In Sweden, bariatric surgery has increased more than tenfold in the past decade, from 700 to 8,600 procedures annually, and laparoscopic gastric bypass (LRYGB) dominates (92% of all procedures). This expansion makes safety issues crucial. The aim of this nationwide survey was to identify aortic injuries in LRYGB.
All 41 centers performing LRYGB in Sweden were asked if an aortic injury had occurred during the years 2009-2010. Techniques for entering the first trocar and way of establishing pneumoperitoneum were evaluated. The total number of procedures was collected from the national quality registry, Scandinavian Obesity Surgery Registry (SOReg), and the National Patient Register.
During the study period, 11,744 LRYGBs were performed. The analysis revealed 5 aortic injuries, all occurring in patients in whom an optical trocar had been placed before establishing pneumoperitoneum. Outcomes varied from no major sequelae to bilateral lower limb amputation and death. Based on the total number of LRYGBs, the risk for an aortic injury was .043% overall and .091% when an optical trocar was used.
Aortic injury is a rare but serious complication in laparoscopic gastric bypass. In this survey, optical trocars constructed to reduce the risk of intraabdominal damage had been used in all 5 cases.
The reporting on outcome following barlatric procedures should include changes in comorbid conditions and quality of life (QOL), in addition to weight loss. The Bariatric Analysis and Reporting Outcome System (BAROS) appears to provide the means to fulfill these requests. We have re-evaluated our previously published, initial results of laparoscopic adjustable gastric banding, using BAROS.
Our first 60 consecutive patients were treated laparoscopically between the years 1996 and 1999, using the Swedish Adjustable Gastric Band (SAGB). After a minimum follow-up of > or = 17 months (median follow-up 28 months, range 17-61 months), a postal questionnaire concerning QOL, medical condition and excess weight loss (BAROS) was sent to the patients. In addition, the patients' opinion regarding the operation was evaluated as well as the extent that the band had caused the patients any of the more common side-effects.
87% of the patients returned the questionnaire properly answered. According to BAROS, the outcome was regarded as VERY GOOD in 12% of patients, GOOD in 38%, FAIR in 29% and FAILURE in 21%. Not one had an EXCELLENT outcome. 23% of the patients were disappointed with their operation. The incidence of band-related side-effects was high.
Our results are comparable with other published series including the learning curve. In our opinion, BAROS should be widely adopted.
OBJECTIVE: To evaluate the long term outcome after biliary-intestinal bypass for morbid obesity. DESIGN: Retrospective study. SETTING: County hospital, Sweden. SUBJECTS: 120 consecutive patients operated on between 1977 and 1990. INTERVENTIONS: A variation of jejunoileal bypass in which the excluded bowel was anastomosed to the gallbladder. MAIN OUTCOME MEASURES: Weight, concentrations of blood lipids and glucose in blood, results of liver function tests, reversal rates, and complications. RESULTS: The mean body mass index was reduced by 39% (from 42 kg/m2 to 26 kg/m2), serum cholesterol and triglyceride concentrations by more than 30%, and fasting blood glucose concentrations by 1 1%. There were no cases of irreversible hepatic failure, diabetes, deaths related to the operation, or progressive renal failure. The incidence of renal calculi increased by a ratio 2.3. The reversal rate/year was 2% (n = 20). CONCLUSION: We conclude that biliary-intestinal bypass may be used to treat cases of obesity associated with seriously high blood lipid concentrations and where gastric restrictive operations are less suitable.
Obesity increases the risk of several cancers, but the influence of bariatric surgery on the risk of individual obesity-related cancers is unclear. This study aimed to assess the impact of bariatric surgery on cancer risk in a multi-national setting.
This cohort study included all adults with an obesity diagnosis identified from national patient registries in all Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) from 1980 to 2012. Cancer risk in bariatric surgery patients was compared with non-operated patients with obesity. Multivariable Cox regression provided adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). Age, sex, calendar year, country, length of follow-up, diabetes, chronic obstructive pulmonary disease and alcohol-related diseases were evaluated as confounders.
Among 482,572 participants with obesity, 49,096 underwent bariatric surgery. Bariatric surgery was followed by a decreased overall cancer risk in women (HR 0.86, 95% CI 0.80-0.92), but not in men (HR 0.98, 95% CI 0.95-1.01). The risk reduction was observed only within the first five post-operative years. Among specific tumours, HRs decreased for breast cancer (HR 0.81, 95% CI 0.69-0.95), endometrial cancer (HR 0.69, 95% CI 0.56-0.84) and non-Hodgkin lymphoma (HR 0.64, 95% CI 0.42-0.97) in female bariatric surgery patients, while the risk of kidney cancer increased in both sexes (HR 1.44, 95% CI 1.13-1.84).
Bariatric surgery may decrease overall cancer risk in women within the first five years after surgery. This decrease may be explained by a decreased risk of breast and endometrial cancer and non-Hodgkin lymphoma in women.
Biliary complications during pregnancy is an important issue. The aim of this study was to examine if there is an increased risk to perform cholecystectomy during pregnancy in patients with previous bariatric surgery in comparison to other females subjected to cholecystectomy.
The Nationwide Swedish Registry for Gallstone Surgery (GallRiks) and the Scandinavian Obesity Surgery Registry (SOReg) were combined. Female patients 18-45 years old were included. The study group was patients with a history of bariatric surgery whom were pregnant at the time of cholecystectomy. This group was compared with pregnant patients without previous bariatric surgery and non-pregnant with and without previous bariatric surgery.
In total, 21,314 patients were included and 292 underwent surgery during pregnancy. From 1282 patients identified in both registers, 16 patients were pregnant at the time of cholecystectomy. Acute cholecystectomy was performed in 5922 (28%) non-pregnant and 199 (68%) pregnant (p?
The Swedish adjustable gastric band (SAGB) has been in use since 1985. The aim of this study was to analyze short and long-term complications linked to the SAGB.
Between August 1990 and December 1996, we operated on a series of 326 patients (78 men and 248 women) at the Huddinge University Hospital and the Norra Alvsborg County Hospital. The mean age of patients at surgery was 40 years (range 19-62). The mean preoperative weight was 125 kg (range 81-181). The mean excess weight was 80%.
The mean time of follow-up was 28 months (range 6-76). Complications requiring reoperation included two (0.6%) band dislocations, six (1.8%) band leakages, and 16 (4.6%) band migrations-erosions. The most common reason for abdominal reoperation, band migration, was attributed to overfilling of the band system. In the patients in whom migration occurred, the bands had been filled with a mean volume of 12.6 ml fluid. In the remaining patients, the mean volume was 8.7 ml. The most common complication not requiring reoperation was reflux disease (4.7%). In cases with a small pouch, this complication did not seem to be a serious problem. The mean excess weight loss in the 296 patients without complications was 68%.
The overall long-term complication rate following SAGB is reasonable. With improved operating technique and closer follow-up, it should be possible to reduce the complication rate further. Reoperation because of band migration appears to be related to overfilling of the system and should therefore be avoidable in most cases.
Centre for Obesity Research, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: firstname.lastname@example.org.
After Roux-en-Y gastric bypass (RYGB) patients are at higher risk of alcohol problems. In recent years, sleeve gastrectomy (SG) has become a common procedure, but the incidence rates (IRs) of alcohol abuse after SG are unexplored.
To compare IRs of diagnoses indicating problems with alcohol or other substances between patients having undergone SG or RYGB with a minimum of 6-month follow-up.
All government funded hospitals in Norway providing bariatric surgery.
A retrospective population-based cohort study based on data from the Norwegian Patient Registry. The outcomes were ICD-10 of Diseases and Related Health Problems diagnoses relating to alcohol (F10) and other substances (F11-F19).
The registry provided data on 10,208 patients who underwent either RYGB or SG during the years 2008 to 2014 with a total postoperative observation time of 33,352 person-years. This corresponds to 8196 patients with RYGB (27,846 person-yr, average 3.4 yr) and 2012 patients with SG (5506 person-yr; average 2.7 yr). The IR for the diagnoses related to alcohol problems after RYGB was 6.36 (95% confidence interval: 5.45-7.36) per 1000 person-years and 4.54 (2.94-6.70) after SG. When controlling for age and sex, adjusted hazard ratio was .75 (.49-1.14) for SG compared with RYGB. When combining both bariatric procedures, women 40 (1.3%, .9-1.7). The IR after RYGB for the diagnoses related to problems with substances other than alcohol was 3.48 (95% confidence interval: 2.82-4.25) compared with 3.27 (1.94-5.17) per 1000 person-years after SG. Controlling for age and sex, the hazard ratio was .99 (.60-1.64) for SG compared with RYGB.
In our study, procedure-specific differences were not found in the risks (RYGB versus SG) for postoperative diagnoses related to problems with alcohol and other substances within the available observation time. A longer observation period seems required to explore these findings further.
To identify risk factors for serious and specific early complications of laparoscopic gastric bypass surgery using a large national cohort of patients.
Bariatric procedures are among the most common surgical procedures today. There is, however, still a need to identify preoperative and intraoperative risk factors for serious complications.
From the Scandinavian Obesity Surgery Registry database, we identified 26,173 patients undergoing primary laparoscopic gastric bypass operation for morbid obesity between May 1, 2007, and September 30, 2012. Follow-up on day 30 was 95.7%. Preoperative data and data from the operation were analyzed against serious postoperative complications and specific complications.
The overall risk of serious postoperative complications was 3.4%. Age (adjusted P = 0.028), other additional operation [odds ratio (OR) = 1.50; confidence interval (CI): 1.04-2.18], intraoperative adverse event (OR = 2.63; 1.89-3.66), and conversion to open surgery (OR = 4.12; CI: 2.47-6.89) were all risk factors for serious postoperative complications. Annual hospital volume affected the rate of serious postoperative complications. If the hospital was in a learning curve at the time of the operation, the risk for serious postoperative complications was higher (OR = 1.45; CI: 1.22-1.71). The 90-day mortality rate was 0.04%.
Intraoperative adverse events and conversion to open surgery are the strongest risk factors for serious complications after laparoscopic gastric bypass surgery. Annual operative volume and total institutional experience are important for the outcome. Patient related factors, in particular age, also increased the risk but to a lesser extent.