Long-Term Results at 10 Years of Pouch Resizing for Roux-en-Y Gastric Bypass Failure

Background: Roux-en-Y gastric bypass (RYGB) is currently one of the most performed bariatric procedures and it is associated with rapid weight loss. However, weight loss failure and weight regain after RYGB occurs in approximately 30% and 3-5% of patients, respectively, and represent a serious issue. RYGB pouch resizing is a surgical option that may be offered to selected patients with RYGB failure. The aim of this study is to assess long-term results of pouch resizing for RYGB failure. Materials and Methods: From February 2009 to November 2011, 20 consecutive patients underwent gastric pouch resizing for RYGB failure in our tertiary bariatric center. The primary outcome was the rate of failure (%EWL < 50% with at least one metabolic comorbidity) after at least 10 years from pouch resizing. Gastroesophageal Reflux Disease (GERD) was also assessed. Results: Twenty patients (18 women (90%)) were included and seventeen (85%) joined the study. The failure rate of pouch resizing was 47%. Mean %EWL and mean BMI were 47%, and 35.1 kg/m(2), respectively. Some of the persistent co-morbidities further improved or resolved after pouch resizing. Seven patients (41%) presented GERD requiring daily PPI with a significantly lower GERD-HQRL questionnaire score after pouch resizing (p < 0.001). Conclusion: Pouch resizing after RYGB results in a failure rate of 47% at the 10-year follow-up while the resolution of comorbidities is maintained over time despite a significant weight regain

Does Bariatric Surgery Reduce the Risk of Colorectal Cancer in Individuals with Morbid Obesity? A Systematic Review and Meta-Analysis

: Bariatric surgery has shown to be effective in producing sustained weight loss and the resolution of obesity related medical problems. Recent research focused on the role of obesity and adipose tissue in tumorigenesis, finding a strong crosslink through different mechanisms and highlighting an increase in cancer incidence in individuals with obesity. The aim of this meta-analysis is to find if bariatric surgery reduces the incidence of colorectal cancer in patients with obesity. We performed a meta-analysis including 18 studies (PROSPERO ID: CRD4202235931). Bariatric surgery was found to be significantly protective toward colorectal cancer incidence in individuals with obesity (HR: 0.81, p = 0.0142). The protective effect persisted when considering women (RR: 0.54, p = 0.0014) and men (RR: 0.74, p = 0.2798) separately, although this was not significant for the latter. No difference was found when comparing Roux-en-Y gastric bypass and sleeve gastrectomy. Bariatric surgery reduces the incidence of colorectal cancer in individuals with obesity independently from gender and surgical procedure. Prospective large cohort studies are needed to confirm these findings

Does Bariatric Surgery Reduce the Risk of Colorectal Cancer in Individuals with Morbid Obesity? A Systematic Review and Meta-Analysis

Bariatric surgery has shown to be effective in producing sustained weight loss and the resolution of obesity related medical problems. Recent research focused on the role of obesity and adipose tissue in tumorigenesis, finding a strong crosslink through different mechanisms and highlighting an increase in cancer incidence in individuals with obesity. The aim of this meta-analysis is to find if bariatric surgery reduces the incidence of colorectal cancer in patients with obesity. We performed a meta-analysis including 18 studies (PROSPERO ID: CRD4202235931). Bariatric surgery was found to be significantly protective toward colorectal cancer incidence in individuals with obesity (HR: 0.81, p = 0.0142). The protective effect persisted when considering women (RR: 0.54, p = 0.0014) and men (RR: 0.74, p = 0.2798) separately, although this was not significant for the latter. No difference was found when comparing Roux-en-Y gastric bypass and sleeve gastrectomy. Bariatric surgery reduces the incidence of colorectal cancer in individuals with obesity independently from gender and surgical procedure. Prospective large cohort studies are needed to confirm these findings

Is bariatric surgery safer before, during, or after liver transplantation? A systematic review and meta-analysis

Background: The incidence of morbid obesity is increasing constantly. One of the most common complica tions related to obesity is represented by non-alcoholic fatty liver disease that can range from fatty liver to non-alcoholic steatohepatitis, which is progressively becoming the first cause of end-stage liver disease and need for liver transplantation with alcohol hepatitis. Moreover, many factors contribute to an elevated inci dence of morbid obesity in the post-transplant setting and individuals with obesity undergoing liver trans plantation rarely succeed in losing weight postoperatively. Individuals with obesity in the pre- and post transplant setting benefit from weight loss with reduced morbidity and mortality. Bariatric surgery is effec tive in inducing weight loss and obesity-related medical problems resolution but its application in the liver transplant setting is limited. The aim of this systematic review and meta-analysis is to explore postoperative morbidity and mortality of bariatric surgery performed before, during, or after liver transplantation. Method: This is a systematic review and proportion meta-analysis of 24 studies based on the PRISMA (Pre ferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline. Results: Bariatric surgery performed in patients with obesity and end-stage liver disease waiting for liver transplantation is associated with a 5% major post-bariatric surgery complications rate and a 7% 1-year post liver transplantation mortality. Patients who had bariatric surgery for morbid obesity after liver transplanta tion had a 16% post-bariatric surgery major complication rate. For patients undergoing simultaneous bariatric surgery and liver transplantation, meta-analysis was not applicable but the review of the literature found 1/ 10 patients experiencing major postoperative bariatric-related complications and 31/32 patients were alive 1 year after operation. Conclusion: Bariatric surgery must be performed in selected cases in the setting of liver transplantation. Simultaneous bariatric surgery and liver transplantation are associated with low morbidity and mortality while bariatric surgery after liver transplantation showed increased morbidity. Bariatric surgery before LT is feasible and can improve liver function for patients in transplant waiting list

Challenges in Bariatric Surgery: Outcomes in Patients Having Three or More Bariatric Procedures

Introduction Over the last two decades, a progressive increase in failure rate of bariatric surgery (BS) has occurred in conjunction with an exponential increase in BS worldwide. Bariatric surgeons are confronted with challenging situations in patients with a complex bariatric history. In this study, we aim to evaluate the feasibility and outcomes of revisional BS in patients with at least two or more previous bariatric procedures.Methods Data were retrospectively retrieved from a prospectively held database of bariatric procedures performed at our tertiary referral bariatric center and included procedures done from February 2013 up to April 2019 by a single center.Results Thirty patients underwent a third bariatric procedure. The median age was 40 (18-57) and 54 (27-69) years at the time of the first and the last procedures, respectively. Laparoscopic adjustable gastric banding was the first procedure in 26 patients. The complication rate was 33%; no patient required additional surgery because of postoperative complications. A total weight loss of 29.6% and an excess loss of 53.4% were obtained at a mean follow-up of 61 months after the last redo bariatric procedure.Conclusion This study indicates that redo BS either conversional or revisional is feasible and effective in patients with a complex bariatric history including two or more previous procedures. Careful patients' selection is mandatory and extensive information should be given on the increased risk of postoperative complications