by Carol Ewing Garber, PhD, FAHA, FACSM

Dr. Garber is with Teachers College, Columbia University, New York, New York.

Introduction
It is clear that a physically active lifestyle is important for good health and promoting and maintaining weight loss.[1–4] Following bariatric surgery, patients who are physically active lose more weight,[5–7] and greater weight loss is associated with improved quality of life,[5] reduced all-cause mortality, and mortality due to cancer, diabetes, and cardiovascular disease, with the greatest impact on mortality due to the reduction in cancer deaths.[8] Exercise volumes of at least 1,000 to 1,200kcal per week (approximately 150 minutes per week) are ideal for most adults to attain the majority of substantial health and fitness benefits of exercise, but as much as 1,800 to 2,200kcal per week (>250 minutes per week) in purposeful exercise and physical activity may be needed to promote and maintain weight loss, especially among persons who spend much of their time in sedentary pursuits.[1,2,4]

There are many benefits of regular physical activity beyond weight loss that are particularly important to patients being treated with bariatric surgery, and that make physical activity a vital complementary health measure for these patients.

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by Geoffrey P. Kohn, MBBS, FRACS; Stephen P. Haggerty, MD, FACS; D. Wayne Overby, MD; Robert D. Fanelli, MD, FACS, FASGE; and Timothy M. Farrell, MD, FACS

Drs. Kohn, Overby, and Farrell are from the Department of Surgery, University of North Carolina at Chapel Hill, North Carolina; Dr. Haggerty is from the Department of Surgery, North Shore University Health System, Evanston, Illinois; and Dr. Fanelli is from the Department of Surgery, Berkshire Medical Center, Pittsfield, Massachusetts.

Introduction
Obesity may be the most significant disease epidemic affecting Western nations in the 21st century. Morbid obesity and its associated comorbidities threaten the lives of millions of Americans. However, medical therapies have been demonstrated to not achieve persisting weight loss or comorbidity resolution. Three minimally invasive surgical procedures have emerged as viable treatment options for morbid obesity—Roux-en-Y gastric bypass (RGB), adjustable gastric banding (AGB), and biliopancreatic diversion with duodenal switch (BPD-DS), though there remains a marked paucity of comparative data.

We participated in developing the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Guideline for Clinical Application of Bariatric Surgery, and in doing so reviewed the literature and made best-evidence recommendations to allow selection of the type of bariatric operation most appropriate to specific patients’ requirements.[1] This article summarizes our clinical practice guideline.

A search of the literature was performed, using both electronic and physical resources. Inclusion of a study required focus on at least one of the following categories of information: surgical outcomes, guidelines, healthcare economics, or quality of life. Search terms used were therefore combinations of obesity surgery, bariatric surgery, gastric bypass, gastroplasty, gastric band, biliopancreatic diversion, duodenal switch, sleeve gastrectomy, reoperation, revision, laparoscopic, diabetes, hypertension, hyperlipidemia, sleep apnea, nutrition, and complications.

Manual reference checks of published review articles were performed to supplement the above electronic searches. The articles were graded on level of evidence and recommendations were made. Read the rest of this article »

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by Juan Camilo Barreto, MD; Michael G. Sarr, MD; and James M. Swain, MD

All from the Division of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, Minnesota.

The Problem
Cirrhosis is an unexpected finding at the time of bariatric surgery in about 1 to 2 percent of the patients undergoing elective bariatric surgery. The surgeon is then suddenly faced with several questions that may be difficult to address at the moment of a planned bariatric operation, with the patient already under general anesthesia. Would it be appropriate to continue with the planned elective bariatric procedure? Is it necessary to consider a different alternative, and if so, which one? Is portal hypertension present and, if so, is it an absolute contraindication to proceed?

A different situation occurs when a patient with known hepatic cirrhosis presents for consideration for bariatric surgery. What type of workup is required? At what point would a bariatric procedure be contraindicated? What about the patient with morbid obesity who is being evaluated for a liver transplant?

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Popularity: 16% [?]

by Daniel J. Rosen, MD; Shirlee Jaffe, MD; Lawrence Cutler, MD; Alfons Pomp, MD
All from Departments of Obstetrics and Gynecology and Surgery New York Presbyterian Hospital, Weill Cornell Medical College

ABSTRACT
Intussusception is a rare complication of Roux-en-Y gastric bypass, and can present a difficult diagnostic challenge in the pregnant patient. We describe a case of a 20-year-old woman at 32 weeks gestation that presented with sudden onset abdominal pain. On exploration, an intussuception with necrotic bowel was found and resected. Intraoperatively, a cesarean section was emergently performed for active labor and breech presentation. With the increasing number of bariatric procedures being performed in obese women of childbearing age, practitioners should be aware of this serious complication. Read the rest of this article »

Popularity: unranked [?]