Bariatric surgery versus medical therapy in Korean obese patients: prospective multicenter nonrandomized controlled trial (KOBESS trial)

Purpose@#The aim of this study was to show that bariatric surgery (BS) is more effective than medical therapy (MT) in Asian obese patients. @*Methods@#In this prospective, multicenter, nonrandomized, controlled trial, obese patients with body mass index of ≥35 kg/m2 or 30.0–34.9 kg/m2 with obesity-related comorbidities were assigned to undergo BS, such as laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass, or MT. Patients who underwent BS were evaluated 4, 12, 24, and 48 weeks after surgery, whereas patients who received MT were monitored at a hospital every 6 weeks for 1 year. At each visit, weight, waist and hip circumference, and blood pressure were measured, and patients underwent physical examination and laboratory testing. Health-related quality of life (HQOL) was investigated using Euro QOL-5 Dimension, Impact of Weight on Quality of Life questionnaire-Lite and Obesity-related Problems scale. @*Results@#The study included 264 patients from 13 institutions; of these, 64 underwent BS and 200 received MT. Of the patients who underwent BS, 6.3% experienced early complications. Relative weight changes from baseline to 48 weeks were significantly greater in the BS than in the MT group (26.9% vs. 2.1%, P < 0.001), as were the rates of remission of diabetes (47.8% vs. 16.7%, P = 0.014), hypertension (60.0% vs. 26.1%, P < 0.001), and dyslipidemia (63.2% vs. 22.0%, P < 0.001). HQOL was better in the BS than in the MT group at 48 weeks. @*Conclusion@#BS was safe and effective in Korean obese patients, with greater weight reduction, remission of comorbidities, and quality of life improvement than MT.

Long-term effect of bariatric surgery versus conventional therapy in obese Korean patients: a multicenter retrospective cohort study

PURPOSE: Long-term results following bariatric surgery compared to conventional treatments has never been reported in morbidly obese Korean patients. This study aimed to evaluate the long-term efficacy of bariatric surgery in morbidly obese Korean patients compared to conventional medical treatments. METHODS: In this multicenter retrospective cohort study, we reviewed 137 obese subjects between January 2008 and February 2011 with a body mass index (BMI) > 30 kg/m2 who had more than 5 years of follow-up clinical data after bariatric surgery (surgery group, n = 49) or conventional treatment (conventional treatment group, n = 88). Anthropometric data and the status of comorbidities were compared between the 2 groups. RESULTS: The median follow-up period was 72.1 months (range 19.3–109.7 months). At the last follow-up, the surgery group showed a greater amount of total weight loss than the conventional treatment group (24.9% vs. 2.8%, P < 0.001). The prevalence of diabetes and hypertension significantly decreased in the surgery group, while the conventional treatment group showed a marked increase in these comorbidities. In the surgery group, Roux-en-Y gastric bypass and sleeve gastrectomy achieved comparable long-term weight loss (26.5% vs. 22.4%, respectively; P = 0.087). CONCLUSION: In the long-term, bariatric surgery achieved and maintained significantly greater weight reduction, as well as a decrease in obesity-related comorbidities, than did conventional medical therapy in morbidly obese Korean patients.

Outcomes of primary sleeve gastrectomy versus conversion sleeve gastrectomy in morbidly obese patients

PURPOSE: Our aim for this study was to evaluate early and late complications and outcomes of primary sleeve gastrectomy (PSG) versus conversion sleeve gastrectomy (CSG). METHODS: From February 2013 to December 2016, a total of 180 patients underwent sleeve gastrectomy (150 PSG and 30 CSG). All patients received a metal clipping at the end of the stapling line and a continuous seromuscular suture at the resection margin, for reinforcement. RESULTS: There were no differences in the percentages among males and females or age between the 2 groups, but the body mass index (BMI) of the PSG group was higher at 36.8 ± 4.7 than that of the CSG group (32.4 ± 5.7, P < 0.001). Three early postoperative complications were noted in the PSG group; 1 patient underwent repeat laparoscopic exploration due to pancreatic injury, and 2 other patients developed pulmonary atelectasis. On the contrary, 2 early minor complications were noted in the CSG group. Thirty-eight patients (25.3%) in the PSG group developed 43 late, minor complications, while 9 patients (30.0%) developed 11 late minor and 1 major complication in the CSG group. However, there was no difference in complication rate between PSG and CSG. Percentage excess BMI loss at 3, 6, and 12 months after surgery was comparable between the groups. CONCLUSION: PSG and CSG were comparable in terms of postoperative complications and loss of weight. Therefore, CSG could be used for failed primary restrictive bariatric surgery. However, the durability of these outcomes remains unknown.

2014–2017 Nationwide Bariatric and Metabolic Surgery Report in Korea

PURPOSE: The information committee of the Korean Society for Metabolic and Bariatric Surgery (KSMBS) performed the nationwide survey of bariatric and metabolic operations to report IFSO (International Federation for the Surgery of Obesity and Metabolic Disorders) worldwide survey annually. This study aimed to report the trends of bariatric and metabolic surgery in Korea in 2014–2017. MATERIALS AND METHODS: We analyzed the accumulated nationwide survey data conducted for annual ISFO survey from 2014 to 2017. Trends such as the number of operations by hospital type and the number of operations by surgical method were analyzed. RESULTS: The number of operations has decreased sharply in 2015 comparing to 2014 (913⇒550). The number of operations performed in private hospitals dropped sharply from 529 to 250, 198, and 103 cases. The number of revisional surgeries increased to 223 in 2015. The primary surgery number fell from 757 in 2014 to 327 in 2015. In primary surgery, sleeve gastrectomy was gradually increased from 2014 to 143 (18.9%), 105 (32.1%), 167 (47.2%) and 200 (56.3%) and became the most frequently performed surgery. On the other hand, the incidence of adjustable gastric band decreased gradually from 439 (58.0%) to 117 (35.8%), 112 (31.6%) and 59 (16.6%). CONCLUSION: The overall number of obesity metabolic operations has decreased since 2014, especially the number of adjustable gastric band, and the number of operations in private hospitals declined sharply. On the other hand, the number of operations in university hospitals did not change much, and the number of sleeve gastrectomy increased.

Prospective, double center, 1-year results of adjustable gastric banding with MIDBAND (gastro-gastric suture vs. non-gastro-gastric suture)

PURPOSE: Although laparoscopic adjustable gastric banding (LAGB) is a popular bariatric procedure, few comprehensive studies have been investigated on the use of non-gastro-gastric sutures (NGGSs) for decreasing postoperative complications. This study aimed to assess and compare the safety and effectiveness of MIDBAND with or without gastro-gastric sutures (GGSs). METHODS: Between February 2013 and March 2014, 41 severely obese patients underwent primary LAGB using pars flaccid technique at double center in South Korea. Excess weight loss, operative time and postoperative complications were assessed and compared between a GGS group (group 1) and a NGGS group (group 2), and patients were followed monthly for 1 year. RESULTS: Mean body mass indices in groups 1 and 2 were 38.4 ± 4.7 and 38.9 ± 5.0 kg/m², respectively, and mean percentage excess weight losses (%EWLs) were 59.9% ± 28.4% and 50.9% ± 20.0%, respectively, at 6 months, and 75.8% ± 26.6% and 72.5% ± 27.5%, respectively, at 12 months, and these intergroup differences of %EWL were not significant (P = 0.256 and P = 0.704, respectively). Mean operative time (57.2 minutes) was shorter in group 2 than in group 1 (79.2 minutes) (P < 0.001). In terms of complications, pouch dilatation rates were similar in the 2 groups, and no case of gastric band erosion was encountered. CONCLUSION: Operative time was shorter in the NGGS group, and pouch dilatation rates and %EWL were similar in the 2 groups. We conclude NGGS using MIDBAND is both straightforward and effective. A long-term prospective comparative study is needed to demonstrate the safety and efficacy of NGGS.

Roux-en-Y Gastric Bypass vs. Sleeve Gastrectomy vs. Gastric Banding: The First Multicenter Retrospective Comparative Cohort Study in Obese Korean Patients

PURPOSE: Bariatric surgery is relatively new in Korea, and studies comparing different bariatric procedures in Koreans are lacking. This study aimed to compare the clinical outcomes of laparoscopic adjustable gastric banding (LAGB), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) for treating morbidly obese Korean adults. MATERIALS AND METHODS: In this multicenter retrospective cohort study, we reviewed the medical records of 261 obese patients who underwent different bariatric procedures. Clinical outcomes were measured in terms of weight loss and resolution of comorbidities, such as diabetes, hypertension, and dyslipidemia. Safety profiles for the procedures were also evaluated. RESULTS: In terms of weight loss, the three procedures showed similar results at 18 months (weight loss in 52.1% for SG, 61.0% for LAGB, and 69.2% for RYGB). Remission of diabetes, hypertension, and dyslipidemia was more frequent in patients who underwent RYGB (65.9%, 63.6%, and 100% of patients, respectively). Safety profiles were similar among groups. Early complications occurred in 26 patients (9.9%) and late complications in 32 (12.3%). In the LAGB group, five bands (6.9%) were removed. Among all patients, one death (1/261=0.38%) occurred in the RYGB group due to aspiration pneumonia. CONCLUSION: The three bariatric procedures were comparable in regards to weight-loss outcomes; nevertheless, RYGB showed a higher rate of comorbidity resolution. Bariatric surgery is effective and relatively safe; however, due to complications, some bands had to be removed in the LAGB group and a relatively high rate of reoperations was observed in the RYGB group.

Feasibility and Safety of Conversion Sleeve Gastrectomy after Failed Primary Adjustable Gastric Banding or Sleeve Gastrectomy

PURPOSE: Adjustable gastric banding (AGB) and sleeve gastrectomy (SG) are restrictive bariatric surgeries that are popular in Korea. However, patients often require further conversion surgeries because weight loss failure and surgical complications tend to occur. The aim of this study was to evaluate the feasibility and safety of conversion sleeve gastrectomy (CSG) after failed primary AGB (PAGB) or primary SG (PSG). MATERIALS AND METHODS: From February 2010 to April 2016, 21 consecutive patients who underwent CSG after failed PAGB or PSG were enrolled in this study. This study was a retrospective analysis of our prospectively collected database. Demographic, intra and post-operative data were collected and analyzed. RESULTS: Twenty-one patients were enrolled in this study. This comprised 20 women and 1 man, with an average BMI of 31.8±7.8 kg/m². Eighteen patients underwent PAGB and 3 underwent PSG. The mean operative time was 243.6±76.8 minutes, and the estimated blood loss was 190.9±233.2 ml. The mean hospital stay was 4.7±1.7 days. The mean follow-up after CSG was 9.3±1.0 months. Two cases developed immediate postoperative complications: one was a stricture (Clavien-Dindo surgical complication grade II) and the other, a pleural effusion (Grade I). CONCLUSION: CSG is a feasible and safe treatment option after failed PAGB or PSG. Further prospective studies are required to establish the strategy for conversion operations after failed primary restrictive bariatric surgery.

One-Year Outcomes of Laparoscopic Adjustable Gastric Banding Based on Bariatric Analysis and Reporting Outcome System (BAROS) in Morbidly Obese Korean Patients

PURPOSE: This study aimed to compare amount of weight loss, serum laboratory results, and bariatric analysis and reporting outcome system (BAROS) scores obtained before surgery with those obtained 1 year after laparoscopic adjustable gastric banding (AGB). MATERIALS AND METHODS: From January 2013 to November 2014, 32 consecutive patients who underwent AGB were enrolled in this study. This study was a retrospective analysis of our prospectively collected database. The BAROS score included BAROS weight, medical condition, quality of life, and complications recorded 1 year after AGB. Demographic and post-operative data were also collected and analyzed. RESULTS: Thirty-two patients were enrolled in this study, comprising 26 women and 6 men, with an average body mass index of 39.0±6.1 kg/m². The total BAROS score 1 year post AGB was 4.6±1.7, and it was classified as excellent grade. Among them, the quality of life score was 1.8±0.6. Four minor complications were noted. The serum laboratory values improved 1 year post surgery, including hemoglobin A1c, c-peptide, insulin, Homeostatic model assessment of estimated insulin resistance (HOMA IR), Homeostatic model assessment of beta-cell function (HOMA B), triglyceride, total protein, and uric acid. CONCLUSION: AGB showed that it is acceptable in aspect of BAROS outcome as well as weight loss, and serum laboratory result in short-term period.

Spontaneous Unbuckling of the Adjustable Gastric Band; A Rare Complication

Laparoscopic adjustable gastric banding (LAGB) is a restrictive procedure which has a low morbidity and mortality rate in the immediate postoperative period along with a good weight loss. It is necessary for weight loss to adjust gastric band with calibration. Sometimes, patients performed LAGB experienced vomiting, regurgitation, and epigastric discomfort by over-filling. But to the contrary, we may meet patients who do not feel early satiety in the face of over-filling. We report here, the case of a 24-year-old woman with a failure of adjusting gastric band despite of over-filling, and unbuckled band, treated via removal of unbuckled band. Surgical band removal and change, or conversion to other procedures should be considered when unbuckled gastric band are encountered.

Short-term Experience of Laparoscopic Greater Curvature Plication in Morbidly Obese Korean Patients

PURPOSE: Laparoscopic greater curvature plication (LGCP) is the new emerging surgical technique for treating morbid obesity. The short-term results of LGCP are not yet available in Korea. MATERIALS AND METHODS: We retrospectively reviewed prospectively collected 18 patients' data with over 30 kg/m2 body mass index (BMI) who underwent LGCP from January 2013 to October 2014. Fifteen of these patients who had more than 3 months of follow-up were included in this report. LGCP was performed laparoscopically using interrupted and continuous sero-muscular suture from fundus to antrum over a 36-French bougie. RESULTS: Mean age at the time of surgery was 33.1+/-7.9 years in our patients. Mean weight was 98.9+/-15.5 kg and mean BMI was 35.7+/-4.1 kg/m2 preoperatively. The percentage of excess BMI loss (%EBL) in the postoperative first, third and sixth month was 33.6+/-9.1, 51.6+/-15.4 and 64.5+/-18.3%, respectively. There were no 30-day peri-operative mortality and major complications including bleeding, leakage and conversion bariatric surgery. CONCLUSION: These findings show that LGCP is a safe and effective weight loss option for morbidly obese Korean patients in short-term period. Randomized prospective control studies between gastric banding or sleeve gastrectomy and LGCP, are needed to confirm short-term weight loss effect and safety of LGCP in this group of patients.

Conversion Sleeve Gastrectomy for Pouch Dilatation and Band Scar Stenosis: 1 Case

Esophageal and gastric pouch dilatations are common complications that occur after laparoscopic adjustable gastric banding, often performed to treat morbid obesity. Most cases are treated by a gastric band deflation or a removal of band. Nevertheless, additional surgical procedures are rarely ever needed to treat persistent dysphagia and pouch dilatation. We report here, the case of a 38-year-old woman with constant vomiting and severe persistent epigastric pain despite the gastric band deflation, and a band scar stenosis, treated via laparoscopic conversion sleeve gastrectomy. Surgical band scar revision, or revision sleeve gastrectomy, may be considered if gastric pouch dilation and dysphagia are not treated by gastric band deflation.

Acute Gastric Band Slippage During the 3rd Trimester Gestation

Laparoscopic adjustable gastric banding (LAGB) is a popular bariatric procedure in South Korea, and the majority of female patients who receive LAGB are of childbearing age. Due to possible band-related complications, careful evaluation is required for those who become pregnant after LAGB procedures. A 28-year-old female, gravida 1, para 0, who had undergone LAGB two years earlier presented to the clinic at the 31st week of gestation. She had experienced acute epigastric pain and vomiting for one week. She was diagnosed with gastric band slippage. She underwent cesarean section and laparoscopic gastric band removal at the 35th week of gestation. Management of gastric band slippage during the third trimester is difficult, especially before the 34th week of gestation. We report on a case of medical and surgical treatment of gastric band slippage during the third trimester.

Bariatric surgery versus conventional therapy in obese Korea patients: a multicenter retrospective cohort study / 대한외과학회지

PURPOSE: In Korea, the results of bariatric surgery have not been compared with those of nonsurgical treatment. The purpose of this study was to evaluate the effectiveness and safety of bariatric surgery vs. conventional nonsurgical treatment in severely obese Koreans. METHODS: In this retrospective cohort study, we reviewed the medical charts of 261 consecutive subjects who underwent bariatric surgery and 224 subjects who were treated with weight control medication and lifestyle modification therapy between January 2008 and February 2011. Measures of clinical effectiveness, including change in weight (%) and comorbid diseases, and occurrence of complications, were investigated for 18 months after bariatric surgery. RESULTS: Body mass index (BMI) was higher in the surgery group than in the conventionally treated group (mean +/- standard deviation, 39.0 +/- 6.2 vs. 34.3 +/- 3.8). Diabetes was more prevalent in the surgery group than in the conventionally treated group (39.1% vs. 12.9%). The change in weight (%) between baseline and 18 months posttreatment was significantly greater in the surgery group (22.6%) than in the conventional therapy group (6.7%). While 57%, 47%, and 84% of subjects recovered from diabetes, hypertension, and dyslipidemia, respectively, in the surgery group, 10%, 20%, and 24% of subjects recovered from these conditions in the conventional group. Fifty-one subjects (19.5%) in the surgery group reported 61 complications (23.4%). CONCLUSION: Bariatric surgery in Korea was significantly more effective than conventional treatment for weight loss and recovery from comorbidities such as diabetes, hypertension, and dyslipidemia, with a reasonable complication rate.

The Importance of Clinical Indicators for Detecting Postoperative Complications Following Laparoscopic Sleeve Gastrectomy

PURPOSE: The significant drastic complications of performing laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients are gastric staple line leakage and bleeding. The aim of our study is to evaluate the efficacy of the clinical data for detecting postoperative complications after LSG. METHODS: The study enrolled 150 consecutive patients who underwent LSG from January 2003 to July 2006. When abnormal data (heart rate > or = 10/min, or temperature > or = 7.5degrees C) was detected on postoperative day 1, then laboratory tests (blood, urine, chest X-ray and abdominal sonogram) and water soluble gastrografin UGIS were performed to detect the postoperative complications after LSG (group A). The patients who had normal postoperative clinical data (group B) were compared with group A. RESULTS: Of the 150 patients who underwent LSG, 9 patients (6%) had postoperative complications. Two patients had major complications: 1 case of leakage (0.6%) and 1 case of delayed bleeding (0.6%), and 4 patients had minor complications in group A. But no major complications were detected in group B (P 39degrees C). CONCLUSION: Evidence of tachycardia or a high body temperature may be useful to detect major complications after LSG. We also recommend performing laboratory test and UGIS when clinically indicated.

The 3-Year Results of Laparoscopic Sleeve Gastrectomy for the Treatment of Korean Morbid Obesity

PURPOSE: In Asia, the types and the main causes of morbid obesity are different from those in western society. Therefore, the treatment plan should be different, and surgery for morbid obesity should be carefully chosen. The 3-year results for isolated laparoscopic sleeve gastrectomy (LSG) performedin the Korean population are reported. METHODS: We retrospectively reviewed 112 patients that underwent LSG from January 2003 to July 2006. Eighty-three of these patients had more than 3 years follow-up, and represent the subjects of this report. Sleeve gastrectomy was performed laparoscopicaly using the Endo-GIA stapler to create a lesser curve gastric tube over a 48-Fr bougie. RESULTS: The preoperative body mass index (BMI) was 36.4+/-5.2 (30.0~56.1). The mean excess BMI was 13.4+/-5.2. The percentage of excess weight loss (%EWL) in the postoperative first, second, and third year was 72.4+/-23.5, 69.5+/-29.4, and 66.8+/-33.4. The percentage of excess BMI loss (%EBMIL) was 74.1+/-25.6, 71.4+/-32.0, and 68.7+/-32.7. In 83 patients postoperatively after 3 years, 37 patients (44.6%) had >75% EBMIL, 22 patients (26.5%) had 50~75% EBMIL, 14 patients (16.9%) had 25~50% EBMIL, and 10 patients (12.0%) had less than 25% EBMIL. There was no 30-day peri-operative mortality. Two major complications (1 delayed bleeding, 1 leakage) occurred. CONCLUSION: LSG without the duodenal switch operation has been an effective single weight reducing surgical procedure thus far in most of the Korean patients.

Adult Onset Still's Disease Misunderstood as Sepsis with Bile Peritonitis

Adult onset Still's disease (AOSD) is a rare systemic inflammatory disorder of an unknown etiology, and its major clinical manifestations include high spiking fever, polyarthralgia, salmon-colored evanescent rash and neutrophilic leukocytosis. We describe here a 41 year old woman with AOSD who presented with non-remitting high fever, polyarthralgia, sore throat, skin rash, splenomegaly, thrombocytopenia, neutrophilic leukocytosis, hyperferritinemia and coagulopathy with disseminated intravascular coagulation (DIC). The patient had a history of laparoscopic cholecystectomy due to acalculous cholecystitis prior to admission. We suspected sepsis due to bile peritonitis after the previous laparoscopic cholecystectomy. Yet we could not detect infectious organisms on the cultures or serologic studies. Finally, we suspected AOSD-associated hemophagocytic syndrome (HS). So, intravenous immunoglobulin and pulse methylprednisolone treatment brought about transient improvement of the fever and the neutrophilic leukocytosis, but the disease progressed and the patient expired due to acute renal failure. HS is a fatal cause of AOSD. If a patient has DIC and sepsis and these fail to respond to conservative treatment, then AOSD should be added to the differential diagnosis of sepsis and DIC.

Pregnancy after Isolated Sleeve Gastrectomy in Morbidly Obese Patient

Bariatric surgery is the best known procedure for treating severe obesity and the majority of patients who received surgical weight loss procedure were at childbearing age. Female patients who successfully lost weight following bariatric procedure, become pregnant and those are need to be evaluated carefully due to various operative procedures and to ensure intake of quality nutrition. A 35-year-old female, gravida 4, para 2, treated for morbid obesity with vertical sleeve gastrectomy performed 14 months earlier, presented 7 weeks of gestation. Before surgery, she had weighed 92.4 kg (body mass index (BMI); 32.9 kg/m(2)); she had gradually reduced her weight to 65.5 kg (BMI; 23.5 kg/m(2)) postoperatively at 14 months. For the first trimester of pregnancy, her average intake was 698.6 kcal/day from food, and 840~1352.8 kcal/day in second and third trimester. During pregnancy, significant iron, cobalamin and vitamin B12 deficiencies were not founded. She has gained a total of 8 kg. She delivered a healthy female infant at full term. Nutritional supplementation following bariatric surgery and close supervision during pregnancy can prevent nutrition-related complications and improve maternal and fetal health.

Overexpression of Estrogen Receptor in Female Patients with Varicose Vein of Lower Extremities

PURPOSE: The high frequency of varicose veins in female suggests the involvement of female sex hormone in pathophysiology of varicose vein. We investigated the presence of estrogen receptor in the wall of normal and varicose veins, and compared their expression between male and female. METHODS: Twenty normal veins were obtained from patient undergoing peripheral artery bypass surgery. Forty varicose segment and non-varicose segment of varicose veins in same patients were obtained from patient during operation. Using immunohistochemistry, we measured estrogen receptor expression rate and compared the estrogen receptor expression of varicose vein with that of normal vein. RESULTS: There is no difference on estrogen receptor expression between normal vein and varicose vein. The positive rate of estrogen receptor expression was higher in varicose segment of varicose vein than in non-varicose segment of varicose vein (P=0.039). In varicose segments in female, estrogen receptor positive rate was higher than non-varicose segment (P=0.022), and than normal vein (P=0.017). The estrogen receptor positive rate of varicose segment in varicose vein was higher in female than male (P=0.008). But there is no statistical significance for the estrogen receptor positive rate of non-varicose segment in varicose vein between male and female. CONCLUSION: The gender difference may be related to hormonal action. Also, these finding suggested the involvement of female sex hormone in varicosity and provides a basis for the finding of causes of primary varicose veins.

Early Results of Laparoscopic Isolated Sleeve Gastrectomy without Duodenal Switch in the Treatment of Korean Morbid Obesity

PURPOSE: In Korea due to cultural background (food, life style) and environmental factors, type of obesity and previously defined operative indication is different from western country. Therefore, surgical procedure also must be applied differently under pattern of obesity. In this report we are trying to introduce our early results of laparoscopic sleeve gastrectomy without duodenal switch in Korean morbid obesity. METHODS: We retrospectively reviewed 60 consecutive patients who underwent laparoscopic sleeve gastrectomy between January 2003 and May 2004. Four 12mm ports and one 15mm port are placed. The sleeve gastrectomy was done as routine fashion using ligasure and endo-GIA stapler to create a lesser curve gastric tube over 48 French bougie. RESULTS: Excess weight loss was achieved in 71.6% during first six months postoperatively and 83.3% within 12 months. Body mass index (kg/cm2) was decreased average 9.2 during first 12 months postoperatively. Median weight loss at 12 months was 24.6 kg. Postoperative dyslipidemia was improved in 75% of patient within 12 months of operation. Diabetes as a co-morbidity was disappeared 100% of patient within 6 months postoperatively. Hypertension was disappeared in 92.9%, improved in 100% of patients within 12 months postoperatively. Arthritis and joint pain were improved 100% of patient within 12 months postoperatively. Weight loss plateaued at 12 months for the majority of patients. CONCLUSION: Additional studies and further follow up are needed to determine the best surgical treatment for Korean morbid obesity patient. However sleeve gastrectomy without duodenal switch operation can be an effective single weight loss procedure especially in Korea

Excision of Benign Breast Disease by Ultrasound-Guided Vacuum Assisted Biopsy Device (Mammotome)

PURPOSE: The mammotome biopsy is a new surgical technique that is a minimally invasive, image guided procedure, requiring just one small incision and without the need for multiple insertions in the breast. The aim of this study was to evaluate the efficacy and the safety of mammotome biopsy device in the percutaneous removal of breast masses using ultrasound guidance. METHODS: From Jan. 2003 to sept. 2004, a total of 1003 US-guided excisional mammotome biopsy were performed in 827 patients at Kangnam Cha hospital. Lesions with BI-RADS category 3 and 4a features by ultrasonography were included in this study. Lesions below 1.0 cm were removed by 11 gauge probe, and lesions above 1.0 cm were removed by 8 gauge probe. Ultrasonographic follow-up were performed on 3~6 months later to assess residual tissue and scarring. RESULTS: Mean patient age was 36.2 years(range 14-75 years). The average size of lesion was 1.21cm (SD+- 0.43cm). The majority of lesions, 63.5%, were nonpalpable and 36.5% were palpable. The majority of specimens (99.2) were benign. Most of benign specimens (75.7) consisted of fibroadenoma and fibrocystic changes. 8 lesions (0.8%) were malignant. Mean time required to perform mammotome procedures was 6.4+/-3.9 minutes and mean number of cores removed were 14.2+/-7.9 pieces. No bleeding or infections occurred postoperatively. CONCLUSIONS: This study demonstrates that percutaneous breast biopsy using mammotome system is feasible, effective and safe method for the diagnostic and therapeutic management of benign breast lesions with minimal morbidity. And it allows for the complete excision of the lesions less than 3 cm in size. A breast surgeon can use Mammotome to replace open biopsy and core needle procedure for the initial biopsy of breast lesions.