1
|
Ivano VK, Hatto M, Teramoto F, Macedo PRAD, Gestic MA, Utrini MP, Chaim FDM, Ramos AC, Callejas-Neto F, Chaim EA, Cazzo E. Effects of bariatric surgery on renal function: a retrospective cohort study comparing one-year outcomes between one-anastomosis gastric bypass and Roux-en-Y gastric bypass. SAO PAULO MED J 2024; 142:e2023161. [PMID: 38836818 DOI: 10.1590/1516-3180.2023.0161.r1.08022024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 02/08/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Evidence on the effect of one-anastomosis gastric bypass (OAGB) on renal function is limited. OBJECTIVE To compare the evolution of estimated renal function observed 1 year after OAGB and Roux-en-Y gastric bypass (RYGB) in individuals with obesity. DESIGN AND SETTING Observational, analytical, and retrospective cohort study. Tertiary-level university hospital. METHODS This study used a prospectively collected database of individuals who consecutively underwent bariatric surgery. Renal function was assessed by calculating the estimated glomerular filtration rate (eGFR), according to the Chronic Kidney Disease Epidemiology Collaboration. The one-year variation in the eGFR was compared between the procedures. RESULTS No significant differences in age, sex, obesity-associated conditions, or body mass index were observed among individuals who underwent either OAGB or RYGB. OAGB led to a significantly higher percentage of total (P = 0.007) and excess weight loss (P = 0.026). Both OAGB and RYGB led to significantly higher values of eGFR (103.9 ± 22 versus 116.1 ± 13.3; P = 0.007, and 102.4 ± 19 versus 113.2 ± 13.3; P < 0.001, respectively). The one-year variation in eGFR was 11 ± 16.2% after OAGB and 16.7 ± 26.3% after RYGB (P = 0.3). Younger age and lower baseline eGFR were independently associated with greater postoperative improvement in renal function (P < 0.001). CONCLUSION Compared with RYGB, OAGB led to an equivalent improvement in renal function 1 year after the procedure, along with greater weight loss.
Collapse
Affiliation(s)
- Victor Kenzo Ivano
- MD. Postgraduate Student, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Marcelo Hatto
- MD. Postgraduate Student, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Fernanda Teramoto
- MD. Medical Resident, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Paolla Ravida Alves de Macedo
- MD. Medical Resident, Department of Surgery School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Martinho Antonio Gestic
- MD, MSc. Assistant lecturer, Department of Surgery, School of Medical Sciences, Universidade State University of Campinas (UNICAMP), Campinas (SP), Brazil
| | - Murillo Pimentel Utrini
- MD. Assistant Lecturer, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Felipe David Mendonça Chaim
- MD, PhD. Assistant Lecturer, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Almino Cardoso Ramos
- MD, PhD. Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Francisco Callejas-Neto
- MD, MSc. Assistant Professor, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Elinton Adami Chaim
- MD, PhD. Full Professor, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Everton Cazzo
- MD, PhD. Associate Professor, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| |
Collapse
|
2
|
Karabacak U, Mollaoglu MC, Seven TE, Karadayi K. Gastric pouch cancer after mini gastric bypass surgery: The first case report. J Cancer Res Ther 2024; 20:472-475. [PMID: 38554368 DOI: 10.4103/jcrt.jcrt_1749_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/10/2022] [Indexed: 01/05/2023]
Abstract
Development of gastric cancer following bariatric surgery is very rare. Nearly all patients with cancer after mini gastric bypass/one anastomosis gastric bypass have carcinoma in their remnant stomach. This is the first case with the development of gastric cancer in the gastric pouch following mini gastric bypass surgery. Our case was a 32-year-old woman who was admitted to our department with oral intolerance 5 years after mini gastric bypass. In her endoscopic examination, an ulcerovegetan mass in the gastric pouch (Siewert type III) was detected. The pathological examination of the biopsies was reported as low differentiated adenocarcinoma. Clinical staging was performed using Positron emission tomographycomputed tomography (PET-CT) and endoscopic ultrasonography (T3N1M0). Following four cycles of neoadjuvant chemotherapy, en-bloc total gastrectomy, D2 lymph node dissection, and partial small intestine resection were performed. In pathological evaluation, no tumors were detected in the specimen and a total of 38 lymph nodes were dissected. This finding was accepted as a pathologic complete response. Signs and symptoms such as anemia, oral intolerance, and vomiting that develop after bariatric surgery can often be attributed to the surgical procedure performed, but it should be kept in mind that similar symptoms may also be associated with malignancy. In case of clinical suspicion, endoscopic examination and cross-sectional imaging should be performed.
Collapse
Affiliation(s)
- Ufuk Karabacak
- Department of Surgical Oncology, Numune Hospital, Sivas, Turkey
| | | | - Turan Eray Seven
- Department of Surgical Oncology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Kursat Karadayi
- Department of Surgical Oncology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| |
Collapse
|
3
|
Genco A, Castagneto-Gissey L, Gualtieri L, Lucchese M, Leuratti L, Soricelli E, Casella G. GORD and Barrett's oesophagus after bariatric procedures: multicentre prospective study. Br J Surg 2021; 108:1498-1505. [PMID: 34738106 DOI: 10.1093/bjs/znab330] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/25/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Gastro-oesophageal reflux disease (GORD) after bariatric surgery is a debated topic. This study investigated the prevalence of GORD and associated oesophageal complications following bariatric procedures-namely, adjustable gastric banding (AGB), sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one-anastomosis gastric bypass (OAGB). METHODS This was a prospective multicentre study designed to evaluate the long-term effects of bariatric surgery on GORD. Patients were studied at baseline, at >10 years following AGB, SG, and RYGB, and at >3 years following OAGB (due to the more recent recognition of OAGB as a standard bariatric procedure). Patients were assessed by endoscopy and GORD symptom evaluation. RESULTS A total of 241 patients were enrolled. A minimum follow-up of 10 years was completed by 193 patients following AGB (57 patients), SG (95 patients), and RYGB (41 patients), and of >3 years by 48 subjects following OAGB. GORD symptoms increased following AGB and SG (from 14 to 31.6 per cent and from 26.3 to 58.9 per cent, respectively; P < 0.0001), improved following RYGB (from 36.6 to 14.6 per cent; P < 0.0001), and were unchanged following OAGB. The overall prevalence of erosive oesophagitis was greater in the SG group (74.7 per cent) than in the AGB (42.1 per cent), RYGB (22 per cent), and OAGB (22.9 per cent) groups (P < 0.0001). Barrett's oesophagus was found only in patients who had SG (16.8 per cent). Biliary-like gastric stagnation was found in a greater proportion of SG and OAGB patients (79.7 and 69.4 per cent, respectively) than in other treatment groups (P < 0.0001). The prevalence of biliary-type reflux into the oesophagus was higher in patients who underwent SG (74.7 per cent), compared with other treatment groups. CONCLUSION Bariatric surgery leads to gastro-oesophageal complications of variable severity, particularly SG, which can result in a large proportion of patients developing Barrett's oesophagus.
Collapse
Affiliation(s)
- Alfredo Genco
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Loredana Gualtieri
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Marcello Lucchese
- Department of Surgery, Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, Florence, Italy
| | - Luca Leuratti
- Department of Surgery, Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, Florence, Italy
| | - Emanuele Soricelli
- Department of Surgery, Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, Florence, Italy
| | - Giovanni Casella
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
4
|
Network Meta-Analysis of Metabolic Surgery Procedures for the Treatment of Obesity and Diabetes. Obes Surg 2021; 31:4528-4541. [PMID: 34363144 PMCID: PMC8346344 DOI: 10.1007/s11695-021-05643-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 12/11/2022]
Abstract
Background Metabolic surgery is part of a well-established treatment intensification strategy for obesity and its related comorbidities including type 2 diabetes (T2DM). Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and one-anastomosis gastric bypass (OAGB) are the most commonly performed metabolic surgeries worldwide, but comparative efficacy is uncertain. This study employed network meta-analysis to compare weight loss, T2DM remission and perioperative complications in adults between RYGB, SG and OAGB. Methods MEDLINE, EMBASE, trial registries were searched for randomised trials comparing RYGB, SG and OAGB. Study outcomes were excess weight loss (at 1, 2 and 3–5 years), trial-defined T2DM remission at any time point and perioperative complications. Results Twenty randomised controlled trials were included involving 1803 patients investigating the three metabolic surgical interventions. RYGB was the index for comparison. The excess weight loss (EWL) demonstrated minor differences at 1 and 2 years, but no differences between interventions at 3–5 years. T2DM remission was more likely to occur with either RYGB or OAGB when compared to SG. Perioperative complications were higher with RYGB when compared to either SG or OAGB. Two-way analysis of EWL and T2DM remission against the risk of perioperative complications demonstrated OAGB was the most positive on this assessment at all time points. Conclusion OAGB offers comparable metabolic control through weight loss and T2DM remission to RYGB and SG whilst minimising perioperative complications. Registration number: CRD42020199779 (https:// www.crd.york.ac.uk/PROSPERO) Graphical abstract ![]()
Collapse
|
5
|
Sohrabi Maralani M, Azadnajafabad S, Elyasinia F, Abolhasani M, Bagheri M, Kor F, Ashrafi A, Talebpour M. Postoperative Outcomes and Advantages of Hand-Sewn Laparoscopic One-Anastomosis Gastric Bypass: Experience on 805 Patients. Obes Surg 2021; 31:627-633. [PMID: 33047292 DOI: 10.1007/s11695-020-04981-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE One-anastomosis gastric bypass (OAGB) is a novel laparoscopic approach. The anastomosis of OAGB can be sewn either with a stapler or manually. The aim of this study is to determine the outcome of hand-sewn OAGB. MATERIALS AND METHODS A total of 805 consecutive patients were retrospectively enrolled in this study. Data collection included change in weight, body mass index (BMI), symptoms, and complications before surgery and continued during annual follow-up visits up to 5 years. Inclusion criteria were patients with a BMI of higher than 40 kg/m2 or higher than 35 kg/m2 with one severe comorbidity. Patients with BMI > 50 kg/m2 were referred to dieticians. RESULTS The follow-up rate ranged from 93 to 50% at the 1-year and 5-year visits after surgery, respectively. Mean weight and BMI of patients before surgery were 121.93 kg (± 22.92) and 44.79 kg/m2 (± 6.07), respectively. Mean of annual BMI in 5 years of follow-up were 27.83, 27.26, 28.90, 29.45, and 29.56 kg/m2. Excess weight loss (EWL) in 5 years of follow-up were 85.7%, 89.5%, 78.9%, 77.7%, and 76.0%. Reflux was present in 202 patients (25.1%) before surgery and resolved in 153 cases (75.7%) 1 year after surgery. Procedure-specific early complication was an anastomosis leak in one patient, which led to death. Two cases of malnutrition necessitating reversal and two severe reflux disorders leading to Roux-en-Y bypass surgery were remarkable late complications. CONCLUSION Hand-sewn anastomosis could represent an efficient and safe technique in the management of patients undergoing OAGB surgery with acceptable outcomes and rare adverse complications.
Collapse
Affiliation(s)
- Mehran Sohrabi Maralani
- Department of Surgery, Laparoscopic Ward, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Azadnajafabad
- Department of Surgery, Laparoscopic Ward, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fezzeh Elyasinia
- Department of Surgery, Laparoscopic Ward, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Abolhasani
- Primary Prevention of Cardiovascular Diseases Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadjavad Bagheri
- Department of Surgery, Laparoscopic Ward, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Kor
- Department of Surgery, Laparoscopic Ward, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Ashrafi
- Department of Surgery, Laparoscopic Ward, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Talebpour
- Department of Surgery, Laparoscopic Ward, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
6
|
Musella M, Vitiello A, Berardi G, Velotti N, Pesce M, Sarnelli G. Evaluation of reflux following sleeve gastrectomy and one anastomosis gastric bypass: 1-year results from a randomized open-label controlled trial. Surg Endosc 2020; 35:6777-6785. [PMID: 33269429 PMCID: PMC8599401 DOI: 10.1007/s00464-020-08182-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 11/17/2020] [Indexed: 02/07/2023]
Abstract
Background Recent reports have demonstrated that de novo reflux and worsening of pre-existing symptoms occur after SG; concerns are still expressed about the risk of symptomatic biliary reflux gastritis and oesophagitis. The aim of our study was to investigate and compare the rate of postoperative acid and non-acid reflux following Mini-/One anastomosis gastric bypass (MGB/OAGB) and laparoscopic sleeve gastrectomy (LSG). Study design A prospective randomized open-label, controlled trial registered on clinicaltrial.gov (NCT number: NCT02987673) has been carried out to evaluate esophagogastric junction exposure to reflux in the first year after MGB/OAGB and LSG using high impedance manometry, endoscopy, and a validated questionnaire. Results A total of 58 individuals were eventually enrolled in this trial and represented the per-protocol population (n = 28 MGB/OAGB, n = 30 LSG). No difference was found between the two groups in terms of demographic characteristics, PAGI-SYM score, acid exposure time percent of the esophagus (AET%), esophagitis, and other HRiM and MII-pH data at baseline. Comparing MII-pH outcomes of the two groups, AET% resulted significantly higher after LSG at 12 months. Endoscopic findings showed a significant increase of esophagitis ≥ B in the LSG group after 1 year; postoperative esophagitis ≥ B resulted also significantly worsened after LSG when compared to MGB/OAGB. Conclusion Since AET% and rate of esophagitis are significantly higher after LSG when compared to MGB/OAGB, this procedure should be preferred in case of preoperative subclinical reflux or low grade (A) esophagitis.
Collapse
Affiliation(s)
- Mario Musella
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II” - Via S. Pansini 5, 80131 Naples, Italy
| | - Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II” - Via S. Pansini 5, 80131 Naples, Italy
| | - Giovanna Berardi
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II” - Via S. Pansini 5, 80131 Naples, Italy
| | - Nunzio Velotti
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II” - Via S. Pansini 5, 80131 Naples, Italy
| | - Marcella Pesce
- Clinical Medicine and Surgery Department, Naples “Federico II” University, AOU “Federico II” - Via S. Pansini 5, 80131 Naples, Italy
| | - Giovanni Sarnelli
- Clinical Medicine and Surgery Department, Naples “Federico II” University, AOU “Federico II” - Via S. Pansini 5, 80131 Naples, Italy
| |
Collapse
|