The impact of sleeve gastrectomy with or withour omentectomy on the insulin sensitivity, the secretion of gastrointestinal hormones and the adipokines levels in patients with morbid obesity

Background: Increased visceral adipose tissue is a risk factor for the metaboliccomplications associated with obesity and promotes a low-grade chronicinflammatory process. Resection of the great omentum in patients submitted to abariatric procedure has been proposed for the amelioration of metabolic alterationsand the maximization of weight loss. The aim of the present study was to investigatethe impact of omentectomy performed in patients with morbid obesity undergoingsleeve gastrectomy (SG) on metabolic profile, adipokine secretion, inflammatorystatus and weight loss.Methods: Thirty-one obese patients were randomized into two groups, SG alone orwith omentectomy. Adiponectin, omentin, interleukin-6 (IL-6), tumor necrosis factorα (TNF-α), high sensitivity C-reactive protein (hs-CRP), blood lipids, fasting glucose,insulin and insulin resistance were measured before surgery and at 7 days, and 1, 3and 12 months after surgery.Results: During the one year follow up BMI decreased markedly and comparably inboth groups (P<0.001). Insulin, IL-6 and hs-CRP levels decreased significantlycompared to baseline (P<0.05) in both groups with no significant difference betweengroups. Adiponectin and high-density lipoprotein choresterol levels weresignificantly and similarly increased compared to baseline (P<0.001) in both groups.Omentin levels increased significantly (p<0.05) in the control group and decreased in the omentectomy group one year postoperatively. There was no significant change inTNF-α levels in either group.Conclusions: The theoretical advantages of omentectomy in regard to weight loss andobesity related abnormalities are not confirmed in this prospective study.Furthermore, omentectomy does not induce important changes in the inflammatorystatus in patients undergoing SG.ΣΚΟΠΟΣ: Ο αυξηµένος σπλαχνικός λιπώδης ιστός αποτελεί σηµαντικό παράγοντακινδύνου για µεταβολικές επιπλοκές, που συσχετίζονται µε την παχυσαρκία, καιπροάγει µία ήπιου βαθµού χρόνια φλεγµονώδη διαδικασία. Το επίπλουν έχει απόκαιρό εµπλακεί στη, σχετιζόµενη µε την παχυσαρκία, µεταβολική δυσλειτουργία.Αυτό βασίζεται στη σηµαντική του λειτουργία, της έκκρισης αντιποκινών. Η ιδέα τηςεκτοµής του µείζονος επιπλόου, στον ίδιο χρόνο µε µία βαριατρική επέµβαση, έχειπροταθεί για την βελτίωση των µεταβολικών µεταβολών και την µεγιστοποίηση τηςαπώλειας βάρους. Ο σκοπός της συγκεκριµένης µελέτης ήταν να προσδιορίσει εάν ηεκτοµή του µείζονος επιπλόου, στον ίδιο χρόνο µε τη λαπαροσκοπική επιµήκηγαστρεκτοµή, έχει κάποια επίδραση στο µεταβολικό προφίλ, την έκκριση τωναντιποκινών, το στάτους της φλεγµονής και την απώλεια βάρους, σε βραχύ ή µακρόβάθος χρόνου.ΜΕΘΟΔΟΙ: Τριάντα – ένας παχύσαρκοι ασθενείς (Δείκτης Μάζας Σώµατος (ΒΜΙ):42.49±2.03 Kg/m2 ) τυχαιοποιήθηκαν σε δύο οµάδες, λαπαροσκοπικής επιµήκουςγαστρεκτοµής, µε ή χωρίς επιπλεκτοµή. Αντιπονεκτίνη, Οµεντίνη, Ιντερλευκίνη-6(IL-6), tumor necrosis factor-α ((TNF-α), C-αντιδρώσα πρωτεΐνη υψηλήςευαισθησίας (hs-CRP), high-density lipoprotein (HDL) χοληστερόλη, γλυκόζηνηστείας, ινσουλίνη και αντίσταση στην ινσουλίνη (εκτιµωµένη µε εφαρµογή Quickie Test) µετρήθηκαν και εκτιµήθηκαν προεγχειρητικά και 7 µέρες, 1, 3 και 12µήνες µετεγχειρητικά.ΑΠΟΤΕΛΕΣΜΑΤΑ: Κατά τη µετεγχειρητική παρακολούθηση, στη διάρκεια τουπρώτου χρόνου, ο δείκτης µάζας σώµατος µειώθηκε αξιοσηµείωτα και συγκριτικάκαι στις δύο οµάδες (Ρ<0.001). Τα επίπεδα της ινσουλίνης, IL-6 και hs-CRP,µειώθηκαν σηµαντικά σε σχέση µε τις τιµές αναφοράς (προεγχειρητικά) (Ρ<0.05) καιστις δύο οµάδες, χωρίς στατιστικά σηµαντική διαφορά µεταξύ τους. Τα επίπεδααντιπονεκτίνης και HDL αυξήθηκαν οµοίως και σηµαντικά, συγκρινόµενα µε ταεπίπεδα αναφοράς (Ρ<0.001) και στις δύο οµάδες. Τα επίπεδα της Οµεντίνηςαυξήθηκαν σηµαντικά (Ρ<0.05) στην οµάδα ελέγχου (επιµήκης γαστρεκτοµή, χωρίςεκτοµή του επιπλόου) και παρέµειναν χαµηλά στην οµάδα της επιπλεκτοµής(επιµήκης γαστρεκτοµή + επιπλεκτοµή), στο ένα έτος µετεγχειρητικά. Δεν υπήρξεστατιστικά σηµαντική διαφορά στη µεταβολή των επιπέδων TNF-α σε κάθε οµάδα.ΣΥΜΠΕΡΑΣΜΑΤΑ: Τα, µέχρι τώρα, θεωρητικά πλεονεκτήµατα της επιπλεκτοµής,όσον αφορά την απώλεια βάρους και το µεταβολικό σύνδροµο, δεναντικατοπτρίζονται στην προοπτική αυτή µελέτη. Επιπλέον, δοθέντος τουπροστατευτικού ρόλου της οµεντίνης σε συνδυασµό µε τη θετική συσχέτισηή της µετα επίπεδα αντιπονεκτίνης πλάσµατος και HDL, ήδη γνωστώνκαρδιοπροστατευτικών πρωτεϊνών, ανακύπτουν ερωτήµατα γύρω από την αρνητικήεπίδραση της επιπλεκτοµής και καρδιαγγειακής φυσιολογίας, σε βάθος χρόνο

30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries.

BACKGROUND There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates. METHODS We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020. RESULTS Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country. CONCLUSIONS BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak

Safety of Bariatric Surgery in ≥ 65-Year-Old Patients During the COVID-19 Pandemic

Background Age &gt;= 65 years is regarded as a relative contraindication for bariatric surgery. Advanced age is also a recognised risk factor for adverse outcomes with Coronavirus Disease-2019 (COVID-19) which continues to wreak havoc on global populations. This study aimed to assess the safety of bariatric surgery (BS) in this particular age group during the COVID-19 pandemic in comparison with the younger cohort.Methods We conducted a prospective international study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into two groups - patients &gt;= 65-years-old (Group I) and patients &lt; 65-years-old (Group II). The two groups were compared for 30-day morbidity and mortality.Results There were 149 patients in Group 1 and 6923 patients in Group II. The mean age, preoperative weight, and BMI were 67.6 +/- 2.5 years, 119.5 +/- 24.5 kg, and 43 +/- 7 in Group I and 39.8 +/- 11.3 years, 117.7 +/- 20.4 kg, and 43.7 +/- 7 in Group II, respectively. Approximately, 95% of patients in Group 1 had at least one co-morbidity compared to 68% of patients in Group 2 (p = &lt; 0.001). The 30-day morbidity was significantly higher in Group I ( 11.4%) compared to Group II (6.6%) (p = 0.022). However, the 30-day mortality and COVID-19 infection rates were not significantly different between the two groups.Conclusions Bariatric surgery during the COVID-19 pandemic is associated with a higher complication rate in those &gt;= 65 years of age compared to those &lt; 65 years old. However, the mortality and postoperative COVID-19 infection rates are not significantly different between the two groups

Effect of BMI on safety of bariatric surgery during the COVID-19 pandemic, procedure choice, and safety protocols - An analysis from the GENEVA Study

Background: It has been suggested that patients with a Body Mass Index (BMI) of &gt; 60 kg/m2 should be offered expedited Bariatric Surgery (BS) during the Coronavirus Disease-2019 (COVID-19) pandemic. The main objective of this study was to assess the safety of this approach. Methods: We conducted a global study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into three groups according to their preoperative BMI -Group I (BMI &lt; 50 kg/m2), Group II (BMI 50-60 kg/m2), and Group III (BMI &gt; 60 kg/m2). The effect of preoperative BMI on 30-day morbidity and mortality, procedure choice, COVID-19 specific safety protocols, and comorbidities was assessed. Results: This study included 7084 patients (5197;73.4 % females). The mean preoperative weight and BMI were 119.49 &amp; PLUSMN; 24.4 Kgs and 43.03 &amp; PLUSMN; 6.9 Kg/m2, respectively. Group I included 6024 (85 %) patients, whereas Groups II and III included 905 (13 %) and 155 (2 %) patients, respectively.The 30-day mortality rate was higher in Group III (p = 0.001). The complication rate and COVID-19 infection were not different. Comorbidities were significantly more likely in Group III (p = &lt; 0.001). A significantly higher proportion of patients in group III received Sleeve Gastrectomy or One Anastomosis Gastric Bypass compared to other groups. Patients with a BMI of &gt; 70 kg/m2 had a 30-day mortality of 7.7 % (2/26). None of these patients underwent a Roux-en-Y Gastric Bypass. Conclusion: The 30-day mortality rate was significantly higher in patients with BMI &gt; 60 kg/m2. There was, however, no significant difference in complications rates in different BMI groups, probably due to differences in procedure selection

30-Day morbidity and mortality of bariatric metabolic surgery in adolescence during the COVID-19 pandemic – The GENEVA study

Background: Metabolic and bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity. Objectives: This study examined the safety of MBS in adolescents during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This was a global, multicentre and observational cohort study of MBS performed between May 01, 2020, and October 10,2020, in 68 centres from 24 countries. Data collection included in-hospital and 30-day COVID-19 and surgery-specific morbidity/mortality. Results: One hundred and seventy adolescent patients (mean age: 17.75 ± 1.30 years), mostly females (n&nbsp;=&nbsp;122, 71.8%), underwent MBS during the study period. The mean pre-operative weight and body mass index were 122.16 ± 15.92 kg and 43.7&nbsp;± 7.11 kg/m2, respectively. Although majority of patients had pre-operative testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n&nbsp;=&nbsp;146; 85.9%), only 42.4% (n&nbsp;=&nbsp;72) of the patients were asked to self-isolate pre-operatively. Two patients developed symptomatic SARS-CoV-2 infection post-operatively (1.2%). The overall complication rate was 5.3% (n&nbsp;=&nbsp;9). There was no mortality in this cohort. Conclusions: MBS in adolescents with obesity is safe during the COVID-19 pandemic when performed within the context of local precautionary procedures (such as pre-operative testing). The 30-day morbidity rates were similar to those reported pre-pandemic. These data will help facilitate the safe re-introduction of MBS services for this group of patients