Faculty Bibliography

Purpose of Review: Sleeve gastrectomy has become one of the most common bariatric surgical procedures world-wide. The complication rate overall is low, but staple line leak remains one of the most morbid and difficult to manage complications. The management of staple line leaks has evolved over time and now several non-operative, endoscopic, and surgical options exist with varying rates of success. Recent Findings: Based on the available data some interventions appear to be more efficacious than others, and modern management has moved towards a core set of practices. Endoscopic interventions may help many patients avoid operative intervention. Importantly, many patients may require repeated and varying interventions to fully resolve their leak. Summary: Each case should be managed by a multidisciplinary team with the interventions chosen based on patient factors, leak characteristics, and institutional capabilities. Nutritional optimization remains paramount to promote healing regardless of the interventions used.

MAJOR UPDATES TO 1991 NATIONAL INSTITUTES OF HEALTH GUIDELINES FOR BARIATRIC SURGERY: Metabolic and bariatric surgery (MBS) is recommended for individuals with a body mass index (BMI) >35 kg/m², regardless of presence, absence, or severity of co-morbidities.MBS should be considered for individuals with metabolic disease and BMI of 30-34.9 kg/m².BMI thresholds should be adjusted in the Asian population such that a BMI >25 kg/m² suggests clinical obesity, and individuals with BMI >27.5 kg/m² should be offered MBS.Long-term results of MBS consistently demonstrate safety and efficacy.Appropriately selected children and adolescents should be considered for MBS.(Surg Obes Relat Dis 2022; https://doi.org/10.1016/j.soard.2022.08.013 ) © 2022 American Society for Metabolic and Bariatric Surgery. All rights reserved.

Major updates to 1991 National Institutes of Health guidelines for bariatric surgery.

Intussusception following Roux-en-Y gastric bypass (RYGB) is a rare complication of bariatric surgery with an unclear etiology. The pathogenesis underlying intussusception after gastric bypass is likely different from that in the general population. Post-RYGB intussusception might be related to motility issues in the divided small bowel, thinning of the mesentery following rapid weight loss, or anastomotic sutures/staple line acting as the lead point. This condition can cause obstruction with subsequent strangulation and bowel necrosis if not recognized and treated promptly. Clinical presentation is vague and nonspecific, and computerized tomography scan represents the diagnostic test of choice. Surgical treatment consists of reduction with or without anastomosis resection and reconstruction. This literature review provides an extensive overview of this condition, based on multiple studies involving 120 patients.

BACKGROUND:Metabolic and bariatric surgery (MBS), despite being the only effective durable treatment for obesity, remains underused as approximately 1% of all patients who qualify undergo surgery. The American Society for Metabolic and Bariatric Surgery created a Numbers Taskforce to specify annual rate of utilization for obesity treatment interventions and to determine if patients in need are receiving appropriate treatment. OBJECTIVE:The objective of this study was to provide the best estimated number of metabolic and bariatric procedures performed in the United States in 2020. SETTING/METHODS:United States. METHODS:We reviewed data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), National Surgical Quality Improvement Program, Bariatric Outcomes Longitudinal Database, and Nationwide Inpatient Sample. In addition, data from industry and state databases were used to estimate activity at nonaccredited centers. Data from 2020 were compared mainly with data from the previous 2 years. RESULTS:Compared with 2019, the total number of MBS performed in 2020 decreased from approximately 256,000 to 199,000. Sleeve gastrectomy continues to be the most common procedure. The gastric bypass procedure trend remained relatively stable, and the gastric band procedure trend continued to decline. The percentage of revision procedures and biliopancreatic diversion with duodenal switch procedures increased slightly. Single-anastomosis duodeno-ileostomy was listed for the first time in 2020. Intragastric balloons placement declined from the previous year. CONCLUSION/CONCLUSIONS:There was a 22.5% decrease in MBS volume from 2019 to 2020, which coincided with the COVID-19 pandemic. Sleeve gastrectomy continues to be the dominant procedure, and for the first time, single-anastomosis duodeno-ileostomy is reported in the MBSAQIP database.

BACKGROUND:Laparoscopic adjustable gastric band (LAGB) management continues to be an important part of many metabolic and bariatric surgery practices. OBJECTIVES/OBJECTIVE:To replace the existing American Society for Metabolic and Bariatric Surgery (ASMBS) LAGB adjustment credentialing guidelines for physician extenders with consensus statements that reflect the current state of LAGB management. SETTING/METHODS:ASMBS Integrated Health Clinical Issues Committee. METHODS:A modified Delphi process using a 2-stage consensus approach was conducted on LAGB management. Thirty-four consensus statements were developed following a literature search on a wide range of LAGB topics. A 5-point Likert scale was implemented to measure consensus agreement with a Delphi panel of 39 expert participants who were invited and agreed to participate in 2 rounds of Delphi questionnaires. Consensus was set a priori at 75% agreement, defined as the proportion of participants responding with agreement (i.e., 4 or 5) or disagreement (i.e., 1 or 2) on the Likert scale. RESULTS:Consensus was reached on 74% (25 of 34) of the LAGB management statements. In Delphi round 1, 95% (37 of 39) of the participants responded to 34 consensus statements; 21 of the statements (62%) met the 75% criteria for consensus. Thirty-one participants (80%) responded in round 2, shifting the agreement on 4 more statements to the 75% threshold. CONCLUSION/CONCLUSIONS:The ASMBS consensus statement on LAGB management is intended to guide practice with current evidence-based knowledge and professional experience. The ASMBS is not a credentialing body and does not seek to guide credentialing with this document.

BACKGROUND:Bariatric procedures are safe and effective treatments for obesity, inducing rapid and sustained loss of excess body weight. Laparoscopic adjustable gastric banding (LAGB) is unique among bariatric interventions in that it is a reversible procedure in which normal gastrointestinal anatomy is maintained. Knowledge regarding how LAGB effects change at the metabolite level is limited. OBJECTIVES/OBJECTIVE:To delineate the impact of LAGB on fasting and postprandial metabolite responses using targeted metabolomics. SETTING/METHODS:Individuals undergoing LAGB at NYU Langone Medical Center were recruited for a prospective cohort study. METHODS:We prospectively analyzed serum samples from 18 subjects at baseline and 2 months after LAGB under fasting conditions and after a 1-hour mixed meal challenge. Plasma samples were analyzed on a reverse-phase liquid chromatography time-of-flight mass spectrometry metabolomics platform. The main outcome measure was their serum metabolite profile. RESULTS:We quantitatively detected over 4,000 metabolites and lipids. Metabolite levels were altered in response to surgical and prandial stimuli, and metabolites within the same biochemical class tended to behave similarly in response to either stimulus. Plasma levels of lipid species and ketone bodies were statistically decreased after surgery whereas amino acid levels were affected more by prandial status than surgical condition. CONCLUSIONS:Changes in lipid species and ketone bodies postoperatively suggest improvements in the rate and efficiency of fatty acid oxidation and glucose handling after LAGB. Further investigation is necessary to understand how these findings relate to surgical response, including long term weight maintenance, and obesity-related comorbidities such as dysglycemia and cardiovascular disease.

BACKGROUND:Sporadic women involvement in surgery has been recorded since ancient times. Nevertheless, the presence of women in surgical disciplines has been marginal until the last 2 decades, with several barriers still existing worldwide. The aim of the study was to explore the history of women in surgery, with a main focus in North America from until the foundation women surgical societies. METHODS:Database search of studies about the history of women in surgery. RESULTS:The 19th century registered an increased presence of women in medicine; during the 20th century, pioneer women surgeons opened the way to a more consistent involvement of women in surgical specialties. In the last 20 years, increased awareness of barriers limiting women progression in surgical career led to the development of women's surgical societies, with the aim to share common experiences and find solutions to common issues. CONCLUSION/CONCLUSIONS:The history of women in surgery has been paved with challenges: during the last centuries, several barriers limited the inclusion of women in surgical fields, from training to leadership positions. Nevertheless, some pioneers actually broke the rules imposed by a male-dominated field and opened the way to a more diverse and equal future for women surgeons. Nowadays, the existence of women's surgical societies in different countries and their interconnection represents a way to support women surgeons at different stages of their career.