A safety study of laparoscopic single-anastomosis duodeno-ileal bypass with gastric plication (SADI-GP) in the management of morbid obesity.

BACKGROUND: Bariatric surgery is more effective in the management of morbid obesity and related comorbidities than is conservative therapy. Pylorus-preserving single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-SG) is a modified duodenal switch technique. Gastric plication (GP) is an alternate to SG. METHODS: Morbidly obese (BMI of > 40, or > 35 in the presence of diabetes or prediabetes) patients were recruited and operated on to perform SADI with GP. Complications related to surgery were recorded to assess the feasibility of the procedure. Weight-loss outcomes were analysed to determine efficacy. Minnesota Multiphasic Personality Inventory 2 (MMPI-2) was recorded after 1 year of follow-up, and test scales were used to describe physiological phenomena. RESULTS: Seventeen middle-aged (mean: 40 years) patients were involved in our study; 15 of them were females. The mean duration of surgery was 205 min. There were no complications of conversion, death, bleeding, VTE or 30-day readmission to hospital. We did experience CD4a (pulmonary insufficiency due to chronic lung disease) and a CD3b (anastomosis leakage treated laparoscopically) complications. Vomiting occurred in three cases (CD1). Obesity-related comorbidities showed favourable resolution rates (77.8% for hypertension, 81.2% for dyslipidaemia, 100% for diabetes at the 1-year follow-up). Weight-loss outcomes were favourable (53.20 EWL%, and 35.58 TWL% at 1-year follow-up). Greater weight loss caused significantly higher levels of Depression (t(13.958) = - 2.373; p = 0.00; p < 0.05) and Low Positive Emotions (t(13.301) = - 2.954; p = 0.00; p < 0.05) and Introversion/Low Positive Emotionality (t(13.408) = - 1.914; p = 0.02; p < 0.05) in MMPI-2 data. CONCLUSION: According to our safety study, SADI-GP is a promising malabsorptive procedure, but a long-term high-volume case series or a randomised controlled trial is necessary to evaluate complication rates and weight-loss outcomes. Emotional dysregulation is common among bariatric surgery patients according to personality inventory data; therefore, psychological follow-up and psychotherapeutic support are necessary for weight-loss maintenance.

[Laparoscopic gastric plication with pylorus-preserving duodenoileal bypass for treating morbid obesity]. / Laparoszkópos gastroplicatio pylorusmegorzo duodenoilealis bypassmutéttel a kóros elhízás kezelésében.

Bariatric surgery is more effective in the management of morbid obesity and related comorbidities than conservative therapy. There are two main groups, restrictive and malabsorptive procedures. Laparoscopic gastric plication with pylorus-preserving loop duodenoileal bypass is classified into the latter group. It should be considered as the modernized variant of the classical Scopinaro procedure. In this article, the method is presented by a case report. Orv Hetil. 2019; 160(43): 1714-1718.

[Cryosclerosis. The forgotten endovenous cryoablation of the great saphenous vein. Mid-term results of a prospective comparative trial]. / Cryosclerosis. Az elfelejtett endovénás cryoablatio a vena saphena magna elégtelenségének kezelésében. Egy prospektív összehasonlító vizsgálat középtávú eredményei.

INTRODUCTION: Cryosclerosis was introduced by Milleret and Le Pivert in the 1980s. METHOD: A prospective non-randomized comparative study has been performed on initial 96 patients. 48 patients were treated by cryosclerosis and the others received conventional stripping. 52 cases were analyzed for 2-years. The primary end-point of the study was to determine the occlusion rate of cryosclerosis. The clinical failure, the improvement in the Clinical Etiologic Anatomic Pathophysiologic classification and Venous Clinical Severity Scores were analyzed as secondary outcome. RESULTS: Total recanalization of the great saphenous vein causing clinical failure was observed in one case (4%). The reopening of the great saphenous vein was observed in 4 limbs (15%) that did not cause the incompetence of the trunk. The occlusion rate was 81%. Recurrent varicosity was observed by 35% and 42% of the patients in the cryosclerosis and stripping groups respectively. There was no significant difference between the groups (log rank test, p = 0.391). There was significant improvement in both the Clinical Etiologic Anatomic Pathophysiologic classification and Venous Clinical Severity Scores in each group without remarkable differences observed between the groups either at baseline or on the mid-term. CONCLUSIONS: Cryosclerosis seems to be effective in the remodeling of the great saphenous vein. The method has no remarkable mid-term clinical advantages over classical stripping so far. Orv. Hetil., 2016, 157(50), 1994-2001.

Which endovenous ablation method does offer a better long-term technical success in the treatment of the incompetent great saphenous vein? Review.

OBJECTIVE: The aim of this review article was to evaluate the long-term technical success rates of the known endovenous ablation procedures in the treatment of the incompetence of the great saphenous vein. METHODS: A literature search was conducted in the PubMed-database until the 5 January 2016. All publications with four to five years follow-up were eligible. Meta-analysis was performed by the IVhet-model. RESULTS: Eight hundred and sixty-two unique publications were found; 17 of them were appropriate for meta-analysis. Overall, 1420 limbs were included in the trial, 939 for endovenous laser ablation, 353 for radiofrequency ablation and 128 for ultrasound guided foam sclerotherapy. Overall, technical success rates were 84.8% for endovenous laser ablation, 88.7% for radiofrequency ablation and 32.8% for ultrasound guided foam sclerotherapy. There were no significant differences between endovenous laser ablation, radiofrequency ablation and ultrasound guided foam sclerotherapy regarding the great saphenous vein reopening (p = 0.66; OR: 0.22; 95% of CI: 0.08-0.62 for radiofrequency ablation vs. endovenous laser ablation; p = 0.96; OR: 0.11; 95% of CI: 0.06-0.20 for endovenous laser ablation vs. ultrasound guided foam sclerotherapy; p = 0.93; OR: 3.20; 95% of CI: 0.54-18.90 for ultrasound guided foam sclerotherapy vs. radiofrequency ablation). CONCLUSION: Both endovenous laser ablation and radiofrequency ablation are efficient in great saphenous vein occlusion on the long term. Lacking long-conducted large trials, the efficacy and reliability of ultrasound guided foam sclerotherapy to treat great saphenous vein-reflux is not affirmed.

The role of cryosurgery in the treatment of the incompetent great saphenous vein.

Our aim was to determine the place of cryosurgery in the treatment of the incompetence of the great saphenous vein. Primary end-point of this study was to evaluate the clinical effectiveness of cryostripping and cryosclerosis. Complications frequently related to saphenous vein stripping were analyzed secondary. A literature search was conducted in the PubMed-database until September 2014. Randomized controlled trials with at least 6 months follow-up were eligible. Meta-analysis was performed by the IVhet-model. Forty-two unique publications were found- Five of them (3 trials), comparing cryostripping to stripping and endovenous LASER ablation, were eligible for meta-analysis. There were no significant differences between cryostripping and conventional stripping regarding the clinical effectiveness (P=0.06; RR:1.12; 95% of CI: 0.99-1.27) and saphenous neuralgia related to surgery (P=0.48; RR:0.94; 95% of CI: 0.89-0.99). The records of bruising were not uniform and comparable. No randomized controlled trials were found to perform a meta-analysis on cryosclerosis, therefore a short literature review is presented. The study has limitations and weak conclusions because of imprecision (small number of involved trials and limbs) and short term follow-up. Low quality evidences suggest that cryostripping is a reliable, efficient method with better cosmetic results than conventional stripping, however, long term comparisons are not available so far. Cryosclerosis could be an alternate to the known endovenous minimal invasive ablation procedures, but there are no exact strong evidences, especially on the long term.

[Pneumoperitoneum after jacuzzi bathing -- an unusual cause for the development of intraperitoneal free air]. / Jacuzzihasználatot követoen kialakult pneumoperitoneum, avagy a szabad hasi levego keletkezésének ritka esete.

Free air within the intraperitoneal cavity most frequently occurs in conjunction with perforation of a hollow viscus and requires urgent surgical intervention. However, approximately 10% of all cases of pneumoperitoneum may not be correlated with disruption of the gastroinestinal tract. In the literature this condition is termed "nonsurgical" (NS) pneumoperitoneum and usually requires conservative management. NS pneumoperitoneum can be classified into the following categories: abdominal, thoracic, gynecologic, and idiopathic. We present a rare case of NS pneumoperitoneum. A 61-year-old woman who underwent a hysterectomy previously is admitted with diffuse abdominal pain without any other symptoms. Chest and abdominal radiographs verified the presence of free air under the diaphragm. We performed an exploration but no evidence of perforated viscus or peritonitis was found. Finally the patient told us that her complaints developed during Jacuzzi usage. We thought therefore that air entered into the intraperitoneal cavity through the vagina by influence of high pressure douche. In the course of postoperative gynecological examination a vaginoperitoneal fistula was detected in the vault which is developed during Jacuzzi usage leading to NS pneumoperitoneum. Essentially, NS pneumoperitoneum usually occurs without signs and symptoms of peritonitis and requires conservative treatment. Detailed physical examination and medical history taking can help to avoid unnecessary surgery in spite of radiological evidence of intraperitoneal free air.