Background
The objective of this study was to compare the results of transcatheter arterial embolization
(
TAE) with surgery in terms of efficacy in the context of bleeding duodenal ulcer (BDU) ...refractory to endoscopic treatment.
Materials and methods
From January 2006 to December 2016, all patients treated for a BDU refractory to endoscopic treatment were included in this observational, comparative, retrospective, single-center study. Primary endpoint was the overall success of treatment of BDU requiring surgical and/or TAE. The secondary endpoints were pre-interventional data, recurrence rates, feasibility of secondary treatment, morbidity and mortality of surgical and radiological treatment, intensive care unit and length of stay. A systematic review of the literature was performed to compare results of surgery and TAE.
Results
59 out of 396 patients (14.9%) treated for BDU required embolization and/or surgery: 15 patients underwent surgery (group S) including 7 patients after embolization failure and 44 patients underwent TAE (group TAE). The overall treatment success in intention to treat (85.7% vs 67.3%), per protocol (80% vs 79.5%) and bleeding recurrence rates (20% vs 15.9%) were also identical. Mortality (14.2% vs 15.3%) was similar between the two groups. Our study data were pooled with data from eight published studies and suggest that surgery have significant increased overall success (68.3% vs. 55.4%,
p
< 0.005).
Conclusion
The overall success rate was in favour of surgery according our meta-analysis. Our single-center study highlights the fact that predictive factors for recurrent bleeding after TAE must be identified to select good candidates for TAE and/or surgery.
Obesity is recognized as a risk factor for trocar site hernia (TSH) after laparoscopic surgery. Some recent studies have reported a TSH rate after bariatric surgery ranging from 0% to 1.6% using ...clinical evaluation and may underestimate the TSH rate. The objective of this study was to evaluate the TSH rate after sleeve gastrectomy (SG) by abdominal computed tomography (CT) scan.
A retrospective review of all patients who underwent first-line SG and abdominal CT scan between March 2004 and February 2014 was performed. The primary endpoint was the incidence of TSH. Secondary endpoints were the site of TSH, the TSH rate with open laparoscopy using the authors' technique, and risk factors for TSH after SG.
During the period study, 1108 patients underwent first-line SG, including 10 cases of conversion to laparotomy (excluded from the present analysis). Of the remaining patients, 228 had abdominal CT scan (20.7%), with a mean age of 45.1 years (18-68 yr) and a mean BMI of 47.6 kg/m(2) (33-75.4 kg/m(2)). The median time interval between SG and CT scan was 27 months (3-92 mo). CT scan revealed 44 TSH in 43 patients (18.8%). The site of the TSH was epigastric (16.6%), open laparoscopy (1.7%), right subcostal margin (0.8%), with no TSH in the left subcostal margin. In patients with>1 year of follow-up, the TSH rate was 19.7%.
The TSH rate after bariatric surgery is underestimated. The authors' open laparoscopy technique is a reliable technique with a low TSH rate. In the light of these results, the epigastric trocar site is systematically closed at the end of SG.
Recent series have shown the lack of value of routine upper gastrointestinal (UGI) contrast studies on postoperative day 1 or 2 for the detection of gastric leak (GL) after sleeve gastrectomy (SG). ...Despite this finding, many centers still perform routine early UGI contrast studies after SG. No series has evaluated the impact of eliminating this examination on the overall management of patients undergoing SG.
To evaluate the impact of UGI contrast studies on SG management.
University hospital, France, public practice.
This study was an ambispective study of a cohort of patients who underwent primary SG between January 2014 and December 2014 (n = 267). Two consecutive groups were compared: patients with routine UGI contrast studies on postoperative day 1 (UGI+group, n = 154) and patients without routine UGI contrast studies (UGI-group, n = 113). The efficacy endpoint of the study was the overall impact of not performing routine UGI contrast studies (length of hospital stay, radiological data, rehospitalization data, and economic assessment).
The overall complication rate was 9.3% and no deaths were observed. The GL rate was 1.5%. The mean hospital stay was 1.8 days (2.1 days versus 1.5 days; P = .57). Routine UGI contrast studies did not detect any cases of GL or gastric stenosis. After UGI contrast studies, 56 patients complained of events related to UGI contrast studies (36.4%). A total of 27 computed tomography scans were performed during the first 3 postoperative months (16 in the UGI+group (10.4%) versus 11 in the UGI-group (9.7%); P = .52). Twelve patients were rehospitalized (7 and 5; P = .6). The median length of rehospitalization was 7 days (7 and 5 days; P = .6). Overall cost per patient during SG hospitalization was $5,219 in the UGI+group and $3,678 in the UGI-group (P = .01).
Eliminating routine UGI contrast studies was associated with decreased length of hospital stay and cost of SG procedures. Larger series are required to show that not performing routine UGI contrast studies has no impact on the postoperative complication rate and the management of these complications.
Management of a perforated duodenal ulcer is most commonly performed by laparoscopy and consists of suture of the perforation after performing lavage of the peritoneal cavity. In most cases, a flap ...is created, and an omental flap is usually the preferred choice because of its simplicity and its proximity to the site of duodenal perforation. However, in some cases, the greater omentum cannot be used due to the severity of peritonitis or due to previous surgical removal. We report a laparoscopic technique for surgical repair of a perforated duodenal ulcer using a round ligament flap. The present manuscript and the associated video highlight some important technical aspects to easily perform this procedure.
Full text
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IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UL, UM, UPUK
Reports on the postoperative outcomes of sleeve gastrectomy (SG) have only been from small, single-center series and meta-analyses of studies with variable SG management. The objective of this study ...was to evaluate post-SG outcomes in a specialized bariatric surgery center with a routinely performed standardized procedure.
The postoperative complication rate, operating times, and postoperative data were evaluated from all patients undergoing a primary SG between November 2004 and February 2012. Results were analyzed for 3 separate surgical periods, which differed with perioperative management.
Of 600 patients (mean age: 41.8±11.3; mean body mass index BMI: 47.2±16 kg/m²; 80% were women who underwent primary SG), 26.8% had a BMI≥50 kg/m². The mean operating time was 84 minutes. The rate of conversion was 1%. There were no postoperative deaths. The overall complication rate was 8.5%; the major complication rate was 5.6%; the revisional surgery rate was 4.6% and the gastric leak rate was 2.5%. Over the course of the 3 study periods, the operating time fell from 91±32 to 79±22 minutes (P≤.001); the length of hospital stay decreased from 4.5±4.9 to 3.4±4.3 days (P = .02); the major complication rate fell from 6.4% to 5.5% (P = NS); and the gastric fistula rate decreased from 4.6% to 1.9% (P = NS).
In a specialist bariatric surgery center, SG had an acceptable complication rate. Modifications in the perioperative management of SG were associated with a shorter mean operating time and hospital stay and did not increase the major complication or gastric fistula rates.
No data are available concerning the results on weight loss, correction of co-morbidities, and satisfaction rates in patients with healed gastric leak (GL) after sleeve gastrectomy (SG).
Evaluate ...weight loss, correction of co-morbidities, and satisfaction rate of patients with healed GL after SG.
University hospital, France, public practice.
Between March 2004 and October 2012, all patients managed for GL after SG with a minimum of 1 year follow-up were included. These patients (GL group) were matched in terms of preoperative data and type of surgical procedure (first- or second-line SG) on a 1:2 basis with 74 patients without GL (control group) selected from a population of 899 SGs. Primary endpoint was the weight change over a 1-year period after performing SG. Secondary endpoints were GL data, co-morbidities data, and satisfaction rates 1 year after SG.
The GL group consisted of 37 patients (27 first-line SG 73%). The mean EWL in the GL group was 52.2% and 68.8% at 6 and 12 months, whereas the mean EWL in the control group was 58.9% and 72.2%, respectively (P = .12; P = .46). No significant difference was observed between the 2 groups in terms of correction of co-morbidities. At 12 months follow-up, mean BAROS score was 6.02 in the GL group and 7.14 in the control group (P = .08). No significant difference was observed between the 2 groups in terms of the SF-36 questionnaire.
Despite the morbidity associated with GL, the results on weight loss, correction of co-morbidities, and satisfaction rates were similar in patients with healed GL and in patients without GL.
Few studies have evaluated the effect of bariatric surgery on gait parameters, which constitute an important aspect of quality of life.
Evaluate the effects of sleeve gastrectomy (SG) on kinematic ...gait parameters 6 months after surgery.
University Hospital, France, public practice.
This prospective, nonrandomized study was conducted in patients undergoing SG between January 2013 and December 2013. The primary endpoint was the difference in functional parameters of the patient's 6-minute walk test (6 MWT) before and 6 months after SG. Secondary outcomes were surgical data, weight loss, and quality of life score.
Fifty-six patients were included. Mean preoperative body mass index was 46.3±7.1 kg/m
(35.2-71.0). On the preoperative 6 MWT, the mean distance traveled was 467 m (267-606) at an average speed of 4.6 km/hr (2.67-6.06). Three patients were unable to complete the 6 MWT. At 6 months postoperatively, mean body mass index was 34.4±6.0 kg/m
(24.8-53.8). On the 6-month postoperative 6 MWT, the mean distance traveled was 515 m (280-652) at an average speed of 5 km/hr (2.82-6.50; P<.01). All patients completed the test. A decrease in muscle and joint pain and an increased range of motion of the joints were observed (P<.01). All domains of the Short Form 36 questionnaire were significantly improved (P< .01).
SG significantly improves walking as well as range of motion of the joints. It also allows reduction of pain, facilitating the mobilization of obese patients that may be responsible for more marked weight loss after bariatric surgery. Quality of life improves and weight loss occurs after the SG.
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