Laparoscopic Bariatric Procedures Research Articles

Robotic-Assisted and Laparoscopic Bariatric Surgeries Still Have Clinically Comparable Outcomes

PurposeBariatric surgery is considered the main treatment option for patients with severe obesity. The objective of our study is to compare intra- and postoperative outcomes between the robotic and laparoscopic approaches within the sleeve gastrectomy (SG), duodenal switch (DS), and Roux-en-Y gastric bypass (RYGB).Materials and MethodsThe data from the MBSAQIP were collected for patients who underwent SG, DS, and RYGB between 2015 and 2021. The postoperative and procedural outcomes including 30-day morbidity and mortality as well as operation length were analyzed using regression models.ResultsOur analysis included 1,178,886 surgeries with SG comprising the majority (70%) followed by RYGB (28%) and DS (1%). Other than a higher adjusted risk of unplanned reoperation for robotic RYGB (relative risk (RR) 1.07) and a statistically significant higher rate of postoperative wound disruption in robotic SG for robotic surgery (RR 1.56), there were no statistically significant between-approach differences including infection, wound disruption, death, or reoperation for DS, RYGB, or SG. Our data showed no significant difference in anastomotic leak rate between laparoscopic and robotic approaches in either the DS (p = 0.521) or RYGB (p = 0.800) procedures. Across our study period, the median operation lengths decreased significantly per year for both the robotic SG and DS.ConclusionsRobotic and laparoscopic bariatric surgical procedures have statistically similar 30-day patient outcomes. Robotic bariatric procedures do have significantly longer median operative times than laparoscopic procedures. The decision to use a robotic approach or laparoscopic approach should be made based upon surgeon experience and possibly cost.Graphical

Risk factors for bariatric surgery in patients over 65years of age-a multicenter retrospective cohort study.

Societies are aging, life expectancy is increasing, and as a result, the percentage of elderly people in the population is constantly increasing. When qualifying patients over 65years of age for bariatric surgery, the benefits and risks should be carefully assessed. Weighing risk factors against each other to improve the quality of life and better control of obesity-related diseases. The study aimed to determine risk factors for bariatric surgery among patients over 65years of age. A multicenter, retrospective analysis of patients undergoing laparoscopic bariatric procedures from 2008 to 2022. The patients were divided into two groups: complicated (C) and uncomplicated (UC). Uni- and multivariate logistic regression analysis was performed to obtain significant, independent risk factors. There were 20 (7.0%) patients in C group and 264 (93.0%) patients in UC group. The most common complication was intraperitoneal bleeding (8, 2.8). There was no postoperative mortality. The mean follow-up was 47.5months. In a multivariate logistic regression analysis, length of stay and %EWL significantly corresponded to general complications (OR 1.173, OR 1.020). A higher weight loss before surgery lowered the risk for hemorrhagic events after surgery (OR 0.889). A longer length of stay corresponded to leak after surgery (OR 1.175). Bariatric and metabolic surgery appears to be a safe method of obesity treatment in patients over 65years of age. The most common complication was intraperitoneal bleeding. A prolonged hospital stay may increase the risk of leakage, while a higher weight loss before the surgery may lower the risk of bleeding.

Robot-assisted vs laparoscopic bariatric procedures in super-obese patients: clinical and economic outcomes

The increased operative time and costs represent the main limitations of robotic technology application to bariatric surgery. Robotic platforms may help the surgeon to overcome the technical difficulties in super-obese (SO, BMI ≥ 50 kg/m2) patients, in which multi-quadrant operations could be challenging. We aimed to evaluate the effect of robot-assisted (R) versus laparoscopic (L) approaches in Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) and Roux-en-Y Gastric Bypass (RYGB) in SO and Super-Super Obese (SSO, BMI ≥ 60 kg/m2) patients in terms of outcomes and cost-effectiveness. Bariatric procedures performed from 2012 to 2023 were retrospectively reviewed. The inclusion criteria were BMI ≥ 50 kg/m2, primary SADI-S or RYGB. Operative time (OT), early complications, post-operative stay (POS), overall costs and follow-up data were analyzed. A subgroup analysis for surgical procedures and SSO patients was also performed. Among 4596 patients, 174 RYGB and 91 SADI-S in BMI ≥ 50 kg/m2 patients were selected. After Propensity Score Matching analysis, two groups of patients were identified (laparoscopic and robot-assisted), each one composed of 18 RYGB and 26 SADI-S. Intraoperative and post-operative complication rates and POS were comparable. Mean OT was longer in robotic procedures compared with laparoscopy (199.1 ± 65.7 and 109.5 ± 39.1 min, respectively, p < 0.001). The difference in OT was eliminated after only SSO patients were included in the analysis (172.7 ± 24.1 vs 152.6 ± 26.2 min for R-SADI-S and L-SADI-S, respectively, p = 0.107). Robotic surgeries were associated with higher costs (8134.6 ± 1886.7 and 2386.7 ± 388.2 € in R-RYGB and L-RYGB, respectively; 7996.6 ± 873.1 and 3954.6 ± 631.1 € in R-SADI-S and L-SADI-S). Despite increased costs, robotic approach may represent an added value in more complex cases such as SSO patients.

Predictors of complete remission of hypertension in patients over 65 years of age after bariatric surgery - a multicenter study.

In the era of an aging society and a growing number of obese people, an increasing number of older patients are consulting bariatric surgeons. The incidence of hypertension (HT) also rises with age and body weight, making the treatment of the elderly a significant challenge. To identify predictors of HT remission after bariatric surgery in patients over 65 years of age. A retrospective study analyzed patients over 65 years old with HT who underwent laparoscopic bariatric procedures in Poland between 2008 and 2022. The data came from 11 bariatric centers. Patients were categorized into two groups: responders (R) and non-responders (NR). A multivariate logistic regression analysis was conducted to identify significant independent risk factors. The study analyzed 244 patients, with complete HT remission observed in 55 (22.5%) patients. Almost 90% of patients showed improvement in HT. The mean follow-up time was 47.4 months. Factors contributing to HT remission included HT duration of less than 5 years, the use of single medication, and a significant correlation with %EWL. Bariatric surgery in patients aged over 65 has a positive effect on HT remission. The chance of HT remission increases with fewer medications, shorter HT duration, and greater weight loss after surgery.

Endoscopic versus laparoscopic bariatric procedures: A computational biomechanical study through a patient-specific approach

Background and ObjectivesWithin the framework of computational biomechanics, finite element models of the gastric district could be seen as a potential clinical tool not only to study the effects apported by bariatric surgery, but also to compare different surgical techniques such as the new emerging Endoscopic Sleeve Gastroplasty (ESG) with respect to well-established ones (such as the Laparoscopic Sleeve Gastrectomy, LSG). MethodsThis work realized a fully computational comparison between the outcomes obtained from 10 patient-specific stomach models, which were used to simulate ESG, and the complementary results obtained from models representing the post-LSG of the same subjects. Specifically, once the ESG was simulated, a mechanical stimulus was applied by increasing an intragastric pressure up to a maximum of 5 kPa, in order to replicate the process of food intake, as well as for post-LSG models. Results: Results revealed non negligible differences between the techniques also within the same subject. In particular, not only LSG could lead to a greater reduction in the stomach volume (about 77 % at baseline, which is strictly linked to weight loss), but also influence the gastric distension (12 % less than pre-operative models). On the contrary, if ESG would be performed, a more similar pre-operative mechanical stimulation of the gastric walls may be seen (difference of about 1 %), thus preserving the mechanosensation, but the detriment of the volume reduction (about 56 % at baseline, and even decreases with increasing pressure). Moreover, since results suggested ESG may be more influenced by the pre-operative gastric cavity than LSG, a predictive model was proposed to support the surgical planning and the estimation of the volume reduction after ESG. Conclusions: ESG and LSG have substantial differences in their protocols and post-surgical effects. This work pointed out that variations between the two procedures may be observed also from a computational point of view, especially when including patient-specific geometries. These insights support gastric modelling as a valuable tool to evaluate, design and critically compare emerging bariatric surgical procedures, not only from empirical aspects and clinical outcomes, but also from a mechanical point of view.

Comparative Study for Portomesentric Venous Thrombosis after Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients with BMI 35-45 with and without Anticoagulation, Retrospective Study

Abstract Background Portomesentric vein thrombosis is a rare but documented complication of laparoscopic surgery. This rare complication is currently being encountered more frequently with the increase in the rates of laparoscopic bariatric surgery procedures being performed worldwide. Obesity is a worldwide health problem and Bariatric surgery has demonstrated to be an effective and sustainable method for regulation of morbid obesity, especially when it is resistant to both pharmaceuticals and combinations of diet and lifestyle regimens. Aim of the Work This study will evaluate the efficacy of use of anticoagulation after LSG in morbidly obese patients with BMI 35-45, to guard against PVT, through retrospective comparative study. Patients and Methods A retrospective analysis was performed on all sleeve gastrectomies performed in Ain Shams University Hospitals &amp; some other hospitals between January 2020 &amp; January 2021 to identify cases complicated by Portomesentric venous thrombosis. A total of 60 patients underwent LSG between January 2020 &amp; January 2021 were divided into two groups in a retrospective comparative Pilot study with an average BMI 39.53 kg/m2. Patients from the two groups 10 patients underwent laparoscopic cholecystectomy along with LSG. Results There are chemical prophylactic measures can be used pre and post laparoscopic sleeve surgery however, as suggested by some papers post-operative thromboprophylaxis to all patients for 1 week duration and from 3 to 6 months for thrombophilia and high-risk patients, yet specific recommendation regarding VTE prophylaxis after sleeve gastrectomy is in need for prospective trial to guard from developing PVT. Conclusion As a phenomenon with an ambiguous and unpredictable symptom, PMVT should be kept in mind in any patient with unexplained abdominal pain after sleeve gastrectomy; in addition, portal venous phase contrast enhanced studies should always be considered when a diagnostic computerized tomography scan is performed. Strong evidence data about PMVT anticoagulant prophylaxis plan is still lacking, however; extended prophylaxis to 2 weeks in a high-risk patient may lower the PMVT incidence.

Bariatric and Metabolic Surgery in Patients Older than 65 Years – a Multicenter Study

IntroductionWith the increase in life expectancy and a growing number of people suffering from obesity, bariatric and metabolic surgery is becoming a major concern in the elderly population. The study aimed to collect, systematize and present the available data on the surgical treatment of obesity among Polish patients over 65 years of age.Material and MethodsA retrospective study analysed patients over 65 years who underwent laparoscopic bariatric procedures in Poland from 2008 to 2022. The efficacy endpoints were percentage of excess weight loss (EWL%), percentage of total weight loss (%TWL), improvement in obesity-related diseases.ResultsThe group consisted of 284 patients (173 women, 60.9%). The mean follow-up was 47.5 months. The mean BMI before surgery was 43.1 kg/m2. 146 (51.4%) patients had T2D, and 244 (85.9%) had HT. The most common procedure was sleeve gastrectomy (82.0%). The mean EWL% after surgery was 50.9%, and the mean TWL% after surgery was 20.6%. There was the statistically significant difference between AGB vs OAGB, SG vs OAGB in %EWL (p = 0.0116, p = 0.009, respectively) and RYGB vs OAGB in %TWL (p = 0.0291). After surgery, 93 patients (63.7%) had complete or partial remission of T2D, and 112 patients (45.9%) had complete or partial remission of HT.ConclusionBariatric surgery appears to be a safe and effective method of treatment of obesity in patients over 65 years of age. OAGB seems to have better results in weight loss than SG, RYGB, and AGB in older patients.Graphical

Predictors of complete remission of type 2 diabetes in patients over 65 years of age – a multicenter study

IntroductionThe type 2 diabetes (T2D) improvement rate in the elderly is high after bariatric and metabolic surgery, but not all patients achieve complete remission of disease. There are some predictors for T2D remission after bariatric surgery in patients of different ages, but there are few studies describing these factors in elderly patients. The study aimed to determine predictors for diabetes remission after bariatric surgery among patients over 65 years of age.Material and methodsA retrospective study analyzed patients over 65 years with T2D who underwent laparoscopic bariatric procedures in European country from 2008 to 2022. Multivariate logistic regression analysis was performed to obtain significant, independent risk factors.ResultsThe group consisted of 146 patients divided into two groups: responders (R) and nonresponders (NR). The complete remission of T2D was achieved in 51 (34.9%) patients. There were 95 (65.1%) patients in the NR group with partial remission, improvement, or no changes in T2D. The mean follow-up was 50.0 months. In a multivariate logistic regression analysis, a T2D duration of less than 5 years was found to be a predictor to T2D remission (OR = 5.5, p = 0.002), %EWL significantly corresponded to T2D remission (OR = 1.090, p = 0009).ConclusionBariatric and metabolic surgery appears to be a good option for T2D treatment in elderly patients. A shorter duration of T2D before surgery and higher %EWL after surgery were independent predictors of T2D remission in patients over 65 years of age.Graphical abstract

Analysis of the risk factors for perioperative morbidity after laparoscopic revisional bariatric procedures: results from the multicenter Polish Revision Obesity Surgery Study.

The growing number of primary bariatric operations has led to an increase in demand for revision surgeries. Higher numbers of revisional operations are also observed in Poland, yet their safety and efficacy remain controversial because of a lack of current recommendations and guidelines. To review risk factors influencing perioperative morbidity. A retrospective study was conducted to analyze the results of surgical treatment among 12 Polish bariatric centers. Inclusion criteria were laparoscopic revisional bariatric surgeries and patients ≥18 years of age. The study included 795 patients, of whom 621 were female; the mean age was 47 years (range: 40-55 years). Perioperative morbidity occurred in 92 patients (11.6%) enrolled in the study, including 76 women (82.6%). The median age was 45 years (range: 39-54 years). Statistically significant risk factors in univariate logistic regression models for perioperative complications were the duration of obesity, revisional surgery after Roux-en-Y gastric bypass (RYGB) or adjustable gastric band (AGB), difference in body mass index before revisional surgery and the lowest achieved after primary surgery, and postoperative morbidity of the primary surgery as the cause for revisional bariatric surgery. These factors were included in the multivariate regression model. Revisional surgery after AGB (odds ratio [OR] = 2.18; 95% confidence interval [CI]: 1.28-3.69; P = .004), revisional surgery performed after RYGB (OR = 6.52; 95% CI: 1.98-21.49; P = .002), and revisions due to complication of the primary surgery (OR = 1.89; 95% CI: 1.06-3.34; P = .030) remained independent risk factors for perioperative morbidity. Revisional operations after RYGB or AGB and those performed because of postoperative morbidity after primary surgery as the main cause for revisional surgery were associated with a significantly increased risk of postoperative morbidity.

Analysis of the Factors Contributing to Bariatric Success After Laparoscopic Redo Bariatric Procedures: Results from Multicenter Polish Revision Obesity Surgery Study (PROSS)

IntroductionWith continuously growing number of redo bariatric surgeries (RBS), it is necessary to look for factors determining success of redo-surgeries.Patients and methodsA retrospective cohort study analyzed consecutive patients who underwent RBS in 12 referral bariatric centers in Poland from 2010 to 2020. The study included 529 patients. The efficacy endpoints were percentage of excessive weight loss (%EWL) and remission of hypertension (HT) and/or type 2 diabetes (T2D).ResultsGroup 1: weight regainTwo hundred thirty-eight of 352 patients (67.6%) exceeded 50% EWL after RBS. The difference in body mass index (BMI) pre-RBS and lowest after primary procedure < 10.6 kg/m2 (OR 2.33, 95% CI: 1.43–3.80, p = 0.001) was independent factor contributing to bariatric success after RBS, i.e., > 50% EWL.Group 2: insufficient weight lossOne hundred thirty of 177 patients (73.4%) exceeded 50% EWL after RBS. The difference in BMI pre-RBS and lowest after primary procedure (OR 0.76, 95% CI: 0.64–0.89, p = 0.001) was independent factors lowering odds for bariatric success.Group 3: insufficient control of obesity-related diseasesForty-three of 87 patients (49.4%) achieved remission of hypertension and/or type 2 diabetes. One Anastomosis Gastric Bypass (OAGB) as RBS was independent factor contributing to bariatric success (OR 7.23, 95% CI: 1.67–31.33, p = 0.008), i.e., complete remission of HT and/or T2D.ConclusionsRBS is an effective method of treatment for obesity-related morbidity. Greater weight regain before RBS was minimizing odds for bariatric success in patients operated due to weight regain or insufficient weight loss. OAGB was associated with greater chance of complete remission of hypertension and/or diabetes.Graphical abstract

SP2.1.4 Predictors of Type-2 Diabetes Remission Following Bariatric Surgery After a Two-Year Follow Up

Abstract Purpose Bariatric surgery is evolving as a successful tool for managing morbid obesity and T2DM. This study aimed to identify predictors of diabetes remission after two types of bariatric procedures. Methods This prospective study enrolled 172 patients with morbid obesity associated with T2DM scheduled for bariatric surgery. Two laparoscopic bariatric procedures were done; single anastomosis gastric bypass (SAGB, n=83) and sleeve gastrectomy (LSG, n=68). Lipid accumulation product index (LAP) and quantitative insulin sensitivity check index (QUICKI) were used to evaluate lipid profile and insulin sensitivity. Two years after surgery condition of DM was evaluated as complete remission (CR), partial remission (PR), or improvement. The primary outcome measure was predictors of diabetes remission. Results Two years after surgery, 151 patients were available for evaluation, where 75 patients (49.7%) achieved CR, while PR was found in 36 (23.8%). CR was significantly associated with younger age, shorter duration of DM (p &amp;lt; 0.001, for both), higher C-peptide and GLP-1 levels (p &amp;lt; 0.001 and p = 0.002, respectively), and bypass surgery (p = 0.027). On multivariate analysis, shorter duration of DM, lower BMI, and higher C-peptide levels were the independent factors predicting CR. Conclusion Complete remission of T2DM can be achieved in nearly half of the patients two years after SG or SAGB. The duration of diabetes and preoperative BMI and C-peptide levels are the independent factors predicting complete remissions.

Long-term weight loss after bariatric procedures for morbidly obese adolescents and youth: a single-institution analysis with up to 19-year follow-up.

Obesity is a public health concern among adolescents and young adults. Bariatric surgery is the most effective treatment for morbid obesity and has been increasingly utilized in young patients. Long-term outcomes data for bariatric surgery in this age group are limited. This is a single-institution, prospective analysis of 167 patients aged 15-24years who underwent one of three laparoscopic bariatric procedures between 2001 and 2019: Roux-en-Y gastric bypass (LRYGB, n = 71), adjustable gastric banding (LAGB, n = 22), and sleeve gastrectomy (LSG, n = 74). Longitudinal weight and body mass index (BMI) measurements were compared to evaluate patterns of weight loss. All operations were completed laparoscopically using the same clinical pathways. Patients were predominantly female (82.6%), had a median age of 22.0 [Q1-Q3 20.0-23.0] years, and had a mean presurgical BMI of 48.5 ± 6.5kg/m2 (range 38.4-68.1kg/m2). All procedures produced significant weight loss by 1year, peak weight loss by 2years, and modest weight regain after 5years. Mean percent weight/BMI losses at 5years for LRYGB, LAGB, and LSG were -36.7 ± 10.8%, -14.5 ± 15.3%, and -25.1 ± 13.4%, respectively (p < 0.001). LRYGB patients were most likely to achieve ≥ 25% weight loss at 1, 3, and 5years and maintained significant average weight loss for more than 15years after surgery. Reoperations were procedure-specific, with LAGB, LRYGB, and LSG having the highest, middle, and lowest reoperation rates, respectively (40.9% vs. 16.9% vs. 5.4%, p < 0.001). All procedures provided significant and durable weight loss. LRYGB patients achieved the best and most sustained weight loss. LSG patients experienced second-best weight loss between 1 and 5years, with lowest chance of reoperation. LAGB patients had the least weight loss and the highest reoperation rate. Compared to other factors, type of bariatric procedure was independently predictive of successful weight loss over time. More studies with long-term follow-up are needed.

Predictors of type-2 diabetes remission following bariatric surgery after a two-year follow-up

Bariatric surgery is evolving as a successful tool for managing morbid obesity and T2DM. This study aimed to identify predictors of diabetes remission after two types of bariatric procedures. This prospective study enrolled 172 patients with morbid obesity associated with T2DM scheduled for bariatric surgery. Two laparoscopic bariatric procedures were done; single anastomosis gastric bypass (SAGB, n=83) and sleeve gastrectomy (LSG, n=68). Lipid accumulation product index (LAP) and quantitative insulin sensitivity check index (QUICKI) were used to evaluate lipid profile and insulin sensitivity. Two years after surgery condition of DM was evaluated as complete remission (CR), partial remission (PR), or improvement. The primary outcome measure was predictors of diabetes remission. Two years after surgery, 151 patients were available for evaluation, where 75 patients (49.7%) achieved CR, while PR was found in 36 (23.8%). CR was significantly associated with younger age, shorter duration of DM (p<0.001, for both), higher C-peptide and GLP-1 levels (p<0.001 and p=0.002, respectively), and bypass surgery (p=0.027). On multivariate analysis, shorter duration of DM, lower BMI, and higher C-peptide levels were the independent factors predicting CR. Complete remission of T2DM can be achieved in nearly half of the patients two years after SG or SAGB. The duration of diabetes and preoperative BMI and C-peptide levels are the independent factors predicting complete remissions.

Comparative Study on Nutritional Intake and Nutritional Status of Elective Pre- and Post-operative Bariatric Surgery Patients

Obesity is a global epidemic affecting populations worldwide. Bariatric surgery is effective in treating morbid obesity in individuals who fail to lose weight even after modifying lifestyle, dietary habits, and pharmacotherapy. To provide better health care management pre- and post-bariatric surgery, it is imperative to establish the nutritional status of patients before surgery. The aim of this study was to assess and compare pre- and post-surgery nutritional status of bariatric candidates. Obesity is the basis for cluster of non-communicable diseases creating an enormous socioeconomic and public health burden. For this, laparoscopic bariatric procedures; sleeve gastrectomy, Roux-en Y Gastric Bypass, and Mini Gastric Bypass were done for treating obesity and other related co-morbidities. The medical records of 50 subjects were reviewed for this study. Mean age and body mass index are 42.2 ± 12.9 (kg/m2) and 42.77 ± 7.9 (kg/m2), respectively. The pre-surgery mean intake of energy, carbohydrate, protein, and fat was 3048 ± 485.4 (kcal/d), 200.4 ± 40.1 (g/d), 101.6 ± 17.02 (g/d), and 156.09 ± 108.4 (g/d), respectively, which were above Recommended Dietary Allowances. The mean intake of energy, carbohydrate, protein, and fat was significantly decreased post operatively (P &gt; 0.001) to 1400 ± 99 (kcal/d), 132.1 ± 22.3 (g/d), 69.9 ± 3.6 (g/d), and 30.9 ± 6.4 (g/d), respectively. Low intake of fiber, Vitamin A (74%), and Vitamin C (32%) was observed during pre-operative condition. The findings in this study advocates nutritional intervention and tailored supplementation pre- and post-bariatric surgery for promising results.

The effect of different types of laparoscopic bariatric procedures on type 2 diabetic obese patients

The effect of different types of laparoscopic bariatric procedures on type 2 diabetic obese patients

Patients with sleep-disordered breathing for bariatric surgery

ABSTRACTThe prevalence of patients with obesity continues to rise worldwide and has reached epidemic proportions. There is a strong correlation between obesity and sleep-disordered breathing (SDB), and, in particular, obstructive sleep apnea (OSA). OSA is often undiagnosed in the surgical population. Bariatric surgery has been recognized as an effective treatment option for both obesity and OSA. Laparoscopic bariatric procedures, particularly laparoscopic sleeve gastrectomy (LSG), have become the most frequently performed procedures. OSA has been identified as an independent risk factor for perioperative complications and failure to recognize and prepare for patients with OSA is a major cause of postoperative adverse events, suggesting that all patients undergoing bariatric surgery should be screened preoperatively for OSA. These patients should be treated with an opioid-sparing analgesic plan and continuous positive airway pressure (CPAP) perioperatively to minimize respiratory complications. With the number of bariatric surgical patients with SDB likely to continue rising, it is critical to understand the best practices to manage this patient population.

Technical Feasibility, Outcomes, and Patient SatisfactionAfter Needlescopic and Laparoscopic Bariatric Surgery: a Randomized Study.

Needlescopic instruments create a 3-mm incision and may result in less pain and superior cosmesis. There is limited understanding of the effectiveness of needlescopic instruments in patients with a body mass index (BMI) > 35 kg/m2. We report perioperative outcomes and perception of body image with use of needlescopic instruments after bariatric surgery. Laparoscopic bariatric procedures were performed on 30 adults at a single academic medical center from January to December 2017. Patients were randomized to conventional laparoscopy (LAP) or needlescopic (NEED) surgery. The Multidimensional Body-Self Relations Questionnaire (MBSRQ) and Patient Scar Assessment Questionnaire (PSAQ) were completed at 6 months and 1 year. Univariate analysis was performed on perioperative outcomes and survey scores. Surgery was completed on patients in the LAP group (N = 13) and compared to the NEED group (N = 17). The mean BMI was 41.4 kg/m2 LAP and 41.1 kg/m2 NEED. The most common procedure was Roux-en-Y gastric bypass (RYGB), with 13 RYGB in LAP and 12 RYGB in NEED (P = 0.76).The operative time was not significantly different between the LAP and the NEED group (209.5 ± 66.1 vs 181.9 ± 58.1 min, P = 0.48). There was no leak or mortality in the 30-day follow-up period. Within MBSRQ, the patient's appearance self-evaluation score was similar between LAP and NEED (2.5 ± 0.6 vs 2.4 ± 0.6, P = 0.61). Within PSAQ, the mean satisfaction score for incision appearance was also similar between LAP and NEED (16.1± 2.9 vs 15.4 ± 4.6, P = 0.85). Incision-related perceptions remained consistent at 6 months and 1 year after bariatric surgery. Needlescopic instruments are safe and a viable alternative to use during bariatric surgery. Appearance and perception of scar were similar between groups. Further studies with needlescopic instruments should include patients with a BMI > 35 kg/m2 and compare additional factors associated with body image.

P29: TRANSVERSUS ABDOMINIS PLANE BLOCK IN LAPAROSCOPIC BARIATRIC SURGERY- A SYSTEMATIC REVIEW AND META ANALYSIS OF RANDOMISED CONTROLLED TRIALS

Abstract Introduction Effective postoperative analgesia is paramount in the management of patients undergoing bariatric surgery, given their increased predisposition to systemic narcotic-induced respiratory depression. Transversus abdominis plane (TAP) block has shown promise in the enhanced recovery pathway for several abdominal procedures. We performed a systematic review and meta-analysis to compare the effectiveness of TAP block in laparoscopic bariatric surgery. Method PubMed, EMBASE and Cochrane databases were searched for relevant articles from inception until November 2019. All trials that compared TAP blocks versus none in laparoscopic bariatric procedures were included. The primary outcome measure was narcotic consumption at 24 hours postoperatively, while secondary outcomes included pain scores, time to ambulation, postoperative nausea and vomiting (PONV) and complication rates. Random effects models were used to calculate pooled effect size estimates. Result Seven randomised controlled trials were included capturing 617 patients. There was high statistical heterogeneity across studies. On random effects analysis, there were no significant differences in narcotic consumption (Mean difference –18.4 mg, 95% CI=-38.7 to 1.91, p=0.08), pain scores (Mean difference -0.71, 95% CI=-1.93 to 0.50, p=0.25) or complications (OR=0.67, 95% CI=0.11 to 4.23, p=0.67) between TAP and no TAP groups. However, TAP was associated with significantly less time to ambulation (Mean difference -2.22 hours, 95% CI=-3.89 to -0.56, p=0.009), and PONV (OR=0.13, 95% CI=0.05 to 0.35, p&amp;lt;0.0001) rates. Conclusion TAP in laparoscopic bariatric surgery is associated with significantly less PONV and time to ambulation but similar narcotic usage, postoperative pain and complication rates, compared to no TAP. Take-home message TAP in laparoscopic bariatric surgery is associated with a shorter time to ambulation and less PONV but similar postoperative pain and narcotic usage, compared to no TAP.

Bariatric surgery in over 60 years old patients: is it worth it?

The high prevalence of obesity in the elderly and the increase in life expectancy pushed up the age limit as an indication to bariatric surgery. Nevertheless, results on safety and effectiveness of these procedures in over 60 years old population are still controversial. Objectives of the study were to evaluate the safety and effectiveness of bariatric surgery in the elderly. A prospectively collected database was queried for patients older than 60years who underwent laparoscopic bariatric procedures between 2010 and 2017 at a single institution. These patients were matched with a group of younger patients who had the same procedure in the same period of time. Basal characteristic, intra- and post-operative data were compared. Patients were followed up at 36months reporting the percentage of excess weight loss (%EWL) and comorbidities remission rate. A total of 100 patients ≥ 60years old were included (Group 1) and matched with a control group of 96 patients < 60years (Group 2). Post-operative complications rate was similar (15.0% versus 10.4% p = 0.395). %EWL at 36months was significantly higher in Group 2 (44.6% versus 68.2% p < 0.001), while remission of medical morbidities was similar in both groups, with a higher rate for type 2 diabetes (T2D) remission among older people (p = 0.017). Patients older than 60years have post-operative outcomes comparable to younger population. Long-term results are inferior in terms of %EWL, but similar regarding morbidities remission rates, with particular benefits on T2D.

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.