Obesity, bariatric surgery, and weight regain parameters: a concise systematic review

Introduction: Obesity, an easily diagnosed disease, is multifactorial, chronic, and difficult to manage. It has increased alarmingly and is now one of the main public health problems. It is associated with several comorbidities and poorer quality of life. Bariatric surgery is currently widely accepted and described in the literature as the most effective method for the treatment of obesity. Even though this is the best method, weight regain (WR) is also checked. In the literature, there are several parameters used to configure WR, and with that, several results are presented. Objective: This paper aims to review the parameters used to assess WR after bariatric surgery. Method: A bibliographic review of the last 5 years was carried out in the PubMed and Scielo virtual databases with the following keywords: bariatric surgery, obesity, and weight regain, in October and November 2019. Result: Lack of unanimity in the definition and parameters for WR is still a reason for further studies. And with that, the results are also presented in a varied way, depending on the parameter used. Conclusion: The subject is relatively new and there is a need for more studies to define and quantify the meaning of WR, to also improve the approach and management of the patient with weight regain. But there seems to be a tendency to adapt itself as a favorable response to surgical success when at least 50% excess weight loss (%EWL) and > 20% total weight loss is achieved, and that any regain should not be used. as a parameter to define it.

EP.WE.595Long-term Effects of Psychiatric Medication on Weight Loss after Bariatric Surgery: 5-year Outcomes with 100% Follow Up

Aims The long-term effect of psychiatric medication on weight loss after bariatric surgery is unknown. The aim of this study was to compare the 1 year and 5 year percentage excess weight loss (%EWL) and BMI between those prescribed and not prescribed psychiatric medication who underwent laparoscopic bariatric surgery. Methods Consecutive patients, who received identical perioperative care were selected from a prospectively maintained database. Patients who had gastric bands and revisional procedures were excluded. Patients were defined as “prescribed psychiatric medication” if prescribed antidepressant, antipsychotic or mood stabilizer at baseline and subdivided into those taking a single agent and those on two or more agents. Results Of 119 patients (58 sleeve gastrectomy, 61 gastric bypass), 46 patients were prescribed psychiatric medication (40 one agent, 6 two or more agents). At 1 year, median %EWL did not differ significantly in those taking no agent, 1 agent and 2 or more agents respectively (66.8, 63.3, 57.4, p = 0.433). At 5 years this approached, but did not reach statistical significance (56.6, 54.4, 40.6, p = 0.099). The same pattern was observed for median BMI at 5 years (35.7, 39.2, 40.7, p = 0.086). Conclusion There is no significant difference in excess weight loss or BMI at 1 year post surgery between patients prescribed psychiatric medication and those not prescribed psychiatric medication but there is a difference at 5 years, which shows a trend towards statistical significance. Such patients should receive intensive specialist bariatric psychological support for a prolonged period after surgery.

TP8.2.11 Impact of surgical training on long-term patient outcomes in sleeve gastrectomy

Aims Although few studies have examined the impact of surgical training on early postoperative outcomes in bariatric surgery, there is limited data on longer-term outcomes in trainee-performed cases. Our aim was to evaluate the effect of surgical training on weight loss outcomes following laparoscopic sleeve gastrectomy (LSG). Methods Data was prospectively collated on patients undergoing primary LSG at a Quaternary Bariatric London teaching Hospital between 2016-2017. Inclusion criteria was BMI≥35. Exclusion criteria were BMI<35 or > 60, planned HDU admission and LSG with concomitant hiatus hernia repair. Operative time, length of stay, complications and longer-term excess weight loss was recorded with outcomes of consultant and trainee cases compared. Results 76 LSG patients were included; 44 performed by consultants, 32 by trainees. There was no difference in age, gender, pre-operative weight, BMI and number of obesity-related comorbidities between groups. Operative time (trainee105±10.0 vs consultant91±18.1 mins) and length of stay (trainee2.6±0.4 vs consultant2.8±0.9 days) were similar between groups. There were 3 complications in the trainee group (intra-abdominal collection requiring drainage, wound infection, hypokalaemia); and 2 with consultants (wound infection, intra-operative bleeding with ICU admission). Excess Weight Loss (%) at 2years was 55.9%±7.5% for trainee cases and 52.4%±6.7% for consultants(p = 0.49). Excess Weight Loss (%) at 3.5years was 54.9%±9.9% for trainee cases and 50.7%±9.9% for consultants(p = 0.54). Conclusion Outcomes in trainee-performed LSG are comparable to those performed by consultants. Surgical training in a high-volume teaching hospital does not appear to have detrimental effect on patient outcomes following LSG.

Relationship between monocyte-to-high-density lipoprotein cholesterol ratio and excess weight loss in laparoscopic sleeve gastrectomy

Aim: The present study evaluates the relationship between the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) and the percentage of excess weight loss (%EWL) in patients undergoing laparoscopic sleeve gastrectomy. Method: This prospective cohort study evaluated 125 patients who underwent laparoscopic sleeve gastrectomy. The MHR before and at 6 months after surgery were compared in patients with <50 and ≥50 %EWL. Results: The MHR was lower in patients with a %EWL of <50 than in patients with a %EWL of ≥50 (p = 0.019). The decrease in the MHR at postoperative 6 months was more remarkable in patients with a %EWL of ≥50 (p < 0.001). Conclusion: The present study suggests that MHR decreased more remarkably at postoperative 6 months in patients with high %EWL, predicting a decrease in cardiovascular risk.

420 Impact of Surgical Training on Long-Term Patient Outcomes in Sleeve Gastrectomy

Aim Although few studies have examined the impact of surgical training on early postoperative outcomes in bariatric surgery, there is limited data on longer-term outcomes in trainee-performed cases. Our aim was to evaluate the effect of surgical training on weight loss outcomes following laparoscopic sleeve gastrectomy (LSG). Method Data was prospectively collated on patients undergoing primary LSG at a Quaternary Bariatric London teaching Hospital between 2016-2017. Inclusion criteria was BMI≥35. Exclusion criteria were BMI&lt;35 or &gt; 60, planned HDU admission and LSG with concomitant hiatus hernia repair. Operative time, length of stay, complications and longer-term excess weight loss was recorded with outcomes of consultant and trainee cases compared. Results 76 LSG patients were included; 44 performed by consultants, 32 by trainees. There was no difference in age, gender, pre-operative weight, BMI and number of obesity-related comorbidities between groups. Operative time (trainee105±10.0 vs consultant91±18.1 mins) and length of stay (trainee2.6±0.4 vs consultant2.8±0.9 days) were similar between groups. There were 3 complications in the trainee group (intra-abdominal collection requiring drainage, wound infection, hypokalaemia); and 2 with consultants (wound infection, intra-operative bleeding with ICU admission). Excess Weight Loss(%) at 2 years was 55.9%±7.5% for trainee cases and 52.4%±6.7% for consultant cases(p=0.49). Excess Weight Loss(%) at 3.5 years was 54.9%±9.9% for trainee cases and 50.7%±9.9% for consultant cases(p=0.54). Conclusions Outcomes in trainee performed LSG are comparable to those performed by consultants. Surgical training in a high-volume teaching hospital does not appear to have detrimental effect on patient outcomes following LSG.

Estimation Of Excessive Weight Loss In Bariatric Surgery Patients: A Prediction Model Retrospective Cohort Study

Background and Objective: Bariatric surgery has been recognized as the most effective long-term treatment for morbid obesity. Despite the considerable positive results, adverse consequence can develop. Excessive Weight Loss (EXWL), a rare consequence of bariatric surgery, can lead to a broad adverse consequence. The aim of this study was determining of prevalence and the predicting model of EXWL in patient underwent bariatric surgery until 24 months after surgery.Material and Methods: Data have been extracted from the National Obesity Surgery Database in obesity clinic of * University of Medical Sciences. The subjects of this retrospective cohort study were morbid obese individuals who underwent three various types of bariatric surgery (One Anastomosis Gastric Bypass (OAGB), Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG)) in period of 24 months ago. EXWL has been defined as excess weight loss more than 100% at any time until 24 months after surgery. SPSS (version 23) was used in data analysis.Results: Among 4214 subjects of this study, most excess weight loss after surgery has taken place in 18 months after surgery. 18.5% (n=407) of patients experienced EXWL with highest percentage among OAGB patients (22.6%). The females (20.4% vs.9.9%) and younger persons (35.45 ± 10.25 vs. 39.06 ± 10.76) were more susceptible to EXWL. patients with EXWL had significantly lower BMI (body mass index) (41.11± 4.51 vs. 46.73±6.26) (Kg/m2), and were less probable to had emotional eating. Visceral fat level, fat percentage and BMI were the best predictor of EXWL (P-value for all <0.05).Conclusions: Surgery should be adjusted in younger females with a lower BMI and healthy metabolic status who are more prone to EXWL. In such a way that minimize weight loss speed/value. It may be possible by selection of other surgery procedures, rather than OAGB, tighter follow ups and consultations of patients after surgery is emphasized for more EXWL vulnerable patients.

What is The Effect of Sleeve Gastrectomy in Patients with a BMI ≥ 50 kg/m2?

Background: To investigate the effect of Sleeve Gastrectomy (SG) in patient with a Body Mass Index (BMI)≥50 kg/m² groups on weight loss and comorbidities as the first and alone option. Methods: The prospectively maintained data obtained from patients with a BMI ≥ 50 who underwent SG between February, 2016 - February, 2020 were evaluated. Results: 138 patient with a BMI≥50 kg/m² underwent surgery. Average BMI: 56.36±7.661, age 37.41±12.33. Forty eight patients underwent cholecystectomy and/or hiatal hernia repair (HHR), as well. The percentage of excess weight loss (%EWL) values of patients in months 3, 6, 12 and 24 were 36.70%, 54.34%, 67.58%, 72.45%, 74.14% and the percentage of total weight loss (TWL%) values were 20.17%, 29.59%, 36.93%, 39.62%, 40.65%, respectively. The mean BMI values in month 0 and in the 3rd, 6th, 12th, 18th, 24th months were 56.36, 45.10, 39.76, 35.48, 33.96 and 33.42 respectively. The values measured in the month 0 and in the 3rd, 6th, 12th, 18th, 24th months were significantly different for EWL%, TWL% and BMI variables (p<0.001), but EWL% (p = 0.527), TWL% (p = 0.396) and BMI (p=0.657) were not found significantly different between the 18th and 24th months. When EWL% was accepted as ≥50, the success rate was found to be 93.55%(n=93) and 92%(n=50) in months 12 and 24, respectively. Conclusion: SG appears to be an effective and safe treatment method as the first option for weight loss and for treatment of concomitant disorders in patient with a BMI ≥ 50 kg/m² groups. Further long-term studies are needed to confirm these results.

Five-year Outcomes of Sleeve Gastrectomy: A Prospective Multicenter study

Background Sleeve gastrectomy (SG) is the most frequently performed bariatric procedure in the world. Our purpose was to evaluate the percentage of excess weight loss (%EWL), resolution of obesity-related comorbidities after SG, and identify predictive factors of weight loss failure. Methods A prospective cohort study of adults who underwent SG during 2014 in 7 Belgian-French centers. Their demographic, preoperative, and postoperative data were prospectively collected and analyzed statistically. Results Overall, 529 patients underwent SG, with a mean preoperative weight and body mass index (BMI) of 118.9 ± 19.9 kg and 42.9 ± 5.5 kg/m2, respectively. Body mass index significantly decreased to 32.2 kg/m2 at 5 years ( P < .001). The mean %EWL was 63.6% at 5 years. A significant reduction in dyslipidemia (28.0%-18.2%), obstructive sleep apnea (OSAS) (34.6%-25.1%), and arterial hypertension (HTN) (30.4%-21.5%) was observed after 5 years, but not for diabetes and gastroesophageal reflux disease (GERD). At multivariate analysis, age >50 years old, BMI >50 kg/m2, and previous laparoscopic adjustable gastric banding (LAGB) remained independent predictors of weight loss failure. Conclusions Five years after SG, weight loss was satisfactory; the reduction of comorbidities was significant for dyslipidemia, OSAS, and HTN, but not diabetes and GERD. Age >50 years old, BMI >50 kg/m2, and previous LAGB were independent predictors of weight loss failure.

The Impact of the Pre-operative Neutrophil-lymphocyte Ratio as the Predictive Marker of Post-operative Weight Loss and Improving Diabetes in Sleeve Gastrectomy.

Background: The aim of this study was to investigate the impact of the neutrophil-lymphocyte ratio (NLR) in sleeve gastrectomy (SG).Methods: 15 obese patients were enrolled in this study. They consisted of 5 males and 10 females: mean body weight (BW) 127.5kg; mean body mass index (BMI) 46.7kg/m2. 10 of these were diabetics who underwent a SG. The impact of the pre-operative NLR on the percentage of excess weight loss (%EWL) and remission of diabetes 1 year post-operative were examined.Results: The BMI, %EWL and %TWL at 1 year post-operative were 35.1 kg/m2, 46.3% and 26.2%, respectively. Improvements were also evident in the diabetes at 1 year post-operative: complete remission (CR) (No medication and hemoglobin A1c (HbA1c) HbA1c<6.0%) 40%, PR (HbA1c<6.5) 20%; and (decrease of anti diabetic drug and HbA1c<7.0%) 40%. Comparing pre-operative NLR in %EWL<50% and >50% in one (1) year post-operative, <50% was 2.64 and >50% was 2.03 (p<0.05). The NLR in CR and partial remission (PR) was significantly lower than that in improved (Improve) (2.22 vs 3.27, p<0.05).Conclusions: The pre-operative NLR may be a predictive marker of weight loss and improving diabetes after SG.