Vamsi V. Alli

Gastric Bypass and Influence on Improvement of NAFLD

Purpose of ReviewObesity is recognized as a chronic and recurring disease, often accompanied by other weight-related comorbid conditions such as obstructive sleep apnea, hypertension, type 2 diabetes, and non-alcoholic fatty liver disease (NAFLD). This chapter will seek to focus on the effect of weight loss surgery (WLS), in particular Roux-en-Y gastric bypass (RYGB), on NAFLD.Recent FindingsAmong several modalities available to treat NAFLD, the one most likely to achieve rapid, significant, and sustained improvement of liver disease is WLS.SummaryThe most commonly studied WLS procedure at this time is RYGB, and there is significant evidence that this is a safe and effective procedure both for weight loss and to bring about improvement of multiple associated comorbid conditions, including NAFLD. Further research focusing on non-surgical approaches that might mimic the effect of WLS on liver pathology is needed.

Transabdominal Preperitoneal (TAPP) Repair

Successful completion of a transabdominal preperitoneal (TAPP) repair of hernias of the myopectineal orifice requires advanced laparoscopic skills. This chapter describes the anatomic, technical, and ergonomic considerations of performing a laparoscopic TAPP repair. Methods to both avoid and manage complications will also be addressed.

The Role of the Obesity Medicine Physician in the Management of the Bariatric Patient

As obesity rates rise worldwide and with improved understanding of the biological, genetic, social, and psychological underpinnings of obesity, weight loss programs are challenged to manage overweight patients through a multidisciplinary approach. The obesity medicine physician is a crucial component of a successful medical and surgical weight loss program. Such a specialist can discuss and recommend weight loss for a given patient in an individualized manner, using a variety of different tools depending on what may be deemed most successful in a given situation. The obesity medicine physician may incorporate dietary recommendations, exercise, digital technology, weight loss medications, and medical devices to assist patients with nonsurgical weight loss or to help manage weight regain after weight loss surgery. Collaboration between bariatric surgeons and obesity medicine specialists provides an improved approach to patients that will likely foster success.