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Hailstone L, Tovmassian D, Nguyen CL, Wong P, Le Page PA, Martin D, Taylor C. Medium-Term Outcomes from a Series of 1000 One Anastomosis Gastric Bypass in Australia: A Case Series. Obes Surg 2024; 34:2111-2115. [PMID: 38609707 PMCID: PMC11127843 DOI: 10.1007/s11695-024-07213-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE This study presents the short- (less than 6 months) and medium-term (6 months to 2 years) outcomes for weight loss and type 2 diabetes mellitus (T2DM) for all patients undergoing one anastomosis gastric bypass (OAGB) across multiple institutions between 2015 and 2021. MATERIALS AND METHODS A retrospective analysis of prospectively collected databases was performed including 1022 participants who underwent OAGB at multiple institutions by multiple surgeons between 2015 and 2021. Primary outcome was percentage total weight loss (TWL) and secondary outcomes were achieving resolution of T2DM; OAGB specific short- and medium-term complications including bile reflux, marginal ulceration and internal herniation. RESULTS One thousand and twenty-two patients underwent OAGB (81% primary surgery). A percentage of 34.1% (n = 349) had a preoperative diagnosis of type 2 diabetes mellitus (T2DM). Mean TWL was 33.6 ± 9% with a T2DM remission rate of 74% at 1-year post-op. Rates of bile reflux and marginal ulceration was 1.1% (n = 11) and 1.1% (n = 11). There were no cases of internal herniation during the follow-up period. CONCLUSION OAGB results has echoed previously published work as being efficacious and safe in a short-medium term. The prevalence of complications, especially bile reflux is overall low in our population and no current evidence exists to support an increased risk of metaplasia or malignancy related to bile within the stomach.
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Affiliation(s)
- Laura Hailstone
- Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - David Tovmassian
- Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia.
- University of Sydney, Sydney, NSW, Australia.
| | - Chu Luan Nguyen
- Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
| | - Pearl Wong
- Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | | | - David Martin
- Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Craig Taylor
- Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia
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Karabacak U, Mollaoglu MC, Seven TE, Karadayi K. Gastric pouch cancer after mini gastric bypass surgery: The first case report. J Cancer Res Ther 2024; 20:472-475. [PMID: 38554368 DOI: 10.4103/jcrt.jcrt_1749_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/10/2022] [Indexed: 01/05/2023]
Abstract
Development of gastric cancer following bariatric surgery is very rare. Nearly all patients with cancer after mini gastric bypass/one anastomosis gastric bypass have carcinoma in their remnant stomach. This is the first case with the development of gastric cancer in the gastric pouch following mini gastric bypass surgery. Our case was a 32-year-old woman who was admitted to our department with oral intolerance 5 years after mini gastric bypass. In her endoscopic examination, an ulcerovegetan mass in the gastric pouch (Siewert type III) was detected. The pathological examination of the biopsies was reported as low differentiated adenocarcinoma. Clinical staging was performed using Positron emission tomographycomputed tomography (PET-CT) and endoscopic ultrasonography (T3N1M0). Following four cycles of neoadjuvant chemotherapy, en-bloc total gastrectomy, D2 lymph node dissection, and partial small intestine resection were performed. In pathological evaluation, no tumors were detected in the specimen and a total of 38 lymph nodes were dissected. This finding was accepted as a pathologic complete response. Signs and symptoms such as anemia, oral intolerance, and vomiting that develop after bariatric surgery can often be attributed to the surgical procedure performed, but it should be kept in mind that similar symptoms may also be associated with malignancy. In case of clinical suspicion, endoscopic examination and cross-sectional imaging should be performed.
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Affiliation(s)
- Ufuk Karabacak
- Department of Surgical Oncology, Numune Hospital, Sivas, Turkey
| | | | - Turan Eray Seven
- Department of Surgical Oncology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Kursat Karadayi
- Department of Surgical Oncology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
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Ding Z, Jin L, Song Y, Feng C, Shen P, Li H. Comparison of single-anastomosis gastric bypass and sleeve gastrectomy on type 2 diabetes mellitus remission for obese patients: A meta-analysis of randomized controlled trials. Asian J Surg 2023; 46:4152-4160. [PMID: 37002039 DOI: 10.1016/j.asjsur.2023.03.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 02/27/2023] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
Currently, the increasing numbers of one anastomosis gastric bypass (OAGB) brought this technique in the third position in order of frequency, behind sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). However, OAGB is still considered lack of evidence in reducing obesity- related comorbidities. Our study aimed to compare the efficacy for SG and OAGB improving type 2 diabetes mellitus (T2DM) remission and weight loss in obese patients. PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for randomized controlled trials (RCTs) comparing OAGB and SG. Review Manager 5.4.1 was used to analyze the data, and the right effect model was chosen based on heterogeneity. Five randomized controlled trials were included in the study. The remission of T2DM in the OAGB group was more efficient at 1 year and 5 years. Meanwhile, the OAGB group has a greater improvement than the SG group in terms of hypertension (HTN) and fasting plasma glucose (FPG). Although the percentage of excess BMI loss (%EBMIL) between the OAGB and SG groups was not significant at 6 months, the OAGB group had a conspicuous %EBMIL at 1 year. And 5 years after surgery, a higher percentage of excess weight loss (%EWL) was found in the OAGB group. Besides, the OAGB group showed a lower body mass index (BMI) at 5 years than the SG group, but the BMI at 6 months and 1 year were not significant. Finally, at 6 months, the OAGB group exhibited a more remarkable percentage of total weight loss (%TWL) than the SG group. In general, OAGB exhibited a better therapeutic effect in T2DM, HTN, and weight loss than SG in the medium-term follow-up period. To assess the long-term efficacy, clinics should be encouraged to continue longer-term follow-up studies and possibly RCTs.
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Affiliation(s)
- Zujun Ding
- Department of General Surgery, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Ling Jin
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, East China Normal University, Shanghai, China
| | - Yu Song
- Department of Translational Medicine Platform, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Chenglei Feng
- Department of General Surgery, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Pengfei Shen
- Department of General Surgery, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Hang Li
- Department of General Surgery, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.
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4
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Ali M, Wang Y, Ji J, Wang W, Wang D. One Anastomosis Gastric Bypass Versus Sleeve Gastrectomy for Obesity: a Systemic Review and Meta-analysis. J Gastrointest Surg 2023; 27:2226-2244. [PMID: 37488422 DOI: 10.1007/s11605-023-05782-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/01/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND A long-lasting and efficient method of managing obesity and therapeutic associated comorbidities is bariatric surgery. However, a debated comparison between one-anastomosis gastric bypass (OAGB) and sleeve gastrectomy is still essential (SG). The goal of this study is to evaluate outcomes using RCT and NRCT from 2015 to 2022. METHODS By contrasting the OAGB and SG for bariatric surgery from January 2015 to September 2022, an RCT and NRCT were prospectively gathered using the PubMed, Cochrane Library, and MEDLINE databases of published research. This meta-statistical analysis was carried out in RevMan 5.4, and the best effect model was selected based on heterogeneity. RESULTS Twelve retrospective studies describing 6344 patients (3725 OAGB and 2619 SG) satisfied the inclusion criteria. A statistically significant result was in %EWL first year (MD = 8.03, 95% CI: 4.54-11.52, P < 0.05), second year (MD = 8.94, 95% CI: 2.95-14.94, P < 0.05), third year (MD = 8.93, 95% CI: 5.75-12.10, P < 0.05), fourth year (MD = 15.09, 95% CI:0.87-29.31, P < 0.05), and fifth year (MD = 14.25, 95% CI: 5.34, P < 0.05). OAGB was associated with a lower rate of remission in dyslipidemia, hypertension, diabetes mellitus, and hemorrhage. However, OAGB increased the incidence of GERD and leakage. CONCLUSIONS In terms of weight loss and comorbidity remission, OAGB is more effective than SG, although postoperative consequences are rather comparable between the two methods.
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Affiliation(s)
- Muhammad Ali
- Medical College of Yangzhou University, Yangzhou, People's Republic of China
- Department of General Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 98 Nantong West Road, Yangzhou, Jiangsu, 225001, People's Republic of China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, Jiangsu, 225001, People's Republic of China
| | - Yang Wang
- Medical College of Yangzhou University, Yangzhou, People's Republic of China
- Department of General Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 98 Nantong West Road, Yangzhou, Jiangsu, 225001, People's Republic of China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, Jiangsu, 225001, People's Republic of China
| | - Jin Ji
- Medical College of Yangzhou University, Yangzhou, People's Republic of China
- Department of General Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 98 Nantong West Road, Yangzhou, Jiangsu, 225001, People's Republic of China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, Jiangsu, 225001, People's Republic of China
| | - Wei Wang
- Medical College of Yangzhou University, Yangzhou, People's Republic of China
- Department of General Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 98 Nantong West Road, Yangzhou, Jiangsu, 225001, People's Republic of China
| | - Daorong Wang
- Medical College of Yangzhou University, Yangzhou, People's Republic of China.
- Department of General Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 98 Nantong West Road, Yangzhou, Jiangsu, 225001, People's Republic of China.
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, Jiangsu, 225001, People's Republic of China.
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Salman MA, Salman A, Assal MM, Elsherbiney M, Tourky M, Elewa A, Khalaf AM, Gadallah MA, Gebril M, Khalid S, Shaaban H, Mohammed AA, Osman MHA, Hassan H. One Anastomosis Gastric Bypass (OAGB) with a 150-cm Biliopancreatic Limb (BPL) Versus a 200-cm BPL, a Systematic Review and Meta-analysis. Obes Surg 2023:10.1007/s11695-023-06556-9. [PMID: 37022609 DOI: 10.1007/s11695-023-06556-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/07/2023]
Abstract
This is a systematic review and meta-analysis that assessed the impact of performing OAGB with a 150-cm BPL versus a 200-cm BPL concerning weight loss, comorbidities remission, and adverse nutritional effects. The analysis included studies that compared patients who underwent OAGB with a 150-cm BPL and 200-cm BPL. Eight studies were eligible for this review after searching in the EMBASE, PubMed central database, and Google scholar. The pooled analysis revealed favoring the 200-cm BPL limb length for weight loss, with a highly significant difference in the TWL% (p=0.009). Both groups showed comparable comorbidities remission. Significantly higher ferritin and folate deficiency rates were found in the 200-cm BPL group. Considering a 200-cm BPL when performing OAGB delivers a better weight loss outcome than a 150-cm BPL, which is at the expense of a more severe nutritional deficiency. No significant differences were found regarding the comorbidities' remission.
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Affiliation(s)
| | | | | | | | | | - Ahmed Elewa
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | | | | | | | | | - Hossam Shaaban
- North Cumbria Integrated Care NHS Foundation Trust, Cumberland Infirmary Hospital, Carlisle, UK
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Rezaei MT, Sheikhbahaei E, Zefreh H, Allami M, Sayadi Shahraki M, Shahabi S. Single-anastomosis Sleeve Jejunal: a Mid-term Follow-up Report of a New Surgical Technique. Obes Surg 2023; 33:1245-1252. [PMID: 36847922 DOI: 10.1007/s11695-023-06520-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Single anastomosis sleeve ileal bypass (SASI) is a combined bariatric metabolic technique, in which few studies have shown its outcomes efficacy. However, this technique has a high risk of malnutrition due to long biliopancreatic limb. Single anastomosis sleeve jejunal bypass (SASJ) has a shorter limb. Therefore, it seems to have a lower risk of nutrient deficiency. Furthermore, this technique is relatively new, and little is known about the efficacy and safety of SASJ. We aim to report our mid-term follow-up of SASJ from a high-volume center for bariatric metabolic surgery in the Middle East region. METHODS For the current study, the 18-month follow-up data of 43 patients with severe obesity who underwent SASJ was collected. The primary outcome measures were demographic data, weight change variables according to ideal body mass index (BMI) of 25 kg/m2 at 6, 12, and 18 months, laboratory assessments, remission of obesity-associated medical problems, and other potential bariatric metabolic complications after the surgery. RESULTS No patient was lost due to follow-up. After 18 months, patients lost 43.4 ± 11 kg of their weight and 68 ± 14% of their excess weight, and their BMI decreased from 44.9 ± 4.7 to 28.6 ± 3.8 kg/m2 (p < 0.001). The percentage of total weight loss till 18 months was 36.3%. The T2D remission rate at 18 months was 100%. Patients neither faced deficiency in significant markers for nutrition state nor represented major bariatric metabolic surgery complications. CONCLUSION SASJ bypass achieved satisfactory weight loss and remissions in obesity-associated medical problems within 18 months after surgery without major complications and malnutrition.
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Affiliation(s)
- Mohammad Taghi Rezaei
- Department of Surgery, Division of Minimally Invasive and Bariatric Operations, Mehrad Hospital, Tehran, Iran
| | - Erfan Sheikhbahaei
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Minimally Invasive Surgery and Obesity Research Center, Alzahra University Hospital, Isfahan University of Medical Sciences, Sofe Blvd, Isfahan, Iran
| | - Hamidreza Zefreh
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Minimally Invasive Surgery and Obesity Research Center, Alzahra University Hospital, Isfahan University of Medical Sciences, Sofe Blvd, Isfahan, Iran
| | - Mostafa Allami
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Sayadi Shahraki
- Isfahan Minimally Invasive Surgery and Obesity Research Center, Alzahra University Hospital, Isfahan University of Medical Sciences, Sofe Blvd, Isfahan, Iran.
| | - Shahab Shahabi
- Minimally Invasive Surgery Research Center, Rasool-E Akram University Hospital, Iran University of Medical Sciences, Tehran, Iran
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7
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Endoscopic and histopathological assessment of individuals undergoing one anastomosis gastric bypass: a 2-year follow-up. Surg Endosc 2023; 37:3720-3727. [PMID: 36650354 DOI: 10.1007/s00464-023-09884-0] [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: 10/02/2022] [Accepted: 01/08/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND There is much debate over the occurrence of biliary reflux to the gastric pouch after one anastomosis gastric bypass (OAGB) and its potential risks. OBJECTIVE To assess endoscopic and histopathological findings following a standardized protocol of biopsy collection two years after OAGB. METHODS A historical cohort study was conducted, based on a prospectively collected database, which involved 39 participants who underwent OAGB. Participants underwent clinical evaluation and esophagogastroduodenoscopy at the time of surgery and 24 months afterward. Post-operatively, biopsy specimens in esophagogastric junction, pouch, and anastomosis were systematically collected. RESULTS 92.3% of the participants were female and the mean age was 37 ± 8.5 years. The mean body mass index (BMI) significantly decreased from 37.6 ± 5.7 kg/m2 to 27 ± 4.1 kg/m2 after 2 years (p < 0.001). The mean %TWL was 27.2 ± 10.5%. The prevalence of non-erosive gastritis significantly increased from 25.6 to 51.3% (p = 0.02). Erosive gastritis significantly decreased from 28.2 to 10.3% (p = 0.04). Four cases of marginal ulcers were identified (10.3%). The commonest histopathological finding was mild inflammation in 74.3% (esophagogastric junction), 58.9% (pouch), and 71.8% (anastomosis). There was one case of focal intestinal metaplasia in each site of interest and no cases of dysplasia or severe inflammation. CONCLUSIONS Using a standardized protocol of post-operative biopsy collection, low rates of severe endoscopic and histopathological abnormalities were observed two years after OAGB. Nevertheless, as most patients have histologically proven inflammation, bile in the gastric pouch, and endoscopic gastritis, long-term surveillance is essential because of the uncertain risk of these abnormalities.
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Sewefy AM, Atyia AM, Mohammed MM, Kayed TH, Hamza HM. Single anastomosis sleeve jejunal (SAS-J) bypass as a treatment for morbid obesity, technique and review of 1986 cases and 6 Years follow-up. Retrospective cohort. Int J Surg 2022; 102:106662. [PMID: 35568310 DOI: 10.1016/j.ijsu.2022.106662] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/16/2022] [Accepted: 05/01/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Santoro's operation is a sleeve gastrectomy with transit bipartition. The operation aims to maintain passage to the duodenum to minimize nutritional deficiency. This procedure is rapidly changed to single anastomosis sleeve ileal (SASI) bypass. SAS-J bypass is a modification of SASI with a short biliary limb. MATERIAL AND METHODS This study is a retrospective study of prospectively collected data. The study includes a comprehensive review of 1986 patients who underwent SAS-J bypass over 6 years. The total number is used to evaluate the perioperative data. One- and two-year follow-up was used to evaluate weight loss and comorbidities; follow-up of more than 5 years was used to obtain long-term results. RESULTS In this study, 70.4% of patients were female and 29.6% were male. The mean body mass index (BMI) was 44.7. The mean age was 42 years. Regarding comorbidities, 25.8% of the patients had type 2 diabetes, 31% were hypertensive, 14.2% had sleep apnea syndrome, 6.6% had gastroesophageal reflux disease (GERD), and 39.6% had hyperlipidemia. Of the 1294 patients who complete one-year follow up, %EWL reached 87%. Blood glucose levels were normalized in 98.5% of patients, hypertension remitted in 93%, hyperlipidemia improved in 97%, SAS is improved in all cases, and GERD improved in 89% of patients. After 5 years, 94 patients' BMI decreased from 44.3 to 28.3 without significant nutritional deficiency. CONCLUSIONS Laparoscopic SAS-J bypass is an effective and simple alternative bariatric procedure at short- and long-term follow-up.
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Affiliation(s)
- Alaa M Sewefy
- Department of Surgery, Minia University Hospital, Egypt.
| | - Ahmed M Atyia
- Department of Surgery, Minia University Hospital, Egypt
| | | | - Taha H Kayed
- Department of Surgery, Minia University Hospital, Egypt
| | - Hosam M Hamza
- Department of Surgery, Minia University Hospital, Egypt
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Moolenaar LR, de Waard NE, Heger M, de Haan LR, Slootmaekers CPJ, Nijboer WN, Tushuizen ME, van Golen RF. Liver Injury and Acute Liver Failure After Bariatric Surgery: An Overview of Potential Injury Mechanisms. J Clin Gastroenterol 2022; 56:311-323. [PMID: 35180151 DOI: 10.1097/mcg.0000000000001662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The obesity epidemic has caused a surge in the use of bariatric surgery. Although surgery-induced weight loss is an effective treatment of nonalcoholic fatty liver disease, it may precipitate severe hepatic complications under certain circumstances. Acute liver injury (ALI) and acute liver failure (ALF) following bariatric surgery have been reported in several case series. Although rare, ALI and ALF tend to emerge several months after bariatric surgery. If so, it can result in prolonged hospitalization, may necessitate liver transplantation, and in some cases prove fatal. However, little is known about the risk factors for developing ALI or ALF after bariatric surgery and the mechanisms of liver damage in this context are poorly defined. This review provides an account of the available data on ALI and ALF caused by bariatric surgery, with emphasis on potential injury mechanisms and the outcomes of liver transplantation for ALF after bariatric surgery.
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Affiliation(s)
- Laura R Moolenaar
- Departments of Gastroenterology and Hepatology
- Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang Province, P.R. China
| | | | - Michal Heger
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht
- Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang Province, P.R. China
| | - Lianne R de Haan
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht
- Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang Province, P.R. China
| | - Caline P J Slootmaekers
- Department of Gastroenterology and Hepatology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | | | | | - Rowan F van Golen
- Departments of Gastroenterology and Hepatology
- Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang Province, P.R. China
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ElAbd R, AlMutairi R, Alhaj A, AlKhayat H, Jamal MH. One-Anastomosis Gastric Bypass as A Primary Bariatric Surgery: Initial Experience and Short-Term Outcomes. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rawan ElAbd
- Department of Surgery, Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait
| | - Rawan AlMutairi
- Department of Surgery, Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait
| | - Ahmad Alhaj
- Department of Surgery, Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait
| | - Haytham AlKhayat
- Department of Surgery, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
| | - Mohammad H. Jamal
- Department of Surgery, Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait
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11
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Szymański M, Marek I, Wilczyński M, Janczy A, Bigda J, Kaska Ł, Proczko-Stepaniak M. Evaluation of esophageal pathology in a group of patients 2 years after one-anastomosis gastric bypass (OAGB) — Cohort study. Obes Res Clin Pract 2021; 16:82-86. [DOI: 10.1016/j.orcp.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/21/2021] [Accepted: 12/12/2021] [Indexed: 12/11/2022]
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12
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Haggag M, Salem A, Sultan AM, Elghawalby AN, Eldesoky RT, Eldegwi SA, Gad Elhak N, Shehta A. Early and intermediate term outcomes after laparoscopic one-anastomosis gastric bypass for morbidly obese patients: a single center experience. Turk J Surg 2021; 37:324-335. [PMID: 35677485 PMCID: PMC9130952 DOI: 10.47717/turkjsurg.2021.5274] [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: 03/30/2021] [Accepted: 10/06/2021] [Indexed: 11/23/2022]
Abstract
Objectives To evaluate our outcomes of laparoscopic one-anastomosis gastric bypass (LOAGB) as a primary weight loss procedure. We evaluated the impact of biliary reflux by combination of upper endoscopy (UGIE), ambulatory pH metry, and ambulatory biliary reflux monitoring. Material and Methods We reviewed the data of patients who underwent LOAGB during the period between July 2015 till August 2018. Results Forty consecutive patients were included in the study. Thirty-seven patients (92.5%) had obesity related comorbidities. The median follow-up duration was 18 months (6-36 months). The 1-, 2-, and 3-years excess weight loss percentages were 53.1%, 60.4%, and 62.3%. At three years follow-up, complete remission of diabetes mellitus occurred in 7/7 patients (100%) and of hypertension in 4/7 patients (57.1%). Eighteen patients (45%) accepted to undergo UGIE with routine biopsies and evaluation of acidic and biliary reflux. All examined patients had negative acid reflux results according to ambulatory PH metry with median DeMeester score of 2 (0.3-8.7). According to ambulatory biliary reflux monitoring, 17/18 patients (94.1%) had posi- tive result. Only 6/18 patients (33.3%) had symptoms of biliary reflux and had positive symptom index on bilimetric study. Regarding UGIE, all patients had just gastritis and reflux esophagitis with no evidence of gross mucosal changes. Pathological examination of all routine biopsies did not show any sign of faveolar hyperplasia, atypia or malignancy. Conclusion LOAGB is a safe and efficient bariatric procedure with acceptable morbidity rate. LOAGB is not associated with significant biliary reflux or pathological changes in the esophagogastric mucosa.
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Affiliation(s)
- Mahmoud Haggag
- Department of General Surgery, Gastrointestinal Surgery Center, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Ali Salem
- Department of General Surgery, Gastrointestinal Surgery Center, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Ahmad M. Sultan
- Department of General Surgery, Gastrointestinal Surgery Center, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Ahmed N. Elghawalby
- Department of General Surgery, Gastrointestinal Surgery Center, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Rehab T. Eldesoky
- Department of Clinical Pathology, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Sara A. Eldegwi
- Department of Clinical Pathology, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Nabil Gad Elhak
- Department of General Surgery, Gastrointestinal Surgery Center, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Ahmed Shehta
- Department of General Surgery, Gastrointestinal Surgery Center, Mansoura University Faculty of Medicine, Mansoura, Egypt
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Khitaryan AG, Mezhunts AV, Starzhinskaya OB, Orekhov AA, Voronova OV, Sarkisyan AV, Melnikov DA, Amegninou MJC, Adizov SA, Rogut AA. Pathological and Histological Aspects of Biliary Reflux After Mini-Gastric Bypass. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexander G. Khitaryan
- NHI “Railway Clinical Hospital at the “Rostov-Glavnyi” Station, Russian Railways, OJSC” Rostov-on-Don, Russian Federation
- Department of General Surgery, Rostov State Medical University, Rostov-on-Don, Russian Federation
| | - Arut V. Mezhunts
- NHI “Railway Clinical Hospital at the “Rostov-Glavnyi” Station, Russian Railways, OJSC” Rostov-on-Don, Russian Federation
- Department of General Surgery, Rostov State Medical University, Rostov-on-Don, Russian Federation
| | - Olesya B. Starzhinskaya
- Department of General Surgery, Rostov State Medical University, Rostov-on-Don, Russian Federation
| | - Alexey A. Orekhov
- NHI “Railway Clinical Hospital at the “Rostov-Glavnyi” Station, Russian Railways, OJSC” Rostov-on-Don, Russian Federation
- Department of General Surgery, Rostov State Medical University, Rostov-on-Don, Russian Federation
| | - Olga V. Voronova
- NHI “Railway Clinical Hospital at the “Rostov-Glavnyi” Station, Russian Railways, OJSC” Rostov-on-Don, Russian Federation
- Department of General Surgery, Rostov State Medical University, Rostov-on-Don, Russian Federation
| | - Aram V. Sarkisyan
- Department of General Surgery, Rostov State Medical University, Rostov-on-Don, Russian Federation
| | - Denis A. Melnikov
- Department of General Surgery, Rostov State Medical University, Rostov-on-Don, Russian Federation
| | | | - Suleyman A. Adizov
- NHI “Railway Clinical Hospital at the “Rostov-Glavnyi” Station, Russian Railways, OJSC” Rostov-on-Don, Russian Federation
| | - Alexander A. Rogut
- NHI “Railway Clinical Hospital at the “Rostov-Glavnyi” Station, Russian Railways, OJSC” Rostov-on-Don, Russian Federation
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Acid Reflux Is Common in Patients With Gastroesophageal Reflux Disease After One-Anastomosis Gastric Bypass. Obes Surg 2021; 31:4717-4723. [PMID: 34232446 DOI: 10.1007/s11695-021-05542-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Patients with one-anastomosis gastric bypass (OAGB) can develop gastroesophageal reflux disease (GERD). The nature of this GERD (acid or biliary) remains unclear. OBJECTIVE To assess the nature of GERD via impedance pH testing in patients presenting with reflux post OAGB. METHODS Retrospective analysis of a prospectively collected database of 43 patients with OAGB backgrounds who developed postoperative GERD and were investigated with impedance pH monitoring between 2006 and 2019. RESULTS Mean age was 52.48 ± 9 years. Mean body mass index (BMI) prior to OAGB was 46.82 kg/m2. None of these patients had clinical GERD before surgery. The median time interval between surgery and investigation with 24-h impedance pH monitoring was 64 (56) months. The mean BMI at the time of investigations was 32.67 ± 6.9 kg/m2. The type of reflux was acid in 13 (30.2%), non-acid (biliary) in 12 (27.9%), and mixed (acid and biliary) in 5 (11.6%) patients. However, it remained not confirmed in 13 (30.2%). Median DeMeester score was 48.95 (27.67) in patients with acid, 2.8 (7.4) in patients with biliary, and 28.7 (5.6) in patients with mixed reflux. Median percent of time spent with pH < 4 was 9.65 (8) in patients with acid, 0.6 (1.75) in patients with biliary, and 7.7 (3.9) in patients with mixed reflux. CONCLUSION Acid reflux seems to be as common as bile reflux in patients presenting with GERD after OAGB. In case of revisional surgery for severe GERD post OAGB, 24-h impedance pH monitoring could be essential to determine the surgical procedure of choice.
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Voglino C, Tirone A, Ciuoli C, Benenati N, Bufano A, Croce F, Gaggelli I, Vuolo ML, Badalucco S, Berardi G, Cuomo R, Castagna MG, Vuolo G. Controlling Nutritional Status (CONUT) Score and Micronutrient Deficiency in Bariatric Patients: Midterm Outcomes of Roux-en-Y Gastric Bypass Versus One Anastomosis Gastric Bypass/Mini Gastric Bypass. Obes Surg 2021; 31:3715-3726. [PMID: 34031850 DOI: 10.1007/s11695-021-05486-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Two of the most common bariatric procedures performed worldwide are Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB). Comparative data regarding nutritional status are lacking and no previous study focus on malnutrition according to a validated score. METHODS Retrospective data from a single institution were reviewed. Anthropometric variables and nutritional data were assessed. The primary aim was to analyze and compare the nutritional status before and 3 years after RYGB vs OAGB using the controlling nutritional status (CONUT) score. The incidence of micronutrient deficiency and the remission of comorbidities in each group were defined as secondary outcomes. RESULTS Fifty-seven patients in each arm were enrolled. A 3-year mild malnutrition (CONUT score 2-3) was found in 38% and 37.05% in the RYGB and OAGB groups, respectively (p > 0.05). In terms of percentage of total weight loss (%TWL) and percentage of adjustable weight loss (%AWL), no differences were found between OAGB and RYGB groups. OAGB and RYGB patients had similar vitamin deficiencies. Anemia, hypoproteinemia, hypoalbuminemia, and hypocalcemia were comparable between groups. At 3-year follow-up, total protein and albumin values were similar between arms while prealbumin deficit was more frequent after OAGB than after RYGB. The rate of type 2 diabetes (87.5% in OAGB and 92% in RYGB), arterial hypertension (51.6% in OAGB and 58.3% in RYGB), and dyslipidemia (69.7% in OAGB and 78.6% in RYGB) remission was not significantly different between the two groups. CONCLUSIONS Postoperative CONUT score, micronutrient deficiency, comorbidity remission, and improvement of anthropometric parameters 3 years postoperatively were comparable between RYGB and OAGB groups.
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Affiliation(s)
- Costantino Voglino
- Department of general and specialized surgery - Unit of Bariatric Surgery, University of Siena, Policlinico "Le Scotte", Viale Bracci 14, 53100, Siena, Italy.
| | - Andrea Tirone
- Department of general and specialized surgery - Unit of Bariatric Surgery, University of Siena, Policlinico "Le Scotte", Viale Bracci 14, 53100, Siena, Italy
| | - Cristina Ciuoli
- Department of medicine, surgery and neurosciences - Unit of Endocrinology, University of Siena, Viale Bracci - Policlinico "Le Scotte", 53100, Siena, Italy
| | - Nicoletta Benenati
- Department of medicine, surgery and neurosciences - Unit of Endocrinology, University of Siena, Viale Bracci - Policlinico "Le Scotte", 53100, Siena, Italy
| | - Annalisa Bufano
- Department of medicine, surgery and neurosciences - Unit of Endocrinology, University of Siena, Viale Bracci - Policlinico "Le Scotte", 53100, Siena, Italy
| | - Federica Croce
- Department of Diagnostic Imaging - Hospital Campostaggia, Campostaggia, 53036, Poggibonsi, SI, Italy
| | - Ilaria Gaggelli
- Department of general and specialized surgery - Unit of Bariatric Surgery, University of Siena, Policlinico "Le Scotte", Viale Bracci 14, 53100, Siena, Italy
| | - Maria Laura Vuolo
- Department of general and specialized surgery - Unit of Bariatric Surgery, University of Siena, Policlinico "Le Scotte", Viale Bracci 14, 53100, Siena, Italy
| | - Simona Badalucco
- Department of general and specialized surgery - Unit of Bariatric Surgery, University of Siena, Policlinico "Le Scotte", Viale Bracci 14, 53100, Siena, Italy
| | - Giovanna Berardi
- Department of Advanced Biomedical Science, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Roberto Cuomo
- Department of Medicine, Surgery and Neurosciences - Unit of Plastic Surgery, University of Siena, Policlinico "Le Scotte", Viale Bracci 14, 53100, Siena, Italy
| | - Maria Grazia Castagna
- Department of medicine, surgery and neurosciences - Unit of Endocrinology, University of Siena, Viale Bracci - Policlinico "Le Scotte", 53100, Siena, Italy
| | - Giuseppe Vuolo
- Department of general and specialized surgery - Unit of Bariatric Surgery, University of Siena, Policlinico "Le Scotte", Viale Bracci 14, 53100, Siena, Italy
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The Role of Ursodeoxycholic Acid (UDCA) in Cholelithiasis Management After One Anastomosis Gastric Bypass (OAGB) for Morbid Obesity: Results of a Monocentric Randomized Controlled Trial. Obes Surg 2021; 30:4315-4324. [PMID: 32583297 DOI: 10.1007/s11695-020-04801-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Bariatric surgery leads to rapid weight loss, a well-known risk factor for gallstone formation. Postoperative biliary complication rate requiring cholecystectomy is between 0.9 and 7.5% after laparoscopic sleeve gastrectomy and between 6 and 50% after laparoscopic gastric bypass. Several authors recommended ursodeoxycholic acid (UDCA) administration to reduce gallstone formation after diet-induced weight reduction. The aim of this randomized monocentric study is to evaluate gallstone incidence after prophylactic administration of UDCA in patients undergoing one anastomosis gastric bypass (OAGB). METHODS Patients undergoing OAGB were prospectively randomized into 2 groups: the UDCA group receiving oral UDCA 600 mg/days for 6 months in the immediate postoperative days, and the control group not administered with UDCA. Each group included 95 patients. Abdominal ultrasound, clinical evaluation, and quality of life scoring with Gastrointestinal Quality of Life Index (GIQLI) were performed postoperatively in all patients at 3, 6, and 12 months. RESULTS At 12 months of postoperative follow-up, 4 (4.2%) and 24 patients (25.2%) showed gallstones in the UDCA group and control group, respectively (p < 0.05). Among those who developed gallstones, 8 (28.6%) cases were symptomatic whereas 20 (71.4%) did not show any symptom. No statistically significant difference in GIQLI score between the two groups was found. CONCLUSION OAGB, as other malabsorbent procedures, appears to have higher rate of cholelithiasis than purely restrictive procedures. In our prospective randomized controlled study, a regular postoperative UDCA intake during the first 6 months seems to significantly reduce cholelithiasis incidence after OAGB, with no case of intolerance reported. Further studies are needed to assess this issue.
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Pizza F, Lucido FS, D'Antonio D, Tolone S, Gambardella C, Dell'Isola C, Docimo L, Marvaso A. Biliopancreatic Limb Length in One Anastomosis Gastric Bypass: Which Is the Best? Obes Surg 2021; 30:3685-3694. [PMID: 32458362 DOI: 10.1007/s11695-020-04687-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The use of one anastomosis gastric bypass (OAGB) is rapidly spreading. Concerns about biliary reflux and malabsorption with consequent nutritional deficits exist, so studies on biliopancreatic limb (BPL) adequate length in OAGB are required to balance excess weight loss in percentage (% EWL), resolution of comorbidities, and nutritional deficit. The purpose was to evaluate, at 2 years after OAGB, the effects of BPL length on weight loss, resolution of comorbidity, and nutritional deficiencies in patients. METHODS From January 2015 to January 2017, 180 patients were collected into three groups based BPL length: group A, 150 cm; group B, 180 cm; and group C, 200 cm. Aims were to compare %EWL, co-morbidity resolution rates, nutritional parameters, and morbidity/mortality in the three groups. RESULTS The total number of patients was 180: 60 for each group. One hundred seventy-two (95%) patients attended the 1-year follow-up (group A = 58; group B = 58, group C = 56). One hundred fifty-seven (87%) patients attended the 2-year follow-up (group A = 52 (87%); group B = 53 (88%); group C = 52 (87%)). There was no statistically significant difference in %EWL, %TWL, T2DM, and hypertension resolution rates among the groups. About vitamin deficiency, differences were not statistically significant. Iron and ferritin deficiency rate were statistically significant only between A and C groups. CONCLUSIONS According to our evidence, standardization of BPL length shorter than 200 cm is suggested, potentially minimizing malnutrition-related outcomes. Our study seems to show that a BPL of 150-180 cm is safe and effective in terms of EWL and comorbidity improvement with low malnutrition effects even in BMI > 50.
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Affiliation(s)
- Francesco Pizza
- Division of Surgery, Hospital "A. Rizzoli", Lacco Ameno, Naples, Italy.
| | - Francesco Saverio Lucido
- Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Dario D'Antonio
- Division of Surgery, Hospital "A. Rizzoli", Lacco Ameno, Naples, Italy
| | - Salvatore Tolone
- Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Claudio Gambardella
- Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Ludovico Docimo
- Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alberto Marvaso
- Division of Surgery, Hospital "A. Rizzoli", Lacco Ameno, Naples, Italy
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Ansar H, Zamaninour N, Pazouki A, Kabir A. Weight Loss After One Anastomosis Gastric Bypass-Mini Gastric Bypass (OAGB-MGB): Patient-Related Perioperative Predictive Factors. Obes Surg 2021; 30:1316-1323. [PMID: 31820407 DOI: 10.1007/s11695-019-04270-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM The aim of this study was to find independent perioperative factors predicting unsuccessful weight loss following one anastomosis gastric bypass-mini gastric bypass (OAGB-MGB), a recently developed technique of bariatric surgery. METHODS Using regression analysis, this prospective cohort study assessed the role of demographic and socioeconomic factors, clinical features, body composition, length of biliopancreatic limb (LBL), nutritional habits, comorbidities, and early post-operative weight reduction values, in predicting 1-year weight loss after OAGB-MGB. All patients at the center who underwent laparoscopic OAGB-MGB between October 2010 and May 2017 were included. The dependent variable was the percent of excess weight loss (%EWL) after 12-month follow-up. Weight loss outcome was defined as successful EWL (≥ 50%) or unsuccessful EWL (< 50%). RESULTS Follow-up data at 1 year was available for 1309 (77%) patients. Mean EWL and BMI reduction were 81.63% and 16.82 ± 4.37 kg/m2 at 1 year. In addition, 48 (3.7%) patients had unsuccessful weight loss. Pre-operative higher BMI (OR, 1.34; p = 0.001), type 2 diabetes (OR, 4.26; p = 0.039), pre-surgery volume eating habit (OR, 0.12; p = 0.003), weight reduction value in the first month after surgery (OR, 0.80; p = 0.002), and length of biliopancreatic limb (LBL) (OR, 1.05; p = 0.017) were independently associated with unsuccessful weight loss at 1-year follow-up. CONCLUSIONS OAGB-MGB provides considerable weight loss for most patients. Initial lower BMI, absence of diabetes, being volume eater, and higher first month weight loss are independently associated with successful weight loss after 1 year.
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Affiliation(s)
- Hastimansooreh Ansar
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Negar Zamaninour
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.,Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-e Rasool Hospital, Tehran, Iran
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Gastric Remnant Perforation Caused by Peterson's Hernia Following One Anastomosis Gastric Bypass: a Rare Complication. Obes Surg 2021; 30:3229-3232. [PMID: 32144635 DOI: 10.1007/s11695-020-04524-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION One anastomosis gastric bypass (OAGB) has gained popularity over the recent years; it appears to be an effective bariatric procedure with acceptable weight loss, co-morbidity resolution, and complication rates in the short and medium term. However, it still continues to have concerns in the bariatric community due to a spectrum of potential complications. To our knowledge, there are few published cases of internal hernia, but no published reports of gastric remnant perforation following OAGB. CASE PRESENTATION We report a case of a 32-year-old female who developed a perforation of the remnant stomach along the gastric fundus secondary to bowel obstruction 5 years after OAGB. The perforation was managed by stapled resection of the perforated fundus and closure of Peterson's space for potential hernia as a causative factor, and the patient had a smooth postoperative recovery. DISCUSSION Early diagnosis is crucial in post bariatric emergencies with a low threshold of early intervention. Gastric remnant perforation was previously described in some reports following Roux-en-Y gastric bypass (RYGB) but not after OAGB. Etiology of perforation can be rationalized to primary gastric remnant pathology or secondary to external factors such as back pressure of mechanical/functional bowel obstruction. CONCLUSION Peterson's hernia and gastric remnant perforation are rare, yet serious, complications that need to be kept in mind while dealing with post-OAGB patients presenting with abdominal pain. Early diagnosis and treatment are essential for a better outcome.
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20
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Sam MA, Hussain A, Pegler ME, Pearson EJB, Omar I, Boyle M, Singhal R, Mahawar K. Effect of one anastomosis gastric bypass on liver function tests: A comparison between 150 cm and 200 cm biliopancreatic limbs. J Minim Access Surg 2021; 18:38-44. [PMID: 33885014 PMCID: PMC8830576 DOI: 10.4103/jmas.jmas_249_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Context: Some studies have shown that one anastomosis gastric bypass (OAGB) results in the derangement of liver function tests (LFTs). We wanted to study this in our patients. Aims: The aims are to study the effect of OAGB on LFTs and to compare the effect of a biliopancreatic limb (BPL) of 150 cm (OAGB-150) to a BPL of 200 cm (OAGB-200). Settings and Design: The study was a retrospective cohort study conducted at a university hospital. Materials and Methods: Information was obtained from our prospectively maintained database and hospital's computerised records. Statistical Analysis: A P < 0.05 was regarded statistically significant; however, given the number of variables examined, findings should be regarded as exploratory. Results: A total of 405 patients underwent an OAGB-200 (n = 234) or OAGB-150 (n = 171) in our unit between October 2012 and July 2018. There were significant improvements in gamma-glutamyl transpeptidase (GGT) levels at 1 and 2 years after OAGB-200 and significant worsening in the levels of alkaline phosphatase (ALP) and albumin at 1 and 2 years. There was a significant improvement in GGT levels at 1 and 2 years after OAGB-150 and in alanine transaminase levels at 1 year. There was a significant worsening in ALP and albumin levels at both follow-up points in this group. OAGB-150 group had a significantly lower bilirubin level at 1 year and significantly fewer abnormal ALP values at 2 years in comparison with OAGB-200 patients. Conclusions: This exploratory study demonstrates the overall safety of OAGB with regard to its effect on LFTs, with no remarkable difference between OAGB-150 and OAGB-200.
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Affiliation(s)
- Miraheal Adadzewa Sam
- Bariatric Unit, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, UK
| | - Abdulzahra Hussain
- Bariatric unit, Doncaster and Bassetlaw Teaching Hospitals, Doncaster, UK
| | - Maya Elizabeth Pegler
- Bariatric Unit, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, UK
| | - Emma Jane Bligh Pearson
- Bariatric Unit, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, UK
| | - Islam Omar
- Bariatric Unit, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, UK
| | - Maureen Boyle
- Bariatric Unit, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, UK
| | - Rishi Singhal
- Department of Upper GI Surgery, Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, UK
| | - Kamal Mahawar
- Bariatric Unit, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, UK
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Slagter N, Hopman J, Altenburg AG, de Heide LJM, Jutte EH, Kaijser MA, Damen SL, van Beek AP, Emous M. Applying an Anti-reflux Suture in the One Anastomosis Gastric Bypass to Prevent Biliary Reflux: a Long-Term Observational Study. Obes Surg 2021; 31:2144-2152. [PMID: 33496931 DOI: 10.1007/s11695-021-05238-8] [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: 11/12/2020] [Revised: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The one anastomosis gastric bypass (OAGB) is an effective treatment to induce sustained weight loss in morbidly obese patients. Concerns remain regarding the development of reflux. The aim of this study was to investigate the effect of an "anti-reflux suture" as anti-reflux modification to prevent reflux. METHOD This is a single-center retrospective cohort study of patients who underwent a primary OAGB at the Center Obesity North-Netherlands (CON) between January 2015 and December 2016. Reflux was defined as symptoms of acid/bilious regurgitation or pyrosis. This was consequently asked and reported at each follow-up visit. Outcomes of patients with an anti-reflux suture were compared to those without. RESULTS In 414 (59%) of the 703 included patients, an anti-reflux suture was applied. Follow-up at 3 years was 74%. The incidence of reflux did not differ between patients with or without an anti-reflux suture (57 versus 56%, respectively; P = 0.9). The presence of an anti-reflux suture was significantly associated with a lower incidence of conversion to Roux-en-Y gastric bypass (RYGB) for reflux (OR 0.56, 95%CI 0.34-0.91). Patients preoperatively diagnosed with gastroesophageal reflux disease (GERD) were 5.2 times more likely to need a conversion to RYGB for reflux (95%CI 2.7-10.1). CONCLUSION The presence of preoperative GERD should be weighted heavily in the decision to perform an OAGB as this is a major risk factor for conversion surgery due to reflux. The anti-reflux suture might be a valuable addition to the procedure of the OAGB because it results in fewer conversion surgeries for reflux.
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Affiliation(s)
- Nienke Slagter
- Center for Obesity Northern-Netherlands (CON), Medical Center Leeuwarden, Leeuwarden, the Netherlands.
| | - Jonne Hopman
- Center for Obesity Northern-Netherlands (CON), Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Anna G Altenburg
- Center for Obesity Northern-Netherlands (CON), Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Loek J M de Heide
- Center for Obesity Northern-Netherlands (CON), Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Ewoud H Jutte
- Center for Obesity Northern-Netherlands (CON), Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Mirjam A Kaijser
- Center for Obesity Northern-Netherlands (CON), Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Stefan L Damen
- Center for Obesity Northern-Netherlands (CON), Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - André P van Beek
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marloes Emous
- Center for Obesity Northern-Netherlands (CON), Medical Center Leeuwarden, Leeuwarden, the Netherlands
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Musella M, Vitiello A, Berardi G, Velotti N, Pesce M, Sarnelli G. Evaluation of reflux following sleeve gastrectomy and one anastomosis gastric bypass: 1-year results from a randomized open-label controlled trial. Surg Endosc 2020; 35:6777-6785. [PMID: 33269429 PMCID: PMC8599401 DOI: 10.1007/s00464-020-08182-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 11/17/2020] [Indexed: 02/07/2023]
Abstract
Background Recent reports have demonstrated that de novo reflux and worsening of pre-existing symptoms occur after SG; concerns are still expressed about the risk of symptomatic biliary reflux gastritis and oesophagitis. The aim of our study was to investigate and compare the rate of postoperative acid and non-acid reflux following Mini-/One anastomosis gastric bypass (MGB/OAGB) and laparoscopic sleeve gastrectomy (LSG). Study design A prospective randomized open-label, controlled trial registered on clinicaltrial.gov (NCT number: NCT02987673) has been carried out to evaluate esophagogastric junction exposure to reflux in the first year after MGB/OAGB and LSG using high impedance manometry, endoscopy, and a validated questionnaire. Results A total of 58 individuals were eventually enrolled in this trial and represented the per-protocol population (n = 28 MGB/OAGB, n = 30 LSG). No difference was found between the two groups in terms of demographic characteristics, PAGI-SYM score, acid exposure time percent of the esophagus (AET%), esophagitis, and other HRiM and MII-pH data at baseline. Comparing MII-pH outcomes of the two groups, AET% resulted significantly higher after LSG at 12 months. Endoscopic findings showed a significant increase of esophagitis ≥ B in the LSG group after 1 year; postoperative esophagitis ≥ B resulted also significantly worsened after LSG when compared to MGB/OAGB. Conclusion Since AET% and rate of esophagitis are significantly higher after LSG when compared to MGB/OAGB, this procedure should be preferred in case of preoperative subclinical reflux or low grade (A) esophagitis.
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Affiliation(s)
- Mario Musella
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II” - Via S. Pansini 5, 80131 Naples, Italy
| | - Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II” - Via S. Pansini 5, 80131 Naples, Italy
| | - Giovanna Berardi
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II” - Via S. Pansini 5, 80131 Naples, Italy
| | - Nunzio Velotti
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II” - Via S. Pansini 5, 80131 Naples, Italy
| | - Marcella Pesce
- Clinical Medicine and Surgery Department, Naples “Federico II” University, AOU “Federico II” - Via S. Pansini 5, 80131 Naples, Italy
| | - Giovanni Sarnelli
- Clinical Medicine and Surgery Department, Naples “Federico II” University, AOU “Federico II” - Via S. Pansini 5, 80131 Naples, Italy
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Gero D, Schneider MA, Suter M, Peterli R, Vonlanthen R, Turina M, Bueter M. Sleeve gastrectomy or gastric bypass: a "post-code" lottery? A comprehensive national analysis of the utilization of bariatric surgery in Switzerland between 2011-2017. Surg Obes Relat Dis 2020; 17:563-574. [PMID: 33281057 DOI: 10.1016/j.soard.2020.10.023] [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: 08/18/2020] [Revised: 10/10/2020] [Accepted: 10/17/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) recently became the most frequently performed bariatric surgery (BS) worldwide, overtaking the long-time standard Roux-en-Y gastric bypass (RYGB). Main indications for one or the other procedure show large inter-center variations and warrant further investigations. OBJECTIVES The aim of this study was to identify the influencers of primary BS selection in Switzerland. SETTING Switzerland. METHODS Retrospective analysis of all hospitalizations in Switzerland January 1, 2011 through December 31, 2017 with anonymized data provided by the Swiss Federal Statistical Office. BS procedures were identified based on ICD-10 and national surgical codes. Statistical analyses were performed with R. RESULTS During the study period 27,375 BS were performed. The annual BS caseload doubled over time, whereas inpatient complications decreased (∼-33%). RYGB was the prevailing procedure, although its annual proportion decreased from 80% to 70% over 7 years. Meanwhile, use of SG increased from 14% to 23%. Primary RYGB and SG had similar rates of inpatient mortality (∼.05%) and morbidity (8.0 versus 7.4%, P =.148), with the exception of higher ileus rates following RYGB (.7 versus .1%, P < .001). Patient-related factors favoring the indication of SG were male sex, extremes of age, and metabolic co-morbidities , while gastroesophageal reflux disease and private insurance-favored RYGB. Strikingly, differences between geographic regions outweighed patient-related factors in procedure selection: inhabitants of German- and Italian-speaking areas had higher likelihood (OR 4.6; 3.9, P < .001) to receive SG than those in French-speaking areas. CONCLUSION Geographic differences in primary BS procedure selection indicate a lack of objective rationales. Long-term risk-benefit and cost-effectiveness analyses are needed to assist evidence-based decision making.
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Affiliation(s)
- Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Marcel A Schneider
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Michel Suter
- Department of Surgery, Hopital Riviera-Chablais, Rennaz, Switzerland
| | - Ralph Peterli
- Department of Visceral Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - René Vonlanthen
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Turina
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
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The outcomes of single anastomosis sleeve jejunal bypass as a treatment for morbid obesity (Two-year follow-up). Surg Endosc 2020; 35:5698-5704. [PMID: 32989534 DOI: 10.1007/s00464-020-08029-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 09/16/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Santoro's operation is a sleeve gastrectomy with transit bipartition. The aim of the procedure is to keep pass to the duodenum to decrease nutritional deficiency and to allow endoscopic management of obstructive jaundice. To be easier, this procedure was rapidly altered to a single anastomosis sleeve ileal bypass (SASI). In this study, we shifted the anastomosis up to the jejunum to evaluate the effect of laparoscopic single anastomosis sleeve jejunal (SASJ) bypass as a treatment for morbid obesity and related comorbidities. In addition, the effect of the SASJ procedure on nutritional deficiency was examined. METHODS In this study, 150 morbidly obese patients underwent SASJ bypass with a biliary limb length of 200-250 cm. All patients were followed up at 1, 3, 6, 12, 18, and 24 months. We evaluated all cases by assessing BMI, complications, nutritional status, and obesity-related comorbidities. RESULTS The mean age of participants was 30.6 years, and the mean body mass index (BMI) was 44.6 kg/m2. Of the patients, 35 (23.2%) had type two diabetes and 47 (31.3%) were hypertensive. Postoperative bleeding occurred in two cases (1.3%). One patient developed a gastric leak (0.7%), and five patients developed biliary gastritis (3.3%). One patient (0.7%) developed a pulmonary embolism. The %EWL reached 85% in 1 year. Normalization of blood glucose occurred within 2 months after surgery in all diabetic patients. Hypertension underwent remittance in 89% of hypertensive patients. All patients were gradually weaned from four types of multivitamin regimens to only one multivitamin regimen without apparent nutritional deficiency. CONCLUSIONS Laparoscopic SASJ bypass is an effective, safe, and simple procedure for treating morbid obesity and comorbid conditions with least nutritional deficiency. However, long-term studies are needed.
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Liagre A, Debs T, Kassir R, Ledit A, Juglard G, Chalret du Rieu M, Lazzati A, Martini F, Petrucciani N. One Anastomosis Gastric Bypass with a Biliopancreatic Limb of 150 cm: Weight Loss, Nutritional Outcomes, Endoscopic Results, and Quality of Life at 8-Year Follow-Up. Obes Surg 2020; 30:4206-4217. [DOI: 10.1007/s11695-020-04775-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Kermansaravi M, Kabir A, Mousavimaleki A, Pazouki A. Association between hiatal hernia and gastroesophageal reflux symptoms after one-anastomosis/mini gastric bypass. Surg Obes Relat Dis 2020; 16:863-867. [PMID: 32331999 DOI: 10.1016/j.soard.2020.03.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 02/01/2020] [Accepted: 03/05/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND One-anastomosis gastric bypass (OAGB) is an accepted bariatric and metabolic surgery with certain important complications, such as postoperative gastroesophageal reflux disease (GERD) and bile reflux (BR), which are not well addressed in literature. OBJECTIVES The present study was conducted to determine the true incidence of postoperative de novo GERD and BR and their associations with a hiatal hernia (HH). SETTING The present research setting comprised the Center of Excellence of the European Branch of the International Federation for the Surgery of Obesity and Metabolic Disorders, Hazrat-e-Rasoul Hospital, Tehran, Iran. METHODS The present cohort study recruited 200 patients with morbid obesity undergoing OAGB/minigastric bypass from December 2016 to February 2018 without any preoperative GERD symptoms. These patients were followed up for 1 year after the surgery. The incidence of post-OAGB GERD and BR was determined in all the patients using the GERD symptom questionnaire, GerdQ. RESULTS The mean age of the patients was 41.0 ± 11.6 years. A hernia was observed in 56 (29.2%) cases and GERD in 37 (19.3%). Hernia was small in 44 (22.9%) cases, medium in 11 (5.7%), and large in 1 (.5%). HH was found to be significantly correlated with GERD (P = .012). CONCLUSION The important post-OAGB complications, such as GERD and BR, have not been adequately addressed in literature. The present study found moderate and large HHs to be important factors for de novo GERD and repairing a HH during OAGB may be essential for preventing GERD-like symptoms.
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Affiliation(s)
- Mohammad Kermansaravi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran; Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat_e Rasool Hospital, Tehran, Iran.
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Ali Mousavimaleki
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran; Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat_e Rasool Hospital, Tehran, Iran
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Kermansaravi M, Pishgahroudsari M, Kabir A, Abdolhosseini MR, Pazouki A. Weight loss after one-anastomosis/mini-gastric bypass - The impact of biliopancreatic limb: A retrospective cohort study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2020; 25:5. [PMID: 32055245 PMCID: PMC7003543 DOI: 10.4103/jrms.jrms_117_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/17/2019] [Accepted: 10/24/2019] [Indexed: 12/26/2022]
Abstract
Background One-anastomosis/mini-gastric bypass (OAGB/MGB), as a popular bariatric surgery method, has many advantages; however, the biliopancreatic limb length (BPL) in this surgery is under debate. The aim of the study was to evaluate the effect of BPL on weight-loss outcome after OAGB/MGB. Materials and Methods A retrospective cohort study was performed on 653 patients who underwent OAGB/MGB with adjusted BPL based on preoperative body mass index (BMI) and patient's age, between 2010 and 2015 with 12-month follow-ups. Weight-loss outcomes and complications were analyzed in these patients, considering BPL. Results Weight, age, sex, and type 2 diabetes mellitus were the most contributory predictors as independent predictors of 12-month excess weight loss, respectively, and BPL was the least contributory predictor. Conclusion Tailoring BPL in OAGB/MGB based on patient's age and preoperative BMI seems to have acceptable results.
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Affiliation(s)
- Mohammad Kermansaravi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.,Center of Excellence of International Federation for Surgery of Obesity and Metabolic Disorders, Tehran, Iran
| | | | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.,Center of Excellence of International Federation for Surgery of Obesity and Metabolic Disorders, Tehran, Iran
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Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) claims its place among bariatric operations, proving itself a safe and effective procedure. METHODS This is a retrospective analysis of prospectively collected data regarding 94 patients who underwent surgery in a single surgical unit. Tailoring of the biliopancreatic limb length decided upon preoperative BMI was applied. Patients' excess weight loss and resolution of comorbidities were evaluated. Data on patients' nutritional status is also presented. RESULTS Mean BMI reduction at 36 months postoperatively was 21.7 ± 6.3 kg/m2. Mean excess weight loss (%EWL) was 83.6%, 91.8%, and 92.5% at 12, 24, and 36 months postoperatively, respectively. When controlling for preoperative BMI, a 36-month %EWL of 89.1% for the 2-m subgroup, a 95.3% for the 2.5-m subgroup, and a 104.7% for the 3-m subgroup were found. Operation's success, defined as %EWL greater than 50%, was 97.9% 36 months postoperatively. All patients suffering from hypertension, diabetes, and dyslipidemia achieved full remission. Furthermore, the percentage of patients with obstructive sleep apnea and gastroesophageal reflux disease, achieving full remission was 91.7% and 86.7%, respectively. An incidence of 5.3% new onset regurgitation was noted. Iron deficiency presented in 26 (27.7%) patients postoperatively, vitamin B12 deficiency in 13 (13.8%), folic acid deficiency in 18 (19.1%), and mild hypoalbuminemia in 7 (7.4%). Major early postoperative complications (Clavien-Dindo grade ≥ 3) were reported in 1.7% of our patients. One (1.1%) patient developed marginal ulcer and two (2.2) patients had late dumping. CONCLUSIONS OAGB is a safe and efficient technique; however, careful selection of patients and postoperative surveillance with respect to weight regain and nutritional deficiencies are mandatory for optimal results.
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Keleidari B, Mahmoudieh M, Shahabi S, Sheikhbahaei E, Rezaei M, Sayadi M, Melali H. Reversing One-Anastomosis Gastric Bypass Surgery due to Severe and Refractory Hypoalbuminemia. World J Surg 2019; 44:1200-1208. [DOI: 10.1007/s00268-019-05290-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Clinical Outcomes of One Anastomosis Gastric Bypass Versus Sleeve Gastrectomy for Morbid Obesity. Obes Surg 2019; 30:1021-1031. [PMID: 31797208 DOI: 10.1007/s11695-019-04303-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) and sleeve gastrectomy (SG) are popular bariatric surgeries for morbid obesity. Reports on the safety and effectiveness of SG and OAGB are inconsistent. This meta-analysis investigated the clinical outcomes of SG versus those of OAGB for morbid obesity. METHODS Based on PRISMA guidelines, we searched the published articles in English from Scopus, PubMed (Medline), Central (Cochrane), and Embase databases. Articles were retrieved from the start date of each database to February 13, 2019. Statistical analysis of this meta-analysis was conducted in Stata 14.0, and the most appropriate effect model was chosen based on heterogeneity. RESULTS A total of 20 articles examining 4064 OAGB patients and 3733 SG patients were included in this meta-analysis. Compared with SG, OAGB showed a higher percentage excess weight loss (%EWL) at 6 months (weighted mean difference (WMD) = 11.32; 95% CI 6.00-16.64), 12 months (WMD = 8.22; 95% CI 3.78-12.66), 24 months (WMD = 10.19; 95% CI 0.88-21.25), 36 months (WMD = 7.93; 95% CI 3.37-12.48), 48 months (WMD = 17.22; 95% CI 7.37-27.06), and 60 months (WMD = 16.43; 95% CI 8.96-23.90). In addition, OAGB was associated with a lower rate of postoperative leak, gastroesophageal reflux disease, revisions, mortality, and dyslipidemia remission rates. However, OAGB increased the incidence of ulcers, malnutrition, and bile reflux. CONCLUSION OAGB is more effective for %EWL and dyslipidemia remission than SG. In addition, OAGB may lower the risk of postoperative leak, gastroesophageal reflux disease, revision, and mortality. Further comparisons of the clinical outcomes of OAGB versus SG for morbid obesity would benefit from more high-quality controlled studies.
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Landreneau JP, Barajas-Gamboa JS, Strong AT, Corcelles R, Kroh MD. Conversion of one-anastomosis gastric bypass to Roux-en-Y gastric bypass: short-term results from a tertiary referral center. Surg Obes Relat Dis 2019; 15:1896-1902. [DOI: 10.1016/j.soard.2019.09.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/10/2019] [Accepted: 09/03/2019] [Indexed: 12/27/2022]
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Olmi S, Oldani A, Cesana G, Ciccarese F, Uccelli M, De Carli SM, Villa R, David G, Giorgi R, Zanoni AAG. Laparoscopic One Anastomosis Gastric Bypass Versus Laparoscopic One Anastomosis Gastric Bypass with Braun Anastomosis: What's Better? J Laparoendosc Adv Surg Tech A 2019; 29:1469-1474. [DOI: 10.1089/lap.2019.0218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Stefano Olmi
- Department of General and Oncological Surgery, Policlinico San Marco, Zingonia, Italy
| | - Alberto Oldani
- Department of General and Oncological Surgery, Policlinico San Marco, Zingonia, Italy
| | - Giovanni Cesana
- Department of General and Oncological Surgery, Policlinico San Marco, Zingonia, Italy
| | - Francesca Ciccarese
- Department of General and Oncological Surgery, Policlinico San Marco, Zingonia, Italy
| | - Matteo Uccelli
- Department of General and Oncological Surgery, Policlinico San Marco, Zingonia, Italy
| | | | - Roberta Villa
- Department of General and Oncological Surgery, Policlinico San Marco, Zingonia, Italy
| | - Giulia David
- Department of General and Oncological Surgery, Policlinico San Marco, Zingonia, Italy
| | - Riccardo Giorgi
- Department of General and Oncological Surgery, Policlinico San Marco, Zingonia, Italy
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Ribeiro R, Pouwels S, Parmar C, Pereira J, Manaças L, Guerra A, Borges N, Ribeiro J, Viveiros O. Outcomes of Long Pouch Gastric Bypass (LPGB): 4-Year Experience in Primary and Revision Cases. Obes Surg 2019; 29:3665-3671. [PMID: 31267476 DOI: 10.1007/s11695-019-04051-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND One of the most important complications of the one anastomosis gastric bypass (OAGB) is enterobilio acid reflux (EBAR). We report the concept of the long pouch Roux-en-Y gastric bypass (LPRYGB) meaning a Roux-en-Y with a long pouch and a 100-cm alimentary limb to avoid EBAR, with a long biliopancreatic limb to increase metabolic effects. METHODS A total of 300 LPRYGB cases in a 4-year period, with a 90% follow-up rate, were analysed. Anthropometric, technical feasibility, morbidity, weight loss and comorbidity outcomes were analysed. RESULTS The percentage total weight loss (%TWL) was 30.5% at 4 years of follow-up (32.3% in primary and 28.3% in revisions). Six intra-operative (2%) and 28 postoperative complications (9.3%) were seen. Out of this 28 complications, 11 (3.6%) were late complications. Reoperations were performed in 15 patients (5.0%). Clinically relevant EBAR was present in 3 cases only (1%) 4 years after the operation. CONCLUSIONS The LPRYGB combines the main advantages of the OAGB (light restriction and moderate malabsorption) with the anti-reflux effect from the Roux-en-Y diversion.
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Affiliation(s)
- Rui Ribeiro
- Clínica de Santo António, Metabolic Patient Multidisciplinary Centre, Reboleira, Lisbon, Portugal
| | - Sjaak Pouwels
- Department of Surgery, Haaglanden Medical Center, Lijnbaan 32, P.O. Box 432, 2501 CK, The Hague, The Netherlands.
| | | | - João Pereira
- Obesity and Endocrine Diseases Unit, Department of Surgery, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Leonor Manaças
- Obesity and Endocrine Diseases Unit, Department of Surgery, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Anabela Guerra
- Obesity and Endocrine Diseases Unit, Department of Surgery, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Nuno Borges
- Obesity and Endocrine Diseases Unit, Department of Surgery, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - João Ribeiro
- Clínica de Santo António, Metabolic Patient Multidisciplinary Centre, Reboleira, Lisbon, Portugal
| | - Octávio Viveiros
- Obesity and Endocrine Diseases Unit, Department of Surgery, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
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One Anastomosis Gastric Bypass–Mini Gastric Bypass with Tailored Biliopancreatic Limb Length Formula Relative to Small Bowel Length: Preliminary Results. Obes Surg 2019; 29:3062-3070. [DOI: 10.1007/s11695-019-04019-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Affiliation(s)
- Kamal K Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK.
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Mahawar KK, Parmar C, Graham Y. One anastomosis gastric bypass: key technical features, and prevention and management of procedure-specific complications. MINERVA CHIR 2019; 74:126-136. [DOI: 10.23736/s0026-4733.18.07844-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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38
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Aggarwal S, Bhambri A, Singla V, Dash NR, Sharma A. Adenocarcinoma of oesophagus involving gastro-oesophageal junction following mini-gastric bypass/one anastomosis gastric bypass. J Minim Access Surg 2019; 16:175-178. [PMID: 30777997 PMCID: PMC7176000 DOI: 10.4103/jmas.jmas_320_18] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Mini-gastric bypass/one anastomosis gastric bypass (MGB/OAGB) is an emerging weight loss surgical procedure. There are serious concerns not only regarding the symptomatic biliary reflux into the stomach and the oesophagus but also the increased risk of malignancy after MGB/OAGB. A 54-year-old male, with a body mass index (BMI) of 46.1 kg/m2, underwent Robotic MGB at another centre on 22nd June 2016. His pre-operative upper gastrointestinal endoscopy was not done. He lost 58 kg within 18 months after the surgery and attained a BMI of 25.1 kg/m2. However, 2-year post-MGB, the patient had rapid weight loss of 19 kg with a decrease in BMI to 18.3 kg/m2 within a span of 2 months. He also developed progressive dysphagia and had recurrent episodes of non-bilious vomiting. His endoscopy showed eccentric ulcerated growth in lower oesophagus extending up to the gastro-oesophageal junction and biopsy reported adenocarcinoma of oesophagus. MGB/OAGB has a potential for bile reflux with increased chances of malignancy. Surveillance by endoscopy at regular intervals for all patients who have undergone MGB/OAGB might help in early detection of Barrett's oesophagus or carcinoma of oesophagus or stomach.
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Affiliation(s)
- Sandeep Aggarwal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Bhambri
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Vitish Singla
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Nihar Ranjan Dash
- Department of Gastro-intestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
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Keleidari B, Mahmoudieh M, Davarpanah Jazi AH, Melali H, Nasr Esfahani F, Minakari M, Mokhtari M. Comparison of the Bile Reflux Frequency in One Anastomosis Gastric Bypass and Roux-en-Y Gastric Bypass: a Cohort Study. Obes Surg 2019; 29:1721-1725. [DOI: 10.1007/s11695-018-03683-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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40
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Jamal W, Zagzoog MM, Sait SH, Alamoudi AO, Abo'ouf S, Alghamdi AA, Bamashmous RO, Maghrabi AA. Initial outcomes of one anastomosis gastric bypass at a single institution. Diabetes Metab Syndr Obes 2019; 12:35-41. [PMID: 30613157 PMCID: PMC6307494 DOI: 10.2147/dmso.s180111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION One anastomosis gastric bypass (OAGB) is an emerging bariatric procedure, which has been reported to be safe and effective. This study aims to evaluate the short-term outcome of OAGB and its midterm effects on weight loss and remission of type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS A retrospective review of patients who had undergone OAGB between January 2013 and January 2017 in King Abdulaziz University Hospital, Jeddah, Saudi Arabia, is presented here. Patients' perioperative characteristics, biochemical profile (fasting blood glucose, HbA1c and iron profile) and details on subsequent weight loss in terms of body mass index (BMI) and excess weight loss percentage (EWL%) along with early and late postoperative complications were evaluated. RESULTS Out of the 47 patients who underwent OAGB, 42 were included in this study and completed the 2-year follow-up. Average operative time was 107±21.3 minutes and average length of hospital stay was 2.5±0.53 days. Mean preoperative BMI was 47.6±9.1 kg/m2, and at 1 and 2 years of follow-up, it was 30.5±7.4 and 27.1±5.1, respectively. No mortality, anastomotic leak or bleeding were reported. Most common midterm complication was iron deficiency anemia (n=7/42). Remission of T2DM at 6 months was 80%. Patients with preoperative T2DM for less than 10 years showed better remission (P<0.001). CONCLUSION Our analysis suggests that OAGB is a safe and effective weight loss procedure that carries low perioperative risk and acceptable nutritional complications in the midterm, with a notable remission of T2DM. Preoperative duration of T2DM plays a major role in achieving remission after OAGB.
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Affiliation(s)
- Wisam Jamal
- Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Mohammad M Zagzoog
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Salma H Sait
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Ahmed O Alamoudi
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Shaza Abo'ouf
- Beverly Medical Care Clinics for Obesity Management, Jeddah, Saudi Arabia
| | - Ayman A Alghamdi
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Ryan O Bamashmous
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Ashraf A Maghrabi
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
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Mahawar KK, Himpens J, Shikora SA, Chevallier JM, Lakdawala M, De Luca M, Weiner R, Khammas A, Kular KS, Musella M, Prager G, Mirza MK, Carbajo M, Kow L, Lee WJ, Small PK. The First Consensus Statement on One Anastomosis/Mini Gastric Bypass (OAGB/MGB) Using a Modified Delphi Approach. Obes Surg 2018; 28:303-312. [PMID: 29243145 DOI: 10.1007/s11695-017-3070-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND An increasing number of surgeons worldwide are now performing one anastomosis/mini gastric bypass (OAGB/MGB). Lack of a published consensus amongst experts may be hindering progress and affecting outcomes. This paper reports results from the first modified Delphi consensus building exercise on this procedure. METHODS A committee of 16 recognised opinion-makers in bariatric surgery with special interest in OAGB/MGB was constituted. The committee invited 101 OAGB/MGB experts from 39 countries to vote on 55 statements in areas of controversy or variation associated with this procedure. An agreement amongst ≥ 70.0% of the experts was considered to indicate a consensus. RESULTS A consensus was achieved for 48 of the 55 proposed statements after two rounds of voting. There was no consensus for seven statements. Remarkably, 100.0% of the experts felt that OAGB/MGB was an "acceptable mainstream surgical option" and 96.0% felt that it could no longer be regarded as a new or experimental procedure. Approximately 96.0 and 91.0% of the experts felt that OAGB/MGB did not increase the risk of gastric and oesophageal cancers, respectively. Approximately 94.0% of the experts felt that the construction of the gastric pouch should start in the horizontal portion of the lesser curvature. There was a consensus of 82, 84, and 85% for routinely supplementing iron, vitamin B12, and vitamin D, respectively. CONCLUSION OAGB/MGB experts achieved consensus on a number of aspects concerning this procedure but several areas of disagreements persist emphasising the need for more studies in the future.
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Affiliation(s)
- Kamal K Mahawar
- Bariatric Unit, Department of General Surgery, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK.
| | | | - Scott A Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | - Rudolf Weiner
- Clinic Obesity Surgery, Sana-Klinikum Offenbach, Offenbach, Germany
| | - Ali Khammas
- Rashid Hospital, Dubai, United Arab Emirates
| | | | - Mario Musella
- Advanced Biomedical Sciences Department, Federico II University, Naples, Italy
| | | | | | - Miguel Carbajo
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Valladolid, Spain
| | - Lilian Kow
- Adelaide Bariatric Centre, Adelaide, Australia
| | - Wei-Jei Lee
- Min-Sheng General Hospital, Taoyuan City, Taiwan
| | - Peter K Small
- Bariatric Unit, Department of General Surgery, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
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Fahmy MH, Sarhan MD, Salman MA, Fathy E. Gastro-Esophageal Reflux Disease After Laparoscopic Mini-Gastric Bypass and Roux-en-Y Gastric Bypass: Is There a Difference? Bariatr Surg Pract Patient Care 2018. [DOI: 10.1089/bari.2018.0018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mohamed Hassan Fahmy
- Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohammed Diaa Sarhan
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Ehab Fathy
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
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Ahuja A, Tantia O, Goyal G, Chaudhuri T, Khanna S, Poddar A, Gupta S, Majumdar K. MGB-OAGB: Effect of Biliopancreatic Limb Length on Nutritional Deficiency, Weight Loss, and Comorbidity Resolution. Obes Surg 2018; 28:3439-3445. [DOI: 10.1007/s11695-018-3405-7] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Parmar CD, Mahawar KK. One Anastomosis (Mini) Gastric Bypass Is Now an Established Bariatric Procedure: a Systematic Review of 12,807 Patients. Obes Surg 2018; 28:2956-2967. [DOI: 10.1007/s11695-018-3382-x] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Attention to Technical Details Is Important for Best Outcomes with One Anastomosis Gastric Bypass. Obes Surg 2018; 28:2920-2921. [DOI: 10.1007/s11695-018-3367-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
BACKGROUND One-anastomosis gastric bypass (OAGB) is a promising laparoscopic procedure with various benefits including shorter operating times and less operative complications. That said, it is yet to gain widespread acceptance. Here, we describe our first-year experience with OAGB in our department, in particular the safety and efficacy of this procedure. METHODS This study is a retrospective analysis of all patients who underwent OAGB between March 2015 and March 2016 by our bariatric surgery unit. Patient demographics, comorbidities, operative and postoperative data were collected and analyzed as well as outcomes during the first year. RESULTS Four hundred and seven patients underwent OAGB (254 females, average age 41.8 ± 12.05, BMI = 41.7 ± 5.77 kg/m2). Ninety-eight patients (24%) had prior bariatric surgery. Ninety-four patients (23%) had diabetes, 93 patients (22.8%) had hypertension, 123 (28.8%) had hyperlipidemia, and 35 patients (8.6%) suffered from obstructive sleep apnea. Eight patients (1.96%) had early minor complications (Clavien-Dindo 1-3a), and 10 patients (2.45%) suffered early major complications (Clavien-Dindo ≥3b). The average length of hospital stay was 2.2 ± 0.84 days (range 2-10 days). Twenty patients (4.8%) were readmitted, and 10 patients underwent reoperation. Patients who had had previous bariatric surgery had higher rates of complications, a prolonged hospital admission, higher rates of readmission, and early reoperations. The average excess weight loss (%EWL) 1 year following surgery was 88.9 ± 27.3 and 72.8 ± 43.5% in patients that underwent primary and revision OAGB, respectively. CONCLUSIONS OAGB is both safe and effective as a primary as well as a revision bariatric surgery.
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Complications Following the Mini/One Anastomosis Gastric Bypass (MGB/OAGB): a Multi-institutional Survey on 2678 Patients with a Mid-term (5 Years) Follow-up. Obes Surg 2018; 27:2956-2967. [PMID: 28569357 DOI: 10.1007/s11695-017-2726-2] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND In recent years, several articles have reported considerable results with the Mini/One Anastomosis Gastric Bypass (MGB/OAGB) in terms of both weight loss and resolution of comorbidities. Despite those positive reports, some controversies still limit the widespread acceptance of this procedure. Therefore, a multicenter retrospective study, with the aim to investigate complications following this procedure, has been designed. PATIENTS AND METHODS To report the complications rate following the MGB/OAGB and their management, and to assess the role of this approach in determining eventual complications related especially to the loop reconstruction, in the early and late postoperative periods, the clinical records of 2678 patients who underwent MGB/OAGB between 2006 and 2015 have been studied. RESULTS Intraoperative and early complications rates were 0.5 and 3.1%, respectively. Follow-up at 5 years was 62.6%. Late complications rate was 10.1%. A statistical correlation was found for perioperative bleeding both with operative time (p < 0.001) or a learning curve of less than 50 cases (p < 0.001). A statistical correlation was found for postoperative duodenal-gastro-esophageal reflux (DGER) with a preexisting gastro-esophageal-reflux disease (GERD) or with a gastric pouch shorter than 9 cm, (p < 0.001 and p = 0.001), respectively. An excessive weight loss correlated with a biliopancreatic limb longer than 250 cm (p < 0.001). CONCLUSIONS Our results confirm MGB/OAGB to be a reliable bariatric procedure. According to other large and long-term published series, MGB/OAGB seems to compare very favorably, in terms of complication rate, with two mainstream procedures as standard Roux-en-Y gastric bypass (RYGBP) and laparoscopic sleeve gastrectomy (LSG).
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Petersen's Space Internal Hernia after Laparoscopic One Anastomosis (Mini) Gastric Bypass. Case Rep Surg 2018; 2018:9576120. [PMID: 29808157 PMCID: PMC5901483 DOI: 10.1155/2018/9576120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/08/2018] [Indexed: 11/17/2022] Open
Abstract
Background One anastomosis gastric bypass (OAGB) is now considered as an appropriate alternative for Roux-en-Y gastric bypass (RYGB) with some advantages such as absence of risk for internal hernia (IH). But, is really the risk of IH equal zero after OAGB? Case Summary. A 37-year-old male was admitted due to severe abdominal crampy pain, nausea, vomiting, and obstipation. He had chronic and intermittent abdominal pain from 2 years after OAGB. With high suspicion of complete obstruction, the exploratory laparoscopy was performed. Intraoperative findings showed incarcerated bowel hernia from Petersen's defect. The incarcerated bowel was reduced, and the defect was repaired. The patient was discharged 2 days after operation. Conclusion The incidence of IH after OAGB is rare but not zero. In any suspicious signs and symptoms for IH, the early exploratory laparoscopy is mandatory to diagnose and treat.
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Implementation of mini gastric bypass in the Netherlands: early and midterm results from a high-volume unit. Surg Endosc 2018; 32:3949-3955. [PMID: 29492707 DOI: 10.1007/s00464-018-6136-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 02/23/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Mini gastric bypass (MGB) is a promising and attractive alternative bariatric procedure. In 2011, we introduced MGB in our high-volume bariatric unit. Subsequently, we evaluated short- and midterm results of this procedure. METHODS A prospective cohort of patients who underwent MGB between 2012 and 2013 was retrospectively evaluated. RESULTS From 2012 to 2013, primary MGB was performed in 287 patients with a mean BMI of 42 kg/m2 (range 32-76 kg/m2). The mean operation time was 50 min (range 25-120 min). The mortality rate was 0%. Serious complications, such as leakage, pulmonary embolism, or bleeding, occurred in 3.1% of patients; anastomotic leaks occurred in 1.4% of patients. Conversion to Roux-en-Y gastric bypass for biliary reflux or other indications occurred in six patients (2%). During our initial learning phase, biliary reflux rates were higher due to an overly short pouch. Surgical revision for malnutrition was performed in one patient. Percent excess weight loss and percent total body weight loss were 85 and 35%, respectively, after 1 year; 88 and 36.6%, respectively, after 2 years; and 83 and 34.3%, respectively, after 3 years. Follow-up rates after 1, 2, and 3 years were 96% (277/287), 72% (208/287), and 66% (190/287), respectively. CONCLUSIONS As a primary bariatric procedure, MGB is associated with good early and midterm results. MGB has the potential to become a significant alternative bariatric procedure. Correct technique is of extreme importance when performing MGB; therefore, the appointment of an experienced MGB surgeon as a guide when beginning to utilize this technique is advised.
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