Nutritional Outcomes One Year after One Anastomosis Gastric Bypass Compared to Sleeve Gastrectomy

One Anastomosis Gastric Bypass (OAGB) and Sleeve Gastrectomy (SG) are the most common bariatric procedures performed worldwide. SG is a restrictive procedure whereas OAGB involves malabsorption as well, supposing a risk of deficiency development post OAGB. The aim of the study was to compare nutritional deficiencies and metabolic markers one year after the procedures, while adhering to the current protocols. Retrospective analysis was performed for data on 60 adults undergoing primary OAGB, compared to 60 undergoing primary SG. Mean pre-surgery BMI for SG was 42.7 kg/m2 and 43.3 kg/m2 for OAGB. A multidisciplinary team followed up with the patients at least 3 times during the first year. Mean weight loss was 39.0 kg for SG and 44.1 kg for OAGB. The OAGB group presented a significantly sharper decline in T.Chol and a trend for sharper LDL decrease; a higher increase in folate and a trend for a greater decrease in albumin and hemoglobin were observed in OAGB. For vitamin B12, D, iron and ferritin, no difference was observed between the treatment groups, although there were some in-group differences. Nutritional recommendations and adopted supplement plans minimize the risk of deficiencies and result in improvement in metabolic biomarkers one year after OAGB, which was comparable to SG

The Obesogenic and Glycemic Effect of Bariatric Surgery in a Family with a Melanocortin 4 Receptor Loss-of-Function Mutation

We report the long-term response to bariatric surgery in a singular family of four adolescents with severe obesity (41–82 kg/m2), homozygous for the C271R loss-of-function mutation in the melanocortin 4 receptor (MC4R), and three adults heterozygous for the same mutation. All patients had similar sociodemographic backgrounds and were followed for an average of 7 years. Three of the four homozygous patients regained their full weight (42–77 kg/m2), while the fourth lost weight but remained obese with a body mass index of 60 kg/m2. Weight regain was associated with relapse of most comorbidities, yet hyperglycemia did not relapse or was delayed. A1c levels were reduced in homozygous and heterozygous patients. The long-term follow-up data on this very unique genetic setting show that weight loss and amelioration of obesity following bariatric surgery require active MC4R signaling, while the improvement in glycemia is in part independent of weight loss. The study validates animal models and demonstrates the importance of biological signaling in the regulation of weight, even after bariatric surgery

Results of conversion of gastric banding to gastric bypass in patients between 50 and 60 years of age are similar to those observed in younger patients

BACKGROUND: The effect of age and gender on outcomes of revisional bariatric surgery has not been assessed. METHODS: A retrospective analysis of patients undergoing revision from laparoscopic adjustable gastric banding (LAGB) to laparoscopic roux en Y gastric bypass (LRYGB) between 2007 and 2017 was performed. Patients were divided according to gender and age (≥ 50 years), and the outcomes of the subgroups were compared. RESULTS: During the study period, 161 revisional LRYGBs were performed. Postoperative percentage of total body weight loss was comparable between the subgroups. No significant difference was observed between the groups in the improvement/resolution of comorbidities. Overall early complication rates were comparable, however major postoperative bleeding was more common in older patients (6.7 vs. 0.9%, p = 0.03). More late complications were demonstrated in females when compared to males (14.3 vs. 2.0%, p = 0.02). CONCLUSIONS: Revisional LRYGB after failed LAGB yields acceptable results, regardless of patient gender and age