Long-Term Results at 10 Years of Pouch Resizing for Roux-en-Y Gastric Bypass Failure

Background: Roux-en-Y gastric bypass (RYGB) is currently one of the most performed bariatric procedures and it is associated with rapid weight loss. However, weight loss failure and weight regain after RYGB occurs in approximately 30% and 3-5% of patients, respectively, and represent a serious issue. RYGB pouch resizing is a surgical option that may be offered to selected patients with RYGB failure. The aim of this study is to assess long-term results of pouch resizing for RYGB failure. Materials and Methods: From February 2009 to November 2011, 20 consecutive patients underwent gastric pouch resizing for RYGB failure in our tertiary bariatric center. The primary outcome was the rate of failure (%EWL < 50% with at least one metabolic comorbidity) after at least 10 years from pouch resizing. Gastroesophageal Reflux Disease (GERD) was also assessed. Results: Twenty patients (18 women (90%)) were included and seventeen (85%) joined the study. The failure rate of pouch resizing was 47%. Mean %EWL and mean BMI were 47%, and 35.1 kg/m(2), respectively. Some of the persistent co-morbidities further improved or resolved after pouch resizing. Seven patients (41%) presented GERD requiring daily PPI with a significantly lower GERD-HQRL questionnaire score after pouch resizing (p < 0.001). Conclusion: Pouch resizing after RYGB results in a failure rate of 47% at the 10-year follow-up while the resolution of comorbidities is maintained over time despite a significant weight regain

Gallbladder polyps between ultrasound and histopathology

BackgroundGallbladder polyps (GBP) are rare. Ultrasound is the most widely used screening method for Gallbladder pathology.AimsWe aim to analyse polyps identified in gallbladders removed by laparoscopy over a 14-year period, and to assess the ability of conventional ultrasound to differentiate GBPs from stones.MethodsThis is a retrospective study of 11,391 patients who underwent laparoscopic cholecystectomy from 2002–2016. Data concerning patients' characteristics, preoperative ultrasound findings, number and size of lesions, histologic features of polyps and gallbladder were collected.ResultsForty-six patients had GBP(s) (0.4 per cent). Mean age was 54(range 17-85), 67.4 per cent were females. Body mass index (BMI) was 30 (range 19-43). GBP(s) were single in 63 per cent of cases. Polyp size ranged between 0.2 and 2.2cm (average 1cm). Preoperative ultrasound successfully differentiated polyps from stones in nine cases (20 per cent). The most common histopathologic pattern was hyperplastic polyps in 18 cases (39.1), followed by cholesterol polyps (28.3 per cent), adenomyoma (13 per cent) and adenoma (8.7 per cent). The rest (10.9 per cent) were malignant polyps (adenocarcinoma). Polyps were associated with chronic cholecystitis in 40/46 patients.ConclusionGBPs are rare. Hyperplastic polyps are the commonest in our region, probably due to chronic inflammation induced by gallstones.   Although ultrasound seems to be sensitive to gallbladder lesions; its utility to differentiate polyps from stones is relatively low. Since one tenth of polyps were hiding malignancy, cholecystectomy is advised especially in elderly people

Challenges in Bariatric Surgery: Outcomes in Patients Having Three or More Bariatric Procedures

Introduction Over the last two decades, a progressive increase in failure rate of bariatric surgery (BS) has occurred in conjunction with an exponential increase in BS worldwide. Bariatric surgeons are confronted with challenging situations in patients with a complex bariatric history. In this study, we aim to evaluate the feasibility and outcomes of revisional BS in patients with at least two or more previous bariatric procedures.Methods Data were retrospectively retrieved from a prospectively held database of bariatric procedures performed at our tertiary referral bariatric center and included procedures done from February 2013 up to April 2019 by a single center.Results Thirty patients underwent a third bariatric procedure. The median age was 40 (18-57) and 54 (27-69) years at the time of the first and the last procedures, respectively. Laparoscopic adjustable gastric banding was the first procedure in 26 patients. The complication rate was 33%; no patient required additional surgery because of postoperative complications. A total weight loss of 29.6% and an excess loss of 53.4% were obtained at a mean follow-up of 61 months after the last redo bariatric procedure.Conclusion This study indicates that redo BS either conversional or revisional is feasible and effective in patients with a complex bariatric history including two or more previous procedures. Careful patients' selection is mandatory and extensive information should be given on the increased risk of postoperative complications