By Amy Cha, MD; Stacy A. Brethauer MD; Aurora Pryor MD; and Bipan Chand, MD

Column Editor: Marc Bessler, MD

This ongoing column investigates current research in the surgical and clinical aspects of obesity treatment and educates bariatric care professionals on the most up-to-date, concrete information on emerging technologies in the field. The second article in 2009’s Emerging Technologies series is authored by Dr. Amy Cha, Dr. Stacy A. Brethauer, and Dr. Bipan Chand, all from the Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, and Dr. Aurora Pryor from the Duke Center for Weight Loss and Metabolic Surgery, Duke University Medical Center, Durham, North Carolina.Column Editor, Dr. Marc Bessler, a leading authority in the surgical treatment of obesity,  is the Surgical Director, New York-Presbyterian Hospital Center for Obesity Surgery, and Assistant Professor of Surgery, Department of Surgery, Director of Laparoscopic Surgery, Columbia University College of Physicians and Surgeons, New York, New York.  Read the rest of this article »

By Ismael Court, MD; Omar Bellorin, MD; Fernando Dip, MD; Christopher DuCoin, MD; Samuel Szomstein, MD, FACS; and Raul J. Rosenthal, MD, FACS

All from the Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, Florida

Key words: Bariatric surgery, laparoscopy, morbid obesity, Roux-en-Y gastric bypass, sleeve gastrectomy

Introduction
Surgery has become the most effective option in the management of morbid obesity and comorbid conditions.[1–3] Surgery for morbid obesity provides excellent short-term and long-term outcomes, decreasing overall mortality and providing a marked survival advantage.[5] Sleeve gastrectomy (SG) appears as a novel surgical treatment option to manage morbid obesity.[3–10] Read the rest of this article »

by J.K. Champion, MD, FACS

Dr. Champion is Director of Bariatric Surgery, Northside Hospital, Atlanta, GA and Clinical Professor of Surgery, Mercer University School of Medicine, Macon, Georgia.

Introduction
Bariatric surgery—no matter the procedure, no matter the surgeon with however much experience—will result in complications and surgical emergencies. The average incidence of in-hospital complications after bariatric surgery, as reported by Livingston,[1] is approximately 10 percent, and the American Society for Metabolic and Bariatric Surgery Centers of Excellence program (ASMBS SRC) reports a 90-day incidence of readmissions of 4.7 percent and a reoperation rate of 2.6 percent in its initial review of the first 106 centers approved. Read the rest of this article »

by Erica R. Podolsky, MD, Wade Naziri, MD, and Paul G. Curcillo II, MD

Drs. Podolsky and Curcillo are from Drexel University College of Medicine, Department of Surgery, Philadelphia, Pennsylvania, and Dr. Naziri is from Southern Surgical Associates, PA, Greenville, North Carolina.

Objective. The single port access (SPA) technique was introduced in 2007 as an alternative means to enter the abdominal cavity for laparoscopic procedures.[1] We present a series of patients who underwent gastric band placement using this access technique.
Design/Setting/Participants. Nineteen obese patients underwent placement of SPA gastric band by a single surgeon.
Results. All bands were placed successfully, leaving the port in the initial access incision. No operative or postoperative complications were encountered.

Conclusions. We present a series of successful gastric band placement using the SPA technique. This technique is an alternative to standard multiport insertion, and offers an enhanced cosmetic result and the possibility of decreased morbidity by reducing incision number. The end result is a right lateral abdominal incision accommodating the port. Read the rest of this article »

by James W. Saxton, JD; Maggie M. Finkelstein, JD; and Susan Gallagher Camden, RN, MSN, PhD Read the rest of this article »

by Daniel J. Rosen, MD, and Alfons Pomp, MD, FACS

Both from Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York.

Introduction
It has been over a decade since Hess described a significant modification of the Scopinaro bilio-pancreatic diversion (BPD).[1,2] In the duodenal switch (DS), a vertical sleeve gastrectomy provides intake restriction, replacing the horizontal gastric pouch of the Scopinaro operation with its distensible fundus. A pylorus-sparing duodenoileostomy accomplishes a very distal intestinal bypass, contributing a malabsorptive component to the weight loss. This can be construed as a bariatric application of the duodeno-jejunostomy DeMeester pioneered to treat bile reflux, and decreases the incidence of marginal ulcerations seen with antrectomy and Roux-en-Y biliary diversion.[3] The DS provides excellent weight loss and achieves significant improvement of obesity-related comorbidities.[4,5] Read the rest of this article »

by Manuel Cáceres, MD; David. A. Geller, MD, FACS;
and Carol A. McCloskey, MD, FACS

Drs. Cáceres and McCloskey are from University of Pittsburgh Medical Center Division of Minimally Invasive Bariatric and General Surgery Pittsburgh, Pennsylvania. Dr. Geller is from University of Pittsburgh Medical Center Liver Cancer Center.

Background
The obesity epidemic and the evolution of minimally invasive surgical techniques have dramatically increased the number of bariatric procedures performed annually. Roux-en-Y gastric bypass (RYGB) is the most frequently performed bariatric procedure in the United States. Based on incidental pathology, it is estimated that 2 to 2.5 percent of patients undergoing bariatric surgery will have an unexpected pathology found during surgery or during preoperative workup.[1,2] These unexpected findings rarely interfere with the completion of the planned bariatric surgery. Hepatic hemangiomas are the most common benign liver lesions. The prevalence of this hepatic lesion is between 5 and 20 percent.[3] Usually these benign tumors are asymptomatic and are found incidentally on screening radiological images, intraoperatively, or at autopsy. Controversy still exists about the excision of giant hemangiomas, defined as lesions larger than 4cm in diameter,[4,5] and resection is often limited to lesions that have an uncertain diagnoisis, rapid growth, or associated symptoms. Read the rest of this article »

by Tracy Martinez, RN, BSN, CBN

Background
There are an estimated 93 million Americans who are obese and an estimated 12 million suffering from morbid obesity. This life-threatening disease in and of itself affects one’s mobility and quality of life, and creates social stigmas.[1] Studies suggest a considerable increase in this disease among all groups regardless of age, ethnicity, and socioeconomic background.[2]

Some of the most alarming statistics are in our children, predicting an even graver future. The proportion of obese and overweight children and adolescents in the United States nearly doubled in the 1980s alone, and the numbers continue to rise.[3,4] Unfortunately, many, if not most, of our patients who suffer from morbid obesity have endured a lifetime of loneliness, discrimination, and self blame. Why is this still true? As you read this article, reflect on the statistics that still remain in today’s day and age, and why these stigmas still exist. Read the rest of this article »