Effect of very large body mass loss on energetics, mechanics and efficiency of walking in adults with obesity: mass-driven versus behavioural adaptations.

Understanding the mechanisms involved in the higher energy cost of walking (NCw : the energy expenditure above resting per unit distance) in adults with obesity is pivotal to optimizing the use of walking in weight management programmes. Therefore, this study aimed to investigate the mechanics, energetics and mechanical efficiency of walking after a large body mass loss induced by bariatric surgery in individuals with obesity. Nine adults (39.5 ± 8.6 year; BMI: 42.7 ± 4.6 kg m-2 ) walked at five fixed speeds before (baseline) and after the bariatric surgery (post 1 and post 2). Gas exchanges were measured to obtain NCw . A motion analysis system and instrumented treadmill were combined to assess total mechanical work (Wtot ). Mechanical efficiency (Wtot NCw-1 ) was also calculated. Participants lost 25.7 ± 3.4% of their body mass at post 1 (6.6 months; P < 0.001) and 6.1 ± 4.9% more at post 2 (12 months; P = 0.014). Mass-normalized NCw was similar between baseline and post 1 and decreased at post 2 compared to that at baseline (-6.2 ± 2.7%) and post 1 (-8.1 ± 1.9%; P ≤ 0.007). No difference was found in mass-normalized Wtot during follow-up (P = 0.36). Mechanical efficiency was similar at post 1 and post 2 when compared to that at baseline (P ≥ 0.19), but it was higher (+14.1 ± 4.6%) at post 2 than at post 1 (P = 0.013). These findings showed that after a very large body mass loss, individuals with obesity may reorganize their walking pattern into a gait more similar to that of lean adults, thus decreasing their NCw by making their muscles work more efficiently. KEY POINTS: A higher net (above resting) energy cost of walking (lower gait economy) is observed in adults with obesity compared to lean individuals. Understanding the mechanisms (i.e. mass driven, gait pattern and behavioural changes) involved in this extra cost of walking in adults with obesity is pivotal to optimizing the use of walking to promote daily physical activity and improve health in these individuals. We found that very large weight loss induced by bariatric surgery significantly decreased the energy cost of walking per kg of body mass after 1 year with similar total mechanical work per kg of body mass, resulting in an increased mechanical efficiency of walking. Individuals with obesity may reorganize their walking pattern into a gait more similar to that of adults of normal body mass, thus decreasing their energy cost of walking by making their muscles work more efficiently.

[Bariatric surgery: role of sleeve gastrectomy in 2022]. / Chirurgie bariatrique : place de la gastrectomie en manchon (sleeve gastrectomy) en 2022.

Two main procedures currently dominate the panel of bariatric interventions. Sleeve gastrectomy is technically easier and the most widely performed in the world. It shows slightly inferior results and is also associated with a slightly lower morbidity compared to gastric bypass. This is counterbalanced by its irreversibility and a high prevalence of postoperative gastro-esophageal reflux. For this reason, gastric bypass remains the dominant procedure in Switzerland, thanks to its good long-term weight and metabolic results. Sleeve gastrectomy is also an important option in bariatric surgery, with some specific indications.

Deux procédures principales dominent actuellement la chirurgie bariatrique: la gastrectomie en manchon (ou sleeve gastrectomy) et le bypass gastrique. La première, la plus pratiquée dans le monde, est techniquement plus simple. Elle donne des résultats légèrement inférieurs à ceux du bypass gastrique, avec une morbidité aussi légèrement inférieure. Son irréversibilité et la fréquence du reflux gastro-œsophagien postopératoire représentent des facteurs limitants. Pour cette raison, le bypass gastrique reste en Suisse l'intervention de choix grâce à ses bons résultats pondéraux et métaboliques à long terme. En 2022, la gastrectomie en manchon est aussi une option importante dans l'arsenal bariatrique, avec quelques indications spécifiques.

Defining Global Benchmarks in Elective Secondary Bariatric Surgery Comprising Conversional, Revisional, and Reversal Procedures.

OBJECTIVE: To define "best possible" outcomes for secondary bariatric surgery (BS). BACKGROUND: Management of poor response and of long-term complications after BS is complex and under-investigated. Indications and types of reoperations vary widely and postoperative complication rates are higher compared to primary BS. METHODS: Out of 44,884 BS performed in 18 high-volume centers from 4 continents between 06/2013-05/2019, 5,349 (12%) secondary BS cases were identified. Twenty-one outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of centers. Benchmark cases had no previous laparotomy, diabetes, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, thromboembolic events, BMI> 50 kg/m2 or age> 65 years. RESULTS: The benchmark cohort included 3143 cases, mainly females (85%), aged 43.8 ±â€Š10 years, 8.4 ±â€Š5.3 years after primary BS, with a BMI 35.2 ±â€Š7 kg/m2. Main indications were insufficient weight loss (43%) and gastro-esophageal reflux disease/dysphagia (25%). 90-days postoperatively, 14.6% of benchmark patients presented ≥1 complication, mortality was 0.06% (n = 2). Significantly higher morbidity was observed in non-benchmark cases (OR 1.37) and after conversional/reversal or revisional procedures with gastrointestinal suture/stapling (OR 1.84). Benchmark cutoffs for conversional BS were ≤4.5% re-intervention, ≤8.3% re-operation 90-days postoperatively. At 2-years (IQR 1-3) 15.6% of benchmark patients required a reoperation. CONCLUSION: Secondary BS is safe, although postoperative morbidity exceeds the established benchmarks for primary BS. The excess morbidity is due to an increased risk of gastrointestinal leakage and higher need for intensive care. The considerable rate of tertiary BS warrants expertise and future research to optimize the management of non-success after BS.

[Super obesity, an exponentially growing epidemic : surgical treatment options and expectations]. / Superobésité, une épidémie en croissance exponentielle : options thérapeutiques chirurgicales et attentes.

Obesity is a major health problem with a prevalence that has tripled since 1976, affecting a large portion of the population across all ages. Bariatric surgery is currently considered as the most efficient and durable treatment in terms of weight loss and remission of long-term co-morbidities. The objective of this article is to describe briefly the different surgical options for patients with severe obesity and to report their effectiveness, as well as to provide primary care physicians with simple instructions, regarding initial management and the appropriate guidance of their patients to a specialized service.

L'obésité représente un problème de santé publique majeur avec une prévalence qui a triplé depuis 1976 et qui touche une grande partie de la population, tous âges confondus. La chirurgie bariatrique est actuellement considérée comme le traitement le plus efficace et le plus durable en termes de perte de poids et de rémission des comorbidités à long terme. L'objectif de cet article est de décrire brièvement les différentes options chirurgicales pour les patients souffrant d'une obésité sévère, de rapporter leur efficacité, ainsi que de fournir aux médecins de premier recours des instructions simples en ce qui concerne la prise en charge initiale et l'orientation appropriée de leurs patients vers un service spécialisé.

[Long-term results after Roux-en-Y gastric bypass for severe obesity]. / Bypass gastrique en Y selon Roux pour obésité sévère ­ Résultats à long terme.

Long-term results after Roux-en-Y gastric bypass for severe obesity Abstract. Roux-en-Y gastric bypass (RYGB) has been performed for almost 50 years, yet long-term results have only been scarcely reported. In this paper, we report results up to 15 years after gastric bypass and review the relevant literature on long-term results after this operation. MATERIAL AND METHODS: Our prospective database has been reviewed for this study. A literature search via Pubmed was done, and articles reporting on 10-year results after RYGB in at least 50 patients were retrieved and analyzed. RESULTS: A total of 822 patients underwent primary RYGB in our institutions between 1999 and 2007. All are eligible for 10-year analysis, and 186 operated before 2003 for 15-year analysis. Follow-up rates after 10 and 15 years are 76 and 55 % respectively. Patients loose a mean of 12,9 BMI units after 10 years, a figure that remains unchanged after 15 years. 80 %, respectively 72 % of patients maintain a %total body weight loss of at least 20 % after 10 and 15 years. Comorbidities are markedly improved, as well as quality of life. These results compare well with those reported in the literature after this length of time. Studies from the literature also show a preventive effect of RYGB in the development of metabolic comorbidities in obese individuals submitted to RYGB. CONCLUSIONS: RYGB provides good to excellent long-term weight loss which persists up to 15 years after surgery. This is associated with markedly improved comorbidities and reduced cardiovascular risk, improved quality-of-life and reduced mortality. RYGB represents a good option for most patients who seek surgery for severe obesity.

[Functional and surgical complications after bariatric surgery for severe obesity]. / Complications fonctionnelles et chirurgicales après chirurgie bariatrique pour obésité sévère.

Bariatric surgery, the most effective treatment for obesity, can lead to long-term complications. These may be of functional nature (dumping, hypoglycemia, reflux) or of surgical nature. Acute or chronic abdominal pain is not unusual after gastric bypass. Often unrelated to surgery, it can be caused by an acute surgical problem (internal hernia, obstruction, intussusception), which can lead to extensive bowel necrosis if not treated quickly. Other complications (candy cane, anastomotic ulcer, reflux) can also develop. An «â€…obstructed sleeve ¼ can develop early or late after sleeve gastrectomy. Rapid management of acute abdominal pain is essential and should, ideally, be done in a specialized setting where appropriate imaging and specific surgical skills are readily available.

Traitement le plus efficace de l'obésité, la chirurgie bariatrique peut cependant comporter des complications à long terme, de nature fonctionnelle (dumping précoce, hypoglycémie, reflux) ou chirurgicale. Des douleurs abdominales aiguës ou intermittentes ne sont pas rares après bypass gastrique. Souvent sans lien avec la chirurgie, elles peuvent traduire une problématique aiguë (hernie interne, occlusion, invagination), source potentielle de nécrose intestinale étendue en l'absence de traitement adéquat. D'autres complications (candy cane, ulcère anastomotique, reflux) peuvent survenir. Un syndrome occlusif précoce ou chronique peut survenir après sleeve gastrectomy. Une prise en charge rapide des douleurs aiguës est indispensable, idéalement en milieu spécialisé où imagerie et compétences chirurgicales spécifiques sont à disposition.

[Recommendations for monitoring nutritional deficiencies after bariatric surgery]. / Recommandations de suivi des carences nutritionnelles après chirurgie bariatrique.

Bariatric surgery is the most effective long-term therapy for the management of patients with obesity but all bariatric surgical procedures have the potential to cause clinically significant micronutrient deficiencies due to reduced food intake, decreased gastric acid and intrinsic factor secretion, poor food choices and food intolerance. For clinicians, the acquisition of special knowledge is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present article, we summarize existing recommendations for monitoring and replacement of vitamins and minerals following bariatric surgery.

La chirurgie bariatrique est le traitement le plus efficace pour la prise en charge des patients souffrant d'obésité. Cependant, ces interventions peuvent provoquer des déficits nutritionnels cliniquement significatifs en raison d'apports alimentaires réduits, de la diminution de production d'acide gastrique et de facteur intrinsèque, d'une consommation d'aliments de faible qualité ou d'intolérances digestives. Il est essentiel pour les professionnels de la santé d'avoir des connaissances minimales pour offrir des soins appropriés et efficaces à leurs patients opérés. Dans cet article, nous résumons les recommandations pour la surveillance et le remplacement des vitamines et minéraux après une chirurgie bariatrique.

[Abdominal pain after bariatric surgery†: what to do†?] / Douleurs abdominals après chirurgie bariatrique†: que faire†?

Bariatric and metabolic surgery is the only effective long-term treatment for morbid obesity. The three main practiced surgeries during the last 30 years are the Roux-en-Y gastric bypass (RYGB), the sleeve gastrectomy (SG) and the laparoscopic adjustable gastric banding (AGB). These surgeries can lead to long-term complications of a functional or of a surgical nature. Rapid management in a specialized setting where appropriate investigations can be done is essential. Abdominal pain after bariatric surgery are frequent, multiple and difficult to apprehend. They should not be trivialized because the risks of severe complications without an adequate and quick management are important.

La chirurgie bariatrique est montrée comme étant le seul traitement efficace pour traiter l'obésité morbide sur le long terme. Les trois interventions ayant été les plus pratiquées ces 30 dernières années en Suisse sont le bypass gastrique en Y selon Roux (RYGB), la gastrectomie longitudinale (SG) et la mise en place d'un cerclage gastrique (CG). Ces chirurgies peuvent amener à des complications à long terme de nature fonctionnelle ou chirurgicale. Une prise en charge rapide en milieu spécialisé est primordiale. Les douleurs abdominales après chirurgie bariatrique sont fréquentes, multiples et difficiles à appréhender. Souvent, elles ne sont pas en lien avec la chirurgie primaire mais elles ne doivent pas être banalisées car les risques de complications sévères en l'absence de prise en charge adéquate et rapide sont importants.

Roux-en-Y Gastric Bypass: Ten-year Results in a Cohort of 658 Patients.

OBJECTIVE: The aim of this paper is to report, with a high follow-up rate, 10-year results in a large cohort of patients after Roux-en-Y gastric bypass (RYGBP) done essentially by laparoscopy. BACKGROUND: RYGBP has been performed for 50 years, including 20 years by laparoscopy, yet very few long-term results have been reported, mostly after open surgery. METHODS: Prospective bariatric database established since the introduction of bariatric surgery. Retrospective data analysis on weight loss, long-term complications, quality of life, and comorbidities. RESULTS: In all, 658 consecutive patients (515 women/143 men) were included: 554 with primary RYGBP, 104 with reoperative RYGBP. There was 1 (0.15%) postoperative death. Thirty-two (5%) patients died during follow-up from causes unrelated to surgery. Ten years after primary RYGBP, patients lost 28.6 ±â€Š10.5% of their initial weight, corresponding to a mean of 13.2 body mass index (BMI) units. Among them, 72.8% achieved a BMI <35. Weight loss ≥20% was seen in 80.3% and <10% in 3.9% of patients. Results were similar in patients undergoing primary or reoperative RYGBP, but were better in patients who were initially less obese (BMI <50 kg/m) than in superobese patients. Quality of life and comorbidities significantly improved with 80% resolution or improvement of metabolic comorbidities. All patients required supplementations, and 14.6% required long-term reoperation. CONCLUSIONS: RYGBP provides long-term satisfactory weight loss up to 10 years, and significantly improves quality of life and comorbidities. Long-term complications requiring reoperation can develop. Mineral and vitamin supplementation are universally necessary. Other more effective surgical options should be discussed in patients with very severe obesity.

[Long-term results (≥ 10 years) after bariatric surgery : review of the literature.] / Résultats à long terme (≥ 10 ans) après chirurgie bariatrique :revue de la littérature.

Bariatric and metabolic surgery (BMS) is currently the cornerstone of treatment for severe obesity. It produces significant and lasting weight loss in the vast majority of cases, which depends on the procedure performed, in any case much greater than that observed with non-surgical treatments. This weight loss along with direct metabolic effects of BMS, result in a substantial and lasting improvement in many obesity-related comorbidities, notably metabolic ones, sometimes with complete remission. This leads to a reduction in cardiovascular risk and mortality. Any BMS must be carried out by a multidisciplinary team, which will ensure lifelong follow-up in order to optimize results and prevent complications, including micronutrient deficiencies, by adequate supplementations.

La chirurgie bariatrique et métabolique (CBM) est la pierre angulaire du traitement de l'obésité sévère. Elle permet une perte pondérale conséquente et durable dans la grande majorité des cas, variable selon l'intervention, largement supérieure à celle obtenue de traitements conservateurs. Celle-ci ainsi que les effets métaboliques directs de la CBM s'accompagnent d'améliorations substantielles et durables des comorbidités liées à l'obésité, en particulier métaboliques, voire de rémissions complètes. Ces effets entraînent une réduction du risque cardiovasculaire et de la mortalité. Toute CBM doit être encadrée par une équipe multidisciplinaire, qui s'assurera du suivi à long terme pour optimaliser les résultats et, prévenir les complications, notamment carentielles, par des substitutions adaptées.

[Overweight and obesity in the canton of Vaud : projections for 2040]. / Surpoids et obésité morbide dans le canton de Vaud : projections pour 2040.

The worldwide prevalence of obesity has more than doubled since 1980. This global figure needs to be addressed tackled at the local level to face our future challenges at the local level. We attempted to project the prevalence of obesity in the canton of Vaud in the next 25 years. Data from the Enquête suisse sur la santé, a survey conducted every five years since 1992 by the Swiss Federal Office of Public Health, were used. Using different mathematical assumptions, the rate of increase in the prevalence of obesity in Switzerland between 1992 and 2012 was calculated allowing a projection of future prevalences. Between 1992 and 2016, the prevalence of obesity was 9.64%. Effective growth rate of obesity from 2016 to 2040 should be between 16'500 cases and 69'500 cases depending on the uncertainty of the effective prevalence increase over this period.

La prévalence mondiale a plus que doublé depuis 1980. Nous avons projeté la prévalence de l'obésité dans le canton de Vaud au cours des 25 prochaines années. Des données de l'Enquête suisse sur la santé, menée tous les cinq ans depuis 1992 par l'Office fédéral de la santé publique, ont été employées. En utilisant différentes hypothèses mathématiques, le taux d'augmentation de la prévalence de l'obésité en Suisse entre 1992 et 2012 a été calculé permettant une projection des prévalences futures. La prévalence de l'obésité était de 9,64 % en 2012. Le taux de croissance effectif entre 2016 et 2040 devrait être compris entre 16 500 cas et 69 500 cas en fonction de l'incertitude liée à l'augmentation effective de la prévalence au cours de cette période. La prévalence de l'obésité est en constante augmentation dans notre région et les projections ne sont pas rassurantes.

[The Lausanne Obesity Cohort: why and how?]. / La Cohorte obésité de Lausanne (COOL): pourquoi, comment?

Bariatric surgery has become the treatment of choice for severe obesity. The significant weight loss induced by these procedures is accompanied by spectacular improvements in the metabolic comorbidities that participate in morbidity and mortality of obesity. However, several questions remain open regarding the identification of patients that will benefit the most from the intervention or the long-term outcomes in terms of weight and co-morbidities. The Cohort obesity of Lausanne was initiated in order to try and answer some of these questions, and more specifically to identify predictive factors of long-term response to gastric by-pass.

[Pregnancy after bariatric surgery]. / Grossesse après chirurgie bariatrique.

Bariatric surgery interventions are rapidly growing and most are performed on female patients. Thus, pregnancies after bariatric surgery are increasingly common. Awareness of the consequences and risks of bariatric surgery on subsequent pregnancies is important. Literature data report a reduction of the usual pregnancy risks of pregnancies in obese patients, but also an increased risk of small-for-gestational-age infants, possibly related to nutritional deficiencies. A careful screening for micronutrient deficiencies is therefore already advised before conception. Nutritional follow-up and serious evaluation of any abdominal complaints are recommended as well during pregnancy.

Meticulous Closure of Mesenteric Defects Effectively Reduces the Incidence of Internal Hernia After Laparoscopic Roux-en-Y Gastric Bypass.

INTRODUCTION: Internal hernia (IH) after Roux-Y gastric bypass (RYGB) can lead to extended small bowel ischemia if it not recognized and treated promptly. The aim of this study is to show whether improvement in mesenteric defect (MD) closure reduces the incidence of IH. PATIENTS AND METHODS: Retrospective analysis of prospectively collected data from our database including all patients who underwent laparoscopic RYGB between 1999 and 2015. The usual technique was a retrocolic/retrogastric RYGB. We divided patients in four groups according to the closure technique for MD and compared incidences of IH between groups. All patients had at least 8 years of follow-up. RESULTS: A total of 1927 patients (1497 females/460 males, mean age of 41.5 ± 11 years) were operated. A retrocolic/retrogastric RYGB was performed in 1747 (90.7%) and an antecolic RYGB in 180 patients. Mean duration of follow-up was 15 (8-24) years. 111 patients (5.8%) developed IH, the majority through the jejunojejunostomy (JJ, 3.7%) and Petersen (1.7%) defects. With improvement of closure technique, the incidence decreased over time, from 12.9% in the group with separate sutures to 1.05% in the most recent group with running non-absorbable sutures and an additional purse-string at the JJ defect (p < 0.0001). CONCLUSION: Meticulous closure of MD during RYGB is a very important step that significantly reduces the IH risk after RYGB, even with a retrocolic/retrogastric anatomy. Using running non absorbable braided sutures and an additional purse-string suture at the JJ is the most effective technique, but a small IH risk persists. A high index of suspicion remains necessary in patients who present with acute abdominal pain after RYGB.

A human omentum-specific mesothelial-like stromal population inhibits adipogenesis through IGFBP2 secretion.

Adipose tissue plasticity is orchestrated by molecularly and functionally diverse cells within the stromal vascular fraction (SVF). Although several mouse and human adipose SVF cellular subpopulations have by now been identified, we still lack an understanding of the cellular and functional variability of adipose stem and progenitor cell (ASPC) populations across human fat depots. To address this, we performed single-cell and bulk RNA sequencing (RNA-seq) analyses of >30 SVF/Lin- samples across four human adipose depots, revealing two ubiquitous human ASPC (hASPC) subpopulations with distinct proliferative and adipogenic properties but also depot- and BMI-dependent proportions. Furthermore, we identified an omental-specific, high IGFBP2-expressing stromal population that transitions between mesothelial and mesenchymal cell states and inhibits hASPC adipogenesis through IGFBP2 secretion. Our analyses highlight the molecular and cellular uniqueness of different adipose niches, while our discovery of an anti-adipogenic IGFBP2+ omental-specific population provides a new rationale for the biomedically relevant, limited adipogenic capacity of omental hASPCs.

[Bariatric surgery in 2013: principles, advantages and disadvantages of the available procedures]. / Chirurgie bariatrique en 2013: principes, avantages et inconvénients des interventions a disposition.

For severe obesity (BMI > 35 kg/m2), bariatric surgery is not only the best, but often the only means of obtaining sufficient and durable weight loss. This article aims to review the available bariatric procedures. Gastric bypass remains the reference when it comes to the risk/benefit ratio. Gastric banding is declining rapidly due to the high prevalence of long-term complications. Primary malabsorptive procedures remain largely unpopular because of their potential nutritional complications. Sleeve gastrectomy, although it is not reversible as it includes a significant gastric resection, increases currently in popularity because of its apparent simplicity and the fact that early results regarding weight loss mimic those obtained with gastric bypass.

Protein malnutrition after Roux-en-Y gastric bypass: a challenging case and scoping review of the literature.

Although protein malnutrition (PM) is often reported after highly malabsorptive procedures, its exact incidence and mechanisms after Roux-en-Y gastric bypass (RYGB) are poorly understood. The aim of this study was to present a challenging clinical case of PM after RYGB and conduct a scoping review of the literature. Among the 18 studies with 3015 RYGB patients included in the review, the median incidence of PM was 1.7% (range, 0%-8.9%), and it was diagnosed 12 to 120 months after RYGB. The most common cause is insufficient oral intake of protein; however, in cases of persistent hypoalbuminemia, a thorough diagnostic workup needs to be performed. Risk factors for PM after RYGB include specific triggering events such as intractable vomiting and dysphagia, and a total alimentary limb length less than 250 to 300 cm.

2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery.

MAJOR UPDATES TO 1991 NATIONAL INSTITUTES OF HEALTH GUIDELINES FOR BARIATRIC SURGERY: Metabolic and bariatric surgery (MBS) is recommended for individuals with a body mass index (BMI) >35 kg/m2, regardless of presence, absence, or severity of co-morbidities.MBS should be considered for individuals with metabolic disease and BMI of 30-34.9 kg/m2.BMI thresholds should be adjusted in the Asian population such that a BMI >25 kg/m2 suggests clinical obesity, and individuals with BMI >27.5 kg/m2 should be offered MBS.Long-term results of MBS consistently demonstrate safety and efficacy.Appropriately selected children and adolescents should be considered for MBS.(Surg Obes Relat Dis 2022; https://doi.org/10.1016/j.soard.2022.08.013 ) © 2022 American Society for Metabolic and Bariatric Surgery. All rights reserved.

Early Bleeding After Laparoscopic Roux-en-Y Gastric Bypass: Incidence, Risk Factors, and Management - a 21-Year Experience.

PURPOSE: Morbidity and mortality associated with bariatric surgery are considered low. The aim of this study is to assess the incidence, clinical presentation, risk factors, and management of early postoperative bleeding (POB) after laparoscopic Roux-en-Y gastric by-pass (RYGB). MATERIALS AND METHODS: Retrospective analysis of prospectively collected data of consecutive patients who underwent RYGB in 2 expert bariatric centers between January 1999 and April 2020, with a common bariatric surgeon. RESULTS: A total of 2639 patients underwent RYGB and were included in the study. POB occurred in 72 patients (2.7%). Intraluminal bleeding (ILB) was present in 52 (72%) patients and extra-luminal bleeding (ELB) in 20 (28%) patients. POB took place within the first 3 postoperative days in 79% of patients. The most frequent symptom was tachycardia (63%). Abdominal pain was more regularly seen with ILB, compared to ELB (50% vs. 20%, respectively, p = 0.02). Male sex was an independent risk factor of POB on multivariate analysis (p < 0.01). LOS was significantly longer in patients who developed POB (8.3 vs. 3.8 days, p < 0.01). Management was conservative for most cases (68%). Eighteen patients with ILB (35%) and 5 patients with ELB (25%) required reoperation. One patient died from multiorgan failure after staple-line dehiscence of the excluded stomach (mortality 0.04%). CONCLUSION: The incidence of POB is low, yet it is the most frequent postoperative complication after RYGB. Most POB can be managed conservatively while surgical treatment is required for patients with hemodynamic instability or signs of intestinal obstruction due to an intraluminal clot.

Long-term weight loss and metabolic benefit from Roux-en-Y gastric bypass in patients with superobesity.

BACKGROUND: Although Roux-en-Y gastric bypass (RYGB) is widely performed worldwide, its efficacy in patients with a body mass index (BMI) greater than 50 kg/m2 remains controversial. The aim of the present paper was to assess long-term (10 years or more) weight loss and metabolic results of RYGB in patients with superobesity (SO; BMI > 50 kg/m2), compared with patients with morbid obesity (MO; BMI 35-50 kg/m2). METHODS: This study involved retrospective analysis of a prospectively followed cohort of adult patients operated on for a primary RYGB between 1999 and 2008. Long-term weight loss and metabolic parameters were compared between SO and MO patients, with a sex-specific subgroup analysis in SO patients. Multiple logistic regression assessed independent predictors of poor long-term weight loss. RESULTS: Among the 957 included patients, 193 (20.2 per cent) were SO (mean BMI 55.3 kg/m2versus 43.3 kg/m2 in MO). Upon 10-year follow-up, which was complete in 86.3 per cent of patients, BMI remained higher in SO patients (mean 39.1 kg/m2versus 30.8 kg/m2, P < 0.001) although total bodyweight loss (per cent TBWL) was similar (28.3 per cent versus 28.8 per cent, P = 0.644). Male SO patients had a trend to higher 10-year per cent TBWL, while initial BMI greater than 50 kg/m2 and low 5-year per cent TBWL were independent predictors of long-term TBWL less than 20 per cent. Diabetes remission was observed in 39 per cent SO and 40.9 per cent MO patients (P = 0.335) at 10 years, and all patients had a significant lipid profile improvement. CONCLUSION: Substantial improvement in co-morbidities was observed in all patients 10 years after RYGB. Total weight loss was similar in SO and MO patients, leaving SO patients with higher BMI. Suboptimal TBWL 5 years after surgery in SO, especially female patients, may warrant prompt reassessment to improve long-term outcomes.