Patient Selection in One Anastomosis/Mini Gastric Bypass—an Expert Modified Delphi Consensus

Purpose: One anastomosis/mini gastric bypass (OAGB/MGB) is up to date the third most performed obesity and metabolic procedure worldwide, which recently has been endorsed by ASMBS. The main criticisms are the risk of bile reflux, esophageal cancer, and malnutrition. Although IFSO has recognized this procedure, guidance is needed regarding selection criteria. To give clinicians a daily support in performing the right patient selection in OAGB/MGB, the aim of this paper is to generate clinical guidelines based on an expert modified Delphi consensus. Methods: A committee of 57 recognized bariatric surgeons from 24 countries created 69 statements. Modified Delphi consensus voting was performed in two rounds. An agreement/disagreement among ≥ 70.0% of the experts was considered to indicate a consensus. Results: Consensus was achieved for 56 statements. Remarkably, ≥ 90.0% of the experts felt that OAGB/MGB is an acceptable and suitable option "in patients with Body mass index (BMI) > 70, BMI > 60, BMI > 50 kg/m2 as a one-stage procedure," "as the second stage of a two-stage bariatric surgery after Sleeve Gastrectomy for BMI > 50 kg/m2 (instead of BPD/DS)," and "in patients with weight regain after restrictive procedures. No consensus was reached on the statement that OAGB/MGB is a suitable option in case of resistant Helicobacter pylori. This is likely as there is a concern that this procedure is associated with reflux and its related long-term complications including risk of cancer in the esophagus or stomach. Also no consensus reached on OAGB/MGB as conversional surgery in patients with GERD after restrictive procedures. Consensus for disagreement was predominantly achieved "in case of intestinal metaplasia of the stomach" (74.55%), "in patients with severe Gastro Esophageal Reflux Disease (GERD)(C,D)" (75.44%), "in patients with Barrett's metaplasia" (89.29%), and "in documented insulinoma" (89.47%). Conclusion: Patient selection in OAGB/MGB is still a point of discussion among experts. There was consensus that OAGB/MGB is a suitable option in elderly patients, patients with low BMI (30-35 kg/m2) with associated metabolic problems, and patients with BMIs more than 50 kg/m2 as one-stage procedure. OAGB/MGB can also be a safe procedure in vegetarian and vegan patients. Although OAGB/MGB can be a suitable procedure in patients with large hiatal hernia with concurrent hiatal hernia, it should not be offered to patients with grade C or D esophagitis or Barrett's metaplasia.info:eu-repo/semantics/publishedVersio

Robotic Roux-En-Y gastric bypass: Comparison of Da Vinci S and Xi Robotic platforms outcomes robotic bariatric surgery

Robotic surgery is an emerging and promising technology in bariatric surgery. Current studies have confirmed its feasibility and safety with a relatively short learning curve. The advantages for the surgeon are already well established with better ergonomics. The potential benefits to the patient are still being studied. Robotic surgery seems to offer more advantages for complex cases, such as super obesity and revisional surgery.International Federation for Surgery of Obesity and Metabolic Disorders SEC

A Spanish Society joint SECO and SEEDO approach to the Post-operative management of the patients undergoing surgery for obesity

[Purpose] Bariatric surgery is the method of choice for the management or treatment of obesity. Bariatric surgery brings about several physiological changes in the body and is associated with set of complications. The aim of this study is to provide guidelines on post bariatric surgery management based on consensus by the Spanish society for Obesity Surgery (Sociedad Española de Cirugía de la Obesidad) (SECO) and the Spanish Society for the Study of Obesity (Sociedad Española para el Estudio de la Obesidad) (SEEDO).[Method] The boards proposed seven experts from each society. The experts provided the evidence and a grade of recommendation on the selected topics based on systematic reviews/meta-analysis. A list of clinical practical recommendations levels of evidence and grades of these recommendations was derived from the consensus statements from the members of these societies.[Results] Seventeen topics related to post-operative management were reviewed after bariatric surgery. The experts came with 47 recommendations and statements. The mean number of persons voting at each statement was 54 (range 36-76).[Conclusion] In this consensus, we have designed a set of guidelines to be followed while managing patients after bariatric surgery. Expertise and knowledge of the clinicians are required to convey suitable considerations to the post-bariatric patients. There should also be extensive follow-up plans for the bariatric surgery patients.Peer reviewe

Tabagismo em amostra de adolescentes escolares de Salvador-Bahia Smoking among school adolescents in Salvador (BA)

INTRODUÇÃO: O hábito de fumar em geral se inicia na adolescência. No Brasil, as estimativas da freqüência deste hábito entre adolescentes variam de 1% até 35%. OBJETIVO: Estimar a prevalência do tabagismo entre os adolescentes da oitava série do ensino fundamental à terceira série do curso médio, em escolas de Salvador - Bahia, Brasil. MÉTODO: Feito um estudo do tipo corte transversal de caráter exploratório. Foram aplicados 3.500 questionários a alunos matriculados entre a 8ª série do ensino fundamental e a 3ª série do ensino médio, em cinco escolas da região metropolitana de Salvador (BA). Análise estatística: medidas descritivas e de associação (razão de prevalência) e o teste t de Student e o do qui-quadrado. RESULTADOS: A prevalência do tabagismo entre adolescentes de Salvador (BA) foi de 9,6%, considerando-se os 3.180 questionários válidos, sendo maior no sexo masculino (14%) que no feminino (6%). À medida que aumentava a idade, elevava-se essa prevalência. A média de idade do início do tabagismo foi de 14 ± 2 anos. Dentre adolescentes, 46% experimentaram o cigarro e 20% destes continuaram fumando. Entre filhos de fumantes a freqüência foi maior. O número médio de cigarros consumidos por dia pelos adolescentes que fumavam diariamente (n = 132) foi de 7 ± 6, sendo maior no sexo masculino. CONCLUSÃO: A prevalência do tabagismo em uma amostra selecionada de adolescentes escolares de Salvador (BA) foi de 9,6%, sendo maior entre os indivíduos do sexo masculino. A experimentação e a influência dos pais foram associadas ao tabagismo nos adolescentes.<br>BACKGROUND: Most tobacco users become addicted during adolescence. In Brazil, smoking prevalence among teenagers varies from 1% to 35%. OBJECTIVE: To estimate the prevalence of smoking among teenagers, aged from 13 to 20, in fundamental and high school in Salvador, Bahia, Brazil. METHOD: Cross-sectional exploratory study. Thirty five hundred questionnaires were applied to students at fundamental and high school in five schools at the metropolitan region of Salvador (BA). Statistical analysis: descriptive and associative measurements (Prevalence Rate), Student's t and qui-square tests. RESULTS: Smoking prevalence among teenagers in Salvador (BA) was 9.6%, considering 3,180 valid questionnaires. The frequency was higher in males (14%) than in females (6%). The prevalence increased with age. The mean age ± SD for tobacco initiation was 14 ± 2 years. Among the teenagers, 46% tried cigarettes, and 20% became addicted. The frequency was higher among teenagers whose parents were smokers. The mean ± SD number of daily cigarettes smoked by adolescent tobacco users (n = 132) was 7.4 (± 6.4) units per day, with a higher frequency among boys. CONCLUSION: Smoking prevalence in a selected set of adolescent students in Salvador (BA) was 9.6%, and it was higher among males. Parental smoking and cigarette experimentation were the major factor found to be associated to tobacco addiction among teenagers

Psychological and behavioral aspects of primary and reoperative surgery: a 6-month longitudinal study

Background: Problematic eating behaviors and general psychopathology have been associated with poor weight loss after bariatric surgery. However, little is known about how these aspects impact weight loss outcomes for the increasing number of patients undergoing reoperative surgeries. This study compares disordered eating and weight-related outcomes before and 6months after surgery in patients undergoing primary (P-Group) and reoperative bariatric surgery (R-Group).MethodsThis longitudinal study assessed 122 P-Group and 116 R-Group patients before and 6months after surgery. The assessment included the eating disorder examination diagnostic items, and a set of self-report measures assessing eating disorder symptomatology, grazing, depression, anxiety, and negative urgency.ResultsPreoperatively, no differences were found between the R- and P-Groups in terms of disordered eating-related variables (except for shape concern, which was higher for the R-Group). At 6months after surgery, the R-Group revealed significantly higher values for restraint (F(1,219)=5.84, p=0.016), shape (F(1,219)=5.59, p=0.019), weight concerns (F(1,219)=13.36, p=0.000), depression (F(1,219)=7.17, p=0.008), anxiety (F(1,219)=6.94, p=-0.009), and compulsive grazing (F(1,219)=6.13, p=0.014). No significant pre- or post-surgery predictors of weight loss were found for the P-Group (2=0.70, p=0.872). In the R-Group, post-surgery anxiety (Wald(2)(1)=6.19, p=0.01) and the post-surgery number of days with grazing in the previous month (Wald(2)(1)=3.90, p=0.04) were significant predictors of weight loss.ConclusionAt 6months after surgery, the R-Group presented more problematic eating and general psychological distress, which may put these patients at greater risk of poorer long-term weight outcomes.This study was partially conducted at Psychology Research Centre (PSI/01662), University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through national funds, and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653), by the following grants to Eva Conceicao (IF/01219/2014 and POCI-01-0145-FEDER-028209), and doctoral scholarship to Ana Pinto-Bastos (SFRH/BD/104159/2014). The funding body had no role in the design, collection, analysis, and interpretation of data; the writing of the manuscript; or the decision to submit the manuscript for publication

New directions in the political history of the Spanish-Atlantic world, c. 1750–1850

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