Situs inversus is a congenital condition in which the major visceral organs are mirrored from their normal position. Its incidence is about 1 in 10.000 people. This condition is usually diagnosed incidentally during childhood although is not uncommon to be found for the first time in the adult patient.

Background: Laparoscopic sleeve gastrectomy (LSG) procedures are growing in popularity which makes it important for institutions to be as efficient as possible. Suction calibration system (SCS) devices have been shown to reduce cork-screwing during the stapling process in LSG procedures which would also mean a shorter staple line. This shorter staple line may translate to a decrease in staple usage.

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most common surgical procedures for severe obesity. Incidental findings at the time of surgery may alter the planned procedure. Malrotation of the bowel is a rare condition that may be present at the time of surgery.

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is 1 of the most common procedures performed for severe obesity. Incidental anatomic abnormalities found at surgery are uncommon and can require an alternative operative approach. We present a video case report of a patient incidentally found to have midgut congenital malrotation at LRYGB.

Although vertical banded gastroplasty (VBG) was endorsed by the 1991 NIH Consensus Conference for the treatment of morbid obesity, it has largely been abandoned due to poor long-term weight loss and band-related complications. We present our experience with laparoscopic revision of VBG to Roux-en-Y Gastric Bypass (RYGB) and review the safety, efficacy, results, and outcomes.

Background: Although vertical banded gastroplasty (VBG) was endorsed by the 1991 National Institutes of Health Consensus Conference for the treatment of morbid obesity, it has largely been abandoned owing to the poor long-term weight loss and band-related complications. The objective of the present study was to review the outcomes of patients who had undergone laparoscopic conversion of VBG to Roux-en-Y gastric bypass (RYGB) for weight loss or dysphagia and gastroesophageal reflux.Methods: A retrospective review of prospectively collected data from all patients who had undergone revision of VBG to RYGB was performed. The data on the symptoms, weight loss, co-morbidities, and complications were collected.Results: From July 1999 to April 2010, 2397 bariatric procedures were performed. Of these, 105 (4.4%) were laparoscopic revisions of previous VBG to RYGB. Of the 105 patients, 103 had undergone open VBG and 2 laparoscopic VBG. Of the 105 patients, 97 were women and 8 were men. The average patient age was 49 years (range 23-71). The median preoperative body mass index was 42 kg/m(2) (range 20-72). Short- and long-term complications occurred in 40 patients (38%). No patients died. The median length of stay was 2 days. At an average follow-up of 31 months (range 1-96), the median percentage of excess weight loss was 47% (range -24% to 138%). The median decrease in body mass index was 8 kg/m(2) (range -6 to 30). Dysphagia had improved or resolved in 100%. Gastroesophageal reflux disease had improved or resolved in 95%. Diabetes had improved or went into remission in 90%. Hypertension had improved or resolved in 62%. Obstructive sleep apnea had improved or resolved in 96%.Conclusion: The results of our study have shown that laparoscopic revision of VBG to RYGB is a feasible procedure that can provide acceptable weight loss and reversal of weight-related co-morbidities. Complications were common after revisional bariatric surgery. (Surg Obes Relat Dis 2011;7:493-499.) (c) 2011 American Society for Metabolic and Bariatric Surgery. All rights reserved.

Immunosuppression is considered by some surgeons to be a relative contraindication for weight loss surgery. We describe our experience with immunosuppressed patients undergoing weight loss surgery.

Background: Immunocompromised patients tire at high risk of medical complications. Immunosuppression might be a relative contraindication to bariatric surgery. WC describe our experience with immunosuppressed patients undergoing bariatric surgery and review the safety, efficacy, results and outcomes.Methods: We performed I retrospective review of prospectively collected data. All patients taking, long-term immunosuppressive medications or with a diagnosis of an immunosuppressive condition were included in this study. Data on weight loss, co-morbidites, complications, and postoperative immunosuppression were collected.Results: From July 1999 to February 2008. 1566 patients underwent bariatric surgery. Of these 1566 patients, 61 (3.9%) were taking medications or had an immunosuppressive condition. Of these 61 patients, 49 were taking immunosuppressive medications for asthma. autoimmune disorders, endocrine deficiency, or chronic inflammatory disorders. The medications included oral, inhaled, and topical glucocorticoids for 39 patients and other immunosuppression or disease-modifying antirheumatic drugs for 24 patients. The bariatric procedures included laparoscopic Roux-en-Y gastric bypass in 55, laparoscopic revisional procedures in 5 and laparoscopic sleeve gastrectomy in 1. No patient died periopertitively. A total of 26 complications occured in 20 patients. The average percentage of excess weight loss was 72% (range 20-109%) at 1 year postoperatively. At a median postoperative follow-up of 18 months (range 2-68.6%), 25(51%) of 49 patients 110 longer required immunosuppressive medications owing to improvement of their underlying disease. Obesity-related health poblems (diabetes mellitus. hypertension. obstructive sleep apnea, gastroesophaged reflux disease, asthma) had resolved or improved in 80-100% of patients.Conclusion: The results of our study have shown that immunocompromised patients can safely undergo bariatric surgery with good weight loss results and improvement in co-morbidities. A large percentage of patients were bale to discrimintate immunosuppressive medications postoperativerly (Surg Obcs Relat Dis 2009:5:339-345.) (C) 2009 American Society for Metabolic and Bariatric Surgery. All rights reserved.