Gastric Laparoscopic Sleeve Research Articles

Influence of Liver Disease on Perioperative Outcome After Bariatric Surgery in a Northern German Cohort.

The aim of this study was to assess the prevalence of non-alcoholic fatty liver disease (NAFLD) in morbidly obese patients and evaluate the influence on perioperative complications. Patients undergoing bariatric surgery have a high incidence of non-alcoholic steatohepatitis (NASH). Upcoming data indicates that liver disease has a significant effect on perioperative complications. However, the influence of NAFLD/NASH on perioperative outcome in bariatric patients is still controversial. We identified a total of 302 patients with concomitant liver biopsies, while performing either laparoscopic Roux-Y gastric bypass or sleeve gastrectomy. Liver biopsy was performed in case of abnormal liver appearance at time of bariatric surgery. Histological results were compared to perioperative complication rate. NAFLD is common in our patient cohort. Abnormal findings in liver histology were found in 82.3% of our patients. Liver cirrhosis was newly diagnosed in 12 patients (4%). There were no complications due to liver biopsy. The mortality rate was 0.3%, leakage rate was 1%, and postoperative bleeding occurred in 3.3%. Pulmonary complications were observed in 1.7% and cardiovascular complications in 1.3%. One patient developed portal vein thrombosis and one patient acute pancreatitis; both were treated conservatively. No patient had postoperative liver failure. We found no association between histological findings and perioperative outcomes. The prevalence of NAFLD among morbidly obese surgical patients was high, although this condition was not associated with increased risk for postoperative complications. Because of unexpected findings in intraoperative liver biopsies, the routine indication of liver biopsies in patients at high risk for liver disease should be discussed.

The impact of history of exposure to abuse on outcomes after bariatric surgery: data from the Ontario Bariatric Registry

BackgroundStudies worldwide have reported an increased prevalence of abuse histories among bariatric surgery candidates. The impact of abuse history on weight loss after surgery has not been examined in Canada. ObjectivesDetermine the prevalence of abuse and its impact on postoperative outcomes in Ontario, Canada. SettingData from the Ontario Bariatric Registry. MethodsA retrospective cohort study of laparoscopic gastric bypass and sleeve gastrectomy surgeries from 2010 to 2014, for which any follow-up data were available (N = 6016). Weight loss outcomes at 3 months (n = 5147), 6 months (n = 4749), and 1 year (n = 4024) were compared between those with and without a self-reported history of any of emotional, physical or sexual abuse and those with and without a history of sexual abuse specifically. Mixed repeated measures models were adjusted for age, sex, type of surgery, and baseline body mass index. One-year postoperative occurrence of revisions or repairs, hospitalization, and death were also examined. ResultsThe prevalence of documented abuse was 21.5%. Emotional abuse was most common (13.1%), followed by sexual abuse (10.6%), then physical abuse (8.9%). There was no significant association between presence of abuse history and weight loss at any time point in repeated measures analyses. ConclusionAbuse histories are common in bariatric surgery candidates in Ontario, but at a lower prevalence than what has been reported elsewhere. History of abuse does not appear to affect weight loss out to 1 year postoperatively and may alert providers to offer additional support perioperatively and postoperatively, particularly in the setting of psychiatric co-morbidity.

Laparoscopic gastric sleeve in gastric volvulus secondary to diaphragmatic eventration in an adult patient

Acute gastric volvulus is a rare, but potentially life-threatening, cause of upper gastrointestinal obstruction. Male of 60 years old with severe epigastric pain and abdominal distension with haematemesis on two occasions. The patient was haemodynamically stable, with abdominal distension and palpable epigastric fullness. Hematic cytology showed: haemoglobin 8.2 g/dl and haematocrit 27%. Abdominal X-ray showed an elevation of left diaphragm with a hugely dilated stomach. A nasogastric tube was inserted. Endoscopy was performed. There was no active bleeding, but it was impossible to reach the duodenum due to the stomach distortion. The upper gastrointestinal X-ray study showed the appearance of an inverted stomach in the chest and an organoaxial gastric torsion. The CT scans of thorax and abdomen showed a gastric ascent into the thoracic cavity. Laparoscopic surgery was performed, finding the left hemi-diaphragm elevated, and the stomach, splenic angle of the colon, the spleen and tail of the pancreas were also raised. A linear gastrectomy (gastric sleeve) was performed. The postoperative progress was satisfactory. Oral feeding was started 72 h after surgery, and the patient was discharged, and has remained asymptomatic during the following by 8 years. Emergency physicians must maintain a high level of suspicion in patients that present with signs and symptoms suggesting upper digestive tract occlusion. The gastric sleeve is an excellent alternative to avoid recurrence of gastric volvulus. El vólvulo gástrico agudo es un problema infrecuente como causa de obstrucción gastrointestinal. Paciente varón de 60 años que acude a urgencias por dolor epigástrico severo acompañado de distensión abdominal, con hematemesis en 2 ocasiones. A la exploración física: hemodinámicamente estable, con distensión abdominal en epigastrio, ruidos abdominales disminuidos; la citometría hemática mostró: hemoglobina 8.2 g/dl y hematocrito de 27%. La radiografía de abdomen mostró: elevación del hemidiafragma izquierdo y gran dilatación de estómago; por lo que se le colocó sonda nasogástrica. Por endoscopia no se observó sangrado activo, siendo imposible alcanzar el duodeno por torsión gástrica. El estudio con medio de contraste mostró: estómago invertido dentro del tórax y con torsión gástrica axial. La tomografía de tórax y abdomen confirmó los hallazgos, con diagnóstico de vólvulo gástrico por eventración. Se procedió a efectuar laparoscopia, encontrando: hemidiafragma izquierdo elevado, así como estómago, ángulo esplénico del colon, bazo y cola del páncreas. Se realizó gastrectomía lineal (manga gástrica). La evolución fue satisfactoria; se inició alimentación por vía oral 72 h después de la cirugía, y el paciente fue dado de alta, con seguimiento de 8 años, en los que permanece asintomático. El médico de Urgencias debe mantener un alto índice de sospecha en pacientes que presentan signos y síntomas sugestivos de oclusión intestinal alta. El manejo con gastrectomía lineal (manga gástrica) es una excelente alternativa para evitar la recidiva.

Nutritional approach in late gastric stenosis after gastric sleeve

Laparoscopic gastric sleeve(LGS) is a very frequent used procedure nowadays in Romania, with more than 100,000 reported patients operated until now, the most part of patients being operated in private settings. It is a simple and efficient procedure, less expensive than gastric by-pass, with fewer complications, but can reduce obesity complications almost as well as gastric by-pass.

Bariatric Surgery in University Clinic Center Tuzla - Results After 30 Operations.

Introduction:Project of Bariatric surgery in University clinic center (UCC) Tuzla has been initiated in 2009 as an idea of professor Dešo Mešić and soon after that Bariatric surgical team led by doctor Fuad Pasic has been created.Material and methods:Practical team education was realized in Croatia in hospital „Sisters of Mercy” under supervision of professor Miroslav-Bekavac Beslin. First bariatric operations in UCC Tuzla has been done in 2011 and it was biliopancreatic diversion (BPD) Scopinaro.Results and discussion:So far there has been done 30 operations and among them there have been used almost all operative modalities - restrictive, malabsorptive and combined (laparoscopic gastric banding-LAPGB, Roux-y mini gastric bypass, open and laparoscopic gastric sleeve resection, and over mentioned Scopinaro’s BPD). Beginning results are very promising according to the fact that almost all operated patients after one year stopped using antihypertensive, antidiabetic and antidepressant therapy, that average year’s weight loss is 35-100 kilograms and total satisfactions of patients after surgeries is obvious.

Laparoscopic Sleeve Gastrectomy as a Good Surgical Alternative in Gastric Volvulus Caused by Diaphragmatic Eventration

Background: Acute gastric volvulus is a rare but potentially life-threatening cause of upper gastrointestinal obstruction. Therefore, emergency physicians must maintain a high index of suspicion when patients present signs and symptoms suggesting foregut occlusion. Surgical treatment of gastric volvulus, secondary to diaphragmatic eventration, can vary with no standard routines. In this communication, we discuss the value of a laparoscopic gastric sleeve to prevent recurrence.

Excess Weight Loss and Cardiometabolic Parameter Reduction Diminished among Hispanics Undergoing Bariatric Surgery: Outcomes in More than 2,000 Consecutive Hispanic Patients at a Single Institution

Bariatric surgery has been established as the most effective long-term treatment for morbid obesity and obesity-related comorbidities. Despite its success, there is a paucity of data on the outcomes of bariatric surgery on Hispanic patients. We performed a retrospective review of obese patients treated at our institute between 2008 and 2014. We identified self-reported Hispanic patients who underwent a laparoscopic gastric bypass (LGBP), sleeve gastrectomy (LSG), or gastric band (LGB) procedure. The primary end point was excess weight loss (EWL) at 6, 12, 24, and 36 months. Secondary end points included improvement of obesity-related metabolic parameters at 1 year. We performed a repeated measures analysis of variance to calculate statistical significance throughout our study time period. We identified 2002 Hispanic patients who underwent bariatric surgery (1,235 LGBP, 600 LSG, 167 LGB) at our institute from 2008 to 2014. Follow-ups at 6, 12, 24, and 36 months were 62.2%, 54.5%, 36.2%, and 19.8%, respectively. Mean preoperative BMIs were 47.0 ± 7.2 kg/m2, 46.1 ± 7.8 kg/m2, and 44.9 ± 6.0 kg/m2 for the LGBP, LSG, and LGB cohorts, respectively. Excess weight loss was significantly more pronounced in the LGBP and the LSG groups than in the LGB group; this difference was accentuated over time (p < 0.0001). Obesity-related metabolic parameters and the need for comorbidity medical therapy decreased in all 3 surgical groups. Bariatric surgery is highly successful in Hispanic obese patients. In the largest series to date, LGBP and LSG seem to yield more effective EWL and reduction of cardiometabolic parameters than LGB among Hispanics; however, outcomes are still markedly reduced when compared with those in non-Hispanic populations.

A122 - Taste and Olfactory Changes Following Laparoscopic Gastric Bypass and Sleeve Gastrectomy

Background Alterations in taste/smell after bariatric surgery have been observed, but few data is available. Some authors documented these changes and their role on weight loss but there is no evidence after laparoscopic sleeve gastrectomy (LSG). Methods Cohortstudywithpatientssubmittedtolaparoscopic gastric bypass (LGBP) and LSG that were asked to participate in a validated survey. The primary objective was to determinate the differences between procedures for taste and smell changes; a demographic and anthropometric analysis were also performed. Secondarily, the relation between food aversion and weight loss was also obtained. Results Final analysis was based on 154 patients (104 LGBP and 50 LSG). The overall mean time between surgery and questionnaire was 10±6.7 months. Most of the patients (87.6 %) experienced some taste/smell change. There were no differences between procedures for any change, taste or smell change. More patients submitted to LGBP referred that food smelled different (51.9 vs 34 % for the LSG group; p= 0.040). Higher %EWL was observed for patients presenting food aversion (73.3±19.7 vs 65.8±19.4 % for those without aversion; p=0.046). Based on type of surgery, the LGBP group had the same trend (%EWL of 78.2±17.3 vs 70.4± 18.6 % for those without aversion; p=0.044). Conclusion The majority of patients presented taste and olfactory changes soon after surgery independently of type of procedure. Patients submitted to LGBP referred more often a different smell in food. Higher %EWL was observed in patients presenting any food aversion, especially in the LGBP group.

A5098 - Value of Routine Contrast Radiograms Following Laparoscopic Gastric Bypass and Sleeve Gastrectomy.

A5098 - Value of Routine Contrast Radiograms Following Laparoscopic Gastric Bypass and Sleeve Gastrectomy.

A5240 - A single center comparison of laparoscopic gastric bypass, sleeve gastrectomy, and duodenal switch in those ≥ 65 years old

A5240 - A single center comparison of laparoscopic gastric bypass, sleeve gastrectomy, and duodenal switch in those ≥ 65 years old

Taste and Olfactory Changes Following Laparoscopic Gastric Bypass and Sleeve Gastrectomy.

Alterations in taste/smell after bariatric surgery have been observed, but few data is available. Some authors documented these changes and their role on weight loss but there is no evidence after laparoscopic sleeve gastrectomy (LSG). Cohort study with patients submitted to laparoscopic gastric bypass (LGBP) and LSG that were asked to participate in a validated survey. The primary objective was to determinate the differences between procedures for taste and smell changes; a demographic and anthropometric analysis were also performed. Secondarily, the relation between food aversion and weight loss was also obtained. Final analysis was based on 154 patients (104 LGBP and 50 LSG). The overall mean time between surgery and questionnaire was 10 ± 6.7months. Most of the patients (87.6%) experienced some taste/smell change. There were no differences between procedures for any change, taste or smell change. More patients submitted to LGBP referred that food smelled different (51.9 vs 34% for the LSG group; p = 0.040). Higher %EWL was observed for patients presenting food aversion (73.3 ± 19.7 vs 65.8 ± 19.4% for those without aversion; p = 0.046). Based on type of surgery, the LGBP group had the same trend (%EWL of 78.2 ± 17.3 vs 70.4 ± 18.6% for those without aversion; p = 0.044). The majority of patients presented taste and olfactory changes soon after surgery independently of type of procedure. Patients submitted to LGBP referred more often a different smell in food. Higher %EWL was observed in patients presenting any food aversion, especially in the LGBP group.

Comprehensive evaluation of the effect of bariatric surgery on pelvic floor disorders

BackgroundThe association of pelvic floor disorders (PFD) with obesity is well documented. The spectrum of PFD includes stress urinary incontinence (SUI), urge urinary incontinence (UUI), pelvic organ prolapse (POP), and fecal incontinence (FI). Resolution or improvement of SUI after bariatric surgery has been previously reported. However, the data regarding UUI and other forms of PFD with objective testing are sparse. ObjectivesProspectively evaluate the effects of bariatric surgery on the prevalence and severity of pelvic floor disorders. SettingU.S. Academic Hospital. MethodsFrom December 2008 to December 2012, patients who screened positive on a screening questionnaire were asked to participate in the study. Participants completed 3 validated condition-specific questionnaires before surgery and 6–12 months after. A subgroup consented to gynecologic examination (Pelvic Organ Prolapse Quantification [POP-Q] test) and urodynamic testing at similar time points. ResultsSeventy-two study patients underwent laparoscopic gastric bypass (n = 65), sleeve gastrectomy (n = 5), and gastric banding (n = 2). Mean BMI decreased from 47.5 to 32.7 kg/m2 1 year after surgery (P<.001). Based on questionnaires, the most prevalent PFD was SUI, identified in 60 (83.3%) patients at baseline and 32 (44.4%, P<.001) at follow-up. There was significant improvement in PFD-related symptoms, quality of life, POP, and sexual function at follow-up. Decrease in prevalence of SUI after surgery was also confirmed with urodynamic testing (from 76.9% to 30.8%, P = .01). There was no significant change in prevalence and severity of POP based on POP-Q exam. ConclusionsBariatric surgery is associated with a decrease in prevalence and severity of diverse forms of urinary incontinence as well as improvement in quality of life and sexual function of morbidly obese women.

Improvement in severe pulmonary hypertension in obese patients after laparoscopic gastric bypass or sleeve gastrectomy.

Case reports have suggested that bariatric surgery improves pulmonary hypertension. We performed a retrospective, case-control study to evaluate the safety and efficacy of bariatric surgery in obese patients with severe pulmonary hypertension. Morbidly obese patients followed in a specialty pulmonary hypertension clinic who underwent laparoscopic gastric bypass or sleeve gastrectomy between 2008 and 2013 (n = 10) were compared to a BMI-matched cohort managed with maximal medical therapy (n = 10). Patients with advanced malignancy, prior heart/lung transplantation, and pulmonary hypertension from thromboembolism were excluded. Primary outcomes assessed were changes in use of pulmonary vasodilatory and diuretic medications, need for home oxygen therapy, and mean pulmonary arterial pressures. Secondary outcomes measured were excess body weight loss, perioperative mortality and morbidity, and hospital length of stay. More patients who underwent bariatric surgery experienced improvements in pulmonary arterial pressures (75 vs. 0%, p = 0.02), reduction in or discontinuation of pulmonary vasodilatory therapy (67 vs. 0%, p = 0.01), and decreased diuretic requirements (86 vs. 13%, p = 0.01) than the control cohort. Seventy-five percent of patients previously on home oxygen discontinued therapy after surgery, while oxygen requirements increased in 50% of the control cohort. Excess body weight loss was greater in the surgical group (EWL 68 vs. 19%, p < 0.001). Seven significant complications in five patients occurred in the first postoperative year, but there were no mortalities. Mean inpatient length of stay was 5 days. Laparoscopic gastric bypass and sleeve gastrectomy in obese patients improves pulmonary hypertension in the short term.

Impact of laparoscopic gastric bypass and sleeve gastrectomy on anti-hyperglycaemic medication use in pre-existing type 2 diabetes mellitus

Impact of laparoscopic gastric bypass and sleeve gastrectomy on anti-hyperglycaemic medication use in pre-existing type 2 diabetes mellitus

Laparoscopic Roux-en-Y Gastric Bypass versus Sleeve Gastrectomy for Obese Patients with Type 2 Diabetes: A Meta-analysis of Randomized Controlled Trials

We aimed to evaluate the efficacy and safety of laparoscopic Roux-en-Y gastric bypass versus sleeve gastrectomy for obese patients with Type 2 diabetes. We searched the Cochrane Library, PubMed, EMBASE, Google Scholar, and the Chinese Wan fang database up to October 2013. Randomized controlled trials regarding the efficacy and safety of laparoscopic gastric bypass versus sleeve gastrectomy for obese diabetic patients were included. Two review authors independently abstracted data and assessed the risk of bias. The mean difference and relative risk were estimated with 95 per cent confidence intervals. Four randomized controlled trials met inclusion criteria. There was no significant difference between gastric bypass and sleeve gastrectomy groups with regard to glycosylated hemoglobin (mean difference [MD], 0.41%; 95% confidence interval [CI], -0.09 to 0.91), fasting plasma glucose (standardized MD, 0.61 mg/mL; 95% CI, -0.10 to 1.32), the numbers of subjects using oral antihyperglycemic medications and insulin (relative rate [RR], 1.53; 95% CI, 0.45 to 5.24; RR, 1.44; 95% CI, 0.47 to 4.39, respectively), body weight (MD, 0.42 kg; 95% CI, -5.01 to 5.85), body mass index (MD, 0.85 kg/m(2); 95% CI, 0.13 to 1.58), or waist circumference (MD, 1.59 cm; 95% CI, -3.02 to 6.19). However, cardiovascular risk was more significantly lessened in the gastric bypass group. Our meta-analysis demonstrated that compared with laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass offers equal efficacy for treatment of diabetes in obese patients but is associated with a significantly decreased cardiovascular risk.

Perioperative analgesic requirements in severely obese adolescents and young adults undergoing laparoscopic versus robotic-assisted gastric sleeve resection.

Purpose:One of the major advantages for patients undergoing minimally invasive surgery as compared to an open surgical procedure is the improved recovery profile and decreased opioid requirements in the perioperative period. There are no definitive studies comparing the analgesic requirements in patients undergoing two different types of minimally invasive procedure. This study retrospectively compares the perioperative analgesic requirements in severely obese adolescents and young adults undergoing laparoscopic versus robotic-assisted, laparoscopic gastric sleeve resection.Materials and Methods:With Institutional Review Board approval, the medication administration records of all severely obese patients who underwent gastric sleeve resection were retrospectively reviewed. Intra-operative analgesic and adjuvant medications administered, postoperative analgesic requirements, and visual analog pain scores were compared between those undergoing a laparoscopic procedure versus a robotic-assisted procedure.Results:This study cohort included a total of 28 patients who underwent gastric sleeve resection surgery with 14 patients in the laparoscopic group and 14 patients in the robotic-assisted group. Intra-operative adjuvant administration of both intravenous acetaminophen and ketorolac was similar in both groups. Patients in the robotic-assisted group required significantly less opioid during the intra-operative period as compared to patients in the laparoscopic group (0.15 ± 0.08 mg/kg vs. 0.19 ± 0.06 mg/kg morphine, P = 0.024). Cumulative opioid requirements for the first 72 postoperative h were similar in both the groups (0.64 ± 0.25 vs. 0.68 ± 0.27 mg/kg morphine, P = NS). No difference was noted in the postoperative pain scores.Conclusion:Although intraoperative opioid administration was lower in the robotic-assisted group, the postoperative opioid requirements, and the postoperative pain scores were similar in both groups.

Long-term Results of Dyslipidemia after Bariatric Surgery: A Comparison between Gastric Bypass and Sleeve Gastrectomy

Background: Dyslipidemia is frequent in obese patients. Long-term outcomes of dyslipidemia after bariatric surgery have not been reported. Our aim is to report long-term evolution of dyslipidemia after bariatric surgery, comparing laparoscopic Roux-Y gastric bypass (LRYGB) versus sleeve gastrectomy (LSG). Methods: Retrospective analysis between 2001 and 2010. Demographics, comorbidities, lipid profiles and excess weight loss (%EWL) at 5 years were retrieved, comparing values and dyslipidemia remission after LRYGB and LSG. Results: 2.416 LRYGB and 1.408 LSG patients were included. Basal demographics and comorbidities were similar between groups, except for higher body mass index in LRYGB patients. 152 LRYGB and 94 LSG patients achieved 5 years follow-up, reaching 83% and 70% EWL, respectively (p<0.01). Long-term dyslipidemia remission for LRYGB and LSG was achieved in 60% and 25% for total cholesterol; 80% and 57% for LDL-cholesterol; 80% and 92% for low HDL-cholesterol and 74% and 59% for triglycerides, respectively. Multivariate analysis showed that total cholesterol and triglycerides were significantly lower in LRYGB patients (p<0.05) at the fifth year. LDL-cholesterol and HDL-cholesterol showed no differences between groups (p=0.08 and 0.33, respectively). Conclusion: At long-term, bariatric surgery reach an acceptable remission or improvement of dyslipidemia, especially for total cholesterol and triglycerides after LRYGB compared to LSG.

Incidence of type 2 diabetes after bariatric surgery: population-based matched cohort study

The effect of currently used bariatric surgical procedures on the development of diabetes in obese people is not well defined. We aimed to assess the effect of bariatric surgery on development of type 2 diabetes in a large population of obese individuals. We did a matched cohort study of adults (age 20–100 years) identified from a UK-wide database of family practices, who were obese (BMI ≥30 kg/m2) and did not have diabetes. We enrolled 2167 patients who had undergone bariatric surgery between Jan 1, 2002, and April 30, 2014, and matched them--according to BMI, age, sex, index year, and HbA1c--with 2167 controls who had not had surgery. Procedures included laparoscopic gastric banding (n=1053), gastric bypass (795), and sleeve gastrectomy (317), with two procedures undefined. The primary outcome was development of clinical diabetes, which we extracted from electronic health records. Analyses were adjusted for matching variables, comorbidity, cardiovascular risk factors, and use of antihypertensive and lipid-lowering drugs. During a maximum of 7 years of follow-up (median 2·8 years [IQR 1·3–4·5]), 38 new diagnoses of diabetes were made in bariatric surgery patients and 177 were made in controls. By the end of 7 years of follow-up, 4·3% (95% CI 2·9–6·5) of bariatric surgery patients and 16·2% (13·3–19·6) of matched controls had developed diabetes. The incidence of diabetes diagnosis was 28·2 (95% CI 24·4–32·7) per 1000 person-years in controls and 5·7 (4·2–7·8) per 1000 person-years in bariatric surgery patients; the adjusted hazard ratio was 0·20 (95% CI 0·13–0·30, p<0·0001). This estimate was robust after varying the comparison group in sensitivity analyses, excluding gestational diabetes, or allowing for competing mortality risk. Bariatric surgery is associated with reduced incidence of clinical diabetes in obese participants without diabetes at baseline for up to 7 years after the procedure. UK National Institute for Health Research.

Laparoscopic Tubal Ligation Performed at the Time of Bariatric Surgery

Study Objective: To evaluate all patients who underwent laparoscopic tubal ligation in combination with laparoscopic bariatric surgery. Design: Case controlled retrospective study performed between January 2009 and March 2014. Setting: University based tertiary care medical center. Patients: Four reproductive age women undergoing bariatric surgery with desire for permanent surgical sterilization. Intervention: Laparoscopic vertical gastric sleeve procedure and laparoscopic tubal ligation. Measurements and Main Results: Four combined laparoscopic tubal ligations and gastric sleeve procedures were attempted. All four cases were successfully completed using a minimally invasive approach. The mean age of the patients was 44.25 years; the mean BMI was 49.25 kg/m (mean weight 303.75 lbs). The mean parity was 2.25 and none of the patients were nulliparous. Two patients had one prior cesarean section. Co –morbid conditions included hypertension, sleep apnea, polycystic ovarian disorder, type II diabetes mellitus, and gastro esophageal reflux disease. All patients successfully underwent laparoscopic tubal ligation as well as laparoscopic vertical gastric sleeve procedure. There were no intraoperative complications were noted in any of the cases. Post-surgical complications were reported in one of the four patients. Complications were related to intraabdominal adhesive disease and development of a paraesophageal hernia. This patient underwent lysis of adhesions and paraesophageal hernia repair with mesh. This complications were not thought to be related to the tubal ligation. Conclusion: Performing tubal occlusion at the time of bariatric surgery is a safe and effectiveway to eliminate the risk of future pregnancy. Fifty percent of pregnancies are undesired despite adequate and available contraception. Pregnancy presents additional risk to obese patients and those who have undergone bariatric surgery. It is therefore reasonable to screen patients for their desire for future child bearing and offer combined surgical tubal ligation in patients planning to undergo bariatric weight loss surgery.

Body Mass Index is Predictive of Higher In-hospital Mortality in Patients Undergoing Laparoscopic Gastric Bypass but Not Laparoscopic Sleeve Gastrectomy or Gastric Banding

High body mass index (BMI) has been shown to be a factor predictive of increased morbidity and mortality in several single-institution studies. Using the University HealthSystem Consortium clinical database, we examined the impact of BMI on in-hospital mortality for patients who underwent laparoscopic gastric bypass, sleeve gastrectomy, and gastric banding between October 2011 and February 2014. Outcomes were examined within each procedure according to BMI groups of 35 to 49.9, 50.0 to 59.9, and 60.0 kg/m(2) or greater. Outcome measures included in-hospital mortality, major complications, length of hospital stay, 30-day readmission, and cost. A total of 40,102 bariatric procedures were performed during this time period. For gastric bypass, there was an increase of in-hospital mortality (0.01 and 0.02 vs 0.34%; P < 0.01) and major complications (0.93 and 0.99 vs 2.62%; P < 0.01) in the BMI 60 kg/m(2) or greater group. In contrast, sleeve gastrectomy and gastric banding had no association between BMI and rates of mortality and major complications. Cost increased with increasing BMI groups for all procedures. A strong association was found between BMI 60 kg/m(2) or greater and higher in-hospital mortality and major complication rates for patients who underwent laparoscopic gastric bypass but not in patients who underwent sleeve gastrectomy or gastric banding.