Total Alimentary Limb Length Is Not Associated with Weight Loss Following Proximal Roux-en-Y Gastric Bypass.

Background: Standard Roux-en-Y gastric bypass (RYGB) typically manipulates the proximal portion of the small intestine, leaving a variable and unknown common channel and total alimentary limb length (TALL). Despite high variability in postoperative weight loss, the factors contributing to this variability remain unknown. Given the known variability in small intestinal length, this unmeasured variability in TALL may be associated with weight loss responses.

Patients experience with preoperative use of anti-obesity medications and associations with bariatric surgery expectations.

Background: Few studies have investigated the use of anti-obesity medications (AOMs) before bariatric surgery and how prior use impacts patients' goals and expectations for surgery.

Objectives: This study investigated associations between patients' experiences with AOMs and weight loss expectations before bariatric surgery.

Settings: Single tertiary university hospital.

Adverse event comparison between glucagon-like peptide-1 receptor agonists and other antiobesity medications following bariatric surgery.

Aim: To compare the incidence of adverse events (AEs) related to antiobesity medications (AOMs; glucagon-like peptide-1 receptor agonists [GLP-1RAs] vs. non-GLP-1RAs) after bariatric surgery.

Methods: This single-centre retrospective cohort included patients (aged 16-65 years) who had undergone laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy (cohort entry date) and initiated AOMs.

Sex- and operation-dependent effects on 5-year weight loss results of bariatric surgery.

Background: Weight loss response after bariatric surgery is highly variable, and several demographic factors are associated with differential responses to surgery. Preclinical studies demonstrate numerous sex-specific responses to bariatric surgery, but whether these responses are also operation dependent is unknown.

Objective: To examine sex-specific weight loss outcomes up to 5 years after laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).

Combination anti-obesity medications to effectively treat bariatric surgery weight regain at an academic obesity center.

Background: Combination anti-obesity medications (AOMs) to treat postoperative bariatric surgery weight regain have limited data on their use in the clinical setting. Understanding the optimal treatment protocol in this cohort will maximize weight loss outcomes.

Methods: A retrospective review of bariatric surgery patients ( = 44) presenting with weight regain at a single academic multidisciplinary obesity center who were prescribed AOM(s) plus intensive lifestyle modification for 12 months.

Shared Decision-Making in General Surgery: Prospective Comparison of Telemedicine vs In-Person Visits.

Background: The coronavirus disease 2019 (COVID-19) pandemic has accelerated a shift toward virtual telemedicine appointments with surgeons. While this form of healthcare delivery has potential benefits for both patients and surgeons, the quality of these interactions remains largely unstudied. We hypothesize that telemedicine visits are associated with lower quality of shared decision-making.

Caloric Restriction and Weight Loss Are Primary Factors in the Early Tissue-Specific Metabolic Changes After Bariatric Surgery.

Objective: To evaluate changes in insulin sensitivity, hormone secretion, and hepatic steatosis immediately after caloric restriction, vertical sleeve gastrectomy (VSG), and Roux-en-Y gastric bypass (RYGB).

Research Design And Methods: Obese subjects were assessed for 1) insulin sensitivity with hyperinsulinemic-euglycemic clamp with glucose tracer infusion, 2) adipokine concentrations with serum and subcutaneous adipose interstitial fluid sampling, and 3) hepatic fat content with MRI before and 7-10 days after VSG, RYGB, or supervised caloric restriction.

Results: Each group exhibited an ∼5% total body weight loss, accompanied by similar improvements in hepatic glucose production and hepatic, skeletal muscle, and adipose tissue insulin sensitivity.

Benefits of Adjuvant Medical Weight Loss Intervention in Setting of Weight Regain and Inadequate Weight Loss After Weight Loss Surgery.

Background: Currently, there is no nationally accepted protocol for addressing weight regain or inadequate weight loss after MBS.

Objectives: To devise, implement, and evaluate a protocol targeting weight regain or inadequate weight loss in MBS patients at our institution.

Setting: Vanderbilt University Medical Center, Nashville, TN, United States.

Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment.

Introduction: This systematic review provides supporting evidence for the accompanying clinical practice guideline on the referral of adults with obstructive sleep apnea (OSA) for surgical consultation.

Methods: The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of upper airway sleep apnea surgery or bariatric surgery to no treatment as well as studies that reported on patient-important and physiologic outcomes pre- and postoperatively.

Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine clinical practice guideline.

Introduction: This guideline establishes clinical practice recommendations for referring adults with obstructive sleep apnea (OSA) for surgical consultation.

Methods: The American Academy of Sleep Medicine (AASM) commissioned a task force of experts in sleep medicine, otolaryngology, and bariatric surgery to develop recommendations and assign strengths based on a systematic review of the literature and an assessment of the evidence using the GRADE process. The task force evaluated the relevant literature and the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations that support the recommendations.

Prevalence of thiamine deficiency is significant in patients undergoing primary bariatric surgery.

Background: Patients undergoing metabolic and bariatric surgery are prone to developing micronutrient deficiencies, necessitating life-long nutritional supplementation and monitoring. Historically, these deficiencies were thought to be driven by postsurgical changes in absorption. Recent data, though, have demonstrated that obesity alone is also associated with micronutrient deficiencies.

Change in Total Body Water as a Metric for Predicting Need for Outpatient Intravenous Fluids in Postoperative Bariatric Patients.

Background: Dehydration drives a significant proportion of readmissions following bariatric surgery. Routinely performed body composition testing and total body water (TBW) calculations may present a novel method for diagnosing dehydration for outpatient intervention. We sought to determine if a change in TBW from preoperative baseline could help identify bariatric patients requiring outpatient intravenous fluid (IVF) administration for dehydration.

Cardiovascular risk reduction following metabolic and bariatric surgery.

Cardiovascular disease (CVD) is the world's leading cause of mortality and obesity is a well-recognized risk factor of CVD. Early detection and management of CVD is critical to reduce CVD risk. Especially in patients suffering from obesity with obesity-related CVD risk factors such as hypertension (HTN), dyslipidemia, and diabetes mellitus (DM).

Efficacy and Safety of Recurrent Paraesophageal Hernia Repair with Roux-en-Y Gastric Bypass.

Roux-en-Y gastric bypass (RYGB) has been explored as a revisional option to failed paraesophageal hernia (PEH) repair with fundoplication, particularly in patients suffering from obesity. However, few studies have assessed long-term outcomes of RYGB with revisional PEH repair in regard to acid-suppressing medication use. We retrospectively identified 19 patients who underwent revisional PEH repair with RYGB between 2011 and 2018.

Early improvement in patient reported disability after bariatric surgery.

Background: Bariatric surgery is an effective intervention for managing morbid obesity. Little evidence has been reported regarding objective assessments of patient disability after surgery. The World Health Organization Disability Assessment Score 2.

Randomized sham-controlled trial of the 6-month swallowable gas-filled intragastric balloon system for weight loss.

Background: Obesity is a significant health problem and additional therapies are needed to improve obesity treatment.

Objective: Determine the efficacy and safety of a 6-month swallowable gas-filled intragastric balloon system for weight loss.

Setting: Fifteen academic and private practice centers in the United States.

An enhanced recovery program for bariatric surgical patients significantly reduces perioperative opioid consumption and postoperative nausea.

Background: Patients frequently remain in the hospital after bariatric surgery due to pain, nausea, and inability to tolerate oral intake. Enhanced recovery after surgery (ERAS) concepts address these perioperative complications and therefore improve length of stay for bariatric surgery patients.

Objectives: To determine if ERAS concepts increase the proportion of patients discharged on postoperative day 1.

Endoscopic management of erosion after banded bariatric procedures.

Background: Prosthetic materials wrapped around a portion of the stomach have been used to provide gastric restriction in bariatric surgery for many years. Intraluminal erosion of adjustable and nonadjustable gastric bands typically occurs many years after placement and results in various symptoms. Endoscopic management of gastric band erosion has been described and allows for optimal patient outcomes.

Characteristics of burn patients injured in methamphetamine laboratory explosions.

The use of methamphetamine (MA) as a recreational drug has increased exponentially in recent years, resulting in an emergence of clandestine laboratories. Consequently, the frequency with which burn centers across the country are admitting patients injured as a consequence of the volatile manufacturing process of MA is increasing. This study focused on comparing outcomes between burn patients injured secondary to MA laboratory explosions and patients sustaining burns from other mechanisms.