Weight loss maintenance after bariatric surgery

Metabolic and bariatric surgery(MBS)is an effective treatment for patients with morbid obesity and its comorbidities.However,many patients experience weight regain(WR)after achieving their nadir weight.Establishing the definition of WR is challenging as postoperative WR has various definitions.Risk factors for WR after MBS include anatomical,racial,hormonal,metabolic,behavioral,and psychological factors,and evaluating such factors preoperatively is necessary.Long-term regular follow-up and timely treatment by a multidisciplinary team are important because WR after surgery is multi-factorial.Although lifestyle interventions that focus on appropriate dietary education,physical activity education or interventions,and behavioral psychological interventions are suggested,more well-designed studies are needed because studies evaluating intervention methods and the effectiveness of WR prevention are lacking.Antiobesity drugs can be used to prevent and manage patients with WR after MBS;however,more research is needed to determine the timing,duration,and type of anti-obesity drugs used to prevent WR.

Postoperative adjuvant chemoradiotherapy in D2-dissected gastric cancer: Is radiotherapy necessary after D2-dissection?

Studies from the Far East have demonstrated that D2-dissection is superior to D0/1-dissection. The effect of postoperative chemoradiotherapy(CRT) after D2-dissection has not been accepted due to the lack of D2-dissection in Western countries, as well as the potential harmful effect of radiotherapy. In the current NCCN guideline, adjuvant chemotherapy alone is recommended in D2-dissected patients. However, three recent prospective randomized controlled trials in South Korea and China(ARTIST, NCC and Multicenter IMRT Trials) demonstrated that adjuvant CRT can be safely administered to D2-dissected patients with notable benefits. To identify the role of radiotherapy(RT) in the D2-dissected postoperative setting, clinical research attempts should include(1) identification of high-risk patients for loco-regional recurrence who might benefit from CRT;(2) modification of RT target volume based on the findings that failure patterns should be different after D1- and D2-dissection; and(3) integration of new RT techniques to decrease treatment-related toxicity. The present paper is a review of recent studies addressing these fields. Well-designed prospective randomized studies are needed to clearly define the role of adjuvant CRT in D2-dissected gastric cancer, however, future clinical studies should also focus on answering these questions.

Hoarseness of voice and discomfort in the throat observed after quadratus lumborum block

To the Editor:Transmuscular quadratus lumborum block(TQLB)is known to provide visceral analgesia by blocking sympathetic fibers by spreading into the thoracic paravertebral spaces.[1]It is relatively safer than other conventional methods of analgesia.However,to our knowledge,there have been no reports of hoarseness associated with TQLB.Herein,we report two cases of hoarseness and discomfort to the throat after TQLB.

Novel saline injection technique for the reversal of the continuous costoclavicular block

To the Editor:Although regional anesthesia provides prolonged post-operative analgesia,there is no suitable method that can facilitate an early reversal of the blockade until the duration of action of the local anesthetic has elapsed.A large quantity of saline is used to reverse the central neuraxial block.[1,2]However,to our knowledge,no study has reported a method for reversing nerve blockade in peripheral nerve blocks,especially costoclavicular blocks.Herein,we report a case of dramatic recovery of both motor and sensory functions after saline injection through the catheter in a patient who was administered a continuous costoclavicular block for analgesia after shoulder surgery.