Gastric greater curvature plication combined with Nissen fundoplication in the treatment of gastroesophageal reflux disease and obesity

Background and aim: Established anti-reflux procedures such as fundoplications are less efficient in obese patients. The aim of this study was to investigate clinical effectiveness of the fundoplication combined with gastric greater curvature plication in the treatment of gastroesophageal reflux disease (GERD) in obese patients. Materials and methods: During the period from June 2010 to September 2014, patients operated for GERD with BMI from 30 to 39.9 kg/m2 were included into the prospective study. Laparoscopic Nissen fundoplication (LNF, n = 58) was performed until February 2013 and later laparoscopic Nissen fundoplication was combined with gastric greater curvature plication (LNFGP, n = 56). The groups were compared according to the control of GERD and weight loss. Results: In LNF group there were significantly more males, patients had lower BMI and longer duration of GERD symptoms. Duration of surgery was significantly longer in LNFGP group, 96.5 (17.3) min vs. 59.8 (16.1) min (P < 0.0001). Postoperative morbidity was similar, 3.6% and 3.4% in LNFGP and LNF groups, respectively (P = 0.9539). The average percentage of excess BMI loss after 12 months was 45.3 (5.8) in LNFGP group as compared to 18.4 (4.6) in LNF group (P < 0.0001). Significantly more patients experienced remission or improvement of type 2 diabetes mellitus (P = 0.03) and hypercholesterolemia (P = 0.0001) in LNFGP group. No significant differences between the groups in postoperative DeMeester score, GERD-HRQL mean score, overall satisfaction and healing of esophagitis were observed

Bariatric surgery outcomes: a single-center study in the United Arab Emirates

BACKGROUND: Bariatric surgery has become an attractive treatment for severe obesity over the last decade, due to its impacts on weight loss and remission of type 2 diabetes and metabolic syndrome. In the United Arab Emirates, a country where the rate of obesity is dramatically increasing bariatric surgery has gained popularity in recent years; however, published data on its outcomes in the Emirati population are lacking. METHODS: We retrospectively reviewed the medical records of 95 patients who underwent bariatric surgery (ie, laparoscopic Roux-en-Y gastric bypass [RYGB] or laparoscopic sleeve gastrectomy) at the Rashid Center for Diabetes and Research in Ajman, United Arab Emirates. Weight outcomes and metabolic marker data were abstracted at baseline and at 3, 6, and 12 months postoperatively. RESULTS: Laparoscopic RYGB was the main procedure performed by our bariatric unit. All variables demonstrated postoperative improvement. An average excess weight loss of 68% was observed at 12 months. Fat mass was the body component that decreased the most, with an average reduction of 46%. Additionally, lipid profiles were significantly different (P<0.01) at 12 months, with triglyceride levels improving by 27% and low-density lipoprotein levels improving by 21%. Similarly, glycated hemoglobin (HbA1c) levels decreased significantly (P<0.001) in patients with type 2 diabetes, with an average reduction of 73%. CONCLUSION: Our results show that a substantial short-term reduction in weight and significant improvements in metabolic markers followed bariatric surgery in severely obese Emirati patients. Our results are consistent with the outcomes of other internationally published studies. Additional studies are warranted to determine whether the favorable impacts of bariatric surgery can be sustained over the long term

Practically-exploitable Vulnerabilities in the Jitsi Video Conferencing System

Jitsi Meet is an open-source video conferencing system, and a popular alternative to proprietary services such as Zoom and Google Meet. The Jitsi project makes strong privacy and security claims in its advertising, but there is no published research into the merits of these claims. Moreover, Jitsi announced end-to-end encryption (E2EE) support in April 2020, and prominently features this in its marketing. We present an in-depth analysis of the design of Jitsi and its use of cryptography. Based on our analysis, we demonstrate two practical attacks that compromised server components can mount against the E2EE layer: we show how the bridge can break integrity by injecting inauthentic media into E2EE conferences, whilst the signaling server can defeat the encryption entirely. On top of its susceptibility to these attacks, the E2EE feature does not apply to text-based communications. This is not made apparent to users and would be a reasonable expectation given how Jitsi is marketed. Further, we identify critical issues with Jitsi\u27s poll feature, which allow any meeting participant to arbitrarily manipulate voting results. Our findings are backed by proof-of-concept implementations and were verified to be exploitable in practice. We communicated our findings to Jitsi via a coordinated disclosure process. Jitsi has addressed the vulnerabilities via a mix of technical improvements and documentation changes

Risk factors of esophagojejunal anastomosis leakage after total gastrectomy

Background/AimEsophagojejunal anastomotic leakage (EJAL) after total gastrectomy is one of the most frequent life-threatening complications. The rate of EJAL after total gastrectomy is about 2–11% worlwide. The aim of this study was to identify the independent prognostic risk factors that may predict EJAL progression for patients after total gastrectomy.Materials and methodsThis retrospective study analyzed medical records of 175 patients. All these patients had underwent radical gastrectomy due to gastric cancer. The analyzed factors were: age, gender, American Society of Anaesthesiologists (ASA) funtional class, splenectomy, anastomosis technique, operative time, cancer stage, the number of dissected lymph nodes, the number of metastatic lymph nodes, resection margins. White blood cells count, C reactive protein (CRP) value, body temperature, drain output were calculated in the early postoperative period.ResultsThe average age of the patients was 63.2 ± 11.5 years. The EJAL rate was found to be 6.3%. The mortality rate among patients who developed EJAL was 9%. Postoperative laboratory and clinical findings significantly related to EJAL were the average temperature of 4 postoperative days &gt;37.2 oC (p = 0.018), postoperative white blood cell count &gt;16.7 x 109/l (p = 0.031), postoperative CRP level &gt;160 mg/l (p = 0.001) and operative time &gt;248 min (p = 0.009), although the binary logistic regression analysis revealed that none of these variables can be used as statisticaly significant predictors for EJAL.ConclusionsThe esofagojejunal anastomotic leakage rate of 6.3% was found among patients undergoing radical gastrectomy due to gastric carcinoma. Mortality rate in case of EJAL increases up to 9%. In our study, we didn’t find any independent predictors for EJAL.Key words: gastrectomy, esophagojejunal anastomosis leakage, risk factorsEzofagojejuninės jungties nesandarumo išsivystymo rizikos veiksniai po gastrektomijosĮvadasEzofagojejuninės jungties nesandarumas (EJJN) po gastrektomijos yra viena iš didžiausią grėsmę gyvybei keliančių komplikacijų. Mokslinių tyrimų duomenimis, EJJN dažnis svyruoja nuo 2 iki 11 %. Darbo tikslas – nustatyti rizikos veiksnius,darančius įtaką ezofagojejuninės jungties nesandarumo vystymuisi po gastrektomijos dėl skrandžio vėžio, ir prognozuoti jų įtaką EJJN išsivystymui.Ligoniai ir metodaiRetrospektyviai ištirta 175 pacientų medicininė dokumentacija. Tirtiems pacientams 2006–2010 metais atlikta gastrektomija dėl skrandžio vėžio. Analizuoti veiksniai: amžius, lytis, Amerikos anesteziologų asociacijos (ASA) funkcinė klasė, splenektomija, jungties susiuvimo būdas, operacijos trukmė, naviko stadija, operacijos metu pašalintų limfmazgių skaičius, limfmazgių su mestazėmis skaičius, rezekciniai kraštai. Ankstyvuoju pooperaciniu laikotarpiu vertinta leukocitų kiekis, C reaktyviojo baltymo (CRB) koncentracija kraujyje, pooperacinė temperatūra, sekrecija pro drenus.RezultataiTirtų pacientų amžiaus vidurkis 63,2±11,5 metų. Vyrų 50,6 %, moterų 49,4 %. EJJN dažnis 6,3 %. Turėjusių EJJN pacientų mirtingumas siekė 9 %. Nustatyti rizikos veiksniai, statistiškai patikimai susiję su EJJN išsivystymu. Jų reikšmės patikslintosrandant ROC kreivės lūžio taškus: 4 parų vidutinė temperatūra 37,15oC (p=0,018), maksimalios leukocitų (11,7x109/l, p=0,031) ir C reaktyviojo baltymo reikšmės (159,95 mg/l, p=0,001), operacijos trukmė 247,5 min (p=0,009). Tačiau binarinė logistinė regresija parodė, kad šie kriterijai negali būti statistiškai patikimi prognoziniai EJJN vystymosi veiksniai.IšvadosEzofagojejuninės jungties nesandarumo dažnis po gastrektomijos dėl skrandžio vėžio yra 6,3%, šią komplikaciją turėjusių pacientų mirštamumas – 9%. Savo tyrime neradome prognostiškai reikšmingų rizikos veiksnių.Reikšminiai žodžiai: gastrektomija, ezofagojejuninės jungties nesandarumas, rizikos veiksnia

Risk factors of esophagojejunal anastomosis leakage after total gastrectomy

Background/AimEsophagojejunal anastomotic leakage (EJAL) after total gastrectomy is one of the most frequent life-threatening complications. The rate of EJAL after total gastrectomy is about 2–11% worlwide. The aim of this study was to identify the independent prognostic risk factors that may predict EJAL progression for patients after total gastrectomy.Materials and methodsThis retrospective study analyzed medical records of 175 patients. All these patients had underwent radical gastrectomy due to gastric cancer. The analyzed factors were: age, gender, American Society of Anaesthesiologists (ASA) funtional class, splenectomy, anastomosis technique, operative time, cancer stage, the number of dissected lymph nodes, the number of metastatic lymph nodes, resection margins. White blood cells count, C reactive protein (CRP) value, body temperature, drain output were calculated in the early postoperative period.ResultsThe average age of the patients was 63.2 ± 11.5 years. The EJAL rate was found to be 6.3%. The mortality rate among patients who developed EJAL was 9%. Postoperative laboratory and clinical findings significantly related to EJAL were the average temperature of 4 postoperative days &gt;37.2 oC (p = 0.018), postoperative white blood cell count &gt;16.7 x 109/l (p = 0.031), postoperative CRP level &gt;160 mg/l (p = 0.001) and operative time &gt;248 min (p = 0.009), although the binary logistic regression analysis revealed that none of these variables can be used as statisticaly significant predictors for EJAL.ConclusionsThe esofagojejunal anastomotic leakage rate of 6.3% was found among patients undergoing radical gastrectomy due to gastric carcinoma. Mortality rate in case of EJAL increases up to 9%. In our study, we didn’t find any independent predictors for EJAL.Key words: gastrectomy, esophagojejunal anastomosis leakage, risk factorsEzofagojejuninės jungties nesandarumo išsivystymo rizikos veiksniai po gastrektomijosĮvadasEzofagojejuninės jungties nesandarumas (EJJN) po gastrektomijos yra viena iš didžiausią grėsmę gyvybei keliančių komplikacijų. Mokslinių tyrimų duomenimis, EJJN dažnis svyruoja nuo 2 iki 11 %. Darbo tikslas – nustatyti rizikos veiksnius,darančius įtaką ezofagojejuninės jungties nesandarumo vystymuisi po gastrektomijos dėl skrandžio vėžio, ir prognozuoti jų įtaką EJJN išsivystymui.Ligoniai ir metodaiRetrospektyviai ištirta 175 pacientų medicininė dokumentacija. Tirtiems pacientams 2006–2010 metais atlikta gastrektomija dėl skrandžio vėžio. Analizuoti veiksniai: amžius, lytis, Amerikos anesteziologų asociacijos (ASA) funkcinė klasė, splenektomija, jungties susiuvimo būdas, operacijos trukmė, naviko stadija, operacijos metu pašalintų limfmazgių skaičius, limfmazgių su mestazėmis skaičius, rezekciniai kraštai. Ankstyvuoju pooperaciniu laikotarpiu vertinta leukocitų kiekis, C reaktyviojo baltymo (CRB) koncentracija kraujyje, pooperacinė temperatūra, sekrecija pro drenus.RezultataiTirtų pacientų amžiaus vidurkis 63,2±11,5 metų. Vyrų 50,6 %, moterų 49,4 %. EJJN dažnis 6,3 %. Turėjusių EJJN pacientų mirtingumas siekė 9 %. Nustatyti rizikos veiksniai, statistiškai patikimai susiję su EJJN išsivystymu. Jų reikšmės patikslintosrandant ROC kreivės lūžio taškus: 4 parų vidutinė temperatūra 37,15oC (p=0,018), maksimalios leukocitų (11,7x109/l, p=0,031) ir C reaktyviojo baltymo reikšmės (159,95 mg/l, p=0,001), operacijos trukmė 247,5 min (p=0,009). Tačiau binarinė logistinė regresija parodė, kad šie kriterijai negali būti statistiškai patikimi prognoziniai EJJN vystymosi veiksniai.IšvadosEzofagojejuninės jungties nesandarumo dažnis po gastrektomijos dėl skrandžio vėžio yra 6,3%, šią komplikaciją turėjusių pacientų mirštamumas – 9%. Savo tyrime neradome prognostiškai reikšmingų rizikos veiksnių.Reikšminiai žodžiai: gastrektomija, ezofagojejuninės jungties nesandarumas, rizikos veiksnia

30-day morbidity and mortality of sleeve gastrectomy, Roux-en-Y gastric bypass and one anastomosis gastric bypass: a propensity score-matched analysis of the GENEVA data

Background: There is a paucity of data comparing 30-day morbidity and mortality of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). This study aimed to compare the 30-day safety of SG, RYGB, and OAGB in propensity score-matched cohorts. Materials and methods: This analysis utilised data collected from the GENEVA study which was a multicentre observational cohort study of bariatric and metabolic surgery (BMS) in 185 centres across 42 countries between 01/05/2022 and 31/10/2020 during the Coronavirus Disease-2019 (COVID-19) pandemic. 30-day complications were categorised according to the Clavien–Dindo classification. Patients receiving SG, RYGB, or OAGB were propensity-matched according to baseline characteristics and 30-day complications were compared between groups. Results: In total, 6770 patients (SG 3983; OAGB 702; RYGB 2085) were included in this analysis. Prior to matching, RYGB was associated with highest 30-day complication rate (SG 5.8%; OAGB 7.5%; RYGB 8.0% (p = 0.006)). On multivariate regression modelling, Insulin-dependent type 2 diabetes mellitus and hypercholesterolaemia were associated with increased 30-day complications. Being a non-smoker was associated with reduced complication rates. When compared to SG as a reference category, RYGB, but not OAGB, was associated with an increased rate of 30-day complications. A total of 702 pairs of SG and OAGB were propensity score-matched. The complication rate in the SG group was 7.3% (n = 51) as compared to 7.5% (n = 53) in the OAGB group (p = 0.68). Similarly, 2085 pairs of SG and RYGB were propensity score-matched. The complication rate in the SG group was 6.1% (n = 127) as compared to 7.9% (n = 166) in the RYGB group (p = 0.09). And, 702 pairs of OAGB and RYGB were matched. The complication rate in both groups was the same at 7.5 % (n = 53; p = 0.07). Conclusions: This global study found no significant difference in the 30-day morbidity and mortality of SG, RYGB, and OAGB in propensity score-matched cohorts

30-Day morbidity and mortality of bariatric metabolic surgery in adolescence during the COVID-19 pandemic – The GENEVA study

Background: Metabolic and bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity. Objectives: This study examined the safety of MBS in adolescents during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This was a global, multicentre and observational cohort study of MBS performed between May 01, 2020, and October 10,2020, in 68 centres from 24 countries. Data collection included in-hospital and 30-day COVID-19 and surgery-specific morbidity/mortality. Results: One hundred and seventy adolescent patients (mean age: 17.75 ± 1.30 years), mostly females (n = 122, 71.8%), underwent MBS during the study period. The mean pre-operative weight and body mass index were 122.16 ± 15.92 kg and 43.7 ± 7.11 kg/m2, respectively. Although majority of patients had pre-operative testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n = 146; 85.9%), only 42.4% (n = 72) of the patients were asked to self-isolate pre-operatively. Two patients developed symptomatic SARS-CoV-2 infection post-operatively (1.2%). The overall complication rate was 5.3% (n = 9). There was no mortality in this cohort. Conclusions: MBS in adolescents with obesity is safe during the COVID-19 pandemic when performed within the context of local precautionary procedures (such as pre-operative testing). The 30-day morbidity rates were similar to those reported pre-pandemic. These data will help facilitate the safe re-introduction of MBS services for this group of patients

Gastric greater curvature plication combined with Nissen fundoplication in the treatment of gastroesophageal reflux disease and obesity

Background and aim: Established anti-reflux procedures such as fundoplications are less efficient in obese patients. The aim of this study was to investigate clinical effectiveness of the fundoplication combined with gastric greater curvature plication in the treatment of gastroesophageal reflux disease (GERD) in obese patients. Materials and methods: During the period from June 2010 to September 2014, patients operated for GERD with BMI from 30 to 39.9 kg/m2 were included into the prospective study. Laparoscopic Nissen fundoplication (LNF, n = 58) was performed until February 2013 and later laparoscopic Nissen fundoplication was combined with gastric greater curvature plication (LNFGP, n = 56). The groups were compared according to the control of GERD and weight loss. Results: In LNF group there were significantly more males, patients had lower BMI and longer duration of GERD symptoms. Duration of surgery was significantly longer in LNFGP group, 96.5 (17.3) min vs. 59.8 (16.1) min (P < 0.0001). Postoperative morbidity was similar, 3.6% and 3.4% in LNFGP and LNF groups, respectively (P = 0.9539). The average percentage of excess BMI loss after 12 months was 45.3 (5.8) in LNFGP group as compared to 18.4 (4.6) in LNF group (P < 0.0001). Significantly more patients experienced remission or improvement of type 2 diabetes mellitus (P = 0.03) and hypercholesterolemia (P = 0.0001) in LNFGP group. No significant differences between the groups in postoperative DeMeester score, GERD-HRQL mean score, overall satisfaction and healing of esophagitis were observed