Long-term (11 + years) efficacy of sleeve gastrectomy as a stand-alone bariatric procedure: a single-center retrospective observational study.

INTRODUCTION: Sleeve gastrectomy (SG) is currently the most commonly performed bariatric procedure worldwide. The aim of the present study was to evaluate the long-term efficacy of SG as a stand-alone bariatric procedure. METHODS: A single-center retrospective analysis of 104 patients who underwent SG as a stand-alone bariatric procedure between January 2005 and December 2009. Weight loss, weight regain, remission or improvement of comorbidities and the new onset of comorbidities were the main outcomes of the study. RESULTS: The percent excess body weight loss (%EBWL), percent excess body mass weight (BMI) loss (%EBMIL), and percent total body weight loss (%TBWL) were 59 ± 25, 69 ± 29, and 29 ± 12, respectively, after a mean follow-up of 13.4 years. At the last follow-up, nearly two thirds of patients (67.3%) had an %EBWL greater than 50. The percentage of patients who experienced significant weight regain ranged from 47 to 64%, depending on the definition used for weight regain. The rate of improvement or remission of hypertension, type 2 diabetes, dyslipidemia, obstructive sleep apnea, and degenerative joint disease at a mean follow-up of 13.4 years was 40%, 94.7%, 70%, 100%, and 42.9%, respectively. The new onset of gastroesophageal reflux disease (GERD) symptoms in the same period was 43%. CONCLUSION: Our data supports that SG results in long-lasting weight loss in the majority of patients and acceptable rates of remission or improvement of comorbidities. Weight regain and GERD may be issues of particular concern during long-term follow-up after SG.

Comparison of one anastomosis gastric bypass versus standard Roux-en-Y gastric bypass versus a variant of biliopancreatic diversion, in a case-matched, non-superobese population: 6 years of follow-up.

INTRODUCTION: One anastomosis gastric bypass (OAGB) is gaining increasing acceptance as a simple, safe, and effective operation for treating morbid obesity. Data comparing this procedure with the most effective biliopancreatic diversions (BPD) remain scarce, and most studies evaluate OAGB against standard Roux-en-Y gastric bypass (RYGB). AIM: To present the mid-term results of a comparison of RYGB, OAGB, and our modification of BPD in an exclusively non-superobese population, regarding safety, efficacy, preservation of weight loss, as well as late postoperative metabolic and non-metabolic complications. MATERIAL AND METHODS: From our cohorts of patients treated for morbid obesity with OAGB, RYGB, and BPD at Patras University Hospital, we identified patients who had case-matched preoperative profiles regarding age, preoperative body mass index (BMI), and obesity-related comorbidities (diabetes mellitus, hypertension, and dyslipidaemia). Thirty-four patients from each group were included in the study. Bariatric outcomes, non-metabolic complications, and postoperative metabolic parameters were followed until the 6th postoperative year. RESULTS: The average patient age was 37.4 years (range: 19-57), 85.3% were female and 14.7% were male, with a mean BMI of 46.3 kg/m2 (range: 38.3-49.7). Regarding weight loss and glycaemic control, OAGB had comparable results to BPD and was significantly better than RYGB. The safety profile was analogous to RYGB, with the exception of calcium levels, which, even though they were within normal range, were significantly lower than those in RYGB. Comorbidities were successfully treated with all operations at comparable rates. In this cohort, no other major complications were observed. CONCLUSIONS: OAGB offered mid-term results comparable to BPD while being safe and with minimal impact on the patient's nutritional state. It is an effective procedure for treating morbid obesity, which results in sustained weight loss and a high rate of resolution of comorbidities.

Primary aortoenteric fistula: is endovascular repair the prime option? A review of the literature.

Primary aortoenteric fistula (PAEF) is a rare entity that demands high clinical suspicion and efficient management in a limited time. The evolution of interventional radiology established endovascular repair (EVAR) as an attractive option. The English literature was searched using the PubMed database with the terms "primary aortoenteric fistula", "primary aortoduodenal fistula" or "aortoduodenal fistula", and "endovascular repair" in different combinations. Studies and original articles that described the role and the outcomes of EVAR for primary aortoenteric fistula were included. Fourteen articles with a total of 15 patients with primary aortoenteric fistula who were managed with EVAR were included in our literature review. PAEF is a rare and lethal entity that everyone should be aware of. EVAR is a salvage option and a valuable weapon in our armamentarium. Is EVAR really a "bridge to surgery" or is it the birth pangs of a minimally invasive definite treatment of PAEF?

Symptomatic pseudoaneurysms following laparoscopic cholecystectomy: Focus on an unusual and dangerous complication.

BACKGROUND: Laparoscopic cholecystectomy (LC) has been associated with an increase in the incidence of biliary and vascular injuries. Pseudoaneurysms (PAs) following LC are rare life-threatening events with limited available experience regarding diagnosis and treatment. MATERIALS AND METHODS: An extensive review of literature during a 26-year period (1994-2020) using MEDLINE® database and Google Scholar® academic search engine revealed 134 patients with at least one symptomatic PA following LC. RESULTS: Nearly.81% of patients with PAs become symptomatic during the first 8 weeks following LC. The most common symptoms were gastrointestinal bleeding (74%) and abdominal pain (61%). In 28% of cases, there was a concomitant bile duct injury or leak from the cystic duct stump, whereas in about one-third of cases, PAs presented following an uneventful LC. The most common involved arteries were the right hepatic artery (70%), the cystic artery (19%) or both of them (3%). Trans-arterial embolisation was the favoured first-line treatment with a success rate of 83%. During a median follow-up of 9 months, the mortality rate was 7%. CONCLUSION: Clinicians should be aware of the PA occurrence following LC. Prompt diagnosis and treatment are essential.

Outcomes of percutaneous cholecystostomy in elderly patients: a systematic review and meta-analysis.

INTRODUCTION: Percutaneous cholecystostomy (PC) represents a management option to control sepsis in patients with acute cholecystitis, who are unable to tolerate surgery. AIM: This review aimed to evaluate the outcomes of elderly patients treated with PC and compare it with emergent cholecystectomy. MATERIAL AND METHODS: An electronic search of the Embase, Medline Web of Science, and Cochrane databases was performed. Percutaneous cholecystostomy was used as the reference group, and weighted mean differences (WMD) were calculated for the effect of PC on continuous variables, and pooled odds ratios (POR) were calculated for discrete variables. RESULTS: There were 20 trials included in this review. Utilisation of PC was associated with significantly increased mortality (POR = 4.85; 95% CI: 1.02-7.30; p = 0.0001) and increased re-admission rates (POR = 2.95; 95% CI: 2.21-3.87; p < 0.0001). CONCLUSIONS: This pooled analysis established that patients treated with PC appear to have increased mortality and readmission rates relative to those managed with cholecystectomy.

Posterior shoulder dislocation with reverse Hill-Sachs lesion. A technical note and report of two cases.

Posterior shoulder dislocation (PSD) with a reverse Hill-Sachs lesion is a rare injury with challenging management. This article is a technical note, describing the combination of both, modified McLaughlin procedure with posterior Bankart repair, for the surgical treatment of traumatic PSD associated with a substantial reverse Hill-Sachs lesion. Two patients with mid-term follow-up are presented. Approaching and repairing both sides of the joint, balance and congruency are restored, the humeral head is centralized in the glenoid and the patient starts early mobilization and rehabilitation safely.

Combination treatment for glioblastoma with temozolomide, DFMO and radiation.

PURPOSE: Glioblastoma multiforme (GBM) is the most malignant primary brain tumor with dismal prognosis. This tumor is characterized by extensive heterogeneity, thus is difficult to treat and every established or new treatment faces significant hazard of resistance. Temozolomide (TMZ), an oral alkylating agent, is the first-line treatment for GBM, but resistance to TMZ is a major problem. Herewith, we investigated the combined effect of TMZ, difluoromethylornithine (DFMO), an inhibitor of ornithine decarboxylase, and radiation in GBM cell lines. METHODS: We used the U87G, U251MG and T98G GBM cell lines. A linac 6MV accelerator (Varian Medical Systems) was used for cell irradiation. Viability and proliferation of the cells were examined with trypan blue exclusion assay, crystal violet and xCELLigence system. Cell cycle and activation of caspase-8 were evaluated with flow cytometry. RESULTS: The combination treatment resulted in a consistent higher suppression of proliferation in all cell lines treated and induced a significant higher cell cycle arrest in G2/M phase in U251MG and T98G cell lines. In U251MG cells caspase-8 was increased with each treatment alone, however the combination treatment had lower level of caspase-8 induction, suggesting a co-existence of another mechanism of cell death apart from apoptosis. In T98G cells the combination treatment increased the activation of caspase-8. CONCLUSION: Combination treatment with DFMO, TMZ and radiation significantly reduced cell viability in all cell lines tested. Given that both TMZ and DFMO can be administered orally and are related to minimal toxicities, this combination treatment may be a novel treatment strategy for GBM that deserves further investigation.

Bladder training prior to urinary catheter removal in total joint arthroplasty. A randomized controlled trial.

BACKGROUND: Urinary catheters are commonly used in patients undergoing total hip and knee arthroplasty. Bladder training before catheter removal is reported to shorten the time to return to normal bladder function and reduce the incidence of urinary retention. OBJECTIVE: To evaluate the results of bladder training in patients with total hip and knee arthroplasty. DESIGN: Randomized controlled trial. SETTING: Orthopaedic Department of a tertiary Military Hospital. PARTICIPANTS: We enrolled consecutive patients undergoing total hip or knee arthroplasty during a period of 14 months. METHODS: We randomly allocated the participants into either a bladder training group, in which clamping was considered prior to catheter removal, or a free drainage removal group, using a computer-generated list and subsequently assessed their need for re-catheterization due to urinary retention. The primary outcome of this study was to evaluate if bladder training in patients with total hip and knee arthroplasty reduces the need for re-catheterization due to urinary retention. Multivariable logistic regression was used to model the association between postoperative urinary retention and independent variables (total hip or total knee arthroplasty, age, gender, and history of diabetes mellitus or prostatism). Secondary outcomes were the incidence of urinary tract infection, and subjective patients' symptoms. RESULTS: We included 218 patients in the study; 114 in the bladder training group and 104 in the free drainage removal group. All patients were over 50 years old with a mean age of 69.3 (SD = 8) years. We observed three cases of urinary retention in the bladder training and six in free drainage removal group, and the difference was not statistically significant (2.6% and 5.8% respectively, p = 0.316). We also observed increased odds of re-catheterization in patients with prostatism under medication (odds ratio was 26.42, p < 0.001). No infections or major subjective symptoms were noted. CONCLUSION: This trial shows that bladder training by catheter clamping offers no advantage over free draining removal of short-term urinary catheters in patients with total hip and knee arthroplasty. Therefore, we conclude that the bladder training procedure is not indicated. However, healthcare providers should monitor patients' urination after removal of the catheter.

Adhesive Capsulitis of the Shoulder. Is there Consensus Regarding the Treatment? A Comprehensive Review.

BACKGROUND: Adhesive capsulitis of the shoulder (ACS) is a common self-limiting condition characterized by disabling pain and restricted movements. Its pathophysiology is poorly understood, clinically it is characterized by stages of pain and stiffness, and finally often patients never recover fully. However, there is no consensus about available methods of treatment for ACS. The aims of this paper are to discuss and develop issues regarding approaches to management in ACS in the stages of it. METHODS: A review of the literature was performed and guidelines for the treatment of that clinical entity for doctors and health care professionals are provided. RESULTS: Anti-inflammatory medications, steroid and/or hyaluronate injections and physiotherapy is the mainstay of conservative management either alone in the first stages or in combination with other treatment modalities in the later stages. Next line of treatment, involving minor to moderate intervention, includes suprascapular nerve block, distension arthrography and manipulation under anaesthesia. In order to avoid complications of "blind intervention", arthroscopic capsular release is gradually more commonly applied, and in recalcitrant severe cases open release is a useful option. CONCLUSION: Various modalities of conservative management and gradually more surgical release are applied. However, often clinicians choose on personal experience and training rather than on published evidence.

The natural history of donor hamstrings unit after anterior cruciate ligament reconstruction: a prospective MRI scan assessment.

PURPOSE: The aim of this prospective study was to assess the natural history of the donor hamstrings, compared to the contralateral knee and thigh. METHODS: In 47 patients who had ACL reconstruction (hamstrings technique), bilateral knees and thighs were investigated using MRI scans, up to 2 years post-operatively. RESULTS: Tendon regeneration below the knee joint line of the semitendinosus occurred in 30/47 (64 %) patients and of the gracilis tendon in 17/47 (36 %) patients. Insertion of both tendons at the "pes anserinus", with normal anatomic relations, was observed in 5/47 (11 %) patients. Semitendinosus and gracilis donor muscles were found retracted in 41/47 (87 %) patients. In 25/47 (53 %) patients, there was evidence of fatty infiltration of the semitendinosus muscle. All (47/47) (100 %) patients showed semitendinosus muscle atrophy and 41/47 (87 %) patients showed gracilis muscle atrophy, compared to the contralateral limb. High signal intensity on STIR images was observed in the semitendinosus in 22/47 (46 %) patients and in the gracilis muscle in 30/47 (64 %) patients, on MRI examination performed up to 24 months post-operatively. CONCLUSIONS: The "regenerated" hamstrings tendons most commonly do not regenerate fully anatomically, so they should not be considered as a first choice for re-harvesting in revision ACL reconstruction. The "donor hamstrings muscles" are found to be shorter, contracted, thinner and with a long-term abnormal MRI signal, features which are considered to be related to reduced muscle performance (knee flexion and internal rotation) post-operatively. LEVEL OF EVIDENCE: II.

Benefits and drawbacks of SILS cholecystectomy: a report of 60 SILS cholecystectomies with conventional instrumentation from an academic center.

BACKGROUND: Single-incision laparoscopic surgery is a rapidly emerging approach to gallbladder disease. METHODS: From February 2009 to September 2010, 60 patients were subjected to single-incision laparoscopic cholecystectomy. In all the patients, a 12-mm incision was made in the umbilicus and a 2-trocar technique was applied. Gallbladder was suspended with 2 sutures and the procedure was accomplished with standard partly reusable laparoscopic instruments. RESULTS: In all, 41 women (68.3%) and 19 men (31.7%) were enrolled in this study. Mean age was 50.7 years (range = 17-72 years), mean body mass index was 26.2 kg/m(2) (range = 18.3-37.7 kg/m(2)) and mean operative time was 52.6 minutes (range = 30-120 minutes). No mortality or morbidity was recorded and hospital stay was less than 24 hours. At follow-up visits, no complications were recorded and cosmesis was excellent. CONCLUSION: Single-incision laparoscopic cholecystectomy can be safely performed with conventional instrumentation with minimal cost.