Faculty Bibliography

INTRODUCTION/BACKGROUND:GLP-1 receptor agonists (GLP1-RAs) are increasingly prescribed as an alternative to bariatric surgery for weight loss, and may pose as an alternative to conversion Roux-En-Y Gastric Bypass (cRYGB) in patients with insufficient weight loss or weight recurrence after sleeve gastrectomy [A C, N C, A I. Postoperative morbidity and weight loss after revisional bariatric surgery for primary failed restrictive procedure: a systematic review and network meta-analysis. International Journal of Surgery; 2022;Jensen et al. in Obes Surg 33:1017-1025, 2023; Jamal et al. in Obes Surg 34:1324-1332, 2024; Lautenbach A, Wernecke M, Stoll FD, Meyhöfer SM, Meyhöfer S, Aberel J. 1422-P: The potential of semaglutide once-weekly in patients without Type 2 Diabetes with weight regain or insufficient weight loss after bariatric surgery. Diabetes 2022; 71(Supplement_1);]. METHODS AND PROCEDURES/METHODS:Adult patients ≥ 18 years old, who previously underwent a sleeve gastrectomy and were subsequently treated with weekly injectable Semaglutide or Tirzepatide, or treated with conversion from sleeve gastrectomy were included for analysis. Patients converted for GERD, GLP1-RA use with BMI ≤ 35, or pre operative GLP1-RA use were excluded. Post operative weights and Hgb A1C were assessed from 3 months to 3 years post intervention (start of GLP1-RA or surgery). T-test, ANOVA, and chi-squared analysis were used to compare groups, while multivariable linear regression analysis was used to evaluate the effect of bariatric surgery on %TBWL at 3 years post intervention when adjusting for baseline characteristics. RESULTS:4901 patients were included for analysis (3004 cRYGB, 1897 GLP1-RA). There was no difference in pre-intervention weight (242.8 ± 44.4 GLP1-RA vs 242.3 ± 57.8 cRYGB, p = .993). cRYGB patients had a higher baseline Hgba1c (6.19 ± 1.4 vs 5.85 ± 1.2, p < 0.001). cRYGB was associated with significantly greater weight loss at all post operative time points up to 3 years post intervention, (26.1 vs 13.7%, p < 0.001). There was no significant difference in Hgba1c control between treatments at all post intervention time points (all p > 0.05). In the multivariate linear regression analysis, when adjusting for sex, baseline BMI, baseline age, and non-white race, cRYGB was associated with an 11% greater %TBWL compared to those who were treated with a GLP1-RA. CONCLUSIONS:For patients who have had insufficient weight loss or weight recurrence following sleeve gastrectomy, conversion to RYGB offers greater, long-term weight loss compared to GLP1-RAs.

INTRODUCTION/BACKGROUND:Robotic sleeve gastrectomy (RSG) is increasingly used in bariatric surgery, but its safety compared to laparoscopic sleeve gastrectomy (LSG) remains debated. METHODS:We retrospectively reviewed electronic medical records of 927 (575 RSG, 352 LSG) patients at a single academic center from June 2021 to August 2023. The baseline and operative characteristics of the study groups were compared using two-sample t tests, Wilcoxon rank-sum tests, chi-square tests, and Fisher's exact tests. Thirty-day complication rates were compared using multiple logistic regression, adjusted for baseline factors, operative characteristics, ASA class, and staple-line reinforcement. Statistical analysis was conducted using SAS 9.4, and p-values < 0.05 were considered significant. Logistic regression was used to evaluate whether complication rates were different between RSG and LSG while adjusting for other factors. RESULTS:(RSG 43, LSG 43.12, p = 0.806), average age 39.8 (RSG 39.3, LSG 40.7, p = 0.084), and 74% were females (RSG 75%, LSG 69.8%, p = 0.032). Baseline characteristics were comparable between the two groups. Median operative time was 73 min for RSG vs 66 min for LSF (p = 0.0002). Thirty-day complication rates were 3.5% in both groups (adjusted OR = 1.00, 95% CI 0.43-2.35, p = 0.998). Quarterly analysis and CUSUM demonstrated no residual learning-curve effect on complications. Power analysis confirmed ≥ 80% power to detect a ≥ 5% absolute difference. Missing-data sensitivity analyses corroborated primary findings. CONCLUSIONS:RSG is as safe as LSG within 30 days, with a modest 7-min operative-time penalty that is unlikely to be clinically meaningful.

BACKGROUND:Globally, many surgeons perform varying revisional procedures to convert either a primary sleeve gastrectomy (SG) or laparoscopic adjustable gastric band (LAGB) for the management of recurrent weight gain. There is no consensus on efficacious revision surgery in terms of long-term weight loss and comorbidity management. Nationally, the most common revision procedure is to a Roux-en-Y gastric bypass (RYGB). Internationally, there are other options in frequent use. This includes the one-anastomosis gastric bypass (OAGB). Both RYGB and OAGB have different potential complications and issues but have been very successful in many patients. OBJECTIVES/OBJECTIVE:To assess OAGB and RYGB as revision surgery, differences in weight loss, and nutritional status at approximately 1 year. SETTING/METHODS:Single university hospital system. METHODS:Patients who underwent OAGB as a revision of SG or LAGB were case matched by age, sex, and primary bariatric procedure to patients who underwent RYGB during January 2019 to October 2022. RESULTS:This study looked at 113 patients with either a primary SG or LAGB. Fifty-eight patients were converted to OAGB, and 55 patients were converted to RYGB. The OAGB cohort had a greater total body weight loss compared with the RYGB. There were no significant differences in postoperative nutritional values between the groups, except for decreased vitamin B12 levels in the RYGB cohort. CONCLUSION/CONCLUSIONS:Patients who underwent conversion from either SG or LAGB to OAGB experienced a greater TBWL at 1-year postoperatively compared with those who underwent conversion to RYGB, without difference in nutritional deficiencies.

BACKGROUND:With the increasing complexity of metabolic and bariatric surgery (MBS) techniques, the integration of endoscopic modalities has become indispensable in both pre-, intra-, and postoperative management. This survey aimed to evaluate the current landscape of endoscopic training, practice patterns, and proficiency among early-career surgeons. METHODS:Cross-sectional study based on online survey voluntary and open to all Young-IFSO members (surgeons aged ≤ 45 years) between September and December 2024. The questionnaire addressed participants' socio-demographic characteristics, professional background, and details regarding their endoscopic training and practice. Particular emphasis was placed on current engagement in endoscopic management of MBS-related complications and endoscopic bariatric therapies (EBTs). RESULTS:A total of 273 respondents from 49 countries completed the survey. Endoscopic training was included in the general surgery curriculum for half of the participants, yet 33.8% do not perform endoscopy in current practice. Nearly half (46.9%) reported lacking confidence in managing MBS complications endoscopically. Although EBTs are available in half of the respondents' institutions, only 23.9% perform these procedures themselves. CONCLUSION/CONCLUSIONS:This Young-IFSO survey highlights the limited endoscopic involvement of early-career metabolic and bariatric surgeons and the need for structured training to meet the demands of modern MBS.

BACKGROUND:Sleeve gastrectomy (SG) is the most commonly performed metabolic and bariatric surgery (MBS) procedure. Technical considerations related to the performance of SG are well established and reported in the literature but not in relation to robotic-assisted (RA) SG. We report the results of the first modified Delphi consensus-building exercise addressing technical considerations of RA da Vinci (dV) SG. OBJECTIVES/OBJECTIVE:Develop best practices for the performance of robotic-assisted da Vinci sleeve gastrectomy. SETTING/METHODS:Survey based consensus statement. METHODS:A consensus building committee (CBC) was created comprising 10 experts in the field of RA surgery and MBS based on strict selection criteria. The CBC developed 49 consensus statements which were then shared with 240 experts in RA surgery. Our stopping criterion was stability in responses (≤15%). The consensus cut point was 70%. RESULTS:The overall response rate was 49%. In the first round of voting, there was consensus agreement on 25 statements (51%), consensus disagreement on 14 (28%), and no consensus on the remaining statements (21%). In the second round of voting, we reached agreement on 3 additional statements. Experts recommended the use of the number of pauses generated by the stapler to guide choice of staple height (91.2%) and to upsize the staple height when using buttressing (92%). There was also consensus (81.4%) that the use of the closed staple height of 1.00 mm (white) is acceptable and that stapling of the antrum using a 1.5-mm staple (blue load) is also acceptable (73%). CONCLUSIONS:Collective expert opinion structured through a modified Delphi consensus statement presents a practical guide for surgeons interested in performing dV-SG.

PURPOSE/OBJECTIVE:With the continued increase in bariatric procedures being performed in the USA, a growing percentage are revisions for weight regain after sleeve gastrectomy (SG) and gastric banding (LAGB). Standard practice in the USA involves conversion to Roux-en-Y gastric bypass (RYGB). Internationally, one anastomosis gastric bypass (OAGB) has become a popular and effective alternative. Without the jejuno-jejunal anastomosis, OAGB has reduced potential related long-term complications. The purpose of this study is to compare the short-term safety of revision to OAGB versus RYGB. MATERIALS AND METHODS/METHODS:Patients who underwent conversion to OAGB from LAGB or SG for weight regain from January 2019 to October 2021 were compared to BMI, sex, and age-matched patients who underwent conversion to RYGB. RESULTS:In our study, 82 patients were included, 41 in each cohort (41 OAGB vs. 41 RYGB). The majority in both groups underwent conversion from SG (71% vs. 78%). Operative time, estimated blood loss, and length of stay were comparable. There was no difference in 30-day complications (9.8% vs. 12.2%, p = .99) or reoperation (4.9% vs. 4.9%, p = .99). Mean weight loss at 1 month was also comparable (7.91 lbs vs 6.36 lbs). CONCLUSIONS:Patients undergoing conversion to OAGB for weight regain had similar operative times, post-operative complication rates, and 1-month weight loss compared to those who underwent RYGB. While more research is needed, this early data suggests that OAGB and RYGB provide comparable outcomes when used as conversion procedures for to failed weight loss. Therefore, OAGB may present a safe alternative to RYGB.