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Zhu J. Kill Three Birds with One Stone: Sleeve Reduction, Cruroplasty, Gastropexy, and Concomitant Sleeve Ileal Bypass for Patients with Gastroesophageal Reflux, Constipation, and Weight Regain After Laparoscopic Sleeve Gastrectomy. Obes Surg 2024; 34:1961-1963. [PMID: 38523170 DOI: 10.1007/s11695-024-07186-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 02/16/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Jiangfan Zhu
- Bariatric and Metabolic Surgery Center, The 10th Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, China.
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2
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Lyyjynen HS, Andersen JR, Liem RSL, Mala T, Nienhuijs SW, Ottosson J, Sundbom M, Thorell A, Våge V. Surgical Aspects of Sleeve Gastrectomy Are Related to Weight Loss and Gastro-esophageal Reflux Symptoms. Obes Surg 2024; 34:902-910. [PMID: 38329707 PMCID: PMC10899332 DOI: 10.1007/s11695-023-07018-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/17/2023] [Accepted: 12/17/2023] [Indexed: 02/09/2024]
Abstract
INTRODUCTION A large variation in outcome has been reported after sleeve gastrectomy (SG) across countries and institutions. We aimed to evaluate the effect of surgical technique on total weight loss (TWL) and gastro-esophageal reflux disease (GERD). METHODS Observational cohort study based on data from the national registries for bariatric surgery in the Netherlands, Norway, and Sweden. A retrospective analysis of prospectively obtained data from surgeries during 2015-2017 was performed based on 2-year follow-up. GERD was defined as continuous use of acid-reducing medication. The relationship between TWL, de novo GERD and operation technical variables were analyzed with regression methods. RESULTS A total of 5927 patients were included. The average TWL was 25.6% in Sweden, 28.6% in the Netherlands, and 30.6% in Norway (p < 0.001 pairwise). Bougie size, distance from the resection line to the pylorus and the angle of His differed between hospitals. A minimized sleeve increased the expected total weight loss by 5-10 percentage points. Reducing the distance to the angle of His from 3 to just above 0 cm increased the risk of de novo GERD five-fold (from 3.5 to 17.8%). CONCLUSION Smaller bougie size, a shorter distance to pylorus and to the angle of His were all associated with greater weight loss, whereas a shorter distance to angle of His was associated with more de novo reflux.
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Affiliation(s)
| | - John R Andersen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Centre of Health Research, Førde Hospital Trust, Førde, Norway
| | - Ronald S L Liem
- Department of Surgery, Groene Hart Hospital, Gouda, Netherlands
- Nederlandse Obesitas Kliniek (NOK) in The Hague and Gouda, The Hague and Gouda, Netherlands
| | - Tom Mala
- Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Johan Ottosson
- Department of Surgery, Örebro University Hospital, Örebro, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anders Thorell
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
- Department of Surgery and Anesthesia, Ersta Hospital, Stockholm, Sweden
| | - Villy Våge
- Scandinavian Obesity Surgery Registry, Bergen, Norway
- Centre of Health Research, Førde Hospital Trust, Førde, Norway
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3
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Aiolfi A, Bona D, Lipham JC, Bonavina L. Is Endoscopic Surveillance Needed After Laparoscopic Sleeve Gastrectomy? Curr Obes Rep 2024; 13:183-185. [PMID: 38172480 DOI: 10.1007/s13679-023-00545-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Alberto Aiolfi
- Department of Biomedical Sciences for Health, Division of General Surgery, Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Milan, Italy
| | - Davide Bona
- Department of Biomedical Sciences for Health, Division of General Surgery, Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Milan, Italy
| | - John C Lipham
- Division of Upper GI and General Surgery, Keck Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy.
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Mu SZ, Saber AA. Gastroesophageal Reflux Disease and Weight Loss After Fundoplication Sleeve Gastrectomy: a Systematic Review and Meta-analysis. Obes Surg 2024; 34:318-329. [PMID: 38109011 DOI: 10.1007/s11695-023-06927-2] [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: 08/16/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Fundoplication sleeve gastrectomy (FSG) is a novel bariatric procedure that combines anti-reflux fundoplication with sleeve gastrectomy (SG) to simultaneously address gastroesophageal reflux disease (GERD) and obesity. We performed a systematic review and meta-analysis to quantify the prevalence of postoperative GERD and amount of weight loss after FSG. METHODS We searched PubMed, Embase, and Web of Science Core Collection in May 2023 for full-text reports of case series, registries, cohort studies, and randomized clinical trials that reported postoperative GERD and percent excess weight loss (%EWL) after FSG for patients with preoperative GERD and obesity, excluding reports including patients with previous history of bariatric procedures. We used random effects models to estimate postoperative GERD prevalence and %EWL. Risk of bias and evidence quality were assessed with the ROBINS-I and GRADE frameworks (PROSPERO CRD42023420067). RESULTS Of the 935 records initially identified, 13 studies from 8 countries met our inclusion criteria. The prevalence of postoperative GERD pooled from 418 patients was 4.8% (95% CI: 2.8 to 8.4%). Pooled %EWL, available for 225 patients from 7 studies, was 67.8% (95% CI: 55.2 to 80.5). The overall quality of evidence was low, largely due to observational study design, lack of blinded outcome assessment, and evidence of publication bias. CONCLUSION Fundoplication sleeve gastrectomy is an emerging surgical approach for patients with obesity and GERD with promising initial outcomes. Additional studies of efficacy and safety are needed to compare FSG and its technical variations with other weight loss procedures.
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Affiliation(s)
- Scott Z Mu
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Alan A Saber
- Department of Surgery, Division of Bariatric and Metabolic Surgery, Newark Beth Israel Medical Center, 201 Lyons Ave., F4, Newark, New Jersey, 07112, USA.
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Bonaldi M, Rubicondo C, Andreasi V, Giorgi R, Cesana G, Ciccarese F, Uccelli M, Zanoni A, Villa R, De Carli S, Oldani A, Dokic D, Olmi S. Reply to Letter to the Editor: Role of Preoperative High-Resolution Manometry in the Identification of Patients at High Risk of Postoperative GERD Symptoms 1 Year After Sleeve Gastrectomy. Obes Surg 2023; 33:3309-3310. [PMID: 37632586 DOI: 10.1007/s11695-023-06807-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 08/18/2023] [Accepted: 08/20/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Marta Bonaldi
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Viale Europa 7, 24040, Zingonia, BG, Italy.
| | - Carolina Rubicondo
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Viale Europa 7, 24040, Zingonia, BG, Italy
| | - Valentina Andreasi
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Viale Europa 7, 24040, Zingonia, BG, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Riccardo Giorgi
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Viale Europa 7, 24040, Zingonia, BG, Italy
| | - Giovanni Cesana
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Viale Europa 7, 24040, Zingonia, BG, Italy
| | - Francesca Ciccarese
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Viale Europa 7, 24040, Zingonia, BG, Italy
| | - Matteo Uccelli
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Viale Europa 7, 24040, Zingonia, BG, Italy
| | - Adelinda Zanoni
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Viale Europa 7, 24040, Zingonia, BG, Italy
| | - Roberta Villa
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Viale Europa 7, 24040, Zingonia, BG, Italy
| | - Stefano De Carli
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Viale Europa 7, 24040, Zingonia, BG, Italy
| | - Alberto Oldani
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Viale Europa 7, 24040, Zingonia, BG, Italy
| | - Dusanka Dokic
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Viale Europa 7, 24040, Zingonia, BG, Italy
| | - Stefano Olmi
- Department of General Surgery, Centre of Excellence S.I.C.Ob (Italian Society in Obesity Surgery), Viale Europa 7, 24040, Zingonia, BG, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
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6
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Aiolfi A, Bona D, Ogliari C, Bonitta G, Bonavina L. Letter to the Editor: Role of Preoperative High-Resolution Manometry in the Identification of Patients at High Risk of Postoperative GERD Symptoms 1 Year After Sleeve Gastrectomy. Obes Surg 2023; 33:3307-3308. [PMID: 37610698 DOI: 10.1007/s11695-023-06806-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 07/23/2023] [Accepted: 08/18/2023] [Indexed: 08/24/2023]
Affiliation(s)
- Alberto Aiolfi
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157, Milan, Italy.
| | - Davide Bona
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157, Milan, Italy
| | - Cristina Ogliari
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157, Milan, Italy
| | - Gianluca Bonitta
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157, Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
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Castagneto-Gissey L, Gualtieri L, Diddoro A, Genco A, Casella G. Conversion from Sleeve Gastrectomy to Roux-en-Y Gastric Bypass for Refractory GERD and Barrett's Esophagus. J Gastrointest Surg 2023; 27:1713-1715. [PMID: 37069458 DOI: 10.1007/s11605-023-05678-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/01/2023] [Indexed: 04/19/2023]
Affiliation(s)
- Lidia Castagneto-Gissey
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy.
| | - Loredana Gualtieri
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Annalisa Diddoro
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Alfredo Genco
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Giovanni Casella
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
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8
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Li R, Eskander W, Teixeira AF, Zorron R. Sleeve-Dor Fundoplication - An Innovative Surgical Technique to Avoid the Epidemic Long Term de Novo Gastroesophageal Reflux and Barrett´s Esophagus After Sleeve Gastrectomy for Obesity. Surg Innov 2023; 30:526-528. [PMID: 36413570 DOI: 10.1177/15533506221139967] [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: 08/06/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) in current literature showed an increased risk of "de novo" gastroesophageal reflux disease (GERD) and increased risk for Barrett's esophagus in longer follow-up series, with a possibility of esophageal adenocarcinoma in this population. Adding primarily an anterior Dor Fundoplication to SG (Sleeve-Dor) may protect the patient for future and can potentially avoid these chronic complications for patients with obesity. METHODOLOGY A standard SG is performed laparoscopically, and a small redundance of the fundus is maintained as a wrap, and this will be fixed to the right crura without dissection of the anatomy of the hiatus. The resulted anterior 180° Dor fundoplication is usually sufficient to relieve or to avoid reflux symptomatic. DISCUSSION Based on our preliminary and literature experiences, the SG with anterior Dor fundoplication (Sleeve-Dor) procedure could provide favorable safety profile, satisfactory reflux control and good bariatric outcomes. The complication rate is lower compared to published for Nissen Sleeve or Sleeve-Rossetti technique, with no leaks or major complications recorded to date. Sleeve-Dor procedure may be a potential primary and standard surgery for morbidly obese patients, especially for patients with preoperative GERD symptoms without major findings at endoscopy.
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Affiliation(s)
- Renjie Li
- Center for Bariatric and Metabolic Surgery, Klinikum Ernst von Bergmann, Potsdam, Germany
- Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Wael Eskander
- Center for Bariatric and Metabolic Surgery, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Andre F Teixeira
- Orlando Health Weight Loss and Bariatric Surgery Institute, Orlando, FL, USA
| | - Ricardo Zorron
- Center for Bariatric and Metabolic Surgery, Klinikum Ernst von Bergmann, Potsdam, Germany
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Fehervari M, Banh S, Varma P, Das B, Al-Yaqout K, Al-Sabah S, Khwaja H, Efthimiou E, Ashrafian H. Weight loss specific to indication, remission of diabetes, and short-term complications after sleeve gastrectomy conversion to Roux-en-Y gastric bypass: a systematic review and meta-analysis. Surg Obes Relat Dis 2023; 19:384-395. [PMID: 36581551 DOI: 10.1016/j.soard.2022.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/03/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022]
Abstract
Laparoscopic sleeve gastrectomy (SG) is the most frequently performed bariatric procedure worldwide. Long-term complications such as insufficient weight loss (IWL) and gastroesophageal reflux disease (GERD) may necessitate SG conversion to Roux-en-Y gastric bypass (RYGB). The aim of this review was to determine the indication-specific weight loss and diabetes remission after SG conversion to RYGB (STOBY). Our objective was to extract all available published data on indication for conversion, weight loss, remission of diabetes, and short-term complications after STOBY. A systematic literature search was conducted to identify studies reporting outcomes following STOBY. A random effects model was used for meta-analysis. The search identified 44 relevant studies. Overall short-term (12-mo) excess weight loss (EWL) was 54.6% (95% confidence interval [CI], 46%-63%) in 23 studies (n = 712) and total weight loss (TWL) was 19.9% (95% CI, 14%-25%) in 21 studies (n = 740). For IWL, short-term (12-mo) pooled weight loss outcomes were 53.9% EWL (95% CI, 48%-59%) in 14 studies (n = 295) and 22.7% TWL (95% CI, 17%-28%) in 12 studies (n = 219), and medium-term (2-5 yr) outcomes were 45.8% EWL (95% CI, 38%-53%) in 7 studies (n = 154) and 20.6% TWL (95% CI, 15%-26%) in 9 studies (n = 206). Overall diabetes remission was 53% (95% CI, 33%-72%), and the perioperative complication rate was 8.2% (95% CI, 7.6%-8.7%). Revisional SG conversion to RYGB for IWL can achieve good weight loss outcomes and diabetes remission.
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Affiliation(s)
- Matyas Fehervari
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
| | - Serena Banh
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Piyush Varma
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Bibek Das
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | | | - Haris Khwaja
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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10
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Martínez Caballero J, de la Cruz Vigo F, Gómez Rodríguez P, Hernández García-Gallardo D, Pérez Zapata AI, Alegre Torrado C, Ferrero Herrero E, Rodríguez Cuéllar E. Ligamentum Teres Cardiopexy Might Not Prevent Gastro-esophageal Reflux After Laparoscopic Sleeve Gastrectomy: Case Series. Obes Surg 2023; 33:965-968. [PMID: 36585604 DOI: 10.1007/s11695-022-06413-1] [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: 06/27/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 01/01/2023]
Abstract
Roux-en-Y gastric bypass (RYGB) is considered the gold standard procedure in patients with obesity and gastroesophageal reflux (GERD), but in patients with preoperative hiatal hernia (HH) or GERD, who are unfit for RYGB, there are no clear guidelines. Ligamentum teres cardiopexy (LTC) has been proposed as an effective alternative. The purpose of this study was to analyze medium-term results of LTC procedure associated with laparoscopic sleeve gastrectomy (LSG) in patients with GERD or HH, according to the absence of pathologic acid reflux in esophageal 24 h pH monitoring test, symptom release, or PPI reduction. Five patients underwent LSG-LTC between March 2018 and October 2019. In one patient, the effectiveness of LTC as an anti-reflux procedure could not be assessed because of conversion to RYGB was required. After a follow-up period of 30 [24-42] months and excessive BMI loss of 62.74 ± 18.18%, GERD recurrence was observed in 75% of patients. The study was discontinued due to unsatisfactory preliminary results with LTC. Our results suggest that LTC might not prevent GERD after LSG in patients with preoperative GERD or HH.
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Affiliation(s)
- Javier Martínez Caballero
- General and Digestive Surgery, 12th October University Hospital, Av. de Córdoba, s/n, 28041, Madrid, Spain.
| | - Felipe de la Cruz Vigo
- Bariatric, Metabolic and Upper-GI surgery department, 12th October University Hospital, Av. de Córdoba, s/n, 28041, Madrid, España
| | - Pilar Gómez Rodríguez
- Bariatric, Metabolic and Upper-GI surgery department, 12th October University Hospital, Av. de Córdoba, s/n, 28041, Madrid, España
| | - Diego Hernández García-Gallardo
- Bariatric, Metabolic and Upper-GI surgery department, 12th October University Hospital, Av. de Córdoba, s/n, 28041, Madrid, España
| | - Ana Isabel Pérez Zapata
- Bariatric, Metabolic and Upper-GI surgery department, 12th October University Hospital, Av. de Córdoba, s/n, 28041, Madrid, España
| | - Cristina Alegre Torrado
- Bariatric, Metabolic and Upper-GI surgery department, 12th October University Hospital, Av. de Córdoba, s/n, 28041, Madrid, España
| | - Eduardo Ferrero Herrero
- General and Digestive Surgery, 12th October University Hospital, Av. de Córdoba, s/n, 28041, Madrid, Spain
| | - Elías Rodríguez Cuéllar
- Bariatric, Metabolic and Upper-GI surgery department, 12th October University Hospital, Av. de Córdoba, s/n, 28041, Madrid, España
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11
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Veziant J, Benhalima S, Piessen G, Slim K. Obesity, sleeve gastrectomy and gastro-esophageal reflux disease. J Visc Surg 2023; 160:S47-S54. [PMID: 36725450 DOI: 10.1016/j.jviscsurg.2023.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Sleeve gastrectomy (SG) is the most frequently performed operation for morbid obesity in the world. In spite of its demonstrated efficacy, the Achilles' Heel of this procedure seems to be either pre-existing or de novo gastro-esophageal reflux disease (GERD) with its potential complications such as peptic esophagitis, Barrett's esophagus and, in the long-term, esophageal adenocarcinoma. According to factual literature, it appears clear that Roux-en-Y gastric bypass is the preferred choice in case of pre-existing GERD or hiatal hernia discovered during preoperative workup for bariatric surgery. Nonetheless, certain authors propose performance of SG with an associated antireflux procedure such as Nissen fundoplication. Strict endoscopic surveillance is recommended after bariatric surgery. Revisional surgery (conversion of SG into Roux-en-Y gastric bypass (RYGB)) is the treatment of choice for patients who develop GERD after SG when conservative treatment (modified lifestyle and proton pump inhibitors) has failed. Lastly, with regard to the risk of esophageal adenocarcinoma after SG, large scale studies with adequate follow-up are necessary to come to factual conclusions. In all cases, the management of this conundrum remains a major technical challenge that has to be taken in consideration in future years, especially because of the current expansion of bariatric surgery.
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Affiliation(s)
- J Veziant
- Department of Digestive and Oncological Surgery, CHU of Lille, University of Lille, 59000 Lille, France.
| | - S Benhalima
- Department of Digestive and Oncological Surgery, CHU of Lille, University of Lille, 59000 Lille, France
| | - G Piessen
- Department of Digestive and Oncological Surgery, CHU of Lille, University of Lille, 59000 Lille, France
| | - K Slim
- CHU of Estaing, 63003 Clermont-Ferrand, France; Groupe francophone de réhabilitation améliorée après chirurgie (GRACE), France
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12
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Noel P, Layani L, Manos T, Adala M, Carandina S, Nedelcu A, Nedelcu M. The Reflux and BariClip: Initial Results and Mechanism of Action. J Clin Med 2022; 11:jcm11226698. [PMID: 36431175 PMCID: PMC9696891 DOI: 10.3390/jcm11226698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Laparoscopic BariClip Gastroplasty (LBCG) represents a new bariatric procedure that mimics the principle of the Laparoscopic Sleeve Gastrectomy (LSG), but using a completely reversible mechanism, which is essential for gastroesophageal reflux disease (GERD). The purpose of our study was to evaluate the evolution of GERD following the initial experience with LBCG. METHODS The first 43 obese patients who underwent LBCG performed by the same surgeon in two different medical centers in May 2018-December 2019 were included in the current study. Twelve patients had issues of reflux, regularly receiving PPIs (proton pump inhibitors) treatment in eight cases, and occasionally in four cases. Thirty-two patients completed the follow-up at one year and the GERD was evaluated using the PPI medications and the GerdQ. RESULTS The median preoperative GerdQ score was (14.58 ± 1.9). Three patients out of the twelve who had complained about preoperative GERD did not consent to the one year follow-up form. For the rest of nine patients, the median post-operative GerdQ score was (10.11 ± 3.2). The PPIs were used at one year follow-up in six patients: four with occasional use, one patient with regular use showing no improvement, and one who experienced de novo GERD symptomatology (3.1%). No statistically significant difference between the groups was recorded in terms of GERD. We recorded no intraoperative complications. No case of erosion occurred in the post-operative period, but we encountered two cases of slippage. One additional BariClip was removed at 14 months. CONCLUSION LBCG represents a new bariatric procedure that mimics the principle of the laparoscopic sleeve gastrectomy, but with a completely reversible mechanism. Even with limited cases, our experience reports several mechanisms of action that will be evaluated and discussed in further prospective clinical trials. After this preliminary clinical study, LBCG's effects on GERD and its safety are highly encouraging.
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Affiliation(s)
- Patrick Noel
- Emirates Specialty Hospital, Dubai 505240, United Arab Emirates
- Mediclinic Airport Road Hospital, Abu Dhabi 48481, United Arab Emirates
- ELSAN, Clinique Bouchard, 13000 Marseille, France
| | | | | | | | - Sergio Carandina
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Óbesite, 83100 Toulon, France
| | - Anamaria Nedelcu
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Óbesite, 83100 Toulon, France
| | - Marius Nedelcu
- ELSAN, Clinique Bouchard, 13000 Marseille, France
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Óbesite, 83100 Toulon, France
- Correspondence: ; Tel.: +33-695-950-965
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13
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Factors Associated with Increased Severity of Erosive Esophagitis 1 Year After Laparoscopic Sleeve Gastrectomy. Obes Surg 2022; 32:3891-3899. [PMID: 36205881 DOI: 10.1007/s11695-022-06268-6] [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: 06/06/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Weight reduction decreases gastroesophageal reflux disease (GERD), but laparoscopic sleeve gastrectomy (LSG) that damages the structure of the stomach may worsen GERD. We aimed to elucidate the factors associated with increased severity of erosive esophagitis (EE) at 1 year after LSG. MATERIALS AND METHODS Data on patients who underwent LSG between February 2007 and March 2016 were reviewed. Endoscopic findings and anthropometric data before and after surgery were recorded. The severity of EE was assessed according to the Los Angeles classification; severe EE was defined as grade C or D esophagitis. RESULTS Totally, 316 patients were enrolled. Before LSG, 96 patients (30.4%) had grade A or B EE. One year after LSG, 215 patients (68%) had EE, including 136 (43%) with grade A, 62 (19.6%) with grade B, and 17 (5.4%) with grade C or D EE. One-hundred and twenty-seven of 220 patients (57.7%) without EE before LSG developed de novo EE following LSG. The incidence of severe EE after LSG in patients without pre-operative EE, grade A EE, or grade B EE at baseline was 3.2%, 6.8%, and 50%, respectively. Independent factors for an increased severity of EE after LSG were male gender (OR = 2.55, 95% CI = 1.52-4.28) and post-operative hiatal hernia (OR = 3.17, 95% CI = 1.66-6.06). CONCLUSION The prevalence and severity of EE increased after LSG. Male gender and post-operative hiatal hernia are independent factors for an increased severity of EE after LSG. The incidence of severe EE after LSG is low for patients without pre-operative EE or grade A EE at baseline.
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Yadlapati R, Hubscher E, Pelletier C, Jacob R, Brackley A, Shah S. Induction and maintenance of healing in erosive esophagitis in the United States. Expert Rev Gastroenterol Hepatol 2022; 16:967-980. [PMID: 36254610 DOI: 10.1080/17474124.2022.2134115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Erosive esophagitis (EE) occurs when refluxate from the stomach causes T-lymphocyte infiltration of the esophageal mucosa, resulting in mucosal breaks. Currently, therapy with proton-pump inhibitors (PPIs) is the standard treatment for EE in the United States, but few comprehensive reviews exist on the efficacy of PPIs in US populations. Here, we present the most contemporary, thorough analysis of PPI efficacy rates, and identify and characterize patient subgroups at risk for poor healing outcomes. AREAS COVERED We searched the literature to identify studies reporting rates of endoscopic healing and maintained healing of EE with PPI therapies in the US and found a paucity of recent evidence and real-world evidence. Twenty-two studies from 2009 and earlier were included in the final dataset. EXPERT OPINION Rates of EE healing with PPIs were highest after 8 weeks of treatment, with over 80% of patients in most treatment arms demonstrating endoscopic healing, compared to lower efficacy (<80%) at 4 weeks. Rates of maintained healing with PPIs at 6 and 12 months were mostly lower than 80%, although the data were limited. Symptomatic patients and those with severe EE were less likely to achieve healing. Obese patients experienced similar healing rates as non-obese patients.
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Affiliation(s)
- Rena Yadlapati
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | | | - Corey Pelletier
- Health Economics and Outcomes Research, Phathom Pharmaceuticals, Florham Park, New Jersey, USA
| | - Rinu Jacob
- Health Economics and Outcomes Research, Phathom Pharmaceuticals, Florham Park, New Jersey, USA
| | - Allison Brackley
- Real-World Advanced Analytics, Cytel, Inc, Waltham, Massachusetts, USA
| | - Shailja Shah
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
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15
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Gagner M. Response to " Comment on: Alarmists at the Gates: Esophageal Adenocarcinoma After Sleeve Gastrectomy Is Not Different than with Other Bariatric/Metabolic Surgery". Obes Surg 2022; 32:3466-3468. [PMID: 35997932 DOI: 10.1007/s11695-022-06242-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/07/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Michel Gagner
- Hôpital du Sacre Coeur, Montreal, Canada. .,Westmount Square Surgical Center, Westmount, Canada.
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16
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The Hill's Classification Is Useful to Predict the Development of Postoperative Gastroesophageal Reflux Disease and Erosive Esophagitis After Laparoscopic Sleeve Gastrectomy. J Gastrointest Surg 2022; 26:1162-1170. [PMID: 35445323 DOI: 10.1007/s11605-022-05324-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is one of the commonest bariatric procedures. However, it is associated with postoperative gastroesophageal reflux disease (GERD) and erosive esophagitis (EE). This study aims to assess the impact of various preoperative clinical and endoscopic characteristics on the development of postoperative GERD and EE. METHODS This study is a single-institution retrospective cohort study involving all patients who underwent LSG. A univariate and multivariate analysis was performed to identify preoperative parameters that were significantly associated with the development of postoperative GERD and EE, at up to 1-year follow-up. RESULTS At up to 1-year follow-up, out of 127 patients, only preoperative endoscopic presence of a hiatal hernia noted on axial length (p=0.024) and the Hill's classification of the gastroesophageal junction (p<0.001) were significantly associated with the development of postoperative GERD. Similarly, at 1-year follow-up endoscopy, the presence of a hiatal hernia (p=0.041) and the Hill's classification (p=0.001) were associated with postoperative EE. On the multivariate analysis, compared to patients with a Hill's I flap valve, Hill's II patients were more likely to develop postoperative GERD (OR 7.13, 95% CI: 1.69-29.98, p=0.007), and Hill's III patients were more likely to develop postoperative GERD (OR 20.84, 95% CI: 3.98-109.13, p<0.001) and EE (OR 34.49, 95% CI: 1.08-1105.36, p=0.045). All patients with Hill's IV developed postoperative GERD and EE in this study. CONCLUSION Postoperative GERD and EE remain an important limitation following LSG. Proper preoperative assessment using the Hill's classification can help to accurately predict patients at risk of postoperative GERD and EE.
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Auge M, Menahem B, Savey V, Lee Bion A, Alves A. Long-term complications after gastric bypass and sleeve gastrectomy: What information to give to patients and practitioners, and why? J Visc Surg 2022; 159:298-308. [PMID: 35304081 DOI: 10.1016/j.jviscsurg.2022.02.004] [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] [Indexed: 12/12/2022]
Abstract
Bariatric surgery is now recognized as the most effective treatment of morbid obesity, leading to durable weight loss and resolution of associated co-morbidities. Roux-en-Y gastric bypass and sleeve gastrectomy are the two most widely used operations today. However, potentially serious medical, surgical, and/or psychiatric complications can occur that raise questions regarding the benefits of this type of surgery. These complications can lead to surgical re-operations, iterative hospitalizations, severe nutritional deficiencies and psychological disorders. Indeed, death from suicide is said to be three times higher than in non-operated obese patients. These results are of concern, all the more because of the high prevalence of patients lost to follow-up (for various and multifactorial reasons) after bariatric surgery. However, better knowledge of post-surgical sequelae could improve the information provided to patients, the preoperative evaluation of the benefit/risk ratio, and, for patients undergoing surgery, the completeness and quality of follow-up as well as the detection and management of complications. The development of new strategies for postoperative follow-up such as telemedicine but also the mobilization of all the actors along the healthcare pathway can make inroads and warrant further study.
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Affiliation(s)
- M Auge
- Department of visceral and digestive surgery, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - B Menahem
- Department of visceral and digestive surgery, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Unité INSERM UMR1086, Normandie University, UNICAEN, centre François-Baclesse, 14045 Caen cedex, France.
| | - V Savey
- Service de nutrition, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - A Lee Bion
- Department of visceral and digestive surgery, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - A Alves
- Department of visceral and digestive surgery, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Unité INSERM UMR1086, Normandie University, UNICAEN, centre François-Baclesse, 14045 Caen cedex, France
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18
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Olmi S, Cesana G, Gambioli A, Bonaldi M, Ferrari D, Uccelli M, Ciccarese F, Stefano DC, Riccardo G, Lorenzo M. Effect of laparoscopic sleeve gastrectomy vs laparoscopic sleeve + Rossetti fundoplication on weight loss and de novo GERD in patients affected by morbid obesity: a randomized clinical study. Obes Surg 2022; 32:1451-1458. [PMID: 35137287 PMCID: PMC9055016 DOI: 10.1007/s11695-022-05955-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/26/2022] [Accepted: 02/03/2022] [Indexed: 12/11/2022]
Abstract
Purpose To compare sleeve gastrectomy (SG) to SG associated with Rossetti fundoplication (SG + RF) in terms of de novo gastro-esophageal reflux disease (GERD) after surgery, weight loss, and postoperative complications. Materials and methods Patients affected by morbid obesity, without symptoms of GERD, who were never in therapy with proton pump inhibitors (PPIs), were randomized into two groups. One group underwent SG and the other SG + RF. The study was stopped on February 2020 due to the COVID pandemic. Results A total of 278 patients of the programmed number of 404 patients were enrolled (68.8%). De novo esophagitis was considered in those patients who had both pre- and postoperative gastroscopy (97/278, 34.9%). Two hundred fifty-one patients (90.3%) had completed clinical follow-up at 12 months. SG + RF resulted in an adequate weight loss, similar to classic SG at 12-month follow-up (%TWL = 35. 4 ± 7.2%) with a significantly better outcome in terms of GERD development. One year after surgery, PPIs were necessary in 4.3% SG + RF patients compared to 17.1% SG patients (p = 0.001). Esophagitis was present in 2.0% of SG + RF patients versus 23.4% SG patients (p = 0.002). The main complication after SG + RF was wrap perforation (4.3%), which improved with the surgeon’s learning curve. Conclusion SG + RF seemed to be an effective alternative to classic SG in preventing de novo GERD. More studies are needed to establish that an adequate learning curve decreases the higher percentage of short-term complications in the SG + RF group. Graphical abstract ![]()
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Affiliation(s)
- Stefano Olmi
- Department of Surgery, S.I.C.OB. (Italian Society of Bariatric Surgery) Referral Center for Bariatric Surgery, Policlinico San Marco, GSD University and Research, viale Europa 7, 24040 Zingonia-Osio Sotto, Bergamo, Italy.,Vita-Salute San Raffaele University, via Olgettina 58, 20132, Milano, Italy
| | - Giovanni Cesana
- Department of Surgery, S.I.C.OB. (Italian Society of Bariatric Surgery) Referral Center for Bariatric Surgery, Policlinico San Marco, GSD University and Research, viale Europa 7, 24040 Zingonia-Osio Sotto, Bergamo, Italy. .,University of Milan, via Francesco Sforza 35, 20122, Milano, Italy.
| | - Angela Gambioli
- Research Centre on Public Health (CESP) of the University of Milan-Bicocca, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Marta Bonaldi
- Department of Surgery, S.I.C.OB. (Italian Society of Bariatric Surgery) Referral Center for Bariatric Surgery, Policlinico San Marco, GSD University and Research, viale Europa 7, 24040 Zingonia-Osio Sotto, Bergamo, Italy
| | - Davide Ferrari
- Department of Surgery, S.I.C.OB. (Italian Society of Bariatric Surgery) Referral Center for Bariatric Surgery, Policlinico San Marco, GSD University and Research, viale Europa 7, 24040 Zingonia-Osio Sotto, Bergamo, Italy.,University of Milan, via Francesco Sforza 35, 20122, Milano, Italy
| | - Matteo Uccelli
- Department of Surgery, S.I.C.OB. (Italian Society of Bariatric Surgery) Referral Center for Bariatric Surgery, Policlinico San Marco, GSD University and Research, viale Europa 7, 24040 Zingonia-Osio Sotto, Bergamo, Italy
| | - Francesca Ciccarese
- Department of Surgery, S.I.C.OB. (Italian Society of Bariatric Surgery) Referral Center for Bariatric Surgery, Policlinico San Marco, GSD University and Research, viale Europa 7, 24040 Zingonia-Osio Sotto, Bergamo, Italy.,University of Milan, via Francesco Sforza 35, 20122, Milano, Italy
| | - De Carli Stefano
- Department of Surgery, S.I.C.OB. (Italian Society of Bariatric Surgery) Referral Center for Bariatric Surgery, Policlinico San Marco, GSD University and Research, viale Europa 7, 24040 Zingonia-Osio Sotto, Bergamo, Italy
| | - Giorgi Riccardo
- Department of Surgery, S.I.C.OB. (Italian Society of Bariatric Surgery) Referral Center for Bariatric Surgery, Policlinico San Marco, GSD University and Research, viale Europa 7, 24040 Zingonia-Osio Sotto, Bergamo, Italy
| | - Mantovani Lorenzo
- Research Centre on Public Health (CESP) of the University of Milan-Bicocca, Via Pergolesi 33, 20900, Monza, MB, Italy
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19
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Montana L, Colas PA, Valverde A, Carandina S. Alterations of digestive motility after bariatric surgery. J Visc Surg 2022; 159:S28-S34. [DOI: 10.1016/j.jviscsurg.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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20
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Bedirli A, Yavuz A, Dikmen K, Buyukkasap C, Ozaydin S. Robotic Roux-en-Y Gastric Bypass: A Single Surgeon's Experience with 527 Consecutive Patients. JSLS 2022; 26:JSLS.2021.00072. [PMID: 35444400 PMCID: PMC8993462 DOI: 10.4293/jsls.2021.00072] [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] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives Robotic bariatric surgery is increasingly adopted by surgeons. We present the surgical results of 527 consecutive patients who underwent robotic Roux-en-Y gastric bypass (RYGB) using the standard technique. Methods A retrospective analysis of a prospectively maintained database was performed including 527 consecutive patients who underwent robotic RYGB between January 1, 2018 and December 31, 2021. Results The mean age of the patients was 41 years, with a male/female sex distribution of 143/384 (27.1%/72.9%). Type 2 diabetes in the pre-operative period was diagnosed in 31% of patients. The median pre-operative body mass index (BMI) was 44.6 kg/m2 (range, 35-64). The mean operation time was 134 min for robotic RYGB, including the docking process. Early (< 30 days) complications included ileus (0.2%), atelectasis (0.2%), thromboembolic (0.2%) events, and surgical-site infection (0.2%). No leakage or bleeding of the gastrojejunal and jejunojejunal anastomoses were recorded. Oral food intake was begun at 1.8 days on average. The average hospital stay was 2 days. Despite a range of BMI values, operation times and gastrojejunal anastomosis times did not show significant differences. There were no significant differences in mean operation time or mean gastrojejunal anastomosis time over the years. Conclusions The robotic approach is effective and safe for patients undergoing RYGB. This technique provides satisfactory results with short-term surgical outcomes. However, the real benefits of robotic RYGB should be further evaluated by well-conducted randomized trials. Even in difficult cases with higher BMI values, optimal operation times and similar operative efficiency can be obtained if a standard operation technique is applied.
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Affiliation(s)
| | - Aydin Yavuz
- Department of General Surgery, Gazi University, Ankara, Turkey
| | - Kursat Dikmen
- Department of General Surgery, Gazi University, Ankara, Turkey
| | | | - Safa Ozaydin
- Department of General Surgery, Gazi University, Ankara, Turkey
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21
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High rate of de novo esophagitis 5 years after sleeve gastrectomy: a prospective multicenter study in Spain. Surg Obes Relat Dis 2021; 18:546-554. [DOI: 10.1016/j.soard.2021.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/02/2021] [Accepted: 11/07/2021] [Indexed: 01/10/2023]
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22
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Elkassem S. Gastroesophageal Reflux Disease, Esophagitis, and Barrett's Esophagus 3 to 4 Years Post Sleeve Gastrectomy. Obes Surg 2021; 31:5148-5155. [PMID: 34599728 DOI: 10.1007/s11695-021-05688-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Sleeve gastrectomy (SG) has become the most popular bariatric procedure worldwide. However, SG is associated with de novo gastroesophageal reflux (GERD) and esophagitis, with concerns for progression into Barrett's esophagus (BE). The purpose of this study is to assess the clinical and endoscopic progression of GERD, esophagitis, and BE 3 to 4 years after SG. METHODS Fifty-eight patients (pts) were assessed with endoscopy preoperative and at 3 to 4 years post SG, representing 44.9% follow-up. Endoscopy was offered to all SG pts regardless of symptoms. Outcomes including percent total weight loss (%TWL), PPI use, esophagitis progression, de novo reflux, and BE formation. RESULTS At post-op follow-up, the %TWL was 23%. The average BMI dropped from 49.07 to 37.5. De novo reflux developed in 13 pts (30.9%). Of the 16 pts with GERD pre-op, 37.5% improved, 25% had stable disease, and 37.5% had worsening symptoms. The rate of esophagitis nearly doubled from 37.9% pre-op to 70.6% post-op. A majority of post-op pts had mild esophagitis (87.8%), with 12.1% with LA classes C and D. Asymptomatic esophagitis was found in 68.2% of post-op pts. The incidence of BE was 12.7% post-op, with de novo BE developing in 4 pts, representing 7.2%. CONCLUSION SG is associated with increased rates of asymptomatic esophagitis and de novo reflux at 3 to 4 years post-op. De novo BE was detected as well, highlighting the importance of post-op screening. The majority of pts with GERD pre-op have stable disease or improve.
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Affiliation(s)
- Samer Elkassem
- Division of General Surgery, Medicine Hat Regional Hospital, 116 Carry Dr, Suite 114, Medicine Hat, Alberta, T1B 3Z8, Canada.
- Faculty of Medicine, University of Calgary, Calgary, Canada.
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23
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Tian P, Fu J, Liu Y, Bian S, Li M, Zhang M, Liu J, Jin L, Zhang Z, Zhang P. Current status of gastroesophageal reflux disease after sleeve gastrectomy: Still a long way to go. Biosci Trends 2021; 15:305-312. [PMID: 34373428 DOI: 10.5582/bst.2021.01288] [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: 11/05/2022]
Abstract
Obesity is a public health concern that is becoming increasingly more serious around the world. Bariatric surgery has become more prevalent due to the obesity epidemic worldwide. Sleeve gastrectomy (SG) is one of the most popular procedures which is safe and efficient. Despite all its favorable features, however, there is an increasing evidence from the literature that the long-term incidence of gastroesophageal reflux disease (GERD) is likely to represent the Achilles' heel of this procedure. Management of severe reflux after SG usually requires revisional surgery. The relationship between SG and GERD needs to be better ascertained in order to prevent related complications, such as esophageal adenocarcinoma. This review attempts to elucidate the effect of SG on GERD and the postoperative management of reflux disease according to recent literature in the hope of drawing the attention of clinicians to postoperative gastroesophageal reflux and guiding the optimal management strategy associated with this "troublesome complication".
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Affiliation(s)
- Peirong Tian
- Division of Metabolic and Bariatric Surgery, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Jing Fu
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yang Liu
- Division of Metabolic and Bariatric Surgery, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Shibo Bian
- Division of Metabolic and Bariatric Surgery, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Mengyi Li
- Division of Metabolic and Bariatric Surgery, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Meng Zhang
- Division of Metabolic and Bariatric Surgery, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Jia Liu
- Division of Metabolic and Bariatric Surgery, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Lan Jin
- Division of Metabolic and Bariatric Surgery, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Zhongtao Zhang
- Division of Metabolic and Bariatric Surgery, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Peng Zhang
- Division of Metabolic and Bariatric Surgery, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
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Curell A, Beisani M, García Ruiz de Gordejuela A, Vilallonga R, Verdaguer Tremolosa M, González López Ó, Caubet Busquet E, Fort López-Barajas JM. Outcomes of Conversion from Sleeve Gastrectomy to Roux-en-Y Gastric Bypass Due to GERD-a Retrospective Analysis of 35 Patients. Obes Surg 2021; 31:4100-4106. [PMID: 34227017 DOI: 10.1007/s11695-021-05541-4] [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] [Received: 03/13/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Sleeve gastrectomy (SG) has become one of the most performed bariatric procedures worldwide. Its main weaknesses are weight regain and gastroesophageal reflux disease (GERD). Conversion to Roux-en-Y gastric bypass (RYGB) is considered the gold standard to manage GERD and related symptoms. METHODS Retrospective evaluation from a prospective bariatric surgery database of all our institution's patients converted from SG to RYGB due to GERD between January 2010 and December 2018. Clinical characteristics and workups before SG and before and after RYGB were analyzed. RESULTS During the study period, 35 patients needed a conversion to RYGB, due to GERD or GERD-related symptoms. Mean age was 48.6 years, 85.7% were women, and mean BMI was 31.4 kg/m2. The interval between SG and RYGB was in a range 7 to 70 months (mean 33 months). All conversions were completed laparoscopically, associating a hiatoplasty in 45.7% of cases. A complete remission of symptoms was observed in 74% of patients, some improvement in 20%, and no relief in 6%. There were 3 cases of hiatal hernia persistence and 2 of recidivism. Only 1 patient presented pathological pHmetry, while moderate esophagitis was demonstrated in 2 patients. CONCLUSIONS Conversion to RYGB was effective in almost all patients. Pathological acid exposure and hiatal hernias seem to be the main findings prior to conversion, justifying an exhaustive examination and aggressive approach to the hiatus. Due to the insufficient correlation between symptoms and findings on morphological and functional tests, actively searching for signs of GERD is advisable.
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Affiliation(s)
- Anna Curell
- General and Digestive Surgery Department, Vall d'Hebron Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Marc Beisani
- Bariatric Surgery Unit, General and Digestive Surgery Department, Moises Broggi Hospital, CSI, Sant Joan Despi, Barcelona, Spain
| | - Amador García Ruiz de Gordejuela
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron Hospital Campus, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron Hospital Campus, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Mireia Verdaguer Tremolosa
- General and Digestive Surgery Department, Vall d'Hebron Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Óscar González López
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron Hospital Campus, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Enric Caubet Busquet
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron Hospital Campus, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - José Manuel Fort López-Barajas
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron Hospital Campus, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
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25
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Carandina S, Zulian V, Nedelcu A, Danan M, Vilallonga R, Nocca D, Nedelcu M. Is It Safe to Combine a Fundoplication to Sleeve Gastrectomy? Review of Literature. ACTA ACUST UNITED AC 2021; 57:medicina57040392. [PMID: 33919520 PMCID: PMC8073310 DOI: 10.3390/medicina57040392] [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: 02/22/2021] [Revised: 04/11/2021] [Accepted: 04/16/2021] [Indexed: 02/05/2023]
Abstract
Background and Objectives: The rising numbers of laparoscopic sleeve gastrectomy (LSG) procedures now being performed worldwide will likely be followed by an increasing number of patients experiencing gastro-esophageal reflux disease (GERD). The purpose of the current review was to analyze in terms of safety different techniques of fundoplication used to treat GERD associated with LSG. Methods: An online search was performed in PubMed/MEDLINE in December 2020 to identify articles reporting LSG and fundoplication. The following term combination was used: (sleeve, fundoplication), (sleeve, Nissen), (sleeve, Rossetti), (sleeve, Toupet) and (sleeve, Dor). The extracted information included details of the methods (e.g., retrospective case series), demographic characteristics (e.g., age, gender), clinical characteristics, number of patients, rate of conversion, and postoperative outcomes. Results: A total of 154 studies were identified and after an assessment of title according to our exclusion criteria, 116 articles were removed. Of the 38 studies analyzed for full content review, a total of seven primary studies (487 patients) were identified with all inclusion criteria. Analyzing the different types of fundoplication used, we have identified: 236 cases of Nissen-Sleeve, 220 cases with modified Rossetti fundoplication, 31 cases of Dor fundoplication, and no case of Toupet fundoplication. The overall postoperative complication rate was 9.4%, with the most common reported complication being gastric perforation, 15 cases-3.1%. The second most common complication was bleeding identified in nine cases (1.8%) followed by gastric stenosis in six cases (1.2%). The mortality was nil. Conclusions: Different types of fundoplication associated with LSG appear to be a safe surgical technique with an acceptable early postoperative complication rate. Any type of fundoplication associated with LSG to decrease GERD should be evaluated cautiously while prospective clinical randomized trials are needed.
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Affiliation(s)
- Sergio Carandina
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obésité (CCO), 83100 Toulon, France; (S.C.); (V.Z.); (A.N.); (M.D.)
- Clinica Madonna della Salute, Department of Digestive and Bariatric Surgery, 45014 Porto Viro, Italy
| | - Viola Zulian
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obésité (CCO), 83100 Toulon, France; (S.C.); (V.Z.); (A.N.); (M.D.)
| | - Anamaria Nedelcu
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obésité (CCO), 83100 Toulon, France; (S.C.); (V.Z.); (A.N.); (M.D.)
| | - Marc Danan
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obésité (CCO), 83100 Toulon, France; (S.C.); (V.Z.); (A.N.); (M.D.)
| | - Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Hospital Vall d’Hebron, 08023 Barcelona, Spain;
- Faculty of Medicine, Universitat Autònoma de Barcelona, 08023 Barcelona, Spain
| | - David Nocca
- CHU de Montpellier, 34080 Montpellier, France;
- University Montpellier 1, 34080 Montpellier, France
| | - Marius Nedelcu
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obésité (CCO), 83100 Toulon, France; (S.C.); (V.Z.); (A.N.); (M.D.)
- ELSAN, Clinique Bouchard, 13000 Marseille, France
- Correspondence: ; Tel.: +33-695950965
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Nocca D, Loureiro M. Comment on: sleeve gastrectomy with tailored 360° fundoplication according to Rossetti in patients affected by obesity and gastroesophageal reflux: a prospective observational study. Surg Obes Relat Dis 2021; 17:e29-e30. [PMID: 34031011 DOI: 10.1016/j.soard.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Affiliation(s)
- David Nocca
- Centre Hospitalier Universitaire de Montpellier, University Montpelier, Montepellier, France
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Sleeve gastrectomy with tailored 360° fundoplication according to Rossetti in patients affected by obesity and gastroesophageal reflux. Surg Obes Relat Dis 2021; 17:1065-1067. [PMID: 33691994 DOI: 10.1016/j.soard.2021.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 11/21/2022]
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Olmi S, Cesana G, D'Angiolella L, Bonaldi M, Uccelli M, Mantovani L. Sleeve gastrectomy with tailored 360° fundoplication according to Rossetti in patients affected by obesity and gastroesophageal reflux: a prospective observational study. Surg Obes Relat Dis 2021; 17:1057-1065. [PMID: 33622604 DOI: 10.1016/j.soard.2021.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/04/2021] [Accepted: 01/11/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed bariatric procedure. Recent studies demonstrated the correlation between LSG and gastroesophageal reflux disease (GERD). OBJECTIVES To evaluate the effectiveness of LSG + Rossetti antireflux fundoplication in patients affected by morbid obesity and GERD. SETTING High-volume bariatric center, Italy. METHODS This is a prospective, observational cohort study that enrolled 58 patients affected by obesity and GERD who underwent surgery. All the patients had a 12-month follow-up. Gastroscopies were performed preoperatively and at month 12 for 35 patients. RESULTS At 1 year after surgery, patients had a consistent decrease in body mass index, from 41.9 ± 4.6 kg/m2 to 28.2 ± 3.7 kg/m2. GERD improved in 97.1% of patients. Co-morbidities, such as hypertension, type 2 diabetes, respiratory dysfunction, and arthropathies improved as well. The visual analogue scale score regarding the global state of health increased significantly, from 58.1 ± 17.1% before surgery to 98.8 ± 4.1% at 1 year after surgery. Two patients had a fundoplication perforation and needed reparative surgery (3.5%). One patient had anemia that needed a blood transfusion (1.7%). Complications were reduced with a learning curve. CONCLUSION LSG + Rossetti fundoplication was shown to be a safe and effective intervention. It could be considered an option in obese patients affected by GERD. A longer follow-up is needed to establish the long-term outcomes.
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Affiliation(s)
- Stefano Olmi
- Department of Surgery, S.I.C.OB. (Italian Society of Bariatric Surgery) Referral Center for Bariatric Surgery, Policlinico San Marco, GSD University and Research, Bergamo, Italy; Vita-Salute San Raffaele University, Milano, Italy
| | - Giovanni Cesana
- Department of Surgery, S.I.C.OB. (Italian Society of Bariatric Surgery) Referral Center for Bariatric Surgery, Policlinico San Marco, GSD University and Research, Bergamo, Italy; University of Milan, Milano, Italy.
| | - Lucia D'Angiolella
- Research Centre on Public Health (CESP) of the University of Milan-Bicocca, Monza, Italy
| | - Marta Bonaldi
- Department of Surgery, S.I.C.OB. (Italian Society of Bariatric Surgery) Referral Center for Bariatric Surgery, Policlinico San Marco, GSD University and Research, Bergamo, Italy; University of Milan, Milano, Italy
| | - Matteo Uccelli
- Department of Surgery, S.I.C.OB. (Italian Society of Bariatric Surgery) Referral Center for Bariatric Surgery, Policlinico San Marco, GSD University and Research, Bergamo, Italy
| | - Lorenzo Mantovani
- Research Centre on Public Health (CESP) of the University of Milan-Bicocca, Monza, Italy
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Scott JD. Comment on: Repair of postbariatric, recurrent, and de novo hiatal hernias improves bloating, abdominal pain, regurgitation, and food intolerance. Surg Obes Relat Dis 2021; 17:691-693. [PMID: 33619008 DOI: 10.1016/j.soard.2021.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 01/06/2021] [Indexed: 11/16/2022]
Affiliation(s)
- John D Scott
- Prisma Health, University of South Carolina School of Medicine-Greenville, Greenville, South Carolina
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Li S, Jiao S, Zhang S, Zhou J. Revisional Surgeries of Laparoscopic Sleeve Gastrectomy. Diabetes Metab Syndr Obes 2021; 14:575-588. [PMID: 33603423 PMCID: PMC7882429 DOI: 10.2147/dmso.s295162] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/08/2021] [Indexed: 12/11/2022] Open
Abstract
Bariatric surgery has become increasingly common due to the worldwide obesity epidemic. A shift from open to laparoscopic surgery, specifically, laparoscopic sleeve gastrectomy (LSG), has occurred in the last two decades because of the low morbidity and mortality rates of LSG. Although LSG is a promising treatment option for patients with morbid obesity due to restrictive and endocrine mechanisms, it requires modifications for a subset of patients because of weight regain and tough complications, such as gastroesophageal reflux, strictures, gastric leak, and persistent metabolic syndrome., Revision surgeries have become more and more indispensable in bariatric surgery, accounting for 7.4% in 2016. Mainstream revisional bariatric surgeries after LSG include Roux-en-Y gastric bypass, repeated sleeve gastrectomy, biliopancreatic diversion, duodenal switch, duodenal-jejunal bypass, one-anastomosis gastric bypass, single anastomosis duodeno-ileal bypass (SAID) and transit bipartition. This review mainly describes the revisional surgeries of LSG, including the indication, choice of surgical method, and subsequent effect.
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Affiliation(s)
- Siyuan Li
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Siqi Jiao
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Siwei Zhang
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Jiangjiao Zhou
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
- Correspondence: Jiangjiao Zhou Department of General Surgery, The Second Xiangya Hospital, Central South University, No. 139 Middle Renmin Road, Changsha, Hunan, 410011, People’s Republic of China Email
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Curell A, Balibrea JM, Ibarzábal A, Lacy A. Letter to the editor following "Gastroesophageal Reflux and Laparoscopic Sleeve Gastrectomy: Results of the First International Consensus Conference" by Assalia et al. Obes Surg 2020; 31:1846-1847. [PMID: 33145719 DOI: 10.1007/s11695-020-05087-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/16/2020] [Accepted: 10/26/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Anna Curell
- Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Carrer Villarroel 170, 08036, Barcelona, Spain
| | - José M Balibrea
- Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Carrer Villarroel 170, 08036, Barcelona, Spain.
- Universitat de Barcelona, Barcelona, Spain.
| | - Ainitze Ibarzábal
- Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Carrer Villarroel 170, 08036, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Antonio Lacy
- Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Carrer Villarroel 170, 08036, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
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Boru CE, Termine P, Antypas P, Iossa A, Ciccioriccio CM, DE Angelis F, Micalizzi A, Silecchia G. Concomitant hiatal hernia repair during bariatric surgery: does the reinforcement make the difference? Minerva Surg 2020; 76:33-42. [PMID: 33006451 DOI: 10.23736/s2724-5691.20.08503-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hiatal hernia repair (HHR) is still controversial during bariatric procedures, especially in case of laparoscopic sleeve gastrectomy (LSG). AIMS to report the long-term results of concomitant HHR, evaluating the safety and efficacy of posterior cruroplasty (PC), simple or reinforced with biosynthetic, absorbable Bio-A® mesh (Gore, Flagstaff, AZ, USA). Primary endpoint: PC's failure, defined as symptomatic HH recurrence, nonresponding to medical treatment and requiring revisional surgery. METHODS The prospective database of 1876 bariatric operations performed in a center of excellence between 2011-2019 was searched for concomitant HHR. Intraoperative measurement of the hiatal surface area (HSA) was performed routinely. RESULTS A total of 250 patients undergone bariatric surgery and concomitant HHR (13%). Simple PC (group A, 151 patients) was performed during 130 LSG, 5 re-sleeves and 16 gastric bypasses; mean BMI 43.4±5.8 kg/m2, HSA mean size 3.4±2 cm2. Reinforced PC (group B) was performed in 99 cases: 62 primary LSG, 22 LGB and 15 revisions of LSG; mean BMI 44.6±7.7 kg/m2, HSA mean size 6.7±2 cm2. PC's failure, with intrathoracic migration (ITM) of the LSG was encountered in 12 cases (8%) of simple vs. only 4 cases (4%) of reinforced PC (P=0.23); hence, a repeat, reinforced PC and R-en-Y gastric bypass (LRYGB) was performed laparoscopically in all cases. No mesh-related complications were registered perioperatively or after long-term follow-up (mean 50 months). One case of cardiac metaplasia without goblet cells was detected 4 years postoperatively; conversion to LRYGB, with reinforced redo of the PC was performed. The Cox hazard analysis showed that the use of more than four stitches for cruroplasty represents a negative factor on recurrence (HR=8; P<0.05). CONCLUSIONS An aggressive search for and repair of HH during any bariatric procedure seems advisable, allowing a low HH recurrence rates. Additional measures, like mesh reinforcement of crural closure with biosynthetic, absorbable mesh, seem to improve results on long term follow-up, especially in case of larger hiatal defects. In our experience, reinforcement of even smaller defects seems advisable in obese population.
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Affiliation(s)
- Cristian E Boru
- Division of General Surgery and Bariatric Center of Excellence-IFSO EC, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy -
| | - Pietro Termine
- Division of General Surgery and Bariatric Center of Excellence-IFSO EC, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Pavlos Antypas
- Division of General Surgery and Bariatric Center of Excellence-IFSO EC, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Angelo Iossa
- Division of General Surgery and Bariatric Center of Excellence-IFSO EC, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Chiara M Ciccioriccio
- Division of General Surgery and Bariatric Center of Excellence-IFSO EC, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Francesco DE Angelis
- Division of General Surgery and Bariatric Center of Excellence-IFSO EC, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Alessandra Micalizzi
- Division of General Surgery and Bariatric Center of Excellence-IFSO EC, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Gianfranco Silecchia
- Division of General Surgery and Bariatric Center of Excellence-IFSO EC, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
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