¿Cómo guía la mente al cuerpo? Reganancia de peso dos años después de la cirugía bariátrica, desde un enfoque psico-social.

Introduction: There is no consensus about the cause-effect relationship between psychopathologies and obesity, but it is accepted that the emotional state can interfere with the destructuring of eating patterns and sedentary lifestyle, having an important influence on both body weight. Objective: To analyze the relationship between psychiatric disorders and weight loss failure, two years after bariatric surgery. Material and methods: Cohort, retrospective study. Population: 331 patients who underwent bariatric surgery from 2007 to 2016 at the Hospital de la Santa Creu and Sant Pau. Sample: 331 patients. The data was obtained from the query log. Methods of descriptive and inferential statistics were applied, the factorial ANOVA test of repeated measures was specified, forall cases, a statistical significance p <0.05 was considered. Results: 331 patients were analyzed, of which 95 (28.7%) men and 236 (n = 71.3%) women. The age range ranged from 18 to 65 years. Gastric sleeve is performed in 208 (62.8%) of cases and bypass in 123 (37.2%). The most frequent eating disorder was Glutton (n = 44; 12.4%). The most frequent psychiatric disorder was depression (n = 34; 76.7%). With the student t-test different differences were obtained in the weight loss in the control at the first year and the second year of the surgery (p <0.05). In the repeated measures factorial ANOVA test, a statistically significant relationship between depressive symptoms and weight loss failure was obtained, similarly, between the type of surgery (gastric sleeve) and the weight loss failure. Conclusion: The history of depressive disorders before surgery and the gastric cuff technique is related to the failure in weight loss in these patients.Introducción: No existe un consenso acerca de la relación causa-efecto entre las psicopatologías y la obesidad, pero se acepta que el estado emocional puede interferir en la desestructuración de los patrones alimentarios y en el sedentarismo, teniendo importante influencia ambos en el peso corporal. Objetivo: Analizar la relación que existe entre los trastornos psiquiátricos y la falla en la pérdida de peso, dos años después de la cirugía bariátrica. Material y métodos: Estudio de cohorte, retrospectivo. Población: 331 pacientes a los que se les realizó cirugía bariátrica desde el año 2007 hasta el año 2016 en el Hospital de la Santa Creu y Sant Pau. Muestra: 331 pacientes. Los datos se obtuvieron del registro de consultas. Se aplicaron métodos de estadística descriptivae inferencial, se utilizó el test de ANOVA factorial de medidas repetidas, para todos los casos, se consideró una significación estadística p<0,05. Resultados: se analizaron 331 pacientes, de los cuales 95(28,7%) hombres y 236 (n=71,3%) mujeres. El rango de edad oscilaba entre los 18 y 65 años. Se practicó sleeve gástrico en 208 (62,8%) de los casos y bypass en 123 (37,2%). El trastorno alimentario más frecuente fue el Glotón (n=44; 12,4%). El trastorno psiquiátrico más frecuente fue la depresión (n=34; 76,7%). Con la prueba t de student se obtuvieron diferencias significativas en la pérdida de peso en el control al primer año y al segundo año de la cirugía (p<0,05). En el test de ANOVA factorial de medidas repetidas, se obtuvo una relación estadísticamentesignificativa entre los síntomas depresivos y la falla en la pérdida de peso, de igual manera, entre el tipo de cirugía (Sleeve gástrico) y la falla en la pérdida de peso. Conclusiones: El antecedente de trastornos depresivos antes de la cirugía y la técnica del Sleeve gástrico se relacionaron con la falla en la pérdida de peso en estos pacientes

A delayed acute complication of bariatric surgery: Gastric remnant haemorrhagic ulcer after Roux-en-Y gastric bypass

Acute gastric remnant bleeding is an exceptionally rare complication when it occurs long after bariatric surgery. We present the case of a patient with a bleeding ulcer of the excluded stomach (i.e., the remnant), occurring 7 years after Roux-en-Y gastric bypass (RYGB) for morbid obesity. A computed tomography scan managed to locate the active bleeding source in the gastric remnant. During emergency laparotomy, a bleeding ulcer of the fundic region of the excluded stomach was identified. Total resection of the remnant was performed, with good post-operative recovery. To the best of our knowledge, this is the first full report of a significantly delayed haemorrhagic ulcer of the gastric remnant, occurring years after RYGB

Surgical challenges and research priorities in the era of the COVID-19 pandemic: EAES membership survey

Background Healthcare systems and general surgeons are being challenged by the current pandemic. The European Association for Endoscopic Surgery (EAES) aimed to evaluate surgeons’ experiences and perspectives, to identify gaps in knowledge, to record shortcomings in resources and to register research priorities. Methods An ad hoc web-based survey of EAES members and affiliates was developed by the EAES Research Committee. The questionnaire consisted of 69 items divided into the following sections: (Iota) demographics, (II) institutional burdens and management strategies, and (III) analysis of resource, knowledge, and evidence gaps. Descriptive statistics were summarized as frequencies, medians, ranges,, and interquartile ranges, as appropriate. Results The survey took place between March 25th and April 16th with a total of 550 surgeons from 79 countries. Eighty-one percent had to postpone elective cases or suspend their practice and 35% assumed roles not related to their primary expertise. One-fourth of respondents reported having encountered abdominal pathologies in COVID-19-positive patients, most frequently acute appendicitis (47% of respondents). The effect of protective measures in surgical or endoscopic procedures on infected patients, the effect of endoscopic surgery on infected patients, and the infectivity of positive patients undergoing laparoscopic surgery were prioritized as knowledge gaps and research priorities. Conclusions Perspectives and priorities of EAES members in the era of the pandemic are hereto summarized. Research evidence is urgently needed to effectively respond to challenges arisen from the pandemic

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