Duodenal switch without versus with laparoscopic cholecystectomy: a perioperative risk comparative analysis of the MBSAQIP database (2015-2019).

BACKGROUND: The results of concurrent cholecystectomy with Roux-en Y gastric bypass and sleeve gastrectomy have been well elucidated. Large-scale data on the outcomes of concomitant cholecystectomy during biliopancreatic diversion with duodenal switch (BPD-DS) are still lacking. Our study aimed to explore whether simultaneous cholecystectomy with BPD-DS alters the 30-day postoperative outcomes. METHODS: We conducted a retrospective analysis of the MBSAQIP database between 2015 and 2019. Propensity-score matching (PSM) in BPD-DS with cholecystectomy (Group 1) and BPD-DS without cholecystectomy (Group 2) cohorts was performed (PSM ratio 1:2). The two groups were matched for a total of 21 baseline variables including age, gender, BMI, ASA class, and other medical comorbidities and conditions. The 30-day postoperative morbidity, mortality, reoperation, reintervention, and readmissions were obtained. RESULTS: Initially, 568 patients in Group 1 and 5079 in Group 2 were identified. After performing PSM, 564 and 1128 patients respectively were compared. The BPD-DS with cholecystectomy group reported a higher rate of reoperation and reintervention compared to BPD-DS alone (3.9% versus 2.4% and 3.2% versus 2%, respectively), even though it did not reach statistical significance. The intervention time was significantly higher in Group 1 compared to Group 2 (192.4 ± 77.6 versus 126.4 ± 61.4 min). Clavien-Dindo complications (1-5) were similar between these two PSM cohorts. CONCLUSION: Concomitant cholecystectomy during BPD-DS increases operative times but does not affect the other outcomes. Based on our results, the decision of cholecystectomy at the time of BPD-DS should be left to the surgeon's judgment.

Revisional bariatric surgery after adjustable gastric band: a multicenter Polish Revision Obesity Surgery Study (PROSS).

BACKGROUND: Adjustable gastric band (AGB) hadbeen the preferred treatment for morbid obesity because it is minimally invasive and reversible. But now it seems to be slowly becoming a historic procedure due to the disappointing effects. The aim of the study was to systematize and present the available data on revisional bariatric surgery (RBS) after AGB among Polish patients. METHODS: It is a multicenter, retrospective analysis of patients undergoing laparoscopic RBS after AGB in 12 Polish bariatric centers. The database included patient demographics, comorbidities and surgical outcomes. RESULTS: The group consisted of 234 patients who underwent AGB, which accounted for 29% of revisional cases recorded in the Polish Revisional Obesity Surgery Study (PROSS). 195 were women (83%), and 39 were men (17%). One hundred seventy-five patients after AGB experienced a weight regain (74.5%), 36 patients a gastric band slippage (15.0%), 14 patients had gastric band intolerance (6.0%). Types of RBS included 116 sleeve gastrectomies (SG) (49.4%), 86 Roux-en Y gastric by-passes (RYGB) (36.6%), 20 one anastomosis gastric by-passes (OAGB) (8,5%). The highest weight loss expressed as %EBMIL was observed after OAGB (63.5 ± 32.4%). CONCLUSIONS: The main indication for RBS after AGB was weight regain. SG was the most frequently chosen type of RBS after AGB. RBS after AGB leads to weight loss and improvement in type 2 diabetes and hypertension with an acceptable low risk of complications. TRIAL REGISTRATION: NCT05108532.

Will ChatGPT pass the Polish specialty exam in radiology and diagnostic imaging? Insights into strengths and limitations.

Purpose: Rapid development of artificial intelligence has aroused curiosity regarding its potential applications in medical field. The purpose of this article was to present the performance of ChatGPT, a state-of-the-art language model in relation to pass rate of national specialty examination (PES) in radiology and imaging diagnostics within Polish education system. Additionally, the study aimed to identify the strengths and limitations of the model through a detailed analysis of issues raised by exam questions. Material and methods: The present study utilized a PES exam consisting of 120 questions, provided by Medical Exami-nations Center in Lodz. Questions were administered using openai.com platform that grants free access to GPT-3.5 model. All questions were categorized according to Bloom's taxonomy to assess their complexity and difficulty. Following the answer to each exam question, ChatGPT was asked to rate its confidence on a scale of 1 to 5 to evaluate the accuracy of its response. Results: ChatGPT did not reach the pass rate threshold of PES exam (52%); however, it was close in certain question categories. No significant differences were observed in the percentage of correct answers across question types and sub-types. Conclusions: The performance of the ChatGPT model in the pass rate of PES exam in radiology and imaging diagnostics in Poland is yet to be determined, which requires further research on improved versions of ChatGPT.

The effect of smoking on bariatric surgical 30-day outcomes: propensity-score-matched analysis of the MBSAQIP.

BACKGROUND: The exact impact of smoking within the last 12 months on the safety outcome of sleeve gastrectomy and Roux-Y gastric bypass is not well known. The study aimed to assess the effects of smoking on 30-day surgical outcomes. METHODS: Preoperative characteristics and outcomes from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program dataset 2015-2018 were selected for all patients who underwent primary sleeve gastrectomy or Roux-Y gastric bypass. 30-day postoperative outcomes were assessed. We used propensity score matching to control for potential confounding. RESULTS: In laparoscopic sleeve gastrectomy group, 29 165 pairs were included in the analysis. Smoking increased risk for inpatients readmission rate (3.67% vs. 3.10%; RR, 1.18; 95%CI 1.08-1.29, p < 0.001), intervention rate (1.03% vs. 0.84%; RR, 1.22; 95%CI 1.00-1.24, p = 0.020), reoperation rate (0.99% vs. 0.79%; RR, 1.25; 95%CI 1.05-1.48, p = 0.010), and leak rate (0.59% vs. 0.32%; RR, 1.83; 95%CI 1.43-2.37, p < 0.001). In laparoscopic Roux-Y gastric bypass cohort,11 895 pairs were included in the ultimate analysis. Smoking increased risk for inpatients readmission rate (7.54% vs. 5.88%; RR, 1.28; 95%CI 1.16-1.41, p < 0.001), intervention rate (3.53% vs. 2.30%; RR, 1.54; 95%CI 1.32-1.80, p < 001), reoperation rate (3.17% vs. 1.86%; RR, 1.70; 95%CI 1.45-2.00, p < 0.001), leak rate (1.05% vs. 0.59%; RR, 1.78; 95%CI 1.33-2.39, p < 0.001), bleed rate (2.03% vs. 1.45%; RR, 1.39; 95%CI 1.15-1.69, p < 0.001), and morbidity (4.20% vs. 3.38%; RR, 1.24; 95%CI 1.09-1.41, p = 0.001). CONCLUSION: Smoking cigarettes at any point within the 12 months before admission for surgery increased the risk for surgical short-term complications in bariatric patients. The effect was the most significant regarding leaks.

Influence of COVID-19 Pandemic Lockdown on Patients from the Bariatric Surgery Waiting List.

Background and Objectives: Social isolation and lockdown due to the COVID-19 pandemic have influenced dietary habits and physical activity of all the population, but the obese population is the most vulnerable to weight gain. Material and Methods: A group of 189 patients (166 female and 23 male) from the bariatric surgery waiting list filled in a survey about the influence of COVID-19 pandemic lockdown on their dietary habits, physical activity, and the possibility of contact with their bariatric care center. Results: The majority of patients with weight gain declared a decrease in physical activity, compared to half of the patients without weight gain (50.5% vs. 74.5%, p < 0.05). The continuation of bariatric care and the possibility of contact with a bariatric surgeon, dietician, and psychologist had each significant influence on reducing the risk of patients' weight gain (p < 0.05). Conclusions: Maintaining physical activity and contact with bariatric care specialists are important factors in allowing to avoid weight gain in patients waiting for bariatric surgery.

Impact of the COVID-19 Pandemic on the Patient's Decision about Bariatric Surgery: Results of a National Survey.

Background: the COVID-19 pandemic and the implemented restrictions have changed the functioning of healthcare systems worldwide. The purpose of the study was to evaluate the impact of the present epidemiological situation on patients' decisions about undergoing weight loss surgery. Methods: data were collected from 906 bariatric patients by the means of a national online survey, the majority of whom were women (87.9%). The survey started on 9 April 2020 and was open until 28 April 2020. The questionnaire included multiple choice and open questions, divided into three chapters: general information about the patient, life during the COVID-19 pandemic, and bariatric care during the COVID-19 pandemic. Results: despite the pandemic and the associated risk of COVID-19 infection, 443 responders (48.9%) would have decided to undergo bariatric surgery. Awareness of the negative impact of obesity on the course of COVID-19 illness had only marginable impact on patients' decision-making (76.6% vs. 75.3%; p < 0.80). Contact with COVID-19 prior to the survey had a negative impact on the willingness to undergo bariatric surgery (3.0% vs. 4.4%; p < 0.55). There was a positive correlation between the BMI and preference for bariatric surgery in the time of the pandemic (37.4 ± 9.0 vs. 34.9 ± 8.7; p < 0.001). Conclusions: the level of awareness about the advantages of operative treatment of obesity is high among bariatric patients. The majority of patients awaiting bariatric surgery at the moment of the survey were positive about undergoing bariatric surgery despite the increased risk of a serious course of COVID-19 infection. Therefore, a large proportion of patients was determined to have bariatric treatment even during the pandemic, being aware of the increased risk of worse pace of COVID-19 disease in case of obesity and related diseases.

Safety of Revision Sleeve Gastrectomy Compared to Roux-Y Gastric Bypass After Failed Gastric Banding: Analysis of the MBSAQIP.

OBJECTIVE: The aim of this study was to assess the safety of revisional surgery to laparoscopic sleeve gastrectomy (LSG) compared to laparoscopic Roux-Y gastric bypass (LRYGB) after failed laparoscopic adjustable gastric banding (LAGB). BACKGROUND: The number of reoperations after failed gastric banding rapidly increased in the United States during the last several years. A common approach is band removal with conversion to another weight loss procedure such as gastric bypass or sleeve gastrectomy in a single procedure. The safety profile of those procedures remains controversial. METHODS: Preoperative characteristics and 30-day outcomes from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Participant Use Files 2015 were selected for all patients who underwent a 1-stage conversion of LAGB to LSG (conv-LSG) or LRYGB (conv-LRYGB). Conv-LSG cases were matched (1:1) with conv-LRYGB patients by age (±1 year), body mass index (±1 kg/m(2)), sex, and comorbidities including diabetes, hypertension, hyperlipidemia, venous stasis, and sleep apnea. RESULTS: A total of 2708 patients (1354 matched pairs) were included in the study. The groups were closely matched as intended. The mean operative time in conv-LRYGB was significantly longer in comparison to conv-LSG patients (151 ±â€Š58 vs 113 ±â€Š45 minutes, P < 0.001). No mortality was observed in either group. Patients after conv-LRYGB had a clinically increased anastomotic leakage rate (2.07% vs 1.18%, P = 0.070) and significantly increased bleed rate (2.66% vs 0.44%, P < 0.001). Thirty-day readmission rate was significantly higher in conv-LRYGB patients (7.46% vs 3.69%, P < 0.001), as was 30-day reoperation rate (3.25% vs 1.26%, P < 0.001). The length of hospital stay was longer in conv-LRYGB. CONCLUSIONS: A single-stage conversion of failed LAGB leads to greater morbidity and higher complication rates when converted to LRYGB versus LSG in the first 30 days postoperatively. These differences are particularly notable with regards to bleed events, 30-day reoperation, 30-day readmission, operative time, and hospital stay.

What Makes Bariatric Operations Difficult-Results of a National Survey.

Background and objective: The most commonly performed bariatric procedures include laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), and one anastomosis gastric bypass-mini gastric bypass (OAGB-MGB). A study comparing the degree of difficulty among those procedures could serve as a guide for decision making in bariatric surgery and further improve training programs for general surgery trainees. The aim of this study was to compare the subjective level of technical difficulty of LSG, LRYGB, and OAGB-MGB as perceived by surgeons and surgical residents. Materials and Methods: An anonymous internet-based survey was designed to evaluate the subjective opinions of surgeons and surgical residents in training in Poland. It covered baseline characteristics of the participants, difficulty of LSG, OAGB-MGB, LRYGB and particular stages of each operation assessed on a 1-5 scale. Results: Overall, 70 surgeons and residents participated in our survey. The mean difficulty degree of LSG was 2.34 ± 0.89. The reinforcing staple line with sutures was considered most difficult stage of this operation (3.17 ± 1.19). The LRYGB operation had an average difficulty level of 3.87 ± 1.04. Creation of the gastrojejunostomy was considered the most difficult stage of LRYGB with a mean difficulty level (3.68 ± 1.16). Responders to our survey assessed the mean degree of difficulty of OAGB-MGB as 2.34 ± 0.97. According to participating surgeons, creating the gastrojejunostomy is the most difficult phase of this operation (3.68 ± 1.16). Conclusion: The LSG is perceived by surgeons as a relatively easy operation. The LRYGB was considered to be the most technically challenging procedure in our survey. Operative stages, which require intra-abdominal suturing with laparoscopic instruments, seem to be the most difficult phases of each operation.

Impact of age on postoperative outcomes in bariatric surgery.

BACKGROUND: Age is often related to the increase of perioperative complications and reoperation rates. The authors aimed to determine the influence of age on outcomes of most commonly performed bariatric procedures. METHODS: The retrospective study included patients qualified for primary Laparoscopic Sleeve Gastrectomy (LSG) or Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) in two academic hospitals. Patients were divided into two groups: ≥50 (21.2-26.9%) and <50 (57.6-73.1%) years old. Endpoints assessed the influence of patients' age on the perioperative and the one-year postoperative period. RESULTS: Operative time was longer in the ≥50-year-old group, but only for LRYGB. There were no differences in the intraoperative adverse events, postoperative morbidity, reoperation and readmission rates between the groups. The risk of port site hernia was increased (OR: 4.23, CI: 1.49-12.06) in the ≥50-year-old group. The mean % of total weight loss 12 months after the bariatric procedure was comparable, but % of excess weight loss and % of excess body mass index loss were lower in the ≥50-year-old group (p = .033 and .032). CONCLUSIONS: Bariatric surgery is safe and feasible in patients over 50 years old. The weight loss effect can be worse among patients over 50 years old; nevertheless, the treatment should be considered as effective.

The influence of obesity on the safety of laparoscopic cholecystectomy: a retrospective analysis.

Introduction: The increasing prevalence of obesity worldwide has raised concerns about its impact on surgical outcomes across various procedures. Laparoscopic cholecystectomy (LC), a common surgical intervention for benign gallbladder disease, is no exception. The relationship between obesity and LC outcomes remains complex and merits further investigation. Aim: This retrospective study aimed to assess the influence of obesity on the safety and surgical outcomes of LC. Material and methods: Patients were divided into 2 groups: those with obesity (body mass index (BMI) ≥ 30 kg/m²) and non-obese controls (BMI < 30 kg/m²). Baseline characteristics, operative duration, hospitalization length, and post-operative complications, categorized by the Clavien-Dindo classification, were evaluated. Results: Among 116 patients with obesity and 176 non-obese controls, differences in age and gender were noted but were not clinically significant. Operative time was longer in the group with obesity. Hospitalization length and adverse event occurrence did not differ significantly. Importantly, post-operative complications showed no substantial differences between the groups, suggesting that obesity may not significantly increase the complication risk in this population. Conclusions: Obesity may not substantially elevate the risk of adverse events or severe complications following LC in this patient population. Careful patient selection, preoperative evaluation, and surgical technique remain crucial. Further research in larger, diverse populations is needed to validate these findings.

Digital Subtraction Angiography of Cerebral Arteries: Influence of Cranial Dimensions on X-ray Tube Performance.

(1) Background. Digital subtraction angiography (DSA) is indispensable for diagnosing cerebral aneurysms due to its superior imaging precision. However, optimizing X-ray parameters is crucial for accurate diagnosis, with X-ray tube settings significantly influencing image quality. Understanding the relationship between skull dimensions and X-ray parameters is pivotal for tailoring imaging protocols to individual patients. (2) Methods. A retrospective analysis of DSA data from a single center was conducted, involving 251 patients. Cephalometric measurements and statistical analyses were performed to assess correlations between skull dimensions and X-ray tube parameters (voltage and current). (3) Results. The study revealed significant correlations between skull dimensions and X-ray tube parameters, highlighting the importance of considering individual anatomical variations. Gender-based differences in X-ray parameters were observed, emphasizing the need for personalized imaging protocols. (4) Conclusions. Personalized approaches to DSA imaging, integrating individual anatomical variations and gender-specific differences, are essential for optimizing diagnostic outcomes. While this study provides valuable insights, further research across multiple centers and diverse imaging equipment is warranted to validate these findings.

Radiation Dose during Digital Subtraction Angiography of the Brain-The Influence of Examination Parameters and Patient Factors on the Dose.

Cerebral vascular angiography, or digital subtraction angiography (DSA), is essential for diagnosing neurological conditions but poses radiation risks. This study aims to analyze the impact of examination parameters and patient characteristics on the radiation dose received during DSA to optimize safety and minimize exposure. A retrospective analysis of 251 DSA procedures using the GE Innova IGS 630 dual-plane instrument was conducted. Data on dose area product (DAP) and air kerma (KERMA), along with patient and examination details, were collected. Statistical analyses, including Mann-Whitney, Kruskal-Wallis, and Spearman rank correlation tests, assessed the relationships between variables and radiation dose outcomes. Significant correlations were found between the sides examined (left, right, or both) and DAP (p < 0.0001) and KERMA (p < 0.0001) values, with bilateral studies showing the highest values. The post hoc Dunn tests showed that the 'L + P' group significantly differs from both the right group (p < 0.0001 and the left group (p < 0.0001). There is no significant difference between the 'P' group and the 'L' group (p-value = 0.53). These results suggest that the right and left (both) group have unique KERMA mGy values compared to the other two groups. A strong correlation (rS = 0.87) existed between DAP and KERMA. The number of projections significantly impacted radiation dose (rS = 0.61). Tube parameters (kV and mA) and skull size had low correlations with DAP and KERMA. Optimizing imaging protocols and individualizing parameters can significantly enhance patient safety and diagnostic efficacy while also reducing occupational exposure for medical staff.

Deep Learning in Cardiothoracic Ratio Calculation and Cardiomegaly Detection.

Objectives: The purpose of this study is to evaluate the performance of our deep learning algorithm in calculating cardiothoracic ratio (CTR) and thus in the assessment of cardiomegaly or pericardial effusion occurrences on chest radiography (CXR). Methods: From a database of 8000 CXRs, 13 folders with a comparable number of images were created. Then, 1020 images were chosen randomly, in proportion to the number of images in each folder. Afterward, CTR was calculated using RadiAnt Digital Imaging and Communications in Medicine (DICOM) Viewer software (2023.1). Next, heart and lung anatomical areas were marked in 3D Slicer. From these data, we trained an AI model which segmented heart and lung anatomy and determined the CTR value. Results: Our model achieved an Intersection over Union metric of 88.28% for the augmented training subset and 83.06% for the validation subset. F1-score for subsets were accordingly 90.22% and 90.67%. In the comparative analysis of artificial intelligence (AI) vs. humans, significantly lower transverse thoracic diameter (TTD) (p < 0.001), transverse cardiac diameter (TCD) (p < 0.001), and CTR (p < 0.001) values obtained using the neural network were observed. Conclusions: Results confirm that there is a significant correlation between the measurements made by human observers and the neural network. After validation in clinical conditions, our method may be used as a screening test or advisory tool when a specialist is not available, especially on Intensive Care Units (ICUs) or Emergency Departments (ERs) where time plays a key role.

The effect of bariatric surgery on reducing the risk of colorectal cancer: a meta-analysis of 3,233,044 patients.

BACKGROUND: The published literature presents conflicting results regarding the impact of bariatric surgery on the incidence of colorectal cancer. There are important new studies that have addressed this question with longer follow-up. OBJECTIVE: To investigate the effect of bariatric surgery on the risk of developing colorectal cancer in patients with obesity. SETTING: Meta-analysis. METHODS: PubMed and Scopus were searched for relevant articles. Articles published by November 2021 were retrieved; data were extracted according to the evidence-based PICO (population, intervention, control, outcome) model and analyzed using a random-effects model to estimate the pooled relative risk (RR) and its 95% confidence interval. The heterogeneity of studies was tested and quantified using Cochran's Q. RESULTS: The initial search yielded 327 articles. After evaluation, 13 studies were analyzed. The thorough evaluation resulted in 13 articles, which were analyzed. A total number of 3,233,044 patients were included in the meta-analysis. The mean time of follow-up was 9.5 ± 7.9 years. The pooled estimate of the adjusted RR was .63 (95% confidence interval, .50-.79). Heterogeneity χ2 was 107.96 (df = 12; P < .001; I2 = 89%). CONCLUSION: Patients who underwent bariatric surgery had a 37% reduction in the risk of developing colorectal cancer compared with patients with obesity who had no surgery.

Influence of staple line reinforcement on the occurrence of bleeding complications following laparoscopic sleeve gastrectomy: a retrospective analysis.

Introduction: Laparoscopic sleeve gastrectomy (LSG) has gained prominence as a therapeutic option for obesity and metabolic diseases. The choice of staple line reinforcement technique in LSG remains a subject of debate, particularly concerning postoperative bleeding complications. Aim: The aim of this retrospective analysis is to assess the influence of different staple line reinforcement techniques on the occurrence of bleeding complications LSG. Material and methods: We conducted a retrospective analysis of patients undergoing LSG between September 2021 and April 2023 at our institution. Patients were stratified into two groups based on the staple line reinforcement method: continuous suturing (n = 53) and clipping (n = 28). Surgical outcomes, including operative time, length of hospital stay, and bleeding complications, were assessed. Complications were classified using the Clavien-Dindo classification. Results: Continuous suturing was associated with a significantly longer operative time (88.15 min vs. 74.64 min, p < 0.05) but a similar length of hospital stay. Notably, no bleeding complications occurred in the continuous suturing group, while the clipping group experienced postoperative bleeding in 7.14% of cases (p < 0.05). Continuous suturing exhibited a slightly higher incidence of minor complications classified as Class I in the Clavien-Dindo classification (7.55% vs. 0%). Conclusions: This retrospective analysis suggests that continuous suturing may provide enhanced hemostasis along the staple line, reducing the risk of postoperative bleeding compared to clipping. Despite the longer operative time and a slightly higher rate of minor complications, the clinical significance of these findings should be considered within the context of individual patient risk profiles.

Mobile applications in radiology: own study based on polish data.

As the number of smartphones increases, so does the number of medical apps. Medical mobile applications are widely used in many medical fields by both patients and doctors. However, there are still few approved mobile applications that can be used in the diagnostic-therapeutic process and radiological apps are affected as well. We conducted our research by classifying radiological applications from the Google Play® store into appropriate categories, according to our own qualification system developed by researchers for the purposes of this study. In addition, we also evaluated apps from the App Store®. The radiology application rating system we created has not been previously used in other articles. Out of 228 applications from the Google Play store, only 6 of them were classified as "A" category with the highest standard. Apps from the App Store (157) were not categorized due to the lack of download counts, which was necessary in our app-rating system. The vast majority of applications are for educational purposes and are not used in clinical practice. This is due to the need of obtaining special permits and certificates from relevant institutions in order to use them in medical practice. We recommend applications from the Google Play store that have been classified in the "A" category, evaluating them as the most valuable. App Store apps data is described and presented in the form of diagrams and tables.

What Is Machine Learning, Artificial Neural Networks and Deep Learning?-Examples of Practical Applications in Medicine.

Machine learning (ML), artificial neural networks (ANNs), and deep learning (DL) are all topics that fall under the heading of artificial intelligence (AI) and have gained popularity in recent years. ML involves the application of algorithms to automate decision-making processes using models that have not been manually programmed but have been trained on data. ANNs that are a part of ML aim to simulate the structure and function of the human brain. DL, on the other hand, uses multiple layers of interconnected neurons. This enables the processing and analysis of large and complex databases. In medicine, these techniques are being introduced to improve the speed and efficiency of disease diagnosis and treatment. Each of the AI techniques presented in the paper is supported with an example of a possible medical application. Given the rapid development of technology, the use of AI in medicine shows promising results in the context of patient care. It is particularly important to keep a close eye on this issue and conduct further research in order to fully explore the potential of ML, ANNs, and DL, and bring further applications into clinical use in the future.

Effect of Significant Postoperative Complications on Decision Regret After Laparoscopic Sleeve Gastrectomy: a Case-Control Study.

BACKGROUND: Thus far, no data are available on decision regret about sleeve gastrectomy (SG), particularly in patients who experienced perioperative complications. This study aimed to assess whether patients with postoperative complications regret their decision to undergo laparoscopic SG more than patients with an uneventful postoperative course. METHODS: The study group comprised patients with complications after laparoscopic SG (cases). The control group comprised patients who did not experience any postoperative complications (controls). A telephone survey was conducted on all patients. Patients' satisfaction regarding their decision to undergo surgery was assessed using the Decision Regret Scale. RESULTS: In total, 21 patients who experienced postoperative complications and 69 controls were included. The patients in the study and control groups achieved similar percentages of total weight loss (32.9 ± 11.9 vs. 33.8 ± 15.0, p = 0.717) and excessive body mass index loss (74.9 ± 30.7 vs. 73.1 ± 36.7, p = 0.398) at 1 year postoperatively. The difference in weight change at 12 months postoperatively was not significant in both groups. The mean regret scores in the study and control groups were 13.2 ± 1.2 (range, 28-63) and 13.3 ± 1.1 (range, 12-66) (p = 0.818), respectively. Moreover, no significant difference was found among patients who expressed regret between the study and control groups (regret score > 50; 4.76% vs. 4.35%) (p = 1.000). CONCLUSION: This study suggests that patients with postoperative complications do not regret their decision to undergo SG more than patients with an uneventful postoperative course.

Five-Year Analysis of the MBSAQIP Database: Are We Getting Better?

BACKGROUND: The MBSAQIP has been used to evaluate risk and create risk models. Previous studies have determined what complications matter most. STUDY DESIGN: This study was a registry-based analysis of patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) between January 1, 2015, and December 31, 2019, at centers participating in MBSAQIP. Cases were identified using Current Procedural Terminology. Patients less than 18 years old were excluded. A chi-square test was used to assess differences in the prevalence of complications and effects across years. Using a multivariable Poisson regression model with a link log and robust estimation, prevalence ratio estimates and 95% CI were obtained. RESULTS: A total of 690,770 observations met the inclusion criteria. Mean (SD) age was 44.5 (±12.0) years, and mean (SD) BMI was 45.2 kg/m2 (±7.9). SG cases accounted for 73.45% of all observations. There was a significant relative reduction in readmissions, end-organ dysfunction, and all-cause mortality from 2015 to 2019 in the SG subgroup. There were also noticeable reductions in 30-day readmission, ICU admission, and end-organ dysfunction in the RYGB subgroup. For complications, bleeding, postoperative pneumonia, and stroke were significantly decreased in the RYGB subgroup, but only bleeding was significantly decreased in the SG subgroup during the 5-year study period. CONCLUSIONS: There has been a continuous improvement in several (but not all) outcomes through the years that the MBSAQIP has been collecting data. Different outcomes were reduced between the SG and RYGB subgroups, and the decrease in all-cause mortality was only noted in the SG subgroup.

Decision Regret after Laparoscopic Sleeve Gastrectomy-5 Years' Perspective.

INTRODUCTION: Patient's satisfaction after weight loss surgery is in the research spotlight. However, there are still no quantitative data regarding whether patients regret their decision to undergo laparoscopic sleeve gastrectomy (SG). OBJECTIVES: The present study aimed to evaluate whether patients regret their decision to undergo SG 5 years after surgery. The secondary objective was to identify whether weight loss and a higher quality of life (QoL) score correlate with the regret expressed by patients. SETTING: Military Hospital, Poland METHODS: A telephone survey was carried out among patients 5 years after surgery. Patient satisfaction regarding their decision to undergo SG was assessed using the Decision Regret Scale. QoL scores were determined using the 36-Item Short Form Survey (SF-36). RESULTS: One hundred and four patients who answered a full telephone survey were enrolled in the study. Change in body mass index (ΔBMI) was 12.31±6.2, excess body mass index loss (%EBMIL) was 55.45%±25.52%, and percent total weight loss (%TWL) was 25.20%±11.7%. At the 5-year postoperative telephone survey, the mean general health score was 50.96±14.0 and the mean regret score was 32.33±13.24 (range, 25-85). A statistically significant negative correlation was observed between %EBMIL and regret score (r=-0.435; p<0.001). There was a significant negative association between regret score and energy/fatigue QoL (r=-0.205; p=0.040). Only eight patients (7.69%) scored >50 on the Decision Regret Scale, which was considered to represent overall regret for their decision. CONCLUSION: Our study suggests that, in general, patients did not regret their decision to undergo SG. KEY POINTS: The majority of patients did not regret their decision to undergo SG. There was a statistically significant negative correlation between weight loss and patients' feelings of regret. Energy/fatigue QoL was the strongest correlate of whether patients regretted their decision to undergo SG.