Long-term outcomes of laparoscopic sleeve gastrectomy in Denmark from 2010 to 2016: a nationwide cohort study.

BACKGROUND: Bariatric surgery is the most effective treatment of morbid obesity and obesity-related conditions. Laparoscopic sleeve gastrectomy (LSG) has become increasingly popular in Denmark and worldwide. OBJECTIVE: To evaluate long-term outcomes including postoperative complications after LSG. SETTING: University Hospitals, Denmark. METHODS: This was a nationwide multicenter cohort study including all patients who underwent LSG during 2010 to 2016 in Denmark. Data were collected from the Danish Obesity Surgery Registry and medical records. Representatives from all public bariatric centers in Denmark registered information on demography, indication, preoperative tests, operative information, weight loss, status of co-morbidities, and early and late complications. RESULTS: In total, 541 patients were included in the study. Median follow-up was 6 years, and 536 patients (99%) were available at the end of follow-up. The patients achieved a persistent weight loss. Quality of life significantly improved after both 12 and 24 months. Overall, 3% of the patients had a major complication ≤30 days after the procedure and 3% underwent reoperation. One in 5 patients (22%) had an early minor complication. In the long term, 3% of the patients had a major complication and 24% of the patients had ≥1 minor complication. The most common surgery-related healthcare contacts addressed gastroesophageal reflux, weight recurrence, and stenosis symptoms. CONCLUSIONS: Patients after LSG achieved sufficient weight loss and improved quality of life. The procedure was safe with low risk of early and late major complications. However, there was a high frequency of early and late minor complications in 22% and 24% of the patients, respectively.

Obesity Influences the Knee Injury and Osteoarthritis Outcome Score.

Purpose The primary aim of this study was to report the outcome of the Knee Injury and Osteoarthritis Outcome Score (KOOS) in obese patients with a body mass index (BMI) > 35. Methods This is a prospective cohort study, including patients referred with the aim of planning bariatric surgery between October 2015 and January 2017. The primary outcome measurement was KOOS. An experienced radiologist obtained and evaluated standard radiological osteoarthritis examinations of the knee joints. Results The mean age was 43.1 years, and ages ranged from 24 to 69 years. The mean BMI was 48.3, and BMI ranged from 35 to 66. Results show that obese patients reported significantly worse in the KOOS subscales pain, activities of daily living, sport, and quality of life (QOL) compared with a reference population, due to nonoverlapping 95% confidence intervals. No significant differences between obese and superobese patients were observed on the KOOS subscales ( p > 0.08). The KOOS subscales showed worse outcome with increasing severity of radiological knee osteoarthritis; however, only significant differences were observed for the KOOS subscales sport and QOL ( p < 0.05). Conclusion Results imply that the KOOS scores vary significantly with obesity. When utilizing KOOS outcome, considering obesity in the interpretation of outcome is highly recommended. Level of Evidence This is an observational, level III study.

Internal herniation after laparoscopic antecolic Roux-en-Y gastric bypass: a nationwide Danish study based on the Danish National Patient Register.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the most common surgical treatment for morbid obesity in Denmark. Internal herniation (IH) or intermittent internal herniation (IIH) is a major late complication after LRYGB due to persistent mesenteric defects. However, the incidence of IH/IIH is still not known in Denmark. OBJECTIVES: The primary aim of the study was to assess the incidence of IH/IIH after LRYGB performed in the period between 2006 and 2011 with a follow-up until 2013, where mesenteric defects were not routinely closed during the primary operation. SETTING: Department of Bariatric Surgery, Koege University Hospital, Denmark METHODS: We performed a retrospective nationwide analysis of prospectively collected data from all patients with LRYGB performed in Denmark from 2006 to 2011 based on the Danish National Patient Registry (NPR). From January 2006 to December 2011, 12,221 patients underwent an LRYGB procedure in Denmark. Relevant data from all 12,221 patients were retrieved from the NPR during the follow-up period from January 2006 to May 2013; we registered possible subsequent abdominal operations in these patients. RESULTS: Operations were performed on 398 patients because of suspected IH/IIH; 383 of these patients had IH/IIH (3.1%; 95% CI 2.8-3.5). The estimate for the 5-year cumulative incidence of clinically significant cases with IH/IIH was 4%. The median time interval until the onset of IH/IIH after LRYGB was 15 months (range 0-67 months) in a follow-up period with a median of 38 months (range 16-87 months). CONCLUSION: In the period from 2006 to 2011, mesenteric defects were not routinely closed during LRYGB in Denmark. The cumulative 5-year incidence of IH/IIH after LRYGB was 4% in a median follow-up period of 38 months (range 16-87) in Denmark when data was retrieved from the NPR.

Renal effects of long-term ciclosporin A treatment in a large animal model.

BACKGROUND: Most experimental studies of chronic ciclosporin A (CsA) nephrotoxicity have been performed in rodents; however, the pig possesses several advantages. The aim of this study was to investigate renal functional and structural changes during CsA treatment with 20 mg/kg/day for 6 months in a pig model. METHODS: Gottingen minipigs were randomized to oral CsA treatment or as controls. At 0, 5, 10, 15, 20 and 25 weeks body weight, blood pressure, serum creatinine, and whole blood CsA levels were measured. Magnetic resonance imaging was used to estimate relative glomerular filtration rate (rGFR), renal blood flow (RBF), kidney length and volume. Renal vascular resistance (RVR) was calculated. Kidney tissue biopsies were taken and volume fraction of cortical interstitial tissue estimated by a stereology-based method. RESULTS: CsA induced significant increases in serum creatinine, blood pressure, RVR, and a significant decrease in RBF. Furthermore, renal volume increased significantly. This finding was inversely related to the decrease in RBF and initially followed by an increase in rGFR, which then decreased. No significant histopathological kidney changes were observed. CONCLUSION: CsA treatment with 20 mg/kg/day for 6 months causes increased serum creatinine, blood pressure, RVR, and renal volume along with a decrease in RBF in accordance with data obtained in humans. The initial temporal changes in renal volume and function during CsA administration have similarities to the functional changes seen in early diabetes.