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Introduction Sleeve gastrectomy has become a popular stand-alone bariatric procedure with comparable weight loss and resolution of comorbidities to that of laparoscopic gastric bypass. The simplicity of the procedure and the decreased long-term risk profile make this surgery more appealing. Nonetheless, the ever present risk of a staple-line leak is still of great concern and needs further investigation. Methods An electronic literature search of MEDLINE database plus manual reference checks of articles published on laparoscopic sleeve gastrectomy for morbid obesity and its complications was completed. Keywords used in the search were “sleeve gastrectomy” OR “gastric sleeve” AND “leak.” We analyzed 29 publications, including 4,888 patients. We analyzed the frequency of leak after sleeve gastrectomy and its associated risks of causation. Results The risk of leak after sleeve gastrectomy in all comers was 2.4%. This risk was 2.9% in the super-obese [body mass index (BMI) > 50 kg/m 2 ] and 2.2% for BMI < 50 kg/m 2 . Staple height and use of buttressing material did not affect leak rate. The use of a size 40-Fr or greater bougie was associated with a leak rate of 0.6% compared with those who used smaller sizes whose leak rate was 2.8%. Leaks were found at the proximal third of the stomach in 89% of cases. Most leaks were diagnosed after discharge. Endoscopic management is a viable option for leaks and was documented in 11% of cases as successful. Conclusions Sleeve gastrectomy has become an important surgical option for the treatment of the ever growing morbidly obese population. The risk of leak is low at 2.4%. Attention to detail specifically at the esophagogastric junction cannot be stressed enough. Careful patient selection (BMI < 50 kg/m 2 ) and adopting the use of a 40-Fr or larger bougie may decrease the risk of leak. Vigilant follow-up during the first 30 days is critical to avoid catastrophe, because most leaks will happen after patient discharge.

Antarctic ice shelves control the flow of ice into the ocean, affecting the rate of sea level rise. This flow is regulated by ice‐shelf thickness, which depends on tributary flux across the grounding line and the balance between surface accumulation and ocean‐induced melting. Consequently, ice shelves that are tributary‐sustained will be more susceptible to dynamic changes upstream of the grounding line. In contrast, atmospherically sustained ice shelves will be more susceptible to changing local atmospheric and oceanographic conditions. Our results differentiate between these internal and external regimes by mapping which ice shelves are tributary‐ and which are atmospherically sustained and we compare these findings with published estimates of local ice‐shelf buttressing strength. This approach identifies buttressing relevant areas, particularly near pinning points, in West Antarctica and the Peninsula, which are highly dependent on surface accumulation and therefore vulnerable to the predicted decline of coastal snowfall through the end of the century.

Recent studies have identified widespread vulnerable ice shelf regions in Antarctica which are both highly buttressed and susceptible to crevasse hydrofracturing, raising concern for potential crevasse driven ice‐shelf collapse and future sea level rise. Here, we employ the finite element ice flow model, Úa, to investigate whether crevasses which have propagated through the entire ice column have a significant impact on upstream flow and quantify their contribution to sea level rise. We find a large variability in the response of ice shelves to this perturbation, with changes in grounding line flux as large as 155% for the Filchner‐Ronne and 46% for the Ross, when compared to the present day. Crevasses located close to the grounding lines contribute most of this change. When compared to a second perturbation in which ice shelves are completely removed, however, the response is relatively small for all modeled ice shelves. Plain Language Summary In the last two decades, many ice shelves in Antarctica have disintegrated through the process of ice shelf thinning and calving. These processes reduce the resistance that ice shelves exert on upstream glaciers, increasing their mass flow and causing sea level to rise. In this work, we used a sophisticated model to quantify the maximum possible impact that crevasses developed throughout the ice shelf thickness would have on upstream glaciers’ flow. We find that in all cases, fully propagated crevasses cause an increase in sea level rise, with Filchner & Ronne and Ross Ice Shelves having the largest contributions. The effect on upstream glaciers is dominated by crevasses located in grounded zone regions, where the ice shelf is thickest, and the provided back‐stress is highest. However, when compared to other simulations in which all floating ice is disintegrated, the effect of crevasse propagation is minimal. Key Points The instantaneous vertical propagation of pre‐existing crevasses on major Antarctic ice shelves increases the mass flux of upstream glaciers These flux changes are highly variable among ice shelves, with the largest effects occurring at the Filchner & Ronne and Ross Ice Shelves Crevasses located near the main grounding lines are responsible for the majority of these flux changes

IntroductionThe objective of this study is to evaluate the outcomes for Staple Line Reinforcement (SLR) in RA-SG based on the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database for 2019.Materials and MethodsWe selected patients who underwent RA-SG in the MBSAQIP PUF (Public Utility File) for the year 2019 and grouped them based on their SLR status: Oversewing (OS), Buttressing (BR), both OS and BR and neither. Our primary outcomes were bleeding, organ space infection (OSI), and adverse events (AEs), and our secondary outcomes were operation length, hospital length of stay, readmissions, and conversion to open rates. We conducted separate chi square or one-way analysis of variance (ANOVA) as appropriate and multivariable direct logistic regression models for the categorical outcomes.ResultsWe found 115,621 patients with complete data of which there were 16,494 who underwent RA-SG. Our results did not show a statistically significant decrease in incidence of postoperative bleeding for BR and OS (Adjusted OR = 0.782, p = 0.2291 and Adjusted OR of 0.482, p = 0.054 for BR and OS respectively). There was a statistically significant effect for SLR status on operation length, with OS patients having the highest operative times (log-transformed mean = 2.03), followed by both BR + OS patients (log-transformed mean = 1.99). BR patients had the shortest operation length.ConclusionSLR did not result in any significant differences related to bleeding, OSI or AEs following RA-SG according to MBSAQIP for the year 2019. However, OS resulted in significantly longer operative time compared to BR alone.

Increase in ice‐shelf melting is generally presumed to have triggered recent coastal ice‐sheet thinning. Using a full‐Stokes finite element model which includes a proper description of the grounding line dynamics, we investigate the impact of melting below ice shelves. We argue that the influence of ice‐shelf melting on the ice‐sheet dynamics induces a complex response, and the first naive view that melting inevitably leads to loss of grounded ice is erroneous. We demonstrate that melting acts directly on the magnitude of the buttressing force by modifying both the area experiencing lateral resistance and the ice‐shelf velocity, indicating that the decrease of back stress imposed by the ice‐shelf is the prevailing cause of inland dynamical thinning. We further show that feedback from melting and buttressing forces can lead to nontrivial results, as an increase in the average melt rate may lead to inland ice thickening and grounding line advance.

Various staple line reinforcement (SLR) techniques in sleeve gastrectomy, including oversewing/suturing (OS/S), gluing, and buttressing, have emerged to mitigate postoperative complications such as bleeding and leaks. A meta-analysis of randomized controlled trials has demonstrated OS/S as an efficacious strategy for preventing postoperative complications, encompassing leaks, bleeding, and reoperations. Given that OS/S is the sole SLR technique not incurring additional costs during surgery, our study aimed to compare postoperative outcomes associated with OS/S versus alternative SLR methods. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we reviewed the literature and conducted fifteen pairwise meta-analyses of comparative studies, each evaluating an outcome between OS/S and another SLR technique. Thirteen of these analyses showed no statistically significant differences, whereas two revealed notable distinctions.

Background Gastric leak and hemorrhage are the most important challenges after laparoscopic sleeve gastrectomy (LSG). In order to reduce these complications, the staple line can be reinforced by absorbable sutures or by the use of glycolide trimethylene carbonate copolymer onto the linear stapler (Gore Seamguard®; W.L. Gore & Associates, Inc, Flagstaff, AZ). To our knowledge, there are no randomized studies showing the utility of staple line reinforcement during LSG. The purpose of this study was to randomly compare three techniques in LSG: no staple line reinforcement (group 1), buttressing of the staple line with Gore Seamguard® (group 2), and staple line suturing (group 3). Methods Between January 2008 and February 2009, 75 patients were prospectively and randomly enrolled in the three different techniques of handling the staple line during LSG. The patient groups were similar (NS). Results Mean operative time to perform the stomach sectioning was 15.9 ± 5.9 min (group 1), 20.8 ± 8.1 min (group 2), and 30.8 ± 10.1 min (group 3) ( p  < 0.001). Mean total operative time was 47.4 ± 10.7 min (group 1), 48.9 ± 18.4 min (group 2), and 59.9 ± 19.6 min (group 3) ( p  = 0.02). Mean blood loss during stomach sectioning was 19.5 ± 21.3 mL (group 1), 3.6 ± 4.7 mL (group 2), and 16.7 ± 23.5 mL (group 3) ( p  < 0.001). Mean total blood loss was 48.9 ± 67.1 mL (group 1), 32.5 ± 46.5 mL (group 2), and 61.9 ± 69.4 mL (group 3) ( p  = 0.03). Mean number of stapler cartridges used was 5.6 ± 0.7 (group 1), 5.7 ± 0.7 (group 2), and 5.8 ± 0.6 (group 3) (NS). Postoperative leak affected one patient (group 1), two patients (group 2), and one patient (group 3) (NS). Mean hospital stay was 3.6 ± 1.4 days (group 1), 3.9 ± 1.5 days (group 2), and 2.8 ± 0.8 days (group 3) ( p  = 0.01). Conclusions In LSG, buttressing the staple line with Gore Seamguard® statistically reduces blood loss during stomach sectioning as well as overall blood loss. No staple line reinforcement statistically decreases the time to perform stomach sectioning and the total operative time. No significant difference is evidenced in terms of postoperative leak between the three techniques of LSG.

Background Gastric leaks and bleeding are the most important complications after laparoscopic sleeve gastrectomy (LSG). The use of absorbable membranes as staple line reinforcement may decrease this risk. On the other hand, these materials bring additional costs and their economic impact is not well known. The purpose of this study was to assess the clinical and economic performance of one of the commercially available buttressing absorbable materials when treating a high-risk population. Methods A retrospective, observational, and comparative study was conducted at Montpellier University Hospital, France, between July 2013 and September 2014. Patients undergoing LSG, who were at a high risk for leaks and bleeding, were included and treated according to two groups: no buttressing (July 2013 to January 2014) and buttressing (February 2014 to September 2014). Clinical and economic outcomes were measured throughout the first 6 months. Results Two hundred two patients were included in the study: 116 during the no stapling reinforcement period and 86 during the buttressing period. Baseline characteristics were similar. There was no significant difference between the two groups regarding gastric leaks. However, buttressing reduced hemorrhagic complications (0 vs 8.6 %, p  = 0.005) and decreased average total hospital costs for the first hospitalization (5768 vs 6025 €, p  < 0.001), as well as 6-month total inpatient cost (5944 vs. 6246 €, p  < 0.001). Conclusions Staple line reinforcement with absorbable material reduces bleeding in high-risk population. Therefore, this type of material can also result in cost-savings.

Alveolar bone exostoses (ABE) are benign localized convex outgrowths of buccal or lingual bone, which could be delineated from the surrounding cortical plate, also known as a buttress bone formation. Our review and case series demonstrate the development of alveolar bone exostoses during orthodontic therapy. It is crucial to keep in mind that every case presented had a history of palatal tori. In our clinical observations, higher precedence of ABE development was seen in participants during incisor retraction, especially with preexisting palatal tori. Additionally, we have successfully demonstrated surgical techniques to eliminate ABE in the event that self‐remission does not occur once orthodontic forces are discontinued. Alveolar bone exostoses (ABE) are benign localized convex outgrowths of buccal or lingual bone from the cortical plate, often known as buttress bone development. Our review and case series shows ABE following orthodontic treatment. In case self‐remission fails after orthodontic forces are removed, we have shown surgical methods to correct ABE.