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Kara YB, Ozel Y, Yardimci S. Efficacy of Omentopexy on Complications of Laparoscopic Sleeve Gastrectomy. Obes Surg 2024; 34:3298-3305. [PMID: 38914741 PMCID: PMC11349786 DOI: 10.1007/s11695-024-07363-6] [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: 04/14/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a commonly performed type of bariatric surgery. Early complications of LSG include bleeding, leakage, pulmonary embolism, and surgical site infections. Most surgeons try to implement preventive methods, such as omentopexy. Staple line-imbrication, which has a difficult learning curve, often prevents complications. This study aimed to evaluate the effect of omentopexy on patients with imbricated LSG. MATERIAL AND METHODS The study applied a retrospective data analysis design to patients who underwent LSG between 2020 and 2023. All patients' staple lines were imbricated, and patients were then divided into two groups: omentopexy group and control group. Patients' demographic features, such as age, gender, height, weight, body mass index(BMI), bleeding, leakage, and reoperations, were recorded and examined retrospectively. RESULTS A total of 1356 patients were included in the study (540 in omentopexy, 816 in control), of which the mean age was 37.9 ± 10.5 years, 82.3% were women, and mean BMI was 40.9 ± 5.8 kg/m2. The mean bleeding rate was 1.0% (1.3-0.7%), the mean leakage rate was 0.2% (0.2-0.2%, respectively), and the mean reoperation rate was 0.6% (0.7% and 0.5%, respectively). No statistically significant differences were observed. CONCLUSION Omentopexy is a technique that is widely used to prevent staple line complications. According to our study, omentopexy applied to an imbricated stapler line increased the operation time but did not affect bleeding or leakage ratios. This is the first study to evaluate the effect of omentopexy on imbricated staple lines. The findings of the study indicate that omentopexy has no additional benefit on early complications when using staple-line imbrication.
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Affiliation(s)
- Yalcin Burak Kara
- General Surgery Department, Bahcesehir University VM Medical Park Pendik Hospital, Fevzi Çakmak Mahallesi, D100, Cemal Gürsel Cd. No:9, Pendik, 34899, Istanbul, Turkey.
| | - Yahya Ozel
- General Surgery Department, Dogus University VM Medical Park Pendik Hospital, Fevzi Çakmak Mahallesi, D100, Cemal Gürsel Cd. No:9, Pendik, 34899, Istanbul, Turkey
| | - Samet Yardimci
- General Surgery Department, Istinye University VM Medical Park Pendik Hospital, Fevzi Çakmak Mahallesi, D100, Cemal Gürsel Cd. No:9, Pendik, 34899, Istanbul, Turkey
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Kowal S, Vendrov M, Vaz D, Mir ZM, Hanna NM, Zevin B. The Safety and Efficacy of Concurrent Laparoscopic Cholecystectomy during Minimally Invasive Roux-en-Y Gastric Bypass: A Systematic Review. Obes Surg 2024; 34:2650-2655. [PMID: 38767785 DOI: 10.1007/s11695-024-07270-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/26/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
We conducted a systematic review to examine perioperative outcomes for adults undergoing minimally invasive Roux-en-Y gastric bypass (RYGB) with and without concurrent cholecystectomy (CCE). We reviewed the literature using OVID MEDLINE(R), Embase, Cochrane CENTRAL, Web of Science, and medRxiv and identified studies published between 1946 and May 2023. We identified a total of 2402 studies with 11 included in the final analysis (combined 149,356 patients). Studies suggested increased operative time associated with RYGB-CCE, with mixed results regarding length of stay and rates of bile duct injury. Presently available data is not robust enough to conclude whether minimally invasive RYGB with CCE harms or benefits patients compared to RYGB alone.
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Affiliation(s)
- Sloane Kowal
- School of Medicine, Queen's University, 80 Barrie Street, Kingston, ON, K7L 3N6, Canada
| | - Mitchell Vendrov
- Department of Medicine, Queen's University, Kingston, Ontario 76 Stuart St, Kingston, ON, K7L 2V7, Canada
| | - David Vaz
- School of Medicine, Queen's University, 80 Barrie Street, Kingston, ON, K7L 3N6, Canada
| | - Zuhaib M Mir
- Department of Surgery, Division of General Surgery, Dalhousie University, Halifax, Nova Scotia Room 8-848, 1278 Tower Road, Halifax, NS, B3H 2Y9, Canada
| | - Nader M Hanna
- Department of Surgery, Queen's University, Kingston, Ontario 76 Stuart St, Kingston, ON, K7L 2V7, Canada
| | - Boris Zevin
- Department of Surgery, Queen's University, Kingston, Ontario 76 Stuart St, Kingston, ON, K7L 2V7, Canada.
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Kermansaravi M, Shikora S, Dillemans B, Kurian M, LaMasters T, Vilallonga R, Prager G, Chiappetta S. The Management of Biliary Disease in Patients with Severe Obesity Undergoing Metabolic and Bariatric Surgery-An International Expert Survey. Obes Surg 2024; 34:1086-1096. [PMID: 38400945 DOI: 10.1007/s11695-024-07101-y] [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: 12/20/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE This study aimed to survey international experts in metabolic and bariatric surgery (MBS) to improve and consolidate the management of biliary disease in patients with severe obesity undergoing MBS. BACKGROUND Obesity and rapid weight loss after MBS are risk factors for the development of gallstones. Complications, such as cholecystitis, acute cholangitis, and biliary pancreatitis, are potentially life-threatening, and no guidelines for the proper management of gallstone disease exist. METHODS An international scientific team designed an online confidential questionnaire with 26 multiple-choice questions. The survey was answered by 86 invited experts (from 38 different countries), who participated from August 1, 2023, to September 9, 2023. RESULTS Two-thirds of experts (67.4%) perform concomitant cholecystectomy in symptomatic gallstones during MBS. Half of experts (50%) would wait 6-12 weeks between both surgeries with an interval approach. Approximately 57% of the experts prescribe ursodeoxycholic acid (UDCA) prophylactically after MBS, and most recommend a 6-month course. More than the half of the experts (59.3%/53.5%) preferred laparoscopic assisted transgastric ERCP as the approach for treating CBD stones in patients who previously had RYGB/OAGB. CONCLUSION Concomitant cholecystectomy is preferred by the experts, although evidence in the literature reports an increased complication rate. Prophylactic UDCA should be recommended to every MBS patient, even though the current survey demonstrated that not all experts are recommending it. The preferred approach for treating common bile duct stones is a laparoscopic assisted transgastric ERCP after gastric bypass. The conflicting responses will need more scientific work and clarity in the future.
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Affiliation(s)
- Mohammad Kermansaravi
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Hazrat-E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Scott Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bruno Dillemans
- Department of General Surgery, AZ Sint Jan Brugge-Oostende, Brugge, Belgium
| | - Marina Kurian
- Department of Surgery, NYU Langone Medical Center, New York, NY, 10016, USA
| | - Teresa LaMasters
- UnityPoint Clinic Weight Loss Specialists, West Des Moines, IA, USA
| | - Ramon Vilallonga
- Endocrine, Bariatric and Metabolic Surgery Department, University Hospital Vall Hebron, Barcelona, Spain
| | - Gerhard Prager
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Sonja Chiappetta
- Bariatric and Metabolic Surgery Unit, Department of General and Laparoscopic Surgery, Ospedale Evangelico Betania, Via Argine 604, 80147, Naples, Italy.
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Huseynov E, Aliyev V, Coban G. Bile Leakage From the Luschka Duct After Laparoscopic Sleeve Gastrectomy and Cholecystectomy: A Case Report. Cureus 2023; 15:e35684. [PMID: 37009350 PMCID: PMC10065306 DOI: 10.7759/cureus.35684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 03/06/2023] Open
Abstract
Bile leakage may develop as a result of traumatic or iatrogenic injuries of bile ducts during laparoscopic cholecystectomy (LC). The frequency of Luschka duct injuries during LC is extremely rare. In this case, we present a case of bile leakage due to Luschka duct injury during sleeve gastrectomy (SG) and LC. The leakage was not noticed during the surgery, and on postoperative day 2, bilious drainage was seen from the drain. Magnetic resonance imaging (MRI) was helpful to determine Luschka duct injury. Biliary leakage resolved after endoscopic retrograde cholangiopancreatography (ERCP) with stent placement.
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Affiliation(s)
- Elnur Huseynov
- General and Obesity Surgery, Avrupa Safak Hospital, Istanbul, TUR
| | - Vusal Aliyev
- General Surgery, Bogazici Academy for Clinical Sciences, Istanbul, TUR
| | - Gulcan Coban
- General Surgery, Avrupa Safak Hospital, Istanbul, TUR
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Dayan D, Dvir N, Nizri E, Abu-Abeid S, Lahat G, Abu-Abeid A. Safety of concomitant cholecystectomy during one anastomosis gastric bypass compared with sleeve gastrectomy and Roux-en-Y gastric bypass. Updates Surg 2023; 75:671-678. [PMID: 36790632 DOI: 10.1007/s13304-023-01463-1] [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: 11/06/2022] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
Candidates of metabolic and bariatric surgery (MBS) are prone for gallstone formation. Concomitant cholecystectomy (CC) during MBS is controversial. This study is first to examine the safety of CC during one anastomosis gastric bypass (OAGB), compared with sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Single-center retrospective comparative study of CC (2012-2021) during OAGB, to SG and RYGB. CC was performed in 115 patients during OAGB (n = 50), SG (n = 39), and RYGB (n = 26). All procedures were completed laparoscopically. Baseline characteristics were similar except age, body mass index, gastroesophageal reflux disease, obstructive sleep apnea, and previous MBS (p < 0.05). Intraoperative complications occurred in one OAGB patient (2% vs. 0%, 0%; p = 0.52), which was not cholecystectomy related. There were no differences in total (6% vs. 2.6%, 15.4%; p = 0.13) and major (2% vs. 0%, 3.8; p = 0.50) early-complication rates. Of them, cholecystectomy-related complications occurred in one OAGB, compared with none of SG and one RYGB (2% vs. 0%, 3.8%; p = 0.50). The former was major, and the latter was minor complication. None of the OAGB patients needed re-admission (0% vs. 0%, 11.5; p = 0.04). All CC outcome parameters were similar between asymptomatic and symptomatic gallstones. Previous bariatric procedures were found to be a significant risk for major complications and readmissions (OR = 16.87, p = 0.019). CC during OAGB for gallstones seems safe, as in SG and RYGB. No cholecystectomy-related intraoperative complications occurred, and postoperative complication rates were low and acceptable. Outcomes for asymptomatic gallstones were similar to symptomatic ones, and we cautiously support CC in the presence of gallstones.
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Affiliation(s)
- Danit Dayan
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman Street, 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
| | - Nadav Dvir
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman Street, 6423906, Tel Aviv, Israel
| | - Eran Nizri
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman Street, 6423906, Tel Aviv, Israel
| | - Subhi Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman Street, 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
| | - Guy Lahat
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman Street, 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
| | - Adam Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman Street, 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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