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Obesity, defined by the world health organization as a body mass index (BMI) greater than 30, is an epidemic issue that has major implications on health. (1) It is estimated [...], Obesity is an epidemic that is known to play a role in the development of gastroesophageal reflux disease (GERD). Studies have shown that increasing body mass index plays a role in the incompetence of the gastroesophageal junction and that weight loss and lifestyle modifications reduce the symptoms of GERD. As a method of producing effective and sustainable weight loss, bariatric surgery plays a major role in the treatment of obesity. We reviewed the literature on the effects of different types of bariatric surgery on the symptomatic relief of GERD and its complications. Roux-en-Y gastric bypass was considered an effective method to alleviate symptoms of GERD, whereas laparoscopic sleeve gastrectomy appeared to increase the incidence of the disease. Adjustable gastric banding was seen to initially improve the symptoms of GERD; however, a subset of patients experienced a new onset of GERD symptoms during long-term follow-up. The literature suggests that different surgeries have different impacts on the symptomatology of GERD and that careful assessment may be needed before performing bariatric surgery in patients with GERD. L'obesite atteint des proportions epidemiques et on sait qu'elle joue un role dans l'apparition du phenomene de reflux gastro-aesophagien (RGO). Des etudes ont montre que l'augmentation de l'indice de masse corporelle contribue a l'incompetence de la jonction entre l'aesophage et l'estomac et que la perte de poids et des modifications de l'hygiene de vie reduisent les symptomes de RGO. Comme methode pour obtenir une perte de poids efficace et durable, la chirurgie bariatrique occupe une place importante dans le traitement de l'obesite. Nous avons passe en revue la litterature traitant des effets de differents types de chirurgie bariatrique sur le soulagement des symptomes du RGO et ses complications. La derivation gastrique Roux-en-Y a ete consideree comme une methode efficace pour le soulagement des symptomes de RGO, tandis que la gastrectomie verticale par laparoscopie a semble faire augmenter l'incidence de la maladie. Quant au cerclage gastrique ajustable, il a semble ameliorer initialement le RGO; toutefois chez une categorie de patients, le RGO s'est manifeste de nouveau lors du suivi a long terme. Selon la litterature, chaque type d'intervention exerce un impact different sur la symptomatologie du RGO et une evaluation soigneuse s'impose avant de proceder a une chirurgie bariatrique chez les patients souffrant de RGO.

Extreme obesity (body mass index [BMI] ≥ 35) in Canada has increased in prevalence by 400% over 2 decades and is rising at a disproportionately faster rate than lesser degrees [...], Background: Access to publicly funded bariatric surgery is limited, potential candidates face lengthy waits, and no universally accepted prioritization criteria exist. We examined patients' perspectives regarding prioritization for surgery. Methods: We surveyed consecutively recruited patients awaiting bariatric surgery about 9 hypothetical scenarios describing patients waiting for surgery. Respondents were asked to rank the priority of these hypothetical patients on the wait list relative to their own. Scenarios examined variations in age, clinical severity, functional impairment, social dependence and socioeconomic status. Willingness to pay for faster access was assessed using a 5-point ordinal scale and analyzed using multivariable logistic regression. Results: The 99 respondents had mean age of 44.7 ± 9.9 years, 76% were women, and the mean body mass index was 47.3 ± SD 7.6. The mean wait for surgery was 34.4 ± 9.4 months. Respondents assigned similar priority to hypothetical patients with characteristics identical to theirs (p = 0.22) and higher priority (greater urgency) to those exhibiting greater clinical severity (p < 0.001) and functional impairment (p = 0.003). Lower priority was assigned to patients at the extremes of age (p = 0.006), on social assistance (p < 0.001) and of high socioeconomic status (p < 0.001). Most (85%) respondents disagreed with payment to expedite access, although participants earning more than $80 000/year were less likely to disagree. Conclusion: Most patients waiting for bariatric surgery consider greater clinical severity and functional impairments related to obesity to be important prioritization indicators and disagreed with paying for faster access. These findings may help inform future efforts to develop acceptable prioritization strategies for publicly funded bariatric surgery. Contexte: Les regimes publics donnent un acces limite a la chirurgie bariatrique; les candidats potentiels font face a des attentes prolongees et il n'existe pas de criteres de priorisation universellement acceptes. Nous avons analyse le point de vue des patients relativement a la priorisation des candidats a la chirurgie. Methodes: Nous avons recrute consecutivement des patients en attente de chirurgie bariatrique et nous les avons interroges au sujet de 9 scenarios hypothetiques decrivant des patients en attente de chirurgie. Nous avons demande aux repondants de classer ces patients hypothetiques par ordre de priorite sur la liste d'attente par rapport a la priorite de leur propre cas. Les scenarios presentaient des variations d'age, de gravite de l'etat clinique, d'atteintes fonctionnelles, de dependance sociale et de statut socioeconomique. Nous avons determine au moyen d'une echelle ordinale en 5 points si les patients etaient disposes a payer pour acceder plus rapidement au traitement et nous avons analyse les reponses par regression logistique multivariee. Resultats: Les 99 repondants avaient en moyenne 44,7 ± 9,9 ans, 76 % etaient des femmes dont l'indice de masse corporelle moyen etait de 47,3 ± 7,6. Le temps d'attente moyen pour la chirurgie etait de 34,4 ± 9,4 mois. Les repondants ont assigne une priorite similaire aux patients hypothetiques dont les caracteristiques etaient identiques aux leurs (p = 0,22) et une priorite plus elevee (urgence superieure) a ceux qui presentaient un etat clinique plus grave (p < 0,001) et une deterioration fonctionnelle plus prononcee (p = 0,003). Une priorite moins grande a ete assignee aux patients qui se trouvaient aux 2 extremites de l'eventail des ages (p = 0,006), aux beneficiaires de l'aide sociale (p < 0,001) et aux personnes de statut socioeconomique eleve (p < 0,001). La plupart des repondants (85 %) se sont exprimes contre le paiement pour accelerer l'acces, meme si les participants qui gagnaient plus de 80 000 $ par annee etaient moins enclins a s'y opposer. Conclusion: La plupart des patients en attente d'une chirurgie bariatrique considerent que la gravite de l'etat clinique et les atteintes fonctionnelles associees a l'obesite sont d'importants indicateurs de priorisation et s'opposent a payer pour un acces plus rapide a l'intervention. Ces observations pourraient guider une eventuelle mise au point de strategies de priorisation pour la chirurgie bariatrique financee par les regimes publics.

Obesity is a common disease affecting more than 300 million adults worldwide. (1) It is defined as a body mass index greater than 30. In Canada, the prevalence of obesity [...], Obesity is a common disease affecting adults and children. The incidence of obesity in Canada is increasing. Laparoscopic sleeve gastrectomy (LSG) is a relatively new and effective procedure for weight loss. Owing to an increase in the number of bariatric surgical procedures, general surgeons should have an understanding of the complications associated with LSG and an approach for dealing with them. Early postoperative complications following LSG that need to be identified urgently include bleeding, staple line leak and development of an abscess. Delayed complications include strictures, nutritional deficiencies and gastresophageal reflux disease. We discuss the principles involved in the management of each complication. L'obesite est une maladie fort repandue, tant chez les adultes que chez les enfants, et son incidence est en hausse au Canada. La gastrectomie longitudinale laparoscopique (GLL) est une intervention relativement nouvelle et efficace pour la perte de poids. Compte tenu de l'augmentation du nombre d'interventions chirurgicales bariatriques, les chirurgiens generalistes doivent se familiariser avec les complications associees a la GLL et avec leur prise en charge. Les complications postoperatoires immediates de la GLL qu'il faut savoir reconnatre sans retard sont l'hemorragie, les fuites le long de la ligne d'agrafes et la formation d'abces. Parmi les complications plus tardives, mentionnons les stenoses, les carences alimentaires et le reflux gastro-oesophagien. Nous presentons les principes qui sous-tendent la prise en charge de chaque complication.

Minimally invasive splenectomy has become an established standard of care in general surgery. Minimally invasive splenectomy was first reported in 1991 by Delaitre and Maignien, (1) who performed laparoscopic splenectomy [...], Laparoscopic splenectomy (LS) has become an established standard of care in the management of surgical diseases of the spleen. The present article is an update and review of current procedures and controversies regarding minimally invasive splenectomy. We review the indications and contraindications for LS as well as preoperative considerations. An individual assessment of the procedures and outcomes of multiport laparoscopic splenectomy, hand-assisted laparoscopic splenectomy, robotic splenectomy, natural orifice transluminal endoscopic splenectomy and single-port splenectomy is included. Furthermore, this review examines postoperative considerations after LS, including the postoperative course of uncomplicated patients, postoperative portal vein thrombosis, infections and malignancy. La splenectomie laparoscopique (SL) est devenue la norme de soins etablie pour la prise en charge des maladies de la rate justiciables d&apos;une chirurgie. Le present article fournit une mise a jour et une synthese des interventions et des controverses actuelles entourant la splenectomie minimalement effractive. Nous passons en revue les indications et contre-indications de la SL, de meme que les considerations preoperatoires. Nous incluons une analyse individuelle des interventions et des resultats de la SL multiport, de la SL manuellement assistee, de la splenectomie robotisee, de la splenectomie endoscopique transluminale par voie naturelle et de la splenectomie par simple incision. De plus, cette synthese explore les considerations postoperatoires suivant la SL, y compris l&apos;evolution postoperatoire des cas non compliques, la thrombose de la veine porte postoperatoire, les infections et les cancers.

Laparoscopic adjustable gastric banding (LAGB) was first demonstrated successfully by Belachew and colleagues in 1995. (1) Despite the early enthusiasm and an explosive growth of interest in this technique for [...], Background: Laparoscopic adjustable gastric banding (LAGB) is considered a safe and effective treatment for severe obesity and obesity-related comorbidities. We sought to examine the outcome of LAGB delivered through a Canadian publicly funded obesity program. Methods: We retrospectively analysed the cases of patients who underwent LAGB within a comprehensive, multidisciplinary, publically funded obesity program. Results: A total of 178 patients underwent LAGB. Mean percentage total body weight loss at 1, 2 and 3 years was 15.8%, 20.7% and 20.3%, respectively. The most common short-term complication was postoperative nausea (19%). The medium-term complications included band migration (5.6%) and port site complications, band leakage and incisional hernia at 1% each. The reoperation rate was 4.5%. The mean surgery duration was 56 minutes and the mean length of stay was 1.4 days. The average numbers of clinic visits and band adjustments were highest in the first year. The most common investigation for postoperative symptoms was fluoroscopy (86%). An outcome comparison between the 2 generations of the REALIZE gastric band was inconclusive, requiring further data collection. Conclusion: Publicly funded LAGB results in effective weight loss and acceptable safety over the short term. Our patients may represent a distinct population that differs from that in the private system. Long-term data are necessary to determine the cost-effectiveness of this important surgical option for severe obesity. Contexte: L'anneau gastrique ajustable pose par laparoscopie (AGAL) est considere comme un traitement securitaire et efficace contre l'obesite severe et les comorbidites connexes. Nous avons cherche a analyser le resultat de la pose d'un AGAL realisee dans le cadre d'un programme public de lutte contre l'obesite au Canada. Methodes: Nous avons analyse de facon retrospective les cas de patients qui ont recu un AGAL dans le contexte d'un programme integre et multidisciplinaire de lutte contre l'obesite finance par le secteur public. Resultats: Au total, 178 patients ont recu un AGAL. La perte procentuelle moyenne totale de masse corporelle a 1, 2 et 3 ans s'est etablie a 15,8%, 20,7% et 20,3% respectivement. Les nausees postoperatoires ont constitue la complication a court terme la plus frequente (19%). Les complications a moyen terme ont inclus le deplacement de l'anneau (5,6%) et des complications du cote porte, la fuite au niveau de l'anneau et une hernie a celui de l'incision: elles ont atteint 1% dans chaque cas. Le taux de repetition de l'intervention a atteint 4,5%. L'intervention chirurgicale a dure en moyenne 56 minutes et le sejour moyen 1,4 jours. Le nombre moyen de visites a la clinique et celui des rajustements de l'anneau etaient les plus eleves au cours de la premiere annee. Les symptomes postoperatoires sont examines le plus souvent par fluoroscopie (86%). Une comparaison des resultats entre les 2 generations de l'anneau gastrique REALIZE n'a pas ete concluante, ce qui oblige a reunir d'autres donnees. Conclusion: La pose d'un AGAL financee par le secteur public entraine une perte de poids efficace et offre une securite acceptable a court terme. Nos patients peuvent representer une population distincte qui differe de celle du secteur prive. Il faut des donnees a long terme pour determiner la rentabilite de cette option chirurgicale importante en cas d'obesite severe.

Obesity has become a major health concern in Canada, (1) with extreme obesity increasing in prevalence across the country by more than 400% in the last 2 decades. (2) Given [...], Obesity has become a major health concern in Canada. This has resulted in a steady rise in the number of bariatric surgical procedures being performed nationwide. The laparoscopic Roux-en-Y gastric bypass (LRYGB) is not only the most common bariatric procedure, but also the gold standard to which all others are compared. With this in mind, it is imperative that all gastrointestinal surgeons understand the LRYGB and have a working knowledge of the common postoperative complications and their management. Early postoperative complications following LRYGB that demand immediate recognition include anastomotic or staple line leak, postoperative hemorrhage, bowel obstruction and incorrect Roux limb reconstructions. Later complications may be challenging to differentiate from other gastrointestinal disorders and include anastomotic stricture, marginal ulceration, fistula formation, weight gain and nutritional deficiencies. We discuss the principles involved in the management of each complication and the timing of referral to specialist bariatric centres. L&apos;obesite est devenue un probleme de sante majeur au Canada. Le phenomene est a l&apos;origine d&apos;une augmentation constante du nombre de chirurgies bariatriques effectuees partout au pays. La derivation gastrique laparoscopique Roux-en-Y n&apos;est pas seulement la technique bariatrique la plus courante, elle est aussi la norme a laquelle toutes les autres se comparent. Compte tenu de cela, il est crucial que tous les specialistes en chirurgie digestive comprennent cette intervention et aient une connaissance pratique de ses complications postoperatoires frequentes et de leur prise en charge. Les complications postoperatoires immediates de cette technique qu&apos;il faut reconnaitre sans tarder incluent : la fuite anastomotique (le long de la ligne d&apos;agrafes), l&apos;hemorragie postoperatoire, l&apos;obstruction intestinale et les reconstructions incorrectes de la branche Roux. Les complications tardives peuvent etre difficiles a distinguer des autres troubles gastro-intestinaux et comprennent, notamment : la stenose anastomotique, l&apos;ulceration marginale, la formation de fistules, l&apos;echec de la perte ponderale et certains deficits nutritionnels. Nous discutons ici les principes qui sous-tendent la prise en charge de chaque complication et le moment ou il est indique d&apos;adresser les patients vers des centres specialises en soins bariatriques.

It has recently been estimated that 1 in 10 premature deaths among Canadian adults aged 20-64 years is directly attributable to obesity. (1) In addition to affecting personal health, the [...], Laparoscopic adjustable gastric banding (LAGB) is considered to be a safe and effective method of weight loss and reduction of comorbidities associated with obesity. Despite its improved early safety profile compared with Roux-en-Y gastric bypass, patients with LAGB can manifest unique complications that must be recognized and managed appropriately to achieve good outcomes. This review will prepare the general surgeon to identify, diagnose and manage the common complications encountered in patients presenting following LAGB. On considere que le cerclage gastrique laparoscopique par anneau modulable constitue une methode sure et efficace pour la perte de poids et la reduction des comorbidites associees a l'obesite. Malgre son profil d'innocuite precoce ameliore comparativement a la derivation gastrique de Roux-en-Y, les patients soumis a un cerclage gastrique peuvent presenter des complications particulieres qu'il faut savoir reconnaitre et corriger de maniere appropriee pour obtenir de bons resultats. La presente synthese preparera le chirurgien general a reconnaitre, diagnostiquer et traiter les complications courantes chez les patients qui consultent apres un cerclage gastrique laparoscopique.

Minimally invasive surgery (MIS) is one of the fastest growing areas in surgery today and is an approach that is desirable among patients and physicians because of the shorter hospital [...], Despite the complexities of minimally invasive surgery (MIS), a Canadian approach to training surgeons in this field does not exist. Whereas a limited number of surgeons are fellowship-trained in the specialty, guidelines are still clearly needed to implement advanced MIS. Leaders in the field of gastrointestinal surgery and MIS attended a consensus conference where they proposed a comprehensive mentoring program that may evolve into a framework for a national mentoring and training system. Leadership and commitment from national experts to define the most appropriate template for introducing new surgical techniques into practice is required. This national framework should also provide flexibility for truly novel procedures such as natural orifice translumenal endoscopic surgery. Malgre les complexites de la chirurgie minimalement invasive (CMI), il n'existe aucune approche canadienne de formation des chirurgiens dans ce domaine. Quelques chirurgiens ont ete formes dans cette specialite par le biais de stages, mais il s'impose de toute evidence d'implanter des cours avances en CMI. Des chefs de file en chirurgie gastro-intestinale et CMI ont participe a une conference de consensus ou ils ont propose un programme de mentorat exhaustif qui pourrait devenir le cadre d'un systeme national de mentorat et de formation. Les experts nationaux doivent faire preuve de leadership et d'engagement pour definir la meilleure facon d'implanter dans la pratique les nouvelles techniques chirurgicales. Le cadre national doit aussi etre suffisamment souple pour permettre l'integration d'interventions de pointe telles que la chirurgie endoscopique transluminale par orifice naturel.

Background: This study investigates the feasibility of performing advanced minimally invasive surgery (MIS) in a nonspecialized practice environment. Methods: We conducted a cross-sectional survey of all community general surgeons currently [...]

Introduction: Laparoscopic repair of ventral and incisional hernias (LVIHRs) is feasible; however, many facets of this procedure remain poorly defined. The indications, essential technical features and postoperative management should be [...]

Introduction: Practising surgeons need an effective means for learning new skills and procedures in advanced minimal access surgery (MASA). Currently, available educational methods include traditional continuing medical education symposia (1-day [...]

Introduction: A meta-analysis of the literature suggests there is an increased rate of intra-abdominal abscess after laparoscopic appendectomy (LA) compared with open appendectomy (OA). Methods: To analyze the infectious complications [...]

Background: There is compelling evidence to suggest that undergraduate surgical education may fail to provide appropriate instruction in basic surgical principles and skills. Methods: We completed a descriptive, cross-sectional survey [...]

Background: There are no comprehensive evidence-based guidelines for deep vein thrombosis (DVT) prophylaxis in patients undergoing minimal-access surgery (MAS). Methods: We completed a cross-sectional survey of general surgeons practising in [...]

Background: Although nationally recognized learning objectives for undergraduate surgical education exist, the extent to which Canadian medical schools follow these guidelines has never been established. Methods: We distributed a survey [...]