George Hopkins

Laparoscopic Gastric Banding in Morbidly Obese Adolescents

Background: 4% of adolescents in the U.S.A. are obese, 80% of whom will become obese adults. Obesity in adolescence is associated with increased mortality and morbidity in adulthood. Is laparoscopic adjustable silicone gastric banding a safe and effective method of weight loss in morbidly obese adolescents? Methods: Since 1996, data has been prospectively collected on all patients undergoing laparoscopic adjustable gastric banding (LAGB) by a single surgeon. Patients are reviewed at 6 and 12 weeks following surgery,then at 3 monthly intervals.Weight loss is measured in absolute terms, reduction in body mass index (BMI) and as percentage of excess weight loss. Results: 17 patients with a median age of 17 (12 to 19) years underwent LAGB. Median follow-up was 25 (12 to 46) months. 2 complications occurred, 1 slipped band and 1 leaking port. BMI fell from a preoperative median of 44.7 to 30.2 kg/m2 at 24 months following surgery, corresponding to a median loss of 35.6 kg or 59.3% of excess weight. 13 of 17 patients (76.5%) lost at least 50% of their excess weight, and 9 of 11 patients (81.8%) had a BMI <35 kg/m2 at 24 months following surgery. Conclusion: LAGB is a safe and effective method of weight loss in morbidly obese adolescents, at least in the medium term. Its role in preventing obesity and obesity-related disease in adulthood remains to be determined as part of our long-term study.

A prospective study of the impact of fluorodeoxyglucose positron emission tomography with concurrent non‐contrast CT scanning on the management of operable pancreatic and peri‐ampullary cancers

BACKGROUND The role of fluorodeoxyglucose (FDG) positron emission tomography (PET/CT) scanning in operable pancreas cancer is unclear. We, therefore, wanted to investigate the impact of PET/CT on management, by incorporating it into routine work-up. METHODS This was a single-institution prospective study. Patients with suspected and potentially operable pancreas, distal bile duct or ampullary carcinomas underwent PET/CT in addition to routine work-up. The frequency that PET/CT changed the treatment plan or prompted other investigations was determined. The distribution of standard uptake values (SUV) among primary tumours, and adjacent to biliary stents was characterised. RESULTS Fifty-six patients were recruited. The surgical plan was abandoned in 9 (16%; 95% CI: 6-26) patients as a result of PET/CT identified metastases. In four patients, metastases were missed and seven were inoperable at surgery, not predicted by PET/CT. Unexpected FDG uptake resulted in seven additional investigations, of which two were useful. Among primary pancreatic cancers, a median SUV was 4.9 (range 2-12.1). SUV was highest around the biliary stent in 17 out of 28 cases. PET/CT detected metastases in five patients whose primary pancreatic tumours demonstrated mild to moderate avidity (SUV < 5). CONCLUSIONS PET/CT in potentially operable pancreas cancer has limitations. However, as a result of its ability to detect metastases, PET/CT scanning is a useful tool in the selection of such patients for surgery.

Laparoscopic revision of gastric band surgery.

Aim:  To identify the outcome of laparoscopic revision of gastric band surgery with respect to percentage of excess weight lost (%EWL).

GASTRIC BANDING AT THE ROYAL BRISBANE AND WOMEN’S HOSPITAL: TRIALS AND TRIBULATIONS OF A PUBLIC SERVICE

Background:  The Royal Brisbane and Women’s Hospital provides the only gastric banding service for the public to the state of Queensland. Our patients are potentially a different group from the previously reported Australian series with respect to weight, comorbidities and ease of follow up and we therefore present this series of public patient for comparison of medium‐term results.

Does Bariatric Surgery Cause Vitamin A, B1, C or E Deficiency? A Systematic Review

BackgroundThe restrictive and/or malabsorptive nature of bariatric surgery may increase the risk for micronutrient deficiencies. This systematic review aimed to identify and critique the evidence for vitamin A, B1, C or E deficiencies associated with bariatric surgery.MethodsThis review utilised PRISMA and MOOSE frameworks with NHMRC evidence hierarchy and the American Dietetic Association bias tool to assess the quality of articles.ResultsTwenty-one articles were included and once critiqued all studies were of level IV grade and neutral or negative in quality. The relevance of measuring micronutrient supplementation and inflammatory markers for validity of serum vitamins is absent within the literature.ConclusionsFuture research is needed to investigate the risk of deficiency for these procedures with focus on confounders to serum micronutrients.

Revision gastric bypass after laparoscopic adjustable gastric band: a 10‐year experience at a public teaching hospital

In Australia, there is limited access to public revisional bariatric procedures. However, the need for such procedures is rising. We investigated the safety and efficacy of band‐to‐bypass procedures in our experience at a public teaching hospital over a period of 10 years.

Outcomes of laparoscopic sleeve gastrectomy in Crohn's disease patients: an initial Australian experience: Laparoscopic sleeve gastrectomy

Crohns disease (CD) in association with obesity is becoming an increasing issue in Australia and worldwide. This report looks at outcomes for patients with CD undergoing laparoscopic sleeve gastrectomy.