Purpose
Despite the importance of follow-up and multidisciplinary care after bariatric surgery, many patients do not attend postoperative appointments, particularly those with the medical team. The ...present study aimed to identify factors associated with loss to follow-up after bariatric surgery.
Materials and Methods
We recruited patients who underwent bariatric surgery between 01/01/2012 and 31/12/2013. Data were collected on demographic and socioeconomic information and comorbidities. Ten baseline psychological evaluations were blindly reviewed to evaluate the relationship between emotions and compliance with follow-up. During the 3-year postoperative period, we defined frequent attendees as those who attended at least two visits, whereas non-attendees were those who attended one visit or none
.
We evaluated baseline variables associated with non-adherence with follow-up schedules.
Results
Among 92 patients, 41 patients (44.6%) attended at least two postoperative appointments, while 51 (55.4%) were classified as non-attendees. Among the non-attendees, significantly more were younger than 45 years compared with attendees. No other statistically significant differences were found in terms of socioeconomic variables. Multivariate logistic regression revealed male gender and psychological issued related to obesity to be independent predictors of poor compliance with follow-up. Blinded psychological evaluation of ten patients did not suggest that psychological factors are predictive of follow-up attendance.
Conclusion
Identifying factors associated with loss to follow-up after bariatric surgery is challenging. However, this is important in order to enable the design of personalized follow-up plans, especially for younger patients and those with psychological issues.
Single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) is a simplified biliopancreatic diversion. The objective of this study was to develop a reproducible animal model for SADI-S. ...We used three techniques for duodenal exclusion and duodenoileal anastomosis: (a) surgical clip and side-to-side anastomosis, (b) ligation and side-to-side anastomosis and (c) sectioning the duodenum, closing the duodenal stump and end-to-side anastomosis. We recorded the surgical technique and complications for each method. Twenty-five of 31 rats survived to the end of the study period. One death occurred from accidental anaesthesia overdose and the others from anastomosis leak. Four duodenal exclusions had repermeabilised at necropsy. Our murine model of SADI-S can be consistently reproduced. Sectioning the duodenum is preferable to avoid repermeabilisation of the duodenum.
Background
Airway management during the administration of anesthesia to patients undergoing bariatric surgery is challenging. The goal is to avoid multiple intubation attempts because the risk of ...complications increases with the number of attempts. The objective of this study was to determine the failed first intubation attempt rate, as well as variables associated with this failure, in patients undergoing bariatric surgery.
Methods
We enrolled patients scheduled for bariatric surgery in this prospective, observational, single-center study. We determined predictive criteria for difficult intubation at the preoperative anesthesia consultation. All patients were evaluated for obstructive sleep apnea by polygraphy. The primary study endpoint was a failed first intubation attempt.
Results
We enrolled 519 patients between December 2012 and January 2015. The cohort consisted of 425 women (82%), with a median (interquartile range IQR) age of 39 (30–50) years and a body mass index of 42 (39–46) kg/m
2
. The first intubation attempt failed in 60 patients, with an incidence rate of 11.5% (95% confidence interval CI, 8.8–14.2%). We included nine variables in the final multivariate model. Two variables were associated with failed first intubation attempt: male sex (odds ratio OR 95% CI, 6.9% 2.5–18.7%) and Mallampati score 3–4 (OR 95% CI, 2.2% 1.0–4.7%).
Conclusions
In this morbidly obese population, the first intubation attempt failed in 11.5% of patients, and the risk factors for failure were male sex and a high Mallampati score.
Laparoscopic sleeve gastrectomy (LSG) has become a valuable surgical option to rescue laparoscopic adjustable gastric banding (LAGB) failures.
The aim of this study was to determine whether ...conversion to LSG after failed LAGB (CLSG) is a well-tolerated and effective rescue procedure compared with primary LSG (PLSG) in the long term.
University hospital, France.
A retrospective review of data concerning consecutive patients receiving a LSG between February 2008 and December 2014 was conducted. Mortality, postoperative complications, and weight loss outcomes were analyzed.
Of 701 LSG, 601 (85.7%) were PLSG and 100 (14.3%) were CLSG. The mortality rate was 0%. Overall morbidity was comparable between the primary and conversion group (10% versus 6%, P = .27). The mean percentage of excess weight loss at 3, 36, and 72 months was 34.9%, 72.1%, and 57.2% after PLSG and 22.6%, 51.2% and 29.8% after CLSG (P<.05). The failure rate (mean percentage of excess weight loss<50%) was higher in the CLSG group during the first 5 postoperative years (P < .001) with more than two thirds of the CLSG considered as having failed at 60 months. Patients who underwent band ablation as a result of insufficient weight loss or weight regain presented the worst results after conversion to LSG.
In this study, the conversion of failed LAGB to LSG in 2 steps indicated a safety profile comparable to that of primary LSG but was significantly less effective from the early postoperative course (3 mo) up to 6 years postoperatively. CLSG may not be the best option because a third operation may be needed as a result of insufficient weight loss.
After publication of this work 1, the authors noticed that the first names and last names of all the authors were inverted. In the original manuscript, they appear on PubMed as.
Hepatic endometriosis has an extremely rare occurrence characterized by the presence of ectopic endometrium in the liver. A diagnosis of hepatic endometriosis is established after surgery. A ...51-year-old multiparous female was referred to our unit for investigation of a liver tumor. The patient reported a 6-month history of epigastric pain and vomiting. She had undergone conservative hysterectomy for uterine leiomyomas several years earlier. The results of liver function tests and the levels of tumor markers (CA 19.9, CEA, CA125, αFP) were normal. Radiological imaging (USS, CT and MRI) suggested the presence of liver cystadenoma, liver cystadenocarcinoma or cystic metastasis of the liver in the left liver lobe extending to the diaphragm with left hepatic vein compression. Laparotomy was performed. The intraoperative frozen sections suggested a diagnosis of endometriosis. Anatomical resection was performed, including left lobectomy with diaphragm resection. The final histology confirmed the presence of hepatic endometrioma without malignant transformation. Fourteen cases of hepatic endometrioma have been described in the medical literature. We herein report the 15th case. Making a preoperative diagnosis of hepatic endometriosis is very difficult, despite conducting a complete investigation, in the absence of clinical and radiological characteristics. The diagnosis is made according to a histological examination of the whole surgical sample.
Cecal endometriosis and ileocolic intussusception due to a cecal endometriosis is extremely rare. We report a case of a woman who presented an ileocecal intussusception due to a cecal endometriosis. ...The patient gave two months history of chronic periombilical pain requiring regular hospital admission and analgesia. The symptoms were not related to menses. A laparotomy was performed and revealed an ileocolic intussusception. The abdominal exploration did not find any endometriosis lesion. Ileocaecal resection was performed. Microscopic examination showed a cystic component, lined by a regular cylindric epithelium. Foci of endometrial tissue were observed in the cecal subserosa and muscularis mucosal, with irregular endometrial glands lined by cylindric epithelium without atypia immunostained with CK7, and characteristic endometrial stroma immunostained with CD10. Cecal endometriosis and ileocolic intussusception due to a cecal endometriosis is extremely rare. Diagnose of etiology remains challenging due to the absence of clinical and radiological specific characteristics.
The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2975867306869166.
At long (≥5 years) and very long term (≥10 years) bariatric and metabolic surgery (BMS) is the only treatment that allows a significant and durable weight loss concomitant with a control of the ...different obesity related diseases. Regardless of the surgical technique, BMS significantly decrease long-term mortality (-30% at 15 years). The maximum weight loss is reached at postoperative year 2. Beyond, a weight regain and is usually observed in all procedures. The variability of long-term outcomes underlines the importance of multidisciplinary care throughout follow-up. In 2017, Roux-en-Y-gastric bypass and sleeve gastrectomy were the most popular bariatric procedures and seem to have comparable long-term outcomes.
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