Obesity surgery
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Case Reports
Vertical gastric resection (sleeve gastrectomy) in a morbidly obese patient with past jejunoileal bypass.
Jejunoileal bypass (JIB) is a purely malabsorptive operation, which has been abandoned in the USA and Western Europe due to occasional serious complications. We are still seeing past JIB patients who have become obese again over the years, but are not suffering side-effects of the previous JIB, and are complaining of typical co-morbidities of the obesity. ⋯ The patient has been followed for another 4 years with regular laboratory tests, monitoring of weight loss, bone densitometry and possible complications. Selected morbidly obese patients who have undergone past JIB, can be safely treated by a restrictive procedure, sleeve gastrectomy, to accomplish successful weight loss without increasing the risk of possible serious complications.
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The bariatric surgery community is complaining about the multiple barriers that hamper the growth of procedures that have been found to be the only effective treatment for morbid obesity. The French situation demonstrates that the number of procedures has stabilized after a period of rapid growth, despite the facts that the needs are not satisfied and that there are less important barriers to surgery than in most countries. This new "French paradox" is understandable if one accepts the reluctance of the public audience and an insufficient level of evidence for a systematic referral to bariatric surgery. Less invasive procedures should make it possible to re-unify the physicians who deal with obesity, as well as the implementation of comparatives and randomized clinical studies.