Revisional One-Anastomosis Gastric Bypass (OAGB) After Intrathoracic Migration of Nissen Fundoplication.

According to the latest IFSO recommendations, bariatric and metabolic surgery is the recommended treatment for patients with a BMI above 35 kg/m2 (with or without associated pathology), achieving good results in terms of weight loss in the medium to long term, as well as improving a significant percentage of comorbidities in this type of patient (diabetes mellitus, arterial hypertension, dyslipidaemia, gastro-esophageal reflux disease (GERD)...). The incidence of GERD is higher in patients with obesity, with more severe symptoms. Over the years, Nissen fundoplication has been the gold standard treatment for patients with GERD who do not respond to medical treatment. However, in patients with obesity, gastric bypass is a valid option to consider. We present the case of a patient who had previously undergone anti-reflux surgery (laparoscopic Nissen) for GERD, with favorable evolution, who presented intrathoracic migration of the same after 8 years, with new onset of symptoms, and who was offered revision bariatric surgery. The video presents on the performance of OAGB in a patient who had previously undergone antireflux surgery, with intrathoracic Nissen. Performing this technique after a previous Nissen fundoplication (as well as migration of the Nissen) is a somewhat more complex procedure than primary surgery but can be performed safely with careful technique (there are often previous adhesions that hinder mobility and separation of the fundoplication) and provides good symptom control.

Supervised Exercise Immediately After Bariatric Surgery: the Study Protocol of the EFIBAR Randomized Controlled Trial.

BACKGROUND: Previous studies have investigated weight loss caused by exercise following bariatric surgery. However, in most cases, the training program is poorly reported; the exercise type, volume, and intensity are briefly mentioned; and the sample size, selection criteria, and follow-up time vary greatly across studies. PURPOSE: The EFIBAR study aims to investigate over 1 year the effects of a 16-week supervised exercise program, initiated immediately after bariatric surgery, on weight loss (primary outcome), body composition, cardiometabolic risk, physical fitness, and quality of life in patients with severe/extreme obesity. MATERIAL AND METHODS: The EFIBAR study is a parallel-group, superiority, randomized controlled trial (RCT), comprising 80 surgery patients. Half of the participants, randomly selected, perform a 16-week supervised exercise program, including both strength and aerobic training, starting immediately after the surgery (7-14 days). For each participant, all primary and secondary outcomes are measured at three different time points: (i) before the surgery, (ii) after the intervention (≈4 months), and (iii) 1 year after the surgery. CONCLUSION: The EFIBAR study will provide new insights into the multidimensional benefits of exercise in adults with severe/extreme obesity following bariatric surgery. TRIAL REGISTRATION: EFIBAR randomized controlled trial was prospectively registered at Clinicaltrials.gov (NCT03497546) on April 13, 2018.

Sexuality amongst heterosexual women with morbid obesity in a bariatric surgery programme: A qualitative study.

AIMS: The objective of this study is to describe and understand the experiences of sexuality amongst heterosexual women with morbid obesity (MO) who are in a bariatric surgery program. BACKGROUND: Morbid obesity is a chronic, metabolic disease that affects women's physical, psychological and sexual health. MO is associated with anxiety, depression and body image disorders. Bariatric surgery is a reliable method for weight loss in people with MO. DESIGN: A qualitative descriptive study research design was adopted. METHODS: Twenty-one heterosexual women with MO in a bariatric surgery program were recruited through purposive sampling. Data collection included individual semi-structured interviews conducted between November 2018 and May 2019. Interviews were audio recorded, transcribed verbatim and analysed using a computer-assisted qualitative data. FINDINGS: Three main themes emerged from the analysis: (1) trapped in a body that limits my sexuality; (2) between neglect and hope and (3) the partner as a source of support for sexuality in women with MO. CONCLUSION: Women hide a body that they do not accept and ignore their own sexuality, focusing on that of their partner. Although the women have doubts about their partners' desire for them, they share the decision-making process with them whilst waiting for bariatric surgery, on which they place all of their hopes for improved sexuality and quality of life. IMPACT: The findings highlight the importance of exploring the experiences and sexual issues faced by heterosexual women with MO in a bariatric surgery program. Bariatric nurses have a privileged position to assess these women's sexuality, recommend alternatives to sexual intercourse or refer them to sexologists. As part of the multidisciplinary team, nurses can contribute to managing the expectations of women with MO and their partners in relation to the improvement of their sex lives following bariatric surgery.

Social Support for People with Morbid Obesity in a Bariatric Surgery Programme: A Qualitative Descriptive Study.

Background-Morbid obesity (MO) is a chronic metabolic disease affecting physical, psychological and social wellbeing. Bariatric surgery is a reliable method for losing weight in the long term, improving the quality of life, body image and social life of people with MO. Current literature recognises the importance of social support in controlling weight and coping with MO. The objective of this study was to describe and understand experiences related to social support for patients with MO included in a bariatric surgery programme. Methods-A qualitative descriptive study, where data collection included thirty-one interviews with people diagnosed with MO involved in a bariatric surgery programme. Results-Three main themes emerged from the analysis: (1) accepting the problem in order to ask for help, (2) the need for close support and (3) professional support: opposing feelings. Conclusions-A partner, family and friends are the key pillars of social support for those with MO included in a bariatric surgery programme. Healthcare professionals gave formal support; the bariatric surgery team provided information, trust and assurance. Nurses provided healthcare 24 h a day, making them the main formal support for people in the bariatric surgery programme.

Sexuality amongst heterosexual men with morbid obesity in a bariatric surgery programme: A qualitative study.

AIM AND OBJECTIVES: To describe and understand the experiences of sexuality amongst heterosexual men diagnosed with morbid obesity (MO) who are in a bariatric surgery programme. BACKGROUND: Morbid obesity is a chronic metabolic disease that affects men's physical, psychological and sexual health. Evidence suggests that MO could be linked to anxiety, depression, low self-esteem, sexual life and social disorders. Bariatric surgery is a reliable method for weight loss in patients with MO. DESIGN: This is a qualitative study based on Merleau-Ponty's phenomenology, and the COREQ checklist was employed to report on the current study. METHODS: Convenience and purposive sampling was carried out and included 24 in-depth interviews with heterosexual men with MO in a bariatric surgery programme between October 2018-March 2019 in Spain. RESULTS: Two main themes emerged from the analysis: (a) a corporality which is judged and condemned; and (b) adapting sexual practices to bariatric surgery. CONCLUSIONS: Men with MO reject a body that limits their physical, social and sexual life. A negative body image and low self-esteem, which do not respond to the traditional masculine role or new masculinities, reduce men's self-concept. Men with MO feel rejection, stigma and isolation. Support from their partner is fundamental to adapt. RELEVANCE TO CLINICAL PRACTICE: The results of the study draw attention to how heterosexual men with MO experience their sexuality in a bariatric surgery programme and the challenges nurses face. Recognising the problem, helping to develop coping strategies or referring to specialists in sexuality could improve the quality of life in patients and their partners.

Physical Exercise following bariatric surgery in women with Morbid obesity: Study protocol clinical trial (SPIRIT compliant).

BACKGROUND: Severe and morbid obesity are increasing globally, particularly in women. As BMI increases, the likelihood of anovulation is higher. The primary aim of the EMOVAR clinical trial is to examine, over the short (16 weeks) and medium (12 months) term, the effects of a supervised physical exercise program (focused primarily on aerobic and resistance training) on ovarian function in women with severe/morbid obesity who have undergone bariatric surgery. Secondary objectives are to examine the effects of the intervention on chronic inflammation, insulin resistance, arterial stiffness, physical fitness, and health-related quality of life. METHODS: This is a randomized controlled trial in which ∼40 female bariatric surgery patients, aged between 18 and 45 years old, will be included. Participants assigned to the experimental group will perform a total of 48 sessions of supervised concurrent (strength and aerobic) training (3 sessions/week, 60 min/session) spread over 16 weeks. Patients assigned to the control group will receive lifestyle recommendations. Outcomes will be assessed at baseline, week 16 (i.e., after the exercise intervention) and 12 months after surgery. The primary outcome is ovarian function using the Sex-Hormone Binding Globuline, measured in serum. Secondary outcomes are serum levels of anti-mullerian hormone, TSH, T4, FSH, LH, estradiol, prolactine, and free androgen index, as well as oocyte count, the diameters of both ovaries, endometrial thickness, and uterine arterial pulsatility index (obtained from a transvaginal ultrasound), the duration of menstrual bleeding and menstrual cycle duration (obtained by personal interview) and hirsutism (Ferriman Gallwey Scale). Other secondary outcomes include serum markers of chronic inflammation and insulin resistance (i.e., C-reactive protein, interleukin 6, tumor necrosis factor-alpha, leptin, glomerular sedimentation rate, glucose, insulin and the HOMA-IR), arterial stiffness, systolic, diastolic and mean blood pressure, body composition, and total weight loss. Physical fitness (including cardiorespiratory fitness, muscular strength, and flexibility), health-related quality of life (SF-36 v2) and sexual function (Female Sexual Function Index) will also be measured. DISCUSSION: This study will provide, for the first time, relevant information on the effects of exercise training on ovarian function and underlying mechanisms in severe/morbid obese women following bariatric surgery. TRIAL REGISTRATION NUMBER: ISRCTN registry (ISRCTN27697878).

Supervised exercise following bariatric surgery in morbid obese adults: CERT-based exercise study protocol of the EFIBAR randomised controlled trial.

BACKGROUND: There is increasing evidence of weight regain in patients after bariatric surgery (BS), generally occurring from 12 to 24 months postoperatively. Postoperative exercise has been suggested to ad long-term weight maintenance and to improve physical function in BS patients. However, there are a limited number of intervention studies investigating the possible benefits of exercise in this population. The aim of the current report is to provide a comprehensive CERT (Consensus on Exercise Reporting Template)-based description of the rationale and details of the exercise programme implemented in the EFIBAR Study (Ejercicio FÍsico tras cirugía BARiátrica), a randomised controlled trial investigating the effects of a 16-week supervised concurrent (aerobic and strength) exercise intervention program on weight loss (primary outcome), body composition, cardiometabolic risk, physical fitness, physical activity and quality of life (secondary outcomes) in patients with severe/morbid obesity following bariatric surgery. METHODS: A total of 80 BS patients [60-80% expected women, aged 18 to 60 years, body mass index (BMI) ≥ 40 kg/m2 or ≥ 35 kg/m2 with comorbid conditions)] will be enrolled in the EFIBAR Randomized Control Trial (RCT). Participants allocated in the exercise group (n = 40) will undertake a 16-week supervised concurrent (strength and aerobic) exercise programme (three sessions/week, 60 min/session), starting 7 to 14 days after surgery. The rationale of the exercise programme will be described following the CERT criteria detailing the 16 key items. The study has been reviewed and approved by the Ethics Committee of the Torrecárdenas University Hospital (Almería, Spain) (ref. N° 76/2016). DISCUSSION: The present study details the exercise programme of the EFIBAR RCT, which may serve: 1) exercise professionals who would like to implement an evidence-based exercise programme for BS patients, and 2) as an example of the application of the CERT criteria. TRIAL REGISTRATION: The trial was prospectively registered at Clinicaltrials.gov NCT03497546 on April 13, 2018.

[Revision bariatric surgery after endoscopic sleeve gastroplasty]. / Revisión quirúrgica bariátrica tras gastroplastia vertical endoscópica.

BACKGROUND: Attempts are being made in recent years to replace open surgery with endoscopic techniques in some obese patients when medical treatment fails, as they are considered to be less-invasive procedures. To date, there is little scientific evidence regarding their effectiveness. CLINICAL CASES: The cases are reported of 2 patients who attended our surgery looking for an effective bariatric surgical treatment after failed endoscopic sleeve gastroplasty. CONCLUSIONS: Laparoscopic sleeve gastrectomy after failure of an endoscopic technique does not offer great variation from the standard technique.

Revisión quirúrgica bariátrica tras POSE / Bariatric revision surgery after POSE

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