Annals of Bariatric Surgery
Volume:10 Issue: 1, Winter and Spring 2021

The association between gastroesophageal reflux disease (GERD) and obesity with a prevalence of 50-100% has been proven, while 8-26% of non-obese patients experienced GERD. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the gold standard for obese patients with GERD. RYGB can accelerate gastric emptying and thus improve reflux symptoms.

A 56-year-old man weighing 101 kg and 167 cm tall (BMI 36.2) presented to the hospital with major complaints of obesity and mild gastroesophageal reflux disease. He also suffered from comorbidities like DM, HTN, and IHD. 15 years ago he underwent Nissen Fundoplication due to severe GERD. We candidate the patient for LRYGB surgery because of obesity, Mild reflux, and comorbidities such as DM, and HTN. Due to past fundoplication, severe adhesions, and fibrosis at the last operation site, LRYGB without Wrap taken down was done.

Laparoscopic conversion of Fundoplication to RYGB is a complex technique because of extended operative time, morbidity, and length of hospital stay. RYGBP after fundoplication leads to more complications than other forms of reoperative bariatric surgery; however, it gives a good weight loss that satisfies the patient.

LRYGB after previous anti-reflux surgery without wrap takedown is technically safe and brings in reflux symptoms and comorbidities improvement, satisfactory weight loss, and less morbidity.

Any physiologic or pathologic situation can affect oral and dental health. Obesity and Bariatric surgery are two different factors which have their own signs and symptoms in the oral cavity. Soft tissue, hard tissue, oral flora and saliva can manifest changes in these patients and some intervention would be needed to control it. Our goal is to review oral manifestations in obese and bariatric patients to attract attention to oral care in these patients.

Bariatric surgery is considered the most effective treatment for morbid obesity. Despite the successful weight loss, as result of bariatric surgery, patients are susceptible to protein deficiency. Change in food intake after surgery can cause some nutritional deficiencies. The aim of this study was to determine the status of protein before and after bariatric surgery

The systematic search was performed in April 2021. Cochrane, PubMed, and google scholar databases were used for our literature search by searching these keywords: body composition, fat free mass, bariatric surgery, protein malnutrition and protein intake.

Our studies showed few evaluation of protein has been done before surgery in candidates for surgery. Obesity surgery reduces muscle mass and serum protein so evaluation of these factors is necessary. Bariatric surgery method exposes people to protein malnutrition and changes in body composition therefore more attention to their protein intake needs to be done.

Based on our results dietary intake can affect the outcome of surgery, so, we recommended evaluating protein status and lean body mass before and following the bariatric surgery. Also, the effect of different types of protein supplementation to improve body composition can be assessed in further studies.

An enlarged liver, which is resulted from fatty liver and/or steatohepatitis, makes difficulties in gastric bypass surgery procedure and increases the risk of liver laceration. omega-3 polyunsaturated fatty acids (ω-3 PUFAs) recently have been suggested as a potential intervention to reduce liver inflammation and volume. This review aimed to provide a comprehensive overview of the recent advances on fish oil/ ω-3 PUFAs supplementation to reduce the liver volume proceeding to bariatric surgery.

This review summarizes studies that were investigated the influence of fish oil/omega-3 PUFA in the liver volume of bariatric surgery candidates. Scopus and PubMed databases were systematically searched up to May 2021, for studies providing knowledge relating to the effects of omega-3 and/or fish oil supplementation on liver size, fatty liver, or steatohepatitis.

Most of the randomized controlled trials showed that ω-3 PUFA supplementation, mostly due to its anti-inflammatory and antioxidative properties, is a practical and effective treatment for fatty liver, and to decrease ALT, AST, and GGT.  Omega-3 fatty acids as important regulators of hepatic gene transcription can reduce hepatic steatosis and inflammation markers, also improve insulin sensitivity. As well, the access to the gastroesophageal junction was reported as simple.

The collective data suggest that preoperative fish oil ω-3 PUFA supplementation could be an effective approach in improving liver function and decrease liver volume before bariatric surgery. Although, well-designed randomized clinical trials are needed to confirm these results and determine a clear protocol of supplementation regarding the optimal dose and duration before surgery.

  Helicobacter pylorus (H. pylori) is a gram-negative spiral bacterium related to varieties of gastric and extra-gastric complications. The effects of H. pylori infection on cardiometabolic conditions such as dyslipidemia, diabetes, and metabolic syndrome have to need to be investigated. The present paper aims to assess the effects of body mass index on the success of helicobacter-pylori eradication therapy for the first time.

  This study included 198 patients with H. pylori infection. Patients underwent H. pylori eradication using clarithromycin (500 mg, twice daily, pantoprazole (40 mg, twice daily), amoxicillin (500 mg, three times daily), and bismuth substrate (120 mg, twice daily) for 14 days. After that, the success of eradication was assessed through stool antigen within a month following the treatment. The association of eradication success with age, gender, and BMI were evaluated. 

 H. pylori infection was eradicated in 76.3% (P-value<0.001) of the patients following the eradicative treatment. The rate of response to the anti-H. Pylori remedy was affected by age (P-value=0.29). But it wasn’t affected by gender (P-value=0.81), and BMI (P-value=0.60).

 Based on the findings of this study, the patientschr('39') response to the H. Pylori eradication was not affected by age, gender, and BMI.

The aim of this study was to evaluate the prevalence of H.pylori, before and one year after Roux-en Y gastric bypass surgery.

The laparoscopic research center database from 2018 to 2020 was queried to identify patients undergoing laparoscopic Roux-en Y gastric bypass surgery(LRYGB). Retrospectively, the patients were evaluated for the presence of H.pylori infection via endoscopy or H. pylori Stool Ag before and 1 year after the surgery.

Among the 106 patients, H.pylori was positive in 50 (47.2%) patients pre-operatively. Based on post-op evaluation among 54 patients, only 4 (7.4%) developed post-op H.pylori infection.

. eradicating H. pylori in patients under Roux-en Y gastric bypass surgery remains efficient. So, it is not recommended to re-checked H.pylori Ag in patients after Roux-en Y gastric bypass surgery in the short term; but, further studies are suggested to evaluate the need for re-screening patients for H.pylori Ag in the long term after Roux-en Y gastric bypass surgery

 To evaluate the association between menstrual cycle disorders with obesity in Iranian women.

In the present case-control study, 405 obese women of reproductive age who referred to the Obesity Clinic of Minimally Invasive Surgery Research Center, Rasoul-e-Akram Hospital, Tehran, between Jan 2013 and Oct 2015 were included as the case group and were compared with a control normal-weight group, selected from their family members (N=293). Menstrual cycle characteristics were documented in a researcher-designed checklist. For the statistical analysis, we used SPSS version 19 and Stata version 5.0.

In the case group, 47 women (11.6%) had irregular menstrual cycles, while it existed in 22 (7.5%) of the control group (P<0.001). The prevalence of different menstrual disorders was as follows: polymenorrhea 107 (26.4%) in cases and 51 (17.4%) in controls (P<0.001), oligomenorrhea 22 (5.4%) in cases and 16 (5.5%) in controls (P<0.001).

The results of the present study showed that morbid obesity increases the risk of menstrual irregularities and dysmenorrhea; therefore, it is essential to pay greater attention to this issue in morbid obese patients for proper management of this disturbing comorbidity.

Surgical treatment of patients with morbid obesity is now the most successful way to return to active life and overcome its effects. Complications during surgery, but still are varied and plentiful. One of the most important of these effects is increased bleeding during surgery and may require further surgery is surgery duration. The use of propranolol in other operations under the impact of which is helpful in reducing blood loss in surgery Bariatric still not been investigated. The purpose of this study is the use of propranolol in reducing gastric bypass surgery is bleeding.

The aim of this study was to describe three neglected pregnancy at the time of bariatric surgery (BS) who had negative pregnancy test before surgery and underwent single-anastomosis gastric bypass surgery in obesity clinic in Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. The first case was a 38 years old woman with BMI of 47.1 suffering from nausea and vomiting one month after surgery that medical treatment did not work and it was found positive βHCG test as and 13W + 6D fetus in sonography. The second case was a 30 years old woman with BMI of 46.2 suffering uterus bleeding four months after surgery. The third case was a 32 years old woman with BMI of 44.6 with suffering from resistant nausea and vomiting, epigastric pain, and delayed mense three month after surgery. These cases show the necessity of βHCG test at the time of bariatric surgery for childbearing females.

Nowadays, surgical option is the most powerful and durable treatment modality for morbid obese patients in the world. Postoperative Gastrointestinal bleeding is one of complications which has been encountered in the early and late postoperative period after bariatric surgery. One of probable locations of gastrointestinal bleeding after gastric bypass is gastrojejunostomy anastomosis site. Use of metal clips in the tip of inner aspect of gastrojejunostomy anastomosis may reduce intraluminal bleeding in early postoperative period.

Roux-en-Y gastric bypass (RYGBP) has received a lot of attention with the prevalence of obesity. However, some patients report more weight loss and more malnutrition, which is thought to be due to differences in common Limb length (CLL) in patients. Surgeons reported alimentary limb length (ALL) and biliopancreatic limb length (BPLL), and CLL is generally unknown.

During 2015-2017, this study was conducted among 600 patients to evaluate CLL and excessive weight loss (EWL) and malnutrition in patients undergoing RYGBP. To measure the length of the small intestine, 30 minutes after the start of the surgery, the measurement was performed by micro forceps and grasping the midpart of the small intestine and, the average measurement time was 7 minutes.

the median length of the small bowel was 712 cm. The results of this study showed that patients with CLL ˂650 cm had more EWL% and malnutrition than CLL >750 cm.

 Since 0.5% and 2% of the participants in this study had a small bowel length of fewer than 4 m and 4.5 m, respectively, and assuming that the ALL + CLL should be more than 3 m, the length of the small bowel was usually bypassed in these people is 2 meters. If the BPLL is less than 125 cm, small bowel measurement is not necessary, but if it is higher than 125 cm, 2% of people will have the chance of shortness of small bowel and it is better to measure the length of the intestine.

Previous studies have demonstrated that patients with obesity can be metabolically healthy. However, little is known about the healthy or unhealthy metabolic status of patients undergoing bariatric surgery. This study, therefore, assesses the prevalence of metabolically healthy (MHO) and unhealthy (MUO) obesity among bariatric surgery candidates.

The study involved 713 bariatric surgery candidates (580 women and 133 men; age range 18-69 years). MHO and MUO were defined according to The National Cholesterol Education Program-Adult Treatment Panel III (ATP III).

Mean (±SD) patient age, weight, body mass index (BMI), waist and hip circumference were 40.44 (±10.26) years, 127.15 (±22.15) kg, 164.33 (±8.85) cm, 46.90 (±5.79) kg/m2, 122.57 (±13.93) cm, and 140.10 ( ±12.40) cm, respectively. 318 patients (44.6%) were classified as MHO and 395 (55.4%) as MUO. A higher percentage of participants aged 40 years and older suffered from unhealthy metabolic status (61%).

A large percentage of bariatric surgery candidates are metabolically healthy.  Additionally, the prevalence of MHO was higher at younger ages