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BackgroundOne anastomosis gastric bypass (OAGB) may expose the patient to certain specific complications. Here, we report the results of conversion of OAGB to Roux-en-Y gastric bypass (RYGB) in terms of outcomes and weight loss.MethodsBetween January 2009 and January 2019, all patients undergoing conversion of OAGB to RYGB because of complications due to OAGB (n = 23) were included. The primary efficacy endpoint was the effectiveness of converting OAGB to RYGB. The secondary endpoints were overall mortality and morbidity during the first 3 postoperative months, specific morbidity, reoperation, length of hospitalization, weight loss, and progression of comorbidities related to obesity at 2-year follow-up.ResultsIndications for conversion were bile reflux (n = 14; 60.9%), severe malnutrition (n = 3; 13%), gastro-gastric fistula (n = 4; 17.4%), and anastomotic leak (n = 2; 8.7%). The median time interval between OAGB and conversion to RYGB was 34 months (0–158). At the time of RYGB, median body mass index (BMI) was 28.0 kg/m2 (18.2–50.7), representing a median BMI change of 14.0 (− 1.7–43.5). Fifteen surgeries (65.1%) were completed laparoscopically. Five complications (21.7%) were recorded, including 2 major ones (8.7%). Reoperation rate was 4.3% (n = 1). At 24 months of follow-up (n = 18; 78.3%), median BMI was 28.7 kg/m2 (19.4–35.4), representing a median BMI change of 19.5 (12.2–43.1). No patient complained of bile reflux or persistent malnutrition.ConclusionRYGB performed as revisional surgery for complications after OAGB is an effective procedure with no major weight regain at 2 years of follow-up.

Objective To analyze the surgical management of sigmoid diverticular disease (SDD) before, during, and after the first containment rules (CR) for the first wave of COVID-19. Methods From the French Surgical Association multicenter series, this study included all patients operated on between January 2018 and September 2021. Three groups were compared: A (before CR period: 01/01/18–03/16/20), B (CR period: 03/17/20–05/03/20), and C (post CR period: 05/04/20–09/30/21). Results A total of 1965 patients (A n  = 1517, B n  = 52, C n  = 396) were included. The A group had significantly more previous SDD compared to the two other groups ( p  = 0.007), especially complicated ( p  = 0.0004). The rate of peritonitis was significantly higher in the B (46.1%) and C (38.4%) groups compared to the A group (31.7%) ( p  = 0.034 and p  = 0.014). As regards surgical treatment, Hartmann’s procedure was more often performed in the B group (44.2%, vs A 25.5% and C 26.8%, p  = 0.01). Mortality at 90 days was significantly higher in the B group (9.6%, vs A 4% and C 6.3%, p  = 0.034). This difference was also significant between the A and B groups ( p  = 0.048), as well as between the A and C groups ( p  = 0.05). There was no significant difference between the three groups in terms of postoperative morbidity. Conclusion This study shows that the management of SDD was impacted by COVID-19 at CR, but also after and until September 2021, both on the initial clinical presentation and on postoperative mortality.

BackgroundAcute right colic diverticulitis (ARD) is less frequent in Western countries than acute sigmoid diverticulitis (ASD). We aimed to compare the management of ARD and ASD operated on in emergency.MethodsAll consecutive patients who had emergency surgery for ASD and ARD (2010–2021) were included in a retrospective, multicenter, cohort study. Patients were identified from databases in French centers that were members of the French Surgical Association. Emergency surgery was performed during the same hospitalization for peritonitis or after failure of conservative treatment. Early and late postoperative outcomes were studied.ResultsA total of 2297 patients were included with 2256 (98.2%) ASD and 41 (1.8%) ARD patients. Baseline characteristics were similar. Overall, patients were rated Hinchey 3–4 (63.9%, n = 1468, p = 0.287). ARD was more often treated with resection and anastomosis, protected or not (53.7%, n = 22), whereas ASD was mainly treated with resection and terminal ostomy (62.5% (n = 1409), p < 0.001). Median operative time was shorter for ARD (120 vs 146 min, p = 0.04). The group of ARD patients showed a higher prevalence of Clavien III/IV complications compared to the group of ASD patients, although no statistically significant difference was observed (41.5%, n = 17 vs. 27.6%, n = 620, p = 0.054). However 90-day mortality only happened in ASD patients (9.8%, n = 223 vs 0, p = 0.03). ARD patients had more diverticulitis recurrence (46.3%, n = 19 vs 13.4%, n = 303, p < 0.001). Multivariate analysis identified female sex as a protective factor for recurrence [odds ratio (OR) 0.55, p < 0.001] and ARD as a risk factor (OR 8.85, p < 0.001).ConclusionOperated on in emergency, ARDs have more resection anastomosis, with a similar rate of complications, less mortality, and more recurrence of diverticulitis than ASD.

Background Acute right colic diverticulitis (ARD) is less frequent in Western countries than acute sigmoid diverticulitis (ASD). We aimed to compare the management of ARD and ASD operated on in emergency. Methods All consecutive patients who had emergency surgery for ASD and ARD (2010–2021) were included in a retrospective, multicenter, cohort study. Patients were identified from databases in French centers that were members of the French Surgical Association. Emergency surgery was performed during the same hospitalization for peritonitis or after failure of conservative treatment. Early and late postoperative outcomes were studied. Results A total of 2297 patients were included with 2256 (98.2%) ASD and 41 (1.8%) ARD patients. Baseline characteristics were similar. Overall, patients were rated Hinchey 3–4 (63.9%, n  = 1468, p  = 0.287). ARD was more often treated with resection and anastomosis, protected or not (53.7%, n  = 22), whereas ASD was mainly treated with resection and terminal ostomy (62.5% ( n  = 1409), p  < 0.001). Median operative time was shorter for ARD (120 vs 146 min, p  = 0.04). The group of ARD patients showed a higher prevalence of Clavien III/IV complications compared to the group of ASD patients, although no statistically significant difference was observed (41.5%, n  = 17 vs. 27.6%, n  = 620, p  = 0.054). However 90-day mortality only happened in ASD patients (9.8%, n  = 223 vs 0, p  = 0.03). ARD patients had more diverticulitis recurrence (46.3%, n  = 19 vs 13.4%, n  = 303, p  < 0.001). Multivariate analysis identified female sex as a protective factor for recurrence [odds ratio (OR) 0.55, p  < 0.001] and ARD as a risk factor (OR 8.85, p  < 0.001). Conclusion Operated on in emergency, ARDs have more resection anastomosis, with a similar rate of complications, less mortality, and more recurrence of diverticulitis than ASD.