INTRODUCTION: This study was conducted to evaluate the efficacy of postoperative computed tomography (CT) measurements of aortic lumen volumes in predicting aortic-related complications following acute type A aortic dissection (ATAAD) repair. METHODS: We conducted a single-institution retrospective aortic volumetric analysis of patients after ascending aorta replacement performed during 2001-2015. The volumetric measurements of total lumen (total-L), true lumen (TL), false lumen (FL), as well as the TL:FL ratio from the first and second postoperative computer angiograms were obtained. A generalised structural equation model was created to analyse the predictive utility of TL:FL ratio. RESULTS: One hundred and twenty-five patients underwent surgical intervention, of whom 97 patients were eventually discharged and analysed for postoperative complications. A total of 19 patients were included in the final analysis. Patients with late postoperative aortic complications had a significantly higher FL volume and total-L volume on the first (FL volume P = 0.041, total-L volume P = 0.05) and second (FL volume P = 0.01, total-L volume P = 0.007) postoperative scans. The odds of having aortic complications were raised by 1% with a 1 cm 3 increase in total-L volume and by 2% with a 1 cm 3 increase in FL volume. The TL:FL ratio was significantly lower in patients who developed complications. CONCLUSION Postoperative CT volumetric measurements in patients who developed complications are characterised by a significant increase in the FL volume and total-L volume from the first postoperative scans. Patients with disproportionately expanded FL presenting with TL:FL ratios less than 1 were associated with aortic complications. Hence, the TL:FL ratio may be a reliable and useful parameter to monitor postoperative disease progression and to evaluate the risk of late complications in ATAAD patients.
Humans ; Male ; Female ; Retrospective Studies ; Singapore ; Aortic Dissection/diagnostic imaging* ; Middle Aged ; Postoperative Complications/diagnostic imaging* ; Aged ; Tomography, X-Ray Computed ; Aortic Aneurysm/diagnostic imaging* ; Aorta/surgery* ; Adult ; Treatment Outcome ; Computed Tomography Angiography

INTRODUCTIONOutcomes of bariatric surgery for super obese Asians are not well reported. We aimed to compare short-term outcomes of laparoscopic sleeve gastrectomy (LSG) in Asian patients with body mass index (BMI) <47.5 kg/m to those with BMI •••••• ≥47.5 kg/m.

MATERIALS AND METHODSA total of 272 patients from Singapore university hospital who underwent LSG from 2008 to 2015 with a follow-up of at least 6 months were included in the study. Primary endpoint was weight loss at 1-year and 3-years. Morbid obesity (Group 1, G1) was defined as BMI <47.5 kg/m and super obesity (Group2, G2) was defined as BMI ≥47.5 kg/m.

RESULTSThere were 215 patients in G1 and 57 patients in G2 (mean preoperative weight: 107.3 kg and 146.8 kg; mean follow-up: 27.9 and 26.8 months, respectively). Mean total weight loss at 3-year of 41.9 kg for G2 was significantly higher ( = 0.003) than 27.2 kg for G1. Mean percentage excess weight loss (EWL) did not differ at 3-years. There was no difference in operating time, blood loss, length of stay, 30-day morbidity and readmission. There were no conversions and mortality in both groups. Remission of herpertension ( - 0.001) and dyslipidaemia ( = 0.038) were significantly associated with achieving EWL percentage (%EWL) >50 in G1.

CONCLUSIONLSG is an equally safe and effective operation in Asians with BMI ≥47.5 kg/m2 when compare to patients with BMI <47.5 kg/m in achieving significant weight loss and improvement in comorbidities. Super obese lose more weight but have lower %EWL.

Asian Continental Ancestry Group ; Gastrectomy ; methods ; Humans ; Laparoscopy ; instrumentation ; methods ; Obesity, Morbid ; surgery ; Outcome Assessment (Health Care) ; Patient Safety ; Retrospective Studies ; Singapore