Gastric Bypass, has a better risk-benefit profile than the Band

Rny Gastric Bypass has ** greater weight loss **, ** increased resolution of diabetes **, and ** improved quality of life** than Gastric Band,



RnY Gastric Bypass, has a better risk-benefit profile than the Band.



RnY Gastric Bypass has a similar rate of overall complications and lower rate of reoperations than LB.

Amplify’d from archsurg.ama-assn.org

Vol. 146 No. 2, February 2011   Online Only  • Online First Table of Contents Original Article  • Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Public Health  • Obesity  • Quality of Life  • Surgery  • Surgical Interventions  • Bariatric Surgery  • Gastrointestinal/ Upper Foregut  • Prognosis/ Outcomes  • Endocrine Diseases  • Alert me on articles by topic  Social Bookmarking   What's this? Better Weight Loss, Resolution of Diabetes, and Quality of Life for Laparoscopic Gastric Bypass vs Banding Results of a 2-Cohort Pair-Matched Study Guilherme M. Campos, MD; Charlotte Rabl, MD; Garrett R. Roll, MD; Sofia Peeva, BA; Kris Prado, BA; Jessica Smith, MD; Eric Vittinghoff, PhD Arch Surg. 2011;146(2):149-155. doi:10.1001/archsurg.2010.316 Background  Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic gastric banding (LB) are the 2 most common operations used to treat morbid obesity, but few controlled comparative studies have reported perioperative and long-term outcomes. Design  Two-cohort pair-matched study. Setting  Academic tertiary referral center. Patients  One hundred consecutive morbidly obese patients treated with LB were pair-matched by sex, race, age, initial body mass index, and presence of type 2 diabetes mellitus with 100 patients who were treated with RYGB. Main Outcome Measures  Perioperative and postoperative complications, reoperations, and 1-year outcomes, including weight loss, type 2 diabetes resolution, and quality of life. Results  The RYGB and LB groups had similar characteristics. One-year outcomes were available for 93 patients in the LB group and 92 in the RYGB group. The overall rate of complications was similar in both groups (11 patients in the LB group [12%] vs 14 in the RYGB group [15%]; P = .83), with a higher rate of early complications (30 days) after RYGB (11 patients [11%] vs 2 [2%] for LB; P = .01) and a higher rate of reoperations after LB (12 patients [13%] vs 2 for RYGB [2%]; P = .009). No deaths occurred. Excess weight loss (36% vs 64%; P < .01), resolution of diabetes (17 patients [50%] vs 26 [76%]; P = .04), and quality-of-life measures were better in the RYGB group. Conclusions  When performed in high-volume centers by expert surgeons, RYGB has a similar rate of overall complications and lower rate of reoperations than LB. With the benefit of greater weight loss, increased resolution of diabetes, and improved quality of life, RYGB, in these circumstances, has a better risk-benefit profile than LB. Read more at archsurg.ama-assn.org

 

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Sitting is killing you.

Sitting is killing you.

Amplify’d from lifehacker.com

nfographics Share this post × Share on Tumblr Email this post The "Sitting Is Killing You" Infographic Shows Just How Bad Prolonged Sitting Is Melanie Pinola — Sitting is killing you. Numerous studies have pointed to the health risks of sitting all day, but here you have in one illustration how prolonged sitting affects our bodies and reminders to interrupt sitting time whenever possible. The human body simply isn't built to sit all day at a desk or for hours vegging out on the couch. Many of us spend more time sitting than sleeping. To avoid the health risks, we need not just 30 minutes of daily exercise, the infographic advises, but taking every opportunity to get up during the day. You don't need adopt a standing desk; there were many great suggestions offered by Lifehacker commenters recently on how to avoid sitting down all day, like placing important items (phone, copier) away from the desk. Sitting Is Killing You | Medical Billing & Coding [via How-To Geek] Read more at lifehacker.com

 

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Creatine is an inexpensive and safe dietary supplement

The benefits to older adults of creatine are substantial,

*can improve quality of life, and

*ultimately may reduce diseases associated with

*muscle loss and

*cognitive dysfunction.



The well documented benefits of creatine supplementation in young adults, including increased lean body mass, increased strength, and enhanced fatigue resistance are particularly important to older adults.



Higher brain creatine is associated with improved neuropsychological performance, and recently,

*creatine supplementation has been shown to increase brain creatine and phosphocreatine.



Subsequent studies have demonstrated that cognitive processing, that is either experimentally (following sleep deprivation) or naturally (due to aging) impaired, can be

*improved with creatine supplementation.



Creatine is an inexpensive and safe dietary supplement that has both peripheral and central effects.

Amplify’d from www.ncbi.nlm.nih.gov

Amino Acids. 2011 May;40(5):1349-62. Epub 2011 Mar 11. Use of creatine in the elderly and evidence for effects on cognitive function in young and old. Rawson ES, Venezia AC. Source Department of Exercise Science, 131 CEH, Bloomsburg University, Bloomsburg, PA, 17815, USA, erawson@bloomu.edu. Abstract The ingestion of the dietary supplement creatine (about 20 g/day for 5 days or about 2 g/day for 30 days) results in increased skeletal muscle creatine and phosphocreatine. Subsequently, the performance of high-intensity exercise tasks, which rely heavily on the creatine-phosphocreatine energy system, is enhanced. The well documented benefits of creatine supplementation in young adults, including increased lean body mass, increased strength, and enhanced fatigue resistance are particularly important to older adults. With aging and reduced physical activity, there are decreases in muscle creatine, muscle mass, bone density, and strength. However, there is evidence that creatine ingestion may reverse these changes, and subsequently improve activities of daily living. Several groups have demonstrated that in older adults, short-term high-dose creatine supplementation, independent of exercise training, increases body mass, enhances fatigue resistance, increases muscle strength, and improves the performance of activities of daily living. Similarly, in older adults, concurrent creatine supplementation and resistance training increase lean body mass, enhance fatigue resistance, increase muscle strength, and improve performance of activities of daily living to a greater extent than resistance training alone. Additionally, creatine supplementation plus resistance training results in a greater increase in bone mineral density than resistance training alone. Higher brain creatine is associated with improved neuropsychological performance, and recently, creatine supplementation has been shown to increase brain creatine and phosphocreatine. Subsequent studies have demonstrated that cognitive processing, that is either experimentally (following sleep deprivation) or naturally (due to aging) impaired, can be improved with creatine supplementation. Creatine is an inexpensive and safe dietary supplement that has both peripheral and central effects. The benefits afforded to older adults through creatine ingestion are substantial, can improve quality of life, and ultimately may reduce the disease burden associated with sarcopenia and cognitive dysfunction. Read more at www.ncbi.nlm.nih.gov

 

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Level I: Evidence; Controlled Prospective Trial; MGB vs RNY

Laparoscopic Roux-en-Y Versus Mini-Gastric Bypass for the Treatment of Morbid Obesity

A Prospective Randomized Controlled Clinical Trial



The Mini-Gastric Bypass is a ** simpler ** and ** safer ** procedure that has

** no disadvantage ** compared with RnY Gastric Bypass



Evidence-based medicine (EBM) or evidence-based practice (EBP) aims to apply the best available evidence gained from the scientific method to clinical decision making.[



Level I: Evidence obtained from at least one properly designed randomized controlled trial. Provides the "current best evidence in making decisions about the care of individual patients"

Amplify’d from www.ncbi.nlm.nih.gov

Laparoscopic Roux-en-Y Versus Mini-Gastric Bypass for the Treatment of Morbid Obesity A Prospective Randomized Controlled Clinical Trial Wei-Jei Lee, MD, PhD,* Po-Jui Yu, RN,† Weu Wang, MD,* Tai-Chi Chen, MD,* Po-Li Wei, MD,* and Ming-Te Huang, MD

Abstract

Objectives: This prospective, randomized trial compared the safety and effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGBP) and laparoscopic mini-gastric bypass (LMGBP) in the treatment of morbid obesity. Summary Background Data: LRYGBP has been the gold standard for the treatment of morbid obesity. While LMGBP has been reported to be a simple and effective treatment, data from a randomized trial are lacking. Methods: Eighty patients who met the NIH criteria were recruited and randomized to receive either LRYGBP (n = 40) or LMGBP (n = 40). The minimum postoperative follow-up was 2 years (mean, 31.3 months). Perioperative data were assessed. Late complication, excess weight loss, BMI, quality of life, and comorbidities were determined. Changes in quality of life were assessed using the Gastro-Intestinal Quality of Life Index (GIQLI). Results: There was one conversion (2.5%) in the LRYGBP group. Operation time was shorter in LMGBP group (205 versus 148, P < 0.05). There was no mortality in each group. The operative morbidity rate was higher in the LRYGBP group (20% versus 7.5%, P < 0.05). The late complications rate was the same in the 2 groups (7.5%) with no reoperation. The percentage of excess weight loss was 58.7% and 60.0% at 1 and 2 years, respectively, in the LPYGBP group, and 64.9% and 64.4% in the LMGBP group. The residual excess weight <50% at 2 years postoperatively was achieved in 75% of patients in the LRYGBP group and 95% in the LMGBP group (P < 0.05). A significant improvement of obesity-related clinical parameters and complete resolution of metabolic syndrome in both groups were noted. Both gastrointestinal quality of life increased significantly without any significant difference between the groups. Conclusion: Both LRYGBP and LMGBP are effective for morbid obesity with similar results for resolution of metabolic syndrome and improvement of quality of life. LMGBP is a simpler and safer procedure that has no disadvantage compared with LRYGBP at 2 years of follow-up.  Other Sections▼ Abstract METHODS RESULTS DISCUSSION CONCLUSION REFERENCES Read more at www.ncbi.nlm.nih.gov

 

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"I told you..." Dr. Rutledge

Gluten causes gastrointestinal symptoms in subjects without celiac disease: !!!

Amplify’d from www.medscape.com

Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol.  2011; 106(3):508-14; quiz 515 (ISSN: 1572-0241) Biesiekierski JR; Newnham ED; Irving PM; Barrett JS; Haines M; Doecke JD; Shepherd SJ; Muir JG; Gibson PR Monash University Department of Medicine and Gastroenterology, Box Hill Hospital, Box Hill, Victoria, Australia. OBJECTIVES: Despite increased prescription of a gluten-free diet for gastrointestinal symptoms in individuals who do not have celiac disease, there is minimal evidence that suggests that gluten is a trigger. The aims of this study were to determine whether gluten ingestion can induce symptoms in non-celiac individuals and to examine the mechanism. METHODS: A double-blind, randomized, placebo-controlled rechallenge trial was undertaken in patients with irritable bowel syndrome in whom celiac disease was excluded and who were symptomatically controlled on a gluten-free diet. Participants received either gluten or placebo in the form of two bread slices plus one muffin per day with a gluten-free diet for up to 6 weeks. Symptoms were evaluated using a visual analog scale and markers of intestinal inflammation, injury, and immune activation were monitored. RESULTS: A total of 34 patients (aged 29-59 years, 4 men) completed the study as per protocol. Overall, 56% had human leukocyte antigen (HLA)-DQ2 and/or HLA-DQ8. Adherence to diet and supplements was very high. Of 19 patients (68%) in the gluten group, 13 reported that symptoms were not adequately controlled compared with 6 of 15 (40%) on placebo (P=0.0001; generalized estimating equation). On a visual analog scale, patients were significantly worse with gluten within 1 week for overall symptoms (P=0.047), pain (P=0.016), bloating (P=0.031), satisfaction with stool consistency (P=0.024), and tiredness (P=0.001). Anti-gliadin antibodies were not induced. There were no significant changes in fecal lactoferrin, levels of celiac antibodies, highly sensitive C-reactive protein, or intestinal permeability. There were no differences in any end point in individuals with or without DQ2/DQ8. CONCLUSIONS: "Non-celiac gluten intolerance" may exist, but no clues to the mechanism were elucidated. Read more at www.medscape.com

 

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We Want to Know; How Are You?

We want to know how you are doing, so to encourage you to fillout one of our follow up forms we are going to be giving away an iPad in June to one of the people that fills out our follow up forms.



Please help us understand how you are doing





Dr. Rutledge, Email: DrR@clos.net, 702-714-0011,  www.CLOS.net



http://www.facebook.com/DrRutledge

http://twitter.com/DrRR

http://www.youtube.com/user/DrRRutledge    

Over 1,000 videos, Videos Viewed over  1,800,000 times!



For more information, Consider joining one of our online Groups:

http://minigastricbypassrus.ning.com/

http://health.groups.yahoo.com/group/Mini-Gastric-Bypass/

http://groups.google.com/group/mgbers

Amplify’d from clos.net

Fill out a follow up form and you could win an iPad!!! OK! Here it is: We are offering another Drawing for Free iPad!  To encourage participation in our survey in July we gave away a free iPad to one of the patients that completed this survey. (P.S. the winner was from Canada!)   If you fill out this survey in the next few days we are going to be drawing for another new iPad!   We are particularly interested in survey results rating your surgeon and a new section on heart disease before and after surgery  Tell us what has happened to you since you contacted us. Email questions:   ( https://www.surveymonkey.com/s/mgbfollowup ) Read more at clos.net

 

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High Dose Prilosec Sometimes Better

CONCLUSION: Intravenous standard-dose omeprazole was inferior to high-dose omeprazole in preventing rebleeding after endoscopic haemostasis for peptic ulcer bleeding. Registration number: NCT00519519 (http://www.clinicaltrials.gov). Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Amplify’d from www.medscape.com

MEDLINE Abstract Printer-Friendly Email This Download This processing....   [ Close Window ] Download This MEDLINE Bookends Endnote Papyrus Procite Refman Quickdoc  Format. Information from Industry Your eligible patients could save up to $50 Start Saving Now View This Abstract Online Randomized controlled trial of standard versus high-dose intravenous omeprazole after endoscopic therapy in high-risk patients with acute peptic ulcer bleeding. Br J Surg.  2011; 98(5):640-4 (ISSN: 1365-2168) Chan WH; Khin LW; Chung YF; Goh YC; Ong HS; Wong WK Department of Surgery, Singapore General Hospital, National Heart Centre Singapore, Singapore, Republic of Singapore. gsucwh@sgh.com.sg. BACKGROUND: Rebleeding from peptic ulcers is a major contributor to death. This study compared standard (40-mg intravenous infusion of omeprazole once daily for 3 days) and high-dose (80-mg bolus of omeprazole followed by 8-mg/h infusion for 72 h) in reducing the rebleeding rate (primary endpoint), need for surgery, duration of hospital stay and mortality in patients with peptic ulcer bleeding after successful endoscopic therapy. METHODS: This was a single-institution prospective randomized controlled study based on a postulated therapeutic equivalence of the two treatments. All patients who had successful endoscopic haemostasis of a bleeding peptic ulcer (Forrest classification Ia, Ib, IIa or IIb) were recruited. Informed consent was obtained and patients were randomized to receive standard- or high-dose infusions of intravenous omeprazole. RESULTS: Two (3 per cent) of 61 patients in the high-dose group and ten (16 per cent) of 61 in the standard-dose group exhibited rebleeding, a difference of - 13 (95 per cent confidence interval - 25 to - 2) per cent. The upper limit of the one-sided confidence interval exceeded a predefined equivalence absolute difference of 16 per cent. Equivalence of standard- and high-dose omeprazole in preventing rebleeding was not demonstrated. CONCLUSION: Intravenous standard-dose omeprazole was inferior to high-dose omeprazole in preventing rebleeding after endoscopic haemostasis for peptic ulcer bleeding. Registration number: NCT00519519 (http://www.clinicaltrials.gov). Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Read more at www.medscape.com

 

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Reflux (GERD) from Sleeve and the Band

Among bariatric procedures,

** gastric sleeve ** and

vertical banded gastroplasty were shown to worsen reflux symptoms



** Gastric banding ** is associated with reflux symptoms in a considerable proportion of patients.

Amplify’d from www.ncbi.nlm.nih.gov

Curr Gastroenterol Rep. 2011 Jun;13(3):205-12. Obesity and GERD: Pathophysiology and Effect of Bariatric Surgery. Tutuian R. Source Division of Gastroenterology, University Clinics of Visceral Surgery and Medicine, Bern University Hospital, Inselspital Bern, Bern, Switzerland, radu.tutuian@insel.ch. Abstract Epidemiologic, endoscopic, and pathophysiologic studies document the relationship between obesity and gastroesophageal reflux disease (GERD). Increased body mass index and accumulation of visceral fat are associated with a two- to threefold increased risk of developing reflux symptoms and esophageal lesions. Given this association, many studies were designed to evaluate the outcome of reflux symptoms following conventional and surgical treatment of obesity. Among bariatric procedures, gastric sleeve and banded gastroplasty were shown to have no effect or even worsen reflux symptoms in the postoperative setting. Gastric banding improves reflux symptoms and findings (endoscopic and pH-measured distal esophageal acid exposure) in many patients, but is associated with de novo reflux symptoms or lesions in a considerable proportion of patients. To date, Roux-en-Y gastric bypass is the most effective bariatric procedure that consistently leads to weight reduction and improvement of GERD symptoms in patients undergoing direct gastric bypass and among those converted from restrictive bariatric procedures to gastric bypass. Read more at www.ncbi.nlm.nih.gov

 

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Sleeve Gastrectomy; Another Bad Idea

In the present study, Sleeve Gastrectomy showed persistence of GERD symptoms in patients with GERD preoperatively.



Also, patients who did not have GERD preoperatively had an increased risk of postoperative GERD symptoms after Sleeve!!



Another bad idea by American Bariatric surgeons:

Jejunal ileal bypass = abandoned/failure

Stomach stapling = abandoned/failure

Lapband = abandoned/failure (in Europe and coming to America, I believe it will be abandoned)

RNY = why are Drs trying so many other operations?

Sleeve = 50% failure from reflux or weight regain reported from Europe, I believe it will be abandoned

Amplify’d from www.ncbi.nlm.nih.gov

In the present study, LSG correlated with the persistence of GERD symptoms in patients with GERD preoperatively. Also, patients who did not have GERD preoperatively had an increased risk of postoperative GERD symptoms.

Surg Obes Relat Dis. 2011 Mar 21. [Epub ahead of print] Association between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy. Carter PR, Leblanc KA, Hausmann MG, Kleinpeter KP, Debarros SN, Jones SM. Source Midwest Surgical Associates, LaGrange, Illinois. Abstract BACKGROUND: Gastroesophageal reflux disease (GERD) is a common co-morbidity identified in obese patients. It is well established that patients with GERD and morbid obesity experience a marked improvement in their GERD symptoms after Roux-en-Y gastric bypass. Conflicting data exist for adjustable laparoscopic gastric banding and GERD. Laparoscopic sleeve gastrectomy (LSG) has become a popular adjunct to bariatric surgery in recent years. However, very little data exist concerning LSG and its effect on GERD. METHODS: A retrospective chart review was performed of 176 LSG patients from January 2006 to August of 2009. The preoperative and postoperative GERD symptoms were evaluated using follow-up surveys and chart review. RESULTS: Of the 176 patients, 85.7% of patients were women, with an average age of 45 years (range 22-65). The average preoperative body mass index was 46.6 kg/m(2) (range 33.2-79.6). The average excess body weight lost at approximately 6, 12, 24 months was calculated as 54.2%, 60.7%, and 60.3%, respectively. Of the LSG patients, 34.6% had preoperative GERD complaints. Postoperatively, 49% complained of immediate (within 30 d) GERD symptoms, 47.2% had persistent GERD symptoms that lasted >1 month after LSG, and 33.8% of patients were taking medication specifically for GERD after LSG. The most common symptoms were heartburn (46%), followed by heartburn associated with regurgitation (29.2%). CONCLUSION: In the present study, LSG correlated with the persistence of GERD symptoms in patients with GERD preoperatively. Also, patients who did not have GERD preoperatively had an increased risk of postoperative GERD symptoms. Copyright © 2011 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved. PMID: 21429818 [PubMed - as supplied by publisher] Read more at www.ncbi.nlm.nih.gov

 

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Sleeve Gastrectomy; Another Bad Idea

In the present study, Sleeve Gastrectomy showed persistence of GERD symptoms in patients with GERD preoperatively.



Also, patients who did not have GERD preoperatively had an increased risk of postoperative GERD symptoms after Sleeve!!

Amplify’d from www.ncbi.nlm.nih.gov

Obes Surg. 2011 Mar;21(3):295-9. Symptoms of gastroesophageal reflux following laparoscopic sleeve gastrectomy are related to the final shape of the sleeve as depicted by radiology. Lazoura O, Zacharoulis D, Triantafyllidis G, Fanariotis M, Sioka E, Papamargaritis D, Tzovaras G. Source Department of Radiology, University Hospital of Larissa, Larissa, Greece. Abstract BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is gaining popularity as a primary procedure in selected morbidly obese patients. Like most other bariatric procedures LSG results in alterations of the upper GI anatomy that might affect gastroesophageal reflux postoperatively. The study was conducted to assess the presence of reflux symptoms in patients before and after laparoscopic sleeve gastrectomy and any possible relation of these symptoms to the postoperative gastric anatomy as depicted by gastrografin swallow studies. METHODS: The study included 85 consecutive morbidly obese patients who underwent LSG as a primary bariatric procedure. Patients were evaluated for symptoms of gastroesophageal reflux (heartburn, regurgitation, and vomiting) preoperatively and at 1 and 6 months and 1 year postoperatively. To assess the postoperative gastric anatomy, the gastrografin studies that were routinely performed in all patients on the third postoperative day were retrospectively evaluated. Changes of each one of the reflux symptoms were assessed in relation to the radiological pattern of the gastric sleeve. RESULTS: Three radiological patterns of the gastric sleeve were identified: (a) the tubular (65.9%), (b) the superior pouch (25.9%), and (c) the inferior pouch pattern (8.2%). Patients showed an overall tendency towards relief of heartburn and increase of regurgitation and vomiting postoperatively. However, only changes in regurgitation and vomiting were found to be statistically significant (p < 0.01); interestingly, those were observed in patients with the tubular gastric pattern. CONCLUSIONS: The final shape of the gastric sleeve as depicted by radiological studies seems to have an impact on reflux symptoms after laparoscopic sleeve gastrectomy. Read more at www.ncbi.nlm.nih.gov

 

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Low Revision Rate for the MGB

From January 2001 to December 2009, ** 1322 patients ** (996 women and 326 men, mean age 31.6 ± 9.1 years, mean body mass index 40.2 ± 7.4 kg/m(2)), had ** MGB **



Of the 1322 patients,

** 23 (1.7%) ** required revision surgery during

** a follow-up of 9 years. **



revision was for:

malnutrition in 9

inadequate weight loss in 8

** bile reflux ** in 3 out of 1,322!!!



Conclusion MGB appears to be By Far the best form of long term bariatric surgery.

Amplify’d from www.ncbi.nlm.nih.gov

Surg Obes Relat Dis. 2010 Oct 30. [Epub ahead of print] Revisional surgery for laparoscopic minigastric bypass. Lee WJ, Lee YC, Ser KH, Chen SC, Chen JC, Su YH. Source Department of Surgery, Min-Sheng General Hospital, National Taiwan University, Taipei, Taiwan. Abstract BACKGROUND: Laparoscopic minigastric bypass (LMGB), a sleeved gastric tube with Billroth II anastomosis, has been proposed as an alternative to laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity. However, the data regarding revision surgery after LMGB during long-term follow-up is not clear. METHODS: From January 2001 to December 2009, 1322 patients (996 women and 326 men, mean age 31.6 ± 9.1 years, mean body mass index 40.2 ± 7.4 kg/m(2)), who were enrolled in a surgically supervised weight loss program and had undergone LMGB were included. All the patients received regular yearly follow-up, and all the clinical data were prospectively collected and stored. The reasons and type of surgery for revision surgery were identified and analyzed. RESULTS: The excess weight loss and mean body mass index at 5 years after LMGB was 72.1% and 27.1 ± 4.6 kg/m(2). Of the 1322 patients, 23 (1.7%) had undergone revision surgery during a follow-up of 9 years. The estimated accumulated revision rate of 9 years was 2.69% for LMGB. The most common cause of revision was malnutrition in 9 (39.1%), followed by inadequate weight loss in 8 (34.7%), and intractable bile reflux and dissatisfaction each in 3 (13.0%). The type of revision surgery was LRYGB in 11 (47.8%), sleeve gastrectomy in 10 (43.5%), and conversion to a normal anatomic state in 2 (8.6%). All the revision procedures were performed using a laparoscopic approach, without major complications. Two patients underwent repeat second revision surgery to duodenal switch and biliopancreatic diversion each in 1 patient. All patients had satisfactory results after revision surgery. No patients had undergone revision surgery for internal hernia or ileus during the follow-up period. CONCLUSION: LMGB resulted in significant and sustained weight loss with an acceptably low revision rate at long-term follow-up. Revision surgery after LMGB can be performed using a laparoscopic approach with a low risk. Copyright © 2010 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved. Read more at www.ncbi.nlm.nih.gov

 

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