Long-term follow-up after bariatric surgery in a national cohort.

BACKGROUND: Lifelong medical follow-up is mandatory after bariatric surgery. The aim of this study was to assess the 5-year follow-up after bariatric surgery in a nationwide cohort of patients. METHODS: All adult obese patients who had undergone primary bariatric surgery in 2009 in France were included. Data were extracted from the French national health insurance database. Medical follow-up (medical visits, micronutrient supplementation and blood tests) during the first 5 years after bariatric surgery was assessed, and compared with national and international guidelines. RESULTS: Some 16 620 patients were included in the study. The percentage of patients with at least one reimbursement for micronutrient supplements decreased between the first and fifth years for iron (from 27.7 to 24.5 per cent; P < 0.001) and calcium (from 14·4 to 7·7 per cent; P < 0·001), but increased for vitamin D (from 33·1 to 34·7 per cent; P < 0·001). The percentage of patients with one or more visits to a surgeon decreased between the first and fifth years, from 87·1 to 29·6 per cent (P < 0·001); similar decreases were observed for visits to a nutritionist/endocrinologist (from 22·8 to 12·4 per cent; P < 0·001) or general practitioner (from 92·6 to 83·4 per cent; P < 0·001). The mean number of visits to a general practitioner was 7·0 and 6·1 in the first and the fifth years respectively. In multivariable analyses, male sex, younger age, absence of type 2 diabetes and poor 1-year follow-up were predictors of poor 5-year follow-up. CONCLUSION: Despite clear national and international guidelines, long-term follow-up after bariatric surgery is poor, especially for young men with poor early follow-up.

[Infectious complications of diverticular sigmoiditis: can the failure of medical treatment be predicted?]. / Les complications infectieuses des sigmoïdites diverticulaires: peut-on prévoir l'échec du traitement médical?

A retrospective study of case histories of 36 patients with infectious complications of sigmoid diverticulitis (excluding peritonitis) compared clinical, biologic and radiologic signs in a group responding favorably to medical treatment (24 cases) and a group requiring surgery after a mean of 9 days of treatment in a surgical ward (12 cases). Six signs were found to be related to the course of the disease: a painful left iliac mass on admission, persistence or increase in pain after 48 hours, absence of restoration of normal intestinal transit, temperature below 36.5 degrees C or above 37.8 degrees C, leucocytosis of less than 2,500 or more than 13,500/mm3, evidence of radiologic stenosis by simple contrast enema. A prospective study could assess the prognostic value of these signs as determinants of failure to respond to medical treatment.

[Perineal hernia of the rectum (author's transl)]. / Hernie périnéale du rectum.

A case of perineal hernia of the rectum is presented; this case has been successfully treated by a fixation of the rectum to the sacrum by analogy with the treatment of the prolapsus of the rectum.