Utility of transient elastography (fibroscan) and impact of bariatric surgery on nonalcoholic fatty liver disease (NAFLD) in morbidly obese patients

Background

Controlled attenuation parameter (CAP) is a novel, noninvasive technique for assessing hepatic steatosis. However, its role in morbidly obese individuals is unclear. The effect of bariatric surgery on inflammation and fibrosis needs to be explored.

Antral resection versus antral preservation during laparoscopic sleeve gastrectomy for severe obesity: Systematic review and meta-analysis

Although laparoscopic sleeve gastrectomy is an established operation for severe obesity, there is controversy regarding the extent to which the antrum is excised. The objective of this systematic review was to investigate the effect on perioperative complications and medium-term outcomes of antral resecting versus antral preserving sleeve gastrectomy. MEDLINE, EMBASE, and Cochrane databases were searched from 1946 to April 2017. Eligible studies compared antral resection (staple line commencing 2–3 cm from pylorus) with antral preservation (>5 cm from pylorus) in patients undergoing primary sleeve gastrectomy for obesity. Meta-analyses were performed with a random-effects model, and risk of bias within and across studies was assessed using validated scoring systems. Eight studies (619 participants) were included: 6 randomized controlled trials and 2 cohort studies. Overall follow-up was 94% for the specified outcomes of each study. Mean percentage excess weight loss was 62% at 12 months (7 studies; 574 patients) and 67% at 24 months (4 studies; 412 patients). Antral resection was associated with significant improvement in percentage excess weight loss at 24-month follow-up (mean 70% versus 61%; standardized mean difference .95; confidence interval .35–1.58, P<.005), an effect that remained significant when cohort studies were excluded. There was no difference in incidence of perioperative bleeding, leak, or de novo gastroesophageal reflux disease. According to the available evidence, antral resection is associated with better medium-term weight loss compared with antral preservation, without increased risk of surgical complications. Further randomized clinical trials are indicated to confirm this finding.     

Indications and Outcomes of Re-Exploratory Laparotomy in Adult Living Donor Liver Transplantation—Single-Center Experience of 1352 Consecutive Liver Transplantations from Indian Subcontinent

Liver transplantation (LT) is the gold standard for end-stage liver disease (Prince Postgrad Med J 78:135–141, 2002). LT is a technically demanding operation. It needs experienced surgical team along with good anesthesia and critical care support (David et al. Gastroenterol Clin North Am 17:1–18, 1988). Survival after LT is approximately 90% at 1 year. Unlike other organs, 1 and 10-year survival for liver transplantation are the same (Jain and Reyes Ann Surg 232(4):490–500, 2000). Complications after LT are classified into technical, infective, and immunological (Moon and Lee Gut Liver 3(3):145–165, 2009). Re-exploratory laparotomy (REL) is one of the surgical complications of LT. Our study was aimed at analyzing the indications and impact of REL on the patient outcomes after living donor liver transplantation in our center. Retrospective analysis of all LTs done at our center by the same surgical team from January 1 2011 to June 30 2016 was included in the study. Pediatric transplants, combined liver kidney transplants, cadaveric transplants, planned REL, and re-transplantations were excluded from the study. Re-explored patients (REL) were classified as study group, and non-re-explored (NREL) patients were used as controls for statistical comparison. Twenty-five parameters (preoperative, intraoperative, and postoperative) between the two groups were studied. SPSS 22 statistical software was used for statistical analysis. The total number of LT during the study period was 1352. After exclusion, 1241 patients were in the study group. REL group had 111 patients. Out of 111 patients, 97 had one REL, 13 patients had two RELs, and 1 had three RELs. Hence, there were 126 RELs in 111 patients. NREL group had 1140 patients. REL rate in our series was 10.02%. On univariate analysis of 25 parameters analyzed between the two groups, age, graft weight, multiple bile ducts, and mortality were found to be statistically significant (P < 0.05). Preoperative total leucocyte count, model for end-stage liver disease, and warm ischemia time were statistically significant (P < 0.1). On subgroup analysis of REL, bleeding was the commonest indication followed by intraabdominal sepsis. Delayed non-function and small for size had high mortality rates. Multiple RELs were associated with higher mortality compared to single REL (P < 0.05). REL is associated with poor prognosis after adult living donor liver transplantation.