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The enemy of good is better, colonic obstruction post gastric bypass: an international video case series
We present 3 cases of transverse colon obstruction after antecolic-antegastric Roux-en-Y gastric bypass (RYGB) and describe the technical steps in relieving the obstruction. All patients have consented and approved to publish this work.Effects of body composition profiles on oncological outcomes and postoperative intraabdominal infection following colorectal cancer surgery
Anthropometric data as prognostic factors of colorectal cancer are promising but contradictory. The aim of this study was to assess the preoperative body composition profiles as predictive factors for postoperative, oncologic, and inflammation outcomes.Laparoscopic duodenojejunostomy to manage small bowel obstruction due to superior mesenteric artery syndrome after Roux-en-Y gastric bypass
Superior mesenteric artery (SMA) syndrome (Wilkie or cast syndrome) is a rare disease that was first described in 1842. It is seen in patients most often after dramatic weight loss due to starvation, burns, anorexia nervosa, or bariatric surgery.Laparoscopic conversion from mini gastric bypass/1 anastomosis gastric bypass to Roux-en-Y gastric bypass for perforated marginal ulcer: video case report
In 1997, Rutledge [1] introduced a new bariatric procedure consisting of a single anastomosis gastric bypass, which he named a mini gastric bypass (MGB).Single and dual anastomosis duodenal switch for obesity treatment: a single-center experience
Biliopancreatic diversion with duodenal switch (BPD/DS) is the most effective bariatric surgery in super-obese patients, although technically complex and time consuming. As a primary surgery, single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is similar to BPD/DS in terms of short-term outcomes, but long-term and comparative data are lacking.Effect of surgical versus medical therapy on estimated cardiovascular event risk among adolescents with type 2 diabetes and severe obesity
Cardiovascular disease (CVD) remains the leading cause of mortality in type 2 diabetes (T2D). Better interventions are needed to mitigate the high lifetime risk for CVD in youth T2D.Counterregulatory responses to postprandial hypoglycemia after Roux-en-Y gastric bypass
Postbariatric hypoglycemia (PBH) is a potentially serious complication after Roux-en-Y gastric bypass (RYGB), and impaired counterregulatory hormone responses have been suggested to contribute to the condition.Factors implicated in discharge disposition following elective bariatric surgery
Current bariatric surgery studies have focused on traditional outcomes such as mortality and morbidity and have thus far have neglected an important marker of surgical care- discharge destination.Concurrent hiatal hernia repair and bariatric surgery: outcomes after sleeve gastrectomy and Roux-en-Y gastric bypass
Hiatal hernias are often repaired concurrently with bariatric surgery to reduce risk of gastroesophageal reflux disease–related complications.Long-term outcomes of Roux-en-Y gastric diversion after failed surgical fundoplication in a large cohort and a systematic review
Roux-en-Y gastric diversion (RNYG) is an alternative approach for patients with persistent or recurrent gastroesophageal reflux disease (GERD) after surgical fundoplication, especially in patients with esophageal dysmotility or morbid obesity, because redo fundoplication could offer unfavorable outcomes.First prospective clinical trial of reduced incision bariatric procedures using magnetic liver retraction
Exposure of the surgical field is an essential component of minimally invasive surgery. Liver retraction is an important element of bariatric procedures because visualization of the stomach and gastroesophageal junction is key. The magnetic surgical system provides a well-tolerated and effective option for adjustable liver retraction without the use of a dedicated port.Laparoscopic modified Nissen fundoplication over Roux-en-Y gastric bypass and hiatal hernia repair for intractable gastroesophageal reflux
Roux-en-Y gastric bypass (RYGB) is an effective treatment for morbid obesity and gastroesophageal reflux disease (GERD) [1] Despite majority of patients with resolution of GERD after RYGB, some patients will continue to complain of significant, persistent reflux symptomatology or develop de novo symptoms despite aggressive medical management. Its true incidence is unknown and 1 study showed an improvement in GERD but not resolution in 22% of patients after RYGB with GERD [2]. Possible mechanisms may include primary lower esophageal sphincter incompetence, disruption of the angle of His, or development of hiatal hernia with intrathoracic migration of the gastric pouch.Laparoscopic sleeve gastrectomy after endoscopic sleeve gastroplasty and primary obesity surgery endoluminal: technical aspects
Endoscopic techniques have emerged as effective treatments for overweight and obesity; the intragastric balloon is the most widely practiced procedure [1]. Endoscopic sleeve gastroplasty (ESG) entails gastric volume reduction via placement of full-thickness suturing of the anterior wall, greater curvature, and posterior wall of the stomach. The stomach is imbricated and shortened from the antrum to the gastroesophageal junction to create sleeve-like anatomy by using The OverStitch device (Apollo Endosurgery, Austin, TX, USA) [2].Laparoscopic resection of intussusception after Roux-en-Y gastric bypass: comparison between the conventional and a simplified approach
Intussusception after Roux-en-Y gastric bypass (RYGB) is a rare, long-term complication most commonly occurring in a retrograde fashion just distal to the jejunojejunostomy with approximately .5% incidence [1]. Management options include reduction, pexy, and resection of jejunojejunostomy [2–4]. Our traditional approach in management of symptomatic intussusception is resection and creation of new jejunojejunostomy,y preferably end-to-side anastomosis with a smaller anastomosis of <60 mm. In this video, we compare 2 techniques used to resect the anastomosis.Laparoscopic revision of a transected silastic vertical gastric bypass (Fobi pouch) with totally hand sewn gastrojejunostomy for complicated marginal ulcer
Transected silastic vertical gastric bypass (Fobi pouch bypass) is a modified open gastric bypass, introduced by Dr. Mathias Fobi in 1990s. Although long-term weight maintenance is excellent, it was not widely adopted by bariatric surgeons in the minimally invasive era. This video illustrates a laparoscopic approach to a particularly complicated marginal ulcer that was eroding into the liver and pancreas.Comment on: Slipped capital femoral epiphysis and Blount’s disease as indicators for early metabolic surgical intervention
Patient selection criteria for adolescent metabolic bariatric surgery (MBS) have historically included adolescents who have achieved an extreme body mass index value, have developed a major complication of their obesity that would justify surgical therapy, show evidence of physiologic maturity evidence of mature decision-making, and demonstrate understanding of the dietary and physical activity changes that are required for optimal postoperative outcomes.Laparoscopic repair of diaphragmatic hernia with mesh after sleeve gastrectomy
The patient was a 46-year-old female with a history of morbid obesity and was post–laparoscopic sleeve gastrectomy (performed at an outside institution), complicated by a left diaphragmatic thermal injury. On review of the sleeve gastrectomy operative dictation, an approximately 3-cm defect was incidentally made in the left diaphragm by a harmonic scalpel; this was repaired primarily with interrupted permanent suture at that time. She presented 3 years later with a several-day history of emesis, obstipation, and left upper quadrant abdominal pain.Eating expectancies before bariatric surgery: assessment and associations with weight loss trajectories
While presurgical eating behaviors have demonstrated limited prognostic value, cognitions regarding the effects of eating may serve as important predictors of weight loss outcomes after bariatric surgery. The Eating Expectancies Inventory (EEI) is a commonly used, self-report measure of expected consequences of eating; however, its psychometric and predictive properties have not yet been evaluated among bariatric surgery patients.Predictors and outcomes of bleed after sleeve gastrectomy: an analysis of the MBSAQIP data registry
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, however, have been implemented without a clear understanding of the pre-, intra-, and postoperative predictors of bleeding in patients undergoing SG.Sleeve gastrectomy in patients with previous antireflux surgery. Preliminary results of the “no-touch to posterior wrap” technique
Reported morbidity of Roux-en-Y gastric bypass in patients with previous antireflux surgery warrants caution, and data on sleeve gastrectomy (SG) are unexpectedly scarce.Combined robotic/laparoscopic sleeve gastrectomy with transit bipartition for an obese patient with complicated metabolic syndrome
A recent international consensus conference stated that metabolic surgery should be a recommended option to treat diabetes regardless of the level of glycemic control. This video demonstrates combined robotic/laparoscopic sleeve gastrectomy with transit bipartition for an obese patient with complicated metabolic syndrome. The procedure was performed at a university hospital.Clinical periodontal conditions in individuals after bariatric surgery: a systematic review and meta-analysis
The aim of the present study was to perform a systematic review and meta-analysis to assess the influence of bariatric surgery on the clinical periodontal conditions in patients with obesity. This review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and registered at the International Prospective Registry of Systematic Reviews (CRD42018099313). A search was conducted by 2 investigators in the PubMed/MEDLINE, Web of Science, and Cochrane Library databases for relevant articles published up to May 2018.One-year follow-up of a dissonance-based intervention on quality of life, wellbeing, and physical activity after Roux-en-Y gastric bypass surgery: a randomized controlled trial
Health-related quality of life (HRQoL) peaks around 1 year after Roux-en-Y gastric bypass (RYGB) surgery, and thereafter, in many patients, slowly deteriorates.Does pregnancy increase the risk of cholecystectomy following bariatric surgery? A cross-sectional cohort study
Reproductive-aged women constitute a substantial proportion of patients who undergo weight loss procedures. While the risk of gallstone disease after such procedures has been addressed extensively, the impact of pregnancy on gallstone disease after bariatric procedures has not been reported.
