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Background: Roux-en-Y gastric by-pass (RYGB) is one of the most effective bariatric procedures, but the rate of weight regain (WR) can reach 63% after the second year. Enlargement of the gastrojejunal anastomosis is one of the reported causes. A newly CE-marked flexible endoscopic system, Bariatric Anastomotic Reduction System (BARS) (Ovesco Endoscopy, Tuebingen, Germany), derivative of the well-established endoscopic over-the-scope-clip (OTSC) clipping system, has been recently developed. It was tested in pre-clinical and preliminary clinical use for feasibility and effectiveness in bariatric anastomotic reduction., Material and Methods: Using a single-channel endoscope with external supplemental working channel, the BARS device captures the two limbs of the anastomosis, reducing its size, thus slowing food passage. After preclinical assessment, six patients with at least a 15% WR and the presence of an enlarged gastrojejunostomy > 20 mm were enrolled. The mean patient age was 49 years (range 24-67). Average interval between gastric bypass and BARS procedure: 8 years (4-13)., Results: All procedures were safely performed without complications. Mean procedure time: 52 min (37 - 75). Preliminary results: mean weight loss 6 kg (4-9) at a 3-month FU., Conclusions: BARS could be a promising endoscopic system in case of WR after gastric bypass due to enlargement of the anastomosis.

Background: The prevalence of obesity is increasing worldwide and has lately reached epidemic proportions in western countries. Several epidemiological studies have consistently shown that both overweight and obesity are important risk factors for the development of various functional defaecatory disorders (DDs), including faecal incontinence and constipation. However, data on their prevalence as well as effectiveness of bariatric surgery on their correction are scant. The primary objective of this study was to estimate the effect of morbid obesity on DDs in a cohort of patients listed for bariatric surgery. We also evaluated preliminary results of the effects of sleeve gastrectomy on these disorders., Patients and Methods: A questionnaire-based study was proposed to morbidly obese patients having bariatric surgery. Data included demographics, past medical, surgical and obstetrics histories, as well as obesity related co-morbidities. Wexner Constipation Score (WCS) and the Faecal Incontinence Severity Index (FISI) questionnaires were used to evaluate constipation and incontinence. For the purpose of this study, we considered clinically relevant a WCS ≥5 and a FISI score ≥10. The same questionnaires were completed at 3 and 6 months follow-up after surgery., Results: A total of 139 patients accepted the study and 68 underwent sleeve gastrectomy and fully satisfied our inclusion criteria with a minimum follow-up of 6 months. Overall, mean body mass index (BMI) at listing was 47 ± 7 kg/m(2) (range 35-67 kg/m(2)). Mean WCS was 4.1 ± 4 (range 0-17), while mean FISI score (expressed as mean±standard deviation) was 9.5 ± 9 (range 0-38). Overall, 58.9% of the patients reported DDs according to the above-mentioned scores. Twenty-eight patients (20%) had WCS ≥5. Thirty-five patients (25%) had a FISI ≥10 while 19 patients (13.7%) reported combined abnormal scores. Overall, DDs were more evident with the increase of obesity grade: Mean BMI decreased significantly from 47 ± 7 to 36 ± 6 and to 29 ± 4 kg/m(2) respectively at 3 and 6 months after surgery (p < 0.0001). According to the BMI decrease, the mean WCS decreased from 3.7 ± 3 to 3.1 ± 4 and to 1.6 ± 3 respectively at 3 and 6 months (p = 0.02). Similarly, the FISI score decreased from 10 ± 8 to 3 ± 4 and to 1 ± 2 respectively at 3 and 6 months (p = 0.0001)., Conclusions: Defaecatory disorders are common in morbidly obese patients. The risk of DDs increases with BMI. Bariatric surgery reduces DDs, mainly faecal incontinence, and these findings correlated with BMI reduction.

Background: Laparoscopic sleeve gastrectomy has been recently proposed as a sole bariatric procedure because of the resulting considerable weight loss in morbidly obese patients. Traditionally, laparoscopic sleeve gastrectomy requires 5-6 skin incisions to allow for placement of multiple trocars. With the introduction of single-incision laparoscopic surgery, multiple abdominal procedures have been performed using a sole umbilical incision, with good cosmetic outcomes. The purpose of our study was to evaluate the feasibility and safety of laparoscopic single incision sleeve gastrectomy for morbid obesity., Methods: A total of 8 consecutive patients underwent laparoscopic single-incision sleeve gastrectomy at the Operative Unit of Bariatric Surgery of the University of Rome Tor Vergata from March 2009 to June 2009., Results: Of the 8 patients, 5 were women and 3 were men, with a mean age of 44.4 years. The mean preoperative body mass index was 56.2 kg/m(2). The mean operative time was 128 minutes. The mean postoperative stay was 2.4 days. The mean postoperative body mass index was 49.3 kg/m(2) at a mean follow-up period of 3.6 months. The mean percentage of excess weight loss was 33% for the same period., Conclusions: Laparoscopic single-incision sleeve gastrectomy seems to be safe, technically feasible, and reproducible. A randomized trial comparing single-incision sleeve gastrectomy and conventional sleeve gastrectomy might be needed to evaluate the postoperative results in relation to the development of abdominal wall complications., (Copyright © 2010 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Aim: Retrospective multicenter analysis of the results of two different approaches for band positioning: perigastric and pars flaccida., Methods: Data were collected from the database of the Italian Group for LapBand (GILB). Patients operated from January 2001 to December 2004 were selected according to criteria of case-control studies to compare two different band positioning techniques: perigastric (PG group) and pars flaccida (PF group). Demographics, laparotomic conversion, postoperative complications, and weight loss parameters were considered. Data are expressed as mean +/- standard deviation., Results: 2,549 patients underwent the LapBand System procedure [age: 40 +/- 11.7 years; sex: 2,130 female, 419 male; body mass index (BMI): 46.4 +/- 6.9 kg/m(2); excess weight (EW): 60.1 +/- 23.6 kg; %EW: 90.1 +/- 32.4]. During this period 1,343/2,549 (52.7%) were operated via the pars flaccida (PF group) and 1,206/2,549 (47.3%) via the perigastric approach (PG group). Demographics for both groups were similar. Thirty-day mortality was absent in both groups. Operative time was significantly longer in the PG group (80 +/- 20 min versus 60 +/- 40 min; p < 0.05). Hospital stay was similar in the two groups (2 +/- 2 days). Laparotomic conversion was significantly higher in the PG group (6 versus 2 patients; p < 0.001). Overall postoperative complication rate was 172/2,549 (6.7%) and was linked to gastric pouch dilation/slippage (67/172), intragastric migration/erosion (17/172), and tube/port failure (88/172). Gastric pouch dilation and intragastric migration were significantly more frequent in the PG group: 47 versus 20 (p < 0.001) and 12 versus 5 (p < 0.001), respectively. Patients eligible for minimum 3-year follow-up were 1,118/1,206 (PG group) and 1,079/1,343 (PF group). Mean BMI was 33.8 +/- 12.1 kg/m(2) (PG group) and 32.4 +/- 11.7 kg/m(2) (PF group) (p = ns), and mean percentage excess weight loss (%EWL) was 47.2 +/- 25.4 and 48.9 +/- 13.2 in PG and PF groups, respectively (p = ns)., Conclusions: Significant improvement in LapBand System results with regard to laparotomic conversion and postoperative complication rate, with similar weight loss results, was observed in the pars flaccida group.

Liver transplantation is a life-saving procedure for end-stage liver disease. In liver transplant recipients, morbid obesity influences post-operative survival and graft function. In 1996, our patient underwent a successful liver transplantation because of a HCV-related liver failure (body mass index (BMI) 31). Follow-up showed a functional graft and the development of severe obesity up to a BMI of 61 in January 2006. In January 2007, he was submitted to intragastric balloon therapy for 6 months, reaching a BMI of 54. In September 2007, he underwent a biliopancreatic diversion. During follow-up to March 2008, he reached a BMI of 42 with ameliorations of comorbidities. In May 2008, during a hospital admission, he suddenly died of a heart attack. Post mortem study revealed a myocardial infarction. This is the first world case report for this approach. According to our opinion, patient's death was not related to bariatric surgery.

The aim of the study was to evaluate the laparoscopic approach to reoperative bariatric surgery. From January 2003 to July 2007, 26 obesity surgery patients were referred to our Institution for revision. Nineteen patients previously had an open gastric banding, 3 an open vertical banded gastroplasty, 2 an open jejunoileal by-pass (J-l BP) and 2 an open gastric by-pass. Indications for re-operation were insufficient weight loss in 14 patients, band slippage in 7, band erosion in 3 and severe malabsorptive syndrome in 2. Mean preoperative BMI was 45 kg/m2. Twenty-six laparoscopic re-operative procedures were performed. Three patients required a third operation. Eleven gastric banding patients underwent band removal, 7 gastric banding patients were converted to an open gastric by-pass, 1 band was removed and simultaneously re-placed, the 2 jejuno-ileal by-pass patients underwent an intestinal restoration, 3 vertical banded gastroplasty patients were converted to laparoscopic gastric by-pass, 1 open gastric by-pass patient was converted to a laparoscopic long-limb gastric by-pass and in 1 patient with a gastro-gastric fistula after open gastric by-pass the fistula was resected. Further procedures included 1 laparoscopic gastric banding, 1 laparoscopic gastric bypass and 1 laparoscopic bilio-pancreatic diversion. Conversion to laparotomy was needed in 5 cases (5/29, 17.2%). Early complications included 1 case of pneumothorax and 6 cases of wound infection (24.1%). Mortality was zero. The mean follow-up was 36.2 months. Mean postoperative BMI was 34.3 kg/m2. Laparoscopic reoperative bariatric surgery is feasible, safe and effective after open bariatric surgery.