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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 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.Robotic-assisted conversion of Nissen fundoplication to Roux-en-Y gastric bypass (avoiding pitfalls)
Conversion of Nissen fundoplication to Roux-en-Y gastric bypass can be technically challenging due to factors present for any reoperation, such as presence of scar tissue, altered tissue planes, and often unclear anatomy. Meticulous hiatus and wrap dissection, repair of hiatal hernia if present, complete unwrapping of the fundoplication and clarification of gastric redundancy before pouch creation, and preservation of the left gastric artery are keys to improving outcomes and reducing morbidity.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.Laparoscopic conversion of Roux-en-Y gastric bypass to omega loop gastric bypass
The Roux-en-Y gastric bypass (RYGB) has been performed for>3 decades and is the procedure of choice for severe obesity with metabolic disorders in most of the bariatric surgical centers worldwide [1]. Nevertheless, RYGB is a technically demanding procedure, with a learning curve of>75 cases and a complication rate ranging between 5% and 10% [2,3]. RYGB has been the standard procedure in bariatric surgery; however, some patients have not achieved the intended weight loss. In contrast, omega loop bypass (OLB) has proven to have greater efficacy in weight loss and remission of type 2 diabetes in 1 year [4].Endoscopic management of erosion after banded bariatric procedures
Prosthetic materials wrapped around a portion of the stomach have been used to provide gastric restriction in bariatric surgery for many years. Intraluminal erosion of adjustable and nonadjustable gastric bands typically occurs many years after placement and results in various symptoms. Endoscopic management of gastric band erosion has been described and allows for optimal patient outcomes.Laparoscopic Roux-en-Y gastric bypass reversal
Bariatric surgery is the most effective long-term treatment for morbid obesity [1]. With the establishment of an accreditation process and the development of laparoscopic approaches to bariatric surgery, in addition to the development of fellowship training, bariatric surgery has become a role model for other surgical specialties in terms of efficacy and tolerability [2,3]. Despite the outstanding positive results, undesirable side effects can develop. One of the undesirable side effects that is not well reported in the literature is excessive weight loss after gastric bypass surgery [4,5].Comparative physiogenomic analyses of weight loss in response to 2 modes of bariatric surgery: demonstration with candidate neuropsychiatric and cardiometabolic genes
Surgical weight loss response is variable, with suboptimal outcomes in some patients. We hypothesized that genetic biomarkers may be related to weight change.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.Increased levels of chemerin and its receptor, chemokine-like receptor-1, in obesity are related to inflammation: tumor necrosis factor-α stimulates mRNA levels of chemerin in visceral adipocytes from obese patients
Chemerin is a novel adipokine that regulates adipocyte development and metabolic function and glucose metabolism. Our aim was to determine the effect of chemerin and its receptor, chemokine-like receptor-1, in obesity-associated low-grade chronic inflammation, exploring its circulating and gene expression levels in obesity and the effect of weight loss and to analyze the effect of the stimulation with tumor necrosis factor-α in human visceral adipocytes at a University hospital.Laparoscopic conversion of laparoscopic sleeve gastrectomy to gastric bypass for intractable gastroesophageal reflux disease
Laparoscopic sleeve gastrectomy (LSG) has proved to be a safe and efficacious step or stand-alone surgical procedure for the treatment of morbid obesity. An increase in the body mass index and the accumulation of visceral fat are associated with a two- to threefold increased risk of developing reflux symptoms [1]. Long-term complications appear to have a low incidence; however, in recent publications, gastroesophageal reflux disease (GERD) has been reported to occur in ≤27% of patients 6 years after the procedure.Diagnosis and treatment of Zollinger Ellison syndrome in a morbidly obese patient after Roux-en-Y gastric bypass
Zollinger Ellison syndrome (ZES) is rare entity characterized by recurrent peptic ulcers due to high acid production from gastric parietal cells as a result of elevated secretion of the hormone gastrin [1–5]. The abnormally high levels of gastrin are caused by a gastrin-secreting neuroendicrine tumor (gastrinoma) that frequently develops from the pancreas or from the first or second portion of the duodenum, in the denominated “gastrinoma triangle” [2–5]. Approximately 75% of ZES cases are sporadic, with the remaining 25% associated with multiple endocrine neoplasm type 1 [1].Laparoscopic gastrojejunostomy revision: a novel approach to intractable marginal ulcer management
Marginal ulcers are a known complication after Roux-en-Y gastric bypass, with a variable incidence of .6–16% [1,2]. Initial therapy involves elimination of the inciting risk factors [3] and medical management with a proton pump inhibitor and sucralfate therapy [4]. Although most marginal ulcers will heal with such treatment, approximately one third of patients will require operative intervention [5]. Surgery typically involves total revision of the gastrojejunostomy [6]. Revisional bariatric surgery, however, is technically difficult and has been associated with high morbidity and mortality rates.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].
