Long-term outcomes of laparoscopic sleeve gastrectomy in Denmark from 2010 to 2016: a nationwide cohort study.

BACKGROUND: Bariatric surgery is the most effective treatment of morbid obesity and obesity-related conditions. Laparoscopic sleeve gastrectomy (LSG) has become increasingly popular in Denmark and worldwide. OBJECTIVE: To evaluate long-term outcomes including postoperative complications after LSG. SETTING: University Hospitals, Denmark. METHODS: This was a nationwide multicenter cohort study including all patients who underwent LSG during 2010 to 2016 in Denmark. Data were collected from the Danish Obesity Surgery Registry and medical records. Representatives from all public bariatric centers in Denmark registered information on demography, indication, preoperative tests, operative information, weight loss, status of co-morbidities, and early and late complications. RESULTS: In total, 541 patients were included in the study. Median follow-up was 6 years, and 536 patients (99%) were available at the end of follow-up. The patients achieved a persistent weight loss. Quality of life significantly improved after both 12 and 24 months. Overall, 3% of the patients had a major complication ≤30 days after the procedure and 3% underwent reoperation. One in 5 patients (22%) had an early minor complication. In the long term, 3% of the patients had a major complication and 24% of the patients had ≥1 minor complication. The most common surgery-related healthcare contacts addressed gastroesophageal reflux, weight recurrence, and stenosis symptoms. CONCLUSIONS: Patients after LSG achieved sufficient weight loss and improved quality of life. The procedure was safe with low risk of early and late major complications. However, there was a high frequency of early and late minor complications in 22% and 24% of the patients, respectively.

Smoking Is Correlated to Internal Hernia After Gastric Bypass Surgery: a Post hoc Analysis of Data from a Randomized Clinical Trial.

PURPOSE: Internal herniation is a well-known complication of laparoscopic Roux-en-Y gastric bypass (L-RYGB). The aim of this study was to evaluate smoking as an independent risk factor for internal herniation after L-RYGB. MATERIALS AND METHODS: This study was performed as an exploratory post hoc analysis of data from a previous published randomized controlled trial (RCT) designed to compare closure and non-closure of mesenteric defects in patients undergoing L-RYGB. The primary outcome of this study was to assess the significance of smoking as a risk factor for internal herniation after L-RYGB. Secondary outcome was early postoperative complications defined as Clavien-Dindo grade ≥ 2. RESULTS: Four hundred one patients were available for post hoc analysis. The risk of internal herniation was significantly higher among patients who were smoking preoperatively (hazard ratio (HR) 2.4, 95% confidence interval (c.i.) 1.3 to 4.5; p = 0.005). This result persisted after adjusting for other patient characteristics (HR 2.2, 1.2 to 4.2; p = 0.016). 6.0% of the patients had postoperative complications within the first 30 days. 4.9% of these patients were smoking and 6.3% were not smoking, p = 0.657. 11.0% of the patients underwent surgery due to internal herniation by 5 years after the primary procedure. CONCLUSION: Smoking is a significant risk factor for internal herniation but did not increase risk for 30 days postoperative complications.

Perioperative clinical management in relation to emergency surgery for perforated peptic ulcer: A nationwide questionnaire survey.

BACKGROUND & AIMS: Perforation is a severe complication of peptic ulcer disease. Evidence regarding perioperative management of patients undergoing surgery for perforated peptic ulcer is scarce without any clear guidelines. This study aimed to investigate the clinical practice and possible differences in the perioperative management of patients undergoing emergency surgery for perforated peptic ulcers in Denmark. METHODS: The study was an anonymous, nationwide questionnaire survey. All doctors working at general surgical departments in Denmark were included. The questionnaire consisted of four parts; 1) demographic details including job position, subspecialty, geographic location, and surgical experience, 2) pre- and postoperative use of nasoenteral tubes, 3) routine use of nil-by-mouth (NBM) regime, 4) questions regarding postoperative nutrition.Subgroup analyses were performed according to job position and subspecialty. RESULTS: In total, the questionnaire was answered by 287 surgeons, of which 74% were experienced surgeons being able to perform surgery for perforated peptic ulcers independently.Pre- and postoperative nasoenteral tubes were used routinely by the majority of the respondents. One of five surgeons routinely practiced a postoperative NBM regime. Generally, the respondents allowed clear fluids postoperatively without restrictions but were reluctant to allow free fluids or solid foods. Two of three surgeons routinely used tube- or parental nutrition. The results varied depending on job position and subspecialty. CONCLUSIONS: After emergency surgery, the postoperative management of patients with perforated peptic ulcers varies considerably among general surgeons in Denmark. Evidence-based national or international guidelines are needed to standardize and optimize the clinical practice.

Prevalence and Risk Factors for Chronic Abdominal Pain After Roux-en-Y Gastric Bypass Surgery: A Cohort Study.

OBJECTIVE: To investigate the prevalence and risk factors for chronic abdominal pain after Roux-en-Y gastric bypass (RYGB) surgery. SUMMARY BACKGROUND DATA: Abdominal pain is a frequent postoperative complication after RYGB surgery. Even if there have been defined several long-term complications, the literature regarding patients with unexplained chronic abdominal pain is sparse. METHODS: A single-center register-based cohort study with inclusion of all patients who underwent RYGB surgery between 2010 and 2015. Data from multiple registries, medical records, and a questionnaire were used. Patients with chronic abdominal pain were defined as those using strong analgesics, diagnosed with chronic pain, or referred to a specialized pain clinic. Patients with severe self-reported abdominal pain were defined as those reporting abdominal pain more than 2 times weekly within the last month. RESULTS: A total of 787 patients were followed for a median of 63 months. The prevalence of postoperative chronic abdominal pain was 11% and the prevalence of severe self-reported abdominal pain was 21%. Preoperative use of strong analgesics was a risk factor for chronic abdominal pain (OR, 2.26; 95% CI, 1.59-3.23) and severe self-reported abdominal pain (OR 2.82, 95% CI 1.64-4.84). Further risk factors for severe self-reported pain were unemployment or retirement (OR 1.80, 95% CI 1.09-2.93), postoperative complications (OR 2.75, 95% CI 1.44-5.22), and smoking (OR 1.80, 95% CI 1.09-2.96). CONCLUSIONS: One in 10 patients undergoing RYGB surgery developed chronic abdominal pain requiring strong analgesics, and one in five suffered from severe abdominal pain. Risk factors were preoperative use of strong analgesics, unemployment, postoperative complications, and smoking.

[Quality of life after bariatric surgery evaluated by standardised questionnaires].

There is an increasing focus on patient-reported outcome measures (PROMs) to document bariatric surgical quality. In this review, the literature has been scrutinised, and 19 clinical studies (including 14 validated bariatric procedure/disease-specific and generic questionnaires) have been analysed. Long-term PROMs are significantly improved after bariatric surgery, and we recommend to use a combination of the disease-specific IWQOL Lite questionnaire and the generic EQ-5D-5L questionnaire for future research and for the monitoring of bariatric surgical quality.

Impact of cardiovascular risk factors on chronic abdominal pain after laparoscopic gastric bypass.

INTRODUCTION: Patients with chronic pain after laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery frequently report intense postprandial abdominal pain. Reduced blood supply due to atherosclerosis was hypothesised to be a contributing cause. METHODS: This was a retrospective, single-centre cohort study including all patients with LRYGB surgery from 2010 through 2015. Data from multiple registries, medical records and a questionnaire were used. The risk of chronic abdominal pain was analysed using multivariate logistic regression. RESULTS: We included 787 patients. Among these, 177 (23%) patients were defined as having chronic abdominal pain. The median follow-up was 63 months. When investigating the impact of risk factors for atherosclerosis including dyslipidaemia, Type 2 diabetes, hypertension, smoking and cardiovascular co-morbidities, the "atherosclerosis composite score" was a significant risk factor (odds ratio = 1.22, 95% confidence interval: 1.02-1.45). In a multivariate model specifically investigating dyslipidaemia, the association with chronic abdominal pain was non-significant. CONCLUSIONS: In this exploratory study, development of chronic abdominal pain was significantly associated with risk factors for atherosclerosis, but the specific association with dyslipidaemia was non-significant. FUNDING: The study was supported by the Danish Medical Association's Research Foundation and the Edgar Schnohr Foundation. TRIAL REGISTRATION: The study was approved by the Danish Data Protection Agency (No. REG-063-2017).

Quality of life and occupational outcomes after laparoscopic Roux-en-Y gastric bypass surgery.

BACKGROUND: Until now, no detailed long-term data regarding patients with declining quality of life or occupational status after laparoscopic Roux-en-Y gastric bypass surgery have been presented. The aim of this study was to evaluate the long-term effect of laparoscopic Roux-en-Y gastric bypass surgery on quality of life and occupational status. METHODS: The study was a single-center register-based cohort study including all patients who underwent laparoscopic Roux-en-Y gastric bypass surgery from 2010 through 2014. Quality of life was based on the validated Moorehead-Ardelt questionnaire, measured preoperatively and postoperatively after 12, 24, and median 63 months. Longitudinal trends of occupational status were created and compared with overall trends in the Danish population. Subgroup analyses were conducted, investigating associations between declining quality of life, declining occupational status, and postoperative chronic abdominal pain. RESULTS: In total, 749 patients were included in the study. All aspects of quality of life improved after laparoscopic Roux-en-Y gastric bypass surgery. After a median follow-up of 63 months, quality of life was significantly reduced in 14% of the patients compared with the preoperative baseline. Lower quality of life was associated with a decline in occupational status (P = .008) and postoperative chronic abdominal pain (P < .0001). Overall, occupational status was unchanged compared with before surgery. Throughout the study period occupational status declined in 21% of the patients. Declining occupational status was associated with declining quality of life (P = .008) and development of chronic abdominal pain (P = .009). CONCLUSION: In general, quality of life and occupational status improved after laparoscopic Roux-en-Y gastric bypass surgery. Subgroups of patients had declining quality of life and declining occupational status both being associated with postoperative chronic abdominal pain.