Weight Regain After Bariatric Surgery—A Multicentre Study of 9617 Patients from Indian Bariatric Surgery Outcome Reporting Group

Baig, Sarfaraz Jalil; Priya, Pallawi; Mahawar, Kamal; Shah, Sumeet

doi:10.1007/s11695-019-03734-6

Cited by 84 publications

(39 citation statements)

References 37 publications

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“…Their results showed that individuals with diabetes lost more weight after GBP than SG, but diabetes outcomes results were not published [32]. Our data shows a greater weight regain after SG than GBP and MAs, in the same direction as an Indian cohort (n = 9617), although their data were not adjusted for baseline differences and data on the percentage of diabetes was not provided [33]. On the other hand, a Spanish cohort recently reported a high percentage of reoperations after SG, expressly 23%, due to issues regarding gastroesophageal reflux or insufficient weight loss; however, this may be an advantage of GBP over SG [31].…”

Section: Discussioncontrasting

confidence: 52%

New Metrics to Assess Type 2 Diabetes after Bariatric Surgery: The “Time-Within-Remission Range”

Hollanda

Lecube

Rubio

et al. 2020

JCM

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Almost one third of patients do not achieve type 2 diabetes remission after bariatric surgery or are unable to sustain this effect long term. Our objective was to delve further into the dynamic responses of diabetes after bariatric surgery and to evaluate the "time-within-remission range" as a variable of metabolic control. A descriptive cohort study was done using a computerised multicentre and multidisciplinary registry. All data were adjusted by propensity score. A total of 1186 subjects with a follow-up of 4.5 ± 2.5 years were included. Type of surgery, diabetes remission, recurrence of diabetes, "time-within-remission range" and key predictors of diabetes outcomes were assessed. All patients (70% women, 51.4 ± 9.2 years old, body mass index (BMI) 46.3 ± 6.9 kg/m 2 ) underwent primary bariatric procedures. "Time-within-remission range" were 83.3% (33.3-91.6) after gastric bypass, 68.7% (7.1-87.5) after sleeve gastrectomy and 90% (83.3-92.8) after malabsorptive techniques (p < 0.001 for all). Duration of diabetes, baseline HbA1c and insulin treatment were significantly negatively correlated with the "time-within-remission range". The association of bariatric techniques with "time-within-remission range", using gastric bypass as a reference, were: odds ratio (OR) 3.70 (2.34-5.84), p < 0.001 for malabsorptive techniques and OR 0.55 (0.40-0.75), p < 0.001 for sleeve gastrectomy. Characteristics of type 2 diabetes powerfully influence the outcomes of bariatric surgery. The "time-within-remission range" unveils a superiority of gastric bypass compared to sleeve gastrectomy.

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Section: Discussioncontrasting

confidence: 52%

New Metrics to Assess Type 2 Diabetes after Bariatric Surgery: The “Time-Within-Remission Range”

Hollanda

Lecube

Rubio

et al. 2020

JCM

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“…Changes to the structure and diameter of the gastroenterostomy are described as a major factor in weight re-gain, which is influenced by surgical technique. However, weight regain following these gastrojejunostomy techniques has not been evaluated over midterm or long term [23,24].…”

Section: Purposementioning

confidence: 99%

“…Nadir weight was determined as the lowest weight during the first 3 or 5 years of the follow-up [29]. As described by Lauti et al and Baig et al weight regain (WR) was defined by either regaining more than 25% of weight lost from the NADIR weight or gained more than 5 BMI points from the BMI calculated at NADIR weight [23,30].…”

Section: Assessment Of Weight Loss and Weight Regainmentioning

confidence: 99%

Gastrojejunal Anastomotic Technique. Does It Matter? Weight Loss and Weight Regain 5 Years After Laparoscopic Roux-en-Y Gastric Bypass

et al. 2020

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Purpose The gastrojejunostomy during laparoscopic Roux-en-Y gastric bypass (LRYGB) can be constructed by hand sewn (HSA), linear (LSA) and circular (CSA) stapler technique. They are all considered safe; however, it is not known which the best technique is. Short-term follow-up suggest no difference in weight loss or weight regain between them. However, there is no information on these parameters in the long term. Theatre time and cost are other important factors defining the best way to form gastrojejunostomy. Materials and Methods In a prospective longitudinal cohort study consecutive patients following primary LRYGB were recruited to a bariatric database in a tertiary care centre. Anastomotic technique, diameter, the length of operations and associated costs, weight loss and weight regain were recorded. Patients were followed up for 5 years. Results A total of 385 patients with an initial body mass index of 47.1 kg/m 2 (35-68) were enrolled to this study. This decreased to 33.3 kg/m 2 (21-54 kg/m 2) after 5 years. There was no difference in %TWL after 3 years, P = 0.296, or 5 years, P = 0.187, between the techniques. The number of patients with weight regain was not different after 3 years, P = 0.224, or 5 years, P = 0.795. All techniques had similar operative time. CSA has a higher material cost. Early anastomotic stricture was more common following HSA; however, the difference was not significant. Conclusion Mid-term weight loss and weight regain are not related to anastomotic technique, and there is no difference in operative time associated to them. Circular stapler technique has a higher material cost due to the additional stapler.

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“…SG can also be relatively easier to perform in these patients but the weight loss can be disappointing, increasing the need for a second line procedure. Previous authors [14] In the long-term, major problems seem to be GORD and Weight Regain with SG [15][16]; GORD and malnutrition with OAGB [24]; and Internal Hernia and chronic abdominal pain with RYGB [25] respectively. A recent study [26] found that at 5-year follow up SG was associated with a significantly lower rate of re-intervention compared to RYGB.…”

Section: Comparative Efficacy Of Procedures For Weight Lossmentioning

confidence: 99%

“…We, therefore, feel SG should probably be reserved for those with a lesser burden of obesity such as those with a BMI of < 45 kg/m 2 , in whom the difference in weight loss between SG and a gastric bypass would be clinically irrelevant. It is all the more important because SG also seems to be associated with more weight regain in comparison with RYGB or OAGB[16]. Our current practice is to avoid SG in those with a BMI of ≥ 45 kg/m 2 and avoid RYGB in those with a BMI of ≥ 50 kg/m 2 unless dictated by other factors or patient preference OAGB appears to be superior to RYGB and SG in terms of diabetes remission rates[2,5,[17][18] but many authors[2] have not found RYGB to be significantly superior to SG for diabetes remission.…”

mentioning

confidence: 99%

Procedure and patient selection in bariatric and metabolic surgery

Mahawar¹,

Parmar²,

Graham³

2019

Minerva Chir

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Introduction: Sleeve Gastrectomy (SG), Roux-en-Y Gastric Bypass (RYGB), and One Anastomosis Gastric Bypass (OAGB) are the commonest bariatric procedures performed worldwide. The purpose of this review was to analyse comparative data on these three procedures to aid patient and procedure selection for patients seeking Bariatric and Metabolic Surgery (BMS). Evidence Acquisition: We examined published English language scientific literature available on PubMed for data comparing SG, RYGB, and OAGB for various groups of patients. Evidence Synthesis: There are a number of variables that can influence patient and procedure selection for individuals seeking BMS. High-quality data comparing each of these procedures for every patient subgroup, for each possible outcome measure is lacking. It is, therefore, not currently possible to make strict recommendations regarding patient and procedure selection. At the same time, the multidisciplinary teams should understand that risks of surgery may simply be too high for some patients-such as those suffering from end-stage organ disease and those suffering from mega obesity (BMI ≥ 70 kg/m 2). Surgery should only be offered to such high-risk groups in dedicated centres with appropriate expertise. For other patients, surgeons should carefully consider the pros and cons of each procedure, their own experience, and patient preferences before deciding the most appropriate BMS procedure for them. Conclusion: This review examines various factors influencing patient and procedure selection in bariatric surgery. Authors feel it is currently not possible to make strict recommendations and surgeons should carefully discuss the pros and cons of bariatric surgery and that of various options available in their practice with the patients before making a final recommendation.

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Weight Regain After Bariatric Surgery—A Multicentre Study of 9617 Patients from Indian Bariatric Surgery Outcome Reporting Group

Cited by 84 publications

References 37 publications

New Metrics to Assess Type 2 Diabetes after Bariatric Surgery: The “Time-Within-Remission Range”

New Metrics to Assess Type 2 Diabetes after Bariatric Surgery: The “Time-Within-Remission Range”

Gastrojejunal Anastomotic Technique. Does It Matter? Weight Loss and Weight Regain 5 Years After Laparoscopic Roux-en-Y Gastric Bypass

Procedure and patient selection in bariatric and metabolic surgery

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