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Comparison of revisional surgeries after OAGB versus RYGB: Results from the multicenter Polish Revision Obesity Surgery Study (PROSS)

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Stefura T., Mulek R., Krefft M., Wysocki M., Zając M., Rusinek J., Wierdak M., 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
63-68
EN
Introduction: Roux-en-Y gastric bypass (RYGB) is a leading bariatric surgery globally. One-anastomosis gastric bypass (OAGB), a modification of RYGB, ranks as the third most common bariatric procedure in Poland. While clinical trials show that OAGB outcomes are comparable to those of RYGB regarding weight loss, remission of comorbidities, and hormonal impact, there is limited data on long-term outcomes and complications. Aim: The aim of the study was to compare the outcomes of revisional surgeries conducted after OAGB versus RYGB. Material and methods: This retrospective study analyzed patients undergoing revisional bariatric surgeries from January 2010 to January 2020 across 12 Polish centers. The inclusion criteria were an age of at least 18 years and prior OAGB or RYGB surgery. Those with incomplete primary surgery data and follow-up post-revision were excluded. Data were collected regarding parameters for anthropometrics, comorbidities, and perioperative details. The patients were categorized based on their initial surgery: OAGB or RYGB. The primary endpoints were the reasons for and types of revisional surgery and weight changes; the secondary endpoints were postoperative complications and length of hospital stay (LOS). Results: In total, 27 patients participated, with a mean age of 38.18 ±7 years. Differences between the OAGB (13 patients) and RYGB (14 patients) groups included median initial body weight (100 kg vs. 126 kg, p<0.016), number of postoperative complications (9 vs. 3, p = 0.021), and median LOS (3 vs. 4.5 days, p = 0.03). GERD was the primary reason for OAGB revisions (69.2%), whereas insufficient weight loss led to the most RYGB revisions (42.9%). Conclusions: The RYGB patients commonly needed revisions due to weight issues, whereas reoperations in the OAGB patients were conducted due to postoperative complications. The postoperative complications and LOS were similar between the groups. The importance of research for the development of the field: The results may influence clinical surgeons’ choice of surgical technique.
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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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Preliminary results of Polish national multicenter LILEO study on ileostomy reversal

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Kisielewski M., Wysocki M., Stefura T., Wojewoda T., Safiejko K., Wierdak M., Sachanbiński T., Jankowski M., Tkaczyński K., Richter K., Wysocki W.
Polish Journal of Surgery
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2024
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vol. 96
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issue 3
26-30
EN
Introduction: Ileostomy reversal is a common surgical procedure and currently standardized perioperative and surgical protocols are lacking. Aim: LILEO study was designed to perform a multicenter analysis on numerous perioperative parameters and estimation of the incidence of postoperative complications. Materials and methods: The study is an open multicenter prospective cohort study. Preliminary results of the LILEO study after 3 months were available from 18 Polish surgical centers comprising full data of 59 patients who underwent ileostomy reversal. Results: Parameters such as preoperative care, surgical technique, postoperative course and complications were analyzed. Preoperative fasting was used in 49.1% of patients. Fifty nine percent of anastomosis were handsewn and in 72.9% of patients had primary single suture wound closure. Mean length of hospital stay was 7.9 days (min 2 days, max 26 days). Complications occurred overall in 20 patients (33.9%). In 11.9% of patient’s complications had grade III A/B in Clavien-Dindo classification. Discussion: The perioperative care in the group of patients undergoing ileostomy reversal still lacks standardized and optimized treatment. Conclusions: Ileostomy removal is a procedure with high risk of postoperative complications. Standardization of perioperative care based on further multicenter national study could result in a decrease of complications rate.
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