Esophageal and gastric pouch dilatations are common complications that occur after laparoscopic adjustable gastric banding, often performed to treat morbid obesity. Most cases are treated by a gastric band deflation or a removal of band. Nevertheless, additional surgical procedures are rarely ever needed to treat persistent dysphagia and pouch dilatation. We report here, the case of a 38-year-old woman with constant vomiting and severe persistent epigastric pain despite the gastric band deflation, and a band scar stenosis, treated via laparoscopic conversion sleeve gastrectomy. Surgical band scar revision, or revision sleeve gastrectomy, may be considered if gastric pouch dilation and dysphagia are not treated by gastric band deflation.
Adult ; Cicatrix* ; Constriction, Pathologic* ; Deglutition Disorders ; Dilatation* ; Esophagitis, Peptic ; Female ; Gastrectomy* ; Humans ; Obesity, Morbid ; Vomiting

PURPOSE: Laparoscopic greater curvature plication (LGCP) is the new emerging surgical technique for treating morbid obesity. The short-term results of LGCP are not yet available in Korea. MATERIALS AND METHODS: We retrospectively reviewed prospectively collected 18 patients' data with over 30 kg/m2 body mass index (BMI) who underwent LGCP from January 2013 to October 2014. Fifteen of these patients who had more than 3 months of follow-up were included in this report. LGCP was performed laparoscopically using interrupted and continuous sero-muscular suture from fundus to antrum over a 36-French bougie. RESULTS: Mean age at the time of surgery was 33.1+/-7.9 years in our patients. Mean weight was 98.9+/-15.5 kg and mean BMI was 35.7+/-4.1 kg/m2 preoperatively. The percentage of excess BMI loss (%EBL) in the postoperative first, third and sixth month was 33.6+/-9.1, 51.6+/-15.4 and 64.5+/-18.3%, respectively. There were no 30-day peri-operative mortality and major complications including bleeding, leakage and conversion bariatric surgery. CONCLUSION: These findings show that LGCP is a safe and effective weight loss option for morbidly obese Korean patients in short-term period. Randomized prospective control studies between gastric banding or sleeve gastrectomy and LGCP, are needed to confirm short-term weight loss effect and safety of LGCP in this group of patients.
Bariatric Surgery ; Body Mass Index ; Follow-Up Studies ; Gastrectomy ; Hemorrhage ; Humans ; Korea ; Mortality ; Obesity, Morbid ; Prospective Studies ; Retrospective Studies ; Sutures ; Weight Loss

PURPOSE: Sleeve gastrectomy (SG) is an emerging approach, but there have been a surge in popularity because of its perceived technical simplicity, feasibility, and good outcomes. We describe results of a single fully experienced gastric surgeon's short-term outcomes of laparoscopic sleeve gastrectomy (LSG) and robotic sleeve gastrectomy (RSG) for morbidly obese patients. MATERIALS AND METHODS: We retrospectively reviewed 20 patients underwent LSG and RSG from July 2010 to February 2014. RESULTS: The mean age was 36.3+/-10.1 years, the mean preoperative body mass index (BMI) was 37.3+/-5.4 kg/m2. Mean operative time was 124.4+/-36.2 min. The postoperative length of stay was 5.1+/-4.1 day. There was no open conversion and mortality, nor severe postoperative complication found in the LSG and RSG cases. The mean BMI decreased to 26.1+/-2.5 kg/m2 at 1 year and the mean percentage excess weight loss was 69.8+/-24.9% at 1 year. CONCLUSION: Effective weight loss without complication would be achieved by sleeve gastrectomy if the procedure is performed by experienced gastric surgeon. However, further well-designed comparative studies with larger sample size are warranted to prove this preliminary result.
Body Mass Index ; Gastrectomy* ; Humans ; Laparoscopy ; Length of Stay ; Mortality ; Obesity, Morbid ; Operative Time ; Postoperative Complications ; Retrospective Studies ; Sample Size ; Weight Loss

As the epidemic of morbid obesity has been rising globally over the decade, bariatric surgery has also been grown to manage obesity and its comorbidities. Besides of its safety, laparoscopic adjustable gastric banding (LAGB) has been known to be more effective in handling obesity with regard to weight loss and its long-term sustainability, compared to medical treatments. Failure of LAGB, defined as either the unsatisfactory weight loss or the development of major long-term complications, results in revision or removal of gastric band. After explantation of gastric band, rebanding or conversion into other bariatric surgeries such as Roux-en-Y gastric bypass or sleeve gastrectomy is required in terms of maintaining weight loss. Major cause of band removal alone is psychogenic factors like patients' anxiety or feeing discomfort without anatomic problems. In Korea there has been grown of patients' vague demand to remove their gastric band regarding the death of a celebrity. Considering such trend, in order to prevent indiscriminate finish of the treatment, suggestion of appropriate time for gastric band removal on the basis of analyzing the course of weight loss and the occurrence of complications is essential.
Anxiety ; Bariatric Surgery ; Comorbidity ; Fees and Charges ; Gastrectomy ; Gastric Bypass ; Korea ; Obesity ; Obesity, Morbid ; 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

The prevalence of morbid obesity is rising progressively among elderly patients in the world. The incidence of obesity in Koreans, 60 years and older was 34.2% in 2012. Although there was no consensus on criteria for weight loss management in aged persons, it is clear that weight loss therapy improves metabolic syndrome, physical function and health-related quality of life in obese older persons. The current therapeutic tools available for weight management in older persons do not differ from those for weight management in general; 1) lifestyle intervention involving diet, physical activity, and behavior modification; 2) pharmacotherapy; and 3) surgery. Currently, bariatric surgery can be safely performed with low morbidity and mortality rates in obese older people. In addition, the elderly can lose clinically significant amounts of weight after bariatric surgery and significant weight reduction is associated with an improvement in obesity-related co-morbidities and an overall reduction in medication requirements. Patient selection for bariatric surgery should not be based on age alone.
Aged* ; Bariatric Surgery* ; Behavior Therapy ; Consensus ; Diet ; Drug Therapy ; Humans ; Incidence ; Life Style ; Mortality ; Motor Activity ; Obesity* ; Obesity, Morbid ; Patient Selection ; Prevalence ; Quality of Life ; Weight Loss

Body weight and body mass index (BMI) to be simply measured and analyzed are most common methods to assess the effect of bariatric surgery. In addition, measurement of subcutaneous and visceral adipose tissues by imaging technique has been adapted as a kind of anthropometrics. After bariatric surgery, obese patients with metabolic disorder are tested by conventional parameters such as fasting blood glucose, blood lipid panel, insulin level and blood pressure. Recently, the adipokines associated with inflammation, such as high-sensitive C-reactive protein and adiponectin, are accepted as new measure of follow-up examination. In this review, various measurement parameters, from anthropometrics to cytokine, to assess the effect of bariatric surgery are introduced, so that bariatric surgeons could keep in mind its significance in Korea where bariatric surgery is still unpopular.
Adipokines ; Adiponectin ; Bariatric Surgery* ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Body Weight ; C-Reactive Protein ; Fasting ; Follow-Up Studies ; Humans ; Inflammation ; Insulin ; Korea

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

PURPOSE: The authors undertook this study to compare their modified version of sleeve gastrectomy with conventional sleeve gastrectomy in terms of the severity and incidence of gastroesophageal reflux. MATERIALS AND METHODS: This study was conducted for the patients that underwent primary laparoscopic sleeve gastrectomy in a single center from 2011 to 2015. Patients that underwent conventional LSG were allocated to Group A (n=46), and sleeve contouring gastrectomy to Group B (n=45). Postoperatively %EBMIL, PPI use, and endoscopy findings, and receipt of conversion surgery were compared. RESULTS: Age, gender (F:M), and baseline BMI in groups A and B were 34.2±10.5 years vs. 30.9±8.9 years (P=0.142), 28:18 vs. 30:15 (P=0.565), and 36.8±8.9 kg/m² vs. 35.5±5.8 kg/m² (P=0.046), respectively. %EBMIL values at 1 year postoperatively were not different (P=0.946), mean durations of PPI use were 141.2±240.3 (30–1160) days vs. 71.9±24.3 (60–128) days, respectively (P=0.058). Endoscopic findings at 1 year were LA-M in 22/32 (68.8%) vs 19/24 (79.2%), LA-A in 7/32 (21.9%) vs. 5/24 (20.8%), LA-B in 1/32 (3.1%) vs. 0/24 (0.0%), and LA-C in 2/32 (6.3%) vs. 0/24 (0.0%) (P=0.483). Numbers of patients used PPIs over 1 year were 4/46 (8.77%) vs. 0/45 (0.0%) (P=0.043), and conversions to RYGP were 1/46 (2.21%) vs. 0/45 (0.0%), respectively (P=0.320). CONCLUSION: Contouring of the sleeve in LSG in this study might reduce the incidence of de novo GERD without compromising weight loss.
Endoscopy ; Gastrectomy* ; Gastroesophageal Reflux* ; Hernia, Hiatal ; Humans ; Incidence ; Weight Loss

While conventional laparoscopy is the gold standard for bariatric procedures, robot platforms can provide better ergonomics for the surgeon, better visualization of the anatomy, easier dissection through articulated devices, which cannot be supported by laparoscopy. This review explores the literature and examines the reported outcomes and complications in using robotics for bariatric surgery. Robotic approaches to adjustable gastric banding, sleeve gastrectomy, gastric bypass, biliopancreatic diversion with duodenal switch, and revisional surgery are examined. Although many studies suffer from low levels of evidence, robotic application in the field of bariatric surgery continues to evolve with increasing literature and technology in surgical robotics.
Bariatric Surgery* ; Biliopancreatic Diversion ; Gastrectomy ; Gastric Bypass ; Human Engineering ; Laparoscopy ; Robotics