The present retrospective study assessed 30 obese patients subjected to BS. RYGB was performed in 25 patients, SG in 4 and AGB in 1. At the 1-year follow-up, 17 patients were assessed, with 12 RYGB, 4 SG, and 1 AGB. The 12 RYGB patients reported a mean BMI of 41.8 and 27.7 kg/m2 before and after surgery, respectively (p < 0.05), and lost an average of 89.5% of their excess BMI (%EBMIL). The %EBMIL after one year was excellent, but no long-term data for this group was available. Other studies with larger sample sizes reported a %EBMIL of 60–70% after one year (17), and of 73.9% after five years (22). After one year, none of our patients had weight gain, but 16.6% (2/12) persisted with a BMI ≥ 30 kg/m2. The 10 patients assessed at the 3-year follow-up had a mean BMI of 46.49 and 31.6 kg/m2 before and after surgery, respectively, and a mean %EBMIL of 70.8%. Overall, 70% (7/10) had weight regain and persisted with a BMI ≥ 30, while 50% (5/10) had a BMI of ≥ 35 kg/m2. Several strategies have been proposed for weight reduction in patients with insufficient weight loss or weight regain, including surgical or endoscopic re-interventions (25–27). More recently, drugs such as glucagon-like peptides 1 (GLP-1) (28,29), phentermine, and topiramate (30) have been studied. There are so far no specific recommendations on when these BS-adjuvant drugs should be indicated. However, encouraging results from the aforementioned studies have suggested such adjuvants as a safer alternative to post-BS reoperations which carry a greater morbidity and mortality risk than initial surgery (26), and can be used at the discretion of the physician. In our case series, liraglutide was used in patients who regained weight. Weight regain is multifactorial (25) and is associated with genetic factors, surgical modifications of the gastrointestinal tract, hormonal imbalances, and non-adherence to lifestyle interventions (25). In this case series, only 53% of patients were informed about OB being incurable and, therefore, about the need to follow a strict diet. Patients with a high education level (university) were significantly associated with greater weight loss (p = 0.02), similar to patients who were followed up after surgery (p = 0.02). These findings demonstrated the importance of establishing a follow-up center after BS (31), since the risks inherent to OB would reappear when weight is regained (25,31).
The 4 patients subjected to SG had a mean BMI of 39.95 and 25.6 kg/m2 before and after surgery, respectively (p < 0.04). The patient subjected to AGB had a BMI of 38.9 and 26 kg/m2, respectively, and reported no weight regain. Preoperative comorbidities were found to improve significantly. Overall, 28 patients (93.3%) showed improvements in at least 1 disease. There was a 100% remission in T2DM (12/12), and no antidiabetic drugs were taken in all 12 cases. The 11/13 (84.6%) hypertensive patients reported dose reduction of antihypertensive drugs. Overall, 70% (21/30) discontinued at least one medication for their comorbidities. However, the metabolic impact found in this case series contrasted with that reported by other authors, with a 44.5% remission in T2DM (32) and 51.0% in hypertension (33). The significant improvement, and even complete resolve, of T2DM observed in this study has been well recognized, and was in line with BS being considered a metabolic surgery (34). Ultrasound scans did not detect fatty liver disease at the one-year follow-up in 85.7% of our patients, although liver biopsy would have been the best method to determine this (8). With liver biopsy, improvement or remission of hepatic steatosis, steatohepatitis, and liver fibrosis has been reported in 88%, 59%, and 30% cases, respectively (8).
Only 73.3% (22/30) of patients had a regular prescription of multivitamins, although vitamin prescription has been recommended to all BS patients (31), since OB is frequently associated with decreased serum vitamin levels, This decrease in vitamin levels is further exacerbated after BS (35), probably due to the decrease in the surface area for absorption (36).