Revisional Surgery of One Anastomosis Gastric Bypass for Severe Protein–Energy Malnutrition

Background: One anastomosis gastric bypass (OAGB) is safe and effective. Its strong malabsorptive component might cause severe protein–energy malnutrition (PEM), necessitating revisional surgery. We aimed to evaluate the safety and outcomes of OAGB revision for severe PEM. Methods: This was a single-center retrospective analysis of OAGB patients undergoing revision for severe PEM (2015–2021). Perioperative data and outcomes were retrieved. Results: Ten patients underwent revision for severe PEM. Our center’s incidence is 0.63% (9/1425 OAGB). All patients were symptomatic. Median (interquartile range) EWL and lowest albumin were 103.7% (range 57.6, 114) and 24 g/dL (range 19, 27), respectively, and 8/10 patients had significant micronutrient deficiencies. Before revision, nutritional optimization was undertaken. Median OAGB to revision interval was 18.4 months (range 15.7, 27.8). Median BPL length was 200 cm (range 177, 227). Reversal (n = 5), BPL shortening (n = 3), and conversion to Roux-en-Y gastric bypass (RYGB) (n = 2) were performed. One patient had anastomotic leak after BPL shortening. No death occurred. Median BMI and albumin increased from 22.4 kg/m2 (range 20.6, 30.3) and 35.5 g/dL (range 29.2, 41), respectively, at revision to 27.5 (range 22.2, 32.4) kg/m2 and 39.5 g/dL (range 37.2, 41.7), respectively, at follow-up (median 25.4 months, range 3.1, 45). Complete resolution occurs after conversion to RYGB or reversal to normal anatomy, but not after BPL shortening. Conclusions: Revisional surgery of OAGB for severe PEM is feasible and safe after nutritional optimization. Our results suggest that the type of revision may be an important factor for PEM resolution. Comparative studies are needed to define the role of each revisional option

Creative Responses to Separation: Israeli and Palestinian Joint Activism in Bil\u27in

This article examines creative ways in which Israeli and Palestinian activists engage with each other and the powers seeking to separate them in their nonviolent struggles for a just and lasting peace. Using the geopolitical theory of territoriality, the article briefly examines a number of administrative, physical, and psychological barriers facing joint activism and the strategies activists use to counteract them. Drawing on nonviolent theory and practice, the article analyzes how activists exert power through the creative use of symbols and practices that undermine the legitimacy of occupation policies. Based on fieldwork conducted in 2004-05 and July 2006, the article explores the implications of this activism on conceptions of identity, and strategies for restarting a moribund peace process. The relative \u27success\u27 of sustained joint action in Bil\u27in can provide scholars and policymakers with innovative approaches for addressing some of the outstanding issues needing to be addressed by official negotiators. Although government bodies are more constrained than activists, the imaginative means of engaging with the system- and the reframing of issues through the redeployment of \u27commonplaces\u27-can perhaps provide inspiration, if not leverage, for thinking outside of the box