Publications

A Multi-institutional Study on the Mid-Term Outcomes of Single Anastomosis

This is a multicenter retrospective study of prospectively collected database of patients who underwent revisional SADI-S surgery from failed SG between at four US centers chosen because of the relationships among the surgeons (center 1: Bariatric Medicine Institute in UT, performed by author), (center 2: Rex Bariatric Specialists in NC, performed by author), (center 3: WakeMed Bariatric Specialists of NC, performed by author), (center 4: Ventura Advanced Surgical Associates in CA performed by author).

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Safety And Effectiveness Of Single Anastomosis

The first bariatric procedure was the jejunocolic bypass followed by the jejunoileal bypass, which resulted in substantial weight loss but unacceptable life threatening complication rates. These procedures along with several others have fallen out of favor over the years, due to failure rates, health risks, and severe deficiencies. Currently, laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are most commonly performed for surgical treatment of morbid obesity.

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Sadi-S With Right Gastric Artery Ligation

Considering the first historical cases of jejunoileal bypass done in the beginning of the 1950s by Victor Henriksson in Sweden and Richard Varco in United States of America, bariatric surgery has completed a long medical history with the proposition of several surgical alternatives, reaching global numbers around 500.000 cases yearly

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Liver Retractor

Fixed Liver Retraction (FLR) has traditionally been considered mandatory for all foregut surgery. For most procedures (RYGB, Hiatal Hernia repair) operative exposure of the lesser curvature of the stomach and right crusdoes require fixed retraction.

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Portal Vein Thrombosis After LSG

10 patients who required reoperation for bleeding, 6(60%)received blood transfusions before their reoperation. There was one death (0.13%) in our series. Patient demographics were similar in both groups in terms of age,sex,American Society of Anesthesiologists (ASA)score, comorbidities and medication use, including antic-agulants, non steroidal anti-inflammatory drugs (NSAIDS) and selective serotonin reuptake inhibitors (SSRIs).

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Post Predictor Of SG At 3 Months

Predictors of long-term weight loss in sleeve gastrectomy (SG) currently do not exist. We reviewed our
long term data in a single private practice to assess for variables that will help surgeons predict weight loss failure early after SG.

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Predictor Of GBP

The Use od Predictive Markers for the Development of a Model to Predict Lowest Quartile Weight Loss Following Roux-en-Y Gastric Bypass

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Predictor Of SG

Diabetes Remission Following Gastric Bypass: Does Diarem Stand the test of Time?

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Pre Operative Predictor Of SG

The goal of this study is to show a further reduction in leak rate when multiple methods of reinforcement are combined, specifically the use of bioabsorbable material as a buttress with suture line imbrication.

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Weight Loss After Band to DS

The aim of this study was to determine the effects of the adjustable gastric band (AGB) one sophageal motility in patients who present for removal of the AGB.

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Weight Loss After RYGB to DS

over time following RYGB and LAGB.There was also an increase in alcohol problems and non-prescribed druguse, and related treatment, following RYGB only, such that more than double as many participants reported alcohol problems in years 3-7 com-pared to baseline.

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Symptomatic gastric diverticulum after gastric imbrication with conversion to sleeve gastrectomy

Laparoscopic gastric imbrication (LGI) helps to promote weight loss by reducing the size of the stomach by plicating the greater curve of the stomach.However, if the stomachis not adequately plicated at the fundus, gastric diverticula occur. In this case the gastric diverticulum became sympto-matic (chronicnausea) and necessitated conversiontoa laparoscopic sleeve gastrectomy, which resulted in a resolution of the patient’s symptoms.

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A Video Case Repost of Stomach INtestinal Pylorus Sparing Surgery (SIPS) with Laparoscopic Fundopolication (LF): A Surgical Procedure to Treat Gastrointestinal Reflux Disease (GERD) in the Detting of Morbid Obesity.

A video case report of stomach intestinal pylorus sparing surgery with Laparoscopic Fundoplication. The increasing prevalence of obesity worlswide has coincided with an increased prevalence of gastroesophageal reflux disease (GERD).

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Stomach intestinal pylorus sparing surgery (SIPS) with laparoscopic fund oplication (LF): a new approach to gastroesophageal reflux disease (GERD) in the setting of morbid obesity

The increase in the prevalence of obesity and gastroesophageal reflux disease (GERD) has paralleled one
another. Laparoscopic fundoplication (LF) (Nissen or Toupet) is a minimally invasive form of anti-reflux surgery.

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Stomach Intestinal Pylorus Sparing (SIPS) Surgery for Morbid Obesity: Retrospective Analyses of Our Preliminary Experience

Although the duodenal switch (DS) has been the most effective weight loss surgical procedure, it is a small
minority of the total bariatric surgical cases performed.

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A safer and simpler technique of duodenal dissection and transection of the duodenal bulb for duodenal switch

One common reasons that many surgeons do not perform a duodenal switch(DS) is lack of experience with
the dissection over the head of the pancreas.

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Retrograde filling of the afferent limb as a cause of chronic nausea after single anastomosis loop duodenal switch

Single anastamosis loop duodenal switch (SALDS) is a new surgical technique that was first described by Torresin Spain. As this procedure is gaining in popularity worldwide, it is important to document the rare complica- tions associated with it

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Portl Vein Thrombosis after Laparoscopic Sleeve Gastrectomy: Presentations and Management

Portlal vein thrombosis (PVT) is a serious problem with a high morbidity and mortality, often exceeding 40% of affected patients. Recently, PVT has been reported in a patients after laparoscopicsleeve gastrectomy (LSG).

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A Matched Cohort Analysis of Sleeve Gastrectomy With and Without 300 cm Loop Duodenal Switch With 18-Month Follow-Up

In bariatric surgery, a significant question remains unanswered—What proportion of weight loss comes from each component and does this differ with time? Single anastomosis duodenal switch (LDS) combines a vertical sleeve astrectomy (VSG) with a loop attachment of the duodenal stump.

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Internal hernia after revisional laparoscopic loop duodenal switch surgery

Loop duodenal switch(LDS) is a new surgical technique that allows surgeons to perform a duodenal switch with less effort and fewer complications

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Indications and Operative Outcomes of Gastric Bypass Reversal

Roux-en-Y gastric bypass (RYGB) is one of the best-known and most commonly performed bariatric
procedures. However, this procedure carries infrequent but serious long-term complications, which may require revisional procedures. This study reports the indications and outcomes of gastric bypass reversal that have not been described well in the literature.

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A matched cohort analysis of single anastomosis loop duodenal switch versus Roux-en-Y gastric bypass with 18-month follow-up

The Roux-en-Y gastric bypass (GBP) has been considered the gold standard for many years. The loop duodenal
switch (LDS) is a relatively new procedure that simplifies the complexity of the duodenal switch (BPDDS) by making it a single anastomosis procedure while at the same time giving it more intestinal absorption to reduce the rates of malnutrition associated with traditional BPDDS.

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Mid Term Outcomes of Gastric Bypass Weight Loss Falure to Duodenal Switch

The Roux-en-Y gastric bypas (RYGB) is a very effective treatment for obesity and its related co-morbidities.

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Long Term Results after DS and Diabetes

This report summarizes our 15-year experience with duodenal switch (DS) as a primary procedure on 1,423 patients from 1992 to 2005.

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20 Year Diabetes Resolution after DS

Biliopancreatic diversion (BPD) is a complex bariatric operation requiring meticulous surveillance which has impeded its broad adoption. Improvements in surgical care and technique, better teaching programs, and stringent norms for follow-up have contributed to increased safety of BPD for patients with BMI < 50, achieving better long-term results than other bariatric operations. Here we report 20-year outcomes of 2615 consecutive patients (median 8) having open BPD with duodenal switch (DS) between 1992 and 2010.

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Randomized Double-Blinded Trial of Laparoscopic Gastric Imbrication v Laparoscopic Sleeve Gastrectomy at a Single Indian Institution

Currently, there is a debate whether the laparoscopic gastric imbrication (LGI) offers similar weight loss when compared to the laparoscopic sleeve gastrectomy (LSG). On the surface, they seem to offer similar-sized stomachs after the procedures are performed. We chose to perform a randomized double-blinded trial to see if similar-sized pouches result in similar types of weight loss. Our belief was that sleeve gastrectomy would offer at least a 10 % better weight loss over a 3-year period.

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Chronic Inflammatory Hypothesis

The Chronic Inflammatory Hypothesis for the Morbidity Associated with Morbid Obesity: Implications and Effects of Weight Loss

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The Effect of Obesity on Neutrophil

Background: There is a large body of epidemlologi· cal data associating obesity with a wide variety of clinical disease processes, including cancer and wound infections. However, defining the specific defects of neutrophils has proved difficult and often contradictory.

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Acute changes in renal function after laparoscopic gastric surgery for morbid obesity

Acute renal failure (ARF) is a serious complication that contributes to patient morbidity and may result in death. To date, no data are available regarding the predictive risk of ARF or its effect on the outcome of patients who undergo laparoscopic gastric bypass.

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The impact of laparoscopy on bariatric surgery

Abstract. The rising popularity of bariatric surgery over the past several years is attributable in part to the development of laparoscopic bariatric surgery. Morbidly obese patients have associated comorbid conditions that may predispose them to postoperative morbidity.

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Laparoscopic Gastric Bypass Surgery: Current Technique

THE TECHNIQUE OF LAPAROSCOPIC Roux -en-Y gastric bypass has evolved significantly since Wittgrove and Clark developed their technique in the early 1990s.1 Multiple variations of each key aspect of the procedure have evolved.2- 8 The major steps of the procedure include patient positioning, setup and port placement, pouch creation, Roux-limb construction, jejuno-jejunostomy, and gastrojejunostomy.

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Diabetes Mellitus

Objective: To evaluate pre- and postoperative clinical parameters associated with improvement of diabetes up to 4 years after laparoscopic Roux-en-Y gastric bypass (LRYGBP) in patients with type 2 diabetes mellitus (T2DM).

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Duodenal Varices: A Novel Treatment and Literature Reviezv

Hemorrhage associated with duodenal varices is an uncommon but often fatal manifestation of portal hypertension. We report a case of duodenal varices, review the literature, and present a new treatment modality. A 63-year-old man presented with hematemesis and hematochezia

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Diagnostic and Therapeutic Laparoscopy for Trauma: A Technique of Safe and Systematic Exploration

Summary: Laparoscopy has a limited role in the evaluation of a stable trauma patient. The main concern addressed in the literature is a significant potential for missed visceral injury and a minimal role for therapeutic application.

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Is Ghrelin the Culprit for Weight Loss after Gastric Bypass Surgery? A Negative Answer

Background: Ghrelin is a potent appetite stimulator, mainly synthesized in the stomach. Paradoxically, obese subjects have lower plasma ghrelin than lean subjects and increase their weight in spite of low ghrelin levels.

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Laparoscopic Era of Operations for Morbid Obesity

The goal of this article is to review the status of the emerging field of laparoscopic bariatric surgery, to discuss developmental issues regarding technique and training, and finally, to summarize the present and future roles of laparoscopic bariatric surgery

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Bupivicaine Pain Pumps

A Randomized Trial of Bupivicaine Pain Pumps to Eliminate the Need for Patient Controlled Analgesia Pumps in Primary Laparoscopic Roux-en-Y Gastric Bypass

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The impact of laparoscopic bariatric workshops on the practice patterns of surgeons

This study was designed to evaluate the impact of a 2-day laparoscopic bariatric workshop on the practice patterns of participating surgeons.

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Effect of Surgically-Induced Weight Loss on Leukocyte Indicators of Chronic Inflammation in Morbid Obesity

Recent evidence suggests that morbid trophlls, and by 12 months had become abnormally obesity Is a chronic Inflammatory condition that may elevated In monocytes (monocytes 391 gmf, be associated with Immune dysfunction.

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Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity

The surgical treatment of obesity in the high-risk, high-body-mass-index (BMI) (>60) patient remains a challenge. Major morbidity and mortality in these patients can approach 38% and 6%, respectively. In an effort to achieve more favorable outcomes, we have employed a two-stage approach to such high-risk patients. This study evaluates our initial outcomes with this technique.

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Lower Extremity Compartment Syndrome Following a Laparoscopic Roux-en-Y Gastric Bypass.

“Candy cane” Roux syndrome-a possible complication after gastric bypass surgery

Effective treatment of polycystic ovarian syndrome with Roux-en-Y gastric bypass

Preperitoneal Herniation Into a Laparoscopic Port Site Without a Fascial Defect

Weight loss, quality of life and employment status after Roux-en-Y gastric bypass: 5-year analysis

Results of Laparoscopic Gastric Bypass in Patients with Cirrhosis

Medicolegal analysis of 100 malpractice claims against bariatric surgeons

DRG, Costs and Reimbursement following Roux-en-V Gastric Bypass: an Economic Appraisal

A 37-year-old man was brought to our comprehensive Levell trauma center by the Coast Guard after being involved in a fishing accident.

A Case-Controlled Matched-Pair Cohort Study of Laparoscopic Roux-en-Y Gastric Bypass and Lap-Band® Patients in a Single US Center with Three-Year Follow-up

Incidence of gastroenterostomy stenosis in laparoscopic Roux-en-Y gastric bypass using 21- or 25-Inm circular stapler: a randomized prospective blinded study

A Case-Controlled Matched-Pair Cohort Study of Laparoscopic Roux-en-Y Gastric Bypass and Lap-Band® Patients in a Single US Center with Three-Year Follow-up

Duodenal Varices: A Novel Treatment and Literature Reviezv

Hemorrhage associated with duodenal varices is an uncommon but often fatal manifestation of portal hypertension. We report a case of duodenal varices, review the literature, and present a new treatment modality. A 63-year-old man presented with hematemesis and hematochezia.

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Dysfunctional Immune-Privilege In Morbid Obesity: Implications and Effect of Gastric Bypass Surgery

Background: Despite the epidemiological e’vldence linking obesity and cancer, there has never been a causal link. We believe the chronic inflammation pres· ent In obesity may predispose the obese to cancer through Fas-receptor over-expression and L-selectln under-expression In leukocytes, and elevated Fas llg· and secretion In tumors affecting the morbidly obese.

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Effect of Surgically-Induced Weight Loss on Leukocyte Indicators of Chronic Inflammation in Morbid Obesity

Background: Recent evidence suggests that morbid trophlls, and by 12 months had become abnormally obesity Is a chronic Inflammatory condition that may elevated In monocytes (monocytes 391 gmf, be associated with Immune dysfunction.

Read More

The impact of laparoscopy on bariatric surgery

Abstract. The rising popularity of bariatric surgery over the past several years is attributable in part to the development of laparoscopic bariatric surgery. Morbidly obese patients have associated comorbid conditions that may predispose them to postoperative morbidity.

Read More

Laparoscopic Era of Operations for Morbid Obesity

The goal of this article is to review the status of the emerging field of laparoscopic bariatric surgery, to discuss developmental issues regarding technique and training, and finally, to summarize the present and future roles of laparoscopic bariatric surgery. We reviewed all published literature from 1992 to the present on MEDLINE

Read More

Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity

The surgical treatment of obesity in the high-risk, high-body-mass-index (BMI) (>60) patient remains a challenge. Major morbidity and mortality in these patients can approach 38% and 6%, respectively.

Read More

A Randomized Trial of Bupivicaine Pain Pumps to Eliminate the Need for Patient Controlled Analgesia Pumps in Primary Laparoscopic Roux-en-Y Gastric Bypass

Medicolegal analysis of 100 malpractice claims against bariatric surgeons

Although malpractice litigation involves all specialties in medicine, certain specialties, such as eurosurgery, obstetrics, pediatrics, cardiology, and cardiac surgery, appear to cm·ry the brunt of malpractice litigation.

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The mini-fellowship concept: a six-week focused training program for minimally invasive bariatric surgery

To devise a six-week hands-on training program customized to meet the needs of practicing general surgeons. The aim of this program is to provide the required training experience that will bestow the knowledge and skill necessary to implement a successful practice in laparoscopic bariatric surgery.

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Effective treatment of polycystic ovarian syndrome with Roux-en-Y gastric bypass

Purpose: Many women with polycystic ovarian syndrome (PCOS) are overweight. This study investigated the impact of weight Joss surgery on the clinical manifestations of this disorder in morbidly obese women with PCOS-a major risk factor for the development of heart disease, stroke, and type II diabetes.

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Tumor growth factor expression in obesity and changes in expression with weight loss: another cause of increased virulence and incidence of cancer in obesity

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Preperitoneal Herniation Into a Laparoscopic Port Site Without a Fascial Defect

Port site herniation is an uncommon event that usually occurs as a result of incomplete fascial closure. This allows the omentum or viscera to herniate through the incompletely closed defect. However, in laparoscopic surgery for morbid obesity, the omentum and viscera can herniate through the thick preperitoneal space even with a complete closure of the fascia.

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The Chronic Inflammatory Hypothesis for the Morbidity Associated with Morbid Obesity: Implications and Effects of Weight Loss

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The Effect of Obesity on Neutrophil Fe Receptors and Adhesion Molecules {CD16, CD11 b, CD62L)

There is a large body of epidemlologi· cal data associating obesity with a wide variety of clinical disease processes, including cancer and wound infections. However, defining the specific defects of neutrophils has proved difficult and often contradictory.

Read More

Is Ghrelin the Culprit for Weight Loss after Gastric Bypass Surgery? A Negative Answer

Ghrelin is a potent appetite stimulator, mainly synthesized in the stomach. Paradoxically, obese subjects have lower plasma ghrelin than lean subjects and increase their weight in spite of low ghrelin levels.

Read More

“Candy cane” Roux syndrome-a possible complication after gastric bypass surgery

An excessive length of nonfunctional Roux limb proximal to the gastrojejunostomy can cause abnormal upper gastrointestinal symptoms after gastric bypass surge1y. The purpose of this study was to characterize the syndrome and provide the practitioner with diagnosis and management options.

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Results of Laparoscopic Gastric Bypass in Patients with Cirrhosis

Background: The safety and efficacy of bariatric surgery in patients with cirrhosis has not been well studied.

Read More

Diagnostic and Therapeutic Laparoscopy for Trauma: A Technique of Safe and Systematic Exploration

Laparoscopy has a limited role in the evaluation of a stable trauma patient. The main concern addressed in the literature is a significant potential for missed visceral injury and a minimal role for therapeutic application.

Read More

Lower Extremity Compartment Syndrome Following a Laparoscopic Roux-en-Y Gastric Bypass.

Bariatric surgery has the potential for serious complications. A case is presented of unilateral lower extremity compartment syndrome after a laparoscopic Roux-en-Y gastric bypass performed in the modified lithotomy position.

Read More

The impact of laparoscopic bariatric workshops on the practice patterns of surgeons

This study was designed to evaluate the impact of a 2-day laparoscopic bariatric workshop on the practice patterns of participating surgeons.

Read More

Laparoscopic Gastric Bypass Surgery: Current Technique

THE TECHNIQUE OF LAPAROSCOPIC Roux -en-Y gastric bypass has evolved significantly since Wittgrove and Clark developed their technique in the early 1990s.

Read More

Effect of Laparoscopic Raux-En Y Gastric Bypass on Type 2 Diabetes Mellitus

To evaluate pre- and postoperative clinical parameters associated with improvement of diabetes up to 4 years after laparoscopic Roux-en-Y gastric bypass (LRYGBP) in patients with type 2 diabetes mellitus (T2DM).

Read More

Acute changes in renal function after laparoscopic gastric surgery for morbid obesity

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Acute renal failure (ARF) is a serious complication that contributes to patient morbidity and may result in death. To date, no data are available regarding the predictive risk of ARF or its effect on the outcome of patients who undergo laparoscopic gastric bypass.

Read More

Weight loss, quality of life and employment status after Roux-en-Y gastric bypass: 5-year analysis

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Why am I struggling with my weight? I am doing everything right!

As I write this, it’s just one short week after the Your Weight Matters Inaugural Convention in Dallas. Many thanks to all the speakers and organizers; almost every talk gave a nugget of useful information for this article.

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Stapler Stenosis

Incidence of gastroenterostomy stenosis in laparoscopic Roux-en-Y gastric bypass using 21- or 25-mm circular stapler: a randomized prospective blinded study.

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Posters

Sips Procedure With Nissen Fundoplication

Increase in prevalence of obesity and GERD have paralleled one another over the past.

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Linx Reflux Management System

In GERD, the underlying mechanism is Lower Esophageal Sphincter muscle which is either weak or relaxes inconsistently, allowing the content of the stomach to reflux into the esophagus, the airway & the mouth.

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Laparoscopic Revision Of Lap Band To Sips

The Laparoscopic Lap Band is designed to be an adjustable laparoscopically placed gastric restriction device for treatment of severe obesity.

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Lapaoscopic Revision Of Lap Roux En-Y Gastric Bypass To Duodenal Switch

Morbid obesity is chronic insidious disease which leads to range of diseases and reduces the health related quality of life.

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