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Lin H, Baker JW, Meister K, Lak KL, Martin Del Campo SE, Smith A, Needleman B, Nadzam G, Ying LD, Varban O, Reyes AM, Breckenbridge J, Tabone L, Gentles C, Echeverri C, Jones SB, Gould J, Vosburg W, Jones DB, Edwards M, Nimeri A, Kindel T, Petrick A. American society for metabolic and bariatric surgery: intra-operative care pathway for minimally invasive Roux-en-Y gastric bypass. Surg Obes Relat Dis 2024; 20:895-909. [PMID: 39097472 DOI: 10.1016/j.soard.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Clinical care pathways help guide and provide structure to clinicians and providers to improve healthcare delivery and quality. The Quality Improvement and Patient Safety Committee (QIPS) of the American Society for Metabolic and Bariatric Surgery (ASMBS) has previously published care pathways for the performance of laparoscopic sleeve gastrectomy (LSG) and pre-operative care of patients undergoing Roux-en-Y gastric bypass (RYGB). OBJECTIVE This current RYGB care pathway was created to address intraoperative care, defined as care occurring on the day of surgery from the preoperative holding area, through the operating room, and into the postanesthesia care unit (PACU). METHODS PubMed queries were performed from January 2001 to December 2019 and reviewed according to Level of Evidence regarding specific key questions developed by the committee. RESULTS Evidence-based recommendations are made for care of patients undergoing RYGB including the pre-operative holding area, intra-operative management and performance of RYGB, and concurrent procedures. CONCLUSIONS This document may provide guidance based on recent evidence to bariatric surgeons and providers for the intra-operative care for minimally invasive RYGB.
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Affiliation(s)
- Henry Lin
- Department of Surgery, Signature Healthcare, Brockton, Massachusetts.
| | - John W Baker
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Kathleen L Lak
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - April Smith
- Department of Pharmacy, Creighton University School of Pharmacy and Health Professions, Omaha, Nebraska
| | | | - Geoffrey Nadzam
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Lee D Ying
- Department of Surgery, Yale New Haven Hospital, New Haven, Connecticut
| | - Oliver Varban
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Angel Manuel Reyes
- Department of General Surgery, St. Michael Medical Center, Silverdale, Washington
| | - Jamie Breckenbridge
- Department of General Surgery, Fort Belvoir Community Hospital, Fort Belvoir, Virginia
| | - Lawrence Tabone
- Department of Surgery, West Virginia University, Morgantown, West Virginia
| | - Charmaine Gentles
- Department of Surgery, Northshore University Hospital, Manhasset, New York
| | | | - Stephanie B Jones
- Department of Anesthesiology, Northwell Health, New Hyde Park, New York
| | - Jon Gould
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Wesley Vosburg
- Department of Surgery, Grand Strand Medical Center, Myrtle Beach, South Carolina
| | - Daniel B Jones
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Abdelrahman Nimeri
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tammy Kindel
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anthony Petrick
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
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Bruinsma FFE, van der Burg SJC, El Adel S, Schouten R, Smeets SJM. Quality of stapled mesenteric defect closure influences the chance of reopening after laparoscopic Roux-en-Y gastric bypass surgery. Updates Surg 2024; 76:1405-1412. [PMID: 38332391 PMCID: PMC11341638 DOI: 10.1007/s13304-024-01751-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 12/31/2023] [Indexed: 02/10/2024]
Abstract
Internal herniation (IH) is a common problem after laparoscopic Roux-en-Y gastric bypass surgery (RYGB). Routine closure of the mesenteric defects (MDs) reduces the risk of IH. Only very few articles report on risk factors for IH or describe detailed closing techniques. There is no consensus yet on the best closing method. The objective of this study is to determine the optimal stapling method for closure of MDs after RYGB. All performed RYGB procedures in our high-volume bariatric institute were included. Quality of the closure was scored in the categories poor, sub-optimal, and optimal, to see if the quality of the closure would predict the chance of reopening of the MDs and, therefore, the chance of IH. During any type of laparoscopy in the follow-up of the patient, the conditions of the MDs were stated, for example during diagnostic laparoscopy in symptomatic patients suspicious for IH or during laparoscopic cholecystectomy. Technically well-executed closure of Petersen's space (PS) with two rows of staples had a greater chance of still being closed upon re-inspection compared to closure with one row (odds ratio = 8.1; 95% confidence interval [1.2-53.2], p = 0.029). Optimal closure of the MD at the jejuno-jejunostomy (JJ-space, JJS) resulted in more closed JJSs upon re-inspection compared to sub-optimal closure (odds ratio = 3.6 [CI 95% 0.8-16.1], p = 0.099). Non-optimally closed MDs had higher reopening rates and, therefore, pose an additional risk for IH. Our classification provides a quality assessment of MD closure during RYGB and gives insight into how to optimize surgical technique.
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Affiliation(s)
- F F E Bruinsma
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands.
| | - S J C van der Burg
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - S El Adel
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - R Schouten
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - S J M Smeets
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
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Muir D, Choi B, Clements C, Ratnasingham K, Irukulla S, Humadi S. Mesenteric Defect Closure and the Rate of Internal Hernia in Laparoscopic Roux-en-Y Gastric Bypass: A Systematic Review and Meta-analysis. Obes Surg 2023; 33:2229-2236. [PMID: 37162714 DOI: 10.1007/s11695-023-06597-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 05/11/2023]
Abstract
Internal hernias are a worrying complication from laparoscopic Roux-en-Y gastric bypass (LRGB), with potential small bowel necrosis and obstruction. An electronic database search of Medline, Embase, and Pubmed was performed. All studies investigating the internal hernia rates in patients whose mesenteric defects were closed vs. not closed during LRGB were analysed. Odds ratios were calculated to assess the difference in internal hernia rate. A total of 14 studies totalling 20,553 patients undergoing LRGB were included. Internal hernia rate (220/12,445 (2%) closure vs. 509/8108 (6%) non-closure) and re-operation for small bowel obstruction (86/5437 (2%) closed vs. 300/3132 (10%) non-closure) were reduced when defects were closed. There was no difference observed when sutures were used to close the defects compared to clips/staples.
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Affiliation(s)
- Duncan Muir
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK.
| | - Byung Choi
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | | | | | - Shashi Irukulla
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - Samer Humadi
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
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Wu QL, Liu QZ, Xi YY, Deng XQ, Xu TS, Xie ZC, Chen JA, Yuan Y. Closed or Unclosed Mesentery? A Meta-analysis of Internal Herniation After Laparoscopic Roux-en-Y Gastric Bypass. Obes Surg 2023:10.1007/s11695-023-06594-3. [PMID: 37081253 DOI: 10.1007/s11695-023-06594-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
During the laparoscopic Roux-en-Y gastric bypass procedure, closing mesentery or not was still controversial according to preexisted studies. So, the current meta-analysis aimed to compare the outcome of closure versus non-closure of mesenteric defects in laparoscopic Roux-en-Y gastric bypass. Fifteen studies were included, enrolling 53,488 patients. Based on the outcome of analysis, regarding internal hernia, Petersen space's IH, jejunal mesenteric's IH, hospital days, and reoperation, closure of the mesentery was better than non-closure. Besides, small bowel obstruction, anastomosis ulcer, stenosis, leakage, bleeding, gastrointestinal perforation, and postoperative BMI of patients show no difference between non-closure and closure.
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Affiliation(s)
- Qian-Long Wu
- Guangzhou Medical University, Guangzhou, 510180, China.
| | - Quan-Zhen Liu
- Guangzhou Medical University, Guangzhou, 510180, China
| | - Ying-Yun Xi
- Guangzhou Medical University, Guangzhou, 510180, China
| | | | - Tong-Shan Xu
- Guangzhou Medical University, Guangzhou, 510180, China
| | - Zi-Chun Xie
- Guangzhou Medical University, Guangzhou, 510180, China
| | - Jin-An Chen
- Guangzhou Medical University, Guangzhou, 510180, China
| | - Yi Yuan
- Guangzhou Medical University, Guangzhou, 510180, China
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Verrelst L, Blockhuys M, Hendrickx L, Gypen B, Valk J, Heyman S, Vervloessem D, van Sprundel F. Effect of Suture Used for Closure of Mesenteric Defects After Laparoscopic Roux-en-Y Gastric Bypass: Single-Center Study. Obes Surg 2023; 33:506-512. [PMID: 36564621 DOI: 10.1007/s11695-022-06411-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Small bowel obstruction (SBO) due to internal herniation (IH) is a well-known complication of laparoscopic Roux-en-Y gastric bypass (LRYGBP). The objective of this study is to evaluate different types of non-absorbable sutures used for closure of the defects regarding the incidence of SBO due to IH/adhesions, adhesion formation in general, or reopening of the defects. METHODS A single-center retrospective study was performed. Patients who underwent LRYGBP were divided in 3 groups: group A closure of the defects with monofilament Polypropylene suture (Prolene®), group B with braided polyester suture (Ethibond®), group C with barbed knotless Polybutester suture (V-Loc®). Descriptive statistics were performed regarding SBO due to IH/adhesions, adhesion formation, and reopening of closed defects. RESULTS From 5145 patients, 224 patients underwent exploratory laparoscopy for suspicion of SBO. Mean time interval was 28.4 months. IH or intermittent IH was found in 1.94% in group A, 1.78% in group B, and 1.40% in group C. Obstruction due to adhesions was found in 0.70%, 0.36%, and 0.42% per group, respectively. Adhesions in general were observed in 1.47% in group A, 1.43% in group B, and 1.06% in group C. The incidence of reopening was higher in group A (2.24%) in comparison with group B (1.13%, P = 0.041) and group C (1.05%, P = 0.001). CONCLUSIONS After descriptive analysis, these results can withhold no difference among the 3 non-absorbable sutures regarding incidence of SBO due to IH or SBO due to adhesions, yet tendency for higher reopening rates after closure with monofilament Polypropylene suture is observed.
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Affiliation(s)
- Lynn Verrelst
- Department of Abdominal Surgery, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium.
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Magali Blockhuys
- Department of Abdominal Surgery, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium
| | - Leo Hendrickx
- Department of Abdominal Surgery, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium
| | - Bart Gypen
- Department of Abdominal Surgery, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium
| | - Jody Valk
- Department of Abdominal Surgery, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium
| | - Stijn Heyman
- Department of Abdominal Surgery, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium
| | - Dirk Vervloessem
- Department of Abdominal Surgery, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium
| | - Frank van Sprundel
- Department of Abdominal Surgery, ZNA Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium
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Apostolou KG, Lazaridis II, Kanavidis P, Triantafyllou M, Gkiala A, Alexandrou A, Ntourakis D, Delko T, Schizas D. Incidence and risk factors of symptomatic Petersen's hernias in bariatric and upper gastrointestinal surgery: a systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:49. [PMID: 36662172 DOI: 10.1007/s00423-023-02798-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/29/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE The aim of this study was to investigate the actual incidence of symptomatic Petersen's hernias (PH) as well as identify risk factors for their occurrence. METHODS Search was performed in Medline (via PubMed), Web of Science, and Cochrane library, using the keywords "Petersen Or Petersen's AND hernia" and "Internal hernia." Only studies of symptomatic PH were eligible. Fifty-three studies matched our criteria and were included. Risk of bias for each study was independently assessed using the checklist modification by Hoy et al. Analysis was performed using random-effects models, with subsequent subgroup analyses. RESULTS A total of 81,701 patients were included. Mean time interval from index operation to PH diagnosis was 17.8 months. Total small bowel obstruction (SBO) events at Petersen's site were 737 (0.7%). SBO incidence was significantly higher in patients without defect closure (1.2% vs 0.3%, p < 0.01), but was not significantly affected by anastomosis fashion (retrocolic 0.7% vs antecolic 0.8%, p = 0.99). SBO incidence was also not significantly affected by the surgical approach (laparoscopic = 0.7% vs open = 0.1%, p = 0.18). However, retrocolic anastomosis was found to be associated with marginally, but not significantly, increased SBO rate in patients with Petersen's space closure, compared with the antecolic anastomosis (p = 0.09). CONCLUSION PH development may occur after any gastric operation with gastrojejunal anastomosis. Contrary to anastomosis fashion and surgical approach, defect closure was demonstrated to significantly reduce SBO incidence. Limitations of this study may include the high heterogeneity and the possible publication bias across the included studies.
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Affiliation(s)
- Konstantinos G Apostolou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece.
| | - Ioannis I Lazaridis
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Prodromos Kanavidis
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece
| | - Margarita Triantafyllou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece
| | - Anastasia Gkiala
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece
| | - Andreas Alexandrou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece
| | | | - Tarik Delko
- Chirurgie Zentrum St. Anna, St. Anna-Strasse 32, 6006, Lucerne, Switzerland
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece
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Liu S, Hu Q, Song P, Tao L, Ai S, Miao J, Wang F, Kang X, Shen X, Sun F, Xia X, Wang M, Lu X, Guan W. Risk Factor and Surgical Outcome of Petersen's Hernia After Gastrectomy in Gastric Cancer. Front Oncol 2021; 11:765509. [PMID: 34820331 PMCID: PMC8606515 DOI: 10.3389/fonc.2021.765509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022] Open
Abstract
Background Petersen’s hernia is a life-threatening complication after gastrectomy. This study is dedicated to identify risk factors for Petersen’s hernia and compare clinical outcomes between patients receiving early or delayed surgical interventions. Methods Data from all patients who received gastrectomy due to gastric cancer were collected. Clinical characteristics were compared between Petersen and non-Petersen groups, bowel necrosis and non-necrotic groups. Propensity score matching (PSM) was conducted to generate two comparative groups. Univariate analysis and multivariate logistic regression were performed for risk factor evaluation. Results A total of 24 cases of Petersen’s hernia were identified from 1,481 cases of gastrectomy. PSM demonstrated that lower body mass index [BMI; odds ratio (OR) = 0.2, p < 0.01] and distal gastrectomy (OR = 6.2, p = 0.011) were risk factors for Petersen’s hernia. Longer time interval from emergence visit to laparotomy (p = 0.042) and elevated preoperative procalcitonin (p = 0.033) and C-reactive protein (CRP; p = 0.012) were associated with higher risk of bowel necrosis in Petersen’s hernia. Early surgical intervention resulted in less bowel necrosis rate (p = 0.012) and shorter length of necrotic bowel (p = 0.0041). Conclusions Low BMI and distal gastrectomy are independent risk factor for Petersen’s hernia after gastrectomy. Curtailing observing time and executing prompt surgery are associated with bowel viability and better outcome in patients with Petersen’s hernia.
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Affiliation(s)
- Song Liu
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Qiongyuan Hu
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Peng Song
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Liang Tao
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Shichao Ai
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ji Miao
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Feng Wang
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Xing Kang
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Xiaofei Shen
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Feng Sun
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xuefeng Xia
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Meng Wang
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiaofeng Lu
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Wenxian Guan
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.,Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, China
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Care of Pregnant Women With a History of Bariatric Surgery. Nurs Womens Health 2021; 25:384-394. [PMID: 34534496 DOI: 10.1016/j.nwh.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/30/2021] [Accepted: 08/01/2021] [Indexed: 11/21/2022]
Abstract
In recent years, the incidence of bariatric surgery has increased among women of reproductive age. Health care providers should be knowledgeable about the impact bariatric surgery has on women and developing fetuses to effectively provide care from preconception through postpartum. Although pregnancy in women with normal weight or with excess weight after bariatric surgery has better outcomes when compared to pregnancy complicated by obesity, it is associated with complications such as nutritional deficiencies, low birth weight, and fetal growth restriction. Consequently, a multidisciplinary approach is recommended to ensure adequate nutrition, counseling, and screening before and during pregnancy. This article summarizes evidence regarding pregnancy complications that may occur in women with a history of bariatric surgery and presents a nursing, advanced practice nursing, and midwifery plan of care for these women before, during, and after pregnancy.
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Magouliotis DE, Tzovaras G, Tasiopoulou VS, Christodoulidis G, Zacharoulis D. Closure of Mesenteric Defects in Laparoscopic Gastric Bypass: a Meta-Analysis. Obes Surg 2021; 30:1935-1943. [PMID: 31955371 DOI: 10.1007/s11695-020-04418-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The purpose of the current study was to review the available literature on morbidly obese patients treated with laparoscopic Roux-en-Y gastric bypass (LRYGB) in order to assess the clinical outcomes of the routine closure of the mesenteric defects. METHODS A literature search was performed in PubMed, Cochrane library, and Scopus, in accordance with the PRISMA guidelines. RESULTS Nine studies met the inclusion criteria. A total of 16,520 patients were incorporated with a mean follow-up ranging from 34 to 120 months. The closure of the mesenteric defects was associated with a lower incidence of internal hernias (odds ratio, 0.25 [95% confidence interval 0.20, 0.31]; p < 0.01), small bowel obstruction (SBO) (0.30 [0.17, 0.52]; p < 0.0001) and reoperations (0.28 [0.15, 0.52]; p < 0.001). Both approaches presented similar complication rates and % excess weight loss (%EWL). CONCLUSION The present meta-analysis is the best currently available evidence on the topic and supports the routine closure of the mesenteric defects.
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Affiliation(s)
- Dimitrios E Magouliotis
- Department of Surgery and Interventional Sciences, UCL, London, UK.,Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - George Tzovaras
- Department of Surgery, University of Thessaly, Biopolis, 41110, Larissa, Greece
| | | | | | - Dimitris Zacharoulis
- Department of Surgery, University of Thessaly, Biopolis, 41110, Larissa, Greece.
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10
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Collard MK, Torcivia A, Genser L. Descriptive anatomy and closure modalities of inter-mesenteric spaces in laparoscopic Roux-en-Y gastric bypass. J Visc Surg 2020; 157:418-422. [PMID: 32981885 DOI: 10.1016/j.jviscsurg.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- M K Collard
- Sorbonne Université, Institut hospitalo-universitaire ICAN, Service de chirurgie digestive hépato-bilio-pancréatique, Hôpital Pitié Salpêtrière, Assistance publique-hôpitaux de Paris, AP-HP, 75013 Paris, France
| | - A Torcivia
- Sorbonne Université, Institut hospitalo-universitaire ICAN, Service de chirurgie digestive hépato-bilio-pancréatique, Hôpital Pitié Salpêtrière, Assistance publique-hôpitaux de Paris, AP-HP, 75013 Paris, France
| | - L Genser
- Sorbonne Université, Institut hospitalo-universitaire ICAN, Service de chirurgie digestive hépato-bilio-pancréatique, Hôpital Pitié Salpêtrière, Assistance publique-hôpitaux de Paris, AP-HP, 75013 Paris, France.
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11
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Douissard J, Gambon-Stow P, Dupuis A, Jung MK, Toso C, Hagen ME. Chronic Pain After Gastric Bypass: Another Argument to Support Mesenteric Windows Closure. Surg Laparosc Endosc Percutan Tech 2019; 30:134-136. [PMID: 31764863 DOI: 10.1097/sle.0000000000000737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chronic pain is frequent after Roux-en-Y gastric bypass (RYGB). Recurrent internal hernias (IHs) may be responsible for chronic abdominal pain. Physical examination and computed tomography are often inconclusive. This observational retrospective study describes 11 patients who underwent elective laparoscopy for post-RYGB chronic abdominal pain of undetermined etiology after noninvasive investigations and failure of conservative treatment. Open intermesenteric and/or Peterson spaces were found in all cases; IH was present in 6 cases. Nine patients were totally relieved from symptoms after mesenteric windows closure; substantial improvement was noted in the remaining 2 cases. Peterson space was found more likely to be responsible for chronic IH. In such selected patients, laparoscopic exploration and windows closure should be discussed. These findings add support to initial windows closure during RYGB.
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Affiliation(s)
- Jonathan Douissard
- Visceral Surgery Department, Geneva University Hospital, Geneva, Switzerland
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12
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Guimarães M, Monteiro MP. Comment on: Internal hernias in pregnant females with Roux-en-Y gastric bypass: a systematic review. Surg Obes Relat Dis 2019; 15:1640-1642. [PMID: 31427221 DOI: 10.1016/j.soard.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/08/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Marta Guimarães
- Clinical and Experimental Endocrinology, Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal; Department of General Surgery, Hospital de São Sebastião, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Mariana P Monteiro
- Clinical and Experimental Endocrinology, Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
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Schizas D, Apostolou K, Krivan S, Kanavidis P, Katsaros I, Vailas M, Koutelidakis I, Chatzimavroudis G, Pikoulis E. Paraduodenal hernias: a systematic review of the literature. Hernia 2019; 23:1187-1197. [PMID: 31006063 DOI: 10.1007/s10029-019-01947-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 04/01/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Paraduodenal hernias (PDH), also called mesocolic hernias, account for up to 53% of all internal hernias, but they cause only 0.2-0.9% of all cases of intestinal obstruction. This is the first systematic review of all reported cases so far, investigating their clinical presentation, radiological imaging, and treatment outcomes. METHODS After a detailed search in PubMed and Medline, using the keywords "paraduodenal hernia", 115 studies matched our criteria. A review of these reports was conducted and the full texts were examined. RESULTS A total of 159 patients were included in our analysis, with 69.8% and 30.2% of them suffering from either a left or a right PDH, respectively. Mean age at diagnosis was 44.1 years, with a 2/1 male/female ratio. PDH were associated with non-specific symptoms and signs; abdominal pain being the most common. Computed tomography (CT) scan of the abdomen was the most frequently used diagnostic modality. Regardless of PDH localization, all patients were operated on, with approximately one-third of them undergoing a laparoscopic operation, which was associated with a significantly decreased morbidity rate as well as length of hospital stay, compared with the open repair. CONCLUSIONS PDH are not usually associated with specific symptoms and signs; thus, they constitute a diagnostic challenge, requiring a high level of knowledge and clinical suspicion. Undoubtedly, CT scan of the abdomen is the gold standard diagnostic tool. Their operative repair is mandatory, with the laparoscopic approach demonstrating significant advantages over the open repair, seeming to be the optimum treatment strategy.
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Affiliation(s)
- D Schizas
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece
| | - K Apostolou
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece.
| | - S Krivan
- Department of Upper Gastrointestinal and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, UK
| | - P Kanavidis
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece
| | - I Katsaros
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece
| | - M Vailas
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece
| | - I Koutelidakis
- Second Department of Surgery, G.Gennimatas General Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - G Chatzimavroudis
- Second Department of Surgery, G.Gennimatas General Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - E Pikoulis
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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