Quality of Life After Bariatric Surgery-a Systematic Review with Bayesian Network Meta-analysis.

OBJECTIVE: Comprehensive analysis and comparison of HRQoL following different bariatric interventions through systematic review with network meta-analysis. BACKGROUND: Different types of bariatric surgeries have been developed throughout the years. Apart from weight loss and comorbidities remission, improvement of health-related quality of life (HRQoL) is an important outcome of metabolic surgery. METHODS: MEDLINE, EMBASE, and Scopus databases have been searched up to April 2020. Inclusion criteria to the analysis were (1) study with at least 2 arms comparing bariatric surgeries; (2) reporting of HRQoL with a validated tool; (3) follow-up period of 1, 2, 3, or 5 years. Network meta-analysis was conducted using Bayesian statistics. The primary outcome was HRQoL. RESULTS: Forty-seven studies were included in the analysis involving 26,629 patients and 11 different surgeries such as sleeve gastrectomy (LSG), gastric bypass (LRYGB), one anastomosis gastric bypass (OAGB), and other. At 1 year, there was significant difference in HRQoL in favor of LSG, LRYGB, and OAG compared with lifestyle intervention (SMD: 0.44; 95% CrI 0.2 to 0.68 for LSG, SMD: 0.56; 95% CrI 0.31 to 0.8 for LRYGB; and SMD: 0.43; 95% CrI 0.06 to 0.8 for OAGB). At 5 years, LSG, LRYGB, and OAGB showed better HRQoL compared to control (SMD: 0.92; 95% CrI 0.58 to 1.26, SMD: 1.27; 95% CrI 0.94 to 1.61, and SMD: 1.01; 95% CrI 0.63 to 1.4, respectively). CONCLUSIONS: LSG and LRYGB may lead to better HRQoL across most follow-up time points. Long-term analysis shows that bariatric intervention results in better HRQoL than non-surgical interventions.

Medical student experience with robot-assisted surgery after limited laparoscopy exposure.

The purpose of the study was to evaluate the objective and subjective experience of medical students completing robotic surgery tasks after limited laparoscopy exposure. Twenty-three medical students without previous laparoscopy and robotic surgery experience self-enrolled into 0 min (n = 11), 20 min (n = 6), and 40 min (n = 6) laparoscopy training groups. Subjects completed rope passing and ball placement tasks on a laparoscopy trainer before repeating similar tasks on the Senhance Surgical System, a robot-assisted digital laparoscopy device. Videos were recorded to evaluate objective measures including time, completion rate, clutch use, out of view instruments, ball drops, and manual adjustments. The NASA-TLX survey was administered to assess subjective experience using workload and task demand measures. There were no statistically significant differences in objective performance between the groups (p > 0.05). Subjects who completed laparoscopy training reported higher workloads, but these differences were not statistically significant (p > 0.05). NASA-TLX workload was correlated with time performance on Pearson and Spearman tests (r = 0.623, rho = 0.681, p < 0.01). Initial experience of medical students with robot-assisted surgery did not differ significantly after limited laparoscopy exposure.

Feasibility of modified Edmonton Obesity Staging System in bariatric center.

BACKGROUND: The number of bariatric procedures is growing worldwide annually. While there is no doubt that a high body mass index is fundamental in qualification for surgical intervention, the Edmonton Obesity Staging System (EOSS) developed in 2009 may be an additional tool for identifying patients for whom surgery should be performed and those for whom the surgery should be postponed. OBJECTIVE: Assessment of the feasibility of modified EOSS as a qualification tool for surgery for obesity and related diseases and its association with morbidity. SETTING: University Hospital, Jagiellonian University Medical College, Cracow, Poland. METHODS: A retrospective study of prospectively collected data. All patients were assigned an EOSS score based on their medical record. We only considered the medical aspect, so the achieved results may be underpowered. Analyzed outcomes involved specific and overall complication rate, length of hospital stay, and weight loss. Regression models were created to assess the influence of EOSS on length of stay and complications. RESULTS: We included 761 patients who were operated on between 2009 and 2018 in our department. Of these, 505 patients received sleeve gastrectomy and 256 patients received Roux-en-Y gastric bypass. The median EOSS score was 2, which was assigned to 80% of the patients. The analysis showed no influence of modified EOSS on peri- or postoperative outcomes. Additionally, there were no significant differences in the number of patients who achieved bariatric success. The follow-up rate at 1 year was 70%. CONCLUSIONS: Our study suggests that modified EOSS score has no influence on the risk of developing complications and prolonged hospital stay. Patients with an EOSS score of ≥3 have higher major complication rate.