In our experience, LESS surgery for adjustable gastric banding shows this technique to be both feasible and safe for selected patients. Although technical limitations exist that will be improved upon, further studies are needed to compare LESS surgery for placement of an adjustable gastric band with traditional laparoscopic techniques.

In our experience, SILC performed with a flexible endoscope is feasible and safe. Further studies are needed to determine its advantages in reference to postoperative pain and complication rate in juxtaposition with the current standard laparoscopic cholecystectomy.

Intestinal malrotation is an anomalous disorder resulting from the incomplete rotation and fixation of the midgut during embryonic development. Although most patients present early in life with symptoms of bowel obstruction, others remain asymptomatic throughout their lives. We report the case of a 40-year-old morbidly obese woman with no significant past medical history, found to have intestinal malrotation on initial laparoscopic exploration for gastric bypass.

The injection of saline to develop surgical planes is an effective tool in performing a cholecystectomy using flexible endoscopic instrumentation. The enhancement of this potential space improved visualization in all patients. This technique has great potential value for dissections and requires further evaluation of its effectiveness in other applications.

Purpose Antibiotic dosing in obese surgical patients has not been adequately evaluated. Cefoxitin is an antibiotic commonly utilized for surgical prophylaxis in cases involving the abdominal cavity. The objective of our study was to identify whether currently prescribed doses of cefoxitin achieve adequate and sustained plasma and tissue concentrations in obese patients undergoing sleeve gastrectomy Methods A prospective evaluation of plasma and tissue cefoxitin concentrations in patients undergoing sleeve gastrectomy was performed. On the day of surgical procedure, venous blood samples (5 mL) were collected just prior to cefoxitin administration and then at 5, 30, 60, 120, and 240 minutes after dose administration. In addition subcutaneous adipose tissue was collected from the surgical site and the time of surgical incision and closure. Cefoxitin concentrations in the collected samples were quantified using HPLC – UV. A standard noncompartmental analysis was performed for each individual cefoxitin plasma concentration-time profile. In addition, the ratio of tissue to plasma concentration was calculated for all patients. Findings Plasma and tissue pharmacokinetics of cefoxitin were evaluated in 6 patients undergoing sleeve gastrectomy. At the time of surgical closure subcutaneous adipose tissue cefoxitin concentrations were subtherapeutic (< 8 mcg/mL) in all evaluated patients. Implications Current dosing strategies for cefoxitin in obese surgical patients may be inadequate and there is an urgent need to define the appropriate dosage.