[Endoscopic management of complications after laparoscopic sleeve gastrectomy]. / Endoskopisches Komplikationsmanagement nach Schlauchmagenbildung.

Laparoscopic sleeve gastrectomy (SG) is currently the most commonly performed standalone bariatric procedure worldwide. Gastric staple line leakage is the feared immanent complication of the operation, which is difficult to treat and often persists. This article presents the endoscopic treatment options for complications after laparoscopic SG, particularly the treatment of gastric staple line leakage. Most important for a successful treatment is the understanding of the underlying pathophysiological causes, the exact surgical comprehension of the procedure and advanced endoscopic skills. The choice of endoscopic intervention depends on the available strategies as well as on the skills of the executing endoscopist. Currently, internal drainage seems to be the most expedient method.

Alterations in energy expenditure in Roux-en-Y gastric bypass rats persist at thermoneutrality.

BACKGROUND: The compensatory decrease in energy expenditure (EE) in response to body weight loss is attenuated by Roux-en-Y gastric bypass (RYGB) surgery in rats. The thermoneutral zone (TNZ) is at higher temperatures in rodents than in humans. Consequently, rodents may be under moderate cold stress if EE is measured at room temperature, leading to increased EE due to adaptive thermogenesis. We speculated that the reported alterations in EE of RYGB rats at room temperature are caused by higher adaptive thermogenesis and are therefore not present at thermoneutrality. METHODS: Male Wistar rats were randomized for RYGB or sham surgery. Some sham rats were body weight matched (BWM) to the RYGB rats by food restriction, the others received ad libitum access to food (AL). EE, body temperature, physical activity and food intake were measured at ambient temperatures between 22 and 32 °C to determine the TNZ. Adaptive thermogenesis requires ß3-adrenergic receptor-mediated uncoupling protein-1 (UCP-1) expression in brown adipose tissue (BAT). The in vivo thermogenic capacity of BAT was determined by administering the ß3-adrenergic agonist CL316,243, and UCP-1 protein expression was measured at room temperature. RESULTS: The TNZ was between 28 and 30 °C for AL and RYGB and between 30 and 32 °C for BWM rats, respectively. In contrast to AL and BWM rats, EE was not significantly higher at room temperature than at thermoneutrality in RYGB rats, reflecting a lack of adaptive thermogenesis. Consistently, both the thermogenic capacity of BAT and UCP-1 expression were decreased in RYGB compared with AL rats at room temperature. CONCLUSIONS: Our data confirm that the decrease in EE after body weight loss is attenuated by RYGB surgery and show that this effect persists at thermoneutrality. Contrary to our hypothesis, we found that adaptive thermogenesis at room temperature is reduced in RYGB rats.

[Surgery as pluripotent instrument for metabolic disease. What are the mechanisms?]. / Chirurgie als pluripotentes Instrument gegen eine metabolische Erkrankung : Was sind die Mechanismen?

Bariatric metabolic surgery currently offers the most effective treatment to achieve sustained weight loss and improvement in metabolic comorbidities, such as type 2 diabetes, hypertension, dyslipidemia and cardiovascular diseases. The number of cases performed in Germany and also worldwide is continuously increasing but the underlying mechanisms of bariatric metabolic surgery are still not completely elucidated. Roux-en-Y gastric bypass (RYGB) surgery represents one of the most commonly used and therefore most frequently investigated bariatric metabolic procedures. Traditionally, its effectiveness was attributed to food restriction and malabsorption but in the meantime it has become evident that the underlying postoperative mechanisms of RYGB seem to be much more complex. Potential mechanisms include multiple physiological changes, such as altered levels of gastrointestinal hormones, increased energy expenditure and modified gut microbiota as well as many other factors. This review article therefore aims to offer an up to date overview of relevant mechanisms that improve obesity and its associated comorbidities after RYGB surgery.

Pelvic organ prolapse: does the postoperative course of mesh-repair surgery differ in elderly women when compared with younger patients?

Pelvic organ prolapse (POP) is a common disease in elderly women. Among a wide range of possibilities in POP surgery, the use of partially absorbable meshes appears to be very promising. The problem concerning POP therapy in elderly patients has not yet been not sufficiently investigated. We enrolled 64 patients with POP stages 3 and 4. All patients underwent mesh-repair surgery and afterwards were stratified into two age groups. Data obtained from anamnesis, pelvic organ prolapse quantification (POP-Q) scale, dynamic MRI and prolapse quality of life (P-QoL) questionnaire were analysed and compared between both age groups. A total of 64 patients completed the study protocol. Outcome of the surgery was promising and comparable between both age groups. One recurrence of prolapse and one mesh erosion was reported. P-QoL showed a good overall satisfaction. Our data show that the surgical correction of POP with use of polypropylene mesh in elderly women appears to be a successful method with an acceptable morbidity, adverse events rate and high satisfaction of the patients.