Mid-term Effects of Bariatric Surgery on Metabolic Dysfunction-Associated Fatty Liver Disease Remission and Predictive Factors: A Prospective Study with a Focus on Non-invasive Diagnosis.

PURPOSE: Non-alcoholic fatty liver disease (NAFLD), now termed metabolic dysfunction-associated fatty liver disease (MAFLD), is a growing health concern associated with obesity and type 2 diabetes. Bariatric surgery offers potential benefits, but its impact on MAFLD remains incompletely understood, with scarce long-term follow-up prospective studies. Moreover, being liver biopsy the gold standard for liver condition measurement, the need for non-invasive techniques that allow the assessment of MAFLD development after bariatric surgery is imperative. OWLiver® Care and OWLiver® represent two serum lipidomic tests, featuring panels comprising 11 and 20 triglycerides, respectively. MATERIALS AND METHODS: We conducted a prospective study involving 80 Caucasians to assess the effects of bariatric surgery on MAFLD using non-invasive diagnostics and to identify baseline predictors of MAFLD remission. Serum samples were collected before surgery and at a 3-year follow-up. RESULTS: After 3 years, the proportion of patients exhibiting a healthy liver escalated from 5.0% at baseline to 26.3%. Conversely, the percentage of steatohepatitis declined from 35.1% to a mere 7.6%. Younger age, female gender, and the absence of type 2 diabetes were associated with MAFLD remission. However, age stood as the only independent variable associated with this favorable liver evolution (R2 = 0.112). CONCLUSION: Bariatric surgery demonstrates mid-term benefits in improving MAFLD, with younger age as a baseline predictor of remission. Non-invasive diagnostic methods, like OWLiver®, are valuable tools for monitoring MAFLD evolution. Further research with larger populations and longer follow-up periods is warranted to refine personalized treatment approaches.

Metabolic Dysfunction-Associated Steatotic Liver Disease in Severe Obesity and Concordance between Invasive (Biopsy) and Noninvasive (OWLiver®) Diagnoses.

INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD), now termed metabolic dysfunction-associated steatotic liver disease (MASLD), is an escalating health concern linked to obesity and type 2 diabetes. Despite liver biopsy being the gold standard, its invasiveness underscores the need for noninvasive diagnostic methods. METHODS: A cross-sectional study was performed to assess MASLD using the noninvasive OWLiver® serum lipidomics test in a cohort of 117 patients with severe obesity undergoing bariatric surgery, comparing outcomes with liver biopsy. Exclusions (n = 24) included insufficient data, liver disease etiology other than MASLD, corticosteroid treatment, excessive alcohol consumption, low glomerular filtration rate, and declination to participate. Comprehensive laboratory tests, demographic assessments, and liver biopsies were performed. Serum metabolites were analyzed using OWLiver®, a serum lipidomic test that discriminates between healthy liver, steatosis, metabolic dysfunction-associated steatohepatitis (MASH), and MASH with fibrosis ≥2 by means of three algorithms run sequentially. RESULTS: Liver biopsy revealed a MASLD prevalence of 95.7%, with MASH present in 28.2% of cases. OWLiver® demonstrated a tendency to diagnose more severe cases. Body mass index (BMI), rather than the presence of type 2 diabetes, emerged as the sole independent factor linked to the probability of concordance. Therefore, the all-population concordance of 63.2% between OWLiver® and liver biopsy notably raised to 77.1% in patients with a BMI <40 kg/m2. These findings suggest a potential correlation between lower BMI and enhanced concordance between OWLiver® and biopsy. CONCLUSION: This study yields valuable insights into the concordance between liver biopsy and the noninvasive serum lipidomic test, OWLiver®, in severe obesity. OWLiver® demonstrated a tendency to amplify MASLD severity, with BMI values influencing concordance. Patients with BMI <40 kg/m2 may derive optimal benefits from this noninvasive diagnostic approach.

[Ligasure vs conventional diathermy in excisional haemorrhoidectomy: a retrospective study of a single center]. / Hemorroidectomía con Ligasure vs diatermia convencional: análisis retrospectivo monocéntrico.

INTRODUCTION: Hemorrhoids are a prolapse of vasculopathic structures that cushion the anal canal and haemorrhoidectomy is the most effective treatment for grades III and IV In this retrospective study we compare the outcome after haemorrhoidectomy with Ligasure or with conventional diathermy. METHODS: From June 2005 to March 2009 we analyzed 75 patients affected by hemorrhoids (grades III and IV) who underwent haemorrhoidectomy in the University Hospital Arnau de Vilanova in Lleida. We evaluated the technique, the age and the sex, and compared the post-operative hospital stay, the post-operative pain and the complications with each of the techniques. RESULTS: We used Ligasure technique in 49 patients (65%) and conventional diathermy technique in 26 (35%). The mean age was 50.3 years. There was no significant difference in both postoperative length ofstay, with an average of2.13 days (P = 0.60), and postoperative pain in the first 15 days (P = 0.275). On the contrary, we found a significant difference in the rate of postoperative complications (P = 0.032) and in the post-surgical pain at one month (P = 0.03). CONCLUSIONS: In our experience the Ligasure haemorrhoidectomy has shown to have fewer complications and post-operative pain when compared with conventional diathermy haemorrhoidectomy.

Abdominal tuberculosis mimicking Crohn's disease's exacerbation: A clinical, diagnostic and surgical dilemma. A case report.

INTRODUCTION: Tuberculosis in Europe is a health public problem, which has increased constantly over the last few decades. The most common clinical manifestation of tuberculosis is pulmonary. The diagnosis of extrapulmonary tuberculosis can be challenging and clinical manifestations of gastrointestinal tuberculosis are unspecific and can mimic other pathologies. PRESENTATION OF CASE: A young Chinese man, who had recently been diagnosed with Crohn's disease, was admitted to the emergency room of our hospital with a one-month history of diffuse abdominal pain and weight loss. The patient initially presented with epigastric pain, which had been constantly increasing over the last 48 h. Other symptoms included diarrhea, nausea, and fever. The patient was then admitted with the diagnosis of Crohn's disease exacerbation, and a treatment with corticosteroids, azathioprine, mesalazine, adalimumab, and antibiotic therapy was started. The symptoms were due to an initially misdiagnosed case of abdominal tuberculosis. DISCUSSION: Intestinal tuberculosis is mainly localized at the ileocecal level in 85% of patients. Medical therapy is the treatment of choice and surgery is not required if it is diagnosed at an early stage. CONCLUSION: The diagnosis of abdominal tuberculosis still remains a challenge for both internists and surgeons. Before starting a therapy with adalimumab, every patient should be tested for latent tuberculosis infection.

Hemorroidectomía con Ligasure vs diatermia convencional: análisis retrospectivo monocéntrico / [Ligasure vs conventional diathermy in excisional haemorrhoidectomy: a retrospective study of a single center].

INTRODUCTION: Hemorrhoids are a prolapse of vasculopathic structures that cushion the anal canal and haemorrhoidectomy is the most effective treatment for grades III and IV In this retrospective study we compare the outcome after haemorrhoidectomy with Ligasure or with conventional diathermy. METHODS: From June 2005 to March 2009 we analyzed 75 patients affected by hemorrhoids (grades III and IV) who underwent haemorrhoidectomy in the University Hospital Arnau de Vilanova in Lleida. We evaluated the technique, the age and the sex, and compared the post-operative hospital stay, the post-operative pain and the complications with each of the techniques. RESULTS: We used Ligasure technique in 49 patients (65

) and conventional diathermy technique in 26 (35

). The mean age was 50.3 years. There was no significant difference in both postoperative length ofstay, with an average of2.13 days (P = 0.60), and postoperative pain in the first 15 days (P = 0.275). On the contrary, we found a significant difference in the rate of postoperative complications (P = 0.032) and in the post-surgical pain at one month (P = 0.03). CONCLUSIONS: In our experience the Ligasure haemorrhoidectomy has shown to have fewer complications and post-operative pain when compared with conventional diathermy haemorrhoidectomy.