Surgical Outcomes of Bariatric Surgery in Siriraj Hospital for the First 100 Morbidly Obese Patients Treated

Objective: Bariatric surgery is considered the most effective treatment for morbid obesity, and is increasingly performed in Thailand and globally. We aimed to establish the outcomes of bariatric surgery performed at Siriraj Hospital, Bangkok. Materials and Methods: This was a retrospective study of patients who underwent bariatric surgery between January 2012 and June 2016. Results: The records of the first 100 patients who underwent bariatric surgery were reviewed, comprising 58 patients who underwent laparoscopic sleeve gastrectomy (LSG) and 42 patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB). The median patient age, preoperative body weight, and BMI were 36 years old, 129 kg, and 46.3 kg/m2. All the procedures were performed by a laparoscopic approach. The median operative times for LSG and LRYGB were 156 [85-435] and 265 [180-435] minutes. The median hospital stay was 3 days [3-14]. The major complication rate was 4%. There was no mortality in the 30-day postoperative period. The mean %excess weight loss (%EWL) of LSG was 56.8 ± 19.8%, 59.9 ± 21.7%, and 55.1 ± 21.3%, at 1, 2, and 3 years after surgery. The mean %EWL of LRYGB was 67 ± 18.3%, 66.2 ± 21.4%, and 63.6 ± 19.9%, at 1, 2, and 3 years after surgery. In the patients with type-II diabetes mellitus, 67% had complete diabetic remission at 1 year. The median FBS dropped from 127 to 99 mg/dL (p < 0.001) and HbA1c from 6.6% to 5.5% (p < 0.001). The remission rates of hypertension and dyslipidemia were 58% and 73%. Conclusion: The bariatric procedures are safe with a low complication rate. The procedures also provide good outcomes in postoperative weight loss and comorbidity resolution

Aerosol protection using modified N95 respirator during upper gastrointestinal endoscopy: a randomized controlled trial

Background/Aims The coronavirus disease 2019 pandemic has affected the worldwide practice of upper gastrointestinal endoscopy. Here we designed a modified N95 respirator with a channel for endoscope insertion and evaluated its efficacy in upper gastrointestinal endoscopy. Methods Thirty patients scheduled for upper gastrointestinal endoscopy were randomized into the modified N95 (n=15) or control (n=15) group. The mask was placed on the patient after anesthesia administration and particles were counted every minute before (baseline) and during the procedure by a TSI AeroTrak particle counter (9306-04; TSI Inc.) and categorized by size (0.3, 0.5, 1, 3, 5, and 10 µm). Differences in particle counts between time points were recorded. Results During the procedure, the modified N95 group displayed significantly smaller overall particle sizes than the control group (median [interquartile range], 231 [54–385] vs. 579 [213–1,379]×103/m3; p=0.056). However, the intervention group had a significant decrease in 0.3-µm particles (68 [–25–185] vs. 242 [72–588]×103/m3; p=0.045). No adverse events occurred in either group. The device did not cause any inconvenience to the endoscopists or patients. Conclusions This modified N95 respirator reduced the number of particles, especially 0.3-µm particles, generated during upper gastrointestinal endoscopy

Changes in Physical Components after Gastrectomy for Adenocarcinoma of Stomach and Esophagogastric Junction

Objective: Enhanced Recovery After Surgery (ERAS) is a multidisciplinary approach that aims to optimize perioperative management, promote postoperative recovery, reduce postoperative complications, and improve long-term survival. The current study aimed to evaluate and compare the postoperative physical activity after gastrectomy between patients who underwent upper gastrointestinal surgery according to ERAS and those who underwent surgery based on the conventional care (CC) protocol. Materials and Methods: This prospective and retrospective review enrolled 60 patients (n = 31, ERAS group; n = 29, CC protocol group) diagnosed with adenocarcinoma of the stomach and esophagogastric junction who underwent curative surgical resection. Physical outcomes, including body weight, body mass index, body fat percentage, basal metabolic rate, muscle mass, gait speed, and handgrip strength at the preoperative and immediate postoperative periods and at 1, 3, and 6 months postoperatively, were comparedbetween the ERAS and CC protocol groups. Results: One month after surgery, the ERAS group had a lower percentage of body weight loss than the CC protocol group. There was no significant difference in terms of muscle mass loss between the two groups. The hand grip strength of the ERAS group increased after surgery. Further, at 1 month postoperatively, the gait speed of patients who underwent total gastrectomy in the ERAS group was significantly higher than that of patients in the CC protocol group. Conclusion: ERAS for gastrectomy was associated with a lower percentage of weight loss and a trend toward physical activity enhancement in the early postoperative period

The First Robotic Bariatric Surgery Performed in Thailand – Surgical Techniques and Review of the Literature

Morbid obesity is associated with multiple life-threatening comorbidities. Bariatric surgery is the most effective intervention to achieve the long-term weight loss required to reverse many of these comorbid conditions. Laparoscopic bariatric surgery is the current gold standard approach; however the robotic approach has potential intraoperative and postoperative advantages that may be realized if limitations to instrument torque effect are overcome. We review the literature about the robotic bariatric surgery and describe our first robotic sleeve gastrectomy (RSG) and a single docking operative approach to robotic Roux-en-Y gastric bypass (RRYGB) in Siriraj Hospital, and also the first in Thailand. We demonstrate the operative room setup, the port sites, the technical details, and the key step illustrations, that both operative procedures were performed using the da Vinci® Si platform. According to the literature review, a robotic approach to bariatric surgery is an alternative option with comparable outcomes to laparoscopic approach and the potential for intraoperative and postoperative advantages. It is safe, feasible, and provides good clinical outcomes that are comparable to a conventional laparoscopic method