The Effects of Post-Surgical Pregnancy on Weight Loss Trajectories after Bariatric Surgery: Are Initial Weight and Age Prognostic Factors?

Introduction: A substantial percentage of patients undergoing bariatric surgery are of childbearing age. Pregnancy outcomes after bariatric surgery are known. However, there are limited data on the impact of pregnancy on weight loss after surgery. Objectives: This study aims to evaluate the effects of pregnancy on post-bariatric surgery weight loss trajectories (WLTs) and to determine the association with age and initial weight. Methods: All who had primary bariatric surgeries (Roux-en-Y gastric bypass or sleeve) between September 2015 and July 2020 were classified into two groups: post-surgery gravid (GG) and post-surgery non-gravid (NG). WLTs were examined using a random intercept mixed-effects model with repeated measures nested within patients. The post-surgery/pre-gravid time phase (PoPG) was modelled using a third-degree polynomial. For GG, two third-degree spline functions modelled the post-surgery while gravid (PoWG) and post-partum (PoPP) time phases. Age and initial weight were used to control for pre-existing differences during PoPG. Weight differences at 6 months PoPP were examined by applying general linear hypothesis testing to the mixed-model results. Results: A total of 508 patients were included, 20 in GG and 488 in NG. The mean age at surgery was 33 years in GG and 37 years in NG. The mean initial BMI was 47 kg/m2 and 43 kg/m2, respectively. During PoPG, adjusted average weight in both groups follows the path across time. For GG, weight decreases and then increases during PoWG. For GG during PoPP, weight immediately decreases after delivery and then increases over time to levels similar to NG. Weight differences at 6 months PoPP for GG and NG were not statistically different. Older age was associated with reduced weight loss during PoPG by Baseline Age, while higher initial weight was associated with increased weight loss during PoPG by Baseline Weight. In both instances, these effects attenuate over time. Conclusions: This model indicates that pregnancy following bariatric surgery affects WLT during PoWG and PoPP, and no difference in weight is expected after 6 months post-gravid. Age and initial weight could be considered prognostic factors during PoPG. Patients wishing to conceive should undergo preconception counselling and be advised to avoid pregnancy during the period of rapid weight loss. They also should be informed that WLT may vary during pregnancy and early post-partum.

Bariatric Surgery Outcomes in Patients with Severe Obesity Compared to Patients with Non-Severe Obesity at A New Institution in The United Arab Emirates.

Background: Bariatric surgery is an effective treatment for weight loss, but a higher body mass index (BMI) may lead to higher postoperative complication rates. This study aims to compare perioperative and postoperative outcomes between UAE patients with severe obesity (SO) [BMI ≥ 50 kg/m2] and non-severe obesity (NSO) [BMI < 50 kg/m2] undergoing primary bariatric surgery. Methods: From September 2015 to July 2019, 542 patients, 94 SO (56.5 ± 6.2 kg/m2) and 448 NSO (41.8 ± 4.1 kg/m2), were retrospectively reviewed. Results: Patients with SO were younger (33.8 ± 13.4 vs. 37.0 ± 11.5 years, p = 0.02) but otherwise had similar demographic characteristics. Their rates of Roux-en-Y gastric bypass (39.4% SO vs. 44.4% NSO, p = 0.37) and sleeve gastrectomy (60.6% vs. 55.6%, p = 0.37) were similar. There were no differences between perioperative complications (6.4% SO vs. 5.8% NSO, p = 0.83), major postoperative complications (5.3% vs. 3.5%, p = 0.42), readmissions (5.3% vs. 3.3%, p = 0.36), or reoperations (3.2% vs. 2.7%, p = 0.78). There were no mortalities. Their total body weight loss was comparable at 12 months (28.1 ± 10.2% vs. 29.0 ± 7.7%, p = 0.58). Conclusions: Although a higher BMI may pose operative challenges, UAE patients with SO do not have worsened outcomes in bariatric surgery, demonstrating similarly low morbidity to patients with NSO, and similar rates of improvement in their BMI.

Safety and Efficacy of Metabolic Surgery in Patients with Type 2 Diabetes in the Middle East and North Africa Region: An Analysis of Primary Roux-en-Y Gastric Bypass and Sleeve Gastrectomy Outcomes.

INTRODUCTION: Type 2 diabetes (T2D) is a chronic medical condition that results in significant health implications and reduced life expectancy. The International Diabetes Federation (IDF) estimated that in 2021, 51.8% of all deaths of people under 60 years old in the Middle East and North Africa (MENA) region were related to diabetes. Bariatric surgery has been demonstrated to be a safe and effective treatment for T2D in different populations worldwide, though few specific data exist on outcomes of procedures in the MENA region. The aim of this study was to compare the safety and postoperative outcomes between patients with and without T2D undergoing primary bariatric surgery at a tertiary referral academic medical center in the United Arab Emirates. METHODS: All patients who underwent primary metabolic surgery between September 2015 and July 2020 were retrospectively reviewed from a prospective database. Group 1 included patients with T2D, and Group 2 included patients without T2D. Patients undergoing revisional or correctional operations were excluded. The procedure performed was based on surgeon discretion in discussion with a multidisciplinary team and the patient. Demographics as well as perioperative and postoperative results were examined. RESULTS: Our study included 542 patients, 160 (29.5%) with T2D and 382 (70.5%) with non-T2D. Mean age was 44.5 years (range 16-70) in the T2D group and 33.3 years (range 15-63) in the non-T2D group; median BMI was 41.8 ± 7.3 and 43.2 ± 7.2, respectively. The T2D group was 37.5% male and 62.5% female, and the non-T2D group was 38.7% male and 61.3% female. There were no significant differences in comorbidities. In the T2D group, 45.6% of patients underwent Roux-en-Y gastric bypass and 54.4% sleeve gastrectomy. In the non-TD2 group, 42.7% of patients received Roux-en-Y gastric bypass and 57.3% sleeve gastrectomy. There were no statistically significant differences in postoperative ED visits (21.8% vs. 24.3%, p = 0.21), minor complications within 30 days (4.3% vs. 5.2%, p = 0.67), readmission rates (5.6% vs. 4.9%, p = 0.77), re-operation rates (3.7% vs. 1.5%, p = 0.11), median hospital stay (2.0 days vs. 3.0, p = 0.05), or complications after 30 days (6.2% vs. 11.2%, p = 0.07). There were no deaths either group. CONCLUSIONS: In this cohort of patients from the MENA region, bariatric surgery in T2D patients is safe and effective, with perioperative outcomes comparable to those of non-T2D patients. To the best of our knowledge, our postoperative findings, which are the first report in the MENA region, are consistent with studies published in North America and Europe.

Resuming Bariatric Surgery Procedures During COVID-19 Pandemic: Early Surgical Outcomes at a Tertiary Referral Center in the Middle East.

Background: In response to the COVID-19 pandemic, elective surgical procedures have been delayed. Even with the implementation of surgical societies' recommendations, patient safety remains a concern. This study evaluates the postoperative outcomes in patients undergoing bariatric surgery after reopening (RO) elective surgery during the COVID-19 pandemic. Methods: All patients who underwent bariatric surgery from September 2015 to July 2020 were included. Patients were divided into two cohorts: the pre-COVID-19 (PC) cohort and the RO cohort. Propensity score weighting was used to evaluate postoperative outcomes. Results: Our study included 1076 patients, 1015 patients were in the PC and 61 patients in the RO. Sixty-four percent were female with a mean age of 37 years and median body mass index of 41 kg/m2. There were no statistically significant differences in 30 days perioperative outcomes, including emergency department visits 24.8% PC versus 19.7% RO (p = 0.492), readmission 4.2% PC versus 8.2% RO (p = 0.361), reoperation 2.6% PC versus 0% RO (p = 0.996), and major complications 4.0% PC versus 4.9% RO (p = 0.812). No patients in the RO contracted COVID-19. Conclusions: With the appropriate policies and precautionary measures, there appear to be no differences in the 30-day postoperative outcomes before and during the COVID-19 pandemic.

Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass to Enhance Weight Loss: Single Enterprise Mid-Term Outcomes and Literature Review.

Background: Suboptimal weight loss (SWL) occurs up to 30% after sleeve gastrectomy (SG). Conversion to Roux-en-Y gastric bypass (cRYGB) has shown heterogeneous results in terms of additional weight loss and resolution of weight-related comorbidities. We aim to evaluate mid-term outcomes of cRYGB specifically for SWL after SG. Methods: All patients who underwent cRYGB for SWL from April 2010 to June 2019 from prospective registries at three affiliated tertiary care centers were retrospectively reviewed. Patients who underwent revision or conversion for complications were excluded. Mixed-effects and polynomial regression models were used to evaluate weight loss results after conversion. Results: Thirty-two patients underwent cRYGB from SG. About 68.7% were women with mean age of 46.6 years. Mean body mass index (BMI) before SG was 55.3 kg/m2. Before conversion, mean BMI was 44.5 kg/m2 with 17.3% total weight loss (TWL). All procedures were completed laparoscopically in a median surgical time of 183 min. Three major complications occurred (9.3%), one gastrojejunal (GJ) leak and two reoperations. Four cases (12.5%) of GJ stenosis were diagnosed. No mortality was registered. Mean follow-up time was 24 months and patients had 36 kg/m2 mean BMI, 17.4% TWL, 27.2% had BMI >35 kg/m2. Conclusions: cRYGB after SG for SWL showed good mid-term results, better than those reported in literature.

Transanal total mesorectal excision in rectal cancer: short-term outcomes in comparison with laparoscopic surgery.

OBJECTIVE: The aim of this study was to compare short-term results obtained with transanal total mesorectal excision (TME) and laparoscopic surgery. BACKGROUND: Transanal TME appears as an alternative in the treatment of rectal cancer and other rectal disease. Natural orifices transluminal endoscopic surgery using the rectum as access in colorectal surgery is intuitively better suited than other access routes. METHODS: All consecutive patients with middle or low rectal cancer submitted to surgery were included into a prospective cohort and treated by transanal TME assisted by laparoscopy. They were compared with a retrospective cohort of consecutive patients of identical characteristics treated by laparoscopic TME in the immediate chronological period. RESULTS: Thirty-seven patients were included in both study groups. No differences were observed between them with respect to baseline characteristics, thus emphasizing the comparability of both cohorts. Surgical time was higher in the laparoscopy group (252 ± 50 minutes) than in the transanal group (215 ± 60 minutes) (P < 0.01). Moreover, coloanal anastomosis was performed less frequently (16% vs 43%, respectively; P = 0.01) and distal margin was lower (1.8 ± 1.2 mm vs 2.7 ± 1.7 mm, respectively; P = 0.05) in the laparoscopy group than in the transanal one. Although there was no significant difference in 30-day postoperative complication rate (laparoscopy, 51% vs transanal, 32%; P = 0.16), early readmissions were more frequent in the laparoscopy group than in the transanal one (22% vs 6%, respectively; P = 0.03). CONCLUSIONS: Evaluation of short-term outcomes demonstrated that transanal TME is a feasible and safe technique associated with a shorter surgical time and a lower early readmission rate.