PURPOSE: This study aimed to compare amount of weight loss, serum laboratory results, and bariatric analysis and reporting outcome system (BAROS) scores obtained before surgery with those obtained 1 year after laparoscopic adjustable gastric banding (AGB). MATERIALS AND METHODS: From January 2013 to November 2014, 32 consecutive patients who underwent AGB were enrolled in this study. This study was a retrospective analysis of our prospectively collected database. The BAROS score included BAROS weight, medical condition, quality of life, and complications recorded 1 year after AGB. Demographic and post-operative data were also collected and analyzed. RESULTS: Thirty-two patients were enrolled in this study, comprising 26 women and 6 men, with an average body mass index of 39.0±6.1 kg/m². The total BAROS score 1 year post AGB was 4.6±1.7, and it was classified as excellent grade. Among them, the quality of life score was 1.8±0.6. Four minor complications were noted. The serum laboratory values improved 1 year post surgery, including hemoglobin A1c, c-peptide, insulin, Homeostatic model assessment of estimated insulin resistance (HOMA IR), Homeostatic model assessment of beta-cell function (HOMA B), triglyceride, total protein, and uric acid. CONCLUSION: AGB showed that it is acceptable in aspect of BAROS outcome as well as weight loss, and serum laboratory result in short-term period.
Bariatric Surgery ; Body Mass Index ; C-Peptide ; Female ; Humans ; Insulin ; Insulin Resistance ; Male ; Prospective Studies ; Quality of Life ; Retrospective Studies ; Triglycerides ; Uric Acid ; Weight Loss

PURPOSE: Adjustable gastric banding (AGB) and sleeve gastrectomy (SG) are restrictive bariatric surgeries that are popular in Korea. However, patients often require further conversion surgeries because weight loss failure and surgical complications tend to occur. The aim of this study was to evaluate the feasibility and safety of conversion sleeve gastrectomy (CSG) after failed primary AGB (PAGB) or primary SG (PSG). MATERIALS AND METHODS: From February 2010 to April 2016, 21 consecutive patients who underwent CSG after failed PAGB or PSG were enrolled in this study. This study was a retrospective analysis of our prospectively collected database. Demographic, intra and post-operative data were collected and analyzed. RESULTS: Twenty-one patients were enrolled in this study. This comprised 20 women and 1 man, with an average BMI of 31.8±7.8 kg/m². Eighteen patients underwent PAGB and 3 underwent PSG. The mean operative time was 243.6±76.8 minutes, and the estimated blood loss was 190.9±233.2 ml. The mean hospital stay was 4.7±1.7 days. The mean follow-up after CSG was 9.3±1.0 months. Two cases developed immediate postoperative complications: one was a stricture (Clavien-Dindo surgical complication grade II) and the other, a pleural effusion (Grade I). CONCLUSION: CSG is a feasible and safe treatment option after failed PAGB or PSG. Further prospective studies are required to establish the strategy for conversion operations after failed primary restrictive bariatric surgery.
Bariatric Surgery ; Constriction, Pathologic ; Female ; Follow-Up Studies ; Gastrectomy* ; Humans ; Korea ; Length of Stay ; Operative Time ; Pleural Effusion ; Postoperative Complications ; Prospective Studies ; Retrospective Studies ; Weight Loss

Since patients with morbid obesity undergoing bariatric surgery are vulnerable to micronutrient deficiencies, close monitoring and supplementation are necessary. The importance of screening prior to surgery has increased in recent studies; preoperative screening is recommended for thiamine, vitamin B12, vitamin D and calcium, vitamin A, E, K, folic acid, and iron. Though preoperative weight loss (PWL) of more than 10% excess body weight may be beneficial for postoperative weight loss and shorter operative time, insurance-mandated PWL before bariatric surgery is not evidence-based, unsafe, and therefore strongly discouraged. Very-low-calorie diet (VLCD) in liquid form is recommended as a safe and effective way to lose weight preoperatively. Also, screening and correction of eating disorder and psychiatric problems prior to surgery contribute to better outcome.
Bariatric Surgery ; Body Weight ; Calcium ; Caloric Restriction ; Diet ; Eating ; Folic Acid ; Humans ; Iron ; Malnutrition ; Mass Screening ; Micronutrients ; Obesity, Morbid* ; Operative Time ; Preoperative Care ; Thiamine ; Vitamin A ; Vitamin B 12 ; Vitamin D ; Weight Loss

Roux-en-y gastric bypass (RYGB) is currently used to treat obesity and metabolic syndrome. It is however technically challenging with a steep learning curve and long operating times. Laparoscopitc mini-gastric bypass (LMGB) is another surgical method that is acclaimed to achieve similar efficacy and yet safe with acceptable complication rates. We reviewedcurrent literature on LMGB on its efficacy and safety profile. Comprehensive search of available literature using a combination of key words was performed, looking out for efficacy and safety end points. Efficacy end points include excess weight loss, change in body mass index (BMI), resolution of metabolic syndrome or T2DM remission. Safety end points include mortality and morbidity rates, short and long term complications. 18 studies were selected with a total of 9392 patients. Follow up range was from 1 year to 6 years with majority of studies achieving 57%-92% excess weight loss (%EWL) within 1 year. Remission of T2DM rates were mostly more than 84%. Several studies reported better %EWL and T2DM remission when compared to SG and RYGB. Overall mortality rate was 0.152%. Morbidity rates vary from 2.7%-12.5%. Some studies reported lower mortality and complication rates in LMGB when compared to SG and RYGB. In summary, MGB is a safe and effective metabolic-bariatric procedure in treating morbid obesity and T2DM. It should be considered an alternative to standard RYGB. Risk of bile reflux, marginal ulcer and anemia needs to be explained to the patient when counselling for such procedure.
Anemia ; Bile Reflux ; Body Mass Index ; Follow-Up Studies ; Gastric Bypass* ; Humans ; Learning Curve ; Methods ; Mortality ; Obesity ; Obesity, Morbid* ; Peptic Ulcer ; Weight Loss

There has been a sharp increase in the number of obese people worldwide thanks to modern prosperity in accordance with rapid industrialization and economic development. Recently, bariatric surgery has been applied actively to extremely obese patients (BMI>35 kg/m2) and presented as an alternative solution to provide not only weight loss but also a treatment for metabolic diseases such as diabetes mellitus, hypertension, and hyperlipidemia. Gastroesophageal reflux disease (GERD) is one of the most important diseases in morbidly obese patients, and many patients suffer from symptoms like epigastric pain, regurgitation, and dry cough. However, such symptoms are easy to be overlooked and studies on GERD are scarce in relation to bariatric surgery. In morbidly obese patients, high abdominal pressure leads to a pressure gradient between esophagus and stomach. This induces a hiatal hernia causing a greater likelihood of GERD. Many studies in regards to GERD were made after bariatric surgery (sleeve gastrectomy, Roux-en-Y gastric bypass, and gastric band), and various results have been presented. Studies should be carried out on pre-operative diagnosis of GERD, choice of operative method, and improvement of symptoms after the operation. Research is also needed upon bariatric operation in patients with uncontrolled GERD.
Bariatric Surgery ; Cough ; Diabetes Mellitus ; Diagnosis ; Economic Development ; Esophagus ; Gastrectomy ; Gastric Bypass ; Gastroesophageal Reflux ; Hernia, Hiatal ; Humans ; Hyperlipidemias ; Hypertension ; Metabolic Diseases ; Methods ; Obesity, Morbid* ; Stomach ; Weight Loss

Obesity is a complex metabolic disease. Currently, obesity treatment includes lifestyle modification, obesity drug treatment, and bariatric surgery. Lifestyle modification is an essential part of obesity treatment, but it is limited by itself. And anti-obesity treatment drugs also showed limited weight loss effect, about 3-9% per year, and can cause serious side effects such as cardiovascular side events. Surgical treatment requires high cost, permanent resection of the gastrointestinal tract and can cause complication related to surgery. Recently, several promising endoscopic bariatric therapies are emerging. Endoluminal bariatric treatment using flexible gastrointestinal endoscopy could offer a minimally invasive treatment aimed at achieving an effect comparable to obesity surgery, while offering advantages of low cost and safety. In this paper, we described a new technological method, recent clinical data, and the latest findings on obstacles to be overcome for endoscopic gastroplasty using endoscopic suture instruments. Endoscopic gastroplasty presented reduced gastric volume, effective weight loss and maintenance effect without severe adverse events. It could suggest an attractive treatment option for obesity.
Bariatric Surgery ; Bariatrics ; Endoscopy ; Endoscopy, Gastrointestinal ; Gastrointestinal Tract ; Gastroplasty* ; Life Style ; Metabolic Diseases ; Methods ; Obesity* ; Sutures ; Weight Loss

The concept of bariatric surgery, which was intended to lose weight, has turned into metabolic surgery. These changes were due to the fact that the resolution of diabetes and metabolic diseases after weight loss surgery were not associated with weight loss. The key pathogenesis of type 2 diabetes is explained by increased insulin resistance and reduced insulin secretion. Therefore, postoperative resolution of diabetes can be explained by improvement of insulin secretion or insulin resistance. It is known that the improvement of insulin secretion after surgery depends on the degree of preservation of preoperative beta cell function. In this study, the method of measuring insulin resistance is concretely summarized, and the improvement of diabetes after metabolic obesity surgery is focused on the improvement of insulin resistance.
Bariatric Surgery ; Insulin Resistance* ; Insulin* ; Metabolic Diseases ; Methods ; Obesity ; Weight Loss

Obesity is a chronic disease with serious health consequences, but weight loss is difficult to maintain through lifestyle intervention alone. Bariatric surgery is considered to be the most effective treatment modality in maintaining long-term weight reduction and improving obesity-related conditions in morbidly obese patients. Since the properly executed pharmacologic treatment is a good option for weight reduction. Surgeons should be aware of the efficacy and side effects of medical treatment.
Bariatric Surgery* ; Chronic Disease ; Humans ; Life Style ; Obesity ; Surgeons ; Weight Loss*

Laparoscopic adjustable gastric banding (LAGB) is a restrictive procedure which has a low morbidity and mortality rate in the immediate postoperative period along with a good weight loss. It is necessary for weight loss to adjust gastric band with calibration. Sometimes, patients performed LAGB experienced vomiting, regurgitation, and epigastric discomfort by over-filling. But to the contrary, we may meet patients who do not feel early satiety in the face of over-filling. We report here, the case of a 24-year-old woman with a failure of adjusting gastric band despite of over-filling, and unbuckled band, treated via removal of unbuckled band. Surgical band removal and change, or conversion to other procedures should be considered when unbuckled gastric band are encountered.
Calibration ; Female ; Humans ; Mortality ; Postoperative Period ; Vomiting ; Weight Loss ; Young Adult

PURPOSE: The aim of the study is to present surgical techniques and treatment outcomes of re-banding and sleeve gastrectomy after removal of eroded adjustable gastric band. MATERIALS AND METHODS: A retrospective database analysis was performed to study re-banding or LSG as revisional surgery for band erosion. Technical advancement we adopted included adhesiolysis of liver edge and cardia, retrogastric tunneling, and stapling away from fibrotic cardia. Main outcome measures were success of therapeutic strategies, morbidity, and body mass index (BMI), percentage excess weight loss [%EWL] before and after revision. RESULTS: From 2013 to 2017, a total of 11 patients underwent revisional surgery. Male to female was ratio was 1:10. Six patients underwent revisional sleeve gastrectomy, and five patients underwent re-banding. One patient in sleeve gastrectomy group was diagnosed to have minor leak on CT scan, and recovered by conservative management. The median BMI of the six patients who underwent sleeve gastrectomy was 29.5 kg/m² (27.9 kg/m²–40.8 kg/m²), their median follow-up was 24.8 months (6.5–54.7 months), and their BMI and %EWL at last follow-up was 24.4 kg/m² (22.5 kg/m²–34.6 kg/m²) and 78.4% (19.2%–110.2%) respectively. The median BMI of the five patients who underwent rebanding was 27.3 kg/m² (26.1 kg/m²–41.4 kg/m²), their median follow-up was 16.5 months (4.5–36.4 months), and their BMI and %EWL at last follow-up was 23.5 kg/m² (22.0 kg/m²–30.1 kg/m²) and 83.9% (36.4–123.3%) respectively. CONCLUSION: With advanced surgical techniques we adopted, both re-banding and sleeve gastrectomy are safe and effective as a revisional procedure after removal of eroded gastric band.
Body Mass Index ; Cardia ; Cytochrome P-450 CYP1A1* ; Female ; Follow-Up Studies ; Gastrectomy* ; Humans ; Liver ; Male ; Outcome Assessment (Health Care) ; Retrospective Studies ; Tomography, X-Ray Computed ; Weight Loss