Various Types Of Surgery Research Articles

Increased Risk of Complications After Pancreatoduodenectomy in Uninephrectomized Patients

Objective: The study objective is to investigate the impact of unilateral nephrectomy on the complications after pancreatoduodenectomy (PD). Summary of background data: Preoperative renal insufficiency is a risk factor for postoperative complications and mortality after various types of surgery. However, the specific postoperative risks in uninephrectomized (UN) patients are largely unknown. Methods: Between January 2010 and June 2014, a total of 177 patients underwent PD at the Department of Surgery, Nara Medical University. Among them, 7 patients (4.0%) were UN. We retrospectively evaluated the influence of the UN status on the postoperative complications. Results: The rate of acute kidney injury in the UN group was significantly higher than that in the control group (28.6% versus 1.2%; P = 0.017). In addition, the rates of surgical site infection of the organ/space (57.1% versus 9.0%; P = 0.006) and sepsis (42.9% versus 3.5%; P = 0.003) in UN group were significantly higher. Even on a reanalysis of only patients with soft pancreas, the significance remained. Conclusions: The UN status has a significant impact on the rate of morbidities, such as acute kidney injury and various infectious complications, including surgical site infections of organ/space, sepsis, and cholangitis after PD. Appropriate intervention should be implemented to decrease the morbidity rate for UN patients.

The Impact of Preoperative Hemoglobin Level on the Short-Term Outcomes After Living Donor Liver Transplantation.

Preoperative anemia was reportedly associated with increased morbidity and mortality after various types of surgeries. However, its impact on the outcomes after liver transplantation has not been thoroughly investigated. We retrospectively investigated the clinical outcome of 216 consecutive adult patients who underwent living donor liver transplantation at our institute between January 2010 and June 2017 and stratified them according to the hemoglobin level before transplant. Risk factors for 90-day patient mortality, especially infection-related mortality and early graft loss, were evaluated. We found that patients with preoperative hemoglobin below 10g/dl required more intraoperative packed red blood cell transfusions (p = 0.002) and had significantly higher early 90-day postoperative mortality rate (p = 0.007), particularly infection-related mortality (p = 0.002), lower overall graft, and patient survival rates (p = 0.007, p = 0.013, respectively). Preoperative hemoglobin below 10g/dl was an independent risk factor for increased post-transplant 90-day patient mortality (OR 2.92, p = 0.02), infection-related mortality (OR 6.81, p = 0.02), and early graft loss (OR 3.26, p = 0.01). Preoperative hemoglobin level below 10g/dl is associated with poorer short-term outcomes after liver transplantation and should be corrected preoperatively if possible through safe and effective treatment modalities.

Nonsurgical and surgical treatment of periodontitis: how many options for one disease?

Treatment of periodontitis aims at preventing further disease progression with the intentions to reduce the risk of tooth loss, minimize symptoms and perception of the disease, possibly restore lost periodontal tissue and provide information on maintaining a healthy periodontium. Therapeutic intervention includes introduction of techniques to change behavior, such as: individually tailored oral-hygiene instructions; a smoking-cessation program; dietary adjustment; subgingival instrumentation to remove plaque and calculus; local and systemic pharmacotherapy; and various types of surgery. No single treatment option has shown superiority, and virtually all types of mechanical periodontal treatment benefit from adjunctive antimicrobial chemotherapy. Periodontal treatment, because of the chronic nature of periodontitis, is a lifelong commitment to intricate oral-hygiene techniques, which, when properly implemented, will minimize the risk of disease initiation and progression.

Duration of surgical hand scrub in orthopaedic surgeries

A prospective study based at a tertiary hospital involving orthopedic surgeons. The study was aimed at assessing the required duration of surgical hand scrub to prevent infections. The surgeons scrubbed at sink equipped with timers, and used a scrub protocol based on existing guidelines. They were observed for the quality of their surgical hand scrubs for various types of surgeries and duration. Post-operatively hand swab culture of surgeon’s hands was done and patients followed up for any surgical site infections. The average scrub time of the orthopedic surgeons was found to be 2mins 40 secs. It was observed that there was no growth on culture when surgical hand scrub time was more than 2minute 20seconds.There was just one incidence of infected implant and there was no evidence of infections post-operatively in all of the remaining patients. It was also noted that the surgeons scrubbed for a longer duration for more complex surgeries. In conclusion, it is our opinion that a surgical hand scrub for 2minutes and 30 seconds significantly reduced the risk of transmission of infective pathogens in orthopedic surgeries. There is a need for creating awareness and educating young surgeons with regards to the importance of surgical hand scrub.

Thromboprophylaxis in Cancer Patients Undergoing Surgery.

AbstractVenous thromboembolism (VTE) is a common, complex, and costly complication in cancer patients undergoing surgery. VTE risk varies with types of cancer surgery as well as patient-, cancer-, and treatment-associated factors. Current VTE preventive measures with pharmacological, mechanical, and combination of both are shown to be effective. Clinical questions remain and more research is needed, focusing on the role of thromboprophylaxis for minimally invasive surgery and major cancer surgery other than abdominal/pelvic surgery, as well as optimal duration of thromboprophylaxis in high-risk patients. Routine individual VTE risk assessment and better adherence to thromboprophylaxis guidelines may offer improved outcomes in cancer patients undergoing surgery. A summary of currently available evidence and consensus guidelines on the primary prevention of VTE in cancer patients undergoing various types of surgery is presented here.

Effectiveness of surgery for adults with hallux valgus deformity: a systematic review.

Hallux valgus (HV) is a common foot deformity. In severe stages of this condition, surgery is often necessary. Currently, there is no systematic review comparing the effectiveness of surgery over conservative treatment. The objective of this review was to establish the effectiveness of surgery compared to conservatory management for adults with HV. The current review included adults (18 years or over) with HV deformity, excluding adults with neurological problems causing foot deformities, for example, cerebral palsy, neuropathy, stroke and multiple sclerosis. The review included any type of HV surgery compared to no surgery, conservative treatment or different types of HV surgeries. The primary outcome was gait measurement, and secondary outcomes included quality of life, patient satisfaction, pain assessed using any validated assessment tool and adverse events. The review included randomized controlled trials. The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in 16 databases without language and date limitations. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments developed by the Joanna Briggs Institute (JBI). Data were extracted from papers included in the review using the standardized data extraction tool developed by the JBI. Quantitative data were, where possible, pooled in statistical meta-analysis using RevMan5 (Copenhagen: The Nordic Cochrane Centre, Cochrane). Effect sizes expressed as risk ratio (for categorical data) and mean differences (MD) or standardized MD (for continuous data) and their 95% confidence intervals were calculated for analysis. Where statistical pooling was not possible, the findings have been presented in narrative form. Searching identified 2412 citations. After removal of duplicates, paper retrieval and critical appraisal, 25 studies were included in the review. The included trials were of medium-to-poor quality.Twenty-four trials compared the effectiveness of different types of surgeries. Meta-analysis revealed no difference in level of pain between distal chevron-type osteotomy and other surgical procedures (standard mean difference [SMD] 0.02, 95% confidence interval [CI] -0.24 to 0.28). One single trial reported that distal chevron osteotomy is more effective than Lindgren osteotomy in terms of walking speed (MD -0.24, 95% CI -0.43 to -0.05).One medium quality trial assessed the effectiveness of HV surgery compared to conservative or no treatment. This trial showed that surgery, specifically distal chevron osteotomy of the first metatarsal, is a more effective procedure for pain compared to conservative treatment (MD -15.00, 95% CI -22.79 to -7.21) and also no treatment in the first year (MD -18.00, 95% CI -25.62 to -10.38). The current systematic review showed that differences between various types of surgical procedures, specifically osteotomies of the first metatarsal on clinical outcomes, are minimal. There is evidence from one study, that surgery, specifically distal chevron osteotomy of the first metatarsal is a more effective procedure than conservative or no treatment in reducing pain in the first year following surgery. However, this systematic review has identified that there is a lack of high-quality studies comparing similar types of HV treatments that assess the same outcomes.

\u2018Waiting for\u2019 and \u2018waiting in\u2019 public and private hospitals: a qualitative study of patient trust in South Australia

BackgroundWaiting times for hospital appointments, treatment and/or surgery have become a major political and health service problem, leading to national maximum waiting times and policies to reduce waiting times. Quantitative studies have documented waiting times for various types of surgery and longer waiting times in public vs private hospitals. However, very little qualitative research has explored patient experiences of waiting, how this compares between public and private hospitals, and the implications for trust in hospitals and healthcare professionals. The aim of this paper is to provide a deep understanding of the impact of waiting times on patient trust in public and private hospitals.MethodsA qualitative study in South Australia, including 36 in-depth interviews (18 from public and 18 from private hospitals). Data collection occurred in 2012–13, and data were analysed using pre-coding, followed by conceptual and theoretical categorisation.ResultsParticipants differentiated between experiences of ‘waiting for’ (e.g. for specialist appointments and surgery) and ‘waiting in’ (e.g. in emergency departments and outpatient clinics) public and private hospitals. Whilst ‘waiting for’ public hospitals was longer than private hospitals, this was often justified and accepted by public patients (e.g. due to reduced government funding), therefore it did not lead to distrust of public hospitals. Private patients had shorter ‘waiting for’ hospital services, increasing their trust in private hospitals and distrust of public hospitals. Public patients also recounted many experiences of longer ‘waiting in’ public hospitals, leading to frustration and anxiety, although they rarely blamed or distrusted the doctors or nurses, instead blaming an underfunded system and over-worked staff. Doctors and nurses were seen to be doing their best, and therefore trustworthy.ConclusionAlthough public patients experienced longer ‘waiting for’ and ‘waiting in’ public hospitals, it did not lead to widespread distrust in public hospitals or healthcare professionals. Private patients recounted largely positive stories of reduced ‘waiting for’ and ‘waiting in’ private hospitals, and generally distrusted public hospitals. The continuing trust by public patients in the face of negative experiences may be understood as a form of exchange trust norm, in which institutional trust is based on base-level expectations of consistency and minimum standards of care and safety. The institutional trust by private patients may be understood as a form of communal trust norm, whereby trust is based on the additional and higher-level expectations of flexibility, reduced waiting and more time with healthcare professionals.

The Use of Aromatherapy for Postoperative Pain Management: A Systematic Review of Randomized Controlled Trials

Aromatherapy (AT) is a complementary therapy recently used inthe perianesthetic period. However, the scientific data on its effectiveness are limited. The aim of this systematic review is to present and analyze the results of all randomized controlled trials (RCTs) that studied the effectiveness of AT as a complementary treatment for postoperative pain. PubMed and Cochrane Library databases were searched from 1965 to December 2015. Nine randomized controlled trials that met the inclusion criteria were eventually included. The studies included a total of 644 patients, who underwent various types of surgeries. The modified Jadad scale with eight items was used for the methodological evaluation of the RCTs. Five RCTs support AT, which can alleviate postoperative pain, whereas four found no statistically significant differences between groups. Although AT is presented as an inexpensive complementary treatment with a low rate of adverse effects that improves patient satisfaction, it cannot be determined that there is sufficient evidence to conclude its effectiveness as a nonpharmacologic approach to the reduction of postoperative pain intensity.

Pathophysiology and Therapeutic Options for Fecal Incontinence.

Fecal incontinence (FI), defined as the involuntary loss of solid or liquid feces through the anus is a prevalent condition with significant effects on quality of life. FI can affect individuals of all ages and in many cases greatly impairs quality of life but, incontinent patients should not accept their debility as either inevitable or untreatable. The severity of incontinence can range from unintentional elimination of flatus to the complete evacuation of bowel contents. It is reported to affect up to 18% of the population, with a prevalence reaching as high as 50% in nursing home residents. However, FI is often underreported, thus obscuring its true prevalence in the general population. The options for treatment vary according to the degree and severity of the FI. Treatment can include dietary and lifestyle modification, certain medications, biofeedback therapy, bulking agent injections, sacral nerve stimulation as well as various types of surgery. In this article, we aim to provide a comprehensive review on the diagnosis and management of FI.

CT typing and surgical approach for adenocarcinoma of the esophagogastric junction

Objective: To investigate the feasibility, safety and efficacy of preoperative CT in the classification of adenocarcinoma of the esophagogastric junction. Methods: A total of 517 consecutive patients from May 2012 to June 2016 with esophagogastric junction carcinoma in the department of general surgery of Henan Cancer Hospital was retrospectively analyzed, according to the clinical pathological data of three type four layer method and statistics of various types of surgery in patients with preoperative enhanced CT. Results: 517 patients were successfully received surgery, including 152 cases of type Ⅰ(131 cases of complete abdominal surgery, 21 cases of abdominal incision diaphragm in thoracic surgery), 239 cases of type Ⅱ (177 cases of complete abdominal surgery, 62 cases of abdominal incision diaphragm in thoracic surgery), Ⅲ/Ⅳ type choice of chest abdominal surgery in 126 cases. The operation time was (102±17) min, the amount of hemorrhage was (136±18) ml, the dominant anastomotic fistula happened in 16 cases, 5 cases of pancreatic fistula, 7 cases of intestinal obstruction, anastomotic stenosis in 3 cases, thoracic and abdominal sensation in 12 cases, all the complications were cured by conservative treatment. The average value of esophageal resection margin was(5.1±0.6)cm, 2 cases with positive residual tumor margin and average length of stay was (8.9±1.6)d. Conclusion: Using preoperative enhanced CT in the adenocarcinoma of the esophagogastric junction to choose surgical approach can ensure the safety margin. What's more, unnecessary thoracotomy is reduced which is expected to be a new classification method for the operation of esophagogastric junction cancer.

Candida Prosthetic Joint Infection. A Review of Treatment Methods.

Fungal microorganisms are still a rare cause of bone and joint infections. We report a new case of knee prosthetic joint infection due to Candida albicans in a patient with a previous two-stage right knee arthroplasty for septic arthritis due to S. epidermidis occurred several months ago. Moreover, the treatment in 76 cases of Candida prosthetic joint infection has been discussed. Forty patients were female and mean age at diagnosis was 65.7 (± SD 18) yrs. No risk factors for candidal infection were found in 25 patients. Infection site was the knee in 38 patients and hip in 36; pain was present in 44 patients and swelling in 24. The most frequent species was C. albicans, followed by C. parapsilosis. Eleven patients were only treated with antifungal drugs being the outcome favourable in all of them. Two-stage exchange arthroplasty was performed in 30 patients, and resection arthroplasty in other 30; in three patients one-stage exchange arthroplasty was done. A favourable outcome was found in 58 patients after antifungal plus surgical treatment, in 11 after antifungal treatment alone and in one after surgery alone. The type of treatment is still not clearly defined and an algorithm for treatment in fungal PJI should be established, but various types of surgical procedures may be applied.

The Clinical Effectiveness of the Bispectral Index (BIS) To Reduce the Risk of Awareness for Elective Surgical Patients Undergoing General Anesthesia: A Prospective, Randomized, Double-Blind, Controlled Trial

The Clinical Effectiveness of the Bispectral Index (BIS) To Reduce the Risk of Awareness for Elective Surgical Patients Undergoing General Anesthesia: A Prospective, Randomized, Double-Blind, Controlled Trial

Risk Factors for Persistent Pain and its Influence on Maternal Wellbeing After Cesarean Section

(Acta Obstet Gynecol Scand. 2015;94(6):622–628) After surgery, patients might develop persistent pain, which is defined as pain that lasts for 3 months or more and continues even after the time it takes for the tissue to heal. Persistent pain is more common after major surgeries, but can also occur after other procedures. The literature reports that pain management might be inadequate following various types of surgeries, including cesarean section. The authors of this study sought to determine the incidence of persistent pain following a cesarean section as well as any possible risk factors.

IBIS: an OR ready open-source platform for image-guided neurosurgery.

Navigation systems commonly used in neurosurgery suffer from two main drawbacks: (1) their accuracy degrades over the course of the operation and (2) they require the surgeon to mentally map images from the monitor to the patient. In this paper, we introduce the Intraoperative Brain Imaging System (IBIS), an open-source image-guided neurosurgery research platform that implements a novel workflow where navigation accuracy is improved using tracked intraoperative ultrasound (iUS) and the visualization of navigation information is facilitated through the use of augmented reality (AR). The IBIS platform allows a surgeon to capture tracked iUS images and use them to automatically update preoperative patient models and plans through fast GPU-based reconstruction and registration methods. Navigation, resection and iUS-based brain shift correction can all be performed using an AR view. IBIS has an intuitive graphical user interface for the calibration of a US probe, a surgical pointer as well as video devices used for AR (e.g., a surgical microscope). The components of IBIS have been validated in the laboratory and evaluated in the operating room. Image-to-patient registration accuracy is on the order of [Formula: see text] and can be improved with iUS to a median target registration error of 2.54 mm. The accuracy of the US probe calibration is between 0.49 and 0.82 mm. The average reprojection error of the AR system is [Formula: see text]. The system has been used in the operating room for various types of surgery, including brain tumor resection, vascular neurosurgery, spine surgery and DBS electrode implantation. The IBIS platform is a validated system that allows researchers to quickly bring the results of their work into the operating room for evaluation. It is the first open-source navigation system to provide a complete solution for AR visualization.

Postoperative Delirium in Patients after Pancreaticoduodenectomy

Background/Aims: Postoperative delirium (POD) is one of the most common complications after various types of surgery. The aim of this study was to investigate the incidence and risk factors for delirium after pancreaticoduodenectomy (PD). Methods: This was a retrospective study of 146 consecutive patients who underwent PD between April 2007 and June 2015 at Saiseikai Yokohamashi Tobu Hospital. Results: Twenty-nine patients (19.9%) were diagnosed with delirium. Patients who were >70 years were divided into a delirium group (n = 24) and a non-delirium group (n = 41). Multivariate analysis showed that only the Charlson Age Comorbidity Index (CACI) (OR 1.8; 95% CI 1.067-3.036; p = 0.028) was an independent risk factor of delirium for patients >70 years. The receiver operating characteristic curve revealed an optimal cutoff value of 4.5 for the CACI score in all patients (sensitivity 62.1%; specificity 82.9%; area under the curve 0.782). The higher CACI score (≥5) is significantly different from the lower CACI score (p < 0.0001) with respect to POD occurrence. Conclusions: The CACI, especially in elderly patients, was associated with the incidence of POD. Therefore, utilizing this validated and practical tool preoperatively might be useful for POD.

Outcomes of ACL Reconstruction in Patients with Diabetes

Diabetes has been associated with adverse outcomes after various types of surgery. There are no previously published data regarding the effect of diabetes on outcomes from anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to test the hypotheses that diabetes is associated with worse clinical outcomes and a higher prevalence of subsequent surgeries after ACLR. Anterior cruciate ligament-deficient patients (n = 2198) undergoing unilateral ACLR from a multicenter prospective study were included. Patients who self-reported diabetes on the basis of comorbidity questions before surgery were identified from the database. They were compared with the remainder of the cohort who did not self-report diabetes. All patients were followed up for a minimum of 2 yr after their index surgery. A minimum 2-yr follow-up was attained on 1905/2198 (87%) via completed outcome questionnaires and 2096/2198 (95%) regarding subsequent surgery. The primary outcome measures were three validated outcome instruments. The secondary outcome measure was the incidence of additional surgery on the ipsilateral and contralateral knees. Patients with diabetes had a significantly higher activity level at 2 yr (OR = 2.96; 95% CI, 1.30-6.77; P = 0.01), but otherwise slightly worse clinical outcomes, compared with patients without diabetes (OR range = 0.42-0.59). The prevalence of subsequent surgeries in patients with diabetes was not significantly different from the prevalence in patients without diabetes. Patients with diabetes maintain a higher activity level after ACLR despite slightly lower patient-reported outcome scores compared with patients without diabetes and do not have a higher rate of subsequent surgery.

Evaluating Persistent Postoperative Pain in One Tertiary Hospital: Incidence, Quality of Life, Associated Factors, and Treatment.

BackgroundPersistent postoperative pain (PPP) is defined as persistent pain after surgery of greater than three months’ duration.ObjectivesIdentify the incidence of PPP in our hospital and its associated factors; evaluate quality of life (QoL) and treatment of patients.Patients and MethodsWe conducted an observational prospective study in adults proposed to various types of surgery using the brief pain inventory short form preoperatively (T0), one day after surgery, and three months later (T3). If the patient had pain at T3 and other causes of pain were excluded, they were considered to have PPP, and the McGill Pain Questionnaire Short Form was applied. QoL was measured with the EuroQol 5-dimension questionnaire (EQ-5D).ResultsOne hundred seventy-five patients completed the study. The incidence of PPP was 28%, and the affected patients presented lower QoL. The majority referred to a moderate to severe level of interference in their general activity. Cholecystectomies were less associated with PPP, and total knee/hip replacements were more associated with it. Preoperative pain, preoperative benzodiazepines or antidepressants, and more severe acute postoperative pain were associated with the development of PPP. Half of the patients with PPP were under treatment, and they refer a mean symptomatic relief of 69%.ConclusionsThis study, apart from attempting to better characterize the problem of PPP, emphasizes the lack of its treatment.

The influence of perioperative decreasing total psoas area on prognosis of esophagieal cancer patients.

38 Background: Depression of skeletal muscle mass (sarcopenia) has been linked to postoperative mortality in several carcinomas and various types of surgeries. Total psoas muscle area (TPA) has received attention as one of the indicators of systemic total skeletal muscle volume. The objective of this study is to determine the correlation between the patients who decreased TPA during pre-post operation and prognosis of esophageal cancer treated by surgical resection. Methods: We enrolled 40 esophageal cancer patients who underwent esophagectomy between April 2008 and May 2009. TPA was estimated by measuring the cross-sectional area of the psoas major muscle at the level of the third lumbar vertebra using an image-analysing software, identified on a preoperative CT scan, and a postoperative CT scan, which was taken on post-operative day 6. We divided the patients who decreased TPA between pre-post operation, into “decreasing group”, and the patients who preserved or increased TPA, into “non-decreasing group”. We investigated their backgrounds and prognosis. Results: Eighteen patients (45.0%) were classified as decreasing group, and 22(55.0%) patients were classified as non-decreasing group. Tumor locations, TMN Stage, or rates of neo-adjuvant chemotherapy, did not significantly differ between the two groups. Five-year overall survival rates (54.2% vs 85.7%, P = 0.046) were significantly lower in decreasing group in comparison with non-decreasing group. Recurrence-free survival rates (42.9% vs 85.7%, P = 0.012) were also significantly lower in decreasing group. The incidences of anastomotic leakage, or postoperative pneumonitis, did not differ between the two groups. Conclusions: The patients who decreased TPA during perioperative period associated with poor prognosis of esophageal cancer. The surgical operation for esophageal cancer is highly invasive, therefore active nutrition support and early rehabilitation during perioperative period might be indispensable.

Lack of Analgesic Effect Induced by Ropivacaine Wound Infiltration in Thyroid Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial.

Surgical site infiltration with local anesthetic reduces analgesic requests in various types of surgeries. Because thyroid surgery may induce severe postoperative pain, we tested the hypothesis that ropivacaine surgical site infiltration would significantly decrease postoperative administration of morphine in patients undergoing thyroid surgery. We performed a double-blind, placebo-controlled superiority trial to assess the efficacy of surgical site analgesia with ropivacaine (10 mL, 75 mg) performed at the end of thyroid surgery in adult patients. The primary end point was the proportion of patients not requiring IV morphine in the postanesthesia care unit. One hundred sixty-three patients completed the study, 85 in the placebo group and 88 in the ropivacaine group. The proportion of patients requiring morphine administration in the postanesthesia care unit (55% vs 53%, P = 0.80), the dose of IV morphine administered (5.6 ± 6.1 vs 5.5 ± 6.0 mg, P = 0.90), the total dose of opioids administered (expressed as oral morphine equivalent dose: 64 ± 27 vs 69 ± 29 mg, P = 0.20), and the visual analog pain scale over the first 24 hours were not significantly different between groups. The incidence of adverse events (36% vs 39%, P = 0.88), morphine-related adverse events (19% vs 17%, P = 0.84), serious adverse events (0% vs 2%, P = 0.50), and the patient satisfaction scores (9 ± 1 vs 9 ± 1, P = 0.70) was not significantly different between the 2 groups. Surgical site analgesia with ropivacaine at the end of thyroid surgery is not associated with any significant analgesic benefit.

The Future of Sleeve Gastrectomy

The International Diabetes Federation has recently published a position statement on bariatric surgery. Facing a global diabetes crisis, it has added various types of surgery on the gastrointestinal tract as powerful options among the armamentarium to normalise glycaemia, avoid regular medications and decrease costs in severely obese patients. Laparoscopic sleeve gastrectomy has been shown to be effective for the treatment of type 2 diabetes, with extremely low mortality and acceptable morbidity. It decreases caloric consumption, modifies gut hormones, changes gastric emptying, and lowers glycaemia. In the long term, if recurrences in weight or diabetes occur, it can be converted to a duodenal switch, potentially reaching 90% of patients with partial or complete remission.