Search

Morbid obesity and being overweight are a growing problem worldwide. They also affect patients with end-stage solid-organ disease and patients after transplant. Bariatric surgery is the most effective available weight loss procedure. Bariatric surgery can be helpful for the treatment of some conditions, such as nonalcoholic fatty liver disease or nonalcoholic steatohepatitis, which may lead to transplant, and weight loss can improve or even reverse them. In other cases, morbid obesity is a limitation to accessing a transplant program, so bariatric surgery can serve as a conduit to transplant. After transplant, obesity and obesity-related comorbidities can be a significant health problem that may be treated, as in patients without a transplant, with bariatric surgery. There are some specific conditions and issues to be considered in patients with end-stage solid-organ disease who are candidates for bariatric surgery, such as increased morbidity and mortality. After transplant, immunosuppressant regimens and technical limitations may be also significant.

Introduction: For the past 20 years, robotic surgical systems have been used for the Roux-en-Y gastric bypass (RYGB). The da Vinci Surgical System (Intuitive Surgical, Inc.) has been one of the mos...

Coronavirus; Operacions quirúrgiques; Epidemiologia Coronavirus; Intervenciones quirúrgicas; Epidemiología Coronavirus; Surgical procedures; Epidemiology Background: Surgical failure-to-rescue (FTR, death rate following complications) is a reliable cross-sectional quality of care marker, but has not been evaluated dynamically. We aimed to study changes in FTR following emergency surgery during the COVID-19 pandemic. Material and methods: Matched cohort study including all COVID-19-non-infected adult patients undergoing emergency general surgery in 25 Spanish hospitals during COVID-19 pandemic peak (March-April 2020), non-peak (May-June 2020), and 2019 control periods. A propensity score-matched comparative analysis was conducted using a logistic regression model, in which period was regressed on observed baseline characteristics. Subsequently, a mixed effects logistic regression model was constructed for each variable of interest. Main variable was FTR. Secondary variables were post-operative complications, readmissions, reinterventions, and length of stay. Results: 5003 patients were included (948, 1108, and 2947 in the pandemic peak, non-peak, and control periods), with comparable clinical characteristics, prognostic scores, complications, reintervention, rehospitalization rates, and length of stay across periods. FTR was greater during the pandemic peak than during non-peak and pre-pandemic periods (22.5% vs. 17.2% and 12.7%), being this difference confirmed in adjusted analysis (odds ratio [OR] 2.13, 95% confidence interval [95% CI] 1.27-3.66). There was sensible inter-hospital variability in FTR changes during the pandemic peak (median FTR change +8.77%, IQR 0-29.17%) not observed during the pandemic non-peak period (median FTR change 0%, IQR -6.01-6.72%). Greater FTR increase was associated with higher COVID-19 incidence (OR 2.31, 95% CI 1.31-4.16) and some hospital characteristics, including tertiary level (OR 3.07, 95% CI 1.27-8.00), medium-volume (OR 2.79, 95% CI 1.14-7.34), and high basal-adjusted complication risk (OR 2.21, 95% CI 1.07-4.72). Conclusion: FTR following emergency surgery experienced a heterogeneous increase during different periods of the COVID-19 pandemic, suggesting it to behave as an indicator of hospital resilience. FTR monitoring could facilitate identification of centres in special needs during ongoing health care challenges.

IntroductionChange in lifestyle and diets is a part of the bariatric surgery process. Preoperative weight loss is still considered obligatory in some programs, but its benefits remain controversial. This study aimed to evaluate the influence of the preoperative weight loss on the postoperative results, in terms of long-term weight loss and perioperative morbidity.Methods.A retrospective review from the prospective collected database was performed. Patients operated for Roux-n-Y Gastric bypass (RYGB) or Sleeve Gastrectomy (SG) as a primary procedure with at least 5 years of follow-up were analysed. Two group of patients were defined depending on if any preoperative weight loss was achieved or not. Patients with 5% or more weight loss were independently evaluated too. Weight loss up to 5 years, nadir weight loss and early postoperative morbidity were analysed.Results.419 Patients were included (225 RYGB and 194 SG), 324 (77.3%) were women, with a mean age of 45.85 years (ranging 15 to 69). 178 patients (42.5%) achieved any weight loss prior to surgery, and just 26 (13.4%) more than 5%. Preoperative weight loss did not correlate with less morbidity, leak o reoperation rate after SG. In the RYGB preoperative weight loss patients showed a trend to higher morbidity.In terms of weight loss, preoperative weight loss patients did not achieve better nadir BMI (27.99kg/m2 vs 28.55kg/m2, p=0.213) nor final BMI (31.56kg/m2 vs 32.04kg/m2, p=0.412). Those results were repeated when RYGB and SG patients were analysed independently. Univariate and multivariate analyses did not find that PWL had any relationship to nadir BMI, final BMI nor postoperative morbidity, leak or reoperation risk.Conclusions.Preoperative weight loss did not correlate to better postoperative results nor to better weight loss results in our series.

Long-term studies comparing the mechanisms of different bariatric techniques for T2DM remission are scarce. We aimed to compare type 2 diabetes (T2DM) remission after a gastric bypass with a 200-cm biliopancreatic limb (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP), and to assess if the initial secretion of gastrointestinal hormones may predict metabolic outcomes at 5 years. Forty-five patients with mean BMI of 39.4(1.9)kg/m2 and T2DM with HbA1c of 7.7(1.9)% were randomized to mRYGB, SG, or GCP. Anthropometric and biochemical parameters, fasting concentrations of PYY, ghrelin, glucagon, and AUC of GLP-1 after SMT were determined prior to and at months 1 and 12 after surgery. At 5-year follow-up, anthropometrical and biochemical parameters were determined. Total weight loss percentage (TWL%) at year 1 and GLP-1 AUC at months 1 and 12 were higher in the mRYGB than in the SG and GCP. TWL% remained greater at 5 years in mRYGB group − 27.32 (7.8) vs. SG − 18.00 (10.6) and GCP − 14.83 (7.8), p = 0.001. At 5 years, complete T2DM remission was observed in 46.7% after mRYGB vs. 20.0% after SG and 6.6% after GCP, p

Most relative weight-loss metrics follow the formula “Weight loss(%) = 100 · (Initial BMI - Final BMI) / (Initial BMI-a),” where a is the reference point that defines the metric. The percentage of total weight loss (%TWL, a = 0) and percentage of excess weight loss (%EWL, a = 25) are influenced by a patient’s initial weight. Recently, the percentage of alterable weight loss metric (%AWL, a = 13) has been reported to produce initial-weight-independent outcomes. This study aimed to replicate the methodology used for %AWL determination in a Mediterranean cohort of bariatric patients. Multicenter study in 10 large hospitals in Spain. Two large prospective databases were retrospectively searched for all primary laparoscopic gastric bypass patients with 2 years of follow-up. Outcomes at nadir were expressed and analyzed with 26 different metrics (a from 0 to 25), looking for the metric whose outcomes produced (1) the lowest coefficient of variation, (2) no differences between initially lighter and heavier patients, and (3) no correlation with patients’ initial BMI. A cohort of 1793 patients was stratified into 4 gender-age groups: younger women (YW, n = 733), older women (OW, n = 674), younger men (YM, n = 197), and older men (OM, n = 189). The calculations suggested an optimal reference point of 18 kg/m2, defining a new metric (percentage of Mediterranean alterable weight loss, %MAWL). When %TWL, %EWL, %AWL, and %MAWL were tested on the whole sample, only %MAWL produced initial-weight-independent results. In our Mediterranean cohort of patients, a reference point of 18 (and not 13) yielded initial-weight-independent outcomes.

Resumen La pandemia SARS-CoV-2 ha tenido un gran impacto en todo el mundo, siendo Espana uno de los paises mas afectados. La demora en la cirugia bariatrica puede tener consecuencias fatales, ya que hasta el 50% de los pacientes que se encuentran en lista de espera desarrollan una nueva comorbilidad durante el tiempo que permanecen en ella y el 1,5% de pacientes fallecen mientras esperan la intervencion. Es por ello por lo que la cirugia bariatrica no debe demorarse en cuanto la ocupacion del hospital por pacientes COVID-19+ disminuya de forma significativa y se disponga de recursos y seguridad suficiente para realizar la cirugia en pacientes con patologia benigna. Este documento recoge las principales recomendaciones para los programas de cirugia bariatrica en nuestro pais desde el punto de vista tanto de seguridad como de preparacion y seguimiento del paciente bariatrico en el contexto de la pandemia SARS-CoV-2.

Introduction The aim of this work is to analyze the weight evolution of the main bariatric surgical techniques (Roux-en-Y gastric Bypass-RYGB and Sleeve Gastrectomy-SG) performed in a representative sample of Spanish centers, in order to make a percentiles charts of the percentage of total weight loss during the first 3 years after surgery. Methods A retrospective longitudinal cohort study was conducted based on the data provided by 9 Spanish hospitals. Weight data were analyzed both in %TWL (total weight loss) and %EWL (excess weight lost) corresponding to the RYGB (n = 1887) and SG (n = 1210). Results BPGY remains the most frequently performed technique in our national sample. In both surgical techniques, maximum weight loss occurs 18 months after surgery. Both techniques follow the same weight evolution, although the %TWL values are lower in the case of the SG at 36 months (% TWL RYGB = 33.6 ± 10 vs %TWL GV = 29.3 ± 10). Age and gender are decisive in the weight results (better in younger patients for both techniques and better in women for BPGY) Conclusions Percentile charts of % TWL after bariatric surgery represent a very useful tool and an important advance in the quality of patient management.

Resumen Introduccion El objetivo de este trabajo es analizar la evolucion ponderal de las principales tecnicas quirurgicas bariatricas (bypass gastroyeyunal en Y de Roux [BPGY] y gastrectomia vertical [GV]) realizadas en un conjunto representativo de centros nacionales espanoles, con el fin de confeccionar unos graficos de percentiles del porcentaje de perdida total de peso perdido durante los 3 primeros anos despues de la cirugia. Metodos Se realiza un estudio de cohortes longitudinal retrospectivo a partir de los datos aportados por 9 centros hospitalarios espanoles. Se han analizado los datos ponderales tanto en porcentaje de perdida total de peso perdido como en porcentaje de exceso de peso perdido correspondientes al BPGY (n = 1.887) y a la GV (n = 1.210). Resultados El BPGY sigue siendo la tecnica mas frecuentemente realizada en nuestra muestra nacional. En ambas tecnicas quirurgicas, la perdida de peso maxima se produce a los 18 meses de la cirugia. Ambas tecnicas siguen la misma evolucion ponderal, aunque los valores del porcentaje de perdida total de peso perdido sean inferiores en el caso de la GV a los 36 meses (29,3 ± 10 vs. 33,6 ± 10). La edad y el genero son determinantes en los resultados ponderales (mejores en paciente mas jovenes para ambas tecnicas y mejores en mujeres para el BPGY). Conclusiones Los graficos de percentiles del porcentaje de peso total perdido despues de la cirugia bariatrica representan una herramienta muy util y un avance importante en la calidad asistencial para el seguimiento ponderal del paciente.

The aims were to compare the 5-year outcomes of duodenal switch (DS) and single-anastomosis duodenal switch (SADI-S) in terms of weight loss; remission of comorbidities; nutritional status short- and long-term complications; postoperative mortality; and need for revisional surgery.Multicenter prospective observational study of all consecutive patients undergoing DS or SADI-S in three high-volume hospitals.A total of 87 patients were included in the study, 43 submitted to DS and 44 to SADI-S, with similar basal characteristics, nutritional parameters, and BMI (52.9 kg/mBoth DS and SADI-S allowed good weight control and resolution of comorbidities. DS achieved a greater weight loss compared to SADI-S, at the expense of longer operative time and lower vitamin and mineral levels.

Cholelithiasis is an issue in bariatric surgery patients. The incidence of cholelithiasis is increased in morbidly obese patients. After bariatric surgery, the management maybe sometimes challenging. There is no consensus about how to deal with cholelithiasis prior to bariatric surgery.A retrospective review from our prospectively collected bariatric surgery database. Primary bariatric procedures from 2009 to 2020 were included. Prevalence of cholelithiasis and its management prior to bariatric surgery and the incidence and management of postoperative biliary events were analyzed.Over 1445 patients analyzed, preoperatively cholelithiasis was found in 153 (10.58%), and 68 out of them (44.44%) were symptomatic. Seventy-six patients had a concomitant cholecystectomy. In those cases, the bariatric procedure did not show increased operative time, length of stay, morbidity, or mortality compared to the rest of primary bariatric procedures. Twelve patients (15.58%) with previous cholelithiasis and no concomitant cholecystectomy presented any kind of biliary event and required cholecystectomy. De novo cholelithiasis rate requiring cholecystectomy was 3.86%. Postoperative biliary events both in de novo and persistent cholelithiasis population did not show any difference between the type of surgery, weight loss, and other characteristics.Cholelithiasis was present in 10.58% of our primary bariatric surgery population. Concomitant cholecystectomy was safe in our series. Non-surgical management of asymptomatic cholelithiasis did not lead to a higher risk of postoperative biliary events. The global postoperative cholecystectomy rate was equivalent to the general population.

Background: After the first laparoscopic Roux-en-Y gastric bypass (RYGB) in 1994 by Wittgrove, the introduction of robot-assisted procedures was the next step in the surgical race to reduce invasiv...

Introduction: Obesity remains a major public chronic disease, and the multifactorial components of its relapse in many patients remain inevitable. Methods: This article provides a panoramic view of the most commonly performed revisional bariatric surgery (RBS). RBS is a complex procedure; thus, primary procedures should be well chosen and performed to avoid the increasing number of RBS cases. Results: Bariatric surgery is the only successful long-term treatment for obesity. However, a proportion of primary bariatric surgeries has failed during the follow-up period. In recent decades, the solution for these complications is by performing RBS. It is mandatory to understand obesity as a chronic disease to appropriately treat patients. Treatment strategies are needed to determine the indications for revision. RBS requires a meticulous evaluation to facilitate good long-term results. Conclusions: Treatment strategies will be a fundamental pillar to wisely determine the indications for revision and identify the factors influencing failure by prudently and rationally evaluating the revisional procedure that the patient will benefit from and acquiring a high level of surgical skills.

Resumen Introducción: la obesidad en el siglo XXI continúa siendo un problema de salud mundial, la cirugía bariátrica, en la actualidad, es el único tratamiento exitoso a largo plazo para el manejo de ésta y sus comorbilidades, ha tenido un incremento importante en los últimos años apareciendo complicaciones que son objetivos de la cirugía revisional. Objetivos: el presente artículo pretende evaluar las principales cirugías revisionales que han permeado en el campo de la cirugía bariátrica así como nuestra experiencia en los últimos años. Material y métodos: análisis estadístico descriptivo de una cohorte retrospectiva de pacientes sometidos a cirugía de revisión en el Hospital Universitario Vall d'Hebron de Barcelona, España. EAC-BS Center of Excellence. Resultados: se han realizado 1.890 cirugías bariátricas desde los inicios de la cirugía bariátrica en nuestra Unidad hasta el 31 de julio de 2019. 143 (7,56%) corresponden a cirugías de revisión. Las más frecuentes fueron la conversión de gastrectomía vertical (GV) a bypass gástrico (BPG) 30,76% y a SADI-S 20,97%. Dentro de éstas, las principales indicaciones se encuentra el reflujo esofagogástrico (RGE) en un 30,76% y pérdida inadecuada de peso 20,97% en la GV. El BPG requirió conversión a GV en 12,58% y revisión de BGP en 7,69% principalmente por hipoglucemias. Conclusiones: el incremento de cirugía primaria para la obesidad implica que un porcentaje considerable de procedimientos primarios presentarán algún tipo de indicación que requerirá revisión. La cirugía revisional requerirá una evaluación meticulosa debería permitir dar un buen manejo a largo plazo.