Restrictive Procedures Research Articles

Incidence of adverse mental health outcomes after sleeve gastrectomy compared with gastric bypass and restrictive bariatric procedures: a retrospective cohort study.

This study examined rates of suicide and hospitalization with psychiatric diagnoses after sleeve gastrectomy compared with gastric bypass and restrictive procedures (gastric banding/gastroplasty). This was a longitudinal retrospective cohort study comprising all patients who underwent primary bariatric surgery in New South Wales or Queensland, Australia, between July 2001 and December 2020. Hospital admission records, death registration, and cause of death records (if applicable) within these dates were extracted and linked. Primary outcome was death by suicide. Secondary outcomes were admissions with self-harm; substance-use disorder,schizophrenia,mood, anxiety, behavioral, and personality disorders; any of these; and psychiatric inpatient admission. A total of 121,203 patients were included, with median follow-up of 4.5 years per patient. There were 77 suicides, with no evidence of difference in rates by surgery type (rates [95% CI] per 100,000 person years: 9.6 [5.0-18.4] restrictive, 10.8 [8.4-13.9] sleeve gastrectomy, 20.4 [9.7-42.8] gastric bypass; p=0.18). Rates of admission with self-harm declined after restrictive and sleeve procedures. Admission with anxiety disorders, any psychiatric diagnosis, and as a psychiatric inpatient increased after sleeve gastrectomy and gastric bypass, but not restrictive procedures. Admissions with substance-use disorder increased after all surgery types. Variable associations between bariatric surgeries and hospitalization with psychiatric diagnoses might indicate distinct vulnerabilities among patient cohorts or that differing anatomical and/or functional changes may contribute to effects on mental health.

A critical assessment of a protected area conflict analysis based on secondary data in the age of datafication

Recently, a global trend towards a broader use of secondary data in social sciences has been reinforced by the COVID-19 pandemic. This evoked doubts about the validity of the results unless restrictive assessment procedures are implemented. To address this need in the field of protected area (PA) conflict analysis, we propose a three-fold approach (theory-, method-, and cross-scale simulation-driven) to assess the usefulness of the utilized state register dataset and the indicator analysis methodology for the multi-level recognition of PA conflict determinants. With the ultimate aim to inform case study selection, we processed 187 relevant indicators from the official Statistics Poland register for a Lesser Poland region. We distinguished five types of PA conflict determinants in Lesser Poland (‘urbanity’, ‘agriculture’, ‘tourism’, ‘small-scale entrepreneurship’, and ‘sprawl’) and respective groups of 15 clusters comprising local-level units. For one cluster, we juxtaposed the obtained results with secondary data from another source (Internet content) and for a specific PA (Tatra National Park). Although the reported conflict issues corresponded to the indicator-derived descriptors of the cluster, in the theory-driven phase of the assessment, the state register failed to address the key prerequisites of PA conflicts. We have demonstrated that, in crisis conditions such as COVID-19, the proposed method can serve as a proxy for a multi-level recognition of PA conflict potentials, provided that it synthesises the results of different methodological approaches, followed by in-person interviews in the selected case studies.

Public Meetings, Respectable Requisitions, and Popular Politics in Great Britain and Ireland, c.1769–1850

Abstract This article examines the practice of ‘requisitioning’ public meetings in Great Britain and Ireland. These written requests to office-holders emerged in Ireland and then Great Britain, following bitter contests over the authenticity and authority of addresses and meetings claiming to represent a county or town in the decade after 1769. If the Seditious Meetings Acts privileged meetings officially convened by local elites, they also codified the practice of householders signing their own advertisements to requisition meetings under magisterial oversight. This would, especially when revolutionary threats receded and local justices’ sympathies permitted, allow local organisers some legal and constitutional claims to public assembly, even if Peterloo demonstrated the continuing threat of the Riot Act. Alongside bi-partisan opportunism encouraging public meetings, the article emphasises the creative use of constitutional and legal claims by ‘political entrepreneurs’. Comparison with Ireland demonstrates ministers’ greater recourse to new legislation and executive powers, but also the exchange of political practices with Great Britain. The prosecution of intimidating numbers, rather than seditious conduct, after 1842 diminished the role of requisitions, as did the hybridisation of ‘public meetings’. This was not so much the loss of a demotic form of community deliberation, but a proliferation and multiplication of the meetings—and voices—claiming to represent public opinion. The changing uses of a subscriptional practice can illuminate the relationship between government initiatives and local enforcement, and highlight the talents of those forging new meanings of the law, the constitution, and the political nation from restrictive procedures.

Commentary on: 'Postoperative morbidity and weight loss after revisional bariatric surgery for primary failed restrictive procedure: a systematic review and network meta-analysis'.

aDepartment of General Surgery, Shanxi Bethune Hospital, Shanxi, China, 030032 bDepartment of General Surgery, Third Hospital of Shanxi Medical University, Shanxi, China, 030032 Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. Published online ■ ■ *Corresponding author. Address: China. E-mail address: [email protected] (J. Han). This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/

A Comprehensive Review on Bariatric Endoscopy: Where We Are Now and Where We Are Going

Background: Obesity is a chronic disease that impairs quality of life and leads to several comorbidities. When conservative therapies fail, bariatric surgical options such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most effective therapies to induce persistent weight loss. Over the last two decades, bariatric endoscopy has become a valid alternative to surgery in specific settings. Primary bariatric endoscopic therapies: Restrictive gastric procedures, such as intragastric balloons (IGBs) and endoscopic gastroplasty, have been shown to be effective in inducing weight loss compared to diet modifications alone. Endoscopic gastroplasty is usually superior to IGBs in maintaining weight loss in the long-term period, whereas IGBs have an established role as a bridge-to-surgery approach in severely obese patients. IGBs in a minority of patients could be poorly tolerated and require early removal. More recently, novel endoscopic systems have been developed with the combined purpose of inducing weight loss and improving metabolic conditions. Duodenal mucosal resurfacing demonstrated efficacy in this field in its early trials: significant reduction from baseline of HbA1c values and a modest reduction of body weight were observed. Other endoscopic malabsorptive have been developed but need more evidence. For example, a pivotal trial on duodenojejunal bypasses was stopped due to the high rate of severe adverse events (hepatic abscesses). Optimization of these more recent malabsorptive endoscopic procedures could expand the plethora of bariatric patients that could be treated with the intention of improving their metabolic conditions. Revisional bariatric therapies: Weight regain may occur in up to one third of patients after bariatric surgery. Different endoscopic procedures are currently performed after both RYGB and SG in order to modulate post-surgical anatomy. The application of argon plasma coagulation associated with endoscopic full-thickness suturing systems (APC-TORe) and Re-EndoSleeve have shown to be the most effective endoscopic treatments after RYGB and SG, respectively. Both procedures are usually well tolerated and have a very low risk of stricture. However, APC-TORe may sometimes require more than one session to obtain adequate final results. The aim of this review is to explore all the currently available primary and revisional endoscopic bariatric therapies focusing on their efficacy and safety and their potential application in clinical practice.

Is endoscopic approach superior to laparoscopic surgery for gastric plication in terms of complications and efficacy? A systematic review including meta-analysis.

Metabolic surgery is a more effective manner to manage weight loss for morbidly obese patients than conservative therapy. There are many surgical and endoscopic modalities to choose which represents a real challenge for bariatric surgeons. LGCP is a restrictive procedure, the greater curvature of stomach is folded into the gastric lumen in one or two layers. Endoscopic bariatric and metabolic therapies (EBMTs) are evolving methods in metabolic interventions' inventory. There are two methods imitating LGCP (endoscopic sleeve gastroplasty and primary obesity surgery endoluminal). We have conducted wide literature searches in Pubmed database in order to perform meta-analysis comparing endoscopic and surgical treatment modalities (EBMTs vs. LGCP). Safety and weight-loss outcomes were measured. A number of 3585 patients for EBMTs and 2350 cases for LGCP were enrolled to final analysis. Comparison of complications (Clavien Dindo grade 1-5) showed almost equal risk. Percent of excess of weight loss was well matched at all follow-up timepoints, however, percent of total weight loss was in favor of LGCP. Changes of BMI were compared and showed similar efficacy for both methods. EBMTs appeared to be superior to LGCP regarding safety but differences did not reach statistical threshold. Weight loss outcomes were favorable after each method. EBMTs imitating LGCP are promising safe and effective methods.

Long-term outcome after biliopancreatic diversion with duodenal switch: a single-center experience with up to 20 years follow-up.

Biliopancreatic diversion with duodenal switch (BPD/DS) is the most effective standard bariatric procedure in terms of weight loss and remission of co-morbidities but carries the risk of severe long-term side effects. The aim of this study was to analyze the long-term effects of BPD/DS in terms of morbidity, weight loss, remission of associated medical problems, deficiencies, and reoperations. Academic teaching hospital, Switzerland. This is a retrospective, single-center study of prospectively collected data of all patients who underwent BPD/DS from 1999 to 2011 with a minimal follow-up (FU) of 10 years. A total of 116 patients (83.6% female) underwent BPD/DS with a mean initial body mass index (BMI) of 47 ± 6.5 kg/m2. Of these, 68% of the procedures were performed in open technique and 32% laparoscopically. The majority (76.7%) of patients had laparoscopic adjustable gastric banding before BPD/DS. The mean FU time was 14 ± 4.4 years and the FU rate at 5, 10, and 14 years was 95.6% (n = 108), 90% (n = 98), and 75.3% (n = 70), respectively. The mean excess BMI loss at 5, 10, and 14 years was 78% ± 24.1%, 76.5% ± 26.7%, and 77.8% ± 33.8%, respectively. Complete (n = 22) or partial remission (n = 4) of type 2 diabetes was observed in 92.8% of patients. Forty reoperations were necessary in 34 patients (29.3%) because of malnutrition or refractory diarrhea (n = 13), insufficient weight loss or weight rebound (n = 7), reflux or stenosis (n = 10), and various/combined indications (n = 10). The mean time to reoperation was 7.7 ± 5 years. There were no procedure-related deaths in the short or long term. BPD/DS offers sustainable long-term weight loss but is associated with important side effects that may be acceptable in selected patients with a high initial BMI (>50 kg/m2) and/or for nonresponders after primary restrictive procedures. Regular FU is necessary to detect and treat malnutrition and vitamin deficiencies.

Impact of the COVID-19 Pandemic and Governmental Policies on Rehabilitation Services and Physical Medicine in Jordan: A Retrospective Study.

Background: Although the COVID-19 pandemic led to a series of governmental policies and regulations around the world, the effect of these policies on access to and provision of rehabilitation services has not been examined, especially in low and middle- income countries. Aims: The aim of this study was to investigate the impact of governmental policies and procedures on the number of patients who accessed rehabilitation services in the public sector in Jordan during the pandemic and to examine the combined effect of sociodemographic factors (age and gender) and the governmental procedures on this number of patients. Methods: A retrospective cohort study was conducted based on records of 32,503 patients who visited the rehabilitation center between January 2020 and February 2021. Interrupted time-series analysis was conducted with three periods and by age and gender. Results: The number of patients who visited the rehabilitation clinics decreased significantly between January 2020 and May 2020 due to government-imposed policies, then increased significantly until peaking in September 2020 (p = 0.0002). Thereafter, the number of patients decreased between October 2020 and February 2021 as a result of the second wave of the COVID-19 pandemic (p = 0.02). The numbers of male and female patients did not differ (p > 0.05). There were more patients aged 20 years and older attending rehabilitation clinics than younger patients during the first strict lock down and the following reduction of restriction procedures periods (p < 0.05). Conclusions: The COVID-19 public measures in Jordan reduced access to rehabilitation services. New approaches to building resilience and access to rehabilitation during public health emergencies are needed. A further examination of strategies and new approaches to building resilience and increasing access to rehabilitation during public health emergencies is warranted.

Prioritizing choice and assent in the assessment and treatment of food selectivity

Food selectivity affects up to 72% and 45% of individuals with and without disabilities, respectively, and there is a need for interventions that rely on positive, unrestrictive strategies. We evaluated an assessment and treatment package for food selectivity for young children with developmental disabilities that prioritized caregiver collaboration, client autonomy, and did not rely on restrictive procedures (e.g. escape extinction). The process involved: (a) collaborating with caregivers on the selection of foods and design of the children’s functional analyses; (b) indirectly and directly measuring food preferences prior to treatment; (c) evaluating the sensitivity of mealtime problem behavior to environmental variables through an interview-informed synthesized contingency analysis (IISCA); and (c) incorporating the assessment results into a progressive treatment process consisting of choice-making opportunities and differential reinforcement of successive approximations to consumption. Children also had the ability to opt in and out of treatment sessions. The treatment was effective in increasing consumption of nonpreferred foods and successfully extended to caregivers. Practical implications and directions for future research are discussed.

How might the public contribute to the discussion on cattle welfare? Perspectives of veterinarians and animal scientists.

Veterinarians and animal scientists can provide leadership on issues relevant to farm animal welfare, but perceptions of these stakeholders regarding societal expectations for welfare are underexplored. This study involved five focus groups of veterinarians and animal scientists (n=50 in total), recruited at a European meeting focused on cattle welfare. Participants were invited to discuss topics related to cattle welfare and were prompted with questions to elicit their perspectives of public concerns and how the participants felt public input should be included when developing solutions. Discussions were moderated by trained facilitators, audio-recorded and transcribed, and transcripts analysed using reflexive thematic analysis. Ultimately, four primary themes were developed: (1) The public as concerned; (2) The public as ignorant; (3) The public as needing education; and (4) The public as helper or hindrance. Groups identified specific farming practices viewed as concerning to the public, including lack of pasture access, behavioural restriction, and painful procedures. Discussions about these concerns and the role of the public were often framed around the assumption that the public was ignorant about farming, and that this ignorance needed to be rectified through education. Participants were generally ambivalent in their beliefs regarding public contributions to solutions for farm animal welfare but suggested that consumers should pay more for products to help shoulder any costs of welfare improvements.

Pregnancy Outcomes After Bariatric Surgery: Should We Favour Restrictive Procedures in Women of Reproductive Age?

Pregnancy Outcomes After Bariatric Surgery: Should We Favour Restrictive Procedures in Women of Reproductive Age?

Bariatrické restrikční výkony a výživa

In the case of restrictive procedures, more than elsewhere, consistent preparation of the patient is crucial. A nutritional therapist participates in this and tries to pass on partial knowledge not only about nutrition, to such an extent that the patient is subsequently able to continue the reduction himself. The entire multidisciplinary team participates in the education making an effort to maximize the probability of the success of the restrictive procedure and thereby increase the patient’s quality of life. Approaches differ within the individuality of patients and within the type of restrictive procedure. Sufficient motivation and cooperation fundamentally influence the entire process that the person goes through. Keywords restrictive procedures, bariatric surgery, enteral nutrition, nutritional intervention

IBCOx-8 Bile reflux after laparoscopic mini-gastric bypass; Is it really a major concern?

Abstract Background Laparoscopic mini gastric bypass MGB, first performed in late 1990s, become a popular bariatric procedure with proven comparable efficiency. Its popularity can be explained by many factors including: its technical simplicity and efficacy in weight loss compared to RYGB, its superiority in controlling metabolic syndrome compared to restrictive procedures and its efficacy as revision surgery for failed restrictive procedures. However, many debates still exist among bariatric surgery experts regarding its complications; mainly bile reflux and its consequences. We presented our experience, as a tertiary university institute in dealing with bile reflux complications after laparoscopic mini gastric bypass that necessitated endoscopic and/or operative interventions. Methods This is a retrospective study of all cases who were admitted in a tertiary hospital because of bile reflux related complications in one year duration. Results Three cases were admitted because of bile reflux complications. The first case presented by hemorrhagic shock due to massive hemorrhage at a marginal ulcer after 26 days of mini gastric bypass. The second case was re-operated electively because of intractable bile reflux after failure of medical treatment. The third case presented with peritonitis on top of perforated marginal ulcer seven month after mini gastric bypass. Conclusion Despite its claimed safety and efficacy, laparoscopic mini gastric bypass is not the procedure of no-morbidities. Incidence of postoperative bile reflux is under-estimated. All patients should undergo a regular endoscopy to assess it even if asymptomatic.

Economic burden of the novel coronavirus infection: a systematic review

Background. The sudden emergence and rapid spread of the novel coronavirus infection (COVID-19) caused tremendous burden on the health care system including the economic one. In this regard, many questions concerning the prioritization of funding for various restrictive and preventive procedures have arisen; also the introduction of various intervention methods for monitoring and timely treatment of post-COVID consequences became an urgent problem. These challenges actualized the development of pharmacoeconomic methods that improve the quality of decisions making in such extreme conditions.Objective: to systematize available studies on the assessment of the global economic burden of the novel coronavirus infection.Material and methods. A feature of the proposed review design was the highlighting of the observed shortcomings and areas in which scientists make additions to the assessment methods taking into account the chronology of the pandemic determining changes in the information field. Therefore, an analysis was made of 80 studies published in 2020–2022 and dedicated to the assessment and forecast of the global economic burden of COVID-19. The main inclusion criteria for the studies was the estimation of COVID-19 global burden. The search was carried out in PubMed/MEDLINE, Web of Science, Scopus, and eLibrary databases. Using a predefined data collection form, two reviewers independently extracted information characterizing the studies.Results. An analysis of the publications showed a fairly wide variety of studies in the field of the COVID-19 burden, including those determined by the difference in observation objects, analysis methods, factors taken into account, etc. Scientists actively use international (73.8%) and national (90%) databases, and surveys (57.5%). Predominantly, the estimates involve the calculation of quality-adjusted life years lost (QALY) (66.3%), 37.6% of the studies are based on the results of constructing scenario models, 28.8% consume algorithms of epidemiological SIR (susceptible, infected, or recovered) models, and 66.3% provide for cost assessment. As part of the estimated economic burden, the loss of productivity (26.3% of publications), the introduction of vaccination (32.5%), comorbidity (25%), post-COVID complications (17.5%) are considered.Conclusion. A significant interest of the world scientific community in assessing the COVID-19 global burden is observed, determined by the search for the most effective study methods. Further investigations in this area should focus on detailing within the estimated economic burden of losses associated with post-COVID-19 complications, including their various combinations, as well as on the analysis of the correlation and mutual compensation of effects from various types of treatment, with a deeper study of indirect losses. The results of this work will be also useful in conducting similar studies, including for determining their design and applying modern mathematical modeling tools.

Comparison of mechanistic pathways of metabolic bariatric surgery in diabetic patients

Abstract Background and aims Metabolic bariatric surgeries are potentially efficacious treatment options in patients with type 2 diabetes mellitus (T2DM). However, previous meta-analyses focused on individual operative approaches rather than the mechanistic pathways behind different bariatric procedures. Thus, this updated network meta-analysis aimed to synthesize new evidence and comparatively evaluate the efficacy of bypass against restrictive procedures and standard first-line treatment for patients with T2DM. Methods Embase, Medline and trial registries were searched for randomized controlled trials on bariatric surgeries in patients with T2DM. A Bayesian network meta-analysis was conducted to compare between bypass, restrictive bariatric procedures, medical therapy and lifestyle intervention. Primary outcomes were T2DM remission and improvements in glycated haemoglobin (HbA1c). Secondary outcomes included changes in body mass index (BMI), lipoprotein levels and blood pressure. Results Thirty-two articles comprising 2,071 patients were included. Bypass surgery was statistically superior to restrictive procedures (RR: 2.57, 95% CrI: 1.36 to 5.43), medical therapy (RR: 35.29, 95% Crl: 10.56 to 183.23), and lifestyle intervention (RR: 40.51, 95% Crl: 5.32 to 402.59) in T2DM remission. Both bypass surgery and restrictive procedures were largely comparable in lowering HbA1c (MD: 0.02, 95% Crl: −0.03 to 0.08). In addition, bypass surgery significantly lowered BMI and blood pressure compared to other interventions. While restrictive procedures significantly increased high-density lipoproteins compared to bypass surgery, lifestyle intervention and bypass surgery were statistically superior to restrictive procedures in reducing low-density lipoproteins. Conclusion This study demonstrates that bypass surgery is superior to restrictive bariatric procedures in diabetes remission and glycaemic control. Additionally, significant metabolic advantages support the choice of bypass surgery over restrictive bariatric procedures in T2DM management. Funding Acknowledgement Type of funding sources: None.

Hypocalcaemia following thyroidectomy among patients who have previously undergone bariatric surgery: systematic review and meta-analysis.

Hypocalcaemia is a common complication after thyroidectomy. Bariatric surgery is associated with significant changes in calcium metabolism. Some studies have identified bariatric surgery as a risk factor for hypocalcaemia after thyroidectomy. This systematic review and meta-analysis assessed whether a history of bariatric surgery was associated with an increased risk of hypocalcaemia after thyroidectomy. This prospectively registered systematic review (PROSPERO; CRD42021295423) was performed in accordance with PRISMA guidelines. Meta-analysis was undertaken using the Mantel-Haenszel method, with outcomes reported as ORs with 95 per cent confidence intervals. Twenty studies were included in the qualitative synthesis. Five studies incorporating 19 547 patients met the inclusion criteria for meta-analysis, of whom 196 (1.0 per cent) had a history of bariatric surgery. Patients with a history of bariatric surgery were more likely to develop hypocalcaemia after thyroidectomy (30.6 versus 13.0 per cent; OR 3.90, 95 per cent c.i. 1.50 to 10.12; P = 0.005). Among those with a history of bariatric surgery, patients who underwent a bypass procedure were more likely to develop hypocalcaemia after thyroidectomy than those who had a restrictive procedure (38 versus 23 per cent; OR 2.12, 1.14 to 3.97; P = 0.020). Patients with a history of bariatric surgery have a significantly greater risk of hypocalcaemia after thyroidectomy, with a heightened risk among those who have had a bypass procedure. Surgeons performing thyroid surgery should be aware of the increased risk of hypocalcaemia after thyroidectomy among these patients.

One Anastomosis Gastric Bypass for Revision of Restrictive Procedures: Mid-Term Outcomes and Analysis of Possible Outcome Predictors.

Revisional one anastomosis gastric bypass (OAGB) for insufficient weight reduction following primary restrictive procedures is still investigated. We report mid-term outcomes and possible outcome predictors. Single-center retrospective comparative study of revisional OAGB outcomes (2015-2018) following laparoscopic adjustable gastric banding (LAGB) and sleeve gastrectomy (SG); silastic ring vertical gastroplasty (SRVG) is separately discussed. In all, 203 patients underwent revisional OAGB following LAGB (n = 125), SG (n = 64), and SRVG (n = 14). Comparing LAGB and SG, body mass index (BMI) at revision were 41.3 ± 6.6 and 42 ± 11.2kg/m2 (p = 0.64), reduced to 31.3 ± 8.3 and 31.9 ± 8.3 (p = 0.64) at mid-term follow-up, respectively. Excess weight loss (EWL) > 50% was achieved in ~ 50%, with EWL of 79.4 ± 20.4% (corresponding total weight loss 38.5 ± 10.4%). SRVG patients had comparable outcomes. Resolution rates of type 2 diabetes (T2D) and hypertension (HTN) were 93.3% and 84.6% in LAGB compared with 100% and 100% in SG patients (p = 0.47 and p = 0.46), respectively. In univariable analysis, EWL > 50% was associated with male gender (p < 0.001), higher weight (p < 0.001), and BMI (p = 0.007) at primary surgery, and higher BMI at revisional OAGB (p < 0.001). In multivariable analysis, independent predictors for EWL > 50% were male gender (OR = 2.8, 95% CI 1.27-6.18; p = 0.01) and higher BMI at revisional OAGB (OR = 1.11, 95% CI 1.03-1.19; p = 0.006). Revisional OAGB for insufficient restrictive procedures results in excellent weight reduction in nearly 50% of patients, with resolution of T2D and HTN at mid-term follow-up. Male gender and higher BMI at revision were associated with EWL > 50% following revisional OAGB. Identification of more predictors could aid judicious patient selection.

Comparison of endoscopic sleeve gastroplasty versus surgical sleeve gastrectomy: a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database analysis

Endoscopic sleeve gastroplasty (ESG) is an incisionless, transoral, restrictive bariatric procedure designed to imitate sleeve gastrectomy (SG). Comparative studies and large-scale population-based data are limited. Additionally, no studies have examined the impact of race on outcomes after ESG. This study aims to compare short-term outcomes of ESG with SG and evaluate racial effects on short-term outcomes after ESG. We retrospectively analyzed over 600,000 patients in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database from 2016 to 2020. We compared occurrences of adverse events (AEs), readmissions, reoperations, and reinterventions within 30 days after procedures. Multivariate regression evaluated the impact of patient factors, including race, on AEs. A total of 6054 patients underwent ESG and 597,463 underwent SG. AEs were low after both procedures with no significant difference in major AEs (SG vs ESG: 1.1% vs 1.4%; P > .05). However, patients undergoing ESG had more readmissions (3.8% vs 2.6%), reoperations (1.4% vs .8%), and reinterventions (2.8% vs .7%) within 30 days (P< .05). Race was not significantly associated with AEs after ESG, with black race associated with a higher risk of AEs in SG. ESG demonstrates a comparable major AE rate with SG. Race did not impact short-term AEs after ESG. Further prospective studies long-term studies are needed to compare ESG with SG.

Attracting Foreign Investment in Cyclic Imbalances of the Economy

Foreign investment is an important economic resource for many countries including Ukraine. The relevance of this study lies in the need to solve problems of attracting foreign investment. The purpose of this study was to consider the conditions for attracting foreign investment in the cyclic imbalances of the world economy. Using the method of correlation-regression analysis, the impact of indicators of financial imbalances was found both in general and by individual sub-indices. The study found the financial imbalances (fiscal, monetary, exchange rate, debt, trade, households, investment, and savings), both present and potential, in the face of the threat of financial and economic crisis. The procedure for assessing financial imbalances in economic activity of the world and their regional groups that implement the process of investment-oriented development was defined. To assess their impact on the volume of foreign direct investment, a comprehensive method of calculating sub-indicators of financial imbalances was proposed, which on the set of certain parameters forms an integrated index of financial imbalances. Methodological approaches to determining the restrictive procedures for the accumulation of financial imbalances associated with the transition of the financial system to a state of financial danger, considering the budget, currency, monetary and debt components were substantiated. The complex method of calculating sub-indicators of financial imbalances in the economy involves the identification of economic risks at the initial stages using the Alert Mechanism on the violation of the balance of the financial and economic systems of the participating countries. Priority areas (real estate and professional services) for attracting foreign investment from around the world were identified. The geostrategic matrix of attraction of foreign investments by the countries of the world was offered.

217 Calciphylaxis arising following bariatric surgery

Calciphylaxis is a rare, highly morbid disease leading to vascular calcification and cutaneous necrosis, typically associated with end-stage renal disease (ESRD). While the pathogenesis and risk factors of calciphylaxis are poorly understood, some cases of calciphylaxis in patients who had previously undergone gastric bypass have been reported. The objective of this study is to report cases and describe an association between nutritional deficiencies in the context of bariatric surgery and calciphylaxis. Retrospective study in one large academic hospital that serves as a referral center for calciphylaxis in Boston, Massachusetts between 2012-2018 involving 11 patients who had bariatric surgery prior to calciphylaxis. Median time between bariatric surgery and calciphylaxis diagnosis was 2 years and 2 months, (range 7 months – 30 years). Parathyroid hormone levels were significantly higher in patients with ESRD compared to those with non-uremic calciphylaxis (p=0.036). Corrected calcium levels were significantly higher in patients who had malabsorptive compared to restrictive procedures (p=0.01). Limitations include retrospective nature, sample size, and missing weight loss data from remote bariatric surgical cases. Recognition of risk factors for calciphylaxis and careful evaluation of therapies for other comorbidities in patients who have undergone bariatric procedures is essential to improve outcomes for this rare but problematic disease.