The outcomes of Re-Redo bariatric surgery-results from multicenter Polish Revision Obesity Surgery Study (PROSS).

The increasing prevalence of bariatric surgery has resulted in a rise in the number of redo procedures as well. While redo bariatric surgery has demonstrated its effectiveness, there is still a subset of patients who may not derive any benefits from it. This poses a significant challenge for bariatric surgeons, especially when there is a lack of clear guidelines. The primary objective of this study is to evaluate the outcomes of patients who underwent Re-Redo bariatric surgery. We conducted a retrospective cohort study on a group of 799 patients who underwent redo bariatric surgery between 2010 and 2020. Among these patients, 20 individuals underwent a second elective redo bariatric surgery (Re-Redo) because of weight regain (15 patients) or insufficient weight loss, i.e. < 50% EWL (5 patients). Mean BMI before Re-Redo surgery was 38.8 ± 4.9 kg/m2. Mean age was 44.4 ± 11.5 years old. The mean %TWL before and after Re-Redo was 17.4 ± 12.4% and %EBMIL was 51.6 ± 35.9%. 13/20 patients (65%) achieved > 50% EWL. The mean final %TWL was 34.2 ± 11.1% and final %EBMIL was 72.1 ± 20.8%. The mean BMI after treatment was 31.9 ± 5.3 kg/m2. Complications occurred in 3 of 20 patients (15%), with no reported mortality or need for another surgical intervention. The mean follow-up after Re-Redo was 35.3 months. Although Re-Redo bariatric surgery is an effective treatment for obesity, it carries a significant risk of complications.

MCPIP1 Inhibits Hepatic Stellate Cell Activation in Autocrine and Paracrine Manners, Preventing Liver Fibrosis.

BACKGROUND & AIMS: Hepatic fibrosis is characterized by enhanced deposition of extracellular matrix (ECM), which results from the wound healing response to chronic, repeated injury of any etiology. Upon injury, hepatic stellate cells (HSCs) activate and secrete ECM proteins, forming scar tissue, which leads to liver dysfunction. Monocyte-chemoattractant protein-induced protein 1 (MCPIP1) possesses anti-inflammatory activity, and its overexpression reduces liver injury in septic mice. In addition, mice with liver-specific deletion of Zc3h12a develop features of primary biliary cholangitis. In this study, we investigated the role of MCPIP1 in liver fibrosis and HSC activation. METHODS: We analyzed MCPIP1 levels in patients' fibrotic livers and hepatic cells isolated from fibrotic murine livers. In vitro experiments were conducted on primary HSCs, cholangiocytes, hepatocytes, and LX-2 cells with MCPIP1 overexpression or silencing. RESULTS: MCPIP1 levels are induced in patients' fibrotic livers compared with their nonfibrotic counterparts. Murine models of fibrosis revealed that its level is increased in HSCs and hepatocytes. Moreover, hepatocytes with Mcpip1 deletion trigger HSC activation via the release of connective tissue growth factor. Overexpression of MCPIP1 in LX-2 cells inhibits their activation through the regulation of TGFB1 expression, and this phenotype is reversed upon MCPIP1 silencing. CONCLUSIONS: We demonstrated that MCPIP1 is induced in human fibrotic livers and regulates the activation of HSCs in both autocrine and paracrine manners. Our results indicate that MCPIP1 could have a potential role in the development of liver fibrosis.

Analysis of Changes in Glucose and Lipid Metabolism in Patients with Clinically Severe Obesity and Type 2 Diabetes Mellitus Undergoing Laparoscopic Sleeve Gastrectomy-Prospective Observational Study.

INTRODUCTION: We still lack studies providing analysis of changes in glucose and lipid metabolism after laparoscopic sleeve gastrectomy (LSG) in patients with type 2 diabetes mellitus (DM2). We aimed to investigate postoperative changes in glucose and lipid metabolism after LSG in patients with DM2. MATERIAL AND METHODS: Prospective, observational study included patients with BMI ≥ 35 kg/m2 and ≤ 50 kg/m2, DM2 < 10 years of duration, who were qualified for LSG. Perioperative 14-day continuous glucose monitoring (CGM) began after preoperative clinical assessment and OGTT, then reassessment 1 and 12 months after LSG. Thirty-three patients in mean age of 45 ± 10 years were included in study (23 females). RESULTS: EBMIL before LSG was 17 ± 11.7%, after 1 month-36.3 ± 12.8%, while after 12 months-66.1 ± 21.7%. Fifty-two percent of the patients had DM2 remission after 12 months. None required then insulin therapy. 16/33 patients initially on oral antidiabetics still required them after 12 months. Significant decrease in HbA1C was observed: 5.96 ± 0.73%; 5.71 ± 0.80; 5.54 ± 0.52%. Same with HOMA-IR: 5.34 ± 2.84; 4.62 ± 3.78; 3.20 ± 1.99. In OGTT, lower increase in blood glucose with lesser insulin concentrations needed to recover glucose homeostasis was observed during follow-ups. Overtime perioperative average glucose concentration in CGM of 5.03 ± 1.09 mmol/L significantly differed after 12 months, 4.60 ± 0.53 (p = 0.042). Significantly higher percentage of glucose concentrations above targeted compartment (3.9-6.7 mmol/L) was observed in perioperative period (7% ± 4%), than in follow-up (4 ± 6% and 2 ± 1%). HDL significantly rose, while triglyceride levels significantly decreased. CONCLUSIONS: Significant improvement in glucose and lipid metabolism was observed 12 months after LSG and changes began 1 month after procedure.

The impact of perioperative fluid therapy on the short-term outcomes after laparoscopic colorectal cancer surgery with ERAS protocol: a prospective observational study.

The main goals of the Enhanced recovery after surgery (ERAS) protocol are focused on shortening the length of hospital stay (LOS), expediting convalescence, and reducing morbidity. A balanced perioperative fluid therapy is among the significant interventions incorporated by the ERAS protocol. The article contains extensive discussion surrounding the impact of this individual intervention on short-term outcomes. The aim of this study was to assess the impact of perioperative fluid therapy on short-term outcomes in patients after laparoscopic colorectal cancer surgery. The analysis included consecutive patients, who had undergone laparoscopic colorectal cancer operations between 2013 and 2020. Patients were divided into two groups: restricted (≤ 2500 ml) or excessive (> 2500 ml) perioperative fluid therapy. A standardized ERAS protocol was implemented in all patients. The study outcomes included recovery parameters and the morbidity rate, LOS and 30 days readmission rate. There were 361 and 80 patients in groups 1 and 2, respectively. There were no statistically significant differences between the groups in terms of demographic parameters and factors related to the surgical procedure. Logistic regression showed that restricted fluid therapy as a single intervention was associated with improvement in tolerance of diet on 1st postoperative day (OR 2.18, 95% CI 1.31-3.62, p = 0.003), accelerated mobilization on 1st postoperative day (OR 2.43, 95% CI 1.29-4.61, p = 0.006), lower risk of postoperative morbidity (OR 0.58, 95%CI 0.36-0.98, p = 0.046), shorter LOS (OR 0.49, 95% CI 0.29-0.81, p = 0.005) and reduced readmission rate (OR 0.48, 95% CI 0.23-0.98, p = 0.045). A balanced perioperative fluid therapy on the day of surgery may be associated with faster convalescence, lower morbidity rate, shorter LOS and lower 30 days readmission rate.

The analysis of factors increasing the odds for type 2 diabetes mellitus remission following re-do bariatric surgery after laparoscopic sleeve gastrectomy- cohort study.

INTRODUCTION: Metabolic/bariatric surgery is the only proven treatment for type 2 diabetes mellitus (T2D) with curative intent. However, in a number of patients, the surgery is not effective or they may experience a relapse. Those patients can be offered re-do bariatric surgery (RBS). PURPOSE: The study aimed to determine factors increasing the odds for T2D remission one year after RBS following primary laparoscopic sleeve gastrectomy. METHODS: A multicenter retrospective cohort study was conducted between January 2010 and January 2020, which included 12 bariatric centers in Poland. The study population was divided into groups: Group 1- patients with T2D remission after RBS (n = 28) and Group 2- patients without T2D remission after RBS (n = 49). T2D remission was defined as HBA1c < 6.0% without glucose-lowering pharmacotherapy and glycemia within normal range at time of follow-up that was completed 12 months after RBS. RESULTS: Fifty seven females and 20 males were included in the study. Patients who achieved BMI < 33 kg/m2 after RBS and those with %EBMIL > 60.7% had an increased chance of T2D remission (OR = 3.39, 95%CI = 1.28-8.95, p = 0.014 and OR = 12.48, 95%CI 2.67-58.42, p = 0.001, respectively). Time interval between primary LSG and RBS was significantly shorter in Group 1 than in Group 2 [1 (1-4) vs. 3 (2-4) years, p = 0.023]. CONCLUSIONS: Shorter time interval between LSG and RBS may ease remission of T2D in case of lack of remission after primary procedure. Significant excess weight loss seems to be the most crucial factor for T2D remission.

Is triggering receptor expressed on myeloid cell 1 (TREM-1) protein a new marker of serious infectious complications in colorectal surgery?: case-matched pilot study.

PURPOSE: The purpose of the study was to evaluate the usefulness of the triggering receptor expressed on myeloid cell 1 (TREM-1) protein as a marker for serious infectious complications during laparoscopic colorectal surgery. METHODS: Sixty-four patients with colon or rectal cancer, who underwent an elective laparoscopic colorectal cancer surgery from November 2018 to February 2020, were included in the analysis. Blood samples of the TREM-1 protein testing were collected four times from each patient: before and on three following postoperative days (PODs). Patients were divided into two groups according to the presence of infectious complications. Subsequently, patients with infectious complications (group 1) were matched 1:1 with patients without complications (group 2). The case-matched analysis was done by selecting patients from the control group by age, ASA scale, cancer stage, and type of surgery. RESULTS: There was no significant difference in demographic and operative characteristics between the two groups. The median length of hospital stay was longer in group 1 than in group 2 (11 days vs. 5 days, p < 0.001). Preoperative measurements of TREM-1 protein did not differ between the two groups. There were no significant differences in the measurements on the first and third postoperative days. However, the median TREM-1 measurement was higher in group 1 on the second postoperative day (542 pg/ml vs. 399 pg/ml; p = 0.040). The difference was more apparent when only severe postoperative complications were considered. When compared to the group without any complications, the median TREM-1 level was significantly higher in the group with severe infection complications in POD 1, POD 2, and POD 3 (p < 0.05). The receiver operating characteristic (ROC) curve demonstrated that TREM-1 readings in POD 2 had a sensitivity of 83% and a specificity of 84% for the presence of severe infection complications at a value of 579.3 pg/ml (AUC 0.8, 95%CI 0.65-0.96). CONCLUSION: TREM-1 measurements might become a helpful predictive marker in the early diagnosis of serious infectious complications in patients following laparoscopic colorectal surgery.

Minimizing blood loss and transfusion rate in laparoscopic liver surgery: a review.

Laparoscopic liver resection has become a standard practice in many surgical wards in elective liver surgery, due to its positive impact on reducing hospital stay and postoperative complications, including lower blood loss and transfusion rate. However, achieving proper hemostasis in liver surgery, due to its vast blood supply, still remains a main concern to surgeons. Therefore, numerous techniques were and are still being developed to further reduce blood loss and transfusion rate. The aim of this literature review was to summarize the best available methods for achieving the minimal blood loss and transfusion rate in laparoscopic liver surgery, according to the newest data.

Initial experience with laparoscopic revisional single anastomosis duodeno-ileal bypass (SADI-S) after failed sleeve gastrectomy.

Introduction: Laparoscopic sleeve gastrectomy (SG) is currently the most commonly performed bariatric operation, but re-do surgery may be necessary in up to half of the patients. Single anastomosis duodeno-ileal bypass (SADI-S) is quickly gaining recognition as a revisional procedure after failed SG. Aim: To discuss the surgical technique and analyze initial outcomes after introduction of SADI-S after SG with 1-year follow-up. Material and methods: This is a retrospective cohort study of consecutive patients who underwent re-do bariatric surgery - revisional SADI-S - in 2021 at a secondary referral public hospital. All patients' follow-up was completed 1 year after. Results: 14 consecutive patients, 6 (43%) males and 8 females, were included. Median maximal body mass index (BMI) was 52.29 (47.96-77.16) kg/m2, BMI before SADI-S was 43.09 (41.64-48.99) kg/m2. No perioperative morbidity was recorded. Four (28%) patients reported recurrent abdominal crampy pain and diarrhea that required dietary advisement and pharmacological therapy in the postoperative period. No reoperations, mortality or readmissions were recorded during 1-year follow-up. SADI-S was associated with further weight loss, resulting in median BMI of 37.55 (36.29-39.43) kg/m2 1 year after SADI-S. Observed additional percentage total weight loss (%TWL) 1 year after SADI-S was 18.65% (17.25-21.89%), while additional percentage excess body mass index loss (%EBMIL) was 35.88% (29.18-41.92%). There was 1 case of diabetes mellitus type 2 remission and improvement in glycemic control in 1 patient. 4/6 patients (66.67%) had improvement in control of hypertension. Conclusions: SADI-S is promising re-do surgery after SG with low postoperative morbidity. Additional %TWL 1 year after SADI-S is ~19%, while additional %EBMIL is ~36%, with significant improvement of obesity-related comorbidities.

Differences in Technical Aspects of Primary Sleeve Gastrectomy Prior to Redo Bariatric Surgery-A Multicenter Cohort Study (PROSS Study).

Background and Objectives: Although the technical simplicity of laparoscopic sleeve gastrectomy is relatively well understood, many parts of the procedure differ according to bariatric surgeons. These technical variations may impact postoperative weight loss or the treatment of comorbidities and lead to qualification for redo procedures. Materials and Methods: A multicenter, observational, retrospective study was conducted among patients undergoing revision procedures. Patients were divided into three groups based on the indications for revisional surgery (insufficient weight loss or obesity-related comorbidities treatment, weight regain and development of complications). Results: The median bougie size was 36 (32-40) with significant difference (p = 0.04). In 246 (51.57%) patients, the resection part of sleeve gastrectomy was started 4 cm from the pylorus without significant difference (p = 0.065). The number of stapler cartridges used during the SG procedure was six staplers in group C (p = 0.529). The number of procedures in which the staple line was reinforced was the highest in group A (29.63%) with a significant difference (0.002). Cruroplasty was performed in 13 patients (p = 0.549). Conclusions: There were no differences between indications to redo surgery in terms of primary surgery parameters such as the number of staplers used or the length from the pylorus to begin resection. The bougie size was smaller in the group of patients with weight regain. Patients who had revision for insufficient weight loss were significantly more likely to have had their staple line oversewn. A potential cause could be a difference in the size of the removed portion of the stomach, but it is difficult to draw unequivocal conclusions within the limitations of our study.

Obesity in Adults: Position Statement of Polish Association for the Study on Obesity, Polish Association of Endocrinology, Polish Association of Cardiodiabetology, Polish Psychiatric Association, Section of Metabolic and Bariatric Surgery of the Association of Polish Surgeons, and the College of Family Physicians in Poland.

Obesity in adults and its complications are among the most important problems of public health. The search was conducted by using PubMed/MEDLINE, Cochrane Library, Science Direct, MEDLINE, and EBSCO databases from January 2010 to December 2022 for English language meta-analyses, systematic reviews, randomized clinical trials, and observational studies from all over the world. Six main topics were defined in the joint consensus statement of the Polish Association for the Study on Obesity, the Polish Association of Endocrinology, the Polish Association of Cardio-diabetology, the Polish Psychiatric Association, the Section of Metabolic and Bariatric Surgery of the Society of Polish Surgeons, and the College of Family Physicians in Poland: (1) the definition, causes and diagnosis of obesity; (2) treatment of obesity; (3) treatment of main complications of obesity; (4) bariatric surgery and its limitations; (5) the role of primary care in diagnostics and treatment of obesity and barriers; and (6) recommendations for general practitioners, regional authorities and the Ministry of Health. This statement outlines the role of an individual and the adequate approach to the treatment of obesity: overcoming obstacles in the treatment of obesity by primary health care. The approach to the treatment of obesity in patients with its most common complications is also discussed. Attention was drawn to the importance of interdisciplinary cooperation and considering the needs of patients in increasing the long-term effectiveness of obesity management.

Influence of Bariatric Surgery on Erectile Dysfunction-a Systematic Review and Meta-Analysis.

INTRODUCTION: Obesity is associated with a higher prevalence of various comorbidities including erectile dysfunction (ED). Bariatric surgery leads to weight loss and remission of weight-related diseases. The exact influence of bariatric treatment on ED is yet to be established; however, the number of papers on the subject is growing. METHODOLOGY: A systematic review with meta-analysis comparing erectile dysfunction before and after surgery was conducted according to PRISMA guidelines with a literature search performed in June 2022. Inclusion criteria involved (1) ED assessment using the International International Index of Erectile Function (IIEF) and (2) longitudinal study design. Secondary endpoints involved hormonal changes and specific fields of IIEF. RESULTS: An initial search yielded 878 records. Fourteen studies were included in the meta-analysis involving 508 patients. The quality of analyzed studies was moderate. Analysis showed significant differences in IIEF before and after surgery (Std. MD = 1.19, 95% CI 0.72 to 1.66, p<0.0001). Testosterone after surgery is higher by 156.32 pg/ml (95% CI 84.78 to 227.86, p<0.0001). There were differences in erectile function (MD:4.86, p < 0.0001), desire (MD: 1.21, p < 0.0001), intercourse satisfaction (MD: 2.16, p < 0.0001), and overall satisfaction (MD: 1.21, p = 0.003). There were no differences in terms of orgasms (MD: 0.65, p = 0.06). CONCLUSION: There are differences in ED before and after bariatric surgery. Patients achieve 19% more in the IIEF questionnaire showing improvement. Further studies, including multivariate regression models on large cohorts, are required to determine whether the surgery is an independent factor in alleviating ED.

Total versus partial adrenalectomy in bilateral pheochromocytoma - a systematic review and meta-analysis.

Background: In patients with bilateral pheochromocytoma, partial adrenalectomy offers the chance to preserve adrenal function and avoid the need for lifelong steroid supplementation. However, the risk of tumour recurrence raises questions about this procedure. The aim of our study was to compare partial and total adrenalectomy in bilateral pheochromocytoma through a systematic review with meta-analysis. Methods: A systematic search was carried out using databases (MEDLINE, EMBASE, Scopus, Web of Science, CENTRAL) and registers of clinical trials (ClinicalTrials.gov, European Trials Register, WHO International Trials Registry Platform). This meta-analysis included studies up to July 2022 without language restrictions. A random effects model meta-analysis was performed to assess the risk of tumor recurrence, steroid dependence and morbidity in these patients. Results: Twenty-five studies were included in the analysis involving 1444 patients. The relative risk (RR) of loss of adrenal hormone function during follow-up and the need for steroid therapy was 0.32 in patients after partial adrenalectomy: RR 0.32, 95% Confidence Interval (CI): 0.26-0.38, P < 0.00001, I2 = 21%. Patients undergoing partial adrenalectomy had a lower odds ratio (OR) for developing acute adrenal crisis: OR 0.3, 95% CI: 0.1-0.91, P=0.03, I2 = 0%. Partial adrenalectomy was associated with a higher risk of recurrence than total adrenalectomy: OR 3.72, 95% CI: 1.54-8.96, P=0.003, I2 = 28%. Conclusion: Partial adrenalectomy for bilateral pheochromocytoma is a treatment that offers a chance of preserving adrenal hormonal function, but is associated with a higher risk of local tumor recurrence. There was no difference for the risk of metastasis and in overall mortality among the group with bilateral pheochromocytomas undergoing total or partial adrenalectomy. This study is in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (A Measurement Tool to Assess Systematic Reviews) Guidelines (10, 11). Systematic review registration: https://osf.io/zx3se.

Hepatic MCPIP1 protein levels are reduced in NAFLD patients and are predominantly expressed in cholangiocytes and liver endothelium.

BACKGROUND AND AIMS: NAFLD is characterized by the excessive accumulation of fat in hepatocytes. NAFLD can range from simple steatosis to the aggressive form called NASH, which is characterized by both fatty liver and liver inflammation. Without proper treatment, NAFLD may further progress to life-threatening complications, such as fibrosis, cirrhosis, or liver failure. Monocyte chemoattractant protein-induced protein 1 (MCPIP1, alias Regnase 1) is a negative regulator of inflammation, acting through the cleavage of transcripts coding for proinflammatory cytokines and the inhibition of NF-κB activity. METHODS: In this study, we investigated MCPIP1 expression in the liver and peripheral blood mononuclear cells (PBMCs) collected from a cohort of 36 control and NAFLD patients hospitalized due to bariatric surgery or primary inguinal hernia laparoscopic repair. Based on liver histology data (hematoxylin and eosin and Oil Red-O staining), 12 patients were classified into the NAFL group, 19 into the NASH group, and 5 into the control (non-NAFLD) group. Biochemical characterization of patient plasma was followed by expression analysis of genes regulating inflammation and lipid metabolism. The MCPIP1 protein level was reduced in the livers of NAFL and NASH patients in comparison to non-NAFLD control individuals. In addition, in all groups of patients, immunohistochemical staining showed that the expression of MCPIP1 was higher in the portal fields and bile ducts in comparison to the liver parenchyma and central vein. The liver MCPIP1 protein level negatively correlated with hepatic steatosis but not with patient body mass index or any other analyte. The MCPIP1 level in PBMCs did not differ between NAFLD patients and control patients. Similarly, in patients' PBMCs there were no differences in the expression of genes regulating ß-oxidation (ACOX1, CPT1A, and ACC1) and inflammation (TNF, IL1B, IL6, IL8, IL10, and CCL2), or transcription factors controlling metabolism (FAS, LCN2, CEBPB, SREBP1, PPARA, and PPARG). CONCLUSION: We have demonstrated that MCPIP1 protein levels are reduced in NAFLD patients, but further research is needed to investigate the specific role of MCPIP1 in NAFL initiation and the transition to NASH.

Thyroidectomy: is it safe to be performed by general surgery residents? - single centre experience.

BACKGROUND: Thyroidectomy carries a risk of two crucial complications - recurrent nerve palsy and hypocalcaemia. The aim of the study was to assess the safety of thyroidectomy performed by general surgery residents. METHODS: Data of 515 patients, who underwent total thyroidectomy between the years 2015 and 2019, were prospectively collected. Inclusion criteria were as follows: age >18 years old, patients who underwent total thyroidectomy, no change of operator during the surgery. The study group was divided into two groups: operated by general surgery specialists (385 patients-group 1) and operated by residents with the supervision of experienced general surgery specialists as assistants (130 patients-group 2). RESULTS: Demographic factors did not differ statistically between groups. Median operative time was 65 min (55-85 IQR) and 90 min (75-110 IQR) in groups 1 and 2, respectively (p < 0.001). Complications occurred in 97 (18.7%) patients in group 1 and 25 (19.3%) patients in group 2 (p = 0.893). Recurrent nerve palsy diagnosed with laryngoscopy was the most common complication - 10.2% and 9.2% of patients, respectively (p = 0.754). Permanent vocal paresis occurred in 2.3% and 3.2%, respectively (p = 0.786). Postoperative symptomatic hypocalcaemia occurred in 7% of patients in group 1 and 10% of patients in group 2 (p = 0.271). Logistic regression did not show that resident as the operator with or without intraoperative neuromonitoring is a risk factor for any complications. CONCLUSION: The results of the present study show that thyroidectomy performed by a general surgery resident under supervision can be as safe as the one performed by a specialist.

Analysis of the risk factors for perioperative morbidity after laparoscopic revisional bariatric procedures: results from the multicenter Polish Revision Obesity Surgery Study.

BACKGROUND: The growing number of primary bariatric operations has led to an increase in demand for revision surgeries. Higher numbers of revisional operations are also observed in Poland, yet their safety and efficacy remain controversial because of a lack of current recommendations and guidelines. OBJECTIVE: To review risk factors influencing perioperative morbidity. METHODS: A retrospective study was conducted to analyze the results of surgical treatment among 12 Polish bariatric centers. Inclusion criteria were laparoscopic revisional bariatric surgeries and patients ≥18 years of age. The study included 795 patients, of whom 621 were female; the mean age was 47 years (range: 40-55 years). RESULTS: Perioperative morbidity occurred in 92 patients (11.6%) enrolled in the study, including 76 women (82.6%). The median age was 45 years (range: 39-54 years). Statistically significant risk factors in univariate logistic regression models for perioperative complications were the duration of obesity, revisional surgery after Roux-en-Y gastric bypass (RYGB) or adjustable gastric band (AGB), difference in body mass index before revisional surgery and the lowest achieved after primary surgery, and postoperative morbidity of the primary surgery as the cause for revisional bariatric surgery. These factors were included in the multivariate regression model. Revisional surgery after AGB (odds ratio [OR] = 2.18; 95% confidence interval [CI]: 1.28-3.69; P = .004), revisional surgery performed after RYGB (OR = 6.52; 95% CI: 1.98-21.49; P = .002), and revisions due to complication of the primary surgery (OR = 1.89; 95% CI: 1.06-3.34; P = .030) remained independent risk factors for perioperative morbidity. CONCLUSION: Revisional operations after RYGB or AGB and those performed because of postoperative morbidity after primary surgery as the main cause for revisional surgery were associated with a significantly increased risk of postoperative morbidity.

Revisional bariatric procedures in the group of patients over 60 years of age: a multicenter cohort study (PROSS Study).

Introduction: The constantly increasing prevalence of obesity in the population and the lengthening of life expectancy affect the appearance of the problem of pathological obesity also in the elderly. At the same time, an increase in the number of bariatric procedures (also revisional) performed in elderly patients is observed. Aim: To assess the indications for revisional bariatric procedures along with the safety and postoperative results in the group of patients over 60 years of age. Material and methods: The study was conducted in 2019-2020 among patients undergoing revisional bariatric procedures in Polish bariatric centers. The data were obtained through a multicenter, observational retrospective study. Results: Our data consist of 55 (8.1%) patients older than 60 years of age who underwent revisional bariatric procedures. Revisional procedures in the group of patients over 60 years of age had fewer postoperative complications (16.4% vs. 23.1%, p < 0.05). Remission of type II diabetes or arterial hypertension was achieved to a lesser extent in patients operated on over the age of 60 (13% and 15%, respectively) compared to patients operated on under the age of 60 (47% and 34%, respectively; p < 0.05). Conclusions: Revisional bariatric procedures in the group of patients over 60 years of age do not cause an increased risk of postoperative complications or prolonged hospital stay. The possibility of achieving remission or improvement in the treatment of comorbidities in patients operated on over 60 years of age is relatively lower compared to a younger group.

Analysis of the Factors Contributing to Bariatric Success After Laparoscopic Redo Bariatric Procedures: Results from Multicenter Polish Revision Obesity Surgery Study (PROSS).

INTRODUCTION: With continuously growing number of redo bariatric surgeries (RBS), it is necessary to look for factors determining success of redo-surgeries. PATIENTS AND METHODS: A retrospective cohort study analyzed consecutive patients who underwent RBS in 12 referral bariatric centers in Poland from 2010 to 2020. The study included 529 patients. The efficacy endpoints were percentage of excessive weight loss (%EWL) and remission of hypertension (HT) and/or type 2 diabetes (T2D). RESULTS: Group 1: weight regain Two hundred thirty-eight of 352 patients (67.6%) exceeded 50% EWL after RBS. The difference in body mass index (BMI) pre-RBS and lowest after primary procedure < 10.6 kg/m2 (OR 2.33, 95% CI: 1.43-3.80, p = 0.001) was independent factor contributing to bariatric success after RBS, i.e., > 50% EWL. Group 2: insufficient weight loss One hundred thirty of 177 patients (73.4%) exceeded 50% EWL after RBS. The difference in BMI pre-RBS and lowest after primary procedure (OR 0.76, 95% CI: 0.64-0.89, p = 0.001) was independent factors lowering odds for bariatric success. Group 3: insufficient control of obesity-related diseases Forty-three of 87 patients (49.4%) achieved remission of hypertension and/or type 2 diabetes. One Anastomosis Gastric Bypass (OAGB) as RBS was independent factor contributing to bariatric success (OR 7.23, 95% CI: 1.67-31.33, p = 0.008), i.e., complete remission of HT and/or T2D. CONCLUSIONS: RBS is an effective method of treatment for obesity-related morbidity. Greater weight regain before RBS was minimizing odds for bariatric success in patients operated due to weight regain or insufficient weight loss. OAGB was associated with greater chance of complete remission of hypertension and/or diabetes.

Predicting complications following bariatric surgery: the diagnostic accuracy of available tools.

BACKGROUND: Bariatric surgery is effective and safe obesity treatment. Obesity-related co-morbidities contribute to higher postoperative morbidity. Assessment of possible outcomes seems to be crucial in the qualification process and perioperative care. Recently, various tools predicting complications after bariatric surgery have been proposed. OBJECTIVES: The objective of the study was to validate the performance of available diagnostic algorithms as the predictors of 30-day complications after bariatric procedures. SETTING: Department of General Surgery, University Hospital, Poland. METHODS: The literature review was done to identify available risk prediction models. The analysis included patients after Roux-en-Y gastric bypass or sleeve gastrectomy (SG). The probability of postoperative complications was calculated for each patient. The assessed endpoints were general and severe morbidity stratified with Clavien-Dindo classification. The relationship between predicted and observed outcomes was assessed by logistic regression. Diagnostic accuracy was evaluated by the area under the receiver operating characteristic curves and Hosmer-Lemeshow test. RESULTS: Out of 1329 patients, 65.31% were women with a mean body mass index of 45 kg/m2. The majority of patients underwent SG (75.02%). The most common co-morbidities were as follows: dyslipidemia, hypertension, and diabetes. General morbidity reached 8.43%, whereas severe morbidity was 2.78%. We identified 10 eligible models. Only Gupta and Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) calculators presented a significant association with any and severe complications and reached acceptable accuracy in predicting severe complications. None of the models achieved sufficient discrimination in predicting general morbidity. All models remained well-fitted. CONCLUSIONS: MBSAQIP and Gupta's calculators seem to be helpful in the assessment of severe complications after bariatric surgery. Further studies should focus on improving the predictive accuracy of existing models.

Impact of Intragastric Balloon Placement on the Stomach Wall: A Prospective Cohort Study.

PURPOSE: Endoscopic intragastric balloon (IGB) placement is a minimally invasive treatment for morbid obesity that is sometimes used as a preparatory step before surgical intervention. This study was performed to analyze the changes in the stomach wall induced by IGB placement, with particular emphasis on pathomorphology, inflammatory markers, and tissue growth factors. MATERIAL AND METHODS: In total, 30 patients with morbid obesity were prospectively analyzed. A total of 16 patients with body mass index (BMI) ≥ 53 kg/m2 underwent two-stage treatment comprising IGB placement followed by laparoscopic sleeve gastrectomy (LSG) (IGB group), while 14 patients underwent one-stage LSG (non-IGB group). The gastric specimens removed during LSG were examined. The two groups were compared regarding the surgical results, microscopic structure and inflammatory process exponents of the stomach wall, and receptors for selected tissue growth factors. RESULTS: The IGB group had a longer median hospital stay than that of the non-IGB group. Compared with the non-IGB group, the IGB group had a thicker stomach wall, more submucosal fibrosis, and increased amounts of growth factors and inflammatory markers. CONCLUSION: Patients with IGB placement before LSG showed greater changes in the stomach wall than those of patients who received LSG alone. IGB placement was associated with stomach muscle layer thickening, submucosal fibrosis, and increased levels of inflammatory markers and tissue growth factors.