Bariatric Literature Research Articles

Single Anastomosis Duodeno-ileal Bypass As a Revisional Procedure Following Sleeve Gastrectomy: Review of the Literature.

Laparoscopic sleeve gastrectomies (LSGs) can experience weight-loss failure and conversion to another bariatric procedure. An analysis of the bariatric literature concerning the single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) as revisional surgery after LSG in terms of safety and efficacy identified 607 studies. Fifty-nine studies were analyzed for full content review and 9 primary studies (398 patients) were included. Revisional single anastomosis duodeno-ileal bypass (SADI) was performed in 294 patients at a mean interval of 37.7 months (range 11-179). Total weight loss (%) varies from 20.5% to 46.2%. Early complications after surgery occurred in 4.1% surgeries including leak (7 cases -1.9%). Mortality was nil. SADI after LSG, after failed sleeve gastrectomy or as a sequential procedure, offers a satisfactory weight loss result. Both early and late term complications are acceptable.

Meta-Analysis of Gastrointestinal Quality of Life After Laparoscopic Sleeve Gastrectomy or Laparoscopic Roux-en-Y Gastric Bypass

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) and laparoscopic sleeve gastrectomy (LSG) are the most common bariatric procedures globally and they have been reported to impart similar weight loss outcomes. However, their effects on gastrointestinal quality of life (GIQoL), which is a major determinant of patient satisfaction, are less well defined. This meta-analysis aims to compare GIQoL in patients who have undergone LRYGBP or LSG. Methods: A systematic review and meta-analysis of the studies comparing changes in the gastrointestinal quality of life index (GIQLI) scores after LSG or LRYGBP was performed. This meta-analysis is exempt from ethical approval because the data is collected from the clinical studies in which informed consent has already been obtained by the study investigators. Results: Six studies including 1726 patients were included. Although there was a significant improvement in GIQoL after bariatric surgery (LSG mean difference [MD] −14.98, 95% confidence interval [CI], −22.28 to −7.69, p < 0.0001; LRYGBP [MD] −16.99, 95% CI, −26.28 to −7.71, p = 0.0003), there was no significant difference in GIQLI scores between LSG and LRYGBP in short- or long-term follow-up in random effect meta-analysis. Conclusion: Bariatric surgery is associated with significant improvements in GIQoL, and similar changes in this outcome measure are reported after LSG and LRYGBP. It is infrequently reported in the bariatric literature and inclusion of this relevant patient-reported outcome measure in future bariatric studies is recommended.

Characteristics and resolution of hypertension in obese African American bariatric cohort

Weight reduction continues to be first-line therapy in the treatment of hypertension (HTN). However, the long-term effect of bariatric malabsorptive surgical techniques such as Roux-en-Y Gastric Bypass (RYGB) surgery in the management of hypertension (HTN) is less clear. African Americans (AA) are disproportionately affected by obesity and hypertension and have inconsistent outcomes after bariatric surgery (BS). Despite a plethora of bariatric literature, data about characteristics of a predominantly AA bariatric hypertensive cohort including hypertension in obese (HIO) are scarce and underreported. The aims of this study were, (1) to describe the preoperative clinical characteristics of HIO with respect to HTN status and age, and (2) to identify predictors of HTN resolution one year after RYGB surgery in an AA bariatric cohort enrolled at the Howard University Center for Wellness and Weight Loss Surgery (HUCWWS). In the review of 169 AA bariatric patients, the average BMI was 48.50 kg/m2 and the average age was 43.86 years. Obese hypertensive patients were older (46 years vs. 37.89 years; p < .0001); had higher prevalence of diabetes mellitus (DM, 43.09% vs. 10.87%; p < .0001) and dyslipidemia (38.2% vs. 13.04%; p 0.002). Hypertensive AA who were taking ≥ 2 antihypertensive medications prior to RYGB were 18 times less likely to experience HTN resolution compared to hypertensive AA taking 0–1 medications, who showed full or partial response. Also, HIO was less likely to resolve after RYGB surgery in patients who needed ≥ 2 antihypertensive medications prior to surgical intervention.

The New Interest of Bariatric Surgeons in the Old Ligamentum Teres Hepatis.

The search for an operation that effectively prevents and treats intrathoracic gastric migration (ITGM) after bariatric surgery has revived a long-forgotten technique: ligamentum teres cardiopexy (LTC) by which a vascularized flap of the teres ligament is wrapped around the distal esophagus. The systematic search of publications in the English language revealed 4 studies (total number of patients 53) in the non-bariatric literature with an unsatisfactory resolution of GERD. There were 5 reports from the bariatric literature with small patient numbers (total 64) and a short follow-up (6-36months). There were no objective signs of gastric remigration in 93% of investigated patients. Acknowledging the limitations of these preliminary reports, bariatric surgeons are encouraged to further investigate the potentials of LTC in their patients.

Weight Regain After Bariatric Surgery-A Multicentre Study of 9617 Patients from Indian Bariatric Surgery Outcome Reporting Group.

There is little robust data on weight regain (WR) after bariatric surgery making it difficult to counsel patients regarding long-term outcomes of different bariatric procedures. The purpose of this study was to see WR in medium and long term after SG, RYGB, and OAGB in Indian population. In a multicentre study, data on preoperative and postoperative weights over 5years were collected. Multiple definitions were applied to find the proportion of patients with significant WR increase of 25% of lost weight from nadir (definition 1), weight gain of > 10kg from nadir (definition 2), and BMI gain of > 5kg/m2 from nadir (definition 3). The proportion of those with significant WR was compared across sub-groups. A total of 9617 patients were included. Median WR at 5years was 14.1% of lost weight, 1.92kg/m2, and 5kg. Significant WR using definition 1 was 35.1%, 14.6%, and 3% after sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and mini-one anastomosis gastric bypass (OAGB) respectively. Severe albumin deficiency was highest in OAGB (5.9%) patients followed by SG (2.9%) and RYGB (2.2%) at 5years(p = 0.023). Haemoglobin levels < 10g/dL were seen in 8.2%, 9.0%, and 13.9% of SG, RYGB, and OAGB patients respectively (p = 0.041). In the first comparative study of WR, OAGB had lesser WR in comparison to SG and RYGB but had the most impact on Hb and albumin levels in the long term. Definition selection for reporting WR has a significant impact on the results. There is a need for standardising the reporting of WR in bariatric literature.

Ongoing Inconsistencies in Weight Loss Reporting Following Bariatric Surgery: a Systematic Review.

Weight loss is the primary outcome following bariatric surgery; however, its documentation within current literature is heterogeneous and poorly defined, limiting meaningful comparison between studies. Randomized controlled trials from 2012 to 2016 were identified using the Medline database through "Gastric bypass OR sleeve gastrectomy AND weight" search terms. A total of 73 studies with 5948 patients were included. Reporting of preoperative weight was done primarily using mean body mass index (BMI) (87.7%) and mean weight (65.8%). Postoperative weight reporting was more variable, with the most frequently reported measure being mean postoperative BMI (71.2%). Overall, nearly one third of all bariatric literature contained discrepancies that precluded meaningful meta-analysis. Reporting of weight loss following bariatric surgery is becoming increasingly diverse for both pre- and post-operative outcomes. Ongoing heterogeneity will continue to act as a barrier to meaningful comparison of bariatric outcomes until standardized reporting practices become adopted.

'No one is as invested in your continued good health as you should be:' an exploration of the post-surgical relationships between weight-loss surgery patients and their home bariatric clinics.

This article traces the post-surgical relationship between weight-loss surgery (WLS) patients and their home bariatric clinics. Following surgery, there is substantive drop off in patient attendance at both follow-up appointments and support groups. While barriers to follow-up are often discussed with the bariatric literature, patients themselves are typically defined as the problem. Based upon a thematic analysis of 217 blog posts and comments in two top patient-led online forums, I demonstrate that bariatric patients tell a more complex story about their post-surgical lives. I argue that WLS patients constitute a population with highly specialised medical needs that is caught between the requirements for living with surgically altered digestive systems and a lack of sufficient post-operative follow-up care from their home bariatric clinics. Although online forums provide spaces for patients to examine these post-operative social and clinical experiences in critical terms, seek information and get support, ultimately the conversations serve to underline the value of personal responsibility for post-operative outcomes-a framing that echoes that of the bariatric profession. This framing should be understood within a larger climate of weight-based stigma and discrimination as well as neoliberal healthism.

The Dutch bariatric weight loss chart: A multicenter tool to assess weight outcome up to 7 years after sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass

BackgroundCurrent methods for weight loss assessment after bariatric surgery do not meet the high standards required to accurately judge patient outcome in a fair and evidence-based way. ObjectivesTo build an evidence-based, versatile tool to assess weight loss and weight regain and identify poor responders up to 7 years after laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG), for any preoperative body mass index (BMI). SettingMulticenter, observational study. MethodsBariatric weight loss charts were built with standard deviation (SD) percentile (p) curves p+2SD/p+1SD/p50(median)/p−1SD/p−2SD, based on all last measured weight results after primary LRYGB and LSG, performed in 3 large bariatric centers, expressed with percentage total weight loss (%TWL) and percentage-alterable weight loss (%AWL), a special BMI-independent metric. The p−1SD %AWL curves were compared with popular bariatric criteria 50% excess weight loss and 20%TWL. The p50 %TWL curves were compared with %TWL outcome in literature (external validation). ResultsIn total, 9393 patients (5516 LRYGB, 3877 LSG, baseline BMI 43.7 (±SD 5.3) kg/m2, age 43 (±SD 10.9) years, 20% male, 21% type 2 diabetes) had mean follow-up 26 (range, 0–109) months, with .09% 30-day mortality. Independent outcome is presented in percentile charts for %AWL and %TWL. Percentile curves p+2SD/p+1SD/p50/p−1SD/p−2SD showed for LRYGB 72%/62%/50%/38%/28%AWL at nadir, 66%/55%/43%/30%/17%AWL at 4 years, 64%/52%/38%/25%/11%AWL at 7 years, and for LSG 69%/58%/46%/34%/22%AWL, 65%/53%/38%/23%/12%AWL, and 63%/51%/35%/22%/9%AWL, respectively. Bariatric criteria 50% excess weight loss and 20%TWL matched with most insufficient results for LSG, but not for LRYGB (low specificities). Both p50 %TWL curves are comparable with long-term weight loss in bariatric literature. ConclusionsJust as well-known growth charts are essential for pediatrics, weight loss charts should become the tools of choice for bariatrics. These multicenter charts are baseline BMI independent, superior to current bariatric criteria, and quite intuitive to use. They allow to readily detect poor responders in any postoperative phase, monitor the effect of extra counseling, judge weight regain, and manage patient expectations.

A242 - Contemporary racial and ethnic disparities in bariatric surgery in the United States (206619)

Background: Obesity prevalence continues to increase and disproportionately impact ethnic minorities. Review of the bariatric literature highlights both the lack of representation of ethnic minorities in the published data and may represent a lack of access to an effective treatment option for those most severely impacted by obesity.

Definition determines weight regain outcomes after sleeve gastrectomy

BackgroundSleeve gastrectomy (SG) is one of the most commonly undertaken bariatric procedures. Weight regain after bariatric surgery, when significant, may be associated with recurrence of diabetes and deterioration in quality of life. Furthermore, it may be more common after SG than bypass procedures. Yet the understanding of the significance of weight regain is hampered by poor reporting and no consensus statements or guidelines. ObjectivesTo illustrate how the lack of a standard definition significantly alters reported SG outcomes and to contribute to the discussion of how weight regain should be defined. SettingCounties Manukau Health, a public teaching hospital that performs over 150 bariatric procedures per year. MethodsA retrospective cohort of SG patients followed up at 5 years was used to illustrate how the presence of multiple definitions in the literature significantly affects outcome reporting for weight regain. Post hoc analyses were used to explore the relationship between weight change and clinical outcomes. ResultsApplying 6 definitions of weight regain to a retrospective cohort of SG patients resulted in 6 different rates ranging from 9%–91%. Post hoc analyses revealed significant associations between weight change and the Bariatric Analysis Reporting Outcome System (BAROS) score as well as patient opinion. ConclusionThe nonuniform reporting of weight regain appears to significantly affect SG outcome reporting. Development of consensus statements and guidelines would ameliorate this problem. Ideally, research groups with access to large robust databases would aid in the development of any proposed weight regain definitions. In the interim, bariatric literature would benefit by all published series clearly reporting how weight regain is defined in the study population.

Rates and Risk Factors for Unplanned Emergency Department Utilization and Hospital Readmission Following Bariatric Surgery.

To identify unplanned emergency resource utilization in the perioperative period following bariatric surgery. Avoidable emergency department (ED) utilization and hospital readmissions pose a significant economic burden to our healthcare system. The extent of this problem is poorly studied in the bariatric literature. Using New York statewide longitudinal administrative data, 38,776 patients, who underwent primary bariatric surgery from 2010 to 2013, were analyzed. Multiple logistic regression models analyzed all variables with P < 0.05 on univariate models. The 30-day unplanned ED utilization rate was 11.3% and 30-day hospital readmission rate was 5.3%. ED visits resulted in an inpatient admission 34.9% of the time. In total, 17.5% had 2 or more 30-day unplanned ED presentations. Patients presenting to the ED were more likely to be black, have pulmonary disease, be insured by the Centers for Medicaid and Medicare Services, travel further distances for index procedure, and have a surgical procedure other than gastric banding. In total, 46.7% presented to a nonindex hospital and 32.5% were admitted. Patients presenting to a nonindex hospital were significantly less likely to be admitted than those presenting to an index hospital. Unplanned perioperative healthcare utilization is a significant burden incurred by the bariatric population. A clear opportunity is identified for improvement in healthcare delivery-particularly for high-risk and high-frequency utilizers. Presentation to nonindex hospitals has important implications to the accuracy of current patient safety and quality outcomes measures. System measures designed to capture all unplanned resource utilization, not just those to index hospitals, are crucial for accurate evaluation.

Weight Regain Following Sleeve Gastrectomy-a Systematic Review.

Sleeve gastrectomy (SG) is a commonly performed bariatric procedure. Weight regain following SG is a significant issue. Yet the defining, reporting and understanding of this phenomenon remains largely neglected. Systematic review was performed to locate articles reporting the definition, rate and/or cause of weight regain in patients at least 2years post-SG. A range of definitions employed to describe weight regain were identified in the literature. Rates of regain ranged from 5.7% at 2years to 75.6% at 6years. Proposed causes of weight regain included initial sleeve size, sleeve dilation, increased ghrelin levels, inadequate follow-up support and maladaptive lifestyle behaviours. Bariatric literature would benefit from standardising definitions used to report weight regain and its rate in clinical series. Larger prospective studies are required to further understand mechanisms of weight regain following SG.

Early Adherence Targeted Therapy (EATT) for Postbariatric Maladaptive Eating Behaviors

Current bariatric literature on postoperative interventions that prevent or remediate suboptimal weight loss outcomes is limited. In response, Early Adherence Targeted Therapy (EATT), an efficient early postoperative intervention to target patients at high risk for suboptimal postoperative weight loss outcomes was developed. The rationale for and a detailed description of EATT is provided, including sample session transcripts. Preliminary findings from a pilot designed to explore EATT’s feasibility and acceptability are reported.EATT is a principle driven, skills-based intervention that addresses psychological skill deficits that underlie poor dietary adherence and maladaptive eating behaviors associated with suboptimal weight loss outcomes. Of 22 postoperative patients who consented to participate, 13 screened positive for poor dietary adherence and thus received EATT (77% female, 69% White, 23% Hispanic; mean age=42.9years; mean BMI=45.4±12.8kg/m2). The majority had undergone gastric bypass surgery (54%) and 76.9% had a psychiatric diagnosis, with 61% on psychotropic medications. Patient retention was high, with 11/13 (85%) completing treatment. Treatment was delivered efficiently, with an average of only 4.5 sessions (out of a possible 12) required to significantly increase dietary adherence (p<.001). At 12months postoperative, 62% (8/13) of this at-risk group experienced successful weight losses, with a mean %EWL=70.9% ±17.9. Acceptability of delivery formats was high, with 92% preferring telephone or video conferencing.EATT, a new intervention for postoperative patients at risk of poor weight loss outcomes, targets poor dietary adherence and associated maladaptive eating behaviors in a flexible format. EATT shows preliminary positive outcomes but longer-term efficacy needs to be examined in a longer, larger-scale randomized controlled trial.

Ideal Body Weight Calculation in the Bariatric Surgical Population

BackgroundIn bariatric surgery, ideal body weight (IBW) is used to calculate excess body weight (EBW) and percent excess weight lost (%EWL). Bariatric literature typically uses the midpoint of the medium frame from older Metropolitan Life Insurance (MetLife) tables to estimate IBW. This is neither universal nor always clinically accurate. ObjectiveThe objective of this study was to determine the accuracy of standard IBW formulas compared to MetLife data. MethodsWeight loss data from 200 bariatric surgical patients between 2009 and 2011 was used to assess the accuracy of IBW formulas. IBWs assigned from the midpoint of the medium frame and reassigned using different gender targets were compared to standard formulas and a new formula to assess the accuracy of all formulas to both targets. ResultsUsing standard MetLife data, the mean IBW was 136 lb, the mean EBW was 153.6 lb, and the mean %EWL was 43.8 %. Using the new target baseline, the mean IBW was 137.1 lb, the mean EBW was 152.6 lb, and the mean %EWL was 44 %. Deitel and Greenstein’s formula was accurate to 0.3 % of EBW using the standard method, while our new formula was accurate to 0.03 % of EBW. ConclusionsDeitel and Greenstein’s formula is most accurate using standard target IBW. The most accurate is our formula using the new MetLife target IBW.

Prophylactic inferior vena cava filter placement prior to lumbar surgery in morbidly obese patients: Two-case study and literature review.

Background:Preoperative “prophylactic” placement of inferior vena cava (IVC) filters in morbidly obese patients (e.g., body mass index [BMI] >40 or BMI over 35 with hypertension/diabetes) undergoing multilevel decompressive lumbar laminectomies may reduce the risk of postoperative pulmonary embolism (PE), and death.Methods:Two patients, ages 69 and 68, with morbid obesity (BMI's of 40.4 and 37.5 both with hypertension and diabetes), received prophylactic IVC filters prior to L1–S1 laminectomies. Intraoperatively and postoperatively, both received alternating compression stocking prophylaxis, and received subcutaneous heparin 5000 U q12 h 48 h after surgery until discharge; none developed deep venous thrombosis (DVT) or PE, and both filters were uneventfully removed within 3 postoperative months.Results:The spinal surgical literature largely supports the placement of IVC filters for major risk factors; obesity (BMI >40), a history of DVT/PE, cancer, fusions, hypercoagulation syndromes, pulmonary/circulatory disorders, preoperative/postoperative immobility, staged procedures (five spinal levels), combined anterior-posterior surgery, iliocaval manipulation, age >80, and prolonged surgery (e.g., >261 min vs. >8 h). Although the safety and efficacy of prophylactic IVC filters for spine surgery in patients with morbidly obesity are well substantiated, those for bariatric patients are less clear.Conclusions:Prophylactic IVC filters were successfully placed/retrieved in 2 morbidly obese patients, ages 68 and 69, undergoing L1–S1 lumbar decompressions. Although the spine surgery literature documents the safety/efficacy of prophylactic IVC filters in patients with morbid obesity, the bariatric literature still has major concerns.

Laparoscopic “Gastrojejunal Sleeve Reduction” as a Revision Procedure for Weight Loss Failure After Roux-En-Y Gastric Bypass

Weight regain after Roux-en-Y gastric bypass (RYGB) is increasingly reported in the bariatric literature. Laparoscopic sleeve reduction of the gastrojejunal complex is a surgical option to revise a dilated gastric pouch. We report our short-term results. Sleeve reduction entails serial firing of a linear stapler along the jejunal alimentary limb, across the gastric pouch and towards the left crus, with a bougie in place, thus, creating a new 20-25-cm reduced gastrojejunal complex. Data analyzed included age, body mass index (BMI), excess weight loss (EWL), comorbidity resolution, and any other simultaneous operative procedures. Fourteen patients were identified, all done laparoscopically. Nine underwent gastrojejunal sleeve reduction alone and five underwent additional lengthening of the Roux limb. There were no mortalities. Mean age at revision was 43 years (31-59). Mean BMI and EWL prior to revision were 35.5 ± 4.0 kg/m² and 48.9 ± 15.8%, respectively. Nine of 14 patients (64%) had obesity-related comorbidities prior to the revision. Average BMI decrease was 2.7 kg/m². Post-revision mean BMI and %EWL were 32.9 ± 4.7 kg/m² and 12.0 ± 13.9%, respectively, with mean follow-up of 12 months. Three of nine patients (33%) experienced improvement and/or resolution of comorbidities. We did not find a significant difference between pre-and post-revision mean BMI and %EWL (p = 0.13) even after separately evaluating those patients who underwent Roux limb lengthening (p = 0.16). For RYGB patients who regained weight, laparoscopic gastrojejunal sleeve reduction does not seem to offer a major therapeutic benefit. Additional malabsorptive Roux lengthening also does not provide a significant benefit. Other options should be considered, such as placing a band on the gastric pouch or conversion to duodenal switch.

Changes in depressive symptoms among adolescent bariatric candidates from preoperative psychological evaluation to immediately before surgery

Background The preoperative psychological evaluation (including the assessment of depressive symptoms) is an important component in determining adolescent bariatric candidacy. The adult bariatric data have suggested that candidates can engage in “impression management” and underreport depressive symptoms during their preoperative evaluation. The present study examined whether adolescent depressive symptoms among bariatric candidates change during preoperative preparation compared with adolescents with extreme obesity who were not seeking surgery. Methods Adolescent candidates for bariatric surgery (n = 30; 60% female; mean age 16.5 ± 1.4 years) completed the Beck Depression Inventory-II (BDI-II) at initial consultation (time 1, mean body mass index [BMI] 64.5 ± 11.5 kg/m 2) and again immediately preoperatively (time 2, mean interval 4.7 ± 2.9 months; mean BMI 64.4 ± 10.4 kg/m 2). Comparators (n = 25; 64% female; mean age 16.2 ± 1.2 years; mean BMI 46.5 ± 4.8 kg/m 2) were studied at enrollment in a research protocol and again 6 months later (mean interval 6.2 ± 0.4 months; mean BMI 46.8 ± 5.0 kg/m 2). The height and weight were also taken. Results We found a small, but statistically significant, difference in the BDI-II scores at time 1, with bariatric candidates reporting greater depressive symptoms (mean 16.6 ± 12.9) than the comparators (mean 10.6 ± 9.0; P < .05). No difference was seen in the BDI-II scores between the bariatric candidates (mean 14.4 ± 12.1) and the comparators (mean 10.4 ± 8.2) at time 2 ( P = .17). The change in BDI-II scores for the bariatric candidates showed a trend toward significance ( P = .09). Conclusion These results reinforce the position that the adult bariatric literature does not necessarily generalize to the adolescent bariatric population. They further suggest that impression management might not be a significant concern in the assessment of adolescent bariatric candidates. Future research should examine whether preoperative changes in psychological functioning predict the postoperative outcomes.

Moving beyond dichotomous psychological evaluation: the Cleveland Clinic Behavioral Rating System for weight loss surgery

Background Most bariatric programs require a preoperative psychological evaluation. The criteria for such decision-making and acceptance rates have been well described in published reports. Most programs have made categorical distinctions of accept, reject, or delay, although this limits utility. Methods Bariatric surgery candidates (n = 389; 77.1% women; 74.3% white; mean ± SD BMI 49.84 ± 11.51 kg/m 2) were evaluated using the CCBRS across 8 domains of interest in the psychological bariatric literature. Each domain was graded using a 5-point scale (poor, guarded, fair, good, excellent). A summary assessment was also given. The in-patient length of stay and preoperative, 1-, 3-, 6-, 9-, and 12-month BMI changes were assessed in the subset (n = 241) who had undergone surgery. Results The CCBRS had excellent internal consistency (Chronbach's alpha = .88) and good consistency across providers (test-retest for overall determination r = .82). Most candidates were deemed acceptable, but 25.7% were initially considered guarded or poor candidates. Only 2.6% of the sample was unable to achieve the goals to improve their candidacy and undergo surgery. Hierarchical regression analyses on the overall CCBRS score demonstrated that unemployment, less education, greater BMI, smoking, and psychiatric medication use were associated with lower assessment scores. Guarded candidates spent significantly longer in the hospital and fair candidates had less preoperative BMI change than guarded or good candidates, although no significant postoperative BMI changes were demonstrated. Conclusion The results of our study have shown that the CCBRS is an internally consistent and useful tool for multidimensional psychological assessment of preoperative bariatric candidates.

When Is a Petersen's Hernia Not a Petersen's Hernia

F e a v Chir 1900;62:95. urious about the origin of the eponymous “Petersen’s heria” so frequently noted in the bariatric literature, we perormed a literature search for the original description of this ernia. What we found was surprising, not only because of the emote publication date of the article, but because on translaion from the original German, Dr Petersen’s actual description f the hernia bears little if any similarity to modern usage of he terms Petersen’s hernia, 3,4,6,8-10,12,13,15,17,19,21,24,26-28,31,33,34,35 efect,space,site,or indow used to describe internal hernia formation after Rouxn-Y gastric bypass (RYGB) procedures. In 1900, DrWalther Petersen, first clinical assistant surgeon t the Surgical Clinic in Heidelberg, Germany published a 0-page article entitled “Ueber Darmverschlingung nach der astro-Enterostomie” (“Concerning Twisting of the Intesines Following a Gastroenterostomy”). In it, he described hree similar cases of internal small bowel herniation fter creation of a loop gastrojejunostomy. All three cases esulted in death, and Dr Petersen subsequently decribed the autopsy findings in great detail. Within the rticle, he acknowledged previously published forms of nternal herniation after this procedure, but differentited his observations from earlier reports with this tatement:

P31: Roux-en-Y gastric bypass and the development of leukopenia/atypical infections

In the bariatric literature there are no studies on the relationship of roux-en-Y gastric bypass (RYGB) and the development of leukopenia and/or atypical infections. Leukocytes are known to play a significant role in the defense against microorganisms. We want to find out the incidence of post gastric bypass leukopenia and whether it contributes to the development of atypical infections, such as cytomegalovirus (CMV) or Epstein-Barr virus (EBV).