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Page 2 of 3 Jones. Mini-invasive Surg 2021;5:4 I http://dx.doi.org/10.20517/2574-1225.2020.116
[2]
For lower weights, endoscopic therapy is evolving. Mlabasati et al. at BIDMC shared lessons learned
setting up an Endoscopic Bariatric multidisciplinary program to provide intragastric balloon and endo
[3]
plication for obesity. Dr. Aurora Pryor reviewed the endoscopic approaches to treating complications of
bariatric surgery. She noted a 4%-10% complication rate in the first month after bariatric surgery. She went
on to describe endoscopic treatments for complications of bleeding, strictures, ulcer, reflux, and weight
regain. With endoscopic techniques of injection, clipping, stents, balloons, and Stretta, the endoscope is a
valuable adjunct to providing comprehensive care.

Long-term complications of malabsorption may include vitamin deficiency such as vitamin B12, iron,
[4]
vitamin D, calcium, and folate. Çalapkorur and Küçükkatirci from Nevsehir, Turkey described each
deficiency in detail. This review is a must read for all providers caring for postoperative bariatric surgery
patients. Vitamin deficiencies, such as in thiamine, if go unrecognized, can lead to serious and irreversible
neurological problems. Early identification and early treatment are crucial.

The sleeve gastrectomy and Roux-en-Y gastric bypass (RYGB) are the most commonly performed weight
loss operations in the world. Fontan et al. stated they prefer RYGB for patients with gastro-esophageal
[5]
reflux disease (GERD). However, other procedures such as the one anastomosis gastric bypass (OAGB)
have been growing in popularity despite the concern for bile reflux. The Paris Descartes Faculty of Medicine
[6]
studied reflux, Barrett’s esophagus, and esophageal cancer . They shared their findings and concluded that
the OAGB operation appears to be safe in an animal model.

[7]
The devil is in the details with any operation. Aktokmakyan et al. from Istanbul, Turkey reviewed the
technical steps to a perfect sleeve gastrectomy. They cited the literature including the 5th International
Consensus Conference. Their paper includes high resolution intraoperative photographs. While I also
use a 36 fr Bougie to size my sleeve, I disagree that the anastomosis must be checked by methylene blue
or endoscopy. I also no longer place a drain. Today, many providers utilize an ERAS protocol that limits
narcotics and shortens hospital stay.

[8]
Fewer than 1% of the patients who meet criteria for weight loss surgery actually have an operation. Aly et al.
from Boston Medical Center reviewed psychological, social, and cultural barriers to seeking treatment and
getting care.

The Special Issue “Metabolic and Bariatric Surgery” covers the essentials of technique and perioperative
[9]
care. The Special Issue is also the first to report the use of intra-aortic balloon pump (IABP) during sleeve
[10]
gastrectomy and complication of patulous eustachian tube (PET) after sleeve gastrectomy.
Bariatric surgeons have known for a long time that metabolic operations reverse many comorbid
conditions. Society is learning that obesity and related conditions may be life-threatening and metabolic
operations lifesaving in the era of COVID-19.

DECLARATIONS
Authors’ contributions
The author contributed solely to the article.

Availability of data and materials
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Financial support and sponsorship
None.