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Ferreira EVB, Queiroz GT, Corrêa ALC, Annelli GL, Ribeiro GR, Salgado W. Long-term Comparative Evaluation of Weight Loss and Complications of Banded and Non-banded Roux-en-Y Gastric Bypass. Obes Surg 2024:10.1007/s11695-024-07354-7. [PMID: 38884901 DOI: 10.1007/s11695-024-07354-7] [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: 04/16/2024] [Revised: 06/04/2024] [Accepted: 06/04/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE The use of a nonadjustable silicone band around the gastric pouch of Roux-en-Y gastric bypass (RYGB) to reduce the recurrence of obesity is still being debated in the literature. The primary objective of this study was to evaluate banded and non-banded RYGB regarding % total weight loss (%TWL) and complications up to 10 years postoperatively and regarding the removal rate of the silicone band. MATERIAL AND METHODS A retrospective study of the medical records of all patients submitted to banded and non-banded RYGB between 2000 and 2020 was conducted. Clinical data (age, gender, weight, body mass index-BMI, comorbidities, %TWL, and the prevalence of vomiting) and laboratory data (hemoglobin, serum iron, albumin, and vitamin B12) were obtained preoperatively and at 6 months, 1, 2, 3, 5, 7, and 10 years for both groups and at 12, 15, and 20 years after banded RYGB. RESULTS In total, 858 patients underwent RYGB: 409 underwent banded RYGB and 449 underwent non-banded RYGB. In the preoperative period, banded RYGB patients were heavier and had higher rates of hypertension and dyslipidemia. The %TWL was higher in the banded RYGB group up to 7 years. The prevalence of vomiting is much higher in this group, which also had lower laboratory test values. Of the banded RYGB patients, 9.53% had to have the silicone ring removed after presenting complications. CONCLUSION Banded RYGB promotes significantly higher rates of TWL at the expense of a higher frequency of food intolerance and vomiting.
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Affiliation(s)
- Emmanuel V B Ferreira
- Department of Surgery and Anatomy, Clinical Hospital, Faculty of Medicine, University of São Paulo, Ribeirao Preto, Brazil
| | - Gabriele T Queiroz
- Department of Surgery and Anatomy, Clinical Hospital, Faculty of Medicine, University of São Paulo, Ribeirao Preto, Brazil
| | - Ana-Luisa C Corrêa
- Department of Surgery and Anatomy, Clinical Hospital, Faculty of Medicine, University of São Paulo, Ribeirao Preto, Brazil
| | - Guilherme L Annelli
- Department of Surgery and Anatomy, Clinical Hospital, Faculty of Medicine, University of São Paulo, Ribeirao Preto, Brazil
| | - Gabriel R Ribeiro
- Department of Surgery and Anatomy, Clinical Hospital, Faculty of Medicine, University of São Paulo, Ribeirao Preto, Brazil
| | - Wilson Salgado
- Department of Surgery and Anatomy, Clinical Hospital, Faculty of Medicine, University of São Paulo, Ribeirao Preto, Brazil.
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2
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Pavone G, Chierici A, Drai C, Alromayan M, Alamri A, Tartaglia N, Liddo G, Iannelli A. Banded versus non-banded Roux-en-Y gastric bypass: short, mid, and long-term surgical outcomes - a systematic review and meta-analysis. Surg Obes Relat Dis 2024:S1550-7289(24)00638-5. [PMID: 38960827 DOI: 10.1016/j.soard.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 04/29/2024] [Accepted: 05/17/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND The Roux-en-Y gastric bypass (RYGB) is considered as one of the most effective treatments for people with obesity. A variant of this procedure, the banded-RYGB, may present several advantages over the standard technique. These potential benefits include enhanced weight loss, decreased recurrent weight gain, a lower incidence of dumping syndrome, and less distention of the jejunum below the gastrojejunostomy. OBJECTIVES The objective of this meta-analysis is to compare the surgical outcomes of RYGB procedures with a band (banded-RYGB) and without a band (RYGB) in the management of individuals with obesity. SETTING A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane protocol (PROSPERO ID: CRD42023439874). METHOD The systematic review process led to the identification of 13 comparative studies involving 3230 patients who underwent banded-RYGB and 5302 who received RYGB, all of which were eligible for inclusion and meta-analysis. RESULTS Four studies reported data on 1-year postoperative percent excess weight loss (%EWL), demonstrating a significant increase of 6.03 %EWL in patients who underwent banded-RYGB. Four studies reported the 2-year postoperative %EWL, showing that patients who had banded-RYGB experienced a 5.32 greater %EWL compared to those who received RYGB, even if this was not statistically significant. For 5-year %EWL after bariatric surgery, 5 studies were included for continuous outcome meta-analysis. The average 5-years %EWL difference was 7.6 in favor of banded-RYGB. Patients who had banded-RYGB presented a nonsignificant 1.45 OR of developing postoperative complications compared to patients receiving RYGB. CONCLUSION This meta-analysis demonstrates that, compared to RYGB, patients who underwent banded-RYGB surgery showed a statistically significant increase in the %EWL at 1, 2, and 5 years postoperatively. Moreover, the banding procedure does not significantly increase the risk of postoperative complications.
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Affiliation(s)
- Giovanna Pavone
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France
| | - Andrea Chierici
- Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France
| | - Céline Drai
- Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France; Université Côte d'Azur, Nice, France
| | - Mohamed Alromayan
- Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France; Security Forces Medical City, Riyadh, Saudi Arabia
| | - Abdelrhamane Alamri
- Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France; Department of Surgery, Medical College, Najran University, Najran, Saudi Arabia
| | - Nicola Tartaglia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Guido Liddo
- Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France
| | - Antonio Iannelli
- Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France; Université Côte d'Azur, Nice, France; Inserm, U1065, Team 8 "Hepatic Complications of Obesity and Alcohol" Nice, France.
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Małczak P, Mizera M, Lee Y, Pisarska-Adamczyk M, Wysocki M, Bała MM, Witowski J, Rubinkiewicz M, Dudek A, Stefura T, Torbicz G, Tylec P, Gajewska N, Vongsurbchart T, Su M, Major P, Pędziwiatr M. Quality of Life After Bariatric Surgery-a Systematic Review with Bayesian Network Meta-analysis. Obes Surg 2021; 31:5213-5223. [PMID: 34633614 PMCID: PMC8595157 DOI: 10.1007/s11695-021-05687-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Comprehensive analysis and comparison of HRQoL following different bariatric interventions through systematic review with network meta-analysis. BACKGROUND Different types of bariatric surgeries have been developed throughout the years. Apart from weight loss and comorbidities remission, improvement of health-related quality of life (HRQoL) is an important outcome of metabolic surgery. METHODS MEDLINE, EMBASE, and Scopus databases have been searched up to April 2020. Inclusion criteria to the analysis were (1) study with at least 2 arms comparing bariatric surgeries; (2) reporting of HRQoL with a validated tool; (3) follow-up period of 1, 2, 3, or 5 years. Network meta-analysis was conducted using Bayesian statistics. The primary outcome was HRQoL. RESULTS Forty-seven studies were included in the analysis involving 26,629 patients and 11 different surgeries such as sleeve gastrectomy (LSG), gastric bypass (LRYGB), one anastomosis gastric bypass (OAGB), and other. At 1 year, there was significant difference in HRQoL in favor of LSG, LRYGB, and OAG compared with lifestyle intervention (SMD: 0.44; 95% CrI 0.2 to 0.68 for LSG, SMD: 0.56; 95% CrI 0.31 to 0.8 for LRYGB; and SMD: 0.43; 95% CrI 0.06 to 0.8 for OAGB). At 5 years, LSG, LRYGB, and OAGB showed better HRQoL compared to control (SMD: 0.92; 95% CrI 0.58 to 1.26, SMD: 1.27; 95% CrI 0.94 to 1.61, and SMD: 1.01; 95% CrI 0.63 to 1.4, respectively). CONCLUSIONS LSG and LRYGB may lead to better HRQoL across most follow-up time points. Long-term analysis shows that bariatric intervention results in better HRQoL than non-surgical interventions.
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Affiliation(s)
- Piotr Małczak
- Department of Medical Education, Jagiellonian University Medical College, Medyczna 7 , 30-688, Cracow, Poland
| | - Magdalena Mizera
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Yung Lee
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Magdalena Pisarska-Adamczyk
- Department of Medical Education, Jagiellonian University Medical College, Medyczna 7 , 30-688, Cracow, Poland.
| | - Michał Wysocki
- Department of General Surgery and Surgical Oncology, Ludwik Rydygier Memorial Hospital in Cracow, Cracow, Poland
| | - Małgorzata M Bała
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Cracow, Poland
| | - Jan Witowski
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz Rubinkiewicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Alicja Dudek
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Tomasz Stefura
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Grzegorz Torbicz
- Department of General Surgery and Surgical Oncology, Ludwik Rydygier Memorial Hospital in Cracow, Cracow, Poland
| | - Piotr Tylec
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Natalia Gajewska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Tanawat Vongsurbchart
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Michael Su
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
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4
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Weight Loss and Vomiting 1 Year After Banded Versus Non-banded One Anastomosis Gastric Bypass: a Prospective Randomized Trial. Obes Surg 2020; 30:1719-1725. [PMID: 31942688 DOI: 10.1007/s11695-020-04393-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The weight loss outcomes after banded one-anastomosis gastric bypass (OAGB) remain to be determined. OBJECTIVE To compare weight loss and vomiting 1 year after banded versus non-banded OAGB. METHODS This is a prospective, open-label, randomized study, which evaluated 33 individuals with morbid obesity, which underwent banded (16 individuals) and non-banded OAGB (17 individuals) and were followed up for 12 months. Weight loss (percentages of total weight loss-%TWL-and excess weight loss-%EWL) and occurrence of vomiting were assessed and compared before surgery and after 6 and 12 months. RESULTS At baseline, there were no differences between groups in regard to age, gender, and body mass index (BMI). At 6 and 12 months post-op, and the overall mean %TWL regardless of band use was 22.4 ± 7% and 29 ± 6.9%, respectively, and the overall average %EWL regardless of band use was 66.8 ± 22.9% and 86.3 ± 24%, respectively. %TWL did not differ between the banded and non-banded groups at 6 (21.8 ± 6.8% vs. 23.1 ± 7.4%; p = 0.7) and 12 months post-op (27.5 ± 6.6% vs. 30.4 ± 7.1%; p = 0.3), as well as %EWL at 6 (67 ± 22.9% vs. 67.6 ± 23.6%; p = 0.6) and 12 months post-op (83.5 ± 24.4% vs. 89 ± 24.1%; p = 0.4). The occurrence of vomiting did not significantly differ between banded and non-banded OAGB at 6 (12.5% vs. 11.8%; p = 0.9) and 12 months post-op (12.5% vs. 5.9%; p = 0.5). CONCLUSION OAGB led to an overall satisfactory weight loss after 1 year, regardless of band use. Banded OAGB did not lead to neither significantly higher weight loss nor more vomiting than non-banded OAGB 1 year after surgery.
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Galal AM, Boerma EJ, Fransen S, Meesters B, Olde-Damink S, Abdelmageed MK, Sabry AA, Elsuity AHM, Greve JW. Impact of Laparoscopic Banded Gastric Bypass on Weight Loss Surgery Outcomes: 5 Years' Experience. Obes Surg 2019; 30:630-639. [PMID: 31643030 DOI: 10.1007/s11695-019-04229-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Evaluate 5-year outcomes of banded gastric bypass (BRYGB) as a primary and conversion bariatric procedure. METHODS Retrospective review of BRYGB between January 2011and March 2013. Outcomes included percentage of total weight loss (%TWL), weight loss maintenance, and band-related complications. RESULTS One hundred forty-two patients underwent BRYGB, 106 primary and 36 conversions. Indications for conversion to BRYGB were complications of the primary procedure (n = 19), insufficient weight loss (n = 5), and weight regain (n = 12). In the primary group, mean preoperative BMI was 44.8 kg/m2 (± 6.9 kg/m2). Compared with preoperative weight, mean %TWL was 33.9% (n = 95), 34.1% (n = 82), 34.0% (n = 70), 33.9% (n = 62), and 31.8% (n = 75) after 1, 2, 3, 4, and 5 years, respectively. In conversions secondary to failed primary procedure (insufficient WL and weight regain), mean preoperative BMI was 40.8 kg/m2 (± 6.01 kg/m2). Despite one patient gaining weight, mean %TWL was 25.7% (n = 13), 28% (n = 11), 23.9% (n = 8), 18.3% (n = 8), and 15.1% (n = 12) after 1, 2, 3, 4, and 5 years, respectively. In conversions secondary to primary procedure complications (n = 19), mean preoperative BMI was 28.4 kg/m2 (± 3.5 kg/m2). After 1, 2, 3, 4, and 5 years, mean BMI was 28.1 (n = 15), 29 (n = 10), 29.8 (n = 9), 30.6 (n = 10), and 30.9 (n = 12) kg/m2, respectively. Band-related complications after 5 years: three erosion and five patients complained of persistent dysphagia. One band needed reposition. Perioperative surgical complications: two bleeding, one leakage, one port-site hernia, and one food impaction. CONCLUSION Banded gastric bypass has good results in terms of weight loss and weight loss maintenance in both primary and conversional bariatric procedures with acceptable incidence of band-related complications.
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Affiliation(s)
- Abdelrahman Mohammad Galal
- Surgery Department, Zuyderland Medical Center, Heerlen, The Netherlands. .,Dutch Obesity Clinic South, Heerlen, The Netherlands. .,Metabolic and Bariatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. .,General Surgery Department, Sohag Faculty of Medicine, Sohag University Hospitals, Sohag, Egypt.
| | - Evert-Jan Boerma
- Surgery Department, Zuyderland Medical Center, Heerlen, The Netherlands.,Dutch Obesity Clinic South, Heerlen, The Netherlands
| | - Sofie Fransen
- Surgery Department, Zuyderland Medical Center, Heerlen, The Netherlands.,Dutch Obesity Clinic South, Heerlen, The Netherlands
| | - Berry Meesters
- Surgery Department, Zuyderland Medical Center, Heerlen, The Netherlands.,Dutch Obesity Clinic South, Heerlen, The Netherlands
| | - Steven Olde-Damink
- Metabolic and Bariatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Alaa Abass Sabry
- Surgery department, Ainshams Faculty of Medicine, Ainshams University Hospital, Cairo, Egypt
| | | | - Jan Willem Greve
- Surgery Department, Zuyderland Medical Center, Heerlen, The Netherlands. .,Dutch Obesity Clinic South, Heerlen, The Netherlands. .,Metabolic and Bariatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
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Bhandari M, Ponce de Leon-Ballesteros G, Kosta S, Bhandari M, Humes T, Mathur W, Fobi M. Surgery in Patients with Super Obesity: Medium-Term Follow-Up Outcomes at a High-Volume Center. Obesity (Silver Spring) 2019; 27:1591-1597. [PMID: 31479206 DOI: 10.1002/oby.22593] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/15/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE There is a need to determine which bariatric operations are the most effective for patients with super obesity and super-super obesity. METHODS A retrospective cohort study was performed on patients with super obesity and super-super obesity at Mohak Bariatrics and Robotics Surgery Center in Indore, India. RESULTS Five hundred fourteen patients with super obesity and super-super obesity had surgery at our center from January 2010 through December 2013. The baseline characteristics were different in different operations. The initial average age, weight, and BMI were 44.4 (SD 11.9) years, 145.4 (SD 24.2) kg, and 55.48 (SD 5.32) kg/m2 , respectively. Sleeve gastrectomy (SG) (227 [44.2%]) was the most common procedure, followed by one-anastomosis gastric bypass (OAGB) (124 [24.1%]), Roux-en-Y gastric bypass (RYGB) (102 [19.8%]), banded sleeve gastrectomy (BSG) (33 [6.4%]), and banded Roux-en-Y gastric bypass (BRYGB) (28 [5.4%]). After 3 years, the percentages of excess body weight loss (%EBWL) for SG, OAGB, RYGB, BSG, and BRYGB were 62.38%, 78.59%, 69.55%, 85.11%, and 75.77% (P < 0.0001), respectively. Failure to achieve BMI < 35 kg/m2 was more frequent in the group who underwent SG (67.9%), followed by RYGB (29.16%), BRYGB (22.2%), OAGB (9.87%), and none in the BSG group. CONCLUSIONS BSG, OAGB, and BRYGB have very good to excellent midterm outcomes for patients with super obesity and super-super obesity, whereas RYGB and SG have average outcomes at 3 years. There is a need for multicenter, long-term, and prospective studies to be performed to confirm these findings.
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Affiliation(s)
- Mohit Bhandari
- Mohak Bariatrics and Robotics Surgery Center, Indore, India
| | | | - Susmit Kosta
- Mohak Bariatrics and Robotics Surgery Center, Indore, India
| | - Mahak Bhandari
- Mohak Bariatrics and Robotics Surgery Center, Indore, India
| | - Terrel Humes
- Mohak Bariatrics and Robotics Surgery Center, Indore, India
| | - Winni Mathur
- Mohak Bariatrics and Robotics Surgery Center, Indore, India
| | - Mathias Fobi
- Mohak Bariatrics and Robotics Surgery Center, Indore, India
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Magouliotis DE, Tasiopoulou VS, Svokos KA, Svokos AA, Sioka E, Tzovaras G, Zacharoulis D. Banded vs. non-banded Roux-en-Y gastric bypass for morbid obesity: a systematic review and meta-analysis. Clin Obes 2018; 8:424-433. [PMID: 30144284 DOI: 10.1111/cob.12274] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/11/2018] [Accepted: 06/21/2018] [Indexed: 01/05/2023]
Abstract
We aim to review the available literature on patients with morbid obesity treated with banded (BRYGB) or non-banded Roux-en-Y gastric bypass (NBRYGB), in order to compare the clinical outcomes and intraoperative parameters of the two methods. A systematic literature search was performed in PubMed, Cochrane library and Scopus databases, in accordance with the PRISMA guidelines. Eight studies met the inclusion criteria incorporating 3899 patients. This study reveals similar rates of complications, mortality, remission of type 2 diabetes, hypertension, dyslipidaemia, gastroesophageal reflux and obstructive sleep apnoea, along with similar % excess weight loss (%EWL) at 1 and 2 years postoperatively. In contrast, according to an analysis of two eligible studies the BRYGB procedure was associated with increased %EWL at 5 years postoperatively. These results should be interpreted with caution due to the small number of statistical arms and randomized controlled studies. However, the present article represents the best available evidence in the field. Well-designed, randomized controlled studies, comparing BRYGB to NBRYGB, are necessary to further assess their clinical outcomes.
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Affiliation(s)
- D E Magouliotis
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - V S Tasiopoulou
- School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - K A Svokos
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - A A Svokos
- Department of Obstetrics and Gynecology, Riverside Regional Medical Center, Newport News, VA, USA
| | - E Sioka
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - G Tzovaras
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - D Zacharoulis
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
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Laparoscopic Silastic Ring Mini-Gastric Bypass (SR-MGBP): Up to 11-Year Results from a Single Centre. Obes Surg 2018; 27:2229-2234. [PMID: 28378207 DOI: 10.1007/s11695-017-2659-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Bariatric surgery is well established as an effective method for treating obesity and its related comorbidities. The laparoscopic mini-gastric bypass (MGBP) represents a simpler alternative to a Roux-en-Y gastric bypass (RYGBP). The placement of a silastic ring (SR) may enhance excess weight loss and minimize weight regain. This study reports long-term results from a cohort of patients undergoing a SR-MGBP in a single centre. METHODS Long-term outcomes (up to 11 years) in a cohort of 156 patients undergoing surgery between August 2005 and January 2008 were analysed. A combination of follow-up questionnaires and electronic hospital records were used to assess weight loss, comorbidity resolution and complications. RESULTS A total of 156 patients (mean body mass index 46 kg/m2) underwent surgery. Ninety-two patients responded to the follow-up questionnaires. Computer-based hospital information was available on a total of 139 patients. Mean percent excess weight loss (%EWL) at 11 years was 84.3%. Comorbidity resolution, determined by medication use, showed a reduction in diabetes (21.8% to 7.1%), hypertension (37.2% to 21.4%) and hypercholesterolaemia (40.4% to 13.4%). Five of 139 patients (3.6%) had SR problems needing removal. Two other patients had the SR changed to a bigger size and a further two had endoscopic removal of the SR for erosion. Of the 139 patients, 9.4% required conversion to a Roux-en-Y gastric bypass (RYGBP). The number of patients on anti-reflux medications increased from 5.1% to 44.6% at 11 years. There were two deaths unrelated to surgery. CONCLUSIONS SR-MGBP appears to be a safe and effective operation for the morbidly obese. It is durable, with good weight loss at up to 11 years post-surgery. The SR can easily be removed or exchanged for another size and is reasonable to consider when performing a MGBP. Concerns about bile reflux appear to be well founded, and some patients who are poorly controlled medically will require revision.
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9
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Fink JM, Hoffmann N, Kuesters S, Seifert G, Laessle C, Glatz T, Hopt UT, Konrad Karcz W, Marjanovic G. Banding the Sleeve Improves Weight Loss in Midterm Follow-up. Obes Surg 2017; 27:1098-1103. [PMID: 28214956 DOI: 10.1007/s11695-017-2610-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) can achieve excellent weight loss, yet sleeve dilatation with concomitant weight regain proves to be a relevant issue. Hence, additional restriction might improve results after LSG. METHODS In a retrospective matched-pair analysis, 42 patients who underwent banded LSG (BLSG) using a MiniMizer® ring between January 2012 and October 2014 were analysed regarding weight loss, complications and comorbidity. Median follow-up was 3 years. Forty-two patients who had undergone conventional LSG were selected as matched pairs. RESULTS Mean preoperative BMI was 54.93 ± 7.42 kg/m2 for BLSG and 53.46 ± 6.69 kg/m2 for LSG (Mann-Whitney P = 0.540). Total weight loss (%TWL) was significantly greater in the BLSG group 3 years after surgery (BLSG 38.22% ± 7.26; n = 26 vs. LSG 32.69 ± 9.47; n = 26; P = 0.0154). Ring placement had no relevant impact on new-onset reflux (Fisher's exact test P = 1.0) but a tendency towards reflux improvement when reflux pre-existed (odds ratio 1.96). The major side effect of ring implantation was regurgitation with over 44% of patients presenting with regurgitation >1 per week (Fisher's exact test P = 0.0019, odds ratio 18.07). CONCLUSION BLSG is a safe procedure showing similar comorbidity to conventional LSG. However, BLSG leads to a higher rate of postoperative regurgitation. Weight loss is significantly improved 3 years after surgery. Hence, additional ring implantation might be an option for increased restriction in LSG surgery.
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Affiliation(s)
- Jodok M Fink
- Department of General, Visceral and Transplant Surgery, Centre for Metabolic Surgery, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
| | - Natalie Hoffmann
- Department of General, Visceral and Transplant Surgery, Centre for Metabolic Surgery, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Simon Kuesters
- Department of General, Visceral and Transplant Surgery, Centre for Metabolic Surgery, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Gabriel Seifert
- Department of General, Visceral and Transplant Surgery, Centre for Metabolic Surgery, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Claudia Laessle
- Department of General, Visceral and Transplant Surgery, Centre for Metabolic Surgery, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Torben Glatz
- Department of General, Visceral and Transplant Surgery, Centre for Metabolic Surgery, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Ulrich T Hopt
- Department of General, Visceral and Transplant Surgery, Centre for Metabolic Surgery, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - W Konrad Karcz
- Department of General, Visceral, Vascular and Transplant Surgery, University of Munich, Munich, Germany
| | - Goran Marjanovic
- Department of General, Visceral and Transplant Surgery, Centre for Metabolic Surgery, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
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Comparison of Banded Versus Non-banded Roux-en-Y Gastric Bypass: a Series of 1150 Patients at a Single Institution. Obes Surg 2017; 28:212-217. [DOI: 10.1007/s11695-017-2832-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
BACKGROUND Banded-gastric bypass is a highly effective bariatric procedure, yet the possibility of band erosion remains a significant drawback. Surgical removal of eroded bands may be associated with significant morbidity. In this study, we assess the efficacy and safety of a solely peroral endoscopic approach for the management of eroded bands in patients with a banded-gastric bypass. MATERIALS AND METHODS Starting January 2012, all patients with banded-gastric bypass and an eroded band were subjected to an attempt at peroral endoscopic removal using endoscopic scissors and/or argon plasma coagulation (APC), regardless of the circumference of band eroding inside the lumen. RESULTS Sixteen patients presented with eroded bands, 2 were deemed not amenable to endoscopic removal as only part of the thickness was eroded. Of the 14 patients where endoscopic attempts were performed, 12 (86%) were completely removed successfully, while 2 (14%) were cut but could not be extracted and only the intraluminal portion was trimmed. Complete resolution of symptoms occurred in 13 (93%) while in 1 patient (7%) there was partial improvement. Only one endoscopic session was performed per patient with a median time of 37.5 min per session (22-55 min). No complications were encountered. CONCLUSION Endoscopic removal of eroded gastric bands in patients with banded-gastric bypass is effective and safe in the majority of patients. When bands are adherent to the gastric wall, removal of the intraluminal portion of the band may lead to full or partial improvement of symptoms. Endoscopic band removal can be attempted even when a small part of band circumference has eroded.
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