Management and outcomes of gastric leak after sleeve gastrectomy: results from the 2010-2020 national registry / 中华医学杂志(英文版)

BACKGROUND@#Management of gastric leak after sleeve gastrectomy (SG) is challenging due to its unpredictable outcomes. We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world setting.@*METHODS@#To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry. A cumulative sum analysis was used to identify a fitting curve of gastric leak rate. The Kaplan-Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant outcomes. The logistic regression analysis was conducted to determine the predictors of acute leaks.@*RESULTS@#A total of 78 cases of SG leaks were collected with an incidence of 0.5% (78/15,721) from this registry (6 patients who had the primary SG in non-participating centers). After accumulating 260 cases in a bariatric surgery center, the leak rate decreased to a stably low value of under 1.17%. The significant differences presented in sex, waist circumference, and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population ( P = 0.005, = 0.026, <0.001, and = 0.001, respectively). Moreover, 83.1% (59/71) of the leakage was near the esophagogastric junction region. Leakage healed in 64 (88.9%, 64/72) patients. The median healing time of acute and non-acute leaks was 5.93 months and 8.12 months, respectively. Acute leak (38/72, 52.8%) was the predominant type with a cumulative reoperation rate >50%, whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment ( P = 0.013). Precise dissection in the His angle area was independently associated with a lower acute leak rate, whereas preservation ≥2 cm distance from the His angle area was an independent risk factor.@*CONCLUSIONS@#Male sex, elevated waist circumference, hypoproteinaemia, and type 2 diabetes are risk factors of gastric leaks after SG. Optimizing surgical techniques, including precise dissection of His angle area and preservation of smaller gastric fundus, should be suggested to prevent acute leaks.

The Prevalence and Predictors of Obstructive Sleep Apnea in Chinese Bariatric Surgery Candidates: A Single-Center Study

Purpose@#The purpose of the study is to determine the prevalence and predictors of OSA in Chinese bariatric surgery candidates. @*Materials and Methods@#The clinical data were collected from 326 patients evaluated for bariatric surgery and referred for polysomnography. Multiple logistic regression was used for identifying independent predictors of presence of OSA and ROC curve analysis to determine the best cut-off value for continuous variable. @*Results@#Baseline BMI and age were 33.3±3.7 kg/m2 and 24.3±3.1 years. 62.9% of the patients fulfilled the diagnostic criteria for OSA; Of these, 22.7% had mild OSA; 11.3% had moderate OSA, and 28.8% had severe OSA. The prevalence was significantly higher in males (84.2%) than in females (47.3%) (P＜0.001). The superobese patients and the obese patients aged older than 50 years that all of those were diagnosed with OSA. A multivariate logistic regression model displayed that increasing age, BMI and neck circumference together with presence of habitual snoring and male sex were identified as risk factors of OSA. The best cut-off values for the presence of OSA for age, BMI, neck circumference were 24.5 years, 39.45 kg/m2 , 40.40 cm. @*Conclusion@#The prevalence of OSA is very prevalent (62.9%) in Chinese bariatric surgery candidates, especially in male patients (84%). Age, BMI and neck circumference together with presence of habitual snoring and male sex are independent predictors of OSA in these patients. As clinical predictors are not enough to be a properly screening for OSA, routine PSG testing should be recommended to bariatric surgery candidates.

The Prevalence and Predictors of Obstructive Sleep Apnea in Chinese Bariatric Surgery Candidates: A Single-Center Study

Purpose@#The purpose of the study is to determine the prevalence and predictors of OSA in Chinese bariatric surgery candidates. @*Materials and Methods@#The clinical data were collected from 326 patients evaluated for bariatric surgery and referred for polysomnography. Multiple logistic regression was used for identifying independent predictors of presence of OSA and ROC curve analysis to determine the best cut-off value for continuous variable. @*Results@#Baseline BMI and age were 33.3±3.7 kg/m2 and 24.3±3.1 years. 62.9% of the patients fulfilled the diagnostic criteria for OSA; Of these, 22.7% had mild OSA; 11.3% had moderate OSA, and 28.8% had severe OSA. The prevalence was significantly higher in males (84.2%) than in females (47.3%) (P＜0.001). The superobese patients and the obese patients aged older than 50 years that all of those were diagnosed with OSA. A multivariate logistic regression model displayed that increasing age, BMI and neck circumference together with presence of habitual snoring and male sex were identified as risk factors of OSA. The best cut-off values for the presence of OSA for age, BMI, neck circumference were 24.5 years, 39.45 kg/m2 , 40.40 cm. @*Conclusion@#The prevalence of OSA is very prevalent (62.9%) in Chinese bariatric surgery candidates, especially in male patients (84%). Age, BMI and neck circumference together with presence of habitual snoring and male sex are independent predictors of OSA in these patients. As clinical predictors are not enough to be a properly screening for OSA, routine PSG testing should be recommended to bariatric surgery candidates.

Hyperinsulinemic Hypoglycemia after Bariatric Surgery

Postprandial hyperinsulinemic hypoglycemia (PHH) is one of the serious complications after bariatric surgery, it can lead life-threatening neuroglycopenic symptoms, such as seizures, disorientation, impairment of version and loss of consciousness without any premonitory. The presentation, prevalence, diagnosis, pathology and treatment are reviewed in this summary.

Comparison between ABCD and IMS Scores in the Prediction of Long-Term T2DM Remission after Metabolic Surgery in East Asian Obese Patients

Recently, several scoring systems have been proposed to predict remission from type 2 diabetes mellitus (T2DM) after metabolic surgery. The ABCD score was compared to the individualized metabolic surgery (IMS) score in terms of the prediction of long-term T2DM remission; however, which of the two scoring systems is better remains controversial. Thus, Three East Asian countries Metabolic Surgery (TEAMS), which has been organized as a study group since 2016, is conducting a retrospective, international, multi-institutional study to compare the two scoring systems in East Asian obese patients after metabolic surgery. The primary study objective is to compare the ABCD score with the IMS score at 3 and 5 years after sleeve gastrectomy (SG), Roux-en-Y gastric bypass, one anastomosis gastric bypass and SG with duodenojejunal bypass. The secondary objectives include evaluating patients who were good candidates for SG, and adjusting the IMS scoring system for East Asian patients.