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Al-Fagih OS, Zuberi S, Niaz O, Jambulingam P, Whitelaw D, Rashid F, Adil MT, Jain V, Al-Taan O, Munasinghe A, Askari A, Iqbal FM. Impact of Gastrojejunostomy Anastomosis Diameter on Weight Loss Following Laparoscopic Gastric Bypass: A Systematic Review. Obes Surg 2024; 34:2227-2236. [PMID: 38652437 DOI: 10.1007/s11695-024-07237-x] [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: 01/04/2024] [Revised: 04/13/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Abstract
Laparoscopic Roux-en-Y gastric bypass (RYGB) is crucial for significant weight reduction and treating obesity-related issues. However, the impact of gastrojejunostomy (GJ) anastomosis diameter on weight loss remains unclear. We investigate this influence on post-RYGB weight loss outcomes. A systematic search was conducted. Six studies met the inclusion criteria, showing varied GJ diameters and follow-up durations (1-5 years). Smaller GJ diameters generally correlated with greater short-to-medium-term weight loss, with a threshold beyond which complications like stenosis increased. Studies had moderate-to-low bias risk, emphasizing the need for precise GJ area quantification post-operation. This review highlights a negative association between smaller GJ diameters and post-RYGB weight loss, advocating for standardized measurement techniques. Future research should explore intra-operative and AI-driven methods for optimizing GJ diameter determination.
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Affiliation(s)
- Othman S Al-Fagih
- Department of General Surgery, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK.
| | - Sharukh Zuberi
- Department of General Surgery, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Osamah Niaz
- Department of General Surgery, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Periyathambi Jambulingam
- Department of General Surgery, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Douglas Whitelaw
- Department of General Surgery, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Farhan Rashid
- Department of General Surgery, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Md Tanveer Adil
- Department of General Surgery, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Vigyan Jain
- Department of General Surgery, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Omer Al-Taan
- Department of General Surgery, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Aruna Munasinghe
- Department of General Surgery, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Alan Askari
- Department of General Surgery, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, W2 1NY, UK
| | - Fahad M Iqbal
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, W2 1NY, UK
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Meyers MH, Swei EC, Tarter W, Schoen J, Rothchild K, Pratap A, Sullivan SA. Factors Associated with Weight Loss After Endoscopic Transoral Outlet Reduction (TORe). J Gastrointest Surg 2023; 27:1587-1593. [PMID: 37237090 PMCID: PMC10215034 DOI: 10.1007/s11605-023-05695-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 04/01/2023] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Endoscopic transoral outlet reduction (TORe) has emerged as a safe and effective treatment option for weight regain after Roux-en-Y Gastric Bypass (RYGB). Factors that predict successful weight loss after TORe are incompletely understood. The aims of this study were to evaluate procedural factors and patient factors that may affect percent total body weight loss (%TBWL) after TORe. METHODS A retrospective cohort study was performed on patients after TORe. The primary outcomes were %TBWL at 6 and 12 months based on four procedural factors: purse-string (PS) vs. non-purse-string (NPS) suture pattern, gastric pouch sutures (N), change in the diameter of the gastrojejunal anastomosis, and change in the length of the gastric pouch. Secondary outcomes included patient factors that affected weight loss. RESULTS Fifty-one patients underwent TORe. Weight loss for completers was 11.3 ± 7.6% and 12.2 ± 9.2% at 6 and 12 months. There was a correlation between %TBWL and change in pouch length at 6 and 12 months and number of sutures in the pouch at 6 months. The difference in %TBWL between PS and NPS groups at 6 months (PS, n=21, 12.3 ± 8.5% and NPS, n=8, 8.7 ± 3.7%) and 12 months (PS, n=21, 13.5 ± 9.2% and NPS, n=5, 7.0 ± 7.9%) did not reach statistical significance. For secondary outcomes, depression was associated with %TBWL. CONCLUSION Change in pouch length and number of sutures in the pouch correlated positively while depression correlated negatively with weight loss after TORe. Further studies are needed to understand these effects.
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Affiliation(s)
- Matthew H Meyers
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Eric C Swei
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Wyatt Tarter
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Jonathan Schoen
- Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Kevin Rothchild
- Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Akshay Pratap
- Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Shelby A Sullivan
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA.
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Maselli DB, Hoff AC, Kucera A, Waseem A, Wooley C, Donnangelo LL, Coan B, McGowan CE. Endoscopic revision of one-anastomosis gastric bypass (ER-OAGB) for weight recurrence: a case series of 17 adults. Ther Adv Gastrointest Endosc 2023; 16:26317745231210120. [PMID: 38026683 PMCID: PMC10666552 DOI: 10.1177/26317745231210120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Weight recurrence after one-anastomosis gastric bypass (OAGB), the third most common metabolic and bariatric surgery performed worldwide, is observed in a subset of patients due to the chronic, progressive nature of obesity. Endoscopic revision of the OAGB (ER-OAGB) through full-thickness suturing to reduce the gastrojejunal anastomosis and gastric pouch is a potential alternative to surgical revision. Here, we present a case series of ER-OAGB and long-term nutritional support at two international centers with expertise in bariatric endoscopy. Data were retrospectively evaluated from a prospectively maintained database. The primary outcome was total body weight loss (TBWL) at 12 months. Secondary outcomes included TBWL at 3, 6, and 15 months; excess weight loss (EWL) at 3, 6, 12, and 15 months; frequency of new/worsening symptoms of gastroesophageal reflux disease (GERD); and the frequency of serious adverse events. In this series, 17 adults (70.6% female, mean age 46.8 years, mean BMI 39.1 kg/m2) successfully underwent ER-OAGB an average of 8 years (range 2-21 years) after OAGB for a mean weight recurrence of 43.2% (range 10.9-86.9%). TBWL from ER-OAGB was 9.7 ± 1.8% at 3 months, 13.4 ± 3.5% at 6 months, 18.5 ± 2.1% at 12 months, and 18.1 ± 2.2% at 15 months. EWL from ER-OAGB was 30.5 ± 14.7% at 3 months, 42.6 ± 16.2% at 6 months, 54.2 ± 11.3% at 12 months, and 54.2 ± 11.7% at 15 months. There were no instances of new/worsening GERD symptoms or serious adverse events. In this small series of adults who experienced weight recurrence after OAGB, ER-OAGB facilitated safe and clinically meaningful weight loss, without new or worsening GERD symptoms, when performed by experienced bariatric endoscopists in concert with longitudinal nutritional support.
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Affiliation(s)
| | | | | | | | | | | | | | - Christopher E. McGowan
- Medical Director and Research Director, True You Weight Loss, 2001 Weston Parkway, Cary, NC 27513, USA
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Hort A, Cheng Q, Morosin T, Yoon P, Talbot M. Optimal common limb length in
Roux‐en‐Y
gastric bypass surgery: is it important for an ideal outcome? – a systematic review. ANZ J Surg 2022; 93:851-858. [PMID: 36480354 DOI: 10.1111/ans.18192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/07/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND In Roux-en-Y gastric bypass (RYGB) surgery the common limb length (CLL) is thought to significantly impact on nutritional and metabolic outcomes. However, there has been little focus on establishing routine standardized CLL measurements and its subsequent effect on weight loss and nutritional status. This review aimed to determine the effect of variations of CLL in RYGB surgery on post-operative outcomes, particularly nutritional status, while considering the need for routine CLL measurements in addition to measuring biliopancreatic limb and alimentary limb lengths. METHODS A systematic review was performed in accordance with the PRISMA guidelines. All English language articles addressing CLL and impact on weight loss, nutritional and metabolic outcomes were retrieved and reviewed. RESULTS Thirteen relevant studies were identified with CLLs varying from 76 to >600 cm. No significant difference in total body weight loss or excess weight loss was observed. Significant metabolic improvements occurred with shorter CLLs. Nutritional deficiencies were more severe when the CLL was <400 cm. CONCLUSION The data from this systematic review suggests that reasonable weight loss and positive impacts on metabolic outcomes can be achieved with CLLs of >400 cm.
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Affiliation(s)
- Amy Hort
- Department of Surgery Westmead Hospital Sydney New South Wales Australia
- Department of Surgery, The School of Medicine The University of Sydney Sydney New South Wales Australia
| | - Qiuye Cheng
- Department of Surgery Westmead Hospital Sydney New South Wales Australia
- UNSW St George and Sutherland Clinical School Sydney New South Wales Australia
| | - Tia Morosin
- Department of Surgery Westmead Hospital Sydney New South Wales Australia
| | - Peter Yoon
- Department of Surgery Westmead Hospital Sydney New South Wales Australia
| | - Michael Talbot
- UNSW St George and Sutherland Clinical School Sydney New South Wales Australia
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Haghighat N, Kamran H, Moaddeli MN, Hosseini B, Karimi A, Hesameddini I, Amini M, Hosseini SV, Vahidi A, Moeinvaziri N. The impact of gastric pouch size, based on the number of staplers, on the short-term weight outcomes of Roux-en-Y gastric bypass. Ann Med Surg (Lond) 2022; 84:104914. [DOI: 10.1016/j.amsu.2022.104914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/27/2022] [Accepted: 11/13/2022] [Indexed: 11/19/2022] Open
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De Luca M, Piatto G, Sartori A, Zese M, Lunardi C, Targa S, Giardiello C, Gentileschi P, Himpens J. Single Anastomosis Jejuno-ileal (SAJI): a New Model of Malabsorptive Revisional Procedure for Insufficient Weight Loss or Weight Regain After Roux-en-Y Gastric Bypass. Obes Surg 2022; 32:3194-3204. [PMID: 35763129 DOI: 10.1007/s11695-022-06174-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 03/13/2022] [Accepted: 03/18/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND In case of insufficient weight loss or weight regain or relapse of weight-related comorbidities after Roux-en-Y gastric bypass (RYGB), other procedures such as reduction of a large gastric pouch and stoma, lengthening of the Roux limb, conversion to sleeve gastrectomy and/or bilio-pancreatic diversion with duodenal switch have been advocated. Single anastomosis jejuno-ileal (SAJI) is a new revisional simple operation performed after RYGB failure which adds malabsorption to the previous gastric bypass. METHODS SAJI includes a single jejuno-ileal anastomosis specifically joining the ileum 250-300 cm proximal to the ileo-caecal valve and the jejunum 30 cm below the gastro-jejunal anastomosis on the Roux limb of the previous RYGB. Thirty-one patients underwent SAJI for insufficient weight loss and/or weight regain after RYGB. The percent total weight loss (%TWL) after RYGB and before SAJI was 21.8 ± 7.8. All SAJI operations were performed laparoscopically. The SAJI mean operating time was 145 min. RESULTS Regarding weight loss after SAJI, %TWL is 27.2 ± 7.4, 31.2 ± 6.4, 33.7 ± 5.9 and 32.9 ± 5.2 at 12, 24, 36 and 48 months, respectively. Our series recorded a low rate of peri-operative and medium-term complications with a low grade of severity (Clavien-Dindo classification grade). One patient required reoperation 36 days after SAJI for epigastrium incarcerated incisional hernia at the previous RYGB laparotomy site. Mortality was 0. Comorbidity reduction/resolution after SAJI is 83.2% for type 2 diabetes mellitus, 42.8% for arterial hypertension, 72.8% for dyslipidemia and 45.3% for OSA. CONCLUSIONS Treatment of failed RYGB is challenging. SAJI is a less complicated, purely low invasive malabsorptive operation that should reach satisfactory %TWL and comorbidity reduction/resolution.
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Affiliation(s)
- Maurizio De Luca
- Chief Department of General and Metabolic Surgery, Rovigo Hospital, Rovigo, Italy.
| | - Giacomo Piatto
- Department of Surgery, San Valentino Montebelluna Hospital, Treviso, Italy
| | - Alberto Sartori
- Department of Surgery, San Valentino Montebelluna Hospital, Treviso, Italy
| | - Monica Zese
- Department of General and Metabolic Surgery, Rovigo Hospital, Rovigo, Italy
| | - Cesare Lunardi
- Department of Surgery, San Valentino Montebelluna Hospital, Treviso, Italy
| | - Simone Targa
- Department of Surgery, Adria Hospital, Rovigo, Italy
| | - Cristiano Giardiello
- Department of Emergency and Metabolic Surgery, Pineta Grande Hospital, Caserta, Italy
| | - Paolo Gentileschi
- Department of Bariatric and Metabolic Surgery, San Carlo Nancy Hospital, Rome, Italy
| | - Jacques Himpens
- Metabolic & Obesity Unit, Chirec Delta Hospital, Brussels, Belgium
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Bouchard-Mercier A, de Toro-Martín J, Nadeau M, Lescelleur O, Lebel S, Richard D, Biertho L, Tchernof A, Vohl MC. Molecular remodeling of adipose tissue is associated with metabolic recovery after weight loss surgery. Lab Invest 2022; 20:283. [PMID: 35739539 PMCID: PMC9219157 DOI: 10.1186/s12967-022-03485-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/13/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Bariatric surgery is an effective therapy for individuals with severe obesity to achieve sustainable weight loss and to reduce comorbidities. Examining the molecular signature of subcutaneous adipose tissue (SAT) following different types of bariatric surgery may help in gaining further insight into their distinct metabolic impact. RESULTS Subjects undergoing biliopancreatic diversion with duodenal switch (BPD-DS) showed a significantly higher percentage of total weight loss than those undergoing gastric bypass or sleeve gastrectomy (RYGB + SG) (41.7 ± 4.6 vs 28.2 ± 6.8%; p = 0.00005). Individuals losing more weight were also significantly more prone to achieve both type 2 diabetes and dyslipidemia remission (OR = 0.75; 95%CI = 0.51-0.91; p = 0.03). Whole transcriptome and methylome profiling showed that bariatric surgery induced a profound molecular remodeling of SAT at 12 months postoperative, mainly through gene down-regulation and hypermethylation. The extent of changes observed was greater following BPD-DS, with 61.1% and 49.8% of up- and down-regulated genes, as well as 85.7% and 70.4% of hyper- and hypomethylated genes being exclusive to this procedure, and mostly associated with a marked decrease of immune and inflammatory responses. Weight loss was strongly associated with genes being simultaneously differentially expressed and methylated in BPD-DS, with the strongest association being observed for GPD1L (r2 = 0.83; p = 1.4 × 10-6). CONCLUSIONS Present findings point to the greater SAT molecular remodeling following BPD-DS as potentially linked with higher metabolic remission rates. These results will contribute to a better understanding of the metabolic pathways involved in the response to bariatric surgery and will eventually lead to the development of gene targets for the treatment of obesity. Trial registration ClinicalTrials.gov NCT02390973.
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Affiliation(s)
- Annie Bouchard-Mercier
- School of Nutrition and Centre Nutrition, Santé et Société (NUTRISS)-Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Pavillon des Services (suite 2729K), 2440 Hochelaga Blvd, Quebec City, QC, G1V 0A6, Canada
| | - Juan de Toro-Martín
- School of Nutrition and Centre Nutrition, Santé et Société (NUTRISS)-Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Pavillon des Services (suite 2729K), 2440 Hochelaga Blvd, Quebec City, QC, G1V 0A6, Canada
| | - Mélanie Nadeau
- Centre de recherche de l'institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), 2725 chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
| | - Odette Lescelleur
- Centre de recherche de l'institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), 2725 chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
| | - Stéfane Lebel
- Centre de recherche de l'institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), 2725 chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
| | - Denis Richard
- Centre de recherche de l'institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), 2725 chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
| | - Laurent Biertho
- Centre de recherche de l'institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), 2725 chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
| | - André Tchernof
- Centre de recherche de l'institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), 2725 chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
| | - Marie-Claude Vohl
- School of Nutrition and Centre Nutrition, Santé et Société (NUTRISS)-Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Pavillon des Services (suite 2729K), 2440 Hochelaga Blvd, Quebec City, QC, G1V 0A6, Canada.
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Gao X, Dai S, Wang G, Li W, Song Z, Su Z, Zhu S, Zhu L, Li P. Large Versus Small Gastric Pouch for Roux-en-Y Gastric Bypass in Individuals With Type 2 Diabetes and a Body Mass Index < 35 kg/m2: Six-Year Outcomes. Front Endocrinol (Lausanne) 2022; 13:913062. [PMID: 36120423 PMCID: PMC9474650 DOI: 10.3389/fendo.2022.913062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/22/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) results in extraordinary weight loss and glycemic control outcomes for patients with obesity; however, the effect of gastric pouch size is still unclear, and the reported results are contradictory. Additionally, long-term data on type 2 diabetes (T2D) patients with low body mass index (BMI) are sparse. This study was to assess the effect of 6-year outcomes in Chinese patients with T2D and a BMI < 35 kg/m2 who underwent RYGB with gastric pouches of different sizes. METHODS A retrospective cohort study was performed. There were 42 patients in the large gastric pouch group (L) and 53 patients in the small gastric pouch group (S). Baseline demographic history, pre- and postoperative BMI, waist circumference, and glucose- and lipid metabolism-related indicators were compared. RESULTS Assessments were completed in 100%, 100%, 93.6%, and 89.4% of patients at baseline, 1 year, 3 years, and 6 years, respectively. At 6 years, the changes in BMI and fasting plasma glucose were greater in the S group (-4.25 ± 0.51 kg/m2 and -4.58 ± 0.73 mmol/l) than in the L group (-2.06 ± 0.48 kg/m2 and -2.64 ± 0.61 mmol/l). The independent predictors of complete remission of T2D were preoperative BMI and the size of the gastric pouch. A large gastric pouch was associated with a higher risk for marginal ulcers. CONCLUSIONS A small gastric pouch results in better weight loss and glycemic control. High preoperative BMI and a small gastric pouch are associated with better T2D remission rates. A large gastric pouch leads to a higher incidence of marginal ulcers.
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Affiliation(s)
| | | | | | | | | | | | | | - Liyong Zhu
- *Correspondence: Pengzhou Li, ; Liyong Zhu, @uni.edu
| | - Pengzhou Li
- *Correspondence: Pengzhou Li, ; Liyong Zhu, @uni.edu
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Wijngaarden LH, Reiber BMM, Yousufzai F, Demirkiran A, Klaassen RA. Resizing a large pouch after laparoscopic Roux-en-Y gastric bypass: comparing the effect of two techniques on weight loss. Surg Endosc 2021; 36:3495-3503. [PMID: 34374871 DOI: 10.1007/s00464-021-08671-z] [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: 03/27/2021] [Accepted: 08/02/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Insufficient weight loss or weight regain has many causes including a large gastric pouch. A large gastric pouch may be due to the surgical technique or can be patient related (dilation). Resizing the gastric pouch may lead to additional weight loss. Currently, there is no gold standard for the revisional surgical technique. Therefore this study was performed to determine which surgical technique for revisional bariatric surgery (BS) has superior outcomes in terms of weight loss: sleeve resection of the gastrojejunostomy and gastric pouch (SGP), or resection of the gastrojejunostomy with resizing of the pouch and creation of a new anastomosis (RGJ). METHODS All patients who underwent revisional BS for insufficient weight loss or weight regain as a result of an enlarged pouch after LRYGB from April 2014 to June 2018 in our hospitals were included in this observational cohort study. Outcomes were measured in percentage total weight loss (%TWL). RESULTS A total of 37 patients who underwent SGP and 21 patients who underwent RGJ as revisional BS were included in this study. The median body mass index before revisional BS was 37.6 kg/m2 versus 35.7 kg/m2 (SGP vs RGJ, respectively, P = 0.115). There was no significant difference in %TWL between the two cohorts 1 and 2 years after revisional BS, respectively; SGP 14.5% vs RGJ 11.0%, P = 0.885 and SGP 12.3% vs RGJ 10.8%, P = 0.604. Comparing %TWL based on weight at LRYGB, there was also no significant difference two years after revisional BS (SGP 22.0% vs RGJ 22.2%, P = 0.885). The average use of surgical disposables for the SGP technique were lower compared to the RGJ technique. CONCLUSIONS Resizing a large pouch leads to additional weight loss. Both techniques have comparable outcomes in terms of weight loss. However, based on average surgical costs, the SGP technique may be preferable.
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Affiliation(s)
- L H Wijngaarden
- Department of Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands.
| | - B M M Reiber
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - F Yousufzai
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - A Demirkiran
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - R A Klaassen
- Department of Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
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10
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Kumar P, Yau HCV, Trivedi A, Yong D, Mahawar K. Global Variations in Practices Concerning Roux-en-Y Gastric Bypass-an Online Survey of 651 Bariatric and Metabolic Surgeons with Cumulative Experience of 158,335 Procedures. Obes Surg 2021; 30:4339-4351. [PMID: 32592015 DOI: 10.1007/s11695-020-04796-7] [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] [Indexed: 02/15/2023]
Abstract
INTRODUCTION There is significant variation in practices concerning Roux-en-Y gastric bypass (RYGB) among bariatric surgeons, but there is currently a lack of robust data on the nature and extent of these variations. The purpose of this study was to understand global variations in practices concerning RYGB. METHODS A questionnaire-based survey on Survey Monkey® was created, and the link was shared freely on various social media platforms. The link was also distributed through a personnel email network of authors. RESULTS A total of 657 surgeons from 65 countries completed the survey. Crohn's disease and liver cirrhosis were considered absolute contraindications for RYGB by 427 surgeons (64.98%) and 347 surgeons (53.30%), respectively. More than 68.5% of surgeons performed routine upper GI endoscopy while 64.17% performed routine ultrasound of abdomen preoperatively. The majority of surgeons (77.70%) used the perigastric technique for Gastric pouch creation. Approximately, 79.5% used orogastric bougie. More than 70% of the respondents did not use any staple line reinforcement routinely. Only 17.67% of surgeons measured the whole small bowel length, and the majority of surgeons (86.5%) used constant length of BP limb. Approximately, 89% used constant length of alimentary limb. Approximately, 95% of surgeons preferred antecolic bypass, and more than 86% routinely closed the Petersen defect. Marginal ulcer prophylaxis was used by the majority (91.17%). Almost 95% of surgeons recommended lifelong vitamin and mineral supplements. CONCLUSION This survey identifies global variations in practices concerning RYGB. It identifies several areas for future research and consensus building.
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Affiliation(s)
- Parveen Kumar
- Sir Charles Gairdner Hospital, Nedlands, Western Australia.
| | | | | | - David Yong
- Joondalup Health Campus, Joondalup, Western Australia
| | - Kamal Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, UK
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Boerboom A, Aarts E, Lange V, Plamper A, Rheinwalt K, Linke K, Peterli R, Berends F, Hazebroek E. Banding the Pouch with a Non-adjustable Ring as Revisional Procedure in Patients with Insufficient Results After Roux-en-Y Gastric Bypass: Short-term Outcomes of a Multicenter Cohort Study. Obes Surg 2021; 30:797-803. [PMID: 31898043 DOI: 10.1007/s11695-019-04361-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND After laparoscopic Roux-en-Y gastric bypass (RYGB), approximately 10-35% of patients with morbid obesity regain weight after an initial good result or fail to achieve a sufficient amount of weight loss. Patients in which conservative measures are not successful may potentially benefit from revisional surgery. OBJECTIVE To evaluate the effect of a non-adjustable ring placed around the gastric pouch in patients with insufficient weight loss or weight regain after RYGB. SETTING Four specialized bariatric hospitals in The Netherlands, Germany, and Switzerland. METHODS From 2011 to 2017, 79 patients underwent revisional surgery using a non-adjustable silicone ring because of insufficient results after RYGB. Data on weight loss and complications up to 2 years after revisional surgery was collected and analyzed retrospectively. RESULTS A follow-up percentage of 86% after 1 year and 61% after 2 years was achieved. In 75% of patients, further weight regain was prevented. Percentage total body weight loss improved by 7 to 26% 1 year after revisional surgery and remained stable during 2 years of follow-up. The additional weight loss effect of placing a non-adjustable ring was more pronounced in patients with an initial good result after primary RYGB. Eighteen (23%) rings were removed, most often due to dysphagia. CONCLUSION Especially for patients who experience weight regain after initial good weight loss, placing a non-adjustable silicone ring around the gastric pouch results in modest improvements in weight loss. To prevent the risk of ring removal due to dysphagia, surgeons should take notice not to place the ring too tight around the gastric pouch during revisional surgery.
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Affiliation(s)
- Abel Boerboom
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
| | - Edo Aarts
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Volker Lange
- Department of Obesity and Metabolic surgery, Helios Klinikum, Berlin, Germany
| | - Andreas Plamper
- Department of Bariatric, Metabolic and Plastic Surgery, St. Franziskus-Hospital, Cologne, Germany
| | - Karl Rheinwalt
- Department of Bariatric, Metabolic and Plastic Surgery, St. Franziskus-Hospital, Cologne, Germany
| | - Katja Linke
- Department of Surgery, Clarunis Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
| | - Ralph Peterli
- Department of Surgery, Clarunis Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
| | - Frits Berends
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Eric Hazebroek
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
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12
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Kermansaravi M, Abbas A, Pishgahroudsari M, Pazouki A. Short-term outcomes of the conversion of one anastomosis gastric bypass to Roux-en-Y gastric bypass in symptomatic reflux patients without revising the size of the gastric pouch. J Minim Access Surg 2021; 17:318-321. [PMID: 32964872 PMCID: PMC8270032 DOI: 10.4103/jmas.jmas_27_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Revising the size of the gastric pouch during the conversion of one anastomosis gastric bypass (OAGB)/mini-gastric bypass to Roux-en-Y gastric bypass (RYGB) is an important point. Even in patients undergoing RYGB, marginal ulcer is regarded as a known complication. Materials and Methods: In our Centre of Excellence in Bariatric and Metabolic Surgery, 2492 patients underwent OAGB from February 2012 to January 2019. Twelve of 2492 patients were enrolled in this clinical case series because of persistent gastroesophageal reflux-like symptoms which underwent conversional RYGB. All patients regularly received proton-pump inhibitors (PPIs) for 6 months after the surgery. After this period, the cases with symptomatic reflux were invited to be visited in the clinic by a bariatric surgeon and a gastroenterologist and received 6 months of PPI therapy until their symptoms disappeared. Twelve refractory reflux cases underwent conversional RYGB after 1 year. An enteroenterostomy was created in all the patients 75 cm distal to the gastrojejunostomy without resizing the gastric pouch, and the jejunal loop was cut just before the gastrojejunostomy. Results: Before conversional surgery, mean ± standard deviation (SD) body mass index (BMI) and gastroesophageal reflux disease (GERD)-Q score were found to be 26.45 ± 2.34 kg/m2 and 10.08 ± 0.56, respectively. At 1 year after conversion, mean ± SD BMI in the patients was 28.12 ± 4.71, and GERD-Q score was 5.08 ± 1.5. Conclusion: It seems that resizing the gastric pouch is not necessary during the conversion of OAGB to RYGB.
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Affiliation(s)
- Mohammad Kermansaravi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences; Center of Excellence of International Federation for Surgery of Obesity and Metabolic Disorders, Tehran, Iran
| | - Aamir Abbas
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences; Center of Excellence of International Federation for Surgery of Obesity and Metabolic Disorders, Tehran, Iran
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13
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Arnoldner MA, Felsenreich DM, Langer FB, Weber M, Mang T, Kulinna-Cosentini C, Prager G. Pouch volume and pouch migration after Roux-en-Y gastric bypass: a comparison of gastroscopy and 3 D-CT volumetry: is there a “migration crisis”? Surg Obes Relat Dis 2020; 16:1902-1908. [DOI: 10.1016/j.soard.2020.07.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/14/2020] [Accepted: 07/21/2020] [Indexed: 12/30/2022]
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14
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Jaruvongvanich V, Vantanasiri K, Laoveeravat P, Matar RH, Vargas EJ, Maselli DB, Alkhatry M, Fayad L, Kumbhari V, Fittipaldi-Fernandez RJ, Hollenbach M, Watson RR, Gustavo de Quadros L, Galvao Neto M, Aepli P, Staudenmann D, Brunaldi VO, Storm AC, Martin JA, Gomez V, Abu Dayyeh BK. Endoscopic full-thickness suturing plus argon plasma mucosal coagulation versus argon plasma mucosal coagulation alone for weight regain after gastric bypass: a systematic review and meta-analysis. Gastrointest Endosc 2020; 92:1164-1175.e6. [PMID: 32692991 DOI: 10.1016/j.gie.2020.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/05/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Endoscopic transoral outlet reduction (TORe) has been used to manage weight regain after Roux-en-Y gastric bypass. We conducted a meta-analysis to summarize the efficacy and safety of the two most commonly used techniques: full-thickness suturing plus argon plasma mucosal coagulation (ft-TORe) and argon plasma mucosal coagulation alone (APMC-TORe). METHODS A literature search of publication databases was performed from their inception to February 2020 for relevant studies. The outcomes of interest were percentage total body weight loss, gastrojejunal anastomosis (GJA) diameter, and adverse events (AEs). The pooled effect estimates were analyzed using a random-effects model. Meta-regression was conducted to identify associations between GJA diameter and weight loss. RESULTS Nine ft-TORe (n = 737) and 7 APMC-TORe (n = 888) studies were included. APMC-TORe was performed as a series of sessions (mean number of sessions ranging from 1.2 to 3), whereas ft-TORe was mostly performed as a single session. Percentage total body weight loss was 8.0% (95% confidence interval [CI], 6.3%-9.7%), 9.5% (95% CI, 8.1%-11.0%), and 5.8% (95% CI, 4.3%-7.1%) after ft-TORe and 9.0% (95% CI, 4.1%-13.9%), 10.2% (95% CI, 8.4%-12.1%), and 9.5% (95% CI, 5.7%-13.2%) after APMC-TORe at 3, 6, and 12 months, respectively, with no weight-loss difference at 3 and 6 months (P > .05). Only one severe AE was observed after APMC-TORe and none after ft-TORe. Stricture formation was the most common AE (ft-TORe 3.3% and APMC-TORe 4.8%, P = .38). All were successfully treated by endoscopic dilation or conservative treatment. Smaller aperture of the post-TORe GJA and greater change in the GJA diameter correlated with greater weight loss in APMC-TORe and numerical trends in ft-TORe. CONCLUSIONS This meta-analysis demonstrates that both ft-TORe and APMC-TORe offer significant and comparable weight-loss outcomes with a high and comparable safety profile. However, APMC-TORe typically required multiple endoscopic sessions. Identifying a goal for the final and change in GJA diameter could be useful treatment targets.
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Affiliation(s)
| | - Kornpong Vantanasiri
- Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota
| | | | - Reem H Matar
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Eric J Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Daniel B Maselli
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Maryam Alkhatry
- Division of Gastroenterology, IBHO hospital, Ras Al Khaimah, United Arab Emirates
| | - Lea Fayad
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | | | - Marcus Hollenbach
- Medical Department II - Gastroenterology, Hepatology, Infectious Diseases, Pulmonology - University of Leipzig Medical Center, Leipzig, Germany
| | - Rabindra R Watson
- Interventional Endoscopy Services, California Pacific Medical Center, University of California, San Francisco, San Francisco, California, USA
| | | | | | - Patrick Aepli
- Gastroenterology and Hepatology Unit, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Dominic Staudenmann
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Vitor Ottoboni Brunaldi
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - John A Martin
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Victoria Gomez
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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15
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Does the Length of the Common Channel as Part of the Total Alimentary Tract Matter? One Year Results from the Multicenter Dutch Common Channel Trial (DUCATI) Comparing Standard Versus Distal Roux-en-Y Gastric Bypass with Similar Biliopancreatic Bowel Limb Lengths. Obes Surg 2020; 30:4732-4740. [PMID: 32955672 DOI: 10.1007/s11695-020-04982-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE Although the laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is the gold-standard bariatric procedure, it remains uncertain what the optimal bowel limb lengths are to accomplish maximal weight loss while minimizing nutritional deficiencies and related gastro-intestinal complaints. The aim of this randomized controlled multicenter trial is to investigate the effect of significant lengthening of the length of the Roux limb (RL) at the cost of the length of the common channel (CC) while keeping the biliopancreatic limb (BPL) lengths the same on both study arms. METHODS Four hundred forty-four patients were randomized to receive either a Very Long Roux Limb LRYGB (VLRL-LRYGB) (variable RL length, BPL 60 cm, and CC 100 cm) or a Standard LRYGB (S-LRYGB) (RL 150 cm, BPL 60 cm, and a variable CC length). Results at 1-year follow-up for weight loss, effect on obesity-related comorbid conditions, complications, re-operation rate, malnutrition rate, and re-admission rate were investigated. RESULTS Weight loss at 1-year showed no significant differences for %EWL (84.3% versus 85.3%, p = 0.72) and %TWL (34.2% versus 33.6%, p = 0.359) comparing VLRL-LRYGB versus S-LRYGB. Malabsorption requiring surgical bowel length adjustment was observed in 1.4% in VLRL-LRYGB group versus 0.9% in S-LRYGB group (p = 0.316). CONCLUSION Significant lengthening of the RL at the cost of the common channel seems to have no effect on the weight loss at 1-year follow-up, which supports the theory that absorption of nutrients also occurs in the RL. Nevertheless, long-term results of the VLRL-LRYGB have to be awaited to draw final conclusions as part of the discussion towards optimal limb length in LRYGB surgery.
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16
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Ludwig PE, Huff TJ, Bremer K, Nandipati KC. Pressure-Sensing Gastric Calibration Tube for Minimizing Sleeve Volume Variation in Sleeve Gastrectomy Compared with Current Standard Technique. Obes Surg 2020; 30:5162-5166. [PMID: 32748199 DOI: 10.1007/s11695-020-04885-7] [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: 03/01/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 11/24/2022]
Abstract
The sleeve gastrectomy technique is dependent on the size of the bougie and the surgeon's technical skills. Standardization of the sleeve gastrectomy technique may potentially minimize the volume inconsistency and improve outcomes. A volume and pressure-sensitive gastric calibration tube may create a standard sleeve size and minimize interoperator variation. The objective of preliminary testing was to establish the variability of sleeve gastrectomy size in gastric explants, and to compare that with the variability of sleeve gastrectomy size when performed with a volume and pressure-sensitive gastric calibration tube. Three operators performed six sleeve gastrectomies each on commercially processed porcine gastric explants, half with a 40 Fr bougie, and a half with a pressure-sensing and volume-controllable gastric calibration tube prototype. The resulting sleeves were evaluated using standard statistical methods. The pressure-sensitive gastric calibration tube demonstrated superior consistency to a standard 40 Fr bougie by common measures of variation. However, further investigation is warranted to characterize the significance of this difference.
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Affiliation(s)
- Parker E Ludwig
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68178, USA
| | - Trevor J Huff
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68178, USA
| | - Kristin Bremer
- Department of Surgery, Creighton University School of Medicine, 7710 Mercy Road, Suite 501, Omaha, NE, 68124, USA
| | - Kalyana C Nandipati
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68178, USA. .,Department of Surgery, Creighton University School of Medicine, 7710 Mercy Road, Suite 501, Omaha, NE, 68124, USA.
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17
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Ospanov O, Buchwald JN, Yeleuov G, Bekmurzinova F. Laparoscopic One-Anastomosis Gastric Bypass with Band-Separated Gastric Pouch (OAGB-BSGP): a Randomized Controlled Trial. Obes Surg 2020; 29:4131-4137. [PMID: 31654345 DOI: 10.1007/s11695-019-04236-1] [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: 12/20/2022]
Abstract
BACKGROUND One-anastomosis gastric bypass with band-separated gastric pouch (OAGB-BSGP) is a novel "staplerless" version of OAGB. This randomized controlled trial (RCT) compared 2-year outcomes for OAGB-BSGP and standard OAGB. METHODS The parallel-group RCT randomly allocated patients to group A, staplerless OAGB-BSGP, or group B, stapled OAGB. RESULTS Respective mean values for groups A and B (n = 40 each): baseline body mass index (BMI, kg/m2), 40.6 ± 5.6 vs 41.2 ± 6.4 (p = 0.64); abdominal bleeding (mL), 5.9 ± 8.0 vs 31.1 ± 30.5 (p < 0.0001). Two-year outcomes: BMI, 26.3 ± 3.2 vs 29.0 ± 4.7; %TWL, 34.1 ± 9.0 vs 29.3 ± 10.6, p < 0.03; %EBMIL, 94.3 ± 23.6 vs 77.9 ± 29.3, p < 0.007; bile reflux, n = 1 (2.5%) vs n = 7 (17.5%) (p = 0.05); revisions, n = 0 vs n = 4 (10.0%), p = 0.12. CONCLUSIONS At 2-year RCT follow-up, staplerless OAGB-BSGP patients had fewer complications, no revisions, and greater weight loss than stapled OAGB patients. TRIAL REGISTRATION ISRCTN56106651 (OSPAN-RCT).
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Affiliation(s)
- Oral Ospanov
- University Medical Center, Nur-Sultan, Kazakhstan. .,Department of Laparoscopic and Bariatric Surgery, Astana Medical University, Syganak Str. 5/1. K. 48, Nur-Sultan, Kazakhstan.
| | - J N Buchwald
- Division of Scientific Research Writing, Medwrite Medical Communications, Maiden Rock, WI, USA
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18
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Optimization of a Technique to Standardize the Rodent Roux-En-Y Gastric Bypass Model and Troubleshooting of Postoperative Failures. Obes Surg 2020; 29:1681-1689. [PMID: 30810973 DOI: 10.1007/s11695-019-03789-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Rodent models are required in studies on the mechanism of Roux-en-Y gastric bypass (RYGB). However, the construction of the model is hard, and there are various causes of death after surgery in rats. METHODS RYGB models with procedures containing a series of anatomic landmark were established in rats. Optimized procedures during surgery, possible complications after surgery, and corresponding solutions were studied. RESULTS With the introduction of perioperative nursing and optimized surgery procedures, less time-consuming surgeries were performed and higher survival rates were achieved. Trouble-shooting data based on death time points are listed and discussed for various causes of failure. CONCLUSIONS This study provides practical suggestions for investigators to perform RYGB surgery on rats. The troubleshooting suggestions will help operators to efficiently identify problems in their procedures.
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19
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Mahawar K, Sharples AJ, Graham Y. A systematic review of the effect of gastric pouch and/or gastrojejunostomy (stoma) size on weight loss outcomes with Roux-en-Y gastric bypass. Surg Endosc 2019; 34:1048-1060. [DOI: 10.1007/s00464-019-07277-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/12/2019] [Indexed: 01/13/2023]
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20
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An Extended Pouch in a Roux-En-Y Gastric Bypass Reduces Weight Regain: 3-Year Results of a Randomized Controlled Trial. Obes Surg 2019; 30:3-10. [PMID: 31444776 DOI: 10.1007/s11695-019-04156-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although the Roux-en-Y gastric bypass (RYGB) is considered a standard procedure, many variations exist in the basic design. In order to achieve more pronounced and sustainable results after RYGB, factors such as diameter of the gastroenterostomy, limb length, and pouch size are gripping points for improvement of design. Extending the pouch could improve results by altering food passage through the pouch. OBJECTIVE The aim of this randomized controlled trial was to evaluate the effect of an extended pouch RYGB (EP-GB) and standard pouch RYGB (S-GB). METHODS In total, 132 patients were randomized in two groups: 68 patients received an EP-GB (pouch length 10 cm) and 64 a S-GB (pouch length 5 cm). Subsequently, weight loss, remission of comorbidities, nutritional status, complications, quality of life, and GERD-symptoms were assessed during a follow-up of 3 years. RESULTS During the first 2 years of follow-up, no significant differences in terms of weight loss were observed. In the third year of follow-up, the S-GB group regained 3 kg, while in the EP-GB group no weight regain was observed. The mean TBWL after 36 months in the EP-GB group was 31% versus 27% in the S-GB group (p = 0.023). Additionally, besides a better remission rate of hypertension in the EP-GB group, no differences in complications, quality of life, and GERD-symptoms were found. CONCLUSION Creation of an extended gastric pouch is a safe and effective modification in RYGB design. An EP-GB improves mid-term weight loss, potentially driven by a lower occurrence of weight regain.
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21
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Boerboom A, Homan J, Aarts E, Aufenacker T, Janssen I, Berends F. A long biliopancreatic and short alimentary limb results in more weight loss in revisional RYGB surgery. Outcomes of the randomized controlled ELEGANCE REDO trial. Surg Obes Relat Dis 2018; 15:60-69. [PMID: 30471927 DOI: 10.1016/j.soard.2018.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/11/2018] [Accepted: 10/13/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND For a number of years the laparoscopic adjustable gastric band has been one of the leading bariatric procedures with good short-term outcomes. However, inadequate weight loss, weight regain, and other band-related complications in the long term led to an increase in revisional Roux-en-Y gastric bypass (RYGB) procedures. Lengthening the biliopancreatic limb, a relatively simple and safe adjustment of the standard technique, could improve the results of the revisional procedure. OBJECTIVES The aim of this randomized controlled trial was to evaluate the effect of a long biliopancreatic limb RYGB (LBP-GB) and standard RYGB (S-GB) as revisional procedure after laparoscopic adjustable gastric band. SETTING General hospital specialized in bariatric surgery METHODS: One hundred forty-six patients were randomized in 2 groups; 73 patients underwent an S-GB (alimentary/biliopancreatic limb 150/75 cm), and 73 patients underwent LBP-GB (alimentary/biliopancreatic limb 75/150). Weight loss, remission of co-morbidities, quality of life, and complications were assessed during a period of 4 years. RESULTS Baseline characteristics between the groups were comparable. At 48 months the follow-up rate was 95%. Mean total weight loss after 24 months was 27% for LBP-GB versus 22% S-GB (P = .015); mean total weight loss after 48 months was 23% and 18%, respectively (P = .036). No significant differences in other parameters were found between the groups. CONCLUSIONS A LBP-GB as revisional procedure after a failing laparoscopic adjustable gastric band improves short- and long-term total weight loss compared with an S-GB. Together with future modifications this technically simple adjustment of the RYGB could significantly improve disappointing results after revisional surgery.
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Affiliation(s)
- Abel Boerboom
- Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.
| | - Jens Homan
- Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Edo Aarts
- Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Theo Aufenacker
- Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Ignace Janssen
- Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Frits Berends
- Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
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22
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Reiber BMM, Tenhagen M, Hunfeld MAJM, Cense HA, Demirkiran A. Calibration of the Gastric Pouch in Laparoscopic Roux-en-Y Gastric Bypass: Does It Matter? The Influence on Weight Loss. Obes Surg 2018; 28:3400-3404. [DOI: 10.1007/s11695-018-3352-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Khalayleh H, Pines G, Imam A, Sapojnikov S, Buyeviz V, Mavor E. Anastomotic Stricture Rates Following Roux-en-Y Gastric Bypass for Morbid Obesity: A Comparison Between Linear and Circular-Stapled Anastomosis. J Laparoendosc Adv Surg Tech A 2018; 28:631-636. [DOI: 10.1089/lap.2017.0619] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Harbi Khalayleh
- Department of Surgery, Kaplan Medical Center, Rehovot and The Hebrew University School of Medicine, Jerusalem, Israel
| | - Guy Pines
- Department of Surgery, Kaplan Medical Center, Rehovot and The Hebrew University School of Medicine, Jerusalem, Israel
| | - Ashraf Imam
- Department of Surgery, Kaplan Medical Center, Rehovot and The Hebrew University School of Medicine, Jerusalem, Israel
| | - Shimon Sapojnikov
- Department of Surgery, Kaplan Medical Center, Rehovot and The Hebrew University School of Medicine, Jerusalem, Israel
| | - Victor Buyeviz
- Department of Surgery, Kaplan Medical Center, Rehovot and The Hebrew University School of Medicine, Jerusalem, Israel
| | - Eli Mavor
- Department of Surgery, Kaplan Medical Center, Rehovot and The Hebrew University School of Medicine, Jerusalem, Israel
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24
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Borbély Y, Winkler C, Kröll D, Nett P. Pouch Reshaping for Significant Weight Regain after Roux-en-Y Gastric Bypass. Obes Surg 2017; 27:439-444. [PMID: 27510586 DOI: 10.1007/s11695-016-2329-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Significant weight regain after Roux-en-Y gastric bypass (RYGB) occurs in around 20 % of patients in the long term. Anatomical reasons include dilatation of the gastric pouch and/or the pouch-jejunal anastomosis, leading to loss of restriction. Pouch reshaping (PR) aims at reestablishing restriction with a subsequent feeling of satiety. This study reports the outcome of PR embedded in a multidisciplinary treatment pathway. METHODS Twenty-six patients after PR for weight regain >30 % following RYGB in a university hospital between October 2010 and March 2016 were analyzed. Excluded were patients with PR for gastro-gastric fistulae, hypoglycemia, candy cane syndrome, and concomitant alteration of limb lengths. PR consisted in laparoscopic lateral resection of the gastric pouch, the anastomosis and the proximal 5 cm of the alimentary limb over a 32F bougie. RESULTS Median follow-up after PR was 48 months (range 24-60). Median BMI at PR was 39.1 kg/m2 (32.7-59.1). Median operation time was 85 min (25-190), and median length of stay was 3 days (1-35). Minor complications (grade ≤ 2) occurred in seven (27 %) patients and major complications (grade ≥ 3) in four patients (15 %). Nadir BMI and %EBMIL after PR were 32.9 kg/m2 and 43.3 %, reached after a median of 12 months (3-48). Comorbidities were resolved in 81 %. After 48 months, median BMI was 33.8 kg/m2 (20.4-49.2) and %EBMIL was 61.4 (39.1-121.2). CONCLUSIONS Used selectively in a multidisciplinary treatment pathway, PR leads to prolonged weight stabilization around the previous nadir. However, its associated perioperative morbidity must not be disregarded.
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Affiliation(s)
- Yves Borbély
- Department of Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, 3010, Bern, Switzerland.
| | - Carmen Winkler
- Department of Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, 3010, Bern, Switzerland
| | - Dino Kröll
- Department of Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, 3010, Bern, Switzerland
| | - Philipp Nett
- Department of Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, 3010, Bern, Switzerland
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Deden LN, Cooiman MI, Aarts EO, Janssen IMC, Gotthardt M, Hendrickx BW, Berends FJ. Gastric pouch emptying of solid food in patients with successful and unsuccessful weight loss after Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis 2017; 13:1840-1846. [PMID: 28935201 DOI: 10.1016/j.soard.2017.07.031] [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] [Received: 06/30/2017] [Revised: 07/25/2017] [Accepted: 07/25/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND After Roux-en-Y gastric bypass (RYGB), approximately 10% of patients have insufficient weight loss (excess body mass index loss<50%). Gastric pouch emptying may have a role in weight loss. OBJECTIVES To compare pouch emptying of patients with poor weight loss and patients with successful weight loss after RYGB. SETTING A research-intensive nonacademic hospital and center of expertise in bariatric surgery in the Netherlands METHODS: Female patients were included from among patients with the least (poor weight loss group [P-WL]) and the most weight loss (successful weight loss group [S-WL]) in our center 2 years after RYGB. Pouch emptying scintigraphy was performed after ingestion of a radiolabeled solid meal. Emptying curves, intestinal content (IC) at meal completion and after 15, 30, 45, and 60 minutes, half emptying time, and maximal pouch emptying rate were compared. RESULTS Five individuals were included in P-WL and 5 in S-WL, on average 2.5 ± .3 years after RYGB. Total weight loss was 18 ± 4.1% in P-WL and 44 ± 5.7% in S-WL (P<.001). In P-WL, a fast initial pouch emptying and exponential emptying curve was observed, compared with a slower initial emptying and more linear curve in S-WL. Faster emptying in P-WL was also shown by a larger ICmeal (42 ± 18% versus 4.0 ± 3.3%,), IC15 (76 ± 15% versus 35 ± 22%), and IC30 (85 ± 12% versus 54 ± 25%), and a greater maximal pouch emptying rate (17 ± 4.7 versus 5.6 ± 3.4%/min) compared with S-WL (P<.05). A linear correlation was found between total weight loss and maximal pouch emptying rate (Pearson R = .82, P = .004). CONCLUSIONS Pouch emptying for solid food was faster in patients with the least weight loss compared with patients with the most weight loss after RYGB. If pouch emptying is an important mechanism in weight loss, altering the pouch outlet may improve poor weight loss management.
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Affiliation(s)
- Laura N Deden
- Vitalys Clinic, Velp, the Netherlands; Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.
| | - Mellody I Cooiman
- Vitalys Clinic, Velp, the Netherlands; Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Edo O Aarts
- Vitalys Clinic, Velp, the Netherlands; Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Ignace M C Janssen
- Vitalys Clinic, Velp, the Netherlands; Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Martin Gotthardt
- Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Baudewijn W Hendrickx
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frits J Berends
- Vitalys Clinic, Velp, the Netherlands; Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
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Revision of sleeve gastrectomy to Roux-en-Y Gastric Bypass: A Canadian experience. Am J Surg 2017; 213:970-974. [DOI: 10.1016/j.amjsurg.2017.04.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/05/2017] [Indexed: 01/03/2023]
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Aryaie AH, Fayezizadeh M, Wen Y, Alshehri M, Abbas M, Khaitan L. "Candy cane syndrome:" an underappreciated cause of abdominal pain and nausea after Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis 2017; 13:1501-1505. [PMID: 28552743 DOI: 10.1016/j.soard.2017.04.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 02/24/2017] [Accepted: 04/04/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND "Candy cane" syndrome (a blind afferent Roux limb at the gastrojejunostomy) has been implicated as a cause of abdominal pain, nausea, and emesis after Roux-n-Y gastric bypass (RYGB) but remains poorly described. OBJECTIVES To report that "candy cane" syndrome is real and can be treated effectively with revisional bariatric surgery SETTING: All patients underwent "candy cane" resection at University Hospitals of Cleveland. METHODS All patients who underwent resection of the "candy cane" between January 2011 and July 2015 were included. All had preoperative workup to identify "candy cane" syndrome. Demographic data; pre-, peri-, and postoperative symptoms; data regarding hospitalization; and postoperative weight loss were assessed through retrospective chart review. Data were analyzed using Student's t test and χ2 analysis where appropriate. RESULTS Nineteen patients had resection of the "candy cane" (94% female, mean age 50±11 yr), within 3 to 11 years after initial RYGB. Primary presenting symptoms were epigastric abdominal pain (68%) and nausea/vomiting (32%), particularly with fibrous foods and meats. On upper gastrointestinal study and endoscopy, the afferent blind limb was the most direct outlet from the gastrojejunostomy. Only patients with these preoperative findings were deemed to have "candy cane" syndrome. Eighteen (94%) cases were completed laparoscopically. Length of the "candy cane" ranged from 3 to 22 cm. Median length of stay was 1 day. After resection, 18 (94%) patients had complete resolution of their symptoms (P<.001). Mean body mass index decreased from 33.9±6.1 kg/m2 preoperatively to 31.7±5.6 kg/m2 at 6 months (17.4% excess weight loss) and 30.5±6.9 kg/m2 at 1 year (25.7% excess weight loss). The average length of latest follow-up was 20.7 months. CONCLUSION "Candy cane" syndrome is a real phenomenon that can be managed safely with excellent outcomes with resection of the blind afferent limb. A thorough diagnostic workup is paramount to proper identification of this syndrome. Surgeons should minimize the size of the blind afferent loop left at the time of initial RYGB.
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Affiliation(s)
- Amir H Aryaie
- Department of Surgery, Division of Bariatric Surgery, Texas Tech University Health Science Center, Lubbock, Texas.
| | - Mojtaba Fayezizadeh
- Department of Surgery, Division of Bariatric Surgery. University Hospitals Case Medical Center, Cleveland, Ohio
| | - Yuxiang Wen
- Department of Surgery, Division of Bariatric Surgery. University Hospitals Case Medical Center, Cleveland, Ohio
| | - Mohammed Alshehri
- Department of Surgery, Division of Bariatric Surgery. University Hospitals Case Medical Center, Cleveland, Ohio
| | - Mujjahid Abbas
- Department of Surgery, Division of Bariatric Surgery. University Hospitals Case Medical Center, Cleveland, Ohio
| | - Leena Khaitan
- Department of Surgery, Division of Bariatric Surgery. University Hospitals Case Medical Center, Cleveland, Ohio
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Abstract
BACKGROUND While gastric bypass has been the treatment of choice for morbid obesity, insufficient weight loss and even weight regain has been observed in a sub-group of patients. Dilatation of the pouch, pouch outlet, and proximal alimentary limb have been suggested to cause weight regain on the long term. The banded gastric bypass surgery has been introduced to overcome this problem. METHODS Four hundred thirty-two patients (n = 254, non-banded/n = 178, banded-GaBP Ring™) were followed-up for 5 years. Patients were evaluated for weight loss, % excess weight loss (%EWL), weight regain and BMI. RESULTS No significant differences between groups in the first year following surgery were observed in terms of weight loss and %EWL. %EWL at 5 years was as follows: non-banded 65.2 ± 20.0 %; banded 74.0 ± 15.1 %. At 5 years, the banded group showed more weight loss (non-banded 35.4 ± 12.5; banded 43.9 ± 11.9 kg, P < 0.0001); weight regain was significantly higher in the non-banded group (P < 0.0001). Only minor complications were reported; no signs of ring migration or slippage were reported. CONCLUSION Although, following the first year after surgery, no differences in treatment groups were observed in terms of weight loss, 5 years following surgery, patients who received banded surgery maintained better weight loss and had less weight regain compared to the non-banded group. These results suggest that laparoscopic banded gastric bypass using a silastic ring was effective in maintaining weight loss on the long term, while the complication rate was low. The banded gastric bypass is regarded by us as the new gold standard.
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Affiliation(s)
- Luc Lemmens
- Abdominal Surgery, AZ Nikolaas, Campus Sint-Niklaas, Moerlandstraat 1, 9100, Sint-Niklaas, Belgium.
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Evers SS, Sandoval DA, Seeley RJ. The Physiology and Molecular Underpinnings of the Effects of Bariatric Surgery on Obesity and Diabetes. Annu Rev Physiol 2017; 79:313-334. [DOI: 10.1146/annurev-physiol-022516-034423] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Simon S. Evers
- Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109;
| | - Darleen A. Sandoval
- Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109;
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109
| | - Randy J. Seeley
- Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109;
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, Michigan 48109
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Steinert RE, Feinle-Bisset C, Asarian L, Horowitz M, Beglinger C, Geary N. Ghrelin, CCK, GLP-1, and PYY(3-36): Secretory Controls and Physiological Roles in Eating and Glycemia in Health, Obesity, and After RYGB. Physiol Rev 2017; 97:411-463. [PMID: 28003328 PMCID: PMC6151490 DOI: 10.1152/physrev.00031.2014] [Citation(s) in RCA: 358] [Impact Index Per Article: 51.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The efficacy of Roux-en-Y gastric-bypass (RYGB) and other bariatric surgeries in the management of obesity and type 2 diabetes mellitus and novel developments in gastrointestinal (GI) endocrinology have renewed interest in the roles of GI hormones in the control of eating, meal-related glycemia, and obesity. Here we review the nutrient-sensing mechanisms that control the secretion of four of these hormones, ghrelin, cholecystokinin (CCK), glucagon-like peptide-1 (GLP-1), and peptide tyrosine tyrosine [PYY(3-36)], and their contributions to the controls of GI motor function, food intake, and meal-related increases in glycemia in healthy-weight and obese persons, as well as in RYGB patients. Their physiological roles as classical endocrine and as locally acting signals are discussed. Gastric emptying, the detection of specific digestive products by small intestinal enteroendocrine cells, and synergistic interactions among different GI loci all contribute to the secretion of ghrelin, CCK, GLP-1, and PYY(3-36). While CCK has been fully established as an endogenous endocrine control of eating in healthy-weight persons, the roles of all four hormones in eating in obese persons and following RYGB are uncertain. Similarly, only GLP-1 clearly contributes to the endocrine control of meal-related glycemia. It is likely that local signaling is involved in these hormones' actions, but methods to determine the physiological status of local signaling effects are lacking. Further research and fresh approaches are required to better understand ghrelin, CCK, GLP-1, and PYY(3-36) physiology; their roles in obesity and bariatric surgery; and their therapeutic potentials.
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Affiliation(s)
- Robert E Steinert
- University of Adelaide Discipline of Medicine and National Health and Medical Research Council of Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia; DSM Nutritional Products, R&D Human Nutrition and Health, Basel, Switzerland; Institute of Veterinary Physiology, University of Zurich, Zurich, Switzerland; Department of Biomedicine and Division of Gastroenterology, University Hospital Basel, Basel, Switzerland; and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
| | - Christine Feinle-Bisset
- University of Adelaide Discipline of Medicine and National Health and Medical Research Council of Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia; DSM Nutritional Products, R&D Human Nutrition and Health, Basel, Switzerland; Institute of Veterinary Physiology, University of Zurich, Zurich, Switzerland; Department of Biomedicine and Division of Gastroenterology, University Hospital Basel, Basel, Switzerland; and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
| | - Lori Asarian
- University of Adelaide Discipline of Medicine and National Health and Medical Research Council of Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia; DSM Nutritional Products, R&D Human Nutrition and Health, Basel, Switzerland; Institute of Veterinary Physiology, University of Zurich, Zurich, Switzerland; Department of Biomedicine and Division of Gastroenterology, University Hospital Basel, Basel, Switzerland; and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
| | - Michael Horowitz
- University of Adelaide Discipline of Medicine and National Health and Medical Research Council of Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia; DSM Nutritional Products, R&D Human Nutrition and Health, Basel, Switzerland; Institute of Veterinary Physiology, University of Zurich, Zurich, Switzerland; Department of Biomedicine and Division of Gastroenterology, University Hospital Basel, Basel, Switzerland; and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
| | - Christoph Beglinger
- University of Adelaide Discipline of Medicine and National Health and Medical Research Council of Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia; DSM Nutritional Products, R&D Human Nutrition and Health, Basel, Switzerland; Institute of Veterinary Physiology, University of Zurich, Zurich, Switzerland; Department of Biomedicine and Division of Gastroenterology, University Hospital Basel, Basel, Switzerland; and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
| | - Nori Geary
- University of Adelaide Discipline of Medicine and National Health and Medical Research Council of Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia; DSM Nutritional Products, R&D Human Nutrition and Health, Basel, Switzerland; Institute of Veterinary Physiology, University of Zurich, Zurich, Switzerland; Department of Biomedicine and Division of Gastroenterology, University Hospital Basel, Basel, Switzerland; and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
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Iceta S, Disse E, Gouillat C, Laville M, Saoud M, Robert M. Personality but not Eating Behavior Is Different in Revisional Bariatric Surgery Candidates. Bariatr Surg Pract Patient Care 2016. [DOI: 10.1089/bari.2016.0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Sylvain Iceta
- Centre Référent pour l'Anorexie et les Troubles du Comportement Alimentaire (CREATYON), Hospices Civils de Lyon, Bron Cedex, France
- INSERM U1028, CNRS UMR5292, University Lyon 1, Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Centre Hospitalier Le Vinatier, France
- Centre Intégré de l'Obésité Rhône-Alpes; Fédération Hospitalo-Universitaire DO-iT, Department of Endocrinology and Nutrition, Groupement Hospitalier Sud, Hospices Civils de Lyon, Lyon, France
| | - Emmanuel Disse
- Centre Intégré de l'Obésité Rhône-Alpes; Fédération Hospitalo-Universitaire DO-iT, Department of Endocrinology and Nutrition, Groupement Hospitalier Sud, Hospices Civils de Lyon, Lyon, France
- Department of Endocrinology, Diabetology and Nutrition, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Christian Gouillat
- Centre Intégré de l'Obésité Rhône-Alpes; Fédération Hospitalo-Universitaire DO-iT, Department of Endocrinology and Nutrition, Groupement Hospitalier Sud, Hospices Civils de Lyon, Lyon, France
- Department of Digestive Surgery, Center of Bariatric Surgery, University Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon cedex, France
| | - Martine Laville
- Centre Intégré de l'Obésité Rhône-Alpes; Fédération Hospitalo-Universitaire DO-iT, Department of Endocrinology and Nutrition, Groupement Hospitalier Sud, Hospices Civils de Lyon, Lyon, France
- Department of Endocrinology, Diabetology and Nutrition, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Mohamed Saoud
- INSERM U1028, CNRS UMR5292, University Lyon 1, Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Centre Hospitalier Le Vinatier, France
| | - Maud Robert
- Centre Intégré de l'Obésité Rhône-Alpes; Fédération Hospitalo-Universitaire DO-iT, Department of Endocrinology and Nutrition, Groupement Hospitalier Sud, Hospices Civils de Lyon, Lyon, France
- Department of Digestive Surgery, Center of Bariatric Surgery, University Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon cedex, France
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Palmisano S, Silvestri M, Giuricin M, Baldini E, Albertario S, Capelli P, Marzano B, Fanti G, Zompicchiatti A, Millo P, Fabozzi M, Brachet Contul R, Ponte E, Allieta R, de Manzini N. Preoperative Predictive Factors of Successful Weight Loss and Glycaemic Control 1 Year After Gastric Bypass for Morbid Obesity. Obes Surg 2016; 25:2040-6. [PMID: 25845353 DOI: 10.1007/s11695-015-1662-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Gastric bypass (GBP) is one of the most effective surgical procedures to treat morbid obesity and the related comorbidities. This study aimed at identifying preoperative predictors of successful weight loss and type 2 diabetes mellitus (T2DM) remission 1 year after GBP. METHODS Prospective longitudinal study of 771 patients who underwent GBP was performed at four Italian centres between November 2011 and May 2013 with 1-year follow-up. Preoperative anthropometric, metabolic and social parameters, the surgical technique and the previous failed bariatric procedures were analyzed. Weight, the body mass index (BMI), the percentage of excess weight lost (% EWL), the percentage of excess BMI lost (% BMIL) and glycated haemoglobin (HbA1c) were recorded at follow-up. RESULTS Univariate and multivariate analysis showed that BMI <50 kg/m(2) (p = 0.006) and dyslipidaemia (p = 0.05) were predictive factors of successful weight loss. Multivariate analysis of surgical technique showed significant weight loss in patients with a small gastric pouch (p < 0.001); the lengths of alimentary and biliary loops showed no statistical significance. All diabetic patients had a significant reduction of HbA1c (p < 0.001) after surgery. BMI ≥ 50 kg/m(2) (p = 0.02) and low level of preoperative HbA1c (p < 0.01) were independent risk factors of T2DM remission after surgery. CONCLUSIONS This study provides a useful tool for making more accurate predictions of best results in terms of weight loss and metabolic improvement.
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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.
| | - Marta Silvestri
- Department of Medical, Surgical and Health Sciences, General Surgery Clinic, University Hospital of Trieste, Strada di Fiume, 447, Trieste, Italy.
| | - Michela Giuricin
- Department of Medical, Surgical and Health Sciences, General Surgery Clinic, University Hospital of Trieste, Strada di Fiume, 447, Trieste, Italy.
| | - Edoardo Baldini
- Unità Operativa di Chirurgia Generale, Toracica e Vascolare, Ospedale "Guglielmo da Saliceto", via Taverna 49, 29122, Piacenza, Italy.
| | - Simone Albertario
- Unità Operativa di Chirurgia Generale, Toracica e Vascolare, Ospedale "Guglielmo da Saliceto", via Taverna 49, 29122, Piacenza, Italy.
| | - Patrizio Capelli
- Unità Operativa di Chirurgia Generale, Toracica e Vascolare, Ospedale "Guglielmo da Saliceto", via Taverna 49, 29122, Piacenza, Italy.
| | - Bernardo Marzano
- Department of Surgery, Santa Maria degli Angeli Hospital, Via Montereale 24, 33170, Pordenone, Italy.
| | - Giovanni Fanti
- Department of Surgery, Santa Maria degli Angeli Hospital, Via Montereale 24, 33170, Pordenone, Italy.
| | - Aron Zompicchiatti
- Department of Surgery, Santa Maria degli Angeli Hospital, Via Montereale 24, 33170, Pordenone, Italy.
| | - Paolo Millo
- Department of General Surgery, Bariatric and Metabolic Unit, "Umberto Parini" Regional Hospital of Aosta, Viale Ginevra 3, Aosta, Italy.
| | - Massimiliano Fabozzi
- Department of General Surgery, Bariatric and Metabolic Unit, "Umberto Parini" Regional Hospital of Aosta, Viale Ginevra 3, Aosta, Italy.
| | - Riccardo Brachet Contul
- Department of General Surgery, Bariatric and Metabolic Unit, "Umberto Parini" Regional Hospital of Aosta, Viale Ginevra 3, Aosta, Italy.
| | - Elisa Ponte
- Department of General Surgery, Bariatric and Metabolic Unit, "Umberto Parini" Regional Hospital of Aosta, Viale Ginevra 3, Aosta, Italy.
| | - Rosaldo Allieta
- Department of General Surgery, Bariatric and Metabolic Unit, "Umberto Parini" Regional Hospital of Aosta, Viale Ginevra 3, Aosta, Italy.
| | - Nicolò de Manzini
- Department of Medical, Surgical and Health Sciences, General Surgery Clinic, University Hospital of Trieste, Strada di Fiume, 447, Trieste, Italy.
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Al-Bader I, Khoursheed M, Al Sharaf K, Mouzannar DA, Ashraf A, Fingerhut A. Revisional Laparoscopic Gastric Pouch Resizing for Inadequate Weight Loss After Roux-en-Y Gastric Bypass. Obes Surg 2016; 25:1103-8. [PMID: 25599857 PMCID: PMC4460267 DOI: 10.1007/s11695-015-1579-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Weight regain due to gastric pouch dilatation after Roux-en-Y gastric bypass (RYGB) is seen more frequently after long-term follow-up. We studied the feasibility and safety of laparoscopic pouch resizing (LPR) for dilated gastric pouch after RYGB associated with inadequate weight loss. Methods From 1st June 2011 to 1st September 2013, patients who underwent LPR after failed RYGB were retrospectively compared and analyzed. Data included patient demographics, comorbidity, indication for revision, preoperative weight and BMI, operative time, hospital stay, conversion rate, mean follow-up, body mass index (BMI) loss, percentage excess weight loss (%EWL), reoperation rate, morbidity, and mortality. Results Out of 170 revisional bariatric procedures, 32 LPR (27/5, F/M) were performed for dilated gastric pouch after RYGB. The mean age, preoperative weight, and BMI were 38.3 ± 9.3 years, 101.7 ± 22.8 kg, 38.8 ± 6.4 kg/m2, respectively. The median operative time and hospital stay were 100 min and 2 days, respectively. All pouch resizing procedures were carried out laparoscopically, with none requiring conversion to open surgery. The overall complication and reoperation rates were 15.6 and 3.1 %, respectively. There were no deaths. The mean follow-up was 14.1 ± 6.2 months. The mean postoperative BMI was 32.8 ± 7.3 kg/m2, and the median %EWL was 29.1 %. Conclusions LPR is safe and can lead to adequate weight loss. However, long-term follow-up is needed to determine the efficiency and durability of this procedure.
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Affiliation(s)
- Ibtisam Al-Bader
- Department of Surgery, Faculty of Medicine, Kuwait University, Safat, PO Box 24923, Jabriya, 13110, Kuwait
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Nguyen D, Dip F, Huaco JA, Moon R, Ahmad H, LoMenzo E, Szomstein S, Rosenthal R. Outcomes of revisional treatment modalities in non-complicated Roux-en-Y gastric bypass patients with weight regain. Obes Surg 2015; 25:928-34. [PMID: 25720514 DOI: 10.1007/s11695-015-1615-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (RYGB) is an effective treatment modality for severe obesity. Failure of weight loss and/or weight regain due to lack of restriction has been reported in long-term follow-up studies. The aim of this study is to determine the safety and effectiveness of reestablishing the restrictive component of the operation by trimming the pouch and/or anastomosis for pouch and/or anastomotic enlargement using a laparoscopic approach. METHODS We retrospectively reviewed our prospectively collected database for all patients that underwent revisional surgery of RYGB for weight regain or failure of weight loss. Percent excess weight loss (%EWL) and BMI loss (BMIL) were characterized into the following three time periods: (1) primary operation to pre-revision, (2) pre-revision to post-revision, and (3) primary operation to post-revision. Post-operative follow-up was at 6, 12, 18, 24, 36, and 48 months. RESULTS Between 2005 and 2011, a total of 121 patients in the database underwent revision of RYGB. Forty-four patients were identified that fulfilled the aforementioned parameters. In this group, 30 patients underwent trimming of the pouch and/or redo anastomosis (TPA), 8 TPA and conversion from retrocolic to antecolic Roux limb, and 6 TPA with remnant gastrectomy. Mean follow-up period was 26.1 ± 22.7 months. The post-revision mean %EWL was 38%, and the BMI loss was 7 kg/m(2). In the pre-revision to 48 months post-revision time period, mean %EWL and BMIL were 28.6% and 4.9 kg/m(2) in the TPA-only group, 52% and 8.8 kg/m(2) in the TPA with conversion to antecolic, antegastric group, and 33.4% and 5.9 kg/m(2) in the TPA with gastrectomy group, respectively (%EWL, p = 0.096; BMIL, p = 0.227). One patient (2.3%) developed a left upper quadrant hematoma. There was no mortality in this series. CONCLUSIONS Trimming of the pouch and/or anastomosis appears to be a safe and effective revisional modality for patients with insufficient weight loss or weight regain after gastric bypass in the hands of experienced surgeons.
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Affiliation(s)
- David Nguyen
- The Bariatric and Metabolic Institute and Section of Minimally Invasive Surgery, Department of General Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
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Effect of Roux-en-Y gastric bypass with different pouch size in Chinese T2DM patients with BMI 30-35 kg/m2. Obes Surg 2015; 25:457-63. [PMID: 25236397 DOI: 10.1007/s11695-014-1411-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The purpose of this study was to assess the effect of Roux-en-Y gastric bypass (RYGB) with different pouch size in Chinese type 2 diabetes mellitus (T2DM) patients with measured body mass index (BMI) 30-35 kg/m(2). METHODS In this randomized and prospective study, we evaluated the efficacy of RYGB with smaller size pouch (10-20 ml) versus larger pouch size (25-35 ml) in 76 Chinese obese patients (33 F, 43 M) with T2DM. According to protocol, all patients were divided into two groups, smaller pouch size group and larger pouch size group, and underwent RYGB surgery. Primary inclusion criteria of study were (a) a diagnosis of type 2 diabetes (glycated hemoglobin level >7.0 %), (b) measured BMI of at least 30 kg/m(2) and not yet 35 kg/m(2), and (c) age between 25 and 60 years old, and (d) patients were excluded if they had previously undergone complex abdominal surgery or bariatric surgery. Weight loss, BMI, percentage of excess weight loss (% EWL), glycated hemoglobin, and fasting plasma glucose were obtained at 3, 6, 9, and 12 months after surgery. RESULTS Of these 76 patients, 69 (91 %) patients completed follow-up postoperative 12 months. Weight loss and % EWL at 12 months was greater in smaller pouch size group (mean 15.8 kg, 95 % CI -17.2 to -14.4 and mean 68.9, 95 % CI 62.5-75.2 %) than in larger pouch size group (mean -13.7 kg, 95 % CI -15.3 to -12.1, and mean 59.1, 95 % CI 52.8-65.5) (P = 0.046, P = 0.033, respectively). Glycemic control improved in both two groups, with a mean glycated hemoglobin level of 6.2 % (95 % CI 6.0-6.5 %) in smaller size group, and 6.7 % (95 % CI 6.4-7.0 %) in larger size group (P = 0.025, P < 0.05). The fasting plasma glucose level decreased significantly after surgery, with a mean level of 5.4 mmol/L (95 % CI 5.2-5.5 mmol/L) and 5.6 mmol/L (95 % CI 5.5-5.8 mmol/L) respectively, (P = 0.040, P < 0.05). CONCLUSIONS In this short-term study, in Chinese T2DM patients with BMI 30-35 kg/m(2), we observed a greater efficiency on weight loss and glycemic control with smaller pouch size compared to larger pouch size. In the future, long-term follow-up and large sample study will be necessary to confirm these outcomes.
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Aminian A, Schauer PR, Brethauer SA. Reply to: Assessment of pouch and stoma size in weight loss failure after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2015; 12:211-2. [PMID: 26433640 DOI: 10.1016/j.soard.2015.08.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 08/27/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic Cleveland, Ohio
| | - Philip R Schauer
- Bariatric and Metabolic Institute, Cleveland Clinic Cleveland, Ohio
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Edholm D, Ottosson J, Sundbom M. Importance of pouch size in laparoscopic Roux-en-Y gastric bypass: a cohort study of 14,168 patients. Surg Endosc 2015; 30:2011-5. [PMID: 26194258 DOI: 10.1007/s00464-015-4432-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 07/09/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most common bariatric procedures worldwide, but the importance of gastric pouch size is still under debate. We have studied how pouch size affects risk of marginal ulcer and excess body mass index loss (EBMIL%) at 6 weeks and 1 year postoperatively. METHODS Scandinavian Obesity Surgery Registry included 14,168 LRYGB patients with linear stapled gastrojejunostomies, having complete pre- and postoperative data concerning length of stapler needed to complete the gastric pouch, incidence of marginal ulcers and weight loss. LRYGB technique in Sweden is highly standardized, and total length of stapler was used as a proxy for pouch size. RESULTS Mean length of stapler used for the pouch was 145 mm. At 1 year, symptomatic marginal ulcers were noted in 0.9 % of the patients. The relative risk of marginal ulcer increased by 14 % (95 % confidence interval 9-20 %), for each centimeter of stapler used for the pouch. Body mass index (BMI) was reduced from 42.4 ± 5.1 to 36.1 kg/m(2) at 6 weeks and 28.9 kg/m(2) at 1 year. The total length of stapler predicted EBMIL% at 6 weeks but not at 1 year. Female gender, low preoperative BMI, young age and absence of diabetes predicted better EBMIL% at 1 year. CONCLUSION A smaller pouch reduces the risk of marginal ulcers, but does not predict better weight loss at 1 year. Additional stapling should be avoided as each extra centimeter increases the relative risk of marginal ulcers by 14 %.
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Affiliation(s)
- David Edholm
- Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden.
| | - Johan Ottosson
- Department of Surgical Sciences, Örebro University, Örebro, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden
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Moon RC, Teixeira AF, Jawad MA. Treatment of weight regain following roux-en-Y gastric bypass: revision of pouch, creation of new gastrojejunostomy and placement of proximal pericardial patch ring. Obes Surg 2015; 24:829-34. [PMID: 24446076 DOI: 10.1007/s11695-014-1188-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In the literature, weight regain or failure of weight loss has been reported in up to 35% of patients after Roux-en-Y gastric bypass (RYGB). Several revisional procedures have been suggested to reinitiate further weight loss in this group of patients, and placing a silastic ring around the pouch proximal to the gastrojejunostomy is one among those procedures. The aim of our study is to evaluate and compare the safety and efficacy of salvage banding using a pericardial patch after RYGB for further weight loss. Between December 2009 and April 2013, a total of 46 patients underwent revision with pericardial patch ring after RYGB for weight regain/failure of weight loss. A retrospective review of a prospectively collected database was performed, noting the outcomes and complications of the procedure. The mean body mass index at the time of revision was 40.1 ± 6.8 kg/m2. Mean percentage of excess weight loss was 23.4 ± 15.7%, 39.0 ± 27.4%, and 18.9 ± 20.5% at 6, 12 and 24 months after revision, respectively. Eight (17.4%) patients required a total of 11 readmissions due to nausea, vomiting, dysphagia and abdominal pain. Six (13.0%) patients underwent a total of six reoperations, including four patients with laparoscopic removal of the pericardial patch and another revision of RYGB, and two patients with repair of perforated ulcers. Revision with pericardial patch ring after gastric bypass for weight regain or failure of weight loss may not be feasible, safe and effective.
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Affiliation(s)
- Rena C Moon
- Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, 89 W Copeland Drive, 1st Floor, Orlando, FL, USA
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Manometry of the Upper Gut Following Roux-en-Y Gastric Bypass Indicates That the Gastric Pouch and Roux Limb Act as a Common Cavity. Obes Surg 2015; 25:1833-41. [DOI: 10.1007/s11695-015-1639-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
BACKGROUND Bariatric surgical procedures are classified by their presumed mechanisms of action: restrictive, malabsorptive or a combination of both. However, this dogma is questionable and remains unproven. We investigated post-operative changes in nutrient absorption and transit time following bariatric surgery. METHODS Participants were recruited into four groups: obese controls (body mass index (BMI) >30 kg/m2, n = 7), adjustable gastric banding (n = 6), Roux-en-Y gastric bypass (RYGB, n = 7) and biliopancreatic diversion with duodenal switch (DS, n = 5). Participants underwent sulphasalazine/sulphapyridine tests (oro-caecal transit time); fasting plasma citrulline (functional enterocyte mass); 3 days faecal collection for faecal elastase 1 (FE-1); calprotectin (FCp); faecal fatty acids (pancreatic exocrine function, gut inflammation and fat excretion, respectively); and 5 h D-xylose, L-rhamnose and lactulose test (intestinal absorption and permeability). RESULTS Age and gender were not different but BMI differed between groups (p = 0.001). No difference in oro-caecal transit time (p = 0.935) or functional enterocyte mass (p = 0.819) was detected. FCp was elevated post-RYGB vs. obese (p = 0.016) and FE-1 was reduced post-RYGB vs. obese (p = 0.002). Faecal fat concentrations were increased post-DS vs. obese (p = 0.038) and RYGB (p = 0.024) and were also higher post-RYGB vs. obese (p = 0.033). Urinary excretion of D-xylose and L-rhamnose was not different between the groups; however, lactulose/rhamnose ratio was elevated post-DS vs. other groups (all p < 0.02), suggesting increased intestinal permeability. CONCLUSIONS Following RYGB, there are surprisingly few abnormalities or indications of severe malabsorption of fats or sugars. Small bowel adaptation after bariatric surgery may be key to understanding the mechanisms responsible for the beneficial metabolic effects of these operations.
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Aminian A, Corcelles R, Daigle CR, Chand B, Brethauer SA, Schauer PR. Critical appraisal of salvage banding for weight loss failure after gastric bypass. Surg Obes Relat Dis 2014; 11:607-11. [PMID: 26093767 DOI: 10.1016/j.soard.2014.11.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 11/06/2014] [Accepted: 11/18/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Placement of an adjustable gastric band (AGB) over the gastric pouch after RYGB failure has had varied results. The aim of this study was to evaluate safety and outcomes of AGB after RYGB failure. METHODS Twenty-eight patients who underwent laparoscopic placement of an AGB around the gastric pouch as a revisional procedure for inadequate weight loss or recidivism after RYGB between 2008-2011 were identified. RESULTS Twenty-four (86%) patients had a dilated gastric pouch and/or stoma. The mean operative and adhesiolysis times were 137.9±52.3 minutes and 83±51 minutes, respectively. History of a previous open RYGB was associated with a longer adhesiolysis time (P = .03). Three (11%) major intraoperative and 5 (18%) early postoperative complications occurred. Late complications (all requiring band removal) were observed in 6 (21%) patients and included ineffectiveness (n = 2), dysphagia/esophageal dilation (n = 2), band erosion (n = 1), and peritonitis (n = 1). In all 4 patients with a normal-sized pouch and stoma at the time of band placement, the band was removed. After a mean follow-up of 38.3±14.8 months, the mean body mass index (BMI) change and median excess weight loss (EWL) after salvage banding were -3.6±4.5 kg/m(2) and 12.7%, respectively. In the subset of patients with a dilated pouch/stoma, BMI less than 42 kg/m(2) at the time of band placement was associated with a significantly higher EWL (41.4%±37.0%) compared with a baseline BMI>42 kg/m(2) (12.1%±7.2%, P = .03). CONCLUSIONS Salvage banding is technically challenging due to dense adhesions, carries significant morbidity, and is associated with only 13% additional EWL. However, this approach may still be an option in carefully selected patients, such as those with previous laparoscopic RYGB who have a dilated pouch and/or stoma and lower BMI.
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Affiliation(s)
- Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ricard Corcelles
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Gastrointestinal Surgery, Hospital Clinic Barcelona, Barcelona, Spain
| | | | - Bipan Chand
- Department of Surgery, Loyola University, Chicago, Illinois
| | - Stacy A Brethauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Philip R Schauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
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Lemmens L, Karcz WK, Bukhari W, Fink J, Kuesters S. Banded gastric bypass - four years follow up in a prospective multicenter analysis. BMC Surg 2014; 14:88. [PMID: 25391401 PMCID: PMC4236457 DOI: 10.1186/1471-2482-14-88] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 10/17/2014] [Indexed: 12/21/2022] Open
Abstract
Background The gastric bypass is the gold standard of bariatric surgery. Nevertheless some patients show insufficient weight loss or weight regain. Dilation of the pouch or the pouch outlet may be the cause. The banded gastric bypass tries to overcome dilation by placing an implant around the pouch or pouch outlet. In this study we describe our results using the GaBP™ ring system in banded gastric bypass operations in 3 bariatric centers. Methods 183 patients in 3 bariatric reference centers received a banded gastric bypass operation using the GaBP™ ring system. Up to 4 years follow up was evaluated including weight loss and complications. Results Mean EWL after 6 Months was 60% with a mean BMI of 30.1 kg/m2. After one year mean EWL reached 75.3% with a mean BMI of 27 kg/m2 (110 patients). After two and three years the EWL was 78.8% (n = 49) and 79.9% (n = 35). There was a mean EWL of 85% after 4 years. Thirteen patients finished a 4 year follow up period and mean BMI after 4 years was 25.2 kg/m2. In the perioperative and early postoperative period there was a low complication rate (4.3%). Stenosis or dysphagia was observed in only one patient. There was only one ring related complication. Conclusion Banded gastric bypass using the GaBP™ ring system allows good weight loss with no regain of weight in a four year follow up. The complication rate is low. A randomized controlled trial is currently underway to compare banded and conventional gastric bypass.
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Affiliation(s)
| | - W Konrad Karcz
- Department of Surgery, University of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
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Abstract
Several techniques for the surgical management of obesity are available to bariatric surgeons. These interventions are performed more frequently with worsening of the obesity epidemic. Radiologists should be familiar with the surgical techniques, normal postoperative appearances, and potential complications for which imaging may be employed to establish a diagnosis to optimize patient care.
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Robert M, Pechoux A, Marion D, Laville M, Gouillat C, Disse E. Relevance of Roux-en-Y gastric bypass volumetry using 3-dimensional gastric computed tomography with gas to predict weight loss at 1 year. Surg Obes Relat Dis 2014; 11:26-31. [PMID: 25500226 DOI: 10.1016/j.soard.2014.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 04/21/2014] [Accepted: 05/18/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Causes of Roux-en-Y gastric bypass (RYGB) failures are still controversial. Literature data suggest that gastric pouch or gastrojejunal anastomosis distentions over time could be a key factor. Making the hypothesis that progressive distention of RYGB volumes is 1 of the main factors of weight loss failure, the aim of our study was to evaluate bypass volumes changes using repeated 3-dimensional gastric computed tomography with gas and the possible negative correlation with weight loss results at 1 year. METHODS Thirty-nine patients eligible for RYGB were prospectively included. Gastric bypass volumes were assessed at 3 and 12 months postsurgery performing 3-dimensional gastric computed tomography with gas and weight loss outcomes were recorded during the first postoperative year. RESULTS There was no loss to follow up. Mean % excess body mass index lost (%EBMIL) at 1 year was 66.7%. Seven patients (17.9%) did not reach Reinhold criteria and were considered as RYGB failures. We found no linear correlation between the 1 year %EBMIL and mean values of the gastric pouch (r=.01; P=.94), and the neo stomach (r=.09 ; P=.57) at 3 months. Revisional surgery was correlated negatively with %EBMIL at 1 year. CONCLUSION Weight loss at 1 year does not seem to be correlated to RYGB volume changes. Behavioral factors probably play a major role in weight loss failure.
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Affiliation(s)
- Maud Robert
- Department of Digestive Surgery, Center of Bariatric Surgery, Hospital Edouard Herriot, Hospices Civils de Lyon, F69437, Lyon cedex 03, France; Centre Intégré et Spécialisé de L'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, F69495 Pierre Bénite, France; Université Claude Bernard Lyon 1, Lyon, France.
| | - Albane Pechoux
- Department of Digestive Surgery, Center of Bariatric Surgery, Hospital Edouard Herriot, Hospices Civils de Lyon, F69437, Lyon cedex 03, France
| | - Denis Marion
- Department of Radiology, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, F69495 Pierre Bénite, France
| | - Martine Laville
- Centre Intégré et Spécialisé de L'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, F69495 Pierre Bénite, France; Université Claude Bernard Lyon 1, Lyon, France; Department of Endocrinology, Diabetology and Nutrition, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, F69495 Pierre Bénite, France
| | - Christian Gouillat
- Department of Digestive Surgery, Center of Bariatric Surgery, Hospital Edouard Herriot, Hospices Civils de Lyon, F69437, Lyon cedex 03, France; Centre Intégré et Spécialisé de L'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, F69495 Pierre Bénite, France; Université Claude Bernard Lyon 1, Lyon, France
| | - Emmanuel Disse
- Centre Intégré et Spécialisé de L'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, F69495 Pierre Bénite, France; Université Claude Bernard Lyon 1, Lyon, France; Department of Endocrinology, Diabetology and Nutrition, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, F69495 Pierre Bénite, France
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Mueller CL, Jackson TD, Swanson T, Pitzul K, Daigle C, Penner T, Urbach DR, Okrainec A. Linear-stapled gastrojejunostomy with transverse hand-sewn enterotomy closure significantly reduces strictures for laparoscopic Roux-en-Y gastric bypass. Obes Surg 2014; 23:1302-8. [PMID: 23526084 DOI: 10.1007/s11695-013-0920-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Gastrojejunostomy (GJ) stricture is a common complication after Roux-en-Y gastric bypass (RYGB) for morbid obesity, and the optimal anastomotic technique remains uncertain. The objective of this study was to use cumulative summation (CUSUM) analysis to compare rates of gastrojejunostomy strictures after linear stapling with longitudinal versus transverse enterotomy closure in gastric bypass patients. METHODS Charts of all consecutive patients with at least 60 days of post-operative follow-up after laparoscopic RYGB (LRYGB) at our tertiary care institution from Nov 2009 to Dec, 2011 were retrospectively reviewed. Gastrojejunostomy stricture was diagnosed by history and upper endoscopy. CUSUM method of quality control analysis was used to determine sequential improvement in stricture rates with the change in technique. RESULTS A total of 197 patients were included (97 longitudinal closure, median age 44 (21-67), median BMI 47 (35-80), 85.8 % female). Gastrojejunostomy strictures occurred in 16 % of longitudinal and 0 % of transverse patients (p = <0.0001). CUSUM analysis demonstrated sequential statistically significant improvement in stricture rates after the change in technique was applied. The longitudinal group had a statistically significant increased rate of surgery-related readmissions (15.5 vs 6.0 %, p = 0.038), with 43.7 % of those readmissions related to GJ strictures. There were no other significant outcome differences between groups. CONCLUSIONS Linear-stapled anastomosis with a transverse enterotomy closure significantly reduces the rate of gastrojejunostomy stricture for LRYGB, considerably reducing procedural morbidity.
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Affiliation(s)
- Carmen L Mueller
- Division of General Surgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, ON, Canada M8Y 1E8
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Langer FB, Prager G, Poglitsch M, Kefurt R, Shakeri-Leidenmühler S, Ludvik B, Schindler K, Bohdjalian A. Weight loss and weight regain-5-year follow-up for circular- vs. linear-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass. Obes Surg 2014; 23:776-81. [PMID: 23483356 DOI: 10.1007/s11695-013-0892-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Weight regain (WR) occurs in some patients after laparoscopic Roux-en-Y gastric bypass (LRYGBP). Loss of restriction due to dilation of the gastrojejunostomy (GJS) or the gastric pouch might be the main cause for WR. With different techniques available for the establishment of the GJS, the surgical technique might influence long-term success. METHODS We present a 5-year follow-up for weight loss and WR of a matched-pair study comparing circular stapled (CSA) to linear stapled (LSA) GJS in a series of 150 patients who underwent primary antecolic antegastric LRYGBP. Complete 5-year follow-up was obtained for 79 % of the patients. RESULTS Excess BMI loss (EBL) at 3 months was better with the CSA (p = 0.02) and comparable thereafter. The 5-year %EBL was 67.3 ± 23.2 vs. 73.3 ± 24.3 % (CSA vs. LSA, p = 0.19) WR of > 10 kg from nadir was found in 24 patients (16 %) with higher incidence in CSA than in LSA patients (20 % vs. 12 %). The %WR was comparable for both groups, 16 ± 13 vs. 15 ± 19 % (CSA vs. LSA, p = 0.345). Eleven patients underwent surgical re-intervention for WR by placement of a non-adjustable band (n = 2), adjustable band (n = 7) and conversion to distal gastric bypass (n = 2). CONCLUSIONS CSA and LSA lead to comparable weight loss in this 5-year follow-up. More patients in the CSA group had WR. Weight regain of more than 10 kg was found in one out of seven patients within 5 years postoperatively.
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Affiliation(s)
- F B Langer
- Department of Surgery, Division of General Surgery, Medical University of Vienna, General Hospital Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Faria G, Preto J, Almeida AB, Guimarães JT, Calhau C, Taveira-Gomes A. Fasting glycemia: a good predictor of weight loss after RYGB. Surg Obes Relat Dis 2013; 10:419-24. [PMID: 24462312 DOI: 10.1016/j.soard.2013.11.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 10/02/2013] [Accepted: 11/07/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND Preoperative prediction of weight loss after Roux-en-Y gastric bypass (RYGB) could help surgeons in managing surgical lists and patients' expectations. The objective of this study was to understand if preoperative metabolic control might improve surgical results. METHODS Prospective cohort of 163 consecutive patients who underwent RYGB with at least 1 year of follow-up. RESULTS Most patients were female (90.2%), with a mean age of 38 (19-60) and a BMI of 46.0 (34.3-59.9) kg/m(2). After 12 months, the mean body mass index (BMI) was 29.7 kg/m(2) (21.5-39.9) with a corresponding percentage of excess weight lost (%EWL) of 78.8% and a percentage of weight loss (%WL) of 35.1%. Patients with the highest preoperative fasting blood glucose (FBG) were older (42 versus 36; P<.001); were more likely to have type 2 diabetes (T2 DM, 40% versus 6.8%; P<.001) and metabolic syndrome (89% versus 25%; P<.001), had a slightly higher BMI (30.8 versus 29.3 kg/m(2); P = .03), and had achieved a significantly lower %EWL and %WL at 12 months (72.5% versus 81.2%; P = .004; 33.2 versus 35.9%; P = .03, respectively). We observed a dose-response effect with increasing FBG (<85 mg/dL, 85-100 mg/dL, and ≥ 100 mg/dL, respectively), with 83.5%, 80.0%, and 72.5% (P = .009) of %EWL at 12 months. By multivariate logistic regression, initial BMI and FBG>100, were the only variables related (inversely) with the probability of achieving a %EWL>80 or %WL>35. This effect was not detected in patients receiving oral antidiabetic medications. CONCLUSION Higher preoperative FBG is independently related to a poorer weight loss 12 months after RYGB; this suggests the need to offer earlier surgical intervention for severely obese patients with impairment of glucose metabolism. The potential for less weight loss in patients with a higher FBG should not discourage RYGB, given the significant metabolic improvement after surgery.
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Affiliation(s)
- Gil Faria
- Department of Surgery, Faculty of Medicine, University of Porto, Portugal.
| | - John Preto
- Department of Surgery, Faculty of Medicine, University of Porto, Portugal; Department of Surgery, São João Medical Center, Portugal
| | - Ana Beatriz Almeida
- Department of Surgery, Faculty of Medicine, University of Porto, Portugal; Department of Surgery, São João Medical Center, Portugal
| | - João Tiago Guimarães
- Department of Biochemistry, Faculty of Medicine, University of Porto, Portugal; Department of Clinical Pathology, São João Medical Center, Porto, Portugal
| | - Conceição Calhau
- Department of Biochemistry, Faculty of Medicine, University of Porto, Portugal
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Delko T, Köstler T, Peev M, Esterman A, Oertli D, Zingg U. Revisional versus primary Roux-en-Y gastric bypass: a case-matched analysis. Surg Endosc 2013; 28:552-8. [PMID: 24196539 DOI: 10.1007/s00464-013-3204-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 08/23/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding (LAGB) has been a widely performed bariatric procedure. Unfortunately, revisional surgery is required in 20-30% of cases. Data comparing revisional and primary gastric bypass procedures are scarce. This study compared revisional malabsorptive laparoscopic very very long limb (VVLL) Roux-en-Y gastric bypass (RYGB) with primary VVLL RYGB and tested the hypothesis that one-stage revisional laparoscopic VVLL RYGB is an effective procedure after failed LAGB. METHODS In this study, 48 revisional VVLL RYGBs were matched one-to-one with 48 primary VVLL RYGBs. The outcome measures were operating time, conversion to open surgery, excess weight loss (EWL), and early and late morbidity. RESULTS Surgical and medical morbidities did not differ significantly. No conversions occurred. The revisional group showed an EWL of 41.8% after 12 months of follow-up evaluation and 45.1% after 24 months based on the pre-revisional weight. The total EWL based on the weight before the LAGB was calculated to be 54.3% after 12 months and 57.2% after 24 months. The EWL in the primary RYGB group was significantly higher for both types of calculation: 41.8%/54.3% versus 64.1 % (p < 0.001 and <0.01) after 12 months and 45.1%/57.2% versus 70.4% (p < 0.001 and <0.002) after 24 months. CONCLUSIONS Revisional laproscopic VVLL RYGB can be performed as a one-stage procedure by experienced bariatric surgeons but shows less effective EWL than primary RYGB procedures.
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Affiliation(s)
- Tarik Delko
- Department of Surgery, Limmattal Hospital Zurich-Schlieren, Zurich, Switzerland,
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Zarate X, Arceo-Olaiz R, Montalvo Hernandez J, García-García E, Pablo Pantoja J, Herrera MF. Long-term results of a randomized trial comparing banded versus standard laparoscopic Roux-en–Y gastric bypass. Surg Obes Relat Dis 2013; 9:395-7. [DOI: 10.1016/j.soard.2012.09.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 08/10/2012] [Accepted: 09/14/2012] [Indexed: 11/16/2022]
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