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Gärtner D, Stroh C, Hukauf M, Benedix F, Manger T. Sleeve gastrectomy in the German Bariatric Surgery Registry from 2005 to 2016: Perioperative and 5-year results. Surg Obes Relat Dis 2019; 15:187-193. [DOI: 10.1016/j.soard.2018.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/14/2018] [Accepted: 11/02/2018] [Indexed: 02/07/2023]
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Iossa A, Silecchia G. Mid-term safety profile evaluation of Bio-A absorbable synthetic mesh as cruroplasty reinforcement. Surg Endosc 2019; 33:3783-3789. [PMID: 30675663 DOI: 10.1007/s00464-019-06676-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 01/17/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of the present paper is to report the results of a single institution series of hiatal hernia repair (HHR) with augmented mesh hiatoplasty focusing on safety and efficacy profile of Bio-A absorbable synthetic mesh. MATERIALS AND METHODS A retrospective evaluation of prospectively maintained database showed 120 consecutive patients submitted to HHR reinforced with bio-absorbable synthetic mesh. The study populations included two groups: (A) 92 obese patients-reinforced hiatoplasty concurrent with bariatric procedure; (B) 28 non-obese patients-reinforced hiatoplasty concurrent with antireflux surgery. Symptoms assessment was made with GERD-HRQL and Rome III. The X-ray with barium swallow, the CT scan, in selected cases, and the endoscopy were used as recurrence evaluation and as endoscopic complications assessment. Only patients with a mean follow-up of 12 months were included in this study. A Cox hazard was made to evaluate factors affecting the recurrence. RESULTS No case of intra-peri and post-operative (mean follow-up of 41 months) complications mesh related were registered. The dysphagia-rate was 8.7% for Group A and 11% for Group B. 74% of Group A and 61% of Group B patients are actually PPIs free with median GERD-HRQL score of 4 (from 16) and 6 (from 23), respectively (difference pre-post-operative < 0.05). Recurrence rate was 5.4% in Group A and 7.1% in Group B. The Cox hazard analysis showed that the use of more than four stitches for cruroplasty represents a negative factor on recurrence (HR = 8; p < 0.05). CONCLUSIONS This is, in our knowledge, the largest report (120 consecutive patients) with mid-term follow-up (41 months of mean FU) on bio-absorbable mesh on the hiatus in obese and non-obese patients. These results supports the use of absorbable mesh for HHR (safe profile-0% of complications rate), showing excellent recurrence rate results and good GERD symptoms control.
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Affiliation(s)
- Angelo Iossa
- Division of General Surgery and Bariatric Centre of Excellence, Department of Medical-Surgical Sciences and Biotechnologies, University of Rome "La Sapienza", Rome, Italy.
| | - Gianfranco Silecchia
- Division of General Surgery and Bariatric Centre of Excellence, Department of Medical-Surgical Sciences and Biotechnologies, University of Rome "La Sapienza", Rome, Italy
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Arman GA, Himpens J, Bolckmans R, Van Compernolle D, Vilallonga R, Leman G. Medium-Term Outcomes after Reversal of Roux-en-Y Gastric Bypass. Obes Surg 2018; 28:781-790. [PMID: 28929425 DOI: 10.1007/s11695-017-2928-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) can be reversed into normal anatomy (NA) or into sleeve gastrectomy (NASG) to address undesired side effects. Concomitant hiatal hernia repair (HHR) may be required. Before reversal, some patients benefit from placement of a gastrostomy, mostly to predict the result of recreating the native anatomy. METHODS Retrospective study on mid-term effects of RYGB reversal to NA and NASG, including clinical and weight evolution, surgical complications, and incidence of gastro-esophageal reflux (GERD). RESULTS Undesired side effects leading to reversal included early dumping syndrome, hypoglycemia, malnutrition, severe diarrhea and excessive nausea and vomiting. Twenty-five participants to the study, 13 NA, 12 NASG, and 15 HHR. Mean follow-up time was 5.3 ± 2.3 years. Reversal corrected early dumping, malnutrition, diarrhea, and nausea/vomiting. For hypoglycemic syndrome, resolution rate was 6/8 (75%). NA caused significant weight regain (14.2 ± 13.7 kg, (p = .003)). NASG caused some weight loss (4.8 ± 15.7 kg (NS)). Gastrostomy placement gave complications at reversal in five of seven individuals. Eight patients suffered a severe complication, including leaks (one NA vs. three NASGs). Eight out of 14 (57.1%) patients who previously had never experienced GERD developed de novo GERD after reversal, despite HHR. CONCLUSIONS RYGB reversal is effective but pre-reversal gastrostomy and concomitant HHR may be aggravating factors for complications and development of de novo GERD, respectively.
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Affiliation(s)
- Gustavo Andrés Arman
- Division of Bariatric Surgery, AZ Sint-Blasius, Kroonveldlaan 50, 9200, Dendermonde, Belgium.
| | - J Himpens
- Division of Bariatric Surgery, AZ Sint-Blasius, Kroonveldlaan 50, 9200, Dendermonde, Belgium
| | - R Bolckmans
- Division of Bariatric Surgery, AZ Sint-Blasius, Kroonveldlaan 50, 9200, Dendermonde, Belgium
| | - D Van Compernolle
- Division of Bariatric Surgery, AZ Sint-Blasius, Kroonveldlaan 50, 9200, Dendermonde, Belgium
| | - R Vilallonga
- Division of Bariatric Surgery, AZ Sint-Blasius, Kroonveldlaan 50, 9200, Dendermonde, Belgium
| | - G Leman
- Division of Bariatric Surgery, AZ Sint-Blasius, Kroonveldlaan 50, 9200, Dendermonde, Belgium
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Is Routine Preoperative Esophagogastroduodenoscopy Screening Necessary Prior to Laparoscopic Sleeve Gastrectomy? Review of 1555 Cases and Comparison with Current Literature. Obes Surg 2018; 28:52-60. [PMID: 28685362 DOI: 10.1007/s11695-017-2813-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Controversy exists as to whether routine preoperative esophagogastroduodenoscopy (p-OGD) in bariatric surgery should be routinely undertaken or undertaken selectively based on patients' symptoms. As very few studies have focused on the role of p-OGD prior to the increasingly common laparoscopic sleeve gastrectomy (LSG), we assessed the role/impact of p-OGD in LSG patients. METHODS Retrospective review of records of all LSG patients operated upon at Hamad General Hospital, Qatar (2011-2014, n = 1555). All patients were screened by p-OGD. Patient characteristics were analyzed, and p-OGD findings were categorized into four groups employing Sharaf et al.'s classification (Obes Surg 14:1367-1372, 23). We assessed the impact of p-OGD findings on any change in surgical management or lack thereof. RESULTS p-OGD findings indicated that 89.5% of our patients had normal or mild findings and were asymptomatic (groups 0 and 1, not necessitating any change in surgical management), and no patients had gastric cancer or varices (group 3). A total of 10.5% of our sample were categorized as group 2 patients who, according to Sharaf et al. (Obes Surg 14:1367-1372, 23), might have their surgical approach changed. All patients diagnosed preoperatively with hiatal hernia (HH) had LSG with crural repair and their symptoms resolved postoperatively. CONCLUSION Due to effectiveness and best utilization of resources, routine p-OGD screening in patients scheduled for LSG may require further justification for asymptomatic patients especially in regions with low upper GI cancers. p-OGD findings had low impact on the management of asymptomatic patients. Crural repair plus LSG was effective for hiatal hernia.
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Macedo FIB, Mowzoon M, Mittal VK, Sabir M. Outcomes of Laparoscopic Hiatal Hernia Repair in Nine Bariatric Patients with Prior Sleeve Gastrectomy. Obes Surg 2018; 27:2768-2772. [PMID: 28808884 DOI: 10.1007/s11695-017-2880-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) may exacerbate gastroesophageal reflux disease (GERD) in patients with a hiatal hernia (HH). Surgical repair may be needed, however prior LSG precludes standard HH repair with fundoplication. METHODS We retrospectively reviewed our experience with bariatric patients with prior LSG undergoing laparoscopic HH repair from August 2010 to July 2016. Patient demographics and outcomes including mortality, length of stay (LOS), readmission rates, reoperation, and complications were described. A validated 13-point questionnaire was used to determine symptomatic relief, weight loss, and overall satisfaction. RESULTS A total of nine consecutive patients with prior LSG underwent HH repair and were included in the analysis. Repair was performed using Bio-A Gore® mesh (W.L Gore Inc., Newark, DE) in six (66.7%) cases and posterior cruroplasty in three (33.3%) patients. Heartburn was significantly decreased at 1 year (1.4 ± 0.9 vs. 2.6 ± 0.9, p = 0.031), and 78% of patients reported some degree of symptomatic relief after HH repair. CONCLUSIONS Laparoscopic HH repair offers a safe and feasible approach in the management of persistent GERD after LSG in well-selected bariatric patients. Larger prospective studies are warranted to investigate the effectiveness of HH repair in this population as 22% of our patients did not demonstrate postoperative symptomatic improvement.
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Affiliation(s)
- Francisco Igor B Macedo
- Department of Surgery, Providence Hospital and Medical Centers, Michigan State University College of Human Medicine, 16001 W Nine Mile Rd, Southfield, MI, 48075, USA.
| | - Mia Mowzoon
- Department of Surgery, Providence Hospital and Medical Centers, Michigan State University College of Human Medicine, 16001 W Nine Mile Rd, Southfield, MI, 48075, USA
| | - Vijay K Mittal
- Department of Surgery, Providence Hospital and Medical Centers, Michigan State University College of Human Medicine, 16001 W Nine Mile Rd, Southfield, MI, 48075, USA
| | - Mubashir Sabir
- Department of Surgery, Providence Hospital and Medical Centers, Michigan State University College of Human Medicine, 16001 W Nine Mile Rd, Southfield, MI, 48075, USA
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Suumann J, Sillakivi T, Riispere Ž, Syrjänen K, Sipponen P, Kirsimägi Ü, Peetsalu A. Serological biomarker testing helps avoiding unnecessary endoscopies in obese patients before bariatric surgery. BMC OBESITY 2018; 5:9. [PMID: 29484193 PMCID: PMC5819710 DOI: 10.1186/s40608-018-0185-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 02/01/2018] [Indexed: 02/06/2023]
Abstract
Background To assess the value of serological biomarker testing as a substitute for esophagogastroduodenoscopy (EGDS) in pre-operative assessment of patients referred for bariatric surgery. Methods Sixty-five obese patients with a mean age of 43 years (range: 21–65) and a mean body mass index (BMI) of 44 (range: 36–59) were studied. The patients were tested with a four-biomarker panel: pepsinogen I and II, gastrin-17 (basal and stimulated), and Helicobacter pylori (HP) antibodies (GastroPanel®, Biohit Oyj, Finland). On the basis of the biomarker test, the patients were classified into the HS (healthy stomach) group (n = 22) with the normal biomarker profile and the NHS (non-healthy stomach) group (n = 43). The classification of patients into HS and NHS was evaluated against the gold standard, i.e. EGDS with biopsies. Results The concordance (Cohen’s kappa) between the biomarker test and gastric histology was 0.68; 95% CI 0.504–0.854, with an overall agreement of 84.6% (95% CI 73.9–91.4%). In the NHS group, all 43 patients had biopsy-confirmed chronic gastritis: 39 non-atrophic HP-gastritis, 4 atrophic antrum gastritis (AGA) of moderate severity. In the HS group only 6 patients had mild superficial H.pylori negative gastritis. Of the 22 HS subjects with the normal biomarker profile, 20 (31% of all 65) had no complaints either, while the remaining two had reflux symptoms with esophagitis. In the NHS group 10 patients had esophagitis and 8 had also reflux symptoms. Conclusions The normal biomarker profile is an excellent surrogate for healthy stomach, implicating that pre-operative EGDS could have been avoided in 31% of our asymptomatic bariatric surgery patients who had the normal biomarker profile.
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Affiliation(s)
- Jaanus Suumann
- 1Department of Surgery, University of Tartu, Tartu, Estonia
| | | | - Živile Riispere
- 2Department of Pathology, University of Tartu, Tartu, Estonia
| | - Kari Syrjänen
- Department of Clinical Research, Biohit Oyj, Helsinki, Finland
| | | | - Ülle Kirsimägi
- 1Department of Surgery, University of Tartu, Tartu, Estonia
| | - Ants Peetsalu
- 1Department of Surgery, University of Tartu, Tartu, Estonia
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Soricelli E, Casella G, Baglio G, Maselli R, Ernesti I, Genco A. Lack of correlation between gastroesophageal reflux disease symptoms and esophageal lesions after sleeve gastrectomy. Surg Obes Relat Dis 2018; 14:751-756. [PMID: 29571635 DOI: 10.1016/j.soard.2018.02.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/12/2018] [Accepted: 02/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The postoperative development or worsening of gastroesophageal reflux disease (GERD) represents the major drawback of laparoscopic sleeve gastrectomy (SG). A GERD diagnosis is often based only on symptoms and proton pump inhibitors (PPI) intake, while objective tests like esophagogastroduodenoscopy and pH measurements are performed less frequently. OBJECTIVES To evaluate the association between reflux symptoms and GERD-related esophageal lesions. SETTINGS University hospital, Rome, Italy. METHODS A comprehensive clinical control entailing GERD symptoms, PPI intake, and esophagogastroduodenoscopy was proposed to all patients who underwent SG between June 2007 and February 2011, irrespective of the presence of GERD symptoms. One hundred forty-four of 219 patients agreed to take part in the study (follow-up rate: 65.8%). RESULTS After a mean follow-up of 66 months, GERD symptoms and PPI intake were recorded in 70.2% and 63.9% of patients, respectively. Mean visual analogue scale score was 2.9 ± 3.3. The overall frequency of erosive esophagitis was 59.8%, while nondysplastic Barrett's esophagus was detected in 13.1%. The frequency of esophageal biliary reflux was 68%. GERD symptoms and visual analogue scale score were not significantly associated with the development of erosive esophagitis and Barrett's esophagus and the severity of the esophageal lesions. Moreover, the frequency of erosive esophagitis and Barrett's esophagus in patients consuming PPI were similar to that of patients without PPI. CONCLUSION Symptoms investigation alone is not a reliable tool to diagnose GERD after SG. The use of objective diagnostic tests, such as esophagogastroduodenoscopy, should be carefully considered in the postoperative follow-up schedule of SG patients.
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Affiliation(s)
- Emanuele Soricelli
- Department of Surgical Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
| | - Giovanni Casella
- Department of Surgical Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Roberta Maselli
- Endoscopic unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ilaria Ernesti
- Department of Experimental Medicine-Medical Physiopathology, Food Science and Endocrinology Section, Sapienza University of Rome, Rome, Italy
| | - Alfredo Genco
- Department of Surgical Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Viscido G, Gorodner V, Signorini F, Navarro L, Obeide L, Moser F. Laparoscopic Sleeve Gastrectomy: Endoscopic Findings and Gastroesophageal Reflux Symptoms at 18-Month Follow-Up. J Laparoendosc Adv Surg Tech A 2018; 28:71-77. [DOI: 10.1089/lap.2017.0398] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Germán Viscido
- Hospital Privado Centro Médico de Córdoba, Cordoba, Argentina
- Clínica Reina Fabiola, Córdoba, Argentina
| | | | | | - Luciano Navarro
- Hospital Privado Centro Médico de Córdoba, Cordoba, Argentina
| | - Lucio Obeide
- Hospital Privado Centro Médico de Córdoba, Cordoba, Argentina
| | - Federico Moser
- Hospital Privado Centro Médico de Córdoba, Cordoba, Argentina
- Clínica Reina Fabiola, Córdoba, Argentina
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Braghetto I, Csendes A. Patients Having Bariatric Surgery: Surgical Options in Morbidly Obese Patients with Barrett's Esophagus. Obes Surg 2017; 26:1622-6. [PMID: 27167837 DOI: 10.1007/s11695-016-2198-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This article summarizes the currently knowledge and results observed in patients with obesity and Barrett's esophagus which were presented and discussed during the IFSO 2014 held in Montreal. In this meeting, the surgical options for the management after bariatric surgery were discussed. For this purpose, a complete revision of the available literature was done including Pubmed, Medline, Scielo database, own experience, and experts opinion. A total of 49 publications were reviewed and included in the present paper. The majority of authors agree that gastric bypass is the procedure of choice. Sleeve gastrectomy is not an absolute contraindication. Up to now, gastric bypass appears to be the best procedure for treatment of obese patients with Barrett's esophagus. Future investigations should give the definitive consensus.
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Affiliation(s)
- I Braghetto
- Department of Surgery, University Hospital "Dr. Jose J. Aguirre" Faculty of Medicine, University of Chile, Santos Dumont 999, Santiago, Chile.
| | - A Csendes
- Department of Surgery, University Hospital "Dr. Jose J. Aguirre" Faculty of Medicine, University of Chile, Santos Dumont 999, Santiago, Chile
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Hiatoplasty with Crura Buttressing versus Hiatoplasty Alone during Laparoscopic Sleeve Gastrectomy. Gastroenterol Res Pract 2017; 2017:6565403. [PMID: 29259626 PMCID: PMC5702400 DOI: 10.1155/2017/6565403] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/24/2017] [Indexed: 01/17/2023] Open
Abstract
Introduction In obese patients with hiatal hernia (HH), laparoscopic sleeve gastrectomy (LSG) with cruroplasty is an option but use of prosthetic mesh crura reinforcement is debated. The aim was to compare the results of hiatal closure with or without mesh buttressing during LSG. Methods Gastroesophageal reflux disease (GERD) was assessed by the Health-Related Quality of Life (GERD-HRQL) questionnaire before and after surgery in two consecutive series of patients with esophageal hiatus ≤ 4 cm2. After LSG, patients in group A (12) underwent simple cruroplasty, whereas in group B patients (17), absorbable mesh crura buttressing was added. Results At mean follow-up of 33.2 and 18.1 months for groups A and B, respectively (p = 0.006), the mean preoperative GERD-HRQL scores of 16.5 and 17.7 (p = 0.837) postoperatively became 9.5 and 2.4 (p = 0.071). In group A, there was no difference between pre- and postoperative scores (p = 0.279), whereas in group B, a highly significant difference was observed (p = 0.002). The difference (Δ) comparing pre- and postoperative mean scores between the two groups was significantly in favor of mesh placement (p = 0.0058). Conclusions In obese patients with HH and mild-moderate GERD, reflux symptoms are significantly improved at medium term follow-up after cruroplasty with versus without crura buttressing during LSG.
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Gero D, Ribeiro-Parenti L, Arapis K, Marmuse JP. Sleeve Gastrectomy Combined with the Simplified Hill Repair in the Treatment of Morbid Obesity and Gastro-esophageal Reflux Disease: Preliminary Results in 14 Patients. World J Surg 2017; 41:1035-1039. [PMID: 27896401 DOI: 10.1007/s00268-016-3829-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Our aim is to report our initial experience with a novel technique which addresses morbid obesity and gastro-esophageal reflux disease (GERD) simultaneously by combination of laparoscopic sleeve gastrectomy (LSG) and simplified laparoscopic Hill repair (sLHR). METHODS Retrospective analysis of LSG+sLHR patients >5 months postoperatively includes demographics, GERD status, proton-pump inhibitor (PPI) use, body mass index (BMI), excess BMI loss (EBMIL), complications and GERD-Health Related Quality of Life (GERD-HRQL) questionnaire. LSG+sLHR surgical technique: posterior cruroplasty, standard LSG, fixation of the esophagogastric junction to the median arcuate ligament. RESULTS Fourteen patients underwent LSG+sLHR [12 women and 2 men, mean (range) age 47 years (27-57), BMI 41 kg/m2 (35-65)]. Five patients had previous gastric banding (GB). All had symptomatic GERD confirmed by gastroscopy and/or upper-gastrointestinal contrast study, two with chronic cough, 10 took PPI daily. Twelve had hiatus hernia and two patulous cardia at surgical exploration. Associated interventions were three GB removals and one cholecystectomy. Postoperative complication was one surgical site infection. Follow-up of all patients at median 12.5 months (5-17) is as follows: symptomatic GERD 3/14 patients, chronic cough 0/14, daily PPI use in 1/14, mean EBMIL 68% (17-120), satisfaction 93%, mean GERD-HRQL score 3,28/50 (0-15), with 4 patients 0/50, occasional bloatedness in 2 patients and dysphagia not reported. CONCLUSION The novel technique which combines LSG with sLHR is feasible, safe and can be associated with GB removal. Preliminary results showed patient satisfaction, high remission rate of preexisting GERD, decrease in PPI use and unimpaired weight loss. Further evaluation is necessary in a controlled and staged manner to establish the technique's real effectiveness.
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Affiliation(s)
- Daniel Gero
- Department of General and Digestive Surgery, University Hospital Bichat - Claude-Bernard, 46 Rue Henri Huchard, 75018, Paris, France.
| | - Lara Ribeiro-Parenti
- Department of General and Digestive Surgery, University Hospital Bichat - Claude-Bernard, 46 Rue Henri Huchard, 75018, Paris, France
| | - Konstantinos Arapis
- Department of General and Digestive Surgery, University Hospital Bichat - Claude-Bernard, 46 Rue Henri Huchard, 75018, Paris, France
| | - Jean-Pierre Marmuse
- Department of General and Digestive Surgery, University Hospital Bichat - Claude-Bernard, 46 Rue Henri Huchard, 75018, Paris, France
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Lasnibat JP, Braghetto I, Gutierrez L, Sanchez F. SLEEVE GASTRECTOMY AND FUNDOPLICATION AS A SINGLE PROCEDURE IN PATIENTS WITH OBESITY AND GASTROESOPHAGEAL REFLUX. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2017; 30:216-221. [PMID: 29019565 PMCID: PMC5630217 DOI: 10.1590/0102-6720201700030012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/04/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Bariatric surgery in Chile has seen an exponential increase in recent years, especially in sleeve gastrectomy. Its use is currently discussed in patients suffering from gastroesophageal reflux disease. Different options have been considered for the management of these patients but up to now laparoscopic Roux-en-Y gastric bypass seems to be the best option. Sleeve gastrectomy plus concomitant fundoplication or hiatal hernia repair also has been suggested in patients having reflux or small hiatal hernia. AIM To present a cohort of obese patients with gatroesophageal reflux undergoing this procedure, which seeks to provide the benefits of both laparoscopic gastric sleeve (LSG) and antireflux surgery focused on the evaluation of presence of reflux and BMI after surgery, and to compare the result observed in this cohort with a previous group of obese patients without reflux submitted to sleeve gastrectomy alone. METHODS Retrospective case series in 15 patients who underwent this surgery between the years 2003 and 2012. Clinical records were analyzed and values of 24 hr pH monitoring, esophageal manometry and clinical outcome were recorded. Results were compared to a previous series of patients who underwent LSG. No statistical analyses were made. RESULTS Group A consisted of 15 patients submitted to LSG plus fundoplication. 93% (n=14) were female. Mean age was 46.2 years. Mean preoperative body mass index (BMI) was 33.9. All patients had altered pH monitoring and manometry preoperatively. There was one minor complication corresponding to a seroma. There was no perioperative mortality. Group B consisted of 23 obese patients who underwent LSG. These patients developed de novo reflux, hypotensive LES and esophagitis after the surgery. Group A patients showed improvement in esophageal pH monitoring and manometry at three months. During long-term follow-up, six underwent revision surgery, four for weight regain, one regained weight associated with symptomatic reflux, and one underwent re-intervention for reflux. CONCLUSIONS Good results are observed in the short-term follow up in both reflux resolution and weight loss. Nevertheless, results at long term are discouraging, with 53.3% of the patients requiring revision surgery during follow-up.
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Affiliation(s)
- Juan Pablo Lasnibat
- Department of Surgery, Faculty of Medicine, University Hospital Dr José J. Aguirre, Santiago, Chile
| | - Italo Braghetto
- Department of Surgery, Faculty of Medicine, University Hospital Dr José J. Aguirre, Santiago, Chile
| | - Luis Gutierrez
- Department of Surgery, Faculty of Medicine, University Hospital Dr José J. Aguirre, Santiago, Chile
| | - Felipe Sanchez
- Department of Surgery, Faculty of Medicine, University Hospital Dr José J. Aguirre, Santiago, Chile
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Chiappetta S, Stier C, Scheffel O, Theodoridou S, Weiner R. The first case report of failed single-anastomosis-duodeno-ileal bypass converted to One anastomosis gastric bypass/Mini-gastric bypass. Int J Surg Case Rep 2017; 35:68-72. [PMID: 28448862 PMCID: PMC5406540 DOI: 10.1016/j.ijscr.2017.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/05/2017] [Accepted: 04/12/2017] [Indexed: 12/12/2022] Open
Abstract
Revisional bariatric surgery will rise in the future. The established single-anastomosis-duodeno-ileal bypass with sleeve gastrectomy (SADI-S) as the restrictive part of the procedure. Due to preserved pylorus, SG has the disadvantage of a high-pressure system with de-novo or worsening of existing gastroesophageal reflux disease in the long-term. One anastomosis gastric bypass/Mini-gastric bypass (OAGB/MGB) reduces the high-pressure system of SG in a low-pressure system of OAGB/MGB. OAGB/MGB might be a simple method to rescue failed SADI-S patients.
Introduction The established single-anastomosis-duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is based on a sleeve gastrectomy (SG) as the restrictive part of the procedure. Due to preserved pylorus, SG has the disadvantage of a high-pressure system with de novo or worsening of existing gastroesophageal reflux disease (GERD). Case presentation A female patient presented herself due to protracted GERD and weight regain after multiple bariatric surgeries. At an initial weight of 158 kg (BMI 62.5 kg/m2) the patient underwent adjustable gastric banding in 2009. After band removal in slippage, the patient underwent SG at a weight of 135 kg in 2012. Nine months after SG, SADI-S was performed as a malabsorptive second step procedure. After 32 months the patient suffered from severe GERD under proton pump inhibitor therapy. Actual weight was 107.9 kg (BMI 42.7 kg/m2). Upper endoscopy showed a hiatal hernia and esophagitis B and dorsal hiatoplasty was performed. After 6 months in still existing severe GERD and weight regain indication for laparoscopic conversion to One anastomosis gastric bypass/Mini-gastric bypass (OAGB/MGB) was given, aiming to reduce the high-pressure system of SG in a low-pressure system of OAGB/MGB. One year after revisional surgery reflux was reported to be only occasionally. Further weight loss was seen (91 kg, BMI 36 kg/m2, EWL 67.7%). Conclusion SG as the restrictive part of SADI-S may lead to GERD and consequently to pathologic eating of “soft” calories, that defeats the operation and results in weight regain. OAGB/MGB might be a simple method to rescue such failed SADI-S patients.
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Affiliation(s)
- Sonja Chiappetta
- Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach, Offenbach/Main, Germany.
| | - Christine Stier
- Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach, Offenbach/Main, Germany.
| | - Oliver Scheffel
- Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach, Offenbach/Main, Germany.
| | - Sophia Theodoridou
- Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach, Offenbach/Main, Germany.
| | - Rudolf Weiner
- Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach, Offenbach/Main, Germany.
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64
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Rebecchi F, Allaix ME, Patti MG, Schlottmann F, Morino M. Gastroesophageal reflux disease and morbid obesity: To sleeve or not to sleeve? World J Gastroenterol 2017; 23:2269-2275. [PMID: 28428706 PMCID: PMC5385393 DOI: 10.3748/wjg.v23.i13.2269] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/15/2017] [Accepted: 03/15/2017] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic sleeve gastrectomy (LSG) has reached wide popularity during the last 15 years, due to the limited morbidity and mortality rates, and the very good weight loss results and effects on comorbid conditions. However, there are concerns regarding the effects of LSG on gastroesophageal reflux disease (GERD). The interpretation of the current evidence is challenged by the fact that the LSG technique is not standardized, and most studies investigate the presence of GERD by assessing symptoms and the use of acid reducing medications only. A few studies objectively investigated gastroesophageal function and the reflux profile by esophageal manometry and 24-h pH monitoring, reporting postoperative normalization of esophageal acid exposure in up to 85% of patients with preoperative GERD, and occurrence of de novo GERD in about 5% of cases. There is increasing evidence showing the key role of the surgical technique on the incidence of postoperative GERD. Main technical issues are a relative narrowing of the mid portion of the gastric sleeve, a redundant upper part of the sleeve (both depending on the angle under which the sleeve is stapled), and the presence of a hiatal hernia. Concomitant hiatal hernia repair is recommended. To date, either medical therapy with proton pump inhibitors or conversion of LSG to laparoscopic Roux-en-Y gastric bypass are the available options for the management of GERD after LSG. Recently, new minimally invasive approaches have been proposed in patients with GERD and hypotensive LES: the LINX® Reflux Management System procedure and the Stretta® procedure. Large studies are needed to assess the safety and long-term efficacy of these new approaches. In conclusion, the recent publication of pH monitoring data and the new insights in the association between sleeve morphology and GERD control have led to a wider acceptance of LSG as bariatric procedure also in obese patients with GERD, as recently stated in the 5th International Consensus Conference on sleeve gastrectomy.
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65
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Using Video Analysis to Understand and Improve Technical Quality in Bariatric Surgery. CURRENT SURGERY REPORTS 2017. [DOI: 10.1007/s40137-017-0170-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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66
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Goitein D, Sakran N, Rayman S, Szold A, Goitein O, Raziel A. Barium swallow for hiatal hernia detection is unnecessary prior to primary sleeve gastrectomy. Surg Obes Relat Dis 2017; 13:138-142. [DOI: 10.1016/j.soard.2016.08.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/28/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
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A randomized trial comparing reflux symptoms in sleeve gastrectomy patients with or without hiatal hernia repair. Surg Obes Relat Dis 2016; 12:1681-1688. [DOI: 10.1016/j.soard.2016.09.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 08/10/2016] [Accepted: 09/03/2016] [Indexed: 12/12/2022]
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Dakour Aridi HN, Tamim H, Mailhac A, Safadi BY. Concomitant hiatal hernia repair with laparoscopic sleeve gastrectomy is safe: analysis of the ACS-NSQIP database. Surg Obes Relat Dis 2016; 13:379-384. [PMID: 27919836 DOI: 10.1016/j.soard.2016.09.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 08/21/2016] [Accepted: 09/27/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gastroesophageal acid reflux disease (GERD) is prevalent after laparoscopic sleeve gastrectomy (LSG), a common bariatric surgical procedure worldwide. Some studies have suggested that concomitant hiatal hernia repair (HHR) during LSG reduces the risk of GERD, but this has not been substantiated. Little is known about the safety of adding an HHR in this setting. The present study aims to compare 30-day morbidity and mortality and length of hospital stay between patients undergoing LSG alone and those undergoing LSG with HHR. METHODS A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database was performed to identify patients who underwent LSG procedures alone or with concomitant HHR between 2010 and 2014. Univariate and multivariate analyses of 30-day morbidity and mortality and length of hospital stay were performed. RESULTS Between 2010 and 2014, 32,581 patients underwent LSG. Of those, 4687 (14.4%) underwent concomitant HHR. No significant differences in 30-day mortality; overall morbidity; reoperation; sepsis; and wound, cardiac, respiratory, and renal complications were found between the 2 study groups on univariate and multivariate analyses. Length of hospital stay, risk of thromboembolic events, and blood transfusions were lower in the LSG+HHR group, even on multivariate analysis. CONCLUSIONS Concomitant HHR at the time of LSG is not associated with increased risk of 30-day mortality or major morbidity. However, the effectiveness of this additional procedure should be assessed using long-term data on the resolution of GERD symptoms after LSG.
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Affiliation(s)
- Hanaa N Dakour Aridi
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Clinical Research Institute, Biostatistics Unit, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aurelie Mailhac
- Clinical Research Institute, Biostatistics Unit, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bassem Y Safadi
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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69
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Iannelli A, Sans A, Martini F, Santonicola A, Iovino P, Angrisani L. Hiatal Hernia, GERD, and Sleeve Gastrectomy: a Complex Interplay. Obes Surg 2016; 26:2485-7. [PMID: 27460694 DOI: 10.1007/s11695-016-2291-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Antonio Iannelli
- Service de Chirurgie Digestive et Centre de Transplantation Hépatique, Hôpital Archet 2, 151 Route Saint Antoine de Ginestière, BP 3079, Nice Cedex 3, France.
- Inserm, U1065, Team 8 "Hepatic complications of obesity", F-06204, Nice, France.
- University of Nice Sophia-Antipolis, F-06107, Nice, France.
| | - Arnaud Sans
- Inserm, U1065, Team 8 "Hepatic complications of obesity", F-06204, Nice, France
| | | | - Antonella Santonicola
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Paola Iovino
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Luigi Angrisani
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy
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Abstract
BACKGROUND AND OBJECTIVES Hiatal hernia is a common condition often associated with symptomatic gastroesophageal reflux disease (GERD). The objectives of this study were to examine the efficacy and safety of laparoscopic hiatal hernia repair (LHHR) with biologic mesh to reduce and/or alleviate GERD symptoms and associated hiatal hernia recurrence. METHODS We retrospectively reviewed consecutive LHHR procedures with biologic mesh performed by a single surgeon from July 2009 to October 2014. The primary efficacy outcome measures were relief from GERD symptoms, as measured according to the GERD-health-related quality-of-life (GERD-HRQL) scale and hiatal hernia recurrence. A secondary outcome measure was overall safety of the procedure. RESULTS A total of 221 patients underwent LHHR with biologic mesh during the study period, and pre- and postoperative GERD-HRQL studies were available for 172 of them. At baseline (preoperative), the mean GERD-HRQL score for all procedures was 18.5 ± 14.4. At follow-up (mean, 14.5 ± 11.0 months [range, 2.0-56.0]), the score showed a statistically significant decline to a mean of 4.4 ± 7.5 (P < .0001). To date, 8 patients (3.6%, 8/221) have had a documented anatomic hiatal hernia recurrence. However, a secondary hiatal hernia repair reoperation was necessary in only 1 patient. Most complications were minor (dysphagia, nausea and vomiting). However, there was 1 death caused by a hemorrhage that occurred 1 week after surgery. CONCLUSIONS Laparoscopic hiatal hernia repair using biologic mesh, both with and without a simultaneous bariatric or antireflux procedure, is an efficacious and safe therapeutic option for management of hiatal hernia, prevention of recurrence, and relief of symptomatic GERD.
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Affiliation(s)
- Craig G Chang
- Bariatric Surgery Center of Excellence, Victoria, Texas, USA
| | - Lisa Thackeray
- North American Science Associates, Minneapolis, Minnesota, USA
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71
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Gero D, Karila-Cohen P, Marmuse JP. Simplified laparoscopic Hill repair for the treatment of symptomatic sliding hiatus hernia after bariatric surgery. Surg Obes Relat Dis 2016; 12:1630-1634. [DOI: 10.1016/j.soard.2016.08.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/13/2016] [Accepted: 08/15/2016] [Indexed: 02/08/2023]
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Sutherland V, Kuwada I, Gersin K, Simms C, Stefanidis D. Impact of Bariatric Surgery on Hiatal Hernia Repair Outcomes. Am Surg 2016. [DOI: 10.1177/000313481608200835] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Large hiatal hernias are notorious for their high recurrence rates after conventional repair. Recurrence rates have been described to be higher in obese patients due to increased intraabdominal pressure. We hypothesized that patients who undergo hiatal hernia repair (HHR) with bariatric surgery (BAR) will have a lower hernia recurrence rate when compared to patients who undergo HHR with fundoplication (FP) due to the decrease in intra-abdominal pressure observed with weight loss. This was an Institutional Review Board approved retrospective review. The outcomes of patients who underwent HHR+BAR as well as patients who had HHR+FP only from 2007 to 2014 were reviewed. Patients who had small hiatal hernias (<2 cm), underwent an anterior repair, or had gastropexy only were excluded. The primary outcome was hernia recurrence and reflux resolution. The outcomes of 58 patients who had HHR+BAR were compared with 30 patients with HHR+FP. Hernia recurrence rate for HHR+BAR was 12 per cent, whereas hernia recurrence rate for HHR+FP was 38 per cent ( P < 0.01). Reflux resolution for HHR+FP was 78 per cent, whereas reflux improvement rate for HHR+BAR was 84 per cent ( P = n.s.). Combining HHR with BAR leads to a lower hernia recurrence rate when compared to patients who undergo HHR with FP.
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Affiliation(s)
- Victoria Sutherland
- Division of Bariatric Surgery, Department of Surgery, Carolinas Healthcare System, Charlotte, North Carolina
| | - Imothy Kuwada
- Division of Bariatric Surgery, Department of Surgery, Carolinas Healthcare System, Charlotte, North Carolina
| | - Keith Gersin
- Division of Bariatric Surgery, Department of Surgery, Carolinas Healthcare System, Charlotte, North Carolina
| | - Connie Simms
- Division of Bariatric Surgery, Department of Surgery, Carolinas Healthcare System, Charlotte, North Carolina
| | - Dimitrios Stefanidis
- Division of Bariatric Surgery, Department of Surgery, Carolinas Healthcare System, Charlotte, North Carolina
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Melissas J, Braghetto I, Molina JC, Silecchia G, Iossa A, Iannelli A, Foletto M. Gastroesophageal Reflux Disease and Sleeve Gastrectomy. Obes Surg 2016; 25:2430-5. [PMID: 26428250 DOI: 10.1007/s11695-015-1906-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Gastroesophageal reflux disease (GERD) and/or hiatus hernia (HH) are one of the most common disorders of the upper gastrointestinal tract. Despite the positive effect of sleeve gastrectomy (SG) regarding weight loss and improvement in obesity co-morbidities, there are concerns about the development of de novo gastroesophageal reflux disease or worsening the existing GERD after this bariatric operation. Furthermore, controversy exists on the consequences of SG in lower esophageal sphincter function and about the ideal procedure when a hiatus hernia is preoperatively diagnosed or discovered during the laparoscopic SG. This review systematically investigates the incidence, the pathophysiology of GERD and/or HH in morbidly obese individuals before and after SG, and the treatment options for concomitant HH repair during laparoscopic sleeve gastrectomy.
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Affiliation(s)
- John Melissas
- Bariatric Unit, Heraklion University Hospital, University of Crete, 164 Erythreas Street, 714 09, Heraklion, Crete, Greece.
| | - Italo Braghetto
- Department of Surgery, Hospital Clínico "Dr Jose J. Aguirre", Faculty of Medicine, University of Chile, Santiago, Chile.
| | - Juan Carlos Molina
- Department of Surgery, Hospital Clínico "Dr Jose J. Aguirre", Faculty of Medicine, University of Chile, Santiago, Chile
| | - Gianfranco Silecchia
- Division of General Surgery and Bariatric Centre of Excellence, Department of Medico-Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Rome, Italy.
| | - Angelo Iossa
- Division of General Surgery and Bariatric Centre of Excellence, Department of Medico-Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Rome, Italy
| | - Antonio Iannelli
- Centre Hospitalier Universitaire de Nice, Hôpital de l'Archet, Pôle Digestif, Nice, F-06202, France. .,Faculté de Médecine, Université de Nice-Sophia Antipolis, Nice, F-06107, France.
| | - Mirto Foletto
- Week Surgery, Bariatric Unit, Padova University Hospital, Padova, Italy.
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Nocca D, Skalli EM, Boulay E, Nedelcu M, Michel Fabre J, Loureiro M. Nissen Sleeve (N-Sleeve) operation: preliminary results of a pilot study. Surg Obes Relat Dis 2016; 12:1832-1837. [PMID: 27234340 DOI: 10.1016/j.soard.2016.02.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/02/2016] [Accepted: 02/14/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) is one of the most frequently performed bariatric procedures worldwide. Despite its impressive results, there is a growing concern about the relationship between SG and gastroesophageal reflux disease (GERD). OBJECTIVES We present our pilot study of patients operated with a Nissen anti-reflux valve added to a standard SG. SETTING University hospital in Montpellier, France. METHODS A prospective monocentric study including 25 consecutive patients operated with a laparoscopic Nissen-Sleeve (N-Sleeve) gastrectomy was carried out between September 2013 and March 2014. Inclusion criteria were indication for bariatric surgery for patients with GERD (Montreal's definition and classification). All patients were followed postoperatively for 1 year. RESULTS There were 13 (54%) females and 12 (46%) males with mean age of 41±12 (20-65) years. Mean body mass index was 42±4.8 (35-53) kg/m2. Preoperatively, all patients had esophageal syndromes. Twenty-three (92%) patients had typical symptoms of GERD, but 2 were asymptomatic; however, they had esophageal injury. Esophagitis grade I-III presented in 10 (40%) patients and Barrett's esophagus in 8 (32%) cases. Two (8%) patients also had extraesophageal syndrome represented by asthma. Nineteen (76%) patients previously took proton pump inhibitors, regularly and 22 (88%) had experienced a hiatal hernia. There was no conversion to the open technique. Operative time was 84±13 (54-106) minutes. There were no deaths. Complications included one case of staple line bleeding and one Nissen valve perforation without recognized ischemia. No staple line failure was observed. Three months after N-Sleeve, 19 (76%) patients remained asymptomatic without proton pump inhibitor use. At 6 months and 1 year, 3 (12%) patients were still experiencing reflux. Excess weight loss at 1 year was 58±23%, total weight loss was 27±10%, and body mass index change was -11±4 kg/m². CONCLUSION The N-Sleeve seems to be a safe procedure that provides an adequate reflux control with no clear interference on the expected bariatric results of a standard SG.
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Affiliation(s)
- David Nocca
- CHU de Montpellier, Montpellier, France; University Montpellier 1, Montpellier, France
| | | | | | | | - Jean Michel Fabre
- CHU de Montpellier, Montpellier, France; University Montpellier 1, Montpellier, France
| | - Marcelo Loureiro
- CHU de Montpellier, Montpellier, France; University Montpellier 1, Montpellier, France; Universidade Positivo, Curitiba, Brazil.
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Arman GA, Himpens J, Dhaenens J, Ballet T, Vilallonga R, Leman G. Long-term (11+years) outcomes in weight, patient satisfaction, comorbidities, and gastroesophageal reflux treatment after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2016; 12:1778-1786. [PMID: 27178613 DOI: 10.1016/j.soard.2016.01.013] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/06/2016] [Accepted: 01/13/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND More than 10 years of outcomes for sleeve gastrectomy (LSG) have not yet been documented. OBJECTIVES Analysis of>11 years of outcomes of isolated LSG in terms of progression of weight, patient satisfaction, and evolution of co-morbidities and gastroesophageal reflux disease (GERD) treatment. SETTING Two European private hospitals. METHODS Chart review and personal interview in consecutive patients who underwent primary isolated LSG (2001-2003). RESULTS Of the 110 consecutive patients, complete follow-up data was available in 65 (59.1%). Mean follow-up was 11.7±.4 years. Two patients had died of non-procedure-related causes. Twenty (31.7%) patients required 21 reoperations: 14 conversions (10 duodenal switch (DS), 4 Roux-en-Y gastric bypass (RYGB), and 3 resleeve procedures) for weight issues and 2 conversions (RYGB), and 2 hiatoplasties for gastroesophageal reflux disease (GERD). For the 47 (74.6%) individuals who thus kept the simple sleeve construction, percentage of excess body mass index loss (%EBMIL) at 11+years was 62.5%, versus 81.7% (P = .015) for the 16 patients who underwent conversion to another construction. Mean %EBMIL for the entire cohort was 67.4%. At 11+years postoperatively, 30 patients versus 28 preoperatively required treatment for co-morbidities. None of the 7 patients preoperatively suffering from GERD were cured by the LSG procedure. Nine additional patients developed de novo GERD. Overall satisfaction rate was 8 (interquartile range 2) on a scale of 0-10. CONCLUSION Isolated LSG provides a long-term %EBMIL of 62.5%. Conversion to another construction, required in 25% of the cases, provides a %EBMIL of 81.7% (P = .015). Patient satisfaction score remains good despite unfavorable GERD outcomes.
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Affiliation(s)
- Gustavo A Arman
- Division of Bariatric Surgery, AZ St-Blasius, Dendermonde, Belgium; Cavell Obesity Center, CHIREC, Brussels, Belgium.
| | - Jacques Himpens
- Division of Bariatric Surgery, AZ St-Blasius, Dendermonde, Belgium; Cavell Obesity Center, CHIREC, Brussels, Belgium
| | - Jeroen Dhaenens
- Division of Bariatric Surgery, AZ St-Blasius, Dendermonde, Belgium
| | | | - Ramon Vilallonga
- Division of Bariatric Surgery, AZ St-Blasius, Dendermonde, Belgium
| | - Guido Leman
- Division of Bariatric Surgery, AZ St-Blasius, Dendermonde, Belgium
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76
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Simple versus reinforced cruroplasty in patients submitted to concomitant laparoscopic sleeve gastrectomy: prospective evaluation in a bariatric center of excellence. Surg Endosc 2015; 30:2374-81. [DOI: 10.1007/s00464-015-4487-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/01/2015] [Indexed: 12/11/2022]
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77
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Oor JE, Roks DJ, Ünlü Ç, Hazebroek EJ. Laparoscopic sleeve gastrectomy and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Surg 2015; 211:250-67. [PMID: 26341463 DOI: 10.1016/j.amjsurg.2015.05.031] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 05/17/2015] [Accepted: 05/17/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND The effect of sleeve gastrectomy (SG) on the prevalence of gastroesophageal reflux disease (GERD) remains unclear. We aimed to outline the currently available literature. DATA SOURCES All relevant databases were searched for publications examining the effect of laparoscopic SG on GERD. Primary outcome measure was change in prevalence of GERD symptoms, antireflux medication use, and esophageal function tests. Secondary outcomes were prevalence of new-onset GERD and esophagitis. Thirty-three articles were included. Eleven studies used questionnaires to assess changes in the prevalence of GERD symptoms, with a risk difference in prevalence of 4.3%. Eight studies used esophageal function tests, with paradoxical results. Pooled incidence of new-onset GERD symptoms was 20%, with a strong suggestion of heterogeneity. New-onset esophagitis ranged from 6.3% to 63.3%. CONCLUSIONS Because of high heterogeneity among available studies and paradoxical outcomes of objective esophageal function tests, the exact effect of laparoscopic SG on the prevalence of GERD remains unanswered. Surgeons should carefully evaluate preoperative GERD symptoms when choosing the proper bariatric technique.
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Affiliation(s)
- Jelmer E Oor
- Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3430 VB Nieuwegein, The Netherlands.
| | - David J Roks
- Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands
| | - Çagdas Ünlü
- Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3430 VB Nieuwegein, The Netherlands
| | - Eric J Hazebroek
- Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3430 VB Nieuwegein, The Netherlands
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Nadaleto BF, Herbella FAM, Patti MG. Gastroesophageal reflux disease in the obese: Pathophysiology and treatment. Surgery 2015; 159:475-86. [PMID: 26054318 DOI: 10.1016/j.surg.2015.04.034] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 04/07/2015] [Accepted: 04/28/2015] [Indexed: 12/12/2022]
Abstract
Obesity is a condition that has increased all over the world in the last 3 decades. Overweight and gastroesophageal reflux disease (GERD) are related. GERD may have different causative factors in the obese compared with lean individuals. This review focuses on the proper treatment for GERD in the obese based on its pathophysiology. Increased abdominal pressure may play a more significant role in obese subjects with GERD than the defective esophagogastric barrier usually found in nonobese individuals. A fundoplication may be used to treat GERD in these individuals; however, outcomes may be not as good as in nonobese patients and it does not act on the pathophysiology of the disease. All bariatric techniques may ameliorate GERD symptoms owing to a decrease in abdominal pressure secondary to weight loss. However, some operations may lead to a disruption of natural anatomic antireflux mechanisms or even lead to slow gastric emptying and/or esophageal clearance and thus be a refluxogenic procedure. Roux-en-Y gastric bypass decreases both acid and bile reflux from the stomach into the esophagus. On the other hand, gastric banding is a refluxogenic operation, and sleeve gastrectomy may show different outcomes based on the anatomy of the gastric tube.
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Affiliation(s)
- Barbara F Nadaleto
- Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Fernando A M Herbella
- Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil.
| | - Marco G Patti
- Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, IL
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Praveenraj P, Gomes RM, Kumar S, Senthilnathan P, Parathasarathi R, Rajapandian S, Palanivelu C. Diagnostic Yield and Clinical Implications of Preoperative Upper Gastrointestinal Endoscopy in Morbidly Obese Patients Undergoing Bariatric Surgery. J Laparoendosc Adv Surg Tech A 2015; 25:465-9. [PMID: 25942627 DOI: 10.1089/lap.2015.0041] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND AIMS Upper gastrointestinal (UGI) endoscopy in patients undergoing bariatric surgery is controversial. It is recommended routinely by some authors to detect benign or malignant pathology that mostly remains asymptomatic. Others recommend selective use, suggesting not much impact on surgical management of detected pathology, especially in asymptomatic patients. The aim of this study was to evaluate the diagnostic yield and impact of pathological findings on routine UGI endoscopy before bariatric surgery in a cohort of morbidly obese Indian patients. MATERIALS AND METHODS We retrospectively reviewed preoperative screening UGI endoscopy reports of 283 patients who underwent bariatric surgery from February 2012 to August 2014. Data were collected on clinical information, UGI endoscopic findings, Helicobacter pylori testing, and management. RESULTS Ten patients gave a history of gastroesophageal reflux, and the rest had no specific UGI complaints. Fifty-four had no abnormal findings. One hundred ninety-six had a lax lower esophageal hiatus, hiatal hernias of <5 cm, Grade I-II esophagitis, or mild to moderate gastritis or duodenitis that did not have an impact on surgery. Thirty-one had severe erosive gastritis or duodenitis, or polyposis that delayed surgery for treatment and review of biopsies. A large hiatal hernia >5 cm changed surgical plan to Roux-en-Y gastric bypass from a sleeve gastrectomy in 2 cases. None had varices or malignancy. CONCLUSIONS Preoperative UGI endoscopy yielded a high proportion of endoscopic abnormalities even in asymptomatic patients. Surgery was delayed to treat severe mucosal lesions and to investigate polypoidal findings in the majority. A change in surgical approach and surveillance for malignancy was needed in a few cases.
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Affiliation(s)
- Palanivelu Praveenraj
- 1 Department of Bariatric Surgery, GEM Hospital and Research Centre , Coimbatore, Tamil Nadu, India
| | - Rachel M Gomes
- 1 Department of Bariatric Surgery, GEM Hospital and Research Centre , Coimbatore, Tamil Nadu, India
| | - Saravana Kumar
- 1 Department of Bariatric Surgery, GEM Hospital and Research Centre , Coimbatore, Tamil Nadu, India
| | - Palanisamy Senthilnathan
- 2 Department of Surgical Gastroenterology, GEM Hospital and Research Centre , Coimbatore, Tamil Nadu, India
| | | | - Subbiah Rajapandian
- 2 Department of Surgical Gastroenterology, GEM Hospital and Research Centre , Coimbatore, Tamil Nadu, India
| | - Chinnusamy Palanivelu
- 2 Department of Surgical Gastroenterology, GEM Hospital and Research Centre , Coimbatore, Tamil Nadu, India
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