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Tarun Mittal, Ashish Dey, Abhilash Nali, Sheikh Mohammad Taha Mustafa, Vinod K Malik
INTRODUCTION: Ischemia of the tip of the alimentary limb involving the gastrojejunostomy (GJ) is an unusual complication during Roux-en-Y gastric bypass (RYGB). Revision of the GJ may be needed to manage this complication. OBJECTIVES: We present a case of inadvertent perforation of the jejunum by a gastric calibration tube, which was recognized on the table and appropriate measures are then taken. Repair of this enterotomy however then led to ischemia of the tip of alimentary limb extending to a portion of the GJ anastomosis...
March 13, 2018: Obesity Surgery
Laurentiu M Pop, Andrea Mari, Tong-Jin Zhao, Lori Mitchell, Shawn Burgess, Xilong Li, Beverley Adams-Huet, Ildiko Lingvay
AIM: To investigate the physiological mechanisms leading to rapid improvement in diabetes after Roux-en-Y Gastric Bypass (RYGB). In particular, the roles of concurrent peri-operative dietary restrictions, which may also alter glucose metabolism, have not been completely elucidated. MATERIALS AND METHODS: To assess the differential contributions of diet and surgery to the mechanisms leading to the rapid improvement in diabetes after RYGB we enrolled ten patients with type 2 diabetes scheduled to undergo RYGB...
March 13, 2018: Diabetes, Obesity & Metabolism
Ji Yeon Park, Yong Jin Kim
BACKGROUND: Percentage of excess weight loss (%EWL) is the most common metric used after bariatric surgery. However, there has been consistent argument against its use since it varies significantly by initial body mass index (BMI). This study aimed to validate the newly suggested percentage of alterable weight loss (%AWL) metric in Korean patients. METHODS: A retrospective review of the prospectively established database at Soonchunhyang University Seoul Hospital identified 165 patients who underwent primary laparoscopic Roux-en-Y gastric bypass (RYGB) and had at least 2-year follow-up weight loss results after surgery...
March 12, 2018: Obesity Surgery
Luciana Teixeira de Siqueira, Marcela Silvestre Outtes Wanderley, Roberto Afonso da Silva, Adriana da Silva Andrade Pereira, José Luiz de Lima Filho, Álvaro Antônio Bandeira Ferraz
BACKGROUND: Obesity has been associated with the development of various types of cancer. Biomarker studies may provide molecular level knowledge of the factors involved in this association, improving clinical practice through new methods of prevention and treatment. PURPOSE: The present study aimed to analyze proteins found in the plasma of obese patients prior to and 6 months after bariatric surgery, using body mass index (BMI) and percentage total weight loss (%TWL) to evaluate, in a prospective manner, the effects of weight loss on the regulation of proteins related to the appearance of tumors...
March 10, 2018: Obesity Surgery
Arnaud Pasquer, Elise Pelascini, Gilles Poncet, Maud Robert
PURPOSE: Postoperative abdominal pain after Roux en Y gastric bypass associated with gastro esophageal reflux is difficult to manage. A gastro-gastric fistula can be the etiology and besides pain and weight regain, it can also be revealed by a dilatation of the excluded stomach and duodenum. METHODS: We present the case of a 45-year-old woman who had a medical history of revisional RYGB after failure of gastric band. She recently complained of recurrent epigastric abdominal pain and biliary GERD...
March 5, 2018: Obesity Surgery
Eugene Y Wang, Timothy R Shope
To raise awareness for surgeons encountering bariatric patients with anatomy that deviates from the standard Roux-en-Y gastric bypass (RYGB). This is a single-institution retrospective case series over 12 years (2003-2014) involving patients who believed they received RYGBs, but actually did not. Data was obtained reviewing physician encounters, imaging, and operative reports. There were six cases with confusing clinical pictures, found to have aberrant RYGB anatomy: (1) gastric bypass with jejuno-jejunostomy only without gastrojejunostomy, (2) distal partial vertical gastrectomy without expected prosthetic band, (3) inverse vertical banded gastroplasty, (4) non-divided gastric bypass with no gastrojejunostomy, (5) 20-cm Roux limb, with gastro-gastric fistula, and (6) 200-cm bilio-pancreatic limb similar to the traditional Scopinaro procedure...
March 5, 2018: Obesity Surgery
L S Kornerup, C L Hvas, C B Abild, B Richelsen, E Nexo
BACKGROUND & AIMS: Bariatric surgery increases the risk of micronutrient deficiencies, including vitamin B12 (B12) deficiency. We analysed early changes in biomarkers of B12 status following bariatric surgery. METHODS: We prospectively included adult patients (n = 27) referred for either Roux-en-Y Gastric Bypass (RYGB) (n = 19) or Sleeve Gastrectomy (SG) (n = 8). Blood samples were drawn before surgery and 2 and 6 months following surgery for measurement of B12, holotranscobalamin (holoTC), and methylmalonic acid (MMA)...
February 15, 2018: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Lisa Walther, Carl-Magnus Brodén, Anders Isaksson, Jan L Hedenbro
INTRODUCTION: Roux-en-Y gastric bypass (RYGB) causes more rapid and enhanced absorption of alcohol. RYGB patients have also been reported to use more inpatient care for alcohol-related disease than do patients after other bariatric procedures. The present study was designed to evaluate alcohol consumption level before and after gastric bypass using a sensitive and specific alcohol biomarker. MATERIALS AND METHODS: Two separate consecutive groups of patients and a group of healthy blood donors, as reference group, were included in the study...
March 2, 2018: Obesity Surgery
Jamie Perin, Gregory Prokopowicz, Margaret Furtado, Konstantinos Papas, Kimberley E Steele
BACKGROUND: Vitamin and mineral deficiencies are common following Roux-en-Y gastric bypass (RYGB) and can lead to significant morbidity, but little research on the efficacy of vitamin supplementation regimens exists. We compared the efficacy and tolerability of an investigational versus a standard multivitamin regimen in patients undergoing RYGB. METHODS: Fifty-six patients, aged 18 to 65, were randomized to an investigational versus a standard multivitamin. Plasma levels of vitamins A, B-12, D, E-α, E-β/γ, thiamine, folate, iron, iron-binding capacity, iron saturation, prealbumin, and parathyroid hormone (PTH) were measured at 3 and 6 months postoperatively...
March 2, 2018: Obesity Surgery
Andrew T Strong, Gautam Sharma, Zubaidah Nor Hanipah, Chao Tu, Stacy A Brethauer, Philip R Schauer, Derrick Cetin, Ali Aminian
BACKGROUND: Warfarin dosing after bariatric surgery may be influenced by alterations in gastrointestinal pH, transit time, absorptive surface area, gut microbiota, food intake, and adipose tissue. OBJECTIVES: The aim of this study was to describe trends in warfarin dosing after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). SETTING: Single academic center. METHODS: All patients chronically on warfarin anticoagulation before RYGB or SG were retrospectively identified...
January 2, 2018: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Maria S Altieri, Jie Yang, Lizhou Nie, Robin Blackstone, Konstantinos Spaniolas, Aurora Pryor
BACKGROUND: A primary measure of the success of a procedure is the whether or not additional surgery may be necessary. Multi-institutional studies regarding the need for reoperation after bariatric surgery are scarce. OBJECTIVES: The purpose of this study is to evaluate the rate of revisions/conversions (RC) after 3 common bariatric procedures over 10 years in the state of New York. SETTING: University Hospital, involving a large database in New York State...
December 29, 2017: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Ian A Thomas, Jeffrey J Gaynor, Tameka Joseph, Nestor De La Cruz-Munoz, Junichiro Sageshima, Warren Kupin, Linda J Chen, Gaetano Ciancio, George W Burke, Adela D Mattiazzi, David Roth, Giselle Guerra
Body mass index(BMI)>35-40kg/m2 is often a contraindication, while Roux-en-Y gastric bypass(RYGB) is performed to enable kidney transplantation. This single-center retrospective study evaluated pre- and post-transplant outcomes of 31 morbidly obese end-stage-renal-disease patients having RYGB before kidney transplantation between July,2009-June,2014. Fourteen RYGB patients were subsequently transplanted. Nineteen recipients not having GB with a BMI>36kg/m2 at transplantation were used as historical controls...
February 28, 2018: Clinical Transplantation
E Nilsson-Condori, J L Hedenbro, A Thurin-Kjellberg, A Giwercman, B Friberg
STUDY QUESTION: Do serum levels of anti-Müllerian hormone (AMH) change in women of reproductive age following dietary and surgery-induced weight loss? SUMMARY ANSWER: AMH levels increased after very low-calorie diet (VLCD) before surgery and decreased at 6 and 12 months after Roux-en-Y gastric bypass (RYGB), beyond expected normal age-related decline. WHAT IS KNOWN ALREADY: Obesity has negative effects on fertility and IVF outcomes, and possibly also on AMH levels...
February 22, 2018: Human Reproduction
Tuure Saarinen, Ulla Kettunen, Kirsi H Pietiläinen, Anne Juuti
BACKGROUND: Consensus on the necessity of esophagogastroduodenoscopy (EGD) before bariatric surgery is lacking. Recommendations and practices vary by country and unit. Several reports have expressed concerns on gastroesophageal reflux disease (GERD) and its consequences after sleeve gastrectomy (SG) and the risk of leaving a premalignant lesion in the excluded stomach after Roux-en-Y gastric bypass (RYGB). OBJECTIVES: We explored the number and types of clinically significant findings in preoperative EGDs and how they associate with preexisting GERD-symptoms (SG) and premalignant lesions (RYGB)...
February 14, 2018: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Mohammed K Hankir, Florian Seyfried, Alexander D Miras, Michael A Cowley
Metabolic surgical procedures, such as Roux-en-Y gastric bypass (RYGB), uniquely reprogram feeding behavior and body weight in obese subjects. Clinical neuroimaging and animal studies are only now beginning to shed light on some of the underlying central mechanisms. We present here the roles of key brain neurotransmitter/neuromodulator systems in food choice, value, and intake at various stages after RYGB. In doing so, we elaborate on how known signals emanating from the reorganized gut, including peptide hormones and microbiota products, impinge on newly mapped homeostatic and hedonic brain feeding circuits...
February 20, 2018: Trends in Endocrinology and Metabolism: TEM
Swetha R Palli, John A Rizzo, Natalie Heidrich
OBJECTIVE: The objective of this study was to estimate a payer's budget impact of bariatric surgery coverage under (1) unrestricted, (2) budget-restricted ($500,000/year), and (3) quantity-restricted (100/year) medical benefit plan scenarios versus non-coverage in general and type 2 diabetes mellitus (T2DM) populations over a 10-year period. METHODS: Using recently published literature and health technology assessment reports, the model evaluated a hypothetical payer population of 100,000 members under current real-world trends: BMI-defined obesity groups (31...
February 21, 2018: Obesity Surgery
Jessica Sacks, Anny Mulya, Ciaran E Fealy, Hazel Huang, John D Mosinski, Mangesh R Pagadala, Hideharu Shimizu, Esam Batayyah, Philip R Schauer, Stacy A Brethauer, John P Kirwan
Bariatric surgery provides significant and durable improvements in glycemic control and hepatic steatosis, but the underlying mechanisms that drive improvements in these metabolic parameters remain to be fully elucidated. Recently, alterations in mitochondrial morphology have shown a direct link to nutrient adaptations in obesity. Here, we evaluate the effects of Roux-en-Y gastric bypass (RYGB) surgery on markers of liver mitochondrial dynamics in a diet-induced obesity Sprague-Dawley (SD) rat model. Livers were harvested from adult male SD rats 90-days after either Sham or RYGB surgery and continuous high-fat feeding...
February 2018: Physiological Reports
Luca Meoli, Nitin K Gupta, Nima Saeidi, Courtney Panciotti, Sudha B Biddinger, Kathleen E Corey, Nicholas Stylopoulos
Treatment of non-alcoholic fatty liver disease (NAFLD) focuses on the underlying metabolic syndrome, and Roux-en-Y gastric bypass surgery (RYGB) remains one of the most effective options. In rodents and human patients, RYGB induces an increase in the gene and protein expression levels of the M2 isoenzyme of Pyruvate Kinase (PKM2) in the jejunum. Since PKM2 can be secreted in the circulation, our hypothesis was that the circulating levels of PKM2 increase after RYGB. Our data, however, revealed an unexpected finding and a potential new role of PKM2 for the natural history of metabolic syndrome and NAFLD...
February 20, 2018: American Journal of Physiology. Endocrinology and Metabolism
B C Toh, W H Chan, Akh Eng, Ekw Lim, C H Lim, K W Tham, S Fook-Chong, Jth Tan
Bariatric surgery is an effective treatment for morbid obesity and its metabolic related comorbidities - Type II Diabetes, Hypertension and Hyperlipidaemia.1 However, the literature is scarce regarding the long-term outcome after bariatric surgery especially among multi-ethnic Asian populations. Considering the growing number of bariatric metabolic operations in Asia, we have attempted to provide a regional perspective on 5-year long-term clinical outcomes post bariatric surgery in Singapore. Between years 2010 to 2016, all bariatric operative cases consisted of 393 Laparoscopic Sleeve Gastrectomy (LSG), 125 Laparoscopic Roux-En-Y Gastric Bypass (RYGB) and 43 Laparoscopic Mini-gastric Bypass (MGB) were included...
February 20, 2018: Diabetes, Obesity & Metabolism
Haijun Liu, Hong Zhang, Xiao Wang, Xuemei Yu, Cheng Hu, Xueli Zhang
BACKGROUND: Changes in gut microbiota induced by bariatric surgery have been associated with metabolic benefits. OBJECTIVES: Our aim was to identify specific gut microbiota that may contribute to the improvement of type 2 diabetes (T2D) after Roux-en-Y gastric bypass (RYGB). SETTING: Laboratories of Shanghai Diabetes Institute and Shanghai Sixth People's Hospital. METHODS: Diabetic rats induced via a high-fat diet and low-dose streptozotocin administration were randomized to RYGB or sham surgery, and stool samples were collected at baseline and at postoperative week 8...
January 17, 2018: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
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