IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures.

BACKGROUND AND AIM: The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), being a Federation of 62 national societies, is the ideal network to monitor the number and type of procedures at a global level. The IFSO survey, enriched with a special section on revisional procedures, aims to report the number and types of bariatric procedures performed worldwide in 2016 and analyzes the surgical trends from 2008 to 2016. METHODS: The 2016 IFSO Survey form was emailed to all IFSO societies. Each Society was requested to indicate the number and type of bariatric procedures performed in the country. Trend analyses from 2008 to 2016 were also performed. RESULTS: The total number of bariatric/metabolic procedures performed in 2016 was 685,874; 634,897 (92.6%) of which were primary and 50,977 were revisional (7.4%). Among the primary interventions, 609,897 (96%) were surgical and 25,359 (4%) were endoluminal. The most performed primary surgical bariatric/metabolic procedure was sleeve gastrectomy (SG) (N = 340,550; 53.6%), followed by Roux-en-Y gastric bypass (N = 191,326; 30.1%), and one-anastomosis gastric bypass (N = 30,563; 4.8%). CONCLUSIONS: In 2016, there was an increase in the total number both of surgical and endoluminal bariatric/metabolic procedures. Revisional procedures represent about 7% of the total bariatric interventions. SG remains the most performed surgical procedure in the world.

Bariatric Surgery and Endoluminal Procedures: IFSO Worldwide Survey 2014.

BACKGROUND AND AIM: Several bariatric surgery worldwide surveys have been previously published to illustrate the evolution of bariatric surgery in the last decades. The aim of this survey is to report an updated overview of all bariatric procedures performed in 2014.For the first time, a special section on endoluminal techniques was added. METHODS: The 2014 International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) survey form evaluating the number and the type of surgical and endoluminal bariatric procedures was emailed to all IFSO societies. Trend analyses from 2011 to 2014 were also performed. RESULTS: There were 56/60 (93.3%) responders. The total number of bariatric/metabolic procedures performed in 2014 consisted of 579,517 (97.6%) surgical operations and 14,725 (2.4%) endoluminal procedures. The most commonly performed procedure in the world was sleeve gastrectomy (SG) that reached 45.9%, followed by Roux-en-Y gastric bypass (RYGB) (39.6%), and adjustable gastric banding (AGB) (7.4%). The annual percentage changes from 2013 revealed the increase of SG and decrease of RYGB in all the IFSO regions (USA/Canada, Europe, and Asia/Pacific) with the exception of Latin/South America, where SG decreased and RYGB represented the most frequent procedure. CONCLUSIONS: There was a further increase in the total number of bariatric/metabolic procedures in 2014 and SG is currently the most frequent surgical procedure in the world. This is the first survey that describes the endoluminal procedures, but the accuracy of provided data should be hopefully improved in the next future. We encourage the creation of further national registries and their continuous updates taking into account all new bariatric procedures including the endoscopic procedures that will obtain increasing importance in the near future.

Bariatric Surgery Worldwide 2013.

BACKGROUND: The first global survey of bariatric/metabolic surgery based on data from the nations or national groupings of the International Federation for the Surgery of Obesity and Metabolic Diseases (IFSO) was published in 1998, followed by reports in 2003, 2009, 2011, and 2012. In this survey, we report a global overview of worldwide bariatric surgery in 2013. MATERIALS AND METHODS: A questionnaire evaluating the number and the type of bariatric procedure performed in 2013 was emailed to all members of bariatric societies belonging to IFSO. Trend analyses from 2003 to 2013 were also performed. RESULTS: There were 49/54 (90.7%) responders; 37 of the 49 with national registries. The total number of bariatric procedures performed worldwide in 2013 was 468,609, 95.7% carried out laparoscopically. The highest number (n = 154,276) was from the USA/Canada region. The most commonly performed procedure in the world was Roux-en-Y gastric bypass (RYGB), 45%; followed by sleeve gastrectomy (SG), 37%; and adjustable gastric banding (AGB), 10%. Most significant were the rise in prevalence of SG from 0 to 37% of the world total from 2003 to 2013, and the fall in AGB of 68% from its peak in 2008 to 2013. CONCLUSIONS: SG is currently the most frequently performed procedure in the USA/Canada and in the Asia/Pacific regions, and second to RYGB in the Europe and Latin/South America regions. The accuracy of the IFSO-based world survey of procedures would be enhanced if each nation or national group would create a national registry.

Systematic review and meta-analysis of medium-term outcomes after banded Roux-en-Y gastric bypass.

This is the first systematic review and meta-analysis focused exclusively on intermediate-term outcomes for the banded Roux-en-Y gastric bypass (B-RYGB). B-RYGB articles published from 1990 to 2013 were identified through MEDLINE, ScienceDirect, and SpringerLink databases augmented by manual reference review. Articles were assigned an evidence level (Centre for Evidence-Based Medicine [Oxford UK] criteria) and Jadad quality score (randomized controlled trials). Simple and weighted means (95% confidence interval (CI)) for excess weight loss (EWL) at follow-up (1-10+ years) were calculated. At 5 years, a pooled estimate for BMI (kg/m(2)) change (weighted mean difference and 95% CI) for banded bypass patients was computed. Rates for weighted mean complications, non-band- and band-related reoperations, and overall comorbidity resolution were calculated. Three hundred twenty-one articles were identified: 286 failed inclusion criteria (i.e., non-English, B-RYGB unrelated, <10 per arm, <3-year follow-up), leaving 35 articles. Manual review added 10 potentially relevant articles; 30 that failed inclusion criteria were excluded, leaving 15 for analysis. B-RYGB was performed on 8,707 patients: 79.0% female, mean age 38.7, and BMI 47.6 (41.0-59.4). Overall BMI weighted mean difference (reduction) at 5 years was 17.8 (95% CI 12.8, 22.7; p < 0.001). Five-year weighted mean EWL of 72.5% (67.5, 77.4) was sustained at 10+ years (69.4%; 58.9, 80.0). Weighted mean complication rates were as follows: early, 10.9%, and late, 20.0%. Non-band-related reoperation rate was 15.2%, and band-specific reoperation rate was 4.1%. Gastric outlet stenosis, band erosion, and band slippage were 2.8, 2.3, and 1.5%, respectively. Diabetes remitted in 80/95 (84.2%). By systematic review and meta-analysis, albeit with limited rates of follow-up, B-RYGB appeared to result in significant, sustained excess weight loss of approximately 70.0% out to 10 years.

Hereditary hyperferritinemia cataract syndrome: clinical, genetic, and laboratory findings in 5 families.

BACKGROUND: The hereditary hyperferritinemia cataract syndrome (HHCS) is an autosomal dominant disorder characterized by high serum ferritin and early onset cataract. Mutations in the iron responsive element (IRE) within the 5' untranslated region of the L-ferritin (FTL) gene lead to constitutive L-ferritin synthesis resulting in hyperferritinemia. Bilateral cataract formation is caused by the intracellular accumulation of ferritin in the lens. PATIENTS: 4 children from unrelated families were referred for further exploration of hyperferritinemia which was detected during the diagnostic work-up of gastroenterological or hematological disorders. 1 patient was primarily referred for the investigation of bilateral cataract.Diagnostics included routine blood analysis, including complete blood count, iron status, liver and kidney parameters, a physical and an ophthalmological examination. Molecular genetic analysis of the FTL IRE was performed in 4 patients by PCR from genomic DNA and subsequent direct sequencing. RESULTS: All index patients presented with isolated hyperferritinemia without iron overload and had a positive family history for early onset cataract. Age at onset and disease severity varied between different families and among family members. Molecular genetic analysis revealed point mutations within the FTL IRE. CONCLUSION: In patients with hyperferritinemia but without any other sign of iron overload or inflammation HHCS should be considered to avoid complex and invasive procedures. Vice versa, in patients with familial inherited cataract the early serum ferritin measurement helps to avoid unnecessary diagnostics.

Pilot study of oxygen transport rate of banked red blood cells.

BACKGROUND AND OBJECTIVES: Dynamic oximetry provides a new way to assess the effect of blood storage on the oxygen transport rate (OTR). MATERIALS AND METHODS: In dynamic oximetry, the rate at which oxyhemoglobin becomes deoxyhemoglobin is measured optically, thereby, indirectly measuring the rate at which oxygen leaves the red blood cell (RBC) making it available for transfer to tissues. Extending the physiologic diffusion time in an in vitro apparatus, consisting of a diffusion system and gas exchanger capable of controlling the surface area and the time of exposure for oxygenation and deoxygenation, makes OTR measurement feasible. Eight normal blood donor units, collected in adenine, dextrose, sorbitol, sodium chloride and mannitol , were stored for 8 weeks under standard conditions and serially sampled for OTR. RESULTS: We report that the OTR at the time of blood bank donation appears to be singular for each donor, that the interdonor differences are maintained over time, and that the individual OTR increased 1.72-fold (95% CI 1.51, 1.95) over 8 weeks, adjusting for sex, age and plasma cholesterol level. CONCLUSION: Oxygen transport rate increases during storage; blood units with similar haemoglobin content may have significant differences in OTR. Studies examining blood parameters at the time of donation and blood storage on patient outcomes should consider measuring OTR, as it may contribute to differences in observed efficacy of tissue oxygenation.

[Intra- and interindividual comparison of corneal refraction measured by IOL-Master vs. corneal topography]. / Intra- und interindividueller Vergleich der Hornhautbrechkraft gemessen mit IOL-Master vs. Hornhauttopografen.

BACKGROUND: Especially for the implantation of toric intraocular lenses an exact regulation of the corneal astigmatism is important. PATIENTS AND METHODS: 60 eyes of 30 subjects with astigmatism were examined in a period of one year. The corneal refraction was measured at three different times, each examination was repeated three times, both with the IOL-Master (Fa. Zeiss, Jena) and a corneal topograph (CSO Eye Top). The results were compared intra- and interindividually. Eyes with conjunctival or corneal inflammation, dry eye syndrome or malformation of the eyelid were excluded. Data were statistically evaluated. RESULTS: Both the amount and the axis of corneal astigmatism were significantly different for the two devices (IOL-Master and corneal topography). Intraindividually, the mean astigmatism was 1.18 D measured by the IOL-Master (median 1.0 D) and 1.07 D measured by corneal topography (median 0.88 D). This results in a dispersion about the median of 0.54% by the IOL-Master and of 0.32% by corneal topography. Intraindividually, the mean axis of astigmatism was 73 degrees measured by the IOL-Master (median 103 degrees) and 90 degrees measured by corneal topography (median 104 degrees). The dispersion about the median of axis values was 0.55% by the IOL-Master and 0.28% by corneal topography. Use of the Wilcoxon test results in a dispersion of values of less than 2% probability value for both the amount and the axis of corneal astigmatism (p < 0.1). CONCLUSIONS: Values measured by the IOL-Master show a wider distribution than values measured by corneal topography. The statistical spread was significant, although it was less than 3% for both intra- and interindividual measurements by the two devices. Although the median is almost equal for measurements by the IOL-Master and corneal topography, dispersion about the median is almost twice as high for intraindividual measurements by the IOL-Master. Therefore, the accuracy of measurements conducted with corneal topography is significantly higher as compared to the IOL-Master.

Inter-disciplinary European guidelines on surgery of severe obesity.

In 2005, for the first time in European history, an extraordinary Expert panel named 'The BSCG' (Bariatric Scientific Collaborative Group), was appointed through joint effort of the major European Scientific Societies which are active in the field of obesity management. Societies that constituted this panel were: IFSO - International Federation for the Surgery of Obesity, IFSO-EC - International Federation for the Surgery of Obesity - European Chapter, EASO - European Association for Study of Obesity, ECOG - European Childhood Obesity Group, together with the IOTF (International Obesity Task Force) which was represented during the completion process by its representative. The BSCG was composed not only of the top officers representing the respective Scientific Societies (four acting presidents, two past presidents, one honorary president, two executive directors), but was balanced with the presence of many other key opinion leaders in the field of obesity. The BSCG composition allowed the coverage of key disciplines in comprehensive obesity management, as well as reflecting European geographical and ethnic diversity. This joint BSCG expert panel convened several meetings which were entirely focused on guidelines creation, during the past two years. There was a specific effort to develop clinical guidelines, which will reflect current knowledge, expertise and evidence based data on morbid obesity treatment.

[Refractive aspects of modern cataract surgery]. / Refraktive Gesichtspunkte moderner Katarakt- Chirurgie.

OBJECTIVE: Modern cataract surgery is a refractive procedure whereby one basically can achieve the targeted postoperative refraction. METHODS: To achieve this goal, according to the patient's wishes, biometry, mathematical calculation of IOL power and astigmatism management are important factors. On the other hand, multifarious developments in intraocular lens technology also contribute to this target. RESULTS: The individual choice of incision (on axis surgery: incision in the steeper meridian, length, shape and location concerning cornea or sclera) reduces the preoperatively existing astigmatism. Biometry with personalised data and formulas of the third generation are important factors to achieve the targeted refraction. In addition to this, the development of manifold lens designs in the last years to improve intraocular lens quality has enabled progress within various domains, for example, the use of optimised intraocular lenses to compensate corneal aberration, the implantation of toric lenses for corrections of higher pre-existing corneal astigmatism or the use of phacic intraocular lenses to correct higher ametropia. CONCLUSION: Patient satisfaction postoperatively depends on the precise refractive result as desired. With our current operative and technical possibilities we are able to achieve this with high probability and safety.

[Comparison of different methods for pupillometry for mesopic and scotopic conditions]. / Vergleich verschiedener Pupillometrieverfahren unter mesopischen und skotopischen Bedingungen.

BACKGROUND: The aim of the study was to compare different methods for pupillometry, namely the Goldmann perimeter (gp), the Colvard pupillometer (cp) and the Procyon Video pupillometer (pvp). For the pvp three different illuminations were available: mesopic high, mesopic low, and scotopic. PATIENTS: The size of the pupil was measured in 100 eyes (50 healthy subjects) with the three different methods. We examined 29 females (58 %) and 21 males (42 %) with an average age of 25.16 years, ranging from 18 to 30 years. RESULTS: For the Goldmann perimeter, a mean pupil diameter of 4.39 mm +/- 0.62 mm was found under mesopic conditions (1.40 lux). For the Colvard pupillometer for scotopic conditions (0 lux), a mean pupil diameter of 6.80 mm +/- 0.81 mm was found. For pvp the pupil diameter ranged from 7.06 mm +/- 0.71 mm for scotopic (0.04 lux), over 6.24 mm +/- 0.80 mm for mesopic low (0.40 lux) to 4.65 mm +/- 0.73 mm for mesopic high conditions (4.00 lux). CONCLUSION: The comparison of the results showed a high correlation between the Goldmann perimeter and the Procyon Video Pupillometer for mesopic high with a minimum difference of 0.25 +/- 0.69 mm. By addition of 2.67 mm to the mesopic measurement of the Goldmann perimeter, the results for the Procyon Video pupillometer at the scotopic level, by addition of 2.4 mm the scotopic measurement of the Colvard pupillometer could be achieved.

[Cataract surgery with implantation of toric silicone lenses for severe astigmatism after keratoplasty]. / Kataraktoperation mit Implantation torischer Silikonlinsen bei hohem Astigmatismus nach Keratoplastik.

BACKGROUND: The treatment of high astigmatism after keratoplasty is often not possible with glasses or refractive corneal surgery, particularly in patients with anisometropia and contact lens incompatibility. METHODS: In 3 patients with cataract and high astigmatism after penetrating keratoplasty, phacoemulsification was performed via a 4 mm sclerocorneal tunnel incision. A toric silicone lens with Z-haptic was implanted in the bag (Type MS 6116 TU, Dr. Schmidt). All patients had high anisometropia and contact lens incompatibility. The follow-up was ten weeks, uncorrected and corrected visual acuity, corneal and total astigmatism were evaluated. RESULTS: A 68-year-old female presented with corneal astigmatism of 10 dpt. Keratoplasty was performed two years earlier. After implantation of a toric lens (+ 22.5 + 11.0 dpt.) uncorrected visual acuity increased from 1/50 to 20/40, corrected visual acuity increased from 20/30 to 20/25. A 78-year-old male presented with irregular corneal astigmatism of 6.5 dpt. Keratoplasty was performed 25 years previously. Due to high myopia (corneal radii 5.3/5.9 mm), implantation of a toric lens (- 3.0 + 7.0 dpt.) in the bag was combined with implantation of a spheric lens (- 6.0 dpt., Type MS 614, Dr. Schmidt) in the sulcus. Uncorrected visual acuity increased from light perception to 1/20, corrected visual acuity increased to 1/10. An 84-year-old female presented with irregular corneal astigmatism of 8.6 dpt. Keratoplasty was performed two years earlier. After implantation of a toric lens (+ 16.0 + 11.0 dpt.) uncorrected visual acuity increased to 20/50, corrected visual acuity increased from 20/100 to 20/25. During the follow-up all implanted lenses were well-centered and no significant IOL rotation was observed. CONCLUSION: Implantation of foldable toric silicone lenses during cataract surgery may improve considerably the uncorrected visual acuity by reducing the total astigmatism in patients with high astigmatism after keratoplasty. Preoperatively, a reliable keratometry is important.

[Spontaneous dislocation of intraocular lens with capsule as a late complication of cataract surgery in patients with pseudoexfoliation syndrome --five case reports]. / Spontane Dislokation der Hinterkammerlinse mit Kapselsack als späte Komplikation einer Kataraktoperation bei Patienten mit Pseudoexfoliationssyndrom -- fünf Fallbeispiele.

PURPOSE: Pseudoexfoliation syndrome (PEX) is associated with zonular weakness and a higher frequency of intraoperative complications during cataract surgery, including rupture of the posterior lens capsule, zonular dialysis and a rise of intraocular pressure occurring postoperatively. Delayed dislocation of an IOL is a rarely reported phenomenon. PATIENTS: Within one year, late dislocation of the lens capsule with the in the bag fixated IOL was observed following cataract surgery in five patients (67, 74, 79, 90 and 92 years old) with pseudoexfoliation syndrome. RESULTS: All patients had an uneventful in the bag implantation of the IOL 6 (three patients), 3 and 11 years ago, respectively. Postoperatively occurring secondary cataract was treated by a YAG-capsulotomy in four cases. No patient had any other predisposing factors that would lead to zonular weakness besides the pseudoexfoliation syndrome. The dislocation of the IOL and capsule occurred spontaneously. In one patient with preexisting glaucoma, the dislocation was followed by an increase of intraocular pressure. All cases were successfully treated with IOL explantation, anterior vitrectomy and placement of an anterior chamber IOL. CONCLUSION: Patients with pseudoexfoliation syndrome undergoing cataract surgery may be at risk not only for intraoperative complications but also for delayed spontaneous dislocation of the IOL and capsule. This possible complication should be considered in surgical planning for patients with pseudoexfoliation syndrome. In these patients it may be better to implant the IOL in the ciliary sulcus.

[Optic nerve evulsion: Metaanalysis]. / Evulsio nervi optici: Metaanalyse.

BACKGROUND: Evulsion of the optic nerve is a rare form of traumatic optic neuropathy. It is a rupture of the optic nerve at the disc without damage of its sheaths occurring in association with a blunt skull trauma or a blunt bulbar trauma. MATERIAL AND METHODS: We searched the literature using Medline database for all articles with evulsion of the optic nerve. The bibliographies of the papers found therein were used to get a complete review. The data were analyzed with special regard to age, sex, mechanism of injury, and (if available) defects of visual field. RESULTS: Sixty-three patients with a mean age of 22 years (range 4 to 60 years) were included in the study. In 22 patients (35 %) a partial and in 41 patients (65 %) a complete evulsion was present. In 31 patients (49 %) the cause was a small blunt object or finger that stroke the eye or entered the orbita. In 19 patients (30 %) a severe blunt skull trauma had occurred. The analysis of visual fields in eyes with partial evulsion of the optic nerve revealed a defect in the superior visual field in 6 of 12 patients and a defect in the inferonasal visual field in 3 of 12 patients. PATHOGENESIS: Our review suggests that the most common mechanism of injury is a severe rotation of the eye leading to rupture of the optic nerve fibers and an anterior displacement of the bulbus, possibly with deformation of the posterior eye walls.