Effect of Inverse Ratio Ventilation on Respiratory Mechanics and Postoperative Pulmonary Complications in Morbidly Obese Patients Under-going Laparoscopic Sleeve Gastrectomy / 医学研究杂志

Objective To observe the effects of inverse ratio ventilation on respiratory mechanics and postoperative pulmonary com-plications in morbidly obese patients during laparoscopic sleeve gastrectomy Methods A total of 62 morbidly obese patients for a laparo-scopic sleeve gastrectomy were scheduled(18-65 years old,BMI≥35kg/m2 in combination with diabetes,hypertension,hyperlipemia,and other metabolic diseases,or BMI≥40kg/m2,ASA Ⅱ or Ⅲ).Patients were randomly assigned to two groups:inverse ratio ventilation group(IRV)and control group(PVG).Two groups were adjusted with an actual tidal volume(VT)of 7-8ml/kg,and respiratory rates of 12 breaths/min.In the IRV group,the ratio of I∶E was 2∶1;in the control group,the ratio of I∶E was 1∶2.We recorded the indexes of respiratory mechanics and the blood gas at the baseline(T0),5min after anesthesia(T,),15min after pneumoperitoneum(T2),30min after pneumoperitoneum(T3),60min after pneumoperitoneum(T4)and the end of surgery(T5),and the occurrence of pulmonary com-plications on day 1,day 2 after operation was observed,and the cumulative incidence of PPCs at 7 days was counted.Results Compared to the control group,the dynamic lung compliance(Cdyn),mean airway pressure(Pmean),positive end expiratory pressure(PEEP),and the PaO2 at T,-T5 of the inverse ventilation group were increased significantly(P＜0.05),the Ppeak、Pplat at T2-T5 and dynamic lung compliance(VD/VT)at T3-T5 were decreased significantly(P＜0.05),and no difference in the PaCO2 and PETCO2 in the two groups.Grade 1 pulmonary complications occurred in both groups,and there was no difference in the total occurrence of pulmonary com-plications at 7 days.Conclusion Inverse ventilation effectively may improve respiratory mechanics and oxygenation in morbidly obese pa-tients undergoing laparoscopic sleeve gastrectomy.

Laparoscopic sleeve gastrectomy based on two points and one line as anatomical landmark / 临床外科杂志

Objective To investigate the viability and safety of laparoscopic sleeve gastrectomy(LSG)based on the TJ point at the junction of the posterior gastric wall and the apex of the medial edge of the left diaphragm.Methods A retrospective analysis of 135 patients with obesity or obesity with metabolic syndrome who underwent LSG from January 2019 to January 2022 were divided into two groups according to the different free modes of fundogastric body.68 patients underwent surgery using the TPOL model LSG.A control group of 67 patients was treated with conventional LSG surgery.To analyze and compare the duration of operation,gastric fundus free time,intraoperative blood loss time,hospital stay time,postoperative gastric fistula,bleeding rate,and occurrence of gastroesophageal reflux disease(GERD)between the two groups.Results All patients successfully completed LSG surgery and were safely discharged.They were followed for a period of 12 to 36 months.the duration of operation for the study group was(56.13±10.56)minutes,while for the control group it was(62.45±12.74)minutes.The gastric fundus was freed in(6.34±4.16)minutes for the study group and(12.58±6.37)minutes for the control group.The duration of hospitalization was(3.84±0.42)days for the study group and(4.06±0.69)days for the control group.The intraoperative blood loss was(10.87±1.28)ml for the study group and(15.56±3.39)ml for the control group.The incidence of postoperative GERD was 5(7.35％)for the study group and 13(19.40％)for the control group.The differences between the two groups were statistically significant(P＜0.05).The decrease in excess weight at 12 months after surgery,as well as complications such as bleeding and gastric fistula,were not statistically significant(P＞0.05).Conclusion LSG(TPOL model)extends from the TJ point(the Tri-junction point where the gastric left mesangium,gastric posterior mesangium,and pancreatic mesangium meet)to the apex of the medial foot edge of the left diaphragm.LSG(TPOL model)can be efficiently and safely achieve tension-free anastomosis,resulting in a complete free gastric fundus.This method is feasible,and has clinical value for the standardized free gastric fundus of LSG.

Patients who received sleeve gastrectomy have lower plasma osteopontin levels than those who did not

Abstract Background: The aim of this study was to compare metabolic parameters, plasma Osteopontin (OPN) and Hepatocyte Growth Factor (HGF) levels between Sleeve Gastrectomy (SG) patients in their 6th post-operation month and healthy control patients. Methods: Height, weight, Body Mass Index (BMI) and laboratory parameters of 58 SG patients aged 18‒65 years (Group 1) and 46 healthy control patients (Group 2) were compared. In addition, preoperative and postoperative sixth-month BMI and laboratory parameters of the patients in Group 1 were compared. Results: The mean age and gender distributions of the groups were similar (p > 0.05). Mean BMI was 28.9 kg/m2 in Group 1 and 27 kg/m2 in Group 2 (p < 0.01). While plasma HGF levels were similar between both groups, plasma OPN levels were higher in Group 2 (p < 0.001). Fasting plasma glucose, total cholesterol, triglyceride, fasting plasma insulin and insulin resistance values were higher in Group 1, while alanine aminotransferase and aspartate aminotransferase levels were higher in Group 2 (p < 0.05). There was a strong correlation between plasma HGF and OPN levels in Group 1, but not in Group 2 (Rho = 0.805, p < 0.001). Conclusion: OPN and HGF are promising biomarkers that can be used to better understand and detect problems related to obesity. The fact that patients in the early post-SG period had lower plasma OPN and similar plasma HGF compared to non-surgical patients of similar age and gender with higher BMI may be another favorable and previously unknown metabolic effect of SG.

Cirugía bariátrica: resultados clínicos en términos de pérdida de peso y resolución de comorbilidades / Bariatric surgery: Clinical outcomes in terms of weight loss and resolution of comorbidities

Introducción. La cirugía bariátrica es una estrategia válida de tratamiento en obesidad severa. El objetivo de este estudio fue evaluar la reducción de peso y la resolución de comorbilidades comparando dos técnicas quirúrgicas, baipás gástrico en Y de Roux y manga gástrica. Métodos. Estudio descriptivo de tipo analítico que incluyó pacientes con obesidad grados II y III. Se analizaron variables demográficas y perioperatorias, y las comorbilidades asociadas a la obesidad. La reducción del peso se evaluó con el porcentaje de pérdida del exceso de peso. Se realizó un análisis descriptivo univariado, usando medianas, rangos intercuartílicos, frecuencias y proporciones. Se usaron las pruebas de U de Mann-Whitney y Chi cuadrado para el análisis de grupos. Un valor de p<0,05 fue considerado estadísticamente significativo. Resultados. Fueron incluidos 201 pacientes. La mediana del porcentaje de pérdida del exceso de peso a 18 meses fue de 77,4 % para el grupo de baipás gástrico en Y de Roux vs 69,5 % para el grupo de manga gástrica (p=0,14). La mayoría de los pacientes presentaron resolución o mejoría de la hipertensión arterial (76 %), diabetes mellitus (80 %), dislipidemia (73 %), apnea del sueño (79 %) y artropatías (94 %), sin diferencia significativa según la técnica quirúrgica empleada. La tasa de complicaciones mayores fue del 1,9 %. No se presentó mortalidad. La mediana de seguimiento fue 28 meses. Conclusión. El baipás gástrico en Y de Roux y la manga gástrica son procedimientos muy seguros y efectivos para la reducción del exceso de peso y la resolución de las comorbilidades asociadas a la obesidad

Introduction. Bariatric surgery is a valid strategy of treatment for severe obesity. The aim of this study is to evaluate weight loss and resolution of comorbidities comparing two procedures, Roux-en-Y gastric bypass and sleeve gastrectomy. Methods. Descriptive study of analytical type that included patients with obesity grades II and III. Demographic and perioperative variables were analyzed. The weight reduction was evaluated among others with the percentage of excess of body weight loss. Comorbidities associated with obesity were also analyzed. A univariate descriptive analysis was performed, using medians, interquartile ranges, frequencies, and proportions. The Mann-Whitney U and Chi squared tests were used for analysis of groups. A value of p <0.05 was considered statistically significant. Median follow-up was 28 months. Results. A total of 201 patients were included in the analysis. The median percentage of excess of body weight loss at 18 months was 77.4% for Roux-en-Y gastric bypass group vs 69.5% for sleeve gastrectomy group (p=0.14). The majority of patients presented resolution or improvement of hypertension (76%), diabetes mellitus (80%), dyslipidemia (73%), sleep apnea (79%), and arthropathy (94%), without significant differences according to the surgical technique used. Major complication rate was 1.9%. There was not mortality. The median follow-up was 28 months. Conclusion. Roux-en-Y gastric bypass and sleeve gastrectomy are both very safe and effective procedures for excess weight reduction and resolution of comorbidities associated with obesity

Detalles técnicos para prevenir la Enfermedad por Reflujo Gastroesofágico durante la Gastrectomía en manga

La gastrectomía en manga es el procedimiento bariátrico más frecuentemente efectuado en la actualidad. La complicación alejada más frecuente es el aumento de la tasa de enfermedad por reflujo gastro-esofágico. Se han descrito las razones anatómicas y fisiopatológicas de su origen. En este artículo se describen los puntos claves de la técnica quirúrgica de la manga gástrica para su prevención como también otros procedimientos que han sugerido tanto para su prevención como tratamiento.

Sleeve gastrectomy is the most frequently performed bariatric procedure today. The most common distant complication is the increased rate of gastroesophageal reflux disease. The anatomical and pathophysiological reasons for its origin have been described. This article describes the key points of the gastric sleeve surgical technique for its prevention as well as other procedures that have been suggested both for its prevention and treatment.

Manga traqueal cartilaginosa. Reporte de dos casos / Tracheal cartilaginous sleeve. Report of two cases

La manga traqueal cartilaginosa es una malformación de la vía aérea donde no se distinguen anillos traqueales. Un segmento continuo de cartílago se extiende desde el cricoides, pudiendo llegar hasta los bronquios principales. Está asociada a síndromes de craneosinostosis con la mutación FGFR2, además de muertes prematuras por oclusión de la tráquea con tapones mucosos. Se presenta el curso clínico de pacientes portadores de manga traqueal cartilaginosa en el contexto de una malformación craneofacial. Caso 1. Masculino, al nacer hipoplasia del tercio medio facial. Polisomnografía: índice de apnea/hipopnea de 37,7/hr. Laringotraqueobroncoscopía (LTBC): tráquea sin anillos cartilaginosos desde cricoides hasta bronquios fuentes. Se indica traqueostomía. Caso 2. Masculino, al nacer cráneo en trébol. Poligrafía: Síndrome de apnea/hipopnea obstructiva del sueño (SAHOS) leve. Revisión vía aérea: desde subglotis hasta bronquios principales se extiende tráquea en manga. Se indica traqueostomía. En el contexto de una craneosinostosis en niños, especialmente con mutación FGFR2, creemos necesario realizar una LTBC en búsqueda de manga traqueal, ya que si es diagnosticada se debe recomendar traqueostomía, mejorando su expectativa de vida. Si la indicación de traqueostomía fuese por SAHOS, es obligatoria una LTBC preoperatoria, para evitar el no tener referencias anatómicas en el proceso.

A tracheal cartilaginous sleeve is a malformation of the airway in which the tracheal rings are indistinguishable. A continuous segment of cartilage extends from the cricoid, and it may reach all the way to the main bronchi. It is associated with various craniosynostosis syndromes with the FGFR2 mutation, in addition to premature deaths due to occlusions caused by mucus plugs in the trachea. Here we present the clinical course of patients who suffer from Tracheal Cartilaginous Sleeve in the context of a craniofacial malformation. First case. Male, presenting at birth a midfacial hypoplasia. Polysomnography: presents a 37,7/h index of apnea/hypopnea. Laryngotracheobronchoscopy (LTB): trachea is without cartilaginous rings from the cricoid to the main bronchi. A tracheostomy is indicated. Second case. Male, cloverleaf skull at birth. Polysomnography: Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) non-severe degree. Revision of the airway: the trachea in sleeve extends from the subglottis to the main bronchi. A tracheostomy is indicated. In the context of craniosynostosis in children, especially with FGFR2 mutation, we believe it is necessary to do an LTB in the search of a tracheal sleeve, since if it is diagnosed a tracheostomy must be indicated, to better the life expectancy of the patient. If the tracheostomy indication comes from an OSAHS, a preoperatory LTB is obligatory to avoid not having anatomical references during the procedure.

Improvement and development direction of bariatric metabolic surgery / 中华消化外科杂志

In more than half a century of the development of bariatric metabolic surgery, a variety of classic surgical methods have been formulated. However, the improvement and innovation of bariatric metabolic surgery has never stopped. The replacement of new and old surgical methods in clinical application and development reflects the vitality and progress in the field of bariatric metabolic surgery, and also promotes the development of bariatric metabolic surgery to the best balance between benefits and risks. In the early stages, studies in metabolic surgery are more inclined to confirm the efficacy, safety and mechanism of classical procedures. In recent years, metabolic surgeons around the world have become more inclined to focus on the exploration and innovation of new procedures. In addition, the improvement of biliopancreatic diversion with duodenal switch and the sleeve gastrectomy plus procedures have gradually become hot spots for surgical innovation. However, the new techniques are diverse, scattered and partially overlapping. The authors make a comment on this content, in order to provide assistance to clinical and scientific research.

Oblique supine one-piece posterior laparoscopic total nephroureterectomy plus cystic sleeve resection in the treatment of 24 cases of upper urinary tract uroepithelial carcinoma / 现代泌尿外科杂志

【Objective】 To explore the safety and efficacy of a modified one-piece posterior laparoscopic total nephroureterectomy with cystic sleeve resection in the treatment of upper urinary tract uroepithelial carcinoma (UTUC). 【Methods】 A total of 24 patients treated during Jan. and Jun. 2022 were involved, including 16 males and 8 females, aged 62 to 90 (average 73) years. The UTUC was in the left side in 15 cases, and in the right side in 9 cases. There were 10 cases of renal pelvis tumor, 6 cases of upper ureteral tumor and 8 cases of lower ureteral tumor. 【Results】 All operations were successful without conversion to open surgery. The operation time ranged from 60 to 100 minutes, average (71.25±9.80) minutes. The intraoperative bleeding volume was 20 to 200 mL, average (30.03±8.13) mL. No significant intraoperative or postoperative complications occurred. The postoperative hospital stay was 4 to 7 days, average (5.83±1.44) days. Bladder perfusion chemotherapy was performed after surgery. 【Conclusion】 The modified one-piece posterior laparoscopic total nephroureterectomy plus cystic sleeve resection for UTUC is an effective and feasible procedure with satisfactory tumor control, which is worth further promotion in clinical practice.

Bilateral Tibial Tuberosity Periosteal Sleeve Fracture in an Adolescent: A Case Report

@#Tibial tuberosity avulsion fracture is a rare injury, and bilateral occurrence is more uncommon. Periosteal sleeve fracture is a unique fracture pattern which was first described in the lower pole of patella in children. We are reporting a rare case of bilateral tibial tuberosity sleeve fracture in a teenage boy which occurred while sprinting. The patient underwent open reduction, pull through suture fixation of the bilateral tibial tuberosity and screw fixation of left tibial tuberosity. Post-operative rehabilitation included gradual increment of range of motion with hinged brace and quadriceps muscle strengthening. Close follow-up was done to monitor the progression of his recovery. At six months follow-up, the patient recovered well. Both knees had full range of motion with an intact extensor mechanism.

Clinical efficacy of laparoscopic sleeve gastrectomy in obesity patients of different grades / 中华消化外科杂志

Objective:To investigate the clinical efficacy of laparoscopic sleeve gastrectomy (LSG) in obesity patients of different grades.Methods:The retrospective and descriptive study was conducted. The clinical data of 139 obesity patients of different grades who were admitted to the General Hospital of Ningxia Medical University from January 2018 to December 2021 were collected. There were 37 males and 102 females, aged (32±9)years. Of the 139 patients, there were 45 cases of grade Ⅰ obesity, 44 cases of grade Ⅱ obesity and 50 cases of grade Ⅲ obesity, respectively. Obser-vation indicators: (1) intraoperative and postoperative situations in obesity patients of different grades; (2)hematological related indicators in obesity patients of different grades; (3)body quality related indicators in obesity patients of different grades. Measurement data with normal distribution were represented as Mean± SD, and comparison within three groups was conducted using the One-way Anova test and comparison between groups was conducted using the LSD test. Measurement data with skewed distribution were represented as M(range), and comparison within three groups was conducted using the Kruskal-Wallis H test. Count data were described as absolute numbers, and comparison between groups was performed using the chi-square test or Fisher exact probability. Repeated measurement data were analyzed by the repeated ANOVA. Results:(1) Intraoperative and postoperative situations in obesity patients of different grades. The operation time,volume of intraoperative blood loss,duration of postoperative hospital stay and cases readmitted within 30 days after surgery were 2.0(range, 1.5-2.0)hours,50(range, 50-100)mL, 5(range, 4-6)days and 2 in the 45 cases of grade Ⅰ obesity. The above indicators were 2.0(range, 1.5-2.0)hours, 60(range, 50-187)mL, 5(range, 4-6)days and 4 in the 44 cases of grade Ⅱ obesity and 2.0(range, 1.5-2.1)hours, 60(range, 50-135)mL, 5(range, 4-7)days and 4 in the 50 cases of grade Ⅲ obesity. There was no significant difference in the operation time, volume of intraoperative blood loss,duration of postoperative hospital stay among the three groups of patients ( H=4.11, 0.77, 3.59, P>0.05) and there was no significant difference in cases readmitted within 30 days after surgery among the three groups of patients ( P>0.05). (2) Hematological related indicators in obesity patients of different grades. All 139 patients were followed up at postoperative 3, 6 and 12 month. The total cholesterol (TC) were (4.5±0.9)mmol/L, (4.6±0.9)mmol/L, (4.3±0.8)mmol/L, (4.6±1.1)mmol/L at preoperative and postoperative 3, 6 and 12 month in cases of grade Ⅰ obesity. The above indicators were (4.5±0.8)mmol/L, (4.4±0.8)mmol/L, (4.4±1.0)mmol/L, (4.3±0.9)mmol/L in cases of grade Ⅱ obesity and (4.4±1.0)mmol/L, (4.7±1.1)mmol/L, (4.5±0.8)mmol/L, (4.4±0.5)mmol/L in cases of grade Ⅲ obesity. The above indicators among the three groups not meeting the mauchly′s test of sphericity ( χ2=20.81, P<0.05) and results of multi-variate test showed that there was no significant difference in the time effect, intergroup effect and interaction effect of TC among the three groups( Ftime=0.45, Fgroup=0.40, Finteraction=0.66, P>0.05). The triglyceride (TG) were (2.0±1.1)mmol/L, (1.3±0.4)mmol/L, (1.0±0.4)mmol/L, (1.0±0.4)mmol/L at preoperative and postoperative 3, 6 and 12 month in cases of grade Ⅰ obesity. The above indicators were (2.2±1.1)mmol/L, (1.5±0.5)mmol/L, (1.1±0.3)mmol/L, (1.0±0.3)mmol/L in cases of grade Ⅱ obesity and (2.3±1.1)mmol/L, (1.7±0.7)mmol/L, (1.4±0.6)mmol/L, (1.2±0.4)mmol/L in cases of grade Ⅲ obesity. The above indicators among the three groups not meeting the mauchly′s test of sphericity ( χ2=290.49, P<0.05) and results of multi-variate test showed that there were significant differences in the time effect, intergroup effect and interaction effect of TG among the three groups ( Ftime=80.44, Fgroup=4.13, Finteraction=2.67, P<0.05). The vitamin D were (12.9±5.9)μg/L, (16.5±5.9)μg/L, (18.0±6.3)μg/L, (20.1±5.7)μg/L at preoperative and postoperative 3, 6 and 12 month in cases of grade Ⅰ obesity. The above indicators were (11.5±4.4)μg/L, (17.1±5.0)μg/L, (18.2±5.6)μg/L, (20.2±6.6)μg/L in cases of grade Ⅱ obesity and (9.8±3.5)μg/L, (17.2±4.6)μg/L, (18.1±4.7)μg/L, (19.5±5.2)μg/L in cases of grade Ⅲ obesity. The above indicators among the three groups not meeting the mauchly′s test of sphericity ( χ2=53.07, P<0.05) and results of multi-variate test showed that there were significant differences in the time effect and interaction effect of vitamin D among the three groups ( Ftime=150.88, Finteraction=3.86, P<0.05)and there was no significant difference in the intergroup effect of vitamin D among the three groups ( Fgroup=0.35, P>0.05). (3) Body quality related indicators in obesity patients of different grades. The body mass and body mass index (BMI) were (88±8)kg, (71±8)kg, (65±8)kg, (61±7)kg, (32±2)kg/m 2, (26±2)kg/m 2, (24±2)kg/m 2, (22±2)kg/m 2 at preoperative and postoperative 3, 6 and 12 month in cases of grade Ⅰ obesity. The above indicators were (106±11)kg, (82±8)kg, (75±9)kg, (70±9)kg, (37±1)kg/m 2, (29±2)kg/m 2, (26±2)kg/m 2, (25±3)kg/m 2 in cases of grade Ⅱ obesity and (131±20)kg, (101±15)kg, (89±13)kg, (79±12)kg, (45±6)kg/m 2, (35±5)kg/m 2, (31±4)kg/m 2, (27±4)kg/m 2 in cases of grade Ⅲ obesity. The above indicators among the three groups not meeting the mauchly′s test of sphericity ( χ2=194.60, 179.52, P<0.05) and results of multi-variate test showed that there were significant differences in the time effect, intergroup effect and interaction effect of body mass and BMI among the three groups( Ftime=492.59, 543.86, Fgroup=89.13, 95.91, Finteraction=13.97, 13.32, P<0.05). The percen-tage of excess weight loss (EWL%) were 61%±16%,84%±21%,96%±23% at postoperative 3, 6 and 12 month in cases of grade Ⅰ obesity. The above indicators were 55%±7%,72%±16%,85%±19% in cases of grade Ⅱ obesity and 45%±12%,64%±15%,78%±7% in cases of grade Ⅲ obesity. The above indicators among the three groups not meeting the mauchly′s test of sphericity ( χ2=51.61, P<0.05) and results of multi-variate test showed that there were significant differences in the time effect and intergroup effect of EWL% among the three groups ( Ftime=374.52, Fgroup=15.69, P<0.05) and there was no significant difference in the interaction effect of EWL% among the three groups ( Finteraction=1.08, P>0.05). The percentage of total body weight loss (TWL%) were 19%±5%, 26%±6%, 30%±6% at postoperative 3, 6 and 12 month in cases of grade Ⅰ obesity. The above indicators were 21%±6%, 29%±6%, 34%±7% in cases of grade Ⅱ obesity and 22%±7%, 32%±7%, 39%±8% in cases of grade Ⅲ obesity. The above indicators among the three groups not meeting the mauchly′s test of sphericity ( χ2=58.54, P<0.05) and results of multi-variate test showed that there were significant differences in the time effect, intergroup effect and interaction effect of TWL% among the three groups ( Ftime=290.61, Fgroup=12.32, Finteraction=5.49, P<0.05). The waist to hip ratio (WHR) and visceral fat area (VFA) were 0.92±0.04, 0.86±0.03, 0.84±0.03, 0.83±0.03, (129±19)cm 2, (79±17)cm 2, (63±15)cm 2, (57±14)cm 2 at preoperative and postoperative 3, 6 and 12 month in cases of grade Ⅰ obesity. The above indi-cators were 0.98±0.05, 0.90±0.05, 0.87±0.05, 0.86±0.05, (169±20)cm 2, (105±23)cm 2, (85±20)cm 2, (73±20)cm 2 in cases of grade Ⅱ obesity and 1.05±0.09, 0.94±0.06, 0.91±0.06, 0.89±0.05, (218±42)cm 2, (144±35)cm 2, (114±26)cm 2, (96±19)cm 2 in cases of grade Ⅲ obesity. The above indicators among the three groups not meeting the mauchly′s test of sphericity ( χ2 =289.99, 191.92, P<0.05) and results of multi-variate test showed that there were significant differences in the time effect, intergroup effect and interaction effect of WHR and VFA among the three groups ( Ftime=361.39, 707.60, Fgroup=34.28, 12.69, Finteraction=8.31, 94.89, P<0.05). Conclusion:Treatment of obesity patients of different grades with LSG can improve patients′ TG and vitamin D levels, and reduce patients′ body mass, BMI, EWL%, TWL%, WHR and VFA.

Learning curve analysis and influencing factors of operation time of laparoscopic sleeve gastrectomy / 中华消化外科杂志

Objective:To investigate the influencing factors of operation time for laparos-copic sleeve gastrectomy (LSG) and analyze the learning curve of LSG in sarcopenic obesity (SO) and non-sarcopenic obesity (NSO).Methods:The retrospective cohort study was conducted. The clinical data of 240 obesity patients who underwent LSG in the Fujian Medical University Union Hospital from January 2018 to June 2022 were collected. There were 52 males and 188 females, aged (30±8)years. Patients underwent L3 vertebral body horizontal axial computer tomography (CT) scanning before and after receiving LSG to accurately segment muscles and fats. Observation indicators: (1) treatment and follow-up; (2) influencing factors of operation time for LSG; (3) cumulative sum (CUSUM) of learning curve; (4) comparison of clinical data between patients in the initial and profi-cient stages. Measurement data with normal distribution were represent as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(IQR), and comparison between groups was conducted using the non-parameter test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Univariate and multivariate analyses were conducted using the Logistic regression model. The CUSUM of learning curve was calculated and the fitting process was conducted on scatter plot of learning curves. Results:(1) Treatment and follow-up. Of the 240 patients, there were 97 cases of SO and 143 cases of NSO. All 240 patients underwent LSG successfully, without conversion to open surgery. The operation time of 240 patients was (108±23)minutes. None of patient died during the perioperative period and all patients underwent follow-up during the postoperative 6 months. (2) Influencing factors of operation time for LSG. Results of multivariate analysis showed that SO was an independent factor influencing operation time for LSG ( odds ratio=2.207, 95% confidence interval as 1.207-4.038, P<0.05). (3) CUSUM of learning curve. Results of CUSUM of operation time in patients of SO and NSO showed that the best fit equation of patients of SO was y=-4E-08x 6+1E-05x 5-0.001 1x 4+0.063 1x 3-1.89x 2+28.126x-48.671 (x means the number of surgical cases), with goodness-of-fit R 2 as 0.833, and the best fit equation of patients of NSO was y=3E-09x 6-1E-06x 5+0.000 2x 4-0.010 9x 3+0.063 8x 2+12.053x-65.025 (x means the number of surgical cases), with goodness-of-fit R 2 as 0.716. Based on the trend of CUSUM of learning curve of operation time, the peak value of number of surgical cases in patients of SO and NSO was 81 and 36, respec-tively, which was used to divide the learning curve as two stages of the initial stage and the proficient stage. (4) Comparison of clinical data between patients in the initial and proficient stages. ① Of the 97 patients of SO, there were 81 cases and 16 cases in the initial stage and the proficient stage of LSG, with the operation time, postoperative duration of hospital stay as (119±23)minutes, (5.9±2.3)days and (106±21)minutes, (4.7±0.5)days, showing significant differences between them ( t=2.074, 2.147, P<0.05). ②Of the 143 patients of NSO, there were 36 cases and 107 cases in the initial stage and the proficient stage of LSG, with gender (female), height, preoperative body mass, defatted body mass, operation time, postoperative duration of hospital stay, body mass at postoperative 6 month, body mass index (BMI) at postoperative 6 month, percentage of excess weight loss (EWL%) at postoperative 6 month, cases with EWL% >100% at postoperative 6 month, excess BMI at post-operative 6 month as 20, (170±10)cm, (110±25)kg, (57±12)kg, (108±22)minutes, (6.1±1.6)days, (80±16)kg, (27.63±4.22)kg/m2, 83%±35%, 9, 1.99(6.03)kg/m2 and 87, (164±8)cm, (99±20)kg, (52±12)kg, (100±19)minutes, (4.7±1.1)days, (71±16)kg, (25.89±4.48)kg/m2, 103%±42%, 48, 0.31(5.82)kg/m2, showing significant differences between them ( χ2=9.484, t=3.266, 2.424, 2.141, 2.137, 5.821, 2.740, 1.993, -2.524, χ2=4.432, Z=-2.300, P<0.05). Conclusions:SO is an independent factor influencing operation time for LSG. It is suggested that the surgeons need to finish 81 cases and 36 cases master LSG in patients of SO and NSO.

Influencing factors of reflux esophagitis after sleeve gastrectomy and its plus procedures / 中华消化外科杂志

Objective:To investigate the influencing factors of reflux esophagitis after sleeve gastrectomy and its plus procedures.Methods:The retrospective case-control study was conducted. The clinical data of 130 patients who underwent sleeve gastrectomy and its plus procedures (jejunal bypass, duodenal-jejunal bypass) for the treatment of metabolic diseases in the First Affiliated Hospital of Nanjing Medical University from May 2010 to August 2021 were collected. There were 34 males and 96 females, aged (32±8)years, with the body mass index (BMI) as (38±7)kg/m 2. Observation indicators: (1) incidence of reflux esophagitis before and after surgery; (2) clinical manifestations of reflux esophagitis and treatment; (3) influencing factors of reflux esopha-gitis after surgery; (4) follow-up. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. In univariate analysis, the median value of clinical variable was used for grouping and the chi-square test was used for subsequent analysis. Multivariate analysis was conducted using Logistic stepwise regression model. Results:(1) Incidence of reflux esophagitis before and after surgery. Of 130 patients, there were 5 cases with Los Angeles classification grade A reflux esopha-gitis before the surgery, and there were 35 cases with reflux esophagitis after surgery, including 26 cases as Los Angeles classification grade A esophagitis, 8 cases as Los Angeles classification grade B esophagitis and 1 case as Los Angeles classification grade C esophagitis. There was a significant difference in the incidence of reflux esophagitis for patients before and after surgery ( P<0.05). (2) Clinical manifestations of reflux esophagitis and treatment. The 5 patients with preoperative reflux esophagitis described with no obvious heartburn and acid regurgitation and did not receive treat-ment. For the 35 patients with postoperative reflux esophagitis, 22 cases described with heartburn and acid regurgitation, and 13 cases described without any symptoms. Of the 35 patients, 10 were treated with continuous oral proton pump inhibitors, 2 were treated with intermittent oral proton pump inhibitors, 10 were relieved by dietary adjustment, and 13 were not treated. For the 95 patients without postoperative reflux esophagitis, 5 cases described with heartburn and acid regurgitation, requiring continuous oral proton pump inhibitor treatment. The remaining 90 cases described no heartburn and acid regurgitation and did not receive treatment. (3) Influencing factors of reflux esophagitis after surgery. Results of multivariate analysis showed that the preoperative reflux diagnostic questionnaire scoring >0 and the occurrence of postoperative heartburn and acid regurgi-tation were independent risk factors of postoperative reflux esophagitis ( odds ratio=7.84, 47.16, 95% confidence interval as 2.04?30.20, 11.58?192.11, P<0.05). (4) Follow-up. All 130 patients were followed up for 17(range, 12?60)month after surgery. The BMI, percentage of total weight loss, diabetes remission rate, fasting blood glucose and glycosylated hemoglobin of the 130 patients at postoperative 12 month were (25±4)kg/m 2, 31%±8%, 84.6%(22/26), (5.6±1.2)mmol/L and 5.9%±1.3%. Conclusions:The sleeve gastrectomy and its plus procedures increase the risk of postoperative reflux esophagitis. Preoperative reflux diagnostic questionnaire scoring>0 and the occurrence of postoperative heartburn and acid regurgitation are independent risk factors of postoperative reflux esophagitis. Dietary adjustment and proton pump inhibitor therapy can alleviate symptoms of reflux esophagitis, but cannot cure reflux esophagitis.

Effect of ultrasound-guided transverse abdominal muscle plane block on pain inhibition and stress response in patients undergoing laparoscopic sleeve gastrectomy / 临床外科杂志

Objective To investigate the effect of ultrasound-guided transverse abdominal plane block(TAPB)on pain inhibition and stress response in patients undergoing laparoscopic sleeve gastrectomy(LSG).Methods 98 cases of laparoscopic sleeve Gastrectomy patients admitted from March 2021 to October 2022 were selected as the research object,and they were randomly divided into control group(49 cases)and observation group(49 cases)by double blind method.The control group received general anesthesia,and the observation group received TAPB+general anesthesia.The postoperative pain,analgesic dosage,stress level,hemodynamics and adverse reactions of the two groups were compared.Results The dosage of sufentanil and propofol in the observation group,as well as the effective press frequency of the intravenous analgesia pump 48 hours after surgery[(232.38±29.62)μg,(328.40± 40.68)mg and(5.60±1.25)],were lower than those in the control group[(294.07±35.88)μg,(402.25±46.74)mg and(9.75±2.40)](P＜0.05).The visual analogue scale(VAS)scores for each time period of the observation group were(2.43±0.49),(2.29±0.46),(2.85±0.49),(2.41± 0.39),(2.12±0.41)and(1.82±0.32),respectivly.While,the control group were(2.95±0.46),(3.22±0.51),(3.92±0.47),(3.13±0.65),(2.83±0.57)and(2.05±0.53),respectivly.The difference between the two groups was statistically significant(P＜0.05).At the time of tracheal intubation(T2),at the end of operation(T3),and at the time of leaving the anesthesia recovery room(T4),the fluctuation range of mean arterial pressure[86.00(79.00,94.00)mmHg,87.00(80.00,90.00)mmHg and 89.00(84.00,95.00)mmHg vs 82.00(75.00,90.00)mmHg,85.00(77.00,93.00)mmHg and 87.00(80.00,97.00)mmHg],heart rate[78.00(67.00,83.00)times/min,80.00(74.00,86.00)times/min and 81.00(76.00,90.00)times/min vs 78.00(67.00,83.00)times/min,80.00(74.00,86.00)times/min and 81.00(76.00,90.00)times/min]and blood oxygen saturation[97.38(97.00,97.75)％,98.69(98.30,99.05)％and 99.16(98.80,99.35)％vs 96.54(96.15,96.80)％,98.02(97.65,98.45)％and 98.73(98.43,99.15)％]in the observation group was significantly smaller than that of the control group(P＜0.05).In the observation group,cortisol levels were(192.47 ±40.25)ng/ml,(151.34±39.62)ng/ml and(118.69±30.57)ng/ml at 6 hours,24 hours and 48 hours,respectively,while in the control group were(206.24±45.34)ng/ml,(178.24±37.58)ng/ml and(143.63±32.34)ng/ml,respectively;C-reactive protein(CRP)in the observation group were(25.24±6.29)mg/L,(20.93±5.83)mg/L and(13.61±4.29)mg/L,respectively,while in the control group were(28.13±6.92)mg/L,(23.25±5.21)mg/L and(16.38±4.35)mg/L,respectively;interleukin-6(IL-6)in the observation group were(44.87±7.95)pg/L,(38.34±6.13)pg/L and(34.27±5.32)pg/L,respectively,while in the control group were(56.43±7.23)pg/L、(42.24±6.58)pg/L、(37.66±6.03)pg/L,respectively.The difference between the two groups was statistically significant(P＜0.05).The total incidence of adverse reactions of the observation group(4.08％)was lower in than that of the control group(20.41％)(P＜0.05).Conclusion Ultrasound-guided TAPB for LSG patients has a good effect on postoperative pain suppression,can reduce the stress response of the body after surgery,and is safe.

Transversus abdominis plane block reduce post-operative nausea and vomiting after laparoscopic sleeve gastrectomy in morbid obesity patients / 中华内分泌外科杂志

Objective:To study the effect of ultrasound guided transabdominal plane block (TAPB) on postoperative nausea and vomiting (PONV) in obese patients after laparoscopic sleeve gastrectomy (LSG) .Methods:From Jan. 2017 to Jan. 2022, 285 patients who underwent LSG surgery in the Department of General Surgery, Tianjin Medical University General Hospital were selected and randomly divided into two groups, including 145 patients in TAPB group and 140 patients in the control group (The TAPB group was injected with ropivacaine; the control group injected with physiological saline) . Data between TAPB group and control group were compared, including operation related data, postoperative acute pain assessment, and postoperative recovery assessment.Results:There was no significant difference between the two groups in ASA grading, operation duration, awakening time, extubation time or intraoperative hemodynamic index. The dosage of remifentanil [ (2.0±0.6) vs (2.9±0.9) mg], sufentanil [ (24.7±2.5) vs (50.0±3.2) μg], and dexmedetomidine [ (60.0±0.4) vs (65.0±0.5) μg] in TAPB group was significantly reduced compared with that in the control group, and there was no significant difference in the dosage of propofol. The VAS score and NRS score of resting state and motor state in TAPB group at 1, 3, 6, 12, 24, 48 h after operation were significantly lower than those in the control group. In TAPB group, the first use time of PCIA [ (2.0±0.8) vs (1.1±0.9) h] was significantly prolonged, the number of effective pressing of PCIA (3±1 vs 5±2) within 48 hours and the incidence of rescue analgesia in wards (19.3 % vs 31.4 %) were significantly lower than those in the control group. The frequency (3.0±1.5 vs 3.6±1.8) and severity (2.8±1.4 vs 3.4±1.8) of PONV and the incidence of additional antiemetic drugs (15.9 % vs 27.9 %) in TAPB group were significantly lower than those in the control group. The ambulation time [ (1.4±0.3) vs (1.5±0.3) h] and exhaust time [ (1.2±0.9) vs (1.4±1.0) h] in TAPB group was significantly earlier than those in the control group. There was no significant difference in postoperative length of hospitalization.Conclusion:TAPB for LSG can significantly reduce postoperative pain and PONV, reduce the use of opioid analgesics and antiemetics, and promote recovery of patients.

Embarazo postmanga gástrica en pacientes con irregularidades menstruales / Pregnancy after gastric sleeve in patients with menstrual irregularities

Resumen OBJETIVO: Estimar la cantidad de pacientes con irregularidades menstruales que se embarazaron luego de una cirugía bariátrica (manga gástrica) y describir los desenlaces de los embarazos. MATERIALES Y MÉTODOS: Estudio retrospectivo de serie de casos de pacientes obesas y con irregularidades menstruales intervenidas mediante cirugía bariátrica (manga gástrica). Se operaron entre el 1 de junio de 2014 y el 31 de diciembre de 2019 en el Centro Médico Imbanaco Cali, Colombia. RESULTADOS: De 1418 cirugías bariátricas, tipo manga gástrica, 117 pacientes cumplieron con los criterios de inclusión, 80 de ellas se localizaron telefónicamente y aceptaron incluirse al estudio. Luego de la manga gástrica, el 86.25% (n = 69) de las pacientes logró la regularización de sus ciclos menstruales. Además, el 31% (n = 25) consiguió el embarazo, 80% (n = 20) de ellas tenían la intención de buscar el embarazo. Los desenlaces de esos embarazos fueron favorables, con partos a término, con adecuado peso y talla al nacer. CONCLUSIONES: Después de la cirugía bariátrica, tipo manga gástrica, en mujeres con irregularidades menstruales, 25 de las 80 pacientes se embarazaron y los desenlaces obstétricos fueron satisfactorios. Sin duda, hacen falta más estudios prospectivos para poder afirmar, con una mejor representación estadística, las repercusiones de la disminución del peso corporal en la tasa de fertilidad.

Abstract OBJECTIVE: To estimate the number of patients with menstrual irregularities who became pregnant after bariatric surgery (gastric sleeve) and to describe the pregnancy outcomes. MATERIALS AND METHODS: Retrospective study of a series of cases of obese patients with menstrual irregularities who underwent bariatric surgery (gastric sleeve). They were operated between June 1, 2014 and December 31, 2019 at the Imbanaco Cali Medical Center, Colombia. RESULTS: Of 1418 bariatric surgeries, gastric sleeve type, 117 patients met the inclusion criteria, 80 of them were located by telephone and agreed to be included in the study. After gastric sleeve, 86.25% (n = 69) of the patients achieved regularization of their menstrual cycles. In addition, 31% (n = 25) achieved pregnancy, 80% (n = 20) of them intended to seek pregnancy. The outcomes of these pregnancies were favorable, with full-term deliveries, with adequate weight and height at birth. CONCLUSIONS: After bariatric surgery, gastric sleeve type, in women with menstrual irregularities, 25 of the 80 patients became pregnant and the obstetric outcomes were satisfactory. Undoubtedly, more prospective studies are needed to be able to affirm, with a better statistical representation, the repercussions of the decrease in body weight on the fertility rate.

Hemorragia digestiva alta grave por fistula entre arteria esplénica y manga gástrica / Severe upper gastrointestinal bleeding due to fistula between splenic artery and gastric sleeve / Hemorragia digestiva alta grave devido a fístula entre artéria esplênica e manga gástrica

La hemorragia digestiva determinada por una fístula entre manga gástrica y seudoaneurisma de arteria esplénica o polo superior de bazo es infrecuente. Se presenta un caso clínico de una paciente de 52 años con antecedentes de cirugía de manga gástrica y fuga anastomótica. Ingresó por hemorragia digestiva alta grave. Se operó de emergencia y realizó punto hemostático sobre cara posterior de manga gástrica. Se reintervino por resangrado realizándose la gastrectomía y esplenopancreatectomía distal por solución de continuidad de arteria esplénica. Dada la inestabilidad hemodinámica se efectuó un esofagostoma y yeyunostomía, reconstruyéndose a los 8 meses con buena evolución.

Gastrointestinal bleeding caused by a fistula between the gastric sleeve and a pseudoaneurysm of the splenic artery or upper pole of the spleen is uncommon. A clinical case of a 52-year-old patient with a history of gastric sleeve surgery and anastomotic leak is presented. She was admitted for severe upper gastrointestinal bleeding. She underwent emergency surgery and performed a hemostatic stitch on the posterior face of the gastric sleeve. She underwent reoperation due to rebleeding, performing gastrectomy and distal splenopancreatectomy due to discontinuation of the splenic artery. Given the hemodynamic instability, an esophagostomy and jejunostomy were performed, reconstructing at 8 months with good evolution.

O sangramento gastrointestinal causado por uma fístula entre a manga gástrica e um pseudoaneurisma da artéria esplênica ou pólo superior do baço é incomum. Apresenta-se o caso clínico de um paciente de 52 anos com história de cirurgia de manga gástrica e fístula anastomótica. Ele foi internado por hemorragia digestiva alta grave. Uma operação de emergência foi realizada e um ponto hemostático foi realizado na face posterior da manga gástrica. Foi reoperado por ressangramento, realizando gastrectomia e esplenopancreatectomia distal por descontinuação da artéria esplênica. Dada a instabilidade hemodinâmica, foi realizada esofagostomia e jejunostomia, reconstruindo aos 8 meses com boa evolução.

Cáncer gástrico post gastrectomía vertical: a propósito de un caso

Introducción: La obesidad y el índice de masa corporal (IMC) actúan como factores de riesgo para diversas neoplasias, sin una clara relación con el cáncer gástrico no cardial. La cirugía bariátrica es el manejo más efectivo contra la obesidad. La incidencia de cáncer gástrico posterior a la gastrectomía vertical es aún incierta. El primer caso de cáncer gástrico, 4 años posterior a una gastrectomía vertical, se publicó en 2014, y hasta la fecha se han descrito 11 casos en la literatura. Caso Clínico: Masculino de 52 años, con antecedente de gastrectomía vertical, presenta cuadro clínico, endoscópico e histopatológico compatible con adenocarcinoma de cuerpo gástrico 5 años posterior a cirugía bariátrica. Recibe tratamiento neoadyuvante con quimioterapia esquema FLOT 6 ciclos, luego gastrectomía total oncológica laparoscópica con disección ganglionar D2 y adyuvancia con esquema FOLFOX 6 ciclos. Estudio histopatológico resulta adenocarcinoma pobremente diferenciado con 90% de regresión tumoral, sin metástasis ganglionar en lo extraído (pT1bN0M0). Seguimiento por 6 meses sin signos clínicos e imagenológicos de recidiva tumoral. Discusión: Existiría una relación directa entre el IMC y cáncer de unión gastroesofágica, la que no ha sido demostrada para cáncer gástrico no cardial. El estudio con endoscopía digestiva alta previo a cirugía bariátrica no está estandarizado, sin embargo, es recomendable realizarlo. La cirugía bariátrica podría disminuir el riesgo de ciertas neoplasias, mientras que la incidencia de cáncer gástrico posterior a dicha cirugía aún no está bien definida. Es recomendable realizar seguimiento endoscópico a los pacientes posoperados de gastrectomía vertical, más aún en sintomáticos.

Introduction: Obesity and body mass index (BMI) are risk factors for different types of cancer, yet there is no clear association to non-cardia gastric cancer. Bariatric surgery is the most effective treatment for obesity. Incidence of gastric cancer after bariatric surgery remains unclear. The first case report of gastric cancer 4 years following a vertical sleeve gastrectomy was reported in 2014 and up until now, only 11 cases have been reported. Case report: 52-year-old man, who had undergone a sleeve gastrectomy 5 years ago, presented clinical, endoscopic, and histological features, compatible with a gastric body adenocarcinoma. He received neoadjuvant chemotherapy of 6 cycles of FLOT, an oncological laparoscopic total gastrectomy with D2 lymph node dissection and adjuvant chemotherapy with 6 cycles of FOLFOX. Biopsy reported a poorly differentiated adenocarcinoma with a 90% of tumor regression, with no signs of ganglion metastases (pT1bN0M0). 6-month follow-up showed no clinical or imaging signs of relapse. Discussion: There is a direct association between higher BMI and gastroesophageal junction cancer, but no clear evidence of this association with non-cardia gastric cancer. The preoperative evaluation with an upper endoscopy before bariatric surgery is not standardized, yet it is possible to recommend it. Bariatric surgery could lower the risk of certain cancers, yet the incidence of gastric cancer after this procedure is not yet defined. Endoscopic follow-up is recommended to all postoperative patients, especially if they become symptomatic.

Consulta en servicio de urgencia y reingreso hospitalario después de una cirugía bariátrica primaria / Emergency department visit and Hospital Readmission after Primary Bariatric Surgery

Resumen Introducción: Las consultas en el servicio de urgencia (CU) y el reingreso (RI) hospitalario después de una cirugía bariátrica (CB) son importantes indicadores de calidad y seguridad. Sin embargo, existe escasa información de estos indicadores en nuestro medio nacional. En este trabajo analizamos las CU y RI de pacientes sometidos a una CB primaria en un centro universitario de alto volumen, y buscamos variables asociadas a estos indicadores. Materiales y Método: Estudio observacional retrospectivo que incluyó a todos los pacientes sometidos a bypass gástrico (BPG) o gastrectomía en manga (GM) laparoscópica primaria realizados de forma consecutiva en nuestra institución durante el período 2006-2007 y 2012-2013. Utilizando nuestros registros clínicos y base de seguimiento prospectivo, identificamos aquellos pacientes con CU o RI en nuestro hospital durante los primeros 30 días después del alta. Resultados: Se incluyeron 1.146 CB primarias, 53% (n = 613) fueron BPG y 47% (n = 533) GM. Un 8,03% (n = 92) de los pacientes tuvo al menos una CU y un 3,7% (n = 42) un RI. Las variables independientes asociadas tanto a CU como RI fueron el tiempo operatorio e índice de masa corporal (IMC) preoperatorio. No se encontró asociación estadística, en el periodo estudiado, para el tipo de CB realizada con la CU ni con el RI. Conclusión: Existe una baja proporción de pacientes que requieren CU y RI posterior a la CB, lo que demuestra la seguridad de estas intervenciones.

Introduction: Emergency department visits (EDV) and hospital readmission (HR) after bariatric surgery (BS) are important indicators of quality and safety in surgery, however there is little information on their characteristics in our national environment. Aim: In this work we analyze EDV and HR in patients undergoing a primary BS in a high-volume university center, and identify variables that could be associated with these indicators. Materials and Method: A retrospective observational study where we identified all patients undergoing Roux-in-Y gastric bypass (RYGBP) or primary laparoscopic sleeve gastrectomy (SG) performed consecutively at our institution during the period 2006-2007 and 2012-2013. Using our clinical records and prospective follow-up database, we identify those patients with EDV and/or HR in our hospital during the first 30 days after discharge. Results: 1146 primary BS were included, of these 53% (n = 613) were RYGBP and 47% (n = 533) SG. 8,03% (n = 92) of the patients had at least one EDV, of these 3,7% (n = 42) had an HR. The independent variables associated with EDV and HR were the operative time and preoperative body mass index (BMI). No statistical association was found, in the period studied, for the type of BS performed with EDV or HR. Conclusion: There is a low proportion of patients who require EDV and HR after BS, which demonstrates the safety of these interventions.

The reoperation strategy after laparoscopic sleeve gastrectomy / 中华消化外科杂志

At present, laparoscopic sleeve gastrectomy (LSG) has become the most popular bariatric surgery worldwide. LSG is simple to operate, with few complications and favorable short-term weight loss results. However, with massive LSG performed, its disadvantages have become increasingly prominent. More and more patients require revisional surgery due to insufficient weight loss, weight regain and reflux esophagitis. Based on clinical experience and existing clinical evidence, the author reviews the reoperation strategies after LSG.