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Bariatric surgery complications carry a high rate of morbidity and mortality. This review highlights the pearls and pitfalls of bariatric surgery complications, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. Bariatric surgeries include restrictive procedures (e.g., adjustable gastric banding, endoscopic gastric balloon insertion, and sleeve gastrectomy) and mixed restrictive and malabsorptive procedures (e.g., roux-en-y gastric bypass and duodenal switch-biliopancreatic diversion). Several complications may occur, which may be associated with severe morbidity and mortality. These complications include anastomotic/staple line leaks, small bowel obstruction and internal hernia, marginal ulceration, biliary disease, and device-specific issues. History concerning the type of surgery, when and where it was performed, prior complications, changes in weight, and systemic symptoms is essential. Many signs and symptoms are subtle, but fever, tachycardia, and persistent vomiting are concerning for a severe complication. If there is concern for a complication, emergent consultation with the bariatric surgeon is recommended (preferably the patient's surgeon). Imaging studies can assist in the evaluation, including computed tomography with oral and intravenous contrast. Resuscitation in the ED and early intervention by a bariatric surgeon provide the best opportunity to reduce morbidity and mortality for patients with intra-abdominal pathology. Understanding bariatric surgery complications can assist emergency clinicians in diagnosing and managing this potentially deadly disease. [ABSTRACT FROM AUTHOR]

Despite the variety of proposed solutions, anastomotic leakage is still a critical complication after colorectal surgery, which causes increased clinical mortality and morbidity. By enhancing microcirculation in the colonic mucosa, the use of Iloprost (Ilo) has shown promising results for the healing of anastomosis. The purpose of this study is to examine the performance of Ilo-impregnated Polycaprolactone:Gelatin electrospun membranes (PCL/Gel/Ilo) on anastomosis repair and intra-abdominal adhesion behavior in the Rat colon. Wistar Albino rats were randomly divided into four groups: sham, Control (only resection-anastomosis), PCL/Gel, and PCL/Gel /Ilo (n = 12 for each). On the seventh day after colon anastomosis, a second laparotomy was conducted. During this procedure, intra-abdominal adhesion was examined, and the anastomotic segment was removed for burst pressure and histological evaluation. There was no statistically significant difference in intra-abdominal adhesions and major complications between the electrospun membrane groups and the control group. The membrane-applied groups exhibited significantly higher anastomotic burst pressure than the control group irrespective of their Ilo content. In terms of neovascularization and muscle necrosis, membrane-applied groups demonstrated statistically significant improvements over the control group. Furthermore, the PCL/Gel/Ilo applied group showed enhanced neovascularization and lower muscular necrosis; however, statistically significant differences were not observed compared to the PCL/Gel applied group. Compared to the control group, the application of electrospun PCL/Gel and PCL/Gel/Ilo membranes resulted in safe and effective healing of colon anastomosis. The fact that Ilo application cannot be distinguished from the regular membrane group necessitates additional research into the doped fibrous mat and its application method., (© 2024 Wiley Periodicals LLC.)

Introduction: Esophagectomy is the mainstay of esophageal cancer treatment, but anastomotic insufficiency related morbidity and mortality remain challenging for patient outcome. Therefore, the objective of this work was to optimize anastomotic technique and gastric conduit perfusion with hyperspectral imaging (HSI) for total minimally invasive esophagectomy (MIE) with linear stapled anastomosis., Material and Methods: A live porcine model (n = 58) for MIE was used with gastric conduit formation and simulation of linear stapled side-to-side esophagogastrostomy. Four main experimental groups differed in stapling length (3 vs. 6 cm) and simulation of anastomotic position on the conduit (cranial vs. caudal). Tissue oxygenation around the anastomotic simulation site was evaluated using HSI and was validated with histopathology., Results: The tissue oxygenation (ΔStO 2 ) after the anastomotic simulation remained constant only for the short stapler in caudal position (-0.4 ± 4.4%, n.s.) while it was impaired markedly in the other groups (short-cranial: -15.6 ± 11.5%, p = 0.0002; long-cranial: -20.4 ± 7.6%, p = 0.0126; long-caudal: -16.1 ± 9.4%, p < 0.0001). Tissue samples from avascular stomach as measured by HSI showed correspondent eosinophilic pre-necrotic changes in 35.7 ± 9.7% of the surface area., Conclusion: Tissue oxygenation at the site of anastomotic simulation of the gastric conduit during MIE is influenced by stapling technique. Optimal oxygenation was achieved with a short stapler (3 cm) and sufficient distance of the simulated anastomosis to the cranial end of the gastric conduit. HSI tissue deoxygenation corresponded to histopathologic necrotic tissue changes. The experimental model with HSI and ML allow for systematic optimization of gastric conduit perfusion and anastomotic technique while clinical translation will have to be proven., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interest for the submission of the manuscript “Optimization of anastomotic technique and gastric conduit perfusion with hyperspectral imaging and machine learning in an experimental model for minimally invasive esophagectomy”., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)