Conventional laparoscopic Roux-en-Y gastric bypass (LRYGB) is a gold standard for bariatric surge... more Conventional laparoscopic Roux-en-Y gastric bypass (LRYGB) is a gold standard for bariatric surgery, but the procedure requires five to seven incisions for placement of multiple trocars and thus may produce lessthan-ideal cosmetic results. We have developed a new approach, single-incision transumbilical LRYGB (SITU-LRYGB) to treat morbid obesity. We compared the surgical results and patient satisfaction in a study of five-port LRYGB and SITU-LRYGB. Fifty morbidly obese patients (14 males, 36 females) underwent either Roux-en-Y gastric bypass with five-port LRYGB or the SITU-LRYGB approach. During the operation, we used a novel intraoperative liver traction method with a "liver suspension tape" that we specifically designed for SITU-LRYGB. Compared to five-port surgery with SITU-LRYGB, there were no intraoperative complications, wound healing was excellent, and there was no abdominal scarring. SITU surgical time was longer than that with five-port LRYGB (99.8 vs. 67.6 min, P<0.001). Patients treated with the fiveport method were more obese than those in the SITU group (127.9 vs. 112.4 kg, P=0.016). After the bariatric surgery, no difference in comorbidity was found in both groups. Patient satisfaction was greater with SITU than with the five-port method (4.48 vs. 3.96, P=0.006). Roux-en-Y gastric bypass can be successfully achieved via a single umbilical incision, a method that provides a short operative time and good recovery and eliminates abdominal scarring.
Background Laparoscopic Roux-en-Y gastric bypass (LRYGB) can dramatically ameliorate type 2 diabe... more Background Laparoscopic Roux-en-Y gastric bypass (LRYGB) can dramatically ameliorate type 2 diabetes mellitus (T2DM) in morbidly obese patients. However, there is little evidence supporting the effectiveness of LRYGB in low body mass index (BMI) patients. The study was designed to evaluate the safety and results of LRYGB for achieving T2DM remission in patients with BMI in the range of 25-35 kg/m 2. Methods Twenty-two patients (two men and 20 women) with T2DM underwent LRYGB. Data on patient demographics, BMI, co-morbidities, and details of diabetes mellitus, including disease duration, family history, medication use, and remission, were prospectively collected and analyzed. Results The mean age was 47 years (range, 28-63 years), mean BMI was 30.81 (range, 25.00-34.80 kg/m 2), and mean duration of T2DM onset was 6.57 years (range, 1-20 years). Sixteen (72.27%) patients had a family history of T2DM. There was no mortality, but two (9%) patients experienced complications: an early gastrojejunostomy hemorrhage and frequent loose stools that required revision surgery. At 12 months, 14 (63.6%) patients showed T2DM remission, six (27.3%) showed glycemic control, and two (9.1%) showed improvement. The group achieving remission had a higher BMI (p=0.001), younger age (p=0.002), and shorter duration of diabetes (p=0.001). These three factors may be predictors of diabetes resolution at 12 months. Conclusion Early intervention in low-BMI patients yields better remission rates because age, BMI, and duration of T2DM predict glycemic outcomes.
Background Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgical (MBS) proc... more Background Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgical (MBS) procedure worldwide. Despite the desired effect of SG on weight loss and remission of obesity-associated medical problems, there are some concerns regarding the need to do revisional/conversional surgeries after SG. This study aims to make an algorithmic clinical approach based on an expert-modified Delphi consensus regarding redo-surgeries after SG, to give bariatric and metabolic surgeons a guideline that might help for the best clinical decision. Methods Forty-six recognized bariatric and metabolic surgeons from 25 different countries participated in this Delphi consensus study in two rounds to develop a consensus on redo-surgeries after SG. An agreement/disagreement ≥ 70.0% on statements was considered to indicate a consensus. Results Consensus was reached for 62 of 72 statements and experts did not achieve consensus on 10 statements after two rounds of online voting. Most of the experts believed that multidisciplinary team evaluation should be done in all redoprocedures after SG and there should be at least 12 months of medical and supportive management before performing redo-surgeries after SG for insufficient weight loss, weight regain, and gastroesophageal reflux disease (GERD). Also, experts agreed that in case of symptomatic GERD in the presence of adequate weight loss, medical treatment for at least 1 to 2 years is an acceptable option and agreed that Roux-en Y gastric bypass is an appropriate option in this situation. There was disagreement consensus on efficacy of omentopexy in rotation and efficacy of fundoplication in the presence of a dilated fundus and GERD. Conclusion Redo-surgeries after SG is still an important issue among bariatric and metabolic surgeons. The proper time and procedure selection for redo-surgery need careful considerations. Although multidisciplinary team evaluation plays a key role to evaluate best options in these situations, an algorithmic clinical approach based on the expert's consensus as a guideline can help for the best clinical decision-making.
Adherence to Psychiatric Follow-up Predicts 1-Year BMI Loss in Gastric Bypass Surgery Patients
Obesity Surgery, 2015
The objective of this study was to investigate the effects of adherence to postoperative recommen... more The objective of this study was to investigate the effects of adherence to postoperative recommended psychiatric follow-up on weight loss in morbid obesity patients with psychiatric disorders 1 year after gastric bypass. Three hundred eighteen morbidly obese patients were retrospectively reviewed. They were divided into four groups according to preoperative psychiatric evaluations and adherence to psychiatric follow-up 1 year after their bypass surgery. The first group included patients who did not meet the referral criteria (NMRC). The second group consisted of patients who did not meet the psychiatric diagnostic criteria (NMDC). The third group was patients who met criteria for a psychiatric disorder and were nonadherent (NA) to psychiatric follow-up. The fourth group consisted of patients who met criteria for a psychiatric disorder and were adherent (A) to psychiatric follow-up. The A group exhibited higher % change in BMI than the NA and NMRC groups at 1 year after bypass surgery. Regression analyses to examine the effects of the grouping variable on % change in BMI were performed by controlling the effects of age, gender, educational level, and preoperative BMI. The regression coefficient for the grouping variable was 0.175 (p = .003) at the 6-month and 0.133 (p = .027) at the 1-year % change in BMI. Our preliminary data suggest that adherence to postoperative psychiatric follow-up is associated with greater postoperative weight loss. However, evidence from studies with a longer follow-up is required to justify this therapeutic approach.
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
Ethnic differences exist in the function and distribution of adipose tissue, which influences who... more Ethnic differences exist in the function and distribution of adipose tissue, which influences whole body metabolism, including pulmonary function. The object of this study was to examine the relationships between serum metabolic parameters and pulmonary function in a morbidly obese Asia-Pacific population. One-hundred thirty-seven morbidly obese Chinese patients, aged≥18 years with a body mass index (BMI)>32 kg/m(2) who were being evaluated for bariatric surgery between July 2007 and December 2008, were studied. Cross-sectional associations between serum metabolic parameters, including lipids, glucose, insulin, leptin, and adiponectin levels with forced vital capacity (FVC) and forced expiratory volume in the first second (FEV₁) assessed by spirometry, were analyzed. Multiple regression analyses also were conducted, with age, gender, smoking history, and various anthropometric measurements of obesity as confounders. Serum adiponectin and HDL cholesterol had a positive correlation...
Background: The laparoscopic adjustable gastric band has been widely accepted as 1 of the safest ... more Background: The laparoscopic adjustable gastric band has been widely accepted as 1 of the safest bariatric procedures to treat morbid obesity. However, because of variations in the results and the complications that tend to arise from port adjustment, alternative procedures are needed. We have demonstrated, in a university hospital setting, the safety and feasibility of a novel technique, laparoscopic adjustable gastric banded plication, designed to improve the weight loss effect and decrease gastric band adjustment frequency. Methods: We enrolled 26 patients from May 2009 to August 2010. Laparoscopic adjustable gastric banded plication was performed using 5-port surgery. We placed Swedish bands using the pars flaccida method, divided the greater omentum, and performed gastric plication below the band to 3 cm from the pylorus using a single-row continuous suture. The data were collected and analyzed pre-and postoperatively. Results: The mean operative time was 87.3 minutes without any intraoperative complications. The average postoperative hospitalization was 1.33 days. The mean excess weight loss at 1, 3, 6, 9, and 12 months after surgery was 21.9%, 31.9%, 41.3%, 55.2%, and 59.5%, respectively. The mean follow-up time was 8.1 months (range 2-15), and the gastric band adjustment rate was 1.1 times per patient during this period. Two complications developed: gastrogastric intussusception and tube kinking at the subcutaneous layer. Both cases were corrected by reoperation. No mortality was observed. Conclusion: Laparoscopic adjustable gastric banded plication provides both restrictive and reductive effects and is reversible. The technique is safe, feasible, and reproducible and can be used as an alternative bariatric procedure. Comparative studies and long-term follow-up are necessary to confirm our findings. (Surg Obes Relat Dis 2012;8:41-47.
Laparoscopic adjustable gastric banding (LAGB) has been widely accepted as weight loss surgery fo... more Laparoscopic adjustable gastric banding (LAGB) has been widely accepted as weight loss surgery for treating morbid obesity. However, combating stagnant weight loss after achieving Ͼ50% excess weight loss (EWL) is a tedious problem. We describe the case of a patient who was successfully treated with laparoscopic gastric plication after his weight had plateaued following LAGB. The patient was able to lose an additional 14 kg during the 4 months after gastric plication.
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2013
A total of 22 (14F/8M) patients with a mean age of 50.3 years (range, 33 to 64 y) and a mean body... more A total of 22 (14F/8M) patients with a mean age of 50.3 years (range, 33 to 64 y) and a mean body mass index of 28.4 kg/m 2 (range, 21.8 to 38.3 kg/m 2) underwent loop duodenojejunal bypass with sleeve gastrectomy from October 2011 to March 2012. The mean duration of onset of type 2 diabetes mellitus was 8 years (range, 1 to 20 y). All patients were on oral hypoglycemic agents; 3 (14%) patients were also using insulin. The mean preoperative glycosylated hemoglobin (HbA1c), fasting plasma sugar, and C-peptide levels dropped from 8.6% (range, 7% to 13.2%), 147 mg/dL (range, 108 to 241 mg/dL), and 2.4 ng/mL (range, 0.7 to 4.1 ng/mL) to 6.2% (range, 5.1% to 9.1%), 110 mg/dL (range, 72 to 234 mg/dL), and 1.3 ng/mL (range, 0.6 to 2.8 ng/mL) at 6 months, respectively. At 6 months, 11 (50%) patients showed type 2 diabetes mellitus remission (HbA1c < 6.0%), and 20 (91%) patients achieved HbA1c < 7.0% without medicine. There were no intraoperative or early postoperative complications. Loop duodenojejunal bypass with sleeve gastrectomy is safe, feasible, and shows good efficacy in terms of glycemic control in this preliminary report with short follow-up.
Background: The beneficial role of laparoscopic Roux-en-Y gastric bypass (LRYGB) for type 2 diabe... more Background: The beneficial role of laparoscopic Roux-en-Y gastric bypass (LRYGB) for type 2 diabetes mellitus (T2 DM) in morbidly obese patients has been established; however, there is scant evidence supporting its effectiveness in nonobese T2 DM Asian patients. The objective of this study was to evaluate the effect of LRYGB in nonobese T2 DM patients and elucidate the predictors of DM remission after one year follow-up. Methods: Between June 2009 and May 2011, twenty-nine nonobese (body mass index (BMI) o27 kg/m 2) Asian patients with T2 DM who underwent LRYGB were enrolled. All patients were prospectively followed up for one year. Baseline demographic characteristics, diabetic status, and clinical and biochemical data were collected preoperatively and one year after LRYGB. DM remission was defined as those with hemoglobin A1 c (HbA1 c) o6.5% without oral hypoglycemic drugs (OHA)/insulin. Outcomes in the DM remission group were compared with the nonremission group and analyzed. Results: All clinical and biochemical parameters, except uric acid, were significantly improved. DM remission was achieved in eleven patients (37.9%) of whom five (45.5%) were male. Blood glucose, HbA1 c, c-peptide, homeostatic model assessment (HOMA-%B), and low density lipoprotein (LDL) Q4-cholesterol were the significant variables in patients with DM remission; however, multiple logistic regression showed that only preoperative HOMA-%B (odds ratio (OR) ¼ 1.13, 95% CI ¼ 1.03-1.24) was a predictor for DM remission. Though no mortality was seen, the complication rate was 20.7%, of which 17.3% was related to marginal ulcers. Conclusion: LRYGB resulted in significant clinical and biochemical improvements in nonobese Asian patients, with HOMA-%B indicating β-cell function as the main predictor of T2 DM remission. Appropriate patient selection with better β-cell function and evidence from long-term follow-up may justify this therapeutic approach.
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is widely accepted as a valid surgery in the treatm... more Laparoscopic Roux-en-Y gastric bypass (LRYGB) is widely accepted as a valid surgery in the treatment of morbid obesity [1] and is known to cause remission of type 2 diabetes mellitus (T2DM), although the exact mechanism of T2DM remission remains unclear. Different lengths of the bypassed limbs in LRYGB have been proposed by surgeons [2], but no study has reported on the relationship of the length of the bypassed limbs and T2DM resolution. We describe an interesting case of T2DM remission after LRYGB, T2DM recurrence, and, finally, T2DM remission again after surgical adjustment of the length of the bypassed limbs. This case report demonstrates the importance of technical awareness when performing LRYGB for the treatment of T2DM.
Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been shown to improve both the heal... more Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been shown to improve both the health and the quality of life of morbidly obese patients. We compared the efficacy and safety of using a team approach to LRYGB versus an individual surgeon at a medical center. Methods: Data were collected from 200 consecutive patients undergoing LRYGB for morbid obesity from August 2005 to February 2008. Groups 1 and 2 included 50 patients each who underwent surgery and were cared for by the same surgeon. Group 3 included the next 100 consecutive patients, who underwent LRYGB by the same surgeon but who were cared for by a dedicated bariatric team. Results: For the 76 men (38%) and 124 women (62%) in the study, the excess weight loss at 1 and 3 months of follow-up did not differ; however, it was significantly different at 6 and 12 months. At the mean follow-up period, 30% of group 1, 6% of group 2, and 8% of group 3 had experienced complications. Most complications in group 1 occurred early and were related to the surgical technique; however, in groups 2 and 3, the complications related to the technique were markedly reduced. Men were 4.57 times as likely as women to experience complications related to bariatric surgery. Conclusion: A team-based approach is a better option for patients undergoing LRYGB than care by a single surgeon. With an experienced bariatric surgeon, the team approach resulted in shorter operative times and shorter hospital stays, with the same rate of complications.
Background: Conventional laparoscopic Roux-en-Y gastric bypass (LRYGB) has been the reference sta... more Background: Conventional laparoscopic Roux-en-Y gastric bypass (LRYGB) has been the reference standard for bariatric surgery but requires 5-7 trocar incisions. We have developed a new procedure-single-incision transumbilical LRYGB (SITU-LRYGB)-that results in minimal scarring and is more cosmetically acceptable. To compare the surgical results and patient satisfaction between 5-port LRYGB and the novel SITU-LRYGB at a university hospital. Methods: We performed 5-port or SITU-LRYGB on 140 morbidly obese patients; the patients chose the operation method. We used a novel liver traction method and omega-umbilicoplasty specifically designed for SITU-LRYGB. Results: Before surgery, the patients in the 5-port surgery group were more obese than those in the SITU group (120.8 kg versus 108.9 kg, P ϭ .013). The rate of hypertension was also greater in the former group. The operative time was longer for SITU-LRYGB (101.1 versus 81.1 min, P ϭ .001) without increased intraoperative complications. The total morphine dose for the SITU group seemed to be greater but the difference was not statistically significant. No difference in complications was observed. Postoperatively, the percentage of excess body weight lost the SITU and 5-port surgery groups was 21.2% and 20.9%, 40.4% and 39.4%, 55.0% and 55.2%, 64.8% and 75.2%, and 75.4% and 78.2% at 1, 3, 6, 9, and 12 months, respectively. The SITU-LRYGB patients reported greater satisfaction related to scarring than those who had undergone 5-port surgery (score 4.57 versus 3.96, respectively, P ϭ .005). No patient died. Conclusion: Compared with conventional LRYGB, SITU-LRYGB resulted in acceptable complications, the same recovery, comparative weight loss, and better patient satisfaction related to scarring.
Background Obesity is a risk factor for nonalcoholic fatty liver disease (NAFLD), which appears t... more Background Obesity is a risk factor for nonalcoholic fatty liver disease (NAFLD), which appears to improve after weight loss induced by bariatric surgery in Western countries. The present study aims to determine the alterations of clinical measurements and liver histology of NAFLD after bariatric surgery in morbidly obese Chinese patients. Methods Between November 2006 and December 2007, 21 morbidly obese patients receiving intra-operative liver biopsy and follow-up liver biopsy 1 year after laparoscopic Roux-en-Y gastric bypass were enrolled. NAFLD activity score (NAS) and fibrosis stage were histologically evaluated. Results The mean body mass index fell from 43.8±7.5 to 28.3±4.6 kg/m 2 (P<0.01). Biochemical improvement was found in serum levels of alanine aminotransferase (P<0.01) and γ-glutamyltransferase (P<0.01), but not aspartate aminotransferase (P00.66). Histological improvement was noted in NAS (P<0.01) and individual components, including steatosis (P<0.01), ballooning degeneration (P<0.01), and lobular inflammation (P00.02). Pre-operatively, 4 (19.0%), 11 (52.4%), and 6 (28.6%) patients were found to have NAS ≧5, 3 or 4, and ≦2, respectively. All patients had NAS ≦2 after surgery. Fibrosis stage also showed significant improvement (P<0.01). Conclusions Bariatric surgery can achieve a dramatic improvement of NAFLD both biochemically and histologically in morbidly obese Chinese patients.
Laparoscopic sleeve gastrectomy (LSG) has been accepted as stand-alone restrictive bariatric proc... more Laparoscopic sleeve gastrectomy (LSG) has been accepted as stand-alone restrictive bariatric procedure; laparoscopic adjustable gastric banded plication (LAGBP) is an innovative technique combining gastric banding and plication of the stomach. This study aims to compare LAGBP with LSG in terms of percent excess weight loss (%EWL), resolution of comorbidities, and complications. This study was conducted in a university hospital. We retrospectively analyzed data of 60 patients: 30 each receiving LSG and LAGBP between May 2009 to October 2010. Demographics, operative data, complications, % EWL, and resolution of comorbidities were analyzed and compared. All the patients were followed for at least 1 year. LSG and LAGBP were matched for age, sex, body mass index and comorbidity ratio. Mean operative time was significantly longer in LAGBP: 62.45± 30.1 vs. 86.01± 21.88 (p =0.001). Both groups had similar complication rates (6.67 %) and most of the patients achieved significant resolution of comorbidities. The mean %EWL was statistically significant for LSG till 18 months follow-up as compared to LAGBP, but there was no difference at 2 years (p=0.971). Mean frequency of band adjustment after LAGBP in 2 years was 1.50±1.51. There was no significant difference in comorbidity resolution in both groups. LAGBP is a dual restrictive bariatric procedure offering similar results with LSG at 2 years in terms of complications, % EWL, and comorbidity resolution with potential of continual weight loss due to band.
Uploads
Papers by Chih-kun Huang