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Background: Obesity is a well-known risk factor for gastroesophageal reflux disease (GERD). Even though symptoms may be mitigated or resolved with the weight loss caused by sleeve gastrectomy (SG), it may be associated with higher incidences of postoperative GERD. Ligamentum teres cardiopexy (LTC) is an alternative to Roux-en-Y gastric bypass, the gold standard treatment for GERD. Methods: This study was a retrospective single-center chart review, all patients in this cohort underwent LTC to treat refractory GERD at our institution. The option for LTC was presented after patients' refusal to undergo RYGB conversion. We collected baseline characteristics, standard demographics, pre-operative tests and imaging, and SG information, as well as intraoperative and perioperative data regarding LTC, and postoperative complications. Results: Our cohort included 29 patients; most were Caucasian (44.8%) females (86.2%). The mean weight and BMI before LTC were 216.5 ± 39.3 lb and 36.1 ± 5.4 kg/m2, respectively. Mean total body-weight loss (TBWL) at 12 and 24 months were 28.7% ± 9.5% and 28.4% ± 12.4%, respectively. The mean interval between the index bariatric surgery and LTC was 59.9 ± 34.9 months, mean operative time was 67 ± 18.2 min, and median length of stay (LOS) was 1 day (IQR = 1–2 days). Twelve patients (57.1%) were able to discontinue antisecretory medications, while 9 (42.9%) still required them to remain asymptomatic. Mortality and reoperation rates were 0% and the incidence of complication was 19.4% (n = 6). Conclusions: LTC is a safe and effective surgical alternative to treat refractory GERD symptoms after SG. [ABSTRACT FROM AUTHOR]

Introduction: Totally robotic-assisted biliopancreatic diversion with duodenal switch (BPD/DS) learning curve has been described to be longer at approximately 50 cases, at which point operative time and complications rate decrease and tend to stabilize. This study aimed to form an analysis of the impact of the learning curve on the safety outcomes of the totally robotic-assisted BPD/DS. Methods: A retrospective review of patients who underwent primary totally robotic-assisted BPD/DS by one of our certified bariatric and metabolic surgeon member of our institution was performed. The patients were classified into two groups, the learning stage group (first 50 cases) and the mastery stage group. Differences in operative time in minutes and postoperative outcomes were analyzed. Results: Two hundred seventy-six patients were included. The operative time and the postoperative length of stay were significantly higher in the learning stage group (173.8 ± 35.8 min vs. 139.2 ± 30.2 min, p= 0.0001; 3.4 ± 1.4 days vs. 2.6 ± 0.9 days, p= 0.0002). The overall leakage rate was significantly higher in the learning stage group (8% vs. 0.4%, p= 0.0001). The global rate of complications for the learning stage group was 14%, and for the mastery stage group was 6.6% (p= 0.08). Conclusions: After the first 50 cases, the operative time, the length of stay, and the overall rate of complications decreased, being especially significant the decrease in the duodeno-ileal anastomosis leakage rate after reaching the learning curve. [ABSTRACT FROM AUTHOR]

Background: With the increase in popularity of laparoscopic sleeve gastrectomy (LSG), the number of patients experiencing weight regain has increased as well. This study aims to demonstrate the outcomes of LSG conversions to Roux-en-Y gastric bypass (RYGB), double anastomosis duodenal switch (DS), and single anastomosis duodeno-ileal sleeve (SADI-S) due to weight regain.Methods: A retrospective chart review was performed on 21 patients who underwent a conversion of LSG due to weight regain between March 1, 2013, and April 30, 2017. A longitudinal analysis was performed for the body mass index (BMI) measures, using multilevel model for change.Results: Of 21 patients, 6 underwent a conversion to RYGB, 9 underwent a conversion to SADI-S, and 6 underwent a conversion to double anastomosis DS. Mean percentage of total weight loss was 16.0% at 6 months, 20.1% at 12 months, 18.8% at 24 months, and 21.8% at 36 months after the procedure. The final model suggests that preoperative BMI is the most significant indicator for initial status and the rate of change in BMI. Adjusting for preoperative BMI, type of procedure significantly affected the rate of change in BMI. The rate of decrease was fastest in RYGB patients, adjusting for preoperative BMI. One patient was readmitted 26 days after the conversion for pulmonary embolism and intraabdominal hematoma, and no patient required a reoperation within 30 days after the conversion.Conclusion: Conversions of LSG to RYGB, double anastomosis DS, and SADI-S are safe and can provide significant additional weight loss. [ABSTRACT FROM AUTHOR]

Background: Single-anastomosis duodenal switch (DS) was introduced by Sanchez-Pernaute et al. as a modification of the biliopancreatic diversion with duodenal switch. We have published preliminary results of the loop DS as the first report of the procedure in the USA. This study aims to evaluate the loop DS procedures again, in terms of weight loss, comorbidity resolution, complication rate, and address the nutritional concerns.Methods: A retrospective chart review was performed on initial 128 patients who underwent laparoscopic or robot-assisted laparoscopic single-stage loop DS between December 17, 2013 and September 23, 2016. Sixteen additional patients were prospectively enrolled from September 24, 2016 to May 4, 2017.Results: A total of 102 female and 38 male patients were included in this study with a mean age of 41.2 ± 9.6 years. The mean body mass index (BMI) at the time of procedure was 57.3 ± 9.2 kg/m2. Percentage of total weight loss was 23.1, 37.1, 42.9, and 44.7% at 6, 12, 18, and 24 months, respectively. Percentage of excess BMI loss was 41.9, 68.1, 76.6, and 80.8% at 6, 12, 18, and 24 months, respectively. Mean levels of HbA1c, triglyceride, and LDL-cholesterol decreased significantly after the loop DS. Regarding the fat-soluble vitamins, majority of patients had vitamin A and E levels in the normal range. However, 42 to 56% of the patients had low levels of vitamin D at 6, 12, and 24 months following the procedure. Mean length of hospital stay was 4.1 ± 2.7 days. Thirty-day readmission rate was 7.6% (n = 11), and 30-day reoperation rate was 6.9% (n = 10).Conclusions: Loop DS seems to be effective in weight loss and is a feasible operation in the super-obese population. However, close monitoring of liver enzymes is warranted in addition to nutritional follow-up. [ABSTRACT FROM AUTHOR]

Background: Variations have been proposed in order to improve weight loss and decrease complication profiles in Roux-en-Y gastric bypass (RYGB) patients. We previously reported a preliminary result of pericardial patch ring RYGB. We aim to report a detailed result of banded RYGB by comparing these patients to non-banded RYGB patients with larger case number and longer follow-up. Material and Methods: A retrospective chart review was performed in 543 banded RYGB and 607 non-banded RYGB patients who underwent laparoscopic RYGB between January 2009 and December 2014. Results: Thirty-day readmission rate was 3.1% ( n = 16) in the banded group and 3.8% ( n = 23) in the non-banded group. Thirty-day reoperation rate was 1.5% ( n = 8) in the banded group and 1.6% ( n = 10) in the non-banded group. Two mortalities occurred after a mesenteric venous thrombosis and an intracranial hemorrhage in the non-banded group. The differences in 30-day readmission and reoperation rates were not statistically significant between the two groups. Mean percentage of excess BMI loss (%EBMIL) dating from the time of RYGB was 53.1, 72.5, 76.5, 78.8, and 73.3% in the banded group, and 51.5, 73.5, 78.8, 79.0, and 74.8% in the non-banded group at 6, 12, 18, 24, and 36 months, respectively, adjusted for preoperative BMI. The differences in %EBMIL were not significant at any follow-up points between the two groups. Conclusions: Banded laparoscopic RYGB with a pericardial patch may not demonstrate a significant additional weight loss or prevent future weight regain. We were not able to demonstrate a clear advantage of banded RYGB over non-banded RYGB. [ABSTRACT FROM AUTHOR]

Background: Although effective, duodenal switch can be a complicated and time-consuming operation for surgeons. Purpose: The purpose of this article is to present our technique of biliopancreatic diversion and vertical sleeve gastrectomy, creating a 150-cm common channel and a 100-cm alimentary limb. Material and Methods: A robot-assisted technique was utilized in creating a biliopancreatic diversion and vertical sleeve gastrectomy. Results: Laparoscopy was used for marking stitches and then the robot was docked. After creating a window behind the duodenum, sleeve gastrectomy is performed followed by duodeno-ileal anastomosis and ileo-ileal anastomosis. Conclusion: With the adoption of robots and the described technique, it can be easier to be achieved in less time. [ABSTRACT FROM AUTHOR]

Background: Along with the development of technology, robotic approach is being performed for laparoscopic Roux-en-Y gastric bypass (LRYGB). Some literatures reported same or better peri-operative outcomes with the robotic procedure. The aim of this study is to compare our experience in robot-assisted LRYGB (RA-LRYGB) with LRYGB in terms of peri-operative outcomes. Methods: From January 1, 2012 to April 30, 2014, a total of 270 patients underwent LRYGB by one surgeon at a single institution. Of these, 64 cases were done robotically. A retrospective review was performed for these patients, noting the outcomes and complications of the procedure. Results: The 64 RA-LRYGB patients had a mean age of 45.9 ± 10.0 years (range, 23-67) and a mean preoperative body mass index (BMI) of 48.4 ± 7.9 kg/m (range, 33.8-76.4). The 207 LRYGB patients had a mean age of 45.0 ± 10.7 years (range, 21-67) and a mean preoperative BMI of 48.4 ± 8.1 kg/m (range, 34.0-80.4). These two groups were clinically comparable. Mean length of hospital stay was 3.0 ± 4.1 days (range, 1-19) in RA-LRYGB patients, significantly longer than 1.6 ± 1.7 days (range, 1-17) in LRYGB patients ( p < 0.01). Thirty-day readmission rate was 9.3 % ( n = 6) in the RA-LRYGB group and 6.8 % ( n = 14) in the LRYGB group. Higher leak rate was noticed in RA-LRYGB patients at 7.8 % ( n = 5), compared to 0.5 % ( n = 1) in LRYGB patients ( p < 0.01). All the leaks occurred at the pouch level in the RA-LRYGB group, while one leak from the LRYGB group occurred at the gastrojejunal anastomosis site. Conclusions: Robot-assisted Roux-en-Y gastric bypass may result in higher leak rate at the pouch level, when compared to that of laparoscopic procedures. [ABSTRACT FROM AUTHOR]

Background: As life expectancy increases, more elderly patients fit into the criteria for bariatric procedures. The aim of our study is to evaluate and compare the safety and efficacy of Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic adjustable gastric banding (LAGB) in patients older than 60. Material and Methods: Between January 2005 and December 2013, 68 LAGB, 73 LSG, and 212 RYGB patients were 60 years or older at the time of primary procedure. A retrospective review was performed in these patients. Results: Mean age and body mass index (BMI) was 62.7 ± 2.2, 64.1 ± 2.9, and 62.6 ± 2.3 years and 42.7 ± 5.6, 44.0 ± 7.0, and 45.2 ± 6.7 kg/m for LAGB, LSG, and RYGB at the time of procedure, respectively. Seven (10.3 %) patients from the LAGB, 3 (4.1 %) from the LSG, and 29 (13.8 %) from the RYGB group required readmissions. Reoperation rate was 10.3, 1.4, and 9.5 % in LAGB, LSG, and RYGB, respectively. The difference in reoperation rates was statistically significant ( p < 0.03) while that in readmission rates was not ( p > 0.58). Procedure-related mortality rate was 1.4 % in the RYGB group, while no mortality was observed in LSG and LAGB groups. At 6, 12, and 18 months postoperatively, mean percentage of excess weight loss were highest in the RYGB group, followed by LSG and LAGB group ( p < 0.01). Mean number of comorbidities at the last follow-up significantly decreased in LSG and RYGB patients. Conclusions: LSG showed the lowest readmission and reoperation rate, and RYGB patients had the highest mortality rate. Weight loss and comorbidity resolution were effectively achieved in RYGB and LSG patients. [ABSTRACT FROM AUTHOR]

Background: Bariatric surgery is becoming more appealing as an option in addressing adolescent obesity. Concerns that may be encountered status postbariatric surgery include complications and failure to lose weight. The aim of our study is to describe safety and effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients between the ages of 17 and 19. Methods: A retrospective chart review was completed on LRYGB patients between January 2005 and May 2012. Fifteen patients less than 20 years of age were included. One patient was lost to follow-up, and therefore, 14 patients under the age of 20 were matched to 14 patients greater than 20 years of age for gender ( p > 0.99), preoperative body mass index (BMI) ( p > 0.96), and follow-up interval ( p > 0.80). Results: Mean postoperative BMI at last follow-up did not show statistical difference between the two ( p > 0.74). Mean percentage of excess weight loss (%EWL) in patients under the age of 20 was 43.1 ± 14.6, 70.5 ± 17.0, 69.8 ± 17.3, and 54.8 ± 8.5 % at postoperative 6, 12, 24, and 36 months, respectively. In patients over the age of 20, mean %EWL was 39.9 ± 12.6, 67.0 ± 18.6, 60.2 ± 11.3, and 56.2 ± 6.2 %. Both group of patients showed improvement/remission of their comorbid conditions. No statistical difference was present between the two groups in terms of weight loss and comorbidity resolution. Each group had a single patient that required a revision for weight regain. Conclusion: LRYGB in younger patients almost the age of 20 is both safe and effective when compared to matched adults in regard to weight loss, comorbid condition, and complications. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic Roux-en-Y gastric bypass (RYGB) is an effective treatment for morbid obesity. Failure of weight loss has been reported in 10 to 30 % of RYGB patients. Silastic ring RYGB was introduced to minimize failure rate, however, with higher complication rate. The aim of our study is to evaluate the safety of utilizing pericardial patch as a ring on RYGB patients. Methods: Between March 2010 and June 2011, a total of 189 patients underwent pericardial patch ring RYGB at the Bariatric and Laparoscopy Center. A retrospective review of a prospectively collected database was performed for all pericardial patch ring RYGB patients, noting the outcomes and complications of the procedure. Results: Pericardial patch ring RYGB patients demonstrated a mean percentage of excess weight loss of 57.4 % at a mean follow-up of 11 months. Out of 164 patients with follow-up, five (3.0 %) patients required endoscopic balloon dilation due to dysphagia, abdominal pain, and/or gastric outlet obstruction. All patients did well after the procedure. Three (1.8 %) patients underwent diagnostic laparoscopy for abdominal pain. Of these patients, one (0.6 %) had dilated and enlarged blind limb, and two (1.2 %) patients had partial small bowel obstruction. No patient was readmitted or reoperated due to pericardial patch ring. Conclusions: Longer follow-up is needed to prove the true efficacy of this procedure in reducing weight gain. Pericardial patch ring RYGB seems to be a safe alternative for banded RYGB of other materials. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic Roux-en-Y gastric bypass (RYGB) is an effective treatment for morbid obesity. Current average length of hospital stay (LOS) after RYGB is 2-3 days and 30-day readmission rate is 8-13 %. The aim of our study is to evaluate the effect of routine gastrostomy tube placement in perioperative outcomes of RYGB patients. Methods: Between January 2008 and December 2010, a total of 840 patients underwent RYGB at our institution. All RYGB patients had gastrostomy tube placed, which was kept for 6 weeks. A retrospective review of a prospectively collected database was performed for all RYGB patients, noting the outcomes and complications of the procedure. Results: Average LOS in our patient population was 1.1 days (range, 1-14 days), and 824 (98.3 %) patients were discharged on postoperative day 1. Readmissions within 30 days after the index RYGB was observed in 31 (3.7 %) patients. Reasons included abdominal pain ( n = 14), nausea/vomiting ( n = 6), gastrostomy tube-related complications ( n = 5), chest pain ( n = 3), allergic reaction ( n = 1), urinary tract infection ( n = 1), and dehydration ( n = 1). Of these readmitted patients, nine (1.1 %) patients required reoperations due to small bowel obstruction ( n = 5), perforated anastomotic ulcer ( n = 1), anastomotic leak ( n = 1), subphrenic abscess ( n = 1), and appendicitis ( n = 1). Conclusions: Routine gastrostomy tube placement in the gastric remnant at the time of RYGB seems to have contributed to our short LOS and low 30-day readmission rate. [ABSTRACT FROM AUTHOR]