Lipid risk profile and weight stability after gastric restrictive operations for morbid obesity

There are no longitudinal data that address weight loss stability and lipid levels in bariatric surgical patients. The goal of this study was to determine whether weight regain adversely affected reduction in lipid levels after gastric bariatric operations. Of 651 consecutive patients undergoing gastric restrictive surgery for morbid obesity, 227 (35%) had increased serum levels of total cholesterol (TC), triglycerides, or both preoperatively. High-density lipoprotein cholesterol (HDL-C) levels were subnormal (≤35 mg/dl) in 45 (20%) of the hyperlipidemic patients. Fasting lipid profiles were determined at 6-month intervals postoperatively. This series included the following three operations: gastroplasty (GP; N = 13), standard Roux-en-Y gastric bypass (RYGB; N = 205), and distal Roux-en-Y gastric bypass (DRY; N = 9). By 6 months postoperatively, patients had a ≥15% mean reduction in TC and a ≥50% mean reduction in triglycerides, both of which were significant in comparison with preoperative levels (P ≤0.05). Mean HDL-C levels had increased significantly vs. preoperative levels by 12 months postoperatively (P <0.05) and continued to increase through 5 years. By 18 months both HDL-C and TC were significantly lower after DRY than after GP or RYGB. In 91 patients who were followed for 2 years or longer (mean 48 ± 25 months), mean excess weight loss was 55% with mean body mass index reduced from 48 to 33 kg/m². This group was divided into patients whose weight remained stable (N = 54) and patients who regained ≥l5% of their lost weight or lost less than 50% of excess weight (N = 3 7). Although mean excess weight loss and body mass index were significantly different between the two groups (P <0.0001) at 2 years, there was no difference in the lipid profile (TC/HDL) between the two groups at any interval through 5 years. These results show that abnormal lipid profiles can be permanently improved after gastric bariatric surgery and are not adversely affected by mediocre weight loss or regaining ≥15% of lost weight. DRY appears to be a superior operation for TC reduction in comparison with GP and RYGB.     

10-year weight loss outcomes after Roux-en-Y gastric bypass and attendance at follow-up visits: a single-center study

BackgroundLong-term durability of weight loss is a prerequisite for a greater acceptance of bariatric surgery.ObjectivesTo examine long-term weight trajectory in patients undergoing Roux-en-Y gastric bypass (RYGB) and determine factors predicting long-term follow-up and weight outcomes.SettingUniversity hospital.MethodsA retrospective cohort of adults who underwent RYGB during 1997–2010 were identified and followed until 2017. Predictors for attendance at periodic follow-up visits, reduction in body mass index (BMI), and percent excess BMI lost were determined using multivariable logistic regression and linear mixed-effects models. The latter was used to predict long-term weight outcomes for a typical patient.ResultsThe study included 1104 patients with a mean age of 45.5 (standard deviation [SD] 9.9) years and a preoperative BMI of 54.7 (SD 10.9) kg/m². Follow-up data were available for 92.8% of the patients after 1 year, 50.0% after 5 years, and 35.2% after 10 years post-surgery. Black patients, compared with White patients, were less likely to attend follow-up visits. Attendance at follow-up visits at least every other year was not associated with larger weight loss, but higher preoperative BMI, being White (versus Black), and female sex were. Predicted BMI reduction for a typical patient, a 45-year-old White female with a preoperative BMI of 54.7 kg/m² and private health insurance, undergoing laparoscopic RYGB in 2004, was 18.3 (standard error [SE] .36) kg/m² at year 5 and 17.6 (SE .49) kg/m² at year 10.ConclusionRYGB results in clinically significant and durable weight loss. Attendance at periodic follow-up visits does not appear to be associated with long-term weight loss outcomes. Future work should focus on strategies to remove barriers to post-operative care.     

A one-step conversion from gastric banding to laparoscopic Roux-en-Y gastric bypass is as safe as a two-step conversion: A comparative analysis of 885 patients

Aims: To achieve additional weight loss or to resolve band-related problems, a laparoscopic adjustable gastric banding (LAGB) can be converted to a laparoscopic Roux-en-Y gastric bypass (RYGB). There is limited data on the feasibility and safety of routinely performing a single-step conversion. We assessed the efficacy of this revisional approach in a large cohort of patients operated in a high-volume bariatric institution.

Methods: Between October 2004 and December 2015, a total of 885 patients who underwent LAGB removal with RYGB were identified from a prospectively collected database. In all cases, a single-stage conversion procedure was planned. The feasibility of this approach and peri-operative outcomes of these patients were evaluated and analyzed.

Results: A single-step approach was successfully achieved in 738 (83.4%) of the 885 patients. During the study period, there was a significant increase in performing the conversion from LAGB to RYGB single-staged. No mortality or anastomotic leakage was observed in both groups. Only 45 patients (5.1%) had a 30-d complication: most commonly hemorrhage (N?=?20/45), with no significant difference between the groups.

Conclusion: Converting a LAGB to RYGB can be performed with a very low morbidity and zero-mortality in a high-volume revisional bariatric center. With increasing experience and full standardization of the conversion, the vast majority of operations can be performed as a single-stage procedure. Only a migrated band remains a formal contraindication for a one-step approach.     

Ten-year outcome of one-anastomosis gastric bypass with a biliopancreatic limb of 150 cm versus Roux-en-Y gastric bypass: a single-institution series of 940 patients

BackgroundLong-term outcomes of one-anastomosis gastric bypass (OAGB) need to be compared with those of Roux-en-Y gastric bypass (RYGB).ObjectiveThe present study evaluates the long-term outcomes at 10-year follow-up of OAGB with a biliopancreatic limb of 150 cm versus RYGB.SettingPrivate practice, France.MethodsData of patients who underwent OAGB or RYGB as primary or secondary procedures between 2010 and 2011 at a referral center were collected prospectively and analyzed retrospectively.ResultsA total of 940 patients underwent OAGB (n = 405) or RYGB (n = 535). Operative time was significantly shorter in the OAGB group. Postoperative morbidity occurred in 17.2% of patients after RYGB versus 8.1% after OAGB (P ≤ .0001). Patients in the RYGB group had a significantly higher rate of kinking of the jejuno-jejunal anastomosis, stenosis of the gastrojejunal anastomosis, and dysphagia for early ulcers. At long term, no differences were found in the rate of severe malnutrition. Cumulated morbidity was significantly higher after RYGB, with higher incidence of internal hernia, anastomotic ulcer, blind-loop syndrome, and hypoglycemia. Conversion to RYGB and laparoscopic exploration for chronic pain were more frequent after OAGB. Surgery for weight regain was significantly more frequent after RYGB. Patients in the OAGB group had significantly lower weight, body mass index, and greater percentage excess, and total weight losses at 120 months. No significant differences were detected in co-morbidity outcomes.ConclusionAfter 10 years, both RYGB and OAGB are effective procedures. However, OAGB is associated with shorter operative times and better results in short- and long-term morbidity and weight loss outcomes.     

Comparison of one-anastomosis gastric bypass and Roux-en-Y gastric bypass for treatment of obesity: a 5-year study

BackgroundRoux-en-Y gastric bypass (RYGB) is the gold standard in bariatric surgery. One-anastomosis gastric bypass (OAGB) has been reported to have equivalent or better weight loss, with added advantages of being technically easy, amenable to reintervention/reversal, and offering better food tolerance.ObjectiveThis study was undertaken to compare weight loss, metabolic syndrome outcome, complications, and long-term nutritional outcomes between the 2 procedures.SettingsA high-volume, private-practice bariatric surgery center in India.MethodThis retrospective study is based on prospectively maintained data in a cohort of patients who had either RYGB or OAGB in 2012 at a single institution by a single surgeon. Patients were all eligible for 5-year follow-up.ResultsOn hundred twenty-two patients had RYGB and 90 had OAGB. The mean age was 44 and 46.4 years, body mass index was 45.8 and 42, percentage of total weight loss was 36.4 and 25.9, and percentage of excess weight loss was 81.6 and 66.7 for OAGB and RYGB groups, respectively. Resolution of type 2 diabetes was 79%, hypertension 57%, dyslipidemia 56%, and sleep apnea 94.54% in OAGB patients compared with type 2 diabetes of 61%, hypertension of 43%, dyslipidemia of 53%, and sleep apnea of 90.74% in RYGB patients. OAGB patients had more nutritional deficiencies than RYGB patients: anemia 44% versus 17%, hypoalbuminemia 32% versus 15%, and hypocalcemia 19% versus 8%, and other complications 7.8% versus 1.6%, respectively. There were no deaths in this study.ConclusionOAGB is associated with more weight loss and better resolution of co-morbid conditions. However, it is also associated with more nutritional deficiencies. There is a need for long-term follow-up and multicenter reports to confirm these findings.     

One-year weight loss after primary or revisional Roux-en-Y gastric bypass for failed adjustable gastric banding

BackgroundAdjustable gastric banding has been widely used in Europe, but recently gastric bypass (Roux-en-Y gastric bypass [RYGB]) has become the procedure of choice. With a gastric banding failure rate of nearly 40% at 5 years, the need for revisional surgery is increasing. The effect of a failed previous bariatric surgery on the weight loss curve after RYGB is still a controversial issue.MethodsA total of 259 patients underwent RYGB from 2003 to 2007, 58 after failed gastric banding and 201 as primary surgery. All the procedures were laparoscopically performed by the same surgeon at a single institution. The postoperative course and the percentage of excess weight loss were compared between the 2 groups.ResultsThe 2 groups were similar in age and initial body mass index (46.3 ± 7.2 kg/m² for revision versus 47.7 ± 6.7 kg/m² for primary RYGB). In contrast, the prerevision body mass index was 43.2 ± 7.0 kg/m². Revisional RYGB required a significantly longer operative time (128.3 ± 25.9 minutes versus 89.0 ± 14.7 minutes, P <.0001) and the morbidity was greater (8.6% versus 5.5%), but no patient died in the postoperative period after revision. As determined from the initial body mass index, the 1-year percentage of excess weight loss was comparable between the 2 groups (66.1% ± 26.8% and 70.4% ± 18.9%).ConclusionWhen RYGB is performed after an adjustable gastric band failure to restore weight loss or because of a complication, the weight loss curve is similar to that after primary RYGB. Therefore, the strategy of adjustable gastric banding first is an option that does not seem to preclude satisfactory weight loss after revision to RYGB.     

Longitudinal analysis of cardiovascular parameters after gastric bypass surgery

BackgroundIdentifying the predictors of co-morbidity improvement after gastric bypass surgery (Roux-en-Y gastric bypass) might give insight into disease pathophysiology.MethodsWe performed an observational study of 949 patients undergoing primary RYGB from 2005 to 2010. Multivariate mixed models were used to determine the predictors of change in hemoglobin A1c (HbA1c), lipids, systemic blood pressure, and C-reactive protein.ResultsGreater weight loss, decreased severity of initial disease, and a greater initial body mass index predicted a significantly greater likelihood of improvement in nearly all measured parameters. Male gender predicted greater improvement in diastolic blood pressure and low-density lipoprotein and triglyceride levels. Younger patients had a greater improvement in blood pressure. Improvement in the lipid profile was independent of weight loss, and improved glycemic control was strongly dependent on weight loss. Of the 949 patients, 33% had diabetes before RYGB. A mean of 388 days after RYGB, 66% of these patients had an HbA1c of <6.5, with their mean HbA1c decreasing from 8.0 to 5.9. A greater decrease in HbA1c was also seen in patients who initially were only treated with oral hypoglycemic agents compared with those receiving insulin. The low-density lipoprotein cholesterol levels decreased significantly from a mean of 108 to 87 mg/dL. High-density lipoprotein increased by a mean of 10 mg/dL in both men and women. Also, 15% of the patients had a triglyceride level of ≥200 mg/dL before RYGB and only 1.1% did so afterward. The mean C-reactive protein level decreased from 5.0 to 1.6 mg/dL. We measured a 20% reduction in patients with measured hypertension after RYGB.ConclusionRYGB resulted in dramatic improvement in cardiovascular risk factors, with several significant predictors of outcome.     

The role of total alimentary limb length in Roux-en-Y gastric bypass: a systematic review

BackgroundRoux-en-Y gastric bypass (RYGB) is an established surgical treatment for obesity. Variations in limb length during RYGB procedures have been investigated for optimizing weight loss while minimizing nutritional deficiencies. The role of the total alimentary limb length (TALL; Roux limb plus common channel [CC]), however, is poorly defined.ObjectiveCompare TALL in RYGB procedures for weight loss outcomes and malnutrition.SettingSystematic review.MethodsOvid Medline and PubMed databases were searched for entries between 1993 and 2020. Search terms included “gastric bypass” and “TALL.” Two independent reviewers screened the results.ResultsA total of 21 studies measured TALL in RYGB. Of these, 4 of 6 reported a relationship between TALL and weight loss. Additionally, 11 studies reported that when TALL was ≤400 cm and CC <200 cm, 3.4% to 63.6% of patients required limb lengthening for protein malnutrition.ConclusionsThe majority of studies on RYGB do not report TALL length. There is some evidence that weight loss is affected by shortening TALL, while a TALL ≤400 cm with CC<200 should be avoided due to severe protein malnutrition. More studies on the effect of TALL are needed.     

Roux-en-Y gastric bypass after successful weight loss with a laparoscopic adjustable gastric band: rationales and early outcomes in patients of body mass index<35 kg/m2

BackgroundLaparoscopic adjustable gastric banding (LAGB) has a number of well-established acute and chronic issues that can require revisional surgical procedures. There is no existing data to evaluate conversion of band patients with body mass index (BMI)<35 kg/m² from LAGB to a Roux-en-Y gastric bypass (RYGB). This study aims to report on the indications for and the safety profile of conversion of the LAGB to RYGB in patients with BMI<35 kg/m².MethodsA review of data from 200 consecutive conversions of LAGB to RYGB was conducted. Fifty-two patients whose BMI was<35 kg/m² were included in this analysis. Indications for conversion, technical details, early morbidity, length of hospital stay, and weight loss data were assessed.ResultsLaparoscopic conversion to RYGB was performed in 100% of patients. The median BMI pre-RYGB was 32.8 kg/m². The most common indication for surgery was weight regain after removal of LAGB (28.8%). There was no mortality. Early morbidity was seen in 25% of patients; the most common complication was stricture of the gastrojejunal anastomosis (9 patients).ConclusionMorbidity resulting from conversion of LAGB to RYGB in patients with BMI <35 kg/m² is similar to that seen in the BMI>35 kg/m² population. The procedure is technically challenging and morbidity rates are higher than those reported for surgically ‘naïve’ patients. It is recommended that this procedure be undertaken by appropriately trained surgeons in high-volume bariatric centers to optimize safety and outcomes.     

Plasma progranulin levels in obese patients before and after Roux-en-Y gastric bariatric surgery: a longitudinal study

BackgroundBariatric surgery stands out as the most effective long-term intervention for sustainable weight loss and metabolic improvement in patients with severe obesity. Progranulin was recently identified as an adipokine related to obesity and inflammation, revealing a metabolic function and proinflammatory properties.ObjectiveTo evaluate plasma progranulin levels before and after 6 months of bariatric surgery in Roux-en-Y gastric bypass (RYGB).SettingTertiary referral hospital, southern Brazil.MethodsThis was a prospective longitudinal study, including 23 obese patients who underwent RYGB. Demographic and clinical characteristics, body composition, and resting energy expenditure were evaluated. Plasma progranulin was determined with enzyme-linked immunosorbent assays in a peripheral blood sample collected before and 6 months after the surgical procedure.ResultsThe participants were mostly women (78.3%), with a mean age of 42.3 ± 10.8 years and baseline body mass index of 48.8 ± 10.4 kg/m². Regarding the anthropometric parameters, there were differences in the pre- and post-RYGB values, with reduction of weight, body mass index, body fat percentage, and cervical and abdominal circumferences. All laboratory parameters improved, such as lipid profile and fasting glycemia, and resting energy expenditure values decreased significantly. Plasma progranulin levels decreased from 47.6 ± 13.5 ng/mL before RYGB to 40.4 ± 9.9 ng/mL after 6 months of surgery (P = .005). The reduction of progranulin did not correlate with body composition or laboratory data.ConclusionsPlasma progranulin levels significantly reduced 6 months after RYGB, but it could not be explained by changes in anthropometry, body composition, or glycemic or lipid profile.     

Roux-en-Y gastric bypass increases hepatic and peripheral insulin sensitivity in rats with type 2 diabetes mellitus

BackgroundRoux-en-Y gastric bypass (RYGB) surgery for the treatment of obesity leads to long-term diabetes remission in approximately 80% of cases. The aim of this study was to investigate the effects of RYGB on hepatic and peripheral insulin sensitivity in type 2 diabetic rats and their possible mechanisms. We also tested the hypothesis that RYGB reduces lipid content and improves insulin sensitivity in hepatocytes and skeletal muscle cells.MethodsSprague–Dawley rats were divided into 4 groups: diabetic RYGB group (n = 18), diabetic RYGB sham group (n = 6), diabetic group (n = 6), and nondiabetic control group (n = 6). The hyperinsulinemic-euglycemic clamp with tracer infusion was completed at 2, 4, and 8 weeks postoperatively to assess insulin sensitivity. The lipid content in liver and muscle tissue was examined.ResultsPostoperatively, the diabetic RYGB group had significant decreases in weight, fat mass, and food intake. Two weeks after surgery, RYGB had significantly improved the hepatic insulin sensitivity index and decreased the hepatic triglyceride, total cholesterol, and fatty acyl-CoA content. The significantly increased insulin sensitivity and decreased lipid content in muscle were not detected until 4 weeks after RYGB surgery. The basal insulin and C-peptide concentrations were significantly lower than those in diabetic group by 2 weeks after RYGB.ConclusionThe increased insulin sensitivity after RYGB occurs earlier in the liver than in the muscle and both may contribute to long-term remission of type 2 diabetes. Reduced lipid content of hepatocytes and skeletal muscle cells after RYGB may contribute to the improved insulin sensitivity in these cells.     

Conversion of one-anastomosis gastric bypass to Roux-en-Y gastric bypass: short-term results from a tertiary referral center

BackgroundOne-anastomosis gastric bypass (OAGB), also known as minigastric bypass, is an increasingly popular bariatric surgery option worldwide. While OAGB offers advantage in terms of procedure time and technical ease, revisional operations to correct complications may be necessary.ObjectivesWe aimed to describe the indications and perioperative outcomes for OAGB conversions to Roux-en-Y gastric bypass (RYGB) at a single-referral center.SettingAcademic hospital, Abu Dhabi, United Arab Emirates.MethodsAll patients undergoing conversion from OAGB to RYGB from February 2016 through September 2018 were retrospectively identified from a prospectively maintained database of revisional bariatric surgeries.ResultsSixteen patients underwent conversion from previous OAGB to RYGB during the study period. The cohort was 62.5% female (n = 10) with a mean age of 40.2 years and median body mass index of 30.7 kg/m². Indications for conversion included intractable nausea/vomiting (n = 8, 50.0%), biliary reflux (n = 3, 18.8%), weight recidivism (n = 3, 18.8%), and protein-calorie malnutrition (n = 2, 12.5%). Twelve cases (75.0%) were successfully completed with a laparoscopic approach, with 4 cases (25.0%) converted to open. The median length of stay was 5.5 days. Six patients (37.5%) experienced minor and major complications within 30 days of discharge. Fourteen patients (87.5%) were available for follow-up at 6 months, with 100% of these patients reporting resolution of their preoperative symptoms. There were no mortalities.ConclusionsData from this largest reported single-center experience demonstrates that conversion of OAGB to RYGB is safe and technically feasible. Further studies and longer-term follow-up are needed to definitively describe outcomes after this revisional bariatric surgery.     

Roux-en-Y gastric bypass for obesity after Belsey-Mark IV for large hiatus hernia and intrathoracic stomach,in combination with gastroesophageal reflux disease

Background: Obesity is an increasing problem worldwide; patients who remain obese after non-surgical interventions are potential candidates for surgical intervention. Laparoscopic Roux-en-Y gastric bypass (RYGB) has proven its effects on excess weight loss and its positive effect on comorbidities and also, on reflux correction.

Case report: Our patient, a 53-year-old male, with a BMI of 45?kg/m² and type 2 diabetes, underwent a Belsey-Mark IV procedure in another center because of a large hiatus hernia and intrathoracic stomach, in combination with gastroesophageal reflux disease (GERD). He consulted at our center concerning his morbid obesity. After a positive preoperative evaluation a RYGB was performed with an uneventful postoperative course.

Conclusion: RYGB is a safe and feasible procedure to perform after a Belsey-Mark IV procedure. To our knowledge, this is the first and only report of a RYGB after a Belsey-Mark IV procedure. There were no intra-operative complications and 18 months follow-up was unremarkable, with a 78.10% excess weight loss (EWL), at 86?kg, and no remaining symptoms of GERD. We also mention resolution of the patient’s diabetes mellitus type 2 measured by the cessation of the glucophage, which is an added health benefit.     

Laparoscopic adjustable gastric band versus laparoscopic Roux-en-Y gastric bypass

Background In the United States, the most frequently performed bariatric procedure is the Roux-en-Y gastric bypass (RYGB). Worldwide, the most common operation performed is the laparoscopic adjustable gastric band (LAGB). The expanding use of LAGB is probably driven by the encouraging data on its safety and effectiveness, in contrast to the disappointing morbidity and mortality rates reported for RYGB. The aim of this study was to evaluate the results of LAGB versus RYGB at a single institution. Methods Between November 2000 and July 2004, 590 bariatric procedures were performed. Of these, 120 patients (20%) had laparoscopic RYGB and 470 patients (80%) had LAGB. A retrospective review was performed. Results In the LAGB group, 376 patients (80%) were female, and the mean age was 41 years (range, 17–65). In the RYGB group, 110 patients (91%) were female, and the mean age was 41 years (range, 20–61). Preoperative body mass index was 47 ± 8 and 46 ± 5, respectively (p = not significant). Operative time and hospitalization were significantly shorter in LAGB patients (p < 0.001). Complications and the need for reoperation were comparable in both groups. Weight loss at 12, 18, 24, and 36 months for LAGB and RYGB was 39 ± 21 versus 65 ± 13, 39 ± 20 versus 62 ± 17, 45 ± 25 versus 67 ± 8, and 55 ± 20 versus 63 ± 9, respectively. Conclusions The current study demonstrates that LAGB is a simpler, less invasive, and safer procedure than RYGB. Although mean percentage excess body weight loss (%EBWL) in RYGB patients increased rapidly during the first postoperative year, it remained nearly unchanged at 3 years. In contrast, in LAGB patients weight loss was slower but steady, achieving satisfactory %EBWL at 3 years. Therefore, we believe that LAGB should be considered the initial approach since it is safer than RYGB and is very effective at achieving weight loss.     

The influence of the percentage of the common limb in weight loss and nutritional alterations after laparoscopic gastric bypass

BackgroundRoux-en-Y gastric bypass (RYGB) is considered the gold standard for the treatment of morbid obesity. There is no consensus over ideal limb length when the bypass is created and published studies do not take into account the influence of the common limb (CL) on weight loss. The objective was to study the influence of the common limb after RYGB. The setting was the Virgen de la Arrixaca University Clinical Hospital in Murcia, Spain.Material and MethodsThis prospective study includes 151 patients undergoing laparoscopic RYGB surgery for morbid obesity. The patients were divided into 2 groups according to their body mass index. The small intestine (SI) was measured using micro forceps so that the percentage of common limb (%CL) could then be compared against the total SI in each patient. The percentage of excess weight loss (%EWL) in relation to the %CL was calculated at 3, 12, and 24 months. A series of tests was conducted simultaneously to analyze nutritional deficiencies and their relation to the %CL.ResultsThe total jejunoileal segment and the %CL in the groups of both obese and super-obese patients had no influence on the %EWL in either group for any of the periods studied. The patients with a %CL<50% had greater nutritional deficiencies in the follow-up period and required supplements and more frequent laboratory tests.ConclusionsThe %CL has no effect on weight loss in RYGB patients. A lower %CL is related to greater nutritional deficiencies.     

Comparison of weight loss outcomes between Roux-en-Y gastric bypass and sleeve gastrectomy in a racially mixed urban patient population

BackgroundNational data show a trend favoring laparoscopic sleeve gastrectomy (SG) over Roux-en-Y gastric bypass (RYGB). Published data demonstrating the differences in weight loss between the two procedures are mixed.ObjectiveIn this retrospective study using clinical data from 2010 to 2020, we compared the clinical and demographic characteristics of patients undergoing either SG or RYGB to evaluate their long-term weight loss outcomes.SettingUniversity hospital in the United States.MethodsA total of 3329 patients were identified in our institutional Metabolic and Bariatric Surgery Accreditation and Quality Improvement database using Current Procedural Terminology codes for either RYGB or SG. A general linear model was used for baseline characteristics. Logistic regression was used for factors favoring RYGB versus SG. A multivariable linear mixed model was used for weight-trajectory analysis. Cox regression was used for a cumulative hazard ratio of 10% weight regained from nadir.ResultsFactors favoring RYGB were diagnoses of type 2 diabetes and gastroesophageal reflux disease, Hispanic ethnicity, and surgeon’s preference. SG was favored among Black patients and smokers. RYGB was associated with more weight loss at all time points. The risk of weight regain was significantly higher after SG versus RYGB.ConclusionsThe bariatric procedure choice is significantly influenced by race, medical history, and surgeon’s experience. RYGB results in a significantly more durable weight loss compared with SG regardless of race or other stratification factors.     

The male patient with obesity undergoing metabolic and bariatric surgery: changes in testosterone levels correlate with weight loss after one-anastomosis gastric bypass and Roux-en-Y gastric bypass

BackgroundMale obesity secondary hypogonadism (MOSH) is a common disease among men with obesity and can be associated with metabolic syndrome and a variety of metabolic problems ultimately leading to androgen deficiency. Metabolic and bariatric surgery is a well-established treatment option associated with significant weight loss and reduction in metabolic co-morbidities.ObjectivesTo evaluate the impact of surgery on plasma levels of sexual hormones and their effect on weight loss comparing 2 surgical methods (one-anastomosis gastric bypass [OAGB] and Roux-en-Y gastric bypass [RYGB]) in male patients with obesity.SettingUniversity hospital, Austria.MethodsPatients undergoing OAGB and RYGB between 2012 and 2017 were analyzed retrospectively. Follow-up in this study was up to 24 months. Systemic levels of sexual hormones (luteinizing hormone [LH]), follicle stimulating hormone [FSH], total testosterone [TT], sexual hormone binding globin [SHBG], 17 beta-estradiol [17bE], androstenedione [AS]) were retrieved at each visit. A linear mixed model was used to assess the correlation between changes in testosterone levels and percent excess weight loss (%EWL).ResultsIn 30.8% of all patients, MOSH was present preoperatively. A significant increase of TT was observed postoperatively that led to a complete resolution of hypogonadism within the period observed. Bioavailable testosterone (bTT) and FSH levels significantly increased each month of follow-up after surgery (all P < .01). Levels of 17bE did not change significantly after surgery. The overall change of TT, comparing preoperative and 1-year postoperative TT levels (ΔTT), significantly correlated with %EWL. Changes in TT levels were not affected by the choice of surgical method.ConclusionsSerum plasma testosterone levels rise significantly after metabolic and bariatric surgery in male patients. The change of testosterone levels seems to play a role in continued weight loss after surgery. This is true irrespective of the surgical method used.     

Conversion from one-anastomosis gastric bypass to Roux-en-Y gastric bypass: when and why—a single-center experience of all consecutive OAGB procedures

BackgroundOne-anastomosis gastric bypass (OAGB) is a well-established treatment method in patients with morbid obesity. Its long-term impact on de novo reflux, anastomotic complications, and malnutrition needs further evaluation. Roux-en-Y gastric bypass (RYGB) is a technically feasible procedure in revisional bariatric surgery. This study presents our institutional data on conversion from OAGB to RYGB.ObjectiveTo determine the reasons for conversion, preoperative endoscopic findings, and feasibility of revisional bariatric surgery after OAGB.SettingUniversity hospital in AustriaMethodsRetrospective analysis of a prospectively fed database. All patients undergoing OAGB between January 2012 and December 2019 were included. Screening was carried out for all patients needing conversion to RYGB. Percent total weight loss, percent excess weight loss, time to conversion, postoperative complications, and reasons for conversion were assessed.ResultsEighty-two of 1,025 patients who underwent OAGB were converted laparoscopically to RYGB. Seven patients were converted early because of anastomotic/gastric tube leakage. Median time to late conversion was 29.1 ± 24.3 months, mean percent excess weight loss was 86.6% ± 33.1% and percent total weight loss was 35.1% ± 13.5%. Forty-two patients were converted because of reflux, 11 because of persistent marginal ulcers, 10 because of anastomotic stenosis, 9 because of malnutrition, and 3 because of weight regain. Seven patients showed Barrett’s metaplasia in biopsies at the gastroesophageal junction before conversion.ConclusionLaparoscopic conversion from OAGB to RYGB is technically feasible with a moderate rate of postoperative complications. Severe (bile) reflux is a serious long-term complication after OAGB, with 4.1% of patients needing conversion to RYGB. Endoscopy after OAGB in patients showing clinical symptoms of gastroesophageal reflux disease is strongly advised to detect underlying pathologic changes.     

The effect of laparoscopic gastric bypass surgery on dyslipidemia in severely obese patients

BACKGROUND: Dyslipidemia is common in the morbidly obese population. Lipid parameters typically improve after bariatric surgery, but the effects have been inconsistent and may depend on the surgical procedure performed. If bariatric surgery consistently improves dyslipidemia, there may be associated cost savings in lipid-modifying medications. METHODS: Patients undergoing laparoscopic Roux-en-Y gastric bypass surgery (RYGB) for morbid obesity had lipid analyses performed preoperatively and 1 and 2 years postoperatively. The number of lipid-modifying medications taken was documented by an electronic medical record review. RESULTS: A total of 168 patients were enrolled. Of these, 96 patients had preoperative and 1-year postoperative data and 18 had preoperative and 2-year postoperative data. In the 1-year cohort, total cholesterol (TC) decreased by 12.5%, low-density lipoprotein cholesterol (LDL) decreased by 19.4%, high-density lipoprotein cholesterol (HDL) increased by 23.2%, triglycerides (TG) decreased by 41.2%, and the percentage of dyslipidemic patients decreased from 82.3% to 28.1% (P < .001 for all). In the 2-year cohort, TC decreased by 7.2% (P = .036), LDL decreased by 21.7% (P < .001), HDL increased by 40.3% (P < .001), TG decreased by 27.3% (P = .015), and the percentage of dyslipidemic patients decreased from 94.4% to 27.8% (P < .001). In the 1-year cohort, 26.0% of patients were taking lipid-modifying medications preoperatively, compared with 14.6% postoperatively (P = .049). CONCLUSIONS: Laparoscopic RYGB improved all lipid parameters studied and decreased the percentage of dyslipidemic patients. Furthermore, fewer patients were taking lipid-modifying medications postoperatively, suggesting a substantial medication cost savings over time.     

Linitis plastica of the bypassed stomach 7 years after Roux-en-Y gastric bypass: a case report

Laparoscopic Roux-en-Y gastric bypass (RYGB) is currently the preferred surgical procedure to treat morbid obesity. It has proven its effects on excess weight loss and its positive effect on comorbidities. One of the main issues, however, is the post-operative evaluation of the bypassed gastric remnant. In literature, cancer of the excluded stomach after RYGB is rare. We describe the case of a 52-year-old woman with gastric linitis plastica in the bypassed stomach after Roux-en-Y gastric bypass, diagnosed by means of laparoscopy and Single-Balloon enteroscopy, and it is clinical importance. Linitis plastica of the excluded stomach after RYGB is a very rare entity. This case report shows the importance of long-term post-operative follow-up, and the importance of single-balloon enteroscopy for visualization of the bypassed stomach remnant, when other investigations remain without results. This case report is only the second report of a linitis plastica in the bypassed stomach after Roux-en-Y gastric bypass.