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Barajas-Gamboa JS, Duran V, Romero-Velez G, Mocanu V, Lee Y, Corcelles R, Allemang M, Strong AT, Navarrete S, Rodriguez J, Kroh M, Dang JT. Prevalence, Indications, and Complications of Conversional Surgery After Vertical Banded Gastroplasty: A MBSAQIP Analysis. Obes Surg 2024; 34:2411-2419. [PMID: 38858296 DOI: 10.1007/s11695-024-07353-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 06/04/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE Vertical banded gastroplasty (VBG) was once the most popular bariatric procedure in the 1980's, with many patients subsequently requiring conversional surgery. However, knowledge regarding the prevalence and outcomes of these procedures remains limited. This study aims to determine the prevalence, indications, rate of 30-day serious complications, and mortality of conversional surgery after VBG. MATERIALS AND METHODS A retrospective analysis of the MBSAQIP database from 2020 to 2022 was conducted. Individuals undergoing conversional or revisional surgery after VBG were included. The primary outcomes were 30-day serious complications and mortality. RESULTS Of 716 VBG conversions, the common procedures included 660 (92.1%) Roux-en-Y gastric bypass (RYGB) and 56 (7.9%) sleeve gastrectomy (SG). The main indication for conversion was weight gain for RYGB (31.0%) and for SG (41.0%). RYGB had longer operative times than SG (223.7 vs 130.5 min, p < 0.001). Although not statistically significant, serious complications were higher after RYGB (14.7% vs 8.9%, p = 0.2). Leak rates were higher after SG (5.4 vs 3.5%) but this was not statistically significant (p = 0.4). Mortality was similar between RYGB and SG (1.2 vs 1.8%, p = 0.7). Multivariable regression showed higher body mass index, longer operative time, previous cardiac surgery and black race were independently associated with serious complications. Conversion to RYGB was not predictive of serious complications compared to SG (OR 0.96, 95%CI 0.34-2.67, p = 0.9). CONCLUSIONS Conversional surgery after VBG is uncommon, and the rate of complications and mortality remains high. Patients should be thoroughly evaluated and informed about these risks before undergoing conversion from VBG.
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Affiliation(s)
- Juan S Barajas-Gamboa
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Valentina Duran
- Experimental Surgery and Simulation Center, Catholic University of Chile, Santiago, Chile
| | - Gustavo Romero-Velez
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Valentin Mocanu
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Yung Lee
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Ricard Corcelles
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Matthew Allemang
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Andrew T Strong
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Salvador Navarrete
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - John Rodriguez
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Matthew Kroh
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Jerry T Dang
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
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Attar HM, Najjar AG, Gadah AM, Almaghrabi AH, Batayyah ES, Sultan NA. Gastric mucocele after conversion of open butterfly gastroplasty to Roux-En-Y gastric bypass - A case report with a review of the literature. Int J Surg Case Rep 2024; 118:109561. [PMID: 38579597 PMCID: PMC11004865 DOI: 10.1016/j.ijscr.2024.109561] [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: 02/01/2024] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION There has been a significant increase in the prevalence of morbid obesity across the globe. Various non-surgical weight loss options have shown limited long-term efficacy, leading to the popularity of surgical treatment alternatives with long-term efficacy. PRESENTATION OF CASE This case report describes the development of a gastric mucocele in a 51-year-old female patient. The patient initially underwent open butterfly gastroplasty in August 2016. Seven years later, she presented with severe symptoms of gastroesophageal reflux disease (GERD). After further diagnostic evaluations, laparoscopic Roux-en-Y bypass surgery was performed. However, the patient experienced complications including fever, abdominal pain, and fluid collection around the stomach. Conservative management initially helped, but persistent symptoms led to laparoscopic exploration, which revealed a distended remnant stomach forming a gastric mucocele. Severe adhesions hindered attempts to remove the remnant stomach, resulting in the need for gastro-gastric anastomosis. Following the surgery, the patient had no symptoms, could eat solid food, and was discharged in good condition. DISCUSSION Although various non-surgical weight loss options such as diet modifications, lifestyle changes, and drug therapy have been used for weight loss, they have demonstrated limited long-term efficacy. Surgical treatment has demonstrated long-term efficacy in such patient groups. In recent years, there has been an increased popularity of Roux-en-Y gastric bypass (RYGBP) due to long-term weight loss. However, in some cases, complications have also been reported. CONCLUSION This case emphasizes the challenges in managing complications from open butterfly gastroplasty and Roux-en-Y gastric bypass. Surgeons should be aware of the possibility of gastric mucocele development and consider appropriate management strategies.
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Affiliation(s)
| | - Abrar Ghazi Najjar
- General Surgery Department, Alnoor Specialist Hospital, Mecca, Saudi Arabia.
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Scott AW, Amateau SK, Leslie DB, Ikramuddin S, Wise ES. Rates and Risk Factors for 30-Day Morbidity After One-Stage Vertical Banded Gastroplasty Conversions: A Retrospective Analysis. Am Surg 2024:31348241248817. [PMID: 38641431 DOI: 10.1177/00031348241248817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Background: The vertical banded gastroplasty (VBG) is a historic restrictive bariatric operation often requiring further surgery. In this investigation utilizing the 2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) national dataset, we aim to better define the outcomes of VBG conversions.Methods: We queried the 2021 MBSAQIP dataset for patients who underwent a conversion from a VBG to Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Demographics, comorbidities, laboratory values, and additional patient factors were examined. Rates of key consequential outcome measures 30-day readmission, reoperation, reintervention, mortality, and a composite endpoint (at least 1 of the 4) were further calculated.Results: We identified 231 patients who underwent conversion from VBG to SG (n = 23), RYGB (n = 208), or other anatomy (n = 6), of which 93% of patients were female, and 22% of non-white race. The median age was 56 years and body-mass index (BMI) was 43 kg/m2. The most common surgical indications included weight considerations (48%), reflux (25%), anatomic causes (eg, stricture, fistula, and ulcer; 10%), and dysphagia (6.5%). Thirty-day morbidity rates included reoperation (7.8%), readmission (9.1%), reintervention (4.3%), mortality (.4%), and the composite endpoint (15%). Upon bivariate analysis, we did not identify any specific risk factor for the 30-day composite endpoint.Discussion: One-stage VBG conversions to traditional bariatric anatomy are beset with higher 30-day morbidity relative to primary procedures. Additional MBSAQIP data will be required for aggregation, to better characterize the risk factors inherent in these operations.
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Affiliation(s)
- Adam W Scott
- School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Stuart K Amateau
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Daniel B Leslie
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Sayeed Ikramuddin
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Eric S Wise
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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van Dam KAM, Jense MTF, de Witte E, Fransen S, Boerma EJG, Greve JWM. Laparoscopic Conversion of Vertical Banded Gastroplasty to Roux-en-Y Gastric Bypass Gives Better Result Compared to an Open Approach. Obes Surg 2023:10.1007/s11695-023-06574-7. [PMID: 37043139 DOI: 10.1007/s11695-023-06574-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Vertical banded gastroplasty (VBG) has a relatively high failure rate in the long run, requiring revisional surgery in 30-65%. A common conversion option is to Roux-en-Y gastric bypass (RYGB), which can be performed laparoscopically or open. Current literature contains small cohorts and inconclusive results. Therefore, we set out to compare our series of open and laparoscopic VBG to RYGB conversions. METHODS All conversions performed between 1996 and 2020 were included. Patients were divided into 3 groups based on conversion indication: weight recurrence (group 1), excessive weight loss (group 2), and eating/pouch difficulties (group 3). The primary outcome was postoperative complications according to the Clavien-Dindo (CD) classification. Secondary outcome was %total weight loss (%TWL) 1 to 5 years after revisional surgery. RESULTS We included 205 patients (84.9% female) of whom 105 underwent laparoscopic and 100 open VBG to RYGB conversion. Twenty-three short-term complications occurred in the laparoscopic group, with 16 > CD3a. In the open group, 33 complications occurred with 12 > CD3a. Overall complications were 33.3% in laparoscopic and 64% in open patients. There were no significant differences between the laparoscopic and open group in BMI (p = 0.76) and %TWL (p = 0.694) after 5 years. After 5 years, lost to follow-up was 97% in the open group. Twenty-eight percent of patients who reached follow-up in the laparoscopic group had available data. CONCLUSIONS We demonstrate that the overall complication rate is lower in the laparoscopic group compared to the open group. Regarding BMI, an improvement was achieved in both groups after 5 years.
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Affiliation(s)
- Kayleigh A M van Dam
- Bariatric Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419, PC, Heerlen, The Netherlands.
| | - Marijn T F Jense
- Bariatric Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419, PC, Heerlen, The Netherlands
- Dutch Obesity Clinic South, John F, Kennedylaan 301, 6419, XZ, Heerlen, The Netherlands
| | - Evelien de Witte
- Bariatric Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419, PC, Heerlen, The Netherlands
- Dutch Obesity Clinic South, John F, Kennedylaan 301, 6419, XZ, Heerlen, The Netherlands
| | - Sofie Fransen
- Dutch Obesity Clinic South, John F, Kennedylaan 301, 6419, XZ, Heerlen, The Netherlands
| | - Evert-Jan G Boerma
- Bariatric Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419, PC, Heerlen, The Netherlands
- Dutch Obesity Clinic South, John F, Kennedylaan 301, 6419, XZ, Heerlen, The Netherlands
| | - Jan Willem M Greve
- Bariatric Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419, PC, Heerlen, The Netherlands
- Dutch Obesity Clinic South, John F, Kennedylaan 301, 6419, XZ, Heerlen, The Netherlands
- NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
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How I Do It: a Staged Approach to Reverse Vertical Banded Gastroplasty Utilizing Endoscopy. J Gastrointest Surg 2023; 27:457-459. [PMID: 36604375 DOI: 10.1007/s11605-022-05569-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 12/09/2022] [Indexed: 01/07/2023]
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Bariatric Surgery Conversions in MBSAQIP Centers: Current Indications and Outcomes. Obes Surg 2022; 32:3248-3256. [PMID: 35918597 DOI: 10.1007/s11695-022-06229-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/19/2022] [Accepted: 07/24/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND The demand for revisional bariatric surgery has increased, and bariatric conversions (BC) to a different procedure represent most of the revisional cases. The 2020 Metabolic and Bariatric Surgery Accreditfnation and Quality Improvement Program (MBSAQIP) database was expanded to include additional variables on BC. This study aims to analyze the indications and outcomes of BC. METHODS A retrospective analysis of the 2020 MBSAQIP database was performed. Patients who underwent BC were included in the analysis. Index procedures, rates, and indications for BC of the different bariatric operations were described. Outcomes of the most frequent BC were analyzed. RESULTS A total of 168,548 bariatric surgeries were done; 20,387 (12.1%) were revisional, and from those 15,031 (73.7%) were BC. The most converted index operations were sleeve gastrectomy (SG) (49.3%) and adjustable gastric banding (AGB) (45.9%). The most frequent conversions were SG to Roux-en-Y gastric bypass (RYGB) (40.3%) for gastroesophageal reflux disease (GERD) (54.2%) and weight loss failure (WLF) (35.8%), AGB to SG (27%) or RYGB (16.2%) for WLF (67% and 61.3%, respectively), and SG to biliopancreatic diversion with duodenal switch (3.2%) or single anastomosis duodeno-ileal bypass (2%) for WLF (91.2% and 92.4%, respectively). Postoperative overall morbidity, serious morbidity, reoperation, and mortality rates ranged from 5.3 to 20.8%, 2.3 to 19.2%, 1.5 to 10%, and 0 to 0.8%, respectively. CONCLUSIONS BC represents the most frequent revisional bariatric procedure. GERD and WLF are the main causes for BC. Further research is needed to define the ideal BC according to the index procedure and indication.
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Mirhashemi SH, Hakakzadeh A, Fateh A. Severe malnutrition after single anastomosis sleeve jejunal bypass (SASJ) surgery due to a rare surgical complication: Report of the case. Int J Surg Case Rep 2022; 92:106824. [PMID: 35176582 PMCID: PMC8857433 DOI: 10.1016/j.ijscr.2022.106824] [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: 01/22/2022] [Revised: 02/05/2022] [Accepted: 02/10/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Bariatric procedures rates are increased due to the epidemic in obesity. Up to 50% of patients operated with vertical banded gastroplasty (VBG) procedures experience failure or complications in the mid- and long-term and present for revision bariatric surgery. Despite the increase in revisions, their safety and efficacy remain controversial. Case presentation A 44-year-old female patient with severe malnutrition after single anastomosis sleeve jejunal bypass (SASJ) surgery was referred to this center. SASJ was the chosen bariatric procedure for her after the first failed VBG. She was unable to swallow anything. Upper GI endoscopy was done and the laparoscopic prolene mesh used in the first bariatric surgery (VBG) was seen inside the gastric lumen. Total parental nutrition was initiated and continued for 12 days in this medical center and then she was candidate for exploratory laparoscopy. Clinical discussion Using prophylactic preperitoneal Prolene mesh during wound closure in bariatric surgery is safe and effective in preventing incisional hernia development. During the revision bariatric surgeries, surgeons should be careful about the used mesh in the first bariatric surgery. Conclusion Surgeons should be aware of the management of rare surgical complications that might lead to malnutrition which is insidious. Level of evidence V Bariatric surgeries have increased life expectancy and reduced the complications of obesity. Up to 50% of patients operated with vertical banded gastroplasty (VBG) procedures experience failure or complications and present for revision bariatric surgery. During the revision bariatric surgeries, surgeons should be careful about the used mesh in the first bariatric surgery.
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Affiliation(s)
- Seyed Hadi Mirhashemi
- Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Azadeh Hakakzadeh
- Department of Sports and Exercise Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Physiotherapy Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Fateh
- Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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8
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Gholizadeh B, Meimand FE, Maleknia SA, Amr B, Kermansaravi M. Gastric Remnant Mucocele after Conversion of Vertical Band Gastroplasty to One Anastomosis Gastric Bypass: a Video Vignette. Obes Surg 2022; 32:955-956. [PMID: 35043361 DOI: 10.1007/s11695-021-05842-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/09/2021] [Accepted: 12/04/2021] [Indexed: 11/29/2022]
Abstract
Conversional bariatric surgery is a challenging procedure to patients as well as the surgeon. One anastomosis gastric bypass (OAGB) is a known safe conversional procedure after primary restrictive weight loss surgeries such as vertical banded gastroplasty (VBG). A very rare reported complication after these operations is the formation of mucocele of gastric remnant during pouch creation. This is a video report of diagnosis and management of gastric remnant mucocele after conversion of VBG to OAGB.
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Affiliation(s)
- Barmak Gholizadeh
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of General Surgery, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Seyed Adel Maleknia
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of General Surgery, Faculty of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Bassem Amr
- Department of Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
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Nedelcu M, Noel P, Danan M, Vilallonga R, Zulian V, Nedelcu A, Carandina S. Revisional Surgery from Vertical Banded Gastroplasty to Roux-en-Y Gastric Bypass with Gastric Resection. J Laparoendosc Adv Surg Tech A 2021. [PMID: 34935465 DOI: 10.1089/lap.2021.0386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Vertical banded gastroplasty (VBG) was a common bariatric procedure by laparotomy and or at the beginning of the laparoscopy, but nowadays it is almost an abandoned procedure. However, the young generation of bariatric surgeons should be aware about this procedure especially for revisional cases. Roux-en-Y gastric bypass (RYGB) is considered the procedure of choice for the revision of VBG. Materials and Methods: The evolution of revisional surgery to RYGB has known several technical steps. At the beginning, the procedure was performed with no gastric resection. Then a limited resection of the ancient staple line along with the fibrous tissue under the previous band or mesh was performed. The purpose of this article is to describe a simplified operative technique to simultaneously resect the ancient staple line and the calibration band. Results: After the initial viscrerolysis, an attempt to distinguish the course of the ancient section line of the stomach during the VBG is done. The dissection can become extremely challenging, with too much fibrosis and nonanatomical planes of dissection. At this point, we counsel to abandon the anterior direct dissection of the upper part of the stomach and to switch to a posterior dissection with the approach of greater curvature. Driven by the potential advantages (no risk of mucocele or gastrogastric fistula), for the past several years, we have changed the technique from resecting only the ancient staple line to perform a partial gastrectomy. The gastrectomy is larger and includes the complete resection of the gastric fundus, ancient staple line, the region with the mesh inside, and part of the gastric body. Once the stomach is extracted, the subsequent steps are similar to those of a primary RYGB. Conclusion: The procedure of choice for the revision of VBG is represented by RYGBP. Associating an atypical gastrectomy of the previous staple line with the region of mesh migration is a safe approach, eliminating the risk of mucocele.
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Affiliation(s)
- Marius Nedelcu
- Department of General Surgery, Centre Chirurgical de l'Obesite, ELSAN, Clinique Saint Michel, Toulon, France
- Department of General Surgery, Clinique Bouchard, ELSAN, Marseille, France
| | - Patrick Noel
- Department of General Surgery, Clinique Bouchard, ELSAN, Marseille, France
- Department of General Surgery, Emirates Specialty Hospital, Dubai, United Arab Emirates
| | - Marc Danan
- Department of General Surgery, Centre Chirurgical de l'Obesite, ELSAN, Clinique Saint Michel, Toulon, France
| | - Ramon Vilallonga
- Department of General Surgery, Centre Chirurgical de l'Obesite, ELSAN, Clinique Saint Michel, Toulon, France
- Department of General Surgery, Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Hospital Vall d'Hebron, Barcelona, Spain
- Department of General Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Viola Zulian
- Department of General Surgery, Centre Chirurgical de l'Obesite, ELSAN, Clinique Saint Michel, Toulon, France
| | - Anamaria Nedelcu
- Department of General Surgery, Centre Chirurgical de l'Obesite, ELSAN, Clinique Saint Michel, Toulon, France
| | - Sergio Carandina
- Department of General Surgery, Centre Chirurgical de l'Obesite, ELSAN, Clinique Saint Michel, Toulon, France
- Department of Digestive and Bariatric Surgery, Clinica Madonna della Salute, Porto Viro, Italy
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Petrucciani N, Etienne JH, Sebastianelli L, Iannelli A. Roux-en-Y gastric bypass as revisional surgery. Minerva Surg 2021; 76:8-16. [PMID: 33754587 DOI: 10.23736/s2724-5691.20.08493-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Roux-en-Y gastric bypass (RYGB) is a worldwide-performed procedure as primary surgery, and as conversional procedure after complications and/or failure of other bariatric procedures. RYGB can be performed as revisional surgery after adjustable gastric banding, vertical banded gastroplasty, sleeve gastrectomy and one anastomosis gastric bypass. Each of these revisional procedures may be technically challenging, and accurate preoperative work-up and operative planning is required. If correctly performed, RYGB as revisional procedure is associated with satisfying outcomes and is indicated in the treatment of insufficient weight loss and postoperative complications of a primary bariatric procedure - such as chronic leak or gastroesophageal reflux after sleeve gastrectomy. The present article analyzes the most important indications, technical points and tips and tricks to safely perform RYGB as a secondary procedure.
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Affiliation(s)
- Niccolò Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Jean H Etienne
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, Sapienza University, Rome, Italy.,Université Côte d'Azur, Nice, France
| | - Lionel Sebastianelli
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, Sapienza University, Rome, Italy.,Université Côte d'Azur, Nice, France
| | - Antonio Iannelli
- Université Côte d'Azur, Nice, France - .,Unit of Digestive Surgery and Liver Transplantation, University Hospital of Nice, Nice, France.,Inserm U1065, Nice, France
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11
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Facchiano E. Comment on: Revision of vertical banded gastroplasty to Roux-en-Y gastric bypass with fundectomy. Surg Obes Relat Dis 2021; 17:877-878. [PMID: 33750667 DOI: 10.1016/j.soard.2021.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 01/30/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Enrico Facchiano
- Department of Surgery, General and Bariatric Surgery Unit, Santa Maria Nuova Hospital, Florence, Italy
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12
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Denneval A, Chalumeau C, Iceta S, Pelascini E, Disse E, Robert M. Revision of Mason's procedure (vertical banded gastroplasty) to Roux-en-Y gastric bypass: role of an associated fundectomy in weight loss outcomes. Surg Obes Relat Dis 2021; 17:870-877. [PMID: 33549506 DOI: 10.1016/j.soard.2020.12.014] [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: 11/18/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vertical banded gastroplasty (VBG) presents a significant rate of long-term complications, and revisions are often necessary. Conversion to Roux-en-Y gastric bypass (RYGB) seems to be preferred, but literature data remain limited. OBJECTIVES To analyze the indications, safety, results of conversions from VBG to RYGB, and to identify predictive factors of success or failure. SETTING Two specialized centers of bariatric surgery. METHODS This bicentric retrospective study included all the patients who benefited from a conversion from VBG to RYGB between 2008 and January 2020. Demographic characteristics, indications, preoperative workups, intraoperative data, complications, and weight loss results were analyzed. RESULTS During the study period, 85 patients underwent a conversion to RYGB. The mean body mass index (BMI_ before conversion was 40.6 kg/m2. 82.3% of the patients were converted because of weight loss failure and 17.6% because of a complication of their VBG. The global rate of complications was 25%. After an average follow-up of 35 months and a rate of loss to follow-up of 33%, the mean BMI was 33.5 kg/m. The weight loss success rate according to Reinhold's criteria was 64.7%, and resolution of complications was obtained in 89.1%. The association of a fundectomy was a predictive factor of weight loss (odds ratio, .27; P = .04), whereas primary failure of the VBG was a predictive factor of failure. CONCLUSION Conversion from VBG to RYGB remains the procedure of choice to achieve satisfying weight loss and resolution of functional complications. The addition of a fundectomy appeared to have a significant positive impact on weight loss outcomes.
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Affiliation(s)
- Axel Denneval
- Department of Digestive Surgery, Center of Bariatric Surgery, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Department of Endocrinology Diabetology and Nutrition, Centre Intégré et Spécialisé de l'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.
| | - Claire Chalumeau
- Fédération de Chirurgie Viscérale, Centre Hospitalier William Morey, Chalon-sur-Saône, France
| | - Sylvain Iceta
- Department of Endocrinology Diabetology and Nutrition, Centre Intégré et Spécialisé de l'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France; Université Claude Bernard Lyon 1, Lyon, France; Quebec Heart and Lung Institute (IUCPQ), Québec, Canada; School of Nutrition, Laval University, Québec, Canada
| | - Elise Pelascini
- Department of Digestive Surgery, Center of Bariatric Surgery, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Department of Endocrinology Diabetology and Nutrition, Centre Intégré et Spécialisé de l'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Emmanuel Disse
- Department of Endocrinology Diabetology and Nutrition, Centre Intégré et Spécialisé de l'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France; Université Claude Bernard Lyon 1, Lyon, France; Carmen Lab, INSERM Unit 1060, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Maud Robert
- Department of Digestive Surgery, Center of Bariatric Surgery, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Department of Endocrinology Diabetology and Nutrition, Centre Intégré et Spécialisé de l'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France; Université Claude Bernard Lyon 1, Lyon, France; Carmen Lab, INSERM Unit 1060, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
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