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Paragangliomas are non-epithelial neuroendocrine neoplasms. They are most commonly identified in the head and neck...

The purpose of this analysis is to identify a therapeutic algorithm in case of Staple Line Leack (SLL) after Laparoscopic Sleeve Gastrectomy...

We discuss the presentation of a sudden sensorineural hearing loss (SNHL) occurred as a rare complication after laparoscopic sleeve gastrectomy (LSG). Etiology of this complication is not clear, it seems that diverse and complex pathogenetic mechanism are involved so the prevention and treatment seems to be difficult.

Background We recently showed that an 8-week preoperative protein-enriched diet (PED) is associated with significant reductions in body weight and fat mass (FM) without significant loss of fat-free mass (FFM) in morbidly obese patients scheduled for laparoscopic sleeve gastrectomy (LSG).Objectives The objective of this study is to evaluate the impact of PED vs a normal protein diet (NPD) on total weight loss (TWL), FM, FFM, and resting metabolic rate (RMR) in patients after LSG.Methods Before LSG and at 3, 6, and 12 months after, we prospectively measured and compared total body weight (TBW), FM, FFM, and RMR in 60 male patients who received either a NPD (n = 30) with protein intake 1.0 g/kg of ideal body weight, or a PED (n = 30) with protein intake 2.0 g/kg of ideal body weight. Compliance in following the prescribed diet was determined with food frequency questionnaires in all patients. The impact of NPD and PED on renal function was also evaluated.Results Despite non-significant variation in total body weight (TBW), FM decreased more significantly (p < 0.01) with the PED compared to the NPD. In addition, the PED group showed a significantly (p < 0.01) lower decrease in FFM and RMR when compared with the NPD group. Both groups showed high compliance in following the prescribed diets, without negative impact on renal function.Conclusion PED is more effective than NPD in determining FM loss and is associated with a lower decrease in FFM and RMR, without interfering with renal function in male patients after LSG.

Obese patients with preoperative gout often suffer of gouty attacks after bariatric surgery (BS), probably due to the lack of an adequate postoperative diet. Background: Obese patients with preoperative gout often suffer of gouty attacks after bariatric surgery (BS), probably due to the lack of an adequate postoperative diet. Objectives: The objectives of the study are to assess whether sleeve gastrectomy (SG) is effective in reducing the frequency of gouty attacks and also whether a postoperative low-purine diet (LPD) may further reduce these attacks as compared to a normal-purine diet (NPD) in a series of patients suffering of gout before SG. Methods: In this retrospective study, we measured and compared total body weight (TBW), body mass index (BMI), uric acid levels (UAL), anti-gout medication (allopurinol) requirements, and frequency in gouty attacks in 40 patients that underwent SG and who received either a LPD (n=24) or NPD (n=16). Compliance in following the prescribed diet was assessed in both groups study. Results: Before surgery, LPD and NPD patients had hyperuricemia and were receiving allopurinol. One year after SG, LPD and NPD groups showed a significant decrease in serum UAL (p&nbsp

Background: There is evidence that body composition and resting metabolic rate (RMR) in weight stable patients after Roux-en-Y gastric bypass and duodenal switch is similar to that of nonoperated individuals within the same body mass index (BMI) interval. Currently, data concerning fat mass (FM), fat free mass (FFM), and RMR on weight-stable patients after sleeve gastrectomy (SG) are lacking.Objectives: To assess FM, FFM, and RMR, in a selected and homogenous population of weight stable SG patients (WSSG) and compare them with those obtained from healthy normal weight stable nonoperated (WSNO) volunteers controls of similar sex, age, and BMI.Setting: University hospital, Italy.Methods: We assessed total weight, FM, and FFM by bioelectrical impedance assay, and RIVER by indirect calorimetry, in 70 WSSG patients (47 females, 23 males) at a mean follow-up of 3.2 +/- 2.1 years after SG and compared them with 70 healthy WSNO volunteers, as controls (47 females, 23 males).Results: There was no significant difference between WSSG and WSNO groups concerning total weight (males, 72 +/- 2.66 versus 72.8 +/- 1.99 kg, P = .0254; females 65.1 +/- 2.53 versus 63.7 +/- 2.87 kg, P = .0139), FM (males, 17.7 +/- 1.53 versus 16.7 +/- 1.57 kg, P = .0341; females 19.6 +/- 0.50 versus 18.5 +/- 2.85 kg, P = .0104), FFM (males, 54.3 +/- 3.07 versus 56.1 +/- 3.30 kg; P = .049; females 45.5 +/- 2.29 versus 45.1 +/- 1.13 kg, P = .287), and RMR (males, 1541 +/- 121.3 versus 1463 +/- 74.4 kcal/d; P = .0118; females 1214 +/- 54.9 versus 1250 +/- 90.1 kcal/d, P = .0215).Conclusion: At a mean follow-up of 3.2 2.1 years after SG, WSSG patients of both sexes have a FM, FFM, and RMR comparable to that of healthy WSNO individuals within the same age and BMI interval. These findings further support bariatric surgery-induced weight loss as a physiologic process and indicate that young patients, in the setting of an adequate preoperative and postoperative specific diet and moderate physical activity, do not suffer from excessive FFM depletion after SG in the mid-term. (C) 2017 American Society for Metabolic and Bariatric Surgery. All rights reserved.

Bariatric surgery candidates often show preoperative micronutrient deficiency. Although it is documented that a comprehensive micronutrient assessment should be conducted preoperatively to correct the deficiencies before surgery, no previous studies have been effective in correcting deficiencies in sufficient time prior to surgery. Our aim was to identify micronutrient deficiencies preoperatively and correct them before surgery. 50 patients (18 female, 32 male) scheduled for bariatric surgery were assessed for micronutrient status 20 weeks prior to surgery. Baseline levels of vitamin B12, folic acid, 25-vitamin D, vitamin C, vitamin A, vitamin E, iron, zinc, magnesium, and selenium were measured. Data were compared with accepted clinical cutoff values. Patients found to have one or more micronutrient deficiencies were instructed to take daily micronutrient supplements specially formulated for obese patients and were evaluated every 5 weeks over a 20-week period. Nutrient intake was also evaluated before and after supplementation. Micronutrient deficiencies were observed in 40 patients (80 %, 13 female, 27 male). All 40 patients started prescribed supplementation immediately. 20 patients (10 female, 10 male) completed a follow-up at 20 weeks. Herein we found that 10 weeks of preoperative micronutrient supplementation is capable of effectively treating micronutrient deficiencies in our candidates for bariatric surgery. Considering that: 1) no new medication was allowed during the study; 2) patients already under pharmacological treatment did not change their therapy; 3) no statistically differences in nutrient intake were observed before and after the supplementation, we are confident to attribute the improvements in patients' micronutrient status directly to the supplement.