Reoperation After Loop Duodenojejunal Bypass with Sleeve Gastrectomy: A 9-Year Experience.

PURPOSE: Loop duodenojejunal bypass with sleeve gastrectomy (LDJBSG) is effective for weight loss and resolution of obesity-related associated medical problems. However, a description of the reoperative surgery following LDJBSG is lacking. MATERIAL AND METHODS: In this retrospective study, we analyzed the surgical complications and reoperation (conversion or revision) following LDJBSG from 2011 to 2019 in a single institution. RESULTS: A total of 337 patients underwent LDJBSG during this period. Reoperative surgery (RS) was required in 10LDJBSG patients (3%). The mean age and BMI before RS were 47 ± 9 years and 28.9 ± 3.6 kg/m2, respectively. The mean interval between primary surgery and RS for early (n = 5) and late (n = 5)complications was 8 ± 11 days and 32 ± 15.8 months, respectively. The conversion procedures were Roux-en-Y gastric bypass(n = 5), followed by Roux-en-Y duodenojejunal bypass (n = 2) and one-anastomosis gastric bypass (n = 1); other revision procedures were seromyotomy (n = 1) and re-laparoscopy (n = 1). Perioperative complications were observed in four patients after conversion surgery such as multiorgan failure (n = 1), re-laparoscopy (n = 1), marginal ulcer (n = 1), GERD (n = 1), and dumping syndrome (n = 1). CONCLUSION: LDJBSG has low reoperative rates and conversion RYGB could effectively treat the early and late complications of LDJBSG. Because of its technical demands and risk of perioperative complications, conversion surgery should be reserved for a selected group of patients and performed by an experienced metabolic bariatric surgical team.

Endoscopic sleeve gastroplasty - minimally invasive treatment for non-alcoholic fatty liver disease and obesity.

INTRODUCTION: Adequate weight loss can lead to reduction in steatosis, inflammation, and fibrosis in patients with obesity and non-alcoholic fatty liver disease (NAFLD). We evaluated the role of endoscopic sleeve gastroplasty (ESG) in patients with obesity and NAFLD. METHODS: In this single-center prospective study, consecutive adult patients with NAFLD who underwent ESG between November 2018 and May 2019 were included. The primary outcome was the impact of ESG on hepatic parameters: change in alanine aminotransferase (ALT), hepatic steatosis index (HSI), NAFLD fibrosis score (NFS), fibrosis-4 index (FIB-4), and aspartate aminotransferase (AST)-to-platelet ratio index (APRI) from baseline to 6 and 12 months. Secondary outcomes included change in glycated hemoglobin (HbA1c), percentage weight loss, and safety. Analysis of variance with repeated measures was used for statistical analysis. RESULTS: A total of 26 patients (mean age [SD] 41.5 [9.58] years; 16 females) with mean (SD) weight of 99.43 (21.89) kg at baseline were included. There was significant improvement in ALT (mean ± SD) from baseline of 59.54 ± 17.02 IU/L to 49.50 ± 11.72 IU/L and 48.42 ± 13.22 IU/L at 6 and 12 months (p = 0.001). Mean (SD) NFS was significantly improved from 0.228 (1.00) at baseline to -0.202 (1.16) and -0.552 (1.08) at 6 and 12 months (p 0.001). Mean (SD) HSI, FIB-4, and APRI scores significantly reduced from baseline to 6 and 12 months (p = 0.001). There was 18.07% total body weight loss at 12 months, with significant improvement in HbA1c. There were no major adverse events. CONCLUSION: ESG is a safe and effective treatment option for patients with NAFLD and obesity causing significant weight loss. Rigorous randomized trials are required to incorporate ESG in NAFLD treatment algorithm.

30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries.

BACKGROUND: There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates. METHODS: We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020. RESULTS: Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country. CONCLUSIONS: BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak.

Complications after bariatric surgery: A multicentric study of 11,568 patients from Indian bariatric surgery outcomes reporting group.

BACKGROUND: Complications after bariatric surgery are not uncommon occurrences that influence the choice of operations both by patients and by surgeons. Complications may be classified as intra-operative, early (<30 days post-operatively) or late (beyond 30 days). The prevalence of complications is influenced by the sample size, surgeon's experience and length and percentage of follow-up. There are no multicentric reports of post-bariatric complications from India. OBJECTIVES: To examine the various complications after different bariatric operations that currently performed in India. MATERIALS AND METHODS: A scientific committee designed a questionnaire to examine the post-bariatric surgery complications during a fixed time period in India. Data requested included demographic data, co-morbidities, type of procedure, complications, investigations and management of complications. This questionnaire was sent to all centres where bariatric surgery is performed in India. Data collected were reviewed, were analysed and are presented. RESULTS: Twenty-four centres responded with a report on 11,568 bariatric procedures. These included 4776 (41.3%) sleeve gastrectomy (SG), 3187 (27.5%) one anastomosis gastric bypass (OAGB), 2993 (25.9%) Roux-en-Y gastric bypass (RYGB) and 612 (5.3%) other procedures. Total reported complications were 363 (3.13%). Post-operative bleeding (0.75%) and nutritional deficiency (0.75%) were the two most common complications. Leaks (P = 0.009) and gastro-oesophageal reflux disease (P = 0.019) were significantly higher in SG, marginal ulcers in OAGB (P = 0.000), intestinal obstruction in RYGB (P = 0.001) and nutritional complications in other procedures (P = 0.000). Overall, the percentage of complications was higher in 'other' procedures (6.05%, P = 0.000). There were 18 (0.16%) reported mortalities. CONCLUSIONS: The post-bariatric composite complication rate from the 24 participating centres in this study from India is at par with the published data. Aggressive post-bariatric follow-up is required to improve nutritional outcomes.

Sleeve plus procedures: need of time.

Laparoscopic sleeve gastrectomy as a standalone procedure has gained a lot of popularity over laparoscopic Roux-en-Y gastric bypass in the last decades and is the most frequently performed bariatric procedure worldwide; however, the long-term results are not promising in terms of weight regain and re-emergence of comorbidities. Considering the proven concept of biliopancreatic diversion with duodenal switch, many novel procedures have been developed involving a sleeve gastrectomy along with some intestinal bypass or alteration in small intestine anatomy. These procedures show better technical feasibility and are associated with less post-operative morbidity, sleeve plus procedures permanently adopt the digestive tract to the present lifestyle, by eliminating the gastric storage of hypercaloric and excessively processed food, and providing the ileum with the needed stimulus for incretin release.

Management of gastric fold herniation after laparoscopic adjustable gastric banded plication: a single-center experience.

BACKGROUND: Laparoscopic adjustable gastric banded plication (LAGBP) is a novel bariatric procedure, and little is known about its potential complications. OBJECTIVES: Herein, we report on complications of LAGBP and discuss the clinical features and diagnostic and therapeutic strategies in such situations, with emphasis on gastric fold herniation (GFH). SETTING: University Hospital. METHODS: Prospectively collected data of 223 patients who underwent LAGBP for morbid obesity between August 2009 and December 2014 were retrospectively analyzed. Follow-up at 1 year was 75%. RESULTS: Eight patients (3.5%) required readmission due to major complications, including 1 trocar site hernia, 1 band leak, 1 gastric stenosis, and 5 GFHs. GFHs occurred mostly in the first postoperative month (4/5, 80%) and at the fundus (5/5, 100%); 4 GFHs occurred in the initial 70 patients. Seven laparoscopic reoperations were required for managing GFH. The gastric band was removed in 3 patients (of 5; 60%). Two patients developed residual intra-abdominal abscess and were treated successfully by image-guided drainage. In March 2012, we reversed the order of our surgical techniques for the subsequent 153 patients and performed greater curvature plication first, followed by band placement. Only one GFH occurred after this change in surgical order (1/153 versus 4/70; P< .05). CONCLUSIONS: High clinical suspicion assisted by radiological investigations and early surgical intervention is the key for managing GFH after LAGBP. Though GFH complications were rare, we significantly reduced its occurrence by altering the surgical order in LAGBP to plication followed by banding.

Primary gastric inflammatory myofibroblastic tumor in an adult-case report with brief review.

The term inflammatory myofibroblastic tumor more commonly referred to as "pseudostumor ", denotes a pseudosarcomatous inflammatory lesion that contains spindle cells, myofibroblasts, plasma cells, lymphocytes and histiocytes. It exhibits a variable biological behavior that ranges from frequently benign lesions to more aggressive variants. Inflammatory myofibroblastic tumor (IMT) of the stomach is extremely rare and its prognosis is unpredictable. We present a 45-year-old diabetic man with a gastric Inflammatory myofibroblastic tumor. The histopathological and immunohistochemical analysis was the key to reach diagnosis.