Internal Hernia After One Anastomosis Gastric Bypass (OAGB). Lessons Learned from a Retrospective Series of 3368 Consecutive Patients Undergoing OAGB with a Biliopancreatic Limb of 150 cm

Background: Internal hernia (IH) represents a relatively common and well-known complication after Roux-en-Y gastric bypass. IH after one anastomosis gastric bypass (OAGB) is less frequent and rarely reported in the literature. This study presents a series of IH after OAGB observed in a high-volume bariatric center. Methods: Data of patients who underwent OAGB with an afferent limb of 150 cm between May 2010 and September 2019 were prospectively collected and retrospectively analyzed. Data of patients undergoing surgery for IH during follow-up were collected and analyzed. Results: Ninety-six patients out of 3368 with a history of OAGB had intestinal incarceration in the Petersen’s orifice (2.8%). Specificity and sensitivity of computed tomography scans in the diagnosis of IH were 59% and 76%, respectively. The mean timeframe between OAGB and surgery for IH was 21.9±18.3 months. Mean body mass index at the time of IH surgery was 24.7 ± 3.6. Surgery was completed laparoscopically in 96.8% of cases. Nine patients (9.3%) had signs of bowel hypovascularization. In all patients, the herniated bowel was repositioned, and the Petersen’s orifice was closed, without the need for bowel resection. Mean hospital stay was 1.9 ± 4.8 days. The postoperative morbidity rate was 8.3%. Long-term IH relapse was observed in 14 patients; signs of bowel hypovascularization due to incarceration in a small orifice was observed in eight of these patients (57%). Conclusions: Incidence of IH after OAGB is 2.8%. IH is associated with a low rate of bowel ischemia and the need for intestinal resection

Efficacy and Drawbacks of Single-Anastomosis Duodeno-Ileal Bypass After Sleeve Gastrectomy in a Tertiary Referral Bariatric Center

Background: The need for revisional procedures after sleeve gastrectomy (SG) for insufficient weight loss or weight regain, gastroesophageal reflux, or other complications is reported to be 18–36% in studies with 10-year follow-up. Single-anastomosis duodeno-ileal bypass (SADI) may be performed as a revisional procedure after SG. This study aims to evaluate the short- and mid-term outcomes of SADI after SG in a referral center for bariatric surgery. Materials and Methods: Data of patients who underwent SADI between March 2015 and March 2020 were collected prospectively and analyzed retrospectively. Follow-up comprised clinical and biochemical assessment at 1, 3, 6, 12, 18, and 24 months postoperatively, and once a year thereafter. Results: Overall, 106 patients underwent SADI after a previous SG. The timeframe between SG and SADI was 50 ± 31.3 months. Postoperative mortality was observed in two cases (1.8%) and morbidity in 15.1% of patients. At 24 months, %total weight loss was 37.6 ± 12.3 and %excess weight loss 76.9 ± 25.2 (64 patients). Three patients were treated for malnutrition during follow-up, two with medical treatment and one with SADI reversal. Conclusion: SADI after SG provides effective weight loss results in the short-term, even if in the present series the postoperative complication rate was non-negligible. Further trials are needed to establish the more advantageous revisional bariatric procedure after failed SG

Is One Anastomosis Gastric Bypass with a Biliopancreatic Limb of 150 cm Effective in the Treatment of People with Severe Obesity with BMI > 50?

Purpose: The treatment of people with severe obesity and BMI > 50 kg/m2 is challenging. The present study aims to evaluate the short and mid-term outcomes of one anastomosis gastric bypass (OAGB) with a biliopancreatic limb of 150 cm as a primary bariatric procedure to treat those people in a referral center for bariatric surgery. Material and Methods: Data of patients who underwent OAGB for severe obesity with BMI > 50 kg/m2 between 2010 and 2017 were collected prospectively and analyzed retrospectively. Follow-up comprised clinical and biochemical assessment at 1, 3, 6, 12, 18, and 24 months postoperatively, and once a year thereafter. Results: Overall, 245 patients underwent OAGB. Postoperative mortality was null, and early morbidity was observed in 14 (5.7%) patients. At 24 months, the percentage total weight loss (%TWL) was 43.2 ± 9, and percentage excess weight loss (%EWL) was 80 ± 15.7 (184 patients). At 60 months, %TWL was 41.9 ± 10.2, and %EWL was 78.1 ± 18.3 (79 patients). Conversion to Roux-en-Y gastric bypass was needed in three (1.2%) patients for reflux resistant to medical treatment. Six patients (2.4%) had reoperation for an internal hernia during follow-up. Anastomotic ulcers occurred in three (1.2%) patients. Only two patients (0.8%) underwent a second bariatric surgery for insufficient weight loss. Conclusion: OAGB with a biliopancreatic limb of 150 cm is feasible and associated with sustained weight loss in the treatment of severe obesity with BMI > 50 kg/m2. Further randomized studies are needed to compare OAGB with other bariatric procedures in this setting

Title: A uthor(s) : R DOSE FROM NITROGEN-I3 I E DARHT SECOND AXIS Dynamic Experimentation Division 42th Biennial Radiation Protection and Radiation Serving Society hieldirrg Division Topical Meeting DOSE FROM NITROGEN-I 3 'THE DARHT SECOND AXIS lamos Nati

Los Alanios National Laboratory, an affirmative actioi~kqual opporl unity employer, is opcraled by thc University of California for the IJ.S. C)eparlmcnt of Energy under contract W-7405-ENCi-36.By acccptancc of lhis article, the publisher recognizes that thc 1J.S. Govennnent rclaius a nonexclusive, roy;iltylfce licensc to pul>lisli or reproduce the published lbrm ofthis contribution, or to allow otliers lo do so, for U.S. Government purposes .Los Alainos Nalional Laboratory requcs:ts that the publisher identi€y this arlicle as work performed under the auspices ol'tlie 1J.S. Ikpartnient of'Energ Los Alauios Natiorial L:tborakiry strongly supports acadcmic freedom and a tesearclicr's rig111 to ~I I inslilution, bowcwr, the Latomlory does not cntlorse the viewpoint of a pnblicatinn or yuaraiilec its technical correctness. Form 83

DARHT : integration of shielding design and analysis with facility design /

The design of the interior portions of the Dual Axis Radiographic Hydrodynamic Test (DARHT) Facility incorporated shielding and controls from the beginning of the installation of the Accelerators. The purpose of the design and analysis was to demonstrate the adequacy of shielding or to determine the need for additional shielding or controls. Two classes of events were considered: (1) routine operation defined as the annual production of 10,000 2000-ns pulses of electrons at a nominal energy of 20 MeV, some of which are converted to the x-ray imaging beam consisting of four nominal 60-ns pulses over the 2000-ns time frame, and (2) accident case defined as up to 100 2000-ns pulses of electrons accidentally impinging on some metallic surface, thereby producing x rays. Several locations for both classes of events were considered inside and outside of the accelerator hall buildings. The analysis method consisted of the definition of a source term for each case studied and the definition of a model of the shielding and equipment present between the source and the dose areas. A minimal model of the fixed existing or proposed shielding and equipment structures was used for a first approximation. If the resulting dose from the first approximation was below the design goal (1 rem/yr for routine operations, 5 rem for accident cases), then no further investigations were performed. If the result of the first approximation was above our design goals, the model was refined to include existing or proposed shielding and equipment. In some cases existing shielding and equipment were adequate to meet our goals and in some cases additional shielding was added or administrative controls were imposed to protect the workers. It is expected that the radiation shielding design, exclusion area designations, and access control features, will result in low doses to personnel at the DARHT Facility