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SOARD March issue - the highlights

The March issue of Surgery for Obesity and Related Diseases, the official journal of the American Society for Metabolic and Bariatric Surgery, is now available, featuring 40 articles, studies, and case reports. Here’s a few of the highlights:

Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update: cosponsored by american association of clinical endocrinologists, the obesity society, and american society for metabolic & bariatric surgery.

These guidelines, published jointly in SORD, Obesity, and Endocrine Practice, update the original 2008 recommendations to reflect new data and new trends in bariatric surgery. We cover the recommendations in detail here. (Full text)

Socially desirable responding by bariatric surgery candidates during psychological assessment

It is a concern among mental health professionals tasked with evaluating bariatric surgery candidates that they may minimise the expression of their symptoms of distress, in order to increase the chance that they can get approved. This study supports this intuition, finding that patients’ scores on two systems designed to measure socially acceptable responses were inversely correlated with clinical measures for anxiety and depression; elevated scores for social desirability were associated with the under-reporting of some clinical symptoms. (Full text)

Effects of surgically induced weight loss by Roux-en-Y gastric bypass on cardiovascular autonomic nerve function

After gastric bypass, morbidly obese patients’ cardiovascular autonomic nerve function, as measured by the variability in the period of time between heartbeats, and the ratio between low-frequency and high-frequency power components, improved significantly. However, the researchers did not find any evidence suggesting this was caused by reduced insulin resistance. (Full text)

Treatment of gastric leaks after Roux-en-Y gastric bypass: a paradigm shift

Surgeons at the University Medical Center at Princeton experimented with repairing Roux-en-Y gastric leaks by endoscopically injecting fibrin sealant. Eight leaks were seen after primary bypass operations, while five were experienced after a revisional operation; out of these 13, eight were able to be treated using fibrin sealant. All eight were successful, although six required more than one fibrin treatment. The surgeons concluded that fibrin injection was a “safe and successful” treatment for gastric leak, and recommended it for all patients with endoscopically accessible leaks who can safely be treated non-operatively. (Full text)

Blood clot obstruction of the jejunojejunostomy after laparoscopic gastric bypass

The authors of this paper discuss what they describe as a rare, but potentially rapidly progressive and deadly complication of gastric bypass: an obstruction of the jejunojejunostomy caused by a blood clot. They report seeing this complication in 0.5% of the 1,066 gastric bypass patients they saw between June 2004 to March 2011; all five underwent reoperation to remove the clot, and the gastric remnant was decompressed with a percutaneously placed gastrostomy tube. (Full text)