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Purpose: Applying eHealth interventions via social media is common in modern medicine. LINE® is a popular communication app in Taiwan that can deliver messages 24 h a day. In addition to being free of charge, it also allows bariatric nurses (BNs) and patients to enjoy bidirectional communication via telecommunication services instead of direct, face-to-face contact for patients undergoing bariatric-metabolic surgery (BMS). We conducted this retrospective study to determine the frequency and reasons for early post-discharge of LINE® messages/calls and investigate the relationship between this frequency and contents of these messages and postoperative outcomes after BMS., Materials and Methods: A retrospective review of prospectively collected data was conducted in an Asian weight management center. The study period ran from August 2016 to December 2021, and a total of 143 native patients with severe obesity were enrolled. All patients were informed of the necessity of a postoperative dietitian consultation before bariatric surgery. The patterns of LINE® communication with the BN and associated actions to resolve patients' needs within 180 days after index BMS were analyzed., Results: Among the 143 enrolled patients, 100 underwent laparoscopic sleeve gastrectomy and 43 underwent laparoscopic Roux-en-Y gastric bypass. A total of 1205 messages/calls were analyzed concomitantly; most LINE® communications focused on diet problems (47.97%; n = 578), weight problems (11.54%; n = 139), and medications (9.21%; n = 111). Most problems could be resolved by LINE® communications directly, and only a small portion (5.6%) was directed to local clinics or emergency departments. During the COVID-19 pandemic, the usage of LINE® communications significantly increased (12.2 ± 10.4 vs. 6.4 ± 4.9; p < 0.01); nonetheless, a higher frequency of LINE® communications would not hinder the regular clinic visits (r = 0.359; p = 0.01)., Conclusion: Based on our limited experience, the LINE® consultation service operated by the BN could effectively address patients' problems. Moreover, it might reduce the need for emergency department visits or unexpected clinic appointments for patients after BMS., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Although the procedure of laparoscopic sleeve gastrectomy (LSG) has been standardized either in conventional lateral to medial or medial to lateral approach, surgeons occasionally face the challenge of poor visualization of the His angle and difficulty in complete posterior mobilization in limited surgical field. This study aimed to introduce our novel details of modified approach to address these issues., Methods: One hundred patients with obesity underwent modified approach- three-port laparoscopic sleeve gastrectomy. Herein, we demonstrated our method to ease the procedure of gastric fundus mobilization with extensive posterior mobilization (shown in video, Supplemental Digital Content 1, http://links.lww.com/SLE/A336 ). The demographic characteristics and perioperative data were reviewed., Results: There was no case of conversion to open surgery. The mean operative time, volume of blood loss, and hospital stay were 72.5±22.7 minutes, 11.6±10.5 mL, and 4.3±2.1 days, respectively. One postoperative leakage was observed and it was successfully treated with metallic covered stent. The percentage of total weight loss at 6 months and 1 year were 20.3±8.4 and 29.8±9.2, respectively., Conclusions: Our experience showed that the modified technique is feasible and may help surgeons to accomplish a complete posterior mobilization, and better address the poor visualization of the the His angle-site owing to the interposition of floating omentum or bulging part of the stomach., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Laparoscopic gastric clipping (LGC) is a relatively novel restrictive bariatric surgery wherein a horizontal metallic clip is applied to the gastric fundus. Its intraoperative complications or the difficulties associated with the applied gastric clip (GC) during revisional procedures have seldom been mentioned. Herein, the experience of revisional procedures after initial gastric clipping is reported., Materials and Methods: A retrospective cohort review of LGC based on the Taiwan Bariatric Registry of Taiwan Society Metabolic and Bariatric Surgery was performed. Six patients with severe obesity presented for revisional surgery after initial LGC by other surgeons. Patients' characteristics, indications, and details of revisional surgery were recorded., Results: Between 2012 and 2019, 39 patients who underwent pure LGC and six patients with previous LGC history were referred for revisional surgery. Their mean age and the mean body mass index were 34.7 ± 9.5 years and 38.4 ± 10.5 kg/m 2 , respectively. Three, two, and one patient underwent revisional surgery for insufficient weight loss, weight recidivism, and intractable belching, respectively. The mean interval between initial LGC and revisional surgery was 40.5 ± 22.4 months. Laparoscopic removal of the GC with concomitant revisional surgeries were collected, including a revision to sleeve gastrectomy (n = 5) and revision to Roux-en-Y gastric bypass (n = 1). Moreover, the mean operative time was 286.8 ± 78.2 min. All patients had uneventful recovery postoperatively but experienced significant adhesion around the GC and the left liver., Conclusion: Laparoscopic revisional surgery with concomitant GC removal for patients with severe obesity after gastric clipping could be feasibly conducted by experienced bariatric surgeons., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The standard size of bougie for laparoscopic sleeve gastrectomy (LSG) is not yet established. Therefore, a systematic review and network meta-analysis were conducted to assess the weight loss effects and associated complications of LSG for patients with morbid obesity, based on different bougie sizes. A total of 15 studies were reviewed in this systemic review and network meta-analysis (2,848 participants), including RCTs and retrospective studies in PubMed, and Embase until September 1, 2020. The effectiveness of different bougie calibration sizes was assessed based on excess weight loss (EWL), total complications, and staple line leak. Within this network meta-analysis, S-sized (≤ 32 Fr.) and M-sized (33-36 Fr.) bougies had similar effects and were associated with the highest EWL improvement among all different bougie sizes (S-sized: standardized mean difference [SMD], 10.52; 95% confidence interval [CI] - 5.59 to  - 26.63, surface under the cumulative ranking curve [SUCRA], 0.78; and M-sized: SMD, 10.16; 95% CI - 3.04-23.37; SUCRA, 0.75). M-sized bougie was associated with the lowest incidence of total complications (M-sized: odds ratio, 0.43; 95% CI, 0.16-1.11; SUCRA, 0.92). Based on our network meta-analysis, using M-sized bougie (33-36 Fr.) is an optimal choice to balance the effectiveness and perioperative safety of LSG in the clinical practice., (© 2021. The Author(s).)

Purpose: Laparoscopic gastric clipping is a relatively novel bariatric surgical procedure, which can yield significant weight loss via a restriction of gastric expansion. Medical literature regarding the postoperative complications of this procedure is currently scarce. To this end, we submit here a video presentation of a corrective laparoscopic gastric sleeve procedure performed after an initial gastric clipping that failed to provide adequate weight loss and led to intractable belching., Materials and Methods: A 40-year-old, morbidly obese woman (initial body mass index is 35.3 kg/m 2 ) presented with intractable belching and minimal weight loss 6 months after initial laparoscopic gastric clipping at another institution. A laparoscopic revisional procedure with gastric clip removal and conversion to sleeve gastrectomy was conducted to relieve her condition., Results: The procedure took 270 min without any intraoperative complications. Blood loss was recorded at 100 mL. The patient had an uneventful postoperative course with a postoperative hospital stay of 2 days. The patient's symptoms were relieved successfully after this revisional surgery., Conclusion: Laparoscopic removal of gastric clip with concomitant revision to sleeve gastrectomy is technically feasible in our patient.

Background: Marginal ulcer (MU) is not infrequent after laparoscopic Roux-en-Y gastric bypass (LRYGB). Medication plus lifestyle modification remains the mainstay solution. Patients with refractory MU may be candidates for revisional surgery., Objective: To summarize our experience of revisional surgery for treating refractory MU after LRYGB., Setting: University hospital, Taiwan., Methods: A retrospective analysis was performed for 11 patients with refractory MU undergoing totally hand-sewn gastrojejunostomy and truncal vagotomy at our institution between August 2005 and May 2015. The mean follow-up after surgery was 28.0±16.2 months (range, 10-48 mo); 9 patients (81.8%) were followed up more than 1 year after., Results: The mean age of the cohort (7 males; 4 females) was 39.5±16.0 years (range, 19-66 yr), with a mean initial body mass index of 37.5±9.3 kg/m 2 (range, 32.1-57 kg/m 2 ). Intractability was the dominant manifestation (100%); 8 patients (72%) had stricture at the gastrojejunostomy. The mean interval from initial LRYGB to refractory MU and revisional surgery was 10.2±7.7 months (range, 4-28 mo) and 38.7±21.6 months (range, 10-67 mo), respectively. The average operation time was 150.4±59.8 minutes (range, 80-300 min), and the average length of hospital stay was 4.2±1.4 days (range, 2-7 d). The 9 patients with more than 1 year follow-up all achieved endoscopic resolution of the refractory MU., Conclusions: Although longer follow-up is warranted, revisional surgery with totally hand-sewn gastrojejunostomy and truncal vagotomy can be an effective solution for refractory MU., (Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Laparoscopic sleeve gastrectomy (LSG) is accepted as a stand-alone bariatric procedure. A specific and potentially severe complication of LSG is gastric stenosis (GS)., Objective: Reviewing the treatment and prevention of GS after LSG., Setting: University hospital, Taiwan., Materials and Methods: A retrospective analysis was conducted involving all of the LSG cases (n = 927) at our institution between February 2007 and December 2015., Results: Eight patients (0.8%) with GS were identified in our unit and 1 patient was transferred from another institution with symptomatic GS. The median intervals from initial LSG to the presence of symptoms, endoscopic dilation, and surgical revision were 14±30 days (range, 7-103 days), 21±35.6 days (range, 9-110 days), and 36±473.9 days (range, 11-1185 days), respectively. The majority of stenoses were located at the incisura angularis (8/9 [88.9%]). Among the 9 patients, only 1 responded satisfactorily to repetitive endoscopic dilation and the remaining 8 patients required revisional laparoscopic surgery, including conversion to Roux-en-Y gastric bypass (n = 6), stricturoplasty (n = 1), and Roux-en-Y gastric bypass after failed seromyotomy (n = 1). No patients experienced recurrent symptoms of GS after revisional surgery. In September 2013, we modified our surgical techniques for the subsequent 489 patients and GS did not occur after the change in surgical procedures., Conclusion: A combined treatment modality, endoscopic intervention with and without surgical revision is essential for managing GSs. Based on our own experience, we emphasize the clinical significance of surgical standardization to prevent the occurrence of GS., (Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Laparoscopic adjustable gastric banded plication (LAGBP) is a novel bariatric procedure, and little is known about its potential complications., Objectives: Herein, we report on complications of LAGBP and discuss the clinical features and diagnostic and therapeutic strategies in such situations, with emphasis on gastric fold herniation (GFH)., Setting: University Hospital., Methods: Prospectively collected data of 223 patients who underwent LAGBP for morbid obesity between August 2009 and December 2014 were retrospectively analyzed. Follow-up at 1 year was 75%., Results: Eight patients (3.5%) required readmission due to major complications, including 1 trocar site hernia, 1 band leak, 1 gastric stenosis, and 5 GFHs. GFHs occurred mostly in the first postoperative month (4/5, 80%) and at the fundus (5/5, 100%); 4 GFHs occurred in the initial 70 patients. Seven laparoscopic reoperations were required for managing GFH. The gastric band was removed in 3 patients (of 5; 60%). Two patients developed residual intra-abdominal abscess and were treated successfully by image-guided drainage. In March 2012, we reversed the order of our surgical techniques for the subsequent 153 patients and performed greater curvature plication first, followed by band placement. Only one GFH occurred after this change in surgical order (1/153 versus 4/70; P< .05)., Conclusions: High clinical suspicion assisted by radiological investigations and early surgical intervention is the key for managing GFH after LAGBP. Though GFH complications were rare, we significantly reduced its occurrence by altering the surgical order in LAGBP to plication followed by banding., (Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Laparoscopic adjustable gastric banded plication (LAGBP) is a novel bariatric procedure which is restrictive and reversible. The aim of this study were to compare two LAGBP techniques and analyze its postoperative outcomes, in order to standardize the procedure., Methods: Eighty patients who underwent LAGBP were enrolled in this study. Forty patients who underwent LAGBP (group 1) from December 2011 to June 2012 were compared with 40 patients (group 2) who underwent a modified LAGBP technique, which included preserving the right gastroepiploic vessels and uniform plication volume between July 2012 and January 2013. Relevant patient's data were collected and analyzed., Results: Both groups were similar in age, gender, preoperative body mass index (BMI), and hospital stay. The median total operative time was shorter in group 2 (100.5 min; range 41-189) compared to group 1 (124 min; range 63-192), p = 0.048. There were two major complications involving gastric fold herniation (GFH) in group 1, while none was seen in group 2, p = 0.07. The minor complications encountered in both groups were similar, p = 0.37. At 6-month follow-up, there was no difference in mean frequency of band adjustments, weight, and BMI reduction in both groups. No mortality was seen in our series., Conclusions: A standardized LAGBP procedure which includes uniform plication volume and preservation of right gastroepiploic vessels could potentially avoid early GFH. However, larger comparative studies with longer follow-up would be needed to evaluate the late outcomes of this procedure and its efficacy in weight loss.

Background: The beneficial role of laparoscopic Roux-en-Y gastric bypass (LRYGB) for type 2 diabetes mellitus (T2 DM) in morbidly obese patients has been established; however, there is scant evidence supporting its effectiveness in nonobese T2 DM Asian patients. The objective of this study was to evaluate the effect of LRYGB in nonobese T2 DM patients and elucidate the predictors of DM remission after one year follow-up., Methods: Between June 2009 and May 2011, twenty-nine nonobese (body mass index (BMI)<27 kg/m(2)) Asian patients with T2 DM who underwent LRYGB were enrolled. All patients were prospectively followed up for one year. Baseline demographic characteristics, diabetic status, and clinical and biochemical data were collected preoperatively and one year after LRYGB. DM remission was defined as those with hemoglobin A1 c (HbA1 c)<6.5% without oral hypoglycemic drugs (OHA)/insulin. Outcomes in the DM remission group were compared with the nonremission group and analyzed., Results: All clinical and biochemical parameters, except uric acid, were significantly improved. DM remission was achieved in eleven patients (37.9%) of whom five (45.5%) were male. Blood glucose, HbA1 c, c-peptide, homeostatic model assessment (HOMA-%B), and low density lipoprotein (LDL)-cholesterol were the significant variables in patients with DM remission; however, multiple logistic regression showed that only preoperative HOMA-%B (odds ratio (OR) = 1.13, 95% CI = 1.03-1.24) was a predictor for DM remission. Though no mortality was seen, the complication rate was 20.7%, of which 17.3% was related to marginal ulcers., Conclusion: LRYGB resulted in significant clinical and biochemical improvements in nonobese Asian patients, with HOMA-%B indicating β-cell function as the main predictor of T2 DM remission. Appropriate patient selection with better β-cell function and evidence from long-term follow-up may justify this therapeutic approach., (Copyright © 2014 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Laparoscopic sleeve gastrectomy (LSG) has been accepted as stand-alone restrictive bariatric procedure; laparoscopic adjustable gastric banded plication (LAGBP) is an innovative technique combining gastric banding and plication of the stomach. This study aims to compare LAGBP with LSG in terms of percent excess weight loss (%EWL), resolution of comorbidities, and complications. This study was conducted in a university hospital. We retrospectively analyzed data of 60 patients: 30 each receiving LSG and LAGBP between May 2009 to October 2010. Demographics, operative data, complications, % EWL, and resolution of comorbidities were analyzed and compared. All the patients were followed for at least 1 year. LSG and LAGBP were matched for age, sex, body mass index and comorbidity ratio. Mean operative time was significantly longer in LAGBP: 62.45 ± 30.1 vs. 86.01 ± 21.88 (p = 0.001). Both groups had similar complication rates (6.67 %) and most of the patients achieved significant resolution of comorbidities. The mean %EWL was statistically significant for LSG till 18 months follow-up as compared to LAGBP, but there was no difference at 2 years (p = 0.971). Mean frequency of band adjustment after LAGBP in 2 years was 1.50 ± 1.51. There was no significant difference in comorbidity resolution in both groups. LAGBP is a dual restrictive bariatric procedure offering similar results with LSG at 2 years in terms of complications, % EWL, and comorbidity resolution with potential of continual weight loss due to band.

Background: Laparoscopic sleeve gastrectomy (LSG) is emerging as a popular "stand-alone" bariatric procedure. We report our 5 years experience with LSG as a single-stage bariatric procedure with which to study the technical progress, learning curve, complications, and follow-up results., Methods: Prospectively collected data of 228 patients (145 females and 83 males), who underwent LSG for morbid obesity, from February 2007 to March 2012, was retrospectively analyzed., Results: The mean age was 34.68 years (range, 18-62 years) and the mean preoperative body mass index (BMI) was 37.42 ± 4.75 kg/m(2) (range, 32.08-65.69 kg/m(2)). Mean operative time was 60.63 ± 27.37 min. The mean BMI decreased to 26.15 ± 3.71 kg/m(2) at 3 years (p < 0.001) and to 27.94 ± 4.08 kg/m(2) at 5 years (p < 0.001). Mean percentage excess weight loss was 71.96 ± 21.30 % at 3 years and 63.71 ± 20.08 % at 5 years. The 30-day readmission rate was 3.07 %.Overall complication rate was 4.3 %, including strictures, leaks, peritonitis, gastrocutaneous fistula, and one (0.43 %) mortality. One patient with weight regain and another with stricture underwent conversion to Roux-en-Y gastric bypass. Complication rates significantly decreased after the first 50 cases (p = 0.022), suggesting an initial learning curve. Resolution of diabetes, hypertension, and hyperlipidemia was 66.67, 100, and 50 %, respectively, at 5 years., Conclusions: LSG as a single-stage bariatric procedure is safe and durable, achieving weight loss and resolution of comorbidities up to 5 years. Adherence to technical details is pivotal in reducing complications associated with the initial learning phase.

Background: Recently, single-incision transumbilical (SITU) laparoscopic bariatric surgery has been adopted as an alternative option for treating morbid obesity. Patients prefer SITU because it leaves minimal scarring. However, second surgery after SITU is a new challenge for surgeons. Here, we report on the safety and results for patients at a university hospital who underwent second surgery with the SITU procedure after SITU-laparoscopic Roux-en-Y gastric bypass (LRYGB)., Patients and Methods: From November 2008 to May 2011, in total, 78 morbidly obese patients underwent SITU-LRYGB. After follow-up, 7 cases required reoperation with the SITU procedure because of dilated gastrojejunostomy in 1 patient, intractable hiccups in 1 patient, gallstones in 2 patients, and internal hernia from Petersen's defect in the remaining 3 patients. SITU was repeated via the previous umbilical incision to avoid creating a new scar. Three trocars were inserted separately, and pneumoperitoneum was created. The surgical procedures were performed with straight instruments. All surgical results and complications were recorded., Results: The procedure was successfully completed in all 7 patients without addition of trocars or conversion to conventional LRYGB or open procedure. Mean surgical time was 63±23 minutes. There were no intraoperative complications or postoperative wound complications noted in 3 months of follow-up., Conclusions: Second surgery can be successfully done via a single umbilical incision after SITU-LRYGB, with reasonable operative time and good recovery, without additional abdominal scarring.

Background: No bariatric procedure is perfect, and a plethora of such procedures itself is a proof for the same. Laparoscopic adjustable gastric banding has a high safety profile, but also a high rate of re-operation has been reported (Schouten, Wiryasaputra, van Dielen et al. Obes Surg 20(12):1617-26, 2010). Laparoscopic sleeve gastrectomy (LSG) is becoming popular, but has its own set of complications and is irreversible. We introduced laparoscopic adjustable gastric banded plication (LAGBP) in 2009 (Huang, Lo, Shabbir et al. Surg Obes Relat Dis 8(1):41-5, 2012) In a case matched comparative study with LSG, LAGBP showed similar results at 2 years in terms of weight loss, comorbidity resolution, and complications. (Huang, Chhabra, Goel et al. Obes Surg 23(8):1319-23, 2013). Several authors have reported variations in their technique, bougie size, and suture material used to perform plication. (Ramos, Galvao Neto, Galvao et al. Obes Surg 20(7):913-8, 2010, (Mui, Lee, Lam et al. Obes Surg 23(2): 179-83, 2013, Brethauer, Harris, Kroh et al. Surg Obes Relat Dis 7(1):15-22, 2011) Our initial technique of placing the band first and then plicating the stomach resulted in higher incidence of gastric fundus herniation compared to that reported in a systematic review (Abdelbaki, Huang, Ramos et al. Obes Surg 22(10):1633-9, 2012). After the first 65 cases, we reversed the order by performing the gastric plication first which ensures proper plication of the fundus and a more uniformly placed plication line. This technique has become our standard, and the same is described in this video in a stepwise fashion. Materials and Methods: We performed LAGBP in 202 cases over the last 4 years and recorded the findings. Our standardized technique is shown in this video. The T-suspension technique was used for liver retraction. (Zachariah, Tai, Chang et al. J Laparoendosc Adv Surg Tech A 23(4):311-5, 2013) Gastric plication formula is shown in Fig. 1.[Figure not available: see fulltext.] Results: Two hundred two (69 male, 133 female) patients in over the last 4 years underwent LAGBP. Follow-up at 1 year was 168 patients, and 56 patients reached 4-year follow-up. Age was 16-60 years (mean = 31.1). Mean BMI was 39.5 ± 3.18 and body weight 110 kg ± 19.4. Mean operative time was 104 min ± 39 and length of hospital stay after surgery 2.1 ± 2.3 days. No mortality was recorded. Excess weight loss at 1 year was 57.84 % and at four years 68 %. Conclusion: LAGBP has been proven to be an effective bariatric procedure in the midterm results. Standardization with plication first and then placement of the band could be important to achieve best outcomes. [ABSTRACT FROM AUTHOR]