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Aili A, Li X, Abudureyimu K. Intra-jejunal migration with intestinal obstruction and perforation after gastric banding: A case report. Heliyon 2023; 9:e20756. [PMID: 37860574 PMCID: PMC10582381 DOI: 10.1016/j.heliyon.2023.e20756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/24/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023] Open
Abstract
Laparoscopic adjustable gastric banding (LAGB) is an approved procedure in bariatric surgery. However, serious complications due to band erosion have been reported. There have been few reports of intestinal obstruction and perforation caused by gastric banding invading the gastric wall and migrating to the jejunum. Case introduction: A 56-year-old man was admitted to our hospital with right lower abdominal pain ten years after LAGB surgery. An intraoperative gastric band showed erosion of the gastric wall and movement down to the jejunum, resulting in intestinal obstruction and jejunal perforation. Conclusion: Patients should undergo regular outpatient gastroscopic follow-up after gastric band surgery to prevent serious complications.
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Affiliation(s)
- Aikebaier Aili
- Department of Minimally Invasive Surgery, Hernia and Abdominal Wall Surgery, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi 830011, China
- Institute of General Surgery and Minimally Invasive Surgery, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi 830011, China
- Clinical Research Center for Gastroesophageal Reflux Disease, Weight Loss and Metabolic Surgery, Xinjiang Uyghur Autonomous Region, Urumqi 830011, China
| | - Xin Li
- Department of Minimally Invasive Surgery, Hernia and Abdominal Wall Surgery, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi 830011, China
- Graduate School of Xinjiang Medical University, Urumqi 830054, China
| | - Kelimu Abudureyimu
- Department of Minimally Invasive Surgery, Hernia and Abdominal Wall Surgery, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi 830011, China
- Institute of General Surgery and Minimally Invasive Surgery, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi 830011, China
- Clinical Research Center for Gastroesophageal Reflux Disease, Weight Loss and Metabolic Surgery, Xinjiang Uyghur Autonomous Region, Urumqi 830011, China
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Abu-Abeid A, Gosher N, Ovdat E, Eldar SM. Gastric Band Slippage with Associated Gastric Necrosis. Obes Surg 2023; 33:1625-1628. [PMID: 36920682 DOI: 10.1007/s11695-023-06553-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/16/2023]
Affiliation(s)
- Adam Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel. .,Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
| | - Noa Gosher
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Esther Ovdat
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Shai Meron Eldar
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.,Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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Kermansaravi M, Lainas P, Shahmiri SS, Yang W, Jazi AD, Vilallonga R, Antozzi L, Parmar C, Kassir R, Chiappetta S, Zubiaga L, Vitiello A, Mahawar K, Carbajo M, Musella M, Shikora S. The first survey addressing patients with BMI over 50: a survey of 789 bariatric surgeons. Surg Endosc 2022; 36:6170-6180. [PMID: 35064321 PMCID: PMC9283149 DOI: 10.1007/s00464-021-08979-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/31/2021] [Indexed: 11/27/2022]
Abstract
Background Bariatric surgery in patients with BMI over 50 kg/m2 is a challenging task. The aim of this study was to address main issues regarding perioperative management of these patients by using a worldwide survey. Methods An online 48-item questionnaire-based survey on perioperative management of patients with a BMI superior to 50 kg/m2 was ideated by 15 bariatric surgeons from 9 different countries. The questionnaire was emailed to all members of the International Federation of Surgery for Obesity (IFSO). Responses were collected and analyzed by the authors. Results 789 bariatric surgeons from 73 countries participated in the survey. Most surgeons (89.9%) believed that metabolic/bariatric surgery (MBS) on patients with BMI over 50 kg/m2 should only be performed by expert bariatric surgeons. Half of the participants (55.3%) believed that weight loss must be encouraged before surgery and 42.6% of surgeons recommended an excess weight loss of at least 10%. However, only 3.6% of surgeons recommended the insertion of an Intragastric Balloon as bridge therapy before surgery. Sleeve Gastrectomy (SG) was considered the best choice for patients younger than 18 or older than 65 years old. SG and One Anastomosis Gastric Bypass were the most common procedures for individuals between 18 and 65 years. Half of the surgeons believed that a 2-stage approach should be offered to patients with BMI > 50 kg/m2, with SG being the first step. Postoperative thromboprophylaxis was recommended for 2 and 4 weeks by 37.8% and 37.7% of participants, respectively. Conclusion This survey demonstrated worldwide variations in bariatric surgery practice regarding patients with a BMI superior to 50 kg/m2. Careful analysis of these results is useful for identifying several areas for future research and consensus building. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08979-w.
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Affiliation(s)
- Mohammad Kermansaravi
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat_e Rasool Hospital, Tehran, Iran
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Paris-Saclay University, Clamart, France
- Metropolitan Hospital of Athens, HEAL Academy, Athens, Greece
| | - Shahab Shahabi Shahmiri
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | | | - Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
- ELSAN, Clinique Saint Michel, Centre Chirurgical de L'Obésité, Toulon, France
| | | | - Chetan Parmar
- Department of Surgery, The Whittington Health NHS Trust, London, UK
- University College London Medical School, London, UK
| | - Radwan Kassir
- Department of Digestive Surgery, Centre Hospitalier Universitaire Félix Guyon, St Denis de la Réunion, France
| | - Sonja Chiappetta
- Obesity and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
| | - Lorea Zubiaga
- Miguel Hernandez of Elche University, Alicante, Spain
| | - Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Kamal Mahawar
- South Tyneside and Sunderland Foundation NHS Trust, Sunderland, UK
| | - Miguel Carbajo
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Valladolid, Spain
| | - Mario Musella
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy.
| | - Scott Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Effectiveness and Safety of Adjustable Gastric Banding in Morbidly Obese Patients After 5 Years of Follow-up. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03174-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Obesity is a civilization disease that promotes the emergence and development of many diseases, such as type II diabetes, cardiovascular, and some cancers. It directly affects the length and quality of life. The purpose of this retrospective study was to show the short- and long-term results of weight loss after laparoscopic adjustable gastric banding (LAGB) as well as to assess the results of the procedure and the percentage of reoperations. Case series analysis included 228 subsequent patients who underwent LAGB due to obesity. In the postoperative period, there was a gradual reduction in body weight, especially in the first 24 months after surgery. After 3 years, no further weight reduction was observed, and sometimes, a slight increase in weight was observed 5 years after surgery; the trend in weight reduction over the entire time period was significant. A similar result was found for percentage of BMI loss (%BMIL) and percentage of excess body weight loss (%EWL), especially in the first 36 months after surgery. Our study confirmed the good early results and low effectiveness of laparoscopic adjustable gastric banding in the long-term treatment of pathological obesity. On the other hand, the simplicity and safety of the procedure, the minimal effects of malnutrition, the low number of early complications, and the total reversibility or conversion procedure for any other bariatric surgery are the strengths of laparoscopic adjustable gastric banding for a selected group of patients.
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It is really time to retire laparoscopic gastric banding? Positive outcomes after long-term follow-up: the management is the key. Updates Surg 2021; 74:715-726. [PMID: 34599469 PMCID: PMC8995288 DOI: 10.1007/s13304-021-01178-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/19/2021] [Indexed: 10/31/2022]
Abstract
After the initial widespread diffusion, laparoscopic adjustable gastric banding (LAGB) has been progressively abandoned and laparoscopic sleeve gastrectomy (LSG) has become the worldwide most adopted procedure. Nevertheless, recent reports raised concerns about the long-term weight regain after different bariatric techniques. Considering the large LAGB series recorded in our multicentric bariatric database, we analysed the anthropometric and surgical outcomes of obese patients underwent LAGB at a long-term follow-up, focusing on LAGB management. Between January 2008 to January 2018, demographics, anthropometric and post-operative data of obese patients undergone LAGB were retrospectively evaluated. To compare the postoperative outcomes, the cohort was divided in two groups according to the quantity of band filling (QBF): low band filling group (Group 1) with at most 3 ml of QBF, and patients in the high band filling group (Group 2) with at least 4 ml. 699 obese patients were considered in the analysis (351 in Group 1 and 348 in Group 2). Patients in Group 1 resulted significantly associated (p < 0.05) to higher % EWL and quality of life score (BAROS Score), 49.1 ± 11.3 vs 38.2 ± 14.2 and 5.9 ± 1.8 vs 3.8 ± 2.5, respectively. Moreover, patients with lower band filling (Group 1) complained less episodes of vomiting, epigastric pain and post-prandial reflux and significantly decreased slippage and migration rate (p < 0.001 for all parameters). LAGB is a safe and reversible procedure, whose efficacy is primarily related to correct postoperative handling. Low band filling and strict follow-up seem the success' key of this technique, which deserves full consideration among bariatric procedures.
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Super J, Charalampakis V, Tahrani AA, Kumar S, Bankenahally R, Raghuraman G, Jambulingam PS, Kelly J, Ammori BJ, Singhal R. Safety and feasibility of revisional bariatric surgery following Laparoscopic Adjustable Gastric Band - Outcomes from a large UK private practice. Obes Res Clin Pract 2021; 15:381-386. [PMID: 34147378 DOI: 10.1016/j.orcp.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 05/25/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Revisional bariatric surgery is unavoidable in a proportion of patients. Despite its need, the development of this speciality has been hampered by its complexity and preferred delivery in institutional set ups. Although primary bariatric surgery can be delivered in the private sector; safety and feasibility of revisional bariatric surgery remains unexplored in this setting. MATERIALS AND METHODS Patients undergoing revisional bariatric surgery following previous Laparoscopic Adjustable Gastric Band (LAGB) between 2008 and 2019 at a single private bariatric unit with a minimum follow up of at least 6 months were included. The primary aim was safety outcomes and 30-day morbidity. RESULTS 178 patients with BMI of 45.6 ± 8.2 kg/m2 underwent revisional bariatric surgery. One stage conversion was performed for 86.5% of the cases. At 9.5 ± 5.3 months follow up, BMI and percentage excess BMI loss were 31.8 ± 6.2 kg/m2 and 62.6 ± 40% respectively. There was no mortality, and the major complication rate was 2.8%. There was no statistically significant difference in the incidence of complications based on one-stage vs. two-stage conversion (p = 0.52). There were no differences in weight loss outcomes post-revisional surgery according to the indication for revision (p = 0.446) or weight loss following primary surgery (p = 0.12). CONCLUSION Revisional bariatric surgery can be delivered safely in the private sector with good outcomes. One-stage conversions are feasible and do not detrimentally affect the morbidity of the procedure or the weight loss outcomes. More importantly, success following revisional surgery is independent of the indication for revision and weight loss outcomes following primary surgery.
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Affiliation(s)
- Jonathan Super
- Department of Surgery, St Mary's Hospital, Imperial College Healthcare NHS Trust, UK
| | - Vasileios Charalampakis
- Department of General and GI Surgery, Warwick Hospital, South Warwickshire NHS Foundation Trust, UK; Healthier Weight, UK
| | - Abd A Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Diabetes and Weight Management, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Healthier Weight, UK
| | - Sajith Kumar
- Department of Anaesthesia, Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK; Healthier Weight, UK
| | - Rajneesh Bankenahally
- Department of Anaesthesia, Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK; Healthier Weight, UK
| | - Govindan Raghuraman
- Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital King's Lynn, UK; Healthier Weight, UK
| | - P S Jambulingam
- Department of Upper GI & Bariatric Surgery, Bedfordshire Hospitals NHS Foundation Trust, Luton and Dunstable University Hospital, UK; Healthier Weight, UK
| | - Jamie Kelly
- Dept. of Surgery, University Hospital Southampton, UK; Healthier Weight, UK
| | - Basil J Ammori
- Department of Surgery, Salford Royal Hospital, Manchester, UK; Burjeel Hospital, Abu Dhabi, United Arab Emirates; Healthier Weight, UK
| | - Rishi Singhal
- Department of Bariatric Surgery, Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK; Healthier Weight, UK.
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Mansour S, Borzellino G, Kluger Y, Khuri S. Unexpected Gastrointestinal Tract injury years following Laparoscopic Adjustable Gastric Banding. Int J Surg Case Rep 2020; 77:412-417. [PMID: 33221568 PMCID: PMC7689376 DOI: 10.1016/j.ijscr.2020.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/23/2022] Open
Abstract
Although most complications following LAGB are confined to the stomach and port site, some may envolve the entire bowel causing extensive damage. One must be wary of the presentation of long term complications, as it may initially present as an unrelated pathology, such as acute pancreatitis. Long term complications may be asymptomatic for years despite extensice damage, including multiple contained perforations. The surgical procedure performed to treat long term complications should be planned and performed by physicians experienced in foregut surgery.
Introduction Band migration is a late complication of Laparoscopic Adjustable Gastric Banding insertion, although rare it could be life threatening presenting as peritonitis secondary to gastro-intestinal tract injuries. A case of an unexpected extension of severe gastro-intestinal tract injuries secondary to intra-gastric migration and distal band dislocation is reported. Presentation of case A 53 years old male, with a history of laparoscopic gastric banding 15 years before and known erosion of the band into the gastric lumen was admitted for abdominal pain and raised serum amylase. Imaging revealed dislocation of the band down to the jejunum. Endoscopy and exploratory surgery showed severe decubitus pressure on the gastric antrum up to the duodenum as well as on the pancreas due to rod-like effect of the gastric band catheter and multiple sites of perforation on distal duodenum and small bowel proximal to the band, which migrated within the lumen until 90 cm distal to the Treitz ligament. Extended distal gastrectomy and resection of distal duodenum and small bowel extended to the proximal affected small bowel were necessary. Digestive tract was restored by a gastro-jejunostomy and duodeno-jejunostomy in a Roux-En-Y configuration with duodenal stump closure on tube duodenostomy. A post-operative leakage from the duodenal stump was treated conservatively and the patient was discharged on post-operative day 21. Discussion Erosion and migration of the band within the digestive lumen is one of the less frequent late complications occurring after LAGB, furthermore, the amount of extensive damage reported in this case presentation has yet to be reported in literature. Conclusion Migration of the band should be considered in the differential diagnosis of abdominal complain in patients with adjustable gastric banding. Such a complication could be severe, and lesions may have unexpected extension requiring complex surgical approach.
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Affiliation(s)
- Subhi Mansour
- General Surgery Department, Rambam Health Care Campus, Haifa, Israel.
| | | | - Yoram Kluger
- General Surgery Department, Rambam Health Care Campus, Haifa, Israel; HPB and Surgical Oncology Unit, Rambam Health Care Campus, Haifa, Israel.
| | - Safi Khuri
- General Surgery Department, Rambam Health Care Campus, Haifa, Israel; HPB and Surgical Oncology Unit, Rambam Health Care Campus, Haifa, Israel.
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Abstract
BACKGROUND Standardization of the key measurements of a procedure's finished anatomic configuration strengthens surgical practice, research, and patient outcomes. A consensus meeting was organized to define standard versions of 25 bariatric metabolic procedures. METHODS A panel of experts in bariatric metabolic surgery from multiple continents was invited to present technique descriptions and outcomes for 4 classic, or conventional, and 21 variant and emerging procedures. Expert panel and audience discussion was followed by electronic voting on proposed standard dimensions and volumes for each procedure's key anatomic alterations. Consensus was defined as ≥ 70% agreement. RESULTS The Bariatric Metabolic Surgery Standardization World Consensus Meeting (BMSS-WOCOM) was convened March 22-24, 2018, in New Delhi, India. Discussion confirmed heterogeneity in procedure measurements in the literature. A set of anatomic measurements to serve as the standard version of each procedure was proposed. After two voting rounds, 22/25 (88.0%) configurations posed for consideration as procedure standards achieved voting consensus by the expert panel, 1 did not attain consensus, and 2 were not voted on. All configurations were voted on by ≥ 50% of 50 expert panelists. The Consensus Statement was developed from scientific evidence collated from presenters' slides and a separate literature review, meeting video, and transcripts. Review and input was provided by consensus panel members. CONCLUSIONS Standard versions of the finished anatomic configurations of 22 surgical procedures were established by expert consensus. The BMSS process was undertaken as a first step in developing evidence-based standard bariatric metabolic surgical procedures with the aim of improving consistency in surgery, data collection, comparison of procedures, and outcome reporting.
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Sudlow A, le Roux CW, Pournaras DJ. The metabolic benefits of different bariatric operations: what procedure to choose? Endocr Connect 2020; 9:R28-R35. [PMID: 31917678 PMCID: PMC6993254 DOI: 10.1530/ec-19-0467] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 01/09/2020] [Indexed: 12/20/2022]
Abstract
Bariatric surgery is established as a highly effective treatment for obesity and related metabolic complications. Although once seen as a last resort for patients with obesity, given the data demonstrating the profound weight loss, improvement in comorbidity and safety, perceptions have since shifted. There is evidence from 12 RCTs demonstrating its safety and efficacy in terms of weight loss which is sustained in the long term with a resultant improvement in co-morbidity. Clinicians are increasingly recognising the importance of timely intervention to maximise the effects of bariatric surgery, particularly in light of the low likelihood of being able to adequately manage patients with medication or lifestyle interventions alone. The inclusion of bariatric surgery in the standard treatment algorithm has been a step forward in the approach to treating patients with obesity. What remains challenging for clinicians is knowing which procedure is most beneficial to patients. There is no level one data demonstrating the superiority of one procedure over another. Head to head RCTs are ongoing which may shed light on this question; however, it is likely that there is no single procedure that will be demonstrated to be the gold standard. Herein we review the most commonly performed procedures along with the evidence available to support their effects with regards to weight loss and metabolic changes along with their limitations and recognised risks. The aim is to provide a general framework to allow clinicians to take advantage of the variety of operative approaches to tailor their treatment strategy to the individual patient.
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Affiliation(s)
- Alexis Sudlow
- Department of Upper GI Surgery, Southmead Hospital, Bristol, UK
| | - Carel W le Roux
- Department of Experimental Pathology, University College Dublin, Dublin, Ireland
- Correspondence should be addressed to C le Roux:
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Affiliation(s)
- Ricardo Cohen
- The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, SP, Brazil
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