Update on Endoluminal Treatment Options for Morbid Obesity
June 2009
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 »
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Laparoscopic Sleeve Gastrectomy
June 2009
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 »
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Clinical Pearls in Managing Bariatric Surgical Emergencies
June 2009
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 »
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Single Port Access (SPA) Gastric Band Placement
June 2009
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 »
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The Duodenal Switch Revisited
June 2009
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 »
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