Impact of Bariatric Surgery on Renal Function.

Introduction Bariatric surgery offers superior benefits for weight loss, quality of life and a spectrum of metabolic diseases. Despite these benefits, studies so far have shown varying results on its effect on renal function. Aim In this study, we aim to look at bariatric surgery's effect on renal function at one, two and three year post operation (post-op). Methods This is a retrospective cross-sectional single-center study of patients who underwent bariatric surgery between 11/2008 and 06/2018. Renal function was calculated by using Cockroft-Gault equation, expressed as Creatinine Clearance (CrCl). Statistical analysis used was one-way ANOVA (Welch's) with Games-Howell Post-Hoc Test. Results From 307 patients who underwent bariatric surgery within the time period, 145 were studied. 30.3% (n=44) were male. The average age and body mass index (BMI) at referral were 48.1±8.6 years and 47.96±7.9 kgm-2 respectively, while the average age and BMI at surgery were 49.1±8.8 years and 40.62±4.2 kgm-2 respectively. Mean CrCl at surgery, year 1, year 2, and year 3 post-op were 172.35±53.29 mL/min, 179.20±57.87 mL/min, 142.35±46.05 mL/min, and 119.56±42.46 mL/min. Marginal improvement of CrCl at year one post-op (172.35±53.29mL/min to 179.20±57.87mL/min) was statistically insignificant (p=0.731). Meanwhile, there was statistically significant CrCl decline observed from year 1 to year 3 post-op (p<0.001). Conclusion Statistically insignificant marginal improvement in CrCl at year one post-op was noted. Beyond this, there was steady CrCl decline, albeit remained higher than the lower limit for respective gender. We recommend for further studies that take into account additional factors affecting renal function.

Preoperative Bariatric Surgery Predictors of Type 2 Diabetes Remission.

Obesity represents a significant proportion of the global public health burden, with the World Health Organization (WHO) estimating more than 600 million people are affected worldwide. Unfortunately, the epidemic of obesity is linked to the increased prevalence of associated metabolic diseases such as type 2 diabetes mellitus (T2DM). Bariatric surgery as an intervention has been shown to provide sustainable weight loss, and also leads to superior short- and long-term metabolic benefits including T2DM remission. Despite this added advantage conferred by bariatric surgery, emerging evidence has shown that not all patients with T2DM achieve remission postoperatively. As such, to improve patient selection and optimize preoperative counselling, research has focused on the preoperative predictors of T2DM remission following bariatric surgery. Herein, we provide a critical review of the current literature addressing preoperative predictors of T2DM remission and highlight the current gaps in the literature. The review comprised a multistage advanced electronic search of the Ovid/Medline, Embase, and Cochrane online libraries to identify available studies published over the last decade.

Role of Gastrografin in Patients With Small Bowel Obstruction.

Introduction Gastrografin (GGF) is a radiopaque contrast medium commonly used for diagnostic examination of the gastrointestinal (GI) tract. Available evidence suggests it has therapeutic and predictive value in the management of adhesional small bowel obstruction (ASBO). Thus, we investigated the use of GGF amongst patients who had a small bowel obstruction and audited the practice in University Hospital, Ayr. Methods Initial retrospective data of patients who had gastrografin for small bowel obstruction were extracted from April 2015 to August 2019 and analysed. After our local presentation and on implementing a GGF protocol, we prospectively collected data from February to June 2020 to close our audit. Results GGF showed a comparable therapeutic effect on ASBO in both audit cycles (72.2%-66.7%). Approximately 50% of unresolved cases were operated within 24 hours of GGF administration in both cycles. GGF consistently demonstrated a therapeutic benefit in refractory faecal impaction (100% in both cycles) and postoperative ileus (≥ 80%). Early use of computed tomography (CT) (less than 24 hrs) did not confer any added advantage (82.5% v 61.5%), however, it helped in making an appropriate diagnosis and the subsequent early gastrografin usage (78.3% v 92.3%) in ASBO. Conclusion GGF serves a very good therapeutic purpose in resolving ASBO, refractory constipation, and in rare non-resolving cases of postoperative ileus. Early CT diagnosis of ASBO is advocated before the administration of gastrografin. Unsuccessful resolution after 24 hrs of GGF is an indication for operative intervention.

Atraumatic idiopathic splenic rupture induced by granulocyte-colony stimulating factor (G-CSF) for the treatment of pancytopenia, managed successfully by laparoscopic splenectomy.

Splenic rupture is a potentially life-threatening condition and an uncommon short-term complication of granulocyte-colony stimulating factor (G-CSF) administration. It may present as acute abdominal pain or suddenly precipitously worsening anaemia with haemodynamic instability that requires urgent operative intervention for survival. We present a case of an atraumatic idiopathic splenic rupture in University Hospital, Ayr in a patient who received G-CSF treatment for chemotherapy-induced (methotrexate) pancytopenia and was successfully managed by laparoscopic splenectomy.

Pre-specified Weight Loss Before Bariatric Surgery and Postoperative Outcomes.

Bariatric surgery is increasing exponentially to address the steep rise in the prevalence of severe obesity. Most centers require pre-specified preoperative weight loss before allowing patients to receive surgery. We examined the current evidence surrounding the potential benefits of this requirement on postoperative outcomes. We reviewed the current literature by conducting a multistage advance electronic search in Ovid®/MEDLINE® and PubMed for publications indexed after 2008 reporting preoperative weight loss and postoperative outcomes. Thirteen original publications, three randomized control trials (RCT), and five systematic reviews that met inclusion criteria were included. These were analyzed with regards to weight loss before surgery and postoperative outcomes. There were varied reports regarding the significant effect of preoperative weight loss. Six of the original articles (50%) did not identify a significant difference in the outcome while two of the RCT (essentially the same patient population, started in 2007 and reanalyzed in 2009) demonstrated some advantage. A later RCT (2012) did not show any advantage, albeit in the short term. The results of the systematic reviews, some with heterogenic designs, show no conclusive evidence that weight loss before surgery conferred improved postoperative outcomes. There is not enough high-quality evidence to back up the requirement of pre-specified preoperative weight loss before receiving surgery. Further validation of the possible benefits of pre-specified preoperative weight loss may need to be carried out.

Diabetic Control Outcomes Amongst Patients Who Had Bariatric Surgery in a District General Hospital.

Bariatric surgery remains the most effective weight loss treatment. It leads to significant and sustained weight loss and improvement in various metabolic diseases such as type 2 diabetes (T2DM). This piece of work aimed to investigate the remission of T2DM amongst patients who had laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomies (LSG). This was achieved by carrying out a retrospective review of prospective data of 82 T2DM diabetic patients who had above bariatric surgery at the University Hospital Ayr from 2010 to 2016. Outcomes were assessed at two years postoperatively and documented. The main outcome measure was based on the achievement of partial or complete remission. The average age of patients in this study was 49.6±8.1 with 52% female (n=49) and 48% male (=33). Preoperative body mass index (BMI) averaged at 42.6±6.2 kgm2. The majority (n= 43) of cases had a Roux-en-Y gastric bypass (RYGB) while (n=39) had laparoscopic sleeve gastrectomy (LSG). The average glycated haemoglobin (HbA1c) was 6.7±1.8 units. Fourteen patients who had diet-controlled diabetes were excluded. Of the patients left (n=68), partial or complete remission was achieved by 73.3% (n =50). Remission rates following RYGB, 87.2% (n=43) were higher than those following LSG (55.2%). Age, duration of diabetes, and HbA1c showed a statistically significant difference amongst both cohorts. No statistically significant difference was seen in BMI both at referral and at surgery between both cohorts of patients. We concluded that preoperative BMI plays a very limited role in determining which patients go into remission in the short-term postoperative phase.

Giant Gallbladder Presenting as a Right Iliac Fossa Mass Removed by Mini-laparoscopic Cholecystectomy.

Giant gallbladder (GGB) is a rare condition that can result from cholelithiasis or chronic cholecystitis. Although there are no clear-cut definitions, gallbladders of >14 cm and ≥1.5 L have been regarded as GGBs. To date, most GGBs have been managed by laparotomic removal. This report describes a patient with a GGB that presented as a right iliac fossa mass. The GGB was successfully removed by mini-laparoscopic cholecystectomy. A 63-year-old woman presented with painful swelling in her right lower abdomen associated with dyspepsia and a palpable right iliac fossa mass. Computed tomography of the abdomen revealed a markedly enlarged gall bladder (19.5 x 5.4 x 5.6 cm) containing stones. Magnetic resonance cholangiopancreatography ruled out extra- and intrahepatic ductal dilatation and stones. She underwent a mini-laparoscopic cholecystectomy, and her postoperative recovery was uneventful.

Does Preoperative Weight Loss Predict Significant Postoperative Weight Loss Among Patients who Underwent Laparoscopic Sleeve Gastrectomy?

Background Some bariatric practices, mainly those conducted under public-funded services, have adopted achieving a target preoperative weight loss (PrWL) before offering surgery. There are varied opinions on the correlation between preoperative and postoperative weight loss (PoWL) for the different surgical options. This study investigated the impact of target PrWL on PoWL for patients who underwent laparoscopic sleeve gastrectomy (LSG). Materials and methods A longitudinal retrospective cohort study was carried out on patients who had documented preoperative weight before LSG (n=155) from the authors' institution between February 2008 to October 2017. Patients were grouped into two cohorts based on meeting the 5% target PrWL or not. The endpoint included percent postoperative weight loss (% PoWL) at one year and two to three years. Results A total of 155 individuals were identified and analysed. Of these patients, 78.7% of them (n=122) achieved the 5% target PrWL (target group) while 21.3% (n= 33) did not (non-target group). At one year, there was no statistical significant difference in the mean % PoWL between the non-target and target groups (22.3 ± 8.1% versus 19.4 ± 11.8% p value= 0.08). A similar observation was made at two-three years, where the mean % PoWL in the non-target group was 14.7 ± 10.7% versus 16.3 ± 14.4% in the target group (p value= 0.07). Our further analysis highlighted a statistically significant weak inversely proportional correlation between % PrWL and % PoWL at one year and two to three years. Conclusion Meeting target PrWL does not significantly impact on PoWL after LSG. Therefore, it should not serve as exclusion criteria for eligible patients who are in need of surgery.