Purpose
Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric procedure worldwide. Omentopexy during LSG is a novel variation of this well-established technique. There ...are no clear conclusions on indications for this procedure, safeness, and effects of such a method. We aimed to compare the outcomes of laparoscopic sleeve gastrectomy (LSG) with omentopexy (OP) and without omentopexy.
Materials and Methods
We searched the Medline, EMBASE, and Scopus databases up-to June 2020. Full-text articles and conference abstracts were included for further analysis. This review follows the PRISMA guidelines.
Results
Of initial 66 records, only 4 studies (
N
= 1396 patients) were included in the meta-analysis. Our findings showed that LSG with omentopexy had significantly lowered overall morbidity compared to LSG without omentopexy (RR = 0.38; 95% CI 0.15, 0.94;
p
=0.04). Gastric leakage rate (RR = 0.17; 95% CI 0.04, 0.76;
p
= 0.02) was also significantly lower in LSG with omentopexy. There were no significant differences between groups in length of hospital stay.
Conclusions
Our meta-analysis showed that LSG with omentopexy may be a feasible procedure for decreasing morbidity and gastric leak rate. However, despite promising results, the procedure needs to be researched more in randomized controlled studies to draw solid conclusions.
Purpose
Bariatric surgery is no longer considered only as a weight loss surgery but also a way of treating obesity-related comorbidities such as type 2 diabetes mellitus (T2DM). Short-term T2DM ...remissions in patients undergoing laparoscopic sleeve gastrectomy (LSG) have been shown, but there are very few reports on the mid-term results. We aimed to assess the remission rate of T2DM in obese patients after LSG throughout 5-year follow-up.
Materials and Methodology
We performed a retrospective multicenter cohort analysis of 240 patients who underwent LSG. We assessed the remission rate of T2DM 1 year and 5 years after surgery.
Results
Forty-six percent of patients achieved T2DM remission 5 years after LSG. The remission group had better weight loss results (median% of total weight loss 5 years after: 30.1% (22.9–37.0) vs 23.0% (13.7–30.2),
p
< 0.001) and were significantly younger than the no remission group (43 (38–52) vs 52 (44–58) years,
p
< 0.001). Duration of T2DM was significantly shorter (2 (1–5) vs 5 (3–10) years,
p
< 0.001) with less insulin requirement and less diabetes-related complications (7.2% vs 19.8%,
p
< 0.001) and significantly lower median DiaRem score (4.0 (IQR 2.0–6.0) vs 12.0 (IQR 5.0–16.0),
p
< 0.001). Preoperative body mass index (BMI) had no effect on remission.
Conclusions
Our study suggests that diabetes remission after laparoscopic sleeve gastrectomy occurs frequently, and in the 5-year follow-up, it may remain at the level of 46%. We identified the age of patients, duration, and severity of T2DM as factors affecting mid-term diabetes remission. Nevertheless, further well-designed trials are needed to support our findings.
Enhanced Recovery After Surgery (ERAS) protocol are well established in many surgical disciplines, leading to decrease in morbidity and length of hospital stay. These multi-modal protocols have been ...also introduced to oesophageal cancer surgery. This review aimed to evaluate current literature on ERAS in oesophageal cancer surgery and conduct a meta-analysis on primary and secondary outcomes.
MEDLINE, Embase, Scopus and Cochrane Library were searched for eligible studies. We analyzed data up to May 2016. Eligible studies had to contain four described ERAS protocol elements. The primary outcome was overall morbidity. Secondary outcomes included length of hospital stay, specific complications, mortality and readmissions. Random effect meta-analyses were undertaken.
Initial search yielded 1,064 articles. Thorough evaluation resulted in 13 eligible articles which were analyzed. A total of 2,042 patients were included in the analysis (1,058 ERAS group and 984 treated with traditional protocols). Analysis of overall morbidity as well as complication rate did not show any significant reduction. Non-surgical complications and pulmonary complications were significantly lower in the ERAS group, RR = 0.71 95% CI 0.62-0.80, p < 0.00001 and RR = 0.75, 95% CI 0.60-0.94, p = 0.01, respectively. Meta-analysis on length of stay presented significant reduction Mean difference = -3.55, 95% CI -4.41 to -2.69, p for effect<0.00001.
This systematic review with a meta-analysis on ERAS in oesophageal surgery indicates a reduction of non-surgical complications and no negative influence on overall morbidity. Moreover, a reduction in the length of hospital stay was presented.
To evaluate association between bariatric surgery and changes in obstructive sleep apnea (OSA) severity and sleep architecture was as well as to asses continuous positive airway pressure (CPAP) ...effectiveness and compliance. We enrolled patients undergoing bariatric surgery. Polysomnography was performed in each patient preoperatively and 12 months after the procedure in a subgroup of patients diagnosed with OSA. STOP-BANG, Epworth Sleepiness Scale (ESS) and Berlin questionnaire scores were obtained pre- and postoperatively. CPAP compliance data was recorded during follow-up hospitalization. Among 44 patients with median age of 49.5 years, predominantly women (68.2%) pre- and postoperative polysomnography was performed. We observed significant improvement in STOP-BANG (6.0 vs. 3.0, p < 0.001) and ESS (12.0 vs. 5.0, p < 0.001) scores, apnea-hypopnea index (44.9 vs. 29.2, p < 0.001), oxygen desaturation index (43.6 vs. 18.3, p < 0.001) and sleep architecture parameters. CPAP compliance was poor with a median percentage of days with CPAP use accounting to 49.3%. Bariatric surgery is associated with a significant decrease in the number of sleep-related respiratory disturbances, as well as improvement of sleep efficiency. Postoperative CPAP therapy compliance was poor despite low rate of OSA resolution. This study suggests that patients with OSA undergoing bariatric surgery require postoperative reassessment.
Enhanced Recovery After Surgery (ERAS) is an evidence-based paradigm shift in perioperative care, proven to lower both recovery time and postoperative complication rates. The role of ERAS in several ...surgical disciplines was reviewed. In colorectal surgery, ERAS protocol is currently well established as the best care. In gastric surgery, 2014 saw an establishment of ERAS protocol for gastrectomies with resulting meta-analysis showing ERAS effectiveness. ERAS has also been shown to be beneficial in liver surgery with many centers starting implementation. The advantages of ERAS in pancreatic surgery have been strongly established, but there is still a need for large-scale, multicenter randomized trials. Barriers to implementation were analyzed, with recent studies concluding that successful implementation requires a multidisciplinary team, a willingness to change and a clear understanding of the protocol. Additionally, the difficulty in accomplishing necessary compliance to all protocol items calls for new implementation strategies. ERAS success in different patient populations was analyzed, and it was found that in the elderly population, ERAS shortened the length of hospitalization and did not lead to a higher risk of postoperative complications or readmissions. ERAS utilization in the emergency setting is possible and effective; however, certain changes to the protocol may need to be adapted. Therefore, further research is needed. There remains insufficient evidence on whether ERAS actually improves patients’ course in the long term. However, since most centers started to implement ERAS protocol less than 5 years ago, more data are expected.
Purpose
Improvement of the quality of life after bariatric surgery is an important outcome of the treatment. Assessing the long-term QoL results provides better insights into the effectiveness of ...bariatric surgery.
Materials and Methods
This is a cohort study including patients who underwent bariatric surgery between June 2009 and May 2010 in one academic center. Patients underwent either laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB). Overall, 34 patients underwent LSG (52.3%) and 31 patients underwent LRYGB (47.7%). Preoperatively, and after 1 and 10 years, QoL was assessed using two standardized questionnaires: SF-36 and MA-QoLII. After 10 years, 72% of patients filled out these questionnaires.
Results
The global QoL score before surgery was 48.3 ± 20.6. At the 1-year follow-up, the global total QoL score was 79.7 ± 9.8. At the 10-year follow-up, the global total QoL score was 65.1 ± 21.4. There was a significant increase in total QoL between measurements before the operation and 10 years after surgery in the whole study group (
p
= 0.001) and for patients who underwent LSG (
p
= 0.001). There was no significant difference between total QoL prior to surgery and 10 years after for patients who underwent LRYGB (
p
= 0.450).
Conclusion
LSG led to significant improvement in QoL.
Background
The advantages of laparoscopy are widely known. Nevertheless, its legitimacy in liver surgery is often questioned because of the uncertain value associated with minimally invasive methods. ...Our main goal was to compare the outcomes of pure laparoscopic (LLR) and open liver resection (OLR) in patients with hepatocellular carcinoma.
Methods
We searched EMBASE, MEDLINE, Web of Science, and The Cochrane Library databases to find eligible studies. The most recent search was performed on December 1, 2017. Studies were regarded as suitable if they reported morbidity in patients undergoing LLR versus OLR. Extracted data were pooled and subsequently used in a meta-analysis with a random-effects model. Clinical applicability of results was evaluated using predictive intervals. Review was reported following the PRISMA guidelines.
Results
From 2085 articles, forty-three studies (
N
= 5100 patients) were included in the meta-analysis. Our findings showed that LLR had lower overall morbidity than OLR (15.59% vs. 29.88%,
p
< 0.001). Moreover, major morbidity was reduced in the LLR group (3.78% vs. 8.69%,
p
< 0.001). There were no differences between groups in terms of mortality (1.58% vs. 2.96%,
p
= 0.05) and both 3- and 5-year overall survival (68.97% vs. 68.12%,
p
= 0.41) and disease-free survival (46.57% vs. 44.84%,
p
= 0.46).
Conclusions
The meta-analysis showed that LLR is beneficial in terms of overall morbidity and non-procedure-specific complications. That being said, these results are based on non-randomized trials. For these reasons, we are calling for randomization in upcoming studies. Systematic review registration: PROSPERO registration number CRD42018084576.
The main goals of the Enhanced recovery after surgery (ERAS) protocol are focused on shortening the length of hospital stay (LOS), expediting convalescence, and reducing morbidity. A balanced ...perioperative fluid therapy is among the significant interventions incorporated by the ERAS protocol. The article contains extensive discussion surrounding the impact of this individual intervention on short-term outcomes. The aim of this study was to assess the impact of perioperative fluid therapy on short-term outcomes in patients after laparoscopic colorectal cancer surgery. The analysis included consecutive patients, who had undergone laparoscopic colorectal cancer operations between 2013 and 2020. Patients were divided into two groups: restricted (≤ 2500 ml) or excessive (> 2500 ml) perioperative fluid therapy. A standardized ERAS protocol was implemented in all patients. The study outcomes included recovery parameters and the morbidity rate, LOS and 30 days readmission rate. There were 361 and 80 patients in groups 1 and 2, respectively. There were no statistically significant differences between the groups in terms of demographic parameters and factors related to the surgical procedure. Logistic regression showed that restricted fluid therapy as a single intervention was associated with improvement in tolerance of diet on 1st postoperative day (OR 2.18, 95% CI 1.31-3.62, p = 0.003), accelerated mobilization on 1st postoperative day (OR 2.43, 95% CI 1.29-4.61, p = 0.006), lower risk of postoperative morbidity (OR 0.58, 95%CI 0.36-0.98, p = 0.046), shorter LOS (OR 0.49, 95% CI 0.29-0.81, p = 0.005) and reduced readmission rate (OR 0.48, 95% CI 0.23-0.98, p = 0.045). A balanced perioperative fluid therapy on the day of surgery may be associated with faster convalescence, lower morbidity rate, shorter LOS and lower 30 days readmission rate.
Objective
Comprehensive analysis and comparison of HRQoL following different bariatric interventions through systematic review with network meta-analysis.
Background
Different types of bariatric ...surgeries have been developed throughout the years. Apart from weight loss and comorbidities remission, improvement of health-related quality of life (HRQoL) is an important outcome of metabolic surgery.
Methods
MEDLINE, EMBASE, and Scopus databases have been searched up to April 2020. Inclusion criteria to the analysis were (1) study with at least 2 arms comparing bariatric surgeries; (2) reporting of HRQoL with a validated tool; (3) follow-up period of 1, 2, 3, or 5 years. Network meta-analysis was conducted using Bayesian statistics. The primary outcome was HRQoL.
Results
Forty-seven studies were included in the analysis involving 26,629 patients and 11 different surgeries such as sleeve gastrectomy (LSG), gastric bypass (LRYGB), one anastomosis gastric bypass (OAGB), and other. At 1 year, there was significant difference in HRQoL in favor of LSG, LRYGB, and OAG compared with lifestyle intervention (SMD: 0.44; 95% CrI 0.2 to 0.68 for LSG, SMD: 0.56; 95% CrI 0.31 to 0.8 for LRYGB; and SMD: 0.43; 95% CrI 0.06 to 0.8 for OAGB). At 5 years, LSG, LRYGB, and OAGB showed better HRQoL compared to control (SMD: 0.92; 95% CrI 0.58 to 1.26, SMD: 1.27; 95% CrI 0.94 to 1.61, and SMD: 1.01; 95% CrI 0.63 to 1.4, respectively).
Conclusions
LSG and LRYGB may lead to better HRQoL across most follow-up time points. Long-term analysis shows that bariatric intervention results in better HRQoL than non-surgical interventions.
Graphical abstract
Introduction
Enhanced recovery after surgery had been introduced with success in many surgical fields, including bariatrics. There are numerous studies presenting how ERAS® has positively affected ...the outcomes following weight loss surgery. The effect of compliance with the protocol on postoperative results has not been extensively researched in the literature.
Methodology
The 15-element protocol used in our department was analyzed, and compliance was calculated based on pre- and peri-operative elements. We gathered data on recovery parameters, complications, and length of hospital stay. Patients were divided into two groups according to their compliance: group 1 < 80%, group 2 > 80%. Multivariate analysis was used to determine which element had the greatest effect.
Results
Our study group consisted of 764 patients operated in between 2009 and 2017. The median compliance was 87.94%; group 1 had 68.1% compliance and group 2 reached 92.7%. There were significant differences in morbidity (group 1 13.6% vs. group 2 2.8%,
p
< 0.001) and length of hospital stay (4 vs. 3 days,
p
< 0.001). Compliance, early mobilization, and day of food tolerance have been identified as affecting morbidity, whereas for prolonged hospital stays, it was multimodal analgesia, food tolerance, the volume of oral fluids, and intravenous fluids.
Conclusions
Compliance with the ERAS® protocol affects morbidity and length of hospital stay. More studies are required to establish which elements have the greatest impact and which are essential.
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