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Obesity and Bariatric/Metabolic Surgery: Risks, Outcomes, Prognosis, and Development Trends

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: closed (15 September 2023) | Viewed by 15237

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Dr. Laurent Genser

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1. Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Sorbonne Univeristé, Paris, France
2. INSERM, Nutrition and Obesity: Systemic Approach (NutriOmics) Research Unit, Sorbonne Université, Paris, France
Interests: obesity; bariatric; complication; precision medicine; surgery; metabolic surgery

Special Issue Information

Dear Colleagues,

Bariatric practice is moving toward precision medicine and surgery. Recent advances in the understanding of the pathophysiology of obesity and associated metabolic diseases (e.g., type 2 diabetes, hypertension, dyslipidemia) have enabled the identification of implications in clinical features, the development of precise diagnostic methods or targeted therapy, and the accurate prediction of “metabolic prognosis” after weight loss intervention, including bariatric surgery (BS). BS provides long-term weight loss, and revisional surgery is increasingly being performed either in cases of insufficient weight loss or for chronic complications. While the safety profile of BS is constantly improving, efforts should be focused on identifying predicting factors and optimal treatments of severe postoperative morbidity and of metabolic response in primary and revisional settings to define the outcomes in all surgical situations. In addition, the fantastic improvement of metabolic features following surgery has demonstrated that the gastrointestinal tract is a key organ in metabolic regulation and, therefore, a rational target for interventions aimed at treating metabolic disorders (e.g., metabolic surgery). Several recent randomized clinical trials have demonstrated that bariatric/metabolic surgery causes greater improvement of type 2 diabetes and reduction in cardiovascular risk compared with lifestyle modification and medical therapies and regardless of weight loss at the long term, allowing a paradigm shift. With the recent COVID-19 pandemic, telemedicine is rapidly being applied to bariatric practice for optimal follow-up. All these discoveries have improved the clinicians’ approach to diagnosis, treatment, and the prediction of prognosis after weight loss interventions in different settings. The aim of this Special Issue is to highlight recent advances in the context of obesity and bariatric/metabolic surgery.

Dr. Laurent Genser
Guest Editor

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Keywords

obesity
bariatric
complications
follow-up
outcomes
translational

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Published Papers (9 papers)

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Editorial

Jump to: Research

4 pages, 206 KiB

Open AccessEditorial

Precision Bariatric/Metabolic Medicine and Surgery

by Laurent Genser, Dominique Thabut and Judith Aron-Wisnewsky

J. Clin. Med. 2023, 12(5), 1909; https://doi.org/10.3390/jcm12051909 - 28 Feb 2023

Viewed by 1307

Abstract

Indications and techniques of bariatric surgery (BS) have constantly evolved in recent decades and now face new challenges [...] Full article

(This article belongs to the Special Issue Obesity and Bariatric/Metabolic Surgery: Risks, Outcomes, Prognosis, and Development Trends)

Research

Jump to: Editorial

9 pages, 743 KiB

Open AccessArticle

Laparoscopic Sleeve Gastrectomy versus Laparoscopic Roux-en-Y Gastric Bypass: An Analysis of Weight Loss Using a Multilevel Mixed-Effects Linear Model

by Camille Pouchucq, Olivier Dejardin, Véronique Bouvier, Adrien Lee Bion, Véronique Savey, Guy Launoy, Benjamin Menahem and Arnaud Alves

J. Clin. Med. 2023, 12(6), 2132; https://doi.org/10.3390/jcm12062132 - 8 Mar 2023

Cited by 2 | Viewed by 1341

Abstract

Background: Regarding weight loss outcomes, the results published after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y (LRYGB) are conflicting. At this time, no clear evidence exists that outcomes from LSG are similar to those for LRYGB. The main objective of this study was to compare the percent of total weight loss (%TWL) between LRYGB and LSG over the first 2 years using a multilevel mixed-effects linear regression. Methods: Data were collected from a prospectively maintained database of patients who underwent primary laparoscopic bariatric surgery from January 2016 to December 2017 at a French accredited bariatric center. The medical records of 435 consecutive patients were analyzed. %TWL was calculated at each follow-up surgical consultation and used as a repeated outcome variable in our models to assess the long-term %TWL. Due to this hierarchical structure of the data (%TWL at each visit = level 1) within patients (level 2), a multilevel linear regression adjusted for age, sex, preoperative BMI and comorbidities was used. Results: Among the medical records of 435 consecutive patients included, 266 patients underwent LRYGB and 169 underwent LSG. The average %TWL at 2 years was 31.7% for the LRYGB group and 25.8% for the LSG group. The final multivariate model showed that, compared with LRYGB, LSG was associated with a decreased %TWL at over 2 years of follow-up (β: −4.01; CI95%: −5.47 à −2.54; p ≤ 0.001). Conclusion: This observational study suggests that compared with LRYGB, LSG was associated with a decreased %TWL at 2 years using a multilevel model. Further studies are required to confirm the results observed with this statistical model. Full article

(This article belongs to the Special Issue Obesity and Bariatric/Metabolic Surgery: Risks, Outcomes, Prognosis, and Development Trends)

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7 pages, 419 KiB

Open AccessArticle

Urinary Continence Resolution after Bariatric Surgery: Long-Term Results after Six-Year Follow-Up

by Thibaut Waeckel, Khelifa Ait Said, Benjamin Menahem, Anais Briant, Arnaud Doerfler, Arnaud Alves and Xavier Tillou

J. Clin. Med. 2023, 12(6), 2109; https://doi.org/10.3390/jcm12062109 - 8 Mar 2023

Viewed by 1127

Abstract

Background: Bariatric surgery is known to improve stress urinary incontinence (SUI) and overactive bladder disorders (OAB). However, there is little long-term follow-up in the literature. Objective: To determine the long-term effect of bariatric procedures on SUI and OAB and their impact on quality of life, we applied the ICIQ and USP questionnaires. Setting: The research was conducted at a French university hospital with expertise in bariatric surgery. Methods: We performed an updated follow-up at 6 years of a prospective cohort of 83 women who underwent a bariatric procedure between September 2013 and September 2014. The women completed the USP and ICIQ questionnaires before surgery, 1 year and 6 years after the surgery. Results: Of the 83 patients, 67 responded (80.7%) in full. SUI remained improved at 6 years: the USP score decreased from 3 [1; 7] before surgery to 0 [0; 1] (p = 0.0010) at 1 year after surgery and remained at 0 [0; 0] (p = 0.0253) at 6 years. The decrease in the OAB symptom score remained statistically significant: 3 [1; 7] before the surgery vs. 2 [0; 5] at 6 years (p = 0.0150). However, this improvement was significantly less pronounced than at 1 year: 0 [0; 1] (p = 0.002). Conclusions: Bariatric surgery seems to be effective at treating SUI and OAB with a long-lasting effects, still noted at 6 years. Full article

(This article belongs to the Special Issue Obesity and Bariatric/Metabolic Surgery: Risks, Outcomes, Prognosis, and Development Trends)

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12 pages, 425 KiB

Open AccessArticle

Evaluation of Afamin Level after Bariatric Surgery in Patient with Obesity

by Hilmi Demircioglu, Ugur Dogan, Hamit Yasar Ellidag, Arif Aslaner and Osman Zekai Oner

J. Clin. Med. 2023, 12(3), 848; https://doi.org/10.3390/jcm12030848 - 20 Jan 2023

Cited by 1 | Viewed by 1639

Abstract

Background: The aim of this study is to evaluate afamin levels after weight loss in obese patients who underwent laparoscopic sleeve gastrectomy (LSG) and to investigate the relationship between them. In addition, after bariatric surgery, thyroid stimulating hormone (TSH), thyroxine (T4), low-density lipoprotein (LDL), very low-density protein (VLDL), total cholesterol, triglyceride (TG), high-density lipoprotein (HDL), insulin, and hemoglobin A1c (HgbA1c) levels were evaluated. Methods: Preoperative and postoperative 6th month venous blood samples were obtained from 43 patients included in this study. The preoperative and postoperative 6th month body mass index (BMI), TG, total cholesterol, VLDL, HDL, insulin, HgbA1c, TSH, T4, and afamin levels of the patients who underwent bariatric surgery with obesity were compared. Results: Serum afamin levels of patients decreased at 6 months postoperatively; however, it was not statistically significant. We observed a statistically significant decrease in patients’ BMI, HDL, VLDL, TG, total cholesterol, TSH, T4, HgbA1c, and insulin values (p < 0.05). There were significant increases in HDL and T4 values. The change in LDL value was statistically insignificant. Conclusions: Recent studies have shown that there may be a cause–effect relationship between afamin and obesity. In our study, we observed a decrease in serum afamin levels after weight loss following bariatric surgery. In addition, we think that afamin may be used as a potential marker of metabolic syndrome in the future and may lead to improvements in the medical treatment of obesity. Full article

(This article belongs to the Special Issue Obesity and Bariatric/Metabolic Surgery: Risks, Outcomes, Prognosis, and Development Trends)

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6 pages, 209 KiB

Open AccessArticle

Morbidity and Mortality in Non-Obese Compared to Different Classes of Obesity in Patients Undergoing Transtibial Amputations

by Senthil Sambandam, Syed Muhammad Mashhood Ali Bokhari, Shirling Tsai, Vishaal Sakthivel Nathan, Tejas Senthil, Heather Lanier and Sergio Huerta

J. Clin. Med. 2023, 12(1), 267; https://doi.org/10.3390/jcm12010267 - 29 Dec 2022

Cited by 4 | Viewed by 1535

Abstract

This study assesses the effect of obesity classes on outcomes and inpatient-hospital-cost compared to non-obese individuals undergoing below-knee amputations (BKAs). Retrospective matched-case controlled study performed on data from NIS Database. We identified three groups: N-Ob (BMI < 29.9 kg/m²; n = 3104), Ob-I/II (BMI: 30 to 39.9 kg/m²; n = 3107), and Ob-III (BMI > 40; n = 3092); matched for gender, comorbidities, tobacco use and elective vs. emergent surgery. Differences in morbidity, mortality, hospital length of stay (LOS), and total inpatient cost were analyzed. Blood loss anemia was more common in Ob-III compared to Ob-I/II patients (OR = 1.2; 95% CI = 1.1–1.4); blood transfusions were less commonly required in Ob-I/II (OR = 0.8; 95% CI = 0.7–0.9) comparatively; Ob-I/II encountered pneumonia less frequently (OR = 0.9; 95% CI = 0.4–0.9), whereas myocardial infarction was more frequent (OR = 7.0; 95% CI = 2.1–23.6) compared to N-Ob patients. Acute renal failure is more frequent in Ob-I/II (OR = 1.2; 95% CI = 1.0–1.3) and Ob-III (OR = 1.8; 95% CI = 1.6–1.9) compared to the N-Ob cohort. LOS was higher in N-Ob (13.1 ± 12.8 days) and Ob-III (13.5 ± 12.4 d) compared to Ob-I/II cohort (11.8 ± 10.1 d; p < 0.001). Mortality was 2.8%, 1.4%, and 2.9% (p < 0.001) for N-Ob, Ob-I/II, and Ob-III, respectively. Hospital charges were $22,025 higher in the Ob-III cohort. Ob-I/II is protective against peri-operative complications and death, whereas hospital cost is substantially higher in Ob-III patients undergoing BKAs. Full article

(This article belongs to the Special Issue Obesity and Bariatric/Metabolic Surgery: Risks, Outcomes, Prognosis, and Development Trends)

10 pages, 560 KiB

Open AccessArticle

Next-Generation Sequencing of a Large Gene Panel for Outcome Prediction of Bariatric Surgery in Patients with Severe Obesity

by Gabriele Bonetti, Kristjana Dhuli, Maria Rachele Ceccarini, Jurgen Kaftalli, Michele Samaja, Vincenza Precone, Stefano Cecchin, Paolo Enrico Maltese, Giulia Guerri, Giuseppe Marceddu, Tommaso Beccari, Barbara Aquilanti, Valeria Velluti, Giuseppina Matera, Marco Perrone, Amerigo Iaconelli, Francesca Colombo, Francesco Greco, Marco Raffaelli, Mahmut Cerkez Ergoren and Matteo Bertelli Show full author list Hide full author list

J. Clin. Med. 2022, 11(24), 7531; https://doi.org/10.3390/jcm11247531 - 19 Dec 2022

Cited by 5 | Viewed by 1934

Abstract

Obesity is a chronic disease in which abnormal deposition of fat threatens health, leading to diabetes, cardiovascular diseases, cancer, and other chronic illnesses. According to the WHO, 19.8% of the adult population in Italy is obese, and the prevalence is higher among men. It is important to know the predisposition of an individual to become obese and to respond to bariatric surgery, the most up-to-date treatment for severe obesity. To this purpose, we developed an NGS gene panel, comprising 72 diagnostic genes and 244 candidate genes, and we sequenced 247 adult obese Italian patients. Eleven deleterious variants in 9 diagnostic genes and 17 deleterious variants in 11 candidate genes were identified. Interestingly, mutations were found in several genes correlated to the Bardet–Biedl syndrome. Then, 25 patients were clinically followed to evaluate their response to bariatric surgery. After a 12-month follow-up, the patients that carried deleterious variants in diagnostic or candidate genes had a reduced weight loss, as compared to the other patients. The NGS-based panel, including diagnostic and candidate genes used in this study, could play a role in evaluating, diagnosing, and managing obese individuals, and may help in predicting the outcome of bariatric surgery. Full article

(This article belongs to the Special Issue Obesity and Bariatric/Metabolic Surgery: Risks, Outcomes, Prognosis, and Development Trends)

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14 pages, 385 KiB

Open AccessArticle

Analysis of the Lack of Follow-Up of Bariatric Surgery Patients: Experience of a Reference Center

by Marie Auge, Olivier Dejardin, Benjamin Menahem, Adrien Lee Bion, Véronique Savey, Guy Launoy, Véronique Bouvier and Arnaud Alves

J. Clin. Med. 2022, 11(21), 6310; https://doi.org/10.3390/jcm11216310 - 26 Oct 2022

Cited by 11 | Viewed by 1569

Abstract

Few studies have evaluated the association between non-clinical and clinical determinants in terms of discontinuing follow-up after bariatric surgery. This cohort study aims to assess these associations. Data were collected from a prospectively maintained database of patients who underwent laparoscopic bariatric surgery from January 2012 to December 2019. The Cox model was used to assess the influence of preoperative determinants on follow-up interruptions for more than one year. Multilevel logistic regression was used to evaluate the association between clinical factors and post-operative weight loss with the regularity of follow-up. During the study period, 9607 consultations were performed on 1549 patients. The factors associated with a follow-up interruption from more than 365 days included male gender (HR = 1.323; CI = 1.146–1.527; p = 0.001) and more recent years of intervention (HR = 1.043; CI = 1.012–1.076; p = 0.0068). Revisional bariatric surgery was associated with a lower risk of follow-up interruption (HR = 0.753; CI = 0.619–0.916; p = 0.0045). Independent risk factors of an irregular follow up were higher age (HR = 1.01; CI = 1.002–1.017; p = 0.0086); male gender (OR = 1.272; CI = 1.047–1.545; p = 0.0153); and higher %TWL (Total Weight Loss) (OR = 1.040 CI = 1.033–1.048 p < 0.0001). A higher preoperative BMI (OR = 0.985; CI = 0.972–0.998; p = 0.0263) and revisional surgery (OR = 0.707; CI = 0.543–0.922; p = 0.0106) were protective factors of irregularity. This study suggests that the male gender and most recent dates of surgery are the two independent risk factors for follow-up interruption. Older age, male gender, and higher weight loss were all independent risk factors of an irregular follow-up. Revision bariatric surgery is a protective factor against interruption and irregular follow-up with a higher preoperative BMI. Further studies are needed to obtain long-term results in these patients with discontinued follow-ups. Full article

(This article belongs to the Special Issue Obesity and Bariatric/Metabolic Surgery: Risks, Outcomes, Prognosis, and Development Trends)

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9 pages, 554 KiB

Open AccessArticle

Resizing of the Gastric Pouch for Weight Regain after Laparoscopic Roux-en-Y Gastric Bypass and One-Anastomosis Gastric Bypass: Is It a Valid Option?

by Silvia Ferro, Viola Zulian, Massimiliano De Palma, Andrea Sartori, Anamaria Andreica, Marius Nedelcu and Sergio Carandina

J. Clin. Med. 2022, 11(21), 6238; https://doi.org/10.3390/jcm11216238 - 22 Oct 2022

Cited by 1 | Viewed by 2111

Abstract

Introduction: The laparoscopic resizing of the gastric pouch (LPR) has recently been proposed as a revisional technique in the case of weight regain (WR) after gastric bypass procedures. The aim of this study was to report our experience with LPR for WR. Materials and Methods: All patients with WR ≥ 25% after gastric bypass and with a dilated gastric pouch and/or gastrojejunal anastomosis who underwent LPR between January 2017 and January 2022 were retrospectively reviewed. From a radiological point of view, a gastric pouch was considered dilated when its volume was calculated at >80 cm³ for LRYGB and >200 cm³ for OAGB upon a 3D-CT scan. The endoscopic criterion considered both the diameter of the gastrojejunal anastomosis and the gastric pouch volume. All anastomoses > 20 mm for LRYGB and >40 mm for OAGB were considered dilated, while a gastric pouch was considered endoscopically dilated when the retrovision maneuver with the gastroscope was easily performed. These selection criteria were arbitrarily established on the basis of both our personal experience and literature data. Results: Twenty-three patients had LPR after a Roux-en-Y gastric bypass or one-anastomosis gastric bypass. The mean BMI at LPR was 36.3 ± 4.7 kg/m². All patients underwent LPR, while the resizing of the GJA was also performed in 3/23 (13%) cases, and hiatoplasty was associated with the resizing of the pouch in 6/23 cases (26.1%). The mean BMI at the last follow-up was 29.3 ± 5.8 kg/m². The difference between the BMI before resizing and the BMI at the last follow-up visit was statistically significant (p = 0.00005). The mean %TWL at 24.2 ± 16.1 months was 19.6 ± 9%. Comorbidities had an overall resolution and/or improvement rate of 47%. The mean operative time was 71.7 ± 21.9 min. The conversion rate was nil. Postoperative complications occurred in two cases (8.7%). Conclusions: In our series, LPR for WR showed good results in weight loss and in improvement/resolution of comorbidities, with an acceptable complication rate and operative time. Only further studies with a greater cohort of patients and a longer postoperative follow-up will be able to highlight the long-term benefits of this technique. Full article

(This article belongs to the Special Issue Obesity and Bariatric/Metabolic Surgery: Risks, Outcomes, Prognosis, and Development Trends)

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11 pages, 782 KiB

Open AccessArticle

Physical Exercise to Improve Functional Capacity: Randomized Clinical Trial in Bariatric Surgery Population

by María José Aguilar-Cordero, Raquel Rodríguez-Blanque, Cristina Levet Hernández, Javiera Inzunza-Noack, Juan Carlos Sánchez-García and Jessica Noack-Segovia

J. Clin. Med. 2022, 11(15), 4621; https://doi.org/10.3390/jcm11154621 - 8 Aug 2022

Cited by 2 | Viewed by 1893

Abstract

Background: Bariatric surgery is a safe and effective method to lose weight over time. However, some patients fail to achieve healthy weight losses. We aimed to determine if a moderate-intensity physical exercise intervention in patients who underwent bariatric surgery increases their functional capacity thus improving bariatric surgery results. Methods: We conducted a parallel-group non-blinded randomized controlled trial at a surgery clinic in Talca, Chile. A total of 43 participants with obesity and scheduled bariatric surgery completed the six months follow-up. A physical exercise program was conducted in exercise group participants one month after bariatric surgery. Walked distance in the six-minute walk test, BMI, Borg scale of perceptive exertion results and cardiovascular variables were evaluated. Results: Patients’ weight significantly decreased after bariatric surgery but there was no difference between the groups of study. The exercise group progressed from a base value of 550 ± 75 m walked in the six-minute walk test to a sixth-month value of 649.6 ± 68.5 m (p < 0.05), whilst the control group yielded base values of 554.4 ± 35.1 and a sixth-month walked distance of 591.1 ± 75.34 (p > 0.05). Conclusions: Physical exercise in obese patients undergoing bariatric surgery increased functional capacity independently of weight losses resulting from bariatric surgery. Full article

(This article belongs to the Special Issue Obesity and Bariatric/Metabolic Surgery: Risks, Outcomes, Prognosis, and Development Trends)

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