1
|
Jawhar N, Abi Mosleh K, Bartosiak KZ, Hage K, Kennel KA, Mundi MS, Kendrick ML, Ghanem OM. Comprehensive outcomes after Roux-en-Y gastric bypass with a near-complete 15-year follow-up. Surgery 2024:S0039-6060(24)00181-8. [PMID: 38769035 DOI: 10.1016/j.surg.2024.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/23/2024] [Accepted: 02/25/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass has a well-established safety and efficacy profile in the short and mid-term. Long-term outcomes remain limited in the literature, especially for follow-up periods of >10 years. The purpose of the study is to evaluate the long-term durability and safety of laparoscopic Roux-en-Y gastric bypass over a near-complete 15-year follow-up. METHODS This is a single-center retrospective cohort study of patients who underwent primary laparoscopic Roux-en-Y gastric bypass between 2008 and 2009 with ≥14-year follow-up. Data collected and analyzed were weight loss, obesity-related medical condition resolution and recurrence, weight recurrence, complication rate, and mortality rate. RESULTS A total of 264 patients were included. Patients were predominantly female (81.8%), and the mean age and preoperative body mass index were 48.5 ± 12.2 years and 44.9 ± 7.3 kg/m2, respectively. The maximum mean percentage total weight loss achieved at 1 year was 31.5% ± 5.7% and was consistently >20% throughout follow-up. Sustained resolution of obesity-related medical conditions was achieved with a remission rate of 60.8% for type 2 diabetes mellitus, 46.7% for denoted dyslipidemia, and 40% for hypertension. Obesity-related medical condition recurrence was observed with a recurrence rate of 24.1% for type 2 diabetes mellitus, 17.9% for hypertension, and 14.8% for denoted dyslipidemia. Significant factors associated with weight loss were maximum percentage total weight loss and preoperative type 2 diabetes mellitus. Over 15 years, the weight recurrence rate was 51.1%, with predictors of higher preoperative body mass index and preoperative type 2 diabetes mellitus. CONCLUSION Laparoscopic Roux-en-Y gastric bypass provides sustainable weight loss over a 15-year period, with consistent long-term weight-loss outcomes and resolution of obesity-related medical conditions sustained for ≥10 years after surgery.
Collapse
Affiliation(s)
- Noura Jawhar
- Department of Surgery, Mayo Clinic, Rochester, MN
| | | | | | - Karl Hage
- Department of Surgery, Mayo Clinic, Rochester, MN
| | - Kurt A Kennel
- Division of Endocrinology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Manpreet S Mundi
- Division of Endocrinology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | | |
Collapse
|
2
|
Handojo K, Ismaeil A, Van Huele A, Van Neste C, Debergh I, Dillemans B. Roux-en-Y Gastric Bypass as Conversion Procedure of Failed Gastric Banding: Short-Term Outcomes of 1295 Patients in One Single Center. Obes Surg 2023; 33:2963-2972. [PMID: 37548925 PMCID: PMC10514178 DOI: 10.1007/s11695-023-06746-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 06/30/2023] [Accepted: 07/14/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE Laparoscopic adjustable gastric band (LAGB) has high technical and weight loss failure rates. We evaluate here the 1-year morbidity, mortality, and weight loss of laparoscopic Roux-en-Y-gastric bypass (LRYGB) as a feasible conversion strategy. METHODS Patients with a failed primary LAGB who underwent LRYGB from July 2004 to December 2019 were selected from an electronic database at our center. Patients had a conversion to LRYGB at the same time (one-stage approach) or with a minimum of 3 months in between (two-stage approach). Primary outcomes included 30-day morbidity and mortality. Secondary outcomes were body mass index (BMI), percent excess weight loss (%EWL), and percent excess BMI lost (%EBMIL) at 1 year postoperatively. RESULTS A total of 1295 patients underwent a conversion from LAGB to LRYGB at our center: 1167 patients (90.1%) in one stage and 128 patients (9.9%) in two stages. There was no mortality. An early (30-day) postoperative complication occurred in 93 patients (7.2%), with no significant difference found between groups. Hemorrhage was the most common complication in 39 patients (3.0%), and the reoperation was required in 19 patients (1.4%). At 1 year postoperatively, the mean BMI was 28.0 kg/m2, the mean %EWL 72.8%, and the mean %EBMIL 87.0%. No statistically significant difference was found between the groups. CONCLUSION Conversion to LRYGB can be considered as a safe and effective option with low complication rate and good weight loss outcomes at 1 year. One-stage conversion provides the same early outcome as two-step surgery with a competent surgeon.
Collapse
Affiliation(s)
- Karen Handojo
- Department of General Surgery, AZ Sint Jan Brugge-Oostende AV, Campus Henri Serruys, 8400 Oostende, Belgium
| | - Aiman Ismaeil
- Department of General Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
- Department of General Surgery, Faculty of Medicine, Aswan University, Aswan, 81528 Egypt
| | - Andries Van Huele
- Department of General Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - Isabelle Debergh
- Department of General Surgery, AZ Delta Hospital, Sint-Rembertlaan 21, 8820, Torhout, Belgium
| | - Bruno Dillemans
- Department of General Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
| |
Collapse
|
3
|
Diab ARF, Oviedo RJ, Nazir S, Sujka JA, DuCoin CG. Foregut Malignancy After Metabolic Surgery: a Literature Review. Obes Surg 2023; 33:623-634. [PMID: 36538212 DOI: 10.1007/s11695-022-06412-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
Obesity is known to be epidemiologically associated with malignancy. Although there is an increasing global number of bariatric surgeries, the relationship between bariatric surgery and esophagogastric cancers is not well understood. Diagnosis of esophagogastric cancers following bariatric surgery is challenging because the presentation tends to be nonspecific and may be perceived as usual postoperative symptoms in bariatric patients. Therefore, the early diagnosis requires a high index of suspicion. In addition, endoscopic investigation of the excluded stomach after a Roux-en-Y gastric bypass or a one-anastomosis gastric bypass is technically challenging, which further complicates the diagnosis. The aim of this study is to review the current evidence in the literature on esophagogastric cancers following bariatric surgery.
Collapse
Affiliation(s)
- Abdul-Rahman F Diab
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA.
| | - Rodolfo J Oviedo
- Houston Methodist Department of Surgery, Houston, TX, USA.,Weill Cornell Medical College, New York, NY, USA.,Texas A&M University College of Medicine, Bryan, TX, USA
| | - Sharique Nazir
- Department of Surgery, NYU Grossman School of Medicine, 8714 Fifth Avenue, Brooklyn, NY, 11209, USA
| | - Joseph A Sujka
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA
| | - Christopher G DuCoin
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA
| |
Collapse
|
4
|
Effectiveness and Safety of Adjustable Gastric Banding in Morbidly Obese Patients After 5 Years of Follow-up. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03174-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Obesity is a civilization disease that promotes the emergence and development of many diseases, such as type II diabetes, cardiovascular, and some cancers. It directly affects the length and quality of life. The purpose of this retrospective study was to show the short- and long-term results of weight loss after laparoscopic adjustable gastric banding (LAGB) as well as to assess the results of the procedure and the percentage of reoperations. Case series analysis included 228 subsequent patients who underwent LAGB due to obesity. In the postoperative period, there was a gradual reduction in body weight, especially in the first 24 months after surgery. After 3 years, no further weight reduction was observed, and sometimes, a slight increase in weight was observed 5 years after surgery; the trend in weight reduction over the entire time period was significant. A similar result was found for percentage of BMI loss (%BMIL) and percentage of excess body weight loss (%EWL), especially in the first 36 months after surgery. Our study confirmed the good early results and low effectiveness of laparoscopic adjustable gastric banding in the long-term treatment of pathological obesity. On the other hand, the simplicity and safety of the procedure, the minimal effects of malnutrition, the low number of early complications, and the total reversibility or conversion procedure for any other bariatric surgery are the strengths of laparoscopic adjustable gastric banding for a selected group of patients.
Collapse
|
5
|
Musella M, Berardi G, Velotti N, Schiavone V, Vitiello A. Ten-Year Results of Laparoscopic Sleeve Gastrectomy: Retrospective Matched Comparison with Laparoscopic Adjustable Gastric Banding-Is There a Significant Difference in Long Term? Obes Surg 2021; 31:5267-5274. [PMID: 34601648 PMCID: PMC8595233 DOI: 10.1007/s11695-021-05735-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 12/11/2022]
Abstract
Background The laparoscopic sleeve gastrectomy (LSG) is the most common bariatric procedure performed worldwide while the laparoscopic adjustable gastric banding (LAGB) has been almost abandoned. Aim of this study was to retrospectively assess 10-year outcomes of LSG through a matched comparison with LAGB. Materials and Methods Retrospective search of prospectively maintained database of our university was carried out to find all patients that underwent LSG before December 2010. Each subject with LSG was matched one-to-one with a patient that had undergone LAGB in the same period with correspondent preoperative age, BMI, and sex. Results A total of 76 patients underwent LSG before 2010 and were all included in this study; a matched group of 76 out of 178 LAGB patients with 10-year follow-up was retrieved from our database. Comparison between the two groups showed better outcomes after LSG at 1 and 5 years but weight loss was comparable with the LAGB group at 10 years (%TWL 22.2 ± 13 vs 21.2 ± 16.1; p = 0.89). No significant difference was found in conversion/removal rate (15.8% vs 18.4%; p = 0.67). Conclusion LSG is an effective stand-alone bariatric procedure with better outcomes than LAGB in medium term, but results are comparable at 10 years. Subjects undergoing LSG should be informed that conversion to RYGB or OAGB may be necessary to achieve further weight loss or to treat reflux. Graphical abstract ![]()
Collapse
Affiliation(s)
- Mario Musella
- 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
| | - Vincenzo Schiavone
- 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.
| |
Collapse
|
6
|
Kouzmina E, Bechara R, Zevin B. Resection of Fibrous Pseudocapsule in a Patient with Secondary Achalasia and Persistent Symptoms After Removal of Adjustable Gastric Band: Case Report and Review of the Literature. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2021.0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Robert Bechara
- Department of Medicine, Queen's University, Kingston, Canada
| | - Boris Zevin
- Department of Surgery, Queen's University, Kingston, Canada
| |
Collapse
|
7
|
Baldwin D, Sanchez-Johnsen L, Bustos R, Mangano A, Masrur M. Metabolic Surgery Outcomes in U.S. Patients with Class I Obesity. Bariatr Surg Pract Patient Care 2021; 16:85-91. [PMID: 34164238 PMCID: PMC8217597 DOI: 10.1089/bari.2020.0046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Although numerous studies outside the United States (U.S.) have explored weight loss and comorbidity resolution among patients with class I obesity (body mass index [BMI] 30–34.9 kg/m2) after metabolic surgery, few U.S.-based studies have been conducted. Objective: Our aim was to compare weight loss and comorbidity resolution among U.S. patients with class I obesity, who underwent laparoscopic sleeve gastrectomy (LSG) versus Roux-en-Y gastric bypass (RYGB). Methods: Weight loss and comorbidity data among only patients with class I obesity, who underwent LSG or RYGB, were examined. Between April 2009 and April 2017, 1215 metabolic surgeries were performed with 30 patients meeting the inclusion criteria (17 LSG and 13 RYGB). Results: Percent total weight loss (%TWL) for LSG peaked at 12 months (20.85%), while RYGB %TWL peaked at 18 months (21.65%). Percent excess weight loss (%EWL) peaked at 12 months after LSG (83.59%) and 18 months after RYGB (98.29%). Overall follow-up was 56.3%, 36.7%, and 43.3% at 12, 18, and 24 months. LSG and RYGB were both successful with regard to resolution of medical comorbidities at 12 months. Conclusion: RYGB and LSG appear to have similar, successful outcomes among U.S. patients with class I obesity for weight loss and comorbidity resolution.
Collapse
Affiliation(s)
- Dustin Baldwin
- Department of Surgery, Division of General, Minimally Invasive and Robotics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Lisa Sanchez-Johnsen
- Department of Family Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Roberto Bustos
- Department of Surgery, Division of General, Minimally Invasive and Robotics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alberto Mangano
- Department of Surgery, Division of General, Minimally Invasive and Robotics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mario Masrur
- Department of Surgery, Division of General, Minimally Invasive and Robotics, University of Illinois at Chicago, Chicago, Illinois, USA
| |
Collapse
|
8
|
One Anastomosis Gastric Bypass as a Revisional Procedure After Failed Laparoscopic Adjustable Gastric Banding. Obes Surg 2021; 30:3296-3300. [PMID: 32246414 DOI: 10.1007/s11695-020-04569-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Recent data demonstrates that laparoscopic adjustable gastric banding (LAGB) is found to be associated with high rates of weight loss failure and long-term complications. Therefore, the search for the optimal revisional bariatric procedure is ongoing. OBJECTIVE We aim to assess the safety and efficacy of converting a failed LAGB to laparoscopic one anastomosis gastric bypass (OAGB) as a revisional procedure. SETTING Large, metropolitan, tertiary, university hospital. METHODS Retrospective review of patients who underwent OAGB after LAGB.Demographics, comorbidities, BMI before and after the procedure, complications, and length of stay were documented. RESULTS Fifty-seven patients underwent OAGB after LAGB. For 41 patients, the band was removed, and an OAGB was performed in a single procedure (71.9%), and 96.5% of the cases were completed laparoscopically. Postoperative complications occurred in 9 patients (15.7%), including one mortality. Average BMI decreased from 42.8 ± 7.0 to 31.3 ± 5.2 kg/m2 at least 1 year after surgery, representing a mean %EWL of 64.5%. There was no statistical difference in complication rates between the 1-stage and 2-stage approach. CONCLUSIONS Conversion of a failed LAGB to OAGB is effective but carries higher complication rates. Randomized controlled studies comparing different procedures are necessary to further clarify the optimal revisional bariatric operation.
Collapse
|
9
|
Lazaridis II, Kraljević M, Süsstrunk J, Köstler T, Zingg U, Delko T. Revisional Adjustable Gastric Band in Roux-en-Y Gastric Bypass-Is It Worth It? J Gastrointest Surg 2021; 25:3056-3063. [PMID: 34100249 PMCID: PMC8654708 DOI: 10.1007/s11605-021-05045-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/17/2021] [Indexed: 01/31/2023]
Abstract
PURPOSE A subset of patients undergoing Roux-en-Y gastric bypass (RYGB) presents with either insufficient weight loss or weight regain. Data on the revisional restrictive options including laparoscopic adjustable gastric band (LAGB) is scarce. This study analyzes the mid-term efficacy and safety of LAGB as a revisional procedure after RYGB. METHODS Data of all patients with revisional LAGB after primary RYGB between January 2011 and May 2019 were retrospectively reviewed. Outcomes included assessment of weight changes, resolution of comorbidities, and early and late complications during the study period. RESULTS Twenty patients were included. The median Body Mass Index (BMI) before revisional LAGB was 34.8 (interquartile range [IQR] 31.9-38.1) kg/m2. After a median follow-up of 33.5 (IQR 19.5-76.5) months, the median BMI was 28.7 (IQR 26.1-32.2) kg/m2. The median additional Excess Weight Loss (EWL) was 37.6% (IQR 23-44.4), leading to a median total EWL of 79.5% (IQR 54.4-94.6). BMI and EWL post-LAGB improved significantly compared to BMI and EWL pre-LAGB (p<0.001 and p<0.001, respectively). Obstructive sleep apnea syndrome resolved 6 months after LAGB in one patient. Three band deflations occurred during the follow-up. Six patients underwent band removal after a median time of 19 (IQR 15.8-26) months. Overall, thirteen patients underwent a reoperation. There was no loss of follow-up until 5 years. After that, two patients were lost to follow-up. CONCLUSION LAGB may be a salvage option after failed RYGB. However, the high rate of revisions after secondary LAGB needs to be taken into consideration.
Collapse
Affiliation(s)
- Ioannis I. Lazaridis
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002 Basel, Switzerland
| | - Marko Kraljević
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002 Basel, Switzerland
| | - Julian Süsstrunk
- Obesity & Bariatric Surgery Centre, Department of Surgery, Limmattal Hospital, 8952 Zurich-Schlieren, Switzerland
| | - Thomas Köstler
- Obesity & Bariatric Surgery Centre, Department of Surgery, Limmattal Hospital, 8952 Zurich-Schlieren, Switzerland
| | - Urs Zingg
- Obesity & Bariatric Surgery Centre, Department of Surgery, Limmattal Hospital, 8952 Zurich-Schlieren, Switzerland
| | - Tarik Delko
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002 Basel, Switzerland
| |
Collapse
|
10
|
Is there an indication left for gastric band? A single center experience on 178 patients with a follow-up of 10 years. Updates Surg 2020; 73:657-662. [PMID: 32737822 PMCID: PMC8005389 DOI: 10.1007/s13304-020-00858-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/23/2020] [Indexed: 11/29/2022]
Abstract
Background Laparoscopic Adjustable Gastric Banding (LAGB) has been widely performed in the past at our university bariatric center. Aim of this study was to retrospectively assess long term outcomes of LAGB at our university hospital, with special regard to non-response (EWL < 25%) and rate of band removal. Methods Retrospective search of prospectively maintained database of our university bariatric center was carried out to find all consecutive patients that had undergone LAGB at our department with a minimum follow-up of 10 years. Collected data were sex, age, body mass index (BMI), obesity related diseases remission, complications and weight loss. Results After 10 years, patients with the band (n = 144) in place had a BMI of 35.2 ± 7.5 kg/m2, while %EWL and % TWL were 40.8 ± 52.4 and 18.9 ± 20.7. Seventy-four (41.6%) achieved a success (%EWL > 50), while 38 (21.3%) were non-responders (%EWL < 25), 32 (18%) had an insufficient weight loss (25 < %EWL < 50) and 34 (19.1%) underwent band removal. Among these, 6 (3.4%) were removed for complications and 28 (15.7%) for insufficient weight loss. Weight regain occurred in 38 out of 144 (26.4%) subjects with the band in place at 10 years. Only one case of early vomiting with readmission for medical treatment was recorded. Slippage, erosion/migration and port/tube complications occurred in 4 (2.2%), 2(1.1%) and 9(5%) cases respectively. Conclusion LAGB is a safe and moderately effective bariatric procedure but it showed disappointing rates of removal, non-response and remission from comorbidities. However, LAGB could still be proposed for selected/motivated patients.
Collapse
|
11
|
Mellert LT, Cheung M, Berbiglia L, Shoemaker A, Douglas D, Pozsgay M, Zografakis J, Dan A. Reoperations for Long-Term Complications Following Laparoscopic Adjustable Gastric Banding: Analysis of Incidence and Causality. Cureus 2020; 12:e8127. [PMID: 32550047 PMCID: PMC7294902 DOI: 10.7759/cureus.8127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Laparoscopic adjustable gastric banding (LAGB) gained popularity in the early 2000s as a purely restrictive procedure with modest weight loss. The potential for complications requiring reoperation has since become evident. A retrospective review was performed to determine the incidence of long-term complications and predictive factors requiring surgical reintervention after LAGB. Methods: Institutional review board approval was obtained, and a retrospective review of 200 consecutive patients undergoing LAGB over a period of six years was conducted at a single institution with American Society of Metabolic and Bariatric Surgery Center of Excellence designation. Data were collected on patient characteristics, comorbid conditions and complications requiring reintervention. Statistical analysis was performed using SPSS Statistics software (IBM Corp., Armonk, NY). Results: Of the 200 patients, 176 (90.7%) were female with an average age of 53.6 years and preoperative body mass index (BMI) of 44.2 kg/m2. The average follow-up was 46 months. Complications occurred in 55 (28.4%) patients with band slippage/prolapse as the most common need for reoperation. Younger age, lack of comorbidities and diet/exercise compliance were associated with reintervention. Conclusions: LAGB has a high rate of reoperation secondary to complications associated with younger age. Alternative bariatric procedures may be more appropriate in these patients who have fewer comorbid conditions and are motivated to improve his or her health.
Collapse
Affiliation(s)
- Logan T Mellert
- Bariatric and Minimally Invasive Surgery, Summa Health, Akron, USA
| | - Maureen Cheung
- Cardiothoracic Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | | | | | | | - Mark Pozsgay
- Bariatric and Minimally Invasive Surgery, Summa Health, Akron, USA
| | - John Zografakis
- Bariatric and Minimally Invasive Surgery, Summa Health, Akron, USA
| | - Adrian Dan
- Bariatric and Minimally Invasive Surgery, Summa Health, Akron, USA
| |
Collapse
|
12
|
Gupta S, Beitner M, Skinner C, Hopkins G. Medium-term outcomes of converting laparoscopic adjustable gastric band to Roux-en-Y gastric bypass in patients with body mass index <35 kg/m2: a uniquely Australian perspective. Surg Obes Relat Dis 2020; 16:485-491. [DOI: 10.1016/j.soard.2019.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 09/19/2019] [Accepted: 11/02/2019] [Indexed: 12/15/2022]
|
13
|
Froylich D, Abramovich TS, Fuchs S, Zippel D, Hazzan D. Long-Term (over 13 Years) Follow-Up of Vertical Band Gastroplasty. Obes Surg 2020; 30:1808-1813. [PMID: 32048151 DOI: 10.1007/s11695-020-04448-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Silastic ring vertical gastroplasty (SRVG) was a popular restrictive procedure 2 and 3 decades ago. However, it was associated with severe complications and a high rate of reoperation due to failure. Examination of long-term outcomes of those patients that underwent SVRG is limited. The aim of our study was to determine the long-term outcomes (over 13 years) of SRVG in our institution and to review the literature of long-term outcomes following SVRG. METHODS Following IRB approval, we reviewed patients who underwent SRVG between 1996 and 2001. Weight loss parameters, preoperative comorbidities, were compared to the follow-up data. RESULTS In total, 92 patients underwent SRVG, and 89 met the inclusion criteria. Mean age was 52.4 ± 10.6 years and body mass index (BMI) was 46.1 ± 6.5 Kg/m2. Preoperative comorbidities rate included diabetes mellitus (19.1%), hypertension (32.5%), hyperlipidemia (21.3%), joints disease (6.7%), mood disorders (7.8%), and dyspeptic disorders (3.3%). Mean length of follow-up was 208.5 ± 16.8 months. Thirty-eight patients (43%) had to be reoperated due to complications and 24 (30%) had an additional bariatric surgery. Follow-up BMI was 34.2 ± 9.8 Kg/m2 (p < 0.001). There was no improvement in any of the comorbidities; incidence of joint disease and dyspeptic disorders were significantly higher at the follow-up (p = 0.03, p < 0.001, respectively). CONCLUSIONS SRVG procedure was associated with high rates of reoperations and revisions. The majority of our patients showed poor resolution of comorbidities and even worsening of some. Our data confirms that SRVG is not suitable as a bariatric procedure.
Collapse
Affiliation(s)
- Dvir Froylich
- Department of Surgery B, Carmel Medical Center, 3436212, Haifa, Israel.
| | | | - Steven Fuchs
- Department of Surgery B, Carmel Medical Center, 3436212, Haifa, Israel
| | - Douglas Zippel
- Department of Surgery C, Meirav Breast Health Center, Chaim Sheba Medical Center, Tel Hashomer Hospital, Sackler School of Medicine,Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - David Hazzan
- Department of Surgery B, Carmel Medical Center, 3436212, Haifa, Israel.,Department of Surgery C, Meirav Breast Health Center, Chaim Sheba Medical Center, Tel Hashomer Hospital, Sackler School of Medicine,Tel-Aviv University, Tel Aviv-Yafo, Israel
| |
Collapse
|
14
|
Yayac M, Aggarwal R, Parvizi J. How viable is pre-surgery weight reduction for the reduction of periprosthetic joint infection risk after total joint arthroplasty? Expert Rev Med Devices 2020; 17:149-151. [DOI: 10.1080/17434440.2020.1720509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Michael Yayac
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rajesh Aggarwal
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Javad Parvizi
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
15
|
Tsai C, Zehetner J, Beel J, Steffen R. Long-term outcomes and frequency of reoperative bariatric surgery beyond 15 years after gastric banding: a high band failure rate with safe revisions. Surg Obes Relat Dis 2019; 15:900-907. [PMID: 31378280 DOI: 10.1016/j.soard.2019.03.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/28/2019] [Accepted: 03/10/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic adjustable gastric band (LAGB) has had encouraging early results. However, intermediate and late results were discouraging, and LAGB is presently being replaced by stapled procedures. There is still ongoing debate whether LAGB should be abandoned altogether. OBJECTIVE To present our outcomes beyond 15-year follow-up after LAGB. SETTING Private hospital, Bern, Switzerland. METHODS This is a retrospective review of patients receiving LAGB between 1997 and 2002 with minimum 15-year follow-up. Patient characteristics, co-morbidities, reoperative bariatric surgery (RBS), and weight trends were analyzed. RESULTS A total of 387 LAGB patients were identified. Of them, 342 (88.4%) had a minimum of 15 years of follow-up (range, 15-21 yr). There were 270 (78.9%) women with a mean age of 40.3 years (range, 15-62 yr) and body mass index (BMI) of 43.1 kg/m2 (range, 30.0-60.1 kg/m2) and 72 (21.1%) men with a mean age of 41.2 years (range, 16-61 yr) and BMI of 43.6 kg/m2 (range, 33.0-72.5 kg/m2). During follow-up, 283 (82.7%) patients underwent a mean of 3.3 reoperative bariatric operations (range, 1-5), with 224 (65.5%) converted to Roux-en-Y gastric bypass (RYGB). At the end of the study period, 96 (28%) patients still had a band in place. No deaths were recorded. At most recent follow-up after LAGB, mean excess BMI loss was 65.4% (range, -9.4% to 134.5%) with significant decrease in co-morbidities. CONCLUSIONS Only 28% of patients had sufficient weight loss outcomes after LAGB alone and predictive selection criteria are lacking. The majority of LAGB operations fail even with close structured follow-up. RBS can be performed safely.
Collapse
Affiliation(s)
- Catherine Tsai
- Department of Visceral Surgery, Hirslanden Clinic Beau-Site, Berne, Switzerland
| | - Jörg Zehetner
- Department of Visceral Surgery, Hirslanden Clinic Beau-Site, Berne, Switzerland
| | - Julia Beel
- Department of Visceral Surgery, Hirslanden Clinic Beau-Site, Berne, Switzerland
| | - Rudolf Steffen
- Department of Visceral Surgery, Hirslanden Clinic Beau-Site, Berne, Switzerland.
| |
Collapse
|
16
|
Cho EJ, Kim SM. Explantation of Adjustable Gastric Bands: An Observation Study of 10 Years of Experience at a Tertiary Center. Yonsei Med J 2019; 60:782-790. [PMID: 31347334 PMCID: PMC6660444 DOI: 10.3349/ymj.2019.60.8.782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/05/2019] [Accepted: 06/04/2019] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Although laparoscopic adjustable gastric bands are considered a standard treatment for severe obesity, their use remains controversial. We evaluated rates of band explantation and the incidences of complications leading to and following band explantation. MATERIALS AND METHODS This retrospective review was performed on patients that underwent adjustable gastric band explantation. For each of the three groups of patients that underwent explantation, we compared demographic and anthropometric data, band duration in situ, operative approach, and morbidities. RESULTS Between January 2009 and October 2018, a total of 267 patients underwent primary laparoscopic adjustable gastric band surgery. Of these 267 patients, 99 (37.1%) underwent band explantation. Numbers (%) of patients in the slippage (SL), band erosion (BE), and intolerance (IT) groups were 13 (13.1%), 39 (39.4), and 47 (47.5%), respectively. Mean %EBMIL values at explantation in these groups were 74.6±45.5, 79.7±40.3, and 36.1±46.0, respectively (p<0.001), and mean times for maintaining bands in situ were 45.1±28.0, 39.4±24.3, and 51.2±22.7 months, respectively. Isolated band removal was performed for slippage (SLi, n=12), band erosion (BEi, n=39), and intolerance (ITi, n=31). The numbers (%) of patients in the SLi, BEi, and ITi groups that experienced a surgical complication (Clavien-Dindo class ≥1) were 0 (0.0%), 24 (61.5%), and 3 (9.7%), respectively (p<0.001). In the BEi group, four patients (4/39, 10.3%) underwent reoperation after AGB removal. CONCLUSION During our 10 years of experience, 37.1% of adjustable gastric band had to be removed. Intra-abdominal abscess and intragastric bleeding were rare but serious complications after explantation. Potential candidates for adjustable gastric band should be informed of the high long-term risk of band explantation and its associated morbidities.
Collapse
Affiliation(s)
- Eun Jung Cho
- Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Seong Min Kim
- Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
| |
Collapse
|
17
|
Gutt S, Schraier S, González Bagnes MF, Yu M, González CD, Di Girolamo G. Long-term pharmacotherapy of obesity in patients that have undergone bariatric surgery: pharmacological prevention and management of body weight regain. Expert Opin Pharmacother 2019; 20:939-947. [PMID: 30882259 DOI: 10.1080/14656566.2019.1583746] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The obesity epidemic continues to grow. Bariatric surgery is part of the arsenal to treat the disease. Surgery results in an effective option for patients with severe obesity but also when obesity is associated with significant comorbidities. Weight regain is frequent after bariatric surgery. Consequently, the addition of anti-obesity drugs to prevent and manage weight regain are commonly recommended even when the quality of the evidence supporting this recommendation is relatively weak. cfsda65 AREAS COVERED The aim of this review is to summarize the available evidence concerning long-term pharmacotherapy of obesity in patients that have undergone bariatric surgery with a focus on pharmacological prevention and management of weight regain. The etiology and epidemiology of weight regain are summarized, as well as the available information about the benefits and risks of long-term pharmacotherapy in the prevention and management of recidivism. EXPERT OPINION The available information, mainly obtained from observational studies and small trials, is encouraging but calls for a prudent approach in the selection of appropriate agents for each individual patient and a careful follow-up to detect adverse reactions or drug interactions. Results from well-designed trials are upcoming. In the meantime, a cautious, individualized approach is advisable.
Collapse
Affiliation(s)
- Susana Gutt
- a Sección de Nutrición , Hospital Italiano de , Buenos Aires , Argentina
| | - Silvio Schraier
- a Sección de Nutrición , Hospital Italiano de , Buenos Aires , Argentina
| | | | - Ming Yu
- c Departamento de Medicina Interna. Facultad de Medicina , Instituto Universitario CEMIC , Buenos Aires , Argentina
| | - Claudio Daniel González
- b Departamento de Farmacología. Facultad de Medicina , Instituto Universitario CEMIC , Buenos Aires , Argentina.,d Universidad de Buenos Aires, Facultad de Medicina, Departamento de Toxicología y Farmacología , Tercera Cátedra de Farmacología , Buenos Aires , Argentina
| | - Guillermo Di Girolamo
- d Universidad de Buenos Aires, Facultad de Medicina, Departamento de Toxicología y Farmacología , Tercera Cátedra de Farmacología , Buenos Aires , Argentina.,e Universidad de Buenos Aires, Facultad de Medicina , Instituto de Investigaciones Cardiológicas "Prof. Dr. Alberto C. Taquini " , Buenos Aires , Argentina
| |
Collapse
|
18
|
Esophageal Squamous Cell Carcinoma After Adjustable Gastric Banding. Obes Surg 2019; 29:1083-1085. [PMID: 30656570 DOI: 10.1007/s11695-019-03708-8] [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: 10/27/2022]
Abstract
The prevalence of morbid obesity has been increasing worldwide. Therefore, multiple laparoscopic adjustable gastric bandings (LAGBs) have been placed in Belgium in the nineties. The procedure was considered as minimal invasive with low morbidity rates. However, some publication cases suggest a possible association between LAGB and the onset of an esophageal cancer. We present a case of a 49-year-old female who consulted for dysphagia, epigastric pain, and anorexia 17 years after LAGB. An esophageal squamous cell carcinoma was diagnosed in the distal esophagus, close to the lap band. The diagnostic value of the performed contrast swallow study seemed limited. We suggest that a routinely gastroscopic evaluation in the long-term follow-up after LAGB should be strived for in patients presenting with late-onset dysphagia.
Collapse
|
19
|
Zhou R, Poirier J, Torquati A, Omotosho P. Short-Term Outcomes of Conversion of Failed Gastric Banding to Laparoscopic Sleeve Gastrectomy or Roux-En-Y Gastric Bypass: a Meta-Analysis. Obes Surg 2018; 29:420-425. [DOI: 10.1007/s11695-018-3538-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
20
|
Mahawar KK. Defining Short-term, Medium-term, Long-term, and Very Long-term Follow-up After Bariatric Surgery. Obes Surg 2018; 28:1425-1426. [PMID: 29512035 DOI: 10.1007/s11695-018-3183-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Kamal K Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK.
| |
Collapse
|