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Background: Preoperative HbA1c has been associated with an increased incidence of postoperative morbidity and mortality after abdominal and cardiovascular surgery. The literature on bariatric surgery is inconclusive and guidelines recommend postponement of surgery when HbA1c is above an arbitrary threshold (≥ 8.5%). In this study, we sought to understand the impact of preoperative HbA1c on early and late postoperative complications. Methods: We performed a retrospective analysis of prospectively collected data on obese patients with diabetes who underwent laparoscopic bariatric surgery. Patients were categorized into three groups according to their preoperative HbA1c level: < 6.5% (group 1), 6.5–8.4% (group 2) and ≥ 8.5% (group 3). Primary outcomes were early and late postoperative complications (< and > 30 days, respectively) that were differentiated based on severity (major/minor). Secondary outcomes were length of stay (LOS), duration of surgery, and rate of readmission. Results: In total, 6798 patients underwent laparoscopic bariatric surgery from 2006 to 2016, of which 1021 (15%) patients had Type 2 Diabetes (T2D). Complete data with a median follow-up of 45 months (3–120) were available for 914 patients with HbA1c < 6.5% (n = 227, 24.9%), 6.5–8.4% (n = 532, 58.5%) and ≥ 8.5% (n = 152, 16.6%). Early major surgical complication rate was similar across the groups ranging from 2.6 to 3.3%. No associations between high preoperative HbA1c and late complications—medical as well as surgical—was observed. Groups 2 and 3 had statistically significant more pronounced inflammatory status. LOS (1.8–1.9 days), readmission rates (1.7–2.0%) and surgical time was similar across the three groups. Conclusion: Elevated HbA1c is not associated with more early or late postoperative complications, longer LOS, longer surgical time or higher rates of readmission. [ABSTRACT FROM AUTHOR]

Objective: To find out the incidence of incisional hernia in patients who had resuture of a burst abdomen and to compare different methods of wound closure and the development of incisional hernia. Design: Retrospective study. Setting: University hospital, Norway. Subjects: 78 adults patients who had their burst abdomens resutured between January 1986 and December 1995. Interventions: Five different methods were used to close the burst abdomen: interrupted or continuous sutures with or without retention sutures, or retention sutures alone. Main outcome measure: Incisional hernia after at least one year follow-up. Results: Postoperative mortality was 14% (11/78), and 53 patients were followed up for at least a year. Incisional hernias developed in 43% (23/53) of the patients. When interrupted sutures were used (with or without retention sutures) 34% (13/38) of patients developed incisional hernias compared with 6/10 when the wound was closed with a continuous suture. Retention sutures did not reduce the incidence of incisional hernia. Conclusions: Incisional hernia is a common complication after resuture of a burst abdomen. We found no significant differences in the incidence of incisional hernias when continuous and interrupted techniques were compared. Retention sutures do not reduce the incidence of incisional hernias. There is still a need for refinements of the technique of closure of a burst abdomen. [ABSTRACT FROM AUTHOR]