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Kumar P, Yau HCV, Trivedi A, Yong D, Mahawar K. Global Variations in Practices Concerning Roux-en-Y Gastric Bypass-an Online Survey of 651 Bariatric and Metabolic Surgeons with Cumulative Experience of 158,335 Procedures. Obes Surg 2021; 30:4339-4351. [PMID: 32592015 DOI: 10.1007/s11695-020-04796-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
INTRODUCTION There is significant variation in practices concerning Roux-en-Y gastric bypass (RYGB) among bariatric surgeons, but there is currently a lack of robust data on the nature and extent of these variations. The purpose of this study was to understand global variations in practices concerning RYGB. METHODS A questionnaire-based survey on Survey Monkey® was created, and the link was shared freely on various social media platforms. The link was also distributed through a personnel email network of authors. RESULTS A total of 657 surgeons from 65 countries completed the survey. Crohn's disease and liver cirrhosis were considered absolute contraindications for RYGB by 427 surgeons (64.98%) and 347 surgeons (53.30%), respectively. More than 68.5% of surgeons performed routine upper GI endoscopy while 64.17% performed routine ultrasound of abdomen preoperatively. The majority of surgeons (77.70%) used the perigastric technique for Gastric pouch creation. Approximately, 79.5% used orogastric bougie. More than 70% of the respondents did not use any staple line reinforcement routinely. Only 17.67% of surgeons measured the whole small bowel length, and the majority of surgeons (86.5%) used constant length of BP limb. Approximately, 89% used constant length of alimentary limb. Approximately, 95% of surgeons preferred antecolic bypass, and more than 86% routinely closed the Petersen defect. Marginal ulcer prophylaxis was used by the majority (91.17%). Almost 95% of surgeons recommended lifelong vitamin and mineral supplements. CONCLUSION This survey identifies global variations in practices concerning RYGB. It identifies several areas for future research and consensus building.
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Affiliation(s)
- Parveen Kumar
- Sir Charles Gairdner Hospital, Nedlands, Western Australia.
| | | | | | - David Yong
- Joondalup Health Campus, Joondalup, Western Australia
| | - Kamal Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, UK
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Nurczyk K, Herbella FA, Patti MG. Roux-en-Y Gastric Bypass for Obesity. How We Do It. J Laparoendosc Adv Surg Tech A 2020; 30:623-626. [DOI: 10.1089/lap.2020.0156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Kamil Nurczyk
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- 2nd Department of General and Gastrointestinal Surgery, and Surgical Oncology of the Alimentary Tract, Medical University of Lublin, Lublin, Poland
| | - Fernando A. Herbella
- Department of Surgery, Escola Paulista de Medicina, Federal University of São Paulo, Brazil
| | - Marco G. Patti
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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The role of C-reactive protein after surgery for obesity and metabolic disorders. Surg Obes Relat Dis 2019; 16:99-108. [PMID: 31784329 DOI: 10.1016/j.soard.2019.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/17/2019] [Accepted: 10/08/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND C-reactive protein (CRP) rise might be different in patients with obesity due to chronic inflammation. OBJECTIVES The aim was to analyze postoperative CRP rise and its role as an early prognostic marker of infectious complications. SETTING Center of maximum care in Germany. METHODS Patients who underwent laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, or laparoscopic one-anastomosis gastric bypass as primary treatment for severe obesity were included. Serum CRP and leukocyte count were measured preoperatively, on postoperative days (POD) 1 and 4 and were analyzed regarding sex, body mass index, waist circumference, obesity-associated diseases, laboratory measurements (glycosylated hemoglobin, triglycerides, cholesterol), surgical procedure, infectious complications, and infectious with anastomotic leakage. RESULTS Four hundred seventy-one patients underwent surgery. Postoperative CRP rise was similar across sexes but lower in the super-super obese group (P < .05) and higher in the gastric bypass groups (P < .05). Linear regression model showed, that the higher preoperative value of waist circumference, the higher the preoperative CRP (beta value: .159, P = .006) and the lower the postoperative CRP rise on POD1 (beta value: -.171, P = .004) and 4 (beta value: -.170, P = .003). Only in the laparoscopic one-anastomosis gastric bypass group did a higher glycosylated hemoglobin predict a higher postoperative CRP rise (POD1: beta value: .434, P = .012; POD4: beta value: .513, P = .006). Fourteen patients (3%) developed infections, 7 of whom (1.5%) had anastomotic leakage. Leukocyte count was no predictor of infectious complications. The cut-off for CRP was 80.5 mg/L (POD1) and 164 mg/L (POD4), with 57.1% and 85.7% sensitivity and 97.9% and 99.6% specificity for anastomotic leakage. CONCLUSION Standard postoperative CRP rises less in patients with higher waist circumference and super-super obesity, but more after gastric bypass procedures. CRP but not leukocyte count predicts early anastomotic healing after obesity surgery. These findings should be considered when interpreting CRP values in the routine clinical setting.
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Musella M, Cantoni V, Green R, Acampa W, Velotti N, Maietta P, Cuocolo A. Efficacy of Postoperative Upper Gastrointestinal Series (UGI) and Computed Tomography (CT) Scan in Bariatric Surgery: a Meta-analysis on 7516 Patients. Obes Surg 2019. [PMID: 29516397 DOI: 10.1007/s11695-018-3172-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND To demonstrate the lack of utility and efficacy of routine early postoperative upper gastrointestinal study (UGI) in obese patients undergoing bariatric surgery and to show the higher efficacy of CT scan in cases of clinical suspicion of a leakage, a meta-analysis was performed. MATERIALS AND METHODS A literature search including articles published in last 18 years was performed. For both UGI and CT scan, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. A first analysis considered overall patients, and a second analysis considered only symptomatic patients. RESULTS Starting from 1233 eligible citations, 18 articles, including 7516 patients, were left. The pooled sensitivity was 54% for UGI (95% CI 34-74) with a high heterogeneity (I2 = 99.8%, p < .001), whereas CT scan showed a pooled sensitivity of 91% (95% CI 89-93) significantly higher than sensitivity of UGI series (p < 0.01), with a high heterogeneity (I2 = 98.9%, p < .001). In symptomatic patients the pooled sensitivity of UGI series was significantly lower than sensitivity of CT scan [49% (95% CI 31-68) vs 94% (95% CI 92-96), p < 0.01]. PPV showed a significant difference between UGI series and CT scan (54 vs 100%, p < 0.01). Specificity for UGI series was 98.6%, and specificity for CT scan was 99.7% (p = ns); the mean NPV was 96 and 98% for UGI series and CT scan (p = ns). CONCLUSIONS According to our results, a CT scan triggered by clinical suspicion must be considered the first-line procedure to detect a postoperative leak following primary sleeve gastrectomy or Roux-en-Y gastric bypass.
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Affiliation(s)
- Mario Musella
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy.
| | - Valeria Cantoni
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy
| | - Roberta Green
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy
| | - Wanda Acampa
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy
| | - Nunzio Velotti
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy
| | - Paola Maietta
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy
| | - Alberto Cuocolo
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy
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Tankel J, Rotem R, Wiess J, Mintz A, Spira RM. Routine Early Fluoroscopy and Clinical Observations Following Laparoscopic Roux-En-Y Gastric Bypass for Obesity Fail to Predict Subsequent Anastomotic Leakage. Indian J Surg 2019. [DOI: 10.1007/s12262-018-1802-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Kröll D, Nakhostin D, Stirnimann G, Erdem S, Haltmeier T, Nett PC, Borbély YM. C-Reactive Protein on Postoperative Day 1: a Predictor of Early Intra-abdominal Infections After Bariatric Surgery. Obes Surg 2018; 28:2760-2766. [DOI: 10.1007/s11695-018-3240-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Delko T, Mattiello D, Koestler T, Zingg U, Potthast S. Computed tomography as primary postoperative follow-up after laparoscopic Roux-en-Y gastric bypass. World J Radiol 2018; 10:1-6. [PMID: 29403579 PMCID: PMC5789378 DOI: 10.4329/wjr.v10.i1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/05/2018] [Accepted: 01/26/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate upper abdominal computed tomography (CT) scan as primary follow-up after laparoscopic Roux-en-Y gastric bypass (LRYGB).
METHODS This prospective study was approved by the Ethical Committee of the State of Zurich, and informed consent was obtained from all patients. Sixty-one patients who underwent LRYGB received upper abdominal CT on postoperative day 1, with the following scan parameters: 0.6 mm collimation, 1.2 mm pitch, CareKV with reference 120 mAs and 120 kV, and 0.5 s rotation time. Diluted water-soluble radiographic contrast-medium (50 mL) was administered to achieve gastric pouch distension without movement of the patient. 3D images were evaluated to assess postoperative complications and the radiation dose received was analysed.
RESULTS From the 70 patients initially enrolled in the study, 9 were excluded from analysis upon the intraoperative decision to perform a sleeve gastrectomy and not a LRYGB. In all of the 61 patients who were included in the analysis, CT was feasible and there were no instances of aspiration or vomiting. In 7 patients, two upper abdominal scans were necessary as the pouch was not distended by contrast medium in the first acquisition. Radiologically, no leak and no relevant stenosis were found on the first postoperative day. These early postoperative CT findings were consistent with the findings at clinical follow-up 6 wk postoperatively, with no leaks, stenosis or obstructions being diagnosed. The average total dose length product in CT was 536.6 mGycm resulting in an average effective dose of 7.8 mSv. The most common surgical complication, superficial surgical site infections (n = 4), always occurred at the upper left trocar site, where the circular stapler had been introduced.
CONCLUSION Early LRYGB postoperative multislice spiral CT scan is feasible, with low morbidity, and provides more accurate anatomical information than standard upper gastrointestinal contrast study.
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Affiliation(s)
- Tarik Delko
- Department of Surgery, University Hospital Basel, Basel 4031, Switzerland
| | - Diana Mattiello
- Department of Surgery, Limmattal Hospital, Schlieren 8952, Switzerland
| | - Thomas Koestler
- Department of Surgery, Limmattal Hospital, Schlieren 8952, Switzerland
| | - Urs Zingg
- Department of Surgery, Limmattal Hospital, Schlieren 8952, Switzerland
| | - Silke Potthast
- Department of Radiology, Limmattal Hospital, Schlieren 8952, Switzerland
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Terterov D, Leung PHY, Twells LK, Gregory DM, Smith C, Boone D, Pace D. The usefulness and costs of routine contrast studies after laparoscopic sleeve gastrectomy for detecting staple line leaks. Can J Surg 2017; 60:335-341. [PMID: 28742012 DOI: 10.1503/cjs.015216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although laparoscopic sleeve gastrectomy (LSG) has been shown to be a safe and effective treatment for severe obesity (body mass index ≥ 35), staple line leaks remain a major complication and account for a substantial portion of the procedure's morbidity and mortality. Many centres performing LSG routinely obtain contrast studies on postoperative day 1 for early detection of staple line leaks. We examined the usefulness of Gastrografin swallow as an early detection test for staple line leaks on postoperative day 1 after LSG as well as the associated costs. METHODS We conducted a retrospective review of a prospectively collected database that included 200 patients who underwent LSG for severe obesity between 2011 and 2014. Primary outcome measures were the incidence of staple line leaks and the results of Gastrografin swallow tests. We obtained imaging costs from appropriate hospital departments. RESULTS Gastrografin swallow was obtained on postoperative day 1 for all 200 patients who underwent LSG. Three patients (1.5%) were found to have staple line leaks. Gastrograffin swallows yielded 1 true positive result and 2 false negatives. The false negatives were subsequently diagnosed on computed tomography (CT) scan. The sensitivity of Gastrografin swallow in this study was 33%. For 200 patients, the total direct cost of the Gastrografin swallows was $35 000. CONCLUSION The use of routine upper gastrointestinal contrast studies for early detection of staple line leaks has low sensitivity and is costly. We recommend selective use of CT instead.
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Affiliation(s)
- Dimitry Terterov
- From the Eastern Health Sciences Centre, St. John's, NL (Terterov, Leung, Boone, Pace); the Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL (Terterov, Leung, Twells, Gregory, Smith, Boone, Pace); and the School of Pharmacy, Memoral University of Newfoundland, St. John's, NL (Twells)
| | - Philemon Ho-Yan Leung
- From the Eastern Health Sciences Centre, St. John's, NL (Terterov, Leung, Boone, Pace); the Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL (Terterov, Leung, Twells, Gregory, Smith, Boone, Pace); and the School of Pharmacy, Memoral University of Newfoundland, St. John's, NL (Twells)
| | - Laurie K Twells
- From the Eastern Health Sciences Centre, St. John's, NL (Terterov, Leung, Boone, Pace); the Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL (Terterov, Leung, Twells, Gregory, Smith, Boone, Pace); and the School of Pharmacy, Memoral University of Newfoundland, St. John's, NL (Twells)
| | - Deborah M Gregory
- From the Eastern Health Sciences Centre, St. John's, NL (Terterov, Leung, Boone, Pace); the Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL (Terterov, Leung, Twells, Gregory, Smith, Boone, Pace); and the School of Pharmacy, Memoral University of Newfoundland, St. John's, NL (Twells)
| | - Chris Smith
- From the Eastern Health Sciences Centre, St. John's, NL (Terterov, Leung, Boone, Pace); the Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL (Terterov, Leung, Twells, Gregory, Smith, Boone, Pace); and the School of Pharmacy, Memoral University of Newfoundland, St. John's, NL (Twells)
| | - Darrell Boone
- From the Eastern Health Sciences Centre, St. John's, NL (Terterov, Leung, Boone, Pace); the Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL (Terterov, Leung, Twells, Gregory, Smith, Boone, Pace); and the School of Pharmacy, Memoral University of Newfoundland, St. John's, NL (Twells)
| | - David Pace
- From the Eastern Health Sciences Centre, St. John's, NL (Terterov, Leung, Boone, Pace); the Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL (Terterov, Leung, Twells, Gregory, Smith, Boone, Pace); and the School of Pharmacy, Memoral University of Newfoundland, St. John's, NL (Twells)
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Poris S, Fontaine A, Glener J, Kubovec S, Veldhuis P, Du Y, Pepe J, Eubanks S. Routine versus selective upper gastrointestinal contrast series after omental patch repair for gastric or duodenal perforation. Surg Endosc 2017; 32:400-404. [PMID: 28664428 DOI: 10.1007/s00464-017-5695-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/22/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are no guidelines on the routine or selective use of contrast upper gastrointestinal series (UGI) after omental patch repair (OPR) of a gastric (GP) or duodenal perforation (DP). This study aims to elucidate whether the use of selective versus routine contrast study will lead to worse clinical outcomes. METHODS A retrospective analysis of 115 (n = 115) patients with OPR of GP or DP was performed. Data were obtained from seven Florida Hospital campuses. Patients aged 18 and older from 2006 to 2016 were identified by ICD9 billing information. Patients were divided into two groups: UGI and no UGI. The UGI group was subdivided into selective versus routine. A selective UGI was defined as one or more of the following after post-operative day 3: WBC >12,000, peritonitis, fever >100.4 F, tachycardia >110 bpm on three or more assessments, and any UGI performed after POD 7. Perioperative symptoms, perforation location, size, abdominal contamination, laparoscopic or open, leak detection, length of stay, mortality, and reoperation within 2 weeks were also examined. RESULTS No differences between the UGI group and non-UGI group relating to preoperative symptoms, leak detection, death, and reoperation rate were revealed. Differences in length of stay were found to be statistically significant with the UGI group and non-UGI at a median of 15.5 and 8 days, respectively. In the UGI subgroup, 20 of the 29 patients received selective studies. There were no statistical differences identified in leak detection, death, and reoperation. CONCLUSIONS Rates of leak detection, reoperation, and death in patients with GP or DP repaired with omental patch utilizing an UGI study were not statistically significant. An increased length of stay was observed within the UGI group. There was no advantage demonstrated between a selective versus routine UGI; therefore, the use of selective UGI should be based upon clinical indications.
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Affiliation(s)
- Stephenie Poris
- Institute for Surgical Advancement, Florida Hospital Orlando, 2415 N Orange Ave, #400, Orlando, FL, 32804, USA.
| | - Andrew Fontaine
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Julie Glener
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Stacey Kubovec
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Paula Veldhuis
- Institute for Surgical Advancement, Florida Hospital Orlando, 2415 N Orange Ave, #400, Orlando, FL, 32804, USA
| | - Yuan Du
- Institute for Surgical Advancement, Florida Hospital Orlando, 2415 N Orange Ave, #400, Orlando, FL, 32804, USA
| | - Julie Pepe
- Institute for Surgical Advancement, Florida Hospital Orlando, 2415 N Orange Ave, #400, Orlando, FL, 32804, USA
| | - Steve Eubanks
- Institute for Surgical Advancement, Florida Hospital Orlando, 2415 N Orange Ave, #400, Orlando, FL, 32804, USA
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Salamat A, Afrasiabi MR, Lutfi RE. Is a "retained fundus" seen on postoperative upper gastrointestinal series after laparoscopic sleeve gastrectomy predictive of inferior weight loss? Surg Obes Relat Dis 2017; 13:1145-1151. [PMID: 28325503 DOI: 10.1016/j.soard.2017.01.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 12/17/2016] [Accepted: 01/20/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Postoperative upper gastrointestinal series (UGI) has never been shown to be effective in ruling out leaks or obstruction after gastric bypass or sleeve gastrectomy. In sleeve gastrectomies, UGI will define the shape of the sleeve and rule out a retained fundus that was not optimally excised during surgery. OBJECTIVES We aimed to investigate the impact of a "retained fundus" on weight loss to determine whether UGIs can be used to gauge success of the operation and predict outcome. SETTING Urban community teaching hospital, United States. METHODS Retrospective study analyzing routine UGIs performed on 203 consecutive patients. Exclusion criteria included low quality UGI (absence of a still image of complete fill with contrast), revisions from gastric band to sleeve, absence of weight-loss data, postoperative leak, and postoperative stenosis. RESULTS A total of 149 patients were included. Mean excess weight loss at one year for groups 1 through 4 was 67.3%, 72.7%, 67.8%, and 65.9%, respectively. There was no significant statistical difference in excess weight loss between the optimal group and the group of both mild and severe retained fundus (P = .22). The weight loss remained equivalent even when comparing the optimal sleeves with only those with severe retained fundus (P = .19). There was a statistically significant difference in quality of sleeve gastrectomies on UGI with surgical experience showing less retained fundus on the UGIs (P = .006) in the latter half of the series. CONCLUSION Retained fundus does not seem to cause inferior weight loss in the early postoperative period. Thus, UGI cannot predict weight loss outcomes in the short term.
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Affiliation(s)
| | | | - Rami E Lutfi
- Presence Chicago Institute of Advanced Bariatrics, Chicago, Ilinois
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Gärtner D, Ernst A, Fedtke K, Jenkner J, Schöttler A, Reimer P, Blüher M, Schön MR. [Routine fluoroscopic investigations after primary bariatric surgery]. Chirurg 2017; 87:241-6. [PMID: 26251036 DOI: 10.1007/s00104-015-0063-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Staple line and anastomotic leakages are life-threatening complications after bariatric surgery. Upper gastrointestinal (GI) tract X-ray examination with oral administration of a water-soluble contrast agent can be used to detect leaks. The aim of this study was to evaluate the impact of routine upper GI tract fluoroscopy after primary bariatric surgery. METHODS Between January 2009 and December 2014 a total of 658 bariatric interventions were carried out of which 442 were primary bariatric operations. Included in this single center study were 307 sleeve gastrectomies and 135 Roux-en-Y gastric bypasses. Up to December 2012 upper GI tract fluoroscopy was performed routinely between the first and third postoperative days and the detection of leakages was evaluated. RESULTS In the investigation period 8 leakages (2.6 %) after sleeve gastrectomy, 1 anastomotic leakage in gastrojejunostomy and 1 in jejunojejunostomy after Roux-en-Y gastric bypass occurred. All patients developed clinical symptoms, such as abdominal pain, tachycardia or fever. In one case the leakage was detected by upper GI fluoroscopy and in nine cases radiological findings were unremarkable. No leakages were detected in asymptomatic patients. CONCLUSION Routine upper GI fluoroscopy is not recommended for uneventful postoperative courses after primary bariatric surgery.
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Affiliation(s)
- D Gärtner
- Klinik für Allgemein- und Visceralchirurgie, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland.
| | - A Ernst
- Klinik für Allgemein- und Visceralchirurgie, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland
| | - K Fedtke
- Klinik für Allgemein- und Visceralchirurgie, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland
| | - J Jenkner
- Klinik für Gefäß- und Thoraxchirurgie, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
| | - A Schöttler
- Klinik für Allgemein- und Visceralchirurgie, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland
| | - P Reimer
- Institut für diagnostische und interventionelle Radiologie, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
| | - M Blüher
- Klinik und Poliklinik für Endokrinologie und Nephrologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - M R Schön
- Klinik für Allgemein- und Visceralchirurgie, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland
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Controversies and Pitfalls of Imaging Patients Postoperative Bariatric Surgery. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0152-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Spaniolas K, Kasten KR, Sippey ME, Pender JR, Chapman WH, Pories WJ. Pulmonary embolism and gastrointestinal leak following bariatric surgery: when do major complications occur? Surg Obes Relat Dis 2016; 12:379-83. [DOI: 10.1016/j.soard.2015.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 03/27/2015] [Accepted: 05/03/2015] [Indexed: 02/07/2023]
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Methylene Blue or Upper GI, Which is More Effective for Detecting Leaks in Gastric Bypass Patients? Surg Laparosc Endosc Percutan Tech 2015; 25:451-4. [DOI: 10.1097/sle.0000000000000191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kim J, Azagury D, Eisenberg D, DeMaria E, Campos GM. ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management. Surg Obes Relat Dis 2015; 11:739-48. [DOI: 10.1016/j.soard.2015.05.001] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Mbadiwe T, Prevatt E, Duerinckx A, Cornwell E, Fullum T, Davis B. Assessing the value of routine upper gastrointestinal contrast studies following bariatric surgery: a systematic review and meta-analysis. Am J Surg 2015; 209:616-22. [DOI: 10.1016/j.amjsurg.2014.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/01/2014] [Accepted: 11/13/2014] [Indexed: 01/05/2023]
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Pike TW, White AD, Snook NJ, Dean SG, Lodge JPA. Simplified Fast-Track Laparoscopic Roux-en-Y Gastric Bypass. Obes Surg 2014; 25:413-7. [DOI: 10.1007/s11695-014-1408-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Rawlins L, Penn R, Schirmer B, Hallowell P. Accuracy of routine postoperative swallow study in predicting leak or obstruction after gastric bypass. Surg Obes Relat Dis 2014; 11:1-4. [PMID: 25553886 DOI: 10.1016/j.soard.2014.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 04/29/2014] [Accepted: 07/27/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Many bariatric surgeons use a routine postoperative day 1 swallow study after Roux-en-Y gastric bypass to rule out leak or obstruction. The authors' practice adheres to this dictum, but the aim of this study was to determine how accurate this testing is in properly predicting complications. METHODS A retrospective chart review of all patients undergoing gastric bypass in the past 5 years (2008-2012) was performed; the results of their swallow study was examined and compared with their actual clinical outcome within 30 days of operation. RESULTS The records of 501 patients were reviewed, and there were 15 leaks and 29 obstructions for a total prevalence rate of 9%. When the swallow study was negative, 33 complications were missed and 433 reports were correct. When the swallow study was positive, only 11 complications were correctly identified and 24 of the reports were false positive. The sensitivity of the test was only 25%. The positive predictive value was only 31%. The result of the swallow study was incorrect 12% of the time. CONCLUSION Routine postoperative swallow study after gastric bypass was a poor method of accurately detecting clinically significant obstruction or leak. This test may be unnecessary for all patients and might best be used when clinically indicated.
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Affiliation(s)
- Logan Rawlins
- Department of Surgery, University of Virginia, Charlottesville, Virginia.
| | - Rachel Penn
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Bruce Schirmer
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Pete Hallowell
- Department of Surgery, University of Virginia, Charlottesville, Virginia
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Mathus-Vliegen EMH. The cooperation between endoscopists and surgeons in treating complications of bariatric surgery. Best Pract Res Clin Gastroenterol 2014; 28:703-25. [PMID: 25194185 DOI: 10.1016/j.bpg.2014.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 06/18/2014] [Accepted: 07/05/2014] [Indexed: 02/09/2023]
Abstract
The results of lifestyle interventions and pharmacotherapy are disappointing in severe obesity which is characterised by premature death and many obesity-associated co-morbidities. Only surgery may achieve significant and durable weight losses associated with increased life expectancy and improvement of co-morbidities. Bariatric surgery involves the gastrointestinal tract and may therefore increase gastrointestinal complaints. Bariatric surgery may also result in complications which in many cases can be solved by endoscopic interventions. This requires a close cooperation between surgeons and endoscopists. This chapter will concentrate on the most commonly performed operations such as the Roux-en-Y gastric bypass, the adjustable gastric banding and the sleeve gastrectomy, in the majority of cases performed by laparoscopy. Operations such as the vertical banded gastroplasty and the biliopancreatic diversion with or without duodenal switch will not be discussed at length as patients with these operations will not be encountered frequently and their management can be found under the headings of the other operations.
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Affiliation(s)
- E M H Mathus-Vliegen
- Academic Medical Centre, University of Amsterdam, Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Quartararo G, Facchiano E, Scaringi S, Liscia G, Lucchese M. Upper Gastrointestinal Series after Roux-en-Y Gastric Bypass for Morbid Obesity: Effectiveness in Leakage Detection. a Systematic Review of the Literature. Obes Surg 2014; 24:1096-101. [DOI: 10.1007/s11695-014-1263-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Response to "Gastric stenosis after laparoscopic sleeve gastrectomy in morbidly obese patients". Obes Surg 2014; 24:822-3. [PMID: 24554018 DOI: 10.1007/s11695-014-1211-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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Morbid obesity-the new pandemic: medical and surgical management, and implications for the practicing gastroenterologist. Clin Transl Gastroenterol 2013; 4:e35. [PMID: 23739585 PMCID: PMC3696938 DOI: 10.1038/ctg.2013.6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The gastroenterologist, whether in academic or clinical practice, must face the reality that an increasingly large percentage of adult patients are morbidly obese. Morbid obesity is associated with significant morbidity and mortality including enhanced morbidity from cardiovascular, cerebrovascular, hepatobiliary and colonic diseases. Most of these associated diseases are actually preventable. Based on the 1991 NIH consensus conference criteria, for most patients with a body mass index (BMI=weight in kilograms divided by the height in meters squared) of 40 or more, or for patients with a BMI of 35 or more and significant health complications, surgery may be the only reliable option. Currently in the United States, over 250,000 bariatric surgical procedures are being performed annually. The practicing gastroenterologist in every community, large and small, must be familiar with the various surgical procedures together with their associated anatomic changes. These changes may dramatically increase the prevalence of nutritional deficiencies and profoundly alter the clinical and endoscopic approaches to diagnosis and management.
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23
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van Empel PJ, Verdam MGE, Huirne JA, Bonjer HJ, Meijerink WJ, Scheele F. Open knot-tying skills: Resident skills assessed. J Obstet Gynaecol Res 2013; 39:1030-6. [DOI: 10.1111/jog.12011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 10/12/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Pieter J. van Empel
- Department of Surgery; VU University Medical Centre; Amsterdam The Netherlands
| | | | - Judith A. Huirne
- Department of Obstetrics and Gynaecology; VU University Medical Centre; Amsterdam The Netherlands
| | - H. Jaap Bonjer
- Department of Surgery; VU University Medical Centre; Amsterdam The Netherlands
| | - W. Jeroen Meijerink
- Department of Surgery; VU University Medical Centre; Amsterdam The Netherlands
| | - Fedde Scheele
- Department of Obstetrics and Gynaecology; Saint Lucas Andreas Hospital; Amsterdam The Netherlands
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Griffith PS, Birch DW, Sharma AM, Karmali S. Managing complications associated with laparoscopic Roux-en-Y gastric bypass for morbid obesity. Can J Surg 2012; 55:329-36. [PMID: 22854113 DOI: 10.1503/cjs.002011] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Obesity has become a major health concern in Canada. This has resulted in a steady rise in the number of bariatric surgical procedures being performed nationwide. The laparoscopic Roux-en-Y gastric bypass (LRYGB) is not only the most common bariatric procedure, but also the gold standard to which all others are compared. With this in mind, it is imperative that all gastrointestinal surgeons understand the LRYGB and have a working knowledge of the common postoperative complications and their management. Early postoperative complications following LRYGB that demand immediate recognition include anastomotic or staple line leak, postoperative hemorrhage, bowel obstruction and incorrect Roux limb reconstructions. Later complications may be challenging to differentiate from other gastrointestinal disorders and include anastomotic stricture, marginal ulceration, fistula formation, weight gain and nutritional deficiencies. We discuss the principles involved in the management of each complication and the timing of referral to specialist bariatric centres.
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Affiliation(s)
- P S Griffith
- The Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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Upper gastrointestinal swallow study following bariatric surgery: institutional review and review of the literature. Obes Surg 2012; 22:1039-43. [PMID: 22527600 DOI: 10.1007/s11695-012-0658-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The aim of this study was to determine the efficacy of routine upper gastrointestinal imaging following the three forms of laparoscopic bariatric surgery completed at our institution (laparoscopic Roux en Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LS), and laparoscopic adjustable gastric banding (LAGB)). METHODS Radiograph reports were reviewed from the period of January 2005 to July 2010. During that time, 129 patients underwent LRYGB, 209 underwent LS, and 12 patients underwent LAGB. Of those patients, 120 LRYGB patients, 188 LS patients, and 11 LAGB patients underwent upper gastrointestinal studies on postoperative days (POD) 1 or 2. RESULTS Of the 319 total patients who underwent UGI, no contrast leaks were found. One LRYGB patient was found to have stenosis of the jejunojejunal anastomosis and was taken to the operating room for revision. A total of ten patients went on to develop leaks: four LRYGB patients, six LS patients, and zero LAGB patients. CONCLUSIONS The results of our study show that a positive UGI study for stricture has a specificity of 100 %. In terms of leak, which offers a much higher risk of significant morbidity and mortality, UGI was unable to find any on postoperative days 1 or 2. Based on the results of this study, our institution has stopped completing routine UGI on POD 1 following bariatric surgery.
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C-reactive protein 2 days after laparoscopic gastric bypass surgery reliably indicates leaks and moderately predicts morbidity. J Gastrointest Surg 2012; 16:1128-35. [PMID: 22528569 DOI: 10.1007/s11605-012-1882-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 03/22/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the present study was to evaluate whether serum C-reactive protein (CRP) is a useful predictor of early post-operative complications, particularly of intestinal leaks after laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. METHODS The present study was a retrospective analysis of a prospectively maintained database with 809 patients who underwent LRYGB from 2002 until 2011. For 410 of these patients, at least one CRP measurement within the first seven post-operative days was available. The diagnostic value was determined by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. RESULTS Forty-nine of 410 patients (12.0 %; 95 % confidence intervals [95 % CI], 9.2-15.5 %) developed surgery-related complications. Leaks occurred in 17 patients (4.1 %; 95 % CI, 2.6-6.5 %) at a median of 5 days after surgery. CRP levels 2 days after surgery showed the highest diagnostic value for post-operative complications (AUC, 0.74; 95 % CI, 0.60-0.89). Sensitivity was 0.53 (95 % CI, 0.31-0.74) and specificity was 0.91 (95 % CI, 0.79-0.96) on day 2 (cutoff level, 229 mg/l). The sensitivity for intestinal leaks was 1.00 (95 % CI, 0.51-1.00). CONCLUSION CRP on post-operative day 2 is a valuable predictor of post-operative complications, in particular intestinal leaks. Radiological imaging studies for intestinal leaks could be restricted to patients with CRP values exceeding 229 mg/l.
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Agarwala A, Kellum JM. Prevention, detection, and management of leaks following gastric bypass for obesity. Adv Surg 2010; 44:59-72. [PMID: 20919514 DOI: 10.1016/j.yasu.2010.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ashish Agarwala
- Department of Surgery, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, Richmond, VA 23298, USA
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28
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Routine postoperative upper gastrointestinal fluoroscopy is unnecessary after laparoscopic adjustable gastric band placement. Surg Endosc 2010; 24:2188-91. [PMID: 20349088 DOI: 10.1007/s00464-010-0924-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Accepted: 01/10/2010] [Indexed: 01/30/2023]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding (LAGB) has become an accepted procedure for weight loss surgery, particularly due to fewer early complications and decreased mortality in comparison to other bariatric procedures. Many centers use postoperative upper gastrointestinal fluoroscopy (UGI) to ensure stomal patency and gastric integrity at the banding site. However, UGI increases cost and may increase length of stay due to availability. The purpose of this study is to determine whether routine UGI after LAGB is necessary for detection of early complications. METHODS A prospective database of 200 LAGBs performed by a single surgeon over 3 years was reviewed retrospectively. All patients underwent UGI 2-24 h after surgery. RESULTS Mean age was 43, mean BMI was 45, and mean operative time was 44 min. Forty-four percent of patients stayed overnight. All postoperative UGI results were normal. Six percent underwent intraoperative instillation of methylene blue due to procedural difficulty with no leaks identified. These patients on average were 5 years older ( p< 0.01) and had an operative time 23 min longer (p < 0.01). Differences in gender and BMI were not statistically significant. One patient (0.5%), who had a normal methylene blue test and normal UGI, returned within 2 days with a gastric perforation requiring band explant and gastric repair. CONCLUSIONS We conclude that routine UGI after LAGB is not necessary based on a 0% stomal obstruction rate and detection of not a single gastric leak. Elimination of routine postoperative UGI will decrease cost and length of hospital stay. We suggest a selective approach for those patients at increased risk of early postoperative complications, including those having intraoperative methylene blue instillation, increased length of operation, and increased age.
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Gastroesophageal junction leak with serious sepsis after gastric bypass: successful treatment with endoscopy-assisted intraluminal esophageal drainage and self-expandable covered metal stent. Obes Surg 2009; 20:240-3. [PMID: 19784706 DOI: 10.1007/s11695-009-9978-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 09/04/2009] [Indexed: 10/20/2022]
Abstract
We present a case of gastroesophageal junction leak after gastric bypass with serious sepsis and hemodynamic instability. Minimally invasive treatment was performed in two stages: initial sepsis control by lavage and endoscopy-assisted laparoscopic placement of an intraluminal esophageal drainage tube through the leak orifice; this was followed by definitive leak treatment with a self-expandable covered metal stent after achieving hemodynamic stability. Patient evolution was satisfactory without the need for open surgery.
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Campos GM, Rabl C, Mulligan K, Posselt A, Rogers SJ, Westphalen AC, Lin F, Vittinghoff E. Factors associated with weight loss after gastric bypass. ACTA ACUST UNITED AC 2008; 143:877-883; discussion 884. [PMID: 18794426 DOI: 10.1001/archsurg.143.9.877] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Gastric bypass (GBP) is the most common operation performed in the United States for morbid obesity. However, weight loss is poor in 10% to 15% of patients. We sought to determine the independent factors associated with poor weight loss after GBP. DESIGN Prospective cohort study. We examined demographic, operative, and follow-up data by means of multivariate analysis. Variables investigated were age, sex, race, marital and insurance status, initial weight and body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared), comorbidities (diabetes mellitus, hypertension, joint disease, sleep apnea, hyperlipidemia, and psychiatric disease), laparoscopic vs open surgery, gastric pouch area, gastrojejunostomy technique, and alimentary limb length. SETTING University tertiary referral center. PATIENTS All patients at our institution who underwent GBP from January 1, 2003, through July 30, 2006. MAIN OUTCOME MEASURES Weight loss at 12 months defined as poor (< or =40% excess weight loss) or good (>40% excess weight loss). RESULTS Follow-up data at 12 months were available for 310 of the 361 patients (85.9%) undergoing GBP during the study period. Mean preoperative BMI was 52 (range, 36-108). Mean BMI and excess weight loss at follow-up were 34 (range, 17-74) and 60% (range, 8%-117%), respectively. Thirty-eight patients (12.3%) had poor weight loss. Of the 4 variables associated with poor weight loss in the univariate analysis (greater initial weight, diabetes, open approach, and larger pouch size), only diabetes (odds ratio, 3.09; 95% confidence interval, 1.35-7.09 [P = .007]) and larger pouch size (odds ratio, 2.77;95% confidence interval, 1.81-4.22 [P <.001]) remained after the multivariate analysis. CONCLUSIONS Gastric bypass results in substantial weight loss in most patients. Diabetes and larger pouch size are independently associated with poor weight loss after GBP.
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Affiliation(s)
- Guilherme M Campos
- Department of Surgery, University of California, San Francisco, 521 Parnassus Ave, Room C-341, San Francisco, CA 94143-0790, USA.
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The paradox of the pouch: prompt emptying predicts improved weight loss after laparoscopic Roux-Y gastric bypass. Surg Endosc 2008; 23:790-4. [DOI: 10.1007/s00464-008-0069-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2008] [Revised: 05/20/2008] [Accepted: 06/09/2008] [Indexed: 10/21/2022]
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Takata MC, Campos GM, Ciovica R, Rabl C, Rogers SJ, Cello JP, Ascher NL, Posselt AM. Laparoscopic bariatric surgery improves candidacy in morbidly obese patients awaiting transplantation. Surg Obes Relat Dis 2008; 4:159-64; discussion 164-5. [PMID: 18294923 DOI: 10.1016/j.soard.2007.12.009] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 11/07/2007] [Accepted: 12/23/2007] [Indexed: 12/17/2022]
Abstract
BACKGROUND To evaluate, at a university tertiary referral center, the safety and efficacy of laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients with end-stage renal disease (ESRD) and laparoscopic sleeve gastrectomy (LSG) in patients with cirrhosis or end-stage lung disease (ESLD); and to determine whether these procedures help patients become better candidates for transplantation. METHODS A retrospective review was performed of selected patients with end-stage organ failure who were not eligible for transplantation because of morbid obesity who underwent LRYGB or LSG. The prospectively collected data included demographics, operative details, complications, percentage of excess weight loss, postoperative laboratory data, and status of transplant candidacy. RESULTS Of the 15 patients, 7 with ESRD underwent LRYGB and 6 with cirrhosis and 2 with ESLD underwent LSG. Complications developed in 2 patients (both with cirrhosis); no patient died. The mean follow-up was 12.4 months, and the mean percentage of excess weight loss at > or =9 months was 61% (ESRD), 33% (cirrhosis), and 61.5% (ESLD). Obesity-associated co-morbidities improved or resolved in all patients. Serum albumin and other nutritional parameters at > or =9 months after surgery were similar to the preoperative levels in all 3 groups. At the most recent follow-up visit, 14 (93%) of 15 patients had reached our institution's body mass index limit for transplantation and were awaiting transplantation; 1 patient with ESLD underwent successful lung transplant. CONCLUSION The results of this pilot study have provided preliminary evidence that LRYGB in patients with ESRD and LSG in patients with cirrhosis or ESLD is safe, well-tolerated, and improves their candidacy for transplantation.
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Affiliation(s)
- Mark C Takata
- Department of Surgery, University of California, San Francisco, School of Medicine, San Francisco, California, USA
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