Computed tomography as primary postoperative follow-up after laparoscopic Roux-en-Y gastric bypass

Opportunistic Quantitative Computed Tomography Assessing Bone Mineral Density in Patients With Laparoscopic Roux-En-Y-Gastric Bypass Metabolic Surgery Throughout a 5-Year Observation Window

BACKGROUND

Bariatric surgery is associated with decreasing bone mineral density (BMD).

OBJECTIVE

To assess the long-term vertebral BMD, measured by opportunistic quantitative CT (QCT), and body mass index (BMI) in patients undergoing proximal laparoscopic Roux-en-Y surgery (LRYGB).

METHODS

In 62 patients undergoing LRYGB, opportunistic QCT measurements were performed extracting BMD and BMI on day 1 and years 1, 3, and 5 postoperatively.Primarily, one-way analyses of variance were performed on dependent variables BMI and BMD, with imaging interval defined as an independent factor. Student-Newman-Keuls tests performed pairwise comparisons of imaging interval permutations for BMI/BMD.Secondarily, analyses of covariance were used on dependent variables BMI and BMD, with imaging interval as an independent factor and gender/age as well as BMD/BMI, respectively, as covariates.

RESULTS

A total of 227 opportunistic QCT measurements in 62 patients were performed without the need of a phantom or extra software.The BMD decreased substantially and continuously during 1-, 3-, and 5-year follow-up observations, reaching statistical significance in pairwise comparisons for 3- and 5-year follow-up visits compared to initial BMD values as well as the 5-year follow-up visit compared to the 1-year BMD values, P  < 0.001. Age and BMI were significant covariates, P  < 0.001.The BMI decreased within 1 year and stayed constant until a slight increase at 5 years was observed. Statistical significance in pairwise comparisons for first-year and 3- and 5-year follow-up visits was reached compared to initial BMI values, P  < 0.001. For the BMI assessment, none of the covariates reached statistical significance.

CONCLUSION

Opportunistic QCT is suited for the calculation and follow-up of BMD. There was a continuous decrease of BMD after LRYGB over 5 years post-surgery, whereas BMI decreased in the first year and stayed constant thereafter. Older patients with lower BMI seem particularly prone to an accelerated BMD loss.

Excess visceral fat area as an independent risk factor for early postoperative complications in patients with obesity undergoing bariatric surgery

BACKGROUND

Few studies have investigated the correlation between visceral fat area (VFA) and early postoperative complications in patients with obesity undergoing bariatric surgery. This study aimed to investigate the relationship between VFA and early postoperative complications in patients with obesity following bariatric surgery.

METHODS

The study was conducted at a tertiary university hospital. Patients with obesity who underwent laparoscopic sleeve gastrectomy between June 2016 and October 2020 were divided into two groups based on umbilical level VFA: high-VFA group (umbilical level VFA ≥ 100 cm²) and low-VFA group (umbilical level VFA < 100 cm²). Baseline characteristics, intraoperative and postoperative conditions, and early postoperative complications were compared between the groups. The primary outcome was early postoperative complications, and the secondary outcome was postoperative hospital stay.

RESULTS

The study included 152 patients, with 82 patients in the low-VFA group and 70 patients in the high-VFA group. The high-VFA group had a higher incidence of early postoperative complications (14.29% vs. 2.44%, P = 0.013) than the low-VFA group. The length of postoperative hospital stay did not differ significantly between the groups.

CONCLUSIONS

Our study suggests that excess VFA is an independent risk factor for early postoperative complications following bariatric surgery, and VFA may be used in preoperative evaluations.

The Relationship Between Tachycardia After Laparoscopic Sleeve Gastrectomy and the Development of Postoperative Complications

BACKGROUND

Bariatric surgery can be associated with severe complications. Tachycardia is an important indicator of certain complications, such as anastomotic leak and hemorrhage. Our aim was to examine the relationship between tachycardia following sleeve gastrectomy and the appearance of associated complications.

METHODS

Patients who underwent sleeve gastrectomy over a 2-year period were included in the study. Participants were divided into two groups: the first included patients who suffered from postoperative tachycardia and the second patients with normal postoperative heart rates. Complications in both groups were examined. Other parameters that predict the onset of complications were also reviewed.

RESULTS

A total of 457 patients were included. Postoperative tachycardia was measured in 181 (39.6%) patients; 17 (3.7%) suffered from bleeding and 4 (1%) from staple line leakage. Postoperative bleeding was more common among patients with tachycardia than among those without (14 (7.7%) vs. 3 (1.1%), respectively). Patients in the tachycardia group had more staple line leakages than those in the normal heart rate group (3 (2%) vs. 1 (0%), respectively); tachycardia was also attributed to postoperative pain or other minor complications in 160 (88%) patients. Age ≥ 40 years was found to be predictive factor for postoperative complications.

CONCLUSIONS

The most common causes of tachycardia postoperatively were pain and minor complications. Tachycardia is an essential indicator of postoperative minor and major complications, mainly staple line leakage and bleeding. This should prompt immediate medical intervention in order to avoid serious adverse events.

A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks

BACKGROUND

Bariatric surgery leaks result in significant morbidity and mortality. Experts report variable therapeutic approaches, without uniform guidelines or consensus.

OBJECTIVE

To review the pathogenesis, risk factors, prevention, and treatment of gastric sleeve leaks, with a focus on endoscopic approaches. In addition, the efficacy and success rates of different treatment modalities are assessed.

DESIGN

A comprehensive review was conducted using a thorough literature search of 5 online electronic databases (PubMed, PubMed Central, Cochrane, EMBASE, and Web of Science) from the time of their inception through March 2020. Studies evaluating gastric sleeve leaks were included. MeSH terms related to "endoscopic," "leak," "sleeve," "gastrectomy," "anastomotic," and "bariatric" were applied to a highly sensitive search strategy. The main outcomes were epidemiology, pathophysiology, diagnosis, treatment, and outcomes.

RESULTS

Literature search yielded 2418 studies of which 438 were incorporated into the review. Shock and peritonitis necessitate early surgical intervention for leaks. Endoscopic therapies in acute and early leaks involve modalities with a focus on one of: (i) defect closure, (ii) wall diversion, or (iii) wall exclusion. Surgical revision is required if endoscopic therapies fail to control leaks after 6 months. Chronic leaks require one or more endoscopic, radiologic, or surgical approaches for fluid collection drainage to facilitate adequate healing. Success rates depend on provider and center expertise.

CONCLUSION

Endoscopic management of leaks post sleeve gastrectomy is a minimally invasive and effective alternative to surgery. Their effect may vary based on clinical presentation, timing or leak morphology, and should be tailored to the appropriate endoscopic modality of treatment.

Imaging after laparoscopic sleeve gastrectomy - literature review with practical recommendations

In the XXI century obesity has become one of the most demanding epidemiological threats worldwide. At the same time, bariatric surgery has established itself as an effective treatment for morbidly obese patients, with laparoscopic sleeve gastrectomy (LSG) emerging as the most popular bariatric procedure. This paper reviews the role of imaging studies of patients after LSG. Computed tomography is widely considered as the method of choice in detection of complications in early postoperative period. The dynamic character of upper gastrointestinal examination allows for the assessment of passage through the gastric remnant. The paper also discusses evaluation of the shape and volume of the gastric remnant assessed by imaging studies.