Mini-gastric Bypass Research Articles

Bases conceptuales de la cirugía metabólica

The term Metabolic Syndrome (MS) has been used since its introduction in 2001 by the National Cholesterol Program (NCEP: ATP III). The concept has been discussed in the scientific literature for decades. The X Syndrome and other terms such as "death quartet" and insulin resistance syndrome have been used to describe the association between metabolic and cardiovascular risk factors. In Mexico, the prevalence of MS in the National Health and Nutrition Survey (Encuesta Nacional de Salud y Nutrición, ENSANUT) was 34% in 2000 and 41% in 2012. Lifestyle modifications along with increased physical activity, quitting smoking, and limiting alcohol consumption are essential for management and prevention because they play a central role in metabolic abnormalities. However, despite the large amount of medications available for diabetes, up to 50% of patients have been reported to fail to achieve adequate control goals, as defined by the American Diabetes Association (glycosylated hemoglobin <7%). In contrast, bariatric surgery (BS) has clearly confirmed that it contributes to improved beta cell function in patients with BMI > 35 kg / m 2 , as well as control of dyslipidemia and other metabolic disorders. Keywords: Metabolic surgery; surgery and metabolic syndrome; syndrome X; mini gastric bypass; bypass of an anastomosis; Roux-en-Y bypass; bariatric surgery.

A delayed acute complication: Gastric remnant hemorrhagic ulcer after mini-gastric bypass

Mini-gastric bypass is a common procedure for bariatric surgery. This procedure creates and excluded gastric remnant and this part can’t be accessed easily. Some complications of this gastric remnant has been reported but there is not a reported case of acute bleeding from there. Our report presents and 37 year old woman who had undergone bariatric surgery 6 years ago. Mini-gastric bypass was performed to this patient. The patient comes to the emergency service with signs of upper gastrointestinal bleeding. After hospitalization, examinations showed us that the patient was bleeding from the remnant stomach. The remnant stomach and the first part of the duodenum were resected with laparoscopic surgery. At 6 months followup, the patient has had no further episodes of gastrointestinal hemorrhage. Keywords: Gastric remnant; Hemorrhagic ulcer; Mini-gastric bypass; Red blood cell scintigraphy.

The incidence of gall stones after bariatric surgery and its association with weight loss

IntroductionGallstone (GS) formation is common in obese patients, particularly during rapid weight loss. This study aimed to determine the incidence of GS in patients underwent bariatric surgery (BS) and the influence of weight loss on GS formation. MethodsThis was a prospective study including 148 consecutive patients underwent BS. Patients with preoperative negative abdominal ultrasound (US) for GS were followed-up for at least 12 months. Patients underwent abdominal ultrasound (US) at 3, 6, 9 and 12 months and were clinically screened for symptomatic or complicated cholelithiasis. No GS lowering prophylaxis was used. Clinical and demographic characteristics were compared at baseline and 12 months after surgery. ResultsAt time of surgery GS was found in 40.6% of the studied patients and history of previous laparoscopic cholecystectomy (LC) was in 6.8% of the studied patients. The incidence of post bariatric GS at 12 months was 22.7% with significant difference (P-value<0.05), (Laparoscopic Sleeve Gastrectomy (LSG): 18.8%, Single anastomosis sleeve ileal bypass (SASI): 33.3%, Mini Gastric Bypass (MGB): 40%, LRYGB 50%). BS operations, rapid weight loss and gastro esophageal reflux disease (GERD) patients are at a higher risk for GS. ConclusionsThe incidence of post bariatric GS at 12 months was high (22.7%) with significant difference and we recommend routine US every 3, 6, 9 and 12 months during the first year after BS.

Evaluation of nutritional deficiencies and health-related quality of life during the first year after laparoscopic sleeve gastrectomy and laparoscopic mini-gastric bypass

Background Nutritional deficiencies and health-related quality of life represent a major concern after bariatric procedures and can cause serious complications. Bariatric procedures have different effects on the domains of quality of life. Objective To prospectively compare between the effects of laparoscopic sleeve gastrectomy (LSG) and laparoscopic mini-gastric bypass (LMGB) on nutritional deficiencies and quality of life during the first postoperative year. Patients and methods We included 40 patients. In the first group, 20 patients underwent LSG, whereas 20 patients in the second group underwent LMGB. Postoperative assessment of nutritional parameters and quality of life was performed every 3 months. Quality of life was assessed using bariatric analysis and reporting outcome system (BAROS) and short form-12 questionnaires. Results All nutritional parameters showed significant decrease with more significant deficiencies after LMGB. Quality of life improved significantly after both procedures. Using BAROS questionnaire, LMGB was associated with significant better results. Conclusion LSG and LMGB are associated with significant decrease of nutritional parameters and significant improvement of quality of life. However, LMGB is associated with significantly more nutritional deficiencies and better improvement of quality of life than LSG.

Mini-gastric Bypass—One Anastomosis Gastric Bypass in the Armamentarium of Bariatric Surgeon: a Narrative Review of Complications

Obesity continues to be a major cause of significant mortality and morbidity across the world. Multiple comorbidities like hypertension, hyperlipidaemia, and diabetes mellitus have been associated with obesity. Bariatric surgery has emerged as a most effective tool for sustainable weight loss in obese individuals. Mini-gastric bypass (MGB) has an advantage of being technically simple and having a shorter learning curve. The objective of the present article is to review the results of mini-gastric bypass based on the available literature. Electronic database search including EMBASE, Web of Science, MEDLINE First Search, OVID, Google Scholar, EBSCO host, Science Direct, and PubMed was performed from inception till October 2020. Mini-gastric Bypass had a short learning curve, took less operative time, and had shorter hospital stay when compared to Roux-en-Y gastric bypass. Mini-gastric bypass had comparable results with Roux-en-Y gastric bypass and better results than sleeve gastrectomy in terms of weight loss and comorbidity resolution. In terms of complications, both had similar marginal ulcer rates, malabsorption rates, and nutritional deficiency rates. Mini-gastric bypass-one anastomosis gastric bypass is documented to be better than Roux-en-Y gastric bypass in terms of internal herniation rates, dumping syndrome, and reactive hypoglycaemia rates. Mini-gastric bypass-one anastomosis gastric bypass is comparable to established bariatric procedures like Roux-en-Y gastric bypass both in terms of efficacy and safety and should be considered a mainstream procedure.

Comparison of primer and revisional laparoscopic mini-gastric bypass (MGB) for failed restrictive procedures: 2-year results at a tertiary center

Comparison of primer and revisional laparoscopic mini-gastric bypass (MGB) for failed restrictive procedures: 2-year results at a tertiary center

Mini-gastric Bypass Complications and the Value of the Preoperative Neutrophil to Lymphocyte Ratio in Early Prediction of Complications.

To describe the short-term results of mini-gastric bypass (MGB), the complications in patients who underwent mini-gastric bypass surgery (MGB), and evaluate the value of the neutrophil to lymphocyte ratio (NLR) in predicting complications at an early stage. A descriptive, analytical study. Elazığ Medical Park Hospital, Elazığ, Turkey from January, 2016 to July 2019. Data of patients who had undergone MGB for morbid obesity at the Department of Surgery, Medical Park Hospital, Elazığ, Turkey from January 2016 to July 2019 were retrospectively evaluated. Demographic characteristics, preoperative body weight, body mass index (BMI), weight change after surgery, and postoperative complications were evaluated. The collected data were statistically analysed. The Kolmogorov-Smirnov and Shapiro-Wilk tests were used to evaluate the data distribution. Results: A total of 95 patients were included in the study. The median preoperative BMI was 40.7 kg/m2 (40.2-42.5), the median NLR was 2.1 (1.5-2.8), and the median length of hospital stay was 4.0 (3.0-4.0) days. In univariate analysis, age, gender, preoperative baseline BMI or preoperative NLR were not statistically significant related to the presence of postoperative complications. There was a statistically significant difference in BMI, depending on different measurement times during the follow-up period (p< 0.001). MGB is an effective procedure in obesity and diabetes surgery. Complications with high morbidity and mortality might be seen, although at low rates. Although NLR's efficacy is low in predicting MGB complications, it may be a useful parameter in a large series. Key Words: Bariatric surgery, Complications, Mini-gastric bypass, Morbid obesity.

Sleeve gastrectomy versus mini-gastric bypass and their effects on type II diabetes mellitus and weight loss outcome.

Bariatric surgeries such as sleeve gastrectomy; mini-gastric bypass surgery are successful weight reduction surgeries which significantly impact metabolic syndrome. The purpose of this research was to assess the impact of laparoscopy gastrectomy and mini-gastric bypasses on weight decrease and diabetes remission of diabetic mellitus type 2 through two years of monitoring. Furthermore, this study looked at the difference between the two procedures regarding their efficacy and identify which one is proper for patients according to their comorbidities. A prospective study was held in Al Sadder Medical City and Al-Gadeer private hospitals in Al-Najaf city, Iraq, from January 2016 to February 2018. The study included 35 obese and morbidly obese patients with a known history of diabetes mellitus type 2, diagnosed from at least two years before surgery. 15 patients undergo uneventful laparoscopic sleeve gastrectomy (6 females and 9 males). 20 patients underwent uneventful laparoscopic gastric mini bypass surgery (6 females and 14 males). In addition, the patients were followed in the short-term postoperatively (3, 6, 12, 24 months) by monitoring their BMI, weight loss, and HbA1c. There was a decrease in BMI of about 45% from the baseline BMI in sleeve gastrectomy surgery and a decrease in HbA1c of about 45%, less than 6%. In gastric mini-bypass surgery, there was a decrease in BMI of about 47% from the baseline BMI and a decrease in HbA1c of about 45% from the baseline less than 6%, during a 24-month monitoring. Both surgeries were fruitful and had efficient results on patients, but the gastric mini bypass was more efficient than sleeve gastrectomy in controlling and remission of DM type 2 without the need for medications. A long-term study should be performed to reveal their effect and benefits to the patients.

Evaluation of the Effects of Bariatric Surgery in Terms of Weight Loss and Diabetes Remission in the Indian Population

Objectives: The growing prevalence of obesity rates worldwide is associated with an upsurge in its comorbidities, particularly type 2 diabetes mellitus (T2DM). Bariatric surgery is a proven treatment modality for producing sustained weight loss and resolution of associated T2DM providing marked improvement in quality of life with rapid recovery. This study aims to investigate the effects of laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), and mini-gastric bypass (MGB) on obese patients suffering from T2DM in the Indian population and their long-term association with regard to diabetes remission, resolution of comorbidities, and percentage EWL. Methods: Retrospective data of obese patients with T2DM (preoperative BMI 45.37 ± 8.1) who underwent bariatric surgery (RYGB, LSG, and MGB) were analyzed in this study over a period of 9 years. The mean follow-up period was 2.2 years. Following surgery, the clinical outcome on BMI, resolution of percentage weight loss, and T2DM were studied. The predictive factors of diabetic remission after surgery were determined. Student’s t test and ANOVA and McNemar’s test were applied. Results: Out of a total of 274 patients, complete remission of T2DM was achieved in 52.9% (n = 145) with mean fasting blood glucose and glycated hemoglobin values being 6.1 ± 0.769 (p = 0.00) at 1 year after surgery. The independent predictive factors of remission were age, gender, BMI, preoperative comorbidities, and % EWL. Gender had no correlation with the chance of achieving disease remission. Conclusion: Based on our results, bariatric surgery proves to be a successful treatment option resulting in sustained weight loss in obese patients suffering from T2DM. It is found to be beneficial for the long-term resolution of T2DM and improving comorbidities such as hypertension and dyslipidemia. The outcome of the different surgical methods is found to be similar for all patients irrespective of the independent predictors of complete remission.

Comparison of preoperative and postoperative Lipid Profile changes in obese and morbidly obese patients after mini gastric bypass surgery.

Background & Objective:Obesity has become a serious health problem that has become increasingly important in recent years. Since patients with high levels of obesity have dyslipidemia and an unbalanced lipid profile, they have a high risk of both diabetes mellitus and cardiovascular disease. This study aimed to evaluate the short (3 months) and long term (12 months) effects of mini-gastric bypass surgery from the current bariatric surgical techniques on the lipid profile.Methods:Of the patients undergoing Mini-gastric bypass operation between January 2016 to December 2018 at the General Surgery Clinic of Private Samsun Büyük Anadolu Hospital, demographic data and changes in lipid concentrations at 3 and 12 months were analyzed. Patients were grouped according to age, sex, body mass index (BMI), cardiologic risk groups, bypass lengths, and obesity classes. Total cholesterol, triglyceride, LDL-cholesterol, and HDL cholesterol values of the patients were examined at the time of admission to the outpatient clinic before the operation, at the postoperative third month and at the post-operative twelfth-month. Patients who did not go for a checkup during the one-year follow-up and whose data could not be reached or missing were excluded from the study.Results:There was no significant difference in terms of age, sex, and cardiovascular risk (p> 0.05). Although the HDL-C level was initially low (p <0.001), it significantly increased 12 months after surgical treatment (p <0.001). While serum concentrations of LDL cholesterol, total cholesterol, and triglycerides were high preoperatively, they significantly decreased at 12 months postoperatively (p <0.001). When compared with values in the 3rd- and 12th-month, there was a significant decrease in the class-3 obesity group but not in the class-2 obesity group. When serum HDL cholesterol concentrations were compared with preoperative baseline and postoperative 12th-month those, no statistically-significant difference was found in serum concentrations in the 3rd month, although there was a significant increase in both class 2 and 3 obesity groups.Conclusion:In patients undergoing mini-gastric bypass surgery, serum LDL cholesterol, total cholesterol, and triglyceride concentrations decreased in the 12th postoperative month, but serum HDL cholesterol concentrations increased.

ПРИМЕНЕНИЕ ТЕСТА УТЕЧКИ КРАСИТЕЛЯ ДЛЯ КОНТРОЛЯ ГЕРМЕТИЧНОСТИ ЖЕЛУДОЧНО-КИШЕЧНОГО ТРАКТА ПРИ БАРИАТРИЧЕСКИХ ОПЕРАЦИЯХ

The problem of obesity is widespread both in the Republic of Belarus and on a global scale. So, according to the WHO, 640 million people in the world suffer from obesity [6]. In the Republic of Belarus in 2015—2016.rasprostranennost' ozhireniya sredi vzroslogo naseleniya sostavlyala 24,5 % [5, 6]. Morbidnoye ozhireniye pri IMT &gt;40 kg/m2, ili &gt;35 kg/m2 pri nalichii soputstvuyushchey patologii, chasto okazyvayetsya refrakternym k konservativnym the prevalence of obesity among the adult population was 24.5 % [5, 6]. Morbid obesity with a BMI &gt;40 kg/m2, or &gt;35 kg/m2 in the presence of concomitant pathology, is often weight loss in patients is precisely surgical intervention [2]. Among the performed bariatric operations, interventions involving gastric resection or bypass surgery prevail. Thus, in the world, the share of gastric bypass surgery on a Roux-type loop is 41.9 %, sleeve gastrectomy is 32.6 %, and the share of mini-gastric bypass is 5.0 % [6]. One of the most common complications after the listed bariatric procedures is the failure of the gastric suture line or anastomoses. After gastric sleeve gastrectomy, the incidence of this complication reaches 3.9 %, and after Roux-en-Y loop gastric bypass surgery — up to 8 % [3,7]

AB020. OP20 Robotic mini gastric bypass: is there any advantages?

Background: Gastric bypass described by Mason & Ito in 1967. Rutledge described mini gastric bypass (MGB) in 1997 with a gastric pouch parallel to lesser curve and loop gastroenterostomy, 200 cm (150–300 cm) from Treitz’s Ligament. First laparoscopic mini gastric bypass (LMGB) was made in 2002 and first robotic series presented by Arun Prassad in 2014. In 2015 MGB-OAGB International Club was established. The study aims to describe the technique and analyze our robotic mini gastric bypass (RMGB) cases using da Vinci Xi.

AB005. OP-5 A new approach in bariatric operations: bridged mini gastric bypass is rabbit model suitable for an experimental study?

Background: Obesity is a global health epidemic with considerable co-morbidities. The increasing demand for bariatric surgery has led to the emergence of new techniques. We modified previously described mini gastric bypass (MGB) technique via leaving a bridge at the most cranial 2 cm of the fundus of human stomach to the follow-up and treatment of the remnant stomach and duodenum. We would like to entitle this new technique as Bridged MGB (Sumer’s technique) and aimed to apply on rabbits as an experimental study.

Incidence of Silent Deep Venous Thrombosis after Laparoscopic Bariatric Surgery in Patients Who Received Combined Mechanical and Chemical Thromboprophylaxis Compared to Patients Who Received Mechanical Thromboprophylaxis Only.

Background. This prospective randomized study compares the incidence of silent deep venous thrombosis (DVT) among 2 groups of patients who underwent laparoscopic bariatric surgery. The first group received mechanical thromboprophylaxis only, while the second group received a combination of mechanical and chemical thromboprophylaxis. Methods. This study included 150 morbidly obese patients who underwent primary one-stage laparoscopic bariatric surgery (sleeve gastrectomy and mini-gastric bypass) over a 6-month period. Patients were randomly assigned to 2 groups: group A (n = 75) was subjected to mechanical thromboprophylaxis in the form of perioperative elastic stockings on both lower limbs and early postoperative ambulation, and group B (n = 75) was subjected to combined mechanical thromboprophylaxis and chemical thromboprophylaxis in the form of 40mg subcutaneous enoxaparin 12hours before surgery and postoperative enoxaparin (40mg subcutaneous every 24hours) for 2weeks. Bilateral lower limb venous duplex was done for all patients before discharge, on the second and fourth weeks postoperatively, to detect silent DVT. Results. Nine patients out of 150 patients developed silent DVT (6%). All patients among group A were subjected to mechanical thromboprophylaxis only (12%) [P = .247, relative risk: .45, 95% confidence interval; .37-.62]. There was no silent DVT among group B who received combined mechanical and chemical thromboprophylaxis. No bleeding complications were reported in both groups. Conclusion. Combined mechanical and mechanical thromboprophylaxis is effective and safe in the prevention of silent DVT after laparoscopic bariatric surgery. Trial registration: The trial was registered in the Thai Clinical Trials Registry (TCTR20200127002) on January 20, 2020 retrospectively.

Efficacy of Gastric Bypass in the Treatment of Obesity-Associated Carbohydrate Metabolism Disorders

We have operated on 42 patients ages 22 to62 suffering different forms of obesity and obesity-relatedmetabolic disorders. Body mass indexes have ranged from 28 to 62 kg/m2. All patients have had symptomsof metabolic disorders of different intensity. Our goal has been exerting maximal influence on carbohydratemetabolism processes rather than mere body weight reduction. The patients have undergone sleevegastrectomy, laparoscopic mini-gastric bypass, Roux en Y gastric bypass, as well as modified gastric bypasswith Rouxen Y gastrectomy with a 180-cm bypass and 70-cm alimentary loop as an independent way ofsurgical treatment of diabetes type 2 associated with obesity. Sleeve gastrectomy in terms of weight controlhas demonstrated a 73% efficacy, and gastric bypass –a 89% efficacy. The efficacy of surgeries in patientswith carbohydrate metabolism disorders through Roux en Y gastric bypass has totaled 96%,classic Roux en Ygastric bypass - 92%, sleeve gastrectomy – 60%. Roux en Y gastric bypass andmini-gastric bypass are moreeffective in the treatment of obesity and associated metabolic disorders compared to sleeve gastrectomy.Gastric bypass has proved effective even in diabetes patients with body mass indexes up to 30 kg/m2.

Short-term outcomes of the conversion of one anastomosis gastric bypass to Roux-en-Y gastric bypass in symptomatic reflux patients without revising the size of the gastric pouch.

Background:Revising the size of the gastric pouch during the conversion of one anastomosis gastric bypass (OAGB)/mini-gastric bypass to Roux-en-Y gastric bypass (RYGB) is an important point. Even in patients undergoing RYGB, marginal ulcer is regarded as a known complication.Materials and Methods:In our Centre of Excellence in Bariatric and Metabolic Surgery, 2492 patients underwent OAGB from February 2012 to January 2019. Twelve of 2492 patients were enrolled in this clinical case series because of persistent gastroesophageal reflux-like symptoms which underwent conversional RYGB. All patients regularly received proton-pump inhibitors (PPIs) for 6 months after the surgery. After this period, the cases with symptomatic reflux were invited to be visited in the clinic by a bariatric surgeon and a gastroenterologist and received 6 months of PPI therapy until their symptoms disappeared. Twelve refractory reflux cases underwent conversional RYGB after 1 year. An enteroenterostomy was created in all the patients 75 cm distal to the gastrojejunostomy without resizing the gastric pouch, and the jejunal loop was cut just before the gastrojejunostomy.Results:Before conversional surgery, mean ± standard deviation (SD) body mass index (BMI) and gastroesophageal reflux disease (GERD)-Q score were found to be 26.45 ± 2.34 kg/m2 and 10.08 ± 0.56, respectively. At 1 year after conversion, mean ± SD BMI in the patients was 28.12 ± 4.71, and GERD-Q score was 5.08 ± 1.5.Conclusion:It seems that resizing the gastric pouch is not necessary during the conversion of OAGB to RYGB.

Changes in metabolic parameters and glomerular filtration rate in patients with morbid obesity after bariatric surgery

To study the effect of weight loss in the short term after bariatric surgery (BO) on metabolic parameters and glomerular filtration rate (GFR) in patients with morbid obesity. We studied 40 adult (over 18 years) patients with morbid obesity who underwent bariatric surgery. Metabolic indices and calculated GFR according to the CKD-EPI formula in patients before and after bariatric surgery were compared. In the whole group of operated patients, the average body mass index (BMI) after surgery decreased from 45.8 to 30.5 kg/m2. In 11 (92%) patients with impaired carbohydrate metabolism, remission of diabetes mellitus was achieved and sugar-lowering drugs were canceled. In patients with baseline GFR90 ml/min/1.73 m2 after surgery, there is a tendency towards a decrease in GFR, probably due to a decrease in hyperfiltration. In patients with baseline GFR90 ml/min/1.73 m2 after surgery, a statistically significant increase in the level of GFR was noted. The greater metabolic efficacy of combined operations (mini-gastric bypass, biliopancreatic diversion) in relation to the correction of carbohydrate and fat metabolism was revealed. Obesity is a modifiable risk factor for decreased kidney function and the progression of chronic kidney disease. Bariatric surgery is an effective treatment for morbid obesity. The study proved the positive effect of weight loss after BO on renal function, including by improving the course of diseases associated with obesity.

COMPARATIVE STUDY OF OUTCOMES BETWEEN LAPAROSCOPIC SINGLE ANASTOMOSIS SLEEVE ILEUM BYPASS (SASI BYPASS) VERSUS LAPAROSCOPIC MINI-GASTRIC BYPASS IN MORBID OBESE PATIENTS

Background: The single anastomosis sleeve ileal (SASI) bypass is a Novel Metabolic/Bariatric Surgery operation based on mini gastric bypass operation and Santoro's operation in which a sleeve gastrectomy is followed by a side to side gastro-ileal anastomosis. Objective: To evaluate the short-term outcomes between laparoscopic single anastomosis sleeve ileal bypass and mini gastric bypass, with respect to postoperative weight loss and metabolic and nutritional effects on patients. Patients and methods: This study was done at Al-AzharUniversityHospital and Al-NharHospital. It was a prospective randomized study which compared between single anastomosis sleeve ileum bypass (SASI bypass) Versus Laparoscopic Mini-gastric Bypass, in outcome. The study included 40 patients scheduled for elective laparoscopic bariatric surgery, due to morbid obesity, divided into two groups. The first group (group A) was operated by gastric mini bypass and the second group (group B) where single anastomosis sleeve ileum bypass was done. Results: The results of the study revealed that that there was high significant difference between before and after SASI surgery as regard FBG, HbAIC, triglycerides, cholesterol, HDL and LDL. Conclusion: SASI bypass is a promising operation that offers excellent weight loss and diabetic resolution.

Endoscopic ultrasound-guided gallbladder drainage by transjejunal lumen-apposing metal stent placement in a patient with mini-gastric bypass.

Endoscopic ultrasound-guided gallbladder drainage by transjejunal lumen-apposing metal stent placement in a patient with mini-gastric bypass.

Impaired dexamethasone resorption in two patients with pseudo‐Cushing after bariatric surgery: Implications for immunosuppressive treatment

Two cases of middle-aged female patients treated by gastric bypass surgery for weight loss presented to our clinic for a follow-up examination 3-6 months after the surgical procedure (a mini gastric bypass and a modified single anastomosis sleeve-ileostomy). In both patients increased ACTH levels and either high serum cortisol or an increased urinary cortisol excretion was apparent and triggered further endocrine testing. Serum cortisol could not be suppressed adequately by 2 and 4 mg dexamethasone in the standardized oral overnight suppression test while midnight salivary cortisol dropped well below the desired cut-off. This led to the hypothesis of an impaired dexamethasone resorption and could be further substantiated by suppression of serum cortisol below the cut-off by an intravenous dexamethasone application. The data presented point to an impairment of enteral synthetic corticosteroid resorption in patients after gastric bypass surgery and could be of importance for individuals in need for immunosuppressive treatment. In view of the growing number of bariatric procedures, pharmacokinetics of corticosteroids and other drugs should be tested in clinical trials.