ADVANCED BARIATRIC AND METABOLIC SURGERY Edited by Chih-Kun Huang Advanced Bariatric and Metabolic Surgery Edited by Chih-Kun Huang Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Iva Simcic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published February, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Advanced Bariatric and Metabolic Surgery, Edited by Chih-Kun Huang p. cm. ISBN 978-953-307-926-4 Contents Preface IX Chapter 1 Surgical Procedures to Achieve Weight Loss 1 Roman Grinberg, John N. Afthinos and Karen E. Gibbs Chapter 2 Effect of Obesity on Circulating Adipokines and Their Expression in Omental Adipose Tissue of Female Bariatric Surgery Patients 19 John N. Fain Chapter 3 The Economic Impact of Bariatric Surgery 61 Anke-Peggy Holtorf, Harald Rinde, Frederic Rupprecht, Henry Alder and Diana Brixner Chapter 4 Medical Assessment and Preparation of Patients Undergoing Bariatric Surgery 87 Wen Bun Leong and Shahrad Taheri Chapter 5 Rethinking the Preoperative Psychological Evaluation – A New Paradigm for Improved Outcomes and Predictive Power 117 Susan F. Franks and Kathryn A. Kaiser Chapter 6 Bariatric Surgery – Anesthesiologic Concerns 143 Johan Raeder Chapter 7 Gastric Banding and Bypass for Morbid Obesity – Preoperative Assessment, Operative Techniques and Postoperative Monitoring 157 Brane Breznikar, Dejan Dinevski and Milan Zorman Chapter 8 BPD and BPD-DS Concerns and Results 175 Francesco Saverio Papadia, Hosam Elghadban, Andrea Weiss, Corrado Parodi and Francesca Pagliardi VI Contents Chapter 9 Body Weight and Energy Intake and Expenditure in Bariatric Surgery 211 Maria Rita Marques de Oliveira, Patrícia Fátima Sousa Novais, Karina Rodrigues Quesada, Carolina Leandro de Souza, Irineu Rasera Junior and Celso Vieira de Souza Leite Chapter 10 Origins for Micronutrient Deficiencies 229 Anyea S. Lovette, Timothy R. Shope and Timothy R. Koch Chapter 11 Foot Drop as a Complication of Weight Loss After Bariatric Surgery – Is It Preventable? 255 Frank J. M. Weyns, Frauke Beckers, Linda Vanormelingen, Marjan Vandersteen and Erik Niville Chapter 12 Diabetes Improvement Following Bariatric and Metabolic Surgery 263 Rodolfo Lahsen, Marcos Berry and Patricio Lamoza Chapter 13 Bariatric Surgery on Obese Type 2 Diabetes Patients 275 Junichirou Mori, Yoshihiko Sato and Mitsuhisa Komatsu Chapter 14 Bariatric and Metabolic Surgery for Asians 281 Kazunori Kasama, Yosuke Seki and Tsuyoshi Yamaguchi Chapter 15 Robotic-Assisted Bariatric Surgery 295 Ulises Garza, Angela Echeverria and Carlos Galvani Chapter 16 Scarless Bariatric Surgery 317 Chih-Kun Huang, Rajat Goel and Satish Pattanshetti Preface Obesity was formally recognized as a disease by the World Health Organization (WHO) in 1997, and its prevalence is increasing at epidemic proportions worldwide. The enormous changes in human life regarding labor, exercise and diet habits have largely provoked the development of this multi-factorial disease. It has been confirmed that obesity causes many diseases, including cardiovascular disorders, type 2 diabetes mellitus, obstructive sleep apnea and degenerative joint disease. Even though many kinds of medical treatment are recommended, most therapies have not been successful in keeping sustained weight loss and controlling obesity-related comorbidity, especially in morbid obesity. Until now, only bariatric surgery has proven to be an effective procedure, and in the last 40 years, the number of bariatric procedures has been increasing exponentially in the world. This book provides an overview and updated knowledge of bariatric surgery and patient care. In it, we discussed various procedures, preoperative preparation, perioperative care and postoperative nutrition support, and the brand new, “transformed” bariatric surgery in type 2 diabetes–metabolic surgery and scarless bariatric surgery has also been included. We hope that this book will contribute to the future development of weight loss management. Chih-Kun Huang Bariatric & Metabolic International (B.M.I) Surgery Center, E-Da hospital, Taiwan International Minimally Invasive Surgery Training Center of E-Da hospital, Taiwan Republic of China [...]... operative technique, outcomes and complications Each has an important role to play in the world of weight loss surgery and it behooves those involved in the trenches of 2 Advanced Bariatric and Metabolic Surgery bariatric surgery and the subsequent care of these patients to be familiar with the individual nuances of the operations In this chapter, we will discuss the various common, and not so common, surgical... profile.17,18,38 8 Gastric Bypass The Gastric Bypass (GB) has emerged as the most common operation performed for weight loss in the United States In fact, it is often referred to as the “gold standard” of bariatric 10 Advanced Bariatric and Metabolic Surgery surgery Its long history of good weight loss with low complication rates have led to this status The original GB was performed by Mason and Ito in 1967,... Laparoscopic adjustable gastric banding (LAGB) was advocated in 1992 by Favretti and Cadiere and made a revolutionary change in the history of bariatric surgery Over time and with technological improvements, the first laparoscopic adjustable gastric band device was approved by the FDA for use in the United States in 2001 Fig 3 Adjustable Gastric Banding Adjustable Gastric Banding (AGB) procedures have... protein intake 12 Advanced Bariatric and Metabolic Surgery Along with vitamin deficiencies gastric bypass, due to the lack of a pylorus, can result in dumping syndrome Dumping syndrome occurs in early and late forms Early dumping syndrome (10 to 30 minutes after ingestion of a meal) is the more common form and occurs in about 25% of patients after gastric surgery It is characterized by the rapid gastric... a key role in the pathogenesis of the deleterious metabolic consequences of obesity and ii women comprise 80 to 90% of bariatric surgery patients and iii most intra-abdominal fat is omental fat The omentum also has a central role in an inflammatory response that involves macrophages in defending against peritonitis 20 Advanced Bariatric and Metabolic Surgery (Platell et al., 2000) In obesity per se,... haptoglobin and NGF was only 64, 144, 75 and 72% respectively of that by nonfat cells (Fain, 2006) Release of MIF and PAI-1 by fat cells was 37 and 23% of that by nonfat cells while that of cathepsin S, HGF, IL-1, IL-1Ra, IL-6, IL-8, IL-10 MCP-1, TGF1, VCAM-1 and VEGF was 12% or less of that by nonfat cells (Fain, 2006) Clearly, the majority of the inflammatory adipokines are released by the nonfat... obesity and the resulting quality of life, resolution of comorbidities, food tolerance, and 6-year weight loss Mathieu D`Hondt et al, Surgical Endoscopy (2011) 25:2498-2504, DOI 10.1007/s00464-011-1572-x 18 Advanced Bariatric and Metabolic Surgery [32] Laparoscopic sleeve gastrectomy: surgical technique, indications and clinical results Braghetto I, Korn O, Valladares H, Gutiérrez L, Csendes A, Debandi... posterior stomach and the right diaphragmatic crus.34,35 The band system consists of three components (see Figure 3): 1 The band which is placed at the gastric cardia near the gastroesophageal junction and effectively divides the stomach into two segments; an upper smaller pouch and the larger intact stomach 8 2 3 Advanced Bariatric and Metabolic Surgery The port which is the access point for adjustments... 2003 Dec; 13(6)861-4 [28] Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study Karamanakos SN, Vagenas K, Kalfarentzos F, Alexandrides TK Ann Surg 2008;247(3):401 [29] Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels Langer FB, Reza Hoda... curvature The more receptive greater curvature is resected and the patient is left with a long tube-like 6 Advanced Bariatric and Metabolic Surgery stomach (see Figure 2) The operation consists of releasing the vascular supply of the greater curvature as well as the posterior gastric attachments A bougie is advanced into the distal stomach or duodenum and the greater curvature of the stomach is resected . ADVANCED BARIATRIC AND METABOLIC SURGERY Edited by Chih-Kun Huang Advanced Bariatric and Metabolic Surgery Edited by Chih-Kun. can be obtained from orders@intechweb.org Advanced Bariatric and Metabolic Surgery, Edited by Chih-Kun Huang p. cm. ISBN 978-953-307-926-4