Inferior vena cava filters and postoperative outcomes in patients undergoing bariatric surgery: a meta-analysis.

Background: Pulmonary embolism(PE)accounts for almost 40% of perioperative deaths after bariatric surgery.Placement of prophylactic inferior vena cava(IVC) filter before bariatric surgery to improve outcomes has shown varied results. We performed a meta-analysis to evaluate post- operative outcomes associated with the preoperative placement of IVC filters in these patients. Methods: A systematic review was conducted by three investigators independently in PubMed, EMBASE, the Web of Science and Scopus until February 28,2013.Our search was restricted to studies in adult patients undergoing bariatric surgery with and without IVC filters. Primary outcomes were postoperative deep vein thrombosis(DVT),pulmonary embolism (PE),and postoperative mortality. Meta-analysis used random effects models to account for heterogeneity,and Sidik- Jonkman method to account for scarcity of outcomes and studies. Associations are shown as Relative Risks(RR) and 95% Confidence Intervals(CI). Results: Seven observational studies were identified (n=102,767), with weighted average inci- dences of DVT(0.9%),PE(1.6%),and mortality(1.0%)for a follow-up ranging from 3 weeks to 3 months. Use of IVC filters was associated with an approximately 3-fold higher risk of DVT and death that was nominally significant for the former outcome, but not the latter (RR2.81,95%CI 1.33-5.97, p=0.007; and RR 3.27,95%CI0.78-13.64, p=0.1, respectively);there was no difference in the risk of PE(RR1.02,95%CI0.31-3.77,p=0.9). Moderate to high heterogeneity of effects was noted across studies. Conclusions: Placement of IVC filter before bariatric surgery Is associated with higher risk of postoperative DVT and mortality. A similar risk of PE inpatients with and without IVC filter placement cannot exclude a benefit, given the potential large imbalance in risk at baseline.Ran- domized trials are needed before IVC placement can be recommended. (SurgObesRelatDis 2015;11:268-269.) r 2015 American Society for Metabolic and Bariatric Surgery.

Fewer gastrojejunostomy strictures and marginal ulcers with absorbable suture.

BACKGROUND: The upsurge of gastric bypass procedures has been accompanied by an increase in anastomotic strictures and marginal ulcers. According to the reported literature, the gastrojejunostomy strictures in 3-31% and ulcerates in 1-16% of cases. Several anastomotic techniques are used, however no study has specifically addressed whether choice of reinforcing suture affects rates of stricture or ulcer. We reviewed our case series to determine if a protocol change in suture choice altered the incidence of anastomotic strictures and marginal ulcers. METHODS: We performed a retrospective review of a prospectively collected database for 315 primary Roux-en-Y gastric bypass patients (7/2008 to 3/2008). Nearly all patients had a 25-mm circular stapled anastomosis with an outer suture layer for reinforcement. Before 5/31/06, interrupted permanent suture was used in 231 patients, and after 6/1/06 interrupted absorbable suture was used in 84 patients. We compared overall rates of stricture, marginal ulceration, and aggregate gastrojejunostomy complications between the two suture groups using a proportional hazards model and log-rank statistic. A p-value < 0.05 was used to assign statistical significance. RESULTS: We found statistically fewer gastrojejunostomy complications in the absorbable suture group (4.7%) than the permanent suture group (19.9%). Subgroup analysis showed that anastomotic strictures were less common in the absorbable suture group, but the difference was short of statistical confirmation. Use of absorbable suture did result in statistically fewer marginal ulcers (2.3%) compared with absorbable suture (13.4%). CONCLUSIONS: Use of absorbable reinforcing sutures is associated with fewer gastrojejunostomy complications. We recommend absorbable sutures for the outer layer of stapled gastrojejunal anastomoses when performing isolated Roux-en-Y gastric bypass.