Explore the vast range of titles available.

BackgroundGastroesophageal reflux disease (GERD) is probably the main drawback of laparoscopic sleeve gastrectomy (LSG). Herein, we critically discuss the issue and report the results of the first international consensus conference held in Montpellier, France, during June 2019.MethodsFifty international bariatric experts from 25 countries convened for 2 days for interactive discussions, and to formulate the most relevant questions by electronically submitting 55 preliminary questions to panelists. Following the meeting, a final drafted questionnaire comprised of 41 questions was sent to all experts via e-mail.ResultsForty-six experts responded (92%). Esophago-gastro-duodenoscopy was considered mandatory before (92%) and after (78%) surgery. No consensus was achieved as to time intervals after surgery and the role of specialized tests for GERD. Higher degrees of erosive esophagitis (94%) and Barrett’s esophagus (96%) were viewed as contra-indications for LSG. Roux-en-Y gastric bypass was recommended in postoperative patients with uncontrolled GERD and insufficient (84%) or sufficient (76%) weight loss and Barrett’s esophagus (78%). Hiatal hernia (HH) repair was deemed necessary even in asymptomatic patients without GERD (80% for large and 67% for small HH). LSG with fundoplication in patients with GERD was considered by 77.3% of panelists.ConclusionsThe importance of pre- and postoperative endoscopy has been emphasized. The role of specialized tests for GERD and the exact surveillance programs need to be further defined. LSG is viewed as contra-indicated in higher degrees of endoscopic and clinical GERD. LSG with anti-reflux fundoplication emerges as a new valid option in patients with GERD.

IntroductionLaparoscopic sleeve gastrectomy (LSG) is the most popular bariatric procedure performed worldwide. However, many patients undergo secondary surgery due to either weight-related and complication-related reasons or both. Conversional options vary with one-anastomosis gastric bypass (OAGB) and Roux-n-Y gastric bypass (RYGB) being the most common. The aim of the study was to assess the safety and efficacy of converting failed LSG to either OAGB or RYGB, and compare weight-related results and post-conversion complications.MethodsRetrospective review of hospital records of patients who underwent conversion from LSG to either RYGB or OAGB due to insufficient weight loss or weight regain in 7 bariatric centers between 2013 and 2019. Data retrieved included demographics, anthropometrics, comorbidities, indication for conversion, conversion type, complications, and weight loss.ResultsDuring the study period, 396 patients were included in the study. Eighty-four (21%) patients were lost to follow-up. RYGB and OAGB were performed in 119 and 144 patients, respectively. Mean age and body mass index (BMI) at revision were 44.2 years (range 19–72) and 40.6 ± 5.9 kg/m2 (range 35–71), respectively. Of these, 191 (73%) were female. Percent total body weight loss (%TWL) was 16% ± 1% for the RYGB group vs. 23% ± 12% for the OAGB group (p = 0.0007) at a median follow-up of 29 months (range 7–78 months) following conversion. Gastroesophageal reflux disease (GERD) was significantly higher 1 year following conversion to OAGB vs. RYGB occurring in 25 (17.4%) and 9 (7.6%) patients, respectively (p = 0.018).ConclusionsConversion of LSG to OAGB, compared to RYGB, results in increased weight loss but a higher rate of GERD and potential nutritional deficiencies.

Abstract BackgroundBariatric surgery can be associated with severe complications. Tachycardia is an important indicator of certain complications, such as anastomotic leak and hemorrhage. Our aim was to examine the relationship between tachycardia following sleeve gastrectomy and the appearance of associated complications.MethodsPatients who underwent sleeve gastrectomy over a 2-year period were included in the study. Participants were divided into two groups: the first included patients who suffered from postoperative tachycardia and the second patients with normal postoperative heart rates. Complications in both groups were examined. Other parameters that predict the onset of complications were also reviewed.ResultsA total of 457 patients were included. Postoperative tachycardia was measured in 181 (39.6%) patients; 17 (3.7%) suffered from bleeding and 4 (1%) from staple line leakage. Postoperative bleeding was more common among patients with tachycardia than among those without (14 (7.7%) vs. 3 (1.1%), respectively). Patients in the tachycardia group had more staple line leakages than those in the normal heart rate group (3 (2%) vs. 1 (0%), respectively); tachycardia was also attributed to postoperative pain or other minor complications in 160 (88%) patients. Age ≥ 40 years was found to be predictive factor for postoperative complications.ConclusionsThe most common causes of tachycardia postoperatively were pain and minor complications. Tachycardia is an essential indicator of postoperative minor and major complications, mainly staple line leakage and bleeding. This should prompt immediate medical intervention in order to avoid serious adverse events.

One anastomosis gastric bypass (OAGB) is a widely used bariatric procedure with favorable outcomes and a relatively low complication rate. However, both early and late postoperative complications can occur, including rare but serious events such as gastric remnant volvulus, particularly in the presence of massive hiatal herniation. The altered anatomy following OAGB can make the diagnosis of such complications challenging, especially when clinical presentations are atypical or silent. We report the case of a 67-year-old woman with a history of OAGB and prior hiatal hernia repair who presented nearly 4 years postoperatively with isolated elevations in cholestatic liver enzymes but no abdominal symptoms. Imaging revealed a massive hiatal hernia containing the gastric pouch, gastrojejunal anastomosis, remnant stomach, and a portion of the pancreas, with evidence of partial gastric remnant volvulus and duodenal obstruction. The patient developed acute gastrointestinal bleeding during hospitalization, prompting urgent laparoscopic intervention. Intraoperative findings confirmed a large hiatal defect with herniation and rotation of the gastric remnant. Surgical management included reduction of herniated organs, gastrotomy for decompression, hiatal repair, and resection of the remnant stomach. The patient recovered uneventfully. This case underscores the importance of maintaining a high index of suspicion for rare but life-threatening complications such as gastric remnant volvulus in post-OAGB patients, even in the absence of classic symptoms. Timely imaging and prompt surgical intervention are essential for favorable outcomes. Ongoing, individualized follow-up and multidisciplinary care are crucial for early detection and management of late bariatric surgery complications.

Objective Our study aims to emphasize the novelty of female rats in regard to their hemodynamic changes in response to abdominal compartment syndrome. A group of 64 rats was randomly divided into 4 subgroups for each gender. Except for the control, intra-abdominal pressure was increased to 10, 20, 30 mmHg. Survival time, mean arterial pressure, pH and lactate were determined at different time intervals. Results As IAP was 20 mmHg, a statistically difference was seen between the male group and the female group starting from 15 min (126 ± 9.7 mmHg, 124 ± 14.7 mmHg respectively, p < 0.02) and lasting 2 h. At 30 mmHg, a statistically difference was seen between 30 to 60 min (p < 0.05). Only group 2 presented results with statistical power both at 30 and at 60 min concerning pH (p = 0.003, p < 0.001 respectively). In the lactate measurements at IAP of 10 mmHg, at 60 min male lactate level was 3.93 ± 1.13 and 2.25 ± 0.33 in female rats (p = 0.034). Female rats that were subjected to IAP of 20 mmHg and 30 mmHg had significantly better survival than male rats that were subjected to the same pressure (p < 0.05 and p < 0.01, respectively). We concluded that female rats have better preserved their hemodynamic and metabolic parameters during ACS than male rats.

The experience with laparoscopic pancreatic surgery (LPS) in general, and pancreatic islet cell tumors (ICTs) in particular, is still limited. Because insulinoma is the most prevalent tumor and is mostly benign, single, and curable with surgical excision, it comprises most of the cases. Our experience with 17 cases (10 insulinomas, 2 gastrinomas, 1 nesidioblastoma, 4 nonfunctioning tumors) and those recorded in the literature (93 cases) show that laparoscopic surgery for small, solitary benign islet cell tumors located in the body and tail is feasible and safe and can result in rapid postoperative recuperation and a complication rate comparable or lower than that achieved with open surgery. It duplicates the success rate seen with conventional surgery regarding intraoperative localization and cure of disease. The main morbidity continues to be the occurrence of a fistula (18%), most often after enucleation, but the clinical course is benign in most instances. Preoperative imaging studies are required for localization, and the combined use of biphasic helical computed tomography and endoscopic ultrasonography (US) seems to be cost‐effective. The use of laparoscopic US is an integral part of the laparoscopic procedure, and the information achieved is valuable for both confirming localization and decision making concerning the most appropriate surgical procedure. In cases of distal pancreatectomy, splenic salvage, preferably with preservation of splenic vessels, is feasible albeit more demanding and can be achieved in most cases.

Introduction Prompt appendectomy has long been the standard of care for acute appendicitis in order to prevent complications such as perforation, abscess formation, and diffuse purulent or fecal peritonitis, all resulting in increased morbidity and even mortality. Our study was designed to examine whether the time from the beginning of symptoms to operation correlates with the pathological degree of appendicitis, incidence of postoperative complications, or increased length of hospital stay. Methods A prospective study of 171 patients who underwent emergent appendectomy for acute appendicitis in the course of 2 years was conducted in a single tertiary medical center. The following parameters were monitored and correlated: demographics, time from the onset of symptoms until the arrival to the emergency department (patient interval (PI)), time from arrival to the emergency department (ED) until appendectomy (hospital interval (HI)), time from the onset of symptoms until appendectomy (total interval (TI)), physical examination, preoperative physical findings, laboratory data, pathologic findings, complications, and length of hospital stay. Results The degree of pathology and complications were analyzed according to the time intervals. The time elapsed from the onset of symptoms to surgery was associated with higher pathology grade ( p  = 0.01). We found that longer time from the onset of symptoms to hospital arrival correlates with higher pathology grade ( p  = 0.04), while there was no correlation between the hospital interval and pathology grade ( p  = 0.68). A significant correlation was found between the pathology grade and the incidence of postoperative complications as well as with increased length of hospital stay ( p  = 0.000). Conclusion Time elapsed from the symptom onset to appendectomy correlates with increased pathology grade and complication rate. This correlation was not related to the HI. Since the HI in our study was short, we recommend an early appendectomy in adults in order to shorten the TI and the resulting complications.

Background: Preoperative binge eating behavior has been associated with difficulties in weight loss maintenance among patients pursuing bariatric surgery. However, limited data exists on the relationship between interpersonal difficulties and binge eating. Objectives: To identify interpersonal factors linked with binge eating among bariatric surgery candidates. Setting: One hundred and seventeen adult bariatric surgery candidates (BMI = 42.2 ± 5.2) from three different hospitals completed questionnaires on the day of their bariatric committee meeting for operation approval. Methods: Binge eating was assessed using the Questionnaire on Eating and Weight Patterns-5 (QEWP-5) as a dichotomous variable. Self-esteem was measured using the Rosenberg Self-Esteem Scale (RSES), and interpersonal characteristics were evaluated using the short version of the Inventory of Interpersonal Problems (IIP-32). Sociodemographic variables (age, gender, income, education) and BMI were considered as confounders. Results: Approximately 25% of bariatric surgery candidates reported experiencing binge eating episodes within the previous three months. Participants with binge eating exhibited significantly lower self-esteem and more interpersonal difficulties, particularly in the domains of aggressiveness and dependence, compared to those without binge eating. Logistic regression analysis revealed that aggressiveness was a significant predictor of binge eating in this sample. Conclusions: This study is the first, to the best of our knowledge, to investigate the relationship between interpersonal difficulties and binge eating among bariatric surgery candidates. The findings highlight the significant contribution of aggressiveness to binge eating and emphasize the importance of clinicians assessing patients’ interpersonal functioning, particularly with regard to aggressiveness, as a factor that may contribute to the maintenance and occurrence of binge eating behaviors.

Gastrointestinal bezoar (GIB) is uncommon and is reported to occur in 4% of all admissions for small-bowel obstruction (SBO). Because of a lack of diagnostic features, it is often associated with a delay in treatment, with increased morbidity. In this article, we report our experience with managing bezoar-induced SBO and the role of early computed tomography (CT) imaging in establishing the diagnosis. We retrospectively reviewed all cases of bezoar-induced SBO treated in our unit between 1999 and 2005. There were 43 patients, of whom 2 had a recurrence, giving a total of 45 episodes. The frequency of bezoar in our patients presenting with SBO was 4.3%. All patients were of Asian origin: 41 Chinese, 1 Indian, and 1 Malay. Twenty-eight (65%) patients had previous abdominal surgery of which 26 were gastric surgery. Thirty-eight (88%) patients were edentulous. Forty-one (91%) underwent serial abdominal radiography, whereas only 4 patients (9%) had either CT imaging or contrast study alone. Only 11 (24%) cases had a correct diagnosis of bezoar impaction made preoperatively by CT imaging. The diagnostic accuracy of CT imaging in our series was 65%, with six cases of misdiagnosis. Overall, CT led to a change in management of 76% (13 in 17). The median time to surgery from admission was 2 (0-10) days. There were 2 cases of ischemic bowel that necessitated bowel resection. The median length of hospital stay was 11 (5-100) days. Ten patients (22%) had postoperative complications, and there was one death. Bezoar-induced SBO is uncommon and remains a diagnostic and management challenge. It should be suspected in patients with an increased risk of formation of GIB, such as previous gastric surgery, poor dentition, and a suggestive history of increased fibre intake. We advocate that CT imaging be performed early in these at-risk patients and in patients presenting with SBO with or without a history of abdominal surgery in order to reduce unnecessary delays before appropriate surgical intervention.