Bariatric surgery has been consistently demonstrated in randomized controlled trials to be the most effective treatment currently available for patients with Type 2 diabetes mellitus (T2DM) and obesity. In spite of this, with the emergence of longer-term data, it is now becoming apparent that some of the metabolic benefits afforded by bariatric surgery fatigue with time, prompting clinicians to re-consider how patients should be managed in the postoperative period. As is seen with many other chronic diseases including peripheral vascular disease as well as some cancers, surgery is seen as a means of inducing disease control with medications being employed to maintain sustained remission. In recent years, there have been remarkable advances in pharmacotherapy for the treatment of T2DM as well as additional agents which can produce clinically significant weight loss. Having recognized the potential need for further treatment following bariatric surgery along with the availability of highly effective medical therapies presents the opportunity to explore a multimodal approach to care, combining medications with surgery to potentially improve long-term outcomes.

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Aim: The aim is to assess the long- and very long-term rate of unfavorable outcomes associated with the laparoscopic adjustable gastric band (LAGB) in morbid obesity. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was used in this systematic review. The search for evidence was performed in the MEDLINE (PubMed), EMBASE, LILACS, Clinical Trials, and Google Scholar databases from the inception to October 2021. The main eligibility criteria were obese adult undergoing LAGB, unfavorable outcomes, and a minimum follow-up of 4 years. Outcomes were aggregated using the Comprehensive Meta-Analysis software for noncomparative studies, and the quality of evidence was sorted. Heterogeneity was assumed when I² >50%. Because of expected differences among retrieved studies and several uncontrolled variables, the random-effects model was used to perform a proportional meta-analysis. Results: Data on 23,916 unfavorable outcomes were extracted from 28 studies (N = 107,370 patients). The use of the LAGB may be related to a rate of around 30% for reoperation (95% confidence interval [CI] = 20.4%–41.4%), 18% for band removal (95% CI = 13.3%–24.5%), 12% for nonresponse (95% CI = 5.2%–23.8%), 8% for port/tube complications (95% CI = 5.1%–13.6%), 7% for slippage/prolapse (95% CI = 5.3%–9.7%), 6% for pouch enlargement (95% CI = 3.4%–9.9%), and 3% for erosion/migration (95% CI = 2.0%–4.3%) in the long- and very long-term follow-up. However, the quality of evidence was considered very low. Conclusion: Despite the very low quality of evidence, LAGB was associated with not negligible rates of unfavorable outcomes in long- and very long-term follow-up.

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Introduction: Variations in cultural practices, diet, socioeconomic factors, genetics, and procedure selection have a potential impact on nutritional outcomes after bariatric surgery. There are no updated guidelines from India on clinical practice on the nutritional management of patients undergoing bariatric surgery. This is the first attempt to have a consensus on the subject. Methods: An expert committee was constituted which voted for three rounds on 20 statements/questions based on a Delphi method. Results: There was consensus regarding preoperative screening of hemoglobin, packed cell volume, albumin, iron, ferritin, Vitamin D, Vitamin B12, preoperative weight loss, postoperative prophylactic protein supplementations, therapeutic supplementation of iron, B12, and Vitamin D, postoperative testing, and frequency of follow-up visits. Experts did not agree on the routine preoperative testing of serum folate and thiamine. There was no consensus on lifelong supplementation with bariatric formulation, difference of supplementation dosages for Roux-en-Y gastric bypass and one anastomosis gastric bypass, or postponement of surgery pending correction of nutritional deficiencies. Conclusion: We need a better-quality regional data to formulate guidelines that can provide evidence-based guidance for the clinical practice.

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Background: Early identification of patients at risk of poor weight loss following bariatric surgery may provide an opportunity for timely addition of intervention to optimize weight loss. This study investigates the relationship between early postsurgery weight loss trajectory and final weight loss outcomes. Methods: Data from patients who underwent primary sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or one-anastomosis gastric bypass (OAGB) between October 2014 and March 2020 at a single institution were analyzed retrospectively. Total weight loss percentage (%TWL) was calculated at 1, 3, 6, 9, 12, 18, 24, 30, and 36 months postsurgery. Regression analysis demonstrated associations between early weight loss and %TWL between 12 and 36 months. Multivariate analysis identified predictors of maximal weight loss (MWL) and insufficient weight loss (IWL). Results: Six hundred and sixteen patients met the inclusion criteria. Follow-up weights were available at 12 months for n = 571, 18 months for n = 382, 24 months for n = 344, 30 months for n = 198, and 36 months for n = 187. The median (interquartile range) MWL for SG, RYGB, and OAGB was 29.9% (24.3–35.7), 32.5% (27.5–38.2), and 38.0% (32.6–42.4), respectively. On multivariate linear regression, MWL was best predicted by 3–6-month %TWL after both SG (P < 0.001) and OAGB (P < 0.001) and by 6–9-month %TWL following RYGB (P < 0.001). Conclusion: Early weight loss predicts MWL and %TWL up to 36 months following laparoscopic SG, RYGB, and OAGB. Identification of poor weight loss responders early may represent an opportunity to intervene to optimize postsurgical outcomes.

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