1,721,016 research outputs found
Dietary change associated with bariatric surgery. The winning approach. An Invited Commentary on “Impact of sleeve gastrectomy and dietary change on metabolic and hepatic function in an obesity rat model - experimental research”
No full textSimultaneous Small/Medium Umbilical Hernia Repair with Laparoscopic Sleeve Gastrectomy (LSG): Results of a Retrospective Case-matched Study
No full textPurpose: Periumbilical hernias are a common finding in morbidly obese patients undergoing bariatric surgery; however, the timing of repair is still debated. The aim of this paper is to compare the outcomes of simultaneous versus delayed mesh repair of umbilical hernia in patients undergoing laparoscopic sleeve gastrectomy (LSG). Methods: We retrospectively compared 2 groups of morbidly obese patients with small/medium periumbilical hernia (up to 4 cm) in a casematched study: the first group underwent LSG with simultaneous periumbilical hernia repair; in the second, hernioplasty was performed after weight loss induced by LSG. Patients were matched at a 1:1 ratio according to age, comorbidities, defect size (<2 or ≥2 cm), and obesity grade (<40 or ≥40 kg/m2). Demographic, clinical information, hernia size, data from the surgery, and its complications were retrieved and analyzed. Results: In total, 40 patients were retrieved from our prospectively maintained database and divided into 2 matched groups of 20 subjects each. Baseline characteristics were comparable. After a median time of 19.8±5.6 months, the recurrence rate was not significantly different in the 2 groups. There was no difference in the rate of single complications, but overall morbidity was significantly higher in patients undergoing a 2-step approach. LSG operation time and hospital stay resulted in comparable, but total hospital stay was longer for those readmitted for delayed hernioplasty. Conclusions: In the case of morbidly obese patients with small/ medium periumbilical hernia undergoing LSG, a simultaneous approach should be offered. Our proposed technique did not prolong operative time and showed a lower rate of overall morbidity
Learning curve and global benchmark values of laparoscopic sleeve gastrectomy: results of first 100 cases of a newly trained surgeon in an Italian center of excellence
Full text linkTo evaluate whether the learning curve for sleeve gastrectomy could be completed after 50 cases. First 100 patients undergoing LSG under a newly trained laparoscopic surgeon were included in this study and divided into two groups of 50 consecutive patients each. Perioperative outcomes were compared to recently introduced global benchmarks. Short-term weight loss was calculated as Total Weight Loss Percent (%TWL) and complications were classified in accordance with the Clavien–Dindo classification. CUSUM analysis was performed for operative time and hospital stay. Mean preoperative age and BMI were 41.8 ± 10.3 years and 42.9 ± 5.4 kg/m2, respectively. Demographics and rate of patients with previous surgery were comparable preoperatively in the two groups. Mean operative time was 92.1 ± 19.3 min and hospital stay was 3.4 ± 0.6 days as per our standard protocol of discharge. Uneventful postoperative course was recorded in 93% of patients and only one case of staple line leak was registered in the first 50 cases (group 1). No statistical difference in BMI and %TWL was found between the two groups at any time of follow-up. Comparison between two groups showed a significant reduction in hospital stay and operative time after the first 50 LSGs (p < 0.05). LSG can be performed by newly trained surgeons proctored by senior tutors. At least 50 cases are needed to meet global benchmark cut-offs and few more cases may be required to reach the plateau of the learning curve
Ten-Year Results of Laparoscopic Sleeve Gastrectomy: Retrospective Matched Comparison with Laparoscopic Adjustable Gastric Banding—Is There a Significant Difference in Long Term?
Full text linkBackground: The laparoscopic sleeve gastrectomy (LSG) is the most common bariatric procedure performed worldwide while the laparoscopic adjustable gastric banding (LAGB) has been almost abandoned. Aim of this study was to retrospectively assess 10-year outcomes of LSG through a matched comparison with LAGB. Materials and Methods: Retrospective search of prospectively maintained database of our university was carried out to find all patients that underwent LSG before December 2010. Each subject with LSG was matched one-to-one with a patient that had undergone LAGB in the same period with correspondent preoperative age, BMI, and sex. Results: A total of 76 patients underwent LSG before 2010 and were all included in this study; a matched group of 76 out of 178 LAGB patients with 10-year follow-up was retrieved from our database. Comparison between the two groups showed better outcomes after LSG at 1 and 5 years but weight loss was comparable with the LAGB group at 10 years (%TWL 22.2 ± 13 vs 21.2 ± 16.1; p = 0.89). No significant difference was found in conversion/removal rate (15.8% vs 18.4%; p = 0.67). Conclusion: LSG is an effective stand-alone bariatric procedure with better outcomes than LAGB in medium term, but results are comparable at 10 years. Subjects undergoing LSG should be informed that conversion to RYGB or OAGB may be necessary to achieve further weight loss or to treat reflux. Graphical abstract: [Figure not available: see fulltext.
Roux-en-Y Gastric Bypass and Heller Myotomy: One-Step Surgical Treatment of Symptomatic Achalasia in a Morbid Obese Patient
Full text linkComment on “Wernicke-Korsakoff syndrome despite no alcohol abuse: A summary of systematic reports” – A matter of bariatric patients' management
No full textImpact of COVID-19 Lockdown on Short-term Weight Loss in a Single Italian Institution
Full text linkItaly was the first European country to have a major outbreak of COVID-19. Bariatric procedures were stopped and telemedicine had to be implemented. A large percentage of patients struggled to follow postoperative diet and to start physical activity due to social restrictions. We have compared short-term outcomes of patients who had bariatric procedures prior to lockdown with subjects that had undergone obesity surgery in the same period of the previous year at our institution. A total number of 63 patients were included in this study. Weight loss at 1, 3 and 6 postoperative months in the 2019 group was significantly higher at any point of follow-up when compared to 2020. Social limitations and nonattendance of clinical appointments may have compromised early results. Graphical Abstract: [Figure not available: see fulltext.]
Comment on: Expected Values of Esophageal Transit and Gastric Emptying Scintigraphy Post-Uncomplicated Sleeve Gastrectomy
Full text linkFlap fixation in preventing seroma formation after mastectomy: an updated meta-analysis
Full text linkSeroma formation following mastectomy is one of the most experienced complications, with a very variable incidence ranging from 3 to 90%. In recent years, many publications have been realized to define an effective technique to prevent its formation and several approaches have been proposed. Given the potential of flap fixation in reducing seroma formation, we performed a meta-analysis of the literature to investigate the role of this approach as definitive gold standard in mastectomy surgery. Inclusion criteria regarded all studies reporting on breast cancer patients undergoing mastectomy with or without axillary lymph node dissection; studies that compared mastectomy with flap fixation to mastectomy without flap fixation were selected. Papers were eligible for inclusion if outcome was described in terms of seroma formation. As secondary outcome, also surgical site infection (SSI) was evaluated. The included studies were 12, involving 1887 female patients: 221/986 (22.41%) patients experienced seroma formation after flap fixation and 393/901 (43.61%) patients had this complication not receiving flap fixation, with a significant statistical difference between the two groups (OR = 0.267, p = 0.001, 95% CI 0.153, 0.464). About, SSI 59/686 (8.6%) in flap fixation group and 67/686 (9.7%) in patients without flap fixation, with no statistical differences between groups (OR = 0.59, p = 0.056, 95% CI 0.344, 1.013). The heterogeneity between included studies does not allow us to reach definitive conclusions but only to suggest the strong evaluation of this approach after mastectomy in seroma preventing and SSI reduction
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