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Gastric sleeve stenosis (GSS) is described in 1%–4% of patients. To evaluate the role of endoscopy in the management of stenosis after laparoscopic sleeve gastrectomy using a standardized approach according to the characteristic of stenosis. Retrospective, observational, single-center study on patients referred from several bariatric surgery departments to an endoscopic referral center. We enrolled 202 patients. All patients underwent endoscopy in a fluoroscopy setting, and a systematic classification of the type, site, and length of the GSS was performed. According to the characteristics of the stenosis, patients underwent pneumatic dilatation or placement of a self-expandable metal stent or a lumen-apposed metal stent. Failure of endoscopic treatment was considered an indication for redo surgery, whereas patients with partial or complete response were followed up for 2 years. In the event of a recurrence, a different endoscopic approach was used. We found inflammatory strictures in 4.5% of patients, pure narrowing in 11%, and functional stenosis in 84.5%. Stenosis was in the upper tract of the stomach in 53 patients, whereas medium and distal stenosis was detected in 138 and 11 patients, respectively, and short stenosis in 194 patients. A total of 126 patients underwent pneumatic dilatation, 8 self-expandable metal stent placement, 64 lumen-apposed metal stent positioning, and 36 combined therapy. The overall rate of endoscopy success was 69%. GSS should be considered to be a chronic disease, and the endoscopic approach seems to be the most successful treatment, with a prolonged positive outcome of 69%. Characteristics of the stenosis should guide the most suitable endoscopic approach. [ABSTRACT FROM AUTHOR]

Endoscopy plays a pivotal role in the management of adverse events (AE) following bariatric surgery. Leaks, fistulae, and post-operative collection after sleeve gastrectomy (SG) may occur in up to 10% of cases. To evaluate the efficacy and safety of endoscopic internal drainage (EID) for the management of leak, fistula, and collection following SG. Retrospective, observational, single center study on patients referred from several bariatric surgery departments to an endoscopic referral center. EID was used as first-line treatment for the management of leaks, fistulae, and collections. Leaks and fistulae were treated with double pigtail stent (DPS) deployment in order to guarantee internal drainage and second intention cavity obliteration. Collections were treated with endoscropic ultrasound (EUS)–guided deployment of DPS or lumen apposing metal stents. A total of 617 patients (83.3% female; mean age, 43.1 yr) were enrolled in the study for leak (n = 300, 48.6%), fistula (n = 285, 46.2%), and collection (n = 32, 5.2%). Median follow-up was 19.5 months. Overall clinical success was 84.7% whereas 15.3% of cases required revisional surgery after EID failure. Clinical success according to type of AE was 89.5%, 78.5%, and 90% for leak, fistula, and collection, respectively. A total of 10 of 547 (1.8%) presented a recurrence during follow-up. A total of 28 (4.5%) AE related to the endoscopic treatment occurred. At univariate logistic regression predictors of failure were: fistula (OR 2.012), combined endoscopic approach (OR 2.319), need for emergency surgery (OR 1.755), and previous endoscopic treatment (OR 4.818). Early EID for the management of leak, fistula, and post-operative collection after SG seems a safe and effective first-line approach with good long-term results. - Endoscopy has become the treatment of choice for the mini-invasive management of most complications after sleeve gastrectomy - Endoscopic Internal Drainage is a safe and effective approach for the management of leaks, fistula and post-operative collections in stable patients. - Fistula, concomitant strictures, previous emergency surgery and previous endoscopic treatment are independent risk factors for treatment failure. [ABSTRACT FROM AUTHOR]

Background Few data on bariatric surgery are available regarding obese human immunodeficiency virus (HIV)-infected patients. Settings Antoine Beclere hospital, Clamart, Paris-sud University, France Methods Prospective observational follow-up study recruited HIV-infected patients who underwent bariatric surgery from 2009 to 2015. Baseline demographic characteristics, surgery characteristics, perioperative outcomes, changes in weight loss, HIV markers, antiretroviral drug plasma levels are described. Results There were 10 patients followed before and after sleeve gastrectomy: 2 men and 8 women; 50% of African origin; median age, 48.5 years, median time since HIV infection, 7.5 years; median body mass index, 48.5 kg/m 2 . Of patients, 8 had co-morbidities. All except 2 patients received antiretroviral drugs at the time of surgery with a median CD4 cell count at 709/mm 3 . There was no death or postoperative infectious complications. The median follow-up was 18 months (range, 15–55). The median postoperative weight loss was 43 kg (range, 17–83). Median percentage of excess weight loss was 82.5% (range, 35–119) at the latest visit after surgery. All co-morbidities were resolutive with weight loss. We observed no significant modification of CD4 cell count before and after surgery. Pharmacokinetics of antiretroviral drugs remains adequate and efficacious. Conclusion Our prospective series is the largest one on sleeve gastrectomy procedures performed on obese-treated HIV-infected patients. The sleeve generates good results in weight loss, with no significant impact on HIV infection, and with improvement of obesity-associated co-morbidities. Optimal management of HIV-infected patients with morbid obesity may include classical surgical procedures. [ABSTRACT FROM AUTHOR]

Background Laparoscopic sleeve gastrectomy, which has become a primary bariatric procedure in super-obese patients (SOPs), is associated with considerable weight loss. Traditionally, laparoscopic sleeve gastrectomy requires 4–7 skin incisions. Single-port laparoscopic surgery is now feasible for bariatric surgery. Objectives To evaluate the feasibility and safety of single-port sleeve gastrectomy (SPSG) for SOPs. Setting Department of Abdominal and Minimally Invasive Surgery, Antoine Beclere Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, France. Methods Evaluation of the outcomes on patients who underwent surgery consecutively from June 2010 to June 2013 with follow-up of>1 year. Results In total, 62 patients (46 women, 16 men) underwent SPSG. The median age was 41 years (range 19–67), median preoperative body mass index was 52.2 kg/m 2 (range 50–87), median operative time was 89 minutes (range 42–212). Twelve patients required additional trocars, and 4.8 % developed complications. The median postoperative stay was 4 days (range 3–9 days) and median follow-up period was 21 months (range 12–48 months) with no loss of follow-up. The median percentage of excess weight loss was 69.7% (range 52%–100%) and percentage of weight loss was 36% (28%–56%) for the same period. Conclusion SPSG for SOPs was found to be technically feasible, reproducible, and safe in this series. [ABSTRACT FROM AUTHOR]

Background Dietary and lifestyle modifications, which are commonly proposed to overweight or obese youth, lack efficacy in individuals who are severely obese. Early results with bariatric procedures in obese adolescents suggest that weight loss and safety are comparable or better than seen in adults. One of these procedures, laparoscopic sleeve gastrectomy, is commonly performed using multiple ports. Methods We selected single-port sleeve gastrectomy (SPSG) as a minimally invasive surgery to be tested in severely obese adolescents. Prospective clinical and biochemical data were collected from 16 young severely obese patients who underwent SPSG. The setting was a university hospital. Results The mean age of the cohort was 17.8 years (12 girls, 4 boys). The individuals’ average weight was 125.5 kg and their average body mass index was 45.3 kg/m 2 . All patients were insulin-resistant and 6 showed hypertriglyceridemia. The median operating time was 66 minutes, and there were no intraoperative complications. No conversion to open surgery was required. No patient required additional trocars and no patient had postoperative complications. The median hospital stay was 3 days. After a one-year follow-up, the average weight decrease was 40.3 kg, resulting in a decrease in excess weight loss by 70.61%. Insulin-resistance decreased in 16/16 patients and hypertriglyceridemia decreased in 5/6 patients. Conclusion SPSG seems safe and effective in the short term in severely obese adolescents. [ABSTRACT FROM AUTHOR]

Abstract: Background: Single-port surgery has been developed for many digestive procedures, such as cholecystectomy and colectomy. Our objective was to present our preliminary results for laparoscopic single-port sleeve gastrectomy (SPSG), performed in our department for the treatment of morbid obesity, at Antoine Beclere Hospital and Paris XI University. Methods: From July 2010 to February 2011, all patients evaluated by our multidisciplinary team for morbid obesity and eligible for sleeve gastrectomy underwent SPSG. The data were collected prospectively. Results: Sixty consecutive patients underwent SPSG. The median age was 40.1 years; 6 patients were men and 48 were white. The median body mass index was 46.5 kg/m2. The co-morbidities included diabetes in 12, essential hypertension in 31, sleep apnea in 39, dyslipidemia in 33, and coronary artery disease in 9. Of the 60 patients, 9 had previously undergone laparotomy and 5 had undergone bariatric surgery. The median operating time was 86 minutes. All procedures were achieved laparoscopically, with 10 patients requiring a second trocar and 3 patients 2 additional trocars. No conversion to open surgery was required. One leak was reported, and 1 patient experienced cubital nerve compression. The median hospital stay was 4 days. During a median follow-up of 8 months, most preoperative co-morbidities resolved, and the Bariatric Analysis and Reporting Outcome System score for care efficacy was 6.8 of 9. Conclusion: SPSG is feasible in routine bariatric surgery. The results for weight loss and co-morbidity resolution seem to be equivalent to those with “multiple port” laparoscopy. New instruments and specific training are required. We believe that this technique is a natural evolution of minimally invasive surgery requiring additional investigation in prospective studies. [Copyright &y& Elsevier]