Primary care provider management of patients with obesity at an integrated health network: A survey of practices, views, and knowledge.

Background: Obesity is a serious health problem that affects a wide range of patients and disease processes.

Objective: The purpose of this study is to evaluate perceptions, knowledge, and practice habits of primary care providers (PCPs) regarding the care of patients with obesity, including barriers to effective care and their experience with bariatric surgery in our integrated health network.

Setting: Integrated health network.

Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity.

Background: Roux-en-Y gastric bypass (RYGB) surgery causes profound weight loss and improves insulin sensitivity (S(I)) in obese patients. Regular exercise can also improve S(I) in obese individuals; however, it is unknown whether exercise and RYGB surgery-induced weight loss would additively improve S(I) and other cardiometabolic factors.

Methods: We conducted a single-blind, prospective, randomized trial with 128 men and women who recently underwent RYGB surgery (within 1-3 months).

Groin defects seen at extra-peritoneal laparoscopic dissection during surgical treatment of athletic pubalgia.

Background: Recently new disease process, often referred to as athletic pubalgia (AP), has been acknowledged by the medical community. The patients suffering from this ailment present with unilateral or bilateral chronic groin pain associated with physical activity without a clear diagnosis of a groin hernia. Though physical therapy and medical treatments are considered first line remedies, some believe that surgical treatment may have better, quicker, and more durable outcomes and procedures aimed at groin reinforcement seem to relieve most of symptoms in the majority of the patients.

Changes in hormones and biomarkers in polycystic ovarian syndrome treated with gastric bypass.

Background: Small retrospective studies have demonstrated reduction in weight and co-morbid hirsutism and diabetes in women with polycystic ovary syndrome (PCOS) treated with Roux-en-Y gastric bypass. The objective of this study was to prospectively determine clinical improvements in obese women with PCOS treated with gastric bypass and identify postoperative biomarker changes.

Methods: Data were collected on obese women with PCOS undergoing Roux-en-Y gastric bypass over 1 year.

Bariatric surgery interest around the world: what Google Trends can teach us.

Background: Bariatric surgery may prove an effective weight loss option for those struggling with severe obesity, but it is difficult to determine levels of interest in such procedures at the population level through traditional approaches. Analysis of Google Trend information may give providers and healthcare systems useful information regarding Internet users' interest in bariatric procedures. The objective of this study was to gather Google Trend information on worldwide Internet searches for "bariatric surgery", "gastric bypass", "gastric sleeve", "gastric plication", and "lap band" from 2004-2012 and to explore temporal relationships with relevant media events, economic variations, and policy modifications.

StomaphyX vs a sham procedure for revisional surgery to reduce regained weight in Roux-en-Y gastric bypass patients : a randomized clinical trial.

Importance: Revisional laparoscopic surgery after Roux-en-Y gastric bypass (RYGB) has been linked to substantial complications and morbidity.

Objective: To investigate the safety and effectiveness of endoscopic gastric plication with the StomaphyX device vs a sham procedure for revisional surgery in RYGB patients to reduce regained weight.

Design, Setting, And Participants: A prospective, single-center, randomized, single-blinded study from July 2009 through February 2011, evaluating revisional surgery using StomaphyX was conducted in patients with initial weight loss after RYGB performed at least 2 years earlier.

Ventral hernias in morbidly obese patients: a suggested algorithm for operative repair.

With the rise in prevalence of obesity, most general surgeons will have to face the problem of the obese patient with an abdominal wall defect. Treatment of these bariatric patients raises unique challenges, and at this time there is still no consensus on the best treatment option. This study was performed in a high-volume bariatric and minimally invasive surgery center at a tertiary care facility in the USA.

Laparoscopic sleeve gastrectomy for super obese patients: forty-eight percent excess weight loss after 6 to 8 years with 93% follow-up.

Objectives: In this study, we report long-term outcomes of high-risk, high-BMI (body mass index) patients who underwent laparoscopic sleeve gastrectomy (LSG).

Background: Short- and medium-term data appear to support the effectiveness of LSG, but long-term data to support its durability are sparse.

Methods: A prospective database was reviewed on all high-risk patients who underwent LSG as part of a staged approach for surgical treatment of severe obesity between January 2002 and February 2004.

Pre- to postoperative changes in physical activity: report from the longitudinal assessment of bariatric surgery-2 (LABS-2).

Background: Numerous studies have reported that bariatric surgery patients report more physical activity (PA) after surgery than before; however, the quality of the PA assessment has been questionable.

Methods: The longitudinal assessment of bariatric surgery-2 is a 10-center longitudinal study of adults undergoing bariatric surgery. Of 2458 participants, 455 were given an activity monitor, which records the steps per minute, and an exercise diary before and 1 year after surgery.

Walking capacity of bariatric surgery candidates.

Background: This study characterizes the walking limitations of bariatric surgery candidates by age and body mass index (BMI) and determines factors independently associated with walking capacity. The setting was multi-institutional at research university hospitals in the United States.

Methods: Participants of the Longitudinal Assessment of Bariatric Surgery study (n=2458; age 18-78 yr, BMI 33-94 kg/m(2)) attended a preoperative research visit.

Long-term outcomes of laparoscopic Roux-en-Y gastric bypass in US veterans.

Background: The objective of this study is to evaluate the long-term outcomes following laparoscopic Roux-en-Y gastric bypass (LREYGB) in veteran patients. The VA bariatric population differs from its counterpart in the private sector by the predominance of a male population, a higher percentage of patients from a lower socioeconomic background, a higher mean age, and a higher rate of obesity-related comorbidities.

Methods: A retrospective review with prospectively collected data was used to analyze postoperative changes of comorbidities and percent of excess weight loss (% EWL) in consecutive patients who underwent LREYGB between August 2003 and September 2006.

Transoral endoscopic inner layer esophagectomy: management of high-grade dysplasia and superficial cancer with organ preservation.

Introduction: Limitations of endoscopic therapies for Barrett's esophagus and superficial cancer include a compromised histological assessment, the need for surveillance, subsequent procedures, and stricture formation. Circumferential en bloc resection of the mucosa-submucosa complex followed by deployment of a biologic scaffold onto the remaining muscularis propria may address these concerns. The objective of this study was to determine technical feasibility of transoral resection of the esophageal lining.

Physical activity levels of patients undergoing bariatric surgery in the Longitudinal Assessment of Bariatric Surgery study.

Background: Bariatric surgery candidates' physical activity (PA) level might contribute to the variability of weight loss and body composition changes following bariatric surgery. However, there is little research describing the PA of patients undergoing bariatric surgery to inform PA recommendations in preparation for, and following, surgery. We describe the PA assessment in the Longitudinal Assessment of Bariatric Surgery-2 study at 6 sites in the United States and report preoperative PA level.

Physical activity and physical function changes in obese individuals after gastric bypass surgery.

Background: Little is known about the effects of gastric bypass surgery (GBS) on physical activity and physical function. We examined the physical activity, physical function, psychosocial correlates to physical activity participation, and health-related quality of life of patients before and after GBS.

Methods: A total of 20 patients were assessed before and 3 months after GBS.

Laparoscopic colorectal surgery is safe in the high-risk patient: a NSQIP risk-adjusted analysis.

Background: Laparoscopic colectomy was considered initially to be contraindicated in patients at high risk for operative morbidity and mortality. We hypothesized that this procedure is safe to perform in high-risk patients, stratifying this risk using National VA Surgical Quality Improvement Program (NSQIP) algorithms.

Methods: A case-matched, comparative study was performed for high-risk veteran patients who underwent colectomy during the period October 2002-September 2004.

Incidence of marginal ulcers and the use of absorbable anastomotic sutures in laparoscopic Roux-en-Y gastric bypass.

Objectives: A precipitating factor for marginal ulcer formation after Roux-en-Y gastric bypass may be the prolonged irritation by foreign material, such as nonabsorbable suture at the gastrojejunostomy. This study examines the incidence of marginal ulcers before and after a change was made from using nonabsorbable suture to using absorbable suture for the inner layer of the anastomosis.

Methods: A total of 3285 laparoscopic Roux-en-Y gastric bypass operations were performed during a 5-year period.

Effective treatment of polycystic ovarian syndrome with Roux-en-Y gastric bypass.

Purpose: Many women with polycystic ovarian syndrome (PCOS) are overweight. This study investigated the impact of weight loss surgery on the clinical manifestations of this disorder in morbidly obese women with PCOS-a major risk factor for the development of heart disease, stroke, and type II diabetes.

Methods: We reviewed the outcomes of women diagnosed with PCOS who had undergone weight loss surgery at the University of Pittsburgh between July 1997 and November 2001.

Laparoscopic repair of umbilical hernias in conjunction with other laparoscopic procedures.

Background: This study evaluates the feasibility of laparoscopic transfascial suture repair of umbilical hernias when combined with another laparoscopic procedure that potentially contaminates the peritoneal cavity.

Method: From August 1997 to November 2001, 32 patients underwent laparoscopic umbilical suture repair in association with another laparoscopic procedure. The repair was performed with the Carter-Thomason suture passer.

Surgically-induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome.

Objective: To evaluate the effects of surgical weight loss on fatty liver disease in severely obese patients.

Summary Background Data: Nonalcoholic fatty liver disease (NAFLD), a spectrum that extends to liver fibrosis and cirrhosis, is rising at an alarming rate. This increase is occurring in conjunction with the rise of severe obesity and is probably mediated in part by metabolic syndrome (MS).

Application of a trocar wound closure system designed for laparoscopic procedures in morbidly obese patients.

Herniation into the trocar-site is a relatively common complication of laparoscopic surgery, and represents a serious cause of morbidity because of the potential to develop into a Richter's hernia. The risk of trocar-site herniation is greater in obese and bariatric patients, because of the larger preperitoneal space and elevated intra-abdominal pressure; thus, fascial closure alone is not adequate. Full-thickness trocar-wound closure can prevent this complication.

Results of laparoscopic gastric bypass in patients with cirrhosis.

Background: The safety and efficacy of bariatric surgery in patients with cirrhosis has not been well studied.

Methods: A retrospective review was conducted of patients with cirrhosis who underwent weight-loss surgery at a single institution.

Results: Out of a total of 2119 patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGBP), 30 patients (1.