surgery ◽

10.1007/s11695-021-05359-0 ◽

2021 ◽

Author(s):

Erman O. Akpinar ◽

Perla J. Marang- van de Mheen ◽

Simon W. Nienhuijs ◽

Jan Willem M. Greve ◽

Ronald S. L. Liem

Keyword(s):

Standard Of Care ◽

Population Based ◽

Substantial Agreement ◽

Perfect Agreement ◽

Moderate Agreement ◽

Real World Evidence ◽

International Collaborations ◽

Global Registry ◽

Registry Report

Abstract Introduction Pooling population-based data from all national bariatric registries may provide international real-world evidence for outcomes that will help establish a universal standard of care, provided that the same variables and definitions are used. Therefore, this study aims to assess the concordance of variables across national registries to identify which outcomes can be used for international collaborations. Methods All 18 countries with a national bariatric registry who contributed to The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Global Registry report 2019 were requested to share their data dictionary by email. The primary outcome was the percentage of perfect agreement for variables by domain: patient, prior bariatric history, screening, operation, complication, and follow-up. Perfect agreement was defined as 100% concordance, meaning that the variable was registered with the same definition across all registries. Secondary outcomes were defined as variables having “substantial agreement” (75–99.9%) and “moderate agreement” (50–74.9%) across registries. Results Eleven registries responded and had a total of 2585 recorded variables that were grouped into 250 variables measuring the same concept. A total of 25 (10%) variables have a perfect agreement across all domains: 3 (18.75%) for the patient domain, 0 (0.0%) for prior bariatric history, 5 (8.2%) for screening, 6 (11.8%) for operation, 5 (8.8%) for complications, and 6 (11.8%) for follow-up. Furthermore, 28 (11.2%) variables have substantial agreement and 59 (23.6%) variables have moderate agreement across registries. Conclusion There is limited uniform agreement in variables across national bariatric registries. Further alignment and uniformity in collected variables are required to enable future international collaborations and comparison. Graphical abstract

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Caspase-Cleaved Keratin 18 Measurements Identified Ongoing Liver Injury after Bariatric Surgery

Journal of Clinical Medicine ◽

10.3390/jcm10061233 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1233

Author(s):

Felix Hempel ◽

Martin Roderfeld ◽

Lucas John Müntnich ◽

Jens Albrecht ◽

Ziya Oruc ◽

...

Keyword(s):

Bariatric Surgery ◽

Liver Disease ◽

Liver Injury ◽

Response To Treatment ◽

Morbidly Obese ◽

Alcoholic Fatty Liver ◽

Laboratory Parameters ◽

Nafld Fibrosis Score ◽

Keratin 18 ◽

One Year

Bariatric surgery has emerged as an effective treatment option in morbidly obese patients with non-alcoholic fatty liver disease (NAFLD). However, worsening or new onset of non-alcoholic steatohepatitis (NASH) and fibrosis have been observed. Caspase-cleaved keratin 18 (ccK18) has been established as a marker of hepatocyte apoptosis, a key event in NASH development. Thus, ccK18 measurements might be feasible to monitor bariatric surgery patients. Clinical data and laboratory parameters were collected from 39 patients undergoing laparoscopic Roux-en-Y gastric bypass at six timepoints, prior to surgery until one year after the procedure. ccK18 levels were measured and a high-throughput analysis of serum adipokines and cytokines was carried out. Half of the cohort’s patients (20/39) presented with ccK18 levels indicative of progressed liver disease. 21% had a NAFLD-fibrosis score greater than 0.676, suggesting significant fibrosis. One year after surgery, a mean weight loss of 36.87% was achieved. Six and twelve months after surgery, ccK18 fragments were significantly reduced compared to preoperative levels (p < 0.001). Yet nine patients did not show a decline in ccK18 levels ≥ 10% within one year postoperatively, which was considered a response to treatment. While no significant differences in laboratory parameters or ccK18 could be observed, they presented with a greater expression of leptin and fibrinogen before surgery. Consecutive ccK18 measurements monitored the resolution of NAFLD and identified non-responders to bariatric surgery with ongoing liver injury. Further studies are needed to elicit the pathological mechanisms in non-responders and study the potential of adipokines as prognostic markers.

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Evaluation of the Vertical Movement of Ribeiro’s Dermolipoglandular Mammary Flap One Year After Mammaplasties in Post-Bariatric Patients

Aesthetic Surgery Journal ◽

10.1093/asj/sjz188 ◽

2019 ◽

Vol 40 (1) ◽

pp. NP21-NP31 ◽

Cited By ~ 3

Author(s):

Rodrigo P Sizenando ◽

Marco Túlio C Diniz ◽

Paulo Roberto da Costa ◽

Luiz Gustavo S Manhães

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Plastic Surgery ◽

Breast Tissue ◽

Vertical Movement ◽

Level Of Evidence ◽

Significance Level ◽

Areola Complex ◽

Ptotic Breast ◽

One Year

Abstract Background In 1971, Ribeiro isolated a segment in the inferior pole of the ptotic breast, nourished by muscular perforating vessels, and moved it cranially to the posterior region of the remaining detached breast tissue, where it was fixed to the pectoral fascia. This maneuver created a flap with autologous implant function, independent from the rest of the breast’s support, that maintained long-term mammary projection. Objectives The objectives of this study were to measure the vertical movement of this flap 1 year after mammaplasty and to evaluate the factors involved. Methods The sample included 13 patients who had previously undergone bariatric surgery. The position of a titanium marker attached to the Ribeiro flap was compared on chest radiographs taken 1 day and 1 year after the mammaplasty. The significance level was set at 5%. Results All of the titanium markers moved 0.6 cm to 4.1 cm caudally during the study period (average, 2.4 cm ± 1.02 cm). The greater the weight loss after the plastic surgery, the further the marker’s descent. Weight loss between bariatric surgery and plastic surgery, the vertical dimension of the ptotic breast tissue immediately before plastic surgery, the vertical extent of the nipple-areola complex elevation during mammaplasty, the Ribeiro flap thickness and volume, and the breast volume after mammaplasty were not associated with the vertical movement of the flap. Conclusions The Ribeiro flap employed in mammaplasty of patients who previously underwent bariatric surgery undergoes ptosis that is exacerbated by weight loss after mammaplasty. Level of Evidence: 4

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Bariatric Surgery Worldwide 2013

Obesity Surgery ◽

10.1007/s11695-015-1657-z ◽

2015 ◽

Vol 25 (10) ◽

pp. 1822-1832 ◽

Cited By ~ 863

Author(s):

L. Angrisani ◽

A. Santonicola ◽

P. Iovino ◽

G. Formisano ◽

H. Buchwald ◽

...

Keyword(s):

Bariatric Surgery ◽

Bariatric Surgery Worldwide

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Bariatric Surgery Worldwide 2003

Obesity Surgery ◽

10.1381/0960892042387057 ◽

2004 ◽

Vol 14 (9) ◽

pp. 1157-1164 ◽

Cited By ~ 447

Author(s):

Henry Buchwald ◽

Stanley E. Williams

Keyword(s):

Bariatric Surgery ◽

Bariatric Surgery Worldwide

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Renal Outcomes One Year After Metabolic Bariatric Surgery: A Clinical Audit

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.050 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A26-A26

Author(s):

Zongwen Wee ◽

Kwang Wei Tham ◽

Hong Chang Tan ◽

Sonali Ganguly ◽

Chin Hong Lim ◽

...

Keyword(s):

Bariatric Surgery ◽

Renal Function ◽

Positive Impact ◽

Primary Outcome Measure ◽

Ethnic Composition ◽

Lipid Lowering ◽

Diabetes Group ◽

Tertiary Centre ◽

Post Surgery ◽

One Year

Abstract Introduction: Obesity increases the risk of incident chronic kidney disease (CKD), being one of the strongest risk factors for new-onset CKD even in the metabolically normal obese. Weight loss has been shown to reduce renal hyperfiltration and proteinuria. Metabolic Bariatric Surgery (MBS) remains an effective treatment for obesity and its metabolic related complications. However, literature on its impact on long term renal function remains limited. Methods: This was an observational retrospective study in a tertiary centre in Singapore. MBS cases performed at the centre between 2008 and 2019 were included. The primary outcome measure was estimated Glomerular Filtration Rate (eGFR), calculated using the CKD Epidemiology Collaboration equation, and albuminuria (defined as urine Albumin-Creatinine Ratio (uACR) >3.5 mg/mmol) at baseline and at one-year post surgery. Results: 557 patients were included. Baseline parameters are as follows: mean age 41.7 ±10.1 years; female 65.4%; ethnic composition: Chinese (35.2%), Malay (33.0%), Indian (26.9%); BMI 42.5 ±7.9 kg/m²; glycaemic status: Diabetes Mellitus (34.5%), Pre-diabetes (13.5%), Non-diabetic (52.1%); Hypertensive status: Hypertension (55.2%), Pre-Hypertension (1.9%), Normotensive (42.9%). Median eGFR was 110.9 (92.4 - 121.5) mL/min/1.73 m² and median uACR was 1.00 (0.40 - 3.55) mg/mmol. At one-year post surgery, patients achieved statistically significant reductions in mean BMI (-11.3 ±4.2 kg/m2), systolic BP (-3.24 ±19.3 mmHg), diastolic BP (-5.23 ±13.8 mmHg), fasting glucose (-1.95 ±2.89 mmol/L) and improvement in HDL (0.29 ±0.26 mmol/L). In addition, statistically significant reductions in the proportion of patients on anti-hypertensive (48.8% to 14.4%), anti-diabetic (34.1% to 12.7%) and lipid-lowering medications (37.8% to 20.4%) were seen. In particular, ACE-inhibitor and/or angiotensin receptor blocker (32.9% to 9.2%, p< 0.001) usage was reduced. At one-year post surgery, median eGFR increased by 1.66 mL/min/1.73 m² (p<0.001). Further stratification by glycemic status showed significant increases in GFR in patients without diabetes or pre-diabetes. There was a decrease in median uACR (0.30 mg/mmol, p=0.001) at one-year post surgery; this remained statistically significant in patients with diabetes and pre-diabetes. 12.9% of patients had improvements in CKD staging. The proportion of patients with albuminuria decreased from 24.8% at baseline to 1.89% one-year post surgery (p<0.001). Conclusions: Metabolic bariatric surgery had a positive impact on renal function as shown by the improvement in eGFR in the non-diabetic group, and the reduction in albuminuria in the diabetes and pre-diabetes group at one-year post surgery. More adequately powered, longer-term data is required to investigate the durability of this impact.

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