Multimedia Library
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.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.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.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.Mental disorders and weight change in a prospective study of bariatric surgery patients: 7 years of follow-up
Long-term, longitudinal data are limited on mental disorders after bariatric surgery.Laparoscopic Heller myotomy after previous Roux-en-Y gastric bypass
Obesity has been shown to be an independent risk factor for developing esophageal motility disorders, with a prevalence of 20% to 61% [1–4]. Achalasia is a rare primary esophageal motility disorder that is even more rare among the obese population. It is characterized by aperistalsis of the esophagus and lack of relaxation of the lower esophageal sphincter. Associated symptoms in the nonobese patient include dysphagia, regurgitation, reflux, and weight loss. On the contrary, among the obese population regurgitation, cough and aspiration are the presenting symptoms.Surgery-related gastrointestinal symptoms in a prospective study of bariatric surgery patients: 3-year follow-up
Having accurate information on bariatric surgery-related gastrointestinal (GI) symptoms is critical for patient care.Laparoscopic revision of transoral endoscopic vertical gastroplasty to Roux-en-Y gastric bypass
There are a number of endoscopic bariatric therapies, which have been proven to be safe and effective in the treatment of obesity [1]. The transoral endoscopic vertical gastroplasty (TOGA) is an endoscopic procedure in which flexible instruments are introduced through the mouth, passed to the stomach, and used to acquire tissue along the anterior and posterior stomach walls, fold the tissue, and staple it to create a restrictive pouch [2]. This procedure has been shown to be safe and produce up to 44.8% excess weight loss at one year [2,3].Anastomotic techniques in open Roux-en-Y gastric bypass: primary open surgery and converted procedures
Open Roux-en-Y gastric bypass (RYGB) may be chosen because of known widespread adhesions or as a result of conversion during laparoscopic surgery. Although conversions are rare, they occur even in experienced hands. The gastrojejunostomy may be performed with a circular stapler (CS) or a linear stapler (LS) or may be entirely hand sewn (HS). Our aim was to study differences in outcomes regarding the anastomotic techniques utilized in open surgery.Laparoscopic revision of chronic marginal ulcer and bilateral truncal vagotomy
In accredited centers, bariatric surgery is performed with very low mortality, morbidity, and readmission rates [1–3]. However, a small number of bariatric patients develop postoperative complications such as marginal ulcers. Previous reports cite the incidence of marginal ulcer with significant variability, from .6% to 16% [4]. The etiology of marginal ulcers after a laparoscopic Roux-en-Y gastric bypass is a matter of debate. Many factors are believed to contribute to the development of marginal ulcers, such as smoking, ischemia, foreign body reaction, gastrogastric fistulas, large gastric pouches, and tension at the anastomosis [5–9].Plateaued national utilization of adolescent bariatric surgery despite increasing prevalence of obesity-associated co-morbidities
The number of adolescent bariatric surgeries (ABS) performed from 2003 to 2009 has been stable despite reports of an increase in adolescent morbid obesity.Effect of Roux-en-Y gastric bypass-induced weight loss on the transcriptomic profiling of subcutaneous adipose tissue
The changes in the transcriptomic profiling of subcutaneous adipose tissue (SAT) when weight loss stabilizes after a Roux-en-Y gastric bypass (RYGB) are still largely unknown.Laparoscopic hand sewn regastrojejunostomy for complicated Roux-en-Y gastric bypass
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a popular bariatric procedure associated to potential risk of late complications like anastomotic marginal ulceration, stricture, fistula formation, weight gain, and nutritional deficiencies [1–6].A population-based, shared decision-making approach to recruit for a randomized trial of bariatric surgery versus lifestyle for type 2 diabetes
Randomized trials of bariatric surgery versus lifestyle treatment likely enroll highly motivated patients, which may limit the interpretation and generalizability of study findings. The objective of this study was to assess the feasibility of a population-based shared decision-making (SDM) approach to recruitment for a trial comparing laparoscopic Roux-en-Y gastric bypass surgery with intensive lifestyle intervention among adults with mild to moderate obesity and type 2 diabetes.Risk stratification of serious adverse events after gastric bypass in the Bariatric Outcomes Longitudinal Database
There is now sufficient demand for bariatric surgery to compare bariatric surgeons and bariatric centers according to their postsurgical outcomes, but few validated risk stratification measures are available to enable valid comparisons. The purpose of this study was to develop and validate a risk stratification model of composite adverse events related to Roux-en-Y gastric bypass (RYGB) surgery.Endoscopic neogastrogastrostomy in a postgastric bypass patient by application of an endoscopic antegrade–retrograde rendezvous technique
The patient, a 45-year-old woman, initially underwent Roux-en-Y gastric bypass for morbid obesity. Three years later, it was complicated by a gastrojejunostomy ulcer with perforation requiring local repair. Additional complications with ischemic bowel and subsequent surgical revisions resulted in complete gastric outlet obstruction. A venting gastrostomy tube was placed in the gastric pouch, and a feeding gastrostomy tube was surgically placed in the gastric remnant. After some time, the patient strongly expressed her desire to eat orally.Long-term results 11 years after primary gastric bypass in 384 patients
Roux-en-Y gastric bypass surgery (RYGB) as treatment of morbid obesity results in substantial weight loss. Most published long-term studies have included few patients at the last follow-up point. The aim of the present study was to explore long-term results in a large cohort of patients 7–17 years after gastric bypass.Laparoscopic revision of gastrojejunostomy and vagotomy for intractable marginal ulcer after revised gastric bypass
The incidence of marginal ulceration after gastric bypass has been reported with significant variability (1–16%) [1]. Although its pathogenesis is unclear, several factors are associated with ulcer formation, including acid exposure, ischemia, foreign body, medications, and tobacco. In general, pharmacologic therapy is highly effective for ulcer healing, and surgical intervention is usually reserved for complications—typically bleeding or perforation. Rarely, surgical intervention is indicated for cases refractory to medical therapy.Malrotation—an unexpected finding at laparoscopic Roux-en-Y gastric bypass: a video case report
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is 1 of the most common procedures performed for severe obesity. Incidental anatomic abnormalities found at surgery are uncommon and can require an alternative operative approach. We present a video case report of a patient incidentally found to have midgut congenital malrotation at LRYGB.Plication followed by resection for intussusception after laparoscopic gastric bypass
Laparoscopic Roux-en-Y gastric bypass is the most commonly performed surgical intervention for morbid obesity. Internal hernias are the most common cause of postoperative bowel obstruction after laparoscopic Roux-en-Y gastric bypass, with a reported incidence of 3.1% despite mesenteric defect closure [1,2]. A less common cause of postoperative bowel obstruction is small bowel intussusception.Laparoscopic repair of internal hernia during pregnancy after Roux-en-Y gastric bypass
Laparoscopic Roux-en-Y gastric bypass as a treatment of severe obesity has increased dramatically in the past decade, and most of the patients have been women [1,2]. The health risks experienced by obese women during pregnancy can be reduced by the weight loss induced by bariatric surgery [3–5], but these patients are at risk of bariatric surgical complications during their pregnancies. Women who have undergone Roux-en-Y gastric bypass for morbid obesity are at risk of internal hernias, intussusception, and small bowel obstruction during pregnancy, which can lead to maternal and/or fetal death [6].Laparoscopic Roux-en-Y gastric bypass after previous Nissen fundoplication
The prevalence of both gastroesophageal reflux disease (GERD) and obesity has increased significantly during the past 25 years, and an association between the 2 has been demonstrated [1–6]. Laparoscopic Nissen fundoplication has been shown to be safe and effective in the treatment of GERD and to offer significant advantages compared with long-term medical therapy [7–12]. However, it might have decreased efficacy in morbidly obese patients [13,14]. Thus, an increasing number of patients might require a bariatric procedure after previous Nissen fundoplication, whether for weight loss or recurrent reflux [15].
