Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Remission of type-2 diabetes mellitus (T2DM) is a known benefit of bariatric surgery in morbidly obese patients who have T2DM. This article examined data from a retrospective analysis of patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) in a single institution (n = 224) to determine whether this benefit was eliminated or altered in patients who experienced postoperative weight recurrence (WR).
Included patients had a preoperative diagnosis of T2DM, postoperative WR, and were followed for 5 years after RYGB or SG. The data analysis showed that continued diabetes remission (CDR) was documented in 75% of patients who underwent RYGB compared with 34.8% of patients who had SG. Rates of CDR were slightly lower in patients who regained more than 45% of lost weight.
Risk factors for T2DM recurrence included preoperative insulin use, higher HbA1c, and longer preoperative duration of T2DM.
The authors hypothesized that bypass of the upper small intestine that is a component of RYGB produces metabolic effects that contribute to CDR and this benefit is independent of the effects of weight loss.
Algorithmic Approach for Laparoscopic Cholecystectomy is Safe and Effective for Minimizing Common Bile Duct Injury
This study analyzed postoperative outcomes in a cohort of patients (n = 136) with severe cholecystitis who had laparoscopic cholecystectomy or laparoscopic subtotal cholecystectomy according to an algorithmic approach that included criteria for selecting subtotal cholecystectomy (fenestrated or reconstituting) as a bailout strategy to avoid common bile duct injury.
The data analysis showed that there had been no documented common bile duct injuries since the algorithmic approach was implemented in 2016. Rates of postoperative bile leak were higher in the subtotal cholecystectomy cohort, especially in those patients who were treated with the fenestrated technique; rates of endoscopic retrograde cholangiopancreatography and biliary stent insertion were also higher in the subtotal cholecystectomy group.
The authors noted that postoperative bile leaks were manageable using endoscopic and radiologic interventions with minimal morbidity and concluded that the algorithmic approach was a safe and effective method for minimizing the risk for common bile duct injury in patients with severe cholecystitis.
Article Reviews Diagnosis and Management of Frailty in Surgical Patients
This article summarized the information presented at the Society for Surgery of the Alimentary Tract State-of-the Art session that reviewed the diagnosis and management of “frailty” in surgical patients. Frailty refers to a condition that includes weight loss, malnutrition, loss of muscle mass (sarcopenia), cognitive decline, weakness, and low physical activity; this condition is associated with an increased risk for postoperative mortality and morbidity.
Interventions such as preoperative nutritional therapy and physical therapy (prehabilitation) have been shown to improve patients’ functional status and lower risk for mortality and morbidity. Frailty scores have been shown to accurately diagnose preoperative frailty; the article contains descriptions of five scores that can be easily used by surgical teams to quantify frailty and document effectiveness of treatments.
CT imaging, commonly used as part of the preoperative diagnostic process, can be used for diagnosing sarcopenia. Prehabilitation protocols developed and conducted by a multispecialty team including surgeons, geriatric specialists, nutritionists, nurses, and physical therapists have been shown to be effective in preparing patients for surgery when delaying the planned procedure is feasible.
The authors also stressed the importance of the team approach in implementing palliative care interventions in patients who are not candidates for a surgical procedure or prehabilitation.
Surgeons are encouraged to review the entire content of the article.
