Piero Giustacchini

Introduction Fluid-filled intragastric balloon (FF-IGB) placement is an endoscopic bariatric procedure that effectively achieves short-term weight loss in patients affected by obesity. Comparative data among different balloon volumes are lacking. This study aimed to assess efficacy and safety of FF-IGB at different volumes. Methods A randomized single-center analysis over 156 patients undergoing FF-IGB at a volume of 500 ml, 600 ml, or 700 ml with 6-month follow-up was conducted. Outcomes included postprocedural adverse events (AEs), early device removal for intolerance, evaluation of percentage of total weight loss (TWL%), excess weight loss (EWL%), and quality of life (QoL) at 6-month follow-up. Results The mean age of our cohort was 46.2 years, and 69.2% were female. The mean BMI was 41.9 kg/m². Pain was the main adverse event being detected in 78.3% patients, followed by nausea (76.8%), and vomiting (50.7%). No serious AEs were reported. Ten patients required early balloon removal for epigastric pain, nausea, and vomiting. The FF-IGB volume was not associated with nausea (p = 0.657), vomiting (p = 0.487), pain (p = 0.182), or early removal (p = 0.988). Decrease in body mass index (BMI) after 6 months was significant (mean BMI 35.24 kg/m², SD 7.17, p < 0.001). Mean TWL% after 6 months was 14.16. No significant difference between the FF-IGB volume and TWL% (p = 0.412) was detected. At 6 months follow-up, the mean EWL% was 30.8 ± 23.3 with no differences among the three groups of different FF-IGB volumes (p = 0.733). A significant improvement of QoL was detected at 6 months unrelated to the FF-IGB volume (p = 0.849). Conclusion FF-IGB placement resulted in significant weight loss over a 6-month period. No differences in TWL%, EWL%, rate of AEs, percentage of early device removal, and QoL were detected among the three groups with a different IGB volume. A 500 ml filling volume could be “the magic number” as no significant benefits are achieved with a greater volume. Key Points • Fluid-filled intragastric balloon (FF-IGB) placement effectively achieves short-term weight loss in patients affected by obesity, but comparative data among different balloon volumes are lacking. • Weight-loss outcomes, adverse-event rates, and quality-of-life gains were identical across 500 ml, 600 ml, and 700 ml balloon volumes. • A 500 ml filling volume for fluid-filled intragastric balloons could be “the magic number,” as larger volumes confer no additional benefit.

Background: Patients with obesity seeking bariatric surgery often display high rates of depressive symptoms, which are linked to worse clinical and surgical outcomes. A comprehensive evaluation of depression-related features in this population is lacking. Therefore, this study investigated clinical and psychopathological factors associated with depressive symptoms’ severity in 946 outpatients with obesity undergoing pre-surgical evaluation. Methods: The sample (45.1 ± 12 years) was subdivided according to Patient Health Questionnaire-9 (PHQ-9) into ‘absent’, ‘mild’, and ‘moderate-to-severe depression’ groups, which were compared for sociodemographic characteristics, childhood trauma, and emotional dysregulation. Assessments included the Childhood Trauma Questionnaire-Short-Form (CTQ-SF) and Difficulties in Emotion Regulation Scales (DERS). Inflammatory levels were evaluated through the Systemic Immune-inflammatory Index (SII). Multinomial logistic regression and correlations were performed to evaluate predictors of depression severity and their interrelationship. Results: Beyond sociodemographic and clinical differences, patients with moderate-to-severe depression displayed higher childhood trauma, emotional dysregulation, and inflammatory levels. Logistic regression with 95% confidence intervals showed that higher CTQ-SF scores were significantly associated with moderate-to-severe vs. absent depression (p = 0.005, 95% CI: 1.02–1.09), while elevated DERS scores were a risk factor for both moderate-to-severe vs. mild (p < 0.001, 95% CI: 1.04–1.11) and vs. absent depression (p < 0.001, 95% CI: 1.11–1.18). Additionally, PHQ-9 was significantly correlated with CTQ-SF, DERS, and SII. Conclusions: A worse clinical picture was observed in patients with moderate-to-severe depression, and significant interactions were found between psychopathology and inflammatory indexes. Emotional dysregulation was primarily associated with depression severity. These preliminary results support the implementation of rigorous pre-operative screening to identify and deliver targeted psychotherapeutic/pharmacological interventions aimed at improving clinical and post-surgical outcomes.

Background Bariatric surgery (BS) is an effective intervention for severe obesity, but some patients may experience sub-optimal weight loss. This study investigates the role of preoperative body composition parameters, measured via bioelectrical impedance analysis (BIA), in predicting postoperative weight loss outcomes. Methods A retrospective analysis was conducted on 102 patients who underwent sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or one-anastomosis gastric bypass (OAGB) between January 2020 and April 2023. Preoperative body composition metrics, including fat mass (FM), fat-free mass (FFM), body cell mass (BCM), and phase angle (PhA), were correlated with percentages of excess weight loss (%EWL) and total weight loss (%TWL) at 12 months post-surgery. Results The study found that patients with higher preoperative BCM and PhA showed significantly better weight loss outcomes. Specifically, patients with optimal weight loss had a mean BCM of 35.2 ± 3.5 kg and a PhA of 6.1 ± 0.5, whereas those with sub-optimal outcomes had a mean BCM of 29.8 ± 4.2 kg and a PhA of 4.9 ± 0.6 (p < 0.01 for both). Additionally, higher FM was associated with lower %EWL (r = − 0.40, p < 0.01). Multivariable logistic regression analysis identified BCM (OR 2.1, 95% CI 1.3–3.4) and %FM (OR 0.7, 95% CI 0.5–0.9) as independent predictors of successful weight loss. Conclusions Preoperative BIA parameters, particularly BCM and %FM, are significantly associated with weight loss outcomes in BS patients. These findings suggest a potential role in guiding pre-surgical patient assessment and tailored care, while acknowledging that this relationship is correlational and not necessarily causal.

Background: Laparoscopic bariatric surgery provides many benefits including lower postoperative pain scores, reduced opioid consumption, shorter hospital stays, and improved quality of recovery. However, the anaesthetic management of obese patients requires caution in determining postoperative risk and in planning adequate postoperative pathways. Currently, there are no specific indications for intensive care unit (ICU) admission in this surgical population and most decisions are made on a case-by-case basis. The aim of this study is to investigate whether Obesity Surgery Mortality Risk Score (OS-MRS) is able to predict ICU admission in patients undergoing laparoscopic bariatric surgery (LBS). Methods: We retrospectively reviewed data of patients who underwent LBS during a 2-year period (2017–2019). The collected data included demographics, comorbidities and surgery-related variables. Postoperative ICU admission was decided via bariatric anaesthesiologists’ evaluations, based on the high risk of postoperative cardiac or respiratory complications. Anaesthesia protocol was standardized. Logistic regression was used for statistical analysis. Results: ICU admission was required in 2% (n = 15) of the 763 patients. The intermediate risk group of the OS-MRS was detected in 84% of patients, while the American Society of Anaesthesiologists class III was reported in 80% of patients. A greater OS-MRS (p = 0.01), advanced age (p = 0.04), male gender (p = 0.001), longer duration of surgery (p = 0.0001), increased number of patient comorbidities (p = 0.002), and previous abdominal surgeries (p = 0.003) were predictive factors for ICU admission. Conclusions: ICU admission in obese patients undergoing LBS is predicted by OS-MRS together with age, male gender, number of comorbidities, previous abdominal surgeries, and duration of surgery.

The implementation of barbed sutures appears to enhance the process of suturing and knot tying, particularly in the field of bariatric surgery, where they can offer significant advantages. The objective of this study is to evaluate the safety and effectiveness of utilising barbed sutures for gastric pouch-jejunal anastomosis (GPJA) and jejuno-jejunal anastomosis (JJA) anastomosis in Roux-en-Y Gastric Bypass (RYGB). Data from patients who underwent primary RYGB between January 2012 and October 2018 were retrospectively collected using Propensity Score Matching (PSM) to randomise groups (barbed sutures—BS-G and conventional sutures—CS-G). The primary outcome was postoperative early complications. The secondary outcomes were late complications (internal hernias and small bowel obstructions), operative time and postoperative hospital stay. A total of 969 patients were included. After PSM, 322 (161 in BS-G vs. 161 in CS-G) patients were compared (chi-square 0.287, p = 0.862). Postoperative early and late complications were comparable between the two groups. BS-G had a significantly shorter median operative time (65 vs. 95 min p < 0.001). Median postoperative hospital stay was significantly shorter for BS-G (2 vs. 5 days, p < 0.001). Barbed sutures effectively reduce the operation duration and are as safe as conventional sutures for closing anastomotic defects during RYGB.

Concerns still exist regarding the role of early routine upper gastrointestinal contrast study (UGI) after bariatric procedures for detection of early complications. We reviewed our database to identify patients who underwent laparoscopic primary or redo surgery (previously placement of adjustable gastric banding), between January 2012 and December 2017. All the patients underwent UGI within 48 h after surgery. Among 1094 patients, early UGI was abnormal in 5 patients: in 4 cases a leak (one false positive) and in one case stenosis (one true positive) were suspected. In this clinical setting, five leaks were observed and required surgical re-exploration: 3 correctly identified and 2 not detected at UGI. Overall, 3 patients developed anastomotic stenosis. Our data suggest that early routine UGI after bariatric procedures has limited utility.

E Capristo, S Panunzi, A De Gaetano, V Spuntarelli, R Bellantone, P Giustacchini, A L Birkenfeld, S Amiel, S R Bornstein, M Raffaelli, G Mingrone; Response to

The use of barbed sutures for constructing an anastomosis is favoured by a few bariatric surgeons as compared to conventional sutures. The aim of this study is to assess safety and efficacy of barbed sutures to close the gastric pouch–jejunal anastomosis (GPJA) in laparoscopic gastric bypass (Roux-en-Y gastric bypass—RYGB, and One-Anastomosis gastric bypass—OAGB) using propensity score-matching (PSM) analysis. A retrospective analysis of patients who underwent primary laparoscopic gastric bypasses between January 2012 and December 2017 was performed. Patients were divided into two different groups (RYGB-G and OAGB-G). PSM analysis was performed to minimize patient selection bias between the two types of sutures (barbed—BS and conventional—CS) in each group. A total of 808 patients were reviewed. After PSM, 488 (244 BS vs 244 CS) patients in RYGB-G and 48 in OAGB-G (24 BS vs 24 CS) patients were compared. Median operative time was significantly shorter (p < 0.001) for BS in RYGB-G. In OAGB-G, BS were associated with a shorter operative time, although no significant difference was observed (p = 0.183). Post-operative hospital stay was significantly shorter for BS in both the groups (p < 0.001). Post-operative 30th-day complications were comparable: no leakage or bleeding of GPJA was observed in BS groups. At median follow-up of 28.78 months, no late complications were observed. Barbed sutures appear to be effective to close GPJA during gastric bypass and as safe as conventional suture. Further studies are necessary to draw definitive conclusions.

Pregnancy after bariatric surgery (BS) has an increased risk for small-for-gestational-age infants (SGA), shorter length of gestation, and probably perinatal mortality. The aim of this study was to investigate if biliopancreatic diversion could impair pregnancy outcomes in comparison to other bariatric surgery procedures.

The outcomes of failed laparoscopic sleeve gastrectomies (LSG) converted to laparoscopic standard R-Y gastric bypass (LRYGB) in case of insufficient weight loss (IWL), weight regain (WR), and/or severe gastro-esophageal reflux disease (GERD) are scanty.