Effects of Bariatric Surgery on COVID-19: a Multicentric Study from a High Incidence Area

Introduction: The favorable effects of bariatric surgery (BS) on overall pulmonary function and obesity-related comorbidities could influence SARS-CoV-2 clinical expression. This has been investigated comparing COVID-19 incidence and clinical course between a cohort of patients submitted to BS and a cohort of candidates for BS during the spring outbreak in Italy. Materials and Methods: From April to August 2020, 594 patients from 6 major bariatric centers in Emilia-Romagna were administered an 87-item telephonic questionnaire. Demographics, COVID-19 incidence, suggestive symptoms, and clinical outcome parameters of operated patients and candidates to BS were compared. The incidence of symptomatic COVID-19 was assessed including the clinical definition of probable case, according to World Health Organization criteria. Results: Three hundred fifty-three operated patients (Op) and 169 candidates for BS (C) were finally included in the statistical analysis. While COVID-19 incidence confirmed by laboratory tests was similar in the two groups (5.7% vs 5.9%), lower incidence of most of COVID-19-related symptoms, such as anosmia (p: 0.046), dysgeusia (p: 0.049), fever with rapid onset (p: 0.046) were recorded among Op patients, resulting in a lower rate of probable cases (14.4% vs 23.7%; p: 0.009). Hospitalization was more frequent in C patients (2.4% vs 0.3%, p: 0.02). One death in each group was reported (0.3% vs 0.6%). Previous pneumonia and malignancies resulted to be associated with symptomatic COVID-19 at univariate and multivariate analysis. Conclusion: Patients submitted to BS seem to develop less severe SARS-CoV-2 infection than subjects suffering from obesity

Fluorescence‐based bowel anastomosis perfusion evaluation: results from the IHU‐IRCAD‐EAES EURO‐FIGS registry

Background: Anastomotic leakage (AL) is one of the dreaded complications following surgery in the digestive tract. Near-infrared fluorescence (NIRF) imaging is a means to intraoperatively visualize anastomotic perfusion, facilitating fluorescence image-guided surgery (FIGS) with the purpose to reduce the incidence of AL. The aim of this study was to analyze the current practices and results of NIRF imaging of the anastomosis in digestive tract surgery through the EURO-FIGS registry. Methods: Analysis of data prospectively collected by the registry members provided patient and procedural data along with the ICG dose, timing, and consequences of NIRF imaging. Among the included upper-GI, colorectal, and bariatric surgeries, subgroup analysis was performed to identify risk factors associated with complications. Results: A total of 1240 patients were included in the study. The included patients, 74.8% of whom were operated on for cancer, originated from 8 European countries and 30 hospitals. A total of 54 surgeons performed the procedures. In 83.8% of cases, a pre-anastomotic ICG dose was administered, and in 60.1% of cases, a post-anastomotic ICG dose was administered. A significant difference (p < 0.001) was found in the ICG dose given in the four pathology groups registered (range: 0.013–0.89 mg/kg) and a significant (p < 0.001) negative correlation was found between the ICG dose and BMI. In 27.3% of the procedures, the choice of the anastomotic level was guided by means of NIRF imaging which means that in these cases NIRF imaging changed the level of anastomosis which was first decided based on visual findings in conventional white light imaging. In 98.7% of the procedures, the use of ICG partly or strongly provided a sense of confidence about the anastomosis. A total of 133 complications occurred, without any statistical significance in the incidence of complications in the anastomoses, whether they were ICG-guided or not. Conclusion: The EURO-FIGS registry provides an insight into the current clinical practice across Europe with respect to NIRF imaging of anastomotic perfusion during digestive tract surgery

Ligand Assisted Desulfurization of Lignite Using the Perchloroethylene Coal Refining Process

The perchloroethylene coal refining process was used on North Dakota lignite coal. Effects of extraction time, perchloroethylenexoal ratio and artificial weathering were studied to determine their effects on the removal of organic sulfur. The artificial weathering conditions used were found to be too harsh and caused a decrease in the amount of organic sulfur removed, unlike normal weathering conditions. Additional studies were done involving various ligands, and showed that the addition of certain ligands during the process aided in the extraction of organic sulfur from the coal

Internal Hernias and Angina Abdominis After Laparoscopic Gastric Bypass: The Challenging Management of an Underestimated Problem

Introduction:. Internal hernia represents one of the most common late complications of Roux-en-Y gastric bypass (RYGBP), with an estimated incidence varying from 0.7% to 3.25%, reaching 6% considering only procedures with transmesocolic alimentary loop [1-2-3]. Such incidence only account for complicated hernias, while a greater part of internal hernias occur (si manifesta) as a recurrent episode of postprandial colic pain (angina abdominis). Those latter cases are probably the most challenging to diagnose, to treat and to prevent.. Case series: we present a video of four cases of laparoscopic exploration in patients with recurrent, not complicated, postprandial abdominal pain (angina abdominis) after RYGB. All the patients were mid age (mean age 39.5) females, previously submitted to an antecolic RYGB; mean EWL was 83%. Preoperative study revealed in all cases a partial or complete twist of the mesenteric axis at CT san. None presented with an acute syndrome (occlusion, leucocytosis, shock) and they were all operated on a not urgent setting. A Petersen non complicated hernia was detected in three patients, and reduction with stitch fixation was performed, while an adhesion to an intraperitoneal mesh with loop rotation was detected in the last case, and treated by a laparoscopic adhesiolysis. Postoperative course was uneventful for all the patients (mean hospital stay 2.5 days), and abdominal pain resolution was achieved at follow-up. Conclusions: Laparoscopic exploration yields a sure diagnosis and a safe and effective treatment of non complicated internal hernias after RYGBP