“It’s a tool,not a cure”: the preoperative teen perspective on bariatric surgery

BackgroundBariatric surgery is well established in adults as the most effective tool for sustained weight loss and reduction of obesity-related co-morbidities, and is an emerging option for adolescents in whom conservative approaches have failed. Narratives are vital in understanding the motivating reasons and psychosocial profiles of adolescents considering bariatric surgery during a developmental period of evolving self-concept, body image sensitivity, peer pressure, and increased opportunity for risky behaviors.ObjectivesTo explore preoperative adolescent patient perspectives on their decision to pursue bariatric surgery, anticipated physical and psychosocial effects, and preparation process.SettingsThe Hospital for Sick Children (SickKids) in Toronto, Ontario, Canada.MethodsWe conducted 14 semi-structured interviews with adolescents (16–18 yr old) 2–4 months before bariatric surgery. A theoretical thematic analysis was conducted with 3 independent reviewers (interrater reliability, Cronbach’s α= .81) and conflicts were resolved through discussion.ResultsPatients’ perspectives are captured in 4 themes: motivation for surgery, effects on health and habits, psychosocial changes, and support systems during preparation. Participants perceived surgery as a tool but not a solution for weight loss. Most were motivated for health and daily functional improvement rather than aesthetic reasons, and some anticipated improved social interactions while maintaining their self-identity. Participants were selective in sharing news of their surgery, and received varying levels of support from families, friends, and healthcare teams.ConclusionAdolescents seem generally prepared for and informed about surgery, with expectations for weight loss and psychosocial improvements, although uncertainty and contradictory thoughts were prevalent. Insights provided by these adolescent patients will help optimize bariatric surgery assessments and support from clinical teams and inform preoperative education for future patients and families.     

Editorial Commentary: Knee Medial Meniscus Root Tears: “You May Not Have Seen It,But It's Seen You”

Medial meniscus root tears are becoming increasingly recognized in clinical practice as a source of profound pain and dysfunction in patients. There has been considerable debate about the cause of these distinct meniscus tears, and what the optimal treatment should be for an individual patient. Midterm medial meniscus root repair results suggest that in a well-aligned knee with minimal degenerative change, transtibial root repair is an effective technique for improving pain, function, and possibly preventing further cartilage degeneration.     

Editorial Commentary: Rotator Cuff Repair: How Much Tension Can a Tendon Stand? If It Hurts My Finger,It's Probably Hurting the Tendon

Rotator cuff repairs may fail anatomically because of greater-than-needed tension to approximate the tendon to the greater tuberosity during repair. Surgeons should make every effort to minimize the tension when reapproximating a torn rotator cuff.     

Editorial Commentary: Which Allograft Is Superior for Hip Capsular Reconstruction? Let's Choose the Right Patient Before We Choose the Right Graft

The hip is an inherently stable joint. Acetabular depth and version, femoral torsion, and congruency of articulation form the pillars of hip stability, with the labrum and capsule serving as secondary stabilizers. The increasing prevalence of capsular deficiency in the setting of revision hip arthroscopy has led to the development of capsular reconstruction techniques. The first step in hip capsular reconstruction, however, is selecting the right patient for the procedure.     

Editorial Commentary: Great Expectations or “We'll See,” Said the Zen Master—Hip Arthroscopy Patient Selection

Successful hip arthroscopy is most dependent on patient selection. Chief among the selection criteria are patient expectations. There are few objective contraindications to hip arthroscopy. Subjective contraindications may take precedence and can be less well defined. Paramount among these subjective considerations are unreasonable expectations. Efforts to quantitate patient expectations can be helpful to surgeons to avoid patient selection traps and unsuccessful outcomes.     

Editorial Commentary: Knee Medial Patellofemoral Ligament Reconstruction Does Not Always Result in the “Bee's Knees”

Reconstruction of the medial patellofemoral ligament has gained in popularity as a surgical technique to reconcile recurrent lateral patellar instability. This technique has shown success in a variety of settings including with concomitant osseous abnormalities. Despite the general good to excellent results with medial patellofemoral ligament reconstruction, a number of technical errors are still commonly made and may result in decreased range of motion, pain, chondrosis, and arthrofibrosis. In a recent study, the importance of knee flexion angle during final fixation of the graft is emphasized. Even with appropriate tunnel placement, and minimal tension on the graft, graft fixation performed at less than or greater than 60° of knee flexion results in medial patellar overload with risk of the aforementioned complications.     

Editorial Commentary: “Just When I Thought I'd Seen Everything That Could Go Wrong?” (Often Overheard in the Surgeon's Lounge): Osteonecrosis of the Humeral Head After Arthroscopic Rotator Cuff Surgery

Osteonecrosis occurs postoperatively after rotator cuff repair, but is there a cause-and-effect relation?