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

Obesity is a serious worldwide health problem causing numerous obesity-related comorbidities such as hyperlipidemia, hypertension, diabetes, and cardiovascular dysfunctions. Recently, many studies indicate that obesity is strongly related with high rate of renal lesions and reducing weight with surgical intervention can improve renal parameters in obese patients, but the effect of bariatric surgery on obesity-induced chronic kidney disease (CKD) is hardly documented. This review study shows that bariatric surgery demonstrates beneficial reduction in proteinuria and albuminuria leading to improve both glomerular hyperfiltration and chronic kidney disease in obese population. Yet, bariatric surgery is not a definite treatment of choice for the obese patients with CKD because of lack of evidence explaining the risk of complications following bariatric surgery and clarification on estimating glomerular filtration rate (eGFR) in obese patients. Future, high quality studies with a long term follow up are required to determine the effective durability of bariatric surgery on obese-related CKD patients.
Albuminuria ; Bariatric Surgery* ; Comorbidity ; Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Hyperlipidemias ; Hypertension ; Obesity ; Proteinuria ; Renal Insufficiency, Chronic*

In United States, national facility accreditation in bariatric surgery was first implemented in 2004 by the ASMBS and by the ACS in 2005. The two programs unified to a single program in 2012: the MBSAQIP (Metabolic and Bariatric Surgery Accreditation & Quality Improvement Program). Accreditation in bariatric surgery signifies that the center has the infrastructure and equipment to care for the morbidly obese, has experienced and qualified staff and surgeons, and participates in data reporting and quality improvement initiatives. In an effort to improve the quality of service offered to bariatric patients worldwide, IFSO elected to form an international board that will advise and endorse national and regional 'centers of excellence' programs. The creation of guidelines that could be applied to different global areas and define surgeon's credentials and institutional requirements for safe and efficient management of morbidly obese patients was the main task. Substantial data have shown that the presence of bariatric facility accreditation is associated with improved outcomes. Therefore, we have to develop and establish a new metabolic and bariatric surgery accreditation system for surgeons and facilities adapted to our country to ensure the safe and effective performance of bariatric surgery.
Accreditation* ; Bariatric Surgery* ; Humans ; Quality Improvement ; Research Design ; Surgeons ; United States

As being obesity is associated with numerous health problems, effective fat loss strategies are required. Although dieting has been the major fat loss method, aerobic exercise programs have been shown to increase cardiorespiratory fitness and preserve fat-free mass. Most aerobic exercise interventions have consisted of moderate-intensity steady-state exercise. Disappointingly, these kinds of exercise programs have resulted in minimal fat loss. In contrast, high-intensity intermittent exercise (HIIE) has been shown to result in greater fat loss. Accumulating evidence suggests that high intensity intermittent exercise (HIIE) has the potential to be an economical and effective exercise protocol for reducing fat of overweight individuals, especially Tabata workout and Crossfit.
Diet ; Exercise ; Methods ; Obesity* ; Overweight

Morbid obesity is associated with several comorbidities and increase risk of mortality. To avoid risk multifactorial intervention must be implemented. Morbid obese subjects who failed dietary and medical treatment should be considered as candidates for bariatric surgery. Although bariatric surgery is the most effective and sustainable treatment for morbidly obese patients, several nutritional deficiencies and metabolic complications can occur. Therefore, the perioperative assessment of nutritional status and education in all undergoing bariatric surgery, and encouragement of adherence to supplementation are important aspects of long term result. The patient had bariatric surgery also should understand postoperative dietary habit and component. The postoperative bariatric diet is based on modification of food texture and consistency, volume of food and liquid, frequency, and duration of meal, food intolerance and nutrients requirement for the patients. In addition, the bariatric patients need to adhere to dietary guideline to optimize long-term weight loss. Therefore structured nutrition counseling and education by qualified dietitians is essential part in the lifetime management of the patients.
Bariatric Surgery ; Comorbidity ; Counseling ; Diet ; Education ; Food Habits ; Humans ; Malnutrition ; Meals ; Mortality ; Nutrition Policy ; Nutritional Status ; Nutritionists ; Obesity, Morbid* ; Weight Loss

Few are familiar with the gluconeogenesis that occurs in the intestine under fasting or the influence of insulin. Recently, however, studies that revealed the function of intestinal gluconeogenesis as a regulatory process for glucose homeostasis and appetite were described. The intestine produces about 25% of total endogenous glucose during fasting and regulates energy homeostasis through communication with the brain. Glucose produced via intestinal gluconeogenesis is delivered to portal vein where periportal neural system senses glucose and sends a signal to the brain to regulate appetite and glucose homeostasis. Moreover, studies uncovered that intestinal gluconeogenesis contributes to the rapid metabolic improvements induced by gastric bypass surgery.
Appetite ; Bariatric Surgery ; Brain ; Fasting ; Gastric Bypass ; Gluconeogenesis ; Glucose* ; Homeostasis ; Insulin ; Intestines* ; Metabolism* ; Portal Vein

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