Ethnicity Influences Weight Loss 1 Year After Bariatric Surgery: a Study in Turkish, Moroccan, South Asian, African and Ethnic Dutch Patients

Several studies conducted in the USA have demonstrated that the effectiveness of bariatric surgery differs between patients from African and European origin. However, little is known on differences in outcomes after bariatric surgery between individuals from other ethnic backgrounds. In this retrospective study, we found that, in terms of weight loss, gastric bypass surgery is less effective in African, South Asian, Turkish and Moroccan patients than in their ethnic Dutch counterparts. Our results underscore that ethnic differences in the effectiveness of bariatric surgery are not limited to those between patients of African and European origin, but extend to other minority groups as well. Therefore, it is important that prospective studies both determine ethnic differences in weight loss-related improvement of co-morbidities and elucidate the exact reasons for these ethnic disparities.     

Four-year weight outcomes of laparoscopic gastric bypass surgery and adjustable gastric banding among multiethnic adolescents

BackgroundExtreme obesity among U.S. adolescents is a serious problem and has disproportionally affected ethnic minorities. Recently, surgical intervention for morbid obesity in adolescents has gained increasing support. Little information is available on the long-term effectiveness of bariatric surgery among ethnic minority adolescents. We have reported the weight and body mass index (BMI) results for a large cohort of predominantly Hispanic adolescents who underwent bariatric surgery in a private practice setting.MethodsA retrospective medical chart analysis of 78 adolescents (77% Hispanic, 19% non-Hispanic white, 1% non-Hispanic black, and 3% other; 77% female; 16–19 years old), who had undergone gastric bypass or banding surgery from 2002 to 2009, was conducted. All patients had met the National Institutes of Health criteria for bariatric surgery. Repeated measures mixed linear modeling was used to assess the changes in weight/BMI from baseline to 4 years after surgery.ResultsNon-Hispanic whites had lost 104.81 lb and 17.29 BMI units at 1 year after surgery (P <.001 for both). Hispanics had lost 91.55 lb and 15.06 BMI units at 1 year after surgery (P <.001 for both). The non-Hispanic whites had lost 18.56 BMI units and Hispanics 16.15 units during the 4 year postoperative period. A weight loss plateau occurred at 12 months for the non-Hispanic whites and at 18 months for the Hispanics; both groups had maintained their weight loss at 4 years after surgery.ConclusionBariatric surgery resulted in significant weight loss that was maintained at 4 years postoperatively among obese ethnic minority adolescents. Our results have shown that bariatric surgery is a safe and effective treatment option for permanent weight improvements in this demographic.     

Race, Socioeconomic Status, and the Use of Bariatric Surgery in Michigan

Studies examining the characteristics of patients undergoing bariatric surgery in the USA have concluded that the procedure is not being used equitably. We used population-based data from Michigan to explore disparities in the use of bariatric surgery by gender, race, and socioeconomic status. We constructed a summary measure of socioeconomic status (SES) for Michigan postal ZIP codes using data from the 2000 census and divided the population into quintiles according to SES. We then used data from the state drivers’ license list and 2004–2005 state inpatient and ambulatory surgery databases to examine population-based rates of morbid obesity and bariatric surgery in adults according to gender, race, and socioeconomic status. There is an inverse linear relationship between SES and morbid obesity. In the lowest SES quintile, 13% of females and 7% of males have a body mass index >40 compared to 4% of females and males in the highest SES quintile. Overall rates of bariatric surgery were highest for black females (29.4/10,000), followed by white (21.3/10,000), and other racial minority (8.6/10,000) females. Rates of bariatric surgery were low (<6/10,000) for males of all racial groups. An inverse linear relationship was observed between SES and rates of bariatric surgery among whites. However, for racial minorities, rates of surgery are lower in the lowest SES quintiles with the highest rates of bariatric surgery in the medium or highest SES quintiles. In contrast with prior studies, we do not find evidence of wide disparities in the use of bariatric surgery.     

Burn patterns of Asian ethnic minorities living in West Yorkshire, UK

Whereas burn morbidity and mortality have been well studied among natives of Southeast Asia, few have studied the epidemiology of burn injury among UK Asian ethnic minority immigrants. A 1 year prospective study of all patients presenting with burns to Bradford Royal Infirmary was carried out. Four hundred and sixty patients were studied, 188 (41%) were Asian ethnic minorities. The average patient age was 17 years for the Asian group and 27 years for the non-Asian patients. Contact burns were responsible for 29% of injuries in Asian patients and 19% in the other group. Thirty-seven percent of contact burns in the Asian ethnic minority group were caused by hot irons. Eleven percent of Asian patients had treated their burn with inappropriate remedies including saiti, butter, and toothpaste. There were no significant differences between Asian and non-Asian patients in terms of large or deep burns, nor in mortality. Morbidity and mortality from burn injury among UK Asian patients and other groups in the UK are similar; however, a disproportionate number of Asian patients sustain smaller burns. Much of this is behaviour related, and it is hoped that through preventative measures a marked reduction in the number of Asian ethnic minority burns can be achieved.     

Procedure incidence and in-hospital complication rates of bariatric surgery in the United States

BACKGROUND: Complication rates for bariatric surgery have been reported primarily from academic centers with specialized programs. The rates may not reflect those occurring in the community. METHODS: The National Hospital Discharge Survey (NHDS) database maintained by the Center for Disease Control (CDC) was queried to determine the national incidence and complication rate for bariatric surgery as performed in the United States. RESULTS: The number of bariatric procedures rapidly increased from 6,868 in 1996 to 45,473 in 2001, with most of the increase attributable to a very large rise in the annual number of Roux-en-Y gastric bypasses performed. The in-hospital complication rate was 9.6% and 8.6% of patients has a length of stay exceeding 7 days. Cholecystectomies were performed concurrently in 28% of cases and were not associated with increases in complication rates or longer hospital stays. For those undergoing surgery, the most common preoperative comorbid conditions were hypertension (34%), arthritis (27%), GERD (22%), sleep apnea (22%), and diabetes (18%). CONCLUSIONS: The rate at which bariatric procedures are being performed is rapidly increasing, resulting in the need to establish practice standards. In-house complication rates derived from a cross section of US practices compare favorably with those reported from specialized centers. Based on these nationally representative data, the expected in-house clinically significant complication rate for bariatric operations is approximately 10%. As that is the average complication rate observed nationally, it serves as the benchmark to which bariatric surgery programs can compare themselves.     

Investigating racial disparities in bariatric surgery referrals

BackgroundPrior studies investigating racial, socioeconomic, and/or insurance disparities with regard to access to care and outcomes in bariatric surgery have been performed with varying results.ObjectivesOur aim was to determine if racial or ethnic disparities exist in referral patterns for bariatric surgery at a single center.MethodsAn institutional, retrospective chart review from January 2012 through June 2017 was performed for patients meeting referral criteria to bariatric surgery. Data collection was limited to patients referred to the bariatric surgery clinic from on-site primary care clinics.ResultsIn total, 4736 patients were eligible for bariatric surgery during the study period. Patients were 63.8% female (n = 3022), and 36.2% male (n = 1714); 53.9% white (n = 2553), 37.8% black (n = 1790), and 8.3% Hispanic (n = 393). Female patients were more likely to be referred than male patients (5.5% versus 4.1%, χ² 4.59, P = .032). On univariate comparison, Hispanic patients were less likely to be referred compared with black or white patients (2.0% versus 5.3% and 5.2%, χ² 7.88, P = .019).ConclusionHispanic patients were less likely to be referred at our institution for bariatric surgery compared with white or black patients. A barrier to referral may be explained by the disproportionate number of Hispanic patients that were designated as “self-pay” rather than private insurance or Medicaid/Medicare coverage that is required for bariatric surgery referral. This finding underscores the need for further research surrounding barriers to access to care for Hispanic patients.     

Patient perspectives on surgeon-specific outcome reports in bariatric surgery

BackgroundSurgeon specific outcome reports (SSOR) in the UK can be accessed freely by the general public to promote transparency and informed decision-making. However, the views amongst bariatric patients concerning these data are unknown.ObjectivesThe aims of this study were to determine patient awareness, views and priorities for outcome reporting in bariatric surgery, and to provide recommendations for future surgeon-specific outcome reporting through the United Kingdom National Bariatric Surgery Registry.SettingBariatric surgical unit in a UK university teaching hospital.MethodsWe adapted a previously validated questionnaire and surveyed the views of 150 patients in a single bariatric surgical unit. We collected data concerning awareness, views, and future priorities for outcome reporting.ResultsA full 73% of participants were unaware they could access SSOR. Of the participants that were unaware, 75% stated that they would have accessed SSOR had they been aware they could. Of the participants that had previously accessed SSOR, 86% stated they understood the data, although 61% indicated it did not influence their choice of surgeon. The majority of participants favored public release of outcome reports at the surgeon-level (75%) and hospital-level (83%). The 3 main priorities indicated by participants for future outcome reporting were complication rates (91%), patient reported outcome measures (90%), and reoperation rate (89%), all at the surgeon level.ConclusionPatient awareness of outcome reporting is poor. Efforts must be made to increase awareness of SSOR. Patients should be incorporated as key stakeholders in determining future outcome reporting in bariatric surgery.     

Bariatric surgery history among substance abuse treatment patients: prevalence and associated features

BackgroundIn 2006, Brighton Hospital (Brighton, Michigan), a comprehensive substance abuse treatment facility, began observing increasing admissions who reported a history of bariatric surgery. Data on the magnitude of this postoperative outcome is lacking. The hospital instituted procedures to better track this variable in the electronic medical records at admission to estimate the prevalence of bariatric surgery history among substance abuse treatment admissions.MethodsThe data analyzed for the present report included the electronic medical record data obtained from 7199 patients admitted from 2006 to 2009 and the chart review data from 54 bariatric patients and 54 controls.ResultsThe findings suggested that 2-6% of recent admissions were positive for a bariatric surgery history. The substance abuse treatment patients with a bariatric surgery history were significantly more likely to be women and nonsmokers. The bariatric and nonbariatric patients were equally likely to have been diagnosed with alcohol dependence; however, bariatric patients were significantly more likely to also have a diagnosis of alcohol withdrawal. Relative to the matched control cases, the alcohol-dependent bariatric patients reported consuming a significantly greater maximum quantity of drinks per drinking day.ConclusionA bariatric surgery history might be overrepresented in substance use programs and such patients' recovery efforts might pose unique challenges.     

Patient race and the likelihood of undergoing bariatric surgery among patients seeking surgery

Background

Ethnic minority adults have disproportionately higher rates of obesity than Caucasians but are less likely to undergo bariatric surgery. Recent data suggest that minorities might be less likely to seek surgery. Whether minorities who seek surgery are also less likely to proceed with surgery is unclear.

Methods

We interviewed 651 patients who sought bariatric surgery at two academic medical centers to examine whether ethnic minorities are less likely to proceed with surgery than Caucasians and whether minorities who do proceed with surgery have higher illness burden than their counterparts. We collected patient demographics and abstracted clinical data from the medical records. We then conducted multivariable analyses to examine the association between race and the likelihood of proceeding with bariatric surgery within 1 year of initial interview and to compare the illness burden by race and ethnicity among those who underwent surgery.

Results

Of our study sample, 66 % were Caucasian, 18 % were African-American, and 12 % were Hispanics. After adjustment for socioeconomic factors, there were no racial differences in who proceeded with bariatric surgery. Among those who proceeded with surgery, illness burden was comparable between minorities and Caucasian patients with the exception that African-Americans were underrepresented among those with reflux disease (0.4, 95 % CI 0.2–0.7) and depression (0.4, 0.2–0.7), and overrepresented among those with anemia (4.8, 2.4–9.6) than Caucasian patients.

Conclusions

Race and ethnicity were not independently associated with likelihood of proceeding with bariatric surgery. Minorities who proceeded with surgery did not clearly have higher illness burden than Caucasian patients.

     

Obesity and bariatric surgery: a systematic review of associations with defecatory dysfunction

Aim Background Obesity rates are rapidly growing in the developed world. While upper gastrointestinal disturbances and urinary incontinence are independently associated with obesity, the relationship between obesity and defecatory dysfunction is less well defined. Objectives To summarize the literature on faecal incontinence, diarrhoea and constipation in obese patients and its effects of bariatric surgery. Method Search strategy A Medline search was carried out on articles published from January 1966 to March 2010. Selection criteria Original articles on adult obese or morbidly obese patients were identified, including results following bariatric surgery that reported faecal incontinence, diarrhoea or constipation. Other forms of pelvic floor dysfunction were excluded. Main outcome measures included faecal incontinence, diarrhoea and constipation rates and their severity in obese patients and following bariatric surgery. Results Twenty studies reported defecatory outcomes in obese patients (n = 14) and after bariatric surgery (n = 6). While constipation rates were similar, the rates of faecal incontinence and diarrhoea were higher in obese patients compared with non‐obese patients. The exact rates of these conditions, and the correlations between body mass index (BMI) and faecal incontinence, diarrhoea and constipation, were not clear. Faecal incontinence improved after Roux‐en‐Y gastric bypass in studies with preoperative data. The effects of bariatric surgery on diarrhoea were unclear. Conclusion Few studies have assessed the correlations between obesity and defecatory function and the effect of bariatric surgery. Studies were often not well controlled and used non‐uniform instruments to assess bowel function. Obesity appears to be correlated with higher rates of faecal incontinence and diarrhoea. The effects of bariatric surgery on these conditions are not well defined. Well‐controlled studies correlating outcome with physiological pelvic floor function are needed.     

The UK National Potential Donor Audit

As part of a series of measures designed to improve organ donation rates in the United Kingdom, a potential donor audit has been established by UK Transplant. The audit will identify the number of patients who could be solid organ donors and will establish the obstacles to donation. Results from the first full year of the audit indicate that the overall relative refusal rate for heart-beating solid organ donation is 41.5%. The age and gender of the potential heart-beating donor has little impact on the relative refusal rate, but relatives of ethnic minority groups are more than twice as likely to deny consent than those of white potential heart-beating donors.     

Ethnic differences in burn mechanism and severity in a UK paediatric population

Background

Burns in children are a major public health problem with long-lasting physical and psychological sequelae. Previous studies have identified that children from ethnic minorities have higher rates of burns.

Objective

The purpose of this study was to analyse the differences in paediatric burn mechanism and severity within different ethnic groups.

Methods

Demographic and burn data from all paediatric patients presenting with burn at the Burns Service, Alder Hey Children's NHS Foundation Trust, Liverpool, UK were collected over a 5 year period.

Results

766 paediatric patients (age range: 7 days to 16 years old, mean: 4.5 years) were included in the study. Ethnic minority children had higher total body surface area of burn (p < 0.001) and length of stay (p < 0.001) compared with non-ethnic minority children. Chinese children had most burns from hot food (60%), whereas non-ethnic minority children had most burns from hot beverages (35.8%). Ethnic minority children were more deprived compared with non-ethnic minority children (Index of Multiple Deprivation 48.7 vs. 40.9; p = 0.02).

Conclusion

These results show that there are significant differences in the patterns of burns in ethnic minority groups. This data should guide targeted public health prevention and educational strategies.     

Racial disparities in perioperative outcomes after metabolic and bariatric surgery: a case-control matched study

BackgroundMetabolic and bariatric surgery remains a safe and effective treatment for severe obesity. Ethnic minorities are disproportionately affected by obesity but are less likely to undergo metabolic and bariatric surgery. There remains controversy about outcomes among black patients compared with other ethnic groups after bariatric surgery.ObjectiveThe purpose of this case-control matched study using the largest clinically available bariatric data was to determine if there is racial disparity in perioperative outcomes after primary bariatric surgery.SettingsUniversity Hospital, United States.MethodsPatients who had a primary Roux-en-Y gastric bypass or sleeve gastrectomy in 2015 to 2016 were identified from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Case controlled–matched analyses were performed.ResultsWe compared 80,238 equally matched nonHispanic black and white patients. Operative length and hospital stay were longer in black patients. All-cause mortality was 2-fold higher in black patients (P = .003). Black patients had significantly higher rates of 30-day readmission and reintervention (P < .0001), pulmonary embolism (P =.0004), and aggregate renal (P = .01) and venous thromboembolic (P = .001) complications. Postoperative myocardial infarction, cardiac arrest, pulmonary embolism, and all-cause mortality were significant higher in black patients after sleeve gastrectomy, but not Roux-en-Y gastric bypass.ConclusionIn this study, pulmonary embolism and mortality were significantly higher in black patients after sleeve gastrectomy. Further studies are needed to determine causality.     

Total knee arthroplasty in morbidly obese patients treated with bariatric surgery: a comparative study

Our objective was to compare outcomes (anesthesia time, total operative time, tourniquet time, duration of hospital stay, 90-day complication rate, and transfusion rates) of patients with total knee arthroplasty (TKA) who underwent bariatric surgery before or after TKA. One hundred twenty-five patients were included: TKA before bariatric surgery (group 1; n = 39), TKA within 2 years of bariatric surgery (group 2; n = 25), and TKA more than 2 years after bariatric surgery (group 3; n = 61). Patients with TKA more than 2 years after bariatric surgery had shorter anesthesia and total operative and tourniquet times than other groups; differences were significant between groups. Ninety-day complication and transfusion rates approached but did not meet statistical significance. Ninety-day complication rates and duration of hospital stay did not differ significantly between the 3 groups. The level of evidence was level II (cohort study).     

Natural history of morbid obesity without surgical intervention.

BACKGROUND: To study the mortality among morbidly obese patients qualifying for bariatric surgery. Mortality from bariatric surgery for morbid obesity has been widely reported; however, little is known about the mortality in morbidly obese patients who defer surgery. METHODS: Consecutive patients evaluated for bariatric surgery with an initial encounter between 1997 and 2004 were identified. The Social Security Death Index and office records were used to identify mortality through 2006. We conducted telephone interviews to determine whether the 305 patients who did not undergo bariatric surgery at our institution had undergone the surgery elsewhere. Using Cox proportional hazards models, we compared the mortality in patients undergoing surgery with that of those who did not. To evaluate bias resulting from missing data, we conducted analyses assuming that all patients with missing data had (1) undergone surgery and (2) not undergone surgery. RESULTS: A total of 908 patients underwent bariatric surgery (880 patients at our institution and 28 patients elsewhere). A total of 112 patients did not undergo surgery. Data regarding surgery on 165 patients could not be obtained. The mortality in those patients who did not undergo surgery was 14.3% compared with 2.9% for those who did undergo surgery. Adjusting for age, gender, and body mass index, patients who had undergone surgery had an 82% reduction in mortality (hazard ratio 0.18, 95% confidence interval 0.09-0.35, P <.0001). Sensitivity analysis, assuming that all patients with missing data received surgery resulted in an 85% mortality reduction (P <.001) and assuming that patients did not receive surgery resulted in a 50% mortality reduction (P = .04). CONCLUSIONS: Mortality among morbidly obese patients without surgery was 14.3% during the study period. Surgical intervention offered a 50%-85% mortality reduction benefit.     

National variations in morbid obesity and bariatric surgery use

BACKGROUND: Exploring bariatric surgery use provides data on effective treatment allocation. This study analyzed national rates of bariatric surgery use and the burden of morbid obesity by gender, census region, and age. STUDY DESIGN: Patients 18 years of age or older undergoing bariatric surgery were identified from the US 2002 Nationwide Inpatient Sample, and the national morbidly obese population 18 years of age or older was determined using the Centers for Disease Control and Prevention 2002 Behavioral Risk Factor Surveillance System databases. General population data were obtained from 2000 census data. Annual rates of bariatric surgery procedures were determined by gender, age group, and census region (Northeast, Midwest, South, and West). Rate ratios were calculated and significance tested through 95% confidence intervals (95% CI), accounting for the Nationwide Inpatient Sample and Behavioral Risk Factor Surveillance System sampling design. RESULTS: In 2002, a national cohort of 69,490 bariatric surgery patients was identified. Of these patients 85% were women and 76% were ages 18 to 49 years. The prevalence of morbid obesity (body mass index > or = 40 kg/m(2)) in the US in 2002 was 1.8%; 60% of morbidly obese people were women, and 63% were ages 18 to 49 years. The rates of bariatric surgery procedures per 100,000 morbidly obese individuals ranged from a low of 139 in men aged 60 years and older in the Midwest to a high of 5,156 in women ages 40 to 49 years in the Northeast. For both men and women, bariatric surgery rates in the West and Northeast were 1.35 (95% CI 1.31 to 1.40, p < 0.05) to 4.51 (95% CI 4.15 to 4.89, p < 0.05) times higher than in the South, respectively; rates in the Midwest were similar to those in the South. CONCLUSIONS: National estimates suggest that bariatric surgery rates do not parallel the burden of morbid obesity by region or age. Additional evaluation of these differences is necessary for optimal bariatric surgery use.     

One-year Readmission Rates at a High Volume Bariatric Surgery Center: Laparoscopic Adjustable Gastric Banding, Laparoscopic Gastric Bypass, and Vertical Banded Gastroplasty-Roux-en-Y Gastric Bypass

BACKGROUND: An increasing importance has been placed on a bariatric program's readmission rates. Despite the importance of such data, there have been few studies that document 1-year readmission rates. There have been even fewer studies that delineate the causes of readmission. The objective of this study is to delineate the rates and causes of readmissions within 1 year of bariatric operations performed in a high-volume center. METHODS: Records for all patients undergoing bariatric operations during a 31-month period were harvested from the hospital electronic medical database. Readmissions for these patients were then identified within the hospital database for the year following the index operation. The electronic medical records of all readmitted patients were reviewed. RESULTS: The overall 1-year readmission rate for 1,939 consecutive bariatric operations was 18.8%. The laparoscopic adjustable gastric band (LAGB) had the lowest readmission rate of 12.69%. Next was the vertical banded gastroplasty-Roux-en-Y gastric bypass (VBG-RYGB) with a rate of 15.4%. The laparoscopic Roux-en-Y gastric bypass (LRYGB) had the highest readmission rate of 24.2%. Leading causes of readmission were abdominal pain with normal radiographic studies and elective operations. Independent factors predicting readmission were found to be LOS > 3 days (odds ratio 1.69 p = 0.004) and having a LRYGB (odds ratio of 1.49 p = 0.003). The previously reported reoperation rate for bowel obstruction of 9.7% had decreased to 3.7% due to changes in operative technique. CONCLUSION: Rates of readmissions for patients undergoing bariatric surgery center at our high-volume center decreased over time and are comparable to other major abdominal operations.     

Outcomes of obese patients hospitalized with COVID-19: the impact of prior bariatric surgery

BackgroundObesity and several obesity-related co-morbidities are risk factors for severe COVID-19 disease. Because bariatric surgery successfully treats obesity-related conditions, we hypothesized that prior bariatric surgery may be associated with less severe COVID-19 disease.ObjectivesTo examine the association between prior bariatric surgery and outcomes in patients with obesity admitted with COVID-19.SettingUnited StatesMethodsThe Vizient database was used to obtain demographic and outcomes data for adults with obesity admitted with COVID-19 from May 2020 to January 2021. Patients were divided into 2 groups: those with and those without prior bariatric surgery. The primary outcome was in-hospital mortality. Secondary outcomes were mortality by age, sex, race/ethnicity, and co-morbidity; intubation rate; hemodialysis rate; and length of stay. Because the database only provides aggregate data and not patient-level data, multivariate analysis could not be performed.ResultsAmong the 124,699 patients with obesity admitted with COVID-19, 2,607 had previous bariatric surgery and 122,092 did not. The proportion of patients ≥65 years of age was higher in the non–bariatric surgery group (36.0% versus 27.6%, P < .0001). Compared with patients without prior bariatric surgery, patients with prior bariatric surgery had lower in-hospital mortality (7.8 versus 11.2%, P < .0001) and intubation rates (18.5% versus 23.6%, P = .0009). Hemodialysis rate (7.2% versus 6.9%, P = .5) and length of stay (8.8 versus 9.6 days, P = .8) were similar between groups. Mortality was significantly lower in the bariatric surgery group for patients 18–64 years of age (5.9% versus 7.4%, P = .01) and ≥65 years of age (12.9% versus 17.9%, P = .0006).ConclusionsThis retrospective cohort study found that inpatients with obesity and COVID-19 who had prior bariatric surgery had improved outcomes compared with a similar cohort without prior bariatric surgery. Further studies should examine mechanisms for the association between bariatric surgery and less severe COVID-19.     

Behavioral Outcomes Following Laparoscopic Sleeve Gastrectomy Performed After Failed Laparoscopic Adjustable Gastric Banding

A healthy diet and good eating behaviors are essential components of long-term success in weight maintenance after bariatric surgery. Although rates of revised bariatric surgery have increased, data on subsequent behavioral outcomes are sparse. The aim of our study was to investigate behavioral outcomes following revised laparoscopic sleeve gastrectomy (R-LSG) that was indicated for failed laparoscopic adjustable gastric banding and compare with outcomes following primary laparoscopic sleeve gastrectomy (P-LSG). Twelve patients who underwent R-LSG and 25 patients who underwent P-LSG between 2007 and 2009 in our medical center completed a questionnaire that assessed weight loss, eating behaviors, physical activity, food tolerance, and satisfaction. The average time elapsed since the operation was 18 months for both groups. In the R-LSG group, more patients reported non-normative eating patterns and less healthy food selection than in the P-LSG group. Food tolerance and satisfaction were also lower after R-LSG. Engagement in regular physical activity increased from 0 to 16.7 % in the R-LSG group and from 8 to 33 % in the P-LSG group. After R-LSG, 58 % reported eating at scheduled times, compared with 85 % after P-LSG. Levels of healthy food selection, food tolerance, normative eating patterns, and physical activity were lower in the R-LSG group than in the P-LSG group. This study highlights the need to develop pre- and post-surgery treatment that would promote better behavioral outcomes in the growing number of individuals undergoing repeat bariatric surgery.     

Technique of resection of esophageal adenocarcinoma after Roux-en-Y gastric bypass and literature review of esophagogastric tumors after bariatric procedures

BackgroundThe number of bariatric procedures has continued to increase worldwide. However, experience with tumors arising in the esophagus or stomach after gastric bypass is lacking. We report our technique for curative resection of esophageal adenocarcinoma in a patient who had undergone previous gastric bypass and review the reported data on esophagogastric tumors after bariatric surgery.MethodsWe have described the operative details of esophagectomy after gastric bypass and reviewed the published data regarding type of bariatric surgery, gender predilection, presentation, symptom duration, cancer stage, and prognosis of patients with esophagogastric tumors occurring after bariatric surgery.ResultsOnly 22 esophagogastric tumors have been reported so far after bariatric surgery. The majority of them are locally advanced or metastatic at presentation.ConclusionEsophagogastric tumors after bariatric surgery are uncommon. This operative technique pays particular attention to the altered anatomy, dissection of the gastric pouch, and preservation of the blood supply to the excluded stomach. This technique can also be applied to manage tumors arising in the gastric pouch after previous gastric bypass. Close collaboration with the bariatric surgeon during surgery is essential to achieve a successful oncologic outcome in this subset of patients.