Causes of Death After Bariatric Surgery: Long-Term Study of 10 Years.

BACKGROUND: There is a lack of up-to-date research addressing the causes of death and predictors of long-term mortality after bariatric surgery. METHODS: This was a single-centre retrospective study. Trust records were used to identify deceased patients and their medical history. The demographic data, comorbidities, cause of death, and time since surgery were retrieved and tabulated. Data was recoded to allow for use in IBM SPSS. RESULTS: There were 39 deaths amongst 891 patients who underwent bariatric surgery between 15th June 2010 to 18th September 2022. The main cause of death was pneumonia and respiratory causes with 15.4% of the cohort. A history of asthma/COPD had an association with the cause of death (p = 0.021). A history of hypertension, ischaemic heart disease (IHD), and smoking were all associated with a higher age at death, whilst a history of IHD was associated with a higher number of days from operation to death. Age at operation and number of comorbidities both correlated with age at death, and multiple linear regression of age at death with age at operation and number of comorbidities as predictors was significant (p < 0.001). A Cox regression found age at operation to have a significant effect on survival, with a hazard ratio of 1.063 (95% CI:1.027 to 1.100, p < 0.001). CONCLUSION: Pneumonia and respiratory causes are the largest causes of long-term mortality after bariatric surgery. The only factor found to have a detrimental effect on all-cause mortality was age at operation which reduced survival. Hypertension, IHD, and smoking are indirect factors that are associated with mortality.

What Every Bariatric Surgeon Should Know: How to Relieve Obstruction at the Jejuno-jejunostomy After Roux-en-Y Gastric Bypass.

INTRODUCTION: Roux-en-Y gastric bypass (RYGB) remains one of the key bariatric procedures worldwide. In addition to bleeding and anastomotic leak, there are rarely occurring complications such as obstruction at the jejuno-jejunostomy in the early postoperative phase. PATIENT AND METHODS: A 51-year-old lady (weight 122 kg; BMI 46 kg/m2; with type 2 diabetes mellitus and hypertension) underwent RYGB in our tertiary referral centre 3 days prior to admission. She originally recovered well from the uneventful operation, but began vomiting on day 3. At this point, she complained of no other symptoms. An urgent CT scan identified a gastric remnant dilatation, and an obstructed jejuno-jejunostomy. An urgent laparoscopic exploration was performed, which identified obstruction at this level. RESULTS: Within our video-presentation, detailed technical steps are described. First, gastric remnant decompression was performed by inserting a tube gastrostomy. Secondly, the obstruction was identified. Consequently, a new jejuno-jejunostomy was created, proximal to the original anastomosis, using a linear stapler, and direct suture closure of the enterotomy defects. After thorough washout, drains were placed in the pelvis and alongside the jejuno-jejunostomy. The patient was discharged home after a 2-week hospital stay which included 5 days of invasive ventilation on the ITU. CONCLUSION: A high-level of suspicion is required to suspect, diagnose and treat post-RYGB complications. A bariatric on-call rota with appropriately trained personnel is essential.

Obstructive Sleep Apnoea Screening Preoperatively with the Epworth Questionnaire: Is It Worth It ?

BACKGROUND: The prevalence of obstructive sleep apnoea (OSA) in the bariatric population has been reported to be as high as 60-83%. The Epworth Sleepiness Scale (ESS) is a validated, self-administrated eight-item questionnaire that measures subjective daytime sleepiness and thus helps to identify high-risk for OSA. OBJECTIVES: To find the prevalence of OSA in patients undergoing bariatric surgery who do not routinely undergo polysomnography (PSG) and are screened by the ESS. METHODS: All consecutive 425 patients who underwent bariatric surgery in our tercier referral centre from January 2012 to June 2017 were included in this prospective study. Patient demographics and ESS score were recorded prior to the bariatric surgery and patients were divided into low-risk (ESS < 11), high-risk (≥ 11) and "known-OSA" groups. RESULTS: The community-based OSA prevalence was 14% (59 patients). ESS-positive predictive value was 60%. There was no significant difference in BMI and excess body-weight, but patients with OSA were older and had a lower female ratio (75% vs 42%). The unplanned ICU admission rate was comparable amongst the low- and high-ESS group (2.2% and 2.1%, respectively); similarly, the respiratory and chest complication rate were similar. The median hospital stay for patients diagnosed with OSA was a half day longer; the high-score patients stayed significantly longer than the low-score patients (p = 0.017). CONCLUSION: In our study, the OSA prevalence was low (20%). We think that the ESS does not have significant predicting value before bariatric surgery and overall the OSA is "overhyped" in the bariatric pathway.