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Obeid NR, Gibbs KE, Faler B, Eckhouse S, Corcelles R, Alvarez R, Chen J, Husain F, Ghanem OM, Kroh M, Kurian M. The SAGES MASTERS program bariatric surgery pathway selects 10 seminal publications on adjustable gastric banding. Surg Endosc 2024; 38:2964-2973. [PMID: 38714569 DOI: 10.1007/s00464-024-10812-z] [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: 12/22/2023] [Accepted: 03/21/2024] [Indexed: 05/10/2024]
Abstract
BACKGROUND Bariatric surgery is one of the clinical pathways of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Masters Program, and laparoscopic adjustable gastric banding (LAGB) is one of the three anchoring bariatric procedures. To improve surgeon lifelong learning, the Masters Program seeks to identify sentinel articles of each of the 3 bariatric anchoring procedures. In this article, we present the top 10 articles on LAGB. METHODS A systematic literature search of papers on LAGB was completed, and publications with the most citations and citation index were selected and shared with SAGES Metabolic and Bariatric Surgery Committee members for review. The individual committee members then ranked these papers, and the top 10 papers were chosen based on the composite ranking. RESULTS The top 10 sentinel publications on LAGB contributed substantially to the body of literature related to the procedure, whether for surgical technique, novel information, or outcome analysis. A summary of each paper including expert appraisal and commentary is presented here. CONCLUSION These seminal articles have had significant contribution to our understanding and appreciation of the LAGB procedure. Bariatric surgeons should use this resource to enhance their continual education and acquisition of specialized skills.
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Affiliation(s)
- Nabeel R Obeid
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA.
| | - Karen E Gibbs
- Department of Surgery, Yale Medicine, New Haven, CT, USA
| | - Byron Faler
- Department of Surgery, Dwight D. Eisenhower Army Medical Center, Fort Eisenhower, GA, USA
| | | | | | - Rafael Alvarez
- Department of Surgery, Mosaic Life Care, St Joseph, MO, USA
| | - Judy Chen
- Department of Surgery, University of Washington Medicine, Seattle, WA, USA
| | - Farah Husain
- Department of Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Matthew Kroh
- Department of Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Marina Kurian
- Department of Surgery, New York University Langone Health, New York, NY, USA
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Mills H, Alhindi Y, Idris I, Al-Khyatt W. Outcomes of Concurrent Hiatus Hernia Repair with Different Bariatric Surgery Procedures: a Systematic Review and Meta-analysis. Obes Surg 2023; 33:3755-3766. [PMID: 37917388 PMCID: PMC10687114 DOI: 10.1007/s11695-023-06914-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Hiatus hernia (HH) is prevalent among patients with obesity. Concurrent repair is often performed during metabolic and bariatric surgery (MBS), but a consensus on the safety and effectiveness of concurrent HH repair (HHR) and MBS remains unclear. We performed a systematic review of the safety and effectiveness of concurrent HHR and MBS through the measurement of multiple postoperative outcomes. METHOD Seventeen studies relating to concurrent MBS and HHR were identified. MBS procedures included laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (LRYGB), and adjustable gastric banding (LAGB). Studies with pre- and postoperative measurements and outcomes were extracted. RESULTS For LSG, 9 of 11 studies concluded concurrent procedures to be safe and effective with no increase in mortality. Reoperation and readmission rates however were increased with HHR, whilst GORD rates were seen to improve, therefore providing a solution to the predominant issue with LSG. For LRYGB, in all 5 studies, concurrent procedures were concluded to be safe and effective, with no increase in mortality, length of stay, readmission and reoperation rates. Higher complication rates were observed compared to LSG with HHR. Among LAGB studies, all 4 studies were concluded to be safe and effective with no adverse outcomes on mortality and length of stay. GORD rates were seen to decrease, and reoperation rates from pouch dilatation and gastric prolapse were observed to significantly decrease. CONCLUSION Concurrent HHR with MBS appears to be safe and effective. Assessment of MBS warrants the consideration of concurrent HHR depending on specific patient case and the surgeon's preference.
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Affiliation(s)
- Henry Mills
- Medical School University of Nottingham, Nottingham, UK
| | - Yousef Alhindi
- Clinical, Metabolic and Molecular Physiology Research Group, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby, DE22 3NE, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
- Division of Applied Medical Sciences, University of Hail, Hail, Saudi Arabia
| | - Iskandar Idris
- Clinical, Metabolic and Molecular Physiology Research Group, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby, DE22 3NE, UK.
- East Midlands Bariatric & Metabolic Institute, Royal Derby Hospital, Derby, DE22 3NE, UK.
| | - Waleed Al-Khyatt
- Medical School University of Nottingham, Nottingham, UK.
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK.
- Bariatric & Metabolic Surgery Department of Excellence, Health Point Hospital, A Mubadala Health Partner, Zayed Sports City, United Arab Emirates.
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Aljaroudi ME, Makki M, Almulaify M, Alshabib A, Alfaddagh H, Alzahrani H, Alghamdi S, Alsualiman W, Alsalman J, Alhaddad MJ. Endoscopic Assessment Prior to Bariatric Surgery in Saudi Arabia. Cureus 2023; 15:e36157. [PMID: 37065321 PMCID: PMC10101814 DOI: 10.7759/cureus.36157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND There are marked local inconsistencies in the Arabian Peninsula about the role of preoperative esophagogastroduodenoscopy (EGD) in bariatric surgery. Thus, this study was conducted to determine the frequency of endoscopic and histological findings in the Saudi population presenting for pre-bariatric surgery evaluation. MATERIAL AND METHODS This was a retrospective study that included all the patients who were evaluated by EGD at Dammam Medical Complex, Dammam, Saudi Arabia, between 2018 and 2021 as a part of their pre-bariatric-surgery evaluation. RESULTS A total of 684 patients were included. They consisted of 250 male and 434 female patients (36.5% and 63.5%, respectively). The mean ± standard deviation for the patients' age and body mass index (BMI) were 36.4±10.6 years and 44.6±5.1 kg/m2, respectively. Significant endoscopic or histopathological findings as defined by the presence of large (≥ 2 cm) hiatus hernia, esophagitis, gastroesophageal reflux disease (GERD), Barrett esophagus, gastric ulcer, duodenal ulcer, or intestinal metaplasia were found in 143 patients (20.9%); 364 patients (53.2%) were diagnosed to have Helicobacter pylori infection. CONCLUSION The high number of significant endoscopic and histopathological findings in our study supports the routine use of preoperative EGD in all bariatric surgery patients. However, omitting EGD before Roux-en-Y gastric bypass (RYGB) in asymptomatic patients is still reasonable as the most frequently found significant findings, esophagitis, and hiatus hernia, are less likely to impact the operative plans in RYGB. Similarly, active surveillance and treatment of H. pylori infections in obese patients are important but it is not clear whether H. pylori eradication should be done before bariatric surgery.
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Majdoubeh Y, Abu Hassan F, Abu Alhalawa M, Aljobouri S. Hiatus Hernia as a Complication of Gastric Banding: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e29704. [PMID: 36321050 PMCID: PMC9616345 DOI: 10.7759/cureus.29704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
Worsening hiatus hernia (HH) symptoms have been well recognized as a complication of gastric banding, however, it has not yet been explored whether gastric banding plays a role in the development of HH de novo in patients undergoing gastric banding. From the 696 studies identified, five studies met the eligibility criteria and were included. Data was extracted from PubMed, Embase, Medline, HMIC, and Web of Science databases. The pooled complication rate was evaluated along with 95% confidence intervals (95% CIs). The meta-analysis was performed using the Cochrane RevMan tool (Cochrane, London, UK). Heterogeneity was tested using the I2 index for each outcome. All the included studies assessed HH incidence among followed-up patients who needed a re-operation for upper gastrointestinal symptoms. Between-study variability was high (I2 = 94%, Chi2 = 68.92, df = 4, < 0.00001, Tau2=1.91). Complication rate ranged between 0.24% to 5.55%; pooled complication rate was 2.17% CI 95% (0.90 - 3.44%) P = 0.0008. The included studies show a comparable rate of post-operative HH; the fact that HHs can become symptomatic following the adjustable gastric banding (AGB) procedure indicates that AGB plays a role in creating symptomatic hiatal hernias at the very least. Further research is needed to underpin the mechanism and confirm causation. However, this complication should potentially be discussed with patients opting for this kind of operation as it can be a reason for re-operation.
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American Society of Metabolic and Bariatric Surgery Consensus Statement on Laparoscopic Adjustable Gastric Band Management. Surg Obes Relat Dis 2022; 18:1120-1133. [DOI: 10.1016/j.soard.2022.06.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/26/2022] [Indexed: 11/21/2022]
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Esophagitis After Bariatric Surgery: Large Cross-sectional Assessment of an Endoscopic Database. Obes Surg 2019; 30:161-168. [DOI: 10.1007/s11695-019-04164-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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De Luca M, Angrisani L, Himpens J, Busetto L, Scopinaro N, Weiner R, Sartori A, Stier C, Lakdawala M, Bhasker AG, Buchwald H, Dixon J, Chiappetta S, Kolberg HC, Frühbeck G, Sarwer DB, Suter M, Soricelli E, Blüher M, Vilallonga R, Sharma A, Shikora S. Indications for Surgery for Obesity and Weight-Related Diseases: Position Statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg 2016; 26:1659-96. [PMID: 27412673 PMCID: PMC6037181 DOI: 10.1007/s11695-016-2271-4] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Maurizio De Luca
- Director Department of Surgery, Montebelluna Treviso Hospital, Montebelluna, Treviso, Italy.
| | | | - Jacques Himpens
- The European School of Laparoscopic Surgery, Brussels, Belgium
| | | | | | | | - Alberto Sartori
- Director Department of Surgery, Montebelluna Treviso Hospital, Montebelluna, Treviso, Italy
| | | | | | | | | | - John Dixon
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | | | | | | | - Michel Suter
- University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Mattias Blüher
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | | | - Arya Sharma
- Obesity Research Management, University of Alberta, Edmonton, Canada
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Pilone V, Vitiello A, Hasani A, Di Micco R, Monda A, Izzo G, Forestieri P. Laparoscopic adjustable gastric banding outcomes in patients with gastroesophageal reflux disease or hiatal hernia. Obes Surg 2015; 25:290-4. [PMID: 25030091 DOI: 10.1007/s11695-014-1366-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) and hiatal hernia (HH) are classically considered contraindications to bariatric restrictive procedures. Despite the high number of studies that have been published, the relationship between laparoscopic adjustable gastric banding (LAGB) and GERD/HH is still not clear. METHODS We have retrospectively analyzed the outcomes of LAGB in patients operated in 2010 with HH and/or GERD. The gastroesophageal reflux was diagnosed if the patients had heartburn and regurgitation more than once a week, and hiatal hernia was assessed by esophagogastroduodenoscopy and/or upper GI radiogram with swallow. Data on heartburn, assumption of antacid medication, weight loss, and rate of complications in both patients with and without GERD or HH were collected. RESULTS One hundred and twenty patients that underwent LAGB at our department were enrolled in our study; 40 had symptoms of GERD and 25 had hiatal hernia preoperatively. There was no difference of percentage excess weight loss (%EWL) at 12 months (45.4 ± 20.4 vs 4.6 ± 19.5 kg/m(2)) and 36 months follow-up (49.4 ± 16.5 vs 48.6 ± 18.9 kg/m(2)) between asymptomatic patients and patients with HH or GERD symptoms. The number of patients with preoperative heartburn (40 to 10) and/or assumption of antacid drugs (38 to 7) significantly decreased after LAGB CONCLUSIONS: LAGB is an effective and safe surgical treatment for morbidly obesity in patients with GERD or HH, since it induces both a significant weight loss and an improvement of reflux symptoms.
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Affiliation(s)
- Vincenzo Pilone
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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Boules M, Corcelles R, Guerron AD, Dong M, Daigle CR, El-Hayek K, Schauer PR, Brethauer SA, Rodriguez J, Kroh M. The incidence of hiatal hernia and technical feasibility of repair during bariatric surgery. Surgery 2015; 158:911-6; discussion 916-8. [PMID: 26243345 DOI: 10.1016/j.surg.2015.06.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 06/15/2015] [Accepted: 06/27/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the incidence and outcomes of hiatal hernias (HH) that are repaired concomitantly during bariatric surgery. METHODS We identified patients who had concomitant HH repair during bariatric surgery from 2010 to 2014. Data collected included baseline demographics, perioperative parameters, type of HH repair, and postoperative outcomes. RESULTS A total of 83 underwent concomitant HH during study period. The male-to-female ratio was 1:8, mean age was 57.2 ± 10.0 years, and mean body mass index was 44.5 ± 7.9 kg/m(2). A total of 61 patients had laparoscopic Roux-en-Y gastric bypass, and 22 had laparoscopic sleeve gastrectomy. HH was diagnosed before bariatric surgery in 32 (39%) subjects, whereas 51 (61%) were diagnosed intraoperatively. Primary hernia repair was performed with anterior reconstruction in 45 (54%) patients, posterior in 21 (25%), and additional mesh placement in 7 (8%). A total of 24 early minor postoperative symptoms were reported. At 12 month follow-up, mean body mass index improved to 30.0 ± 6.2 kg/m(2), and anti-reflux medication was decreased from 84% preoperatively to 52%. Late postoperative complications were observed in 3 patients. A comparative analysis with a matched 1:1 control group displayed no significant differences in operative time (P = .07), duration of stay (P = .9), intraoperative complications, or early (P = .09) and late post-operative symptoms (P = .3). In addition, no differences were noted in terms of weight-loss outcomes. CONCLUSION The true incidence of HH may be underestimated before bariatric surgery. Combined repair of HH during bariatric surgery appears safe and feasible.
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Affiliation(s)
- Mena Boules
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
| | - Ricard Corcelles
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH; Fundació Clínic per la Recerca Biomèdica, Hospital Clínic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Matthew Dong
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
| | | | - Kevin El-Hayek
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH; Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH; Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | | | | | - John Rodriguez
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH; Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH
| | - Matthew Kroh
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH; Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH.
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Abstract
OBJECTIVE To assess the impact of revisional surgery after laparoscopic adjustable gastric banding (LAGB) on weight loss at 12 and 24 months. BACKGROUND There is no uniform consensus as to the optimal procedure for patients requiring revision after LAGB. Few studies address the issue of weight loss after band salvage procedures, despite this being a critical factor in deciding which reoperative procedure to choose. METHODS A retrospective analysis was conducted of adult patients who underwent LAGB from January 1, 2001 to June 30, 2009 at a single institution. Patients who required revision for pouch-related problems including band slippage, pouch dilation, and hiatal hernia were studied. Demographic data, body mass index (BMI), percentage excess weight loss (% EWL), and operative details were recorded. Weights were recorded at 12 and 24 months after revision. These were compared with initial weight, weight before revision, and weight in patients who did not have a reoperation. RESULTS Of 3876 patients, 390 patients were included in analysis of weight outcomes after revision. The procedure-related mortality was 0%. Early (30-day) complications occurred in 0.5%, late complications (erosion) in 0.5%, and 29 patients (7.4%) required a second revision. For patients undergoing revision, the initial weight was 124.06 ± 21.28 kg and BMI was 44.80 ± 6.12 kg/m. At reoperation, weight was 89.18 ± 20.51 kg, BMI was 32.25 ± 6.50 kg/m and, %EWL was 54.13 ± 21.80%. Twelve months postrevision, weight was 92.24 ± 20.22 kg, BMI was 33.32 ± 6.41 kg/m, and %EWL was 48.81 ± 22.71%. Weight was 92.42 ± 19.91 kg, BMI was 33.53 ± 6.25 kg/m, and %EWL was 47.50 ± 22.91% twenty-four months postrevision. CONCLUSIONS Reoperation for pouch-related problems after LAGB is safe and effective. Weight loss is maintained after reoperation.
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Broucek JR, Ritter LA, Francescatti AB, Smith CH, Luu MB, Autajay KM, Myers JA. Radiographic predictability of hiatal hernia prior to gastric band surgery. JSLS 2014; 18:243-5. [PMID: 24960487 PMCID: PMC4035634 DOI: 10.4293/108680813x13753907291233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Hiatal hernia (HH) is closely associated with morbid obesity. There is controversy over the need for preoperative imaging before laparoscopic adjustable gastric band placement. The aim of this study is to determine the predictive value of preoperatively diagnosing HH with upper gastrointestinal (UGI) series imaging. Methods: A retrospective review of a single surgeon's experience with laparoscopic adjustable gastric band placements was performed. All patients received a preoperative UGI series. The decision to perform an HH repair at the time of gastric banding was based on intraoperative findings. Each patient's UGI study was compared with the operative report. Patients' outpatient records were also reviewed for subjective reflux symptoms or use of antireflux medications. Results: Of 146 patients, 63 (43%) had intraoperative findings consistent with an HH and underwent repair. Of these, only 32 (50%) had a preoperative UGI study that showed an HH (positive predictive value, 50%). Of the 83 patients who did not have an intraoperative HH, only 51 (61%) had a congruent UGI (negative predictive value, 62%). No correlation was found between patient-reported symptoms and either radiologic or intraoperative findings. Conclusions: UGI series have poor positive and negative predictive values in preoperatively diagnosing HH. In addition, subjective patient symptoms and the need for antireflux medication did not correlate with either radiologic or intraoperative findings of HH. Our results suggest that direct operative diagnosis is a more accurate method of detecting HH.
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Affiliation(s)
| | | | | | | | - Minh B Luu
- Rush University Medical Center, Chicago, IL, USA
| | | | - Jonathan A Myers
- Rush University Medical Center, Chicago, IL, USA; Rush University Medical Center, 1725 W Harrison St, Ste 810, Chicago, IL 60612, USA.
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Kurian M. Comment on: Hiatal hernia and gastroesophageal reflux disease in gastric banding patients: analysis of a national database. Surg Obes Relat Dis 2014; 10:444. [PMID: 24951068 DOI: 10.1016/j.soard.2014.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 01/10/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Marina Kurian
- New York Minimally Invasive Surgery PLLC, New York, New York
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Santonicola A, Angrisani L, Cutolo P, Formisano G, Iovino P. The effect of laparoscopic sleeve gastrectomy with or without hiatal hernia repair on gastroesophageal reflux disease in obese patients. Surg Obes Relat Dis 2014; 10:250-5. [PMID: 24355324 DOI: 10.1016/j.soard.2013.09.006] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 07/29/2013] [Accepted: 09/14/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obesity is an independent risk factor for gastroesophageal reflux disease (GERD), which is often associated with the presence of a hiatal hernia (HH). Despite increasing popularity of laparoscopic sleeve gastrectomy (LSG) in bariatric surgery, its effect on GERD is still unclear. The objective of this study was to evaluate the effect of LSG with or without hiatal hernia repair (HHR) on GERD in obese patients. METHODS Seventy-eight patients with HH underwent LSG with concomitant HHR (LSG+HHR group). Their data were compared with that of 102 patients without HH, who underwent only LSG (LSG-group). All patients underwent a standardized questionnaire, a double-contrast barium swallow, and an upper-gastrointestinal endoscopy before the surgical procedure and at least 6 months later. RESULTS At baseline, the prevalence of GERD symptoms and their frequency-intensity scores did not differ between groups. At follow up, there was a significant decrease in the prevalence of typical GERD symptoms only in the LSG-group (P = .003). LSG+HHR patients showed a significantly higher heartburn frequency-intensity score compared with LSG patients (P = .009). CONCLUSION This finding confirms that LSG has a beneficial effect on relieving GERD symptoms, although the underlying mechanisms are still unclear; conversely, the procedure of HHR did not produce any improvement in GERD symptoms.
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Affiliation(s)
- Antonella Santonicola
- Clinical and Experimental Medicine Department, Federico II University of Naples, Naples, Italy
| | - Luigi Angrisani
- General and Endoscopic Surgery Unit, San Giovanni Bosco Hospital, Naples, Italy
| | - Pierpaolo Cutolo
- General and Endoscopic Surgery Unit, San Giovanni Bosco Hospital, Naples, Italy
| | - Giampaolo Formisano
- General and Endoscopic Surgery Unit, San Giovanni Bosco Hospital, Naples, Italy
| | - Paola Iovino
- Medicine and Surgery Department, University of Salerno, Salerno, Italy.
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Santonicola A, Angrisani L, Iovino P. Reply to "Comment on: The effect of laparoscopic sleeve gastrectomy with or without hiatal hernia repair on gastroesophageal reflux disease in obese patients". Surg Obes Relat Dis 2014; 10:371-2. [PMID: 24582421 DOI: 10.1016/j.soard.2013.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 12/05/2013] [Accepted: 12/05/2013] [Indexed: 02/07/2023]
Affiliation(s)
- Antonella Santonicola
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Luigi Angrisani
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital Naples, Italy
| | - Paola Iovino
- Medicine and Surgery Department, University of Salerno, Salerno, Italy
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Ardestani A, Tavakkoli A. Hiatal hernia repair and gastroesophageal reflux disease in gastric banding patients: analysis of a national database. Surg Obes Relat Dis 2013; 10:438-43. [PMID: 24680760 DOI: 10.1016/j.soard.2013.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 11/18/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hiatal hernia (HH) is a risk factor for complications after laparoscopic adjustable gastric banding (LAGB), with recommendation to repair these at the time of LAGB placement. We reviewed the characteristics and outcomes of bariatric patients undergoing HH repair during LAGB. The aim of this study was to determine the prevalence of HH repair in LAGB patients and its potential effect on outcomes. METHODS Using the Bariatric Outcomes Longitudinal Database, we identified patients who had hiatal hernia repair at the time of their LAGB (HHR group) and compared them to other LAGB patients without a HH repair (NonHHR group). RESULTS Of 41,611 patients who underwent LAGB during 2007-2010, 8120 (19.5%) had HH repair (HHR), adding only 4 minutes to the operating time, without an increase in blood transfusion, length of stay, or band-related complications. Preoperatively, the HHR cohort had a higher incidence of gastroesophageal reflux disease (GERD) compared with nonHHR (49% versus 40%, respectively; P<.001) with a higher GERD score (1.13 versus .88, respectively; P<.001). Of those with GERD, similar percentage of patients in the HHR and nonHHR groups experienced improvement 1-year after surgery (53% versus 52%, respectively, P = .4), with similar GERD scores at this time point. CONCLUSION HH are repaired in one fifth of LAGB patients, with a surprisingly minimal increase in operative times and no change in length of stay, morbidity, or mortality. In patients with GERD, HH repair had minimal effect on postoperative improvements in reflux symptoms. These findings suggest that many of the repairs may involve small hernias with unclear clinical effect.
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Affiliation(s)
- Ali Ardestani
- Postdoctoral Research Fellow, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ali Tavakkoli
- Assistant Professor of Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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al-Haddad BJS, Dorman RB, Rasmus NF, Kim YY, Ikramuddin S, Leslie DB. Hiatal Hernia Repair in Laparoscopic Adjustable Gastric Banding and Laparoscopic Roux-En-Y Gastric Bypass: A National Database Analysis. Obes Surg 2013; 24:377-84. [DOI: 10.1007/s11695-013-1106-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Obeid NR, Deese-Laurent S, Schwack BF, Youn H, Kurian MS, Ren-Fielding C, Fielding GA. Location and number of sutures placed for hiatal hernia repair during laparoscopic adjustable gastric banding: does it matter? Surg Endosc 2013; 28:58-64. [PMID: 24061619 DOI: 10.1007/s00464-013-3161-7] [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: 04/17/2013] [Accepted: 07/31/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND It has been demonstrated that hiatal hernia repair (HHR) during laparoscopic adjustable gastric banding (LAGB) decreases the rate of reoperation. However, the technical aspects (location and number of sutures) are not standardized. It is unknown whether such technical details are associated with differing rates of reoperation for band-related problems. METHODS A retrospective analysis was performed from a single institution, including 2,301 patients undergoing LAGB with HHR from July 1, 2007 to December 31, 2011. Independent variables were number and location of sutures. Data collected included demographics, operating room (OR) time, length of stay (LOS), follow-up time, postoperative BMI/%EWL, and rates of readmission/reoperation. Statistical analyses included ANOVA and Chi squared tests. Kaplan-Meier, log-rank, and Cox regression tests were used for follow-up data and reoperation rates, in order to account for differential length of follow-up and confounding variables. RESULTS There was no difference in length of follow-up among all groups. The majority of patients had one suture (range 1-6; 55 %). Patients with fewer sutures had shorter OR time (1 suture 45 min vs. 4+ sutures 56 min, p < 0.0001). LOS, 30-day readmission, band-related reoperation, and postop BMI/%EWL were not statistically significant. Anterior suture placement (vs. posterior vs. both) was most common (61 %). OR time was shorter in those with anterior suture (41 min vs. posterior 56 min vs. both 59 min, p < 0.0001). Patients with posterior suture had a longer LOS (84 % 1 day vs. anterior 74 % 1 day vs. both 74 % 1 day, p < 0.0001). There was no difference in 30-day readmission, band-related reoperation, and postoperative BMI/%EWL. CONCLUSIONS Patients with fewer or anterior sutures have shorter OR times. However, 30-day readmission, band-related reoperation, and postoperative weight loss were unaffected by number or location of suture. The technical aspects of HHR did not appear to be associated with readmission or reoperation, and therefore a standardized approach may not be necessary.
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Affiliation(s)
- Nabeel R Obeid
- Department of Surgery, New York University Medical Center, 530 First Ave., Suite 10S, New York, NY, 10016, USA,
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Kohn GP, Price RR, DeMeester SR, Zehetner J, Muensterer OJ, Awad Z, Mittal SK, Richardson WS, Stefanidis D, Fanelli RD. Guidelines for the management of hiatal hernia. Surg Endosc 2013; 27:4409-28. [PMID: 24018762 DOI: 10.1007/s00464-013-3173-3] [Citation(s) in RCA: 267] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 08/02/2013] [Indexed: 02/08/2023]
Affiliation(s)
- Geoffrey Paul Kohn
- Department of Surgery, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia,
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20
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Exploration of esophageal hiatus: does crural repair reduce proximal pouch distension? Surg Obes Relat Dis 2013; 9:350-5. [DOI: 10.1016/j.soard.2011.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 11/25/2011] [Accepted: 12/27/2011] [Indexed: 11/24/2022]
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21
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Elazary R, Phillips EH, Cunneen S, Burch MA. Comments on "increase in gastroesophageal reflux disease symptoms and erosive esophagitis 1 year after laparoscopic sleeve gastrectomy among obese adults" (doi:10.1007/s00464-012-2593-9). Surg Endosc 2013; 27:3935-6. [PMID: 23620383 DOI: 10.1007/s00464-013-2974-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 04/10/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Ram Elazary
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA,
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22
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Che F, Nguyen B, Cohen A, Nguyen NT. Prevalence of hiatal hernia in the morbidly obese. Surg Obes Relat Dis 2013; 9:920-4. [PMID: 23810611 DOI: 10.1016/j.soard.2013.03.013] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 03/03/2013] [Accepted: 03/03/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND Morbidly obese patients commonly have gastroesophageal reflux (GERD) and associated hiatal hernias. As such, some surgeons routinely perform a concomitant hiatal hernia repair during bariatric surgery. However, the intraoperative inspection for a hiatal hernia based on laparoscopic visualization can be misleading. The aim of this study was to assess the prevalence of hiatal hernias in morbidly obese patients based on preoperative upper gastrointestinal (GI) contrast study. METHODS Data on 181 patients who underwent routine upper GI contrast study as part of a preoperative workup for bariatric surgery were reviewed. The upper GI studies were examined for the presence of hiatal hernias and GERD. Hiatal hernias were categorized by size as small (≤2 cm), moderate (2-5 cm), or large (>5 cm). GERD was based on radiologic evidence and categorized as mild, moderate, or severe. RESULTS The mean age of the cohort was 44 years, with a mean body mass index of 43 kg/m(2). Of the 181 patients overall, based on the upper GI contrast study, the prevalence of hiatal hernia was 37.0% and of GERD was 39.8%; the prevalence of moderate or large hiatal hernia was 4.4%, and the prevalence of moderate or severe GERD was 13.3%. CONCLUSIONS Based on upper GI contrast study, we identified the presence of a hiatal hernia in nearly 40% of morbidly obese patients. The results from this study suggest that surgeons should evaluate the morbidly obese patient for the presence of hiatal hernias and perform concomitant repair at the time of the bariatric procedure, particularly in patients undergoing gastric banding and sleeve gastrectomy, while less so in the gastric bypass patient.
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Affiliation(s)
- Fredrick Che
- Department of Surgery, University of California, Irvine Medical Center, Orange, California
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Azagury DE, Varban O, Tavakkolizadeh A, Robinson MK, Vernon AH, Lautz DB. Does laparoscopic gastric banding create hiatal hernias? Surg Obes Relat Dis 2013; 9:48-52. [DOI: 10.1016/j.soard.2011.07.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 06/28/2011] [Accepted: 07/11/2011] [Indexed: 10/17/2022]
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Single-Incision Laparoscopic Adjustable Gastric Banding is Effective and Safe: 756 Cases in an Academic Medical Center. Obes Surg 2012; 23:332-7. [DOI: 10.1007/s11695-012-0811-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Impact on Perioperative Outcomes of Concomitant Hiatal Hernia Repair with Laparoscopic Gastric Bypass. Obes Surg 2012; 22:1607-10. [DOI: 10.1007/s11695-012-0714-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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26
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Heacock L, Parikh M, Jain R, Balthazar E, Hindman N. Improving the Diagnostic Accuracy of Hiatal Hernia in Patients Undergoing Bariatric Surgery. Obes Surg 2012; 22:1730-3. [PMID: 23011460 DOI: 10.1007/s11695-012-0721-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Laura Heacock
- Deparment of Radiology, Bellevue Hospital Center, NYU School of Medicine, New York, NY, USA
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Soricelli E, Iossa A, Casella G, Abbatini F, Calì B, Basso N. Sleeve gastrectomy and crural repair in obese patients with gastroesophageal reflux disease and/or hiatal hernia. Surg Obes Relat Dis 2012; 9:356-61. [PMID: 22867558 DOI: 10.1016/j.soard.2012.06.003] [Citation(s) in RCA: 153] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 05/17/2012] [Accepted: 06/06/2012] [Indexed: 01/07/2023]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) with or without hiatal hernia (HH) is now recognized as an obesity-related co-morbidity. Roux-en-Y gastric bypass has been proved to be the most effective bariatric procedure for the treatment of morbidly obese patients with GERD and/or HH. In contrast, the indication for laparoscopic sleeve gastrectomy (SG) in these patients is still debated. Our objective was to report our experience with 97 patients who underwent SG and HH repair (HHR). The setting was a university hospital in Italy. METHODS From July 2009 to December 2011, 378 patients underwent a preoperative workup for SG. In 97 patients, SG was performed with HHR. The clinical outcome was evaluated considering GERD symptom resolution or improvement, interruption of antireflux medications, and radiographic evidence of HH recurrence. RESULTS Before surgery, symptomatic GERD was present in 60 patients (15.8%), and HH was diagnosed in 42 patients (11.1%). In 55 patients (14.5%), HH was diagnosed intraoperatively. The mean follow-up was 18 months. GERD remission occurred in 44 patients (73.3%). In the remaining 16 patients, antireflux medications were diminished, with complete control of symptoms in 5 patients. No HH recurrences developed. "De novo" GERD symptoms developed in 22.9% of the patients undergoing SG alone compared with 0% of patients undergoing SG plus HHR. CONCLUSION SG with HHR is feasible and safe, providing good management of GERD in obese patients with reflux symptoms. Small hiatal defects could be underdiagnosed at preoperative endoscopy and/or upper gastrointestinal contrast study. Thus, a careful examination of the crura is always recommended intraoperatively.
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Affiliation(s)
- Emanuele Soricelli
- Surgical-Medical Department for Digestive Diseases, Policlinico Umberto I, University of Rome Sapienza, Rome, Italy
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Rodriguez JH, Kroh M, El-Hayek K, Timratana P, Chand B. Combined paraesophageal hernia repair and partial longitudinal gastrectomy in obese patients with symptomatic paraesophageal hernias. Surg Endosc 2012; 26:3382-90. [DOI: 10.1007/s00464-012-2347-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 04/12/2012] [Indexed: 12/11/2022]
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Insights into proximal pouch dilatation following adjustable gastric banding--a form of inattentional blindness? Obes Surg 2012; 22:999-1000. [PMID: 22584827 DOI: 10.1007/s11695-012-0678-0] [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]
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Woodman G, Cywes R, Billy H, Montgomery K, Cornell C, Okerson T. Effect of adjustable gastric banding on changes in gastroesophageal reflux disease (GERD) and quality of life. Curr Med Res Opin 2012; 28:581-9. [PMID: 22356120 DOI: 10.1185/03007995.2012.666962] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Bariatric surgery is an effective treatment for the reduction of weight in obese patients (BMI ≥ 40 kg/m(2) or 30 kg/m(2) with ≥1 comorbidities), who are refractory to behavioral and medical therapies. This study examined the effect of the adjustable gastric band (AGB) system on changes in gastroesophageal reflux disease (GERD) and patient-reported outcomes, including measures of quality of life. METHODS Two-year interim analysis of patients (N = 171) in the 5 year, prospective APEX study who reported GERD prior to the AGB procedure. An unrecorded number of hiatal hernia repairs were conducted during the APEX study. RESULTS At baseline, 171 of 395 patients (43%) reported GERD requiring daily medical therapy. After 2 years, 122 patients had sufficient data to assess outcome (71%). Complete resolution of GERD was reported in 98 patients (80%), improvement in 13 (11%), no change in 9 (7%), and worsening in 2 (2%). Overall, 91% of GERD patients experienced resolution and/or improvement of GERD. Baseline BMI was not significantly different among the GERD response categories (resolved, improved, and stable/worse), p = 0.4581. Mean ΔBMI and percentage excess weight loss (%EWL) were: -8.8 kg/m(2)/-0.9%, -11.4 kg/m(2)/-53.9%, -6.4 kg/m(2)/-36.1%, and -7.1 kg/m(2)/-31.2%, respectively. There were no significant differences in reductions in BMI or %EWL between responder groups (resolved versus stable/worse ΔBMI p = 0.1031, %EWL p = 0.0667 OR resolved/improved versus stable/worse ΔBMI p = 0.0918, %EWL p = 0.0552). After 2 years, resolution or improvement occurred in pre-existing comorbidities: type 2 diabetes (96%), hypertension (91%), hyperlipidemia (77%), obstructive sleep apnea (86%), osteoarthritis (93%), and depression (75%). Patient satisfaction with AGB was assessed as: very satisfied/satisfied (87%), very satisfied (50%), dissatisfied (5.0%). Quality of life measured by the Obesity and Weight-Loss Quality of Life Instrument (GERD patients) significantly improved from baseline. CONCLUSION Obese patients with GERD had meaningful improvement in patient-reported outcomes with the AGB system. In addition, other obesity-related comorbidities and measures of quality of life improved.
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Gawart M, Dupitron S, Lutfi R. Laparoendoscopic single-site gastric bands versus standard multiport gastric bands: a comparison of technical learning curve measured by surgical time. Am J Surg 2011; 203:327-9; discussion 330. [PMID: 22206856 DOI: 10.1016/j.amjsurg.2011.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Revised: 10/16/2011] [Accepted: 10/16/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND We aimed to evaluate our learning curve comparing surgical time of laparoendoscopic single-site (LESS) banding with multiport laparoscopy. METHODS We performed a retrospective analysis of prospectively collected data comparing our first 48 LESS bands with our first 50 multiport laparoscopic bands at our institution. We then compared the first 24 LESS bands with the last 24 bands. RESULTS The average body mass index for the LESS group was significantly lower than for the laparoscopic group (43.19 vs 48.3; P < .0001). The surgical time was much faster toward the second half of our experience performing the LESS procedure (85.34 vs 68.8; P = .0055). LESS banding took significantly longer than our early traditional laparoscopic adjustable gastric banding (76.85 vs 64.4; P = .0015). CONCLUSIONS We conclude that in experienced hands, single-incision banding is feasible and safe to perform. Long-term data are needed to prove that LESS banding is as good a surgery as traditional laparoscopic surgery.
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Affiliation(s)
- Matthew Gawart
- University of Illinois, Chicago Metropolitan Group Hospitals, Chicago, IL 60614, USA.
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Chew CR, Jamieson GG, Devitt PG, Watson DI. Prospective randomized trial of laparoscopic Nissen fundoplication with anterior versus posterior hiatal repair: late outcomes. World J Surg 2011; 35:2038-44. [PMID: 21713577 DOI: 10.1007/s00268-011-1172-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The technique used for hiatal closure in laparoscopic Nissen fundoplication might have an impact on the risk of postfundoplication dysphagia and hiatal herniation. In 1997, we commenced a randomized trial to evaluate the impact of anterior versus posterior hiatal repair techniques on these outcomes. In the present study, we evaluated the 10-year outcomes from this trial. METHODS A total of 102 patients were randomized to undergo laparoscopic Nissen fundoplication with either anterior (47 patients) or posterior (55 patients) repair of the diaphragmatic hiatus. Outcomes were assessed using standardized clinical assessment scores that evaluated reflux symptoms, dysphagia, and satisfaction with the outcome following surgery. RESULTS Clinical outcomes 10 years after surgery were available for 93% of patients, and outcome scores were obtained for 43 patients in each group. Patients undergoing anterior hiatal repair were less likely to report dysphagia for lumpy solid foods (14.0% vs. 39.5%, p = 0.01), although there were no significant differences in dysphagia outcomes for six other dysphagia assessment scores. There were no differences between the two groups for reflux symptoms, medication use, and overall satisfaction with the outcome of surgery. CONCLUSIONS At the 10-year follow-up, the outcomes for the two groups were similar. Anterior hiatal repair is an acceptable technique for hiatal closure during laparoscopic Nissen fundoplication.
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Affiliation(s)
- Carolyn R Chew
- Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, SA, 5042, Australia
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Abstract
The number of bariatric operations performed annually in the U.S. for the treatment of severe obesity [body mass index (BMI)≥40 kg/m2] has increased tenfold since the mid 1990s, with approximately 220,000 operations performed in 2009. This article reviews the evolution of laparoscopic bariatric surgery over the last 20 years. The results of the most common procedures are analyzed and current and future trends described.
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Affiliation(s)
- Vivek N Prachand
- Center for the Surgical Treatment of Obesity, Section of General Surgery, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA.
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Parikh M, Dasari M, McMacken M, Ren C, Fielding G, Ogedegbe G. Does a preoperative medically supervised weight loss program improve bariatric surgery outcomes? A pilot randomized study. Surg Endosc 2011; 26:853-61. [PMID: 22011946 DOI: 10.1007/s00464-011-1966-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 09/11/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many insurance payors mandate that bariatric surgery candidates undergo a medically supervised weight management (MSWM) program as a prerequisite for surgery. However, there is little evidence to support this requirement. We evaluated in a randomized controlled trial the hypothesis that participation in a MSWM program does not predict outcomes after laparoscopic adjustable gastric banding (LAGB) in a publicly insured population. METHODS This pilot randomized trial was conducted in a large academic urban public hospital. Patients who met NIH consensus criteria for bariatric surgery and whose insurance did not require a mandatory 6-month MSWM program were randomized to a MSWM program with monthly visits over 6 months (individual or group) or usual care for 6 months and then followed for bariatric surgery outcomes postoperatively. Demographics, weight, and patient behavior scores, including patient adherence, eating behavior, patient activation, and physical activity, were collected at baseline and at 6 months (immediately preoperatively and postoperatively). RESULTS A total of 55 patients were enrolled in the study with complete follow-up on 23 patients. Participants randomized to a MSWM program attended an average of 2 sessions preoperatively. The majority of participants were female and non-Caucasian, mean age was 46 years, average income was less than $20,000/year, and most had Medicaid as their primary insurer, consistent with the demographics of the hospital's bariatric surgery program. Data analysis included both intention-to-treat and completers' analyses. No significant differences in weight loss and most patient behaviors were found between the two groups postoperatively, suggesting that participation in a MSWM program did not improve weight loss outcomes for LAGB. Participation in a MSWM program did appear to have a positive effect on physical activity postoperatively. CONCLUSION MSWM does not appear to confer additional benefit as compared to the standard preoperative bariatric surgery protocol in terms of weight loss and most behavioral outcomes after LAGB in our patient population.
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Affiliation(s)
- Manish Parikh
- Bellevue Center for Obesity and Weight Management, Bellevue Hospital Center, Department of Surgery, New York University School of Medicine, New Bellevue 15 South 7, 550 First Avenue, New York, NY 10016, USA.
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Kasotakis G, Mittal SK, Sudan R. Combined treatment of symptomatic massive paraesophageal hernia in the morbidly obese. JSLS 2011; 15:188-92. [PMID: 21902973 PMCID: PMC3148869 DOI: 10.4293/108680811x13022985132164] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
While repair of giant paraesophageal hernia is associated with a high failure rate in the morbidly obese, laparoscopic Roux-en-Y gastric bypass and repair of giant paraesophageal hernia in the morbidly obese may be safe and effective. Introduction: Repair of large paraesophageal hernias by itself is associated with high failure rates in the morbidly obese. A surgical approach addressing both giant paraesophageal hernia and morbid obesity has, to our knowledge, not been explored in the surgical literature. Methods: A retrospective review of a bariatric surgery database identified patients who underwent simultaneous repair of large type 3 paraesophageal hernias with primary crus closure and Roux-en-Y gastric bypass (RYGB). Operative time, intraoperative and 30-day morbidity, weight loss, resolution of comorbid conditions and use of anti-reflux medication were outcome measures. Integrity of crural closure was studied with a barium swallow. Results: Three patients with a mean body mass index of 46kg/m2 and mean age of 46 years underwent repair of a large paraesophageal hernia, primary crus closure, and RYGB. Mean operative time was 241 minutes and length of stay was 4 days. There was no intraoperative or 30-day morbidity. One patient required endoscopic balloon dilatation of the gastrojejunostomy. At 12 months, all patients were asymptomatic with excellent weight loss and resolution of comorbidities. Contrast studies showed no recurrence of the hiatal hernia. Conclusion: Simultaneous laparoscopic repair of large paraesophageal hernias in the morbidly obese is safe and effective.
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Does adding a lesser-curvature gastrogastric plication suture reduce the need for revision after laparoscopic adjustable gastric band placement? Surg Endosc 2011; 26:514-7. [DOI: 10.1007/s00464-011-1910-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 08/03/2011] [Indexed: 11/26/2022]
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Reynoso JF, Goede MR, Tiwari MM, Tsang AW, Oleynikov D, McBride CL. Primary and revisional laparoscopic adjustable gastric band placement in patients with hiatal hernia. Surg Obes Relat Dis 2011; 7:290-4. [PMID: 21130046 DOI: 10.1016/j.soard.2010.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 08/12/2010] [Accepted: 08/13/2010] [Indexed: 01/29/2023]
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Tariq N, Chand B. Presurgical evaluation and postoperative care for the bariatric patient. Gastrointest Endosc Clin N Am 2011; 21:229-40. [PMID: 21569975 DOI: 10.1016/j.giec.2011.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
With the increasing number of bariatric surgeries being performed, multiple specialties encounter bariatric patients. This article gives an overview of the comprehensive evaluation and preoperative preparation of a bariatric patient. Medical, psychological, and behavioral evaluation is discussed. The role of routine preoperative endoscopy is controversial but can be very important and may alter the operation performed. Immediate postoperative care is also addressed. Undergoing bariatric surgery is a lifelong commitment, and frequent follow up with reinforcement and monitoring for nutritional deficiencies is extremely important.
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Affiliation(s)
- Nabil Tariq
- Flexible Endoscopy and Advanced Laparoscopy, Cleveland Clinic, Cleveland, OH, USA
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Egan RJ, Monkhouse SJW, Meredith HE, Bates SE, Morgan JDT, Norton SA. The Reporting of Gastric Band Slip and Related Complications; A Review of the Literature. Obes Surg 2010; 21:1280-8. [DOI: 10.1007/s11695-010-0344-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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40
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Prachand VN, Alverdy JC. Gastroesophageal reflux disease and severe obesity: Fundoplication or bariatric surgery? World J Gastroenterol 2010; 16:3757-61. [PMID: 20698037 PMCID: PMC2921086 DOI: 10.3748/wjg.v16.i30.3757] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Increases in the prevalence of obesity and gastroesophageal reflux disease (GERD) have paralleled one another over the past decade, which suggests the possibility of a linkage between these two processes. In both instances, surgical therapy is recognized as the most effective treatment for severe, refractory disease. Current surgical therapies for severe obesity include (in descending frequency) Roux-en-Y gastric bypass, adjustable gastric banding, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch, while fundoplication remains the mainstay for the treatment of severe GERD. In several large series, however, the outcomes and durability of fundoplication in the setting of severe obesity are not as good as those in patients who are not severely obese. As such, bariatric surgery has been suggested as a potential alternative treatment for these patients. This article reviews current concepts in the putative pathophysiological mechanisms by which obesity contributes to gastroesophageal reflux and their implications with regards to surgical therapy for GERD in the setting of severe obesity.
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Safety of the laparoscopic adjustable gastric band: 7-year data from a U.S. center of excellence. Surg Endosc 2010; 24:1819-23. [DOI: 10.1007/s00464-009-0858-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Accepted: 11/10/2009] [Indexed: 10/19/2022]
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Soricelli E, Casella G, Rizzello M, Calì B, Alessandri G, Basso N. Initial experience with laparoscopic crural closure in the management of hiatal hernia in obese patients undergoing sleeve gastrectomy. Obes Surg 2010; 20:1149-53. [PMID: 20049652 DOI: 10.1007/s11695-009-0056-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2009] [Accepted: 12/01/2009] [Indexed: 01/07/2023]
Abstract
BACKGROUND The prevalence of gastroesophageal reflux disease (GERD) and/or hiatal hernia (HH) is significantly increased in morbidly obese patients. Laparoscopic bariatric procedures such as gastric banding (LGB) and Roux-en-Y gastric bypass have been shown to improve both obesity and reflux symptoms. The aim of this paper is to evaluate the effectiveness of laparoscopic sleeve gastrectomy (LSG) and hiatal hernia repair (HHR) for the treatment of obesity complicated by HH. METHODS From October 2008, six patients underwent HHR in addition to LSG. Clinical outcomes have been evaluated in terms of GERD symptoms improvement or resolution, interruption of antireflux medication, and X-ray evidence of HH recurrence. RESULTS Symptomatic HH was diagnosed preoperatively in four patients. In two additional patients, HH was asymptomatic and it was diagnosed intraoperatively. Prosthetic reinforcement of crural closure was performed in two symptomatic cases with a HH >5 cm. Mortality was nil and no complications occurred. After a mean follow-up of 4 months, GERD symptoms resolution occurred in three patients, while the other patient reported an improvement of reflux. Body mass index had fallen from 43.4 to 36.2 kg/m(2). A small recurrence in the patient with persistence of reflux symptoms has been radiologically reported. CONCLUSIONS Laparoscopic crural closure in addition to LSG could represent a valuable option for the synchronous management of morbid obesity and HH, providing good outcomes in terms of weight loss and GERD symptoms control.
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Affiliation(s)
- Emanuele Soricelli
- Surgical-Medical Department for Digestive Diseases, Policlinico Umberto I, University Sapienza, Viale del Policlinico, 00161, Rome, Italy
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Korwar V, Peters M, Adjepong S, Sigurdsson A. Laparoscopic Hiatus Hernia Repair and Simultaneous Sleeve Gastrectomy: A Novel Approach in the Treatment of Gastroesophageal Reflux Disease Associated with Morbid Obesity. J Laparoendosc Adv Surg Tech A 2009; 19:761-3. [DOI: 10.1089/lap.2009.0249] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Vijay Korwar
- Department of Upper Gastrointestinal and Laparoscopic Surgery, Princess Royal Hospital, Telford, United Kingdom
| | - Michael Peters
- Department of Upper Gastrointestinal and Laparoscopic Surgery, Princess Royal Hospital, Telford, United Kingdom
| | - Sam Adjepong
- Department of Upper Gastrointestinal and Laparoscopic Surgery, Princess Royal Hospital, Telford, United Kingdom
| | - Audun Sigurdsson
- Department of Upper Gastrointestinal and Laparoscopic Surgery, Princess Royal Hospital, Telford, United Kingdom
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De Groot NL, Burgerhart JS, Van De Meeberg PC, de Vries DR, Smout AJPM, Siersema PD. Systematic review: the effects of conservative and surgical treatment for obesity on gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2009; 30:1091-102. [PMID: 19758397 DOI: 10.1111/j.1365-2036.2009.04146.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Incidence rates of both obesity and gastro-oesophageal reflux disease (GERD) are increasing, particularly in the Western world. It has been suggested that GERD symptoms may be improved by weight reduction. AIM To review the literature on the effect of various weight reducing modalities on manifestations of GERD in obese patients. METHODS A literature search was performed using PubMed, EMBASE and the Cochrane Library, combining the words obesity and gastro-oesophageal reflux with bariatric surgery, diet, lifestyle intervention and weight loss. RESULTS With regard to diet/lifestyle intervention (conservative), four of seven studies reported an improvement of GERD. For Roux-en-Y gastric bypass, a positive effect on GERD was found in all studies, although this was mainly evaluated by questionnaires. In contrast, for vertical banded gastroplasty, no change or even an increase of GERD was noted, whereas the results for laparoscopic adjustable gastric banding were conflicting. CONCLUSIONS Dietary and lifestyle intervention may improve GERD in obese patients; however, the most favourable effect is likely to be found after bariatric surgery, especially after Roux-en-Y gastric bypass. Future studies need to elucidate for which GERD patients laparoscopic adjustable gastric banding might have a beneficial effect and how they can be identified preoperatively.
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Affiliation(s)
- N L De Groot
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
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Endoscopy after bariatric surgery (with videos). Gastrointest Endosc 2009; 70:1161-6. [PMID: 19647249 DOI: 10.1016/j.gie.2009.03.1168] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 03/22/2009] [Indexed: 02/08/2023]
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Upper gastrointestinal investigations before gastric banding. Surg Endosc 2009; 24:1025-30. [DOI: 10.1007/s00464-009-0720-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 08/10/2009] [Indexed: 11/26/2022]
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Pathophysiology of Laparoscopic Adjustable Gastric Bands: Analysis and Classification Using High-Resolution Video Manometry and a Stress Barium Protocol. Obes Surg 2009; 20:19-29. [DOI: 10.1007/s11695-009-9970-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2009] [Accepted: 08/28/2009] [Indexed: 10/20/2022]
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Early U.S. outcomes after laparoscopic adjustable gastric banding in patients with a body mass index less than 35 kg/m2. Surg Endosc 2009; 23:1569-73. [PMID: 19263156 DOI: 10.1007/s00464-009-0341-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Revised: 06/20/2008] [Accepted: 01/08/2009] [Indexed: 01/14/2023]
Abstract
BACKGROUND Many mildly to moderately obese individuals with a body mass index (BMI) lower than 35 kg/m(2) have serious diseases related to their obesity. Nonsurgical therapy is ineffective in the long term, yet surgery has never been made widely available to this population. METHODS Between 2002 and 2007, 53 patients with a BMI lower than 35 kg/m(2) underwent laparoscopic adjustable gastric banding at our institution. Data on all these patients were collected prospectively and entered into an institutional review board-approved electronic registry. The study parameters included preoperative age, gender, BMI, presence of comorbidities, percentage of excess weight loss (%EWL), and resolution of comorbidities. RESULTS The mean preoperative age of the patients was 46.9 years (range, 16-68 years), and the mean preoperative BMI was 33.1 kg/m(2) (range, 28.2-35.0 kg/m(2)). Of the 53 patients, 49 (92%) had at least one obesity-related comorbidity. The mean BMI decreased to 28.1 +/- 2.4 kg/m(2), 25.8 +/- 2.9 kg/m(2), and 25.8 +/- 3.1 kg/m(2) and mean %EWL was 48.3 +/- 17.6, 69.9 +/- 28.0, and 69.7 +/- 31.7 at 0.5, 1, and 2 years, respectively. Substantial improvement occurred for the following comorbidities evaluated: hypertension, depression, diabetes, asthma, hypertriglyceridemia, obstructive sleep apnea, hypercholesterolemia, and osteoarthritis. There was one slip, two cases of band obstruction (from food), two cases of esophagitis, and two port leaks, but no mortality. CONCLUSION The authors are very encouraged by this series of low-BMI patients who underwent laparoscopic adjustable gastric banding. Their weight loss has been excellent, and their complications have been acceptable. Their comorbidities have partially or wholly resolved. With further study, it is reasonable to expect alteration of the weight guidelines for bariatric surgery to include patients with a BMI lower than 35 kg/m(2).
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