The laparoscopic gastric bypass has been refined over 5 years of use. Though we have not changed the basic operation as we originally described, others have modified the various anastomotic techniques. The weight loss results are very good to excellent, with patients now out to "long-term" follow-up. Resolution of the co-morbidities is documented. The operation has an adequate track record to show effectiveness, and training programs should be established to maximize safety.

Adiponectin is an insulin sensitizing fat cell (FC) hormone whose levels are related to adipose tissue (AT) mass and depot distribution. We hypothesized that the nature of AT expansion (hypertrophy vs. hyperplasia) contributes to obesity-related reductions in serum adiponectin and that this effect is influenced by the regional distribution of AT to subcutaneous (S) and visceral (V) depots. Thirteen obese subjects provided paired AT biopsies. Serum total and high molecular weight (HMW) adiponectin levels were determined by ELISA. Secretion was quantified following 24-h explant culture. FC size, number, % large, and % small FC were determined by microscopic analysis. Secretion of total adiponectin was highest by SAT (P = 0.008) and correlated more strongly with serum adiponectin (total: P = 0.015, r = 0.77; HMW: P = 0.005, r = 0.83) than did secretion by VAT (P = 0.05, r = 0.66 for both). FC size was greatest in SAT and correlated negatively with both serum (total: P = 0.01, r = −0.74; HMW: P = 0.03, r = −0.69) and secreted (total: P = 0.05, r = −0.72; HMW: P = 0.02, r = −0.87) adiponectin. The % small FC in SAT correlated positively with both serum (total: P = 0.006, r = 0.87; HMW: P = 0.009, r = 0.79) and secreted (total: P = 0.03, r = 0.75; HMW: P = 0.01, r = 0.92) adiponectin. VAT FC size correlated negatively with serum HMW adiponectin (P = 0.01, r = −0.76) but not with any measure of secretion. VAT had the greatest % small FC, which related positively to serum HMW (P = 0.004, r = 0.81) and to secreted total adiponectin (P = 0.02, r = 0.78). These studies indicate that differences in fat cell size and depot distribution of AT expansion are important influences on adiponectin in obesity.

Since the patients had an operation that restricts their food intake, some basic precautions should be taken when they become pregnant. With this in mind, our patients have done well with their pregnancies. The post-surgical group had fewer pregnancy-related complications than did an internally controlled group that were morbidly obese during their previous pregnancies.

BACKGROUND: Laparoscopic Roux en-Y Gastric Bypass (RYGB) has been performed in 100 patients, in our series. METHODS: The results of surgery, including 3-30 months follow-up, are described with 100% follow-up, for the first 75 patients. Weight loss, operative morbidity and relief of co-morbidities have been thoroughly studied in a prospective fashion. RESULTS: Diabetes mellitus was normalized in 22 of 24 patients and gastroesophageal reflux was relieved in all patients. Length of stay, recovery time and cosmetic results are superior to the 'open' technique, and the operative times are competitive. CONCLUSION: Laparoscopic RYGB deserves a place in the operative repertoire of bariatric surgeons.