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Early postoperative bleeding is a common complication after laparoscopic Roux-en-Y gastric bypass (LRYGB) and is associated with significant morbidity. We aimed to identify predictors of early postoperative bleeding after LRYGB and characterize hemorrhagic events and 30-day postoperative outcomes.We conducted a retrospective cohort study regarding all patients submitted to LRYGB in 2019 at a high-volume obesity center. Early postoperative bleeding was defined as any clinically significant evidence of hemorrhage in the early postoperative period. Demographic, preoperative, and intraoperative factors were evaluated for associations with postoperative bleeding. Postoperative outcomes were compared between patients with and without hemorrhage.Of 340 patients submitted to LRYGB, 14 (4.1%) had early postoperative bleeding. Patients with bleeding had an increased preoperative left hepatic lobe diameter (8.4 vs. 7.3 cm, p = 0.048). Prior cholecystectomy (28.6 vs. 14.5%) and previous bariatric surgery (35.7 vs. 23.9%) tended to be more prevalent among these patients. Bleeding occurred at a median time of 31.2 [IQR 19.7-38.5] h. Thirteen patients presented with intraluminal bleeding and one with extraluminal bleeding. Melena was the most common symptom. All hemorrhages were clinically diagnosed, and 92.9% were managed conservatively. Postoperative bleeding was associated with longer hospital stay (3.5 vs. 2.0 days), higher reintervention (7.1 vs. 0%), and readmission (14.3 vs. 0%), all p 0.05.Bleeding was the most frequent early complication after LRYGB. Patients with hepatomegaly and prior surgeries may have technically challenging LRYGB and should be carefully assessed. Perioperative strategies should be encouraged in high-risk patients to prevent bleeding.

Background The management of locally advanced rectal cancer (LARC) requires a multidisciplinary approach, with an increasing interest for non-operative strategies. Liquid biopsy for obtaining circulating tumor DNA (ctDNA) can provide information on neoadjuvant chemoradiotherapy (nCRT) pathological response and cancer-specific prognosis, and therefore might be a promising guide for these treatments. Methods A systematic review of the studies available in literature has been performed to assess the role of ctDNA as a predictive and prognostic biomarker in LARC patients. Results We retrieved 21 publications, of which 17 full-text articles and 4 abstracts. Results have been labelled into two groups: predictive and prognostic. Data about the usefulness of liquid biopsy in this setting is still inconclusive. However, baseline higher levels of longer fragments of cell-free DNA and integrity index, tumor-specific mutations and certain methylated genes could predict non-responders. Also, undetectable baseline ctDNA and decrease of common rectal cancer mutations throughout treatment (dynamic monitoring) were predictive factors of pathological complete response. The continuous detection of ctDNA in different timepoints of treatment (minimal residual disease) was consistently associated with worse prognosis. Conclusions ctDNA is a promising biomarker that could assist predicting treatment response to nCRT and prognosis in patients with LARC. The ideal methods and timings for the liquid biopsy still have to be defined.

Aims: To investigate the value of previously described pretreatment hematological and biochemical biomarkers as predictors of pathological response. Methods: The authors performed a retrospective analysis of 191 patients with locally advanced rectal cancer who underwent long-course neoadjuvant chemoradiotherapy at two Portuguese centers. The authors performed logistic regression analysis to search for predictive markers of pathological complete and good response. Results: High platelet–neutrophil index (p = 0.042) and clinical tumor stage >2 (p = 0.015) were predictive of poor response. None of the analyzed biomarkers predicted pathological complete response in this study. Conclusion: A high platelet–neutrophil index before neoadjuvant chemoradiotherapy could help predict poorer pathological response in patients with locally advanced rectal cancer. However, no other blood biomarker predicted incomplete or poor response in this study.

Purpose In patients with type 2 diabetes mellitus (T2DM), bariatric surgery appears to be more effective than medical treatment (MT) at improving glycaemic control and decreasing cardiovascular risk. However, long-term effectiveness has not been systematically assessed using randomised controlled trials. In this study, we aimed to systematically assess randomised controlled trials, with at least 5 years of follow-up, on bariatric surgery in patients with T2DM and BMI ≥ 25 kg/m2, as well as to compare different bariatric procedures. Material and methods PubMed, SCOPUS and Web of Science were searched. We performed a network meta-analysis to evaluate the comparative effectiveness of the different procedures and MT in terms of full T2DM remission, weight loss, complications and cardiometabolic biomarkers. The quality of evidence was assessed using the Cochrane Risk of Bias Tool and CINeMA. Results We included 11 primary studies. Laparoscopic one-anastomosis gastric bypass (LOAGB) was found to be one of the most effective treatments for full remission of T2DM (I2 = 0, inconsistency p value = 0.9223). Biliopancreatic diversion without duodenal switch was found to be more effective than laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding regarding percent total cholesterol and low-density lipoprotein change. Regarding percent high-density lipoprotein and weight change, all analysed surgical treatments were shown to be more effective than MT. The confidence rating in our results was overall moderate, but most studies had high risk of performance and detection bias. Conclusion Bariatric surgery seems to be effective for T2DM remission. LOAGB appears to be a good option in this context, and a possible alternative to laparoscopic duodenal switch, but the included primary studies in our review are not sufficiently powered to establish a more definitive conclusion. More studies with longer follow-up times are needed to comprehensively assess bariatric surgery in T2DM.

Copyright © 2022, The Author(s), under exclusive licence to Springer Science Business Media, LLC, part of Springer Nature, Bariatric surgery, although an effective method, still has complications, like nutritional deficiencies. Our aim was to summarize the evidence on the frequency of complex B vitamin deficiencies in studies comparing Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). We included 25 studies for qualitative synthesis and 21 studies for quantitative synthesis. Relevant data was extracted, including proportion of patients with deficiency and mean serum vitamin values in 3 different timeframes. B12 and folate were the most prevalent deficiencies. B12 deficiency was more common after RYGB and folate serum mean levels were higher after RYGB. SG causes less nutrient deficiency and is therefore a better technique from this point of view. More studies are needed on B2, B3, and B6 vitamins to draw better conclusions.

© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021, Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are safe procedures that may present sub-optimal results in superobesity (SO). A meta-analysis was performed aiming to summarize the available evidence on weight loss (primary outcome) and comorbidities resolution of LRYGB and LSG in patients with SO (BMI ≥ 50 kg/m2). From the 16 included studies, 7 integrated the meta-analysis. LRYGB showed a significantly higher weight loss at 6 to 12-months, but not after 24 months and a higher dyslipidemia resolution at 12 months. When compared with LSG, LRYGB achieved better weight loss after 6 and 12 months and higher dyslipidemia resolution after 1 year. There were no significant differences for resolution of the other co-morbidities studied.

Obesity is often accompanied by psychological distress and both can reduce patients' quality of life. Bariatric surgery is proven to be a good method to reduce weight and to alleviate comorbidities, leading ultimately to an improvement in quality of life.The authors studied 80 patients enrolled in the Multidisciplinary Bariatric Unit of a central hospital in Porto, Portugal. Patients submitted to Roux-en-Y gastric bypass and sleeve procedures were compared. Laboratory parameters were collected from patients' files. Quality of life and psychological state - depression and anxiety, were evaluated using the Portuguese versions of the Medical Outcomes Study SF-36 and the hospital anxiety and depression scale, respectively, within one to two years of the surgery.A total of 51 patients were operated and completed a quality of life evaluation, while 21 patients were in a pre-operatory group (control). Patients subjected to bariatric surgery had higher scores of SF-36 and lower scores in both hospital anxiety and depression scale (anxiety and depression) subscales (p0.001); SF-36 presented a Pearson correlation coefficient of 0,475 (p = 0.004) with hemoglobin A1c. Sleeve had better results in the hospital anxiety and depression scale-depression subscale (p = 0.073).In this population, bariatric surgery led to better results, regarding both metabolic and psychological evaluations. No significant differences were found between gastric bypass and sleeve. However, further analyses must be performed.This study supports the theory that bariatric surgery contributes to the improvement of obese patients' quality of life and psychological state.Introdução: A obesidade é frequentemente acompanhada por perturbações psicológicas, e ambos podem reduzir a qualidade de vida dos doentes. Está provado que a cirurgia bariátrica é um bom método de redução de peso e para aliviar comorbilidades, conduzindo em última instância a uma melhoria da qualidade de vida. Material e Métodos: Os autores estudaram 80 doentes seguidos em consulta do Centro Multidisciplinar de Tratamento da Obesidade. Os grupos de bypass gástrico em Y-de-Roux e sleeve gástricos foram comparados. Os parâmetros analíticos foram recolhidos dos processos dos doentes. A qualidade de vida e perturbações psicológicas (depressão e ansiedade) foram avaliadas um a dois anos após a cirurgia usando as versões portuguesa do Medical Outcomes Study SF-36 e da escala de depressão e ansiedade hospitalar. Resultados: Um total de 51 doentes foi operado, tendo completado uma avaliação de qualidade de vida, enquanto 21 estavam num grupo pré-operatório (controlo). Doentes submetidos a cirurgia bariátrica tiveram resultados mais elevados no SF-36 e valores menores em ambas as subescalas (ansiedade e depressão) da escala de depressão e ansiedade hospitalar (p0,001). O SF-36 apresentou um coeficiente de correlação de Pearson de 0,475 (p = 0,004) com a hemoglobina A1c. O sleeve teve melhores resultados na subescala escala de depressão e ansiedade hospitalar-depressão (p = 0,073). Discussão: Nesta população, a cirurgia bariátrica conduziu a melhores resultados nas avaliações metabólica e psicológica, não tendo sido encontradas diferenças significativas entre bypass e sleeve. Contudo, uma análise posterior deverá ser realizada. Conclusão: Este estudo corrobora a teoria de que a cirurgia bariátrica contribui para a melhoria da qualidade de vida e do estado psicológico dos doentes obesos.

Main Goals: Evaluation and comparison of short-term results of totally laparoscopic gastrectomy performed for gastric carcinoma in two groups of patients: older and younger than eighty years. Material and Methods: From 1st January 2011 to 31st October 2012, we have treated 110 patients for gastric carcinoma. 79 patients were submitted to radical gastric resection (the remainder 31 patients either presented with cardia carcinoma or were submitted to palliative treatment). In 33 cases we performed a laparoscopic gastrectomy while in the remainder 46 cases, the open approach was used. The 33 patients operated by a laparoscopic approach were the subject of this study. They were divided in two groups: Group A—patients eighty years old or older (10 cases) and Group B—patients younger than 80 years (23 cases). We evaluated and compared the short-term outcomes of both groups. Results: In all 33 cases, a gastrectomy was performed using a totally laparoscopic approach. There was no need to convert into open surgery. No patient needed to stay in the Intensive Care Unit. One patient needed a night stay in the Post Anesthetic Care Unit, due to subcutaneous emphysema (which resolved within 24 hours). There was a fatality in Group B, due to hepatic failure. The median of the operating time was 224 minutes in Group B and 199 minutes in Group A. The difference was non-significant (pvalue > 0.05). Group A patients were discharged in 6 to 10 days while those in Group B were discharged in 6 to 9 days. Conclusion: The results in this series suggest that totally laparoscopic gastrectomy is effective and safe in patients eighty years old and older, with low morbidity and mortality and short hospital stay. It compares favourably with the results of the same technique applied to younger patients. We suggest that laparoscopic approach to gastrectomy can be used in older patients, allowing them to benefit from the advantages of minimally invasive surgery.

Our objective is to determine which complications lead to reoperation, and the outcomes of reoperation using laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy at Centro Hospitalar de São João.Observational study. Patients included were aged 18 to 65 years at first gastric banding, underwent removal from March 21st 2007 to January 23rd 2014 and were subsequently converted to gastric banding, gastric bypass or sleeve gastrectomy. Women who got pregnant during the initial gastric banding follow-up and patients that performed more than one conversion were excluded.A total of 103 patients were included. Fifteen underwent revision to gastric banding, 71 to gastric bypass and 17 to sleeve gastrectomy. Respectively, percentage of excess weight loss at 1 month were 1.9 ± 12.2% in 6 patients, 36.9 ± 18.2% in 49 patients and 27.1% (13.3 - 68.6) in 11 patients (laparoscopic adjustable-gastric banding-laparoscopic Roux-en-Y gastric bypass p0.001, laparoscopic adjustable-gastric banding-laparoscopic sleeve gastrectomy p = 0.002 and laparoscopic Roux-en-Y gastric bypass-laparoscopic sleeve gastrectomy p = 0.474). At 3 months there were 12.8% (5.7 - 84.8) in 6 patients, 44.8 ± 19.7% in 24 patients and 48 ± 20.1% in 8 patients (laparoscopic adjustable-gastric banding-laparoscopic Roux-en-Y gastric bypass p = 0.017, laparoscopic adjustable-gastric banding-laparoscopic sleeve gastrectomy p = 0.039 and laparoscopic Roux-en-Y gastric bypass-laparoscopic sleeve gastrectomy p = 0.691).At revision, ages and body mass indices are higher than other studies. Gastric bypass is the preferred revision surgery, because combines restriction and malabsorption, surgeons have more experience and long term outcomes are better described.The main indications for reoperation were inadequate weight loss (37.4%) and band slippage (30%). At short term, in our patients, gastric banding as a revision surgery was not effective, as opposed to gastric bypass and sleeve gastrectomy.Introdução: Pretendemos determinar que complicações levaram a reoperação, e os resultados da reoperação com banda gástrica ajustável por laparoscopia, do bypass gástrico em Y de Roux por laparoscopia e da gastrectomia em sleeve por laparoscopia, no Centro Hospitalar de São João. Material e Métodos: Incluímos indivíduos dos 18 aos 65 anos na primeira banda gástrica ajustável por laparoscopia, cuja remoção ocorreu entre 21 de Maio de 2007 e 23 de Janeiro de 2014 e depois convertidos para banda gástrica, bypass gástrico ou gastrectomia em sleeve. Excluímos mulheres que engravidaram no primeiro seguimento e indivíduos submetidos a mais de uma conversão. Resultados: Incluímos 103 indivíduos. Quinze convertidos em banda gástrica, 71 em bypass gástrico e 17 em gastrectomia em sleeve. Respectivamente, no primeiro mês, as percentagens de excesso de peso perdido foram: 1,9 ± 12,2% em seis indivíduos, 36,9 ± 18,2% em 49 indivíduos e 27,1% (13,3 - 68,6) em 11 indivíduos (laparoscopic adjustable-gastric banding-laparoscopic Roux-en-Y gastric bypass p0,001, laparoscopic adjustable-gastric banding-laparoscopic sleeve gastrectomy p = 0,002 e laparoscopic Rouxen-Y gastric bypass-laparoscopic sleeve gastrectomy p = 0,474). No terceiro mês, foram: 12,8% (5,7 - 84,8) em seis indivíduos, 44,8 ± 19,7% em 24 indivíduos e 48 ± 20,1% em oito indivíduos (laparoscopic adjustable-gastric banding-laparoscopic Roux-en-Y gastric bypass p = 0,017, laparoscopic adjustable-gastric banding-laparoscopic sleeve gastrectomy p = 0,039 e laparoscopic Roux-en-Y gastric bypass-laparoscopic sleeve gastrectomy p = 0,691). Discussão: Na revisão, as idades e os índices de massa corporal são superiores a outros estudos. O bypass gástrico é o método de revisão preferido pela restrição e malabsorção, pela maior experiência de execução e pelos resultados a longo prazo melhor estudados. Conclusões: As principais indicações para reoperação foram perda de peso inadequado (37,9%) e deslocamento de banda (34%). A curto prazo, na nossa amostra, a revisão com banda gástrica não foi efectiva, diferente dos bypass gástrico e gastrectomia em sleeve.

We reviewed current knowledge about cumulative and differential consequences of general anesthesia, surgery and hospitalization upon cognitive, academic, emotional and sociobehavioral development in children. Our strategy was to search the databases Pub Med and PsycINFO for all articles published between 1990 and May 2002. Based on the abstracts, we included all articles that related in any way to our subject of interest. Analysis of the articles showed preoperative anxiety as the main contributing factor to perioperative negative developmental effects. These were generally limited in duration and reversible. Research in this area tries to investigate predictors of increased anxiety, as well as the efficacy of different interventional programs for reduction of preoperative anxiety. We found no studies attempting to differentiate the relative influences of 'anesthetic stress', 'surgical stress' and 'hospitalization stress' on 'negative outcomes', 'areas of development affected' or 'duration of effects'. There are very few studies on academic and cognitive consequences. There is a need for more research in this area to provide useful guidelines for clinicians, to identify risk situations and to prevent negative outcomes.