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Khalil A, Gomez E, Gowda PC, Weinstein RM, Eberly HW, Prologo FJ, Birkholz JH, Sarwani NE, Friedberg E, Rogers AM, Weiss CR. Assessment of arterial supply to the stomach after bariatric surgery using multidetector CT arteriography. Abdom Radiol (NY) 2024:10.1007/s00261-024-04467-6. [PMID: 38951233 DOI: 10.1007/s00261-024-04467-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/19/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE To describe residual arterial supply to the stomach after bariatric surgery via a systematic arterial-phase CT assessment approach that can aid in diagnosis and treatment of postoperative complications and facilitate planning for future procedures. METHODS Arterial-phase CT of 46 patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) at 3 academic institutions were retrospectively reviewed to assess patency of left gastric artery (LGA), right gastric artery (RGA), gastroepiploic artery (GEA), and left inferior phrenic artery (LIPA) and presence of gastric perforators. RESULTS In 25 RYGB and 21 SG patients, mean diameters were LGA 2.2 ± 0.4 mm, RGA 1.6 ± 0.5 mm, and GEA 1.7 ± 0.4 mm. On RYGB scans, all LGAs, RGAs, and 24/25 (96%) of GEAs were identified. Excellent to good patency was seen in 20/25 (80%) LGAs, 21/25 (84%) RGAs, and 23/24 (96%) GEAs. On SG scans, all LGAs, 18/21 (86%) of RGAs, and 20/21 (95%) GEAs were identified. Excellent to good patency was seen in 17/21 (81%) LGAs, 15/18 (83%) RGAs, and 20/20 (100%) GEAs. In terms of gastric perforators, LGA supply was seen on 23/25 (92%) of RYGB and 17/17 (100%) of SG scans. RGA supply was seen on 13/21 (62%) RYGB and 9/18 (50%) SG scans. GEA supply was seen on 19/23 (83%) RYGB scans. No gastric supply via GEA was seen on SG scans. CONCLUSION In this study, arterial supply to the stomach through the LGA was consistently identified in all RYGB and SG cases, indicating an uncomplicated surgical approach with regard to preserving the LGA. Dedicated CT angiography protocol or catheter-directed angiography is recommended for accurate and comprehensive assessment of the gastric blood supply, particularly before surgical re-intervention.
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Affiliation(s)
- Adham Khalil
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, 1800 Orleans Street, Zayed Tower 7203, Baltimore, MD, 21287, USA
- Department of Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Erin Gomez
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, 1800 Orleans Street, Zayed Tower 7203, Baltimore, MD, 21287, USA
| | - Prateek C Gowda
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Frank J Prologo
- Department of Biology, University of Georgia, Athens, GA, USA
| | - James H Birkholz
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Nabeel E Sarwani
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Eric Friedberg
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Ann M Rogers
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Clifford R Weiss
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, 1800 Orleans Street, Zayed Tower 7203, Baltimore, MD, 21287, USA.
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Reichmann MTF, Duarte A, Ivano F, Campos ACL. Factors Involved in the Evolution of the Basal Metabolic Rate over 30 Months After Roux-en-Y Gastric Bypass. Obes Surg 2023; 33:3494-3501. [PMID: 37792252 DOI: 10.1007/s11695-023-06853-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/15/2023] [Accepted: 09/24/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION After Roux-en-Y gastric bypass (RYGB), the basal metabolic rate (BMR) falls. However, it is important to know how BMR per kilogram of body weight (BMR/kg) varies in the postoperative period. The present study evaluated the changes in the BMR/kg and its correlates over 30 months after RYGB. METHODS Eighty adult patients of both genders who underwent RYGB agreed to participate in the study. The following evaluations were performed before surgery (n=48) and 6 (n=27), 12 (n=28), 24 (n=40), and 30 months (n=29) after surgery: anthropometry, body composition (bioelectrical impedance), metabolic analysis (indirect calorimetry), and diet (food recall). Statistical analysis was performed (p = 0.05). RESULTS Although BMR decreased after surgery, BMR/kg increased significantly as compared to baseline from 12 months onward, peaking at 24 months and not significantly dipping at 30 months, suggesting stabilization of BMR/kg 2 years after surgery (pre, 10.68 ± 2.33 kcal/kg; 12 months, 12.46 ± 2.85 kcal/kg; 24 months, 18.78 ± 4.81 kcal/kg; 30 months, 18.12 ± 3.69 kcal/kg; p <0.001). Regarding the variables that influenced the BMR/kg, at 12 months, they were %LBM and intake of calcium-source foods (34%); at 24 months, it was protein intake (16%); and at 30 months, it was the intake of calcium-source foods (26.7%). CONCLUSION RYGB is associated with a significant increase in BMR when it is adjusted to body weight from 12 to 24 months postoperatively. Among the factors involved in the increase in BMR/kg are body composition and intake of protein-rich foods.
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Affiliation(s)
- Michelle T F Reichmann
- Universidade Federal do Paraná (UFPR), Rua General Carneiro, 181, Centro, Curitiba, PR, Brazil.
- , Curitiba, Brazil.
| | - Alexia Duarte
- Universidade Federal do Paraná (UFPR), Rua General Carneiro, 181, Centro, Curitiba, PR, Brazil
| | - Flavio Ivano
- Pontifícia Universidade Católica do Paraná (PUCPR), Rua Imaculada Conceição, Curitiba, PR, 1155, Brazil
| | - Antonio Carlos L Campos
- Universidade Federal do Paraná (UFPR), Rua General Carneiro, 181, Centro, Curitiba, PR, Brazil
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Vitiello A, Berardi G, Velotti N, Schiavone V, Manetti C, Musella M. Linear Versus Circular Laparoscopic Gastrojejunal Anastomosis of Roux-en-Y Gastric Bypass: Systematic Review and Meta-Analysis of 22 Comparative Studies. Surg Laparosc Endosc Percutan Tech 2022; 32:393-398. [PMID: 35583520 DOI: 10.1097/sle.0000000000001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/07/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the rate of complications of linear versus circular gastrojejunal anastomosis of laparoscopic Roux-en-Y gastric bypass. METHODS A systematic search of PubMed, Embase, and the Cochrane Library databases was carried out using the terms "laparoscopic," "circular," "linear," "anastomosis," "gastric bypass" in accordance to PRISMA guidelines. Only original articles in English language comparing linear versus circular anastomosis were included. No temporal interval was set. Outcome measures were wound infection, bleeding, marginal ulcer, leak, and stricture. Pooled odds ratio (OR) with a 95% confidence interval (CI) was calculated. Heterogeneity was assessed using the I2 statistic. Funnel plots were used to detect publication bias. RESULTS Twenty-two articles (7 prospective and 15 retrospective) out of 184 retrieved papers were included in this study. The pooled analysis showed a reduced odd of wound infection and bleeding after linear anastomosis. Likelihood of marginal ulcer, leak, and stricture was similar after the 2 techniques. Wound infection was reported in 15 studies (OR, 0.17; 95% CI, 0.06-0.45; P=0.0003; I2=91), bleeding in 9 (OR, 0.45; 95% CI, 0.34-0.59; P=0.00001; I2=6) marginal ulcer in 11 (OR, 0.61; 95% CI, 0.26-1.41; P=0.25; I2=65), leaks in 15 (OR, 0.61; 95% CI, 0.21-1.67; P=0.34; I2=83) and stricture in 18 (OR, 0.48; 95% CI, 0.23-1.00; P=0.05; I2=68). CONCLUSION Laparoscopic RYGB can be safely performed both with circular and linear staplers. Rates of wound infection and bleeding were significantly lower after linear gastrojejunal anastomosis.
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Affiliation(s)
- Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Naples, Italy
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Alalwan AA, Friedman J, Alfayez O, Hartzema A. Drug absorption in bariatric surgery patients: A narrative review. Health Sci Rep 2022; 5:e605. [PMID: 35509385 PMCID: PMC9059175 DOI: 10.1002/hsr2.605] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/14/2022] [Accepted: 03/19/2022] [Indexed: 12/17/2022] Open
Abstract
Background Despite the increase in the number of bariatric surgeries performed, little is known about the impact of the surgery on drug absorption. Unpredictability is assumed with drugs, given the anatomical changes after surgery. Objective To evaluate the impact of bariatric surgery on drug absorption based on the type of procedure performed. Methods We conducted a comprehensive literature review searching PubMed/Medline for published studies (from inception to December 2017) that evaluate the use of drugs and the assessment of drug absorption after bariatric surgery. Pharmacokinetic/pharmacodynamic studies, case reports, and observational studies were included in our review. Results We found 60 studies addressing drug use after bariatric surgery. Twenty‐eight studies reported a decrease in drug absorption after bariatric surgery while only four studies showed an increase in drug absorption. Unchanged absorption of drugs was seen in 23 studies after the surgery. Conclusion The available information shows variations in drug absorption after bariatric surgery. The unpredictability may result from factors related to the patient, drug, and/or type of surgery. Therefore, pharmacists' involvement and close monitoring of patients after bariatric surgery could be effective to avoid sub‐/supratherapeutic responses.
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Affiliation(s)
- Abdullah Abdulaziz Alalwan
- Department of Pharmacy Practice, College of Pharmacy Qassim University Qassim Saudi Arabia
- Pharmaceutical Outcomes and Policy, College of Pharmacy University of Florida Gainesville Florida USA
| | - Jeffrey Friedman
- Department of Surgery, UF Health Bariatric Surgery Center University of Florida Gainesville Florida USA
| | - Osamah Alfayez
- Department of Pharmacy Practice, College of Pharmacy Qassim University Qassim Saudi Arabia
| | - Abraham Hartzema
- Pharmaceutical Outcomes and Policy, College of Pharmacy University of Florida Gainesville Florida USA
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Bedirli A, Yavuz A, Dikmen K, Buyukkasap C, Ozaydin S. Robotic Roux-en-Y Gastric Bypass: A Single Surgeon's Experience with 527 Consecutive Patients. JSLS 2022; 26:JSLS.2021.00072. [PMID: 35444400 PMCID: PMC8993462 DOI: 10.4293/jsls.2021.00072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives Robotic bariatric surgery is increasingly adopted by surgeons. We present the surgical results of 527 consecutive patients who underwent robotic Roux-en-Y gastric bypass (RYGB) using the standard technique. Methods A retrospective analysis of a prospectively maintained database was performed including 527 consecutive patients who underwent robotic RYGB between January 1, 2018 and December 31, 2021. Results The mean age of the patients was 41 years, with a male/female sex distribution of 143/384 (27.1%/72.9%). Type 2 diabetes in the pre-operative period was diagnosed in 31% of patients. The median pre-operative body mass index (BMI) was 44.6 kg/m2 (range, 35-64). The mean operation time was 134 min for robotic RYGB, including the docking process. Early (< 30 days) complications included ileus (0.2%), atelectasis (0.2%), thromboembolic (0.2%) events, and surgical-site infection (0.2%). No leakage or bleeding of the gastrojejunal and jejunojejunal anastomoses were recorded. Oral food intake was begun at 1.8 days on average. The average hospital stay was 2 days. Despite a range of BMI values, operation times and gastrojejunal anastomosis times did not show significant differences. There were no significant differences in mean operation time or mean gastrojejunal anastomosis time over the years. Conclusions The robotic approach is effective and safe for patients undergoing RYGB. This technique provides satisfactory results with short-term surgical outcomes. However, the real benefits of robotic RYGB should be further evaluated by well-conducted randomized trials. Even in difficult cases with higher BMI values, optimal operation times and similar operative efficiency can be obtained if a standard operation technique is applied.
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Affiliation(s)
| | - Aydin Yavuz
- Department of General Surgery, Gazi University, Ankara, Turkey
| | - Kursat Dikmen
- Department of General Surgery, Gazi University, Ankara, Turkey
| | | | - Safa Ozaydin
- Department of General Surgery, Gazi University, Ankara, Turkey
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Du D, Wang L, Chen W, Sang Q, Zheng X, Lian D, Zhang N. Weight loss is the deciding factor to predict the outcome of RYGB in obese Chinese with a BMI < 35 kg/m 2. Asian J Surg 2021; 45:1682-1687. [PMID: 34642048 DOI: 10.1016/j.asjsur.2021.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/16/2021] [Accepted: 09/20/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is considered the gold standard procedure for bariatric surgery that leads to sustained weight loss and amelioration of obesity-related comorbidities. OBJECTIVES To verify long-term efficacy and safety and to investigate the influence of early weight loss on post-RYGB long-term weight maintenance in obese Chinese with body mass index (BMI) < 35 kg/m2. METHODS All patients were followed up for evaluating the variations in their BMI, percentage of excess weight loss (%EWL), and total body percentage weight loss (%TWL). Linear regression models were applied to evaluate the effects of early weight loss on successful weight maintenance. Optimal cutoff values were analyzed via plotting the receiver operative characteristic (ROC) curve. RESULTS In the current study, 143 patients were recruited. Preoperative BMI and weight were recorded as 32.24 (29.39-33.12) kg/m2, and 88.90 ± 9.52 kg, respectively. At 1, 3, and 5 years, successful weight loss i.e., greater than 25% TWL was attained by 46.85%, 37.76%, and 37.06% of patients, respectively. The obtained data revealed that %TWL at 0.5 years was considerably associated with %TWL for up to 5 years (P-value <0.001). Based on the ROC curve, %TWL of 24.39% at 0.5 years best predicted effective weight loss at 5 years (sensitivity 71.70%, specificity 82.22%). CONCLUSION RYGB is a safe and effective approach for weight loss and %TWL at 6 months might be used for predicting weight maintenance up to 5 years post-RYGB in obese Chinese with a BMI <35 kg/m2.
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Affiliation(s)
- Dexiao Du
- Department of General Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China.
| | - Liang Wang
- Department of General Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China.
| | - Weijian Chen
- Department of General Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China.
| | - Qing Sang
- Department of General Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China.
| | - Xuejing Zheng
- Department of General Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China.
| | - Dongbo Lian
- Department of General Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China.
| | - Nengwei Zhang
- Department of General Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China.
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Small bowel obstruction following laparoscopic Roux-en-Y gastric bypass: is it always necessary to operate? A 5-year, high volume center experience. Langenbecks Arch Surg 2021; 406:1839-1846. [PMID: 34259917 DOI: 10.1007/s00423-021-02262-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aims to describe the incidence, associated factors, etiology, and management of small bowel obstructions following laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS A retrospective analysis was conducted between January 15 and December 19 using the surgery database of our hospital. Included LRYGB patients were those that evolved with a prolonged length of stay; readmission; emergency room consult; and re-intervention due to small bowel obstruction (SBO) related symptoms with compatible radiological or intraoperative findings. The LRYGB technique implied an antecolic alimentary limb reconstruction and systematic closure of mesenteric defects. Descriptive and analytical statistics were carried out, using a parametric or non-parametric approach as needed. RESULTS Nine hundred forty-one LRYGB were performed. 9.9% were revisional surgeries of patients with a laparoscopic sleeve gastrectomy. During the study period, 36 SBOs occurred, representing 3.8% of operated patients, with no mortality. 58.3% had successful non-operative management, while 41.7% required surgical exploration, of which 73.3% were treated laparoscopically and 20% needed conversion to open surgery. Etiologies of SBO were jejuno-jejunostomy (JJO) related stenosis (22, 61.1%), internal hernias (6, 16.7%), adherences (3, 8.3%), and other diagnoses (5, 13.9%). Regarding JJO stenosis and internal hernias, median time to diagnosis was 8 days (IQR 7-11) and 12 months (IQR 8.7-16) respectively. Previous sleeve gastrectomy, age, or sex was not associated to the incidence of small bowel obstruction. CONCLUSIONS LRYGB is safe when performed by experienced surgeons. SBO due to internal hernias were scarce in this series. JJO stenosis could explain most cases of SBO; under this diagnosis, non-surgical management was successful frequently.
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Wiggins T, Pournaras DJ, Priestman E, Osborne A, Titcomb DR, Finlay I, Hopkins J, Hollyman M, Mason M, Noble H, Mahon D, Welbourn R. Effect of Preoperative Weight Loss and Baseline Comorbidity on Short-Term Complications and Reoperations After Laparoscopic Roux-en-Y Gastric Bypass in 2,067 Patients. Obes Surg 2021; 31:2444-2452. [PMID: 33768433 DOI: 10.1007/s11695-021-05331-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Decreasing popularity of Roux-en-Y gastric bypass (RYGB) in bariatric-metabolic surgery may be due to higher perceived peri-operative complications. There are few studies on whether preoperative weight loss can reduce complications or reoperations following RYGB. We investigated this using a standardised operative technique. MATERIALS AND METHODS Retrospective single-centre study of RYGB from 2004 to 2019 using a prospective database. Preoperative behavioural management included intentional weight loss. Maximum preoperative weight, weight on the day of operation, and Obesity-Surgery Mortality Risk Score (OS-MRS) class were recorded. Short-term outcomes (post-operative stay, 30-day complication and reoperation rates) were analysed. RESULTS In 2,067 RYGB patients (1,901 primary and 166 revisional), median preoperative total body weight loss (TWL) was 6.2% (IQR: 2.5-10.7%). The median age was 46 (interquartile range (IQR) 38-54) and 80.4% were female (n=1,661). For primary surgery, the median body mass index (BMI) was 47.6 kg/m2 (IQR: 43.1-53.3). Excluding the 100-procedure learning curve, the complication rate for primary cases was 4.4% and reoperation rate of 2.8% and one peri-operative mortality (0.06%). OS-MRS ≥2 (class B or C) predicted higher risk of complications (6.1%) compared to those with a score <2 (class A) (3.8%, p=0.021), but not reoperations. Five percent preoperative TWL did not decrease complications compared to <5% TWL. Patients with ≥10% TWL had greater baseline risk and had an increased risk of complications (6.6% vs 3.7%, p=0.017) and reoperations (4.5% vs 2.7%, p<0.001). CONCLUSIONS RYGB performed using a standardised technique has low overall risk. The influence of preoperative weight loss on outcomes was inconsistent.
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Affiliation(s)
- Tom Wiggins
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Dimitri J Pournaras
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Elena Priestman
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Alan Osborne
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Daniel R Titcomb
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Ian Finlay
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - James Hopkins
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Marianne Hollyman
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Matthew Mason
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Hamish Noble
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - David Mahon
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Richard Welbourn
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK.
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Girishekar B, Rawat S, Ananthasivan R, Reddy P, Patil P, Kaushik K. Role of Imaging in Bariatric Surgery: A Review of the Various Surgical Techniques and Their Complications. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0041-1725240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractAccording to the World Health Organization, obesity has reached epidemic proportions globally, with at least 2.8 million people dying each year as a result of being overweight or obese. Bariatric surgery is being increasingly used as a form of treatment, particularly in those patients where lifestyle modifications are deemed insufficient. With the role of radiologists transitioning from a medical to a surgical evaluation in obesity, it is becoming increasingly important to familiarize oneself with the various imaging techniques used in the preoperative and postsurgical evaluation in such cases. This article aims to review the various surgeries performed, their normal imaging appearance, and the various complications that could be encountered.
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Affiliation(s)
| | - Sudarshan Rawat
- Department of Radiology, Manipal Hospital, Bengaluru, Karnataka, India
| | - Rupa Ananthasivan
- Department of Radiology, Manipal Hospital, Bengaluru, Karnataka, India
| | - Pramesh Reddy
- Department of Radiology, Manipal Hospital, Bengaluru, Karnataka, India
| | - Pooja Patil
- Department of Radiology, Manipal Hospital, Bengaluru, Karnataka, India
| | - Kavya Kaushik
- Department of Radiology, Manipal Hospital, Bengaluru, Karnataka, India
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Beisani M, Sabench Pereferrer F, Vilallonga R, González López Ó, Molina López A, Del Castillo Dejardin D, García Ruiz de Gordejuela A, Fort López-Barajas JM, Armengol Carrasco M. Seeking an Initial-Weight-Independent Metric in a Mediterranean Cohort of Gastric Bypass Patients: the %AWL Revisited. Obes Surg 2021; 31:1524-1532. [PMID: 33398625 DOI: 10.1007/s11695-020-05154-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Most relative weight-loss metrics follow the formula "Weight loss(%) = 100 · (Initial BMI - Final BMI) / (Initial BMI-a)," where a is the reference point that defines the metric. The percentage of total weight loss (%TWL, a = 0) and percentage of excess weight loss (%EWL, a = 25) are influenced by a patient's initial weight. Recently, the percentage of alterable weight loss metric (%AWL, a = 13) has been reported to produce initial-weight-independent outcomes. OBJECTIVES This study aimed to replicate the methodology used for %AWL determination in a Mediterranean cohort of bariatric patients. SETTINGS Multicenter study in 10 large hospitals in Spain. METHODS Two large prospective databases were retrospectively searched for all primary laparoscopic gastric bypass patients with 2 years of follow-up. Outcomes at nadir were expressed and analyzed with 26 different metrics (a from 0 to 25), looking for the metric whose outcomes produced (1) the lowest coefficient of variation, (2) no differences between initially lighter and heavier patients, and (3) no correlation with patients' initial BMI. RESULTS A cohort of 1793 patients was stratified into 4 gender-age groups: younger women (YW, n = 733), older women (OW, n = 674), younger men (YM, n = 197), and older men (OM, n = 189). The calculations suggested an optimal reference point of 18 kg/m2, defining a new metric (percentage of Mediterranean alterable weight loss, %MAWL). When %TWL, %EWL, %AWL, and %MAWL were tested on the whole sample, only %MAWL produced initial-weight-independent results. CONCLUSIONS In our Mediterranean cohort of patients, a reference point of 18 (and not 13) yielded initial-weight-independent outcomes.
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Affiliation(s)
- Marc Beisani
- General and Digestive Surgery Department, Vall d'Hebron University Campus, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Fàtima Sabench Pereferrer
- General and Digestive Surgery Department, Pere Virgili Health's Institute, Faculty of Medicine, University Hospital of Sant Joan de Reus, Avinguda del Doctor Josep Laporte, 2, 43204, Reus, Spain
| | - Ramón Vilallonga
- General and Digestive Surgery Department, Vall d'Hebron University Campus, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Óscar González López
- General and Digestive Surgery Department, Vall d'Hebron University Campus, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Alicia Molina López
- General and Digestive Surgery Department, Pere Virgili Health's Institute, Faculty of Medicine, University Hospital of Sant Joan de Reus, Avinguda del Doctor Josep Laporte, 2, 43204, Reus, Spain
| | - Daniel Del Castillo Dejardin
- General and Digestive Surgery Department, Pere Virgili Health's Institute, Faculty of Medicine, University Hospital of Sant Joan de Reus, Avinguda del Doctor Josep Laporte, 2, 43204, Reus, Spain
| | - Amador García Ruiz de Gordejuela
- General and Digestive Surgery Department, Vall d'Hebron University Campus, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - José Manuel Fort López-Barajas
- General and Digestive Surgery Department, Vall d'Hebron University Campus, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Manel Armengol Carrasco
- General and Digestive Surgery Department, Vall d'Hebron University Campus, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
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El Ansari W, El-Ansari K. Missing something? A scoping review of venous thromboembolic events and their associations with bariatric surgery. Refining the evidence base. Ann Med Surg (Lond) 2020; 59:264-273. [PMID: 33133579 PMCID: PMC7588328 DOI: 10.1016/j.amsu.2020.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/09/2020] [Accepted: 08/09/2020] [Indexed: 11/01/2022] Open
Abstract
Background Venous thromboembolic events (VTE) post-bariatric surgery (BS) lead to morbidity and mortality. Methods This scoping review assessed whether reported VTE post-BS could be under/over-estimated; suggested a possible number of VTE post-BS; appraised whether VTE are likely to decrease/increase; examined BS as risk/protective factor for VTE; and mapped the gaps, proposing potential solutions. Results VTE appears under-estimated due to: identification/coding of BS and VTE; reporting of exposure (BS); and reporting of outcomes (VTE). The review proposes a hypothetical calculation of VTE post-BS. VTE are unlikely to decrease soon. BS represents risk and protection for VTE. Better appreciation of VTE-BS relationships requires longer-term strategies. Conclusion VTE are underestimated. Actions are required for understanding the VTE-BS relationships to in order to crease VTE by better-informed prevention strategy/ies.
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Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad General Hospital, 3050, Doha, Qatar.,College of Medicine, Qatar University, Doha, Qatar.,Schools of Health and Education, University of Skovde, Skövde, Sweden
| | - Kareem El-Ansari
- Volunteer, Hamad General Hospital, Hamad Medical Corporation, 3050, Doha, Qatar
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12
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Nurczyk K, Herbella FA, Patti MG. Roux-en-Y Gastric Bypass for Obesity. How We Do It. J Laparoendosc Adv Surg Tech A 2020; 30:623-626. [DOI: 10.1089/lap.2020.0156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Kamil Nurczyk
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- 2nd Department of General and Gastrointestinal Surgery, and Surgical Oncology of the Alimentary Tract, Medical University of Lublin, Lublin, Poland
| | - Fernando A. Herbella
- Department of Surgery, Escola Paulista de Medicina, Federal University of São Paulo, Brazil
| | - Marco G. Patti
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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13
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Velázquez-Fernández D, Sánchez H, Monraz F, Zanela OO, Cabra HA, Pantoja JP, Sierra M, Mosti M, Herrera MF. Development of an Interactive Outcome Estimation Tool for Laparoscopic Roux-en-Y Gastric Bypass in Mexico Based on a Cohort of 1002 Patients. Obes Surg 2020; 29:2878-2885. [PMID: 31104284 DOI: 10.1007/s11695-019-03929-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is one of the most commonly performed bariatric procedures. Considering significant differences between populations around the world, surgical outcomes may vary widely. The aim of the study was to develop an educational patient-specific interactive application that may estimate the potential outcomes of LRYGB in the Mexican population. METHODS A database with 76 different variables from 1002 patients who underwent LRYGB at two Mexican Institutions between 1992 and 2014 and had a minimum of 6-month follow-up was analyzed. Descriptive and inferential statistics, as well as a multivariate regression analysis, were performed for the primary analysis. Results were based on four statistical models obtained from the cohort outcomes. A tool was designed to provide estimates of absolute weight loss (AWL) and resolution of four major comorbidities: type 2 diabetes (T2D), high blood pressure (HBP), hypercholesterolemia, and the obstructive syndrome of sleep apnea (OSAS). RESULTS There were 353 males (35.2%) and 649 females (64.8%) with a mean age of 41.9 ± 12.1 years and a mean preoperative BMI of 45.3 ± 7.9 kg/m2. Mean AWL at 2 years was 39.02 ± 12.7 kg. Mean accumulative percentage of resolution for T2D, HBP, and dyslipidemias at the same time period was 78%, 66.2%, and 84.7%, respectively. Based on these results, the educational tool was developed. CONCLUSIONS We were able to develop an interactive estimation application to provide a population-based guidance for potential outcomes of LRYGB. This might be useful not only for health professionals but also for patients interested in learning potential outcomes in specific circumstances.
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Affiliation(s)
- David Velázquez-Fernández
- Endocrine and Advanced Laparoscopic Surgery Unit, Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Hugo Sánchez
- Clinic for Nutrition and Obesity, ABC Medical Center, Mexico CIty, Mexico
| | - Fernando Monraz
- Endocrine and Advanced Laparoscopic Surgery Unit, Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Olivo Omar Zanela
- Health Economics & Market Access, Johnson & Johnson Medical, Mexico CIty, Mexico
| | - Hermilo Arturo Cabra
- Health Economics & Market Access, Johnson & Johnson Medical, Mexico CIty, Mexico
| | - Juan Pablo Pantoja
- Endocrine and Advanced Laparoscopic Surgery Unit, Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mauricio Sierra
- Endocrine and Advanced Laparoscopic Surgery Unit, Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Maureen Mosti
- Clinic for Nutrition and Obesity, ABC Medical Center, Mexico CIty, Mexico
| | - Miguel F Herrera
- Endocrine and Advanced Laparoscopic Surgery Unit, Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. .,Clinic for Nutrition and Obesity, ABC Medical Center, Mexico CIty, Mexico.
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14
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Lo HC. Fundectomy as a Modified Technique for One Anastomosis Gastric Bypass. Am Surg 2020. [DOI: 10.1177/000313482008600410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hung-Chieh Lo
- Division of Trauma and Emergency Surgery Department of Surgery Wan Fang Hospital Taipei Medical University Taipei, Taiwan School of Medicine College of Medicine Taipei Medical University Taipei, Taiwan
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15
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Lo HC. The learning curve of one anastomosis gastric bypass and its impact as a preceding procedure to Roux-en Y gastric bypass: initial experience of one hundred and five consecutive cases. BMC Surg 2020; 20:37. [PMID: 32101137 PMCID: PMC7045633 DOI: 10.1186/s12893-020-00697-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/13/2020] [Indexed: 12/17/2022] Open
Abstract
Background The aim of this study was to assess the learning curve of one anastomosis gastric bypass (OAGB-MGB) at the start of a low volume bariatric unit and analyze its impact as a preceding procedure to Roux-en Y gastric bypass (RYGB). Methods From January 2014 to December 2017, all patients who underwent bariatric surgeries in our teaching hospital that were performed by the same surgeon were enrolled. The first 47 patients who underwent OAGB-MGB were assigned to group A. RYGB has been offered as a treatment option since July 2016; thereafter, 26 patients who underwent OAGB-MGB and 32 patients who underwent RYGB at the same time interval were assigned to group B and group C, respectively. Baseline characteristics, perioperative outcomes and percentage of total weight loss (%TWL) up to 12 months postoperatively were collected and analyzed between groups. Results Compared to the patients in group C, those in groups A and B were older (39.4 yrs. and 42.2 yrs., respectively, vs. 34.2 yrs.; p = 0.021) and predominantly male (48.9 and 73.1%, respectively vs. 40.6%; p = 0.04), and they had a higher body mass index (41.8 kg/m2 and 43.3 kg/m2, respectively vs. 37.7 kg/m2; p = 0.002) and a higher incidence of hypertension (44.7 and 61.5%, respectively vs. 21.9%; p = 0.008). In addition, the operation time was significantly reduced (118.2 min and 115.8 min, respectively vs. 153.1 min; p < 0.001), and the length of stay was shortened (3.0 days and 2.9 days, respectively vs. 3.4 days; p = 0.002) in groups B and C compared to group A. No mortality, conversion or leakage was reported throughout the study period. The 30-day complication rate was decreased in group C compared to groups A and B (0% vs. 6.4 and 7.7%, respectively; p = 0.307). The %TWL at the 12-month follow-up was 36.3, 30.9 and 28.3% for groups A, B and C, respectively (p < 0.001). Conclusion Our study verified the early emergence of a learning curve effect for OAGB-MGB, and the proficiency acquired can be transferred to subsequent practice for RYGB in terms of acceptable operation time and length of stay without an increase in complications.
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Affiliation(s)
- Hung-Chieh Lo
- Division of Trauma and Emergency Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan, Republic of China. .,School of Medicine, College of Medicine, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan, Republic of China.
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16
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Bassiouny RH, Chalabi NAM. Value of contrast-enhanced multidetector computed tomography in imaging of symptomatic patients after laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-019-0090-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Abstract
Background
To assess the role of contrast-enhanced multidetector computed tomography (MDCT) in the assessment of symptomatic patients following laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy.
Results
We reviewed the studies of 129 cases and found complications in 113 patients: 55 early complications and 48 late complications. All of these complications were diagnosed with intravenous contrast-enhanced MDCT. Statistically significant difference was found between UGIS and MDCT in the diagnosis of many cases.
Conclusion
The rate of complications in bariatric surgery is high and the associated mortality is not negligible. The interpreting radiologists should know the normal postoperative findings and be aware of possible complications.
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17
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First assistant impact on early morbidity and mortality in bariatric surgery. Surg Obes Relat Dis 2019; 15:1541-1547. [DOI: 10.1016/j.soard.2019.06.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 12/21/2022]
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18
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Guraya SY, Strate T. Effectiveness of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy for morbid obesity in achieving weight loss outcomes. Int J Surg 2019; 70:35-43. [PMID: 31408745 DOI: 10.1016/j.ijsu.2019.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/08/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are commonly performed weight loss procedures worldwide. Unfortunately, few studies have compared percentage total weight loss (%TWL) following these procedures. This research compared short-term, mid-term and long-term %TWL by LRYGB and LSG. METHODS Selected databases were searched for original articles that compared %TWL by LSG and LRYGB. Review manager 5.3 was used for data analysis. Effect summary was presented by forest plot. RESULTS A significantly better %TWL in 5 years was shown by LRYGB than LSG; pooled mean difference (MD) 1.87 (95% CI 0.27-3.48, z statistics = 2.28, p < 0.05). Subgroup analysis showed better %TWL by LRYGB than LSG at 24 months pooled MD 6.47 (95% CI 1.22-11.72, z statistics = 2.42, p < 0.05), however, better %TWL by LSG was noted after 36 months (pooled MD -0.23; 95% CI -0.39-0.06, z statistics = 2.65, p < 0.05). Finally, significantly better %TWL was noted for LRYGB at 60 months. CONCLUSION This study shows %TWL of 70.4% by LRYGB and 59.8% following LSG in at least half of patients from selected cohort. A significantly greater %TWL by LRYGB in short and long term, while higher %TWL by LSG in mid-term is reported.
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Affiliation(s)
| | - Tim Strate
- Head of the Department of Surgery, Reinbek Hospital, Academic Teaching Hospital of the University of Hamburg, Hamburger Straße 33, D-21465, Reinbek, Germany.
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19
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Bhandari M, Nautiyal HK, Mathur W, Kosta S. OAGB vs BGBP: A retrospective comparative study of a cohort of patients who had bariatric surgery in 2012 at one centre by a single surgeon. Clin Obes 2019; 9:e12308. [PMID: 30957418 DOI: 10.1111/cob.12308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 12/17/2022]
Abstract
Two modifications of Roux-en-Y gastric bypass (RYGB), one anastomosis gastric bypass (OAGB) and Roux-en-Y banded gastric bypass (BGBP), are gaining popularity in use because the OAGB is reported to be a simpler operation, and the BGBP is reported to have sustained weight loss compared to standard RYGB. A retrospective review and analysis of data comparing outcomes up to 5 years after BGBP and OAGB from a prospectively maintained database of all bariatric metabolic operations in 2012 was performed. Eighty-two patients underwent a BGBP and 90 an OAGB. The average age and body mass index were 44.12 and 43.97 and 43.57 and 45.79 in the BGBP and OAGB groups, respectively. Postoperative nutrient deficiencies were similar in both groups but were more prominent in the OAGB group. The % excess body weight loss (%EBWL) was 78% and 71.5% at 5 years in the OAGB and BGBP groups, respectively. The % total weight loss (%TWL) was also higher in OAGB compared to the BGBP group, 34.72% and 30.49%, respectively. Resolution of type 2 diabetes (T2DM) was significantly higher in the OAGB group, 79.16%, than in the BGBP group, 71.42%. The resolution of dyslipidaemia and hypertension were similar in both groups, but sleep apnoea resolution was higher in OAGB group. Both operations produced excellent weight loss in the intermediate term. The %EBWL and resolution of T2DM were significantly higher after the OAGB operation at the expense of increased incidence of nutrient deficiencies and hypoproteinemia. Quality of life improvement and patient satisfaction were high after both operations. Long-term follow up and multicentre prospective studies are needed to confirm these intermediate outcomes.
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Affiliation(s)
- Mohit Bhandari
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore, India
| | | | - Winni Mathur
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore, India
| | - Susmit Kosta
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore, India
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Abstract
Obesity is a major health and economic crisis facing the modern world. It is associated with excess mortality and morbidity and is directly linked to common conditions such as type 2 diabetes mellitus, coronary heart disease and sleep apnoea. The management of obesity and its associated complications has evolved in recent years, with a shift towards more definitive strategies such as bariatric surgery. This review encompasses the dietary, pharmacological and surgical strategies currently available for the management of obesity.
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21
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22
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Park JY, Kim YJ. Validation of the Alterable Weight Loss Metric in Morbidly Obese Patients Undergoing Gastric Bypass in Korea. Obes Surg 2018. [DOI: 10.1007/s11695-017-3084-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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23
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Taha O, Abdelaal M, Abozeid M, Askalany A, Alaa M. Outcomes of Omega Loop Gastric Bypass, 6-Years Experience of 1520 Cases. Obes Surg 2018; 27:1952-1960. [PMID: 28303503 DOI: 10.1007/s11695-017-2623-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Omega loop gastric bypass (OLGB) has been viewed with skepticism after the failure of the "old Mason loop." During the past 15 years, a growing number of authors worldwide approved that OLGB is a safe and effective procedure, which appears clearly from the operative outcome and long-term follow-up of consecutive cohort studies of patients who underwent OLGB. The aim of this study is to evaluate the outcomes of OLGB at the bariatric center of our university hospital between 2009 and 2015. METHODS The data of 1520 patients who underwent OLGB from November 2009 to December 2015 at our center were reviewed. Mean age was 37.15 years, mean preoperative BMI was 46.8 ± 6.6 kg/m2, mean preoperative weight was 127.4 ± 25.3 kg, and 62.7% were women. Diabetes mellitus (DM) affected 683 (44.9%) of the 1520 patients, whereas 773 of the 1520 patients (50.9%) presented with hypertension. The mean operative time was 35 min. RESULTS The 1-year postoperative BMI mean decreased to 29.6 ± 3.1 kg/m2, and at the 3-year follow-up, it was 27.5 ± 3.4 kg/m2. The mean of weight decreased to 81.3 ± 16.7 kg and to 78.9 ± 16.9 kg at the 1-year and the 3-year follow-up, respectively. Mortality rate was 0.1%. Overall complications were 9.3%; 0.8% required reoperations. Early complications were encountered in 50 patients (3.3%), and the late complications rate was (6.1%). CONCLUSIONS In this study, greater excess weight loss was observed with OLGB which appeared to be a short, simple, low-risk, effective, and durable bariatric procedure.
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Affiliation(s)
- Osama Taha
- Plastic and Obesity Surgery Department, Assiut University Hospital, Assiut, Egypt
- Overweight Clinics, Cairo, Egypt
- Bariatric Unit, Plastic Surgery Department, Assiut University Hospital, Assiut, Egypt
| | - Mahmoud Abdelaal
- Plastic and Obesity Surgery Department, Assiut University Hospital, Assiut, Egypt.
- Overweight Clinics, Cairo, Egypt.
- Bariatric Unit, Plastic Surgery Department, Assiut University Hospital, Assiut, Egypt.
| | - Mohamed Abozeid
- Overweight Clinics, Cairo, Egypt
- General Surgery Department, Ain Shams University Hospital, Ain Shams University, Cairo, Egypt
| | - Awny Askalany
- Plastic and Obesity Surgery Department, Assiut University Hospital, Assiut, Egypt
- Overweight Clinics, Cairo, Egypt
- Bariatric Unit, Plastic Surgery Department, Assiut University Hospital, Assiut, Egypt
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Mid-Term Remission of Type 2 Diabetes Mellitus After Laparoscopic Roux En-Y Gastric Bypass. World J Surg 2017; 40:2719-2725. [PMID: 27307088 DOI: 10.1007/s00268-016-3609-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Laparoscopic Roux en-Y gastric bypass (LRYGB) is an established therapeutic modality for type 2 diabetes mellitus (T2DM). However, there is paucity of data on the outcomes of LRYGB on T2DM beyond 2 years. This study aimed to examine the medium-term effects of LRYGB on T2DM and determine the predictors of T2DM resolution. METHODS Prospective data were collected for all consecutive LRYGB performed from September 2009 to November 2010. The American Diabetes Association guidelines were used to define complete (CR) or partial (PR) remission of diabetes. Diabetes status was considered improved when there was >50 % reduction in the dose of medications or when glycaemic control was achieved after stopping insulin. The effects of baseline characteristics, diabetes data and weight loss data at 4 years on T2DM remission were studied. RESULTS Forty-six patients with T2DM underwent LRYGB with mean ± SD age and body mass index (BMI) of 48.6 ± 9.6 years and 50.4 ± 6.5 kg/m2, respectively. Median (IQR, interquartile range) duration of T2DM preoperatively was 60 (36-126) months. Median (IQR) follow-up was 52 (50-57) months. T2DM remission was achieved in 64 % of patients (44 % CR, 20 % PR), and a further 28 % of patients had improvement in their diabetes status. Multivariate analyses demonstrated significant excess weight loss (EWL) [P = 0.008] and lower BMI [P = 0.04] at 4 years to be the only independent predictors of T2DM medium-term outcomes. CONCLUSION The medium-term effects of LRYGB on T2DM remission/improvement were maintained in 92 % of patients. EWL and lower BMI at 4 years were independent predictors of T2DM remission.
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Sepúlveda M, Alamo M, Saba J, Astorga C, Lynch R, Guzmán H. Long-term weight loss in laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2017; 13:1676-1681. [PMID: 28807556 DOI: 10.1016/j.soard.2017.07.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/08/2017] [Accepted: 07/10/2017] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) has become an option as a bariatric surgical technique. There is a lack of long-term results of this procedure in the literature. The aim of this study is to present weight loss results of LSG for up to 7 years of follow-up. METHODS A retrospective series of patients who underwent LSG between 2008 and 2011 was examined. The primary endpoint was weight loss: percentage of excess weight loss (%EWL), percentage of total weight loss (%TWL), and body mass index (BMI) were reported. Failure was defined as %EWL<50%. Multivariate analysis for weight loss was performed. The complications rate was reported. RESULTS A total of 148 patients met the inclusion criteria; 76.3% were female. Mean preoperative BMI was 36 ± 4 kg/m2. Mean operative time was 89.3 ± 3.2 minutes. Follow-up at 5, 6, and 7 years was 77.7%, 83.3%, and 82.2%, respectively. Mean %EWL and %TWL at 1, 3, 5, and 7 years was 93.2%, 80.7%, 70.6%, and 51.7%, and 27.2%, 23.3%, 20.4%, and 16.3%, respectively. The failure rate was 30.4% at the fifth year and 51.4% at the seventh year. High preoperative BMI was related to worse %EWL (P<0.001) but not to %TWL. Preoperative BMI<35 kg/m2 was associated with better %EWL but not with %TWL (P = 0.003). Four leaks (2.7%) and no mortalities were reported. CONCLUSIONS LSG is an acceptable surgical technique for weight loss, but in this series, up to one third of the patients fail at the fifth year and half fail in the seventh year. %EWL is better in patients with BMI<35 kg/m2, but this difference disappears when we express outcomes with %TWL.
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Affiliation(s)
- Matías Sepúlveda
- Hospital DIPRECA, Santiago, Chile; Universidad Diego Portales, Santiago, Chile.
| | | | - Jorge Saba
- Hospital DIPRECA, Santiago, Chile; Universidad Diego Portales, Santiago, Chile
| | - Cristián Astorga
- Hospital DIPRECA, Santiago, Chile; Universidad Diego Portales, Santiago, Chile
| | - Raúl Lynch
- Hospital DIPRECA, Santiago, Chile; Universidad Diego Portales, Santiago, Chile
| | - Hernán Guzmán
- Hospital DIPRECA, Santiago, Chile; Universidad Diego Portales, Santiago, Chile
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26
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Chew CAZ, Shabbir A. Revisional Bariatric Surgery: Focus on Quality of Life. J Obes Metab Syndr 2017; 26:97-101. [PMID: 31089502 PMCID: PMC6484905 DOI: 10.7570/jomes.2017.26.2.97] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 03/23/2017] [Accepted: 04/20/2017] [Indexed: 11/25/2022] Open
Abstract
Bariatric surgery is considered to be the most effective treatment for morbid obesity. At present, revisional surgery is considered in patients who experience complications, or in whom the intended weight loss is not achieved. However, as there is no consensus on what constitutes failure of primary surgery, there are no guidelines on who should receive revisional surgery. Physical parameters alone may be insufficient and quality of life has emerged as an alternative to provide a holistic appraisal of the outcome of primary surgery and the need for further revisional surgery in bariatric patients. Quality of life surveys such as short form health survey (SF-36) or Moorehead-Ardelt II (MA-II) assess the patients’ perception of their weight and can also be used to assess the impact of post-operative complications such as gastro-esophageal reflux disease or dysphagia. However, unrealistic expectations of weight loss have been shown to be prevalent in bariatric patients and patients who seek revisional surgery on the basis of disappointment with the primary outcome are unlikely to be satisfied with the revisional outcome. Indications for re-operative surgery must be tailored to improve the quality and longevity of each individual patient’s life. Long term studies are required to investigate and validate quality of life as an indication for revisional surgery.
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Affiliation(s)
| | - Asim Shabbir
- Department of Surgery, Division of Upper Gastrointestinal Surgery, National University Hospital, Singapore
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27
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Roy DJ, Langworthy DR, Thurber KM, Lorentz PA, Dierkhising RA, Mundi MS. Comparison of oral antibiotic failure rates in post-Roux-en-Y gastric bypass patients versus controls. Surg Obes Relat Dis 2017; 13:1524-1529. [PMID: 28545917 DOI: 10.1016/j.soard.2017.03.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/06/2017] [Accepted: 03/28/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Due to the malabsorptive nature of the Roux-en-Y gastric bypass (RYGB), there is a potential for impaired absorption of oral medications. Clinical outcomes of patients who receive oral antibiotics after RYGB have not been adequately described in the literature. OBJECTIVES The primary objective was composite therapeutic failure. Secondary objectives included comparing failure rates between antibiotic classes and at various time points since RYGB. SETTING University hospital, United States. METHODS Patients with a history of RYGB and controls who received an eligible oral antibiotic for urinary tract infection, skin and soft tissue infection, or community acquired pneumonia between April 1, 2008, and September 30, 2015, were included via retrospective chart review. Therapeutic failure rates between groups were compared and adjusted for body mass index and infection type. Failure rates among antibiotic classes and various time points since RYGB (0-1 yr, 1-1.9 yr, and≥2 yr) were also compared. RESULTS A total of 58 RYGB and 128 controls met inclusion and exclusion criteria. Composite therapeutic failure occurred in the RYGB and control group in 14 (24.1%) and 20 patients (15.6%), respectively (P = .18; odds ratio, 1.8; 95% confidence interval .8-4.4). RYGB patients who received fluoroquinolones or sulfonamides had a significantly increased risk of therapeutic failure. CONCLUSIONS RYGB was not associated with a statistically significant increased risk of composite therapeutic failure of oral antibiotics in the treatment of urinary tract infection, skin and soft tissue infection, or community acquired pneumonia compared with patients with no history of gastrointestinal resection. Further research is warranted to understand clinical outcomes of RYGB patients who receive oral antibiotics.
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Affiliation(s)
- David J Roy
- Department of Pharmacy Services, Mayo Clinic Hospital - Rochester, Minnesota.
| | | | - Kristina M Thurber
- Department of Pharmacy Services, Mayo Clinic Hospital - Rochester, Minnesota
| | - Paul A Lorentz
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic Hospital - Rochester, Minnesota
| | - Ross A Dierkhising
- Division of Biomedical Statistics and Informatics, Mayo Clinic Hospital - Rochester, Minnesota
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic Hospital - Rochester, Minnesota
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Taha O, Abdelaal M, Abozeid M, Askalany A, Alaa M. Outcomes of One Anastomosis Gastric Bypass in 472 Diabetic Patients. Obes Surg 2017; 27:2802-2810. [PMID: 28534188 DOI: 10.1007/s11695-017-2711-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The positive impact of Roux-en-Y gastric bypass (RYGB) on metabolic syndrome and glycemic control has been proven in obese patients. One anastomosis gastric bypass (OAGB) is a simple, effective and easy to learn procedure. OAGB provides encouraging results for the treatment of diabetes obese patients, but does it have the ability to be an alternative procedure to RYGB in the treatment of these patients? The aim of this study is to evaluate the outcomes of OAGB on diabetic obese patients at the bariatric centre of our university hospital. By extension, we evaluated the possibility of BMI and the preoperative antidiabetic medication usage to be predictive factors for postoperative diabetes resolution. METHODS This is a retrospective single-centre study of 472 diabetic patients who underwent OAGB from November 2009 to December 2015. All patients were followed-up for at least 1 year, and up to 3 years, where available. Weight, HbA1c, and anti-diabetic medications were recorded at baseline, 3, 6, 12, 24 and 36 months. RESULTS A total of 472 patients have been followed-up for 1 year and 361 for 3 years. The mean BMI decreased from 46.8 ± 7.2 to 29.5 ± 2.8 kg/m2 and HbA1c from 9.6 ± 1.3 to 5.7 ± 1.5% at the 12-month follow-up. At the 3-year follow-up, the mean BMI was 32.1 ± 3.3 and HbA1c mean was 5.8 ± 0.9%. Diabetes remission was achieved by 84.1% of patients. CONCLUSIONS OAGB can be an excellent alternative to RYGB for the treatment of diabetes and obesity. Pre-operative medications may be used to predict postoperative diabetes remission, but not BMI.
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Affiliation(s)
- Osama Taha
- Plastic and Obesity Surgery Department, Assiut University Hospital, Assiut, Egypt.,Overweight Clinics, Cairo, Egypt
| | - Mahmoud Abdelaal
- Plastic and Obesity Surgery Department, Assiut University Hospital, Assiut, Egypt.
| | - Mohamed Abozeid
- General Surgery Department, Ain Shams University hospital, Cairo, Egypt
| | - Awny Askalany
- Plastic and Obesity Surgery Department, Assiut University Hospital, Assiut, Egypt
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Predictors of Inadequate Weight Loss After Laparoscopic Gastric Bypass for Morbid Obesity. Obes Surg 2016; 27:1446-1452. [DOI: 10.1007/s11695-016-2500-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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The technical outcomes of delta-shaped anastomosis in laparoscopic distal gastrectomy: a single-center safety and feasibility study. Surg Endosc 2016; 31:1257-1263. [PMID: 27444837 DOI: 10.1007/s00464-016-5103-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 07/09/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND The indications for laparoscopic gastrectomy for early stomach cancer have spread worldwide, and the short-term outcomes have been favorable. Intraabdominal delta-shaped gastroduodenostomy using endoscopic linear staplers, a technique which was developed by Kanaya et al. is one of the feasible reconstructive procedures. Pure laparoscopic surgery is reported to be associated with several intraoperative and postoperative advantages in comparison with laparoscopy-assisted surgery. However, the clinical results remain uncertain. The present study aimed to evaluate both the technical feasibility and safety of delta-shaped anastomosis with LDG according to the short-term outcomes. METHODS The study group was composed of 229 patients who underwent delta-shaped anastomosis with LDG at Gifu University School of Medicine from December 2004 to December 2014. RESULTS The median total operative blood loss and operative time were 20 ml and 277 min, respectively. Postoperative complications were detected in 20 (8.7 %) patients. The complications included: anastomotic stenosis, n = 3 (1.3 %); anastomotic leakage, n = 3 (1.3 %); pancreatic injury, n = 8 (3.5 %); anastomotic ulcer, n = 1 (0.4 %); bowel obstruction, n = 1 (0.4 %); abdominal abscess, n = 1 (0.4 %); lymphorrhea, n = 1 (0.4 %); cardiac failure, n = 1 (0.4 %); and infection, n = 1 (0.4 %). The complications were classified as grade 2, n = 4 (1.7 %); grade 3a, n = 12 (5.2 %); grade 3b, n = 4 (1.7 %); and grade 4 and 5, n = 0 (0 %). CONCLUSION The findings of the present study indicate the safety of Kanaya's procedure and that it should provide better outcomes in patients who undergo intracorporeal gastroduodenostomy after laparoscopic distal gastrectomy.
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Park JY, Kim YJ. Reply to the Letter to Editor Entitled "The %EBMIL/%EWL Double-Booby Trap. A Comment on Studies that Compare the Effect of Bariatric Surgery Between Heavier and Lighter Patients". Obes Surg 2016; 26:614-6. [PMID: 26620216 DOI: 10.1007/s11695-015-1970-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ji Yeon Park
- Department of Surgery, National Cancer Center, Goyang, Republic of Korea
| | - Yong Jin Kim
- Department of Surgery, Soonchunhyang University Seoul Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul, 140-743, Republic of Korea.
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Laparoscopic Roux en-Y Gastric Bypass Using a Modified Retrocolic–Supracolic Approach: Outcomes from 300 Patients. World J Surg 2016; 40:1918-24. [DOI: 10.1007/s00268-016-3478-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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A Challenge between Trainee Education and Patient Safety: Does Fellow Participation Impact Postoperative Outcomes Following Bariatric Surgery? Obes Surg 2016; 26:1999-2005. [DOI: 10.1007/s11695-016-2073-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Effect of probiotics on postoperative quality of gastric bypass surgeries: a prospective randomized trial. Surg Obes Relat Dis 2016; 12:57-61. [DOI: 10.1016/j.soard.2015.07.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 07/11/2015] [Accepted: 07/15/2015] [Indexed: 11/19/2022]
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Quezada N, León F, Jones A, Varas J, Funke R, Crovari F, Raddatz A, Pérez G, Escalona A, Boza C. High frequency of internal hernias after Roux-en-Y gastric bypass. Obes Surg 2015; 25:615-21. [PMID: 25638655 DOI: 10.1007/s11695-014-1302-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Internal hernias (IH) after Roux-en-Y gastric bypass (RYGB) are a serious concern among surgeons and are often under-diagnosed due to heterogeneity of clinical manifestations. Our aim is to assess the frequency of IH after a RYGB in symptomatic and asymptomatic patients. METHODS Retrospective analysis of our bariatric surgery unit's database between 2001 and 2013 is obtained. Patients are surgically explored after RYGB due to acute bowel obstruction (ABO), intermittent abdominal pain (IAP), or being asymptomatic (during an elective cholecystectomy) in whom anatomical presence of IH was established. Also, we compared patients with retrocolic and antecolic technique. Statistical analysis with non-parametric tests and chi-square are used. RESULTS Of the patients, 3,656 submitted to RYGB during this period, 81.9% (2,993) by laparoscopy and 26.3% (963) with retrocolic technique. Of the patients, 130 (3.5%) were surgically explored due to ABO, 27 patients (0.7%) due to IAP, and 93 patients (2.5%) submitted to an elective cholecystectomy with exploration for IH. IH was present in 75% of the obstructed patients, and in 69%, it was the cause of obstruction. Patients with IAP showed 59% of IH, but only 15% have herniated bowel. In asymptomatic patients, 25% showed IH and none of them have herniated bowel. Retrocolic technique showed a higher risk of whole causes of ABO and IH than the antecolic technique, with a relative risk of 1.53 (1.07-2.17) and 1.62 (1.06-2.47), respectively. CONCLUSIONS A high frequency of IH exists in all operated patients of this series. All members of the bariatric team should be aware of the symptoms related to IH and actively pursue it during follow-up.
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Affiliation(s)
- Nicolás Quezada
- Bariatric Surgery Unit, Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, Patio Interior, Santiago, Chile,
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Abstract
Single-anastomosis (mini-) gastric bypass (SAGB) was proposed by Dr. Robert Rutledge. Criticism and prejudice against this procedure was raised by surgeons who preferred a more difficult procedure, laparoscopic Roux-en-Y gastric bypass (RYGB). Increasing data indicates the procedure is an effective and durable bariatric procedure. SAGB has lower operation risks compared to RYGB. The weight loss is better after SAGB because of a greater malabsorptive component than RYGB, but SAGB had a higher incidence of micronutrient deficiencies. Randomized controlled trial and long-term data demonstrate that SAGB can be regarded as a simpler and safer alternative to RYGB. We propose this procedure to be renamed "single-anastomosis gastric bypass (SAGB)" because the key feature of SAGB is the "single anastomosis" compared with the two anastomoses of RYGB.
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Affiliation(s)
- Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, National Taiwan University, No. 168, Chin Kuo Road, Taoyuan, Taiwan, Republic of China,
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Kular KS, Manchanda N, Rutledge R. A 6-year experience with 1,054 mini-gastric bypasses-first study from Indian subcontinent. Obes Surg 2015; 24:1430-5. [PMID: 24682767 DOI: 10.1007/s11695-014-1220-3] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND We started laparoscopic mini-gastric bypass (MGB) for the first time in India in February 2007 for its reported safety, efficacy, and easy reversibility. METHODS A retrospective review of prospectively maintained data of all 1,054 consecutive patients (342 men and 712 women) who underwent MGB at our institute from February 2007 to January 2013 was done. RESULTS Mean age was 38.4 years, preoperative mean weight was 128.5 kg, mean BMI was 43.2 kg/m(2), mean operating time was 52 ± 18.5 min, and mean hospital stay was 2.5 ± 1.3 days. There were 49 (4.6%) early minor complications, 14 (1.3%) major complications, and 2 leaks (0.2%). In late complications, one patient had low albumin and one had excess weight loss; MGB was easily reversed in both (0.2%). Marginal ulcers were noted in five patients (0.6%) during follow-up for symptomatic dyspepsia, and anemia was the most frequent late complication occurring in 68 patients (7.6%). Patient satisfaction was high, and mean excess weight loss was 84, 91, 88, 86, 87, and 85% at years 1 to 6, respectively. CONCLUSION This study confirms previous publications showing that MGB is quite safe, with a short hospital stay and low risk of complications. It results in effective and sustained weight loss with high resolution of comorbidities and complications that are easily managed.
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Affiliation(s)
- K S Kular
- Department of Metabolic & Bariatric Surgery, Kular College & Hospital, Kular Medical Education & Research Society, NH 1, Bija, Khanna, Ludhiana, Punjab, India,
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Tham JC, le Roux CW, Docherty NG. Cardiovascular, Renal and Overall Health Outcomes After Bariatric Surgery. Curr Cardiol Rep 2015; 17:34. [DOI: 10.1007/s11886-015-0588-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Scopinaro N, Adami GF, Papadia FS, Camerini G, Carlini F, Briatore L, Andraghetti G, Catalano M, Cordera R. Effects of gastric bypass on type 2 diabetes in patients with BMI 30 to 35. Obes Surg 2015; 24:1036-43. [PMID: 24647849 DOI: 10.1007/s11695-014-1206-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study aims to investigate if the benefits on glycemic control following Roux-en-Y gastric bypass (RYGB) in morbidly obese type 2 diabetes (T2DM) patients are maintained in the 30-35 kg/m(2) BMI (body mass index) range, comparing results with those in literature. METHODS The study participants were twenty T2DM patients aging 35-70 years, BMI 30.0-34.9 kg/m(2), minimum diabetes duration 3 years, glycosylated haemoglobin (HbA1c) ≥7.5% despite good clinical practice medical therapy, submitted to laparoscopic RYGB, and monitored during 36 months. Twenty-seven matched diabetic patients as controls. RESULTS Five females, mean age 57 (42-69) years, weight 96.0 (70-111) kg, BMI 32.9 (30.3-34.9) kg/m(2), waist circumference 112 (100-128) cm, diabetes duration 14 (3-28) years, HbA1c 9.5 (7.5-14.2) %, and C-peptide 3.2 (1,6-9.1) mcg/l. Ten patients were on insulin. There was no mortality, and there were two major late complications. BMI and waist decreased stabilizing around 25 kg/m(2) and 92 cm. Fasting serum glucose and HbA1c reached values around 150 mg/dl and 7%, which subsequently maintained. There was remission in 25% of cases, control 45%, and all the others improved. HOMA-IR and insulin sensitivity index normalized at 1 month, then maintained. AIR and insulinogenic index showed no postoperative changes. Diabetes remission correlated negatively with duration (p < 0.05; r (2) = 0.61), while control positively with C-peptide (p < 0.05; r (2) = 0.19). In the control group, FSG, HbA1c, serum triglyceride, and cholesterol significantly decreased with considerable progressive increase of antidiabetic/antihyperlipemic therapy. All patients had HbA1c >7% at 2-3 years. CONCLUSIONS Glycemic control obtained by RYGB in this study was less good than that reported by others, apparently due to different patient selection criteria. Our results do not support RYGB weight loss-independent effect on beta-cell function in the T2DM patients with BMI 30-35 kg/m(2).
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Affiliation(s)
- Nicola Scopinaro
- Department of Surgery, University of Genoa, School of Medicine, Genoa, Italy,
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Baccaro LM, Vunnamadala K, Sakharpe A, Wilhelm BJ, Aksade A. Stricture Rate after Laparoscopic Roux-en-Y Gastric Bypass with a 21-mm Circular Stapler versus a 25-mm Linear Stapler. Bariatr Surg Pract Patient Care 2015; 10:33-37. [PMID: 25830078 DOI: 10.1089/bari.2014.0048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Obesity is estimated to affect more than one and a half billion adults. Laparoscopic Roux-en-Y gastric bypass (LRYGB) has become one of the preferred weight loss procedures. However, complications can occur. Strictures at the gastrojejunal anastomosis lead to clinical symptoms such as vomiting, dysphagia, and patient discomfort. The stricture rate has been correlated with the size and type of stapler used. Methods: A retrospective review of the clinical records of patients who underwent LRYGB was performed between 2003 and 2010. A comparison was made between a 21-mm circular stapler technique and a 25-mm linear stapler technique. Results: The stricture rate for the 21-mm circular stapler group was 7.12% and comparable to the national average. Using the 25-mm linear stapler, this complication rate significantly decreased to 1.09% (p<0.0004; odds ratio 6.5; [95% confidence interval 1.96-33.83]). Conclusions: Stricture after LRYGB is a serious complication. This study found that with a change in technique, this complication can be decreased considerably.
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Affiliation(s)
- Leopoldo M Baccaro
- Department of General Surgery, Easton Hospital, Drexel University College of Medicine, Easton, Pennsylvania
| | - Kalyan Vunnamadala
- Department of General Surgery, Easton Hospital, Drexel University College of Medicine, Easton, Pennsylvania
| | - Aniket Sakharpe
- Department of General Surgery, Easton Hospital, Drexel University College of Medicine, Easton, Pennsylvania
| | - B Jakub Wilhelm
- Department of General Surgery, Easton Hospital, Drexel University College of Medicine, Easton, Pennsylvania
| | - Artun Aksade
- Department of General Surgery, Easton Hospital, Drexel University College of Medicine, Easton, Pennsylvania
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Ribeiro-Parenti L, Arapis K, Chosidow D, Dumont JL, Demetriou M, Marmuse JP. Gastrojejunostomy stricture rate: comparison between antecolic and retrocolic laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2015; 11:1076-84. [PMID: 25892346 DOI: 10.1016/j.soard.2015.01.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 01/15/2015] [Accepted: 01/26/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass procedure is an effective treatment for morbid obesity. One of the most frequent complications after this operation is the appearance of a gastrojejunal anastomotic stricture. Mechanisms underlying the development of such complication are unclear. OBJECTIVE The aim of the present retrospective study was to compare the rates of gastrojejunostomy stricture between the antecolic and retrocolic technique in a large cohort of patients undergoing Roux-en-Y gastric bypass for morbid obesity, with the same gastrojejunal anastomotic technique. SETTING University Hospital, France. METHODS From November 2000 to March 2012, 1500 patients underwent laparoscopic Roux-en-Y gastric bypass. The antecolic and the retrocolic technique were used in respectively 572 and 928 consecutive patients. All procedures were performed using a circular stapled gastrojejunostomy and absorbable sutures. RESULTS There was no significant difference with respect to gender, age, body mass index, and obesity related co-morbidities between both groups. Patients were followed for 24-146 months (mean 67.5 mo). Fifty-one patients developed a gastrojejunal stricture (3.4%), 37 in the antecolic group (6.5%) and 14 in the retrocolic group (1.5%). The difference was significant (P< .0001). The mean time to onset of gastrojejunal stricture symptoms after surgery was 1 month, ranging from 1 to 3 months. All patients were successfully treated using Savary-Gilliard dilatators. All patients with a gastrojejunal stricture were followed up for a minimum of 36 months. No recurrence was observed and no revisional surgery was needed. Weight loss was similar in patients who developed an anastomotic stricture compared with those without stricture. In the antecolic group internal hernia occurred in 12 of the 110 with no closure of mesenteric defects and in 8 of the 462 (1.7%) with defects closed. In the retrocolic group, 11 patients (1.2%) developed an internal hernia. CONCLUSIONS A significant lower gastrojejunal stricture rate was observed in the retrocolic group, with no increased risk of internal hernia, when mesenteric defects were closed. The antecolic technique seems to be a risk factor for gastrojejunal stricture development after laparoscopic gastric bypass.
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Affiliation(s)
- Lara Ribeiro-Parenti
- Service de Chirurgie Générale et Digestive, Hôpital Bichat Claude Bernard, Paris, France.
| | - Konstantinos Arapis
- Service de Chirurgie Générale et Digestive, Hôpital Bichat Claude Bernard, Paris, France
| | - Denis Chosidow
- Service de Chirurgie Générale et Digestive, Hôpital Bichat Claude Bernard, Paris, France
| | - Jean-Loup Dumont
- Service d'Endoscopie Digestive. Hôpital Privé des Peupliers, Paris, France
| | - Monique Demetriou
- Service de d'Anesthésie Réanimation, Hôpital Bichat Claude Bernard, Paris, France
| | - Jean-Pierre Marmuse
- Service de Chirurgie Générale et Digestive, Hôpital Bichat Claude Bernard, Paris, France
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Amorim ACRD, Souza AFOD, Nascimento ALV, Maio R, Burgos MGPDA. Use of alcohol before and after bariatric surgery. Rev Col Bras Cir 2015; 42:3-8. [DOI: 10.1590/0100-69912015001002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 04/15/2015] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE: to assess alcohol intake in the bariatric surgery pre and postoperative periods. METHODS: Patients were interviewed atSurgery Clinic of the Hospital das Clínicas da Universidade Federal de Pernambuco - HC/UFPE (Brazil) from July 2011 to March 2012. We analyzed socioeconomic, anthropometric and clinical variables. We used the Alcohol Use Disorders Identification Test (AUDIT C). RESULTS: One hundred nineteen patients were enrolled (mean age: 41.23+11.30 years), with a predominance of the female gender (83.2%), non-Caucasian race (55%), married individuals or in a stable union (65.5%), with a high school education (40.3%)and active in the job market (37%). Weight and body mass index (BMI) were 128.77+25.28Kg and 49.09+9.26Kg/m2,respectively in the preoperative period (class II obesity) and 87.19+19.16Kg and 33.04+6.21Kg/m2, respectively in the postoperative period (class I obesity) (p<0.001). Hypertension was the most frequent disease in the pre (66.6%) and postoperative (36.5%) periods. The prevalence of alcohol use was 26.6% in the preoperative period, of which 2.2% of high risk, and 35.1% in the postoperative period, of which 1.4% of probable dependence; this difference did not achieve statistical significance (p=0.337). CONCLUSION: The prevalence of abusive alcohol intake and/or probable dependence was low in both the pre and postoperative periods, with little evidence of risky consumption among the patients submitted to bariatric surgery.
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Totally hand-sewn anastomosis using barbed suture device during laparoscopic gastric bypass in obese. A feasibility study and preliminary results. Int J Surg 2014; 12:1385-9. [DOI: 10.1016/j.ijsu.2014.10.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 10/17/2014] [Accepted: 10/25/2014] [Indexed: 11/18/2022]
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Comparability of Weight Loss Reporting After Gastric Bypass and Sleeve Gastrectomy Using BOLD Data 2008–2011. Obes Surg 2014; 25:788-95. [DOI: 10.1007/s11695-014-1496-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Awad S, Aguilo R, Agrawal S, Ahmed J. Outcomes of linear-stapled versus hand-sewn gastrojejunal anastomosis in laparoscopic Roux en-Y gastric bypass. Surg Endosc 2014; 29:2278-83. [PMID: 25380709 DOI: 10.1007/s00464-014-3942-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 10/07/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND In laparoscopic Roux en-Y gastric bypass (LRYGB), the gastrojejunal anastomosis (GJA) may be performed using linear-stapled (LS) or completely hand-sewn (HS) techniques. No published study has compared operative and clinical outcomes following LS and HS LRYGB when performed by surgeons beyond the learning curve. This study examined outcomes of both techniques performed by two 'technique-specific' bariatric fellowship-trained surgeons. METHODS Data on consecutive primary LRYGB undertaken in two university hospitals were prospectively collected over 28-months and included demographics, co-morbidities, postoperative morbidity, mortality, length of stay (LOS), reoperations, and excess weight loss (EWL). Data were presented as mean ± SD. RESULTS There were 366 LRYGB studied (LS = 144 and HS = 222 patients) with 96 % 12-month follow-up. All procedures were completed laparoscopically with no anastomotic leak or mortality. The LS cohort had a lower body mass index (48.3 ± 5.0 vs 53.8 ± 7.1, P < 0.001), greater incidence of diabetes mellitus (P = 0.009) and sleep apnea (P = 0.007). The HS cohort had more patients in Obesity Surgery Mortality Risk Score classes B and C (P = 0.004 and P = 0.01), and shorter operating time (127 ± 30 vs 172 ± 30 min, P < 0.001). There were no differences in LOS, complications, or reoperations. The HS technique was associated with more GJA stenoses requiring endoscopic dilatation (7.7 vs 0 %, P < 0.001). At 12 months, EWL (%) was comparable between the two techniques (LS 71.0 ± 15.5 vs HS 66.5 ± 13.7, P = 0.09). CONCLUSIONS When performed by 'technique-specific' surgeons, both LS and HS GJA in LRYGB may be performed safely with no significant differences in morbidity, reoperations, or EWL.
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Affiliation(s)
- Sherif Awad
- The East-Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, Derby Hospitals NHS Foundation Trust, Uttoxeter Road, Derby, DE22 3NE, UK,
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Sundbom M. Laparoscopic revolution in bariatric surgery. World J Gastroenterol 2014; 20:15135-15143. [PMID: 25386062 PMCID: PMC4223247 DOI: 10.3748/wjg.v20.i41.15135] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 04/08/2014] [Accepted: 05/26/2014] [Indexed: 02/06/2023] Open
Abstract
The history of bariatric surgery is investigational. Dedicated surgeons have continuously sought for an ideal procedure to relieve morbidly obese patients from their burden of comorbid conditions, reduced life expectancy and low quality of life. The ideal procedure must have low complication risk, both in short- and long term, as well as minimal impact on daily life. The revolution of laparoscopic techniques in bariatric surgery is described in this summary. Advances in minimal invasive techniques have contributed to reduced operative time, length of stay, and complications. The development in bariatric surgery has been exceptional, resulting in a dramatic increase of the number of procedures performed world wide during the last decades. Although, a complex bariatric procedure can be performed with operative mortality no greater than cholecystectomy, specific procedure-related complications and other drawbacks must be taken into account. The evolution of laparoscopy will be the legacy of the 21st century and at present, day-care surgery and further reduction of the operative trauma is in focus. The impressive effects on comorbid conditions have prompted the adoption of minimal invasive bariatric procedures into the field of metabolic surgery.
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Skinner M, Velázquez-Aviña J, Mönkemüller K. Using balloon-overtube-assisted enteroscopy for postoperative endoscopic retrograde cholangiopancreatography. Therap Adv Gastroenterol 2014; 7:269-79. [PMID: 25364385 PMCID: PMC4212471 DOI: 10.1177/1756283x14544154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is technically more challenging in patients with postsurgical anatomy such as Roux-en-Y anastomosis, frequently mandating an operative intervention. Although limited, there is growing evidence that ERCP can be performed using the balloon-overtube-assisted enteroscopy (BOAE) in patients with complex postoperative anatomy. We present the technical aspects of performing ERCP with the BOAE in patients presenting with complex postsurgical anatomy having biliary problems. ERCP using the BOAE is feasible in patients with complex postsurgical anatomy, permitting diagnostic and therapeutic interventions in 80% of patients.
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Affiliation(s)
- Matthew Skinner
- Basil I. Hirschowitz Endoscopic Center of Excellence, Division of Gastroenterology and Hepatology, Birmingham, AL, USA
| | - Jacobo Velázquez-Aviña
- Basil I. Hirschowitz Endoscopic Center of Excellence, Division of Gastroenterology and Hepatology, Birmingham, AL, USA
| | - Klaus Mönkemüller
- Division of Gastroenterology and Hepatology, Basil Hirschowitz Endoscopic Center of Excellence, Endoscopy Unit, JT 664, 619 19th Street S, Birmingham, AL 35249, USA
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Waydia S, Gunawardene A, Gilbert J, Cota A, Finlay IG. 23-Hour/Next Day Discharge Post-Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) Surgery Is Safe. Obes Surg 2014; 24:2007-10. [DOI: 10.1007/s11695-014-1409-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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49
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Fried M, Yumuk V, Oppert JM, Scopinaro N, Torres A, Weiner R, Yashkov Y, Frühbeck G. Interdisciplinary European guidelines on metabolic and bariatric surgery. Obes Surg 2014; 24:42-55. [PMID: 24081459 DOI: 10.1007/s11695-013-1079-8] [Citation(s) in RCA: 395] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In 2012, an expert panel composed of presidents of each of the societies, the European Chapter of the International Federation for the Surgery of Obesity (IFSO-EC), and of the European Association for the Study of Obesity (EASO), as well as of the chair of EASO Obesity Management Task Force (EASO OMTF) and other key representatives from IFSO-EC and EASO, devoted the joint Medico-Surgical Workshop of both institutions to the topic of metabolic surgery in advance of the 2013 European Congress on Obesity held in Liverpool. This meeting was prompted by the extraordinary advancement made in the field of metabolic and bariatric surgery during the past decade. It was agreed to revise and update the 2008 Interdisciplinary European Guidelines on Surgery of Severe Obesity produced by focusing in particular on the evidence gathered in relation to the effects on diabetes and the changes in the recommendations of patient eligibility criteria. The expert panel allowed the coverage of key disciplines in the comprehensive management of obesity and obesity-associated diseases, aimed specifically at updating the clinical guidelines to reflect current knowledge, expertise and evidence-based data on metabolic and bariatric surgery.
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Affiliation(s)
- M Fried
- Center for Treatment of Obesity and Metabolic Disorders, OB Klinika, Prague, Czech Republic,
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Palmisano S, Giuricin M, Casagranda B, de Manzini N. Zero frequency of internal hernias after laparoscopic double loop gastric bypass without closure of mesenteric defects. Surg Today 2014; 44:1920-4. [PMID: 24809335 DOI: 10.1007/s00595-014-0916-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 01/23/2014] [Indexed: 01/14/2023]
Abstract
PURPOSE Laparoscopic Roux-en-Y gastric bypass is among the most effective surgical procedures for morbid obesity; however, one of its most common long-term complications is internal hernia. The purpose of this study was to evaluate the incidence of internal hernia in patients undergoing a new gastric bypass surgical technique known as "double loop" without closure of the mesenteric defects. METHODS We reviewed 44 patients with morbid obesity, who underwent laparoscopic double loop gastric bypass. There were 34 women and 10 men, followed up for a mean period of 18 ± 3 months, mainly by periodic medical examinations and blood tests. RESULTS The initial body mass index (BMI) was 44.23 ± 4.7 and the mean % excess weight (%EW) was 105.83 ± 24.41. After 18 postoperative months, the mean BMI was 29.68 ± 3.7 kg/m(2), representing a mean loss of 14.5 BMI units, with the mean % excess weight loss (%EWL) of 64.33 ± 13.47. No cases of internal hernia were recorded. CONCLUSIONS Laparoscopic double loop gastric bypass without closure of the mesenteric defects is a safe and feasible procedure. A longer observational follow-up and a large number of patients are required to confirm significant results.
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Affiliation(s)
- Silvia Palmisano
- Department of Medical, Surgical and Health Sciences, General Surgery Clinic, University Hospital of Trieste, Strada di Fiume, 447, Trieste, Italy,
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