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Chae R, Whitrock J, Nguyen C, Price A, Vaysburg D, Imbus J, Colvin J. Weight loss after Roux-en-Y gastric bypass and single anastomosis duodenoileostomy following failed sleeve gastrectomy. Surg Endosc 2024:10.1007/s00464-024-11055-8. [PMID: 38992284 DOI: 10.1007/s00464-024-11055-8] [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: 04/21/2024] [Accepted: 07/06/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE While sleeve gastrectomy (SG) results in sustained weight loss for the majority of patients, some will experience inadequate weight loss or weight regain requiring revision. The objective of this study was to evaluate differences in weight loss over time between patients undergoing Roux-en-Y gastric bypass (RYGB) or single anastomosis duodenoileostomy (SADI) after SG. METHODS We queried a single institution's bariatrics registry to identify patients who underwent RYGB or SADI after previous SG over a three-year period. Demographics, operative characteristics, and post-operative complications were evaluated. Interval total body weight loss (TBWL) and excess body weight loss (EBWL) were calculated from available follow-ups within 2 years. RESULTS We identified 124 patients who underwent conversion to RYGB (n = 61) or SADI (n = 63) following previous SG. There were no differences in sex, age, or medical comorbidities between groups. The median initial BMI was higher in the SADI group (44.9 vs. 41.9 for RYGB, p = 0.03) with greater excess body weight (56.7 vs. 64.3 kg, p = 0.04). The SADI group had a shorter median operative duration (157 vs. 182 min for RYGB, p < 0.01) and lower readmission rates (0 vs. 14.75%, p < 0.01). There was no difference in post-operative complications or need for rehydration therapy between the groups. Among 122 patients (98.4%) that had follow-up weights available, there were no differences in TBWL between groups. RYGB patients had a higher EBWL at 2, 3, and 6 months (p < 0.05 for all comparisons), but there were no differences between RYGB and SADI at 1 or 2 years. CONCLUSIONS Both RYGB and SADI conversions proved effective for further weight loss following failed SG at our academic center. While neither demonstrated clear superiority in long-term (> 1 year) weight loss, RYGB's restrictive gastric pouch may explain its early weight loss advantage.
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Affiliation(s)
- Ryan Chae
- Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Mail Location 0558, Cincinnati, OH, 45267-0558, USA.
| | - Jenna Whitrock
- Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Mail Location 0558, Cincinnati, OH, 45267-0558, USA
| | - Christopher Nguyen
- Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Mail Location 0558, Cincinnati, OH, 45267-0558, USA
| | - Adam Price
- Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Mail Location 0558, Cincinnati, OH, 45267-0558, USA
| | - Dennis Vaysburg
- Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Mail Location 0558, Cincinnati, OH, 45267-0558, USA
| | - Joseph Imbus
- Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Mail Location 0558, Cincinnati, OH, 45267-0558, USA
| | - Jennifer Colvin
- Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Mail Location 0558, Cincinnati, OH, 45267-0558, USA
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Sánchez-Pernaute A, de Gordejuela AGR, Pérez-Aguirre ME. Comments on the Article "One Stage vs. Two-Step One Anastomosis Duodenal Switch (OADS/ SADI- S): a Safety and Efficacy Single-Center Propensity-Score Matched Analysis". Obes Surg 2024; 34:2303-2304. [PMID: 38862753 DOI: 10.1007/s11695-024-07346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 06/02/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024]
Affiliation(s)
- Andrés Sánchez-Pernaute
- Department of Surgery, Hospital Clínico San Carlos, Madrid, Spain.
- Complutense University of Madrid, Madrid, Spain.
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3
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Rapolti DI, Monrabal Lezama M, Manueli Laos EG, Schlottmann F, Masrur MA. Management of Gastroesophageal Reflux Disease after Sleeve Gastrectomy: Effectiveness of Medical, Endoscopic, and Surgical Therapies. J Laparoendosc Adv Surg Tech A 2024; 34:581-602. [PMID: 38568115 DOI: 10.1089/lap.2024.0111] [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] [Indexed: 07/26/2024] Open
Abstract
Introduction: Sleeve gastrectomy (SG) has become the most frequently performed bariatric operation in the United States. One of the main disadvantages of this procedure is the risk of developing gastroesophageal reflux disease (GERD) after the operation. We aimed to analyze different approaches for the treatment of GERD after SG. Methods: A literature review was performed to identify all possible treatment options for post-SG GERD. All the studies were assessed for full eligibility by manual assessment of their aims, methodology, results, and conclusions. Records were individually reviewed by the authors comparing outcomes and complications between procedures. Results: Although some studies have shown improvement or even resolution of GERD symptoms after SG, most patients develop or worsen symptoms. Lifestyle modifications along with medical therapy should be started on patients with GERD after SG. For those who are refractory to medication, endoscopic and surgical therapies can be offered. Conversion to Roux-en-Y gastric bypass (RYGB) is consistently effective in treatment of GERD and is the ideal therapy in patients with associated insufficient weight loss. Endoscopic and alternative surgical procedures are also available and have shown acceptable short-term outcomes. Conclusions: Several treatment options exist for the treatment of GERD after SG. Although conversion to RYGB remains the most effective therapy, other emerging endoscopic and surgical procedures could avoid the potential morbidity of this procedure and should be further evaluated. An evidence-based algorithm for the management of GERD after SG is proposed to guide decision making.
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Affiliation(s)
- Diana I Rapolti
- Department of Surgery, University of Illinois, Chicago, Illinois, USA
| | | | | | - Francisco Schlottmann
- Department of Surgery, University of Illinois, Chicago, Illinois, USA
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Mario A Masrur
- Department of Surgery, University of Illinois, Chicago, Illinois, USA
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4
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Abu-Abeid A, Shoham G, Keidar A. Conversion of One Anastomosis Gastric Bypass to Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy. Obes Surg 2024; 34:2274-2275. [PMID: 38643296 DOI: 10.1007/s11695-024-07241-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 04/22/2024]
Affiliation(s)
- Adam Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman St., 6423906, Tel Aviv, Israel.
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Gon Shoham
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman St., 6423906, Tel Aviv, Israel
| | - Andrei Keidar
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman St., 6423906, Tel Aviv, Israel
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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5
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Medhati P, Saleh OS, Nimeri A, Apovian C, Thompson C, Jirapinyo P, Sheu EG, Tavakkoli A. Outcomes and Management of Re-Establishing Bariatric Patients. J Am Coll Surg 2024; 238:1035-1043. [PMID: 38421026 DOI: 10.1097/xcs.0000000000001062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Lifelong follow-up after metabolic and bariatric surgery (MBS) is necessary to monitor for patient outcomes and nutritional status. However, many patients do not routinely follow-up with their MBS team. We studied what prompted MBS patients to seek bariatric care after being lost to follow-up and the subsequent treatments they received. STUDY DESIGN A retrospective cohort study of patients after MBS who had discontinued regular MBS follow-up but represented to the MBS clinic between July 2018 and December 2022 to re-establish care. Patients with a history of a sleeve gastrectomy (SG), Roux-En-Y gastric bypass (RYGB), and adjustable gastric banding (AGB) were included. RESULTS We identified 400 patients (83.5% women, mean age 50.3 ± 12.2 years at the time of re-establishment of bariatric care), of whom 177 (44.3%) had RYGB, 154 (38.5%) had SG, and 69 (17.2%) had AGB. Overall, recurrent weight gain was the most common reason for presentation for all three procedures (81.2% in SG, 62.7% in RYGB, and 65.2% in AGB; p < 0.001). Patients who underwent SG were more likely to undergo a revision MBS compared with patients who underwent RYGB (16.9% vs 5.8%, p < 0.001), whereas patients who underwent RYGB were more likely to undergo an endoscopic intervention than patients who underwent SG (17.5% vs 7.8%, p < 0.001). The response to antiobesity medication agents, specifically glucagon-like peptide-1 receptor agonists drugs, was better in patients who underwent RYGB, than that in patients who underwent SG. CONCLUSIONS This study highlights recurrent weight gain as the most common reason for patients after MBS seeking to re-establish care with the MBS team. SG had a higher rate of revision MBS than RYGB, whereas endoscopic interventions were performed more frequently in the RYGB group. Antiobesity medication agents, especially glucagon-like peptide-1 receptor agonists drugs, were more effective in patients who underwent RYGB.
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Affiliation(s)
- Pourya Medhati
- Laboratory for Surgical and Metabolic Research, Brigham and Women's Hospital (Medhati, Saleh, Nimeri, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
| | - Omnia S Saleh
- Laboratory for Surgical and Metabolic Research, Brigham and Women's Hospital (Medhati, Saleh, Nimeri, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
| | - Abdelrahman Nimeri
- From the Division of General and GI Surgery (Nimeri, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
- Center for Weight Management and Wellness (Nimeri, Apovian, Thompson, Jirapinyo, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
- Laboratory for Surgical and Metabolic Research, Brigham and Women's Hospital (Medhati, Saleh, Nimeri, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
| | - Caroline Apovian
- Center for Weight Management and Wellness (Nimeri, Apovian, Thompson, Jirapinyo, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
| | - Christopher Thompson
- Center for Weight Management and Wellness (Nimeri, Apovian, Thompson, Jirapinyo, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
| | - Pichamol Jirapinyo
- Center for Weight Management and Wellness (Nimeri, Apovian, Thompson, Jirapinyo, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
| | - Eric G Sheu
- From the Division of General and GI Surgery (Nimeri, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
- Center for Weight Management and Wellness (Nimeri, Apovian, Thompson, Jirapinyo, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
- Laboratory for Surgical and Metabolic Research, Brigham and Women's Hospital (Medhati, Saleh, Nimeri, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
| | - Ali Tavakkoli
- From the Division of General and GI Surgery (Nimeri, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
- Center for Weight Management and Wellness (Nimeri, Apovian, Thompson, Jirapinyo, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
- Laboratory for Surgical and Metabolic Research, Brigham and Women's Hospital (Medhati, Saleh, Nimeri, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
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6
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Sahagian KG. Invited Commentary. J Am Coll Surg 2024; 238:1043-1044. [PMID: 38506393 DOI: 10.1097/xcs.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
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7
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Shin TH, Dang J, Howell M, Husain FA, Ghanem OM, GBittner J, Eckhouse SR, Fearing N, Elli E, Hussain M, Galvani C, Johnson S, Chand B, Pandya Y, Rogers AM, Kroh M, Kurian M. The SAGES MASTERS program bariatric surgery pathway selects 10 seminal publications on revisional bariatrics. Surg Endosc 2024; 38:2309-2314. [PMID: 38555320 DOI: 10.1007/s00464-024-10811-0] [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: 12/18/2023] [Accepted: 03/21/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Masters Program designated bariatric surgery as a clinical pathway. Among the tiers of the Masters Program, revisional bariatric surgery is the highest tier of "mastery" within the pathway. This article presents the top 10 seminal studies representing the current landscape of revisional bariatrics. METHODS The literature was systematically searched and seminal articles designated by consensus agreement of the SAGES Metabolic and Bariatric Surgery committee using multiple criteria, including impact on the field, citation frequency, and expert opinion. Articles were reviewed by committee members and presented in summarized fashion. RESULTS The top 10 papers are presented in grouped thematic categories covering the early evolution of revisional bariatrics, changing criteria for reoperative bariatric surgery, divergence of revision versus conversion bariatric surgery, and recent technologic innovations in revisional bariatric surgery. Each summary is presented with expert appraisal and commentary. CONCLUSION These seminal papers represent a snapshot of the dynamic field of revisional bariatric surgery and emphasize the need to not only remain current with contemporary trends but also keep a patient-oriented perspective on patient and intervention selection for optimal success.
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Affiliation(s)
- Thomas H Shin
- Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | - Jerry Dang
- Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Melanie Howell
- Department of Surgery, Bassett Medical Center, Cooperstown, NY, USA
| | - Farah A Husain
- Department of Surgery, University of Arizona, Phoenix, AZ, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - James GBittner
- Department of Surgery, St. Francis Hospital, Hartford, CT, USA
| | - Shaina R Eckhouse
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Nicole Fearing
- Department of Surgery, HCA Midwest Health, Overland Park, KS, USA
| | - Enrique Elli
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mustafa Hussain
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Carlos Galvani
- Department of Surgery, University of Arizona Tucson, Tucson, AZ, USA
| | - Shaneeta Johnson
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| | - Bipan Chand
- Department of Surgery, Ascension Illinois, Chicago, IL, USA
| | - Yagnik Pandya
- Department of Surgery, Boston University, Boston, MA, USA
| | - Ann M Rogers
- Department of Surgery, Penn State, Hershey, PA, USA
| | - Matthew Kroh
- Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Marina Kurian
- Department of Surgery, New York University Langone, New York, NY, USA
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8
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Nedelcut S, Axer S, Olbers T. The risk and benefit of revisional vs. primary metabolic- bariatric surgery and drug therapy - A narrative review. Metabolism 2024; 154:155799. [PMID: 38281557 DOI: 10.1016/j.metabol.2024.155799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 01/30/2024]
Abstract
Metabolic and bariatric surgery (MBS) leads to long-term weight loss, reduced risk of cardiovascular events and cancer, and reduced mortality. Sleeve gastrectomy and Roux-en-Y gastric bypass are currently the most common surgical techniques. Weight loss after MBS was previously believed to work through restriction and malabsorption, however, mechanistic studies show that MBS techniques with long term efficacy instead alter physiological signaling between the gut and the brain. In revisional MBS, the initial surgical technique is corrected, modified, or converted to a new one. The indication for revisional MBS can be to achieve further weight loss or improvement in obesity comorbidity, but it may be necessary due to complications (e.g., gastroesophageal reflux or obstruction). Revisional MBS is associated with an increased risk of surgical complications and often less weight loss compared to the results following primary surgery. This narrative review summarizes data from revisional MBS where information is often presented with inconsistent definitions for indications and outcomes, making comparison between strategies difficult. In summary, we suggest careful weighing of potential benefits and risks with revisional MBS, bearing in mind the option of add-on therapy with new anti-obesity drugs.
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Affiliation(s)
| | - Stephan Axer
- Faculty of Health and Medicine, Örebro University, Campus USÖ, 701 82 Örebro, Sweden; Department of General Surgery, Torsby Hospital, Box 502, 685 29 Torsby, Sweden
| | - Torsten Olbers
- Department of Biomedical and Clinical Sciences, Department of Surgery, Linköping University, Norrköping, Sweden
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9
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Gagner M, Almutlaq L, Cadiere GB, Torres AJ, Sanchez-Pernaute A, Buchwald JN, Abuladze D. Side-to-side magnetic duodeno-ileostomy in adults with severe obesity with or without type 2 diabetes: early outcomes with prior or concurrent sleeve gastrectomy. Surg Obes Relat Dis 2024; 20:341-352. [PMID: 38114385 DOI: 10.1016/j.soard.2023.10.018] [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: 06/28/2023] [Revised: 10/19/2023] [Accepted: 10/29/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Conventional metabolic/bariatric surgical anastomoses with sutures/staples may cause severe adverse events (AEs). OBJECTIVES The study aim was to evaluate the feasibility, safety, and effectiveness of primary and revisional side-to-side duodeno-ileostomy (DI) bipartition using a novel magnetic compression anastomosis device (Magnet Anastomosis System [MS]). SETTING Multicenter: private practices and university hospitals. METHODS In patients with body mass index ([BMI, kg/m2] ≥35.0 to ≤50.0 with/without type 2 diabetes [T2D] glycosylated hemoglobin [HbA1C > 6.5 %]), two linear MS magnets were delivered endoscopically to the duodenum and ileum with laparoscopic assistance and aligned, initiating magnet fusion and gradual DI (MagDI). The MagDI-after-SG group had undergone prior sleeve gastrectomy (SG); the MagDI + SG group underwent concurrent SG. AEs were graded by Clavien-Dindo Classification (CDC). RESULTS Between November 22, 2021 and May 30, 2023, 43 patients (88.0% female, mean age 43.7 ± 1.3 years) underwent the study procedures. The MS met feasibility criteria of magnet device placement, creation of patent anastomoses confirmed radiologically, and magnet passage in 100.0% of patients. There were 64 AEs, most were CDC grade I and II, significantly fewer in the MagDI-after-SG group (P < .001). No device-related AEs including anastomotic leakage, bleeding, obstruction, infection, or death. The MagDI-after-SG group experienced 6-month mean weight loss of 8.0 ± 2.5 kg (P < .01), 17.4 ± 5.0% excess weight loss (EWL). The MagDI + SG group had significantly greater weight loss (34.2 ± 1.6 kg, P < .001), 66.2 ± 3.4% EWL. All patients with T2D improved. CONCLUSIONS In early results of a multicenter study, the incisionless, sutureless Magnet System formed patent, complication-free anastomoses in side-to-side DI with prior or concurrent SG.
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Affiliation(s)
- Michel Gagner
- Department of Surgery, Westmount Square Surgical Center, Westmount, Quebec, Canada.
| | - Lamees Almutlaq
- Department of Surgery, Westmount Square Surgical Center, Westmount, Quebec, Canada
| | | | - Antonio J Torres
- Department of Surgery, Hospital Clinico San Carlos, Madrid, Spain
| | | | - Jane N Buchwald
- Medwrite Medical Communications, Maiden Rock, Wisconsin, USA
| | - David Abuladze
- Department of Surgery, Innova Medical Center, Tbilisi, Republic of Georgia
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10
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Abi Mosleh K, Belluzzi A, Jawhar N, Marrero K, Al-Kordi M, Hage K, Ghanem OM. Single Anastomosis Duodenoileostomy with Sleeve: A Comprehensive Review of Anatomy, Surgical Technique, and Outcomes. Curr Obes Rep 2024; 13:121-131. [PMID: 38172473 DOI: 10.1007/s13679-023-00535-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Single anastomosis duodenoileal bypass with sleeve (SADI-S) is a recently endorsed metabolic and bariatric surgery (MBS) procedure in the US. Despite its favorable characteristics, the utilization of SADI-S remains limited, accounting for a mere 0.25% of all MBS procedures performed. This review aims to offer an updated examination of the technique, while also presenting the safety and outcomes associated with SADI-S on both the short and long term. RECENT FINDINGS The safety of SADI-S is well-established, with short-term complication rates as low as 2.6%. A common channel length of 300 cm has consistently shown a lower incidence of malabsorption complications compared to shorter lengths. Bile reflux after SADI-S is relatively rare with an incidence of only 1.23%. SADI-S demonstrated sustained total weight loss (%TWL) at 5 years (37%) and 10 years (34%) postoperatively. Resolution of weight-related medical conditions was also significant after SADI-S, with remission rates of diabetes mellitus as high as 86.6% with over 5 years of follow-up. SADI-S is a safe and effective MBS procedure that has shown impressive and sustainable results in terms of weight loss and improvement in obesity-related medical conditions. Careful limb length selection is essential in minimizing the risk of nutritional deficiencies. SADI-S holds great promise as a valuable option for individuals seeking effective weight loss and improvement in associated health conditions.
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Affiliation(s)
- Kamal Abi Mosleh
- Department of Metabolic and Abdominal Wall Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Amanda Belluzzi
- Department of Metabolic and Abdominal Wall Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Noura Jawhar
- Division of Pediatric Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Katie Marrero
- Department of Surgery, Carle Foundation Hospital, Champaign, IL, USA
| | - Mohammad Al-Kordi
- Department of Metabolic and Abdominal Wall Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Karl Hage
- Department of Metabolic and Abdominal Wall Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Omar M Ghanem
- Department of Metabolic and Abdominal Wall Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Ataya K, Bsat A, Al Tannir AH, Al Jaafareh AM, Rabih Al A, Abi Saad G. Single Anastomosis Duodeno-Ileal Bypass (SADI) as a Second Step After Failed Sleeve Gastrectomy: Systematic Review and Meta-analysis. JOURNAL OF METABOLIC AND BARIATRIC SURGERY 2023; 12:35-43. [PMID: 38196784 PMCID: PMC10771976 DOI: 10.17476/jmbs.2023.12.2.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 01/11/2024]
Abstract
Purpose Our aim in this study is to assess single anastomosis duodeno-ileal bypass (SADI) as a salvage procedure following sleeve gastrectomy (SG), examining its technical feasibility, outcomes, and potential complications. Materials and Methods A systematic review and meta-analysis were conducted, drawing data from PubMed, Medline, and the Cochrane library. The analysis encompassed 14 studies, involving 1,066 patients. We evaluated operative time, comorbidity resolution (hypertension, dyslipidemia, diabetes), post-operative diarrhea incidence, excess weight loss (EWL) at six, twelve, and twenty-four months, and post-operative leak rates. Results SADI as a salvage procedure following SG yielded positive outcomes. Mean operative time was 125.98 minutes (95% CI 102.50-149.46, I2=99%). Importantly, SADI led to comorbidity resolution in a notable proportion of cases: hypertension in 48% (95% CI 38-57%, I2=44%), dyslipidemia in 55% (95% CI 40-69%, I2=30%), and diabetes in 63% (95% CI 53-72%, I2=30%) of patients. Post-operative diarrhea incidence was relatively low at 2% (95% CI 1-9%, I2=75%). In terms of weight loss, SADI patients exhibited substantial EWL: 47.73% (95% CI 37.86-57.61, I2=95%) at six months, 59.39% (95% CI 51.18-67.61, I2=95%) at twelve months, and 23.84% (95% CI 5.76-41.92, I2=100%). At twenty-four months. Furthermore, post-operative leak rate was relatively low, reported in only 1% (95% CI 0-5%, I2=80%) of cases. Conclusion SADI as a salvage procedure post-SG demonstrates technical feasibility and marked effectiveness. It offers substantial comorbidity resolution, significant weight loss, and low post-operative complication rates, notably post-operative leaks. Further research should investigate the long-term impact of SADI on patient nutritional status to facilitate its broader adoption.
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Affiliation(s)
- Karim Ataya
- Department of Bariatric Surgery, Kings College Hospital London, London, UK
| | - Ayman Bsat
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdul Hafiz Al Tannir
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Amir Rabih Al
- Lebanese University Faculty of Medical Sciences, Beirut, Lebanon
| | - George Abi Saad
- Department of General Surgery, American University of Beirut, Beirut, Lebanon
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12
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Esparham A, Roohi S, Ahmadyar S, Dalili A, Moghadam HA, Torres AJ, Khorgami Z. The Efficacy and Safety of Laparoscopic Single-Anastomosis Duodeno-ileostomy with Sleeve Gastrectomy (SADI-S) in Mid- and Long-Term Follow-Up: a Systematic Review. Obes Surg 2023; 33:4070-4079. [PMID: 37880461 DOI: 10.1007/s11695-023-06846-2] [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: 05/03/2023] [Revised: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 10/27/2023]
Abstract
This systematic review of 10 studies aimed to investigate the mid- and long-term results of duodeno-ileostomy with sleeve gastrectomy (SADI-S) according to the PRISMA guideline. Related articles, which reported outcomes of laparoscopic SADI-S with follow-up ≥ 3 years, were selected and analyzed. The percentage of excess weight loss (EWL) was 70.9-88.7%, and 80.4% at 6, and 10 years, respectively. The more common late complications were malabsorption (6.3%) and gastroesophageal reflux disease (GERD) (3.6%). The remission rates of hypertension, diabetes, GERD, obstructive sleep apnea, and dyslipidemia were 62.9%, 81.3%, 53.2%, 60.9%, and 69.7%, respectively. In conclusion, SADI-S is a safe and effective surgical technique with durable weight loss and a high rate of comorbidity resolution in mid and long term.
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Affiliation(s)
- Ali Esparham
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Roohi
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Soheil Ahmadyar
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Dalili
- Department of General Surgery, School of Medicine, Surgical Oncology Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hengameh Anari Moghadam
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Antonio José Torres
- General and Digestive Surgery Service, Hospital Clínico San Carlos, Department of Surgery, Complutense University Medical School, Universidad Complutense de Madrid (UCM), IdISSC, Madrid, Spain
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK, USA.
- Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK, 1919 S. Wheeling Avenue, Suite 600, Tulsa, OK, USA.
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13
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Barajas-Gamboa JS, Moon S, Romero-Velez G, Strong AT, Allemang M, Navarrete S, Corcelles R, Rodriguez J, Kroh M, Dang JT. Primary single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) versus sleeve gastrectomy to SADI conversions: a comparison study of prevalence and safety. Surg Endosc 2023; 37:8682-8689. [PMID: 37500921 DOI: 10.1007/s00464-023-10305-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Conversion from sleeve gastrectomy (SG) to single anastomosis duodeno-ileal bypass (SADI) is becoming increasingly common, but data regarding safety is of these conversions is scarce. As such, the objective of this study was to compare the 30-day rate of serious complications and mortality of primary SADI (p-SADI-S) with SG to SADI (SG-SADI) conversions. METHODS This retrospective cohort study analyzed the MBSAQIP database. Patients undergoing p-SADI-S and SG-SADI were included. Data collection was limited to 2020 and 2021. A multivariable logistic regression analysis was performed between groups to determine if SG-SADI was an independent predictor of 30-day serious complications or mortality. RESULTS A total of 783 patients were included in this study, 488 (62.3%) underwent p-SADI-S and 295 (37.6%) underwent SG-SADI. The mean body mass index (BMI) at the time of surgery was lower in the SG-SADI cohort (45.1 vs 51.4 kg/m2, p < 0.001). Indications for revision in the SG-SADI cohort included weight recurrence (50.8%), inadequate weight loss (41.0%), other (3.0%), GERD (2.7%), and persistent comorbidities (2.5%). SG-SADI had longer operative times (156.7 vs 142.1 min, p < 0.001) and was not associated with a higher rate of serious complications (5.7 vs 6.9%, p = 0.508) compared to p-SADI-S. p-SADI-S was associated with a higher rate of pneumonia (1.2 vs 0.0%, p < 0.001), and SG-SADI was not correlated with higher rates of reoperation (3.0 vs 3.2%, p = 0.861), readmission (5.4 vs 5.5%, p = 0.948) and death (0.0 vs 0.2%, p = 0.437). On multivariable analysis, SG-SADI was not independently predictive of serious complications (OR 0.81, 95% CI 0.43 to 1.52, p = 0.514) when adjusting for age, sex, BMI, comorbidities, and operative time. CONCLUSIONS The prevalence of SG-SADI is high, representing 37.6% of SADI-S procedures. Conversion from sleeve to SADI, is safe, and as opposed to other studies of revisional bariatric surgery, has similar 30-day complication rates to primary SADI-S.
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Affiliation(s)
- Juan S Barajas-Gamboa
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Soon Moon
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Andrew T Strong
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew Allemang
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Salvador Navarrete
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ricard Corcelles
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Ave, Cleveland, OH, 44195, 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, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Matthew Kroh
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Jerry T Dang
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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14
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Dirnberger AS, Süsstrunk J, Schneider R, Poljo A, Klasen JM, Slawik M, Billeter AT, Müller-Stich BP, Peterli R, Kraljević M. Mid-Term Outcomes After Conversion Procedures Following Laparoscopic Sleeve Gastrectomy. Obes Surg 2023; 33:2679-2686. [PMID: 37515694 PMCID: PMC10435413 DOI: 10.1007/s11695-023-06734-9] [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: 05/08/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE In the long term, laparoscopic sleeve gastrectomy (SG) may be associated with insufficient weight loss (IWL), gastroesophageal reflux disease (GERD), and persistence or relapse of associated medical problems. This study's objective is to present mid-term results regarding weight loss (WL), evolution of associated medical problems, and reoperation rate of patients who underwent a conversion after SG. METHODS Retrospective single-center analysis of patients with a minimal follow-up of 2 years after conversion. RESULTS In this series of 549 SGs, 84 patients (15.3%) underwent a conversion, and 71 met inclusion criteria. They were converted to short biliopancreatic limb Roux-en-Y gastric bypass (short BPL RYGB) (n = 28, 39.4%), biliopancreatic diversion with duodenal switch (BPD/DS) (n = 19, 26.8%), long biliopancreatic limb Roux-en-Y gastric bypass (long BPL RYGB) (n = 17, 23.9%), and re-sleeve gastrectomy (RSG) (n = 7, 9.9%). Indications were GERD (n = 24, 33.8%), IWL (n = 23, 32.4%), IWL + GERD (n = 22, 31.0%), or stenosis/kinking of the sleeve (n = 2, 2.8%). The mean pre-revisional body mass index (BMI) was 38.0 ± 7.5 kg/m2. The mean follow-up time after conversion was 5.1 ± 3.1 years. The overall percentage of total weight loss (%TWL) was greatest after BPD/DS (36.6%) and long BPL RYGB (32.9%) compared to RSG (20.0%; p = 0.004; p = 0.049). In case of GERD, conversion to Roux-en-Y gastric bypass (RYGB) led to a resolution of symptoms in 79.5%. 16.9% of patients underwent an additional revisional procedure. CONCLUSION In the event of IWL after SG, conversion to BPD/DS provides a significant and sustainable additional WL. Conversion to RYGB leads to a reliable symptom control in patients suffering from GERD after SG.
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Affiliation(s)
- Amanda S Dirnberger
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
| | - Julian Süsstrunk
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
| | - Romano Schneider
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
| | - Adisa Poljo
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
| | - Jennifer M Klasen
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
| | - Marc Slawik
- Interdisciplinary Center of Nutritional and Metabolic Diseases, St. Clara Hospital, CH-4058, Basel, Switzerland
| | - Adrian T Billeter
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
| | - Beat P Müller-Stich
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
- Department of Clinical Research, University of Basel, CH-4031, Basel, Switzerland
| | - Ralph Peterli
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland.
- Department of Clinical Research, University of Basel, CH-4031, Basel, Switzerland.
| | - Marko Kraljević
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
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15
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Axer S, Lederhuber H, Stiede F, Szabo E, Näslund I. Weight-Related Outcomes After Revisional Bariatric Surgery in Patients with Non-response After Sleeve Gastrectomy-a Systematic Review. Obes Surg 2023; 33:2210-2218. [PMID: 37209388 PMCID: PMC10289909 DOI: 10.1007/s11695-023-06630-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 05/22/2023]
Abstract
Weight non-response after sleeve gastrectomy is an emerging issue. This systematic review compared revisional procedures for weight-related outcomes. We searched several databases for relevant articles and included adult patients with revisional bariatric procedures after primary sleeve gastrectomy. Twelve trials with 1046 patients were included, covering five revisional procedures. There were no randomised controlled trials, and 10 studies had a critical risk of bias. Significant variations in inclusion criteria, therapy benchmarks, follow-up schemes, and outcome measurements were observed, preventing meaningful comparison of results. Evidence-based treatment strategies for weight non-response after sleeve gastrectomy cannot be deduced from the current literature. Prospective studies with well-defined indications, standardised techniques, and strict adherence to outcome measurements are needed.
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Affiliation(s)
- Stephan Axer
- Faculty of Health and Medicine, Örebro University, Campus USÖ, 701 82, Örebro, Sweden.
- Department of General Surgery, Torsby Hospital, Box 502, 685 29, Torsby, Sweden.
| | - Hans Lederhuber
- Royal Devon University Healthcare NHS Foundation Trust, Church Lane, Exeter, EX2 5DW, UK
| | - Franziska Stiede
- GP Practice Dr. Fritz Weidinger & Dr. Katharina Klein, Hauptstraße 93, 82327, Tutzing, Germany
| | - Eva Szabo
- Department of Surgery, Faculty of Health and Medicine, Örebro University, Campus USÖ, 701 82, Örebro, Sweden
| | - Ingmar Näslund
- Department of Surgery, Faculty of Health and Medicine, Örebro University, Campus USÖ, 701 82, Örebro, Sweden
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16
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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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17
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Dang JT, Vaughan T, Mocanu V, Mubashir H, Barajas-Gamboa JS, Codina RC, Rodriguez J, Karmali S, Kroh M. Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass: Indications, Prevalence, and Safety. Obes Surg 2023; 33:1486-1493. [PMID: 36922465 PMCID: PMC10017068 DOI: 10.1007/s11695-023-06546-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) frequently requires conversion to Roux-en-Y gastric bypass (RYGB) due to gastroesophageal reflux disease (GERD) or weight recurrence. Current evidence evaluating the safety of conversion from SG to RYGB and its indications is limited to single centers. METHODS The objective was to determine the rate of serious complications and mortality of conversion of SG to RYGB (SG-RYGB) compared to primary RYGB (P-RYGB). This was a retrospective analysis of the MBSAQIP database which includes 30-day outcomes. Individuals undergoing P-RYGB or SG-RYGB were included. Multivariable logistic regression was performed to determine if revisional surgery was an independent predictor of serious complications or mortality. RESULTS In 2020 and 2021, 84,543 (86.3%) patients underwent P-RYGB and 13,432 (13.7%) underwent SG-RYGB. SG-RYGB cohort had lower body mass index, lower rates of diabetes and hypertension, and higher rates of GERD. GERD was the most common indication for revision (55.3%) followed by weight regain (24.4%) and inadequate weight loss (12.7%). SG-RYGB had longer operative times (145 vs. 125 min, p < 0.001) and a higher rate of serious complications (7.2 vs. 5.0%, p < 0.001). This included higher rates of anastomotic leak (0.5 vs. 0.4%, p = 0.002), bleeding (2.0 vs. 1.6%, p < 0.001), and reoperation (3.0 vs. 1.9%, p < 0.001) but not death (0.1 vs. 0.1%, p = 0.385). On multivariable analysis, SG-RYGB was independently predictive of serious complications (OR 1.21, 95%CI 1.12 to 1.32, p < 0.001) but not mortality (p = 0.316). CONCLUSIONS While SG-RYGB is safe with a low complication rate, SG-RYGB was associated with a higher rate of serious complications compared to P-RYGB.
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Affiliation(s)
- Jerry T Dang
- Digestive Diseases & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Tiffany Vaughan
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Valentin Mocanu
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Hadika Mubashir
- Digestive Diseases & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Juan S Barajas-Gamboa
- Digestive Diseases Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - John Rodriguez
- Digestive Diseases Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Shahzeer Karmali
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Matthew Kroh
- Digestive Diseases & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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18
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Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus. Surg Endosc 2023; 37:1617-1628. [PMID: 36693918 DOI: 10.1007/s00464-023-09879-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/08/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgical (MBS) procedure worldwide. Despite the desired effect of SG on weight loss and remission of obesity-associated medical problems, there are some concerns regarding the need to do revisional/conversional surgeries after SG. This study aims to make an algorithmic clinical approach based on an expert-modified Delphi consensus regarding redo-surgeries after SG, to give bariatric and metabolic surgeons a guideline that might help for the best clinical decision. METHODS Forty-six recognized bariatric and metabolic surgeons from 25 different countries participated in this Delphi consensus study in two rounds to develop a consensus on redo-surgeries after SG. An agreement/disagreement ≥ 70.0% on statements was considered to indicate a consensus. RESULTS Consensus was reached for 62 of 72 statements and experts did not achieve consensus on 10 statements after two rounds of online voting. Most of the experts believed that multi-disciplinary team evaluation should be done in all redo-procedures after SG and there should be at least 12 months of medical and supportive management before performing redo-surgeries after SG for insufficient weight loss, weight regain, and gastroesophageal reflux disease (GERD). Also, experts agreed that in case of symptomatic GERD in the presence of adequate weight loss, medical treatment for at least 1 to 2 years is an acceptable option and agreed that Roux-en Y gastric bypass is an appropriate option in this situation. There was disagreement consensus on efficacy of omentopexy in rotation and efficacy of fundoplication in the presence of a dilated fundus and GERD. CONCLUSION Redo-surgeries after SG is still an important issue among bariatric and metabolic surgeons. The proper time and procedure selection for redo-surgery need careful considerations. Although multi-disciplinary team evaluation plays a key role to evaluate best options in these situations, an algorithmic clinical approach based on the expert's consensus as a guideline can help for the best clinical decision-making.
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19
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Qin ZH, Yang X, Zheng YQ, An LY, Yang T, Du YL, Wang X, Zhao SH, Li HH, Sun CK, Sun DL, Lin YY. Quality evaluation of metabolic and bariatric surgical guidelines. Front Endocrinol (Lausanne) 2023; 14:1118564. [PMID: 36967766 PMCID: PMC10035593 DOI: 10.3389/fendo.2023.1118564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/14/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE To evaluate the quality of surgical guidelines on bariatric/metabolic surgery. METHODS Four independent reviewers used the AGREE II (The Appraisal of Guidelines for Research and Evaluation II) tool to assess the methodological quality of the included guidelines and conducted a comparative analysis of the main recommendations for surgical methods of these guidelines. RESULTS Nine surgical guidelines were included in this study. Five articles with AGREE II scores over 60% are worthy of clinical recommendation. The field of rigor of development was relatively low, with an average score of 50.82%. Among 15 key recommendations and the corresponding best evidence in the guidelines, only 4 key recommendations were grade A recommendations. CONCLUSIONS The quality of metabolic and bariatric guidelines is uneven, and there is much room for improvement.
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Affiliation(s)
- Zi-Han Qin
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xin Yang
- Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Ya-Qi Zheng
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Li-Ya An
- The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ting Yang
- The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yu-Lu Du
- The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xiao Wang
- The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Shu-Han Zhao
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Hao-Han Li
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Cheng-Kai Sun
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Da-Li Sun
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
- *Correspondence: Da-Li Sun, ; Yue-Ying Lin,
| | - Yue-Ying Lin
- The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- *Correspondence: Da-Li Sun, ; Yue-Ying Lin,
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20
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A C, N C, A I. Postoperative morbidity and weight loss after revisional bariatric surgery for primary failed restrictive procedure: A systematic review and network meta-analysis. Int J Surg 2022; 102:106677. [PMID: 35589051 DOI: 10.1016/j.ijsu.2022.106677] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND revisional bariatric surgery is gaining increasing interest as long term follow-up studies demonstrate an elevated failure rate of primary surgery due to insufficient weight loss, weight regain or complications. This particularly concerns restrictive bariatric surgery which has been widely adopted from the '80s till present through different procedures, notably vertical banded gastroplasty, laparoscopic adjusted gastric banding and sleeve gastrectomy. The aim of this study is to define which revisional bariatric procedure performs the best after failure of primary restrictive surgery. METHODS a systematic review and network meta-analysis of 39 studies was conducted following the PRISMA guidelines and the Cochrane protocol. RESULTS biliopancreatic diversion with duodenal switch guarantees the best results in terms of weight loss (1 and 3-years %TWL MD: 12.38 and 28.42) followed by single-anastomosis duodenoileal bypass (9.24 and 19.13), one-anastomosis gastric bypass (7.16 and 13.1), and Roux-en-Y gastric bypass (4.68 and 7.3) compared to re-sleeve gastrectomy. Duodenal switch and Roux-en-Y gastric bypass are associated to an increased risk of late major morbidity (OR: 3.07 and 2.11 respectively) compared to re-sleeve gastrectomy while no significant difference was highlighted for the other procedures. Re-sleeve gastrectomy is the revisional intervention most frequently burdened by weight recidivism; compared to it, patients undergoing single-anastomosis duodenoileal bypass have the lowest risk of weight regain (OR: 0.07). CONCLUSION considering the analyzed outcomes altogether, single-anastomosis duodenoileal bypass and one-anastomosis gastric bypass are the most performing revisional procedures after failure of restrictive surgery due to satisfying short and mid-term weight loss and low early and late morbidity. Moreover, single-anastomosis duodenoileal bypass has low risk of weight recidivism.
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Affiliation(s)
- Chierici A
- Service de Chirurgie Digestive, Centre Hospitalier D'Antibes Juan-les-Pins, 107, av. de Nice, 06600, Antibes, France
| | - Chevalier N
- Inserm U1065, C3M, Nice, France; Université Côte D'Azur, Nice, France; Service D'Endocrinologie, Diabétologie et Médecine de la Reproduction, Archet 2 Hospital, Nice, France
| | - Iannelli A
- Université Côte D'Azur, Nice, France; Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France; Inserm, U1065, Team 8 "Hepatic complications of Obesity and alcohol", France.
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