Bariatric Unit Research Articles

BS P01 Obesity – the last bastion of prejudice and stigma in the NHS?

Abstract Background There is anecdotal evidence to suggest that patients with obesity face stigma in the NHS Methods A multiple-choice survey was sent out to consultants in a university teaching hospital with an established bariatric surgery unit. Respondents provided information on demographics and perceptions of obesity and bariatric surgery. Results were presented as frequencies and this was analysed. Results There were 167 consultant respondents with M:F = 114:53. 58% belonged to medical speciality and the rest belonged to the surgical speciality. 90% had over 10 years of NHS experience. 46.7% were in the normal BMI range and 3.5% had BMI 35 and above. 1.8% were not aware that obesity is classified as a disease. 42.5% felt that obesity is a self-inflicted disease. 73.4% agreed that bariatric surgery should be funded by the NHS, but 12% disagreed. 4.2% were of the opinion that bariatric surgery is a waste of money. 97% agreed that bariatric surgery resulted in weight loss and resolution of comorbidities. Conclusions There is a significant negative perception that obesity is a self inflicted life style disease even amongst the consultant work force reinforcing the premise that perhaps obesity is the last bastion of prejudice in the NHS.

Patient perspectives on surgeon-specific outcome reports in bariatric surgery.

Surgeon specific outcome reports (SSOR) in the UK can be accessed freely by the general public to promote transparency and informed decision-making. However, the views amongst bariatric patients concerning these data are unknown. The aims of this study were to determine patient awareness, views and priorities for outcome reporting in bariatric surgery, and to provide recommendations for future surgeon-specific outcome reporting through the United Kingdom National Bariatric Surgery Registry. Bariatric surgical unit in a UK university teaching hospital. We adapted a previously validated questionnaire and surveyed the views of 150 patients in a single bariatric surgical unit. We collected data concerning awareness, views, and future priorities for outcome reporting. A full 73% of participants were unaware they could access SSOR. Of the participants that were unaware, 75% stated that they would have accessed SSOR had they been aware they could. Of the participants that had previously accessed SSOR, 86% stated they understood the data, although 61% indicated it did not influence their choice of surgeon. The majority of participants favored public release of outcome reports at the surgeon-level (75%) and hospital-level (83%). The 3 main priorities indicated by participants for future outcome reporting were complication rates (91%), patient reported outcome measures (90%), and reoperation rate (89%), all at the surgeon level. Patient awareness of outcome reporting is poor. Efforts must be made to increase awareness of SSOR. Patients should be incorporated as key stakeholders in determining future outcome reporting in bariatric surgery.

Assessment of the Role of Omentopexy in Laparoscopic Sleeve Gastrectomy: A Tertiary Center Experience.

Background: Laparoscopic sleeve gastrectomy is one of the most common bariatric procedures due its high success and low complication rates. However, acid reflux and food intolerance remain drawbacks of the procedure, with high frequency of postoperative gastroesophageal reflux disease (GERD) and eating disorders reported by previous studies. Omentopexy is not a standard technique in laparoscopic sleeve gastrectomy and showed promising results in preventing these sequelae. The present study aimed to evaluate whether omentopexy would decrease the incidence of postoperative GERD, food intolerance, and gastric volvulus without increasing additional complications rates in comparison with laparoscopic sleeve gastrectomy (LSG) without omentopexy. Patients and Methods: Our study included all the patients undergoing laparoscopic sleeve gastrectomy in our bariatric unit, who were divided into two groups. Group II had the added step of omentopexy. Comparison between both groups was done regarding incidence of acid reflux, food tolerance, and postoperative complications. Results: Omentopexy decreased the incidence of acid reflux, gastric kink, volvulus, and intrathoracic migration. Moreover, food tolerance significantly improved in patients, which in turn led to higher compliance with the postoperative dietary plan and better outcome with regard to weight loss. In addition, omentopexy showed lower incidence of postoperative leakage. Conclusion: Omentopexy is a valuable step in laparoscopic sleeve gastrectomy, which should be considered a standard step in all cases.

Interconnection of severe obesity, gastric intestinal metaplasia, gastric cancer, bariatric surgery and the necessity of preoperative endoscopy

Obesity is a growing challenge around the globe accounting for approximately 1.7 billion adults with reduced life expectancy of 5–20 years and these patients are at greater risk for various cancers. Bariatric surgery is one efficient an approved treatment of severe obesity for losing weight and to decrease associated health complications. Besides correct indications and contraindications as well as the various risks of individual bariatric surgical procedures, many more variables influence decision-makings, such as patient’s family history of diseases, as well as individual patient-specific factors, patient and family socioeconomic and nutrition status, and professionalism of a bariatric surgical unit and the presence of intestinal metaplasia that is the replacement of columnar epithelial cells by intestinal architecture and morphology. Patients with severe obesity undergoing esophagogastroduodenoscopy (EGD) and biopsy prior to bariatric surgery may present with gastric IM because regular follow-up to early diagnosis of any subsequent pathological changes is necessary and reveals the importance of addressing interconnections between pre-existing conditions and outcomes. However, there is currently no unified recommendation about preoperative EGD before bariatric surgery. With this short review, we point out the necessary knowledge that undermines why the responsibility for a patient with severe obesity cannot be divided across various disciplines, and why we recommend that EGD always be performed preoperatively.

Laparoscopic Sleeve Gastrectomy Outcomes

Introduction: Sleeve gastrectomy was first defined in 1990 as a part of the duodenal switch procedure with the formation of a narrow stomach tube along the small curvature of the stomach. Later, researchers proposed that Laparoscopic leave gastrectomy (LSG) reduced the risk profile of the duodenal switch procedure in high risk patients. Additionally, LSG was accepted as a rapid single bariatric surgical procedure due to its simplicity and efficacy. The aim of this study was to describe the outcomes of LSG at a single bariatric unit in King Salman North West Armed Forced Hospital (KSAFH), Tabuk, Saudi Arabia. Objective: To compare outcomes of primary LSG regarding pre and post operative sleep apnea, diabetes mellitus (DM), arterial hypertension (HTN), bronchial asthma, female urinary incontinence, infertility, and gastroesophageal reflux (GERD). We will assess our complications according to the Clavein-Dindo classification. We reviewed the medical records of patients who underwent LSG in King Salman Armed Forces Hospital from 1/1/2015 till 31/6/2017. Methods: This retrospective comparative study is performed in the Department of Surgery, KSAFH. All patients are instructed for follow-up at 1 week and 1, 3, 6, 12, 18, 24 months postoperatively. Laboratory tests are requested every 6 months post op. Improvement of Comorbidities assessed post-operatively. Surgical Complications reported according to the Clavein-Dindo classification. Our results were compared with international studies. Inclusion criteria (more than 14 years, morbid obese with BMI > 40 and obese class 11 with comorbidities). Exclusion criteria (less than 14 years, BMI Results: A total of 127 patients underwent LSG at King Salman Armed Forces Hospital from 1/1/2015 till 31/5/2017. Of these, 40 were male (31.5%) and 87 were female (68.5%). The mean age was 35 years. Comorbidities included diabetes 31 (24.4%),

P-B04 Restarting bariatric surgery after the Covid-19 pandemic: a template for safe practice

BackgroundBariatric surgery virtually ceased with the advent of the Covid-19 pandemic and has been amongst the last sector of operative practice to restart. There have been understandable concerns about restarting bariatric surgery including the risks to patients of contracting Covid infection in the peri-operative period, potential de-skilling of surgeons and theatre teams and the appropriateness of directing scarce and limited resources to bariatric surgery when every surgical specialty is experiencing rapidly rising waiting times and ever lengthening waiting lists. This study describes the restart programme at our NHS bariatric unit and offers a template for safe commencement of complex benign surgeries in the current era.MethodsIn the months after the pandemic started, our Bariatric MDT reviewed every case on the waiting list and contacted each patient to explain the current waiting times and the importance of not gaining weight to be eligible for surgery when surgical practice resumed. Group education and Support Group sessions were moved from face-to-face appointments to online classrooms and regular input was sought from specialist dieticians, nurses and psychologists.The expected waiting times for patients was pro-actively submitted to the Executive Board of the Trust with details about >104-week waiting patients being clearly articulated.Once approval was given to restart bariatric surgery, every patient was assessed and prioritised in terms of waiting time and clinical need. A bariatric theatre team was brought together and engaged in pre-operative training and a local refresher course on equipment and the planned surgeries. There was engagement with industry to provide on-the-ground support for the first lists to ensure proper and safe use of energy and stapling devices. Each list had two consultant surgeons assigned to it and just two cases per day were planned and patients were managed on an entirely green pathway within the NHS hospital .ResultsThe bariatric restart programme commenced in May 2021; between May 2021 and August 2021, there have been 27 operations carried out (25 Roux-en-Y gastric bypass, 2 sleeve gastrectomy) and two cancellations on the day (both due to patient choice). Each operating list finished between two and three hours before the planned finish time. Formal debrief sessions after each list identified no problems with the operations of the equipment and none of the patients had any post-operative complications. Length of stay was between 1 to 2 days for the entire cohort. Since the restart programme commenced, the requirement for dual consultant operating has ceased and the last 5 cases have been entirely training cases for the operating registrar, again without complication. Each list is now planned to increase to pre-pandemic levels of activity with four cases per list.ConclusionsRestarting complex benign surgical practice is complicated and requires engagement with management, theatre and nursing colleagues to ensure that cases are not ‘left behind'. It is important to reduce the risk of complications and of peri-operative covid-19 infection in bariatric patients and development of a pathway that all members of the theatre team have input in to meant that there were few problems or issues with either the planning of the lists or the running of the lists. Such an approach could be considered for restarting any high volume, complex benign surgical practice.

EP.TH.632A single centre’s experience with bariatric surgery outcomes compared to UK NBSR third report 2020

Abstract Bariatric Surgery has become a routine elective operation offered to patients with obesity (BMI >30) and obesity related diseases. The UK national Bariatric Surgery registry (NBSR) publishes data from record bariatric surgeries. Aim We compare one Bariatric service’s outcomes with the outcomes of the NBSR- Third Report 2020. Outcomes; 30-day mortality and complications, length of stay (LOS), 1-year weight loss for Gastric Sleeve (GS) and Roux-en-Y gastric bypasses. Method We collected data from one bariatric unit over a 98-month period. Data were taken from bariatric specialist nurses and electronic patient records. This was then compared with the NBSR report 2020. Results NBSR UK records 48.8% bypasses and 35.4% GS compared with our department (81.2% bypasses and 9.5% GS.) The average weight-loss 1-year post op for GS 36.9kg (NBSR 40.3kg) and for bypass 60.2kg (NBSR 44.1 kg) The average LOS for Bypass was 2.37 days (95%CI 2.3-.2.7) compared with the NBSR 2.6 (95% CI: 2.5-2.7). Whereas GS 2.9 (95%CI: 2.3-3.4) compared to NBSR 2.5 (95% CI: 2.4-2.6). 30-day mortality for primary procedures was 0% for Bypasses and GS compared with the NBSR 0.05%. 30 day complications at 1.74% compared with NBSR <2.38%. Conclusion Our unit proportionally performs more bypasses compared with the rest of UK and has greater 1-year weight-Loss with bypass procedures. This bariatric unit had less 30 day mortality and complications compared with NBSR. Our department is meeting the national outcomes when compared with the rest of the UK.

EP.WE.28Routine histopathology examination of the sleeved stomach after sleeve gastrectomy - significance and comparison with preoperative endoscopy

Abstract Background Sleeve gastrectomy (SG) is one of the most commonly performed bariatric procedures. However, the available literature on histological examination of the resected sleeved stomachs is widely inconsistent. This study aimed at assessing the histopathological findings after SG performed in our center compared to the routinely performed preoperative esophagogastroduodenoscopy (OGD) and the intraoperative findings. Material and methods We conducted a retrospective cohort study using the bariatric unit database of all patients who had SG procedures from June 2007 to December 2019. Results Out of the 620 SG performed, there were 219 patients with complete data, including preoperative OGD reports, operative notes, and postoperative histopathology reports. We found normal specimens in 43.83% (n = 96) and evidence of inflammation in 50.68% (n = 111) of cases. There were 10 (4.56%) specimens with evidence of inflammation and other lesions and two (0.91%) specimens with lesions only. Twenty-five patients had inflammation, and 10 had lesions on preoperative OGD with negative histopathology reports. Conclusion Routine histopathology examination after SG does not change the management, and preoperative OGD can detect inflammatory changes and lesions, which could have been missed with histology analysis only.

Analysis of the effect of weight loss through bariatric surgery on depression

Bariatric surgery results in significant improvement in health related quality of life and depressive symptoms irrespective of the wide range of weight change. This experiment was planned to assess the incidence of depression in obese respondents and to analyse the change in depression after weight loss through bariatric surgery.To analyse the incidence of depression in obese individuals undergoing bariatric surgery and the significance of change in depression status after weight loss.The study was conducted in a multispecialty hospital having obesity clinic and bariatric surgery unit. The depression level before the study and at six months post surgery was assessed using a standard tool named Beck’s inventory. Study period was from 2015 to 2017.Respondents having BMI of 33-50 Kg/m belonging to both the genders in the age range of 18-65 years. The respondents having BMI more than 50Kg/m were excluded in this study.18 respondents who underwent bariatric surgery were included in the study. Percentage distribution, Pearson correlation coefficient, ANOVA, and Paired t test were the tools utilised in statistical analysis of the data.Schedule to assess change in nutritional status using a structured questionnaire considering anthropometric, biochemical, clinical and dietary parameters, and standard tool named Beck’s Depression Inventory, which is a tool for depression status. The surgery patients had initial Beck Score ranging from 1 to 14 indicating mild depression which on follow up reduced to 0 to 7. The weight loss in both genders were similar to each other. The change in intake of nutrients and the scores of depression were more prominent in men than that of women. Respondents pre operatively had mild mood disturbances which after weight loss, became a normal mood.Thus it can be concluded that weight loss through bariatric surgery is effective in reducing depression.

Effect of bariatric surgery on invitro fertilization in infertile men with obesity.

Obesity has previously been related to reduced female fertility, with prolonged waiting time to pregnancy among women with a body mass index (BMI) >35 kg/m2 but there are few studies investigating the relationship between high BMI, bariatric surgery, and male fertility. The primary objective of this article was to investigate the effect of bariatric surgery on invitro fertilization (IVF) outcomes in a cohort of men with morbid obesity who underwent sleeve gastrectomy (SG). University hospital, bariatric surgery unit. Pre- and postsurgery data on patient age, body mass index (BMI), and variables related to male fertility (semen volume, concentration, progressively motile sperm count, and sperm morphology) were collected; assisted reproductive technology outcomes before and after bariatric surgery were measured by the number of metaphase II oocytes; the number of top-quality oocytes and embryos; the number of fertilized oocytes; the number of transferred embryo; the implantation rate; the pregnancy rate; the live birth rate and the miscarriage rate. Thirty-five men with obesity and idiopathic infertility were included in this study. We found a significant increase, after bariatric surgery, in semen volume, total sperm concentration, progressively motile sperm count, and sperm morphology. Considering IVF outcomes, mean number of top-quality oocytes, mean number of fertilized oocytes, mean number of embryos obtained, and top-quality embryos were significantly increased after bariatric procedure. Bariatric surgery is confirmed to be safe and effective in increasing the outcomes of assisted reproductive technology treatment also in case of infertile men with obesity, both in terms of pregnancy and live birth rate.

Weight Loss Failure after Sleeve Gastrectomy and its Management

Abstract Background Obesity has become an increasingly important global health problem. Laparoscopic sleeve gastrectomy is the most widely performed bariatric surgery. Aim of the Work To evaluate patients who failed to lose weight or regained weight after perfonning sleeve gastrectomy and how to manage them. Patients and Methods This study has been conducted at Ain Shams university hospital (Al Demerdash hospital) Ain Shams University. This is a prospective randomized controlled study (RCT) where 30 patients (20 females and 10 males) attended the outpatient clinic of the bariatric surgery unit complaining of failure of sleeve gastrectomy defined as: (failure to lose 500 0 of excess body weight or regain up to 200 0 of lost excess weight within one year or more from sleeve gastrectomy). Results All three operations have promising outcomes regarding weight loss and comorbidities resolution like diabetes mellitus and hypertension in morbidly obese patients. When compared to RE-LSG, SADI and OAGB have better results regarding weight loss. Conclusion Weight loss failure and revisional surgery remain primary long term concern after laparoscopic sleeve gastrectomy. There are currently no guidelines or systemic reviews directing the standered of practice tör revisional surgery in patients with failed primary sleeve gastrectomy.

Bariatric surgery is safe during COVID-19 pandemic

Background: The Coronavirus Disease 2019 (COVID-19) pandemic has massively affected bariatric surgical practises across the world. Aim: This report aims to show the effects of the pandemic on bariatric practices in the UK during the early phase of the pandemic. Methods: Bariatric surgeons in United Kingdom (UK) were contacted;seven bariatric units and 20 collaborators agreed to participate in this project. The data includes patients' demographics, type and number of operations, bariatric endoscopic procedures, management of complications, emergency and revisional bariatric surgery. Statistical analysis was used to assess the differences among the categories and to compare the data to the 6th report outcomes provided by British Obesity and the Metabolic Surgery Society 2017-2018 (NBSR). Further analysis of mortality between pre pandemic era and June 2020-June 2021 was performed. Results: A total of 430 bariatric procedures were conducted from 1 January 2020 to 31 March 2020 in seven hospitals in UK. The mean age of the patients was 43.3 years. The mean body mass index was 46.75 kg/m2. 314 (73%) of the patients were women and 116 (27%) were men. The following procedures were performed: 118 (27.4%) Laparoscopic Sleeve Gastrectomy (LSG), 114 (26.5%) One Anastomosis Gastric Bypass (OAGB), 76 (17.6%) Roux En-Y Gastric Bypass (RYGB), 61 (14.18%) Gastric Balloon and 15 (3.5%) Adjustable Gastric Band. 176 bariatric endoscopy procedures were performed for different indications. 26 (6.04%) revisional surgeries and 20 (4.6%) emergency bariatric surgeries were performed. 24 (5.58%) patients had Grade I-IV Clavien-Dindo complications. No mortality was reported. There was a significant difference in the number of operations for each of LSG, RYGB and OAGB in these seven hospitals compared to the data provided by the British Obesity and Metabolic Surgery Society (BOMSS) 2017-2018 .Only one patient was diagnosed with COVID-19, who was successfully treated and discharged home. Only one mortality was reported during June 2020 untill June 2021.There was no significant difference in moratlity between pre and post pandemic, p>0.5. Conclusions: This data reveals safe bariatric practices during the early phase of COVID-19. Copyright © Celsius Publishing House.

Successful Implementation of Enhanced Recovery After Surgery in a Single-Surgeon Bariatric Practice.

The feasibility and safety of unselectively applying an enhanced recovery after surgery (ERAS) protocol in a low-volume bariatric unit were determined. Retrospectively, review patients undergoing bariatric surgeries between 2015 and 2018 were included, and those receiving non-primary procedures or with BMI <32.5kg/m2 were excluded. Demographics and 30-day outcomes were collected and compared between the ERAS (2017-2018) and control (2015-2016) groups. 62 (40.8%) were treated before and 90 (59.2%) were treated after ERAS. No differences in baseline demographics, except ERAS group had more Roux-en-Y gastric bypass procedures (58.9% vs. 12.9%). A markedly reduced operation time (101min vs. 147min) and shortened length of stay (2.6days vs. 3.3days) were observed with no increment of ER visits, readmissions (1.1% vs. 4.8%), or total complications between the groups (5.5% vs. 9.7%). Unselective ERAS implementation in low-volume units is feasible and safe, with significantly reduced operation times and shortened LOS without increased complications.

Safety and feasibility of resuming bariatric surgery under the cloud of COVID-19.

Because of the COVID-19 pandemic, numerous bariatric surgical units globally have halted weight loss surgery. Obesity itself has been shown to be a predictor of poor outcome in people infected with the virus. The aim of this study was to report our experience as a high-volume bariatric institution resuming elective weight loss surgery safely amidst emergency admissions of COVID-19-positive patients. A standard operating procedure based on national guidance and altered to accommodate local considerations was initiated across the hospital. Data were collected prospectively for 50 consecutive patients undergoing bariatric surgery following recommencement of elective surgery after the first national lockdown in the UK. Between 28 June and 5 August 2020, a total of 50 patients underwent bariatric surgery of whom 94% were female. Median age was 41years and median body mass index was 43.8 (interquartile range 40.0-48.8)kg/m2. Half of the patients (n = 25/50) underwent laparoscopic sleeve gastrectomy and half underwent Roux-en-Y gastric bypass (RYGB). Of these 50 patients, 9 (18%) had revisional bariatric surgery. Overall median length of hospital stay was 1 day, with 96% of the study population being discharged within 24h of surgery. The overall rate of readmission was 6% and one patient (2%) returned to theatre with an obstruction proximal to jejuno-jejunal anastomosis. None of the patients exhibited symptoms or tested positive for COVID-19. With appropriately implemented measures and precautions, resumption of bariatric surgery during the COVID-19 pandemic appears feasible and safe with no increased risk to patients.

Safety and feasibility of revisional bariatric surgery following Laparoscopic Adjustable Gastric Band – Outcomes from a large UK private practice

BackgroundRevisional bariatric surgery is unavoidable in a proportion of patients. Despite its need, the development of this speciality has been hampered by its complexity and preferred delivery in institutional set ups. Although primary bariatric surgery can be delivered in the private sector; safety and feasibility of revisional bariatric surgery remains unexplored in this setting. Materials and methodsPatients undergoing revisional bariatric surgery following previous Laparoscopic Adjustable Gastric Band (LAGB) between 2008 and 2019 at a single private bariatric unit with a minimum follow up of at least 6 months were included. The primary aim was safety outcomes and 30-day morbidity. Results178 patients with BMI of 45.6 ± 8.2 kg/m2 underwent revisional bariatric surgery. One stage conversion was performed for 86.5% of the cases. At 9.5 ± 5.3 months follow up, BMI and percentage excess BMI loss were 31.8 ± 6.2 kg/m2 and 62.6 ± 40% respectively. There was no mortality, and the major complication rate was 2.8%. There was no statistically significant difference in the incidence of complications based on one-stage vs. two-stage conversion (p = 0.52). There were no differences in weight loss outcomes post-revisional surgery according to the indication for revision (p = 0.446) or weight loss following primary surgery (p = 0.12). ConclusionRevisional bariatric surgery can be delivered safely in the private sector with good outcomes. One-stage conversions are feasible and do not detrimentally affect the morbidity of the procedure or the weight loss outcomes. More importantly, success following revisional surgery is independent of the indication for revision and weight loss outcomes following primary surgery.

MALNUTRITION IN SURGICAL EMERGENCY PATIENTS: UN UNKOWN ISSUE

Abstract INTRODUCTION Malnutrition in hospitals is increasingly becoming more problematic, although its severity in surgical emergency patients has yet to be researched in depth. It entails higher rates of morbimortality as well as an increase in both days hospitalized and re-admissions which inflates health care-related costs. MATERIAL AND METHODS Using GLIM (Global Leadership Initiative on Malnutrition) criteria, we evaluated the nutritional state of 84 patients admitted through the emergency department in the Oesophago-Gastric and Bariatric Surgery Unit in our centre. RESULTS Of the total patients sampled, 57 (67,85%) were at risk of malnutrition. The percentage of patients suffering malnutrition was 44.04%, of which 15.8% were diagnosed with moderate malnutrition and 48.1% severe malnutrition. Patients suffering malnutrition stay at hospital for 24 days on average, which implies a longer stay that those without malnutrition (13 days hospitalized on average), but no relation was found regarding any increase in overall complications. After performing an analysis, malnutrition was significantly higher in oncological patients than in those who were admitted for other causes (58,3% vs 36.6%). However, the age analysis (over-70 vs under-70) showed no significant difference. CONCLUSION 50% patients admitted through emergency services were diagnosed from malnutrition. Oncological patients suffer greater risk and severity of malnutrition. Malnutrition does imply longer stays at hospital; however there is no correlation with further complications.

The Role of Relaparoscopy in the Management of Early Bariatric Surgery Complications and 30-Day Outcome: a Tertiary Centre Experience.

A retrospective review of a prospectively maintained database was conducted in a tertiary bariatric unit. Data were collected on all bariatric surgical procedures performed between March 2013 and March 2019. Any patient who was returned to theatre for a suspected serious complication was identified and their outcome studied. Over the 5-year study period, the total number of operations performed was 1660 (981 laparoscopic gastric bypass (LRYGB), 612 laparoscopic sleeve gastrectomy (LSG) and 67 revisional bariatric operations). Early postoperative complications (in hospital or within 30 days of surgery) that lead to reoperation were recorded in 33 patients (1.9%). These complications occurred after LRYGB in 26 patients (2.65%) and LSG in 7 patients (1.14%), respectively. Anastomotic leaks occurred in 1.1% of LRYGB, whilst 0.6% of patients have jejuno-jejunostomy obstruction. Obstruction at the gastro-jejunostomy anastomosis occurred in one patient. Following LSG, one mortality was recorded following bleeding from the staple line (0.06%) and five patients (0.3%) had leaks from the staple line. Thirty-one reoperations were performed laparoscopically, and two were converted to the open approach, whilst 2 operations were planned as open from the outset. Relaparoscopy is an effective and safe approach to the management of clinically or radiologically suspected early complications after bariatric surgery. Graphical abstract.

Effectiveness and efficiency of a special program to reduce the bariatric surgery waiting list at a tertiary hospital

IntroductionBariatric surgery is one of the most common surgical practices in Spain. However, this procedure currently has longest delay on surgical waiting lists (SWL). We have developed a special surgical program that aims to reduce this waiting list and to assess the economic and clinical repercussions in a high-volume bariatric surgery unit. MethodsA three-month prospective study was carried out comparing outcomes, results and perioperative resources consumed for 45 patients who underwent bariatric surgery. The patients were divided into 2 groups: patients who underwent the standard procedure in the operating room, and patients treated in the special program. Epidemiological, healthcare and economic factors were taken into account. ResultsTwo homogeneous groups of patients were operated on, successfully reducing the SWL. Morbidity was similar in both groups and the average cost of the surgeries performed was €5,331.40; in the standard group, the cost was €5,372.50±€798.10, and the cost of the special program group was €5,290.30±€685.10, with no significant differences. ConclusionsIn hospitals with a high volume of bariatric surgery, it is feasible to incorporate special surgical programs that are able to reduce surgical waiting lists, while maintaining quality criteria and without incurring a greater expense to the healthcare system.

Surgical resident training program to perform laparoscopic bariatric procedures: Are safety and postoperative outcomes compromised?

IntroductionLaparoscopic bariatric procedures such as laparoscopic Roux-en-Y gastric bypass (LRYGB) are technically demanding and require a long learning curve. Little is known about whether surgical resident (SR) training programs to perform these procedures are safe and feasible. This study aims to evaluate the results of our SR training program to perform LRYGB. MethodsWe designed a retrospective study including patients with LRYGB between January 2014 and December 2018, comparing SR results to experienced bariatric surgeons (EBS). In our country, SR have a five-year surgical formative period, and in the fourth year they are trained for 6 months in our bariatric surgery unit, from January to June. In the beginning, they perform different steps of this procedure, to finally complete an LRYGB. We collected demographic data, comorbidities, intraoperative outcomes, and postoperative complications and outcomes after a one-year follow-up. ResultsTwo hundred and eight patients were eligible for inclusion: 67 in group I (SR), and 141 in group II (EBS). Both groups were comparable. There was no statistically significant difference in operating time (166.45 min in group I vs. 156.69 min in group II; P = 0.156). Conversion to open surgery, hospital stay, postoperative complications, and short-term outcomes had no significant differences between the two groups. There was no mortality registered during this period. ConclusionImplementation of LRYGB stepwise learning as part of an SR training program is safe, and results are comparable to EBS, without loss of efficiency. Therefore, it is feasible to train SR in bariatric surgery under EBS supervision.

Short-term results of single-anastomosis gastric bypass after failed sleeve gastrectomy

Background It is recognized that sleeve gastrectomy (SG) is one of the most common bariatric procedures worldwide. It is considered a relatively safe and effective option in the treatment of morbid obesity. However, SG operations may fail in the treatment of obesity. In cases of unsuccessful SG surgery, revisional bariatric surgery may be used. One anastomosis gastric bypass (OAGB) was considered as an outstanding choice for revision surgery. Objective To assess the efficacy and safety of OAGB as a redo surgery after the failure of previous sleeve gastrectomy operation. Patients and methods This study is a retrospective cohort study, conducted in Bariatric Surgery Unit, Ain Shams University Hospital, Cairo, Egypt, from February 2018 to July 2019, with 6 months of postoperative follow-up till January 2020. We included 50 patients who underwent OAGB who were adults fit for surgery, aged between 18 and 60 years, with a history of failed SG. Results A total of 50 patients with history of failed SG underwent OAGB surgery with excess body weight loss of 14.10% at 1 month, 28.85% at 3 months, and 45.43% at 6 months. Weight loss was 7.14–32.43 kg (SD 6.14). The type 2 diabetes mellitus remission rate was 100% by 6 months, with glycated hemoglobin level of 5.88±0.77 (range, 5.4–7.2). Hypertension resolution was 40%. Overall, 100% of patients with sleep apnea improved symptomatically. No morbidity or mortality cases were reported. Conclusion OAGB operation is considered to be an effective and safe revisional surgical procedure after a failed primary SG operation.