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Introduction: The increasing prevalence of obesity worldwide has raised concerns about its impact on surgical outcomes across various procedures. Laparoscopic cholecystectomy (LC), a common surgical intervention for benign gallbladder disease, is no exception. The relationship between obesity and LC outcomes remains complex and merits further investigation., Aim: This retrospective study aimed to assess the influence of obesity on the safety and surgical outcomes of LC., Material and Methods: Patients were divided into 2 groups: those with obesity (body mass index (BMI) ≥ 30 kg/m²) and non-obese controls (BMI < 30 kg/m²). Baseline characteristics, operative duration, hospitalization length, and post-operative complications, categorized by the Clavien-Dindo classification, were evaluated., Results: Among 116 patients with obesity and 176 non-obese controls, differences in age and gender were noted but were not clinically significant. Operative time was longer in the group with obesity. Hospitalization length and adverse event occurrence did not differ significantly. Importantly, post-operative complications showed no substantial differences between the groups, suggesting that obesity may not significantly increase the complication risk in this population., Conclusions: Obesity may not substantially elevate the risk of adverse events or severe complications following LC in this patient population. Careful patient selection, preoperative evaluation, and surgical technique remain crucial. Further research in larger, diverse populations is needed to validate these findings., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Introduction: Laparoscopic sleeve gastrectomy (LSG) has gained prominence as a therapeutic option for obesity and metabolic diseases. The choice of staple line reinforcement technique in LSG remains a subject of debate, particularly concerning postoperative bleeding complications., Aim: The aim of this retrospective analysis is to assess the influence of different staple line reinforcement techniques on the occurrence of bleeding complications LSG., Material and Methods: We conducted a retrospective analysis of patients undergoing LSG between September 2021 and April 2023 at our institution. Patients were stratified into two groups based on the staple line reinforcement method: continuous suturing (n = 53) and clipping (n = 28). Surgical outcomes, including operative time, length of hospital stay, and bleeding complications, were assessed. Complications were classified using the Clavien-Dindo classification., Results: Continuous suturing was associated with a significantly longer operative time (88.15 min vs. 74.64 min, p < 0.05) but a similar length of hospital stay. Notably, no bleeding complications occurred in the continuous suturing group, while the clipping group experienced postoperative bleeding in 7.14% of cases (p < 0.05). Continuous suturing exhibited a slightly higher incidence of minor complications classified as Class I in the Clavien-Dindo classification (7.55% vs. 0%)., Conclusions: This retrospective analysis suggests that continuous suturing may provide enhanced hemostasis along the staple line, reducing the risk of postoperative bleeding compared to clipping. Despite the longer operative time and a slightly higher rate of minor complications, the clinical significance of these findings should be considered within the context of individual patient risk profiles., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Fundacja Videochirurgii.)

Background: The published literature presents conflicting results regarding the impact of bariatric surgery on the incidence of colorectal cancer. There are important new studies that have addressed this question with longer follow-up., Objective: To investigate the effect of bariatric surgery on the risk of developing colorectal cancer in patients with obesity., Setting: Meta-analysis., Methods: PubMed and Scopus were searched for relevant articles. Articles published by November 2021 were retrieved; data were extracted according to the evidence-based PICO (population, intervention, control, outcome) model and analyzed using a random-effects model to estimate the pooled relative risk (RR) and its 95% confidence interval. The heterogeneity of studies was tested and quantified using Cochran's Q., Results: The initial search yielded 327 articles. After evaluation, 13 studies were analyzed. The thorough evaluation resulted in 13 articles, which were analyzed. A total number of 3,233,044 patients were included in the meta-analysis. The mean time of follow-up was 9.5 ± 7.9 years. The pooled estimate of the adjusted RR was .63 (95% confidence interval, .50-.79). Heterogeneity χ 2 was 107.96 (df = 12; P < .001; I 2 = 89%)., Conclusion: Patients who underwent bariatric surgery had a 37% reduction in the risk of developing colorectal cancer compared with patients with obesity who had no surgery., (Copyright © 2023. Published by Elsevier Inc.)

Background: Thus far, no data are available on decision regret about sleeve gastrectomy (SG), particularly in patients who experienced perioperative complications. This study aimed to assess whether patients with postoperative complications regret their decision to undergo laparoscopic SG more than patients with an uneventful postoperative course., Methods: The study group comprised patients with complications after laparoscopic SG (cases). The control group comprised patients who did not experience any postoperative complications (controls). A telephone survey was conducted on all patients. Patients' satisfaction regarding their decision to undergo surgery was assessed using the Decision Regret Scale., Results: In total, 21 patients who experienced postoperative complications and 69 controls were included. The patients in the study and control groups achieved similar percentages of total weight loss (32.9 ± 11.9 vs. 33.8 ± 15.0, p = 0.717) and excessive body mass index loss (74.9 ± 30.7 vs. 73.1 ± 36.7, p = 0.398) at 1 year postoperatively. The difference in weight change at 12 months postoperatively was not significant in both groups. The mean regret scores in the study and control groups were 13.2 ± 1.2 (range, 28-63) and 13.3 ± 1.1 (range, 12-66) (p = 0.818), respectively. Moreover, no significant difference was found among patients who expressed regret between the study and control groups (regret score > 50; 4.76% vs. 4.35%) (p = 1.000)., Conclusion: This study suggests that patients with postoperative complications do not regret their decision to undergo SG more than patients with an uneventful postoperative course., (© 2022. The Author(s).)

Background: The MBSAQIP has been used to evaluate risk and create risk models. Previous studies have determined what complications matter most., Study Design: This study was a registry-based analysis of patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) between January 1, 2015, and December 31, 2019, at centers participating in MBSAQIP. Cases were identified using Current Procedural Terminology. Patients less than 18 years old were excluded. A chi-square test was used to assess differences in the prevalence of complications and effects across years. Using a multivariable Poisson regression model with a link log and robust estimation, prevalence ratio estimates and 95% CI were obtained., Results: A total of 690,770 observations met the inclusion criteria. Mean (SD) age was 44.5 (±12.0) years, and mean (SD) BMI was 45.2 kg/m2 (±7.9). SG cases accounted for 73.45% of all observations. There was a significant relative reduction in readmissions, end-organ dysfunction, and all-cause mortality from 2015 to 2019 in the SG subgroup. There were also noticeable reductions in 30-day readmission, ICU admission, and end-organ dysfunction in the RYGB subgroup. For complications, bleeding, postoperative pneumonia, and stroke were significantly decreased in the RYGB subgroup, but only bleeding was significantly decreased in the SG subgroup during the 5-year study period., Conclusions: There has been a continuous improvement in several (but not all) outcomes through the years that the MBSAQIP has been collecting data. Different outcomes were reduced between the SG and RYGB subgroups, and the decrease in all-cause mortality was only noted in the SG subgroup., (Copyright © 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Hemorrhagic complications after laparoscopic sleeve gastrectomy (LSG) are among the most common adverse events. The last 10 min of LSG are essential in terms of hemostasis., Aim: To assess the blood pressure profile in the last 10 min of LSG in patients who experienced hemorrhagic complications after laparoscopic sleeve gastrectomy., Material and Methods: We performed a retrospective case-control study. The medical records of 867 patients who underwent primary LSG were analyzed. Cases were defined as patients who required surgical revision due to hemorrhagic complications within 72 h. Controls were matched (1 : 1) with cases by age, body mass index, gender, staple line reinforcement, comorbidities and surgeon's experience. Comparison of the last three intraoperative blood pressure measurements at the end of surgery was made., Results: The bleeding rate was 3.0%. A total of 24 subjects (12 matched pairs) were included in the study. Cases had statistically significant increased mean arterial blood pressure (mm Hg) 5 min before the end of surgery (87.8 ±11.9 vs. 79.4 ±8.8 mm Hg, p = 0.049) and at the end of surgery (89.2 ±11.7 vs. 77.5 ±11.8 mm Hg, p = 0.011). Higher diastolic blood pressure measurements were observed 5 min before the end (72.1 ±10.7 vs. 62.8 ±8.1 mm Hg, p = 0.023) and at the end of surgery (74.2 ±10.0 vs. 60.8 ±11.2 mm Hg, p = 0.004)., Conclusions: Compared with closely matched control subjects, patients with HC after LSG have increased mean arterial pressure in the last 5 min of surgery. This phenomenon has not been reported in the literature before., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2021 Fundacja Videochirurgii.)

Introduction: Patient's satisfaction after weight loss surgery is in the research spotlight. However, there are still no quantitative data regarding whether patients regret their decision to undergo laparoscopic sleeve gastrectomy (SG)., Objectives: The present study aimed to evaluate whether patients regret their decision to undergo SG 5 years after surgery. The secondary objective was to identify whether weight loss and a higher quality of life (QoL) score correlate with the regret expressed by patients., Setting: Military Hospital, Poland METHODS: A telephone survey was carried out among patients 5 years after surgery. Patient satisfaction regarding their decision to undergo SG was assessed using the Decision Regret Scale. QoL scores were determined using the 36-Item Short Form Survey (SF-36)., Results: One hundred and four patients who answered a full telephone survey were enrolled in the study. Change in body mass index (ΔBMI) was 12.31±6.2, excess body mass index loss (%EBMIL) was 55.45%±25.52%, and percent total weight loss (%TWL) was 25.20%±11.7%. At the 5-year postoperative telephone survey, the mean general health score was 50.96±14.0 and the mean regret score was 32.33±13.24 (range, 25-85). A statistically significant negative correlation was observed between %EBMIL and regret score (r=-0.435; p<0.001). There was a significant negative association between regret score and energy/fatigue QoL (r=-0.205; p=0.040). Only eight patients (7.69%) scored >50 on the Decision Regret Scale, which was considered to represent overall regret for their decision., Conclusion: Our study suggests that, in general, patients did not regret their decision to undergo SG., Key Points: The majority of patients did not regret their decision to undergo SG. There was a statistically significant negative correlation between weight loss and patients' feelings of regret. Energy/fatigue QoL was the strongest correlate of whether patients regretted their decision to undergo SG., (© 2021. The Author(s).)

Background: The exact impact of smoking within the last 12 months on the safety outcome of sleeve gastrectomy and Roux-Y gastric bypass is not well known. The study aimed to assess the effects of smoking on 30-day surgical outcomes., Methods: Preoperative characteristics and outcomes from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program dataset 2015-2018 were selected for all patients who underwent primary sleeve gastrectomy or Roux-Y gastric bypass. 30-day postoperative outcomes were assessed. We used propensity score matching to control for potential confounding., Results: In laparoscopic sleeve gastrectomy group, 29 165 pairs were included in the analysis. Smoking increased risk for inpatients readmission rate (3.67% vs. 3.10%; RR, 1.18; 95%CI 1.08-1.29, p < 0.001), intervention rate (1.03% vs. 0.84%; RR, 1.22; 95%CI 1.00-1.24, p = 0.020), reoperation rate (0.99% vs. 0.79%; RR, 1.25; 95%CI 1.05-1.48, p = 0.010), and leak rate (0.59% vs. 0.32%; RR, 1.83; 95%CI 1.43-2.37, p < 0.001). In laparoscopic Roux-Y gastric bypass cohort,11 895 pairs were included in the ultimate analysis. Smoking increased risk for inpatients readmission rate (7.54% vs. 5.88%; RR, 1.28; 95%CI 1.16-1.41, p < 0.001), intervention rate (3.53% vs. 2.30%; RR, 1.54; 95%CI 1.32-1.80, p < 001), reoperation rate (3.17% vs. 1.86%; RR, 1.70; 95%CI 1.45-2.00, p < 0.001), leak rate (1.05% vs. 0.59%; RR, 1.78; 95%CI 1.33-2.39, p < 0.001), bleed rate (2.03% vs. 1.45%; RR, 1.39; 95%CI 1.15-1.69, p < 0.001), and morbidity (4.20% vs. 3.38%; RR, 1.24; 95%CI 1.09-1.41, p = 0.001)., Conclusion: Smoking cigarettes at any point within the 12 months before admission for surgery increased the risk for surgical short-term complications in bariatric patients. The effect was the most significant regarding leaks.

Background: Information on the safety of outpatient sleeve gastrectomy is sparse., Objective: This study aimed to assess the safety of sleeve gastrectomy as a day case surgery., Setting: University health network, United States., Methods: Patients who underwent primary sleeve gastrectomy were identified in the 2015-2017 MBSAQIP database. Day case surgery procedure was defined as having a hospital length of stay of 0 days. Day case surgery patients were matched with inpatient controls using propensity score matching. The primary outcome was 30-day mortality., Results: A total of 271,658 sleeve gastrectomy patients met the inclusion criteria. Of these, only 7825 (2.88 %) were day case surgery procedures. There was no mortality in the group. Day case surgery, compared with inpatient sleeve gastrectomy, was associated with a similar risk of a leak (.56% versus .40%; relative risk [RR], 1.419; 95% CI, .896-2.245; P = .133), bleeding (.38% versus .31%; RR, 1.250; 95% CI, .731-2.138; P = .414), 30-day reoperation (.81% versus .56%; RR, 1.432; 95% CI, .975-2.104; P = .066), and 30-day morbidity (1.15% versus 1.01%; RR, 1.139; 95% CI, .842-1.541; P = .397). Outpatients' SG increased the risk for 30-day readmission (3.35% versus 2.79%; RR, 1.202; 95% CI, 1.009-1.432; P = .039)., Conclusions: Sleeve gastrectomy in the outpatient setting as a day case surgery was associated with no mortality and no statistically significant risk of reoperation, leakage, or bleeding compared with patients admitted to inpatient units. The readmission rate was higher in the day case surgery group., (Copyright © 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Hiatal hernia repair is an essential step to reduce the incidence of gastroesophageal acid reflux disease in patients undergoing sleeve gastrectomy. The safety of addition, a hiatal hernia repair to sleeve gastrectomy, is a critical question., Objectives: Our study aimed to assess the safety of concurrent hiatal hernia repair and sleeve gastrectomy based on Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data., Setting: University health network, United States., Methods: This study was a registry-based analysis. Preoperative characteristics and 30-day outcomes from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Participant Use Files 2015 to 2017 were selected for all patients who underwent sleeve gastrectomy with hiatal hernia repair. Propensity score matching (1:1) was used to control for potential confounding., Results: A total of 101,902 patients (50,951 patients matched pairs) were included in the study. The groups were closely matched as intended. Sleeve gastrectomy with hiatal hernia repair, compared with sleeve gastrectomy alone, was associated with similar risks of death (.02% versus .02%; relative risk [RR], 1.50; 95% confidence interval [CI], .61-3.67, P = .503), and higher risk of 30-day readmission (4.01% versus 2.96%; RR, 1.35; 95%CI, 1.27-1.45, P < .001), 30-day reoperation (1.10% versus .77%; RR, 1.42; 95% CI, 1.25-1.61, P < .001), 30-day intervention (1.24% versus .95%; RR, 1.31; 95%CI, 1.16-1.47, P < .001), and 30-day morbidity (1.85% versus 1.47%; RR, 1.25; 95%CI, 1.14-1.38, P < .001)., Conclusions: Sleeve gastrectomy with hiatal hernia repair is relatively safe in the short term with no increase in the risk of mortality. However, this additional procedure slightly increases the risk of readmission, reoperation, and postoperative intervention, as well as morbidity., Competing Interests: Disclosures The authors have no commercial associations that might be a conflict of interest in relation to this article., (Copyright © 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Introduction: The prevalence of obesity is increasing according to the World Health Organization. Furthermore, global aging is increasing, especially in developed countries in Europe. Whether bariatric surgery should be performed in elderly people is still controversial., Aim: To determine the clinical outcomes of sleeve gastrectomies (SG) in older central European patients. We compared the safety and efficacy of SG in patients older than 60 years with younger patients., Material and Methods: Eighty-nine patients older than 60 years, who underwent SG, were included in the study. Eighty-nine younger patients (aged 18-40 years) were matched according to body mass index (BMI) and comorbidities. The analyzed data included age, sex, total body weight, BMI, length of hospital stay, 30-day complications and improvement in comorbidities., Results: There was no significant difference in the complication rate between the 2 age groups (p = 0.59). An improvement in hypertension was observed in 73.1% of older patients and in 69.2% of younger patients (p = 0.67). There was improvement in diabetes mellitus in 40% of older patients and in 31.1% of younger patients (p = 0.25). The ΔBMI after 12, 24 and 36 months was significantly lower in older patients than in younger patients (p = 0.002, p = 0.001; p = 0.043, respectively). Percent excess BMI loss (%EBMIL) after 12, 24, and 60 months was significantly lower in older than in younger patients (p = 0.001, p = 0.001, p = 0.028, respectively)., Conclusions: Better weight loss is achieved in younger than in older patients, while maintaining a similar effect on the risk of complications and improvement in comorbidities. Therefore, SG is safe and effective in older people., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2019 Fundacja Videochirurgii.)

Purpose: Our goal was to present the experience of bariatric surgeons with medical tourism on a global scale., Materials and Methods: An online-based survey was sent to bariatric surgeons worldwide regarding surgeon's country of practice, number and types of bariatric procedures performed, number of tourists treated, their countries of origin, reasons for travel, follow-up, and complications., Results: Ninety-three responders performed 18,001 procedures in 2017. Sixty-four of those 93 responders operated on foreign patients performing a total of 3740 operations for them. The majority of the responders practice in India (n = 11, 17%), Mexico (n = 10, 16%), and Turkey (n = 6, 9%). Mexico dominated the number of bariatric surgeries for tourists with 2557 procedures performed in 2017. The most frequent procedures provided were laparoscopic sleeve gastrectomy (LSG) provided by 89.1% of the respondents, laparoscopic Roux-en-Y gastric bypass (40.6% of respondents), and one anastomosis gastric bypass (37.5% of respondents)., Conclusion: At least 2% of worldwide bariatric procedures are provided for medical tourists. Countries such as Mexico, Lebanon, and Romania dominate as providers for patients mainly from the USA, UK, and Germany. The lack of affordable bariatric healthcare and long waiting lists are some of the reasons for patients choosing bariatric tourism.

Introduction: Despite the clinical benefits of bariatric surgery, some patients have experienced disappointment with their weight loss. Setting realistic expectations is the key to success., Aim: To develop a specific prediction calculator to estimate the expected body mass index (BMI) at 1 year after laparoscopic sleeve gastrectomy (LSG)., Material and Methods: A retrospective analysis was performed to study 211 patients after primary LSG. Nine baseline variables were analyzed. Least angle regression (LARS) was employed for variable selection and to build the predictive model. External validation was performed on a dataset of 184 patients. To test the accuracy of the model, a Wilcoxon signed-rank test was performed between BMI estimates and the observed BMI. A linear logistic equation was used to construct the online predictive calculator., Results: The model included three variables - preoperative BMI (β = 0.023, p < 0.001), age (β = 0.005, p < 0.001), and female gender (β = 0.116, p = 0.001) - and demonstrated good discrimination (R 2 = 0.672; adjusted R 2 = 0.664) and good accuracy (root mean squared error of estimate, RMSE = 0.124). The difference between the observed BMI and the estimated BMI was not statistically significant (median = 0.737 (-2.676, 3.254); p = 0.223). External validation confirmed good performance of the model., Conclusions: The study revealed a useful predictive model for estimating BMI at 1 year after LSG. The model was used for development of the PREDICT BMI calculator. This tool allows one to set realistic expectations of weight loss at one year after LSG., Competing Interests: The authors declare no conflict of interest.

Introduction: Nowadays laparoscopic right hemicolectomy is widely accepted as the standard of care for benign and malignant colon disease. There are wide variations among laparoscopic techniques. One of the most discussed topics is the ileocolic anastomosis. There are two different techniques: intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA)., Aim: To compare short-term outcomes of performing intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy., Material and Methods: A retrospective chart review was performed of 92 consecutive patients who underwent laparoscopic right hemicolectomy, with either an IA or EA, from January 2013 to December 2016., Results: Eighty-five patients were included in the analysis. There were 53 males and 32 females with a mean age of 67.1 ±13.2 years. Mean body mass index (BMI) was 27.7 ±4.8 kg/m 2 . An intracorporeal anastomosis was performed in 51 patients, while an extracorporeal anastomosis was performed in 34. The duration of operations was significantly longer when intracorporeal anastomosis was performed, taking 154 ±58 min compared to 95 ±34 min (p < 0.001), in the extracorporeal group. No mortality was observed in the IA group. The postoperative mortality in the EA group was 8.8% (p = 0.060). The rate of reoperation in the intracorporeal anastomosis group was 7.8%, whereas in the extracorporeal anastomosis group it was 14.7% (p = 0.474). Length of hospital stay in the IA group was shorter in comparison to the EA group (5.3 ±3.7 vs. 11.2 ±19.8 days, p = 0.022)., Conclusions: Our results are encouraging to consider the intracorporeal approach as the better way to fashion the anastomosis after laparoscopic right hemicolectomy., Competing Interests: The authors declare no conflict of interest.

Introduction: The advancement of minimal invasive techniques pushed the age limit for patients qualified for bariatric surgery., Aim: The aim of the study was to evaluate the safety and effectiveness of laparoscopic sleeve gastrectomy (LSG) in a cohort of patients aged 60 years or more, compared with a group of matched controls below 40 years old., Methods: The medical records of 856 patients were analyzed. Patients aged 60 years or older were identified as cases. Those below 40 years were identified as the controls. Cases were closely matched (1:1) with the controls by body mass index (BMI) (± 1 kg/m 2 ) and presence or absence of hypertension and diabetes mellitus., Results: A 34 matched pairs were included in the study. There was no significant difference in the median operation length. No conversion from laparoscopic to open surgery was needed. The hospital length of stay was significantly longer in the study group (4.5 ± 1.9 vs 3.9 ± 1.5 days, p = 0.047). The complication, 30-day reoperation, and 30-day reoperation rates were comparable in both groups. There were no 30-day readmissions nor 30-day mortality. ΔBMI after 12 months was significantly lower in the study group (13.56 ± 6.05 vs 10.3 ± 4.89, p = 0.008) as well as %EBMIL (50.71 ± 25.94 vs 64.20 ± 23.29, p = 0.015)., Conclusions: The study suggests that LSG is a safe method of bariatric treatment in patients aged above 60 years. Even though weight loss may be lesser than in younger patients, it can still be considered satisfactory.

Objective: The aim of this study was to assess the safety of revisional surgery to laparoscopic sleeve gastrectomy (LSG) compared to laparoscopic Roux-Y gastric bypass (LRYGB) after failed laparoscopic adjustable gastric banding (LAGB)., Background: The number of reoperations after failed gastric banding rapidly increased in the United States during the last several years. A common approach is band removal with conversion to another weight loss procedure such as gastric bypass or sleeve gastrectomy in a single procedure. The safety profile of those procedures remains controversial., Methods: Preoperative characteristics and 30-day outcomes from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Participant Use Files 2015 were selected for all patients who underwent a 1-stage conversion of LAGB to LSG (conv-LSG) or LRYGB (conv-LRYGB). Conv-LSG cases were matched (1:1) with conv-LRYGB patients by age (±1 year), body mass index (±1 kg/m(2)), sex, and comorbidities including diabetes, hypertension, hyperlipidemia, venous stasis, and sleep apnea., Results: A total of 2708 patients (1354 matched pairs) were included in the study. The groups were closely matched as intended. The mean operative time in conv-LRYGB was significantly longer in comparison to conv-LSG patients (151 ± 58 vs 113 ± 45 minutes, P < 0.001). No mortality was observed in either group. Patients after conv-LRYGB had a clinically increased anastomotic leakage rate (2.07% vs 1.18%, P = 0.070) and significantly increased bleed rate (2.66% vs 0.44%, P < 0.001). Thirty-day readmission rate was significantly higher in conv-LRYGB patients (7.46% vs 3.69%, P < 0.001), as was 30-day reoperation rate (3.25% vs 1.26%, P < 0.001). The length of hospital stay was longer in conv-LRYGB., Conclusions: A single-stage conversion of failed LAGB leads to greater morbidity and higher complication rates when converted to LRYGB versus LSG in the first 30 days postoperatively. These differences are particularly notable with regards to bleed events, 30-day reoperation, 30-day readmission, operative time, and hospital stay.

Introduction: As the population ages, there is more interest in bariatric surgery for older patients. There are controversies regarding the safety and effectiveness of surgical weight loss in this population., Aim: The aim of this study was to compare the safety and efficacy of Roux-en-Y gastric bypass in patients over the age of 60 years with younger patients., Methods: The available literature was searched for eligible studies up to February 2018. Inclusion criteria were reports on mortality, morbidity, percentage excess weight loss (%EWL), remission of diabetes, remission of hypertension, and remission of obstructive sleep apnea. Random effects meta-analyses were performed., Results: The initial search yielded 2000 references. The final meta-analysis involved nine studies and revealed significant differences in mortality (odds ratio 4.38, 95% confidence interval [1.25, 15.31], p = 0.02), morbidity (OR 1.88, CI [1.07, 3.30], p = 0.03), %EWL (mean difference - 5.86, 95% CI [- 9.15, - 2.56], p < 0.001), and remission of comorbidities., Conclusion: Higher mortality and morbidity were found in the group of older patients. The analysis suggested lower effectiveness of Roux-en-Y gastric bypass for weight loss and improvement in comorbidity in older patients when compared with younger patients.

Introduction: As obesity has become a major health problem in Poland and bariatric procedures are the best way of treatment, an increasing trend has been observed in Polish bariatric surgery for the last decade., Aim: Our purpose was to provide an updated overview of the bariatric surgical procedures performed in Polish institutions in comparison to the situation in Europe as well as to analyze the trends in Polish bariatric surgery over the last decades., Material and Methods: A questionnaire about the number and type of bariatric procedures performed in 2016 was sent to all Polish surgical departments. Two hundred and sixty surgical departments returned the questionnaires., Results: Twenty-seven departments reported having performed bariatric operative or endoscopic procedures in 2016. The total number of procedures reported was 1958, the most popular being the laparoscopic sleeve gastrectomy (LSG). More than 99% of procedures were performed using laparoscopic techniques. The most common operations were: LSG (64.6%, n = 1032) and laparoscopic Roux-en-Y gastric bypass (LRYGB) (18.2%; n = 291), followed by one anastomosis gastric bypass (OAGB) (8.3%; n = 132) and laparoscopic adjustable gastric banding (LAGB) (7.3%; n = 117)., Conclusions: Registers of bariatric procedures provide information that helps in planning treatment and predicting possible complications. Adequate reporting of bariatric procedures is necessary to present the importance of the high incidence of obesity and the importance of its treatment. To collect reliable data, a national Polish bariatric surgery registry should be created.

Introduction: Obesity is a serious lifestyle disease with various comorbidities and an augmented risk of cancer. Laparoscopic sleeve gastrectomy (LSG) has recently become the most popular bariatric procedure worldwide. While the cost-effectiveness is a major healthcare providers' concern, the point of histological exam of each resected tissue may be questioned., Material/methods: We prospectively included patients who underwent LSG. Before the surgery, gastroscopy and abdominal sonography were performed to exclude malignancies. The gastric specimen was cut open after the surgery and inspected macroscopically, then sent for a microscopic examination., Results: In 5 cases out of 115, macroscopic evaluation of the resected specimen performed by the surgeon suggested existing pathology, confirmed by a microscopic evaluation in 3 out of 5 cases. In the remaining 2 cases, pathological analysis did not reveal abnormalities. In 110 cases, the gastric specimen was recognized to be unchanged by the surgeon, 109 out of which were confirmed by the pathologist to be normal, in 1 case a hyperplastic polyp was found. The sensitivity of macroscopic evaluation reached 75% (95% CI, 19.4-99.4%, p = 0.625), with specificity of 98.2% (95% CI, 93.6-99.8%, p < 0.0001), and negative predictive value of 99.1% (95% CI, 95-99.9%, p < 0.0001)., Conclusions: During LSG, a thorough visual inspection of the peritoneal cavity along with a macroscopic surgical evaluation of specimen in patients who had preoperative endoscopy with no findings allows to achieve very good specificity and good sensitivity. Therefore, this procedure may be useful as a screening test for incidental pathologies in bariatric patients and may exclude unnecessary histological examination.

Objective: The aim was to compare clinical outcomes of patients treated with totally robotic Roux-en-Y gastric bypass (TRRYGB) with those treated with the different laparoscopic Roux-en-Y gastric bypass (LRYGB) techniques. The clinical benefit of the robotic approach to bariatric surgery compared to the standard laparoscopic approach is unclear. There are no studies directly comparing outcomes of TRRYGB with different LRYGB techniques., Methods: Outcomes of 578 obese patients who underwent RYGB between 2011 and 2014 at an academic center were assessed. Multivariable analysis and propensity matching were used for comparing TRRYGB to different LRYGB techniques, including 21-mm EEA circular-stapled gastrojejunal anastomosis (GJA, LRYGB-21CS), linear-stapled GJA (LRYGB-LS), and hand-sewn GJA (LRYGB-HS)., Results: The TRRYGB technique required a longer mean operative time compared to the other groups, respectively 204 ± 46 vs. 139 ± 30 min (LRYGB-21CS), 206 ± 37 vs. 158 ± 30 min (LRYGB-LS), and 210 ± 36 vs. 167 ± 30 min (LRYGB-HS). TRRYGB experienced a lower stricture rate (2 vs. 17%, P = 0.003), shorter hospital stay (2.6 ± 1.2 vs. 4.3 ± 5.5 days, P = 0.008), and lower readmission rate (12 vs. 28%, P = 0.009). No significant differences in outcomes were observed when comparing RRYGB to LRYGB-LS or LRYGB-HS., Conclusions: TRRYGB increases operative time compared to all LRYGB techniques. TRRYGB was superior to LRYGB-21CS in terms of significantly shorter hospital stay, lower readmission rate, and less frequent GJA stricture formation. TRRYGB provides no clinical advantages over the LRYGB-LS and LRYGB-HS techniques.

Background: The HospitAl stay, Readmission, and Mortality rates (HARM) score is a quality indicator that is easily determined from routine administrative data. However, the HARM score has not yet been applied to patients undergoing bariatric surgery., Objective: The aims of the present study were to adjust the HARM score to the bariatric population and to validate the ability of the modified HARM score to serve as an inexpensive tool to measure the quality of bariatric surgery., Methods: A MBSAQIP 2015 PUF database was reviewed. For each discharge, a 1 to 10 score was calculated on the basis of length of stay (LOS), discharge status, and 30-day readmissions. We adjusted the LOS categories to the distribution of LOS in the MBSQIP database. The new LOS categories were used to calculate the modified HARM score, referred to as the BARiatric HARM (BAR-HARM) score. The association between HARM and BAR-HARM scores and complication rate was assessed., Results: A total of 197,141 cases were evaluated: 98.8% were elective and 1.2% were emergent admissions. The mean individual patient BAR-HARM score was 1.75 ± 1.04 for elective cases, and 2.02 ± 1.45 for emergency cases. The complication rates for the respective BAR-HARM categories ≤ 2, > 2 to 3, > 3 to 4, and > 4 were 3.95, 27.53, 40.14, and 79.97% (p < 0.001)., Conclusions: The quality of bariatric surgery can be reliably and validly assessed using the BAR-HARM score, which is a modification of the HARM score.

Background: An increase in the prevalence of obesity and longer life expectancy has resulted in an increased number of candidates over the age of 60 who are pursuing a bariatric procedure., Objective: The aim of this study was to assess the safety of laparoscopic Roux-Y gastric bypass (LRYGB) compared to laparoscopic sleeve gastrectomy (LSG) in patients aged 60 years or older., Setting: University Hospital, United States METHODS: Preoperative characteristics and 30-day outcomes from the MBSAQIP 2015 were selected for all patients aged 60 years or older who underwent a LSG or LRYGB. LRYGB cases were closely matched (1:1) with LSG patients by age (±1 year), BMI (±1 kg/m2), gender, preoperative steroid or immunosuppressant use, preoperative functional health status and comorbidities including: diabetes, gastroesophageal reflux disease, hypertension, hyperlipidemia, venous stasis, sleep apnea and history of severe chronic obstructive pulmonary disease., Results: A 3371 matched pairs were included in the study. The mean operative time in LRYGB was significantly longer in comparison to LSG patients (122 vs 84 min., P<0.001). Patients after LRYGB had a significantly increased anastomotic leakage rate (1.01% vs 0.47 %, p = 0.011), 30-day readmission rate (6.08% vs 3.74%, p < 0.001) and 30-day reoperation rate (2.49% vs 0.89%, p < 0.001) The length of hospital stay was longer in LRYGB. Mortality and bleed rate was comparable., Conclusions: LRYGB and LSG in patients aged 60 years or older are relatively safe in the short term with an acceptable complication rate and low mortality. However, LRYGB is more challenging and is associated with significantly increased rates of leakage events, 30-day reoperation, 30-day readmission, longer operative time and longer hospital stay., (Copyright © 2018 American Society for Bariatric Surgery. All rights reserved.)

Background: Smoking cessation is often associated with weight gain. This study was conducted to verify whether it affects outcomes of bariatric surgery., Objectives: To present cigarette consumption among patients after bariatric surgery in a long-term follow-up and to evaluate whether smoking cessation impacts weight loss., Setting: High-volume bariatric center, Military Hospital, Poland., Methods: We collected data of patients who underwent bariatric surgery between 2003 and 2009. The data included sex, age, weight, body mass index, and smoking habits. An online survey regarding current weight, co-morbidities, and smoking was distributed. Percentage excess weight loss was calculated with an ideal weight for body mass index of 25 kg/m 2 ., Results: One hundred seven patients had laparoscopic adjustable gastric banding between 2003 and 2006; 47 were included in the study. The mean follow-up time was 11.2 (±1.2). Of patients, 51% (n = 24) were smokers before surgery. In the follow-up 43% (n = 20) were smokers, of whom 4 patients began smoking after surgery. Twenty-seven patients were nonsmokers, 8 of whom quit over the years (33% of previous smokers). One hundred twenty-seven underwent laparoscopic sleeve gastrectomy between 2006 and 2009; 84 were included in the study. Our median follow-up was 8.0 years. Thirty-two patients never smoked; 52 were smoking before surgery, yet 24 successfully quit. In both groups there were no statistically significant differences in percentage excess weight loss between smokers and nonsmokers, or between those who quit and did not., Conclusions: In the long-term follow-up after laparoscopic adjustable gastric banding, 33% of smokers quit and 17% previously nonsmoking began smoking. After laparoscopic sleeve gastrectomy, 46% of previously smoking patients successfully quit. Smoking status was not significantly associated with weight loss., (Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Introduction: The prevalence of obesity in Poland and worldwide is constantly rising. High effectiveness of bariatric surgery has been proven in literature. It is recommended that bariatric procedures should be done by highly qualified surgeons with the appropriate, up-to-date medical equipment., Aim: The purpose of the study is to establish Polish recommendations and standards for the use of medical equipment for bariatric surgery centers., Materials and Methods: The review of the present recommendations of the worldwide organizations and societies (including EAES, IFSO, SAGES) and guidelines was made. On the basis of current literature and authors&apos;s clinical experience we proposed standardized protocol for bariatric surgical equipment., Conclusions: Relevant equipping of bariatric surgery centers and implementation of standardized perioperative and surgery protocols will result in significant improvements in bariatric treatment. This will ensure patients safety, a shorter length of hospital stay and considerably reduce the risk of morbidity. Moreover, it will contribute to the efficacy of the bariatric and metabolic surgery procedures, in accordance with the highest globally accepted standards.

Introduction: Sleeve gastrectomy (SG) is one of the most common procedures performed for weight loss. Many seek the "perfect sleeve" with the notion that the type of calibrating device affects sleeve shape, and this in turn will affect outcomes and complications. Two major concerns after SG are amount of weight loss and acid reflux. Our aim was to determine if the various calibration methods could impact sleeve shape and thereby allow for better outcomes of weight loss and reflux., Methods: A retrospective chart review was performed of 210 patients who underwent SG and had postoperative upper gastrointestinal (UGI) study from 2011 to 2015 in a single center by a single (fellowship-trained) bariatric surgeon. Data regarding demographics, calibrating devices and clinical outcomes at 1 year (weight loss and de novo acid reflux) were collected. UGIs were reviewed by two radiologists blinded to the clinical outcomes. Sleeve shape was classified according to a previously described classification as tubular, dumbbell, upper pouch, or lower pouch. The types of calibrating devices used to guide the sleeve size intraoperatively were endoscopy, large-bore orogastric tube, and fenestrated suction tube., Results: One hundred ninety-nine patients met inclusion criteria (11 had no esophagram). Demographics revealed age 45.76 ± 10.6 years, BMI 47 ± 8.6 kg/m 2 , and 82% female. Calibration devices used were endoscopic guidance (7.6%), large bore orogastric tube (41.4%), and fenestrated suction tube (50.5%). Sleeve shape was reported as 32.6% tubular, 20.6% dumbbell, 39.2% lower pouch, and 7.5% upper pouch (100% interrater reliability). No correlation was seen with type of calibration used. Of patients, 62.0% had > 50% excess weight loss at 1 year. Twenty-three percent of patients remained on PPI at 1 year (of which 43.3% did not have reflux preoperatively). The lower pouch shape showed a trend toward less reflux and more weight loss., Conclusion: This study showed no clear association between uniformity of sleeve shape and the type of calibration device used. The study showed a trend toward decreased reflux and improved weight loss with the lower pouch shape, regardless of calibration device.

Introduction: Gallbladder specimens are routinely sent for histopathological examination after cholecystectomy in order to rule out the presence of unexpected pathological findings., Aim: To establish the overall incidence of unexpected pathological findings in patients who underwent laparoscopic cholecystectomy for symptomatic gallbladder disease and determine whether the macroscopic appearance of the gallbladder in ultrasound examination could be a valid method for identifying patients with gallbladder malignancy., Material and Methods: A retrospective study was conducted between 2013 and 2015. All histological reports (n = 1131) after cholecystectomy were searched for unexpected pathological findings. In cases where unexpected pathological findings were identified the additional analysis of preoperative abdominal ultrasound examination (USG) was done to determine the usefulness of USG in diagnosis of gallbladder malignancy., Results: Of the 1131 patients included in the study, 356 (31.47%) were male and 774 (68.43%) were female. Unexpected pathological findings were present in 21 cases. The overall incidence of unexpected pathological findings was 1.86%. Only in 5 patients were suspicious appearances of gallbladder observed in preoperative ultrasound examination. In 16 patients there was no suspicion of malignancy. The positive predictive value of USG was 0.238., Conclusions: The incidence of unexpected pathological findings after laparoscopic cholecystectomy was 1.86%. Ultrasonography has low positive predictive value for identifying patients with malignant findings in a gallbladder specimen.

Introduction: Age is considered as a risk factor in bariatric surgery. The observation was made on the basis of results from studies where patients underwent different type of surgery, but laparoscopic sleeve gastrectomy (LSG) was not among them. It is necessary to reevaluate the association of age with adverse events in the group of patients after LSG., Aim: To investigate the association of age with surgery-related adverse events in patients after LSG., Material and Methods: Retrospective analysis of medical data was performed. The study involved 345 patients who underwent LSG in our institution between January 2013 and December 2014. The patients were subdivided by age into four groups according to quartiles. In 30-day follow-up adverse events were evaluated. We considered the presence of the following events as the endpoint of our study: death, medical events and surgical events., Results: In general, we observed adverse events in 36 (10.4%) patients. The mortality rate in our study was 0.59%. Nineteen events were surgical and 18 medical. In 1 patient a surgical event was associated with a medical event. Bleeding was the most common surgical event and was observed in 17 (4.9%) cases. Age was not associated with surgical events (OR = 1.032, 95% CI: 0.991-1.075, p = 0.33) or medical events (OR = 0.997, 95% CI: 0.956-1.039, p = 0.89)., Conclusions: The LSG is a safe bariatric procedure with low mortality. Bleeding is the most frequent surgical complication. Our findings suggest that age is not associated with increased risk of surgical or medical adverse events after LSG.

Introduction: Sleeve gastrectomy (LSG) is one of the most popular bariatric procedures. We present our long-term results regarding weight loss, comorbidities, and gastric reflux disease., Material and Methods: We identified patients who underwent LSG in our institution between 2006 and 2009. We revised the data, and the patients with outdated contact details were tracked with the national health insurance database and social media (facebook). Each of the identified patients was asked to complete an online or telephone survey covering, among others, their weight and comorbidities. On that basis, we calculated the percent total weight loss (%TWL) and percent excess weight loss (%EWL), along with changes in body mass index (ΔBMI). Satisfactory weight loss was set at >50% EWL (for BMI = 25 kg/m 2 ). We evaluated type 2 diabetes (T2DM) and arterial hypertension (AHT) based on the pharmacological therapy. GERD presence was evaluated by the typical symptoms and/or proton pump inhibitor (PPI) therapy., Results: One hundred twenty-seven patients underwent LSG between 2006 and 2009. One hundred twenty patients were qualified for this study. Follow-up data was available for 100 participants (47 female, 53 male). Median follow-up period reached 8.0 years (from 7.1 to 10.7). Median BMI upon qualification for LSG was 51.6 kg/m 2 . Sixteen percent of patients required revisional surgery over the years (RS group), mainly because of insufficient weight loss (14 Roux-Y gastric bypass-LRYGB; one mini gastric bypass, one gastric banding). For the LSG (LSG group n = 84), the mean %EWL was 51.1% (±22.3), median %TWL was 23.5% (IQR 17.7-33.3%), and median ΔBMI was 12.1 kg/m 2 (IQR 8.2-17.2). Fifty percent (n = 42) of patients achieved the satisfactory %EWL of 50%. For RS group, the mean %EWL was 57.8% (±18.2%) and median %TWL reached 33% (IQR 27.7-37.9%). Sixty-two percent (n = 10) achieved the satisfactory weight loss. Fifty-nine percent of patients reported improvement in AHT therapy, 58% in T2DM. After LSG, 60% (n = 60) of patients reported recurring GERD symptoms and 44% were treated with proton pomp inhibitors (PPI). In 93% of these cases, GERD has developed de novo., Conclusions: Isolated LSG provides fairly good effects in a long-term follow-up with mean %EWL at 51.1%. Sixteen percent of patients require additional surgery due to insufficient weight loss. More than half of the subjects observe improvement in AHT and T2DM. Over half of the patients complain of GERD symptoms, which in most of the cases is a de novo complaint.

Introduction: Gastrointestinal stromal tumors (GISTs), originating from Cajal cells, are most commonly located in the stomach; therefore they can be found in the specimens excised during bariatric operations. The global prevalence of GISTs is about 130 cases per million population. Morbidity differs depending on geographical latitude. Although surgery is the treatment of choice for GISTs, 40-50% of patients after radical surgical treatment will have a relapse or metastases., Aim: To analyze the incidence of GISTs in patients undergoing bariatric surgery and to verify whether an operation performed according to the bariatric protocol is oncologically radical in case of GIST., Material and Methods: A single-center retrospective study. The study group comprised 1252 obese patients qualified for bariatric procedures, with no upper gastrointestinal tract neoplasms found during preoperative diagnostic examinations. In case of suspicious macroscopic pathologies (n = 81) present during the operation, tissue specimens underwent histopathological examination with further investigation performed if GISTs were found, including tumor size and localization, mitotic index and immunohistochemical analysis., Results: Gastrointestinal stromal tumors were found in 16 cases, and benign tumors of various histological origin in 33 cases. All cases of GIST found came from stomach specimens, 7 from the gastric corpus vs. 9 from the fundus. Fourteen GISTs were found during laparoscopic sleeve gastrectomies (LSGs) vs. 2 during laparoscopic Roux-en-Y gastric bypasses (LRYGBs)., Conclusions: In case of incidental findings of GISTs during bariatric surgery, tumor resection with negative margins of incision may be considered as complete oncological treatment if there was very low/low risk stratification of GIST's recurrence after surgery.

Introduction: Laparoscopic sleeve gastrectomy is associated with a moderate risk of hemorrhagic complications (HC). There is a debate regarding the relationship between HC and high blood pressure in postoperative period., Aim: The aim is to clarify whether the postoperative blood pressure is an independent risk factor for hemorrhagic complications after laparoscopic sleeve gastrectomy., Methods: Medical records of 522 patients were reviewed. A case-control study of postoperative blood pressure was undertaken in patients with bleeding after LSG and matched controls. Patients who required surgical revision, due to the hemorrhagic complications within 72 hours, were identified as the cases. Controls were matched (1:1) with cases by age (±1 year), gender (female versus male), staple line reinforcement (running suture versus haemostatic clips) and surgeon's experience (>50 or <50 LSG procedures per year). 12-hour postoperative blood pressure was recorded., Results: 17 patients after LSG with HC in postoperative period were matched with 17 controls. Patients who experienced hemorrhagic complications after LSG had non statistically significant decreased mean systolic blood pressure (mmHg) in 12 hours observation (130.7 ± 12.9 versus 139.1 ± 10.8); p = 0.15; mean difference - 11.6 (95% CI -29.5 - 6.1). Mean 12 hour diastolic pressure was also comparable. The detailed analysis of controls revealed a significantly higher systolic blood pressure measurements in 5th and 11th hour postoperatively, as well as higher diastolic blood pressure in 12th hour postoperatively. However, the differences were not clinically significant., Conclusion: Compared with closely matched control subjects, patients with HC after LSG have decreased systolic blood pressure without clinical significance.

Introduction: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a common, well-established procedure, but no consensus regarding selection of the gastrojejunostomy (GJ) technique has been reached, and standardization of this precise technique is far from being achieved., Aim: To compare circular-stapled and linear-stapled GJ in LRYGB in terms of operative time and postoperative complications., Material and Methods: This retrospective case-control study compared the perioperative and postoperative outcomes of LRYGB with a circular-stapled (LRYGB-CS) versus linear-stapled (LRYGB-LS) gastrojejunostomy. All patients, operated on in two academic referral care centers for bariatric surgery, were enrolled from April 2013 to June 2016. 457 patients were included (255 and 202 respectively in the LRYGB-CS and LRYGB-LS groups). After matching the groups for age, sex, body mass index, arterial hypertension, and presence of type 2 diabetes in a 1 : 1 ratio, 99 patients were enrolled in each., Results: The total operative time was longer in the LRYGB-LS group (140 vs. 85 min, p < 0.001). The postoperative hemorrhage and wound infection rates were lower in the LRYGB-LS group (2.1% vs. 10.3%, p = 0.021, and 1.0% vs. 9.3%, p = 0.011). The readmission rates were comparable (8.2% vs. 6.1%, p = 0.593). There was no significant difference in the incidence of gastrojejunostomy leakage, stricture, port-site hernia, or marginal ulcer., Conclusions: Both anastomosis types for LRYGB are safe and have low and comparable risks of postoperative complications. After LRYGB-CS, postoperative bleeding and wound infections are slightly more frequent; however, the operative time is shorter.

Introduction: Obesity is one of the major lifestyle diseases and provokes various comorbidities, such as hypertension, type 2 diabetes mellitus, obstructive sleep apnea, and even neoplasms. Bariatric surgery is the most effective treatment of obesity. Since cost-effectiveness has become a major concern, there is a tendency to avoid general histological evaluation of surgical specimens during routine procedures., Aim: To evaluate the necessity of histopathological investigation of tissue excised during bariatric surgery and to verify whether the operation should be continued in the case of suspicious macroscopic findings., Material and Methods: From January 2013 to December 2016, 1252 patients with obesity were qualified for bariatric procedures. The qualification was performed according to the current European recommendations. Every operation started with an inspection of the peritoneal cavity performed once the abdomen was insufflated. If a macroscopic pathology was found, the specimen was secured for histopathological investigation., Results: Out of 81 (6.47%) patients from whom histopathological samples were collected, 39% (n = 32) showed negative results, and 61% (n = 49) cases showed abnormalities., Conclusions: As it is impossible to exclude the existence of gastric tumors only in preoperative gastroscopy and ultrasonography, especially as there is a higher risk in obese patients, routine histological examination of tissue excised during bariatric procedures should be considered. Since most of the neoplasms were found to be benign, there is no need to abandon the bariatric procedure if a pathology is found and resected. Bariatric surgeons should always focus on thorough examination of the abdominal and the pelvic cavity, especially in female patients.

Introduction: Laparoscopic sleeve gastrectomy (LSG) is one of the most frequently performed bariatric procedures. Hemorrhagic complications (HC) after surgery are common and require surgical revision. Accurate estimation of the risk of postoperative HC can improve surgical decision-making process and minimize the risk of reoperation. The aim of the present study was to develop a predictive model for HC after LSG., Material and Methods: The retrospective analysis of 522 patients after primary LSG was performed. Patients underwent surgery from January 2013 to February 2015. The primary outcome was defined as a surgical revision due to hemorrhagic complications. Multiple regression analysis was performed., Results: The rate of hemorrhagic complications was 4 %. The mean age of patients was 41.0 (±11.6) years and mean BMI was 47.3 (±7.3) kg/m 2 . Of the 12 examined variables, four were associated with risk of HC. Protective factors for HC were no history of obstructive sleep apnea (odds ratio [OR] 0.22; 95 % CI 0.05-0.94) and no history of hypertension (OR 0.38; 95 % CI 0.14-1.05). The low level of expertise in bariatric surgery (OR 2.85; 95 % CI 1.08-7.53) and no staple line reinforcement (OR 3.34; 95 % CI 1.21-9.21) were associated with higher risk of HC., Conclusions: The result revealed the association between hemorrhagic complications and the following factors: obstructive sleep apnea, hypertension, level of expertise in bariatric surgery, and reinforcement of the staple line. The risk assessment model for hemorrhagic complications after LSG can contribute to surgical decision-making process.

Purpose: The aims of our study were to compare quality of life (QOL) in obese patients after bariatric surgery with that in controls seeking surgery and to investigate which factors are associated with QOL in the Moorehead-Ardelt Quality of Life Questionnaire II (MA II)., Materials and Methods: This was a cross-sectional study. The operated group consisted of patients after laparoscopic sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass. The MA II was administered by e-mail to 305 patients 12-18 months after surgery. The control groups consisted of 101 obese patients. We compared the QOL scores and considered good and very good outcomes to be satisfactory. Multiple logistic regression and correlation analysis was performed to identify factors associated with QOL., Results: In the operated group, the total MA II score was 1.70 ± 0.76, which was higher than 0.59 ± 1.17 in the control group. The score adjusted for the type of surgery was comparable. The prevalence of satisfactory QOL outcomes was similar in both post-operative subgroups and was still higher than in the control group. We identified four factors associated with higher QOL in obese patients. Weight loss was not correlated with total score in MAII., Conclusions: This study demonstrates that patients after bariatric surgery have a higher score in MA II, which reflects better QOL. The scoring adjusted by type of operation is comparable. QOL among obese patients is dependent on age, gender, history of bariatric surgery, and partnered status. Body mass reduction was not associated with outcome in MAII., Competing Interests: The authors declare that they have no conflict of interest. Ethical Statement All procedures involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed Consent Informed consent was obtained from all individual participants included in the study.

Introduction: Obesity is associated with numerous comorbidities and affects various aspects of life, including sexual functioning. Bariatric surgery is an effective treatment for obese people. Male sexual function after bariatric surgery is not well known., Aim: To compare male sexual function and sexual quality of life after surgical weight loss with controls seeking bariatric surgery., Material and Methods: International Index of Erectile Function and Sexual Quality of Life-Male (SQoL-M) questionnaires were administered by e-mail to 152 men who had undergone weight-loss surgery. The control group consisted of 44 obese men who completed the questionnaires during their preoperative evaluation., Results: Fifty-six percent of men in the control group and 20% of men in the postoperative group reported erectile dysfunction (ED) (OR = 5.1; 95% CI: 1.6-16.0, p = 0.005). The median (Q1, Q3) total International Index of Erectile Function (IIEF) score did not show a significant difference between the control (62.0 (37.5, 66.5)) and postoperative groups (67.0 (57.0, 70.0)). However, median scores in domains of erectile function (EF), sexual desire (SD), and overall satisfaction (OS) were significantly higher in the postoperative group. The median SQoL-M was significantly higher (81.8 (51.5, 89.4) vs. 88.6 (84.8, 90.9); p < 0.05) in the postoperative group., Conclusions: A lower prevalence of erectile dysfunction and better sexual quality of life were observed in the patients after surgical weight loss. The improvement in male sexual function may be considered as an advantage of bariatric surgery., Competing Interests: The authors declare no conflict of interest.

Introduction: The first survey of bariatric surgery in Poland was published in 2007. New trends are observed worldwide, and there is a current need to investigate the status of bariatric surgery in Polish institutions. This survey was initiated to gain an overview of Polish bariatric surgery during 2007-2014., Aim: To analyze the number and types of bariatric procedures performed in Polish institutions in 2014 and to perform a trend analysis from 2007 to 2014., Material and Methods: A questionnaire regarding the numbers and types of bariatric procedures performed between 2007 and 2014 was e-mailed to all members of the Bariatric Society (a branch of the Association of Polish Surgeons) and to 28 surgical departments. Trend analyses from 2007 to 2014 were performed., Results: Among the surgical departments, 16 (57%) responded. The results showed that 1499 bariatric procedures were performed in Poland in 2014, with 96.4% done laparoscopically. The highest number was from Masovian Voivodeship. The most commonly reported procedures were laparoscopic sleeve gastrectomy (LSG) (60.7%), followed by laparoscopic Roux-en-Y gastric bypass (19.2%), mini gastric bypass (11.1%), and adjustable gastric banding (7.6%). Most significant was the rise in prevalence of LSG from 8.0% to 60.4% of the total bariatric procedures from 2007 to 2014., Conclusions: Laparoscopic sleeve gastrectomy is currently the most frequently performed bariatric procedure in Poland. The accuracy of the national survey of procedures would be enhanced if we could create a national registry.

Introduction: Laparoscopic sleeve gastrectomy (LSG) is one of the most popular bariatric procedures. The procedure is associated with serious staple-line complications such as bleeding, leaks, and stenosis., Aim: To determine whether oversewing the staple line, compared with clipping, in LSG reduces the incidence of postoperative bleeding., Material and Methods: We conducted a parallel-group, prospective, randomized controlled trial (RCT) of 100 patients who underwent LSG for obesity at a single institution between May 2014 and August 2015. Patients were assigned to one of two groups for reinforcement of the staple line: the oversewing group (staple line oversewn) or the clipping group (staple line clipped). The primary outcome was reoperation for hemodynamic instability caused by staple-line bleeding within 72 h postoperatively. The secondary outcomes were operative duration, length of hospital stay, postoperative leaks, and postoperative stenosis., Results: Mean operative duration was longer in the oversewing group (78.2 ±20.5 min) than in the clipping group (64.1 ±16.5 min, p < 0.001). Mean length of hospital stay was comparable in both groups. Postoperatively, there was no significant between-group difference in bleeding (oversewing, n = 0 vs. clipping, n = 2 (4.6%); p = 0.21) or in stenosis and leakage (both outcomes: oversewing, n = 0, vs. clipping, n = 1 (2.3%); p = 0.46)., Conclusions: Oversewing the staple line prolongs operative duration. No conclusions can be drawn regarding the effects of oversewing on staple-line bleeding, postoperative leakage and stenosis, or length of hospital stay., Competing Interests: The authors declare no conflict of interest.

Background: The aims of the present study were to compare sexual quality of life and prevalence of female sexual dysfunction (FSD) after surgical weight loss with controls seeking bariatric surgery, and to perform a literature review., Methods: Female Sexual Function Index (FSFI) and Sexual Quality of Life-Female (SQoL-F) questionnaires were sent within 12-18 months postoperatively via e-mail to 153 women who had undergone weight loss surgery (postoperative group). The control group comprised of 23 women who were asked to complete the questionnaires during their preoperative evaluation (preoperative group). The total FSFI cutoff score for a diagnosis of FSD was ≤ 26.55., Results: The median (Q1, Q3) FSFI score did not differ significantly between the preoperative (26.9 [24.3, 30.7]) and postoperative groups (26.9 [22.6, 30.0]). There was no difference in the prevalence of FSD between groups. However, median scores in FSFI domains of desire and arousal were significantly higher in the postoperative group. There were no differences in the other FSFI domains. The median SQoL-F was significantly higher in the postoperative group., Conclusions: The FSFI score did not predict the SQoL-F score. The prevalence of FSD was comparable in the two groups. The higher SQoL-F score in the postoperative group may be the result of an improvement in self-esteem, which in turn leads to greater interest in sex and more intense feelings of desire and arousal.

Introduction: The most popular scale to stratify the postoperative risk is the Obesity Surgery Mortality Risk Score (OS-MRS). The design and ease of interpretation make the scale a potential tool for clinical use., Aim: To evaluate the usefulness of the OS-MRS scale in the enrollment of patients for laparoscopic bariatric procedures, including laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB)., Material and Methods: The medical records of patients who underwent LSG or LRYGB due to obesity between January 2010 and December 2010 were reviewed retrospectively. The decision of choosing the surgical procedure was made on the basis of OS-MRS risk category. The primary endpoint of this study was the 90-day mortality, and the secondary endpoint was the presence of major complications., Results: There were 107 patients including 66 women and 41 men. The OS-MRS classes were A (48%), B (47%) and C (5%). The LSG was applied to patients with higher body mass index and to patients of class C. The secondary endpoints occurred in 6 patients, distributed in 10% of class A, 2% of class B and 0% of class C patients (p < 0.05). In 5 of 6 cases the endpoint was observed after LRYGB. Fatal cases were not observed., Conclusions: The OS-MRS can be a useful clinical tool for choosing the appropriate laparoscopic bariatric procedure, depending on the risk of postoperative complications. Low risk of postoperative complications should not lower the watchfulness of the surgeon.