The Impact of Food Insecurity Rate on Bariatric Surgery Outcomes.

INTRODUCTION: Various factors impact outcomes following bariatric surgery. Lack of access to healthy food options (food insecurity [FI]) is another potential factor affecting outcomes. No prior studies have directly explored the relationship between residing in a high FI zip code and patient outcomes relating to weight loss after bariatric surgery. We hypothesized that living in a high FI zip code would be associated with decreased weight loss postsurgery. METHODS: We conducted a retrospective study with 210 bariatric surgery patients at a tertiary referral center from January to December 2020. Patient weight and body mass index (BMI) were recorded at three time points: surgery date, 1 mo, and 12 mo postoperative. Residential addresses were collected, and FI rates for the corresponding Zip Code Tabulation Areas were obtained from the 2022 Feeding America Map the Meal Gap study (2020 data). RESULTS: The FI rate showed a negative correlation of -18.3% (95% confidence interval: -35% to -0.5%; P = 0.039) with the percentage of excess weight loss (%EWL) at 1 y. In multivariate analysis, preoperative BMI (P = 0.001), presence of diabetes mellitus (P = 0.008), and bariatric procedure type (P = 0.000) were significant predictors of %EWL at 1 y. After adjusting for confounding factors, including sex, preoperative BMI, insurance status, primary bariatric procedure, and emergency department visits, the increased FI rate (P = 0.047) remained significantly associated with a decreased %EWL at 1 y. CONCLUSIONS: Residing in a high FI, Zip Code Tabulation Areas correlated with a decreased %EWL at 1 y after bariatric surgery. These findings highlight the importance of assessing FI status in pre-bariatric surgery patients and providing additional support to individuals facing FI.

Omentopexy/Gastropexy (OP/GP) Following Sleeve Gastrectomy Might be an Effective 2-in-1 Method (Reinforcement and Fixation): A Meta-Analysis of 14 Studies and a Call for Randomized Controlled Trials.

BACKGROUND: Laparoscopic sleeve gastrectomy can lead to dangerous complications as leaks and hemorrhage. In addition, it can lead to gastric twist/torsion, prolonged postoperative nausea and vomiting (PONV), and de novo gastroesophageal reflux disease (GERD). We aimed to study the efficacy of omentopexy/gastropexy (OP/GP) in the prevention of these postoperative complications. MATERIALS AND METHODS: PubMed and Google Scholar were queried in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data was analyzed using the Review Manager (RevMen) 5.4.1 software. Mantel-Haenszel statistical method and random effects analysis model were used in all meta-analyses. The odds ratio was used for dichotomous data. Subgroup analysis was done according to bougie size. Subgroup analysis according to the distance between the starting point of gastric transection and pylorus was not possible (limitation). Odds ratio and control event rate across studies were used to calculate the number needed to treat (NNT) with OP/GP for an additional beneficial outcome (prevention of adverse outcome) to occur. RESULTS: The initial search identified 442 records; 371 were found irrelevant after screening and were excluded. The remaining 71 reports were retrieved and assessed for eligibility. An additional 57 reports were excluded following an in-depth assessment. The remaining 14 studies were included in this meta-analysis; 8 were nonrandomized studies (NRSs) while 6 were randomized controlled trials. Most studies originated from a single country (limitation). A statistically significant decrease in favor of OP/GP was observed for all outcomes (bleeding, leaks, gastric twist/torsion, prolonged PONV 1 month postoperatively, and postoperative de novo GERD). Data was consistent across studies (low I2 ), and subgroup analysis according to bougie size revealed no subgroup differences. However, this study had 3 limitations that does not allow for strong conclusions. CONCLUSIONS: Although the current literature lacks strong scientific evidence, this study suggests that omentopexy/gastropexy (OP/GP) may offer protection against bleeding and leaks as a staple line reinforcement method, as well as against gastric twist/torsion, prolonged postoperative nausea and vomiting (PONV), and de novo gastroesophageal reflux disease (GERD) as a staple line fixation method. Therefore, it is worthwhile to proceed with large-scale, multicenter, randomized controlled trials to reevaluate our findings. Furthermore, conducting a comparison between OP/GP and other staple line reinforcement techniques would be beneficial.

Seamguard Buttressing of the Staple Line During Laparoscopic Sleeve Gastrectomy Appears to Decrease the Incidence of Postoperative Bleeding, Leaks, and Reoperations. A Systematic Review and Meta-Analysis of Non-Randomized Comparative Studies.

Leaks and bleeding are major acute postoperative complications following laparoscopic sleeve gastrectomy (LSG). Various staple line reinforcement (SLR) methods have been invented such as oversewing/suturing (OS/S), omentopexy/gastropexy (OP/GP), gluing, and buttressing. However, many surgeons do not use any type of reinforcement. On the other hand, surgeons who use a reinforcement method are often confused of what kind of reinforcement they should use. No robust and high-quality data supports the use of one reinforcement over the other or even supports the use of reinforcement over no-reinforcement. Therefore, SLR is a controversial topic that is worth our focus. The aim of this study is to compare the outcomes of LSG with versus without Seamguard buttressing of the staple line during LSG.

A fully stapled technique for gastrojejunal anastomosis creation in robotic Roux-en-Y gastric bypass.

PURPOSE: The purpose of this paper is to showcase a fully stapled approach to creating a gastrojejunostomy during a robot-assisted Roux-en-Y gastric bypass. METHODS: We utilize two robotic 12-mm ports, two robotic 8-mm ports, and one 8-mm assistant port. The tools used are a fenestrated bipolar forceps, vessel sealer, cadiere grasper, needle driver, and a robotic stapler. After the partial gastrectomy, the roux limb is brought up to the gastric pouch where monopolar scissors are used to create a gastrotomy and enterotomy. The gastrotomy is made just above the staple line of the gastric pouch. The enterotomy is created 2 cm distal to the roux limb's staple line. The stapler is inserted into both the gastrotomy and enterotomy to create the common channel. A 2-0 vicryl suture is used to place four interrupted sutures across the remaining enterotomy in full thickness bites. An endoscope or Visigi bougie is advanced across the anastomosis into the roux limb before the final suture. The tails of the most lateral and medial sutures are grasped and lifted towards the abdominal wall. The stapler is advanced over the approximated enterostomy while holding tension with the suture tails. The stapler is fired transversely across the suture line to seal the gastrojejunostomy. The staple line may be oversewn with silk sutures. A leak test is performed prior to completing the reconstruction with the jejunojejunostomy. CONCLUSIONS: A fully stapled technique of anastomosis creation may reduce operative time, standardizes the process for reproducibility, and increases consistency across operators and patients.

Immune-Mediated Myopathy in a Patient Presenting for Melanoma Resection and Sentinel Lymph Node Biopsy.

Statin-induced necrotizing autoimmune myopathy (SINAM) is a rare side effect in people who are taking a class of drugs called statins. Patients with SINAM will present with subacute severe symmetric proximal muscle weakness. In contrast to more common myopathies, SINAM may not spontaneously resolve with statin discontinuation. These patients may require long-term immunotherapy to limit further disease progression. In this case study, we report a 74-year-old female with SINAM who presented for radical excision of a right upper back melanoma and sentinel lymph node biopsy at an outpatient facility. An anesthetic plan was crafted with the use of a supraglottic airway device without neuromuscular blockade.