Olivier Court

Internal hernia after gastric bypass surgery during middle trimester pregnancy resulting in fetal loss: risk of internal hernia never ends

Internal hernia after gastric bypass surgery during middle trimester pregnancy resulting in fetal loss: risk of internal hernia never ends Evangelos Efthimiou, M.D., M.Sc., F.R.C.S., Larry Stein, M.D., Olivier Court, M.D., Nicolas Christou, M.D., Ph.D. Section of Bariatric Surgery, Division of General Surgery, McGill University Health Center, Montreal, Quebec, Canada Division of Radiology, McGill University Health Center, Montreal, Quebec, Canada Surgery for Obesity and Related Diseases 5 (2009) 378–380

Stent migration causing alimentary limb obstruction necessitating laparotomy and surgical stent extraction

Stent migration causing alimentary limb obstruction necessitating laparotomy and surgical stent extraction Evangelos Efthimiou, M.D., M.Sc., F.R.C.S., Larry Stein, M.D., Peter Szego, M.D., Olivier Court, M.D., Nicolas Christou, M.D., Ph.D. Section of Bariatric Surgery, Division of General Surgery, McGill University Health Center, Montreal, Quebec, Canada Division of Radiology, McGill University Health Center, Montreal, Quebec, Canada Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada Surgery for Obesity and Related Diseases 5 (2009) 375–377

Diabetic Ketoacidosis Following Bariatric Surgery in Patients With Type 2 Diabetes

Diabetic ketoacidosis (DKA) is a life-threatening complication mainly linked to type 1 diabetes. Clinical features of DKA after bariatric surgery are mostly unknown and likely underreported, especially in those with type 2 diabetes. The objective of this study is to emphasize occurrence and clinical presentation of DKA in patients with type 2 diabetes after bariatric surgery. We also aim to describe diagnostic challenges related to new medications such as sodium–glucose cotransporter 2 inhibitors (SGLT-2i) that can cause euglycemic DKA (1,2). We report four cases of DKA in three patients with type 2 diabetes after bariatric surgery at a single institution from January 2010 to December 2015. All cases presented within 30 days following surgery, were classified as moderate to severe based on criteria from the American Diabetes Association (3,4 …

Medium to long-term outcomes of bariatric surgery in older adults with super obesity

BACKGROUND Indications and outcomes of bariatric surgery in older adults suffering from morbid obesity remain controversial. We aimed to evaluate safety and medium to long-term outcomes of bariatric procedures in this patient population. SETTING University Hospital, Canada. METHODS This is a single-center retrospective study of a prospectively collected database. We included patients aged ≥60 years who underwent sleeve gastrectomy, Roux-en-Y gastric bypass, or biliopancreatic diversion with duodenal switch between January 2006 and December 2014 and had at least 2 years of follow-up. RESULTS Of patients, 115 underwent bariatric surgeries (11 patients had 2 procedures). There were 66 were super-obese patients (body mass index>50 kg/m2). Of patients, 74% had sleeve gastrectomy, 16% Roux-en-Y gastric bypass, and 8% underwent biliopancreatic diversion with duodenal switch. Mean age and body mass index were 63.3 ± 2.6 years and 51.7 ± 8.1 kg/m2, respectively. Average follow-up time was 42 ± 19 months. At baseline, 78% had hypertension, 60% had type 2 diabetes, and 30% had obstructive sleep apnea. There was no 30-day mortality. Complication rate was 14% (n = 16): 2 leaks post-Roux-en-Y gastric bypass, 1 leak post-biliopancreatic diversion with duodenal switch, 1 obstruction post-sleeve gastrectomy, 1 bleeding requiring transfusion, 1 liver injury with bile leak, 2 port-site hernias, 1 myocardial infarction, 2 gastrojejunal strictures, 1 wound infection, 1 urinary tract infection, and 3 gastric reflux exacerbations. Mean percent excess weight loss at 2 years was 52.2 ± 23.8. Remission rates of hypertension, type-2 diabetes, and obstructive sleep apnea were 26%, 44%, and 38%, respectively. CONCLUSION Bariatric surgery is safe and effective in improving obesity-related co-morbidities in older patients suffering from morbid obesity. Age alone should not preclude older patients from getting the best bariatric procedure for obesity and related co-morbidities.