Assessing clinical and metabolic responses related to hyperlipidemia, MASLD and type 2 diabetes: sleeve versus RYGB.

OBJECTIVE: Both Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are effective at inducing weight loss, but more information is needed on their comparative effectiveness at improving clinical/biochemical outcomes related to the presence of hyperlipidemia, metabolic dysfunction-associated steatotic liver disease (MASLD), or type 2 diabetes (T2D) at baseline. Here we aimed to assess this in real-world practice. METHODS: This is a prospective cross-sectional and cohort study of 142 patients who underwent RYGB or LSG as per clinical practice. Clinical/biochemical data were collected at baseline, prior to surgery and 12 months post-bariatric surgery. Liver biopsy was performed during surgery to diagnose MASLD. The main outcome was 12-month changes in lipid parameters, mainly total cholesterol, between types of surgery. RESULTS: A TOTAL OF: 107 participants underwent RYGB and 35 underwent LSG. Both groups were similar at baseline except for a higher proportion of males and waist circumference in the LSG group. At 12 months postsurgery, RYGB versus LSG resulted in a significantly lower body mass index, triglycerides, total cholesterol, and low-density lipoprotein. However, alanine aminotransferase was significantly lower in those who underwent LSG. In subgroup analyses RYGB was superior at improving lipid-related parameters in those with hyperlipidemia, whereas LSG was superior at reducing alanine aminotransferase in those with MASLD. CONCLUSIONS: RYGB versus LSG leads to greater reductions in body mass index and lipid parameters, especially in those with hyperlipidemia, whereas LSG showed greater improvements in liver enzymes in those with MASLD.

Effect of bariatric surgery on nutritional and metabolic parameters: does the type of antidepressant medication matter?

PURPOSE: Depression is prevalent in patients undergoing bariatric surgery (BSx). Long-term use of antidepressant is associated with weight gain, particularly the use of selective serotonin reuptake inhibitors (SSRIs). Little is known about whether different types of antidepressants affect the response to BSx. The purpose of this study was to determine the relationship between SSRI use and nutritional and biochemical measurements in those with obesity pre-/post-BSx. METHODS: This is a cross-sectional and prospective cohort study. Patients were enrolled pre-BSx and divided into 3 groups: SSRI, non-SSRI and no antidepressant. Nutritional, biochemical and pharmacological data were collected pre- and 6 months post-BSx. RESULTS: Pre-BSx, 77 patients were enrolled: 89.6% female, median age 45 years and body mass index (BMI) of 45.3 kg/m2. 14.3% were taking SSRIs and had a significantly higher BMI (52.1 kg/m2) compared to 62.3% in no antidepressant (46.0 kg/m2) and 23.4% in non-SSRI antidepressants (43.1 kg/m2). At 6 months post-BSx (n = 58), the SSRI group still had significantly higher BMI in comparison to the other two groups. No other significant differences found between groups. CONCLUSION: Despite higher BMI, patients taking SSRI and undergoing BSx had similar responses, based on nutritional and biochemical parameters, to those on non-SSRI or no antidepressants. LEVEL OF EVIDENCE: Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

Assessment of guidelines for bariatric and metabolic surgery: a systematic review and evaluation using appraisal of guidelines for research and evaluation II (AGREE II).

BACKGROUND: In recent years, multiple guidelines on bariatric and metabolic surgery were published, however, their quality remains unknown, leaving providers with uncertainty when using them to make perioperative decisions. This study aims to evaluate the quality of existing guidelines for perioperative bariatric surgery care. METHODS: A comprehensive search of MEDLINE and EMBASE were conducted from January 2010 to October 2022 for bariatric clinical practice guidelines. Guideline evaluation was carried out using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) framework. RESULTS: The initial search yielded 1483 citations, of which, 26 were included in final analysis. The overall median domain scores for guidelines were: (1) scope and purpose: 87.5% (IQR: 57-94%), (2) stakeholder involvement: 49% (IQR: 40-64%), (3) rigor of development: 42.5% (IQR: 22-68%), (4) clarity of presentation: 85% (IQR: 81-90%), (5) applicability: 6% (IQR: 3-16%), (6) editorial independence: 50% (IQR: 48-67%), (7) overall impressions: 48% (IQR: 33-67%). Only six guidelines achieved an overall score >70%. CONCLUSIONS: Bariatric surgery guidelines effectively outlined their aim and presented recommendations. However, many did not adequately seek patient input, state search criteria, use evidence rating tools, and consider resource implications. Future guidelines should reference the AGREE II framework in study design.

Educational value of a novel telestration device for surgical coaching-a randomized controlled trial.

INTRODUCTION: Communication is fundamental to effective surgical coaching. This can be challenging for training during image-guided procedures where coaches and trainees need to articulate technical details on a monitor. Telestration devices that annotate on monitors remotely could potentially overcome these limitations and enhance the coaching experience. This study aims to evaluate the value of a novel telestration device in surgical coaching. METHODS: A randomized-controlled trial was designed. All participants watched a video demonstrating the task followed by a baseline performance assessment and randomization into either control group (conventional verbal coaching without telestration) or telestration group (verbal coaching with telestration). Coaching for a simulated laparoscopic small bowel anastomosis on a dry lab model was done by a faculty surgeon. Following the coaching session, participants underwent a post-coaching performance assessment of the same task. Assessments were recorded and rated by blinded reviewers using a modified Global Rating Scale of the Objective Structured Assessment of Technical Skills (OSATS). Coaching sessions were also recorded and compared in terms of mentoring moments; guidance misinterpretations, questions/clarifications by trainees, and task completion time. A 5-point Likert scale was administered to obtain feedback. RESULTS: Twenty-four residents participated (control group 13, telestration group 11). Improvements in some elements of the OSATS scale were noted in the Telestration arm but there was no statistical significance in the overall score between the two groups. Mentoring moments were more in the telestration Group. Amongst the telestration Group, 55% felt comfortable that they could perform this task independently, compared to only 8% amongst the control group and 82% would recommend the use of telestration tools here. CONCLUSION: There is demonstrated educational value of this novel telestration device mainly in the non-technical aspects of the interaction by enhancing the coaching experience with improvement in communication and greater mentoring moments between coach and trainee.

Links between gut microbiome, metabolome, clinical variables and non-alcoholic fatty liver disease severity in bariatric patients.

BACKGROUND AND AIMS: Bacterial species and microbial pathways along with metabolites and clinical parameters may interact to contribute to non-alcoholic fatty liver disease (NAFLD) and disease severity. We used integrated machine learning models and a cross-validation approach to assess this interaction in bariatric patients. METHODS: 113 patients undergoing bariatric surgery had clinical and biochemical parameters, blood and stool metabolite measurements as well as faecal shotgun metagenome sequencing to profile the intestinal microbiome. Liver histology was classified as normal liver obese (NLO; n = 30), simple steatosis (SS; n = 41) or non-alcoholic steatohepatitis (NASH; n = 42); fibrosis was graded F0 to F4. RESULTS: We found that those with NASH versus NLO had an increase in potentially harmful E. coli, a reduction of potentially beneficial Alistipes putredinis and an increase in ALT and AST. There was higher serum glucose, faecal 3-(3-hydroxyphenyl)-3-hydroxypropionic acid and faecal cholic acid and lower serum glycerophospholipids. In NAFLD, those with severe fibrosis (F3-F4) versus F0 had lower abundance of anti-inflammatory species (Eubacterium ventriosum, Alistipes finegoldii and Bacteroides dorei) and higher AST, serum glucose, faecal acylcarnitines, serum isoleucine and homocysteine as well as lower serum glycerophospholipids. Pathways involved with amino acid biosynthesis and degradation were significantly more represented in those with NASH compared to NLO, with severe fibrosis having an overall stronger significant association with Superpathway of menaquinol-10 biosynthesis and Peptidoglycan biosynthesis IV. CONCLUSIONS: In bariatric patients, NASH and severe fibrosis were associated with specific bacterial species, metabolic pathways and metabolites that may contribute to NAFLD pathogenesis and disease severity.

Fundamentos de cirugía laparoscópica en Colombia con telesimulación: una herramienta adicional para la formación integral de cirujanos / Fundamentals of laparoscopic surgery in Colombia using telesimulation: an effective educational tool for distance learning

Introducción. El programa "Fundamentos de Cirugía Laparoscópica" es un módulo educativo desarrollado por la Society of American Gastrointestinal Endoscopic Surgeons, que incluye el desarrollo de habilidades prácticas y conocimientos teóricos en cirugía laparoscópica. Su misión principal es brindar a los residentes de las áreas quirúrgicas, y a los cirujanos en general, una herramienta adicional en su formación, para aprender los fundamentos y el conocimiento teórico necesario para la práctica de la cirugía laparoscópica, lo que garantizará un mejor desempeño en las salas de cirugía y, por ende, mayor seguridad para los pacientes. Objetivo. Evaluar la efectividad de la telesimulación para enseñar el componente práctico del programa "Fundamentos de Cirugía Laparoscópica" en Colombia. Materiales y métodos. Veinte participantes (10 cirujanos generales y 10 residentes de cirugía general) de dos ciudades de Colombia, participaron en ocho sesiones (una semanal) de entrenamiento en "Fundamentos de Cirugía Laparoscópica" mediante telesimulación. Se les hizo un examen práctico antes de las telesimulaciones, y un examen teórico y práctico, al final de las ocho sesiones. Resultados. Utilizando parámetros numéricos definidos por la Society of American Gastrointestinal Endoscopic Surgeons, se encontró diferencias significativas el examen previo y el posterior. El 100 % de los participantes aprobaron el componente práctico del programa. Conclusiones. Este estudio demuestra la efectividad de la telesimulación para mejorar las habilidades laparoscópicas de participantes sin conocimiento previo del programa "Fundamentos de Cirugía Laparoscópica", lo que garantizó obtener el puntaje necesario para aprobar la sección práctica del programa.

Introduction: The Fundamentals of Laparoscopic Surgery program is an educational program developed by the Society of American Gastrointestinal Endoscopic Surgeons, which includes a hands-on skills training component, a cognitive component, and an assessment component for laparoscopic surgery. Its main objective is to provide surgical residents and practicing surgeons with the opportunity to learn fundamental skills and obtain the theoretical knowledge required to perform laparoscopic surgery, guaranteeing a better performance in the operating room, and thus, improving patient security. Objective: The purpose of this study was to evaluate the effectiveness of telesimulation for teaching the Fundamentals of Laparosopic Surgery program in Colombia. Materials and methods: Twenty participants (ten general surgeons and ten general surgery residents) in two cities in Colombia participated in eight weekly telesimulation sessions. Fundamentals of Laparoscopic Surgery scores were obtained for each participant before the telesimulation sessions (pre-test scores) and after telesimulation training was completed (post-test scores). Results: Using scoring parameters developed by the Society of American Gastrointestinal Endoscopic Surgeons, we found a significant improvement between pre-test and post-test scores. All the participants passed the skills component of the course. Conclusion: This study evidences the effectiveness of telesimulation to improve the laparoscopic skills of the participants who had no previous knowledge of the Fundamentals of Laparoscopic Surgery program, which guaranteed obtaining the necessary score for approving the practical component of the program.