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Bariatric surgery results in resolution of hypertension in over 50% of patients. While weight loss is a critical component to hypertension resolution after bariatric surgery, there may also be weight loss-independent mechanisms.

We hypothesized that sleeve gastrectomy (SG) initiates changes in the gut microbiome which reduce postoperative blood pressure.

Male, obese Zucker rats underwent SG, pair-fed sham, or ad-lib-fed sham surgery. Ilginatinib mouse Blood pressure measurements were performed 1 week pre-operatively, and at 2 and 6weeks post-operatively. The stool microbiome composition was determined by 16S rDNA gene at 6weeks post-operatively. Regression Random Forest modeling was performed to determine an association of the microbial composition with blood pressure.

SG and pair-fed rats weighed significantly less than ad-lib-fed sham rats throughout the post-surgical period. At 6weeks after surgery, SG rats had a significantly lower systolic blood pressure (149.2 ± 1.99mmHg) than pair-fed (164.7 ± 7.87, p < 0.001) or ad-lib-fed sham rats (167.1 ± 2.41mmHg, p < 0.001). There was a significant difference in multiple measures of beta diversity between SG rats and pair-fed and ad-lib-fed sham rats. 45.11% of the difference in blood pressure variability between samples was explained with the regression Random Forest model.

SG in a rat model prevented hypertension progression independent of weight loss with changes in beta diversity and gut bacterial composition associated with the blood pressure outcome. These findings further support the metabolic efficacy of SG in treating hyperglycemia, cardiac dysfunction, and now hypertension, independent of obesity class.
SG in a rat model prevented hypertension progression independent of weight loss with changes in beta diversity and gut bacterial composition associated with the blood pressure outcome. These findings further support the metabolic efficacy of SG in treating hyperglycemia, cardiac dysfunction, and now hypertension, independent of obesity class.
Utilization of minimally invasive surgery (MIS) has multiple determinants, one being the specialization of the surgeon. The purpose of this study was to assess the differences in the utilization of MIS, associated length of stay (LOS), and complications for colorectal cancer between colorectal (CRS) and general surgeons (GS). Previous studies have documented the influence of surgical volume and surgeon specialty on clinical outcomes and patient survival following colorectal cancer surgery. It is unclear whether there are differences in the utilization of MIS for colorectal cancer based on surgeon's specialization and how this influences clinical outcomes.

Using the 2013-2015 Florida Inpatient Discharge Dataset and the National Plan & Provider Enumeration System, colorectal cancer patients experiencing a colorectal surgery were identified as well as the operating physician's specialty. Mixed-effects regression models were used to identify associations between the use of MIS, complications during the ho the use of MIS, complication, nor LOS between GS and CRS for colorectal cancer surgery. However, physician volume was associated with increased use of MIS (OR 1.26, 95% CI 1.09, 1.46) and MIS was associated with decreases in certain complications as well as reductions in LOS overall (β = - 0.16, p  less then  0.001) and for each specialty (GS β = - 0.18, p  less then  0.001; CRS β = - 0.12, p  less then  0.001) CONCLUSIONS Despite the higher amount of proctectomies performed by CRS, no difference in MIS utilization, complication rate, or LOS was found for colorectal cancer patients based on surgeon specialty. While there are some differences in clinical outcomes attributable to specialized training, results from this study indicate that differences in surgical approach (MIS vs. Open), as well as the patient populations encountered by these two specialties, are key factors in the outcomes observed.
The implementation of the laparoscopic and robotic approaches for major hepatectomy (LMH and RMH) was slower than that for minor hepatectomy, but has significantly increased over the past years. The role or advantages of RMH remains controversial, and we aimed to compare the peri-/postoperative outcomes of LMH versus RMH.

A systematic literature review was conducted using the MEDLINE and Cochrane Library databases according to the PRISMA guidelines (end-of-search date March 16th, 2020). Only comparative studies (LMH vs. RMH) reporting on outcomes of interest were included. Meta-analysis was performed using the random-effects model when substantial heterogeneity was encountered; otherwise, the fixed-effects model was implemented. Quality of evidence assessment was performed using the Newcastle-Ottawa Scale.

Seven retrospective cohort studies comparing LMH (n = 300) versus RMH (n = 225) were identified. No significant difference was observed between LMH and RMH regarding overall complications [odds ratio (OR) 1.42, 95% confidence interval (CI) 0.90-2.23; p = 0.13], severe complications (Clavien-Dindo grade ≥ 3) [risk difference (RD) 0.01, 95% CI - 0.03 to 0.05; p = 0.72], and overall mortality (RD 0.00, 95% CI - 0.02 to 0.03; p = 0.73). The two approaches were also equivalent regarding conversion to open hepatectomy (RD 0.03, 95% CI - 0.01 to 0.08; p = 0.15), margin-positive resection (OR 1.34, 95% CI 0.51-3.52; p = 0.55), and transfusion rate (RD - 0.03, 95% CI - 0.16 to 0.11; p = 0.67). No significant difference was observed for LMH versus RMH regarding blood loss [standardized mean difference (SMD) 0.27, 95% CI - 0.24 to 0.77; p = 0.30), operative time (SMD - 0.08, 95% CI - 0.51 to 0.34; p = 0.70), and length of stay (SMD 0.13, 95% CI - 0.58 to 0.84; p = 0.72).

LMH and RMH have equivalent peri-/postoperative outcomes when performed in select patients and high-volume centers.
LMH and RMH have equivalent peri-/postoperative outcomes when performed in select patients and high-volume centers.
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