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.

Roux-en-Y gastric bypass (RYGB) is the most commonly performed bariatric surgical procedure in the United States. Many of these patients will develop complications, experience inadequate weight loss, or weight regain. We describe our experience with patients undergoing laparoscopic revision of RYGB.

Improvement and resolution of type 2 diabetes occurs in the majority of patients that undergo Roux-en-Y gastric bypass. Some patients with severe obesity and Type I1 (T1DM) require increasing doses of insulin and are at risk for DM related complications. We describe our experience with patients with T1DM undergoing bariatric surgery and review the safety, efficacy, results, and outcomes.

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is 1 of the most common procedures performed for severe obesity. Complications are not uncommon, and the evaluation for symptoms of abdominal pain and dysphagia can be difficult. Extensive evaluation can require upper gastrointestinal (GI) radiologic series, endoscopy, and abdominal computed tomography to help in the diagnosis. Some of these patients could require revisional procedures to alleviate their symptoms. We present a video case report of a patient with chronic abdominal pain, dysphagia, and vomiting due to a hiatal hernia, bile reflux, and a poorly emptying pouch. The video demonstrates the laparoscopic revision of the gastric pouch and gastrojejunal anastomosis, revision of the Roux limb, hiatal hernia repair, and gastrostomy tube placement.

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.

BACKGROUND:Obesity is a risk factor for cancer and is associated with increased mortality from a number of malignancies. We describe our experience with bariatric surgery patients with a history of malignancy and review the safety and outcomes of bariatric surgery in patients with a history of cancer.METHODS:We performed a retrospective review of prospectively collected data from all patients diagnosed with a malignancy before, during, or after bariatric surgery. Data on weight loss, co-morbidities, and recurrence were collected.RESULTS:From July 1999 to February 2008, 1566 patients underwent bariatric surgery. Of these 1566 patients, 36 (2.3%) had a history of malignancy before they underwent bariatric evaluation and surgery, 4 (0.26%) were diagnosed with a malignancy during their preoperative evaluation, 2 of whom subsequently underwent bariatric surgery, and 2 had intraoperative findings suspicious for malignancy; bariatric surgery was completed in both cases. The evaluation revealed renal cell carcinoma and low-grade lymphoma, respectively. No procedures were aborted because of a suspicion of malignancy. Postoperatively, 16 patients (0.9%) were diagnosed with cancer, 3 of whom had a history of malignancy: 1 with metastatic renal cell, 1 with recurrent melanoma, and 1, who had had prostate cancer, with bladder cancer.CONCLUSION:A history of malignancy does not appear to be a contraindication for bariatric surgery as long as the life expectancy is reasonable. Screening for bariatric surgery might reveal the malignancy. Bariatric surgery does not seem to have a negative effect on the treatment of malignancies that are discovered in the postoperative period.

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.

Patients undergoing bariatric surgery while on anticoagulation are considered high risk. We describe our experience with bariatric surgery on patients on active anticoagulation.

Obesity is associated with increased mortality from a variety of malignant diseases. We describe our experience with bariatric surgery and malignant diseases.

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.

Background Previous studies have reported a high prevalence of Helicobacter pylori infection in patients undergoing Roux-en-Y gastric bypass (RYGB) and a greater incidence of anastomotic ulcer in patients positive for H. pylori, leading to recommendations for routine preoperative screening. Our hypotheses were that the prevalence of H. pylori in patients undergoing RYGB is similar to that of the general population and that preoperative H. pylori testing and treatment does not decrease the incidence of anastomotic ulcer or pouch gastritis. Methods A retrospective analysis of H. pylori serology, preoperative and postoperative endoscopy findings, and the development of anastomotic ulcer or erosive pouch gastritis was performed. All patients positive for H. pylori received treatment. Univariate parametric and nonparametric statistical tests, as well as multiple logistic regression analyses, were performed. Results A total of 422 LRYGB patients were included in the study. Of these patients, 259 (61.4%) were tested for H. pylori and 163 (38.6%) were not. Of the 259 patients, 58 (22.4%) tested positive for H. pylori, 197 (76.1%) tested negative, and 4 (1.5%) had an equivocal result. Postoperatively, 53 patients (12.6%) underwent upper endoscopy. Of these 53 patients, 19 (4.5%) had positive endoscopy findings for anastomotic ulcer (n = 16) or erosive pouch gastritis (n = 3). Five patients underwent biopsy at endoscopy; all biopsies were negative for H. pylori. No difference was found in the rate of positive endoscopy between patients tested preoperatively for H. pylori (5%) and patients not tested (3.7%). Conclusion The results of our study have shown that the prevalence of H. pylori infection in patients undergoing RYGB is similar to that of the general population. Our study has shown that H. pylori testing does not lower the risk of anastomotic ulcer or pouch gastritis.