Incidence of nausea and vomiting after intragastric balloon placement in bariatric patients - A systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis was performed to examine the rates of nausea and vomiting along with other common side effects reported from different subtypes of intragastric balloons (IGBs) placed in obese adults. METHODS: The online databases of Pubmed, Cochrane Database, and Web of Science were searched to include studies conducted from 09/31/2012 to 09/31/2017 in English using keywords to identify articles relevant to this study. Two independent reviewers performed a full text review to ensure quality of studies and report rates of primary end point of interest: nausea and vomiting post IGB placement. RESULTS: Ten studies fulfilled the inclusion criteria. The treatment group's sample size comprised of 688 patients and adverse events' sample size comprised of 938 patients. We evaluated rates of nausea and vomiting of four subtypes of IGB systems: Elipse, Obalon, ORBERA, and ReShape and calculated meta-analytic rates based on adverse events' sample size. Total 564 patients reported experiencing nausea which provided a meta-analytic rate of 63.33% (95% CI 61.49%-65.16%), and 507 patients reported experiencing vomiting which resulted in a meta-analytic rate of 55.29% (95% CI 53.59%-56.99%). The ORBERA balloon system had the highest rates of nausea and vomiting compared to other balloon systems. CONCLUSIONS: Based on the findings from previous studies scrutinizing side effects of different types of IGB offered on the market, it has been concluded that nausea and vomiting are very common side effects post gastric balloon placement.

Does single-port laparoscopic sleeve gastrectomy result in improved short-term perioperative outcomes compared to conventional multi-port laparoscopic sleeve gastrectomy?

A best evidence topic in bariatric surgery was written according to a structured protocol. The question asked whether single-port laparoscopic sleeve gastrectomy produces better short-term perioperative outcomes compared to the conventional multi-port laparoscopic sleeve gastrectomy in the treatment of morbid obesity. A Pubmed search generated 82 papers, 6 of which represented the best evidence to answer the clinical question. Of the 6, 1 paper was an updated analysis of the same patient cohort. The evidence on this subject is good. Five papers were level III, nonrandomized studies, 2 of which were prospective and 3 were retrospective cohort studies. The sixth paper was a level II, randomized, prospective study. We conclude that single-port laparoscopic sleeve gastrectomy results in less use of postoperative analgesia and better cosmetic satisfaction compared to multi-port laparoscopic sleeve gastrectomy in the short-term. The two groups showed comparable results in terms of mean operative time, mean hospitalization, and percentage excess weight loss. There was no difference in rate of postoperative complications including trocar site incisional hernia, staple line leaks, and bleeding.

Lack of added predictive value of portable chest radiography in diagnosing ventilator-associated pulmonary infection.

INTRODUCTION: The accurate diagnosis of ventilator-associated pulmonary infection (VAPI) poses an ongoing challenge. At our institution, patients in whom VAPI is strongly suspected on the basis of the Clinical Pulmonary Infection Score (CPIS) undergo diagnostic mini-bronchoalveolar lavage (mBAL) with quantitative cultures, followed by empiric antibiotic therapy in our surgical intensive care unit (sICU). We sought to determine the role of portable chest X-radiography (pCXR) in the diagnosis of VAPI. METHODS: We conducted a retrospective analysis of mechanically ventilated adult (>18 y of age) patients with suspected VAPI undergoing concomitant pCXR and diagnostic mBAL in a combined tertiary-care unit for trauma and surgical intensive care. Portable chest X-radiographs were evaluated in a blinded manner by surgical intensivists, critical care fellows, general surgical residents, and radiologists, and were rated as: (0) Not suspicious for pneumonia, (1) possible pneumonia, or (2) likely pneumonia. These results were compared with the microbiologic results of mBAL culture. Demographic and clinical characteristics including age, gender, white blood cell count (WBC), temperature, purulence of secretions, blood and urine culture results, and length of hospitalization were correlated with the results of mBAL. RESULTS: Regardless of interpreter specialty or level of training, pCXR had no predictive value for VAPI. The overall sensitivity and specificity of pCXR were 77% and 74%, respectively, and its positive predictive value, negative predictive value, and receiver-operating characteristic (ROC) curve areas all had values below 50%. The inter-rater agreement (ρ) was 0.965, showing little discrepancy between raters. The degree of purulence on mBAL, concurrent blood stream infection, and increase in the number of days of hospitalization before diagnostic testing were correlated with an increased frequency of VAPI. The three CPIS criteria of febrile response, leukocytosis/leukopenia, and arterial oxygenation correlated poorly with the results of mBAL culture. CONCLUSION: Portable chest X-radiography has no added predictive value in identifying patients who should be evaluated further for VAPI. This supports the elimination of findings on chest X-radiography as defining characteristics of VAP, which accords with the U.S. Centers for Disease Control and Prevention's recent definition of VAP as but one of a number of types of ventilator-associated pulmonary infection (VAPI).