Learning curve and global benchmark values of laparoscopic sleeve gastrectomy: results of first 100 cases of a newly trained surgeon in an Italian center of excellence

To evaluate whether the learning curve for sleeve gastrectomy could be completed after 50 cases. First 100 patients undergoing LSG under a newly trained laparoscopic surgeon were included in this study and divided into two groups of 50 consecutive patients each. Perioperative outcomes were compared to recently introduced global benchmarks. Short-term weight loss was calculated as Total Weight Loss Percent (%TWL) and complications were classified in accordance with the Clavien–Dindo classification. CUSUM analysis was performed for operative time and hospital stay. Mean preoperative age and BMI were 41.8 ± 10.3 years and 42.9 ± 5.4 kg/m2, respectively. Demographics and rate of patients with previous surgery were comparable preoperatively in the two groups. Mean operative time was 92.1 ± 19.3 min and hospital stay was 3.4 ± 0.6 days as per our standard protocol of discharge. Uneventful postoperative course was recorded in 93% of patients and only one case of staple line leak was registered in the first 50 cases (group 1). No statistical difference in BMI and %TWL was found between the two groups at any time of follow-up. Comparison between two groups showed a significant reduction in hospital stay and operative time after the first 50 LSGs (p < 0.05). LSG can be performed by newly trained surgeons proctored by senior tutors. At least 50 cases are needed to meet global benchmark cut-offs and few more cases may be required to reach the plateau of the learning curve

Flap fixation in preventing seroma formation after mastectomy: an updated meta-analysis

Seroma formation following mastectomy is one of the most experienced complications, with a very variable incidence ranging from 3 to 90%. In recent years, many publications have been realized to define an effective technique to prevent its formation and several approaches have been proposed. Given the potential of flap fixation in reducing seroma formation, we performed a meta-analysis of the literature to investigate the role of this approach as definitive gold standard in mastectomy surgery. Inclusion criteria regarded all studies reporting on breast cancer patients undergoing mastectomy with or without axillary lymph node dissection; studies that compared mastectomy with flap fixation to mastectomy without flap fixation were selected. Papers were eligible for inclusion if outcome was described in terms of seroma formation. As secondary outcome, also surgical site infection (SSI) was evaluated. The included studies were 12, involving 1887 female patients: 221/986 (22.41%) patients experienced seroma formation after flap fixation and 393/901 (43.61%) patients had this complication not receiving flap fixation, with a significant statistical difference between the two groups (OR = 0.267, p = 0.001, 95% CI 0.153, 0.464). About, SSI 59/686 (8.6%) in flap fixation group and 67/686 (9.7%) in patients without flap fixation, with no statistical differences between groups (OR = 0.59, p = 0.056, 95% CI 0.344, 1.013). The heterogeneity between included studies does not allow us to reach definitive conclusions but only to suggest the strong evaluation of this approach after mastectomy in seroma preventing and SSI reduction

Impact of COVID-19 Lockdown on Short-term Weight Loss in a Single Italian Institution

Italy was the first European country to have a major outbreak of COVID-19. Bariatric procedures were stopped and telemedicine had to be implemented. A large percentage of patients struggled to follow postoperative diet and to start physical activity due to social restrictions. We have compared short-term outcomes of patients who had bariatric procedures prior to lockdown with subjects that had undergone obesity surgery in the same period of the previous year at our institution. A total number of 63 patients were included in this study. Weight loss at 1, 3 and 6 postoperative months in the 2019 group was significantly higher at any point of follow-up when compared to 2020. Social limitations and nonattendance of clinical appointments may have compromised early results. Graphical Abstract: [Figure not available: see fulltext.]

Ten-Year Results of Laparoscopic Sleeve Gastrectomy: Retrospective Matched Comparison with Laparoscopic Adjustable Gastric Banding—Is There a Significant Difference in Long Term?

Background: The laparoscopic sleeve gastrectomy (LSG) is the most common bariatric procedure performed worldwide while the laparoscopic adjustable gastric banding (LAGB) has been almost abandoned. Aim of this study was to retrospectively assess 10-year outcomes of LSG through a matched comparison with LAGB. Materials and Methods: Retrospective search of prospectively maintained database of our university was carried out to find all patients that underwent LSG before December 2010. Each subject with LSG was matched one-to-one with a patient that had undergone LAGB in the same period with correspondent preoperative age, BMI, and sex. Results: A total of 76 patients underwent LSG before 2010 and were all included in this study; a matched group of 76 out of 178 LAGB patients with 10-year follow-up was retrieved from our database. Comparison between the two groups showed better outcomes after LSG at 1 and 5 years but weight loss was comparable with the LAGB group at 10 years (%TWL 22.2 ± 13 vs 21.2 ± 16.1; p = 0.89). No significant difference was found in conversion/removal rate (15.8% vs 18.4%; p = 0.67). Conclusion: LSG is an effective stand-alone bariatric procedure with better outcomes than LAGB in medium term, but results are comparable at 10 years. Subjects undergoing LSG should be informed that conversion to RYGB or OAGB may be necessary to achieve further weight loss or to treat reflux. Graphical abstract: [Figure not available: see fulltext.

Is there an indication left for gastric band? A single center experience on 178 patients with a follow-up of 10 years

Background: Laparoscopic Adjustable Gastric Banding (LAGB) has been widely performed in the past at our university bariatric center. Aim of this study was to retrospectively assess long term outcomes of LAGB at our university hospital, with special regard to non-response (EWL 50), while 38 (21.3%) were non-responders (%EWL < 25), 32 (18%) had an insufficient weight loss (25 < %EWL < 50) and 34 (19.1%) underwent band removal. Among these, 6 (3.4%) were removed for complications and 28 (15.7%) for insufficient weight loss. Weight regain occurred in 38 out of 144 (26.4%) subjects with the band in place at 10 years. Only one case of early vomiting with readmission for medical treatment was recorded. Slippage, erosion/migration and port/tube complications occurred in 4 (2.2%), 2(1.1%) and 9(5%) cases respectively. Conclusion: LAGB is a safe and moderately effective bariatric procedure but it showed disappointing rates of removal, non-response and remission from comorbidities. However, LAGB could still be proposed for selected/motivated patients

Should sleeve gastrectomy be considered only as a first step in super obese patients? 5-year results from a single center

Purpose: Sleeve gastrectomy (SG) has been originally conceived as a first step procedure for super obese (SO) patients, but it is currently considered a stand-alone intervention. Medium-term to long-term studies have shown weight regain and risk of de novo gastroesophageal reflux (GERD). The aim of this study was to evaluate outcomes of SG in SO subjects. Materials and Methods: A retrospective analysis of a prospectively maintained database was carried out to find all SO patients who had undergone SG with a minimum follow-up of 5 years. Inclusion criteria were preoperative endoscopy negative for esophagitis and/or hiatal hernia, and no GERD or acid reduction medication before SG. Reflux symptoms were evaluated using a validated questionnaire and endoscopy. Remission rates from comorbidities and percentage of excess body mass index (BMI) loss were recorded. Results: A total of 66 (45 male/21 female) patients were included in our study. Mean preoperative BMI and age were 57.4±5.8 kg/m2 and 32.7±11.2 years, respectively. After 5 years, mean percentage of excess BMI loss was 56.42±27.8, and remission rates from hypertension, diabetes, and dyslipidemia were 33.3%, 5.3%, and 20%, respectively. After 5 years, new-onset GERD occurred in 66.7% of patients and 33.3% were taking acid reduction medication. Endoscopy revealed 12 (18.2%) cases of esophagitis ≥grade A. Conclusions: After 5 years, weight loss in SO patients is satisfactory, but the vast majority of patients is still in class II obesity, and resolution of comorbidities is disappointing. High rates of de novo GERD and esophagitis may occur