Background: The aim of the present study was to report the outcomes of bariatric surgery in patients >70 years of age at a community hospital in the United States.Methods: A retrospective review was performed of prospectively collected data from patients aged >70 years who had undergone bariatric surgery at a single institution from 2002 to 2008. The data analyzed included age, preoperative and postoperative weight and body mass index, postoperative complications, and co-morbidities.Results: Of 42 patients aged >70 years who underwent bariatric surgery, 22 patients (52.4%) had undergone laparoscopic gastric banding, 12 patients (28.6%) laparoscopic sleeve gastrectomy, and 8 patients (19%) laparoscopic Roux-en-Y gastric bypass. The mean preoperative weight and body mass index was 127.4 +/- 25.5 kg and 46.8 +/- 9.3 kg/m(2), respectively. The mean postoperative weight and body mass index was 100.2 +/- 17 kg and 35.5 +/- 5.4 kg/m(2), respectively. The median length of follow-up was 12 months (range 1-66). The mean percentage of excess weight loss was 47.7% at 12 months, with 73.1% follow-up data. Complications included wound infections in 4 patients (9.5%), band removal in 3 patients (7.1%), anastomotic leak in 1 patient (2.3%), and megaesophagus in 1 patient (2.3%). No mortality occurred. The postoperative use of medications for hypertension, hyperlipidemia, diabetes mellitus, and degenerative joint disease were reduced by 56%, 54%, 53%, 66%, and 50%, respectively.Conclusion: Bariatric surgery in carefully screened patients aged >70 years can be performed safely and can achieve modest improvement in co-morbidities. (Surg Obes Relat Dis 2012;8: 458-462.) (C) 2012 American Society for Metabolic and Bariatric Surgery. All rights reserved.

BACKGROUND:Laparoscopic management of distal pancreatic malignancies has been slow to gain a foothold in all but high-volume tertiary referral centers. The aim of this study was to assess the safety and outcomes of laparoscopic distal pancreatectomy (LDP) performed in a low-volume community hospital by a diverse group of surgeons, none of whom have a specialized laparoscopic background.METHODS:We conducted a retrospective review of all patients who underwent open distal pancreatectomies (ODPs) and LDPs between August 2001 and June 2008. Data included type of surgery, open versus laparoscopy, demographics, operative time, blood loss, length of hospital stay, histopathologic diagnosis, postoperative complications, American Society of Anesthesiologists score, and mortality.RESULTS:Twenty-seven patients with pancreatic masses underwent distal pancreatic resection during the study period. Fifty-nine percent (n = 16) underwent LDP, and 41% (n = 11) underwent ODP. Mean patient age was 66 y (range, 40 to 86) for the LDP group and 62 (range, 40 to 84) for the ODP group. Mean operative time was 231 min (range, 195 to 305) for LDP and 240 (range, 150 to 210) for the ODP technique. Mean length of stay for LDP and ODP was 8 (range, 3 to 22) and 12 d (range, 5 to 2), respectively. Morbidity was 25% (n = 4) in the LDP group and 36% (n = 4) in the ODP group. None of the differences between the LDP and ODP groups were statistically significant. No mortalities occurred in either group.CONCLUSION:This study supports the idea that LDP can be safely and effectively performed by any surgeon comfortable with basic laparoscopy and may not require specialized training or a specialized center. Further data are required to make more definitive conclusions.

Laparoscopic sleeve gastrectomy is a viable option that is becoming common in the management of morbid obesity. The aim of this study was to examine the effectiveness and safety of laparoscopic sleeve gastrectomy as a primary step for rapid weight loss in patients who required a second non-bariatric procedure.

INTRODUCTION:Superior mesenteric artery syndrome is a clearly defined and uncommon medical condition. Surgical intervention is needed for failed long-term medical management.MATERIAL AND METHODS:We report a series of 3 cases, a 17-year-old woman, a 23-year-old man, and a 50-year-old woman that were successfully treated by Roux-en-Y duodenojejunal bypass using a laparoscopic approach.TECHNIQUE:A 5-trocar laparoscopic approach was used for the surgery. A 75 cm long Roux limb was used in all cases.RESULTS:The postoperative period was unremarkable and symptoms of obstruction subsided in all 3 cases.CONCLUSIONS:Laparoscopic duodenojejunal bypass seems to be a feasible and safe treatment option for superior mesenteric artery syndrome.

Laparoscopic Sleeve Gastrectomy (LSG) has become an alternative bariatric operation for the management of morbid obesity. To our knowledge these is the largest literature reporting outcomes of this technique in morbidly obese adolescents. We aim to assess initial outcomes of laparoscopic sleeve gastrectomy as a new treatment modality in this controversial patient population.

Open bariatric surgery (OBS) has been associated with increased morbidity and mortality in patients with high body mass index (BMI). With the advent of laparoscopic bariatric surgery (LBS) and in an attempt to avoid complications in this patient population, a staged approach modality was proposed. The aim of this study is to assess the outcomes of LBS in the Super-Super morbidly obese patient with a BMI >70 kg/m2 that were treated with a single approach.

A true chylous effusion is defined as the presence of ascitic fluid with high fat (triglyceride) content, usually higher than 110 mg/dl. We report a case of chyloperitoneum following laparoscopic Roux-en-Y gastric bypass (LRYGB) in a 40-year-old patient who was admitted for surgery on May 31, 2007. On August 2008 an abdominal CT with contrast was ordered for chronic abdominal pain showing diffuse ascites as well as mesenteric adenitis. On September 2008, the patient was admitted to the hospital. An elective diagnostic laparoscopy was scheduled. A large amount of chylous fluid was found. Microscopic analysis came back negative. The patient made an uneventful recovery after surgery. To our knowledge, this is the first reported case of chylous ascites following LRYGB. Chyloperitoneum should be considered as a possible cause of ascites in patients with chronic small bowel obstruction following a LRYGB.

CT scans are commonly used in the evaluation of abdominal pain in post-bariatric patients. In pregnant patients however, owing to the dangers of fetal radiation, MRI is an attractive imaging modality. We present our experience with the use of MRI in a pregnant post-RYGB patient.

It is estimated that 34% of the population age 60 years or older are affected by obesity disease. Eight percent of these patients are super morbidly obese. In previous reports we demonstrated the safety and efficacy of bariatric surgery in patients older than 60 years of age. The aim of this study was to report outcomes in patients older than 70 years of age.

2003-2004 National Health and Nutrition Examination Survey, indicate that an estimated 17% of children and adolescents ages 2-19 years are overweight in the US. We aim to assess the safety and outcomes of laparoscopic bariatric surgery as a treatment option in controversial patient population.

Laparoscopic sleeve gastrectomy (LSG) is becoming a common and viable option in the management of morbid obesity. The aim of this study was to examine the effectiveness and safety of LSG as a primary step to a second non-bariatric procedure.