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Background/Objective: Eating behaviors (EB) correlate with weight loss after bariatric surgery (BS). Therefore, the investigation of EB could guide interventions to prevent insufficient weight outcomes. Method: A prospective cohort of 85 patients undergoing Roux-en-Y Gastric Bypass (RYGB; 84.7% female, mean age 44.7 ± 9.3 years) was included. Six months after undergoing RYGB, EB patterns, including cognitive restraint (CR), uncontrolled (UE), and emotional eating (EE), were assessed using the Three-Factor Eating Questionnaire R21 (TFEQ-R21). History, physical examination, and anthropometric assessments were collected pre- and 12 months postoperative. Patients were divided based on the percentage of excess weight loss (%EWL < 80% or ≥80%) and EB patterns were correlated with weight outcomes at 12 months. Results: The %EWL ≥ 80% group demonstrated significantly higher scores in CR and EE compared to %EWL < 80% (p < 0.001 and p = 0.01, respectively). UE scores were similar between groups (p = 0.41). At 12 months postoperative, the %EWL ≥ 80% group had negative correlations between CR and BMI and positive correlations between CR and EWL (rho = −0.33 and rho = 0.29; p = 0.04). Multiple logistic regression considering %EWL ≥ 80% as the aim outcome revealed that CR had a significant influence (OR = 1.037; p = 0.058), while age (OR = 0.962; p = 0.145), sex (OR = 2.984; p = 0.135), UE (OR = 0.995; p = 0.736), and EE (OR = 1.017; p = 0.296) did not. Conclusions: EBs influence outcomes after BS, and a model using TFEQ-R21 predicted them. CR six months post-surgery was the strongest predictor of higher EWL at 12 months. Further research is needed to understand the relationship between restrictive EB and BS outcomes, possibly identifying strategies to prevent disordered EB in patients with higher scores. [ABSTRACT FROM AUTHOR]

Purpose: The use of a nonadjustable silicone band around the gastric pouch of Roux-en-Y gastric bypass (RYGB) to reduce the recurrence of obesity is still being debated in the literature. The primary objective of this study was to evaluate banded and non-banded RYGB regarding % total weight loss (%TWL) and complications up to 10 years postoperatively and regarding the removal rate of the silicone band. Material and Methods: A retrospective study of the medical records of all patients submitted to banded and non-banded RYGB between 2000 and 2020 was conducted. Clinical data (age, gender, weight, body mass index—BMI, comorbidities, %TWL, and the prevalence of vomiting) and laboratory data (hemoglobin, serum iron, albumin, and vitamin B12) were obtained preoperatively and at 6 months, 1, 2, 3, 5, 7, and 10 years for both groups and at 12, 15, and 20 years after banded RYGB. Results: In total, 858 patients underwent RYGB: 409 underwent banded RYGB and 449 underwent non-banded RYGB. In the preoperative period, banded RYGB patients were heavier and had higher rates of hypertension and dyslipidemia. The %TWL was higher in the banded RYGB group up to 7 years. The prevalence of vomiting is much higher in this group, which also had lower laboratory test values. Of the banded RYGB patients, 9.53% had to have the silicone ring removed after presenting complications. Conclusion: Banded RYGB promotes significantly higher rates of TWL at the expense of a higher frequency of food intolerance and vomiting. [ABSTRACT FROM AUTHOR]

Background: One anastomosis gastric bypass (OAGB) has been proposed as an effective alternative to the current standard procedure in Switzerland, Roux-en-Y gastric bypass (RYGB). Prospective data comparing both procedures are scarce. Therefore, we performed a non-inferiority randomized controlled trial assessing the effectiveness and safety of these 2 operative techniques. Method: Eighty patients were randomized 1:1. OAGB consisted of a very long gastric pouch with a 200 cm biliopancreatic limb, RYGB of a 150 cm ante-colic alimentary and a 60 cm biliopancreatic limb, respectively. Primary endpoint was the percent excess weight loss (%EWL) at 12 months after surgery. Results: Mean %EWL at 12 months was 87.9% (SD24.4) in the RYGB group and 104.1% (SD24.6) in the OAGB group (p = 0.006). There was no mortality. The rate of marginal ulcers was higher in patients with OAGB compared to those with RYGB (p = 0.011), while the total number of late complications did not statistically differ between the two groups. Except for the remission of GERD, which was higher in the RYGB group compared to OAGB, there was no difference between the groups regarding the remission of comorbidities. OAGB showed improved glucose control compared to the RYGB after 1 year (p = 0.001). Furthermore, glucagon-like peptide-1 increase was significantly higher in OAGB at 6 weeks (p = 0.041) and 1 year after surgery (p = 0.029). Quality of life improved after both surgeries, without differences between the groups. Conclusions: %EWL 1 year after surgery was higher in OAGB than in RYGB. A better glycemic control with a higher increase in GLP-1 was observed after OAGB compared to RYGB. Trial registration: This trial is registered on ClinicalTrials.gov under the identifier NCT02601092. [ABSTRACT FROM AUTHOR]

Background: The prevalence of patients suffering from extreme obesity (body mass index (BMI) ≥ 50) has significantly increased over the past three decades, surpassing the rise in the general population of overweight patients. Weight loss outcomes after bariatric surgery in patients suffering from extreme obesity are less favorable, with a higher incidence of weight regain. Variations of existing bariatric procedures have been proposed to address this issue. One such variation is adding a gastric band to limit the expansion of the newly created pouch. Limited data exist regarding the effectiveness of this procedure, called the banded one-anastomosis gastric bypass (BOAGB) procedure, compared to other bariatric procedures. Method: In this retrospective study, we compared all patients who underwent the BOAGB procedure at the Bariatric Surgery Unit in our Medical Center with a postoperative follow-up of at least 1 year with patients who underwent a one-anastomosis gastric bypass (OAGB) or sleeve gastrectomy (SG) procedures. Data collected included demographics, comorbidities, surgical outcomes, complications, and postoperative quality-of-life assessments. Results: One hundred eleven patients were enlisted to our study during the relevant study period—24 patients underwent the BOAGB procedure, 43 underwent OAGB, and 44 underwent a SG. Lost to follow-up beyond 30 days was 9% (at 1-year post-surgery, we were able to establish contact with 101 patients). The pre-op BMI was significantly higher in the BOAGB group compared to the other procedures. Additionally, a higher prevalence of diabetes was observed in the BOAGB group. The duration of surgery was significantly longer for the BOAGB procedure. No significant differences were found in surgical complications. Overall, all procedures resulted in significant excess weight loss (EWL) or change in BMI, improvement in comorbidities, and improved quality of life postoperatively. Conclusions: The BOAGB procedure, like OAGB and SG, demonstrated favorable weight loss outcomes and weight maintenance 1 year postoperatively without significant differences between the procedures. The BOAGB procedure is relatively new, with good bariatric outcomes and a favorable safety profile. Long-term study is needed to evaluate these various bariatric procedures' efficacy further. [ABSTRACT FROM AUTHOR]

Obesity is an emerging worldwide health care issue. It has a direct and indirect bearing on health-related outcomes. Rates of overweight and obesity have grown manifold in the past few decades globally. Once considered a problem of the affluent societies only, obesity is now dramatically on the rise in low- and middle-income countries also. Single anastomosis gastric bypass (SAGB) is one of the combined bariatric procedures adopted for weight loss in patients failing maximal medical therapy. Internal hernia (IH) after SAGB is a less recognized clinical entity. We hereby report our experience with four such cases under light of current available literature. Bariatric procedures are associated with some short- and long-term limitations. IHs are among one of the dreaded complications associated with some bariatric procedures with rates reaching up to 16% after classic Roux-en-Y gastric bypass. The incidence of IH post-SAGB is comparatively rare and is very less frequently reported. Symptoms of IH post-SAGB are quite nonspecific and depend on the time and extent of herniation. The symptoms can vary from benign intermittent colicky pain to severe intra-abdominal pain presenting as a surgical emergency. Routine physical examination and biochemical investigations are nonspecific and unreliable in evaluating those patients. Computed tomography (CT) with intravenous and oral contrast is the most common imaging modality used for preoperative evaluation of those symptoms. The CT findings can be unremarkable in patients having intermittent symptoms/herniation. Diagnostic laparoscopy is the cornerstone for diagnosis and management of patients having high suspicion of IH.

Introduction: Obesity is defined as abnormal or excessive fat accumulation that may impair health. Body Mass Index (BMI) is a simple index of weight for height (kg/m2) that is commonly used to classify overweight and obesity in adults. Mini Gastric Bypass (MGB) leads to improved quality of life, reduction in episodes of Gastroesophageal Reflux Disease (GERD), high patient acceptance, early safety, and efficacy. Laparoscopic Sleeve Gastrectomy (LSG) is a restrictive, irreversible procedure in which stomach capacity is markedly reduced by creating a lesser curvature tube. MGB is mildly restrictive but importantly, a malabsorptive operation. Many observational studies have concluded that better weight loss and diabetes remission are the advantages of MGB. However, comparative studies of outcomes and complications between Laparoscopic Sleeve Gastrectomy (LSG) and MGB are still scarce. Aim: To compare the effectiveness and outcomes regarding weight loss after LSG and MGB in morbidly obese patients. Materials and Methods: This prospective cohort study was carried out in the Department of Surgery of SPS Hospital, Ludhiana, Punjab, India from 1st June 2018 to 31st May 2019. Adults between 20-70 years of age and with BMI >37.5 without co-morbidities, and BMI >32.5 with co-morbidities Type II Diabetes Mellitus (T2DM) were included. The authors included 59 patients; 34 patients underwent MGB (22 were female and 12 were male) and 25 patients underwent LSG (18 were female and 7 were male). A comparison of continuous variables between the study groups was done using the Student’s t-test. For comparing categorical data, a Chi-square (χ2) test was performed. Results: The overall % Excess Weight Loss (EWL) after MGB ranged from 27.74 to 62.32% with a mean of 44.88±17.44%. The overall % EWL after LSG ranged from 26.62 to 45.8% with a mean of 36.21±9.59%. (p0.05). None of the patients required readmission post LSG, while 3% (1/34) required readmission post MGB. None of the patients had postoperative leakage in both groups. Conclusion: The better outcome was associated with MGB in terms of the percentage of Excess Weight Loss (EWL).

Introduction: Obesity is defined as abnormal or excessive fat accumulation that may impair health. Body Mass Index (BMI) is a simple index of weight for height (kg/m2) that is commonly used to classify overweight and obesity in adults. Mini Gastric Bypass (MGB) leads to improved quality of life, reduction in episodes of Gastroesophageal Reflux Disease (GERD), high patient acceptance, early safety, and efficacy. Laparoscopic Sleeve Gastrectomy (LSG) is a restrictive, irreversible procedure in which stomach capacity is markedly reduced by creating a lesser curvature tube. MGB is mildly restrictive but importantly, a malabsorptive operation. Many observational studies have concluded that better weight loss and diabetes remission are the advantages of MGB. However, comparative studies of outcomes and complications between Laparoscopic Sleeve Gastrectomy (LSG) and MGB are still scarce. Aim: To compare the effectiveness and outcomes regarding weight loss after LSG and MGB in morbidly obese patients. Materials and Methods: This prospective cohort study was carried out in the Department of Surgery of SPS Hospital, Ludhiana, Punjab, India from 1st June 2018 to 31st May 2019. Adults between 20-70 years of age and with BMI >37.5 without co-morbidities, and BMI >32.5 with co-morbidities Type II Diabetes Mellitus (T2DM) were included. The authors included 59 patients; 34 patients underwent MGB (22 were female and 12 were male) and 25 patients underwent LSG (18 were female and 7 were male). A comparison of continuous variables between the study groups was done using the Student's t-test. For comparing categorical data, a Chi-square (Χ2) test was performed. Results: The overall % Excess Weight Loss (EWL) after MGB ranged from 27.74 to 62.32% with a mean of 44.88±17.44%. The overall % EWL after LSG ranged from 26.62 to 45.8% with a mean of 36.21±9.59%. (p<0.05) in % EWL at nine months in both procedures as MGB resulted in more % EWL than LSG. Perioperative results regarding the mean operative time for MGB was 3.24 hours and for LSG, 2.43 hours (p<0.05). A total of 50% (5/10) of patients who underwent MGB had remission, and 25% (1/4) of patients who underwent LSG had remission of T2DM after nine months (p>0.05). None of the patients required readmission post LSG, while 3% (1/34) required readmission post MGB. None of the patients had postoperative leakage in both groups. Conclusion: The better outcome was associated with MGB in terms of the percentage of Excess Weight Loss (EWL). [ABSTRACT FROM AUTHOR]

Background and Objectives: Exclusive breastfeeding is recommended for most newborns. However, exclusively breastfed newborns sometimes experience excess weight loss (EWL, loss ≥10% of birth weight) while lactation is being established. Our primary objective was to evaluate the sensitivity and specificity of the Newborn Weight Loss Tool (NEWT) in early identification of exclusively breastfed newborns who develop EWL; and secondarily, identify breastfeeding variables associated with an at-risk NEWT trajectory. Materials and Methods: We conducted a secondary analysis of prospective data from mother-infant dyads screened for inclusion in the U.S. site of the WHO Growth Reference Study. We excluded records if: NEWT-specific criteria not met, missing key data, or >60 mL formula consumed. We defined NEWT "test-positive" based on an in-hospital weight at about 24 hours falling within the NEWT trajectory consistent with eventual EWL. We defined cases as true EWL based on weight measured at home on day of life 4 (DoL4). Results: Of 280 original records, 60 were excluded (n = 27, NEWT-specific exclusion; n = 15, missing data; n = 18, >60 mL formula), resulting in 220 paired newborn weights measured in-hospital (17 ± 8 hours), and at DoL4 (84 ± 8 hours). NEWT status correctly identified 6/28 EWL cases (21% sensitivity [95% confidence interval, CI, 8-34%]), and 158/192 noncases (82% specificity [95% CI, 75-89%]). NEWT test-positive status was associated with greater weight loss, lower perceived breastfeeding support, and infant less often showing feeding cues on DoL4 (p

Introduction: LSG is the gold standard sole bariatric procedure for morbid obesity. Small (2cm) and large (6cm) distance of resection margin from pylorus are both being used for neogastric sleeve formation however what is optimal distance remains controversial. Aims & Objectives: To assess excess weight loss results and complication rate with 6cm and 2cm distance of staple line from pylorus during a prolonged surveillance period. Place and Duration of Study: This retrospective cohort study was conducted at Fatima Memorial Hospital from Dec 2013 to Dec 2022 spanning 9 years. Material & Methods: Medical records of 50 morbidly obese patients aged 41- 50 yrs were segregated into two groups of 25 each based on the LSG procedure conducted. Group 1 had LSG with 6cm resection margin from pylorus while group 2 had a staple line distance of 2cm from pylorus for neogastric sleeve formation. The patients were subsequently followed up for excess weight loss (EXL) and BMI at 6 months, 1 year, 2 years, 3 years & 4-year interval. Data was entered and analyzed using SPSS version 21.P value ? 0.05 was considered significant. Results: EWL in Group 1 & 2 was 39.2± 6.77kg & 41.9± 4.35kg at 6 months,73.64± 6.49kg & 71.06± 7.77kg at 1 year, 65.52± 5.53kg & 63.92± 7.07kg at 2 years,58.16± 4.97kg & 57.28± 5.75kg at 3 years and 55.48± 3.39kg & 55.36± 3.72kg for 4 years were, not significant statistically. BMI in group 1 & 2 were 39.47± 5.11 & 35.88± 4.40 at 6 months, 29.22± 2.68 & 29.12± 2.00 at 1 year, 25.44± 1.96 & 24.73± 2.86 at 2 years, 22.84± 1.79 & 22.40±2.20 at 3 years and 21.66± 1.32, 21.67± 1.62 at 4 years were found to be statistically insignificant. Conclusion: With regards to extra weight loss, distance of resection margin from pylorus of 2cm or 6cm have identical effects but the latter has lowest complication incidence after 4 yrs of surveillance. Hence, a distance of 6cm is favoured to ensure safety of LSG for morbidly obese patients. And the findings of this study will help bariatric surgeons to improve technique of LSG in a safe and successful way for effective weight loss in morbidly obese patients.

Introduction: Bariatric surgery may lead to unsatisfactory weight loss, weight loss plateau, and even weight regain after various types of surgery. Despite the numerous studies, the mid-term results of surgery, after repetitive weight fluctuations remain a major concern. The aim of the present study was to determine the key time points of weight changes after three types of bariatric procedures, as well as to determine 5-year weight loss outcome after surgery. Methods: This is a retrospective cohort study including patients with morbid obesity conducted in the Minimally Invasive Surgery Research Center. The patients underwent one of the three types of bariatric surgeries including laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), and one-anastomosis gastric bypass (OAGB), who had been followed up for weight loss trend during 5 years postoperatively. Results: The mean excessive weight loss (%EWL) and total weight loss (%TWL) of 2,567 participants with obesity (mean age = 39.03, mean BMI = 45.67) in the first 6 months after surgery was independent of the type of surgery (p > 0.05). OAGB and RYGB showed significantly higher weight loss compared to LSG in ninth and 24th month after surgery, respectively (p < 0.05). The 5 years %WL could be comparable with %WL in 6, 9, and 12 months after LSG, RYGB, and OAGB, respectively. Conclusion: OAGB provides the fastest and highest %EWL and %TWL, while LSG induced the earliest and largest weight plateau and weight regain during 5-years post-surgery. The pattern of early weight loss could predict the mid-term outcome of bariatric surgery. So, early identification of suboptimal weight loss could enhance long-term weight loss. [ABSTRACT FROM AUTHOR]

Introduction: The negative impact of obesity on the quality of life (QoL) and its association with multiple comorbidities is unquestionable. The primary objective of this study was to compare the QoL of patients before, 1 year and 5 years after laparoscopic sleeve gastrectomy (LSG). Secondary objectives were to evaluate the resolution of obesity-related comorbidities and weight loss success. Materials and Methods: We included patients who underwent LSG for body mass index (BMI) ≥30 kg/m² between August 2016 and April 2017 and completed the Moorehead-Ardelt QoL Questionnaire II (MA II). Statistical analysis was conducted using SPSS IBM Statistics for Windows version 21. Results: In total, 64 patients participated with a female majority (73.44%) and a mean age of 36.09 with an average BMI at 40.47. Percentage of excess BMI loss and excess weight loss (% EWL) at one and 5 years after surgery went from 90.18% to 85.05% and 72.17% to 67.09%, respectively. The total MA II score before LSG was -- 0.39 ± 0.94. Postoperatively, it increased to 1.73 ± 0.60 at 1 year and 1.95 ± 0.67 at 5 years. The positive impact of LSG on QoL was more significant in patients presenting ≥30% of weight loss and in females. At 5 years, a significant improvement in many comorbidities was noted except for arterial hypertension, coxalgia, gastro-oesophageal reflux disease and lower extremities' varices. Conclusion: LSG maintains a long-term QoL improvement, a significant EWL and a resolution of the most common obesity-associated comorbidities such as diabetes, dyslipidaemia and symptoms related to sleep apnoea. [ABSTRACT FROM AUTHOR]

Guanyang Chen,1,&ast; Zhehong Li,2,&ast; Qing Sang,1,&ast; Liang Wang,2 Qiqige Wuyun,2 Zheng Wang,2 Weijian Chen,2 Chengyuan Yu,1 Dongbo Lian,2 Nengwei Zhang2 1Department of General Surgery, Peking University Ninth School of Clinical Medicine, Beijing, People’s Republic of China; 2Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Dongbo Lian; Nengwei Zhang, Email liandongbo2478@bjsjth.cn; znw@bjsjth.cnBackground: Laparoscopic sleeve gastrectomy (LSG) is considered as an effective bariatric and metabolic surgery for patients with severe obesity. Chronic low-grade inflammation of adipose tissue is associated with obesity and obesity-related complications.Objective: This study intends to establish a nomogram based on inflammatory response-related methylation sites in intraoperative visceral adipose tissue (VAT) to predict excess weight loss (EWL)% at one-year after LSG.Methods: Based on EWL% at one-year after LSG, patients were divided into two groups: the satisfied group (group-A, EWL%≥ 50%) and the unsatisfied group (group-B, EWL%< 50%). Next, we defined genes corresponding to the methylation sites in the 850 K methylation microarray as methylation-related genes (MRGs). We then took the intersection of MRGs and inflammatory response-related genes. After that, inflammatory response-related methylation sites were identified based on overlapping genes. Moreover, difference analysis was carried out to obtain inflammatory response-related differentially methylated sites (IRRDMSs) between group-A and group-B. LASSO analysis was used to identify the hub methylation sites. Finally, we developed a nomogram based on the hub methylation sites.Results: There were 26 patients in the study, with 13 in group-A and 13 in group-B. After data filtering and difference analysis, 200 IRRDMSs were identified (143 hypermethylated sites and 57 hypomethylated sites). Then, we identified three hub methylation sites (cg03610073, cg03208951, and cg18746357) by LASSO analysis and built a predictive nomogram (Area under the curve=0.953).Conclusion: The predictive nomogram based on three inflammatory-related methylation sites (cg03610073, cg03208951, and cg18746357) in intraoperative visceral adipose tissue can predict one-year EWL% after LSG effectively.Keywords: DNA methylation, excess weight loss, laparoscopic sleeve gastrectomy, inflammation, nomogram

Introduction: Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed bariatric procedure in the world. The aim of the study was to evaluate outcomes after 10 years. Methods: Patients who underwent LSG between 2005 and 2010 in a single center were retrospectively assessed, focusing mainly on the percentage of excess weight loss (%EWL) after 10 years. Inadequate weight loss was defined as a %EWL < 50% or the need to perform a revisional bariatric surgery. Results: Overall, 149 patients underwent LSG, with a median preoperative body mass index of 42.0 ± 6.5 kg/m2. Ten patients (6.7%) underwent previous bariatric procedure. Patients eating behavior was described as volume eaters in 73 (49%), sweet eaters in 11 (7.4%) and both volume and sweet eaters in 65 (43.6%). Six patients died during follow-up and 25 patients were lost to follow-up, leaving 118 (79%) patients who completed full follow-up. Thirty-five patients (23.5%) needed a revisional bariatric surgery. For the 83 remaining patients, the mean %EWL was 35.9% at 10 years, only 23 of 83 patients (27.7%) had a %EWL ≥ 50%. Thus 80.5% patients (95/118) experienced inadequate weight loss 10 years after LSG. A lower %EWL after 1 year was predictive for inadequate weight loss after 10 years. Conclusion: Ten years after LSG, the rate of inadequate weight loss was high, reaching 80% of patients. Thirty percent of patients required a revisional bariatric procedure. New studies must try to identify patients who are good candidates for LSG and strategies to improve long-term outcomes. [ABSTRACT FROM AUTHOR]

Introductions: Revision surgery because of weight recurrence is performed in 2.5–33% of primary vertical banded gastroplasty (VBG), laparoscopic sleeve gastrectomy (LSG), and gastric band (GB) cases. These cases qualify for revisional Roux-en-Y gastric bypass (RRYGB). Methods: This retrospective cohort study analyzed data from 2008 to 2019. A stratification analysis and multivariate logistic regression for prediction modeling compared the possibility of sufficient % excess weight loss (%EWL) ≥ 50 or insufficient %EWL < 50 between three different RRYGB procedures, with primary Roux-en-Y gastric bypass (PRYGB) as the control during 2 years of follow-up. A narrative review was conducted to test the presence of prediction models in the literature and their internal and external validity. Results: A total of 558 patients underwent PRYGB, and 338 underwent RRYGB after VBG, LSG, and GB, and completed 2 years of follow-up. Overall, 32.2% of patients after RRYGB had a sufficient %EWL ≥ 50 after 2 years, compared to 71.3% after PRYGB (p ≤ 0.001). The total %EWL after the revision surgeries for VBG, LSG, and GB was 68.5%, 74.2%, and 64.1%, respectively (p ≤ 0.001). After correcting for confounding factors, the baseline odds ratio (OR) or sufficient %EWL ≥ 50 after PRYGB, LSG, VBG, and GB was 2.4, 1.45, 0.29, and 0.32, respectively (p ≤ 0.001). Age was the only significant variable in the prediction model (p = 0.0016). It was impossible to develop a validated model after revision surgery because of the differences between stratification and the prediction model. The narrative review showed only 10.2% presence of validation in the prediction models, and 52.5% had external validation. Conclusion: Overall, 32.2% of all patients after revisional surgery had a sufficient %EWL ≥ 50 after 2 years, compared to PRYGB. LSG had the best outcome in the revisional surgery group in the sufficient %EWL group and the best outcome in the insufficient %EWL group. The skewness between the prediction model and stratification resulted in a partially non-functional prediction model. [ABSTRACT FROM AUTHOR]

Little is known about the role of chronic gastritis on weight loss after laparoscopic sleeve gastrectomy (LSG). This study aims to investigate the relationship between histopathologic findings of gastric specimens, excess weight loss (% EWL), and excess BMI loss (% EBL) at 6 and 12 months follow up after LSG. We retrospectively reviewed the clinical records of 95 patients who had undergone LSG between January 2017 and December 2019. Based on the histopathological findings of gastric resection specimens, patients were divided into those with chronic gastritis (CG) and those without chronic gastritis (NoCG) and compared for their % EWL and % EBL at 6 and 12 months. The mean BMI was 44.74 kg/m2 in the CG group and 44.14 kg/m2 in the NoCG group. At 6 months follow up, the CG group had a mean % EWL of 45.7 and % EBL of 40.5, while NoCG had a mean % EWL of 51.1 and % EBL of 46.7. After 1-year follow-up, the CG group had a mean % EWL of 53.1 and a % EBL of 44.8, while the NoCG group had a % EWL of 54.1 and % EBL of 44. This observational study does not support the hypothesis that the occurrence of chronic gastritis can affect postoperative % EWL and % EBL.

Background and Objectives: Intragastric balloon (IGB) is a safe option for obesity management. However, studies determining the factors influencing the procedure's outcomes are scarce. Therefore, our goal was to determine the factors affecting weight reduction after IGB insertion. Materials and Methods: This retrospective study included 126 obese patients who underwent IGB treatment using the ORBERA® Intragastric Balloon System. Patients' records were retrieved; and demographic data, initial body mass index (BMI), complications, compliance with both diet and exercise programs, and percentage of excess weight reduction were recorded. Results: The study included 108 female (85.7%) and 18 male (14.3%) patients. The mean age was 31.7 ± 8.1 years. The percentage of excess weight loss (EWL) was 55.8 ± 35.7%. The mean weight loss was 13.01 ± 7.51 kg. A significant association was found between EWL and age, initial weight, initial body mass index, and the number of pregnancies. No major complications were observed. However, the balloon had to be removed early in two patients (1.59%) due to its rupture and in two other patients (1.59%) due to severe gastritis. Conclusions: IGB therapy is a safe and effective option for obesity management, associated with low rates of complications. The EWL after IGB insertion is significantly higher among older patients, those with a relatively low initial body mass index, those with a longer duration of IGB insertion, and female patients with less parity. Larger prospective studies are needed to support our results. [ABSTRACT FROM AUTHOR]

Background: Morbid obesity has become a serious health problem due to its fatal consequences and co-morbidities. It is well-accepted that obesity-related comorbidities may be effectively managed by bariatric surgery. Objective: The aim of the current study is to assess the outcomes of laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients, regarding weight loss, effects on associated comorbidities and post-operative complications. Patients and Methods: Our retrospective cohort study was conducted in Sohag University Hospitals. A total of 60 patients who underwent LSG were followed up in the period from January 2017 to May 2018. Participants were patients with BMI =40 or BMI = 35-39 with one or more obesity-related co-morbidities. Results: Statistically significant weight reduction occurred at 3, 6, 12, 18 and 24 months after LSG. Regarding the comorbidities, we found that 12 cases had diabetes (4 cases improved and 8 reached remission). The mean HbA1c was within the prediabetic or the controlled diabetic zone for the vast majority of cases, and 6 cases had Hypertension, improvement occurred in 5 cases and one case reached remission. All cases that had dyslipidemia in the study population (5 cases) were completely controlled. Conclusion: LSG can be considered an effective single-stage procedure in morbidly obese patients showing excellent and reliable results for weight loss in obese patients with a significantly low complication rate. This procedure could significantly resolve obesity-related morbidity. [ABSTRACT FROM AUTHOR]

Background/aim: Obesity is a risk factor for hyperuricemia. Bariatric surgery is an effective treatment method for metabolic control. The aim of our study was to evaluate the correlation between the preoperative and postoperative serum uric acid levels with body mass index, body weight, and excess weight loss in patients that underwent sleeve gastrectomy. Materials and methods: A total of 164 patients that underwent laparoscopic and open sleeve gastrectomy were evaluated in terms of the demographic characteristics, preoperative body weight, body mass index and serum uric acid levels, and postoperative body weight, body mass index, excess weight loss and serum uric acid levels at the first, third, sixth, 12th, 18th and 24th–36th months. Results: There was a statistically significant increase in serum uric acid levels in the first postoperative month (p = 0.000). The patients with a high preoperative body mass index were found to have a lower excess weight loss in the first postoperative month, which was statistically significant (p = 0.000, R = –0.474). Serum uric acid levels were also positively correlated with body weight at the third and sixth postoperative months. Conclusion: The weight loss associated with sleeve gastrectomy is the main reason for the reduced postoperative serum uric acid levels. [ABSTRACT FROM AUTHOR]

Context: Despite the positive outcomes reported in terms of weight loss and resolution of co-morbidities, the impact of bariatric surgery on patient-reported outcomes of quality of life (QoL) still remains scarce, particularly in the Indian population. The present study was conducted to evaluate the efficacy of laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB) procedures in patients with severe obesity over a period of 2 years in terms of weight loss, resolution of comorbidities, safety and changes in QoL using the Bariatric analysis and reporting outcome system (BAROS). Subjects and Methods: The data of 100 patients who underwent RYGB and LSG between March 2014 and December 2017 were analyzed. The study endpoints such as QoL, major and minor complication rates, co-morbidity resolutions and the percentage of excess weight loss (%EWL) were measured using the Moorehead-Ardelt BAROS questionnaire II. Results: At a follow-up point of 2 years, patients achieved a mean %EWL of 79.2 (±28.9) % and the mean postoperative body mass index decreased to 31.7 (±6.22) kg/m2. No major complications were reported to have occurred. Excellent global BAROS outcome was obtained in 20% of patients, very good in 47%, good in 29%, fair 2% and failure in 2% patients 24 months post-surgery. The mean BAROS score was 5.8 ± 1.73, and a 'good' to 'excellent' QoL outcome was observed in 96% of patients. Conclusion: RYGB and LSG are safe and effective bariatric procedures. These procedures provided substantial results in good to excellent health-related QoL, weight loss and medical conditions.

Background: The aim of the present study was to evaluate the efficacy of Roux-en-Y gastric bypass (RYGB) vs. sleeve gastrectomy (SG) on glycemic control and blood lipid profile at preoperative (baseline), three and six months after surgery. Methods: In a prospective non-randomized design, 32 participants, SG (n = 11) and RYGB (n = 21) completed the study. Results: Results showed that fasting blood glucose (FBG) and Hemoglobin A1C (HbA1C) were significantly reduced from 113.55±30.18 mg/dL at baseline to 93.6±14.81 mg/dL at three months post operation following SG (p = 0.006). In addition, HbA1C decreased significantly in both groups at baseline, three- and six-months post operation (SG 6.41± 0.96, 5.4±0.36 and 5.28±0.57 % (p = 0.022) and RYGB 5.91± 0.94, 5.11± 0.57 and 4.96± 0.55% (p Conclusions: Both bariatric surgery (SG and RYGB) improved glycemic control and blood lipid profile. Trial registration: The trial is registered with Thai Clinical Trials Registry ( TCTR20210429004) April 29, 2021.

Purpose: Revisional one anastomosis gastric bypass (OAGB) for insufficient weight reduction following primary restrictive procedures is still investigated. We report mid-term outcomes and possible outcome predictors. Materials and Methods: Single-center retrospective comparative study of revisional OAGB outcomes (2015–2018) following laparoscopic adjustable gastric banding (LAGB) and sleeve gastrectomy (SG); silastic ring vertical gastroplasty (SRVG) is separately discussed. Results: In all, 203 patients underwent revisional OAGB following LAGB (n = 125), SG (n = 64), and SRVG (n = 14). Comparing LAGB and SG, body mass index (BMI) at revision were 41.3 ± 6.6 and 42 ± 11.2 kg/m2 (p = 0.64), reduced to 31.3 ± 8.3 and 31.9 ± 8.3 (p = 0.64) at mid-term follow-up, respectively. Excess weight loss (EWL) > 50% was achieved in ~ 50%, with EWL of 79.4 ± 20.4% (corresponding total weight loss 38.5 ± 10.4%). SRVG patients had comparable outcomes. Resolution rates of type 2 diabetes (T2D) and hypertension (HTN) were 93.3% and 84.6% in LAGB compared with 100% and 100% in SG patients (p = 0.47 and p = 0.46), respectively. In univariable analysis, EWL > 50% was associated with male gender (p < 0.001), higher weight (p < 0.001), and BMI (p = 0.007) at primary surgery, and higher BMI at revisional OAGB (p < 0.001). In multivariable analysis, independent predictors for EWL > 50% were male gender (OR = 2.8, 95% CI 1.27–6.18; p = 0.01) and higher BMI at revisional OAGB (OR = 1.11, 95% CI 1.03–1.19; p = 0.006). Conclusion: Revisional OAGB for insufficient restrictive procedures results in excellent weight reduction in nearly 50% of patients, with resolution of T2D and HTN at mid-term follow-up. Male gender and higher BMI at revision were associated with EWL > 50% following revisional OAGB. Identification of more predictors could aid judicious patient selection. [ABSTRACT FROM AUTHOR]

Objectives: The growing prevalence of obesity rates worldwide is associated with an upsurge in its comorbidities, particularly type 2 diabetes mellitus (T2DM). Bariatric surgery is a proven treatment modality for producing sustained weight loss and resolution of associated T2DM providing marked improvement in quality of life with rapid recovery. This study aims to investigate the effects of laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), and mini-gastric bypass (MGB) on obese patients suffering from T2DM in the Indian population and their long-term association with regard to diabetes remission, resolution of comorbidities, and percentage EWL. Methods: Retrospective data of obese patients with T2DM (preoperative BMI 45.37 ± 8.1) who underwent bariatric surgery (RYGB, LSG, and MGB) were analyzed in this study over a period of 9 years. The mean follow-up period was 2.2 years. Following surgery, the clinical outcome on BMI, resolution of percentage weight loss, and T2DM were studied. The predictive factors of diabetic remission after surgery were determined. Student’s t test and ANOVA and McNemar’s test were applied. Results: Out of a total of 274 patients, complete remission of T2DM was achieved in 52.9% (n = 145) with mean fasting blood glucose and glycated hemoglobin values being 6.1 ± 0.769 (p = 0.00) at 1 year after surgery. The independent predictive factors of remission were age, gender, BMI, preoperative comorbidities, and % EWL. Gender had no correlation with the chance of achieving disease remission. Conclusion: Based on our results, bariatric surgery proves to be a successful treatment option resulting in sustained weight loss in obese patients suffering from T2DM. It is found to be beneficial for the long-term resolution of T2DM and improving comorbidities such as hypertension and dyslipidemia. The outcome of the different surgical methods is found to be similar for all patients irrespective of the independent predictors of complete remission.

Bariatric surgery has been recognized as the most effective long-term treatment for morbid obesity. Despite the considerable positive results, adverse consequence can develop. Excessive Weight Loss (EXWL), a rare consequence of bariatric surgery, can lead to a broad adverse consequence. The aim of this study was determining of prevalence and the predicting model of EXWL in patient underwent bariatric surgery until 24 months after surgery. Data have been extracted from the National Obesity Surgery Database in obesity clinic of Iran University of Medical Sciences. The subjects of this retrospective cohort study were morbid obese individuals who underwent three various types of bariatric surgery [One Anastomosis Gastric Bypass (OAGB), Roux-en-Y Gastric Bypass (RYGB), or Sleeve Gastrectomy (SG)] in period of 24 months ago. EXWL has been defined as reaching to less than or equal to BMI 18.5 at any time until 24 months after surgery. SPSS was used in data analysis. Among 4214 subjects of this study, most excess weight loss after surgery has taken place in 18 months after surgery. 11.4% (n = 495) of patients experienced EXWL with highest percentage among OAGB patients (15.1%) at time of 24 months after surgery. The females (20.4% vs.9.9%) and younger persons (35.45 ± 10.25 vs. 39.06 ± 10.76) were more susceptible to EXWL. Patients with EXWL had significantly lower BMI (body mass index) (41.11 ± 4.51 vs. 46.73 ± 6.26) (Kg/m2), and were less probable to had emotional eating. Visceral fat level, fat percentage, and BMI were the best predictor of EXWL (P value for all < 0.05). So that per level increase in visceral fat, decreases the probability of EXWL as 47% and 61% in SG and OAGB. Moreover, each unit lower BMI leads to 25% higher susceptibility to experience EXWL. Surgery should be adjusted in younger females with a lower BMI and healthy metabolic status who are more prone to EXWL. In such a way that minimize weight loss speed/value. It may be possible by selection of other surgery procedures, rather than OAGB, tighter follow-ups, and consultations of patients after surgery is emphasized for more EXWL vulnerable patients. [ABSTRACT FROM AUTHOR]

Background: Sleeve gastrectomy (SG) is the most frequently performed bariatric procedure in the world. Our purpose was to evaluate the percentage of excess weight loss (%EWL), resolution of obesity-related comorbidities after SG, and identify predictive factors of weight loss failure.Methods: A prospective cohort study of adults who underwent SG during 2014 in 7 Belgian-French centers. Their demographic, preoperative, and postoperative data were prospectively collected and analyzed statistically.Results: Overall, 529 patients underwent SG, with a mean preoperative weight and body mass index (BMI) of 118.9 ± 19.9 kg and 42.9 ± 5.5 kg/m2, respectively. Body mass index significantly decreased to 32.2 kg/m2 at 5 years (P < .001). The mean %EWL was 63.6% at 5 years. A significant reduction in dyslipidemia (28.0%-18.2%), obstructive sleep apnea (OSAS) (34.6%-25.1%), and arterial hypertension (HTN) (30.4%-21.5%) was observed after 5 years, but not for diabetes and gastroesophageal reflux disease (GERD). At multivariate analysis, age >50 years old, BMI >50 kg/m2, and previous laparoscopic adjustable gastric banding (LAGB) remained independent predictors of weight loss failure.Conclusions: Five years after SG, weight loss was satisfactory; the reduction of comorbidities was significant for dyslipidemia, OSAS, and HTN, but not diabetes and GERD. Age >50 years old, BMI >50 kg/m2, and previous LAGB were independent predictors of weight loss failure. [ABSTRACT FROM AUTHOR]

Background:The objective of this prospective randomized study was to study the effect of the residual gastric antrum size on the outcome of laparoscopic sleeve gastrectomy and to evaluate the effect of antral resection on weight reduction and complications after LSG. Patients and Methods: Sixty patients underwent LSG as a primary bariatric procedure from November 2016 to March 2019 were randomized into two groups depending on the distance from the pylorus at which gastric division begins. In group (A), the distance was 2 cm from the pylorus, whereas the distance was 6 cm in group (B). The follow-up period was at least 6 months. Baseline and 3 and 6 month outcomes were analyzed including assessments of the percent excess weight lost (% EWL), reduction in BMI, morbidity, mortality, reoperations, quality of life, and co-morbidities. Result(s): Sixty patients included in this study, whose mean pre-operative age was (32.48± 7.92) years, three (5%) patients were males and 57(95%) patients were females with a mean pre-operative BMI was (53.45 ± 8.00) Kg/m2. In group A, the mean % EWL was (33.1 ± 7.15) and (51.37 ± 8.57) at 3 and 6 months respectively. In group B the mean % EWL was (29.29 ± 6.1) and (46.44 ± 9.85) at 3 and 6 months respectively. Patients with the first staple line started 2 cm from the pylorus had better weight loss than those started 6 cm from the pylorus after 3 and 6 months, but this difference statistically insignificant. Conclusion(s): LSG with 2 cm or 6 cm first staple firing from the pylorus produces significant weight loss after surgery. The 2 procedures are equally effective regarding %EWL, morbidity, quality of life, and improvement of co-morbiditieswith insignificant superiorities of 6 cm group.

Purpose: To identify preoperative factors that influence the outcomes of gastric bypass surgery, in terms of excess weight loss at 24 months. Methods: This retrospective study included two groups of patients who underwent laparoscopic gastric bypass surgery. Group A (poor outcomes) had ≤ 50%EWL or BMI ≥ 30 kg/m2; group B (excellent outcomes) had ≥ 80%EWL at 24 months. A comparative analysis of demography, anthropometry, comorbidities, and metabolic status was performed. A linear regression model was used to evaluate %EWL association; the number of preoperative and postoperative consultations were also compared. Results: A total of 202 patients completed follow-up; 71 (35.1%) and 78 (38%) had poor and excellent outcomes (%EWL 44.1 ± 9.4% vs. 92 ± 10.9%), respectively. Mean age was 40.4 ± 8.9 years. Patients with poor outcomes had higher weight and BMI, lesser preoperative %EWL, higher dyslipidemia and diabetes rates with longer periods of evolution, and increased HbA1c% levels. In the linear regression analysis, preoperative %EWL and initial and preoperative BMI were statistically significant determinants of %EWL at 24 months Diabetes remission was 46.2% (group A) vs. 66.6% (group B). Group A had higher non-attendance rates after surgery. Conclusion: The factors independently associated with greater %EWL at 24 months between groups were higher preoperative %EWL, and lower initial and preoperative BMI. [ABSTRACT FROM AUTHOR]

Context: Despite the positive outcomes reported in terms of weight loss and resolution of co-morbidities, the impact of bariatric surgery on patient-reported outcomes of quality of life (QoL) still remains scarce, particularly in the Indian population. The present study was conducted to evaluate the efficacy of laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB) procedures in patients with severe obesity over a period of 2 years in terms of weight loss, resolution of comorbidities, safety and changes in QoL using the Bariatric analysis and reporting outcome system (BAROS). Subjects and Methods: The data of 100 patients who underwent RYGB and LSG between March 2014 and December 2017 were analyzed. The study endpoints such as QoL, major and minor complication rates, co-morbidity resolutions and the percentage of excess weight loss (%EWL) were measured using the Moorehead-Ardelt BAROS questionnaire II. Results: At a follow-up point of 2 years, patients achieved a mean %EWL of 79.2 (±28.9) % and the mean postoperative body mass index decreased to 31.7 (±6.22) kg/m2. No major complications were reported to have occurred. Excellent global BAROS outcome was obtained in 20% of patients, very good in 47%, good in 29%, fair 2% and failure in 2% patients 24 months post-surgery. The mean BAROS score was 5.8 ± 1.73, and a 'good' to 'excellent' QoL outcome was observed in 96% of patients. Conclusion: RYGB and LSG are safe and effective bariatric procedures. These procedures provided substantial results in good to excellent health-related QoL, weight loss and medical conditions. [ABSTRACT FROM AUTHOR]

Abstract Background Laparoscopic sleeve gastrectomy was recently described as an effective approach for the operative treatment of obesity, but the ideal procedure remains controversial. One of the most debated issues is the resection distance from the pylorus. We conducted this study to elucidate any potential differences in the short-term outcomes between 2 and 6 cm distance from the pylorus in laparoscopic sleeve gastrectomy. Methods A prospective observational cohort study in a selected cohort of 96 patients was conducted from January 2018 to March 2019 in morbidly obese patients who had laparoscopic sleeve gastrectomy performed at Suez Canal University Hospital. Outcome was expressed by excess weight loss percentage, resolution of comorbidities, improvement of quality of life, and incidence of complications after laparoscopic sleeve gastrectomy. The morbidly obese patients (body mass index [BMI] > 40 kg/m2 or > 35 kg/m2 with obesity-related comorbidities) in the study were divided into two equal groups: (1) Group 1 (48 patients) underwent laparoscopic sleeve gastrectomy with a 2 cm distance from the pylorus resection distance and (2) Group 2 (48 patients) underwent laparoscopic sleeve gastrectomy with a 6 cm distance from the pylorus resection distance. Body weight, BMI, bariatric quality of life, lipid profile, and comorbidities were evaluated pre- and post-operatively for a duration of 12 months. Results Statistically, no significant differences between the two study groups regarding the excess weight loss percentage, comorbidity resolution throughout the postoperative follow-up, enhancement of the quality of life score throughout the postoperative follow-up, or incidence of complications (25% in Group 1 versus 25% in Group 2, p > 0.05) were found. Conclusion Laparoscopic sleeve gastrectomy was an effective and safe management for morbid obesity and obesity-related comorbidities with significant short-term weight loss; it also improved weight-related quality of life and had an acceptable complication rate. The distance from the pylorus resection distance did not affect the short-term effects of laparoscopic sleeve gastrectomy regarding excess weight loss percentage, resolution of comorbidities, change in quality of life, or occurrence of complications.

Purpose: Although Roux-en-Y gastric bypass (RYGB) is one of the most common bariatric procedures, insufficient weight loss is described to be as high as 20–35%. To treat weight regain/inadequate weight loss, laparoscopic adjustable gastric banding (LAGB) could be a feasible revisional strategy. Materials and Methods: We report on a prospective study which included 35 patients who presented inadequate weight loss or significant weight regain after primary RYGB (percentage excess weight loss [%EWL] at revision < 50%). All patients underwent revisional LAGB with the placement of an Adhesix® Bioring® adjustable gastric band (Cousin Biotech, Wervicq-Sud, France). Patients' weight loss, complications, frequency of revisions and quality of life were evaluated. Results: Follow-up data at 24 months are available for 80% of the included patients. The mean BMI before RYGB was 43.6 ± 5.4 kg/m2 and before revisional LAGB was 38.8 ± 4.3kg/m2. The %EWL before revisional surgery was 23.3 ± 24.8%. The average time between both procedures was 6.7 (mean) ± 3.6 (SD) years. Twenty-four months after revisional LAGB, the average BMI calculated from the weight at RYGB dropped to 32.0 ± 4.5 kg/m2, with an additional %EWL of 49.9 ± 30.3% resulting in a total %EWL of 60.7 ± 28%. The reoperation rate for complications related to LAGB was 21.2%. No band erosions occurred, but two bands needed to be removed during the study. Conclusion: Revisional LAGB may be considered a valid salvage procedure in patients with weight regain or inadequate weight loss after RYGB, though band- and port-related complications remain a notable concern. [ABSTRACT FROM AUTHOR]

Background: Obesity continues to be a leading public health concern associated with many comorbidities and major hindering effect on the daily lifestyle of many people around the world. Surgical treatment for obesity has proved that it is the best and most effective, durable means of preventing the life- threatening complications and serious problems associated with morbid obesity. Objective: Assessing the effect of the anti-reflux suture on the incidence and clinical consequences of bile reflux in OAGB Procedure. Patients and Methods: In this prospective randomized study, 30 patients were selected in Ain Shams University hospitals between November 2021 and May 2022 for assessment of impact of Anti reflux suture on the incidence of post OAGB biliary gastritis. Results: The cases presented in this study did not undergo upper GI endoscopy when they presented with symptoms of reflux or gastritis and thus it was not possible to differentiate between the presence of GERD or biliary gastritis as the source of their symptoms. Conclusion: OAGB is safe and one of the leading procedures for treatment of obesity but it is still surrounded by controversy regarding its relation and effect on bile reflux gastritis. As far as this study shows, the anti-reflux suture modification alone does not seem to prevent the incidence of biliary reflux gastritis post OAGB. [ABSTRACT FROM AUTHOR]

Background: Obesity surgery has proven successful for weight loss and the resolution of comorbidities. There is, however, little evidence on its success and the risk of complications when considering age of onset of obesity (AOO), years of obesity (YOO), preoperative body mass index (BMI), Edmonton obesity staging system (EOSS) score, and age as possible predictors of weight loss, the resolution of comorbidities, and the risk of complications. Methods: Patients who underwent Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) from a prospective database were analyzed. Multiple regression analyses were used to predict comorbidities and their resolution, percentage excess weight loss (%EWL) and total weight loss (%TWL) 12 months after surgery, and the risk of complications using the predictors AOO, YOO, age, EOSS, and BMI. Results: 180 patients aged 46.8 ± 11.1 years with a preoperative BMI 49.5 ± 7.5 were included. The number of preoperative comorbidities was higher with older age (β = 0.054; p = 0.023) and a greater BMI (β = 0.040; p = 0.036) but was not related to AOO and YOO. Patients with AOO as a child or adolescent were more likely to have an EOSS score of ≥2. Greater preoperative BMI was negatively associated with %EWL (β = –1.236; p < 0.001) and older age was negatively associated with %TWL (β = –0.344; p = 0.020). Postoperative complications were positively associated with EOSS score (odds ratio [OR] 1.147; p = 0.042) and BMI (OR 1.010; p = 0.020), but not with age. AOO and YOO were not related to postoperative outcome. Conclusion: Greater BMI was associated with a lower %EWL and age was associated with a low %TWL. YOO and AOO did not influence outcome. Age, BMI, and EOSS score were the most important predictors for risk and success after obesity surgery. Surgery should be performed early enough for optimal outcomes.

Bariatric surgery achieves appropriate excess weight loss, controlling related co-morbidities, including coagulation abnormalities. We investigated the change in the coagulation profile after postoperative weight stabilization, correlating between EWL ratio and change in the coagulation profile. This study took place in our teaching institution (university setting). Between the years 2012 and 2014, 67 patients underwent surgery; 47 patients underwent laparoscopic sleeve gastrectomy (SG) and 20 patients underwent Roux-en-Y gastric bypass (RYGB). Average follow-up of postoperative thromboelastography (TEG) parameters was 30 ± 10.8 months (12–77). Average body mass index (BMI) before surgery was 41.7 ± 4.6 kg / m 2 , average percentage of EWL at the time of data collection was 79%. Patients were divided into 3 groups, 6 patients had EWL < 50%, 13 had an EWL > 100%, and 48 had EWL between 50% and 100%. Exclusion criteria: use of anticoagulation, antiplatelet, or contraceptive medications; known thrombophilic, renal, hepatic, and hematologic diseases/disorders. Two follow-up groups: 1–2 years and over 2 years. Patients underwent pre and postoperative TEG coagulation studies, including maximal amplitude (MA), and clot strength (G). Coagulation profile improved after bariatric surgery. Most prominent change seen in MA and G. There was a linear correlation between the EWL ratio and improvement of MA values starting at 50% EWL peaking at 60%-70%. There was no difference in the coagulation profile after surgery in the two surgery groups (SG and RYGB). Achieving appropriate weight loss after bariatric surgery improves the coagulation profile as measured by TEG, probably decreasing thromboembolic risk in those patients. We recommend expanding the current indication for bariatric surgery to include patients with altered coagulation profile measured by TEG. 1. We investigated the change in the coagulation profile after post-operative weight stabilization and determined whether there was a correlation between the excess weight loss ratio and the extent of change in the coagulation profile. 2. we found a statistically significant improvement of the coagulation function with a clear reduction in the hypercoagulable state without any effect on the fibrinolytic function (compared to the pre-operative values) 3. Once the goal of achieving appropriate weight loss after bariatric surgery is met, an improvement in the coagulation profile as measured by TEG is seen. This improvement can probably decrease the thromboembolic risk in those patients. 4. We propose expanding the current recommendations for bariatric surgery to include patients with altered coagulation profile or a history of thromboembolic events. [ABSTRACT FROM AUTHOR]

Background Obesity and metabolic syndrome (MS) are global health concerns, with high rates of cardiovascular morbidity and mortality. The current guidelines recommend lifestyle modifications as the best initial treatment for obesity and MS. However, lifestyle interventions have modest effects and high 1-year failure rates. Bariatric surgery offers more weight loss with sustained effect in the long term. Aim The aim was to assess the effect of bariatric surgery on MS and all its components and to detect the probable risk factors for persistent MS after bariatric surgery in Egyptian patients. Patients and methods This prospective multicenter study included 250 obese patients who underwent bariatric surgery and completed 1 year of postoperative follow-up. The patients were evaluated preoperatively and at 1, 6, and 12 months postoperatively for presence of MS and its components according to criteria of the third report of National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP III). Results and discussion After 1 year of follow-up, the percentages of patients who had MS, obesity, type 2 diabetes mellitus, hypertension, hypertriglyceridemia, and low high-density lipoprotein-cholesterol were significantly decreased from 92, 100, 84, 50, 74, and 50% to 17, 2, 8, 17, 42, and 25%, respectively. Smoking, family history of obesity, and less percentage of excess weight loss were the most important risk factors for persistence of MS after bariatric surgery.

Hanadi Alnageeb,1 Elamin Abdelgadir,2 Azza Khalifa,2 Mohamed Suliman,3 Subash Chander Gautam,4 Laurent Layani,4 Sriganesh Subramaniam,4 Alaaeldin Bashier2 1Medical Department, Fujairah Hospital, Fujairah, UAE; 2Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, UAE; 3Endocrinology, Imperial College London Diabetes Centre, Al Ain, UAE; 4Surgical Department, Fujairah Hospital, Fujairah, UAE Background: Owing to its impact on weight loss, remission of diabetes mellitus and metabolic syndrome, bariatric surgery has offered hope for grossly obese individuals. In recent years, obesity has increased in the UAE and the use of bariatric surgery has increased in-line with this trend. However, data regarding bariatric surgery outcomes in diabetic Emirati people is scarce. Objective: To evaluate the effect of bariatric surgery in patients with diabetes mellitus. Methods: This is a retrospective analysis of diabetic patients treated with bariatric surgery with a minimal follow-up of 1 year and extended for some patients (21) to 2 years follow up. A total of 80 patients underwent bariatric surgery. Two surgical procedures were used; laparoscopic sleeve gastrectomy (n=53) or mini-gastric bypass between January 1, 2015, and July 20, 2017. Results: Mean baseline weight was 119.2±31.2 kg, this has significantly dropped to 100.1±23.1, 91.2±22.3, 82.3±17.5, and 81.3±15.3 kg at 3, 6, 12, and 24 months respectively, and this change was statistically significant P