Micronutrient Deficiencies After Roux-en-Y Gastric Bypass: Long-Term Results Abstract Background Patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) are under risk of micronutrient deficiencies. We aimed to assess the preoperative and postoperative micronutrient deficiencies in a sample of patients with obesity who underwent LRYGB. Methods We evaluated 169 patients—satisfying the National Institute of Health criteria for bariatric surgery—who underwent a LRYGB from January 2014 to July 2017. Before surgery, we recorded a detailed medical history for every patient, and after surgery, we instructed them to return at 1, 6, 12, 24, 36, and 48 months after surgery. Results Preoperatively, anemia was present in 4.24% of patients, iron deficiency in 5.33%, vitamin B12 deficiency in 12.3%, and vitamin D deficiency in 74.35%. Postoperatively, the deficiency rates of calcium, magnesium, folate, and vitamins A, B1, and B6 were markedly low at 1, 2, and 3 years after surgery. In regard to anemia, iron, and vitamin B12, rates of deficiency were higher at 2 and 3 years postoperatively versus preoperatively, but only anemia (4% vs 14% and 4% vs 27%, at 2 and 3 years) and iron (5% vs 23% at 3 years) reached statistical significance. Compared with the preoperative assessment, the rates of vitamin D deficiency decreased over time (74% vs 50% at 1 year [p < 0.001], 74% vs 45% at 2 years [p < 0.002] and 74% vs 41% at 3 years [p < 0.04]). Conclusions Vitamin D deficiency remains the most common preoperative deficiency. Anemia and deficiencies of iron and vitamin B12 are common before and after surgery. Deficiencies of calcium, magnesium, folate, and vitamins A, B1, and B6 are markedly low in the postoperative period.

Long-Term Matched Comparison of Adjustable Gastric Banding Versus Sleeve Gastrectomy: Weight Loss, Quality of Life, Hospital Resource Use and Patient-Reported Outcome Measures Abstract Background Comparisons of bariatric procedures across a range of outcomes are required to better inform selection of procedures and optimally allocate health care resources. Aims To determine differences in outcomes between laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) across nine outcome domains. Methods Matched primary LSG or LAGB across age, weight and surgery date were recruited. Data were collected from a prospective database and patient-completed questionnaires. Results Patients (n = 520) were well-matched (LAGB vs. LSG; age 41.8 ± 11.2 vs. 42.7 ± 11.7 years, p = 0.37; male 32.4% vs. 30.2%, p = 0.57; baseline weight 131.2 ± 30.5 vs. 131.0 ± 31.1 kg, p = 0.94). Follow-up rate was 95% at a mean of 4.8 years. LAGB attended more follow-up visits (21 vs. 13, p < 0.05). Mean total body weight loss was 27.7 ± 11.7% vs. 19.4 ± 11.1% (LSG vs. LAGB, p < 0.001). LAGB had more complications (23.8% vs. 10.8%, p < 0.001), re-operations (89 vs. 13, p < 0.001) and readmissions (87 vs. 32, p < 0.001). However, early post-operative complications were higher post-LSG (2.6 vs. 9.2%, p = 0.007). Length of stay (LOS) was higher post-LSG compared with LAGB (5.2 ± 10.9 vs. 1.5 ± 2.2 days, p < 0.001). LSG patients reported better quality of life (SF-36 physical component score 54.7 ± 7.9 vs. 47.7 ± 10.8, p = 0.002) and satisfaction (9.2 ± 1.9 vs. 8.4 ± 1.6, p = 0.001) and less frequent regurgitation (1.2 ± 1.2 vs. 0.7 ± − 1.1, p = 0.032) and dysphagia (2.0 ± 1.3 vs. 1.3 ± 1.6, p = 0.007). Conclusion This study showed high long-term follow-up rates in a large cohort of well-matched patients. Weight loss was greater with LSG. LAGB reported more re-operations and less satisfaction with the outcome. LOS was driven by patients with complications. This study has reinforced the need for comprehensive measurement of outcomes in bariatric surgery.

Letter to the Editor Concerning: Clinical Outcomes of Sleeve Gastrectomy Versus Roux-En-Y Gastric Bypass After Failed Adjustable Gastric Banding

Clinical Practice Guidelines for Childbearing Female Candidates for Bariatric Surgery, Pregnancy, and Post-partum Management After Bariatric Surgery Abstract Emerging evidence suggests that bariatric surgery improves pregnancy outcomes of women with obesity by reducing the rates of gestational diabetes, pregnancy-induced hypertension, and macrosomia. However, it is associated with an increased risk of a small-for-gestational-age fetus and prematurity. Based on the work of a multidisciplinary task force, we propose clinical practice recommendations for pregnancy management following bariatric surgery. They are derived from a comprehensive review of the literature, existing guidelines, and expert opinion covering the preferred type of surgery for women of childbearing age, timing between surgery and pregnancy, contraception, systematic nutritional support and management of nutritional deficiencies, screening and management of gestational diabetes, weight gain during pregnancy, gastric banding management, surgical emergencies, obstetrical management, and specific care in the postpartum period and for newborns.

Surgeon on the Left Side, an Alternative Position that May Improve Exposure in Gastric Sleeve? Abstract Background The position of the patient with the surgeon between the legs “the French position” remains the most commonly used. We describe an alternative technique for sleeve gastrectomy using three trocars (one of 12 mm, 2–4 cm from the umbilicus, and two of 5 mm), and the surgeon positioned to the left side of the patient, in order to facilitate dissection and exposure in sleeve gastrectomy. Methods Between January 2015 and December 2017, this technique was already used in 50 sleeve gastrectomies. Results In one case, a 5-mm trocar was added in the right upper quadrant for liver retractor. The decubitus position without the legs being spread is way easier and more tolerated by the extremely obese patients or those with joint pathologies. However, the supine position has disadvantages for intubation and respiration during the procedure. Conclusions The operation is not really different regardless of where the surgeon stands, but we think that the positon on the left side can give a better exposure of the gastric fundus.

Safety and Utility of Liver Biopsy During Bariatric Surgery in the New Zealand Setting Abstract Background Asymptomatic liver disease is common in bariatric patients and can be diagnosed with intraoperative biopsy. This study aimed to establish the risk-benefit profile of routine liver biopsy, prevalence of clinically significant liver disease, relationship between liver pathology and body mass index, and compare outcomes between ethnic groups. Methods This retrospective cohort study included all patients who had index bariatric surgery at Auckland City Hospital between 2009 and 2016. Diagnosis of liver disease was based on intraoperative biopsy histology. Outcomes included safety (biopsy-related complication) and utility (liver pathology meeting criteria for referral). Liver pathology and referral rates were compared between ethnic groups. Results Of 335 bariatric surgery patients, 234 (70%) underwent intraoperative liver biopsy. There were no biopsy-related complications. Histological findings were as follows: normal 25/234 (11%), non-alcoholic fatty liver disease (NAFLD) 207/234 (88%), and other pathological findings in 35/234 (15%). Histological finding meeting referral criteria was present in 22/234 (9%). Of these, 12/22 (55%) were referred. Number needed to biopsy to identify histology meeting referral criteria: n = 11. Māori had a similar NAFLD rate to non-Māori [51/56 versus 156/178, p = 0.48]. Pasifika patients had a higher rate than non-Pasifika [39/40 versus 168/194, p = 0.049]. Māori and Pasifika patients had similar referral rates to non-Māori and non-Pasifika [2/3 versus 5/9, p = 0.73; 2/2 versus 5/10, p = 0.19]. Conclusions Intraoperative liver biopsy during bariatric surgery is safe and identified liver disease in 89%, with 9% meeting referral criteria. Pasifika patients have a higher rate of NAFLD than non-Pasifika.

Comparative Effectiveness of Laparoscopic Adjustable Gastric Banding vs Laparoscopic Sleeve Gastrectomy in Adolescents—a National Registry-Based Study Abstract Objective Most published work on bariatric surgery (BS) in adolescents describes outcomes after laparoscopic adjustable gastric banding (LAGB) or Roux-en-Y gastric bypass. We compared the efficacy of LAGB and laparoscopic sleeve gastrectomy (LSG) in adolescents. Methods A National Bariatric Registry was queried for adolescents who underwent BS between June 2013 and December 2015. We collected data on weight and height at baseline and 1-year following surgery, subsequent hospitalizations, interventions, and mortality, which were compared at 30 days post-surgery and until last follow-up (maximum 4.2 years post-surgery). Mortality and hospitalization data were extracted from national databases. Results Two hundred fifty-nine adolescents (60% females) aged 12–19 years were included. Mean age and body mass index (BMI) were 17.5 ± 1.2 years and 45.1 ± 5.0 kg/m2, respectively. LSG (n = 227, 87.6%) and LAGB (n = 32, 12.4%) were the most common procedures performed. LSG group achieved greater average at 1 year BMI loss compared to LAGB group (15.4 ± 4.7 kg/m2 vs. 10.3 ± 5.1 kg/m2 respectively; p = 0.0001) and higher rate with BMI < 30 kg/m2 1 year post-surgery (57.7% (n = 131) vs. 25% (n = 8), respectively; p = 0.0005). Males who underwent LSG reduced BMI more than their female counterparts (p = 0.0001), LSG was the strongest independent predictor for BMI < 30 after 1 year (OR = 4.1; 95% CI 1.7–9.9) followed by age (OR = 1.3; 95% CI1.0–1.6). No mortality was observed. Postoperative hospitalizations between the two groups did not differ (hazard ratio 2.4; 95% CI 0.7–7.9; p = 0.1). Conclusion Compared to LAGB, LSG is superior regarding weight loss with a similar risk of short- and long-term hospitalizations, complications, and interventional procedures. Males lose more weight following LSG.

Correction to: Improving Compliance with Very Low Energy Diets (VLEDs) Prior to Bariatric Surgery—A Randomized Controlled Trial of Two Formulations In the original article the name of author Alexandra Klejn was misspelled.

Correction to: Type 2 Diabetes Mellitus and Preoperative HbA1c Level Have no Consequence on Outcomes after Laparoscopic Sleeve Gastrectomy—a Cohort Study Some of the author affiliations were incorrectly assigned in the original article. They are correct here.

Robotic Reversal of One-Anastomosis Gastric Bypass into Sleeve Gastrectomy for Severe Malnutrition: Interest of the Manual Gastro-Gastric Anastomosis?