Bariatric Times

FEB 2018

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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C l i n i c a l D e v e l o p m e n t s a n d M e t a b o l i c I n s i g h t s i n To t a l B a r i a t r i c P a t i e n t C a r e Volume 15, Number 2 February 2018 A P e e r - R e v i e w e d P u b l i c a t i o n Follow us. Inside EDITORIAL MESSAGES ................ 3 A Message from Dr. John M. Morton: The Future of Bariatric Surgery: Digitalization, Democratization, and Doctors A Message from Dr. Christopher Still: More than a Word—Putting Patients First REVIEW .................................. 10 The Ultimate Revisional Laparoscopic Roux-en-Y Gastric Bypass Technique REVIEW .................................. 13 The Role of Bariatric Surgery to Treat Diabetes: Current Challenges and Perspectives BARIATRIC CENTER SPOTLIGHT .............................. 20 Fairfield County Bariatrics, Southern Connecticut COMMENTARY ........................ 24 Response to ACOEM Guideline Statement on Obesity in the Workplace NEWS AND TRENDS ................ 24 OBITUARY ............................... 25 Remembering Dr. Charles Ernest Morton III JOURNAL WATCH .................... 25 REVIEW The Ultimate Revisional Laparoscopic Roux-en-Y Gastric Bypass Technique by FELIPE CHAUX, MD; MAURICIO FRANCO, MD; and J. ESTEBAN VARELA, MD, FACS, FASMBS INTRODUCTION Bariatric surgery failure, weight regain, and diabetes recurrence after laparoscopic Roux-en-Y gastric bypass (LRYGB) has led to an increase in the number of revisional bariatric operations performed, which have now become common practice within United States bariatric centers. The mechanisms for weight loss failure and regain appear to be multifactorial; however, failures might be attributed to technical failures at various steps throughout the LRYGB procedure. We describe a stepwise approach and technique of a complete and single-staged revisional LRYGB (i.e., ultimate revision). Five potential failure sites and techniques are addressed during this revisional LRYGB: 1. Gastric pouch revision 2. Placement of a silastic ring 3. Gastro-jejunal anastomosis revision 4. Remnant gastrectomy 5. Lengthening of the bilio- pancreatic and alimentary limbs to 150cm. This revisional technique might not only reduce the need for future reoperations and its associated morbidity and mortality but might also be associated with significant healthcare system cost savings. Page 10 Download the BT app for your mobile device! iTunes Google (Android) Scan this QR code with your QR reader for the digital edition of Bariatric Times. Page 13 Presorted Standard U.S. Postage PAID Lebanon Junction, KY Permit #344 The Role of Bariatric Surgery to Treat Diabetes: Current Challenges and Perspectives REVIEW by CHRYSI KOLIAKI, STAVROS LIATISE, CAREL W. LE ROUX, and ALEXANDER KOKKINOS INTRODUCTION Type 2 diabetes mellitus (T2DM) is associated with obesity and multiple metabolic derangements, leading to increased morbidity, mortality, and financial burden. Although population-based efforts through lifestyle interventions are essential to prevent and deal with the parallel epidemics of obesity and T2DM, few patients who have already developed T2DM and obesity are able to adhere to and accomplish long-term weight loss and glycemic control. 1 Given its role in metabolic regulation, the gastrointestinal tract constitutes a biologically and clinically meaningful target to treat T2DM, especially in light of accumulating experimental and clinical evidence that surgery with gastrointestinal manipulations might result in T2DM remission. 2 Surgical operations with intestinal diversion and mainly duodenal- jejunal exclusion have consistently shown beneficial effects on glucose homeostasis by reducing insulin resistance and increasing insulin secretion. 3

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