Long Term Effects of Metabolic and Bariatric Surgery on Idiopathic Intracranial Hypertension.

BACKGROUND: Idiopathic Intracranial Hypertension (IIH) is a rare disorder, linked to severe obesity. The study aimed to evaluate long-term effects of metabolic and bariatric surgery (MBS) on IIH outcomes. METHODS: Retrospective study of patients with IIH and severe obesity who underwent MBS. Data were retrieved from prospectively maintained databases of two bariatric surgeons. RESULTS: Thirteen patients were included, of them 12 women. Median age was 36 (interquartile range;IQR 21,47) years and body mass index (BMI) was 40.4 (IQR 37.8,41.8) kg/m2. All patients had visual disturbances,12/13 had headaches, and 6/13 had tinnitus. The mean opening pressure on lumbar puncture was 45 cmH2O, and 11/13 patients had papilledema. Medications for IIH were consumed by 11/13 patients, and 2/13 patients had prior surgical intervention for IIH. MBS types included sleeve gastrectomy (n=7), adjustable gastric banding (n=2), roux-en-y gastric bypass (n=2), one anastomosis gastric bypass (n=1), duodenal switch (n=1). At a median follow-up of 10 years (IQR 8,13), the median BMI and total weight loss were 29.7 kg/m2 and 27%, respectively. Remission of symptoms was achieved in 9/13 patients. CONCLUSIONS: MBS results in significant and sustainable weight loss, with subsequent resolution or improvement of IIH. It may be considered as a preventive measure for IIH in patients with severe obesity.

Anastomotic Ulcer Perforation Following One Anastomosis Gastric Bypass.

PERFORATED ANASTOMOTIC ULCER AFTER ONE ANASTOMOSIS GASTRIC BYPASS: BACKGROUND: One anastomosis gastric bypass (OAGB) is a common bariatric metabolic surgery. Anastomotic ulcer (AU) perforation is a delayed complication, liable to cause sepsis and death. We present a cohort of twelve patients who underwent emergent surgery due to AU perforation. MATERIALS AND METHODS: A retrospective analysis of a single center database of patients operated for AU perforation after OAGB (January 2015 to December 2021). Data retrieved included perioperative characteristics and postoperative outcomes. RESULTS: The incidence of AU perforation among 1425 OAGB patients is 0.7%. AU perforation occurred after OAGB at a median time interval of 13 months (interquartile range (IQR) 5, 23). Eight patients had at least one risk factor for AU perforation. All patients presented with acute abdominal pain. Pneumoperitoneum was evident in ten patients on imaging studies. Surgery was laparoscopic in eleven patients, with one conversion to laparotomy. Operative findings were AU perforation, with a median perforation size of 5 mm (IQR 1.1, 18.7). Laparoscopic omentopexy ± primary AU repair, open omentopexy ± primary AU repair, and laparoscopic conversion to Roux-en-Y gastric bypass were performed (n = 9, 2, 1 patients, respectively). Median length of stay was 7.5 days (IQR 5, 11.5). No major complications occurred. All patients are doing well at a median follow-up of 11.5 months (IQR 2.2, 19.2). Four out of seven smoking patients still smoke. CONCLUSION: AU perforation after OAGB mandates a high index of suspicion, prompt diagnosis, and surgical treatment. Laparoscopic omentopexy ± primary AU repair is feasible in most cases, safe, and confers good outcomes.