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Imed Ben Amor, Tarek Debs, Niccolo Petrucciani, Francesco Martini, Radwan Kassir, Jean Gugenheim
INTRODUCTION: Weight regain after Roux-en-Y gastric bypass (RYGB) is increasingly reported in the literature Debs et al. Surg Obes Relat Dis (2016). Laparoscopic resizing of the gastric pouch and the gastrojejunal anastomosis is an accepted surgical option Nguyen et al. (Obes Surg 25:928-34, 2015); Iannelli et al. (Surg Obes Relat Dis 9:260-7, 2013); Al-Bader et al. (Obes Surg 25:1103-8, 2015). The aim of this video is to present a simple technique of en bloc resection. METHODS: We present the case of a 42-year-old woman with a BMI of 44 kg/m(2) who underwent laparoscopic RYGB in 2007...
October 25, 2016: Obesity Surgery
Keong Chong, Sayeed Ikramuddin, Wei-Jei Lee, Charles J Billington, John P Bantle, Qi Wang, Avis J Thomas, John E Connett, Daniel B Leslie, William B Inabnet, Robert W Jeffery, Michael G Sarr, Michael D Jensen, Adrian Vella, Leaque Ahmed, Kumar Belani, Joyce L Schone, Amy E Olofson, Heather A Bainbridge, Patricia S Laqua, Judith Korner, Lee-Ming Chuang
BACKGROUND: The purpose of this study is to compare effects of different nations on Roux-en-Y gastric bypass (RYGB) vs. intensive medical management (IMM) in achieving remission of type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS: Between April 2008 and December 2011, this randomized, controlled clinical trial was conducted at four teaching hospitals in the United States and Taiwan involving 71 participants with mild obesity (BMI 30-35 kg/m(2)). Thirty-six of 71 participants were randomly assigned to the RYGB group, and the others were in IMM group...
October 25, 2016: Obesity Surgery
Varun Agrawal, Jonathan B Wilfong, Christopher E Rich, Pamela C Gibson
Hyperoxaluria after Roux-en-Y gastric bypass (RYGB) increases the risk for kidney injury. Medical therapies for hyperoxaluria have limited efficacy. A 65-year-old female was evaluated for acute kidney injury [AKI, serum creatinine (Cr) 2.1 mg/dl, baseline Cr 1.0 mg/dl]. She did not have any urinary or gastrointestinal symptoms or exposure to nephrotoxic agents. Sixteen months prior to this evaluation, she underwent RYGB for morbid obesity. Her examination was unremarkable for hypertension or edema and there was no protein or blood on urine dipstick...
September 2016: Case Reports in Nephrology and Dialysis
Sharon Grundfest-Broniatowski, JingLiang Yan, Matthew Kroh, Holly Kilim, Andrew Stephenson
Familial partial lipodystrophy type 2 (FPLD2) is a rare disorder associated with LMNA gene mutations. It is usually marked by loss of subcutaneous fat on the limbs and trunk and severe insulin resistance. Scattered reports have indicated that Roux-en-Y bypass helps to control the diabetes mellitus in these patients. We present here a very unusual patient with FPLD2 who had life-threatening retroperitoneal and renal fat accumulation accompanied by bilateral renal cancers. Following cryotherapy of one renal cancer and a contralateral nephrectomy with debulking of the retroperitoneal fat, Roux-en-Y gastric bypass (RYGB) has successfully controlled the disease for 3 years...
October 24, 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Allison R Schulman, Walter Chan, Aiofe Devery, Michele B Ryan, Christopher C Thompson
BACKGROUND AND AIMS: Marginal ulceration, or ulceration at the gastrojejunal anastomosis, is a common complication of Roux-en-Y gastric bypass (RYGB). Acidity likely contributes to the pathophysiology, and proton pump inhibitors (PPIs) are frequently prescribed for treatment. However, patients with gastric bypass only have a small gastric pouch and rapid small bowel transit, which limits the opportunity for capsule breakdown and PPI absorption. Soluble PPIs (open capsules, OCs) might be more easily absorbed than intact capsules (IC)...
October 20, 2016: Clinical Gastroenterology and Hepatology
Reena Sudan, Ranjan Sudan, Elizabeth Lyden, Jon S Thompson
BACKGROUND: Food cravings and consumption of craved foods after Roux-en-Y gastric bypass (RYGB) are poorly understood. Food cravings after bariatric surgery may explain why some patients fail to change eating behaviors after RYGB, and understanding these cravings may provide better information for nutritional counseling to either enhance weight loss or prevent weight regain. OBJECTIVES: To study cravings in RYGB patients and compare them with cholecystectomy (CC) control patients...
September 9, 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Lava Y Patel, Brittany Lapin, Craig S Brown, Thomas Stringer, Matthew E Gitelis, John G Linn, Woody E Denham, Elizabeth Farwell, Stephen Haggerty, Michael B Ujiki
BACKGROUND: Approximately 20-30 % of morbidly obese patients undergoing Roux-en-Y gastric bypass (RYGB) will experience significant weight regain in the years following surgery. Endoscopic gastrojejunal revision (EGJR) has been shown to be a safe, effective and less invasive alternative to revisional surgery, with promising weight loss outcomes. However, minimal data exist regarding how to perform the procedure most effectively and what factors may predict good outcomes. We compared weight loss outcomes between patients undergoing endoscopic stoma revision by one of two full-thickness suturing techniques...
October 17, 2016: Surgical Endoscopy
Ryan E R Reid, Ekaterina Oparina, Hugues Plourde, Ross E Andersen
We explored differences in dietary behaviours, energy, and macronutrient intake among individuals who had regained or maintained weight loss 5 or more years after Roux-en-Y gastric bypass (RYGB). This study assessed 27 adults who underwent RYGB an average of 12.1 ± 3.7 years before this study was conducted. Dietary assessment was performed using 3-day food records. Daily energy intake (kcal), protein (g), carbohydrate (g), fat (g), and alcohol intake (g) were computed using the ESHA's Food Processor(®). Participants were classified by percent weight loss, maintainers (≥38 %), and regainers (≤30 %)...
July 19, 2016: Canadian Journal of Dietetic Practice and Research
Carolina F Nicoletti, Ana Paula R P de Oliveira, Maria José F Brochado, Marcela A S Pinhel, Bruno A P de Oliveira, Julio S Marchini, José E Dos Santos, Wilson Salgado, Nathalia Moreno Cury, Luiza Ferreira de Araújo, Wilson A Silva, Carla B Nonino
OBJECTIVE: The aim of this study was to investigate whether the Ala55Val and -866G>A polymorphisms of the UCP2 gene are related to weight loss and changes in body composition after bariatric surgery performed by Roux-en-Y gastric bypass (RYGB). METHODS: This longitudinal study enrolled obese patients submitted to RYGB. Data regarding weight (kg), body mass index (kg/m(2)), fat-free mass (FFM; kg), fat mass (kg), weight loss (kg and %), and percent excess weight loss were collected from both preoperative and 1-y postoperative medical records...
August 9, 2016: Nutrition
Rinki Murphy, Peter Tsai, Mia Jüllig, Amy Liu, Lindsay Plank, Michael Booth
BACKGROUND: It is unclear whether specific gut microbiota is associated with remission of type 2 diabetes (T2D) after distinct types of bariatric surgery. AIMS: The aim of this study is to examine gut microbiota changes after laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) surgery in obese patients with T2D. METHODS: Whole-metagenome shotgun sequencing of DNA fragments using Illumina HiSeq2000 was obtained from stool samples collected from 14 obese T2D patients pre-operatively (while on very low calorie diet) and 1 year after randomisation to laparoscopic SG (n = 7) or RYGB (n = 7)...
October 13, 2016: Obesity Surgery
Deanna J M Isaman, Amy E Rothberg, William H Herman
OBJECTIVE: Bariatric surgery may induce remission of type 2 diabetes in obese patients. However, estimates of remission rates reported in the literature range from 25 to 81%, contributing to the uncertainty patients and physicians both face as they assess treatment options. This analysis attempts to reconcile the seemingly disparate rates of diabetes remission reported in studies of Roux-en-Y gastric bypass (RYGB) surgery. It examines variation in the methodologies used to derive the estimates and proposes outcomes that should be reported by all studies...
October 13, 2016: Diabetes Care
Mirjam A Lips, Jan Bert van Klinken, Hanno Pijl, Ignace Janssen, Ko Willems van Dijk, Frits Koning, Vanessa van Harmelen
INTRODUCTION: Weight loss interventions such as Roux-en-Y gastric bypass (RYGB) and very low calorie diets (VLCD) lead to improvement of glucose metabolism in obese individuals with type-2 diabetes. Weight loss can also positively influence the unfavorable inflammatory profile associated with obesity. However, a direct comparison of the effect of VLCD and RYGB on systemic inflammation is lacking. METHODS: Systemic inflammation was investigated in age- and BMI-matched morbidly obese T2DM women by determining the number and activation- or memory status of peripheral blood leukocytes by flow cytometry, in addition to measuring circulating levels of cytokines and CRP...
November 2016: Metabolism: Clinical and Experimental
Abdelrahman A Nimeri, Ahmed Maasher, Talat Al Shaban, Elnazeer Salim, Maha Ibrahim
BACKGROUND: Conversion of laparoscopic adjustable gastric banding (LAGB) to other operations is commonly done for significant weight recidivism and complications. METHODS: This is a consecutive series of LAGB converted to RYGB done at the Bariatric and Metabolic Institute (BMI) Abu Dhabi from 2009 to 2013 for weight recidivism. Our preferred approach is to convert LAGB to LRYGB in one stage. All patients undergo upper endoscopy (EGD) and upper gastrointestinal series and are started on clears liquids 2 h after surgery without performing UGI studies...
October 12, 2016: Obesity Surgery
Małgorzata Szczuko, Natalia Komorniak, Monika Hoffmann, Joanna Walczak, Agata Jaroszek, Bartosz Kowalewski, Krzysztof Kaseja, Dominika Jamioł-Milc, Ewa Stachowska
BACKGROUND: The aim of this study was to evaluate the effect of sleeve gastrectomy (SG) and Roux-en-Y-bypass (RYGB) on anthropometric and biochemical parameters, including changes in glucose levels, lipid profile and liver function. Drastic decrease in all lipid fractions a few weeks or months after the surgery could be regarded as favourable, but low level of HDL is an independent risk factor for heart diseases. Extreme load on the liver without preparation of the patient to the surgery can have negative consequences...
October 11, 2016: Obesity Surgery
Erik K Grasser, Barbara Ernst, Martin Thurnheer, Bernd Schultes
BACKGROUND: A shortening of electrocardiographic QT interval has been observed in obese subjects after weight loss, but previous results may have been biased by inappropriate heart rate (HR) correction. METHODS: Electrocardiography (ECG) recordings of 49 (35 females) severely obese patients before and 12 months after Roux-en-Y gastric bypass (RYGB) surgery were analysed. QT interval (QTc) was calculated by using four different equations, i.e. Bazett, Fridericia, Framingham and Hodges...
October 8, 2016: Obesity Surgery
Benjamin Niland, Andrew Brock
BACKGROUND: Gastrogastric fistulae (GGF) are a well-known complication of Roux-en-Y gastric bypass (RYGB). Endoscopic approaches for closure of GGF have gained popularity, but with limited data and efficacy. OBJECTIVES: The primary arm of the study was to evaluate the safety and efficacy of the endoscopic closure of GGF using the over-the-scope clip (OTSC) device. SETTING: University hospital, United States METHODS: This is a retrospective review of consecutive patients at a single academic center from September 2013 to December 2014 who underwent upper endoscopy with attempted OTSC placement for closure of GGF related to RYGB...
August 5, 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Milene Moehlecke, Carina Andriatta Blume, Jakeline Rheinheimer, Manoel Roberto Maciel Trindade, Daisy Crispim, Cristiane Bauermann Leitão
BACKGROUND: Weight loss and body composition changes after Roux-en-Y gastric bypass (RYGB) may influence resting energy expenditure (REE). The effect of lower REE after the procedure on long-term weight remains to be elucidated. OBJECTIVE: To evaluate the effects of RYGB on REE and body composition 6 months after RYGB and to find out whether postsurgery REE affects weight at 12 and 18 months SETTING: Tertiary referral hospital, southern Brazil METHOD: A prospective study involving 30 RYGB patients aged>18 years was performed...
August 18, 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Piotr Kalinowski, Rafał Paluszkiewicz, Tadeusz Wróblewski, Piotr Remiszewski, Mariusz Grodzicki, Zbigniew Bartoszewicz, Marek Krawczyk
BACKGROUND: Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) cause weight loss and metabolic improvement, but results of published studies are contradictory. OBJECTIVES: The aim of this study was to compare the effects of SG and RYGB on ghrelin, leptin, and glucose homeostasis in a randomized controlled trial. SETTING: University hospital, Poland. METHODS: Seventy-two morbidly obese patients were randomly selected to undergo either SG (n = 36) or RYGB (n = 36)...
August 18, 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Christopher D Morrison, Zheng Hao, Michael B Mumphrey, R Leigh Townsend, Heike Münzberg, Jianping Ye, Hans-Rudolf Berthoud
OBJECTIVE: The mechanisms by which bariatric surgeries so effectively and lastingly reduce body weight and normalize metabolic dysfunction are not well understood. Fibroblast growth fator-21 (FGF21) is a key regulator of metabolism and is currently considered for treatment of obesity. Although elevated by acute food deprivation, it is downregulated after weight loss induced by chronic calorie restriction but not after Roux-en-Y gastric bypass surgery. Therefore, the goal of the present study was to assess the role of FGF21-signaling in the beneficial effects of Roux-en-Y gastric bypass surgery (RYGB)...
October 2016: Molecular Metabolism
Nele Loret, Marieke De Visschere, Luc Berwouts
INTRODUCTION: The exponential increase of bariatric surgery has resulted in a new diagnostic field of postoperative complications. One of the possibly serious complications is trocar site hernia. CASE REPORT: We present a rare case of trocar site hernia, in particular herniation of the blind loop of the jejunojejunostomy in a patient previously operated for laparoscopic gastric bypass. CONCLUSION: In patients with intermittent epigastric pain and regurgitation or nausea after RYGB, the differential diagnosis should include internal herniation and cholecystitis...
August 10, 2016: Acta Chirurgica Belgica
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