BACKGROUND:Surgical complications impact quality of life and escalate healthcare costs. Intraoperative performance, accounting for 40% to 60% of adverse events, is often judged through visual cues. The accuracy of this in predicting postoperative outcomes remains underexplored. We sought to assess surgeon accuracy in predicting outcomes from robotic sleeve gastrectomy (RSG) videos. STUDY DESIGN:Fellowship-trained surgeons reviewed RSG clips collected from a high-volume tertiary bariatric center. Twenty-five cases were chosen: 13 with complications and 12 without. Surgeons predicted which cases would result in complications and assigned Global Evaluative Assessment of Robotic Skills scores (GS) for technical proficiency. The primary outcome was the accuracy of predicting postoperative outcomes, including bleeding, leak, stenosis, or no complications. Secondary outcomes involved correlations between GS, comment themes, predicted outcomes, and actual outcomes. RESULTS:Ninety-one clips were reviewed by 19 surgeons. Accuracy for predicting specific complications was 28.6%, whereas "complicated" vs "uncomplicated" accuracy was 47.3%. Mean GS showed no significant differences between procedures with or without complications (19.97 ± 3.98 vs 21.27 ± 3.47). Videos predicted as uncomplicated had a higher GS (22.15 ± 2.97 vs 19.93 ± 3.89, p < 0.05). Comment analysis showed correlations between predicted outcomes and themes (eg bleeding) as well as staple line or suturing issues and stenosis. CONCLUSIONS:Experienced bariatric surgeons exhibited low accuracy in predicting complications from edited RSG videos. Visual cues failed to reliably predict outcomes, highlighting limitations of using video-based methodology for risk assessment. As this could impact surgical training and medico-legal proceedings, further research is needed to improve predictive accuracy and address cognitive biases in the surgical environment.

Sodium-glucose cotransporters (SGLT) and glucose transporters (GLUT) have been shown to influence diabetes management by modulating glucose uptake by the intestine. Therefore, alterations in gastrointestinal anatomy during bariatric surgery can change SGLT and GLUT receptor activity. These changes offer an additional mechanism for weight loss and may explain the differential impact of the various bariatric surgical procedures. This review examines the current literature on SGLT and GLUT receptors and their effects on weight loss through genetic studies, pharmacologic inhibition, and how SGLT/GLUT receptors impact surgical physiologic modulation. A better understanding of Type I sodium-glucose cotransport receptors (SGLT-1), GLUT-2, and GLUT-5 could provide insight for improved procedures and allow us to determine the best method to tailor operations to a patient's individual needs.

Background Thromboprophylaxis in bariatric surgery is widely debated; however, few large articles evaluate treatment plans and their efficacy. Herein, we make the first large-scale report of the safety and efficacy of apixaban (Eliquis) for thrombus prevention following bariatric surgery. Purpose To evaluate the safety and efficacy of apixaban following bariatric surgery. Setting Three private institutes, USA. Materials and Methods Data from 5017 consecutive bariatric patients that were placed on postoperative apixaban for thromboprophylaxis were used for retrospective analysis. The dose prescribed to patients was 2.5 mg PO BID for a total of 30 days starting on day 3 postoperatively. Results In total, of the 5017 patients, 59.7%, 31.2%, 4.4%, 2.5%, 1.8%, and 0.1% of the patients had undergone sleeve gastrectomy (SG), single-anastomosis duodeno-ileal bypass with SG (SADI-S), Roux-en-Y gastric bypass (RYGB), conversion from SG to SADI, small bowel reconstruction, and RYGB reversal, respectively. The 30-day follow-up rate was 95.3%. In total, 1.7% of patients experienced apixaban-related side effects. The most common side effects were menorrhagia and rash. Two (0.03%) side effects developed into Clavien-Dindo grade II complications. Overall, 10 (0.1%) patients experienced thromboembolic complications (five (0.09%) PVTs and five (0.09%) PEs). In each case, the protocol was not followed for extenuating circumstances. There were no deaths or thromboembolic events in cases where the protocol was able to be fully followed. Conclusions In conclusion, 30 days of postoperative apixaban appears to be safe and effective with minimal side effects while preventing thromboembolic events.

Background/aims:Continuous glucose monitoring is a well-tolerated and versatile tool for management of diabetes and metabolic disease. While its use appears to be feasible to monitor glycemic profiles in diabetics, there is a paucity of data in individuals with obesity and normal glucose tolerance. The aim of this study is to investigate glucose fluctuations and insulin resistance patterns in normoglycemic participants with obesity vs. without obesity and contextualize these results against leading models for obesity.Materials and methods:We designed a prospective, observational pilot study of two cohorts including 14 normoglycemic participants with obesity and 14 normoglycemic participants without obesity. Participants were monitored with continuous glucose monitoring (CGM) for five consecutive days. Insulin resistance levels were measured and glucometric data were extracted from CGM for all participants.Results:Fasting serum insulin and homeostasis model assessment of insulin resistance (HOMA-IR) were significantly higher in the group with obesity (P < 0.05). While the group with obesity had a higher mean blood glucose (MBG), mean amplitude of glycemic excursions (MAGE), and continuous overall glycemic action-1 h (CONGA-1), these differences were not significant. On univariate linear regression, insulin resistance (HOMA-IR) was associated with body mass index (BMI), waist circumference (WC), cohort with obesity, cohort consuming a high glycemic diet, hemoglobin A1c (HbA1c), and fasting insulin levels. WC and fasting insulin levels remained predictors of HOMA-IR in our multivariable model.Conclusion:While there is much excitement surrounding the use of commercial CGM products in obesity management, our results suggest that fasting insulin and HOMA-IR values may be more clinically useful than CGM data alone.

Introduction With the increasing performance of bariatric surgery, rare complications are becoming prevalent. We review the diagnosis and treatment of dysautonomia after bariatric surgery and the limited treatment options available. We summarize the suggested mechanisms and explain why a complete understanding of the etiology has yet to be determined. Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was performed. Results Of 448 studies identified in the literature search, 4 studies were reviewed, describing 87 patients diagnosed with dysautonomia. We present a patient who developed severe dysautonomia following conversion of sleeve gastrectomy to gastric bypass. Conclusion Treatment needs to focus on optimizing nutrition, avoiding hypoglycemia, and optimizing volume status.

ObjectiveThis study examined the association between BMI and clinical outcomes among patients with coronavirus disease 2019 (COVID‐19) infection.MethodsA total of 10,861 patients with COVID‐19 infection who were admitted to the Northwell Health system hospitals between March 1, 2020, and April 27, 2020, were included in this study. BMI was classified as underweight, normal weight, overweight, and obesity classes I, II, and III. Primary outcomes were invasive mechanical ventilation (IMV) and death.ResultsA total of 243 (2.2%) patients were underweight, 2,507 (23.1%) were normal weight, 4,021 (37.0%) had overweight, 2,345 (21.6%) had obesity class I, 990 (9.1%) had obesity class II, and 755 (7.0%) had obesity class III. Patients who had overweight (odds ratio [OR] = 1.27 [95% CI: 1.11‐1.46]), obesity class I (OR = 1.48 [95% CI: 1.27‐1.72]), obesity class II (OR = 1.89 [95% CI: 1.56‐2.28]), and obesity class III (OR = 2.31 [95% CI: 1.88‐2.85]) had an increased risk of requiring IMV. Underweight and obesity classes II and III were statistically associated with death (OR = 1.44 [95% CI: 1.08‐1.92]; OR = 1.25 [95% CI: 1.03‐1.52]; OR = 1.61 [95% CI: 1.30‐2.00], respectively). Among patients who were on IMV, BMI was not associated with inpatient deaths.ConclusionsPatients who are underweight or who have obesity are at risk for mechanical ventilation and death, suggesting that pulmonary complications (indicated by IMV) are a significant contributor for poor outcomes in COVID‐19 infection.

Introduction Single-anastomosis duodenal switch has been suggested to be an effective bariatric procedure that offers excellent weight loss and by lengthening the common channel the potential to reduce micronutrient deficiencies. Purpose To evaluate the weight loss, comorbidity resolution and the 1-year nutritional outcomes of the single-anastomosis duodenal switch (SADS) procedure. Setting Multiple US Hospitals. Methods From October 2014 to January 2017, 120 patients were enrolled at six sites across the USA and underwent the SADS procedure. Weight loss, comorbidities, quality of life, and adverse events were followed post-procedure for 12 months. Results At 1, 6, and 12 months, 98.3%, 85.5%, and 77.1% of the patients were available for assessment, respectively. At 12 months, patients showed significantly reduced body mass index when compared to baseline (46.8 ± 5.8 vs 29.8 ± 4.4, P < 0.001 respectively). Sixty-five patients had type 2 diabetes at baseline; however, 11 patients lost to follow-up. Of the available data (54 patients), 96.3% of the patients had a resolution of type 2 diabetes by 12 months with a mean A1C reduction from 7.8 ± 1.6 to 5.3 ± 0.7. Additionally, there were reductions in hyperlipidemia, sleep apnea, and hypertension at 12 months. Patient gastroesophageal reflux disease satisfaction and quality of life (SF-36) scores were significantly higher at 12 months post-procedure ( P < 0.001 in all cases) while 12-month protein levels remained at normal values. There were abnormalities of parathyroid hormone and vitamin D at 1 year with all other nutritional markers being not significantly different at 1 year from baseline. There were 10, IIIb, or greater complications according to the Clavien-Dindo scoring system during the study period, not all of which were related to the surgery. Conclusions SADS is a highly efficacious weight loss procedure with significant comorbidity reduction at 1 year. At 1 year, complications and vitamin and mineral deficits appear to be consistent with other malabsorption operations. Long-term follow-up is needed, especially around complications and vitamin deficiencies.

Obesity and Diabetes is considered the most significant chronic medical issue reducing life expectancy. Current treatments include pharmacological therapy, behavior modification through diet and exercise and surgery. Despite the efficacy of bariatric surgery only 1% of total candidates receive treatment. Identify barriers, physician concerns and potential misconceptions towards Bariatric Surgery (BS) and explain why with better data and safety, growth remains stagnant. Improve communication and education to prevent patient attrition when referred for bariatric evaluation from other providers. Establish better collaboration and education between healthcare providers on the topic of obesity and spectrum of care. Emphasize that obesity is a chronic disease altering energy regulation.