Obesity surgery
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The benefit of beta-blockade on postoperative outcome remains controversial, though recent studies have suggested a role during major non-cardiac surgery. The benefit of beta-blockade during minimally invasive gastric bypass surgery remains unclear. The aim of the present study was to evaluate the possible association between preoperative beta-blocker therapy and postoperative outcome after laparoscopic gastric bypass surgery. ⋯ Beta-blockade has limited impact on postoperative outcome after laparoscopic gastric bypass surgery.
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Patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) are under risk of micronutrient deficiencies. We aimed to assess the preoperative and postoperative micronutrient deficiencies in a sample of patients with obesity who underwent LRYGB. ⋯ Vitamin D deficiency remains the most common preoperative deficiency. Anemia and deficiencies of iron and vitamin B12 are common before and after surgery. Deficiencies of calcium, magnesium, folate, and vitamins A, B1, and B6 are markedly low in the postoperative period.
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The safety and efficacy of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) to treat obesity and associated comorbidities, including diabetes mellitus, is well established. As diabetes may add risk to the perioperative period, we sought to characterize perioperative outcomes of these surgical procedures in diabetic patients. ⋯ Diabetics who underwent LSG and LRYGB had higher rates of several perioperative complications compared with non-diabetics. IDDM had a stronger association with several perioperative complications compared with NIDDM. This increase in morbidity and mortality is modest and should be weighed against the real benefits of bariatric surgery in patient with obesity and diabetes mellitus.
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As laparoscopic sleeve gastrectomy (LSG) is becoming the most popular bariatric procedure worldwide, treatment options for managing complications, in particular gastric leaks, are also emerging. Staple line leak is a major short-term complication of the procedure. Patients with persistent gastric leaks after failure of endoscopic and radiologic management are candidates for salvage surgery. Laparoscopic Roux-en-Y fistulo-jejunostomy (RYFJ) represents a surgical option to treat persistent gastric leak post-LSG. ⋯ Double LRYFJ for chronic leaks after complicated bariatric procedures seems safe with good postoperative outcomes. However, it remains a challenging procedure and should be reserved for selected patients in specialized bariatric centers.