bluuebunny/crossref_metadata_2025_split huggingface dataset:
IBC Oxford University Poster Abstract 3 - Novel technique in reversal of RYGB leads to remission of postprandial hyperinsulinaemic
Authors: Shah K , Holmer H , Thörn S , Gislason H 
Published: February 2025

Abstract

Background and Aim
Postprandial hyperinsulinaemic hypoglycaemia is one of the complications occurring after Roux-en-Y gastric bypass. Nutritional and medical treatment are considered first line of treatment, but some cases are deemed intractable as to why surgical options are explored. Amongst these, a novel technique—Functional reversal—has been proposed as an alternative to anatomic reversal that elsewise carries a higher complication rate and is technically more demanding. In this case report the effect of functional reversal in alleviating intractable hypoglycaemia was assessed.

Case Presentation
We present the case of a 62-year-old Caucasian male who had undergone Roux-en-Y Gastric bypass for morbid obesity. Shortly after the procedure he started complaining of episodical hypoglycaemia that aggravated to daily symptoms consistent with Whipple’s Triad. Conservative treatment with Acarbose and Liraglutide along with dietary regulations proved futile and he underwent a functional reversal that entailed a laparoscopic construction of a gastro-gastric fistula thus enabling a passageway through the otherwise remnant stomach of his gastric bypass. Immediately after the procedure, serum-glucose levels normalized. Continuous glucose monitoring four months after surgery showed resolution of his postprandial hyperinsulinaemic hypoglycaemia. Eating and dietary habits returned to normal.

Conclusion
Functional reversal leads to resolution of intractable postprandial hyperinsulinaemic hypoglycaemia after RYGB. Prospective studies should evaluate the reproducibility of the treatment effect and could thus prove a safe and viable alternative to anatomic reversal.
IBC Oxford University Poster Abstract 4 - Cicatrized ulcer at the gastro-jejunostomy in OAGB case managed by conversion to RYGB
Authors: Abdelsalam A 
Published: February 2025

Abstract

Background
One Anastomosis Gastric Bypass (OAGB) has gained popularity over the years since introduced by Rutledge in 1997. It has been proposed as a simpler and efficient weight-reducing surgery. It offers improvement/cure for many parts of metabolic syndrome, especially diabetes and hypertension. Needless to mention its effects on sleep apnoea syndrome, osteoarthritis, and many other diseases related to obesity. However, it comes with many risks as well, starting from leakage and bleeding to long-term nutritional deficiencies. Biliary reflux is a fearful complication whose incidence is not accurately reported. There are few papers in the literature talking about stomal ulcers after OAGB, with some of them talking about perforated ulcers.

Case Presentation
We present here a case with the history of OAGB that was done two years before presentation with a weight of 117 kg and a height of 175 cm (BMI = 38.2 kg/m2). He came with a complicated stomal ulcer ending in fibrosis as diagnosed with upper endoscopy and 3D CT volumetry. This led to obstruction of the gastro-jejunostomy with severe vomiting and malnutrition. His BMI at presentation was 17 kg/m2. The patient tried medical treatment, but it failed because of the fibrosis at the level of GJ anastomosis. We went for exploratory laparoscopy aiming at resection of the fibrotic part and going for RYGB. The GJ was adherent to the stomach anteriorly and the remnant stomach posteriorly, so we had to do some sort of partial gastrectomy to be able to resect the fibrotic area and be able to create a pouch for RYGB. We did RYGB with 50 cm BP limb length and 50 cm for the alimentary limb aiming at relieving obstruction not for weight loss.

Results
The patient was admitted to the hospital for 5 days to monitor his vitals as well as his tolerance to fluids. He was discharged then and follow-ups after two weeks, 6 weeks then two months were unremarkable.

Conclusion
There are few papers about stomal ulcers after OAGB, and perforating cicatrized ulcers might not be mentioned in the literature to our knowledge.
IBC Oxford University Poster Abstract 11 - Accessing common bile duct stones after one anastomosis gastric bypass—same destination via different route
Authors: Bhambri A , Budhiraja S 
Published: February 2025

Abstract

Background
Laparoscopic Mini Gastric Bypass/One Anastomosis Gastric Bypass (MGB/OAGB) excludes the common bile duct (CBD) from traditional diagnostic and therapeutic treatment options with Endoscopic Retrograde Cholangiopancreatography (ERCP). Accessing CBD becomes limited and challenging due to altered MGB/OAGB anatomy. Due to the initial rapid weight loss, MGB/OAGB patients have an increased risk of developing cholelithiasis as well as choledocholithiasis.

Case Presentation
This technique demonstrates how to safely treat this rare problem by performing a combined laparoscopic and endoscopic approach—Trans-gastric ERCP. Methods A 53-year-old female with an initial BMI of 41 kg/m2 and an absolute weight of 134 kg, underwent MGB/OAGB 6 months ago. She had normal liver function tests (LFTs) and an ultrasound abdomen preoperatively. She lost 21 kgs of body weight over 5 months postoperatively. She had a history of laparoscopic cholecystectomy done 20 years ago, so she was not started on the Ursodeoxycholic-acid regimen post-operatively. She was admitted given the history of severe episodic epigastric pain for one week. There were no other complaints. Results She was evaluated and showed deranged LFTs including significantly raised serum alkaline phosphatase (ALP) and Gamma glutamyl transferase (GGT) levels, which raised suspicion of some biliary pathology. MRCP abdomen revealed dilated CBD of 24 mm with lower CBD calculus sized 9.8 mm, with sludge or a possible stricture. She underwent Laparoscopic Trans-gastric ERCP. Access was made by creating a gastrotomy in the remnant of the stomach for placement of an endoscope. Getting access to the remnant of the stomach was challenging due to dense adhesions from the previous two surgeries and smaller gastric remnants because of the long and loose gastric pouch of OAGB/MGB as compared to Roux-en-Y gastric bypass. Retrieval of stones and dilatation of lower CBD stricture area was done along with taking biliary stricture brush cytology. Complete clearance of CBD was done with multiple balloon sweeps and endoscopic papillary balloon dilatation was done up to 12 mm. The gastrotomy performed on the remnant of the stomach was closed. Post-surgery her LFTs become normal and biliary brush cytology reported negative for malignancy.

Conclusion
Treating the Bile duct pathology endoscopically after MGB/OAGB is technically challenging and requires multidisciplinary teams. It can be managed safely and effectively at centres with both high endoscopic and bariatric expertise.
IBC Oxford University Poster Abstract 15 - Unsuccess of metabolic and bariatric surgery—beyond the anthropometric criteria: a retrospective cohort study
Authors: Amorim-Cruz F , Santos-Sousa H , Nogueiro J , Vaz S , Vieira-Sousa1 P , Peleteiro B , Lemos J , Resende F , Costa-Pinho A , Preto J , Freitas P , Carneiro S , da-Costa E Lima 
Published: February 2025

Abstract

Background
Despite metabolic and bariatric surgery (MBS) being an effective treatment for clinically severe obesity, some patients experience insufficient weight loss (IWL) and weight regain (WR). MBS also has a significant impact on obesity-related comorbidities, perhaps not reflected in categorical definitions of IWL and WR. Therefore, MBS success should not only be measured by a percentage of weight change. Our study aims to investigate whether the definitions of anthropometric criteria used to determine unsuccessful weight loss have clinical significance for MBS unsuccess.

Methods
We conducted a single-centre retrospective cohort study with 1042 consecutive patients submitted to MBS between 2019 and 2021. In terms of anthropometric criteria, at 2 years of follow-up, unsuccessful weight loss was explored as IWL and WR, both as a dichotomous (IWL defined as percentage of total weight loss (%TWL) &lt;20% and WR as an increase in excess weight loss (%EWL) &gt;30% from nadir) and a continuous variable. MBS clinical unsuccess was defined as a composite endpoint including the worsened or unchanged comorbidities (hypertension, type 2 diabetes, dyslipidaemia, and OSA), need for revisional bariatric surgery and mortality at 90 days. Area under the Receiver Operating Characteristic (AUC-ROC) curve was computed to evaluate model performance.

Results and Discussion
At 2 years of follow-up, for dichotomous definitions (defining anthropometric unsuccessful weight loss), AUC-ROC showed that any anthropometric criteria weren’t good enough to predict unsuccess of bariatric surgery, although IWR was significantly superior to WR [Fig. 1, AUC IWL 0.54 (95%c.i.: 0.52–0.56); AUC WR 0.51 (95% c.i.: 0.49–0.52), P = 0.001]. For continuous variables (Fig. 2), AUC-ROC for TWL was 0.62 (95% c.i.: 0.58–0.66) and for EWL was 0.58 (95% c.i.: 0.54–0.62), suggesting that for the definition of anthropometric criteria (both IWL and WR) a new cut-off could improve prediction of MBS clinical unsuccess.

Conclusion
The present study shows how different definitions of IWL and WR could not reflect the outcomes of MBS, since no single anthropometric criteria can reliably predict the unsuccess of metabolic bariatric surgery (remission of comorbidities, need for revisional surgery, and mortality).
IBC Oxford University Poster Abstract 17 - Early postoperative complications after bariatric surgery in Misurata, Libya: a single centre analysis
Authors: Elzowawi F , Shenaisheh S , Algubbi M , Rmali S , Alhubge M , Shikshaka B 
Published: February 2025

Abstract

Introduction
Bariatric surgery is the most effective treatment for morbid obesity and associated medical co morbidities. Bariatric procedures are generally safe and effective but can be associated with complications. Early complications may include bleeding, leakage, venous thromboembolic events (VTE), wound infection, abdominal wall hematoma, and dehydration required admission.

Aim
The aim of this study is to assess the incidence, clinical presentation, risk factors, and management of early postoperative complication within 30 days.

Materials and Methods
This single centre retrospective cohort study of collected data for all patients who underwent one of Bariatric Surgical operations: Sleeve gastrectomy, One anastomosis gastric bypass, Roux-en-Y gastric bypass (RNYGB), Single anastomosis sleeve ileal (SASI) in the period between January 2018 September 2023.

Results
The total number of patients who underwent bariatric surgeries were 861, of them 562 (65.3%) were females 299 (34.7%) were males. Body mass index (BMI) for the patients ranged from 35 to 65ٍ kg/m2 with mean 46.2 kg/m2. The most common procedures done was sleeve gastrectomy 554 (64.3%), followed by bypass surgery 292(33.9%), and 15(1.8%) were revisional procedures. The most common early complications was abdominal wall hematoma which occurred in 27 (3.1%) patients, followed by dehydration in 21 (2.4%), post operative bleeding (POB) which occurred in 16 (1.9%) patients of them 12 (1.4%) patients extra-luminal bleeding (ELB) and 4 (0.5%) patients Intraluminal bleeding (ILB), followed by wound infection in 11 (1.3%) patients, VTE as well as leakage occurred in 5 (0.6%) patients, and prolonged ileus in 2 (0.25%) patients. Noticeably, the leakage was strongly related to higher BMI (P &lt; 0.01), while bleeding was strongly associated with hypertensive patients (P &lt; 0.05).

Conclusion
The incidence of early complications after bariatric surgery remains within the acceptable range in comparison with the other published studies. Most of the early complication could be managed conservatively while surgical treatment might be required for some patients especially with hemodynamic instability.
IBC Oxford University Poster Abstract 22 - Definition and predictors of weight regain after metabolic and bariatric surgery: a retrospective cohort study
Authors: Amorim-Cruz F , Santos-Sousa H , Nogueiro J , Vaz S , Vieira-Sousa J P , Lemos J , Peleteiro B , Resende F , Costa-Pinho A , Preto J , Freitas P , Carneiro S , da-Costa E Lima 
Published: February 2025

Abstract

Background
Despite the benefits of metabolic and bariatric surgery (MBS), not all patients can maintain sustained weight loss in the long term. There is increasing awareness that weight regain (WR) is a common issue following MBS. However, WR is defined using various criteria, which makes it challenging to understand its prevalence and clinical impact after MBS. As a result, the factors that contribute to WR before, during, and after surgery are not well understood. This study aims to assess WR at two-years after bariatric surgery, using four definitions, and to identify clinically significant predictors of WR to improve patient counselling regarding prevention and optimize intraoperative bariatric procedures.

Methods
We conducted a single-centre retrospective cohort study with 1056 consecutive patients submitted to MBS between 2019 and 2021 and followed for at least 2 years. At two-years of follow-up, WR was defined based on four definitions: (1) an increase in weight of more than 10 kg from nadir, (2) an increase in excess weight loss (%EWL) higher than 30% from nadir, (3) an increase in BMI of 5 kg/m2 from nadir, (4) any weight regain. Nadir’s weight was determined based on all the postoperative weight measures available. Univariate and multivariate analyses were performed using logistic regression to compute the odds ratio (OR) and the 95% confidence intervals (95%c.i.).

Results and Discussion
A total of 1056 patients were included, with a mean age of 45.8 (±10.3) years, of which 82.9% were female. The proportion of WR ranged from 1.0 to 55.0% depending on the definition, being ‘any weight regain’ the definition with the highest proportion of patients (n = 581). Considering %EWL as the definition for WR, after multivariable adjustment, patients with lower presurgical BMI (adjusted odds ratio [adjOR]: 0.81, 95% c.i.:0.70–0.92), diabetes (adjOR: 3.72, 95% c.i.: 1.23–11.26) and history of intragastric balloon placement (adjOR: 9.07, 95% c.i.: 1.34–61.32) had higher risk of WR. Across the 4 definitions, there were no shared independent predictors of WR after MBS. However, in multivariable analysis, history of sleeve gastrectomy was a predictor of WR for 3 definitions, except for %EWL &gt;30% from nadir. Moreover, presurgical BMI was a predictor for 3 definitions, but the direction of effect was not even.

Conclusion
In this cohort of patients, we found that identifying one single definition of clinically significant WR is challenging. The predictors of WR varied depending on the definition applied. No common predictors of WR after MBS were found, across all four definitions.
IBC Oxford University Poster Abstract 23 - Incidence and predictors of petersen’s hernia after laparoscopic antecolic Roux-en-Y gastric bypass—5 year results of an experienced center
Authors: de Almeida M Andrade , Sousa H Santos , Nogueiro J , Araújo Teixeira J P , Cruz D , Lemos J , Peleteiro B , Resende F , Pinho A Costa , Preto J , Freitas P , Carneiro S , da Costa E Lima 
Published: February 2025

Abstract

Background
Roux-en-Y gastric bypass (RYGB) is the second most frequent bariatric procedure worldwide. Internal herniation is a well-described late complication of this operation. Petersen’s hernia (PH) occurs within Petersen’s space, which is iatrogenically created between the transverse mesocolon, the Roux limb, and the retroperitoneum. The aims of this study were to investigate the incidence of symptomatic Petersen’s hernias (PH), to determine risk factors for their occurrence, and provide insight on the eventual benefit of systematic Petersen’s space closure in addition to mesenteric defect closure.

Methods
A single-centre retrospective descriptive study was performed. Patients submitted to laparoscopic RYGB from January 2019 to December 2023 in our centre were included. All patients were reconstructed in an antecolic anastomosis fashion. Only cases of symptomatic PH were eligible.

Results
During a 5-year period, 2117 patients were submitted to laparoscopic RYGB without routine closure of Petersen’s space. Exploratory laparoscopy for suspicion of bowel obstruction and consecutive Petersen’s space closure with running non-absorbable suture was performed in 22 patients. Mean age of PH patients was 43.6 (±10.3) years. Regarding gender, twenty patients (90.9%) were female. In our study’s timeframe 9 patients had BGYR and consequently PH surgery leading to a 0.4% incidence. In this same period, 13 other patients who underwent RYGB prior to 2019 (7), or in another institution (6), were also operated for PH. The median time between RGYB and PH surgery was 28.1 months (IQR 42.7). Mean preoperative BMI at PH surgery was lower than mean 24 months’ post-RYGB BMI for non-PH patients (24.7 ± 4.0 versus 26.9 ± 4.0, P = 0.011). Revisional surgery and gastric remnant resection were not risk factors for PH (P = 0.185 and P = 0.988, respectively). We report no cases of bowel necrosis or mortality. No PH recurrences were recorded.

Conclusions
PH is a potentially serious complication of RGYB. Its clinical presentation ranges widely, from asymptomatic to mild and intermittent abdominal cramping and colicky pain to acute small bowel obstruction and ultimately intestinal strangulation. CT scan is helpful preoperatively and careful attention should be given to indicators of midgut volvulus such as the mesenteric swirl sign. PH must be suspected in RGYB patients even if their symptoms are scarce.
IBC Oxford University Poster Abstract 24 - Effects of bariatric surgery in individuals with PTEN hamartoma tumour syndrome (PHTS): a systematic review
Authors: Oceguera I N , Yang W , Parmar C , Pouwels S 
Published: February 2025

Abstract

Background
The aim of this systematic review is to provide an overview of the literature on the effects of bariatric surgery (BS) in patients with obesity and PTEN Hamartoma Tumour Syndrome (PHTS) diagnosis.

Methods
Two studies were included with a methodological quality ranging from poor to good. Both studies were case reports in young females (&lt;35yo), with massive effects on weight loss and HbA1c levels.

Results
Bariatric surgery in patients with obesity and PHTS diagnosis results in significant decrease in weight and complete remission of Type 2 Diabetes Mellitus (T2DM). The effects on thyroid hormones, lipid levels, renal function, and psychological factors after bariatric surgery in PHTS remain unexplored.

Conclusion
More research is needed to fully understand how bariatric surgery can take part in the preventative treatment options for PHTS patients with obesity.
IBC Oxford University Poster Abstract 25 - Role of intraoperative oesophagogastroscopic guidance in minimizing laparoscopic bariatric surgery related morbidity
Authors: Amer Y 
Published: February 2025

Abstract

Background
Postoperative staple line and gastro-jejunal anastomosis (GJA) leak is one of the most serious complications after LSG and LRYGB. GJA leak has reported frequencies of 0.3–5.1% with mortality ranging from 1.5 to 3%. Early postoperative bleeding and anastomotic stricture are also significant complications in patients after LRYGB with reported frequencies of 3.4% to 11.1%. The use of a leak test is a common practice in bariatric surgery. Some surgeons advocate for an intra-operative endoscopy for their leak test, while others utilize air via a form of an oral gastric tube. Previous articles have demonstrated the value of endoscopy in surgical procedures and the low risk associated with its use.

Objectives
The current study will be conducted to assess the safety and efficacy of using endoscope that serves as the bougie tube and then it is already in place for early detection of complications for example leakage (positive air leak test),maladjustment of lumen size (sleeve or stoma) and bleeding.

Methods
Between September 2021 and August 2023, 100 laparoscopic bariatric surgery were performed. For sleeve gastrectomy, endoscope was used as Bougie tube then staple line will be checked, a positive air leak test was done. For bypass surgery, the stoma was entered by the endoscope for checking staples, patency and early detection and dealing with leakage and bleeding.

Results
Concerning intraoperative complications, no patient had bleeding. two patients had leak which was corrected by reinforcement suture. Another patient had twisting which was corrected. Postoperatively, all patients did not develop leak, bleeding or obstructive symptoms. Three patients had postoperative vomiting which was corrected by prescribing antiemetics. There were no statistically significant associations between incidence of intra/postoperative complications and either age, weight, body mass index, operative time or comorbidities.

Conclusion
Overall, our experience has been very positive with utilization of intraoperative endoscopy after creation of our sleeve gastrectomy. Our leak rate is extremely low and occurred very early in our experience, and we believe that taking the extra time to perform a leak test using an endoscope will pay dividends for both the practitioner and the patient.