Higher Socioeconomic Status is Associated with Improved Outcomes After Obesity Surgery Among Women in Germany

Background Low socioeconomic status (SES) is associated with an increased prevalence of obesity. It is unknown whether SES influences the outcome after bariatric surgery in Germany. Therefore, the aim of our study was to investigate whether the SES is linked with an inferior outcome after bariatric surgery. Methods We included all patients who underwent bariatric surgery in our university hospital from 2012–2014. Net income was estimated by matching the zip codes of patient residency with the region-specific purchasing power index. We analyzed the relationship between SES, weight loss and remission of comorbidities. Results We included 559 patients in this study and detected a mean 5-year percentage excess weight loss (%EWL) of 52.3%. We detected a significantly lower initial body mass index (BMI) and weight in patients with a higher income. One year after surgery, we did not find a significant difference. Further analysis revealed that only women with a higher income had a significantly lower BMI and weight 3 and 5 years after surgery. Conclusions Bariatric surgery is beneficial for all patients regardless of income. Furthermore, we demonstrated that women with high SES have a better outcome after bariatric surgery.

Is One Anastomosis Gastric Bypass with a Biliopancreatic Limb of 150 cm Effective in the Treatment of People with Severe Obesity with BMI > 50?

Purpose The treatment of people with severe obesity and BMI > 50 kg/m2 is challenging. The present study aims to evaluate the short and mid-term outcomes of one anastomosis gastric bypass (OAGB) with a biliopancreatic limb of 150 cm as a primary bariatric procedure to treat those people in a referral center for bariatric surgery. Material and Methods Data of patients who underwent OAGB for severe obesity with BMI > 50 kg/m2 between 2010 and 2017 were collected prospectively and analyzed retrospectively. Follow-up comprised clinical and biochemical assessment at 1, 3, 6, 12, 18, and 24 months postoperatively, and once a year thereafter. Results Overall, 245 patients underwent OAGB. Postoperative mortality was null, and early morbidity was observed in 14 (5.7%) patients. At 24 months, the percentage total weight loss (%TWL) was 43.2 ± 9, and percentage excess weight loss (%EWL) was 80 ± 15.7 (184 patients). At 60 months, %TWL was 41.9 ± 10.2, and %EWL was 78.1 ± 18.3 (79 patients). Conversion to Roux-en-Y gastric bypass was needed in three (1.2%) patients for reflux resistant to medical treatment. Six patients (2.4%) had reoperation for an internal hernia during follow-up. Anastomotic ulcers occurred in three (1.2%) patients. Only two patients (0.8%) underwent a second bariatric surgery for insufficient weight loss. Conclusion OAGB with a biliopancreatic limb of 150 cm is feasible and associated with sustained weight loss in the treatment of severe obesity with BMI > 50 kg/m2. Further randomized studies are needed to compare OAGB with other bariatric procedures in this setting. Graphical abstract

Endoscopic sleeve gastroplasty: suturing the gastric fundus does not confer benefit

Background There is heterogeneity regarding the technical aspects of endoscopic sleeve gastroplasty (ESG), such as applying fundal sutures. Our aim was to determine whether ESG with fundal suturing (ESG-FS) affects weight loss and the serious adverse event (SAE) rate when compared with ESG with no fundal suturing (ESG-NFS). Methods We conducted a two-center retrospective analysis of 247 patients who underwent ESG with or without fundal suturing. The primary outcome was percentage excess weight loss (%EWL) at 3, 6, and 12 months post-ESG. The secondary outcomes included the SAE rate and procedure duration. Results At 3, 6, and 12-months, ESG-NFS had a significantly greater mean %EWL compared with ESG-FS (38.4 % [standard deviation (SD) 15.3 %] vs. 31.2 % [SD 13.9 %], P = 0.001; 54.7 % [SD 19.2 %] vs. 37.7 % [SD 17.3 %], P < 0.001; 65.3 % [SD 21.1 %] vs. 40.6 % [SD 23.5 %], P < 0.001, respectively). There was no statistically significant difference in the SAE rates for ESG-NFS (n = 2; 2.0 %) and ESG-FS (n = 4; 2.6 %; P > 0.99). The mean procedure time was significantly shorter in the ESG-NFS group at 59.1 minutes (SD 32.7) vs. 93.0 minutes (35.5; P < 0.001), and a lower mean number of sutures were used, with 5.7 (SD 1.1) vs. 8.4 (SD 1.6; P < 0.001). Conclusion ESG-NFS demonstrated greater efficacy and shorter procedure duration. Therefore, fundal suturing should not be performed.

Bariatric surgery between encouragement and inhibition: Sohag experience of first 50 cases with encouraging results

Background: The advantages of bariatric surgery are improved co-morbidity, quality of life and survival in obese patients. Nowadays, many studies compare effectiveness of different bariatric surgery procedures. Our aim is to evaluate effectiveness of two laparoscopic bariatric surgery procedures performed in our centre (SG and OAGB) as regard outcome and post- operative complications.Methods: A retrospective study for our first 50 cases of bariatric surgery. Primary outcome was weight loss expressed as kilograms, body mass index (BMI) reduction and percentage excess weight loss % EWL. Secondary outcomes were remission or control of associated diabetes mellitus type2, hypertension and dyslipidaemia.Results: LSG was done in 38 cases and OAGB in 12 cases. Mean operating time for LSG was 75.6±10.5 min and for OAGB was 98.5±11.5 min. Mean length of hospitalization for LSG was 3.7±1.4 days and for OAGB was 5.2±1.6 days. Post-operative complication occurred in one patient (2.6%) with LSG and in two patients (16.6%) with OAGB. No significant statistical differences were found as regard short term complications or death. Mean EWL at 6 months was higher in patients receiving OAGB (59%) compared to those receiving LSG (47%). After 1 year it was (73% vs. 62%) and at 1.5 years (87% vs. 76%), respectively. At 6 months, associated comorbidities showed significant improvement in both groups but more with OAGB.Conclusions: For the short term, OAGB appears to achieve better %EWL and remission of obesity-associated comorbidities compared with the LSG.

Contemporary Role of Robotics in Bariatric Surgery: Experience of CUF Infante Santo Hospital

INTRODUCTION: The use of robotics in bariatric surgery is increasing worldwide, with the main objective of reducing complications and optimising surgical outcome. This study presents a single centre 1.5-year experience and clinical outcome with robotic gastric bypass. METHODS: A retrospective review was performed of 42 consecutive patients who underwent a robotic gastric bypass. Patient files were analysed to obtain patient characteristics, weight loss results and per- and postoperative morbidity. RESULTS: In 32/42 patients, a primary gastric bypass was performed, the remaining 10 procedures were revision cases. Mean start weight was 111.1 (+/- 20.5) kg, mean start BMI was 39.7 (+/- 5.6) kg/m2. Almost half of the patients presented with pre-existing comorbidities. After a mean follow-up of 9.1 (+/-5.2) months, mean body mass index was 30.16 (+/-5.3) kg/m2 with a percentage excess weight loss of 66.16 (+/- 43.6)%. There were no conversions, no leaks and no mortality. Two patients presented with minor complications; one infected hematoma and one anastomotic ulcer. Mean length of stay in the hospital was 2.8 (2-5) days. All but one patients were satisfied with the weight loss result. CONCLUSION: The robotic gastric bypass is a safe and reproducible approach to treat morbid obesity. A secure handsewn gastrojejunal anastomosis, quick recovery and better ergonomics are the main advantages of this technique.

Three-Dimensional Laparoscopic Sleeve Gastrectomy: Improved Patient Safety and Surgeon Convenience

One of the aims of laparoscopic surgery is to improve upon the results obtained by open surgery. This clearly appears to have been achieved in bariatric surgery. Two-dimensional (2-D) systems have been used to date, though new 3-dimensional (3-D) technologies have been introduced in an attempt to improve surgeon vision and thus increase the safety of the surgical techniques. Sixty obese patients underwent sleeve gastrectomy using a device equipped with 3-D optics allowing surgery to be viewed by the surgeon in 3 dimensions by using a specific monitor and wearing appropriate glasses. The mean patient age was 48.1 years. The mean weight was 114 kg (range, 92–172), with a mean body mass index (BMI) of 44 ± 5.21 kg/m2. All surgeries were performed using the 3-D system, with a mean surgical time of 71 ± 49.6 minutes and a mean hospital stay of 3.0 ± 1.2 days. Only 1 intraoperative complication was recorded: retroperitoneal bleeding on insertion of the optical trocar. Over a mean follow-up period of 12 months, the mean body weight of the patients was 88 kg (range, 71–121), with a BMI of 30.56 ± 3.98 kg/m2 and a percentage excess weight loss of 68.14% ± 7.89%. There was clear improvement of both the blood pressure and glucose levels. Three-dimensional sleeve gastrectomy is safe, viable, and fully reproducible compared with 2-D surgery, improving visualization of the surgical field, safety, and surgeon convenience. Randomized studies involving larger patient samples are needed for the comparison of results.

Laparoscopic Sleeve Gastrectomy with Comparable Weight Loss in All Obese Groups: A VA Hospital Experience

Laparoscopic sleeve gastrectomy (LSG) is gaining popularity as a standalone procedure for the surgical treatment of obesity in the superobese because of higher failure with Roux-en-Y gastric bypass. We report a single-institution experience with LSG as the procedure of choice in all obese groups and comparing weight loss in the nonsuperobese and superobese patients. LSGs performed between February 2009 and June 2011 were reviewed. Body mass index (BMI), percentage excess weight loss (%EWL), and percentage excess BMI loss were analyzed for two groups of nonsuperobese (Group I) and superobese (Group II) at 3, 6, and 12 months postoperative visits. Two-sample t tests were used to compare groups. At each postoperative visit, reductions in BMI and amount of weight loss were higher in Group II but %EWL was statistically similar in both groups. The %EWL was 29.5 versus 29.9 per cent at 3 months ( P = 0.9246), 51.7 versus 47.5 per cent at 6 months ( P = 0.9800), and 52.8 versus 52.6 per cent at 12 months ( P = 0.9755). Both groups demonstrated satisfactory resolution of most preoperative comorbidities. Success rate of weight loss after LSG as a standalone procedure is comparable in the superobese and nonsuperobese patients.