Hendrika J. M. Smelt

To evaluate hernia recurrence, postoperative complications, and patient reported outcomes after combined open ventral hernia repair (OVHR) and rectus diast asis (RD) reconstruction with abdominal wall contour correction in postpartum women. This retrospective study included women (BMI < 30 kg/m2) with symptomatic ventral hernia ≥ 1 cm and concomitant RD ≥ 3 cm who underwent elective combined repair between 2018 and 2024. All patients had completed childbearing, experienced functional complaints, and maximized physiotherapy benefit. Primary outcomes were hernia recurrence and postoperative complications, classified as surgical site occurrences (SSO) and SSO requiring procedural intervention. Secondary outcomes included functional, physical, and cosmetic patient-reported outcomes. Fifty-nine patients were included. Wound-related complications occurred in 38.9%, mainly wound dehiscence (18.6%) and umbilical necrosis (13.6%). Wound infection occurred in 5.1%, with 3.4% requiring radiologic drainage and 1.7% reoperation. Significant postoperative improvements were observed in abdominal pain (93.2% to 15.3%, p < 0.001), back pain (64.4% to 3.4%, p < 0.001) abdominal swelling (59.3% to 5.1%, p < 0.001), abdominal wall dysfunction (100% to 8.5%, p < 0.001), and physical limitations (61.0% to 0%, p < 0.001). Dissatisfaction with abdominal aesthetics decreased from 100% preoperatively to 18.6% postoperatively (p < 0.001). No hernia recurrence occured. Combined OVHR and RD reconstruction in postpartum women results in substantial improvements in pain, function, and abdominal wall aesthetics without hernia recurrence. Despite notable wound-related complications, outcomes support the functional and quality-of-life benefits of a multidisciplinary surgical approach. Prospective studies are needed to confirm these findings and optimize perioperative strategies.

Introduction Adherence to daily intake of multivitamin supplementation (MVS) is a major challenge after bariatric surgery (BS). The aim of this study was to identify insights into patients’ beliefs and experiences on adherence to MVS intake. Methods A thematic analysis of qualitative data from four high-volume bariatric centers in the Netherlands was conducted. A series of texts from the open-ended question of 1,246 patients were thematically analyzed for common or overarching themes, ideas, and patterns. Results Five key themes emerged regarding participants’ suggestions on adherence to daily MVS intake: “gastrointestinal side effects to MVS intake” (n = 850, 68.2%), “negative features of MVS” (n = 296, 23.8%), “satisfaction with advice on MVS” (n = 272, 21.8%), “dissatisfaction with service provision” (n = 160, 12.8%), and “costs” (n = 93, 7.5%). Most problems were experienced when using specialized weight loss surgery (WLS) MVS. These supplements may cause gastrointestinal side effects, and costs are too high. After bariatric surgery, numerous patients strongly felt that information provision was poor in several aspects, and the aftercare pathway process did not provide sufficient support. Conclusion This study found five major themes involved in patient adherence to multivitamin intake after BS: gastrointestinal side effects to MVS intake, negative features of MVS, satisfaction with advice on MVS, dissatisfaction with service provision, and costs of specialized MVS. Challenges lie in stronger education for both patients and healthcare professionals. More personalized care could probably increase patient satisfaction, and MVS companies should look at further optimizing supplements for better tolerability and reducing costs.

Purpose Lifelong multivitamin supplementation is recommended to prevent nutritional deficiencies. Despite this advice, deficiencies are common which may be due to poor adherence to MVS intake. The aim of this study was to identify which factors affect patient adherence to Multivitamin Supplement (MVS) intake after bariatric surgery. Materials and Methods A 42-item questionnaire was sent to 15,424 patients from four Dutch bariatric center. In total, 4975 patients wanted to participate of which 361 patients were excluded. A total of 4614 patients were included, and MVS users (n=4274, 92.6%) were compared to non-users (n=340, 7.4%). Most patients underwent Roux-en-Y gastric bypass (64.3%) or sleeve gastrectomy (32.3%). Results Seven hundred and ten patients (15.4%) reported inconsistent MVS use and 340 patients (7.4%) did not use any MVS at all. For inconsistent MVS users, most reported reasons included forgetting daily intake (68.3%), gastro-intestinal side effects (25.6%) and unpleasant taste or smell (22.7%), whereas for non-users gastro-intestinal side effects (58.5%), high costs (13.5%) and the absence of vitamin deficiencies (20.9%) were most frequently reported. Overall, 28.5% were dissatisfied about instructions on MVS use, attention paid to MVS use during medical consultation and the extent to which personal preferences were taken into account. Conclusion The attitude of bariatric patients towards MVS use is predominantly negative. It is important to provide accurate information on different options for MVS intake and collect information about patient’s personal preferences when prescribing supplements. Improving adherence to MVS intake is challenging and requires implementation of a shared decision-making process, further optimization of MVS formulas and exploring options for reimbursement. Graphical abstract

Purpose The aim of this study was to compare the effect of two different limb lengths after RYGB on weight loss, postoperative gastro-intestinal complications, and vitamin deficiencies. Materials and Methods A retrospective analyses of 100 patients after RYGB with 2 different limb lengths were done. Group A (50 patients) had a biliopancreatic limb (BPL) of 75 cm and an alimentary limb (AL) of 150 cm. Group B (50 patients) had a BPL of 150 cm and an AL of 75 cm. The effect on weight loss, body mass index, excess weight loss (EWL), total weight loss (TWL), and postoperative complications was analyzed up to 2 years postoperatively. Results Patients with a longer BPL achieved significantly more %EWL compared to a shorter BPL 2 years postoperatively (82.8 ± 31.2 versus 93.8 ± 15.1; p = 0.038). A significant difference was also seen in %TWL after 1 year (30.3 ± 10.1 versus 37.4 ± 6.9; p < 0.01) and 2 years (31.6 ± 7.5 versus 35.6 ± 8.6; p = 0.022), both in favor of group B. However, patients with a longer BPL (group B) showed significant more diarrhea and steatorrhea compared to group A (p < 0.01). Conclusion BPL of 150 cm is associated with more %EWL and %TWL 2 years after RYGB. However, it is accompanied by an increase of diarrhea and steatorrhea to disadvantage off group B. Future studies need to focus on further tailoring BPL and AL lengths to achieve the best possible outcomes for patients with morbid obesity.

Morbid obesity is a growing problem worldwide and has subsequently resulted in a wide application of bariatric surgery to achieve long-term weight loss and improvement of obesity-related co-morbidities. In spite of these clinical benefits, vitamin deficiencies are common after bariatric surgery; therefore, lifelong multivitamin supplementation (MVS) is recommended. However, patient adherence to MVS intake is generally poor. The aim of this narrative review is to analyse which factors influence the adherence of MVS intake after bariatric surgery. To provide an extensive overview, we will discuss the different factors that influence MVS use in patients who underwent bariatric surgery, but also review the literature on MVS in other patient groups.

The second sentence of the Conclusion section should read as follows.

Vitamin and mineral deficiencies are common after a sleeve gastrectomy (SG). The aim of this study is to examine the effectiveness of a specialized bariatric multivitamin (WLS Optimum) for SG patients on deficiencies compared with a regular multivitamin (MVS) for up to 5 years.