A pilot study for one-stop endoscopic total extraperitoneal inguinal hernia repair.

BACKGROUND: One-stop surgery was developed for patients to undergo surgical evaluation, anesthesia, surgery, and discharge all within 1 day. This study aimed to assess the feasibility, patient satisfaction, and potential of one-stop endoscopic total extraperitoneal (TEP) inguinal hernia surgery. METHODS: After general practitioners had been informed, prospectively selected patients with unilateral or bilateral inguinal hernia underwent one-stop surgery by TEP. Pre- and postoperative questionnaires were used to evaluate patient satisfaction. RESULTS: During 12 months, 52 patients were referred for one-stop surgery. There were no "no shows". The general practitioner correctly diagnosed inguinal hernia in 51 patients. On the scheduled date, 50 patients successfully underwent surgery using TEP, and 49 of these patients were satisfied with the procedure and would repeat one-stop surgery when indicated. CONCLUSION: One-stop endoscopic TEP inguinal hernia surgery is feasible and safe. The majority of patients would give preference to a repeated procedure if necessary. This clinical pathway reduces the number of patient visits to the hospital for inguinal hernia repair and also suggests cost efficiency.

Adenocarcinoma of the lower esophagus after placement of a gastric band.

A 43-year-old man presented with severe back pain. He had a history of morbid obesity, for which an esophagogastric silicone band was placed 2 years before presentation. Magnetic resonance imaging of the vertebral column showed multiple osseous metastases. On the computerized tomography scan of the abdomen, a tumor of the lower esophagus just proximal to the esophagogastric band was seen, of which histological examination revealed an esophageal adenocarcinoma. Esophageal adenocarcinoma after bariatric surgery has been described previously in only a few cases. Although there is no evidence for a causal relationship with bariatric surgery, one should bear in mind that the incidence of esophageal adenocarcinoma is increased in patients with morbid obesity because of the higher incidence of gastroesophageal reflux disease. Also, the symptoms of adenocarcinoma might be masked after bariatric surgery.

Four Weeks of Preoperative Omega-3 Fatty Acids Reduce Liver Volume: a Randomised Controlled Trial.

PURPOSE: Weight loss before bariatric surgery with a low-calorie diet (LCD) has several advantages, including reduction of liver volume and an improved access to the lesser sac. Disadvantages include performing surgery in a state of undernutrition, side effects, costs and patient compliance. Omega-3 fatty acids may serve as an alternative to reduce liver steatosis. MATERIALS AND METHODS: A randomised controlled open-label trial was done to compare the effects of a LCD with Modifast (800 kcal/day) during 2 weeks with 2 g of omega-3 fatty acids a day and a normal diet (2000 kcal/day) during 4 weeks. Total liver volume (TLV) and volume of the left liver lobe (LLL), visceral fat area (VFA) and muscle area (SMA) at the L3-L4 level were measured with MRI before and after preoperative treatment. RESULTS: Sixty-two morbidly obese women undergoing laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) were recruited. In both groups, there was a significant decrease in LLL, TLV and VFA. For LLL and TLV reduction, the LCD had a significantly larger effect (p < 0.05). Only in the LCD group was there a significant decrease in SMA with significantly more side effects and worse compliance. CONCLUSION: Both the LCD and omega-3 diet reduced LLL, TLV and VFA. The LCD outperformed the omega-3 diet in LLL and TLV reduction, but induced significant loss of SMA and had worse compliance due to more side effects. Omega-3 fatty acids may provide a safe and more patient-friendly alternative for a LCD and further research is indicated. TRIAL REGISTRATION: The study is registered at www.clinicaltrials.gov (NCT02206256).

Calibration of the Gastric Pouch in Laparoscopic Roux-en-Y Gastric Bypass: Does It Matter? The Influence on Weight Loss.

PURPOSE: To determine the effect of an orogastric tube for calibration of the gastric pouch on percentage excess weight loss (%EWL) and percentage total weight loss (%TWL) after laparoscopic Roux-en-Y gastric bypass (LRYGB). MATERIAL AND METHODS: A retrospective case-matched control study in 132 patients. Group A (a 40 French orogastric tube was used to calibrate the gastric pouch) was compared to group B (no orogastric tube was used). All other surgical steps were identical in both groups. Postoperative %EWL and %TWL were recorded at 3, 6, 9, 12, and 24 months postoperatively. RESULTS: Baseline characteristics and comorbidities were similar for both groups; a mean age of 43.6 years, 84% of the patients were female and mean initial BMI was 44 kg/m2. At 24 months, 9% of the patients were lost to follow-up. At 1-year follow-up, %EWL and %TWL were 80% and 33.3% in group A versus 70% and 28.6% in group B with p = 0.013 and p = 0.007 respectively. At 2 years, EWL% and %TWL were 79.5% and 32.8% in group A and 67.18% and 28.1% in group B with a p value of 0.019 and 0.001 respectively. The use of a calibration tube, initial BMI, and age predicted the %TWL best with R squared at 30.7%. CONCLUSION: The use of a calibration tube for creating the gastric pouch may lead to a higher %EWL and %TWL at 2-year follow-up. The standardization of the technique for LRYGB is desirable to achieve the maximum success rate in the surgical therapy of morbid obesity.

Perioperative Online Weight Monitoring in Bariatric Surgery with a Digital Internet-Connected Scale.

INTRODUCTION: Strict follow-up after bariatric surgery is an important factor in achieving and maintaining weight loss, whereas regaining weight is the most important threat in long-term follow-up. Stagnation in weight loss or weight regain can be signals of early treatment failure. The aim of this study is to assess the possibility of obtaining frequent objective weight measurements using an Internet-connected home weighing scale. METHODS: Internet-connected home weighing scales were used to perform weekly follow-up in bariatric surgery patients during the first postoperative year. For each patient, weight measurements were registered and excess body weight loss was calculated. This follow-up method was deemed successful if weight measurements were available for 80% of all weeks in the first year. RESULTS: A total of 14 patients started the protocol. Seven patients (50%) performed weekly weight measurements for at least 80% of all weeks in the first year. One-year follow-up was available for 11 patients. Excess weight loss was >50% in nine (82%) of these patients and >40% in the remaining two. CONCLUSIONS: Using an Internet-connected weighing scale at home is feasible in postsurgery bariatric patients. It can provide the treating physicians with valuable information about weight loss over time. This could possibly offer opportunities for timely interventions during follow-up in case of insufficient weight loss or weight regain.

[Bariatric surgery with an adjustable gastric band; long-term follow-up of the first 30 patients in the Netherlands]. / Bariatrische chirurgie met een variabele maagband. Langetermijnfollow-up van eerste 30 patiënten in Nederland.

OBJECTIVE: Evaluation of the long-term results of bariatric surgery with an adjustable gastric band for the treatment of morbid obesity. DESIGN: Retrospective, descriptive. METHOD: From September 1991-September 1993, 30 patients (6 males, 24 females) received an adjustable gastric band because of morbid obesity, being the first group in the Netherlands. The long-term data on these patients: weight loss, band adjustments, complications, reoperations and patient satisfaction, were collected using a medical record survey and a questionnaire and then analysed. RESULTS: Before the operation, the mean BMI was 42.5 kg/m2 (SD: 5.7) and the mean excess body weight was 50.8 kg (SD: 16.7). The mean follow-up time for all patients was 15.3 years (SD: 5.4) and for the responders to the questionnaire, 17.7 years (SD: 0.7); three patients died during follow-up. After surgery, the mean BMI was reduced to 34.7 kg/m2 (SD: 6.4). The mean excess body weight loss of the entire group was 38.1% (SD: 67.8) and of the patients who still had a gastric band in situ, 27.9% (SD: 67.4). In 15 patients, the gastric band reservoir was replaced at least once. The gastric band was replaced in 18 patients due to complications and eventually permanently removed in 6 patients. Of the respondents, 62% were satisfied with the weight loss and 52% were satisfied with regard to possible side effects and complications. CONCLUSION: The treatment of morbid obesity with an adjustable gastric band in this very first group of patients has resulted in substantial weight loss, but also a high rate of complications and reoperations. Treatment of these kinds of complications is an important aspect of bariatric surgery today. The efficacy of gastric banding is therefore currently under debate.