bluuebunny/crossref_metadata_2025_split huggingface dataset:
IBC Oxford University Oral Abstract 2 - Small bowel obstruction due to intraluminal clot (haemobezoar) following laparoscopic gastric bypass—different clinical approaches to a rare complication of bariatric surgery—a case series from a tertiary hospital
Authors: Teixeira J P Araújo , Pinho A Costa , Nogueiro J , Almeida N M , Cruz D , Lemos J , Peleteiro B , Resende F , Preto J , Freitas P , Sousa H Santos , Carneiro S , da Costa E Lima 
Published: February 2025

Abstract

Introduction
The incidence of small bowel obstruction (SBO) after Roux-en-Y gastric bypass (RYGB) ranges from 0.6% to 3.5%, with common causes being surgical adhesions, internal hernias, and anastomotic stenosis. Intraluminal clots causing obstruction are rare. A PubMed search for ‘small bowel obstruction’ AND (‘haemobezoar’ OR ‘intraluminal clot’ OR ‘blood clot’) identified 27 cases reported between 2005 and 2024. This study presents three cases of SBO due to intraluminal clots at the jejuno-jejunostomy in patients who underwent laparoscopic RYGB.

Methods
A retrospective analysis was conducted on three patients who experienced SBO caused by an intraluminal clot after laparoscopic RYGB performed by the CRI-O group. Of 2117 laparoscopic RYGB performed between 2019–2023, 47 (2.22%) had post-operative bleeding and 5 (0.24%) had post-operative SBO. Baseline demographic, preoperative, and intraoperative factors among patients with and without early postoperative bleeding were analysed. Data on preoperative conditions, symptoms, diagnostic methods, and treatment outcomes were collected of each case. The primary outcome was to detail the clinical presentation and management of SBO caused by intraluminal clots.

Results
Three female patients, with a mean BMI of 41.9 kg/m2 and a mean age of 43 years, presented with SBO due to intraluminal clots located at the jejuno-jejunostomy within the first two postoperative days. Symptoms included haematemesis, haematochezia, nausea, vomiting, and abdominal pain, with tachycardia being the most frequent clinical sign. All patients required blood transfusions and were diagnosed using CT scans with intravenous contrast. Surgical intervention varied: two patients underwent emergency surgery due to haemorrhagic shock, involving decompression of the gastric remnant and clot removal, although with different approaches. One patient, hemodynamically stable, was managed conservatively.

Conclusion
SBO caused by intraluminal clots post-RYGB is a rare, but serious complication. Early symptoms include signs of gastrointestinal bleeding and intestinal obstruction, with tachycardia being a frequent indicator. Haemodynamic instability necessitates urgent surgical intervention to prevent severe outcomes like ischemia and septic shock. Conservative management can be effective in hemodynamically stable patients. This case series highlights the importance of prompt diagnosis and individualized treatment strategies for SBO caused by intraluminal clots post-RYGB.
IBC Oxford University Oral Abstract 7 - Outcomes of Braun procedure for reflux after OAGB- audit from a single centre
Authors: Kaur M , Haider I , Baruah V , Javed S , Stewart D , Darrien J , Almerie Q , Kerrigan D 
Published: February 2025

Abstract

Introduction
One anastomosis gastric bypass is an established bariatric procedure that gives good weight loss and resolution of obesity related morbidity. However, some patients suffer with bile reflux, presenting with debilitating symptoms like vomiting, nausea and retro-sternal burning. These symptoms can be difficult to control medically, and some patients require surgical intervention. Conversion to Roux-en-Y bypass is the most common procedure but it is major revisional surgery. Braun procedure, consisting of jejuno-jejunal anastomosis 30 cm distal to GJ anastomosis to bypass bile away from stomach is a less invasive option.

Methods
In this retrospective study of a prospective database, we analysed the outcomes of all the patients who underwent Braun procedure from October 2016–January 2024 for resolution of symptoms of bile reflux and to compare them with those of RYGB conversion. Patients who present with bile reflux are managed in the MDT setting and offered medical management. Diagnosis is confirmed with OGD and Barium study. Non-respond and those with severe reflux are offered surgical options of Braun Procedure and RYGB. Choice of procedure is based on MDT discussion considering the severity of reflux, quality of life, percentage excess weight loss and patient’s choice.Steps of Braun surgery- Video link.

Results
Total number of OAGB procedures done were 1024, 35 patients (3.4%) presented with bile reflux needing surgical management. 31/35 (88.6%) underwent Braun procedure. 4/35 (11.4%) underwent conversion to RYGB (3 for poor weight loss/weight regain and 1 patient choice). 27/31 Braun’s patients (88%) had immediate resolution of reflux symptoms, 23 (74%) maintained at 2 years follow up. None of the 4 had conversion to RYGB with 3 well controlled on PPI and one refused further surgery. 4/31 (13%) Braun’s patients did not improve at all. These were converted to RYGB. In total 8 patients had RYGB conversion (4 primary and 4 after failed Braun’s). All these patients had resolution of symptoms at 1 year follow up. There was no significant morbidity in either group. OAGB to RYGB group had 2 days hospital stay versus Braun group treated as day case.

Conclusions
Conversion to RYGB is the gold standard procedure for managing bile reflux Braun’s procedure is a safe and effective day case procedure with acceptable success rate and should be considered as an alternative.
IBC Oxford University Oral Abstract 21 - Video abstract: laparoscopic giant hydatid cyst and sleeve gastrectomy surgery
Authors: Kasapoğlu İ 
Published: February 2025

Abstract

Introduction
Sleeve Gastrectomy despite being the most performed and an effective bariatric surgery is not always straight forward and coexisting pathologies like hydatid cyst liver disease make it more difficult. We present a video of laparoscopic giant hydatid cyst excision with Sleeve Gastrectomy simultaneously. A video presentation will be made, and the technique of surgery will be analysed.

Methods
The case is a 46-year-old man with BMI of 60 kg/m2 with severe back pain due to a prolapse disc which had not been operated on because of his obesity. He consulted us for weight reduction surgery and was found to have a large hydatid cyst on preoperative ultrasound confirmed by CT abdomen which showed a 20 cm by 20 cm cyst occupying most of the left lobe and some of the central part of the liver. Laparoscopic sleeve surgery was done using 5 trocars. The cyst was punctured and emptied with care to avoiding spillage of the cyst content then part of the cyst excised. After that sleeve gastrectomy done and at the end of the surgery 3 drains were placed; one along the sleeve staple line, one drain adjacent to the cyst and a T tube drain inside the cyst cavity.

Results
Postoperatively the patient was mobilised 3 hours after the surgery and discharged on day 3 post operatively. The sleeve drain was removed on postoperative day 2, the para-cystic drain on day 10 and the T tube on day 20. The patient was reviewed ion postoperative day 10, day 30 and day 90. At 6 months the patient had lost 60 kg and had no complications related to the cyst drainage and excision.

Conclusions
Laparoscopic hydatid cyst excision and sleeve gastrectomy can be done effectively if the expertise is available. Further cases and studies are required to support our experience.
IBC Oxford University Oral Abstract 26 - The outcome of concomitant laparoscopic cholecystectomy and sleeve gastrectomy in patients with morbid obesity: a systematic review and meta-analysis
Authors: Bawahab M 
Published: February 2025

Abstract

Objective
Gallstones are up to five times more common in obese people than in healthy people. Several studies have demonstrated the safety of prophylactic cholecystectomy in patients without gallstones during bariatric surgeries. However, no evidence supports its safety in patients with gallstones. Therefore, this study aimed to evaluate the safety and effect of concomitant cholecystectomy (CC) for asymptomatic cholelithiasis (AC) patients during LSG on postoperative complications.

Material and Methods
A systematic review and meta-analysis were performed according to the PRISMA guidelines. Two groups of patients (CC and LSG alone) were compared regarding operative duration, hospital stay, and intraoperative and postoperative surgical complications. Analysis was performed using RevMan software.

Results
Operative time was significantly longer among those who underwent CC, with a mean difference of 28.89 minutes (95% c.i.: 22.77 to 35.02 minutes). Associated complications and length of hospital stay did not differ significantly between the two groups (OR: 1.38, 95% c.i.: 0.99 to 1.91, and a mean difference of 0.12, 95% c.i.: −0.05 to 0.29 days, respectively).

Conclusion
This study provides evidence that confirms the safety of performing CC during sleeve gastrectomy in patients with asymptomatic gallstones.
IBC Oxford University Oral Abstract 33 - The role of bariatric surgery in the management of psoriasis: a systematic review and meta-analysis
Authors: Alves A L , Pinto A C , Pinheiro F , Rosa R , Resende F , Costa-Pinho A , Preto J , Carneiro S , da Costa E Lima , Sousa-Pinto B , Santos-Sousa H 
Published: February 2025

Abstract

Background
Psoriasis is a chronic immune-mediated skin disease that is more prevalent and severe in obese patients. To the best of our knowledge, no systematic review about the influence of bariatric surgery in the management of psoriasis has been conducted until now. Therefore, we aimed to systematically review all the current literature about the presumptive positive effects of bariatric surgery in the management of psoriasis, evaluating the impact of surgery in psoriasis improvement.

Methods
We conducted our systematic review and meta-analysis in accordance with the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA). We searched three major databases: PubMed, Scopus, and Web of Science. We evaluated qualitatively the included studies and in our meta-analysis, we focused on evaluating the dichotomous variable of ‘Downgrade of Systemic Medication after Surgery,’ an indirect measure of psoriasis improvement, analyzing the proportion of patients experiencing this outcome.

Results
The analysis included four studies with a total of 127 participants and 69.3% of them were women. Roux-en-Y Gastric Bypass was the most common procedure (78%). Three studies evaluated psoriasis improvement post-surgery, showing improvements ranging from 39.4% to 70% based on DLQI score, ABSA score, and even on subjective evaluation by the patients. Metabolic comorbidities improvement was confirmed in two studies and older age was also associated with a higher probability of improvement. Results from the meta-analysis showed that out of 67 patients using systemic medications, 45% (Proportion = 0.45, 95% c.i. [0.33;0.57]) experienced reduced medication post-surgery.

Conclusion
Although there is promising evidence of psoriasis improvement following bariatric surgery, the limited number of studies and participants prevents broad generalization to real-world situations. This underscores the necessity for additional research, particularly randomized studies, to determine whether bariatric surgery offers superior outcomes compared to alternative weight loss interventions for managing and improving psoriasis in obese patients.
IBC Oxford University Oral Abstract 36 - Predictive factors of postoperative haemorrhagic complications after laparoscopic Roux-En-Y gastric bypass: analysis of a high-volume centre
Authors: Coutinho C , Santos-Sousa H , Nogueiro J , Machado M , Oliveira A , Lemos J , Peleteiro B , Resende F , Costa-Pinho A , Preto J , Freitas P , Carneiro S , da-Costa E Lima 
Published: February 2025

Abstract

Introduction
Laparoscopic Roux-En-Y gastric bypass (LRYGB) is one of the most performed procedures for morbid obesity. Morbidity and mortality associated with bariatric surgery are considered low. Nevertheless, post-operative haemorrhage is the most frequent early complication after LRYGB.

Methods
We conducted a retrospective cohort study regarding all patients submitted to LRYBG between 2019 and 2023 at our centre. Postoperative haemorrhage was defined as clinically significant evidence of bleeding in the early postoperative period (first 30 days). Demographic, preoperative and intraoperative characteristics of our population were evaluated. We aimed to assess associations and predictive factors of postoperative haemorrhage in our population.

Results
Our population comprised a total of 2117 patients submitted to LRYGB. Most were female (86.3%) and mean age was 47 years old. Mean pre-surgical body mass index (BMI) was 41.8 kg/m2. Regarding previous comorbidities, 23.1% had diabetes, 44.2% hypertension and 33.1% dyslipidaemia. Of the 2117 cases, 307 (14.5%) were revisional surgeries. Concerning postoperative complications, 47 (2.2%) patients had early postoperative haemorrhagic events. Of those, 2 (4.2%) had extraluminal haemorrhage and underwent surgical reintervention. The remaining 45 (95.8%) had intraluminal bleeding and were managed conservatively. Previous cholecystectomy was significantly more prevalent amongst these patients (21.3% versus 11.0%, P = 0.028). However, no statistically significant differences were found according to age, gender, pre-surgical BMI, left liver lobe diameter as well as for revisional surgery. Patients with bleeding complications had a longer hospital stay (2.8 days versus 3.7 days) as well as higher number of reinterventions and readmissions (8.5% versus 3.1%, P = 0.039 and 10.6% versus 3.4%, P = 0.008, respectively). Early postoperative complications include leakage, bleeding and obstruction. Even though these are considered common, postoperative morbidity remains low, particularly in high-volume centres. Adequate and on time management is of utmost important.

Conclusions
Intraluminal bleeding is usually managed conservatively, especially if hemodynamical stability is present, however extra-luminal haemorrhages are more likely to impose surgical treatment, just as shown in our series. Importantly, one must focus on the early detection, diagnosis and treatment for the purpose of patient and treatment outcome improvement. The identification of risk factors for such complications is of utmost importance, to allow for the implementation of perioperative strategies in high-risk patients.
IBC Oxford University Oral Abstract 46 - Bariatric surgery for adolescent obesity: what is the current evidence?
Authors: Foula M , AlJoaib N , AlGhamdi F , AlOtaibi G , Alratrout H , AlArfaj M , Aldabeab A , Zakaria H 
Published: February 2025

Abstract

Objectives
In this systematic review and meta-analysis, we aimed to assess the impact of bariatric surgical procedures on weight reduction in adolescents. Laparoscopic sleeve gastrectomy (LSG), laparoscopic adjustable gastric band (LAGB), and laparoscopic Roux-en-Y gastric bypass (LRYGB) were evaluated, along with their associated complications.

Methods
We conducted a systematic review following PRISMA and Cochrane Handbook guidelines, searching databases from inception to May 12, 2023. Inclusion criteria comprised studies in the English language investigating the effects of bariatric surgery on weight loss, reporting BMI outcomes, and involving human adolescents. The quality assessment used the Newcastle-Ottawa Scale and the National Institutes of Health tool, and the meta-analysis was conducted using Stata software.

Results
From 1,826 initial studies, 56 met our inclusion criteria, and 45 were included in the meta-analysis. LSG and LAGB showed significant body mass index (BMI) reductions up to the 60th postoperative week (LSG: −10.008, P = 0.002; LAGB: −9.684, P = 0.003). Also, LRYGB demonstrated a significant and sustained BMI reduction, notably at 24th postoperative weeks (−18.076, P &lt; 0.001) and 36th postoperative weeks (−18.145, P &lt; 0.001). Minimal complications were reported after LRYGB and LAGB. However, LSG was associated with a 1% incidence of hernia (Relative Risk (RR) = 0.01, P = 0.001), an 11% occurrence of cholecystectomy (RR = 1.1, P = 0.01), and a 10% leak incidence (RR = 1.01, P = 0.01).

Conclusion
This systematic review and meta-analysis highlights the efficacy of bariatric surgery in reducing BMI among adolescents. LSG, LAGB, and LRYGB all yielded significant and sustained BMI reductions. While complications were generally low, LSG exhibited specific risks, emphasizing the importance of individualized patient assessment.
IBC Oxford University Oral Abstract 47 - 12-years’ experience with the endoscopic sleeve gastroplasty: suggestion for an upgraded device
Authors: Dargent J 
Published: February 2025

Abstract

Introduction
The Endoscopic Sleeve Gastroplasty represents an innovative and successful solution in the bariatric field. Starting in 2011, we introduced it in our practice in Lyon.

Methods
We performed 92 EGP till 2023, both primary (N = 71) and secondary (N = 21). The learning curve has been steep concerning at least one device (Apollo Endosurgery, N = 55), while easier with Endomina (N = 16) and POSE (USGI Medical) (N = 20).

Results
All patients stayed overnight, 5 stayed 2 days or more. 19 patients were included into a re-do protocol in former bypass (aimed at narrowing a gastro-jejunal anastomosis). There were mild complications in 32 patients (35%), mostly abdominal pain with marginal pneumoperitoneum in 10, non-specific abdominal pain in 30, and nausea in 21, and SAE in one patient (pneumo-mediastinum, spontaneously resolutive). Weight loss at 2 months was 5.5%, 9% at 6 months and 8% at 12 months.

Conclusion
Endogastric plication is a safe method, current material being unsatisfactory in many regards, because of frequent upgrades and variations regarding the advised pattern of plication. Real life results do not match those found in most publications. Still, this method represents probably the promising innovative endoscopic bariatric tool for the time being. We wish to develop a simpler and more ergonomic device that could be easily robotized. Research is going on with a new prototype called ENDOPLY, with a pilot study starting in Prague in May 2024, and pending upgrades.
IBC Oxford University Oral Abstract 50 - Addressing leaks in one anastomosis gastric bypass: 2024 comprehensive systematic review and meta-analysis
Authors: Kermansaravi M , Shahmiri S Shahabi , Kassir R , Valizadeh R , Parmar C , Davarpanah Jazi A H , Benois M 
Published: February 2025

Abstract

Introduction
One-anastomosis gastric bypass (OAGB) complication, such as leakage, can be dangerous and should be managed properly, yet little data exist in the literature regarding the management of leaks after OAGB, and there are no guidelines to date.

Methods
The authors performed a systematic review and meta-analysis of the literature and 46 studies, examining 44 318 patients were included.

Results
There were 410 leaks reported in 44 318 patients of OAGB published in the literature, which represents a prevalence of 1% of leaks after OAGB. The surgical strategy was very variable among all the different studies; 62.1% of patients with leaks had to undergo another surgery due to the leak. The most commonly performed procedure was peritoneal washout and drainage (with or without T-tube placement) in 30.8% of patients, followed by conversion to Roux-en-Y gastric bypass in 9.6% of patients. Medical treatment with antibiotics, with or without total parenteral nutrition alone, was conducted in 13.6% of patients. Among the patients with the leak, the mortality rate related to the leak was 1.95%, and the mortality due to the leak in the population of OAGB was 0.02%.

Conclusion
The management of leaks following OAGB requires a multidisciplinary approach. OAGB is a safe operation with a low leak risk rate, and the leaks can be managed successfully if detected in a timely fashion. Keywords: bariatric, leak, one-anastomosis gastric bypass, weight loss.
IBC Oxford University Oral Abstract 51 - Comparison between low-molecular-weight heparin and apixaban for prophylaxis against venous thromboembolism after laparoscopic sleeve gastrectomy: a randomized controlled trial
Authors: Abdelsalam A 
Published: February 2025

Abstract

Background
Venous thromboembolism (VTE) is a possible complication after bariatric-metabolic surgery. Low-molecular-weight heparin (LMWH) is commonly used to prevent VTE, but there is limited data on the use of direct oral anticoagulants (DOACs). Apixaban, which is primarily absorbed in the proximal small bowel, may offer advantages over LMWH.

Objectives
This study aimed to assess the efficacy and safety of apixaban compared to LMWH for VTE prophylaxis after laparoscopic sleeve gastrectomy (LSG), by evaluating the incidence of VTE and bleeding.

Methods
This study was a randomized, single-blind, parallel-group (1:1) controlled clinical trial that enrolled 100 adult participants of both genders, aged 18 to 65 years who were scheduled for LSG at Cairo University Hospitals between August 2022 and January 2024. Subjects with severe obesity (BMI ≥ 40 kg/m² or ≥ 35 kg/m² with comorbidities), normal preoperative human coagulation factor Xa serum level, and normal preoperative mesenteric, portal, splenic, and lower limb venous duplex were recruited. Exclusion criteria for this study included a history of bariatric surgery other than LSG, VTE/pulmonary embolism, or heart valve replacement, as well as pregnancy, lactation, and missed follow-up duplex. Participants were randomly assigned to one of two groups (50 patients each) using a computer-generated random sample table. Group A received postoperative prophylaxis with LMWH (1 mg/kg/day, max 120 mg/day) from day 1 to day 15, while G to day 15. Assessment of VTE was conducted on postoperative day 15 via venous duple roup B received postoperative prophylaxis with apixaban (2.5 mg twice daily) from day 1x of the mesenteric, splenic, portal, and lower limb veins.

Results
No statistically significant differences were observed between groups in VTE (0% incidence) or major postoperative bleeding (2% incidence).

Conclusion
Apixaban is as effective and safe as LMWH in preventing VTE after LSG, highlighting its potential role in this setting.