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Obese Patient (BMI 32) with Reflux Disease and Diabetes Mellitus
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
The four commonly performed bariatric operations around the world are the adjustable gastric band, sleeve gastrectomy, Roux-en-Y gastric bypass, and the one-anastomosis gastric bypass. In recent years, the adjustable gastric band has become less popular due to the increased incidence of late complications and need for subsequent explantation. The sleeve gastrectomy has now surpassed the Roux-en-Y gastric bypass as the most performed weight loss procedure around the world.
Surgical management of type 2 diabetes mellitus and metabolic syndrome: Available procedures and clinical data
Published in Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner, Endocrine Surgery, 2017
Currently, the most common bariatric operations being performed in the United States and around the world are the laparoscopic Roux-en-Y gastric bypass (RYGB) and the laparoscopic sleeve gastrectomy (LSG), also referred to as the vertical sleeve gastrectomy. Although the laparoscopic adjustable gastric band became quite popular in the 2000s, its popularity has declined because of poor long-term weight loss and the frequent need for band removal. Biliopancreatic diversion with duodenal switch (BPD-DS), an operation that combines a sleeve gastrectomy with an intestinal bypass, provides excellent weight loss results but has not become popular due to its technical complexity and numerous malabsorptive side effects.
Surgical Treatment of the Obese Individual
Published in G. Michael Steelman, Eric C. Westman, Obesity, 2016
John B. Cleek, Eric C. Westman
Complications unique to the adjustable gastric band procedure relate to the device itself. The band may erode into the stomach and even cause perforation. The band may slip, causing intolerance of the band with dysphagia or vomiting. The band may become infected, often with redness and drainage at the site of the port. The port may migrate or flip, making access difficult and causing a loss of the ability to adjust the band. The pouch may dilate, as well as the esophagus, if the patient continues to overfill the pouch. Generally, surgical removal is required to solve these issues.
Pseudoachalasia: a diagnostic challenge. When to consider and how to manage?
Published in Scandinavian Journal of Gastroenterology, 2021
Sara N. Haj Ali, Nam Q. Nguyen, Awni T. Abu Sneineh
In a small proportion, pseudoachalasia occurs after fundoplication, which is attributed to vagus nerve injury during surgery [14,15]. In a small case series, up to one-quarter of patients diagnosed with pseudoachalasia had a history of operative or non-operative trauma to the chest, suggesting that trauma to the vagal innervation can lead to neuropathic dysfunction and development of achalasia [16]. Given vagal efferent fibers play a major role in initiating esophageal peristalsis and relaxation of the lower esophageal sphincter (LES), trauma may impair the generation of nitric oxide and lead to a decreased inhibition of the LES and thereby, impaired relaxation of LES [17]. Alternatively, a tight fundic wrap with the formation of scar tissue can also manifest as pseudoachalasia with persistent dysphagia after surgery. Similarly, the high outflow resistance caused by the gastric band at the LES can create a persistent high-pressure area, leading to impaired LES relaxation, progressive weakening of the esophageal body and pseudoachalasia in the setting of the laparoscopic adjustable gastric band [18]. Another possibility is what Ravi et al suggested when they reported four cases of achalasia-like picture presenting years after bariatric surgeries; and that was changes in gastric pressure created by the surgery rather than LES dysfunction – as evidenced by a normal integrated relaxation pressure (IRP) on high resolution manometry – led to pseudoachalasia [19].
Idiopathic intracranial hypertension and bariatric surgery: a literature review and a presentation of two cases
Published in British Journal of Neurosurgery, 2019
Francois Okoroafor, Muhammad Ali Karim, Abdulmajid Ali
Obesity is an endemic health problem within the UK, affecting approximately 25% of the population. Awareness of the implications of obesity on individual health and economics has increased. The treatment options for obesity naturally include conservative and medical weight loss measures. A landmark study on obesity published by the Lancet in 2011, reviewed the evidence relating to weight loss interventions and found that bariatric is the most effective for adult weight loss.2 The National Institute for Health and Clinical Excellence (NICE) regularly reviews its guidance on bariatric surgery. The core guidance is that surgery is a treatment option if (1) a patient has a BMI of 40 kg/m2 alone, or a BMI of between 35 and 40 with significant co-morbid disease (2) non-surgical measures were not successful (3) they are being managed at a specialist centre (4) the patient is fit for surgery (5) the patient commits to long term follow-up.3 Surgical options include restrictive procedures such as the sleeve gastrectomy and adjustable gastric band, and restrictive-malabsorptive intervention such as Roux-en-Y gastric bypass and the classical biliopancreatic diversion (now less commonly used).4,5 Treatment option varies from centre to centre and patient preference is also considered when offering a weightless procedure. There are general and specific risks related to bariatric surgery, but these risks can be minimised by working within an accredited high volume bariatric unit.4
Long-term pharmacotherapy of obesity in patients that have undergone bariatric surgery: pharmacological prevention and management of body weight regain
Published in Expert Opinion on Pharmacotherapy, 2019
Susana Gutt, Silvio Schraier, Maria Florencia González Bagnes, Ming Yu, Claudio Daniel González, Guillermo Di Girolamo
A retrospective study published by Schwartz et al. [28] suggests that phentermine alone or combined with topiramate, added onto diet and exercise, might be a viable option for weight loss in patients with a gastric bypass or laparoscopic adjustable gastric banding who experience relapse or plateau in weight loss. In this study, 52 patients received phentermine and 13 were treated with the combination therapy (phentermine plus topiramate). A 78% of the included individuals underwent RYGB; 22% a laparoscopic adjustable gastric band. A 9.6% in the phentermine cohort and 15.4% on combination therapy were male; African American ethnicity was registered in 13.5% and 15.4% of the individuals, respectively. Preoperative weight differed: 50.4 kg/m2 (SD = 8.8) and 46.4 kg/m2 (SD = 4.3), higher at the phentermine alone cohort. Body weight at nadir was also higher among patients treated with phentermine alone (34.4 ± 7.8 vs 32.1 ± 6.3 kg/m2). Median time from minimum weight to the initiation of drug therapies were 35.3 months and 36.3 months for the phentermine and combination cohorts, respectively. In patients whose body weights were collected and recorded at 90 days, phentermine treated patients lost 6.35 kg (representing a 12.8% excess weight loss) while those treated with the combination lost 3.81 kg (a 12.9% excess weight loss). After adjustment for baseline weight, time since surgical intervention and visit through 90 days, patients treated with phentermine weighed significantly less [28]. Some other unbalanced factors (e.g. gender, ethnicity, age, etc.) remained unadjusted at the statistical analysis. Having into account the retrospective nature of this study as well as the obvious power limitations, these comparative conclusions should be considered with care.