Management of the Postbariatric Medial Thigh Deformity.

Background: Thigh contour deformities-in particular, those of the medial thighs-are a common concern for many individuals seeking body contouring. Despite the frequency of this concern, some plastic surgeons have often been reluctant to embrace the medial thigh-lift procedure because of the risk for significant complications and relatively poor results. The authors' approach to medial thigh contouring is to address the variables outside of the medial thighs affecting the medial thighs before considering a medial thigh-lift procedure with a vertical component.

The vertical medial thigh lift.

This article discusses management of the post-weight loss thigh deformity. Beginning with an explanation of the soft tissue variables contributing to the thigh and medial thigh deformity in the postbariatric individual, the article describes the important elements of selecting and screening candidates for surgery and the ideal sequence of procedures that should be followed to optimize results in this patient population. A detailed step-by-step description of the author's technique for medial thigh lift is provided along with multiple examples of outcomes.

An analysis of gastric pouch anatomy in bariatric surgery.

Background: The goal of most bariatric surgeons has been to construct small volume pouches in the proximal stomach to restrict the intake of food. The purpose of this study is to demonstrate that in addition to pouch volume, specific gastric pouch anatomy plays a significant role in weight loss.

Materials And Methods: The physical properties and dynamics of the pouch in our form of gastric bypass were compared with those in the most commonly performed bariatric procedures by creating a model.

Body lift.

The body in the patient who has lost a massive amount of weight presents an extreme form of traditional esthetic and functional body contour concerns. Routine body contouring procedures usually produce only suboptimal results in this patient population. The body lift described herein is an excellent alternative to treat the body contour deformity of the patient who has undergone bariatric surgery.

Reducing the incidence of incisional hernias following open gastric bypass surgery.

Background: Abdominal wall hernias are a common complication following open gastric bypass (RYGBP) surgery. In an effort to reduce the incidence of incisional hernias with our form of open RYGBP, progressively smaller, upper midline epigastric incisions have been utilized along with permanent sutures. The purpose of this study is to analyze whether incision location, size and choice of suture material affect the incidence of incisional hernias following open RYGBP.

Bowel obstruction after open and laparoscopic gastric bypass surgery for morbid obesity.

Background: Bowel obstruction is increasingly recognized as an important complication after gastric bypass. This study analyzed late bowel obstruction after open and laparoscopic gastric bypass surgery.

Study Design: The medical records of 1,378 patients who had proximal gastric bypass during the years 2002 and 2003 at a large bariatric center were evaluated for readmission with bowel obstruction requiring operations.

Body lift: an account of 200 consecutive cases in the massive weight loss patient.

Background: The epidemic of obesity in the United States has led to a rapid increase in the number of bariatric procedures performed over the past several years. The dramatic changes to the torso following massive weight loss are only partially addressed by routine procedures such as abdominoplasty and liposuction. Circumferential body lifts or simultaneous abdominoplasty, thigh, and buttock lifts are becoming the method of choice for treating the postbariatric condition.

The learning curve measured by operating times for laparoscopic and open gastric bypass: roles of surgeon's experience, institutional experience, body mass index and fellowship training.

Background: Surgeons must overcome a substantial learning curve before mastering laparoscopic Roux-en-Y gastric bypass (LRYGBP). This learning curve can be defined in terms of mortality, morbidity or length of surgery. The aim of this study was to compare the learning curves in terms of surgical time for the first 3 surgeons performing LRYGBP in our hospital with the length of surgery for open gastric bypass (CONTROLS).

Predictors of prolonged hospital stay following open and laparoscopic gastric bypass for morbid obesity: body mass index, length of surgery, sleep apnea, asthma, and the metabolic syndrome.

Background: The number of weight reduction operations performed for type II and type III obesity is rapidly escalating. Risk of surgery has been infrequently stratified for patient subgroups. The purpose of this study was to identify patient characteristics that increased the odds of a prolonged hospital length of stay (LOS) following open or laparoscopic Roux-en-Y gastric bypass (RYGBP).

Bariatric surgery in adolescence. is this the best age to operate?

Background: Bariatric surgery in morbidly obese adolescents is controversial. Many argue that morbidly obese individuals should be of adult age before undergoing bariatric operations, despite the progressive and debilitating course of this increasingly common disease.

Materials And Methods: 19 consecutive adolescent patients, aged 13-17, underwent vertical banded gastroplasty-Roux-en-Y gastric bypass between May 1990 and August 2001.

An assessment of vertical banded gastroplasty-Roux-en-Y gastric bypass for the treatment of morbid obesity.

Objective: To analyze retrospectively the mortality, morbidity, and weight loss of a specific form of gastric bypass for the treatment of morbid obesity. The technique incorporates a small pouch along the lesser curvature of the stomach, an outlet restricted by a nondistensible band and a Roux-en-Y gastric bypass.

Material And Methods: We analyzed 652 consecutive patients with no previous bariatric surgery who underwent our present form of gastric bypass.

Gastro-gastric fistulas and marginal ulcers in gastric bypass procedures for weight reduction.

Background: Gastro-gastric fistulas and marginal ulcers are frequent and serious complications of gastric compartmentalization procedures for obesity.

Methods: The authors analyzed 810 patients after 911 operations for gastro-gastric fistulas and marginal ulcers over an 8-year period. All patients underwent a form of gastric bypass, in which a pouch is constructed along the lesser curvature of the stomach.

Converting vertical banded gastroplasty to a lesser curvature gastric bypass: technical considerations.

Background: Vertical banded gastroplasty (VBG) is occasionally followed by poor weight loss or complications requiring reoperation. Several studies have analyzed the morbidity and mortality associated with conversions of VBG to gastric bypass, but few have described the actual technique. The most frequent complications related to this type of reoperation are gastrointestinal leaks.

Reducing early technical complications in gastric bypass surgery.

Background: The incidence of complications following gastric bypass surgery has decreased markedly over the last 30 years; nevertheless, significant morbidity and mortality is still associated with this procedure. Much of the improved risk of this technique can be attributed to the numerous modifications that have taken place in its evolution.

Methods: We compared our series of 640 primary cases of vertical banded gastroplasty-Roux-en-Y gastric bypass (VBG-RGB), a form of gastric bypass, with gastric bypass series reported in the literature from 1966 to 1996.

Complement activation and subclassification of tissue immunoglobulin G in the abdominal aortic aneurysm.

Features of autoimmunity in abdominal aortic aneurysm (AAA) have been described, including increases in IgG content. The present experiments were carried out to determine (1) whether the increases in IgG are subclass specific and (2) whether the IgG complex is associated with an increase in the isoforms of complement C3. Seven AAA, four athero-occlusive (AOD), and two normal (NL) aortic tissue extracts were evaluated for immunoreactive complement (C3) components, both by ELISA and by Western immunoblots (probed with a polyclonal goat anti-human C3).

Is Routine Invasive Monitoring Indicated in Surgery for the Morbidly Obese?

BACKGROUND: Morbid obesity is generally considered to be a surgical and anesthetic risk. Some surgeons have advised the routine use of invasive monitoring for morbidly obese individuals undergoing surgery. The purpose of this study was to identify morbidly obese individuals undergoing primary gastric bypass procedures who required central or other forms of invasive monitoring for their management.

Staple Disruption and Marginal Ulceration in Gastric Bypass Procedures for Weight Reduction.

BACKGROUND: Staple disruption is a frequent and serious complication of the segmentation procedures of gastric bypass surgery for weight reduction. Staple-line failure is frequently followed by weight gain and often marginal ulceration. METHODS: We reviewed the literature and analyzed our own series of 623 consecutively performed gastric bypass procedures for staple-line disruption and peptic ulceration.

The weight reduction operation of choice: vertical banded gastroplasty or gastric bypass?

Background: Despite important advances in the field of bariatric surgery over the last 40 years, no single operation has clearly emerged as the optimum procedure. Over the last decade, however, attention has focused on vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RGB).

Patients And Methods: We compared 329 VBG procedures consecutively performed in 328 patients, and 623 VBG-RGB operations in 560 patients for mortality, early and late complications requiring reoperation, and for weight loss up to 5 years.

Incidence and pathogenesis of aneurysmal disease of the abdominal aorla.

Abdominal aortic aneurysms (AAAs) are a major cause of illness and death in the United States and abroad. Along with progress in the surgical management of this condition, numerous advances have been made in understanding the pathogenesis of AAAs. Since the time of Scarpa (1804), AAA disease has been associated with, and attributed to, atherosclerotic vessel changes.

Ethnicity, Type of Obesity Surgery and Weight Loss.

In our study we compared weight loss among non-Hispanic whites (NHW), black Afro-Americans (BAA) and Hispanic Americans (HA) following vertical banded gastroplasty (VBG) and vertical banded gastroplastygastric bypass (VBG-RGB). From a total of 1222 patients, 662 qualified for the study (471 VBG, 211 VBG-RGB) based on type of surgery, follow-up and ethnicity. When comparing percentage excess weight loss, VBG-RGB patients lost significantly more than VBG patients.

Vertical Banded Gastroplasty-Gastric Bypass: preliminary report.

Vertical banded gastroplasty-gastric bypass is a surgical technique combining the advantages of the vertical banded gastroplasty with those of gastric bypass. The procedure was performed on 148 morbidly obese individuals: 83% were female, and 17% were male. Ages ranged from 15 to 64 years, with a mean age of 35.