Minimising Haemorrhagic Complications with Bariatric Surgery

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Editorial: Foundations of understanding to challenge the stigma surrounding overweight, obesity, and bariatric surgery

Many illnesses are embedded and shaped within cultural meaning, which often influences how society responds to those living with the condition, and peoples’ lived experiences.[1] The social construction of illness may not always be rooted in medical knowledge but lie within the inherent beliefs and attitudes toward the condition, which may not always be positive. For people living with overweight and obesity, there are negative connotations associated with the condition. A higher body weight is a visually apparent condition, meaning immediate value judgement are more likely in terms of assumptions and presuppositions. These attitudes can impact on a person’s quality of life, and lead to stigmatization. Bariatric surgery is an intervention which is not widely understood by society, and is often perceived as a contested intervention, described as cheating, taking the easy way out, and that surgery does the work, not the patient. These value judgments of bariatric surgery can lead to further stigma, despite the person achieving often significant weight loss.[2] Understanding how overweight, obesity, and bariatric surgery are socially constructed are key to identifying and being aware of roots of surrounding stigma, and how this can be challenged to support, and reduce discrimination against those living with excess weight who undergo bariatric surgical procedures

Who Publishes in Leading General Surgical Journals? The Divide Between the Developed and Developing Worlds

BackgroundMost articles in top general surgical journals seem to originate from a limited few developed countries. The purpose of this study was to establish which countries publish the most in leading general surgical journals.MethodsWe analysed all the studies, reviews and case reports published in 2003-2004 in 10 leading English-language general surgical journals with the highest impact factors to obtain country-wise data with regard to the origin of articles. Editorials, historical articles, commentaries, guidelines, biographies, interviews and letters to editors were excluded from the analysis.ResultsA total of 5,081 articles were reviewed. Out of these, 834 were excluded as detailed above and the remaining 4,247 articles were analysed. Most of these were from USA, European countries, Japan, and Australia. It seems that the vast majority of the world's population living in the developing countries do not find adequate representation in leading general surgical journals.ConclusionVery few articles are published from developing countries in leading general surgical journals. Both developing countries and medical journals need to take steps to curb this trend. Steps are suggested to improve the situation so that the developing world is also adequately represented in the surgical literature

Patient experiences of adjusting to life in the first two years after bariatric surgery: a qualitative study

Background: There is a limited amount of research into the experiences of those who have undergone bariatric surgery, and how this impacts on their everyday lives and social interactions. Methods Semi-structured interviews were carried out with 18 participants (11 female, 7 male) who had undergone permanent bariatric surgical procedures 5-24 months prior to interview at a large NHS hospital in North East England. Constructivist grounded theory was used, with a constant comparative analytic framework. Results Participants conceptualised social encounters after bariatric surgery as being underpinned by risk. Their attitudes towards social situations guided their actions in the context of social interaction. Three profiles of attitudes towards risk were constructed: Risk Accepters, Risk Contenders and Risk Challengers. These profiles were based on participant-reported narratives of their experiences in the first two years post-surgically Conclusions The social complexities occurring as a consequence of bariatric surgery require adjustments to patients’ lives. Participants reported that the social aspects of bariatric surgery do not appear to be widely understood by those who have had bariatric surgery. The three risk attitude profiles that emerged from our data offer an understanding of ways in which patients adjust to life and can be used reflexively by healthcare professionals in the support of patients both pre- and post-operatively

Acute appendicitis presenting as small bowel obstruction: two case reports

Acute appendicitis is a common surgical problem however the diagnosis is often overlooked when it presents as a small bowel obstruction. In this report we present two cases of elderly patients who presented with small bowel obstruction and raised inflammatory markers. Both patients were successfully treated with a laparotomy, adhesiolysis and appendicectomy and went on to make a good recovery

Procedure and Patient Selection in Bariatric and Metabolic Surgery

Introduction: Sleeve Gastrectomy (SG), Roux-en-Y Gastric Bypass (RYGB), and One Anastomosis Gastric Bypass (OAGB) are the commonest bariatric procedures performed worldwide. The purpose of this review was to analyse comparative data on these three procedures to aid patient and procedure selection for patients seeking Bariatric and Metabolic Surgery (BMS). Evidence Acquisition: We examined published English language scientific literature available on PubMed for data comparing SG, RYGB, and OAGB for various groups of patients. Evidence Synthesis: There are a number of variables that can influence patient and procedure selection for individuals seeking BMS. High-quality data comparing each of these procedures for every patient subgroup, for each possible outcome measure is lacking. It is, therefore, not currently possible to make strict recommendations regarding patient and procedure selection. At the same time, the multidisciplinary teams should understand that risks of surgery may simply be too high for some patients – such as those suffering from end-stage organ disease and those suffering from mega obesity (BMI ≥ 70 kg/m2). Surgery should only be offered to such high-risk groups in dedicated centres with appropriate expertise. For other patients, surgeons should carefully consider the pros and cons of each procedure, their own experience, and patient preferences before deciding the most appropriate BMS procedure for them. Conclusion: This review examines various factors influencing patient and procedure selection in bariatric surgery. Authors feel it is currently not possible to make strict recommendations and surgeons should carefully discuss the pros and cons of bariatric surgery and that of various options available in their practice with the patients before making a final recommendation

Zinc deficiency after gastric bypass for morbid obesity: a systematic review

The final publication is available at Springer via http://dx.doi.org/10.1007/s11695-016-2474-8 Up to 50% of patients have zinc deficiency before bariatric surgery.Roux-en-Y gastric bypass (RYGB) is the commonest bariatric procedure worldwide. It can further exacerbate zinc deieciency by reducing intake as well as absorption. The British Obesity and Metabolic Surgery Society therefore, recommends that zinc level should be monitored routinely following gastric bypass. However the American guidance does not recommend such monitoring for all RYGB patients and reserves it for patients with 'specific findings' This review concludes that clinically relevant zinc deficiency is rare after RYGB Routine monitoring of zinc levels is hence unnecessary for asymptomatic patients after RYGB and should be reserved for patients with skin lesions, hair loss, pica, disgeusia, hypogonadism, or erectile dysfunction in male patients and unexplained iron deficiency anaemia