Is Adherence to Follow-Up After Bariatric Surgery Necessary? A Systematic Review and Meta-Analysis

The association of adherence to follow-up (FU) after laparoscopic gastric bypass — and gastric sleeve with weight loss (WL) is unclear. The aim of this study was to evaluate this association. Fourteen full text articles were included in the systematic review. Eight studies were included in the meta-analysis concerning FU up to 3 years postoperatively and 3 for the FU between 3 and 10 years postoperatively. Results showed a significant association between adherence to FU 0.5 to 3 years postoperatively and percentage excess WL (%EWL) but did not demonstrate a significant association between FU > 3 years postoperatively and total WL (%TWL). In conclusion, adherence to FU may not be associated with WL and therefore stringent lifelong FU in its current form should be evaluated.

P060 TROCAR SITE HERNIA AFTER GASTRIC SLEEVE

Aim Laparoscopy is common in abdominal surgery. Trocar site hernia (TSH) is a most likely underestimated complication. Among risk factors, obesity, the use of larger trocars and the umbilical trocar site has been described. In a previous study, CT scan in the prone position upon a ring was found to be a reliable method for the detection of TSH in obese. Our aim was to examine the incidence of TSH after gastric sleeve. Material and Methods 79 patients subjected to laparoscopic gastric sleeve in 2011-2016 were examined using CT in the prone position upon a ring. Symptoms of TSH were assessed using a digital survey. Results The incidence of trocar site hernia was 17 out of 79 (21,5 %), all at the umbilical trocar site. The mean follow-up time was 37 months. There was no clear correlation between symptomatic TSH and TSH on CT. Conclusions The incidence of TSH is high in this group of patients. Up to follow-up, none of the patients had been subjected to hernia repair. Although the consequence of trocar site hernia can be serious, the proportion of symptomatic TSH is unknown.

Trocar site hernia after gastric sleeve

Background Laparoscopy is common in abdominal surgery. Trocar site hernia (TSH) is a most likely underestimated complication. Among risk factors, obesity, the use of larger trocars and the umbilical trocar site has been described. In a previous study, CT scan in the prone position was found to be a reliable method for the detection of TSH following gastric bypass (LRYGB). In the present study, our aim was to examine the incidence of TSH after gastric sleeve, and further to investigate the proportion of symptomatic trocar site hernias. Methods Seventy-nine patients subjected to laparoscopic gastric sleeve in 2011–2016 were examined using CT in the prone position upon a ring. Symptoms of TSH were assessed using a digital survey. Results The incidence of trocar site hernia was 17 out of 79 (21.5%), all at the umbilical trocar site. The mean follow-up time was 37 months. There was no significant correlation between patient symptoms and a TSH. Conclusions The incidence of TSH is high after laparoscopic gastric sleeve, a finding in line with several recent studies as well as with our first trial on trocar site hernia after LRYGB. Up to follow-up, none of the patients had been subjected to hernia repair. Although the consequence of a trocar site hernia can be serious, the proportion of symptomatic TSH needs to be more clarified.

Ligamentum teres augmentation (LTA) for hiatal hernia repair after minimally invasive esophageal resection: a new use for an old structure

Purpose Hiatal hernias with intrathoracic migration of the intestines are serious complications after minimally invasive esophageal resection with gastric sleeve conduit. High recurrence rates have been reported for standard suture hiatoplasties. Additional mesh reinforcement is not generally recommended due to the serious risk of endangering the gastric sleeve. We propose a safe, simple, and effective method to close the hiatal defect with the ligamentum teres. Methods After laparoscopic repositioning the migrated intestines, the ligamentum teres is dissected from the ligamentum falciforme and the anterior abdominal wall. It is then positioned behind the left lobe of the liver and swung toward the hiatal orifice. Across the anterior aspect of the hiatal defect it is semi-circularly fixated with non-absorbable sutures. Care should be taken not to endanger the blood supply of the gastric sleeve. Results We have used this technique for a total of 6 patients with hiatal hernias after hybrid minimally invasive esophageal resection in the elective (n = 4) and emergency setting (n = 2). No intraoperative or postoperative complications have been observed. No recurrence has been reported for 3 patients after 3 months. Conclusion Primary suture hiatoplasties for hiatal hernias after minimally invasive esophageal resection can be technically challenging, and high postoperative recurrence rates are reported. An alternative, safe method is needed to close the hiatal defect. Our promising preliminary experience should stimulate further studies regarding the durability and efficacy of using the ligamentum teres hepatis to cover the hiatal defect.

EP.TH.632A single centre’s experience with bariatric surgery outcomes compared to UK NBSR third report 2020

Bariatric Surgery has become a routine elective operation offered to patients with obesity (BMI >30) and obesity related diseases. The UK national Bariatric Surgery registry (NBSR) publishes data from record bariatric surgeries. Aim We compare one Bariatric service’s outcomes with the outcomes of the NBSR- Third Report 2020. Outcomes; 30-day mortality and complications, length of stay (LOS), 1-year weight loss for Gastric Sleeve (GS) and Roux-en-Y gastric bypasses. Method We collected data from one bariatric unit over a 98-month period. Data were taken from bariatric specialist nurses and electronic patient records. This was then compared with the NBSR report 2020. Results NBSR UK records 48.8% bypasses and 35.4% GS compared with our department (81.2% bypasses and 9.5% GS.) The average weight-loss 1-year post op for GS 36.9kg (NBSR 40.3kg) and for bypass 60.2kg (NBSR 44.1 kg) The average LOS for Bypass was 2.37 days (95%CI 2.3-.2.7) compared with the NBSR 2.6 (95% CI: 2.5-2.7). Whereas GS 2.9 (95%CI: 2.3-3.4) compared to NBSR 2.5 (95% CI: 2.4-2.6). 30-day mortality for primary procedures was 0% for Bypasses and GS compared with the NBSR 0.05%. 30 day complications at 1.74% compared with NBSR <2.38%. Conclusion Our unit proportionally performs more bypasses compared with the rest of UK and has greater 1-year weight-Loss with bypass procedures. This bariatric unit had less 30 day mortality and complications compared with NBSR. Our department is meeting the national outcomes when compared with the rest of the UK.

General public awareness of indications and complications of sleeve gastrectomy in Al'qassim region, Saudi Arabia

Background: Obesity is risingly becoming a health care problem. After ineffective tries to lose weight with lifestyle-based conservative methods, the most effective obesity treatment will become bariatric surgery. Objective of this study aimed to assess the awareness of the general public about indications and complications of sleeve gastrectomy in Al'Qassim region, Saudi Arabia.Methods: This was a cross-sectional study conducted among the general population living in Al'Qassim region, Saudi Arabia. A validated Arabic/English questionnaires were distributed among the targeted individual using an online platform. Questionnaires included demographic data, general knowledge about gastric sleeve and the knowledge toward the indication and complication of sleeve gastrectomy. All statistical analyses were performed using SPSS version 26.Results: Nearly all participants were aware of sleeve gastrectomy (99.1%). The prevalence of participants who knew the indications and complications of sleeve gastrectomy were 60.9% and 72.2%, respectively. Furthermore, approximately three quarters (70.3%) were confident that the most common indication of the gastric sleeve was an adult with BMI >40 kg/m2. Statistical tests revealed that the knowledge toward the indication and complication of sleeve gastrectomy were more common among those who have heard about BMI and those who knew the BMI range of obese person (p<0.05).Conclusions: Although, general population awareness toward the indication and complication of sleeve gastrectomy was moderate, however, their knowledge about the BMI seems to be lacking. Having better knowledge about BMI likely influenced their awareness of the indications and complications of gastric sleeve.