Short-term outcomes after long inverted versus short standard biliopancreatic limb in Roux-en-Y gastric bypass

Background: Obesity is a public health issue that affects the entire world and it is rising. Roux-en-Y gastric bypass is one of the most common bariatric procedures and it can reach a significant and sustained excess weight loss and efficient comorbidity control. The main objective was to compare short-term outcomes between standard versus long biliopancreatic limb gastric bypass patients.Methods: it was a retrospective, comparative, descriptive, single-center study. We evaluated obese patients that underwent a laparoscopic Roux-en-Y gastric bypass with standard or long biliopancreatic limb in Centro Medico ABC, Mexico City, and compared general demographics, weight loss, excess weight loss, comorbidities and quality of life.Results: Of 50 patients analyzed, 24 were in the standard gastric bypass (S-GB) and 26 in the long biliopancreatic limb (LBPL-GB). Mean weight loss in the S-GB group was 33.1±12.1 kg and in the LBPL-GB was 40.2±12.6 kg with a difference of 7.1 kg. The percentage of excess weight loss (%EWL) was 72.5±14% in S-GB and 72.9±19% in LBPL-GB, with a difference of 0.4% in the 12 months of follow-up. There was a complete reduction of hypoglycemic drugs in 80% in the S-GB group and 100% in the LBPL-GB group.Conclusions: With this modification of the technique, we achieved important outcomes in regard of comorbidities, without affecting drastically weight loss or the EWL. This procedure is safe and feasible

Experience of 10 years in routine trans operative endoscopy and calibration in fundoplication due to gastroesophageal reflux disease

Background: Endoscopy and intraoperative calibration in fundoplication for gastroesophageal reflux disease (GERD), confirm an adequate technique avoiding postoperative failure. Intraoperative changes and morbidity in routine use are unknown.Methods: Retrospective study in a single center, data were taken primarily from electronic archive medical records. A total of 899 who underwent fundoplication surgery with endoscopy and/or routine intraoperative calibration due to GERD met the required criteria between 1 January 2010 and 31 December 2020. The primary objective was to identify the number of calibration and intraoperative endoscopy findings. Also, the morbidity associated with its routine use was analyzed.Results: Over a 10-year study period, the most frequent calibration in the Nissen Fundoplication was 60Fr in 472 cases (61.4 %). The most used calibration in Toupet Fundoplication was 60Fr in 26 cases (21.1%). Endoscopy was performed in 786 patients (71.38%), of which; 3 patients (0.3%) required changes, secondary to fundoplication rotation in 2 patients (0.2%) and redundant gastric fundus in 1 patient (0.1%).Conclusions: Routine intraoperative calibration and endoscopy achieved excellent results in 96.8% of fundoplication’s, ensuring adequate esophageal position and corroborating an adequate intraoperative technique; decreasing the rate of failures and immediate postoperative dysphagia

Neuroendocrine and psychological assessment in a guinness 10 days scuba dive

his study was designed to evaluate physiological and psychological stress parameters in 2 professional trained scuba divers, using a unique Physiopathologic model, offered by the guinness 240 hours scuba dive. Two scuba dive masters have spent 240 hours at 6-8 meters depth (26.4 ft) in Ponza Island water (Italy). Blood samples were collected daily in the underwater bell; samples were carried out of water in waterproof bags. Breath samples were collected, measuring ethylene release. Psychological assessment was performed using the State and Trait Anxiety Inventory and the Zung self-rating depression scale. In the studied subjects, Cortisol and prolactin showed physiological pulsatile secretion. Breath ethylene didn't exceed normal values. At the start of the study, no subjects showed high levels of state anxiety, trait anxiety and current depression. Psychometric scales scores remained steady during the diving period and no subjects showed anxiety and/or depression and/or panic symptoms during the time of observation. The present study shows that, although the long-time diving, well trained professional divers did not develop anxiety and/or depression. No subject discontinued the diving due to occurred psychological disorders or systemic events. The present report shows that the long-term diving permanence is possible, at least in well trained scuba divers

Tiroidectomia video-assistita per carcinoma papillifero della tiroide

AIM. The results of video-assisted thyroidectomy (VAT) in a large series of patients with papillary thyroid carcinoma (PTC) were evaluated, especially in terms of the completeness of the surgical resection. METHODS. The medical records of all patients who underwent video-assisted total thyroid resection (single procedure total thyroidectomy or lobectomy followed by completion thyroidectomy) for PTC between June 1998 and December 2006 were reviewed. RESULTS. Two hundred and seventy-one patients were included. One hundred and two patients underwent central neck node removal by the same approach. Post-operative complications included 5 transient recurrent nerve palsies, 59 transient hypocalcemia cases, 3 permanent hypoparathyroidism cases and 1 postoperative haematoma. Final histology showed 215 pT1, 23 pT2, and 33 pT3 PTCs. Lymph node metastases were found in 19 cases. Follow-up evaluations were completed for 231 patients. Mean postoperative serum thyroglobulin (sTg) level after levothyroxine (LT4) withdrawal was 5.5 ng/ml. Post-operative ultrasonography showed no residual thyroid tissue in all patients. Mean post-operative 131I uptake was 2.1%. One patient developed lateral neck recurrence. CONCLUSIONS. The completeness of the surgical resection achieved with VAT seems comparable to that reported for conventional surgery. A longer follow-up is necessary to draw definitive conclusions in terms of recurrence and survival rate

30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries.

BACKGROUND There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates. METHODS We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020. RESULTS Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country. CONCLUSIONS BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak

Safety of Bariatric Surgery in ≥ 65-Year-Old Patients During the COVID-19 Pandemic

Background Age >= 65 years is regarded as a relative contraindication for bariatric surgery. Advanced age is also a recognised risk factor for adverse outcomes with Coronavirus Disease-2019 (COVID-19) which continues to wreak havoc on global populations. This study aimed to assess the safety of bariatric surgery (BS) in this particular age group during the COVID-19 pandemic in comparison with the younger cohort.Methods We conducted a prospective international study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into two groups - patients >= 65-years-old (Group I) and patients < 65-years-old (Group II). The two groups were compared for 30-day morbidity and mortality.Results There were 149 patients in Group 1 and 6923 patients in Group II. The mean age, preoperative weight, and BMI were 67.6 +/- 2.5 years, 119.5 +/- 24.5 kg, and 43 +/- 7 in Group I and 39.8 +/- 11.3 years, 117.7 +/- 20.4 kg, and 43.7 +/- 7 in Group II, respectively. Approximately, 95% of patients in Group 1 had at least one co-morbidity compared to 68% of patients in Group 2 (p = < 0.001). The 30-day morbidity was significantly higher in Group I ( 11.4%) compared to Group II (6.6%) (p = 0.022). However, the 30-day mortality and COVID-19 infection rates were not significantly different between the two groups.Conclusions Bariatric surgery during the COVID-19 pandemic is associated with a higher complication rate in those >= 65 years of age compared to those < 65 years old. However, the mortality and postoperative COVID-19 infection rates are not significantly different between the two groups