Complications in Patients Undergoing Laparoscopic Bariatric Surgery in an ERABS-optimized, High-Volume, Single Center During 2020 and 2021.

PURPOSE: Complication rates after fast-track optimization in bariatric surgery are varying. The aim of this study was to identify short-term complications in patients undergoing laparoscopic sleeve gastrectomy (SG) in an ERABS (enhanced recovery after bariatric surgery) optimized setup. MATERIALS AND METHODS: This study is an observational analysis of a consecutive cohort of 1600 patients undergoing SG at an ERABS-optimized, private hospital during 2020 and 2021. Primary outcomes were length of stay, mortality, readmissions, reoperations, and complications according to the Clavien-Dindo classification (CDC) within postoperative day (POD) 30 and 90. Secondary outcomes were weight loss and quality of life (QoL) according to Moorehead-Ardelt questionnaires during the first postoperative year. RESULTS: Primary outcomes: 99.1% of patients were discharged within POD 1. The 90-day mortality rate was zero. There were 1% readmissions and 1.2% reoperations within POD 30. Total 30-day complication rate was 4.6%, where 3.4% accounted for CDC grades ≤ II, and 1.3% accounted for CDC grade III. There were zero grade IV-V complications. SECONDARY OUTCOMES: One year after surgery, weight loss was substantial (p < 0.001), with an excess weight loss of 71.9%, and QoL had significantly increased (p < 0.001). CONCLUSION: This study demonstrates that the use of an ERABS protocol in bariatric surgery does not compromise neither safety nor efficacy. Complication rates were low, and weight loss was significant. This study thus provides strong arguments that ERABS programs are beneficial in bariatric surgery.

[Clinical differentiation between intestinal tuberculosis and morbus Crohn]. / Klinisk differentiering mellem intestinal tuberkulose og morbus Crohn.

We describe a case of intestinal tuberculosis in a 34-year-old Indonesian woman. She presented with diarrhoea, weight loss, fever and night sweat over a period of weeks. She underwent colonoscopy which showed a major cobblestone pattern like necrosis in part of the colon. An MR scan showed oedema involving the small intestine near the ileocoecal area and abdominal lymphadenopathy. Because of the patient history of recent TB exposure, ethnicity and positive T-SPOT-TB, she was given a course of four-drug tuberculosis treatment and responded quickly. Later on Mycobacterium tuberculosis was found in faeces culture.

[Presentation, diagnosis and management of swallowed foreign bodies]. / Præsentation, diagnose og håndtering af slugte fremmedlegemer.

Foreign body ingestion occurs commonly. In 80-90% of cases, the ingested foreign body passes uneventfully through the gastrointestinal tract; endoscopy is performed in 20% of cases, and surgery in less than 1%. Complications usually occur when the ingested foreign body is sharp, large, a button battery or multiple magnets. We present a potential algorithm for the management of swallowed foreign bodies. Most patients can be treated conservatively by observation alone, but often it is convenient to proceed to endoscopic retrieval. Surgery is reserved for complicated cases.