Impact of age on postoperative outcomes in bariatric surgery.

BACKGROUND: Age is often related to the increase of perioperative complications and reoperation rates. The authors aimed to determine the influence of age on outcomes of most commonly performed bariatric procedures. METHODS: The retrospective study included patients qualified for primary Laparoscopic Sleeve Gastrectomy (LSG) or Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) in two academic hospitals. Patients were divided into two groups: ≥50 (21.2-26.9%) and <50 (57.6-73.1%) years old. Endpoints assessed the influence of patients' age on the perioperative and the one-year postoperative period. RESULTS: Operative time was longer in the ≥50-year-old group, but only for LRYGB. There were no differences in the intraoperative adverse events, postoperative morbidity, reoperation and readmission rates between the groups. The risk of port site hernia was increased (OR: 4.23, CI: 1.49-12.06) in the ≥50-year-old group. The mean % of total weight loss 12 months after the bariatric procedure was comparable, but % of excess weight loss and % of excess body mass index loss were lower in the ≥50-year-old group (p = .033 and .032). CONCLUSIONS: Bariatric surgery is safe and feasible in patients over 50 years old. The weight loss effect can be worse among patients over 50 years old; nevertheless, the treatment should be considered as effective.

[Retroperitoneal perforation of duodenum - surgical approach]. / Zaotrzewnowa perforacja dwunastnicy - postEpowanie chirurgiczne.

Retroperitoneal perforation of the duodenum, caused by abdominal trauma, endoscopic examination or diverticulitis, is a serious clinical problem, because of it's lack of specific symptoms. Surgical treatment is often performed in sepsis. That is why the knowledge of adequate techniques is crucial for surgeons. We would like to present our model of surgical approach, based on several trauma center's cases. Among the methods and techniques presented we emphasize the duodenal by-pass with bile duct drainage. Post-op cases of gastrojejunal anastomosis' bleeding prompt to implement a selective vagotomy, which however requires further studies.

[Usefulness of the multislices computed tomography in post-operative anatomy assessment in patients after bariatric surgery]. / Przydatnosc wielorzedowej tomografii komputerowej w ocenie prawidlowej anatomii pooperacyjnej u pacjentów poddanych zabiegom bariatrycznym.

Obesity is a systemic disease, which, together with complications and comorbidities is a major health problem of a large percentage of the world population. Because of the failure of behavioral and pharmacological treatment the new branch of surgery has been developed - the so-called bariatric surgery, dealing with operative treatment of obesity. Rapid increase of performed bariatric procedures requires the ability to interpret correctly the multislice CT imaging studies of patients treated with this innovative procedures. This paper is a review of commonly used methods of surgical treatment of obesity and identifies the usefulness of multislice computed tomography (CT) imaging of postoperative abdominal and pelvic anatomy. Surgical techniques are divided into treatments for restrictive mechanism, malabsorptive mechanism and combined both mechanisms. Abdominal and pelvic CT imaging before and after intravenous contrast agent administration confirmed their clinical utility.

Nutritional Status, Selected Nutrients Intake, and Metabolic Disorders in Bariatric Surgery Patients.

Bariatric surgery is the most effective treatment for obesity and its complications. However, failure to adhere to dietary recommendations can result in both unsatisfactory weight loss and metabolic disorders. The aim of this study was to evaluate the effects of bariatric surgery on the anthropometric parameters and selected nutrient intake. A total of 12 months postoperatively, percent excess weight loss (%EWL) was significantly higher after laparoscopic Roux-en-Y gastric bypass (LRYGB) than laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) (93.78% vs. 56.13% and 55.65%, p < 0.001). The same was true for waist-to-hip ratio (WHR) (p = 0.017) and waist-to-height ratio (WHtR) changes (p = 0.022). There was a significant decrease in total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels after RYGB. A significant decrease (p < 0.05) in daily intake was found for energy (4278.4 kcal vs. 1355.17 kcal), sucrose (122.23 g vs. 38.22 g), dietary fiber (30.90 g vs. 14.20 g), eicosapentaenoic fatty acid and docosahexaenoic acid (EPA+DHA) (142.46 mg vs. 52.90 mg) and % energy from fats (42.43% vs. 35.17%), saturated fatty acids (SAFAs) (19.96% vs. 14.11%) and alpha-linolenic fatty acid (ALA) (0.87% vs. 0.69%). Energy intake and energy % from fats positively correlated with body weight (BW), waist circumference (WC), WHR, and WHtR, and negatively with %EWL. The percentage of unsaturated fatty acids positively correlated with WC and WHR. Energy intake correlated positively with serum triglycerides (TGs) and energy % from fats and carbohydrates. Despite significant weight loss, the patient's diet deviated from recommendations and may have contributed to metabolic disorders.

The Association of Polish Surgeons (APS) clinical guidelines for the use of laparoscopy in the management of abdominal emergencies. Part I.

Introduction: Over the past three decades, almost every type of abdominal surgery has been performed and refined using the laparoscopic technique. Surgeons are applying it for more procedures, which not so long ago were performed only in the classical way. The position of laparoscopic surgery is therefore well established, and in many operations it is currently the recommended and dominant method. Aim: The aim of the preparation of these guidelines was to concisely summarize the current knowledge on laparoscopy in acute abdominal diseases for the purposes of the continuous training of surgeons and to create a reference for opinions. Material and methods: The development of these recommendations is based on a review of the available literature from the PubMed, Medline, EMBASE and Cochrane Library databases from 1985 to 2022, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. Recommendations were formulated in a directive form and evaluated by a group of experts using the Delphi method. Results and conclusions: There are 63 recommendations divided into 12 sections: diagnostic laparoscopy, perforated ulcer, acute pancreatitis, incarcerated hernia, acute cholecystitis, acute appendicitis, acute mesenteric ischemia, abdominal trauma, bowel obstruction, diverticulitis, laparoscopy in pregnancy, and postoperative complications requiring emergency surgery. Each recommendation was supported by scientific evidence and supplemented with expert comments. The guidelines were created on the initiative of the Videosurgery Chapter of the Association of Polish Surgeons and are recommended by the national consultant in the field of general surgery. The first part of the guidelines covers 5 sections and the following challenges for surgical practice: diagnostic laparoscopy, perforated ulcer, acute pancreatitis, incarcerated hernia and acute cholecystitis. Contraindications for laparoscopy and the ERAS program are discussed.

Effect of Significant Postoperative Complications on Decision Regret After Laparoscopic Sleeve Gastrectomy: a Case-Control Study.

BACKGROUND: Thus far, no data are available on decision regret about sleeve gastrectomy (SG), particularly in patients who experienced perioperative complications. This study aimed to assess whether patients with postoperative complications regret their decision to undergo laparoscopic SG more than patients with an uneventful postoperative course. METHODS: The study group comprised patients with complications after laparoscopic SG (cases). The control group comprised patients who did not experience any postoperative complications (controls). A telephone survey was conducted on all patients. Patients' satisfaction regarding their decision to undergo surgery was assessed using the Decision Regret Scale. RESULTS: In total, 21 patients who experienced postoperative complications and 69 controls were included. The patients in the study and control groups achieved similar percentages of total weight loss (32.9 ± 11.9 vs. 33.8 ± 15.0, p = 0.717) and excessive body mass index loss (74.9 ± 30.7 vs. 73.1 ± 36.7, p = 0.398) at 1 year postoperatively. The difference in weight change at 12 months postoperatively was not significant in both groups. The mean regret scores in the study and control groups were 13.2 ± 1.2 (range, 28-63) and 13.3 ± 1.1 (range, 12-66) (p = 0.818), respectively. Moreover, no significant difference was found among patients who expressed regret between the study and control groups (regret score > 50; 4.76% vs. 4.35%) (p = 1.000). CONCLUSION: This study suggests that patients with postoperative complications do not regret their decision to undergo SG more than patients with an uneventful postoperative course.

Bariatric tourists. Foreign bariatric patients treated in Poland - a survey based study.

<b>Introduction:</b> Bariatric procedures are becoming more popular worldwide. We present a current situation of foreign patients treated by high-volume bariatric surgeons in Poland in 2016. <br><b>Material and Methods:</b> We sent an online survey to twenty high-volume bariatric surgeons. The questionnaire regarded the year 2016. We asked for number and types of bariatric procedures performed or supervised, number of foreign bariatric patients, their qualification process, country of origin, types of procedure, and post-op recommendations. <br><b>Results:</b> We received 9 surveys (45%). Five surgeons performed or supervised from 100 to 300 bariatric procedures, 2 performed or supervised over 300 procedures, 2 performed or supervised from 50 to 100 procedures. All of the respondents performed laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LRYGB), four carried out mini gastric bypass, two - gastric banding (LAGB), one - SADI-S and duodenal switch (DS). Six surgeons operated on the total of 64 foreign patients, mainly performing LSG, LRYGB and mini gastric bypass. Most of the patients were qualified based on international criteria [body mass index (BMI) over 40 kg/m² or BMI over 35 kg/m² with comorbidities]. United Kingdom was the most popular country of origin, followed by Germany, USA, Ireland and Sweden. Qualification for surgery was based on a personal visit. After surgery, 83.3% (n = 5) of the respondents gave out discharge documents in English, recommending long-term bariatric follow-up in the country of origin. Every respondent carried out 3-month personal follow-up of every foreign patient. <br><b>Conclusions:</b> Foreign bariatric patients travelling to Poland are qualified for surgery according to known international standards. Most of the patients receive post-op discharge documents in English, with a 3-month follow-up performed by their surgeon. Further bariatric supervision in the country of origin is routinely recommended.

Metabolic and Bariatric Surgery Chapter of the Association of Polish Surgeons. Bariatric and metabolic surgery care standards.

The Metabolic and Bariatric Surgery Chapter of the Association of Polish Surgeons (Polish acronym: SCMiB TCHP) is a Polish specialist scientific society representing bariatric surgeons as well as specialists from other disciplines and professions cooperating with them during the provision of services in the field of bariatric and metabolic surgery, as well as the entire care process before and after surgery. The following standards constitute the minimum requirements set by the SCMiB TCHP for good practice of the basic process of bariatric care throughout its entire period, which ensure satisfactory safety and effectiveness of the obesity treatment and its metabolic complications.

[Syndromic surveillance in circumstances of bioterrorism threat--the essence, application abilities and superiority over a traditional epidemiological surveillance]. / Nadzór syndromowy w sytuacji zagrozenia atakiem bioterrorystycznym--istota, mozliwosci zastosowania oraz przewaga nad tradycyjnym nadzorem epidemiologicznym.

This article provides a short review about trends of developing current syndromic surveillance systems. To improve methods of early detection of natural or bioterrorism-related outbreaks, it has to be established a new way of epidemiological thinking, which uses innovative real-time surveillance systems. Syndromic surveillance has been created for an early detection, to monitor the temporo-spatial spread of an outbreak, and to provide prompt data for immediate analysis and feedback to public health authorities. It supports timely decision making process for countermeasure procedures. Framework of syndromic surveillance system requires a proper electronic infrastructure to be build up. Optimal syndrome definitions and data sources for continuing specific diseases outbreak surveillance have not been determined so far. Systems of interest might enhance collaboration among clinical providers, primary care providers, emergency services, information-systems professionals and public health agencies. However economic scope of this undertakings effectively limits ability to implement it in Polish public health service right now. Besides, syndromic surveillance cannot replace traditional public health surveillance with a post-factum epidemiological investigation and laboratory analysis. It can be a useful supplement.

[The outcomes of treatment of gastroesophageal reflux disease with laparoscopic "floppy" fundoplication]. / Ocena wyników leczenia choroby z zarzucania zoladkowo-przelykowego laparoskopowa metoda pelnej luznej fundoplikacji.

UNLABELLED: Gastroesophageal reflux disease (GERD) has been a serious health and social problem. Population based survey revealed that around 40 per cent of the whole population reported monthly GERD related symptoms. When not treated properly GERD can lead to severe complications such as Barrett's oesophagus (BE) and adenocarcinoma as a consequence. Various methods can be useful in diagnosis of GERD but only gastroscopy is a widespread investigation that enables to establish the diagnosis of reflux disease. The symptoms of reflux disease can be effectively treated by drugs, surgical procedures remain the way of curing the cause of gastroesophageal reflux. Nowadays the laparoscopic fundoplication is a standard in operative treatment of the ailment. AIM OF STUDY: was to evaluate of GERD treatment with laparoscopic "floppy" Nissen fundoplication (LFN). MATERIAL AND METHODS: A group of 41 patients who underwent LNF were recruited for the study. All qualified patients underwent pre and post-surgical upper GI endoscopy and were requested to answer the questions in a GERD-related quality of life questionnaire. The main group of patients was divided into two subgroups--those with concomitant hiatal hernia and those without hernia. The outcomes of treatment were then compared between the subgroups. RESULTS: After the procedure the endoscopic improvement of reflux oesophagitis and better symptoms self-assessment were found. CONCLUSIONS: Laparoscopic "floppy" Nissen fundoplication is an effective method of treatment of erosive oesophagitis and its symptoms.

[Therapeutic and diagnostic problems in a patient with a pelvic tumour--case report]. / Problemy diagnostyczno-lecznicze u chorego z guzem miednicy--opis przypadku.

Colorectal cancer has become the commonest form of cancer in gastrointestinal (GI) tract and nowadays it is the second cause of death among all malignant tumours. Bladder cancer is the fourth commonest tumour in males and eighth in females. In the article we present the case of 72-year-old patient with pelvic tumour and accompanied diagnostic and therapeutic problems. Despite repeated colon and bladder biopsies no malignancy was found. The results of imaging investigations suggested a bladder-derived tumour (from a bladder diverticulum or persisting urachus). An inflammatory tumour was also taken into consideration. The diagnosis confirmed in histological examination was adenocarcinoma of the colon. The article presents successive stages of diagnosis and therapy.

[Evolution of views on surgical treatment of gastroesophageal reflux disease and hiatal hernia]. / Ewolucja pogladów na chirurgiczne leczenie choroby refluksowej przelyku i przepuklin rozworu przelykowego.

This year it has been 90 years since the first hiatal hernia repair was performed (Soresi, 1919). Nowadays surgeons' approach to operational treatment has changed as a result of development of more precise imaging techniques, better understanding of physiology and pathology of gastroesophageal reflux disease (GERD), invention of effective medicines and alternative endoscopic procedures. Complications and discomfort in patients during a follow-up resulted in evolution of surgical methods. Close co-operation between surgeons and gastroenterologists and interchange of experiences among surgeons have allowed establishing general algorithm for therapeutic and preoperational management. It seems crucial for further defining of surgical management of hiatal hernia and reflux disease to have at least basic knowledge on previous medical views on GERD. Another reason for taking the subject is epidemiology, oncological prophylaxis and quality of life improvement in patients with reflux disease. It has been proven that the most effective way of operational treatment of GERD is creating with the liberated gastric fundus a full "floppy" wrap around the lower esophagus. The procedure is completed with narrowing of esophageal hiatus. In cases of impaired esophageal motor activity the partial (180 degrees) posterior fundoplication is widely used. In hiatal hernias, particularly of type II or paraesophageal hernias, the diaphragmatic defect can be repaired with surrounding tissues or, when large, with a synthetic mesh.

[New trends in bariatric surgery]. / Nowe trendy w chirurgii bariatrycznej.

The surgical treatment of obesity reaches the 50th of last century. The first operations were based on significant shortening of digestive tract and were associated with many metabolic disturbances. The growing epidemic of obesity was the most decisive factor for the development of bariatric surgery. Because of its high efficacy (80%) comparing to the conservative treatment (5%), bariatric surgery today is the only effective therapy for morbid obesity. Surgical procedures can be categorized as restrictive, restrictive-malabsorptive, malabsorptive and others. The restrictive operations limit gastric volume. There are Vertical Banded Gastroplasty (VBG), Adjustable Gastric Banding (AGB) and Sleeve Resections (SR). The restrictive-malabsorptive are based on the creation of small gastric pouch or the resection of 4/5 of stomach and the shortening of common digestive tract. There are Gastric bypass (GB), and Biliopancreatic divertion with duodenal switch (BPD-DS). The malabsorptive procedure (Biliopancreatic divertion--BPD) are based on resection of 2/3 of stomach and significant shortening of digestive tract. The appearance of new bariatric operation such as SR changed the pattern of treating obesity with BMI >50 kg/m2. The two or three stage treatment of obesity minimizes the perioperative risk for patients. Although the great development of bariatric surgery there is no golden standard. The choice of procedure should be done by surgeon and patient together.

[Current methods of ventral hernias repair]. / Wspólczesne metody leczenia przepuklin brzusznych.

Hernioplasty is the most common procedure performed on surgical wards. The golden standard among the different techniques of hernia repair is the usage of mesh. It resulted in the reduction of recurrences below 1% of primary repairs. Usage of the artificial material results in less numbers of recurrences which is 1% less than primary repairs. The aim of this article was to review contemporary opinions on repair operations of an abdominal hernia. Appropriate documentation and publications were reviewed in this area. We presented the usage of new techniques in ventral hernioplasty including laparoscopic approach and the intraperitoneal usage of mesh. The presentation was based on references and our experience. Conclusions regarding the lack of treatment standards and superiority of usage of the artificial materials method were formulated accordingly.

[Selected lifestyle characteristic of patients with extreme obesity qualified for bariatric surgery]. / Wybrane cechy trybu zycia pacjentów z otyloscia olbrzymia zakwalifikowanych do operacji bariatrycznych.

The aim of the study was the analysis of chosen nutritional habits and physical activity among patients qualified for bariatric surgery. The research was conducted by questionnaire method. The results of the study show that number and regularity of meals was improper. Everybody snack, eg. sweets. About 50% of researched read information on the food packages, but only few participants paid attention to the nutritional and energy value of food products. TV and radio were the main source of nutritional information. Nutritional behaviors men and women were different. The level of physical activity was low.

Bulimia nervosa in obese patients qualified for bariatric surgery - clinical picture, background and treatment.

Eating is a basic human physiological need which is necessary to keep the body alive. Eating disorders are diagnosed when eating (or not eating) and associated body weight gain anxiety become the main interest of an individual and all other spheres of life depend on it. Bulimia nervosa is a psychiatric disorder which is more and more commonly diagnosed in patients suffering from obesity and in patients after surgical treatment of obesity. In patients eligible for bariatric surgery this disorder should be diagnosed appropriately early and treated successfully before the procedure, because bulimia nervosa does not regress spontaneously. When untreated, it may last for years, reducing the efficacy of a surgical treatment of obesity, or even lead to complications that are health- and life-threatening for patients.

Assessment of health behaviors, nutritional behaviors, and self-efficacy in patients with morbid obesity. / Ocena zachowan zdrowotnych, zywieniowych i poczucia wlasnej skutecznosci chorych z otyloscia olbrzymia.

OBJECTIVES: The objective of the study was to assess the frequency of health and nutritional behaviors concerning emotional, habitual, and restrictive eating as well as to evaluate self efficacy in patientswith morbid obesity and determine the correlation between patients'BMI index and their health behaviors as well as self-efficacy. METHODS: The study included 37 patients diagnosed with class two and three obesity, aged 18-62 (M = 39.94; SD = 12.20). Patients' BMI ranged from 36 to 60 kg/m2 (M = 43.50; SD = 5.36). Research tools used in the study: the Inventory of Lifestyle Behaviors (ILB), the Dietary Behaviors Questionnaire (DBQ), and the General Self-Efficacy Scale (GSES). RESULTS: Patients with morbid obesity were characterized by medium (men; a sten score of 5) and low (women; a sten score of 4) intensity of health behaviors. Subjects showed a tendency for negative nutritional behaviors, emotional and habitual eating as well as dietary restrictions. General self-efficacy ranged between sten scores of 4 to 10, with mean at a high level (a sten score of 7). CONCLUSIONS: Patients with morbid obesity need health, nutritional, and psychological education.

XXL-TYPE PERSONALITY. Personality traits promoting excess body weight.

THE AIM OF THE STUDY: The study aimed to determine whether persons suffering from obesity may be characterised by specific personality traits which promote the development of excess body weight. Additionally, the aim involved finding whether persons suffering from morbid obesity differed from healthy individuals and somatic patients as regards selected personality traits. MATERIAL AND METHODS: The study enrolled 34 patients with the diagnosis of morbid obesity in the process of qualification for surgical treatment of obesity. The patients' BMI ranged from 35 to 54 kg/m2. Study participants completed NEO-FFI personality inventory (Costa, McCare; 1998) and the authors' questionnaire designed to collect demographic data and anthropometric measurements. R esults: The study showed that patients with morbid obesity significantly differed from healthy individuals and somatic patients as regards the analysed measurements of the Big Five. C onclusions: The traits which were significantly distinctive in morbidly obese patients included lowered conscientiousness and increased neuroticism. The results indicate that the above pattern of personality traits may promote the development of excessive body weight.

Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy - single center experience.

INTRODUCTION: Nowadays laparoscopic right hemicolectomy is widely accepted as the standard of care for benign and malignant colon disease. There are wide variations among laparoscopic techniques. One of the most discussed topics is the ileocolic anastomosis. There are two different techniques: intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA). AIM: To compare short-term outcomes of performing intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy. MATERIAL AND METHODS: A retrospective chart review was performed of 92 consecutive patients who underwent laparoscopic right hemicolectomy, with either an IA or EA, from January 2013 to December 2016. RESULTS: Eighty-five patients were included in the analysis. There were 53 males and 32 females with a mean age of 67.1 ±13.2 years. Mean body mass index (BMI) was 27.7 ±4.8 kg/m2. An intracorporeal anastomosis was performed in 51 patients, while an extracorporeal anastomosis was performed in 34. The duration of operations was significantly longer when intracorporeal anastomosis was performed, taking 154 ±58 min compared to 95 ±34 min (p < 0.001), in the extracorporeal group. No mortality was observed in the IA group. The postoperative mortality in the EA group was 8.8% (p = 0.060). The rate of reoperation in the intracorporeal anastomosis group was 7.8%, whereas in the extracorporeal anastomosis group it was 14.7% (p = 0.474). Length of hospital stay in the IA group was shorter in comparison to the EA group (5.3 ±3.7 vs. 11.2 ±19.8 days, p = 0.022). CONCLUSIONS: Our results are encouraging to consider the intracorporeal approach as the better way to fashion the anastomosis after laparoscopic right hemicolectomy.

Macroscopic Evaluation of Gastric Specimens After Laparoscopic Sleeve Gastrectomy-an Optimum Screening Test for Incidental Pathologies?

INTRODUCTION: Obesity is a serious lifestyle disease with various comorbidities and an augmented risk of cancer. Laparoscopic sleeve gastrectomy (LSG) has recently become the most popular bariatric procedure worldwide. While the cost-effectiveness is a major healthcare providers' concern, the point of histological exam of each resected tissue may be questioned. MATERIAL/METHODS: We prospectively included patients who underwent LSG. Before the surgery, gastroscopy and abdominal sonography were performed to exclude malignancies. The gastric specimen was cut open after the surgery and inspected macroscopically, then sent for a microscopic examination. RESULTS: In 5 cases out of 115, macroscopic evaluation of the resected specimen performed by the surgeon suggested existing pathology, confirmed by a microscopic evaluation in 3 out of 5 cases. In the remaining 2 cases, pathological analysis did not reveal abnormalities. In 110 cases, the gastric specimen was recognized to be unchanged by the surgeon, 109 out of which were confirmed by the pathologist to be normal, in 1 case a hyperplastic polyp was found. The sensitivity of macroscopic evaluation reached 75% (95% CI, 19.4-99.4%, p = 0.625), with specificity of 98.2% (95% CI, 93.6-99.8%, p < 0.0001), and negative predictive value of 99.1% (95% CI, 95-99.9%, p < 0.0001). CONCLUSIONS: During LSG, a thorough visual inspection of the peritoneal cavity along with a macroscopic surgical evaluation of specimen in patients who had preoperative endoscopy with no findings allows to achieve very good specificity and good sensitivity. Therefore, this procedure may be useful as a screening test for incidental pathologies in bariatric patients and may exclude unnecessary histological examination.