Laparoscopic Sleeve Gastrectomy in Patients with Situs Inversus.

BACKGROUND: Situs inversus is a congenital condition in which the major visceral organs are reversed or mirrored from their normal positions. Situs inversus is found in about 0.01% of the population. In the most common situation, situs inversus totalis involves complete transposition (right to left reversal) of all of the abdominal organs. Several successful and safe laparoscopic weight loss surgeries were previously reported in morbidly obese patients with situs inversus (Aziret et al. Obes Res Clin Pract. 32;11(5S1):144-51, 2017; Catheline et al. Obes Surg.;16(8):1092-5, 2006). METHODS: We present a case of a 47-year-old female patient with a BMI of 51 kg/m2, who was referred to our clinic for the treatment of morbid obesity. Her past medical history included hypertension, type II diabetes mellitus, asthma, and situs inversus. During the preoperative evaluation, the chest x-ray showed dextrocardia and upper GI series showed the stomach and duodenum in a mirror position. RESULTS: The operative time was 62 min, oral intake started on postoperative day 1, and the patient was discharged on postoperative day 2 in good medical condition. CONCLUSIONS: Situs inversus is a rare condition that can be challenging for a laparoscopic surgeon. LSG is feasible and safe for morbidly obese patients with this anomaly. Well understanding of the mirrored image anatomy will facilitate the performance of the procedure without special difficulties by an experienced surgeon.

Midterm outcomes of sleeve gastrectomy in the elderly.

BACKGROUND: The increase in life expectancy presents health systems with a growing challenge in the form of elderly obesity. Bariatric surgery has been shown to be a safe and effective treatment for obesity with reduction of excess weight and improvement in obesity-related co-morbidities. However, only recently have surgeons begun performing these operations on elderly patients on a larger scale, making data regarding mid- and long-term outcomes scarce. The objective of this study was to evaluate the safety and midterm efficacy of laparoscopic sleeve gastrectomy (LSG) in patients aged ≥60 years. METHODS: All patients aged ≥60 years who underwent LSG between 2008 and 2014 and achieved ≥24-month follow-up were retrospectively reviewed. Demographic characteristics and perioperative data were analyzed. Weight loss parameters and co-morbidity resolution rates were compared with preoperative data. RESULTS: In total 55 patients aged ≥60 years underwent LSG. Mean patient age was 63.9 ± 3.2 years (range, 60-75.2), and mean preoperative body mass index was 43 ± 6.0 kg/m2. Perioperative morbidity included 5 cases of hemorrhage necessitating operative exploration, 2 cases of reduced hemoglobin levels treated with blood transfusion, and 1 case of portal vein thrombosis managed with anticoagulation. There were no mortalities. Mean follow-up time was 48.6 (range, 25.6-94.5) months. Mean percentage of excess weight loss was 66.4 ± 19.7, 67.5 ±1 6.4, 61.4 ± 18.3, 66.7 ± 25.6, 50.7 ± 21.4 at 12, 24, 36, 37 to 60, and 61 to 96 months, respectively. Statistically significant improvement of type 2 diabetes, hypertension, and dyslipidemia were observed at the latest follow-up (P < .01). CONCLUSION: LSG offers an effective treatment of obesity and its co-morbidities in patients aged ≥60 years, albeit with a high perioperative bleeding rate at our center; efficacy is maintained for at least 4.5 years.

Correction to: Long-Term (over 10 Years) Retrospective Follow-up of Laparoscopic Adjustable Gastric Banding.

In the original article the spelling of author Naama Kafri was incorrect.

Long-Term (over 10 Years) Retrospective Follow-up of Laparoscopic Adjustable Gastric Banding.

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) placements have progressively decreased in recent years. This is related to poor long-term weight loss outcomes and necessity for revision or removal of these bands. Long-term outcome results following LAGB are limited. The aim of our study was to determine the long-term outcome after LAGB at our institution. OBJECTIVES: The aim of our study was to determine the long-term outcome after LAGB at our institution. SETTING: The setting of this is Academic Center, Israel. METHODS: Patients who underwent LAGB between 1999 and 2004 were reviewed. Patient comorbidities and weight loss parameters were collected preoperatively and at defined postoperative periods. Improvement in weight loss was defined as percent excess weight lost, and improvement in comorbidities was defined based on standardized reporting definitions. RESULTS: In total, 74 (80%) patients who underwent LAGB met inclusion criteria. The mean age at LAGB placement was 50.5 ± 9.6 years, and the mean body mass index (BMI) was 45.5 ± 4.8 kg/m2. Preoperative comorbidities were diabetes mellitus (13.5%), hypertension (32%), hyperlipidemia (12.1%), obstructive sleep apnea (5.4%), joints disease (10.8%), mood disorders (5.4%), and gastro-esophageal reflux disease (GERD) symptoms (8.1%). The mean follow-up was 162.96 ± 13.9 months; 44 patients (59.4%) had their band removed, and 22 (30%) had another bariatric surgery. The follow-up BMI was 35.7 ± 6.9 (p < 0.001), and the % total weight loss was 21.0 ± 0.13. There was no improvement in any of the comorbidities. GERD symptoms worsened at long-term follow-up (p < 0.001). Undergoing another bariatric procedure was associated with a higher weight loss (OR 12.8; CI 95% 1.62-23.9; p = 0.02). CONCLUSION: LAGB required removal in the majority of our patients and showed poor resolution of comorbidities with worsening of GERD-related symptoms. Patients who go on to have another bariatric procedure have more durable weight loss outcomes.

P-glycoprotein dysfunction contributes to hepatic steatosis and obesity in mice.

Although the main role of P-glycoprotein (Pgp) is to extrude a broad range of xenochemicals and to protect the organism against xenotoxicity, it also transports a large range of endogenous lipids. Using mice lacking Pgp, we have investigated the possible involvement of Pgp in lipid homeostasis in vivo. In a long term study, we have followed the food intake, body status and lipid markers in plasma and liver of wild-type and mdr1ab(-/-) mice over 35 weeks. Pgp-deficient mice showed excess weight, hypertrophy of adipose mass, high insulin and glucose levels in plasma. Some of these metabolic disruptions appeared earlier in Pgp-deficient mice fed high-fat diet. Moreover, hepatosteatosis with increased expression of genes involved in liver detoxification and in de novo lipid synthesis occurred in Pgp-deficient mice. Overall, Pgp deficiency clearly induced obesity in FVB genetic background, which is known to be resistant to diet-induced obesity. These data reinforce the finding that Pgp gene could be a contributing factor and possibly a relevant marker for lipid disorder and obesity. Subsequent to Pgp deficiency, changes in body availabilities of lipids or any Pgp substrates may affect metabolic pathways that favour the occurrence of obesity. This is of special concern because people are often facing simultaneous exposition to many xenochemicals, which inhibits Pgp, and an excess in lipid dietary intake that may contribute to the high prevalence of obesity in our occidental societies.

Influence of dyslipidemia on moxidectin distribution in plasma lipoproteins and on its pharmacokinetics.

PURPOSE: We studied the influence of dyslipemia on the distribution of moxidectin, a potent antiparasitic drug of the macrocyclic lactone (ML) family, in plasma lipoproteins and on its pharmacokinetic behaviour. MATERIALS AND METHODS: Plasma samples from normolipidemic or dyslipidemic subjects were spiked with moxidectin (20 ng/ml). Rabbits fed with standard (n = 5) or cholesterol-enriched diet (n = 5) were injected subcutaneously with moxidectin (300 microg/kg) and blood samples were collected over 32 days. Lipoproteins were separated from plasma samples by ultracentrifugation on density gradients. Moxidectin and lipids were measured in plasma and in lipoproteins and the pharmacokinetic parameters calculated. RESULTS: In normolipidemic subjects or rabbits, the drug bound preferentially to HDL. In hyperlipidemic samples, moxidectin shifted to the VLDL-LDL fraction. In addition, hyperlipidemic rabbits had a 2.8-fold higher area under the plasma concentration versus time curve (AUC) and a lower clearance and volume of distribution when compared with controls. CONCLUSION: Dyslipidemia led to major changes in moxidectin plasma distribution and in drug disposition. Therefore, a high variability in moxidectin disposition might be expected in humans or animals liable to develop dyslipidemia, with a possible impact on the efficacy and safety of this class of drugs.