Late Complications after Laparoscopic Longitudinal Gastrectomy - Case Report.

INTRODUCTION: Bariatric surgery is now widely regarded as the most effective treatment for morbid obesity. It aims to enhance patients' health by achieving long-lasting weight loss, reducing associated comorbidities, and improving their quality of life. CASE REPORT: The case involves a 51-year-old female patient who underwent sleeve gastrectomy eight years ago to address morbid obesity (Body Mass Index (BMI) = 43). Subsequently, the patient developed gastric obstructive syndrome, leading to diagnostic investigations including repeated upper digestive endoscopies and native computed tomography. These examinations revealed the presence of a hiatal hernia. In 2021, the patient underwent fundoplication type Dor with anterior hemivalve. However, post-surgery, the patient's condition did not improve, with persistent symptoms including regurgitation, heartburn, difficulty ingesting food, sensation of gastric fullness, and epigastralgia. Further exploratory procedures, including upper digestive endoscopy, abdominal computed tomography with contrast substance, and barium transit with contrast substance, led to the diagnosis of mediogastric stenosis postgastrectomy longitudinal, necessitating surgical intervention. This finding prompted a surgical approach involving distal gastric resection and restoration of digestive tract continuity through Hoffmeister-Finsterer gastro-jejunal anastomosis. Following the surgery, the patient's postoperative symptoms showed improvement. DISCUSSION: Several other studies have demonstrated that the incisura angularis is the most common site of obstruction, as was observed in our study. This particular location appears to be more prone to narrowing, likely attributable to its angular shape. The linear staple line in this area can create a locus minoris resistentiae for kinking, as well as increase the risk of true stenosis if stapling is performed too close to the incisura angularis. CONCLUSIONS: Bariatric surgery should not be considered as the initial treatment option. However, in cases where it becomes necessary, postoperative monitoring is essential to prevent complications or address them promptly.

A single-center prospective study on the efficiency of negative pressure wound therapy versus conventional wound therapy in the postoperative management of devitalized and infected wounds.

INTRODUCTION: In this study, we aim to present the benefits of using negative pressure wound therapy, particularly with respect to the speed up of recovery time of devitalized and infected post-operative wounds, cost-effectiveness of local healing, pain relief during treatment, and returning to work and resuming normal daily activities at an earlier time. MATERIALS AND METHODS: This was a prospective study performed in General Surgery Clinic, between 2016-2018. The study comprised 67 patients divided into two groups: A (29 patients who underwent negative pressure wound therapy) and B (38 patients who underwent conventional wound therapy). RESULTS: The average age of patients included in group A was 64.2 ± 12.3 years and in group B, 63.2 ± 9.7 years (p=0.440). The wounds were located on the foot, thigh, abdomen, and other areas, and the average length of stay in hospital was 33 ± 18 days for group A versus 17 ± 14 days for group B (p=0.042) but with an average local healing time of 12 ± 5 days in group A versus 44 ± 17 days in group B (p<0.001). The average cost of hospitalization was higher in group A: 17,868 ± 9,560 RON (3,834 ± 2,051 euros) compared to group B: 6,025 ± 4,137 RON (1,292 ± 887 euros) (p=0.443) but the average cost of local healing was lower in group A: 5,437 ± 2,238 RON (1,166 ± 480 euro) compared to group B: 6,840 ± 3,520 RON (1,467 ± 755 euro) (p=0.005). CONCLUSIONS: The treatment of devitalized and infected post-operative wounds by using negative pressure wound therapy reduces local and complete healing time by approximately 30%, local healing costs by 26%, and allows better pain management during treatment with minimal complications. KEY WORDS: Negative pressure wound Therapy, Conventional wound therapy, Local healing, average cost.

The visceral adipose tissue bacterial microbiota provides a signature of obesity based on inferred metagenomic functions.

BACKGROUND: Metabolic inflammation mediated obesity requires bacterial molecules to trigger immune and adipose cells leading to inflammation and adipose depot development. In addition to the well-established gut microbiota dysbiosis, a leaky gut has been identified in patients with obesity and animal models, characterized by the presence of a tissue microbiota in the adipose fat pads. METHODS: To determine its potential role, we sequenced the bacterial 16 S rRNA genes in the visceral adipose depot of patients with obesity. Taking great care (surgical, biochemical, and bioinformatic) to avoid environmental contaminants. We performed statistical discriminant analyses to identify specific signatures and constructed network of interactions between variables. RESULTS: The data showed that a specific 16SrRNA gene signature was composed of numerous bacterial families discriminating between lean versus patients with obesity and people with severe obesity. The main discriminant families were Burkholderiaceae, Yearsiniaceae, and Xanthomonadaceae, all of which were gram-negative. Interestingly, the Morganellaceae were totally absent from people without obesity while preponderant in all in patients with obesity. To generate hypotheses regarding their potential role, we inferred metabolic pathways from the 16SrRNA gene signatures. We identified several pathways associated with adenosyl-cobalamine previously described to be linked with adipose tissue development. We further identified chorismate biosynthesis, which is involved in aromatic amino-acid metabolism and could play a role in fat pad development. This innovative approach generates novel hypotheses regarding the gut to adipose tissue axis. CONCLUSIONS: This innovative approach generates novel hypotheses regarding the gut to adipose tissue axis in obesity and notably the potential role of tissue microbiota.

A Comprehensive Summary of the Current Understanding of the Relationship between Severe Obesity, Metabolic Syndrome, and Inflammatory Status.

At present, obesity, as a part of metabolic syndrome, represents the leading factor for disability, and is correlated with higher inflammation status, morbidity, and mortality. The purpose of our study is to add new insights to the present body of knowledge regarding the correlations between chronic systemic inflammation and severe obesity, which cannot be treated without considering other metabolic syndrome conditions. Biomarkers of high-level chronic inflammation are recognized as important predictors of pro-inflammatory disease. Besides the well-known pro-inflammatory cytokines, such as WBCs (white blood cells), IL-1 (interleukin-1), IL-6 (interleukin-6), TNF-alpha (tumor necrosis factor-alpha), and hsCRP (high-sensitivity C-reactive protein), as well as anti-inflammatory markers, such as adiponectin and systemic inflammation, can be determined by a variety of blood tests as a largely available and inexpensive inflammatory biomarker tool. A few parameters, such as the neutrophil-to-lymphocyte ratio; the level of cholesterol 25-hydroxylase, which is part of the macrophage-enriched metabolic network in adipose tissue; or levels of glutamine, an immune-metabolic regulator in white adipose tissue, are markers that link obesity to inflammation. Through this narrative review, we try to emphasize the influence of the weight-loss process in reducing obesity-related pro-inflammatory status and associated comorbidities. All data from the presented studies report positive results following weight-loss procedures while improving overall health, an effect that lasts over time, as far as the existing research data show.

Oversewing and Gastropexy in Laparoscopic Sleeve Gastrectomy - Two Futile Steps of the Procedure? An Observational Case-Control Study.

PURPOSE: Laparoscopic sleeve gastrectomy (LSG) is the most popular primary bariatric metabolic procedure worldwide but severe complications are still reported, and there is no ideal technique to avoid them. This study analyses the impact of oversewing (OS) and gastropexy (GP) on complication rate, early dyspeptic and late de novo GERD symptoms after LSG. MATERIAL AND METHOD: A case-control study was conducted on patients with obesity who underwent LSG. The total cohort was divided in group A (control group) - patients with no oversewing (OS) or gastropexy (GP), group B - patients with OS but no gastropexy and group C - patients with both OS and GP performed during LSG. RESULTS: We included 272 patients with obesity with a mean BMI 42.9±6.94 kg/m2, 96 patients in group A, 90 patients in group B and 86 in group C with no statistical differences between them. We had 5 cases of postoperative hemorrhage (4 in group A) and three patients who developed leaks (2 in group A and one in group B). Prolonged and severe early dyspeptic episodes and after 6 months reflux symptoms were significantly more in groups A and B (p<0.05). The operative time was longer in group B and C (p<0.05) but with no difference in procedure -related morbidity and in hospital length of stay. CONCLUSION: Adding both OS and GP to LSG reduce complications rate with no influence on procedure-related postoperative morbidity and in-hospital length of stay. GP reduces early postoperative dyspeptic and de novo GERD symptoms after LSG.

Human liver microbiota modeling strategy at the early onset of fibrosis.

BACKGROUND: Gut microbiota is involved in the development of liver diseases such as fibrosis. We and others identified that selected sets of gut bacterial DNA and bacteria translocate to tissues, notably the liver, to establish a non-infectious tissue microbiota composed of microbial DNA and a low frequency live bacteria. However, the precise set of bacterial DNA, and thereby the corresponding taxa associated with the early stages of fibrosis need to be identified. Furthermore, to overcome the impact of different group size and patient origins we adapted innovative statistical approaches. Liver samples with low liver fibrosis scores (F0, F1, F2), to study the early stages of the disease, were collected from Romania(n = 36), Austria(n = 10), Italy(n = 19), and Spain(n = 17). The 16S rRNA gene was sequenced. We considered the frequency, sparsity, unbalanced sample size between cohorts to identify taxonomic profiles and statistical differences. RESULTS: Multivariate analyses, including adapted spectral clustering with L1-penalty fair-discriminant strategies, and predicted metagenomics were used to identify that 50% of liver taxa associated with the early stage fibrosis were Enterobacteriaceae, Pseudomonadaceae, Xanthobacteriaceae and Burkholderiaceae. The Flavobacteriaceae and Xanthobacteriaceae discriminated between F0 and F1. Predicted metagenomics analysis identified that the preQ0 biosynthesis and the potential pathways involving glucoryranose and glycogen degradation were negatively associated with liver fibrosis F1-F2 vs F0. CONCLUSIONS: Without demonstrating causality, our results suggest first a role of bacterial translocation to the liver in the progression of fibrosis, notably at the earliest stages. Second, our statistical approach can identify microbial signatures and overcome issues regarding sample size differences, the impact of environment, and sets of analyses. TRIAL REGISTRATION: TirguMECCH ROLIVER Prospective Cohort for the Identification of Liver Microbiota, registration 4065/2014. Registered 01 01 2014.

Explicitly sexing health security: analysing the downstream effects of Panama's sex-segregated COVID-19 disease control policy.

In response to COVID-19, Panama implemented a sex-segregated lockdown policy whereby women were allowed to access essential services on Monday, Wednesday and Friday and men on Tuesday, Thursday and Saturday. The logic was to reduce disease transmission by controlling population circulation at any one time. We sought to understand the impact of this policy approach on Panamanian society. To do so, we undertook key informant interviews with representatives from groups of society that have been significantly affected by this policy across Panamanian society. Framework analysis was undertaken on interview transcripts to identify key trends, which were latterly triangulated with academic, media and grey literature. Firstly, we engage with intersectional analyses to show that those most affected were marginalised groups including trans population, disabled groups, indigenous groups and migrants who faced discrimination as a consequence of this policy. Secondly, we highlight practical tensions that individuals faced relating to access to resources (financial, health-related and beyond), and third we interrogate the methods used to enforce this policy, and the role of the police and exemption passes. We conclude that this policy was regressive in that it affected those most vulnerable in Panamanian society, entrenching existing inequalities. Before implementing sex-segregated policies in future health crises, governments must seek advice of gender and equality advisors and ensure impact assessments are undertaken to understand the burden such policies may pose across society.

A comparative analysis of three types of parathyroidectomies in renal hyperparathyroidism Single centre prospective cohort of 77 patients.

BACKGROUND: There is no consensus regarding optimal timing or best surgical procedure for refractory renal hyperparathyroidism patients. We aim to compare the results after three types of parathyroidectomies performed for sHPT in a single referral centre. METHODS: This study included patients on chronic hemodialysis submitted to three types of parathyroidectomy between 2010 and 2017. The primary outcome measure was relief of the symptoms and normalization of the main biochemical parameters. RESULTS: All symptoms improved significantly after surgery, especially osteoatricular pains. iPth dropped significantly immediately and during the follow up in all 3 groups; on short term, iPth values for group C(tPtx) were significantly lower compared to the other 2 subgroups (p=0.009). Furthermore, 5 patients from group C presented iPth values <12 pg/ml one year post-surgery, though this values tend to improve after. Patients from group B and C developed most often acute postoperative hypocalcemia, and persistent hyperparathyroidism was encountered especially after sPtx(10.3%). CONCLUSION: Significant improvement of both symptoms and biochemical parameters was noted in the majority of cases, regardless the parathyroidectomy type. tPtx is frequently followed by chronic hypoparathyroidism and subtotal parathyroidectomy is followed by a higher number of persistent and recurrent sHPT. KEY WORDS: Secondary hyperparathyroidism, Parathyroidectomy, Parathyroid autotransplant.

Safety of anastomotic techniques and consequences of anastomotic leakage in patients with colorectal cancer: a single surgeon experience.

INTRODUCTION: Colorectal cancer is a common type of malignant disease of the digestive tract. Anastomotic leakage (AL) still represents a serious complication in gastrointestinal surgery, associated with high morbidity and mortality. METHODS: We conducted a retrospective case-control study and analyzed a single surgeon's data about 359 patients treated for colorectal cancer. Patients were divided as follows: Study Group (patients with AL - 37 patients) and Control Group (patients without AL - 322 patients). Surgical and anastomotic technique-related information was processed. RESULTS: Surgical procedures for right sided colon tumors resulted in a significantly lower rate of anastomotic leakage (P=0.0231). For left sided colectomies end to end handsewn double layer anastomosis presented decreased odds (OR=0.176). For sigmoid segmental resection end to end anastomotic techniques developed low rate of fistula formation (handsewn - OR=0.593, stapled - OR=0.685). Performing Dixon type surgical interventions, anastomotic techniques seemed without influence on anastomotic leak appearance (handsewn and stapled), although distal anastomoses were identified as significant risk factors for fistula formation (P=0.0017). In order to perform subtotal colectomy, side to side sutures (handsewn and stapled) seemed safe choices for anastomotic procedure (P=0.0073). Patient with anastomotic leakage suffered a significantly longer hospital stay (P=0.0079), presented higher rate of surgical reintervention (P=0.0001), increased mortality (P=0.0001) and elevated hospitalization costs (P=0.0079). CONCLUSION: Postoperative complications like anastomosis leakage significantly increase hospitalization period, necessity of surgical reintervention, mortality and financial costs. In order to avoid these unpleasant events, bowel anastomoses require standardization during surgery.

Influence of Mesh Fixation on the Development of Postoperative Pain after Laparoscopic Inguinal Hernia Repair: A Single Surgeon Experience.

OBJECTIVE: Primary aim of the present article was to determine the relationship between mesh fixation methods and the occurrence of postoperative pain after laparoscopic inguinal hernia repair. Materials and Methods: 101 patients diagnosed with inguinal hernia benefited from elective laparoscopic treatment of the abdominal wall defect. Follow up was realized at one and three months after surgical intervention. The followed details contained clinical, surgical and pain-related data. Results: Multivariable analysis resulted young adults (OR=4.226; p=0.0467), recurrent hernia (OR=4.862; p=0.0415) and use of fixation requiring surgical mesh (OR=4.226; p=0.0467) as significant risk factors in the development of chronic postoperative pain. During the follow up period, patients who benefitted of mesh fixation complained about significantly higher pain sensation (pain index at one month: SG=10.27; CG=5.07; p=0.0080; pain index at three months: SG=5.02; CG=1.42; p=0.0406). Concerning chronic postoperative pain syndrome, six patients from SG (12.76%) and only a single patient from CG complained after three months about pain index greater than 18.5 points, concluding that mesh fixation significantly increases the possibility of chronic postoperative pain syndrome (p=0.0455). Conclusions: Mesh fixation methods during laparoscopic inguinal hernia repair seem to contribute to the development of chronic postoperative pain. Avoiding traumatizing mesh fixation methods could be a suitable option for surgeons.

Elderly Patients with Colorectal Cancer - A Predisposed Category for Postoperative Complications.

Introduction: Colorectal cancer (CRC) is among the leading causes of cancer-related deaths around the world. Elderly patients are often considered as a high-risk category of patients, predisposed for postoperative complications. Materials and methods: 138 patients aged over 75 years and diagnosed with colorectal cancer were retrospectively reviewed. Patients were divided in two groups, as follows: Study Group including patients who developed postoperative complications, and Control Group including patients without problems in the postoperative period. There were compared clinical, preoperative, surgical, postoperative and oncological data. The aim of study was to determine possible risk factors for short-term postoperative complications and analyze of the influence of postoperative complications on survival. Results: Risk factors as male gender, obesity, heart failure, diabetes type II, severe anemia, low total protein level, ASA III-IV classification, emergency surgery, prolonged surgical intervention, increased intraoperative blood loss, prolonged hospital stay, distal localization of tumors, TNM stages III-IV, surgery for digestive cancer and non-cancerous major abdominal surgery in the medical history were identified. Conclusion: The surgical treatment of colorectal cancer in the aging population still remains a challenge, these category of patients should benefit of special attention in order to ensure a chance to minimize or avoid these complications.

Sepsis in Acute Mediastinitis - A Severe Complication after Oesophageal Perforations. A Review of the Literature.

BACKGROUND: Despite recent advancements in antibiotic therapy and the progress made in critical care and modern diagnostic methods, acute mediastinitis continues to be a severe condition. DIAGNOSIS AND TREATMENT: Acute mediastinitis can occur in the context of cardio-thoracic surgery, oesophageal perforations and oropharyngeal infections condition. Forty-five percent of oesophageal perforations occurs during simple endoscopy. Spontaneous perforation (Boerhaave syndrome) accounts for 15% of perforations, and twelve percent are due to the ingestion of foreign bodies. Other causes include blind or penetrating trauma, and circa 9% to intraoperative lesions. CT scan is the standard investigation that reveals direct signs of mediastinitis.The oral administration of contrast substances can underscore the level of oesophageal perforation. Conservative treatment is the first-choice treatment and surgical treatment is reserved only for specific situations.The principles of surgical treatment consist of drainage, primary suture, oesophageal exclusion with or without the application of oesophagectomy, endoscopic vacuum wound assisted therapy of the perforation and associated paraoesophageal mediastinal drainage and endoscopic stenting associated with drainage. CONCLUSIONS: The lowest mortality rate is recorded in patients with perforations diagnosed less than twenty-four hours after the onset of symptoms. Surgical treatment remains the gold standard especially in cases of thoracic and abdominal perforations while further investigations are mandatory before endoscopic stenting is carried out.

Safety of Anastomoses in Right Hemicolectomy for Colon Cancer.

Introduction: Colorectal cancer is one of the most common malignant tumor of the digestive system, the incidence of this cruel disease has been increasing at a constant rate. Materials and methods: 236 patients diagnosed with right colon cancer were retrospectively reviewed. For all patients included in this study, right hemicolectomy or extended right hemicolectomy with ileo-colonic anastomosis was performed. Patients were divided in two groups, as follows: study group including patients which developed anastomotic leakage, and control group including patients without anastomotic leak. There were compared clinical, surgical, postoperative and anastomotic leakage (AL) related data within the two groups.The study investigates possible risk and protective factors for developing anastomotic leakage, furthermore the relationship between anastomotic leakage and mortality was analyzed. Results: risk factors for AL as advanced age, tumors of the right 1/3 of transvers colon, emergencysurgery, mechanical suture, S-E anastomosis, late start of bowel motility were identified during the current research. S-S anastomotic technique were identified as protective factor in the development of fistula. Conclusion: According to the results of the present research, in right colon tumors S-S anastomotic technique should be used, being linked with the lowest chances of anastomotic leakage.

Long-term outcomes of laparoscopic sleeve gastrectomy - a single-center prospective observational study.

INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) is an established bariatric procedure. AIM: We present our long-term results regarding weight loss and comorbidities during 9 years. MATERIAL AND METHODS: We calculated the percent excess weight loss (%EWL) and changes in body mass index (ΔBMI). We evaluated arterial hypertension (AHT), type 2 diabetes (T2DM) and obstructive sleep apnea syndrome (OSAS). RESULTS: One hundred seventy-nine patients were included (136 female/43 male), mean age of 40.47 ±11.08 years, median preoperative body mass index (BMI) of 42.93 kg/m2. Median follow-up period was 72 months (36-84 months). The %EWL during follow-up was 41.8 (n = 179 patients, at 3-month follow-up), 64.1 (n = 163), 75.33 (n = 134), 77.1 (n = 103), 76,03 (n = 99), 73.78 (n = 64), 71.58 (n = 37), 63.83 (n = 22) and 64.1 (n = 14) at 6, 12, 18, 24, 36, 48, 60 and 72 months, respectively. We noted a negative correlation between %EWL and both the age and initial weight and BMI of the patient; a negative correlation between gender (male patients) and %EWL was also found. After LSG, 68.2% of patients with AHT presented resolution (no medication) or significant improvement (doses reduced) of the disease. As regards T2DM, 65.8% described resolution or significant improvement after surgery. Furthermore, 31 (70.4%) patients with preoperative OSAS reported resolution/improvement within a year from surgery. CONCLUSIONS: Laparoscopic sleeve gastrectomy is a safe and effective procedure, with good results in the short and medium term. Long-term follow-up reveals a tendency to weight regain after approximately 2 years from primary surgery, with the need for revisional surgery in some cases.

A prospective follow-up study on completion thyroidectomy for well-differentiated thyroid cancer. A single-center report.

BACKGROUND: Completion thyroidectomy (cT) becomes a choice after any type of less than total thyroid surgery, when a "total" would have been indicated on primary intervention if malignancy diagnosis had been available. The study main aim is to define predictive factors of malignancy in the thyroid remnant and to assess the morbidity risk after cT according to the type of initial intervention. MATERIAL AND METHOD: Sixty-three patients on whom cT was performed were finally included with 61 surgeries performed in our department. RESULTS: Or cohort included 55 (87.3%) women and 8 men (12.7%), with a mean age of 48.3 on whom were primary performed 34 lobectomies with isthumusectomies (LwI=53.96%) and 29 subtotal thyroidectomies or hemithyroidectomies (STT=46.03%). Histopathological examination after reintervention detected malignancy in 30.15% of excised thyroid remnants (19 patients), in the majority of these cases microcarcinoma. We found statistically significant correlations between the risk of malignancy in the thyroid remnant and both the primary thyroid tumor multicentricity (p=0,001) and its extracapsular and/or vascular invasion (p=0,006) respectively. The time span between the two interventions ranged from 3 days to 12 months (mean 63 days). No 30-day mortality occurred in our group of patients. We noted 3 cases of RLN palsy (4.76%) of which one permanent (1.58%) and 12 cases (19.04%) of postoperative hypoparathyroidism, of which two (3.17%) permanent. CONCLUSIONS: Multicentricity and capsular and/ or vascular invasion of the initial tumor are factors predictive of malignancy in the remnant thyroid. The rate of postoperative hypoparathyroidism is higher after initial subtotal thyroidectomy. KEY WORDS: Completion thyroidectomy, Incidental parathyroidectomy, Multifocality, Thyroid cancer.

Fatal Hypocalcaemia Due to Hungry Bone Syndrome with Secondary Refractory HyperParathyroidism After Parathyroidectomy: A Case Report.

INTRODUCTION: Hungry bone syndrome (HBS) refers to the rapid, profound, and prolonged hypocalcaemia associated with hypophosphatemia and hypomagnesaemia, and is exacerbated by suppressed parathyroid hormone (PTH) levels, which follows parathyroidectomy in patients with severe primary hyperparathyroidism (PHPT) and preoperative high bone turnover. [1]. CASE REPORT: This report concerns a dialysed patient who underwent surgical treatment for secondary refractory hyperparathyroidism. Haemodialysis was carried out pre-operatively, and subsequently, a total parathyroidectomy with auto-transplantation of parathyroid tissue in the sternocleidomastoid muscle (SCM) was performed. Rapid and progressive hypocalcaemia symptoms developed during the second day postoperatively. Acute cardiac symptoms with tachyarrhythmia, haemodynamic instability and finally asystole occurred, which required cardiopulmonary resuscitation (CPR). The ionic calcium level was 2.2 mg/dL being consistent with a diagnosis of HBS. A second cardiac arrest unresponsive to CPR followed an initial period of normal sinus rhythm. Death ensued shortly after. Before death, the ionic calcium was 3.1 mg/dL. CONCLUSION: HBS, after parathyroidectomy in patients with secondary hyperparathyroidism (SHPT), may be severe, prolonged and sometimes fatal. Generally, HBS symptomatology is that of a mild hypocalcaemia. It can, however, include heart rhythm disturbances with haemodynamic alterations requiring intensive care measurements and even cardiopulmonary resuscitation. A close clinical and laboratory post-parathyroidectomy monitoring of dialysed patients is of the utmost importance.

Laparoscopic Gastric Plication vs Laparoscopic Sleeve Gastrectomy - A Single Center, Prospective and Case-Control Study.

BACKGROUND AND OBJECTIVES: The laparoscopic gastric plication (LGP) is a restrictive bariatric procedure, still under investigation, considered to be an alternative to laparoscopic sleeve gastrectomy (LSG). The aim of the present study was to compare the outcome of LGP with the results of LSG. Materials and Methods: The study was conducted on a total of 100 patients, from which 50 patients underwent LGP and other 50 patients had the LSG operation. To analyze the effectiveness of both procedures total weight loss (%TWL), change in body mass index ( BMI) and percentage of excess weight loss (%EWL) were measured and calculated for four distinct timelines: 6 months, 12 months, 24 months and 36 months after the procedure. Comorbidities were evaluated based on clinical and laboratory investigation. Results: Starting from 6 months after surgery, weight reduction was statistically significant in favor of the LSG group, with the highest differences found after two and three years postoperatively (p=0.0001). No differences were found between the two procedures in terms of compliance or improvement of the main comorbidities. Conclusions: As compared to LSG, LGP has similar outcomes in terms of the length of hospitalization, major complications and improvement of the main comorbidities. LSG procedure was found to be superior in terms of medium- to long-term weight reduction. LGP is a technique that may provide better results in obese patients with a lower BMI (less than 40 kg/m2).

Durability of an Advanced Skin Protectant Compared With Other Commercially Available Products in Healthy Human Volunteers.

BACKGROUND: A new skin protectant with improved adhesion to denuded skin and resistance to wash off has been developed to protect skin from incontinence-associated dermatitis (IAD) or general loss of skin integrity. OBJECTIVE: This controlled, randomized, prospective, open-label study determines the durability of the new protectant when applied to intact skin in 21 healthy human volunteers and compares it to 3 other products used for similar clinical indications. MATERIALS AND METHODS: Eight 0.75-in circles of black carbon pigment were applied to the bilateral forearms (4 per arm to allow for duplicates) of the participants and covered with the various products. Participants conducted normal routine activities over 7 days. Photographs were taken and a test site assessment was completed before and after application of the products on day 0 and at days 1, 2, 3, 4, and 7 to evaluate pigment loss over time. Carbon integrated optical density (CIOD) was measured under the assumption that a loss of pigment correlated with a loss of the protective product. These data were used to calculate the percent barrier remaining over time. RESULTS: The percent of intact film was significantly greater (P < .05) from day 3 onwards for the new skin protectant compared with the other 3 products. The new product showed no significant change in CIOD (P = .46) from day 1 through day 7, indicating no meaningful wear over time. The other 3 products showed significant changes in CIOD (P < .01) beginning at either day 2 or day 3. CONCLUSIONS: The new skin protectant was more durable than the other products tested. It remained in place for up to 7 days for all participants, whereas the other products had < 50% remaining on the skin by that time point.