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*

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

Bariatric surgery is considered the most effective treatment for reducing and maintaining weight for morbid obesity. Moreover, this surgery not only reduces weight but also improves comorbidity. However, concern about the safety of the surgery has grown with the favorable effects and has been heightened by high-profile reports in the death of a famous singer after bariatric surgery in Korea. In the beginning of the era of bariatric surgery, animal experiments had been conducted to improve surgical techniques in bariatric surgery. Among animals, a large animal such as pig and rabbit was used to develop and assess surgical skill. Recently, many researchers have been trying to investigate the mechanism of bariatric surgery for the resolution of morbid obesity and related comorbidities. An experimental model employing small animal has been developed to study underlying mechanism. We expect that this experiment will pave the way for developing a novel morbid obesity treatment.
Animal Experimentation* ; Animals* ; Bariatric Surgery* ; Comorbidity ; Korea ; Models, Theoretical ; Obesity, Morbid ; Singing

Laparoscopic sleeve gastrectomy is one of the most popular procedure for the treatment of morbid obesity. Postoperative bronchogastric fistula is very rare and difficult to manage. This complication requires multiple radiological, endoscopic, and surgical procedures. We report here the case of a 28 years old foreign woman who underwent laparoscopic sleeve gastrectomy for morbid obesity in her contury. She complained of a cough with fever and was diagnosed a postoperative bronchogastric fistula. After failure of conservative treatment, she wanted to treat at our hospital. First of all, we inserted a stent for the fistula, however, it failed to treatment. And then, we performed a thoracoscopic segmentectomy and laparoscopic proximal gastrectomy with double tract reconstruction.
Cough ; Female ; Fever ; Fistula* ; Gastrectomy* ; Humans ; Mastectomy, Segmental ; Obesity, Morbid ; Stents

PURPOSE: An obesity clinic was newly opened at a single university hospital in South Korea. We aimed to characterize the profile of patients and current status of the clinic. MATERIALS AND METHODS: 60 patients who have visited the obesity clinic from October 2015 to April 2016 were included in this study. Baseline examination included anthropometric measurement, bioelectrical impedance analysis, blood sampling, and abdominal computed tomography (CT) analysis to estimate abdominal fat distribution. Weight loss program of the clinic constituted of 8 sessions of physician encounter and nutrition counselling. Data on the profile of patients and their completion status were collected and analyzed. RESULTS: Sixty obese adults (21 males and 39 females) were included in the study. The mean (±standard deviation [SD]) body mass index was 31.1±5.7, and abdominal circumference was 100.2±18.3. The mean±SD percentage of body fat measured by bioelectrical impedance analysis was analyzed 35.7±6.2% in males, and 40.6±6.2% in females. The average intra-abdominal fat area was 243.7 cc in males, and 142.5 cc in females. Among 60 subjects, 37 patients (61.7%) are currently on their sessions; 11 patients (18.3%) completed 8 sessions of the program; 8 patients (13.3%) dropped out; 4 patients (6.7%) did not register the program session with initial evaluation only. The mean weight loss (kg) of 11 completers was 5.1 kg. CONCLUSION: Using the strengths of a university hospital as multidisciplinary team care, effective treatment strategies for overweight and obesity are the future directions of our clinic.
Abdominal Fat ; Adipose Tissue ; Adult ; Body Mass Index ; Electric Impedance ; Female ; Humans ; Intra-Abdominal Fat ; Korea ; Male ; Obesity* ; Overweight ; Weight Loss ; Weight Reduction Programs