The analysis of factors increasing the odds for type 2 diabetes mellitus remission following re-do bariatric surgery after laparoscopic sleeve gastrectomy- cohort study.

INTRODUCTION: Metabolic/bariatric surgery is the only proven treatment for type 2 diabetes mellitus (T2D) with curative intent. However, in a number of patients, the surgery is not effective or they may experience a relapse. Those patients can be offered re-do bariatric surgery (RBS). PURPOSE: The study aimed to determine factors increasing the odds for T2D remission one year after RBS following primary laparoscopic sleeve gastrectomy. METHODS: A multicenter retrospective cohort study was conducted between January 2010 and January 2020, which included 12 bariatric centers in Poland. The study population was divided into groups: Group 1- patients with T2D remission after RBS (n = 28) and Group 2- patients without T2D remission after RBS (n = 49). T2D remission was defined as HBA1c < 6.0% without glucose-lowering pharmacotherapy and glycemia within normal range at time of follow-up that was completed 12 months after RBS. RESULTS: Fifty seven females and 20 males were included in the study. Patients who achieved BMI < 33 kg/m2 after RBS and those with %EBMIL > 60.7% had an increased chance of T2D remission (OR = 3.39, 95%CI = 1.28-8.95, p = 0.014 and OR = 12.48, 95%CI 2.67-58.42, p = 0.001, respectively). Time interval between primary LSG and RBS was significantly shorter in Group 1 than in Group 2 [1 (1-4) vs. 3 (2-4) years, p = 0.023]. CONCLUSIONS: Shorter time interval between LSG and RBS may ease remission of T2D in case of lack of remission after primary procedure. Significant excess weight loss seems to be the most crucial factor for T2D remission.

Is triggering receptor expressed on myeloid cell 1 (TREM-1) protein a new marker of serious infectious complications in colorectal surgery?: case-matched pilot study.

PURPOSE: The purpose of the study was to evaluate the usefulness of the triggering receptor expressed on myeloid cell 1 (TREM-1) protein as a marker for serious infectious complications during laparoscopic colorectal surgery. METHODS: Sixty-four patients with colon or rectal cancer, who underwent an elective laparoscopic colorectal cancer surgery from November 2018 to February 2020, were included in the analysis. Blood samples of the TREM-1 protein testing were collected four times from each patient: before and on three following postoperative days (PODs). Patients were divided into two groups according to the presence of infectious complications. Subsequently, patients with infectious complications (group 1) were matched 1:1 with patients without complications (group 2). The case-matched analysis was done by selecting patients from the control group by age, ASA scale, cancer stage, and type of surgery. RESULTS: There was no significant difference in demographic and operative characteristics between the two groups. The median length of hospital stay was longer in group 1 than in group 2 (11 days vs. 5 days, p < 0.001). Preoperative measurements of TREM-1 protein did not differ between the two groups. There were no significant differences in the measurements on the first and third postoperative days. However, the median TREM-1 measurement was higher in group 1 on the second postoperative day (542 pg/ml vs. 399 pg/ml; p = 0.040). The difference was more apparent when only severe postoperative complications were considered. When compared to the group without any complications, the median TREM-1 level was significantly higher in the group with severe infection complications in POD 1, POD 2, and POD 3 (p < 0.05). The receiver operating characteristic (ROC) curve demonstrated that TREM-1 readings in POD 2 had a sensitivity of 83% and a specificity of 84% for the presence of severe infection complications at a value of 579.3 pg/ml (AUC 0.8, 95%CI 0.65-0.96). CONCLUSION: TREM-1 measurements might become a helpful predictive marker in the early diagnosis of serious infectious complications in patients following laparoscopic colorectal surgery.

Thyroidectomy: is it safe to be performed by general surgery residents? - single centre experience.

BACKGROUND: Thyroidectomy carries a risk of two crucial complications - recurrent nerve palsy and hypocalcaemia. The aim of the study was to assess the safety of thyroidectomy performed by general surgery residents. METHODS: Data of 515 patients, who underwent total thyroidectomy between the years 2015 and 2019, were prospectively collected. Inclusion criteria were as follows: age >18 years old, patients who underwent total thyroidectomy, no change of operator during the surgery. The study group was divided into two groups: operated by general surgery specialists (385 patients-group 1) and operated by residents with the supervision of experienced general surgery specialists as assistants (130 patients-group 2). RESULTS: Demographic factors did not differ statistically between groups. Median operative time was 65 min (55-85 IQR) and 90 min (75-110 IQR) in groups 1 and 2, respectively (p < 0.001). Complications occurred in 97 (18.7%) patients in group 1 and 25 (19.3%) patients in group 2 (p = 0.893). Recurrent nerve palsy diagnosed with laryngoscopy was the most common complication - 10.2% and 9.2% of patients, respectively (p = 0.754). Permanent vocal paresis occurred in 2.3% and 3.2%, respectively (p = 0.786). Postoperative symptomatic hypocalcaemia occurred in 7% of patients in group 1 and 10% of patients in group 2 (p = 0.271). Logistic regression did not show that resident as the operator with or without intraoperative neuromonitoring is a risk factor for any complications. CONCLUSION: The results of the present study show that thyroidectomy performed by a general surgery resident under supervision can be as safe as the one performed by a specialist.

Differences in Technical Aspects of Primary Sleeve Gastrectomy Prior to Redo Bariatric Surgery-A Multicenter Cohort Study (PROSS Study).

Background and Objectives: Although the technical simplicity of laparoscopic sleeve gastrectomy is relatively well understood, many parts of the procedure differ according to bariatric surgeons. These technical variations may impact postoperative weight loss or the treatment of comorbidities and lead to qualification for redo procedures. Materials and Methods: A multicenter, observational, retrospective study was conducted among patients undergoing revision procedures. Patients were divided into three groups based on the indications for revisional surgery (insufficient weight loss or obesity-related comorbidities treatment, weight regain and development of complications). Results: The median bougie size was 36 (32-40) with significant difference (p = 0.04). In 246 (51.57%) patients, the resection part of sleeve gastrectomy was started 4 cm from the pylorus without significant difference (p = 0.065). The number of stapler cartridges used during the SG procedure was six staplers in group C (p = 0.529). The number of procedures in which the staple line was reinforced was the highest in group A (29.63%) with a significant difference (0.002). Cruroplasty was performed in 13 patients (p = 0.549). Conclusions: There were no differences between indications to redo surgery in terms of primary surgery parameters such as the number of staplers used or the length from the pylorus to begin resection. The bougie size was smaller in the group of patients with weight regain. Patients who had revision for insufficient weight loss were significantly more likely to have had their staple line oversewn. A potential cause could be a difference in the size of the removed portion of the stomach, but it is difficult to draw unequivocal conclusions within the limitations of our study.

Bowel function after laparoscopic right hemicolectomy: a randomized controlled trial comparing intracorporeal anastomosis and extracorporeal anastomosis.

BACKGROUND: The laparoscopic right hemicolectomy is the standard surgical treatment for right-sided colon cancer. The continuity of the digestive tract is restored through ileocolic anastomosis which can be performed extracorporeally or intracorporeally. The study aimed to compare both anastomotic techniques in laparoscopic right hemicolectomy. MATERIALS AND METHODS: A single-blinded two-armed randomized control trial with 1:1 parallel allocation carried out from 2016 to 2020 in a single center. The follow-up period was 30 days. Compared interventions involved extracorporeal and intracorporeal ileocolic anastomosis in laparoscopic right hemicolectomy. The main outcome of the study was bowel recovery measured as the time to the first stool. Other outcomes involved the time to the first flatus, morbidity, and duration of surgery. RESULTS: One hundred and seventeen patients undergoing a laparoscopic right hemicolectomy with curative intent were eligible for the trial. Eight patients refused to participate. One hundred and two patients were analyzed, 52 in the intracorporeal group and 50 in the extracorporeal group. The groups did not differ in terms of cancer stage or body mass index, but did differ in age and sex. Intracorporeal anastomosis was associated with a shorter time to the first stool than extracorporeal, 32.8 h (26.0-43.7) vs. 41.7 (35.9-50.0), p = 0.017. There was no significant difference in the time to the first flatus, 30 h (23.2-42.3) vs. 26.6 h (21.8-37.3), p = 0.165. Similarly, overall complications did not differ (EC 12/50 vs. IC 10/52, p = 0.56). There were no differences in length of surgery, 190 min (150-230) and 190 min (180-220), p = 0.55. CONCLUSION: Intracorporeal ileocolic anastomosis following laparoscopic right hemicolectomy results in slightly faster bowel recovery, with no differences in morbidity and duration of surgery.

External validation of predictive scores for diabetes remission after metabolic surgery.

PURPOSE: Bariatric surgery has proven to be the most efficient treatment for obesity and type 2 diabetes mellitus (T2DM). Despite detailed qualification, desirable outcome after an intervention is not achieved by every patient. Various risk prediction models of diabetes remission after metabolic surgery have been established to facilitate the decision-making process. The purpose of the study is to validate the performance of available risk prediction scores for diabetes remission a year after surgical treatment and to determine the optimal model. METHODS: A retrospective analysis comprised 252 patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2009 and 2017 and completed 1-year follow-up. The literature review revealed 5 models, which were subsequently explored in our study. Each score relationship with diabetes remission was assessed using logistic regression. Discrimination was evaluated by area under the receiver operating characteristic (AUROC) curve, whereas calibration by the Hosmer-Lemeshow test and predicted versus observed remission ratio. RESULTS: One year after surgery, 68.7% partial and 21.8% complete diabetes remission and 53.4% excessive weight loss were observed. DiaBetter demonstrated the best predictive performance (AUROC 0.81; 95% confidence interval (CI) 0.71-0.90; p-value > 0.05 in the Hosmer-Lemeshow test; predicted-to-observed ratio 1.09). The majority of models showed acceptable discrimination power. In calibration, only the DiaBetter score did not lose goodness-of-fit in all analyzed groups. CONCLUSION: The DiaBetter score seems to be the most appropriate tool to predict diabetes remission after metabolic surgery since it presents adequate accuracy and is convenient to use in clinical practice. There are no accurate models to predict T2DM remission in a patient with advanced diabetes.

Impact of SARS-CoV-2 pandemic on bariatric care in Poland: results of national survey.

BACKGROUND: The SARS-CoV-2 pandemic has reached Poland on March 4th, 2020 and undoubtedly affected all areas of life and medical care, including bariatric care. The study was planned to identify the impact of the SARS-CoV-2 pandemic on bariatric care in Poland. METHODS: The online survey was designed and distributed to bariatric surgeons. The questionnaire was divided into three parts: demographic characteristics of participants and their bariatric centers, examining the impact of the pandemic on the bariatric care and last part with questions about planned care after the pandemic. RESULTS: 49 surgeons participated in the survey. 27 (55%) participants worked in hospitals transformed into COVID-dedicated units. Only 9 (18%) respondents declared uninterrupted bariatric surgery during a pandemic. 91% of surgeons declared continuation of bariatric care with telemedicine techniques. All participants declared a high willingness to resume bariatric surgery after the SARS-CoV-2 pandemic and responded that bariatric procedures should resume immediately when World Health Organisation (WHO) announces the end of a pandemic regardless of oncological treatment. 90% of respondents believe that the pandemic will not affect the safety of bariatric procedures in the future. CONCLUSIONS: Access to bariatric care during the pandemic is limited and redirected to telemedicine. Surgeons are ready to resume bariatric operations immediately after the pandemic, but its end is difficult to determine. In surgeons' opinion pandemic will not affect the safety of bariatric surgery in the future. The extended waiting list and financial aspects will be the main issues after the pandemic.

Arterial resections in pancreatic cancer - Systematic review and meta-analysis.

BACKGROUND: The number of pancreatic resections due to cancers is increasing. While concomitant venous resections are routinely performed in specialized centers, arterial resections are still controversial. Nevertheless they are performed in patients presenting with locally advanced tumors. Our aim was to summarize currently available literature comparing peri-operative and long-term outcomes of arterial and non-arterial pancreatic resections. METHODS: We included studies comparing pancreatic operations with and without concomitant arterial resection. Inclusion criteria were morbidity or mortality. Studies additionally reporting venous resections with no possibility of excluding this data during the extraction were discarded. RESULTS: The initial search yielded 1651 records. Finally, 19 studies were included in the analysis involving 2710 patients. Arterial resection was associated with a greater risk of death(RR: 4.09; p < 0.001) and complications (RR: 1.4; p = 0.01). There were no differences in the rate of pancreatic fistula, biliary fistula rate, cardiopulmonary complications, length of hospital stay and non-R0 rate. Oncologically, patients after arterial resection were at higher risk of worse 3-year survival. CONCLUSION: Arterial resection in pancreatic cancer is associated with an increased risk of mortality and complications in comparison to standard non-arterial resections. Nevertheless, arterial resection may become a viable treatment for selected patients in high volume centers.

Meta-analysis of short- and long-term outcomes after pure laparoscopic versus open liver surgery in hepatocellular carcinoma patients.

BACKGROUND: The advantages of laparoscopy are widely known. Nevertheless, its legitimacy in liver surgery is often questioned because of the uncertain value associated with minimally invasive methods. Our main goal was to compare the outcomes of pure laparoscopic (LLR) and open liver resection (OLR) in patients with hepatocellular carcinoma. METHODS: We searched EMBASE, MEDLINE, Web of Science, and The Cochrane Library databases to find eligible studies. The most recent search was performed on December 1, 2017. Studies were regarded as suitable if they reported morbidity in patients undergoing LLR versus OLR. Extracted data were pooled and subsequently used in a meta-analysis with a random-effects model. Clinical applicability of results was evaluated using predictive intervals. Review was reported following the PRISMA guidelines. RESULTS: From 2085 articles, forty-three studies (N = 5100 patients) were included in the meta-analysis. Our findings showed that LLR had lower overall morbidity than OLR (15.59% vs. 29.88%, p < 0.001). Moreover, major morbidity was reduced in the LLR group (3.78% vs. 8.69%, p < 0.001). There were no differences between groups in terms of mortality (1.58% vs. 2.96%, p = 0.05) and both 3- and 5-year overall survival (68.97% vs. 68.12%, p = 0.41) and disease-free survival (46.57% vs. 44.84%, p = 0.46). CONCLUSIONS: The meta-analysis showed that LLR is beneficial in terms of overall morbidity and non-procedure-specific complications. That being said, these results are based on non-randomized trials. For these reasons, we are calling for randomization in upcoming studies. Systematic review registration: PROSPERO registration number CRD42018084576.

Perioperative changes in lymphocyte subpopulations in patients undergoing surgery for colorectal cancer.

Surgical procedure has immense impact on the immune balance. However, little is known about perioperative changes in T regulatory and Th17 lymphocyte subpopulations in patients undergoing colorectal resection. Patients with resectable colon cancer were enrolled in the study. Blood samples were obtained on two occasions, i.e. before the procedure and two days after the surgery. We also recruited a control group of young, healthy individuals. Lymphocyte subpopulations were analyzed with the use of flow cytometry. Investigated subpopulations consisted of total lymphocyte count, CD4+, CD8+, T regulatory Foxp3+ (Tregs), Th17 lymphocytes and white blood cell (WBC) count. There were significant differences in immune cell levels before and after the surgery. Reduction was recorded in the CD4+, CD8+, Tregs and total lymphocyte counts (p=0.002, p=0.01, p=0.008 and p=0.001, respectively). Increase was observed in total WBC and Th17 cells, however, Th17 lymphocytes did not reach statistical significance (p=0.01 and p=0.5, respectively). In conclusion, surgical intervention caused changes in all lymphocyte subpopulations investigated in patients undergoing surgery for colorectal cancer. However, it seemed to be an effect of perioperative trauma. Further studies are needed to investigate the impact of surgical intervention on lymphocyte subpopulations.

Changes in plasma albumin levels in early detection of infectious complications after laparoscopic colorectal cancer surgery with ERAS protocol.

BACKGROUND: Combination of laparoscopic approach with ERAS protocol in colorectal surgery allows for an early discharge. However there is a risk that some of the discharged patients are developing, asymptomatic at the time, infectious complications. This may lead to a delay in diagnostics and proper treatment introduction. We aimed to assess the usefulness of preoperative plasma albumin concentration and their changes as indicators of infectious complications in patients undergoing colorectal cancer surgery. METHODS: Prospective analysis included 105 consecutive patients who underwent laparoscopic colorectal cancer resection between August 2014 and September 2016. In all cases standardised 16-item perioperative care ERAS protocol was used (mean compliance > 85%). Patients with IBD, distant metastases, undergoing emergency or multivisceral resection were excluded. Blood samples were collected preoperatively and on POD 1, 2, 3. Plasma albumin concentration was measured. Patients were divided into two groups depending on the presence of infectious complications. We analysed the differences in the levels of albumin and the dynamics of changes. RESULTS: Group 1-82 not complicated patients, Group 2-23 patients with at least one infectious complication. Preoperatively, there were no significant differences in the levels of serum albumin between those groups (Group 1-38.7 ± 4.9 g/l; Group 2-37.7 ± 5.0 g/l). In postoperative period, decrease was observed in both (POD 1: Group 1-36.5 ± 4.2 g/l, Group 2-34.7 ± 4.2 g/l, p = 0.07; POD 2: Group 1-36.2 ± 4.1 g/l, Group 2-32.6 ± 5.6 g/l, p = 0.01; POD 3: Group 1-36.0 ± 4.4 g/l, Group 2-30.9 ± 3.5 g/l, p = 0.01). The decrease was significantly greater in Group 2 on POD 2 and 3. CONCLUSIONS: We showed that a regular measurement of albumin in the early postoperative days may be beneficial in the detection of postoperative infectious complications. Although changes in albumins are observed early after surgery, this parameter is relatively unspecific.

Minimally invasive versus open pancreatoduodenectomy-systematic review and meta-analysis.

PURPOSE: The purpose of this systematic review was to compare minimally invasive pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) by using meta-analytical techniques. METHODOLOGY: Medline, Embase, and Cochrane Library were searched for eligible studies. Data from included studies were extracted for the following outcomes: operative time, overall morbidity, pancreatic fistula, delayed gastric emptying, blood loss, postoperative hemorrhage, yield of harvested lymph nodes, R1 rate, length of hospital stay, and readmissions. Random and fix effect meta-analyses were undertaken. RESULTS: Initial reference search yielded 747 articles. Thorough evaluation resulted in 12 papers, which were analyzed. The total number of patients was 2186 (705 in MIPD group and 1481 in OPD). Although there were no differences in overall morbidity between groups, we noticed reduced blood loss, delayed gastric emptying, and length of hospital stay in favor of MIPD. In contrary, meta-analysis of operative time revealed significant differences in favor of open procedures. Remaining parameters did not differ among groups. CONCLUSION: Our review suggests that although MIPD takes longer, it may be associated with reduced blood loss, shortened LOS, and comparable rate of perioperative complications. Due to heterogeneity of included studies and differences in baseline characteristics between analyzed groups, the analysis of short-term oncological outcomes does not allow drawing unequivocal conclusions.

Laparoscopic uncinate process first pancreatoduodenectomy-feasibility study of a modified 'artery first' approach to pancreatic head cancer.

PURPOSE: The aim of this study was to discuss the feasibility of laparoscopic 'uncinate first' pancreatoduodenectomy. METHODS: The analysis included prospectively collected data from 12 consecutive patients undergoing elective pure laparoscopic 'uncinate process first' pancreatoduodenectomy (Group 1). They were compared with patients previously operated on with a classical laparoscopic approach (Group 2). The primary outcome was the quality of the resected specimen (lymph node (LN) yield, R0 rate, involved resection margins). Secondary outcomes were perioperative parameters. RESULTS: The LN yield in Group 1 was 19.3 and in Group 2 it was 13.9 (p = 0.03). R0 resection rates did not vary (66.7 vs. 63.2%, p = 0.84). Although the involvement of the superior mesenteric artery margin and uncinate process margin seemed lower in Group 1, the difference was not significant. Total operative time (467 vs. 425 min, p = 0.13) and resection time (221 vs. 232 min, p = 0.34) were similar in both groups. The estimated blood loss in Group 1 was 408 ml, whereas in Group 2 it was 392 ml (p = 0.33). Complication rates were 66.7% in Group 1 and 63.2% in Group 2 (p = 0.84). Median length of stay was 9 days in both groups (p = 0.36). Postoperative complication rates did not differ between groups. CONCLUSIONS: Laparoscopic uncinate first approach is a feasible method for pancreatic head neoplasms. Achieved quality of the specimen is comparable with the traditional laparoscopic approach, whereas intra- and postoperative course is not inferior. However, further studies on larger cohorts are required to fully establish whether the novel approach has potential advantages over classical access in pancreatic head cancer.

Laparoscopic approach to splenic aneurysms.

Background Splenic artery aneurysm is a rare disease with possibly mortal complications. For years, the main method of treatment was excision of aneurysm with spleen. In recent years, several methods have been developed in order to salvage the spleen such endovascular techniques and aneurysmectomy. Objective The aim of our study was to determine the feasibility of laparoscopic aneurysmectomy with spleen salvage in cases of splenic artery aneurysm. Materials Analysis of prospectively gathered data containing records of patients operated laparoscopically due to diseases of the spleen in 1998-2016 in our department. Inclusion criteria were attempted laparoscopic aneurysmectomy with intent to salvage spleen. Results Out of 11 patients, seven patients underwent aneurysmectomy with spleen preservation, one patient had partial-splenectomy, two patients had intra-operative splenectomies and one patient had a re-operation on post-op day 1 with splenectomy. Re-operation with splenectomy was the only recorded complication. Conclusions Laparoscopic aneurysmectomy of SAA may be considered as a safe treatment method, with good short- and long-term results; however, a complete evaluation requires further research on a larger study group. It allows permanent treatment of SAA with maintaining spleen function.

One hundred seventy-nine consecutive bariatric operations after introduction of protocol inspired by the principles of enhanced recovery after surgery (ERAS®) in bariatric surgery.

BACKGROUND: Obese patients are a very large high-risk group for complications after surgical procedures. In this group, optimized perioperative care and a faster recovery to full activity can contribute to a decreased rate of postoperative complications. The introduction of ERAS®-based protocol is now even more important in bariatric surgery centers. The results of our study support the idea of implementation of ERAS®-based protocol in this special group of patients. MATERIAL AND METHODS: This analysis included 170 patients (62 male/108 female, mean BMI 46.7 kg/m2) who had undergone laparoscopic bariatric surgery, and whose perioperative care was conducted according to a protocol inspired by ERAS® principles. Examined factors included oral nutrition tolerance, time until mobilization after surgery, requirements for opioids, duration of hospitalization, and readmission rate. RESULTS: During the first 24 postoperative hours, oral administration of liquid nutrition was tolerated by 162 (95.3%) patients and 163 (95.8%) were fully mobile. In 44 (25.8%) patients it was necessary to administer opioids to relieve pain. Intravenous liquid supply was discontinued within 24 hours in 145 (85.3%) patients. The complication rate was 10.5% (mainly rhabdomyolysis and impaired passage of gastric contents). The average time of hospitalization was 2.9 days and the readmission rate was 1.7%. CONCLUSIONS: The introduction of an ERAS® principles-inspired protocol in our center proved technically possible and safe for our patients, and allowed for reduced hospitalization times without increased rate of complications or readmissions.

Analysis of Changes in Glucose and Lipid Metabolism in Patients with Clinically Severe Obesity and Type 2 Diabetes Mellitus Undergoing Laparoscopic Sleeve Gastrectomy-Prospective Observational Study.

INTRODUCTION: We still lack studies providing analysis of changes in glucose and lipid metabolism after laparoscopic sleeve gastrectomy (LSG) in patients with type 2 diabetes mellitus (DM2). We aimed to investigate postoperative changes in glucose and lipid metabolism after LSG in patients with DM2. MATERIAL AND METHODS: Prospective, observational study included patients with BMI ≥ 35 kg/m2 and ≤ 50 kg/m2, DM2 < 10 years of duration, who were qualified for LSG. Perioperative 14-day continuous glucose monitoring (CGM) began after preoperative clinical assessment and OGTT, then reassessment 1 and 12 months after LSG. Thirty-three patients in mean age of 45 ± 10 years were included in study (23 females). RESULTS: EBMIL before LSG was 17 ± 11.7%, after 1 month-36.3 ± 12.8%, while after 12 months-66.1 ± 21.7%. Fifty-two percent of the patients had DM2 remission after 12 months. None required then insulin therapy. 16/33 patients initially on oral antidiabetics still required them after 12 months. Significant decrease in HbA1C was observed: 5.96 ± 0.73%; 5.71 ± 0.80; 5.54 ± 0.52%. Same with HOMA-IR: 5.34 ± 2.84; 4.62 ± 3.78; 3.20 ± 1.99. In OGTT, lower increase in blood glucose with lesser insulin concentrations needed to recover glucose homeostasis was observed during follow-ups. Overtime perioperative average glucose concentration in CGM of 5.03 ± 1.09 mmol/L significantly differed after 12 months, 4.60 ± 0.53 (p = 0.042). Significantly higher percentage of glucose concentrations above targeted compartment (3.9-6.7 mmol/L) was observed in perioperative period (7% ± 4%), than in follow-up (4 ± 6% and 2 ± 1%). HDL significantly rose, while triglyceride levels significantly decreased. CONCLUSIONS: Significant improvement in glucose and lipid metabolism was observed 12 months after LSG and changes began 1 month after procedure.

The outcomes of Re-Redo bariatric surgery-results from multicenter Polish Revision Obesity Surgery Study (PROSS).

The increasing prevalence of bariatric surgery has resulted in a rise in the number of redo procedures as well. While redo bariatric surgery has demonstrated its effectiveness, there is still a subset of patients who may not derive any benefits from it. This poses a significant challenge for bariatric surgeons, especially when there is a lack of clear guidelines. The primary objective of this study is to evaluate the outcomes of patients who underwent Re-Redo bariatric surgery. We conducted a retrospective cohort study on a group of 799 patients who underwent redo bariatric surgery between 2010 and 2020. Among these patients, 20 individuals underwent a second elective redo bariatric surgery (Re-Redo) because of weight regain (15 patients) or insufficient weight loss, i.e. < 50% EWL (5 patients). Mean BMI before Re-Redo surgery was 38.8 ± 4.9 kg/m2. Mean age was 44.4 ± 11.5 years old. The mean %TWL before and after Re-Redo was 17.4 ± 12.4% and %EBMIL was 51.6 ± 35.9%. 13/20 patients (65%) achieved > 50% EWL. The mean final %TWL was 34.2 ± 11.1% and final %EBMIL was 72.1 ± 20.8%. The mean BMI after treatment was 31.9 ± 5.3 kg/m2. Complications occurred in 3 of 20 patients (15%), with no reported mortality or need for another surgical intervention. The mean follow-up after Re-Redo was 35.3 months. Although Re-Redo bariatric surgery is an effective treatment for obesity, it carries a significant risk of complications.

MCPIP1 Inhibits Hepatic Stellate Cell Activation in Autocrine and Paracrine Manners, Preventing Liver Fibrosis.

BACKGROUND & AIMS: Hepatic fibrosis is characterized by enhanced deposition of extracellular matrix (ECM), which results from the wound healing response to chronic, repeated injury of any etiology. Upon injury, hepatic stellate cells (HSCs) activate and secrete ECM proteins, forming scar tissue, which leads to liver dysfunction. Monocyte-chemoattractant protein-induced protein 1 (MCPIP1) possesses anti-inflammatory activity, and its overexpression reduces liver injury in septic mice. In addition, mice with liver-specific deletion of Zc3h12a develop features of primary biliary cholangitis. In this study, we investigated the role of MCPIP1 in liver fibrosis and HSC activation. METHODS: We analyzed MCPIP1 levels in patients' fibrotic livers and hepatic cells isolated from fibrotic murine livers. In vitro experiments were conducted on primary HSCs, cholangiocytes, hepatocytes, and LX-2 cells with MCPIP1 overexpression or silencing. RESULTS: MCPIP1 levels are induced in patients' fibrotic livers compared with their nonfibrotic counterparts. Murine models of fibrosis revealed that its level is increased in HSCs and hepatocytes. Moreover, hepatocytes with Mcpip1 deletion trigger HSC activation via the release of connective tissue growth factor. Overexpression of MCPIP1 in LX-2 cells inhibits their activation through the regulation of TGFB1 expression, and this phenotype is reversed upon MCPIP1 silencing. CONCLUSIONS: We demonstrated that MCPIP1 is induced in human fibrotic livers and regulates the activation of HSCs in both autocrine and paracrine manners. Our results indicate that MCPIP1 could have a potential role in the development of liver fibrosis.

Minimizing blood loss and transfusion rate in laparoscopic liver surgery: a review.

Laparoscopic liver resection has become a standard practice in many surgical wards in elective liver surgery, due to its positive impact on reducing hospital stay and postoperative complications, including lower blood loss and transfusion rate. However, achieving proper hemostasis in liver surgery, due to its vast blood supply, still remains a main concern to surgeons. Therefore, numerous techniques were and are still being developed to further reduce blood loss and transfusion rate. The aim of this literature review was to summarize the best available methods for achieving the minimal blood loss and transfusion rate in laparoscopic liver surgery, according to the newest data.

Total versus partial adrenalectomy in bilateral pheochromocytoma - a systematic review and meta-analysis.

Background: In patients with bilateral pheochromocytoma, partial adrenalectomy offers the chance to preserve adrenal function and avoid the need for lifelong steroid supplementation. However, the risk of tumour recurrence raises questions about this procedure. The aim of our study was to compare partial and total adrenalectomy in bilateral pheochromocytoma through a systematic review with meta-analysis. Methods: A systematic search was carried out using databases (MEDLINE, EMBASE, Scopus, Web of Science, CENTRAL) and registers of clinical trials (ClinicalTrials.gov, European Trials Register, WHO International Trials Registry Platform). This meta-analysis included studies up to July 2022 without language restrictions. A random effects model meta-analysis was performed to assess the risk of tumor recurrence, steroid dependence and morbidity in these patients. Results: Twenty-five studies were included in the analysis involving 1444 patients. The relative risk (RR) of loss of adrenal hormone function during follow-up and the need for steroid therapy was 0.32 in patients after partial adrenalectomy: RR 0.32, 95% Confidence Interval (CI): 0.26-0.38, P < 0.00001, I2 = 21%. Patients undergoing partial adrenalectomy had a lower odds ratio (OR) for developing acute adrenal crisis: OR 0.3, 95% CI: 0.1-0.91, P=0.03, I2 = 0%. Partial adrenalectomy was associated with a higher risk of recurrence than total adrenalectomy: OR 3.72, 95% CI: 1.54-8.96, P=0.003, I2 = 28%. Conclusion: Partial adrenalectomy for bilateral pheochromocytoma is a treatment that offers a chance of preserving adrenal hormonal function, but is associated with a higher risk of local tumor recurrence. There was no difference for the risk of metastasis and in overall mortality among the group with bilateral pheochromocytomas undergoing total or partial adrenalectomy. This study is in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (A Measurement Tool to Assess Systematic Reviews) Guidelines (10, 11). Systematic review registration: https://osf.io/zx3se.