Sleeve gastrectomy or gastric bypass as revisional bariatric procedures: retrospective evaluation of outcomes.

BACKGROUND: A considerable number of patients require revisional surgery after laparoscopic adjustable gastric banding (LAGB). Studies that compared the outcomes of revisional sleeve gastrectomy (r-SG) and revisional Roux-en-Y gastric bypass (r-RYGB) after failed LAGB are scarce in the literature. Our objective was to determine whether significant differences exist in outcomes between r-SG and r-RYGB after failed LAGB. METHODS: From 2005 to 2012, patients who underwent laparoscopic r-SG and r-RYGB after failed LAGB were retrospectively compared and analyzed. Data included demographics, indication for revision, operative time, hospital stay, conversion rate, percentage excess weight loss (%EWL), and morbidity and mortality. RESULTS: Out of 693 bariatric procedures, 42 r-SG and 53 r-RYGB were performed. The median preoperative weight (107.7 and 117.7 kg, respectively, p = 0.02) and body mass index (BMI) (38.5 vs. 43.2 kg/m(2), respectively, p = 0.01) were statistically significantly lower in r-SG than in r-RYGB. The mean operative time and median hospital stay were significantly shorter in r-SG than in r-RYGB (108.4 vs. 161.2 min, p < 0.01) (2 vs. 3 days, p = 0.02), respectively. One patient underwent conversion to open surgery after r-RYGB (p = 0.5). The reoperation rate was lower in r-SG than in r-RYGB (0.0 vs. 3.8 %, p = 0.5). There was one postoperative leak in the r-RYGB, and the overall complication rate was significantly lower in r-SG patients than in r-RYGB patients (7.1 vs. 20.8 %, p = 0.05). The mean follow-up was significantly shorter in the r-SG group (9.8 vs. 29.3 months, p < 0.01). However, the mean postoperative BMI was not different at 1 year (32.3 vs. 34.7, p = 0.29) as well as mean %EWL was (47.4 vs. 45.6 %, p = 0.77). CONCLUSIONS: Both r-SG and r-RYGB are safe procedures with similar outcomes in terms of %EWL. As a result of the long-term potential nutritional complication of r-RYGB, r-SG may be a better option in this group of patients. Longer follow-up is needed.

Postoperative Bleeding and Leakage After Sleeve Gastrectomy: a Single-Center Experience.

BACKGROUND: Sleeve gastrectomy is being performed increasingly, mainly due to its low morbidity and mortality, but complications do occur. The aim of this study was to evaluate bleeding and leakage rates of primary and revisional sleeve gastrectomy in a personal series of 664 consecutive patients. METHODS: Medical charts of all patients undergoing a primary or revisional sleeve gastrectomy between August 2008 and December 2014 were reviewed retrospectively. Subgroup analysis compared bleeding in patients after reduced port versus multiport technique and primary versus revisional sleeve gastrectomy. RESULTS: A total of 664 sleeve gastrectomies (489 women and 175 men) were performed. Mean age and body mass index were 36.03 ± 11.4 years and 42.9 ± 8.3 kg/m2, respectively. Mean operative time was 58.5 ± 20.0 min, with a 0.15 % conversion rate. Mean hospital stay was 2.1 ± 0.3 days. The overall 30-day complication rate was 7.5 %. Thirteen patients sustained postoperative bleeding (2 %), three of whom required reoperation (0.5 %). Staple line leakage and mortality were both nil in this series. No difference in postoperative complications was found between the subgroups. CONCLUSIONS: In this single-surgeon, single-center experience, sleeve gastrectomy was a safe and effective bariatric procedure with a low complication rate. Staple line reinforcement by oversewing was associated with low bleeding complications and no leakage. The majority of patients with postoperative bleeding could be managed conservatively. In our experience, reduced port technique and revisional sleeve gastrectomy had similar complication rates compared to multiport and primary sleeve gastrectomy.

Prevalence and antibiotic resistance of Salmonella isolated from a poultry farm and processing plant environment in the State of Kuwait.

The prevalence of Salmonella isolated from a poultry farm and from the poultry processing plant environment were evaluated from August 2004 to July 2005 along with microbial antibiotic resistance. In total, 3242 samples were collected from the farm and processing plant. Samples collected from the farm included hatching eggs, paper liners, litter, feed, water, drinkers, air, bird rinse, and ceca. While samples collected from the processing plant included carcass rinse and ceca. Out of 2882 samples collected from the farm, the overall percentage prevalence of Salmonella was 5.4% with prevalence rates of 10%, 1.5%, 0.7%, 0.2%, 13.5%, and 12.6% for hatching eggs, litter, feed, drinkers, bird rinse and ceca, respectively. No Salmonella were detected in any of the paper liner, water, or air samples. Out of 360 samples collected from the processing plant, the overall percentage prevalence of Salmonella was 4.7% with prevalence rates of 6.1% and 3.3% for carcass rinse and ceca samples, respectively. Salmonella Enteritidis was the most prevalent serotype. All of the isolates were resistant to at least one antibiotic and 10 different resistance profiles were found among 173 isolates of Salmonella Enteritidis. Resistance to ampicillin, nalidixic acid, and tetracycline were the most common. The widespread occurrence of multiple resistant Salmonella Enteritidis is a cause for concern, and local regulatory enforcement agencies should ensure prudent use of antibiotics.