Global 30-Day Morbidity and Mortality of Primary Bariatric Surgery Combined with Another Procedure: The BLEND Study.

Background: No robust data are available on the safety of primary bariatric and metabolic surgery (BMS) alone compared to primary BMS combined with other procedures.

Objectives: The objective of this study is to collect a 30-day mortality and morbidity of primary BMS combined with cholecystectomy, ventral hernia repair, or hiatal hernia repair.

Setting: This is as an international, multicenter, prospective, and observational audit of patients undergoing primary BMS combined with one or more additional procedures.

Resolution of Hyperandrogenism, Insulin Resistance and Acanthosis Nigricans (HAIR-AN) Syndrome After Sleeve Gastrectomy.

Hyperandrogenism, insulin resistance, and acanthosis nigricans (HAIR-AN) is a severe subphenotype of polycystic ovary syndrome (PCOS). A 32-year-old woman with HAIR-AN and class 3 obesity presented to an endocrinology clinic after she failed sequential trials of treatment with metformin, estrogen-progestin OCP, spironolactone, leuprolide, and a levonorgestrel intrauterine device. She complained of hirsutism and acanthosis nigricans severely affecting her quality of life and had secondary amenorrhea.

Predictors of 30-day follow-up visit completion after primary bariatric surgery: an analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry.

Background: Adherence to follow-up visits is often unsatisfactory after bariatric surgery.

Objectives: To identify predictors, including surgery type and preoperative demographics, body mass index (BMI), medical conditions, and smoking status, of 30-day follow-up visit completion.

Setting: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program participating centers (2015-2018).

Cellular Uptake and Photo-Cytotoxicity of a Gadolinium(III)-DOTA-Naphthalimide Complex "Clicked" to a Lipidated Tat Peptide.

A new bifunctional macrocyclic chelator featuring a conjugatable alkynyl-naphthalimide fluorophore pendant group has been prepared and its Gd(III) complex coupled to a cell-penetrating lipidated azido-Tat peptide derivative using Cu(I)-catalysed "click" chemistry. The resulting fluorescent conjugate is able to enter CAL-33 tongue squamous carcinoma cells, as revealed by confocal microscopy, producing a very modest anti-proliferative effect (IC50 = 93 µM). Due to the photo-reactivity of the naphthalimide moiety, however, the conjugate's cytotoxicity is significantly enhanced (IC50 = 16 µM) upon brief low-power UV-A irradiation.

Luminescent Alkyne-Bearing Terbium(III) Complexes and Their Application to Bioorthogonal Protein Labeling.

Two new bifunctional macrocyclic chelate ligands that form luminescent terbium(III) complexes featuring an alkyne group for conjugation to (bio)molecules via the Cu(I)-catalyzed "click" reaction were synthesized. Upon ligation, the complexes exhibit a significant luminescent enhancement when excited at the λ(max) of the "clicked" products. To demonstrate the utility of the complexes for luminescent labeling, they were conjugated in vitro to E.

Zwitterionic-coated "stealth" nanoparticles for biomedical applications: recent advances in countering biomolecular corona formation and uptake by the mononuclear phagocyte system.

Nanoparticles represent highly promising platforms for the development of imaging and therapeutic agents, including those that can either be detected via more than one imaging technique (multi-modal imaging agents) or used for both diagnosis and therapy (theranostics). A major obstacle to their medical application and translation to the clinic, however, is the fact that many accumulate in the liver and spleen as a result of opsonization and scavenging by the mononuclear phagocyte system. This focused review summarizes recent efforts to develop zwitterionic-coatings to counter this issue and render nanoparticles more biocompatible.

Root cause analysis of internal hernia and Roux limb compression after laparoscopic Roux-en-Y gastric bypass using observational clinical human reliability assessment.

Background: Internal hernia (IH) and Roux limb compression (RC) are recognized complications after retrocolic laparoscopic Roux-en-Y gastric bypass for obesity. The aim of the present study was to systematically identify the surgical technical errors leading to these complications.

Methods: An observational clinical human reliability assessment approach was used to analyze the operating videos of 3 groups: an IH group (n = 12), a Roux compression group (n = 13), and a control group (no complications, n = 21).

Nanomaterials: applications in cancer imaging and therapy.

The application of nanomaterials (NMs) in biomedicine is increasing rapidly and offers excellent prospects for the development of new non-invasive strategies for the diagnosis and treatment of cancer. In this review, we provide a brief description of cancer pathology and the characteristics that are important for tumor-targeted NM design, followed by an overview of the different types of NMs explored to date, covering synthetic aspects and approaches explored for their application in unimodal and multimodal imaging, diagnosis and therapy. Significant synthetic advances now allow for the preparation of NMs with highly controlled geometry, surface charge, physicochemical properties, and the decoration of their surfaces with polymers and bioactive molecules in order to improve biocompatibility and to achieve active targeting.

A facile, click chemistry-based approach to assembling fluorescent chemosensors for protein tyrosine kinases.

A group of fluorophore-labeled peptide substrates of Src kinases have been synthesized with the aid of click chemistry. Some of the generated peptides exhibit an increase in fluorescence upon phosphorylation and are capable of detecting Src kinases with high sensitivity and specificity. Their availability permits real-time activity measurement of aberrantly activated oncogenic Src kinases in the crude lysate of chronic myelogenous leukemia cells.

Breast cancer and bariatric surgery: temporal relationships of diagnosis, treatment, and reconstruction.

Background: Given the increased prevalence of bariatric surgery, a certain number of women will develop breast cancer before or after bariatric intervention. Whether bariatric surgery reduces the risk of breast cancer remains uncertain. Similarly, reconstructive options for these patients and timing of reconstruction relative to their weight loss have not been established.

Radiological findings in symptomatic internal hernias after laparoscopic gastric bypass.

Background: Internal hernias (IHs) can complicate laparoscopic Roux-en-Y gastric bypass (LRYGB). A number of radiological investigations can be used in the diagnosis. These include plain X-rays, upper gastrointestinal (UGI) series, ultrasound, and computed tomography (CT) scanning.

Patterns of plastic surgical use after gastric bypass: who can afford it and who will return for more.

Background: More patients are undergoing plastic surgery after gastric bypass. Socioeconomic factors influencing the decision to have body contouring after gastric bypass have not been studied in the current literature.

Methods: In this study, 2501 consecutive gastric bypass patients were surveyed.

Laparoscopic Roux-en-Y gastric bypass and its early effect on blood pressure.

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery is known to have a significant effect on obesity-related comorbidities such as hypertension curing it in some (50-70%) while improving control in others. Our aim was to observe the changes in blood pressure (BP) in a cohort of 100 patients followed prospectively for 1 year after LRYGB.

Methods: BP measurements were recorded prospectively in 100 consecutive patients preoperatively and then postoperatively at weeks 1, 5, 9, and months 6 and 12.

Post-bariatric surgery reconstruction: patient myths, perceptions, cost, and attainability strategies.

Background: A discrepancy exists between patient perceptions of post-bariatric surgery reconstruction and cost, value, and ultimate attainability. The authors investigated prospective gastric bypass patients to identify misconceptions and strategies to aid in the attainability of post-bariatric surgery reconstruction.

Methods: One hundred seventy-six prospective gastric bypass patients were surveyed for perceptions of plastic surgery, a "club" concept integrating plastic surgical/bariatric teams, and payment strategies.

Roux limb obstruction secondary to constriction at transverse mesocolon rent after laparoscopic Roux-en-Y gastric bypass.

Background: Partial small bowel obstruction can occur as a result of circumferential extrinsic compression of the Roux limb as it traverses the transverse mesocolic rent from thickened cicatrix formation in this area. The aim of this study is to examine the incidence of Roux limb compression with particular attention to the timing of presentation and associated weight loss in the setting of a university hospital in the United States.

Methods: A retrospective chart review was performed of all patients undergoing laparoscopic Roux-en-Y gastric bypass who developed symptomatic small bowel obstruction requiring operative intervention from January 1, 2000 and September 15, 2006.

Temporal and demographic factors influencing the desire for plastic surgery after gastric bypass surgery.

Background: An increasing number of gastric bypass patients desire plastic surgery after massive weight loss. However, the timing of interest and factors influencing the desire for body contouring have not been studied.

Methods: Two thousand five hundred one gastric bypass patients were surveyed.

Bioabsorbable glycolide copolymer staple-line reinforcement decreases internal hernia rate after laparoscopic Roux-en-Y gastric bypass.

Background: Internal hernias (IHs) can occur after laparoscopic Roux-en-Y gastric bypass (LRYGBP), perhaps because of a lack of adhesion formation at the cut edges of the mesentery and a cutting through of sutures with a decrease in fat from weight loss. In patients undergoing reoperation after LRYGBP, we observed that bioabsorbable glycolide copolymer staple-line reinforcement (SLR) placed to mitigate staple-line bleeding had evoked adhesiogenesis and tissue fusion at the mesentery edges; therefore, we investigated whether use of this material decreases post-LRYGBP IH rates.

Methods: The records of the 43 patients (3%) in whom an IH developed during a mean follow-up time of 2 years in a series of 1,704 LRYGBP procedures were reviewed retrospectively.

CT scan diagnosis of bleeding peptic ulcer after gastric bypass.

Investigation of the bypassed stomach in patients with suspected peptic ulcer disease presents a major challenge to bariatric surgeons. Various methods have been suggested for visualization of the duodenum and bypassed stomach. These include endoscopy via percutaneous gastrostomy access, retrograde endoscopy and virtual gastroscopy using CT scan.

Trends in internal hernia incidence after laparoscopic Roux-en-Y gastric bypass.

Background: Internal hernia is a known complication after gastric bypass, especially when performed laparoscopically. The aim of this study was to see when internal hernias occur in relation to weight loss and time course after surgery. Furthermore, we wish to examine the impact of Roux limb positioning ante- versus retrocolic and whether switching to running versus interrupted closure of the mesenteric defects created at surgery made any difference.

Cholecystectomy during laparoscopic gastric bypass has no effect on duration of hospital stay.

Background: Laparoscopic cholecystectomy can be safely performed at the time of laparoscopic Roux-en-Y gastric bypass (LRYGBP). This study was primarily conducted to examine whether there is any difference in the length of hospital stay and duration of operation in patients who undergo concomitant cholecystectomy with their LRYGBP. In addition, the frequency and nature of complications in the two groups were compared.

Small-bowel obstruction after laparoscopic Roux-en-Y gastric bypass: etiology, diagnosis, and management.

Objective: To summarize our experience with small-bowel obstructions after laparoscopic Roux-en-Y gastric bypass.

Design: Retrospective record review.

Setting: University-affiliated hospital.

Accessing the common bile duct after Roux-en-Y gastric bypass.

We report on the clinical course of 2 patients who underwent laparoscopic Roux-en-Y gastric bypass for obesity and subsequently presented with biliary complications of choledocholithiasis in 1 case and sphincter of Oddi dysfunction in the other. The approach to these complex problems is described. Both patients underwent percutaneous transhepatic access to the common bile duct (CBD) for balloon sphincteroplasty.

Laparoscopic Roux-en-Y gastric bypass in a patient with situs inversus.

We report the case of a morbidly obese patient with situs inversus totalis presenting for laparoscopic Roux-en-Y gastric bypass (RYGBP). The operative technique is detailed and we recommend the use of a mirror image approach to all parts of the operation. Consequently, the operative time is only moderately longer than usual.

Internal hernia with Roux loop obstruction during pregnancy after gastric bypass surgery.

We report the rare case of a pregnant woman who had undergone Roux-en-Y gastric bypass 8 months previously, and now presented with subacute small bowel obstruction secondary to internal herniation of some of the proximal Roux limb into the lesser sac through the transverse mesocolon rent, which was widely spread apart. At laparoscopy, the hernia contents were reduced and the defect was repaired. The patient made a good recovery.