Quality of life, post-operative complications, and hernia recurrence following enhanced-view Totally Extra-Peritoneal (eTEP) Rives-Stoppa for incisional and primary ventral hernia repair.

The purpose of this study was to evaluate the quality of life (QoL), early post-operative complications, and hernia recurrence rate following laparoscopic enhanced-view Totally Extra-Peritoneal (eTEP) Rives-Stoppa (RS) for incisional and primary ventral hernia repair. Retrospective review of a prospectively maintained database of all patients undergoing eTEP-RS between 2017 and 2020. Data retrieved included demographics, and clinical and operative variables. QoL was assessed using the EuraHS-QoL scale prior to- and following eTEP-RS. During the study period, 61 patients met the inclusion criteria. Age and BMI were 62 (60.4 ± 13.8) years and 29.7 (30.4 ± 6) kg/m2, respectively. Incisional hernia was the most common pathology (n = 40, 65%) followed by primary ventral hernia (n = 21, 35%), with 24 patients (39%) having a previous hernia repair. Diastasis-recti repair was undertaken in 34 patients (55%), a concomitant inguinal hernia was repaired in 6 patients (10%), and 13 patients (21%) underwent transversus abdominis release (TAR). Median follow-up time was 13 months and 15 patients (25%) had at least 2 years of follow-up. Hernia recurrence was found in 4 patients (6.5%). Pre-operative and post-operative EuraHS-QOL questionnaire scores were available for 46 patients (75%) and showed significant improvement in pain (7 vs. 0.5, p < 0.0001; 5 vs. 0.5, p < 0.0001; 5 vs. 1.5; p < 0.006), restrictions (median of 5 vs. 0.5, p < 0.0001; 5 vs. 0, p < 0.0001; median of 5 vs. 1, p < 0.0001, of 6.5 vs. 1.5, p < 0.0001), and cosmetic appearance (8 vs. 4, p < 0.0001). Abdominal wall repair using the eTEP-RS approach significantly improves subjective QoL variables with an acceptable post-operative complications and hernia recurrence rates in a short-term follow-up.

Clinical influence of conversion of laparoscopic sleeve gastrectomy to one anastomosis gastric bypass on gastroesophageal reflux disease.

PURPOSE: Assess the subjective impact of gastro-esophageal reflux disease (GERD) symptoms on patients undergoing revision from laparoscopic sleeve gastrectomy (LSG) to one-anastomosis gastric bypass (OAGB) using the Reflux Disease Questionnaire for GERD (RDQ) and the GERD-health related quality of life score (GERD-HRQL), prior to- and following conversion. METHODS: Patients undergoing revision from LSG to OAGB were prospectively followed between May 2015 and December 2020. Data retrieved included demographics, anthropometrics, previous bariatric history, time interval between LSG and OAGB, weight loss, and co-morbidities. Pre- and post-OAGB RDQ and GERD-HRQL questionnaires were obtained. In the case of sleeve dilatation, sleeve resizing was performed. RESULTS: During the study period, 37 patients underwent revision from LSG to OAGB. Mean ages at LSG and pre-OAGB were 38 ± 11.74 and 46 ± 12.75, respectively. Median follow-up time was 21.5 months (range 3-65). All patients underwent sleeve resizing. RDQ and GERD-HRQL scores were obtained at a median of 14 months (range 3-51) between pre- and post-OAGB. Median RDQ score pre-OAGB vs post-OAGB was significantly reduced (30 (range 12-72) vs 14 (range 12-60), p = 0.007). All 3 parts of the GERD- HRQL questionnaires were significantly reduced between pre-OAGB and post-OAGB: Symptoms (20; 62.5% vs 10; 31.3%, p = 0.012), overall score (15 (0-39) vs 7 (0-28), p = 0.04) and subjective improvement (10; 31% vs 20; 62.5%, p = 0.025). CONCLUSION: Conversion of LSG to OAGB showed subjective improvement of GERD symptoms both in RDQ and in GERD-HRQL.

[BODY-CONTOURING AFTER MASSIVE WEIGHT LOSS - THE POST-BARIATRIC SERVICE SAMSON ASSUTA ASHDOD UNIVERSITY HOSPITAL].

INTRODUCTION: Bariatric surgery is an effective tool for weight loss in the obese population, improving and often resolving related co-morbidities such as diabetes and hypertension, reducing overall morbidity and mortality. However, many patients suffer from excess and redundant skin in many areas of their body. Skin excess can cause physical, functional, psychological and aesthetic impairments such as fungal infections and skin rashes, difficulty maintaining personal hygiene, low self-esteem and self-image, social isolation, depression and low quality of life. Areas most commonly affected are the abdomen, upper arms, thighs and breasts. Body contouring surgery (post-bariatric surgery) can resolve health issues related to skin excess, improve quality of life and body image and help maintain weight loss. Since its establishment, the post-bariatric unit has performed 76 post-bariatric surgeries on 56 patients in Assuta Ashdod Hospital (67.1% abdominoplasties, 14.47% thigh-lifts, 10.52% brachioplasties, 5.26% breast surgeries, 2% gynecomastia repairs). In this article, we present the post-bariatric service in Assuta Ashdod Hospital including the pre-and post-operative treatment protocols and results.

Laparoscopic revision to total gastrectomy or fistulo-jejunostomy as a definitive surgical procedure for chronic gastric fistula after laparoscopic sleeve gastrectomy.

BACKGROUND: Staple-line leaks (SLL) after sleeve gastrectomy (SG) are a rare but serious complication requiring radiologic and endoscopic interventions with varying degrees of success. When failed, a chronic gastrocutaneous fistula forms with decreasing chances of closure with time. Definitive surgical management of chronic SLL after SG include laparoscopic revision to total/subtotal gastrectomy (LTG/LSTG) or a fistulo-jejunostomy (LRYFJ), both with Roux-en-Y reconstruction. OBJECTIVES: Comparison of SG revisions to LTG/LSTG versus LRYFJ as a definitive treatment for chronic SLL. SETTING: High-volume bariatric unit. METHODS: Retrospective review of a prospectively maintained database identified 17 patients with chronic gastric fistula after SG that were revised to either LTG/LSTG or LRYFJ between September 2011 and May 2020. Demographic characteristics, clinical data, quality of life, and laboratory values for both options were compared. RESULTS: Of the 17 conversions, 8 were revised to LTG/LSTG and 9 to LRYFJ. Mean age and body mass index at revision were 36.85 years (range, 21-66 yr) and 29 kg/m2 (range, 21-36 kg/m2), respectively. Average preoperative endoscopic attempts was 5 (range, 1-16). The overall average operation time of revision was 183 minutes (range, 130-275 min) with no significant difference between either conversion options. Mean follow-up time was 46.5 months (range, 1-81 mo) and was available for 10 patients (58.8%). Food intolerance was significantly better after revision to LRYFJ (n = 6/6, 100% versus n = 1/5, 20%, P < .05). There were no significant differences between revisional procedures and laboratory abnormalities. CONCLUSION: Laparoscopic revision to LRYFJ is a safe and feasible treatment for chronic SLL.

Routine Upper Gastrointestinal Fluoroscopy Before Laparoscopic Sleeve Gastrectomy: Is It Necessary?

BACKGROUND: Controversy exists regarding the clinical utility of routine preoperative upper gastrointestinal (GI) fluoroscopy in morbid obese patients undergoing laparoscopic sleeve gastrectomy (LSG). The aim of our study was to determine the efficacy of these studies in detecting hiatal hernias (HH). METHODS: The institution's prospectively maintained, IRB-approved database was retrospectively queried to identify all consecutive patients who underwent LSG between 2011 and 2017. All patients underwent routine preoperative upper GI fluoroscopy. Reports from all imaging studies were retrospectively reviewed and compared to the presence of an intraoperative HH. RESULTS: During the study period, a total of 1810 patients (854 males, 956 females) underwent LSG at our institution. Mean age was 40.95 ± 13 years (range 11-75), and mean BMI was 42.8 ± 5 kg/m2 (range 30-86). The overall prevalence of HH was 11.1% (201 patients). All HHs detected were repaired. Considering the intraoperative identification of HH the gold standard for diagnosis, the sensitivity and specificity of preoperative UGI fluoroscopy for HH detection were 32% (66/201) and 94% (1512/1609), respectively. The median operative time was significantly longer when concomitant LSG and HH repair was performed compared to LSG alone (76 min vs. 55 min, p < 0.001, respectively). The foreknowledge of HH had no influence on the median operative times (77 min vs. 75 min, predicted vs. incidental, respectively, p = 1.34). HH repair did not affect the complication rate (p = 0.3). CONCLUSION: Routine preoperative upper GI fluoroscopy holds a low sensitivity for HH detection. Health policy regulators should consider omitting this exam from routine preoperative evaluation for bariatric patients.

Perioperative outcomes of delayed laparoscopic cholecystectomy for acute calculous cholecystitis with and without percutaneous cholecystostomy.

INTRODUCTION: The role of percutaneous cholecystostomy (PC) in the management of patients with acute calculous cholecystitis (ACC) remains controversial. The aim of this study is to report operative outcomes in a large cohort of patients undergoing PC before their delayed laparoscopic cholecystectomy (DLC). METHODS: All patients who underwent DLC because of ACC between 2003 and 2012 were included. Outcomes of patients with and without previous PC were compared. RESULTS: Of 639 patients who underwent DLC because of ACC at our institution during a 10-year time interval beginning 2003, 163 (25.5%) patients had PC before their DLC. Patients who underwent PC were older (64 ± 1 years vs 48 ± 0.8 years, P < .001) and had more comorbid conditions (P < .001). Accumulated duration of stay was longer in the PC group (16.2 ± 0.4 days vs 9.7 ± 0.1 days, P < .001). Rate of conversion to open procedure was greater in the PC group (11% vs 4%, P = .001) and operative time was longer (142 ± 4 minutes vs 107 ± 4 minutes, P < .001). Patients in the PC group had a greater rate of biliary-related complications (10% vs 4%, P = .003) and surgical-site infections; both superficial (5% vs 1%, P = .004) and deep (7% vs 3%, P = .04). On multivariable analysis PC was an independent risk factor for conversion to open cholecystectomy (odds ratio 2.67 95% CI 1.18-6.72) as well as to biliary-related complications (odds ratio 4.85 95% CI 1.57-14.92). CONCLUSION: DLC for ACC in patients with previous PC is associated with longer duration of stay, more readmissions, and, most importantly, greater conversion rate, biliary related complications, and surgical-site infections.