Surgical Procedure For Morbid Obesity Research Articles

Hand-Sewn Gastrojejunostomy In Situ to Solve Acute Anastomotic Stricture Due to Submucosal Tunneling in Gastric Bypass.

Roux-en-Y gastric bypass (RYGB) is the second most widely used bariatric surgical procedure for morbid obesity and its related comorbidities. Anastomotic stricture is one of the major complications after RYGB. Submucosal tunneling is a rare cause of anastomotic stricture or occlusion, and clinical symptoms will appear soon after surgery. We present our technical suggestions to perform a hand-sewn gastrojejunostomy in situ when the gastric pouch is too small and the tissue is not enough to be resected to solve acute anastomotic stricture due to submucosal tunneling in gastric bypass.

Comparison of short-term outcomes between multi-port and single-port sleeve gastrectomy: a prospective study

Background: Single-incision laparoscopic surgery has attracted a great deal of interest in the surgical community in recent years, including bariatric surgery. Literature is scarce about operative and clinical outcomes of single port sleeve gastrectomy (SPSG) compared to conventional laparoscopy. SPSG has been proposed as an alternative to the multiport laparoscopic procedure; however, it has yet to meet wide acceptance and application.Methods: This was a prospective non-randomized clinical study, to evaluate the feasibility and short-term outcomes of SPSG in comparison to the conventional multiport sleeve gastrectomy (MPSG).Results: Weight loss, resolution of comorbidities, length of hospital stay, complications were almost comparable in both groups. Operating times were longer in SPSG group. Two patients only required re-laparoscopy, one in either group. There were no leakage or mortalities. Patients in the SPSG group had better wound satisfaction and less post-operative pain.Conclusions: SPSG is a safe, effective, and feasible surgical procedure for morbid obesity in selected individuals and comparable to the conventional laparoscopic technique in terms of outcomes. It has equally effective weight loss and resolution of comorbidities. It also has the added benefits of little/ no visible scarring and reduced postoperative pain.

Evaluation of esophageal pathology in a group of patients 2 years after one-anastomosis gastric bypass (OAGB) — Cohort study

BackgroundOne-anastomosis gastric bypass (OAGB) is a well established surgical procedure for morbid obesity. There are ongoing speculations and a debate regarding biliary reflux (BR) following OAGB. Studies considered OAGB as a risk for symptomatic and asymptomatic BR and marginal ulceration. The aim of the study was to evaluate the rate of gastroesophageal reflux disease (GERD) and esophagitis in microscopic and macroscopic evaluations among post OAGB patients diagnosed by means of upper endoscopy (UE) with a mucosal biopsy, and to assess the influence of comorbidities and medical history on endoscopic findings. MethodsPatients operated between 1st January 2016 to 31st December 2017 were schedule, two years after OAGB for UE with a biopsy. In all cases, biopsies from the distal esophagus were obtained. All patients received a validated GERD-Health-Related Quality of Life questionnaire to assess their current symptoms. ResultsFifty patients were finally enrolled in the study. Twenty-four (48%) had grade A or B esophagitis. Four patients (8%) had endoscopically suspected esophageal metaplasia (ESEM). 34/50 (68%) patients had various histopathological esophageal changes, based on the conducted endoscopy, among which four cases of Barrett’s esophagus were observed. ConclusionsDespite the high rates of esophagitis in our cohort, most of the patients did not report any symptoms which confirm the thesis of the essential role of asymptomatic bile reflux following OAGB. Theoretically, chronic bile reflux can degenerate Barrett’s esophagus into esophageal cancer.

Canagliflozin: A New Therapeutic Option in Patients That Present Postprandial Hyperinsulinemic Hypoglycemia after Roux-en-Y Gastric Bypass: A Pilot Study

Introduction: Roux-en-Y gastric bypass (RYGB) is the most common surgical procedure for morbid obesity. However, it can present serious late complications, like postprandial hyperinsulinemic hypoglycemia (PHH). Recent data suggested an increase in intestinal SGLT-1 after RYGB. However, there is no data on the inhibition of SGLT-1 to prevent PHH in patients with prior RYBG. On this basis, we aimed to evaluate (a) the effect of canagliflozin 300 mg on the response to 100 g glucose overload (oral glucose tolerance test [OGTT]); (b) the pancreatic response after intra-arterial calcium stimulation in the context of PHH after RYGB. Materials and Methods: This is a prospective pilot study including patients (n = 21) with PHH after RYGB, matched by age and gender with healthy controls (n = 5). Basal OGTT and after 2 weeks of daily 300 mg of canagliflozin was performed in all cases. In addition, venous sampling after intra-arterial calcium stimulation of the pancreas was performed in 10 cases. Results: OGTT after canagliflozin showed a significant reduction of plasma glucose levels (minute 30: 161.5 ± 36.22 vs. 215.9 ± 58.11 mg/dL; minute 60: 187.46 ± 65.88 vs. 225.9 ± 85.60 mg/dL, p < 0.01) and insulinemia (minute 30: 95.6 ± 27.31 vs. 216.35 ± 94.86 mg/dL, p = 0.03; minute 60: 120.85 ± 94.86 vs. 342.64 ± 113.32 mIU/L, p < 0.001). At minute 180, a significant reduction (85.7%) of the rate of hypoglycemia was observed after treatment with canagliflozin (p < 0.00001). All cases presented normal pancreatic response after intra-arterial calcium administration. Conclusion: Canagliflozin (300 mg) significantly decreased glucose absorption and prevented PHH after 100 g OGTT in patients with RYGB. Our results suggest that canagliflozin could be a new therapeutic option for patients that present PHH after RYGB.

Postoperative Clinical-Endoscopic Follow-up for GERD and Gastritis After One Anastomosis Gastric Bypass for Morbid Obesity: How, When, and Why.

The one anastomosis gastric bypass (OAGB) is a widely diffused surgical procedure for morbid obesity. Several studies considered OAGB at risk for biliary reflux and anastomotic ulcers. The aim of the study was to evaluate gastro-esophageal reflux disease (GERD) and esophagitis/gastritis rate after OAGB diagnosed by upper endoscopy (UE), comparing the results with GERD-Health-Related Quality of Life (HRQL) score. From July 2014 to February 2019, patients underwent OAGB with at least 12-month follow-up were retrospectively evaluated. Clinical evaluation was associated with GERD-HRQL scoring. UE with a mucosal biopsy was also performed. A comparison among clinical scores and endoscopic findings was performed. Two hundred forty-one patients were analyzed in the study. Anthropometric features (BMI, %Excess weight loss, %Total weight loss) were significantly improved. Only 30% of patients with GERD-HQRL>30 showed esophagitis at UE: 11/181 (6.1%) showed grade A erosive esophagitis, 2/181 (1.1%) grade B esophagitis, whereas no patient resulted in grade C/D. Fifty-two patients (28.7%) showed endoscopic remnant gastritis of at least grade 1, with histological gastritis of at least mild grade in 70/181 patients (38.7%). OAGB is a feasible and effective procedure in terms of weight reduction and comorbidities control, but controversies remain about the long-term onset of GERD and bile reflux. The incidence of esophagitis was increased after OAGB. However, the severity and incidence were lower compared to sleeve gastrectomy. Conversely, the incidence of gastritis, ileo-gastric anastomotic inflammation, and HP positivity were not negligible, suggesting the potential benefits of endoscopic surveillance after OAGB.

Acute mesenteric venous thrombosis after laparoscopic sleeve gastrectomy: a case report and a literature review

Over the last decade, laparoscopic sleeve gastrectomy has become an increasingly popular surgical procedure for morbid obesity. Moreover, post-laparoscopic sleeve gastrectomy mesenteric venous thrombosis is very rarely reported. The presentation varies from mild non-specific abdominal symptoms to life threatening surgical emergency. Superior mesenteric vein thrombosis after bariatric surgery is a difficult diagnosis that needs a high index of suspicion. We report a case of thrombosis of the superior mesenteric vein, who presented as acute emergency to emergency room, shortly after sleeve gastrectomy. Patient underwent laparotomy and offered a resection of 60 cm of infarcted proximal jejunum with restoration of bowel continuity later. Patient subsequently recovered and followed several times in our outpatient and was free of symptoms.

Laparoscopic One Anastomosis Gastric Bypass Versus Laparoscopic One Anastomosis Gastric Bypass with Braun Anastomosis: What's Better?

Background and Aims: Although laparoscopic one anastomosis gastric bypass (LOAGB) is a promising bariatric procedure, a large number of surgeons have strong objections mainly because of risk of bile reflux, marginal ulceration, malnutrition, and long-term risk of gastric and esophageal cancer. Lateral enteroenterostomy placed distally to a gastrojejunal anastomosis shows efficacy in preventing bile reflux after gastric resection and gastrojejunal anastomosis, but at present its efficacy in a bariatric surgery context has not been evaluated. Patients and Methods: From January 2013 to December 2018, 100 patients have been admitted to our department to be treated by performing LOAGB. Patients have been divided into two groups on the basis of the indications to this surgical procedure; Group A: presence of de novo gastroesophageal reflux disease (GERD) or severe esophagitis after laparoscopic sleeve gastrectomy, with or without weight regain; Group B: LOAGB as primary procedure. Another group of 30 patients (Group C) underwent LOAGB with Braun anastomosis as primary bariatric surgical procedure for morbid obesity. We have conducted a retrospective analysis of the surgical outcomes in terms of perioperative mortality, short-, mid-, and long-term postoperative complications and weight loss. Results: Group A: 50 patients; incidence of postoperative GERD, esophagitis, or esophageal ulcers was 26% (13 cases). All these patients have been successfully treated by performing Braun anastomosis. Group B: 20 patients; incidence of de novo reflux was 25% (5 cases); Braun anastomosis was performed with complete resolution of signs and symptoms in all cases. Group C: 30 patients; no cases of de novo reflux, esophagitis, or anastomotic ulcers occurred. Conclusion: Braun anastomosis seems to be a useful surgical tool to prevent the onset of de novo reflux, esophagitis, and anastomotic ulcers.

The role of laparoscopic sleeve gastrectomy as a treatment for morbid obesity; review of outcomes.

Global prevalence of obesity has soared. Where lifestyle and medical treatments have failed, laparoscopic sleeve gastrectomy (LSG) is increasingly regarded as a good surgical procedure for morbid obesity. Following the introduction of LSG, we assessed our surgical outcomes. We reviewed a consecutive series of LSGs from January 2009 to January 2015. Our primary focus was to assess the success of this procedure on the percentage excess body weight loss (%EWL), Body Mass Index (BMI), hypertension and diabetes. Additionally, we evaluated the rate of procedure-related complications. There were 183 consecutive patients evaluated. Median age was 45years (24-73). The majority were female (73.2%, n=134). At 1year post-op, median %EWL was 57.6%. There was an associated median reduction in BMI of 16kg/m2 (0-33). At 2 years, median %EWL was sustained at 58.4%. The median reduction in BMI was 16kg/m2 (4-32). At 2-year post-op, 78.9% of diabetic patients had their diabetic medications completely discontinued, while a further 15.8% having their medication reduced. 34.6% of hypertensive patients had their antihypertensives discontinued, with 50% having medications reduced. There was no procedure related mortality. 3.3% (n=6) of patients had a confirmed staple-line leak. This study shows LSG is a safe and successful management strategy for morbid obesity. In addition to the direct effects of sustained weight loss, it highlights indirect effects that LSG has on obesity-related health issues, with substantial reduction in diabetic and anti-hypertensive medications. Our results reaffirm international studies of the beneficial effects of LSG on Type II diabetes and hypertension.

Is sleeve gastrectomy a therapeutic procedure for all obese patients?

BackgroundLaparoscopic sleeve gastrectomy (LSG) is a worldwide surgical procedure for morbid obesity. However patients selection is still anecdotal. The aim of this study is to analyse clinical and anthropometric parameters correlated with LSG and to check the validity of this procedure for different categories of obese patients. MethodsTwo-hundred one consecutive patients were submitted to LSG as a primary bariatric procedure between 2008 and 2014. One year follow-up was completed in 159 patients. Smaller groups of patients completed 2 and 3 years follow-up (78, 46 patients respectively). Median preoperative body mass index (BMI) was 45.4 kg/m2 (range: 34.8–73.8); 135 patients (80%) had one or more comorbidities. Potential correlations between age, gender, preoperative BMI, preoperative excess weight, early excess weight loss (EWL) and 1 and 3 year-EWL were investigated. ResultsAll procedures were regularly completed with laparoscopic approach without conversion to laparotomy. Postoperative complications occurred in six patients (3.7%); no postoperative mortality was observed. Median one-year BMI and EWL were 32.8 kg/m2 and 55.34%, respectively. Three year-EWL was significantly influenced by age, and early EWL. A complete normalization of glycemic levels after the three-year follow-up was also observed in high percentage of diabetic patients. In patients with preoperative BMI>50 kg/m2 we observed most failure cases in terms of EWL and the worst metabolic results. ConclusionsOur experience indicates that LSG is a safe procedure with satisfactory three-year late weight loss in patients with preoperative BMI <50 kg/m2. Promising results, in terms of improvements of comorbidities, were also observed. These results make LSG one of the most attractive first stage surgical procedure for morbid obesity.

Zero frequency of internal hernias after laparoscopic double loop gastric bypass without closure of mesenteric defects.

Laparoscopic Roux-en-Y gastric bypass is among the most effective surgical procedures for morbid obesity; however, one of its most common long-term complications is internal hernia. The purpose of this study was to evaluate the incidence of internal hernia in patients undergoing a new gastric bypass surgical technique known as "double loop" without closure of the mesenteric defects. We reviewed 44 patients with morbid obesity, who underwent laparoscopic double loop gastric bypass. There were 34 women and 10 men, followed up for a mean period of 18 ± 3 months, mainly by periodic medical examinations and blood tests. The initial body mass index (BMI) was 44.23 ± 4.7 and the mean % excess weight (%EW) was 105.83 ± 24.41. After 18 postoperative months, the mean BMI was 29.68 ± 3.7 kg/m(2), representing a mean loss of 14.5 BMI units, with the mean % excess weight loss (%EWL) of 64.33 ± 13.47. No cases of internal hernia were recorded. Laparoscopic double loop gastric bypass without closure of the mesenteric defects is a safe and feasible procedure. A longer observational follow-up and a large number of patients are required to confirm significant results.

Integrating qualitative research in a multi-centre trial - the clinical trials unit perspective

Background Recruitment into surgical trials is often hampered because of surgeon or patient preferences. Qualitative research to explore and standardise methods for communicating clinical equipoise and addressing patient concerns has been shown to be effective in maximising recruitment. Often this research runs alongside the trial without being fully integrated within it. We describe how we integrated qualitative research into the multi-centre By-Band study comparing two surgical procedures for morbid obesity.

Laparoscopic Gastric Bypass Versus Laparoscopic Sleeve Gastrectomy as a Definitive Surgical Procedure for Morbid Obesity. Mid-Term Results

Laparoscopic sleeve gastrectomy (LSG) has been gaining acceptance because it has shown good short- and mid-term results as a single procedure for morbid obesity. The aim of this study was to compare short- and mid-term results between laparoscopic Roux-en-Y gastric bypass (LRYGB) and LSG. Observational retrospective study from a prospective database of patients undergoing LRYGB and LSG between 2004 and 2011, where 249 patients (mean age 44.7 years) were included. Patients were followed at 1, 3, 6, 12, and 18 months, and annually thereafter. Short- and mid-term weight loss, comorbidity improvement or resolution, postoperative complications, re-interventions, and mortality were evaluated. One hundred thirty-five LRYGB and 114 LSG were included. Significant statistical differences between LRYGB and LSG were found in operative time (153 vs. 93 min. p < 0.001), minor postoperative complications (21.5 % vs. 4.4 %, p = 0.005), blood transfusions (8.8 % vs. 1.7 %, p = 0.015), and length of hospital stay (4 vs. 3 days, p < 0.001). There were no differences regarding major complications and re-interventions. There was no surgery-related mortality. The percentage of excess weight loss up to 4 years was similar in both groups (66 ± 13.7 vs. 65 ± 14.9 %). Both techniques showed similar results in comorbidities improvement or resolution at 1 year. There is a similar short- and mid-term weight loss and 1-year comorbidity improvement or resolution between LRYGB and LSG, although minor complication rate is higher for LRYGB. Results of LSG as a single procedure need to be confirmed after a long-term follow-up.

Single-Incision Sleeve Gastrectomy Versus Conventional Laparoscopic Sleeve Gastrectomy—a Randomised Pilot Study

This is a prospective pilot study done to evaluate the feasibility and to assess the outcomes and complication rates of the single-incision sleeve gastrectomy versus the conventional five-port laparoscopic sleeve gastrectomy. A prospective comparative analysis was done of 50 patients in each arm who underwent laparoscopic sleeve gastrectomy and single-incision sleeve gastrectomy from September 2009 until April 2010. Both groups were matched for age, gender and BMI and were then randomly assigned to either group. Postoperative pain scoring was done using the visual analogue scale. Postoperative outcomes in terms of pain scores, excess weight loss, resolution of comorbidities and complication rates were compared in both groups, at the end of 6months. Operating times in both groups were comparable with experience. Intraoperative blood loss was similar in both groups. VAS scoring revealed lesser postoperative pain after the first 8h in the single-incision group as compared to the laparoscopy group-P < 0.0001. At 6months, excess weight loss and resolution of comorbidities were comparable in both groups. There were no major complications or mortalities in either group. Single-incision laparoscopic sleeve gastrectomy is a feasible surgical procedure for morbid obesity in selected individuals. When compared to conventional laparoscopic sleeve gastrectomy, it has equally effective weight loss and resolution of comorbidities. It also has the added benefits of little or no visible scarring and reduced postoperative pain.

Osteomalacia with Bone Marrow Fibrosis Due to Severe Vitamin D Deficiency After a Gastrointestinal Bypass Operation for Severe Obesity

To present 5 cases of bone biopsy-proven osteomalacia with marrow fibrosis (in 3 cases) after gastric bypass operation, review the relevant literature, and offer preventive strategies. We summarize the clinical presentation, pertinent biochemical and radiologic data, and bone histomorphometric findings in 5 patients, encountered during a period of 17 years, in whom severe vitamin D deficiency developed after a gastrointestinal bypass surgical procedure for morbid obesity. Five patients (39 to 60 years of age) were seen for evaluation of metabolic bone disease not responding to "usual" therapy after a gastric bypass surgical procedure. All had generalized bone pain and tenderness, muscle weakness, stooping posture, difficulty walking, and waddling gait due to severe proximal muscle weakness for a period of 2 to 5 years. Diagnoses before the referral varied from arthritis and gout to vitamin D deficiency and osteoporosis despite highly suggestive biochemical or radiologic findings (or both) of osteomalacia in each patient, which was confirmed by bone biopsy. After therapy with pharmacologic doses of ergocalciferol (100,000 IU daily) and calcium carbonate (1 to 2.5 g daily), considerable improvements occurred in clinical symptoms and functional status, biochemical indices, bone mineral density, and bone histomorphometric features. Gastric bypass operations predispose patients to severe vitamin D deficiency and osteomalacia in the absence of pharmacologic doses of vitamin D therapy. In general, the current recommendations are grossly inadequate in this high-risk population, and the clinical presentation is both nonspecific and often misleading. Prospective long-term studies are needed to determine the appropriate vitamin D dose required to prevent osteomalacia in such patients.

Adjustable Laparoscopic Gastric Banding

Laparoscopic adjustable gastric banding (LAGB) is a widely performed surgical procedure for morbid obesity in Europe and Australia. An upper gastrointestinal examination is usually used to assess for band placement and possible complications. Computed tomography (CT) is not used routinely but may be beneficial to evaluate LAGB and possible complications. Also, LAGB may be incidentally demonstrated on CT. We report 2 patients with LAGB that was well demonstrated on multidetector CT with multiplanar reformation and 3-dimensional imaging.

Reoperations after gastric banding: replacement or alternative procedures?

Laparoscopic gastric banding (LAGB) is the most popular surgical procedure for morbid obesity in Europe. Long-term complications like slippage of the band or pouch dilatation are well known and lead to reoperations in a substantial number of patients. In this study, results and follow-ups of patients with reoperations after gastric banding were analyzed. Between May 1997 and June 2006, 172 patients were treated with LAGB for morbid obesity. 41 of these patients underwent one or more band-related reoperations (female symbol = 32, male symbol = 9). Causes for and type of reoperation were analyzed. Weight loss and comorbidities were compared for different types of reoperations. There were no deaths following the reoperations. Band replacement (n = 18), band repositioning (n = 7), conversion to sleeve gastrectomy (SG, n = 2) and Roux-en-Y gastric bypass (RYGBP, n = 2) or band removal without any further substitution (n = 12) were performed as first reoperation. Seven patients had a second reoperation: RYGBP (n = 3), SG (n = 1), or band removal (n = 3). Median follow-up since reoperation was 56 months (range 7-113). Excess weight loss (EBWL%) of patients was 59.4% after RYGBP (n = 5), 45.1% after re-banding (n = 18), and 33.4% after SG (n = 2). Comorbidities were further reduced or even resolved after reoperation. Patients whose band was removed without subsequent bariatric procedures lost significantly less weight (n = 13, EBWL% 23.4) than patients with band replacement (n = 18, EBWL% 46.4, p = 0.04). Laparoscopic reoperation after LAGB is safe and feasible. Reoperation leads to further decrease of BMI and obesity-related comorbidities. Band replacement is a good option for patients with good weight loss after initial LAGB. Alternative procedures, preferably RYGBP, are required for cases of band failure. Overall, RYGBP appears to be the most effective option to induce further weight loss.

Comparative study between laparoscopic adjustable gastric banding and laparoscopic gastric bypass: single-institution, 5-year experience in bariatric surgery

Background Laparoscopic Roux-en- Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB) are common surgical procedures for morbid obesity. Few single-institution studies have compared LRYGB and LAGB. Methods All patients underwent LRYGB or LAGB at Legacy Health System. The data for the study were obtained from a prospectively maintained database. Preoperatively, most patients were allowed to choose between LRYGB and LAGB. Age, gender, body mass index, complications, mortality, and weight loss were examined. Results From October 2000 to October 2005, 492 patients underwent LRYGB and 406 patients underwent LAGB. The mean age was 44 ± 10 and 47 ± 11 years, respectively ( P <.001). The mean preoperative body mass index was 49 ± 8 and 51 ± 9 kg/m 2 ( P <.05). Patients undergoing LRYGB had longer operative times (134 ± 41 min versus 68 ± 26 min, P <.001) and longer hospital stays (2.5 ± 3.5 d versus 1.1 ± 1.1 d, P <.001). Blood loss was minimal in both groups. The percentage of excess weight loss was significantly better for patients who underwent LRYGB at all points of follow-up, except at 5 years. Total complications occurred in 32% of patients who underwent LRYGB and 24% of patients who underwent LAGB ( P = .002). The 90-day mortality rate was .2% in both groups. The reoperation rate was the same (17%) in both groups. Conclusions Patients undergoing LAGB had shorter operative times and shorter hospital stays compared with patients undergoing LRYGB. LAGB was associated with a lower complication rate. Early weight loss was significantly greater after LRYGB, but the data comparing long-term weight loss after LRYGB and LAGB have been inconclusive.

Abnormalities of Vitamin D and Calcium Metabolism after Surgical Treatment of Morbid Obesity: A Study of 136 Patients

To assess the effect of bariatric surgical treatment of morbid obesity on bone mineral metabolism. We analyzed pertinent vitamin D and calcium metabolic variables in 136 patients who had undergone a malabsorptive bariatric operation. Measurements of bone mineral density (BMD), serum 25-hydroxyvitamin D (25-OHD), 1,25-dihydroxyvitamin D [1,25-(OH)2D], parathyroid hormone (PTH), calcium, phosphorus, and alkaline phosphatase were performed. Statistical analyses assessed correlations among various factors. The mean age (+/-SD) of the study group was 48.34 +/- 10.28 years. Their mean weight loss was 114.55 +/- 45.66 lb, and the mean duration since the bariatric surgical procedure was 54.02 +/- 51.88 months. Seventeen patients (12.5%) had a T-score of -2.5 or less, and 54 patients (39.7%) had a T-score between -1.0 and -2.5. Of 119 patients in whom serum 25-OHD was measured, 40 (34%) had severe hypovitaminosis D (25-OHD <8ng/mL), and 50 patients (42%) had low hypovitaminosis D (serum 25-OHD 8 to 20 ng/mL). The magnitude of weight loss correlated negatively with serum 25-OHD, calcium, phosphorus, and calcium x phosphorus product values and positively with serum alkaline phosphatase level. Serum 25-OHD and calcium concentrations correlated positively with the BMD. PTH, serum 1,25-(OH)2D, and alkaline phosphatase concentrations correlated negatively with the BMD, a reflection of the presence of secondary hyperparathyroidism, an accelerated conversion of 25-OHD to 1,25-(OH)2D by the elevated PTH levels, and increased osteoblastic activity. The mean daily vitamin D supplementation was 6,472 +/- 9,736 IU. Hypovitaminosis D and subsequent bone loss are common in patients who have undergone a bariatric surgical procedure for morbid obesity. These patients require rigorous vitamin D supplementation.

Fatores preditivos de colelitíase em obesos mórbidos após astroplastia em Y de Roux

OBJECTIVE: This study intended to evaluate predictive factors for cholelithiasis in morbidly obese submitted to gastroplasty with Y de Roux reconstruction. METHODS: The population under study was a group of obese patients enrolled in a program of surgical procedure for morbid obesity at the Department of Surgery, College of Medical Sciences, Santa Casa de Sao Paulo. The exclusion criteria were: patients previously cholecystectomized, patients with diagnosis of pre-operative cholelithiasis and patients with a questionable ultrasonography about existence of billiary stones. A total of 160 patients were operated, 29 with prior cholecystectomy, 23 with pre-operative biliar lithiasis , 5 with questionable ultrasonography about billiary stones and 103 with normal gallbladders at abdominal ultrasonography. RESULTS: Results showed that (46.6%) of patients developed cholelithiasis, 22 of them symptomatic. When patients with or without cholelithiasis were compared, no significant difference related to age, gender and preoperative weight was observed. The body mass index, the triglycerides serum levels, total cholesterol and the fractions HDL-cholesterol and LDL-cholesterol were higher in the group who developed cholelithiasis compared to patients without gallstones and this difference was statistically significant. The percentage of weight loss in the 6th and 12th postoperative month was significantly higher in patients who developed billiary stones. CONCLUSION: The study leads to conclude that body mass index, levels of triglycerides, total cholesterol and the fractions LDL and VLDL are predictive factors for cholelithiasis post-gastroplasty with the Y de Roux reconstruction.

Acute vena cava thrombosis after placement of retrievable inferior vena cava filter before laparoscopic gastric bypass

Roux-en-Y gastric bypass has been established as an effective safe surgical procedure for morbid obesity. The overall mortality rate is low at ≤1% in many series, in which pulmonary embolism and anastomostic leak are the number 1 and 2 causes of death [1,2]. Despite widespread use of perioperative prophylaxis for venous thromboembolism (VTE) with sequential compression devices, antiembolic stockings, anticoagulation, and early ambulation, the incidence of symptomatic pulmonary embolism remains at 0.3–2.4% [1,3].