Explore the vast range of titles available.

In 2018, Christine Stroh was the first female surgeon to lead a department of obesity and metabolic surgery in Germany. She is working together with nutritionists, psychologists, and other scientists on several topics to evaluate the outcome of patients after metabolic surgery

BackgroundStaple line leakage is a well-known complication after laparoscopic sleeve gastrectomy (LSG). Gastric wall thickness and the staple height may be determining factors for the occurrence of insufficiencies. To investigate this problem, an observational cohort study was carried out. Investigation concentrated on the gastroesophageal junction close to the angle of His, since this area is at highest risk for a leakage.MethodsFundus wall thickness of 141 specimens after LSG was measured by light microscopy at a predetermined location by a blinded pathologist. Furthermore, fundus wall thickness was compared with demographic data, clinical outcome, and the rate of insufficiencies.ResultsOne hundred forty-one patients, 38 male and 103 female undergoing LSG, between January 2014 and July 2015 were included in the study. Male gender was associated with thicker gastric fundus wall. Overall leak rate was 2.1% (3/141). Median wall thickness of the 3 patients with detected leaks in the study group was thinner compared to the non-leak group (2810 vs. 3249 μm, respectively).Discussion/ConclusionOnly male gender correlated with higher wall thickness of the fundus. The fact that all three patients who developed a leak were female, and the fundus of female patients as well as those of the leak group was thinner, indicates that wall thickness may have an impact on the rate of staple line leakage. Further studies with larger patient cohorts are needed.

Background The aim of this systematic study was to investigate patient outcomes and nutritional deficiencies following sleeve gastrectomy (SG) during a median follow-up of two years. Methods Over a period of 56 months, all consecutive patients who underwent SG were documented in this prospective, single-center, observational study. The study endpoints included complication rates, nutritional deficiencies and percentage of excess weight loss (%EWL). Results From September 26, 2005 to May 28, 2009, 100 patients (female: male = 59:41) with a mean age of 43.6 years (range: 22–64) and a preoperative BMI of 52.3 kg/² (range: 36–77) underwent SG. The mean operative time was 86.4 min (range: 35–275). Major complications were observed in 8.0 % of the patients. During the follow-up period, 25 patients (25.0 %) underwent a second bariatric intervention (22 DS and 3 RYGBP). Out of the total 100 patients, 48 % were supplemented with iron, 33 % with zinc, 34 % with a combination of calcium carbonate and cholecalciferol, 24 % with vitamin D, 42 % with vitamin B12 and 40 % with folic acid. The patients who received only a SG (n = 75) had %EWL of 53.6, 65.8 and 62.6 % after 6, 12 and 24 months, respectively. Conclusions SG is a highly effective bariatric intervention for morbidly obese patients. Nutritional deficiencies resulting from the procedure can be detected by routine nutritional screening. Results of the study show that Vitamin B12 supplementation should suggested routinely.

PurposeSleeve gastrectomy (SG) is a common bariatric procedure that has been shown to be effective in both the short and long term, but it is not without risks, some of which necessitate revision or redo surgery (RS).Materials and MethodsGBSR (German Bariatric Surgery Registry) data were evaluated in this multicenter analysis. Short-term results (1-year follow-up) of RS (Re-Sleeve gastrectomy, Roux-en-Y gastric bypass, RYGB, Omega-loop gastric bypass, OLGB, and duodenal switch, DS) following primary SG (n = 27939) were evaluated.ResultsOf PSG patients, 7.9% (n=2195) needed revision surgery. Nine hundred ninety-four patients underwent the aforementioned four surgical procedures (95 with R-SG, 665 with RYGB, 141 with OLGB, and 93 DS). Loss of follow-up within 1 year 52.44%. The most common reasons for RS were weight regain and/or a worsening of preexisting comorbidities. Regarding the operating time, R-SG was the shortest of the four procedures, and DS was the longest. In general, there were no significant advantages of one procedure over another in terms of complication incidence in these categories. However, certain complications were seen more often after R-SG and DS than with other redo procedures. There were significant differences in BMI reduction 1 year after surgery (RYGB: 5.9; DS: 10.1; OLGB: 9.1; and R-SG: 9.1; p<0.001). GERD, hypertension, and sleep apnea demonstrated statistically significant comorbidity remission. Diabetes exhibited non-significant differences.ConclusionAccording to the findings of our study, all revision surgeries effectively resolved comorbidities, promoted weight loss, and lowered BMI. Due to the disparate outcomes obtained by various methods, this study cannot recommend a particular redo method as the gold standard. Selecting a procedure should consider the redo surgery’s aims, the rationale for the revision, the patient’s current state, and their medical history.

PurposeBeginning January 1, 2005, bariatric surgery cases were examined with the help of the quality assurance study for operative medicine. All data were registered and analyzed prospectively in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University Magdeburg, Germany. The comparative study focuses on perioperative morbidity, complications, and remission of obesity-associated diseases after gastric bypass (RYGB) and sleeve gastrectomy (SG) at 5-year follow-up.Materials and MethodsData collection includes patients of full age who underwent SG or RYGB surgery between 2005 and 2017. The bougie is limited to 33–40 French for SG. The Roux-en-Y length for RYGB is set to 120–180 cm, and the biliodigestive length is set to 40–60 cm. Outcome criteria are perioperative morbidity, postoperative and intraoperative complications, and remission on comorbidities.ResultsBetween 2005 and 2017, 64,349 patients were enrolled in German Bariatric Surgery Registry (GBSR). Primary operations that were performed were 56.328. Out of 24,146 RYGB and 24,085 SG procedures, 922 patients had a complete 5-year follow-up. These are 342 SG patients and 580 patients with RYGB. A matching was realized for n = 285 (83.3%) patient pairs based on age, BMI, gender, ASA, and comorbidities. A significant disadvantage was identified for the SG procedure regarding reflux disease compared with RYGB (36.3% vs. 8.10%; p < 0.001). There were no significant disadvantages in terms of BMI reduction [14.92 in the RYGB and 14.50 in the SG (p = 0.437)] and %EWL [60.32 in the RYGB and 58.98 in the SG (p = 0.504)]. This also applies to the remission of NIDDM, IDDM, hypertension, and sleep apnea; no significant differences were found.ConclusionThe results of the study show significant findings for gastroesophageal reflux. In terms of complications and obesity-associated diseases, no significant disadvantages between both treatments were found. RYGB and SG had comparable postoperative morbidity rates. The two surgical methods are legitimate bariatric procedures. However, there is a need for further evaluation to optimize patient selection in the coming years.

Purpose Both surgical and endoscopic procedures represent a mainstay of obesity treatment. Several procedures have been developed in recent years, although their impact on obesity is variable. This study examines and presents the results of a 6-month gastric balloon implantation (GBI). Material and Methods The data from the German Bariatric Surgery Registry (GBSR) for the period from 2005 to 2021 were subjected to a multi-center analysis. Six months following GBI, demographic data, the peri-interventional course, weight, BMI reduction, as well as the development of comorbidities (arterial hypertension (aHTN), diabetes mellitus (T2D), reflux (GERD), and sleep apnea syndrome (OSAS)), were evaluated in male and female patients. Results Of 3754 patients, 788 (45.3% male, 54.7% female) met the inclusion criteria for the study. Following 6 months of therapy, an average weight loss of 19.3 ± 15.2 kg was observed in male patients, while female patients exhibited an average weight loss of 16.3 ± 13.1 kg ( p  = 0.013). The EWL was found to be significantly higher in female patients than in male patients (24.8 vs. 18; p  < 0.001). BMI reduction, %TWL, and mortality rate showed no significant disadvantage in either group ( p  > 5%). After 6 months of therapy, there was a significant advantage for women in the remission of aHTN. The remaining comorbidities did not differ significantly between the two groups ( p  > 5%). Conclusions GBI is an efficacious procedure for the treatment of obese patients with mild obesity and comorbidities or as a bridging procedure prior to planned bariatric surgery. Graphical Abstract

Background This study investigates the outcome of one-stage and two-stage Roux-Y gastric bypass (RYGB) as a revision procedure after failed adjustable gastric banding (AGB). Material and Methods Data of patients who underwent a one-stage RYGB (OS-RYGB) or a two-stage RYGB (TS-RYGB) revision procedure after failing AGB between 2005 and 2019 were analyzed. Outcome criteria were perioperative complications, operating time, change in weight and BMI, and remission of comorbidities at 1-year follow-up. Results Data from 230 patients after OS-RYGB and 197 after TS-RYGB were analyzed. The total perioperative complication rates were not significantly different between the two groups (overall p  > 5%). In the category of other complications, there was a significant difference between the two groups, with a lower rate in TS-RYGB than in OS-RYGB ( p  = 0.020). Wound infections occurred more frequently after TS-RYGB than after OS-RYGB ( p  = 0.015). Mean operating time differed significantly between the two groups (OS-RYGB (149.9 min) and TS-RYGB 191 min; p  < 0.001). The change in hypertension was significantly higher in OS-RYGB (37.9 vs. 21.1%; p  = 0.007). Other comorbidities showed no significant change within 1 year after surgery. Regarding the change in BMI, %TWL, and %EWL, there were no significant benefits for either group ( p  = 0.574, 0.762, and 0.378, respectively). Conclusion Removing a failed AGB using the OS- or TS-RYGB is safe and feasible. The decision between OS- and TS-RYGB is still individual and depends on the patient’s general condition, the desired goal of the procedure, and the personal competence of the surgeon. Further studies are needed to clarify long-term outcome and effect of both procedures. Graphical abstract

Introduction Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most performed techniques in bariatric surgery. The aim of this study is to compare two surgical procedures in terms of weight loss and the development of comorbidities such as type II diabetes mellitus T2D, arterial hypertension, sleep apnea (OSAS), and gastroesophageal reflux disease (GERD). Methods Data from the German Bariatric Surgery Registry (GBSR) from 2005 to 2021 were used. 1,392 RYGB and 1,132 SG primary surgery patients were included. Minimum age 18 years; five-year follow-up data available. Tests were performed with a 5% significance level. Results Loss of follow-up 95.41% within five years. Five years after surgery, the RYGB showed significant advantages in terms of excess weight loss (%EWL 64.2% vs. 56.9%) and remission rates of the studied comorbidities: hypertension (54.4% vs. 47.8%), OSAS (64.5% vs. 50.1%), and GERD (86.1% vs. 66.9%). Compared to the pre-test, individuals diagnosed with insulin-dependent T2D showed significant improvements with RYGB over a five-year period (remission rate: 75% vs. 63%). In contrast, non-insulin-dependent T2D showed no significant difference between the two approaches (p = 0.125). Conclusion Both surgical procedures resulted in significant weight loss and improved comorbidities. However, the improvement in comorbidities was significantly greater in patients who underwent RYGB than in those who underwent SG, suggesting that the RYGB technique is preferable. Nevertheless, RYGB requires a high degree of surgical skill. Therefore, acquiring expertise in the technical facets of the surgery is essential to achieving favorable outcomes.

Background Staple line leak after laparoscopic sleeve gastrectomy (LSG) still represents the most feared complication. The purpose of this study was to investigate whether there are factors that increase the risk for a leakage. Furthermore, we aimed to analyze the impact of a leak on weight change and resolution of comorbidities. Methods Since 2005, data from obese patients that undergo bariatric procedures in Germany are prospectively registered. For the current analysis, all adult subjects that had undergone primary LSG from 2005 to 2014 were considered. Results Overall, 241/15,756 (1.53%) patients experienced a leak. The occurrence of a leakage resulted in a significant increase of the mortality rate (3.7 vs. 0.2%; p  < 0.01). Percent excess weight loss did not differ between leak and non-leak patients, both, at 12 (64.2 vs. 60.9%; p  = 1.0) and 24 months (68.5 vs. 64.0%, p  = 0.86). Similarly, no significant difference was observed for resolution rate of all comorbid conditions. Matched pair analysis confirmed these findings. Multivariable analysis identified operation time, conversion, intraoperative complications, and hypertension and degenerative joint disease as risk factors for a leak. Oversewing the staple line was associated with the lowest risk. Conclusion The postoperative staple line leak after primary LSG significantly increases postoperative morbidity and mortality. We found that there are patient-related factors and operative variables that predispose to leakage after LSG. However, the occurrence of a leakage does not adversely impact the weight loss and resolution of comorbidities in the mid-term.

BackgroundSince 1 January 2005, the practice of bariatric surgery has been examined with the help of the German Bariatric Surgery Registry (GBSR) in Germany. The focus of the study was to evaluate if sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) has the best benefit in terms of perioperative risk in patients over 60 years of age.MethodsData collection includes patients over the age of 60 years who underwent SG or RYGB between 2005 and 2017. The bougie is limited to 33–40 French for SG. Furthermore, the RYGB is determined to be 120–180 cm alimentary and 40–60 cm biliopancreatic length. Outcome criteria are perioperative morbidity, postoperative complications, 30-day mortality, and postoperative length of stay.ResultsThe study analyzes data from 3561 patients beyond the age of 60 years who underwent SG (1970 patients) and RYGB (1591 patients). Mean age of the patients was 63.4 ± 3.2 in the RYGB group and 63.8 ± 3.5 in the SG group. Mean BMI was 46.4 ± 6.8 in the RYGB group and 49.1 ± 8.0 in the SG group. The average number of comorbidities was 4.5 ± 2.4 for RYGB and 4.5 ± 2.3 for SG. For the 30-day mortality, identical results were found SG vs. RYGB (0.31 vs. 0.38, p = 1.000).ConclusionBased on the results of this study, it can be concluded that both SG and RYGB in patients ≥ 60 years can be considered safe surgical procedures.