Impact of Robotic Assistance on Complications in Bariatric Surgery at Expert Laparoscopic Surgery Centers: A Retrospective Comparative Study With Propensity Score.

OBJECTIVE: To investigate the way robotic assistance affected rate of complications in bariatric surgery at expert robotic and laparoscopic surgery facilities. BACKGROUND: While the benefits of robotic assistance were established at the beginning of surgical training, there is limited data on the robot's influence on experienced bariatric laparoscopic surgeons. METHODS: We conducted a retrospective study using the BRO clinical database (2008-2022) collecting data of patients operated on in expert centers. We compared the serious complication rate (defined as a Clavien score≥3) in patients undergoing metabolic bariatric surgery with or without robotic assistance. We used a directed acyclic graph to identify the variables adjustment set used in a multivariable linear regression, and a propensity score matching to calculate the average treatment effect (ATE) of robotic assistance. RESULTS: The study included 35,043 patients [24,428 sleeve gastrectomy (SG); 10,452 Roux-en-Y gastric bypass (RYGB); 163 single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S)], with 938 operated on with robotic assistance (801 SG; 134 RYGB; 3 SADI-S), among 142 centers. Overall, we found no benefit of robotic assistance regarding the risk of complications (average treatment effect=-0.05, P =0.794), with no difference in the RYGB+SADI group ( P =0.322) but a negative trend in the SG group (more complications, P =0.060). Length of hospital stay was decreased in the robot group (3.7±11.1 vs 4.0±9.0 days, P <0.001). CONCLUSIONS: Robotic assistance reduced the length of stay but did not statistically significantly reduce postoperative complications (Clavien score≥3) following either GBP or SG. A tendency toward an elevated risk of complications following SG requires more supporting studies.

Weight Loss and Quality of Life After Sleeve Gastrectomy or One-Anastomosis Gastric Bypass: Results of a Prospective Study of 120 Women with Morbid Obesity.

Our aim was to compare quality of life (QoL) after laparoscopic sleeve gastrectomy (SG) and laparoscopic one-anastomosis gastric bypass (OAGB) on obese female adult patients in the first 2 years following surgery. One hundred twenty patients with BMI over 40 kg/m2 and who underwent either SG or OAGB agreed to take part in this study. Weight loss and QoL were assessed via an online platform (e-baros®) before surgery and every 6 months after it. Two years after the operation, results showed a clinically meaningful reduction in BMI of 40.4% and a significantly meaningful improvement of QoL. No significant difference was found between the two surgical techniques for each data collection. In conclusion, both SG and OAGB techniques are effective in reducing BMI and improving QoL.

Weight loss and quality of life after bariatric surgery: a 2-year longitudinal study.

BACKGROUND: Bariatric surgery is currently recognized as being an effective technique for weight loss and the improvement of patients' postoperative well-being. OBJECTIVES: The objective of the study was to measure changes in quality of life (QoL) and body mass index (BMI) according to patients' sex and 2 types of surgical procedures. SETTING: Longitudinal cohort study using an online platform from a private hospital in West France. METHODS: Two hundred six patients (38 men and 168 women) undergoing one-anastomosis gastric bypass or sleeve gastrectomy surgery provided online information concerning their QoL and weight both before the operation and then every 3 months over a postoperative period of 24 months. RESULTS: BMI clinically decreased on average by 19.6% in the first 3 months and up to 39.2% 24 months after surgery. Slight differences between men and women appeared as from 18 months after the operation, with men experiencing increased BMI between 18 and 24 months, contrary to women whose BMI remained unchanged during the same period. QoL also improved significantly. The average level of women's quality of life increased between 3 and 15 months after surgery, then decreased between 15 and 24 months. As for men, no change was observed in their improved QoL between 3 and 24 months after the operation. CONCLUSIONS: This study highlights the importance of optimizing patients' monitoring, notably around 15 to 18 months after bariatric surgery. This period can be identified as a first "critical" period during which weight regain (especially for men) and diminished self-perceived quality of life (especially for women) appear.

Postoperative Outcomes of Laparoscopic Bariatric Surgery in Older Obese Patients: a Matched Case-Control Study.

BACKGROUND: Laparoscopic bariatric surgery (LBS) in older obese patients remains debated regarding postoperative outcomes. OBJECTIVES: The aim of this case-control study is to evaluate global results of LBS in patients ≥60 years (yr) with a matched case control study. METHODS: All patients ≥60 years who benefited from LBS in our center between January 2009 and January 2014 were included in this retrospective study. They were matched (1:2) to patients <40 and 40-59 years on BMI, surgical procedure and year, and history of previous LBS. Postoperative complications in the first 90 days following LBS, micronutrient and mineral deficiencies, and Bariatric Analysis and Reporting Outcome System (BAROS) were analyzed. RESULTS: Fifty-five patients ≥60 year (40 sleeve gastrectomy, 14 one anastomosis gastric bypass, 1 gastric bypass revision) were matched to patients <40 year and patients 40-59 year (n = 55 each). Patients ≥60 year presented more obesity-related comorbidities at baseline. Except for bleeding complications (P = 0.01), no difference in major complication rate was observed (P = 0.43). At 24 months, %EWL was lower in older patients compared to others (76.3, 82.2 and 89.7, respectively, P = 0.009). Iron and vitamin B12 deficiencies were less prevalent in patients ≥60 year After a mean follow-up of 27 months, BAROS score (filled in by 82% of patients) was lower in patients ≥60 years (P = 0.01). CONCLUSION: Despite less weight loss, postoperative complications rate, and lower BAROS results, LBS keeps an acceptable benefit-risk balance in selected older patients and should not be rejected on the sole argument of age. Additional studies are needed to assess the long-term benefits of LBS in older patients.

Laparoscopic sleeve gastrectomy versus laparoscopic mini gastric bypass: One year outcomes.

PURPOSE: Sleeve gastrectomy (LSG) and mini gastric bypass (LMGB) was considered as emerging procedures but are now considered for many authors as an alternative of the Roux-Y gastric bypass because of similar percentages of weight loss and better postoperative morbidity profiles. However, studies comparing LSG and LMGB are scarce. MATERIALS AND METHODS: From January 2010 to July 2014, 262 and 161 patients underwent LSG or LMGB in two centre of bariatric surgery, respectively. At one year, rate of follow-up was 88.4%. Main outcome was % of Total Weight Loss (%TWL) at one year. Propensity score matching and multivariable analyses were used to compensate for differences in some baseline characteristics. RESULTS: After matching LSG (N = 136) and LMGB (N = 136) groups did not differ for initial BMI (kg/m(2)) (43.4 ± 6.5 vs. 42.8 ± 5.0; P = 0.34), % of female patients (91.9% vs. 93.4%; P = 0.64), age (years) (41.2 ± 12.3 vs. 41.2 ± 11.3; P = 0.99) and diabetes (15.4% vs. 19.9%; P = 0.34). At one year, %TWL, change in BMI and rate of stenosis were higher for LMGB group, respectively: 38.2 ± 8.4 vs. 34.3 ± 8.4 (P < 0.0001); -16.5 ± 4.6 vs. -14.9 ± 4.4 (P = 0.005) and 16.9% vs. 0% (P < 0.0001). In multivariate analyses (ß coefficient), LMGB was a positive independent factor of %TWL (2.8; P = 0.008). CONCLUSION: LMGB seems to have better weight loss at one year compared to LSG with higher gastric complications. Further long term studies are needed.

Secondary implantation of an artificial sphincter after abdominoperineal resection and pseudocontinent perineal colostomy for rectal cancer.

INTRODUCTION: Fecal continence with a perineal colostomy performed after abdominoperineal resection (APR) is not always satisfactory despite retrograde colonic enemas. Functional improvement is currently examined using artificial sphincters. Preliminary results are disclosed. PATIENTS: In 3 female patients, 45, 59 and 68 years old, curative APR and perineal colostomy were performed after radiotherapy in 2, for T1-2N0 cancer of the lower rectum. Due to occasional leaks, need for strict diet and fear of incontinence, an Acticon Neosphincter (AMS) was implanted consecutively at a mean 4.5 years after APR. RESULTS: Device implantation was feasible and uneventful. In one case, a superficial hematoma was drained and healed by second intention. Devices were activated 3 months after implantation. At a mean 2.5 years follow-up, the 3 patients had an activated and functional artificial sphincter. Leaks and fecal urgency significantly decreased but colonic enemas were maintained. Dietary restrictions were less and quality of life improved. All 3 considered the device as a useful adjunct. CONCLUSION: In this limited experience, implantation of artificial sphincter around a perineal colostomy following APR for rectal cancer appeared feasible and safe even in case of previous radiotherapy. Mid-term tolerance was satisfactory. Continence and quality of life significantly improved.

Adoptive immunotherapy monitored by micro-MRI in experimental colorectal liver metastasis.

In this study we used the colon carcinoma DHDK12 cell line and generated single metastasis after subcapsular injection in BDIX rats as an experimental tumor model. The aim of the work was to set up in vitro experimental conditions to prepare immune effector cells and in vivo conditions for monitoring the effects of such cells injected as adoptive immunotherapy. Dendritic cells can process tumor cell antigens, induce a T-cell response and be used ex vivo to prepare activated lymphocytes. Lymphocytes were harvested from mesenteric lymph nodes and cocultured with bone marrow-derived autologous dendritic cells previously loaded with irradiated tumor cells. In vitro, the coculture: 1) induced the proliferation of lymphocytes, 2) expanded a preferential subpopulation of T CD8 lymphocytes, and 3) was in favor of lymphocyte cytotoxic activity against the DHDK12 tumor cell line. Activated lymphocytes were injected in the tumor-bearing rat portal vein. Parameters could be set to monitor tumor volume by micro MRI. This monitoring before and after treatment and immunohistochemical examinations revealed that: 1) micro MRI is an appropriate tool to survey metastasis growth in rat, 2) injected lymphocytes increase lesional infiltration with T CD8 cells even 15 days after treatment, 3) a dose of 50 millions lymphocytes is not sufficient to act on the course of the tumor.