American Society for Metabolic and Bariatric Surgery literature review on risk factors, screening recommendations, and prophylaxis for marginal ulcers after metabolic and bariatric surgery.

Background: Marginal ulcers (MU) are a significant postoperative complication following anastomotic metabolic and bariatric surgeries including Roux-en-Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB), and biliopancreatic diversion with duodenal switch (BPD/DS). This review summarizes current knowledge on MU risk factors, screening, and prophylactic strategies.

Objectives: The goal of this review is to examine technical and patient-related risk factors for MU, assess screening strategies, and recommend prophylactic approaches to reduce MU incidence after anastomotic metabolic and bariatric surgery (MBS).

ASMBS literature review on the treatment of marginal ulcers after metabolic and bariatric surgery.

Marginal ulcers (MUs) encompass a group of mucosal disruptions and subsequent inflammatory changes and their sequala found after Roux-en-Y gastric bypass (RYGB) oneanastomosis gastric bypass (OAGB), and, less commonly, after biliopancreatic diversion with duodenal switch (BPD/DS) or single anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S). Prevalence of MU after RYGB ranges from .6%-16%.

Patient proximity to follow-up care after bariatric surgery: Does it matter?

One factor that may play a significant role in the follow-up care compliance and long-term weight loss of post-bariatric surgery patients is the geographical distance from the surgery center to the patient's home address. This is a retrospective review which aims to evaluate whether the distance from a patient's home address to two Gundersen Health System (GHS) facilities (La Crosse and Onalaska, Wisconsin) is predictive of follow-up appointment compliance and subsequent long-term weight loss. 1336 patients undergoing bariatric surgery at GHS between October 15, 2013 and Dec 31, 2022 were included.

Impact of Bariatric Surgery on Asthma Severity and Medication Use.

Introduction: Bariatric surgery improves many obesity-related comorbidities, yet the literature remains inconclusive on the impact of bariatric surgery on asthma. Our primary objective was to identify the long-term impact of bariatric surgery on asthma severity and medication use.

Methods: A retrospective review was completed of all patients with a diagnosis of asthma who underwent bariatric surgery over 10 years at a single institution.

Cancer incidence, type, and survival after bariatric surgery.

Background: Many types of cancer have been found to be associated with being overweight or obese. Literature has demonstrated a reduction in cancer risk in patients who have undergone bariatric surgery.

Objectives: To compare the incidence and types of new cancer diagnoses, cumulative cancer incidence, cancer risk, and overall survival in patients with obesity who underwent bariatric surgery with that of those who did not.

American Society for Metabolic and Bariatric Surgery position statement on one-anastomosis gastric bypass.

The following position statement is issued by the American Society for Metabolic and Bariatric Surgery in response to inquiries made to the society by patients, physicians, society members, hospitals, health insurance payors, and others regarding one-anastomosis gastric bypass as a treatment for obesity and metabolic disease. This statement is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time. The statement may be revised in the future as more information becomes available.

Obesity, Bariatric Surgery, and Hip/Knee Arthroplasty Outcomes.

Obesity is an independent risk factor for osteoarthritis due to mechanical and inflammatory factors. The gold-standard treatment of end-stage knee and hip osteoarthritis is total joint arthroplasty (TJA). Weight loss decreases progression of osteoarthritis and complications following TJA in patients with obesity.

Pre-screening for bariatric surgery patients: comparative effectiveness of transnasal endoscopy versus esophagogastroduodenoscopy.

Background: Endoscopic evaluation is frequently performed before bariatric surgery to identify foregut pathology that may alter procedure selection. Transnasal endoscopy (TNE) is an alternative to esophagogastroduodenoscopy (EGD). The objective of this study was to compare TNE to EGD.

Follow-up trends after emergency department discharge for acutely symptomatic hernias: A southwestern surgical congress multi-center trial.

Background: The objective of this multi-center study was to examine the follow-up trends after emergency department (ED) discharge in a large and socioeconomically diverse patient population.

Methods: We performed a 3-year retrospective analysis of adult patients with acutely symptomatic hernias who were discharged from the EDs of five geographically diverse hospitals.

Results: Of 674 patients, 288 (43%) were evaluated in the clinic after discharge from the ED and 253 (37%) underwent repair.

Defining Weight Loss After Bariatric Surgery: a Call for Standardization.

Background: Some weight regain is expected after bariatric surgery; however, this concept is not well defined. A favorable weight loss response has commonly been defined as 50% excess weight loss (EWL). The medical literature uses %total weight loss (%TWL), which has recently been adopted in some surgical literature.

The southwestern surgical congress multi-center trial on suspected common duct stones.

Background: Choledocholithiasis is present in up to 15% of cholecystectomy patients. Treatment can be surgical, endoscopic, or via interventional radiology. We hypothesized significant heterogeneity between hospitals exists in the approach to suspected common duct stones.

Roux-en-Y gastric bypass versus sleeve gastrectomy: what factors influence patient preference?

Background: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most commonly performed bariatric procedures. RYGB involves altered gastrointestinal anatomy and 2 anastomoses, while SG involves gastric resection. When potential patients view images of the procedures, they may perceive RYGB to involve significant risk compared with SG, in which no significant gastrointestinal alterations are depicted.

Long-term (>10-year) outcomes after laparoscopic Roux-en-Y gastric bypass.

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been the "gold standard" for weight loss surgery. Long-term data are limited, and reporting methods for LRYGB outcomes vary in the literature. In addition, follow-up compliance within bariatric centers is poor due to insurance and access to care issues, making long-term follow-up evaluation difficult.

Impact of laparoscopic Roux-en-Y Gastric bypass versus sleeve gastrectomy on postoperative lipid values.

Background: Metabolic surgery has been shown to significantly improve many obesity-related co-morbidities, including dyslipidemia. The literature has produced mixed results comparing postoperative lipid values after laparoscopic Roux-en-Y gastric bypass (LRYGB) compared to laparoscopic sleeve gastrectomy (LSG); with some indicating significantly greater reductions in total cholesterol and low-density lipoprotein (LDL) in LRYGB versus LSG, and others reporting no significant differences.

Objectives: To evaluate the postoperative lipid values after LRYGB versus LSG at a community hospital.

Fellowship Training: Need and Contributions.

Surgical subspecialties are now well established, and many surgery residents pursue fellowship training for various reasons. Fellowships can bridge the gaps found in many residency programs by providing graduating residents with opportunities to master surgical skills, gain confidence and progressive autonomy, and receive further mentorship. The experience also eases the transition to independent practice by allowing surgeons to tailor their training to coincide with personal interests and future practice goals.

Management of biliary symptoms after bariatric surgery.

Background: Biliary disease requiring intervention can be complicated in the postbariatric surgery patient.

Methods: A retrospective review was completed to identify patients who underwent laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy from September 2001 to September 2014, and those who underwent biliary intervention were identified.

Results: A total of 1527 patients underwent bariatric surgery during the study period.

Reoperative antireflux surgery.

Patient satisfaction with primary antireflux surgery is high, but a small percentage of patients experience recurrent reflux and dysphagia, requiring reoperation. The major anatomic causes of failed fundoplication are slipped fundoplication, failure to identify a short esophagus, and problems with the wrap. Minimally invasive surgery has become more common for these procedures.

Biliary issues in the bariatric population.

Biliary disease is common in the obese population and increases after bariatric surgery. This article reviews management of the gallbladder at the time of bariatric surgery, as well as imaging modalities in the bariatric surgery population and prevention of lithogenesis in the rapid weight loss phase. In addition, diagnosis and treatment options for biliary diseases are discussed, including laparoscopic-assisted percutaneous transgastric endoscopic retrograde cholangiopancreatography in the patient having bariatric surgery.

Intensive care unit stay not required for patients with obstructive sleep apnea after laparoscopic Roux-en-Y gastric bypass.

Background: Many programs admit morbidly obese patients with obstructive sleep apnea (OSA) to the intensive care unit after laparoscopic gastric bypass (LGB), fearing pulmonary complications. Our practice has been to admit these patients to the surgical floor. Our objective was to compare the perioperative course and outcomes in morbidly obese patients with OSA to those of patients without OSA undergoing LGB in a physician-led health system with a 325-bed community teaching hospital serving 19 counties.

Video. Laparoscopic distal pancreatectomy and splenectomy for splenic artery aneurysm.

Background: Large splenic artery aneurysms are rare but comprise 60% of all visceral artery aneurysms. Most are found incidentally and rupture in the nonpregnant patient has an approximate 25 to 36% mortality rate. Historically these have been managed with an open surgical approach for resection.

Benefits of laparoscopic fellowship training: a survey of former fellows.

Objective: The objective of this study was to assess the impact of minimally invasive surgery (MIS) fellowship training on the fellows' clinical practice as well as former fellows' perception of their fellowship experience.

Methods: A survey composed of 50 multiple-choice questions was e-mailed to 268 former MIS fellows who began a fellowship in the United States between 2000 and 2005. E-mail addresses were obtained from Covidien, an industry sponsor of MIS fellowships.