69 research outputs found
Bariatric surgery evolution in Romania. Results during first year after a variety of bariatric procedures
No full textObesity is a worldwide public health problem (both in developed and developing countries), the most frequent nutritional disease in the world, with considerable morbidity-mortality and high costs for the public healthcare systems. Bariatric surgery has been found to be the only method capable of maintaining proper and long-lasting weight loss for morbid obesity. Laparoscopy is the gold standard for bariatric procedures. We studied a group of 341 patients who underwent different types of laparoscopic bariatric surgical procedures: laparoscopic adjustable gastric banding (LAGB), laparoscopic sleeve gastrectomy (LSG), laparoscopic gastric bypass (LGB) and laparoscopic bilio-pancreatic diversion (LBPD). They were evaluated preoperative (weight, BMI, co-morbidities) and followed-up for 1 year: 238 patients LAGB, 46 LSG, 49 LGB and 8 LBPD. Mortality and conversion rate were nil for all groups. A significant reduction in patients' weight was shown at 12 months postoperatively. BMI decreased from 45.6 kg/m 2 to 37.9 for LAGB, from 54.12 to 40.8 kg/m 2 for LGB and from 49.1 to 31.2 kg/m 2 for LSG. The excess weight loss for LBPD was 63%. A significant improvement of co-morbidities was noticed; all patients with type 2 diabetes have normal serum glucose levels at 1 year after surgery. Bariatric surgery is safe with a low complication rate and the outcome was similar to literature data. Although we do not benefit of a long time follow-up, the favorable results allow us to state that minimally invasive surgical techniques deserve an important place in the efforts of struggling against obesity and its consequences
Platelet-rich plasma PRP vs. absorbable mesh as cruroplasty reinforcement: a study on an animal model
No full textBackground: Reinforcement of posterior cruroplasty has been proposed to minimize the failure of hiatal hernia repair (HHR). The applications of autologous platelet-rich plasma (PRP) and absorbable mesh are barely reported in this area. Aims: To analyze local macroscopic and microscopic changes induced by mesh vs. PRP as reinforcement of HHR, using a reliable laparoscopic experimental porcine model. Material and methods: This prospective, comparative pilot study was conducted on 14 female pigs, aged four to six months. An iatrogenic hiatal defect was laparoscopically simulated and repaired, reinforced with Bio-A® mesh (group A) or PRP (group B). Specimen retrieval was performed after seven months for histopathological (HP) examination. Results: No local or general complications were registered, with complete resorption of reinforcements, that determined inflammatory infiltrates with local collagen production and tissue neo-vascularization. Group A had an increased mean chronic inflammation score (p =.3061), showing significant sclerotic collagenizing process. PRP enhanced angiogenesis, collagenizing, myofibroblast recruitment and tissue ingrowth. Conclusions: No residual materials or evidence of anatomical distortion were found. Animal model was safe and reliable. This is the first report of complete absorption of Bio-A® positioned on crural area. HP results suggest the clinical application of PRP in HHR as a promising co-adjuvant to local remodeling and healing. Abbreviations: ASA: American Society of Anesthesiologists; AB: Alcian Blue; PAS: Periodic Acid-Schiff; CP: platelet concentrate; fPC: filtered plasma concentrate; GERD: gastro-esophageal reflux disease; HSA: hiatal surface area; HHR: hiatal hernia repair; HP: histopathological; HH: hiatal hernia; HE: hematoxylin and eosin; HR: hiatus repair alone; HRM: hiatus repair and acellular dermal matrix; NM: Nicolae Manolesccu; LNF: laparoscopic Nissen fundoplication; PC: posterior cruroplasty; PPP: platelet-poor plasma; RP: platelet-rich plasma
Acute complications after laparoscopic bariatric procedures: update for the general surgeon
No full textBACKGROUND:
Development and widespread use of laparoscopic bariatric surgery exposes emergency room physicians and general surgeons to face acute or chronic surgical complications of bariatric surgery.
METHODS:
The most common surgical emergencies after bariatric surgery are examined based on an extensive review of bariatric surgery literature and on the personal experience of the authors' practice in four high-volume bariatric surgery centers.
RESULTS:
An orderly stepwise approach to the bariatric patient with an emergency condition is advisable. Resuscitation should follow the same protocol adopted for the non-bariatric patients. Consultation with the bariatric surgeon should be obtained early, and referral to the bariatric center should be considered whenever possible. The identification of the surgical procedure to which the patient was submitted will orient in the diagnosis of the acute condition. Procedure-specific complication should always be taken into consideration in the differential diagnosis. Acute slippage is the most frequent complication that needs emergency treatment in a laparoscopic gastric banding. Sleeve gastrectomy and gastric bypasses may present with life-threatening suture leaks or suture line bleeding. Gastric greater curvature plication (investigational restrictive procedure) can present early complications related to prolonged postoperative vomiting. Both gastric bypass and bilio-pancreatic diversion may cause anastomotic marginal ulcer, bleeding, or rarely perforation and severe stenosis, while small bowel obstruction due to internal hernia represents a surgical emergency, also caused by trocar site hernia, intussusceptions, adhesions, strictures, kinking, or blood clots. Rapid weight loss after bariatric surgery can cause cholecystitis or choledocholithiasis, which are difficult to treat after bypass procedures
Fluorescence-based sentinel lymph node mapping and lymphography evaluation: results from the IHU-IRCAD-EAES EURO-FIGS registry
No full textBackground: The identification of metastatic lymph nodes is one of the most important prognostic factors in gastrointestinal (GI) cancers. Near-infrared fluorescence (NIRF) imaging has been successfully used in GI tumors to detect the lymphatic pathway and the sentinel lymph node (SLN), facilitating fluorescence image-guided surgery (FIGS) with the purpose to achieve a correct nodal staging. The aim of this study was to analyze the current results of NIRF SLN navigation and lymphography through data collected in the EURO-FIGS registry. Methods: Prospectively collected data regarding patients and ICG-guided lymphadenectomies were analyzed. Additional analyses were performed to identify predictors of metastatic SLN and determinants of fluorescence positivity and nodal metastases outside the boundaries of standard lymphadenectomies. Results: Overall, 188 patients were included by 18 surgeons from 10 different centers. Colorectal cancer was the most reported pathology (77.7%), followed by gastric (19.1%) and esophageal tumors (3.2%). ICG was injected with higher doses (p < 0.001) via extraparietal side (63.3%), and with higher volumes (p < 0.001) via endoluminal side (36.7%). Overall, NIRF SLN navigation was positive in 75.5% of all cases and 95.5% of positive SLNs were retrieved, with a metastatic rate of 14.7%. NIRF identification of lymph nodes outside standard lymphatic stations occurred in 52.1% of all cases, 43.8% of which were positive for metastatic involvement. Positive NIRF SLN identification was an independent predictor of metastasis outside standard lymphatic stations (OR = 4.392, p = 0.029), while BMI independently predicted metastasis in retrieved SLNs (OR = 1.187, p = 0.013). Lower doses of ICG were protective against NIRF identification outside standard of care lymphadenectomy (OR = 0.596, p = 0.006), while higher volumes of ICG were predictive of metastatic involvement outside standard of care lymphadenectomy (OR = 1.597, p = 0.001). Conclusions: SLN mapping helps identifying potentially metastatic lymph nodes outside the boundaries of standard lymphadenectomies. The EURO-FIGS registry is a valuable tool to share and analyze European surgeons’ practices
ENDOSCOPIC ULTRASOUND FINE NEEDLE ASPIRATION (EUS-FNA) OF A PANCREATIC MASS AFTER ROUX-EN-Y GASTRIC RESECTION - A LAPAROSCOPIC ASSISTED TRANS-JEJUNAL APPROACH
No full textEarly Improvement in Glycemic Metabolism after Laparoscopic Sleeve Gastrectomy in Obese Patients -A Prospective Study
No full textRezumat Ameliorarea rapidã a metabolismului glucidic dupã gastrectomia longitudinalã laparoscopicã la pacienåii cu obezitate -studiu prospectiv Introducere: Conform Organizaåiei Mondiale a Sãnãtãåii, existau în 2014 peste 600 de milioane de adulåi cu obezitate (mai mult decât dublu faåã de anul 1980) care prezintã un risc crescut de dezvoltare a sindromului metabolic, deci inclusiv pentru diabetul zaharat de tip 2. Datoritã controlului slab glicemic în urma tratamentului conservator al DZ tip 2, chirurgia metabolicã a fost capabilã sã câaetige un rol important în managementul pacientului cu DZ tip 2 aei obezitate, cu remisii sau îmbunãtãåiri semnificative raportate în literatura de specialitate. Obiectiv: studierea efectelor gastrectomiei longitudinale laparoscopice (LSG) asupra metabolismului glucidic la pacienåii cu obezitate, cu sau fãrã DZ tip 2. Metodã: 60 de pacienåi consecutivi, operaåi în spitalul Ponderas pentru obezitate prin gastrectomie longitudinalã laparoscopicã, au fost incluaei într-un studiu prospectiv, în perioada FebruarieMartie 2013. IMC-ul (indicele de masã corporalã), circumferinåã abdominalã aei parametrii glicemici au fost studiaåi pre-operator, la 10 zile aei 6 luni postoperator. Rezultate: controlul glicemic a fost semnificant îmbunãtãåit începând cu ziua 10 postoperatorie. Imbunãtãåiri semnificative statistic au fost notate la 6 luni postoperator în valorile IMCului (p<0.0001), circumferinåa abdominalã (p<0.0001), glicemie (p<0.0001), insulinemie (p<0.0001), peptid C (p<0.0001) aei HOMA. Concluzii: o îmbunãtãåire rapidã a metabolismului glucidic, atât la pacienåii cu obezitate aei DZ tip 2 cât aei la cei fãrã DZ tip 2, se regãseaete înaintea scãderii ponderale semnificative (10 zile postoperator). La 6 luni postoperator, când se asociazã aei o scãdere ponderalã semnificativã, atât pacienåii diabetici cât aei cei nediabetici prezintã o îmbunãtãåire suplimentarã a metabolismului glicemic, care poate susåine ideea ca gastrectomia longitudinalã laparoscopicã este o metodã eficientã pentru tratamentul pacienåilor cu obezitate aei sindrom metabolic. Aceste modificãri benefice pot explica atât remisia DZ tip 2 dar aei prevenåia acestuia la pacienåii cu obezitate supuaei tratamentului chirurgical metabolic. Cuvinte cheie: obezitate, metabolism glucidic, gastrectomie longitudinalã laparoscopicã, remisia aei prevenåia diabetului zaharat tip 2 Abstract Background: according to W.H.O. in 2014 more than 600 million adults were obese, (more than doubled since 1980), and face a major risk for the onset of metabolic syndrome, including T2DM. Due to the poor control of glycemic imbalance for the conservative treatment of T2DM, the metabolic surgery was able to gain an important role in modern management of T2DM, with significant reported improvements or remissions for these patients. Objective: to study the effects of laparoscopic sleeve gastrec- BMI, waist circumference and glycemic parameters were studied at the moment of entering the study, 10 days after surgery and at 6 months follow up. Results: the glycemic control was significantly improved starting with postoperative day 10. Statistically significant improvements were noticed after six months postoperatively in BMI values (p<0,0001), waist circumference (p<0,0001), glycemic levels (p<0,0001), insulin (p<0,0001), C-peptide (p<0,0001) and HOMA. Conclusions: a rapid induced improvement of glucose metabolism in both diabetic and non-diabetic patients occurs before a significant weight loss (POD 10). At 6 months, when associated with an important weight loss, both diabetic and non-diabetic patients present a furthermore improvement in glycemic metabolism, that enables us to consider that sleeve gastrectomy is an efficient method for a sustained improvement in the metabolic status of patients with obesity. These beneficial changes that can explain the remission of T2DM can also explain the prevention of T2DM after metabolic surgery
Impact of retrograde transillumination while securing the airway in obese patients undergoing bariatric surgery
No full textVideo laryngoscopy (VL) is a well-established technique used in anaesthetising obese patients who present with higher risks of airway-related difficulties and desaturations due to shorter safe apnoea periods. However, VL has certain limitations and may fail. We present the Infrared Red Intubation System (IRRIS), a new technique facilitating glottis identification in severely obese patients undergoing anaesthesia for bariatric surgery. This single-centre, prospective trial assessed the efficacy of the IRRIS for VL tracheal intubation in 20 severely obese adult patients undergoing elective bariatric surgery under general anaesthesia. We assessed the ability of the IRRIS to differentiate the transilluminated glottis from the oesophagus and laryngeal folds and evaluated the ease of intubation. The average weight in the investigated patient cohort was 145 ± 29 kg, the suprasternal tissue thickness was 12 ± 4 mm. The median IQR [range] larynx recognition time was 10 [2–50] s, which was similar to that of lean patients. The degree of obesity correlated with the duration to achieve optimal laryngoscopic view and complete the intubation procedure. We achieved successful VL insertion on the first attempt in 13 of 20 cases (65%), and on the second attempt in 7 cases (35%), emphasising the increased probability of successful intubation on the first attempt. Tracheal intubation with the IRRIS lasted 50 [IQR 20–100] s. The lowest SpO2 during intubation was 98 [IQR 83–100] %. Addition of IRRIS to VL insertion facilitated the intubation of difficult airways in severely obese patients. IRRIS improves the visualization of the intubation pathway by selectively highlighting the airway entrance and shortens the time to successfully conclude the intubation procedure
Development of the International Federation for Surgery of Obesity and Metabolic Disorders-European Chapter (IFSO-EC) Grade-Based Guidelines on the Surgical Treatment of Obesity Using Multimodal Strategies: Design and Methodological Aspects
No full textBackground: The prevalence of obesity is already a worldwide health concern. The development of straightforward guidelines regarding the whole available armamentarium (i.e., medical, endoscopic, and surgical interventions in conjunction with a guidance program) is paramount to offering the best multimodal approach to patients with obesity. Methods: The International Federation for Surgery of Obesity and Metabolic Disorders-European Chapter (IFSO-EC) identified a panel of experts to develop the present guidelines. The panel formulated a series of clinical questions (based on the patient, intervention, comparison, and outcome conceptual framework), which have been voted on and approved. A GRADE methodology will be applied to assess the quality of evidence and formulate recommendations employed to minimize selection and information biases. This approach aims to enhance the reliability and validity of recommendations, promoting greater adherence to the best available evidence. Results: These guidelines are intended for adult patients with a body mass index (BMI) >= 30 kg/m2 who are candidates for metabolic bariatric surgery (MBS). The expert panel responsible for developing these guidelines comprised 25 panelists (92% were bariatric surgeons) and 3 evidence reviewers, with an average age of 50.1 +/- 10.2 years. The panel focused on 3 key questions regarding the combined use of structured lifestyle interventions, approved obesity management medications, and endoscopic weight loss procedures with MBS. Conclusions: The complexity of obesity as a chronic disease requires a comprehensive knowledge of all the available and feasible therapeutic options. The IFSO-EC society felt the urgent need to develop methodologically valid guidelines to give a full picture and awareness of the possible surgical and non-surgical therapeutic strategies employed with a multimodal approach
EAES Recommendations for Recovery Plan in Minimally Invasive Surgery Amid COVID-19 Pandemic
No full textBackground
COVID-19 pandemic presented an unexpected challenge for the surgical community in general and Minimally Invasive Surgery (MIS) specialists in particular. This document aims to summarize recent evidence and experts’ opinion and formulate recommendations to guide the surgical community on how to best organize the recovery plan for surgical activity across different sub-specialities after the COVID-19 pandemic.
Methods
Recommendations were developed through a Delphi process for establishment of expert consensus. Domain topics were formulated and subsequently subdivided into questions pertinent to different surgical specialities following the COVID-19 crisis. Sixty-five experts from 24 countries, representing the entire EAES board, were invited. Fifty clinicians and six engineers accepted the invitation and drafted statements based on specific key questions. Anonymous voting on the statements was performed until consensus was achieved, defined by at least 70% agreement.
Results
A total of 92 consensus statements were formulated with regard to safe resumption of surgery across eight domains, addressing general surgery, upper GI, lower GI, bariatrics, endocrine, HPB, abdominal wall and technology/research. The statements addressed elective and emergency services across all subspecialties with specific attention to the role of MIS during the recovery plan. Eighty-four of the statements were approved during the first round of Delphi voting (91.3%) and another 8 during the following round after substantial modification, resulting in a 100% consensus.
Conclusion
The recommendations formulated by the EAES board establish a framework for resumption of surgery following COVID-19 pandemic with particular focus on the role of MIS across surgical specialities. The statements have the potential for wide application in the clinical setting, education activities and research work across different healthcare systems
- …
