Outcomes of same-day discharge in bariatric surgery.

BACKGROUND: Restrictions during the COVID-19 pandemic influenced a shift to same-day discharge in bariatric surgery. Current studies show conflicting findings regarding morbidity and mortality. We aim to compare outcomes for same-day discharge versus admission after bariatric surgery. METHODS: Subjects included patients who underwent primary laparoscopic or robotic-assisted sleeve gastrectomy or Roux-En-Y gastric bypass at an academic center. The inpatient group included patients discharged postoperative day one, and the outpatient group included patients discharged on the day of surgery. Primary outcomes included the number of emergency room visits, reoperations, IV fluid treatments, readmissions, and mortality within 30 days. Secondary outcomes were morbidity, including skin and soft tissue infection, pulmonary embolism, and acute kidney injury. RESULTS: 1225 patients met the inclusion criteria. In the gastric sleeve group, 852 subjects were outpatients and 227 inpatients. In the gastric bypass group, 70 subjects were outpatients, and 40 were inpatients. The mean age was 44.63 (17.38-85.31) years, and the mean preoperative BMI was 46.07 ± 8.14 kg/m2. The subjects in the outpatient group had lower BMI with fewer comorbidities. The groups differed significantly in age, BMI, and presence of several chronic comorbidities. The inpatient and outpatient groups for each surgery type did not differ significantly regarding reoperations, IV fluid treatments, or 30-day mortality. The inpatient sleeve group demonstrated a significantly higher readmission percentage than the outpatient group (4.6% vs 2.1%; p = 0.02882). The inpatient bypass group showed significantly greater ER visits (21.7% vs 10%; p = 0.0108). The incidence of adverse events regarding the secondary outcomes was not statistically different. CONCLUSION: Same-day discharge after bariatric surgery is a safe and reasonable option for patients with few comorbidities.

Hiatal reconstruction is safe and effective for control of reflux after laparoscopic sleeve gastrectomy.

BACKGROUND: Gastroesophageal reflux is a known complication following laparoscopic sleeve gastrectomy (LSG) as anatomical changes predispose to reduced lower esophageal sphincter pressure and development of hiatus hernia. The mainstay of surgical management has been Roux-en-Y gastric bypass (RYGB) which is not without risk. Hiatus hernia repair (HHR) with surgical reattachment of the oesophagus to the crura, recreating the phreno-esophageal ligament is a simple procedure specifically targeting a number of anatomical changes responsible for reflux in this population. METHODS: We conducted a single centre retrospective analysis of adult patients with post-sleeve reflux refractory to medical treatment, managed with either HHR, RYGB or One-anastomosis Duodenal switch (OADS). PPI use and symptoms of reflux were assessed at early and mid-term time points via validated questionnaires. RESULTS: 99 patients were included, of these the surgical procedure was HHR alone in 58, RYGB in 29 and OADS in 12. At early follow-up control of reflux symptoms was achieved in 72.4% after HHR, 82.1% after RYGB and 100% after OADS with no significant difference between groups (p = 0.09). At mid-term followup (median 10 months IQR 7-21) there was no significant difference in the presence of symptomatic reflux as determined by post-op Visick score nor a difference in PPI use. The GerdQ score was significantly lower after OADS as compared to HHR and RYGB (4.6 ± 2.3 vs 7.7 ± 2.2 vs 8.7 ± 3.5, p = 0.006). CONCLUSION: HHR with reconstruction of the phreno-esophageal ligament is a safe and effective procedure for patients with reflux after LSG, that avoids more complex operations such as RYGB and OADS and their associated long-term sequelae.

Endoscopic trans-oral outlet reduction after bariatric surgery is safe and effective for dumping syndrome.

BACKGROUND: Dumping syndrome (DS) is a common complication of bariatric surgery. Treatments include dietary and behavioral changes, as well as pharmacotherapy and revision surgery. All can be costly or hard to adhere to. In recent years, evidence accumulates in favor of endoscopic trans-oral outlet reduction (TORe) as an effective treatment for DS, targeting the pathophysiology of rapid gastric clearance. The objective of this study is to assess the safety and efficacy of TORe for DS in a single referral center. METHODS: Patients after bariatric surgery suffering DS were followed, and data were retrospectively analyzed. Diagnosis and post-procedural assessment of DS were made clinically using Sigstad score. During the procedure, the anastomotic rim was cauterized. Afterwards, 2 non-interrupted "8-figure" sutures were placed, resulting in imbrication of additional gastric tissue on top of the anastomosis and narrowing to <1 cm at the end of the procedure. Patients were instructed to keep a liquid diet for 14 days and follow-up continued for 6 months. RESULTS: Between 8/2018 and 9/2019 TORe was carried out in 13 patients (M:F = 3:10) with mean age of 45.1 (range 25-56) and BMI of 33.5 (range 28.1-40.3). Average time since recent surgery was 5.5 years (range 1-9). Mean pre-procedure anastomosis diameter was 25.2 mm (range 15-30) and was reduced to a mean of 5.6 mm (range 5-10). Three patients (23%) were admitted overnight due to inability to drink which resolved spontaneously. No major complications were reported. At 6 months, the Sigstad score was significantly reduced (19.4 ± 3.6 vs 5.2 ± 5.5, P < 0.001), and 11/13 (85%) of patients had a complete resolution of their dumping symptoms. In addition, BMI decreased by a mean of 2.3 kg/m2 (-1 to 7.5, p = 0.002). CONCLUSION: TORe is a safe and effective treatment for patients suffering dumping syndrome and should be considered early in the treatment of DS.

Higher Edmonton Obesity Staging System scores are associated with complications following laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: The Edmonton Obesity Staging System (EOSS) is a staging system describing comorbidities and functional limitations associated with obesity, thus facilitating the prioritization of patients for bariatric surgery. Our objective was to elucidate any associations of EOSS scores with major complications after laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS: A retrospective chart review examined patients who received primary LRYGB from 2009 to 2015 at a single center. Collected data included patient comorbidities, preoperative EOSS stage, body mass index (BMI), age, percent excess weight loss, and 1-year major complications. Major complications were defined by a Clavien-Dindo classification ≥ IIIa. RESULTS: 378 patients (81.7% female) receiving primary LRYGB were reviewed with the following EOSS stages: 0 (3.7%), 1 (10.8%), 2 (78.6%), 3 (6.9%), and 4 (0.0%). The mean preoperative BMI was 45.9 (SD 6.3) kg/m2. The overall major complication rate was 9.3%. Major complication rates for EOSS stages 0, 1, 2, and 3 were 7.1%, 4.9%, 8.8%, and 23.1%, respectively. Follow-up rates at 12 months were 76.6% with a mean overall follow-up of 10.9 (2.1) months. Multivariable analysis showed that patients undergoing LRYGB with an EOSS of 3 were more likely to experience major complications (OR 2.94; CI 1.04 to 8.35, p = 0.043). CONCLUSION: Our findings suggest that undergoing LRYGB with EOSS stage 3 has increased odds of major complications. As such, the EOSS demonstrates utility in identifying bariatric surgery candidates at risk of major postoperative morbidity. Further studies are required to assess the applicability of the EOSS for patients undergoing other forms of bariatric surgery.

Refractory Hyperinsulinemic Hypoglycemia as a Complication of Roux-en-Y Gastric Bypass Surgery.

This case involves a 45-year-old woman with severe obesity who underwent Roux-en-Y gastric bypass (RYGB) surgery. After one year, she developed daily episodes of severe hypoglycemia, presenting with symptoms of palpitations, diaphoresis, and syncope. The patient was diagnosed with endogenous hyperinsulinemic hypoglycemia, a condition characterized by abnormally high insulin levels leading to low blood glucose, commonly associated with insulinoma. In rare instances, this can be due to nesidioblastosis, an overgrowth of pancreatic beta cells, which is more prevalent in individuals who have undergone bariatric surgery. Diagnostic evaluations included blood tests, abdominal computed tomography and magnetic resonance imaging, continuous glucose monitoring, and hepatic venous sampling to exclude insulinoma. This report details the diagnosis and unsuccessful treatment of endogenous hyperinsulinemic hypoglycemia following RYGB surgery. Interventions included dietary modifications (small, frequent, low-carbohydrate meals), medical management with acarbose 100 mg three times daily, diazoxide 150 mg three times daily, verapamil 40 mg twice daily, and surgical reversal of the RYGB. Ultimately, a percutaneous gastrostomy tube was placed for 24-hour continuous parenteral feeding. Despite these extensive treatment efforts, the patient continues to experience frequent hypoglycemic episodes four years after the bariatric procedure.

Laparoscopic Removal of a Non-Adjustable Gastric Band and Conversion to a Gastric Sleeve: A Case Report.

Obesity has long been recognized as a global epidemic. One of the most effective treatments is bariatric surgery. Since the first modern procedure was reported, it has evolved over time, and multiple techniques have emerged. More than 20 years ago, one of the most widely used techniques was the non-adjustable gastric band (NAGB), which showed very promising short-term results. However, over time, it became apparent that it was not as effective in the long term. Associated gastrointestinal symptoms, such as reflux and constant vomiting, along with considerable weight regain, caused this technique to fall out of favor and be replaced by other procedures like the gastric sleeve (GS). Although the technique has fallen into disuse and is no longer recommended in the literature, there are still patients with associated complications. Few recent cases associated with these complications have been reported. Most undergo band removal, and whether to perform another procedure remains with limited evidence. We present the case of a patient who underwent an NAGB procedure 10 years ago and later experienced symptoms (reflux) and weight regain. She successfully underwent band removal and conversion to a GS at our institute in Mexico.

Intussusception and Gut Dysmotility: A Systematic Review Assessing Unexpected Complications of Bariatric Surgery.

Bariatric surgery, although effective in treating obesity-related comorbidities, rarely results in intussusception, which is a severe complication. This study aimed to enhance clinical practice and establish early diagnosis by elucidating risk factors and management strategies associated with intussusception. We conducted this systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 criteria. We looked through PubMed, PubMed Central, ScienceDirect, ScienceOpen, MyScienceWork, Hyper Articles en Ligne (HAL), Google Scholar, and the Medical Literature Analysis and Retrieval System Online for relevant studies and research. Articles were screened according to inclusion and exclusion criteria, and relevance. We employed pertinent quality appraisal instruments to look for bias. Initially, we discovered 2,833 items. We eliminated redundant and unnecessary publications. After reviewing all the articles, we selected 30 studies based on their titles and abstracts. Out of the 30 studies reviewed, 12 papers were included in this review, with the remaining 18 being eliminated due to low quality. Medical practitioners and surgeons have a responsibility to meticulously monitor and provide postoperative surveillance, with a particular emphasis placed on individuals exhibiting symptoms of abdominal pain and vomiting, as there is a clinical imperative to consider the possibility of intussusception. The management approach, whether conservative or surgical, remains contingent upon the clinical context.

Anterior Abdominal Wall Necrotizing Fasciitis Following Laparoscopic Sleeve Gastrectomy With Hiatal Hernia Repair: A Case Report.

Necrotizing fasciitis (NF), commonly known as necrotizing soft tissue infection (NSTI), or flesh-eating disease is a rare but rapidly fatal aggressive bacterial infection of soft tissue and deep skin that results in the destruction of the underlying fascia. Symptoms include fever, tachycardia, hypotension, leukocytosis, pain, and large areas of red and swollen skin. Early diagnosis and aggressive management are compulsory for a better prognosis. In this case report, we present a 58-year-old obese woman who initially presented to the emergency department three weeks post-sleeve gastrectomy with hernia repair and was initially suspected of having a large, uncomplicated abdominal wall abscess. Several repeated drainages of the abdominal wall abscess and continued deterioration of the patient revealed foul-smelling, necrotic tissue and the subsequent diagnosis of NF. This case report highlights the importance of high clinical suspicion for NF and early, aggressive debridement and treatment to improve patient outcomes.

Endoluminal Vacuum Therapy as a Salvage Procedure for Difficult Anastomotic Leak Post Roux-en-Y Gastric Bypass.

We present a case of a woman in her 60s, with a history of a gastric sleeve resection, over 50% excess body weight loss, and subsequent severe gastroesophageal reflux disease refractory to maximal medical therapy, who underwent a conversion of a sleeve gastrectomy to a Roux-en-Y gastric bypass with hiatal hernia repair. On postoperative day five, she was evaluated at our emergency department for vomiting and inability to tolerate oral intake. Imaging revealed a large retrocardiac hiatal hernia and extraluminal contrast extravasation. She was taken to the operating room after resuscitation, where the gastric pouch and roux limb were found to have significant edema with recurrence of the hernia. This was able to be reduced and a frank perforation was found at the posterior aspect of the anastomosis. A covered metal stent was placed by the gastroenterologist and drains were left in place.  In the ICU, nasojejunal feeds were stopped given suspicion of backflow with persistent leak. A decision was made to remove the stent and place an endoluminal vacuum (endoscopic vacuum-assisted wound closure [EVAC]). After three subsequent vacuum-sponge changes, the perforation was found to have healed. Patient was tolerating a diet on discharge. This case is an example of a complication where a multidisciplinary approach to a difficult leak resulted in recovery with the use of EVAC. We believe this is a valuable tool to have in our armamentarium for difficult-to-manage leaks.

Patients with a History of Bariatric Surgery Are 8 Years Younger at Presentation with Severe Alcoholic Hepatitis.

PURPOSE: Patients with prior bariatric surgery (BS) are at risk to develop alcohol use disorder (AUD) and alcohol-related liver disease (ALD). Severe alcoholic hepatitis (sAH) is one of the most severe manifestations of ALD with a 28-day mortality of 20-50%. The impact of prior BS on patients presenting with sAH was assessed. METHODS: From 01/2008 to 04/2021, consecutive patients admitted to a tertiary referral center with biopsy-proven sAH were included in a database. RESULTS: One hundred fifty-eight sAH patients of which 28 patients had a history of BS (BS group) were identified. Of this BS group, 24 patients underwent a Roux-en-Y gastric bypass (RYGB), 3 a biliopancreatic diversion, 1 an adjustable gastric band, and no patients a sleeve gastrectomy. The proportion of patients with BS increased threefold over time during the study period. Patients in the BS group were significantly younger at diagnosis of sAH (44.3 years vs 52.4 years), were more frequently female, and had a higher body mass index and a higher grade of steatosis on liver biopsy. The correlation between BS and a younger age at diagnosis remained significant in a multivariate regression analysis. There were no differences in disease severity between both groups. Furthermore, there were no differences in corticosteroid response, 28-day, 90-day, or 1-year survival. CONCLUSION: Prior BS is independently associated with a younger age of presentation with sAH, but is not independently associated with a different disease severity or outcome. These findings support the need for early detection of AUD in patients who underwent BS, in particular RYGB.

Postoperative Stomach Volvulus and Pancreatitis Following a Sleeve Gastrectomy.

The laparoscopic sleeve gastrectomy is the most common bariatric surgery performed to promote weight loss and improve obesity-related comorbidities. As the number of patients undergoing sleeve gastrectomy increases, so does the prevalence of complications. It is crucial to recognize both common and unusual complications of sleeve gastrectomy to properly diagnose and manage them. We present a unique case of gastric outlet obstruction not visualized on initial imaging and acute pancreatitis following a sleeve gastrectomy. We recommend performing an endoscopy and ordering serum lipase levels in a patient with negative CT scans but persistent postoperative nausea, vomiting, and abdominal pain. The management of postoperative gastric outlet obstruction includes supportive care, balloon dilation of the stenotic area, or gastric bypass if symptoms persist.

Uncommon Complication of a Biliary Leak After Adjustable Gastric Band Removal: A Case Report.

In the context of adjustable gastric band (AGB) placements and the prevalent issue of weight regain with associated complications, revision surgery for gastric bands becomes imperative. Such revisions may encompass band removal or conversion to bariatric procedures, often accompanied by an escalated risk profile, potentially contributing to a 20% morbidity rate. Laparoscopic sleeve gastrectomy (LSG) has gained prominence due to its technical simplicity, effectiveness in weight loss, and lower complication rates. Specific cases involving LSG post-AGB complications are associated with staple line disruptions and leaks. This case report describes a rare complication in a 59-year-old patient following AGB removal and subsequent laparoscopic sleeve gastrectomy. The complication emerged six hours after the surgery, with approximately 400 cc of bile material reported in the drainage. A laparoscopic reintervention was conducted, revealing bile leakage from the second Couinaud hepatic segment. Successful management of the leakage was achieved through simple hepatic suturing using non-absorbable monofilament. Within 24 hours, no further leakage occurred, and the patient was discharged without additional complications. Our case also demonstrates how complex it can be to switch between different medical procedures, and it emphasizes the need for careful planning and precise surgery in the evolving world of bariatric medicine. It is worth noting that there is a dearth of literature addressing this specific complication. Consequently, this study has the potential to provide valuable insights for surgeons who may encounter a similar scenario in their clinical practice.

Small Bowel Obstruction Secondary to Laparoscopic Adjustable Gastric Band Connecting Tube Intertwinement Within the Mesentery: A Case Report.

Laparoscopic adjustable gastric banding (LAGB) is a technique used for the surgical management of morbid obesity. This report illustrates the case of a 46-year-old African American woman who presented with a rare case of small bowel obstruction (SBO) two years post-LAGB placement. SBO, in this case, was a result of LAGB connecting tube intertwinement within the mesentery, accompanied by adhesions. The patient was diagnosed clinically and radiologically by computed tomography (CT) scan, which showed high-grade SBO. Initially, an exploratory laparoscopy was conducted, which soon transformed into an exploratory laparotomy when the cause of obstruction was seen to be the intertwinement of the connecting tube of the gastric band with the mesentery. With the rise of bariatric procedures to combat the epidemic of obesity in American society, this rare complication secondary to one of the most widely performed procedures beckons the attention of bariatric surgeons, emergency personnel, and device manufacturers.

The Prevalence of Hearing Symptoms Associated With Patulous Eustachian Tube Dysfunction Following Bariatric Surgery at King Khalid University Hospital, Saudi Arabia.

Background A patulous Eustachian tube (PET) is defined as a persistent tubal opening, which affects 0.3-6.6% of the population, with a female preponderance. PET is caused by the loss of subcutaneous adipose tissue enclosing the cartilaginous portion of the Eustachian tube (Ostmann's pad) as a result of acute, rapid, and substantial loss of weight which occurs during bariatric surgery. The most common complaint of PET is autophony, in which patients hear their own voices or breaths, with additional symptoms including crackling sounds, tinnitus, and aural congestion. In this study, we aimed to determine the prevalence of symptoms associated with PET dysfunction subsequent to bariatric surgery at King Khalid University Hospital (KKUH). Methodology A cross-sectional study was conducted at KKUH, Saudi Arabia. The presence of symptoms consistent with the diagnosis of PET dysfunction was assessed through in-person and telephonic interviews of bariatric surgery patients using a standardized questionnaire. Results A total of 450 patients were evaluated. The preoperative body mass index (BMI) of evaluated patients ranged from 28 to 117 kg/m2 (mean = 46.07 kg/m2), with no significant difference between symptomatic and asymptomatic groups (p = 0.303). The postoperative BMI ranged from 16 to 100 kg/m2 (mean = 29.37 kg/m2), with no significant difference between symptomatic and asymptomatic groups (p = 0.263). Hypertension was the most prevalent comorbid condition (12.2%), followed by diabetes (9.3%). In total, 91 (20.22%) patients exhibited symptoms (aural fullness and autophony) compatible with patent auditory tube dysfunction. Conclusions Overall, 20.22% of the bariatric surgery patients in our study sample displayed symptoms consistent with patulous auditory tubal dysfunction. The preoperative and postoperative BMI of symptomatic and asymptomatic patients did not differ significantly. To improve patient outcomes and satisfaction following bariatric surgery hearing symptoms associated with PET need to be included in postoperative follow-ups after bariatric surgery.

Successful Pregnancy in a Woman of Advanced Maternal Age at Sixteen Months Post-Roux-en-Y Gastric Bypass Revision.

Obesity, defined as body mass index (BMI) > 30 kg/m2, complicates maternal and neonatal outcomes. Bariatric surgery (BS) is an option for weight reduction in several populations, including reproductive-aged women. However, there is a lack of consensus regarding the ideal time interval between BS and pregnancy. We report the case of a 43-year-old Hispanic female who underwent an initial Roux-en-Y gastric bypass (RYGB) in 2011, followed by a revision eight years later in 2019. The revision entailed the reduction of the gastric pouch size and the excision of the remnant stomach. It occurred sixteen months before the conception of her second pregnancy. Despite advanced maternal age and nutritional challenges following BS, this patient delivered a healthy male neonate and maintained a net weight loss compared to her preoperative weight. Factors leading to this positive outcome included the patient's adherence to dietary recommendations following the procedure and using weight loss adjuncts (phentermine and topiramate) to promote post-procedure weight loss. Sixteen months between RYGB revision and conception can lead to positive pregnancy outcomes, even in women of advanced maternal age and multiple prior BS. Further studies are required to understand better the optimal interval to reduce maternal and neonatal complications following RYGB specifically and the use of medications as weight loss adjuncts.

Midgut Volvulus Evolving From Internal Herniation Following Roux-en-Y Gastric Bypass Surgery.

In the literature, midgut volvulus is a well-known surgical complication following gastric bypass surgery that is serious and necessitates an immediate intervention. Here, we report a case of internal herniation that was misdiagnosed twice but eventually managed appropriately. A 27-year-old male with a surgical history of Roux-en-Y gastric bypass came to the emergency department complaining of severe epigastric abdominal pain. Two months earlier, he had a similar pain which was treated with Helicobacter pylori eradication therapy. Despite completing the eradication therapy, the pain reoccurred. Computed tomography angiography showed a filling defect in the superior mesenteric artery that was followed by a diagnostic laparoscopy ending with internal hernia reduction. Physicians should consider internal herniation as a differential diagnosis for every patient with a history of gastric bypass surgery presenting with abdominal pain.

Post-laparoscopic sleeve gastrectomy with splenic abscess: Case report.

INTRODUCTION AND IMPORTANCE: One of the complications of laparoscopic sleeve gastrectomy (LSG) is a splenic abscess, considered a rare complication. As it is rare, it is a challenge to diagnose. CASE PRESENTATION: In this case, a 62-year-old male patient who underwent LSG returned after three weeks with abdominal pain and fever. CLINICAL DISCUSSION: leak, Infection, spleen infarction These seemed like common complications, such as leaking from the stapler line, but the CT findings indicated a splenic abscess. The primary explanation for such an abscess is unclear in our case as the other reported cases were with the hypothesis of the late leak. A different treatment approach, laparoscopic exploration with incision and drainage, is the preferred option for this patient. CONCLUSION: rare complications can be a challenge and how to manage them can be different from the standard to help the patient.

Prevalence of Symptomatic Gallbladder Disease After Bariatric Surgery: A Literature Review.

Introduction Gallbladder disease (GBD) encompasses several medical conditions, including gallbladder stone formation, biliary colic, and cholecystitis. These conditions may arise following bariatric surgery, including bypass or laparoscopic sleeve gastrectomy (LSG). The development of GBD after surgery may be attributed to various factors, including the formation of stones shortly after the procedure, the exacerbation of existing stones due to the surgery, or inflammation of the gallbladder. Rapid weight loss after surgery has also been proposed as a contributing factor. Methodology This observational study consisted of a review of retrospective hospital patient medical records of 350 adult participants who underwent LSG, with 177 participants included in the study after excluding those with cholecystectomy or GBD prior to surgery. The participants were followed for a median of two years, during which we recorded any hospitalizations, emergency department visits, clinic visits, and incidents of cholecystectomy or abdominal pain due to GBD. The participants were grouped into two: those with GBD and those without GBD after bariatric surgery, and quantitative data were summarized using mean and standard deviations. The data were analyzed using IBM SPSS Statistics for Windows, Version 20.0. (IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp), with a statistical significance of P<0.05. Results In our retrospective study of 177 patients who underwent LSG, the incidence of GBD after bariatric surgery was 4.5%. Most patients with GBD after bariatric surgery were White, but this difference was not statistically significant. Patients with type 2 diabetes had a higher incidence of GBD after bariatric surgery than those without diabetes (8.3% vs. 3.6%, P=0.355). Patients with HTN had a lower incidence of GBD after bariatric surgery than those without HTN (1.1% vs. 8.2%, P=0.032). Anti-hyperglycemia medication use did not significantly increase the risk of GBD after bariatric surgery (7.5% vs. 3.8%, P=0.389). None of the patients on weight loss medication developed GBD after bariatric surgery, compared to 5% of patients who did not take weight loss medication. Our sub-data analysis showed that patients who developed GBD after bariatric surgery had a high BMI (above 40 kg/m2) before surgery, which decreased to 35 kg/m2 and below 30 kg/m2 at six months and 12 months post-surgery, respectively. Conclusions Our findings demonstrate that the prevalence of GBD after LSG is low and comparable to the general population without LSG. Thus, LSG does not increase the risk of GBD. We found that rapid weight loss after LSG is a significant risk factor for GBD. These findings suggest that patients who undergo LSG should be informed of the risks of GBD and undergo careful screening before surgery to detect any pre-existing gallbladder issues. Overall, our study highlights the importance of continued research into the factors associated with GBD after bariatric surgery and the need for standardized prophylactic measures to prevent this potentially serious complication.

Wandering Spleen After Sleeve Gastrectomy as a Cause of Sigmoid Volvulus.

The report highlights a rare instance of colonic volvulus due to a wandering spleen. Wandering spleen is characterized by the displacement of the spleen due to absent or weakened ligaments due to congenital factors or acquired factors such as pregnancy or prior surgery leading to ligament disruption. The 26-year-old patient presented with severe abdominal pain and distention, leading to a diagnosis of sigmoid volvulus secondary to the wandering spleen. This case underscores the importance of considering the wandering spleen in the differential diagnosis of acute abdomen, especially in patients with a surgical history of gastric sleeve resection. The article emphasizes the critical role of imaging in diagnosis and the necessity of timely surgical intervention to prevent severe complications. The case contributes to a broader understanding of the wandering spleen, particularly in post-surgical contexts, highlighting diagnostic challenges and management strategies.

Perforated Duodenal Ulcer Post-Roux-en-Y Gastric Bypass: A Case Report.

Obesity is a growing health concern worldwide, with bariatric surgeries such as gastric bypass providing an effective treatment choice. However, a rare complication of gastric bypass is a duodenal ulcer. Currently, there is no exact incidence of this complication, and only a few case reports have been published in the literature. Presented is a case of a 32-year-old patient, eight years status post gastric bypass, who was evaluated for surgical repair of a large anterior perforated duodenal ulcer. This case report explores the relationship between patient history and gastric bypass surgery in the case of duodenal ulcer formation and perforation, as well as the diagnostic difficulty and modalities for duodenal ulcers in post-gastric bypass patients.