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Robotic surgery is becoming increasingly popular in bariatric-metabolic surgery. However, its superiority regarding postoperative outcomes compared with conventional laparoscopy has not been clearly proven. With growing adoption of robotic surgery and improved technologies, benefits should become more evident. Evaluate readmission and reoperation rates after bariatric-metabolic surgery performed by conventional laparoscopy versus robotic-assisted from 2015 to 2021. Academic institution. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) was reviewed for primary bariatric operations performed with conventional laparoscopy versus robotic-assisted. Postoperative outcomes were compared in a propensity score-matched sample. Of 1,059,348 cases meeting inclusion criteria, 921,322 (87%) were conventional laparoscopic bariatric-metabolic surgeries, which were matched 1:1 with robotic-assisted cases (138,026). Reoperation (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.00–1.15, P =.0463), postoperative morbidity (OR 1.07; 95% CI 1.01–1.12, P =.0193), readmission (OR 1.14; 95% CI 1.09–1.18, P <.0001), and emergency department visits (OR 1.06; 95% CI 1.03–1.09, P =.0003) at 30 days postoperatively were significantly greater for robotic-assisted cases. Robotic-assisted cases had a similar mortality rate at 30 days postoperatively and length of stay >3 days when compared with conventional laparoscopic cases. Similar results were observed in cases from 2020 to 2021, except for reoperation and emergency department visits, which showed no difference between groups and length of stay >3 days, which was greater in robotic-assisted cases. Our results show a greater readmission and reoperation rate and greater morbidity at 30 days postoperatively in robotic-assisted bariatric-metabolic surgery compared with conventional laparoscopy. Analyzing only cases performed between 2020 and 2021, robotic surgery also does not show superiority over conventional laparoscopy. [ABSTRACT FROM AUTHOR]

We previously demonstrated how kidney injury in patients with morbid obesity can be reversed by bariatric surgery (BaS). Based on previous experience, we hypothesize patients' potentially reversible kidney injury might be secondary to reduction in renal blood flow (RBF), which improves following BaS. Academic Hospital. We conducted a retrospective analysis of patients who underwent BaS at our institution from 2002 to 2019. We identified patients with chronic kidney disease (CKD) using the estimated glomerular filtration rate (eGFR) from the CKD Epidemiology Collaboration Study (CKD-EPI) classification system. We used the BUN/Creatinine (Cr) ratio pre- and postoperatively to determine a prerenal (decreased RBF) versus intrinsic component as the responsible cause of CKD in this patient population. Decreased RBF was defined as BUN/Cr > 20 preoperatively. Our analysis included n = 2924 patients, of which 11% (n = 325) presented decreased RBF. From our original sample, only n = 228 patients had the complete data necessary to assess both eGFR and RBF (BUN/Cr). Patients with baseline CKD stage 2 demonstrated preoperative BUN/Cr 20.85 ± 10.23 decreasing to 14.99 ± 9.10 at 12-month follow-up (P <.01). Patients with baseline CKD stage 3 presented with preoperative BUN/Cr 23.88 ± 8.75; after 12-month follow-up, BUN/Cr ratio decreased to 16.38 ± 9.27 (P <.01). Patients with CKD stage 4 and ESRD (eGFR < 30) did not demonstrate a difference for pre- and postoperative BUN/Cr 21.71 ± 9.28 and 19.21 ± 14.58, respectively. According to our findings, patients with CKD stages 1–3 present improvement of their kidney function after BaS. This amelioration could be secondary to improvement of the RBF, an unstudied reversible mechanism of kidney injury in the bariatric population. [ABSTRACT FROM AUTHOR]

Axillary sentinel lymph node biopsies are standard of care in patients with breast cancer and no clinically apparent metastases. Traditionally, technetium-99m, blue dye, or both have been used to identify sentinel lymph nodes. However, blue dyes miss up to 40% of sentinel lymph nodes, while technetium-99m use is complex, costly, and exposes patients to radiation. Over the past decade, studies have consistently found the biologically inert fluorescent indocyanine green to be 95% to 100% sensitive in detecting breast cancer sentinel lymph nodes, yet indocyanine green remains infrequently used. We conducted an extensive meta-analysis comparing indocyanine green against blue dye, technetium-99m, and the dual-marker combination of technetium-99m + BD. Unlike prior meta-analyses that only assessed either per-case or per-node sentinel lymph node detection, we analyzed the following 5 metrics: per-case and per-node sentinel lymph node detection and metastasis-positive sentinel lymph node sensitivity, and mean number of sentinel lymph nodes/case. We further examined the consistency and magnitude of between-study superiority and statistically significant within-study superiority of each marker against others. For every metric and analysis approach, indocyanine green was clearly superior to blue dye and at least non-inferior, if not superior, to technetium-99m and technetium-99m + blue dye. Assessing the consistency of superiority by at least 2.0%, indocyanine green was superior to blue dye 73 times versus 1, to technetium-99m 42 times versus 9, and to technetium-99m + blue dye 6 times versus 0. Within-study statistically significant differences favored indocyanine green over blue dye 29 times versus 0 and over technetium-99m 11 times versus 2. For sentinel lymph node detection in patients with breast cancer with no clinically apparent metastases, indocyanine green is clearly and consistently superior to blue dye and either non-inferior or superior to technetium-99m and technetium-99m + blue dye. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) after surgery increases long-term risk of kidney dysfunction. The major risk factor for AKI after bariatric surgery is having preoperative renal insufficiency. Little is known about the outcomes and risk factors for developing AKI in patients undergoing bariatric surgery with normal renal function. We aimed to describe factors that may increase risk of AKI after primary bariatric surgery in patients without history of kidney disease. Academic hospital, United States. We performed a retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry for patients aged ≥18 years undergoing laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass (LRYGB) from 2015 to 2019. Patients with diagnosis of chronic kidney disease were excluded. The primary outcome was incidence of AKI. Secondary outcomes included 30-day complications, readmissions, reoperations, and mortality. Univariate and multivariate analyses were performed to identify differences between patients with and without AKI. A total of 747,926 patients were included in our analysis (laparoscopic sleeve gastrectomy = 73.1%, LRYGB = 26.8%). Mean age was 44.40 ± 11.94 years, with female predominance (79.7%). AKI occurred in 446 patients (.05%). Patients with postoperative AKI had higher rates of complications, readmissions, reoperations, and mortality. Significant predictors of AKI were male sex, history of venous thromboembolism, hypertension, limitation for ambulation, and LRYGB. High albumin levels and White race were protective factors. New-onset AKI was associated with adverse 30-day outcomes in patients undergoing bariatric surgery. Male sex, venous thromboembolism, hypertension, limited ambulation, and LRYGB were independent predictors of AKI. Prospective studies are needed to better describe these results. • New onset of AKI was associated with adverse 30-day outcomes in patients undergoing bariatric surgery. • Cardiovascular comorbidities and gastric bypass are independent predictors of AKI. • Postoperative AKI after bariatric surgery has been associated with increased morbidity, mortality, and long-term kidney dysfunction. [ABSTRACT FROM AUTHOR]

Severe obesity could be an independent risk factor for peripheral artery disease (PAD) and critical limb ischemia (CLI). Bariatric surgery reduces cardiac risk factors, decreasing cardiovascular morbidity and mortality in subjects with severe obesity. We aimed to describe the impact of bariatric surgery on risk of hospitalization due to PAD and CLI. Academic hospital. The National Inpatient Sample data collected from 2010 to 2015 were examined. Patients were classified as treatment and control groups. Treatment was defined as patients with a previous history of bariatric surgery, and control was defined as patients with a body mass index ≥35 without a history of bariatric surgery. The primary outcome was hospitalization due to PAD; secondary outcomes were CLI, revascularization, major amputation, length of hospital stay (LOS), and total cost of hospitalization. Univariate and multivariate analyses were performed to assess the differences between groups. There were a total of 2,300,845 subjects: 2,004,804 controls and 296,041 treatment patients. Hospitalization rate for PAD was significantly lower compared to the control group (.10% versus.21%, P <.0001), which was confirmed after adjusting for covariables (control versus treatment: odds ratio= 1.20, confidence interval: 1.15-1.47). Subgroup analysis showed patients without a history of bariatric surgery had a higher prevalence of CLI (59.3% versus 52.4%, P <.0219) and a higher mean LOS (6.7 versus 5.7 days, P =.0023) and cost of hospitalization (78.756 versus 72.621$, P =.0089), with no significant differences in other outcomes. After multivariate analysis, only LOS and total costs were significantly different. Bariatric surgery may decrease the risk of hospitalization due to PAD, similarly to the LOS and total cost of hospitalization. Prospective studies should be performed to describe this relationship. • Bariatric Surgery may decrease the risk of hospitalization due to Peripheral Artery Disease. • Length of hospital stay and cost of hospitalization, is significantly decreased in patients with history of Bariatric Surgery. • The prevalence of Critical limb ischemia is significantly lower in patients who had undergone bariatric surgery interventions. [ABSTRACT FROM AUTHOR]

Stroke is the second leading cause of death worldwide and fifth in the United States, and it represents the major cause of disability in older adults. We aimed to determine the risk of acute ischemic stroke (AIS) in individuals with obesity with a history of transient ischemic attack (TIA) compared with patients with a history of bariatric surgery. Academic hospital, United States. Using the Nationwide Inpatient Sample (NIS) database from 2010 to 2015, we retrospectively identified patients with obesity and past medical history of TIA and divided them into 2 groups: a treatment group of patients who underwent bariatric surgery, and a control group of patients with obesity. We compared incidence of new AIS in both groups using a univariate analysis and multivariate regression model. Covariates included were lifestyle (smoking status, alcohol habits, cocaine use), family history of stroke, co-morbidities (diabetes, hypertension, hyperlipidemia, atrial fibrillation) and long-term medical treatment (antiplatelet/antithrombotic treatment). A total of 91,640 patients met inclusion criteria, of which treatment patients were 12.3% (n = 11,284) and control patients 87.6% (n = 80,356). The average age of the treatment group was 62.9 ± 17.08 years, and the average of the control was 59.6 ± 12.74 years. The rate of AIS in the treatment group was significantly lower compared with the control group (2.8% versus 4.2%, P <.0001). After adjusting for covariables, the risk difference of AIS was still significant between groups (odds ratio = 1.33, P <.0001), showing that patients in the treatment group were less likely to have AIS compared with the control group. After analyzing nationwide information, we conclude bariatric surgery helps decrease risk of AIS in patients with a history of TIA. However, this comparison is limited by the nature of the database; further studies are needed to better understand these results. [Display omitted] • Subjects with obesity have an increased risk of developing an ischemic stroke after a transient ischemic attack. • In this study, bariatric surgery was shown to decrease the risk of ischemic stroke in patients with a prior transient ischemic attack. • A positive impact on hospital stay length and total charges of hospitalization was observed. [ABSTRACT FROM AUTHOR]

Gastroparesis is a gastric motility disorder characterized by delayed gastric emptying. It is a rare disease and difficult to treat effectively; management is a dilemma for gastroenterologists and surgeons alike. We conducted a systematic review of the literature to evaluate current diagnostic tools as well as treatment options. We describe key elements in the pathophysiology of the disease, in addition to current evidence on treatment alternatives, including nutritional considerations, medical and surgical options, and related outcomes. • Gastroparesis may improve with lifestyle, dietary, and pharmacologic interventions. • Many patients with gastroparesis may require endoscopic or surgical treatment. • Bariatric Surgery showed promising results when gastroparesis is associated with morbid obesity. [ABSTRACT FROM AUTHOR]

Pseudotumor cerebri is a serious obesity-related disorder that can result in severe complications. The aim of this study was to compare metabolic surgery with medical management of pseudotumor cerebri at a single bariatric center. After institutional review board approval, a retrospective review was conducted of individuals with severe obesity and pseudotumor cerebri (nonbariatric group) and patients with preoperative pseudotumor cerebri (bariatric group). The variables included demographic characteristics, comorbidities, and pseudotumor cerebri–related risk factors. Symptoms, medication use, and body mass index were analyzed during a 4-year follow-up. A total of 86 patients with pseudotumor cerebri were included in the analysis. In the nonbariatric group (n = 77), the mean age was 34.1 ± 10.5 years and initial body mass index 37.2 ± 6.5 kg/m2. Initially, the most common symptom was headache (90.9%; n = 70), with a mean lumbar opening pressure of 341.94 ± 104.50 mm H 2 O. In the bariatric group (n = 9), the mean age was 36.1 ± 8.9 years and preoperative body mass index 46.1 ± 5.5 kg/m2. The most common preoperative symptom was headache (100%; n = 9), with a lumbar opening pressure of 320 ± 44.27 mm H 2 O. During the 4-year follow-up, both groups presented with a significant decrease in pseudotumor cerebri–related symptoms at 3 months (P <.0001). Additionally, pseudotumor cerebri medication use significantly decreased after 3 months in the bariatric group (P =.0406), whereas in the nonbariatric group decreased at 18 months (P =.023). Bariatric patients presented with a significant decrease in body mass index in ≤3 months of surgery (P =.0380), which was not observed in nonbariatric patients (P =.6644). Metabolic surgery seems to provide a greater decrease in pseudotumor cerebri symptoms and medication use in a shorter period of time compared with medical management alone. [ABSTRACT FROM AUTHOR]

Fluorescence imaging with indocyanine green is increasingly used during lymphedema patient management. However, to date, no guidelines exist on when it should and should not be used or how it should be performed. Our objective was to have an international panel of experts identify areas of consensus and nonconsensus in current attitudes and practices in fluorescence imaging with indocyanine green use during lymphedema surgery patient management. A 2-round Delphi study was conducted involving 18 experts in the use of fluorescence imaging during lymphatic surgery, all asked to vote on 49 statements on patient preparation and contraindications (n = 7 statements), indocyanine green dosing and administration (n = 10), fluorescence imaging uses and potential advantages (n = 16), and potential disadvantages and training needs (n = 16). Consensus ultimately was reached on 40/49 statements, including consistent consensus regarding the value of fluorescence imaging with indocyanine green in almost all facets of lymphedema patient management, including early detection, assessing disease extent, preoperative work-up, surgical planning, intraoperative guidance, monitoring short- and longer-term outcomes, quality control, and resident training. All experts felt it was very safe, while 94% felt it should be part of routine care and that indocyanine green was superior to colored dyes and ultrasound. Nonetheless, there also was consensus that limited high-quality evidence remains a barrier to its widespread use and that patients should still be provided with specific information and asked to sign specific consent for both fluorescence imaging and indocyanine green. Fluorescence imaging with or without indocyanine green appears to have several roles in lymphedema prevention, diagnosis, assessment, and treatment. [ABSTRACT FROM AUTHOR]

Despite exponentially growing evidence supporting the use of intraoperative fluorescence imaging + indocyanine green dye, considerable variability exists in how and when it is used, and no published consensus guidelines exist. We have conducted Delphi surveys of international experts in the use of intraoperative fluorescence imaging covering 6 distinct surgical scenarios: laparoscopic cholecystectomy; colorectal, lymphedema, gastric cancer, and plastic surgery; and thyroid and parathyroid resections. Although each survey asked experts to vote on field-specific consensus statements, they also had 29 shared statements to permit some analysis spanning the 6 specialties. This article summarizes these results. Data on the 29 shared statements from 6 two-round Delphi consensus surveys were compiled to identify areas of overall consensus and compare the different specialties. As with the individual surveys, consensus was defined as ≥70% intervoter agreement. Among 140 participating experts, overall consensus was achieved on 16 statements, including strong agreement that using indocyanine green is extremely safe, that it can be used even when informed written consent cannot be provided, that it significantly enhances anatomical visualization and impacts how procedures are performed, and that it significantly reduces overall procedural risk. However, indocyanine green dosing and timing are procedure-specific, with considerable variability persisting for some applications, and the overall consensus is that further research is necessary to optimize this facet of intraoperative fluorescence imaging. Fluorescence imaging is gaining traction across multiple surgical specialties as an invaluable intraoperative tool. Its use in clinical practice and research seems destined to increase. [ABSTRACT FROM AUTHOR]

Published empirical data have increasingly suggested that using near-infrared fluorescence cholangiography during laparoscopic cholecystectomy markedly increases biliary anatomy visualization. The technology is rapidly evolving, and different equipment and doses may be used. We aimed to identify areas of consensus and nonconsensus in the use of incisionless near-infrared fluorescent cholangiography during laparoscopic cholecystectomy. A 2-round Delphi survey was conducted among 28 international experts in minimally invasive surgery and near-infrared fluorescent cholangiography in 2020, during which respondents voted on 62 statements on patient preparation and contraindications (n = 12); on indocyanine green administration (n = 14); on potential advantages and uses of near-infrared fluorescent cholangiography (n = 18); comparing near-infrared fluorescent cholangiography with intraoperative x-ray cholangiography (n = 7); and on potential disadvantages of and required training for near-infrared fluorescent cholangiography (n = 11). Expert consensus strongly supports near-infrared fluorescent cholangiography superiority over white light for the visualization of biliary structures and reduction of laparoscopic cholecystectomy risks. It also offers other advantages like enhancing anatomic visualization in obese patients and those with moderate to severe inflammation. Regarding indocyanine green administration, consensus was reached that dosing should be on a milligrams/kilogram basis, rather than as an absolute dose, and that doses >0.05 mg/kg are necessary. Although there is no consensus on the optimum preoperative timing of indocyanine green injections, the majority of participants consider it important to administer indocyanine green at least 45 minutes before the procedure to decrease the light intensity of the liver. Near-infrared fluorescent cholangiography experts strongly agree on its effectiveness and safety during laparoscopic cholecystectomy and that it should be used routinely, but further research is necessary to establish optimum timing and doses for indocyanine green. [ABSTRACT FROM AUTHOR]

In recent years, indocyanine green angiography (ICG-A) has been used increasingly to assist tissue perfusion assessments during plastic and reconstructive surgery procedures, but no guidelines exist regarding its use. We sought to identify areas of consensus and non-consensus among international experts on the use of ICG-A for tissue-perfusion assessments during plastic and reconstructive surgery. A two-round, online Delphi survey was conducted of 22 international experts from four continents asking them to vote on 79 statements divided into five modules: module 1 = patient preparation and contraindications (n = 11 statements); module 2 = ICG administration and camera settings (n = 17); module 3 = other factors impacting perfusion assessments (n = 10); module 4 = specific indications, including trauma debridement (n = 9), mastectomy skin flaps (n = 6), and free flap reconstruction (n = 8); and module 5 = general advantages and disadvantages, training, insurance coverage issues, and future directions (n = 18). Consensus was defined as ≥70% inter-voter agreement. Consensus was reached on 73/79 statements, including the overall value, advantages, and limitations of ICG-A in numerous surgical settings; also, on the dose (0.05 mg/kg) and timing of ICG administration (∼20–60 seconds preassessment) and best camera angle (61-90o) and target-to-tissue distance (20–30 cm). However, consensus also was reached that camera angle and distance can vary, depending on the make of camera, and that further research is necessary to technically optimize this imaging tool. The experts also agreed that ambient light, patient body temperature, and vasopressor use impact perfusion assessments. ICG-A aids perfusion assessments during plastic and reconstructive surgery and should no longer be considered experimental. It has become an important surgical tool. [ABSTRACT FROM AUTHOR]

Obesity can worsen outcomes in patients with chronic respiratory diseases. The objective of the study was to determine the impact of bariatric surgery (BaS) on risk of hospitalization due to acute exacerbation (AE) of chronic obstructive lung diseases (OLDs). Academic, University-affiliated Hospital; United States. Nationwide Inpatient Sample data collected from 2010 to 2015 were examined. Patients were classified as treatment and control groups. Treatment subjects were defined as patients with a previous history of BaS, and control subjects, as patients with a body mass index ≥35 kg/m2 and without a history of BaS. The primary outcome was hospitalization due to AE of any OLD (chronic obstructive pulmonary disease, asthma, and bronchiectasis), and the secondary outcome was the total length of stay (LOS). Univariate analysis and multivariate regression model were performed to assess the difference in outcomes between groups. We included a total of 2,300,845 subjects: 2,004,804 controls and 296,041 treatments. Univariate analysis showed that the hospitalization rate was significantly lower for the treatment group than that for the control group (3.7% versus 9.8%, P <.0001), confirmed after adjusting for covariates (control versus treatment: odds ratio [OR] = 2.46, P <.0001). Subgroup analysis showed that the treatment group had a lower risk of LOS ≥3 days than controls (69.8% versus 77.4%, P <.0001), confirmed by multivariate analysis (control versus treatment: OR = 1.40, P <.0001). BaS-induced weight loss may decrease the risk of hospitalization due to AE in patients with OLD, also decreasing the LOS. We acknowledge that this comparison is limited by the nature of the database; hence, further prospective studies are needed to better understand these results. • Bariatric surgery in patients with obesity decreases the rate of hospitalizations due to acute exacerbation in patients with associated obstructive lung disease. • Bariatric surgery results in a decreased length of stay in patients with obesity and concomitant obstructive lung disease. [ABSTRACT FROM AUTHOR]

In the last 10 years, severe obesity and the associated metabolic syndrome have reached pandemic proportions and consequently have significantly increased the prevalence of related co-morbidities such as chronic kidney disease (CKD). One in 7 people in the United States have CKD, and 90% of those are not aware of it. Following sleeve gastrectomy (SG) in patients with severe obesity and baseline CKD stage ≥2, to determine improvement of glomerular function and analyze the relationship between kidney function and weight loss. US Hospital, Academic Institution. We retrospectively reviewed the charts of all patients who underwent SG at our institution from 2010 to 2019. Kidney function assessment using the Chronic Kidney Disease Epidemiology Collaboration Study (CKD-EPI) equation and classification was carried out preoperatively and postoperatively at 12-months follow-up. Propensity score matching (1:1 ratio) was used to balance the distribution of covariates between patients with a baseline estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m2 and patients with normal kidney function. We calculated the eGFR of 1330 bariatric patients who underwent SG. Of these patients, 18.79% (n = 250) met the criteria for CKD-EPI eGFR calculation preoperatively and at 12-months follow-up after SG. From the 250 patients included in the analysis, 42% (n = 105) were classified as CKD stage ≥2. When comparing the baseline preoperative eGFR at 12-months follow-up after SG, we observed an improvement of 8.26 ± 11.89 mL/min/1.73 m2 in CKD stage ≥2 (eGFR <90 mL/min/1.73 m2) as compared with 1.98 ± 10.25 mL/min/1.73 m2 in patients with eGFR >90 mL/min/1.73 m2 (P <.001). There is short-term improvement of the eGFR in patients with severe obesity following SG. This improvement is significant in CKD stages ≥2 and seems unrelated to weight loss. 1. Sleeve gastrectomy is associated with a decrease of kidney function in patients with baseline CKD. 2. The benefits of sleeve gastrectomy on baseline CKD seem not to be related strictly to weight loss. 3. Patients in CKD stage 3 benefit the most following sleeve gastrectomy at 1 year follow-up. [ABSTRACT FROM AUTHOR]

Laparoscopic sleeve gastrectomy (SG) has been proven safe and effective in achieving weight loss. However, the distance from the pylorus where resection should begin has been debated. To compare the clinical outcomes of laparoscopic SG with antrum resection (AR) versus preservation (AP) for bariatric purposes by conducting a meta-analysis of randomized controlled trials (RCT). Academic hospital, United States. PubMed and Cochrane Library were queried for RCTs from establishment to August 2020. The following key search terms were used: "sleeve gastrectomy" AND ("antrectomy" OR "antrum") AND ("randomized" OR "random"). The following data were extracted: author, publication year, country, sample size, follow-up duration, and clinical outcomes, including weight-related: excess weight loss (EWL), total weight loss (TWL), body mass index (BMI), operation time, length of hospital stay, complication rates, and resolution of obesity-related comorbidities. A total of 9 unique RCTs including 492 AR and 385 AP patients were screened and included in the final quantitative analysis. Patients who underwent SG with AR showed higher EWL and TWL at 6 months (EWL: P <.001; TWL: P =.006), and 1 year (EWL: P =.013; P <.001) postoperatively. The BMI was also lower in the AR group 3 months (P =.013) and 6 months (P =.003) postoperatively. However, the EWL and BMI at 2 years were comparable between both groups (P =.222 and P =.908, respectively). No statistical significance was observed in terms of operating time, staple line disruption, bleeding, complications with a Clavien-Dindo Grade >III, resolution of comorbidities (hypertension, diabetes, hyperlipidemia, arthritis/back pain), and de novo gastroesophageal reflux disease (P >.05). AP was associated with a slightly shorter postoperative hospital stay (4.0 versus 3.1 days, P =.039). Laparoscopic SG with AR is associated with superior weight loss in the short-term compared with AP. However, mid-term follow-up beyond 1 year showed no significant differences in BMI or incidence of de novo gastroesophageal reflux disease. Based on evidence from randomized controlled trials, laparoscopic sleeve gastrectomy (LSG) with antrectomy is associated with superior short-term weight loss compared to LSG without antrectomy. Both procedures are equally effective in mid-term follow-up and beyond one year. Operating time, staple line disruption, bleeding, complications with Clavien-Dindo grade >3, resolution of comorbidities (hypertension, diabetes, hyperlipidemia, arthritis/back pain) and de novo gastroesophageal reflux disease were similar in both groups. Future randomized controlled trials with long-term results are warranted. [ABSTRACT FROM AUTHOR]

We examined the link between increased intra-abdominal pressure, intracranial pressure, and vasopressin release as a potential mechanism. Intra-abdominal pressure, produced by abdominal-cavity insufflation with carbon dioxide (CO 2) during laparoscopic abdominal procedures to facilitate visualization, is associated with various complications, including arterial hypertension and oliguria. Mean arterial pressure, optic nerve sheath diameter, measured as a proxy for intracranial pressure, plasma vasopressin, serum and urine osmolarity, and urine output were measured 4 times during laparoscopic sleeve gastrectomy in 42 patients: before insufflation with CO 2 (T 0); after insufflation to 15 cm water (H 2 O) pressure, with 5 cm H 2 O positive end-expiratory pressure (T 1); after positive end-expiratory pressure was raised to 10 cm H 2 O (T 2); and after a return to the baseline state (T 3). Mean values at T 0 to T 3 and the directional consistency of changes (increase/decrease/ unchanged) were compared among the 4 data-collection points. Statistically significant elevations (all P ≤.001) were noted from T 0 to T 1 and from T 0 to T 2 in mean arterial pressure, optic nerve sheath diameter, and vasopressin, followed by decreases at T 3. For optic nerve sheath diameter and vasopressin, the increases at T 1 and T 2 occurred in 98% and 100% of patients, ultimately exceeding normal levels in 88 and 97%, respectively. Conversely, urine output fell from T 0 to T 1 and T 2 by 60.9 and 73.4%, decreasing in 88.1% of patients (all P <.001). Patients with class II obesity exhibited statistically greater increases in optic nerve sheath diameter and vasopressin, but statistically less impact on urine output, than patients with class III obesity. Increased mean arterial pressure, intracranial pressure, and vasopressin release appear to be intermediary steps between increased intra-abdominal pressure and oliguria. Further research is necessary to determine any causative links between these physiological changes. [ABSTRACT FROM AUTHOR]

In the past five 5 years our team has studied the effects of bariatric surgery on chronic kidney disease (CKD) at our institution. The objective of this study was to assess the impact of bariatric surgery (BaS) on the prevalence and likelihood of CKD and end-stage renal disease (ESRD) nationwide. Academic hospital, United States. We conducted a retrospective analysis of the U.S. National Inpatient Sample (NIS) database for the years 2010–2015 and compared. Univariate and multivariable analysis were performed to assess the impact of BaS on the point prevalence and the probability of CKD and ESRD. Similarly, a multivariable logistic regression was conducted to measure the impact of the most important risk factors for CKD exclusively in a severely obese population. Data on 296,041 BaS cases and 2,004,804 severely obese controls was extracted from the NIS database and relative to controls, all baseline CKD risk factors were less common among bariatric surgery cases. Nonetheless, even after adjusting for all CKD risk factors, controls exhibited marked increases in the odds of CKD-stage III (odds ratio [OR] 3.10 [3.05–3.14], P <.0001) and modes increase for ESRD (OR 1.13 [1.09–1.18], P <.0001). Overall, even after adjusting for risk factors we observed that the rate of CKD is significantly higher in the control group, 12% when compared with 5.3% in the bariatric surgery group (P <.0001). In this retrospective, case control study of a large, representative national sample of patients with severe obesity, BaS was found to be associated with significantly reduced point-prevalence and likelihood for CKD when adjusted for baseline CKD risk factors as compared with patients with obesity who did not undergo BaS. Overall, BaS resulted in a reduced rate and a moderate decrease in the likelihood of ESRD. 1. Bariatric surgery is associated with a decrease on the prevalence of chronic kidney disease and end stage renal disease. 2. Bariatric surgery is strongly associated with a decrease in the odds of prevalence for chronic kidney disease. 3. Severely obese patients with an accompanying diagnosis of diabetes carry the highest risk for chronic kidney disease. [ABSTRACT FROM AUTHOR]

Obesity is considered a major cardiovascular risk factor. The excess of pericardial fat (PF) in patients with obesity has been associated with a variety of electrocardiographic alterations. In previous studies, we demonstrated that rapid weight loss and bariatric interventions result in decreased PF. The aim of this study is to report the changes in PF after bariatric surgery and its effect on ventricular conduction. US hospital, academic institution. A linear measurement of PF thickness on computed tomography scans was obtained for 81 patients, as well as a retrospective review of electrocardiographic changes before and after bariatric surgery. We compared the changes in PF thickness and electrocardiographic components before and after procedures. Common demographics and co-morbidities were collected along with lipid profiles preoperative and postoperative. A total of 81 patients had electrocardiograms done before and 1 year after bariatric surgery. Females comprised 67.9% (n = 55), and the average age for our population was 55.07 ± 14.17 years. Pericardial fat thickness before surgery was 5.6 ± 1.84 and 4.5 ± 1.62 mm after surgery (P =.0001). Ventricular conduction (QT and QT corrected [QTc] intervals) showed a significant improvement from 438.7 + 29 before to 426.8 + 25.3 after bariatric surgery (P =.006). We found a statistically significant association between the decrease in PF and the decrease in QTc intervals (P =.002). Obesity is a risk factor for arrhythmias and sudden cardiac death. Bariatric surgery and its effect on PF produce an improvement in ventricular conduction, which may reduce the ventricular electrical instability in patients with obesity. 1. Bariatric surgery and rapid weight loss in patients with obesity is associated with a decreased pericardial fat thickness. 2. Bariatric surgery induces a significant decrease in QT intervals (ventricular conduction). 3. There is a positive correlation between the decrease in pericardial fat thickness and QT interval [ABSTRACT FROM AUTHOR]

Considerable evidence documents the effectiveness and efficacy of bariatric surgery (BaS) in reducing the prevalence and severity of obesity-related co-morbidities. Diastolic heart failure (DHF) is a condition with considerable morbidity and mortality, yet recalcitrant to medical therapy. Our objectives were to assess whether BaS is associated with a decrease in hospital admissions for DHF and determine its impact upon DHF hospital admissions among patients with hypertension (HTN) and coronary artery disease (CAD). Academic institution. Data on 296 041 BaS cases and 2 004 804 controls with severe obesity were extracted from the US National Inpatient Sample database for the years 2010 to 2015 and compared. Univariate and multivariable analysis were performed to assess the impact of pre-2010 BaS on the rate of hospital admissions for DHF, adjusting for demographics, co-morbidities, and other risk factors associated with cardiovascular disease (CVD). Relative to controls, all baseline CVD risk factors were less common among BaS cases. Nonetheless, even after adjusting for all CVD risk factors, controls exhibited marked increases in the odds of DHF overall (odds ratio = 2.80; 95% confidence interval = 2.52–3.10). Controls with HTN and CAD demonstrated an almost 3-fold increase in odds of DHF admissions. Similarly, controls with no HTN demonstrated a 5-fold increase in odds of admissions for DHF when compared to the surgical group. In this retrospective, case control study of a large, representative national sample of patients with severely obesity, BaS was found to be associated with significantly reduced hospitalizations for DHF when adjusted for baseline CVD risk factors. It also reduced DHF incidence in high-risk patients with HTN and CAD. 1. Bariatric surgery is associated with a decrease in hospital admissions for acute diastolic Heart failure. 2. Bariatric surgery is associated with a decrease in the odds of prevalence and hospital admissions for chronic diastolic heart failure. 3. Bariatric surgery is a feasible therapeutic measure in patients with severe obesity and diagnosis of diastolic heart failure. [ABSTRACT FROM AUTHOR]

The incidence of obesity has been steadily increasing, especially in developed countries. Also, obesity is considered one of the modifiable risk factors of kidney cancer. This study aims to determine the impact of bariatric surgery-induced weight loss on the prevention of kidney cancer. Academic Hospital, United States. The National (Nationwide) Inpatient Sample (NIS) was queried for the period 2010 to 2015 for first-time kidney cancer-related hospitalization, used as a proxy for cancer incidence, in patients with a history of bariatric surgery (cases) and patients with obesity but no history of bariatric surgery (controls). Patients with a previous diagnosis of cancer were excluded from the analysis. In order to identify comparable patients, all controls had to have a body mass index ≥35 kg/m2, as per the existing qualification criteria for bariatric surgery. The International Classification of Diseases-9 codes (ICD-9) was used to identify admissions for kidney cancer. A univariate analysis was conducted to compare demographics and co-morbidities between groups. A multivariate logistic regression model was performed to assess differences between surgical and control groups and adjust for independent variables such as smoking history and family history of malignancy. All percentages and means (with confidence intervals [CIs]) were weighted. A total of 2,300,845 were included in the analysis, of which 2,004,804 controls-subjects, with a mean age of 54.4 ±.05 years, and 296,041 treatment-subjects, with a mean age of 51.9 ±.05 years. Demographics and co-morbidities, such as tobacco use, diabetes, and hypertension, were also measured. Patients with a history of bariatric surgery were significantly less likely to experience renal cancer than patients without a history of bariatric surgery, with 5935 cases in the control group and 684 in the case group (P <.0001). After a multivariate logistic regression was performed, the OR was 1.10 (95% CI: 1.02–1.22, P <.0224). Our finding suggests that bariatric surgery-induced weight loss could significantly prevent first-time kidney cancer-related hospitalizations in patients with obesity. Prospective studies are needed to confirm our findings. Brief summary The aim of our study was to evaluate the impact of rapid weight loss following bariatric surgery on first time hospitalization for kidney cancer, when compared with a severely obese control group. Highlights 1. Rapid weight loss via bariatric surgery in patients with obesity is associated with decrease incidence for obesity-related cancer, such as kidney cancer. 2. Rapid weight loss via bariatric surgery decreases other known risk factors of the development of kidney cancer, such as Diabetes Mellitus and Hypertension. 3. Bariatric Surgery is a feasible and safe procedure in patients with obesity. [ABSTRACT FROM AUTHOR]

The population undergoing bariatric surgery (BaS) has many cardiovascular risk factors that can lead to significant perioperative cardiovascular morbidity. We aimed to examine trends in the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) after BaS. Academic Hospital, United States We performed a retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry for patients aged ≥18 years undergoing laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) from 2015 to 2019. Data on demographics, co-morbidities, and type of procedure were collected. MACCE was defined as a composite variable including perioperative acute myocardial infarction (AMI), cardiac arrest requiring cardiopulmonary resuscitation, acute stroke, and all-cause mortality. We utilized the Cochrane-Armitage and Jonckheere-Terpstra tests to assess for significant trend changes throughout the years. A total of 752,722 patients were included in our analysis (LSG = 73.2%, LRYGB = 26.8%). Postoperative MACCE occurred in 1058 patients (.14%), and was more frequent in patients undergoing LRYGB (.20%). The frequency of MACCE declined from.17% to.14% (P =.053), driven by a decline in the frequency of AMI (.04% to.02%, P =.002), cardiac arrest (.05% to.04%, P =.897), and all-cause death (.11% to.08%, P =.040), but with an increase in perioperative stroke (.01% to.02%, P =.057). The overall risk of MACCE after BaS is.14% and has been declining in the last 5 years. This trend is likely multifactorial and further analysis is necessary to provide a detailed explanation. 1. The population undergoing bariatric surgery has many cardiovascular risk factors that can lead to significant perioperative cardiovascular morbidity. 2. The overall risk of MACCE after bariatric surgery is 0.14% and has been declining in the last 5 years. 3. This decrease was driven by a decline in the frequency of acute myocardial infarction, and all-cause death mortality. [ABSTRACT FROM AUTHOR]

Obesity independently increases the risk of hospitalization due to viral respiratory infections, including influenza virus and, more recently, severe acute respiratory syndrome coronavirus 2. As an independent risk factor, obesity impairs the immune response to viral infections and decreases the effectiveness of immunizations. Using influenza as a proxy, we aimed to determine the impact of bariatric surgery (BaS) on the risk of hospitalization due to viral respiratory infections. Academic hospital, United States. National (Nationwide) Inpatient Sample data collected from 2010 to 2015 were examined. Patients were classified as treatment and control groups. Treatment subjects were defined as patients with a history of BaS and control subjects as patients with a body mass index ≥35 kg/m2 and without a history of BaS. Any hospitalization with influenza as a primary diagnosis was identified. Univariate analysis and multivariate regression models were performed to assess the differences between groups. A total of 2,300,845 subjects were reviewed, of which 2,004,804 were control subjects and 296,041 were treated patients. Univariate analysis showed that the hospitalization rate in the treatment group was significantly lower than in the control group (.007% versus.019%, P <.0001), which was confirmed after adjusting for covariables (control versus treatment: odds ratio = 2.21, P =.0010). BaS may decrease the risk of hospitalization due to influenza, but further prospective studies are needed to confirm these results. We also suggest that these results should be translated into the development of similar studies to determine the impact of BaS on the incidence and severity of the coronavirus disease 2019. 1. Obesity independently increases the risk of hospitalization due to viral respiratory infections. 2. As an independent risk factor, obesity impairs the immune response to viral infections and decreases the effectiveness of immunizations. 3. Patients with a previous history of BaS have a lower risk of being admitted to the hospital with a primary diagnosis of influenza infection [ABSTRACT FROM AUTHOR]

Gastroesophageal reflux disease (GERD) is a common disease in patients with obesity. The incidence of de novo GERD and the effect of bariatric surgery on patients with pre-existing GERD remain controversial. Management of GERD following bariatric surgery is complicated and can range from medical therapy to non-invasive endoscopic options to invasive surgical options. To address these issues, we performed a systematic review of the literature on the incidence of GERD and the various modalities of managing GERD in patients following bariatric surgery. Given the increased number of laparoscopic sleeve gastrectomy (LSG) procedures being performed and the high incidence of GERD following LSG, bariatric surgeons should be familiar with the options available to manage GERD following LSG as well as other bariatric procedures. • The effect of bariatric surgery on GERD remains controversial. • Management of GERD following bariatric surgery is complex. • Bariatric surgeons should be familiar with GERD management options. [ABSTRACT FROM AUTHOR]

Aortic dissection (AD) is an uncommon but life-threatening condition associated with high morbidity and mortality. Hypertension (HTN) and hyperlipidemia (HLD) are common modifiable risk factors. Since bariatric surgery is associated with remission of obesity-related co-morbidities, we hypothesize that surgical weight loss might be protective against this feared aortic pathology. A cross-sectional analysis was performed using the National Inpatient Sample database from 2010 to 2015. The treatment group included bariatric patients and the control group patients with obesity (body mass index [BMI] ≥ 35kg/m2) without previous bariatric surgery. Analyzed covariates included demographics, co-morbidities, aortic diseases, and AD. A multivariate logistic regression analysis (MLRA) was performed to assess the odds of admission for AD in both groups. A total of 2,300,845 patients were identified (2,004,804 controls and 296,041 cases). The mean (SEM) age was 54.4 (.05) versus 51.9 (.05) years, for the control and treatment groups, respectively (P <.0001). Bariatric patients posed a significantly lower prevalence of type 2 diabetes (T2D), HTN, HLD, aortic aneurysm, and bicuspid aortic valve (P <.0001) than control subjects. In the control group, 1411 individuals (.070%) had AD, whereas only 94 patients (.032%) in the bariatric surgery group had such diagnosis (P <.0001). The MLRA showed that non-bariatric obese patients had a significantly higher likelihood of suffering from AD (OR = 1.8 [95%CI 1.44–2.29] P <.0001). Considering different age groups, bariatric surgery was found to be less associated with admission for AD for individuals below and above 40 years of age (OR = 2.95 [95%CI 1.09–7.99] P =.0345) and (OR = 1.75 [95%CI 1.38–2.22] P <.0001), respectively. Bariatric surgery could be a protective factor against aortic dissection and should be considered in patients with obesity and risk factors for this cardiovascular complication. • Aortic dissection is a life-threatening condition. • Some obesity-related comorbidities are modifiable risk factors for it. • Since bariatric surgery is associated with remission of such risk factors, including hypertension and hyperlipidemia, this surgical intervention seems to decrease likelihood of having aortic dissection in patients with obesity. [ABSTRACT FROM AUTHOR]

Obesity is a major risk factor for the development of metabolic syndrome, coronary artery disease, and heart failure (HF). Rapid weight loss following bariatric surgery can significantly improve outcomes for patients with these diseases. To assess whether bariatric surgery improves ventricular ejection fraction in patients with obesity who have heart failure. Private practice, United States. We conducted a retrospective review of echocardiographic changes in systolic functions in patients with obesity that underwent bariatric surgery at our institution. Patients were divided into 2 groups, those (1) without known preoperative HF and (2) with preoperative HF. We compared the left ventricular ejection fraction (LVEF) before and after bariatric surgery in both groups. Common demographics and co-morbidities were also analyzed. A total of 68 patients were included in the analysis: 49 patients in group 1 and 19 in group 2. In group 1, 59.2% (n = 29) of patients were female, versus 57.9% (n = 11) in group 2. The excess body mass index lost at 12 months was 52.06 ± 23.18% for group 1 versus 67.12 ± 19.27% for group 2 (P =.0001). Patients with heart failure showed a significant improvement in LVEF, from 38.79 ± 13.26% before to 48.47 ± 14.57% after bariatric surgery (P =.039). Systolic function in patients from group 1 showed no significant changes (59.90 ± 6.37 mmHg) before and (59.88 ± 7.85 mmHg) after surgery (P =.98). Rapid weight loss after bariatric surgery is associated with a considerable increase in LVEF and a significant improvement of systolic function. Brief summary The aim of our study was to evaluate the impact of rapid weight loss following bariatric surgery on ventricular ejection fraction in severely obese subjects with heart failure. Highlights 1. Bariatric surgery and rapid weight loss in patients with obesity is associated with an increase in left ventricular ejection fraction. 2. Bariatric surgery induces a significant improvement of ejection fraction and systolic function in obese patients with heart failure. 3. Bariatric Surgery is a feasible and safe procedure in patients with obesity and diagnosis of systolic heart failure. [ABSTRACT FROM AUTHOR]

Bariatric surgery in the elderly population has been reported as feasible and safe. Sleeve gastrectomy (SG) seems to have fewer complications than Roux-en-Y gastric bypass (RYGB) even in the 65 years of age population. We analyzed the difference in weight loss between SG and RYGB in patients age 65 years. To analyze and compare outcomes between SG and RYGB in patients 65 years of age and older. Academic hospital, United States. After internal review board approval, we retrospectively reviewed 2486 patients who underwent either SG or RYGB between 2005 and 2018 at our institution. Basic demographics, preoperative body mass index (BMI), and co-morbidities were described. We identified all patients age ≥65 years and subsequently divided them into 2 groups based on type of bariatric procedure performed. Analysis and comparison of outcomes between these groups were completed. Postoperative BMI was reviewed at 6, 12, and 24 months and percent excess BMI loss (%EBMIL, as defined by the ASMBS clinical committee) was calculated accordingly. The t test and χ2 analysis were performed for nominal and categorical variables, respectively. From 2486 patients reviewed, 22.7% (n = 565) were aged ≥65 years. From these, 43.1% (n = 244) underwent SG and 56.8% (n = 321) underwent RYGB. White and female patients were predominant in both groups. Mean age was similar for both populations (SG: 71.1 ± 4.0, RYGB: 71.7 ± 4.5; P =.12). Pre-procedure mean BMI for both groups was close in value, but the difference was statistically significant (40.5 ± 5.5 for SG versus 43.7 ± 7.2 for RYGB; P <.0001). Postoperative follow-up rates were similar in both groups at 12 and 24 months (SG: 51.2% and 31.6%; RYGB: 48.3% and 34.3%; P =.49 and P =.5). The %EBMIL at 6, 12, and 24 months was higher for the RYGB group than the SG group (59.3 ± 27.9, 72.1 ± 29.5, 77.4 ± 26.1 versus 50.2 ± 21.9, 55.2 ± 25.6, 43.9 ± 32.2; P <.01, P <.01, and P <.01, respectively). Complication rates were significantly higher in RYGB versus SG (27.7% versus 9.4%; P <.01). We observed significantly higher anastomotic ulcer and stricture rates for RYGB versus SG (7.2% and 5.9 versus 0% and 0%; P <.01 and P <.01, respectively). RYGB had a higher rate for gastrointestinal obstruction requiring intervention (2.2% versus.4%; P =.07). A similar de novo gastroesophageal reflux disease rate was noted in both procedures (3.7% versus 3.7%; P =.98). No leaks were reported in either group. Both SG and RYGB are effective weight loss procedures for patients aged ≥65 years. RYGB seems to have higher %EBMIL at 1 and 2 years; however, when compared with SG, complication rates appear to be almost 3 times higher. Both operations seem to have similar efficacy when it comes to comorbidity remission in the elderly patient. As previously known and established, RYGB is superior to SG in terms of weight loss. This tendency was also noted for patients ≥65 years of age. RYGB carries a complication rate three-times higher than SG in patients ≥65 years of age. SG appears to be the best initial procedure for elderly patients as it is both effective for weight loss and comorbidity remission. [ABSTRACT FROM AUTHOR]

Obesity is a well-known risk factor for heart disease, resulting in a broad spectrum of cardiovascular changes. Left ventricular mass (LVM) and contractility are recognized markers of cardiac function. To determine the changes of LVM and contractility after bariatric surgery (BaS). University hospital, United States To determine the cardiac changes in ventricular mass, ventricular contractility, and left ventricular shortening fraction (LVSF), we retrospectively reviewed the 2-dimensional echocardiographic parameters of patients with obesity who underwent BaS at our institution. We compared these results before and after BaS. A total of 40 patients met the inclusion criteria. The majority were females (57.5%; n = 23), with an average age of 63.5 ± 12.1. The excess body mass index (BMI) lost at 12 months was 48.9 ± 28.9%. The percent total weight loss after BaS was 16.46 ± 9.9%. The left ventricular mass was 234.9 ± 88.1 grams before and 181.5 ± 52.7 grams after BaS (P =.002). The LVM index was 101.3 ± 38.3 g/m2 before versus 86.7 ± 26.6 g/m2 after BaS (P =.005). The LVSF was 31% ± 8.8% before and 36.3% ± 8.2% after BaS (P =.007). We found a good correlation between the decrease in LVM index and the BMI after BaS (P =.03). Rapid weight loss results in a decrease of the LVM index, as well as improvement in the left ventricular muscle contractility. Our results suggest that there is left ventricular remodeling and an improvement of heart dynamics following bariatric surgery. Further studies are needed to better assess these findings. Highlights 1. Bariatric surgery and rapid weight loss decrease Ventricular mass index. 2. Bariatric surgery induces left ventricular remodeling 3. Bariatric Surgery improves left ventricular contractility [ABSTRACT FROM AUTHOR]

Body fat distribution is highly associated with metabolic disturbances. Skeletal muscle plays an important role in glucose metabolism, as it serves as an important organ for glucose storage in the form of glycogen. In fact, low muscle mass has been associated with metabolic syndrome, type 2 diabetes (T2D), systemic inflammation, and decreased survival. To compare the relationship between visceral abdominal fat (VAF) and fat free mass (FFM) with the improved glucose metabolism after bariatric surgery. University hospital, United States. A retrospective review was performed of all patients who underwent bariatric surgery between 2011 and 2017 at a university hospital in the United States. In severely obese patients with T2D, we measured the VAF via abdominal computed tomography scan and we calculated the FFM preoperatively and at a 12-month follow-up. Data collected included baseline demographic characteristics and perioperative parameters, such as treatment for hypertension (HTN) and T2D, body mass index (BMI), glycated hemoglobin (HbA1C), glucose, and lipid profile. A total of 25 patients met the inclusion criteria. The average age was 52.5 ± 11.6 years. The initial BMI was 41.41 ± 5.7 kg/m2 and the postoperative BMI was 31.7 ± 6.9 kg/m2 (P <.0001). The preoperative VAF volume was 184.6 ± 90.2 cm3 and the postoperative VAF volume was 93.8 ± 46.8 cm3 at the 12-month follow-up (P <.0001). The preoperative FFM was 55.2 ± 11.4 kg and the postoperative FFM was 49.1 ± 12 kg (P <.072). The preoperative HbA1C was 5.8% ±.9%, which decreased postoperatively to 5.3% ±.4% at the 12-month follow-up (P <.013). Bariatric surgery has been demonstrated to be an effective treatment modality for severe obesity and T2D. Our results suggest that at 12 months, there is a reduction in VAF and HbA1C without a significant loss of FFM. Further prospective studies are needed to better understand these findings. Bariatric surgery has demonstrated to be an effective treatment modality for severe obesity and type 2 diabetes mellitus. Visceral fat seems to be related to insulin resistance in obese patients. This surgical intervention seems to cause a reduction in visceral fat and hemoglobin A1C without a significant loss of free fat muscle mass. [ABSTRACT FROM AUTHOR]

Bile duct injury and conversion-to-open–surgery rates remain unacceptably high during laparoscopic and robotic cholecystectomy. In a recently published randomized clinical trial, using near-infrared fluorescent cholangiography with indocyanine green intraoperatively markedly enhanced biliary-structure visualization. Our systematic literature review compares bile duct injury and conversion-to-open–surgery rates in patients undergoing laparoscopic or robotic cholecystectomy with versus without near-infrared fluorescent cholangiography. A thorough PubMed search was conducted to identify randomized clinical trials and nonrandomized clinical trials with ≥100 patients. Because all near-infrared fluorescent cholangiography studies were published since 2013, only studies without near-infrared fluorescent cholangiography published since 2013 were included for comparison. Incidence estimates, weighted and unweighted for study size, were adjusted for acute versus chronic cholecystitis, and for robotic versus laparoscopic cholecystectomy and are reported as events/10,000 patients. All studies were assessed for bias risk and high-risk studies excluded. In total, 4,990 abstracts were reviewed, identifying 5 near-infrared fluorescent cholangiography studies (3 laparoscopic cholecystectomy/2 robotic cholecystectomy; n = 1,603) and 11 not near-infrared fluorescent cholangiography studies (5 laparoscopic cholecystectomy/4 robotic cholecystectomy/2 both; n = 5,070) for analysis. Overall weighted rates for bile duct injury and conversion were 6 and 16/10,000 in near-infrared fluorescent cholangiography patients versus 25 and 271/10,000 in patients without near-infrared fluorescent cholangiography. Among patients undergoing laparoscopic cholecystectomy, bile duct injuries, and conversion rates among near-infrared fluorescent cholangiography versus patients without near-infrared fluorescent cholangiography were 0 and 23/10,000 versus 32 and 255/10,000, respectively. Bile duct injury rates were low with robotic cholecystectomy with and without near-infrared fluorescent cholangiography (12 and 8/10,000), but there was a marked reduction in conversions with near-infrared fluorescent cholangiography (12 vs 322/10,000). Although large comparative trials remain necessary, preliminary analysis suggests that using near-infrared fluorescent cholangiography with indocyanine green intraoperatively sizably decreases bile duct injury and conversion-to-open–surgery rates relative to cholecystectomy under white light alone. [ABSTRACT FROM AUTHOR]

Gastroparesis (GPS) is a rare disease with multiple etiologies that results in delayed gastric emptying. Diagnosis of GPS can be challenging due to its rather complex clinical presentation. Pharmacologic refractory cases require surgical interventions, all of which have yet to be standardized and characterized. We present a review of the literature and provide an update of current therapies for patients with GPS. Department of General Surgery, Academic Hospital, United States. We conducted a comprehensive search in PubMed, Google Scholar, and Embase of English-written articles published in the last 38 years, with an advance title search of "gastroparesis management." Other keywords included: "surgical management" and "refractory gastroparesis." Further references were obtained through cross-reference. A total of 12,250 articles were selected after eliminating duplicates. Following thorough screening of selection criteria, 68 full-text articles were included for review. GPS is a challenging disease to manage. Nutritional support must remain the primary approach, followed by either medical or surgical treatment modalities if necessary. In patients with refractory gastroparesis, adjunctive therapies have been proposed as promising long-term options. • Gastroparesis is a challenging disease with multiple etiologies. • Medical therapy is widely available in the form of nutritional and pharmacological interventions. • Various surgical alternatives have been proposed to treat refractory gastroparesis. • Multimodal surgical interventions result in better outcomes. • The reduction of symptoms and improvement of the patient's quality of life should be the main goal of the treatment of this disease. [ABSTRACT FROM AUTHOR]

Sleeve gastrectomy (SG) has become the most prevalent bariatric-metabolic surgical approach in the United States. Its popularity among surgeons and patients is mainly due to a better safety profile and less overall morbidity, with broad benefits from a systemic and metabolic perspective. Comprehensively describe the short-term multiorgan metabolic effects of rapid weight loss after SG. Academic hospital, United States. We retrospectively reviewed the charts of patients that underwent SG at our institution between 2012 and 2016. We analyzed the required variables to calculate multiple risk scores, such as cardiovascular, hypertension, and diabetes risk scores. Furthermore, the renal and hepatic functions and the metabolic and hematologic profiles were assessed at 12 months of follow-up. A total of 1002 patients were included in the analysis. The percentage of excess body mass index loss was, on average, 65% at 12 months of follow-up. We observed a positive cardio-renal-hepatic improvement, demonstrated by a substantial reduction of the 10-year cardiovascular risk. We noticed an improvement of renal function, which was more significant in chronic kidney disease (stage ≥2), and a significant improvement on liver function tests (measured by decreased aspartate aminotransferase and alanine transaminase) at 12 months of follow-up. Our data also show a positive impact on decreasing the risk of developing hypertension and type 2 diabetes. There was a positive impact on the lipid profile, with the exception of low-density lipoprotein. There are significant short-term benefits on multiorgan metabolic parameters after rapid weight loss in severely obese patients undergoing sleeve gastrectomy. [ABSTRACT FROM AUTHOR]

Pericardial fat has a local atherosclerotic effect and is associated with both metabolic syndrome (MetS) and coronary artery disease (CAD). The aim of this study is to report changes in pericardial fat thickness (PFT) after bariatric surgery, and to investigate its significance on the risk of developing coronary artery disease (CAD). Academic institution. We retrospectively measured the linear pericardial thickness from patients' computed tomography (CT) scans within 5 years preoperatively and compared to any available CT scan within 5 years postoperatively. The PFT was measured at the right ventricular wall, perpendicular to the myocardium, at the level of the sternum. The risk of developing CAD was estimated by calculating the Framingham risk score (FRS). We divided the patients into 2 groups: laparoscopic sleeve gastrectomy (SG, Group 1), and laparoscopic gastric Roux-en-Y gastric bypass (LRYGB, Group 2). Common demographic characteristics and co-morbidities were collected along with the preoperative and postoperative lipid profiles. A total of 113 patients met the inclusion criteria, with 64 (56.6%) patients in group 1 and 49 (43.3%) patients in group 2. Group 1 consisted of 83.6% (n = 53) female patients versus 75.5% (n = 37) in group 2. The percent excess body mass index loss (%EBMIL) at 12 months was 74.4 ± 35.8% for group 1 versus 67 ± 30.1% for group 2 (P =.292). Pericardial thickness before surgery was 5.6 ± 1.9 mm and 4.6 ± 1.6 mm after surgery (P =.0001). The risk of CAD in females was 9.1% before and 6.6% after surgery. We found statistically significant linear association between pericardial thickness after surgery and a lower risk of CAD (P =.001). Bariatric surgery decreases the PFT lowering risk of developing CAD. Further studies may be needed to better assess these findings. • Pericardial fat has a local atherosclerotic effect and is associated with both metabolic syndrome (MetS) and coronary artery disease (CAD). • The aim of this study is to report changes in pericardial fat thickness (PFT) after bariatric surgery (BS), and to investigate its significance on the risk of developing CAD. • Findings are: The obese population is at greater risk of developing CAD. BS decreases the PF thickness, lowering risk of developing CAD. [ABSTRACT FROM AUTHOR]

Bariatric surgery (BaS) is the safest, most effective, and most durable therapy for obesity but is performed in less than 1% of the affected United States (US) population. It is challenging to determine from traditional surveys if this phenomenon is the result of poor access to care or lack of interest among Internet users. The aim of this study was to use Google Trends (GT) as a tool to analyze the US general population interest in BaS. Academic Hospital, United States. GT was used to access data searched for the term bariatric surgery. The gathered information included data from 2008 through 2018 in English within the US. Search frequency, time intervals, locations, frequent topics of interest, and related searches were analyzed. GT reports search frequency on means, and a value of 100 represented peak popularity. The number of Google searches related to the term bariatric surgery has gradually increased over time, from a mean of 67% in 2008 to a 94% interest in 2017. Regarding interest by subregion in 2017, the state of Michigan lead the frequency of searches, followed by Indiana, Delaware, West Virginia, and Tennessee. Top searched terms by frequency were the following: patient eligibility for BaS, what is BaS, what are the complications of BaS, financial costs of BaS, and what insurance companies cover BaS. It appears that traditional Web sites only address a few. GT complements the understanding of interest in BaS. Using these trends can improve an Internet user's education, and tailor specific official Web sites for the public's general interest. • Bariatric surgery • Google trends • Patient therapeutic education • Worldwide web • Web-based search engines • US web-based search tendencies [ABSTRACT FROM AUTHOR]

According to the U.S. Centers for Disease Control, cancers linked to overweight or obesity accounted for roughly 40% of all U.S. malignancies in 2014. The primary aim of this epidemiologic study was to assess whether bariatric surgery might have any preventative role against obesity-linked cancers among individuals with obesity. Hospitals across the United States participating in the National Inpatient Sample database, created, updated, and monitored by the U.S. Healthcare Cost and Utilization Project. National Inpatient Sample data collected from 2010 to 2014 were examined to identify any difference in the number of first cancer-related hospitalizations, as a proxy for cancer incidence, between patients with a history of prior bariatric surgery (cases) and those without (controls). Patients with any prior cancer diagnosis were excluded. To match the body mass index ≥35 kg/m2 generally required for bariatric surgery, all controls had to have a body mass index ≥35 kg/m2. International Classification of Diseases-9 codes were employed to identify admissions for 13 obesity-linked cancers. Multivariate logistic regression analysis was performed to identify any case-control differences, after matching for all baseline demographic, co-morbidity, and cancer risk-factor variables. All percentages and means (with confidence intervals) were weighted, per Healthcare Cost and Utilization Project guidelines. Among 1,590,579 controls and 247,015 bariatric surgery cases, there were 29,822 (1.93%; 95% confidence interval 1.91–1.96) and 3540 (1.43%; 1.38–1.47) first hospitalizations for cancer (adjusted odds ratio 1.17; 1.13–1.23; P <.0001). Preliminary findings from a large U.S. database suggest that bariatric surgery may reduce the incidence of cancer in patients considered at high risk because of severe obesity. [ABSTRACT FROM AUTHOR]

The number of patients undergoing bariatric surgery with prior cardiac revascularization (CR) is rising. However, scarce data exist regarding the safety of bariatric procedures in these patients. The aim of this study is to compare postoperative cardiovascular and noncardiovascular outcomes among patients with different CR procedures. Academic hospital, United States. We retrospectively reviewed 2884 patients undergoing bariatric surgery from 2009–2018. Patients with prior CR were included and stratified into groups: coronary artery bypass graft (CABG), percutaneous coronary intervention with stent (PCI), and CABG + PCI. We described patient demographic characteristics, co-morbidities, smoking status, history of myocardial infarction, type of bariatric surgery, number of vessels grafted/stents, time from CR to bariatric surgery, length of stay, and cardiovascular and noncardiovascular 30-day outcomes. A control group composed of patients without prior CR undergoing bariatric surgery was used to compare the rate of complications to the total patients with prior CR. For continuous and categorical variables, t test and χ2 tests were performed, respectively. We identified 76 patients with prior CR undergoing bariatric surgery. The mean patient age was 61.4 ± 7.9 years, the mean body mass index was 41.7 ± 6.5 kg/m2, and male sex was predominant (71.1%). Among these, 50% (n = 38) had PCI, 39.4% (n = 30) had CABG, and 10.5% (n = 8) had CABG + PCI. Early cardiovascular complications rate included ST-segment-elevation myocardial infarction (n = 2), pulmonary embolism (n = 1), supraventricular arrhythmia (n = 2), ventricular arrhythmia (n = 1), and pacemaker/defibrillator-insertion (n = 1). The overall rate of cardiovascular and noncardiovascular complications was 9.2% (n = 7) and 10.5% (n = 8) during the 30 days. Mortality rate was 0%. Comparison of rate of complications between groups did not show any statistical difference; no significant difference was found when comparing patients with prior CR to the 76 patients in the control group (P >.05). Although revascularized individuals have severe co-morbidities and are high-risk patients, bariatric surgery remains safe in this population when outcomes are compared with bariatric patients without prior CR. [ABSTRACT FROM AUTHOR]

Coronary heart disease (CHD) accounts for one third of all deaths in people older than 35 years in the United States. The aim of this study is to determine the impact of bariatric surgery, especially laparoscopic sleeve gastrectomy, on the risk of developing CHD. Academic, University affiliated hospital. We retrospectively reviewed all patients who underwent bariatric surgery from 2010–2016. All patients between 30 and 74 years of age without a previous history of CHD were included in our study. The risk score for predicting the incidence of CHD was measured preoperatively and at 12 months of follow-up. Of the 1330 patients studied, 225 patients (16.9%) had all the required variables to calculate the CHD risk score. The mean age of our population was 51.4 ± 11.3 years, mostly female (67%, n = 152) and white (58.7%, n = 132). At the preoperative setting, our patient population had a systolic blood pressure in the prehypertensive ranges, with 40% (n = 90) having type 2 diabetes and 60% (n = 134) having arterial hypertension. The preoperative CHD preoperative risk was 8.9 ± 7.7% or 8-fold higher than the ideal risk. After 12 months of follow-up, the CHD absolute risk reduction was 2.7%, and the relative risk reduction was 42.0% for female patients and 5.4% and 38.8%, respectively, for male patients. All the metabolic factors used to calculate the risk of developing CHD had a significant improvement after 12 months. Surgical weight loss reduces the risk of developing CHD. Further studies should assess these findings in a long-term follow-up. [ABSTRACT FROM AUTHOR]

Despite its popularity, sleeve gastrectomy (SG) is not devoid of postoperative complications and weight regain. Some of these cases warrant conversion to Roux-en-Y gastric bypass or proximal gastrectomy with Roux-en-Y esophagojejunostomy. Complications after conversion are scarcely reported in the literature. Report and review the outcomes of reoperation on severely obese patients with weight regain or complications after SG. Bariatric Surgery Center of Excellence; Community Hospital, United States. We retrospectively reviewed the medical records of patients converted from SG to Roux-en-Y gastric bypass/proximal gastrectomy with Roux-en-Y esophagojejunostomy at our center, from 2004 to 2018. Patients were stratified by reason for conversion. Group A included those converted for complications (leaks, strictures, or gastroesophageal reflux disease) and group B for reported weight regain. Demographic characteristics, postoperative outcomes, and complications were described. From 77 conversions identified, 63.6% (n = 49) underwent primary SG at an outside hospital. We observed predominant female (68.8%; n = 53) and Caucasian (76.6%; n = 59) populations. Conversions for complications were performed in 67.5% (n = 52) and for weight regain in 32.4% (n = 25). The most common conversion indication in group A was chronic leak (29.9%; n = 23), followed by gastroesophageal reflux disease (20.8%; n = 16), and stricture (16.9%; n = 13). Overall, major complications occurred in 16.9% (n = 13) and minor complications in 19.4% (n = 15). In group A, most common major complications were anastomotic leak and organ space surgical site infection (3.9%; n = 2 each); the most common minor complication was nonperforated marginal ulcer (7.7%; n = 4). In group B, the most common major complication was perforated marginal ulcer (8%; n = 2); the most common minor complication was stricture (16%; n = 4). Group B mean preconversion body mass index was 38.4 ± 4.3 and percentage excess body mass index loss was 48 ± 33, 63 ± 45, 59 ± 63, and 73 ± 25 (12, 24, 36, ≥48 mo). Our experience shows that major complications can occur in up to 17% of patients after conversion. Conversion to Roux-en-Y gastric bypass in nonresponders appears to be a safe and effective option for body mass index reduction. [ABSTRACT FROM AUTHOR]

Abdominal compartment syndrome has been linked to detrimental hemodynamic side effects that include increased intracranial pressure and diminished renal function, but the mechanisms behind this continue to be elucidated. In this study, we sought to investigate any direct association between acute elevations in intra-abdominal pressure and intracranial hypertension during experimentally induced abdominal compartment syndrome and between acutely elevated intracranial pressure and the hemodynamic response that might be elicited by a vasopressin-induced Cushing reflex affecting urine osmolality and urine output. The aim of this study is to explain the Cushing reflex and the vasopressin-mediated hemodynamic response to intracranial pressure during acute elevations in intra-abdominal pressure. We measured intra-abdominal pressure, intrathoracic pressure, optic nerve sheath diameter as an indirect sign of intracranial pressure, vasopressin levels in blood, urine osmolality, and urine output at 4 time points during surgery in 16 patients undergoing sleeve gastrectomy for morbid obesity. Values for the 4 time points were compared by repeated-measures analysis of variance. More than 50-fold elevations in serum vasopressin paralleled increases in optic nerve sheath diameter, rising throughout prepneumoperitoneum and tapering off afterward, in conjunction with a marked decrease in urine but not serum osmolality. Mean arterial pressure rose transiently during pneumoperitoneum without elevated positive end-expiratory pressure but was not significantly elevated thereafter. These findings support our hypothesis that the oliguric response observed in abdominal compartment syndrome might be the result of the acutely elevated intra-abdominal pressure triggering increased intrathoracic pressure, decreased venous outflow from the central nervous system, increased intracranial pressure, and resultant vasopressin release via a Cushing reflex. [ABSTRACT FROM AUTHOR]

Morbid obesity is strongly associated with hypertension. The objective of this study is to compare the risk of developing hypertension before and after bariatric surgery. U.S. university hospital. We retrospectively reviewed all patients who underwent bariatric surgery from 2010 to 2015 at our institution. Nonhypertensive white individuals without diabetes at baseline were included in our study. The Framingham Hypertension Risk Score was used to predict the near-term incidence of the disease. This calculator predicts 1-, 2-, and 4-year incidence of hypertension. A total of 475 patients met the criteria for the hypertension risk score calculation. Females composed 72% (n = 342) of our population with a mean age of 42.6 ± 11.6 years. Laparoscopic sleeve gastrectomy was the most prevalent procedure at 81.89% (n = 389). At 12- month follow-up, the 1-year absolute risk reduction (ARR) and the relative risk reduction (RRR) were 6.2% and 69.2% (P <.01), respectively. The 2-year ARR was 11.9%, with an RRR of 67.9% (P <.01). The 4-year risk was also calculated at 12-month follow-up, resulting in an ARR of 20.1%, and RRR of 63.7% (P <.01). Furthermore, stratifying by type of procedure, the results were comparable between sleeve gastrectomy and Roux-en-Y gastric bypass. Regarding blood pressure values at 12-month follow-up, the systolic blood pressure was reduced 11.4 mm Hg (P <.01) and the diastolic blood pressure was reduced 4.4 mm Hg (P =.07). The percentage of estimated body mass index loss at 12-month follow-up was 71.7%. Sleeve gastrectomy and Roux-en-Y gastric bypass significantly diminish the risk of developing hypertension in morbidly obese patients. Prospective studies are needed to better comprehend these findings. • Morbid obesity is strongly associated with hypertension. • The objective of this study is to compare the risk of developing hypertension prior to and following bariatric surgery. • We retrospectively reviewed all patients who underwent bariatric surgery from 2010 to 2015 at our institution; non-hypertensive white individuals without diabetes at baseline were included in our study. • LSG and RYGB significantly diminish the risk of developing hypertension in morbidly obese patients. Prospective studies are needed to better comprehend these findings. [ABSTRACT FROM AUTHOR]

Highlight • This study analyzed the impact of laparoscopic sleeve gastrectomy (LSG) in the risk reduction of developing type 2 diabetes in otherwise severely obese non-diabetic patients. • Laparoscopic sleeve gastrectomy significantly decreases the risk of developing T2DM in middle-aged severely obese patients. • Prospective studies are needed to further understand these findings. Abstract Background Obesity is a major independent risk factor for developing type 2 diabetes (T2D). Objectives Our goal in this study was to analyze the impact of laparoscopic sleeve gastrectomy in the risk reduction of developing T2D in middle-aged, severely obese nondiabetes patients. Setting University Hospital, United States. Methods We retrospectively reviewed our prospectively collected database from 2010 to 2016. All severely obese patients between 45 and 64 years of age without diabetes at baseline that underwent sleeve gastrectomy were included in our study. The T2D risk score for predicting the incidence of diabetes was measured preoperatively and at 12 months postoperatively and was based on the Framingham Offspring Study that calculates an 8-year risk of developing T2D. Results Of the 1330 patients included in this study, 6.5% (n = 86) met the criteria for the T2D risk score calculation. The population was predominantly composed of females (68.9%; n = 59) with a mean age of 52.8 ± 5.3 years. Preoperative body mass index was 43.1 ± 6.9 kg/m2 with a percentage of estimated body mass index loss and percentages of total weight loss were 72.2 ± 26.3% and 26.39 ± 18.15%, respectively, with fasting plasma glucose of 103.3 ± 14.9 mg/dL. The preoperative risk for T2D was 13.9 ± 11.6%, with an absolute risk reduction 12 months after surgery of 10.3%, corresponding to a 74.2% relative risk reduction. When comparing between sexes, risk reduction in females was slightly better than in males; however, this was not statistically significant. At 12-month follow-up, all measured variables were significantly improved, except for diastolic blood pressure. Conclusions Laparoscopic sleeve gastrectomy significantly decreases the risk of developing T2D in middle-aged severely obese patients. Prospective studies are needed to further understand these findings. [ABSTRACT FROM AUTHOR]

Abstract Background Bariatric surgery has proven to be the most durable treatment for obesity, and it also provides improvement of obesity's associated co-morbidities. Although several mechanisms for its metabolic effects have been studied, the implications of the surgically constructed anatomy on its functioning physiology have not been elucidated. This leaves some uncertainty regarding the recommended limb lengths in Roux-en-Y gastric bypass. The alimentary limb length and function has been studied extensively, but few have studied the influences of the biliopancreatic limb length. Objective To present a systematic review of the literature comparing variations in length of BP limb and results in order to determine BP limb length influence. Setting Academic Hospital, United States. Methods We present a systematic review of all the articles comparing variations of the biliopancreatic limb length and their results. Results Thirteen articles were identified and analyzed. Most of the articles are prospective studies. Weight loss was superior in longer limbs. Conclusion Based on our review of the subject, we can conclude that the release of enterohormones in response to a food load in the distal small bowel seems to play an important role in the remission of co-morbidities. Hence, the length of the biliopancreatic limb might affect this process. [ABSTRACT FROM AUTHOR]

Abstract Background There is a paucity of studies comparing risk reduction of the atherosclerotic cardiovascular disease (ASCVD) and Framingham-body mass index (BMI) Coronary Heart risk score after a laparoscopic Roux-en-Y gastric bypass (RYGB), and few studies have assessed the efficacy of laparoscopic sleeve gastrectomy (SG) in reducing cardiovascular risk. Objective Our goal in this study was to compare the impact of SG and RYGB on cardiovascular risk reduction. Setting U.S. university hospital. Methods We retrospectively reviewed the records of all SG or RYGB cases at our institution between 2010 and 2015. Patients who met the criteria for calculating the ASCVD 10-year and Framingham-BMI score were included in the study. Propensity score matching was used to match SG and RYGB on demographic characteristics and co-morbidities. Results Of the 1330 bariatric patients reviewed in the study period, 219 (19.3%) patients met the criteria for risk score calculation. SG was the most prevalent surgery in 72.6% (N = 159) of cases compared with RYGB in 27.4% (N = 60) of cases. At 12-month follow-up, ASCVD 10-year score had an absolute risk reduction of 3.9 ± 6.5% in SG patients and 2.9 ± 5.8% in RYGB patients (P =.3). Framingham-BMI score absolute risk reduction was 11.0 ± 12.0% in SG and 9.0 ± 11.0% in RYGB patients (P =.4), and the decrease in estimated heart age was 12.1 ± 15.6 years in SG versus 9.2 ± 9.6 years in RYGB (P =.1). The percentage of estimated BMI loss at 1 year was 68.1 ± 23.3% in SG versus 74.2 ± 24.8% in RYGB (P =.1). Conclusion Our results suggest that SG and RYGB are equally effective in improving cardiovascular risk and decreasing the estimated vascular/heart age at 12-month follow-up. [ABSTRACT FROM AUTHOR]

Background Gastroparesis (GP) is a chronic disorder of gastric motility with delayed gastric emptying. Gastric electrical stimulator (GES) implantation and Roux-en-Y gastric bypass (RYGB) are surgical options for medically refractory GP. Objective Evaluate operational outcomes and symptom improvement of patients with diabetic (DM) and idiopathic (IP) GP. Setting University Hospital, United States. Methods A retrospective chart review was performed of all patients who underwent surgical treatment of GP from February 2003 to December 2014. Subgroup analysis was performed based on etiology of GP (DM versus IP) and procedure received (GES versus RYGB). Postoperative outcomes and postoperative symptom improvements were compared between groups. Results Of 93 patients, 47 (50.5%) had IP and 46 (49.5%) had DM. The majority underwent GES implantation (83.8%, n = 78), and 15 patients (16%) underwent RYGB. There were significant differences in hospital stay (2 versus 3 days) and reoperation rate (30% versus 7%) between IP and DM. Operation time, complication rate, and 30-day readmission rate were similar in both groups. DM patients significantly improved GP-related complaints compared with preoperatively. IP patients also improved nausea and vomiting and had no change in abdominal pain between pre- and postoperative period. GES showed significant improvement of nausea, vomiting, and abdominal pain. RYGB showed improvement of nausea, but not vomiting or abdominal pain. Conclusions Surgery is a feasible intervention for GP for both DM and IP patients; however, based on the data presented in this manuscript and the current literature, the use of gastric bypass as an effective treatment modality for patients with intractable GP remains highly controversial. Care must be taken for IP patients in the postoperative period due to high incidence of reoperation. Although both procedures offer some degree of symptomatic improvement, GES seems to provide improvement of more GP symptoms. However, there is no significant difference in the need for postoperative medications regardless of the procedure used. [ABSTRACT FROM AUTHOR]