Compression pre-stapler firing and post-ignition wait during sleeve gastrectomy: a prospective randomized trial

ABSTRACT BACKGROUND: Insufficient research exists on the stapling technique in and duration of laparoscopic sleeve gastrectomy (LSG). OBJECTIVES: This study aimed to assess the clinical outcomes using a 30-second precompression and post-firing waiting time without extra support for the stapling line. DESIGN AND SETTINGS: Randomized controlled prospective study at a university hospital. METHODS: This study included 120 patients treated between January 2022 and February 2023. The patients were divided into the non-waiting group (T0) and waiting group (T1), each with 60 patients. Perioperative complications were analyzed using statistical tests. RESULTS: The waiting group (T1) showed a significant reduction in the number of intraoperative bleeding points requiring intervention compared with the non-waiting group (T0) (81 versus 134, P < 0.05). In T0, postoperative C-reactive protein (CRP) levels increased (P < 0.05) and hemoglobin levels decreased significantly (P <0.05). The study recorded 22 postoperative complications, accounting for 18.3% of all cases during the 30-day postoperative period. CONCLUSIONS: The study concluded that the 30 sec + 30 sec stapling technique reduces perioperative bleeding, length of stay, and serious complication rates and is practical and effective for LSG. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov with registration code NCT05703035; link: https://clinicaltrials.gov/ct2/show/NCT05703035.

Various Intragastric Balloons Under Clinical Investigation

Obesity is a chronic disease with an exponentially increasing incidence rate, and its negative effects are well documented in numerous studies. As a result, the importance of bariatric therapy cannot be overemphasized, and many bariatric treatment methods with varying mechanisms have been developed. Of the available treatment methods, intragastric balloons, introduced in the 1980s, have been shown to be a safe and effective treatment modality; various intragastric balloon products have been developed and are currently being widely used in clinical settings. However, the disadvantages of intragastric balloons, such as unclear long-term weight loss benefits and complications experienced during insertion and removal, preclude their wider use. In this review, we discuss different intragastric balloon products, focusing on those under clinical investigation, and suggest future research directions.

Small Bowel Endoscopic Bariatric Therapies

Endoscopic bariatric therapies that emulate some of the principles of bariatric surgery have been developed as a less invasive option for the treatment of obesity and related comorbidities. Small bowel endoscopic bariatric therapies include bypass sleeves, incisionless anastomosis systems, and duodenal mucosal resurfacing. Clinical experience with small bowel devices suggests that endoscopic bariatric procedures can be safely implemented and that these devices are effective for both weight loss and metabolic improvement. Although the mechanisms behind these effects should be further elucidated, endoscopic bariatric therapies may be more effective and safer adjunctive interventions than lifestyle modifications and pharmacological regimens for patients with obesity or obesity-related comorbidities.

Role of Endoscopy in the Treatment of Bariatric and Metabolic Disease

Obesity is a complex metabolic disease caused by excess body fat, which can be associated with many health problems. Bariatric surgery is the most effective treatment for morbid obesity. However, only small number of patients undergo surgery despite definite benefits. The upper gastrointestinal endoscopy with flexible device is an essential tool in the evaluation of post bariatric surgery patient. It plays an important role in treating complications occurring after bariatric surgery. Recently, there has been active research and development on endoscopic procedures to achieve similar effects with bariatric surgery in less invasive ways. Endoluminal interventions performed using flexible endoscopy might be less effective than current surgical approaches, but it can offer alternative approaches to the treatment of obesity that are safer and more cost-effective. This article provides an overview of endoscopic procedures for postoperative complication and new emerging endoscopic techniques for primary endoscopic bariatric therapies. Knowing the type, indication, expected effect, and development potential of endoscopic procedures might be of great help to surgeons performing bariatric procedures.

Serum expressions of adipocytokines in overweight and obese patients with acute leukemia / 白血病·淋巴瘤

Objective To investigate the influence of overweight and obese on serum expressions of adipocytokines and prognosis of patients with acute leukemia. Methods Five hundred and seventy patients diagnosed as acute leukemia in the People's Hospital of Liaoning Province and Shengjing Hospital of China Medical University from July 2008 to July 2015 were collected. According to the body mass index (BMI), the patients were subdivided into two groups as obese/overweight group (BMI≥24 kg/m2) and control group (BMI<24 kg/m2). The avidinbiotincomplex-enzyme-linked immunosorbent assay (ELLSA) was used to detect the adiponectin, leptin, and resistin levels in the two groups. The t test was used to compare the difference of serum adiponectin, leptin and resistin expression between the two groups; Kaplan-Meier method was used to compare the difference of survival between the two groups. Results In patients with acute lymphoblastic leukemia (ALL)and acute myeloid leukemia (AML), the adiponectin levels in obese/overweight group were lower than those in the control group [adult ALL:(3.8±2.1) pg/ml vs. (6.4±2.9) pg/ml, child ALL:(4.2±2.7) pg/ml vs. (7.4±3.1) pg/ml, AML:(4.1±2.3) pg/ml vs. (6.9±3.1) pg/ml;t values were-2.291,-2.462,-2.244;P values were 0.023, 0.015, 0.026, respectively]. The leptin levels were high in the child ALL obese/overweight group than those in the control group (34±17 vs. 21±17) (t= 2.092, P= 0.038). The resistin levels of all the acuteleukemia patients did not have statistical difference between the obese/overweight group and control group(all P>0.05). In AML and adult ALL patients, the survival analysis showed that the 5-year overall survival rate in obese/overweight group were lower than that in the control group (38.0％vs. 46.6％,χ2= 1.449, P= 0.001;41.4％vs. 48.4％,χ2= 4.166, P= 0.041). Conclusion For the acute leukemia, the adiponectin levels are low in obese or overweight patients, and the 5-year survival rate of obese or overweight AML and adult ALL patients is lower than that of normal weight patients.

Recent Trends in Endoscopic Bariatric Therapies

Obesity and its associated metabolic diseases including diabetes mellitus are severe medical problems that are increasing in prevalence worldwide and result in significant healthcare expenses. While behavioral and pharmacological treatment approaches are partly effective in the short term, their effects are not long-lasting. Although previous studies have described bariatric surgery as the most effective treatment for obesity, it is associated with morbidity, mortality, and economic burden. Endoluminal interventions performed entirely using gastrointestinal flexible endoscopy offer alternative approaches to the treatment of obesity that are safer and more cost-effective than current surgical approaches. The use of endoluminal techniques in the field of metabolic obesity disease has diverse promising applications including endoscopic gastroplasty, intragastric balloon, endoluminal malabsorptive bariatric procedures, and gastric electrical stimulation (GES) for the modulation of gastric emptying. This review discusses recent trends and roles in endoscopic bariatric therapies using the currently available endoluminal and transgastric technologies.

Endoluminal Gastroplasty for Obesity Treatment: Emerging Technology and Obstacles

Obesity is a complex metabolic disease. Currently, obesity treatment includes lifestyle modification, obesity drug treatment, and bariatric surgery. Lifestyle modification is an essential part of obesity treatment, but it is limited by itself. And anti-obesity treatment drugs also showed limited weight loss effect, about 3-9% per year, and can cause serious side effects such as cardiovascular side events. Surgical treatment requires high cost, permanent resection of the gastrointestinal tract and can cause complication related to surgery. Recently, several promising endoscopic bariatric therapies are emerging. Endoluminal bariatric treatment using flexible gastrointestinal endoscopy could offer a minimally invasive treatment aimed at achieving an effect comparable to obesity surgery, while offering advantages of low cost and safety. In this paper, we described a new technological method, recent clinical data, and the latest findings on obstacles to be overcome for endoscopic gastroplasty using endoscopic suture instruments. Endoscopic gastroplasty presented reduced gastric volume, effective weight loss and maintenance effect without severe adverse events. It could suggest an attractive treatment option for obesity.

Experiencia de gastrectomía vertical en manga en el Hospital Carlos Andrade Marín / Vertical sleeve gastrectomy experience in the Carlos Andrade Marin Hospital

Introducción: la obesidad se ha convertido en un problema a nivel mundial. Ecuador no podía ser la excepción y según el INEC, 4 millones de personas en el país padecen de sobrepeso. La cirugía bariátrica ha sido reconocida como un método seguro y eficaz en el tratamiento de la obesidad y sus comorbilidades. Materiales y métodos: con el objetivo de analizar los resultados y complicaciones de la manga gástrica (LSG, por sus siglas en inglés) en el Hospital Carlos Andrade Marín, se realiza un estudio descriptivo retrospectivo, de los pacientes operados entre 2008 y 2013 en el Servicio de Cirugía General del Hospital Carlos Andrade Marín, se realiza un estudio descriptivo retrospectivo, de los pacientes operados entre 2008 y 2013 en el Servicio de Cirugía General del Hospital Carlos Andrade Marín (HCAM). Del total, 309 sujetos, se evaluaron características demográfcas y complicaciones perioperatorias. De un grupo más pequeño, 162 pacientes que tuvieron un seguimiento posoperatorio de al menos un año, se analizó la reducción de peso y resolución de comorbilidades asociadas a la obesidad. Resultados: el 87% de los pacientes tienen un índice de masa corporal (IMC) entre 30 y 40. El promedio de reducción de peso al año de la cirugía fue de 9.5 puntos de IMC. La morbilidad general relacionada al procedimiento fue de 7.2%, con una tasa de fístulas de 4.5%. Se reoperaron 14 pacientes, ya sea por fístula o por sangrado. En cuanto a la morbilidad que se relaciona a la obesidad, más del 60% de pacientes presentaron mejoría. Conclusión: el resultado de este estudio demuestra que la manga gástrica es un excelente procedimiento aplicado al tipo de obesidad que maneja este servicio, la gran mayoría tipo I y II. Se ha logrado llevar a estos pacientes a valores casi normales de IMC al año del procedimiento, con una aceptable morbilidad y con un adecuado manejo de las complicaciones.

Introduction: obesity has become a worldwide problem. Ecuador is not the exception an according to the INEC, 4 million people in the country have overweight. The bariatric surgery has been recognized as a safe and effective treatment for obesity and its comorbidities. Materials and methods: in order to analyze the results and complications of the laparoscopic sleeve gastrectomy (LSG) at the Carlos Andrade Marín Hospital, a descriptive study of patients operated between 2008 and 2013 in the Department of Surgery at the Carlos Andrade Marin Hospital was performed. Of the 309 subjects, demographics and perioperative complications were evaluated. In a smaller group, 162 patients who had a postoperative follow-up of at least one year, weight loss and resolution of comorbidities associated with obesity was analyzed. Results: eighty seven percent (87%) of patients have a body mass index (BMI) between 30 and 40. The average weight loss at one year after surgery was 9.5 BMI points. The overall procedure -related morbidity was 7.2 %, with a 4.5% rate of gastric sleeve fstula. Fourteen patients were operated again due to gastric sleeve bleeding. There were no deaths related to surgery. Regarding morbidity associated with obesity, more than 60% of patients showed improvement. Conclusion: the result of this study shows that gastric sleeve is an excellent procedure applied to the type of obesity of this service, most type I and II. It has managed to bring these patients to near normal values of BMI within a year of the procedure, with acceptable morbidity and proper management of complications.

Role of Gastroenterologists in Management of Obesity / 대한소화기학회지

Obesity is a serious disorder that increases morbidity and mortality. Primary intervention with life style modification and medication is not always effective for obese patients. Endoscopic management of obesity may be a less invasive, more cost-effective, and relatively safer option than bariatric surgery. Moreover, therapeutic endoscopy is considered to be the primary modality for managing complications that occur after bariatric surgery. In the near future, role of gastroenterologists will be more important in the management of obesity and its related problems.

Manga gástrica laparoscópica. Revisión detallada / Laparoscopic sleeve gastrectomy

Resumen La cirugía bariátrica es una rama de la medicina que se dedica al tratamiento de la obesidad y sus posibles comorbilidades a través de procedimientos quirúrgicos. Presentamos la historia y varios aspectos de la manga gástrica laparoscópica a través de 20 años. La reducción de peso se logra aquí por varios mecanismos: uno es la reducción del volumen estomacal y otro es la menor secreción de la hormona ghrelina; lo que promueve una saciedad más rápida y una reducción del apetito. Karamankos S.N. encontraron un mayor porcentaje en la apérdida del exceso de peso con manga gástrica que con bypass gástrico en un seguimiento a 1 año (69,7 ± 14,6% contra 60,5 ± 10,7%). En un metaanálisis publicado en 2011, Padwal R. y cols. concluyeron que existe una mayor disminución de índice de masa corporal en pacientes sometidos a manga gástrica que en bypass gástrico de −10,1 kg/m2 y -9 kg/m2 respectivamente.

Abstract Bariatric surgery is a medical specialty dedicated to the treatment of obesity and its comorbidities through surgical procedures. We present a detailed collection on the history and evolution of laparoscopic sleeve gastrectomy over the course of 20 years. The gastric sleeve induces weight loss by several mechanisms. It significantly reduces gastric chamber size and decreases the secretion of the hormone called ghrelin, thus promoting quicker satiety and decreasing appetite. Karamankos S.N. found a greater percentage of excess-weight loss with gastric sleeve than with bypass in a 1-year follow-up (69,7% ± 14,6% versus 60,5% ± 10,7%). A 2011 meta-analysis by Padwal R. et al. concluded that there is a greater decrease in body mass index in patients undergoing sleeve gastrectomy than with gastric bypass, -10,1 kg/m2 and -9 kg/m2, respectively.

Cirugía bariátrica endoscópica para el tratamiento de la obesidad mórbida: presentación de 3 casos / Endoscopic bariatrics surgery for treatment of morbid obesity: presentation of three cases

La obesidad es un importante problema de salud por el riesgo aumentado de morbilidad y de mortalidad cardiovascular y global. Cuando han fracasado los tratamientos convencionales, la cirugía bariátrica es un tratamiento eficaz, pues consigue normalizar las comorbilidades en un elevado número de pacientes. Se presentan los casos de 3 pacientes con obesidad mórbida (IMC ≥ 40 kg/m2), operadas por vía endoscópica (derivación gástrica), para identificar las enfermedades asociadas antes y después del tratamiento, valorar los análisis de laboratorio antes y después de la cirugía, evaluar la pérdida de peso después de la operación e identificar las complicaciones perioperatorias(AU)

The obesity is an important health problem due to the increased risk of global and cardiovascular morbidity and mortality. When conventional treatments fail, the bariatrics surgery is an effective treatment since normalizes the comorbidities in a significant number of patients. This is the presentation of three female cases presenting with morbid obesity (CMI ≥ 40 kg/m²), operated on via endoscopy (gastric bypass) to identify the associated diseases before and after treatment, to assess the laboratory analyses before and after surgery, to assess the weight loss after surgery and to identify the perioperative complications(AU)

Conservative management of esophageal perforation following obesity surgery

CONTEXT: Laparoscopic adjustable silicone gastric banding (LASGB) is one of the several surgical techniques for treating patients with morbid obesity. Erosion and perforation in the gastric chamber caused by LASGB are rare complications that have already been described. There have not yet been any reports of perforation of the middle esophagus during this procedure. CASE REPORT: The authors describe the case of a patient who presented the complication of very extensive perforation of the middle third of the esophagus following LASGB. This was successfully managed using conservative treatment.

CONTEXTO: Banda gástrica laparoscópica ajustável de silicone (LASGB) é uma das várias técnicas cirúrgicas para o tratamento de pacientes com obesidade mórbida. A erosão e a perfuração para o interior da câmara gástrica causados pela LASGB são complicações raras já descritas. Não se encontram relatos de perfuração do esôfago médio durante esse procedimento. RELATO DE CASO: Descrevemos o caso de uma paciente que apresentou como complicação, uma perfuração extensa do esôfago médio após LASGB, submetida a tratamento conservador com sucesso absoluto.