Clinical Updates on Bariatric Surgery

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 (30 November 2023) | Viewed by 8223

Special Issue Editors


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Guest Editor
Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, NA, Italy
Interests: laparoscopic surgery; morbid obesity bariatric and metabolic surgery; minimal invasive procedures; general surgery
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Guest Editor
Division of General, Mininvasive, Oncologic and Bariatric Surgery, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Via Pansini 5, 80131 Naples, Italy
Interests: bariatric surgery; general surgery; colorectal surgery; oncological surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Obesity is currently considered a global epidemic condition, and bariatric surgery is one of the most effective available treatments, in addition to lifestyle changes. In this respect, thousands of bariatric procedures (restrictive, malabsorptive, and mixed) are currently performed around the world with exponentially increasing trends and outcomes. During the past several years, intense scientific activities in this field have been realized, allowing us to obtain more in-depth knowledge of the effect of bariatric procedures on obesity comorbidities, a more complete view on perioperative complications, medium-term effectiveness, and new bariatric surgery techniques, among others. The scope of this topical collection is to provide an overview of recent advances in the field of bariatric surgery. Therefore, we encourage researchers in the field of bariatric surgery to submit an original article (no animal research) or review to this topical collection (case reports and short reviews are not accepted).

Dr. Claudio Gambardella
Prof. Dr. Ludovico Docimo
Guest Editors

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Keywords

  • bariatric surgery
  • morbid obesity
  • sleeve gastrectomy
  • gastric bypass
  • surgical complications
  • diabetes remission
  • hypertension remission
  • hypercholesterolemia remission
  • long-term results

Published Papers (6 papers)

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Editorial

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2 pages, 173 KiB  
Editorial
Editorial: Clinical Updates on Bariatric Surgery
by Claudio Gambardella and Ludovico Docimo
J. Clin. Med. 2023, 12(3), 894; https://doi.org/10.3390/jcm12030894 - 23 Jan 2023
Viewed by 866
Abstract
Dear Editor and Colleagues, [...] Full article
(This article belongs to the Special Issue Clinical Updates on Bariatric Surgery)

Research

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12 pages, 872 KiB  
Article
One Anastomosis Gastric Bypass vs. Sleeve Gastrectomy in the Remission of Type 2 Diabetes Mellitus: A Retrospective Analysis on 3 Years of Follow-Up
by Claudio Gambardella, Federico Maria Mongardini, Maddalena Paolicelli, Francesco Saverio Lucido, Salvatore Tolone, Luigi Brusciano, Simona Parisi, Rosetta Esposito, Francesco Iovino, Luca Nazzaro, Francesco Pizza and Ludovico Docimo
J. Clin. Med. 2024, 13(3), 899; https://doi.org/10.3390/jcm13030899 - 4 Feb 2024
Viewed by 799
Abstract
Background. Obesity is a prevalent condition associated with various comorbidities, impacting mortality, fertility, and quality of life. Its relationship with type 2 diabetes mellitus (DMII) is well established, with nearly 44% prevalence. Bariatric surgery has proven crucial for treating both obesity and DMII. [...] Read more.
Background. Obesity is a prevalent condition associated with various comorbidities, impacting mortality, fertility, and quality of life. Its relationship with type 2 diabetes mellitus (DMII) is well established, with nearly 44% prevalence. Bariatric surgery has proven crucial for treating both obesity and DMII. The comparison between surgical techniques, such as sleeve gastrectomy (SG) and one anastomosis gastric bypass (OAGB), remains controversial in terms of glycemic control efficacy. This retrospective study aimed to assess DMII remission efficacy between SG and OAGB after 36 months. Methods. From January 2016 to September 2020, 201 patients who underwent SG and OAGB for morbid obesity associated with DMII were accurately followed-up with for 36 months, focusing on %HbA1c, DMII remission, anthropometric results, and nutrient deficiency. Results. Although DMII remission did not exhibit statistical significance between the groups (82% vs. 93%, SG vs. OAGB, p = 0.051), OAGB demonstrated a more robust association with glycemic control (Odds Ratio 0.51) throughout the entire follow-up and yielded superior anthropometric outcomes. Notably, nutrient deficiencies, excluding cholecalciferol, iron, and riboflavin, did not show significant intergroup differences. Conclusions. This study contributes valuable insights into the extended-term efficacy of SG and OAGB in DMII remission. The nuanced findings underscore the multifaceted nature of metabolic outcomes, suggesting that factors beyond weight loss influence diabetes resolution. Larger comparative studies are warranted to comprehensively address this issue. Full article
(This article belongs to the Special Issue Clinical Updates on Bariatric Surgery)
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14 pages, 869 KiB  
Article
One Anastomosis Gastric Bypass in 6722 Patients: Early Outcomes from a Private Hospital Registry
by Nasser Sakran, Shiri Sherf-Dagan, Keren Hod, Uri Kaplan, Bella Azaria, Asnat Raziel and Assuta Bariatric Surgeons Collaborative
J. Clin. Med. 2023, 12(21), 6872; https://doi.org/10.3390/jcm12216872 - 31 Oct 2023
Cited by 2 | Viewed by 1231
Abstract
Background: One-anastomosis gastric bypass (OAGB) is an emerging metabolic bariatric surgery (MBS) type used in both primary OAGB (pOAGB) and revisional OAGB (rOAGB). We studied ≤30-day outcomes of pOAGB and rOAGB and identified predictors of early complications. Methods: Electronic medical records of all [...] Read more.
Background: One-anastomosis gastric bypass (OAGB) is an emerging metabolic bariatric surgery (MBS) type used in both primary OAGB (pOAGB) and revisional OAGB (rOAGB). We studied ≤30-day outcomes of pOAGB and rOAGB and identified predictors of early complications. Methods: Electronic medical records of all OAGBs performed between January 2017 and December 2021 at a high-volume bariatric clinic in Israel comprising four hospital centers were scanned retrospectively using specialized data software (MDClone software, version 6.1). Data gathered were patients’ characteristics, surgical procedure, and ≤30-day complications with Clavien–Dindo Classification (CDC). Multivariate logistic regression analyses were used to identify factors related to early complications of pOAGB and rOAGB. Results: A total of 6722 patients underwent a pOAGB (n = 5088, 75.7%) or rOAGB (n = 1634, 24.3%) procedure at our institution. Preoperative mean age and body mass index (BMI) were 40.6 ± 11.5 years and 41.2 ± 4.6 kg/m2, respectively. Early complications occurred in 258 (3.8%) patients (176 pOAGB and 82 rOAGB) and included mainly bleeding (n = 133, 2.0%), leaks (n = 31, 0.5%), and obstruction/strictures (n = 19, 0.3%). CDC complications for grades 1–2 and grades 3a-–5 were 1.5% and 1.6%, respectively. The overall mortality rate was 0.03% (n = 2). Age, operative time ≥3 h, and any additional concomitant procedure were independent predictors of early complications following pOAGB, while a diagnosis of diabetes mellitus and operative time ≥3 h were independent predictors of early complications following rOAGB. Conclusions: OAGB was found to be a safe primary and revisional MBS procedure in the ≤30-postoperative day term. The most common complications were gastrointestinal bleeding, leaks, and obstruction/stricture. Full article
(This article belongs to the Special Issue Clinical Updates on Bariatric Surgery)
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14 pages, 285 KiB  
Article
Outcomes at 10-Year Follow-Up after Roux-en-Y Gastric Bypass, Biliopancreatic Diversion, and Sleeve Gastrectomy
by Georgios-Ioannis Verras, Francesk Mulita, Sjaak Pouwels, Chetan Parmar, Nikolas Drakos, Konstantinos Bouchagier, Charalampos Kaplanis and George Skroubis
J. Clin. Med. 2023, 12(15), 4973; https://doi.org/10.3390/jcm12154973 - 28 Jul 2023
Cited by 7 | Viewed by 1086
Abstract
Introduction: Morbid obesity is a well-defined chronic disease, the incidence of which is constantly rising. Surgical treatment of morbid obesity has produced superior outcomes compared to conventional weight loss measures. Currently, there is a gap in the literature regarding long-term outcomes. Our single-institution, [...] Read more.
Introduction: Morbid obesity is a well-defined chronic disease, the incidence of which is constantly rising. Surgical treatment of morbid obesity has produced superior outcomes compared to conventional weight loss measures. Currently, there is a gap in the literature regarding long-term outcomes. Our single-institution, retrospective cohort study aims to evaluate weight loss outcomes, comorbidity reduction, and adverse effects at 10 years following Roux-en-Y Gastric Bypass (RYGB), Biliopancreatic Diversion (BPD), and Sleeve Gastrectomy (SG). Materials and Methods: We included all consecutive patients with 10-year follow-up records operated on within our institution. The comparison was carried out on the average percentage of weight and BMI loss. Nausea and vomiting were evaluated through self-reporting Likert scales. Diabetes resolution and nutritional deficiencies were also evaluated. Results: A total of 490 patients from 1995 up to 2011 were included in our study. Of these, 322 underwent RYGB, 58 underwent long-limb BPD, 34 underwent laparoscopic RYGB with fundus excision, 47 underwent laparoscopic SG, and 29 underwent laparoscopic RYGB as a revision of prior SG. RYGB and BPD were significantly associated with higher percentages of weight loss (37.6% and 37.5%), but were not found to be independent predictors of weight loss. Nausea and vomiting were associated with SG and laparoscopic RYGB with fundus excision, more so than the other operations. No differences were observed regarding diabetes resolution and nutritional deficiencies. Conclusions: Longer follow-up reports are important for the comparison of outcomes between different types of bariatric operations. BPD and RYGB resulted in superior weight loss, with no observed differences in diabetes resolution and adverse outcomes. Full article
(This article belongs to the Special Issue Clinical Updates on Bariatric Surgery)

Review

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12 pages, 568 KiB  
Review
Reports of Gastric Banding and Bowel Obstruction: A Narrative Review of the Literature
by Antonio Vitiello, Alessandro Matarese, Giulia Sansone, Emanuela Cappiello, Giovanna Berardi, Pietro Calabrese, Roberto Peltrini and Vincenzo Pilone
J. Clin. Med. 2024, 13(6), 1740; https://doi.org/10.3390/jcm13061740 - 18 Mar 2024
Viewed by 611
Abstract
The utilization rates of laparoscopic gastric banding (LAGB) declined worldwide from 42.3% in 2008 to 1.8% in 2018. Rates of complications requiring removal may reach 40–50% in the medium to long term. Bowel obstruction is a rare but severe complication that occurs after [...] Read more.
The utilization rates of laparoscopic gastric banding (LAGB) declined worldwide from 42.3% in 2008 to 1.8% in 2018. Rates of complications requiring removal may reach 40–50% in the medium to long term. Bowel obstruction is a rare but severe complication that occurs after LAGB. A comprehensive literature search in PubMed was carried out to identify all available case reports of intestinal obstruction after gastric banding. The search terms were as follows: “intestinal obstruction”, “small bowel obstruction”, “gastric band”, “gastric banding”, “gastric band complications”, and “laparoscopic gastric band obstruction”. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) flowchart was used. Forty-three case reports were included in our review. Laparotomy was necessary in 18/43 (41%) of patients. Vomit was not always reported, while abdominal pain was constantly present. A CT scan was the preferred diagnostic tool. The main causes of occlusion were found to be the erosion of the gastrointestinal tract or internal hernia due to a loose tube loop. Forty-six percent of cases occurred within 5 years from insertion. Even if rare, small bowel obstruction after LAGB requires surgical intervention often with an open approach. The absence of vomit masks symptoms, but an obstruction must be always suspected in the case of severe colicky abdominal pain. A CT scan is recommended for making diagnoses. Full article
(This article belongs to the Special Issue Clinical Updates on Bariatric Surgery)
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Other

16 pages, 1859 KiB  
Systematic Review
Efficacy of Sleeve Gastrectomy with Concomitant Hiatal Hernia Repair versus Sleeve–Fundoplication on Gastroesophageal Reflux Disease Resolution: Systematic Review and Meta-Analysis
by Lidia Castagneto-Gissey, Maria Francesca Russo, Vito D’Andrea, Alfredo Genco and Giovanni Casella
J. Clin. Med. 2023, 12(9), 3323; https://doi.org/10.3390/jcm12093323 - 6 May 2023
Cited by 4 | Viewed by 3056
Abstract
(1) Background: There is still disagreement over how sleeve gastrectomy (SG) affects gastroesophageal reflux disease (GERD). The debate regarding the best option for patients undergoing bariatric surgery who are also affected by GERD and/or hiatal hernia continues to divide the community of bariatric [...] Read more.
(1) Background: There is still disagreement over how sleeve gastrectomy (SG) affects gastroesophageal reflux disease (GERD). The debate regarding the best option for patients undergoing bariatric surgery who are also affected by GERD and/or hiatal hernia continues to divide the community of bariatric surgeons. While concomitant hiatal hernia repair (SG + HHR) has been proposed as a means of reducing the risk of GERD following SG with varying degrees of success, the addition of a fundoplication (SG + FP) has been suggested in recent years as a way to improve the lower esophageal sphincter’s competency. The aim of this study is to systematically review and meta-analyze the efficacy of SG + HHR versus SG + FP on GERD remission in patients with obesity. (2) Methods: A systematic review of the literature was conducted, and studies analyzing the effects of SG + HHR versus SG + FP on postoperative GERD were included. The methodological quality of included trials was evaluated. The primary outcome was postoperative GERD rate, erosive esophagitis, and 12-month weight loss. Secondary outcomes included postoperative complications and mortality. The PRISMA guidelines were used to carry out the present systematic review (PROSPERO Registration Number: CRD42023405600). (3) Results: Fifteen articles with a total of 1164 patients were included in the meta-analysis; 554 patients underwent SG + HHR while 610 underwent SG + FP. In the SG + HHR group, 58.5 ± 28.9% of subjects presented clinical GERD symptoms compared to 20.4 ± 17.5% postoperatively (p < 0.001). In the SG + FP group, 64.8 ± 39.4% were affected by GERD preoperatively compared to only 5 ± 8.1% postoperatively (p < 0.001). SG + FP patients had a significantly greater GERD remission compared to SG + HHR (p < 0.001). Weight loss was similar between groups (p = 0.125). The rate of leaks was 0.18% and 0.33% in the SG + HHR and SG + FP, respectively (p = 0.657), while perforations were significantly higher after SG + FP compared to the SG + HHR group (3.1% versus 0%, p = 0.002). The mortality rate was significantly greater in the SG + FP group (0.5% versus 0%, p = 0.002). (4) Conclusions: This study revealed that both SG with concomitant HHR and sleeve–fundoplication are effective in terms of reflux resolution and weight outcomes, with superiority of SG + FP in terms of GERD control, despite a greater overall complication rate. Both strategies can therefore be suggested as a suitable alternative variant to a conventional SG in subjects with obesity and concomitant hiatal hernia and/or GERD. Studies with extended follow-up and direct comparisons of these surgical approaches to conventional SG are warranted. Full article
(This article belongs to the Special Issue Clinical Updates on Bariatric Surgery)
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