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Cao, Y., Fang, X., Ottosson, J., Näslund, E. & Stenberg, E. (2019). A Comparative Study of Machine Learning Algorithms in Predicting Severe Complications after Bariatric Surgery. Journal of Clinical Medicine, 8(5), Article ID 668.
Open this publication in new window or tab >>A Comparative Study of Machine Learning Algorithms in Predicting Severe Complications after Bariatric Surgery
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2019 (English)In: Journal of Clinical Medicine, ISSN 2077-0383, Vol. 8, no 5, article id 668Article in journal (Refereed) Published
Abstract [en]

Background: Severe obesity is a global public health threat of growing proportions. Accurate models to predict severe postoperative complications could be of value in the preoperative assessment of potential candidates for bariatric surgery. So far, traditional statistical methods have failed to produce high accuracy. We aimed to find a useful machine learning (ML) algorithm to predict the risk for severe complication after bariatric surgery.

Methods: We trained and compared 29 supervised ML algorithms using information from 37,811 patients that operated with a bariatric surgical procedure between 2010 and 2014 in Sweden. The algorithms were then tested on 6250 patients operated in 2015. We performed the synthetic minority oversampling technique tackling the issue that only 3% of patients experienced severe complications.

Results: Most of the ML algorithms showed high accuracy (>90%) and specificity (>90%) in both the training and test data. However, none of the algorithms achieved an acceptable sensitivity in the test data. We also tried to tune the hyperparameters of the algorithms to maximize sensitivity, but did not yet identify one with a high enough sensitivity that can be used in clinical praxis in bariatric surgery. However, a minor, but perceptible, improvement in deep neural network (NN) ML was found.

Conclusion: In predicting the severe postoperative complication among the bariatric surgery patients, ensemble algorithms outperform base algorithms. When compared to other ML algorithms, deep NN has the potential to improve the accuracy and it deserves further investigation. The oversampling technique should be considered in the context of imbalanced data where the number of the interested outcome is relatively small.

Place, publisher, year, edition, pages
MDPI, 2019
Keywords
machine learning, bariatric surgery, severe complication, prediction, comparative study
National Category
Surgery General Practice
Identifiers
urn:nbn:se:oru:diva-75270 (URN)10.3390/jcm8050668 (DOI)000470992500103 ()31083643 (PubMedID)
Funder
Stockholm County CouncilNovo Nordisk
Note

Funding Agencies:

Örebro Region County Council  

Örebro University 

SRP Diabetes

Available from: 2019-07-24 Created: 2019-07-24 Last updated: 2019-07-24Bibliographically approved
Stenberg, E., Ottosson, J., Szabo, E. & Näslund, I. (2019). Comparing Techniques for Mesenteric Defects Closure in Laparoscopic Gastric Bypass Surgery: a Register-Based Cohort Study. Obesity Surgery, 29(4), 1229-1235
Open this publication in new window or tab >>Comparing Techniques for Mesenteric Defects Closure in Laparoscopic Gastric Bypass Surgery: a Register-Based Cohort Study
2019 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 29, no 4, p. 1229-1235Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Routine closure of mesenteric defects is generally considered standard part of laparoscopic gastric bypass surgery today. Controversy still exists regarding the optimal method for mesenteric defects closure. The objective was to compare different methods for mesenteric defects handling in laparoscopic gastric bypass surgery.

METHODS: Primary laparoscopic gastric bypass procedures from 2010 until 2015 reported to the Scandinavian Obesity Surgery Registry (SOReg), where the mesenteric defects closure method was identifiable, were included. Main outcome measures were serious postoperative complication within 30 days after surgery, and reoperation for small bowel obstruction within 5 years after surgery. Quality-of-life before and after surgery, duration of surgery, and risk factors for complication were also analyzed. Information on operation for small bowel obstruction was based on data from the SOReg, the Swedish National Patient Register and reviews of hospital charts.

RESULTS: In all, 34,707 patients were included. Serious postoperative complication occurred in 174 (2.9%) patients with sutures, in 592 (3.1%, adjusted p = 0.079) with clips, and 278 (3.1%; adjusted p = 0.658) in the non-closure group. Reoperation for small bowel obstruction within 5 years after surgery was lower with sutures (cumulative incidence 6.9%) and clips (cumulative incidence 7.3%; adjusted HR 1.16, 95% CI 1.02-1.32, p = 0.026), compared to non-closure (cumulative incidence 11.2%; adjusted HR 1.63, 95% CI 1.44-1.84, p < 0.0001).

CONCLUSION: Closure of the mesenteric defects using either non-absorbable metal clips or non-absorbable running sutures is a safe and effective measure to reduce the risk for small bowel obstruction after laparoscopic gastric bypass surgery. Sutures appear slightly more effective and should remain gold standard for mesenteric defects closure.

Place, publisher, year, edition, pages
Springer Science+Business Media B.V., 2019
Keywords
Bariatric surgery, Gastric bypass, Internal hernia, Postoperative complication, Prevention, Small bowel obstruction
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-71852 (URN)10.1007/s11695-018-03670-x (DOI)000467148300022 ()30675687 (PubMedID)2-s2.0-85060594258 (Scopus ID)
Note

Funding Agencies:

Örebro Region County Council  

Örebro University 

Available from: 2019-02-12 Created: 2019-02-12 Last updated: 2019-06-18Bibliographically approved
Stenberg, E., Mohseni, S., Cao, Y. & Näslund, E. (2019). Limited Effect of Beta-blockade on Postoperative Outcome After Laparoscopic Gastric Bypass Surgery. Obesity Surgery
Open this publication in new window or tab >>Limited Effect of Beta-blockade on Postoperative Outcome After Laparoscopic Gastric Bypass Surgery
2019 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: The benefit of beta-blockade on postoperative outcome remains controversial, though recent studies have suggested a role during major non-cardiac surgery. The benefit of beta-blockade during minimally invasive gastric bypass surgery remains unclear. The aim of the present study was to evaluate the possible association between preoperative beta-blocker therapy and postoperative outcome after laparoscopic gastric bypass surgery.

METHODS: Patients operated with primary laparoscopic gastric bypass surgery in Sweden between 2007 and 2017 were identified through the Scandinavian Obesity Surgery Registry. The dataset was linked to the Swedish National Patient Registry, the Swedish Prescribed Drug Registry, and Statistics Sweden. The main outcome was serious postoperative complication within 30 days of surgery; with postoperative complication, 90-day and 1-year mortality, and weight loss at 2 years after surgery as secondary endpoints. The Poisson regression model was used to evaluate primary and secondary categorical outcomes. A general mixed model was performed to evaluate 2-year weight loss.

RESULTS: In all, 50281 patients were included in the study. No difference was seen between patients on beta-blockade and the control group regarding postoperative complications (adjusted incidence rate ratio 1.04 (95%CI 0.93-1.15), p = 0.506), serious postoperative complication (adjusted IRR 1.06 95%CI 0.89-1.27), p = 0.515), 90-day mortality (adjusted IRR 0.71 (95%CI 0.24-2.10), p = 0.537), and 1-year mortality (adjusted IRR 1.26 (95%CI 0.67-2.36), p = 0.467). Weight loss 2 years after surgery was slightly greater in patients on beta-blockade (adjusted coefficient 0.53 (95%CI 0.19-0.87), p = 0.002).

CONCLUSIONS: Beta-blockade has limited impact on postoperative outcome after laparoscopic gastric bypass surgery.

Place, publisher, year, edition, pages
Springer Science+Business Media B.V., 2019
Keywords
Beta-blockade, Gastric bypass, Postoperative outcome
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-75571 (URN)10.1007/s11695-019-04108-8 (DOI)31346982 (PubMedID)
Available from: 2019-08-09 Created: 2019-08-09 Last updated: 2019-08-09Bibliographically approved
Kedestig, J. & Stenberg, E. (2019). Loss to follow-up after laparoscopic gastric bypass surgery - a post hoc analysis of a randomized clinical trial. Surgery for Obesity and Related Diseases, 15(6), 880-886
Open this publication in new window or tab >>Loss to follow-up after laparoscopic gastric bypass surgery - a post hoc analysis of a randomized clinical trial
2019 (English)In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 15, no 6, p. 880-886Article in journal (Refereed) Published
Abstract [en]

Background: Follow-up after bariatric surgery is important if we are to identify long-term complications at an early stage and thereby improve long-term outcome. Despite great efforts, many patients are lost to follow-up. Definition of characteristics of patients failing to attend follow-up could help in defining a specific group for whom extra resources may be applied to improve the situation.

Objectives: To identify characteristics of patients failing to attend follow-up 2 years after laparoscopic gastric bypass surgery.

Setting: Multicenter study, Sweden.

Methods: Post hoc analysis of a randomized clinical trial in which preoperative patient characteristics and postoperative outcome measures were compared between patients who attended or did not attend a 2-year follow-up visit after laparoscopic gastric bypass surgery.

Results: Of the 2495 patients included, 260 did not attend a 2-year follow-up visit. Factors associated with higher risk for failure to attend were younger age (adjusted odds ratio [OR] .96, 95% confidence interval [CI].94.98/yr, P < .001); male sex (adjusted OR 2.34, 95% CI 1.51-3.63, P < .001); depression (adjusted OR 1.61, 95% CI 1.05-2.47, P = .029); history of smoking (adjusted OR 1.78, 95% CI 1.26-2.51, P = .001); being single (adjusted OR 1.47, 95% CI 1.03-2.11, P = .036); and being first generation immigrant (adjusted OR 1.74, 95% CI 1.05-2.88; P = .032). Elementary occupation (adjusted OR .42, 95% CI .18.99, P = .047) was associated with lower risk.

Conclusion: These findings indicate that there are preoperative characteristics that may help in identifying patients likely to fail to attend follow-up visits after laparoscopic gastric bypass surgery. Special effort should be made to inform these patients of the importance of follow-up and to encourage them to attend.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Gastric bypass, Lost to follow-up, Risk, Treatment outcome, Multicenter study
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-75737 (URN)10.1016/j.soard.2019.03.010 (DOI)000478006800013 ()31014947 (PubMedID)
Note

Funding Agencies:

Örebro County Council  

Örebro University 

Available from: 2019-08-13 Created: 2019-08-13 Last updated: 2019-08-13Bibliographically approved
Jaensson, M., Dahlberg, K., Nilsson, U. & Stenberg, E. (2019). The impact of self-efficacy and health literacy on outcome after bariatric surgery in Sweden: a protocol for a prospective, longitudinal mixed methods study. BMJ Open, 9(5), Article ID e027272.
Open this publication in new window or tab >>The impact of self-efficacy and health literacy on outcome after bariatric surgery in Sweden: a protocol for a prospective, longitudinal mixed methods study
2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 5, article id e027272Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: A person-centred approach, to know about a person's individual weaknesses and strengths, is warranted in today's healthcare in Sweden. When a person suffers from obesity, there are not only risks for comorbidities but also increased risk for decreased health-related quality of life (HRQoL). After bariatric surgery, there are also risks for complications; however, healthcare service expects the person to have sufficient ability to handle recovery after surgery. The need is to investigate how a person's self-efficacy and health literacy(HL) skills are important to determine their effect on recovery as well as HRQoL after bariatric surgery. It can, involve the person in the care, improve shared decision-making, and perhaps decrease complications and readmissions.

METHOD AND ANALYSIS: This is a prospective, longitudinal mixed-methods study with the intent of including 700 patients from three bariatric centres in Sweden (phase 1); 20 patients will be included in a qualitative study (phase 2). Inclusion criteria will be age >17 years, scheduled primary bariatric surgery and ability to read and understand the Swedish language in speech and in writing. Inclusion criteria for the qualitative study will be patients who reported a low self-efficacy, with a selection to ensure maximum variation regarding age and gender. Before bariatric surgery patients will answer a questionnaire including 20 items. Valid and reliable instruments will be used to investigate general self-efficacy (10 items) and functional and communicative and critical HL (10 items). This data collection will then be merged with data from the Scandinavian Obesity Surgery Registry. Analysis will be performed 30 days, 1 year and 2 years after bariatric surgery. One year after bariatric surgery the qualitative study will be performed. The main outcomes are the impact of a person's self-efficacy and HL on recovery after bariatric surgery.

ETHICS AND DISSEMINATION: The study has received approval from the ethical review board in Uppsala, Sweden (number 2018/256). The study results will be disseminated through peer-reviewed publications and conference presentations to the scientific community and social media.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
Bariatric surgery, health literacy, postoperative period, self-efficacy
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-73583 (URN)10.1136/bmjopen-2018-027272 (DOI)000471192800262 ()31076473 (PubMedID)2-s2.0-85065722307 (Scopus ID)
Note

Funding Agency:

Örebro University  ORU 2018/00376  ORU 2018/01219

Available from: 2019-04-08 Created: 2019-04-08 Last updated: 2019-07-22Bibliographically approved
Stenberg, E., Persson, C., Näslund, E., Ottosson, J., Sundbom, M., Szabo, E. & Näslund, I. (2019). The impact of socioeconomic factors on the early postoperative complication rate after laparoscopic gastric bypass surgery: A register-based cohort study. Surgery for Obesity and Related Diseases, 15(4), 575-581
Open this publication in new window or tab >>The impact of socioeconomic factors on the early postoperative complication rate after laparoscopic gastric bypass surgery: A register-based cohort study
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2019 (English)In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 15, no 4, p. 575-581Article in journal (Refereed) Published
Abstract [en]

Background: Socioeconomic factors may influence the outcome of certain surgical procedures, but it is not known whether such factors influence the risk for postoperative complication after bariatric surgery.

Objectives: Determining whether different socioeconomic factors influence the risk for postoperative complication after laparoscopic gastric bypass surgery.

Setting: Nationwide in Sweden.

Methods: Retrospective register-based cohort study that includes all primary laparoscopic gastric bypass procedures in Sweden between 2010 and 2016, using data from the Scandinavian Obesity Surgery Registry, Statistics Sweden, and the Swedish Population Register. Main outcome measures were occurrence and severity of early postoperative complications.

Results: Included in this study were 41,537 patients with 30-day follow-up percentage of 96.7%. Study groups with increased risk for postoperative complication (age, sex, body mass index, and co-morbidity adjusted odds ratio with 95% confidence intervals) were as follows: being divorced, a widow, or a widower (1.14 [1.03-1.23]); receiving disability pension (1.37 [1.23-1.53]) or social assistance (1.22 [1.07-1.401); and being first- (1.22 [1.04-1.44]) or second-generation (1.20 [1.09-1.32]) immigrant. In contrast, being single (.90 [.83.991), having higher disposable income (50th-80th percentile:.84 [.76.93]; >80th percentile:.84 [72.98]), and living in a medium (.90 [.83.98]) or small (.84 [.76.92]) town were associated with lower risk. Increased risk for severe postoperative complication was seen for divorced, widowm, or widower (1.30 [1.12-1.521) and those receiving disability pension (1.37 [1.16-1.611) or social assistance (1.32 [1.08-1.62]), while higher disposable income (50th-80th percentile:.79 [.68.92]; >80th percentile .57 [.46.72]) was associated with lower risk.

Conclusion: Socioeconomic factors influence the risk for early postoperative complication after laparoscopic gastric bypass surgery. The impact is not enough to exclude patients from surgery, but they must be taken into account in preoperative risk assessment.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Laparoscopy, Gastric bypass, Postoperative complication, Risk factor, Socioeconomic
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-75276 (URN)10.1016/j.soard.2019.01.025 (DOI)000471741000006 ()30826242 (PubMedID)2-s2.0-85062107978 (Scopus ID)
Funder
Stockholm County CouncilNovo Nordisk
Note

Funding Agencies:

Örebro Region county council

Örebro University  

SRP Diabetes 

Available from: 2019-07-24 Created: 2019-07-24 Last updated: 2019-07-24Bibliographically approved
Lundvall, E., Ottosson, J. & Stenberg, E. (2019). The influence of staple height on postoperative complication rates after laparoscopic gastric bypass surgery using linear staplers. Surgery for Obesity and Related Diseases, 15(3), 404-408
Open this publication in new window or tab >>The influence of staple height on postoperative complication rates after laparoscopic gastric bypass surgery using linear staplers
2019 (English)In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 15, no 3, p. 404-408Article in journal (Refereed) Published
Abstract [en]

Background: The use of circular staplers with a low staple height is associated with a lower risk for complication when used to construct the gastroenterostomy in laparoscopic gastric bypass surgery. The influence of staple height on outcome when using linear staplers has not been studied.

Objectives: To investigate the influence of staple height when constructing the gastric pouch and gastroenterostomy using a linear stapler in laparoscopic gastric bypass surgery.

Setting: Nationwide, Sweden.

Methods: A retrospective, register-based cohort study, including all primary laparoscopic gastric bypass surgical procedures in Sweden registered in the Scandinavian Obesity Surgery Registry from January 2010 until January 2017, where linear staplers were used to construct the gastric pouch and the gastroenterostomy. Low stapler heights (closed height <= 1.0 mm) were compared with higher stapler heights (closed height >= 1.5 mm). The main outcome was postoperative complication within 30 days of surgery.

Results: Within the study period, 27,975 patients were identified from the Scandinavian Obesity Surgery Registry. A closed staple height >= 1.5 mm was associated with higher risk for postoperative complication within 30 days of surgery compared with lower staple height. The risk was greater when used to construct the gastric pouch (adjusted odd ratio 1.30, 95% confidence interval 1.17-1.44, P < .001) as well as when constructing the gastroenterostomy (adjusted odd ratio 1.32, 95% confidence interval 1.20-1.45, P < .001).

Conclusion: The use of low staple height for construction of the gastric pouch and gastroenterostomy in laparoscopic gastric bypass surgery was associated with lower complication rates. (C) 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Surgical technique, Laparoscopy, Gastric bypass, Postoperative complication
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-74740 (URN)10.1016/j.soard.2019.01.017 (DOI)000470048300006 ()30738736 (PubMedID)2-s2.0-85061056385 (Scopus ID)
Note

Funding Agency:

Region Örebro County and Örebro University

Available from: 2019-07-22 Created: 2019-07-22 Last updated: 2019-07-22Bibliographically approved
Bergström, H., Larsson, L.-G. & Stenberg, E. (2018). Audio-video recording during laparoscopic surgery reduces irrelevant conversation between surgeons: a cohort study. BMC Surgery, 18(1), Article ID 92.
Open this publication in new window or tab >>Audio-video recording during laparoscopic surgery reduces irrelevant conversation between surgeons: a cohort study
2018 (English)In: BMC Surgery, ISSN 1471-2482, E-ISSN 1471-2482, Vol. 18, no 1, article id 92Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The prevalence of perioperative surgical complications is a worldwide issue: In many cases, these events are preventable. Audio-video recording during laparoscopic surgery provides useful information for the purposes of education and event analyses, and may have an impact on the focus of the surgeons operating. The aim of the present study was to investigate how audio-video recording in the operating room during laparoscopic surgery affects the focus of the surgeon and his/her assistant.

METHODS: A group of laparoscopic procedures where video recording only was performed was compared to a group where both audio and video recordings were made. All laparoscopic procedures were performed at Lindesberg Hospital, Sweden, during the period August to September 2017. The primary outcome was conversation not relevant to the ongoing procedure. Secondary outcomes were intra- and postoperative adverse events or complications, operation time and number of times the assistant was corrected by the surgeon.

RESULTS: The study included 41 procedures, 20 in the video only group and 21 in the audio-video group. The material comprised laparoscopic cholecystectomies, totally extraperitoneal inguinal hernia repairs and bariatric surgical procedures. Irrelevant conversation time fell from 4.2% of surgical time to 1.4% when both audio and video recordings were made (p = 0.002). No differences in perioperative adverse event or complication rates were seen.

CONCLUSION: Audio-video recording during laparoscopic abdominal surgery reduces irrelevant conversation time and may improve intraoperative safety and surgical outcome.

TRIAL REGISTRATION: Available at FOU Sweden (ID: 232771) and retrospectively at Clinical trials.gov (ID: NCT03425175 ; date of registration 7/2 2018).

Place, publisher, year, edition, pages
BioMed Central, 2018
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-70123 (URN)10.1186/s12893-018-0428-x (DOI)000449362700001 ()30400860 (PubMedID)2-s2.0-85056128239 (Scopus ID)
Note

Funding Agencies:

Örebro County Council  

Örebro University 

Available from: 2018-11-12 Created: 2018-11-12 Last updated: 2018-11-23Bibliographically approved
Stenberg, E., Szabo, E., Ottosson, J., Thorell, A. & Näslund, I. (2018). Health-Related Quality-of-Life after Laparoscopic Gastric Bypass Surgery with or Without Closure of the Mesenteric Defects: a Post-hoc Analysis of Data from a Randomized Clinical Trial. Obesity Surgery, 28(1), 31-36
Open this publication in new window or tab >>Health-Related Quality-of-Life after Laparoscopic Gastric Bypass Surgery with or Without Closure of the Mesenteric Defects: a Post-hoc Analysis of Data from a Randomized Clinical Trial
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2018 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 28, no 1, p. 31-36Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Mesenteric defect closure in laparoscopic gastric bypass surgery has been reported to reduce the risk for small bowel obstruction. Little is known, however, about the effect of mesenteric defect closure on patient-reported outcome. The aim of the present study was to see if mesenteric defect closure affects health-related quality-of-life (HRQoL) after laparoscopic gastric bypass.

METHODS: Patients operated at 12 centers for bariatric surgery participated in this randomized two-arm parallel study. During the operation, patients were randomized to closure of the mesenteric defects or non-closure. This study was a post-hoc analysis comparing HRQoL of the two groups before surgery, at 1 and 2 years after the operation. HRQoL was estimated using the short form 36 (SF-36-RAND) and the obesity problems (OP) scale.

RESULTS: Between May 1, 2010, and November 14, 2011, 2507 patients were included in the study and randomly assigned to mesenteric defect closure (n = 1259) or non-closure (n = 1248). In total, 1619 patients (64.6%) reported on their HRQoL at the 2-year follow-up. Mesenteric defect closure was associated with slightly higher rating of social functioning (87 ± 22.1 vs. 85 ± 24.2, p = 0.047) and role emotional (85 ± 31.5 vs. 82 ± 35.0, p = 0.027). No difference was seen on the OP scale (open defects 22 ± 24.8 vs. closed defects 20 ± 23.8, p = 0.125).

CONCLUSION: When comparing mesenteric defect closure with non-closure, there is no clinically relevant difference in HRQoL after laparoscopic gastric bypass surgery.

Place, publisher, year, edition, pages
Springer-Verlag New York, 2018
Keywords
Bariatric surgery, Laparoscopic gastric bypass, Small bowel obstruction, Internal hernia, Health-related quality-of-life, Randomized clinical trial
National Category
Gastroenterology and Hepatology Surgery
Identifiers
urn:nbn:se:oru:diva-61780 (URN)10.1007/s11695-017-2798-z (DOI)000418304500005 ()28676957 (PubMedID)2-s2.0-85021846101 (Scopus ID)
Note

Funding Agencies:

Örebro County Council, Örebro University  

Erling-Persson Family Foundation 

Available from: 2017-10-24 Created: 2017-10-24 Last updated: 2018-08-16Bibliographically approved
Stenberg, E., Näslund, I., Szabo, E. & Ottosson, J. (2018). Impact of mesenteric defect closure technique on complications after gastric bypass. Langenbeck's archives of surgery (Print), 403(4), 481-486
Open this publication in new window or tab >>Impact of mesenteric defect closure technique on complications after gastric bypass
2018 (English)In: Langenbeck's archives of surgery (Print), ISSN 1435-2443, E-ISSN 1435-2451, Vol. 403, no 4, p. 481-486Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Closure of mesenteric defects during laparoscopic gastric bypass surgery markedly reduces the risk for small bowel obstruction due to internal hernia. However, this procedure is associated with an increased risk for early small bowel obstruction and pulmonary complication. The purpose of the present study was to evaluate whether the learning curve and subsequent adaptions made to the technique have had an effect on the risk for complications.

METHODS: The results of patients operated with a primary laparoscopic gastric bypass procedure, including closure of the mesenteric defects with sutures, during a period soon after introduction (January 1, 2010-December 31, 2011) were compared to those of patients operated recently (January 1, 2014-June 30, 2017). Data were retrieved from the Scandinavian Obesity Surgery Registry (SOReg). The main outcome was reoperation for small bowel obstruction within 30 days after surgery.

RESULTS: A total of 5444 patients were included in the first group (period 1), and 1908 in the second group (period 2). Thirty-day follow-up rates were 97.1 and 97.5% respectively. The risk for early (within 30 days) small bowel obstruction was lower in period 2 than in period 1 (13/1860, 0.7% vs. 67/5285, 1.3%, OR 0.55 (0.30-0.99), p = 0.045). The risk for pulmonary complication was also reduced (5/1860, 0.3%, vs. 41/5285, 0.8%, OR 0.34 (0.14-0.87), p = 0.019).

CONCLUSION: Closure of mesenteric defects during laparoscopic gastric bypass surgery can be performed safely and should be viewed as a routine part of that operation.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Bariatric surgery, Postoperative complication, Small bowel obstruction, Internal hernia
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-67133 (URN)10.1007/s00423-018-1684-z (DOI)000435997100007 ()29858618 (PubMedID)2-s2.0-85047921185 (Scopus ID)
Note

Funding Agencies:

Örebro County council  

Örebro University 

Available from: 2018-06-04 Created: 2018-06-04 Last updated: 2018-07-24Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-4958-1611

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