Long-term complications after gastric bypass and sleeve gastrectomy: What information to give to patients and practitioners, and why?

Auge, Marie; Menahem, Benjamin; Savey, Véronique; Bion, Adrien Lee; Alvès, Arnaud

doi:10.1016/j.jviscsurg.2022.02.004

Cited by 12 publications

(18 citation statements)

References 69 publications

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“…A recent review of the literature shows that few studies provide long-term data because of the low rate of follow-up beyond 4 years [ 33 ]. Long-term multidisciplinary follow-ups are recommended because poor-quality surveillance is associated with an increased risk of medical, surgical, and/ or psychiatric complications [ 34 ]. Our findings are consistent with the literature, and this study reflects the general practice in bariatric centers.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the Lack of Follow-Up of Bariatric Surgery Patients: Experience of a Reference Center

Auge

Dejardin

Menahem

et al. 2022

JCM

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Few studies have evaluated the association between non-clinical and clinical determinants in terms of discontinuing follow-up after bariatric surgery. This cohort study aims to assess these associations. Data were collected from a prospectively maintained database of patients who underwent laparoscopic bariatric surgery from January 2012 to December 2019. The Cox model was used to assess the influence of preoperative determinants on follow-up interruptions for more than one year. Multilevel logistic regression was used to evaluate the association between clinical factors and post-operative weight loss with the regularity of follow-up. During the study period, 9607 consultations were performed on 1549 patients. The factors associated with a follow-up interruption from more than 365 days included male gender (HR = 1.323; CI = 1.146–1.527; p = 0.001) and more recent years of intervention (HR = 1.043; CI = 1.012–1.076; p = 0.0068). Revisional bariatric surgery was associated with a lower risk of follow-up interruption (HR = 0.753; CI = 0.619–0.916; p = 0.0045). Independent risk factors of an irregular follow up were higher age (HR = 1.01; CI = 1.002–1.017; p = 0.0086); male gender (OR = 1.272; CI = 1.047–1.545; p = 0.0153); and higher %TWL (Total Weight Loss) (OR = 1.040 CI = 1.033–1.048 p < 0.0001). A higher preoperative BMI (OR = 0.985; CI = 0.972–0.998; p = 0.0263) and revisional surgery (OR = 0.707; CI = 0.543–0.922; p = 0.0106) were protective factors of irregularity. This study suggests that the male gender and most recent dates of surgery are the two independent risk factors for follow-up interruption. Older age, male gender, and higher weight loss were all independent risk factors of an irregular follow-up. Revision bariatric surgery is a protective factor against interruption and irregular follow-up with a higher preoperative BMI. Further studies are needed to obtain long-term results in these patients with discontinued follow-ups.

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Section: Discussionmentioning

confidence: 99%

Analysis of the Lack of Follow-Up of Bariatric Surgery Patients: Experience of a Reference Center

Auge

Dejardin

Menahem

et al. 2022

JCM

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“…Andreu et al found that the number of attended support group sessions during the first-, second-, and fifth-year post-surgery predicted %TWL and %EWL at 1, 2, and 5 years [6]. Auge et al recommend long-term multidisciplinary follow-up (four times during the first year and once or twice a year thereafter) to detect and prevent WR, nutritional deficiencies, and complications [15]. At our hospitals, the followup at the outpatient clinic was 2-5 years.…”

Section: Discussionmentioning

confidence: 99%

The Long-Term Impact of Postoperative Educational Programs on Weight Loss After Roux-en-Y Gastric Bypass

et al. 2022

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Purpose Roux-en-Y gastric bypass (RYGB) is a well-documented treatment of severe obesity. Attending postoperative educational programs may improve the outcome. The aim of this study was to evaluate whether participation in educational programs lasting 2–3 years after RYGB influences long-term weight loss, weight regain, physical activity, and compliance to multivitamin supplements. Materials and Methods The Bariatric Surgery Observation Study (BAROBS) is a multicenter retrospective, cross-sectional study 10–15 years after primary RYGB. Four hundred and ninety-seven participants answered questions regarding participation in postoperative educational programs. Participants were divided into frequent attendees (FA) and infrequent attendees (IFA) at the educational programs. Results Ten to 15 years after surgery, a total weight loss (TWL) of 23.2 ± 11.6% were seen in the FA group vs 19.5 ± 12.6% in the IFA group, p < 0.001. Percent excess weight loss (%EWL) was 55.7 ± 28.9% vs 46.0 ± 31.1%, p < 0.001. Weight regain in percent of maximal weight loss for the FA was 32.1 ± 32.8% vs IFA 38.4 ± 40.0%, p = 0.052. No difference between the groups in compliance to multivitamin and physical activity. Conclusion Participants with frequent participation in group-based educational programs had better weight loss outcomes 10–15 years after RYGB and tended to have less weight regain. There was no difference between the two groups in participants compliance to recommended multivitamin supplements and physical activity. Graphical abstract

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“…Nutritional deficiencies associated with malabsorptive weight loss surgery can have significant consequences to an individual's long-term health, including vision loss, osteoporotic fracture, cardiomyopathy, and neurological deficits related to Gayet-Wernicke encephalopathy. 59 Key micronutrient deficiencies that occur after malabsorptive weight loss surgery include folate (15%-38%), vitamin B12 (37%-50%), iron (47%-66%), vitamin D (20%-80%), and vitamin E (5%-12%). 59 The risk of osteoporotic fractures varies with time; however, based on some studies, the risk is increased 3-5 years following surgery.…”

Section: Micronutrient Deficiency With Weight Loss Surgerymentioning

confidence: 99%

“…59 Key micronutrient deficiencies that occur after malabsorptive weight loss surgery include folate (15%-38%), vitamin B12 (37%-50%), iron (47%-66%), vitamin D (20%-80%), and vitamin E (5%-12%). 59 The risk of osteoporotic fractures varies with time; however, based on some studies, the risk is increased 3-5 years following surgery. 60,61 Women have the additional risk factor of osteoporosis in…”

Section: Micronutrient Deficiency With Weight Loss Surgerymentioning

confidence: 99%

“…119 High expectations of weight loss surgery in the early postoperative period may also contribute to substance abuse and worsening depression postoperatively. 59 Conservative management of depression related to obesity may include cognitive behavioral therapy, mental wellness support groups, and physical activity. Psychiatric evaluation before and after weight loss surgery to reduce risk of self-harm is strongly recommended.…”

Section: Depressionmentioning

confidence: 99%

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Management of obesity across women's life course: FIGO Best Practice Advice

Maxwell

Shirley

O’Higgins

et al. 2023

Intl J Gynecology & Obste

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Obesity is a chronic, progressive, relapsing, and treatable multifactorial, neurobehavioral disease. According to the World Health Organization, obesity affects 15% of women and has long‐term effects on women's health. The focus of care in patients with obesity should be on optimizing health outcomes rather than on weight loss. Appropriate and common language, considering cultural sensitivity and trauma‐informed care, is needed to discuss obesity. Pregnancy is a time of significant physiological change. Pre‐, ante‐, and postpartum clinical encounters provide opportunities for health optimization for parents with obesity in terms of, but not limited to, fertility and breastfeeding. Pre‐existing conditions may also be identified and managed. Beyond pregnancy, women with obesity are at an increased risk for gastrointestinal and liver diseases, impaired kidney function, obstructive sleep apnea, and venous thromboembolism. Gynecological and reproductive health of women living with obesity cannot be dismissed, with accommodations needed for preventive health screenings and consideration of increased risk for gynecologic malignancies. Mental wellness, specifically depression, should be screened and managed appropriately. Obesity is a complex condition and is increasing in prevalence with failure of public health interventions to achieve significant decrease. Future research efforts should focus on interprofessional care and discovering effective interventions for health optimization.

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Long-term complications after gastric bypass and sleeve gastrectomy: What information to give to patients and practitioners, and why?

Cited by 12 publications

References 69 publications

Analysis of the Lack of Follow-Up of Bariatric Surgery Patients: Experience of a Reference Center

Analysis of the Lack of Follow-Up of Bariatric Surgery Patients: Experience of a Reference Center

The Long-Term Impact of Postoperative Educational Programs on Weight Loss After Roux-en-Y Gastric Bypass

Management of obesity across women's life course: FIGO Best Practice Advice

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