This book presents and describes the various uses of gastric bypass in bariatric and metabolic surgery and outlines the different techniques currently available. Furthermore, the possible complications with the procedure and ways to avoid them are also discussed. The use of the gastric bypass for the treatment of diabetes is emphasized and the new indications for the operative treatment of diabetes are featured in detail. Endoscopic uses concerning the gastric bypass are also addressed, covering preoperative evaluation, complications treatment, weight regain treatment and endoscopic treatment of obesity. The most advanced techniques and new technologies available for performing gastric bypass surgeries are presented in the most didactic possible way, making use of value-added learning features throughout the text.Gastric Bypass - Bariatric and Metabolic Surgery Perspectives is intended as a practical guide for all those interested and involved with bariatric surgery, including general surgeons, bariatric surgeons, GI surgeons and surgery residents.

João Ettinger: Associate Professor of Surgical and Clinical Anatomy at UNIME- School of Medicine in Lauro de Freitas, Brazil. He is a General, Digestive and Bariatric surgeon at São Rafael Hospital and at Ana Nery Hospital, Salvador, Brazil; where he also acts as preceptor of surgery. He finished his residency in General Surgery at Ana Nery Hospital in 1995, finished his fellowship in laparoscopic surgery at São Rafael Hospital in 1996. In 1997 he was an observer Surgeon at Lichtenstein Hernia Center-Los Angeles, Hernia Center-Memphis and Shouldice Hospital-Toronto. He specialized in Bariatric Surgery at Beneficência Portuguesa Hospital in São Paulo in 1988. He received his PhD at the Escola Bahiana de Medicina, in Internal Medicine during the year of 2007. In 2013 was an observer of bariatric surgery at Sachsenhausen Hospital in Frankfurt. Member of the Brazilian College of Surgery, Brazilian Society of Bariatric and Metabolic Surgery, Brazilian College of Digestive Surgery, Brazilian Society of Laparoscopic and Robotic Surgery and Brazilian Hernia Society.Euler Ázaro: General, Digestive and Bariatric surgeon at São Rafael Hospital and at Aliança Hospital in Salvador, Brazil; where he also acts as preceptor of surgery. He finished his residency in General Surgery at Ana Nery Hospital in 1989, finished his fellowship in laparoscopic surgery at Fatebenefratelli Hospital, Milan, Italy in 1996. During the year of 1997 he travelled to North America to learn techniques in coloproctology at the Cleveland Clinic of Fort Lauderdale- Florida, USA. He started bariatric surgery practice in the year of 1999 at São Rafael Hospital, Salvador. He received his PhD at Federal University of Rio Grande do Sul, in Surgery. Member of the Brazilian College of Surgery, Brazilian Society of Bariatric and Metabolic Surgery, Brazilian College of Digestive Surgery and Brazilian Society of Laparoscopic and Robotic Surgery.Rudolf Weiner: MD by the University of Leipzig (Germany, 1976) and PhD by the University of Berlin (Germany, 1977). General surgery and urology training at the Hospital of "St. Georg", Leipzig (Germany, 1977-1984). Qualified Urologic (1981) and General (1984) surgeon. Training in traumatology and vascular surgery at the University Hospital of Leipzig (1979-1984). Associate professor of surgery at Leipzig University (1992-1993). Associate professor of surgery at Johan Wolfgang Goethe University Frankfurt am Main (Germany, 1993-2000). Professor of Surgery at Johan Wolfgang Goethe University Frankfurt am Main (2000). Head of Surgery at the Frankfurt Sachsenhausen Hospital and Center for Minimally invasive Surgery (Germany, 2001).Kevin Higa:Graduated from the University of California, Los Angeles School of Medicine in 1983. He is board certified in general surgery. After completing his residency training in 1988, he served as Chief of Vascular Surgery at the Veterans Affairs Medical Center in Fresno. In 1990, he entered private practice but has continued to devote a large amount of his time to teaching while also serving as Chief of Surgery for Community Medical Centers as well as Saint Agnes Medical Center. Dr. Higa has performed open bariatric surgical procedures since the early 1990s. He and his partner Dr. Boone performed the first laparoscopic gastric bypass in the Central Valley in 1998. The two also pioneered the current technique used by many surgeons throughout the world. He and Professor Paul OBrien from Australia performed the very first adjustable gastric band in Fresno. Dr. Higa specializes in difficult and challenging cases, including revision bariatric surgery. He serves as associate editor for many peer-reviewed journals and has authored many original articles and book chapters regarding bariatric surgery and complication management. In addition to his title of clinical professor of surgery at the University of California San Francisco Fresno Medical Education Program, Dr. Higa has been appointed to the National Faculty for Bariatric Surgery by the American College of Surgeons. He was also president of the American Society of Metabolic and Bariatric Surgery (ASMBS) and continues to chair many international conferences devoted to bariatric surgery.Manoel Passos Galvão Neto: MD by the Bahiana School of Medicine and Public Health (1989, Brazil) followed by residency in Digestive Surgery at July 9th Hospital (São Paulo, Brazil). Invited professor of surgical technique at Bahiana School (1993-1998) and coordinator of experimental surgery research group and assistant professor (1998-2000). Board certified specialist by the Brazilian College of Digestive Surgery (CBCD, 1992), Brazilian Federation of Gastroenterology (FBG, 1995) and Brazilian Society of Digestive Endoscopy (SOBED, 2011). Affiliated professor of surgery at ABC University in Santo Andre (Brazil) and appointed as faculty for the FIU Herbert Wertheim College of Medicine, Department of Surgery (Miami, USA). Dr. Galvão has extensive experience in foregut surgery and interventional endoscopy and international practice with surgical and endoscopic privileges granted in 8 hospitals in São Paulo, Chile, Colombia and Spain.Andre F. Teixeira: Bariatric surgeon for the Bariatric Program at Orlando Regional Medical Center. He received his medical degree at Morehouse School of Medicine and completed his internship in general surgery at Orlando Regional Medical Center. Following his internship, completed his residency training at Orlando Health, where he also served as general surgery chief resident. Following his residency, completed his bariatric and advanced MIS fellowship at Cleveland Clinic Florida. Dr. Teixeira has published in multiple peer review journals. He also has published several book chapters. He has presented at many local and national conferences on various topics relating to general surgery and bariatric surgery. He is a member of the Society of American Gastrointestinal and Endoscopic Surgeons, the Florida Medical Association, the American College of Surgeons, the American Society and Metabolic Surgery (ASMBS). He is a fellow of the American College of Surgeons and ASMBS. Currently he serves as vice chair of general surgery of Orlando Regional Medical Center.Muhammad A. Jawad: is board certified through the American Board of Surgery and serves as the Medical Director of Orlando Regional Medical Centers Bariatric Program. Received his Medical Degree from Ain Shams University in Cairo, Egypt, graduating with honors. He completed a surgical internship at Cook County Hospital in Chicago, IL. Following his internship, he practiced at Jackson Hospital in Alabama. Before joining ORMC, Dr. Jawad served as chief of surgery at Ocala Regional Medical Center in Florida following his position as chief of staff at Monroe Regional Hospital. Serving as an expert in the laparoscopic field and performing bariatric surgery since 1984, he has performed more than 4,000 laparoscopic bariatric surgical cases since 2000. Fellow of the American College of Surgeons, and member of many organizations including the American Society of Bariatric Surgery, the Florida Medical Association, the Society of Laparoendoscopic Surgeons and the Florida Physicians Association.

Part I Introduction

1. History of the gastric bypass2. Gastric bypass - Mechanisms of functioning3. Rationale for gastric bypass

Part II Bariatric SurgerySection A General concepts4. Morbid obesity5. Obesity and related diseases6. Obesity and cancer7. Systemic inflammation in the morbidly obese patient8. Metabolic syndrome9. Non-Alcoholic fatty liver disease NAFLD

Section B Preoperative concerns

10. The bariatric team11. Bariatric clinic/hospital infrastructure12. Patient selection13. Preparing the patient for gastric bypass14. Tests and exams15. Preoperative endoscopy16. Informed consent17. Nutritional issues18. Psychological and psychiatric issues19. Sleep apnea management20. Preoperative weight loss21. The superobese patient 

Section C Anaesthesia

22. Airway evaluation and management23. Positioning the patient before the procedure24. Monitoring the morbidly obese25. Methods of anaesthesia26. Perioperative anaesthesia27. Postoperative Analgesia 

Section D Techniques for Gastric bypass

28. Instruments and materials29. Anatomic considerations30. Open Roux-en Y gastric bypass31. Developing the laparoscopic gastric bypass32. Robotic Roux-en Y gastric bypass33. Roux-en-Y Gastric Bypass Learning curve34. Ante colic Roux-en-Y gastric bypass35. Retro colic Roux-en Y gastric by-pass36. Fobi Roux-en Y gastric bypass37. Capella Roux-en Y gastric bypass38. Roux-en-Y gastric bypass hand sewn39. Roux-en-Y gastric bypass gastrojejunostomy with Trans-oral circular stapling40. Roux-en-Y gastric bypass gastrojejunostomy with circular stapler via transabdominal41. Roux-en-Y gastric bypass gastrojejunostomy with linear stapler42. Mini gastric bypass Technique43. Staged gastric bypass for high risk patients44. Roux-en Y gastric bypass in adolescents45. Conversion of sleeve gastrectomy to gastric bypass46. Conversion of gastric banding to gastric bypass47. Conversion of vertical banded gastroplasty48. Gastric bypass reoperation for weight regain49. Banding the gastric bypass due to weight regain50. Pancreatic neoplasm after gastric bypass51. Gastric Bypass Leaning Curve Laparoscopic& Robotic 

Section E Technical issues

52. Staple lines reinforcement53. Drainage54. Gastrojejunostomy testing55. Closing the gaps56. Preventing complications 

Section F Postoperative care

57. ICU for the gastric bypass patient58. Preventing thromboembolism59. Physiotherapy60. Vitamins and minerals61. Nutrition62. Psicological assistance 

Section G Complications

63. Intraoperative complications64. Leaks65. Infection - diagnosis and  treatment66. Bleeding67. Bowel obstruction68. Internal hernias69. Stenosis70. Ulcer disease71. Reflux72. Dumping syndrome73. Thromboembolism74. Rhabdomyolisis75. Weight regain76. Depression, suicide and alcoholism77. Eating disorders78. Gallbladder stones79. Bacterial overgrowth80. The rebel patient81. Therapeutic endoscopy 

Section H Endoscopy

82. Preoperative intragastric balloon83. Endoscopic treatment of obesity84. Endoscopic treatment of complications85. Endoscopic treatment of weight regain 

Section I Miscellaneous

86. Plastic surgery after gastric bypass87. Malpractice and medico-legal issues88. Pregnancy89. Bariatric surgeon training90. Re-operative bariatric surgery91. Quality of life before and after gastric bypass92. Radiographic evaluation93. Cost and economics of gastric bypass94. Gastric bypass outcomes in bariatric surgery 

Part III Metabolic surgery / Type 2 diabetes

95. Type 2 diabetes96. Type 2 diabetes and the foregut97. Mechanisms of control of diabetes 2 with gastric bypass98. Experimental studies99. Tests and exams100. Endocrinology point of view101. Selecting patients102. Preoperative care103. Gastric bypass in patients with metabolic syndrome104. Gastric bypass for type 2 diabetes BMI> 35kg/m2105. Gastric bypass for type 2 diabetes BMI< 35kg/m2106. Postoperative care107. Complications108. Gastric bypass outcomes in patients with type 2 diabetes109. Selected articles