Background: Reliable identification of the lumbar interspace is essential for safe neuraxial anesthesia. Landmark-based techniques such as the Tuffier line may be unreliable in patients with obesity because excess adipose tissue obscures anatomical landmarks. Ultrasonography may improve vertebral level identification in patients with difficult anatomy. Methods: This prospective observational study evaluated concordance between landmark-guided palpation and ultrasound-confirmed lumbar interspace identification. Sixty-six adult surgical patients (33 obese and 33 nonobese controls) with American Society of Anesthesiologists physical status I–III scheduled for elective procedures were prospectively enrolled. Landmark-based identification directed at the presumed L4–L5 interspace was performed independently by three specialist anesthesiologists in both the sitting and lateral decubitus positions. Ultrasound confirmation was conducted by a blinded senior specialist anesthesiologist. Primary outcomes were exact interspace concordance rates and predictors of discordance. Results: Concordance in the sitting position was 35.5% (11/31; 95% confidence intervals [CI] 21.1–53.1) in assessable patients with obesity and 84.8% (28/33; 95% CI: 69.1–93.3) in nonobese controls (absolute risk difference [RD]: 49.3%, 95% CI: 27.8–70.8%; p < 0.001 ). In the lateral position, concordance rates were 25.8% (8/31; 95% CI: 13.7–43.2) and 78.8% (26/33; 95% CI: 62.2–89.3), respectively (absolute RD: 53.0%, 95% CI: 31.8–74.2%; p < 0.001 ). In the obesity group, palpation identified a more cranial interspace than ultrasound in 54.8% (17/31) of cases. In multivariable generalized estimating equation analysis, central obesity (adjusted odds ratio [OR] 5.95; 95% CI: 1.02–34.84; p = 0.048 ) and higher Karraz palpation difficulty grade (adjusted OR 3.02 per grade increase; 95% CI: 1.02–8.96; p = 0.047 ) were independent predictors of discordance. Conclusions: Landmark-guided identification of lumbar interspaces shows substantially lower concordance with ultrasound in patients with obesity, predominantly identifying a more cranial interspace. Such cranial misidentification, if used to guide neuraxial needle placement, may increase the potential risk of unintended higher-level puncture and complications. Preprocedural ultrasound should be considered to enhance anatomical verification in this challenging cohort.
Purpose: This study evaluated knowledge of and attitudes toward bariatric surgery and obesity treatment options among adults seeking obesity treatment at a tertiary obesity center. Methods: In this descriptive cross-sectional study, 249 adults attending the center between December 2023 and February 2024 completed a structured questionnaire developed from the literature and expert opinion. The questionnaire assessed sociodemographic characteristics, awareness of bariatric surgery, knowledge of treatment options, surgical expectations, and postoperative care knowledge. It was pilot-tested before implementation. Psychiatric evaluations were conducted by experienced psychiatrists after questionnaire completion. Results: More than half of the participants reported awareness of bariatric surgery; however, knowledge of surgical procedures and postoperative management was limited. Only 14 participants (5.6%) correctly identified all recommended obesity treatment approaches. Educational level showed weak but significant associations with selected knowledge indicators, whereas gender was not significantly associated with most outcomes. Health-related problems and impaired daily functioning were the most frequently reported reasons for considering surgery. Conclusions: Adults seeking obesity treatment had limited knowledge of bariatric surgery and postoperative requirements. Structured preoperative education and psychosocial assessment may support informed decision-making, realistic expectations, and long-term postoperative adherence among bariatric surgery candidates within multidisciplinary obesity care and surgical preparation processes in practice.
Aim: This study evaluated the effects of preoperative administration of 200 mL of a 12.5% sucrose solution on postoperative nausea and vomiting (PONV) and functional recovery in patients undergoing metabolic bariatric surgery (MBS).Methods: Single-center, parallel-group randomized controlled trial included 105 patients undergoing elective MBS (American Society of Anesthesiologists physical status I-IV). Participants were allocated by block randomization to an intervention or control group. The intervention group received 200 mL of a 12.5% sucrose solution 2 h before surgery, whereas the control group followed standard fasting. Participant and investigator blinding was not feasible; however, follow-up nurses and the statistician were blinded. PONV was assessed at 24 h using the Rhodes Index of Nausea, Vomiting, and Retching, and functional recovery at discharge and postoperative day 30 using the Postoperative Recovery Index (PoRI).Results: No significant between-group differences were observed in PONV at 24 h or total PoRI scores. However, the intervention group showed significantly better physical activity and general symptoms subscale scores on postoperative day 30. No intervention-related adverse events occurred.Conclusion: Low-volume sucrose-based carbohydrate loading appeared safe and improved physical activity and general symptoms during recovery after MBS. Although the lack of a placebo or equal-volume clear-fluid control warrants cautious interpretation, this simple nurse-led intervention may represent a feasible Enhanced Recovery After Surgery-aligned strategy to enhance postoperative recovery.
Introduction: Bariatric surgery leads to sustained weight loss and improvement in obesity-related comorbidities, but its effects on quality of life (QOL) and psychosocial functioning remain less understood. Objective: The study analyzed the impact of surgery on patients’ psychosocial functioning and body experiences 3 years postsurgery. Methods: A qualitative semistructured interviews explored psychosocial and body image changes. Results: The mean percentage of excess weight loss (%EWL) was 84.07%. Women experienced significantly greater weight loss than men (88% vs. 71%EWL, p = 0.025), but no differences were found for other sociodemographic factors. Improvement in comorbidities (diabetes, hypertension, and sleep apnea) was seen in 86.8% of patients. Despite an overall enhancement in QOL, some difficulties persisted, such as fear of weight regain, disordered eating, and body image problems. Conclusion: Body image issues after bariatric surgery are still insufficiently studied. Addressing all aspects of body image after surgery is essential to better prepare patients for the psychological challenges they may face.
Background: Bariatric surgery is an effective treatment for severe obesity, but psychosocial challenges often emerge postoperatively, affecting patients and their partners. Despite evidence that romantic relationships influence health outcomes, limited research explores the relational experience of couples following bariatric surgery.Methods: This qualitative study included six heterosexual couples (N = 12) in which one partner had undergone bariatric surgery 1.5-3 years prior. Separate focus groups were conducted for patients and partners to explore emotional, relational, and behavioral changes. Transcripts were analyzed using thematic analysis attentive to narrative and temporal context.Results: Both patients and partners described overlapping needs related to improved communication, emotional support, and shared health behaviors. Patients highlighted body image concerns, intimacy changes, and mismatched physical abilities; partners emphasized uncertainty about how to provide effective support. Both groups expressed enthusiasm for structured, couple-based interventions to enhance adjustment.Conclusions: Findings illustrate the interdependence of patient and partner experiences following bariatric surgery and underscore the importance of addressing relational processes in postsurgical care. Integrating relationship-based interventions into bariatric aftercare may improve psychosocial adjustment and long-term outcomes.
