Obesity Surgery最新文献

{"title":"Chronic Abdominal Pain After Roux-en-Y Gastric Bypass Surgery: A Prospective Cohort Study with 2-Year Follow-Up in a Swedish Population.","authors":"Angelos Al Nimer, Hanna de la Croix, Monika Fagevik Olsén, Anna Elmered, Eva Haglind, Lars Fändriks, Eva Angenete, Hans Axelsson, Srdjan Kostic, Ville Wallenius","doi":"10.1007/s11695-025-08272-y","DOIUrl":"https://doi.org/10.1007/s11695-025-08272-y","url":null,"abstract":"<p><strong>Background: </strong>The risk of developing chronic abdominal pain after Roux-en-Y gastric bypass (RYGB) surgery has come under scrutiny. Few prospective studies exist on this subject. The aim of this prospective paired analysis cohort study was to evaluate the risk of developing chronic abdominal pain and QoL 2 years after RYGB surgery.</p><p><strong>Methods: </strong>An unselected cohort of 107 patients living with obesity, scheduled to undergo elective RYGB surgery, filled out the study questionnaires before surgery. Two years after surgery, 84 patients responded to the questionnaires, resulting in a response rate of 78.5%.</p><p><strong>Results: </strong>The gastrointestinal symptom rating scale showed no change for diarrhea, indigestion, or obstipation, but on the other hand, a tendency to increased abdominal pain (p = 0.05) 2 years after RYGB. Gastroesophageal reflux symptoms decreased (2.1 ± 1.3 to 1.4 ± 0.9; p < 0.0001). Pain anxiety using the Pain Catastrophizing Scale decreased (from 13.5 ± 11.3 preoperatively to 10.1 ± 9.4 postoperatively, p = 0.001). The Hospital Anxiety and Depression Scale showed a decreased score for depression (4.4 ± 3.7 to 2.4 ± 3.3, p < 0.0001), but no change for anxiety. Quality of life increased significantly (EQ5D-3L health state from 0.69 ± 0.25 to 0.83 ± 0.23, p < 0.0001; EQ VAS: from 57.4 ± 19.6 to 80.1 ± 16.3, p < 0.001). Self-reported physical activity, according to the Saltin-Grimby Physical Activity Level Scale (SGPALS), increased (preoperative: median = 2, Q1 = 1, Q3 = 2; postoperative: median = 2, Q1 = 2, Q3 = 2.75, p < 0.0001).</p><p><strong>Conclusions: </strong>Our study indicates no significant increase in abdominal pain but decreased pain anxiety 2 years after RYGB surgery. Self-reported physical activity, depression symptoms, and general quality-of-life were improved compared to baseline values.</p>","PeriodicalId":19460,"journal":{"name":"Obesity Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145337361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Analysis of the Effectiveness and Frequency of Complications of Different Techniques of Laparoscopic Sleeve Gastrectomy in Patients with Obesity.","authors":"Umid Ruziyev, Oktyabr Teshayev, Nilufarxon Niyazova, Azam Babadjanov, Chetan Parmar","doi":"10.1007/s11695-025-08338-x","DOIUrl":"https://doi.org/10.1007/s11695-025-08338-x","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Relevance: &lt;/strong&gt;Laparoscopic sleeve gastrectomy (LSG) is recognized as an effective method for treating severe obesity; however, technical variations in this procedure significantly impact the complication profile and long-term metabolic outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare the clinical effectiveness, frequency of postoperative complications, and body weight outcomes using three LSG strategies: standard (Standard), enhanced (Tight), and modified (Wide).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;The study included 1,194 patients with obesity who underwent LSG between 2019 and 2022. Patients were not randomized to a specific LSG technique; rather, the choice reflected both clinical profile and the chronological evolution of practice in our center. Initially, the Standard technique was applied, followed by the Tight technique in cases of suboptimal initial response, and finally the Wide technique was adopted to achieve a safer balance between efficacy and safety. Early and late surgical and metabolic complications, body mass index (BMI) reduction, and the frequency of weight recurrence over 36 months (per IFSO definition: ≥ 25% regain from nadir) were assessed. Data analysis was performed using Python (SciPy, StatsModels, Pandas). Normality of distribution was tested using the Shapiro-Wilk test. For between-group comparisons, Student's t-test or the Mann-Whitney U test were used for continuous variables depending on distribution, and the χ&lt;sup&gt;2&lt;/sup&gt; test was used for categorical variables. In addition to p-values, 95% confidence intervals (95% CI) were calculated for all main outcomes. To address the issue of multiple comparisons, the Bonferroni correction was applied where appropriate. All results were reported with appropriate rounding (one or two decimals), and differences were considered statistically significant at p &lt; 0.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The lowest overall complication rate was observed in the Wide group (26.85%) compared to the Tight (49.39%) and Standard (35.22%) groups (p &lt; 0.001). The incidence of early metabolic disorders was 15.76% in the Wide group versus 64.34% in the Wide group (p &lt; 0.001). Late complications (GERD, nutritional deficiencies) were also significantly less frequent in the Wide group. Although the Tight technique resulted in the greatest BMI reduction (to 22.4 ± 3.8 kg/m&lt;sup&gt;2&lt;/sup&gt; at 12 months), it was associated with a high complication rate. The modified technique (Soft) achieved a comparable BMI reduction (to 24.1 ± 4.1 kg/m&lt;sup&gt;2&lt;/sup&gt;) with significantly better tolerance. Weight recurrence (defined as ≥ 25% regain of lost weight per IFSO consensus) at the 2-year follow-up was observed in 30.3% of patients in the Wide group, which was significantly lower than in the Standard group (62.4%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The modified LSG technique provides the optimal balance between effectiveness and safety. It enables significant and sustained weight los","PeriodicalId":19460,"journal":{"name":"Obesity Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145337359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analgesic Efficacy of External Oblique Intercostal Block in Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-Analysis.","authors":"Burhan Dost, Yunus Emre Karapinar, Esra Turunc, Muzeyyen Beldagli, Cengiz Kaya, Yasemin Burcu Ustun, Ersin Koksal, Alessandro De Cassai","doi":"10.1007/s11695-025-08270-0","DOIUrl":"https://doi.org/10.1007/s11695-025-08270-0","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic sleeve gastrectomy (LSG) is associated with significant postoperative pain despite being minimally invasive. External oblique intercostal block (EOIB) has emerged as a novel regional anesthesia technique targeting upper abdominal wall innervation. In this systematic review and meta-analysis with trial sequential analysis (TSA), we aimed to systematically assess the analgesic efficacy of EOIB in patients undergoing LSG, focusing on opioid consumption, pain scores, rescue analgesia use, and recovery outcomes.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science (from inception to until 22 May 2025). The primary outcome was 24-h opioid consumption. Secondary outcomes included pain scores, postoperative nausea and vomiting (PONV), and rescue analgesic use. Risk of bias was assessed using RoB 2, and the certainty of evidence was evaluated using the GRADE approach.</p><p><strong>Results: </strong>Four RCTs (n = 249) were included. EOIB significantly reduced 24-h morphine milligram equivalent (MME) consumption (MD - 12.76 mg; 95% CI - 16.76 to - 8.77; p < 0.001). EOIB also lowered postoperative pain scores and decreased rescue analgesic use (OR 0.20; 95% CI 0.09-0.45). PONV incidence was reduced, but not statistically significant. TSA demonstrated that the current evidence is sufficient to confirm a statistically significant effect, with no further trials required.</p><p><strong>Conclusions: </strong>EOIB appears to be a safe and effective component of multimodal analgesia in LSG, with TSA results supporting the robustness of current evidence.</p>","PeriodicalId":19460,"journal":{"name":"Obesity Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145337424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-Port Bikini Line vs. Conventional Sleeve Gastrectomy: A Prospective Cohort Study on Safety, Efficacy, and Aesthetic Outcomes.","authors":"Mohamed Elshawy, Sherif Albalkiny, Ramy Helmy, Derar Jaradat, Ahmed S M Omar, Mostafa Mahmoud Salama, Mohamed Gamal Qassem","doi":"10.1007/s11695-025-08273-x","DOIUrl":"https://doi.org/10.1007/s11695-025-08273-x","url":null,"abstract":"<p><strong>Background: </strong>Sleeve gastrectomy becomes increasingly popular worldwide, with ongoing efforts to minimize abdominal trauma and postoperative pain and enhance aesthetic outcomes. Bikini line sleeve gastrectomy (BLSG) is a novel technique that achieves improved cosmetic results while maintaining the fundamental goal of effective weight loss. We aim to evaluate the feasibility and safety of three-port bikini sleeve gastrectomy in achieving both aesthetic satisfaction and weight reduction.</p><p><strong>Methods: </strong>A prospective cohort study included 85 patients who underwent laparoscopic sleeve gastrectomy between October 2018 and October 2019 at Ain Shams University Hospitals, with 24-month follow-up. Based on BMI and defined anthropometric criteria, patients were allocated to Group I (n = 40), who underwent laparoscopic bikini line sleeve gastrectomy (BLSG), while Group II (n = 45), who underwent conventional laparoscopic sleeve gastrectomy (LSG). Outcomes assessed included patient satisfaction with scar appearance, percentage of excess weight loss, and early and late postoperative complications. Statistical analyses used chi-square and t-tests, with significance at p < 0.05.</p><p><strong>Results: </strong>There was no statistically significant difference in weight loss outcomes between groups at any of the measured time points (6, 12, 18, and 24 months). The bikini line sleeve gastrectomy group reported significantly higher satisfaction with scar appearance. Despite the modest ergonomic challenges of the lower abdominal access in the bikini group, BLSG demonstrated low complication rates, confirming its safety.</p><p><strong>Conclusions: </strong>In appropriately selected patients, three-port bikini line sleeve gastrectomy demonstrates a favourable safety profile and significantly enhances patient satisfaction while maintaining comparable clinical efficacy. Large multicentre randomized trials are warranted to further validate these outcomes. Key Points • In selected patients, three-port BLSG is reliable technique without compromising weight loss efficacy. • Three-port BLSG provides enhanced cosmetic satisfaction for patients prioritizing aesthetic outcomes. • With proper patient selection, the procedure can be safely integrated into routine practice • Future advancements in technique and instrumentation may broaden the application of three-port BLSG to patients with higher BMI and larger abdominal dimensions.</p>","PeriodicalId":19460,"journal":{"name":"Obesity Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extraocular Manifestations of Obstructive Sleep Apnea as a Potential Screening Tool for Perioperative Complications: A Case Control Study.","authors":"Megan Folsom, Juan Diaz, Nick Lowe, Abhinav Dronavalli, Jason A Sokol, Radwan S Ajlan, Arun George, Yoon Ji, Niaman Nazir","doi":"10.1007/s11695-025-08211-x","DOIUrl":"https://doi.org/10.1007/s11695-025-08211-x","url":null,"abstract":"<p><strong>Background: </strong>Obstructive sleep apnea presents with a variety of potential intra- and post-operative complications; thus, adequate screening is needed to properly manage them. The gold standard for diagnosing OSA is polysomnography; however, due to access and practicality, alternative tools such as the STOP-BANG score are utilized. Another avenue to be investigated is the association between floppy eye syndrome (FES) and OSA. The aim of this study is to use STOP-BANG and FES to predict perioperative risk of complications arising from obstructive sleep apnea.</p><p><strong>Methods: </strong>Prospective case-control study with 160 clinic participants was used in this study. Patients with known formal OSA diagnosis were excluded from the study. OSA was classified as a STOP-BANG score ≥ 3. FES was classified as grading ≥ 2. We took photographs while vertically and horizontally retracting the patient's eyes. Two blinded ophthalmologists and two blinded anesthesiologists used a graded scale to classify eyelid laxity.</p><p><strong>Results: </strong>A total of 32.5% of patients were in the experimental OSA group and 67.5% were in the control group. FES prevalence among the OSA group was 15% and 2% among control. Ophthalmologist reviewers showed a greater incidence of FES in the OSA group compared to control (p < 0.05), while anesthesiologist reviewers did not. Ophthalmologists and anesthesiologists exhibited significant specificity (93% and 98%, respectively) and positive predictive value (88% and 86%, respectively).</p><p><strong>Conclusions: </strong>Using FES to determine probability of OSA, as determined by the STOP-BANG questionnaire, may have utility in the perioperative setting due to its high rule-in value as shown by high specificity and positive pressure ventilation (PPV).</p>","PeriodicalId":19460,"journal":{"name":"Obesity Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital Transfer Between Primary and Secondary Metabolic Bariatric Surgery in The Netherlands: A Cross-sectional Multi-party Computation Analysis of Frequency and Associated Factors.","authors":"Floris F E Bruinsma, Steven van Schuppen, Ronald S L Liem, Perla J Marang-van de Mheen, Simon W Nienhuijs","doi":"10.1007/s11695-025-08284-8","DOIUrl":"https://doi.org/10.1007/s11695-025-08284-8","url":null,"abstract":"<p><strong>Introduction: </strong>Some patients undergoing metabolic bariatric surgery (MBS) may transfer to another hospital for subsequent procedures. Due to legal constraints imposed by privacy regulations on inter-hospital data sharing, limited research has examined the characteristics and outcomes of these patients. This study aimed to identify the frequency and factors associated with hospital transfer using a novel privacy-enhancing approach based on secure multi-party computation (MPC).</p><p><strong>Methods: </strong>All primary and secondary MBS procedures registered in the Dutch Audit for Treatment of Obesity between January 1, 2014, and December 31, 2022, were considered. MPC enabled privacy-preserving linkage of surgeries across different hospitals. Patients undergoing secondary surgery in the same or a different hospital were compared on patient and treatment characteristics and outcomes of primary MBS to investigate associations with hospital transfer.</p><p><strong>Results: </strong>Two thousand three hundred eighty-two patients with data on both primary and secondary MBS were identified. A minority (n = 275; 11.5%) underwent their second procedure elsewhere. At baseline, these patients on average were younger (37.9 vs. 42.5, p < 0.001), less often had hypertension or GERD, and had similar BMI (43.9 vs 43.9, p = 0.89) compared with those who stayed. At secondary surgery, the BMI of patients transferring hospitals on average was lower (39.0 vs. 43.0, p < 0.001), and the indication was more often recurrent weight gain (49.0% vs. 23.0%, p < 0.001).</p><p><strong>Conclusion: </strong>A minority of patients (1 in 9) transferred to a different hospital for secondary MBS. These patients were generally younger and had fewer obesity-related diseases. Although they presented with a lower BMI at the time of secondary surgery, they more frequently sought surgery for recurrent weight gain.</p>","PeriodicalId":19460,"journal":{"name":"Obesity Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Treatment of Staple-Line Leaks After Sleeve Gastrectomy in Patients with Obesity: Which One is the Best Option, if Any? A Systematic Review with Meta-Analysis and Meta-regression.","authors":"Giuseppe Galloro, Mariano Cesare Giglio, Alessia Chini, Rosa Maione, Matteo Pollastro, Rosa Vitale, Antonio Pisani, Mario Musella","doi":"10.1007/s11695-025-08294-6","DOIUrl":"https://doi.org/10.1007/s11695-025-08294-6","url":null,"abstract":"<p><p>Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric surgery, with staple-line leak (SLL) as its most severe complication. Various endoscopic treatments exist, but no universal algorithm is established. The aim of this paper is to estimate the success rates of different endoscopic techniques for SLL management. A search of Medline, Embase, and SCOPUS identified studies on endoscopic treatments. Pooled success rates were calculated using random-effects modeling. Seventy-nine studies (2205 patients) showed an overall success rate of 84.1%. Double-pigtail drainage (90.07%), endoscopic vacuum therapy (90.2%), and septotomy (88.25%) were most effective. Meta-regression indicated significantly higher success with double-pigtail drainage (p = 0.035). Endoscopic treatments, especially double-pigtail drainage and vacuum therapy, are highly effective for SLL. Further research is needed to compare techniques and evaluate additional clinical factors.</p>","PeriodicalId":19460,"journal":{"name":"Obesity Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Broadening the Scope: Additional Considerations for Long-Term Evaluation of Sleeve Gastrectomy in Adolescents.","authors":"Yaxin Ma, Jingwen Wang, Yonghong Sun","doi":"10.1007/s11695-025-08343-0","DOIUrl":"https://doi.org/10.1007/s11695-025-08343-0","url":null,"abstract":"","PeriodicalId":19460,"journal":{"name":"Obesity Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International Federation for Surgery for Obesity and Metabolic Disorders Position Statement on the role of Upper Gastrointestinal Endoscopy Before and After Metabolic Bariatric Surgery.","authors":"Wendy A Brown, Oliver M Fisher, Yazmin Johari, Jessica Au, Christine Stier, Rachel Moore, Chetan Parmar, John B Dixon, Paulina Salminen","doi":"10.1007/s11695-025-08206-8","DOIUrl":"https://doi.org/10.1007/s11695-025-08206-8","url":null,"abstract":"<p><strong>Background: </strong>The International Federation for Surgery for Obesity and Metabolic Diseases (IFSO) provides Position Statements to assist clinical decision making. The use of upper gastrointestinal endoscopy (UGIE) before and after MBS is a topic of debate in clinical practice. This Position Statement updates two previous Position Statements on this issue.</p><p><strong>Methods: </strong>A taskforce undertook a systematic review of available literature according to PRISMA guidelines. Critical appraisal of the methodology of each paper was performed according to the Joanna Briggs Institute. Recommendations based on the derived data were generated and then approved by the Scientific Committee of IFSO.</p><p><strong>Results: </strong>The rate of abnormal findings on pre-MBS UGIE was 61% (95% CI 55%-67%; I² 98.99%). However, less than 1% (I² 58.39%) of people undergoing a pre-MBS UGIE were found to have a condition that precluded MBS; although, 35% either needed treatment for their condition and in 23% there was a Change of the planned MBS procedure type. Despite the frequency of abnormal pathology on pre-MBS UGIE, symptoms were a poor predictor of abnormal findings. The post-operative incidence of BE after MBS was estimated at 2.4% (95% CI 1.66-3.45; I² = 92.1%). The rates of both regression and progression of known BE present prior to MBS were poorly defined.</p><p><strong>Conclusions: </strong>Noting the heterogenous nature of the data, high likelihood of bias, variability of definitions of UGIE detected pathology and Limited follow-up beyond 2 years, seven recommendations for clinical practice are provided, with a caveat that the data should be re-explored in 3 years.</p>","PeriodicalId":19460,"journal":{"name":"Obesity Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal Use of Computed Tomography in Diagnosing Internal Herniation After Roux-en-Y Gastric Bypass: A Proposition for the Application of a Radiological Prediction Score.","authors":"Lilian L van Hogezand, Lucas Goense, Erik J R J van der Hoeven, Charlotte J Tutein Nolthenius, Niek van Oorschot, Luigi A M J G van Riel, Marinus J Wiezer, Niels A T Wijffels, Marijn Takkenberg, Wouter W Te Riele, Lea M Dijksman, Hjalmar C van Santvoort, Wouter J M Derksen","doi":"10.1007/s11695-025-08323-4","DOIUrl":"https://doi.org/10.1007/s11695-025-08323-4","url":null,"abstract":"<p><strong>Background: </strong>Structured assessment of abdominal computed tomography (CT)-scans is increasingly used to identify signs of internal herniation after Roux-en-Y gastric bypass (RYGB), aiding in the decision-making process to perform a diagnostic laparoscopy (DLS). This study aimed to develop a prediction score based on structured assessment of CT-signs for internal herniation.</p><p><strong>Methods: </strong>Patients presenting with abdominal pain after RYGB, who underwent a CT-scan for suspicion of internal herniation and subsequently DLS, were included. CT-scans were reassessed for presence of ten CT-signs for internal herniation by two radiologists and two registrars. Diagnostic accuracy for detection of internal herniation for each sign and an overall suspicion score were calculated and compared with the original CT-reports. Interobserver agreement was measured using Fleiss' kappa. A prediction score was developed based on variables identified by multivariable logistic regression.</p><p><strong>Results: </strong>With DLS 44 internal herniations (114 CT-scans, 92 patients) were identified. Structured assessment improved diagnostic accuracy compared to the original CT-report (AUC of 0.69 to 0.79, p = 0.03), and the positive (67% to 81%) and negative predictive value (75% to 82%). The three-sign prediction score (venous congestion, swirl sign, right-sided anastomosis) resulted in improved diagnostic accuracy compared to the original CT-report (AUC of 0.69 to 0.79, p = 0.038). Interobserver agreement of these signs was adequate between all readers (K = 0.56-0.75).</p><p><strong>Conclusions: </strong>Structured assessment of CT-scans improves diagnostic accuracy for internal herniation after RYGB. Our three-sign prediction-model offers a simplified, reproducible alternative to extensive assessment, without compromising the improved diagnostic effectiveness.</p>","PeriodicalId":19460,"journal":{"name":"Obesity Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}