A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
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Clinical Developments and Metabolic Insights in Total Bariatric Patient Care Volume 8, Number 9
Inside
EDITORIAL MESSAGE..........................3 EDITORIAL BOARD..............................4
SURGICAL PEARLS: TECHNIQUES IN BARIATRIC SURGERY How to Perform an Antiobstruction Stitch .......................8
CASE SERIES
Early Complications of 120 Laparoscopic Greater Curvature Plication Procedures .......................10
REVIEW
Gastric Banding and the Fine Art of Eating ....................................18
ASMBS UPDATE ...............................22
ASK THE EXPERTS: DILEMMAS IN BARIATRIC SURGERY Management of Large Left Upper Quadrant Air-fluid Collection after Laparoscopic Sleeve Gastrectomy ....................................24
TOTAL BARIATRIC CARE Part 1 of 2:
A Proposal: Why We Need a New Aftercare Plan ................................ 26
NEWS AND TRENDS..........................28 CALENDAR OF EVENTS .....................29 MARKETPLACE.................................29 AD INDEX .........................................31
REVIEW GASTRIC
BANDING and the Fine Art of Eating by PAUL O'BRIEN, MD
INTRODUCTION
Laparoscopic adjustable gastric banding (LAGB) has been shown to enable patients with obesity to achieve substantial, durable, and safe weight loss,1,2
which can help
reduce or resolve multiple diseases,3
and prolong survival in patients with obesity.4
improve quality of life, LAGB is a weight loss
surgical procedure performed solely for the purpose of affecting a key physiological function in weight loss, appetite control. In 2005, we conducted a randomized, blinded, crossover trial that showed that the LAGB controls the appetite.5 However, if the LAGB is not placed properly or if the patient does not eat properly, it will not perform at an optimal level. For example, if the band is placed too loosely, then it will not provide the proper level of reduced satiety and appetite, and likely will have little effect on the patient's weight and health. If the band is placed too tightly or if patient eats too fast or takes large
ASK THE EXPERTS This Month's Featured Expert
ALEX GANDSAS,MD, FACS
THIS MONTH'S DILEMMA Management of Large Left Upper Quadrant Air-fluid Collection after Laparoscopic Sleeve Gastrectomy
p24
DON'T MISS!
bites of food, slips and enlargements can occur, leading to reflux, heartburn, vomiting, and sometimes the need for revision. Optimally, the band should be adjusted so that it squeezes the stomach at just the right pressure. If the patient eats correctly and the band is placed correctly, the LAGB should adequately control the patient's appetite, resulting in optimal weight loss.
THE PHYSIOLOGY OF LAGB Dr. Paul Burton, a bariatric surgeon at the Centre for Obesity Research and Education, Melbourne Australia, has studied the physiology and the pathophysiology of the LAGB closely. He used high-resolution video manometry, isotope transit studies, endoscopy, and contrast imaging to understand what happens during eating in normal controls, eating in patients who are doing well after LAGB, and eating in patients who have symptoms of reflux, heartburn,
Continued on Page 18
TOTAL BARIATRIC CARE by ERIC J. DEMARIA, MD
THIS MONTH: Part 1
A PROPOSAL: Why We Need a New Aftercare Plan
p26
Early Complications of 120 Laparoscopic Greater Curvature Plication Procedures
by YOUSSEF ANDRAOS, MD; DANY ZIADE, MD; RANA ACHCOUTY, MD; and MARIETTE AWAD, PhD
INTRODUCTION
A number of bariatric surgical procedures achieve weight loss in patients by multiple mechanisms, including restriction of food intake. Adjustable gastric banding (AGB) and vertical sleeve gastrectomy (VSG) are restrictive procedures that reduce the volume of ingested food in a patient. Roux-en-Y gastric bypass (RYGB) and duodenal switch (DS) work by diminishing the quantity of and the absorption of ingested food.1,2,5,6,15
AGB, VSG,
RYGB, and DS can all be highly effective in achieving weight loss; however, they are not without significant complications, such as perforation, slippage, and gastric erosions for bands. Moreover, VSG, DS, and RYGB are irreversible procedures and are associated with high rates of perforation, bleeding, infection due to foreign material in the body, and gastric leaks.3,4,7,13–15 Leaks in a patient who has undergone VSG are dangerous and can lead to morbidity and mortality. Leaks after VSG are difficult to manage, especially at the level of Angle of His.
Continued on Page 10 ASMBS NEWS AND UPDATE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 CASE SERIES
September 2011