Comparative Effectiveness of Laparoscopic Adjustable Gastric Banding vs Laparoscopic Sleeve Gastrectomy in Adolescents-a National Registry-Based Study.

OBJECTIVE: Most published work on bariatric surgery (BS) in adolescents describes outcomes after laparoscopic adjustable gastric banding (LAGB) or Roux-en-Y gastric bypass. We compared the efficacy of LAGB and laparoscopic sleeve gastrectomy (LSG) in adolescents. METHODS: A National Bariatric Registry was queried for adolescents who underwent BS between June 2013 and December 2015. We collected data on weight and height at baseline and 1-year following surgery, subsequent hospitalizations, interventions, and mortality, which were compared at 30 days post-surgery and until last follow-up (maximum 4.2 years post-surgery). Mortality and hospitalization data were extracted from national databases. RESULTS: Two hundred fifty-nine adolescents (60% females) aged 12-19 years were included. Mean age and body mass index (BMI) were 17.5 ± 1.2 years and 45.1 ± 5.0 kg/m2, respectively. LSG (n = 227, 87.6%) and LAGB (n = 32, 12.4%) were the most common procedures performed. LSG group achieved greater average at 1 year BMI loss compared to LAGB group (15.4 ± 4.7 kg/m2 vs. 10.3 ± 5.1 kg/m2 respectively; p = 0.0001) and higher rate with BMI < 30 kg/m2 1 year post-surgery (57.7% (n = 131) vs. 25% (n = 8), respectively; p = 0.0005). Males who underwent LSG reduced BMI more than their female counterparts (p = 0.0001), LSG was the strongest independent predictor for BMI < 30 after 1 year (OR = 4.1; 95% CI 1.7-9.9) followed by age (OR = 1.3; 95% CI1.0-1.6). No mortality was observed. Postoperative hospitalizations between the two groups did not differ (hazard ratio 2.4; 95% CI 0.7-7.9; p = 0.1). CONCLUSION: Compared to LAGB, LSG is superior regarding weight loss with a similar risk of short- and long-term hospitalizations, complications, and interventional procedures. Males lose more weight following LSG.

Elevated Levels of miR-122 in Serum May Contribute to Improved Endothelial Function and Lower Oncologic Risk Following Bariatric Surgery.

BACKGROUND: Weight loss surgery is the most effective treatment for obesity, and it reduces cardiovascular and cancer risk through poorly understood mechanisms. MicroRNAs (miRNAs) are short RNA molecules that regulate the stability and translation of many mRNAs. We hypothesized that levels of specific circulating miRNAs are altered following surgery and may contribute to lower cancer risk. OBJECTIVES: To investigate the change of miRNA following surgery. METHODS: All patients underwent gastric "sleeve operation". RNA was isolated from sera of 21 patients (14 men, 7 women) before and 3 months after surgery. Sera were combined into two pools, which served for cDNA library construction followed by miSeq sequencing. The levels of candidate miRNAs were validated in the individual samples by QRT-PCR. RESULTS: Serum miR-122 was significantly up-regulated 3 months post-bariatric surgery in sera of patients, whose endothelial function had greatly improved. In addition, serum miR-122 levels correlated positively with endothelial function as measured by FMD. The changes in miR-122 levels from pre-surgery to 3 months post-surgery also tended to correlate with the respective changes in FMD. CONCLUSIONS: The serum miR-122/miR-451 ratio may serve as a marker for endothelial function in obese patients. miR-122 is the dominant miRNA in the liver and a known tumor suppressor. Our findings suggest a role for circulating miR-122 in the maintenance of vascular endothelial cells (VECs) and in the prevention of cancer. Further studies are required to elucidate the mechanism of its secretion into circulation and its absorption by VECs, as well as its relevant cellular targets.

The outcome of self-expanding metal stents in elderly patients.

BACKGROUND AND OBJECTIVES: Emergency surgery for large bowel obstruction is associated with high morbidity and mortality rates, especially in elderly patients. Colonic self-expanding metal stents may provide temporary relief of obstructions and enable preoperative evaluation. The aim of this retrospective study was to assess the clinical outcomes of emergency stenting in elderly patients with large bowel obstructions. METHODS: Between 1997 and 2010, patients presenting with large bowel obstructions were treated predominantly with self-expanding metal stent insertion. Clinical data, including age, site of obstruction, success rate, and surgery and mortality rates, were collected. Patients were divided into 3 groups (I, II, and III) according to age: <69, 70 to 79, or >80 years. RESULTS: One hundred thirty-two consecutive patients underwent stent implantation, with a mean age of 72.1 years (range, 28-95 years). Similar diversity of sex, indication, and stricture location was found. There were no significant differences in clinical success (88.7%, 73.8%, and 78.4%, P=.16) and stent-related mortality (2.1%, 3.3%, and 3.6%, P=1.00). Similar rates of stoma creation were also found (59.3%, 46.7%, and 60.0%, P=.76). In contrast, rates of surgery were lower in older patients (50.9%, 38.1%, and 13.5%, P=.0013), and mortality during the same admission was significantly higher in patients>70 years of age (4.0%, 15.0%, and 22.2%, P=.027). Kaplan-Meier 30-day survival curves for the 3 groups showed a trend toward earlier death among patients>70 years of age. CONCLUSIONS: This study demonstrates that stenting provides similar success rates in all age groups but is associated with higher mortality rates in older patients.

Laparoscopic treatment of duodenal injury caused by gunshot.

Duodenal injury in most cases, presents as a complex trauma of all adjacent organs which it is generally treated with a midline laparotomy though laparoscopic treatment in selected cases might be beneficial. We present a case of haemodynamically stable patient who suffered abdominal gunshot injury causing grade II trauma of the liver and penetrating wound of the first part of the duodenum and was treated laparoscopically. We believe that laparoscopic primary or assisted repair of injured duodenum is an appropriate surgical option in haemodynamically stable patients who sustain focal abdominal trauma.

Gender effect on vascular inflammation following bariatric surgery.

Studies have shown that mortality was reduced by 31.6% in patients that underwent bariatric surgery compared with the non-operative control group. However, in most surgical series the majority of patients were women, and men had higher post-operative mortality rates and a higher postoperative morbidity, regardless of weight. Our primary end point was to study gender effects on vascular inflammation following bariatric surgery for weight loss. Methods. A prospective study evaluated vascular inflammation in obese patients before and three months after bariatric surgery. Markers of vascular inflammation were measured - before surgery and three months afterwards. Results. One hundred and two patients (73 women and 29 men, 40.5 ± 12.3 years old) underwent bariatric surgery. Correlation was found between BMI change and waist circumference change (r = 0.658, P<0.001). Three months post-surgery, BMI was significantly decreased (p<0.001) (a decrease of 8.82), waist circumference was reduced (p<0.001) (a decrease of 17.33 cm). ICAM-1 levels and hs-CRP levels were decreased (both P = 0.0001). Gender differences seem to be borderline significant with respect to the prevalence of type II diabetes mellitus (men > women; P = 0.05) and hypertension (men > women; P = 0.06). In women, following bariatric surgery, BMI was decreased (p<0.001) (a decrease of 9.25), waist circumference was reduced (p<0.001) (a decrease of 18.8cm). ICAM-1 levels were decreased (p = 0.002) and hs-CRP levels were also decreased (P = 0.0001). In men, following bariatric surgery, BMI was decreased (p = 0.001) (a decrease of 8.1), waist circumference was reduced (p<0.005) (a decrease of 14.6cm); however, although ICAM-1 levels and hs-CRP levels were decreased the decreases were non-significant (both P = 0.09). Discussion. Our study examined gender effects of bariatric surgery on vascular inflammation. Bariatric surgery had no significant effect on biochemical inflammatory markers in male patients, while females undergoing the same kind of bariatric surgery for weight loss showed a significant decrease in these markers of inflammation. These results may explain the epidemiological data that described higher morbidity and mortality among obese men undergoing bariatric operation for weight loss. This is the first study that has demonstrated a gender difference in the inflammatory responses that may affect clinical outcome, and cardiovascular morbidity and mortality.

Bouveret's syndrome as a rare complication of cholecystolithiasis: report of a case.

Bouveret's syndrome, which is gastric outlet obstruction caused by a gallstone in the duodenum or pylorus, is a very rare complication of gallstone disease. It occurs most commonly in women (65%), with a median age of 68.6 years. This disorder is usually treated by surgery, but it has also been successfully treated by endoscopy, with or without extracorporeal shock wave lithotripsy. The mortality rate has improved to 12% in recent years. Herein we report the case of a 76-year-old woman with Bouveret's syndrome, and review the literature on this unusual entity.