Older models of intragastric balloons (IGBs) had unacceptably high complication rates and inconsequential weight loss. With FDA approval of newer models, we aimed to systematically examine the literature regarding the efficacy of IGB therapy for obesity. A comprehensive electronic database search was completed. Title searching was restricted to the following keywords: bariatric, gastric, gastric bypass, gastric band, sleeve gastrectomy, and intragastric balloon. Twenty-six primary studies (n = 6101) were included. At balloon removal, mean change in weight and BMI were 15.7 ± 5.3 kg and 5.9 ± 1.0 kg/m(2). The most common complications were nausea/vomiting (23.3 %) and abdominal pain (19.9 %). Serious complications were rare: mortality (0.05 %) and gastric perforation (0.1 %). IGBs are associated with marked short-term weight loss with limited serious complications.
In the setting of massive splenomegaly, LAS or HALS with preoperative SAE is safe and has a low conversion rate. Postoperative imaging surveillance for PVT should be performed routinely in this patient population.
A day in the life of emergency general surgery in Canada: a multicentre observational study Background: Emergency general surgery (EGS) services are gaining popularity in Canada as systems-based approaches to surgical emergencies. Despite the high volume, acuity and complexity of the patient populations served by EGS services, little has been reported about the services' structure, processes, case mix or outcomes. This study begins a national surveillance effort to define and advance surgical quality in an important and diverse surgical population.
Methods:A national cross-sectional study of EGS services was conducted during a 24-hour period in January 2017 at 14 hospitals across 7 Canadian provinces recruited through the Canadian Association of General Surgeons Acute Care Committee. Patients admitted to the EGS service, new consultations and off-service patients being followed by the EGS service during the study period were included. Patient demographic information and data on operations, procedures and complications were collected.
Results
Conclusion:The characteristics and case mix of these Canadian EGS services are heterogeneous, but all services are busy and provide comprehensive operative and nonoperative care to acutely ill patients with high levels of comorbidity.Contexte : Les services de chirurgie générale d'urgence (CGU) gagnent en popularité au Canada en tant qu'approches systémiques aux urgences chirurgicales. Malgré le volume élevé, le caractère urgent et la complexité des populations de patients desservies en CGU, peu de rapports ont porté sur la structure, les processus, les clientèles ou les résultats de ces services. La présente étude instaure une démarche de surveillance nationale qui servira à définir et à améliorer la qualité des chirurgies destinées à cette population importante et hétérogène.
BackgroundTransarterial chemoembolization (TACE) is a well accepted treatment for inoperable hepatocellular carcinoma (HCC). While minor complications involve 10% of all patients, severe complications are rare.Case PresentationWe describe a case of a 90-year-old male with a large, superficial HCC who underwent TACE. He had a significant intraperitoneal bleed secondary to tumor rupture immediately following the procedure.ConclusionTumor size and superficial location must be considered risk factors for tumor rupture and related complications.
Introduction:
The effects of bariatric surgery on improvement of the metabolic syndrome is well-described, but its effect on intrinsic bone fragility and fracture propagation is unclear. Therefore, the aims of this systematic review of the literature were to examine (1) the incidence of fracture following bariatric surgery, (2) the association of fracture with the specific bariatric surgical procedure, and (3) site-specific types of fractures associated with bariatric surgery.
Methods:
A comprehensive literature search was conducted through Medline, Embase, Scopus, Web of Science, Dare, Cochrane library, and HTA database. The search terms used were gastric bypass, sleeve gastrectomy and fracture.
Results:
Eight studies were included (n = 42,567 patients). This included no randomized controlled trials. The average patient age was 43.3 years and 24.9% of patients were male. The average follow-up time was 3.7 years. 1960 patients had at least one fracture, and the total number of fractures encountered was 2326. Overall, 4.6% of patients who underwent bariatric surgery suffered from a fracture post-operatively. The operation associated with the greatest risk of fractures post-operatively was following a biliopancreatic diversion (10.66%), followed by restrictive procedures such as adjustable gastric band and sleeve gastrectomy (5.71%), with the Roux-en-Y gastric bypass having the lowest risk (2.66%). Of the fractures encountered, 1458 (63.08%) were of the lower extremity and pelvis and 763 (33.01%) were of the upper extremity. Only 90 (3.89%) axial skeleton fractures were reported.
Conclusions:
The overall risk of sustaining a fracture of any type after undergoing bariatric surgery is approximately 5 percent after an average follow up of 3.7 years. The greatest risk of fractures is associated with the biliopancreatic diversion surgery, with the Roux-en-Y gastric bypass being the most favorable. Fractures following bariatric surgeries tend to occur mostly in the lower extremity and pelvis.
Highlights:
Canadian assoCiation of BariatriC PhysiCians and surgeons assoCiation Canadienne des médeCins et Chirurgiens Bariatriques
02The usefulness and costs of routine contrast studies after laparoscopic sleeve gastrectomy for detecting staple line leaks. P
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