Despite the growing experience of bariatric surgeons in performing laparoscopic sleeve gastrectomy, the number of complications involving staple line leaks remains constant. Hence a solution to avoid such complications is still sought. A defect of the staple line may be the consequence of an...

Obesity in adults and its complications are among the most important problems of public health. The search was conducted by using PubMed/MEDLINE, Cochrane Library, Science Direct, MEDLINE, and EBSCO databases from January 2010 to December 2022 for English language meta-analyses, systematic reviews, randomized clinical trials, and observational studies from all over the world. Six main topics were defined in the joint consensus statement of the Polish Association for the Study on Obesity, the Polish Association of Endocrinology, the Polish Association of Cardio-diabetology, the Polish Psychiatric Association, the Section of Metabolic and Bariatric Surgery of the Society of Polish Surgeons, and the College of Family Physicians in Poland: (1) the definition, causes and diagnosis of obesity; (2) treatment of obesity; (3) treatment of main complications of obesity; (4) bariatric surgery and its limitations; (5) the role of primary care in diagnostics and treatment of obesity and barriers; and (6) recommendations for general practitioners, regional authorities and the Ministry of Health. This statement outlines the role of an individual and the adequate approach to the treatment of obesity: overcoming obstacles in the treatment of obesity by primary health care. The approach to the treatment of obesity in patients with its most common complications is also discussed. Attention was drawn to the importance of interdisciplinary cooperation and considering the needs of patients in increasing the long-term effectiveness of obesity management.

Background: The aim of the study was to assess changes in body composition in patients subjected to laparoscopic sleeve gastrectomy (LSG). Methods: Changes in body composition following LSG were determined in a group of 155 patients with obesity (117 women and 38 men), with dual-energy X-ray absorptiometry (DXA). Whole body fat mass (FM) and lean body mass (LBM) were determined, and abdominal fat mass (AbdF) was assessed within the region extending from the top of the pubic bone up to the line between 12th thoracic and 1st lumbar vertebras. Results: Over the period of 12 months following LSG, body mass index decreased by 28.2 ± 9.0% (p < 0.001). The reduction of body weight by 35.4 ± 12.6 kg (p < 0.001) was the result of a decrease in FM by 23.9 ± 8.9 kg (p < 0.001) and LBM by 10.5 ± 3.8 kg (p < 0.001). AbdF decreased from 13.2 ± 3.1 to 8.2 ± 2.7 kg (p < 0.001), but abdominal fat to total fat mass ratio increased from 24.9 ± 4.7 to 28.0 ± 5.8% (p < 0.001). The loss of AbdF was more pronounced in men than in women. The rate of FM loss was attenuated with patients’ age. Conclusions: Over the period of 12 months following LSG, the reduction of FM was more than twice as much as decrease of LBM. The loss of AbdF was slower than a loss of peripheral subcutaneous fat.

Estrogen affects adipose tissue function. Therefore, this study aimed at assessing changes in the transcriptional activity of estrogen receptor (ER) α and β genes (ESR1 and ESR2, respectively) in the adipose tissues of obese individuals before and after weight loss and verifying whether epigenetic mechanisms were involved in this phenomenon. ESR1 and ESR2 mRNA and miRNA levels were evaluated using real-time PCR in visceral (VAT) and subcutaneous adipose tissue (SAT) of 78 obese (BMI > 40 kg/m²) and 31 normal-weight (BMI = 20–24.9 kg/m²) individuals and in 19 SAT samples from post-bariatric patients. ESR1 and ESR2 methylation status was studied using the methylation-sensitive digestion/real-time PCR method. Obesity was associated with a decrease in mRNA levels of both ERs in SAT (p < 0.0001) and ESR2 in VAT (p = 0.0001), while weight loss increased ESR transcription (p < 0.0001). Methylation levels of ESR1 and ESR2 promoters were unaffected. However, ESR1 mRNA in the AT of obese subjects correlated negatively with the expression of hsa-miR-18a-5p (r_s = −0.444), hsa-miR-18b-5p (r_s = −0.329), hsa-miR-22-3p (r_s = −0.413), hsa-miR-100-5p (r_s = −0.371), and hsa-miR-143-5p (r_s = −0.289), while the expression of ESR2 in VAT correlated negatively with hsa-miR-576-5p (r_s = −0.353) and in SAT with hsa-miR-495-3p (r_s = −0.308). In conclusion, obesity-associated downregulation of ER mRNA levels in adipose tissue may result from miRNA interference.

Background: The long-term follow-up studies investigating the risk of anemia and iron deficiency following bariatric procedures are scarce. This study aimed to determine the influence of body weight reduction and type of bariatric surgery on iron metabolism parameters. Methods: We included 138 consecutive patients who underwent bariatric surgery (120 underwent sleeve gastrectomy and 18 underwent other types of bariatric surgery) between 2010 and 2016. At baseline and at follow-up (median observation: 10 years), examination weight and height were measured, and blood samples for iron metabolism parameters were taken. Results: Red blood cells (4.75 [4.59–4.96] 10⁶/μL vs. 4.51 [4.25–4.83] 10⁶/μL, p < 0.0001), hemoglobin (14.0 [13.3–14.7] g/dL vs. 13.0 [12.1–14.3] g/dL, p < 0.0001), and folic acid (7.4 [5.9–10.4] ng/ml vs. 6.0 [4.5–9.1] ng/mL, p = 0.01) were significantly lower, while anemia prevalence (6.52% vs. 28.99%, p < 0.0001) was significantly higher at the follow-up examination compared to the baseline values. In contrast, iron concentration (86.5 [68.0–109.0] µg/dL vs. 86.5 [55.0–110.0] µg/dL, p = 0.42) and TIBC values (351 [326–391] µg/dL vs. 345 [5311–387] µg/dL, p = 0.08) did not change significantly. The multivariable regression analyses showed that the only factors independently related to the hemoglobin concentration change were initial hemoglobin concentration, age, and bariatric procedures other than sleeve gastrectomy. Similarly, in the multivariable logistic analysis, the only variables independently related to the risk of anemia were age (adjusted odds ratio 0.93 [95% confidence intervals 0.89–0.97]), initial hemoglobin concentration (0.69 [0.49–0.97]), and procedures other than sleeve gastrectomy bariatric procedures (6.12 [1.86–20.15]). Conclusions: Age, initial hemoglobin concentration, and type of bariatric procedure but not sex, baseline iron serum level, or weight change are related to the risk of anemia in the long-term follow-up following bariatric surgery.

Introduction: The effectiveness of sleeve gastrectomy has been confirmed in many studies. The impact of individual factors on the parameters of weight loss is still not clear. Aim : To identify important factors affecting the parameters of weight loss after sleeve gastrectomy. Material...