Demographic factors associated with length of stay in hospital and histological diagnosis in adults undergoing appendicectomy.

Objectives: Appendicectomy remains of the most common emergency operations in the United Kingdom. The exact etiologies of appendicitis remain unclear with only potential causes suggested in the literature. Social deprivation and ethnicity have both been demonstrated to influence outcomes following many operations. There are currently no studies evaluating their roles with regards to severity and outcomes following appendicectomy. Material and Methods: Demographic data were retrieved from health records for adult patients who underwent appendicectomy between 2010-2016 within a single NHS trust. To measure social deprivation, Indices of Multiple Deprivation (IMD) rankings were used. Histology reports were reviewed and diagnosis classified into predefined categories: non-inflamed appendix, uncomplicated appendicitis, complicated appendicitis and gangrenous appendicitis. Results: Three thousand four hundred and forty-four patients were identified. Mean age was 37.8 years (range 73 years). Using a generalized linear model, South Asian ethnicity specifically was found to be independently predictive of increased length of stay following appendicectomy (p <0.001). Amongst South Asian patients, social deprivation was found to be further predictive of longer hospital stay (p= 0.005). Deprivation was found to be a predictor of complicated appendicitis but not of gangrenous appendicitis (p= 0.01). Male gender and age were also independent predictors of positive histology for appendicitis (p <0.001 and p= 0.021 respectively). Conclusion: This study is the first to report an independent association between South Asian ethnicity and increased length of stay for patients undergoing appendicectomy in a single NHS trust. The associations reported in this study may be a result of differences in the pathophysiology of acute appendicitis or represent inequalities in healthcare provision across ethnic and socioeconomic groups.

Setting up a surgical complex gallstone service in a non-HPB unit.

Objectives: Complex gallstone disease is associated with a higher risk of complication during laparoscopic cholecystectomy than biliary colic and simple cholecystitis. It is traditionally managed in a hepatopancreaticobiliary (HPB) unit where there is expertise for common bile duct exploration and repair. We developed a mentorship scheme for a busy upper gastro-intestinal (UGI) unit, with support from a specialist HPB unit to treat complex gallstone disease, to reduce the burden on the HPB unit and enable local treatment of patients. Material and Methods: Through the creation of a service level agreement, the specialist HPB unit were commissioned to provide mentorship for two surgeons at a large UGI unit with an interest in providing a complex gallstone service to their local population. Eight sessions of mentored operating were supported, with the provision for additional support if complications occurred. Results: There were 14 patients included in the mentorship phase of the programme from November 2015 to May 2017. Cholecystectomies were performed on patients with previously complex histories, which included: previous cholecystostomy; CBD stones and multiple ERCPs; suspected choledochoduodenal fistula; suspected cholecystoduodenal fistula; suspected Mirrizzi's syndrome; previous significant intra-abdominal operation; and significant medical co-morbidities. There was one post-operative complication requiring a return to theatre, and one minor wound infection associated with the complex gallstone lists. Conclusion: We demonstrated a method to reduce the burden on specialist HPB unit for the operative management of complex gallstone disease and safely implement such a service at large UGI unit with an interest in providing a complex gallstone service.

Publication output of National Health Service Bariatric centres in England.

Obesity has been identified as an independent risk factor for a wide range of health conditions. Therefore, there is a clear need for high quality Bariatric research in order to improve patient selection, outcomes and safety for patients with obesity. We sought to identify and compare the quantitative and qualitative publication output from Bariatric centres in England. We identified 42 National Health Service (NHS) Trusts and 162 surgeons providing Bariatric services in England. A median of 4 (range 1-7) Bariatric surgeons were identified per centre. Eight NHS Trusts (19%) and 75 surgeons (46.3%) had no Bariatric publications during the study period, while 87 surgeons published a total of 432 Bariatric papers. Only 15 surgeons (9%) had ≥10 publications within the study period. However, these surgeons produced >50% of all Bariatric publications. Departments with more than 4 surgeons produced a significantly higher number of Bariatric publications (median 8.5 vs 2, p = 0.01). There is significant variation in research contribution amongst Bariatric centres in England. Academia should be encouraged and promoted across all bariatric services in order to broaden our understanding on Bariatric outcomes by expanding the service and proportional increase in funding. Given that a number of health conditions can afflict individuals living with obesity, bariatric surgery research becomes all the more important.

Challenges and outcomes for bariatric surgery in patients with paraplegia: Case series and systematic review.

INTRODUCTION: Obesity contributes to a plethora of significant chronic diseases. Bariatric surgery has been demonstrated to be the most cost-effective treatment for severe obesity and significantly reduces morbidity and mortality from metabolic syndrome. Patients with paraplegia have significantly impaired mobility and are therefore at a much higher risk of developing severe obesity and its sequelae. Bariatric surgery may bring significant improvements to mobility, morbidity and quality of life for patients with paraplegia, but evidence in the literature is poor for this group of patients. METHODS: A systematic review was conducted conforming to PRISMA guidelines. The MEDLINE and Cochrane databases were searched for all articles published prior to April 2019 matching all of the keywords 'bariatric', 'paraplegia' and 'spinal cord'. Articles were assessed for relevance and full texts reviewed. In addition, clinical records were reviewed for three patients who underwent bariatric surgery at a single UK private institution. Non-identifiable demographic, clinical, operative and outcome data were obtained from electronic records. RESULTS: Twenty seven articles were retrieved from the initial database search, of which nine eligible full texts were reviewed. Eight articles were case reports or case series and the final article was a systematic review. All cases reported had positive outcomes with significant weight loss, improvement in mobility and increased quality of life. Outcomes from the three diversely aged patients in our case series were similarly positive, with no significant post-operative complications. DISCUSSION: Patients with obesity and paraplegia may significantly benefit from bariatric surgery. There is a need for multi-centre cohort studies to evaluate outcomes and the choice of bariatric intervention. UK guidelines do not include criteria based on mobility or neurological deficit, resulting in a potential missed opportunity to offer a cost-effective treatment that can significantly improve quality of life for patients with severe obesity and paraplegia.

The effect of laparoscopic sleeve gastrectomy on quality of life: A prospective cohort study with 5-years follow-up.

BACKGROUND: Obesity has a negative effect on quality of life (QoL). Bariatric surgery results in significant weight loss with improvement of QoL. Very few studies have evaluated QoL after sleeve gastrectomy (SG), especially with a long-term follow-up. OBJECTIVES: To assess long-term longitudinal changes of QoL of a laparoscopic SG cohort, with the obesity specific Moorehead-Ardelt II questionnaire (MAII) and to identify parameters associated with QoL outcome. SETTING: Bariatric Unit, University Hospital of Heraklion, Greece. METHODS: Morbidly obese patients admitted for laparoscopic SG over a 30-month period were prospectively studied. QoL was assessed using the Greek version of the MAII questionnaire and a visual analog scale preoperatively and at 6, 12, 24, and 60 months postoperatively. Anthropometric data and obesity-related co-morbidities were recorded. RESULTS: A total of 95 patients with mean age of 37.4 ± 9.2 years and body mass index of 48.3 ± 7.1 kg/m2 completed the 5-year follow-up. Percentage excess body mass index loss was 51.7 ± 14.2, 64.8 ± 16.9, 67.4 ± 17.7, and 55.8 ± 25.5 at 6, 12, 24, and 60 months, respectively. All obesity-related co-morbidities improved significantly. MAII score increased from -.38 ± 1.3 preoperatively to 1.77 ± .8, 2.08 ± 0.8, 2.12 ± .7, and 1.67 ± 1.1 at the above time points, respectively (trend P < .001), and visual analog scale increased from 3.05 ± 1.6 to 9.11 ± 1.0, 9.2 ± 1.1, 9.03 ± 1.3, and 7.85 ± 2.4 (P < .001). Overall QoL scores at 6 and 24 months (P < .001), as well as patients' female sex, correlated significantly with higher QoL at the end of the study. CONCLUSIONS: Laparoscopic SG is an effective bariatric operation, resulting in significant weight loss and improvements in QoL. Female sex and higher MAII score at 6 and 24 months predict better long-term QoL outcome.

Roux-en-Y Gastric Bypass: Does the Direction of Staples Matter?

PURPOSE: Mechanical gastro-intestinal anastomosis using stapler is a critical step in laparoscopic Roux-en-Y gastric bypass (RYGB). To date the effect of the direction of staples on anastomotic leak has not been investigated. The study aim was to investigate the impact of the direction of staples on the integrity of the gastro-jejunal anastomosis. MATERIALS AND METHODS: Eight gastro-jejunostomy (GJ) models were performed using porcine stomach and small intestine. Specimens were divided into group A where the cartridge was in the gastric lumen with the anvil in the jejunal lumen and vice versa in group B. Enterotomy was closed and gastric and jejunal ends were stapled off. Burst pressure (BP) was measured by infusion of methylene blue saline into the GJ model until leak occurred. Site of leak, BP, and total volume (TV) infused were recorded. Compliance (C) was calculated from the equation ΔTV/ΔBP. RESULTS: The BP was greater in group A compared to group B (18 mmHg (range 15-25) versus 11 mmHg (range 8-15); p = 0.045) despite similar TV between the groups 60.00 mL (range 55.00-65.00) versus 51.25 mL (range 40.00-60.00); p = 0.11). The compliance did not significantly differ between groups A and B (6.38 mL/mmHg (range 4.34-8.59) versus 5.61 mL/mmHg (range 3.93-7.21); p = 0.48). CONCLUSION: BP recorded when the stapler cartridge was introduced in the gastric lumen was higher than when it was introduced from the jejunal lumen. The lack of difference in compliance between groups suggests that the difference in BP was due to the difference in the direction of staples.

Building a model for day case hiatal surgery - Lessons learnt over a 10 year period in a high volume unit: A case series.

BACKGROUND: Laparoscopic anti-reflux surgery has become the standard treatment for symptomatic gastro-oesophageal reflux disease refractory to medical therapy. Successful anti-reflux surgery involves safe, minimally invasive surgery, resulting in symptom resolution with minimal side effects. This study aims to assess the feasibility and safety of day case anti-reflux surgery focussing on peri- and post-operative outcomes as a measure of success. METHODS: Data was collected from the hospital database from 2003 to 2012. Data collection included demographics, surgeon, mode of admission, length of stay and complications. Electronic records were independently scrutinised for all patients with a length of stay of more than two nights. RESULTS: 723 patients underwent laparoscopic fundoplication ±â€¯small hiatus hernia repair (<5 cm) with a day case rate of 67.1%. The 30 day readmission rate in these patients was 2.9% (21/723 patients). Nine patients had a failure of their initial laparoscopic fundoplication (defined as recurrence of symptoms). Three patients required a re-operation within 12 months of their initial procedure (re-operation rate = 0.41% (3/723 patients)). CONCLUSION: Laparoscopic hiatal surgery can be performed safely as a day case in high volume specialist centres with good outcomes. Raising the national standard for day case fundoplication promotes good practice and should be the model for future commissioning.

Systematic Review and Meta-Analysis of Outcomes After Revisional Bariatric Surgery Following a Failed Adjustable Gastric Band.

INTRODUCTION: Laparoscopic adjustable gastric band (LAGB)-related complications have been reported in significant numbers of patients often leading to band removal. Increasingly revisional bariatric surgery (RBS) is offered, most commonly either band to Roux-en-Y gastric bypass (B-RYGB) or band to sleeve gastrectomy (B-SG). OBJECTIVES: We conducted a systematic review and meta-analysis of studies to evaluate the efficacy of RBS following failed LAGB. METHODS: Medline, Embase, The Cochrane Library and NHS Evidence were searched for English language studies assessing patients who had undergone LAGB and who subsequently underwent either B-RYGB or B-SG. RESULTS: Thirty-six studies met the inclusion criteria. There were 2617 patients. B-RYGB was performed in 60.5% (n = 1583). There was one death within 30 days (0.0004%). The overall pooled morbidity rate was 13.2%. There was no difference between the B-RYGB and B-SG groups in morbidity, leak rate or return to theatre. Percentage excess weight loss (%EWL) following the revisional procedure for all patients combined at 6, 12 and 24 months was 44.5, 55.7 and 59.7%, respectively. There was no statistical difference in %EWL between B-RYGB and B-SG at any time point. The rates of remission of diabetes, hypertension and obstructive sleep apnoea were 46.5, 35.9 and 80.8%, respectively. CONCLUSIONS: Randomised controlled trials (RCTs) do not exist on this issue but the available observational evidence does suggest that RBS is associated with generally good outcomes similar to those experienced after primary surgery. Further, high-quality research, particularly RCTs, is required to assess long-term weight loss, comorbidity and quality of life outcomes.

The impact of bariatric surgery on estimated glomerular filtration rate in patients with type 2 diabetes: a retrospective cohort study.

BACKGROUND: Diabetes mellitus is the most common cause of end-stage renal disease, which is associated with increased morbidity and mortality. The impact of bariatric surgery on chronic kidney disease is unclear. OBJECTIVES: Our primary aim was to assess the impact of bariatric surgery on estimated glomerular filtration rate (eGFR) in type 2 diabetes (T2D) patients. Our secondary aim was to compare the impact of bariatric surgery versus routine care on eGFR in patients with T2D. SETTING: University Hospital, United Kingdom. METHODS: A retrospective cohort analysis of adults with T2D who underwent bariatric surgery at a single center between January 2005 and December 2012. Data regarding eGFR were obtained from electronic patients records. eGFR was calculated using the Modification of Diet in Renal Disease formula. Data regarding patients with T2D who did not undergo bariatric surgery ("routine care") were obtained from patients attending the diabetes clinic at the same center from 2009 to 2011. RESULTS: One hundred sixty-three patients were included (mean age 48.5±8.8 yr; baseline body mass index 50.8±9.1 kg/m2) and were followed for 3.0±2.3 years. Bariatric surgery resulted in an improvement in eGFR (median [interquartile range] 86.0 [73.0-100.0] versus 92.0 [77.0-101.0] mL/min/1.73 m2 for baseline versus follow-up, respectively; P = .003), particularly in patients with baseline eGFR≤60 mL/min/1.73 m2 (48.0 [42.0-57.0] versus 61.0 [55.0-63.0] mL/min/1.73 m2; P = .004). After adjusting for baseline eGFR, glycated hemoglobin (HbA1C), body mass index, age, and gender, bariatric surgery was associated with higher study-end eGFR compared with routine care (B = 7.787; P< .001). CONCLUSION: Bariatric surgery results in significant improvements in eGFR in T2D patients, particularly those with an eGFR≤60 mL/min/1.73 m2, while routine care was associated with a decline in eGFR.

Computed tomography-based assessment of abdominal adiposity changes and their impact on metabolic alterations following bariatric surgery.

BACKGROUND: The aim of this study was to evaluate the effects of surgically induced weight loss on the abdominal adipose tissue depots and the metabolic profile in morbidly obese (MO) patients. METHODS: The study was performed with a semi-automated quantification of adipose tissue compartments on single-slice abdominal CT series before surgery, 6 and 12 months after bariatric surgery. Thirty-eight MO patients with mean age of 35.7 ± 10.1 years and mean body mass index (BMI) of 43.6 ± 6.5 kg/m(2) were studied (20 patients underwent gastric banding and 18 patients underwent sleeve gastrectomy). Anthropometric measurements, metabolic and inflammatory parameters were analyzed in each patient. RESULTS: Markedly decreased levels of total abdominal adipose tissue, abdominal subcutaneous adipose tissue (AbSAT) and visceral adipose tissue (VAT) at 6 and 12 months were noted in comparison to the preoperative values. The total % reduction of VAT was significant higher in comparison to the total % reduction of AbSAT at 12 months after bariatric surgery (P < 0.01) with the mean ratio of AbSAT/VAT to increase from 4.1 ± 1.7 preoperatively to 6.2 ± 3.1 at 12 months postoperatively (P < 0.001). In addition, high-sensitivity C-reactive protein (hsCRP) decreased significantly with weight loss after bariatric surgery and the total abdominal lipid loss was related to the decrease in hsCRP. CONCLUSIONS: Significant changes in abdominal lipid deposition occurred in MO patients 6 and 12 months after bariatric surgery. The changes were significantly, correlated with the magnitude of BMI loss. The fat redistribution may contribute to the improvements in metabolic abnormalities.

Cupriavidus metallidurans biomineralization ability and its application as a bioconsolidation enhancer for ornamental marble stone.

Bacterially induced calcium carbonate precipitation of a Cupriavidus metallidurans isolate was investigated to develop an environmentally friendly method for restoration and preservation of ornamental stones. Biomineralization performance was carried out in a growth medium via a Design of Experiments (DoE) approach using, as design factors, the temperature, growth medium concentration, and inoculum concentration. The optimum conditions were determined with the aid of consecutive experiments based on response surface methodology (RSM) and were successfully validated thereafter. Statistical analysis can be utilized as a tool for screening bacterial bioprecipitation as it considerably reduced the experimental time and effort needed for bacterial evaluation. Analytical methods provided an insight to the biomineral characteristics, and sonication tests proved that our isolate could create a solid new layer of vaterite on marble substrate withstanding sonication forces. C. metallidurans ACA-DC 4073 provided a compact vaterite layer on the marble substrate with morphological characteristics that assisted in its differentiation. The latter proved valuable during spraying minimum amount of inoculated media on marble substrate under conditions close to an in situ application. A sufficient and clearly distinguishable layer was identified.

Adipose tissue fatty acid composition in Greek patients with breast cancer versus those with benign breast tumors.

BACKGROUND: Fatty acid composition of adipose tissue is a most reliable biomarker of long-term dietary fatty acid intake. Few studies have implemented biomarkers of fatty acid intake in relation to breast cancer. In this study the relation between adipose tissue composition and breast cancer was investigated. PATIENTS AND METHODS: Fatty acid composition in breast and buttock adipose tissue from 94 Greek women with breast cancer and 57 with benign breast tumors was determined. Multivariate analysis was performed to determine the association between fatty acid groups and breast cancer risk. RESULTS: In pre-menopausal women, elevated total polyunsaturated fatty acids (PUFA) in breast adipose tissue and N-3 PUFA in buttock adipose tissue were associated with reduced odds of breast cancer (odds ratio, OR=0.19; 95% confidence interval, CI=0.05-0.76, p<0.02 and OR=0.02; 95% CI=0.0009-0.36, p<0.009). CONCLUSION: Adipose total PUFA and N-3 PUFA were inversely-related to breast cancer risk in Greek pre-menopausal women. These results may have specific impact on habitual fat intake recommendations.

Alterations in gut hormones after laparoscopic sleeve gastrectomy: a prospective clinical and laboratory investigational study.

OBJECTIVE: To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on fasting and meal-stimulated release of the gut hormones ghrelin, pancreatic polypeptide (PP), peptide-YY (PYY), glucagon-like peptide-1 (GLP-1), and amylin and of the adipocytokine leptin. BACKGROUND: Mounting evidence suggests that the mechanisms of weight loss and the improvement in glucose metabolism seen after LSG are related not only to gastric restriction but also to neurohormonal changes. METHODS: : Fasting and postprandial levels at 60 and 120 minutes after a standard test meal of the above peptides and glucose metabolism indices were evaluated in 15 consecutive morbidly obese (MO) subjects before and 6 and 12 months after LSG. As study controls, 15 lean subjects matched for age and sex were also assessed. RESULTS: Body mass index values notably decreased at 6 and 12 months (P < 0.01), postoperatively. In addition, an overall improvement of the glycemic profile of MO patients was noted. After LSG, markedly decreased fasting and postprandial levels of ghrelin, amylin, and leptin were observed. A significant postprandial increase of PYY and GLP-1 levels was also noted postoperatively. Interestingly, significantly increased levels of PP were noted only at 60 minutes postprandially after LSG. CONCLUSIONS: LSG markedly improved glucose homeostasis and generated significant changes in ghrelin, PP, PYY, GLP-1, amylin, and leptin levels. These multiple hormonal actions may have several beneficial effects on the underlying mechanism of weight loss, demonstrating that LSG could be more than just a restrictive bariatric operation.

Validation of the Greek translation of the obesity-specific Moorehead-Ardelt Quality-of-Life Questionnaire II.

Morbid obesity adversely affects quality of life. The assessment of health-related quality of life (HRQoL) needs specific measuring instruments. The Moorehead-Ardelt Quality-of-Life Questionnaire II (MA II) is an obesity-specific instrument widely used in bariatric surgery. The objective of this study was to translate and validate the MA II in Greek language. The study included the translation of the MA II followed by cross-validation with the Greek version of 36-item Short Form Health Survey (SF-36) and a Visual Analogue Scale (VAS) in subjects visiting an obesity clinic. Internal consistency was indicated by Cronbach's alpha coefficient and test-retest reliability by intraclass correlation coefficient (ICC). Construct validity was studied using Pearson's correlations between the MA II, the SF-36 and the VAS. A total of 175 patients were enrolled in the study. Test-retest analysis was applied to 40 patients with a 15-day interval. A very good internal consistency with Cronbach's alpha coefficient of 0.85 was shown. Excellent test-retest reliability was observed with an overall ICC of 0.981. Significant correlations between the Greek MA II and the other instruments as well as of each item of the MA II with the scores of SF-36 and the VAS indicated high construct and convergent validity. A negative correlation between the translated MA II total score and BMI confirmed high clinical validity. The Greek version of the MA II questionnaire has been generated and shown to be valid and reliable in measuring HRQoL in morbidly obese patients before and after bariatric surgery.

Two important criteria for reducing the risk of postoperative ulcers at the gastrojejunostomy site after gastric bypass: patient compliance and type of gastric bypass.

BACKGROUND: Ulcers at the gastrojejunostomy site are a common problem after gastric surgery. Their postoperative development seems to be associated with Helicobacter pylori-related gastritis or abuse of nicotine, alcohol or non-steroidal anti-inflammatory drugs (NSAIDs), but is also dependent on the choice of surgical method (Roux-en-Y or B-II gastric bypass). PATIENTS AND METHODS: This study evaluated the follow-up of 1,908 patients over a period of 5 years (January 2006-December 2010). In 1,861 cases, we performed a Roux-en-Y gastric bypass, and in 47 cases a B-II gastric bypass. RESULTS: All patients (n = 407) with symptoms such as dysphagia, reflux, nausea, vomiting or epigastric pain underwent gastroscopy. In 52 cases, ulcers were found at the gastrojejunostomy site. Of these patients, 39 (75%; p < 0.0001) had consumed alcohol, nicotine or NSAIDs; in 14 patients (27%; p < 0.0001) we detected H. pylorirelated gastritis. A total of 2.4% of the patients after Roux-en-Y gastric bypass (45/1,861) and 14.9% of the patients after B-II gastric bypass (7/47) developed ulcers at the gastroenteral junction. The difference is clearly significant (Fisher's exact test, p = 0.0002). Furthermore, there were significant differences regarding the recurrence rate: 86% of the B-II gastric bypass group and 13.3% of the Roux-en-Y gastric bypass group needed to be treated several times. CONCLUSIONS: Every patient needs to be informed preoperatively that there is a markedly increased risk of ulcers at the gastroenteral junction, particularly if the patient cannot avoid potential risk factors (nicotine, alcohol, NSAIDs). Preoperative gastroscopy with H. pylori testing and subsequent eradication can also reduce the risk of ulcers. An increased incidence of peptic ulcers after B-II gastric bypass was noted. All of these patients were converted to Roux-en-Y.

Changes in metabolic profile and adipoinsular axis in morbidly obese premenopausal females treated with restrictive bariatric surgery.

BACKGROUND: The aim of the present study was to evaluate the effects of surgically induced weight loss on the metabolic profile and adipocytokine levels in premenopausal morbidly obese females. METHODS: Twenty premenopausal morbidly obese (MO) women with a median age of 34 years (range: 24-48 years) and a median body mass index (BMI) of 41.47 kg/m(2) (range: 38.0-56.73 kg/m(2)) were studied (13 women underwent gastric banding and 7 women underwent sleeve gastrectomy). In addition, 20 lean premenopausal women with a median age of 32 years (range: 22-44 years) and a median BMI of 20.0 kg/m(2) (range: 18.5-24.7 kg/m(2)) were also studied. Anthropometric measurements and metabolic parameters were analyzed in each patient, along with changes in leptin, adiponectin, resistin, and interleukin-6 (IL-6) before surgery, 6 months after surgery, and 12 months after surgery. Comparisons with the reference normal-weight subjects were also performed. RESULTS: Both weight and BMI were found to be significantly decreased postoperatively. A 54.5% loss of excess BMI was observed 12 months after surgery, and was associated with significant improvement in all anthropometric and metabolic parameters. Twelve months after surgery we also observed decreased levels of serum leptin, resistin, and IL-6; increased levels of serum adiponectin; and a remarkable improvement in metabolic syndrome markers. Furthermore, postoperative serum resistin and IL-6 levels were found to reach those of normal-weight volunteers. CONCLUSIONS: The results of this study suggest that weight loss through restrictive bariatric surgery results in a significant reduction in leptin, resistin, and IL-6 levels, and an increase in adiponectin levels, in addition to improving insulin sensitivity and glucose and lipid homeostasis in young morbidly obese female patients. These changes were significantly correlated with the magnitude of weight loss.

Impact of surgeon experience and buttress material on postoperative complications after laparoscopic sleeve gastrectomy.

BACKGROUND: Sleeve gastrectomy is gaining popularity whether as a primary, staged or revisional operation. The aim of this study is to evaluate the perioperative safety and the learning curve for laparoscopic sleeve gastrectomy (LSG). METHODS: We performed a retrospective review of the prospectively collected data for all patients who underwent LSG for the treatment of morbid obesity at our institution from January 2003 to December 2008. RESULTS: Data from 230 consecutive patients [male 47%, female 53%; mean age 44.0 ± 10.0 years, mean preoperative body mass index (BMI) 56.7 ± 11.5 kg/m(2)], who were operated upon by three surgeons with different degrees of bariatric experience, were analyzed. There was no 30-day mortality, but there were two cases of late mortality (0.87%). Early complications were noted in 23 cases (10.0%), including 10 cases of leak (4.3%) and 10 cases of hemorrhage (4.3%). In 17 cases (7.4%) reoperations were performed. The rates of overall and major complications did not differ among surgeons or between early and late period of experience for the three surgeons; this trend held true individually and in subgroups. Overall, over the course of the learning curve, a significant decrease in operative time was noted. The only factor that was independently associated with complications was use of buttress material; the likelihood of complications was found to be 72% lower in patients in whom buttress material was used. CONCLUSIONS: LSG constitutes a potentially safe anti-obesity procedure with acceptable morbidity. Experience at the beginning can be discouraging, even for surgeons with advanced laparoscopic skills. LSG can be performed safely, with proper mentoring and in appropriate settings, even by less experienced bariatric surgeons. The use of staple-line reinforcement was associated with improved perioperative outcomes, and it should be considered in an attempt to decrease leaks.