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Smoking and obesity are independent risk factors of cardiovascular diseases [1]. Although nicotine is a known metabolic stimulant, heavy smokers tend to have greater body weight than light or non-smokers [2]. Smoking also increases the risk of diabetes mellitus and hypertension [3]. It increases the risk of organ space infection, prolonged intubation, reintubation, pneumonia, sepsis, shock, and longer length of stay in all patients undergoing bariatric surgery [4,5].
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More than 600 million people worldwide are categorized as obese [1]. Dietary and lifestyle modifications are typically only able to induce minimal weight loss [2] and many patients require more aggressive therapy. Bariatric surgery has been proven to have long-term weight loss effects in those with severe obesity [3,4]. However, bariatric surgery is invasive, requires specialized expertise and is costly [5].
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Within the context of recent evidence highlighting the seemingly unabated rise in childhood obesity and in particular, the alarming increase in the prevalence of severe obesity (BMI ≥ 120% of the 95th percentile or BMI ≥ 40kg.m2) within the adolescent sub-population [1], it is not surprising that the use of bariatric surgery among teens in the U.S. and elsewhere is on the rise [2]. Although current estimates in the U.S. remain relatively uncertain, due in part to adolescent bariatric surgery being carried out in multiple clinical setting (i.e.
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It is with great interest that I have had the privilege of reviewing and commenting on the manuscript “Laparoscopic Sleeve Gastrectomy in Patients with Heart Failure and Left Ventricular Assist Devices as a Bridge to Transplant” by Hawkins, et al. [1]. The authors have clearly and concisely reported the outcomes of this high risk procedure performed in an even higher risk population. 11 patients with concomitant morbid obesity and heart failure requiring left ventricular assist device (LVAD) placement were followed after sleeve gastrectomy.
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Obesity is a serious health problem that affects a wide range of patients and disease processes. The U.S. Preventive Services Task Force recommends screening and counseling for adults with obesity [1]. It has been estimated that even modest weight reduction can extend life expectancy and reduce lifetime medical expenditures associated with chronic conditions [2]. However, physicians often avoid the topic of weight loss and obesity altogether [3]. Several barriers to management of patients with obesity have previously been described, including perceived inability to change behavior [4], lack of known effective treatments [5], negative attitudes [6], and lack of motivation [7].
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There are now a multitude of studies that demonstrate the high incidence weight recidivism and long-term complications in adjustable gastric banding (AGB) [1-6]. To date, several authors have reported their approach to dealing with this often-complex problem with sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), mini gastric bypass (MGB), and biliopancreatic diversion with duodenal switch (BPD-DS) [7-10]. Controversy currently exists regarding the best choice for patients once they require removal of the AGB.
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The positive effects of bariatric surgery (BS), including significant weight loss and resolution of comorbidities, have been well established [1,2]. However, the massive weight loss can lead to excess skin, which may negatively affect patients’ well-being by causing medical, functional and psychological problems [3–6]. Body contouring surgery (BCS) is the only treatment for restoration of the contour of the body and is desired by a large part of the post-bariatric population [6–14]. Yet, only a small portion (18-33%) of the post-bariatric patients actually undergoes BCS; the high costs of this procedures are considered a major reason for this reluctance [6,8,12,15].
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