Subcutaneous placement of lap band port without fascial fixation provides safe and durable access.

Background: Laparoscopic adjustable gastric band access port has been routinely sutured to the anterior fascia of the abdominal wall using nonabsorbable sutures. We present our technique demonstrating that nonfascial fixation with using a mesh allows for a safe and durable placement of the port in the superficial subcutaneous tissue.

Methods: Retrospective chart review included 102 consecutive patients who had Lap band surgery performed by single surgeon (EA) from June 2011 until April 2013.

Catastrophic bleeding from a marginal ulcer after gastric bypass.

Marginal ulceration at the gastrojejunal anastomosis is a common complication following Roux-Y gastric bypass (RYGB). Hemodynamically significant hemorrhagic marginal ulcers are usually treated either endoscopically or surgically. We describe a unique case of life-threatening hemorrhagic marginal ulcer eroding into the main splenic artery.

Bariatric surgery evolution from the malabsorptive to the hormonal era.

While bariatric procedures continued to evolve and develop since the 1950s, their classification has not matched this evolution. The procedures are commonly classified into restrictive, malabsorptive, or combined. In this day and age, we recognize different mechanisms of action of the bariatric procedures.

Superior mesenteric artery aneurysm: an uncommon disease with potentially serious complications.

Superior mesenteric artery aneurysms (SMAAs) are visceral arterial aneurysms that can result from a variety of conditions. About half of SMAAs are mycotic and occur subsequent to infective endocarditis. The clinical presentation of SMAA is nonspecific, and some patients may be asymptomatic while others may report mild to severe abdominal pain.

Sutureless laparoscopic ventral hernia repair in obese patients.

Background And Objective: Transfascial sutures (TFS) are a standard component of laparoscopic ventral herniorrhaphy (LVHR) that contribute to the durability of repair, but also pain and, resultantly, hospital stay. We sought to examine LVHR without TFS in obese patients with small abdominal wall hernias.

Methods: Between September 2002 and December 2007, 174 patients underwent LVHR at Yale-New Haven Hospital.

Survey of the effective exercise habits of the formerly obese.

Background And Objective: Patients must subscribe to behavioral and lifestyle modifications for continued success after weight loss surgery (WLS). Few data exist about the ideal type, duration, and intensity of exercise for WLS patients. After surgery, should we mandate that patients exercise like a young, lean individual does? To reconcile this, we compared the exercise habits of successful bariatric surgery patients with physically fit controls.

The role of haptic feedback in laparoscopic simulation training.

Introduction: Laparoscopic virtual reality simulators are becoming a ubiquitous tool in resident training and assessment. These devices provide the operator with various levels of realism, including haptic (or force) feedback. However, this feature adds significantly to the cost of the devices, and limited data exist assessing the value of haptics in skill acquisition and development.

Socioeconomic predictors of weight loss after laparoscopic Roux-Y gastric bypass.

Introduction: Successful weight loss after laparoscopic Roux-Y gastric bypass (LRYGB) hinges on many elements including neurohormonal, anatomical, and postoperative behavioral changes. To date, the effects of socioeconomic factors have been inadequately studied. We examine several components of socioeconomic status and its relationship to weight loss after LRYGB.

The paradox of the pouch: prompt emptying predicts improved weight loss after laparoscopic Roux-Y gastric bypass.

Introduction: The utility of routine upper gastrointestinal (UGI) evaluations after laparoscopic Roux-Y gastric bypass (LRYGB) has yet to be determined, primarily being used to rule out a gastrojejunal leak. Additional information can be assessed with these studies, including the rate of contrast emptying from the pouch; some patients show no or very slow emptying while others show a faster rate of emptying. No or slow emptying is likely due to anastomotic edema and/or a small initial stomal diameter.

Deciphering the sleeve: technique, indications, efficacy, and safety of sleeve gastrectomy.

Some institutions perform sleeve gastrectomy (SG) as the initial operation for high-risk, high body mass index patients planning a definitive weight loss operation in 12-18 months. Other institutions consider SG a viable alternative to other bariatric operations. SG is frequently debated among the bariatric surgeons.