Abdominal wall surgery in bariatric patients

Morbid obesity is one of the main factors related to hernia recurrences after an open repair, while laparoscopic approach has offered excellent results in this type of patients. Concomitant laparoscopic bariatric procedure and ventral hernia repair (VHR) with intraperitoneal mesh has been described as a safe option, but the need to place a mesh intraperitoneally has arisen some concerns. However, the literature does not show good results with the use of transfascial suture neither for primary closures nor with biological meshes. There is still not enough evidence to reach a consensus regarding when is the best time to perform the hernia repair on patients undergoing bariatric surgery, simultaneously or differing the hernia repair. For that reason, it seems that an individualized approach is recommended, informing the patient of the risks and benefits of each option. The type of bariatric surgery, the type and location of the hernia, previous surgery in case of an incisional hernia, symptoms related to the hernia and the surgical approach are factors to be analyzed. It is necessary to consider repairing simultaneously a ventral hernia (VH) in the patient who is going to undergo a bariatric procedure or differing it in order to perform simultaneously a concomitant repair (CR) and the dermolipectomy needed after weight loss. For this reason, only clear symptomatic hernias are recommended to be repair during the bariatric procedure. Finally, it is important to inform properly the patient about possible changes intraoperatively of the bariatric procedure because existing findings, especially due to the presence of adhesions

Minimally invasive distal pancreatectomy A retrospective review of 30 cases

OBJECTIVES: Pancreatic surgery has been greatly influenced by the advent of laparoscopic surgery and increasing experience in its performance and by advances in techniques and surgical devices. This study aimed to represent two centers' initial experiences in laparoscopic distal pancreatic surgery

EAES rapid guideline: systematic review, network meta-analysis, CINeMA and GRADE assessment, and European consensus on bariatric surgery-extension 2022

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