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Laparoscopic sleeve gastrectomy for class III obesity in a patient with a left ventricular assist device (LVAD) Heartmate III
We describe the successful management of an obese patient suffering end-stage heart failure by the combination mechanical circulatory support, using a left ventricular assist device (LVAD), and bariatric surgery, using laparoscopic sleeve gastrectomy (LSG).Is age a real or perceived discriminator for bariatric surgery? A long-term analysis of bariatric surgery in the elderly
Obesity has become an epidemic in the United States and around the world. At the same time, we are seeing an aging of human populations both nationally and globally. The U.S. Census Bureau projects that the percentage of the population aged ≥65 years will increase from 13.7% in 2012 to 16.8% in 2020 to 20.3% in 2030 [1]. This trend holds true on the global scale with 8.5% of the world population being ≥65 years in 2015, and expected to nearly double to 16.7% in 2050. From 2011 to 2014 the obesity rate in the U.S.Simplified laparoscopic Hill repair for the treatment of symptomatic sliding hiatus hernia after bariatric surgery
Sliding hiatus hernia (SHH) is a frequent condition associated with obesity [1]. After Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), SHH may be asymptomatic, may predispose to gastroesophageal reflux disease (GERD) [2], and occasionally may trigger painful dysphagia. The pathophysiology of pain is thought to be related to the rubbing of the gastric staple line on the left diaphragmatic pillar, transmitted by the left phrenic nerve [3].Fifth International Consensus Conference: current status of sleeve gastrectomy
For the purpose of building best practice guidelines, an international expert panel was surveyed in 2014 and compared with the 2011 Sleeve Gastrectomy Consensus and with survey data culled from a general surgeon audience.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.Hypopharyngeal perforation with mediastinal dissection during orogastric tube placement: a rare complication of bariatric surgery
Although currently considered the most successful treatment for morbid obesity, bariatric surgery is associated with certain complications. Placement of an orogastric tube or bougie has resulted in complications because of overstapling or suturing [1,2]. Iatrogenic upper aerodigestive tract perforation, such as hypopharyngeal or esophageal perforation, can occur during endotracheal intubation or esophagogastroduodenoscopy [3,4] and, by contrast, is extremely rare after placement of an orogastric tube or bougie in bariatric surgery [3–8].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.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.Late gastric perforation after insertion of intragastric balloon for weight loss—video case report and literature review
The BioEnterics intragastric balloon (BIB) is used in the treatment of morbid obesity, as a method for short-term weight loss, especially before definitive surgery. Previous studies have demonstrated that patients who have a BIB inserted can achieve ≤48% reduction of their excess weight, although this is not maintained in the long term [1–5]. The BIB is recommended to stay in place for 6 months and either removed or replaced after that period, because the risk of spontaneous rupture owing to material degradation increases.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.Conversion of laparoscopic adjustable gastric band to robot-assisted laparoscopic biliopancreatic diversion with duodenal switch
The laparoscopic adjustable gastric band (LAGB) is the most commonly performed restrictive operation for morbid obesity. The LAGB is associated with a mean excess weight loss (EWL) of 50%, as well as a decrease in morbidity and mortality through the resolution of co-morbid conditions, such as diabetes mellitus. Despite these benefits, ≤33% of patients will experience a complication, including port infections or leaks, slippage, pouch dilation, erosion, and food intolerance. Furthermore, nearly 40% of patients will not achieve their target of 50% EWL, necessitating an additional intervention [1–3].Video case report: multiple intraperitoneal transections of Lap-Band tubing with descending colon inflammation: cause or effect?
We present the case of a patient with a rare complication of laparoscopic gastric banding. The patient presented with vague, left-sided abdominal pain 23 months after Lap-Band (Allergan, Irvine, CA) placement. Radiographic studies revealed complete disruption of the intraperitoneal Lap-Band tubing with descending colonic inflammation. Operative exploration revealed an abnormally stiff section of tubing with 1 complete transection and another partial disruption, neither of which were located at the connector site.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].Laparoscopic management of chronic gastric pouch fistula after laparoscopic gastric bypass
We present the case of a 47-year-old man who had undergone uneventful antecolic antegastric laparoscopic Roux-en-Y gastric bypass (LRYGB) in June 2002 for super morbid obesity. Ten months later, laparoscopic reduction of an internal hernia at the jejunojejunostomy was performed for an acute small bowel obstruction. Three months later, he underwent laparoscopic gastric pouch trimming for failure of weight loss, epigastric pain, marginal ulceration, and an increasing ability to tolerate larger food volumes with pouch dilation.Surgical implantation and adjustment technique with the Realize Band System
Laparoscopic adjustable gastric banding (LAGB) for the treatment of morbid obesity (body mass index ≥40 kg/m2 or ≥35 kg/m2 with co-morbidities [1]) is the safest of the bariatric procedures [2–4]. LAGB is associated with weight loss efficacy [5–10], resolution of weight-related co-morbid disease [11–13], and improvements in quality of life [14]. In widespread use in Europe and other countries since 1996 [15], LAGB has become the most prevalent bariatric operation outside of the United States [16].Laparoscopic adjustable gastric banding
Laparoscopic adjustable gastric banding (LAGB) brings several unique aspects to bariatric surgery. It has provided a very safe, effective, reversible, and adjustable system that is widely applicable. The first human LAGB procedure, using the Lap-Band system (INAMED Health, Santa Barbara, CA), was performed on September 1, 1993 [1]. Since then, more than 130,000 Lap-Band devices have been placed, and more than 100 peer-reviewed reports on its use have been published. The extent of the literature on the outcomes of LAGB surgery is comparable (and, in certain aspects, superior) to that on alternative bariatric surgery.Gastric bypass for severe obesity: Approaches and outcomes
Bariatric surgery has experienced unprecedented growth in the United States during the last 10 years [1]. Compared with the late 1980s and early 1990s, when approximately 15,000 bariatric operations were performed each year, in 2003 more than 100,000 bariatric operations were performed in the United States. This growth in bariatric surgery, the fastest-growing major operation in the United States, can be explained by 3 factors: (1) the 4-decades-old epidemic of obesity, (2) steadily improving outcomes for several bariatric operations, and (3) the introduction of laparoscopic bariatric surgery with improved perioperative outcomes.
