Laparoscopic Sleeve Gastrectomy in Adolescents: Ten-Years Follow-up.

PURPOSE: Metabolic and bariatric surgery (MBS) has emerged as the most effective treatment for adolescents with severe obesity. Despite the steady increase in frequency of MBS in adolescents, most reports focus on short-term (1-2 years) follow-up. OBJECTIVE: To report on long-term weight loss and status of obesity-related comorbidities of adolescents who underwent laparoscopic sleeve gastrectomy (LSG). METHODS: A retrospective analysis of prospectively collected data of patients younger than 18 years who underwent LSG between January 2008 and July 2014 was performed. RESULTS: During the study period, 46 patients (mean age 16.19 ± 1.07 years) underwent LSG, 31 of them (67.39%) completed long-term follow-up and were included in the study. Mean follow-up time was 10.84 ± 2.35 years. There were 18 females (58%). Mean body-mass index (BMI) was 44.94 ± 4.33 kg/m2 and 30.11 ± 710, before, and 10-year following surgery, respectively, a reduction of 33.24% (P < 0.001). Long-term TWL% was 32.31 ± 12.02. Twenty-one patients (67.74%) achieved a BMI < 30 kg/m2. Following weight reduction, resolution of hypertension was noted in 8 patients (88.9%, P < 0.001). Frequent long-term side effects of surgery were gastrointestinal reflux disease (GERD) and alopecia in 22.58% and 48.39%, respectively. Symptomatic cholelithiasis necessitated cholecystectomy in 22.58% of the patients. Using a 1-10 scale, the overall patient satisfaction in the long term was 8.97. CONCLUSION: Our data suggests that LSG is a durable intervention for weight reduction in adolescents.

Impact of "critical lesions" on outcomes following cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy.

BACKGROUND: Peritoneal Cancer Index (PCI) and complete cytoreduction are the best outcome predictors following cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Lesions in critical areas, regardless of PCI, complicate surgery and impact oncological outcomes. We prospectively defined "Critical lesions" (CL) as penetrating the hepatic hilum, diaphragm at hepatic outflow, major blood vessels, pancreas, or urinary tract. METHODS: Retrospective analysis of a prospective database of 352 CRS + HIPEC patients from 2015 to 2019. Excluded patients with aborted/redo operation (n = 112), or incomplete data (n = 19). Patients categorized by CL status and compared: operative time, estimated blood loss (EBL), PCI, transfusions, hospital stay, post-operative complications and mortality, overall survival (OS) and disease-free survival (DFS). RESULTS: Included 221 patients (78 CL; 143 no-CL). No difference in patients' characteristics: age, BMI, gender or co-morbidities noted. Operative time longer (5.3 h vs 4.3 h, p < 0.01), EBL higher (769 ml vs 405 ml, p < 0.01), transfusions higher (1.9 vs 0.7 Units, p < 0.001) and PCI higher (15.5 vs 9.5, p < 0.01) in CL. No difference in major complications. Postoperative complications, CL, OR-time and transfusions were predictive of OS in univariate analysis, while only complications remained on multivariate analysis. Median follow up of 21.4 months, 3-year DFS/OS was 22% vs 30% (p < 0.037) and 73% vs 87% (p < 0.014) in CL and non-CL, respectively. Despite CL complete resection, 17/38 patients (44.7%) that recurred had recurrence at previous CL site. CONCLUSIONS: Critical lesions complicate surgery and may be associated with poor oncological outcomes with high local recurrence rate, despite no significant difference in complications. Utilizing adjuvant or intra-operative radiation may be beneficial.