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One-Year Outcomes of Laparoscopic Adjustable Gastric Banding Based on Bariatric Analysis and Reporting Outcome System (BAROS) in Morbidly Obese Korean Patients.

Jong Seob PARK ; Sang Moon HAN

Journal of Metabolic and Bariatric Surgery.2016;5(2):67-72.

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

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Feasibility and Safety of Conversion Sleeve Gastrectomy after Failed Primary Adjustable Gastric Banding or Sleeve Gastrectomy.

Jong Seob PARK ; Sang Moon HAN

Journal of Metabolic and Bariatric Surgery.2016;5(2):62-66.

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

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Preoperative Nutritional Management of Patients with Morbid Obesity.

Juyeon HONG ; Sungsoo PARK

Journal of Metabolic and Bariatric Surgery.2016;5(2):53-61.

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

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A Safe and Efficacious Alternative to Roux-en-Y Gastric Bypass for the Treatment of Morbid Obesity and Type 2 Diabetes - One Anastamosis / Mini Gastric Bypass.

Chun Hai TAN ; Young Suk PARK ; Dong Wook KIM ; Yoontaek LEE ; Sang Hoon AHN ; Do Joong PARK ; Hyung Ho KIM ; Anton CHENG

Journal of Metabolic and Bariatric Surgery.2016;5(2):45-52.

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

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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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