The Association of Polish Surgeons (APS) clinical guidelines for the use of laparoscopy in the management of abdominal emergencies. Part I.

Introduction: Over the past three decades, almost every type of abdominal surgery has been performed and refined using the laparoscopic technique. Surgeons are applying it for more procedures, which not so long ago were performed only in the classical way. The position of laparoscopic surgery is therefore well established, and in many operations it is currently the recommended and dominant method. Aim: The aim of the preparation of these guidelines was to concisely summarize the current knowledge on laparoscopy in acute abdominal diseases for the purposes of the continuous training of surgeons and to create a reference for opinions. Material and methods: The development of these recommendations is based on a review of the available literature from the PubMed, Medline, EMBASE and Cochrane Library databases from 1985 to 2022, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. Recommendations were formulated in a directive form and evaluated by a group of experts using the Delphi method. Results and conclusions: There are 63 recommendations divided into 12 sections: diagnostic laparoscopy, perforated ulcer, acute pancreatitis, incarcerated hernia, acute cholecystitis, acute appendicitis, acute mesenteric ischemia, abdominal trauma, bowel obstruction, diverticulitis, laparoscopy in pregnancy, and postoperative complications requiring emergency surgery. Each recommendation was supported by scientific evidence and supplemented with expert comments. The guidelines were created on the initiative of the Videosurgery Chapter of the Association of Polish Surgeons and are recommended by the national consultant in the field of general surgery. The first part of the guidelines covers 5 sections and the following challenges for surgical practice: diagnostic laparoscopy, perforated ulcer, acute pancreatitis, incarcerated hernia and acute cholecystitis. Contraindications for laparoscopy and the ERAS program are discussed.

Nutritional Status, Selected Nutrients Intake, and Metabolic Disorders in Bariatric Surgery Patients.

Bariatric surgery is the most effective treatment for obesity and its complications. However, failure to adhere to dietary recommendations can result in both unsatisfactory weight loss and metabolic disorders. The aim of this study was to evaluate the effects of bariatric surgery on the anthropometric parameters and selected nutrient intake. A total of 12 months postoperatively, percent excess weight loss (%EWL) was significantly higher after laparoscopic Roux-en-Y gastric bypass (LRYGB) than laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) (93.78% vs. 56.13% and 55.65%, p < 0.001). The same was true for waist-to-hip ratio (WHR) (p = 0.017) and waist-to-height ratio (WHtR) changes (p = 0.022). There was a significant decrease in total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels after RYGB. A significant decrease (p < 0.05) in daily intake was found for energy (4278.4 kcal vs. 1355.17 kcal), sucrose (122.23 g vs. 38.22 g), dietary fiber (30.90 g vs. 14.20 g), eicosapentaenoic fatty acid and docosahexaenoic acid (EPA+DHA) (142.46 mg vs. 52.90 mg) and % energy from fats (42.43% vs. 35.17%), saturated fatty acids (SAFAs) (19.96% vs. 14.11%) and alpha-linolenic fatty acid (ALA) (0.87% vs. 0.69%). Energy intake and energy % from fats positively correlated with body weight (BW), waist circumference (WC), WHR, and WHtR, and negatively with %EWL. The percentage of unsaturated fatty acids positively correlated with WC and WHR. Energy intake correlated positively with serum triglycerides (TGs) and energy % from fats and carbohydrates. Despite significant weight loss, the patient's diet deviated from recommendations and may have contributed to metabolic disorders.

Effect of Significant Postoperative Complications on Decision Regret After Laparoscopic Sleeve Gastrectomy: a Case-Control Study.

BACKGROUND: Thus far, no data are available on decision regret about sleeve gastrectomy (SG), particularly in patients who experienced perioperative complications. This study aimed to assess whether patients with postoperative complications regret their decision to undergo laparoscopic SG more than patients with an uneventful postoperative course. METHODS: The study group comprised patients with complications after laparoscopic SG (cases). The control group comprised patients who did not experience any postoperative complications (controls). A telephone survey was conducted on all patients. Patients' satisfaction regarding their decision to undergo surgery was assessed using the Decision Regret Scale. RESULTS: In total, 21 patients who experienced postoperative complications and 69 controls were included. The patients in the study and control groups achieved similar percentages of total weight loss (32.9 ± 11.9 vs. 33.8 ± 15.0, p = 0.717) and excessive body mass index loss (74.9 ± 30.7 vs. 73.1 ± 36.7, p = 0.398) at 1 year postoperatively. The difference in weight change at 12 months postoperatively was not significant in both groups. The mean regret scores in the study and control groups were 13.2 ± 1.2 (range, 28-63) and 13.3 ± 1.1 (range, 12-66) (p = 0.818), respectively. Moreover, no significant difference was found among patients who expressed regret between the study and control groups (regret score > 50; 4.76% vs. 4.35%) (p = 1.000). CONCLUSION: This study suggests that patients with postoperative complications do not regret their decision to undergo SG more than patients with an uneventful postoperative course.

Bariatric tourists. Foreign bariatric patients treated in Poland - a survey based study.

<b>Introduction:</b> Bariatric procedures are becoming more popular worldwide. We present a current situation of foreign patients treated by high-volume bariatric surgeons in Poland in 2016. <br><b>Material and Methods:</b> We sent an online survey to twenty high-volume bariatric surgeons. The questionnaire regarded the year 2016. We asked for number and types of bariatric procedures performed or supervised, number of foreign bariatric patients, their qualification process, country of origin, types of procedure, and post-op recommendations. <br><b>Results:</b> We received 9 surveys (45%). Five surgeons performed or supervised from 100 to 300 bariatric procedures, 2 performed or supervised over 300 procedures, 2 performed or supervised from 50 to 100 procedures. All of the respondents performed laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LRYGB), four carried out mini gastric bypass, two - gastric banding (LAGB), one - SADI-S and duodenal switch (DS). Six surgeons operated on the total of 64 foreign patients, mainly performing LSG, LRYGB and mini gastric bypass. Most of the patients were qualified based on international criteria [body mass index (BMI) over 40 kg/m² or BMI over 35 kg/m² with comorbidities]. United Kingdom was the most popular country of origin, followed by Germany, USA, Ireland and Sweden. Qualification for surgery was based on a personal visit. After surgery, 83.3% (n = 5) of the respondents gave out discharge documents in English, recommending long-term bariatric follow-up in the country of origin. Every respondent carried out 3-month personal follow-up of every foreign patient. <br><b>Conclusions:</b> Foreign bariatric patients travelling to Poland are qualified for surgery according to known international standards. Most of the patients receive post-op discharge documents in English, with a 3-month follow-up performed by their surgeon. Further bariatric supervision in the country of origin is routinely recommended.

Metabolic and Bariatric Surgery Chapter of the Association of Polish Surgeons. Bariatric and metabolic surgery care standards.

The Metabolic and Bariatric Surgery Chapter of the Association of Polish Surgeons (Polish acronym: SCMiB TCHP) is a Polish specialist scientific society representing bariatric surgeons as well as specialists from other disciplines and professions cooperating with them during the provision of services in the field of bariatric and metabolic surgery, as well as the entire care process before and after surgery. The following standards constitute the minimum requirements set by the SCMiB TCHP for good practice of the basic process of bariatric care throughout its entire period, which ensure satisfactory safety and effectiveness of the obesity treatment and its metabolic complications.

XXL-TYPE PERSONALITY. Personality traits promoting excess body weight.

THE AIM OF THE STUDY: The study aimed to determine whether persons suffering from obesity may be characterised by specific personality traits which promote the development of excess body weight. Additionally, the aim involved finding whether persons suffering from morbid obesity differed from healthy individuals and somatic patients as regards selected personality traits. MATERIAL AND METHODS: The study enrolled 34 patients with the diagnosis of morbid obesity in the process of qualification for surgical treatment of obesity. The patients' BMI ranged from 35 to 54 kg/m2. Study participants completed NEO-FFI personality inventory (Costa, McCare; 1998) and the authors' questionnaire designed to collect demographic data and anthropometric measurements. R esults: The study showed that patients with morbid obesity significantly differed from healthy individuals and somatic patients as regards the analysed measurements of the Big Five. C onclusions: The traits which were significantly distinctive in morbidly obese patients included lowered conscientiousness and increased neuroticism. The results indicate that the above pattern of personality traits may promote the development of excessive body weight.

Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy - single center experience.

INTRODUCTION: Nowadays laparoscopic right hemicolectomy is widely accepted as the standard of care for benign and malignant colon disease. There are wide variations among laparoscopic techniques. One of the most discussed topics is the ileocolic anastomosis. There are two different techniques: intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA). AIM: To compare short-term outcomes of performing intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy. MATERIAL AND METHODS: A retrospective chart review was performed of 92 consecutive patients who underwent laparoscopic right hemicolectomy, with either an IA or EA, from January 2013 to December 2016. RESULTS: Eighty-five patients were included in the analysis. There were 53 males and 32 females with a mean age of 67.1 ±13.2 years. Mean body mass index (BMI) was 27.7 ±4.8 kg/m2. An intracorporeal anastomosis was performed in 51 patients, while an extracorporeal anastomosis was performed in 34. The duration of operations was significantly longer when intracorporeal anastomosis was performed, taking 154 ±58 min compared to 95 ±34 min (p < 0.001), in the extracorporeal group. No mortality was observed in the IA group. The postoperative mortality in the EA group was 8.8% (p = 0.060). The rate of reoperation in the intracorporeal anastomosis group was 7.8%, whereas in the extracorporeal anastomosis group it was 14.7% (p = 0.474). Length of hospital stay in the IA group was shorter in comparison to the EA group (5.3 ±3.7 vs. 11.2 ±19.8 days, p = 0.022). CONCLUSIONS: Our results are encouraging to consider the intracorporeal approach as the better way to fashion the anastomosis after laparoscopic right hemicolectomy.

Bulimia nervosa in obese patients qualified for bariatric surgery - clinical picture, background and treatment.

Eating is a basic human physiological need which is necessary to keep the body alive. Eating disorders are diagnosed when eating (or not eating) and associated body weight gain anxiety become the main interest of an individual and all other spheres of life depend on it. Bulimia nervosa is a psychiatric disorder which is more and more commonly diagnosed in patients suffering from obesity and in patients after surgical treatment of obesity. In patients eligible for bariatric surgery this disorder should be diagnosed appropriately early and treated successfully before the procedure, because bulimia nervosa does not regress spontaneously. When untreated, it may last for years, reducing the efficacy of a surgical treatment of obesity, or even lead to complications that are health- and life-threatening for patients.

The Safety and Benefits of Laparoscopic Sleeve Gastrectomy in Elderly Patients: a Case-Control Study.

INTRODUCTION: The advancement of minimal invasive techniques pushed the age limit for patients qualified for bariatric surgery. AIM: The aim of the study was to evaluate the safety and effectiveness of laparoscopic sleeve gastrectomy (LSG) in a cohort of patients aged 60 years or more, compared with a group of matched controls below 40 years old. METHODS: The medical records of 856 patients were analyzed. Patients aged 60 years or older were identified as cases. Those below 40 years were identified as the controls. Cases were closely matched (1:1) with the controls by body mass index (BMI) (± 1 kg/m2) and presence or absence of hypertension and diabetes mellitus. RESULTS: A 34 matched pairs were included in the study. There was no significant difference in the median operation length. No conversion from laparoscopic to open surgery was needed. The hospital length of stay was significantly longer in the study group (4.5 ± 1.9 vs 3.9 ± 1.5 days, p = 0.047). The complication, 30-day reoperation, and 30-day reoperation rates were comparable in both groups. There were no 30-day readmissions nor 30-day mortality. ΔBMI after 12 months was significantly lower in the study group (13.56 ± 6.05 vs 10.3 ± 4.89, p = 0.008) as well as %EBMIL (50.71 ± 25.94 vs 64.20 ± 23.29, p = 0.015). CONCLUSIONS: The study suggests that LSG is a safe method of bariatric treatment in patients aged above 60 years. Even though weight loss may be lesser than in younger patients, it can still be considered satisfactory.

Postoperative pain relief in general surgery - recommendations of the Association of Polish Surgeons, Polish Society of Anaesthesiology and Intensive Therapy, Polish Association for the Study of Pain and Polish Association of Regional Anaesthesia and Pain Treatment.

It is estimated that there are over 310 million surgeries performed in the world every year. Appropriate analgesic management in the perioperative period constitutes a fundamental right of every patient, significantly reducing the number of postoperative complications and the time and costs of hospitalization, particularly in the high-risk group of patients (ASA III-V) subject to extensive surgical procedures and hospitalized in intensive care units. Despite such significant arguments speaking for the conduct of effective analgesia in the perioperative period, nearly 79% of patients operated in hospitalization settings and 71% of patients operated in outpatient settings (so-called first day surgery) experienced postoperative pain of moderate, strong or extreme intensity. Hence, effective relief of postoperative pain should constitute one of the priorities of integrated, modern perioperative management, the components of which apart from adequate analgesia involve early nutrition through the alimentary canal, early patient activation and active physiotherapy. In the currently published "Guidelines", a team of authors has updated the previous "Recommendations" primarily in terms of methods for optimizing postoperative pain relief and new techniques and drugs introduced for postoperative pain therapy in recent years. The algorithms of postoperative pain management in different treatment categories were also updated.

Present trends in bariatric surgery in Poland.

INTRODUCTION: As obesity has become a major health problem in Poland and bariatric procedures are the best way of treatment, an increasing trend has been observed in Polish bariatric surgery for the last decade. AIM: Our purpose was to provide an updated overview of the bariatric surgical procedures performed in Polish institutions in comparison to the situation in Europe as well as to analyze the trends in Polish bariatric surgery over the last decades. MATERIAL AND METHODS: A questionnaire about the number and type of bariatric procedures performed in 2016 was sent to all Polish surgical departments. Two hundred and sixty surgical departments returned the questionnaires. RESULTS: Twenty-seven departments reported having performed bariatric operative or endoscopic procedures in 2016. The total number of procedures reported was 1958, the most popular being the laparoscopic sleeve gastrectomy (LSG). More than 99% of procedures were performed using laparoscopic techniques. The most common operations were: LSG (64.6%, n = 1032) and laparoscopic Roux-en-Y gastric bypass (LRYGB) (18.2%; n = 291), followed by one anastomosis gastric bypass (OAGB) (8.3%; n = 132) and laparoscopic adjustable gastric banding (LAGB) (7.3%; n = 117). CONCLUSIONS: Registers of bariatric procedures provide information that helps in planning treatment and predicting possible complications. Adequate reporting of bariatric procedures is necessary to present the importance of the high incidence of obesity and the importance of its treatment. To collect reliable data, a national Polish bariatric surgery registry should be created.

Macroscopic Evaluation of Gastric Specimens After Laparoscopic Sleeve Gastrectomy-an Optimum Screening Test for Incidental Pathologies?

INTRODUCTION: Obesity is a serious lifestyle disease with various comorbidities and an augmented risk of cancer. Laparoscopic sleeve gastrectomy (LSG) has recently become the most popular bariatric procedure worldwide. While the cost-effectiveness is a major healthcare providers' concern, the point of histological exam of each resected tissue may be questioned. MATERIAL/METHODS: We prospectively included patients who underwent LSG. Before the surgery, gastroscopy and abdominal sonography were performed to exclude malignancies. The gastric specimen was cut open after the surgery and inspected macroscopically, then sent for a microscopic examination. RESULTS: In 5 cases out of 115, macroscopic evaluation of the resected specimen performed by the surgeon suggested existing pathology, confirmed by a microscopic evaluation in 3 out of 5 cases. In the remaining 2 cases, pathological analysis did not reveal abnormalities. In 110 cases, the gastric specimen was recognized to be unchanged by the surgeon, 109 out of which were confirmed by the pathologist to be normal, in 1 case a hyperplastic polyp was found. The sensitivity of macroscopic evaluation reached 75% (95% CI, 19.4-99.4%, p = 0.625), with specificity of 98.2% (95% CI, 93.6-99.8%, p < 0.0001), and negative predictive value of 99.1% (95% CI, 95-99.9%, p < 0.0001). CONCLUSIONS: During LSG, a thorough visual inspection of the peritoneal cavity along with a macroscopic surgical evaluation of specimen in patients who had preoperative endoscopy with no findings allows to achieve very good specificity and good sensitivity. Therefore, this procedure may be useful as a screening test for incidental pathologies in bariatric patients and may exclude unnecessary histological examination.

Effectiveness and Safety of Roux-en-Y Gastric Bypass in Elderly Patients-Systematic Review and Meta-analysis.

INTRODUCTION: As the population ages, there is more interest in bariatric surgery for older patients. There are controversies regarding the safety and effectiveness of surgical weight loss in this population. AIM: The aim of this study was to compare the safety and efficacy of Roux-en-Y gastric bypass in patients over the age of 60 years with younger patients. METHODS: The available literature was searched for eligible studies up to February 2018. Inclusion criteria were reports on mortality, morbidity, percentage excess weight loss (%EWL), remission of diabetes, remission of hypertension, and remission of obstructive sleep apnea. Random effects meta-analyses were performed. RESULTS: The initial search yielded 2000 references. The final meta-analysis involved nine studies and revealed significant differences in mortality (odds ratio 4.38, 95% confidence interval [1.25, 15.31], p = 0.02), morbidity (OR 1.88, CI [1.07, 3.30], p = 0.03), %EWL (mean difference - 5.86, 95% CI [- 9.15, - 2.56], p < 0.001), and remission of comorbidities. CONCLUSION: Higher mortality and morbidity were found in the group of older patients. The analysis suggested lower effectiveness of Roux-en-Y gastric bypass for weight loss and improvement in comorbidity in older patients when compared with younger patients.

Assessment of health behaviors, nutritional behaviors, and self-efficacy in patients with morbid obesity. / Ocena zachowan zdrowotnych, zywieniowych i poczucia wlasnej skutecznosci chorych z otyloscia olbrzymia.

OBJECTIVES: The objective of the study was to assess the frequency of health and nutritional behaviors concerning emotional, habitual, and restrictive eating as well as to evaluate self efficacy in patientswith morbid obesity and determine the correlation between patients'BMI index and their health behaviors as well as self-efficacy. METHODS: The study included 37 patients diagnosed with class two and three obesity, aged 18-62 (M = 39.94; SD = 12.20). Patients' BMI ranged from 36 to 60 kg/m2 (M = 43.50; SD = 5.36). Research tools used in the study: the Inventory of Lifestyle Behaviors (ILB), the Dietary Behaviors Questionnaire (DBQ), and the General Self-Efficacy Scale (GSES). RESULTS: Patients with morbid obesity were characterized by medium (men; a sten score of 5) and low (women; a sten score of 4) intensity of health behaviors. Subjects showed a tendency for negative nutritional behaviors, emotional and habitual eating as well as dietary restrictions. General self-efficacy ranged between sten scores of 4 to 10, with mean at a high level (a sten score of 7). CONCLUSIONS: Patients with morbid obesity need health, nutritional, and psychological education.

Recommendations for the standards of equipping of the Bariatric and Metabolic Surgery Center.

INTRODUCTION: The prevalence of obesity in Poland and worldwide is constantly rising. High effectiveness of bariatric surgery has been proven in literature. It is recommended that bariatric procedures should be done by highly qualified surgeons with the appropriate, up-to-date medical equipment. AIM: The purpose of the study is to establish Polish recommendations and standards for the use of medical equipment for bariatric surgery centers. MATERIALS AND METHODS: The review of the present recommendations of the worldwide organizations and societies (including EAES, IFSO, SAGES) and guidelines was made. On the basis of current literature and authors's clinical experience we proposed standardized protocol for bariatric surgical equipment. CONCLUSIONS: Relevant equipping of bariatric surgery centers and implementation of standardized perioperative and surgery protocols will result in significant improvements in bariatric treatment. This will ensure patients safety, a shorter length of hospital stay and considerably reduce the risk of morbidity. Moreover, it will contribute to the efficacy of the bariatric and metabolic surgery procedures, in accordance with the highest globally accepted standards.

Pharmacotherapy of pain in cancer patients - recommendations of the Polish Association for the Study of Pain, Polish Society of Palliative Medicine, Polish Society of Oncology, Polish Society of Family Medicine, Polish Society of Anaesthesiology and Intensive Therapy and Association of Polish Surgeons.

Guidelines for the pharmacotherapy of pain in cancer patients were developed by a group of 21 experts of the Polish Association for the Study of Pain, Polish Society of Palliative Medicine, Polish Society of Oncology, Polish Society of Family Medicine, Polish Society of Anaesthesiology and Intensive Therapy and Association of Polish Surgeons. During a series of meetings, the experts carried out an overview of the available literature on the treatment of pain in cancer patients, paying particular attention to systematic reviews and more recent randomized studies not included in the reviews. The search was performed in the EMBASE, MEDLINE, and Cochrane Central Register of Controlled Trials databases using such keywords as "pain", "cancer", "pharmacotherapy", "analgesics", and similar. The overviewed articles included studies of pathomechanisms of pain in cancer patients, methods for the assessment of pain in cancer patients, and drugs used in the pharmacotherapy of pain in cancer patients, including non-opioid analgesics (paracetamol, metamizole, non-steroidal anti-inflammatory drugs), opioids (strong and weak), coanalgesics (glucocorticosteroids, α2-adrenergic receptor agonists, NMDA receptor antagonists, antidepressants, anticonvulsants, topical medications) as well as drugs used to reduce the adverse effects of the analgesic treatment and symptoms other than pain in patients subjected to opioid treatment. The principles of opioid rotation and the management of patients with opioidophobia were discussed and recommendations for the management of opioid-induced hyperalgesia were presented. Drugs used in different types of pain experienced by cancer patients, including neuropathic pain, visceral pain, bone pain, and breakthrough pain, were included in the overview. Most common interactions of drugs used in the pharmacotherapy of pain in cancer patients as well as the principles for the management of crisis situations. In the final part of the recommendations, the issues of pain and care in dying patients are discussed. Recommendations are addressed to physicians of different specialties involved in the diagnostics and treatment of cancer in their daily practice. It is the hope of the experts who took part in the development of these recommendations that the recommendations would become helpful in everyday medical practice and thus contribute to the improvement in the quality of care and the efficacy of pain treatment in this group of patients.

Usefulness of Cryoprobe in Office Hysteroscopy for Removal of Polyps and Myomas.

Hysteroscopy is a gold standard in 21st-century gynaecology for both diagnosis and treatment procedures of intrauterine pathologies. Miniaturisation of the equipment and better techniques of performing this procedure allowed it to become the gold standard. Nevertheless, hysteroscopy has its limitations, which is the size of the endometrial polyps or submucous myomas. We have invented a new device for the 5Fr working channel hysteroscopes for possessing and resecting intrauterine structures: the cryoprobe. The retrospective cryobiopsy study presented here was conducted at the Department of Gynaecology and Oncological Gynaecology, Military Institute of Medicine in Warsaw, Poland, from October 2017 to January 2018. Its purpose was to assess the usefulness of the new device in office hysteroscopy for the removal of polyps and myomas with a diameter over 10 mm. Thirteen patients with an initial diagnosis of an endometrial polyp or submucous myoma were enrolled in the trial. All procedures took place in day-surgery settings, with a total resection of the pathological intrauterine structure, without complications. The application of the cryoprobe may enhance the usefulness of office hysteroscopy, without extending the procedure. The cryoprobe efficiency is still under research in a bigger group.

Intrahepatic cholangiocarcinoma in an obese patient qualified for laparoscopic bariatric surgery - a case study.

Intrahepatic cholangiocarcinoma is a rare type of biliary tract malignancy, seldom found resectable at diagnosis, the 5-year survival rate depending on the possibility of complete surgical excision. In most cases it is only accidentally found in the early stage. The report presents a case of a 58-year-old obese male patient qualified for laparoscopic Roux-en-Y gastric bypass. During general inspection of the abdominal cavity, a tumor of 10 mm in diameter was found in the second hepatic segment and resected. Final pathology results showed low-grade intrahepatic cholangiocarcinoma without vascular invasion, with positive margins of incision (R1), classified as stage I. The abdominal computed tomography scan showed no evidence of metastatic disease. Two months later the patient underwent a laparoscopic partial hepatectomy. Pathological investigation showed focal bile duct hamartoma with no signs of malignancy. No adjuvant therapy was administered and no recurrence has been found to date.

Cigarette smoking and its impact on weight loss after bariatric surgery: A single center, retrospective study.

BACKGROUND: Smoking cessation is often associated with weight gain. This study was conducted to verify whether it affects outcomes of bariatric surgery. OBJECTIVES: To present cigarette consumption among patients after bariatric surgery in a long-term follow-up and to evaluate whether smoking cessation impacts weight loss. SETTING: High-volume bariatric center, Military Hospital, Poland. METHODS: We collected data of patients who underwent bariatric surgery between 2003 and 2009. The data included sex, age, weight, body mass index, and smoking habits. An online survey regarding current weight, co-morbidities, and smoking was distributed. Percentage excess weight loss was calculated with an ideal weight for body mass index of 25 kg/m2. RESULTS: One hundred seven patients had laparoscopic adjustable gastric banding between 2003 and 2006; 47 were included in the study. The mean follow-up time was 11.2 (±1.2). Of patients, 51% (n = 24) were smokers before surgery. In the follow-up 43% (n = 20) were smokers, of whom 4 patients began smoking after surgery. Twenty-seven patients were nonsmokers, 8 of whom quit over the years (33% of previous smokers). One hundred twenty-seven underwent laparoscopic sleeve gastrectomy between 2006 and 2009; 84 were included in the study. Our median follow-up was 8.0 years. Thirty-two patients never smoked; 52 were smoking before surgery, yet 24 successfully quit. In both groups there were no statistically significant differences in percentage excess weight loss between smokers and nonsmokers, or between those who quit and did not. CONCLUSIONS: In the long-term follow-up after laparoscopic adjustable gastric banding, 33% of smokers quit and 17% previously nonsmoking began smoking. After laparoscopic sleeve gastrectomy, 46% of previously smoking patients successfully quit. Smoking status was not significantly associated with weight loss.

Does previous abdominal surgery affect the course and outcomes of laparoscopic bariatric surgery?

BACKGROUND: Global experiences in general surgery suggest that previous abdominal surgery may negatively influence different aspects of perioperative care. As the incidence of bariatric procedures has recently increased, it is essential to assess such correlations in bariatric surgery. OBJECTIVES: To assess whether previous abdominal surgery influences the course and outcomes of laparoscopic bariatric surgery. SETTING: Seven referral bariatric centers in Poland. METHODS: We conducted a retrospective analysis of 2413 patients; 1706 patients who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) matched the inclusion criteria. Patients with no history of abdominal surgery were included as group 1, while those who had undergone at least 1 abdominal surgery were included as group 2. RESULTS: Group 2 had a significantly prolonged median operation time for RYGB (P = .012), and the longest operation time was observed in patients who had previously undergone surgeries in both the upper and lower abdomen (P = .002). Such a correlation was not found in SG cases (P = .396). Groups 1 and 2 had similar rates of intraoperative adverse events and postoperative complications (P = .562 and P = .466, respectively). Group 2 had a longer median duration of hospitalization than group 1 (P = .034), while the readmission rate was similar between groups (P = .079). There was no significant difference between groups regarding the influence of the long-term effects of bariatric treatment on weight loss (percentage of follow-up was 55%). CONCLUSIONS: Previous abdominal surgery prolongs the operative time of RYGB and the duration of postoperative hospitalization, but does not affect the long-term outcomes of bariatric treatment.