This paper reviews reoperations rates for short- and long-term complications following secondary bariatric procedures and need for further bariatric surgery. The search revealed 28 papers (1317 secondary cases) following at least 75 % of patients for 12 months or more. For adjustable gastric banding (AGB), rebanding had higher re-revisional rates than conversions into other procedures. Conversion of AGB to Roux-en-Y gastric bypass had the highest number of short- (10.7 %) and long-term (22.0 %) complications. We estimated 194 additional reoperations per 1000 patients having a secondary procedure, 8.8 % needing tertiary surgery. Despite being poorly reported, risks of reoperations for long-term complications and tertiary bariatric surgery are higher than usually reported risks of short-term complications and should be taken into account when choosing a secondary bariatric procedure and for economic evaluations.

The aim of the present study was to determine the potential demand for publicly and privately funded bariatric surgery in Australia. Nationally representative data from the 2011-13 Australian Health Survey were used to estimate the numbers and characteristics of Australians meeting specific eligibility criteria as recommended in National Health and Medical Research Council guidelines for the management of overweight and obesity. Of the 3352037 adult Australians (aged 18-65 years) estimated to be obese in 2011-13, 882441 (26.3%; 95% confidence interval (CI) 23.0-29.6) were potentially eligible for bariatric surgery (accounting for 6.2% (95% CI 5.4-7.1) of the adult population aged 18-65 years (n=14122020)). Of these, 396856 (45.0%; 95% CI 40.4-49.5) had Class 3 obesity (body mass index (BMI) ≥40kgm-2), 470945 (53.4%; 95% CI 49.0-57.7) had Class 2 obesity (BMI 35-39.9kgm-2) with obesity-related comorbidities or risk factors and 14640 (1.7%; 95% CI 0.6-2.7) had Class 1 obesity (BMI 30-34.9kgm-2) with poorly controlled type 2 diabetes and increased cardiovascular risk; 458869 (52.0%; 95% CI 46.4-57.6) were female, 404594 (45.8%; 95% CI 37.3-54.4) had no private health insurance and 309983 (35.1%; 95% CI 28.8-41.4) resided outside a major city. Even if only 5% of Australian adults estimated to be eligible for bariatric surgery sought this intervention, the demand, particularly in the public health system and outside major cities, would far outstrip current capacity. Better guidance on patient prioritisation and greater resourcing of public surgery are needed. In the period 2011-13, 4million Australian adults were estimated to be obese, with obesity disproportionately more prevalent in areas of socioeconomic disadvantage. Bariatric surgery is considered to be cost-effective and the most effective treatment for adults with obesity, but is mainly privately funded in Australia (>90%), with 16650 primary privately funded procedures performed in 2015. The extent to which the supply of bariatric surgery is falling short of demand in Australia is unknown. The present study provides important information for health service planners. For the first time, population estimates and characteristics of those potentially eligible for bariatric surgery in Australia have been described based on the best available evidence, using categories that best approximate the national recommended eligibility criteria. Even if only 5% of those estimated to be potentially eligible for bariatric surgery in Australia sought a surgical pathway (44122 of 882441), the potential demand, particularly in the public health system and outside major cities, would still far outstrip current capacity, underscoring the immediate need for better guidance on patient prioritisation. The findings of the present study provide a strong signal that more funding of public surgery and other effective interventions to assist this population group are necessary.

BackgroundWithin the Australian public hospital setting, no studies have previously reported total hospital utilisation and costs (pre/postoperatively) and costed patient-level pathways for primary bariatric surgery and surgical sequelae (including secondary surgery) informed by Australia’s Independent Hospital Pricing Authority’s activity-based funding (ABF) model.ObjectiveWe aimed to provide our Tasmanian state government partner with information regarding key evidence gaps about the resource use and costs of bariatric surgery (including pre- and postoperatively, types of surgery and comorbidities), the costs of surgical sequelae and policy direction regarding the types of bariatric surgery offered within the Tasmanian public hospital system.MethodsHospital inpatient length of stay (days), episodes of care (number) and aggregated cost data were extracted for people who were waiting for and subsequently received bariatric surgery (for the fiscal years 2007–2008 to 2015–2016) from administrative sources routinely collected, clinically coded/costed according to ABF. Aggregated ABF costs were expressed in 2016–2017 Australian dollars ($A). Sensitivity (cost outliers) and subgroup analyses were conducted.ResultsA total of 105 patients entered the study. Total costs (pre/postoperative over 8 years) for all inpatient episodes of care (n = 779 episodes of care) were $A6,018,349. When the ten cost outliers were omitted from the total cost, this cost reduced to $A4,749,265. Mean costs for primary laparoscopic adjustable gastric band (LAGB) and sleeve gastrectomy (SG) bariatric surgery were $A14,622 and $A15,014, respectively. The average cost/episode of care for people with diabetes decreased in the first year postoperatively, from $A7258 to $A5830/episode of care. In total, 27 LAGB patients (30%) required surgery due to surgical sequelae (including revisional/secondary surgery; n = 58 episodes of care) and 56% of these episodes of care were secondary LAGB device related (mostly port/reservoir related), with a mean cost of $A6267.ConclusionsTaking into account our small SG sample size and the short time horizon for investigating surgical sequalae for SG, costs may be mitigated in the Tasmanian public hospital system by substituting LAGB with SG when clinically appropriate due to costs associated with the LAGB device for some patients. At 3 years postoperatively versus preoperatively, episodes of care and costs reduced substantially, particularly for people with diabetes/cardiovascular disease. We recommend that a larger confirmatory study of bariatric surgery including LAGB and SG be undertaken of disaggregated ABF costs in the Tasmanian public hospital system.

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Aim.To generalize and present current data on the development of approaches to hemorrhoidectomy, as well as to analyse the function of the rectal closing apparatus after surgery.Key findings.The haemorrhoid disease is one of the most common human diseases and the most common reason for visiting a coloproctologist. In Russia, the prevalence of haemorrhoids amounts to 130–145 people per 1,000 adult population, with its proportion in the structure of colon diseases varying from 34 to 41 %. Minimally invasive methods for treating such conditions have been shown to be effective in patients with 1–3 stage haemorrhoids. However, these methods have shown little value at stage 4 hemorrhoids, largely because they fail to affect all parts of the disease pathogenesis. Thus, hemorrhoidectomy remains to be the “gold standard” for stage 4 hemorrhoids treatment, which is aimed at eliminating the three main vascular collectors. Hemorrhoidectomy is accompanied by the risk of stricture and postoperative anal sphincter failure. In this regard, it is necessary to assess the functional state of the rectal closing apparatus after hemorrhoidectomy. Improving hemorrhoidectomy, for example, by the use of an ultrasonic scalpel, allows the hemorrhoidectomy to be performed without additional sewing of vessels and coagulation, and the injury of the anal sphincter to be minimized.Conclusion. The possibility of injuring the anal sphincter is a serious problem in anal surgery. Anal sphincter incontinence is a serious illness that exacerbates the patients’ social life. Unfortunately, the issue of anal sphincter incontinence after hemorrhoidectomy is under-investigated, resulting in few rehabilitation programs.

Objectives The aim of this exploratory study was to investigate resource use and predictors associated with critical care unit (CCU) admission after primary bariatric surgery within the Tasmanian public healthcare system. Methods Patients undergoing primary bariatric surgery in the Tasmanian Health Service (THS) public hospital system between 7 July 2013 and 30 June 2019 were eligible for inclusion in this study. The THS provides two levels of CCU support, an intensive care unit (ICU) and a high dependency unit (HDU). A mixed-methods approach was performed to examine the resource use and predictors associated with overall CCU admission, as well as levels of HDU and ICU admission. Results There were 254 patients in the study. Of these, 44 (17.3%) required 54 postoperative CCU admissions, with 43% requiring HDU support and 57% requiring more resource-demanding ICU support. Overall, CCU patients were more likely to have higher preoperative body mass index and multimorbidity and to undergo sleeve gastrectomy or gastric bypass. Patients undergoing gastric banding were more likely to require HDU rather than ICU support. Total hospital stays and median healthcare costs were higher for CCU (particularly ICU) patients than non-CCU patients. Conclusions Bariatric surgery patients often have significant comorbidities. This study demonstrates that patients with higher levels of morbidity are more likely to require critical care postoperatively. Because this is elective surgery, being able to identify patients who are at increased risk is important to plan either the availability of critical care or even interventions to improve patients’ preoperative risk. Further work is required to refine the pre-existing conditions that contribute most to the requirement for critical care management (particularly in the ICU setting) in the perioperative period. What is known about the topic? Few studies (both Australian and international) have investigated the use of CCUs after bariatric surgery. Those that report CCU admission rates are disparate across the contemporaneous literature, reflecting the different healthcare systems and their associated incentives. In Australia, the incidence and utilisation of CCUs (consisting of HDUs and ICUs) after bariatric surgery have only been reported using Western Australian administrative data. What does the paper add? CCU patients were more likely to have a higher preoperative body mass index and multimorbidity and to undergo a sleeve gastrectomy or gastric bypass procedure. Just over half (57%) of these patients were managed in the ICU. Sleeve gastrectomy patients had a higher incidence of peri- and postoperative complications that resulted in an unplanned ICU admission. Hospital length of stay and aggregated costs were higher for CCU (particularly ICU) patients. What are the implications for practitioners? The association of increased CCU (particularly ICU) use with multimorbidity and peri- and postoperative complications could enable earlier recognition of patients that are more likely to require CCU and ICU support, therefore allowing improved planning when faced with increasing rates of bariatric surgery. We suggest streamlined clinical guidelines that anticipate CCU support for people with severe and morbid obesity who undergo bariatric surgery should be considered from a national perspective.

AIM: to improve the results of treatment in hemorrhoid Grade IV.PATIENTS AND METHODS: the prospective randomized study included 101 patients with combined hemorrhoids Grade IV were divided in two groups. Both groups were homogenous in age and gender. All patients underwent open hemorrhoidectomy with monopolar coagulation. Low-temperature argon plasma application was implemented in postoperative period as an additional option in the main group at 2, 4, 6, 8, 14, 21, 30 days after surgery. Visual Analogue Scale (VAS, 0 to 10 points) was used to assess pain intensity. Bacteriological and cytological tests performed at 2, 8, 14, 21, 30 days and then every 7 days until the wounds were completely healed. The area of the postoperative wound and the rate of healing were calculated using a planimetric method. Quality of life was assessed before surgery, and on days 8 and 30 using the SF-36 questionnaire.RESULTS: on the 30th day after surgery, cytology confirmed wound healing occurred in 38 (76.0%) patients of the main group and in 18(36.0%) patients in the control group, p = 0.0001. VAS score at day 8 after surgery was 3 (3; 4) and 4 (3; 5) points in main and control group, respectively, p = 0.00003. Quality of life measuring showed significant difference in the physical component between groups: 48 (44; 53) vs 42 (38; 48) points in the main and control group, respectively (p < 0.05). On the 30th day after the procedure, the physical component of the quality of life was 48 (44; 53) points in the patients of the main group, 42 (38; 48) — in the control group, p = 0.005. There was found significant difference in wound microbial content between groups: 104 vs 107 CFU on the 30th day after the surgery.CONCLUSION: the low-temperature argon plasma accelerates wound healing, as well as reduces the pain intensity. A significant antimicrobial effect was detected.

Несмотря на рост количества выполняемых бариатрических вмешательств в Российской Федерации, отсутствует прозрачный инструмент, который бы позволил проводить долгосрочное наблюдение и оценивать результаты хирургического лечения ожирения. С 2014 г. ведутся разработка и совершенствование национального бариатрического реестра (РНБР). В составе РНБР на данный момент насчитывается 34 бариатрических центра. Имеются конкретные критерии включения пациентов, позволяющие в дальнейшем провести наиболее полный и достоверный аудит данных. Интерфейс РНБР предполагает возможность первичного скрининга пациента, оценки качества жизни, внесения характеристик оперативного вмешательства и долгосрочного наблюдения. 1 раз в 2 года производится проверка данных на соответствие критериям отбора и составляется ежегодный онлайн-отчет. Одной из важных опций НБР является автоматическое вычисление параметров динамики снижения массы тела (BMI, % EWL, TWL) и статуса коморбидных состояний, представления их в виде графиков, что позволяет оценивать эффективность методики. Авторы видят основную цель РНБР в создании программы для централизованного сбора объективных данных по бариатрической хирургии с возможностью активного участия в деятельности Международной федерации хирургии ожирения и метаболических нарушений (IFSO) и интеграции в мировое сообщество, в проведении базового аудита результатов лечения и выработке единой тактики хирургической коррекции ожирения.