Emergency cesarean section has always been a challenge for patients, surgeons, and anesthesiologists, as it endangers the safety of both parturients and fetuses. Obesity and hypertension are common among pregnant women, but severe obesity combined with refractory hypertension is very rare in clinical practice. The optimal anesthetic management strategy for obese pregnant women with a difficult airway and poorly controlled hypertension remains debatable. This report presents a 32-year-old woman with severe obesity and refractory hypertension at 36 weeks and 6 days of pregnancy. Owing to fetal heart rate abnormalities, she was scheduled for emergency cesarean section. Given the urgency of the fetal condition and the challenges posed by the patient's obesity for epidural puncture, the anesthesiologist opted for rapid sequence induction and tracheal intubation instead of intervertebral anesthesia. Short-acting antihypertensive medications were adminstrated preoperatively to control elevated blood pressure, and vasopressor agents were continuously infused during surgery to prevent severe hypotension induced by anesthetic drugs. The entire anesthesia and surgical procedure proceeded uneventfully, with no major adverse events observed. Both the patient and fetus achieved favorable outcomes. This case indicates that early anesthetic risk assessment and meticulous pre-delivery planning are paramount, necessitating personalized management of airway and hemodynamics to optimize outcomes in obese parturients.
Humans ; Female ; Cesarean Section/methods* ; Pregnancy ; Adult ; Hypertension/complications* ; Obesity/complications* ; Obesity, Morbid/complications* ; Anesthesia, Obstetrical/methods*

Bariatric and metabolic surgery has become a primary treatment for decompensated obesity, with the number of procedures rapidly increasing in China in recent years. Various improved and novel surgical techniques have emerged. Given the characteristics of the Chinese obese population lower body mass index compared to Western populations and frequent pancreatic islet dysfunction laparoscopic Roux-en-Y gastric bypass remains one of the mainstream procedures in China. Although the Procedural Guideline for Laparoscopic Roux-en-Y Gastric Bypass (2019 Edition) has provided standardized surgical steps, mastering and routinely implementing the procedure in clinical practice continues to pose significant challenges. Compared to laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass is more technically demanding and requires a longer learning curve. To avoid suboptimal weight loss or severe postoperative complications resulting from non-standardized techniques, this article summarizes the authors' clinical experience, emphasizing key technical steps: creation of the gastric pouch, standardization of gastrojejunal and jejunojejunal anastomoses, hiatal closure, and full serosalization. These insights aim to improve procedural safety and therapeutic efficacy by offering a set of practical process optimization strategies.
Humans ; Gastric Bypass/methods* ; Laparoscopy/methods* ; Obesity, Morbid/surgery* ; Postoperative Complications/prevention & control* ; China ; Jejunum/surgery* ; Gastrectomy/methods* ; Anastomosis, Surgical/methods* ; Weight Loss

Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy characterized by simple operation and few postoperative complications have gradually become the two most commonly used surgical methods in clinical practice.A series of complications often occur after bariatric surgery,including gallstone disease,anemia,malnutrition,gastroesophageal reflux disease,kidney stones,and birth defects in offspring of women of childbearing age.There are controversies regarding the causes and countermeasures of these complications.This article mainly reviews the risk factors and countermeasures for the complications after bariatric surgery.
Humans ; Female ; Bariatric Surgery/methods* ; Gastric Bypass/methods* ; Gastroesophageal Reflux/surgery* ; Postoperative Complications/prevention & control* ; Risk Factors ; Gastrectomy/methods* ; Laparoscopy/methods* ; Obesity, Morbid/surgery* ; Retrospective Studies

BACKGROUND: Management of gastric leak after sleeve gastrectomy (SG) is challenging due to its unpredictable outcomes. We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world setting. METHODS: To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry. A cumulative sum analysis was used to identify a fitting curve of gastric leak rate. The Kaplan-Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant outcomes. The logistic regression analysis was conducted to determine the predictors of acute leaks. RESULTS: A total of 78 cases of SG leaks were collected with an incidence of 0.5% (78/15,721) from this registry (6 patients who had the primary SG in non-participating centers). After accumulating 260 cases in a bariatric surgery center, the leak rate decreased to a stably low value of under 1.17%. The significant differences presented in sex, waist circumference, and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population ( P = 0.005, = 0.026, <0.001, and = 0.001, respectively). Moreover, 83.1% (59/71) of the leakage was near the esophagogastric junction region. Leakage healed in 64 (88.9%, 64/72) patients. The median healing time of acute and non-acute leaks was 5.93 months and 8.12 months, respectively. Acute leak (38/72, 52.8%) was the predominant type with a cumulative reoperation rate >50%, whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment ( P = 0.013). Precise dissection in the His angle area was independently associated with a lower acute leak rate, whereas preservation ≥2 cm distance from the His angle area was an independent risk factor. CONCLUSIONS Male sex, elevated waist circumference, hypoproteinaemia, and type 2 diabetes are risk factors of gastric leaks after SG. Optimizing surgical techniques, including precise dissection of His angle area and preservation of smaller gastric fundus, should be suggested to prevent acute leaks.
Humans ; Male ; Retrospective Studies ; Diabetes Mellitus, Type 2/complications* ; Obesity, Morbid ; Anastomotic Leak/epidemiology* ; Gastrectomy/methods* ; Reoperation/methods* ; Registries ; Laparoscopy/methods* ; Treatment Outcome

Objective: To analyze the incidence of early severe complications following bariatric and metabolic surgery and the experience of their diagnosis, treatment, and risk factors. Methods: In this retrospective observational study, the clinical data of 4255 patients who underwent bariatric and metabolic surgery between May 2010 and May 2022 in the Department of Bariatric and Metabolic Surgery of the First Affiliated Hospital of Nanjing Medical University were retrospectively collected. Among these patients, 1125 were male and 3130 were female. The mean age and body mass index (BMI) of the patients at the time of operation were 31.3±4.5 years and 36.5±6.4 kg/m², respectively. Regarding surgical type, 2397 patients underwent sleeve gastrectomy (SG), 489 underwent Roux-en-Y gastric bypass (RYGB), 1028 underwent sleeve gastrectomy plus jejunojejunal bypass (SG+JJB), and 341 underwent single anastomosis duodenal switch (SADS). The inclusion criteria were patients (1) with a Clavien-Dindo grade of ≥III; (2) who were undergoing SG, RYGB, SG-JJB, or SADS; and (3) who had complete clinical data. The exclusion criteria were patients (1) undergoing revisional surgery and (2) other operations during the bariatric and metabolic surgery. The Clavien-Dindo classification was used to analyze the incidence of early severe postoperative complications and their prognosis. Early severe postoperative complications were defined as Clavien-Dindo ≥ III complications within 30 days after surgery. Meanwhile, multivariate logistic regression model was used to identify risk factors of the complications. Results: Summary of early severe complications following bariatric and metabolic surgery: (1) of the 4255 patients, 22 (12 male and 10 female) exhibited early severe complications (0.52%). The mean age and BMI of these patients were 41.1±9.9 years and 36.9±8.2 kg/m², respectively. Preoperatively, 7 patients had hypertension, 10 had type 2 diabetes mellitus, 1 had respiratory failure, and 1 had heart failure. The severe complications included 9 patients (0.21%) with grade IIIa, 11 (0.26%) with grade IIIb, 1 (0.02%) with grade IVa, and 1 (0.02%) with grade V complications. The incidences of severe postoperative complications in the different surgical procedures were 0.17% for SG (4/2397), 0.61% for RYGB (3/489), 0.58% for SG+JJB (6/1028), and 2.64% for SADS (9/341). The common severe complications were leakage (0.28%, 12 patients), bleeding (0.14%, 6 patients), and obstruction (0.05%, 2 patients). (2) Management of complications: Grade IIIa complications (including eight patients with leakage and one with severe inflammation) were treated with antibiotics, nasogastric and nutritional tube placements, and CT-guided drainage. For grade IIIa complications, five patients with bleeding were treated with reoperation, and all the patients recovered; four patients with leakage were treated with reoperation, wherein three were converted to RYGB and one patient underwent resuturing of the leakage site; two patients with obstruction were treated with adhesiolysis. The patient with grade IVa complication (including respiratory failure complicated with acid aspiration) was treated in the ICU. For the grade V complication, bleeding in a patient with SG+JJB was treated with reoperation, which confirmed the bleeding of short gastric vessels. Unfortunately, the patient died. (3) Risk factor analysis of early severe complications: univariate analysis detected that sex, age, type 2 diabetes mellitus, operation time, and surgical type were associated with postoperative complications (P<0.05). However, multivariate analysis indicated that an age of ≥31.3 years (odds ratio [OR] = 5.423, 95% confidence interval [CI]: 1.004-29.278, P=0.049) and surgical type (SADS: OR = 19.758, 95%CI: 5.803-67.282, P<0.001; RYGB: OR = 9.752, 95%CI: 2.456-38.723, P=0.001; SG+JJB: OR = 5.706, 95%CI: 1.966- 16.559, P=0.001) were independent risk factors of early severe complications following bariatric and metabolic surgery. Conclusion: Bariatric and metabolic surgery is safe. Its common postoperative complications include leakage, bleeding, and obstruction, which require early detection, diagnosis, and treatment to improve treatment outcomes. Age and surgical type are independent risk factors of early severe complications following bariatric and metabolic surgery.
Adult ; Anti-Bacterial Agents ; Bariatric Surgery/adverse effects* ; Diabetes Mellitus, Type 2/surgery* ; Female ; Gastrectomy/methods* ; Gastric Bypass/adverse effects* ; Humans ; Male ; Obesity, Morbid/surgery* ; Postoperative Complications/epidemiology* ; Respiratory Insufficiency/etiology* ; Retrospective Studies ; Risk Factors ; Treatment Outcome

PURPOSE: Vertical sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are currently the most common bariatric procedures. Although the safety of these operations has markedly improved, there continues to be a certain rate of complications. Such adverse events can have a significant deleterious effect on the outcome of these procedures and represent a costly burden on patients and society at large. A better understanding of these complications and their predictive factors may help ameliorate and optimize outcomes. METHODS: Seven hundred seventy-two consecutive patients who underwent SG or RYGB for morbid obesity between January 2011 and October 2015, in the Division of Bariatric Surgery at a tertiary institution, were included through retrospective review of the medical database. The complications were categorized and evaluated according to severity using the Clavien-Dindo classification system. Significant risk factors were evaluated by binary logistic regression to identify independent predictors and analyzed to identify their relationship with the type of complication. RESULTS: Independent predictors of severe complication after these procedures included male gender, open and revisional surgery, hypertension, and hypoalbuminemia. Hypoalbuminemia had significant associations with occurrence of deep surgical site infection and leak. Open surgery had significant associations with occurrence of superficial and deep surgical site infection and respiratory complications. Independent predictors of severe complication after laparoscopic primary RYGB included previous abdominal surgery. Previous abdominal surgery had significant associations with deep surgical site infection and leak. CONCLUSION: Recognition and optimization of these risk factors would be valuable in operative risk prediction before bariatric surgery.
Bariatric Surgery* ; Classification ; Gastrectomy ; Gastric Bypass ; Humans ; Hypertension ; Hypoalbuminemia ; Logistic Models ; Male ; Obesity, Morbid ; Postoperative Complications* ; Retrospective Studies ; Risk Factors* ; Surgical Wound Infection

Obesity is a complex metabolic disease caused by excess body fat, which can be associated with many health problems. Bariatric surgery is the most effective treatment for morbid obesity. However, only small number of patients undergo surgery despite definite benefits. The upper gastrointestinal endoscopy with flexible device is an essential tool in the evaluation of post bariatric surgery patient. It plays an important role in treating complications occurring after bariatric surgery. Recently, there has been active research and development on endoscopic procedures to achieve similar effects with bariatric surgery in less invasive ways. Endoluminal interventions performed using flexible endoscopy might be less effective than current surgical approaches, but it can offer alternative approaches to the treatment of obesity that are safer and more cost-effective. This article provides an overview of endoscopic procedures for postoperative complication and new emerging endoscopic techniques for primary endoscopic bariatric therapies. Knowing the type, indication, expected effect, and development potential of endoscopic procedures might be of great help to surgeons performing bariatric procedures.
Adipose Tissue ; Bariatric Surgery ; Bariatrics ; Endoscopy ; Endoscopy, Gastrointestinal ; Humans ; Metabolic Diseases ; Obesity ; Obesity, Morbid ; Postoperative Complications ; Surgeons

PURPOSE: The study aimed to analyze changes in patient indicators and surgical indices in relation to bariatric surgery performed at a university hospital and determine the development direction of its obesity center. MATERIALS AND METHODS: From December 2010 to June 2018, a total of 35 obese patients underwent surgery at the center. Patients' height, weight, body mass index (BMI), abdominal circumference, and hip circumference before surgery were measured. Laboratory tests were performed to observe changes before and after surgery. Patients underwent Roux-en Y gastric bypass (RYGB) or laparoscopic sleeve gastrectomy (LSG), and postoperative complications were analyzed. RESULTS: A total of 35 patients underwent obesity surgery: 23 with RYGB and 12 with LSG. Postoperative complications occurred: bleeding in one case, abscess in one case, respiratory failure in one case, and incisional hernia in two cases. The mean preoperative weight was 105.1±27.2 kg and postoperative weight was 84.3±19.9 kg. The difference was 20.7±13.5 kg. BMI also decreased from 38.3±8.4 preoperatively to 31.0±6.4 postoperatively by 7.3±4.6. CONCLUSION: Through our study, we determined that in this hospital, a multidisciplinary team approach to postoperative weight management and health care should be undertaken as well as continuous and systematic management after surgery.
Abscess ; Bariatric Surgery ; Body Weight ; Delivery of Health Care ; Gastrectomy ; Gastric Bypass ; Hemorrhage ; Hip ; Humans ; Incisional Hernia ; Obesity ; Obesity, Morbid ; Postoperative Complications ; Respiratory Insufficiency ; Weight Loss

As lifestyle and diet patterns have become westernized in East Asia, the prevalence of obesity has rapidly increased. Bariatric surgeries, such as Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB), are considered the first-line treatment option in patients with severe obesity. However, postoperative complications have increased and the proper management of these complications, including the use of endoscopic procedures, has become important. The most serious complications, such as leaks and fistulas, can be treated with endoscopic stent placement and injection of fibrin glue, and a novel full-thickness closure over-the-scope clip (OTSC) has been used for treatment of postoperative leaks. Stricture at the gastrojejunal (GJ) anastomosis site after RYGB or incisura angularis in SG can be managed using stents or endoscopic balloon dilation. Dilation of the GJ anastomosis or gastric pouch may lead to failure of weight loss, and the use of endoscopic sclerotherapy, novel endoscopic suturing devices, and OTSCs have been attempted. Intragastric migration of the gastric band can be successfully treated using various endoscopic tools. Endoscopy plays a pivotal role in the management of post-bariatric complications, and close cooperation between endoscopists and bariatric surgeons may further increase the success rate of endoscopic procedures.
Bariatric Surgery* ; Constriction, Pathologic ; Diet ; Endoscopy ; Far East ; Fibrin Tissue Adhesive ; Fistula ; Gastrectomy ; Gastric Bypass ; Humans ; Life Style ; Obesity ; Obesity, Morbid ; Postoperative Complications ; Prevalence ; Sclerotherapy ; Stents ; Surgeons ; Weight Loss

INTRODUCTIONBariatric surgery is increasingly recognised as an effective treatment for type 2 diabetes that significantly improves glycaemic control, even achieving remission. This study examined perceptions and concerns of diabetic patients towards bariatric surgery as a treatment option for diabetes.

MATERIALS AND METHODSA total of 150 patients were recruited from a specialised diabetic outpatient clinic and completed a questionnaire (items were rated on a Likert scale from slightly important [lowest score of 1] to extremely important [maximum score of 5]). Logistic regression was performed to identify factors influencing decision for surgery.

RESULTSThe 74 males and 76 females had mean age of 50 (range 20 to 78) and body mass index (BMI) of 29.6 kg/m(range 18.1 to 51); 61% considered surgery favourably. Predictive factors for interest in surgery: higher educational levels (OR = 2.3; 95% CI, 1.2 to 4.4), duration of diabetes (OR = 0.4; 95% CI, 0.2 to 1.0) and use of insulin (OR = 2.1; 95% CI, 1.1 to 4.1). Reasons for surgery: desire for remission (Likert scale 4.7 ± 0.7), to prevent complications (Likert scale 4.5 ± 0.9) and to reduce medications (Likert scale 4.3 ± 1.1). For those not keen on surgery, main reasons were fear of surgery (Likert scale 4 ± 1.5) and satisfaction with current therapy (Likert scale 3.7 ± 1.6).

CONCLUSIONMany diabetic patients would consider surgery as an option to improve their metabolic disorder (greater interest in patients with higher educational levels, currently using insulin and with shorter duration of diabetes). Surgical complications, length of recovery and duration of benefits were the main concerns.

Adult ; Aged ; Attitude to Health ; Bariatric Surgery ; Decision Making ; Diabetes Mellitus, Type 2 ; complications ; drug therapy ; surgery ; Educational Status ; Female ; Humans ; Hypoglycemic Agents ; therapeutic use ; Insulin ; therapeutic use ; Logistic Models ; Male ; Middle Aged ; Motivation ; Obesity ; complications ; surgery ; Obesity, Morbid ; complications ; surgery ; Time Factors ; Young Adult