Major deficits in nutrient status occurred and persisted after surgery although supplementation was prescribed. Interventions are mandated to avoid nutrient deficiency.

Weight loss during the first year was well maintained, resolving comorbidities and improving quality of life. Rates of surgical complications resemble other bariatric procedures. Long-term nutrient deficiencies are of concern.

ObjectiveThis study examined whether changes in adipocyte LCFA uptake kinetics explain the weight regain increasingly observed post bariatric surgery.DesignThree groups (10 patients each) were studied: patients who were not obese (NO: BMI 24.2±2.3 kg/m2); patients with obesity (O: BMI 49.8±11.9); and patients classified as super obese (SO: BMI 62.6±2.8). NO patients underwent omental & subcutaneous fat biopsies during clinically indicated abdominal surgeries; O were biopsied during bariatric surgery, and SO during both a sleeve gastrectomy and at another bariatric operation 16±2 months later, after losing 113±13 lbs. Adipocyte sizes & [3H]-LCFA uptake kinetics were determined in all biopsies.ResultsVmax for facilitated LCFA uptake by omental adipocytes increased exponentially from 5.1±0.95 to 21.3±3.20 to 68.7±9.45 pmol/sec/50,000 cells in NO, O, and SO patients, respectively, correlating with BMI (r = 0.99, p < 0.001). Subcutaneous results were virtually identical. By the 2nd operation, the mean BMI (SO patients) fell significantly (p<0.01) to 44.4±2.4 kg/m2, similar to the O group. However, Vmax (40.6±11.5) in this weight-reduced group remained ~2X that predicted from the BMI:Vmax regression among NO, O, & SO patients.ConclusionsFacilitated adipocyte LCFA uptake remains significantly up-regulated ≥1 year after bariatric surgery, possibly contributing to weight re-gain.

Objective Weight-loss is recommended for obese cancer survivors who are at increased risk of recurrence and non-cancer related mortality. It remains unknown if this vulnerable population benefits from bariatric surgery to the same extent as those without a history of cancer. Methods A retrospective chart review of 1013 patients revealed twenty-nine bariatric surgery patients with a history of cancer who were then matched to patients without a history of cancer. Results At one-year post-surgical follow-up, individuals with a history of cancer had lost less weight than those without a history of cancer (14.2 vs. 14.8); however this difference was not significant (p=0.76). Discussion Cancer survivors appear to draw similar benefit from bariatric surgery as those without a history of cancer, although a larger study with greater statistical power to detect differences is needed to confirm these results. These preliminary results are encouraging in light of the increasing focus on weight-loss among this population.

Oesophageal achalasia is a rare, but serious condition in which the motility of the lower oesophageal sphincter (LES) is inhibited. This disorder of idiopathic aetiology complicates the peristaltic function and relaxation of the LES that may cause symptoms such as dysphagia, epigastric pain, and regurgitation of an obstructed food. The following case describes achalasia in a patient 5 years following a laparoscopic Roux-en-Y gastric bypass (RYGB). The patient underwent a laparoscopic Heller myotomy without a fundoplication. Although achalasia seems to be a rare occurrence in obese patients, this is the third case documented in a patient who previously had an RYGB. The role of performing a fundoplication in these patients remains to be elucidated.