Higher Preoperative Weight loss Is Associated with Greater Weight Loss up to 12 Months After Bariatric Surgery.

BACKGROUND: Prior research suggested presurgical weight loss is associated with greater total weight loss, resulting in a more effective bariatric intervention. We aimed to assess whether preoperative weight loss is a predictor for total weight loss, and which patient factors are associated with successful weight loss. METHODS: All patients (N = 773) that underwent primary bariatric surgery between June 2017 and August 2019 were included in this single-center retrospective study. Outcome measures were preoperative weight loss (%preopWL) and total weight loss (%TWL) up to 1 year postoperatively. Patients were divided into 4 groups based on quartiles of %preopWL. RESULTS: Total weight loss after 1, 6, and 12 months for the upper quartile was 16.9%, 33.4%, and 37.8%, and for the lower quartile 11.8%, 28.9%, and 35.2%, respectively (p < 0.001). Seven hundred fourteen patients (92.4%) were available for the 1-year follow-up. Preoperative weight loss was not associated with the incidence of complications. Independent factors predicting increased %preopWL were mandated preoperative weight loss program (MWP) (p < 0.001), older age (p = 0.005), weight measurement in the week before surgery (p = 0.031), and non-diabetic status (p = 0.010). Predictors for superior %TWL were MWP (p = 0.014), younger age (p = 0.001), non-diabetic status (p = 0.005), female gender (p = 0.001), higher Body Mass Index (p = 0.006), and banded gastric bypass (p = 0.001). CONCLUSION: Higher preoperative weight loss is associated with persisting greater weight loss up to at least 12 months post-surgery. In order to optimize preoperative weight loss, we recommend extra preoperative support to younger and diabetic patients. We advise nutritional counseling and additional weight measurement in the week before surgery.

Is Single-Port Laparoscopy More Precise and Faster with the Robot?

BACKGROUND: Single-port laparoscopy is a step forward toward nearly scar less surgery. Concern has been raised that single-incision laparoscopic surgery (SILS) is technically more challenging because of the lack of triangulation and the clashing of instruments. Robotic single-incision laparoscopic surgery (RSILS) in chopstick setting might overcome these problems. This study evaluated the outcome in time and errors of two tasks of the Fundamentals of Laparoscopic Surgery on a dry platform, in two settings: SILS versus RSILS. METHODS: Nine experienced laparoscopic surgeons performed two tasks: peg transfer and a suturing task, on a standard box trainer. All participants practiced each task three times in both settings: SILS and a RSILS setting. The assessment scores (time and errors) were recorded. RESULTS: For the first task of peg transfer, RSILS was significantly better in time (124 versus 230 seconds, P = .0004) and errors (0.80 errors versus 2.60 errors, P = .024) at the first run, compared to the SILS setting. At the third and final run, RSILS still proved to be significantly better in errors (0.10 errors versus 0.80 errors, P = .025) compared to the SILS group. RSILS was faster in the third run, but not significant (116 versus 157 seconds, P = .08). For the second task, a suturing task, only 3 participants of the SILS group were able to perform this task within the set time frame of 600 seconds. There was no significant difference in time in the three runs between SILS and RSILS for the 3 participants that fulfilled both tasks within the 600 seconds. CONCLUSIONS: This study shows that robotic single-port surgery seems easier, faster, and more precise to perform basis tasks of the Fundamentals of laparoscopic surgery. For the more complex task of suturing, only the single-port robotic setting enabled all participants to fulfill this task, within the set time frame.

[A woman with increasing pain after cholecystectomy]. / Een vrouw met toenemende buikpijn na cholecystectomie.

A 25-year-old female presented with abdominal pain and collapse 3 days after a laparoscopic cholecystectomy. The MRCP images suggested a leakage from the stump of the cystic duct. However, an ERCP showed a leakage of a subvesical bile duct arriving from the left hepatic duct. Diagnostic and treatment modalities are discussed.

[A dog's groomer with a painful hand]. / Een hondentrimmer met een pijnlijke hand.

A dog's groomer suffered from an abscess on the palmar side of his right hand which was caused by the migration of cut dog hairs into the epidermis, diagnosed as an occupational interdigital sinus pilonidalis. The patient was treated by surgical excision of the abscess.