Incidence of Barrett's Esophagus Following Sleeve Gastrectomy in Southeast Asian Population.

Background: Variable incidences (up to 18.8%) of Barrett's esophagus (BE) have been reported following sleeve gastrectomy (SG), however, there is no published data from the Southeast Asian population. Objective: To determine the incidence of BE following SG in Southeast Asians. Materials and Methods: In this cross-sectional observational study from a tertiary-care center, all patients who had undergone SG from 2008 to 2021 and completed a minimum of 1-year follow-up were contacted to participate. Preoperative data were retrieved from a prospectively maintained database. On recruitment, all patients underwent barium swallow and upper gastrointestinal endoscopy, and weight parameters and reflux symptoms were recorded. Results: One hundred fourteen patients with no preoperative evidence of BE were included. The mean follow-up duration was 5.4 ± 3.1 years. On follow-up endoscopy, Barrett's was suspected in 4 patients. However, 3 patients had columnar-lined epithelium and only 1 patient (0.87%) had evidence of intestinal metaplasia without dysplasia on histology. Reflux esophagitis (grade LA-A) resolved in 9 out of 11 patients, while the rate of de novo esophagitis was reported in 22.3%. The mean reflux Symptom Severity score increased from 0.6 ± 1.8 to 2.6 ± 5.4 (P = .002). The mean body mass index reduced from 44.1 ± 7.1 to 33.6 ± 6.9 kg/m2 (P < .0001), however, 23.7% of the patients experienced significant weight recidivism. Conclusions: Southeast Asians might have a low incidence of BE following SG. Hence, endoscopic surveillance for the sole purpose of diagnosing BE may not be advisable for these patients.

Effect of supervised surgical training provided to general surgery residents on clinical maturation of arteriovenous fistula surgery: A retrospective cohort study.

Introduction: With the advent of endovascular technique and the emergence of vascular surgery as a separate branch distinct from general surgery, there is a decrease in exposure of open vascular technique to general surgery resident. Vascular access surgery is a vascular subspecialty area and not all residents get similar exposure during training, and this has implications if one becomes a vascular consultant in the future and have to undertake access surgery. There is no established protocol or duration, following which a surgical resident can be named as "trained" in vascular anastomosis. Our study tries to address the aforementioned problems; in particular the actual training that a general surgery resident needs in vascular access. Objective: To study and compare the outcomes of AV Fistula surgeries, created by "trained" general surgical residents and consultant. Method: A single-institution retrospective cohort study comparing two groups of cohorts: trained residents (group A) and consultant (group B). Study has been done in accordance with the standards of ICMJE and registered with the Clinical Trial Registry of India. (CTRI/2021/12/038581). Result: Out of 238 patients recruited, 157 underwent surgery in group 'A' (the trained residents performing arteriovenous fistula surgery) and 81 underwent surgery in group 'B' (by consultant of general surgery). Clinical maturation noted after 8 weeks was 83.4% (131/157) in group A and 90.1% (73/81) in group 'B'; (p = 0.113). The mean duration of surgery in group 'A' was 99.8 ± 18.2 min and group 'B' was 56.2 ± 10.4 min; (p value < 0.0001). Conclusion: A structured training in vascular anastomosis provided to the newly recruited residents in general surgery for 6 months lead to outcomes that were comparable with the consultants.