Factors influencing long-term weight loss after bariatric surgery.

BACKGROUND: Bariatric surgery provides sustained weight loss and improves comorbidities. However, long term data has shown that patients gradually regain weight after 1 year. Several factors have been associated with poor weight loss after bariatric surgery. OBJECTIVE: Our goal is to investigate factors associated with poor weight loss following laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). SETTING: Military academic medical center. METHODS: Retrospective review of 247 patients who underwent laparoscopic SG or RYGB between 2010-2012 at Eisenhower Army Medical Center and followed for 5 years postoperatively. Factors of age, type of surgery, sex, hypertension, depression, and type 2 diabetes (T2D) are analyzed in univariate and multivariate analysis with percent total weight loss (%TWL) and Body Mass Index (BMI) change as primary endpoints measured at 3 and 5 years. RESULTS: Average BMI change are maximized at 1 year and decreased at 3 and 5 years post-surgery. Age, diabetes, hypertension and type of surgery significantly influenced weight loss at 3 and 5 years on univariate analysis. However, patients with diabetes, hypertension and sleeve gastrectomy were significantly older than comparable control group. Multivariable analysis showed that age and type of surgery, not diabetes or hypertension, were associated with poor %TWL and BMI change at 3 and 5 years. CONCLUSION: While presence of hypertension and diabetes initially appeared to be associated with weight recidivism, their impacts were negligible on multivariable analysis. However, age and sleeve gastrectomy are independent risk factors. Our data can be used to counsel patients on expected weight loss after bariatric surgery.

Time Course of Blood Pressure Decrease After Bariatric Surgery in Normotensive and Hypertensive Patients.

BACKGROUND: Bariatric surgery leads to remission of several obesity-related comorbidities, including hypertension. Although antihypertensive medication use is decreased after bariatric surgery, the exact time course of decrease in blood pressure after surgery is not known. METHODS: A database of patients undergoing bariatric surgery at our institute was used to study the effect of surgery on time course of blood pressure changes. Data from surgeries performed between January 2010 and December 2012 were used. RESULTS: Maximum blood pressure and body weight decreases were observed at 2 weeks and 1 year after surgery, respectively. Average decrease in the mean arterial pressure (MAP) was 4.46 mmHg (61.5 ± 17.1% of maximal decrease) and 7.17 mmHg (maximum decrease) at 1 and 2 weeks after surgery, when the decrease in body weight is 22.8 ± 1.6 and 28 ± 1.4% of maximal weight loss, respectively. In hypertensive patients, MAP decreased from 98.5 ± 0.78 to 92.3 ± 1.76 and 93.1 ± 0.92 mmHg at 1 and 2 weeks post-surgery, respectively. In normotensive patients, the MAP decreased from 96.2 ± 0.79 to 88.7 ± 1.25, 90.0 ± 0.94, 86.5 ± 1.35, 88.0 ± 1.13, and 86.4 ± 2.13 mmHg at 2 weeks, 3 and 6 months, and 1 and 3 years after surgery, respectively. CONCLUSIONS: These data demonstrate that significant decrease in MAP occurs within 2 weeks after bariatric surgery in hypertensive as well as normotensive patients. Future studies are required to investigate the weight-independent mechanisms of blood pressure decreases after bariatric surgery.

A multicenter study of routine versus selective intraoperative leak testing for sleeve gastrectomy.

BACKGROUND: Staple line leaks after sleeve gastrectomy are dreaded complications. Many surgeons routinely perform an intraoperative leak test (IOLT) despite little evidence to validate the reliability, clinical benefit, and safety of this procedure. OBJECTIVES: To determine the efficacy of IOLT and if routine use has any benefit over selective use. SETTING: Eight teaching hospitals, including private, university, and military facilities. METHODS: A multicenter, retrospective analysis over a 5-year period. The efficacy of the IOLT for identifying unsuspected staple line defects and for predicting postoperative leaks was evaluated. An anonymous survey was also collected reflecting surgeons' practices and beliefs regarding IOLT. RESULTS: From January 2010 through December 2014, 4284 patients underwent sleeve gastrectomy. Of these, 37 patients (.9%) developed a postoperative leak, and 2376 patients (55%) received an IOLT. Only 2 patients (0.08%) had a positive finding. Subsequently, 21 patients with a negative IOLT developed a leak. IOLT demonstrated a sensitivity of only 8.7%. There was a nonsignificant trend toward increased leak rates when an IOLT was performed versus when IOLT was not performed. Leak rates were not statistically different between centers that routinely perform IOLT versus those that selectively perform IOLT. CONCLUSIONS: Routine IOLT had very poor sensitivity and was negative in 91% of patients who later developed postoperative leaks. The use of IOLT was not associated with a decrease in the incidence of postoperative leaks, and routine IOLT had no benefit over selective leak testing. IOLT should not be used as a quality indicator or "best practice" for bariatric surgery.