Bypass Patients Research Articles

Infrainguinal bypass for limb salvage has comparable mortality and affords a better chance of home discharge than amputation among octogenarians.

Infrainguinal bypass for chronic limb-threatening ischemia (CTLI) in octogenarians is considered a high-risk procedure due to the presumed associated frailty of the patient population. However, the alternative which is major amputation may not be a better option. This study retrospectively compares the outcomes of bypass versus major amputation for functionally independent and partially dependent patients. Patients greater than and equal to 80 years old who underwent non-emergent infrainguinal bypasses for CTLI presenting with rest pain/tissue loss were selected from the targeted NSQIP database 2011-2022. Patients with major amputations (CPT codes 27880, 27882, 27590, 27592) for atherosclerosis by ICD9/10 codes were selected from the general database. We stratified the patients based on functional status (independent or partially dependent) and compared outcomes of bypass versus amputation within each group. Multivariable logistic regression was performed for 30-day mortality, major organ dysfunction, length of stay (LOS), and discharge destinations. There were 2,419 patients who underwent a bypass and 1,326 patients who underwent an amputation in the independent functional group. Patients with bypass were generally healthier. Multivariable analysis revealed that having a bypass was associated with significantly higher major adverse cardiac events (aOR: 1.7; p<0.01), bleeding requiring transfusion (aOR: 4.3; p<0.01), and wound complications (aOR: 1.7; p<0.01). There was no significant difference in mortality, renal complications, or sepsis. Additionally, bypass patients had longer operation time (p<0.01) and return to the operating room (aOR: 2.7; p<0.01). However, bypass patients were more likely to be discharged to home rather than to a facility (aOR: 4.2; p<0.01). Similar outcomes were observed for partially dependent patients, except that bypass patients had a longer LOS (12.40 ± 9.86 vs. 10.78 ± 9.94 days; p<0.01). Bypass for limb salvage for octogenarians does incur higher morbidities than amputation but does not increase mortality. The immediate higher morbidities of bypass should be weighed against a better chance of home discharge, which could potentially imply less functional decline.

Prevalence of sarcopenia after bariatric surgery: a systematic review and meta-analysis

Introduction: Bariatric surgery, after failed weight loss and comorbidity resolution, can lead to postoperative sarcopenia, characterized by the gradual loss of muscle mass and strength, impacting functionality and quality of life. Objective: This systematic review aims to determine the prevalence of sarcopenia after bariatric surgery. Methods: The protocol was registered on PROSPERO CRD42023447294). Comprehensive searches of electronic databases and journal references, without language restrictions, were conducted. Sarcopenia was defined as a progressive disorder involving muscle mass and function loss. The primary outcome was sarcopenia prevalence after bariatric surgery. Meta-analysis was realized using R software (version 4.1.0). Results: Among 1,445 reviewed studies from databases like MEDLINE, Embase, Web of Science, BVS, LILACS, and BDENF, eight met the criteria. The global sarcopenia prevalence was 32%, with an average age of 42 ± 10 years. It was higherin Roux-en-Y gastric bypass (RYGB) patients (59%). DXA was the primary data collection method (45%). After bariatric surgery, sarcopenia prevalence was 55% after more than a year, 3% within a year, and 24% at one year. Conclusion: The high sarcopenia prevalence highlights the need for healthcare professionals to enhance screening, intervention, and follow-up for this condition. Additional studies are needed to understand associated factors and develop interventions to prevent sarcopenia in this population.

BS O04 - Audit of outcome of SADIS- Results from a single Bariatric center

Abstract Background SADIS- Single anastomosis Duodeno-ileal switch is a bariatric procedure that has been accepted widely as a bariatric procedure. Literature has shown that it gives good outcomes in terms of weight loss and resolutions of obesity related morbidity. There has been criticism about the nutritional deficiencies associated with SADIS. It is a technically challenging procedure, so it is not extremely popular in the bariatric world where sleeve is the most done procedure and RYGB is the gold standard. Method All the patients at our centre undergo MDT assessment. Based on the MDT discussion and the patient preference, the decision of surgery is made. All the patients who underwent SADIS were included in the study Primary aim: Weight loss at 6 months, 1 year, 2 years and 6-10 years ORM resolution at 6 months, 1 year, 2 years and 6-10 years Nutritional deficiencies in the short term and long term. Results 17 patients underwent SADIS. Average BMI 55, it is higher than the usual BMI cohort, saying that higher BMI patients were offered SADIS as compared to the lower BMIs, who were offered Sleeve, Bypass. The weight loss pattern followed by SADIS patients was more than bypass patients over 6 m, 1 y and 2 y. The SADIS patients had better sustained weightloss over 6-10 y. One crucial factor in patient profile is the ratio of psychological vs physiological co-morbidities is higher than the average; which corresponds to our findings of the feasibility study for bariatric surgery for BMI &amp;gt;65 Conclusion SADIS gives good outcomes in terms of weight loss and resolution of co-morbidities. Long term results with SADI in terms of sustained weight loss are better than bypass. It did not lead to increased nutritional deficiencies.

BS SO15 - Outcomes of Braun procedure for reflux after OAGB- Audit from a single center

Abstract Background Braun procedure is a procedure used for management of reflux in gastric bypass patients. It is a simple procedure offering a jejuno-jejunal anastomosis to bypass bile away from stomach to prevent symptoms of reflux. It has been used in cancer patients needing bypass surgery. This has also been used in One anastomosis gastric bypass patients presenting with reflux. Method We would like to present the steps of Braun procedure. At the same time, we would like to take this opportunity to present the results of our audit of patients presenting with bile reflux needing surgical management of symptoms. We analysed our operation sheets from December 2016- Jan 2024 and retrospectively looked into the patients who needed surgical management of bile reflux. Results Total number of OAGB procedures done –1024, out of these 30 patients presented with bile reflux needing surgical management. 26 of these 30 patients underwent Braun procedure and 4 underwent RYGB. 6 patients out of the 26 patients who underwent Braun procedure needed conversion to RYGB because of non-resolution of symptoms. Since we looked at operation sheets, we have not analysed the total number of patients who have reflux post OAGB. Conclusion Conversion to RYGB is the gold standard procedure for managing bile reflux after OAGB. Braun’s procedure is a simpler procedure which can be done as day case and suffices in 86 % of patients. Patients should be offered both the procedures.

The safety of cell saver washing all shed mediastinal blood before re-transfusing it to the patient.

Cardiotomy suction blood is used in cardiopulmonary bypass (CPB) surgery to maintain blood volume in the CPB system, although it is known to contain micro emboli, cytokines and free plasma hemoglobin. Our aim was to investigate whether cell saver washing the cardiotomy suction blood before re-transfusing it is safe. This is a retrospective study of 1671 elective coronary artery bypass patients, 209 of whom had their pericardial blood processed in a cell saver (Ce-S group). PS matching was performed with patients who had their pericardial blood returned back to the CPB-system by the cardiotomy suction (Ca-S group). Perioperative transfusion requirements, surgical outcome, postoperative lab data and mortality were then compared. There were no differences in baseline characteristics or EuroSCORE between the groups. The number of patients requiring transfusions did not differ, but the patients in the Ca-S group received more platelets (0.34 ± 1.0 vs 0.16 ± 0.7 units, p = .03) than in the Ce-S group. CRP (c-reactive protein) levels at day 2 and 4 were higher in the Ca-S group (174.8 ± 67.2 and 148.9 ± 74.3mg/L vs 160.1 ± 64.6 and 125.9 ± 67.2mg/L, p = .03, p = .002) and so were ASAT (aspartate aminotransferase) levels (0.97 ± 0.8 vs 0.81 ± 0.6μkat/L, p = .03). Mortality, postoperative ventilation time, stroke, mediastinal infections and length of stay in the ICU were the same in both groups. In this retrospective study of patients undergoing elective CABG surgery, washing the cardiotomy suction blood before re-transfusion was not associated with higher risk of allogenic blood transfusion, postoperative stroke, mediastinal infections, or 30- and 365-days mortality. LU EPN 2016/4.

Risk of atrial fibrillation recurrence after new-onset transient episode during ST-elevation myocardial infarction

Abstract Background Atrial fibrillation (AF) often complicates ST-elevation myocardial infarction (STEMI) and is associated with major in-hospital complications and increased mortality. The data on AF recurrence after new-onset transient STEMI-associated AF is scarce, and electrocardiographic (ECG) predictors of AF recurrence are unknown. Purpose Our aim was to assess the risk of AF recurrence and to find out the predictors of AF recurrence after transient STEMI-associated AF. Methods STEMI patients admitted during 2007-2010 for primary percutaneous coronary interventions (PCI) were followed up until 2018. All ECGs ever recorded before, during or after STEMI (n=58907) were exported from regional database in digital format and processed using Glasgow algorithm. Clinical characteristics and mortality status were retrieved from the Swedish national registries. Information regarding AF was obtained from the national registries and the regional ECG database. STEMI-associated AF was defined as first-ever AF episode occurring between symptom onset and hospital discharge. Patients with pre-existing AF, AF after acute coronary artery bypass surgery and patients discharged with ongoing AF were excluded from analysis. P-wave indexes were assessed from the latest sinus rhythm ECG before discharge. The primary endpoint was the first documented AF episode after discharge. The secondary endpoints were total mortality and ischemic stroke. Cox regression analysis was adjusted for relevant clinical covariates. Results 1) 1956 patients who were discharged alive on sinus rhythm were included in the analysis (age 65±12, 70% males), 127(6.5%) of them had transient STEMI-associated AF. 2) Patients with STEMI-associated AF were more likely to develop AF during follow-up (n=74 [58.3%]) than patients without AF before or during STEMI (No AF) (n=56 [3.1%], HR=4.80 95%CI 3.93-5.97) (Figure 1). 3) None of the clinical and demographic characteristics was associated with AF recurrence. P-wave duration, P-terminal force in V1 and P-voltage in lead I were associated with AF recurrence, however only reduced P-wave voltage in lead I &amp;lt;93 µV (75th percentile) (HR=2.29 95% CI 1.21-4.35, p=0.011) remained independently associated with AF recurrence in adjusted analysis (Figure 2). 4) During follow-up, 134 patients had an ischemic stroke and 522 died. STEMI-associated AF was associated with higher long-term mortality risk comparing to No AF (HR=1.18 95%CI 1.02-1.36). The risk of stroke was not associated with STEMI-associated AF (HR=1.08 95%CI 0.79-1.49). In patients with STEMI-associated AF, occurrence of stroke did not differ between patients with and without AF recurrence (5[7%] vs 8 [15%] respectively, p=0.147). Conclusion STEMI-associated transient AF is associated with a 4.8-fold increased risk of AF after discharge, reaching 28% by 1 year after discharge. ECG-based P-wave indexes reflecting atrial remodeling can be used for the prediction of AF recurrence after discharge.

A randomized controlled trial of an eight-week cardiac rehabilitation home verse hospital exercise programme for post coronary cardiac bypass patients

Abstract Background The prevalence and morbidity and mortality rates of coronary heart disease (CHD) continue to increase towards epidemic proportions in the Kingdom of Saudi Arabia (KSA). Despite the advances in Cardiac surgery, currently there are no established out-patient phase program of Cardiac Rehabilitation (CR) for CHD participants in KSA. Aim of the study To evaluate the effectiveness of a home-based CR (Home CR) program using individualized exercise (Physiotools-R) and out-patient phase of CR (Hospital CR) program compared to standard care of home instructions on physical function, physiological and psychological status, body composition and the quality of life of the CHD participants post Coronary Artery Bypass Graft (CABG) surgery. Methods 73 participants post-CABG surgery were randomly assigned to one of three groups: Hospital CR group (n=25), Home CR group (n=24) and Control group (n=24). Outcome measures include Incremental Shuttle Walk Test (ISWT), Metabolic Equivalent Tasks (METs), Psychosocial outcomes and body composition were recorded at baseline, eight weeks of CR intervention, and after four weeks of observation follow up. Intervention: Hospital CR program comprised of group based Aerobic Circuit Training, home based structured individualized exercise program. Each programme had 2 hours’ sessions, 3 times a week for 8 weeks, followed by four weeks of observation follow-up. The control group followed standard care comprised usual advice on post-operation precautions. Results Post intervention, there was an increase in mean ISWT score from baseline in both the home-based cardiac rehabilitation and outpatient-based cardiac rehabilitation groups (66 [0.58] m and 71 [9.19] m, respectively). No difference was observed in the control group. At the 4-week follow-up, both intervention groups showed statistically significant improvements in all outcome measures (ISWT, metabolic equivalence tasks, HADS-A, HADS-D, and Short Form-36) compared with baseline (all P &amp;lt; .001). The home-based cardiac rehabilitation group showed statistically continuous improvement compared with the outpatient-based cardiac rehabilitation group. The control group did not show any significant changes across time in outcome measures Conclusion Home-based CR is as effective as hospital-based CR at improving exercise capacity in patients following CABG surgery. Home-based CR appears to be more effective at maintaining these improvements with no further input in the longer term.

Assessment of Gastric Remnant Activity, Symptoms, and Quality of Life Following Gastric Bypass

IntroductionWhile most gastric bypass patients recover well, some experience long-term complications, including nausea, abdominal pain, food intolerance, and dumping. This study aimed to evaluate symptoms and quality of life (QoL) in association with the residual activity of the remnant stomach.MethodsPatients undergoing gastric bypass and conversion-to-bypass were recruited. The Gastric Alimetry® System (Auckland, NZ) was employed, comprising a high-resolution electrode array, wearable reader, and validated symptom logging app. The protocol comprised 30-min fasting baseline, a 218-kCal meal stimulus, and 4-h of post-prandial recordings. Symptoms and QoL were evaluated using validated questionnaires. Remnant gastric electrophysiology evaluation included frequency, BMI-adjusted amplitude, and Gastric Alimetry Rhythm Index (GA-RI, reflecting pacemaker stability), with comparison to validated reference intervals and matched controls.ResultsThirty-eight participants were recruited with mean time from bypass 46.8 ± 28.6 months. One-third of patients showed moderate to severe post-prandial symptoms, with patients’ median PAGI-SYM 28 ± 19 vs controls 9 ± 17 (p < 0.01); PAGI-QOL 37 ± 31 vs 135 ± 22 (p < 0.0001). Remnant gastric function was markedly degraded shown by undetectable frequencies in 84% (vs 0% in controls) and low GA-RI (0.18 ± 0.08 vs 0.51 ± 0.22 in controls; p < 0.0001; reference range > 0.25). Impaired GA-RI and amplitude were correlated with worse PAGI-SYM and PAGI-QOL scores.ConclusionOne-third of post-bypass patients suffered significant upper GI symptoms with reduced QoL. The bypassed remnant stomach shows highly deranged electrophysiology in-situ, reflecting disuse degeneration. These derangements correlated with QoL; however, causality is not implied by the present study.

S1543 Management of Gastro-Jejunal Anastomotic Strictures: Comparing Endoscopic Outcomes in Primary vs Conversion Roux-en-Y Gastric Bypass Patients

S1543 Management of Gastro-Jejunal Anastomotic Strictures: Comparing Endoscopic Outcomes in Primary vs Conversion Roux-en-Y Gastric Bypass Patients

S4040 Successful Single Session EUS-directed Transgastric ERCP After Unsuccessful Laparoscopic ERCP in Roux-en-Y Gastric Bypass Patients

S4040 Successful Single Session EUS-directed Transgastric ERCP After Unsuccessful Laparoscopic ERCP in Roux-en-Y Gastric Bypass Patients

S1515 The Role of Endoscopic Submucosal Dissection, Pursestring Suturing, and Anti-Obesity Medications in Enhancing Weight Loss After Transoral Outlet Reduction in Roux-en-Y Gastric Bypass Patients With Weight Regain

S1515 The Role of Endoscopic Submucosal Dissection, Pursestring Suturing, and Anti-Obesity Medications in Enhancing Weight Loss After Transoral Outlet Reduction in Roux-en-Y Gastric Bypass Patients With Weight Regain

Endoscopic Management of Biliary and Pancreatic Pathologies in Roux-en-Y Gastric Bypass Patients: Development of a Treatment Algorithm Based on 9-Year Experience.

Management of biliopancreatic pathology in Roux-en-Y gastric bypass (RYGB) patients is challenging despite the availability of multiple approaches like single-balloon enteroscopy-assisted ERCP (SBE-ERCP), laparoscopy-assisted ERCP (LA-ERCP), and EUS-directed transgastric intervention (EDGI). We evaluated the outcomes of the interchangeable combination of endoscopic procedures to treat biliopancreatic pathology in RYGB patients. This is a monocentric retrospective study of consecutive RYGB patients with biliopancreatic pathology between June 2014 and September 2023. Primary endpoints were technical success, adverse events (AE), and parameters of endoscopic procedures according to etiology. A clinically useful management algorithm was developed. A total of 102 patients with RYGB (73 women; mean age 55 ± 10years) were included. A total of 113 SBE-ERCP (in 90 patients), 26 EDGI (in 23 patients), and 2 LA-ERCP (in 2 patients) were performed. Technical success of SBE-ERCP was lower compared to EDGI (74.4% vs 95.1%, p = 0.002). The AE rate was lower using SBE-ERCP compared to EDGI (12.4% vs 38.5%, p = 0.003). Two sub-groups based on etiology were identified as "common bile duct stone" (CBDS) and "Other." In the CBDS group, the mean number and time of procedures were lower in SBE-ERCP as the first-line technique compared to first-line EDGI (1.1 vs 2.7, p < 0.00 and 91 ± 20.7min vs 161 ± 61.3min, p < 0.00). A combination of endoscopic procedures can achieve high technical success in managing biliopancreatic pathology in RYGB patients with an acceptable AE rate. In the case of CBDS, SBE-ERCP appeared to be a good first-line single-step option. For other indications, EDGI should be proposed as the first line.

Prognostic Value of Myocardial Flow Reserve in Coronary Artery Bypass Patients

Prognostic Value of Myocardial Flow Reserve in Coronary Artery Bypass Patients

Late-"de novo" paraesophageal hernia after Roux-en-Y gastric bypass (RYGB)-should it be repaired?

This study presents a case series of "de novo" paraesophageal hernia (dnPEH) in post-Roux-en-Y gastric bypass (RYGB) patients and analyzes the predisposing factors, symptoms, and outcomes after repair. This is a lesser known complication after RYGB and when symptomatic, may warrant surgery. A retrospective review of data from a single academic institution from 2002 to 2022 was performed identifying patients who developed dnPEH after RYGB and compared them to patients with primary RYGB without post-operative symptomatic dnPEH. Patient characteristics from initial RYGB were analyzed to identify predisposing factors for dnPEH development. Additional information analyzed included time to dnPEH repair, indications for surgery, types of herniation, type of surgical repair, and symptom resolution. There were 6975 RYGB in the study period of which 6619 underwent RYGB alone at index surgery, with 31 of those patients developing late stage PEH requiring repair. Patients with older age (51.8years with dnPEH vs 45.2years without, p = 0.001) and increased weight loss at 1year (33.4% vs 30.5%, p = 0.048) from index RYGB were more likely to develop dnPEH. The incidence of dnPEH was 31/6619 (0.47%). Late dnPEH after RYGB took an average of 74months (45-102months IQR) to develop symptoms and undergo repair. The most common symptoms were heartburn/reflux 19/31 (61.3%) and epigastric pain 13/31 (41.9%). Symptom resolution rate after repair was highest with 100% for globus and 89.5% heartburn/reflux. The most common form of dnPEH was pouch herniation in 25/31. Surgical repair most commonly included primary cruroplasty alone in 25/31 with additional mesh in 1 case. Recurrence rate was 2/31 (6.54%). Late dnPEH after RYGB is an emerging entity typically occurring years after index RYGB. Symptomatic patients with dnPEH warrant hernia repair and responded well to surgical repair in this case series.

Early postoperative outcomes following bariatric surgery in the United States: Are racial disparities improving?

BackgroundBariatric surgery offers effective treatment for morbid obesity and associated medical comorbidities, with excellent short- and long-term outcomes. Although it has been well documented that racial minority bariatric patients have worse outcomes than White patients, it remains unclear whether this recognition has led to improvement. Herein, we assess recent trends in bariatric surgery among Black and White patients and compare early postoperative outcomes by race.MethodsPrimary sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) patients from 2015 to 2021 reported to the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program were studied. Bariatric patients were stratified by race (Black and White) and perioperative outcomes were compared between matched Black and White patients. Primary outcome was 30-day mortality. Secondary outcomes included hospital readmissions, hospital length of stay (LOS), reoperation, and postoperative complications.ResultsOverall, there were 193,071 Black and 645,224 White primary bariatric patients, with a higher volume of SG and RGYB performed among White patients. A total of 219,566 Black and White bariatric patients were matched and included in the case–control. Black patients were found to have higher rates of 30-day mortality (0.02% vs. 0.01%; p = 0.03) and readmissions (3.68% vs. 2.65%; p < 0.001). There were no significant differences in LOS, reoperations, or overall postoperative complications. However, there was a higher postoperative pulmonary thromboembolism rate (0.16% vs 0.08%; p < 0.001).). The differences in perioperative outcomes stratified by race persisted over the study period (Fig. 1).ConclusionBlack bariatric surgery patients continue to have worse perioperative outcomes compared with their White counterparts. Further work must be done to determine contributing factors in order to effect improvement in outcomes in bariatric surgical care for racial minority patients.

Long-term outcomes of magnetic sphincter augmentation in sleeve gastrectomy and Roux-en-Y gastric bypass patients: a comprehensive analysis

IntroductionManagement of gastroesophageal reflux disease after bariatric procedures can be challenging. There are very few long-term studies in this arena. This study aims to evaluate the long-term outcomes of the magnetic sphincter augmentation (MSA) reflux management system in a cohort of bariatric patients who had previously undergone sleeve gastrectomy and Roux-en-Y gastric bypass, with a focus on assessing gastroesophageal reflux disease (GERD) scores, medication use, and patient-reported symptoms.MethodsWe conducted a retrospective chart review of 16 consecutive bariatric patients who received MSA implants following sleeve gastrectomy (n = 14) or gastric bypass (n = 2) surgeries. Data were collected regarding BMI, GERD quality of life assessments (GERD-HRQL), reflux symptoms, and use of PPIs in the sleeve/RGB patients through an extended period with a mean follow-up of 48 months.ResultsPatients were followed up for a range of .5–84 months. Preoperative assessments included upper gastrointestinal imaging (UGI), high-resolution manometry, Bravo pH studies, and esophagogastroduodenoscopy (EGD). Three patients exhibited reflux on UGI, and 13/13 patients had positive Bravo studies preoperatively. Sixteen patients had a lower esophageal sphincter (LES) pressure under 18 mmHg, and eight patients had biopsy-proven esophagitis. Long-term outcomes are as follows. Daily PPI use fell from 88 to 25% at greater than three years. GERD-HRQL scores fell from 50.6 at baseline (range 27–70) and normalized at long-term follow-up. GERD symptom of regurgitation completely resolved. At long term, two patients had dysphagia and two patients had ongoing reflux. No adverse events were noted.ConclusionThis is the first long-term outcomes study of magnetic sphincter augmentation placement after bariatric surgery. Our study showed the majority of patients had long-term improvement in GERD-HRQL scores and resolution/ relief of their reflux symptoms, with decreased use of PPIs. MSA is a safe, effective and durable management tool for reflux after bariatric surgery in carefully selected patients.

Cancer incidence following bariatric surgery in renal transplant recipients: a retrospective multi-center analysis

BackgroundObesity, a known independent risk factor for developing malignancy. Additionally, renal transplant recipients (RTR) confer a 2- to 4-fold increased risk of overall malignancies with an excess absolute risk of .7% per year. While transplant recipients are at risk for obesity and malignancy, the effect of bariatric surgery (BS) in the posttransplantation setting is not well known. ObjectivesOur study primarily evaluated the impact of BS on cancer incidence in RTR with severe obesity in the posttransplantation setting. Weight loss outcomes were analyzed secondarily. SettingUniversity Hospital. MethodsA retrospective study using TriNetX database was developed to analyze cancer outcomes in RTR with posttransplantation BS versus RTR without BS from 2000 to 2023. After the exclusion process and propensity matching, both cohorts consisted of 153 patients. ResultsRTR-BS had a significantly lower incidence of overall cancer and transplant-related cancers (P < .05). No significant difference was identified in cutaneous, gastrointestinal, and reproductive cancers. Percent Excess Weight Loss (%EWL) was significantly lower in RTR-only cohort (11.4%) versus RTR-BS cohort (57.8%) at 5 years. Sleeve gastrectomy (SG) patients (73.19%) had significantly higher %EWL than Roux en-Y gastric bypass (RYGB) patients (49.33%) at 3 years. No difference in cancer incidence was noted between SG and RYGB patients. ConclusionPostrenal transplantation BS had a diminishing effect on overall and transplant-related cancer incidence in RTR with severe obesity. Significant weight loss was also demonstrated with post-renal transplantation BS.

Impact of Bariatric Surgery on Asthma Severity and Medication Use.

Bariatric surgery improves many obesity-related comorbidities, yet the literature remains inconclusive on the impact of bariatric surgery on asthma. Our primary objective was to identify the long-term impact of bariatric surgery on asthma severity and medication use. A retrospective review was completed of all patients with a diagnosis of asthma who underwent bariatric surgery over 10years at a single institution. Primary outcomes were the number of asthma medications prescribed at five time points (preoperative, postoperative < 18months, 19-36months, 37-60months, 60 + months) after bariatric surgery. Secondary outcomes were spirometry results and BMI. There were 260 patients with 84.6% female predominance. There were 168 sleeve gastrectomy patients and 92 Roux-en-Y gastric bypass patients. Mean age was 47.6 ± 10.7years, mean BMI was 46.0 ± 6.8kg/m2, and 54.2% were previous tobacco users. The total number of patients on two or more asthma medications decreased from 46% preoperatively to 41% at 18months, to 36% at 36months, and to 32% at 60months after surgery. The total number of patients free from asthma medication increased from 25% preoperatively to 33% at 60months postoperatively. Asthma medication use decreased in both surgery groups, and neither operation demonstrated superiority. No significant improvement nor differences were found between groups at any time point regarding FEV1/FVC ratio spirometry measures. Bariatric surgery reduces the use of medications taken for management of asthma. The amount of asthma medication usage decreases with time and is sustained at 60months after bariatric surgery.

Safety of gastric bypass with same-day discharge: a propensity score-matched analysis of the Dutch Audit for treatment of Obesity

BackgroundBariatric surgery with same-day discharge (SDD) is becoming increasingly common. Nevertheless, there is limited data available comparing gastric bypass patients with SDD to those with overnight hospitalization. ObjectiveThe aim of this study was to investigate the short-term outcomes of gastric bypass with SDD compared to overnight hospitalization in The Netherlands. SettingRetrospective database study with the use of the Dutch national registry. MethodsPatients who underwent gastric bypass surgery in 2022 were included and propensity score matching was performed to compare SDD with patients discharged on postoperative days (POD) 1-4. The primary outcome was the occurrence of severe complications within 30 days postoperative. ResultsA total of 775 SDD patients were matched with 1550 patients discharged on POD 1-4. The occurrence of severe complications was .9% in both groups (P = 1.000), and there were no significant differences in reoperations or mortality. A significant difference was observed in the readmission rate, with 3.9% in the SDD group compared to 1.6% in the other group (P = .001). A proportionally small, yet statistically significant difference favored the control group regarding anastomotic leakages (.6% versus 0%, P = .004) and unspecified surgical complications (1.4% versus .5%, P = .028). ConclusionGastric bypass with SDD is safe, with no increased risk of short-term severe complications, reoperations, or mortality. However, SDD is associated with a higher 30-day readmission rate compared to patients who stay overnight in the hospital after surgery.

Comparison of coronary CT angiography and invasive coronary angiography results

IntroductionCoronary artery disease (CAD) is a leading cause of death worldwide. Accurate diagnosis and management are critical. Non-invasive imaging, such as coronary computed tomography angiography (CCTA), is vital for early diagnosis and treatment planning. This study evaluates the accuracy of CAD-Reporting and Data System (CAD-RADS) scoring and the compatibility between CCTA and invasive coronary angiography (ICA) in patients suspected of having CAD.Materials and methodsFrom January 1, 2022 to January 15, 2024, 214 patients suspected of CAD underwent both CCTA and ICA. CCTA artifacts led to the exclusion of 32 patients and 128 vessels, leaving 586 vessels for analysis. CAD-RADS scoring categorized coronary stenosis. Diagnostic performance was measured by specificity, sensitivity, accuracy, positive and negative predictive value (NPV). Extracardiac findings were analyzed with a wide field of view (FOV) during CCTA.ResultsA total of 214 patients (67.3% male, median age 56) were examined. Hypertension, smoking, calcium score, and high-risk plaques correlated with CCTA and ICA CAD-RADS scores; calcium score also related to hypertension, smoking, diabetes, and dyslipidemia (p < 0.05). CCTA showed a sensitivity of 80.8% and NPV of 90.3% for detecting stenosis of 70% or more; for 50% stenosis, sensitivity was 93.5% and NPV 92.1%. Agreement between CCTA and ICA was excellent in bypass patients; stenosis detection in stented patients had 85.7% sensitivity and 96.2% NPV.ConclusionThis study highlights the importance of CAD-RADS and CCTA in CAD diagnosis and treatment planning. CCTA effectively evaluates stents and grafts, emphasizing the benefits of extracardiac findings and a wide FOV.