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Kachmar M, Corpodean F, Danos DM, Cook MW, Schauer PR, Albaugh VL. Early marginal ulceration prevalence following primary RYGB: a rare events model of the MBSAQIP 2015-2021. Surg Obes Relat Dis 2024; 20:916-924. [PMID: 39060190 DOI: 10.1016/j.soard.2024.06.011] [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: 03/22/2024] [Revised: 06/05/2024] [Accepted: 06/28/2024] [Indexed: 07/28/2024]
Abstract
PURPOSE Marginal ulceration (MU) following Roux-en-Y gastric bypass (RYGB) is an established complication, with early MU (within 30-days of operation) being less understood compared to its late counterpart. This study aims to identify risk factors for early MU in patients undergoing primary RYGB. METHODS Utilizing data from the Metabolic and Bariatric Surgery Accreditation Quality Improvement Project (MBSAQIP 2015-2021), 1,346,468 records were evaluated. After exclusions for revisions, conversions, pediatric cases, nonbinary gender, missing body mass index (BMI) data, and missing operative time; 291,625 cases of primary RYGB were included for full analysis and rare events modeling of early MU. RESULTS The prevalence of early MU was .29% (n = 850). Higher rates of early MU were associated with BMI, race, history of diabetes mellitus (DM), prior thrombotic complications (deep vein thrombosis (DVT) and pulmonary embolism (PE)), prior percutaneous cardiac intervention (PTC), immunosuppressive therapy, and anticoagulation status. Additionally, procedural aspects like the nonspecialization of the surgeon and longer operative times also correlated with higher early MU rates. Rare-events regression modeling noted significant associations of early MU with younger age, diabetes requiring insulin, history of PTC, DVT, immunosuppressive therapy, and anticoagulation status. CONCLUSION Early MU remains a relatively rare complication. The lower than previously reported occurrence suggests possible improvements in both patient preparation and surgical technique. The identification of relevant risk factors enables better perioperative and intraoperative management of patients at risk of developing early MU.
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Affiliation(s)
- Michael Kachmar
- Metamor Institute, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana; Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Florina Corpodean
- Metamor Institute, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana; Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Denise M Danos
- Department of Behavioral & Community Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Michael W Cook
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana; University Medical Center, New Orleans, Louisiana
| | - Philip R Schauer
- Metamor Institute, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana; Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Vance L Albaugh
- Metamor Institute, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana; Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
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Carrillo-Levin TS, Jaramillo-Ocharan MF, Salinas-Sedo G, Toro-Huamanchumo CJ. Association between the presence of Helicobacter pylori and the development of de novo anemia in adults undergoing sleeve gastrectomy. SAGE Open Med 2024; 12:20503121241275340. [PMID: 39224894 PMCID: PMC11367693 DOI: 10.1177/20503121241275340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Background Sleeve gastrectomy has gained prominence in obesity treatment, yet it is not without complications, such as the development of anemia in the medium term. Given the high prevalence of Helicobacter pylori infection in Peru, it is imperative to explore its potential association with this postoperative complication. Objective To evaluate the association between the presence of Helicobacter pylori and the development of anemia 12 months after sleeve gastrectomy. Methods A retrospective cohort study was carried out based on an analysis of secondary data from a private clinic in Lima, Peru, which included two groups of people over 18 years of age who had undergone sleeve gastrectomy between 2010 and 2020. We considered the subjects who had the previous diagnosis of Helicobacter pylori as well as those who did not have the infection, according to the detection of the bacteria by endoscopy before surgery. Results A total 313 individuals were analyzed, and it was found that the prevalence of Helicobacter pylori was 46.0% and the incidence of anemia 12 months after sleeve gastrectomy was 18.2%. The presence of Helicobacter pylori increased the risk of de novo anemia (Relative Risk = 1.56; 95% confidence intervals: 1.02-2.41; p = 0.043). When stratifying by sex, the association was maintained only for the male group (Relative Risk = 2.84; 95% confidence intervals: 1.02-7.02; p = 0.047). Conclusions It was identified that the presence of Helicobacter pylori had a significant association with the development of de novo anemia, mainly in male subjects, 1 year after undergoing sleeve gastrectomy.
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Affiliation(s)
| | | | | | - Carlos J Toro-Huamanchumo
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
- OBEMET Center for Obesity and Metabolic Health, Lima, Peru
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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Kupietzky A, Dodi O, Cohen N, Dover R, Maden A, Mazeh H, Grinbaum R, Mizrahi I. Similar Rates of Symptomatic Marginal Ulcers After One-Anastomosis-Gastric Bypass Compared to Roux-en-Y Gastric Bypass. Obes Surg 2024; 34:2331-2337. [PMID: 38789681 DOI: 10.1007/s11695-024-07298-y] [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: 04/02/2024] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE One-anastomosis-gastric-bypass (OAGB) has become a common bariatric procedure worldwide. Marginal ulcers (MU) are a significant non-immediate complication of gastric bypass surgeries. There seems to be concern among surgeons that MU are more common after OAGB compared with Roux-en-Y gastric bypass (RYGB) due to the constant and extensive exposure of the anastomosis to bile. The aim of this study was to compare the incidence, presentation, and management of MU between the two surgeries. MATERIALS AND METHODS A retrospective study of prospectively collected data was performed to include all consecutive patients between 2010 and 2020, who underwent elective OAGB or RYGB at our institution. Patients diagnosed with symptomatic MU were identified. Factors associated with this complication were assessed and compared between the two surgeries. RESULTS Symptomatic MU were identified in 23/372 OAGB patients (6.2%) and 35/491 RYGB patients (7.1%) (p = 0.58). Time to ulcer diagnosis was shorter in OAGB patients (12 ± 11 vs. 22 ± 17 months, p < 0.01). Epigastric pain was the common symptom (78% OAGB vs. 88.5% RYGB, p = 0.7) and approximately 15% of ulcers presented with perforation upon admission (17% vs.11.4%, p = 0.7). Re-operation was required in 5/23 OAGB (21.7%) and 6/36 RYGB (17%) patients (p = 0.11) while the rest of the patients were managed non-operatively. CONCLUSIONS The risk of developing a marginal ulcer is similar between patients who underwent OAGB and RYGB. Patients diagnosed with MU following OAGB tend to present earlier; however, the clinical presentation is similar to RYGB patients. The management of this serious complication seems to be associated with acceptable outcomes with comparable operative and non-operative approaches.
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Affiliation(s)
- Amram Kupietzky
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Omri Dodi
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Noa Cohen
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Roi Dover
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ata Maden
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Haggi Mazeh
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronit Grinbaum
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ido Mizrahi
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Cornejo J, Evans LA, Celik NB, Elli EF. Early Marginal Ulcer After Roux-en-Y Gastric Bypass: MBSAQIP Database Analysis of Trends and Predictive Factors. Obes Surg 2024; 34:1536-1543. [PMID: 38502517 DOI: 10.1007/s11695-024-07179-4] [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: 01/22/2024] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE Marginal ulcer (MU) is a known complication after Roux-en-Y gastric bypass (RYGB) that carries significant morbidity. First, we aimed to determine the trends and the rates of readmission, reintervention, and reoperation of 30-day MU. Second, we aim to determine the predictive factors associated with this complication. MATERIALS AND METHODS Patients who had 30-day marginal ulcer (MU) after LRYGB were identified using the 2015-2021 MBSAQIP database. Those who had a 30-day complication other than MU were excluded. Bivariate and logistic regression analyses were performed. RESULTS Among 213,104 patients undergoing laparoscopic RYGB, 638 (0.3%) showed 30-day MU. This group of patients required endoscopic interventions, readmissions, and reoperations at rates of 88%, 72%, and 9%, respectively. Predictive factors for 30-day MU after RYGB were renal insufficiency, history of DVT, previous cardiac stent, African American race, chronic steroid use, COPD, therapeutic anticoagulation, anastomotic leak test, GERD, and operative time > 120 min. Additionally, patients who had 30-day MU showed significantly higher rates of overall complications such as pulmonary, cardiac and renal complications, unplanned ICU admission, blood transfusions, venous thromboembolism (VTE), and non-home discharge (p < 0.05). The MU group showed similar rates of 30-day mortality as those without this complication (0.2% vs 0.1%, p = 0.587). CONCLUSIONS The incidence of 30-day MU following RYGB was 0.3%. Patients with MU required endoscopic interventions, readmissions, and reoperations at rates of 88%, 72%, and 9%, respectively. Some preoperative and intraoperative factors contributed to an increased risk of 30-day MU.
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Affiliation(s)
- Jorge Cornejo
- Department of General Surgery, Mayo Clinic, Jacksonville, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Lorna A Evans
- Department of General Surgery, Mayo Clinic, Jacksonville, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Nafiye Busra Celik
- Department of General Surgery, Mayo Clinic, Jacksonville, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Enrique F Elli
- Department of General Surgery, Mayo Clinic, Jacksonville, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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Capaverde LH, Trindade EN, Leite C, Cerski CTS, Trindade MRM. Marginal Ulcer Incidence and the Population of Gastrin Producing G cells Retained in the Gastric Pouch after Roux-en-Y Gastric Bypass: Is There a Relationship? Obes Surg 2024; 34:1152-1158. [PMID: 38351199 DOI: 10.1007/s11695-024-07078-8] [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: 02/19/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Marginal ulcers are the most prevalent endoscopic abnormality after RYGB. The etiology is still poorly understood; however, an increase in acid secretion has been strongly implicated as a causal agent. Although gastrin is the greatest stimulant of acid secretion, to date, the presence of gastrin producing G cells retained in the gastric pouch, related to the occurrence of marginal ulcers, has not been evaluated. OBJECTIVE Evaluate the density of G cells and parietal cells in the gastric pouch of RYGB patients with a diagnosis of marginal ulcer on the post-op EGD. METHOD We retrospectively evaluated 1104 gastric bypasses performed between 2010 and 2020. Patients with marginal ulcer who met the inclusion criteria and controls were selected from this same population. Endoscopic gastric pouch biopsies were evaluated using immunohistochemical study and HE staining to assess G cell and parietal cell density. RESULTS In total, 572 (51.8%) of the patients performed endoscopic follow-up after RYGB. The incidence of marginal ulcer was 23/572 (4%), and 3 patients required revision surgery due to a recalcitrant ulcer. The mean time for ulcer identification was 24.3 months (2-62). G cell count per high-power field (× 400) was statistically higher in the ulcer group (p < 0.05). There was no statistical difference in parietal cell density between groups (p 0.251). CONCLUSION Patients with a marginal ulcer after gastric bypass present a higher density of gastrin-producing G cells retained in the gastric pouch.
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Affiliation(s)
- Luiz H Capaverde
- Department of Digestive Surgery, Hospital São Lucas da PUC-RS, Centro Clínico Sala 506, Av Ipiranga 6690, Porto Alegre, RS, CEP: 90610-000, Brazil.
| | - Eduardo N Trindade
- Department of Digestive Surgery, Hospital de Clínicas de Porto Alegre and Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Carine Leite
- Department of Gastroenterology and Endoscopy, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Carlos T S Cerski
- Department of Pathology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Manoel R M Trindade
- Department of Digestive Surgery, Hospital de Clínicas de Porto Alegre and Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
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Maria CR, Rodriguez CM, Ines P, Helder V, Mafalda S, Ricardo V, Conceição MM. Bismuth-Based Therapy: The New Therapy for Obese Patients Undergoing Gastric Bypass Surgery? Obes Surg 2024; 34:123-127. [PMID: 37914885 DOI: 10.1007/s11695-023-06549-8] [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: 10/21/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 11/03/2023]
Abstract
AIMS Our aim was to assess, in obese patients undergoing Roux-en Y gastric bypass surgery, the bismuth quadruple therapy (BQT) eradication rates at the first-line Helicobacter pylori (Hp) treatment as proposed by the Maastricht V/Florence consensus in areas with high clarithromycin (CLT) resistance rates-10 days proton pump inhibitor bid and three-in-one single capsule bismuth therapy containing bismuth, metronidazole, and tetracycline, marketed as Pylera four times a day. METHODS This is a single-center prospective study over a 3-year period. Endoscopy and Hp assessment by histology was performed at baseline, and posttreatment Hp status was assessed by C13 urea breath test 4-6 weeks after the end of therapy. Data analysis was performed using the IBM® SPSS® Statistics 28.0 (IBM Corp. 2021, Armonk, NY) using mostly nonparametric comparisons (α = 0.05). RESULTS The study cohort consisted of 598 adult obese Hp-positive patients [476, 78.6% female, age 43.2 (± 10.4) years] consecutively scheduled for Hp eradication therapy. Hp was eradicated in 500 patients [83.6.3% (95% CI: 80.4%-86.5%)], and the eradication was independent of gender, age, endoscopic diagnosis, and smoking status (p > 0.05). CONCLUSION Ten days of BQT did achieve Maastricht V/Florence recommended first-line eradication rates (at least 80%) in obese Portuguese patients undergoing Roux-en Y gastric bypass, being by now the most reliable choice for Hp eradication.
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Affiliation(s)
- Cerqueira Rute Maria
- Serviço de Gastrenterologia, Centro Hospitalar Entre Douro E Vouga, R Dr. Cândido Pinho, 4520-271, Santa Maria Feira, Portugal.
| | - Correia Manuel Rodriguez
- Serviço de Gastrenterologia, Centro Hospitalar Entre Douro E Vouga, R Dr. Cândido Pinho, 4520-271, Santa Maria Feira, Portugal
| | - Pita Ines
- Serviço de Gastrenterologia, Centro Hospitalar Entre Douro E Vouga, R Dr. Cândido Pinho, 4520-271, Santa Maria Feira, Portugal
| | - Vilar Helder
- Serviço de Gastrenterologia, Centro Hospitalar Entre Douro E Vouga, R Dr. Cândido Pinho, 4520-271, Santa Maria Feira, Portugal
| | - Sousa Mafalda
- Serviço de Gastrenterologia, Centro Hospitalar Entre Douro E Vouga, R Dr. Cândido Pinho, 4520-271, Santa Maria Feira, Portugal
| | - Veloso Ricardo
- Serviço de Gastrenterologia, Centro Hospitalar Entre Douro E Vouga, R Dr. Cândido Pinho, 4520-271, Santa Maria Feira, Portugal
| | - Manso M Conceição
- Biostastistics, Faculty of Health Sciences, FP-I3ID (Instituto de Investigação, Inovação E Desenvolvimento), University Fernando Pessoa, Portugal & LAQV-REQUIMTE-UP, Porto, Portugal
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7
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Klair N, Patel U, Saxena A, Patel D, Ayesha IE, Monson NR, Ramphall S. What Is Best for Weight Loss? A Comparative Review of the Safety and Efficacy of Bariatric Surgery Versus Glucagon-Like Peptide-1 Analogue. Cureus 2023; 15:e46197. [PMID: 37905277 PMCID: PMC10613430 DOI: 10.7759/cureus.46197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Obesity is a global health concern, necessitating effective weight-loss interventions. This study aimed to compare the efficacy and safety of semaglutide, a pharmacotherapeutic option, with bariatric surgery, a commonly utilized surgical intervention, for weight reduction. A systematic review of clinical trials, including the STEP (Semaglutide Treatment Effect in People) trials, sustain trials, pioneer trials, and the STAMPEDE (Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently) trial, was conducted to evaluate the outcomes of these interventions. The analysis of the clinical trials revealed that semaglutide demonstrated significant weight reduction in participants. However, adverse effects such as gastrointestinal (GI) disturbances, increased pulse rate, and rare cases of thyroid cancer were observed. Long-term effects showed partial weight regain and a return of certain cardiometabolic variables to baseline levels after semaglutide withdrawal. Comparatively, bariatric surgery, as demonstrated in the Longitudinal Assessment of Bariatric Surgery (LABS) consortium and supported by the STAMPEDE trial, exhibited higher efficacy in weight reduction and the management of obesity-induced complications such as diabetes. The STAMPEDE trial demonstrated that bariatric surgery, specifically Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), led to a significantly higher percentage of patients achieving desired diabetes treatment targets compared to medical therapy alone. While bariatric surgery showed superior efficacy, it also carried a higher risk of complications. In contrast, semaglutide presented a noninvasive alternative with significant weight reduction and lower incidences of adverse effects. In conclusion, this study highlights that bariatric surgery, such as Roux-en-Y gastric bypass and sleeve gastrectomy, remains a highly effective intervention for weight loss and management of obesity-induced complications. However, semaglutide represents a valuable noninvasive alternative, offering significant weight reduction and lower risks of adverse effects. The choice between these interventions should be based on individual patient characteristics and a comprehensive assessment of the risk-benefit profile.
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Affiliation(s)
- Nimra Klair
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Utkarsh Patel
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ayushi Saxena
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Dhara Patel
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ismat E Ayesha
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Neetha R Monson
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Shivana Ramphall
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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8
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Salame M, Jawhar N, Belluzzi A, Al-Kordi M, Storm AC, Abu Dayyeh BK, Ghanem OM. Marginal Ulcers after Roux-en-Y Gastric Bypass: Etiology, Diagnosis, and Management. J Clin Med 2023; 12:4336. [PMID: 37445371 DOI: 10.3390/jcm12134336] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Marginal ulcer (MU) is a potential complication following Roux-en-Y gastric bypass (RYGB), with a mean prevalence of 4.6%. Early identification and prompt intervention are crucial to mitigating further complications. The pathophysiology of MU is complex and involves multiple factors, including smoking, Helicobacter pylori infection, non-steroidal anti-inflammatory drug (NSAID) use, and larger pouch size. Patients with MU may experience acute or chronic abdominal pain. Rarely, they may present with a complication from the ulceration, such as bleeding, perforation, or strictures. Following diagnosis by endoscopy, management of MU typically involves modification of risk factors and medical therapy focused on proton pump inhibitors. In case of complicated ulcers, surgical intervention is often required for the repair of the perforation or resection of the stricture. For recurrent or recalcitrant ulcers, endoscopic coverage of the ulcer bed, resection of the anastomosis, and abdominal or thoracoscopic truncal vagotomy may be considered. This review aims at providing an overview of the etiology, diagnosis, and management of MU after RYGB.
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Affiliation(s)
- Marita Salame
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Noura Jawhar
- Division of Pediatric Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Amanda Belluzzi
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Andrew C Storm
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
| | - Barham K Abu Dayyeh
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
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9
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Kerbage A, Al Annan K, Brunaldi VO, Razzak FA, Abboud DM, Gala K, Ghanem O, Abu Dayyeh BK. Management of a refractory marginal ulcer following Roux-en-Y gastric bypass with EUS-guided Roux-en-Y gastric bypass reversal. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:220-223. [PMID: 37303702 PMCID: PMC10256954 DOI: 10.1016/j.vgie.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Video 1EUS-guided Roux-en-Y gastric bypass reversal procedure to treat a refractory marginal ulcer following Roux-en-Y gastric bypass.
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Affiliation(s)
- Anthony Kerbage
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Karim Al Annan
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Vitor O Brunaldi
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota
- Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Farah Abdul Razzak
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Donna Maria Abboud
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Khushboo Gala
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Omar Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Barham K Abu Dayyeh
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota
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10
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Giannopoulos S, Athanasiadis DI, Clapp B, Lyo V, Ghanem O, Puzziferri N, Stefanidis D. Proton pump inhibitor prophylaxis after Roux-en-Y gastric bypass: A national survey of surgeon practices. Surg Obes Relat Dis 2023; 19:303-308. [PMID: 36379840 DOI: 10.1016/j.soard.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/27/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Proton pump inhibitors (PPIs) are frequently used after Roux-en-Y gastric bypass (RYGB) to prevent marginal ulceration. The optimal duration of PPI treatment after surgery to minimize ulcer development is unclear. OBJECTIVES Assess bariatric surgeon practice variability regarding postoperative PPI prophylaxis. SETTING Survey of medical directors of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program-accredited centers. METHODS Members of the American Society for Metabolic and Bariatric Surgery research committee developed and administered a web-based anonymous survey in November 2021 to bariatric surgeons of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program-accredited programs detailing questions related to surgeons' use of PPI after RYGB including patient selection, medication, dosage, and treatment duration. RESULTS The survey was completed by 112 surgeons (response rate: 52.6%). PPIs were prescribed by 85.4% of surgeons for all patients during their hospitalization, 3.9% for selective patients, and 10.7% not at all. After discharge, 90.3% prescribed PPIs. Pantoprazole was most often used during hospitalization (38.5%), while omeprazole was most prescribed (61.7%) after discharge. The duration of postoperative PPI administration varied; it was 3 months in 43.6%, 1 month in 20.2%, and 6 months in 18.6% of patients. Finally, surgeons' practice setting and case volume were not associated with the duration of prophylactic PPI administration after RYGB. CONCLUSIONS PPI administration practices vary widely among surgeons after RYGB, which may be related to the limited comparative evidence and guidelines on best duration of PPI administration. Large prospective clinical trials with objective outcome measures are needed to define optimal practices for PPI prophylaxis after RYGB to maximize clinical benefit.
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Affiliation(s)
| | | | - Benjamin Clapp
- Paul Foster School of Medicine, Texas Tech HSC, El Paso, Texas
| | - Victoria Lyo
- Department of Surgery, University of California Davis, Sacramento, California
| | - Omar Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Nancy Puzziferri
- Department of Surgery, Oregon Health & Science University, Portland, Oregon
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
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11
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Velleman J, Masereel B, Geyskens P. Acute perforation in a gastrojejunocolic fistula after a laparascopic Roux-en-Y gastric bypass: case report. Surg Case Rep 2023; 9:41. [PMID: 36939949 PMCID: PMC10027975 DOI: 10.1186/s40792-023-01620-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/12/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Gastrojejunocolic fistulas are a rare type of fistulas after a laparascopic Roux-en-Y gastric bypass (LRYGB). They are known as a chronic complication. This case report is the first to describe an acute perforation in a gastrojejunocolic fistula after LRYGB. CASE PRESENTATION A 61-year-old woman with a history of a laparascopic gastric bypass was diagnosed with an acute perforation in a gastrojejunocolic fistula. A laparascopic repair was performed by closing the defect in the gastrojejunal anastomosis as well as the defect in the transverse colon. However, 6 weeks later, a dehiscence of the gastrojejunal anastomosis occured. This was reconstructed by an open revision of the gastric pouch and gastrojejunal anastomosis. Long-term follow up showed no recurrence. CONCLUSIONS Combining the findings of our case with other literature, a laparoscopic repair with wide resection of the fistula, a revision of the gastric pouch and gastrojejunal anastomosis as well as closing the defect in the colon seems to be the best approach in case of an acute perforation in a gastrojejunocolic fistula after LRYGB.
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Affiliation(s)
- Jos Velleman
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Benoit Masereel
- Department of Abdominal Surgery, Sint-Trudo Hospital, 100 Diestersteenweg, 3800, Sint-Truiden, Belgium
| | - Paul Geyskens
- Department of Abdominal Surgery, Sint-Trudo Hospital, 100 Diestersteenweg, 3800, Sint-Truiden, Belgium.
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12
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Zulfiqar M, Ludwig DR, Strnad B, McVay M, Rengarajan A, Kushnir V, Mellnick V. Imaging features of marginal ulcers on multidetector CT. Clin Radiol 2023; 78:227-233. [PMID: 36376111 DOI: 10.1016/j.crad.2022.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 11/13/2022]
Abstract
AIM To assess the inter-reader agreement and frequency of various imaging findings of marginal ulcers on computed tomography (CT) in a series of patients with endoscopically or surgically confirmed marginal ulcer disease. MATERIALS AND METHODS This was a institutional review board-approved retrospective analysis involving a single academic institution. Eighty patients with a gastro-enteric anastomosis with confirmed marginal ulcer on endoscopy or surgery and multidetector (MD)CT performed within a month reviewed by two fellowship-trained abdominal radiologists to assess for the presence or absence of predetermined imaging characteristics categorised under signs of inflammation, signs of penetration, signs of perforation, and signs of obstruction. Inter-rater reliability was assessed using the Cohen kappa test. RESULTS Findings of perforation had moderate to substantial agreement, including the presence of extraluminal air, extraluminal fluid, and leakage of oral contrast medium (kappa 0.83 [0.61, 1.05], 0.57 [0.35, 0.79] and 0.75 [0.18, 1.31], respectively) although these were present relatively infrequently (23-26%, 30-43%, 3-4%, respectively). Additional imaging characteristics with moderate agreement were the presence of perienteric fat stranding, a dilated stomach proximal to the anastomosis, and penetration into adjacent organ (kappa 0.45 [0.23, 0.69], 0.47 [0.26, 0.69], and 0.47 [0.25, 0.69], respectively) which were variably present (80-88%, 11-16%, 5%, respectively). Wall thickening and contour abnormalities, although frequently present (61-90% and 60-80%, respectively) had only slight to fair agreement (kappa 0.09 [-0.14, 0.30] and 0.29 [0.07, 0.51]). CONCLUSION Signs of perforation have high inter-reader agreement but occur relatively infrequently. Fat stranding, wall thickening, and contour abnormalities are much more common; however, only fat stranding had moderate agreement.
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Affiliation(s)
- M Zulfiqar
- Department of Radiology, Mayo Clinic Phoenix Arizona, AZ, USA.
| | - D R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - B Strnad
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - M McVay
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - A Rengarajan
- Department of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA
| | - V Kushnir
- Department of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA
| | - V Mellnick
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
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13
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Beran A, Shaear M, Al-Mudares S, Sharma I, Matar R, Al-Haddad M, Salame M, Portela R, Clapp B, Dayyeh BKA, Ghanem OM. Predictors of marginal ulcer after gastric bypass: a systematic review and meta-analysis. J Gastrointest Surg 2023:10.1007/s11605-023-05619-7. [PMID: 36795250 DOI: 10.1007/s11605-023-05619-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/04/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Marginal ulcer (MU) is a common complication following Roux-en-Y gastric bypass (RYGB) with an incidence rate of up to 25%. Several studies have evaluated different risk factors associated with MU with inconsistent findings. In this meta-analysis, we aimed to identify the predictors of MU after RYGB. METHODS A comprehensive literature search of PubMed, Embase, and Web of Science databases was conducted through April 2022. All studies that used a multivariate model to assess risk factors for MU after RYGB were included. Pooled odds ratios (OR) with 95% confidence intervals (CI) for risk factors reported in ≥ 3 studies were obtained within a random-effects model. RESULTS Fourteen studies with 344,829 patients who underwent RYGB were included. Eleven different risk factors were analyzed. Meta-analysis demonstrated that Helicobacter pylori (HP) infection (OR 4.97 [2.24-10.99]), smoking (OR 2.50 [1.76-3.54]), and diabetes mellitus (OR 1.80 [1.15-2.80]), were significant predictors of MU. Increased age, body mass index, female gender, obstructive sleep apnea, hypertension, and alcohol use were not predictors of MU. There was a trend of an increased risk of MU associated with nonsteroidal anti-inflammatory drugs (OR 2.43 [0.72-8.21]) and a lower risk of MU with proton pump inhibitors use (OR 0.44 [0.11-2.11]). CONCLUSIONS Smoking cessation, optimizing glycemic control, and eradication of HP infection reduce the risk of MU following RYGB. Recognition of predictors of MU after RYGB will allow physicians to identify high-risk patients, improve surgical outcomes, and reduce the risk of MU.
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Affiliation(s)
- Azizullah Beran
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mohammad Shaear
- Department of General Surgery, College of Medicine, Central Michigan University, Saginaw, MI, USA
| | - Saif Al-Mudares
- Department of Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ishna Sharma
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Reem Matar
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marita Salame
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ray Portela
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Benjamin Clapp
- Department of Surgery, Texas Tech University, El Paso, TX, USA
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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14
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Altieri MS, Rogers A, Afaneh C, Moustarah F, Grover BT, Khorgami Z, Eisenberg D. Bariatric Emergencies for the General Surgeon. Surg Obes Relat Dis 2023; 19:421-433. [PMID: 37024348 DOI: 10.1016/j.soard.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/04/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Ann Rogers
- Department of Surgery, Hershey School of Medicine, Penn State University, Hershey, Pennsylvania
| | | | - Fady Moustarah
- Department of Surgery, Beaumont Hospital, Bloomfield Hills, Michigan
| | - Brandon T Grover
- Department of Surgery, Gundersen Lutheran Medical Center, La Crosse, Wisconsin
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma College of Community Medicine, Tulsa, Oklahoma; Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Dan Eisenberg
- Department of Surgery, Stanford School of Medicine and VA Palo Alto Health Care System, Palo Alto, California
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15
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Sia GB, Gestic MA, Utrini MP, Chaim FDM, Chaim EA, Cazzo E. DO HELICOBACTER PYLORI INFECTION AND ERADICATION THERAPY STATUS INFLUENCE WEIGHT LOSS OUTCOMES AND ENDOSCOPIC FINDINGS AFTER ROUX-EN-Y GASTRIC BYPASS?A HISTORICAL COHORT STUDY. ARQUIVOS DE GASTROENTEROLOGIA 2023; 60:57-64. [PMID: 37194781 DOI: 10.1590/s0004-2803.202301000-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/30/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Currently, there is conflicting evidence linking Helicobacter pylori (HP) infection with weight loss and endoscopic findings after Roux-en-Y gastric bypass (RYGB). OBJECTIVE To identify correlations between HP infection and its eradication with weight loss and endoscopic findings after RYGB. METHODS This is an observational retrospective cohort study based on a prospectively collected database of individuals who underwent RYGB from 2018-2019 at a tertiary university hospital. HP infection and the HP eradication therapy outcomes were correlated with post-operative weight loss and endoscopic findings. Individuals were classified according to the status of HP infection into four groups: no infection; successful eradication; refractory infection; and new-onset infection. RESULTS Of 65 individuals, 87% were female and the mean age was 39±11.2 years. Body mass index significantly decreased from 36.2±3.6 to 26.7±3.3 kg/m2 one year after RYGB (P<0.0001). The percentage of total weight loss (%TWL) was 25.9±7.2% and the percentage of excess weight loss was 89.4±31.7%. HP infection prevalence decreased from 55.4% to 27.7% (p=0.001); 33.8% never had HP infection, 38.5% were successfully treated, 16.9% had refractory infection and 10.8 % had new-onset HP infection. %TWL was 27.3±7.5% in individuals who never had HP, 25.4±8.1% in the successfully treated, 25.7±5.2% in those with refractory infection, and 23.4±6.4% in the new-onset HP infection group; there were no significant differences among the four groups (P=0.6). Pre-operative HP infection significantly associated with gastritis (P=0.048). New-onset HP infections significantly associated with a lower frequency of jejunal erosions after surgery (P=0.048). CONCLUSION No effects of the HP infection on weight loss were identified in individuals undergoing RYGB. A higher prevalence of gastritis was observed in individuals with HP infection before RYGB. New-onset HP infection after RYGB was a protective factor for jejunal erosions.
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Affiliation(s)
- Gabriela Beatriz Sia
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
| | - Martinho Antonio Gestic
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
| | - Murillo Pimentel Utrini
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
| | - Felipe David Mendonça Chaim
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
| | - Elinton Adami Chaim
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
| | - Everton Cazzo
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
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16
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Holt BL, Rice WV. A prospective single-center study evaluating the efficacy of the stomach, intestinal, and pylorus-sparing procedure. Surg Obes Relat Dis 2022; 19:612-618. [PMID: 36641352 DOI: 10.1016/j.soard.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/17/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The stomach, intestinal, and pylorus-sparing (SIPS) procedure is a single-anastomosis duodeno-intestinal bypass used in obesity management. OBJECTIVE Weight and metabolic outcomes in patients with severe obesity who underwent the SIPS procedure were evaluated in a community hospital-based study. SETTING Community hospital. METHODS This single-site prospective study of patients who underwent the SIPS procedure evaluated outcomes at 12 and 24 months. Mean changes in total weight loss and body mass index (BMI) and resolution of gastroesophageal reflux disease (GERD), obstructive sleep apnea (OSA), hypertension, type 2 diabetes (T2D), and hyperlipidemia were evaluated. RESULTS At baseline, 185 patients were enrolled; mean weight and BMI were 144.0 kg and 52.2 kg/m2, respectively. Data for 88 (47.6%) and 29 (15.7%) patients who completed follow-up at 12 and 24 months, respectively, were available. At 12 months, mean total weight loss was 35.6% (weight reduction of 51.3 kg) and BMI reduction of 17.8 points were achieved and were maintained for the 29 patients who completed 24-month follow-up. No leaks or infections occurred. Complications occurred in 8 patients (.4%) and were not serious. Resolution of GERD, OSA, hypertension, T2D, and hyperlipidemia achieved in 87.1%, 59.2%, 32.7%, 93.1%, and 87.6% of patients, respectively, at 12 months was maintained at 24 months. Nutritional deficiency was absent. CONCLUSIONS Patients who underwent the SIPS procedure had meaningful reductions in weight and BMI, and many had resolution of metabolic co-morbidities; procedural complication rates were low. Our results support that the SIPS procedure is a safe and effective primary treatment for clinically severe obesity in a community-based hospital setting.
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Affiliation(s)
- Brian L Holt
- Presbyterian Bariatric Center, Rio Rancho, New Mexico.
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17
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Vogelaerts R, Van Pachtenbeke L, Raudsepp M, Morlion B. Chronic abdominal pain after bariatric surgery: a narrative review. ACTA ANAESTHESIOLOGICA BELGICA 2022. [DOI: 10.56126/73.4.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Objective: This paper reviews the prevalence, etiology, risk factors, diagnosis and prevention of chronic abdominal pain after bariatric surgery.
Introduction: Chronic pain is a very common and complex problem that has serious consequences on individuals and society. It frequently presents as a result of a disease or an injury. Obesity and obesity-related comorbidities are a major health problem and are dramatically increasing year after year. Dieting and physical exercise show disappointing results in the treatment of obesity. Therefore, bariatric surgery is increasingly widely offered as a weight reducing strategy. In our pain clinic we see a lot of patients who suffer from chronic abdominal pain after bariatric surgery. This review aims to explore the link between chronic abdominal pain and bariatric surgery in this specific type of patients.
Method: The review is based on searches in PubMed, Embase and Cochrane databases. Keywords are used in different combinations. We did a cross-reference of the articles included.
Results: Chronic abdominal pain after bariatric surgery is very common. Around 30% of the bariatric patients experience persistent abdominal pain. An explanation for the abdominal pain is found in 2/3 of these patients.
There is a wide variety of causes including behavioral and nutritional disorders, functional motility disorders, biliary disorders, marginal ulceration and internal hernia. Another, frequently overlooked, cause is abdominal wall pain. Unexplained abdominal pain after bariatric surgery is present in 1/3 of the patients with persistent abdominal pain. More studies are needed on the risk factors and prevention of unexplained abdominal pain in bariatric patients.
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Tawfik MR, Aldawas NF, Almegbil NS, Bin Hamad AA, Alanazi AN, Alaidaroos AM, AlRawaf TM, Fayed AA. Preoperative Assessment of Patients Undergoing Bariatric Sleeve Gastrectomy: A Cross-Sectional Study. Gastroenterol Res Pract 2022; 2022:3622119. [PMID: 39263533 PMCID: PMC11390197 DOI: 10.1155/2022/3622119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/29/2022] [Indexed: 09/13/2024] Open
Abstract
Introduction Saudi Arabia (SA) is one of the top countries in the world when it comes to the number of bariatric procedures performed each year. There is still some debate on whether to do regular or selective upper endoscopy during the preoperative examination. The purpose of this study was to explore various endoscopic findings and Helicobacter pylori (HP) infection in symptomatic and asymptomatic patients having laparoscopic sleeve gastrectomy (LSG) prior to surgery. Methods We investigated a cohort of 132 patients referred to the endoscopy unit from the bariatric surgery outpatient clinic for prebariatric esophagogastroduodenoscopy (EGD) as a part of preoperative LSG. Data extraction from medical records included clinical data such as body mass index (BMI), gastrointestinal symptoms (that include heartburn, regurgitation, epigastric pain, and nausea), medical comorbidities, and laboratory investigations. It included data about the endoscopic findings of EGD procedure as esophageal, gastric, and duodenal findings results as well as the results of biopsy specimens that were taken. Results Out of 132 patients, 29 (22%) had a BMI of less than 40 kg/m2 whereas 103 (78%) had a BMI of 40 kg/m2 or above, with an average of 44.4 ± 6.4 kg/m2. The average age of participants was 33.6 ± 10.4 years. HP was detected in 36 patients (35.0%) with a slightly greater prevalence in patients with a higher BMI (33.7%) than in patients with lower BMI (35.0%). Collectively, 73 patients (55.7%) had positive endoscopic findings of various grades, sites, and combinations. Incompetent cardia (35.6%) was the most often seen esophageal finding, antral gastritis (34.1%) was the most frequently encountered gastric finding, and duodenitis 1st part was the commonest duodenal endoscopic finding (7.8%). Among asymptomatic patients, incompetent cardia was detected in 33.3%, antral gastritis was found in 30.1%, and around one-quarter of them were positive on HP testing (26.6%). Additionally, 16.1% of them had signs of reflux esophagitis, 17.2% had hiatal hernia, and 14.0% had nodular gastritis. Conclusion The current study revealed a high prevalence of positive endoscopic findings as well as HP infection upon routine endoscopic examination among patients undergoing bariatric surgery even those who were asymptomatic from any gastrointestinal symptoms.
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Affiliation(s)
- M R Tawfik
- King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
- Hepatobiliary Unit, Internal Medicine Department, Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - N F Aldawas
- King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - N S Almegbil
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - A A Bin Hamad
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - A N Alanazi
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - A M Alaidaroos
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - T M AlRawaf
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - A A Fayed
- Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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Vitiello A, Berardi G, Velotti N, Schiavone V, Manetti C, Musella M. Linear Versus Circular Laparoscopic Gastrojejunal Anastomosis of Roux-en-Y Gastric Bypass: Systematic Review and Meta-Analysis of 22 Comparative Studies. Surg Laparosc Endosc Percutan Tech 2022; 32:393-398. [PMID: 35583520 DOI: 10.1097/sle.0000000000001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/07/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the rate of complications of linear versus circular gastrojejunal anastomosis of laparoscopic Roux-en-Y gastric bypass. METHODS A systematic search of PubMed, Embase, and the Cochrane Library databases was carried out using the terms "laparoscopic," "circular," "linear," "anastomosis," "gastric bypass" in accordance to PRISMA guidelines. Only original articles in English language comparing linear versus circular anastomosis were included. No temporal interval was set. Outcome measures were wound infection, bleeding, marginal ulcer, leak, and stricture. Pooled odds ratio (OR) with a 95% confidence interval (CI) was calculated. Heterogeneity was assessed using the I2 statistic. Funnel plots were used to detect publication bias. RESULTS Twenty-two articles (7 prospective and 15 retrospective) out of 184 retrieved papers were included in this study. The pooled analysis showed a reduced odd of wound infection and bleeding after linear anastomosis. Likelihood of marginal ulcer, leak, and stricture was similar after the 2 techniques. Wound infection was reported in 15 studies (OR, 0.17; 95% CI, 0.06-0.45; P=0.0003; I2=91), bleeding in 9 (OR, 0.45; 95% CI, 0.34-0.59; P=0.00001; I2=6) marginal ulcer in 11 (OR, 0.61; 95% CI, 0.26-1.41; P=0.25; I2=65), leaks in 15 (OR, 0.61; 95% CI, 0.21-1.67; P=0.34; I2=83) and stricture in 18 (OR, 0.48; 95% CI, 0.23-1.00; P=0.05; I2=68). CONCLUSION Laparoscopic RYGB can be safely performed both with circular and linear staplers. Rates of wound infection and bleeding were significantly lower after linear gastrojejunal anastomosis.
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Affiliation(s)
- Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Naples, Italy
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20
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Non-Steroid Anti-Inflammatory Drugs and the risk of peptic ulcers after gastric bypass and sleeve gastrectomy. Surg Obes Relat Dis 2022; 18:888-893. [DOI: 10.1016/j.soard.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/01/2022] [Accepted: 03/26/2022] [Indexed: 11/17/2022]
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21
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Lye TJY, Eng AKH. Late Stricture from Marginal Ulceration after Roux-en-Y Gastric Bypass: Endoscopic Complications and Surgical Management. Obes Surg 2021; 31:5508-5509. [PMID: 34570307 DOI: 10.1007/s11695-021-05716-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/03/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Tiffany Jian Ying Lye
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Outram Road, 169608, Singapore, Singapore.
| | - Alvin K H Eng
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Outram Road, 169608, Singapore, Singapore
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22
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Gastrojejunal Anastomotic Stricture Following Roux-en-Y Gastric Bypass: an Analysis of Anastomotic Technique at a Single Institution. Obes Surg 2021; 31:4947-4952. [PMID: 34518993 DOI: 10.1007/s11695-021-05678-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) are at risk of developing strictures of the gastrojejunal anastomosis (GJA). Several variables can affect this, one of which may be the method of anastomosis. Between 2010 and 2014, our institution utilized three different anastomotic techniques for creating the GJA (25 mm end-to-end circular-stapled (CS), linear-stapled (LS), and robotic hand sewn (HS)). Our objectives were to compare the method of GJA relative to the subsequent development of anastomotic stricture. METHODS We queried our electronic health record for all patients who underwent an upper endoscopy (EGD) after RYGB (2010-2014). Patient charts were retrospectively reviewed for type of GJA, weight loss, complications, interventions, and revisions of the GJA. RESULTS In total, 1112 RYGB were performed at our institute, and 17.4% of patients (194/1112) had an upper endoscopy (EGD). Overall, 3.1% (34/1112) were found to have a stricture of the GJA. Patients undergoing a CS, LS, and HS anastomosis had GJA stricture rates of 4.9%, 0.5%, and 1.2% respectively (CS to LS (p < 0.05), p = NS among CS vs. HS, and LS vs. HS). The rate of GJA revision was 1.5%, 0.5%, and 0.1% (p = NS). In patients who had an EGD, excess BMI loss was 57.4%, 64.6%, and 59.2% (p = NS). In patients symptomatic from strictures, excess BMI loss was 69.4%, 83%, and 63.5% respectively (p = NS). CONCLUSION The anastomotic technique for creating of the GJA may impact the formation of strictures. Based on our experience, gastrojejunostomies created with a 2-mm EEA-stapling technique are at higher risk of strictures.
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23
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Schäfer A, Gehwolf P, Kienzl-Wagner K, Cakar-Beck F, Wykypiel H. Linear or circular: Anastomotic ulcer after gastric bypass surgery. Surg Endosc 2021; 36:3011-3018. [PMID: 34152456 PMCID: PMC9001202 DOI: 10.1007/s00464-021-08597-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/06/2021] [Indexed: 11/29/2022]
Abstract
Background After laparoscopic Gastric Bypass Procedure (GBP), anastomotic ulcers (AU) at the gastrojejunostomy (GJ) occur in up to 16% of the patients. Surgical techniques seem to influence the development of AU, but this is still a matter of discussion. This study aims to compare the incidence of AU in circular-stapled (CS) versus linear-stapled (LS) gastrojejunostomy. Methods Single-centre retrospective analysis of 241 (m 77 /f 164) consecutive patients (126 CS, 115 LS) with primary or revisional GBP including Roux-Y-Gastric Bypass (RYGB) and One-Anastomosis Gastric Bypass (OAGB) between 01/2014 and 01/2018. Follow-up with oesophagogastroduodenoscopy was only performed in symptomatic patients. Age, body mass index (BMI), comorbidities, smoking and medication were analyzed in both groups. The data are reported as total numbers (%) and mean ± standard deviation. Results AU occurred significantly more often in the CS group than in the LS group (p = 0.0034). Moreover, refractory AU and the need for revisional surgery were higher in the CS group. Smoking correlates significantly with the development of AU, whereas other risk factors had no impact on its incidence. Conclusion Linear-stapled gastrojejunostomy with a long and narrow pouch should be the preferable procedure for reducing AU development risk. Smoking cessation minimizes the risk for AU and is a necessary part of the treatment.
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Affiliation(s)
- Aline Schäfer
- Department of Visceral-, Transplant- and Thoracic Surgery, Medical University of Innsbruck, Anichstrasse35, 6020, Innsbruck, Austria
| | - Philipp Gehwolf
- Department of Visceral-, Transplant- and Thoracic Surgery, Medical University of Innsbruck, Anichstrasse35, 6020, Innsbruck, Austria.
| | - Katrin Kienzl-Wagner
- Department of Visceral-, Transplant- and Thoracic Surgery, Medical University of Innsbruck, Anichstrasse35, 6020, Innsbruck, Austria
| | - Fergül Cakar-Beck
- Department of Visceral-, Transplant- and Thoracic Surgery, Medical University of Innsbruck, Anichstrasse35, 6020, Innsbruck, Austria
| | - Heinz Wykypiel
- Department of Visceral-, Transplant- and Thoracic Surgery, Medical University of Innsbruck, Anichstrasse35, 6020, Innsbruck, Austria
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Ergin A, Çiyiltepe H, Karip AB, Fersahoğlu MM, Bulut NE, Çakmak A, Topaloğlu B, Bilgili AC, Somay A, Taşdelen İ, Akyüz Ü, Memişoğlu K. The Effect of Helicobacter pylori Eradication on Gastric Wall Thickness in Patients Undergoing Laparoscopic Sleeve Gastrectomy. Obes Surg 2021; 31:4024-4032. [PMID: 34075550 DOI: 10.1007/s11695-021-05513-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE The most important cause affecting the thickness of the gastric wall other than the tumor is chronic gastritis caused by Helicobacter pylori (Hp), which is most frequently detected in the antrum. This study aims to investigate the effect of bismuth-based treatment (BBT) combined with proton pump inhibitor (PPI) on wall thicknesses measured in the postoperative gastric specimen and early postoperative complications in patients with Hp-positive pre-LSG endoscopic gastric biopsies. MATERIALS AND METHODS The patients who underwent LSG procedure for morbid obesity were divided into three groups as follows: Hp-negative, Hp-positive without eradication treatment, and Hp-positive, and LSG was performed after eradication treatment. Macroscopic and microscopic gastric wall thickness measurements were made at a distance of 1 cm from the proximal surgical margin, from the middle part of the specimen, and 1 cm from the distal surgical margin in the gastric specimen and the results were compared. RESULTS A total of 132 patients were included in the study, 44 patients in each group. Microscopically measured antrum mucosal thickness was found to be statistically significantly higher in group 2 compared to other groups (groups 1.15, 1.35, 1.16 mm, respectively, p = 0.000). There was no difference between the groups in terms of early complications such as bleeding, wound site infection, or leakage from the staple line within the first 28 days after surgery. CONCLUSION This study found that LSG had no effect on early complications due to Hp positivity or eradication of Hp. KEY POINTS • The presence of HP increases the wall thickness of the gastric antrum mucosa. • After HP eradication, stomach antrum wall thickness returns to normal. • HP eradication before LSG reduces the wall thickness of the gastric antrum mucosa. • It was determined that HP scanning and eradication before LSG had no effect on postoperative complications.
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Affiliation(s)
- Anıl Ergin
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Hastane Street No: 1/8 Icerenkoy, 34752, Istanbul, Turkey.
| | - Hüseyin Çiyiltepe
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Hastane Street No: 1/8 Icerenkoy, 34752, Istanbul, Turkey
| | - Aziz Bora Karip
- General Surgery Department, Istanbul Oncology Hospital, Cevizli Mah. Toros Street No:86 Maltepe, Istanbul, Turkey
| | - Mehmet Mahir Fersahoğlu
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Hastane Street No: 1/8 Icerenkoy, 34752, Istanbul, Turkey
| | - Nuriye Esen Bulut
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Hastane Street No: 1/8 Icerenkoy, 34752, Istanbul, Turkey
| | - Ahmet Çakmak
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Hastane Street No: 1/8 Icerenkoy, 34752, Istanbul, Turkey
| | - Berk Topaloğlu
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Hastane Street No: 1/8 Icerenkoy, 34752, Istanbul, Turkey
| | - Ali Cihan Bilgili
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Hastane Street No: 1/8 Icerenkoy, 34752, Istanbul, Turkey
| | - Adnan Somay
- Pathology Department, Fatih Sultan Mehmet Training and Research Hospital, Hastane Street No: 1/8 Icerenkoy, 34752, Istanbul, Turkey
| | - İksan Taşdelen
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Hastane Street No: 1/8 Icerenkoy, 34752, Istanbul, Turkey
| | - Ümit Akyüz
- Gastroenterology Department, Fatih Sultan Mehmet Training and Research Hospital, Hastane Street No: 1/8 Icerenkoy, 34752, Istanbul, Turkey
| | - Kemal Memişoğlu
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Hastane Street No: 1/8 Icerenkoy, 34752, Istanbul, Turkey
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25
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Sivan RF, Bar Lev MR, Silbermintz A, Mozer-Glassberg Y, Seguier-Lipzyc E, Shalitin S, Stafler P, Tiroler S, Shamir R, Waisbourd-Zinman O. Clinical and Esophagogastroduodenoscopy Findings in Pediatric Patients With Severe Obesity Evaluated Before Bariatric Surgery. J Pediatr Gastroenterol Nutr 2021; 72:854-858. [PMID: 33633080 DOI: 10.1097/mpg.0000000000003109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Severe obesity in the pediatric population has lifelong consequences. Bariatric surgery has been suggested for selected adolescents with severe obesity after careful evaluation. The indications for preoperative esophagogastroduodenoscopy (EGD) in this age group are not clear, despite its established usefulness in adults. We aimed to assess the usefulness of EGD before bariatric surgery in pediatric patients with severe obesity and metabolic comorbidities. METHODS We conducted a retrospective chart review in a single tertiary pediatric medical center of adolescents treated during 2011 to 2018. Data collected from electronic medical records included patient demographics, endoscopic findings, and laboratory parameters. RESULTS A total of 80 patients (40 boys) underwent evaluation. Macroscopic abnormalities were detected in 54% of the endoscopies, including gastritis, esophagitis, and duodenitis in 46%, 16%, and 13%, respectively. Forty-nine percentage of the biopsies showed histological abnormalities; in 35 (44%) patients, Helicobacter pylori was detected. Thirty-three patients (41%) received medical treatment and 2 (2.5%) required a second EGD. Metabolic comorbidities included hypertriglyceridemia (38% of the patients), low high-density lipoprotein (23%), and prediabetic (16%) or diabetic levels of HbA1C (4%). Fifty-five percentage of the cohort had elevated alanine aminotransferase (ALT), suggestive of nonalcoholic fatty liver disease (NAFLD). CONCLUSIONS Endoscopies performed before bariatric surgeries suggest a higher prevalence of clinically significant findings, many of which required treatment. These findings support incorporating an EGD into the preoperative evaluation of this patient population.
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Affiliation(s)
- Rachel Frenklak Sivan
- Pediatric Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Michal Rozenfeld Bar Lev
- Pediatric Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva
| | - Ari Silbermintz
- Pediatric Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva
| | - Yael Mozer-Glassberg
- Pediatric Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | | | - Shlomit Shalitin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- The Jesse Z. and Lea Shafer Institute of Endocrinology and Diabetes
| | - Patrick Stafler
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Division of Pulmonology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | | | - Raanan Shamir
- Pediatric Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Orith Waisbourd-Zinman
- Pediatric Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
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Gastro-colic Fistula: a Rare Complication of a Marginal Ulcer Following One Anastomosis Gastric Bypass. Obes Surg 2021; 31:3899-3900. [PMID: 34036553 DOI: 10.1007/s11695-021-05498-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
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Di Palma A, Alhabdan S, Maeda A, Chetty R, Serra S, Quereshy F, Jackson T, Okrainec A. Preoperative Helicobacter pylori Screening and Treatment in Patients Undergoing Laparoscopic Sleeve Gastrectomy. Obes Surg 2021; 30:2816-2820. [PMID: 32030613 DOI: 10.1007/s11695-020-04436-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The role of preoperative screening and treatment of Helicobacter pylori (HP) in asymptomatic patients undergoing laparoscopic sleeve gastrectomy (LSG) remains unclear. This study aims to define the preoperative prevalence and management of HP and their effect on postoperative outcomes at our institution. MATERIALS AND METHODS We reviewed the medical records and surgical specimens of all LSG performed at an academic centre in Toronto, ON between 2010 and 2017. RESULTS Review of our institutional database identified 222 patients that underwent LSG, of which 200 had preoperative HP screening: 18% tested positive and 15% were treated. Seven surgical specimens were HP-positive (3.2%). No association was found between preoperative HP status, treatment or HP-positive specimen and postoperative complications at 1 year. CONCLUSION Although preoperative screening and treatment likely reduce the prevalence of HP in LSG specimens, our findings suggest that they may be of limited clinical value in LSG as they have little influence on surgical morbidity.
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Affiliation(s)
- Adam Di Palma
- Division of General Surgery, University Health Network, Toronto, ON, Canada
| | - Sultan Alhabdan
- Division of General Surgery, University Health Network, Toronto, ON, Canada
| | - Azusa Maeda
- Division of General Surgery, University Health Network, Toronto, ON, Canada
| | - Runjan Chetty
- Department of Pathology, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stefano Serra
- Department of Pathology, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Fayez Quereshy
- Division of General Surgery, University Health Network, Toronto, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Timothy Jackson
- Division of General Surgery, University Health Network, Toronto, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Allan Okrainec
- Division of General Surgery, University Health Network, Toronto, ON, Canada.
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Incidence and Prognostic Factors for the Development of Symptomatic and Asymptomatic Marginal Ulcers After Roux-en-Y Gastric Bypass Procedures. Obes Surg 2021; 31:3005-3014. [PMID: 33761070 DOI: 10.1007/s11695-021-05363-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Marginal ulcer (MU) is a serious complication after Roux-en-Y gastric bypass (RYGB) procedures. This study reports the incidence, risk factors, and treatment outcomes of symptomatic and incidentally, at routine endoscopy diagnosed, MU. METHODS All patients undergoing RYGB procedures between 2013 and 2018 at a single center were included. Upper endoscopy was performed in case of symptoms and/or routinely 2 and 5 years postoperatively. RESULTS In total, 568 patients (83.3% female) underwent RYGB procedure with a median age of 40 years and median initial body mass index of 41 kg/m2. The median time to follow-up was 2.99 years. Routine 2- and 5-year upper endoscopy was performed in 256 (55.3%) and 65 (38.0%) eligible patients, respectively. In 86 (15.1%) patients, MU was diagnosed at a median time of 14.2 months (4.58-26.2) postoperatively and 24.4% of patients with MU were asymptomatic. In total, 76.7% of MUs were located on the side of the Roux limb. 88.4% of MUs were treated conservatively; re-operation was necessary in 10 (11.6%) patients. Smoking and type 2 diabetes mellitus were the only independent risk factors for MU development in multivariate analysis with a hazard ratio of 2.65 and 1.18 (HbA1c per unit >6.0), respectively. CONCLUSION MU is a common complication after gastric bypass surgery with 25% of patients being asymptomatic. Follow-up routine endoscopy is recommended for early MU detection and subsequent accurate therapy, especially in patients with the independent risk factors smoking and type 2 diabetes mellitus.
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MEREI F, WITZTUM R, ABU SHAKRA I, BICKEL A, KHATIB K, GANAM S, BEZ M, FISCHER D, KAKIASHVILI E. A rare complication of single anastomosis gastric bypass surgery: perforated marginal ulcer. Chirurgia (Bucur) 2021. [DOI: 10.23736/s0394-9508.20.05078-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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30
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Qi XY, Gong Y, Jiao YW, Zhao J, Zhou Y, Cui XH, Li S, Yang HJ, Qian J, Tang LM. Influence of Helicobacter pylori Infection on Outcomes After Bariatric Surgery: A Systematic Review and Meta-Analysis. Bariatr Surg Pract Patient Care 2020. [DOI: 10.1089/bari.2019.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Xiao-yang Qi
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yu Gong
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yu-wen Jiao
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jie Zhao
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yan Zhou
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Xiao-han Cui
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Song Li
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Hao-jun Yang
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jun Qian
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Li-ming Tang
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
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A review of commonly performed bariatric surgeries: Imaging features and its complications. Clin Imaging 2020; 72:122-135. [PMID: 33232899 DOI: 10.1016/j.clinimag.2020.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/13/2020] [Accepted: 11/08/2020] [Indexed: 01/15/2023]
Abstract
Obesity is a disease that has achieved the level that can be considered an epidemic. According to the National Center for Health Statistics data, the prevalence of obesity has increased from 30.5% in 1999-2000 to 42.4% in 2017-2018. During the same period, severe obesity has increased from 4.7% to 9.2%. With the growing prevalence of obesity, related conditions such as coronary artery disease, diabetes, and strokes have also become more prevalent. In the past few years, the need for bariatric surgeries such as laparoscopic Roux-en-Y gastric bypass, sleeve gastrectomy, and laparoscopic adjustable gastric banding has increased considerably. With an increasing number of bariatric surgeries, multiple postoperative complications have become common. In this review, we have attempted to describe normal postsurgical anatomical findings after bariatric surgeries and pictorial review of a few common postoperative complications.
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Comparison of gastrojejunostomy techniques and anastomotic complications: a systematic literature review. Surg Endosc 2020; 35:6489-6496. [PMID: 33159295 DOI: 10.1007/s00464-020-08142-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/27/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND There are several ways to perform the gastrojejunostomy (GJ) anastomosis in laparoscopic Roux-en-Y gastric bypass (LRYGB). Surgeons typically use a variation of three techniques: Hand-sewn anastomosis (HSA), Linear stapled (LS) and Circular stapled anastomosis (CSA). The purpose of this literature review is to determine which of the GJ techniques, if any, is superior and results in the least amount of postoperative complications, with a specific focus on rates of marginal ulcers, postoperative bleeding, and strictures. METHODS PubMed, Embase, and Cochrane electronic databases were consulted for studies on LRYGB procedures utilizing a GJ anastomosis, from January 1, 2015 to December 31, 2019. Cochrane and PRISMA screening methods were used to select the studies. RESULTS Eleven studies published between 2015 and 2019 were selected and included 135,899 patients that underwent LRYGB with a GJ anastomosis. Sample sizes ranged from 114 to 49,331 patients. Four studies reported that CSA had statistically significant higher rates of marginal ulcers when compared to HSA and LS techniques. Three studies concluded that CSA had statistically significant higher rates of postoperative bleeding when compared to HSA and LS. Five studies observed that CSA had statistically significant higher rates of strictures when compared to HSA and LS techniques. There was no consensus whether HSA or LS was superior in terms of reduced postoperative complications. CONCLUSION This study revealed statistically significant increases in rates of postoperative bleeding, marginal ulcer, and strictures with the use of mechanical circular staplers at the GJ anastomosis in LRYGB. Based on our results, avoiding the use of mechanical circular staplers can result in fewer postoperative complications. Nevertheless, there are limitations to retrospective studies which may influence the results and therefore a randomized controlled trial directly comparing HSA, CSA, and LS should be performed to truly determine which technique is superior.
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Athanasiadis DI, Christodoulides A, Monfared S, Hilgendorf W, Embry M, Stefanidis D. High Rates of Nicotine Use Relapse and Ulcer Development Following Roux-en-Y Gastric Bypass. Obes Surg 2020; 31:640-645. [PMID: 32959330 DOI: 10.1007/s11695-020-04978-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/05/2020] [Accepted: 09/11/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Given that smoking is known to contribute to gastrojejunal anastomotic (GJA) ulcers, cessation is recommended prior to laparoscopic Roux-en-Y gastric bypass (LRYGB). However, smoking relapse rates and the exact ulcer risk remain unknown. This study aimed to define smoking relapse, risk of GJA ulceration, and complications after LRYGB. MATERIALS AND METHODS We performed a retrospective cohort study of patients who underwent primary LRYGB during 2011-2015. Initially, three patient categories were identified: lifetime non-smokers, patients who were smoking during the initial visit at the bariatric clinic or within the prior year (recent smokers), and patients who had ceased smoking more than a year prior to their initial clinic visit (former smokers). Smoking relapse, GJA ulcer occurrences, reinterventions, and reoperations were recorded and compared. RESULTS A total of 766 patients were included in the analysis. After surgery, 53 (64.6%) recent smokers had resumed smoking. Out of these relapsed smokers, 51% developed GJA ulcers compared with 14.8% in non-relapsed recent smokers, 16.1% in former smokers, and 6% in lifetime nonsmokers (p < 0.001). Furthermore, relapsed smokers required more frequently endoscopic reinterventions (60.4%) compared with non-relapsed smokers (20.8%, p < 0.001), former smokers (20.7%, p < 0.001), and lifetime non-smokers (15.4%, p < 0.001). Additionally, relapsed smokers required a reoperation (18.9%) more often than non-relapsed recent smokers (5.7%, p < 0.001) and lifetime non-smokers (1.3%, p < 0.001). CONCLUSION Smokers relapse frequently after LRYGB, and the majority experience GJA complications. They should be counseled about this risk preoperatively and directed towards less ulcerogenic procedures when possible. Alternatively, longer periods of preoperative smoking abstinence might be needed.
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Affiliation(s)
- Dimitrios I Athanasiadis
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 130, Indianapolis, IN, 46202, USA
| | | | - Sara Monfared
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 130, Indianapolis, IN, 46202, USA
| | | | - Marisa Embry
- Department of Surgery, Indiana University Health, Indianapolis, IN, USA
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 130, Indianapolis, IN, 46202, USA. .,Department of Surgery, Indiana University Health, Indianapolis, IN, USA.
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Which Factors Correlate with Marginal Ulcer After Surgery for Obesity? Obes Surg 2020; 30:4821-4827. [DOI: 10.1007/s11695-020-04960-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 12/28/2022]
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35
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Singh A, Koenen B, Kirby DF. Bariatric Surgery and Its Complications in Inflammatory Bowel Disease Patients. Inflamm Bowel Dis 2020; 26:1155-1165. [PMID: 31626698 DOI: 10.1093/ibd/izz246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Indexed: 12/14/2022]
Abstract
Recent data have suggested that bariatric procedures, especially laparoscopic sleeve gastrectomy (SG), are safe and effective weight loss measures in patients with inflammatory bowel disease (IBD). But most of the studies have looked at short-term outcomes, and there is a general lack of awareness of underlying disease processes and baseline comorbidities in IBD patients undergoing bariatric procedures. Postbariatric issues in IBD patients including diarrhea from dumping syndrome, choleretic diarrhea, a high prevalence of small intestinal bacterial overgrowth, gastroesophageal reflux disease, Barrett's esophagus, stomal ulcerations, stenosis, and renal and gallstones can complicate the natural history of IBD. This could lead to unnecessary hospitalizations, change of medical therapy, and poor surgical and quality of life outcomes. In this review, we will discuss major complications after common bariatric procedures (SG, Roux-en-Y gastric bypass, and gastric banding) and suggest possible management strategies.
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Affiliation(s)
- Amandeep Singh
- Department of Gastroenterology, Hepatology & Nutrition, Center for Human Nutrition, Center for Gut Rehabilitation and Intestinal Transplantation, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian Koenen
- Department of Gastroenterology, Hepatology & Nutrition, Center for Human Nutrition, Center for Gut Rehabilitation and Intestinal Transplantation, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Donald F Kirby
- Department of Gastroenterology, Hepatology & Nutrition, Center for Human Nutrition, Center for Gut Rehabilitation and Intestinal Transplantation, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Jaruvongvanich V, Matar R, Maselli DB, Storm AC, Abu Dayyeh BK. Endoscopic reversal of Roux-en-Y anatomy for the treatment of recurrent marginal ulceration. VideoGIE 2020; 5:286-288. [PMID: 32642613 PMCID: PMC7332762 DOI: 10.1016/j.vgie.2020.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Reem Matar
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Daniel B Maselli
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Di Palma A, Liu B, Maeda A, Anvari M, Jackson T, Okrainec A. Marginal ulceration following Roux-en-Y gastric bypass: risk factors for ulcer development, recurrence and need for revisional surgery. Surg Endosc 2020; 35:2347-2353. [DOI: 10.1007/s00464-020-07650-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/13/2020] [Indexed: 01/29/2023]
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Laparoscopic Conversion of One Anastomosis Gastric Bypass to Roux-en-Y Gastric Bypass Due to Penetrated Marginal Ulcer. Obes Surg 2020; 30:2854-2855. [PMID: 32300946 DOI: 10.1007/s11695-020-04602-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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39
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Symptomatic marginal ulcer after pancreatoduodenectomy. Surgery 2020; 168:67-71. [PMID: 32276736 DOI: 10.1016/j.surg.2020.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/02/2020] [Accepted: 02/10/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Marginal ulcer is a well-known complication after pancreatoduodenectomy. In light of increasing long-term survival after pancreatoduodenectomy, the identification of risk factors and preventive strategies are of utmost importance. We assessed the incidence, clinical impact, and potential risk factors of marginal ulcer after pancreatoduodenectomy. METHODS A prospectively maintained database of patients undergoing pancreatoduodenectomy was analyzed retrospectively. Univariate and bivariate competing-risk Cox regression analyses were performed to identify risk factors for marginal ulcer. RESULTS Two hundred and fifty-five consecutive patients underwent pancreatoduodenectomy. The median follow-up was 35.7 months. Marginal ulcer was diagnosed in 19 patients (7.5%), and the median time from pancreatoduodenectomy to marginal ulcer diagnosis was 450 days. Thirteen of these 19 patients presented with abdominal pain, melena, or anemia. In all these 13 patients, marginal ulcer resolved with proton pump inhibitor therapy and endoscopic surveillance. Six patients with marginal ulcer presented with an acute abdomen and underwent emergency laparotomy for marginal ulcer perforation and peritonitis. There was no marginal ulcer-related mortality. Univariate and bivariate competing-risk analyses showed an increased risk for marginal ulcer with discontinuation of proton pump inhibitor therapy, smoking, alcohol intake, and the use of non-steroidal anti-inflammatory drugs. Discontinuation of proton pump inhibitor therapy was an independent risk factor for marginal ulcer development. CONCLUSION Marginal ulcer is a relevant long-term complication after pancreatoduodenectomy that occurs more frequently after proton pump inhibitor therapy is discontinued. Based on our data, permanent use of proton pump inhibitor after pancreatoduodenectomy is strongly recommended especially for those patients who smoke, consume alcohol, or use non-steroidal anti-inflammatory drugs.
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Abstract
We present a case-based review of abdominal postoperative complications, organized by organ system affected, including wound/superficial, hepatobiliary, pancreatic, gastrointestinal, genitourinary, and vascular complications. Both general complications and specific considerations for certain types of operations are described, as well as potential pitfalls that can be confused with complications. Representative cases are shown using all relevant imaging modalities, including CT, fluoroscopy, ultrasound, MRI, and nuclear medicine. Management options are also described, highlighting those that require radiologist input or intervention.
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Affiliation(s)
- Ryan B O'Malley
- Department of Radiology, Abdominal Imaging, University of Washington, 1959 Northeast Pacific Street, Box 357115, Seattle, WA 98195, USA.
| | - Jonathan W Revels
- Department of Radiology, Body and Thoracic Imaging, University of New Mexico, Albuquerque, NM, USA
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41
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Barola S, Fayad L, Hill C, Magnuson T, Schweitzer M, Singh V, Chen YI, Ngamruengphong S, Khashab MA, Kalloo AN, Kumbhari V. Endoscopic Management of Recalcitrant Marginal Ulcers by Covering the Ulcer Bed. Obes Surg 2019; 28:2252-2260. [PMID: 29556889 DOI: 10.1007/s11695-018-3162-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Management options for marginal ulcers (MU) vary from medical therapy to revision surgery. Medical therapy is often ineffective and revision surgery is associated with a high morbidity and possible recurrence. AIMS To evaluate technical feasibility, efficacy, and safety of endoscopic management of MU by covering the ulcer bed using oversewing and/or deploying a fully covered self-expandable metallic stent (FCSEMS). METHODS Medical records of consecutive patients who underwent endoscopic suturing and/or FCSEMS deployment for recalcitrant MU between August 2016 and June 2017 at a single academic center were reviewed. Recalcitrant MU was defined as an ulcer that persists after 6 to 8 weeks despite maximal medical therapy (open capsule PPI, 40 mg bid as well as sucralfate qid), cessation of smoking and nonsteroidal anti-inflammatory drugs (NSAIDs), and Helicobacter pylori eradication. RESULTS Eleven patients (age range 31-60; all females) with mean BMI of 27.72 ± 5.93 kg/m2 underwent endoscopic suturing and/or stent deployment for recalcitrant MU with abdominal pain at a median of 50 months (range 3-120) post-Roux-en-Y gastric bypass (RYGB). Seven patients were managed by oversewing, two were managed by FCSEMS, and two patients required both. Technical success was 100%. All patients reported resolution of abdominal pain at 1 week. Surveillance endoscopy performed in 10/11 (90.9%) patients at 8 weeks revealed complete ulcer healing in 9/10 (90%). No adverse events were reported. CONCLUSION Endoscopic management is an effective and safe method to treat MU and should be considered an alternative to surgical revision. It appears effective for perforated and recalcitrant MU.
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Affiliation(s)
- Sindhu Barola
- Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, A Building, 3rd floor 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Lea Fayad
- Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, A Building, 3rd floor 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Christine Hill
- Diversity Summer Internship Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thomas Magnuson
- Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Michael Schweitzer
- Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Vikesh Singh
- Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, A Building, 3rd floor 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Yen-I Chen
- Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, A Building, 3rd floor 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Saowanee Ngamruengphong
- Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, A Building, 3rd floor 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Mouen A Khashab
- Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, A Building, 3rd floor 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Anthony N Kalloo
- Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, A Building, 3rd floor 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Vivek Kumbhari
- Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, A Building, 3rd floor 600 N Wolfe St, Baltimore, MD, 21287, USA.
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Ma P, Ghiassi S, Lloyd A, Haddad A, Boone K, DeMaria E, Higa K. Reversal of Roux en Y gastric bypass: largest single institution experience. Surg Obes Relat Dis 2019; 15:1311-1316. [DOI: 10.1016/j.soard.2019.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/30/2019] [Accepted: 05/05/2019] [Indexed: 01/04/2023]
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43
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Keleidari B, Mahmoudieh M, Davarpanah Jazi AH, Melali H, Nasr Esfahani F, Minakari M, Mokhtari M. Comparison of the Bile Reflux Frequency in One Anastomosis Gastric Bypass and Roux-en-Y Gastric Bypass: a Cohort Study. Obes Surg 2019; 29:1721-1725. [DOI: 10.1007/s11695-018-03683-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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44
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Influence of Helicobacter pylori infection on gastrointestinal symptoms and complications in bariatric surgery patients: a review and meta-analysis. Surg Obes Relat Dis 2018; 14:1645-1657. [DOI: 10.1016/j.soard.2018.06.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/22/2018] [Accepted: 06/27/2018] [Indexed: 12/17/2022]
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Evaluation of the rate of marginal ulcer formation after bariatric surgery using the MBSAQIP database. Surg Endosc 2018; 33:1890-1897. [PMID: 30251139 DOI: 10.1007/s00464-018-6468-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/20/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Marginal ulcer (MU) formation is a known problem after gastric bypass. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database contains data from all US and Canadian Centers of Excellence including complication rates. We hypothesized that the short-term rate of ulceration is low. METHODS We queried the MBSAQIP database for the year 2015. We searched patients with primary gastric bypass who developed MU. We then compared preoperative, operative, and postoperative characteristics with patients who did not develop MU. RESULTS The incidence of MU in the entire cohort of GB patients was 155 of 44,379 (0.35%, 95% CI 0.297%, 0.409%). Among the 155 patients with an ulcer, 88 (57%) patients had only one procedure, 69 had an intervention (therapeutic or diagnostic endoscopy), 16 had readmission, and 3 had reoperation. 65 patients (42%) had two procedures with the majority having both readmissions and endoscopy (n = 59); and two patients (1%) had three procedures. Ulcer formation was most common in the intervention group (11.4%). The occurrence of ulcer formation was associated with unplanned ICU admissions (6.45%), transfusions (5.16%), postoperative UTI (3.87%), sepsis (1.94%), and myocardial infarction (0.65%). Death occurred in 76 patients with no related cases to MUs. The risk of ulcer was associated with increased BMI (OR 1.02, p = 0.01), presence of percutaneous transluminal cardiac catheterization (PTC) (2.17, p = 0.038), histories of DVT (1.72, p = 0.085), and pulmonary embolism (2.84, p = 0.002). CONCLUSIONS In a nationally reported database, symptomatic MUs rarely occur in the first month. The large majority are diagnosed and treated endoscopically with minimal need for surgical intervention. The risk of anastomotic ulcer was increased with increased BMI, need for PTC, and history of DVT/PE.
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Tilak A, Ramirez AG, Turrentine FE, Sohn MW, Jones RS. Preoperative Gastroesophageal Reflux Disorder Is Associated With Increased Morbidity in Patients Undergoing Abdominal Surgery. J Surg Res 2018; 232:587-594. [PMID: 30463778 DOI: 10.1016/j.jss.2018.07.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/27/2018] [Accepted: 07/13/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND In North America, the prevalence of gastroesophageal reflux disorder ranges from 18.1% to 27.8%. We measured the risk posed by preoperative esophageal disease for patients undergoing abdominal operations. METHOD American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP; 2005-2015) data were merged with institutional clinical data repository records to identify esophageal disease in surgical patients undergoing intra-abdominal procedures. Patients with esophageal disease were classified as gastroesophageal reflux disorder (GERD) or other, which included patients with esophageal stricture, spasm, ulcer, or diverticuli, achalasia, esophagitis, reflux esophagitis, Barrett's esophagus, and multiple esophageal diagnoses, excluding GERD. ACS NSQIP-targeted procedure groups included were colectomy, proctectomy, ventral hernia repair, bariatric surgery, hepatectomy, appendectomy, abdominal aortic aneurysm repair, open aortoiliac repair, hysterectomy, myomectomy, and oophorectomy. Multivariable logistic regression was used to model postoperative complication rates, adjusting for ACS NSQIP risk of morbidity, demographic factors, ACS NSQIP-targeted procedure groups, and open versus laparoscopic surgery. RESULTS Of 9172 intra-abdominal cases, 21.3% had preoperative esophageal disease (19.6% GERD and 1.7% other). After adjustment, patients with GERD were at higher risk for experiencing a number of complications, including all-cause 30-d complication (odds ratio [OR] = 1.21, 95% confidence interval [CI] 1.05-1.41, P = 0.044), renal complication (OR = 1.43, 95% CI 1.09-1.87, P = 0.036), wound complication (OR = 1.40, 95% CI 1.10-1.79, P = 0.028), and readmission within 30 d (OR = 1.66, 95% CI 1.35-2.04, P < 0.001). CONCLUSIONS Preoperative GERD is associated with increased postoperative complication rate. Surgeons should consider assessing GERD in patients undergoing abdominal operations.
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Affiliation(s)
- Ashwini Tilak
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Adriana G Ramirez
- Department of Surgery, University of Virginia, Charlottesville, Virginia.
| | | | - Min-Woong Sohn
- Department of Public Health Sciences, Charlottesville, Virginia
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Abstract
The growing population of intestinal transplant recipients present a unique challenge to the gastroenterologists responsible for their support and evaluation. Improvements in patient and graft survival are largely attributed to surgical advancements, refined antirejection therapy, and enhanced endoscopic surveillance protocols that better perceive rejection and other complications. This article reviews the endoscopic management and interventions provided for transplant recipients at the University of Illinois Hospital with complications, such as acute rejection, ischemia, bleeding, fistula, post-transplant lymphoproliferative disorder, and gastroparesis. Further research is needed on promising strategies currently used for related diseases to treat and sustain the intestinal graft.
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Affiliation(s)
- Robert E Carroll
- Department of Medicine, University of Illinois at Chicago, Chicago Veterans Administration Medical Center (West Side Division), 840 South Wood Street (M/C 787), Chicago, IL 60612, USA.
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48
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The incidence of complications associated with loop duodeno-ileostomy after single-anastomosis duodenal switch procedures among 1328 patients: a multicenter experience. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.01.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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49
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Pintar T, Kaliterna N, Carli T. The need for a patient-tailored Helicobacter pylori eradication protocol prior to bariatric surgery. J Int Med Res 2018; 46:2696-2707. [PMID: 29690823 PMCID: PMC6124286 DOI: 10.1177/0300060518769543] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective High-quality data indicating the advantages of preoperative Helicobacter pylori screening and eradication as well the clinical outcomes of patients with and without H. pylori after bariatric surgery are lacking. Methods In total, 96 morbidly obese patients with H. pylori preparing for bariatric surgery were retrospectively reviewed. Results Of 96 biopsy specimens, 73 (76%) were positive for H. pylori on initial Giemsa staining. These patients were treated with the standard 7-day antibiotic treatment protocol corrected by the individual patient's creatinine clearance rate and body mass index and received a 30% higher dose because of their H. pylori positivity. A linear correlation was found between the effective antibiotic dose and the BMI with a recurrence rate of only 2.1% (2/96 patients). The preoperative percent estimated weight loss before surgery (17%) and in the first year of follow-up (68%-88%) was statistically equal between H. pylori-positive and -negative patients. Two early postoperative infectious complications and two postoperative surgical complications occurred in the preoperatively H. pylori-positive patients. Conclusions A patient-tailored H. pylori eradication protocol prior to bariatric surgery is mandatory to improve the eradication rate and reduce the incidence of postoperative complications in mostly asymptomatic H. pylori-positive bariatric candidates.
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Affiliation(s)
- Tadeja Pintar
- 1 University Medical Center Ljubljana, Abdominal Surgery Department, Zaloška cesta, Ljubljana, Slovenia
| | | | - Tanja Carli
- 3 Institute of Physiology, Faculty of Medicine, University of Ljubljana, Zaloška cesta, Ljubljana, Slovenia
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50
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D’Silva M, Bhasker AG, Kantharia NS, Lakdawala M. High-Percentage Pathological Findings in Obese Patients Suggest that Esophago-gastro-duodenoscopy Should Be Made Mandatory Prior to Bariatric Surgery. Obes Surg 2018; 28:2753-2759. [DOI: 10.1007/s11695-018-3230-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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