51
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Hyperirritable stomach as a cause of obstructive symptoms after sleeve gastrectomy: clinical and radiographic findings. Clin Imaging 2017; 47:118-123. [PMID: 28946102 DOI: 10.1016/j.clinimag.2017.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/26/2017] [Accepted: 09/06/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE To characterize clinical and radiographic features of a hyperirritable stomach after sleeve gastrectomy. MATERIALS/METHODS Radiology reports revealed that 10/76 patients (13%) with obstructive symptoms after sleeve gastrectomy had a hyperirritable stomach. RESULTS All 10 patients presented with nausea, vomiting, and/or regurgitation. All 10 had emesis on barium studies in the absence of gastric outlet obstruction, gastroparesis, or small bowel obstruction/ileus. Five had extraintestinal causes of nausea/vomiting. Eight had improvement/resolution of symptoms on medical treatment. CONCLUSION In 13% of patients with nausea/vomiting after sleeve gastrectomy, barium studies revealed a hyperirritable stomach, which likely is multifactorial and self-limited in most patients.
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Celiker H. A new proposed mechanism of action for gastric bypass surgery: Air hypothesis. Med Hypotheses 2017; 107:81-89. [PMID: 28915970 DOI: 10.1016/j.mehy.2017.08.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/02/2017] [Accepted: 08/08/2017] [Indexed: 02/07/2023]
Abstract
Roux-en-Y gastric bypass (RYGB) surgery is one of the most effective treatments for obesity and type II diabetes. RYGB was originally believed to work by mechanically restricting caloric intake or causing macronutrient malabsorption. However, such mechanical effects play no role in the remarkable efficacy of gastric bypass. Instead, mounting evidence shows that altered neuroendocrine signaling is responsible for the weight reducing effects of RYGB. The exact mechanism of this surgical response is still a mystery. Here, we propose that RYGB leads to weight loss primarily by inducing a functional shift in the gut microbiome, manifested by a relative expansion of aerobic bacteria numbers in the colon. We point to compelling evidence that gastric bypass changes the function of the microbiome by disrupting intestinal gas homeostasis, causing excessive transit of swallowed air (oxygen) into the colon.
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Affiliation(s)
- Hasan Celiker
- Xeno Biosciences Inc., 12 Mt Auburn St #7, Cambridge, MA, USA.
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53
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Sánchez-Carpintero de la Vega M, García Villar C. Estudios telemandados con control fluoroscópico del tracto digestivo superior: Técnicas e indicaciones. RADIOLOGIA 2017; 59:343-354. [DOI: 10.1016/j.rx.2016.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 10/18/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
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54
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Tonolini M, Bracchi E. Early postoperative imaging after non-bariatric gastric resection: a primer for radiologists. Insights Imaging 2017. [PMID: 28631148 PMCID: PMC5519498 DOI: 10.1007/s13244-017-0559-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Abstract Surgical resection represents the mainstay treatment and only potentially curative option for gastric carcinoma, and is increasingly performed laparoscopically. Furthermore, other tumours and selected cases of non-malignant disorders of the stomach may require partial or total gastrectomy. Often performed in elderly patients, gastric resection remains a challenging procedure, with significant morbidity (14–43% complication rate) and non-negligible postoperative mortality (approximately 3%). This paper provides an overview of contemporary surgical techniques for non-bariatric gastric resection, reviews and illustrates the expected postoperative imaging appearances, common and unusual complications after partial and total gastrectomy. Albeit cumbersome or unfeasible in severely ill or uncooperative patients, contrast fluoroscopy remains useful to rapidly check for anastomotic patency and integrity. Currently, emphasis is placed on multidetector CT, which comprehensively visualizes the surgically altered anatomy and consistently detects complications such as anastomotic leaks and fistulas, duodenal stump leakage, afferent loop syndrome, haemorrhages, pancreatic fistulas and porto-mesenteric venous thrombosis. Our aim is to help radiologists become familiar with early postoperative imaging, in order to understand the surgically altered anatomy and to differentiate between expected imaging appearances and abnormal changes heralding iatrogenic complications, thus providing a consistent basis for correct choice between conservative, interventional or surgical treatment. Teaching points • Radical gastrectomy is associated with frequent postoperative morbidity and non-negligible mortality. • In cooperative patients fluoroscopy allows checking for anastomotic patency and leaks. • Multidetector CT with / without oral contrast comprehensively visualizes the operated abdomen. • Awareness of surgically altered anatomy and expected postoperative appearances is warranted. • Main complications include anastomotic and duodenal leaks, haemorrhages and pancreatic fistulas.
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Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
| | - Elena Bracchi
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy
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Abstract
Obesity and its association with long-term health problems constitutes one of the major challenges in medicine. Though diet regulation and exercise are the primary treatment strategies, surgery is the most reliable long-term solution. Although bariatric surgical complications continue to decline, prompt recognition is essential to optimize patient outcomes. Despite their relative rarity, it is important to recognize thoracic complications, as several of these can result in severe morbidity and mortality. This article describes common bariatric surgical procedures performed, their expected postoperative appearances, and intrathoracic complications.
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56
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Ekinci T, Stein MW, Mazzariol FS, Wolf EL. Laparoscopic sleeve gastrectomy: Everything the radiologist needs to know. Clin Imaging 2017; 43:36-41. [DOI: 10.1016/j.clinimag.2017.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 11/26/2016] [Accepted: 01/24/2017] [Indexed: 11/30/2022]
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57
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Slippage—a Significant Problem Following Gastric Banding—a Single Centre Experience. Obes Surg 2017; 27:2637-2642. [DOI: 10.1007/s11695-017-2683-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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58
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Gonzalez LE, Kedar RP. Gastric and colonic erosion caused by laparoscopic gastric band: a case report. BJR Case Rep 2017; 3:20160135. [PMID: 30363251 PMCID: PMC6159200 DOI: 10.1259/bjrcr.20160135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/11/2017] [Accepted: 01/25/2017] [Indexed: 11/25/2022] Open
Abstract
Laparoscopic adjustable gastric banding is commonly used to treat obesity. It rarely results in complications, one of which is gastrointestinal erosion. Simultaneous erosion of the stomach and colon is a rare finding that has been documented in only a few case reports. We present a 62-year-old female with abdominal pain, nausea, and hematochezia. She was found to have simultaneous gastric and colonic erosion identified on CT scan. Imaging findings were confirmed and device was removed during surgery.
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Affiliation(s)
- Luis E Gonzalez
- Department of Radiology, Tampa General Hospital, University of South Florida College of Medicine, Tampa, FL, USA
| | - Rajendra P Kedar
- Department of Radiology, Tampa General Hospital, University of South Florida College of Medicine, Tampa, FL, USA
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Contribution of Computed Tomographic Imaging to the Management of Acute Abdominal Pain after Gastric Bypass: Correlation Between Radiological and Surgical Findings. Obes Surg 2017; 27:1961-1972. [DOI: 10.1007/s11695-017-2601-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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60
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de Quadros LG, Galvão Neto MDP, Campos JM, Kaiser Junior RL, Grecco E, Flamini Junior M, de Santana MF, Zotarelli Filho IJ, Almeida Alexandre AATV. Validation of a new method for the endoscopic measurement of post-bariatric gastric outlet using a standard guidewire: an observer agreement study. BMC Res Notes 2017; 10:13. [PMID: 28057045 PMCID: PMC5217566 DOI: 10.1186/s13104-016-2350-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 12/16/2016] [Indexed: 01/14/2023] Open
Abstract
Background and aims Between 10 and 20% of all patients undergoing bariatric surgery procedures regain weight secondary to a gastrojejunostomy enlargement. The aim of this study was to validate the interobserver agreement while measuring gastric outlet diameters using a new standard guidewire. Methods We selected thirty-five videos of consecutive endoscopic procedures on patients undergoing esophagogastroduodenoscopy after a Roux-en-Y gastric bypass procedure. All videos were evaluated by four raters: two expert endoscopists and two trainees. We excluded videos having a slipped Fobi ring or a strictured gastric outlet. Anastomosis diameter was measured using a novel device with standardized markings on a guidewire (Hydra jagwire, Boston Scientific, Natick. MA) as well as the current gold standard defined as a calibrated endoscopic measuring instrument (Olympus America, Center Valley, PA). Results We obtained 272 measurements of the gastric outlet. Overall agreement measured through intra-class correlation coefficients for the gold standard was 0.84 (p < 0.01) and 0.83 (p < 0.01) for the new guidewire. Agreement among experts was 0.699 (p < 0.01), while among trainees it was 0.822 (p < 0.01). Conclusion The new guidewire demonstrated a high degree of observer reliability, also presenting similar results between expert endoscopists and trainees.
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Affiliation(s)
- Luiz Gustavo de Quadros
- Department of Endoscopy and Bariatric Surgery, Kaiser Clinic and Day Hospital, São José do Rio Preto, SP, 15015-110, Brazil. .,Department of Digestive Surgery, School of Medicine of ABC, Santo Andre, SP, 09080-650, Brazil. .,Brazilian Bariatric Endoscopy International Group, São Paulo, Brazil.
| | - Manoel Dos Passos Galvão Neto
- Brazilian Bariatric Endoscopy International Group, São Paulo, Brazil.,Gastro Obeso Center, São Paulo, SP, 01308-000, Brazil
| | - Josemberg Marins Campos
- Brazilian Bariatric Endoscopy International Group, São Paulo, Brazil.,Department of Surgery, Federal University of Pernambuco (UFPE), Recife, PE, 50670-901, Brazil
| | - Roberto Luiz Kaiser Junior
- Department of Endoscopy and Bariatric Surgery, Kaiser Clinic and Day Hospital, São José do Rio Preto, SP, 15015-110, Brazil
| | - Eduardo Grecco
- Department of Digestive Surgery, School of Medicine of ABC, Santo Andre, SP, 09080-650, Brazil.,Brazilian Bariatric Endoscopy International Group, São Paulo, Brazil
| | - Mario Flamini Junior
- Department of Endoscopy and Bariatric Surgery, Kaiser Clinic and Day Hospital, São José do Rio Preto, SP, 15015-110, Brazil
| | - Marcelo Falcao de Santana
- Brazilian Bariatric Endoscopy International Group, São Paulo, Brazil.,Department of Surgery, Federal University of Pernambuco (UFPE), Recife, PE, 50670-901, Brazil
| | - Idiberto Jose Zotarelli Filho
- State University of Sao Paulo-Unesp-Ibilce, Rua Cristovão Colombo 2265, Sao Jose do Rio Preto, SP, 15054-000, Brazil
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61
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Scharitzer M, Pokieser P. Radiology of the Lower Esophageal Sphincter and Stomach in Patients with Swallowing Disorders. Dysphagia 2017. [DOI: 10.1007/174_2017_115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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62
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Abstract
Gastric infarction is an extremely rare occurrence owing to the stomach's extensive vascular supply. We report an unusual case of gastric infarction following gastric bypass surgery. We describe the imaging findings and discuss possible causes of this condition.
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Affiliation(s)
- Patrick H Do
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, USA
| | - Young S Kang
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, USA
| | - Peter Cahill
- Department of Surgery, Santa Clara Valley Medical Center, San Jose, USA
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63
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Controversies and Pitfalls of Imaging Patients Postoperative Bariatric Surgery. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0152-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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64
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Wise ES, Hocking KM, Kavic SM. Prediction of excess weight loss after laparoscopic Roux-en-Y gastric bypass: data from an artificial neural network. Surg Endosc 2016; 30:480-488. [PMID: 26017908 PMCID: PMC4662927 DOI: 10.1007/s00464-015-4225-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 04/17/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Laparoscopic Roux-en-Y gastric bypass (LRYGB) has become the gold standard for surgical weight loss. The success of LRYGB may be measured by excess body mass index loss (%EBMIL) over 25 kg/m(2), which is partially determined by multiple patient factors. In this study, artificial neural network (ANN) modeling was used to derive a reasonable estimate of expected postoperative weight loss using only known preoperative patient variables. Additionally, ANN modeling allowed for the discriminant prediction of achievement of benchmark 50% EBMIL at 1 year postoperatively. METHODS Six hundred and forty-seven LRYGB included patients were retrospectively reviewed for preoperative factors independently associated with EBMIL at 180 and 365 days postoperatively (EBMIL180 and EBMIL365, respectively). Previously validated factors were selectively analyzed, including age; race; gender; preoperative BMI (BMI0); hemoglobin; and diagnoses of hypertension (HTN), diabetes mellitus (DM), and depression or anxiety disorder. Variables significant upon multivariate analysis (P < .05) were modeled by "traditional" multiple linear regression and an ANN, to predict %EBMIL180 and %EBMIL365. RESULTS The mean EBMIL180 and EBMIL365 were 56.4 ± 16.5 % and 73.5 ± 21.5%, corresponding to total body weight losses of 25.7 ± 5.9% and 33.6 ± 8.0%, respectively. Upon multivariate analysis, independent factors associated with EBMIL180 included black race (B = -6.3%, P < .001), BMI0 (B = -1.1%/unit BMI, P < .001), and DM (B = -3.2%, P < .004). For EBMIL365, independently associated factors were female gender (B = 6.4%, P < .001), black race (B = -6.7%, P < .001), BMI0 (B = -1.2%/unit BMI, P < .001), HTN (B = -3.7%, P = .03), and DM (B = -6.0%, P < .001). Pearson r(2) values for the multiple linear regression and ANN models were 0.38 (EBMIL180) and 0.35 (EBMIL365), and 0.42 (EBMIL180) and 0.38 (EBMIL365), respectively. ANN prediction of benchmark 50% EBMIL at 365 days generated an area under the curve of 0.78 ± 0.03 in the training set (n = 518) and 0.83 ± 0.04 (n = 129) in the validation set. CONCLUSIONS Available at https://redcap.vanderbilt.edu/surveys/?s=3HCR43AKXR, this or other ANN models may be used to provide an optimized estimate of postoperative EBMIL following LRYGB.
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Affiliation(s)
- Eric S Wise
- Department of Surgery, Vanderbilt University Medical Center, 1161 21st Ave S, MCN T2121, Nashville, TN, 37232-2730, USA.
- Department of General Surgery, University of Maryland Medical Center, Baltimore, MD, USA.
| | - Kyle M Hocking
- Department of Surgery, Vanderbilt University Medical Center, 1161 21st Ave S, MCN T2121, Nashville, TN, 37232-2730, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Stephen M Kavic
- Department of General Surgery, University of Maryland Medical Center, Baltimore, MD, USA
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65
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Riaz RM, Myers DT, Williams TR. Multidetector CT imaging of bariatric surgical complications: a pictorial review. Abdom Radiol (NY) 2016; 41:174-88. [PMID: 26830623 DOI: 10.1007/s00261-015-0604-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The prevalence of obesity is increasing, along with the number of bariatric surgical procedures performed to treat obesity. Laparoscopic sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and laparoscopic gastric banding (GB) comprise the vast majority of procedures with SG now the dominant procedure in the USA. Although multidetector computed tomography (MDCT) is not always the examination of choice for a particular suspected complication, many of these patients present with non-specific abdominal symptoms and undergo MDCT evaluation as an initial diagnostic test. This pictorial essay will review and discuss the normal post-surgical bariatric appearance on MDCT, and the appearance of common and uncommon complications associated with the common bariatric procedures on MDCT with correlative imaging. SG complications include leak/abscess, hemorrhage, splenic injury, and portomesenteric thrombosis. RYGB complications include leak/abscess, gastrogastric fistula, small bowel obstruction, internal hernia, and intussusception. Although GB is waning in popularity, radiologists continue to see the legacy of these patients and complications include gastric prolapse, band erosion, and port/tubing mechanical failures. Awareness of the characteristic findings of bariatric complications on MDCT is critical, allowing for earlier recognition and prompt intervention.
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Affiliation(s)
- Rehan M Riaz
- Department of Radiology, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA.
| | - Daniel T Myers
- Department of Radiology, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
| | - Todd R Williams
- Department of Radiology, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
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Hassan TA, Mohey N, Kamar WH. Clinical–radiologic evaluation of the complications of laparoscopic sleeve gastrectomy: Value of multidetector CT. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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67
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Guniganti P, Bradenham CH, Raptis C, Menias CO, Mellnick VM. CT of Gastric Emergencies. Radiographics 2015; 35:1909-21. [DOI: 10.1148/rg.2015150062] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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68
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Miao TL, Kielar AZ, Patlas MN, Riordon M, Chong ST, Robins J, Menias CO. Cross-sectional imaging, with surgical correlation, of patients presenting with complications after remote bariatric surgery without bowel obstruction. ACTA ACUST UNITED AC 2015; 40:2945-65. [PMID: 26467447 DOI: 10.1007/s00261-015-0548-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Both restrictive and malabsorptive types of bariatric surgery may be associated with short- and long-term complications. The lack of small bowel obstruction is not necessarily indicative of a normal study, as a variety of non-obstructed complications exist. These include stenosis at the gastrojejunostomy, leaks, abscesses, hemorrhage, internal hernias, and gastric band erosions. Radiologists should be familiar with these complications for early diagnosis and intervention before symptoms become life threatening. An understanding of the intraoperative appearances of these complications may improve imaging descriptions and add value to radiological consults for surgeons. This review provides surgical correlations to the imaging features of post-bariatric complications without obstruction of the bowel.
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69
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Meredith I, Lim YK, Wickremesekera SK, Bann S. Experience of imaging following laparoscopic sleeve gastrectomy. ANZ J Surg 2015; 86:568-71. [PMID: 26333708 DOI: 10.1111/ans.13284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND We aimed to report our experience with upper gastrointestinal (UGI) contrast studies and computed tomography (CT) swallow studies after laparoscopic sleeve gastrectomy, and comment on the merits of each modality. METHOD Retrospective review of all patients undergoing laparoscopic sleeve gastrectomy (LSG) in a New Zealand hospital between 2011 and 2014 was conducted. Over this time period, routine UGI was replaced by CT swallow studies. All medical records and radiology were reviewed and pertinent findings reported. RESULTS Seventy-nine patients underwent LSG over this time period and one patient had to be excluded; 48 (61.5%) had a UGI study and 30 patients (38.5%) had CT swallow. There were no leaks in this study and no leaks became clinically significant. Sixteen of 30 patients (53.3%) undergoing CT swallow had significant incidental findings demonstrated on axial imaging that required follow-up. CONCLUSION CT swallow can provide the same information as a UGI but has a significant rate of incidental findings. The rate of incidental pathology on CT is higher than that quoted in the general population. In a bariatric population, this may allow early detection and treatment of co-existent pathology.
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Affiliation(s)
- Ineke Meredith
- Department of General Surgery, North Shore Hospital, Auckland, New Zealand.,Wellington School of Medicine, University of Otago, Wellington, New Zealand
| | - Yu Kai Lim
- Department of General Surgery, Wellington Regional Hospital, Wellington, New Zealand
| | | | - Simon Bann
- Wellington School of Medicine, University of Otago, Wellington, New Zealand.,Department of General Surgery, Wellington Regional Hospital, Wellington, New Zealand.,Victoria University, Wellington, New Zealand
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70
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Cheung D, Switzer NJ, Gill RS, Shi X, Karmali S. Revisional bariatric surgery following failed primary laparoscopic sleeve gastrectomy: a systematic review. Obes Surg 2015; 24:1757-63. [PMID: 24927693 DOI: 10.1007/s11695-014-1332-9] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Revisional bariatric surgery following laparoscopic sleeve gastrectomy (LSG) failure presents a clinical challenge for the bariatric surgeon. Limited evidence exists in selecting the appropriate revisional operation: laparoscopic gastric bypass (LGB), laparoscopic re-sleeve gastrectomy (LRSG), or other surgical intervention (OSI), to address weight regain. We systematically reviewed the literature to assess the efficacy of existing revisional surgery. A comprehensive search of electronic databases (e.g., Medline, Embase, Scopus, Web of Science, and the Cochrane Library) was completed. All randomized controlled trials, non-randomized comparison study, and case series were included. Eleven primary studies (218 patients) were identified and included in the systematic review. Studies were grouped into three main categories: LGB, LRSG, and OSI. Preoperative body mass index (BMI) was 41.9 kg/m(2) (LGB), 38.5 kg/m(2) (LRSG), and 44.4 kg/m(2) (OSI). After conversion to LGB, BMI decreased to 33.7 and 35.7 kg/m(2) at 12 and 24 months of follow-up, respectively. Excess weight loss (EWL) was 60 and 48 % over the same periods. After LRSG, BMI decreased to 30.4 and 35.3 kg/m(2) with corresponding EWL of 68 and 44 %, at 12 and 24 months, respectively. After OSI, BMI decreased to 27.3 kg/m(2) with an EWL of 75 % at 24-month follow-up but could not be analyzed due to incomplete data collection in primary studies. Both LGB and LRSG achieve effective weight loss following failed LSG. The less technically challenging nature of LRSG may be more widely applicable. Further research is required to elicit sustainability in long-term weight loss benefits.
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Affiliation(s)
- Douglas Cheung
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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71
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Relationship between gastric pouch and weight loss after laparoscopic sleeve gastrectomy. Surg Endosc 2015; 30:1559-63. [PMID: 26150226 DOI: 10.1007/s00464-015-4377-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 06/25/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is considered safe and effective even as conversion procedure after primary bariatric operations. The correlation between gastric pouch volumes and patients weight loss remains unclear. METHODS To assess a correlation between the gastric remnant size and the weight loss, we reviewed 49 consecutive barium swallow UGS performed at our institute from August 2012 through May 2014 in LSG patients with symptoms and/or unsatisfactory weight loss. The anteroposterior (AP), laterolateral (LL) and vertical (CC) diameters of the gastric pouch were measured to calculate the volume by the formula of the ellipsoid (AP × LL × CC × 0.5). Patients were divided in two groups: group 1 without gastric pouch (n = 36) and group 2 with gastric pouch (n = 13). Correlation between pouch volume and weight loss data was calculated with t Student's and Fisher tests to compare the percent excess body mass index (BMI) and percent excess body mass loss (EBL) between two groups, and P < 0.05 was considered statistically significant. RESULTS The mean percent EBL was 26.54 ± 11.02 and 27.12 ± 12.35 kg/m(2) in groups with and without pouch, respectively. The mean volume of the pouch after LSG was 17.13 ± 21.56 mm(3). Pouch volume, when present, was not significantly correlated to weight loss (P = 0.88 95% CI, CL 19.88-33.20 group 2; CL 22.94-31.30 group 1). CONCLUSIONS No statistical correlation was found between the volume of the gastric pouch and weight loss (percent EBL) after LSG in symptomatic or with unsatisfactory weight loss patients.
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Kim J, Azagury D, Eisenberg D, DeMaria E, Campos GM. ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management. Surg Obes Relat Dis 2015; 11:739-48. [DOI: 10.1016/j.soard.2015.05.001] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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74
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Knebel RJ, Lamba R, Lin C, Fananapazir G, Corwin MT, Evans S. Ruptured aortic pseudoaneurysm complicating laparoscopic adjustable gastric banding. J Vasc Interv Radiol 2015; 26:292-5. [PMID: 25645419 DOI: 10.1016/j.jvir.2014.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/14/2014] [Accepted: 10/14/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
- Robert Justin Knebel
- Department of Radiology, University of California, Davis, 4860 Y St., Suite 3100, Sacramento, CA 95817
| | - Ramit Lamba
- Department of Radiology, University of California, Davis, 4860 Y St., Suite 3100, Sacramento, CA 95817
| | - Cheryl Lin
- Department of Surgery, University of California, Davis, 4860 Y St., Suite 3100, Sacramento, CA 95817
| | - Ghaneh Fananapazir
- Department of Radiology, University of California, Davis, 4860 Y St., Suite 3100, Sacramento, CA 95817
| | - Michael T Corwin
- Department of Radiology, University of California, Davis, 4860 Y St., Suite 3100, Sacramento, CA 95817
| | - Scott Evans
- Department of Radiology, University of California, Davis, 4860 Y St., Suite 3100, Sacramento, CA 95817
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Utility of barium studies for patients with recurrent weight gain after Roux-en-Y gastric bypass. Clin Radiol 2014; 70:67-73. [PMID: 25459676 DOI: 10.1016/j.crad.2014.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/20/2014] [Accepted: 09/24/2014] [Indexed: 01/06/2023]
Abstract
AIM To determine the utility of barium studies for detecting abnormalities responsible for recurrent weight gain after gastric bypass surgery. METHODS A computerized search identified 42 patients who had undergone barium studies for recurrent weight gain after gastric bypass and 42 controls. The images were reviewed to determine the frequency of staple-line breakdown and measure the length/width of the pouch and gastrojejunal anastomosis. A large pouch exceeded 6 cm in length or 5 cm in width and a wide anastomosis exceeded 2 cm. Records were reviewed for the amount of recurrent weight gain and subsequent weight loss after additional treatment. RESULTS Staple-line breakdown was present in 6/42 patients (14%) with recurrent weight gain. When measurements were obtained, 13/35 patients (37%) with recurrent weight gain had a large pouch, three (9%) had a wide anastomosis, and four (11%) had both, whereas 22/42 controls (52%) had a large pouch, one (2%) had a wide anastomosis, and two (5%) had both. Ten patients (24%) with recurrent weight gain underwent staple-line repair (n = 3) or pouch/anastomosis revision (n = 7). These 10 patients had a mean weight loss of 38.1 lbs versus a mean loss of 8.6 lbs in 19 patients managed medically. CONCLUSION Only 14% of patients with recurrent weight gain after gastric bypass had staple-line breakdown, whereas 57% had a large pouch, wide anastomosis, or both. Not all patients with abnormal anatomy had recurrent weight gain, but those who did were more likely to benefit from surgical intervention than from medical management.
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