Complications of Laparoscopic Roux-en-Y Gastric Bypass.

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Authors: Al Harakeh AB
Abstract
Despite the well-documented safety of laparoscopic RYGB, several short-term and long-term complications, with varying degrees of morbidity and mortality risk, are known to occur. Bariatric surgeons, all too familiar with these complications, should be knowledgeable in risk-reduction strategies to minimize the incidence of complication occurrence and recurrence. Bariatric and nonbariatric surgeons who evaluate and treat abdominal pain should be familiar with these complications to facilitate early recognition and intervention, thereby minimizing the associated morbidity and mortality.
PMID: 22054150 [PubMed – in process] (Source: The Surgical Clinics of North America)

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Complications of adjustable gastric banding.

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Authors: Snow JM, Severson PA
Abstract
Adjustable gastric banding (AGB) has become increasingly used by bariatric surgeons and their patients as the surgical weight loss procedure of choice. The popularity of this procedure is in large part a result of the remarkable safety profile and low initial complication rate. Complications of AGB were initially believed to be minor and infrequent, but longer-term studies have increasingly described complications that lead to revisional surgery. In addition, a larger fraction of patients fail to lose weight than with other surgical weight loss procedures, frequently necessitating conversion to these other options.
PMID: 22054152 [PubMed – in process] (Source: The Surgical Clinics of North America)

Biliopancreatic diversion with duodenal switch.

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Authors: Sudan R, Jacobs DO
Abstract
The biliopancreatic diversion with a duodenal switch (BPD-DS) is a less commonly performed but very effective bariatric procedure that has been in existence for more than 20 years. It is particularly effective for the resolution of diabetes and is associated with the highest weight loss among other bariatric operations. Typically, the BPD-DS is not associated with postgastrectomy symptoms, such as dumping and marginal ulceration. Because of its complexity, it has usually been performed by laparotomy in the past; but, more recently, minimally invasive techniques are being used with acceptable risk.
PMID: 22054154 [PubMed – in process] (Source: The Surgical Clinics of North America)

Impact of bariatric surgery on comorbidities.

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Authors: Kaul A, Sharma J
Abstract
Published data show that bariatric surgery not only leads to significant and sustained weight loss but also resolves or improves multiple comorbidities associated with morbid obesity. Evidence suggests that the earlier the intervention the better the resolution of comorbidities. Patients with metabolic syndrome and comorbidities associated with morbid obesity should be promptly referred for consideration for bariatric surgery earlier in the disease process.
PMID: 22054155 [PubMed – in process] (Source: The Surgical Clinics of North America)

Bariatric surgery outcomes.

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Authors: Dumon KR, Murayama KM
Abstract
Obesity is associated with an increased risk of death, and morbid obesity carries a significant risk of life-threatening complications such as heart disease, diabetes, and high blood pressure. Bariatric surgery is recognized as the only effective treatment of morbid obesity. The estimated number of bariatric operations performed in the United States in 2008 was more than 13 times the number performed in 1992. Despite this increase, only 1% of the eligible morbidly obese population are currently treated with bariatric surgery.
PMID: 22054156 [PubMed – in process] (Source: The Surgical Clinics of North America)

Adolescent bariatric surgery.

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This article reviews the demographics and health implications of adolescent obesity, describes the most common adolescent bariatric surgical procedures and their outcomes, discusses the ethical issues involved in elective surgery in this population, and outlines the key components of an adolescent bariatric surgical program.
PMID: 22054157 [PubMed – in process] (Source: The Surgical Clinics of North America)

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Revisional bariatric surgery.

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Authors: Kellogg TA
Abstract
With the increase in bariatric surgical procedures, an increase in revision operations is expected. A thorough preoperative work-up is essential to formulate an appropriate revision strategy. Outcomes vary according to the primary operation and chosen approach to revision. Recent studies have shown acceptably low complication rates and good weight loss with the associated health benefits. Although there is no direct evidence in the form of randomized studies indicating which patients with inadequate weight loss or weight regain will benefit most from revision, or to support one particular revision approach rather than another, it is possible to develop general, effective strategies.
PMID: 22054158 [PubMed – in process] (Source: The Surgical Clinics …

Future directions in bariatric surgery.

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Authors: Lee SM, Pryor AD
Abstract
Bariatric surgery is a field in rapid evolution, and the speed of this evolution has been accelerating over the last several decades. A thorough understanding of past developments is crucial to anticipating the future intelligently. The trends that have driven evolution historically often persist, and continue to be influential in the future. With this in mind, this article briefly outlines the historical and current trends in bariatric surgery, and follows the trajectory of these trends into the future to anticipate the technologies and techniques that will be most important to the field in the coming years.
PMID: 22054159 [PubMed – in process] (Source: The Surgical Clinics of North America)

Bariatric and metabolic surgery.

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Authors: Martin RF
PMID: 22054160 [PubMed – in process] (Source: The Surgical Clinics of North America)

Treat Obese Diabetics With Surgery, IDF Says

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Obese patients with type 2 diabetes should have bariatric surgery to treat their disease, according to a new position statement from the International Diabetes Federation.

Patients with diabetes and a body mass index (BMI) of 35 or more should be treated with any of the various forms of bariatric surgery, including gastric bypass and gastric banding, the IDF said.

Surgery should also be used in patients with a BMI of 30 to 35 whose diabetes is not adequately controlled by medications — especially among those with other major risk factors for heart disease, including hyperlipidemia, hypertension, and a history of myocardial infarction, according to the statement.

That latter recommendation conflicts with that of the American Diabetes Association, which recommends that surgery be used only for diabetic patients with a BMI of 35 or above, especially if they have other heart disease risk factors.

There’s not enough evidence to recommend surgery for patients with a BMI under 35, according to the ADA.

The IDF said it took the position in light of increasing rates of both obesity and diabetes, sparked by an “obesogenic” environment in developed countries. Research has shown that the surgery normalizes blood glucose levels and reduces the need for medications, according to the organization.

The IDF guideline writers noted that physicians should use a lower BMI reference for Asian patients and some other ethnicities — as much as 2.5 BMI points lower.

The statement was released Monday at the organization’s 2nd World Congress on Interventional Therapies for Diabetes in New York City.

The paper calls for the establishment of a national registry of patients who’ve had bariatric surgery “in order to ensure quality patient care and to monitor both short- and long-term outcomes.”

It also highlights the need for studies to establish criteria that help determine which patients will benefit most from surgery, and which ones will benefit most from which surgical procedures.

The new recommendations coincide with an FDA ruling last month that expanded the indication for Allergan’s Lap-Band device to include patients with a lower BMI — of 30 and up.