Foregut Issues After Bariatric Surgery

Weight loss surgery has overall been shown to be very safe and effective. However, long-term outcomes data has allowed codification of post-operative complications specific to the type of weight loss surgery performed. This review focuses specifically on foregut-related postoperative complications after weight loss surgery, most of which are not discussed on a broad scale in the literature yet whose prevalence continues to rise. Clinicians should maintain a broad differential when treating patients with complications after bariatric surgery in order to perform a thorough and precise workup to identify the diagnosis and guide management.

Percutaneous gastrostomy tube placement in a patient with prior sleeve gastrectomy

Sleeve gastrectomies have quickly become the most common bariatric weight loss surgery performed in the United States (U.S.). Given that hundreds of thousands of gastrostomy tubes (G tubes) are also placed each year, the number of patients with prior sleeve gastrectomies requiring a G tube will surely rise in the coming years. The case presented herein is a patient with prior sleeve gastrectomy who underwent percutaneous G tube placement.

Changes in Work Ability after Weight-Loss Surgery: Results of a Longitudinal Study of Persons with Morbid Obesity before and after Bariatric Surgery

<b><i>Introduction:</i></b> Bariatric surgery is a life-changing treatment, but knowledge of its influence on changes in work ability is still limited. We hypothesized that self-reported work ability improves in response to surgery-induced weight loss and sociodemographical variables (e.g., age, sex, and marital status), and that psychosocial characteristics (e.g., depressive symptoms and dysfunctional eating) may have predictive value as to patients’ work ability. <b><i>Methods:</i></b> A total of 200 participants scheduled for bariatric surgery were recruited between September 2015 and June 2018. They completed several self-report measures at the preoperative examination (t1) and at 6- (t2) and 12 months (t3) after bariatric surgery. A repeated-measures analysis of variance was calculated to detect any changes in the work ability and body mass index (BMI) among the 3 time points. Further, a hierarchical multiple regression analysis was used to determine whether any demographical and psychosocial characteristics at (t1) would predict work ability at (t3). <b><i>Results:</i></b> Participants (82% of whom were women) were middle-aged and showed a BMI of nearly 46 at the preoperative medical examination. Excess weight loss at (t2) and at (t3) was 49 and 66%, respectively. Work ability increased toward a moderate level after weight-loss surgery. Work ability and dysfunctional eating at (t1) showed significant predictive value with respect to work ability at (t3). <b><i>Discussion:</i></b> The results suggest that weight-loss surgery has a positive impact on work ability, and indicate a predictive value for the extent of weight loss and dysfunctional eating behavior. Against our hypothesis and in contrast to former research, a predictive value for depressive symptoms and age was not revealed. Further research must show how interventions can support and maintain improvements in work ability after bariatric surgery, in order to reduce sick leave and unemployment in patients with preoperative morbid obesity.

All in the Family: Child and Adolescent Weight Loss Surgery in the Context of Parental Weight Loss Surgery

Background: Bariatric surgery is the most effective current treatment option for patients with severe obesity. More children and adolescents are having surgery, many whose parents have also had surgery. The current study examines whether parental surgery status moderates the association between perceived social support, emotional eating, food addiction and weight loss following surgery, with those whose parents have had surgery evidencing a stronger relationship between the psychosocial factors and weight loss as compared to their peers. Methods: Participants were 228 children and adolescents undergoing sleeve gastrectomy between 2014 and 2019 at one institution. Children and adolescents completed self-report measures of perceived family social support, emotional eating, and food addiction at their pre-surgical psychological evaluation. Change in body mass index (BMI) from pre-surgery to 3, 6, and 12 months post-surgery was assessed at follow-up clinic visits. Parents reported their surgical status as having had surgery or not. Results: There were no differences in perceived family support, emotional eating, or food addiction symptoms between those whose parents had bariatric surgery and those whose parents did not. There were some moderating effects of parent surgery status on the relationship between social support, emotional eating/food addiction, and weight loss following surgery. Specifically, at 3 months post-surgery, higher change in BMI was associated with lower perceived family support only in those whose parents had not had surgery. More pre-surgical food addiction symptoms were associated with greater weight loss at 3 months for those whose parents had not had surgery, whereas this finding was true only for those whose parents had surgery at 12 months post-surgery. Conclusions: Children and adolescents whose parents have had bariatric surgery may have unique associations of psychosocial factors and weight loss. More research is needed to determine mechanisms of these relationships.

The Effect of Body Mass Index on the Creation of an End-Colostomy in Rectal Cancer Patients

With the increasing prevalence of obesity, there has been a parallel increase in the incidence of rectal cancer. The association of body mass index (BMI) and end-colostomy creation versus primary anastomosis in patients undergoing proctectomy for rectal cancer has not been described. This is a retrospective study of patients with rectal cancer from 2012 to 2018 using data from the National Surgical Quality Improvement Project. 16,446 (92.1%) underwent primary anastomosis and 1,418 (7.9%) underwent creation of an end-colostomy. Patients with a BMI of 25-29.9 (overweight) comprised the most frequent group to have a proctectomy (reference group), but the least likely to have an end-colostomy. Patients with severe obesity (BMI 50+) had an adjusted odds ratio for end-colostomy of 2.7 (95% CI 1.5-4.7) compared to the reference group. Patients who have severe obesity should be counseled regarding the likelihood of an end-colostomy and may benefit from medical weight management or weight-loss surgery.

O024 Weight loss surgery in obese patients with obstructive sleep apnoea is associated with increased inter-hemispheric electroencephalographic coherence

Introduction Electroencephalogram (EEG) analysis of obstructive sleep apnoea (OSA) patients has shown reductions in both delta band frequency power and interhemispheric coherence. Weight loss surgery is increasing in popularity and is often effective in reducing the symptoms and severity of OSA. No study has examined the effects of weight loss surgery on the sleep EEG of OSA patients. Methods Twenty patients underwent diagnostic polysomnography (PSG) prior to- and twelve months after weight loss surgery. Quantitative EEG analysis was conducted to calculate spectral power (fast fourier transform with four second overlapping windows) as well as amplitude and phase coherence between the two hemispheres (C3/C4 electrodes). Results Weight loss surgery was successful in reducing weight (137±17 kg vs 102±17kg P&lt;0.001 for pre- and post-surgery, respectively), and OSA severity (Apnoea-Hypopnoea Index: 26±15 events/hour vs 10±12 events/hour P&lt;0.001 for pre- and post-surgery, respectively). Stage N1 proportions were slightly decreased (12±7% vs 9±8%; P=0.039 for pre- and post-surgery, respectively) but all other stages were unchanged. Increases in interhemispheric phase coherence was observed following weight loss surgery, with significant changes observed in theta (-0.07±0.09 degrees vs -0.03±0.03 degrees P=0.035), alpha (-0.12±0.13 degrees vs -0.03±0.06 degrees P=0.008), sigma (-0.19±0.18 degrees vs -0.07±0.07 degrees P=0.011) and beta (-0.29±0.25 degrees vs -0.11±0.09 degrees P=0.004) band frequencies. There were no differences in EEG spectral power or interhemispheric amplitude coherence. Discussion Sleep EEG coherence, a putative marker of neurocognitive susceptibility in OSA, improves following weight loss surgery. Further studies are needed to determine the functional consequences of these EEG changes.