Beyond the scale
Beyond the scale
Obesity is a growing health concern worldwide. In 2023, nearly 12,500 metabolic bariatric procedures were performed in the Netherlands alone. The increasing demand highlights the importance of expanding knowledge on metabolic bariatric surgery (MBS), refining surgical techniques, and evaluating long-term outcomes more broadly. This thesis of Lindsy van der Laan addresses these aspects in three parts.
Part I compares the current gold standard, Roux-en-Y gastric bypass (RYGB), with the one anastomosis gastric bypass (OAGB). OAGB showed comparable or superior outcomes in terms of weight loss, fewer short-term complications, and potentially higher remission rates of hypertension. OAGB also emerged as a suitable alternative for patients with a BMI ≥ 50 kg/m².
In Part II, the optimal length of the biliopancreatic limb (BPL) in OAGB was investigated in the TAILOR study. This randomized controlled trial compared a fixed BPL length to an individualized length based on total small bowel length. One year postoperatively, no significant differences were observed between groups in weight loss, nutritional deficiencies, or remission of comorbidities.
In Part III, the PEBBLE study demonstrated that improvement of mobility and health were the main reasons for undergoing MBS. Although participants had high weight loss expectations, their estimations for comorbidity resolutions were realistic. Despite prioritizing being informed about potential complications, it did not discourage patients from choosing MBS. With the DELTO study we developed a core outcome set (COS) to provide a standardized framework for comparing long-term outcomes after MBS.