Efficacy of Liraglutide 3.0 Mg Treatment on Weight-Loss in Patients with Weight Regain After Bariatric Surgery

Purpose Bariatric surgery, as Roux-en-Y gastric bypass (RYGB), laparoscopic gastric banding (LGB) and laparoscopic sleeve gastrectomy (LSG), is considered the gold standard treatment to achieve long-term weight-loss in severe obesity. In patients who fail to maintain the achieved weight, pharmacological treatment may be required. Here, we reported our real-life experience on efficacy of liraglutide therapy in 62 patients who regained weight after bariatric surgery.MethodsWe retrospectively evaluated 62 (60 F-2 M; mean age: 43.6±9.9 years) patients received liraglutide for weight-loss after bariatric surgery (17 RYGB, 22 LGB and 23 LSG). Body mass index (BMI) before and after surgery was respectively of 45.4±5.5 kg/m2 and 29.5±4.9 kg/m2. Patients were followed from 2016 until 2021. Liraglutide was administered after weight regain once-daily subcutaneously at starting dose of 0.6 mg and with weekly increases up to 3.0 mg. Treatments were administered when a weight regain of 10-15% occurred after reaching a minimum weight-loss from bariatric surgery or if weight-loss after bariatric surgery was unsatisfactory. ResultsAfter a mean of 70.7±43.7 months from any bariatric surgery, all patients started liraglutide therapy. At this time, mean BMI was 34.2±4.8 kg/m2 (mean increased BMI: 4.7±2.8 kg/m2). After a mean of 10.5±4.4 months from the beginning of liraglutide, 9 patients achieved normal weight (BMI 24.1±0.9 kg/m2), 28 were overweight (BMI 26.9±1.6 kg/m2). Twenty patients achieved grade I (BMI 32.1±1.5 kg/m2), 5 grade II (BMI 37.3±2.0 kg/m2) obesity, none had grade III obesity (mean BMI change: -5.1±2.5 kg/m2). The treatment was well tolerated, and no serious adverse events were recorded.ConclusionThese data confirm the efficacy and safety of liraglutide in patients who experienced weight regain after bariatric surgery. Considering the long-term follow-up, patients should be followed up regularly and the pharmacological treatment should be adapted to the weight fluctuations observed during the clinical history.

P-B03 Gastric Band Tubing Causing Small Bowel Obstruction

Background Laparoscopically adjustable gastric bands (LAGB) have been widely employed as a means of weight loss in bariatric surgery over the past two decades. Although now largely superseded by other bariatric surgical techniques, complications from gastric bands continue to be encountered in surgical practice. We report an unusual case of small bowel obstruction due to an internal hernia caused by gastric band tubing resulting in closed loop small bowel obstruction. This is not commonly encountered and emergency general surgeons need to have a high index of suspicion for this condition as a possible cause for small bowel obstruction. Methods A 40 year old male presented with abdominal pain, vomiting and failure to open bowels or pass flatus for nine days. Twelve years previously (2008) he had had Roux n Y gastric bypass (RYGB), followed by by laparoscopic gastric banding of the RYGB about two years later (2010) also in the private sector. He had a soft but distended abdomen, and empty rectum on rectal examination. CT scan abdomen reported as: Multiple loops of distended small bowel demonstrated. No air seen in rectum, indicative of small bowel obstruction. No pneumoperitoneum. There is dilatation of the mid and distal small bowel seen to an apparent transition point in the mid abdomen where a loop is noted associated with the tubing for the inflation device for the gastric band. This appears to be centred on the cause of obstruction and appears tied around the base of mesentery and may be creating a closed loop obstruction, by having created an internal hernia. This patient had an internal hernia around loop of the gastric band tubing with resultant closed loop small bowel obstruction. The patient underwent diagnostic laparoscopy with ileo-caecal resection and primary anastomosis. He made successful recovery. Deflated gastric band remains in-situ. Results While small bowel obstruction is most commonly due to adhesions in individuals who have had previous laparotomy, it is important to bear in mind other causes such as internal hernias particularly in cases of those with history of previous gastric banding or Roux n Y gastric bypass. Early intervention may be necessary to reduce the likelihood of bowel ischaemia and bowel resection. Laparoscopy is a useful tool in the management of small bowel obstruction. Keywords: gastric band, small bowel obstruction, closed loop, emergency surgery, laparoscopy Conclusions Connection tubing causing small bowel obstruction and colonic erosion as a rare complication after laparoscopic gastric banding: a case report. Liza BK Tan, Jimmy BY So, and Asim Shabbir - J Med Case Reports. 2012; 6: 9. Acute small bowel obstruction due to the connecting tube of a gastric band. Federico Oppliger, M.D. Gonzalo Wiedmaier, M.D. Juan. Published April 07 2017. https://doi.org/10.1016/j.soard.2014.03.021 An unusual complication of gastric banding: recurrent small bowel obstruction caused by the connecting tube. M A Zappa, E Lattuada, E Mozzi, M Francese, I Antonini, S Radaelli, G Roviaro. Obes Surg . 2006 Jul;16(7):939-41. doi: 10.1381/096089206777822250 Total small bowel herniation through the space between the connecting tube of gastric band and abdominal wall: A case report of a surgical emergency. Tarek Hashem, Soliman M Soliman, Sherif Wagih 2. Int J Surg Case Rep. 2017;30:66-68. doi: 10.1016/j.ijscr.2016.11.021. Epub 2016 Nov 17

It is really time to retire laparoscopic gastric banding? Positive outcomes after long-term follow-up: the management is the key

After the initial widespread diffusion, laparoscopic adjustable gastric banding (LAGB) has been progressively abandoned and laparoscopic sleeve gastrectomy (LSG) has become the worldwide most adopted procedure. Nevertheless, recent reports raised concerns about the long-term weight regain after different bariatric techniques. Considering the large LAGB series recorded in our multicentric bariatric database, we analysed the anthropometric and surgical outcomes of obese patients underwent LAGB at a long-term follow-up, focusing on LAGB management. Between January 2008 to January 2018, demographics, anthropometric and post-operative data of obese patients undergone LAGB were retrospectively evaluated. To compare the postoperative outcomes, the cohort was divided in two groups according to the quantity of band filling (QBF): low band filling group (Group 1) with at most 3 ml of QBF, and patients in the high band filling group (Group 2) with at least 4 ml. 699 obese patients were considered in the analysis (351 in Group 1 and 348 in Group 2). Patients in Group 1 resulted significantly associated (p < 0.05) to higher % EWL and quality of life score (BAROS Score), 49.1 ± 11.3 vs 38.2 ± 14.2 and 5.9 ± 1.8 vs 3.8 ± 2.5, respectively. Moreover, patients with lower band filling (Group 1) complained less episodes of vomiting, epigastric pain and post-prandial reflux and significantly decreased slippage and migration rate (p < 0.001 for all parameters). LAGB is a safe and reversible procedure, whose efficacy is primarily related to correct postoperative handling. Low band filling and strict follow-up seem the success’ key of this technique, which deserves full consideration among bariatric procedures.

High plasma renin activity associates with obesity-related diabetes and arterial hypertension, and predicts persistent hypertension after bariatric surgery

Background Information about the renin–angiotensin–aldosterone system (RAAS) in obese individuals before and after bariatric surgery is scarce. Aim of this study was to analyze the RAAS in severely obese subjects, in relation to anthropometric and metabolic variables, with special reference to glucose tolerance. Methods 239 subjects were evaluated at baseline, and 181 one year after bariatric surgery [laparoscopic gastric banding (LAGB)]. Results At baseline, renin (plasma renin activity, PRA) was increased from normal to glucose tolerance and more in diabetes, also correlating with ferritin. After LAGB, the decrease of PRA and aldosterone was significant in hypertensive, but not in normotensive subjects, and correlatied with decrease of ferritin. PRA and glucose levels were predictive of persistent hypertension 1 year after LAGB. Conclusions These data support the role of RAAS in the pathophysiology of glucose homeostasis, and in the regulation of blood pressure in obesity. Ferritin, as a proxy of subclinical inflammation, could be another factor contributing to the cross-talk between RAAS and glucose metabolism.

Long-term effects of laparoscopic sleeve gastrectomy: What are the results beyond 10 years?

Objective Sleeve gastrectomy (SG) has become the most commonly performed bariatric procedure worldwide. Newer studies providing long-term follow-up are showing high incidence of weight regain and high incidence of de novo reflux or worsening of preexisting GERD leading to conversion to different bariatric procedure. The objective of our study was to present 5 to 15-year follow-up results in terms of weight loss, remission of comorbidities and reoperation rate. Methods This is a retrospective analysis of prospectively collected data. The minimal follow-up time was 5 years. Patients who underwent SG between August 2004 and December 2014 were included. In case of reoperation patients were converted to Roux-en-Y gastric bypass or biliopancreatic diversion type duodenal-switch with or without hiatal hernia repair. Results A total of 307 patients underwent SG either as primary bariatric procedure (n = 262) or as redo operation after failed laparoscopic gastric banding (n = 45). Mean body mass index at time of primary SG was 46.4 ± 8.0 kg/m2. Mean age at operation was 43.7 ± 12.4 years with 68% females. Follow-up was 84% and 70% at 5 and 10 years respectively. The mean EBMIL for primary SG was 62.8 ± 23.1% after 5 years, 53.6 ± 24.6% after 10 years and 51.2 ± 20.3% after 13 years. Reoperation after SG was necessary in almost every fifth SG patient: 24 patients (7.8%) were reoperated due to insufficient weight loss, 12 patients (3.9 %) due to reflux, while 23 patients (7.5%) needed conversion due to both, insufficient weight loss and reflux. Comorbidities improved considerably while the incidence of new onset reflux was 29.7%. Conclusion SG provides a long-term EBMIL from 51 to 54% beyond 10 years and a significant improvement of comorbidities. On the other hand, a high incidence of both weight loss failure and de novo reflux was observed leading to conversion.

A case of chronic tophi gout in morbidly obese patient after laparoscopic adjustable gastric banding

Currently, increasing attention is being paid to studying the metabolic activity of adipose tissue, a source of biologically active mediators involved in vascular remodeling, immunological and inflammatory reactions. Today obesity is considered not only as independent risk factor of development of chronic noninfectious diseases (such as arterial hypertension, diabetes mellitus types 2, pathology of a cardiovascular system, malignant neoplasms), but also as a significant predictor of metabolic disorders (dyslipidemia, insulin resistance, hyperuricemia), contributes to the early formation of metabolic syndrome and goat. Despite such an obvious problem, the current state of conservative therapy for overweight and obesity remains unsatisfactory. Most of patients, even after successful treatment, have a recurrence of the disease with the restoration of the initial anthropometric indicators or even an increase in body weight. In this regard, currently more widely used surgical methods of correction of obesity. However along with the expected positive effects of treatment bariatric surgery may be accompanied by the development of a number of specific surgical complications and impaired energy metabolism with aggravation of the existing polymorbid pathology. This clinical case demonstrates the association of obesity with the development of metabolic disorders, illustrates the development of severe tophaceous gout in a patient during 2 years after laparoscopic gastric banding. It shows the possible reasons for its debut and reflects the dynamics of the patients condition, as well as the nature and characteristics of the course of the joint syndrome in the postoperative period.