Adipocyte Proteins and Storage of Endogenous Fatty Acids in Visceral and Subcutaneous Adipose Tissue in Severe Obesity.

Objective: This study tested whether substrate concentrations or fatty acid storage proteins predict storage of endogenous lipids in visceral adipose tissue (VAT) and upper body subcutaneous adipose tissue (UBSQ) fat.

Methods: The day prior to surgery, 25 patients undergoing bariatric procedures received an infusion of autologous [1- C]triolein-labeled very low-density lipoprotein (VLDL) particles, and during surgery, they received a continuous [U- C]palmitate infusion/bolus [9,10- H]palmitate tracer. VAT and UBSQ fat were collected to measure VLDL-triglyceride (TG) storage, direct free fatty acid (FFA) storage rates, CD36 content, lipoprotein lipase (LPL), acyl-CoA synthetase, diacylglycerol acetyl-transferase, and glycerol-3-phosphate acyltransferase activities.

Hepatic Fatty Acid Balance and Hepatic Fat Content in Humans With Severe Obesity.

Objective: Nonalcoholic fatty liver disease can lead to hepatic inflammation/damage. Understanding the physiological mechanisms that contribute to excess hepatic lipid accumulation may help identify effective treatments.

Design: We recruited 25 nondiabetic patients with severe obesity scheduled for bariatric surgery.

Randomized sham-controlled trial evaluating efficacy and safety of endoscopic gastric plication for primary obesity: The ESSENTIAL trial.

Objective: Evaluate safety and efficacy of the pose™ procedure for obesity treatment.

Methods: Subjects with Class I to II obesity were randomized (2:1) to receive active or sham procedure, after each investigator performed unblinded lead-in cases. All subjects were provided low-intensity lifestyle therapy.

Stop regain: a pilot psychological intervention for bariatric patients experiencing weight regain.

Background: A subset of bariatric patients fails to achieve or maintain long-term successful weight loss. Psychological and behavioral factors contributing to poor long-term outcomes include decreased adherence to surgical eating guidelines, life stressors that derail weight maintenance, unhealthy eating patterns, and substance use.

Objectives: A 6-week pilot group behavioral intervention utilizing techniques of cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) was developed to treat bariatric patients experiencing weight regain.

The effect of vagal nerve blockade using electrical impulses on glucose metabolism in nondiabetic subjects.

Purpose: Vagal interruption causes weight loss in humans and decreases endogenous glucose production in animals. However, it is unknown if this is due to a direct effect on glucose metabolism. We sought to determine if vagal blockade using electrical impulses alters glucose metabolism in humans.

Adipocyte mitochondrial function is reduced in human obesity independent of fat cell size.

Context: It has been suggested that mitochondrial dysfunction in adipocytes contributes to obesity-related metabolic complications. However, obesity results in adipocyte hypertrophy, and large and small adipocytes from the same depot have different characteristics, raising the possibility that obesity-related mitochondrial defects are an inherent function of large adipocytes.

Objective: Our goal was to examine whether obesity, independent of fat cell size and fat depot, is associated with mitochondria dysfunction.

Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial.

Importance: Controlling glycemia, blood pressure, and cholesterol is important for patients with diabetes. How best to achieve this goal is unknown.

Objective: To compare Roux-en-Y gastric bypass with lifestyle and intensive medical management to achieve control of comorbid risk factors.

Nonalcoholic steatohepatitis in bariatric patients with a diagnosis of obstructive sleep apnea.

Objective: To study a possible association between obstructive sleep apnea (OSA) severity, managed with noninvasive ventilation, and nonalcoholic steatohepatitis (NASH) in bariatric surgical patients.

Methods: Medical records of 218 bariatric surgical patients who underwent liver biopsy were reviewed. OSA severity was determined from preoperative polysomnography (apnea-hypopnea index (AHI) ≤ 15 no/mild OSA vs.

The EMPOWER study: randomized, prospective, double-blind, multicenter trial of vagal blockade to induce weight loss in morbid obesity.

Background: Intermittent, reversible intraabdominal vagal blockade (VBLOC® Therapy) demonstrated clinically important weight loss in feasibility trials. EMPOWER, a randomized, double-blind, prospective, controlled trial was conducted in USA and Australia.

Methods: Five hundred three subjects were enrolled at 15 centers.

Laparoscopic sleeve gastrectomy in a pediatric patient.

Laparoscopic sleeve gastrectomy (LSG) is a novel technique in pediatric bariatric surgery. The patient reported here participated in our pediatric weight management clinic for 2 years. His obesity was complicated by obstructive sleep apnea, acanthosis nigricans, and hypertension.

Adolescent bariatric surgery.

Overall it is clear that bariatric surgical intervention in appropriately selected adolescents is effective at both adequate weight loss and resolution of weight related co-morbidities in the short and medium term. Long-term results are being conducted currently to assess durability of bariatric surgical interventions. We believe that adolescents undergoing bariatric evaluation have unique needs and until more long-term data are available, the indications for surgery should be stricter than those used in adults.

Combined group and individual model for postbariatric surgery follow-up care.

Background: The prevalence of bariatric surgery in the United States has increased significantly during the past decade, increasing the number of patients requiring postbariatric surgery follow-up care. Our objective was to develop and implement an efficient, financially viable, postbariatric surgery practice model that would be acceptable to patients. The setting was the Mayo Clinic (Rochester, MN).

Nonalcoholic steatohepatitis (NASH) does not increase complications after laparoscopic bariatric surgery.

Background: Advanced liver disease is associated with increased risk for postoperative complications. It is not well known whether the presence of nonalcoholic steatohepatitis (NASH) in morbidly obese patients contributes to the rate of postoperative complications. The main objective was to study the association between NASH and postoperative complications in bariatric patients.

Evaluation of commercially available port access devices for single-incision laparoscopy.

Background: Laparoendoscopic single-site surgery has created a need for new technologies to simplify and expedite these procedures. We evaluated 3 different commercially available single-incision laparoscopic port access devices for their ease of use.

Methods: Four laparoscopic surgeons performed multiple laparoscopic procedures through a single fascial incision in a porcine model.

Effects of CPAP on gastric pouch pressure after bariatric surgery.

Background: The purpose of this study was to determine if the routine use of postoperative continuous positive airway pressure (CPAP) in patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) is associated with an increase in transmural gastric pouch pressure, which may create the risk for anastomotic leak.

Methods: Transmural gastric pressures (difference between gastric pouch and bladder pressures) were measured postoperatively [post-anesthesia recovery care unit (PACU) arrival (prior to initiation of CPAP), 5 min, 30 min, and PACU discharge] in 28 patients (19 patients used CPAP, 9 patients did not) following laparoscopic RYGB. Changes in pressure over time were assessed using a generalized estimating equation, taking into account the repeated measurements obtained for each subject.

Refractory strictures after Roux-en-Y gastric bypass: operative management.

Background: Stricture of the gastrojejunostomy after Roux-en-Y gastric bypass (RYGB) is common in the early postoperative period, with a reported incidence of 3-27%. Late recalcitrant strictures are much less common. Treatment has varied from endoscopic therapy to operative revision of the gastrojejunostomy with or without additional anatomic revisions.

All strictures are not alike: laparoscopic removal of nonadjustable Silastic bands after banded Roux-en-Y gastric bypass.

Background: The concept of a nonadjustable Silastic band (NASB) has been used to promote surgically induced weight loss for >30 years. Vertical banded Roux-en-Y gastric bypass is an example. Some patients develop serious, band-related complications requiring treatment.

Gastric and pancreatoduodenal resection for malignant lesions after previous gastric bypass--diagnosis and methods of reconstruction.

Background: The diagnosis and treatment of gastric and pancreatoduodenal neoplasms after previous gastric bypass has been limited. Experience should increase in the future owing to the number of bariatric procedures being performed. The diagnosis and resection of these neoplasms and restoration of biliopancreatic intestinal continuity pose challenges.

Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome.

Background: Superior mesenteric artery (SMA) syndrome, also called Wilkie's syndrome, is a rare clinical phenomenon believed to be caused by compression of the third portion of the duodenum by the overlying superior mesenteric artery. We present the case of a 32-year-old female who presented with epigastric pain, weight loss, and vomiting.

Methods: Her workup included a normal upper endoscopy as well as an abdominal CT scan and upper GI contrast study that confirmed the diagnosis of superior mesenteric artery syndrome.

Changes in functional walking distance and health-related quality of life after gastric bypass surgery.

Background And Purpose: Early physical functional changes after gastric bypass surgery (GBS) are unclear, and the relationship between these changes and health-related quality of life (HR-QOL) has not been reported. We measured distances from a 6-minute walk test (6MWT) and scores on the 36-Item Short-Form Health Survey (SF-36) before and after GBS.

Subjects And Methods: Twenty-five people undergoing GBS completed the SF-36 and 6MWT presurgically and at the 3-month and 6-month follow-up visits.

Nausea, bloating and abdominal pain in the Roux-en-Y gastric bypass patient: more questions than answers.

Bariatric surgery is the most effective treatment for severe obesity. After surgery, patients may complain of gastrointestinal symptoms but their altered anatomy can make investigations difficult to perform or interpret. In particular, the Roux-en-Y gastric bypass (RYGBP) creates an excluded segment that is not easily accessible.

Gastrointestinal and nutritional complications after bariatric surgery.

The prevalence of obesity has increased to epidemic proportions, making obesity and its comorbid conditions a major public health concern. Bariatric surgery is the most effective treatment, but it carries substantial morbidity. The subsequent gastrointestinal and nutritional complications are often not recognized or properly managed.

Is Roux-en-Y gastric bypass safe after previous antireflux surgery? Technical feasibility and postoperative symptom assessment.

Background: Clinically significant morbid obesity is associated with an increased risk of gastroesophageal reflux disease. Vertical Roux-en-Y gastric bypass (RYGBP) is known to eliminate acid (and bile) in the pouch of cardia, which would provide control of reflux symptoms. The aim of our study was to assess the technical considerations, morbidity, and safety of RYGBP after previous antireflux surgery and evaluate postoperative reflux symptoms.