Effective Bariatric Procedure Research Articles

Weight Loss and Nutritional Outcomes 10 Years after Biliopancreatic Diversion with Duodenal Switch.

Biliopancreatic diversion with duodenal switch (BPD/DS) is the most effective bariatric surgical procedure, but major concerns exist about the nutritional consequences. The study reported weight loss and nutritional outcomes of 80 patients with a follow-up of at least 10years. The follow-up was conducted at a university hospital as well as in a private practice institution in France. Eighty patients operated on between February 2002 and May 2006 were reviewed. Weight outcomes were analyzed as well as complete biological status. Revisions were reported as well as the number of patients taking vitamin supplementation. A follow-up of 141±16months was available for 87.7% of the patients at least 10years from surgery. Preoperative BMI decreased from 48.9±7.3 to 31.2±6.2kg/m2 with an EWL of 73.4±26.7% and a TWL of 35.9%±17.7%. Despite weight regain ≥10% of the weight loss in 61% of the cases, 78% of the patients maintained a BMI <35. Fourteen percent of the patients had a revision. Normal vitamin D levels were found in 35.4%. The overall PTH level was 91.9±79.5ng/mL, and 62% of the patients had hyperparathyroidism. Other deficiencies were less frequent but fat-soluble deficiencies as well as a PTH >100ng/mL were significantly associated with the absence of vitamin supplementation. BPD/DS maintains a significant weight loss, but remains associated with side effects leading to revision and multiple vitamin deficiencies. The most severe deficiencies are related to the lack of supplementation compliance.

Metabolic Improvement in Blood Glucose and Cholesterol after Sleeve Gastroectomy

Objective: To investigate the long-term effects of laparoscopic sleeve gastrectomy on weight loss, blood sugar and cholesterol. Materials & Methods: A total of 306 morbidly obese patients who underwent laparoscopic sleeve gastrectomy over three years from 2014-02-2017 at King Khalid Hospital Obesity Center, Najran (Saudi Arabia ) monitored postoperatively for a periodically over 24 months duration for weight reduction and metabolic changes by measurement of BMI, total body cholesterol and fasting blood sugar lower than 126 mg/(5.6-7 mmol). Hypercholesterolemia was defined as a total cholesterol level higher than 240 mg/dl (6.2 mmol), total cholesterol 200-240 mg/dl (5.2-6.2 mmol) considered as borderline, and less than 200 mg/dl (5.2 mmol) is normal. Result: The percentage of excess body weight was 50.8% (68 kh) and the percentage of excess weight loss was 18%, 34%, 55.6% and 73% at 3, 6, 12 and 24 months respectively and this excess weight loss was significant with P value less than 0.00001 and T value of 9.08. Blood sugar was significantly improved from preoperative 6 mmol to postoperative 5.75, 5.3, 5 and 4.3 mmol at 3, 6, 12 and 24 month respectively and this improvement was statistically significant as calculated using both T calculator for two dependent mean and the f-ratio value both yield P-value is <0.00001 which is statistically significant at p<0.01 and continue follow up for the mean blood sugar was normalized (4.3 mmol) which also statistically significant. Total body cholesterol was decreased from mean preoperative 5.6 mmol to 5.24, 5.2, 2, 4.97 and 4.3 mmol in 3, 6, 12, 24 months respectively and this reduction was statistically significant at P-value less than 0.01. Conclusion: Sleeve gastrectomy is a safe and effective bariatric procedure with approximately 75% of the excessive weight loss achieved at the first two-years, normalized blood sugar occurs in 96% of patients with normalization of total body cholesterol in all with satisfactory long-term results regarding weight loss and comorbidities.

Life with a Gastric Band. Long-Term Outcomes of Laparoscopic Adjustable Gastric Banding\u2014a Retrospective Study

BackgroundLaparoscopic adjustable gastric banding (LAGB) is the third most popular bariatric procedure worldwide. Various authors present ambivalent long-term follow up results.MethodsWe revised records of the patients who underwent LAGB between 2003 and 2006 along with history of additional check-ins. Patients with outdated details were tracked with the national health insurance database and social media (Facebook). An online survey was sent. The patients who did not have their band removed were included in this study. We calculated the percent total weight loss (%TWL) and percent excess weight loss (%EWL), along with changes in body mass index (ΔBMI). Satisfactory weight loss was set at >50% EWL (for BMI = 25 kg/m2). Since eight patients gained weight, we decided to include negative values of %TWL, %EWL, and ΔBMI.ResultsOne hundred seven patients underwent LAGB from 2003 to 2006. The mean follow-up time was 11.2 (±1.2) years. Eleven percent of patients were lost to follow up (n = 12). There was one perioperative death. Fifty-four of the patients (n = 57) had their band removed. Thirty-seven patients still have the band (39%) and were included in the study. The mean %EWL was 27% (−56–112%) and %TWL was 11% (−19–53%). Twelve patients achieved %EWL > 50% (32%). Thiry-two patients still suffer from obesity, with BMI over 30 kg/m2. Eight patients (22%) gained additional weight. Patients with %EWL > 50% suffered less from gastroesophageal reflux disease symptoms than those with EWL < 50% (p < 0.05).ConclusionsOut of 107 cases, only 11.2% of patients with gastric band (n = 12) achieved satisfactory %EWL. Twenty–two percent of patients regained their weight or even exceeded it. Overall results suggest that LAGB is not an effective bariatric procedure in long term observation.

Laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass for morbid obesity: a 1:1 matched cohort study in a Chinese population.

ObjectivesThis 1:1 matched cohort study with 3-year follow-up aimed to compare the safety and efficacy of LSG with LRYGB for morbid obesity patients.MethodsFrom 2009 to 2013, patients undergoing LRYGB (n = 63) were matched with LSG (n = 63) by gender, age, and body mass index (BMI). Major complications, BMI, percentage of excess weight loss (%EWL), and obesity-related comorbidities after 6, 12, 24, and 36 months were compared.ResultsHospital stay and major complication rates were comparable, but operative time in LSG was significantly shorter (83.2 ± 23.7 vs. 108.3 ± 21.3 min). No significant differences in mean %EWL and BMI were observed at 6, 12, 24 months. At 3-year follow-up, mean %EWL in the LRYGB group was significantly higher than in the LSG group (76.5 ± 9.2% vs. 65.7 ± 10.3%) and, consequently, mean BMI was significantly lower in LRYGB (28.2 ± 1.5 vs. 30.9 ± 2.4 kg/m2). No significant differences in remission of comorbidities were observed at 1- or 3-year follow-up.ConclusionsBoth LRYGB and LSG were safe and effective bariatric procedures in this Chinese population, but LRYGB seemed to be superior to LSG in terms of mid-term weight loss.

A comparative study of the metabolic effects of LSG and LRYGB in Chinese diabetes patients with BMI

BackgroundThe metabolic effects of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in type 2 diabetes (T2D) patients who do not meet National Institutes of Health indications has not been well studied. ObjectivesTo compare the effectiveness of LSG and LRYGB in Chinese T2D patients with body mass index (BMI)<35 kg/m2. SettingUniversity hospital, China. MethodsA nonrandomized cohort of patients who underwent LRYGB (n = 64) and LSG (n = 19) were followed up for 3 years and the outcomes (weight loss and remission of diabetes and other metabolic parameters) were compared. Univariate and multivariate analyses were applied to find associated parameters of T2D remission. ResultsIn total, 5 patients (6%) were lost to follow-up. No significant differences in mean percentage of excess weight loss and BMI were observed between the 2 groups at 2 years. At 3-year follow-up, the LRYGB group had significantly higher percentage of excess weight loss and lower BMI. The total (complete and partial) remission rate achieved with both bariatric procedures was 75.9% at 1 year and 56.4% at 3 years. Surgical safety, diabetes remission, and remission of other obesity-related co-morbidities were comparable between the 2 groups. Patients who achieved complete or partial remission had lower fasting plasma glucose, lower plasma glucose at 2 hours, lower glycated hemoglobin, and higher fasting C peptide than the other patients at baseline. High recurrence rates of hypertension and hyperuricemia were observed at 3 years postoperation. ConclusionsBoth LSG and LRYGB are safe and effective bariatric procedures for T2D in this Chinese population with diabetes and BMI<35 kg/m2.

Single Anastomosis Gastric Bypass-Comparative Short-Term Outcome Study of Conversional and Primary Procedures.

Single anastomosis gastric bypass (SAGB) has been established as a safe and effective bariatric procedure. SAGB has also been suggested as a conversion option from other procedures, but so far not extensively explored in that direction. The study retrospectively reviewed and analyzed 154 consecutive SAGB procedures, including 48 conversional SAGB (cSAGB) and 106 primary SAGB (pSAGB). Preoperative physical dimensions and perioperative complications were obtained. Patients were followed 1, 3, and 6months postoperatively, with weight measurements compared between groups. Operative times were longer in the cSAGB group but length of hospital stay was the same for both groups. Sixty-five percent of the cSAGB group had adjustable banding as a primary operation, and 94% opted for conversion due to insufficient weight loss or regain thereof. Follow-up data availability was 98, 82, and 79% for the three checkpoints. Three and 6months postoperatively, cSAGB had inferior mean excess weight loss (EWL) compared to pSAGB, though both groups were successful after 6months (mean EWL >50%). Body mass index loss was significantly higher for pSAGB for the first postoperative 3months. Low complication rates in both groups precluded statistical comparison in that respect. Initial weight loss after conversional SAGB is inferior to primary SAGB after 6months. The observed safety of cSAGB is comparable to previous evidence for this procedure in the conversional settings. SAGB may be considered as a safe and effective conversional procedure, but not as effective as pSAGB for initial weight loss.

Postoperative Bleeding and Leakage After Sleeve Gastrectomy: a Single-Center Experience.

Sleeve gastrectomy is being performed increasingly, mainly due to its low morbidity and mortality, but complications do occur. The aim of this study was to evaluate bleeding and leakage rates of primary and revisional sleeve gastrectomy in a personal series of 664 consecutive patients. Medical charts of all patients undergoing a primary or revisional sleeve gastrectomy between August 2008 and December 2014 were reviewed retrospectively. Subgroup analysis compared bleeding in patients after reduced port versus multiport technique and primary versus revisional sleeve gastrectomy. A total of 664 sleeve gastrectomies (489 women and 175 men) were performed. Mean age and body mass index were 36.03 ± 11.4years and 42.9 ± 8.3kg/m2, respectively. Mean operative time was 58.5 ± 20.0min, with a 0.15% conversion rate. Mean hospital stay was 2.1 ± 0.3days. The overall 30-day complication rate was 7.5%. Thirteen patients sustained postoperative bleeding (2%), three of whom required reoperation (0.5%). Staple line leakage and mortality were both nil in this series. No difference in postoperative complications was found between the subgroups. In this single-surgeon, single-center experience, sleeve gastrectomy was a safe and effective bariatric procedure with a low complication rate. Staple line reinforcement by oversewing was associated with low bleeding complications and no leakage. The majority of patients with postoperative bleeding could be managed conservatively. In our experience, reduced port technique and revisional sleeve gastrectomy had similar complication rates compared to multiport and primary sleeve gastrectomy.

Mesenteric Defect Closure Decreases the Incidence of Internal Hernias Following Laparoscopic Roux-En-Y Gastric Bypass: a Retrospective Cohort Study

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most effective bariatric procedures. Internal hernia (IH) is the commonest long-term complication seen after LRYGB. We analyzed the impact of closure of mesenteric defect at primary surgery on the incidence of IH. We also studied the effectiveness of pre-operative abdominal contrast-enhanced computerized tomography (CECT) in diagnosing IH. This is a retrospective cohort study in which we analyzed prospectively the collected data of all patients who underwent LRYGB from 2005 to 2014. All patients post-LRYGB presenting with unexplained abdominal pain with a suspicion of IH were subjected to a CECT abdomen, in which we looked specifically for "whirlpool" sign and "clustering of bowel loops." All patients underwent diagnostic laparoscopy. We compared the incidence of IH in those who did not undergo mesenteric defect closure (2005-2008, i.e., group A) with those who had the mesenteric defects closed during primary surgery (2009-2014, i.e., group B). We also calculated the sensitivity of abdominal CECT in diagnosing IH pre-operatively. Among patients who did not undergo closure of any mesenteric defect (group A 2005-2009), 21/600 (3.5%) developed IH, while 17/976 (1.7%) patients who underwent mesenteric defect closure (group B 2009-2014) developed IH (p = 0.027). Pre-operative CECT abdomen confirmed the diagnosis of IH in 47.5% (19/40 patients). Closing of mesenteric defects after laparoscopic gastric bypass seems to be related to a lower incidence of internal hernia in the follow up. As the sensitivity of abdominal CECT is low, laparoscopic exploration is recommended based on clinical suspicion.

Early Metabolic Outcome After Laparoscopic Sleeve Gastrectomy in Morbid Obese Patients

Background :Morbid Obesity (BMI > 40 kg/m2) is a substantial health problem that is related to many metabolic disorders including diabetes, hypertension and hypercholesterolemia and several cardiovascular diseases. This study we aimed to investigate the early metabolic changes which occur after Laparoscopic Sleeve Gastrectomy. Methods: One hundred morbid obese patients (65 females and 35 males) aged between 18 to 50 years with BMI range between 40-50 kg/m2 were enrolled in this study. Patients were followed up after 3 and 6 months post operation to monitor their BMI, serum glucose level, insulin, serum cholesterol level, triglycerides and systolic blood pressure. Results :A significant correlation was found between the percent decrease in BMI and the percent decrease in the measured metabolic parameters especially cholesterol and triglycerides levels at three and six months postoperatively. Conclusion: From the above results we can conclude that LSG is not only an effective bariatric procedure for loss of weight but also it plays and important and effective role in correction of metabolic disturbance associated to obesity especially diabetes type 2 very early after the operation. Statistically analysis used: Continuous variables are expressed as mean and Standard Deviation. Categorical variables are expressed as frequencies and percent. All statistical procedures were carried out using SPSS version 15 for Windows (SPSS Inc, Chicago, IL, USA).

The Swedish laparoscopic duodenal switch—from omega-loop to Roux-en-Y

The biliopancreatic diversion with duodenal switch (BPDDS) is considered to be the most effective bariatric procedure for introduction and maintenance of weight loss and resolution of obesity-related co-morbidities [1]. Scopinaro described the biliopancreatic diversion (BPD) in 1979 with a partial distal gastrectomy, closure of the duodenal stump, a Roux-en-Y gastroenterostomy, and an anastomosis between the biliary and the alimentary limb 50 cm proximal to ileocecal valve [2]. To gain control of complications related to Scopinaro’s procedure, the common channel was lengthened and the duodenal switch (DS) was added. The latter comprises a vertical sleeve gastrectomy with preservation of the pylorus and a duodenoileostomy [3]. In 1999 a laparoscopic approach for the DS procedure was introduced [4]. Study results concerning postoperative complication rates comparing open and laparoscopic DS are inconsistent [5,6]. This might be a result of the complexity of the surgery and the relatively small number of procedures performed worldwide. Internal herniation (IH) is a common complication after bariatric surgery. It has been shown that the closure of the mesenteric defects reduces the risk of IH and ileus. Closure of the mesenteric defects is technically challenging during standard laparoscopic DS with the entero-entero-anastomosis (EA) in the lower part of the abdomen. For successful advancement of the laparoscopic DS, the following 3 aims were defined that the novel procedure had to fulfill: (1) enhancement of the surgical workflow, (2) better overview of the correct positioning of the different limbs, and (3) facilitation of the closure of the mesenteric defects. The presented procedure accomplishes these targets.

A161 - Rare Complication Post Sleeve Gastrectomy: Acute Irreducible Paraesophageal Hernia

INTRODUCTION: Laparoscopic sleeve gastrectomy has been accepted as a standalone effective bariatric procedure. With the increase in the number of cases done worldwide, we are witnessing the emergence of new unexpected complications. PRESENTATION: A seemingly straight forward sleeve gastrectomy was complicated by acute postoperative vomiting which was diagnosed as an acute intra thoracic migration of part of the new sleeve. Surgical repair was done, with reduction and fixation of the stomach. Patient was subsequently relieved of his symptoms and discharged. DISCUSSION:This is a rare complicationof a relativelywell studiedoperation. Facedwith severepost operative repeated vomiting, clinical suspicion and correct use of all para-clinical tools should help delineate the cause. CONCLUSION: We report this case hoping to expand the existing literature on the topic and to highlight the potential role of gastrophrenic membrane dissection in the occurrence of such complication. © 2015 The Authors. Published by Elsevier Ltd. on behalf of Surgical Associates Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Standardized Technique of Laparoscopic Adjustable Gastric Banded Plication with 4-Year Results.

No bariatric procedure is perfect, and a plethora of such procedures itself is a proof for the same. Laparoscopic adjustable gastric banding has a high safety profile, but also a high rate of re-operation has been reported (Schouten, Wiryasaputra, van Dielen et al. Obes Surg 20(12):1617-26, 2010). Laparoscopic sleeve gastrectomy (LSG) is becoming popular, but has its own set of complications and is irreversible. We introduced laparoscopic adjustable gastric banded plication (LAGBP) in 2009 (Huang, Lo, Shabbir et al. Surg Obes Relat Dis 8(1):41-5, 2012) In a case matched comparative study with LSG, LAGBP showed similar results at 2 years in terms of weight loss, comorbidity resolution, and complications. (Huang, Chhabra, Goel et al. Obes Surg 23(8):1319-23, 2013). Several authors have reported variations in their technique, bougie size, and suture material used to perform plication. (Ramos, Galvao Neto, Galvao et al. Obes Surg 20(7):913-8, 2010, (Mui, Lee, Lam et al. Obes Surg 23(2): 179-83, 2013, Brethauer, Harris, Kroh et al. Surg Obes Relat Dis 7(1):15-22, 2011) Our initial technique of placing the band first and then plicating the stomach resulted in higher incidence of gastric fundus herniation compared to that reported in a systematic review (Abdelbaki, Huang, Ramos et al. Obes Surg 22(10):1633-9, 2012). After the first 65 cases, we reversed the order by performing the gastric plication first which ensures proper plication of the fundus and a more uniformly placed plication line. This technique has become our standard, and the same is described in this video in a stepwise fashion. We performed LAGBP in 202 cases over the last 4 years and recorded the findings. Our standardized technique is shown in this video. The T-suspension technique was used for liver retraction. (Zachariah, Tai, Chang et al. J Laparoendosc Adv Surg Tech A 23(4):311-5, 2013) Gastric plication formula is shown in Fig. 1. Fig. 1 Gastric plication formula Two hundred two (69 male, 133 female) patients in over the last 4 years underwent LAGBP. Follow-up at 1 year was 168 patients, and 56 patients reached 4-year follow-up. Age was 16-60 years (mean = 31.1). Mean BMI was 39.5 ± 3.18 and body weight 110 kg ± 19.4. Mean operative time was 104 min ± 39 and length of hospital stay after surgery 2.1 ± 2.3 days. No mortality was recorded. Excess weight loss at 1 year was 57.84 % and at four years 68 %. LAGBP has been proven to be an effective bariatric procedure in the midterm results. Standardization with plication first and then placement of the band could be important to achieve best outcomes.

Impaired weight loss in laparoscopic adjustable gastric banding patients over 50 years of age: diabetes mellitus as an independent risk factor.

Laparoscopic adjustable gastric banding (LAGB) represents a safe and effective bariatric procedure, particularly for patients over 50. Preoperative risk factors for impaired post-LAGB excess weight loss are not well characterized for this population. This study aimed to identify demographics, characteristics or comorbidities associated with excess weight loss at 6 and 12 months postoperatively (EWL180 and EWL365, respectively) for these patients. One hundred and seventeen LAGB patients >50 years of age from 2005 to 2014 were retrospectively reviewed for factors potentially associated with EWL180 and EWL365. Rationally selected variables chosen for analysis included age, race, gender, initial body mass index and preoperative weight loss; comorbidities assessed included hypertension, psychiatric disorders and diabetes mellitus (DM). Variables correlated with EWL180 or EWL365 on bivariate linear regression analysis (P ≤ .05) were input into multivariate linear regression analysis to confirm independent association. Preoperative DM (B = -9.1% EWL; 95% CI -13.6, -4.5%; P < .001) and African-American race (B = -8.8% EWL; 95% CI -17.3, -0.3%; P = .05) were independent risk factors for impaired EWL180. Only DM was a risk factor for impaired EWL365 (B = -9.7% EWL; 95% CI -17.7, -1.8%; P = .02). LAGB is a successful operation in patients >50 years of age. Preoperative DM is an independent risk factor for impaired EWL in this cohort.

Roux-en-Y Gastric Bypass Alters Brain Activity in Regions that Underlie Reward and Taste Perception.

BackgroundRoux-en-Y gastric bypass (RYGB) surgery is a very effective bariatric procedure to achieve significant and sustained weight loss, yet little is known about the procedure’s impact on the brain. This study examined the effects of RYGB on the brain’s response to the anticipation of highly palatable versus regular food.MethodsHigh fat diet-induced obese rats underwent RYGB or sham operation and were then tested for conditioned place preference (CPP) for the bacon-paired chamber, relative to the chow-paired chamber. After CPP, animals were placed in either chamber without the food stimulus, and brain-glucose metabolism (BGluM) was measured using positron emission tomography (μPET).ResultsBacon CPP was only observed in RYGB rats that had stable weight loss following surgery. BGluM assessment revealed that RYGB selectively activated regions of the right and midline cerebellum (Lob 8) involved in subjective processes related to reward or expectation. Also, bacon anticipation led to significant activation in the medial parabrachial nuclei (important in gustatory processing) and dorsomedial tegmental area (key to reward, motivation, cognition and addiction) in RYGB rats; and activation in the retrosplenial cortex (default mode network), and the primary visual cortex in control rats.ConclusionsRYGB alters brain activity in areas involved in reward expectation and sensory (taste) processing when anticipating a palatable fatty food. Thus, RYGB may lead to changes in brain activity in regions that process reward and taste-related behaviors. Specific cerebellar regions with altered metabolism following RYGB may help identify novel therapeutic targets for treatment of obesity.

Management of Refractory Noninsulinoma Pancreatogenous Hypoglycemia Syndrome with Gastric Bypass Reversal: A Case Report and Review of the Literature.

Background. Roux-en-Y gastric bypass (RYGB) is a commonly performed, effective bariatric procedure; however, rarely, complications such as postprandial hypoglycemia due to noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS) may ensue. Management of refractory NIPHS is challenging. We report a case that was successfully treated with RYGB reversal. Case Report. A 58-year-old male with history of RYGB nine months earlier for morbid obesity presented for evaluation of postprandial, hypoglycemic seizures. Testing for insulin level, insulin antibodies, oral hypoglycemic agents, pituitary axis hormone levels, and cortisol stimulation was unrevealing. Computed tomography (CT) scan of the abdomen was unremarkable. A 72-hour fast was completed without hypoglycemia. Mixed meal testing demonstrated endogenous hyperinsulinemic hypoglycemia (EHH) and selective arterial calcium stimulation testing (SACST) was positive. Strict dietary modifications, maximal medical therapy, gastrostomy tube feeding, and stomal reduction failed to alleviate symptoms. Ultimately, he underwent laparoscopic reversal of RYGB. Now, 9 months after reversal, he has markedly reduced hypoglycemia burden. Discussion. Hyperfunctioning islets secondary to exaggerated incretin response and altered intestinal nutrient delivery are hypothesized to be causative in NIPHS. For refractory cases, there is increasing skepticism about the safety and efficacy of pancreatic resection. RYGB reversal may be successful.

Association Between Postprandial Symptoms and Gastric Emptying After Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric procedure. However, postprandial symptoms can compromise its beneficial effect. It is not known if a changed gastric emptying and these symptoms are related. This study aimed to assess the association between postprandial symptoms and the gastric emptying pattern after LSG. A gastric emptying study with a solid and liquid meal component was performed in the second year after LSG. Before the test, symptoms were assessed using a standardized questionnaire, and during the test, symptoms were scored on a visual analog scale (VAS). Gastric emptying results were expressed as lag phase, half time of gastric emptying (T½), and caloric emptying rate/minute. Twenty patients (14 F/6 M; age 45.6 ± 7.7 years, weight 93.4 ± 28.2 kg, BMI 31.6 ± 8.1 kg/m(2)) participated in this study; 13 had a low symptom score (≤9, group I), 7 a high symptom score (≥18, group II). VAS scores for epigastric pain, nausea, and belching were significantly higher in group II. Lag phase (solid) was 6.4 ± 4.5 min in group I, 7.3 ± 6.3 in group II (p = 0.94); T½ (solid) was 40.6 ± 10.0 min in group I, 34.4 ± 9.3 in group II (p = 0.27); caloric emptying rate was 3.9 ± 0.6 kcal/min in group I, 3.9 ± 1.0 kcal/min in group II (p = 0.32). Patients with postprandial symptoms after LSG reported more symptoms during the gastric emptying study than patients without symptoms. However, there was no difference between gastric emptying characteristics between both groups, suggesting that abnormal gastric emptying is not a major determinant of postprandial symptoms after LSG.

State of the Art: Sleeve Gastrectomy

In the biliopancreatic diversion (BPD) type duodenal switch, sleeve gastrectomy was applied as the restrictive part instead of a horizontal gastrectomy in the original Scopinaro type BPD. Laparoscopic sleeve gastrectomy (LSG) was used as a first step in a staged concept for high-risk patients undergoing bariatric surgery. However, it is now being increasingly favored as a stand-alone procedure. This article discusses the history, surgical technique, early results, metabolic effects, mid- to long-term results regarding weight loss, improvement of comorbidities and quality of life, management of complications and indications. LSG is a safe and effective bariatric procedure with satisfying weight loss results and effects on comorbidities. Further data are required to assess long-term effectiveness and safety of LSG. In patients with very high initial BMI, LSG can be used in a staged concept. Other indications are: in cases with dense adhesions of the small bowel, patients with inflammatory bowel disease and patients where repeated endoscopy of the duodenum is necessary.

Laparoscopic gastric plication in morbidly obese adolescents: a prospective study

BackgroundThe prevalence of obesity has increased rapidly among adolescents. Bariatric surgery is associated with significant weight loss and improvement in obesity related co-morbidities, but may be associated with serious complications. Therefore, attempts on finding a safe and effective bariatric procedure for adolescents are ongoing. The objective of this study was to evaluate safety and efficacy of laparoscopic gastric plication (LGP) on adolescents. MethodA prospective study was performed on adolescents who underwent LGP from 2007–2013. Measured parameters included the percentage of excess weight (%EWL), percentage of body mass index loss (%BMIL), obesity related co-morbidities, operative time, and length of hospitalization and complications. ResultsLGP was performed in 12 adolescents (9 female and 3 male). Mean (SD) age of the patients was 13.8±1 year. Mean preoperative weight and BMI were 112.4±19.7 kg and 46.0±4 kg/m2, respectively. Mean (SD) %EWL and %EBMIL were 68.2±9.9% and 79.0±9.0%, respectively after 2 years. All medical co-morbidities were improved after LGP. There were no deaths. One patient required replication 4 days postoperatively due to obstruction at the site of the last knot. No other major complications were observed. No patient required rehospitalization. ConclusionLGP has the potential of being an ideal weight loss surgery for adolescents, resulting in excellent weight loss and minimal psychological disruption. It is associated with a minimal risk of leakage, bleeding, and nutritional deficiency. However, large well-designed studies with long-term follow-up are needed.

Cefotetan-Induced Hemolytic Anemia After Laparoscopic Sleeve Gastrectomy

The sleeve gastrectomy is one of several effective bariatric procedures, for morbid obesity. The use of prophylactic perioperative antibiotics in gastrointestinal operations has become standard of care, as it has been shown to reduce surgical site infections. Commonly recommended prophylactic antibiotics include a second or third generation cephalosporin such as cefazolin (Ancef, Kefzol), cefoxitin (Mefoxin) and cefotetan (Cefotan). However, cephalosporins have emerged as a leading cause of immune-mediated hemolytic anemia, with cefotetan and ceftriaxone topping the list. To increase awareness of this rare but potentially fatal phenomenon, we present a case of cefotetan-induced, hemolytic anemia in a patient who had recently undergone a laparoscopic sleeve gastrectomy for morbid obesity. J Curr Surg. 2014;4(2):52-54 doi: http://dx.doi.org/10.14740/jcs210w

Lifestyle Modification Parallels to Sleeve Success

The role of laparoscopic sleeve gastrectomy (LSG) has increased over the past 10 years. We present our results of patients who were 5 years out from surgery with regard to safety and long-term efficacy. Retrospective analysis was carried out from prospectively collected data of patients who underwent LSG for morbid obesity. Bariatric Analysis and Reporting Outcome System (BAROS) and Food Tolerance Scores (FTS) were assessed. At 5 years, two lifestyle modification questions (regarding nutrition habits and physical fitness) were separately assessed. One hundred fourteen patients underwent LSG and were available for postoperative visits. Mean excess weight loss (EWL) was >65% during the initial 3 years and declined to 45.3% in 5 years. Of the patients, 71.92% did not reach 50% EWL at 60 months and were considered objective failures. BAROS and FTS scores were 7.15 and 4.32, and 23.5 and 22.5 at 30 and 60 months, respectively. Analyzing the 32 patients with EWL >50% in the 5-year group, 26 (81.25%) of them had scored ≥0.5 on the two lifestyle modification questions compared with 6 (18.75%) that scored <0.5 (P < 0.001). LSG is an effective bariatric surgical procedure with significant long-term (5 year) weight loss, resolution of comorbid medical conditions and significant improvement in the quality of life. The basis for this success, which must be always emphasized preoperatively by the bariatric team, is knowledge and implementation of better nutritional habits and increasing physical fitness or, in other words, in significant lifestyle modification.