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.

[Focus on obesity drug treatments]. / Focus sur les traitements médicamenteux de l'obésité.

The management of obesity is changing dramatically with the emergence of new drug treatments. Glucagon-like peptide-1 (GLP-1) receptor agonists are approved for this indication in Switzerland, and approval is currently being sought for a GLP-1 and glucose-dependent insulinotropic polypetide (GIP) co-agonist. Reimbursement conditions are restrictive, and patients are given only one opportunity to achieve the weight loss required for continued reimbursement. The popularity of these treatments has led to worldwide stock-outs for several months now, and it is essential that prescribers respect the indications so as not to prejudice obese patients. This article provides a review of the treatments available and the conditions under which they are reimbursed, as well as those that should be reimbursed soon.

La prise en charge de l'obésité est profondément modifiée par l'essor de nouveaux traitements médicamenteux. Les agonistes du récepteur du glucagon-like peptide-1 (GLP-1) sont approuvés dans cette indication en Suisse et une approbation est en cours d'analyse pour un coagoniste du GLP-1 et du glucose-dependent insulinotropic polypetide (GIP). Les conditions de remboursement sont cependant strictes et les patients ne bénéficient que d'une seule opportunité pour obtenir les pertes pondérales qui autorisent la poursuite du remboursement. La popularité de ces traitements occasionne des ruptures de stocks depuis plusieurs mois au niveau mondial et il est essentiel que les prescripteurs respectent les indications afin de ne pas prétériter les patients en situation d'obésité. Cet article propose un rappel des traitements disponibles et les conditions encadrant leur remboursement, ainsi que ceux qui le seront prochainement.

[Pregnancy and bariatric surgery : from pre-conception to postpartum]. / Grossesse et chirurgie bariatrique : du préconceptionnel au postpartum.

Bariatric surgery is regularly offered to women of childbearing age. Pregnancy after such surgery should be planned and requires special attention. Some complications associated with obesity during pregnancy are reduced after bariatric surgery, but reduced dietary intake and malabsorption can cause nutritional deficiencies, that need to be carefully screened for and supplemented. Dietary management is recommended, and any unusual abdominal pain should be referred to a bariatric surgeon. We offer a summary of recommendations for appropriate follow-up of these pregnancies.

La chirurgie bariatrique est régulièrement proposée à des femmes en âge de procréer. Une grossesse après une telle chirurgie devrait être planifiée et demande une attention particulière. Certaines complications liées à l'obésité durant la grossesse sont réduites après une chirurgie bariatrique mais une diminution des apports alimentaires et la malabsorption peuvent engendrer des carences nutritionnelles qui doivent être attentivement dépistées et supplémentées. Une prise en charge diététique est recommandée et toute douleur abdominale inhabituelle doit faire demander l'avis d'un chirurgien bariatrique. Nous proposons une synthèse des recommandations pour un suivi adéquat de ces grossesses.

Impact of Preoperative Psychiatric Profile in Bariatric Surgery on Long-term Weight Outcome.

BACKGROUND: Conflicting results have been reported regarding the predictive value of preoperative psychological assessment and weight outcome after bariatric surgery. This might be attributed to different factors affecting early weight loss and long-term weight loss. Herein, we investigated whether preoperative psychiatric profile was associated with preoperative BMI and with both early (1 year) and long-term (5 years) weight loss after Roux-en-Y gastric bypass (RYGB). METHODS: Prospective observational cohort study of patients undergoing RYGB between 2013 and 2019. Symptoms related to anxiety, depression, eating disorder, and alcohol use disorders were assessed by employing validated, specific psychometric tests (STAI-S/T, BDI-II, BITE, AUDIT-C) prior to surgery. Pre-operative BMI, early weight loss (1 year), and long-term weight evolution (up to 5 years) were registered. RESULTS: Two hundred thirty six patients (81% women) were included in the present study. Linear longitudinal mixed model showed a significant effect of preoperative high anxiety (STAI-S) on long-term weight outcome, after controlling for gender, age and type 2 diabetes. Patient with high preoperative anxiety score regained weight faster than those experiencing low anxiety (each year percent excess BMI loss (%EBMIL) - 4.02%, ± 1.72, p = 0.021). No other pre-operative psychiatric symptoms have been shown to have an impact on long-term weight loss. In addition, no significant association was found between any of the pre-operative psychiatric variables and pre-operative BMI, or early weight loss (%EBMIL) at 1-year post-RYGB. CONCLUSION: Herein we identified high anxiety score (STAI-S) as a predictor for long-term weight regain. Thus, long-term psychiatric surveillance of these patients and the development of tailored management tools could serve as a means to prevent weight regain.

The Influence of a Roux-en-Y Gastric Bypass on Plasma Concentrations of Antidepressants.

PURPOSE: Roux-en-Y gastric bypass (RYGB) involves alterations of the gastrointestinal tract resulting in altered absorption. Patients with obesity have a higher prevalence of depression, and antidepressants are often prescribed. Alterations caused by RYGB could modify drug bioavailability and cause potential subtherapeutic plasma concentrations, increasing the risk of depressive relapse. The aim of this study was to describe the evolution of trough drug dose-normalized antidepressant plasma concentrations before and after RYGB. MATERIALS AND METHODS: This naturalistic prospective case series considers patients with trough plasma concentrations in a 1-year timeframe before and after RYGB. Only antidepressants prescribed to at least three patients were included in the present study. RESULTS: Thirteen patients (n = 12 females, median age 44 years, median BMI before intervention = 41.3 kg/m2) were included. Two patients were treated concurrently with fluoxetine and trazodone; the remaining patients were all treated with antidepressant monotherapy. Therapeutic drug monitoring (TDM) values for duloxetine (n = 3), escitalopram (n = 4), fluoxetine (n = 4), and trazodone (n = 4) before (median 4.7 weeks) and after (median 21.3 weeks) RYGB intervention were analyzed. Compared to preintervention, median [interquartile range] decreases in dose-normalized trough plasma concentrations for duloxetine (33% [- 47; - 23]), escitalopram (43% [- 51; - 31]), fluoxetine (9% [- 20; 0.2]), and trazodone (16% [- 29; 0.3]) were observed. CONCLUSION: This study shows a decrease in plasma antidepressant concentrations following RYGB. TDM before and after RYGB, in addition to close monitoring of psychiatric symptomatology, may help optimize antidepressant treatment after bariatric surgery. These results also highlight the need for prospective studies assessing the clinical evidence available through TDM in these patients.

[GLP-1 and GIP receptor agonists: emerging therapies for obesity]. / Agonistes des récepteurs du GLP-1 et du GIP : des thérapies émergentes de l'obésité.

Obesity is a chronic and recurrent metabolic disease associated with serious complications and increased mortality. Bariatric surgery was until recently the only intervention that could lead to significant and sustained weight loss. A better understanding of the endocrine regulation of appetite has allowed the development of new treatments. GLP-1 analogues are already available and a dual treatment of GLP-1 analogue and GIP has recently shown even greater efficacy in terms of weight loss. We present a summary of the known mechanisms of action and clinical data that support the use of these molecules in the treatment of obesity.

L'obésité est une maladie métabolique chronique et récidivante associée à de graves complications et à une mortalité accrue. La chirurgie bariatrique était jusqu'à récemment la seule intervention permettant d'obtenir une perte de poids significative et son maintien. Une meilleure compréhension de la régulation endocrinienne de l'appétit a permis le développement de nouveaux traitements. Les analogues du GLP-1 sont déjà disponibles et une double activation des récepteurs du GLP-1 et du GIP (double agoniste) a récemment montré une efficacité encore plus importante en termes de perte pondérale. Nous proposons une synthèse des mécanismes d'action connus et des données cliniques qui soutiennent l'utilisation de ces molécules dans le traitement de l'obésité.

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.

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.

Long-term body composition improvement in post-menopausal women following bariatric surgery: a cross-sectional and case-control study.

OBJECTIVE: Bariatric surgery (BS) induces loss of body fat mass (FM) with an inexorable loss of lean mass (LM). Menopause leads to deleterious changes in body composition (BC) related to estrogen deficiency including LM loss and increase in total and visceral adipose tissue (VAT). This study aims to describe the long-term weight evolution of post-menopausal women after Roux-en-Y gastric bypass (RYGB) and to compare the BC between BS patients vs post-menopausal non-operated women. DESIGN: Cross-sectional study of 60 post-menopausal women who underwent RYGB ≥2 years prior to the study with nested case-control design. METHODS: Post-menopausal BS women were matched for age and BMI with controls. Both groups underwent DXA scan, lipids and glucose metabolism markers assessment. RESULTS: Median follow-up was 7.5 (2-18) years. Percentage of total weight loss (TWL%) was 28.5 ± 10%. After RYGB, LM percentage of body weight (LM%) was positively associated with TWL% and negatively associated with nadir weight. Forty-one post-BS women were age- and BMI-matched with controls. Post-BS patients showed higher LM% (57.7% (±8%) vs 52.5% (±5%), P = 0.001), reduced FM% (39.4% (±8.4%) vs 45.9% (±5.4%), P < 0.01) and lower VAT (750.6 g (±496) vs 1295.3 g (±688), P < 0.01) with no difference in absolute LM compared to controls. While post-BS women showed a better lipid profile compared to controls, no difference was found in glucose markers. CONCLUSIONS: Post-menopausal women after RYGB have a lower FM and VAT, preserved LM and a better lipid profile compared to controls. Weight loss after RYGB seems to have a persistent positive impact on metabolic health.

Bariatric Surgery Induces a Differential Effect on Plasma Aldosterone in Comparison to Dietary Advice Alone.

Background and Objectives: The pathophysiological mechanisms linking weight loss to blood pressure (BP) reduction are not completely understood. The objective of this study was to compare the effect of weight loss after Roux-en-Y gastric bypass (RYGB) on BP, renin-angiotensin-aldosterone system (RAAS), and urinary electrolytes excretion to those of dietary advice. Methods: This was a case-control prospective study including obese patients referred for RYGB (cases) and obese receiving diet advice only (controls). Ambulatory BP, plasma renin activity (PRA), plasma aldosterone concentration (PAC), and urinary electrolytes were measured before (M0) and after intervention (M3: 3 months and M12: 12 months). Results: Twenty-five patients were included in the RYGB group and twelve patients in the control group. After 12 months, weight loss (-42 ± 11.5 vs -12.3 ± 6.3 kg in the control group, p=0.001) and decrease in PAC were more pronounced in the RYGB group (-34 ± 76 vs +14 ± 45 pg/ml in the control group, p=0.002). There was no difference in PRA between both groups (-0.08 ± 1.68 vs 0.01 ± 0.37 ng/ml/h, p=0.31). Sodium excretion was more marked in the RYGB group after 3 months only (-89 ± 14.9 vs -9.9 ± 27.9 mmol/day, p=0.009). The decrease in SBP was similar between both groups (-6.9 ± 9.9 vs -7.1 ± 11.9 mmHg in the control group, p=0.96). Conclusions: Bariatric-induced weight loss induces a progressive decrease in PAC independently of PRA and sodium excretion. Whether this decrease in PAC affects target organ damage in the long term remains to be determined. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT02218112.

Real-world use of once-weekly semaglutide in patients with type 2 diabetes: Results from the SURE Switzerland multicentre, prospective, observational study.

AIMS: SURE Switzerland (NCT03631186) investigated real-world once-weekly (OW) semaglutide use in adults with type 2 diabetes (T2D). METHODS: This multicentre, prospective, observational study enrolled adults with T2D with ≥ 1 documented HbA1c value ≤ 12 weeks before semaglutide initiation. Primary endpoint was change in HbA1c from baseline to end of study (EOS; ~30 weeks). Secondary endpoints included changes in body weight (BW) and waist circumference (WC), and the proportion of patients achieving HbA1c < 8.0%, <7.5% and <7.0% at EOS. Semaglutide dose at EOS was a prespecified exploratory endpoint. RESULTS: Overall, 214 patients initiated semaglutide (baseline HbA1c 7.8% [62 mmol/mol], BW 99.9 kg and WC 117.4 cm); 187 attended the EOS visit. At EOS, 175 (81.8%) were still receiving semaglutide (mean [SD] dose 0.78 [0.29] mg); in those patients, mean HbA1c reduced by -0.8 [95% CI - 1.01;-0.68] %-points (-9 [-11;-7] mmol/mol), BW by -5.0 kg [-5.73;-4.24] and WC by -4.8 cm [-5.75;-3.79] (all p < 0.0001). At EOS, 85.9%, 76.5% and 55.9% patients achieved, respectively, HbA1c < 8.0%, <7.5% and < 7.0%. No new safety signals were identified. CONCLUSIONS: Patients with T2D in Switzerland initiating OW semaglutide experienced clinically relevant glycaemic control and BW improvements in a real-world setting, supporting semaglutide use in routine clinical practice.

BMI Course Over 10 Years After Bariatric Surgery and Biopsychosocial Complexity Assessed with the INTERMED: a Retrospective Study.

BACKGROUND: While bariatric surgery is an effective therapy for patients with severe obesity, not all patients benefit equally. An explanation might be that psychosocial risk factors hamper outcome. The study aimed to evaluate if biopsychosocial case complexity predicts evolution of BMI over 10 years after bariatric surgery. METHODS: Charts of patients (N = 236) of the Cohort of Obesity Lausanne (COOL) were retrospectively reviewed and rated with the INTERMED, a reliable and validated instrument, which assesses biopsychosocial case complexity and has been proven to predict outcome of medical treatments in different patient populations. The sample was stratified into BMI quartiles, computed from the patients' baseline BMI. For each quartile, BMI evolution was analyzed using individual growth curve analysis. RESULTS: Growth curve analyses showed that in quartiles 1, 2, and 3, none of the INTERMED domain scores significantly predicted the BMI evolution after surgery. However, in the fourth quartile-including patients with the highest pre-surgical BMI-the social domain score of the INTERMED significantly predicted BMI evolution: patients with more social complexity showed higher increase in BMI. CONCLUSION: Effectiveness of interventions targeted at social complexity, especially when patients suffer from severe obesity, may therefore be evaluated in future studies.

Precision medicine in the era of artificial intelligence: implications in chronic disease management.

Aberrant metabolism is the root cause of several serious health issues, creating a huge burden to health and leading to diminished life expectancy. A dysregulated metabolism induces the secretion of several molecules which in turn trigger the inflammatory pathway. Inflammation is the natural reaction of the immune system to a variety of stimuli, such as pathogens, damaged cells, and harmful substances. Metabolically triggered inflammation, also called metaflammation or low-grade chronic inflammation, is the consequence of a synergic interaction between the host and the exposome-a combination of environmental drivers, including diet, lifestyle, pollutants and other factors throughout the life span of an individual. Various levels of chronic inflammation are associated with several lifestyle-related diseases such as diabetes, obesity, metabolic associated fatty liver disease (MAFLD), cancers, cardiovascular disorders (CVDs), autoimmune diseases, and chronic lung diseases. Chronic diseases are a growing concern worldwide, placing a heavy burden on individuals, families, governments, and health-care systems. New strategies are needed to empower communities worldwide to prevent and treat these diseases. Precision medicine provides a model for the next generation of lifestyle modification. This will capitalize on the dynamic interaction between an individual's biology, lifestyle, behavior, and environment. The aim of precision medicine is to design and improve diagnosis, therapeutics and prognostication through the use of large complex datasets that incorporate individual gene, function, and environmental variations. The implementation of high-performance computing (HPC) and artificial intelligence (AI) can predict risks with greater accuracy based on available multidimensional clinical and biological datasets. AI-powered precision medicine provides clinicians with an opportunity to specifically tailor early interventions to each individual. In this article, we discuss the strengths and limitations of existing and evolving recent, data-driven technologies, such as AI, in preventing, treating and reversing lifestyle-related diseases.

[Treatment of type 2 diabetes before, during and after metabolic surgery]. / Traitement du diabète de type 2 avant, pendant et après la chirurgie métabolique.

Metabolic surgery is becoming increasingly important in the treatment of obese and diabetic patients. Its impact is major on immediate post-operative glycemic control and adaptation of anti-diabetic treatments is necessary. Over time, a recurrence of diabetes may be observed and the choice of treatments to be reintroduced must take into account the surgery performed. By discussing pharmacological options during the preoperative, peri-operative and post-operative periods, this article provides a review of the literature on a subject for which few guidelines are currently proposed.

La chirurgie métabolique prend une place toujours plus importante dans l'offre de traitement des patients obèses et diabétiques. Son impact est radical sur l'équilibre glycémique postopératoire immédiat et une adaptation rapide des traitements antidiabétiques est nécessaire. Au fil du temps, une récidive du diabète peut être observée et le choix des traitements à réintroduire doit tenir compte de l'intervention chirurgicale effectuée. En discutant les options pharmacologiques durant les périodes préopératoire, périopératoire et postopératoire, cet article propose une revue de la littérature sur un sujet pour lequel peu de directives sont actuellement proposées.

[Hypophosphatemia after iron infusion†: can we still ignore it†?] / Hypophosphatémie après perfusion de fer†: pouvons-nous encore l'ignorer†?

The occurrence of hypophosphatemia after iron infusion has been known for a long time but has only recently led to clinical concerns. It was considered to be of low clinical importance. The elucidation of the physiological mechanisms responsible for this effect, involving FGF23 and the ever-increasing number of cases with regard to the potentially very serious consequences on bone metabolism have recently raised probably justified concerns. In this article, we summarize the mechanisms of phosphate homeostasis, how intravenous iron can induce a phosphate deficiency and what precautions and treatments needs to be undertaken to prevent it.

La survenue d'une hypophosphatémie après une perfusion de fer est connue de longue date mais n'a que depuis peu suscité des inquiétudes cliniques. L'élucidation des mécanismes physiologiques à l'origine de cet effet indésirable, impliquant le facteur de croissance des fibroblastes 23 (FGF23), et les rapports de cas toujours plus nombreux quant aux conséquences potentiellement graves sur le métabolisme osseux ont récemment soulevé des préoccupations probablement justifiées. Dans cet article, nous résumons les mécanismes de régulation du phosphate et la manière dont le fer par voie intraveineuse peut induire un déficit en phosphate, ainsi que les précautions et traitements à mettre en œuvre pour le prévenir.

Long-Term Weight Loss, Metabolic Outcomes, and Quality of Life at 10 Years After Roux-en-Y Gastric Bypass Are Independent of Patients' Age at Baseline.

BACKGROUND: Conflicting data have been published for bariatric surgery in older patients, with no long-term large-scale studies available. Our aim was to provide long-term (> 10 years) results on weight loss, metabolic outcomes, and quality of life in a large homogenous series of Roux-en-Y gastric bypass (RYGB) patients, according to age at baseline. PATIENTS AND METHODS: All consecutive patients who underwent primary RYGB between 1999 and 2007, and therefore eligible for 10-year follow-up, were retrospectively analyzed. According to their age at baseline, they were divided into three groups: A (< 40 years), B (40-54 years), and C (≥ 55 years). Categorical variables were compared with the χ2 test and continuous variables with ANOVA. RESULTS: Our series consisted of 820 patients, with a 10-year follow-up of 80.6%. Although group C (11% of all patients) had significantly more comorbidities at baseline, there was no difference in postoperative morbidity and mortality between groups. Weight loss was significantly less for group C patients up to the 7th postoperative year, but no difference remained thereafter. 10-year %total weight loss was 32.2, 32.9, and 32.3 respectively in groups A, B, and C. After 10 years, glycemic control and lipid profile improved similarly, rates of partial or complete remission of diabetes and hypertension were identical, and quality of life presented a significant improvement for all patients with no inter-group difference. CONCLUSION: Our results suggest similar short- and long-term outcomes after RYGB for patients ≥ 55 years compared to younger ones; the relative benefit might even be higher for older patients, given their increased comorbidity at baseline.

[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.