Purpose Despite having the highest medical needs by population for weight loss treatment, Pacific patients in Aotearoa New Zealand face substantial levels of attrition in publicly funded weight loss surgery programs. In collaboration with the Auckland City Hospital bariatric surgery team, a Pacific-led preoperative weight loss surgery program was co-designed, delivered, and evaluated between 2020 and 2023. Materials and Methods This was a single-arm, prospective co-designed evaluation study that took place at Auckland City Hospital in Aotearoa New Zealand. Participants were Pacific patients ( n = 14) referred to the weight loss surgery program. Survey and video diaries were analyzed to determine if the program had the potential to increase Pacific patient retention through the preoperative stage of weight loss surgery, increase surgery completion rates, and improve the quality of treatment experiences. Results Nine out of 14 participants attended all preoperative sessions. Six participants subsequently underwent weight loss surgery. Program components that had positive impacts on patient success and satisfaction were accessibility, information quality, having Pacific role models, cultural safety, and the group support system. The patients found the program to be culturally anchored and there was support for the implementation of the program going forward. Conclusion This study demonstrated how a culturally anchored intervention can increase patient retention for those patients who may not respond to mainstream treatment. Adjusting existing preoperative weight loss surgery programs to integrate Pacific-led models of healthcare has the potential to increase Pacific patient resiliency to follow through with surgery. Graphical Abstract

Obesity disproportionately affects 50.8

BACKGROUND:Adverse gastric symptoms persist in up to 20% of fundoplication operations completed for gastroesophageal reflux disease, causing significant morbidity and driving the need for revisional procedures. Noninvasive techniques to assess the mechanisms of persistent postoperative symptoms are lacking. This study aimed to investigate gastric myoelectrical abnormalities and symptoms in patients after fundoplication using a novel noninvasive body surface gastric mapping (BSGM) device. METHODS:Patients with a previous fundoplication operation and ongoing significant gastroduodenal symptoms and matched controls were included. BSGM using Gastric Alimetry (Alimetry Ltd) was employed, consisting of a high-resolution 64-channel array, validated symptom-logging application, and wearable reader. RESULTS:A total of 16 patients with significant chronic symptoms after fundoplication were recruited, with 16 matched controls. Overall, 6 of 16 patients (37.5%) showed significant spectral abnormalities defined by unstable gastric myoelectrical activity (n = 2), abnormally high gastric frequencies (n = 3), or high gastric amplitudes (n = 1). Patients with spectral abnormalities had higher Patient Assessment of Upper Gastrointestinal Disorders-Symptom Severity Index scores than those of patients without spectral abnormalities (3.2 [range, 2.8-3.6] vs 2.3 [range, 2.2-2.8], respectively; P = .024). Moreover, 7 of 16 patients (43.8%) had BSGM test results suggestive of gut-brain axis contributions and without myoelectrical dysfunction. Increasing Principal Gastric Frequency Deviation and decreasing Rhythm Index scores were associated with symptom severity (r > .40; P < .05). CONCLUSION:A significant number of patients with persistent postfundoplication symptoms displayed abnormal gastric function on BSGM testing, which correlated with symptom severity. Our findings advance the pathophysiologic understanding of postfundoplication disorders, which may inform diagnosis and patient selection for medical therapy and revisional procedures.

Background Adverse gastric symptoms persist in up to 20% of fundoplication surgeries completed for gastroesophageal reflux disease, causing significant morbidity, and driving the need for revisional procedures. Non-invasive techniques to assess the mechanisms of persistent postoperative symptoms are lacking. We aimed to investigate gastric myoelectrical abnormalities and symptoms in patients after fundoplication using a novel non-invasive body surface gastric mapping (BSGM) device. Methods Patients with previous fundoplication surgery and ongoing significant gastroduodenal symptoms, and matched controls were included. BSGM using Gastric Alimetry (Alimetry, New Zealand) was employed, consisting of a high resolution 64-channel array, validated symptom-logging App, and wearable reader. Results 16 patients with significant chronic symptoms post-fundoplication were recruited, with 16 matched controls. Overall, 6/16 (37.5%) patients showed significant spectral abnormalities defined by unstable gastric myoelectrical activity (n = 2), abnormally high gastric frequencies (n = 3) or high gastric amplitudes (n = 1). Those with spectral abnormalities had higher Patient Assessment of Upper Gastrointestinal Disorders-Symptom Severity Index scores (3.2 [2.8 to 3.6] vs 2.3 [2.2 to 2.8]; p =0.024). 7/16 patients (43.8%) had Gastric Alimetry tests suggestive of gut-brain axis contributions, and without myoelectrical dysfunction. Increasing Principal Gastric Frequency deviation, and decreasing Rhythm Index were associated with symptom severity (r>0.40, p<0.05). Conclusion A significant number of patients with persistent post-fundoplication symptoms display abnormal gastric function on Gastric Alimetry testing, which correlates with symptom severity. These findings advance the pathophysiological understanding of post-fundoplication disorders which may inform diagnosis and patient selection for medical therapy and revisional surgery.

Purpose: Diabetic peripheral neuropathy can be detected using non-invasive in vivo confocal microscopy of the cornea (IVCM) and such abnormalities may precede the development of clinical neuropathy. The current study aimed to assess any progression or remission of corneal and peripheral neuropathy in patients with type 2 diabetes undergoing bariatric surgery. Methods: People with known type 2 diabetes for at least five years and listed for bariatric surgery were recruited. Participants were assessed before, and 12, 26, and 52 weeks following bariatric surgery. IVCM and corneal sensitivity measurements were performed. A modified total neuropathy score (mTNS) was obtained from neuropathy questionnaire, clinical assessment and biothesiometry. Results: Twenty-nine participants (M:F, 11:18) with mean BMI of 44.7 f 6.4 kg/m(2), and 11 f 7.6 years duration of diabetes, were assessed. Corneal sub-basal nerve fibre length (CNFL), displayed an increase from a baseline mean of 12.20 f 1.00 to 17.48 f 0.92 mm/mm(2) at 52 weeks (p < 0.0001). Corneal sensitivity threshold displayed a decrease over time, thus corneal sensitivity improved, falling from a mean of 1.11 f0 .15 to 0.62 f 0.11 (mBAR) (p < 0.0001). Clinical neuropathy scores demonstrated significant improvements from baseline, displaying a decrease in average mTNS score from 3.29 f 0.68 to 0.76 f 0.30 (p < 0.0001). A significant inverse relationship was shown between CNFL and sensitivity ((3 coefficient = -0.047, p < 0.001), and CNFL and mTNS ((3 coefficient = -0.178, p < 0.001). Conclusion: Bariatric surgery led to an improvement in metabolic control of diabetes and weight loss, along with improvement in corneal nerve microstructure, corneal sensitivity, and neuropathic symptoms, suggesting a reversal of both small and large fibre neuropathy.

While most gastric bypass patients recover well, some experience long-term complications, including nausea, abdominal pain, food intolerance, and dumping. This study aimed to evaluate symptoms and quality of life (QoL) in association with the residual activity of the remnant stomach. Patients undergoing gastric bypass and conversion-to-bypass were recruited. The Gastric Alimetry® System (Auckland, NZ) was employed, comprising a high-resolution electrode array, wearable reader, and validated symptom logging app. The protocol comprised 30-min fasting baseline, a 218-kCal meal stimulus, and 4-h of post-prandial recordings. Symptoms and QoL were evaluated using validated questionnaires. Remnant gastric electrophysiology evaluation included frequency, BMI-adjusted amplitude, and Gastric Alimetry Rhythm Index (GA-RI, reflecting pacemaker stability), with comparison to validated reference intervals and matched controls. Thirty-eight participants were recruited with mean time from bypass 46.8 ± 28.6 months. One-third of patients showed moderate to severe post-prandial symptoms, with patients’ median PAGI-SYM 28 ± 19 vs controls 9 ± 17 (p < 0.01); PAGI-QOL 37 ± 31 vs 135 ± 22 (p < 0.0001). Remnant gastric function was markedly degraded shown by undetectable frequencies in 84

Introduction Oesophagectomy is a complex procedure performed for malignant and benign conditions. Post-oesophagectomy conduit dysfunction is common, which can occur for several reasons including conduit dysmotility. However, reliable tools for evaluating conduit motility are lacking. A non-invasive device for gastric electrical mapping was recently developed to evaluate gastric electrical activity and function. This study aimed to assess the feasibility of BSGM in the post-oesophagectomy stomach.Methods Oesophagectomy patients from Auckland, New Zealand, were recruited. The Gastric Alimetry System® (New Zealand) was employed, comprising a stretchable array (8×8 electrodes), a wearable Reader, and validated iOS app for symptom logging. The protocol comprised a 30-minute baseline, a meal challenge, then 4 hours of post-prandial recordings. Analysis encompassed Principal Gastric Frequency, BMI-adjusted amplitude, Gastric Alimetry Rhythm Index (indicating rhythm stability), meal response, and symptoms. Adverse events were recorded.Results 6 patients were recruited and gastric activity was successfully captured in all except one with the colonic interposition (negative control). Four patients showed abnormalities indicating post-operative gastric hypofunction: four with low or abnormal frequency (<2.65 cycles/min), three with low amplitude (<22μV), two with low GA-RI (<0.25) and one with a reduced meal response. One patient had significant symptoms (nausea, early satiation) who demonstrated marked hypomotility in all four of these domains. No adverse events occurred.Conclusion Gastric Alimetry is a safe and feasible technique to non-invasively assess gastric conduit motility following oesophagectomy. Parameters may need adjustment for post-surgical anatomy. Clinical studies assessing the role in diagnosis and therapy can be advanced.### Competing Interest StatementAG, SC and GOG are shareholders of Alimetry Ltd. There are no other conflicts of interest### Funding StatementThis work was supported by the New Zealand Health Research Council, The Royal Australasian College of Surgeons John Mitchell Crouch Fellowship (GOG), the National Institutes of Health (R56 126935), and the Auckland Medical Research Foundation Douglas Goodfellow Medical Research Fellowship (THHW). ### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:Auckland Health Research Ethics Committee of The University of Auckland gave ethical approval for this workI confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesAll data produced in the present work are contained in the manuscript

Both obesity and type 2 diabetes are associated with an increased risk of skin and soft tissue (SSTI), urinary tract, and lower respiratory tract infections but it is not clear whether the incidence of such infections is reduced after bariatric surgery. In people accepted onto our publicly funded bariatric program, we recorded unplanned admissions to public hospitals over a median follow-up of 4.5 years in those successfully undergoing surgery and in those who withdrew from the program. Rates of admission for the composite outcome (SSTI, urinary tract, or lower respiratory infection) were compared. Of 774 people accepted onto the program, 49% underwent surgery. Infections accounted for 27% of unplanned admissions in those not completing surgery and 13% of those who underwent surgery (p < 0.001). The rate of admission was 60% lower in people who underwent surgery than those who did not: 4.3 vs 12.2 per 100 patient-years (P < 0.002), a difference maintained across 8 years’ follow-up. The impact of surgery was independent of enrolment age, BMI, or diabetes and smoking status. Of the three types of infection in the composite outcome, SSTI were the most prevalent and showed the greatest reduction (p < 0.0001). The median day stay for infection was 0.5 day less in those who underwent surgery (p < 0.01). Hospitalization for these three infectious diseases in people undergoing bariatric surgery was lower than that in people enrolled in the bariatric program but not completing surgery. The effect was greatest for SSTI, and sustained to at least 8 years.

Obesity represents a significant public health problem across the developed world. Bariatric surgery is considered the most effective treatment option for morbidly obese individuals in whom non-surgical weight loss has proved unsuccessful, reflecting large-scale Swedish prospective cohort study data demonstrating superior reductions in related morbidity and all-cause mortality compared with conventional weight loss management.1 The laparoscopic Roux-en-Y gastric bypass (LRYGB) is the bariatric operation associated with a greater proportion of excess weight lost compared to the more popular gastric sleeve based on several large prospective, randomised trials.2-4 Dabigatran is thought to be absorbed in the lower stomach and duodenum based on the relatively rapid time to achieve peak serum levels in the serum.5 This is precisely the absorptive surface excluded from the gastrointestinal (GI) tract by the LRYGB operation. While there is no established therapeutic range, data from the Phase II PETRO study (ClinicalTrials.gov Identifier: NCT01227629) showed a mean (range) peak of 184 (64–443) ng/ml and mean trough of 90 (31–225) ng/ml, both based on 150 mg twice daily dosage.6 In 2017, we opportunistically observed a very low peak serum dabigatran of 11 ng/ml in a 46-year-old woman who had undergone LRYGB surgery for weight loss and management of Type II diabetes. Her preoperative peak level measured 8 months earlier was 160 ng/ml, closely approximating the mean peak observed in the PETRO study. Our patient was safely converted to warfarin without experiencing any clinically apparent breakthrough thrombotic events; however, her case prompted the question of whether her very low dabigatran concentration reflected GI malabsorption due to changes in anatomy following LRYGB surgery. As dabigatran remains the most commonly prescribed direct oral anticoagulant (DOAC) in New Zealand (NZ), we were also concerned that other patients on dabigatran therapy may also have sub-therapeutic concentrations following LRYGB, therefore exposing them to a risk of future thrombotic events. There are limited data on oral anticoagulation following bariatric surgery. Case reports of thromboembolic events following LRYGB-type surgery include cerebral infarcts and a saddle pulmonary embolism.7-9 We carried out a retrospective case series of patients who underwent LRYGB surgery at Auckland City (ACH), Middlemore (MMH) and North Shore (NSH) Hospitals between 1 July 2011 (the date dabigatran was first licensed for use in NZ) and 31 December 2018. Electronic dispensing records of those patients who had undergone LRYGB at each hospital were interrogated to identify those prescribed dabigatran. These patients were asked to attend their local community laboratory and undergo measurement of a peak serum dabigatran concentration, dilute thrombin clotting time (dTCT) and serum creatinine. A peak was defined as the serum concentration between 0·5 and 3 h post-dose, consistent with the PETRO and RE-LY (ClinicalTrials.gov Identifier: NCT00262600) studies.6, 10 The dTCT assay was performed on the STA-R Analyser (Diagnostica Stago, Asi è res sur Seine, France) using citrated patient plasma samples diluted 1:8 in Owren-Koller buffer and mixed with normal plasma, followed by the addition of excess human thrombin reagent (1·5 NIH units thrombin/ml). The time to formation of a fibrin clot was then measured using a viscosity-based detection system. Dabigatran concentrations were calculated from this using a 4-point calibration curve (Hyphen BioMed, Neuvillesur-Oise, France).11 Relevant data of 453 patients who underwent LRYGB surgery across the study period were obtained, comprising 187 at ACH, 149 at NSH and 11 at MMH. Of these, nine were identified as being on dabigatran at the time of study and gave their consent to participate. The results from these nine participants are presented in Table I. The median (range) peak serum dabigatran concentration was 34·6 (10–64) ng/ml and median peak dTCT was 67·5 s. Two patients had additional trough measurements of 17 and 28 ng/ml. The median (range) time from surgery to measurement of dabigatran concentration was 876 (25–2062) days. No clinical thromboembolic events were reported during the study period and no patients were identified to be concurrently taking other medications known to potentially interact with dabigatran. Creatinine, μmol/l These results represent the largest series of serum dabigatran following LRYGB surgery published to date. They demonstrate markedly and consistently reduced concentrations relative to Phase II trial data, with the highest values in our cohort only coinciding with the fifth centile reported in the PETRO dataset. This suggests absorption may either be impaired or delayed in the setting of altered GI tract anatomy following the LRYGB, and raises significant concern regarding the risk of future thromboembolic events, which is supported by the aforementioned case reports. Further work is required to evaluate the exact pharmacokinetic profile of dabigatran in this setting. Limited data on dabigatran absorption following bariatric surgery are available in the literature. A recent case series of DOAC serum concentrations in post-bariatric surgery patients demonstrated dabigatran levels within the normal expected range in two patients who had undergone gastric sleeve procedures. However, unlike the LRGYB, this operation retains the area of the GI tract responsible for dabigatran absorption.12 Additionally, an earlier published review of case reports describing low serum dabigatran concentrations from the World Health Organization (WHO) Global Database of Individual Case Safety Reports ('VigiBase') included two patients who had undergone gastric bypass surgery and one with short gut syndrome, supporting our observations described here. Of note, five of the patients contained in this analysis have since been switched to the alternative DOAC, rivaroxaban, and peak serum concentrations were also obtained on these patients. The median (range) was 174 (80–264) ng/ml, which is comparable to the median (range) of 124·6 (91·4–195·5) ng/ml reported previously in the literature across two Phase IIb trials of this medication.13 Recent international guidance suggests warfarin is the oral anticoagulant of choice after bariatric surgery given its ability to be monitored and dose-adjusted.5 Our present data imply significant caution should be exercised with the use of dabigatran after LRYGB, and obtaining drugs concentrations both before and after surgery to assess for possible malabsorption is strongly advised. Our present results also raise the possibility that rivaroxaban may be an acceptable alternative for patients who prefer the convenience of a DOAC; however, given the very small numbers reported here, further evaluation in this patient group is needed.

Introduction In people accepted onto a bariatric surgery program we compared diabetes-related outcomes in those who completed surgery with those who withdrew before having surgery—examining rates of insulin use in people with type 2 diabetes (T2D), and rates of incident diabetes in people without pre-existing T2D. Research design and methods 771 people were accepted onto the program. 463 people (60%) had T2D at referral, of which 48% completed surgery and 52% withdrew. Of 308 people without T2D at referral, 49% completed surgery, and 51% withdrew. Rates of insulin use and incident diabetes were compared by Kaplan-Meier analyses. Among those with pre-existing T2D, we examined rates of remission and relapse after surgery. Results People without T2D who withdrew from the program had higher mean body mass index and glycated hemoglobin levels than those completing surgery (p<0.005). The rate of incident diabetes at 5 years was 19% in those who withdrew versus 0% in those completing surgery (p<0.001). 30% of people with T2D were taking insulin at referral and all stopped insulin after surgery. During follow-up, the rate of insulin (re)introduction was lower in those who completed surgery (8% vs 26% at 5 years, p<0.001). Of those with T2D who completed surgery, 80% had remission, but 34% had relapsed by 5 years. Diabetes relapse was associated with less weight loss after surgery, a longer duration of T2D and previous insulin use. Conclusions Despite a high relapse rate, people with T2D who completed surgery had lower insulin use at 5 years than those withdrawing from the program. In people without T2D, bariatric surgery prevented incident diabetes. People without T2D who withdrew from the program were at greater risk of diabetes, suggesting those who could benefit the most in terms of T2D prevention are not completing bariatric surgery.

Aim Our primary aim was to determine whether non-attendance at pre-operative clinics were associated with non-attendance at post-operative clinics and its influence on weight loss. We also sought to examine the relationship between gender, ethnicity and post-operative clinic attendance with respect to weight loss post-bariatric surgery. Methods A retrospective audit was performed for patients undertaking the bariatric surgery program at the Auckland City Hospital between 2013 and 2016. Results One hundred and eighty-four patients completed our program, with a mean age of 46.1 years. Mean weight at commencement was 133.3 kg, with a BMI of 47.4. At 2 years follow-up (n = 143), excess weight loss was 70.8% following RYGB and 68.0% following LSG (p = 0.5743). More patients attended all pre-operative than post-operative clinics (67.4% vs 37.5% p = < 0.001). One pre-operative clinic non-attendance was associated with less weight loss at 2 years and it increases the risk of missing at least 50% of post-operative clinics with a risk ratio of 2.73, p = 0.005. Non-attendance of at least 50% of post-operative clinics was also associated with less weight loss at 2 years (33.4 kg vs 44.3 kg, p=0.040). Although Maori and Pacific Islanders more frequently missed > 50% of post-operative clinics, weight loss was similar between European, Maori and Pacific Islander populations (2-year weight loss 44.2 kg vs 40.74 kg vs 44.1 kg, respectively, p = 0.8192). Conclusion Pre-operative clinic non-attendance helps predict post-operative clinic non-attendance. Missing any pre-operative clinics and at least 50% of scheduled post-operative clinics is associated with poorer weight loss outcomes.

Inequitable access to bariatric surgery by geographical region has been reported internationally, but comparable data on provision of bariatric surgery have not previously been reported in New Zealand. We examined allocated funding and provision of bariatric surgery amongst different regions in New Zealand in the 2013/14 year, and found that there was large variation in both. This highlights that public funded bariatric surgery needs to take into account population prevalence of morbid obesity to reduce inequities by geographical region.

Asymptomatic liver disease is common in bariatric patients and can be diagnosed with intraoperative biopsy. This study aimed to establish the risk-benefit profile of routine liver biopsy, prevalence of clinically significant liver disease, relationship between liver pathology and body mass index, and compare outcomes between ethnic groups. This retrospective cohort study included all patients who had index bariatric surgery at Auckland City Hospital between 2009 and 2016. Diagnosis of liver disease was based on intraoperative biopsy histology. Outcomes included safety (biopsy-related complication) and utility (liver pathology meeting criteria for referral). Liver pathology and referral rates were compared between ethnic groups. Of 335 bariatric surgery patients, 234 (70%) underwent intraoperative liver biopsy. There were no biopsy-related complications. Histological findings were as follows: normal 25/234 (11%), non-alcoholic fatty liver disease (NAFLD) 207/234 (88%), and other pathological findings in 35/234 (15%). Histological finding meeting referral criteria was present in 22/234 (9%). Of these, 12/22 (55%) were referred. Number needed to biopsy to identify histology meeting referral criteria: n = 11. Māori had a similar NAFLD rate to non-Māori [51/56 versus 156/178, p = 0.48]. Pasifika patients had a higher rate than non-Pasifika [39/40 versus 168/194, p = 0.049]. Māori and Pasifika patients had similar referral rates to non-Māori and non-Pasifika [2/3 versus 5/9, p = 0.73; 2/2 versus 5/10, p = 0.19]. Intraoperative liver biopsy during bariatric surgery is safe and identified liver disease in 89%, with 9% meeting referral criteria. Pasifika patients have a higher rate of NAFLD than non-Pasifika.

Postsurgical gastric dysfunction is common, but the mechanisms are varied and poorly understood. The pylorus normally acts as an electrical barrier isolating gastric and intestinal slow waves. In this report, we present an aberrant electrical conduction pathway arising between the stomach and small intestine, following pyloric excision and surgical anastomosis, as a novel disease mechanism. A patient was referred with postsurgical gastroparesis following antrectomy, gastroduodenostomy, and vagotomy for peptic ulceration. Scintigraphy confirmed markedly abnormal 4-h gastric retention. Symptoms included nausea, vomiting, postprandial distress, and reflux. Intraoperative, high-resolution electrical mapping was performed across the anastomosis immediately before revision gastrectomy, and the resected anastomosis underwent immunohistochemistry for interstitial cells of Cajal. Mapping revealed continuous, stable abnormal retrograde slow-wave propagation through the anastomosis, with slow conduction occurring at the scar (4.0 ± 0.1 cycles/min; 2.5 ± 0.6 mm/s; 0.26 ± 0.15 mV). Stable abnormal retrograde propagation continued into the gastric corpus with tachygastria (3.9 ± 0.2 cycles/min; 1.6 ± 0.5 mm/s; 0.19 ± 0.12 mV). Histology confirmed ingrowth of atypical ICC through the scar, defining an aberrant pathway enabling transanastomotic electrical conduction. In conclusion, a “gastrointestinal aberrant pathway” is presented as a novel proposed cause of postsurgical gastric dysfunction. The importance of aberrant anastomotic conduction in acute and long-term surgical recovery warrants further investigation. NEW & NOTEWORTHY High-resolution gastric electrical mapping was performed during revisional surgery in a patient with severe gastric dysfunction following antrectomy and gastroduodenostomy. The results revealed continuous propagation of slow waves from the duodenum to the stomach, through the old anastomotic scar, and resulting in retrograde-propagating tachygastria. Histology showed atypical interstitial cells of Cajal growth through the anastomotic scar. Based on these results, we propose a “gastrointestinal aberrant pathway” as a mechanism for postsurgical gastric dysfunction.

Unfortunately, the original version of this article contained an error. The Methods section's first sentence and Table 1 both mistakenly contained the letters XXXX in place of the district health board and hospital city names.

Objective: Writing emotionally about upsetting life events (expressive writing) has been shown to speed healing of punch-biopsy wounds compared to writing objectively about daily activities. We aimed to investigate whether a presurgical expressive writing intervention could improve surgical wound healing. Method: Seventy-six patients undergoing elective laparoscopic bariatric surgery were randomized either to write emotionally about traumatic life events (expressive writing) or to write objectively about how they spent their time (daily activities writing) for 20 min a day for 3 consecutive days beginning 2 weeks prior to surgery. A wound drain was inserted into a laparoscopic port site and wound fluid analyzed for proinflammatory cytokines collected over 24 hr postoperatively. Expanded polytetrafluoroethylene tubes were inserted into separate laparoscopic port sites during surgery and removed after 14 days. Tubes were analyzed for hydroxyproline deposition (the primary outcome), a major component of collagen and marker of healing. Fifty-four patients completed the study. Results: Patients who wrote about daily activities had significantly more hydroxyproline than did expressive writing patients, t(34) = −2.43, p = .020, 95% confidence interval [−4.61, −0.41], and higher tumor necrosis factor–alpha, t(29) = −2.42, p = .022, 95% confidence interval [−0.42, −0.04]. Perceived stress significantly reduced in both groups after surgery. Conclusions: Expressive writing prior to bariatric surgery was not effective at increasing hydroxyproline at the wound site 14 days after surgery. However, writing about daily activities did predict such an increase. Future research needs to replicate these findings and investigate generalizability to other surgical groups.