Publications by authors named "Kamal Mahawar"

180 Publications

The first international Delphi consensus statement on Laparoscopic Gastrointestinal surgery.

Int J Surg 2022 Jul 13;104:106766. Epub 2022 Jul 13.

Imperial College London, UK.

Background: Laparoscopic surgery has almost replaced open surgery in many areas of Gastro-Intestinal (GI) surgery. There is currently no published expert consensus statement on the principles of laparoscopic GI surgery. This may have affected the training of new surgeons. This exercise aimed to achieve an expert consensus on important principles of laparoscopic GI surgery.

Methods: A committee of 38 international experts in laparoscopic GI surgery proposed and voted on 149 statements in two rounds following a strict modified Delphi protocol.

Results: A consensus was achieved on 133 statements after two rounds of voting. All experts agreed on tailoring the first port site to the patient, whereas 84.2% advised avoiding the umbilical area for pneumoperitoneum in patients who had a prior midline laparotomy. Moreover, 86.8% agreed on closing all 15 mm ports irrespective of the patient's body mass index. There was a 100% consensus on using cartridges of appropriate height for stapling, checking the doughnuts after using circular staplers, and keeping the vibrating blade of the ultrasonic energy device in view and away from vascular structures. An 84.2% advised avoiding drain insertion through a ≥10 mm port site as it increases the risk of port-site hernia. There was 94.7% consensus on adding laparoscopic retrieval bags to the operating count and ensuring any surgical specimen left inside for later removal is added to the operating count.

Conclusion: Thirty-eight experts achieved a consensus on 133 statements concerning various aspects of laparoscopic GI Surgery. Increased awareness of these could facilitate training and improve patient outcomes.
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http://dx.doi.org/10.1016/j.ijsu.2022.106766DOI Listing
July 2022

Perforated marginal ulcer after gastric bypass for obesity: a systematic review.

Surg Obes Relat Dis 2022 May 27. Epub 2022 May 27.

Bariatric Unit, Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK.

Marginal ulcers are a recognized complication of gastric bypass procedures for obesity. Perforated marginal ulcer (PMU) is a life-threatening complication of marginal ulcers. We performed a systematic review to understand the presentation, management, and outcomes of PMUs. PubMed, Google Scholar, and Embase databases were searched to identify all studies on PMUs after gastric bypass procedures. A total of 610 patients were identified from 26 articles. The mean age was 39.8±2.59 years, and females represented most of the cohort (67%). The mean body mass index was 43.2±5.67 kg/m. Most of the patients had undergone a Roux-en-Y gastric bypass (98%). The time gap between the primary bariatric surgery and the diagnosis of PMU was 27.5±8.56 months. The most common presenting symptom was abdominal pain (99.5%) and a computed tomography scan was the diagnostic modality used in 72% of the patients. Only 15% of patients were on prophylactic proton pump inhibitors or H2 blockers at the time of perforation, and 41% of patients were smoking at the time. Twenty-three percent of patients were on nonsteroidal anti-inflammatory drugs. Laparoscopic omental patch repair of the perforation (59%) was the most used technique; 18% of patients underwent open surgery, and 20% were managed non-surgically. Thirty-day mortality was 0.97%; it was 1.21% (n=5) and 0% (n=0) in those who were managed surgically and nonsurgically, respectively. Ulcers recurred in 5% of patients. In conclusion, PMU is a surgical emergency after gastric bypass that can result in significant morbidity and even mortality. This is the first systematic review in scientific literature characterizing this condition.
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http://dx.doi.org/10.1016/j.soard.2022.05.024DOI Listing
May 2022

Effect of BMI on safety of bariatric surgery during the COVID-19 pandemic, procedure choice, and safety protocols - An analysis from the GENEVA Study.

Obes Res Clin Pract 2022 May-Jun;16(3):249-253. Epub 2022 Jun 8.

Bariatric Unit, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK.

Background: It has been suggested that patients with a Body Mass Index (BMI) of > 60 kg/m should be offered expedited Bariatric Surgery (BS) during the Coronavirus Disease-2019 (COVID-19) pandemic. The main objective of this study was to assess the safety of this approach.

Methods: We conducted a global study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into three groups according to their preoperative BMI - Group I (BMI<50 kg/m), Group II (BMI 50-60 kg/m), and Group III (BMI>60 kg/m). The effect of preoperative BMI on 30-day morbidity and mortality, procedure choice, COVID-19 specific safety protocols, and comorbidities was assessed.

Results: This study included 7084 patients (5197;73.4 % females). The mean preoperative weight and BMI were 119.49 ± 24.4 Kgs and 43.03 ± 6.9 Kg/m respectively. Group I included 6024 (85 %) patients, whereas Groups II and III included 905 (13 %) and 155 (2 %) patients, respectively. The 30-day mortality rate was higher in Group III (p = 0.001). The complication rate and COVID-19 infection were not different. Comorbidities were significantly more likely in Group III (p = <0.001). A significantly higher proportion of patients in group III received Sleeve Gastrectomy or One Anastomosis Gastric Bypass compared to other groups. Patients with a BMI of > 70 kg/m had a 30-day mortality of 7.7 % (2/26). None of these patients underwent a Roux-en-Y Gastric Bypass.

Conclusion: The 30-day mortality rate was significantly higher in patients with BMI > 60 kg/m. There was, however, no significant difference in complications rates in different BMI groups, probably due to differences in procedure selection.
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http://dx.doi.org/10.1016/j.orcp.2022.06.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9174153PMC
June 2022

Research priorities in emergency general surgery (EGS): a modified Delphi approach.

World J Emerg Surg 2022 06 16;17(1):33. Epub 2022 Jun 16.

Department of General Surgery, Forth Valley Royal Hospital, Larbert, FK5 4WR, UK.

Background: Emergency general surgery (EGS) patients account for more than one-third of admissions to hospitals in the National Health Service (NHS) in England. The associated mortality of these patients has been quoted as approximately eight times higher than that of elective surgical admissions. This study used a modified Delphi approach to identify research priorities in EGS. The aim was to establish a research agenda using a formal consensus-based approach in an effort to identify questions relevant to EGS that could ultimately guide research to improve outcomes for this cohort.

Methods: Three rounds were conducted using an electronic questionnaire and involved health care professionals, research personnel, patients and their relatives. In the first round, stakeholders were invited to submit clinical research questions that they felt were priorities for future research. In rounds two and three, participants were asked to score individual questions in order of priority using a 5-point Likert scale. Between rounds, an expert panel analysed results before forwarding questions to subsequent rounds.

Results: Ninety-two EGS research questions were proposed in Phase 1. Following the first round of prioritisation, forty-seven questions progressed to the final phase. A final list of seventeen research questions were identified from the final round of prioritisation, categorised as condition-specific questions of high interest within general EGS, emergency colorectal surgery, non-technical and health services research. A broad range of research questions were identified including questions on peri-operative strategies, EGS outcomes in older patients, as well as non-technical and technical influences on EGS outcomes.

Conclusions: Our study provides a consensus delivered framework that should determine the research agenda for future EGS projects. It may also assist setting priorities for research funding and multi-centre collaborative strategies within the academic clinical interest of EGS.
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http://dx.doi.org/10.1186/s13017-022-00432-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9202984PMC
June 2022

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

Obes Surg 2022 08 15;32(8):2512-2524. Epub 2022 Jun 15.

Min-Sheng General Hospital, Taoyuan City, Taiwan.

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/m as a one-stage procedure," "as the second stage of a two-stage bariatric surgery after Sleeve Gastrectomy for BMI > 50 kg/m (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/m) with associated metabolic problems, and patients with BMIs more than 50 kg/m 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.
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http://dx.doi.org/10.1007/s11695-022-06124-7DOI Listing
August 2022

Solve study: a study to capture global variations in practices concerning laparoscopic cholecystectomy.

Surg Endosc 2022 Jun 9. Epub 2022 Jun 9.

South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK.

Background: There is a lack of published data on variations in practices concerning laparoscopic cholecystectomy. The purpose of this study was to capture variations in practices on a range of preoperative, perioperative, and postoperative aspects of this procedure.

Methods: A 45-item electronic survey was designed to capture global variations in practices concerning laparoscopic cholecystectomy, and disseminated through professional surgical and training organisations and social media.

Results: 638 surgeons from 70 countries completed the survey. Pre-operatively only 5.6% routinely perform an endoscopy to rule out peptic ulcer disease. In the presence of preoperatively diagnosed common bile duct (CBD) stones, 85.4% (n = 545) of the surgeons would recommend an Endoscopic Retrograde Cholangio-Pancreatography (ERCP) before surgery, while only 10.8% (n = 69) of the surgeons would perform a CBD exploration with cholecystectomy. In patients presenting with gallstone pancreatitis, 61.2% (n = 389) of the surgeons perform cholecystectomy during the same admission once pancreatitis has settled down. Approximately, 57% (n = 363) would always administer prophylactic antibiotics and 70% (n = 444) do not routinely use pharmacological DVT prophylaxis preoperatively. Open juxta umbilical is the preferred method of pneumoperitoneum for most patients used by 64.6% of surgeons (n = 410) but in patients with advanced obesity (BMI > 35 kg/m, only 42% (n = 268) would use this technique and only 32% (n = 203) would use this technique if the patient has had a previous laparotomy. Most surgeons (57.7%; n = 369) prefer blunt ports. Liga clips and Hem-o-loks® were used by 66% (n = 419) and 30% (n = 186) surgeons respectively for controlling cystic duct and (n = 477) 75% and (n = 125) 20% respectively for controlling cystic artery. Almost all (97.4%) surgeons felt it was important or very important to remove stones from Hartmann's pouch if the surgeon is unable to perform a total cholecystectomy.

Conclusions: This study highlights significant variations in practices concerning various aspects of laparoscopic cholecystectomy.
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http://dx.doi.org/10.1007/s00464-022-09367-8DOI Listing
June 2022

Chyloperitoneum and Chylothorax Following Bariatric Surgery: a Systematic Review.

Obes Surg 2022 08 8;32(8):2764-2771. Epub 2022 Jun 8.

Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.

Chyloperitoneum and chylothorax (ChP/ChT) are rare complications after bariatric surgery. This systematic review aims to evaluate the incidence, cause, treatment, and outcome of ChP and ChT after bariatric surgery. This review investigates published English language scientific literature systematically in an attempt to answer these questions. Our literature search revealed 66 studies, of which 23 were included. There were a total of 40 patients (38, ChP; 2, ChT). Eighteen of 40 (43.9%) patients were treated laparoscopically, and one patient (2.44%) underwent thoracoscopy and ligation of the thoracic duct. Both ChP and ChT are rare complications after bariatric surgery.
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http://dx.doi.org/10.1007/s11695-022-06136-3DOI Listing
August 2022

Comment on: Effect of the COVID-19 pandemic on bariatric surgery in North America: a retrospective analysis of 834,647 patients.

Surg Obes Relat Dis 2022 07 22;18(7):e47-e48. Epub 2022 Apr 22.

Department of Surgery, Sunderland Royal Hospital, Sunderland, United Kingdom.

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http://dx.doi.org/10.1016/j.soard.2022.04.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9023114PMC
July 2022

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

Obes Surg 2022 07 5;32(7):1-13. Epub 2022 May 5.

Faculty of Health Sciences and Wellbeing, University of Sunderland, North East, Sunderland, UK.

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.
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http://dx.doi.org/10.1007/s11695-022-06067-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9071248PMC
July 2022

Biography: Professor Radwan Kassir, MD, PhD.

Authors:
Kamal Mahawar

Obes Surg 2022 06;32(6):1795

Bariatric Unit, Department of Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, SR4 7TP, UK.

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http://dx.doi.org/10.1007/s11695-022-06072-2DOI Listing
June 2022

Global variations in preoperative practices concerning patients seeking primary bariatric and metabolic surgery (PACT Study): A survey of 634 bariatric healthcare professionals.

Int J Obes (Lond) 2022 07 11;46(7):1341-1350. Epub 2022 Apr 11.

Helen McArdle Nursing and Care Research Institute, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK.

Background: Bariatric and Metabolic Surgery (BMS) is a popular weight loss intervention worldwide, yet few scientific studies have examined variations in preoperative practices globally. This study aimed to capture global variations in preoperative practices concerning patients planned for BMS.

Methods: A 41-item questionnaire-based survey was designed and the survey link was freely distributed on social and scientific media platforms, email groups and circulated through personal connections of authors. The survey included eight parts: basic information; criteria for BMS; preoperative nutritional screening; preoperative weight loss; preoperative diets for liver size reduction; preoperative glycemic control; other laboratory investigations and preparations; decision making, education, and consents. Descriptive statistics were used to analyse data and graphs were used for representation where applicable.

Results: Six hundred thirty-four bariatric healthcare professionals from 76 countries/regions completed the survey. Of these, n = 310 (48.9%) were from public hospitals, n = 466 (73.5%) were surgeons, and the rest were multidisciplinary professionals. More than half of respondents reported using local society/association guidelines in their practice (n = 310, 61.6%). The great majority of respondents routinely recommend nutritional screening preoperatively (n = 385, 77.5%), mandatory preoperative diets for liver size reduction (n = 220, 53.1%), routine screening for T2DM (n = 371, 90.7%), and mandate a glycemic control target before BMS in patients with T2DM (n = 203, 55.6%). However, less than half (n = 183, 43.9%) recommend mandatory preoperative weight loss to all patients. Most respondents (n = 296, 77.1%) recommend psychological intervention before surgery for patients diagnosed with psychological conditions. Variations were also identified in laboratory investigations and optimisation; and in the aspects of decision making, education and consent.

Conclusions: This survey identified significant global variations in preoperative practices concerning patients seeking primary BMS. Our findings could facilitate future research for the determination of best practice in these areas of variations, and consensus-building to guide clinical practice while we wait for that evidence to emerge.
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http://dx.doi.org/10.1038/s41366-022-01119-xDOI Listing
July 2022

Non-alcoholic fatty liver disease (NAFLD): a review of pathophysiology, clinical management and effects of weight loss.

BMC Endocr Disord 2022 Mar 14;22(1):63. Epub 2022 Mar 14.

Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands.

Given the increasing prevalence of diabetes and obesity worldwide, the deleterious effects of non-alcoholic fatty liver disease (NAFLD) are becoming a growing challenge for public health. NAFLD is the most common chronic liver disease in the Western world. NAFLD is closely associated with metabolic disorders, including central obesity, dyslipidaemia, hypertension, hyperglycaemia and persistent abnormalities of liver function tests.In general NAFLD is a common denominer for a broad spectrum of damage to the liver, which can be due to hepatocyte injury, inflammatory processes and fibrosis. This is normally seen on liver biopsy and can range from milder forms (steatosis) to the more severe forms (non-alcoholic steatohepatitis (NASH), advanced fibrosis, cirrhosis and liver failure). In these patients, advanced fibrosis is the major predictor of morbidity and liver-related mortality, and an accurate diagnosis of NASH and NAFLD is mandatory. Histologic evaluation with liver biopsy remains the gold standard to diagnose NAFLD. Diagnosis of NAFLD is defined as presence of hepatic steatosis, ballooning and lobular inflammation with or without fibrosis. Weight loss, dietary modification, and the treatment of underlying metabolic syndrome remain the mainstays of therapy once the diagnosis is established. Dietary recommendations and lifestyle interventions, weight loss, and the treatment of underlying metabolic syndrome remain the mainstays of therapy once the diagnosis is established with promising results but are difficult to maintain. Pioglitazone and vitamin E are recommended by guidelines in selected patients. This review gives an overview of NAFLD and its treatment options.
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http://dx.doi.org/10.1186/s12902-022-00980-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8919523PMC
March 2022

Safety considerations in laparoscopic surgery: A narrative review.

World J Gastrointest Endosc 2022 Jan;14(1):1-16

Department of General Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland SR4 7TP, United Kingdom.

Laparoscopic surgery has many advantages over open surgery. At the same time, it is not without its risks. In this review, we discuss steps that could enhance the safety of laparoscopic surgery. Some of the important safety considerations are ruling out pregnancy in women of the childbearing age group; advanced discussion with the patient regarding unexpected intraoperative situations, and ensuring appropriate equipment is available. Important perioperative safety considerations include thromboprophylaxis; antibiotic prophylaxis; patient allergies; proper positioning of the patient, stack, and monitor(s); patient appropriate pneumoperitoneum; ergonomic port placement; use of lowest possible intra-abdominal pressure; use of additional five-millimetre (mm) ports as needed; safe use of energy devices and laparoscopic staplers; low threshold for a second opinion; backing out if unsafe to proceed; avoiding hand-over in the middle of the procedure; ensuring all planned procedures have been performed; inclusion of laparoscopic retrieval bags and specimens in the operating count; avoiding 10-15 mm ports for placement of drains; appropriate port closures; and use of long-acting local anaesthetic agents for analgesia. Important postoperative considerations include adequate analgesia; early ambulation; careful attention to early warning scores; and appropriate discharge advice.
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http://dx.doi.org/10.4253/wjge.v14.i1.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8788169PMC
January 2022

Effect of Biliopancreatic Limb Length on Weight Loss, Postoperative Complications, and Remission of Comorbidities in One Anastomosis Gastric Bypass: a Systematic Review and Meta-analysis.

Obes Surg 2022 03 29;32(3):892-903. Epub 2022 Jan 29.

Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Aimed to evaluate the effects of biliopancreatic limb (BPL) length on weight loss, postoperative complications, and remission of comorbidities in OAGB.. An extensive search was conducted in PubMed, Scopus, EMBASE, and Google Scholar databases to find related OAGB articles. Both BPL length < 200 cm (by - 17.79, 95% CI - 19.23, - 16.34) and BPL length ≥ 200 cm (by - 14.93, 95% CI - 15.66, - 14.20) significantly decreased BMI. Regarding the effect of BPL length on comorbidities and postoperative complications, it was shown that BPL length < 200 cm is safer and more effective. Therefore, standardization of BPL length < 200 cm is suggested. Bypassing ≥ 200 cm of the small bowel does not ameliorate weight loss or resolve comorbidities significantly, and it is related to more frequent postoperative complications and nutritional deficiencies. Registration number in PROSPERO: PROSPERO 2021 CRD42021225499.
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http://dx.doi.org/10.1007/s11695-021-05848-2DOI Listing
March 2022

Esophageal and gastric malignancies after bariatric surgery: a retrospective global study.

Surg Obes Relat Dis 2022 04 3;18(4):464-472. Epub 2021 Dec 3.

Department of Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK.

Background: Bariatric surgery can influence the presentation, diagnosis, and management of gastrointestinal cancers. Esophagogastric (EG) malignancies in patients who have had a prior bariatric procedure have not been fully characterized.

Objective: To characterize EG malignancies after bariatric procedures.

Setting: University Hospital, United Kingdom.

Methods: We performed a retrospective, multicenter observational study of patients with EG malignancies after bariatric surgery to characterize this condition.

Results: This study includes 170 patients from 75 centers in 25 countries who underwent bariatric procedures between 1985 and 2020. At the time of the bariatric procedure, the mean age was 50.2 ± 10 years, and the mean weight 128.8 ± 28.9 kg. Women composed 57.3% (n = 98) of the population. Most (n = 64) patients underwent a Roux-en-Y gastric bypass (RYGB) followed by adjustable gastric band (AGB; n = 46) and sleeve gastrectomy (SG; n = 43). Time to cancer diagnosis after bariatric surgery was 9.5 ± 7.4 years, and mean weight at diagnosis was 87.4 ± 21.9 kg. The time lag was 5.9 ± 4.1 years after SG compared to 9.4 ± 7.1 years after RYGB and 10.5 ± 5.7 years after AGB. One third of patients presented with metastatic disease. The majority of tumors were adenocarcinoma (82.9%). Approximately 1 in 5 patients underwent palliative treatment from the outset. Time from diagnosis to mortality was under 1 year for most patients who died over the intervening period.

Conclusion: The Oesophago-Gastric Malignancies After Obesity/Bariatric Surgery study presents the largest series to date of patients developing EG malignancies after bariatric surgery and attempts to characterize this condition.
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http://dx.doi.org/10.1016/j.soard.2021.11.024DOI Listing
April 2022

The first survey addressing patients with BMI over 50: a survey of 789 bariatric surgeons.

Surg Endosc 2022 Aug 21;36(8):6170-6180. Epub 2022 Jan 21.

Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Background: Bariatric surgery in patients with BMI over 50 kg/m is a challenging task. The aim of this study was to address main issues regarding perioperative management of these patients by using a worldwide survey.

Methods: An online 48-item questionnaire-based survey on perioperative management of patients with a BMI superior to 50 kg/m was ideated by 15 bariatric surgeons from 9 different countries. The questionnaire was emailed to all members of the International Federation of Surgery for Obesity (IFSO). Responses were collected and analyzed by the authors.

Results: 789 bariatric surgeons from 73 countries participated in the survey. Most surgeons (89.9%) believed that metabolic/bariatric surgery (MBS) on patients with BMI over 50 kg/m should only be performed by expert bariatric surgeons. Half of the participants (55.3%) believed that weight loss must be encouraged before surgery and 42.6% of surgeons recommended an excess weight loss of at least 10%. However, only 3.6% of surgeons recommended the insertion of an Intragastric Balloon as bridge therapy before surgery. Sleeve Gastrectomy (SG) was considered the best choice for patients younger than 18 or older than 65 years old. SG and One Anastomosis Gastric Bypass were the most common procedures for individuals between 18 and 65 years. Half of the surgeons believed that a 2-stage approach should be offered to patients with BMI > 50 kg/m, with SG being the first step. Postoperative thromboprophylaxis was recommended for 2 and 4 weeks by 37.8% and 37.7% of participants, respectively.

Conclusion: This survey demonstrated worldwide variations in bariatric surgery practice regarding patients with a BMI superior to 50 kg/m. Careful analysis of these results is useful for identifying several areas for future research and consensus building.
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http://dx.doi.org/10.1007/s00464-021-08979-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9283149PMC
August 2022

Does powered stapler improve the mechanical integrity of gastrojejunal anastomosis compared to the current techniques? Experimental study in porcine models.

J Minim Access Surg 2022 Jan-Mar;18(1):90-96

Department of Upper Gastrointestinal and Bariatric Surgery, University Hospitals Birmingham NHS Foundation Trust; Department of Bariatric Surgery, Healthier Weight, Birmingham, UK.

Background: Numerous techniques have been described for fashioning gastrojejunostomy (GJ) in a Roux-en-Y gastric bypass. These include hand-sewn anastomosis (HSA) and mechanical anastomosis; the latter includes circular stapled anastomosis (CSA) or manual linear stapled anastomosis (mLSA). More recently, this list also includes powered linear stapled anastomosis (pLSA). The aim of this study was to analyse if addition of power to stapling would improve the integrity of GJ anastomosis in ex vivo porcine models.

Subjects And Methods: The present study included five groups - mLSA1, mLSA2, HSA, CSA, and pLSA. Sequential infusions of methylene blue-coloured saline were performed into the GJ models. Pressure readings were recorded till the point of leak denoting burst pressure (BP). Total volume (TV) and site of leak were recorded. Compliance was calculated from the equation ΔTV/ΔBP.

Results: Differences in pouch and intestinal thickness were not statistically significant between the models. BPs were higher in the mechanical anastomosis groups, i.e., pLSA 21 ± 9.85 mmHg, CSA 20.33 ± 5.78 mmHg, mLSA1 18 ± 4.69 mmHg and mLSA2 11 ± 2.94 mmHg, when compared to HSA 9.67 ± 3.79 mm Hg, which was found to be statistically significant (Kruskal-Wallis test, P = 0.03). Overall, the highest BP was recorded for powered stapling followed by circular, and then, linear stapling; however, this difference was not statistically significant (P = 0.86). There was no statistically significant difference among groups with regard to compliance (Kruskal-Wallis test, P = 0.082).

Conclusion: Despite the limited number of samples, mechanical anastomosis showed a statistically higher BP when compared to HSA, suggesting better anastomotic integrity. The pLSA group showed promising results with the highest BP recorded among all groups; however, this did not reach statistical significance.
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http://dx.doi.org/10.4103/jmas.JMAS_222_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8830564PMC
January 2022

The many faces of diabetes. Is there a need for re-classification? A narrative review.

BMC Endocr Disord 2022 Jan 7;22(1). Epub 2022 Jan 7.

Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.

The alarming rise in the worldwide prevalence of obesity and associated type 2 diabetes mellitus (T2DM) have reached epidemic portions. Diabetes in its many forms and T2DM have different physiological backgrounds and are difficult to classify. Bariatric surgery (BS) is considered the most effective treatment for obesity in terms of weight loss and comorbidity resolution, improves diabetes, and has been proven superior to medical management for the treatment of diabetes. The term metabolic surgery (MS) describes bariatric surgical procedures used primarily to treat T2DM and related metabolic conditions. MS is the most effective means of obtaining substantial and durable weight loss in individuals with obesity. Originally, BS was used as an alternative weight-loss therapy for patients with severe obesity, but clinical data revealed its metabolic benefits in patients with T2DM. MS is more effective than lifestyle or medical management in achieving glycaemic control, sustained weight loss, and reducing diabetes comorbidities. New guidelines for T2DM expand the use of MS to patients with a lower body mass index.Evidence has shown that endocrine changes resulting from BS translate into metabolic benefits that improve the comorbid conditions associated with obesity, such as hypertension, dyslipidemia, and T2DM. Other changes include bacterial flora rearrangement, bile acids secretion, and adipose tissue effect.This review aims to examine the physiological mechanisms in diabetes, risks for complications, the effects of bariatric and metabolic surgery and will shed light on whether diabetes should be reclassified.
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http://dx.doi.org/10.1186/s12902-021-00927-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8740476PMC
January 2022

30-day morbidity and mortality of sleeve gastrectomy, Roux-en-Y gastric bypass and one anastomosis gastric bypass: a propensity score-matched analysis of the GENEVA data.

Int J Obes (Lond) 2022 04 15;46(4):750-757. Epub 2021 Dec 15.

Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK.

Background: There is a paucity of data comparing 30-day morbidity and mortality of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). This study aimed to compare the 30-day safety of SG, RYGB, and OAGB in propensity score-matched cohorts.

Materials And Methods: This analysis utilised data collected from the GENEVA study which was a multicentre observational cohort study of bariatric and metabolic surgery (BMS) in 185 centres across 42 countries between 01/05/2022 and 31/10/2020 during the Coronavirus Disease-2019 (COVID-19) pandemic. 30-day complications were categorised according to the Clavien-Dindo classification. Patients receiving SG, RYGB, or OAGB were propensity-matched according to baseline characteristics and 30-day complications were compared between groups.

Results: In total, 6770 patients (SG 3983; OAGB 702; RYGB 2085) were included in this analysis. Prior to matching, RYGB was associated with highest 30-day complication rate (SG 5.8%; OAGB 7.5%; RYGB 8.0% (p = 0.006)). On multivariate regression modelling, Insulin-dependent type 2 diabetes mellitus and hypercholesterolaemia were associated with increased 30-day complications. Being a non-smoker was associated with reduced complication rates. When compared to SG as a reference category, RYGB, but not OAGB, was associated with an increased rate of 30-day complications. A total of 702 pairs of SG and OAGB were propensity score-matched. The complication rate in the SG group was 7.3% (n = 51) as compared to 7.5% (n = 53) in the OAGB group (p = 0.68). Similarly, 2085 pairs of SG and RYGB were propensity score-matched. The complication rate in the SG group was 6.1% (n = 127) as compared to 7.9% (n = 166) in the RYGB group (p = 0.09). And, 702 pairs of OAGB and RYGB were matched. The complication rate in both groups was the same at 7.5 % (n = 53; p = 0.07).

Conclusions: This global study found no significant difference in the 30-day morbidity and mortality of SG, RYGB, and OAGB in propensity score-matched cohorts.
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http://dx.doi.org/10.1038/s41366-021-01048-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8671878PMC
April 2022

The power of collaboration.

Authors:
Kamal Mahawar

Cir Esp (Engl Ed) 2021 Dec;99(10):705-706

Sunderland Royal Hospital, Sunderland, United Kingdom; University of Sunderland, Sunderland, United Kingdom. Electronic address:

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http://dx.doi.org/10.1016/j.cireng.2021.11.003DOI Listing
December 2021

Safe Surgery During the COVID-19 Pandemic.

Curr Obes Rep 2021 Oct 28. Epub 2021 Oct 28.

Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK.

Purpose Of Review: Coronavirus Disease-2019 (COVID-19) has had an enormous impact on all aspects of healthcare, but its effect on patients needing surgery and surgeons has been disproportionate. In this review, we aim to understand the impact of the pandemic on surgical patients and teams. We compiled the emerging data on pre-operative screening methods, vaccinations, safe-surgery pathways and surgical techniques and make recommendations for evidence-based safe-surgical pathways. We also present surgical outcomes for emergency, oncological and benign surgery in the context of the pandemic. Finally, we attempt to address the impact of the pandemic on patients, staff and surgical training and provide perspectives for the future.

Recent Findings: Surgical teams have developed consensus guidelines and established research priorities and safety precautions for surgery during the COVID-19 pandemic. Evidence supports that surgery in patients with a peri-operative SARS-CoV-2 infection carries substantial risks, but risk mitigation strategies are effective at reducing harm to staff and patients. Surgery has increased risk for patients and staff, but this can be mitigated effectively, especially for elective surgery. Elective surgery can be safely performed during the COVID-19 pandemic employing the strategies discussed in this review.
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http://dx.doi.org/10.1007/s13679-021-00458-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552630PMC
October 2021

Influence of Pre-operative HbA1c on Bariatric Surgery Outcomes-the Sunderland (UK) Experience.

Obes Surg 2022 01 11;32(1):42-47. Epub 2021 Oct 11.

Department of Upper GI and Bariatric Surgery, Sunderland Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK.

Purpose: UK guidelines recommend an HbA1c < 8.5% prior to elective surgery. Optimisation of pre-operative glycaemic control can be often difficult. Aim to correlate the effect of pre-operative HbA1c on the peri-operative complication rates and whether elective bariatric surgery should be delayed in poorly controlled diabetics.

Material And Methods: Retrospective data of consecutive patients who underwent laparoscopic Roux-en-Y gastric bypass, one-anastomosis gastric bypass and laparoscopic sleeve gastrectomy during January 2014 and April 2018. Patients were categorised into group 1, non-diabetics with an HbA1c < 6.5%; group 2, well-controlled diabetics with HbA1c between 6.5 and 8.4%; and group 3, poorly controlled diabetics with HbA1c ≥ 8.5%. Primary outcome was peri-operative complication rates.

Results: Group 1 (n = 978), 81.8% female, median (i.q.r.) age 44.0 (34-52) years, median (i.q.r.) BMI 42.0 (38.7-46.7); group 2 (n = 350), 66.3% female, age 51.0 (45-59) years, BMI 41.8 (37.5-46.5); and group 3 (n = 90), 60% female, age 52.0 (45-56) years and BMI 41.4(36.9-44.8). Early complication rates in each group were low, 1.0% vs 1.7% vs 1.1% (p = 0.592). Mean length of stay was 2 days across the groups (p > 0.05). There was no difference in 30-day re-admission rates between groups 2.8%, 2.9% and 3.3% (p = 0.983). At 6 months and 1 year, there was sustained and equal reduction in HbA1c in all groups (p < 0.05).

Conclusion: Patients undergoing metabolic surgery for poorly controlled diabetes achieve non-inferior peri-operative outcomes. Hence, delaying metabolic surgery in an attempt to optimise diabetic control is not justifiable.
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http://dx.doi.org/10.1007/s11695-021-05741-yDOI Listing
January 2022

Religious Fasting of Muslim Patients After Metabolic and Bariatric Surgery: a Modified Delphi Consensus.

Obes Surg 2021 12 6;31(12):5303-5311. Epub 2021 Oct 6.

In Charge Metabolic, Thoracic and General Surgery Unit III, Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan.

Background: Fasting during Ramadan is one of the five pillars of the Muslim faith. Despite the positive effects of fasting on health, there are no guidelines or clear recommendations regarding fasting after metabolic/bariatric surgery (MBS). The current study reports the result of a modified Delphi consensus among expert metabolic/bariatric surgeons with experience in managing patients who fast after MBS.

Methods: A committee of 61 well-known metabolic and bariatric surgeons from 24 countries was created to participate in the Delphi consensus. The committee voted on 45 statements regarding recommendations and controversies around fasting after MBS. An agreement/disagreement ≥ of 70.0% was regarded as consensus.

Results: The experts reached a consensus on 40 out of 45 statements after two rounds of voting. One hundred percent of the experts believed that fasting needs special nutritional support in patients who underwent MBS. The decision regarding fasting must be coordinated among the surgeon, the nutritionist and the patient. At any time after MBS, 96.7% advised stopping fasting in the presence of persistent symptoms of intolerance. Seventy percent of the experts recommended delaying fasting after MBS for 6 to 12 months after combined and malabsorptive procedures according to the patient's situation and surgeon's experience, and 90.1% felt that proton pump inhibitors should be continued in patients who start fasting less than 6 months after MBS. There was consensus that fasting may help in weight loss, improvement/remission of non-alcoholic fatty liver disease, dyslipidemia, hypertension and type 2 diabetes mellitus among 88.5%, 90.2%, 88.5%, 85.2% and 85.2% of experts, respectively.

Conclusion: Experts voted and reached a consensus on 40 statements covering various aspects of fasting after MBS.
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http://dx.doi.org/10.1007/s11695-021-05724-zDOI Listing
December 2021

Portomesenteric Vein Thrombosis after Bariatric Surgery: An Online Survey.

J Clin Med 2021 Sep 6;10(17). Epub 2021 Sep 6.

PhD Program in Applied Medical-Surgical Sciences, University of Rome "Tor Vergata", 00133 Rome, Italy.

Portomesenteric vein thrombosis (PMVT) is a rare post-operative complication of bariatric procedures, occurring in between 0.3% and 1% of cases. A structured questionnaire consisting of 27 items was available online to members of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) to investigate the occurrence of PMVT. A total of 89 bariatric surgeons from 61 countries participated. Twenty-six (29.21%) reported at least one case of PMVT (46.15% males; 53.84% females). The surgery most associated with PMVT occurrence was sleeve gastrectomy (84.6%), followed by Roux-en-Y gastric bypass (RYGB) (7.69%), and laparoscopic adjustable gastric banding (LAGB) (7.69%). The time gap between surgery and PMVT was 19.28 ± 8.72 days. The predominant symptom was abdominal pain in 96.15% of patients, followed by fever in 26.9%. Complete occlusion of the portal vein was reported in 34.6% of cases, with involvement of the portal system in 69%, extension to the superior mesenteric district in 23%, and extension to the splenic vein in two patients (7.7%). Our survey, which is the largest regarding PMVT to date, revealed a diffuse lack of standardization in the choice, duration, and dosing of prophylaxis regimens as well as treatment modalities, reflecting the literature gap on the topic.
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http://dx.doi.org/10.3390/jcm10174024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432580PMC
September 2021

Never events in orthopaedics: A nationwide data analysis and guidance on preventative measures.

Int J Risk Saf Med 2021 Aug 23. Epub 2021 Aug 23.

Bariatric Unit, Department of General Surgery, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Trust, Sunderland, UK.

Background: Never Events (NE) are serious clinical incidents that are wholly preventable if appropriate institutional safeguards are in place and followed. They are often used as a surrogate of the quality of healthcare delivered by an institution. Most NEs are surgical and orthopaedic surgery is one of the most involved specialties.

Objective: The aim of this study was to identify common NE themes associated with orthopaedics within the National Health Service (NHS) of England.

Method: We conducted an observational study analysing the annual NE data published by the NHS England from 2012 to 2020 to collate all orthopaedic surgery-related NE and construct relevant recurring themes.

Results: We identified 460 orthopaedic NE out of a total of 3247 (14.16%) reported NE to NHS England. There were 206 Wrong implants/prostheses under 8 different themes. Wrong hip and knee prosthesis were the commonest "wrong implants" (n = 94; 45.63% and n = 91; 44.17% respectively). There were 197 "Wrong-site surgery" incidents in 22 different themes. The commonest of these was the laterality problems accounting for 64 (32.48%) incidents followed by 63 (31.97%) incidents of wrong spinal level interventions. There were 18 (9.13%) incidents of intervention on the wrong patients and 17 (8.62%) wrong incisions. Retained pieces of instruments were the commonest retained foreign body with 15 (26.13%) incidents. The next categories were retained drill parts and retained instruments with 13 (22.80%) incidents each.

Conclusion: We identified 47 different themes of NE specific to orthopaedic surgery. Awareness of these themes would help in their prevention. Site marking can be challenging in the presence of cast and on operating on the digits and spine. Addition of a Real-time intra-operative implant scan to the National Joint Registry can avoid wrong implant selection while Fiducial markers, intraoperative imaging, O-arm navigation, and second time-out could help prevent wrong level spinal surgery.
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http://dx.doi.org/10.3233/JRS-210051DOI Listing
August 2021

Network Meta-Analysis of Metabolic Surgery Procedures for the Treatment of Obesity and Diabetes.

Obes Surg 2021 10 7;31(10):4528-4541. Epub 2021 Aug 7.

Bariatric Unit, Sunderland Royal Hospital, Sunderland, UK.

Background: Metabolic surgery is part of a well-established treatment intensification strategy for obesity and its related comorbidities including type 2 diabetes (T2DM). Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and one-anastomosis gastric bypass (OAGB) are the most commonly performed metabolic surgeries worldwide, but comparative efficacy is uncertain. This study employed network meta-analysis to compare weight loss, T2DM remission and perioperative complications in adults between RYGB, SG and OAGB.

Methods: MEDLINE, EMBASE, trial registries were searched for randomised trials comparing RYGB, SG and OAGB. Study outcomes were excess weight loss (at 1, 2 and 3-5 years), trial-defined T2DM remission at any time point and perioperative complications.

Results: Twenty randomised controlled trials were included involving 1803 patients investigating the three metabolic surgical interventions. RYGB was the index for comparison. The excess weight loss (EWL) demonstrated minor differences at 1 and 2 years, but no differences between interventions at 3-5 years. T2DM remission was more likely to occur with either RYGB or OAGB when compared to SG. Perioperative complications were higher with RYGB when compared to either SG or OAGB. Two-way analysis of EWL and T2DM remission against the risk of perioperative complications demonstrated OAGB was the most positive on this assessment at all time points.

Conclusion: OAGB offers comparable metabolic control through weight loss and T2DM remission to RYGB and SG whilst minimising perioperative complications. Registration number: CRD42020199779 (https:// www.crd.york.ac.uk/PROSPERO ).
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http://dx.doi.org/10.1007/s11695-021-05643-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8346344PMC
October 2021

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

Obes Surg 2021 10 30;31(10):4272-4288. Epub 2021 Jul 30.

Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK.

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.
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http://dx.doi.org/10.1007/s11695-021-05493-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8323543PMC
October 2021

30-Day morbidity and mortality of bariatric metabolic surgery in adolescence during the COVID-19 pandemic - The GENEVA study.

Pediatr Obes 2021 12 8;16(12):e12832. Epub 2021 Jul 8.

Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK.

Background: Metabolic and bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity.

Objectives: This study examined the safety of MBS in adolescents during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: This was a global, multicentre and observational cohort study of MBS performed between May 01, 2020, and October 10,2020, in 68 centres from 24 countries. Data collection included in-hospital and 30-day COVID-19 and surgery-specific morbidity/mortality.

Results: One hundred and seventy adolescent patients (mean age: 17.75 ± 1.30 years), mostly females (n = 122, 71.8%), underwent MBS during the study period. The mean pre-operative weight and body mass index were 122.16 ± 15.92 kg and 43.7 ± 7.11 kg/m , respectively. Although majority of patients had pre-operative testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n = 146; 85.9%), only 42.4% (n = 72) of the patients were asked to self-isolate pre-operatively. Two patients developed symptomatic SARS-CoV-2 infection post-operatively (1.2%). The overall complication rate was 5.3% (n = 9). There was no mortality in this cohort.

Conclusions: MBS in adolescents with obesity is safe during the COVID-19 pandemic when performed within the context of local precautionary procedures (such as pre-operative testing). The 30-day morbidity rates were similar to those reported pre-pandemic. These data will help facilitate the safe re-introduction of MBS services for this group of patients.
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http://dx.doi.org/10.1111/ijpo.12832DOI Listing
December 2021

Obstructive sleep apnea remission following bariatric surgery: a national registry cohort study.

Surg Obes Relat Dis 2021 Sep 21;17(9):1576-1582. Epub 2021 May 21.

Department of Upper Gastrointestinal and Bariatric Surgery, St George's Hospital, London, United Kingdom & Population Health Research Institute, St George's, University of London, London, United Kingdom.

Background: Obstructive sleep apnea (OSA) is strongly associated with metabolic syndrome. Bariatric surgery is an effective available treatment for OSA; however, limited research predicts which patients undergoing bariatric surgery will undergo OSA resolution.

Objectives: To determine perioperative predictors for OSA resolution following bariatric surgery using a national database.

Setting: United Kingdom national bariatric surgery database.

Methods: The UK National Bariatric Surgery Registry (NBSR) was interrogated to identify all patients with OSA that underwent primary bariatric surgery between January 2009 and June 2017. Those with at least 1 follow-up recording postoperative OSA status were selected for further analysis. Demographic, pre- and postoperative outcomes were collected and analyzed. Poisson multivariate regression was conducted to identify predictors of OSA remission.

Results: A total of 4015 bariatric cases were eligible for inclusion: 2482 (61.8%) patients underwent laparoscopic Roux-en-Y gastric bypass (LRYGB), 1196 (29.8%) sleeve gastrectomy (LSG), and 337 (8.4%) adjustable gastric banding (LAGB). Overall, the mean excess weight loss (EWL) % for the whole group was 61.2 (SD ± 27.2). OSA resolution was recorded in 2377 (59.2%) patients. Following Poisson regression, LRYGB (risk ratio [RR], 1.49 confidence interval [CI] 1.25-1.78) and LSG (RR, 1.46 [CI 1.22-1.75] were associated with approximately 50% increased likelihood of OSA remission compared with LAGB. Greater weight loss following intervention was associated with greater likelihood of OSA remission, while both greater age and greater preoperative body mass index (BMI) were associated with reduced likelihood of OSA remission (P < .001).

Conclusion: This study demonstrated that metabolic surgery results in OSA remission in the majority of patients with obesity. Younger age, lower BMI preprocedure, greater %EWL and the use of LSG or LRYGB positively predicted OSA remission.
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http://dx.doi.org/10.1016/j.soard.2021.05.021DOI Listing
September 2021
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