Robotic Revisional Single Anastomosis Duodenoileal Bypass After Sleeve Gastrectomy.

Introduction: Single anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) is a metabolic operation emerging as an option for patients with morbid obesity. It is a promising revisional procedure for weight regain or suboptimal weight loss after sleeve gastrectomy (SG). Currently, there is limited literature describing robotic revisional SADI-S. This study describes the safety, feasibility, and early outcomes of robotic revisional SADI-S after previous SG. Methods: This is a retrospective review from May 26 2019 to January 31 2021. Perioperative outcomes were analyzed. Results: A total of 16 patients underwent the procedure. There were 11 females (69%) with a mean age of 39 ± 11 years. Mean body mass index (BMI) was 44.0 ± 5.1 kg/m2 and median ASA was two. Comorbidities included hypertension (25%), hyperlipidemia (19%), and obstructive sleep apnea (13%). Mean interval from primary to revisional surgery among patients was 5.5 ± 1.4 years. Median operative console time was 110 minutes (IQR = 103-137). There were no intraoperative complications. The median hospital stay was 2 days (IQR = 2-3). Perioperative outcomes included no reoperations, perioperative complications, or deaths. There were two (12.5%) emergency department visits for wound checks without infection but no readmissions. At a median follow-up of 4.5 months (IQR = 1-10), patients had a mean BMI of 38.3 ± 7.3 kg/m2 and a mean percent total body weight loss (%TBW) of 12.7%. Conclusions: Initial outcomes suggest that robotic revisional SADI-S after previous SG is feasible and safe. Future studies are needed to evaluate intermediate- and long-term postoperative outcomes.

Outcomes of ipsilateral breast tumor recurrence after breast conserving surgery: Repeat lumpectomy as an alternative to salvage mastectomy.

BACKGROUND: We examined the outcomes of salvage mastectomy and repeat lumpectomy for management of ipsilateral breast tumor recurrence. METHODS: Between 2013 and 2019, 113 patients with an ipsilateral breast tumor recurrence after breast conserving surgery were identified. Patients and tumor characteristics at initial diagnosis and at recurrence were collected. Outcomes evaluated included second recurrence and overall survival. Complications at 30-days and 90-days after surgery for ipsilateral breast tumor recurrence were evaluated. RESULTS: Seventy-two percent of patients underwent salvage mastectomy (n = 84) and 28% underwent repeat lumpectomy (n = 32 overall, n = 13 reirradiation). Salvage mastectomy patients were younger at initial diagnosis (P = .007) with longer time to ipsilateral breast tumor recurrence from first diagnosis (P = .03). At 2.5 years median follow-up, the overall incidence of second recurrence was 8% with 5% rate (n = 4) in salvage mastectomy group versus 16% (n = 5) in repeat lumpectomy group; however, among patients undergoing repeat lumpectomy with reirradiation (n = 13), only one patient developed a second recurrence (8%). There was no significant difference in rates of second local recurrence (P = .11), disease free survival (P = .13), or overall survival (P = .95) between repeat lumpectomy with reirradiation and salvage mastectomy. CONCLUSION: At a short-term follow-up, repeat lumpectomy with reirradiation could be considered in a select group of patients presenting with an ipsilateral breast tumor recurrence with multidisciplinary input with low rates of postoperative complications and equivalent survival outcomes.

Resuming Bariatric Surgery Procedures During COVID-19 Pandemic: Early Surgical Outcomes at a Tertiary Referral Center in the Middle East.

Background: In response to the COVID-19 pandemic, elective surgical procedures have been delayed. Even with the implementation of surgical societies' recommendations, patient safety remains a concern. This study evaluates the postoperative outcomes in patients undergoing bariatric surgery after reopening (RO) elective surgery during the COVID-19 pandemic. Methods: All patients who underwent bariatric surgery from September 2015 to July 2020 were included. Patients were divided into two cohorts: the pre-COVID-19 (PC) cohort and the RO cohort. Propensity score weighting was used to evaluate postoperative outcomes. Results: Our study included 1076 patients, 1015 patients were in the PC and 61 patients in the RO. Sixty-four percent were female with a mean age of 37 years and median body mass index of 41 kg/m2. There were no statistically significant differences in 30 days perioperative outcomes, including emergency department visits 24.8% PC versus 19.7% RO (p = 0.492), readmission 4.2% PC versus 8.2% RO (p = 0.361), reoperation 2.6% PC versus 0% RO (p = 0.996), and major complications 4.0% PC versus 4.9% RO (p = 0.812). No patients in the RO contracted COVID-19. Conclusions: With the appropriate policies and precautionary measures, there appear to be no differences in the 30-day postoperative outcomes before and during the COVID-19 pandemic.