Insufficient weight loss after banded vs. non-banded primary gastric bypass surgery: insights from an observational 5 year follow-up study.

Background: While Roux-en-Y gastric bypass (RYGB) is effective in achieving weight loss and improving obesity-related co-morbidities, insufficient weight loss in the long-term can occur. The goal was to assess whether banded vs. non-banded RYGB reduces the risk of insufficient weight loss at 5-year follow-up.

Surgical Prevention of Weight Regain and Type 2 Diabetes Recurrence in 3 Different Bariatric Operations and Their Differential Long-Term Outcome: An 8-Year Prospective Observational Study.

Introduction: Comparative data on long-term outcomes of mechanistically different bariatric operations are scarce.

Methods: In this prospective, observational study, consecutive patients with severe obesity were studied using a predefined reoperation algorithm to determine long-term health outcomes after bariatric surgery (BS): adjustable gastric banding (AGB), Roux-en-Y gastric bypass (RYGB), or biliopancreatic diversion (BPD). All patients were assessed for mortality, postoperative weight loss, rate of reoperation, comorbidities, and quality of life (QoL) 8 years after surgery.

Reversal of Long-Term Weight Regain After Roux-en-Y Gastric Bypass Using Liraglutide or Surgical Revision. A Prospective Study.

Purpose: This study investigates whether pharmacotherapy with liraglutide is similarly effective in reversing weight regain more than 6 years after Roux-en-Y gastric bypass (RYGB) as revisional surgery aimed at restoring restriction.

Methods: Ninety-five consecutive patients (11 male, 84 female; mean BMI 45 ± 6 kg/m) undergoing RYGB 9 ± 4 years ago were treated for 24 months as follows: Patients, who gained less than 10% from weight NADIR, served as controls and were provided lifestyle counseling (DC, n = 30). The others were allowed to choose between three different treatment groups: daily s.

Postoperative Dysphagia Following Magnetic Sphincter Augmentation for Gastroesophageal Reflux Disease.

The addition of posterior cruroplasty to magnetic sphincter augmentation (MSA-PC) has been shown to be effective in treating gastroesophageal reflux disease (GERD). This study evaluates the predictors of persistent postoperative dysphagia, one of the major complaints after MSA-PC. From August 2015 to February 2018 the medical records of 118 patients (male=59, female=59) receiving MSA-PC for GERD were reviewed.

Short-term outcomes of endoscopic gastro-jejunal revisions for treatment of dumping syndrome after Roux-En-Y gastric bypass.

Background: Dumping syndrome is a known long-term complication of Roux-en-Y gastric bypass (RYGB). Most cases can be avoided with dietary and lifestyle changes. Severe dumping is characterized by multiple daily episodes with significant impact on quality-of-life.

Long-term outcomes and frequency of reoperative bariatric surgery beyond 15 years after gastric banding: a high band failure rate with safe revisions.

Background: Laparoscopic adjustable gastric band (LAGB) has had encouraging early results. However, intermediate and late results were discouraging, and LAGB is presently being replaced by stapled procedures. There is still ongoing debate whether LAGB should be abandoned altogether.

Endoscopic Gastrojejunal Revisions Following Gastric Bypass: Lessons Learned in More Than 100 Consecutive Patients.

Background: Weight regain and dumping after Roux-en-Y gastric bypass (RYGB) are long-term challenges thought to be due to dilation of the gastrojejunal anastomosis. The aim of this study was to analyze the feasibility, safety, and outcomes of endoscopic gastrojejunal revisions (EGRs) after its introduction in a tertiary bariatric surgery center.

Methods: From January 2016 to March 2018, we reviewed the electronic records of all patients undergoing EGR with the OverStitch suturing device.

Endoscopic Closure of Gastro-gastric Fistula After Gastric Bypass: a Technically Feasible Procedure but Associated with Low Success Rate.

Background: Gastro-gastric fistulas (GGF) are reported to be as high as 12% after gastric bypass for treatment of morbid obesity. While different endoscopic methods are described, the management traditionally consists of surgical revision with high associated morbidity. The aim of the study was to assess feasibility, safety and success rate of endoscopic closure using an endoscopic suturing device.

Is testing for postprandial hyperinsulinemic hypoglycemia after gastric bypass necessary?

Introduction: Postprandial hyperinsulinemic hypoglycemia (pHH) is an increasingly reported complication after Roux-en-Y gastric bypass (RYGB). As pHH can cause life-threatening emergencies if occurring without warning symptoms, challenge testing may detect patients at risk. The study objective was to determine the frequency of occurrence of pHH with or without symptoms of hypoglycemia after RYGB.

Circular stapler introducer: a novel device to facilitate stapled colorectal anastomosis.

Objectives: A circular stapler introducer was developed to protect the head of the circular stapler and enable atraumatic introduction and advancement of the circular stapler without interfering with the application and safety of an anastomosis.

Methods: In a Phase I prospective study, we tested the feasibility and safety of the novel circular stapler introducer device in 60 consecutive patients undergoing left-sided colorectal resections.

Results: The median distance of the anastomoses from the anal verge was 12 cm (7-20, n = 60).

Advances in circular stapling techniques for gastric bypass: the circular stapler introducer.

Background: Modern laparoscopic bariatric surgery relies strongly on stapling devices and the perfection of the anastomotic technique is at the core of the patient's safety.

Methods: Circular stapler anastomosis is a common technique for performing gastro-jejunostomy in gastric bypass surgery. In obese patients, transabdominal circular stapler introduction can be challenging and associated with morbidity.

Successful multi-intervention treatment of severe obesity: a 7-year prospective study with 96% follow-up.

Background: No long-term, high participation study of the outcome of bariatric surgery has examined how a multi-intervention approach to the treatment of severe obesity can achieve and sustain weight loss after an initial bariatric procedure.

Methods: We employed a multi-intervention treatment that combines adjustable gastric banding with intensive follow-up to support patient life-style change and use of an algorithm allowing reoperation-to bypass, if necessary-in the event of complications. Four hundred four severely obese patients with an average BMI = 42.

The history and role of gastric banding.

Gastric banding has emerged in the development of bariatric surgery as an important therapeutic option for morbidly obese patients. Following the major pioneering milestones of Wilkinson and Peloso, who placed a nonadjustable band around the upper part of a patient's stomach in 1978, and Hallberg and Forsell, as well as Kuzmak, who worked on separate continents to develop the clinical application of adjustable gastric bands in the early 1980s, banding entered into widespread use in the mid 1990s, when the innovation of the laparoscopic technique made it possible to insert adjustable bands without open surgery. Today, several institutions have reported long-term (> or =5-year) results with laparoscopic adjustable gastric banding (LAGB).

Severe recurrent hypoglycemia after gastric bypass surgery.

Background: Bariatric surgery is, at present, the most effective method to achieve major, long-term weight loss in severely obese patients. Recently, severe recurrent symptomatic hyperinsulinemic hypoglycemia was described as a consequence of gastric bypass surgery (GBS) in a small series of patients with severe obesity. Pancreatic nesidioblastosis, a hyperplasia of islet cells, was postulated to be the cause, and subtotal or total pancreatectomy was the suggested treatment.

Bowel habits after bariatric surgery.

Background: Disordered bowel habits might influence quality of life after bariatric surgery. Different types of bariatric operations-gastric banding (AGB), Roux-en-Y gastric bypass (RYGB), or biliopancreatic diversion (BPD)-might alter bowel habits as a consequence of the surgical procedure used. Whether change in bowel habits affects quality of life after AGB, RYGB, or BPD differently is unknown.

Interdisciplinary European guidelines on surgery of severe obesity.

In 2005, for the first time in European history, an extraordinary expert panel named BSCG (Bariatric Scientific Collaborative Group), was appointed through joint effort of the major European scientific societies which are active in the field of obesity management. Societies that constituted this panel were: IFSO - International Federation for the Surgery of Obesity, IFSO-EC - International Federation for the Surgery of Obesity - European Chapter, EASO - European Association for Study of Obesity, ECOG - European Childhood Obesity Group, together with the IOTF (International Obesity Task Force) which was represented during the completion process by its representative. The BSCG was composed not only of the top officers representing the respective scientific societies (four acting presidents, two past presidents, one honorary president, two executive directors), but was balanced with the presence of many other key opinion leaders in the field of obesity.

Impact of age, sex and body mass index on outcomes at four years after gastric banding.

Background: Adjustable gastric banding for weight reduction in severely obese persons allows reversible individualized restriction during postoperative follow-up. It is unknown whether preoperative age, sex and BMI might modulate treatment outcome.

Methods: 404 severely obese patients (79% women; age 42 +/- 0.

Salvage of gastric restriction following staple-line dehiscence after vertical banded gastroplasty by insertion of an adjustable gastric band.

Background: Vertical banded gastroplasty (VBG) has been a common and safe surgical treatment for morbid obesity. However, the complication of staple-line dehiscence (SLD) results in VBG failure. We present a minimally invasive revision procedure when SLD occurs: gastric restriction is salvaged by adjustable gastric banding (AGB), usually laparoscopically, providing that the previous restriction had achieved sufficient weight loss initially and was well-tolerated.

Management of failed adjustable gastric banding.

Background: About 100,000 adjustable gastric band placements have been performed worldwide, but more than 10% of patients have needed reoperation for insufficient weight loss or device-related complications. This study investigates the complications following gastric banding, and the outcome using a structured management strategy.

Methods: In the period April 1996 to January 2002, 824 severely obese patients (body mass index 43 +/- 1 kg/m 2 [mean +/- standard error under the mean], age 43 +/- 1 years; 77% women) underwent gastric banding in a single institution and were followed prospectively.

Gene variants and binge eating as predictors of comorbidity and outcome of treatment in severe obesity.

Melanocortin-4 receptor gene (MC4R) variants are associated with obesity and binge eating disorder (BED), whereas the more prevalent proopiomelanocortin (POMC) and leptin receptor gene (LEPR) mutations are rarely associated with obesity or BED. The complete coding regions of MC4R, POMC, and leptin-binding domain of LEPR were comparatively sequenced in 300 patients (233 women and 67 men; mean +/- SEM age, 42 +/- 1 years; mean +/- SEM body mass index, 43.5 +/- 0.

Effect of significant intermediate-term weight loss on serum leptin levels and body composition in severely obese subjects.

Background: Leptin, produced by adipose tissue, signals body fat content to the hypothalamus. Serum leptin levels (SLL), elevated in obese humans, decrease with weight loss. This study investigated the reduction of SLL and fat mass following restrictive bariatric surgery.

Laparoscopic gastric bypass versus laparoscopic adjustable gastric banding: a comparative study of 1,200 cases.

Background: Indications for and results of laparoscopic adjustable gastric banding (LAGB) and laparoscopic gastric bypass (LGB) are still controversial, especially between Europe and the United States. The recent availability of gastric bandings in the United States made it necessary to compare the two techniques.

Study Design: We compared a series of 456 LGB to a series of 805 LAGB performed in two different institutions.