[Weight gain after bariatric surgery]. / Gewichtstoename na bariatrische chirurgie.

Despite the frequent success of bariatric surgery, 20-30% of patients do not respond well. These patients may experience insufficient weight loss, defined as primary non-response, or may regain an excessive amount of weight after sufficient weight loss, defined as secondary non-response. The aetiology and subsequent treatment of these two types of non-response may differ. This is illustrated by three cases: a patient with primary non-response after gastric bypass (total weight loss 18%) treated conservatively; a patient with secondary non-response after gastric bypass (total weight loss 27%) treated conservatively and lost 7kg as a result of this therapy; a patient with secondary non-response after gastric bypass (total weight loss 27%) treated surgically though experienced malabsorptive complaints as result of distalisation. These cases can be used to demonstrate the challenges that are faced by professionals in the current treatment of post-bariatric surgery patients.

Banded Roux-en-Y gastric bypass in patients with super morbid obesity (BRandY-study): protocol of a cohort study with 10 year follow-up.

BACKGROUND: Weight loss outcomes after bariatric surgery are less favorable in super morbidly obese patients (BMI ≥50 kg/m2). Non-response, either defined as insufficient weight loss or weight regain after initial successful weight loss, is a matter of serious concern in these patients. The primary banded Roux-en-Y gastric bypass has shown promising results regarding weight loss in the bariatric population. However, up to now, long-term comparative data about the banded and non-banded bypass in superobese patients is lacking. The aim of this study is to assess the added value of the banded Roux-en-Y gastric bypass in superobese patients on long-term weight loss outcomes. METHODS: This single center study will evaluate superobese patients who receive a non-banded Roux-en-Y gastric bypass (NB-RYGB) and a banded Roux-en-Y gastric bypass (B-RYGB). Data from the NB-RYGB group will be collected in retrospect, while data from the B-RYGB group will be collected prospectively. When performing a B-RYGB, a 7.0-8.0 cm silastic ring (MiniMizer®) will be placed proximal to the gastrojejunostomy. The main outcomes of this study are weight loss and non-response during a 10 year follow-up period. Secondary outcomes are reduction of obesity related comorbidities and medication, (ring-related) morbidity and mortality, complications, re-operations, patient satisfaction and health-related quality of life. A total of 142 patients will be included in this study. DISCUSSION: This study will help establish the clinical utility of the B-RYGB in superobese patients. TRIAL REGISTER: NL8093. Registered 15 October 2019 - Retrospectively registered on the Dutch Registry of Clinical trials, www.trialregister.nl.

[A woman with a red, painful breast]. / Een vrouw met een rode, pijnlijke borst.

A 79-year-old woman presented with swelling and pain in her right breast after re-excision of a melanoma and an axillary sentinel lymph node biopsy. The cellulitis was caused by Clostridium perfringens, a rare cause of a postoperative infection.