Additional Metabolic Effects of Bariatric Surgery in Patients with a Poor Mid-Term Weight Loss Response: A 5-Year Follow-Up Study

To ascertain the 5-year metabolic effects of bariatric surgery in poor weight loss (WL) responders and establish associated factors. Methods: Retrospective analysis of a non-randomised prospective cohort of bariatric surgery patients completing a 5-year follow-up. Mid-term poor WL was considered when 5-year excess weight loss was <50%. Results: Forty-three (20.3%) of the 212 included patients were mid-term poor WL responders. They showed an improvement in all metabolic markers at 2 years, except for total cholesterol. This improvement with respect to baseline was maintained at 5 years for plasma glucose, HbA1c, HOMA, HDL and diastolic blood pressure; however, LDL cholesterol, triglycerides and systolic blood pressure were similar to presurgical values. Comorbidity remission rates were comparable to those obtained in the good WL group except for hypercholesterolaemia (45.8% vs. poor WL, p = 0.005). On multivariate analysis, lower baseline HDL cholesterol levels, advanced age and lower preoperative weight loss were independently associated with poor mid-term WL. Conclusions: Although that 1 in 5 patients presented suboptimal WL 5 years after bariatric surgery, other important metabolic benefits were maintained.

Complications of the Intragastric Balloon

Intragastric balloons (IGB) have been used in the treatment of obesity for over 30 years. The first notable IGB device (the Garren Edwards Gastric Bubble) was withdrawn from the market due to patients’ poor weight loss and a high rate of complications. Several subsequent devices have been designed to address these shortcomings, but high-quality data are needed to compare complication rates among devices. Mortality across all IGB variants is extremely low compared to other bariatric procedures. Complications are mainly associated with visceral injury related to device insertion and retrieval, and with the presence or migration of an in-situ device, such as gastric ulceration and perforation, intolerance, gastrointestinal obstruction, and, rarely, acute pancreatitis. The incidence of postoperative venous thromboembolism (VTE) has not been extensively investigated, and it is not clear whether VTE is device-related or is due to increased VTE risk in bariatric patients.