Impact of Gastrojejunostomy Anastomosis Diameter on Weight Loss Following Laparoscopic Gastric Bypass: A Systematic Review.

Laparoscopic Roux-en-Y gastric bypass (RYGB) is crucial for significant weight reduction and treating obesity-related issues. However, the impact of gastrojejunostomy (GJ) anastomosis diameter on weight loss remains unclear. We investigate this influence on post-RYGB weight loss outcomes. A systematic search was conducted. Six studies met the inclusion criteria, showing varied GJ diameters and follow-up durations (1-5 years). Smaller GJ diameters generally correlated with greater short-to-medium-term weight loss, with a threshold beyond which complications like stenosis increased. Studies had moderate-to-low bias risk, emphasizing the need for precise GJ area quantification post-operation. This review highlights a negative association between smaller GJ diameters and post-RYGB weight loss, advocating for standardized measurement techniques. Future research should explore intra-operative and AI-driven methods for optimizing GJ diameter determination.

Changes in social care after major emergency general surgery procedures.

BACKGROUND: Emergency general surgery (EGS) is a major part of the provision of healthcare, and patients undergoing EGS are at elevated risk of morbidity and mortality. This study aimed to determine factors contributing to patients losing their independence and being discharged to residential and nursing homes having previously lived in their own residences. METHODS: Our local data uploaded to the National Emergency Laparotomy Audit (NELA) (2014-2022) were analyzed. This national database encompasses all major EGS cases undertaken in the United Kingdom. The variables considered were patient demographics, American Society of Anesthesiologists score, admission and discharge dates, presenting pathology, operation type, and discharge destination. Comparative analyses segmented patients based on postdischarge EGS destinations. Multivariable logistic regression identified factors linked to residential/nursing home placement after discharge. Significance was set at P < .05. RESULTS: Data from all patients in the NELA database (n = 1611) were analyzed. Approximately 1 in 10 patients older than 70 years never returned home. Patients requiring additional support were on average 8.6 years older (P = .008). At older than 80 years, the need for extra social support increased substantially with each increasing year in age, and those older than 85 years were more than twice as likely to require extra support than 80-year-olds (P < .001). Patients who died were 11.4 years older than those discharged without additional support (P < .001). CONCLUSION: A significant proportion of patients, particularly the elderly, do not return to their usual place of residence and require a higher level of care postemergency surgery. These important social factors need to be considered before operating given that they may have significant quality of life and economic implications.

Surgical and medical interventions for abdominal aortic graft infections.

BACKGROUND: Abdominal aortic graft infections are a major complication following abdominal aortic aneurysm surgery, with high morbidity and mortality rates. They can be treated surgically or conservatively using medical management. The two most common surgical techniques are in situ replacement of the graft and extra-anatomical bypass. Medical management most commonly consists of a course of long-term antibiotics. There is currently no consensus on which intervention (extra-anatomical bypass, in situ replacement, or medical) is the most effective in managing abdominal aortic graft infections. Whilst in emergency or complex situations such as graft rupture surgical management is the only option, in non-emergency situations it is often personal preference that influences the clinician's decision-making. OBJECTIVES: To assess and compare the effects of surgical and medical interventions for abdominal aortic graft infections. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases and WHO ICTRP and ClinicalTrials.gov trials registers to 2 December 2019. We also reviewed the bibliographies of the studies identified by the search and contacted specialists in the field and study authors to request information on any possible unpublished data. SELECTION CRITERIA: We aimed to include all randomised controlled trials that used surgical or medical interventions to treat abdominal aortic graft infections. The definitions of abdominal aortic graft infections were accepted as presented in the individual studies, and included secondary infection due to aortoenteric fistula. We excluded studies presenting data on prosthetic graft infections in general, unless data specific to abdominal aortic graft infections could be isolated. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed all studies identified by the search. We planned to independently assess risk of bias of the included trials and to evaluate the quality of the evidence using the GRADE approach. Our main outcomes were overall mortality, amputation, graft re-infection, overall graft-related complications, graft-related mortality, acute limb ischaemia, and re-intervention. MAIN RESULTS: We identified no randomised controlled trials to conduct meta-analysis. AUTHORS' CONCLUSIONS: There is currently insufficient evidence to draw conclusions to support any treatment over the other. Multicentre clinical trials are required to compare different treatments for the condition.

Migrated biliary stent causing perforation of sigmoid colon and pelvic abscess.

Endoscopically placed biliary stents are a well-established procedure for the treatment of benign and malignant causes of obstructive jaundice. A plastic stent is usually inserted in patients with obstructive jaundice due to pancreatic cancer as a short-term procedure. Stent migration has been reported as a complication, although in most cases the stent will pass through or remain in the bowel lumen for a period of time. In rare cases, the stent may cause sigmoid perforation and pelvic abscess formation, especially in patients with sigmoid diverticulae or abdominal adhesions due to previous surgery. We present a patient with sigmoid perforation and pelvic abscess due to distal migration of a biliary stent placed to decompress a pancreatic head carcinoma.