Search

Gall stone disease was known to increase after bariatric surgery. Ursodeoxycholic acid (UDCA) might reduce the gallstone formation rate after bariatric surgery. However, other option for gallstone prevention was unclear. We reported the result of a randomized trial comparing the gallstone prevention efficacy of probiotics and digestive enzyme versus UDCA.This prospective, randomized trial was held in an institute of Taiwan. Patients were eligible for inclusion if their body-mass index (BMI) was 32.5 kg/m2 or higher with the presence of comorbidity, or 27.5 kg/mw or higher with not-well controlled type 2 diabetes, and were aged 18-65 years. Participant were randomized assigned (1:1:1) to probiotic, digestive enzyme or UDCA. The primary endpoint was assessed in the incidence of gallstone disease at 6 months after surgery. This study is registered with ClinicalTrials.gov. number NCT03247101, and is now completed.From January 2016 to December 2018, of 186 patients screened for eligibility, 152 were randomly assigned to probiotic (52) or digestive enzyme (52) or UDCA (52). In the per-protocol population, mean age was 35.9 years (SD 10.6), mean BMI was 40.3 kg/mProbiotic is not inferior to UDCA regarding gall bladder disease prevention after bariatric surgery at 6 months.

One anastomosis gastric bypass (OAGB) is gradually accepted worldwide but still new in China.Retrospective review of the patients who received OAGB in a new bariatric/metabolic surgical center in China and compared the data with a center of excellence in Taiwan. All in-patient and outpatient follow-up data were analyzed. The main outcome measures were (1) operation risk (2) weight loss (3) diabetes remission.Between August 2019 and October 2021, 100 consecutive patients who received OAGB in situ in China and 225 patients who received OAGB with the same technique were recruited from Taiwan. Taiwan patients were older (39.2 ± 10.6 vs. 33.3 ± 8.8 years old, p 0.001), and to have more diabetes (32.4% vs. 20.0%, p = 0.022) comparing to the patients of China. Operation time was significantly longer for Taiwan patients (172.4 ± 36.9 vs. 128.5 ± 29.8, p 0.001). Taiwan patients lost more blood during the operation (35.5 ± 25.2 vs. 22.4 ± 15.6, p 0.001) but patients in China need more time to postoperative flatus passage (1.3 ± 0.5 vs. 2.0 ± 0.5, p 0.001). There was no major surgical complication in this study, minor complication rates were similar low for both groups (1.0% vs. 1.8%, p = 0.891). At 1 year after surgery, %TWL and %EWL of both centers were similar (33.9 ± 7.43% vs. 32.6 ± 11.2%, p = 0.91; 81.9 vs. 19.8 vs. 85.4 ± 13.2, p = 0.798). T2DM remission (HbA1c 6.5%) was 100% for patients of China and 95.9% for patients of Taiwan (p = 0.836).OAGB in situ is a safe and effective bariatric/metabolic surgery. With proper training and proctorship, these results are reproduceable in a new bariatric/metabolic surgical center in China.

Laparoscopic 1- (single-) anastomosis gastric bypass (OAGB) was developed as a simplified technique of Roux-en-Y gastric bypass (RYGB), but super long-term data are lacking.To evaluate the risks and long-term results of OAGB over a period of 20 years.Tertiary teaching hospital.A total of 2223 patients underwent OAGB from 2001 to 2020; the mean age was 35.3 ± 11.4 years (range, 14-71 yr), 70.2% were female, and the mean body mass index was 40.2 ± 11.9 kg/mThe means for operating time, intraoperative blood loss, and length of hospital stay after OAGB were 131.9 ± 40.1 minutes, 38.5 ± 30.7 mL, and 4.5 ± 4.0 days, respectively. There were 27 patients (1.2%) with 30-day postoperative major complications overall, but the group rate decreased to .4% in the last 5-year period. At postoperative years 5, 10, and 15, the percentages of total weight loss were 31.9%, 29.6%, and 29.5%, respectively, and the percentages of excess weight loss were 77.2%, 68.4%, and 65.5%, respectively. Among 739 patients (33.2%) with type 2 diabetes (T2D), the rates of complete remission (glycated hemoglobin60%) at 5, 10, and 15 years were 67.3%, 73.8%, and 66.7%, respectively. The weight loss and antimetabolic effects were similar in each 5-year period, but a significant malnutrition effect was observed. A total of 113 (5.1%) patients needed revision surgery at follow-up, due to malnutrition (n = 51), weight regain (n = 24), acid or bile reflux (n = 22), marginal ulcer (n = 8), ileus (n = 3), and other causes (n = 5). At 15 years, the overall revision rate was 11.9% (27/226), and 80% of the patients were very satisfied with their procedures.Our results showed that OAGB is a safe and durable primary bariatric procedure, with sustained weight loss and a high resolution of T2D up to 20 years post surgery in Taiwan, although malnutrition is a major side effect.

Asian patients with diabetes exhibit different characteristics from Western patients. However, limited large-scale data are available on metabolic surgery procedures in Asia. We compared the short-term efficacies of metabolic surgery procedures for the management of Asian patients with different severities of diabetes. We included patients undergoing metabolic surgery in five Asian institutions from January 2008 to December 2015 with at least 1-year postoperative follow-up. Outcomes of weight loss and diabetes control were determined. Diabetes remission rates in different ABCD scores and factors affecting diabetes remission were analyzed. A total of 1016 patients (mean BMI, 39.0 ± 7.2 kg/m2; HbA1c, 8.3% ± 1.7%) underwent metabolic surgery (197, Roux-en-Y gastric bypass [RYGB]; 171, one anastomosis gastric bypass [OAGB]; 437, sleeve gastrectomy [SG]; 130, SG with duodenal-jejunal bypass [SG-DJB]; and 81, single anastomosis duodenal-jejunal bypass with SG [SA-DJBSG]). The OAGB group exhibited significantly higher 1-year total weight loss (30.5%) and type 2 diabetes mellitus (T2DM) remission (78.4%) rates than did the other groups (p

Small bowel length is drawing attention in the development of gastrointestinal bariatric/metabolic surgery, but the importance of the length of the small bowel in bariatric/metabolic is not clear. The present study was conducted to investigate variations in small bowel length and their clinical significance in patients undergoing laparoscopic sleeve gastrectomy (LSG). Small bowel length was measured in 620 patients diagnosed with obesity who underwent LSG between March 2014 and August 2018. Prospectively obtained demographic and clinical data were investigated, focusing on the association between small bowel length and weight loss. Small bowel length varied widely among patients (mean 739.8 + 115.7 cm, range 380–1050 cm). Linear regression analysis revealed a significant association between small bowel length and body height, body weight, waist circumference, and serum levels of low-density lipoprotein cholesterol, hemoglobin, C-peptide, glycated hemoglobin (A1C), and gamma-glutamyl transferase (r-GT). Multivariate analysis confirmed that body height and serum A1C% levels independently predicted small bowel length in bariatric patients, strongly with body height (p

IntroductionPrevious studies have demonstrated that one anastomosis gastric bypass (OAGB) is not inferior to Roux-en-Y gastric bypass (RYGB) in treating obesity. However, high level evidence comparing the efficacy and safety of both procedures in type 2 diabetes (T2D) treatment is still lacking, which is another main aim of bariatric surgery. The presented trial has been designed to aim at investigating the superiority of OAGB over the reference procedure RYGB in treating T2D as primary endpoint. And diabetes-related microvascular and macrovascular complications, cardiovascular comorbidities, weight loss, postoperative nutritional status, quality of life and overall complications will be followed up for 5 years as secondary endpoints.Methods and analysisThis prospective, multicentre, randomised superiority open-label trial will be conducted in patients of Asian descent. A total of 248 patients (BMI≥27.5 kg/m2) who are diagnosed with T2D will be randomly assigned (1:1) to OAGB or RYGB with blocks of four. The primary endpoint is the complete diabetes remission rate defined as HbA1c≤6.0% and fasting plasma glucose≤5.6 mmol/L without any antidiabetic medications at 1 year after surgery. All secondary endpoints will be measured at different follow-up visit points, which will start at least 3 months after enrolment, with a continuous annual follow-up for five postoperative years in order to provide solid evidence on the efficacy and safety of OAGB in patients with T2D.Ethics and disseminationThe study has been approved by the ethics committee of leading centre (Beijing Friendship Hospital, Capital Medical University, no. 2021-P2-037-03). The results generated from this work will be disseminated to academic audiences and the public via publications in international peer-reviewed journals and conferences. The data presented will be imported into a national data registry. Findings are expected to be available in 2025, which will facilitate clinical decision-making in the field.Trial registration numberNCT05015283.

While clinical findings demonstrate a superior benefit of cardiovascular (CV) risk reduction in obese patients with type 2 diabetes mellitus (T2D) receiving bariatric surgery over non-T2D patients, the mechanism is unclear. This study aimed to investigate the changes in the CV risk score and five CV-associated biomarkers after gastric bypass surgery.We enrolled 80 obese subjects who underwent gastric bypass (40 T2D and 40 non-T2D). CV risks were assessed using the United Kingdom Prospective Diabetes Study (UKPDS) engine before and after surgery. Levels of five biomarkers -fasting serum fibroblast growth factor (FGF)-19, FGF-21, corin, oxidized low-density lipoprotein (ox-LDL), and soluble receptor for advanced glycation end-products (sRAGE)-were measured before surgery and one year after surgery.The T2D group was significantly older and had a higher CV risk score than the non-T2D group, but body mass index (BMI) was similar between the groups. Preoperative biomarker levels were similar in both the T2D and the non-T2D groups. One year after surgery, the percentage of total weight loss (%TWL) was similar between the two groups (32.2 ± 19.5% versus 34.1% ± 8.8%, p = 0.611). Complete T2D remission (hemoglobin A1c (HbA1c) 6.0%) was achieved in 29 patients (72.5%). The 10-year CV risk scores by the UKPDS risk engine reduced significantly in both the T2D and the non-T2D groups, but more in the T2D group. Three of five biomarkers changed significantly after surgery: the FGF-19 increased from 195.6 ± 249.1 pg/mL to 283.2 ± 211.8 pg/mL, corin increased from 3.3 ± 2.3 ng/mL to 4.6 ± 3.7 ng/mL, and ox-LDL decreased from 148.5 ± 71.7-107.9 U/L; the P values were 0.002, 0.002 and 0.001, respectively. The T2D group showed a significantly different change in FGF-19 increase and FGF-21 decrease compared to the non-T2D group. The changes in corin and ox-LDL levels were not different between the T2D and non-T2D groups.Gastric bypass surgery resulted in a higher UKPDS CV risk score reduction in obese T2D Asians than in those without. FGF-19 and FGF-21 may be associated with the underlying mechanism of this difference.

BACKGROUND Gastric bypass (GB) and sleeve gastrectomy (SG) were found to achieve different remission rates in the treatment of type 2 diabetes (T2DM). The alteration in several gut hormones after bariatric surgery has been demonstrated to play a key role for T2DM remission. Nevertheless, amylin, one of the diabetes-associated peptides, so far has an undetermined position on T2DM remission after bariatric surgery. METHODS Sixty eligible patients with T2DM (GB, 30; SG, 30) were initially enrolled in the hospital-based randomized trial. Twenty patients (GB, 10; SG, 10) who met the inclusion criteria and agreed to undergo 75-g oral glucose tolerance test (OGTT) were recruited. The recruited subjects underwent anthropometric measurements, routine laboratory tests, and 75-g OGTT before and 1 year after bariatric surgery. Enzyme immunoassays for plasma amylin were analyzed. RESULTS All subjects that underwent GB and half of those who underwent SG achieved T2DM remission. Plasma amylin levels significantly decreased 60-90 min after OGTT in the GB group (p < 0.05) and 30-60 minutes after OGTT in the SG group (p < 0.05). Significantly decreased plasma amylin levels were observed at 30-90 minutes after OGTT in the noncomplete remitters of the GB group (p < 0.05). Plasma amylin levels initially increased (p < 0.05) within 30 minutes after OGTT and then decreased (p < 0.05) in the next 30-minute interval in the nonremitters of the SG group. CONCLUSION Postoral glucose challenge amylin levels could be as one of the parameters to evaluate T2DM remission after bariatric surgery, especially in those after SG.

Background Limited studies have focused on diabetes relapse after metabolic surgery, especially among Asians. Objectives To identify the predictors of diabetes relapse following initial postoperative remission in Asia. Setting Four tertiary hospitals Methods We assessed 342 patients (age, 41.0±10.8 years; body mass index (BMI), 39.6±7.3 kg/m2) with complete diabetes data before and 1 and 3 years after metabolic surgery. A total of 290 (84.8%) and 277 (81.0%) patients had diabetes remission at 1 and 3 years after surgery. Logistic regressions were performed to identify the independent predictors of diabetes relapse. Two published predictive models for diabetes remission were also tested for relapse. Results Of the 290 patients with 1-year diabetes remission, 29 (10%) experienced a relapse at 3 years after surgery. The area under the receiver operating characteristic curve of the ABCD score in predicting 1-year remission, 3-year remission, and 3-year relapse were 0.814, 0.793, and 0.795, while those of the DiaRem2 score were 0.823, 0.774, and 0.701, respectively. The baseline age, BMI, and insulin use were independent predictors for relapse. The most powerful predictive model for relapse was composed of preoperative insulin use, 1-year A1c, and a change in BMI between the first and third year (C-statistic: 0.919). Conclusions The ABCD score predicted both mid-term postoperative diabetes remission and relapse in Asians. Initial older age, lower BMI, insulin use, higher 1-year A1c, and weight regain were independent predictors of relapse. Personalized strategies should be proposed for those at risk of relapse to optimize diabetes outcomes after surgery.

The YOMEGA study (Y-study) was a randomized trial comparing one anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB). Here, we aim to compare the Y-study and our pioneer trial from Taiwan (T-study). Data from the Y-study and the T-study were collected and compared. The Y-study recruited 234 patients with a mean body mass index (BMI) of 43.9 and age of 43.5 years. The T-study recruited 80 patients with a similar mean BMI of 44.3 and mean age of 31.4 years. The studies had similar findings including (1) OAGB is easier and possibly safer procedure than RYGB. Both studies showed that OAGB had a shorter operation time than RYGB, but a lower surgical complication rate was only demonstrated in T-study. (2) Both procedures have similar weight loss but OAGB features better glycemic control than RYGB. Weight loss at 2 years after surgery was similar between two procedures, but OAGB reduced HbA1c to a greater degree than RYGB at 2 years in Y-study (− 2.3% vs. − 1.3%; p = 0.025). The resolution of the metabolic syndrome was 100% for both groups in the T-study. (3) OAGB carried a higher risk of malnutrition. OAGB had more malabsorptive problems with a lower hemoglobin level than RYGB at 2 years after surgery. Adverse malnutrition events occurred in nine (7.8%) OAGB patients in the Y-study. Four (3.4%) patients of OAGB received revision surgery in Y-study but none in T-study. (4) Bile reflux was noted in OAGB patients but did not influence quality of life or revision rate. Y-study found that bile in the gastric pouch was present in 16% of patients in the OAGB group versus none in the RYGB, but no inter-group difference in quality of life was detected. There was a trend for RYGB patients to experience more abdominal pain than OAGB. Both studies showed that OAGB is a technically easier procedure and features better glycemic control than RYGB, but has a mal-absorptive effect. However, the bile reflux and abdominal pain controversies persisted.

Gastroesophageal reflux disease (GERD) is the major drawback of laparoscopic sleeve gastrectomy (LSG). Conversion to Roux-en-Y bypass is recommended but might not be suitable for all patients. We retrospectively reviewed the data of patients who underwent laparoscopic hiatal repair and gastropexy for intractable GERD after LSG between 2015 and 2017. Data on upper gastrointestinal (GI) study findings and proton pump inhibitor (PPI) use was collected. The GERD-health-related quality of life (GERD-HRQL) questionnaire assessed patient symptoms. Perioperative outcomes, GERD symptoms, and medication details were analyzed. Twenty-eight patients were included. Mean interval from the initial LSG to revision surgery was 40.8 months (range, 6–108). Mean body mass index before LSG was 34 kg/m2, whereas that before revision surgery was 25.7 kg/m2. Mean revision surgery time was 126 min, whereas the mean length of stay was 3.6 days. No major surgical complication occurred. The mean GERD-HRQL score before revision surgery was 24.3 and decreased to 12.3 at 1 month after surgery. Mean GERD-HRQL scores at 6, 12, and 24 months after revision surgery were 16.8, 17.4, and 18.9, respectively. All patients required daily proton pump inhibitor pre-operatively; only 26% could discontinue them postoperatively. Of the 28 patients, 14 (50.0%) were satisfied with the surgery, 8 (28.6%) had a neutral attitude, and 6 (21.4%) were dissatisfied. Three (11.1%) patients agreed to undergo Roux-en-Y gastric bypass. Hiatal repair with gastropexy is an acceptable treatment option for GERD after LSG but not very effective because of partial remission of symptoms.

Bariatric surgery, especially the gastric bypass procedure, is an effective therapy for morbid obesity, but may reduce protein absorption and induce protein deficiency (PD). A recent study reported an issue about common limb length for PD.This study aimed to examine the prevalence of PD after gastric bypass surgery and investigate the role of common limb length in PD-related revision surgery.Hospital-based bariatric center.From 2001 to 2016, 2397 patients with morbid obesity who underwent bariatric/metabolic surgery with 1-year follow-up were recruited. Serum albumin and total protein were measured before and 1 year after surgery. Medical records of patients who underwent revision surgery due to PD were reviewed.The overall prevalence of PD was .5% preoperatively. The prevalence of PD increased to 2.0% at 1 year after surgery. The incidence was highest in one-anastomosis gastric bypass (2.8%) followed by Roux-en-Y gastric bypass (1.8%). Until the end of follow-up, all 19 patients who underwent revision surgery for intractable PD had a relatively short common limb length of400 cm. After elongation of the common limb length to400 cm in revision surgery, PD improved in all patients.A subset of patients can develop PD after gastric bypass surgery when the common limb length is400 cm. In patients with intractable PD after gastric bypass surgery, revision surgery for elongation of common limb length to400 cm is mandatory to avoid PD-related complications.

Single-anastomosis duodeno-jejunal bypass with sleeve gastrectomy (SADJB-SG) was developed as a simplified technique of DJB-SG, but long-term data are lacking.To report the long-term data of SADJB-SG.Tertiary Teaching Hospital.A total of 148 SADJB-SG was performed from 2011 to 2016 with mean age of 42.0 ± 10.9-years old (14-71), female 64.9%, and mean body mass index 34.2 ± 5.9 kg/mThe mean operating time, intraoperative blood loss, and hospital stay of SADJB-SG were 189.6 ± 32.1 minutes, 43.5 ± 17.9 mL, and 5.0 ± 5.1 days, respectively. The 30-days postoperative major complication occurred in 7(4.7%) patients, all in patients with type 2 diabetes (T2D). At postoperative 1, 2, and 5 years, the mean percentage of total weight loss and excess weight loss of SADJB-SG patients were 25.5%, 22.8%, 22.5%, and 83.9%, 76.1%, 58.6%, respectively. Among 118 patients with T2D, 62 (52.5%) achieved complete remission (hemoglobin A1C60%) at 1 year and 36.5% at 5 years after surgery. A total of 15 patients needed reoperation at follow-up, due to reflux disease (n = 11), weight regain, and recurrent of T2D (n = 2), ileus (n = 1), and peritonitis (n = 1). Among them, 8 were converted to RYGB and the others remained in same anatomy. At 5 years, the overall revision rate was 12.9% (8/62) and 24.5% (14/57) of the remaining required proton pump inhibitor for reflux symptoms.Our results show that primary SADJB-SG is a durable primary bariatric procedure with sustained weight loss and a high resolution of T2D at 5 years, but de novo GERD is the major side effect.

Summary: Background: Nonalcoholic steatohepatitis (NASH) is closely associated with obesity and is one of the important etiologies of hepatocellular carcinoma (HCC and liver failure. Bariatric surgery is proven to be effective in causing weight loss and improvement of NASH) but there is limited long term data. Objectives: To identify the predictors of NASH in morbidly obese patients and evaluate long term data of bariatric surgery effects on NASH. Methods: 308 bariatric patients (mean age 30.2 years old, body mass index (BMI) 45.0 kg/m2) with concurrent liver biopsy form 2003 to 2008 were included. We compared the clinical data between the NASH and non-NASH group and identify predictors of NASH in this cohort of patients. Remission of NASH was evaluated using the predictor of NASH. Results: Prevalence of NASH was 43.8%. At baseline, the NASH and non-NASH groups both had similar age, BMI and sex ratio but the NASH group had significantly worse glycemic control, liver enzymes, triglycerides and uric acid. Highly sensitive-C Reactive Protein (HSCRP) level was identified as the only independent predictor of NASH. Ten years follow up (60.4% loss to follow up) showed good weight loss, resolution of co-morbidities and reduction of HSCRP. Patients with bypass surgery had better weight loss and lower levels of HSCRP. (HSCRP 0.2 ± 0.1 mg/dL vs. 0.8 ± 0.7 mg/dL, p = 0.009). than non-bypass group. Conclusion: NASH is common in bariatric patients. HSCRP is the only independent predictor of NASH and can be used as a surrogate marker in predicting long term effect of Bariatric Surgery on resolution of non-alcoholic steatohepatitis Bypass procedure was better in resolution of NASH than non-bypass procedure. Keywords: Bariatric surgery, NAFLD, NASH, Nonalcoholic fatty liver disease, Steatohepatitis

Summary: Background: Strong evidence has shown that metabolic surgery is more effective than medical treatment in the treatment of type 2 diabetic patients. However, no study demonstrated a survival benefit and reduction of diabetes-related end-organ damage. Here, we describe the study design of a large prospective cohort study, the Taiwan Diabesity Study (TDS) which would compare the long-term survival rate and end-organ damage between overweight/obese type 2 diabetic patients receiving metabolic surgery and medical treatment. Methods: Eligibility criteria include type 2 diabetic patients with duration > 6 months, body mass index (BMI) over 25 kg/m2 and age between 20 and 67 years. Exclusion criteria are serum creatinine over 2.0 mg/dL, C-peptide below 1.0 ng/ml, recent history of cancer, and major diabetic complications. Eligible participants were recruited from six medical centers in Taiwan. The survival rate and diabetes-related end organ damage will be compared between the metabolic surgery group and medical group after follow-up for 10 years. Results: In 3 years, 1016 participants were identified from 38,751 patients. The average BMI of patients was 30.6 (±2.6) kg/m2 and the average hemoglobin A1c was 8.2% (±1.5%) with 18% of them receiving insulin treatment. Among them, 126 patients received metabolic surgery and 890 patients received conventional medical treatment. The metabolic surgery group are younger, have a higher proportion of females, higher BMI and blood lipids as compared to the medical group. Conclusion: The TDS recruited 1016 overweight/obese type 2 diabetic patients including 126 patients receiving metabolic surgery and 890 patients receiving medical treatment. Keywords: Type 2 diabetes mellitus, Obesity, Diabesity, Metabolic surgery, Bariatric surgery, Recruitment

Background In recent years, bariatric surgery was found to have therapeutic potential for the treatment of type 2 diabetes (T2D) in severely obese patients (body mass index [BMI] ≥35 kg/m2) and to reduce cardiovascular disease (CVD) risk and mortality. However, the benefit of CVD risk reduction after metabolic surgery in nonseverely obese T2D patients (BMI Objective To evaluate the CVD risk after metabolic surgery in T2D patients using The UK Prospective Diabetes Study score. Setting Tertiary referral general hospital, Taiwan, Republic of China. Methods Outcomes of 392 patients (235 women and 147 men) who had undergone sleeve gastrectomy (87) or gastric bypass (305) for treatment of T2D with 1-year follow-up were assessed. Data were prospectively collected for study, and cerebral and coronary heart disease risk was calculated by using The UK Prospective Diabetes Study risk engine. Outcomes of patients who had undergone different surgical procedures were assessed. Results One year after surgery, weight and glycemic control with complete and partial remission of T2D were significant in most of the patients. The 10-year coronary heart disease risk and fatal coronary heart disease risk were also reduced from 8.8% to 4.6% and from 4.6% to 2.1%, respectively (both P Conclusion The present study confirms the efficacy of metabolic surgery for the T2D treatment and reduction of CVD risk up to 50% 1 year after surgery. Gastric bypass surgery has more power on CVD risk reduction than sleeve gastrectomy.

There is strong association between obesity and ventral hernia. Obesity is not only increasing the risk of developing ventral hernia (VH) but also increasing the risk of perioperative complications and recurrence rate. Surgical treatment of Obesity (Bariatric Surgery) is the most effective treatment and increasing worldwide. Bariatric surgeries that are most commonly performed are laparoscopic sleeve gastrectomy (LSG) followed by Roux-en-Y gastric bypass (RYGB). Being obese and having ventral hernia makes bariatric surgery challenging. For small umbilical or incisional hernias, concurrent LSG and VH repair can be done safely. However, a sequential LSG followed by VH repair is recommended for asymptomatic VH with unfavorable anatomy or significant medical co-morbidities. Complexity of ventral hernia associated with obesity requires a careful approach. Successful treatment should be individualized based on patient’s symptoms and concern.

Although jejunoileal bypass has been abandoned due to the high rate of hepatic complications, cases of hepatic complications of current bariatric procedures are still reported. Even though weight loss after bariatric surgery frequently induces an improvement of non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, and fibrosis, bariatric procedures have been also associated with cases of acute liver failure or of chronic liver disease evolving until cirrhosis. The clinical manifestations of hepatic complications after bariatric surgery vary from elevated liver enzymes, hypoproteinemia, and hyperammonemia to liver failure. Possible underlying mechanisms include (1) rapid and drastic weight loss, (2) protein–calorie malnutrition, (3) gut microbiota alteration and bacterial overgrowth, and (4) pre-existing chronic hepatic diseases. Although the incidence is low, bariatric surgeons should be alert to this catastrophic complication, recognize high-risk patients, select appropriate procedures, and follow the patients carefully including early diagnosis and appropriate treatment.

Bariatric/metabolic surgery has been incorporated into the therapeutic treatment of type 2 diabetes mellitus (T2DM). Among many bariatric/metabolic procedures, one anastomosis gastric bypass (OAGB) is one of the most effective procedures but long-term data about T2DM recurrence after OAGB are lacking. Outcomes of 134 patients who had undergone OAGB for the treatment of T2DM with long-term (5 years) follow-up were assessed in a retrospective cohort study. The remission of T2DM after OAGB surgery was evaluated in different groups using a scoring system composed of the age, BMI, C-peptide level, duration of T2DM (ABCD score), and percent of total weight loss (%TWL). The %TWL and percent of excess weight loss (%EWL) of the OAGB patients at 5 years after surgery were 29.2 (10.6) and 72.1(27.5), respectively. The mean BMI decreased from 39.5(7.9) to 27.6(5.3) kg/m2 and mean glycated hemoglobin A1C (HbA1c) decreased from 8.9 to 5.9% in OAGB patients at 5 years after OAGB. The complete T2DM remission rate of OAGB was 76.1% at 1 year and 64.2% at 5 years after surgery. Forty-one (57.8%) out of 71 patients who completed a 10-year follow-up remained in complete T2DM remission. The T2DM recurrence rate of OAGB patients was 15.7% at 5 years after surgery. OAGB is highly effective in inducing T2DM remission but a significant number of patients will still have T2DM recurrence. To select patient with an ABCD score > 5 and maintaining a weight loss greater than 30% is important for durable T2DM remission after OAGB.

Laparoscopic sleeve gastrectomy (LSG) is becoming a primary bariatric/metabolic surgical procedure for treating obesity and related type 2 diabetes mellitus (T2D). This study presents the long-term outcome of LSG about the remission and recurrence of T2D. A total of 59 obese patients (38 women and 21 male) with T2D (mean body mass index [BMI] 37.6 ± 5.1 kg/m2) who underwent LSG from 2006 to 2014 with complete 5 years followed up were selected for present study. The remission of T2D was evaluated in stratified groups using the ABCD scoring system which is composed of the age, BMI, C-peptide, and duration of T2D. The weight loss at 5 years after surgery was 23.5% and the mean BMI decreased to 27.7 ± 4.5 kg/m2. The mean HbA1c decreased from 8.1 to 6.1% at 5 years. The 1-year and 5-year complete remission rate (HbA1c

Background Bariatric surgery has been shown to improve glycemic control in patients with type 2 diabetes. However, less is known whether it can also reduce diabetic renal, neurological, and ophthalmic complications. Methods This prospective multicenter cohort study compared renal, ophthalmic, and neurological complications between 49 patients with obesity/overweight receiving bariatric surgery and 338 patients receiving standard medical treatment after follow-up for 2 years. Patients received neurological examinations including toe tuning fork vibration test, ankle tendon reflex test, 10-g monofilament test, and ophthalmic examinations including visual acuity measurement and fundus examinations. Multiple regressions, propensity score weighting, and matching were employed to adjust for baseline differences. Results After 2 years of follow-up, patients with type 2 diabetes receiving bariatric surgery had greater reduction in BMI, HbA1c, and urine albumin–creatinine ratio, greater improvement in estimated glomerular filtration rate, and greater increase in tuning fork test score of right and left toes compared with the medical group. However, there is no improvement in 10 g-monofilament test, visual acuity, diabetic non-proliferative retinopathy, and proliferative retinopathy. Similar results were obtained using multiple regression adjustment, propensity-score weighting, or comparing age-, sex-, and BMI-matched subjects. Conclusions After 2-year follow-up, patients with obesity/overweight and type 2 diabetes receiving bariatric surgery have increased glomerular filtration rate, reduced albuminuria, and improved tuning folk vibration sensation.

Background Nonalcoholic steatohepatitis (NASH) is an important etiology of end-stage liver disease. Long-term effect of bariatric surgery in improvement of NASH is not clear. Objectives To validate a scoring system for predicting NASH in morbidly obese patients and using it to evaluate the long-term effect of bariatric surgery on NASH. Setting Tertiary referral hospital, Taiwan. Methods A new 5-point clinical NASH (C-NASH) score incorporating body mass index, alanine aminotransferase, and triglyceride was validated in a group of 307 bariatric patients (mean age 30.2 years, incorporating body mass index 45.0 kg/m2) with concurrent liver biopsy from 2003 to 2008. Remission of NASH in 5741 obese patients undergoing bariatric/metabolic surgery with long-term follow-up was then evaluated using the C-NASH score. Results Among 307 patients with liver biopsy, the prevalence of NASH was 44.0%. At baseline, the NASH group had significantly worse fasting glucose levels, triglycerides, uric acid, aspartate aminotransferase, alanine aminotransferase, gamma glutamyl transferase, and glycated hemoglobin. The diagnostic sensitivity of C-NASH score was 84.4%, and the accuracy was 68.4%. Among 5741 bariatric patients, the prevalence of high risk for NASH evaluated by C-NASH score was 40.9%. Postoperative follow-up showed good weight loss and almost complete remission of high risk for NASH up to 10 years. Patients with gastric banding had less weight loss, higher mean level of C-NASH score, and a higher incidence of high risk for NASH compared with other procedures at follow-up. Conclusion This study demonstrated that improvement in C-NASH score suggesting remission of NASH is durable up to 10 years in all kinds of bariatric procedures.

Laparoscopic single anastomosis (mini-)gastric bypass (LSAGB) has been validated as a safe and effective treatment for morbid obesity. However, data of the long-term outcome remain lacking. Between October 2001 and December 2015, 1731 morbidly obese patients who received LSAGB as primary bariatric procedure at the Min-Sheng General Hospital were recruited. Surgical outcome, weight loss, resolution of comorbidities, and late complications were followed, then compared with groups of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG). All data derived from a prospective bariatric database and a retrospective analysis were conducted. The average patient age was 33.8 ± 10.4 years with a mean body mass index (BMI) of 40.4 ± 7.7 kg/m2. Of them, 70.0% were female while 30.0% were male. Mean operating time, intraoperative blood, and hospital stay of LSAGB were 124.6 ± 38.8 min, 39.5 ± 38.7 ml, and 5.0 ± 4.1 days, respectively. The 30-day post-operative major complication occurred in 30 (1.7%) of LSAGB patients, 16 (2.0%) of LRYGB, and 15 (1.4%) of LSG patients. The follow-up rates at 1, 5, and 10 years were 89.3, 52.1, and 43.6%, respectively. At postoperative 1, 5, and 10 years, the mean percentage of weight loss (%WL) of LSAGB patients were 32.7, 32.2, and 29.1%, and mean BMI became 27, 26.9, and 27 kg/m2, respectively. The LSAGB had a higher weight loss than LRYGB and LSG at 2–6 years after surgery. LSG had a lower remission rate in dyslipidemia comparing to LSAGB and LRYGB. The overall revision rate of LSAGB is 4.0% (70/1731) which was lower than the 5.1% in LRYGB and 5.2% in the LSG. LSAGB is an effective procedure for treating morbid obesity and metabolic disorders, which results in sustained weight loss and a high resolution of comorbidities.

Gastrointestinal stromal tumors (GISTs) treatment has improved remarkably in recent years. However, giant and unresectable lesions could still be challenging, especially from the surgical aspect. We reported a case of a 44-year-old male patient who complained about abdominal pain and distention. Computed tomography scans, upper GI endoscopy, and tissue biopsy proved the diagnosis of a giant GIST which was considered unresectable. With the aid of neoadjuvant imatinib therapy, the tumor shrank tremendously, and we successfully performed en bloc resection with clean margins. Therefore, we suggested combining imatinib therapy and surgery in managing giant and unresectable GIST lesions.

BACKGROUND: An increasing number of surgeons worldwide are now performing one anastomosis/mini gastric bypass (OAGB/MGB). Lack of a published consensus amongst experts may be hindering progress and affecting outcomes. This paper reports results from the first modified Delphi consensus building exercise on this procedure. METHODS: A committee of 16 recognised opinion-makers in bariatric surgery with special interest in OAGB/MGB was constituted. The committee invited 101 OAGB/MGB experts from 39 countries to vote on 55 statements in areas of controversy or variation associated with this procedure. An agreement amongst ≥ 70.0% of the experts was considered to indicate a consensus. RESULTS: A consensus was achieved for 48 of the 55 proposed statements after two rounds of voting. There was no consensus for seven statements. Remarkably, 100.0% of the experts felt that OAGB/MGB was an "acceptable mainstream surgical option" and 96.0% felt that it could no longer be regarded as a new or experimental procedure. Approximately 96.0 and 91.0% of the experts felt that OAGB/MGB did not increase the risk of gastric and oesophageal cancers, respectively. Approximately 94.0% of the experts felt that the construction of the gastric pouch should start in the horizontal portion of the lesser curvature. There was a consensus of 82, 84, and 85% for routinely supplementing iron, vitamin B12, and vitamin D, respectively. CONCLUSION: OAGB/MGB experts achieved consensus on a number of aspects concerning this procedure but several areas of disagreements persist emphasising the need for more studies in the future.

Ten to 50% of patients who received restrictive bariatric operations may require reoperation for unsatisfactory weight loss or weight regain. Failed restrictive procedures are usually managed with conversion to another bariatric procedure with a favor of conversion to laparoscopic gastric bypass. Our aim is to evaluate two different bypass techniques, laparoscopic RY gastric bypass (RYGB) versus single-anastomosis (mini-) gastric bypass (SAGB) as a revision option (R-RYGB and R-SAGB) for failed restrictive bariatric operations. From May 2001 to December 2015, a total of 116 patients with failed restrictive bariatric operations underwent laparoscopic revisional bypass surgery (81 R-SAGB and 35 R-RYGB). Among them, 81 were failed after vertical banded gastroplasty (VBG) and 35 were after adjustable gastric band (AGB). The demographic data, surgical parameters, and outcomes were studied. The average age at revision surgery was 35.7 years (range 22–56), and the average body mass index (BMI) before reoperation was 37.2 kg/m2 (29.0–51.8). Revision surgery was performed after 58.8 months from the primary surgery on average (14–180 months). The main reasons for the revisions were weight regain (50.9%), inadequate weight loss (31%), and intolerance (18.1%). All of the procedures were completed laparoscopically as one-stage procedure. R-RYGB had significantly longer operative times than R-SAGB. Major complication occurred in 12 (10%) patients without significant difference between R-SAGB group and R-RYGB group. At 1 year follow-up, weight loss was better in R-SAGB than R-RYGB (76.8 vs. 32.9% EWL; p = 0.001). At 5 year follow-up, a significantly lower hemoglobin level was found in R-SAGB group (p = 0.03). Both SAGB and RYGB are acceptable options for revising a restrictive type of bariatric procedures with equal safety profile. R-SAGB was shown to be a simpler procedure with better weight reduction than R-RYGB but anemia is a considerable complication at long-term follow-up.

Bariatric surgery is an effective therapy for morbid obesity but may reduce calcium absorption and significantly decrease the bone mineral density. This study examined the prevalence of secondary hyperparathyroidism (SHPT) in obese subjects during follow-up after different bariatric surgeries. We investigated predictors of SHPT. We enrolled 1470 obese subjects undergoing bariatric/metabolic surgery with at least 1-year follow-up, including 322 patients undergoing Roux-en-Y gastric bypass (RYGB), 695 undergoing single anastomosis (mini-) gastric bypass (SAGB), 93 undergoing laparoscopic adjustable gastric banding (LAGB), and 360 undergoing sleeve gastrectomy (SG). Five years of data were available for 215 patients. Patients were instructed to supplement their diet according to the guideline. Calcium, parathyroid hormone (PTH), and vitamin D levels were measured before surgery and at 1 and 5 years after surgery. SHPT was defined as PTH > 69 pg/mL. The overall prevalence of SHPT was high, 21.0% before surgery and was not different between patients with different bariatric procedures. Pre-operative PTH correlated with age, BMI, and vitamin D levels. Multi-variate analysis confirmed that vitamin D level was the only independent predictor of SHPT before surgery. The prevalence of SHPT increased to 35.4% at 1 year after surgery and 63.3% at 5 years after surgery. SAGB had the highest prevalence of SHPT (50.6%) followed by RYGB (33.2%), LAGB (25.8%), and SG (17.8%) at 1 year after surgery. At 5 years after surgery, SAGB still had the highest prevalence of SHPT (73.6%), followed by RYGB (56.6%), LAGB (38.5%), and SG (41.7%). Serum PTH at 1 year after surgery correlated with decreased BMI and weight loss. Multi-variate analysis confirmed that age, sex, calcium level, and bypass procedure were independent predictor of SHPT after surgery. The prevalence of SHPT is high in morbidly obese patients before bariatric surgery which is related to vitamin D deficiency. The prevalence of SHPT increased continually along with the time after bariatric surgery, especially in patients receiving SAGB, followed by RYGB. The supplementation of vitamin D and calcium have to be higher in bypass procedure, especially in malabsorptive procedure.

Obesity and type 2 diabetes mellitus (T2DM) are currently two pan‐endemic health problems worldwide and are associated with considerable increase in morbidity and mortality. Both diseases are closely related and very difficult to control by current medical treatment, including diet, drug therapy and behavioral modification. Bariatric surgery has proven successful in treating not just obesity but also in significantly decreasing overall obesity‐associated morbidities as well as improving quality of life in severely obese patients (body mass index [BMI] >35 kg/m2). A rapid increase in bariatric surgery started in the 2000s when the laparoscopic surgical technique was introduced into this field. Many new procedures had been developed and changed the face of modern bariatric surgery. Recently, bariatric surgery played as gastrointestinal metabolic surgery has been proposed as a new treatment modality for obesity‐related T2DM for patients with BMI >35 kg/m2. Strong evidence has demonstrated that bariatric/metabolic surgery is an effective and durable treatment for obese T2DM patients. Bariatric/metabolic surgery is now becoming an important surgical division. The present article examines and discusses recent advancements in bariatric/metabolic surgery and covers four major fields: (i) the rapid increase in numbers and better safety; (ii) new procedures with better outcomes; (iii) from bariatric to metabolic surgery; and (iv) understanding the mechanisms and personalized treatment.

Laparoscopic adjustable gastric banding (LAGB) was one of the commonly performed bariatric operations; however, it carries a high revision rate. The aim of the present study was to report the long-term outcomes of LAGB and compare the outcomes between the different revision procedures. All patients who underwent LAGB in a large bariatric center in Asia between May 2002 and April 2011 were included. Interval between primary LAGB to the revision operation, the reason and type of revision surgery were identified and analyzed. A total of 275 consecutive patients were included. All of the procedures were completed laparoscopically with no major complications. The percentage of excess weight loss (%EWL) at 10-year follow-up was 45%. In this study, 53 patients (19.3%) had revision surgery, including with 26 single anastomosis (mini-) gastric bypass (R-LSAGB) (49%), 17 sleeve gastrectomy (R-LSG) (32.1%), 9 Roux-en-Y gastric bypass (R-LRYGB) (17%), and 1 other procedure (1.9%). A major complication occurred in 6 patients (11.3%). All of the follow-up patients with revision surgeries had %EWL > 50% at the 2-year follow-up. R-LSAGB patients achieved better weight loss than those who underwent R-LSG and R-LRYGB (p = 0.001). The long-term result for weight loss after LAGB is unsatisfactory. The revision of failed LAGB to other bariatric surgeries is safe and can be performed in one stage with a low complication rate. Patients who underwent R-LSAGB had better weight loss results than the R-LSG or R-LRYGB patients.

Background: Hepassocin is a liver-derived protein and its serum concentrations significantly increase in diabetes and fatty liver patients. Hepassocin is also a biomarker for diabetes and fatty liver, therefore, we aimed to investigate the impacts of different types of bariatric surgery on hepassocin plasma levels in obese patients with diabetes, and to determine if hepassocin could be a potential new marker for monitoring the effects of bariatric surgery and a treatment target. Methods: Overall, 12 patients undergoing gastric bypass (GB), 10 patients undergoing sleeve gastrectomy (SG) and 11 patients undergoing duodeno-jejunal bypass with sleeve gastrectomy (DJB-SG) were enrolled. Fasting hepassocin levels were measured at baseline, three, 12, and 24 months after surgery. Results: All the three groups significantly decreased their body mass index, waist-to-hip ratio, a body shape index (ABSI), triglycerides, fasting blood sugar, hemoglobin A1c, C-peptide levels and homeostasis model assessment of insulin resistance 24 months after surgery. There were no significant changes in hepassocin levels, even 24 months after the three surgeries. Hepassocin had a significant negative relationship with the ABSI (p&lt, 0.001) 24 months after the SG. Conclusions: Neither GB, SG, nor DJB-SG altered plasma hepassocin levels in diabetic patients up to 24 months after surgery. The use of hepassocin in clinical settings requires more investigation.

Background: Very few studies have explored the changes of serum pepsinogen after bariatric surgery and no research has evaluated the feasibility of ABC classification to predict gastric cancer risk after bariatric surgery. Methods: We enrolled 94 obese subjects that received bariatric surgery, including 41 sleeve gastrectomy (SG) and 53 Roux-en-Y gastric bypass (RYGB). The serum pepsinogen I (PGI), pepsinogen II (PGII), PGI/II ratio and seropositivity of Helicobacter pylori ( H. pylori ) were measured before and one year after surgery. Patients were classified according to ABC classification and post-operative change was evaluated. Results: Preoperatively, four (4.2%) patients were classified into high risk group (classification C and D) for gastric cancer. Significant reduction of PGI, PGII and decrease of PGI/II ratio were noted after bariatric surgery. H. pylori seropositive patients had a greater postoperative change of PGI (-38.6μg/L vs -22.1μg/L, p=0.003) and PGII (-8.0μg/L vs -2.5μg/L, p

“The authors would like to withdraw the manuscript entitled “Do different bariatric surgery procedures impact hepassocin plasma levels in patients with type 2 diabetes mellitus?” due to unauthorized alteration of authors' affiliation by the Editorial Office of Liver Research. The Editorial Office of Liver Research takes the full responsibility and apologize to the authors for this oversight.” The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal

Laparoscopic one (single)-anastomosis gastric bypass (OAGB) is an effective and durable treatment for morbidly obese patients. However, the ideal length of the small bowel bypass remains controversial.The study aimed to report the clinical results of using a tailored bypass based on the total length of the small bowel.Academic medical center.Since 2005, we have performed OAGB with tailored limb according to preoperative body mass index. From July 2014, we modified our technique, measuring the whole small bowel length to keep the common channel at least 400-cm long. Data from 470 patients treated with the new technique (Group II) were compared with those of a matched group treated with tailored bypass only (Group I). The preoperative clinical data and outcomes were analyzed. All clinical data were prospectively collected and stored.Both groups had similar clinical profiles at baseline. All procedures were completed laparoscopically. Group II had a significant longer operation time (161.9 versus 122.6 min; P.001), but shorter hospital stay (2.9 versus 5.3 d; P.001) and lower complication rate (.2% versus 1.5%; P = .002) than Group I. One year after surgery, the mean body mass index (27.4 versus 26.8 kg/mRoutine measurement of the whole bowel length to keep the common channel at least 400-cm long may reduce the incidence of malnutrition after OAGB with tailored limb bypass, without compromising efficacy in weight loss and diabetes resolution.

Prevalence of obesity in Asia has been on the increasing trend, with corresponding increase in utilisation of bariatric surgery. The objective of this study was to examine differences in weight loss outcomes following bariatric surgery between Asian ethnicities. A retrospective database review was conducted of patients undergoing primary laparoscopic sleeve gastrectomy between 2009 and 2013 in 14 centres from Singapore, Malaysia, Taiwan, Hong Kong, Japan, Korea, India, Australia, Switzerland, and the USA. All patients with available follow-up data at 12 months and 36 months post-surgery were included in this study. Outcome measures used were percentage excess weight loss (%EWL) and percentage total weight loss (%TWL). Differences in outcomes between ethnicities were analysed after adjusting for age, gender, baseline body mass index (BMI), and presence of diabetes. The study population (n = 2150) consisted of 1122 Chinese, 187 Malays, 309 Indians, 67 Japanese, 259 Koreans, and 206 Caucasians. 67.1% were female and 32.9% were male. Mean age was 37.1 ± 11.2 years. Mean pre-operative BMI was 40.7 ± 8.1 kg/m2. With the Caucasian population as reference, Japanese had the best %TWL (3.90, 95% CI 1.16–6.63, p

Laparoscopic gastric clip (GC), a novel pure restrictive procedure, is a safe and effective treatment for morbid obesity. However, whether adding a proximal jejunal bypass (PJB) to this procedure might increase the efficacy is unknown. Outcomes of 74 (43 women and 31male) obese patients who had undergone PJB-GC (41) or GC (33) for the treatment of type 2 diabetes mellitus (T2D) with 1 year follow-up were assessed. GC consists of creating a transverse gastric partition with a metallic clip. PJB consists of a jejuno-ileostomy between 20 and 320 cm distal to the ligament of Treitz. Postoperative body mass index (BMI) reduction, total weight loss (TWL), and remission rates of T2D were evaluated. The preoperative clinical characters in both groups were similar. The mean operative time was significantly longer in the PJB-GC group than in the GC group. At 24 months after surgery, the BMI was lower (32.5 ± 6.2 vs. 37.0 ± 5.9 kg/m2, p = 0.002) and weight loss higher in PJB-GC than GC (TWL 31.3 ± 14.8 vs. 23.5 ± 10.4%, p = 0.011). Remission of T2D was greater in the PJB-GC group (90.2 vs. 57.2%; p

Hepatitis C virus (HCV) is an important cause of liver cirrhosis and its complications. The safety and efficacy of bariatric surgery in patients with HCV infection is not clear.Charts were reviewed to identify patients with HCV infection before bariatric surgery. Bariatric surgical patients with non-alcoholic steatohepatitis (NASH) and without NASH (non-NASH) were recruited as comparative groups. Demographic variables, perioperative data, follow-up, and HCV-related parameters were extracted and compared.Forty-seven bariatric patients between 2000 and 2016 that suffered from HCV infection were identified. The mean age and body mass index (BMI) at baseline were 34.5 ± 9.9 years and 40.4 ± 7.7 kg/mCo-existence of HCV infection does not influence the outcome of bariatric surgery but continued monitoring of the liver function is indicated.

Functional studies of how duodenal–jejunal exclusion (DJE) brings a superior glycemic control when added to sleeve gastrectomy in duodenal–jejunal bypass with sleeve gastrectomy (DJB-SG) patients, are lacking. To study this, we compared the appetite sensations and the β-cell response following a standard mixed meal in patients with DJB-SG, versus those with sleeve gastrectomy (SG) alone. Twenty one patients who underwent DJB-SG and 25 with SG, who participated in mixed-meal tests (MMTT) preoperatively and at 1 year, with complete data were included and compared. Blood glucose, C-peptide, and insulin levels were estimated, along with the visual analogue scale (VAS) scoring of the six appetite sensations, as a part of the MMTT. At 1 year following surgery, compared to SG group, DJB-SG group had greater complete remission rates (HbA1C

Laparoscopic gastric bypass is a commonly performed bariatric surgery for the treatment of morbid obesity. Revision surgery for patients who have gastric bypass complications is a challenge for bariatric surgeon. Our aim is to present the early results of the conversions of gastric bypass complications to sleeve gastrectomies. From January 2001 to April 2015, 49 of 2382 gastric bypasses underwent revisional surgery to convert gastric bypasses to sleeve gastrectomies. The demographic data, surgical parameters, and outcomes were studied. The mean age of the study group was 35.0 years (range 20 to 55), and the average body mass index (BMI) prior to the reoperation was 25.3 kg/m2. Seven patients had previous laparoscopic Roux-en-Y gastric bypasses (LRYGBs), and 42 had laparoscopic single anastomosis (mini-) gastric bypasses (LSAGBs). The main reasons for the revisions were malnutrition (58 %), weight regain (10 %), intolerance (18 %), and others (14 %). The revisional surgeries had longer operative times, greater blood loss, and longer flatus passage times than the primary gastric bypass surgeries. Four patients (8.1 %) developed major complications during revisional surgery, including three (6.1 %) cases of leakage and one (2.0 %) case of internal bleeding. No mortality was noted. After conversion to sleeve gastrectomy, the body weights of the patients remained stable, and all patients improved in terms of malnutrition, including anemia, hypoalbuminemia, and secondary hyperparathyroidism. Conversion to sleeve gastrectomy is an effective and safe option for patients with gastric bypass complications. The conversions to sleeve gastrectomy resulted in significant improvements in malnutrition and maintained weight loss at the early follow-ups.

Background Gastric bypass surgery is the recommended treatment for severely obese patients. However, postoperative symptomatic gastrointestinal (GI) episodes are common complaints. Objectives To determine if administration of probiotics improves symptomatic GI episodes after gastric bypass surgery. Setting Hospital-based bariatric center. Methods This double-blind, randomized trial was conducted between March 2010 and September 2010 with 60 patients who underwent gastric bypass for severe obesity and experienced postoperative symptomatic GI episodes. Patients were randomly assigned to the probiotics group A (n = 20; 1 g Clostridium butyricum MIYAIRI twice daily); probiotics group B (n = 20; Bifidobacterium longum BB536 twice daily); or digestive enzymes group (n = 20; Aczym, containing 100 mg takadiastase N, 20 mg cellulase AP, 50 mg lipase MY, and 100 mg pancreatin, twice daily). Quality of life was measured using the modified Gastrointestinal Quality of Life Index (mGIQLI) before and after the 2-week intervention. Results Preintervention patient characteristics and mGIQLI scores were similar among the 3 groups. After the 2-week intervention, the mean mGIQLI score improved from 57.4 to 63.9 points in the entire sample and also within each group for 7 items specifically for 7: excessive passage of gas, foul smell of flatulence, belching, heartburn, abdominal noises, abdominal bloating, and abdominal pain. Conclusions Administration of probiotics or digestive enzymes may improve symptomatic GI episodes after gastric bypass surgeries and improve quality of life, at least initially.