{"title":"Hyperinsulinemic Hypoglycemia after Bariatric Surgery.","authors":"Songhao Hu, Hanlin Tang, Huaxi Wang, Zhiyong Dong, Shuwen Jiang, Cunchuan Wang, Xiaomei Chen, Wah Yang","doi":"10.17476/jmbs.2020.9.1.1","DOIUrl":"https://doi.org/10.17476/jmbs.2020.9.1.1","url":null,"abstract":"<p><p>Postprandial hyperinsulinemic hypoglycemia (PHH) is one of the serious complications after bariatric surgery, it can lead life-threatening neuroglycopenic symptoms, such as seizures, disorientation, impairment of version and loss of consciousness without any premonitory. The presentation, prevalence, diagnosis, pathology and treatment are reviewed in this summary.</p>","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"9 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f0/50/jmbs-9-1.PMC9847643.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10582835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jimin Son, Chang Seok Ko, Yun Chan Park, Moon-Won Yoo
{"title":"Portomesenteric Vein Thrombosis after Laparoscopic Sleeve Gastrectomy: A Case Report.","authors":"Jimin Son, Chang Seok Ko, Yun Chan Park, Moon-Won Yoo","doi":"10.17476/jmbs.2020.9.1.19","DOIUrl":"https://doi.org/10.17476/jmbs.2020.9.1.19","url":null,"abstract":"<p><p>Portomesenteric vein thrombosis is an uncommon but potentially life-threatening complication associated with laparoscopic sleeve gastrectomy. We present the case of a 26-year-old male who underwent an uneventful laparoscopic sleeve gastrectomy and presented on postoperative day 14 with portomesenteric vein thrombosis. The patient was treated conservatively with IV heparinization, followed by an oral anticoagulant agent. He was discharged in stable condition without further problems. A high index of suspicion for the disease is required not to miss or delay the diagnosis of portomesenteric vein thrombosis which could lead to a fatal outcome. All patients should be screened beforehand for underlying hypercoagulability before surgery.</p>","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"9 1","pages":"19-23"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/14/02/jmbs-9-19.PMC9847642.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10587467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dong-Wook Kim, Dae Hoon Kim, Jeong Goo Kim, Myoung Won Son, Geum Jong Song, Seong-Il Oh, Han Mo Yoo, Moon-Soo Lee, Sang Kuon Lee, Sang Eok Lee, Ye Seob Jee, Seong Ho Hwang, Si Eun Hwang, Sang-Il Lee
{"title":"Current Status of Bariatric and Metabolic Surgery in Daejeon and Chungcheong Province: Early Experiences after Public Medical Insurance Coverage in 2019.","authors":"Dong-Wook Kim, Dae Hoon Kim, Jeong Goo Kim, Myoung Won Son, Geum Jong Song, Seong-Il Oh, Han Mo Yoo, Moon-Soo Lee, Sang Kuon Lee, Sang Eok Lee, Ye Seob Jee, Seong Ho Hwang, Si Eun Hwang, Sang-Il Lee","doi":"10.17476/jmbs.2020.9.1.7","DOIUrl":"10.17476/jmbs.2020.9.1.7","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the current status of bariatric and metabolic surgery in Daejeon and Chungcheong province and to describe the early experiences after public medical insurance coverage in 2019.</p><p><strong>Materials and methods: </strong>Between January 2019 and August 2019, 64 cases of bariatric and metabolic surgery were performed in patients with morbid obesity or uncontrolled type 2 diabetes. We prospectively collected and analyzed data regarding the patients' demographics and comorbidities, surgical results, and early complications. The patient information before and after the insurance coverage was also compared.</p><p><strong>Results: </strong>The number of surgeries in 9 years has been caught up only in the last 8 months after insurance coverage (58 vs. 64 patients). The mean body mass index was 37.7±5.8 kg/m<sup>2</sup> (range, 22.7-52.1 kg/m<sup>2</sup>). The most frequently performed surgery was sleeve gastrectomy (53 cases, 82.8%), followed by Roux-en-Y gastric bypass (9 cases, 14.1%), and adjustable gastric banding (2 cases, 3.1%). Postoperative complications occurred in 6 patients (9.4%), and there was no mortality. The mean operation time (225.3±85.4 vs. 156.1±61.8 min, P<0.001) and postoperative stay (5.9±4.5 vs. 4.3±2.0 days, P=0.013) after the insurance coverage were significantly shorter than those before the insurance coverage.</p><p><strong>Conclusion: </strong>We could assess the patients who had bariatric and metabolic surgery in Daejeon and Chungcheong province after public medical insurance coverage in 2019.</p>","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"9 1","pages":"7-12"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d3/e7/jmbs-9-7.PMC9847644.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10582833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dae Geun Park, Yoona Chung, Sang Hyun Kim, Yong Jin Kim
{"title":"Diabetes Remission Rate after Sleeve Gastrectomy or Roux-en-Y Gastric Bypass; Utilizing Individualized Metabolic Surgery Score for Korean Patients.","authors":"Dae Geun Park, Yoona Chung, Sang Hyun Kim, Yong Jin Kim","doi":"10.17476/jmbs.2020.9.1.13","DOIUrl":"https://doi.org/10.17476/jmbs.2020.9.1.13","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study is to evaluate the usefulness of individualized metabolic surgery score for Korean patients in determining bariatric surgical procedures.</p><p><strong>Materials and methods: </strong>A total of 135 patients with type 2 diabetes mellitus who underwent sleeve gastrectomy (n=19) or Roux-en-Y gastric bypass (n=116) at our institute with a 1-year follow up were analyzed for the predictive power of diabetes remission using the individualized metabolic surgery scoring system.</p><p><strong>Results: </strong>At the postoperative follow-up of 1 year, the remission of type 2 diabetes mellitus (HbA<sub>1C</sub><6.5%, off medications) was achieved in 88 (65.2%) patients. The remission rates showed no significant differences between patients who underwent sleeve gastrectomy and Roux-en-Y gastric bypass (63.2% versus 65.5%; P=0.84), regardless of the severity of type 2 diabetes mellitus. Although there was no statistically significant difference in the remission rate according to the bariatric surgery procedures (P>0.99 in mild, P=0.11 in moderate, P>0.99 in severe IMS score), remission rates were higher in moderate severity patients who underwent Roux-en-Y gastric bypass than in those who underwent sleeve gastrectomy (69.7% versus 37.5%).</p><p><strong>Conclusion: </strong>The remission rates after bariatric surgery procedures were similar to that of the previously reported study. Despite the limitations of our data, the individualized metabolic surgery score can be used as a complement to other scoring systems in Korean patients.</p>","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"9 1","pages":"13-18"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1f/a3/jmbs-9-13.PMC9847645.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10582834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hussain Alanezi, Abdulaziz Alshehri, Abdulaziz Alrobiea, M. Yoo
{"title":"The Causes, Prevention, and Management of Gastric Leakage after Laparoscopic Sleeve Gastrectomy: A Review Article","authors":"Hussain Alanezi, Abdulaziz Alshehri, Abdulaziz Alrobiea, M. Yoo","doi":"10.17476/jmbs.2019.8.2.28jmbs","DOIUrl":"https://doi.org/10.17476/jmbs.2019.8.2.28jmbs","url":null,"abstract":"Obesity has been considered a chronic relapsing disease. The increasing number of obese individuals has resulted in an increase in the demand for bariatric surgeries annually. Post-laparoscopic sleeve gastrectomy complications are challenging for both patients and surgeons. Thus, this paper reviews the most common and significant risk factors for leakage occurrence after laparoscopic sleeve gastrectomy and presents new tools, techniques, management options, and recommendations, gathered from newly published articles, for post-laparoscopic sleeve gastrectomy leakage. Causes of post-laparoscopic sleeve gastrectomy leakage include technical factors such as bougie size, transection point, reinforcement materials, and patient co-morbidities as well as ischemic reasons. Ischemic leakage, which is most commonly seen in laparoscopic sleeve gastrectomy, occurs usually after the fourth day, although some leakage may appear earlier within 1-3 days due to technical issues. Use of varied bougie sizes results in similar excess weight loss % at the one-year follow-up. Buttressing materials also reduce post-laparoscopic sleeve gastrectomy bleeding, but not the leakage rate. Endoscopic stents play a significant role in gastric leakage treatment in post-laparoscopic sleeve gastrectomy patients. Intra-operative or even early postoperative diagnostic tools can help in detecting early leaks, but minor leaks as well as those due to ischemic causes may be missed. In conclusion, laparoscopic sleeve gastrectomy is still one of the most effective bariatric surgeries, exhibiting approximately 70% excess weight loss. Although complications of post-laparoscopic sleeve gastrectomy are severe and may be life-threatening, most patients can be treated conservatively. However, those with persistent fistula require surgical intervention.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45688229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Initial Experience with Laparoscopic Mini-gastric Bypass in Korean Obese Patients","authors":"C. Lim, Sang Hyun Kim, Yong Jin Kim","doi":"10.17476/jmbs.2019.8.2.43","DOIUrl":"https://doi.org/10.17476/jmbs.2019.8.2.43","url":null,"abstract":"Purpose: To report our initial experience with laparoscopic mini-gastric bypass (LMGB) in Korean obese patients. Materials and Methods: From July 2016 to February 2018, 14 male patients underwent LMGB for morbid obesity at a single institution. Five trocars were placed in a U-shape formation and 1 trocar was placed at the epigastrium as a liver retractor; a window was created between the vagal nerve and lesser curvature at the gastric angle for entering the lesser sac; a narrow gastric tube (∼100-120 ml volume) was made; a linear-stapled gastrojejunostomy was created after bypassing the jejunum 200 cm from the Treitz’ ligament; and the Petersen defect was closed to prevent internal hernia. Patient demographics, operative time, estimated blood loss, postoperative hospital stay, complications, weight loss, and resolution of comorbidities were evaluated during 1 year of follow-up. Results: All procedures were successful by laparoscopy. The average age was 29 (19-49) years; weight, 164.9 (127-250) kg; and body mass index, 51.0 (42.4-81.6) kg/m. In 1 case, nephrectomy was simultaneously performed for early renal cell carcinoma. The mean operative time was 148.8 (120-175) min. The mean postoperative hospital stay was 1.9 (1-4) days. The percentage excess weight loss at 1, 3, 6, 9, and 12 months was 16.6%, 31.0%, 41.4%, 45.4%, and 50.4%, respectively. The resolution rate of type 2 diabetes mellitus, hypertension, and dyslipidemia was 75%, 40%, and 66.7%, respectively. There was no major complication including mortality during the follow-up. Conclusion: LMGB is a technically simple, safe, and effective procedure in Korean obese patients.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48817750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Ohta, Y. Seki, Sungsoo Park, Cunchuan Wang, Wah Yang, K. Kasama
{"title":"Comparison between ABCD and IMS Scores in the Prediction of Long-Term T2DM Remission after Metabolic Surgery in East Asian Obese Patients","authors":"M. Ohta, Y. Seki, Sungsoo Park, Cunchuan Wang, Wah Yang, K. Kasama","doi":"10.17476/jmbs.2019.8.2.34jmbs","DOIUrl":"https://doi.org/10.17476/jmbs.2019.8.2.34jmbs","url":null,"abstract":"Recently, several scoring systems have been proposed to predict remission from type 2 diabetes mellitus (T2DM) after metabolic surgery. The ABCD score was compared to the individualized metabolic surgery (IMS) score in terms of the prediction of long-term T2DM remission; however, which of the two scoring systems is better remains controversial. Thus, Three East Asian countries Metabolic Surgery (TEAMS), which has been organized as a study group since 2016, is conducting a retrospective, international, multi-institutional study to compare the two scoring systems in East Asian obese patients after metabolic surgery. The primary study objective is to compare the ABCD score with the IMS score at 3 and 5 years after sleeve gastrectomy (SG), Roux-en-Y gastric bypass, one anastomosis gastric bypass and SG with duodenojejunal bypass. The secondary objectives include evaluating patients who were good candidates for SG, and adjusting the IMS scoring system for East Asian patients.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44815790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Snakeskin Appearance of Gastric Mucosa Compressed by Adjustable Gastric Bands: A Novel Diagnostic Marker of Band Migration","authors":"T. Park, S. Kim","doi":"10.17476/jmbs.2019.8.2.37","DOIUrl":"https://doi.org/10.17476/jmbs.2019.8.2.37","url":null,"abstract":"Purpose: The aim of this retrospective study is to describe changes of gastric mucosa in patients with adjustable gastric band migration, and to evaluate the diagnostic value of these changes. Materials and Methods: The postoperative endoscopies of all patients that underwent adjustable gastric band surgery at a single tertiary center were retrospectively reviewed. Gastric mucosal patterns were classified based on the appearance of gastric mucosae compressed by adjustable gastric bands, as follows; Group A: normal appearance, Group B: snakeskin (reticular) appearance without band migration, Group C: snakeskin appearance with band migration, and Group D: recuperated gastric mucosa with advanced band migration. Results: Postoperative endoscopic findings of 109 patients obtained from Jan 2012 to Oct 2018 were available, and these patients were assigned to the four groups, as follows; 82 to group A, 5 to group B, 14 to group C, and 8 to group D. Times (months) between AGB implantation and initial postoperative endoscopy evaluations were 45.2±22.3, 40.0±28.2, 36.2±18.6, and 42.1±17.0, respectively (P=0.531). Of the five patients in Group B, 3 underwent band explantation due to band migration (P=0.000). Conclusion: Conclusion A snakeskin pattern of gastric mucosa compressed by adjustable gastric band is strongly associated with adjustable band migration. The presence of this pattern might predict band migration before endoscopic confirmation and its identification might prevent complications associated with long-standing band migration.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49148898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jong-hyuk Ahn, Eun-Kee Bae, Y. Suh, Y. Jeon, Y. Lee, and Yoonseok Heo
{"title":"Continuous Positive Airway Pressure Therapy Can Prevent Pulmonary Atelectasis after Laparoscopic Roux-en-Y Gastric Bypass Surgery in Obese Patients","authors":"Jong-hyuk Ahn, Eun-Kee Bae, Y. Suh, Y. Jeon, Y. Lee, and Yoonseok Heo","doi":"10.17476/JMBS.2019.8.1.8","DOIUrl":"https://doi.org/10.17476/JMBS.2019.8.1.8","url":null,"abstract":"Purpose: To compare the prophylactic effects of postoperative continuous positive airway pressure (CPAP) therapy plus conventional postoperatively pulmonary physiotherapy (CPP) and postoperative CPP alone on the development of pulmonary atelectasis after laparoscopic Roux-en-Y gastric bypass (LGBP) in obese patients. Materials and Methods: Patients with BMIs>27.5 kg/m aged between 20 and 65 years were enrolled in the present study. All subjects received LGBP and were divided into 2 groups. Patients in the CPAP group received both CPAP and CPP therapy postoperatively, and patients in the conventional group received CPP alone. The primary outcome was the incidence of postoperative pulmonary atelectasis as determined by chest X-ray after LGBP, and the secondary outcome was duration of postoperative hospital stay (HS). Results: Seventy-three patients were enrolled in this study. Fifty-seven patients received CPAP plus CPP, and 16 patients received CPP. The CPAP group had an atelectasis incidence of 40.4% (23/57) and the conventional group an incidence of 62.5% (10/16). Multivariate analysis showed the incidence of atelectasis after LGBP was significantly lower in the CPAP group (OR 0.198, 95% CI 0.045-0.874; P=0.033) and that HS was significantly correlated with the developments of atelectasis, pneumonia, and complications (partial correlation coefficients 0.271, 0.444 and 0.382; P-values 0.025, <0.05 and <0.05, respectively). Conclusion: Patients that received continuous positive airway pressure therapy plus conventional pulmonary physiotherapy postoperatively were at significantly less risk of developing pulmonary atelectasis after LGBP than patients that received conventional pulmonary physiotherapy postoperatively.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47655418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Imam, Harbi Khalayleh, Maya M. Rahat, E. Mavor, G. Pines, and Shimon Sapojnikov
{"title":"Chylous Ascites Following Bariatric Surgery Report of Two Cases","authors":"A. Imam, Harbi Khalayleh, Maya M. Rahat, E. Mavor, G. Pines, and Shimon Sapojnikov","doi":"10.17476/JMBS.2019.8.1.22","DOIUrl":"https://doi.org/10.17476/JMBS.2019.8.1.22","url":null,"abstract":"Chylous ascites is a rare complication following bariatric surgeries. Little data is available regarding chylous ascites following bariatric surgeries per se or in association with internal hernias. Herein we present two cases of chylous ascites following Roux-En-Y gastric bypass; the first one is a 60-year-old male who was presented to the ER six months after a gastric bypass operation suffering from abdominal pain, CT scan and upper endoscopy were normal, however chylous ascites and internal hernia were found during exploratory laparoscopy. The second case is a 39-year-old female patient who was admitted three years following the gastric bypass operation and diagnosed to have small bowel obstruction due to internal hernia, and during exploratory laparoscopy a chylous ascites was found.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43849388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}