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Introduction: Routine intra-abdominal drainage has been recommended for detecting surgical complications, such as anastomotic leaks or intra-abdominal hemorrhage, after laparoscopic gastric bypass for morbid obesity. The aim of this study was to determine whether routine drainage after laparoscopic gastric bypass is indeed necessary. Methods: Patients undergoing laparoscopic gastric bypass with intra-abdominal drainage (D-group) were compared with those without drainage (N-group) in a retrospective study. The main outcome measures were postoperative course and complications. Results: No differences were observed in the postoperative complications. Both groups had one major complication of leakage (1/90, 1.1%). Minor complications occurred in six D-group patients (6/90, 6.7%) and eight N-group patients (8/90, 8.9%) (P=0.578). No difference was observed in postoperative analgesic dose usage (mean±SD: 63±37 mg vs 60±31 mg; P=0.963) or length of stay hospital (5.2±2.6 d vs 4.7±1.8 d; P=0.135). However, the N-group had a shorter time to flatus passage compared to the D-group (1.6±0.7 d vs 1.2±0.5 d; P=0.006). Conclusion: Routine abdominal drainage is not necessary after a successful laparoscopic gastric bypass for morbidly obese patients. Drainage omission may contribute to a quicker recovery without additional surgical complications.

Gastrojejunostomy through laparotomy is a traditional procedure for the relief of gastric outlet obstruction in patients with unresectable carcinoma of the gastric antrum. However, patients face pain and high rates of morbidity and mortality after this operation. We present two cases of gastrojejunostomy for unresectable and obstructing gastric antral cancer using a double scope technique. The operative time was approximately 90 minutes for each patient, and the postoperative hospital stays were 9 and 10 days, respectively. Operative results were good. Vomiting was relieved. There were no delays in gastric emptying. No recurrence of gastric outlet obstruction was noted in the first patient, who died 9 months postoperatively. The second patient survived without this problem 6 months postoperatively. Palliative gastrojejunostomy via the double scope technique is a safe and effective minimally invasive procedure for the relief of gastric outlet obstruction in patients with unresectable carcinoma of the gastric antrum. It also provides accurate staging of the disease perioperatively. It should be considered the surgical choice for geriatric patients when clinically appropriate.

Renal transplant is the only curative treatment for end-stage renal disease. As diabetes and obesity are the major causes of graft failure and post-transplant complication, it is important to manage obesity in patients with renal transplant. Herein, we report a case of a morbidly obese renal-transplant patient with poorly controlled diabetes who received bariatric surgery. A 34-year-old obese Taiwanese man with type 2 diabetes had end-stage renal disease that had progressed since 2008, when he had commenced hemodialysis (January 2008) and had a renal transplant (July 2008). Because of persistent obesity and poorly controlled diabetes, he received LRYGB at Chiayi Christian hospital on 18 August 2010. In the month that followed, he lost 10 kg. His serum creatinine decreased to 1.11 mg/dL (1.4 mg/dL, preoperative) and his hemoglobin A1c decreased to 8.5% (10.4%, preoperative). These results indicate that, in obese renal transplant patients, LRYGB may be employed to treat obesity, control diabetes and stabilize or improve the renal function.

We report the case of a 51-year-old man who had abdominal distension and intermittent cramping pain for 4 months. A lower gastrointestinal double-contrast study revealed a protruding mass at the transverse colon. Endoscopic ultrasonography showed a lesion arising from the submucosal layer. Instead of a laparotomy, the lesion was removed laparoscopically with the assistance of a colonoscope. No operative morbidity was noted. With future improvements of this technique, tumors that are difficult to remove with colonoscopy can be excised laparoscopically without the aid of an endoscopic stapler. In our case, the tumor was localized intraoperatively and extracted using the intraoperative colonoscopy. This double-scope technique is safe and cost-effective for some difficult colonic lesions.

Background: Type 2 Diabetes Mellitus (T2DM) is a serious health problem that has increased dramatically worldwide due to the high and increasing prevalence of obesity. Medical management of T2DM is of limited success. Recent data on the relative effectiveness of gastric bypass surgery as a treatment for T2DM suggests that it may be significantly more effective. However, no randomized clinical trials have been performed to evaluate the effectiveness of the procedure in reducing adverse health outcomes in patients with T2DM. Aims: To compare the effectiveness of gastric bypass and gastric sleeve surgery at 1 year. Methods: Obese T2DM patients were recruited and randomized to receive gastric bypass or gastric surgery and follow them for one year. Results: Obese T2DM patients receiving gastric bypass or gastric sleeve surgery show comparable body weight loss, similar changes of body mass index and waist hip ratio at one year after operation. Plasma fasting glucose, HbA1c, total cholesterol and triglyceride levels are higher in patients with gastric sleeve than those with gastric bypass. Plasma glucose levels are higher in patients with gastric sleeve than those with gastric bypass at 0, 30, 60, 90 and 120 min after oral glucose tolerance test. Patients receiving gastric bypass have higher plasma level of leptin, while patients receiving gastric sleeve surgery have higher plasma level of resistin. Patients receiving gastric bypass exhibit more desire to eat but stop eating earlier than patients receiving gastric sleeve surgery. Conclusions: Both gastric bypass and gastric sleeve surgery are effective in reducing body weight, body mass index and waist hip ratio at one year after surgery. However, gastric bypass seems a better mode of metabolic surgery than gastric sleeve. Plasma adipokines may be involved in this mechanism and play important roles in insulin resistance between these two modes of surgery.