The effect of bariatric-metabolic surgery on selected components of metabolic syndrome and visceral adipose tissue - the pilot study.

The aim of this study was to monitor changes in the components of the metabolic syndrome defined by Adult Treatment Panel III and the risk of adipose tissue. The study population consisted of 45 patients (30 women, 15 men) who underwent one bariatric procedure - partial jejuno-ileal derivation (n=17), sleeve resection (n=14) or laparoscopic gastric - plication (n=14). Components of metabolic syndrome such as waist circumference, morning glycemia/antihypertension, TAG, HDL cholesterol and blood pressure (BP)/antihypertension were monitored in probands. In addition, Dual Energy X-Ray Absorciometry measurements were performed. Parameters were monitored over the course of one year. The study shows that it is an effective method of weight reduction for the study population with metabolic effects in the risk components of metabolic syndrome - fasting glycemia, increase in HDL cholesterol and reduction in triacylglycerols in the blood, reduction in waist circumference and BP or direct disappearance of metabolic syndrome. Significantly, of the entire cohort, 68.9 % of the probands studied showed signs of metabolic syndrome when measured before the intervention. At the end of follow-up, only 22.2 % of probands showed metabolic syndrome. It was also found that if the amount of visceral fat was reduced, the overall risk of metabolic syndrome was also reduced. The study demonstrates a significant positive effect of bariatric surgery on parameters of metabolic syndrome. The study also showed a positive effect of reduced visceral fat volume on the components of metabolic syndrome.

Partial jejunal diversion (PJD) with jejunocolic anastomosis preliminary results of a pilot study.

INTRODUCTION: Bariatric-metabolic surgery is an effective tool in the treatment of severe obesity and related diseases. Its importance has increased even more in the era of the type II diabetes mellitus and COVID 19 pandemics. The aim of our study is to present the initial results of a new operation that minimizes surgical trauma. METHODS: In the prospective study, laparoscopic side-to-side anisoperistaltic jejunocolic anastomosis was constructed in order to derive part of the chyme by the anastomosis. Patients were operated in the period of IV/2018VII/2019; their mean age was 48.43±10.36 years, mean weight 112.3±16.6 kg and mean BMI 41.9±5.2. Patients were examined one month before surgery and then followed at 3, 6 and 12 months after surgery. We evaluated weight loss and changes in carbohydrate metabolism. RESULTS: We did not record any perioperative or postoperative surgical complications. There was a statistically significant weight loss during the study period. There was a significant decrease in absolute weight in kilograms (p.

The present and future of metabolic surgery.

The term metabolic surgery has become familiar to the professional and lay public with the beginning of the new millennium. The focus is not only on weight reduction, but also on the improvement of obesity-related medical conditions. This is reflected in guidelines of surgical societies as well as in the therapeutic algorithms of other, for instance diabetology, societies. Standard procedures which represent a significant portion of the operations performed worldwide, along with procedures still lacking adequate proof of effectiveness, have been defined. There are also new types of interventions focusing rather on comorbidity treatment than on weight reduction. Effort to reduce invasiveness of the procedures has been evident, paving the way for endoscopic procedures with laparoscopic assistance or purely endoscopic procedures. The authors present the current view on the status of metabolic surgery, reporting on the most frequently performed procedures and also introducing newer surgical and endoscopic interventions which may represent the future of metabolic surgery.

Partial magnetic jejunal diversion (PMJD) in severely obese patients.

Most patients with type 2 diabetes mellitus suffer from obesity. Studies show that surgical intervention is a suitable method for the improvement or remission of type 2 diabetes mellitus. However, a very small percentage of the total number of obese patients (diabetics in addition) undergo surgery. For this reason, less invasive endoscopic methods appear to be an appropriate alternative. The primary aim of a pilot study of partial jejunal diversion using the SFM (Self-Forming Magnetic) device for the creation of jejuno-ileal anastomosis was to verify the technical feasibility and safety of the new procedure. Secondary goals included achieving weight reduction and improving metabolic parameters in patients with type II diabetes. Key words.

[10 years of sleeve gastrectomy in the Czech Republic in terms of the surgical procedure]. / 10 let sleeve gastrectomy - tubulizace zaludku v Ceské republice z hlediska operacního výkonu.

INTRODUCTION: Sleeve gastrectomy (SG) as a single bariatric/metabolic procedure has been performed since 2003 in the world, and since 2006 in the Czech Republic. We report 10 years experience with SG in the Czech Republic from 2006 to 2015. METHOD: Prospectively collected data from 14 surgical departments was evaluated retrospectively using descriptive statistics for every year from 2006 to 2015 and subsequently evaluated and compared for the entire period. The number of the patients, mean age, mean weight and BMI at the time of surgery, the number of patients with T2DM after SG, mean follow-up, mean %BMIL (% Body Mass Index Loss), distance of the starting point of the resection line from the pylorus, the size of the calibration bougie, the rate of complications, and the number and type of conversion procedures were evaluated. RESULTS: 4134 sleeve gastrectomies were done in the Czech Republic from 2006 to 2015 with the mean follow-up of 32.9 months (range 2145 months) from the procedure. The mean weight at the time of surgery fluctuated between 114.2 kg and 128.9 kg; mean BMI fluctuated between 42.3 and 46.7. Mean %BMIL was 63.2% for the entire evaluated period. The distance of the starting point of the resection line from the pylorus changed from the mean 6.1 cm (range 67 cm) to mean 4.2 cm (range 36 cm) and the size of the calibration bougie changed from the mean 39.2 F (range 3642 F) to mean 37.1 F (range 3542 F). As regards early postoperative complications, bleeding from the resection line occurred in 1.4% and a leak from the staple line occurred in 1.1%. The gastroesophageal reflux disease and hiatal hernia occurred in 17.3% as the most frequent late complications. Conversion to another bariatric procedure was approached in 3.8% in the event of an unsatisfactory effect of the SG. CONCLUSION: Bariatric or metabolic surgery, respectively, is a safe and effective surgical method for the treatment of severe obesity and T2DM in morbidly obese patients. Currently, SG is the most widely used bariatric/metabolic procedure in the Czech Republic as well as in most other countries and the long-time results are similar in comparison with other authors.Key words: bariatric surgery - sleeve gastrectomy - resection line - complications.

Body Size, Bone Mineral Density, and Body Composition in Obese Women After Laparoscopic Sleeve Gastrectomy: A 1-Year Longitudinal Study.

Changes in body weight, waist and hip circumferences, body composition, and skeletal status in women after bariatric surgery were evaluated. Thirty-six women [mean age 41.2 ± (SD) 9.5 years, weight 115.7±18.0 kg, and BMI 42.1±5.3 kg/m(2)] underwent laparoscopic sleeve gastrectomy. Bone mineral density (BMD) at lumbar spine, femoral neck, total hip, and total body, and body composition were evaluated at baseline and 3, 6, and 12 months after surgery.Weight, BMI, waist and hip circumferences decreased significantly. Total body bone mineral content (TBBMC) increased by 2.5±3.5%, and fat, lean body mass, total mass and fat-% decreased significantly by 38.9±12.0%, 15.4±5.9%, 26.5±8.1%, and 17.6±8.9%, respectively. Slight decreases in total body (0.6±2.2%) and spine (1.2±7.1%) BMD were not significant, whereas total hip and femoral neck BMD decreased significantly by 5.3±8.2%, and 6.2±7.0% (p<0.001). Change (Δ) in TBBMC correlated only with Δ in weight (r=0.38, p<0.05) whereas Δ in all other body composition parameters correlated significantly with Δ in body weight and circumferences (r=0.46-0.98). The Δ in BMD (except total body BMD) correlated significantly with Δ in body composition parameters (r=0.34-0.59). Baseline fat and lean content besides changes in body fat and lean mass accounted for bone changes. In conclusion, bone loss after bariatric surgery is related to post-operative changes in body composition, as well as to weight loss and decrease in waist and hip circumferences.

[Czech bariatry in 2010]. / Ceská bariatrie v roce 2010.

INTRODUCTION: It is only during the past two decades, when obesity has become to be considered a pandemic disorder. However, in 1953 Varco performed jejunoileal bypass as the world's first bariatric surgical procedure. 30 years later, Pesková performed the first bariatric surgery--a gastroplasty--in Czechoslovakia. From 1984 she started to perform fixed gastric bandages, through laparotomic app- roach at that time. The first laparoscopic fixed bandage in Czechoslovakia was performed in 1993. Over the years, the number of surgical procedures to treat morbid obesity, as well as the number of bariatric surgeons, continued to increase. In 2004, Czech Bariatric Section of the Czech Surgical Society and the Czech Society of Obesitology of the Czech Medical Association of J. E. Purkyne, were established. MATERIAL AND METHODS: 170 bariatric surgeries were performed in the Czech Republic in 1999. The majority of procedures included fixed gastric bandage, rarely, adjustable bandage was performed. At that time, bariatric procedures were performed at five sites only. However, over the past 10 years, bariatric surgery has largely developed in the Czech Republic. The exact number of bariatric procedures completed per year was unknown, therefore, 21 surgical clinics, at which bariatric procedures are performed, were contacted from January to June 2010. Heads of the clinics were asked to provide basic data on surgical treatment of obesity. The aim of the study was to analyze the situation in bariatric surgery in the Czech Republic at the end of 2009. A total of 18 clinics (85.8%) joined the study and provided their own statistical data. 14 of them perform over 20 bariatric procedures a year. RESULTS: The analysis data showed that, in 2009, a total of 1558 bariatric procedures were completed at 18 surgical clinics and approximately 1600 procedures were performed in the whole Czech Republic. However, out of the total, over 230 patients were foreigners. In 99% of bariatric procedures in morbid obese subjects, laparoscopic approach was used. CONCLUSION: Over the ten year period, the number of clinics performing over 20 bariatric procedures a year increased from five to 14 clinics and the number of bariatric procedures increased from 170 to 1600 procedures a year. It is 900% increase, compared to the year 1999! Nevertheless, compared to other countries, e.g. Austria, the number of bariatric procedures does not correspond with prevalence rates of obesity in the Czech Republic.

[Endoscopic diagnostics and treatment of flat intestinal lesions]. / Endoskopická diagnostika a lécba plochých nádorových lézí strevních.

The aim of the article is to provide information on current options for endoscopic diagnostics and treatment of flat tumor intestinal lesions. These neoplasms are frequently and inaccurately described as sessile polyps, which have different genetic and diagnostic features, different prognosis and therapy. Although until recently, the lesions have been managed using surgery, the current approach is predominantly endoscopic.

[Vertical rectus abdominis myocutaneous flap for the closure of perineal wound after abdominoperineal resection of the rectum]. / Uzáver defektu perinea po abdominoperineální resekci rekta pomocí vertical rectus abdominis flap.

INTRODUCTION: A major source of morbidity after abdominoperineal resection (APR) after neoadjuvant external beam pelvic radiation are perineal wound complications. Wound complications are common for 25-66% of patients overall. There are many of procedures provided to reconstruct the perineal defect after APR e.g. primary closure, secondary closure, superior gluteal artery flap and vertical rectus abdominus myocutaneous (VRAM) flap. Our purpose was to describe the effect of VRAM flap on reconstruction of perineal wound. VRAM flaps are ideally suited to bring nonirradiated tissue into defect associated with radical surgical extirpation procedures and irradiated fields. This flap, distally based in the deep inferior epigastric vessels, provides several distinct advantages. It is well perfused by the robust dominant pedicle and the deep inferior epigastric artery and vein. In addition, this flap provides adequate muscle bulk to obliterate pelvic dead space. The skin island can be used for resurfacing the perineal region, including the vaginal wall, and provides versatility for all patterns of resection. CONCLUSION: VRAM flap provides very good aesthetic and functional results, is technically relatively simple and radically decreases wound complications rate. The additional possibility is pull-through the flap transpelvically intraabdominally instead of pull-through via subcutaneous channel, especially with females.

[Unusual treatment of late complications of acute pancreatitis]. / Neobvyklé riesenie neskorej komplikácie akútnej pankreatitídy.

AIM OF THE STUDY: To present the case of 28 years old man operated on acutely for gastric bleeding. Pancreatic pseudocyst and portal hypertension was diagnosed intraoperatively. METHODS: For this reason the Jurasz procedure (pseudocystogastrostomy) was performed. In emergency reoperation for recurrent bleeding total gastrectomy had to be performed. The situation was solved by creating the oesophago-jejunostomy and pseudocystojejunostomy on the Roux-Y limb as a single anastomosis. RESULTS: Postoperative course was uneventful. After 5 years time the patient was readmitted for secondary malabsorbtive syndrome. The conservative treatment was used successfully. CONCLUSION: Unusual solving of above mentioned complication was successful in this case. The follow up and substitutive treatment is necessary following the total gastrectomy.

[Angio-organic ischemic syndromes--etiopathogenesis and differential diagnosis]. / Angio-orgánové ischemické syndrómy--etiopatogenéza a diferenciálna diagnóza.

The authors analyze in the submitted review the classification, etiopathogenesis and in particular the differential diagnostic principles of the main obliterating arterial diseases which condition angio-organ syndromes. The most frequent disease which causes angio-organ ischaemic syndromes worldwide is at present atherosclerosis which however is not the only nosological unit, and in clinical practice it is important to consider also other organically conditioned diseases of the vascular system. In addition to ischaemic hypoxia it is important to consider also all types and varieties non-angiogenic (non-vascular) hypoxia. In the management of angio-organ ischaemic syndromes the surgeon (angiosurgeon) must collaborate in particular with the angiologist because vascular diseases are conditioned by many risk factors of a medical character and their elimination and treatment are within the competence of internal medicine and its specialized branch--angiology.

30% complications with adjustable gastric banding: what did we do wrong?

BACKGROUND: The authors analyzed the complications in patients following laparoscopic adjustable gastric banding (LAGB) for morbid obesity. METHODS: Retrospective analysis of the 36 LAGB patients was done. The operations were performed from December 1997 to the December 1999 using the Lap-Band. RESULTS: 11 complications occurred. Most common was port-site infection or port migration (5 patients). These complications were termed minor. In 3 patients, slippage of the gastric wall was observed, all corrected laparoscopically. In another 3 patients, removal of the band was necessary for poor patient compliance (1), for intussusception of the gastric wall through the band with occlusion of the stoma (1), and for infection of the band (1). These complications were termed major. The overall complication rate was 30.5%. CONCLUSION: Compared to the literature, our complication rate was rather high. Based on our analysis, the following measures are recommended: 1) antibiotic prophylaxis; 2) drainage of the port-site; 3) proper band and port placement and fixation; 4) closer psychological evaluation and follow-up. By these measures, hopefully we can obtain better results in the future.

[Prevention of venous thromboembolism in general and laparoscopic surgery]. / Prevencia venózneho tromboembolizmu vo vseobecnej a laparoskopickej chirurgii.

Pulmonary embolism and thromboembolic attacks remain the most frequent cause of mortality in patients after general surgery or laparoscopy. The authors review the risk factors, indication of prophylaxis of thromboembolism and the currently used modes of prophylaxis. The so-called low-molecular-weight heparins (LMWH) are the most frequently used modes of prophylaxis. The algorithm of prevention and doses of LMWH used in general surgery and laparoscopy are presented. (Tab. 5, Ref. 17.)

Complications in the first year of laparoscopic gastric banding: is it acceptable?

BACKGROUND: From December 1997 to December 1998, 25 laparoscopic adjustable silicone gastric banding (LASGB) procedures were done without previous experience in bariatric surgery. Body mass index (BMI) ranged from 37 to 57 kg/m2 (average 45.5 kg/m2). METHODS: Retrospective analysis of the 1-year experience was done. Operating time was measured, and BMI and complications were reviewed. RESULTS: Five complications were observed. There was a complication rate of 20%. On two occasions, it was gastric wall slippage, and both were corrected laparoscopically. In one patient, the intususception of the gastric wall through the band resulted after profuse vomiting. Removal of the band was necessary, with conversion to an open procedure. On two occasions, the infection of the port-site was observed, in one of these patients, port removal was necessary. No antibiotic prophylaxis was used. CONCLUSION: Despite lack of experience in bariatric surgery in these laparoscopic surgeons, the complications with LASGB appear to be acceptable. Although prior bariatric surgical experience is preferable.

[Laparoscopic appendectomy in acute appendicitis]. / Laparoskopická apendektómia pre akútnu apendicitídu.

Laparoscopic appendectomy has not yet become a stable part of surgical armamentary as has laparoscopic cholecystectomy. The authors on the basis of their own experience show its benefit for the surgeon and for the patient. The conversion rate (7.7%) in the study group is comparable with literature data. The indication for operation was always periappendical mass, in combination with retroceocal position of the appendix. Minimum complication rate in the study group (one case of subfebrile fever in 5 days), very good overview in operation field with the possibility to treat also another pathologic findings concern the authors together with short hospital stay a clear advantages of laparoscopic appendectomy. On the basis of this experience their advocate the routine use of this operation. (Ref. 19.)

Laparoscopic adjustable gastric band: first experience in Slovakia.

BACKGROUND: Until recently, surgery for obesity was not done in Slovakia. After preparation in workshops, the authors began to perform laparoscopic adjustable gastric banding. Their laparoscopic work is based on a 7-year experience in laparoscopy. METHODS: From December 1997 to May 1998, 14 procedures were done. The laparoscopic adjustable gastric band was used in all procedures. The group consisted of 8 women and 6 men. Their ages ranged from 30 to 53 years (mean 43), the body mass index was 37-56 (average 46.2), the hospital stay was 3-7 days (4.8), and the operating time was 75-285 minutes (145.3). A five-trocar technique was used. RESULTS: Weight loss in the first month ranged from 9 to 15 kg. In follow-up, the weight loss averaged 3-4 kg monthly. Up to the time of writing, no band had been adjusted. Intraoperative hemorrhage occurred in two patients. No conversion was done. One patient underwent reoperation and removal of the band because of obstruction of the stoma caused by profuse vomiting after enormous intake of food. CONCLUSIONS: Despite a small early series, the procedure seems to be safe and well tolerated by patients, with sufficient early weight loss.

Laparoscopic transgastric pancreatic pseudocystogastrostomy--first experience with extraluminal approach.

BACKGROUND/AIMS: Transgastric cystogastrostomy (Jurasz procedure) became a standard procedure in the treatment of mature pancreatic pseudocysts contacting the stomach. The first experience with laparoscopically performed transgastric cystogastrostomy under performing anterior gastrostomy is discussed. METHODOLOGY: Five ports were used. The anterior stomach wall was opened 2 cm in length. The communication channel with the pseudocyst was created by means of precise coagulation of the posterior stomach as well as the pseudocyst wall. The pseudocyst was evacuated and the stoma was completed by stapling with the EndoGIA lineal stapler 3 cm in length. The anterior stomach wall was also closed with EndoGIA stapler. RESULTS: Excellent results could be achieved. The pseudocyst resoluted within 1 month after the operation, and the anastomosis healed completely. The patient was discharged on the 8th post-operative day. The follow-up for 1 year was free of complications. CONCLUSIONS: Laparoscopic pseudocystogastrostomy appears to be a reliable method for treatment of large size mature pancreas pseudocysts because it is a minimally invasive procedure with standardized stapler-performed anastomosis. However, this initial experience has to be confirmed with a large number of patients.

[Laparoscopic cholecystectomy and its safety--observations after 2000 procedures]. / Laparoskopická cholecystektomie a její bezpecnost--zamyslení po 2000 výkonech.

The authors experience with laparoscopic cholecystectomy in the group of 2200 patients operated on from March 1992 to September 1996 is discussed. The complications rate at the beginning and at the end of the study is expressed. In the last 100 cases there was conversion rate of 1%, no biliary injury was observed and the average postoperative hospital stay was 2.26 days. In the whole group of patients biliary injuries were observed in 0.18%. Lethality was 0.13%. The authors conclude, that laparoscopic cholecystectomy is a save method in the treatment of the gallstone disease, when certain rules are respected.