Paweł Ziemiański

Reduced Cardiovascular Risk Indicated by Changes in Triglyceride-Glucose Index After Pancreas Transplantation - Article abstract #950940

BACKGROUND The right and left gastroepiploic arteries supply the stomach and greater omentum. The right gastroepiploic artery originates from the gastroduodenal artery and runs along the greater curvature of the stomach. Aneurysms of the gastroepiploic arteries are rare; however, despite their low incidence, their rupture is associated with a mortality rate of up to 70%. Management options for gastroepiploic artery aneurysms include open surgery, endovascular techniques, and laparoscopic procedures. This report presents the case of a 60-year-old man with an incidentally discovered, asymptomatic aneurysm of the right gastroepiploic artery, managed successfully by laparoscopic resection. CASE REPORT A 60-year-old man was incidentally diagnosed with a right gastroepiploic artery aneurysm during a computed tomography scan. The patient was asymptomatic, reporting no abdominal pain or other clinical signs. He had no history of gastrointestinal bleeding, either from the upper or lower tract. The patient was admitted to the Department of General and Transplant Surgery. Laparoscopic resection of the aneurysm was proposed and performed as definitive treatment. The operative and postoperative courses were uneventful. Histopathological examination did not reveal any lesions suggestive of genetic or connective tissue disorders. CONCLUSIONS This case describes a rare presentation of an asymptomatic aneurysm of the right gastroepiploic artery, which was successfully managed with laparoscopic resection. Laparoscopic management may offer a safe and effective alternative for treating asymptomatic, non-ruptured gastroepiploic artery aneurysms. Compared with noninvasive methods, laparoscopy provides a minimally invasive yet definitive approach and can be particularly beneficial in patients with tortuous vasculature, obesity, or multiple comorbidities.

Background: Chronic post-surgical pain (CPSP) is a phenomenon that negatively influences patients’ quality of life and well-being. By definition, CPSP is a pain in the surgical area of injury that develops or increases after the operation and persists beyond the healing process. One of the populations that is especially vulnerable to CPSP is patients undergoing bariatric surgery, as obesity, chronic inflammation, pre-existing chronic pain, and severe postoperative pain are its risk factors. Therefore, we conducted a cross-sectional study assessing the prevalence of CPSP in patients undergoing laparoscopic sleeve gastrectomy (LSG). We also aimed to explore the potential influence of the promising opioid-free anesthesia (OFA) technique, assess if the CPSP after LSG had a potential neuropathic component, and additionally, determine whether the bariatric surgery altered chronic pain in this patient population. Methods: The study was registered on 11 November 2024, at ClinicalTrials.gov (NCT06686875). A cross-sectional study using e-survey.io was conducted among the patients who underwent LSG 3 months to 5 years earlier. Clinical data were retrieved from the hospital database. Results: Of the 135 patients who responded to our e-survey, 4.4% (n = 6, 95% CI 0.9–8%) reported CPSP. None of them had a PAIN DETECT score above 19, which would indicate a neuropathic component. Of the 32 patients who had pre-existing chronic pain, 31 reported a reduction in its intensity, and of the 16 patients on chronic opioid treatment, 10 discontinued opioid therapy. In a subgroup analysis, there was no significant difference in the prevalence of CPSP and long-term opioid therapy between the patients who had OFA and standard anesthesia (p > 0.05). Conclusions: The main finding of our study is that a minor, yet significant, portion of patients who underwent LSG develop CPSP, and OFA does not alter the risk. LSG appears to reduce pre-existing chronic pain and opioid use.

Background and Objective: Postoperative nausea and vomiting (PONV) ranks among the most common postoperative complications, affecting up to 80% of patients undergoing laparoscopic bariatric surgery. This condition negatively impacts patient comfort and well-being while also potentially delaying ambulation and increasing the risk of anastomotic and wound dehiscence. Although various interventions can mitigate the risk of PONV, none are entirely effective; therefore, combined prophylactic strategies are the standard approach. In recent years, numerous techniques and interventions have emerged; consequently, this scoping review aims to assess the current evidence regarding PONV prevention in patients undergoing laparoscopic bariatric procedures. Methods: This review was conducted in accordance with PRISMA guidelines and registered with OSF. A search was performed across the MEDLINE (PubMed), Scopus, Embase, and Web of Science databases. Inclusion criteria encompassed randomized controlled trials (RCTs) published up to May 2025, focusing on adult patients undergoing laparoscopic bariatric surgeries with PONV as a primary or secondary outcome. Results: A total of 81 studies were included in this review, encompassing a broad range of perioperative techniques, including opioid-sparing adjuvants, regional anesthesia, and pharmacological interventions. Conclusions: While there is general consensus and guidance advocating for a multimodal approach to PONV prevention, debates persist regarding the optimal techniques and antiemetic drug regimens to implement. Emerging evidence, particularly concerning regional anesthesia strategies and combined pharmacological prophylaxis, including novel agents, highlights the potential advantages of innovative approaches. Highlights: Effective management of postoperative nausea and vomiting in patients undergoing laparoscopic bariatric surgery is essential, given its impact on patient comfort, recovery, and the potential to prevent wound or anastomotic dehiscence. Although multimodal antiemetic strategies are regarded as standard, disagreements remain regarding specific measures to be adopted. New techniques and strategies, including advanced regional anesthesia techniques, pharmacological, and non-pharmacological methods, offer promising avenues for improved prophylaxis.

BACKGROUND Patients with obesity with interstitial lung diseases (ILD) are encouraged to lose weight, as it improves lung function and lung transplant eligibility. As exercise tolerance in these patients is low and weight gain is a common adverse effect of corticosteroids, bariatric surgery can be an effective method for the management of obesity in this patient group. However, perioperative complications in such high-risk patients remain a concern. Therefore, we aimed to demonstrate successful anesthetic management for obese patients with ILD, which may be practically utilized to reduce perioperative pulmonary complications and improve outcomes. CASE REPORT Our case report presents a 42-year-old man with ILD who underwent laparoscopic sleeve gastrectomy (LSG). Preoperative studies revealed severe restrictive disease, right ventricular overload with assessed intermediate risk of pulmonary hypertension, and heart failure, with preserved left ventricle fraction but with poor exercise tolerance. Patient had opioid-free anesthesia (OFA) and postoperative multimodal analgesia. Following a 24-h stay in the Post-Anesthesia Care Unit, the patient was transferred to the ward and ultimately discharged home 2 days thereafter. At the 1-year follow-up, the patient reduced his weight by 40 kg and reported a significant improvement in physical capacity. CONCLUSIONS Our record demonstrates that OFA can be successfully used in high-risk patients with ILD undergoing LSG. In a period of a year, the patient improved so much that he no longer required lung transplantation, which may encourage clinicians to provide bariatric surgery using the OFA technique in the population of patients with obesity and severe respiratory illness.

In the XXI century obesity has become one of the most demanding epidemiological threats worldwide. At the same time, bariatric surgery has established itself as an effective treatment for morbidly obese patients, with laparoscopic sleeve gastrectomy (LSG) emerging as the most popular bariatric procedure. This paper reviews the role of imaging studies of patients after LSG. Computed tomography is widely considered as the method of choice in detection of complications in early postoperative period. The dynamic character of upper gastrointestinal examination allows for the assessment of passage through the gastric remnant. The paper also discusses evaluation of the shape and volume of the gastric remnant assessed by imaging studies.