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Hiatal hernia repair during laparoscopic sleeve gastrectomy: systematic review and meta-analysis on gastroesophageal reflux disease symptoms changes

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Małczak P., Pisarska-Adamczyk M., Zarzycki P., Wysocki M., Major P.
Polish Journal of Surgery
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2021
|
vol. 93
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issue 5
1-6
EN
Introduction: Obesity is associated with a higher prevalence of various comorbidities including gastroesophageal reflux disease (GERD). It is yet still unclear whether laparoscopic sleeve gastrectomy (LSG) exacerbates or alleviates GERD symptoms. Available date in the literature on LSG influence on GERD are contradictory. Aim: This study aimed to systematically review literature comparing the influence of HHR on GERD in comparison to LSG alone. Material and methods: The review was conducted in January 2021 in accordance to PRISMA guidelines. Inclusion criteria involved reporting GERD and comparison of above-mentioned techniques. Primary outcome of interest were alleviation of GERD and “de-novo” GERD symptoms. Secondary outcomes were operative time and morbidity. Results: Initial search yielded 831 records. After the review and full-text screening 5 studies were included in the analysis. There were no differences in terms of GERD outcomes, p = 0.74 for alleviation, p = 0.77 for new symptoms. Concomitant hiatal hernia repair significantly prolongs sleeve gastrectomy by 38 mins. Conclusion: There are no differences in GERD between hiatal hernia repair during sleeve gas
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Plastyka przepukliny roztworu przełykowego podczas laparoskopowej rękawowej resekcji żołądka: przegląd systematyczny z meta-analizą na temat refluksu żołądkowo-przełykowego

100%
Małczak P., Pisarska-Adamczyk M., Zarzycki P., Wysocki M., Major P.
Polish Journal of Surgery
|
2021
|
vol. 93
|
issue 5
1-6
PL
Wstęp: Otyłość zwiększa ryzyko występowania refluksu żołądkowo-przełykowego (ang. gastroesophageal reflux disease; GERD). Nie jest wiadome, czy laparoskopowa rękawowa resekcja żołądka nasila, czy łagodzi jego objawy. Dane dostępne w literaturze na ten temat są sprzeczne. Cel: Celem niniejszego badania było wykonanie systematycznej analizy literatury porównującej wpływ wykonania plastyki przepukliny rozworu przełykowego (ang. hiatal hernia repair; HHR) na objawy GERD w porównaniu z samą laparoskopową rękawową resekcją żołądka (ang. laparoscopic sleeve gastrectomy; LSG). Materiał i metody: Badanie przeprowadzono według wytycznych PRISMA w styczniu 2021 r. Kryteria włączenia obejmowały raportowanie GERD i porównanie wyżej wymienionych technik. Analizowane efekty końcowe obejmowały: złagodzenie objawów GERD, nowe objawy GERD, czas operacji oraz występowanie powikłań pooperacyjnych. Wyniki: Przyjęte kryteria wyszukiwania wykazały 831 potencjalnych rekordów. Po przeglądzie do analizy ostatecznie włączono 5 badań. Nie wykazano istotnych statystycznie zmian w zakresie GERD, p = 0,074 dla złagodzenia objawów oraz p = 0,77 dla nowych objawów. Jednoczasowa plastyka przepukliny rozworu przełykowego wydłuża czas operacji o średnio 38 minut. Wnioski: Brak jest istotnych statystycznie różnic w objawach GERD w przypadku porównania samej rękawowej resekcji żołądka z dodatkową jednoczasową plastyką przepukliny rozworu. Dokładna ocena techniki wymaga dalszych badań o wysokiej jakości.
3
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Analysis of quality of life in patients with clinically severe obesity and type 2 diabetes mellitus after laparoscopic sleeve gastrectomy – a 12-month prospective observational study

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Wysocki M., Mizera M., Karpińska I., Ptaszkiewicz K., Małczak P., Pisarska-Adamczyk M., Kania M., Major P.
Polish Journal of Surgery
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2024
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vol. 96
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issue 6
20-30
EN
Introduction: Due to a short history of laparoscopic sleeve gastrectomy (LSG) as an independent bariatric procedure, we still lack studies providing analysis of the quality of life (QoL) in patients with type 2 diabetes mellitus (DM2). Aim: We aimed to assess the influence of LSG on QoL in obese patients with DM2. Material and Methods: Prospective, observational study included patients with: morbid obesity, body mass index (BMI) ≥ 35 kg/m² and ≤ 50 kg/m2, DM2 shorter than 10 years, qualified for LSG. Bariatric Analysis and Reporting Outcome System (BAROS) that included the Moorehead-Ardelt Quality of Life Questionnaire II (MA-QoLQII) score, and the SF-36 Health Survey (SF-36) questionnaire were used for repetitive assessment of QoL before LSG and after one and 12 months following surgery. Selected clinical and biochemical parameters were also repeatedly measured. Results: Thirty-three patients were included in the study (23 females). Patients’ mean age was 45 ±10 years. BAROS significantly increased before LSG, one month, and one year after surgery (0.63 ±1.12, 2.94 ±1.90, and 4.97 ±2.08, respectively). The MA-QoLQII score significantly rose with an increase of excess body mass index loss (EBMIL) (P = 0.002) and remission of DM2 (P = 0.049), while inversely correlated with Homeostatic Model Assessment for Insulin Resistance index (HOMA-IR) (P = 0.003). Degenerative joint disease (P = 0.025) and average time of low glucose concentration in continuous glucose monitoring (CGM) (P = 0.005) had an inverse correlation with SF-36 Physical Component Summaries (PCS), standardized for cardiovascular comorbidity, EBMIL and HOMA-IR (P = 0.839; P = 0.086; P = 0.571, respectively). EBMIL (P = 0.003), remission of DM2 (P < 0.001) had a positive correlation with Mental Component Summaries (MCS), while HOMA-IR (P < 0.001) and count of low glucose concentration events (P = 0.022) had an inverse correlation with MCS, while standardized for average glucose concentration in CGM after 12 months (P = 0.586). Discussion: Significant improvement in QoL was observed in patients with DM2 after LSG. Remission of DM2, higher EBMIL, lower HOMA-IR, fewer and shorter low glucose concentration events in CGM after 12 months were factors that increased selected QoL scores.
4
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Effect of preoperative intragastric balloon treatment on perioperative and postoperative outcomes after laparoscopic sleeve gastrectomy: A retrospective cohort study

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Rzepa A., Karpińska I., Wierdak M., Pisarska-Adamczyk M., Stefura T., Kawa I., Pędziwiatr M., Major P.
Polish Journal of Surgery
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2024
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vol. 96
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issue 3
56-62
EN
Introduction: Intragastric balloon (IGB) insertion is used as a bridging therapy in patients with body mass index (BMI) ≥ 50 kg/m2 . We arranged a retrospective study to evaluate whether pre-operative IGB treatment influences perioperative and postoperative weight loss outcomes after laparoscopic sleeve gastrectomy (SG), and especially to evaluate the impact of post - IGB percentage of excessive weight loss (%EWL) on postoperative %EWL. Materials and methods: Patients who underwent IGB placement followed by laparoscopic SG were divided into the following groups considering %EWL after IGB: Group 1 <=10.38%; Group 2 >10.38% and <=17.27%; Group 3 >17.27% and <=24.86%; Group 4 >24.86%. 1 year after SG data were collected. The following parameters were compared between groups: operative time, total blood loss, length of stay and weight, BMI, percentage of total weight loss (%TWL), %EWL. Results: There were no statistically significant differences between groups in perioperative results. Post-SG %EWL was the highest in intermediate groups: 2 and 3. Post-treatment results were observed: body weight and BMI were the lowest in Group 4 and the highest in Group 1. Post-treatment %EWL was the highest in Group 4, the lowest in Group 1 and grew gradually in subsequent groups. Discussion: The study confirmed the impact of weight loss on IGB on postoperative results. The study showed that %EWL after the IGB treatment influences %EWL after SG and most of all affects definitive %EWL after two-stage treatment and it could be a foreshadowing factor of these outcomes. Importance: The importance of research for the development of the field %EWL after IGB influences the final BMI and final weight, which means that patients with the greatest %EWL after IGB are more likely to have the greatest postoperative weight loss and overall weight loss.
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