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Gadiot RPM, Biter LU, Feskens PG, Dunkelgrun M, Apers JA, 't Hof GV, Mannaerts GHH. Long-term Outcome of the Dutch Common Channel Trial (DUCATI): Preservation of Superior Weight Loss Results Without Significant Malnutrition Side Effects. Obes Surg 2024; 34:4136-4145. [PMID: 39356397 DOI: 10.1007/s11695-024-07424-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 10/03/2024]
Abstract
PURPOSE The optimal bowel limb lengths for laparoscopic Roux-en-Y gastric bypass (LRYGB) to maximize weight loss while minimizing nutritional deficiencies in severe obesity treatment remain a topic of debate. The multi-center Dutch Common Channel Trial (DUCATI) aims to compare the outcomes of a very long Roux Limb Roux-en-Y gastric bypass (VLRL-LRYGB) with a standard Roux-en-Y gastric bypass (S-LRYGB). METHODS A total of 444 patients were randomly assigned in a 1:1, double-blind manner to undergo either VLRL-RYGB or S-LRYGB. Five-year follow-up data were assessed, concentrating on weight loss, obesity-related medical conditions, complications, re-operations, and malnutrition. RESULTS Both groups had comparable total alimentary lengths (RL + CC). The VLRL-LRYGB group demonstrated significantly greater %TWL (32.2% vs. 28.6%, p = 0.002) and %EWL (81.2% vs. 70.3%, p = 0.002) at 5 years. Eight (3.6%) patients in the VLRL-LRYGB group versus 2 (0.9%) in the S-LRYGB group (p = 0.055) needed modification surgery for malabsorption. Suboptimal clinical response rate was significantly higher (22.0% vs. 8.3%) in S-LRYGB group. No significant differences for nutrient deficiencies in favor of the S-LRYGB group were found. CONCLUSION A 100-cm common channel with a relatively long Roux limb provides superior, sustainable weight loss over 5 years, without significantly increased rate of malabsorption-related re-operations. These results suggest that a longer Roux limb can still ensure adequate micronutrient uptake in the total alimentary tract. These findings should be considered in discussions regarding the optimal Roux-en-Y limb length for severe obesity treatment.
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Affiliation(s)
- Ralph P M Gadiot
- Department of Surgery, Fundashon Mariadal, Kaya Soeur Bartola 2, Kralendijk, Bonaire, the Netherlands.
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
| | - L Ulas Biter
- Department of Surgery, Tulp Medisch Centrum, Zwijndrecht, The Netherlands
| | - Pierre G Feskens
- Department of Bariatric Surgery, Bravis Hospital, Bariatric Center South-West Netherlands, Bergen Op Zoom, the Netherlands
| | - Martin Dunkelgrun
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Jan A Apers
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Gerhard van 't Hof
- Department of Bariatric Surgery, Bravis Hospital, Bariatric Center South-West Netherlands, Bergen Op Zoom, the Netherlands
| | - Guido H H Mannaerts
- Department of Surgery, Al Ain Abu Dhabi, Mediclinic, United Arab Emirates
- Department of Surgery, Gulf Specialized Hospital, Muscat, Oman
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Diab ARF, Sujka JA, McCaskey A, Thompson A, Elnagi A, Docimo S, DuCoin CG. A Meta-Analysis Comparing RYGB with Long Biliopancreatic Limb (BPL) Versus Long Alimentary Limb (AL) in Groups with Equal or Nearly Equal Combined Bypass Lengths (Combined BPL and AL Lengths): Does Switching Seats Enhance Weight Loss? Obes Surg 2024:10.1007/s11695-024-07556-z. [PMID: 39446291 DOI: 10.1007/s11695-024-07556-z] [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: 05/16/2024] [Revised: 10/21/2024] [Accepted: 10/21/2024] [Indexed: 10/25/2024]
Abstract
It is well-established that extending either the biliopancreatic limb (BPL), the alimentary limb (AL), or both, results in increased combined bypass (CB) length, which in turn leads to enhanced weight loss and potential nutritional deficiencies due to heightened malabsorptive effects. However, a key question remains: Assuming no change in CB length, does altering BPL length affect outcomes? To address this question, we examined studies comparing long BPL and long AL (short BPL) while maintaining equal or nearly equal CB lengths. We conducted this systematic literature review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed a meta-analysis on weight loss outcomes, adverse events and safety-related outcomes, gastrointestinal complaints, and nutritional outcomes at the 2-year mark.
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Affiliation(s)
- Abdul-Rahman F Diab
- University of Central Florida College of Medicine/HCA Healthcare GME Consortium, 1431 SW 1St Ave, Ocala, FL, 34471, USA.
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, 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
| | - Angelica McCaskey
- University of Central Florida College of Medicine/HCA Healthcare GME Consortium, 1431 SW 1St Ave, Ocala, FL, 34471, USA
| | - Alexander Thompson
- University of Central Florida College of Medicine/HCA Healthcare GME Consortium, 1431 SW 1St Ave, Ocala, FL, 34471, USA
| | - Abdullah Elnagi
- University of Central Florida College of Medicine/HCA Healthcare GME Consortium, 1431 SW 1St Ave, Ocala, FL, 34471, USA
| | - Salvatore Docimo
- 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
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Rizvi SHA, Jamil DK, Rohail S, Inam N, Sam SJ, Bhatti MS, Haseeb A, Ahmed N, Fatima K, Asghar MS. Efficacy and safety of long vs short biliopancreatic limb in Roux-en-y gastric bypass surgery: A systematic review and meta-analysis. Curr Probl Surg 2024; 61:101562. [PMID: 39266128 DOI: 10.1016/j.cpsurg.2024.101562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 06/30/2024] [Accepted: 07/19/2024] [Indexed: 09/14/2024]
Affiliation(s)
| | - Dua Khalid Jamil
- Internal Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Samia Rohail
- Internal Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Nimrah Inam
- Internal Medicine, Aga khan University Hospital, Karachi, Pakistan
| | - Stafford Jude Sam
- Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Abdul Haseeb
- Internal Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Nisar Ahmed
- Internal Medicine, Rapides Regional Medical Center, Alexandria, Louisiana
| | - Kaneez Fatima
- Internal Medicine, Baylor Scott and White Research Institute, Dallas, TX
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Bruinsma FFE, Nienhuijs SW, Liem RSL, Greve JWM, Marang-van de Mheen PJ. The Impact of Longer Biliopancreatic Limb Length on Weight Loss and Comorbidity Improvement at 5 Years After Primary Roux-en-Y Gastric Bypass Surgery: A Population-Based Matched Cohort Study. Obes Surg 2024; 34:3236-3245. [PMID: 38981956 PMCID: PMC11349854 DOI: 10.1007/s11695-024-07267-5] [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: 10/20/2023] [Revised: 04/26/2024] [Accepted: 05/08/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Different limb lengths are used in Roux-en-Y gastric bypass (RYGB) surgery, as there is no consensus which limb length strategy has the best outcomes. The biliopancreatic limb (BPL) is thought to play an important role in achieving weight loss and associated comorbidity resolution. The objective of this study was to assess the impact of a longer BPL on weight loss and comorbidity improvement at 5 years after primary RYGB. METHODS All patients aged ≥ 18 years undergoing primary RYGB between 2014-2017 with registered follow-up 5 years after surgery were included. Long BPL was defined as BPL ≥ 100 cm and short BPL as BPL < 100 cm. The primary outcome was achieving at least 25% total weight loss (TWL) at 5 years. Secondary outcomes included absolute %TWL and improvement of comorbidities. A propensity score matched logistic and linear regression was used to estimate the difference in outcomes between patients with long and short BPL. RESULTS At 5 years, long BPL had higher odds to achieve ≥ 25% TWL (odds ratio (OR) 1.19, 95% confidence interval (CI) [1.01 - 1.41]) and was associated with 1.26% higher absolute TWL (β = 1.26, 95% CI [0.53 - 1.99]). Furthermore, long BPL was more likely to result in improved diabetes mellitus (OR = 2.17, 95% CI [1.31 - 3.60]) and hypertension (OR = 1.45, 95% CI [1.06 - 1.99]). CONCLUSION Patients undergoing RYGB with longer BPL achieved higher weight loss and were more likely to achieve improvement of comorbidities at 5 years.
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Affiliation(s)
- Floris F E Bruinsma
- Department of Surgery, Maastricht University Medical Centre, NUTRIM School for Nutrition and Translational Research in Metabolism, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Ronald S L Liem
- Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands
- Nederlandse Obesitas Kliniek, Gouda and The Hague, Gouda, The Netherlands
| | - Jan Willem M Greve
- Department of Surgery, Maastricht University Medical Centre, NUTRIM School for Nutrition and Translational Research in Metabolism, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
- Nederlandse Obesitas Kliniek, Heerlen, The Netherlands
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
- Safety & Security Science, Faculty of Technology, Policy and Management, Delft University of Technology, Delft, The Netherlands
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Poljo A, Peterli R, Kraljević M. Effects of limb lengths in gastric bypass surgery. Br J Surg 2024; 111:znae220. [PMID: 39190791 DOI: 10.1093/bjs/znae220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/11/2024] [Accepted: 08/07/2024] [Indexed: 08/29/2024]
Affiliation(s)
- Adisa Poljo
- Division of Metabolic Bariatric Surgery, Department of Visceral Surgery, Clarunis-University Digestive Healthcare Center Basel, University Hospital Basel and St. Clara Hospital, Basel, Switzerland
| | - Ralph Peterli
- Division of Metabolic Bariatric Surgery, Department of Visceral Surgery, Clarunis-University Digestive Healthcare Center Basel, University Hospital Basel and St. Clara Hospital, Basel, Switzerland
| | - Marko Kraljević
- Division of Metabolic Bariatric Surgery, Department of Visceral Surgery, Clarunis-University Digestive Healthcare Center Basel, University Hospital Basel and St. Clara Hospital, Basel, Switzerland
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Giannopoulos S, Athanasiadis DI, Hernandez E, Colgate CL, Christodoulides A, Osuji VC, Petrucciani A, Stefanidis D. Does the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program bariatric risk/benefit calculator hold its weight? An assessment of its accuracy. Surg Obes Relat Dis 2024; 20:490-497. [PMID: 38123410 DOI: 10.1016/j.soard.2023.10.019] [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: 01/31/2023] [Revised: 07/23/2023] [Accepted: 10/29/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Bariatric clinical calculators have already been implemented in clinical practice to provide objective predictions of complications and outcomes. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Surgical Risk/Benefit Calculator is the most comprehensive risk calculator in bariatric surgery. OBJECTIVES Evaluate the accuracy of the calculator predictions regarding the 30-day complication risk, 1-year weight loss outcomes, and comorbidity resolution. SETTING MBSAQIP-accredited center. METHODS All adult patients who underwent primary laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy at our institution between 2012 and 2019 were included. Baseline characteristics were used to generate the individualized outcome predictions for each patient through the bariatric risk calculator and were compared to actual patient outcomes. Statistical analysis was performed using c-statistics, linear regression models, and McNemmar chi-square test. RESULTS One thousand four hundred fifty-three patients with a median age of 45 (37, 55) and consisting of 80.1% females were included in the study. The c-statistics for the complications and comorbidity resolution ranged from .533 for obstructive sleep apnea remission to .675 for 30-day reoperation. The number of comorbidity resolutions predicted by the calculator was significantly higher than the actual remissions for diabetes, hyperlipidemia, hypertension and obstructive sleep apnea (P < .001). On average, the calculator body mass index (BMI) predictions deviated from the observed BMI measurement by 3.24 kg/m2. The RYGB procedure (Coef -.89; P = .005) and preoperative BMI (Coef -.4; P = .012) were risk factors associated with larger absolute difference between the predicted and observed BMI. CONCLUSIONS The MBSAQIP Surgical Risk/Benefit Calculator prediction models for 1-year BMI, 30-day reoperation, and reintervention risks were fairly well calibrated with an acceptable level of discrimination except for obstructive sleep apnea remission. The 1-year BMI estimations were less accurate for RYGB patients and cases with very high or low preoperative BMI measurements. Therefore, the bariatric risk calculator constitutes a helpful tool that has a place in preoperative counseling.
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Affiliation(s)
| | | | - Edward Hernandez
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Cameron L Colgate
- Department of Surgery, Center for Outcomes Research in Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Vitalis C Osuji
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Alexa Petrucciani
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
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Eagleston J, Nimeri A. Optimal Small Bowel Limb Lengths of Roux-en-Y Gastric Bypass. Curr Obes Rep 2023; 12:345-354. [PMID: 37466789 DOI: 10.1007/s13679-023-00513-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE OF REVIEW Gastric bypass and biliopancreatic diversion (BPD) have come full circle, from a loop configuration to a Roux-en-Y and finally back to a loop configuration as one anastomosis gastric bypass and single-anastomosis duodenal switch. Most surgeons performing Roux-en-Y gastric bypass (RYGB) do not measure the common channel (CC) length and most surgeons performing BPD do not measure the biliopancreatic limb length (BPL). RECENT FINDINGS The small bowel length in humans is variable from as short as < 400 cm to as long as > 1000 cm. The combination of these two facts means that even if surgeons keep the limb lengths constant, surgeons will get variable limb length due to the variability of small bowel length in patients. Hence, outcomes of weight loss, resolution of medical problems, or developing nutritional deficiencies which are related to limb length are variable. In this article, we evaluate the published literature related to the effect of varying the Roux limb, BPL, CC, and total alimentary limb lengths on the outcomes of RYGB. We have focused on historical and current randomized controlled trials as well as systematic reviews and meta-analysis to outline the current literature and our interpretation of this literature.
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Affiliation(s)
- Justin Eagleston
- Bariatric Surgery, Department of Surgery, Atrium Health, Charlotte, USA
| | - Abdelrahman Nimeri
- Wake Forest School of Medicine, Bariatric Surgery, Atrium Health, Charlotte, NC, USA.
- Director, of Bariatric Surgery, Brigham and Womens Hospital, Harvard Medical School, 75 Francis, MA, 02115, Boston, USA.
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8
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Salman MA, Abelsalam A, Nashed GA, Yacoub M, Abdalla A. Long Biliopancreatic Limb Roux-En-Y Gastric Bypass Versus One-Anastomosis Gastric Bypass: a Randomized Controlled Study. Obes Surg 2023; 33:1966-1973. [PMID: 37178225 PMCID: PMC10289940 DOI: 10.1007/s11695-023-06631-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/29/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is the gold standard in bariatric surgery. The one-anastomosis gastric bypass (OAGB) procedure, first introduced by Dr. Rutledge, has demonstrated a 25% greater weight loss efficiency than the traditional Roux-en-Y gastric bypass (RYGB) procedure due to the substantially longer biliopancreatic limb (BPL). AIM OF THE STUDY The current work aimed to compare the outcomes of OAGB and long BPL RYGB regarding weight loss and comorbidity resolution. PATIENTS AND METHODS This randomized controlled trial was done at our institution between September 2019 and January 2021. Patients who were candidates for bariatric surgery were randomly and equally allocated to two groups. Group A underwent OAGB, while group B underwent long BPL RYGB. Patients were followed up for 6 months postoperatively. RESULTS This study included 62 patients equally allocated to OAGB or long BPL RYGB, with no dropouts during follow-up. At 6 months, there was no statistically significant difference between the two groups regarding postoperative BMI (P = 0.313) and the EBWL (P = 0.238). There was comparable remission of diabetes mellitus (P = 0.708), hypertension (P = 0.999), OSA (P = 0.999), joint pain (P = 0.999), and low back pain (P = 0.999). Seven patients in the OAGB group experienced reflux symptoms (P = 0.011), which were managed by proton pump inhibitors. CONCLUSION Extending the BPL in RYGB provides weight loss and comorbidity remission comparable to that of OAGB. Some OAGB-related reflux cases remain a concern. However, they were sufficiently controlled with PPIs. Due to OAGB superior technical simplicity, long BPL RYGB should be preserved for cases whom are more risky for bile reflux.
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Aleassa EM, Papasavas P, Augustin T, Khorgami Z, Benson-Davies S, Ghiassi S, Carter J, Nimeri A. American Society for Metabolic and Bariatric Surgery literature review on the effect of Roux-en-Y gastric bypass limb lengths on outcomes. Surg Obes Relat Dis 2023; 19:755-762. [PMID: 37268517 DOI: 10.1016/j.soard.2023.04.298] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 04/02/2023] [Indexed: 06/04/2023]
Abstract
This literature review is issued by the American Society for Metabolic and Bariatric Surgery regarding limb lengths in Roux-en-Y gastric bypass (RYGB) and their effect on metabolic and bariatric outcomes. Limbs in RYGB consist of the alimentary and biliopancreatic limbs and the common channel. Variation of limb lengths in primary RYGB and as a revisional option for weight recurrence after RYGB are described in this review.
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Affiliation(s)
- Essa M Aleassa
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
| | | | - Toms Augustin
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma College of Community Medicine, Tulsa, Oklahoma
| | - Sue Benson-Davies
- Department of Surgery, Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota
| | - Saber Ghiassi
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Jonathan Carter
- Department of Surgery, University of California, San Francisco, California
| | - Abdelrahman Nimeri
- Department of Surgery, Carolinas Medical Center, University of North Carolina, Charlotte, North Carolina
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Campschroer T, Van Balken MR, Deden LN, Hazebroek EJ, De Boer H. Effect of preoperative metabolic profiling to reduce the risk of kidney stones after bariatric surgery in patients with a history of stone formation. Surg Obes Relat Dis 2022; 19:633-639. [PMID: 36609096 DOI: 10.1016/j.soard.2022.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/20/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is associated with an increased risk of kidney stone formation. This is not observed after sleeve gastrectomy (SG). OBJECTIVES Aim of this study was to assess whether preoperative metabolic profiling is helpful in selecting the most optimal bariatric procedure for patients with a kidney stone history. SETTING General hospital, the Netherlands. METHODS Patients with a kidney stone history and in the run up to bariatric surgery were screened with non-contrast abdominal computed tomography (CT), serum profiling, and 24-hour urine analysis. Those with stones on radiologic imaging and/or high preoperative urinary oxalate were advised to undergo SG instead of RYGB. Pre- and postoperative urine and serum profile differences between both groups were evaluated retrospectively. RESULTS Postoperatively, RYGB (N = 28, M:F = 8:20) was associated with a 23.5% reduction in urinary volume, a 85% increase in urinary oxalate excretion with a 230% increase in calcium oxalate (CaOx) supersaturation and a 62% decrease in urinary citrate. Although SG (N = 30, M:F = 12:18) was also associated with a reduction in urinary volume, it had no adverse effects on urinary oxalate and citrate excretion, nor on calcium oxalate supersaturation (CaOx-SS). Both RYGB and SG showed favorable effects on postoperative sodium, calcium, uric acid, and phosphate excretion. CONCLUSIONS This study indicates that preoperative metabolic profiling is important to select the optimal bariatric procedure in patients with an a priori increased risk of kidney stone development. These patients should be strongly encouraged to undergo SG instead of RYGB to prevent progressive or recurrent kidney stone disease.
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Affiliation(s)
| | | | - Laura N Deden
- Bariatric Surgery Department, Rijnstate Hospital, Arnhem, the Netherlands
| | - Eric J Hazebroek
- Bariatric Surgery Department, Rijnstate Hospital, Arnhem, the Netherlands
| | - Hans De Boer
- Internal Medicine Department, Rijnstate Hospital, Arnhem, the Netherlands
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Kwon Y, Lee S, Kim D, ALRomi A, Park SH, Lee CM, Kim JH, Park S. Biliopancreatic Limb Length as a Potential Key Factor in Superior Glycemic Outcomes After Roux-en-Y Gastric Bypass in Patients With Type 2 Diabetes: A Meta-Analysis. Diabetes Care 2022; 45:3091-3100. [PMID: 36455123 DOI: 10.2337/dc22-0835] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/29/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Optimal length of biliopancreatic (BP) and Roux limb in Roux-en-Y gastric bypass (RYGB) for improved glycemic control are not known. PURPOSE To investigate how the lengths of the BP and Roux limbs in RYGB differentially affect postoperative glycemic outcomes in patients with type 2 diabetes. DATA SOURCES We conducted a systematic literature search using the PubMed, Embase, and the Cochrane Library databases. STUDY SELECTION We included studies that reported glycemic outcomes after RYGB and lengths of the BP and Roux limbs. DATA EXTRACTION A total of 28 articles were included for data extraction. Glycemic outcomes after RYGB were assessed on the basis of two definitions: remission and improvement. DATA SYNTHESIS We categorized the included studies into four groups according to the BP and Roux limb lengths. The type 2 diabetes remission/improvement rates were as follows: long BP-long Roux group 0.80 (95% CI 0.70-0.90)/0.81 (0.73-0.89), long BP-short Roux group 0.76 (0.66-0.87)/0.82 (0.75-0.89), short BP-long Roux group 0.57 (0.36-0.78)/0.64 (0.53-0.75), and short BP-short Roux group 0.62 (0.43-0.80)/0.53 (0.45-0.61). Meta-regression analysis also showed that a longer BP limb resulted in higher postoperative type 2 diabetes remission and improvement rates, whereas a longer Roux limb did not. There was no significant difference or heterogeneity in baseline characteristics, including diabetes-related variables, among the four groups. LIMITATIONS Not all included studies were randomized controlled trials. CONCLUSIONS Longer BP limb length led to higher rates of type 2 diabetes remission and improvement by 1 year after RYGB in comparisons with the longer Roux limb length.
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Affiliation(s)
- Yeongkeun Kwon
- Division of Foregut Surgery, Korea University College of Medicine, Seoul, South Korea
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, South Korea
- Gut & Metabolism Laboratory, Korea University College of Medicine, Seoul, South Korea
| | - Sungho Lee
- Department of Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Dohyang Kim
- Department of Statistics, Daegu University, Gyeongbuk, South Korea
| | - Ahmad ALRomi
- Division of Foregut Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Shin-Hoo Park
- Division of Foregut Surgery, Korea University College of Medicine, Seoul, South Korea
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, South Korea
- Gut & Metabolism Laboratory, Korea University College of Medicine, Seoul, South Korea
| | - Chang Min Lee
- Division of Foregut Surgery, Korea University College of Medicine, Seoul, South Korea
- Gut & Metabolism Laboratory, Korea University College of Medicine, Seoul, South Korea
| | - Jong-Han Kim
- Division of Foregut Surgery, Korea University College of Medicine, Seoul, South Korea
- Gut & Metabolism Laboratory, Korea University College of Medicine, Seoul, South Korea
| | - Sungsoo Park
- Division of Foregut Surgery, Korea University College of Medicine, Seoul, South Korea
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, South Korea
- Gut & Metabolism Laboratory, Korea University College of Medicine, Seoul, South Korea
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Hosseini SV, Moeinvaziri N, Medhati P, Salem SA, Hosseini E, Clark CCT, Haghighat N. The Effect of Single-Anastomosis Sleeve Ileal (SASI) Bypass on Patients with Severe Obesity in Three Consecutive Years. World J Surg 2022; 46:2744-2750. [DOI: 10.1007/s00268-022-06706-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2022] [Indexed: 01/18/2023]
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13
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Schneider R, Kraljević M, Peterli R, Rohm TV, Bosch AJ, Low AJ, Keller L, AlAsfoor S, Häfliger S, Yilmaz B, Peterson CJ, Lazaridis II, Vonaesch P, Delko T, Cavelti-Weder C. Roux-en-Y gastric bypass with a long compared to a short biliopancreatic limb improves weight loss and glycemic control in obese mice. Surg Obes Relat Dis 2022; 18:1286-1297. [DOI: 10.1016/j.soard.2022.06.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/02/2022] [Accepted: 06/18/2022] [Indexed: 11/30/2022]
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14
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Eckharter C, Heeren N, Mongelli F, Sykora M, Fenner H, Scheiwiller A, Metzger J, Gass JM. Effects of short or long biliopancreatic limb length after laparoscopic Roux-en-Y gastric bypass surgery for obesity: a propensity score-matched analysis. Langenbecks Arch Surg 2022; 407:2319-2326. [PMID: 35536386 PMCID: PMC9468033 DOI: 10.1007/s00423-022-02537-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022]
Abstract
Purpose Although recent studies reported superior weight reduction in patients undergoing Roux-en-Y gastric bypass (RYGB) with long biliopancreatic limb (BPL), no recommendation regarding limb lengths exists. This study compares weight loss and resolution of obesity-related comorbidities in patients undergoing RYGB with either long or short BPL. Methods A retrospective data search from medical records was performed. A total of 308 patients underwent laparoscopic RYGB with a BPL length of either 100 cm or 50 cm. Data was analyzed before and after propensity score matching. Results No statistically significant difference in weight reduction between long and short BPL RYGB in terms of percentage of excess weight loss (%EWL) (86.4 ± 24.5 vs. 83.4 ± 21.4, p = 0.285) and percentage of total weight loss (%TWL) (32.4 ± 8.4 vs. 33.0 ± 8.3, p = 0.543) was found 24 months after surgery. Propensity score–matched analysis did not show any statistically significant difference between groups in both %EWL and %TWL. No significant difference between long and short BPL RYGB in the resolution of obesity-related comorbidities was noted 24 months after surgery. Conclusion Weight loss and resolution of obesity-related comorbidities were not significantly different between long and short BPL RYGB 24 months after surgery.
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Affiliation(s)
- Christoph Eckharter
- Department of General and Visceral Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Nickolaus Heeren
- Department of General and Visceral Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | | | - Martin Sykora
- Department of General and Visceral Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.,Department of Surgery, Nidwalden Cantonal Hospital, Stans, Switzerland
| | - Hartwig Fenner
- Department of General and Visceral Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Andreas Scheiwiller
- Department of General and Visceral Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Jürg Metzger
- Department of General and Visceral Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Jörn-Markus Gass
- Department of General and Visceral Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland. .,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
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15
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Nymo S, Børresen Skjølsvold O, Aukan M, Finlayson G, Græslie H, Mårvik R, Kulseng B, Sandvik J, Martins C. Suboptimal Weight Loss 13 Years After Roux-en-Y Gastric Bypass: Is Hedonic Hunger, Eating Behaviour and Food Reward to Blame? Obes Surg 2022; 32:2263-2271. [PMID: 35505168 PMCID: PMC9276719 DOI: 10.1007/s11695-022-06075-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/16/2022] [Accepted: 04/20/2022] [Indexed: 11/28/2022]
Abstract
Purpose Suboptimal weight loss (SWL) and weight regain (WR) following bariatric surgery are common. The exact reasons for this phenomenon remain to be fully elucidated. To compare hedonic hunger, food preferences, food reward and eating behaviour traits between participants with SWL and optimal weight loss (OWL) 13 years after Roux-en-Y gastric bypass (RYGB). Materials and Method Cross-sectional case control study where participants experiencing SWL or OWL (< or ≥ 50% of excess weight, respectively) post-RYGB were compared to a non-surgical control group matched for pre-operative body mass index. Hedonic hunger (Power of Food Scale), implicit and explicit liking and wanting for high-fat and low-fat savoury and sweet food (Leeds Food Preference Questionnaire) and eating behaviour (Dutch Eating Behavior Questionnaire, Three-Factor Eating Questionnaire and the Food Cravings Questionnaires State and Trait-reduced) were assessed. Results In total, 75 participants were recruited from the bariatric surgery observation study (BAROBS). Disinhibition, hunger, emotional, external and restrained eating, frequency of cravings and hedonic hunger were lower in the OWL, compared with the SWL and/or control groups. Implicit wanting and explicit liking and wanting for high-fat savoury and high-fat sweet food were lower, and implicit wanting for low-fat savoury food higher, in the OWL, compared with the SWL and/or control groups. Conclusion SWL 13 years after RYGB is associated with dysfunctional eating behaviours, increased preference and reward for high-fat food and increased hedonic hunger. Future longitudinal studies are needed to establish the cause-effect relationship between these variables. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s11695-022-06075-z.
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Affiliation(s)
- Siren Nymo
- Obesity Research Group, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Prinsesse Kristinas gate 5, 7030, Forsyningssenteret, Trondheim, Norway. .,Centre for Obesity and Innovation (ObeCe), Clinic of Surgery, St. Olav University Hospital, Trondheim, Norway. .,Clinic of Surgery, Namsos Hospital, Nord-Trøndelag Hospital Trust, Namsos, Norway. .,Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Oda Børresen Skjølsvold
- Obesity Research Group, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Prinsesse Kristinas gate 5, 7030, Forsyningssenteret, Trondheim, Norway.,Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marthe Aukan
- Obesity Research Group, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Prinsesse Kristinas gate 5, 7030, Forsyningssenteret, Trondheim, Norway.,Centre for Obesity and Innovation (ObeCe), Clinic of Surgery, St. Olav University Hospital, Trondheim, Norway.,Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Graham Finlayson
- School of Psychology, University of Leeds, Leeds, UK.,Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hallvard Græslie
- Clinic of Surgery, Namsos Hospital, Nord-Trøndelag Hospital Trust, Namsos, Norway.,Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ronald Mårvik
- Obesity Research Group, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Prinsesse Kristinas gate 5, 7030, Forsyningssenteret, Trondheim, Norway.,Centre for Obesity and Innovation (ObeCe), Clinic of Surgery, St. Olav University Hospital, Trondheim, Norway.,Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bård Kulseng
- Obesity Research Group, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Prinsesse Kristinas gate 5, 7030, Forsyningssenteret, Trondheim, Norway.,Centre for Obesity and Innovation (ObeCe), Clinic of Surgery, St. Olav University Hospital, Trondheim, Norway.,Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jorunn Sandvik
- Obesity Research Group, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Prinsesse Kristinas gate 5, 7030, Forsyningssenteret, Trondheim, Norway.,Centre for Obesity and Innovation (ObeCe), Clinic of Surgery, St. Olav University Hospital, Trondheim, Norway.,Clinic of Surgery, Ålesund Hospital, Møre- og Romsdal Hospital Trust, Ålesund, Norway.,Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Catia Martins
- Obesity Research Group, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Prinsesse Kristinas gate 5, 7030, Forsyningssenteret, Trondheim, Norway.,Centre for Obesity and Innovation (ObeCe), Clinic of Surgery, St. Olav University Hospital, Trondheim, Norway.,Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
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16
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Eskandaros MS, Abbass A. Standard Biliopancreatic Limb (50 cm) Roux-en-Y Gastric Bypass Versus Long Biliopancreatic Limb (100 cm) Roux-en-Y Gastric Bypass in Patients with Body Mass Index 40-50 kg/m 2: a Randomized Prospective Study. Obes Surg 2022; 32:577-586. [PMID: 34981324 DOI: 10.1007/s11695-021-05868-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is a widely performed procedure worldwide especially with the presence of associated medical conditions. Patients with body mass index (BMI) 40-50 kg/m2 are at more risk of weight regain and relapse of comorbidities. There is a controversy on the optimum alimentary (AL) and biliopancreatic (BPL) limb lengths to be used in RYGB to achieve weight loss and remission of comorbidities without causing nutritional deficiencies in those patients. STUDY DESIGN hundred-and-fifty patients with BMI between 40 and 50 kg/m2 were divided equally into 2 groups undergoing standard RYGB (S-RYGB) with AL:150 cm and BPL: 50 cm and long biliopancreatic RYGB (L-RYGB) with AL: 100 cm and BPL: 100 cm. BMI, % of total weight loss (%TWL), effect on diabetes (DM), hypertension (HTN), dyslipidemia, and nutritional statuses were recorded at 1, 2, and 3 years. RESULTS Only 64/75 patients in S-RYGB and 57/75 patients in L-RYGB completed the study. L-RYGB had faster weight loss, higher %TWL, and less BMI than S-RYGB with the maintenance of achieved weight. L-RYGB had better control of DM and dyslipidemia than S-RYGB. There were no significant differences in nutritional status between S-RYGB and L-RYGB rather than lower levels of calcium and Hb and higher levels of PTH in L-RYGB yet they remain within the normal range. CONCLUSION The application of L-RYGB helps in achieving faster weight loss for a longer period with better remission of associated comorbidities as DM, HTN, and dyslipidemia in patients with BMI 40-50 kg/m2 but with effects on the nutritional status.
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Affiliation(s)
| | - Alaa Abbass
- Faculty of Medicine, Ain Shams University, Cairo, 11591, Egypt
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17
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One Anastomosis Gastric Bypass Versus Long Biliopancreatic Limb Roux-en-Y Gastric Bypass. Obes Surg 2022; 32:779-785. [PMID: 35013896 PMCID: PMC8866326 DOI: 10.1007/s11695-021-05874-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 11/06/2022]
Abstract
Background Roux-en-Y gastric bypass (RYGB) is one of the most effective bariatric procedures. The study aimed to explore the value of lengthening the biliopancreatic limb (BPL) in RYGB compared to the outcome of one-anastomosis gastric bypass (OAGB). Methods This prospective study included morbidly obese patients divided into two groups. The RYGB group (n = 36) was subjected to long biliary limb Roux-en-Y gastric bypass (LPRYGB), and the OAGB Group (n = 36) had one anastomosis gastric bypass. During follow-up, weight, BMI, percentage of excess body weight loss (%EBWL), resolution of obesity-related comorbidities, and quality of life (QoL) were evaluated. Results There was no significant difference in weight and BMI after 3 and 6 months. At 12-month follow-up, weight loss was significantly higher in the OAGB group. After 12 months, the two groups showed significant improvement of comorbid conditions without significant difference between the two groups. The Qol was significantly higher in the LPRYGB group 3, 6, and 12 months after surgery compared to the OAGB group. Conclusions Extending the BPL length in RYGB to 150 cm is as effective as OAGB in remission of comorbidities, including diabetes. It was also equally effective in weight reduction in the short term. OAGB was more efficient in weight reduction and a significantly faster operation. LPRYGB showed a better QoL of life 1 year after surgery. Graphical abstract ![]()
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18
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Cooiman MI, Alsters SIM, Duquesnoy M, Hazebroek EJ, Meijers-Heijboer HJ, Chahal H, Le Beyec-Le Bihan J, Clément K, Soula H, Blakemore AI, Poitou C, van Haelst MM. Long-Term Weight Outcome After Bariatric Surgery in Patients with Melanocortin-4 Receptor Gene Variants: a Case-Control Study of 105 Patients. Obes Surg 2022; 32:837-844. [PMID: 34984630 DOI: 10.1007/s11695-021-05869-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Pathogenic heterozygous MC4R variants are associated with hyperphagia and variable degrees of obesity. Several research groups have reported short-term weight loss outcomes after bariatric surgery in a few patients with MC4R variants, but lack of longer-term data prevents evidence-based clinical decision-making. MATERIALS AND METHODS Bariatric surgery patients with heterozygous (likely) pathogenic MC4R variants, from three collaborating centers in the Netherlands, France, and the UK, were compared to matched controls (matched 2:1 for age, sex, preoperative BMI, surgical procedure, and diabetes mellitus, but without MC4R mutations). Weight loss and regain outcomes up to 6 years of follow-up were compared. RESULTS At 60 months of follow-up after RYGB, cases with MC4R variants showed weight regain with a mean of 12.8% (± 10.4 SD) total weight loss (TWL) from nadir, compared to 7.9% (± 10.5 SD) in the controls (p = 0.062). Among patients receiving SG, the cases with MC4R variants experienced inferior weight loss (22.6% TWL) during the first year of follow-up compared to the controls (29.9% TWL) (p = 0.010). CONCLUSIONS This multicenter study reveals inferior mid-term weight outcomes of cases with MC4R variants after SG, compared to RYGB. Since adequate weight loss outcomes were observed after RYGB, this procedure would appear to be an appropriate surgical approach for this group. However, the pattern of weight regain seen in cases with MC4R variants after both RYGB and SG highlights the need for pro-active lifelong management to prevent relapse, as well as careful expectation management.
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Affiliation(s)
- Mellody I Cooiman
- Department of Bariatric Surgery, Rijnstate Hospital/Vitalys Clinic, Wagnerlaan 55, Arnhem, the Netherlands. .,Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Suzanne I M Alsters
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Maeva Duquesnoy
- Nutrition Department, Reference Center for Rare Diseases, Assistance Publique Hopitaux de Paris, Pitie-Salpetriere Hospital, Paris, France
| | - Eric J Hazebroek
- Department of Bariatric Surgery, Rijnstate Hospital/Vitalys Clinic, Wagnerlaan 55, Arnhem, the Netherlands
| | - Hanne J Meijers-Heijboer
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Harvinder Chahal
- Department of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Johanne Le Beyec-Le Bihan
- Department of Biochemistry for Endocrinology and Oncology, Obesity and Dyslipidemia Genetics Unit, Assistance Publique-Hospitaux de Paris, Sorbonne Université, Pitie-Salpetriere Hospital, Paris, France
| | - Karine Clément
- Nutrition Department, Reference Center for Rare Diseases, Assistance Publique Hopitaux de Paris, Pitie-Salpetriere Hospital, Paris, France.,INSERM, Nutrition and Obesities, Systemic Approaches (NutriOmics) Research Unit, Sorbonne Université, Paris, France
| | - Hedi Soula
- INSERM, Nutrition and Obesities, Systemic Approaches (NutriOmics) Research Unit, Sorbonne Université, Paris, France
| | - Alex I Blakemore
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.,Department of Life Sciences, Brunel University London, London, UK
| | - Christine Poitou
- Nutrition Department, Reference Center for Rare Diseases, Assistance Publique Hopitaux de Paris, Pitie-Salpetriere Hospital, Paris, France.,INSERM, Nutrition and Obesities, Systemic Approaches (NutriOmics) Research Unit, Sorbonne Université, Paris, France
| | - Mieke M van Haelst
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands. .,Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
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19
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Roux-en-Y Versus One Anastomosis Gastric Bypass as Redo-Operations Following Sleeve Gastrectomy: A Retrospective Study. World J Surg 2022; 46:855-864. [PMID: 34985543 DOI: 10.1007/s00268-021-06424-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Aim of this study was to improve knowledge about the best conversional bariatric procedure following sleeve gastrectomy (SG). METHODS Data of conversional Roux-en-Y gastric bypass (RYGB) and of one anastomosis gastric bypass (OAGB) after SG were collected prospectively and analyzed retrospectively. Weight loss parameters, gastroesophageal reflux disease (GERD) and comorbidities outcomes were recorded. RESULTS Total of 123 patients (90 female, mean age 44 ± 0.9 years, mean body mass index (BMI) 42 ± 0.8 kg/m2) had either RYGB (n = 68) or OAGB (n = 55). Perioperative mortality was zero. Mean surgery time was significantly shorter for OAGB (168 ± 7.2 vs. 201 ± 6.8 min). Perioperative complication rates were not significantly (ns) different between RYGB and OAGB. Total body weight loss (TBWL) in RYGB and OAGB was 18 ± 2.2% and 18 ± 1.9% (12 months) and 18 ± 3.0% and 23 ± 2.6% (24 months; ns), respectively. Length of (individualized) biliopancreatic limb (BPL) correlated significantly with weight loss. Remission rates after 12 months of RYGB and OAGB for arterial hypertension (aHt) were 89% and 92%, for obstructive sleep apnea (OSAS) 56% and 82%, for Type 2 diabetes mellitus (T2DM) 100% and 92%, for osteoarthritis 64% and 85% and for GERD 89% versus 87% (ns), respectively. Nutritional deficiencies were comparable in RYGB (n = 11) and OAGB (n = 14) group (ns). CONCLUSION Both RYGB and OAGB are effective conversional procedures after SG, leading to comparable TBWL, BMI-loss and high remission rates of comorbidities including GERD. Significantly shorter operation times were in favor of OAGB. BPL, which was longer in OAGB was significantly related to higher %TBWL and %BMI-loss compared to RYGB.
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20
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Tourky M, Issa M, Salman MA, Salman A, Shaaban HED, Safina A, Elias AAK, Elewa A, Noureldin K, Mahmoud AA, Dorra A, Farah M, Gebril M, Gasemelseed Fadlallah Elhaj M, Barbary H. Nutritional Complications After Laparoscopic Roux-en-Y Gastric Bypass and One-Anastomosis Gastric Bypass: A Comparative Systematic Review and Meta-Analysis. Cureus 2022; 14:e21114. [PMID: 35036236 PMCID: PMC8752406 DOI: 10.7759/cureus.21114] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 12/29/2022] Open
Abstract
A systematic review and meta-analysis were carried out involving studies that compared the nutritional complications of Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB); these included the incidence of malnutrition as well as deficiencies of other nutritional elements, such as total protein, albumin, calcium and iron. A comprehensive search strategy was implemented in PubMed, Embase, and the Cochrane Library. Effect sizes included the pooled odds ratios (ORs) and 95% confidence intervals (95% CIs), as well as mean differences (MDs) and 95% CIs of the percentage total weight loss (%TWL) and excess weight loss percentage (%EWL). Thirteen studies were included (12,964 patients, 66.27% females, 53.82% underwent OAGB). At the longest follow-up period (≥3 years), OAGB was associated with significantly higher %TWL (MD=5.41%, 95%CI, 1.52 to 9.29) and %EWL (MD=13.81%, 95%CI, 9.60 to 18.02) compared to RYGB. However, OAGB procedures were associated with malnutrition (OR=3.00, 95%CI, 1.68 to 5.36, p<0.0001), hypoalbuminemia (OR=2.38, 95%CI, 1.65 to 3.43, p<0.0001), hypoproteinemia (OR=1.85, 95%CI, 1.09 to 3.14, p=0.022), anemia (OR=1.38, 95%CI, 1.08 to 1.77, p=0.011), and hypocalcemia (OR=1.78, 95%CI, 1.01 to 3.12, p=0.046). On subgroup analyses, the proportions of anemia and hypoalbuminemia remained significantly higher at longer follow-up periods and in studies published in Asia. Despite the favorable weight loss profile, the unfavorable nutritional consequences of OAGB merits further investigations to explore the malabsorptive element, ethnic variation, and the role of biliopancreatic limb length.
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Affiliation(s)
- Mohamed Tourky
- General Surgery, Great Western Hospital, NHS Foundation Trust, Swindon, GBR
| | - Mohamed Issa
- Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, GBR
- Surgery, Prince Charles Hospital, Myrther Tydfil, GBR
| | - Mohamed A Salman
- Surgery, KasrAlainy School of Medicine, Cairo University, Cairo, EGY
| | - Ahmed Salman
- Internal Medicine, KasrAlainy School of Medicine, Cairo University, Cairo, EGY
| | - Hossam El-Din Shaaban
- Gastroenterology and Hepatology, National Hepatology and Tropical Medicine Research Institute, Cairo, EGY
| | - Ahmed Safina
- General Surgery, KasrAlainy School of Medicine, Cairo University, Cairo, EGY
| | - Abd Al-Kareem Elias
- General Surgery, Faculty of Medicine, Al-Azhar University, Assuit Branch, Kafr El-Sheikh, EGY
| | - Ahmed Elewa
- General Laparoscopic and Hepato-Pancreatico-Biliary (HBP) Surgery, National Hepatology and Tropical Medicine Research Institute, Cairo, EGY
| | - Khaled Noureldin
- General Surgery, KasrAlainy School of Medicine, Cairo University, Cairo, EGY
- Colorectal Surgery, Southend University Hospital, Mid and South Essex NHS Foundation Trust, Essex, GBR
| | | | - Ahmed Dorra
- Surgery, Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, GBR
| | - Mohamed Farah
- Urology, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, GBR
| | - Mahmoud Gebril
- General and Laparoscopic Surgery, Al Qabary Specialized Oncology Center, Alexandria, EGY
| | | | - Hesham Barbary
- General and Laparoscopic Surgery, El Zaitoun Specialized Hospital, Cairo, EGY
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21
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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: 14] [Impact Index Per Article: 4.7] [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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Magema JPMMK, Himpens J. "What Really Matters When Performing a Laparoscopic Roux-en Y Gastric Bypass?" Literature-Based Key Steps Towards Success and Standardization of the Procedure. Obes Surg 2021; 31:5441-5445. [PMID: 34655054 DOI: 10.1007/s11695-021-05750-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/26/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
Lack of standardization in the Roux-en-Y gastric bypass (RY-GBP) is quite well established. We all learned the basics of the technique, but a lot of differences do exist in performing each step of the procedure. Based on scientific evidences, coming from an extensive and meticulous review of the literature of the last 20 years, we thus address the different technical steps of the procedure and their importance to try and propose a standardization of RYGBP. A lot of possibilities exist at each and every step of a RYGBP. They influence the postoperative complications, the end weight loss (EWL), weight regain, and resolution of obesity bounded comorbidities. Furthermore, lack of standardization leads to problems regarding comparison of scientific data in the related literature.
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Affiliation(s)
| | - Jacques Himpens
- Visceral Surgery Unit, Delta CHIREC Hospital, Site Delta, Boulevard du Triomphe 201, 1160, Brussels, Belgium
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Gadiot RPM, Biter LU, Feskens PG, Dunkelgrun M, Apers JA, van 't Hof G, Mannaerts GHH. Midterm Results from the Dutch Common Channel Trial (DUCATI): Superior Weight Loss Results of the Long Roux Limb Gastric Bypass in Comparison to the Standard Bypass at 3-Year Follow-Up. Obes Surg 2021; 31:5132-5140. [PMID: 34476726 DOI: 10.1007/s11695-021-05690-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022]
Abstract
In the multi-center Dutch Common Channel Trial (DUCATI), a very long Roux limb Roux-en-Y gastric bypass (VLRL-RYGB: BP-limb 60 cm, Roux limb variable, and common channel 100 cm) was compared to a standard Roux-en-Y gastric bypass (S-LRYGB: BP-limb 60 cm, Roux limb 150 cm, and common channel variable) in the treatment of morbidly obese patients. As all trial patients are beyond 3-year follow-up a midterm analysis was performed to investigate the effect of the VLRL-RYGB. METHODS A total of 444 patients were randomized (1:1) to receive either a VLRL-RYGB or a S-LRYGB. Follow-up results for weight loss, effect on obesity-related comorbid conditions, complications, reoperation, and malnutrition are investigated. RESULTS At 3-year follow-up a significant difference in %TWL (34.0% vs. 31.4%, p = 0.017) and %EWL (84.7% vs. 76.6%, p = 0.043) was observed in favor of VLRL-LRYGB group. Overall complication rate 3-years after surgery was 15.8% in the VLRL-LRYGB group vs. 9% in the S-LRYGB group (p = 0.031). Eight (3.6%) patients in the VLRL-LRYGB group versus 2 (0.9%) in the S-LRYGB group (p = 0.055) required revisional surgery for malabsorption. In the VLRL-LRYGB group 71.9% of patients had resolution of T2DM versus 48.9% in the S-LRYGB group (p = 0.044). CONCLUSION At midterm FU a considerable, significantly increased effect on weight loss of the VLRL-LRYGB was observed compared to the S-LRYGB, with a higher risk of overall complications, but no significant nutritional side effects. These results might impact the current view on the value of the Roux limb in the discussion on optimum limb lengths in Roux-en-Y gastric bypass surgery.
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Affiliation(s)
- Ralph P M Gadiot
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, Rotterdam, 3045 PM, the Netherlands.
| | - L Ulas Biter
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, Rotterdam, 3045 PM, the Netherlands
| | - Pierre G Feskens
- Department of Bariatric Surgery, Bariatric Center South-West Netherlands, Bravis Hospital, Bergen op Zoom, the Netherlands
| | - Martin Dunkelgrun
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, Rotterdam, 3045 PM, the Netherlands
| | - Jan A Apers
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, Rotterdam, 3045 PM, the Netherlands
| | - Gerhard van 't Hof
- Department of Bariatric Surgery, Bariatric Center South-West Netherlands, Bravis Hospital, Bergen op Zoom, the Netherlands
| | - Guido H H Mannaerts
- Department of Surgery, Tawam Hospital, Al Ain Abu Dhabi, United Arab Emirates
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Gao X, Zhu L, Wang G, Li W, Song Z, Zhu S, Li P. Effect of Roux-en-Y Gastric Bypass with Different Lengths of Biliopancreatic and Alimentary Limbs for Patients with Type 2 Diabetes Mellitus and a BMI < 35 kg/m 2: 5-Year Outcomes in Chinese Patients. Obes Surg 2021; 31:4877-4884. [PMID: 34403077 DOI: 10.1007/s11695-021-05658-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 08/07/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE There have been no definite conclusions about the biliopancreatic limb (BPL) and alimentary limb (AL) lengths in Roux-en-Y gastric bypass (RYGB) operations for different populations and BMIs. Western scholars have performed many studies on the lengths of the BPL and AL in patients with a BMI ≥ 35 kg/m2. However, for diabetic Chinese patients with BMI < 35 kg/m2, few people have compared the effects of different BPL and AL lengths on patient prognosis. PATIENTS AND METHODS Clinical data were collected prospectively and analyzed retrospectively for 87 patients with type 2 diabetes (T2DM) who underwent RYGB with a BPL of 50 cm and an AL of 50 cm (BPL50/AL50) or with a BPL of 100 cm and an AL of 100 cm (BPL100/AL100) and who were followed up for 5 years. RESULTS The cohort included 42 patients in the BPL50/AL50 group and 45 patients in the BPL100/AL100 group. At 5 years, there were significant differences in BMI, total weight loss (TWL%), glycosylated hemoglobin, and homeostasis model assessment insulin resistance between BPL50/AL50 and BPL100/AL100 (P < 0.05). Diabetes remission rate of the BPL100/AL100 group was significantly higher than that of the BPL50/AL50 group. Diabetes remission at 1 year after surgery correlated with the length limb (BPL + AL), duration of diabetes and TWL%. There was no difference in complications between BPL50/AL50 and BPL100/AL100. CONCLUSIONS RYGB with BPL100/AL100 is a safe and effective treatment for diabetic patients with a BMI < 35 kg/m2 and offers significant improvement in weight loss and glycemic control.
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Affiliation(s)
- Xiang Gao
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Liyong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Guohui Wang
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Weizheng Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Zhi Song
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Shaihong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Pengzhou Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China.
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Comparing a Short Biliopancreatic Limb to a Long Biliopancreatic Limb in Patients with a Roux-en-Y Gastric Bypass with 4 Years Follow-up. Obes Surg 2021; 31:4846-4852. [PMID: 34368902 DOI: 10.1007/s11695-021-05651-z] [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: 06/14/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In order to design the most effective weight loss procedure, the ideal biliopancreatic limb (BPL) and alimentary limb (AL) length in Roux-en-Y gastric bypass (RYGB) have been discussed extensively. Yet, no consensus has been reached. The aim of this study was to compare weight loss after a short and long BPL in patients who underwent a RYGB with a minimum of 4 years follow-up. METHODS This retrospective cohort study consisted of 574 patients who underwent a primary RYGB procedure between March 2015 and January 2017. Patients were divided in two groups based on the surgical procedure performed: a short BPL group (BPL of 50 cm with an AL of 150 cm) and long BPL group (BPL of 150 cm with an AL of 75 cm). The percentage total weight loss (%TWL) between groups was compared up to 4 years after surgery. Secondary outcomes were 30-day postoperative complications and health-related quality of life (RAND-36). RESULTS The short BPL group consisted of 286 patient and the long BPL group of 288 patients. Follow-up rates of both groups at the first, second, third, and fourth year after surgery were comparable. The long BPL group showed significantly more %TWL compared to the short BP limb group starting at 6 months (p = 0.004) until 4 years after surgery (p < 0.001). Thirty-day complications and health-related quality of life did not differ. CONCLUSION The results showed significantly more %TWL in patients receiving a long BPL compared to the short BPL up to 4 years after surgery.
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Wang A, Poliakin L, Sundaresan N, Vijayanagar V, Abdurakhmanov A, Thompson KJ, Mckillop IH, Barbat S, Bauman R, Gersin KS, Kuwada TS, Nimeri A. The Role of Total Alimentary Limb Length in Roux-En-Y Gastric Bypass – A Systematic Review. Surg Obes Relat Dis 2021; 18:555-563. [DOI: 10.1016/j.soard.2021.08.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/04/2021] [Accepted: 08/21/2021] [Indexed: 12/21/2022]
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Kraljević M, Schneider R, Wölnerhanssen B, Bueter M, Delko T, Peterli R. Different limb lengths in gastric bypass surgery: study protocol for a Swiss multicenter randomized controlled trial (SLIM). Trials 2021; 22:352. [PMID: 34011386 PMCID: PMC8136210 DOI: 10.1186/s13063-021-05313-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 05/05/2021] [Indexed: 12/30/2022] Open
Abstract
Background Obesity and type 2 diabetes mellitus are reaching epidemic proportions. In morbidly obese patients, bariatric operations lead to sustained weight loss and relief of comorbidities in the majority of patients. Laparoscopic Roux-Y-gastric bypass (RYGB) is one of the most frequently performed operations, but it is still unknown why some patients respond better than others. Therefore, a number of variations of this operation have been introduced. Recent evidence suggests that a longer bypassed biliopancreatic limb (BPL) has the potential to be more effective compared to the standard RYGB with a shorter BPL length. This article describes the design and protocol of a randomized controlled trial comparing the outcome of a RYGB operation with a long versus short BPL. Methods/design The trial is designed as a multicenter, randomized, patient- and observer-blinded trial. The relevant ethics committee has approved the trial protocol. To demonstrate that long BPL RYGB is superior compared to short BPL RYGB in terms of weight loss and resolution of T2DM, the study is conducted as a superiority trial. Postoperative percent total weight loss and nutritional deficiency rate are the primary endpoints, whereas morbidity, mortality, remission of obesity-related comorbidities and quality of life are secondary endpoints. Eight hundred patients, between 18 and 65 years and with a body mass index (BMI) from 35 to 60 kg/m2 who meet the regulatory rules for bariatric surgery in Switzerland, will be randomized. The endpoints and baseline measurements will be assessed pre-, intra-, and postoperatively. Discussion With its high number of patients and a 5-year follow-up, this study will answer questions about effectiveness and safety of long BPL RYGB and provide level I evidence for improvement of the standard RYGB. These findings might therefore potentially influence global bariatric surgery guidelines. Trial registration ClinicalTrials.gov NCT04219787. Registered on 7 January 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05313-6.
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Affiliation(s)
- Marko Kraljević
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland
| | - Romano Schneider
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland
| | | | - Marco Bueter
- Department of Visceral Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Tarik Delko
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland
| | - Ralph Peterli
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland.
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Roux-en-Y Gastric Bypass with Long Biliopancreatic Limb Compared to Single Anastomosis Sleeve Ileal (SASI) Bypass in Treatment of Morbid Obesity. Obes Surg 2021; 31:3615-3622. [PMID: 33942216 DOI: 10.1007/s11695-021-05457-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Bariatric surgery is the most effective treatment of morbid obesity. Bariatric procedures employ different mechanisms of action to induce weight loss. The present study aimed to compare single-anastomosis sleeve ileal (SASI) bypass and roux-en-Y gastric bypass RYGB with long biliopancreatic limb (BPL) in terms of weight loss, remission of comorbidities, complications, and nutritional status. METHODS This was a single-center cohort study on patients with morbid obesity who underwent RYGB with long BPL of 150 cm or SASI bypass. The main outcome measures were weight loss and improvement in comorbidities at 12 months, nutritional status, and complications. RESULTS The present study included 92 patients (59.8% females) of a mean age of 38.4 years and mean BMI of 42 kg/m2. RYGB and SASI bypass were followed by a significant decrease in body mass index at 12 months and were comparable in terms of excess and total weight loss. Improvement in comorbidities after the two procedures was similar. The serum albumin levels showed a significant decline after RYGB, but not after SASI bypass. The postoperative serum iron levels were higher after SASI bypass than after RYGB. There was no significant difference in regard to complication rates (13% vs 4.3%, p = 0.27). CONCLUSIONS RYGB with long BPL and SASI bypass achieved satisfactory weight loss and improvement in comorbidities that were comparable among the two groups. Long BPL RYGB was followed by a significant decrease in serum albumin and iron levels at one year, which was not observed after SASI bypass.
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Miras AD, Kamocka A, Pérez-Pevida B, Purkayastha S, Moorthy K, Patel A, Chahal H, Frost G, Bassett P, Castagnetto-Gissey L, Coppin L, Jackson N, Umpleby AM, Bloom SR, Tan T, Ahmed AR, Rubino F. The Effect of Standard Versus Longer Intestinal Bypass on GLP-1 Regulation and Glucose Metabolism in Patients With Type 2 Diabetes Undergoing Roux-en-Y Gastric Bypass: The Long-Limb Study. Diabetes Care 2021; 44:1082-1090. [PMID: 33158945 PMCID: PMC8132320 DOI: 10.2337/dc20-0762] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/14/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Roux-en-Y gastric bypass (RYGB) characteristically enhances postprandial levels of glucagon-like peptide 1 (GLP-1), a mechanism that contributes to its profound glucose-lowering effects. This enhancement is thought to be triggered by bypass of food to the distal small intestine with higher densities of neuroendocrine L-cells. We hypothesized that if this is the predominant mechanism behind the enhanced secretion of GLP-1, a longer intestinal bypass would potentiate the postprandial peak in GLP-1, translating into higher insulin secretion and, thus, additional improvements in glucose tolerance. To investigate this, we conducted a mechanistic study comparing two variants of RYGB that differ in the length of intestinal bypass. RESEARCH DESIGN AND METHODS A total of 53 patients with type 2 diabetes (T2D) and obesity were randomized to either standard limb RYGB (50-cm biliopancreatic limb) or long limb RYGB (150-cm biliopancreatic limb). They underwent measurements of GLP-1 and insulin secretion following a mixed meal and insulin sensitivity using euglycemic hyperinsulinemic clamps at baseline and 2 weeks and at 20% weight loss after surgery. RESULTS Both groups exhibited enhancement in postprandial GLP-1 secretion and improvements in glycemia compared with baseline. There were no significant differences in postprandial peak concentrations of GLP-1, time to peak, insulin secretion, and insulin sensitivity. CONCLUSIONS The findings of this study demonstrate that lengthening of the intestinal bypass in RYGB does not affect GLP-1 secretion. Thus, the characteristic enhancement of GLP-1 response after RYGB might not depend on delivery of nutrients to more distal intestinal segments.
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Affiliation(s)
| | - Anna Kamocka
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
| | - Belén Pérez-Pevida
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
| | | | - Krishna Moorthy
- Department of Surgery and Cancer, Imperial College London, London, U.K
| | - Ameet Patel
- Department of Surgery, King's College London, London, U.K
| | - Harvinder Chahal
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
| | - Gary Frost
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
| | | | | | - Lucy Coppin
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, U.K
| | - Nicola Jackson
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, U.K
| | - Anne Margot Umpleby
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, U.K
| | - Stephen Robert Bloom
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
| | - Tricia Tan
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
| | - Ahmed Rashid Ahmed
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
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Short-Term Changes on Body Composition and Bone Mass After One-Anastomosis Gastric Bypass: a Prospective Observational Study. Obes Surg 2021; 30:3514-3521. [PMID: 32314255 DOI: 10.1007/s11695-020-04603-3] [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: 12/30/2022]
Abstract
PURPOSE Bariatric surgery generates a large weight loss. It is considered a successful surgery when 50% of the excess weight loss is reached. However, this measure does not include some variables that may have a direct impact on a patient's health, such as fat-free mass (FFM) or bone mass. Therefore, the aim of this study is to evaluate body composition and bone mass in patients undergoing one-anastomosis gastric bypass (OAGB). METHODS A prospective observational study was performed in patients undergoing OAGB. Body composition and bone mass were evaluated by bioelectrical impedance analysis at baseline (1 day prior to surgery), at 6 and 12 months after surgery. RESULTS A total of 94 patients (67% females and 33% males) were included in the study. The excess BMI loss at 6 and 12 months after surgery was 97.9 ± 20.1% and 110.2 ± 30.5% respectively. The FFM showed a reduction of 6.6 ± 4.8 kg (p < 0.01) 6 months after surgery and of 7.9 ± 4.9 kg (p < 0.01) at 12 months, meaning a decrease of 10.5 ± 7.3% and a 12.9 ± 6.6% respectively. The bone mass decrease was 10.1 ± 6.9% (p < 0.01) and 12.9 ± 6.5% (p < 0.01) at 12 months after OAGB. CONCLUSIONS OAGB obtains a relevant weight loss in patients with morbid obesity, mainly, due to fat mass reductions. However, this procedure also provokes FFM and bone mass decreases, especially in females, but not significantly greater than other restrictive or mixed procedures.
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Kraljević M, Köstler T, Süsstrunk J, Lazaridis II, Taheri A, Zingg U, Delko T. Revisional Surgery for Insufficient Loss or Regain of Weight After Roux-en-Y Gastric Bypass: Biliopancreatic Limb Length Matters. Obes Surg 2021; 30:804-811. [PMID: 31863410 DOI: 10.1007/s11695-019-04348-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Weight regain after laparoscopic Roux-en-Y gastric bypass (RYGB) occurs in up to 35% of patients. Revisional surgery may be applied. Conversion from RYGB to a long biliopancreatic limb (BPL) RYGB is a potential option for revisional surgery and short-term results are promising. METHODS All patients who underwent conversion to long BPL RYGB due to weight loss failure, defined as excess weight loss (EWL) < 50% or body mass index (BMI) > 35 kg/m2, were assessed. Proximal RYGB or very very long limb RYGB (VVLL RYGB) was modified by shortening of the total alimentary limb length (TALL) to create a long BPL. RESULTS A total of 28 patients received revisional surgery from either PRYGB (n = 22) or VVLL RYGB (n = 6). Mean age at operation was 45.3 ± 10.4 years, with 78% females. Mean prerevisional BMI was 41.7 ± 4.4 kg/m2. Mean time to revision was 76.5 ± 38.5 months. Limb lengths were 150 cm (95% CI 133-156 cm) for RL and 100 cm (95% CI 97-113 cm) for CC, thus providing a total median alimentary limb length of 250 (95% CI 238-260 cm). Additional %EWL and TWL improved significantly in long-term. Five years postoperatively, all patients (n = 9) had an EWL% > 50%. Six patients (21.4%) required reoperation due to severe malnutrition during the postoperative course. CONCLUSION Conversion from RYGB to BPL RYGB leads to significant additional weight loss in the long term. However, the morbidity is relevant, especially severe protein malnutrition and the frequency of revisional surgery. Therefore, this type of surgery should not be done routinely.
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Affiliation(s)
- Marko Kraljević
- Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
| | - Thomas Köstler
- Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
| | - Julian Süsstrunk
- Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
| | - Ioannis I Lazaridis
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - Amy Taheri
- Institute of Clinical Chemistry, University Hospital Zurich, 8952, Zurich-Schlieren, Switzerland
| | - Urs Zingg
- Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
| | - Tarik Delko
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland.
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A randomized controlled trial comparing oral and intravenous iron supplementation after Roux-en-Y gastric bypass surgery. Clin Nutr 2020; 39:3779-3785. [DOI: 10.1016/j.clnu.2020.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 03/17/2020] [Accepted: 04/08/2020] [Indexed: 01/03/2023]
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Süsstrunk J, Lazaridis II, Köstler T, Kraljević M, Delko T, Zingg U. Long-Term Outcome of Proximal Versus Very-Very Long Limb Roux-en-Y Gastric Bypass: the Roux-Limb to Common Channel Ratio Determines the Long-Term Weight Loss. Obes Surg 2020; 31:994-1003. [PMID: 33196977 DOI: 10.1007/s11695-020-05109-8] [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] [Received: 07/07/2020] [Revised: 10/29/2020] [Accepted: 11/10/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The influence of the Roux limb (RL) length on weight loss in Roux-en-Y (RYGB)-type gastric bypass procedures is still unclear. This study analyzes the true impact of RL length by comparing the long-term outcomes of proximal RYGB (PRYGB) and very-very long limb RYGB (VVLL-RYGB). METHODS RL length in PRYGB was 150 cm. In VVLL-RYGB, common channel length was 100 cm. In both groups, biliopancreatic limbs measured 50-60 cm, resulting in equal total alimentary limb lengths. To adjust for pre-operative differences between groups, and to predict the long-term outcome, a mixed model analysis was performed. RESULTS Two hundred thirty-two patients with VVLL-RYGB (73.7% female, mean age 41.1 ± 10 years, initial BMI 45.8 ± 6.3 kg/m2) and 223 with PRYGB (83.9% female, mean age 38.5 ± 11 years, initial BMI 42.9 ± 4.9 kg/m2) were included. Mean follow-up was 9.4 ± 4 years in VVLL-RYGB and 5.3 ± 1.9 years in PRYGB. After 5 years, mean BMI reduction was 15.7 ± 5.9 kg/m2 in VVLL-RYGB and 11.9 ± 4.1 kg/m2 in PRYGB (p < 0.001), and mean %EWL was 78.3 ± 23.1% and 70.2 ± 23.7% (p = 0.002) with a follow-up rate of 78% and 75.9%, respectively. The mixed model analysis showed a significantly higher weight rebound after PRYGB. Frequency of revisional surgery (i.e., limb length alteration, pouch banding) was similar between VVLL-RYGB and PRYGB (25 vs. 29 revisions, p = 0.463). CONCLUSION The VVLL-RYGB has a significantly higher long-term BMI reduction and a significantly lower weight rebound. The length of the Roux limb significantly influences long-term outcome.
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Affiliation(s)
- Julian Süsstrunk
- Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland.
| | - Ioannis I Lazaridis
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - Thomas Köstler
- Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
| | - Marko Kraljević
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - Tarik Delko
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - Urs Zingg
- Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
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Dey A, Mittal T, Ahuja A, Malik VK, Bambrule P. Biliopancreatic Limb Lengths Affects Weight Loss in Roux-en-Y Gastric Bypass: Are We Close to the Truth? Obes Surg 2020; 31:1349-1350. [PMID: 33089385 DOI: 10.1007/s11695-020-05033-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Ashish Dey
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India.
| | - Tarun Mittal
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| | - Anmol Ahuja
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| | - Vinod K Malik
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| | - Parmeshwar Bambrule
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
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Smelt HJM, Van Rijn S, Pouwels S, Aarts MPW, Smulders JF. The Influence of Different Alimentary and Biliopancreatic Limb Lengths in Gastric Bypass Patients. Obes Surg 2020; 31:481-489. [PMID: 33052551 DOI: 10.1007/s11695-020-05028-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to compare the effect of two different limb lengths after RYGB on weight loss, postoperative gastro-intestinal complications, and vitamin deficiencies. MATERIALS AND METHODS A retrospective analyses of 100 patients after RYGB with 2 different limb lengths were done. Group A (50 patients) had a biliopancreatic limb (BPL) of 75 cm and an alimentary limb (AL) of 150 cm. Group B (50 patients) had a BPL of 150 cm and an AL of 75 cm. The effect on weight loss, body mass index, excess weight loss (EWL), total weight loss (TWL), and postoperative complications was analyzed up to 2 years postoperatively. RESULTS Patients with a longer BPL achieved significantly more %EWL compared to a shorter BPL 2 years postoperatively (82.8 ± 31.2 versus 93.8 ± 15.1; p = 0.038). A significant difference was also seen in %TWL after 1 year (30.3 ± 10.1 versus 37.4 ± 6.9; p < 0.01) and 2 years (31.6 ± 7.5 versus 35.6 ± 8.6; p = 0.022), both in favor of group B. However, patients with a longer BPL (group B) showed significant more diarrhea and steatorrhea compared to group A (p < 0.01). CONCLUSION BPL of 150 cm is associated with more %EWL and %TWL 2 years after RYGB. However, it is accompanied by an increase of diarrhea and steatorrhea to disadvantage off group B. Future studies need to focus on further tailoring BPL and AL lengths to achieve the best possible outcomes for patients with morbid obesity.
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Affiliation(s)
- H J M Smelt
- Obesity Center, Catharina Hospital, Eindhoven, The Netherlands. .,Department of Surgery, Catharina Hospital, Michelangelolaan 2 P.O. Box 1350, 5602, ZA, Eindhoven, The Netherlands.
| | - S Van Rijn
- Department of Surgery, University Medical Center Maastrischt, Maastricht, The Netherlands
| | - S Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - M P W Aarts
- Obesity Center, Catharina Hospital, Eindhoven, The Netherlands
| | - J F Smulders
- Obesity Center, Catharina Hospital, Eindhoven, The Netherlands.,Department of Surgery, Catharina Hospital, Michelangelolaan 2 P.O. Box 1350, 5602, ZA, Eindhoven, The Netherlands
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Does the Length of the Common Channel as Part of the Total Alimentary Tract Matter? One Year Results from the Multicenter Dutch Common Channel Trial (DUCATI) Comparing Standard Versus Distal Roux-en-Y Gastric Bypass with Similar Biliopancreatic Bowel Limb Lengths. Obes Surg 2020; 30:4732-4740. [PMID: 32955672 DOI: 10.1007/s11695-020-04982-7] [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] [Received: 07/23/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE Although the laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is the gold-standard bariatric procedure, it remains uncertain what the optimal bowel limb lengths are to accomplish maximal weight loss while minimizing nutritional deficiencies and related gastro-intestinal complaints. The aim of this randomized controlled multicenter trial is to investigate the effect of significant lengthening of the length of the Roux limb (RL) at the cost of the length of the common channel (CC) while keeping the biliopancreatic limb (BPL) lengths the same on both study arms. METHODS Four hundred forty-four patients were randomized to receive either a Very Long Roux Limb LRYGB (VLRL-LRYGB) (variable RL length, BPL 60 cm, and CC 100 cm) or a Standard LRYGB (S-LRYGB) (RL 150 cm, BPL 60 cm, and a variable CC length). Results at 1-year follow-up for weight loss, effect on obesity-related comorbid conditions, complications, re-operation rate, malnutrition rate, and re-admission rate were investigated. RESULTS Weight loss at 1-year showed no significant differences for %EWL (84.3% versus 85.3%, p = 0.72) and %TWL (34.2% versus 33.6%, p = 0.359) comparing VLRL-LRYGB versus S-LRYGB. Malabsorption requiring surgical bowel length adjustment was observed in 1.4% in VLRL-LRYGB group versus 0.9% in S-LRYGB group (p = 0.316). CONCLUSION Significant lengthening of the RL at the cost of the common channel seems to have no effect on the weight loss at 1-year follow-up, which supports the theory that absorption of nutrients also occurs in the RL. Nevertheless, long-term results of the VLRL-LRYGB have to be awaited to draw final conclusions as part of the discussion towards optimal limb length in LRYGB surgery.
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Almalki OM, Soong TC, Lee WJ, Chen JC, Wu CC, Lee YC. Variation in Small Bowel Length and Its Influence on the Outcomes of Sleeve Gastrectomy. Obes Surg 2020; 31:36-42. [PMID: 32914323 DOI: 10.1007/s11695-020-04958-7] [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] [Received: 06/18/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Small bowel length is drawing attention in the development of gastrointestinal bariatric/metabolic surgery, but the importance of the length of the small bowel in bariatric/metabolic is not clear. The present study was conducted to investigate variations in small bowel length and their clinical significance in patients undergoing laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS Small bowel length was measured in 620 patients diagnosed with obesity who underwent LSG between March 2014 and August 2018. Prospectively obtained demographic and clinical data were investigated, focusing on the association between small bowel length and weight loss. RESULTS Small bowel length varied widely among patients (mean 739.8 + 115.7 cm, range 380-1050 cm). Linear regression analysis revealed a significant association between small bowel length and body height, body weight, waist circumference, and serum levels of low-density lipoprotein cholesterol, hemoglobin, C-peptide, glycated hemoglobin (A1C), and gamma-glutamyl transferase (r-GT). Multivariate analysis confirmed that body height and serum A1C% levels independently predicted small bowel length in bariatric patients, strongly with body height (p < 0.001) but weakly with A1C%(p = 0.021). One-year follow-up rate was 75.3% (467/620), and small bowel length did not influence weight loss or the reduction of obesity related cardiovascular risk factors after LSG. CONCLUSION In this study, small bowel length varied widely among bariatric patients and was strongly associated with body height and weakly with serum A1C levels. Small bowel length has no significant role in weight loss or the resolution of cardiovascular risk factors after LSG.
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Affiliation(s)
- Owaid M Almalki
- Department of Surgery, College of Medicine, Taif University, Ta'if, Saudi Arabia.,Department of Surgery, Min-Sheng General Hospital, No. 168, Ching Kuo Road, Taoyuan, Taiwan
| | - Tien-Chou Soong
- Department of Weight Loss and Health Management Center, E-DA Dachang Hospital, Kaohsiung, Taiwan.,Department of Asia Obesity Medical Research Center, E-DA Hospital, Kaohsiung, Taiwan.,College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, No. 168, Ching Kuo Road, Taoyuan, Taiwan.
| | - Jung-Chien Chen
- Department of Surgery, Min-Sheng General Hospital, No. 168, Ching Kuo Road, Taoyuan, Taiwan
| | - Chun-Chi Wu
- Department of Surgery, Min-Sheng General Hospital, No. 168, Ching Kuo Road, Taoyuan, Taiwan
| | - Yi-Chih Lee
- Department of International Business, Chien Hsin University, Taoyuan, Taiwan
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Torres AJ. Comments on: Early complications, long-term adverse event,s and quality of life after duodenal switch and gastric bypass in a matched national cohort. Surg Obes Relat Dis 2020; 16:e37-e38. [PMID: 32475756 DOI: 10.1016/j.soard.2020.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/22/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Antonio J Torres
- Hospital Clinico San Carlos, Complutense University of Madrid, Madrid, Spain
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Randomized Controlled Trial of One Anastomosis Gastric Bypass Versus Roux-En-Y Gastric Bypass for Obesity: Comparison of the YOMEGA and Taiwan Studies. Obes Surg 2020; 29:3047-3053. [PMID: 31290104 DOI: 10.1007/s11695-019-04065-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The YOMEGA study (Y-study) was a randomized trial comparing one anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB). Here, we aim to compare the Y-study and our pioneer trial from Taiwan (T-study). METHODS Data from the Y-study and the T-study were collected and compared. RESULTS The Y-study recruited 234 patients with a mean body mass index (BMI) of 43.9 and age of 43.5 years. The T-study recruited 80 patients with a similar mean BMI of 44.3 and mean age of 31.4 years. The studies had similar findings including (1) OAGB is easier and possibly safer procedure than RYGB. Both studies showed that OAGB had a shorter operation time than RYGB, but a lower surgical complication rate was only demonstrated in T-study. (2) Both procedures have similar weight loss but OAGB features better glycemic control than RYGB. Weight loss at 2 years after surgery was similar between two procedures, but OAGB reduced HbA1c to a greater degree than RYGB at 2 years in Y-study (- 2.3% vs. - 1.3%; p = 0.025). The resolution of the metabolic syndrome was 100% for both groups in the T-study. (3) OAGB carried a higher risk of malnutrition. OAGB had more malabsorptive problems with a lower hemoglobin level than RYGB at 2 years after surgery. Adverse malnutrition events occurred in nine (7.8%) OAGB patients in the Y-study. Four (3.4%) patients of OAGB received revision surgery in Y-study but none in T-study. (4) Bile reflux was noted in OAGB patients but did not influence quality of life or revision rate. Y-study found that bile in the gastric pouch was present in 16% of patients in the OAGB group versus none in the RYGB, but no inter-group difference in quality of life was detected. There was a trend for RYGB patients to experience more abdominal pain than OAGB. CONCLUSIONS Both studies showed that OAGB is a technically easier procedure and features better glycemic control than RYGB, but has a mal-absorptive effect. However, the bile reflux and abdominal pain controversies persisted.
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Shin RD, Goldberg MB, Shafran AS, Shikora SA, Majumdar MC, Shikora SA. Revision of Roux-en-Y Gastric Bypass with Limb Distalization for Inadequate Weight Loss or Weight Regain. Obes Surg 2020; 29:811-818. [PMID: 30560312 DOI: 10.1007/s11695-018-03635-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Of patients undergoing Roux-en-Y gastric bypass (RYGB), 15-35% of patients fail to achieve "adequate" weight loss or regain significant weight. Multiple solutions have been proposed, but not well studied. We report our experience with limb distalization with lengthening the biliopancreatic (BP) limb and shortening the common channel (CC). METHODS We retrospectively reviewed data from patients undergoing laparoscopic limb distalization for excess weight loss (EWL) <50% or BMI >35 kg/m2 after RYGB from 2012 to 2017. The BP limb was lengthened and CC was shortened to 100-200 cm. Perioperative outcomes such as morbidity, weight loss, nutritional deficiencies, comorbidity remission, and operative details were analyzed. RESULTS Twenty-two patients were included. The mean BMI prior to RYGB was 54.1 ± 8.5 kg/m2 and 43.0 ± 5.5 kg/m2 prior to limb distalization. The mean follow-up was 18.3 ± 12.9 months with a mean BMI change, %EWL, and %TWL (total weight loss) of 11.8 ± 7.4 kg/m2, 62.3 ± 32.4%, and 25.4 ± 14.4%, respectively. The total mean BMI change, %EWL, and %TWL from RYGB was 22.2 ± 9.9 kg/m2, 77.8 ± 23.6%, and 40.2 ± 13.3%, respectively. Of patients with persistent comorbidities, remission rates of diabetes, hypertension, and gastroesophageal reflux disease were 100%, 17%, and 38%, respectively. The mean operative time was 132.6 ± 54.4 min and mean hospital stay was 2.2 ± 1.3 days. Overall morbidity was 27.3%. Three patients (13.6%) developed nutritional deficiencies requiring reversal surgery. CONCLUSION In patients with inadequate weight loss or weight regain after RYGB, limb distalization with lengthening of the BP limb is an effective procedure for additional weight loss and further improvement of comorbidities. Nutritional complications are a risk, but can be minimized with close follow-up and patient compliance.
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Affiliation(s)
- Reuben D Shin
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.,Department of General Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Michael B Goldberg
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.,Department of General Surgery, Crozer Keystone Health System, Upland, PA, USA
| | - Allison S Shafran
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Samuel A Shikora
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Melissa C Majumdar
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Scott A Shikora
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
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Campelo GP, da Cunha Leal P, de Oliveira CMB, Moura ECR, de Oliveira EJSG, de Lima RC, Valadão JA. Long Biliopancreatic Limb Roux-en-Y Gastric Bypass Revisional Surgery in a Myasthenia Gravis Patient: Case Report. Obes Surg 2020; 30:2800-2801. [PMID: 32124211 DOI: 10.1007/s11695-020-04501-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Xu T, Wang C, Zhang H, Han X, Liu W, Han J, Yu H, Chen J, Zhang P, Di J. Timing of Maximal Weight Reduction Following Bariatric Surgery: A Study in Chinese Patients. Front Endocrinol (Lausanne) 2020; 11:615. [PMID: 33042006 PMCID: PMC7522214 DOI: 10.3389/fendo.2020.00615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/28/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Bariatric surgery is a well-received treatment for obesity with maximal weight loss at 12-36 months postoperatively. We investigated the effect of early bariatric surgery on weight reduction of Chinese patients in accordance with their preoperation characteristics. Materials and Methods: Altogether, 409 patients with obesity from a prospective cohort in a single bariatric center were enrolled retrospectively and evaluated for up to 4 years. Measurements obtained included surgery type, duration of diabetic condition, besides the usual body mass index data tuple. Weight reduction was expressed as percent total weight loss (%TWL) and percent excess weight loss (%EWL). Results: RYGB or SG were performed laparoscopically without mortality or complications. BMI generally plateaued at 12 months, having decreased at a mean of 8.78 kg/m2. Successful weight loss of >25% TWL was achieved by 35.16, 49.03, 39.22, 27.74, 20.83% of patients at 6, 12, 24, 36, and 48 months after surgery. Overall, 52.91% of our patients had lost 100% of their excess weight at 12 months, although there was a rather wide range among individuals. Similar variability was revealed in women of child-bearing age. Conclusion: Chinese patients undergoing bariatric surgery tend to achieve maximal weight loss and stabilization between 12 and 24 months postoperatively, instead of at >2 years. The finding of the shorter stabilization interval has importance to earlier intervention of weight loss related conditions and women's conception planning.
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Affiliation(s)
- Ting Xu
- Department of Bariatric & Metabolic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Chen Wang
- Department of Bariatric & Metabolic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hongwei Zhang
- Department of Bariatric & Metabolic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiaodong Han
- Department of Bariatric & Metabolic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Weijie Liu
- Department of Bariatric & Metabolic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Junfeng Han
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Haoyong Yu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jin Chen
- Department of Computer Science, Institute for Biomedical Informatics, University of Kentucky, Lexington, KY, United States
| | - Pin Zhang
- Department of Bariatric & Metabolic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jianzhong Di
- Department of Bariatric & Metabolic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Moon RC, Bornstein A, Teixeira AF, Jawad MA. Short-term results of long biliopancreatic limb Roux-en-Y gastric bypass-is it superior? Surg Obes Relat Dis 2019; 16:492-496. [PMID: 31987734 DOI: 10.1016/j.soard.2019.12.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/06/2019] [Accepted: 12/17/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To compare the short-term safety and effectiveness of long biliopancreatic limb Roux-en-Y gastric bypass (RYGB) to that of regular RYGB. SETTING Academic hospital, United States. METHODS A retrospective chart review was performed on 89 consecutive patients who underwent RYGB between February 4, 2014 and March 12, 2015. Of these, 43 underwent long biliopancreatic limb RYGB (150 versus 60 cm, with 100-cm Roux limb). RESULTS Baseline characteristics including sex, preoperative body mass index, and co-morbidities were similar between the long- and regular-limb RYGB patients. Long-limb patients were older than regular-limb patients. The median length of hospital stay was similar (2 d for both groups). In the long-limb RYGB group, the mean percentage of excess body mass index loss was 50.3%, 71.4%, 75.8%, and 80.5% at 6, 12, 24, and 36 months after the procedure, respectively. In the regular-limb RYGB group, the mean excess body mass index loss was 51.8%, 71.7%, 69.3%, and 68.5% during the same follow-up period. No significant difference in weight loss was observed between the 2 groups at any time point. Two patients in each group required 30-day readmission (4.7% and 4.3%). Two patients in each group required 30-day reoperation. One death occurred in the regular limb group due to a cerebrovascular accident after discharge. CONCLUSIONS Short-term results show that long biliopancreatic limb RYGB was not associated with a more significant weight loss after RYGB. The 2 procedures were similar in 30-day complications.
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Affiliation(s)
- Rena C Moon
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, Orlando, Florida
| | - Aaron Bornstein
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, Orlando, Florida
| | - Andre F Teixeira
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, Orlando, Florida
| | - Muhammad A Jawad
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, Orlando, Florida.
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Pessoa BM, Browning MG, Mazzini GS, Wolfe L, Kaplan A, Khoraki J, Campos GM. Factors Mediating Type 2 Diabetes Remission and Relapse after Gastric Bypass Surgery. J Am Coll Surg 2019; 230:7-16. [PMID: 31672669 DOI: 10.1016/j.jamcollsurg.2019.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/19/2019] [Accepted: 09/16/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Defining factors associated with remission and relapse of type 2 diabetes (T2D) after Roux-en-Y gastric bypass (RYGB) can allow targeting modifiable factors. We investigated factors associated with T2D remission and relapse after RYGB. STUDY DESIGN We conducted a retrospective review of consecutive patients with T2D who underwent RYGB between 1993 and 2017. T2D remission was defined as medication discontinuation and/or hemoglobin A1c <6.5%. Relapse was defined as recurrence medication use and/or hemoglobin A1c ≥6.5%. Independent correlates of T2D remission and relapse were identified using logistic regression. RESULTS Six hundred and twenty-one patients (aged 46.7 ± 10.6 years; 30% on insulin; BMI 49.8 ± 8.3 kg/m2) had at least 1-year follow-up. Median follow-up was 4.9 years (range 1 to 23.6 years). Prevalence of T2D remission was 74% at 1 year, 73% from 1 to 3 years, 63% between 3 and 10 years, and 47% beyond 10 years. Ninety-three percent of remissions occurred within 3 years of RYGB, 25% relapsed. Median time to relapse was 5.3 years (interquartile range 3 to 7.8 years) after remission. Higher 1-year percentage total body weight loss, lack of preoperative insulin use, and younger age at operation were independently associated with T2D remission. Preoperative insulin use, lower percentage total body weight loss at 1 year, and greater percentage total body weight regain after 1 year were independently associated with T2D relapse. CONCLUSIONS This longitudinal retrospective analysis shows that preoperative insulin use and age, 1-year weight loss, and regain after that influence T2D remission and relapse after RYGB. Referring patients at a younger age, before insulin is needed, and optimizing weight loss and preventing weight regain after RYGB can improve the rates and durability of T2D remission.
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Affiliation(s)
- Bernardo M Pessoa
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - Matthew G Browning
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - Guilherme S Mazzini
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - Luke Wolfe
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - Amy Kaplan
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - Jad Khoraki
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - Guilherme M Campos
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA.
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An Extended Pouch in a Roux-En-Y Gastric Bypass Reduces Weight Regain: 3-Year Results of a Randomized Controlled Trial. Obes Surg 2019; 30:3-10. [PMID: 31444776 DOI: 10.1007/s11695-019-04156-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although the Roux-en-Y gastric bypass (RYGB) is considered a standard procedure, many variations exist in the basic design. In order to achieve more pronounced and sustainable results after RYGB, factors such as diameter of the gastroenterostomy, limb length, and pouch size are gripping points for improvement of design. Extending the pouch could improve results by altering food passage through the pouch. OBJECTIVE The aim of this randomized controlled trial was to evaluate the effect of an extended pouch RYGB (EP-GB) and standard pouch RYGB (S-GB). METHODS In total, 132 patients were randomized in two groups: 68 patients received an EP-GB (pouch length 10 cm) and 64 a S-GB (pouch length 5 cm). Subsequently, weight loss, remission of comorbidities, nutritional status, complications, quality of life, and GERD-symptoms were assessed during a follow-up of 3 years. RESULTS During the first 2 years of follow-up, no significant differences in terms of weight loss were observed. In the third year of follow-up, the S-GB group regained 3 kg, while in the EP-GB group no weight regain was observed. The mean TBWL after 36 months in the EP-GB group was 31% versus 27% in the S-GB group (p = 0.023). Additionally, besides a better remission rate of hypertension in the EP-GB group, no differences in complications, quality of life, and GERD-symptoms were found. CONCLUSION Creation of an extended gastric pouch is a safe and effective modification in RYGB design. An EP-GB improves mid-term weight loss, potentially driven by a lower occurrence of weight regain.
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Nimeri A. Comment on: Surgical therapy of weight regain following Roux-en-Y gastric bypass. Surg Obes Relat Dis 2019; 15:1729-1730. [PMID: 31427222 DOI: 10.1016/j.soard.2019.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 07/08/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Abdelrahman Nimeri
- Division of Bariatric Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
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Soong TC, Almalki OM, Lee WJ, Ser KH, Chen JC, Wu CC, Chen SC. Measuring the small bowel length may decrease the incidence of malnutrition after laparoscopic one-anastomosis gastric bypass with tailored bypass limb. Surg Obes Relat Dis 2019; 15:1712-1718. [PMID: 31558409 DOI: 10.1016/j.soard.2019.08.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/07/2019] [Accepted: 08/09/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic one (single)-anastomosis gastric bypass (OAGB) is an effective and durable treatment for morbidly obese patients. However, the ideal length of the small bowel bypass remains controversial. OBJECTIVES The study aimed to report the clinical results of using a tailored bypass based on the total length of the small bowel. SETTING Academic medical center. METHODS Since 2005, we have performed OAGB with tailored limb according to preoperative body mass index. From July 2014, we modified our technique, measuring the whole small bowel length to keep the common channel at least 400-cm long. Data from 470 patients treated with the new technique (Group II) were compared with those of a matched group treated with tailored bypass only (Group I). The preoperative clinical data and outcomes were analyzed. All clinical data were prospectively collected and stored. RESULTS Both groups had similar clinical profiles at baseline. All procedures were completed laparoscopically. Group II had a significant longer operation time (161.9 versus 122.6 min; P < .001), but shorter hospital stay (2.9 versus 5.3 d; P < .001) and lower complication rate (.2% versus 1.5%; P = .002) than Group I. One year after surgery, the mean body mass index (27.4 versus 26.8 kg/m2; P = .244), percent total weight loss (32.0% versus 34.0%; P = .877), and diabetes remission rate (84.7% versus 84.1%; P = .876) were comparable between the 2 groups. However, Group II patients had a significantly lower incidence of anemia (5.9% versus 11.1%; P < .001), secondary hyperparathyroidism (21.7% versus 33.8%; P < .001) and hypoalbuminemia (1.5% versus 2.8%; P < .001) than did Group I. CONCLUSION Routine measurement of the whole bowel length to keep the common channel at least 400-cm long may reduce the incidence of malnutrition after OAGB with tailored limb bypass, without compromising efficacy in weight loss and diabetes resolution.
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Affiliation(s)
- Tien-Chou Soong
- Center for Weight Loss and Health Management, E-DA Dachang Hospital, Kaohsiung, Taiwan; Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Owaid M Almalki
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan; Department of Surgery, College of Medicine, Taif University, Saudi Arabia
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan.
| | - Kong-Han Ser
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Jung-Chien Chen
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Chun-Chi Wu
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Shu-Chun Chen
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan
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48
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The importance of the biliopancreatic limb length in gastric bypass: A systematic review. Surg Obes Relat Dis 2018; 15:43-49. [PMID: 30501957 DOI: 10.1016/j.soard.2018.10.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/26/2018] [Accepted: 10/15/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Bariatric surgery has proven to be the most durable treatment for obesity, and it also provides improvement of obesity's associated co-morbidities. Although several mechanisms for its metabolic effects have been studied, the implications of the surgically constructed anatomy on its functioning physiology have not been elucidated. This leaves some uncertainty regarding the recommended limb lengths in Roux-en-Y gastric bypass. The alimentary limb length and function has been studied extensively, but few have studied the influences of the biliopancreatic limb length. OBJECTIVE To present a systematic review of the literature comparing variations in length of BP limb and results in order to determine BP limb length influence. SETTING Academic Hospital, United States. METHODS We present a systematic review of all the articles comparing variations of the biliopancreatic limb length and their results. RESULTS Thirteen articles were identified and analyzed. Most of the articles are prospective studies. Weight loss was superior in longer limbs. CONCLUSION Based on our review of the subject, we can conclude that the release of enterohormones in response to a food load in the distal small bowel seems to play an important role in the remission of co-morbidities. Hence, the length of the biliopancreatic limb might affect this process.
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