Elliot Goodman

The Psychology of Gastric Bypass Surgery

Background: This article discusses the importance of psychological evaluation of gastric bypass (GBP) surgery candidates and post-surgical psychological support services, using the Center for Weight Reduction Surgery at Montefiore Medical Center as a model. The study of psychological predictors of post-operative outcome is in its beginning stages, and the small body of literature on this topic is reviewed. Methods: 115 GBP surgery candidates completed a clinical interview and a self-report measure, the MMPI-2. Results and Conclusions: A high prevalence of psychopathology and personality disturbance was found in this population.The impact that psychological disturbance may have on post-operative outcome is discussed.The authors also provide a qualitative analysis of the psychological themes commonly found among this population, as well as psychosocial interventions that have been found helpful.

Critical care of the obese and bariatric surgical patient

Obesity is associated with a chronic inflammatory state that predisposes to atherogenesis, thrombogenesis, and carcinogenesis and may increase susceptibility to infections. Critically ill, obese patients have higher mortality. MOF is the best predictor of ICU mortality for obese patients. Pulmonary hypertension and higher BMI are associated with higher surgical risk. Progress in surgical technique and anesthesia has substantially improved the safety of performing operations in severely obese patients.

Intussusception: An Uncommon Cause of Postoperative Small Bowel Obstruction after Gastric Bypass

Intussusception of the jejuno-jejunal anastomosis is a rare complication of the Roux-en-Y gastric bypass (RYGBP).There are only 3 previous cases reported in the surgical literature. We describe 2 adults who developed jejuno-jejunal intussusception requiring emergent laparotomy several months after RYGBP. Both patients underwent exploratory laparotomy after the diagnosis was made with abdominal CT scan. Each patient had an uneventful postoperative course after bowel resection and revision of the enteroenterostomy. Small bowel obstruction due to intussusception may occur many months after RYGBP and may present with non-specific symptoms such as crampy abdominal pain, nausea, and vomiting. The diagnosis of this rare entity is typically made via abdominal CT scan. Treatment mandates urgent abdominal exploration with reduction.

Heterotopic Mesenteric Ossification Following Gastric Bypass Surgery: Case Series and Review of Literature

Heterotopic mesenteric ossification (HMO) is a rare entity with few cases reported in the world literature. We report two cases. Both patients underwent an open gastric bypass with Roux-en-Y reconstruction procedure for morbid obesity and subsequently presented with gastrointestinal fistulae associated with HMO.

Diagnosis and Management of Perforated Duodenal Ulcers following Roux-En-Y Gastric Bypass: A Report of Two Cases and a Review of the Literature

Perforated duodenal ulcers are rare complications seen after roux-en-Y gastric bypass (RYGP). They often present as a diagnostic dilemma as they rarely present with pneumoperitoneum on radiologic evaluation. There is no consensus as to the pathophysiology of these ulcers; however expeditious treatment is necessary. We present two patients with perforated duodenal ulcers and a distant history of RYGP who were successfully treated. Their individual surgical management is discussed as well as a literature review. We conclude that, in patients who present with acute abdominal pain and a history of RYGB, perforated ulcer needs to be very high in the differential diagnosis even in the absence of pneumoperitoneum. In these patients an early surgical exploration is paramount to help diagnose and treat these patients.

Endoscopic gastric pouch plication - a novel endoluminal incision free approach to revisional bariatric surgery

10–40% of Roux-en-Y gastric bypass (RYGB) patients regain significant weight after Roux-en-Y gastric bypass surgery due to dilation of the pouch and/or the gastrojejunal (GJ) anastomosis. Traditional revision surgery is associated with significant morbidity (e.g. post-anastomotic GJ leak) where less invasive endoluminal procedures may represent safer alternatives. The present article reports a case of the safe and successful use of endoluminal gastric pouch plication (EGPP) using the StomaphyX™ device to correct both a dilated gastric pouch and a dilated gastrojejunostomy in a post-RYGB patient who regained significant weight.

Newer Endoluminal Interventions for Obesity

At present, several primary endoluminal weight loss procedures are under investigation, all of which aim to reproduce more invasive, restrictive or malabsorptive operations. They are in various stages of development and clinical application, in the United States of America (USA) and the rest of the world. They have been designed to address refractory obesity for patients with Body Mass Index (BMI) in the range of 30–35, as well as for those individuals who currently are candidates for more traditional bariatric surgery (BMI >35).

Transoral incision free fundoplication (TIF) – A new paradigm in the surgical treatment of GERD

An estimated 10 billion dollars is spent treating gastro-oesophageal reflux disease (GERD) in the USA every year. The present article reports a case of the safe and successful use of transoral incisionless fundoplication (TIF) using the EsophyX90™ device in the surgical treatment of GERD.