Bariatric Surgical Practice and Patient Care

Morbid obesity treatment includes medical and surgical options. Surgical treatment is a more effective method in terms of weight loss and sustainability. This systematic review aimed to investigate the effectiveness of exercise training for subjects with morbid obesity awaiting bariatric surgery (SMOABS) in the preoperative period and whether presurgical exercise practices have an effect on postsurgery.

In our study, “Cochrane Library,” “Pedro,” “PubMed,” and “Google Scholar” databases were searched using keyword synonyms “Bariatrics” or “Bariatric surgery” and “Obesity” or “Morbid obesity,” and “Physical Therapy” or “Physiotherapy” or “Exercise.” The review protocol is available from PROSPERO ID CRD42020164078.

As a result of the research, 195 articles were found to meet the criteria. Thirteen of these articles included presurgical exercise for morbidly obese individuals. This study reports the results of 328 SMOABS. Most of the studies focused on aerobic exercise and functional capacity and physical fitness evaluated, and the effectiveness of the 12-week exercise program was investigated in most of the studies. In the protocols used in the studies, there were differences in terms of the number of sessions, the duration of the intervention, the outcome criteria, and the sample size, etc.

As a result of this study, it was found that there is a limited number of studies investigating the effects of preoperative exercise training in SMOABS. Research shows that exercise training provides positive improvements in functional capacity and physical fitness for SMOABS. To increase the level of evidence, interventions, evaluation methods, and results should be standardized in future studies.

Roux-en-Y gastric bypass (RYGB) surgeries are commonly performed in the bariatric surgery niche. The pros and cons of conventional laparoscopic procedures (conventional laparoscopic RYGB) and robotic surgeries (robotic Roux-en-Y gastric bypass [RRYGB]) are not well defined systematically in terms of procedural safety, efficacy, and costs.

To systematically assess the efficacy, safety, and cost profiles of LRYGB versus RRYGB surgeries among patients with morbid obesity.

A systematic review and meta-analysis were conducted, including studies that compared LRYGB and RRYGB surgeries in terms of the overall cost per procedure (CPP), operative time, length of hospital stay (LOS), postoperative complications, and in-hospital mortality. The overall costs were adjusted to 2020 U.S. dollars to account for the inflation rates. The outcomes were pooled using standardized mean differences (SMDs) and relative risks (RRs) for numerical and categorical variables, respectively.

Thirty studies (one randomized clinical trial) met the eligibility criteria (109,279 patients, 20.52% underwent RRYGB). Compared with LRYGB, RRYGB surgeries were associated with longer operative times (SMD = 0.80, 95% confidence interval [CI]: 0.24 to 1.36, p = 0.005), higher overall CPP (SMD = 0.33, 95% CI: 0.30 to 0.37, p < 0.0001) and lower risks of wound infection (RR = 0.47, 95% CI: 0.25 to 0.88, p = 0.018) and intraabdominal bleeding (RR = 0.49, 95% CI: 0.32 to 0.76, p = 0.001). No significant differences were noted in other complications, postoperative LOS, and in-hospital mortality.

Future high-quality, randomized studies are required to guide clinical decisions regarding the optimal surgical technique that would reduce patient morbidity and mortality while reducing the expected costs. The role of surgeons' expertise and cost-reducing strategies should also be stressed in future research.

This study aimed to assess the impact of sleeve gastrectomy on psychological status, sleep quality, and musculoskeletal complaints.

This prospective study was conducted at a referral hospital in Tehran for 11 months between November 2020 and October 2021. In this study, we included patients of 18–65 years of age with a body mass index (BMI) >40 or >35 kg/m² with obesity-related comorbidities. We also recruited an age- and gender-matched control group. Patients in the surgery group underwent sleeve gastrectomy technique, and controls were instructed to follow lifestyle modifications and diets for weight loss. All evaluations were performed at three time-points of baseline, after 3 months, and after 6 months. The Depression, Anxiety and Stress Scale-21 (DAAS-21), sleep problems (Pittsburgh Sleep Quality Index), and musculoskeletal complaints (Nordic) questionnaires were chosen as the main outcomes of our study. The statistical analysis was performed by IBM SPSS v. 22.0.

Seventy-nine patients in the surgery group and 81 controls were evaluated in our study. Evaluations show significant BMI reductions in the surgery group from 39.29 ± 6.26 at baseline to 26.82 ± 5.50 kg/m² at month 6 postoperative (p < 0.001). Controls also revealed a significant reduction in BMI, which was relatively more rapid in the first 3 months compared with the second 3 months (p < 0.001). Evaluation of levels of depression, anxiety, stress, sleep, and musculoskeletal complaints all showed significant improvement after bariatric surgery (p < 0.05).

Sleeve gastrectomy can significantly improve mental health (depression, anxiety, stress), musculoskeletal complaints, and sleep quality in obese patients undergoing surgery.

Several factors can influence the response to laparoscopic sleeve gastrectomy (LSG). However, preoperative quality of life (QOL) as a predictor for weight loss postbariatric surgery has been scarcely studied. The purpose of this study was to evaluate the impact of preoperative QOL and other factors to determine success, in terms of percentage of excess weight loss (%EWL) after LSG.

A retrospective analysis of patients operated for LSG was performed. The primary variable for analysis was %EWL, which was categorized as <20%, between 21–49%, 50–75%, and >75%. All the variables (demographics, comorbidities, QOL, and nutritional habits) were paired with %EWL and analyzed.

A total of 134 patients were evaluated. The mean follow-up and %EWL was 24.4 months and 83.3%, respectively. Patients between 18 and 40 years, patients with baseline body mass index (BMI) between 30 and 39.9 kg/m², patients without high blood pressure, and those with less impaired QOL previous to surgery had significantly (p = 0.013, 0.01, 0.026, and 0.01) better results in terms of %EWL.

Our analysis shows that younger patients, those with less BMI, and those without HPB have a greater chance of losing weight after LSD. In addition, less impaired preoperative QOL could be a predictor of success in terms of weight loss.

The aim of this study was to formulate recommendations in diagnosing internal herniation (IH) after laparoscopic Roux-en-Y gastric bypass (LRYGB).

All patients that underwent LRYGB between 2011 and 2017 were retrospectively included. Subsequently, all CT scans and reoperation reports between 2011 and 2018 were screened for IH. All cases with discrepancies between radiological and clinical diagnosis were investigated further.

Out of the 525 CT scans for IH, 49 (9.3%) were found to be discrepant. After blinded review by two readers, 30 (61.2%) of these were considered initially misdiagnosed. In the remaining 19 cases, 9 were false negative (FN), and 10 false positive (FP). Eleven cases were considered to be intermittent IH (7 FN and 4 FP). One FP had surgery much later due to persistent complaints, which did eventually prove IH. One CT diagnosis of intussusception (FN) was an IH. Two FPs were adhesions. One FN and three FPs remained unexplained even with knowledge of clinical diagnosis (4/525; 0.8%).

Not all discrepancies can be avoided, but three recommendations can be made. First, experienced reading improves accuracy and second opinion can prevent unnecessary reoperations. Second, intermittent IH remains a pitfall and should be considered if there is delay between complaints, CT scan, and reoperation. Third, adhesions should also be considered, especially in patients with dilated bowel loops.

Bariatric surgery is effective in reducing complications that may develop during pregnancy and childbirth in obese women. The aim of this study was to determine the fertility and pregnancy outcomes of women before and after bariatric surgery.

This descriptive study was conducted in 121 women aged 18–45 years who underwent bariatric surgery in Istanbul between 2014 and 2018. Data were collected by calling the patients whose phone numbers were reached from the hospital records.

Before bariatric surgery, 62.8% of obese women became pregnant, the average weight gained during pregnancy was 17.07 ± 11.39 kg, and 72.6% of newborns' birth weight was ≥3000 g. After bariatric surgery, 82.9% of the women became pregnant, the average weight gained during pregnancy was 10.05 ± 4.03, and 44% of newborns' birth weight was ≥3000 g. Compared with preoperative period, in the postoperative period, the decrease in using a contraceptive method, receiving treatment to get pregnant, getting pregnant, the number of miscarriages, curettage, the mean gestational week, birth weight of the newborns, and weight gain during pregnancy was statistically significant.

Although pregnancy is not a problem in obese women before bariatric surgery, it has a positive effect on pregnancy and obstetric problems. Close follow-up after bariatric surgery, especially for adequate weight gain, maintains its importance.

Thyroid diseases are common in bariatric surgery candidates, and some of these thyroid diseases require surgical treatment. Combined bariatric surgery and thyroidectomy have not been reported yet. This study aimed to evaluate the efficacy and safety of this combined surgery.

A retrospective study was conducted on all patients undergoing combined laparoscopic bariatric surgery and thyroidectomy between March 2015 and April 2021. Perioperative and follow-up outcomes were collected and analyzed.

Combined surgery was successfully conducted in 14 patients, with a mean body mass index of 35.7 ± 5.6 kg/m². Two patients underwent Roux-en-Y gastric bypass, 12 underwent sleeve gastrectomy, and all received unilateral or bilateral thyroid surgery with/without central lymph node dissection. The average operative time was 259.3 ± 54.8 (170–318) minutes. Two patients encountered postoperative transient hypocalcemia, and one experienced transient recurrent laryngeal nerve (RLN) paralysis. No reoperation, mortalities, or readmission was identified. The median duration of follow-up is 27 months; all patients had no hypocalcemia or RLN paralysis at the last follow-up.

Combined laparoscopic bariatric surgery and thyroidectomy are effective and safe for elected patients. Strict operation indications, rich experience in laparoscopic surgery, and appropriate postoperative management are keys to the success of combined surgery.

Enhanced rehabilitation after surgery (ERAS) should be applied to bariatric surgery. Multimodal analgesia is one of the pillars of ERAS, of which spinal analgesia (SA) is a part. The interest of SA in bariatric surgery is poorly described, yet it can be performed easily even in obese patients, reducing postoperative pain, opioid consumption, and hospitalization time.

This is a retrospective and comparative study; the objective was to study the feasibility and interest of SA combining 100 μg of morphine and 150 μg of clonidine in bariatric surgery during the first postoperative day.

Thirty-six patients were included: 29 patients (81%) benefited from SA (group SA) and 7 benefited from standard analgesia (group S). SA was linked to a decrease in postoperative morphine consumption (odds ratio −2.551, 95% confidence interval [−5.212 to −0.570], p = 0.016). The rate of acute high blood pressure was significantly higher in group S (p = 0.05). There was no difference between the two groups in the occurrence of side effects.

SA with morphine and clonidine improves postoperative analgesia. We recommend 0.1 mg as the standard dose. The use of clonidine could make it possible to limit the dose of morphine injected and reduce the postoperative hypertensive risk. french registration: ANSM—RCB ID: 2018-A01310-55.