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Al-Fagih OS, Zuberi S, Niaz O, Jambulingam P, Whitelaw D, Rashid F, Adil MT, Jain V, Al-Taan O, Munasinghe A, Askari A, Iqbal FM. Impact of Gastrojejunostomy Anastomosis Diameter on Weight Loss Following Laparoscopic Gastric Bypass: A Systematic Review. Obes Surg 2024; 34:2227-2236. [PMID: 38652437 DOI: 10.1007/s11695-024-07237-x] [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: 01/04/2024] [Revised: 04/13/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Abstract
Laparoscopic Roux-en-Y gastric bypass (RYGB) is crucial for significant weight reduction and treating obesity-related issues. However, the impact of gastrojejunostomy (GJ) anastomosis diameter on weight loss remains unclear. We investigate this influence on post-RYGB weight loss outcomes. A systematic search was conducted. Six studies met the inclusion criteria, showing varied GJ diameters and follow-up durations (1-5 years). Smaller GJ diameters generally correlated with greater short-to-medium-term weight loss, with a threshold beyond which complications like stenosis increased. Studies had moderate-to-low bias risk, emphasizing the need for precise GJ area quantification post-operation. This review highlights a negative association between smaller GJ diameters and post-RYGB weight loss, advocating for standardized measurement techniques. Future research should explore intra-operative and AI-driven methods for optimizing GJ diameter determination.
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Affiliation(s)
- Othman S Al-Fagih
- Department of General Surgery, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK.
| | - Sharukh Zuberi
- Department of General Surgery, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Osamah Niaz
- Department of General Surgery, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Periyathambi Jambulingam
- Department of General Surgery, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Douglas Whitelaw
- Department of General Surgery, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Farhan Rashid
- Department of General Surgery, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Md Tanveer Adil
- Department of General Surgery, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Vigyan Jain
- Department of General Surgery, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Omer Al-Taan
- Department of General Surgery, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Aruna Munasinghe
- Department of General Surgery, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Alan Askari
- Department of General Surgery, Luton & Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, W2 1NY, UK
| | - Fahad M Iqbal
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, W2 1NY, UK
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Estrada A, Rodriguez-Quintero JH, Pereira X, Moran-Atkin E, Choi J, Camacho D. Gastric bypass revisional surgery: percentage total body weight loss differences among three different techniques. Langenbecks Arch Surg 2024; 409:151. [PMID: 38703235 DOI: 10.1007/s00423-024-03342-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/29/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Suboptimal weight loss or weight regain may occur after Roux-en-Y gastric bypass (RYGB). For this reason, revisional surgery has gained increasing interest. We aimed to compare the percentage of total body weight loss (%TBWL) at one-year follow-up among three different techniques: Jejuno-jejunostomy distalization (JJD), Sleeve resection of the gastrojejunostomy and gastric pouch (SRGJP), and the combination of both (JJD + SRGJP). METHODS This retrospective cohort study included all patients who underwent revisional surgery after RYGB (2020-2021). The cohort was stratified by the type of revisional technique performed. Postoperative bariatric outcomes and nutritional deficiencies were compared among groups. RESULTS A total of 78 patients underwent revisional surgery after RYGB: JJD was performed in 8 (10.3%), SRGJP in 34 (43.6%), and JJD + SRGJP in 36 (46.1%) patients. The most common indication for surgery was weight regain, in 72 (92.3%) patients. The median lengths of the BP limbs before and after distalization, were 50 cm (IQR 40-75 cm) and 175 cm (IQR 150-200 cm), respectively. The median length of the new common limb (NCL) and total alimentary limb length (TALL) were 277 cm (IQR 250-313 cm) and 400 cm (IQR 375-475 cm), respectively. Median percentage of total body weight loss (%TBWL) at one year was 15% (IQR 15-19%) for JJD, 20% (IQR 13-26%) for SRGJP, and 21% (IQR 15- 28%) for JJD + SRGJP (p = 0.40). CONCLUSIONS In this study, the combined procedure (JJD + SRGJP) exhibited higher %TBWL at one year, however no statistically significant difference was identified among the three techniques.
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Affiliation(s)
- Arturo Estrada
- Department of Surgery, Montefiore Medical Center/ Albert Einstein College of Medicine, 111 E 210thSt, Bronx, NY, 10467, USA.
| | | | - Xavier Pereira
- Department of Surgery, Montefiore Medical Center/ Albert Einstein College of Medicine, 111 E 210thSt, Bronx, NY, 10467, USA
| | - Erin Moran-Atkin
- Department of Surgery, Montefiore Medical Center/ Albert Einstein College of Medicine, 111 E 210thSt, Bronx, NY, 10467, USA
| | - Jenny Choi
- Department of Surgery, Montefiore Medical Center/ Albert Einstein College of Medicine, 111 E 210thSt, Bronx, NY, 10467, USA
| | - Diego Camacho
- Department of Surgery, Montefiore Medical Center/ Albert Einstein College of Medicine, 111 E 210thSt, Bronx, NY, 10467, USA
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Kruschitz R, Fahrnberger M, Felsenreich DM, Ress C, Andersen B, Aydinkoc-Tuzcu K, Ciardi C, Huber SL, Kiefer FW. [Prevention and management of postinterventional weight regain]. Wien Klin Wochenschr 2023; 135:743-750. [PMID: 37821697 PMCID: PMC10567866 DOI: 10.1007/s00508-023-02273-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 10/13/2023]
Abstract
Decreasing levels of patient motivation or compliance are far from being the only causes of postinterventional weight regain after lifestyle, psychological, pharmacological and surgical interventions. Weight regain originates from a complex and individually varying set of central and peripheral mechanisms, with the overall purpose of increasing food intake by both stimulating hunger and reducing satiety (mediated by gastrointestinal hormones) and decreasing the body's energy demands (via metabolic adaption). These mechanisms counteract any attempts to reduce or maintain body weight in today's increasingly prevalent adipogenic environments. The knowledge about the biological mechanisms of body weight regulation should be taken into consideration when planning treatment programs for long-term weight reduction, including follow-up treatment for the prevention and individualized treatment of postinterventional weight regain. Therapeutic measures as well as the frequency of medical follow-ups should be based on the extent of weight regain.
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Affiliation(s)
- Renate Kruschitz
- Abteilung für Innere Medizin, Krankenhaus der Elisabethinen, Klagenfurt, Österreich
| | | | - Daniel Moritz Felsenreich
- Klinische Abteilung für Viszeralchirurgie, Universitätsklinik für Allgemeinchirurgie, Medizinische Universität Wien, Wien, Österreich
| | - Claudia Ress
- Universitätsklinik für Innere Medizin I, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | | | - Kadriye Aydinkoc-Tuzcu
- 5. Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Klinik Ottakring, Wien, Österreich
| | - Christian Ciardi
- Abteilung für Innere Medizin, Krankenhaus St. Vinzenz, Zams, Österreich
| | - Simone Leonore Huber
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien, Österreich
| | - Florian W Kiefer
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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Cohen RV, Petry TB. How to address weight regain after bariatric surgery in an individualized way. Rev Endocr Metab Disord 2023; 24:993-1002. [PMID: 37171756 DOI: 10.1007/s11154-023-09806-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/13/2023]
Abstract
Bariatric surgery is the most effective obesity treatment. As a chronic and progressive disease, weight loss response to surgery will vary individually. Thus, insufficient weight loss or regain can happen after surgery, but they lack a standard definition. There are different mechanisms underlying weight regain and/or insufficient weight loss, such as genetics, maladaptive eating behaviors, and the inadequate choice of index operations, among others. Patients with weight regain or insufficient weight loss should be submitted to an individualized and comprehensive evaluation by a multidisciplinary team. This may help identify the causes and direct the appropriate treatment individually. Options for patients with insufficient weight loss and/or weight regain following bariatric surgery include repair of postoperative complications, conversion into another operation, endoscopic therapies with inconsistent outcomes, and dietary/behavioral counseling. Revision and conversion surgeries have higher complication rates than primary operations. Although there is no standard pharmacological regimen for that indication, the new agents seem efficient and safe to promote the loss of the regained weight and even be adjunctive to selected patients before they reach the plateau. This review aims to summarize the knowledge of the best approach for patients with weight regain/insufficient weight loss and suggests an algorithm to customize the approach and therapeutic options after bariatric surgery.
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Affiliation(s)
- Ricardo V Cohen
- Center for the Treatment of Obesity and Diabetes, Hospital Alemao Oswaldo Cruz, São Paulo, Brazil.
| | - Tarissa Bz Petry
- Center for the Treatment of Obesity and Diabetes, Hospital Alemao Oswaldo Cruz, São Paulo, Brazil
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5
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Franken RJ, Franken J, Sluiter NR, de Vries R, Euser S, Gerdes VEA, de Brauw M. Efficacy and safety of revisional treatments for weight regain or insufficient weight loss after Roux-en-Y gastric bypass: A systematic review and meta-analysis. Obes Rev 2023; 24:e13607. [PMID: 37515352 DOI: 10.1111/obr.13607] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023]
Abstract
Weight regain or inadequate weight loss following Roux-en-Y gastric bypass poses a significant clinical challenge. Our objective was to evaluate various revisional techniques for addressing weight regain and insufficient weight loss after Roux-en-Y gastric bypass through a systematic review and meta-analysis. We performed a literature search (in PubMed and Embase) on revisional interventions in collaboration with a medical information specialist. Measured outcomes included body mass index at intervention, total weight loss during follow-up, and complications. Random effects models were used to determine pooled effect size and corresponding 95% confidence intervals. Thirty-nine studies were included: four studies reported on argon plasma coagulation, four studies on transoral outlet reduction, nine studies on transoral outlet reduction + argon plasma coagulation, four studies on pouch/gastrojejunal anastomosis revision, five on laparoscopic gastric banding, two studies on laparoscopic gastric banding + pouch resizing, 10 on distalization-RYGB, and one on duodenal switch. All techniques resulted in short-term clinically relevant weight loss. Endoscopic procedures had a short follow-up and resulted in modest and temporary weight loss. Surgical revision techniques were successful for weight loss in longer term follow-up, at the expense of high complication rates.
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Affiliation(s)
- Rutger J Franken
- Department of Surgery, Spaarne Gasthuis Hoofddorp, Hoofddorp, the Netherlands
| | - Josephine Franken
- Department of Surgery, Spaarne Gasthuis Hoofddorp, Hoofddorp, the Netherlands
| | - Nina R Sluiter
- Department of Surgery, Spaarne Gasthuis Hoofddorp, Hoofddorp, the Netherlands
| | | | - Sjoerd Euser
- Department of Epidemiology, Regional Public Health Laboratory Kennemerland, Haarlem, the Netherlands
| | - Victor E A Gerdes
- Department of Internal Medicine, Spaarne Gasthuis Hoofddorp, Hoofddorp, the Netherlands
- Department of Vascular Medicine, AUMC, Amsterdam, the Netherlands
| | - Maurits de Brauw
- Department of Surgery, Spaarne Gasthuis Hoofddorp, Hoofddorp, the Netherlands
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Barrea L, Verde L, Schiavo L, Sarno G, Camajani E, Iannelli A, Caprio M, Pilone V, Colao A, Muscogiuri G. Very Low-Calorie Ketogenic Diet (VLCKD) as Pre-Operative First-Line Dietary Therapy in Patients with Obesity Who Are Candidates for Bariatric Surgery. Nutrients 2023; 15:nu15081907. [PMID: 37111126 PMCID: PMC10142118 DOI: 10.3390/nu15081907] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/24/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Bariatric surgery is currently the most effective method for achieving long-term weight loss and reducing the risk of comorbidities and mortality in individuals with severe obesity. The pre-operative diet is an important factor in determining patients' suitability for surgery, as well as their post-operative outcomes and success in achieving weight loss. Therefore, the nutritional management of bariatric patients requires specialized expertise. Very low-calorie diets and intragastric balloon placement have already been studied and shown to be effective in promoting pre-operative weight loss. In addition, the very low-calorie ketogenic diet has a well-established role in the treatment of obesity and type 2 diabetes mellitus, but its potential role as a pre-operative dietary treatment prior to bariatric surgery has received less attention. Thus, this article will provide a brief overview of the current evidence on the very low-calorie ketogenic diet as a pre-operative dietary treatment in patients with obesity who are candidates for bariatric surgery.
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Affiliation(s)
- Luigi Barrea
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Centro Direzionale, Via Porzio, Isola F2, 80143 Naples, Italy
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Ludovica Verde
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Department of Public Health, University of Naples Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Luigi Schiavo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Complex Operative Unit of General and Emergency Surgery and Bariatric Centre of Excellence SICOB, University of Salerno, 84081 Salerno, Italy
| | - Gerardo Sarno
- San Giovanni di Dio e Ruggi D'Aragona University Hospital, Scuola Medica Salernitana, 84131 Salerno, Italy
| | - Elisabetta Camajani
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, 00166 Rome, Italy
| | - Antonio Iannelli
- Centre Hospitalier Universitaire de Nice-Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, 151 Route Saint Antoine de Ginestière, BP 3079, CEDEX 3, 06200 Nice, France
- Faculté de Medicine, Université Côte d'Azur, 06000 Nice, France
- Inserm, U1065, Team 8 "Hepatic Complications of Obesity and Alcohol", 06204 Nice, France
| | - Massimiliano Caprio
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, 00166 Rome, Italy
- Laboratory of Cardiovascular Endocrinology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, 00166 Rome, Italy
| | - Vincenzo Pilone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Complex Operative Unit of General and Emergency Surgery and Bariatric Centre of Excellence SICOB, University of Salerno, 84081 Salerno, Italy
| | - Annamaria Colao
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Cattedra Unesco "Educazione Alla Salute e Allo Sviluppo Sostenibile", Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Giovanna Muscogiuri
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Cattedra Unesco "Educazione Alla Salute e Allo Sviluppo Sostenibile", Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
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Resizing of the Gastric Pouch for Weight Regain after Laparoscopic Roux-en-Y Gastric Bypass and One-Anastomosis Gastric Bypass: Is It a Valid Option? J Clin Med 2022; 11:jcm11216238. [PMID: 36362466 PMCID: PMC9659038 DOI: 10.3390/jcm11216238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction: The laparoscopic resizing of the gastric pouch (LPR) has recently been proposed as a revisional technique in the case of weight regain (WR) after gastric bypass procedures. The aim of this study was to report our experience with LPR for WR. Materials and Methods: All patients with WR ≥ 25% after gastric bypass and with a dilated gastric pouch and/or gastrojejunal anastomosis who underwent LPR between January 2017 and January 2022 were retrospectively reviewed. From a radiological point of view, a gastric pouch was considered dilated when its volume was calculated at >80 cm3 for LRYGB and >200 cm3 for OAGB upon a 3D-CT scan. The endoscopic criterion considered both the diameter of the gastrojejunal anastomosis and the gastric pouch volume. All anastomoses > 20 mm for LRYGB and >40 mm for OAGB were considered dilated, while a gastric pouch was considered endoscopically dilated when the retrovision maneuver with the gastroscope was easily performed. These selection criteria were arbitrarily established on the basis of both our personal experience and literature data. Results: Twenty-three patients had LPR after a Roux-en-Y gastric bypass or one-anastomosis gastric bypass. The mean BMI at LPR was 36.3 ± 4.7 kg/m2. All patients underwent LPR, while the resizing of the GJA was also performed in 3/23 (13%) cases, and hiatoplasty was associated with the resizing of the pouch in 6/23 cases (26.1%). The mean BMI at the last follow-up was 29.3 ± 5.8 kg/m2. The difference between the BMI before resizing and the BMI at the last follow-up visit was statistically significant (p = 0.00005). The mean %TWL at 24.2 ± 16.1 months was 19.6 ± 9%. Comorbidities had an overall resolution and/or improvement rate of 47%. The mean operative time was 71.7 ± 21.9 min. The conversion rate was nil. Postoperative complications occurred in two cases (8.7%). Conclusions: In our series, LPR for WR showed good results in weight loss and in improvement/resolution of comorbidities, with an acceptable complication rate and operative time. Only further studies with a greater cohort of patients and a longer postoperative follow-up will be able to highlight the long-term benefits of this technique.
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Intraoperative Patterns of Gastric Microperfusion During Laparoscopic Roux-en-Y Gastric Bypass. Obes Surg 2022; 32:4047-4056. [PMID: 36243899 DOI: 10.1007/s11695-022-06318-z] [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: 05/20/2022] [Revised: 10/01/2022] [Accepted: 10/11/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Visible light spectroscopy (VLS) represents a sensitive, non-invasive method to quantify tissue oxygen levels and detect hypoxemia. The aim of this study was to assess the microperfusion patterns of the gastric pouch during laparoscopic Roux-en-Y gastric bypass (LRYGB) using the VLS technique. METHODS Twenty patients were enrolled. Tissue oxygenation (StO2%) measurements were performed at three different localizations of the gastric wall, prior and after the creation of the gastric pouch, and after the creation of the gastro-jejunostomy. RESULTS Prior to the creation of the gastric pouch, the lowest StO2% levels were observed at the level of the distal esophagus with a median StO2% of 43 (IQR 40.8-49.5). After the creation of the gastric pouch and after the creation of the gastro-jejunostomy, the lowest StO2% levels were recorded at the level of the His angle with median values of 29% (IQR 20-38.5) and 34.5% (IQR 19-39), respectively. The highest mean StO2 reduction was recorded at the level of the His angle after the creation of the gastric pouch, and it was 18.3% (SD ± 18.1%, p < 0.001). A reduction of StO2% was recorded at all localizations after the formation of the gastro-jejunostomy compared to the beginning of the operation, but the mean differences of the StO2% levels were statistically significant only at the resection line of the pouch and at the His angle (p = 0.044 and p < 0.001, respectively). CONCLUSION Gastric pouch demonstrates reduction of StO2% during LRYGB. VLS is a useful technique to assess microperfusion patterns of the stomach during LRYGB.
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Matteo MV, Gallo C, Pontecorvi V, Bove V, De Siena M, Carlino G, Costamagna G, Boškoski I. Weight Recidivism and Dumping Syndrome after Roux-En-Y Gastric Bypass: Exploring the Therapeutic Role of Transoral Outlet Reduction. J Pers Med 2022; 12:jpm12101664. [PMID: 36294803 PMCID: PMC9605651 DOI: 10.3390/jpm12101664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Obesity is a chronic, relapsing disease representing a global epidemic. To date, bariatric surgery is the most effective treatment for morbid obesity in the long-term. Roux-en-Y gastric bypass (RYGB) is one of the most performed bariatric interventions, with excellent long-term outcomes. However, about one-third of patients may experience weight regain over time, as well as dumping syndrome. Both these conditions are challenging to manage and require a multidisciplinary and personalized approach. The dilation of the gastro-jejunal anastomosis is a recognized etiological factor for both weight regain and dumping syndrome. Dietary modifications, behavioral interventions, and medications represent the first therapeutic step. Revisional surgery is the traditional approach when non-invasive treatments fail. However, re-interventions may be technically difficult and are associated with increased morbidity and mortality. Transoral outlet reduction (TORe) is an endoscopic procedure aimed at reducing the size of the anastomosis and is proposed as a minimally invasive treatment of weight regain and/or dumping syndrome refractory to conservative therapies. This review is aimed at providing a narrative overview of the role of TORe as part of the multidisciplinary therapeutic toolkit nowadays available to approach weight regain and dumping syndrome after RYGB.
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Affiliation(s)
- Maria Valeria Matteo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
- Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Correspondence:
| | - Camilla Gallo
- Division of Gastroenterology and Center for Autoimmune Liver Disease, Ospedale San Gerardo, Department of Medicine and Surgery, University of Bicocca, 20900 Monza, Italy
| | - Valerio Pontecorvi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
- Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Vincenzo Bove
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
- Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Martina De Siena
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
- Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Giorgio Carlino
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
- Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
- Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, 00168 Roma, Italy
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Drai C, Chierici A, Schiavo L, Mazahreh TS, Schneck AS, Iannelli A. Long-Term Results at 10 Years of Pouch Resizing for Roux-en-Y Gastric Bypass Failure. Nutrients 2022; 14:nu14194035. [PMID: 36235686 PMCID: PMC9572516 DOI: 10.3390/nu14194035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/11/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Roux-en-Y gastric bypass (RYGB) is currently one of the most performed bariatric procedures and it is associated with rapid weight loss. However, weight loss failure and weight regain after RYGB occurs in approximately 30% and 3−5% of patients, respectively, and represent a serious issue. RYGB pouch resizing is a surgical option that may be offered to selected patients with RYGB failure. The aim of this study is to assess long-term results of pouch resizing for RYGB failure. Materials and Methods: From February 2009 to November 2011, 20 consecutive patients underwent gastric pouch resizing for RYGB failure in our tertiary bariatric center. The primary outcome was the rate of failure (%EWL < 50% with at least one metabolic comorbidity) after at least 10 years from pouch resizing. Gastroesophageal Reflux Disease (GERD) was also assessed. Results: Twenty patients (18 women (90%)) were included and seventeen (85%) joined the study. The failure rate of pouch resizing was 47%. Mean %EWL and mean BMI were 47%, and 35.1 kg/m2, respectively. Some of the persistent co-morbidities further improved or resolved after pouch resizing. Seven patients (41%) presented GERD requiring daily PPI with a significantly lower GERD-HQRL questionnaire score after pouch resizing (p < 0.001). Conclusion: Pouch resizing after RYGB results in a failure rate of 47% at the 10-year follow-up while the resolution of comorbidities is maintained over time despite a significant weight regain.
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Affiliation(s)
- Céline Drai
- Department of Digestive Surgery and Hepatic Transplantation, Centre Hospitalier Universitaire de Nice, Hôpital Archet 2, 06202 Nice, France
- Faculty of Medicine, University Côte d’Azur, 06202 Nice, France
| | - Andrea Chierici
- Department of Digestive Surgery and Hepatic Transplantation, Centre Hospitalier Universitaire de Nice, Hôpital Archet 2, 06202 Nice, France
| | - Luigi Schiavo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Tagleb S. Mazahreh
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Anne-Sophie Schneck
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Guadeloupe, Pointe à Pitre 97159, Guadeloupe
| | - Antonio Iannelli
- Department of Digestive Surgery and Hepatic Transplantation, Centre Hospitalier Universitaire de Nice, Hôpital Archet 2, 06202 Nice, France
- Faculty of Medicine, University Côte d’Azur, 06202 Nice, France
- Inserm, U1065, Team 8 “Hepatic Complications of Obesity and Alcohol”, C3M Bâtiment Universitaire ARCHIMED, 06204 Nice, France
- Correspondence:
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11
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De Luca M, Piatto G, Sartori A, Zese M, Lunardi C, Targa S, Giardiello C, Gentileschi P, Himpens J. Single Anastomosis Jejuno-ileal (SAJI): a New Model of Malabsorptive Revisional Procedure for Insufficient Weight Loss or Weight Regain After Roux-en-Y Gastric Bypass. Obes Surg 2022; 32:3194-3204. [PMID: 35763129 DOI: 10.1007/s11695-022-06174-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 03/13/2022] [Accepted: 03/18/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND In case of insufficient weight loss or weight regain or relapse of weight-related comorbidities after Roux-en-Y gastric bypass (RYGB), other procedures such as reduction of a large gastric pouch and stoma, lengthening of the Roux limb, conversion to sleeve gastrectomy and/or bilio-pancreatic diversion with duodenal switch have been advocated. Single anastomosis jejuno-ileal (SAJI) is a new revisional simple operation performed after RYGB failure which adds malabsorption to the previous gastric bypass. METHODS SAJI includes a single jejuno-ileal anastomosis specifically joining the ileum 250-300 cm proximal to the ileo-caecal valve and the jejunum 30 cm below the gastro-jejunal anastomosis on the Roux limb of the previous RYGB. Thirty-one patients underwent SAJI for insufficient weight loss and/or weight regain after RYGB. The percent total weight loss (%TWL) after RYGB and before SAJI was 21.8 ± 7.8. All SAJI operations were performed laparoscopically. The SAJI mean operating time was 145 min. RESULTS Regarding weight loss after SAJI, %TWL is 27.2 ± 7.4, 31.2 ± 6.4, 33.7 ± 5.9 and 32.9 ± 5.2 at 12, 24, 36 and 48 months, respectively. Our series recorded a low rate of peri-operative and medium-term complications with a low grade of severity (Clavien-Dindo classification grade). One patient required reoperation 36 days after SAJI for epigastrium incarcerated incisional hernia at the previous RYGB laparotomy site. Mortality was 0. Comorbidity reduction/resolution after SAJI is 83.2% for type 2 diabetes mellitus, 42.8% for arterial hypertension, 72.8% for dyslipidemia and 45.3% for OSA. CONCLUSIONS Treatment of failed RYGB is challenging. SAJI is a less complicated, purely low invasive malabsorptive operation that should reach satisfactory %TWL and comorbidity reduction/resolution.
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Affiliation(s)
- Maurizio De Luca
- Chief Department of General and Metabolic Surgery, Rovigo Hospital, Rovigo, Italy.
| | - Giacomo Piatto
- Department of Surgery, San Valentino Montebelluna Hospital, Treviso, Italy
| | - Alberto Sartori
- Department of Surgery, San Valentino Montebelluna Hospital, Treviso, Italy
| | - Monica Zese
- Department of General and Metabolic Surgery, Rovigo Hospital, Rovigo, Italy
| | - Cesare Lunardi
- Department of Surgery, San Valentino Montebelluna Hospital, Treviso, Italy
| | - Simone Targa
- Department of Surgery, Adria Hospital, Rovigo, Italy
| | - Cristiano Giardiello
- Department of Emergency and Metabolic Surgery, Pineta Grande Hospital, Caserta, Italy
| | - Paolo Gentileschi
- Department of Bariatric and Metabolic Surgery, San Carlo Nancy Hospital, Rome, Italy
| | - Jacques Himpens
- Metabolic & Obesity Unit, Chirec Delta Hospital, Brussels, Belgium
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12
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Challenges in Bariatric Surgery: Outcomes in Patients Having Three or More Bariatric Procedures. Obes Surg 2022; 32:3257-3263. [PMID: 35997931 DOI: 10.1007/s11695-022-06248-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 08/13/2022] [Accepted: 08/17/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Over the last two decades, a progressive increase in failure rate of bariatric surgery (BS) has occurred in conjunction with an exponential increase in BS worldwide. Bariatric surgeons are confronted with challenging situations in patients with a complex bariatric history. In this study, we aim to evaluate the feasibility and outcomes of revisional BS in patients with at least two or more previous bariatric procedures. METHODS Data were retrospectively retrieved from a prospectively held database of bariatric procedures performed at our tertiary referral bariatric center and included procedures done from February 2013 up to April 2019 by a single center. RESULTS Thirty patients underwent a third bariatric procedure. The median age was 40 (18-57) and 54 (27-69) years at the time of the first and the last procedures, respectively. Laparoscopic adjustable gastric banding was the first procedure in 26 patients. The complication rate was 33%; no patient required additional surgery because of postoperative complications. A total weight loss of 29.6% and an excess loss of 53.4% were obtained at a mean follow-up of 61 months after the last redo bariatric procedure. CONCLUSION This study indicates that redo BS either conversional or revisional is feasible and effective in patients with a complex bariatric history including two or more previous procedures. Careful patients' selection is mandatory and extensive information should be given on the increased risk of postoperative complications.
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13
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Schiavo L, Calabrese P, Aliberti SM, Tramontano S, Iannelli A, Pilone V. Impact of SARS-CoV-2 Lockdown on the Preoperative Care Program of Patients Scheduled for Bariatric Surgery. Nutrients 2022; 14:nu14071488. [PMID: 35406101 PMCID: PMC9002602 DOI: 10.3390/nu14071488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/26/2022] [Accepted: 03/31/2022] [Indexed: 02/05/2023] Open
Abstract
Objectives: To evaluate the effect of the SARS-CoV-2 lockdown on dietary habits, body weight, left hepatic lobe volume, use of micronutrient supplements, micronutrient status, frequency of physical activity, and evolution of comorbidities in patients undergoing preoperative care for BS. Materials and Methods: We prospectively evaluated the dietary habits (including use of micronutrient supplements and frequency of physical activity) of 36 patients who were candidates for BS from March to May 2020; 7-day food dietary records, body weight, left hepatic lobe volume by ultrasound, micronutrient status, and evolution of comorbidities were assessed. Results: All patients completed the study. Of the participants, 44.4% (16/36), 47.2% (17/36), and 27.8% (10/36) followed the preoperative indications for vegetables, fruits, and legumes, respectively, whereas over 50% did not. Furthermore, 30.6% (11/36) and 55.6% (20/36) of participants followed the prescribed recommendations for carbohydrates/sweets products and alcohol, respectively. A total of 61.1% (22/36) of participants experienced new foods and new culinary preparations. In addition, at the time of the study, we found that only 11.1% (4/36) were engaged in prescribed physical activity and only 36.1% (13/36) were taking prescribed micronutrient supplements. Compared to the initial weight, we observed an increased body weight and body mass index (+4.9%, p = 0.115; +1.89%, p = 0.0692, respectively), and no improvement in left hepatic lobe volume, micronutrient status, or comorbidities was recorded for any patient in the anamnesis. Conclusions: Lockdown determined by the SARS-CoV-2 pandemic has negatively affected the preoperative program of BS candidates, resulting in a postponement to the resumption of bariatric surgical activity.
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Affiliation(s)
- Luigi Schiavo
- Department of Medicine, Surgery, and Dentistry, “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (P.C.); (S.M.A.); (S.T.); (V.P.)
- Center of Excellence of Bariatric Surgery of the Italian Society of Obesity Surgery and Metabolic Disease (SICOB), Unit of General and Emergency Surgery, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Mercato San Severino, 84085 Salerno, Italy
- Correspondence:
| | - Pietro Calabrese
- Department of Medicine, Surgery, and Dentistry, “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (P.C.); (S.M.A.); (S.T.); (V.P.)
- Center of Excellence of Bariatric Surgery of the Italian Society of Obesity Surgery and Metabolic Disease (SICOB), Unit of General and Emergency Surgery, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Mercato San Severino, 84085 Salerno, Italy
| | - Silvana Mirella Aliberti
- Department of Medicine, Surgery, and Dentistry, “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (P.C.); (S.M.A.); (S.T.); (V.P.)
| | - Salvatore Tramontano
- Department of Medicine, Surgery, and Dentistry, “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (P.C.); (S.M.A.); (S.T.); (V.P.)
- Center of Excellence of Bariatric Surgery of the Italian Society of Obesity Surgery and Metabolic Disease (SICOB), Unit of General and Emergency Surgery, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Mercato San Severino, 84085 Salerno, Italy
| | - Antonio Iannelli
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, F-06202 Nice, France;
- Inserm, U1065, Team 8 “Hepatic Complications of Obesity”, F-06204 Nice, France
- Faculty of Medicine, University of Nice Sophia-Antipolis, F-06107 Nice, France
| | - Vincenzo Pilone
- Department of Medicine, Surgery, and Dentistry, “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (P.C.); (S.M.A.); (S.T.); (V.P.)
- Center of Excellence of Bariatric Surgery of the Italian Society of Obesity Surgery and Metabolic Disease (SICOB), Unit of General and Emergency Surgery, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Mercato San Severino, 84085 Salerno, Italy
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14
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Sohail AH, Howell RS, Brathwaite BM, Silverstein J, Amodu L, Cherasard P, Petrone P, Goparaju A, Levine J, Kella V, Brathwaite CEM. Gastric Banding with Previous Roux-en-Y Gastric Bypass (Band over Pouch): Not Worth the Weight. JSLS 2022; 26:JSLS.2022.00010. [PMID: 35815327 PMCID: PMC9205461 DOI: 10.4293/jsls.2022.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: Revisional bariatric surgery continues to increase. Laparoscopic adjustable gastric banding (LAGB) after previous Roux-en-Y gastric bypass (RYGB), known colloquially as “band-overpouch” has become an option despite a dearth of critically analyzed long-term data. Methods: Our prospectively maintained database was retrospectively reviewed for patients who underwent band-overpouch at our Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Center of Excellence in a 18-year period ending October 31, 2021. We evaluated: demographics, comorbidities, operative procedures, and outcomes (30-day and > 30-day). Results: During the study period, of 4,614 bariatric procedures performed, 42 were band-overpouch with 39 (93%) being women. Overall, mean age was 49.8 years (range 26–75), a mean weight 251 pounds (range 141–447), and mean body mass index 42.4 (range 26–62). Comorbidities included: hypertension (n = 31; 74%), diabetes (n = 27; 64%), obstructive sleep apnea (n = 26; 62%), gastroesophageal reflux disease (n = 26; 62%), and osteoarthritis (n = 25; 60%). All procedures were performed laparoscopically with no conversions to open. Mean length of stay was 1.2 days (range 1–3). Mean follow-up time was 4.2 years (range 0.5–11). Mean excess weight loss was 14.9%, 24.3%, and 28.2% at 6 months, 1 year and ≥ 3 years, respectively. There was one 30-day trocar-site hematoma requiring transfusion. Long-term events included: 1-year (1 endoscopy for retained food; 1 internal hernia), 3-year (1 LAGB erosion; 1 LAGB explant), 4-year (1 anastomotic ulcer), 6-year (1 LAGB explant and Roux-en-Y revision), and 8-year (1 LAGB erosion). One 5-year mortality occurred (2.4%), in association with hospitalization for chronic illness and malnutrition. Band erosions were successfully treated surgically without replacement. Conclusion: Band-overpouch is associated with moderate excess weight loss and has good short-term safety outcomes.
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Affiliation(s)
- Amir H Sohail
- Department of Surgery, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine; Mineola, NY
| | - Raelina S Howell
- Department of Surgery, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine; Mineola, NY
| | - Barbara M Brathwaite
- Department of Surgery, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine; Mineola, NY
| | - Jeffrey Silverstein
- Department of Surgery, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine; Mineola, NY
| | - Leo Amodu
- Department of Surgery, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine; Mineola, NY
| | - Patricia Cherasard
- Department of Surgery, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine; Mineola, NY
| | - Patrizio Petrone
- Department of Surgery, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine; Mineola, NY
| | - Anirudha Goparaju
- Department of Surgery, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine; Mineola, NY
| | - Jun Levine
- Department of Surgery, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine; Mineola, NY
| | - Venkata Kella
- Department of Surgery, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine; Mineola, NY
| | - Collin E M Brathwaite
- Department of Surgery, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine; Mineola, NY
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15
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Weight loss and complications of the banded Roux-en-Y gastric bypass: lessons learned from a prospective case control study. Surg Endosc 2022; 36:7516-7520. [PMID: 35294635 DOI: 10.1007/s00464-022-09184-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Obesity is a growing global health burden which is particularly challenging to manage. Bariatric surgery is considered the most effective means of sustained weight loss, and Roux-en-Y gastric bypass is considered the most effective treatment for morbid obesity. The additional benefit of placing a non-adjustable band to form a banded Roux-en-Y gastric bypass has gained interest as a measure to improve weight loss; however, comparative data are few, and complications can be high. METHODS We conducted a prospective case-control study of 484 patients aged 18 and over who received either banded Roux-en-Y gastric bypass with a non-adjustable silastic ring or Roux-en-Y gastric bypass. Patients were followed up for five years and evaluated for weight loss, percentage excess weight loss (%EWL), BMI, and band-related complications. RESULTS No significant difference was detected in %EWL or BMI between BRYGB and RYGB. The mean raw weight loss, %EWL, and BMI for BRYGB verse RYGB were as follows: 27.49 SD (17.11) kg verse 34.46 SD (18.18) kg, 65.7% SD (30%) verse 62.2% SD (37%), and 32.33 SD (6.9) kg/m2 verse 32.43 SD (7.2) kg/m2. A total of 80 (21.7%) patients had the non-adjustable band removed for complications. CONCLUSION There is little difference in weight-loss results when comparing BRYGB to RYGB and non-adjustable bands may cause significant complications.
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16
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Lazaridis II, Kraljević M, Süsstrunk J, Köstler T, Zingg U, Delko T. Revisional Adjustable Gastric Band in Roux-en-Y Gastric Bypass-Is It Worth It? J Gastrointest Surg 2021; 25:3056-3063. [PMID: 34100249 PMCID: PMC8654708 DOI: 10.1007/s11605-021-05045-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/17/2021] [Indexed: 01/31/2023]
Abstract
PURPOSE A subset of patients undergoing Roux-en-Y gastric bypass (RYGB) presents with either insufficient weight loss or weight regain. Data on the revisional restrictive options including laparoscopic adjustable gastric band (LAGB) is scarce. This study analyzes the mid-term efficacy and safety of LAGB as a revisional procedure after RYGB. METHODS Data of all patients with revisional LAGB after primary RYGB between January 2011 and May 2019 were retrospectively reviewed. Outcomes included assessment of weight changes, resolution of comorbidities, and early and late complications during the study period. RESULTS Twenty patients were included. The median Body Mass Index (BMI) before revisional LAGB was 34.8 (interquartile range [IQR] 31.9-38.1) kg/m2. After a median follow-up of 33.5 (IQR 19.5-76.5) months, the median BMI was 28.7 (IQR 26.1-32.2) kg/m2. The median additional Excess Weight Loss (EWL) was 37.6% (IQR 23-44.4), leading to a median total EWL of 79.5% (IQR 54.4-94.6). BMI and EWL post-LAGB improved significantly compared to BMI and EWL pre-LAGB (p<0.001 and p<0.001, respectively). Obstructive sleep apnea syndrome resolved 6 months after LAGB in one patient. Three band deflations occurred during the follow-up. Six patients underwent band removal after a median time of 19 (IQR 15.8-26) months. Overall, thirteen patients underwent a reoperation. There was no loss of follow-up until 5 years. After that, two patients were lost to follow-up. CONCLUSION LAGB may be a salvage option after failed RYGB. However, the high rate of revisions after secondary LAGB needs to be taken into consideration.
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Affiliation(s)
- Ioannis I Lazaridis
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland
| | - Marko Kraljević
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland
| | - Julian Süsstrunk
- Obesity & Bariatric Surgery Centre, Department of Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
| | - Thomas Köstler
- Obesity & Bariatric Surgery Centre, Department of Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
| | - Urs Zingg
- Obesity & Bariatric Surgery Centre, Department of Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
| | - Tarik Delko
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland.
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17
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Wijngaarden LH, Reiber BMM, Yousufzai F, Demirkiran A, Klaassen RA. Resizing a large pouch after laparoscopic Roux-en-Y gastric bypass: comparing the effect of two techniques on weight loss. Surg Endosc 2021; 36:3495-3503. [PMID: 34374871 DOI: 10.1007/s00464-021-08671-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 08/02/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Insufficient weight loss or weight regain has many causes including a large gastric pouch. A large gastric pouch may be due to the surgical technique or can be patient related (dilation). Resizing the gastric pouch may lead to additional weight loss. Currently, there is no gold standard for the revisional surgical technique. Therefore this study was performed to determine which surgical technique for revisional bariatric surgery (BS) has superior outcomes in terms of weight loss: sleeve resection of the gastrojejunostomy and gastric pouch (SGP), or resection of the gastrojejunostomy with resizing of the pouch and creation of a new anastomosis (RGJ). METHODS All patients who underwent revisional BS for insufficient weight loss or weight regain as a result of an enlarged pouch after LRYGB from April 2014 to June 2018 in our hospitals were included in this observational cohort study. Outcomes were measured in percentage total weight loss (%TWL). RESULTS A total of 37 patients who underwent SGP and 21 patients who underwent RGJ as revisional BS were included in this study. The median body mass index before revisional BS was 37.6 kg/m2 versus 35.7 kg/m2 (SGP vs RGJ, respectively, P = 0.115). There was no significant difference in %TWL between the two cohorts 1 and 2 years after revisional BS, respectively; SGP 14.5% vs RGJ 11.0%, P = 0.885 and SGP 12.3% vs RGJ 10.8%, P = 0.604. Comparing %TWL based on weight at LRYGB, there was also no significant difference two years after revisional BS (SGP 22.0% vs RGJ 22.2%, P = 0.885). The average use of surgical disposables for the SGP technique were lower compared to the RGJ technique. CONCLUSIONS Resizing a large pouch leads to additional weight loss. Both techniques have comparable outcomes in terms of weight loss. However, based on average surgical costs, the SGP technique may be preferable.
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Affiliation(s)
- L H Wijngaarden
- Department of Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands.
| | - B M M Reiber
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - F Yousufzai
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - A Demirkiran
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - R A Klaassen
- Department of Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
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18
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Metabolic outcomes after revisional bariatric surgery: a systematic review and meta-analysis. Surg Obes Relat Dis 2020; 16:1442-1454. [DOI: 10.1016/j.soard.2020.05.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/18/2020] [Accepted: 05/29/2020] [Indexed: 12/17/2022]
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19
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Uittenbogaart M, Leclercq WKG, Smeele P, van der Linden AN, Luijten AAPM, van Dielen FMH. Reliability and usefulness of upper gastro intestinal contrast studies to assess pouch size in patients with weight loss failure after Roux-en-Y gastric bypass. Acta Chir Belg 2020; 120:329-333. [PMID: 31203729 DOI: 10.1080/00015458.2019.1631625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Weight loss failure or weight regain occurs in up to 25% of patients with a Roux-en-Y gastric bypass (RYGB). Post-operative anatomical changes, like pouch or stoma dilatation, might contribute. Aim of this study is to assess reliability and usefulness of upper gastro intestinal (UGI) contrast studies to detect pouch dilatation.Methods: Retrospective case-control study of patients with weight loss failure between 2010 and 2015 (failure group, n = 101) and a control group (n = 101) with adequate weight loss. Pouch dilatation was systematically reassessed. Clinical parameters were extracted from the electronic patient records.Results: Systematic reassessment showed 23/101 (23%) pouch dilatation in the failure group, compared to 11/101 (11%) in the control group (p = .024). Revision surgery was performed in 43/101 patients in the failure group. After this surgery, only 8% of patients with pouch dilatation achieved adequate weight loss, whereas 39% of patients without pouch dilatation achieved adequate weight loss (p = .07). There was no difference in return to adequate weight loss between patients treated surgically and conservatively (30% vs 28%).Conclusion: Systematic reassessment of UGI contrast studies showed 23% pouch dilatation in patients with weight loss failure after RYGB. However, low interobserver agreement and discrepancy in success rate of revision surgery greatly questions the reliability and usefulness of this diagnostic modality.
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Affiliation(s)
- Martine Uittenbogaart
- Máxima Obesity Centre, Department of General Surgery, Máxima Medical Centre, Veldhoven, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Department of General Surgery, Maastricht, The Netherlands
| | - Wouter K. G. Leclercq
- Máxima Obesity Centre, Department of General Surgery, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Paul Smeele
- Máxima Obesity Centre, Department of General Surgery, Máxima Medical Centre, Veldhoven, The Netherlands
| | | | - Arijan A. P. M. Luijten
- Máxima Obesity Centre, Department of General Surgery, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Francois M. H. van Dielen
- Máxima Obesity Centre, Department of General Surgery, Máxima Medical Centre, Veldhoven, The Netherlands
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Faul A, Chevallier JM, Poghosyan T. Dilated Gastric Pouch Resizing for Weight Loss Failure After One Anastomosis Gastric Bypass. Obes Surg 2020; 29:3406-3409. [PMID: 31115846 DOI: 10.1007/s11695-019-03972-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Some patients may experience inadequate weight loss or weight regain due to gastric pouch dilation after one anastomosis gastric bypass (OAGB). Dilated gastric pouch resizing (GPR) associated with correction of eating behavior was suggested as an option in the management of these patients. Retrospective analysis of 17 consecutives patients who underwent a GPR between 2007 and 2017 was undertaken. At revision, the mean body mass index (BMI) and percentage of total weight loss (%TWL) were 41.5 ± 11 kg/m2 and 15 ± 10, respectively. Overall morbidity rate was 6.7% (n = 1). Two years after revision, the mean BMI and %TWL were 34.1 ± 5 kg/m2 and 31 ± 13, respectively. GPR appeared to be a satisfactory option resulting in mid-term secondary weight loss in well selected patients at the expense of non-negligible morbidity rate.
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Affiliation(s)
- Adrien Faul
- Department of Digestive, Oncologic and Bariatric Surgery, AP-HP, Hôpital Européen Georges Pompidou and Paris Descartes University, 20 Rue Leblanc, 75015, Paris, France
| | - Jean-Marc Chevallier
- Department of Digestive, Oncologic and Bariatric Surgery, AP-HP, Hôpital Européen Georges Pompidou and Paris Descartes University, 20 Rue Leblanc, 75015, Paris, France
| | - Tigran Poghosyan
- Department of Digestive, Oncologic and Bariatric Surgery, AP-HP, Hôpital Européen Georges Pompidou and Paris Descartes University, 20 Rue Leblanc, 75015, Paris, France.
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Abstract
PURPOSE Resizing of the gastric pouch, with eventually resizing of the gastrojejunal anastomosis, has been proposed as revisional procedure to treat weight regain after Roux-en-Y gastric bypass (RYGB), in patients with large gastric pouch and/or large gastrojejunal (GJ) anastomosis. The aim of this study is to determine the midterm results and the safety of laparoscopic resizing of the gastric pouch after RYGB in cases where gastric pouch is > 200 ml and/or GJ anastomosis > 20 mm. MATERIALS AND METHODS All patients who underwent gastric pouch resizing between January 2009 and December 2016 were retrospectively reviewed from a prospective database. The gastric pouch was resized to a volume of 30-40 ml. RESULTS A total of 48 patients had gastric pouch resizing after RYGB. The mean initial BMI was 42.9 ± 4.8 kg/m2. Perioperative morbidity was 8.3% in this series. Mean follow-up was 5.4 years. The mean BMI was 30.0 ± 7.3 kg/m2 at 1 year, 30.0 ± 6.0 kg/m2 at 3 years, and 30.9 ± 5.7 kg/m2 at 5 years. Mean %EBMIL at 1-, 3-, and 5-year follow-up was 51.9%, 55.1%, and 39%, respectively, in 48% follow-up rate. The obesity-related comorbidities disappeared in 67.3% of cases at maximum follow-up. CONCLUSIONS In carefully selected patients with gastric pouch size > 200 ml and/or GJ anastomosis > 20 mm, and after extensive preoperative evaluation, gastric pouch resizing is a potentially effective option to treat weight regain due to anatomical factors after RYGB, with complication rate of 8%.
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22
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Shin RD, Goldberg MB, Shafran AS, Shikora SA, Majumdar MC, Shikora SA. Revision of Roux-en-Y Gastric Bypass with Limb Distalization for Inadequate Weight Loss or Weight Regain. Obes Surg 2020; 29:811-818. [PMID: 30560312 DOI: 10.1007/s11695-018-03635-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Of patients undergoing Roux-en-Y gastric bypass (RYGB), 15-35% of patients fail to achieve "adequate" weight loss or regain significant weight. Multiple solutions have been proposed, but not well studied. We report our experience with limb distalization with lengthening the biliopancreatic (BP) limb and shortening the common channel (CC). METHODS We retrospectively reviewed data from patients undergoing laparoscopic limb distalization for excess weight loss (EWL) <50% or BMI >35 kg/m2 after RYGB from 2012 to 2017. The BP limb was lengthened and CC was shortened to 100-200 cm. Perioperative outcomes such as morbidity, weight loss, nutritional deficiencies, comorbidity remission, and operative details were analyzed. RESULTS Twenty-two patients were included. The mean BMI prior to RYGB was 54.1 ± 8.5 kg/m2 and 43.0 ± 5.5 kg/m2 prior to limb distalization. The mean follow-up was 18.3 ± 12.9 months with a mean BMI change, %EWL, and %TWL (total weight loss) of 11.8 ± 7.4 kg/m2, 62.3 ± 32.4%, and 25.4 ± 14.4%, respectively. The total mean BMI change, %EWL, and %TWL from RYGB was 22.2 ± 9.9 kg/m2, 77.8 ± 23.6%, and 40.2 ± 13.3%, respectively. Of patients with persistent comorbidities, remission rates of diabetes, hypertension, and gastroesophageal reflux disease were 100%, 17%, and 38%, respectively. The mean operative time was 132.6 ± 54.4 min and mean hospital stay was 2.2 ± 1.3 days. Overall morbidity was 27.3%. Three patients (13.6%) developed nutritional deficiencies requiring reversal surgery. CONCLUSION In patients with inadequate weight loss or weight regain after RYGB, limb distalization with lengthening of the BP limb is an effective procedure for additional weight loss and further improvement of comorbidities. Nutritional complications are a risk, but can be minimized with close follow-up and patient compliance.
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Affiliation(s)
- Reuben D Shin
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.,Department of General Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Michael B Goldberg
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.,Department of General Surgery, Crozer Keystone Health System, Upland, PA, USA
| | - Allison S Shafran
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Samuel A Shikora
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Melissa C Majumdar
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Scott A Shikora
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
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23
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Revisional But Not Conversional Gastric Bypass Surgery Increases the Risk of Leaks: Review of 176 Redo out of 932 Consecutive Cases. Obes Surg 2019; 28:2903-2911. [PMID: 29804282 DOI: 10.1007/s11695-018-3311-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Nowadays, surgeons are dealing more and more with patients experiencing failure of a previous bariatric procedure after the worldwide exponential increase of bariatric surgery. Only a few and contradictory studies investigated both outcomes and complications risk factors in this subset population of bariatric patients. We aimed to study a homogeneous population of patients undergoing redo bariatric surgery (REDO-BS) resulting in bypass anatomy to evaluate early postoperative outcomes and identify risk factors of postoperative complications and mortality. MATERIAL AND METHODS In this study, we compared the outcomes of patients undergoing REDO-BS from another former bariatric procedure into Roux-en-Y gastric bypass (RYGP) to those undergoing primary RYGP. Data were extracted from a prospectively maintained database. RESULTS One hundred thirty-eight conversional bariatric surgery (CBS) cases resulting in RYGP anatomy and 38 RBS cases of pouch resizing (PR) were compared with 756 primary RYGP. There were no statistical significant difference in outcomes between the primary and CBS groups but patients undergoing PR had a significant higher risk of developing a leak than others. CBS complication risk factors were age (OR = 1.05; p = 0.04), operative time, and T2DM (OR = 4.11; p = 0.03). CONCLUSIONS CBS is safe and leads to similar early postoperative outcomes as primary RYGP whereas the indication for revisional surgery such as PR should be carefully evaluated as it is associated with an increased risk of leak.
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Schiavo L, Pilone V, Rossetti G, Barbarisi A, Cesaretti M, Iannelli A. A 4-Week Preoperative Ketogenic Micronutrient-Enriched Diet Is Effective in Reducing Body Weight, Left Hepatic Lobe Volume, and Micronutrient Deficiencies in Patients Undergoing Bariatric Surgery: a Prospective Pilot Study. Obes Surg 2019; 28:2215-2224. [PMID: 29502279 DOI: 10.1007/s11695-018-3145-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Before bariatric surgery (BS), moderate weight loss, left hepatic lobe volume reduction, and micronutrient deficiency (MD) identification and correction are desirable. OBJECTIVES The objective of this study was to assess the safety and the effectiveness of a 4-week preoperative ketogenic micronutrient-enriched diet (KMED) in reducing body weight (BW), left hepatic lobe volume, and correcting MD in patients scheduled for BS. MATERIALS AND METHODS In this prospective pilot study, a cohort of morbidly obese patients (n = 27, 17 females, 10 males) with a mean body mass index (BMI) of 45.2 kg/m2 scheduled for BS underwent a 4-week preoperative KMED. Their BW, BMI, fat mass (FM), fat-free mass (FFM), resting metabolic rate (RMR), left hepatic lobe volume, micronutrient status, and biochemical and metabolic patterns were measured before and after the 4-week KMED. Patient compliance was assessed by validated questionnaires (3-day estimated food records and 72-h recall). Qualitative methods (5-point Likert questionnaire) were used to measure diet acceptability and side effects. RESULTS All patients completed the study. We observed highly significant decreases in BW (- 10.3%, p < 0.001, in males; - 8.2%, p < 0.001, in females), left hepatic lobe volume (- 19.8%, p < 0.001), and an amelioration of patient micronutrient status. All patients showed a high frequency of acceptability and compliance in following the diet. No adverse side effect was reported. CONCLUSION This study demonstrates that a 4-week preoperative KMED is safe and effective in reducing BW, left hepatic lobe volume, and correcting MD in obese patients scheduled for BS.
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Affiliation(s)
- Luigi Schiavo
- Department of Cardio-Thoracic and Respiratory Science, University of Campania "Luigi Vanvitelli", Naples, Italy. .,IX Division of General Surgery, Vascular Surgery, and Applied Biotechnology, Naples University Polyclinic, Naples, Italy.
| | - Vincenzo Pilone
- Department of Medicine, Surgery, and Dentistry, "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Gianluca Rossetti
- Bariatric Surgery and Metabolic Disease Unit, "Beato Matteo" Clinic, Vigevano, Pavia, Italy
| | - Alfonso Barbarisi
- Department of Cardio-Thoracic and Respiratory Science, University of Campania "Luigi Vanvitelli", Naples, Italy.,IX Division of General Surgery, Vascular Surgery, and Applied Biotechnology, Naples University Polyclinic, Naples, Italy
| | - Manuela Cesaretti
- Department of HPB Surgery and Liver Transplantation, Hôpital Beaujon, AP-HP, Clichy, France.,Department of Nanophysics, Italian Institute of Technology, Genoa, Italy
| | - Antonio Iannelli
- University of Nice Sophia-Antipolis, Nice, France.,Digestive Unit, Archet 2 Hospital, University Hospital of Nice, Nice, France.,Inserm, U1065, Team 8 "Hepatic complications of obesity", Nice, France
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25
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Surgical therapy of weight regain after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2019; 15:1719-1728. [PMID: 31474525 DOI: 10.1016/j.soard.2019.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/28/2019] [Accepted: 07/03/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is a well-established surgical method for morbid obesity; however, weight regain (WR) after initially good results may be considered an issue, the treatment of which has found no consensus yet. OBJECTIVES The aim of this study was to compare the different surgical methods treating WR after RYGB that are used at the Vienna Medical University in a larger number of patients, concerning further weight loss, complications, and reoperations. SETTING University hospital, Austria. METHODS This study includes all patients with RYGB who were reoperated due to WR at the Vienna Medical University by December 2016 (n = 84). The follow-up rate was 93%. The following 4 approaches to treating WR after RYGB were taken: (1) pouch resizing, (2) pouch banding, (3) pouch resizing plus pouch banding, and (4) common limb shortening (i.e., distalization). RESULTS The mean maximum excess weight loss referring to the WR procedure in the 4 groups was as follows: group 1: 69.0% ± 35.2%, group 2: 62.8% ± 39.5%, group 3: 83.1% ± 30.9%, and group 4: 81.5% ± 41.6%. Reoperations occurred in the following different groups: group 1 had 2 balloon dilations (20%), groups 2 (n = 13) and 3 (n = 29) had 5 (38% and 17%) band removals each, and group 4 had 9 reversal procedures due to malnutrition (30%). CONCLUSIONS There are nonsignificant differences in terms of additional weight loss between the different methods. However, differences lay in the areas of adverse symptoms and further reoperations. While there was no risk of malnutrition with pouch resizing, there was with distalization. Pouch banding (with or without resizing) poses a higher risk of dysphagia.
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Abstract
Background: The main indications for revision of bariatric surgery are inadequate weight loss, weight regain, or complications. The objective of revision is to restore the restrictive component and/or add a malabsorptive component. Objectives: To evaluate the effectiveness of revisional laparoscopic bariatric surgery for loss of weight and assess the risks and benefits associated with these technically demanding procedures. Methods: Revision cases performed between 2001 and 2013 were identified and grouped according to the primary procedure and type of revision. A retrospective analysis was carried out for weight loss as well as perioperative morbidity and mortality. Results: The total of 271 patients underwent revisional laparoscopic surgery during the study period and were categorized into four groups. Group 1 (n = 67) had an adjustable gastric band converted to gastric bypass (GBP). Group 2 (n = 128) had a dilated gastric pouch after GBP and underwent pouch reduction. Group 3 (n = 57) had a GBP and underwent pouch reduction and elongation of the biliopancreatic limb. Group 4 (n = 19) had a vertical banded gastroplasty converted to a GBP. The mean total body weight loss for Groups 1 to 4 was 35.3%, 22.9%, 39.4%, and 33.2%, respectively. The average operative times were 185, 75, 142, and 205 minutes; and the average hospitalization was 1.5, 1.0, 2.0, and 2.5 days, respectively. All cases were completed laparoscopically. Concomitant procedures were liver biopsy, cholecystectomy, partial gastrectomy, hiatal, ventral, and internal hernia repairs. Complication rates were 2.9%, 0%, 3.5%, and 5.2% for each of the groups and there were no mortalities. Conclusion: Results of revisional bariatric surgery vary depending on the original procedure and the reasons for revision. In particular, if the main reason for reoperation is inadequate weight loss, then the burden is to demonstrate a surgically correctable deficiency. Revisional procedures incorporating malabsorption result in greater weight loss than gastric restriction alone.
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Schiavo L, Pilone V, Rossetti G, Iannelli A. The Role of the Nutritionist in a Multidisciplinary Bariatric Surgery Team. Obes Surg 2019; 29:1028-1030. [DOI: 10.1007/s11695-019-03706-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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28
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Danin PE, Anty R, Patouraux S, Raucoules-Aimé M, Gugenheim J, Tran A, Gual P, Iannelli A. Non-invasive Evaluation of NAFLD with Indocyanine Green Clearance Test: a Preliminary Study in Morbidly Obese Patients Undergoing Bariatric Surgery. Obes Surg 2018; 28:735-742. [PMID: 28875438 DOI: 10.1007/s11695-017-2914-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Overweight and obesity dramatically increased in the last years. Hepatic complication of obesity, integrated in the term of non-alcoholic fatty liver disease (NAFLD), is a spectrum of abnormality ranging from steatosis to non-alcoholic steatohepatitis (NASH), potentially leading to cirrhosis. Liver biopsy remains the gold standard to evaluate the stage of NAFLD; however, the procedure is invasive. The indocyanine green (ICG) clearance test is performed since years to assess hepatic function before partial hepatectomy, or after liver transplantation. This study was designed to detect liver complications with the ICG clearance test in a population of obese patients scheduled for bariatric surgery. METHODS In a prospective cohort study, morbidly obese individuals receiving bariatric surgery with scheduled hepatic biopsies were investigated. Liver function was determined by the ICG test preoperatively, and blood samples were collected. Liver biopsy specimens were obtained for each patient and classified according to the NAFLD activity score (NAS) by a single pathologist that was blinded to the results of the ICG test. RESULTS Twenty-six patients were included (7 male and 19 female). The mean age of participants was 45.8 years; the mean body mass index was 41.4 kg/m2. According to the NAS, 6 (23.1%) patients revealed manifest NASH, and 5 patients were considered borderline (19.2%). A closed correlation was observed between the ICG clearance test and hepatic steatosis (r = 0.43, p = 0.03), NAS (r = 0.44, p = 0.025), and fibrosis (r = 0.49, p = 0.01). CONCLUSIONS In obese patients, non-invasive evaluation of liver function with the indocyanine green clearance test correlated with histological features of NAFLD. This may detect non-invasively hepatopathy in obese population and could motive biopsy.
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Affiliation(s)
- Pierre Eric Danin
- Anesthesia and Intensive care, L'Archet 2 Hospital, University Hospital of Nice, Archet 2 151 Route Saint Antoine de Ginestière, BP 3079, 062014, Nice, Cedex 3, France.,INSERM, U1065, C3M, Team 8 « Hepatic complications in obesity », 151 route Saint Antoine de Ginestière, BP 2 3194, 06204, Nice, Cedex 3, France.,Université Côte d'Azur, Nice, France
| | - Rodolphe Anty
- INSERM, U1065, C3M, Team 8 « Hepatic complications in obesity », 151 route Saint Antoine de Ginestière, BP 2 3194, 06204, Nice, Cedex 3, France.,Université Côte d'Azur, Nice, France.,CHU of Nice, Digestive Center, L'Archet 2 Hospital, University Hospital of Nice, Nice, France.,Digestive Unit, Archet 2 Hospital, 151 Route Saint Antoine de Ginestière, BP 3079, 06204, Nice, Cedex 3, France
| | - Stephanie Patouraux
- INSERM, U1065, C3M, Team 8 « Hepatic complications in obesity », 151 route Saint Antoine de Ginestière, BP 2 3194, 06204, Nice, Cedex 3, France.,Université Côte d'Azur, Nice, France.,CHU of Nice, Biological Center, Pasteur Hospital, University Hospital of Nice, Nice, France.,Biological Center, Archet 2 Hospital, 151 Route Saint Antoine de Ginestière BP 3079, Nice, 06204, Cedex 3, France
| | - Marc Raucoules-Aimé
- Anesthesia and Intensive care, L'Archet 2 Hospital, University Hospital of Nice, Archet 2 151 Route Saint Antoine de Ginestière, BP 3079, 062014, Nice, Cedex 3, France.,Université Côte d'Azur, Nice, France
| | - Jean Gugenheim
- INSERM, U1065, C3M, Team 8 « Hepatic complications in obesity », 151 route Saint Antoine de Ginestière, BP 2 3194, 06204, Nice, Cedex 3, France.,Université Côte d'Azur, Nice, France.,CHU of Nice, Digestive Center, L'Archet 2 Hospital, University Hospital of Nice, Nice, France.,Department of Digestive Surgery, Hôpital Archet 2, 151 Route Saint Antoine de Ginestière, BP3079, 06204, Nice, Cedex 3, France
| | - Albert Tran
- INSERM, U1065, C3M, Team 8 « Hepatic complications in obesity », 151 route Saint Antoine de Ginestière, BP 2 3194, 06204, Nice, Cedex 3, France.,Université Côte d'Azur, Nice, France.,CHU of Nice, Digestive Center, L'Archet 2 Hospital, University Hospital of Nice, Nice, France.,Digestive Unit, Archet 2 Hospital, 151 Route Saint Antoine de Ginestière, BP 3079, 06204, Nice, Cedex 3, France
| | - Philippe Gual
- INSERM, U1065, C3M, Team 8 « Hepatic complications in obesity », 151 route Saint Antoine de Ginestière, BP 2 3194, 06204, Nice, Cedex 3, France. .,Université Côte d'Azur, Nice, France. .,Inserm U1065, Bâtiment Universitaire ARCHIMED, Equipe 8 "Complications hépatiques de l'obésité", 151 route Saint Antoine de Ginestière, BP 2 3194, 06204, Nice, Cedex 3, France.
| | - Antonio Iannelli
- INSERM, U1065, C3M, Team 8 « Hepatic complications in obesity », 151 route Saint Antoine de Ginestière, BP 2 3194, 06204, Nice, Cedex 3, France. .,Université Côte d'Azur, Nice, France. .,CHU of Nice, Digestive Center, L'Archet 2 Hospital, University Hospital of Nice, Nice, France. .,Department of Digestive Surgery, Hôpital Archet 2, 151 Route Saint Antoine de Ginestière, BP3079, 06204, Nice, Cedex 3, France. .,Centre Hospitalier Universitaire de Nice, Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital de l'Archet, Pôle Digestif, 151 route Saint Antoine de Ginestière, 06200, Nice, Cedex, France.
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Conversion of standard Roux-en-Y gastric bypass to distal bypass for weight loss failure and metabolic syndrome: 3-year follow-up and evolution of technique to reduce nutritional complications. Surg Obes Relat Dis 2018; 14:554-561. [DOI: 10.1016/j.soard.2018.01.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 11/11/2017] [Accepted: 01/08/2018] [Indexed: 12/12/2022]
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30
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Tran DD, Nwokeabia ID, Purnell S, Zafar SN, Ortega G, Hughes K, Fullum TM. Revision of Roux-En-Y Gastric Bypass for Weight Regain: a Systematic Review of Techniques and Outcomes. Obes Surg 2017; 26:1627-34. [PMID: 27138603 DOI: 10.1007/s11695-016-2201-5] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Weight regain has led to an increase in revision of Roux-en-Y gastric bypass (RYGB) surgeries. There is no standardized approach to revisional surgery after failed RYGB. We performed an exhaustive literature search to elucidate surgical revision options. Our objective was to evaluate outcomes and complications of various methods of revision after RYGB to identify the option with the best outcomes for failed primary RYGB. METHOD A systematic literature search was conducted using the following search tools and databases: PubMed, Google Scholar, Cochrane Clinical Trials Database, Cochrane Review Database, EMBASE, and Allied and Complementary Medicine to identify all relevant studies describing revision after failed RYGB. Inclusion criteria comprised of revisional surgery for weight gain after RYGB. RESULTS Of the 1200 articles found, only 799 were selected for our study. Of the 799, 24 studies, with a total of 866 patients, were included for a systematic review. Of the 24 studies, 5 were conversion to Distal Roux-en-y gastric bypass (DRYGB), 5 were revision of gastric pouch and anastomosis, 6 were revision with gastric band, 2 were revision to biliopancreatic diversion/duodenal switch (BPD/DS), and 6 were revision to endoluminal procedures (i.e., stomaphyx). Mean percent excess body mass index loss (%EBMIL) after revision up to 1 and 3-year follow-up for BPD/DS was 63.7 and 76 %, DRYGB was 54 and 52.2 %, gastric banding revision 47.6 and 47.3 %, gastric pouch/anastomosis revision 43.3 and 14 %, and endoluminal procedures at 32.1 %, respectively. Gastric pouch/anastomosis revision resulted in the lowest major complication rate at 3.5 % and DRYGB with the highest at 11.9 % when compared to the other revisional procedures. The mortality rate was 0.6 % which only occurred in the DRYGB group. CONCLUSION All 866 patients in the 24 studies reported significant early initial weight loss after revision for failed RYGB. However, of the five surgical revision options considered, BPD/DS, DRYGB, and gastric banding resulted in sustained weight loss, with acceptable complication rate.
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Affiliation(s)
- Daniel D Tran
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA.
| | | | | | - Syed Nabeel Zafar
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Gezzer Ortega
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Kakra Hughes
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Terrence M Fullum
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
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31
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Borbély Y, Winkler C, Kröll D, Nett P. Pouch Reshaping for Significant Weight Regain after Roux-en-Y Gastric Bypass. Obes Surg 2017; 27:439-444. [PMID: 27510586 DOI: 10.1007/s11695-016-2329-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Significant weight regain after Roux-en-Y gastric bypass (RYGB) occurs in around 20 % of patients in the long term. Anatomical reasons include dilatation of the gastric pouch and/or the pouch-jejunal anastomosis, leading to loss of restriction. Pouch reshaping (PR) aims at reestablishing restriction with a subsequent feeling of satiety. This study reports the outcome of PR embedded in a multidisciplinary treatment pathway. METHODS Twenty-six patients after PR for weight regain >30 % following RYGB in a university hospital between October 2010 and March 2016 were analyzed. Excluded were patients with PR for gastro-gastric fistulae, hypoglycemia, candy cane syndrome, and concomitant alteration of limb lengths. PR consisted in laparoscopic lateral resection of the gastric pouch, the anastomosis and the proximal 5 cm of the alimentary limb over a 32F bougie. RESULTS Median follow-up after PR was 48 months (range 24-60). Median BMI at PR was 39.1 kg/m2 (32.7-59.1). Median operation time was 85 min (25-190), and median length of stay was 3 days (1-35). Minor complications (grade ≤ 2) occurred in seven (27 %) patients and major complications (grade ≥ 3) in four patients (15 %). Nadir BMI and %EBMIL after PR were 32.9 kg/m2 and 43.3 %, reached after a median of 12 months (3-48). Comorbidities were resolved in 81 %. After 48 months, median BMI was 33.8 kg/m2 (20.4-49.2) and %EBMIL was 61.4 (39.1-121.2). CONCLUSIONS Used selectively in a multidisciplinary treatment pathway, PR leads to prolonged weight stabilization around the previous nadir. However, its associated perioperative morbidity must not be disregarded.
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Affiliation(s)
- Yves Borbély
- Department of Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, 3010, Bern, Switzerland.
| | - Carmen Winkler
- Department of Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, 3010, Bern, Switzerland
| | - Dino Kröll
- Department of Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, 3010, Bern, Switzerland
| | - Philipp Nett
- Department of Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, 3010, Bern, Switzerland
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Kuzminov A, Palmer AJ, Wilkinson S, Khatsiev B, Venn AJ. Re-operations after Secondary Bariatric Surgery: a Systematic Review. Obes Surg 2017; 26:2237-2247. [PMID: 27272668 DOI: 10.1007/s11695-016-2252-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This paper reviews reoperations rates for short- and long-term complications following secondary bariatric procedures and need for further bariatric surgery. The search revealed 28 papers (1317 secondary cases) following at least 75 % of patients for 12 months or more. For adjustable gastric banding (AGB), rebanding had higher re-revisional rates than conversions into other procedures. Conversion of AGB to Roux-en-Y gastric bypass had the highest number of short- (10.7 %) and long-term (22.0 %) complications. We estimated 194 additional reoperations per 1000 patients having a secondary procedure, 8.8 % needing tertiary surgery. Despite being poorly reported, risks of reoperations for long-term complications and tertiary bariatric surgery are higher than usually reported risks of short-term complications and should be taken into account when choosing a secondary bariatric procedure and for economic evaluations.
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Affiliation(s)
- Alexandr Kuzminov
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia
| | | | | | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia.
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Yan J, Cohen R, Aminian A. Reoperative bariatric surgery for treatment of type 2 diabetes mellitus. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.04.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Debs T, Petrucciani N, Kassir R, Vanbiervliet G, Ben Amor I, Staccini AM, Sejor E, Gugenheim J. Migration of an Endoscopic Double Pigtail Drain into the Abdominal Wall Placed as a Treatment of a Fistula Post Revisional Bariatric Surgery. Obes Surg 2017; 27:1335-1337. [PMID: 28303506 DOI: 10.1007/s11695-017-2580-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tarek Debs
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France.
| | - Niccolo Petrucciani
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Radwan Kassir
- Department of General Surgery, CHU Nord Hospital, Jean Monnet University, Saint-Etienne, France
| | - Geoffrey Vanbiervliet
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Imed Ben Amor
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Aline Myx Staccini
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Eric Sejor
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Jean Gugenheim
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
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van der Wielen N, Paulus G, van Avesaat M, Masclee A, Meijerink J, Bouvy N. Effect of Endoscopic Gastroplication on the Genome-Wide Transcriptome in the Upper Gastrointestinal Tract. Obes Surg 2017; 27:740-748. [PMID: 27620343 PMCID: PMC5306242 DOI: 10.1007/s11695-016-2356-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Bariatric surgery is an effective intervention strategy in obesity, resulting in sustained weight loss and a reduction of comorbidities. Gastroplication, using the articulating circular endoscopic stapler, was recently introduced as a transoral bariatric technique. This procedure reduces gastric volume and induced 34.9 % of excess weight loss in the first year (Paulus et al. Gastrointest Endosc. 81(2):312-20, 3). The aim of the present study was to gain insight in the long-term effects and underlying mechanisms of gastroplication by investigating differences in the genome-wide gastric and duodenal transcriptome before and 1 year after intervention. METHODS Ten morbidly obese patients (BMI 39.8 ± 0.9 kg/m2 (mean ± SEM)) underwent gastroplication. Previous to the procedure and after 1 year, blood samples were taken, and mucosal biopsies were collected from the fundus, antrum and duodenum. Gene expression was measured using microarray analysis. Plasma adiponectin, HbA1c, IL-1β, IL-6, IL-7, TNF-α, IFN-γ, MCP-1, IL-8, TGF-1 and CRP levels were determined. RESULTS Downregulation of inflammatory genes and gene sets was observed in the fundus and duodenum 1 year after surgery. Gene expression of ghrelin and its activating enzyme GOAT were downregulated in the upper gastrointestinal tract. Patients showed a reduction in plasma HbA1c levels (from 6.17 ± 0.51 to 5.32 ± 0.14 %, p = 0.004) and an increase of plasma adiponectin (from 16.87 ± 3.67 to 27.67 ± 5.92 μg/ml, p = 0.002). CONCLUSIONS Individuals undergoing gastroplication displayed a downregulation of inflammatory tone in the stomach and duodenum, which coincided with improved HbA1c and adiponectin levels. The reduction of inflammatory tone in the upper gastrointestinal tract may be a consequence of an improved metabolic health status or alternatively caused by the procedure itself.
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Affiliation(s)
- Nikkie van der Wielen
- Top Institute Food and Nutrition, Wageningen, The Netherlands
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Givan Paulus
- Department of General Surgery, NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mark van Avesaat
- Top Institute Food and Nutrition, Wageningen, The Netherlands
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM, Maastricht, University Medical Center, Maastricht, The Netherlands
| | - Ad Masclee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM, Maastricht, University Medical Center, Maastricht, The Netherlands
| | - Jocelijn Meijerink
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
| | - Nicole Bouvy
- Department of General Surgery, NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
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Maleckas A, Gudaitytė R, Petereit R, Venclauskas L, Veličkienė D. Weight regain after gastric bypass: etiology and treatment options. Gland Surg 2016; 5:617-624. [PMID: 28149808 DOI: 10.21037/gs.2016.12.02] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Roux-en-Y gastric bypass (RYGB) is one of the most common operations performed for the patients with morbid obesity. Weight regain (WR) is a complication that may decrease efficiency of the surgical treatment and demand further interventions. Different factors including lifestyle, mental health, hormonal/metabolic and surgical plays role in WR after RYGB. Various treatment options have been proposed for WR. Conservative treatment is less effective than surgery. Endoscopic refashioning of gastric pouch/stoma fails to achieve sustainable weight loss. Surgical reduction of pouch has acceptable short-term results, but WR after 3 years is substantial. Banded gastric bypass achieves good short-term results, but long-term follow-up data are needed. Distalization of RYGB has a high risk of protein calorie malnutrition (PCM) and conversion to BP diversion (BPD)/duodenal switch (DS) is a technically demanding procedure. Both procedures achieve sustainable long-term weight loss. More studies are needed to explore long-term results of various surgical interventions for WR after RYGB.
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Affiliation(s)
- Almantas Maleckas
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania;; Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rita Gudaitytė
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rūta Petereit
- Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Linas Venclauskas
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Džilda Veličkienė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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One-stage conversion of Roux-en-Y gastric bypass to a modified biliopancreatic diversion with duodenal switch using a hybrid sleeve concept. Surg Obes Relat Dis 2016; 12:1671-1678. [DOI: 10.1016/j.soard.2016.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/16/2016] [Accepted: 02/17/2016] [Indexed: 12/14/2022]
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Amor IB, Debs T, Petrucciani N, Martini F, Kassir R, Gugenheim J. A Simple Technique of Gastric Pouch Resizing for Inadequate Weight Loss After Roux-en-Y Gastric Bypass. Obes Surg 2016; 27:273-274. [DOI: 10.1007/s11695-016-2424-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schiavo L, Sans A, Scalera G, Barbarisi A, Iannelli A. Why Preoperative Weight Loss in Preparation for Bariatric Surgery Is Important. Obes Surg 2016; 26:2790-2792. [DOI: 10.1007/s11695-016-2381-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Cena H, De Giuseppe R, Biino G, Persico F, Ciliberto A, Giovanelli A, Stanford FC. Evaluation of eating habits and lifestyle in patients with obesity before and after bariatric surgery: a single Italian center experience. SPRINGERPLUS 2016; 5:1467. [PMID: 27652042 PMCID: PMC5007240 DOI: 10.1186/s40064-016-3133-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/23/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND The study evaluated and compared the eating habits and lifestyle of patients with moderate to severe obesity who have undergone Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG). METHODS Food frequency (FF), food habits (FH), physical activity and life style (PA) as well as smoking habits (SH) were analyzed in 50 RYGB (25 M; aged: 24-64) and 50 SG patients (25 M; aged: 22-63) by means of a validated questionnaire, before (T0) and 6 months (T1) post bariatric surgery. A score for each section (FF, FH, PA, SH) was calculated. RESULTS ANOVA analysis (age/sex adjusted): FF and FH scores improved at T1 (RYGB and SG: p < 0.001); PA score improved but not significantly; SH score did not change at T1 neither in RYGB nor in SG. Mixed models: FF and PA scores did not correlate with age, gender, weight, BMI, neither in RYGB nor in SG; FH score was negatively correlated both with weight (RYGB: p = 0.002) and BMI (SG: p = 0.003); SH score was positively correlated with age, in SG (p = 0.002); the correlation was stronger in females than in males (p = 0.004). CONCLUSIONS Although dietary habits improved, patients did not change their physical activity level or their smoking habits. Patients should receive adequate lifestyle counseling to ensure the maximal benefit from bariatric surgery.
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Affiliation(s)
- Hellas Cena
- Unit of Human Nutrition and Dietetics, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, via Bassi 21, 27100 Pavia, PV Italy
| | - Rachele De Giuseppe
- Unit of Human Nutrition and Dietetics, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, via Bassi 21, 27100 Pavia, PV Italy.,Scuola di Specializzazione in Scienza dell'Alimentazione, University of Milan, via GB Grassi 74, 20157 Milan, Italy
| | - Ginevra Biino
- Institute of Molecular Genetics, National Research Council of Italy, via Abbiategrasso 207, 27100 Pavia, Italy
| | - Francesca Persico
- Department of General Surgery, Istituto Clinico S. Ambrogio, via Faravelli 16, 20149 Milan, Italy
| | - Ambra Ciliberto
- Department of General Surgery, Istituto Clinico S. Ambrogio, via Faravelli 16, 20149 Milan, Italy
| | - Alessandro Giovanelli
- Department of General Surgery, Istituto Clinico S. Ambrogio, via Faravelli 16, 20149 Milan, Italy
| | - Fatima Cody Stanford
- Department of Medicine and Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
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Al-Bader I, Khoursheed M, Al Sharaf K, Mouzannar DA, Ashraf A, Fingerhut A. Revisional Laparoscopic Gastric Pouch Resizing for Inadequate Weight Loss After Roux-en-Y Gastric Bypass. Obes Surg 2016; 25:1103-8. [PMID: 25599857 PMCID: PMC4460267 DOI: 10.1007/s11695-015-1579-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Weight regain due to gastric pouch dilatation after Roux-en-Y gastric bypass (RYGB) is seen more frequently after long-term follow-up. We studied the feasibility and safety of laparoscopic pouch resizing (LPR) for dilated gastric pouch after RYGB associated with inadequate weight loss. Methods From 1st June 2011 to 1st September 2013, patients who underwent LPR after failed RYGB were retrospectively compared and analyzed. Data included patient demographics, comorbidity, indication for revision, preoperative weight and BMI, operative time, hospital stay, conversion rate, mean follow-up, body mass index (BMI) loss, percentage excess weight loss (%EWL), reoperation rate, morbidity, and mortality. Results Out of 170 revisional bariatric procedures, 32 LPR (27/5, F/M) were performed for dilated gastric pouch after RYGB. The mean age, preoperative weight, and BMI were 38.3 ± 9.3 years, 101.7 ± 22.8 kg, 38.8 ± 6.4 kg/m2, respectively. The median operative time and hospital stay were 100 min and 2 days, respectively. All pouch resizing procedures were carried out laparoscopically, with none requiring conversion to open surgery. The overall complication and reoperation rates were 15.6 and 3.1 %, respectively. There were no deaths. The mean follow-up was 14.1 ± 6.2 months. The mean postoperative BMI was 32.8 ± 7.3 kg/m2, and the median %EWL was 29.1 %. Conclusions LPR is safe and can lead to adequate weight loss. However, long-term follow-up is needed to determine the efficiency and durability of this procedure.
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Affiliation(s)
- Ibtisam Al-Bader
- Department of Surgery, Faculty of Medicine, Kuwait University, Safat, PO Box 24923, Jabriya, 13110, Kuwait
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Corcelles R, Jamal MH, Daigle CR, Rogula T, Brethauer SA, Schauer PR. Surgical management of gastrogastric fistula. Surg Obes Relat Dis 2015; 11:1227-32. [DOI: 10.1016/j.soard.2015.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 02/02/2015] [Accepted: 03/06/2015] [Indexed: 02/08/2023]
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Aminian A, Schauer PR, Brethauer SA. Reply to: Assessment of pouch and stoma size in weight loss failure after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2015; 12:211-2. [PMID: 26433640 DOI: 10.1016/j.soard.2015.08.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 08/27/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic Cleveland, Ohio
| | - Philip R Schauer
- Bariatric and Metabolic Institute, Cleveland Clinic Cleveland, Ohio
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Moon RC, Teixeira AF, Jawad MA. Treatment of weight regain following roux-en-Y gastric bypass: revision of pouch, creation of new gastrojejunostomy and placement of proximal pericardial patch ring. Obes Surg 2015; 24:829-34. [PMID: 24446076 DOI: 10.1007/s11695-014-1188-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In the literature, weight regain or failure of weight loss has been reported in up to 35% of patients after Roux-en-Y gastric bypass (RYGB). Several revisional procedures have been suggested to reinitiate further weight loss in this group of patients, and placing a silastic ring around the pouch proximal to the gastrojejunostomy is one among those procedures. The aim of our study is to evaluate and compare the safety and efficacy of salvage banding using a pericardial patch after RYGB for further weight loss. Between December 2009 and April 2013, a total of 46 patients underwent revision with pericardial patch ring after RYGB for weight regain/failure of weight loss. A retrospective review of a prospectively collected database was performed, noting the outcomes and complications of the procedure. The mean body mass index at the time of revision was 40.1 ± 6.8 kg/m2. Mean percentage of excess weight loss was 23.4 ± 15.7%, 39.0 ± 27.4%, and 18.9 ± 20.5% at 6, 12 and 24 months after revision, respectively. Eight (17.4%) patients required a total of 11 readmissions due to nausea, vomiting, dysphagia and abdominal pain. Six (13.0%) patients underwent a total of six reoperations, including four patients with laparoscopic removal of the pericardial patch and another revision of RYGB, and two patients with repair of perforated ulcers. Revision with pericardial patch ring after gastric bypass for weight regain or failure of weight loss may not be feasible, safe and effective.
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Affiliation(s)
- Rena C Moon
- Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, 89 W Copeland Drive, 1st Floor, Orlando, FL, USA
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Aminian A, Corcelles R, Daigle CR, Chand B, Brethauer SA, Schauer PR. Critical appraisal of salvage banding for weight loss failure after gastric bypass. Surg Obes Relat Dis 2014; 11:607-11. [PMID: 26093767 DOI: 10.1016/j.soard.2014.11.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 11/06/2014] [Accepted: 11/18/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Placement of an adjustable gastric band (AGB) over the gastric pouch after RYGB failure has had varied results. The aim of this study was to evaluate safety and outcomes of AGB after RYGB failure. METHODS Twenty-eight patients who underwent laparoscopic placement of an AGB around the gastric pouch as a revisional procedure for inadequate weight loss or recidivism after RYGB between 2008-2011 were identified. RESULTS Twenty-four (86%) patients had a dilated gastric pouch and/or stoma. The mean operative and adhesiolysis times were 137.9±52.3 minutes and 83±51 minutes, respectively. History of a previous open RYGB was associated with a longer adhesiolysis time (P = .03). Three (11%) major intraoperative and 5 (18%) early postoperative complications occurred. Late complications (all requiring band removal) were observed in 6 (21%) patients and included ineffectiveness (n = 2), dysphagia/esophageal dilation (n = 2), band erosion (n = 1), and peritonitis (n = 1). In all 4 patients with a normal-sized pouch and stoma at the time of band placement, the band was removed. After a mean follow-up of 38.3±14.8 months, the mean body mass index (BMI) change and median excess weight loss (EWL) after salvage banding were -3.6±4.5 kg/m(2) and 12.7%, respectively. In the subset of patients with a dilated pouch/stoma, BMI less than 42 kg/m(2) at the time of band placement was associated with a significantly higher EWL (41.4%±37.0%) compared with a baseline BMI>42 kg/m(2) (12.1%±7.2%, P = .03). CONCLUSIONS Salvage banding is technically challenging due to dense adhesions, carries significant morbidity, and is associated with only 13% additional EWL. However, this approach may still be an option in carefully selected patients, such as those with previous laparoscopic RYGB who have a dilated pouch and/or stoma and lower BMI.
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Affiliation(s)
- Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ricard Corcelles
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Gastrointestinal Surgery, Hospital Clinic Barcelona, Barcelona, Spain
| | | | - Bipan Chand
- Department of Surgery, Loyola University, Chicago, Illinois
| | - Stacy A Brethauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Philip R Schauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
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Vij A, Malapan K, Tsai CC, Hung KC, Chang PC, Huang CK. Worthy or not? Six-year experience of revisional bariatric surgery from an Asian center of excellence. Surg Obes Relat Dis 2014; 11:612-20. [PMID: 26093768 DOI: 10.1016/j.soard.2014.04.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 04/21/2014] [Accepted: 04/28/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Revisional bariatric surgery (RBS) is increasing. The various primary operations with their distinctive complications make this group of patients quite heterogeneous, and treatment has to be individualized. There are concerns regarding the safety profile and efficacy of these procedures. The objective of the present study was to analyze the indications, safety, and efficacy of RBS at a high-volume Asian center and provide insight into the different treatment options. METHODS Of a total of 1578 bariatric surgeries from July 2006 to June 2012, 52 patients underwent revisional bariatric procedures. The primary operations included 6 different procedures. The indications for surgery were grouped into weight loss failure (n = 21) or complications related to the primary operation (n = 31). The revisional operations performed were conversion to another procedure (n = 22), revision of existing anatomy (n = 29), or reversal to normal anatomy (n = 1). RESULTS 96% of revisional surgeries were performed laparoscopically. The median operating time was 72 minutes (25-240 min), and the median duration of hospital stay was 4 days (3-25 d). The mean body mass index for weight loss failure decreased significantly from 36.3 to 29.6 kg/m(2) after 1 year of revisional surgery (P<.01). However, revision of RYGB was only associated with a body mass index loss of 3.2 kg/m(2) and percentage of excess weight loss of 31.8%. More than 90% of the patients with complications had complete resolution of their preoperative symptoms. There were 3 major complications with an overall morbidity rate of 5.8%. There was no mortality. CONCLUSIONS RBS is well-tolerated, with satisfactory early outcomes, in high-volume centers. However, larger studies with longer follow-up periods are needed to determine the long-term efficacy of these procedures.
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Affiliation(s)
- Anirudh Vij
- Bariatric and Metabolic International Surgery Centre, E-Da Hospital, Taiwan, Republic of China
| | - Kirubakaran Malapan
- Bariatric and Metabolic International Surgery Centre, E-Da Hospital, Taiwan, Republic of China
| | - Ching-Chung Tsai
- Department of Pediatrics, E-Da Hospital, Taiwan, Republic of China
| | - Kuo-Chung Hung
- Department of Anesthesia, E-Da Hospital, Taiwan, Republic of China
| | - Po-Chi Chang
- Bariatric and Metabolic International Surgery Centre, E-Da Hospital, Taiwan, Republic of China; Department of General Surgery, E-Da Hospital, Taiwan, Republic of China
| | - Chih-Kun Huang
- Bariatric and Metabolic International Surgery Centre, E-Da Hospital, Taiwan, Republic of China; Department of General Surgery, E-Da Hospital, Taiwan, Republic of China.
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Abstract
Morbid obesity and the associated comorbidities are rapidly increasing worldwide. Bariatric surgery has proven to be an effective treatment option. In 2011 more then 340,000 bariatric procedures were performed worldwide which is accompanied by a growing demand for revision bariatric procedures due to complications or failure, such as insufficient weight loss or weight regain.Redo operation procedures as well as the management of complications require a profound preoperative medical history and diagnostic investigation in combination with an exact knowledge of the anatomical changes made in the primary procedure.
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McKenna D, Selzer D, Burchett M, Choi J, Mattar SG. Revisional bariatric surgery is more effective for improving obesity-related co-morbidities than it is for reinducing major weight loss. Surg Obes Relat Dis 2013; 10:654-9. [PMID: 24708909 DOI: 10.1016/j.soard.2013.12.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 11/22/2013] [Accepted: 12/05/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND Patients having previous bariatric surgery are at risk for weight regain and return of co-morbidities. If an anatomic basis for the failure is identified, many surgeons advocate revision or conversion to a Roux-en-Y gastric bypass. The aim of this study was to determine whether revisional bariatric surgery leads to sufficient weight loss and co-morbidity remission. PATIENTS AND METHODS From 2005-2012, patients undergoing revision were entered into a prospectively maintained database. Perioperative outcomes, including complications, weight loss, and co-morbidity remission, were examined for all patients with a history of a previous vertical banded gastroplasty (VBG) or Roux-en-Y gastric bypass (RYGB). RESULTS Twenty-two patients with a history of RYGB and 56 with a history of VBG were identified. Following the revisional procedure, the RYGB group experienced 35.8% excess weight loss (%EWL) and a 31.8% morbidity rate. For the VBG group, patients experienced a 46.2% %EWL from their weight before the revisional operation with a 51.8% morbidity rate. Co-morbidity remission rate was excellent. Diabetes (VBG:100%, RYGB: 85.7%), gastroesophageal reflux disease (VBG: 94.4%, RYGB: 80%), and hypertension (VBG: 74.2%, RYGB:60%) demonstrated significant improvement. CONCLUSION Revision of a failed RYGB or conversion of a VBG to a RYGB provides less weight loss and a higher complication rate than primary RYGB but provides an excellent opportunity for co-morbidity remission.
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Affiliation(s)
- Daniel McKenna
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
| | - Don Selzer
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Michael Burchett
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Jennifer Choi
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Samer G Mattar
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
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Pereira P, Guenzi M, Guirat A, Chevalier JM. Weight regain after Roux-en-Y gastric bypass: loss of restriction? Surg Obes Relat Dis 2013; 9:1025-6. [PMID: 24321571 DOI: 10.1016/j.soard.2013.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 05/16/2013] [Accepted: 05/16/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Paulo Pereira
- Department of Metabolic and Bariatric Surgery, Georges Pompidou European Hospital, 20 Rue Leblanc, 75015 Paris, France.
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