David Romero Funes

Assessing risk factors, presentation, and management of portomesenteric vein thrombosis after sleeve gastrectomy: a multicenter case-control study

BACKGROUNDnPortomesenteric vein thrombosis (PMVT) is a rare complication of laparoscopic sleeve gastrectomy.nnnOBJECTIVESnTo identify incidence, patient factors, diagnosis, and treatment of PMVT after laparoscopic sleeve gastrectomy in a large administrative data registry.nnnSETTINGnAcademic Hospitals and Private Practices, United States.nnnMETHODSnA retrospective chart review of 5538 sleeve gastrectomy patients between January 1, 2008 and September 30, 2016 was performed at 5 bariatric centers in the United States. A total of 11 patients were identified as developing PMVT, and 3 controls for each patient were selected by matching age, sex, preoperative body mass index, and center.nnnRESULTSnAfter adjusting for confounding variables, 2 patient factors significantly impacted the risk of PMVT after sleeve gastrectomy including personal history of malignancy (odds ratio 62, 95% confidence interval (CI) 1.4-99.9), and type 2 diabetes (odds ratio 12.7, 95% CI 1.2-137.3) compared with controls. Mean period from laparoscopic sleeve gastrectomy to presentation of PMVT was 19.3 ± 15.11 days (range, 8-62). All patients except 1 complained of abdominal pain as the main presenting symptom. Other complaints included nausea and vomiting, no bowel movement, decreased appetite, diarrhea, and dehydration, and leukocytosis was present in 45.5% of the patients. All diagnoses were made by using computed tomography. All initial treatments were anticoagulation, heparin drip being the most common method (90.9%). Of patients, 9 (81.8%) required a secondary anticoagulation therapy, and 1 (9.1%) patient required a reoperation.nnnCONCLUSIONnIncidence of PMVT is low after sleeve gastrectomy. A personal history of malignancy and type 2 diabetes increase the risk of PMVT. Increasing abdominal pain in a context of dehydration is common presenting symptoms with diagnosis confirmed by computed tomography. Anticoagulation is the standard treatment. There was no mortality associated with the occurrence of PMVT in this cohort.

High cardiovascular risk patients benefit more from bariatric surgery than low cardiovascular risk patients

IntroductionAtherosclerotic cardiovascular disease (ASCVD) and Framingham risk scores (FRS) are used to calculate 10-year risk of coronary death, nonfatal myocardial infarction, or fatal/nonfatal stroke. Our goal is to evaluate the association between preoperative cardiovascular risk and weight loss.MethodsWe retrospectively reviewed bariatric surgeries from 2010 to 2016. Patients who met criteria for calculating 10-year ASCVD score and FRS were included. Data collected included baseline demographics, perioperative parameters, and postoperative outcomes at 12xa0months. Simple linear regression and multiple linear regression models were applied to test influence of individual or multiple factors of interest on 12-month weight loss outcomes.ResultsOf 1330 bariatric patients studied, 360 patients met criteria for ASCVD and FRS calculation. Sleeve gastrectomy (LSG) was the most prevalent surgery 63.05%, followed by Roux-en-Y gastric bypass (LRYGB) 20.55%, revision procedures 11.9%, and adjustable gastric banding (LAGB) 4.4%. Initial BMI was 42.71u2009±u20097.85xa0kg/m2 for females and 42.72ku2009±u20097.42xa0kg/m2 for males, with a 12-month percentage of estimated BMI loss (%EBMIL) of 66.51% in females and 60.29% in males. Preoperative 10-year ASCVD score was higher in males than females with a 34.73% relative risk reduction (RRR) in males and 35.3% RRR in females at 12-month follow-up. Regarding FRS, preoperative risk was 33.13u2009±u200921.1% in males and 15.71u2009±u200914.52% in females, with an RRR of 25.8% in males and 32.2% in females. Univariate analysis of preoperative FRS and %EBMIL showed that for every percentage unit increase in the patient’s preoperative FRS, %EBMIL decreases 0.31 percentile unit (Pu2009<u20090.001). Furthermore, preoperative ASCVD score is also significantly associated with %EMBIL—for every percentage unit increase in preoperative ASCVD score, %EBMIL decreases 0.42 percentile credits.ConclusionStudy results suggest ASCVD and FRS are equally reduced after bariatric surgery, especially after LSG and LRYGB. Moreover, preoperative FRS and ASCVD risk score showed an inversely proportional relationship with %EBMIL loss at 12 months.

Laparoscopic Sleeve Gastrectomy versus Roux-en-Y Gastric Bypass in Cardiovascular Risk Reduction: A Match Control Study

BACKGROUNDnThere is a paucity of studies comparing risk reduction of the atherosclerotic cardiovascular disease (ASCVD) and Framingham-body mass index (BMI) Coronary Heart risk score after a laparoscopic Roux-en-Y gastric bypass (RYGB), and few studies have assessed the efficacy of laparoscopic sleeve gastrectomy (SG) in reducing cardiovascular risk.nnnOBJECTIVEnOur goal in this study was to compare the impact of SG and RYGB on cardiovascular risk reduction.nnnSETTINGnU.S. university hospital.nnnMETHODSnWe retrospectively reviewed the records of all SG or RYGB cases at our institution between 2010 and 2015. Patients who met the criteria for calculating the ASCVD 10-year and Framingham-BMI score were included in the study. Propensity score matching was used to match SG and RYGB on demographic characteristics and co-morbidities.nnnRESULTSnOf the 1330 bariatric patients reviewed in the study period, 219 (19.3%) patients met the criteria for risk score calculation. SG was the most prevalent surgery in 72.6% (Nu202f=u202f159) of cases compared with RYGB in 27.4% (Nu202f=u202f60) of cases. At 12-month follow-up, ASCVD 10-year score had an absolute risk reduction of 3.9 ± 6.5% in SG patients and 2.9 ± 5.8% in RYGB patients (Pu202f=u202f.3). Framingham-BMI score absolute risk reduction was 11.0 ± 12.0% in SG and 9.0 ± 11.0% in RYGB patients (Pu202f=u202f.4), and the decrease in estimated heart age was 12.1 ± 15.6 years in SG versus 9.2 ± 9.6 years in RYGB (Pu202f=u202f.1). The percentage of estimated BMI loss at 1 year was 68.1 ± 23.3% in SG versus 74.2 ± 24.8% in RYGB (Pu202f=u202f.1).nnnCONCLUSIONnOur results suggest that SG and RYGB are equally effective in improving cardiovascular risk and decreasing the estimated vascular/heart age at 12-month follow-up.