SAGES guidelines for the management of comorbidities relevant to metabolic and bariatric surgery.

Background: Patients who are under consideration for or have undergone metabolic and bariatric surgery frequently have comorbid medical conditions that may make their perioperative care more complex. These recommendations address routine intraoperative cholangiography in patients with bypass-type anatomy, the management of reflux disease after sleeve gastrectomy, and the optimal bariatric procedure for patients with comorbid inflammatory bowel disease.

Methods: A systematic review was conducted including studies published from 1990 to 2022 to address these questions.

Bariatric Surgery and the Long-Term Risk of Venous Thromboembolism: A Population-Based Cohort Study.

Purpose: Bariatric surgery is associated with a greater venous thromboembolism (VTE) risk in the weeks following surgery, but the long-term risk of VTE is incompletely characterized. We evaluated bariatric surgery in relation to long-term VTE risk.

Materials And Methods: This population-based retrospective matched cohort study within three United States-based integrated health care systems included adults with body mass index (BMI) ≥ 35 kg/m who underwent bariatric surgery between January 2005 and September 2015 (n = 30,171), matched to nonsurgical patients on site, age, sex, BMI, diabetes, insulin use, race/ethnicity, comorbidity score, and health care utilization (n = 218,961).

The Role of Bariatric Surgery on Diabetes and Diabetic Care Compliance.

Purpose Of Review: Bariatric surgery is a durable and long-term solution to treat both obesity and its associated comorbidities, specifically type 2 diabetes mellitus (T2DM). Many studies have demonstrated the benefits of bariatric surgery on T2DM, but weight recidivism along with recurrence of comorbidities can be seen following these procedures. Patient compliance post-bariatric surgery is linked to weight loss outcomes and comorbidity improvement/resolution.

History of Minimally Invasive Surgical Oncology.

Introduction of the fiberoptic light-source and CCD chip camera resulted in the rapid growth of minimally invasive surgical procedures. In surgical oncology, the change came slowly owing to concerns about adhering to oncological principals while learning to use new technology. Pioneers in minimally invasive colorectal surgery proved that minimally invasive resection for cancer was oncologically noninferior to traditional surgery.

Patients with clinically metabolically healthy obesity are not necessarily healthy subclinically: further support for bariatric surgery in patients without metabolic disease?

Background: Nonalcoholic fatty liver disease (NAFLD) increases the risk of liver cirrhosis and hepatocellular carcinoma and is also strongly correlated with extrahepatic diseases, including cardiovascular disease and type 2 diabetes. This risk of NAFLD among obese individuals who are otherwise metabolically healthy is not well characterized.

Objectives: To determine the prevalence and characteristics of NAFLD in individuals with metabolically healthy obesity.

Endoscopic stents in the management of anastomotic complications after foregut surgery: new applications and techniques.

Background: Anastomotic complications after foregut surgery include leaks, fistulas, and late strictures. The management of these complications can be challenging, and it may be desirable to avoid complex reoperation.

Objectives: We aim to describe the indications and outcomes of the use of esophageal self-expanding metal stents in the management of postoperative anastomotic complications after foregut surgery.

Endoscopic management of post-bariatric surgery complications.

Understanding the technical constructs of bariatric surgery is important to the treating endoscopist to maximize effective endoluminal therapy. Post-operative complication rates vary widely based on the complication of interest, and have been reported to be as high as 68% following adjustable gastric banding. Similarly, there is a wide range of presenting symptoms for post-operative bariatric complications, including abdominal pain, nausea and vomiting, dysphagia, gastrointestinal hemorrhage, and weight regain, all of which may provoke an endoscopic assessment.

Gastrointestinal devices for the treatment of type 2 diabetes.

Background: Obesity and type 2 diabetes (T2D) continue to be growing epidemics worldwide. Although bariatric surgery remains the most effective and durable treatment for both of these chronic diseases, there is a need for therapies with risk and benefit profiles between medication and standard surgical procedures. Currently there are several endoscopic and minimally invasive therapies available worldwide to treat T2D.

Medical Devices in the Treatment of Obesity.

Obesity continues to be a growing epidemic worldwide. Although bariatric surgery remains the most effective and durable treatment of obesity and its comorbidities, there is a need for less invasive yet efficacious weight loss therapies. Currently the Food and Drug Administration has approved two endoscopically placed intragastric balloon devices and a surgically placed vagal blockade device.

Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome: intermediate follow-up results and a review of the literature.

Background: Superior mesenteric artery syndrome (SMAS) is a rare condition caused by partial obstruction of the third portion of the duodenum by the SMA anteriorly and aorta posteriorly. Laparoscopic duodenojejunostomy has been described as a safe and feasible surgical intervention with favorable short-term outcomes. However, descriptions of intermediate outcomes are lacking in the literature.

Predictive factors of biliary complications after bariatric surgery.

Background: Obesity and rapid weight loss are risk factors for gallstone development. Bariatric surgery and significant postoperative weight loss are associated with postoperative biliary complications.

Objective: We aim to identify predictive factors of biliary complications after bariatric surgery.

Minilaparoscopy with Interchangeable, Full 5-mm End Effectors: First Human Use of a New Minimally Invasive Operating Platform.

Background: The most common paradigm in minimally invasive surgery is entry of a single trocar through separate incisions in the abdomen. However, in an effort to decrease postoperative pain and minimize scarring, alternative techniques have been described. Needlescopic surgery uses instruments that are 3 mm or less in diameter.

Hybrid laparoscopic-robotic management of type IVa choledochal cyst in the setting of prior Roux-en-Y gastric bypass: video case report and review of the literature.

Background: Choledochal cysts are rare congenital disease of the biliary system. The recommended treatment of these lesions is surgical excision with biliary enteric reconstruction. In patients with normal anatomy, Roux-en-Y hepaticojejunostomy is preferred.

Identification of potential mediators of retinotopic mapping: a comparative proteomic analysis of optic nerve from WT and Phr1 retinal knockout mice.

Retinal ganglion cells (RGCs) transmit visual information topographically from the eye to the brain, creating a map of visual space in retino-recipient nuclei (retinotopy). This process is affected by retinal activity and by activity-independent molecular cues. Phr1, which encodes a presumed E3 ubiquitin ligase (PHR1), is required presynaptically for proper placement of RGC axons in the lateral geniculate nucleus and the superior colliculus, suggesting that increased levels of PHR1 target proteins may be instructive for retinotopic mapping of retinofugal projections.

Resorptive hypercalcemia in post-essential thrombocythemia myelofibrosis: treatment with denosumab.

Context: Hypercalcemia associated with myelofibrosis is rare, and its pathogenesis and treatment are not known.

Objective: We report a unique case of hypercalcemia associated with post-essential thrombocythemia myelofibrosis and review the clinical and laboratory features, pathogenesis, and responsiveness to treatment with the bone antiresorptive agent, denosumab.

Results: A 62-yr-old woman with essential thrombocythemia presented with progression to myelofibrosis with lytic skull lesions and symptomatic hypercalcemia.