Complications Rate Variability after Bariatric Surgery and the Importance of Standardization of a Reporting System

BACKGROUND

The rate of early (< 30 days) complications after bariatric surgery has been reported to be 0.4-27.4%. Although the incidence of serious adverse events has decreased with time and experience, controversy regarding how they are reported persists, and the current literature is heterogeneous.

METHODS

Data from patients, who underwent primary bariatric surgery (gastric bypass and sleeve gastrectomy) at a single institution between 2012 and 2018, were retrospectively reviewed. Any deviation from a "normal" postoperative course (< 30 days) was identified, and a comparative analysis of early complications according to five models was performed: modified Clavien-Dindo; Longitudinal Assessment of Bariatric Surgery (LABS); Bariatric Surgery Centers of Excellence (BSCOE); American Society for Metabolic and Bariatric Surgery (ASMBS); and Li (major/minor).

RESULTS

A total of 788 patients (83.7% gastric bypass), of whom 8.8% deviated from a "normal" postoperative course, were included. After applying the five classifications, the results were as follows: Clavien-Dindo, 8.8%; LABS, 2.3%; BSCOE, 0.4%; ASMBS, 9.9%; and Li, 11.2%. The incidence of major/severe/adverse outcomes were as follows: Clavien-Dindo, 2.4%; LABS, 2.3%; BSCOE, 0.4%; ASMBS, 6.9%; and Li 9.2%. Minor complications were as follows: Clavien-Dindo, 6.5%; ASMBS, 3%; and Li, 2%. There was no mortality.

CONCLUSION

Germane heterogeneity was found in reporting of early complications after bariatric surgery. Incidence varied according to classification system applied, and Clavien-Dindo demonstrated accuracy as a reporting model. To avoid bias, standardized reporting should be mandatory, and a more stringent and homogeneous reporting system should be established.

Fatal meningoencephalitis caused by Scedosporium inflatum (Scedosporium prolificans) in a child with lymphoblastic leukemia

A fatal case of meningoencephalitis caused by Scedosporium inflatum (Scedosporium prolificans) in a 5-year-old boy with acute myeloblastic leukemia who was given intrathecal treatment is reported. Itraconazole treatment was ineffective. The fungus was identified on brain sections at autopsy and was not observed in any other organ. As no other portal of entry was detected, meningoencephalitis may have originated via direct introduction of the fungus at therapeutic lumbar puncture.

[Course of the visual evoked potentials in intracranial tuberculous granuloma]

The case in study is a 13-year-old male with tubercular granuloma in the optic chiasma, affecting the right optic nerve and causing temporary loss of vision in that eye. Evoked visual potentials are performed and a first examination reveals that loss of vision was preceded by an alteration of response through the right optical path. The physiopathology is discussed and an evolutionary study of the lesion is made, evaluating the usefulness of EVPs in the diagnosis and follow-up in these patients.

Laparoscopic sterilization as an outpatient procedure

Since June 1972, more than 2,000 laparoscopic sterilizations have been performed as outpatient procedures using neuroleptanalgesics. Electrocoagulation, spring-loaded clips or tubal rings were the methods used for tubal occlusion. All laparoscopies were performed in a family planning clinic. The surgical facilities were minimal and did not include general anesthesia equipment or a blood bank. The nearest hospital was about one-half mile from the clinic. The procedures were performed by a physician assisted by two paramedical personnel and a technician. Patients were scheduled to be at the clinic on the morning of the procedure and were discharged three to six hours after the procedure. Only one patient required hospitalization for treatment of a complication: her aorta was punctured during placement of the Tuohy needle. The patient was admitted to a local hospital and underwent laparotomy for repair; her subsequent recovery was uneventful. No bowel or bladder burns have occurred. Minor complications (emphysema of the abdominal wall, bleeding from the tubes, infections) have occurred in less than 4% of the patients. The results of this study indicate that laparoscopy in an outpatient clinic is safe and presents minimal additional risks to the patient if the surgeon is experienced.

A comparative study of spring-loaded clips and electrocoagulation for female sterilization

The surgical, immediately postoperative and delayed postoperative complications and complaints associated with spring-loaded clips and electrocoagulation as techniques of tubal sterilization at laparoscopy were evaluated in a comparative study. Each of the two techniques was randomly assigned to 150 subjects. All sterilizations were performed as outpatient procedures. Subjects were followed-up during the first six weeks and again at about six months after sterilization. Rates of complications (surgical and early postoperative) were similar for the two procedures. None of the subjects required subsequent hospitalization. Technical difficulties at surgery were more frequent with the spring-loaded clip technique, principally as a result of mechnical problems with the prototype laparoscope and clip applicator. Postoperative pelvic and abdominal pain were reported by a significantly higher proportion of the patients when the spring-loaded clip was used (spring-loaded clips, 43.6%; electrocoagulation, 31.5%). At the six-month follow-up examination, rates of abnormal pelvic findings and changes in menstrual cycle formation were similar for the two techniques of tubal occlusion. There was one procedure failure among the electrocoagulation patients and none among the spring-loaded clip patients.

Male sterilization in El Salvador: A preliminary report

The expectation that male sterilization would not be an acceptable method of fertility control to the Latin American male has not been upheld in the initial phases of male sterilization programs in Colombia, Costa Rica, Guatemala, and El Salvador. On the contrary, in all of these programs and also at the Asociación Demográfica Salvadoreña, a free-standing, non-profit family planning clinic in San Salvador, the initial success has been impressive, with 180 men accepting sterilization during the first two years (February, 1972 to February, 1974). All sterilizations were performed by excising a 10-15 mm segment of each vas and ligating each vas end. Procedures were performed on an outpatient basis using a local anesthetic. Follow-up examinations were conducted at one week and three months after the procedure. Although complications were reported by 24.0% of the subjects at the one-week follow-up, the complications were minor: most were scrotal infections not requiring antibiotic therapy. Rates of complications were low for subjects returning for a three-month examination and semen test. Only one subject had a positive semen test.