by Louis O. Jeansonne IV, MD; Craig B. Morgenthal, MD; Brent C. White, MD; and Edward Lin, DO

All from Emory Endosurgery Unit, Emory University School of Medicine

Laparoscopic Roux-en-Y gastric bypass (LGBP) has been shown to be an effective treatment for morbid obesity, both in terms of weight loss and improvement in multiple comorbidities. 1 While the laparoscopic approach offers many advantages to the patient in terms of fewer wound complications, decreased length of hospital stay, and decreased postoperative pain, certain complications of this operation continue to pose difficult clinical problems as the number of procedures performed increases. One such complication is internal hernia through one of the mesenteric defects, which can result in small bowel obstruction, ischemia, or infarction and often requires reoperation.
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by Louis J. Aronne, MD, FACP, and Kathy Keenan Isoldi, MS, RD, CDE

The increased prevalence of obesity has undoubtedly been influenced by a multitude of factors. Some factors are obvious, such as an increased consumption of calories and decreased usage of energy. There are, however, more subtle instigators in the development of obesity. For example, sleep debt, a shift in the population’s ethnic composition, and medications, among other factors, have shown an association with the increased body weight of our population.1 Scientists have recently presented data suggesting two new, unconventional culprits that may affect weight gain.2,3 The type of microbes that inhabit the human gut and exposure to certain viruses have emerged as potential catalysts in the development of obesity.2,4

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Interviewed by Kelvin Higa, MD, FACS

The US experience with the jejunoileal (J-I) bypass was bittersweet. It was an effective weight loss and metabolic instrument, but the side effects, complications, and nutritional consequences gave us a healthy respect for malabsorption. I was recently invited to the Società Italiana di Chirurgia dell’Obesità in Florence, Italy, celebrating the 30th anniversary of the biliopancreatic diversion (BPD). As I am intrigued by the European interest in the gastric bypass and possess great admiration for Professor Scopinaro, I accepted the great honor of interviewing him on this subject. The following represents an annotated conversation that actually began over six years ago between Dr. Scopinaro and myself, and serves as a reflection for those of us in the field of bariatric surgery today who enjoy delving into the history and ideology behind some of its biggest developments. -Kelvin Higa, MD, FACS

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