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Case Report: Gastrobronchial Fistula after Sleeve Gastrectomy: Treated by Laparoscopic Proximal Gastrectomy with Double Tract Reconstruction.

Dong Jin PARK ; Ki Hyun KIM ; Young Suk PARK ; Sang Hoon AHN ; Do Joong PARK ; Hyung Ho KIM

Journal of Metabolic and Bariatric Surgery.2016;5(1):41-43.

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

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Characterizing the Profile of Obese Patients: Example from the Newly Opened Obesity Clinic at a Single University Hospital.

Kye Yeung PARK ; Hoon Ki PARK ; Hwan Sik HWANG ; Tae Kyung HA

Journal of Metabolic and Bariatric Surgery.2016;5(1):36-40.

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

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Can Bariatric Surgery Be a Surgical Treatment to Prevent the Progression of Chronic Kidney Disease?.

Sungji CHOI ; Tae Kyung HA

Journal of Metabolic and Bariatric Surgery.2016;5(1):28-35.

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*

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The Current Status and Necessity of Metabolic and Bariatric Surgery Accreditation System in Foreign Country.

Jong Han KIM

Journal of Metabolic and Bariatric Surgery.2016;5(1):18-27.

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

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The Concepts Change of Exercise Intensity for Obesity.

Sang Min YI

Journal of Metabolic and Bariatric Surgery.2016;5(1):11-17.

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

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Perioperative Nutritional Management of Morbid Obesity.

Hee Joon BAEK

Journal of Metabolic and Bariatric Surgery.2016;5(1):4-10.

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

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Glucose Metabolism in the Intestine.

Eunyoung HA

Journal of Metabolic and Bariatric Surgery.2016;5(1):1-3.

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

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Obesity in the Elderly and Bariatric Surgery.

Ju Hee LEE

Journal of Metabolic and Bariatric Surgery.2015;4(1):6-10.

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

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Assessment Parameters after Bariatric Surgery.

Han Hong LEE

Journal of Metabolic and Bariatric Surgery.2015;4(1):1-5.

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

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Re-Banding vs Sleeve Gastrectomy: Technical Reports and Treatment Outcomes of Two Procedures after Removal of Eroded Adjustable Gastric Band.

Seok Ha KANG ; Seong Min KIM

Journal of Metabolic and Bariatric Surgery.2017;6(2):43-48. doi:10.17476/jmbs.2017.6.2.43

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

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