Band Surgery Research Articles

Morbid Obesity Treated With Laparoscopic Band Surgery Over a Sleeve Gastrectomy

Bariatric surgery is the most successful weight management modality. Laparoscopic adjustable gastric band surgery is one bariatric surgical procedure developed for weight reduction in patients with morbid obesity.

Genera of knots in the complex projective plane

Our goal is to systematically compute the [Formula: see text]-genus of as many prime knots up to 8-crossings as possible. We obtain upper bounds on the [Formula: see text]-genus via coherent band surgery. We obtain lower bounds by obstructing homological degrees of potential slice discs. The obstructions are pulled from a variety of sources in low-dimensional topology and adapted to [Formula: see text]. There are 27 prime knots and distinct mirrors up to 7-crossings. We now know the [Formula: see text]-genus of all of these knots. There are 64 prime knots and distinct mirrors up to 8-crossings. We now know the [Formula: see text]-genus of all but 6 of these knots, where the [Formula: see text]-genus was not determined explicitly, it was narrowed down to 2 possibilities. As a consequence of this work, we show an infinite family of knots such that the [Formula: see text]-genus of each knot differs from that of its mirror.

A note on band surgery and the signature of a knot

Band surgery is an operation relating pairs of knots or links in the three-sphere. We prove that if two quasi-alternating knots $K$ and $K'$ of the same square-free determinant are related by a band surgery, then the absolute value of the difference in their signatures is either 0 or 8. This obstruction follows from a more general theorem about the difference in the Heegaard Floer $d$-invariants for pairs of L-spaces that are related by distance one Dehn fillings and satisfy a certain condition in first homology. These results imply that $T(2, 5)$ is the only torus knot $T(2, m)$ with $m$ square-free that admits a chirally cosmetic banding, i.e. a band surgery operation to its mirror image. We conclude with a discussion on the scarcity of chirally cosmetic bandings.

Cosmetic two‐strand twists on fibered knots

Let $K$ be a knot in a rational homology sphere $M$. This paper investigates the question of when modifying $K$ by adding $m>0$ half-twists to two oppositely-oriented strands, while keeping the rest of $K$ fixed, produces a knot isotopic to $K$. Such a two-strand twist of order $m$, as we define it, is a generalized crossing change when $m$ is even and a non-coherent band surgery when $m=1$. A cosmetic two-strand twist on $K$ is a non-nugatory one that produces an isotopic knot. We prove that fibered knots in $M$ admit no cosmetic generalized crossing changes. Further, we show that if $K$ is fibered, then a two-strand twist of odd order $m$ that is determined by a separating arc in a fiber surface for $K$ can only be cosmetic if $m=\pm 1$. After proving these theorems, we further investigate cosmetic two-strand twists of odd orders. Through two examples, we find that the second theorem above becomes false if `separating' is removed, and that a key technical proposition fails when the order equals 1. A closer look at an order-one example, an instance of cosmetic band surgery on the unknot, reveals it to be nearly trivial in a sense that we name `weakly nugatory'. We correct the technical proposition to obtain a means of using double branched covers to show that certain band surgeries are weakly nugatory. As an application, we prove that every cosmetic band surgery on the unknot is of this type.

Which Factors Are Associated with a Higher Prevalence of Anemia Following Bariatric Surgery? Results from a Retrospective Study Involving 1999 Patients

Anemia in obese patients is common and multifactorial and is also a complication of bariatric surgery. The aim of this study is to establish which variables are associated with a higher prevalence of post-bariatric surgery anemia. Retrospective cohort study involving 1999 patients submitted to bariatric surgery with a follow-up period of 4years. Anthropometric, laboratorial parameters and the presence of comorbidities were evaluated before surgery and during follow-up. Patients were divided into two groups, according to whether they developed anemia, or not. Groups were compared using independent sample T-tests or Chi-squared tests, as appropriate. Univariate binary logistic regression models were used to test the association between the diagnosis of anemia during follow-up and all the possible explanatory variables. Independent variables with an association with the outcome (p< 0.1) were included in multivariate binary logistic regression models, as well as possible confounders (age, BMI, and supplementation). Anemia was diagnosed in 24.4% of the patients. Females present a two-fold increased risk of developing anemia (OR 2.11, 95% CI 1.48-3.01, p< 0.001). Patients subjected to gastric sleeve and gastric band surgery present approximately half the risk of anemia when compared with gastric bypass surgery (RYGB) (OR 0.46, 95% CI 0.35-0.59, p< 0.001; OR 0.51, 95% CI 0.36-0.72, p< 0.001). None of the other variables evaluated showed association with the outcome. In our study, the only factors associated with an increased risk of developing anemia were female gender and RYBG surgery. Prospective studies evaluating the risk factors for anemia in patients undergoing bariatric surgery are needed.

Risk of venous thromboembolism, use of enoxaparin and clinical outcomes in obese patients undergoing laparoscopic adjustable gastric band surgery: A retrospective study.

There is a lack of clear guidance for the prophylactic use of anticoagulants for patients undergoing laparoscopic adjustable gastric banding (LAGB) surgery.This study aimed to evaluate the risk of venous thromboembolism (VTE), prophylactic use of enoxaparin and clinical outcomes in patients undergoing primary and revisional LAGB procedures.A retrospective study evaluated the prophylactic use of enoxaparin in adult patients who underwent primary and revisional (band and port) LAGB procedures. The incidence of VTE and major bleeding was investigated during a 90-day follow-up period. Descriptive and inferential statistics were used for data analysis.We included 112 and 100 patients who had undergone primary and revisional (24 band procedures and 76 port procedures) LAGB surgery, respectively. The majority of patients (97%) had a mild risk of VTE development using a post-discharge VTE risk calculator tool published from the Cleveland Clinic. All primary procedure patients received prophylactic enoxaparin, compared to 79% and 20% of revisional patients who underwent band and port procedures, respectively (P < .001). The overall VTE incidence was 0.9%, with no significant difference between patients who did or did not receive chemoprophylaxis (0.7% and 1.5%, respectively; P = .58). No major bleeding events were observed.Chemoprophylaxis may not be required in all patients undergoing low-risk LAGB surgery unless there are additional risk factors, such as the presence of super-super-morbid obesity or concomitant hormone replacement therapy. More studies are needed on the prophylactic use and dosing of enoxaparin in patients undergoing LAGB procedures to provide high-level evidence.

A lower bound of crosscap numbers of alternating knots

We give a lower bound of the crosscap number of alternating knots using band surgery. This lower bound is equal to the minimum number of the first Betti number, i.e. one minus the maximal Euler characteristic, over all (orientable and non-orientable) surfaces spanning a given alternating knot.

Patient preferences regarding bariatric/metabolic procedures: a survey of Korean obese candidates for surgery.

PurposeThe objective of this study was to survey potential candidates for bariatric/metabolic surgery for procedure preferences.MethodsQuestions asked were divided into 5 categories: (1) demographic and anthropometric data, comorbidities, and favored surgery; (2) awareness of safety, effectiveness, and complications of each type of surgery; (3) discordances in opinion between self-selected and medically recommended procedures; and (4, 5) reasons for/against particular surgery.ResultsFrom 1 October to 15 November 2018, 104 respondents adequately responded and were included in the analysis. The number (%) of female respondents was 79 (76.0%). The number (%) of respondents by decade was 17 (16.3%) in their 20s, 65 (62.5%) in their 30s, 19 (18.3%) in their 40s, and 3 (2.9%) in their 60s, respectively. Mean body mass index was 37.1 ± 6.3 kg/m2. Comorbidities were type 2 diabetes in 34 (32.7%) and hypertension in 35 (33.7%). The most favored procedure was sleeve gastrectomy (SG) in 78 (75.0%), adjustable gastric band (AGB) surgery in 12 (11.5%), Roux-en-Y gastric bypass (RYGB) in 6 (5.8%), and gastric plication (GP) in 8 (7.7%). Major reasons for choosing procedures were; “adjustable” for AGB, “stomach sparing” for GP, “excellent weight loss” for SG, and “comorbidity resolution” in RYGB.ConclusionCandidates for bariatric/metabolic surgery favored SG followed by AGB, GP, and RYGB, and their choices were compatible with current evidence-based clinical practice.

Distance one lens space fillings and band surgery on the trefoil knot

We prove that if the lens space $L(n, 1)$ is obtained by a surgery along a knot in the lens space $L(3,1)$ that is distance one from the meridional slope, then $n$ is in $\{-6, \pm 1, \pm 2, 3, 4, 7\}$. This result yields a classification of the coherent and non-coherent band surgeries from the trefoil to $T(2, n)$ torus knots and links. The main result is proved by studying the behavior of the Heegaard Floer $d$-invariants under integral surgery along knots in $L(3,1)$. The classification of band surgeries between the trefoil and torus knots and links is motivated by local reconnection processes in nature, which are modeled as band surgeries. Of particular interest is the study of recombination on circular DNA molecules.

1685 Endoscopic Fistulectomy of an Obstructive Esophagogastric Mucosal Bridge

INTRODUCTION: Esophageal mucosal bridges are rare complications from many causes including congenital abnormalities, radiotherapy, sclerotherapy, nasoenteric feeding tubes, or Crohn’s disease. Mucosal bridges are made of smooth muscle crossing gastrointestinal lumen and resulting in a double barrel appearance on endoscopy. Pathogenesis may involve mucosal undermining by ulceration followed by healing, re-epithelialization of the mucosal undersurface, and formation of a mucosal tube attached to the non-ulcerated wall. Therefore, chronic, repetitive ulcerations and subsequent healing may lead to bridge formation. Another theory is that inflamed walls of esophagus contacting one another allows granulation tissue to form adhesions resulting in a mucosal bridge. This could explain fistula formation in inflammatory bowel disease. CASE DESCRIPTION/METHODS: A 68-year-old woman presented with a 6-year history of progressive solid food dysphagia and gastroesophageal reflux. Her past surgical history was significant for laparoscopic band surgery complicated by gastric band erosion into the stomach at the gastroesophageal junction that required subsequent gastric band removal and omental flap reinforcement of the gastric perforation nine years prior to presentation. A diagnostic upper endoscopy revealed an esophageal fistula at the gastroesophageal junction and biopsies at the junction showed chronic inflammation without dysplasia. The upper endoscope was advanced to the gastroesophageal junction at 37 cm from the entry site. Proximal to the gastroesophageal junction, two esophageal lumens were seen leading to the gastric lumen due to a thick mucosal bridge causing partial obstruction to the stomach. First, four hemostatic clips were placed at both ends of the stalk before mucosal incision to prevent bleeding. The bridge was grasped with forceps and fistulectomy was performed with a needle knife to incise the mucosal bridge between the clipped portion using electrocautery. On post-operative follow-up at week 6 and 12, the patient had complete resolution of dysphagia and no demonstrated recurrence of mucosal bridge formation. DISCUSSION: This is an unusual case of an esophagogastric fistula from a delayed adverse event of laparoscopic gastric band placement even after band removal and corrective surgery that caused dysphagia. It was successfully treated with endoscopic fistulectomy using hemostatic clips and a needle knife under direct visualization. This method has proven to be effective with no reported recurrences. Watch the video: http://bit.ly/2Y0JNws.

Long-Term Inpatient Hospital Utilisation and Costs (2007-2008 to 2015-2016) for Publicly Waitlisted Bariatric Surgery Patients in an Australian Public Hospital System Based on Australia's Activity-Based Funding Model.

BackgroundWithin the Australian public hospital setting, no studies have previously reported total hospital utilisation and costs (pre/postoperatively) and costed patient-level pathways for primary bariatric surgery and surgical sequelae (including secondary surgery) informed by Australia’s Independent Hospital Pricing Authority’s activity-based funding (ABF) model.ObjectiveWe aimed to provide our Tasmanian state government partner with information regarding key evidence gaps about the resource use and costs of bariatric surgery (including pre- and postoperatively, types of surgery and comorbidities), the costs of surgical sequelae and policy direction regarding the types of bariatric surgery offered within the Tasmanian public hospital system.MethodsHospital inpatient length of stay (days), episodes of care (number) and aggregated cost data were extracted for people who were waiting for and subsequently received bariatric surgery (for the fiscal years 2007–2008 to 2015–2016) from administrative sources routinely collected, clinically coded/costed according to ABF. Aggregated ABF costs were expressed in 2016–2017 Australian dollars ($A). Sensitivity (cost outliers) and subgroup analyses were conducted.ResultsA total of 105 patients entered the study. Total costs (pre/postoperative over 8 years) for all inpatient episodes of care (n = 779 episodes of care) were $A6,018,349. When the ten cost outliers were omitted from the total cost, this cost reduced to $A4,749,265. Mean costs for primary laparoscopic adjustable gastric band (LAGB) and sleeve gastrectomy (SG) bariatric surgery were $A14,622 and $A15,014, respectively. The average cost/episode of care for people with diabetes decreased in the first year postoperatively, from $A7258 to $A5830/episode of care. In total, 27 LAGB patients (30%) required surgery due to surgical sequelae (including revisional/secondary surgery; n = 58 episodes of care) and 56% of these episodes of care were secondary LAGB device related (mostly port/reservoir related), with a mean cost of $A6267.ConclusionsTaking into account our small SG sample size and the short time horizon for investigating surgical sequalae for SG, costs may be mitigated in the Tasmanian public hospital system by substituting LAGB with SG when clinically appropriate due to costs associated with the LAGB device for some patients. At 3 years postoperatively versus preoperatively, episodes of care and costs reduced substantially, particularly for people with diabetes/cardiovascular disease. We recommend that a larger confirmatory study of bariatric surgery including LAGB and SG be undertaken of disaggregated ABF costs in the Tasmanian public hospital system.

Coherent band-Gordian distances between knots and links with up to seven crossings

A coherent band surgery is a local move of an oriented knot or link by doing a surgery along an added band. The coherent band-Gordian distance between two links is the minimum number of coherent band surgeries needed to transform one into the other. We give a table of coherent band-Gordian distances between a knot and 2-component link with up to seven crossings.

Image Case : Pancreatic Rest

18 years old female patient presented by epigastric pain and dyspepsia.Upper gastrointestinal endoscopy revealed umplicated small antral mass(pancreatic rest). Pancreatic rests are benign congenital anomalies defined as pancreatic tissue that lacks anatomic or vascular continuity with the pancreas itself . Also referred to as pancreatic heterotopia, heterotopic pancreas, ectopic pancreas, aberrant pancreas, and accessory pancreas. Although they can be located in many sites throughout the body, they are most commonly found in the upper gastrointestinal tract, with the gastric antrum being the most common site. The differential diagnosis of gastric antral subepithelial lesions includes benign entities such as pancreatic rests, lipomas, inflammatory polyps, hyperplastic mucosa, Leiomyoma and cysts as well as entities with malignant potential such as carcinoid tumors and gastrointestinal stromal tumors. Mucosal biopsies can exclude epithelial tumors, and EUS can help exclude other lesions (such as cysts, lipomas, stromal tumors, or extrinsic lesions). The treatment of symptomatic pancreatic rest is:Endoscopic band ligation snare polypectomy(EBLSP) or Surgery. EUS should be performed prior to endoscopic mucosal resection to ensure safety of resection by making sure the lesion is superficial, not vascular, and does not involve the muscularis propria.

Explantation of Adjustable Gastric Bands: An Observation Study of 10 Years of Experience at a Tertiary Center.

PurposeAlthough laparoscopic adjustable gastric bands are considered a standard treatment for severe obesity, their use remains controversial. We evaluated rates of band explantation and the incidences of complications leading to and following band explantation.Materials and MethodsThis retrospective review was performed on patients that underwent adjustable gastric band explantation. For each of the three groups of patients that underwent explantation, we compared demographic and anthropometric data, band duration in situ, operative approach, and morbidities.ResultsBetween January 2009 and October 2018, a total of 267 patients underwent primary laparoscopic adjustable gastric band surgery. Of these 267 patients, 99 (37.1%) underwent band explantation. Numbers (%) of patients in the slippage (SL), band erosion (BE), and intolerance (IT) groups were 13 (13.1%), 39 (39.4), and 47 (47.5%), respectively. Mean %EBMIL values at explantation in these groups were 74.6±45.5, 79.7±40.3, and 36.1±46.0, respectively (p<0.001), and mean times for maintaining bands in situ were 45.1±28.0, 39.4±24.3, and 51.2±22.7 months, respectively. Isolated band removal was performed for slippage (SLi, n=12), band erosion (BEi, n=39), and intolerance (ITi, n=31). The numbers (%) of patients in the SLi, BEi, and ITi groups that experienced a surgical complication (Clavien-Dindo class ≥1) were 0 (0.0%), 24 (61.5%), and 3 (9.7%), respectively (p<0.001). In the BEi group, four patients (4/39, 10.3%) underwent reoperation after AGB removal.ConclusionDuring our 10 years of experience, 37.1% of adjustable gastric band had to be removed. Intra-abdominal abscess and intragastric bleeding were rare but serious complications after explantation. Potential candidates for adjustable gastric band should be informed of the high long-term risk of band explantation and its associated morbidities.

Oesophageal adenocarcinoma following gastric band surgery in two patients

Oesophageal adenocarcinoma following gastric band surgery has only been reported three times previously. The incidence is higher in morbidly obese patients, and its pathogenesis is correlated to reflux-induced microenvironmental changes. Bariatric surgery is transformative and its potential benefit for a substantial population is huge. Although no causal relationship with bariatric procedures has been evidenced to date, symptoms of adenocarcinoma—particularly anorexia, weight loss and dysphagia—can easily be overshadowed by alterations in eating patterns associated with weight-loss procedures. We report two cases of oesophageal adenocarcinoma in patients who had undergone a gastric banding procedure, and invite readers to consider the role that pre- and post-operative acid reflux dynamics may have precipitating neoplastic disease, and how endoscopic surveillance may play a role in prevention.

Acting Fast: A Case of Spontaneous Calculus Migration in a Patient with Bouveretʼs Syndrome

Bouveret's syndrome describes impaction of the duodenum resulting from the passage of a gallstone through a bilioenteric fistula, often presenting diagnostic and therapeutic challenges. Although individualized therapy is recommended in these unique cases, it has generally been accepted that endoscopic retrieval is inferior to surgery due to the large size of most of these calculi. When endoscopy is attempted, it often causes fragmentation of the calculus with migration of fragments to the distal small bowel. Stone migration has previously been described also through surgical fragmentation, and one recent case of migration after contrast administration. We present the case of a 60-year-old morbidly obese male with a history of lap band surgery who presented to the emergency room with sudden onset of nausea and vomiting.The patient was found to be in hemodynamically stable condition and initial labs were notable for an elevated direct bilirubin of 1.3, normal liver function, and alkaline phosphatase of 203. MRCP revealed a cholecystoduodenal fistula and an obstructing 3 cm gallstone within the proximal duodenum resulting in gastric dilatation. Endoscopy was performed and revealed a large cratered duodenal ulcer with a fistulous opening distal to the pyloric channel (Image 1). The stone was not visualized. A repeat CT-scan showed gallstone ileus with progression of the large stone from the duodenum to the distal jejunum/proximal ileum loops, with moderate small bowel obstruction (Image 2). He was taken to surgery for a laparoscopic enterotomy and gallstone extraction, whereby a 5x3cm stone was successfully removed from the distal jejunum (Image 3). The patient had a complicated post-op course, requiring intubation and pressor support in the intensive care unit. To our knowledge, this is the first case of spontaneous calculus migration resulting in ileocecal impaction and necessity for surgery in a high-risk patient. Surgery overall remains the most common approach in these patients who are usually elderly and have multiple comorbidities, and may therefore at least partially explain the persistently high mortality associated with Bouveret's syndrome. We propose that the risk of attempting endoscopy due to possible fragmentation should not prevent this from being considered the initial recommended approach, as the calculi may migrate spontaneously regardless and surgery is often life threatening in this population of patients.1367_A.tif Figure 1: Cholecystoduodenal Fistula1367_B.tif Figure 2: Stone MIgration1367_C.tif Figure 3: Stone extraction - Gross Specimen

Using Google Trends to explore the New Zealand public's interest in bariatric surgery.

Bariatric surgery, in recent times, has gained media attention that has influenced individual, healthcare provider and wider societal attitudes towards bariatric surgery. Studies exploring public and media levels of interest in bariatric surgery have been performed overseas but studies within New Zealand (NZ) are scarce. Analysis of Google Trends data may be a useful source of information in investigating public interest levels in bariatric surgery. We aimed to analyse Google Trends information on Internet searches in NZ and to explore sequential relationships with relevant changes in policy. Key search terms for our Google Trends query were retrieved by independently reviewing news articles relating to bariatric surgery in NZ published between January 2007 and December 2017 and following a brainstorming session. Trend analyses were performed using Microsoft Excel 14.7.2. Data were captured for both NZ and worldwide search interests in Google Trends. Trend analyses showed that total search volumes for 'lap band' and 'lap band surgery' declined while 'gastric sleeve' and 'gastric sleeve surgery' increased exponentially over the 10-year period. Furthermore, search interests for key terms in NZ were comparable with those worldwide. Our findings reveal that search interests related to bariatric surgery in NZ mirror those worldwide. This includes the popularity of some bariatric procedures over others. The use of Google Trends may provide us with an additional tool to evaluate public interest levels related to bariatric surgery in NZ and could add value in examining the socio-cultural and political contexts of obesity and bariatric surgery.

Rhabdomyolysis as a rare but fatal complication of bariatric surgery: A case report.

Rhabdomyolysis after bariatric surgery is a quite rare occurrence with low recognition. Due to the breakdown of the striated muscle fibers, creatine kinase and myoglobin are released into the systemic circulation with variable effects on the renal filtration functions. Herein we present the case of a patient who developed rhabdomyolysis following revision bariatric surgery. A 34-year-old male patient was admitted for bariatric surgery. He had undergone a gastric band surgery approximately 6 years ago, with weight regain starting 1 year postoperatively gradually reaching the previous weight level. Consequently, the gastric band was removed with open surgery 3 years ago. The patient had a body mass index of 69 kg/m2 and an incisional hernia due to the previous surgery. Although initially, laparoscopic sleeve gastrectomy was planned, a switch to open surgery was made due to the presence of diffuse intra-abdominal adhesions and a giant incisional hernia precluding a laparoscopic intervention. The total duration of surgery was 420 min. Postoperative laboratory work-up showed elevated blood creatine kinase levels (25837 U/L). Upon the failure of fluid replacement and diuretics, hemodialysis was initiated on postoperative day 1. Despite daily sessions of hemodialysis, the patient's acidosis did not improve; his general status worsened, and he died on postoperative day 14. Rhabdomyolysis is a severe and potentially life-threatening complication of bariatric surgery. Its severity may vary from asymptomatic elevation in creatine kinase levels to death. Postoperative creatine kinase levels should be routinely monitored in high-risk patients as a practical and inexpensive laboratory modality for early diagnosis.

Predictors of the effect of bariatric surgery on knee osteoarthritis pain

Bariatric surgery reduces obesity and knee osteoarthritis (OA) pain, but some patients improve more than others. We aimed to identify characteristics that predict this knee pain improvement. We reviewed NYU Langone Health bariatrics records (2002-2015) and called eligible patients reporting pre-operative knee pain. Patients were asked to rate their pain on a 10-point scale at three time points: before surgery, one year post-surgery, and time of survey administration. Subjects were asked about pre-operative knee injuries and surgeries, presence of OA in other joints, and OA family history. Data were analyzed using paired t-tests and ANOVA. Of 125 eligible patients reporting knee pain, we analyzed the 120 patients who had laparoscopic gastric band (LAGB) surgery. The cohort was 78.3% female, with an average age at surgery of 49.7 ± 10.2 years. There was no correlation between pre-operative body mass index (BMI) and knee pain reduction at one year post-LAGB, but the subgroup with the most BMI improvement reported the most knee improvement (p = 0.043). We found significantly better pain reduction after one year in younger patients (p = 0.009). Those with prior knee injuries improved less than those who were injury-free (p = 0.044), but a history of prior knee surgery was not similarly significant. Patients with multifocal OA improved less (p = 0.001). Younger knee OA patients and those without prior knee injury or other OA involvement, experience more knee pain relief from LAGB weight loss surgery. LAGB may be a viable treatment option for knee OA pain, irrespective of the degree of obesity.

Impact of Bariatric Surgical Intervention on Peripheral Blood Neutrophil (PBN) Function in Obesity

AimThe aim of this study was to investigate the impact of weight loss following gastric band surgery on multiple measures of peripheral blood neutrophil (PBN) function.Material and MethodsTwenty-three obese patients undergoing gastric band surgery were recruited to a longitudinal intervention study, alongside non-obese, healthy gender- and age-matched controls. Eighteen pairs of patients and controls completed all stages of the study. PBNs were isolated by density centrifugation and a comprehensive analysis of PBN function was undertaken at various stages of the patients’ bariatric surgical care pathway.ResultsObese patients exhibited exaggerated PBN activity in response to various stimuli, characterised by higher reactive oxygen species (ROS) generation (n = 18, p < 0.001) and release of pro-inflammatory cytokines (n = 10, p < 0.05) and lower PBN extracellular trap (NET) formation (n = 18, p < 0.01). PBN chemotactic accuracy was also impaired prior to surgery (n = 18, p < 0.01). Weight loss was associated with normalised NET production and lower ROS production and cytokine release relative to healthy controls. However, chemotactic accuracy remained impaired in patients.ConclusionsWeight loss following gastric band surgery was associated with a decrease in the pro-inflammatory activities of peripheral blood neutrophils (PBNs). A hyper-inflammatory PBN phenotype, involving excess ROS and cytokine release, reduced NET formation and chemotaxis, may lead to a reduced ability to eliminate infection, alongside inflammation-mediated tissue damage in obese individuals.