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Diab ARF, Kim A, Remmel S, Sandstrom R, Docimo S, Sujka JA, DuCoin CG. Antral Preservation in Sleeve Gastrectomy Appears to Protect Against Prolonged Vomiting and Gastroesophageal Reflux Disease. A Meta-Analysis of Randomized Controlled Trials. Obes Surg 2023; 33:4103-4114. [PMID: 37837532 DOI: 10.1007/s11695-023-06884-w] [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: 07/09/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 10/16/2023]
Abstract
The optimal distance between the starting point of gastric transection and the pylorus during laparoscopic sleeve gastrectomy (LSG), which can be referred to as the distance from pylorus (DFP), is controversial. No consensus exist for what DFP is considered antral preservation, and what DFP is considered antral resection. Some surgeons prefer shorter DFP to maximize excess weight loss percentage (EWL%), while others prefer longer DFP because they believe that it shortens length of stay (LOS) and protects against leaks, prolonged vomiting, and gastroesophageal reflux disease (GERD). We sought to compare 6-cm DFP and 2-cm DFP in postoperative outcomes. In addition, we sought to evaluate the magnitude of any observed benefit through number needed to treat (NNT) analysis.
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Affiliation(s)
- Abdul-Rahman F Diab
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
| | - Angie Kim
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Shelby Remmel
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Reagan Sandstrom
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Salvatore Docimo
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Joseph A Sujka
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Christopher G DuCoin
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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Gastroparesis: An Evidence-Based Review for the Bariatric and Foregut Surgeon. Surg Obes Relat Dis 2023; 19:403-420. [PMID: 37080885 DOI: 10.1016/j.soard.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
Abstract
Gastroparesis is a gastric motility disorder characterized by delayed gastric emptying. It is a rare disease and difficult to treat effectively; management is a dilemma for gastroenterologists and surgeons alike. We conducted a systematic review of the literature to evaluate current diagnostic tools as well as treatment options. We describe key elements in the pathophysiology of the disease, in addition to current evidence on treatment alternatives, including nutritional considerations, medical and surgical options, and related outcomes.
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Steenackers N, Vanuytsel T, Augustijns P, Deleus E, Deckers W, Deroose CM, Falony G, Lannoo M, Mertens A, Mols R, Vangoitsenhoven R, Wauters L, Van der Schueren B, Matthys C. Effect of sleeve gastrectomy and Roux-en-Y gastric bypass on gastrointestinal physiology. Eur J Pharm Biopharm 2023; 183:92-101. [PMID: 36603693 DOI: 10.1016/j.ejpb.2022.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/07/2022] [Accepted: 12/30/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Knowledge regarding the gastrointestinal physiology after sleeve gastrectomy and Roux-en-Y gastric bypass is urgently needed to understand, prevent and treat the nutritional and pharmacological complications of bariatric surgery. AIM To investigate the effect of sleeve gastrectomy and Roux-en-Y gastric bypass on gastrointestinal motility (e.g., transit and pressure), pH, and intestinal bile acid concentration. MATERIAL AND METHODS An exploratory cross-sectional study was performed in six participants living with obesity, six participants who underwent sleeve gastrectomy, and six participants who underwent Roux-en-Y gastric bypass. During the first visit, a wireless motility capsule (SmartPill©) was ingested after an overnight fast to measure gastrointestinal transit, pH, and pressure. During the second visit, a gastric emptying scintigraphy test of a nutritional drink labeled with 99mTc-colloid by a dual-head SPECT gamma camera was performed to measure gastric emptying half-time (GET1/2). During the third visit, two customized multiple lumen aspiration catheters were positioned to collect fasting and postprandial intestinal fluids to measure bile acid concentration. RESULTS Immediate pouch emptying (P = 0.0007) and a trend for faster GET1/2 (P = 0.09) were observed in both bariatric groups. There was a tendency for a shorter orocecal transit in participants with sleeve gastrectomy and Roux-en-Y gastric bypass (P = 0.08). The orocecal segment was characterized by a higher 25th percentile pH (P = 0.004) and a trend for a higher median pH in both bariatric groups (P = 0.07). Fasting total bile acid concentration was 7.5-fold higher in the common limb after Roux-en-Y gastric bypass (P < 0.0001) and 3.5-fold higher in the jejunum after sleeve gastrectomy (P = 0.009) compared to obesity. Postprandial bile acid concentration was 3-fold higher in the jejunum after sleeve gastrectomy (P = 0.0004) and 6.5-fold higher in the common limb after Roux-en-Y gastric bypass (P < 0.0001) compared to obesity. CONCLUSION The anatomical alterations of sleeve gastrectomy and Roux-en-Y gastric bypass have an important impact on gastrointestinal physiology. This data confirms changes in transit and pH and provides the first evidence for altered intraluminal bile acid concentration.
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Affiliation(s)
- Nele Steenackers
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Tim Vanuytsel
- Translational Research Center for Gastrointestinal Disorders, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium; Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Augustijns
- Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Ellen Deleus
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium; Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Wies Deckers
- Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Gwen Falony
- Institute, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium; Center for Microbiology, VIB, Leuven, Belgium
| | - Matthias Lannoo
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium; Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Ann Mertens
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium; Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Raf Mols
- Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Roman Vangoitsenhoven
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium; Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Lucas Wauters
- Translational Research Center for Gastrointestinal Disorders, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium; Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Bart Van der Schueren
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium; Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Christophe Matthys
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium; Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium.
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Moursi DMAE, Allam KE, Hetta W, Elsalam AMA, Hussein RS. Role of 3D-CT gastric volumetric study in post-sleeve gastrectomy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00811-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Gastric pouch volumetry after sleeve gastrectomy reflects successful surgery. We aimed to assess the impact of gastric pouch volume after sleeve gastrectomy on weight loss.
Method
The study was performed for 30 patients (22 females and 8 males) who underwent sleeve gastrectomy. Their ages ranged from 18 to 47 years. All patients underwent (multi-slice CT) MSCT examination at 12 months after surgery with oral administration of effervescent emulsion. Post-processing in multi-planar reconstruction and 3D reconstruction was performed to all cases. Gastric pouch volume was measured and correlated with body weight, body mass index (BMI), % reduction in excess body weight and ∆weight at 1 year.
Results
A significant positive association was found among gastric volume pouch and weight loss (P = 0.04), BMI reduction (P value < 0.0001) and ∆weight (P value = 0.013). A significant inverse association was found among gastric pouch volume and % reduction in excess body weight (P value = 0.013).
Conclusion
MSCT gastric volumetry is the gold standard imaging method for assessment of the gastric pouch volume after sleeve gastrectomy. Significant positive association was found among gastric volume pouch and weight loss, BMI reduction and ∆weight at 1 year, i.e., in spite of large gastric pouch volume at 1 year, there is adequate weight loss, BMI reduction and ∆weight. Yet, significant inverse association was found among gastric pouch volume and % reduction in excess body weight.
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Moon SB, Hwang SJ, Baker S, Kim M, Sasse K, Koh SD, Sanders KM, Ward SM. Changes in interstitial cells and gastric excitability in a mouse model of sleeve gastrectomy. PLoS One 2022; 17:e0269909. [PMID: 35737727 PMCID: PMC9223402 DOI: 10.1371/journal.pone.0269909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/31/2022] [Indexed: 11/18/2022] Open
Abstract
Obesity is a critical risk factor of several life-threatening diseases and the prevalence in adults has dramatically increased over the past ten years. In the USA the age-adjusted prevalence of obesity in adults was 42.4%, i.e., with a body mass index (BMI, weight (kg)/height (m)2) that exceeds 30 kg/m2. Obese individuals are at the higher risk of obesity-related diseases, co-morbid conditions, lower quality of life, and increased mortality more than those in the normal BMI range i.e., 18.5–24.9 kg/m2. Surgical treatment continues to be the most efficient and scientifically successful treatment for obese patients. Sleeve gastrectomy or vertical sleeve gastrectomy (VSG) is a relatively new gastric procedure to reduce body weight but is now the most popular bariatric operation. To date there have been few studies examining the changes in the cellular components and pacemaker activity that occur in the gastric wall following VSG and whether normal gastric activity recovers following VSG. In the present study we used a murine model to investigate the chronological changes of gastric excitability including electrophysiological, molecular and morphological changes in the gastric musculature following VSG. There is a significant disruption in specialized interstitial cells of Cajal in the gastric antrum following sleeve gastrectomy. This is associated with a loss of gastric pacemaker activity and post-junctional neuroeffector responses. Over a 4-month recovery period there was a gradual return in interstitial cells of Cajal networks, pacemaker activity and neural responses. These data describe for the first time the changes in gastric interstitial cells of Cajal networks, pacemaker activity and neuroeffector responses and the time-dependent recovery of ICC networks and normalization of motor activity and neural responses following VSG.
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Affiliation(s)
- Suk Bae Moon
- Department of Physiology & Cell Biology, Reno School of Medicine, University of Nevada, Reno, Nevada, United States of America
| | - Sung Jin Hwang
- Department of Physiology & Cell Biology, Reno School of Medicine, University of Nevada, Reno, Nevada, United States of America
| | - Sal Baker
- Department of Physiology & Cell Biology, Reno School of Medicine, University of Nevada, Reno, Nevada, United States of America
| | - Minkyung Kim
- Department of Physiology & Cell Biology, Reno School of Medicine, University of Nevada, Reno, Nevada, United States of America
| | - Kent Sasse
- Sasse Surgical Associates, Reno, Nevada, United States of America
| | - Sang Don Koh
- Department of Physiology & Cell Biology, Reno School of Medicine, University of Nevada, Reno, Nevada, United States of America
| | - Kenton M. Sanders
- Department of Physiology & Cell Biology, Reno School of Medicine, University of Nevada, Reno, Nevada, United States of America
| | - Sean M. Ward
- Department of Physiology & Cell Biology, Reno School of Medicine, University of Nevada, Reno, Nevada, United States of America
- * E-mail:
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Misra S, Balasubramanian S, Srikanth B, Kumar S, Christinajoice S, Nandhini D, Raj PP. Is there a role for upper gastrointestinal contrast study to predict the outcomes of sleeve gastrectomy? Lessons learnt from a prospective study. J Minim Access Surg 2022; 18:97-104. [PMID: 35017399 PMCID: PMC8830558 DOI: 10.4103/jmas.jmas_186_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Context: The importance of upper gastrointestinal (UGI) contrast study following sleeve gastrectomy (SG) is equivocal. It can, however, yield anatomical and functional details, the significance of which mostly remains unknown. Settings and Design: This prospective, single-center study included SG patients between January 2018 and January 2019. Materials and Methods: UGI contrast study was done on post-operative day 1. The findings of the study namely gastroesophageal junction (GEJ) holdup time, presence of fundus, gastroduodenal emptying (GDE) time, and sleeve shape were compared with weight loss, improvement of glycosylated hemoglobin (HbA1c) and gastroesophageal reflux disease (GERD) symptoms at 3, 6, and 12 months follow-up. Results: There were 138 patients with 100% follow-up. Radiological sleeve patterns observed were: tubular (62.3%), superior (16.0%), and inferior (21.7%) pouches. GEJ holdup time had no effect on percentage total weight loss (%TWL) (P = 0.09) or HbA1c improvement (P = 0.077). The absence of fundus led to greater %TWL at 6 months (P = 0.048). GDE time <15 s led to higher %TWL (P = 0.028) and lower HbA1c (P = 0.010) at 12 months. Antrum size <2 cm was associated with higher %TWL (P = 0.022) and lower HbA1c level (P = 0.047) at 12 months. Vomiting and regurgitation were common with tubular sleeves. Conclusion: UGI contrast study can predict weight loss, HbA1c improvement, and GERD symptoms. The absence of fundus, small antrum, and rapid GDE are associated with better weight loss. HbA1c improvement is better with small antrum and rapid GDE. Tubular sleeve predisposes to vomiting and regurgitation.
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Affiliation(s)
- Shivanshu Misra
- Department of Bariatric and Metabolic Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - Shankar Balasubramanian
- Department of Bariatric and Metabolic Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - B Srikanth
- Department of Radiodiagnosis, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - Saravana Kumar
- Department of Bariatric and Metabolic Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - S Christinajoice
- Department of Bariatric and Metabolic Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - Deepa Nandhini
- Department of Bariatric and Metabolic Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - P Praveen Raj
- Department of Bariatric and Metabolic Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
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Yilmaz F, Gedik GK, Yilmaz H. Evaluation of postprandial symptoms in two different laparoscopic sleeve gastrectomy techniques using gastric emptying scintigraphy. Niger J Clin Pract 2022; 25:1875-1882. [DOI: 10.4103/njcp.njcp_315_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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8
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Qi X, Li X, Jiao Y, Chen S, Song P, Qian Z, Tang L. The Effects of Antral Preservation and Antral Resection on Body Composition, Glycemic Control and Bone Mineral Density Following Vertical Sleeve Gastrectomy in C57BL/6J Mice with Obesity and Type 2 Diabetes. Diabetes Metab Syndr Obes 2022; 15:297-305. [PMID: 35140488 PMCID: PMC8820379 DOI: 10.2147/dmso.s351973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/26/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Sleeve gastrectomy (SG) is the most currently popular operation for obesity and related metabolic disorders. The aim of this study was to compare the effect of antrum preservation SG (AP-SG) and antrum resection SG (AR-SG) on the body composition, glycemic control and bone mineral density (BMD) in mice. METHODS Sham, AP-SG and AR-SG operation were performed on obese and T2D C57BL/6J mice (8 in each group). Body weight, food intake, and fasting glucose (FG) levels were measured at the 0, 2, 4, 6 and 8 weeks post-operatively. Oral glucose tolerance test (OGTT) was performed preoperatively and at the eighth postoperative week. The body fat content and total body BMD were evaluated by dual-energy x-ray absorptiometry. After being euthanized, the femurs were harvested and analyzed by micro-CT. RESULTS The improvements in body weight, food intake, FG, glycemic control and body fat were statistically significant following AP-SG and AR-SG. Both AP-SG and AR-SG groups decreased total body BMD and regional BMD in the distal femur compared to the sham group. No significant difference of FG was observed in AP-SG and AR-SG group postoperatively, but AR-SG showed significantly superior OGTT glucose AUC than AP-SG. Except for a lower BMD, AR-SG achieved superior outcomes in body fat and glycemic control than AP-SG. CONCLUSION Antrum resection SG shows a lower percentage of body fat and better glycemic control than antrum preservation SG. However, antrum resection SG has a higher risk of having a lower bone mass. Further human clinical trials are needed to confirm this finding.
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Affiliation(s)
- Xiaoyang Qi
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, People’s Republic of China
- Department of Orthopaedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, People’s Republic of China
| | - Xugang Li
- Department of Orthopaedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, People’s Republic of China
| | - Yuwen Jiao
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, People’s Republic of China
| | - Shuai Chen
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, People’s Republic of China
| | - Peng Song
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, People’s Republic of China
| | - Zhifen Qian
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, People’s Republic of China
| | - Liming Tang
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, People’s Republic of China
- Correspondence: Liming Tang, Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, No. 68, Gehu Middle Road, Changzhou, 213000, Jiangsu, People’s Republic of China, Tel +86-13506112690, Email
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Salman MA, Elshazli M, Shaaban M, Esmat MM, Salman A, Ibrahim HMM, Tourky M, Helal A, Mahmoud AA, Aljarad F, Saadawy AMI, Shaaban HED, Mansour D. Correlation Between Preoperative Gastric Volume and Weight Loss After Laparoscopic Sleeve Gastrectomy. Int J Gen Med 2021; 14:8135-8140. [PMID: 34795518 PMCID: PMC8594781 DOI: 10.2147/ijgm.s335368] [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: 09/02/2021] [Accepted: 10/29/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Long-term studies reported inadequate weight loss or weight regain after laparoscopic sleeve gastrectomy (LSG). This study investigated a possible relationship between preoperative gastric volume (GV) measured by CT volumetry and weight loss one year after LSG. Methods This prospective study included 120 patients scheduled for LSG. 3D CT gastric volumetry was done before surgery. The weight loss in the first year was serially recorded. The primary outcome measure was the correlation between preoperative GV and postoperative weight loss after one year. The secondary outcomes were the correlation between preoperative GV and other patients’ characteristics as age and body mass index (BMI). Results Weight and BMI decreased significantly up to 12 months. The percentage of excess weight loss (%EWL) at 6 and 12 months was significantly higher than at three months. Preoperative GV was 1021 ± 253, ranging from 397 to 1543 mL. GV was not related to sex, age, weight, height, postoperative weight, and BMI. Conclusion Preoperative gastric volume cannot predict weight loss one year after LSG. It is not correlated with age, sex, or preoperative weight, and BMI.
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Affiliation(s)
- Mohamed AbdAlla Salman
- General Surgery Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mostafa Elshazli
- General Surgery Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Shaaban
- Damietta General Hospital, General Surgery Department, Damietta, Egypt
| | | | - Ahmed Salman
- Internal Medicine Department, Kasr Al AinyFaculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Mohamed Tourky
- General Surgery Department, Great Western Hospital, NHS Foundation Trust, Swindon, UK
| | - Alaa Helal
- General Surgery Department, Great Western Hospital, NHS Foundation Trust, Swindon, UK
| | | | - Feras Aljarad
- General Surgery Department, Lewisham and Greenwich NHS Trust, London, UK
| | | | - Hossam El-Din Shaaban
- Gastroenterology and Hepatology Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Doaa Mansour
- General Surgery Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
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Yu Q, Saeed K, Okida LF, Gutierrez Blanco DA, Lo Menzo E, Szomstein S, Rosenthal R. Outcomes of laparoscopic sleeve gastrectomy with and without antrectomy in severely obese subjects. Evidence from randomized controlled trials. Surg Obes Relat Dis 2021; 18:404-412. [PMID: 34933811 DOI: 10.1016/j.soard.2021.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/02/2021] [Accepted: 11/12/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (SG) has been proven safe and effective in achieving weight loss. However, the distance from the pylorus where resection should begin has been debated. OBJECTIVES To compare the clinical outcomes of laparoscopic SG with antrum resection (AR) versus preservation (AP) for bariatric purposes by conducting a meta-analysis of randomized controlled trials (RCT). SETTING Academic hospital, United States. METHODS PubMed and Cochrane Library were queried for RCTs from establishment to August 2020. The following key search terms were used: "sleeve gastrectomy" AND ("antrectomy" OR "antrum") AND ("randomized" OR "random"). The following data were extracted: author, publication year, country, sample size, follow-up duration, and clinical outcomes, including weight-related: excess weight loss (EWL), total weight loss (TWL), body mass index (BMI), operation time, length of hospital stay, complication rates, and resolution of obesity-related comorbidities. RESULTS A total of 9 unique RCTs including 492 AR and 385 AP patients were screened and included in the final quantitative analysis. Patients who underwent SG with AR showed higher EWL and TWL at 6 months (EWL: P < .001; TWL: P = .006), and 1 year (EWL: P = .013; P < .001) postoperatively. The BMI was also lower in the AR group 3 months (P = .013) and 6 months (P = .003) postoperatively. However, the EWL and BMI at 2 years were comparable between both groups (P = .222 and P = .908, respectively). No statistical significance was observed in terms of operating time, staple line disruption, bleeding, complications with a Clavien-Dindo Grade >III, resolution of comorbidities (hypertension, diabetes, hyperlipidemia, arthritis/back pain), and de novo gastroesophageal reflux disease (P > .05). AP was associated with a slightly shorter postoperative hospital stay (4.0 versus 3.1 days, P = .039). CONCLUSION Laparoscopic SG with AR is associated with superior weight loss in the short-term compared with AP. However, mid-term follow-up beyond 1 year showed no significant differences in BMI or incidence of de novo gastroesophageal reflux disease.
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Affiliation(s)
- Qian Yu
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Kashif Saeed
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Luis Felipe Okida
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | | | - Emanuele Lo Menzo
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Samuel Szomstein
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Raul Rosenthal
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida.
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11
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Chen K, Lin Y, Luo P, Yang N, Yang G, Zhu L, Pei Q. Effect of laparoscopic sleeve gastrectomy on drug pharmacokinetics. Expert Rev Clin Pharmacol 2021; 14:1481-1495. [PMID: 34694169 DOI: 10.1080/17512433.2021.1997585] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Given its feasibility and efficacy, laparoscopic sleeve gastrectomy (LSG) has become a widely accepted bariatric surgery for patients with clinically diagnosed severe obesity. LSG induces anatomical changes and subsequent weight loss which may affect drug pharmacokinetics (PK) and consequently impact dosing regimens. This review aims to examine the effect of LSG on drug PK and identify relevant gastrointestinal physiological alterations. AREAS COVERED PubMed, Embase, Scopus, and the Cochrane Library were searched for articles related to drug PK and LSG from inception to July 2021. Moreover, literature concerning postoperative physiological conditions in the gastrointestinal tract, such as gastric pH, gastric emptying, and small bowel transit time, etc., which may affect the PK profile of drug products was also reviewed. EXPERT OPINION Although LSG is classified as having restrictive property without malabsorptive bypass, postoperative changes in gastrointestinal physiology and subsequent weight loss may also lead to increased, decreased or unaltered drug exposure levels. General monitoring on drug efficacy or safety using biomarkers is proposed. In addition, therapeutic drug monitoring for those drugs when it is applicable and available is recommended to ensure efficient drug dosing and avoid adverse effects. Further research into many individual drugs are warranted.
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Affiliation(s)
- Kaifeng Chen
- Department of Pharmacy, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China.,Center of Clinical Pharmacology, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yaqi Lin
- Department of Pharmacy, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China.,Center of Clinical Pharmacology, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ping Luo
- Department of General Surgery, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Nan Yang
- Department of Pharmacy, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guoping Yang
- Center of Clinical Pharmacology, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Liyong Zhu
- Department of General Surgery, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qi Pei
- Department of Pharmacy, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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12
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Shehata MA, Elhaddad A, El-Attar AA, Shehata SM. The Effect of Antrum Size on Weight Loss, Glucagon-Like Peptide-1 (GLP-1) Levels, and Glycemic Control Following Laparoscopic Sleeve Gastrectomy in Adolescents with Obesity and Type 2 Diabetes. Obes Surg 2021; 31:4376-4385. [PMID: 34355337 DOI: 10.1007/s11695-021-05590-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/22/2021] [Accepted: 07/09/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE The aim of this study was to compare the effect of antral resection versus antral preservation sleeve gastrectomy on the post-operative GLP-1, glycemic control, and weight loss in adolescents suffering from severe obesity and type 2 diabetes (T2D). MATERIALS AND METHODS This study included 36 adolescents. Patients were randomly divided into 2 groups: group (A) and group (B). Each group included 18 patients who underwent LSG, starting transection at 2 cm or 5 cm from the pyloric ring in group (A) and group (B), respectively. They were followed up at 1, 3, 6, 12, and 24 months post-operatively. The outcomes were the post-operative GLP-1 response, glycemic control, weight loss, and safety. RESULTS The improvements in the body mass index and the percentage of excess weight loss (%EWL) were statistically significant within each group. The mean GLP-1 levels showed significant increase at the 1, 3, and 6 months but not in the 12 and 24 months in all the studied samples within each group. The mean HbA1c levels and post-prandial serum C-peptide significantly improved within each group (P < 0.05). No statistical differences in the weight loss, %EWL, GLP-1, HbA1c, C-peptide changes, and complication rates were observed between both groups. Diabetic remission was significantly higher (88.9%) in group (A). CONCLUSIONS LSG resulted in generalized significant GLP-1 initial response that decreased over time. The reduced antrum size did not influence the GLP-1 response, glycemic control, or insulin resistance, but resulted in significantly better T2D remission. Since the study examines a small number of patients, further studies are needed. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04388059.
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Affiliation(s)
- Mohamed A Shehata
- Department of General Surgery, Pediatric Surgery Unit, Faculty of Medicine, Tanta University, El-Geish Street, Tanta, 31257, Egypt.
| | - Ahmed Elhaddad
- Department of General Surgery, Pediatric Surgery Unit, Faculty of Medicine, Tanta University, El-Geish Street, Tanta, 31257, Egypt
| | - Ashraf A El-Attar
- Department of General Surgery, Pediatric Surgery Unit, Faculty of Medicine, Tanta University, El-Geish Street, Tanta, 31257, Egypt
| | - Sherif M Shehata
- Department of General Surgery, Pediatric Surgery Unit, Faculty of Medicine, Tanta University, El-Geish Street, Tanta, 31257, Egypt
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Gastric Sensory and Motor Functions and Energy Intake in Health and Obesity-Therapeutic Implications. Nutrients 2021; 13:nu13041158. [PMID: 33915747 PMCID: PMC8065811 DOI: 10.3390/nu13041158] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/18/2021] [Accepted: 03/26/2021] [Indexed: 01/19/2023] Open
Abstract
Sensory and motor functions of the stomach, including gastric emptying and accommodation, have significant effects on energy consumption and appetite. Obesity is characterized by energy imbalance; altered gastric functions, such as rapid gastric emptying and large fasting gastric volume in obesity, may result in increased food intake prior to reaching usual fullness and increased appetite. Thus, many different interventions for obesity, including different diets, anti-obesity medications, bariatric endoscopy, and surgery, alter gastric functions and gastrointestinal motility. In this review, we focus on the role of the gastric and intestinal functions in food intake, pathophysiology of obesity, and obesity management.
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Comparison of Weight Loss in Sleeve Gastrectomy Patients With and Without Antrectomy: a Prospective Randomized Study. Obes Surg 2021; 30:446-450. [PMID: 31707570 DOI: 10.1007/s11695-019-04177-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) restricts gastric volume to achieve weight loss. We aimed to compare the efficacy of LSG with and without antrectomy for achieving weight loss. METHODS The prospective randomized study comprised 127 obese patients that underwent either LSG with antrectomy (2 cm to pylorus) (group 1) or LSG without antrectomy (6 cm to pylorus) (group 2), using 36 Fr and 32 Fr bougies, respectively. Patients were examined at 3-, 6-, 12-, and 24-month intervals for body mass index (BMI) measurements. RESULTS Overall, 66 (51%) and 57 (49%) of patients were assigned to groups 1 and 2, respectively. The mean BMI of group 1 patients were 49.5 ± 8.01, 35.8 ± 5.40, 31.3 ± 4.9, 26.7 ± 4.02, and 22.9 ± 4.01 at the baseline, 3rd, 6th, 12th, and 24th month, respectively. The decreases in BMI were statistically significant. The mean BMI of group 2 patients were 46.7 ± 7.06, 39.3 ± 6.04, 32.4 ± 5.01, 26.6 ± 3.76, and 21.6 ± 3.70 at baseline, 3rd, 6th, 12th, and 24th month, respectively. The differences were also statistically significant. When compared with group 2, group 1 patients showed significantly lower BMI values on the 3rd month. Other differences were not statistically significant. CONCLUSION LSG with or without antrectomy is safe and effective for weight loss. Larger studies are required to identify patients likely to benefit from LSG with antrectomy.
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Steenackers N, Vanuytsel T, Augustijns P, Tack J, Mertens A, Lannoo M, Van der Schueren B, Matthys C. Adaptations in gastrointestinal physiology after sleeve gastrectomy and Roux-en-Y gastric bypass. Lancet Gastroenterol Hepatol 2021; 6:225-237. [PMID: 33581761 DOI: 10.1016/s2468-1253(20)30302-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 01/19/2023]
Abstract
Linked to the growing obesity epidemic, demand for bariatric and metabolic surgery has increased, the most common procedures being sleeve gastrectomy and Roux-en-Y gastric bypass. Originally, bariatric procedures were described as purely restrictive, malabsorptive, or combined restrictive-malabsorptive procedures limiting food intake, nutrient absorption, or both. Nowadays, anatomical alterations are known to affect gastrointestinal physiology, which in turn affects the digestion and absorption of nutrients and drugs. Therefore, understanding gastrointestinal physiology is crucial to prevent postoperative nutritional deficiencies and to optimise postoperative drug therapy. Preclinical and clinical research indicates that sleeve gastrectomy accelerates liquid and solid gastric emptying and small intestinal transit, and increases bile acid serum levels, whereas its effects on gastrointestinal acidity, gastric and pancreatic secretions, surface area, and colonic transit remain largely unknown. Roux-en-Y gastric bypass diminishes gastric acid secretion, accelerates liquid gastric emptying, and increases bile acid serum levels, but its effects on intestinal pH, solid gastric emptying, intestinal transit time, gastric enzyme secretions, and surface area remain largely unknown. In this Review, we summarise current knowledge of the effects of these two procedures on gastrointestinal physiology and assess the knowledge gaps.
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Affiliation(s)
- Nele Steenackers
- Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Tim Vanuytsel
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Patrick Augustijns
- Department of Chronic Diseases and Metabolism, and Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Ann Mertens
- Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Matthias Lannoo
- Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
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16
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Anatomical Quality Criteria for Sleeve Gastrectomy. Obes Surg 2021; 31:1541-1548. [PMID: 33495980 DOI: 10.1007/s11695-020-05156-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Sleeve gastrectomy (SG) is the most common bariatric procedure performed worldwide. However, without a standardised surgical technique, heterogeneous outcomes and complications such as gastro-oesophageal reflux disease (GERD) have been reported. The aim of this study was to identify reproducible anatomical criteria for SG to obtain safe and effective results. METHODS A prospective photographic study that captured every phase of each procedure was completed. The photographic documentation was carefully examined in order to identify anatomical criteria that would help make our technique reproducible. Postsurgical results were reported in terms of complications and mortality, while functional and morphological results were evaluated using 3-month upper gastrointestinal (UGI) series and 12-month computed tomography (CT) scan, respectively. BMI, percentage excess weight loss (%EWL), comorbidities, and GERD symptoms at 12 months were analysed. RESULTS One hundred thirty-four consecutive laparoscopic SG were photographed, and four reproducible anatomical criteria were identified: (1) to preserve the gastric antral posterior ligament (GAPL); (2) to dissect the gastro-pancreatic ligament (GPL); (3) to expose the right edge of the left diaphragmatic crus; and (4) to ensure staple-line linearity. No leaks occurred, and only one patient needed relaparoscopy for staple-line hematoma. Mortality and 30-day readmission rates were null. Gastric tube morphologies on the 12-month CT scans were homogeneous. At 12 months, median BMI was 30.8 kg/m2 [IQR 20-47.2] and mean %EWL was 69.0 ± 24.5%; comorbidities resolved in 65.8-88.1% of patients, and GERD symptoms resolved in 44.4%. CONCLUSION The four anatomical criteria for SG that we propose are safe, effective, and reproducible and have acceptable postsurgical outcomes.
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Alicuben ET, Samaan JS, Houghton CC, Soffer E, Lipham JC, Samakar K. Sleeve Gastrectomy as a Novel Procedure for Gastroparesis. Am Surg 2020; 87:1287-1291. [PMID: 33342255 DOI: 10.1177/0003134820979781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has recently been considered for the surgical management of refractory gastroparesis. Our study aims to determine the efficacy of LSG as a new treatment modality for gastroparesis. METHODS A multi-surgeon single institution retrospective chart review of patients who underwent LSG for refractory gastroparesis from September 2016-December 2017. Pre- and postoperative Patient Assessment of Upper Gastrointestinal Disorders-Symptoms Severity Index and/or Gastroparesis Cardinal Symptom Index (GCSI) questionnaires were reviewed. A telephone survey was conducted. Statistical analysis consisted of two-sample t test and utilized SAS v9.4. A P-value <.05 was considered significant. RESULTS There were 10 patients included and 80% were women with an average age of 43 years (24-63). Mean Body Mass Index was 24.5 (16.8-39.6), and median gastric emptying at 4 hours was 50% (30-85). Etiology of gastroparesis was 50% idiopathic, 40% diabetic, and 10% postsurgical. 80% of patients had previously undergone gastric electrical stimulator implantation, 20% pyloric botox injections, and 1 patient jejunostomy tube placement. One patient required conversion from laparoscopic to open secondary to adhesions. Median length of stay was 5 days (2-13), and median follow-up was 13.3 months. 90% of patients were tolerating a regular diet at longest follow-up with significant improvement in self-reported symptoms. GCSI scores were 33.6 preoperatively and 14.9 postoperatively (P = .01). DISCUSSION Our study adds to the literature examining the role of LSG in the treatment of gastroparesis. LSG has favorable outcomes at short-term follow-up for patients with refractory gastroparesis.
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Affiliation(s)
- Evan T Alicuben
- Department of Surgery, Division of Upper GI and General Surgery, Keck School of Medicine, 12223University of Southern California, Los Angeles, CA, USA
| | - Jamil S Samaan
- Department of Medicine, 22494Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Caitlin C Houghton
- Department of Surgery, Division of Upper GI and General Surgery, Keck School of Medicine, 12223University of Southern California, Los Angeles, CA, USA
| | - Edy Soffer
- Department of Surgery, Division of Upper GI and General Surgery, Keck School of Medicine, 12223University of Southern California, Los Angeles, CA, USA
| | - John C Lipham
- Department of Surgery, Division of Upper GI and General Surgery, Keck School of Medicine, 12223University of Southern California, Los Angeles, CA, USA
| | - Kamran Samakar
- Department of Surgery, Division of Upper GI and General Surgery, Keck School of Medicine, 12223University of Southern California, Los Angeles, CA, USA
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ValadÃo JA, Leal PDC, Oliveira EJSGD, Torres OJM, Pinto LEV, Marchi DDD, Gama-Filho OP, Santo MA, Nassif PAN. VERTICAL GASTRECTOMY VS. EXTENDED VERTICAL GASTRECTOMY: WHAT IS THE IMPACT ON GASTROESOPHAGEAL REFLUX DISEASE IN OBESE RATS? ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2020; 33:e1513. [PMID: 32844876 PMCID: PMC7448852 DOI: 10.1590/0102-672020190001e1513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/26/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Extended vertical gastrectomy is a variation of the vertical gastrectomy technique requiring studies to elucidate safety in relation to gastroesophageal reflux. AIM To analyze comparatively vertical gastrectomy (VG) and extended vertical gastrectomy (EVG) in rats with obesity induced by cafeteria diet in relation to the presence of reflux esophagitis, weight loss and macroscopic changes related to the procedures. METHODS Thirty Wistar rats were randomized into three groups, and after the obesity induction period by means of a 28-day cafeteria diet, underwent a simulated surgery (CG), VG and VGA. The animals were followed up for 28 days in the post-operative period, and after euthanasia, the reflux esophagitis evaluation was histopathologically performed. Weight and macroscopy were the other variables; weight was measured weekly and the macroscopic evaluation was performed during euthanasia. RESULTS All animals presented some degree of inflammation and the presence of at least one inflammation criterion; however, there was no statistically significant difference in the analysis among the groups. In relation to weight loss, the animals in CG showed a gradual increase during the whole experiment, evolving to super-obesity at the end of the study, while the ones with VG and EVG had weight regain after the first post-operative period; however, a less marked regain compared to CG, both for VG and EVG. CONCLUSION There is no difference in relation to reflux esophagitis VG and EVG, as well as macroscopic alterations, and both techniques have the ability to control the evolution of weight during postoperative period in relation to CG.
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Affiliation(s)
- José Aparecido ValadÃo
- Postgraduate Program in Principles of Surgery, Medical Research Institute, Evangelic Mackenzie Faculty of Paraná, Curitiba, PR, Brazil
| | | | | | | | | | | | | | - Marco Aurelio Santo
- Department of Gastroenterology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Paulo Afonso Nunes Nassif
- Postgraduate Program in Principles of Surgery, Medical Research Institute, Evangelic Mackenzie Faculty of Paraná, Curitiba, PR, Brazil
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Thyroid Hormone Changes After Sleeve Gastrectomy With and Without Antral Preservation. Obes Surg 2020; 31:224-231. [PMID: 32748200 DOI: 10.1007/s11695-020-04896-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The effect of bariatric surgery on thyroid hormone changes yielded inconsistent results. The aim of the present study was to assess the change of thyroid hormone levels following laparoscopic sleeve gastrectomy (LSG), with or without antral preservation (AP). METHODS Thyroid hormones (TSH, FT3, FT4) were examined preoperatively, at the end of the first postoperative month, and first postoperative year. Secondly, antral resection (AR) and AP were compared at inducing weight loss and thereby affecting thyroid hormone levels. RESULTS Euthyroid obese patients (86 female/20 male) underwent LSG. Of these, 58 patients underwent AR and 48 patients AP. The mean FT3 levels significantly decreased both in the first postoperative month and the first year (P < 0.001), whereas mean TSH levels decreased significantly in the first postoperative year (P < 0.001). FT4 levels remained nearly unchanged (P = 0.517). Postoperative first year body mass index (BMI) loss, excess BMI loss percentile (%EBMIL), and total body weight loss percentile (%TWL) were significantly higher in AR group than the AP group (P ≤ 0.01). When the change in thyroid hormone levels was analyzed by pyloric distance according to time periods, no significant difference was found in TSH and FT4 levels (P > 0.05); however, reduction in FT3 levels was significantly greater in patients with AR than in AP patients (P = 0.028). CONCLUSION LSG promotes significant reduction in TSH and FT3 levels, whereas FT4 levels remain unchanged. LSG with AR provides more weight loss in short term and appears to be more effective at lowering FT3 levels.
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Khalifa IG, Tobar WL, Hegazy TO, Balamoun HA, Mikhail S, Salman MA, Elsayed EA. Food Tolerance After Laparoscopic Sleeve Gastrectomy with Total Antral Resection. Obes Surg 2020; 29:2263-2269. [PMID: 30895506 DOI: 10.1007/s11695-019-03840-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Among the controversial points in laparoscopic sleeve gastrectomy (LSG) is how much of the antrum to be resected. This study aimed to evaluate food tolerance after preservation or resection of the antrum during LSG. METHODS Prospective randomized study included 50 patients scheduled for LSG. Participants were randomly allocated into one of two groups. In antral resection (AR-LSG) group (n = 25), resection started 2 cm from the pylorus. In antral sparing (AS-LSG) group (n = 25), it started 6 cm from the pylorus. Percentage of excess weight loss (%EWL) and percentage of excess BMI loss (%EBL) were evaluated after 3 and 6 months. Quality of life (QOL) was evaluated by using the Bariatric Analysis and Reporting Outcome System (BAROS). Food tolerance was assessed using the Quality of Alimentation questionnaire. Primary outcome measure was food tolerance and %EWL. RESULTS Food tolerance was significantly better in the antral sparing group compared to the antral resection group after 3 and 6 months. The two groups were comparable in %EWL and BMI change after 3 and 6 months. Six months after surgery, the majority of patients had a very good quality of life, with no significant difference between the two groups (p = 0.877). There was no significant difference between the two groups in operative time, intraoperative blood loss, and hospital stay. CONCLUSIONS Preservation of the pyloric antrum during LSG is associated with significantly better food tolerance and comparable effect of weight loss up to 6 months postoperatively when compared with total antral resection.
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Affiliation(s)
- Ibrahim G Khalifa
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | - Wael L Tobar
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | - Tarek O Hegazy
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | - Hany A Balamoun
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt.
| | - Sameh Mikhail
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | | | - Elsayed A Elsayed
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
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21
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Ongoing Inconsistencies in Weight Loss Reporting Following Bariatric Surgery: a Systematic Review. Obes Surg 2020; 29:1375-1387. [PMID: 30671713 DOI: 10.1007/s11695-018-03702-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Weight loss is the primary outcome following bariatric surgery; however, its documentation within current literature is heterogeneous and poorly defined, limiting meaningful comparison between studies. Randomized controlled trials from 2012 to 2016 were identified using the Medline database through "Gastric bypass OR sleeve gastrectomy AND weight" search terms. A total of 73 studies with 5948 patients were included. Reporting of preoperative weight was done primarily using mean body mass index (BMI) (87.7%) and mean weight (65.8%). Postoperative weight reporting was more variable, with the most frequently reported measure being mean postoperative BMI (71.2%). Overall, nearly one third of all bariatric literature contained discrepancies that precluded meaningful meta-analysis. Reporting of weight loss following bariatric surgery is becoming increasingly diverse for both pre- and post-operative outcomes. Ongoing heterogeneity will continue to act as a barrier to meaningful comparison of bariatric outcomes until standardized reporting practices become adopted.
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Vargas EJ, Bazerbachi F, Calderon G, Prokop LJ, Gomez V, Murad MH, Acosta A, Camilleri M, Abu Dayyeh BK. Changes in Time of Gastric Emptying After Surgical and Endoscopic Bariatrics and Weight Loss: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol 2020; 18:57-68.e5. [PMID: 30954712 PMCID: PMC6776718 DOI: 10.1016/j.cgh.2019.03.047] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/21/2019] [Accepted: 03/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Gastric emptying (GE) is involved in the regulation of appetite. We compared times of GE after different bariatric endoscopic and surgical interventions and associations with weight loss. METHODS We performed a comprehensive search of publication databases, through September 14, 2018, for randomized and nonrandomized studies reporting outcomes of weight-loss surgeries. Two independent reviewers selected and appraised studies. The outcome of interest was GE T1/2 (min), measured before and after the procedure. A random-effects model was used to pool the mean change in T1/2 (min) after the intervention. We performed a meta-regression analysis to find associations between GE and weight loss. Heterogeneity was calculated using the I2 statistic. Methodologic quality was assessed. RESULTS From 762 citations, the following studies were included in our analysis: 9 sleeve gastrectomies, 5 intragastric balloons, and 5 antral botulinum toxins. After sleeve gastrectomy, the pooled mean reduction in GE T1/2 at 3 months was 29.2 minutes (95% CI, 40.9-17.5 min; I2 = 91%). Fluid-filled balloons increased GE T1/2 by 116 minutes (95% CI, 29.4-203.4 min; I2 = 58.6%). Air-filled balloons did not produce a statistically significant difference in GE T1/2. Antral botulinum injections increased GE T1/2 by 9.6 minutes (95% CI, 2.8-16.4 min; I2 = 13.3%). Placebo interventions reduced GE T1/2 by 6.3 minutes (95% CI, 10-2.6 min). Changes in GE were associated with weight loss after sleeve gastrectomy and intragastric balloons, but not botulinum toxin injections. CONCLUSIONS In a systematic review and meta-analysis, we found that sleeve gastrectomy reduced GE T1/2 whereas fluid-filled balloons significantly increased GE T1/2. Air-filled balloons do not significantly change the time of GE, which could account for their low efficacy. Antral botulinum toxin injections produced small temporary increases in GE time, which were not associated with weight loss. Changes in GE time after surgical and endoscopic bariatric interventions correlated with weight loss and might be used to select interventions, based on patients' physiology.
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Affiliation(s)
- Eric J Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Fateh Bazerbachi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Gerardo Calderon
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Larry J Prokop
- Division of Library Services, Mayo Clinic, Rochester, Minnesota
| | - Victoria Gomez
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - M Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
| | - Andres Acosta
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Michael Camilleri
- Clinical Enteric Neuroscience Translational and Epidemiological Research, Mayo Clinic, Rochester, Minnesota
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
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Lim CH, Lee PC, Lim E, Tan J, Chan WH, Tan HC, Ganguly S, Tham KW, Eng A. Correlation Between Symptomatic Gastro-Esophageal Reflux Disease (GERD) and Erosive Esophagitis (EE) Post-vertical Sleeve Gastrectomy (VSG). Obes Surg 2019; 29:207-214. [PMID: 30238218 DOI: 10.1007/s11695-018-3509-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has become the preferred bariatric procedure in many countries. However, there is one shortcoming of LSG in the long-term follow-up and this is the onset of GERD and erosive esophagitis (EE). Current evidence of the effect of SG on GERD did not consolidate to a consensus. In this study, we objectively evaluate the incidence of EE 1 year post-LSG with upper endoscopy (EGD) and try to identify the significant variables and possible underlying mechanisms of the EE post-LSG. METHODS Over a period of 5 years (2011-2016) at Singapore General Hospital, we retrospectively reviewed a prospectively collected database of a cohort of patients whom had LSG by a single surgeon who routinely performed EGD pre-operative and 1 year post-operative to assess EE and hiatal hernia. Patient's endoscopic findings and demographic and anthropometric data were analyzed. RESULTS We identified a total of 97 obese patients who underwent LSG at our hospital by studied surgeon. Sixty-three patients (64.9% of original sample) were finally evaluated in the present study, 40 (59.7%) of whom were female. The mean (range) age of patients was 38.2 (18-66) years, and mean BMI was 36.3 ± 4.1 kg/m2. Median time to follow-up EGD was 13 months (range, 12-15). Following LSG, there was a significant decrease in both BMI (42.1 ± 1.2 vs. 29.9 ± 1.0 kg/m2) and percentage excess weight loss of 56.6 ± 3.6%. The prevalence of EE on endoscopy increased from 9 (14.3%) to 28 (44.4%) patients. Of which 15 (23.8%) were grade A, 11 (17.5%) were grade B, and 2 (3.2%) were grade C. There was no correlation between GERD symptoms with EE; however, our study found a trend suggesting higher prevalence of EE with a sleeve diameter measuring > 2 cm wide (p = 0.069). CONCLUSION Although LSG is effective in treating obesity and its metabolic syndromes, the prevalence of EE increased significantly 1 year after the surgery. Since we do not fully understand the long-term impact of chronic esophagitis in post-sleeve population, we recommend follow-up EGD assessment post-operatively and treat the esophagitis if present.
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Affiliation(s)
- Chin Hong Lim
- Department of Upper Gastrointestinal & Bariatric Surgery, Division of Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore.
| | - Phong Ching Lee
- Department of Endocrinology, Division of Medicine, Singapore General Hospital, Singapore, Singapore
| | - Eugene Lim
- Department of Upper Gastrointestinal & Bariatric Surgery, Division of Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore
| | - Jeremy Tan
- Department of Upper Gastrointestinal & Bariatric Surgery, Division of Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore
| | - Weng Hoong Chan
- Department of Upper Gastrointestinal & Bariatric Surgery, Division of Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore
| | - Hong Chang Tan
- Department of Endocrinology, Division of Medicine, Singapore General Hospital, Singapore, Singapore
| | - Sonali Ganguly
- Department of Endocrinology, Division of Medicine, Singapore General Hospital, Singapore, Singapore
| | - Kwang Wei Tham
- Department of Endocrinology, Division of Medicine, Singapore General Hospital, Singapore, Singapore
| | - Alvin Eng
- Department of Upper Gastrointestinal & Bariatric Surgery, Division of Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore
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Braghetto I, Korn O. Late esophagogastric anatomic and functional changes after sleeve gastrectomy and its clinical consequences with regards to gastroesophageal reflux disease. Dis Esophagus 2019; 32:5487969. [PMID: 31076757 DOI: 10.1093/dote/doz020] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Gastroesophageal reflux disease (GERD) is described as a complication after sleeve gastrectomy. Most studies have used only clinical symptoms or upper gastrointestinal endoscopy for evaluation of reflux after surgery. Manometry, acid reflux tests, and esophageal barium swallow have not been commonly used. The objective of this study is to evaluate the short- and long-term incidence of clinical gastroesophageal reflux, the lower esophageal sphincter (LES) pressure, acid reflux, and endoscopic and radiological changes after sleeve gastrectomy (SG). A total of 315 patients were studied after SG; 248 (78.3%) completed more than 5 years of follow-up and 67 (21.4%) have more than 8 years (range 8-10 years) of follow-up. The preoperative weight was 106 + 14.1 kg with a mean body mass index 38.4 + 3.4 kg/m2. Patients with prior GERD were excluded for SG. During the follow-up patients were subjected to clinical, endoscopic, radiological, manometric, and 24-hour pH monitoring and duodenogastric reflux evaluations. Reflux symptoms were observed in 65.1% of patients at late follow-up. Patients without reflux symptoms presented an LES resting pressure of 13.3 ± 4.2 mmHg while patients with reflux symptoms presented an LES resting pressure of 9.8 + 2.1 mmHg. In patients with reflux symptoms, a positive acid reflux test was observed in 77.5% of patients with a mean DeMeester score of 41.7 ± 2.9 (range 14.1-131.7). During endoscopy, esophagitis was found in 29.4%, hiatal hernia in 5.7%, and Barrett's esophagus was diagnosed in 4.8%. Positive duodenogastric reflux was found in 31.8% of patients and 57.7% of our patients received proton pump inhibitor treatment after SG. Sleeve gastrectomy presents anatomic and functional changes that are associated with increased GERD.
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Affiliation(s)
- Italo Braghetto
- Department of Surgery, Hospital 'Dr. José J. Aguirre', Faculty of Medicine, University of Chile
| | - Owen Korn
- Department of Surgery, Hospital 'Dr. José J. Aguirre', Faculty of Medicine, University of Chile
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Gagner M, Kemmeter P. Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review. Surg Endosc 2019; 34:396-407. [PMID: 30993513 PMCID: PMC6946737 DOI: 10.1007/s00464-019-06782-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/04/2019] [Indexed: 12/19/2022]
Abstract
Background Staple-line leaks following laparoscopic sleeve gastrectomy (LSG) remain a concerning complication. Staple-line buttressing is largely adopted as an acceptable reinforcement but data regarding leaks have been equivocal. This study compared staple-line leaks in five reinforcement options during LSG: no reinforcement (NO-SLR), oversewing (suture), nonabsorbable bovine pericardial strips (BPS), tissue sealant or fibrin glue (Seal), or absorbable polymer membrane (APM). Methods This systematic review study of articles published between 2012 and 2016 regarding LSG leak rates aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Variables of interest included leak rates, bleeding, and complications in addition to surgical and population parameters. An independent Fisher’s exact test was used to compare the number of patients with and without leaks for the different reinforcement options. Results Of the 1633 articles identified, 148 met inclusion criteria and represented 40,653 patients. Differences in age (older in APM; p = 0.001), starting body mass index (lower in Suture; p = 0.008), and distance from pylorus (closer in BPS; p = 0.04) were observed between groups, but mean bougie size was equivalent. The overall leak rate of 1.5% (607 leaks) ranged from 0.7% for APM (significantly lower than all groups; p ≤ 0.007 for next lowest leak rate) to 2.7% (BPS). Conclusions This systematic review of staple-line leaks following LSG demonstrated a significantly lower rate using APM staple-line reinforcement as compared to oversewing, use of sealants, BPS reinforcement, or no reinforcement. Variation in surgical technique may also contribute to leak rates. Electronic supplementary material The online version of this article (10.1007/s00464-019-06782-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michel Gagner
- Department of Surgery, Hopital du Sacré Coeur, 315 Place D’Youville, Suite 191, Montréal, QC H2Y 0A4 Canada
- Herbert Wertheim School of Medicine, Florida International University, Miami, FL USA
- Westmount Square Surgical Center, Westmount, QC Canada
| | - Paul Kemmeter
- Department of Surgery, Mercy Health Saint Mary’s, 2060 E Paris Ave SE #100, Grand Rapids, MI USA
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Celik S, Sumer A, Yavuz A, Zarbaliyev E, Dundar I. Proposal for an Index for Predicting the Success of Sleeve Gastrectomy: A Pilot Study. Bariatr Surg Pract Patient Care 2019. [DOI: 10.1089/bari.2018.0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Sebahattin Celik
- Department of General Surgery, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey
| | - Aziz Sumer
- Bariatric-Metabolic Surgery Clinic of Gaziosmanpasa Hospital, Yeni Yuzyıl University, İstanbul, Turkey
| | - Alpaslan Yavuz
- Department of Radiology, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey
| | - Elbrus Zarbaliyev
- Department of General Surgery, Gaziosmanpasa Hospital, Yeni Yuzyıl University, İstanbul, Turkey
| | - Ilyas Dundar
- Department of Radiology, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey
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Randomized controlled trial of monopolar cautery versus clips for staple line bleeding control in Roux-en-Y gastric bypass. Int J Surg 2018; 58:52-56. [PMID: 30240771 DOI: 10.1016/j.ijsu.2018.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/27/2018] [Accepted: 09/07/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Bleeding from the staple line is a rare but serious problem following bariatric surgery. Staple line bleeding control (SLBC) can be achieved in different ways such as the application of sutures, clips, glue or buttressing materials over the staple line. Cauterization alone is generally not preferred due to concerns about debilitating the staple line. OBJECTIVES The aim of this study was to compare the clip and monopolar cauterization methods for SLBC in laparoscopic Roux-en-Y gastric bypass. SETTING University hospital. METHODS A total of 70 morbidly obese patients were randomized into two groups. Patients with previous upper gastrointestinal surgery, re-do procedures and open surgeries were excluded. Their demographic characteristics, intraoperative and postoperative outcomes were examined. RESULTS A total of 489 SLBC interventions (274 clips and 215 cauterizations) were performed after 280 stapling applications. SLBC intervention number and location, additional trocar requirement, blood loss and operation time were not different between the groups. In the clip group, two patients required monopolar cauterization when clipping failed. No intraabdominal bleeding or gastrointestinal leakage was seen in any group. Postoperative gastrointestinal hemorrhage was seen in three patients, two in the clip group and one in the cautery group. There was no difference between the groups in terms of postoperative pain score, abdominal drainage amount, hemoglobin level alteration, morbidity or length of stay. CONCLUSIONS In laparoscopic Roux-en-Y gastric bypass, monopolar cauterization for SLBC can be used instead of clipping. It appears that monopolar cautery is a safe and effective approach for SLBC in laparoscopic Roux-en-Y gastric bypass.
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Song Y, Deng H, Zhou J, Sun J, Zhang X, Ren Y. The Effects of Laparoscopic Sleeve Gastrectomy on Obesity-Related Hypertriglyceridemia-Induced Acute Pancreatitis. Obes Surg 2018; 28:3872-3879. [DOI: 10.1007/s11695-018-3446-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Vives M, Molina A, Danús M, Rebenaque E, Blanco S, París M, Sánchez A, Sabench F, Del Castillo D. Analysis of Gastric Physiology After Laparoscopic Sleeve Gastrectomy (LSG) With or Without Antral Preservation in Relation to Metabolic Response: a Randomised Study. Obes Surg 2018; 27:2836-2844. [PMID: 28478583 DOI: 10.1007/s11695-017-2700-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy is one of the most common techniques in bariatric surgery, but there is no consensus on the optimal distance from the pylorus to start the gastric transection. The aim of this study is to determine the differences in gastric emptying, gastric distension and metabolic response between two starting distances. MATERIAL AND METHODS This is a prospective randomised study of 60 patients (30 patients with the section at 3 cm and 30 patients at 8 cm from the pylorus). We calculate at 6 and 12 months from surgery gastric emptying by scintigraphy (T1/2 min), gastric volume by CT scan (cc) and metabolic response by blood sample analysis (glucose, HbA1c, insulin, HOMA-IR, GLP-1, GIP and C-peptide). RESULTS Gastric emptying increases the speed significantly in both groups but is greater in the 3-cm group (p < 0.05). Dividing groups into type 2 diabetic patients and non-diabetic patients, the speed in non-diabetic patients is significantly higher for the 3-cm group. Residual volume increases significantly in both groups, and there are no differences between them. One year after surgery, there are significant improvements in the hyperinsulinaemia in the patients of the 3-cm group with respect to the 8-cm group, but only in diabetic patients. No differences between groups are found regarding changes in GLP-1 or GIP. CONCLUSIONS Gastric emptying is faster in patients with antrum resection. The distance does not influence the gastric emptying of diabetic patients. Other mechanisms may explain metabolic response besides GLP-1 and its association with improvements in diabetes via gastric emptying.
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Affiliation(s)
- M Vives
- Surgery Service, University Hospital of Sant Joan, Faculty of Medicine, IISPV, "Rovira i Virgili" University, Reus, Tarragona, Spain
| | - A Molina
- Surgery Service, University Hospital of Sant Joan, Faculty of Medicine, IISPV, "Rovira i Virgili" University, Reus, Tarragona, Spain
| | - M Danús
- Nuclear Medicine Service, University Hospital of Sant Joan, Faculty of Medicine, IISPV, "Rovira i Virgili" University, Reus, Tarragona, Spain
| | - E Rebenaque
- Radiology Service, University Hospital of Sant Joan, Faculty of Medicine, IISPV, "Rovira i Virgili" University, Reus, Tarragona, Spain
| | - S Blanco
- Surgery Service, University Hospital of Sant Joan, Faculty of Medicine, IISPV, "Rovira i Virgili" University, Reus, Tarragona, Spain
| | - M París
- Surgery Service, University Hospital of Sant Joan, Faculty of Medicine, IISPV, "Rovira i Virgili" University, Reus, Tarragona, Spain
| | - A Sánchez
- Surgery Service, University Hospital of Sant Joan, Faculty of Medicine, IISPV, "Rovira i Virgili" University, Reus, Tarragona, Spain
| | - F Sabench
- Surgery Service, University Hospital of Sant Joan, Faculty of Medicine, IISPV, "Rovira i Virgili" University, Reus, Tarragona, Spain.
| | - D Del Castillo
- Surgery Service, University Hospital of Sant Joan, Faculty of Medicine, IISPV, "Rovira i Virgili" University, Reus, Tarragona, Spain.
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Impact of Laparoscopic Sleeve Gastrectomy on Gastrointestinal Motility. Gastroenterol Res Pract 2018; 2018:4135813. [PMID: 29849586 PMCID: PMC5907392 DOI: 10.1155/2018/4135813] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 03/04/2018] [Indexed: 01/19/2023] Open
Abstract
Objective Laparoscopic sleeve gastrectomy (LSG) was considered mainly as a restrictive procedure due to anatomic alterations in the upper gastrointestinal tract. Additionally, due to neurohormonal alterations, LSG modifies the gastrointestinal motility, which controls appetite and feeling of satiety. Aim The aim of the study was to review the impact of laparoscopic sleeve gastrectomy on gastrointestinal motility. Material and Methods A search of the medical literature was undertaken in Pubmed, Web of Science, and Cochrane library. Esophageal, gastric, bowel motility were assessed separately. Results Nine studies assessed esophageal motility. The data remain debatable attributing to the heterogeneity of follow-up timing, surgical technique, bougie size, and distance from pylorus. The stomach motility was assessed in eighteen studies. Functionally, the sleeve was divided into a passive sleeve and an accelerated antrum. All scintigraphic studies revealed accelerated gastric emptying after LSG except of one. Patients demonstrated a rapid gastroduodenal transit time. The resection of the gastric pacemaker had as a consequence aberrant distal ectopic pacemaking or bioelectrical quiescence after LSG. The bowel motility was the least studied. Small bowel transit time was reduced; opposite to that the initiation of cecal filling and the ileocecal valve transit was delayed. Conclusion Laparoscopic sleeve gastrectomy has impacts on gastrointestinal motility. The data remain debatable for esophageal motility. Stomach and small bowel motility were accelerated, while the initiation of cecal filling and the ileocecal valve transit was delayed. Further pathophysiological studies are needed to evaluate the correlation of motility data with clinical symptoms.
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McGlone ER, Gupta AK, Reddy M, Khan OA. Antral resection versus antral preservation during laparoscopic sleeve gastrectomy for severe obesity: Systematic review and meta-analysis. Surg Obes Relat Dis 2018; 14:857-864. [PMID: 29602713 DOI: 10.1016/j.soard.2018.02.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/19/2018] [Accepted: 02/20/2018] [Indexed: 11/24/2022]
Abstract
Although laparoscopic sleeve gastrectomy is an established operation for severe obesity, there is controversy regarding the extent to which the antrum is excised. The objective of this systematic review was to investigate the effect on perioperative complications and medium-term outcomes of antral resecting versus antral preserving sleeve gastrectomy. MEDLINE, EMBASE, and Cochrane databases were searched from 1946 to April 2017. Eligible studies compared antral resection (staple line commencing 2-3 cm from pylorus) with antral preservation (>5 cm from pylorus) in patients undergoing primary sleeve gastrectomy for obesity. Meta-analyses were performed with a random-effects model, and risk of bias within and across studies was assessed using validated scoring systems. Eight studies (619 participants) were included: 6 randomized controlled trials and 2 cohort studies. Overall follow-up was 94% for the specified outcomes of each study. Mean percentage excess weight loss was 62% at 12 months (7 studies; 574 patients) and 67% at 24 months (4 studies; 412 patients). Antral resection was associated with significant improvement in percentage excess weight loss at 24-month follow-up (mean 70% versus 61%; standardized mean difference .95; confidence interval .35-1.58, P<.005), an effect that remained significant when cohort studies were excluded. There was no difference in incidence of perioperative bleeding, leak, or de novo gastroesophageal reflux disease. According to the available evidence, antral resection is associated with better medium-term weight loss compared with antral preservation, without increased risk of surgical complications. Further randomized clinical trials are indicated to confirm this finding.
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Affiliation(s)
- Emma Rose McGlone
- Department of Metabolic and Investigative Medicine, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom.
| | - Ajay K Gupta
- Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Marcus Reddy
- Department of Upper Gastrointestinal and Bariatric Surgery, St George's Hospital, London, United Kingdom; Department of Upper GI and Bariatrics, Hebei Medical University, Shijiazhuang, China
| | - Omar A Khan
- Department of Upper Gastrointestinal and Bariatric Surgery, St George's Hospital, London, United Kingdom; Population Health Research Institute, St George's, University of London, London, United Kingdom
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Garay M, Balagué C, Rodríguez-Otero C, Gonzalo B, Domenech A, Pernas JC, Gich IJ, Miñambres I, Fernández-Ananín S, Targarona EM. Influence of antrum size on gastric emptying and weight-loss outcomes after laparoscopic sleeve gastrectomy (preliminary analysis of a randomized trial). Surg Endosc 2018; 32:2739-2745. [PMID: 29313122 DOI: 10.1007/s00464-017-5972-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 10/29/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has increased in popularity in recent years as a definitive bariatric procedure. Despite its growing popularity worldwide, the surgical technique is not well standardized. There is a lack of evidence on the matter of the antrum size and its relation to gastric emptying and weight-loss outcomes. The aim of the study is to evaluate the influence of antrum size over gastric emptying and weight-loss outcomes. METHODS Twenty-five patients were prospectively randomized according to the distance between the first firing and the pylorus: AR group (antrum resection-2 cm from the pylorus) and AP group (antrum preservation-5 cm from the pylorus). Gastric emptying (%GE) was evaluated by a gastric emptying scintigraphy before surgery, 2 months and 1 year after LSG. Antrum volume was measured using a MultiSlice CT Scan performed 2 months and 1 year after surgery. The percent of excess weight loss (%EWL) was calculated after 1 year follow-up. RESULTS At 2 months after LSG the mean %GE was 69.7 ± 18 in the AR group and 72.8 ± 20 in the AP group (p = 0.69). At 1 year it was 66.5 ± 21 and 74.2 ± 16 in the AR and AP groups, respectively (p = 0.30). A significant accelerated gastric emptying was observed at 2 months (p = 0.025) and at 1 year (p = 0.013) in the AP group. Meanwhile in the AR group this increase was not significant (p = 0.12 at 2 months and p = 0.21 at 1 year). Differences regarding the %EWL between groups were no statistically significant (p = 0.74). CONCLUSIONS After LSG there is a global tendency to an accelerated gastric emptying, although only significant in the antrum preservation group; however, no differences were observed regarding the %EWL between groups after 1 year follow-up.
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Affiliation(s)
- Meritxell Garay
- Surgical Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Carmen Balagué
- Surgical Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Rodríguez-Otero
- Surgical Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Berta Gonzalo
- Surgical Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Domenech
- Department of Nuclear Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Carlos Pernas
- Department of Radiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ignasi J Gich
- Department of Epidemiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Inka Miñambres
- Department of Endocrinology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sonia Fernández-Ananín
- Surgical Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eduardo M Targarona
- Surgical Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Changes in Gastric Volume and Their Implications for Weight Loss after Laparoscopic Sleeve Gastrectomy. Obes Surg 2017; 27:303-309. [PMID: 27484976 DOI: 10.1007/s11695-016-2274-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a relatively new surgical technique for the treatment of morbid obesity. It is unclear whether the volume of the gastric remnant can expand after surgery as a result of intraluminal pressure maintained over time. If this were the case, the increased volume could affect weight loss and the improvement in comorbidities. This study aims to assess the evolution of residual gastric volume (RGV) during the first year after LSG and its relationship with weight loss. MATERIAL AND METHODS We conducted a prospective study of 112 patients who underwent LSG from February 2009 to December 2013. In order to measure the RGV after surgery, all patients were evaluated radiologically by an esophagogastroduodenal (EGD) transit at 1 and 12 postoperative months. RESULTS All patients showed a significant reduction in BMI compared with the preoperative measurement (33.48 ± 5.78 vs. 50.54 ± 6.69 kg/m2; p < 0.001). Increased RGV was observed when comparing the results obtained by EGD transit at 1 (68.39 ± 25.89 cm3) and 12 postoperative months (122.58 ± 38.76 cm3; p < 0.001). There was no association between increase in gastric volume and weight loss at 1-year follow-up (r = 0.01; p = 0.910). CONCLUSIONS The volume of the gastric remnant increased significantly during the first year after LSG. However, this increase was not associated with weight loss. Further prospective research with longer follow-up periods is needed to confirm or contrast the present results.
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Wismann P, Barkholt P, Secher T, Vrang N, Hansen HB, Jeppesen PB, Baggio LL, Koehler JA, Drucker DJ, Sandoval DA, Jelsing J. The endogenous preproglucagon system is not essential for gut growth homeostasis in mice. Mol Metab 2017; 6:681-692. [PMID: 28702324 PMCID: PMC5485241 DOI: 10.1016/j.molmet.2017.04.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 04/21/2017] [Accepted: 04/24/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The prevalence of obesity and related co-morbidities is reaching pandemic proportions. Today, the most effective obesity treatments are glucagon-like peptide 1 (GLP-1) analogs and bariatric surgery. Interestingly, both intervention paradigms have been associated with adaptive growth responses in the gut; however, intestinotrophic mechanisms associated with or secondary to medical or surgical obesity therapies are poorly understood. Therefore, the objective of this study was to assess the local basal endogenous and pharmacological intestinotrophic effects of glucagon-like peptides and bariatric surgery in mice. METHODS We used in situ hybridization to provide a detailed and comparative anatomical map of the local distribution of GLP-1 receptor (Glp1r), GLP-2 receptor (Glp2r), and preproglucagon (Gcg) mRNA expression throughout the mouse gastrointestinal tract. Gut development in GLP-1R-, GLP-2R-, or GCG-deficient mice was compared to their corresponding wild-type controls, and intestinotrophic effects of GLP-1 and GLP-2 analogs were assessed in wild-type mice. Lastly, gut volume was determined in a mouse model of vertical sleeve gastrectomy (VSG). RESULTS Comparison of Glp1r, Glp2r, and Gcg mRNA expression indicated a widespread, but distinct, distribution of these three transcripts throughout all compartments of the mouse gastrointestinal tract. While mice null for Glp1r or Gcg showed normal intestinal morphology, Glp2r-/- mice exhibited a slight reduction in small intestinal mucosa volume. Pharmacological treatment with GLP-1 and GLP-2 analogs significantly increased gut volume. In contrast, VSG surgery had no effect on intestinal morphology. CONCLUSION The present study indicates that the endogenous preproglucagon system, exemplified by the entire GCG gene and the receptors for GLP-1 and GLP-2, does not play a major role in normal gut development in the mouse. Furthermore, elevation in local intestinal and circulating levels of GLP-1 and GLP-2 achieved after VSG has limited impact on intestinal morphometry. Hence, although exogenous treatment with GLP-1 and GLP-2 analogs enhances gut growth, the contributions of endogenously-secreted GLP-1 and GLP-2 to gut growth may be more modest and highly context-dependent.
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Affiliation(s)
| | | | - Thomas Secher
- Gubra Aps, Hørsholm Kongevej 11B, DK-2970 Hørsholm, Denmark
| | - Niels Vrang
- Gubra Aps, Hørsholm Kongevej 11B, DK-2970 Hørsholm, Denmark
| | | | | | - Laurie L. Baggio
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, M5G1X5, Canada
| | - Jacqueline A. Koehler
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, M5G1X5, Canada
| | - Daniel J. Drucker
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, M5G1X5, Canada
| | | | - Jacob Jelsing
- Gubra Aps, Hørsholm Kongevej 11B, DK-2970 Hørsholm, Denmark
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Sleeve Gastrectomy: Correlation of Long-Term Results with Remnant Morphology and Eating Disorders. Obes Surg 2017; 27:2845-2854. [DOI: 10.1007/s11695-017-2713-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Laparoscopic Sleeve Gastrectomy Outcomes of 750 Patients: A 2.5-Year Experience at a Bariatric Center of Excellence. Surg Laparosc Endosc Percutan Tech 2016; 26:e145-e148. [DOI: 10.1097/sle.0000000000000358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Samuel B, Atiemo K, Cohen P, Czerniach D, Kelly J, Perugini R. The Effect of Sleeve Gastrectomy on Gastroparesis: A Short Clinical Review. Bariatr Surg Pract Patient Care 2016. [DOI: 10.1089/bari.2015.0052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Bankole Samuel
- Department of Surgery, University of Massachusetts, Worcester, Massachusetts
| | - Kofi Atiemo
- Department of Surgery, University of Massachusetts, Worcester, Massachusetts
| | - Phillip Cohen
- Department of Surgery, University of Massachusetts, Worcester, Massachusetts
| | - Donald Czerniach
- Department of Surgery, University of Massachusetts, Worcester, Massachusetts
| | - John Kelly
- Department of Surgery, University of Massachusetts, Worcester, Massachusetts
| | - Richard Perugini
- Department of Surgery, University of Massachusetts, Worcester, Massachusetts
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Obeidat F, Shanti H, Mismar A, Albsoul N, Al-Qudah M. The Magnitude of Antral Resection in Laparoscopic Sleeve Gastrectomy and its Relationship to Excess Weight Loss. Obes Surg 2016; 25:1928-32. [PMID: 25744305 DOI: 10.1007/s11695-015-1642-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the effect of antral resection on weight loss and complications after laparoscopic sleeve gastrectomy (LSG). METHODS This was a retrospective study of the prospectively collected data of patients who underwent LSG at Jordan University Hospital from February 2011 to February 2012. Patients were divided into two groups based on antral resection: group A underwent a 6-cm antral resection, and group B underwent a 2-cm antral resection. The percentage of excess weight loss (%EWL) was calculated at 3, 6, 12, and 24 months postoperatively. RESULTS One hundred and ten patients were included in the study, all of whom completed at least 24 months of follow-up (mean follow-up, 33 months). Their mean body mass index was 46.1 ± 7.9 kg/m(2). In group A, the mean %EWL was 38.1 ± 14.1, 54.9 ± 19.9, 65.6 ± 22.8, and 66.8 ± 28.4% at 3, 6, 12, and 24 months, respectively. However, in group B, the mean %EWL was 42.1 ± 13.4, 63.8 ± 19.8, 80.0 ± 22.1, and 81.5 ± 22.9% at 3, 6, 12, and 24 months, respectively. Patients in group B experienced statistically significant greater weight loss than patients in group A. Statistically significant greater weight regain was seen in group A. Group A had a higher incidence of reflux symptoms (six patients; 11%) than group B (four patients; 7.1%). CONCLUSIONS Radical antral resection in association with LSG safely potentiates the restrictive effect achieved and may result in greater and better maintained weight loss.
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Affiliation(s)
- Firas Obeidat
- Department of General Surgery, Faculty of Medicine, The University of Jordan, Amman, Jordan,
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Robert M, Pasquer A, Pelascini E, Valette PJ, Gouillat C, Disse E. Impact of sleeve gastrectomy volumes on weight loss results: a prospective study. Surg Obes Relat Dis 2016; 12:1286-1291. [PMID: 27134194 DOI: 10.1016/j.soard.2016.01.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/24/2015] [Accepted: 01/22/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Causes of weight loss failure after sleeve gastrectomy (SG) are still controversial. The impact of the size of the sleeve continues to be debated. OBJECTIVE The aim of our study was to determine the impact of sleeve volumes assessed at 3 months using gastric computed tomography (CT) on weight loss at 18 months. SETTING University Hospital, France. METHODS Sixty-seven obese patients eligible for SG were prospectively evaluated. Sleeve volumes were assessed postsurgery using 3-dimensional gastric CT with gas at 3 months and weight loss outcomes recorded up to 18 months. The population was divided into 2 groups: the first tertile (n = 22) with the smallest gastric volume was defined as the "small sleeve" group (SSG) and the rest of the population (n = 45) was defined as the "without small sleeve" group (WSSG). RESULTS No patients were lost to follow-up. In the SSG, overall gastric volume was 133±7 mL versus 264±11 mL for the WSSG (P<.0001). Percentage excess body mass index loss (%EBMIL) during the first postoperative 18 months was significantly greater in the SSG compared with the WSSG (P = .04). Although the volume of the gastric tube was not correlated with weight loss (r =-.04, P = .78), there was a negative linear correlation between the volume of the antrum and the %EBMIL at 18 months (r =-.39, P = .005). A narrow gastric tube was also associated with a high digestive intolerance and reflux. CONCLUSION Our data suggest that performing the sleeve with a not-too-small bougie size and a radical antrectomy could improve weight loss and digestive tolerance.
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Affiliation(s)
- Maud Robert
- Department of Digestive and Bariatric Surgery, E. Herriot University Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France.
| | - Arnaud Pasquer
- Department of Digestive and Bariatric Surgery, E. Herriot University Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Elise Pelascini
- Department of Digestive and Bariatric Surgery, E. Herriot University Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Pierre-Jean Valette
- Claude Bernard Lyon 1 University, Lyon, France; Department of Radiology, E. Herriot University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Christian Gouillat
- Department of Digestive and Bariatric Surgery, E. Herriot University Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Emmanuel Disse
- Claude Bernard Lyon 1 University, Lyon, France; Department of Endocrinology, Lyon Sud University Hospital, Hospices Civils de Lyon, Lyon, France
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Mans E, Serra-Prat M, Palomera E, Suñol X, Clavé P. Sleeve gastrectomy effects on hunger, satiation, and gastrointestinal hormone and motility responses after a liquid meal test. Am J Clin Nutr 2015; 102:540-7. [PMID: 26201818 DOI: 10.3945/ajcn.114.104307] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 07/01/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The relation between hunger, satiation, and integrated gastrointestinal motility and hormonal responses in morbidly obese patients after sleeve gastrectomy has not been determined. OBJECTIVE The objective was to assess the effects of sleeve gastrectomy on hunger, satiation, gastric and gallbladder motility, and gastrointestinal hormone response after a liquid meal test. DESIGN Three groups were studied: morbidly obese patients (n = 16), morbidly obese patients who had had sleeve gastrectomy (n = 8), and nonobese patients (n = 16). The participants fasted for 10 h and then consumed a 200-mL liquid meal (400 kcal + 1.5 g paracetamol). Fasting and postprandial hunger, satiation, hormone concentrations, and gastric and gallbladder emptying were measured several times over 4 h. RESULTS No differences were observed in hunger and satiation curves between morbidly obese and nonobese groups; however, sleeve gastrectomy patients were less hungry and more satiated than the other groups. Antrum area during fasting in morbidly obese patients was statistically significant larger than in the nonobese and sleeve gastrectomy groups. Gastric emptying was accelerated in the sleeve gastrectomy group compared with the other 2 groups (which had very similar results). Gallbladder emptying was similar in the 3 groups. Sleeve gastrectomy patients showed the lowest ghrelin concentrations and higher early postprandial cholecystokinin and glucagon-like peptide 1 peaks than did the other participants. This group also showed an improved insulin resistance pattern compared with morbidly obese patients. CONCLUSIONS Sleeve gastrectomy seems to be associated with profound changes in gastrointestinal physiology that contribute to reducing hunger and increasing sensations of satiation. These changes include accelerated gastric emptying, enhanced postprandial cholecystokinin and glucagon-like peptide 1 concentrations, and reduced ghrelin release, which together may help patients lose weight and improve their glucose metabolism after surgery. This trial was registered at clinicaltrials.gov as NCT02414893.
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Affiliation(s)
| | - Mateu Serra-Prat
- Research Unit, and Center for Biomedical Research Network of Hepatic and Digestive Diseases (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain; and
| | | | | | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Maresme Health Consortium, Barcelona, Spain; Center for Biomedical Research Network of Hepatic and Digestive Diseases (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain; and Autonomous University of Barcelona, Barcelona, Spain
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The effect of residual gastric antrum size on the outcome of laparoscopic sleeve gastrectomy: a prospective randomized trial. Surg Obes Relat Dis 2014; 11:997-1003. [PMID: 25638594 DOI: 10.1016/j.soard.2014.12.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/02/2014] [Accepted: 12/19/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is gaining popularity worldwide as a definitive bariatric procedure. However, there are still some controversial issues associated with the technique, one of which is the size of the residual antrum. OBJECTIVES The aim of this prospective randomized trial is to study the effect of the size of the residual gastric antrum on the outcome of LSG. SETTINGS University-affiliated hospital. METHODS Between November 2009 and August 2013, 113 morbidly obese patients submitted for LSG were randomized into 2 groups, namely antral preserving-LSG (AP-LSG) and antral resecting-LSG (AR-LSG), depending on the distance from the pylorus at which gastric division begins. In the AP-LSG group, the distance was 6 cm from the pylorus and included 58 patients, whereas the distance was 2 cm in the AR-LSG group and included 55 patients. The follow-up period was at least 12 months. Baseline and 6 and 12 month outcomes were analyzed including assessments of the percent excess weight lost (%EWL), reduction in BMI, morbidity, mortality, reoperations, quality of life, and co-morbidities. RESULTS Both groups were comparable regarding age, gender, body mass index (BMI), and co-morbidities. There was one 30-day mortality, and there was no significant difference in the complication rate or early reoperations between the 2 groups. Weight loss was significant in both groups at 6 and 12 months. At 12 months, weight loss was greater in the AR-LSG than in the AP-LSG group, but with was no significant difference between the 2 groups at 12 months (%EWL was 64.2% in the AP-LSG group and 67.6% in the AR-LSG group; p>.05). The resolution/improvement of co-morbidities, quality of life outcome and the overall prevalence of co-morbidities were similar. CONCLUSIONS LSG with or without antral preservation produces significant weight loss after surgery. The 2 procedures are equally effective regarding %EWL, morbidity, quality of life, and amelioration of co-morbidities.
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Nassif PAN, Malafaia O, Ribas-Filho JM, Czeczko NG, Garcia RF, Ariede BL. Vertical gastrectomy and gastric bypass in Roux-en-Y induce postoperative gastroesophageal reflux disease? ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2014; 27 Suppl 1:63-8. [PMID: 25409970 PMCID: PMC4743523 DOI: 10.1590/s0102-6720201400s100016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 11/08/2014] [Indexed: 12/15/2022]
Abstract
Background The association between obesity and gastroesophageal reflux disease has a high
incidence and may be present in half of obese patients with surgical indication.
Bariatric operations can also induce reflux alone - differently from BMI factors -
and its mechanisms are dependent on the type of procedure performed. Objective To perform a literature review comparing the two procedures currently most used
for surgical treatment of obesity and analyze their relationship with the advent
of pre-existing reflux disease or its appearance only in postoperative period. Method The literature was reviewed in virtual database Medline/PubMed, SciELO, Lilacs,
Embase and Cochrane crossing the following MeSH descriptors: gastric bypass AND /
OR anastomosis, Roux-en-Y AND / OR gastroesophageal reflux AND / OR
gastroenterostomy AND / OR gastrectomy AND / OR obesity AND / OR bariatric surgery
AND / OR postoperative period. A total of 135 relevant references were considered
but only 30 were used in this article. Also was added the experience of the
authors of this article in handling these techniques on this field. Conclusion The structural changes caused by surgical technique in vertical gastrectomy shows
greater commitment of antireflux mechanisms predisposing the induction of GERD
postoperatively compared to the surgical technique performed in the
gastrointestinal Bypass Roux-en-Y.
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Affiliation(s)
- Paulo Afonso Nunes Nassif
- Medical Research Institute, University Evangelic Hospital of Curitiba, Evangelic Faculty of Paraná, Curitiba, PR, Brazil
| | - Osvaldo Malafaia
- Medical Research Institute, University Evangelic Hospital of Curitiba, Evangelic Faculty of Paraná, Curitiba, PR, Brazil
| | - Jurandir Marcondes Ribas-Filho
- Medical Research Institute, University Evangelic Hospital of Curitiba, Evangelic Faculty of Paraná, Curitiba, PR, Brazil
| | - Nicolau Gregori Czeczko
- Medical Research Institute, University Evangelic Hospital of Curitiba, Evangelic Faculty of Paraná, Curitiba, PR, Brazil
| | - Rodrigo Ferreira Garcia
- Medical Research Institute, University Evangelic Hospital of Curitiba, Evangelic Faculty of Paraná, Curitiba, PR, Brazil
| | - Bruno Luiz Ariede
- Medical Research Institute, University Evangelic Hospital of Curitiba, Evangelic Faculty of Paraná, Curitiba, PR, Brazil
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Obeidat FW, Shanti HA, Mismar AA, Elmuhtaseb MS, Al-Qudah MS. Volume of Resected Stomach as a Predictor of Excess Weight Loss After Sleeve Gastrectomy. Obes Surg 2014; 24:1904-8. [DOI: 10.1007/s11695-014-1330-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
In the biliopancreatic diversion (BPD) type duodenal switch, sleeve gastrectomy was applied as the restrictive part instead of a horizontal gastrectomy in the original Scopinaro type BPD. Laparoscopic sleeve gastrectomy (LSG) was used as a first step in a staged concept for high-risk patients undergoing bariatric surgery. However, it is now being increasingly favored as a stand-alone procedure. This article discusses the history, surgical technique, early results, metabolic effects, mid- to long-term results regarding weight loss, improvement of comorbidities and quality of life, management of complications and indications. LSG is a safe and effective bariatric procedure with satisfying weight loss results and effects on comorbidities. Further data are required to assess long-term effectiveness and safety of LSG. In patients with very high initial BMI, LSG can be used in a staged concept. Other indications are: in cases with dense adhesions of the small bowel, patients with inflammatory bowel disease and patients where repeated endoscopy of the duodenum is necessary.
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Chambers AP, Smith EP, Begg DP, Grayson BE, Sisley S, Greer T, Sorrell J, Lemmen L, LaSance K, Woods SC, Seeley RJ, D'Alessio DA, Sandoval DA. Regulation of gastric emptying rate and its role in nutrient-induced GLP-1 secretion in rats after vertical sleeve gastrectomy. Am J Physiol Endocrinol Metab 2014; 306:E424-32. [PMID: 24368666 PMCID: PMC3923088 DOI: 10.1152/ajpendo.00469.2013] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) are effective weight loss surgeries that also improve glucose metabolism. Rapid, early rises of circulating insulin and glucagon-like peptide-1 (GLP-1) concentrations following food ingestion are characteristic of these procedures. The purpose of the current study was to test the hypothesis that postprandial hormone release is due to increased nutrient emptying from the stomach. Radioscintigraphy and chemical and radiolabeled tracers were used to examine gastric emptying in rat models of VSG and RYGB surgery. Intraduodenal nutrient infusions were used to assess intestinal GLP-1 secretion and nutrient sensitivity in VSG rats compared with shams. Five minutes after a nutrient gavage, the stomachs of RYGB and VSG rats were completely emptied, whereas only 6.1% of the nutrient mixture had emptied from sham animals. Gastric pressure was increased in VSG animals, and rats with this procedure did not inhibit gastric emptying normally in response to increasing caloric loads of dextrose or corn oil, and they did not respond to neural or endocrine effectors of gastric motility. Finally, direct infusion of liquid nutrients into the duodenum caused significantly greater GLP-1 release in VSG compared with shams, indicating that increases in GLP-1 secretion after VSG are the result of both greater gastric emptying rates and altered responses at the level of the intestine. These findings demonstrate greatly accelerated gastric emptying in rat models of RYGB and VSG. In VSG this is likely due to increased gastric pressure and reduced responses to inhibitory feedback from the intestine.
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Affiliation(s)
- Adam P Chambers
- Division of Endocrinology and Metabolism, University of Cincinnati, Cincinnati, Ohio
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Nassif PAN, Valadão JA, Malafaia O, Torres OJM, Garcia RF, Klostemann FC. Technical modification for sleeve gastrectomy. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2014; 26 Suppl 1:74-8. [PMID: 24463904 DOI: 10.1590/s0102-67202013000600016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 06/17/2013] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The surgical technique of sleeve gastrectomy has not been fully standardized and, therefore, there are issues to be solved. There is a tendency to increase its application due to proved efficiency in weight loss, low morbidity and good postoperative results. However, gastroesophageal reflux disease, which can result from it, is still not well understood. AIM To present variant technique for sleeve gastrectomy that leaves the stomach totally with the appearance of a homogeneous tube, without manipulation in pyloric and lower esophageal sphincters. TECNIQUE Vertical gastrectomy starts with vessel ligation of the greater curvature at the pylorus till esophagogastric angle. Stapling also starts from the pylorus in the same direction. For modeling was used Fouchet 32 F and all the staple line was done just to it. At the end, oversuture of the staple line and "sump" drainage were done. RESULTS The procedure was used in 55 patients with BMI between 35 and 41. Complications in this group were two fistulas at the esophagogastric angle, one twist of the gastric tube and one postoperative conversion to Roux-en-Y gastric bypass due to untreatable gastroesophageal reflux disease. Fistulas were treated by endoscopic procedure with dilation and septotomy. Mild dysphagia due to tube twisting responded satisfactorily to dilatation. The longest follow-up was two years. The loss of overweight was 67.7% at one year and 69.7% in two. Patients who were suffering from type 2 diabetes mellitus showed disease control in 84.6 % in the first year and 91.6 % in the second. Comorbidities were controlled in all cases. CONCLUSION The variant technique proposed here for sleeve gastrectomy leaves the stomach homogeneously in a shape of a tube and in small caliber, providing small free gastric cavity and keeping natural functional activity of the sphincters. However, it may lead to unwanted gastroesophageal reflux, which needs to be better measured in future research.
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Trung VN, Yamamoto H, Furukawa A, Yamaguchi T, Murata S, Yoshimura M, Murakami Y, Sato S, Otani H, Ugi S, Morino K, Maegawa H, Tani T. Enhanced Intestinal Motility during Oral Glucose Tolerance Test after Laparoscopic Sleeve Gastrectomy: Preliminary Results Using Cine Magnetic Resonance Imaging. PLoS One 2013; 8:e65739. [PMID: 23823622 PMCID: PMC3688799 DOI: 10.1371/journal.pone.0065739] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/26/2013] [Indexed: 12/11/2022] Open
Abstract
Background Enhanced secretion of glucagon-like peptide-1 (GLP-1) has been suggested as a possible mechanism underlying the improvement in type 2 diabetes mellitus (T2DM) after laparoscopic sleeve gastrectomy (LSG). However, the reason for enhanced GLP-1 secretion during glucose challenge after LSG remains unclear because LSG does not include intestinal bypass. In this study, we focused on the effects of LSG on GLP-1 secretion and intestinal motility during the oral glucose tolerance test (OGTT) using cine magnetic resonance imaging (MRI) before and 3 months after LSG. Methods LSG was performed in 12 obese patients with a body mass index >35 kg/m2. Six patients had T2DM. OGTT was performed before and 3 months after the surgery. Body weight, hemoglobin A1c (HbA1c), and GLP-1 levels during OGTT were examined, and intestinal motility during OGTT was assessed using cine MRI. Results Body weight was significantly decreased after surgery in all the cases. HbA1c was markedly decreased in all the diabetic subjects. In all cases, GLP-1 secretion during OGTT was enhanced and cine MRI showed markedly increased intestinal motility at 15 and 30 min during OGTT after LSG. Conclusions LSG leads to accelerated intestinal motility and reduced intestinal transit time, which may be involved in the mechanism underlying enhanced GLP-1 secretion during OGTT after LSG.
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Affiliation(s)
- Vo Nguyen Trung
- Department of Surgery, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga, Japan
| | - Hiroshi Yamamoto
- Department of Surgery, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga, Japan
- * E-mail:
| | - Akira Furukawa
- Department of Radiology, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga, Japan
| | - Tsuyoshi Yamaguchi
- Department of Surgery, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga, Japan
| | - Satoshi Murata
- Department of Surgery, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga, Japan
| | - Masahiro Yoshimura
- Department of Radiology, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga, Japan
| | - Yoko Murakami
- Department of Radiology, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga, Japan
| | - Shigetaka Sato
- Department of Radiology, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga, Japan
| | - Hideji Otani
- Department of Radiology, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga, Japan
| | - Satoshi Ugi
- Department of Medicine Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga, Japan
| | - Katsutaro Morino
- Department of Medicine Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga, Japan
| | - Hiroshi Maegawa
- Department of Medicine Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga, Japan
| | - Tohru Tani
- Department of Surgery, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga, Japan
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