Daniel W Birch

• University of Alberta

Background Prophylactic drain use during primary bariatric surgeries continues despite previous literature cautioning against their routine use. Modern drain utilization and associated outcomes remain largely poorly studied which limits selective utilization and perhaps may lead to excess morbidity and healthcare resource utilization. This study ai...

Background: The adoption of robotic bariatric surgery has increased dramatically over the last decade. While outcomes comparing bariatric and laparoscopic approaches are debated, little is known about patient factors responsible for the growing delivery of robotic surgery. A better understanding of these factors will help guide the planning of bari...

Microbial-based therapeutics in clinical practice are of considerable interest, and a recent study demonstrated fecal microbial transplantation (FMT) followed by dietary fiber supplements improved glucose homeostasis. Previous evidence suggests that donor and recipient compatibility and FMT protocol are key determinants, but little is known about t...

Purpose Small bowel obstruction (SBO) after bariatric surgery is an uncommon but important complication. We sought to characterize bariatric surgery patients who developed SBO, to compare 30-day complications, and to determine the influence of patient and procedure factors on the development of SBO. Methods and Materials All data was extracted fro...

Introduction Gastroesophageal reflux disease (GERD) is a well-established potential consequence of bariatric surgery and can require revisional surgery. Our understanding of the population requiring revision is limited. In this study, we aim to characterize patients requiring revisional surgery for GERD to understand their perioperative risks and i...

Background The need for surgical management of severe obesity in the context of inflammatory bowel disease (IBD) is becoming an increasingly common clinical scenario, yet has been met with significant reservation due to the paucity of current data from which to inform evidence-based clinical decision making. The aim of our study was to perform a sy...

COVID-19 resulted in dramatic changes to the delivery of bariatric surgery; however, the lasting effect on current and future delivery remains uncharacterized. We sought to characterize differences and trends in bariatric surgery care and outcomes between 2020 and 2021. The Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSA...

Introduction Endoscopic plication offers an alternative to surgical fundoplication for treatment of gastroesophageal reflux disease (GERD). This systematic review and meta-analysis evaluate outcomes following endoscopic plication compared to laparoscopic fundoplication. Methods and procedures Systematic search of MEDLINE, Embase, Scopus, and Web o...

Background The Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) Bariatric Surgical Risk/Benefit Calculator was developed to provide patient-specific information to assist surgical decision making. To date, no study has characterized which patients are being evaluated with this tool. Objectives We sought to characteriz...

Background The North American population with severe obesity is aging and with that so will the number of elderly patients (≥ 65 years) meeting indications for metabolic surgery. Trends in bariatric delivery in this population are poorly characterized and outcomes remain conflicting, limiting potential uptake and delivery. Methods The MBSAQIP data...

Introduction Patients undergoing bariatric surgery experience substantial risk of pre- and postoperative substance use. Identifying patients at risk for substance use using validated screening tools remains crucial to risk mitigation and operative planning. We aimed to evaluate proportion of bariatric surgery patients undergoing specific substance...

Introduction It is important to appropriately risk stratify bariatric surgery patients, as these patients often have obesity-related comorbidities which can increase postoperative complication risk but also benefit the most from bariatric surgery. We aimed to evaluate the utility of risk stratification using ASA class for bariatric surgery patients...

Download PDF Download PDF Original Article Published: 01 March 2023 Characteristics and outcomes for patients undergoing revisional bariatric surgery due to persistent obesity: a retrospective cohort study of 10,589 patients Steffane McLennan, Kevin Verhoeff, …Noah J. Switzer Show authors Surgical Endoscopy (2023)Cite this article Metricsdetails...

Purpose We sought to characterize the prevalence and subsequent impact of pre- and post-operative COVID-19 diagnosis on bariatric surgery outcomes. COVID-19 has transformed surgical delivery, yet little is known regarding its implications for bariatric surgery. Materials and Methods The Metabolic and Bariatric Accreditation and Quality Improvement...

Introduction With expansion of bariatric surgery indications to include Asian patients with diabetes and body mass index (BMI) ≥ 27.5, or BMI ≥ 32.5, it is important to characterize Asian patient population undergoing bariatric surgery and assess their postoperative outcomes. Methods This retrospective study analyzed the 2015–2019 Metabolic and Ba...

Background Effects of the COVID-19 pandemic on rates of early postoperative follow-up after bariatric surgery are poorly understood. Our study characterizes 30-day follow-up after bariatric surgery prior to COVID-19 (years 2015–2019) and during the pandemic of COVID-19 (year 2020) and evaluates general predictive factors of short-term follow-up.Met...

COVID-19 has transformed surgical care, yet little is known regarding implications for bariatric surgery. We sought to characterize the impact of COVID-19 on bariatric surgery delivery and outcomes. The Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) collects data from 885 centers in North America. The MBSAQIP databa...

Background: Interest regarding the utility of intraoperative indocyanine green (ICG) near-infrared fluorescence imaging (NFI) continues to grow. This study aims to assess frequency and perceived barriers to NFI use among general surgeons. Methods: This was an online survey sent to members of the Canadian Association of General Surgeons and the Soci...

Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) offers a novel bariatric procedure with few comparative studies evaluating patient selection or perioperative outcomes. We aim to compare SADI-S to Roux-en-Y gastric bypass (RYGB). The 2020 Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) regis...

Background: Increasing evidence suggests surgical patients are at risk for developing new, persistent opioid use (NPOU) following surgery. This risk may be heightened for patients undergoing bariatric surgery. Few studies have evaluated this important long-term outcome, and little is known about the rate of NPOU, or factors associated with NPOU for...

Background: Bariatric surgery patients are at an increased risk of new persistent opioid use (NPOU) following surgery, with perioperative opioid use increasing their risk. In addition, many patients who have had restrictive and/or malabsorptive procedures also have altered opioid absorption, potentially putting them at increased risk for opioid ove...

Purpose Single anastomosis gastric bypass (SAGB) offers a novel bariatric procedure with increasing popularity. However, its adoption, patient selection, and short-term safety remain poorly characterized. Materials and Methods The 2020 Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) was analyzed comparing SAGB to Ro...

Background The aim of the study was to characterize the prevalence of obstructive sleep apnea (OSA) in elective bariatric surgery patients and to determine if OSA is an independent predictor of 30-day serious complications and 30-day mortality among bariatric surgery patients.Methods An analysis of the MBSAQIP database from 2015 to 2019 was conduct...

Settings Patients with obesity are at increased risk of pulmonary embolus (PE), a risk that increases perioperatively and is challenging to manage. Objective An analysis of the MBSAQIP database was performed to determine predictors of PE in patients undergoing elective bariatric surgery. Methods We extracted data from the MBSAQIP (2020-2021) databa...

Background Several therapeutic modalities have been proposed for the management of choledocholithiasis (CDL) following Roux-en-Y gastric bypass (RYGB), yet debate exists regarding the optimal management. The purpose of our study was to review the current literature to compare the efficacy of various techniques in the management of CDL post-RYGB. M...

Objectives: The objectives of this study were to characterize the prevalence of atrial dysrhythmias for elective bariatric surgery patients and to explore their impact on postoperative outcomes. Setting: Data was extracted from the North American Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registr...

Background Near-infrared fluorescence imaging (NIRFI) is an increasingly utilized imaging modality, however its use amongst general surgeons and its barriers to adoption have not yet been characterized. Methods This survey was sent to Canadian Association of General Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons memb...

Introduction Decreasing the length of stay following bariatric surgery can reduce pressure on hospitals and surgical costs and increase patient satisfaction. We examine trends in length of hospital stay following bariatric surgery and in post-operative complications. Methods and Procedures The 2015–2019 Metabolic and Bariatric Surgery Accreditatio...

Purpose Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) offers a novel bariatric procedure with few comparative studies evaluating patient selection or perioperative outcomes. We aim to compare SADI-S to Roux-en-Y gastric bypass (RYGB). Materials and Methods The 2020 Metabolic and Bariatric Accreditation and Quality Improv...

Introduction Systematic reviews of retrospective studies suggest that indocyanine green (ICG) angiography reduces anastomotic leak (AL) and improves postoperative outcomes. This systematic review and meta-analysis evaluates colorectal surgery outcomes following ICG use with comparison of results found in randomized controlled trials (RCTs) and retr...

Background: Celiac disease (CD) is a clinical entity increasingly recognized in the severe obese population and its impact on outcomes following bariatric surgery is not currently understood. We aimed to systematically review the nutritional and clinical outcomes for patients with obesity and CD following bariatric surgery. Methods: Systematic sea...

Purpose Differences between complication rates of bariatric surgeries performed by general surgeons (GS) versus those performed by metabolic and bariatric surgeons (MBS) are poorly understood. Methods We analyzed the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database focusing on RYGB and SG procedures...

Introduction Increasing evidence suggests surgical patients are at risk for developing new, persistent opioid use (NPOU) following surgery. This risk may be heightened for patients undergoing bariatric surgery. Few studies have evaluated this important long-term outcome and little is known about the rate of NPOU, or factors associated with NPOU for...

Purpose The use of intragastric balloons (IGBs) for the treatment of obesity was approved by the US Food and Drug Administration in 2015. This study aims to characterize preoperative factors and outcomes of patients undergoing IGB therapy compared to bariatric surgery (non-IGB) and evaluate 5-year trends in IGB use. Methods A retrospective cohort...

Introduction: Bariatric surgery patients are at increased risk of postoperative biliary complications, a clinical spectrum of disease which are currently poorly understood and difficult to manage. This study aims to characterize patients experiencing early post-operative biliary complications and to determine risk factors associated with its occurr...

Introduction: Early recovery after surgery (ERAS) protocols outline strategies to optimize the patient preoperatively, reduce recovery time and post-operative pain. Our study examines trends in length of hospital stay as a surrogate of ERAS adoption following elective bariatric surgery and trends in post-operative complications between 2015 and 201...

Background: Differences between complication rates of bariatric surgeries performed by general surgeons versus those performed by fellowship trained bariatric surgeons are poorly understood. The objective of our study was to assess patient trends and outcomes across these two groups across elective gastric bypass and sleeve gastrectomy procedures....

Introduction: Increasing evidence suggests surgical patients are at risk for developing a new, persistent opioid use (NPOU) following surgery. This risk may be heightened for patients undergoing bariatric surgery. Few studies have evaluated this important long term outcome and little is known about the rate of NPOU or risk factors in a bariatric su...

Purpose Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) offers a novel bariatric procedure. This systematic review and meta-analysis evaluates observational and comparative studies evaluating SADI-S, with meta-analysis comparing outcomes to other malabsorptive procedures (MPs). Materials and Methods Systematic search of ME...

Introduction Patients undergoing bariatric surgery are at risk of postoperative biliary complications. This study aims to characterize biliary complications occurring within 30 days of bariatric surgery and to determine factors associated with their occurrence. Methods and Procedures The 2015–2019 Metabolic and Bariatric Surgery Accreditation and...

Bariatric surgery induces significant microbial and metabolomic changes, however, links between microbial and metabolic pathways have not been fully elucidated. The objective of this study was to conduct a comprehensive investigation of the microbial, metabolomic, and inflammatory changes that occur following Roux-en-Y gastric bypass (RYGB) and sle...

Background COVID-19 has transformed surgical care, yet little is known regarding implications for bariatric surgery. Objectives We sought to characterize the impact of COVID-19 on bariatric surgery delivery and outcomes. Setting The Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) collects data from 885 centers in Nor...

Abstract Objective Pulmonary complications in patients with obesity carry a high morbidity and mortality. An analysis of the MBSA- QIP database was performed to determine the effect of post-operative pulmonary complications on patients undergoing elective bariatric surgery, with the primary outcome of 30-day mortality. Methods We extracted data fro...

PurposeIncidence of super obesity (SO; BMI ≥ 50 kg/m2) is growing rapidly and confers worse metabolic complications than non-SO (BMI 30–50 kg/m2). We aim to characterize bariatric surgery patients with SO, their postoperative complications, and treatment trends over the last 5 years in hopes of informing SO-specific treatment protocols.Materials an...

Background: Hypoalbuminemia (HA) may be an important and underinvestigated predictor of serious complications and mortality among patients who undergo bariatric surgery. The aims of this study were therefore to (1) determine the preva- lence of HA and clinical characteristics of HA among patients who undergo bariatric surgery, (2) compare complicat...

Background: Postsurgical anatomy poses unique challenges to the management of choledocholithiasis after Roux-en-Y gastric bypass (RYGB). This study compares the efficacy and safety of various strategies used in its management. Methods: Studies reporting on the management of choledocholithiasis in patients after RYGB and including at least 5 patient...

Background: With the growing prevalence of bariatric proce- dures performed worldwide, it is important to understand the timing of postoperative complications following bariatric sur- gery and the differences that may exist between procedures. Methods: This retrospective study was conducted using the Metabolic and Bariatric Surgery Accreditation an...

Choledocholithiasis

Roux-en-Y gastric bypass (RYGB)-induced glycemic improvement is associated with increases in glucagon-like-peptide-1 (GLP-1) secreted from ileal L-cells. We analyzed changes in ileal bile acids and ileal microbial composition in diet-induced-obesity rats after RYGB or sham surgery to elucidate the early and late effects on L-cells and glucose homeo...

Introduction Bariatric surgery is an evidence-based approach for sustained weight loss in patients with severe obesity. The most common procedures in North America are the laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). The Edmonton Obesity Staging System (EOSS) is a tool that assigns patients a score of 0 t...

Introduction Cameron lesions (CL) are an under-recognized cause of gastrointestinal bleeding. Diagnosis is often impaired by technical difficulty, and once diagnosed, management remains unclear. Typically, patients are medically managed with proton pump inhibitors (PPI). Small studies have demonstrated improved therapeutic success with surgical man...

Background Major adverse cardiac events (MACE) after bariatric surgery are poorly understood yet are thought to be associated with significant morbidity and mortality. Objectives (a) to evaluate the prevalence and clinical impact of short-term 30-day MACE. (b) to develop a pragmatic clinical predictive MACE scoring tool Setting This retrospective...

Purpose With the growing prevalence of bariatric procedures performed worldwide, it is important to understand the timing of postoperative complications following bariatric surgery and the differences which may exist between procedures. Methods This retrospective study was conducted using the Metabolic and Bariatric Surgery Accreditation and Quali...

PurposeThe aims of this study were to (1) characterize the prevalence of hypoalbuminemia (HA), (2) compare complication rates among HA and non-HA patients, and (3) determine the influence of HA on postoperative complications and 30-day mortality among bariatric surgery patients.Materials and Methods Data was extracted from the MBSAQIP registry from...

Fecal microbial transplantation (FMT) from lean donors to patients with obesity has been associated with metabolic benefits, yet results so far have been inconsistent. In this study, we tested the application of daily fiber supplementation as an adjunct to FMT therapy to modulate cardiometabolic outcomes. We performed a double-blind randomized tria...

Background The effects of pre-operative weight loss on bariatric surgery outcomes are still unclear, despite the practice being adopted by bariatric centers worldwide. Ongoing studies are needed for routine adoption of this practice given the multiple issues patients face with following difficult pre-operative weight loss protocols. The aim of this...

Background: Gastrointestinal surgery imparts dramatic and lasting imbalances, or dysbiosis, to the composition of finely tuned microbial ecosystems. The aim of the present study was to use a mouse ileocecal resection (ICR) model to determine if tributyrin (TBT) supplementation could prevent the onset of microbial dysbiosis or alternatively enhance...

Purpose: Early sleeve stenosis (SS) is a rare complication of laparoscopic sleeve gastrectomy (LSG) and is associated with significant morbidity and economic burden. The objective of this study was to determine the prevalence and impact of early SS and identify technical factors which may predict its development. Materials and Methods: Data was ext...

Background: Severe obesity is increasingly common in youth and young adults, but outcomes following bariatric surgery remain largely unknown. The purpose of this study was to examine the trends, clinical characteristics, and postoperative outcomes of youth who underwent bariatric surgery. Methods: This retrospective cohort study was conducted us...

Delays in the delivery of bariatric surgery in Canada in the context of the COVID-19 pandemic have not been previously explored. Understanding the potential barriers associated with these delays may help in the implementation and delivery of enhanced bariatric protocols, thereby minimizing health care system burden and improving bariatric delivery....

Background: Severe obesity is associated with adverse health outcomes and increased risk of death. This study evaluates the real-world cost-utility of therapy for severe obesity, from the publicly funded health care system and societal perspectives. Methods: We conducted a cost-utility analysis using primary data from a prospective observational...

Background Given there are approximately 100,000 primary laparoscopic sleeve gastrectomy (LSG) procedures performed a year in North America, there is a need to evaluate recent trends in LSG. The objective of this study was to analyze the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) to identify trends in te...

Background Obesity is a major risk factor for transplant. Laparoscopic bariatric surgery (LBS) offers transplant patient benefits including improved comorbidities, graft function, and longevity. We completed a scoping review and analyzed the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) to determine the ris...

Background: A number of procedural and technical factors have been adopted over time to optimize outcomes following Roux-en-Y gastric bypass (RYGB). An understanding of the evolution and impact of these factors is needed to continue improving the safety and proficiency of RYGB. Methods: Data was extracted from the Metabolic and Bariatric Surgery Ac...

Objectives The aim of this study was to a) characterize the prevalence of and clinical characteristics of bariatric surgery patients with respect to discharge disposition and to b) evaluate factors which predict alternate care facility (ACF) discharge. Settings Data was extracted from the Metabolic and Bariatric Surgery Accreditation and Quality I...

Purpose: The last five years have produced a dramatic transformation in the landscape of bariatric and metabolic surgery. Yet, while the landscape of bariatric procedures is changing, little is known about these trends or which factors are responsible for their evolution. Methods and Methods: All primary elective laparoscopic Roux-en-Y gastric bypa...

Background The Edmonton Obesity Staging System (EOSS) is a staging system describing comorbidities and functional limitations associated with obesity, thus facilitating the prioritization of patients for bariatric surgery. Our objective was to elucidate any associations of EOSS scores with major complications after laparoscopic Roux-en-Y gastric by...

Background Fluorescence imaging during hepatic resection has the potential to identify additional malignant tumors, increasing the chance for complete tumor resection. Indocyanine green (ICG) is an FDA approved, fluorescent dye used in a variety of surgical procedures. The objective of this study was to define the sensitivity of intraoperative ICG...

Objective The use of sentinel lymph node biopsy (SLNB) has been gaining popularity with the emergence of indocyanine green (ICG) fluorescence imaging. We aimed to systematically review the literature and perform a meta-analysis on the diagnostic accuracy of SLNB using ICG for lung cancer.MethodsA comprehensive search of MEDLINE, EMBASE, SCOPUS, Web...

Background Although bariatric surgery is a safe procedure for severe obesity, incisional surgical site infections (SSI) remain a significant cause of morbidity. Bariatric surgery patients are at high risk due to obesity and diabetes. The objective of this study was to develop a predictive tool for incisional SSI within 30 days of bariatric surgery....

Introduction: Recent research has demonstrated an association between obesity and migraine headaches. Furthermore, studies have demonstrated that migraine improvement can occur with significant weight loss. Given that bariatric surgery is the most effective intervention for obesity and obesity-related comorbidities, there is potential for bariatri...

Background Obesity has been found to be an independent predictor of adverse cardiac and pulmonary embolic events. As the popularity of bariatric surgery grows, surgeons are encountering more patients taking therapeutic anticoagulation medications preoperatively. This study aims to assess the safety of bariatric surgery on these patients. Methods D...

Background Bariatric surgery on patients with body mass index (BMI) ≥ 50 kg/m², historically known as superobesity, is technically challenging and carries a higher risk of complications. Bridging interventions have been introduced for weight loss before bariatric surgery in this population. This systematic review and meta-analysis aims to assess th...

Background Chronic immunosuppression can put surgical patients at additional risk for complications, particularly infection. This is not a contraindication for patients undergoing bariatric surgery. However, with the increasing prevalence of bariatric surgery, it is important to characterize the additional risks for immunosuppressed patients. Meth...

Background: Paraesophageal hernias (PEH) are common among patients with obesity. Most patients with severe obesity and a PEH will have the PEH repaired at the time of bariatric surgery. However, it is unclear whether there is increased risk when repairing a PEH during bariatric surgery. Objectives: To examine short-term outcomes of patients unde...

Background: Hospital readmissions after bariatric surgery can significantly increase health care costs. Rates of readmission after bariatric surgery have ranged from 0.6% to 11.3%, but the rate of complications and the factors that predict readmission have not been well characterized in Canada. The objective of this study was to characterize readm...

Background: Bariatric surgery has been shown to induce type 2 diabetes mellitus (T2DM) remission in severely obese patients. After laparoscopic Roux-en-Y gastric bypass (LRYGB), diabetes remission occurs early and independently of weight loss. Previous research has identified preoperative factors for remission, such as duration of diabetes and HbA...

Background: Bleeding after laparoscopic sleeve gastrectomy (LSG) is an important complication associated with significant morbidity and a drastic increase in healthcare resources. Multiple strategies have been developed to minimize bleeding, including varying bougie size, line reinforcement, and intra-operative tranexamic acid. These techniques, h...

Background: The number of bariatric procedures performed on complex, oxygen-dependent patients has increased. These patients often have other medical co-morbidities that can be improved after bariatric surgery; however, questions remain regarding their perioperative risk. Objective: To assess the safety of bariatric surgery among oxygen-dependen...

Background Ventral hernias are a common finding during bariatric surgery; however, the risks and benefits of repair during surgery remain unclear. Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, we examined the short-term outcomes of patients undergoing bariatric surgery with concurrent ve...

Background Obesity is associated with disturbances in the gut microbiota which is a risk factor for Clostridium difficile infection (CDI). Bariatric surgery can induce substantive changes to the gut microbiota which may affect the risk of developing CDI. Methods The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program capt...