1
|
Shahabi Shahmiri S, Sheikhbahaei E, Davarpanah Jazi A, Zefreh H, Yang W, Valizadeh R, Ribeiro R, Kermansaravi M. Remnant Gastrectomy and Gastric Bypass: A Systematic Review of Indications and Outcomes of Resectional Gastric Bypass. Obes Surg 2024; 34:2634-2649. [PMID: 38735966 DOI: 10.1007/s11695-024-07240-2] [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: 03/13/2024] [Revised: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND In this systematic review, we aim to evaluate the reasons and outcomes behind remnant gastrectomy with or after gastric bypass procedures. RESULTS A total of 66 studies examining 1918 patients were included in this study with 70% of female predominance. Twenty studies reported RGB on 1751 patients and 46 studies reported remnant gastrectomy after gastric bypass in 167 patients. The most common etiology of RGB was related to the in situ remnant stomach neoplasia in 10 studies on 981 patients; mostly for preventive intentions in high prevalence areas. Remnant gastrectomy after gastric bypass was performed to treat a complication such as GGF, retrograde bile reflux gastritis, cancer mostly adenocarcinoma. Studies revealed that RGB has similar weight loss in comparison to standard Roux-en-Y gastric bypass.
Collapse
Affiliation(s)
- Shahab Shahabi Shahmiri
- Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-e Akram University Hospital, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-e Rasool University Hospital, Tehran, Iran
| | - Erfan Sheikhbahaei
- Minimally Invasive and Bariatric Surgery Research Center of Rasool-e Akram University Hospital, Iran University of Medical Sciences, Manaouri St., Niyayesh St., Sattar Khan St., Tehran, Iran
- Minimally Invasive Surgery and Obesity Research Center, School of Medicine, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirhossein Davarpanah Jazi
- Minimally Invasive and Bariatric Surgery Research Center of Rasool-e Akram University Hospital, Iran University of Medical Sciences, Manaouri St., Niyayesh St., Sattar Khan St., Tehran, Iran.
| | - Hamidreza Zefreh
- Minimally Invasive Surgery and Obesity Research Center, School of Medicine, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- The State Key Laboratory of Pharmaceutical Biotechnology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Rui Ribeiro
- Hospital Lusiadas Amadora Metabolic Surgery Unit and General Surgery Department Coordinator, Amadora, Portugal
| | - Mohammad Kermansaravi
- Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-e Akram University Hospital, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-e Rasool University Hospital, Tehran, Iran
| |
Collapse
|
2
|
Yaqub S, Tholfsen T, Waage A, Kleive D, Labori KJ. Pancreatoduodenectomy after Roux-en-Y gastric bypass surgery: Single-center experience and literature review. Scand J Surg 2023; 112:98-104. [PMID: 36803183 DOI: 10.1177/14574969231156350] [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: 02/23/2023]
Abstract
BACKGROUND AND OBJECTIVE Bariatric surgery with Roux-en-Y gastric bypass (RYGB) is widely used to treat morbid obesity and present diagnostic and therapeutic challenges in patients with pancreatic and periampullary tumors. The aim of this study was to describe diagnostic tools and challenges in performing pancreatoduodenectomy (PD) on patients with altered anatomy after RYGB. METHODS Patients undergoing PD after RYGB from April 2015 to June 2022 at a tertiary referral center were identified. Preoperative workup, operative techniques, and outcomes were reviewed. A literature search was performed to identify articles reporting PD in post-RYGB patients. RESULTS Of a total of 788 PDs, six patients had previous RYGB. The majority were women (n = 5), and median age was 59 years. The patients most commonly presented with pain (50%) and jaundice (50%) with a median of 5.5 years after RYGB. The gastric remnant was resected in all cases, and reconstruction of the pancreatobiliary drainage was achieved using the distal part of the pre-existing pancreatobiliary limb in all patients. Median follow-up was 60 months. The Clavien-Dindo grade ⩾3 complications occurred in two patients (33.3%), and 90 days mortality occurred in one patient (16.6%). The literature search revealed 9 articles reporting a total of 122 cases, specifically addressing PD after RYGB. CONCLUSIONS Reconstruction after PD in post-RYGB patients may be challenging. Resection of the gastric remnant and use of the pre-existing biliopancreatic limb may be a safe strategy, but surgeons should be prepared for other reconstruction options for creation of a new pancreatobiliary limb.
Collapse
Affiliation(s)
- Sheraz Yaqub
- Department of Hepato-Pancreato-Biliary SurgeryOslo University HospitalSognsvannsveien 20N-0372 OsloNorwayInstitute of Clinical MedicineUniversity of OsloOsloNorway
| | - Tore Tholfsen
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Anne Waage
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Dyre Kleive
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Knut Jørgen Labori
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, NorwayInstitute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
3
|
Doukas SG, Doukas PG, Vageli DP, Broder A. Gastric cancer after Bariatric Bypass Surgery. Do they relate? (A Systematic Review). Obes Surg 2023; 33:1876-1888. [PMID: 37041375 DOI: 10.1007/s11695-023-06567-6] [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: 11/13/2022] [Revised: 03/18/2023] [Accepted: 03/28/2023] [Indexed: 04/13/2023]
Abstract
Bariatric bypass surgery has been an effective treatment for morbid obesity. However, there is an increasing number of reported cases of gastric cancer after bypass surgery. Our systematic review showed an increasing trend of gastric cancer cases after bariatric bypass surgery in the last decade, mostly located in the excluded stomach (77%) and diagnosed in an advanced stage. In addition to known risk factors such as tobacco smoking (17%), H. pylori infection (6%), and family history of gastric cancer (3%), bile reflux, a recently proposed cancer-promoting factor, was also estimated in 18% of the cases. Our data suggest that gastric cancer risk assessment should be considered before gastric bypass surgery, and further investigations are needed to determine the value of post-operative gastric cancer surveillance.
Collapse
Affiliation(s)
- Sotirios G Doukas
- Department of Medicine, Division of Gastroenterology and Hepatology, Saint Peter's University Hospital/Rutgers-RWJ Medical School, 254 Easton Avenue, New Brunswick, NJ, 08901, USA.
| | - Panagiotis G Doukas
- Departmengt of Surgery, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Dimitra P Vageli
- Departmengt of Surgery, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Arkady Broder
- Department of Medicine, Division of Gastroenterology and Hepatology, Saint Peter's University Hospital/Rutgers-RWJ Medical School, 254 Easton Avenue, New Brunswick, NJ, 08901, USA
| |
Collapse
|
4
|
Youk KM, Kim J, Cho YS, Park DJ. Gastric Cancer After Bariatric Surgeries. JOURNAL OF METABOLIC AND BARIATRIC SURGERY 2022; 11:20-29. [PMID: 36926673 PMCID: PMC10011677 DOI: 10.17476/jmbs.2022.11.2.20] [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: 01/15/2023] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 03/18/2023]
Abstract
Bariatric surgery has been covered by medical insurance in Korea, since January 2019; and its number is steadily increasing. Representative bariatric surgeries include adjustable gastric banding, sleeve gastrectomy, and Roux-en-Y gastric bypass. Each surgical method can be applied according to the patient's condition; however, there are other issues to consider in Korea. Because of the high incidence of gastric cancer in Korea, gastroscopy is recommended every two years after the age of 40. Therefore, it is difficult to perform conventional gastroscopy after Roux-en-Y gastric bypass. In this review, the incidence of gastric cancer after representative bariatric surgery was investigated through a literature review, so that it could be used as a reference for the selection of bariatric surgery in Korea.
Collapse
Affiliation(s)
- Kang Min Youk
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jeesun Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yo-Seok Cho
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
5
|
Chemaly R, Diab S, Khazen G, Al-Hajj G. Gastroesophageal Cancer After Gastric Bypass Surgeries: a Systematic Review and Meta-analysis. Obes Surg 2022; 32:1300-1311. [PMID: 35084611 DOI: 10.1007/s11695-022-05921-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 12/11/2022]
Abstract
Data comparing the occurrence of gastroesophageal cancer after gastric bypass procedures are lacking and are only available in the form of case reports. We perform in this study a systematic review and a meta-analysis of all the reported cases of gastroesophageal cancer following Roux-en-Y gastric bypass (RYGB) and loop gastric bypass-one anastomosis gastric bypass/mini gastric bypass (LGB-OAGB/MGB). We conducted a systematic review of all the reported cases in articles referenced in PubMed/Medline, Cochrane, and Scholar Google. Only cases of gastro-esophageal adenocarcinoma following RYGB or LGB-OAGB/MGB are included. Statistical analysis was done accordingly. Fifty cases were identified, along with 2 reported in this paper. Sixty-one percent (27/44) of the cancers after RYGB were in the gastric tube compared to 37.5% (3/8) after LGB-OAGB/MGB. This resulted in an odds ratio of 0.38 (p-value = 0.26), which failed to prove an increase in cancer occurrence in the gastric tube after LGB-MGB/OAGB compared to RYGB. The most common symptoms were dysphagia for cancers occurring in the gastric tube (15/30) and abdominal pain for those occurring in the excluded stomach (10/22). Twenty-nine/thirty of the cancers in the gastric tube were diagnosed by gastroscopy and 13/22 of the cancers in the excluded stomach were diagnosed by CT scan. Gastroesophageal cancers after gastric bypass procedures occur commonly in the excluded stomach where many are not identified by conventional means. Physician awareness and patient education as well as lifelong follow-up are essential for maintaining bypass surgeries on the beneficial side.
Collapse
Affiliation(s)
- Rodrigue Chemaly
- Department of General Surgery, Lebanese American University Medical Center - Rizk Hospital, LAU Gilbert and Rose-Marie Chagoury School of Medicine, Beirut, Lebanon. .,Department of General Surgery, Middle East Institute of Health (MEIH), Bsalim, Lebanon.
| | - Samer Diab
- Department of General Surgery, Lebanese American University Medical Center - Rizk Hospital, LAU Gilbert and Rose-Marie Chagoury School of Medicine, Beirut, Lebanon
| | - Georges Khazen
- Department of Computer Science and Mathematical, Lebanese American University, Beirut, Lebanon
| | - Georges Al-Hajj
- Department of General Surgery, Lebanese American University Medical Center - Rizk Hospital, LAU Gilbert and Rose-Marie Chagoury School of Medicine, Beirut, Lebanon.,Department of General Surgery, Middle East Institute of Health (MEIH), Bsalim, Lebanon
| |
Collapse
|
6
|
Mak MHW, Shelat VG. Pancreaticoduodenectomy after Roux-en-Y Gastric Bypass: a novel reconstruction technique. Transl Gastroenterol Hepatol 2022; 7:11. [PMID: 35243120 PMCID: PMC8826040 DOI: 10.21037/tgh.2020.02.11] [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] [Received: 10/18/2019] [Accepted: 02/10/2020] [Indexed: 02/05/2023] Open
Abstract
The obesity epidemic continues to increase around the world with its attendant complications of metabolic syndrome and increased risk of malignancies, including pancreatic malignancy. The Roux-en-Y gastric bypass (RYGB) is an effective bariatric procedure for obesity and its comorbidities. We describe a report wherein a patient with previous RYGB was treated with a novel reconstruction technique following a pancreaticoduodenectomy (PD). A 59-year-old male patient with previous history of RYGB was admitted with painless progressive jaundice. Imaging revealed a distal common bile duct stricture and he underwent PD. There are multiple options for reconstruction after PD in patients with previous RYGB. The two major decisions for pancreatic surgeon are: (I) resection/preservation of remnant stomach and (II) resection/preservation of original biliopancreatic limb. This has to be tailored to the patient based on the intraoperative findings and anatomical suitability. In our patient, the gastric remnant was preserved, and distal part of original biliopancreatic limb was anastomosed to the stomach as a venting anterior gastrojejunostomy. A distal loop of small bowel was used to reconstruct the pancreaticojejunostomy and hepaticojejunostomy and further distally a new jejunojejunostomy performed. The post-operative course was uneventful, and the patient was discharged on 7th day. With the increase in number of bariatric procedures performed worldwide, pancreatic surgeons should be aware of the varied surgical reconstruction options for PD following RYGB. This should be tailored to the patient and there is no "one-size-fits-all".
Collapse
|
7
|
Tornese S, Aiolfi A, Bonitta G, Rausa E, Guerrazzi G, Bruni PG, Micheletto G, Bona D. Remnant Gastric Cancer After Roux-en-Y Gastric Bypass: Narrative Review of the Literature. Obes Surg 2020; 29:2609-2613. [PMID: 31001760 DOI: 10.1007/s11695-019-03892-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed procedures for surgical weight loss. It has been shown that overweight may be associated with an increased risk of gastric cancer. However, the risk of remnant gastric cancer after RYGB has not been defined yet and the development of neoplasm in the excluded stomach remains a matter of concern. METHODS PubMed, EMBASE, and Web of Science databases were consulted. Articles that described the diagnosis and management of remnant gastric cancer after RYGB were considered. RESULTS Seventeen patients were included. The age of the patient population ranged from 38 to 71 years. The most commonly reported symptoms were abdominal pain, nausea/vomiting, and anemia. Abdominal computed tomography was used for diagnosis in the majority of patients. The neoplasm was located in the antrum/pre-pyloric region in 70% of cases and adenocarcinoma was the most common tumor histology (80%). An advanced tumor stage (III-IV) was diagnosed in almost 70% of patients and 40% were considered unresectable. Gastrectomy with lymphadenectomy was performed in 9 cases (53%). Post-operative morbidity was 12%. The follow-up ranged from 3 to 26 months and the overall disease-related mortality rate was 33.3%. CONCLUSION The development of remnant gastric cancer after RYGB is rare. Surgeons should be aware of this potential event and the new onset of epigastric pain, nausea, and anemia should raise clinical suspicion. Further epidemiologic studies are warranted to deeply investigate the post-RYGB-related risk of remnant gastric cancer development in high-risk populations.
Collapse
Affiliation(s)
- Stefania Tornese
- Department of Biomedical Science for Health, Division of General Surgery Istitituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Alberto Aiolfi
- Department of Biomedical Science for Health, Division of General Surgery Istitituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy.
| | - Gianluca Bonitta
- Department of Biomedical Science for Health, Division of General Surgery Istitituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Emanuele Rausa
- Department of Biomedical Science for Health, Division of General Surgery Istitituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Guglielmo Guerrazzi
- Department of Pathophysiology and Transplantation, INCO and Department of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Piero Giovanni Bruni
- Department of Biomedical Science for Health, Division of General Surgery Istitituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Giancarlo Micheletto
- Department of Pathophysiology and Transplantation, INCO and Department of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Davide Bona
- Department of Biomedical Science for Health, Division of General Surgery Istitituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| |
Collapse
|
8
|
Machado MA, Surjan R, Bassères T, Ardengh A, Makdissi F. Robotic pancreaticoduodenectomy after Roux-en-Y gastric bypass - Video article. Surg Oncol 2019; 29:118-119. [PMID: 31196474 DOI: 10.1016/j.suronc.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/26/2019] [Accepted: 04/28/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Marcel Autran Machado
- Dept. of Surgery, University of São Paulo, São Paulo, Brazil; Nove de Julho Hospital, São Paulo, Brazil.
| | - Rodrigo Surjan
- Dept. of Surgery, University of São Paulo, São Paulo, Brazil; Nove de Julho Hospital, São Paulo, Brazil
| | | | | | - Fabio Makdissi
- Nove de Julho Hospital, São Paulo, Brazil; Dept. of Gastroenterology, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
9
|
The Surgical Outcomes of Totally Laparoscopic Stomach-partitioning Gastrojejunostomy for Gastric Outlet Obstruction: A Retrospective, Cohort Study. Surg Laparosc Endosc Percutan Tech 2018; 28:e49-e53. [PMID: 29252935 DOI: 10.1097/sle.0000000000000501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND We have reported the effectiveness of laparoscopy-assisted stomach-partitioning gastrojejunostomy Roux-en-Y reconstruction (LASPGJ-RY) for gastric outlet obstruction (GOO). The aim of this study was to evaluate the surgical outcomes of totally laparoscopic stomach-partitioning gastrojejunostomy Roux-en-Y reconstruction (TLSPGJ-RY) for GOO. MATERIALS AND METHODS This retrospective study enrolled 19 consecutive patients with GOO. Surgical outcomes of LASPGJ-RY (LA group; n=8) and TLSPGJ-RY (TL group; n=11) between January 2004 and 2015 were compared. The patients' background characteristics, operative findings, postoperative complications, and period to starting postoperative chemotherapy were examined. RESULTS Eligible cases included 6 patients with gastric cancer, 4 with pancreatic cancer, 4 with duodenal cancer, 4 with urologic malignancies, and 1 with benign duodenal stenosis. The patients' background characteristics were not significantly different. In surgical outcomes, there were no significant differences in operating time, bleeding, complications (≥Clavien-Dindo grade IIIA), and postoperative hospital stay between the groups. The time to resume diet was significantly shorter in the TL group (median, 3 d; range, 3 to 6 d) than in the LA group (median, 5 d; range, 3 to 7 d; P=0.0093), and the number of patients who could receive chemotherapy after surgery was significantly higher in the TL group (P=0.039). CONCLUSIONS TLSPGJ-RY was a safe and feasible gastrojejunostomy procedure for GOO. TLSPGJ-RY might be useful for early resumption of oral intake after surgery.
Collapse
|
10
|
Morano WF, Shaikh MF, Gleeson EM, Galvez A, Khalili M, Lieb J, Renza-Stingone EP, Bowne WB. Reconstruction options following pancreaticoduodenectomy after Roux-en-Y gastric bypass: a systematic review. World J Surg Oncol 2018; 16:168. [PMID: 30103758 PMCID: PMC6090772 DOI: 10.1186/s12957-018-1467-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 08/03/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Obesity is a risk factor for pancreatic cancer which may be treated with Roux-en-Y gastric bypass and represents an increasing morbidity. Post-RYGB anatomy poses considerable challenges for reconstruction after pancreaticoduodenectomy (PD), a growing problem encountered by surgeons. We characterize specific strategies used for post-PD reconstruction in the RYGB patient. METHODS PubMed search was performed using MeSH terms "Gastric Bypass" and "Pancreaticoduodenectomy" between 2000 and 2018. Articles reporting cases of pancreaticoduodenectomy in post-RYGB patients were included and systematically reviewed for this study. RESULTS Three case reports and five case series (25 patients) addressed PD after RYGB; we report one additional case. The typical post-gastric bypass PD patient is a woman in the sixth decade of life, presenting most commonly with pain (69.2%) and/or jaundice (53.8%), median 5 years after RYGB. Five post-PD reconstructive options are reported. Among these, the gastric remnant was resected in 18 cases (69.2%), with reconstruction of biliopancreatic drainage most commonly achieved using the distal jejunal segment of the pre-existing biliopancreatic limb (73.1%). Similarly, in the eight cases where the gastric remnant was spared (30.8%), drainage was most commonly performed using the distal jejunal segment of the biliopancreatic limb (50%). Among the 17 cases reporting follow-up data, median was 27 months. CONCLUSION Reconstruction options after PD in the post-RYGB patient focus on resection or preservation gastric remnant, as well as creation of new biliopancreatic limb. Insufficient data exists to make recommendations regarding the optimal reconstruction option, yet surgeons must prepare for the possible clinical challenge. PD reconstruction post-RYGB requires evaluation through prospective studies.
Collapse
Affiliation(s)
- William F. Morano
- Division of Surgical Oncology, Department of Surgery, Drexel University College of Medicine, 245 N. 15th Street, Suite 7150, Philadelphia, PA 19102 USA
| | - Mohammad F. Shaikh
- Division of Surgical Oncology, Department of Surgery, Drexel University College of Medicine, 245 N. 15th Street, Suite 7150, Philadelphia, PA 19102 USA
| | - Elizabeth M. Gleeson
- Division of Surgical Oncology, Department of Surgery, Drexel University College of Medicine, 245 N. 15th Street, Suite 7150, Philadelphia, PA 19102 USA
| | - Alvaro Galvez
- Division of Minimally Invasive Surgery, Department of Surgery, Drexel University College of Medicine, 245 N. 15th St, Suite 7150, Philadelphia, PA 19102 USA
| | - Marian Khalili
- Division of Surgical Oncology, Department of Surgery, Drexel University College of Medicine, 245 N. 15th Street, Suite 7150, Philadelphia, PA 19102 USA
| | - John Lieb
- Division of Gastroenterology & Hepatology, Department of Medicine, Drexel University College of Medicine, 219 N Broad St, 5th Floor, Philadelphia, PA 19107 USA
| | - Elizabeth P. Renza-Stingone
- Division of Minimally Invasive Surgery, Department of Surgery, Drexel University College of Medicine, 245 N. 15th St, Suite 7150, Philadelphia, PA 19102 USA
| | - Wilbur B. Bowne
- Division of Surgical Oncology, Department of Surgery, Drexel University College of Medicine, 245 N. 15th Street, Suite 7150, Philadelphia, PA 19102 USA
| |
Collapse
|
11
|
Braghetto I, Martinez G, Korn O, Zamorano M, Lanzarini E, Narbona E. Laparoscopic subtotal gastrectomy in morbid obese patients: a valid option to laparoscopic gastric bypass in particular circumstances (prospective study). Surg Today 2018; 48:558-565. [PMID: 29450656 DOI: 10.1007/s00595-018-1625-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/05/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) without resection of the distal stomach is largely performed over the world for morbid obesity. Potential risk of gastric remnant carcinoma development has been suggested. PURPOSE To present the results obtained after LRYGB with resection of distal stomach. METHOD This prospective study includes 400 consecutive patients. The mean body weight was 105.9 ± 16.8 Kg (range 83-145 kg), and body mass index (BMI) was 38.5 ± 4.4 kg/m2 (32.9-50.3). Postoperative morbid-mortality and follow-up were analyzed. RESULTS Operative time was 128.5 ± 18.7 min, hospital discharge occurred at 3rd postoperative day, postoperative complications occurred in 9.25%, early surgical complications were observed in 3% and medical complications 4%, late surgical complications occurred 2.25%, no mortality was observed. At 1 year follow-up, BMI was 25.3 ± 2.7 kg/m2 with % of weight loss (%WL) of 84.6 + 19.1%. At five years follow-up very similar values were observed. CONCLUSION The results obtained after LRYGB with resection of distal stomach are similar to results published after non resection LRYGB regarding early and late results and can be indicated in high risk areas of gastric carcinoma.
Collapse
Affiliation(s)
- Italo Braghetto
- Department of Surgery, University Hospital, Faculty of Medicine, University of Chile, Santos Dumont 999, Santiago, Chile.
| | - Gustavo Martinez
- Department of Surgery, University Hospital, Faculty of Medicine, University of Chile, Santos Dumont 999, Santiago, Chile
| | - Owen Korn
- Department of Surgery, University Hospital, Faculty of Medicine, University of Chile, Santos Dumont 999, Santiago, Chile
| | - Marcelo Zamorano
- Department of Surgery, University Hospital, Faculty of Medicine, University of Chile, Santos Dumont 999, Santiago, Chile
| | - Enrique Lanzarini
- Department of Surgery, University Hospital, Faculty of Medicine, University of Chile, Santos Dumont 999, Santiago, Chile
| | - Enrique Narbona
- Department of Surgery, University Hospital, Faculty of Medicine, University of Chile, Santos Dumont 999, Santiago, Chile
| |
Collapse
|
12
|
Peng JS, Corcelles R, Choong K, Poturalski M, Gandhi N, Walsh RM, Hardacre JM, Brethauer SA, Morris-Stiff G. Pancreatoduodenectomy after Roux-en-Y gastric bypass: technical considerations and outcomes. HPB (Oxford) 2018; 20:34-40. [PMID: 28890311 DOI: 10.1016/j.hpb.2017.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 08/01/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with altered anatomy due to Roux-en-Y gastric bypass (RYGB) present unique diagnostic and therapeutic challenges when they present with periampullary pathology. We describe a series of patients who underwent pancreatoduodenectomy (PD) after gastric surgery with Roux-en-Y reconstruction and review the literature to highlight technical considerations and outcomes. METHODS Patients from two institutions were identified and data regarding preoperative workup, operative conduct, and pathologic and clinical outcomes were collected. RESULTS Eleven patients were included in the institutional series. At the time of periampullary pathology, the median age was 64 years and time since RYGB was 10 years. Median operative time was 361 minutes, estimated blood loss was 500 mLs, and length of stay was 6 days. Remnant gastrectomy was performed in nine patients and reconstruction was performed using the biliopancreatic limb (BP) without revision of the jejuno-jejunostomy in ten patients. Pathology revealed pancreatic cancer (8), chronic pancreatitis (2), and duodenal cancer (1). Three patients experienced major complications and there were no 90-day mortalities. CONCLUSION Pancreatic surgeons will see an increasing number of patients with Roux-en-Y anatomy who will require evaluation and resection for periampullary diseases. For PD after RYGB, we recommend remnant gastrectomy with reconstruction using the BP limb.
Collapse
Affiliation(s)
- June S Peng
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland OH, USA
| | - Ricard Corcelles
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland OH, USA
| | - Kevin Choong
- Department of General Surgery, University Hospitals, Cleveland OH, USA
| | - Matthew Poturalski
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic Foundation, Cleveland OH, USA
| | - Namita Gandhi
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic Foundation, Cleveland OH, USA
| | - R Matthew Walsh
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland OH, USA
| | | | - Stacy A Brethauer
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland OH, USA
| | - Gareth Morris-Stiff
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland OH, USA.
| |
Collapse
|
13
|
Cazzo E, de Almeida de Saito HP, Pareja JC, Chaim EA, Callejas-Neto F, de Souza Coelho-Neto J. Gastric mesenchymal tumors as incidental findings during Roux-en-Y gastric bypass. Surg Obes Relat Dis 2017; 14:23-28. [PMID: 28864106 DOI: 10.1016/j.soard.2017.07.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/10/2017] [Accepted: 07/14/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Occurrences of mesenchymal tumors have been more recognized in recent years, and the incidental diagnosis of these lesions during bariatric surgery has been previously reported. OBJECTIVE To describe the cases of incidentally diagnosed mesenchymal tumors during consecutive bariatric surgeries. SETTING Private health-providing service, Brazil. METHODS A retrospective population-based study, which enrolled individuals who consecutively underwent Roux-en-Y gastric bypass at a single center from January 2006 through July 2016. RESULTS Of 1502 individuals, there were 16 cases (1.1%) of confirmed mesenchymal tumors. Of these 16 cases, 14 (87.5%) were gastrointestinal stromal tumors and 2 (12.5%) were leiomyomas. The affected individuals were significantly older (aged 46.2 ± 6.3 versus 35.4 ± 7.2 yr; P = .00031), presented a lower body mass index (38.2 ± 5.1 versus 45.3 ± 8.1 kg/m2; P<.00001), and had a lower weight (102.1 ± 17.9 versus 121.1 ± 7.4 kg; P = .00321). None of the individuals presented reported relapses of the mesenchymal tumors. CONCLUSION The possibility of incidental gastric mesenchymal tumors during bariatric surgery should not be neglected; a careful inventory of the stomach at the beginning of the procedure and resection of lesions found are mandatory. (Surg Obes Relat Dis 2017;X:XXX-XXX.) © 2017 American Society for Metabolic and Bariatric Surgery. All rights reserved.
Collapse
Affiliation(s)
- Everton Cazzo
- Department of Surgery, State University of Campinas (UNICAMP), Campinas, Brazil; Bariatric Surgery Unit, Instituto de Gastroenterologia e Cirurgia de Campinas (IGCC), Campinas, Brazil.
| | - Helena Paes de Almeida de Saito
- Department of Internal Medicine, State University of Campinas (UNICAMP), Campinas, Brazil; Oncology Unit, Centro de Oncologia de Campinas (COC), Campinas, Brazil
| | - José Carlos Pareja
- Department of Surgery, State University of Campinas (UNICAMP), Campinas, Brazil; Bariatric Surgery Unit, Centro de Cirurgia de Obesidade de Campinas (CCOC), Campinas, Brazil
| | - Elinton Adami Chaim
- Department of Surgery, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Francisco Callejas-Neto
- Department of Surgery, State University of Campinas (UNICAMP), Campinas, Brazil; Bariatric Surgery Unit, Instituto de Gastroenterologia e Cirurgia de Campinas (IGCC), Campinas, Brazil
| | - João de Souza Coelho-Neto
- Department of Surgery, State University of Campinas (UNICAMP), Campinas, Brazil; Bariatric Surgery Unit, Instituto de Gastroenterologia e Cirurgia de Campinas (IGCC), Campinas, Brazil
| |
Collapse
|
14
|
Shah MM, Martin BM, Stetler JL, Patel AD, Davis SS, Sarmiento JM, Lin E. Reconstruction Options for Pancreaticoduodenectomy in Patients with Prior Roux-en-Y Gastric Bypass. J Laparoendosc Adv Surg Tech A 2017; 27:1185-1191. [PMID: 28609220 DOI: 10.1089/lap.2017.0192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patients with prior Roux-en-Y gastric bypass (RYGB) operations for weight loss present reconstruction challenges during a pancreaticoduodenectomy (PD). With over 60,000 RYGB performed annually, the increasing odds of encountering such patients during a PD make it imperative to understand the RYGB anatomy and anticipate reconstruction options. This article describes the possible reconstruction options and their rationale. METHODS We reviewed our PD reconstruction options, compared them to what have been described in the literature, and derived a consensus from internal conferences comprising bariatric and hepatopancreatobiliary surgeons to describe known reconstruction options. RESULTS In general, reconstruction options can include one of three options: (1) remnant gastrectomy, (2) preservation of gastric remnant, or (3) reversal of gastric bypass. CONCLUSION This article describes individualized reconstruction options for RYGB patients undergoing PD. The reconstruction options can be tailored to the needs of the patient.
Collapse
Affiliation(s)
- Mihir M Shah
- Emory Endosurgery Unit, Division of Gastrointestinal and General Surgery, Emory University , Atlanta, Georgia
| | - Benjamin M Martin
- Emory Endosurgery Unit, Division of Gastrointestinal and General Surgery, Emory University , Atlanta, Georgia
| | - Jamil L Stetler
- Emory Endosurgery Unit, Division of Gastrointestinal and General Surgery, Emory University , Atlanta, Georgia
| | - Ankit D Patel
- Emory Endosurgery Unit, Division of Gastrointestinal and General Surgery, Emory University , Atlanta, Georgia
| | - S Scott Davis
- Emory Endosurgery Unit, Division of Gastrointestinal and General Surgery, Emory University , Atlanta, Georgia
| | - Juan M Sarmiento
- Emory Endosurgery Unit, Division of Gastrointestinal and General Surgery, Emory University , Atlanta, Georgia
| | - Edward Lin
- Emory Endosurgery Unit, Division of Gastrointestinal and General Surgery, Emory University , Atlanta, Georgia
| |
Collapse
|
15
|
Younan G, Tsai S, Evans DB, Christians KK. A Novel Reconstruction Technique During Pancreaticoduodenectomy After Roux-En-Y Gastric Bypass: How I do It. J Gastrointest Surg 2017; 21:1186-1191. [PMID: 28447199 PMCID: PMC5486682 DOI: 10.1007/s11605-017-3405-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 03/16/2017] [Indexed: 01/31/2023]
Abstract
The altered anatomy in patients after bariatric surgery who have undergone a Roux-en-Y gastric bypass may pose a technical challenge for surgical removal of the pancreatic head. We treat patients with pancreas cancer with multimodality therapy in a neoadjuvant fashion followed by pancreaticoduodenectomy (PD). In patients with Roux-en-Y gastric bypass anatomy, the gastric remnant is preserved and used for pancreaticogastrostomy reconstruction and subsequently drained by the same jejunal limb used for the hepaticojejunostomy. This method of reconstruction takes advantage of the previous surgically altered anatomy and avoids the morbidity of a gastric remnant resection at the time of PD.
Collapse
Affiliation(s)
- George Younan
- 0000 0001 2111 8460grid.30760.32Pancreatic Cancer Program, Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, 9200 W Wisconsin Ave., Milwaukee, WI 53226 USA
| | - Susan Tsai
- 0000 0001 2111 8460grid.30760.32Pancreatic Cancer Program, Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, 9200 W Wisconsin Ave., Milwaukee, WI 53226 USA
| | - Douglas B. Evans
- 0000 0001 2111 8460grid.30760.32Pancreatic Cancer Program, Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, 9200 W Wisconsin Ave., Milwaukee, WI 53226 USA
| | - Kathleen K. Christians
- 0000 0001 2111 8460grid.30760.32Pancreatic Cancer Program, Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, 9200 W Wisconsin Ave., Milwaukee, WI 53226 USA
| |
Collapse
|
16
|
Abstract
Laparoscopic Roux-en-Y gastric bypass (RYGB) is widely applied in the treatment of morbid obesity. Health personnel meeting these patients should thus be familiar with the potential clinical consequences of the modified anatomy induced by the surgery. After a RYGB, the stomach is left in situ after the closure of the upper part of the organ. This blind-ended gastric remnant may cause complications and surgical emergencies, but also opportunities for diagnostic and therapeutic intervention. The present review focuses on complications related to the gastric remnant including bleeding and acute dilatation in the early postoperative period and later adverse events such as gastroduodenal peptic disease, tumors, gastrogastric fistulas, and late dilatation. Opportunities offered by the remnant, including minimal invasive or open access for enteral nutrition, and therapeutic and diagnostic access to the bile ducts, the duodenum, and the gastric remnant, which is challenged by the modified anatomy, are discussed. Reversal of the gastric bypass and gastrointestinal reconstruction after esophageal resection have been commented on. The review aims to improve the awareness of issues related to the gastric remnant for physicians involved in the treatment and the follow-up of patients after a RYGB.
Collapse
|
17
|
Theodoropoulos I, Franco C, Gervasoni JE. Pancreaticoduodenectomy for pancreatic carcinoma after complicated open Roux-en-Y gastric bypass surgery: an alternative approach to reconstruction. Surg Obes Relat Dis 2012; 8:648-50. [PMID: 22534605 DOI: 10.1016/j.soard.2012.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 02/19/2012] [Accepted: 02/21/2012] [Indexed: 11/21/2022]
Affiliation(s)
- Ioannis Theodoropoulos
- Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania 19102, USA.
| | | | | |
Collapse
|