Obesity Surgery (OBES SURG)

Publications in this journal

• Article: Weight Loss and Weight Regain—5-Year Follow-Up for Circular- vs. Linear-Stapled Gastrojejunostomy in Laparoscopic Roux-en-Y Gastric Bypass

  F. B. Langer, G. Prager, M. Poglitsch, R. Kefurt, S. Shakeri-Leidenmühler, B. Ludvik, K. Schindler, A. Bohdjalian
  Obesity Surgery 03/2013;
• Article: Obesity-Related Female Infertility in Medieval Persian Manuscripts

  Abbasnejad F, Samad EJ Golzari, Ghabili K, Aslanabadi S, Rikhtegar R, Ranjbar Y
  Obesity Surgery 01/2013;
• Article: Reply to letter regarding “Does Pregnancy Increase the Need for Revisional Surgery after Laparoscopic Adjustable Gastric Banding?” (MS#OBSU-D-10-00107R1)

  Paul E. O’Brien, Wendy A. Brown, Rebecca N. Haward
  Obesity Surgery 05/2012; 21(10):1642-1642.
• Article: Erratum to: Gastric MALT Lymphoma and Grade II Obesity: Gastric Bypass Surgery as a Therapeutic Option

  Ricardo Helman, Priscila Pereira dos Santos Teixeira, Carlos José Lazzarini Mendes, Thomas Szegö, Nelson Hamerschlak
  Obesity Surgery 05/2012; 20(7):968-968.
• Article: Wernicke’s Encephalopathy After Laparoscopic Roux-en-Y Gastric Bypass: A Misdiagnosed Complication

  Nishant Tageja
  Obesity Surgery 05/2012; 20(9):1327-1327.
• Article: Does Exercise Improve Weight Loss after Bariatric Surgery? A Systematic Review

  Kristine Egberts, Wendy A. Brown, Leah Brennan, Paul E. O’Brien
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  ABSTRACT: Bariatric surgery leads to significant weight loss in the obese patient. Exercise has been shown to improve weight loss and body composition in non-surgical weight loss programmes. The role of exercise to improve weight loss following bariatric surgery is unclear. The objective of this review is to systematically appraise the evidence regarding exercise for weight loss in the treatment of obesity in bariatric surgery patients. MEDLINE, AMED, CINAHL, EBM Reviews (Cochrane Database, Cochrane Clinical Trials Register) were searched, obesity-related journals were hand-searched and reference lists checked. Studies containing post-surgical patients and exercise were included with the primary outcome of interest being weight loss. A literature search identified 17 publications exploring exercise in bariatric surgery patients. All studies were observational; there were no intervention studies found. The most commonly used instruments to measure activity level were questionnaires followed by telephone interview, surgeon reporting and clinical notes. There was a positive relationship between increased exercise and weight loss after surgery in 15 studies. Meta-analysis demonstrated in patients participating in exercise a standardised mean of 3.62kg (CI = 1.28, 5.96) greater weight loss compared to the minimal exercise groups. Observational studies suggest that exercise is associated with greater weight loss following bariatric surgery. Randomised controlled trials are required to further examine this relationship. KeywordsLaparoscopic adjustable gastric banding–Surgery–Exercise–Weight loss
  Obesity Surgery 05/2012; 22(2):335-341.
• Article: The Psychology of Bariatric Patient: What Replaces Obesity? A Qualitative Research with Brazilian Women

  Ronis Magdaleno, Elinton Adami Chaim, José Carlos Pareja, Egberto Ribeiro Turato
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  ABSTRACT: BackgroundObesity has serious implications on a woman's quality of life and body image. We propose a qualitative investigation aimed at understanding the postoperative significance of bariatric surgery for women suffering from morbid obesity and how these factors influence the outcomes, with an emphasis on body image and on the possible psychological complications that may jeopardize the operation's success. Subjects and MethodsThis study uses a clinical qualitative method, through a semidirected interview with open-ended questions in an intentional sample, closed by saturation, with seven women operated in a period of 1.5–3years, following the definition of emergent categories and qualitative content analysis. ResultsBariatric surgery is a procedure that brings about rapid physical, social, and emotional changes, and it is seen by patients as a possibility of being reinstated and accepted socially. The reencounter with the feminine body after surgery is experienced as a means of reinstatement but also with a feeling of defenselessness, which may lead to the development of phobic symptoms. Imbalance in family and conjugal relationships may be factors that discourage the continuation of the treatment. The patient sees the skin folds, flaccidity, and the scars as therapeutic failures, which can lead to a constant quest for plastic surgery. ConclusionWe observe the necessity of studies that allow the health team to identify those aspects of a patient's psychological makeup which would be expected to improve or worsen their prognosis and to provide the necessary preoperative and postoperative psychosocial interventions. KeywordsBariatric surgery–Obesity–Qualitative method–Morbid obesity
  Obesity Surgery 05/2012; 21(3):336-339.
• Article: Bariatric Surgery in Asia in the Last 5 Years (2005–2009)

  Davide Lomanto, Wei-Jei Lee, Rajat Goel, Jeannette Jen-Mai Lee, Asim Shabbir, Jimmy BY So, Chih-Kun Huang, Pradeep Chowbey, Muffazal Lakdawala, Barlian Sutedja, Simon K. H. Wong, Seigo Kitano, Chin Kin Fah, Hildegardes C. Dineros, Andrew Wong, Anton Cheng, Shanker Pasupathy, Sang Kuon Lee, Paisal Pongchairerks, Tran Binh Giang
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  ABSTRACT: Obesity is a major public health concern around the world, including Asia. Bariatric surgery has grown in popularity to combat this rising trend. An e-mail questionnaire survey was sent to all the representative Asia-Pacific Metabolic and Bariatric Surgery Society (APMBSS) members of 12 leading Asian countries to provide bariatric surgery data for the last 5years (2005–2009). The data provided by representative members were discussed at the 6th International APMBSS Congress held at Singapore between 21st and 23rd October 2010. Eleven nations except China responded. Between 2005 and 2009, a total of 6,598 bariatric procedures were performed on 2,445 men and 4,153 women with a mean age of 35.5years (range, 18–69years) and mean BMI of 44.27kg/m2 (range, 31.4–73kg/m2) by 155 practicing surgeons. Almost all of the operations were performed laparoscopically (99.8%). For combined years 2005–2009, the four most commonly performed procedures were laparoscopic adjustable gastric banding (LAGB, 35.9%), laparoscopic standard Roux-en-Y gastric bypass (LRYGB, 24.3%), laparoscopic sleeve gastrectomy (LSG, 19.5%), and laparoscopic mini gastric bypass (15.4%). Comparing the 5-year trend from 2004 to 2009, the absolute numbers of bariatric surgery procedures in Asia increased from 381 to 2,091, an increase of 5.5 times. LSG increased from 1% to 24.8% and LRYGB from 12% to 27.7%, a relative increase of 24.8 and 2.3 times, whereas LAGB and mini gastric bypass decreased from 44.6% to 35.6% and 41.7% to 6.7%, respectively. The absolute growth rate of bariatric surgery in Asia over the last 5years was 449%. KeywordsGastric banding–Asia–Sleeve gastrectomy–Gastric bypass–Epidemiology
  Obesity Surgery 04/2012; 22(3):502-506.
• Article: Mechanisms of Bolus Clearance in Patients with Laparoscopic Adjustable Gastric Bands

  Paul Robert Burton, Wendy A. Brown, Cheryl Laurie, Geoff Hebbard, Paul E. O’Brien
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  ABSTRACT: BackgroundThe components of esophageal function important to success with laparoscopic adjustable gastric banding (LAGB) are not well understood. A pattern of delayed, however, successful bolus transit across the LAGB is observed. MethodsSuccessful LAGB patients underwent a high-resolution video manometry study in which bolus clearance, flow, and intraluminal pressures were recorded. Liquid and semi-solid swallows and stress barium (a combination of semi-solid swallows and liquid barium) were performed. A new measurement, the lower esophageal contractile segment (LECS), was defined and evaluated. ResultsTwenty patients participated (mean age 48.3 ± 12.0years, four men, %excess weight loss 65.6 ± 18.0). During semi-solid swallows, two patterns of esophageal clearance were observed: firstly, a native pattern (n = 10) similar to that which is expected in non-LAGB patients; secondly, a lower esophageal sphincter-dependent pattern (n = 7), where flow only occurred when the intrabolus pressure increased during the lower esophageal sphincter (LES) aftercontraction. In both patterns, if there was incomplete bolus clearance, reflux was observed and was usually followed by another swallow. A mean of 4.5 ± 2.9 contractions were required to clear the semi-solid bolus. Contractions with an intact LECS demonstrated longer flow duration: 7.1 ± 3.8 vs.1.6 ± 3.2s, p < 0.005. During the stress barium, an intrabolus pressure of 44.5 ± 16.0mmHg leads to cessation of intake. ConclusionsIn LAGB patients, normal esophageal peristaltic contractions transition to a LES aftercontraction, producing trans-LAGB flow. Repeated contractions are required to clear a semi-solid bolus. Incorporating measurements of the LECS into assessments of esophageal motility in LAGB patients may improve the usefulness of this investigation. KeywordsLaparoscopic adjustable gastric band-High-resolution manometry-Esophageal motility-Bolus transit-Bariatric surgery-Video manometry-Lower esophageal contractile segment-Lower esophageal sphincter aftercontraction
  Obesity Surgery 04/2012; 20(9):1265-1272.
• Article: Does Pregnancy Increase the Need for Revisional Surgery After Laparoscopic Adjustable Gastric Banding?

  Rebecca N. Haward, Wendy A. Brown, Paul E. O’Brien
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  ABSTRACT: BackgroundOver 80% of laparoscopic adjustable gastric banding (LAGB) patients are women, and approximately half of these are of reproductive age; therefore, pregnancy post-LAGB is common. It is not known if pregnancy increases the need for revisional procedures. We compare the incidence of revisions in two matched cohorts of LAGB patients, with or without subsequent pregnancy. MethodsFrom September 1994 to May 2009, 5,467 patients underwent LAGB at the Centre for Bariatric Surgery, Australia. Women with births post-LAGB were matched to controls, with a “matched follow-up date” calculated equivalent to pregnancy. Rates of primary and overall revisions for band-related (erosions and proximal pouch dilatations) and port/tubing complications were compared for cases and controls at 2 and 3years post-pregnancy. ResultsOne hundred eighty-nine women had ≥1 pregnancies post-LAGB, including 137 with follow-up at 2years and 104 at 3years post-pregnancy. There was no significant difference in band or port/tubing revisions between groups at either time point: 16.8% vs 10.5% (p = 0.13) and 23.9% vs 14.6% (p = 0.09) for primary band revisions, and 5.8% vs 5.3% (p = 0.84) and 10.5% vs 6.6% (p = 0.35) for primary port/tubing revisions at 2 and 3years, respectively. Percentage excess weight loss (%EWL) 3years post-pregnancy was similar (47.9% vs 47.7%). Pregnancy LAGB management was not found to affect revisions; however, less time between LAGB and pregnancy was associated with a higher rate of primary band revisions (p = 0.03). ConclusionThese data suggest that pregnancy post-LAGB does not affect revision rate or %EWL; however, a shorter time between LAGB operation and pregnancy may predispose to band revisions. KeywordsLaparoscopic adjustable gastric banding–Pregnancy–Revision–Re-operation–Complication–Obstetric–Bariatric
  Obesity Surgery 04/2012; 21(9):1362-1369.
• Article: Re: Wernicke’s Encephalopathy After Laparoscopic Roux-en-Y Gastric Bypass: A Misdiagnosed Complication

  Antonio Iannelli, Pietro Addeo, Jean Gugenheim
  Obesity Surgery 04/2012; 20(9):1328-1328.
• Article: Changes in Satiety, Supra- and Infraband Transit, and Gastric Emptying Following Laparoscopic Adjustable Gastric Banding: A Prospective Follow-up Study

  Paul Robert Burton, Kenneth Yap, Wendy A. Brown, Cheryl Laurie, Matthew O’Donnell, Geoff Hebbard, Victor Kalff, Paul E. O’Brien
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  ABSTRACT: BackgroundLaparoscopic adjustable gastric banding (LAGB) induces and sustains weight loss, likely by activating the peripheral satiety mechanism. Recent data suggests that food is not retained above the optimally adjusted LAGB, suggesting that an alternate mechanism is inducing satiety. How transit and gastric emptying change following LAGB and correlate with satiety and weight loss have not been adequately defined. MethodsLAGB patients underwent preoperative and 12-month follow-up nuclear scintigraphic assessments of esophageal transit and gastric emptying. A new technique that allowed the calculation of emptying times and transit through the supra- and infraband compartments was used to assess emptying and transit patterns postoperatively. ResultsPostoperatively, patients reported increased satiety both after a standard fast (3.7 ± 2.3 vs. 4.8 ± 2.1, p = 0.04) and following a standard semisolid meal (5.9 vs. 7.8 ± 1.7, p = 0.003). The mean percent excess weight loss was 48.5 ± 23.2%. The gastric emptying half-time (minutes) did not change significantly (63.5 ± 41.1 vs. 73.3 ± 26.8, p = 0.64). Semisolid transit into the infraband stomach was delayed briefly postoperatively in more patients (11 vs. 2, p = 0.001). There was minimal retention of the meal above the LAGB 2min after commencing the gastric emptying study (median, 3%; interquartile range, 1.75–10); therefore, an emptying half-time of the supraband region could not be defined. ConclusionsWeight loss, satiety, and early satiation following LAGB were associated with briefly delayed bolus transit into the infraband stomach. Retention of the semisolid meal above the LAGB was not observed. This is further evidence that suggests satiety develops following LAGB without physical restriction of meal size. KeywordsObesity–Gastric emptying–Esophageal transit–Weight loss–Satiety–Satiation–Bariatric–Surgery–Adjustable gastric band–Restrictive
  Obesity Surgery 04/2012; 21(2):217-223.
• Article: Revision to Malabsorptive Roux-En-Y Gastric Bypass (MRNYGBP) Provides Long-Term (10 Years) Durable Weight Loss in Patients with Failed Anatomically Intact Gastric Restrictive Operations

  Myur Srinivasan Srikanth, Ki Hyun Oh, Samuel Ross Fox
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  ABSTRACT: BackgroundTwenty percent of gastric restrictive operations require revision. Conversion to Proximal Roux-en-Y gastric bypass (PRNYGBP) is associated with weight regain. Forty-one percent of these fail to achieve a body mass index (BMI) < 35. Few report follow-up (F/U) or quality of life (QOL) beyond 5years. We report the long-term effectiveness of MRNYGBP as a revision. MethodsRetrospective chart review of patients (1993–2005) with a failed gastric restrictive operation (S1) at least a year out from revision (S2) to a MRNYGBP: small lesser curve 22 ± 10 (11–55) cm3 pouch, long biliopancreatic limb, 150cm alimentary limb, 141 ± 24 (102–190) cm common channel. Staple-line disruptions were excluded. ResultsThirty-eight (37 F, 1M) patients aged 46 ± 8 (17–56) years underwent conversion to a MRYGBP 8 ± 5 (2–23) years after: gastroplasty 25, adjustable gastric band 13 for weight regain (79%), gastroesophageal reflux disease (GERD; 29%), and band problems (24%). S1 provided only 24 ± 25% excess weight loss (EWL; 5.9 ± 6.3 BMI drop) and caused GERD in 32% of patients (p = 0.0124). There were no deaths or leaks. BMI dropped from 41.4 ± 7.8 to 27.3 ± 5.6 (down 20.5 ± 8.3 from S1), 80.1 ± 23.3% EWL (n = 32) at year1 (p < 0.0001). This was maintained for 10years. BMI was 28 ± 4 (21.5–31.9), 75.6 ± 21.1% EWL (57.3–109.6) (n = 5) at 10years. Super obese patients had better 9.95% EWL after S2 (p = 0.0359). QOL (5 = excellent): 4.5 ± 0.5 (3–5). F/U: 5.1 ± 3.3 (1–13) years with 83.3% F/U 10-year rate. Labs at 3years (n = 10): Alb 3.8 ± 0.4, Prot 6.8 ± 0.6, Iron 47.6 ± 33.3, VitD 15.1 ± 7.43, PTH 54.5 ± 27.2, B12 620.1 ± 676.5, Hct 34 ± 4.3. ConclusionsRevision MRNYGBP provides excellent durable long-term weight loss after failed gastric restrictive operations. Non-compliant patients are at a higher risk for malnutrition, anemia, and osteoporosis. KeywordsRevision–Gastric bypass–Adjustable gastric band–Gastroplasty–Malabsorption–Medial gastric bypass–Roux-en-Y gastric bypass–Distal gastric bypass–Malabsorptive Roux-en-Y gastric bypass–Revision gastric bypass–Bariatric surgery–Failed bariatric surgery–Poor weight loss–Poor weight loss after gastric banding–Weight gain
  Obesity Surgery 04/2012; 21(7):825-831.
• Article: Characterization of the Improvement in Depressive Symptoms Following Bariatric Surgery

  Melissa J. Hayden, John B. Dixon, Maureen E. Dixon, Tracey L. Shea, Paul E. O’Brien
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  ABSTRACT: BackgroundThe Beck Depression Inventory (BDI) has been frequently employed as a measure of depression in studies of obesity, with the majority of studies reporting an improvement in scores following weight loss. Given the potential similarity in obesity-related and depressive symptoms, it is uncertain whether all components of depression would improve equally with weight loss. MethodThe study included obese patients who had undergone laparoscopic adjustable gastric banding (LAGB) surgery and had completed BDIs at baseline and 1year after surgery. Two groups of patients were included, a general background group (N = 191, mean age = 41 ± 9, mean BMI = 43 ± 8) and a group identified as experiencing elevated depressive symptoms based on BDI scores ≥23 (EDS group; (N = 67, mean age = 40 ± 9, mean BMI = 45 ± 7). ResultsOverall, BDI scores fell for both groups, background group at baseline 17 ± 9–8 ± 7 at 1year and for the EDS group at baseline 30 ± 5–14 ± 10 at 1year. Patient scores on the negative self-attitude subscale were significantly greater than the two other subscales and showed the greatest improvement 1year following LAGB. Preexisting antidepressant therapy had little or no association on the BDI scores or on its change following weight loss. ConclusionHigh rates of depression are continually reported in obesity, as is a remarkable decrease in depressive symptoms following weight loss. Negative attitudes towards one’s self appears to be driving elevated BDI scores rather than the overlap in physical symptoms between obesity and depression. KeywordsWeight loss–Psychology–Quality of life–Depression–Body image
  Obesity Surgery 04/2012; 21(3):328-335.
• Article: Predicting Outcome of Gastric Bypass Surgery Utilizing Personality Scale Elevations, Psychosocial Factors, and Diagnostic Group Membership

  Scott B. Belanger, Frederick S. Wechsler, Mahsaw Elicia Nademin, Thomas B. Virden
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  ABSTRACT: BackgroundResearchers have traditionally relied upon various presurgical biopsychosocial measures to predict weight loss success following bariatric surgery. The present study proposed a diagnostic grouping system to predict postsurgical outcome. It was hypothesized that psychosocial and Minnesota Multiphasic Personality Inventory (MMPI)/Millon Clinical Multiaxial Inventory (MCMI) psychometric variables could be used to identify gastric bypass surgery candidates requiring additional preoperative and postoperative services. MethodsOf 143 candidates for surgical treatment of morbid obesity, 120 women and 23 men underwent psychological evaluation prior to approval for gastric bypass. Each was placed into one of four diagnostic groups based upon results of personality measures and a preoperative semistructured interview. Results and ConclusionResults support the K scale of the MMPI-2 as a significant predictor of postsurgical outcome; MCMI scores on the schizoid, schizotypal, and compulsive scales appeared to be better overall predictors of outcome. KeywordsGastric bypass-Personality-MMPI-MCMI-Bariatric surgery-Psychosocial
  Obesity Surgery 04/2012; 20(10):1361-1371.
• Article: Comments on “Wernicke’s Encephalopathy after Laparoscopic Roux-en-Y Gastric Bypass: A Misdiagnosed Complication”

  Ke-Jia Zhang, Hong-Liang Zhang, Duo Zhang, Jiang Wu
  Obesity Surgery 04/2012; 20(9):1329-1330.
• Article: Early Identification of Infectious Complications in Bariatric Surgery by the Determination of Peritoneal and Systemic Cytokines

  Wilson Salgado, Fernando de Queiroz Cunha, José Sebastião dos Santos, Carla Barbosa Nonino-Borges, Ajith Kumar Sankarankutty, Orlando de Castro e Silva, Reginaldo Ceneviva
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  ABSTRACT: BackgroundObesity has become a global epidemic and bariatric surgery is one of the therapeutic tools to deal with it. Postoperative complications can occur, such as staple line dehiscence and anastomotic leaks, leading to increased patient mortality. The diagnosis of these complications is frequently difficult. The objective of the present study was to determine whether peritoneal and systemic cytokines could early detect those complications. MethodsAll patients who underwent open Roux-en-Y gastric bypass from February 2007 to August 2008 were prospectively evaluated. Blood and peritoneal effluent from the drain were collected for the determination of cytokine levels. We also evaluated the clinical signs and the leukograms of the patients. ResultsA total of 107 obese patients were studied. Ninety patients had no complications; 17 had at least one infectious complication which include five cases of staple line dehiscence. Until the third postoperative day, the vital signs and the leukogram did not predict the onset of infectious complications, but the cytokines (interleukin-1β and interleukin-6) were early markers of these complications. ConclusionCytokines are good predictors of poor postoperative evolution in bariatric surgery since peritoneal cytokines diagnose better these infectious complications even before changes in blood count and before the occurrence of clinical manifestations.
  Obesity Surgery 04/2012; 19(7):867-872.