Correlation between age and weight loss after bariatric surgery.

BACKGROUND: Conflicting evidence exists regarding age as a predictive factor in excess weight loss after bariatric surgery. The objective of this cross-sectional study is to evaluate differences in excess BMI loss (%EBMIL) 1 year after surgery in patients older and younger than 45 years. METHODS: Adult obese patients fulfilling selection criteria underwent either Roux-en-Y gastric bypass or sleeve gastrectomy and were grouped according to age < and ≥45 years with follow-up at least 1 year. Both groups were compared in terms of excess BMI loss (%EBMIL) and other clinical outcomes. Possible relationship between %EBMIL, age, surgical technique, and presence of comorbidities such as diabetes mellitus, hypertension (HT), and dyslipidemia (DL) was searched. RESULTS: Three hundred thirty-seven patients (72.5 % female), 196 (50.1 %) younger than 45 years and 141 (49.9 %) with age ≥45 years. There was significant difference between age group and %EBMIL 12 months after surgery (p < 0.001), showing better results in younger patients. No differences were found in terms of gender, preoperative body mass index (BMI), surgical technique, nor presence of DL. Using multiple regression, we found significant interaction effect between age group (p < 0.001), presence of HT (p = 0.001), and %EBMIL at follow-up. CONCLUSIONS: Patients younger than 45 years lose greater amount of excess BMI than older patients after bariatric surgery. This tendency might be useful as a preoperative weight loss predictor in bariatric patients.

[Adenocarcinoma of the esophagogastric junction: retrospective analysis of 39 patients]. / Cáncer de la unión gastroesofágica: Evaluación de los resultados quirúrgicos, sobrevida alejada y factores pronósticos en enfermos con terapia resectiva.

BACKGROUND: The long-term survival of adenocarcinoma of the esophago-gastric junction is poor and depends on the possibility of performing a complete surgical excision and the absence of lymph node involvement. AIM: To report surgical results and survival of patients with adenocarcinoma of the esophago-gastric junction. MATERIAL AND METHODS: Retrospective review of medical records of patients with adenocarcinoma of the esophago-gastric junction, subjected to a curative surgical procedure between 2000 and 2008. Deaths that occurred within 60 days of the operation were considered operative mortality. Tumor stage was determined using TNM and Siewert pathological classifications. RESULTS: Thirty-nine patients aged 40 to 80years (27 men), were operated. According to Siewert classification, seven patients had type I, six type II and 26 type III tumors. Twenty-two patients were subjected to a total gastrectomy with partial excision of distal esophagus and mediastinal reconstruction, 10patients were subjected to a trans-hiatal esophagectomy and seven to a total esophagogastrectomy. According to postoperative staging, five patients were in stage I, 12 in stage II, nine in stage III and 13 in stage IV. Median, three and five year's survival figures were 21.4 months, 33 and 25%, respectively. Lymph node and perineural involvement was associated with a lower survival. Well differentiated and stage I tumors had a better survival. Multivariate analysis showed that the presence of a type III tumor, N3 lymph node involvement and vascular permeation were independent predictors' ofa lower survival. CONCLUSIONS: Among patients with adenocarcinoma of the esophago-gastric junction, type III tumors, lymph node involvement and vascular permeations are associated with a lower survival.

Splenic rupture after screening colonoscopy: case report and literature review.

Splenic rupture is a rare complication after colonoscopy, and to date there are only 46 reported cases in the English-language literature. Presented is a case report of splenic rupture after screening colonoscopy that resulted in laparotomy and splenectomy within 24 hours of the original procedure. The article covers the hypothesized mechanisms of injury, various precautions to take during colonoscopy, suggested diagnostic algorithm, determining factors in treatment, and vaccine regimen. The article concludes by stating that as the number of colonoscopies increase, so will the prevalence of associated complications, and that physicians are encouraged to understand this paradigm shift.

Cáncer de la unión gastroesofágica: Evaluación de los resultados quirúrgicos, sobrevida alejada y factores pronósticos en enfermos con terapia resectiva / Adenocarcinoma of the esophagogastric junction: Retrospective analysis of 39 patients

Background: The long-term survival of adenocarcinoma of the esophago-gastric junction is poor and depends on the possibility of performing a complete surgical excision and the absence of lymph node involvement. Aim: To report surgical results and survival of patients with adenocarcinoma of the esophago-gastric junction. Material and Methods: Retrospective review of medical records of patients with adenocarcinoma of the esophago-gastric junction, subjected to a curative surgical procedure between 2000 and 2008. Deaths that occurred within 60 days of the operation were considered operative mortality. Tumor stage was determined using TNM and Siewert pathological classifications. Results: Thirty-nine patients aged 40 to 80years (27 men), were operated. According to Siewert classification, seven patients had type I, six type II and 26 type III tumors. Twenty-two patients were subjected to a total gastrectomy with partial excision of distal esophagus and mediastinal reconstruction, 10patients were subjected to a trans-hiatal esophagectomy and seven to a total esophagogastrectomy. According to postoperative staging, five patients were in stage I, 12 in stage II, nine in stage III and 13 in stage IV. Median, three and five year's survival figures were 21.4 months, 33 and 25 percent, respectively. Lymph node and perineural involvement was associated with a lower survival. Well differentiated and stage I tumors had a better survival. Multivariate analysis showed that the presence of a type III tumor, N3 lymph node involvement and vascular permeation were independent predictors' ofa lower survival. Conclusions: Among patients with adenocarcinoma of the esophago-gastric junction, type III tumors, lymph node involvement and vascular permeations are associated with a lower survival.

T-tube gastrostomy as a novel approach for distal staple line disruption after sleeve gastrectomy for morbid obesity: case report and review of the literature.

Laparoscopic sleeve gastrectomy has recently become a feasible option in the management of morbid obesity. One of the most feared complications of this procedure is staple line disruption and leakage. There are, to our knowledge, few literature reports that try to explain the reasons and management of this rare but serious complication. We report a case of staple line disruption that was managed using a T-tube gastrostomy. A 50-year-old female, 2 weeks status post-sleeve gastrectomy in an outside facility, was admitted to the emergency room at Cleveland Clinic Florida with new onset of fever, abdominal pain, jaundice, hematemesis, and melena. A computed tomography scan of the abdomen revealed a large extravasation of contrast material parallel to the gastric sleeve. A diagnostic laparoscopy was performed that showed a distal and proximal disruption of the staple line. A T-tube gastrostomy with a large proximal and distal limb was placed into the most distal area of disruption. After thorough over sewing and drainage of the proximal site and T-tube, a feeding jejunostomy was placed. The T-tube permitted to control the leak and to have a controlled fistula. Four weeks postoperatively, the T-tube was removed after the patient had a negative Gastrografin study and tolerated oral fluids with a clamped T-tube. The long-term recovery and follow-up were uneventful. T-tube gastrostomy appears to be a safe and feasible treatment option for staple line disruption after vertical sleeve gastrectomy. Early detection and drainage remain the most important principles to manage this type of complication.

Safety and short-term outcomes of laparoscopic sleeve gastrectomy as a revisional approach for failed laparoscopic adjustable gastric banding in the treatment of morbid obesity.

Laparoscopic sleeve gastrectomy (LSG) has been used as a first step of a two-stage approach in bariatric surgery for high-risk patients. Recently, LSG is being utilized as a primary and final procedure for morbid obesity with acceptable short-term results. The aim of this study is to investigate the effectiveness of LSG as a revisional procedure for patients with unsatisfactory outcomes after laparoscopic adjustable gastric band (LAGB). A retrospective review of a prospectively maintained database was performed. Data were reviewed for all patients undergoing revision from LAGB to LSG during the period May 2005 and May 2009. Data collected included demographics, indication for revision, operative time, length of stay, postoperative complications, and degree of weight reduction. Fifteen patients (three males and 12 females) had revisional surgery converting a LAGB to a LSG. The indication in four patients (26.66%) was weight regains and in five patients (33.33%) was poor weight loss; four patients (26.66%) had a band slippage and symptoms of gastroesophageal reflux, and one patient (6.66%) had poor weight loss, band slippage, and reflux. In one patient (6.66%), the indication was slippage and duodenal fistula. One-step revision procedure was done in 13 patients (86.66%), while two-step procedure was done in two patients (13.33%). Mean preoperative weight and BMI were 233.02 (181.4-300) lb and 38.66 (29.7-49.3) kg/m2, respectively. Mean weight loss at 2, 6, 12, 18, and 24 months postoperatively was 20.7, 48.3, 57.2, 60.1, and 13.5 lb, respectively. Mean % excess BMI loss was 28.9%, 64.2%, 65.3%, 65.7%, and 22.25% at 2, 6, 12, 18, and 24 months, respectively. There was one major complication (staple line leak) and one postoperative acute gastric outlet obstruction. We had no mortality. Thirteen patients were followed up postoperatively. The number decreased as follow-up time progressed. LSG could provide short-term weight loss after previously failed LABG, but prone to more complications compared to an initial LSG without a prior bariatric procedure.