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An important challenge for large carnivore conservation is negative human-wildlife interaction. Livestock depredation by carnivores is one important aspect of this negative interaction. Hence, it is critical to understand the extent of livestock depredation by large carnivores through their diet profiles and feeding habits for managing and strategizing conservation measures. We investigated the food habits and dietary patterns of two large sympatric carnivores, the Tiger Panthera tigris and the Leopard Panthera pardus based on scat samples collected in wildlife corridors outside protected areas (PAs) in the Indo-Nepal transboundary and Corbett landscape in Uttarakhand, India. The frequency of occurrence of prey items in the scat samples was used to estimate the relative prey biomass and number of preys consumed by the Tigers and Leopards using a generalised biomass model. Scat analysis revealed the presence of mainly wild prey species, encompassing 12 species in tiger scat and 14 species in Leopard scat. The results show that Tigers and Leopards primarily depend on medium-sized prey, with relative prey biomass consumption of 53% and 60%, respectively. Tigers preyed most frequently on Wild Boar Sus scrofa, followed by Spotted Deer Axis axis, and Leopards preyed mostly on Spotted Deer, followed by Wild Boar. The relative biomass of livestock species in Tiger and Leopard diets is 14.2% and 15.7%, respectively. Dietary overlap between Tiger and Leopard was high, with the Leopard exhibiting a broader dietary niche breadth than the Tiger. Augmenting wild prey population through habitat improvement and protection outside PAs can significantly limit human-large carnivore conflict by decreasing livestock contribution in their diet. Studies on dietary habits need to expand to wildlife corridors and outside PAs in human-dominated landscapes to understand the ecological dynamics of human-wildlife negative interaction for future conservation strategies. [ABSTRACT FROM AUTHOR]

Background: The prevalence of overweight and obesity and an unhealthy diet and lifestyle are the key causes of rising diabetes burden in India. Bariatric surgery is gaining popularity in India as a favored approach to manage obesity and its accompanying comorbidities. Despite this, there is a scarcity of Indian studies evaluating dietary intake. Our goal was to analyse the dietary intake of Indian patients with type 2 diabetes mellitus (T2DM) who have undergone laparoscopic sleeve gastrectomy (LSG) or duodeno-jejunal bypass with sleeve gastrectomy (DJB-SG) or surgeries., Methods: The longitudinal observational study included 64 T2DM patients (32 in each procedure) enrolled through purposive sampling. The patients underwent surgery (LSG or DJB-SG procedure) between January 2017 and July 2019. Dietary data was collected at baseline and postsurgery (12 months) using a 24-h dietary recall method for 2 days (one working and one holiday)., Results: The total sample consisted of 27 (42.2%) females and 37 (57.8%) males. The mean age was 46.8 years. At 12 months, the follow-up for the LSG and DJB-SG procedures was 100% and 78%, respectively. In the short term, a significant reduction was seen in weight, body mass index and haemoglobin A1C (HbA1C) in both surgical groups. The two procedures were comparable with respect to weight loss but improvement in glycaemia was higher in the DJB-SG group. The dietary intake (food groups and nutrients) was similar in the two surgical groups at baseline and 12 months postsurgery. Dietary intake assessment showed significant reduction in calorie dense foods (cereals, roots and tubers, fats and oils, table sugar, and biscuits) in both surgical groups. Among nutrients, intake of energy, fats, carbohydrates, dietary fibre, thiamine, riboflavin, niacin, folate and iron were reduced significantly in both procedures. Vitamin D (84.4% patients in LSG group and 81.3% patients in DJB-SG) and iron (62.5% patients in LSG group and 68.8% patients in DJB-SG) were commonly prevalent nutritional deficiencies at baseline and were significantly reduced at 12 months., Conclusions: In the short term, bariatric surgery resulted in weight loss and improvement in glycaemia. Bariatric surgery does significantly affect dietary intake leading to nutritional deficiencies. Therefore, patients should be recommended vitamin and mineral supplements and regular patient education and counselling by a trained bariatric dietitian to prevent nutritional deficiencies and maintain nutritional status., (© 2024 British Dietetic Association.)

Bariatric surgery is recommended for patients with unhealthy weight. Our study aim to compare and rank different bariatric surgical approaches in reducing weight parameters. We searched MEDLINE, Cochrane CENTRAL, Scopus, and Web of Science databases from inception to September 2023. We extracted all outcomes as mean change from the baseline. The mean difference and 95% confidence interval were used as a summary measure. All analysis was conducted with R version 4.2.2 (2022-10-31) and R Studio version 2022.07.2 (2009-2022) (RStudio, Inc.). Included surgeries were: Biliopancreatic diversion (BPD-RYGB), Roux-en-Y Gastric Bypass (RYGB), Laparoscopic Gastric Plication (LGP), Duodenal-Jejunal Bypass Sleeve (DJBS), Single-anastomosis gastric bypass (SAGB), Laparoscopic vertical banded gastroplasty (LVBG), Sleeve Gastrectomy (SG), Laparoscopic adjustable gastric banding (LAGB), Gastric plication, Biliopancreatic diversion (BPD), and Intra-gastric balloon (IGB). Only clinical trials were included, with outcomes focused on weight parameters such as reductions in BMI (kg/m²), weight (kg), waist circumference (cm), fat mass (kg), and excess weight loss (EWL) (%). Our analysis of 67 studies showed that SADI-S was the best surgical technique in decreasing BMI (kg/m2) (MD = -18.06; 95% CI [-25.31; -10.81]) and DS follows in efficacy with a P-score (MD = -18.88; 95% CI [-31.15; -6.62]) however the pooled analysis was heterogeneous (I 2  = 98.5%). For weight (kg), waist circumference (cm), and fat mass (kg), BPD-RYGB was the best surgical technique to reduce these parameters (MD = -41.48; 95% CI [-47.80, -35.51], MD = -29.08; 95% CI [-37.16, -21.00], and MD = -31.11; 95% CI [-38.77, -23.46]; respectively). The pooled analysis was heterogeneous except in fat mass (I 2  = 0%, p-value = 0.8). Our network meta-analysis showed that the best surgical technique in increasing EWL (%) was RY-DS (MD = -61.27; % CI [-91.72; -30.82]) the next one in efficacy according to P-score was LVBG (MD = -59.03; % CI [-84.47; -33.59]). SADI-S is most effective in reducing BMI followed by RYGB. DS was associated with most estimated weight loss %., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

This study aims to compare different types of metabolic bariatric surgery (MBS) with lifestyle intervention/medical therapy (LSI/MT) for the treatment of overweight/obesity. The present and network meta-analysis (NMA) includes randomized trials. MBS was associated with a reduction of BMI, body weight, and percent weight loss, when compared to LSI/MT, and also with a significant reduction of HbA1c and a higher remission of diabetes. Meta-regression analyses revealed that BMI, a higher proportion of women, and a longer duration of trial were associated with greater effects of MBS. The NMA showed that all surgical procedures included (except greater curvature plication) were associated with a reduction of BMI. MBS is an effective option for the treatment of obesity. The choice of BMI thresholds for eligibility for surgery of patients with different complications should be performed making an evaluation of risks and benefits in each BMI category. [ABSTRACT FROM AUTHOR]

Aim: To compare different types of metabolic surgery with non‐surgical therapy for the treatment of type 2 diabetes (T2D). Methods: The present network meta‐analysis (NMA) includes randomized clinical trials (duration ≥ 52 weeks) comparing different surgery techniques with non‐surgical therapy in diabetes patients. The primary endpoints were endpoint HbA1c, body mass index (BMI) and diabetes remission. The secondary endpoints included fasting plasma glucose, lipid profile, blood pressure, arterial hypertension and dyslipidaemia remission, quality of life and surgical adverse events. Indirect comparisons of different types of surgery were performed by NMA. Mean and 95% confidence intervals for continuous variables, and the Mantel–Haenzel odds ratio for categorial variables, were calculated. Results: The types of surgical procedure included laparoscopic adjustable gastric banding, Roux‐en‐Y gastric bypass (RYGB), sleeve gastrectomy (SG), bilio‐pancreatic diversion (BPD), greater curvature plication (GCP), one‐anastomosis gastric bypass (OAGB) and Duodeno–Jejunal bypass. Thirty‐six trials were included. Metabolic bariatric surgery (MBS) was associated with a significantly higher reduction of HbA1c, diabetes remission and BMI compared with medical therapy. In the NMA, a significant reduction of HbA1c was observed with OAGB and SG. Complete diabetes remission significantly increased with all surgical procedures in comparison with non‐surgical therapy, except for GCP. In addition, only BPD, RYGB and OAGB were associated with a significant reduction of BMI. Conclusions: MBS is an effective option for the treatment of T2D in patients with obesity. Further long‐term trials of appropriate quality are needed for assessing the risk–benefit ratio in some patient cohorts, such as those with a BMI of less than 35 kg/m2 and aged older than 65 years. [ABSTRACT FROM AUTHOR]

Purpose: Loop duodenojejunal bypass with sleeve gastrectomy (LDJBSG) is effective for weight loss and resolution of obesity-related associated medical problems. However, a description of the reoperative surgery following LDJBSG is lacking., Material and Methods: In this retrospective study, we analyzed the surgical complications and reoperation (conversion or revision) following LDJBSG from 2011 to 2019 in a single institution., Results: A total of 337 patients underwent LDJBSG during this period. Reoperative surgery (RS) was required in 10LDJBSG patients (3%). The mean age and BMI before RS were 47 ± 9 years and 28.9 ± 3.6 kg/m 2 , respectively. The mean interval between primary surgery and RS for early (n = 5) and late (n = 5)complications was 8 ± 11 days and 32 ± 15.8 months, respectively. The conversion procedures were Roux-en-Y gastric bypass(n = 5), followed by Roux-en-Y duodenojejunal bypass (n = 2) and one-anastomosis gastric bypass (n = 1); other revision procedures were seromyotomy (n = 1) and re-laparoscopy (n = 1). Perioperative complications were observed in four patients after conversion surgery such as multiorgan failure (n = 1), re-laparoscopy (n = 1), marginal ulcer (n = 1), GERD (n = 1), and dumping syndrome (n = 1)., Conclusion: LDJBSG has low reoperative rates and conversion RYGB could effectively treat the early and late complications of LDJBSG. Because of its technical demands and risk of perioperative complications, conversion surgery should be reserved for a selected group of patients and performed by an experienced metabolic bariatric surgical team., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Concomitant surgeries have been performed previously in several centers with experience in laparoscopic surgeries. These surgeries are performed in one patient under one operation with anesthesia. Methods: We performed a retrospective unicenter study from October 2021 to December 2021 analyzing patients who underwent laparoscopic hiatal hernia repair with cholecystectomy. We extracted data from 20 patients who underwent hiatal hernia repair together with cholecystectomy. Grouping of data by hiatal hernia type showed 6 type IV hernias (complex hernia), 13 type III hernias (mixed type) and 1 type I hernia (sliding hernia). Out of the 20 cases analyzed, 19 were patients suffering from chronic cholecystitis and 1 patient presented with acute cholecystitis. The average operating time was 179 min. Minimum blood loss was achieved. Cruroraphy was performed in all cases, mesh reinforcement was added in five cases, and fundoplication was performed in all cases, with 3 Toupet, 2 Dor and 15 floppy Nissen fundoplication procedures performed. Fundopexy was routinely performed in cases of Toupet fundoplication. A total of 1 bipolar and 19 retrograde cholecystectomies were performed. Results: All patients had favorable postoperative hospitalization. Patient follow-up took place at 1 month, 3 months and 6 months, with no sign of recurrence of hiatal hernia (anatomical or symptomatic) and no symptoms of postcholecystectomy syndrome. In two patients, we had to perform colostomy. Conclusion: Concomitant laparoscopic hiatal hernia repair and cholecystectomy is safe and feasible. [ABSTRACT FROM AUTHOR]

Background: Ventral hernia repair (VHR) for obese patients is often associated with an increased risk of postoperative complications and hernia recurrences. Achieving preoperative weight loss is ideal before VHR; however, it is difficult to attain with medical treatment. Metabolic and bariatric surgery (MBS) offers the most effective and durable treatment for obesity. Therefore, massive weight loss occurring after MBS will improve the outcome of VHR. Case presentation: A 49-year-old man (122.9 kg, BMI 39.1 kg/m2) presented to our hospital wishing to undergo laparoscopic sleeve gastrectomy and VHR. Physical examination revealed a tennis ball-sized lower midline defect. Computed tomography (CT) scans revealed a hernia orifice 5 cm in width and 10 cm in height. As the hernia orifice was large, mesh reinforcement was essential. We planned for him to undergo VHR after massive weight loss was achieved by MBS. VHR was performed using the enhanced-view totally extraperitoneal (eTEP) technique after weight loss of 38 kg was achieved 9 months following laparoscopic sleeve gastrectomy. His postoperative course was uneventful, and neither recurrence nor seroma was observed at 1 year follow-up. Conclusions: eTEP repair of a ventral hernia after massive weight loss following MBS would appear to be the best combination treatment for obese patients with ventral hernias. However, long-term follow-up is necessary to establish its safety and efficacy. [ABSTRACT FROM AUTHOR]

With the rise in obesity and bariatric procedures worldwide, there has been a surge in new and innovative procedures that has been increasingly offered to patients. In this position statement, IFSO highlights the importance of surgical ethics in innovation and when offering new procedures. Furthermore, the task force reviewed the current literature to describe which procedures can be offered as mainstream outside research protocols versus those that are still investigational and need further data. [ABSTRACT FROM AUTHOR]

Background: Bariatric surgery is more effective in the management of morbid obesity and related comorbidities than is conservative therapy. Pylorus-preserving single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-SG) is a modified duodenal switch technique. Gastric plication (GP) is an alternate to SG. Methods: Morbidly obese (BMI of > 40, or > 35 in the presence of diabetes or prediabetes) patients were recruited and operated on to perform SADI with GP. Complications related to surgery were recorded to assess the feasibility of the procedure. Weight-loss outcomes were analysed to determine efficacy. Minnesota Multiphasic Personality Inventory 2 (MMPI-2) was recorded after 1 year of follow-up, and test scales were used to describe physiological phenomena. Results: Seventeen middle-aged (mean: 40 years) patients were involved in our study; 15 of them were females. The mean duration of surgery was 205 min. There were no complications of conversion, death, bleeding, VTE or 30-day readmission to hospital. We did experience CD4a (pulmonary insufficiency due to chronic lung disease) and a CD3b (anastomosis leakage treated laparoscopically) complications. Vomiting occurred in three cases (CD1). Obesity-related comorbidities showed favourable resolution rates (77.8% for hypertension, 81.2% for dyslipidaemia, 100% for diabetes at the 1-year follow-up). Weight-loss outcomes were favourable (53.20 EWL%, and 35.58 TWL% at 1-year follow-up). Greater weight loss caused significantly higher levels of Depression (t(13.958) = − 2.373; p = 0.00; p < 0.05) and Low Positive Emotions (t(13.301) = − 2.954; p = 0.00; p < 0.05) and Introversion/Low Positive Emotionality (t(13.408) = − 1.914; p = 0.02; p < 0.05) in MMPI-2 data. Conclusion: According to our safety study, SADI-GP is a promising malabsorptive procedure, but a long-term high-volume case series or a randomised controlled trial is necessary to evaluate complication rates and weight-loss outcomes. Emotional dysregulation is common among bariatric surgery patients according to personality inventory data; therefore, psychological follow-up and psychotherapeutic support are necessary for weight-loss maintenance. [ABSTRACT FROM AUTHOR]

Background: The European Association for Endoscopic Surgery Bariatric Guidelines Group identified a gap in bariatric surgery recommendations with a structured, contextualized consideration of multiple bariatric interventions. Objective: To provide evidence-informed, transparent and trustworthy recommendations on the use of sleeve gastrectomy, Roux-en-Y gastric bypass, adjustable gastric banding, gastric plication, biliopancreatic diversion with duodenal switch, one anastomosis gastric bypass, and single anastomosis duodeno-ileal bypass with sleeve gastrectomy in patients with severe obesity and metabolic diseases. Only laparoscopic procedures in adults were considered. Methods: A European interdisciplinary panel including general surgeons, obesity physicians, anesthetists, a psychologist and a patient representative informed outcome importance and minimal important differences. We conducted a systematic review and frequentist fixed and random-effects network meta-analysis of randomized-controlled trials (RCTs) using the graph theory approach for each outcome. We calculated the odds ratio or the (standardized) mean differences with 95% confidence intervals for binary and continuous outcomes, respectively. We assessed the certainty of evidence using the CINeMA and GRADE methodologies. We considered the risk/benefit outcomes within a GRADE evidence to decision framework to arrive at recommendations, which were validated through an anonymous Delphi process of the panel. Results: We identified 43 records reporting on 24 RCTs. Most network information surrounded sleeve gastrectomy and Roux-en-Y gastric bypass. Under consideration of the certainty of the evidence and evidence to decision parameters, we suggest sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass over adjustable gastric banding, biliopancreatic diversion with duodenal switch and gastric plication for the management of severe obesity and associated metabolic diseases. One anastomosis gastric bypass and single anastomosis duodeno-ileal bypass with sleeve gastrectomy are suggested as alternatives, although evidence on benefits and harms, and specific selection criteria is limited compared to sleeve gastrectomy and Roux-en-Y gastric bypass. The guideline, with recommendations, evidence summaries and decision aids in user friendly formats can also be accessed in MAGICapp: https://app.magicapp.org/#/guideline/Lpv2kE Conclusions: This rapid guideline provides evidence-informed, pertinent recommendations on the use of bariatric and metabolic surgery for the management of severe obesity and metabolic diseases. The guideline replaces relevant recommendations published in the EAES Bariatric Guidelines 2020. [ABSTRACT FROM AUTHOR]

Purpose: Based on recent scientific evidence, bariatric surgery is more effective in the management of morbid obesity and related comorbidities than conservative therapy. Pylorus preserving surgical procedures (PPBS) such as laparoscopic single-anastomosis duodeno-jejunal or duodeno-ileal bypass with sleeve gastrectomy are modified duodenal switch (DS) surgical techniques. The duodeno-jejunal bypass liner (DJBL) is a novel surgical method in the inventory of metabolism focused manual interventions that excludes duodeno-jejunal mucosa from digestion, mimicking DS procedures without the risk of surgical intervention. The aim of this article is to summarize and compare differences between safety-related features and weight loss outcomes of DJBL and PPBS. Methods: A literature search was conducted in the PubMed database. Records of DJBL-related adverse events (AEs), occurrence of PPBS-related complications and reintervention rates were collected. Mean weight, mean body mass index (BMI), percent of excess of weight loss (EWL%), percent of total weight loss (TWL%) and BMI value alterations were recorded for weight loss outcomes. Results: A total of 11 publications on DJBL and 6 publications on PPBS were included, involving 800 and 1462 patients, respectively. The baseline characteristics of the patients were matched. Comparison of DJBL-related AEs and PPBS-related severe complications showed an almost equal risk (risk difference (RD): −0.03 and confidence interval (CI): −0.27 to 0.21), despite higher rates among patients having received endoscopic treatment. Overall AE and complication rates classified by Clavien-Dindo showed that PPBS was superior to DJBL due to an excess risk level of 25% (RD: 0.25, CI: 0.01–0.49). Reintervention rates were more favourable in the PPBS group, without significant differences in risk (RD: −0.03, CI: −0.27 to 0.20). However, PPBS seemed more efficient regarding weight loss outcomes at 1-year follow-up according to raw data, while meta-analysis did not reveal any significant difference (odds ratio (OR): 1.08, CI: 0.74–1.59 for BMI changes). Conclusion: Only limited conclusions can be made based on our findings. PPBS was superior to DJBL with regard to safety outcomes (GRADE IIB), which failed to support the authors' hypothesis. Surgical procedures showed lower complication rates than the incidence of DJBL-related AEs, although it should be emphasized that the low number of PPBS-related mild to moderate complications reported could be the result of incomplete data recording from the analysed publications. Weight loss outcomes favoured bariatric surgery (GRADE IIB). As the DJBL is implanted into the upper gastrointestinal tract for 6 to 12 months, it seems a promising additional method in the inventory of metabolic interventions. [ABSTRACT FROM AUTHOR]

Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most commonly performed bariatric procedures globally, but both techniques have shortcomings. Several modifications of SG (SG plus procedures) have been developed, but the efficacy of the different procedures has not been completely elucidated. In this meta-analysis, we aimed to evaluate the efficacy and safety of SG plus procedures. Out of the initially identified 2357 studies, thirteen were selected for this meta-analysis: two studies on banded sleeve gastrectomy (BSG), four studies on sleeve gastrectomy plus duodenal–jejunal bypass (SG + DJB) or sleeve gastrectomy with loop duodenal–jejunal bypass (SADJB), two studies on sleeve gastrectomy with jejunal–jejunal bypass (SG + JJB), four studies on single anastomosis duodenal–ileal switch (SADI-S), and one study on stomach intestinal pylorus–sparing surgery (SIPS). SADI-S procedure was found to achieve significantly greater percentage of excess weight loss than the RYGB. SG + DJB and SADJB achieved greater weight loss than the RYGB. Major complications were fewer with SG + JJB than with RYGB, but the difference was not significant. Overall, SG plus procedures appear to achieve better weight loss and cause fewer complications than RYGB. [ABSTRACT FROM AUTHOR]

Introduction: Asian patients with diabetes exhibit different characteristics from Western patients. However, limited large-scale data are available on metabolic surgery procedures in Asia. We compared the short-term efficacies of metabolic surgery procedures for the management of Asian patients with different severities of diabetes. Methods: We included patients undergoing metabolic surgery in five Asian institutions from January 2008 to December 2015 with at least 1-year postoperative follow-up. Outcomes of weight loss and diabetes control were determined. Diabetes remission rates in different ABCD scores and factors affecting diabetes remission were analyzed. Results: A total of 1016 patients (mean BMI, 39.0 ± 7.2 kg/m2; HbA1c, 8.3% ± 1.7%) underwent metabolic surgery (197, Roux-en-Y gastric bypass [RYGB]; 171, one anastomosis gastric bypass [OAGB]; 437, sleeve gastrectomy [SG]; 130, SG with duodenal-jejunal bypass [SG-DJB]; and 81, single anastomosis duodenal-jejunal bypass with SG [SA-DJBSG]). The OAGB group exhibited significantly higher 1-year total weight loss (30.5%) and type 2 diabetes mellitus (T2DM) remission (78.4%) rates than did the other groups (p <.001). The patients with higher preoperative ABCD scores exhibited higher T2DM remission rates (81.8–100% and 9.5–46.2% in ABCD score subgroups of 9–10 and 1–2, respectively). In multivariate analysis, bypass was found to be an independent predictor of T2DM remission compared with SG (odds ratio of OAGB vs SG, 3.72; RYGB vs SG, 1.96; SG-DJB vs SG, 2.73; SA-DJBSG vs SG, 2.12). Conclusion: The metabolic surgeries are highly effective in T2DM treatment. However, SG may not be as effective as gastric bypass and duodenal-jejunum bypass. [ABSTRACT FROM AUTHOR]

Aim: To compare different types of metabolic surgery (MS) with medical therapy (MT) for the treatment of type 2 diabetes (T2D). Materials and methods: We conducted a network‐meta‐analysis (NMA) including randomized clinical trials comparing different MS techniques versus MT in people with T2D, with a duration of ≥24 weeks. Primary endpoints were glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and diabetes remission. Indirect comparisons of different types of surgery were performed by NMA. Mean and 95% confidence intervals for continuous variables, and Mantel−Haenzel odds ratios for categorial variables, were calculated using random effect models. Types of MS included: laparoscopic adjustable gastric banding (LAGB), Roux‐en‐Y gastric bypass, sleeve gastrectomy (SG), bilio‐pancreatic diversion (BPD); greater curvature plication (GCP); one‐anastomosis gastric bypass (OAGB); and duodenojejunal bypass. Results: The 24 retrieved trials included 1351 patients (1014 with MS and 337 with MT). The mean baseline BMI was 36.8 kg/m2. MS was associated with significantly greater reductions in HbA1c and FPG and greater diabetes remission when compared to MT. In the NMA, a significant reduction in HbA1c was observed with OAGB and SG. All surgical procedures were associated with a significant increase in diabetes remission, except GCP and LAGB. All procedures were associated with a reduction of body mass index (BMI). Conclusions: Metabolic surgery is an interesting option for the treatment of T2D, although further data are needed to demonstrate its long‐term efficacy and safety. Present data are not sufficient to modify current recommendations, which consider MS a possible treatment for T2D in those with a BMI >35 kg/m2. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic sleeve gastrectomy (LSG) is evolving to be the frequently executed bariatric universal processes for the variant degree's obese patients Patients and methods: Around two thousand (2000) morbid obese patients having an index body mass of 44.64 ±9.01 kg/m2 tolerated LSG commencing January 2013-2018 at our private organization. Amongst these patients, some of gastric leak diagnosed were involved in our research study as well as the referred gastric leak patients later to LSG were also incorporated. Results: Different results were obtained with significant differences in the study groups as shown in the figures and results in the article. Conclusion: The backbone of the diagnosis of sleeve leaks are found to be the CT scan and clinical suspension. Thus, the leakage cessation period might be shorter along with endoscopic or early surgical intervention as compared to the expectant management. Customization of the choice and sequence of surgical re-intervention or endoscopic esophageal stenting should be done conferring the surgeon’s experience, facility and clinical presentation. A combination of methods depending on the situation is often required to achieve success. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic sleeve gastrectomy (LSG) is one of the mostly performed bariatric surgical procedures. LSG has many advantages as there is no anastomosis, it is performed easily and the gastric antrum is preserved. However, this procedure has some complications, the most disquieting of them is the stable line leakage, it is the main source of postoperative morbidity and mortality after LSG Method: This study was conducted between January 2015 and February 2019 on eight patients diagnosed with post laparoscopic sleeve gastrectomy staple line leak. Underwent endoscopic fully covered mega stent insertion to cover the leak defect, 7 of them underwent rapid stent insertion and one delayed for management of peritonitis. Results: The stent managed to control leak in 7 patients successfully mean time 31.8 ±SD7.1 days, one case needed stent reposition. One patient needed ROUX en Y gastric bypass (RYGB). Conclusion: Endoscopic fully covered mega stent insertion is a safe effective method for treatment of post laparoscopic sleeve gastrectomy staple line leak. [ABSTRACT FROM AUTHOR]

Introduction: The comparative efficacy of various bariatric procedures has not been completely elucidated. We aimed to evaluate efficacy and safety of various bariatric procedures comprehensively. Methods: We searched for randomized controlled trials investigating the efficacy of bariatric surgery. Network meta-analyses were performed to determine the percentage of excess weight loss (%EWL) and remission of diabetes mellitus (DM). Results: Of 45 studies, 33 and 24 provided the data for %EWL and DM remission rates, respectively. Six months after surgery, biliopancreatic diversion with duodenal switch (BPD-DS), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) showed superior efficacy for %EWL compared to the standard-of-care (mean difference [MD], [95% confidence interval [CI]]: BPD-DS, 38.2% [7.3%, 69.1%]; RYGB, 32.1% [3.1%, 61.1%]; SG, 32.5% [5.5%, 59.5%]). However, adjustable gastric banding was not superior to standard-of-care (MD [95% CI] = − 0.2% [− 19.6%, 19.2%]). At 1 year, all bariatric procedures were superior to standard-of-care. At 3 years, RYGB and SG showed superior efficacy when compared to standard-of-care (MD [95% CI]: RYGB, 45.0% [21.8%, 68.2%]; SG, 39.2% [15.2%, 63.3%]). With respect to DM remission 3–5 years after surgery, BPD-DS, RYGB, and SG were superior to standard-of-care. Hernias, obstruction/stricture, bleeding, and ulcers were less common in patients who underwent SG than in those who underwent RYGB. Conclusions: RYGB and SG had excellent long-term outcomes for both the %EWL and DM remission rates. Additionally, SG had a relatively lower risk of adverse events than RYGB. [ABSTRACT FROM AUTHOR]

Weight loss is the primary outcome following bariatric surgery; however, its documentation within current literature is heterogeneous and poorly defined, limiting meaningful comparison between studies. Randomized controlled trials from 2012 to 2016 were identified using the Medline database through "Gastric bypass OR sleeve gastrectomy AND weight" search terms. A total of 73 studies with 5948 patients were included. Reporting of preoperative weight was done primarily using mean body mass index (BMI) (87.7%) and mean weight (65.8%). Postoperative weight reporting was more variable, with the most frequently reported measure being mean postoperative BMI (71.2%). Overall, nearly one third of all bariatric literature contained discrepancies that precluded meaningful meta-analysis. Reporting of weight loss following bariatric surgery is becoming increasingly diverse for both pre- and post-operative outcomes. Ongoing heterogeneity will continue to act as a barrier to meaningful comparison of bariatric outcomes until standardized reporting practices become adopted. [ABSTRACT FROM AUTHOR]

Background: Currently there is no consensus on management of ventral hernias encountered during bariatric surgery (BS). This study aims to evaluate the incidence and outcomes of concomitant ventral hernia repair (VHR) during BS at our institution.Methods: Patients who had concomitant VHR during BS from 2004 to 2015 were identified. Data collected included baseline demographics, comorbidities, perioperative parameters, surgical approach and postoperative outcomes.Results: A total of 159 patients underwent concomitant VHR during the study period at the time of BS. One hundred and one (64 %) patients were female; median age was 53 years (IQR 45.0-60.3) and median BMI was 48.2 kg/m2 (IQR 41.6-54.1). Comorbidities included: hypertension (n = 124, 78 %), type 2 diabetes (n = 103, 65 %), hyperlipidemia (n = 100, 63 %), obstructive sleep apnea (n = 98, 62 %) and reflux disease (n = 54, 34 %). Out of 159 patients, 41 patients (26 %) had a prior VHR. Out of 103 patients, 69 patients (67 %) had a previous abdominal surgery. Of the concomitant VHR, 144 (91 %) were completed laparoscopically, 12 (7 %) patients were converted to open surgery and 3 (2 %) patients underwent primary open procedures. Technique included primary suture closure in 115 (72 %) and mesh repair in 44. Early postoperative complications (<30 days) were reported in 16 (10 %) patients, with superficial wound infection (n = 9), bowel obstruction (n = 2), marginal ulcer (n = 2), DVT (n = 1) and pneumonia (n = 1). Hernia recurrence was reported in 3 patients (2 %) in the early post-op period and in 40 patients (25 %) as a late (>30 days) complication. Surgery for recurrent hernia was performed in 31/42 patients during follow-up. At 12-month follow-up, median BMI and % excess weight loss were 34.2 kg/m2 (IQR 29.5-40.9) and 59.6 % (IQR 44.9-74.8 %), respectively.Conclusion: Ventral hernia is a common finding in patients undergoing BS. Both primary suture repair and mesh repair result in acceptable results, both in terms of recurrence and perioperative complications. [ABSTRACT FROM AUTHOR]

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed 'standalone' bariatric procedure in India. Staple line gastric leaks occur infrequently but cause significant and prolonged morbidity. The aim of this retrospective study was to analyse the management of patients with a gastric leak after LSG for morbid obesity at our institution. PATIENTS AND METHODS: From February 2008 to 2014, 650 patients with different degrees of morbid obesity underwent LSG. Among these, all those diagnosed with a gastric leak were included in the study. Patients referred to our institution with gastric leak after LSG were also included. The time of presentation, site of leak, investigations performed, treatment given and time of closure of all leaks were analysed. RESULTS: Among the 650 patients who underwent LSG, 3 (0.46%) developed a gastric leak. Two patients were referred after LSG was performed at another institution. The mean age was 45.60 ± 15.43 years. Mean body mass index (BMI) was 44.79 ± 5.35. Gastric leak was diagnosed 24 h to 7 months after surgery. One was early, two were intermediate and two were late leaks. Two were type I and three were type II gastric leaks. Endoscopic oesophageal stenting was used variably before or after re-surgery. Re-surgery was performed in all and included stapled fistula excision (re-sleeve), suture repair only or with conversion to roux-en-Y gastric bypass or fistula jujenostomy. There was no mortality. CONCLUSION: Leakage closure time may be shorter with intervention than expectant management. Sequence and choice of endoscopic oesophageal stenting and/or surgical re-intervention should be individualized according to clinical presentation. [ABSTRACT FROM AUTHOR]

Laparoscopic repair of ventral hernias gained strong popularity in the late nineties with some of the early enthusiasm lost later in time. We review the current status and challenges of laparoscopy in ventral hernia repair and best practices in this area. We specifically looked at patient and hernia defect factors, technical considerations that have contributed to the successes, and some of the failures of laparoscopic ventral hernia repair (LVHR). Patients best suited for a laparoscopic repair are those who are obese and diabetic with a total defect size not to exceed 10 cm in width or a "Swiss cheese" defect. Overlap of mesh to healthy fascia of at least 5 cm in every direction, with closure of the defect, is essential to prevent recurrence or bulging over time. Complications specifically related to surgical site occurrence favor the laparoscopic approach. Recurrence rates, satisfaction, and health-related quality of life results are similar to open repairs, but long-term data are lacking. There is still conflicting data regarding ways of fixating the mesh. The science of prosthetic material appropriate for intraperitoneal placement continues to evolve. The field continues to be plagued by single author, single institution, and small nonrandomized observational studies with short-term follow-up. The recent development of large prospective databases might allow for pragmatic and point-of-care studies with long-term follow-up. We conclude that LVHR has evolved since its inception, has overcome many challenges, but still needs better long-term studies to evaluate evolving practices. [ABSTRACT FROM AUTHOR]

Bariatric surgery can be safely combined with laparoscopic intraperitoneal onlay mesh (IPOM) repair. In case of large ventral hernias, laparoendoscopic component separation can also be combined to achieve tension-free closure of the defect. Concomitant bariatric surgery and hernia repair also offer the additional benefit of reduction in recurrence of hernias as obesity, one of the risk factors, is treated in the process. We present a case of 60-year-old man with a body mass index of 45.3 kg/m² with a large recurrent ventral hernia. We performed a lap sleeve gastrectomy with laparoendoscopic anterior component separation with IPOM. The operative steps included hernia contents reduction, conventional sleeve gastrectomy, anterior component separation on either side, intra-corporeal closure of hernia defect and placement of a composite mesh. Patient recovery was uneventful. Concomitant bariatric surgery with laparoendoscopic component separation with IPOM may be safe, but more studies are required. [ABSTRACT FROM AUTHOR]

Background: The Executive board of the Italian Society for Endoscopic Surgery (SICE) promoted an update of the first evidence-based Italian Consensus Conference Guidelines 2010 because a large amount of literature has been published in the last 4 years about the topics examined and new relevant issues. Methods: The scientific committee selected the topics to be addressed: indications to surgical treatment including special conditions (obesity, cirrhosis, diastasis recti abdominis, acute presentation); safety and outcome of intraperitoneal meshes (synthetic and biologic); fixing devices (absorbable/non-absorbable); abdominal border and parastomal hernia; intraoperative and perioperative complications; and recurrent ventral/incisional hernia. All the recommendations are the result of a careful and complete literature review examined with autonomous judgment by the entire panel. The process was supervised by experts in methodology and epidemiology from the most qualified Italian institution. Two external reviewers were designed by the EAES and EHS to guarantee the most objective, transparent, and reliable work. The Oxford hierarchy (OCEBM Levels of Evidence Working Group*. 'The Oxford 2011 Levels of Evidence') was used by the panel to grade clinical outcomes according to levels of evidence. The recommendations were based on the grading system suggested by the GRADE working group. Results and Conclusions: The availability of recent level 1 evidence (a meta-analysis of 10 RCTs) allowed to recommend that not only laparoscopic repair is an acceptable alternative to the open repair, but also it is advantageous in terms of shorter hospital stay and wound infection rate. This conclusion appears to be extremely relevant in a clinical setting. Indications about specific conditions could also be issued: laparoscopy is recommended for the treatment of recurrent ventral hernias and obese patients, while it is a potential option for compensated cirrhotic and childbearing-age female patients. Many relevant and controversial topics were thoroughly examined by this consensus conference for the first time. Among them are the issue of safety of the intraperitoneal mesh placement, traditionally considered a major drawback of the laparoscopic technique, the role for the biologic meshes, and various aspects of the laparoscopic approach for particular locations of the defect such as the abdominal border or parastomal hernias. [ABSTRACT FROM AUTHOR]

Insulin resistance ( IR) plays an important role in the pathogenesis of type 2 diabetes ( T2D) and cardiovascular disease. Hence improving IR is a major target of treatment in patients with T2D. Obesity and lack of exercise are major causes of IR. However, recent evidence implicates sleep disorders and disorders of the circadian rhythm in the pathogenesis of IR. Weight loss and lifestyle changes are the cornerstone and most effective treatments of IR, but adherence and patient's acceptability are poor. Bariatric surgery results in significant and sustainable long-term weight loss associated with beneficial impact on IR and glucose metabolism, making this an attractive treatment option for patients with T2D. Currently available pharmacological options targeting IR (such as metformin and thiazolidinediones) do not maintain glycaemic measures within targets long term and can be associated with significant side effects. Over the last two decades, many pharmacological agents targeting different aspects of the insulin signalling pathway were developed to improve IR, but only a minority reached clinical trials. Such treatments need to be specific and reversible as many of the components of the insulin signalling pathway are involved in other cellular functions such as apoptosis. Recent evidence highlighted the role of circadian rhythm and sleep-related disorders in the pathogenesis of IR. In this article, we review the latest developments in the pharmacological and non-pharmacological interventions targeting IR including bariatric surgery. We will also review the role of circadian rhythm and sleep-related disorders in the development and treatment of IR. [ABSTRACT FROM AUTHOR]

A web-based virtual and remote laboratory environment is developed, realized and proposed for real time control and monitoring of a mobile robot in an indoor environment. In this laboratory, a real time and continuous video stream of indoor laboratory environment is viewed by wireless IP camera mounted to the ceiling. The localization of the robot is also implemented using this IP camera. In this environment, a virtual target and virtual obstacles are located anywhere on the video image taken by the user. The robot is guaranteed to arrive at the virtual target avoiding virtual obstacles using the shortest path. The video stream of the robot's navigation is monitored through the web environment. The robot is controlled by a BeagleBoard-xM single board computer. The PC web server symmetrically communicates with the other web server on the BeagleBoard-xM, executing developed application software. Since genetic algorithms generate alternative solutions, it is utilized as a path planning algorithm. Parameters such as population size and maximum generation of genetic algorithms applied to get the shortest path for the robot are tuned via the web-based virtual laboratory environment. The robot is also controlled manually through the web environment. At the conclusion of the experiments, the results are monitored on the web-based virtual laboratory environment. A low-cost mobile robot virtual remote laboratory is designed and implemented for engineering education in this paper. Consequently, survey and some experimental works, of the usability and performance of the RRC-Lab (remote robot control-laboratory) system are confirmed by students. [ABSTRACT FROM AUTHOR]

The article offers information regarding impact of concomitant bariatric surgery and component separation. Topics discussed include information on higher rate of complications and mortality associated with synchronous bariatric surgery and lap cholecystectomy; determination of pulmonary embolism as important factors leading to mortality in bariatric surgery patients; and long‑term complications associated with intraperitoneal mesh usage which are used generally for ventral hernia repair.