Laparoscopic adjustable gastric banding (LAGB) is commonly used in the treatment of morbid obesity. However, with clinical application and long-term follow-up, the shortcomings of this procedure were also exposed, bringing about surgery-related complications include dysphagia, intragastric band migration, slippage, and gastric band erosion. Lower esophageal and gastric fistula is a rare but dangerous complication after LAGB. We describe a case of esophagogastric fistula occurring twelve years after a laparoscopic band procedure and its successful management in a multidisciplinary and staged manner, followed by a short review of the literature.

Obesity is a growing global health burden which is particularly challenging to manage. Bariatric surgery is considered the most effective means of sustained weight loss, and Roux-en-Y gastric bypass is considered the most effective treatment for morbid obesity. The additional benefit of placing a non-adjustable band to form a banded Roux-en-Y gastric bypass has gained interest as a measure to improve weight loss; however, comparative data are few, and complications can be high.
We conducted a prospective case-control study of 484 patients aged 18 and over who received either banded Roux-en-Y gastric bypass with a non-adjustable silastic ring or Roux-en-Y gastric bypass. Patients were followed up for five years and evaluated for weight loss, percentage excess weight loss (%EWL), BMI, and band-related complications.
No significant difference was detected in %EWL or BMI between BRYGB and RYGB. The mean raw weight loss, %EWL, and BMI for BRYGB verse RYGB were as follows: 27.49 SD (17.11) kg verse 34.46 SD (18.18) kg, 65.7% SD (30%) verse 62.2% SD (37%), and 32.33 SD (6.9) kg/m2 verse 32.43 SD (7.2) kg/m2. A total of 80 (21.7%) patients had the non-adjustable band removed for complications.
There is little difference in weight-loss results when comparing BRYGB to RYGB and non-adjustable bands may cause significant complications.

The popularity of bariatric surgery (BS) began to increase due to the dramatic rise in severe obesity in the past decades. Postoperative follow-up after BS is important to avoid possible medical complications. Therefore, medical complications after BS should be well-known and defined. Herein, we present a case of bilateral peroneal neuropathy (PN) developed after successful BS. The patient lost 40 kg during 16 weeks of follow-up. The foot drop developed after 18 weeks after surgery on the left side and than 24 weeks after surgery on the right side. Peroneal neuropathy-associated weight loss is usually unilateral. Bilateral PN with weight loss is uncommon. The rate of weight loss is an important risk factor for PN. This case report highlights the importance of optimal dietary after BS to control the weight loss rate and nutrient deficiency.

Revisional surgery in bariatric patients can sometimes lead to life-threatening complications that need a fast diagnosis and treatment as well as a multidisciplinary approach. If left undiagnosed or untreated, this may lead to sepsis, multiple organ failure, and death. In this case report, we describe the management of a gastric perforation which occurred after conversion of a gastric banding to a sleeve gastrectomy.

BACKGROUND: Laparoscopic adjustable gastric banding has been the gold standard for surgical management of obesity over the last decades in USA and Europe. However, significant complications have been documented due to foreign body placement, including band erosions. Our treatment approach for erosions is rather observant with regular follow-up until the band has sufficiently perforated the gastric wall which facilitates endoscopic removal. Consequences of a not followed-up band erosion may present even after a long time following initial diagnosis with more severe complications.
METHODS: A 51-year-old Caucasian woman presented to our out-patients\' clinic with a 2-week history of worsening abdominal pain in her left upper quadrant, exacerbated by abdominal flexion and extension maneuvers. Here we describe a case involving gastric penetration and subsequent downward migration of a band into distal jejunum causing small bowel obstruction, which occurred more than 10 years following initial diagnosis of erosion. The perforation was missed due to cessation of endoscopic follow-up.
CONCLUSIONS: Prospective and long-term follow-up is mandatory in those with partial band erosion to avoid further complications.

BACKGROUND: Although carcinoid tumours are a rare gastrointestinal neoplasm with an incidence rate of 1-2.5 cases per 100 000 inhabitants, they are the most common neuroendocrine tumour of the stomach.
METHODS: A 70-year-old-man consulted for epigastric pain and dyspepsia symptoms. His past medical and surgical history included obesity (BMI: 53.9 kg/m2), hypertension, hyperlipidemia, diabetes mellitus type 2, cardiac failure and a surgical treatment with laparoscopic gastric banding. For the analysis and control of the gastric banding an upper gastrointestinal endoscopy was performed evidencing many small polyps in the gastric antrum, body and fundus. The histopathological examination of the resected specimen revealed a well differentiated carcinoid. Laparoscopic surgery for the removal of the gastric banding and the subtotal gastrectomy leaving a small gastric remnant of approximately 2-cm in size similar to the pouch of a bypass was done. Twelve months after surgery the patient presented a body mass index of 36.6 kg /m2.
CONCLUSIONS: Gastric carcinoid increased incidence among the obese population, although the causing mechanisms are not clear, yet it is likely that metabolic and hormonal effects of the obesity play a role. The resection may be performed either endoscopically when the lesions are small, or surgically according to the tumor type and size.
CONCLUSIONS: The resective gastric bypass or gastrectomy with anastomosis by Roux- en- Y bypass may be considered as a treatment of choice for patients who after bariatric surgery were diagnosed with gastric carcinoid and weight regain.

The laparoscopically administrated adjustable gastric banding used to be widely practiced as treatment of extreme obesity. As lots of complaints and complications arose sooner or later after this procedure, they had to be removed quite often. Half year after such a removal we observed a 37-year-old female patient with complete gastric outlet obstruction. The patient was operated and cured completely. The cause of gastric obstruction was an internal incarceration of the pyloric region between the plication made at the time of the ring removal and the gastric body. We found no similar case of gastric outlet obstruction in the corresponding literature.

The aim of this study is to review the reliability of laparoscopic obesity operations in patients with situs inversus totalis(SIT). A new case of SIT was presented together with a literature review of published English language studies on laparoscopic gastric banding (LAGB), laparoscopic gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), laparoscopic obesity surgery (LOS), and SIT, accessed via PubMed and Google Scholar databases. The case is presented of a 21-year-old female patient who underwent LSG due to SIT. A total of 12 publications in literature matched the search criteria for LAGB, LRYGB, LSG, LOS, and SIT, which reported LAGB in five cases, LRYGB in four cases, and LSG in four cases. In the rare event of SIT, LOS can be safely used following good evaluation.

We conducted the following study to evaluate the safety and efficacy of single-stage conversion of failed laparoscopic adjustable gastric band (LAGB) to laparoscopic Roux-en-Y gastric bypass (LRYGB) as compared to a cohort of primary LRYGB patients.
A single-institution, prospectively maintained bariatric database was used to retrospectively identify consecutive patients who underwent single-stage removal of LAGB with concomitant conversion to LRYGB between the years of 2007 and 2013. The study cohort was matched 1:1 for age, gender, body mass index (BMI), and approximate date of operation to patients who underwent primary LRYGB. Primary endpoints were operative time, complication rate, length of hospital stay (LOS), and percent excess BMI lost (%EBMIL) at 24-month follow-up.
Ninety-four conversion patients met inclusion criteria. There were no statistically significant differences in the mean LOS (3.1 vs. 3.0 days, p = 0.97) or the major complication rate (3.2 vs. 1.1 %, p = 0.62) at 30 days postoperatively. Likewise, 30-day minor complication rates, including readmission, were similar between groups (7.5 vs. 6.4 %, p = 0.77). The average operative time was significantly longer for conversion compared to primary LRYGB (193.5 vs. 132 min; p < 0.01). At most recent follow-up after conversion or primary LRYGB, median %EBMIL was 61.3 and 77.3 % (p < 0.01), percent total weight loss was 23.6 and 30.5 % (p < 0.01), and percent change in BMI was 23.4 and 30.5 % (p < 0.01), respectively. Median follow-up time was 17 and 18.6 months after conversion and primary LRYGB, respectively.
Single-stage conversion of LAGB to LRYGB is safe with an acceptable complication rate and similar LOS compared to primary LRYGB.

BACKGROUND: Bariatric surgery is the only effective treatment for the long-term maintenance of significant weight loss. Minimally invasive revisional procedures are on the rise. Data is lacking in terms of safety, feasibility and outcomes with robotic revisional procedures.
METHODS: Robotic revisional bariatric procedures (RRBPs) of gastric band to Roux-en-Y gastric bypass and sleeve gastrectomy, revision of gastro-jejunal anastomosis and stricturoplasty performed during 2009-2013 were retrospectively reviewed.
RESULTS: RRBPs were performed on 14 patients with mean age, pre-operative body mass index (BMI) and weight of 45.2 ± 11.4 years, 40.1 ± 8.7 kg/m2 and 109.4 ± 26 kg, respectively. The mean operative time, estimated blood loss and length of hospital stay were 220.6 ± 64.3) min, 31 ± 22.7 ml and 3.3 ± 1.5 days, respectively. There were no conversions, blood transfusions, gastrointestinal leaks, intraoperative complications or mortalities.
CONCLUSIONS: RRBP can be performed safely without increased morbidity and with the added benefit of a minimally invasive approach. Copyright © 2014 John Wiley & Sons, Ltd.