Management of gastropleural leak by video-assisted thoracoscopy after sleeve gastrectomy.

Obesity is a major public health issue with various comorbidities. Sleeve gastrectomy has become a popular treatment for obesity, but it carries the risk of complications, particularly staple line leakage. This case study focused on a 32-year-old woman with grade II obesity and hiatal hernia who underwent laparoscopic sleeve gastrectomy. Four days after surgery, she presented with abdominal pain, revealing leakage from the gastric sleeve into the thoracic cavity. Diagnostic procedures and interventions were performed, including cavity lavage, drainage placement, and stent placement. The patient showed clinical improvement after video-assisted thoracoscopic surgery and a multidisciplinary approach involving nutrition support and antibiotics. Despite the challenges, the patient's clinical course improved, leading to discharge with no evidence of leakage on follow-up endoscopy. Careful monitoring and timely interventions are essential to manage complications in sleeve gastrectomy procedures and ensure optimal patient outcomes.

Psychological treatment approaches for improvement of maladaptive eating behaviors in bariatric surgery patients: A systematic review / Tratamientos psicológicos para el mejoramiento de las conductas alimentarias desadaptativas en pacientes de cirugía bariátrica: revisión sistemática

Introduction: Maladaptive eating behaviors (MEB) are highly prevalent among bariatric surgery patients and have been demonstrated to be important contributors for weight loss outcomes. A systematic review was conducted to evaluate the effectiveness of psychological treatment approaches on MEB in bariatric surgery patients. Materials and Methods: This systematic review was registered in PROSPERO. Literature review was performed in the databases PubMed, ScienceDirect, Cochrane Library, and Web of Science. We included studies published between January 1st 1990 and October 18th 2019, with pre- or postoperative psychological treatment approaches in bariatric surgery patients aimed to improve MEB. Results: A total of 15 studies met the inclusion criteria (eight RCT and seven pretest-posttest studies), 752 participants were identified, 80.3% were female and the average participant’s age was 46.1 years (SD ± 6.6). Follow-up period after intervention ranged from six weeks to 48 months. Five out of eight RCT reported a positive and significant effect (P <0.05) on MEB and four had medium to large effect size between the groups receiving psychotherapeutic interventions and the control group. Six out of seven pretest-posttest studies reported significant difference (P <0.05) on MEB and had small to large effect size after receiving psychotherapeutic interventions. Conclusion: Overall, the quality of the evidence ranged from low to moderate. Psychological treatments in bariatric surgery patients are inconsistent, though most results indicate improvement on MEB. Well-designed long-term studies and other approaches strategies are warranted to assess the long-term effects on MEB and weight loss in bariatric surgery patients.(AU)

Introducción: Las conductas alimentarias desadaptativas (CAD) son altamente prevalecientes en los pacientes de cirugía bariátrica y han sido demostradas ser contribuyentes importantes en los resultados de la pérdida de peso. Una revisión sistemática fue realizada para evaluar la efectividad de los enfoques de tratamientos psicológicos en CAD, en pacientes de cirugía bariátrica. Materiales y métodos: Esta revisión sistemática fue registrada en PROSPERO. La revisión de la literatura fue realizada en las bases de datos de PubMed, ScienceDirect, Cochrane Library y Web of Science. Incluimos estudios publicados entre 1 de enero de 1990 y 18 de octubre de 2019, con enfoques de tratamiento psicológico pre o posoperatorio en pacientes de cirugía bariátrica destinados a mejorar las CAD. Resultados: Un total de 15 estudios reunieron los criterios de inclusión (ocho ensayos clínicos aleatorizados (ECA) y y siete estudios preprueba-postprueba),752 participantes fueron identificados, 80.3% fueron mujeres y la edad promedio de los participantes fue de 46.1 años (DE ± 6.6). El periodo de seguimiento después de la intervención varió de seis semanas a 48 meses. Cinco de ocho ECA informaron un efecto positivo significativo (P <0.05) en las CAD y cuatro tuvieron un efecto de medio a alto entre los grupos que recibieron intervenciones psicoterapeúticas y el grupo control. Seis de los siete estudios preprueba-postprueba reportaron diferencias significativas (P <0.05) en las CAD y tuvieron un tamaño de efecto de bajo a alto después de recibir intervenciones psicoterapéuticas. Conclusión: En suma, la calidad de la evidencia varió de baja a moderada. Los tratamientos psicológicos en pacientes de cirugía bariátrica son inconsistentes, aunque la mayoría de los resultados indican un mejoramiento en las CAD. Estudios bien diseñados y otras estrategias de enfoque son garantizados para para evaluar...(AU)

Long-term outcomes of metabolic and bariatric surgery in adolescents with severe obesity with a follow-up of at least 5 years: A systematic review.

The practice of metabolic and bariatric surgery for adolescents with severe obesity has been increasing, and evidence of the outcomes in the long term remains unclear. The aim of this study was to review and analyze the outcomes of this therapy in adolescents with a follow-up ≥5 years. MEDLINE, EMBASE, and Cochrane databases were systematically searched. Inclusion criteria were 10- to < 20-year-old adolescents, 5 years minimum of follow-up, and a retention rate ≥70% at 5 years of follow-up. Adiposity indicators outcomes, co-morbidity remission, and complications were analyzed. A total of 10 studies met the inclusion criteria. Surgeries performed included gastric bypass, gastric band, and sleeve gastrectomy. The age of the participants ranged from 13 to 17 years. The longest follow-up after intervention was 156 months. Mean body mass index at baseline and follow-up was 47 and 32.4 kg/m 2 , respectively. Most of the studies reported weight regain within 1 to 12 years of follow-up. Remission rate of co-morbidities was 75% for dyslipidemia, 78% for musculoskeletal problems, 85% for hypertension, and 85% for type 2 diabetes. Not all studies stated that they were looking for all complications. Iron deficiency and anemia were high, ranging from 30% to 70% and 16% to 50%, respectively. The review indicates that there is low to moderate evidence that metabolic and bariatric surgery in adolescents with severe obesity after 5 years of follow-up results in substantial reduction in body mass index, and very low to low evidence in the resolution of related co-morbidities. Although long-term complications were inadequately reported or nonreported, a high prevalence of iron deficiency and anemia was found. Because maternal anemia might be implicated in deleterious effects for offspring, monitoring female patients for anemia after metabolic and bariatric surgery is strongly recommended. Further high-quality studies with long-term follow-up are warranted to assess related co-morbidities and long-term complications.