Endoscopic management of post-laparoscopic sleeve gastrectomy stenosis.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is the most popular bariatric surgery worldwide. Gastric sleeve stenosis is the most common postoperative complication, occurring in up to 3.9% of the cases. Current treatment options include endoscopic treatments, such as dilatations and stent placement as well as surgical revisions such as laparoscopic Roux-en-Y gastric bypass (LRYGB), wedge gastrectomy or seromyotomy. METHODS: A retrospective analysis of our prospectively collected therapeutical endoscopy database was performed between January 2014 and February 2017. We included all cases of axial deviation or stenosis post LSG, which were treated endoscopically. Patients with concomitant sleeve leaks were excluded. Endoscopic interventions were performed under general anaesthesia and fluoroscopic assistance when needed. Sequential treatment with CRE balloons, achalasia balloons (30-40 mm) and fully covered stent placement for refractory cases was performed. RESULTS: A total of 1332 LSG were performed. Overall, 27/1332 patients (2%) developed a gastric stenosis. All patients presented an axial deviation at the incisura angularis and 26% had a concomitant proximal stenosis. Successful endoscopic treatments were performed in 56% (15/27) of patients, 73% of the successful patients underwent a single dilatation procedure. All successful cases had a maximum of 3 interventions. The unsuccessful cases (44%) underwent LRYGB. Mean time between the primary surgery and the diagnosis of the stenosis was 10.3 months. Mean follow-up after the endoscopic treatment was 11.5 months. A stent migration was the only complication (3.7%) recorded. CONCLUSIONS: Endoscopic treatment appears to be effective in 56% of patients with post-LSG stenosis. Only one session of achalasia balloon dilatation is necessary in 73% of successful cases. Pneumatic balloon dilatation seems to be a safe procedure in this patient population. Surgical revision into a LRYGB offers good outcomes in patients that have failed three consecutive endoscopic treatments.

Translation of the Patient Scar Assessment Scale (PSAS) to French with cross-cultural adaptation, reliability evaluation and validation.

BACKGROUND: Patient esthetic satisfaction related to scarring after orthopedic surgery was rarely assessed before the development of the Patient Scar Assessment Scale (PSAS). The purpose of our study was to translate and validate the PSAS and assess the psychometric properties of the French version. METHODS: We conducted a staged validation with forward and backward translation and concurrent validation. The validation committee comrpised bilingual experts. The patient validation sample comprised 53 orthopedic surgery patients who were assessed at a minimum of 1 year postoperatively. We followed a standardized process for cross-cultural adaptation to develop and assess the French version. First, 2 independent translators completed the forward translation of the PSAS and then met to achieve a consensus version. This consolidated version was then backward translated into English and cross-verified with the original version. A group of orthopedic and plastic surgeons assessed this version for content validity. We assessed the test-retest reliability of the new French scale, which was filled out twice by a cohort of 53 patients, using scale distribution analysis, internal consistency (Chronbach alpha) and absolute agreement (intraclass correlation coefficients [ICC (2,1)]). RESULTS: The level of agreement on the translation process between the translators initially and then later among the expert panel was high. The reliability of the translated version (PSAS-Fr) and its internal consistency was high (Chronback alpha 0.87-0.98 for each of the 6 questions), and the test-retest reliability was excellent (ICC 0.96). On the other hand, there was no bias between occasions (retests difference -0.24) and the scores fell within 2 standard deviations of 5. Older patients had higher satisfaction about scar appearance. CONCLUSION: The PSAS-Fr was successfully translated from the original English version and demonstrated strong cross-sectional psychometric properties. Further assessment in longitudinal studies is warranted.