Esophageal function and non-acid reflux evaluated by impedance-24 h-pH-metry, high-resolution manometry, and gastroscopy after one-anastomosis gastric bypass-outcomes of a prospective mid-term study.

BACKGROUND: One-Anastomosis Gastric Bypass (OAGB) is the third most common bariatric operation for patients with obesity worldwide. One concern about OAGB is the presence of acid and non-acid reflux in a mid- and long-term follow-up. The aim of this study was to objectively evaluate reflux and esophagus motility by comparing preoperative and postoperative mid-term outcomes. SETTING: Cross-sectional study; University-hospital based. METHODS: This study includes primary OAGB patients (preoperative gastroscopy, high-resolution manometry (HRM), and impedance-24 h-pH-metry) operated at Medical University of Vienna before 31st December 2017. After a mean follow-up of 5.1 ± 2.3 years, these examinations were repeated. In addition, history of weight, remission of associated medical problems (AMP), and quality of life (QOL) were evaluated. RESULTS: A total of 21 patients were included in this study and went through all examinations. Preoperative weight was 124.4 ± 17.3 kg with a BMI of 44.7 ± 5.6 kg/m2, total weight loss after 5.1 ± 2.3 years was 34.4 ± 8.3%. In addition, remission of AMP and QOL outcomes were very satisfactory in this study. In gastroscopy, anastomositis, esophagitis, Barrett´s esophagus, and bile in the pouch were found in: 38.1%, 28.3%, 9.5%, and 42.9%. Results of HRM of the lower esophageal sphincter pressure were 28.0 ± 15.6 mmHg, which are unchanged compared to preoperative values. Nevertheless, in the impedance-24 h-pH-metry, acid exposure time and DeMeester score decreased significantly to 1.2 ± 1.2% (p = 0.004) and 7.5 ± 8.9 (p = 0.017). Further, the total number of refluxes were equal to preoperative; however, the decreased acid refluxes were replaced by non-acid refluxes. CONCLUSION: This study has shown decreased rates of acid reflux and increased non-acid reflux after a mid-term outcome of primary OAGB patients. Gastroscopy showed signs of chronic irritation of the gastrojejunostomy, pouch, and distal esophagus, even in asymptomatic patients. Follow-up gastroscopies in OAGB patients after 5 years may be considered.

[Exercise-risks and side effects]. / Sport ­ zu Risiken und Nebenwirkungen.

Physical activity and exercise is widely connected with positive effects on human health. However, exercise may also pose as a risk factor for health under specific circumstances. Primarily, the risks connected with exercise are physical risks, but also psychological risks may appear, especially when exercise is conducted excessively. Psychological risks include eating disorders, illegal and legal substance use and exercise dependence. The aims of the present article are to focus on potential risks and side effects of exercise and physical activity and to put the risks in the context of the positive effects of exercise on health.

Endoluminal Vacuum Therapy as Effective Treatment for Patients with Postoperative Leakage After Metabolic Bariatric Surgery-A Single-Center Experience.

BACKGROUND: Metabolic bariatric surgery (MBS) is standardized and safe. Nevertheless, complications such as anastomotic leakage (AL) or staple-line leakage (SLL) can occur. In upper GI or colorectal surgery, endoluminal vacuum therapy (EVT) offers a therapeutic alternative to revisional surgery. Data on EVT in patients with leakage after MBS remain scarce. The aim of this study is to evaluate the efficacy of EVT and its potential as endoscopic alternative to revisional surgery. MATERIAL AND METHODS: All patients treated for AL or SLL with EVT after MBS between 01/2016 and 08/2023 at the Department for General Surgery, Medical University Vienna, were included in this retrospective, single-center study. Therapeutic value of EVT as management option for acute postoperative leakage after MBS in daily practice was evaluated. Statistical analyses were performed descriptively. RESULTS: Twenty-one patients were treated with EVT within the observational period of 7 years. In 11 cases (52.4%), the index surgery was a primary bariatric intervention; in 10 cases (47.6%), a secondary surgery after initial MBS was performed. Favored approach was a combination of revisional surgery and EVT (n = 18; 85.7%), intermediate self-expanding metal stent (SEMS) in 16 (76.2%) cases. EVT was changed six times (0-33) every 3-4 days. Mean EVT time was 25.1 days (3-97). No severe associated complications were detected and EVT showed an efficacy of 95.2%. CONCLUSION: This small case series supports the trend to establish EVT in daily clinical practice when revisional surgery after MBS is needed, thus preventing further reoperation and reducing associated morbidity and mortality in critically ill patients.

Outcome of Sleeve Gastrectomy Converted to Roux-en-Y Gastric Bypass and One-Anastomosis Gastric Bypass.

PURPOSE: Sleeve gastrectomy (SG) is the commonest bariatric procedure worldwide but there is also a high conversion rate mainly due to weight regain and gastroesophageal reflux disease (GERD) reported in studies with long-term follow-up. The aim of this study is to highlight benefits and limitations of converting SG patients to Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB). SETTING: Retrospective cross-sectional-study, medical university clinic setting. METHODS: This study includes all patients converted from primary SG to RYGB or OAGB by 12/2018 at the Medical University of Vienna. Patients were examined using gastroscopy, esophageal manometry, 24-h pH-metry, and questionnaires. RESULTS: Fifty-eight patients were converted from SG to RYGB (n = 45) or OAGB (n = 13). Total weight loss of patients converted to RYGB and OAGB was 41.5% and 44.8%, respectively, at nadir. Six patients had Barrett's esophagus (BE) after SG. In four out of these six patients, a complete remission of BE after conversion to RYGB was observed; nevertheless, two patients after RYGB and one after OABG newly developed BE. Clinical GERD improved at a higher rate after RYGB than after OAGB. Both revisional procedures improved associated medical problems. CONCLUSION: Conversion to RYGB is probably the best option for patients with GERD after SG. OAGB has shown a low potential to cure patients from GERD symptoms after SG. In terms of additional weight loss and remission of associated medical problems, both procedures studied were equal. Surveillance gastroscopies every 5 years after SG revisions are recommended.

New cellular tools reveal complex epithelial-mesenchymal interactions in hepatocarcinogenesis.

To enable detailed analyses of cell interactions in tumour development, new epithelial and mesenchymal cell lines were established from human hepatocellular carcinoma by spontaneous outgrowth in culture. We obtained several hepatocarcinoma (HCC)-, B-lymphoblastoid (BLC)-, and myofibroblastoid (MF)-lines from seven cases. In-depth characterisation included cell kinetics, genotype, tumourigenicity, expression of cell-type specific markers, and proteome patterns. Many functions of the cells of origin were found to be preserved. We studied the impact of the mesenchymal lines on hepatocarcinogenesis by in vitro assays. BLC- and MF-supernatants strongly increased the DNA replication of premalignant hepatocytes. The stimulation by MF-lines was mainly attributed to HGF secretion. In HCC-cells, MF-supernatant had only minor effects on cell growth but enhanced migration. MF-lines also stimulated neoangiogenesis through vEGF release. BLC-supernatant dramatically induced death of HCC-cells, which could be largely abrogated by preincubating the supernatant with TNFbeta-antiserum. Thus, the new cell lines reveal stage-specific stimulatory and inhibitory interactions between mesenchymal and epithelial tumour cells. In conclusion, the new cell lines provide unique tools to analyse essential components of the complex interplay between the microenvironment and the developing liver cancer, and to identify factors affecting proliferation, migration and death of tumour cells, neoangiogenesis, and outgrowth of additional malignancy.

Influencia de la cirugía mayor ambulatoria y de corta estancia en las diferencias por sexo de las hernias inguinocrurales / No disponible

Objetivo: El objetivo del presente estudio es valorar en que medida la cirugía mayor ambulatoria (CMA) y de corta estancia mantienen, aumentan o disminuyen las desigualdades por sexo en la asistencia sanitaria de las intervenciones quirúrgicas practicadas por hernia inguinocrural (HIC). Material y métodos: Estudio transversal sobre 3.834 reparaciones(3.076 hombres/758 mujeres) de HIC practicadas en el Hospital General Universitario de Alicante entre 1995 y 2004.Fuente: conjunto mínimo básico de datos (CMBD). Variables: edad, sexo, diagnóstico principal, procedimiento quirúrgico, fechas de intervención y de alta. Cálculo de frecuencias y tasas por sexo, edad y tipo de admisión: contraste de proporciones. Estancia media (EM) mediante Contraste Mann-Whitney. Resultados: El 78% de las HIC fueron operadas en régimen de CMA o corta estancia, el resto con estancia de tres días o mayor. El 50% de todas las reparaciones se practicaron en niños menores de 14 años, siendo la indicación de CMA mayor en las niñas. A los pacientes mayores de 55 años se les tiende a admitir menos en CMA, con mayor proporción de mujeres. RatioH/M de todas las HIC = 4,06. En CMA: 0-14 ratioH/M= 3,25; > 55 años ratio H/M = 6,87 (p < 0,001). En hospitalización convencional: > 55 ratioH/M = 3,65.EM total: > 55 = 3,66H y 4,09M (p < 0,001); EM CMA: > 55= 1,04H y 1,27M (p < 0,001). Conclusiones: La CMA representa la forma idónea de tratamiento quirúrgico para la HIC no complicada tanto en hombres como en mujeres, sobretodo en la infancia, adolescencia, jóvenes y adultos. La atención de las HIC en mayores de 55 años presenta sesgo de género: a las mujeres se las ingresa 3 días o más en mayor proporción que a los hombres, con menor EM, mientras que siendo casi 7 veces menor el número de casos de mujeres que de hombres en CMA, estas presentan mayor EM. Resulta pues una diferente atención médica por sexo para igual proceso patológico y edad. (AU)

Objective: This study is intended to evaluate in what way ambulatory and short stay surgery maintain, increase or reduce sexinequities on inguinal and femoral hernia (I&FH) repair. Method: Transversal study on 3834 I&FH operations (3076men/ 758 women) between 1995 and 2004. Source: hospital’s minimal basic data set. Variables: age, sex, main diagnosis, surgical procedure, operation and discharge dates. Frequency andrates of hernia procedures by sex, age and admission type: proportion contrast. Length of stay (LOS): Mann-Whitney contrast. Results: 78% of I&FH were operated on an ambulatory or short stay basis (AMB) vs. 22% that stayed in hospital 3 or more days (STAY). 50% of all repairs were done on children 0 to 14 years old, the indication for AMB was higher in girls. In the group of patients older than 55, rate of AMB is lower than in younger patients, being higher in women than in men. RatioM/W for allI&FH = 4.06. In AMB: ratio M/W for 0-14 = 3.25; ratioM/W for> 55 = 6.87 (p < 0.001). In STAY: ratioM/W for > 55 = 3.65.LOS in > 55 (AMB and Stay): 3.66 M 4.09W (p < 0,001).LOS for AMB in > 55: 1.04 M 1.27W (p < 0,001).Conclusions: AMB is the most suitable way for repairing uncomplicated I&FH in men as well as in women, and even more so for children, adolescents, young people and adults. Nevertheless, gender bias in patients older than 55 is revealed: a greater proportion of women are admitted for 3 or more days as compared to men. However LOS is shorter in women. On the other hand, the amount of women treated as AMB is seven times smaller than men, being LOS longer for women in this group. That shows a difference in medical attention depending on sex for the same pathological process and age (AU)