L. Ulas Biter

Treatment of giant hiatal hernia by laparoscopic Roux-en-Y gastric bypass

Highlights • LRYGB plus HHR is safe and feasible.• LRYGB plus HHR results in additional weight loss and improvement of co-morbidity.• LRYGB plus HHR is a good alternative for antireflux surgery in obese HH-patients.• HH-patients meeting bariatric surgery criteria should be informed about LRYGB plus HHR.• Randomized trials comparing fundoplication with LRYGB plus HHR are needed.

Contribution of Type 2 Diabetes Mellitus to Subclinical Atherosclerosis in Subjects with Morbid Obesity

IntroductionType 2 diabetes mellitus (T2DM) and obesity are both related to increased risk of cardiovascular disease and mortality. Early atherosclerotic vascular changes can be detected by non-invasive tests like carotid artery intima-media thickness (cIMT) and pulse wave velocity (PWV). Both cIMT and PWV are significantly impaired in T2DM patients and in obese patients, but the additional effect of T2DM on these vascular measurements in obese subjects has not been evaluated.MethodsTwo hundred morbidly obese patients with or without T2DM were enrolled in a prospective cohort study and underwent extensive laboratory testing, including cIMT and PWV measurements. The cohort was divided into a group with and a group without T2DM.ResultsWithin this cohort, 43 patients (21.5%) were diagnosed with T2DM. These patients were older and had more often (a history of) hypertension as compared to patients without T2DM. HbA1c levels were significantly increased, while LDL cholesterol was significantly lower and the use of statins higher than in non-diabetic participants. cIMT and PWV were significantly increased in subjects suffering from T2DM. The variability in cIMT and PWV was related to differences in age and systolic blood pressure, but not to the presence of T2DM.ConclusionWhile T2DM negatively affects the vasculature in morbid obesity, hypertension and age seem to be the major risk factors, independent from the presence of T2DM.Clinical Trial RegistrationDutch Trial Register NTR5172.

Response to: Letter to the Editor: Long-Term Results of Laparoscopic Sleeve Gastrectomy for Morbid Obesity: 5 to 8-Year Results

In response to the letter to the Editor: We greatly appreciate the interest and comments on our article regarding long-term outcome after sleeve gastrectomy [1]. In response to your first question concerning weight loss failure and weight regain percentages, we consulted our database. Weight loss failure versus weight regain was 4.8% versus 10.9% at 5 years, 8.4% versus 15.4% at 6 years, 7.7% versus 9.2% at 7 years, and 13.3% versus 16.7% at 8 years. For your second question, we analyzed the data of our patients requiring revision to laparoscopic roux-and-Y gastric bypass for inadequate weight loss (n = 38). A total of 22 patients needed revision for weight loss failure versus 16 patients for weight regain. Successful revision, defined as achieving at least 50% excess weight loss from index weight, following revision to LRYGB was achieved in 7 patients (32%) in the weight loss failure group versus 11 patients (73%) in the weight regain group. This difference between both groups is a very interesting finding and should be investigated. This subdivision of failed sleeve gastrectomy in weight loss failure versus weight regain has not been described in literature to our knowledge. The results of this study had no specific implications on our patient selection for either LSG or LRYGB. The same patient characteristics and patient preference are still used in our decision-making. One of the reasons that we still perform both procedures in roughly the same ratio is the randomized controlled Bsleeve versus bypass trial^ which is performed in our institution [2].