Volvulus 8 years after bariatric surgery.

INTRODUCTION: Bariatric surgery is a widespread branch of surgery because of the increase in obesity in population. It is one way to achieve long-term weight loss effect in obese patients. Like other surgeries, bariatric surgery has many complications including ileus and volvulus in small intestine. It is an acute state in surgery and usually leads to a revision surgery. CASE REPORT: 58 years old woman who underwent mini-gastric bypass in 2014. She was admitted to our department because of manifestation of ileus on the second day after TEP of the hip joint. There was a typical sign of volvulus on the CT scan. She was operated on the same day. The reinsertion of enteroenteroanastomosis and denotation of the small intestine, desufflation of the large intestine, and reconstruction of new enteroenteroanastomosis was needed. After the surgery, the patient was without any complications. The bowel function recovery was slower postoperatively. CONCLUSION: Diagnosis of volvulus is not easy because of non-specific clinical symptoms. In this case report, the volvulus occurred 8 years after the primary surgery. Symptoms developed because of paralytic ileus after hip replacement.

Current bariatric-metabolic surgery.

Obesity is a well-known phenomenon of recent times in adult and pediatric population, as well. It has been proved, that numerous comorbidities are in a different way connected with obesity. Conservative treatment of obesity is the domain of obesitologists, diabetologists, nutritionists and psychologists, as well. Great part of the conservative treatment of obesity lies on the experts on physical activities. Surgical treatment is dedicated to the patients with severe obesity. It is targeted not only at the weight reduction, but also, or at first, at the impact on comorbidities. There are standard procedures defined and they represent substantial part of performed procedures. Novel surgical and endoscopic procedures are introduced into the practice. There are many of them. So far neither of these procedures achieve comparable effectivity and durability with standard procedures in a long-time horizon. The aim of this paper is to present standard surgical procedures, to mention novel ones, surgical and endoscopic, as well. The procedures are presented with respect to the pediatric population too.

Ten years of laparoscopic sleeve gastrectomy at the Military University Hospital in Prague.

INTRODUCTION: The aim of this study was to evaluate a group of bariatric patients operated at the Military University Hospital in Prague during the last 10 years (20112020), in whom laparoscopic sleeve gastrectomy was performed. METHODS: Retrospective survey of the internal operation database. The search used the following combination of keywords: “sleeve“, “LSG“ and the diagnosis “E6*“. A total of 279 operated patients were enrolled. We evaluated the sex, age at the time of surgery, complications, need for drainage, weight, BMI, presence of type two diabetes mellitus and any effect of the surgery on its improvement, length of hospital stay, follow-up duration and % excess weight loss. RESULTS: A total of 279 patients, including 195 women and 84 men, underwent laparoscopic sleeve gastrectomy in the period of 10 years. The mean age was 44.46 years. The average operating time was 111 minutes. The mean BMI of the patients before surgery was 42.24 and the weight was 123.4 kg. The mean BMI one year after the surgery corresponded to a decrease of approximately 10 and the mean weight of 93.8 kg. Rather severe acute postoperative complications occurred in 2.87% patients. An improvement or complete cure of type two diabetes mellitus was observed in 57.8% patients. CONCLUSION: Currently, laparoscopic sleeve gastrectomy is the most common bariatric operation at the Military University Hospital in Prague. This study demonstrates a satisfactory effect of bariatric surgery in terms of long-term significant weight loss and an improvement or even cure of associated diseases such as type two diabetes mellitus, arterial hypertension and others.

Bariatry - surgical therapy of the severe obesity.

When conservative therapy of the morbid obesity repeatedly fails bariatric surgery begins. Adults patients from 18 to 60 age with obesity 3rd grade (BMI > 40 kg/m2 ), respectively 2nd grade (BMI > 35 kg/m2 ), with symptomatic diseases caused by obesity as type 2 diabetes, hypertension, dyslipidaemia or heavy failure of the joints, in which conservative therapy failed, are indicate for bariatric surgery. Nearly all of the bariatric procedures are providing by laparoscopy at present. Contemporary bariatric surgery is using restrictive or malabsorptive or combination of both operating methods. Adjustable gastric banding and vertical gastric plication are pure restrictive bariatric method. The most popular restrictive method with partial hormonal effect is sleeve gastrectomy at present. Biliopancreatic diversion is considered to be a pure malabsorptive bariatric method. Majority of the bariatric surgeons consider gastric bypasses as malabsorptive restrictive method.

SADIS Single anastomosis duodeno-ileal bypass with sleeve gastrectomy as a second step after sleeve gastrectomy.

INTRODUCTION: Sleeve gastrectomy (SG) is the most popular bariatric method at present. In case of unsatisfactory effect of the SG, i.e. in case of insufficient weight loss, improving or threatening diabetes or metabolic syndrome or regain of weight, bariatry offers a second possible step. One of the possible methods is biliopancreatic diversion type SADIS (BPD/SADIS). METHOD: Between the years 2009 and 2017, 327 morbidly obese patients underwent laparoscopic sleeve gastrectomy at our surgical department. Between mid-2011 to the end of 2017, 37 (11.3 %) patients after SG with unsatisfactory effect on diabetes or on metabolic syndrome or in case of weight regain in 23.7 (1548) months after the SG underwent the second step - BPD/SADIS. The weight loss, change of the BMI and level of the HbA1c were evaluated during two years after procedure. RESULTS: 31 (83.7 %) patients were evaluated, the others were rejected due to an incomplete follow-up (FU) or a short time elapsed since the procedure. Two years after the SADIS, the average %EBMIL was 47.1 (41.552.7) %, average %EWL was 73.9 (65.183.7) %, average final BMI was 29.4 (24.6-38.2) kg/m2, which means average decrease of the BMI was 9.3 (2.914.1) kg/m2. Average level of the HbA1c was 37.9 (2842) mmol/mol, type 2 diabetes was cured in 20 (64.5 %) cases. CONCLUSION: Biliopancreatic diversion type SADIS offers a satisfactory weight loss effect as well as an improvement of the metabolic syndrome in morbidly obese patients after SG with unsatisfactory result. In comparison with the classic BPD/DS, SADIS is a technically easier method with lesser incidence of complications along with acceptable rate of malnutrition.