Risk factors for early and late complications after laparoscopic sleeve gastrectomy in one-year observation

Background: Although laparoscopic sleeve gastrectomy (LSG) is considered a safe bariatric procedure in the treatment of obesity, it still involves a risk of developing postoperative complications. Knowledge of risk factors for possible complications would allow appropriate preoperative planning, optimization of postoperative care, as well as early diagnosis and treatment. The aim of this study was to evaluate risk factors for complications after laparoscopic sleeve gastrectomy. Methods: A retrospective study of 610 patients who underwent LSG at a tertiary institution were included in the study through retrospective analysis of the medical data. Complications were categorized as early (<30 days) and late (≥30 days) and evaluated according to the Clavien–Dindo Classification. Results: Early complications were observed in 35 patients (5.74%) and late complications occurred in 10 patients (1.64%). Independent risk factors of early complications after laparoscopic sleeve gastrectomy included hypercholesterolemia (OR 3.73; p-value = 0.023) and smoking (OR = 274.66, p-value < 0.001). Other factors that may influence the postoperative course are length of hospital stay and operation time. Smoking, peptic ulcer diseases and co-existence of hiatal hernia were found to be an independent predictors of late complications. Conclusions: Smoking is associated with the higher risk of both, early and late complications, while hypercholesterolemia with only <30 days complications after laparoscopic sleeve gastrectomy

The effect of laparoscopic sleeve gastrectomy on body mass index and obesity-related diseases in patients over 50 years old

Aim of the study: Obesity is a pandemic of the 21st century and may regard people of every age. Persons after 50 years of age are a group especially exposed to severe impact of obesity which is connected, among others, with increased risk of co-morbidities. Along with age, the human body undergoes processes connected with metabolic rate decrease, accumulation of fat tissue, a physical capacity decrease which exacerbates the issue of obesity. Material and methods: Retrospective analysis of biochemical and clinical parameters was conducted in the group of 102 patients, age 50–66 years old, after sleeve gastrectomy. Results: During observation, average BMI decreased from 45.52 (41.26–50.87) kg/m2 before the surgery to 29.71 (26.08–35.42) kg/m2 one year after the surgery (p &lt; 0.001). %TWL 12 months after LSG reached 33.91% (27.81–37.6%) (p &lt; 0.001), average % EBMIL was 76.78% (58.71–93.08%). The study revealed that the most frequently coexisting diseases with obesity were: hypertension (89 patients), type 2 diabetes (39 patients), sleep apnea (27 patients), and dyslipidemia (25 patients). One year follow-up revealed remission of hypertension in 37 patients (41.57%), type 2 diabetes in 16 patients (41.02%), sleep apnea in 12 patients (44.44%), and dyslipidemia in 19 patients (76%). In patients after LSG, improvement of biochemical parameters including lipid and carbohydrate balance, as well as improvement or recovery from co-morbidities were observed. Conclusions: LSG is an efficient method of obesity treatment, especially for patients after 50 years old with co-morbidities, which leads to permanent body mass loss as well as remission or recovery from chronic diseases and improves the quality of life

The Effect of Laparoscopic Sleeve Gastrectomy on the Course of Non-Alcoholic Fatty Liver Disease in Morbidly Obese Patients during One Year of Follow Up

Background: Morbid obesity co-exists with non-alcoholic fatty liver disease in up to 90% of cases. Laparoscopic sleeve gastrectomy leads to a reduction in body mass and thus may improve the course of non-alcoholic fatty liver disease. The aim of this study was to evaluate the effect of laparoscopic sleeve gastrectomy on the resolution of non-alcoholic fatty liver disease. Methods: The study included 55 patients with non-alcoholic fatty liver disease who underwent laparoscopic sleeve gastrectomy at a tertiary institution. The analysis consisted of preoperative liver biopsy, abdominal ultrasound, weight loss parameters, Non-Alcoholic Fatty Liver Fibrosis Score and selected laboratory parameters. Results: Before the surgery, 6 patients were diagnosed with grade 1 liver steatosis, 33 patients with grade 2 and 16 patients with grade 3. One year after the surgery, only 21 patients had features of liver steatosis at ultrasound. All weight loss parameters showed statistically significant changes during the observation; the median percentage of total weight loss was 31.0% (IQR: 27.5; 34.5) with p = 0.0003, the median percentage of excess weight loss was 61.8% (IQR: 52.4; 72.3) with p = 0.0013 and the median percentage of excess body mass index loss was 71.0% (IQR: 61.3; 86.9) with p = 0.0036 12 months after laparoscopic sleeve gastrectomy. The median Non-Alcoholic Fatty Liver Fibrosis Score at baseline was 0.2 (IQR: −0.8; 1.0) and decreased to −1.6 (IQR: −2.4; −0.4) (p p p p < 0.0001) were found. Conclusions: The study supports the thesis that laparoscopic sleeve gastrectomy is an effective method for treatment of non-alcoholic fatty liver disease in patients with morbid obesity

Effect of rocuronium on the heart rate and arterial blood pressure during combined general anaesthesia

INTRODUCTION: Additional mechanisms of neuromuscular blocking agents action create the haemodynamic condition during general anaesthesia. The aim was to investigate the effect of rocuronium on haemodynamic parameters during combined general anaesthesia.   MATERIAL AND METHODS: The study was conducted in two groups: Group I underwent combined anaesthesia with rocuronium and Group II — combined anaesthesia without any muscle relaxants. Haemodynamic parameters: heart rate, systolic, diastolic and mean arterial blood pressure were recorded before anaesthesia, at the end of rocuronium infusion, and after recovery from anaesthesia.   RESULTS: In both groups, the values of the median heart rate, systolic, diastolic and mean arterial blood pressure recorded before and after anaesthesia were similar and did not differ significantly. In Group I, significant reduction in heart rate in the end of rocuronium infusion [74 (61–103)], (p = 0.01) and after recovery from anesthesia [71 (53–100)], (p = 0.03), compared to the value before anesthesia [81 (56–104)], were demonstrated. Additionally, significant reduction in systolic [130 (96–169); 114 (92–144)], (p = 0.04), diastolic [80 (54–109); 73 (47–99)], (p = 0.01), and mean [95 (72–106); 85 (68–109)], (p = 0.02) arterial blood pressure in the end of rocuronium infusion were noticed. The values of systolic, diastolic and mean blood pressure after recovery from anaesthesia significantly increased in relation to the values observed in the end of the rocuronium infusion [129 (96–181)], (p = 0.01); [78 (47–107)], (p = 0.03); [93 (63–107)], (p = 0.03).   CONCLUSIONS: The vagolytic effect was not observed during general anaesthesia with rocuronium. The changes in heart rate and blood pressure were associated with the rocuronium infusion and were normalized after recovery from anaesthesia

The influence of COVID-19 pandemic on number of patients reporting to the Emergency Department and operated of acute cholecystitis and incarcerated hernias

Introduction: The fear of SARS-CoV-2 infection had a significant impact on a number of patients reporting to the hospitals. Despite the presence of disturbing symptoms, patients postponed their medical visits. It resulted in health deterioration that worsened conditions for surgical procedures.Aim of the stdy: The aim of study was to analyze the impact of the COVID-19 pandemic on a number of patients reporting to the Emergency Department at University Hospital in Bialystok and a number of surgical emergency procedures and the Department of General Surgery.Material and methods: The retrospective analysis of patients who reported to the Internal Medicine and Surgical office of the Emergency Department at University Hospital in Bialystok in the same periods from June to December 2019 and 2020 with surgical conditions such as cholecystitis, inguinal hernia, and umbilical hernia.Results: In 2020, there was a significant decrease in the number of patients reporting to the Emergency Department when compared to 2019 (664 vs. 955). In 2020, there were more emergency surgeries performed including laparoscopic cholecystectomy (32 vs. 28) and inguinal hernia repair (17 vs. 5, p = 0.0013) compared to 2019. The analysis of biochemical parameters showed a higher level of C-reactive protein in patients undergoing emergency surgery in 2020 when compared to 2019 (11.85 vs. 3.35 p = 0.0140).Conclusions: The number of patients reporting to the Emergency Department was significantly lower in 2020 when compared to 2019 and patients presented more severe symptoms and general conditions. The above analysis triggered by the Coronavirus pandemic could be a useful tool for better managing similar crisis in the future