Whittington Hospital is a district general and teaching hospital of UCL Medical School and Middlesex University School of Health and Social Sciences. Located in Upper Holloway, it is managed by Whittington Health NHS Trust, operating as Whittington Health, an integrated care organisation providing hospital and community health services in the north London boroughs of Islington and Haringey. Its Jenner Building, a former smallpox hospital, is a Grade II listed building.
BACKGROUND Metabolic and bariatric surgeries (MBS) are effective treatments for obesity and related comorbidities, such as diabetes and hypertension. In patients with morbid obesity and challenges like hepatomegaly, conventional procedures may increase risks. Staged MBS was developed to address these issues, enhancing safety. This report highlights the successful use of isolated intestinal transit bipartition with duodeno-ileal anastomosis, preserving the duodenum, as the first stage of the duodenal switch. CASE REPORT A 40-year-old woman with a BMI of 40.2 kg/m² was booked for MBS. Severe hepatomegaly impaired safe access to the esophagogastric junction, leading to the performance of only the intestinal stage of the duodenal switch. A duodeno-ileal anastomosis was created 250 cm from the ileocecal valve, preserving the stomach and partial duodenal function. Without the gastric stage, the patient achieved 50 kg of weight loss (equivalent to 78.7% excess weight loss) over 19 years, without requiring additional surgery. Minor complications included occasional diarrhea, meteorism, and difficulties with vitamin supplementation, all managed effectively through dietary adjustments and nutritional guidance. A benefit was increased satiety. CONCLUSIONS Isolated intestinal transit bipartition with duodeno-ileal anastomosis is an approach that may be used in exceptional cases, such as with this patient. Despite the favorable long-term follow-up results, further studies are necessary to better understand this approach. This method demonstrated sustained weight loss and long-term metabolic control, potentially representing a promising initial treatment option for patients with lower BMIs, including those with type 2 diabetes.
Metabolic and Bariatric Surgery (MBS) is an established treatment for obesity and its associated metabolic conditions. As obesity prevalence has risen globally over the past two decades, so too has MBS utilization, spurring interest in same-day discharge (SDD) protocols as a cost-effective alternative to inpatient hospitalization. Following the GRADE methodology, this position statement presents a systematic review of all evidence relevant to same-day discharge in MBS. The current position statement was developed using data from a systematic review and meta-analysis (conducted after Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)) included 17 studies encompassing 46,578 patients; four were randomized controlled trials (RCTs) analyzed in the primary meta-analysis. The pooled analysis of four RCTs (n = 2,026) revealed no statistically significant differences between SDD and conventional inpatient groups for complication rates (OR: 1.49; 95
Previous studies reported that the rate of complications after abdominoplasty is higher in patients with a history of metabolic and bariatric surgery (MBS). The current study aims to compare the rate of complications after abdominoplasty in patients with and without a history of MBS and their risk factors in patients with a history of MBS. A systematic search was conducted to identify observational studies that compare postoperative complication rates after abdominoplasty in patients with and without a history of MBS up to 15 April 2025. Pooled odds ratios were computed to compare complication rates between groups, and additional analyses evaluated complication rates and risk factors among MBS. A total of 26 retrospective studies and one prospective study, involving 6328 patients with a history of MBS, were included in the current study. There were no significant differences in the rate of wound dehiscence, surgical site infection, skin necrosis, fat necrosis, deep venous thrombosis, and reoperation after abdominoplasty in patients with and without a history of MBS. In meta-regression analysis, lower body mass index at the time of abdominoplasty is associated with a higher risk of wound dehiscence. Although body contouring surgery after MBS was associated with a higher risk of seroma and hematoma compared to non-MBS cases, the rate of other complications was not significantly different.
Glaucoma is a common condition that damages the optic nerve, usually as a result of an increase in intraocular pressure (IOP). It can be divided into two types: open-angle glaucoma (OAG) and acute angle-closure glaucoma (AACG). OAG is believed to occur due to dysfunction in aqueous outflow through the trabecular meshwork (TM) of the eye as it flows from the posterior to the anterior chamber. AACG manifests when a bulging iris blocks the iridocorneal angle, commonly caused by pupillary block due to pupil dilation, leading to fluid buildup and increased IOP, potentially resulting in complete vision loss. As a result of an aging population, chronic conditions are increasing in number, necessitating the use of systemic medications to treat them. However, many of these medications may affect the eye, predisposing it to different ocular morbidities. This narrative review will examine the effects of these medications on glaucoma development, specifically focusing on the effects of corticosteroids on OAG through increased aqueous humor resistance in the TM and the effects of sulfonamides, anticholinergics, antidepressants, cholinergics, anticoagulants, and certain supplements on AACG as a result of their sympathomimetic properties and the disruption of the lens-iris structure.
ABSTRACT Background and Aims Necrotizing fasciitis (NF) is a rapidly progressive, life‐threatening infection, with the lower limbs being a common site. Diabetes mellitus (DM) is a significant risk factor that influences the progression, outcome, and management of NF. Despite its clinical relevance, comparative data on diabetic versus non‐diabetic NF outcomes remain limited. This study aimed to compare mortality, amputation rates, and other key outcomes between diabetic and non‐diabetic patients with NF. Methods A systematic review and meta‐analysis were conducted in accordance with PRISMA guidelines. Eligible studies assessed outcomes in diabetic and non‐diabetic NF patients. Primary outcome measures included amputation rates, mortality, admission length, debridement frequency, and microbial growth. Secondary outcomes included the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score and unplanned reoperations. Pooled analyses were performed using OpenMeta[Analyst] software, reporting odds ratios (OR) and mean differences (MD) with 95% confidence intervals. Results Nine studies comprising 1,890 patients met the inclusion criteria. Diabetic patients had significantly higher rates of amputation (OR 3.77, 95% CI 3.04 to 4.68; p < 0.001) and polymicrobial infections (OR 2.53, 95% CI 1.50 to 4.26; p < 0.001). Mortality was higher among diabetic patients after sensitivity analysis (OR 1.60, 95% CI 1.09 to 2.33; p = 0.02). Length of admission did not differ significantly between groups, whereas the pooled number of debridements was marginally higher in diabetic patients (MD 0.28, 95% CI 0.05 to 0.52; p = 0.02), based on only two studies. Diabetic patients had significantly higher LRINEC scores (MD 2.02, 95% CI 1.33 to 2.72; p < 0.001). Conclusion Diabetic patients with NF experience worse clinical outcomes, including increased amputation, mortality, and polymicrobial infection. These findings highlight DM as a key prognostic factor and underscore necessity for aggressive intervention and risk stratification. Further high‐quality prospective studies are needed.
