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Moize V, Laferrère B, Shapses S. Nutritional Challenges and Treatment After Bariatric Surgery. Annu Rev Nutr 2024; 44:289-312. [PMID: 38768613 DOI: 10.1146/annurev-nutr-061121-101547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Bariatric surgery is an important weight loss tool in individuals with severe obesity. It is currently the most effective long-term weight loss treatment that lowers obesity-related comorbidities. It also has significant physiological and nutritional consequences that can result in gastrointestinal complications and micronutrient deficiencies. After gastric bypass, clinical events that negatively affect nutritional status include malabsorption, dumping syndrome, kidney stones, altered intestinal bile acid availability, bowel obstruction, ulcers, gastroesophageal reflux, and bacterial overgrowth. Risk factors for poor nutritional status and excessive loss of lean body mass and bone include reduced dietary quality and inadequate intake, altered nutrient absorption, and poor patient compliance with nutrient supplementation. There are unique concerns in adolescents, older individuals, and individuals who become pregnant postoperatively. With careful management, health-care professionals can assist with long-term weight loss success and minimize the risk of acute and long-term nutrition complications after bariatric surgery.
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Affiliation(s)
- Violeta Moize
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- Obesity Unit, Hospital Clinic Barcelona and Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Blandine Laferrère
- Nutrition and Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Sue Shapses
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Department of Nutritional Sciences and New Jersey Institute for Food, Nutrition, and Health, Rutgers University, New Brunswick, New Jersey, USA;
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2
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Kupietzky A, Dodi O, Cohen N, Dover R, Maden A, Mazeh H, Grinbaum R, Mizrahi I. Similar Rates of Symptomatic Marginal Ulcers After One-Anastomosis-Gastric Bypass Compared to Roux-en-Y Gastric Bypass. Obes Surg 2024; 34:2331-2337. [PMID: 38789681 DOI: 10.1007/s11695-024-07298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE One-anastomosis-gastric-bypass (OAGB) has become a common bariatric procedure worldwide. Marginal ulcers (MU) are a significant non-immediate complication of gastric bypass surgeries. There seems to be concern among surgeons that MU are more common after OAGB compared with Roux-en-Y gastric bypass (RYGB) due to the constant and extensive exposure of the anastomosis to bile. The aim of this study was to compare the incidence, presentation, and management of MU between the two surgeries. MATERIALS AND METHODS A retrospective study of prospectively collected data was performed to include all consecutive patients between 2010 and 2020, who underwent elective OAGB or RYGB at our institution. Patients diagnosed with symptomatic MU were identified. Factors associated with this complication were assessed and compared between the two surgeries. RESULTS Symptomatic MU were identified in 23/372 OAGB patients (6.2%) and 35/491 RYGB patients (7.1%) (p = 0.58). Time to ulcer diagnosis was shorter in OAGB patients (12 ± 11 vs. 22 ± 17 months, p < 0.01). Epigastric pain was the common symptom (78% OAGB vs. 88.5% RYGB, p = 0.7) and approximately 15% of ulcers presented with perforation upon admission (17% vs.11.4%, p = 0.7). Re-operation was required in 5/23 OAGB (21.7%) and 6/36 RYGB (17%) patients (p = 0.11) while the rest of the patients were managed non-operatively. CONCLUSIONS The risk of developing a marginal ulcer is similar between patients who underwent OAGB and RYGB. Patients diagnosed with MU following OAGB tend to present earlier; however, the clinical presentation is similar to RYGB patients. The management of this serious complication seems to be associated with acceptable outcomes with comparable operative and non-operative approaches.
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Affiliation(s)
- Amram Kupietzky
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Omri Dodi
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Noa Cohen
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Roi Dover
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ata Maden
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Haggi Mazeh
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronit Grinbaum
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ido Mizrahi
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Kukeev I, Quint E, Sebbag G, Dukhno O. Left gastric artery embolization for recurrent massive intraluminal postoperative bleeding after revisional laparoscopic one anastomosis gastric bypass surgery. J Surg Case Rep 2024; 2024:rjae070. [PMID: 38706484 PMCID: PMC11068415 DOI: 10.1093/jscr/rjae070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 05/07/2024] Open
Abstract
Laparoscopic one-anastomosis gastric bypass (LOAGB) has gained popularity as safe weight-reduction procedure. Bleeding is the common postoperative complication. We present a successful treatment of recurrent bleeding after LOAGB by embolization of the left gastric artery (LGA) and later development of necrotizing pancreatitis. A 41-year-old patient with previous bariatric surgeries undergone LOAGB surgery with development of massive intraluminal bleeding in the postoperative period. Attempts of unsuccessful endoscopic treatment were done and the bleeding was stopped by LGA embolization. In the post-embolization period, the patients developed necrotizing pancreatitis. Postoperative bleeding is the serious complications of the bariatric LOAGB procedure. Transcatheter Arterial Embolization (TAE) is the possible treatments after unsuccessful endoscopic attempts to stop the bleeding. The technical and clinical success rates of TAE in post-gastrectomy bleeding are 100 and 79%, respectively. TAE can be successfully used to stop obstinate recurrent postoperative bleeding after a LOAGB procedure.
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Affiliation(s)
- Ivan Kukeev
- Department of General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, Yitzhack I. Rager Blvd 151, PO Box 151, Beer Sheva 84101, Israel
| | - Elchanan Quint
- Department of General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, Yitzhack I. Rager Blvd 151, PO Box 151, Beer Sheva 84101, Israel
| | - Gilbert Sebbag
- Department of General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, Yitzhack I. Rager Blvd 151, PO Box 151, Beer Sheva 84101, Israel
| | - Oleg Dukhno
- Bariatric Surgery Unit, Department of General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, Yitzhack I. Rager Blvd 151, PO Box 151, Beer Sheva 84101, Israel
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4
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Ghiassi S, Nimeri A, Aleassa EM, Grover BT, Eisenberg D, Carter J. American Society for Metabolic and Bariatric Surgery position statement on one-anastomosis gastric bypass. Surg Obes Relat Dis 2024; 20:319-335. [PMID: 38272786 DOI: 10.1016/j.soard.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 01/27/2024]
Abstract
The following position statement is issued by the American Society for Metabolic and Bariatric Surgery in response to inquiries made to the society by patients, physicians, society members, hospitals, health insurance payors, and others regarding one-anastomosis gastric bypass as a treatment for obesity and metabolic disease. This statement is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time. The statement may be revised in the future as more information becomes available.
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Affiliation(s)
- Saber Ghiassi
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
| | - Abdelrahman Nimeri
- Department of Surgery, Brigham and Women's Hospital, Harvard School of Medicine, Boston, Massachusetts
| | - Essa M Aleassa
- Digestive Disease Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Brandon T Grover
- Department of Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Dan Eisenberg
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Jonathan Carter
- Department of Surgery, University of California, San Francisco, California
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Kabir A, Izadi S, Mashayekhi F, Shokraee K, Rimaz S, Ansar H, Farsi F, Pazouki A. Effect of different bariatric surgery methods on metabolic syndrome in patients with severe obesity. Updates Surg 2024; 76:547-554. [PMID: 38051454 DOI: 10.1007/s13304-023-01699-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: 03/18/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023]
Abstract
Bariatric surgery (BS) has been as a currently developed treatment of choice for metabolic syndrome (MetS). Which, in turn, is well-known as serious public health concern. Therefore, this study assessed the outcomes of different procedures of BS and possible predictors for improving MetS. This single-center retrospective cohort analysis included bariatric candidates between 2009 and 2017. The operational approach was chosen based on the patient's condition, as well as the patient's metabolic profile and the surgeon's experience. All desired information was evaluated at baseline and 6, 12, and 24 months after the operation. Of the 1111 patients included, 918 (82.6%) were female. There was no considerable trend in the improvement of MetS over the follow-up period of each surgery group. After 6 to 24 months of follow-up, waist circumference reduction was significant in all three types of surgery, and sleeve gastrectomy resulted in the best (but not significant) improvement rates after 24 months (P = 0.079). One anastomosis gastric bypass had highest decrease in percentage of excess weight loss than other procedures (P < 0.001). Each year increase in age was associated with a 4% decrease in MetS remission. In addition, the male gender, was correlated with MetS improvement positively (P = 0.049). Each one-unit increase in hemoglobin A1c (HbA1c) reduced the MetS remission rate by 40%. All three methods of BS were similarly effective in MetS. Consider the predictive value of age, gender, and HbA1c before determining the optimum procedure for each patient is recommended.
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Affiliation(s)
- Ali Kabir
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Masouri St. Niyayesh St. Satarkhan Ave, Tehran, Iran.
| | - Simin Izadi
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Masouri St. Niyayesh St. Satarkhan Ave, Tehran, Iran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Mashayekhi
- Rasoul Akram Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Kamyar Shokraee
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Masouri St. Niyayesh St. Satarkhan Ave, Tehran, Iran
| | - Shahnaz Rimaz
- Department of Epidemiology, School of Public Health, Radiation Biology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hastimansooreh Ansar
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Masouri St. Niyayesh St. Satarkhan Ave, Tehran, Iran
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnaz Farsi
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Masouri St. Niyayesh St. Satarkhan Ave, Tehran, Iran
| | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Masouri St. Niyayesh St. Satarkhan Ave, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-E Rasool Hospital, Tehran, Iran
- Iran National Center of Excellence for Minimally Invasive Surgery Education, Iran University of Medical Sciences, Tehran, Iran
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Sakran N, Sherf-Dagan S, Hod K, Kaplan U, Azaria B, Raziel A. One Anastomosis Gastric Bypass in 6722 Patients: Early Outcomes from a Private Hospital Registry. J Clin Med 2023; 12:6872. [PMID: 37959337 PMCID: PMC10648472 DOI: 10.3390/jcm12216872] [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: 08/03/2023] [Revised: 10/16/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND One-anastomosis gastric bypass (OAGB) is an emerging metabolic bariatric surgery (MBS) type used in both primary OAGB (pOAGB) and revisional OAGB (rOAGB). We studied ≤30-day outcomes of pOAGB and rOAGB and identified predictors of early complications. METHODS Electronic medical records of all OAGBs performed between January 2017 and December 2021 at a high-volume bariatric clinic in Israel comprising four hospital centers were scanned retrospectively using specialized data software (MDClone software, version 6.1). Data gathered were patients' characteristics, surgical procedure, and ≤30-day complications with Clavien-Dindo Classification (CDC). Multivariate logistic regression analyses were used to identify factors related to early complications of pOAGB and rOAGB. RESULTS A total of 6722 patients underwent a pOAGB (n = 5088, 75.7%) or rOAGB (n = 1634, 24.3%) procedure at our institution. Preoperative mean age and body mass index (BMI) were 40.6 ± 11.5 years and 41.2 ± 4.6 kg/m2, respectively. Early complications occurred in 258 (3.8%) patients (176 pOAGB and 82 rOAGB) and included mainly bleeding (n = 133, 2.0%), leaks (n = 31, 0.5%), and obstruction/strictures (n = 19, 0.3%). CDC complications for grades 1-2 and grades 3a--5 were 1.5% and 1.6%, respectively. The overall mortality rate was 0.03% (n = 2). Age, operative time ≥3 h, and any additional concomitant procedure were independent predictors of early complications following pOAGB, while a diagnosis of diabetes mellitus and operative time ≥3 h were independent predictors of early complications following rOAGB. CONCLUSIONS OAGB was found to be a safe primary and revisional MBS procedure in the ≤30-postoperative day term. The most common complications were gastrointestinal bleeding, leaks, and obstruction/stricture.
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Affiliation(s)
- Nasser Sakran
- Assuta Medical Center, Tel Aviv 6971028, Israel; (S.S.-D.); (K.H.); (U.K.); (B.A.); (A.R.)
- Department of General Surgery, Holy Family Hospital, Nazareth 1601001, Israel
- The Azrieli Faculty of Medicine Safed, Bar-Ilan University, Ramat Gan 5290002, Israel
| | - Shiri Sherf-Dagan
- Assuta Medical Center, Tel Aviv 6971028, Israel; (S.S.-D.); (K.H.); (U.K.); (B.A.); (A.R.)
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel 4077625, Israel
| | - Keren Hod
- Assuta Medical Center, Tel Aviv 6971028, Israel; (S.S.-D.); (K.H.); (U.K.); (B.A.); (A.R.)
| | - Uri Kaplan
- Assuta Medical Center, Tel Aviv 6971028, Israel; (S.S.-D.); (K.H.); (U.K.); (B.A.); (A.R.)
- Department of Surgery, Emek Medical Center, Afula 1812601, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3200003, Israel
| | - Bella Azaria
- Assuta Medical Center, Tel Aviv 6971028, Israel; (S.S.-D.); (K.H.); (U.K.); (B.A.); (A.R.)
| | - Asnat Raziel
- Assuta Medical Center, Tel Aviv 6971028, Israel; (S.S.-D.); (K.H.); (U.K.); (B.A.); (A.R.)
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Abdelsamee KS. Short-term outcomes of double omentopexy in one anastomosis gastric bypass surgery: A controlled clinical trial. Niger J Clin Pract 2023; 26:1483-1490. [PMID: 37929524 DOI: 10.4103/njcp.njcp_26_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Purpose This study aims to assess the efficacy of implementing a novel technique of reinforcement of gastric pouch and remnant stomach staple line with Double Omentopexy (DO) in patients undergoing One-Anastomosis Gastric Bypass (OAGB) surgery and evaluate its impact in reducing the early postoperative complications. Materials and Methods The 123 patients were allocated into two groups: 61 in the standard OAGB group and 62 in OAGB with DO group. The primary outcomes are postoperative complications (including early postoperative bleeding, leakage, gastric twist, reflux, etc.) and hospital stay. The secondary outcome is excess body weight loss. Follow-up visits were planned after discharge: at two weeks, two months, and three months postoperatively. Results Postoperative complications were significantly lower, 3 (4.84%) in OAGB with DO compared with 10 (16.39%) in standard OAGB (P =0.037). There was no statistically significant difference in the incidence of early postoperative bleeding, deep vein thrombosis, biliary reflux, and gall bladder stone (P >.05). No patient had leakage in either group. The mean operative time was significantly longer (68.66 ± 6.68 min) in OAGB with the DO group when compared with the standard OAGB group (62.16 ± 7.54 min) (P <.001). Conclusion Applying the DO technique may be a good measure to be added during OAGB to decrease the incidence of potential postoperative complications, especially the rate and severity of bleeding.
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Affiliation(s)
- K S Abdelsamee
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Sorek A, Eldar SM, Cohen S, Mazkeret Mayer I, Sukhtnik I, Lubetzky R, Moran-Lev H. Laparoscopic Sleeve Gastrectomy Versus One Anastomosis Gastric Bypass in Adolescents With Obesity. J Pediatr Gastroenterol Nutr 2023; 77:131-136. [PMID: 36930967 DOI: 10.1097/mpg.0000000000003780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
OBJECTIVE Large studies comparing outcomes between laparoscopic sleeve gastrectomy (LSG) and one anastomosis gastric bypass (OAGB) are scarce and involve adult populations. The aim of the study was to compare perioperative, early postoperative, and 1-year postoperative outcomes of adolescents with obesity who underwent LSG or OAGB surgery. METHODS The medical records of adolescents with obesity who underwent LSG or OAGB at the Tel Aviv Sourasky Medical Center from January 2017 to January 2021 were retrospectively reviewed. Data on their gastrointestinal (GI) symptoms and postoperative quality of life were obtained by a telephone interview. RESULTS Included were 75 adolescents (median [interquartile range, IQR] age 17.3 [16-18] years) of whom 22 underwent OAGB and 53 underwent LSG. There were no significant preoperative group differences in age, sex, and body mass index score. A low rate of perioperative (5.7% vs 0) and postoperative complication (15.1% vs 10%) with no statistical differences between LSG and OAGB group, respectively, was noted. At 12 months, the percent excessive weight loss + IQR was 42.40% [30.00, 45.00] and 38.00% [33.550, 44.20] in the LSG and OAGB group, respectively ( P = NS). The results of the Pediatric Quality of Life Inventory Gastrointestinal Symptoms scale revealed significantly less food limitation and heartburn after OAGB compared to LSG (food limitation 71.63 vs 53.85 and heartburn 83.654 vs 61.6, P = 0.03 and P = 0.029, respectively). CONCLUSIONS Both surgeries are effective and safe for weight loss in the adolescent population. OAGB was associated with significantly fewer GI symptoms compared to LSG.
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Affiliation(s)
- Adi Sorek
- From the Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sukhotnik Meron Eldar
- the Bariatric Unit, Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Cohen
- the Pediatric Gastroenterology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbar Mazkeret Mayer
- the Pediatric Gastroenterology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Igor Sukhtnik
- the Department of Paediatric Surgery, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Lubetzky
- From the Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Moran-Lev
- From the Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- the Pediatric Gastroenterology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Rayman S, Staierman M, Assaf D, Rachmuth J, Carmeli I, Keidar A. Clinical influence of conversion of laparoscopic sleeve gastrectomy to one anastomosis gastric bypass on gastroesophageal reflux disease. Langenbecks Arch Surg 2023; 408:163. [PMID: 37103604 DOI: 10.1007/s00423-023-02892-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/10/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE Assess the subjective impact of gastro-esophageal reflux disease (GERD) symptoms on patients undergoing revision from laparoscopic sleeve gastrectomy (LSG) to one-anastomosis gastric bypass (OAGB) using the Reflux Disease Questionnaire for GERD (RDQ) and the GERD-health related quality of life score (GERD-HRQL), prior to- and following conversion. METHODS Patients undergoing revision from LSG to OAGB were prospectively followed between May 2015 and December 2020. Data retrieved included demographics, anthropometrics, previous bariatric history, time interval between LSG and OAGB, weight loss, and co-morbidities. Pre- and post-OAGB RDQ and GERD-HRQL questionnaires were obtained. In the case of sleeve dilatation, sleeve resizing was performed. RESULTS During the study period, 37 patients underwent revision from LSG to OAGB. Mean ages at LSG and pre-OAGB were 38 ± 11.74 and 46 ± 12.75, respectively. Median follow-up time was 21.5 months (range 3-65). All patients underwent sleeve resizing. RDQ and GERD-HRQL scores were obtained at a median of 14 months (range 3-51) between pre- and post-OAGB. Median RDQ score pre-OAGB vs post-OAGB was significantly reduced (30 (range 12-72) vs 14 (range 12-60), p = 0.007). All 3 parts of the GERD- HRQL questionnaires were significantly reduced between pre-OAGB and post-OAGB: Symptoms (20; 62.5% vs 10; 31.3%, p = 0.012), overall score (15 (0-39) vs 7 (0-28), p = 0.04) and subjective improvement (10; 31% vs 20; 62.5%, p = 0.025). CONCLUSION Conversion of LSG to OAGB showed subjective improvement of GERD symptoms both in RDQ and in GERD-HRQL.
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Affiliation(s)
- Shlomi Rayman
- Department of General Surgery, Assuta Ashdod Public Hospital, affiliated with the Faculty of Health and Science at Ben-Gurion University, Ha-Refu'a St 7, 7747629, Ashdod, Israel.
| | - Maor Staierman
- Department of General Surgery, Assuta Ashdod Public Hospital, affiliated with the Faculty of Health and Science at Ben-Gurion University, Ha-Refu'a St 7, 7747629, Ashdod, Israel
| | - Dan Assaf
- Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Israel, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Derech Sheba 2, 52662, Ramat-Gan, Israel
| | - Jacob Rachmuth
- Department of General Surgery, Assuta Ashdod Public Hospital, affiliated with the Faculty of Health and Science at Ben-Gurion University, Ha-Refu'a St 7, 7747629, Ashdod, Israel
| | - Idan Carmeli
- Department of General Surgery, Assuta Ashdod Public Hospital, affiliated with the Faculty of Health and Science at Ben-Gurion University, Ha-Refu'a St 7, 7747629, Ashdod, Israel
| | - Andrei Keidar
- Department of General Surgery, Assuta Ashdod Public Hospital, affiliated with the Faculty of Health and Science at Ben-Gurion University, Ha-Refu'a St 7, 7747629, Ashdod, Israel
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10
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Sakran N, Haj B, Pouwels S, Buchwald JN, Abo Foul S, Parmar C, Awad A, Arraf J, Omari A, Hamoud M. Standardization of the One-anastomosis Gastric Bypass Procedure for Morbid Obesity: Technical Aspects and Early Outcomes. Surg Laparosc Endosc Percutan Tech 2023; 33:162-170. [PMID: 36988293 DOI: 10.1097/sle.0000000000001148] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/06/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND One-anastomosis gastric bypass (OAGB) has become an accepted metabolic/bariatric surgery procedure. This study aimed to describe our center's standardized OAGB operative technique and report early (≤30 d) safety outcomes in patients with severe obesity. METHODS The medical records of patients who had undergone either primary (n=681, 88.0%) or revisional OAGB (n=93, 12.0%) were retrospectively evaluated. Patient demographics, operative time, length of hospital stay, readmissions, reoperations, and ≤30-day morbidity and mortality rates were analyzed. RESULTS A total of 774 consecutive patients with severe obesity (647 female, 83.6%) underwent OAGB between January 2016 and December 2021. Their mean age was 36.2±10.8 years (range: 18 to 70 y) and mean body mass index was 42.7±4.2 kg/m 2 (range: 17.2 to 61 kg/m 2 ). Mean operating time was 52.6±19.9 minutes (range: 25 to 295 min) and length of hospital stay was 1.6±0.9 days (range: 1 to 9 d). Early postoperative complications occurred in 16 cases (2.1%), including 2 leaks with an intra-abdominal abscess (0.3%), bleeding (n=3, 0.4%), acute kidney failure (n=1, 0.15%), urinary tract infection (n=2, 0.3%), and intensive care unit stay (n=4, 0.5%). Seventy patients (9.1%) were readmitted, and re-laparoscopy was performed in 1 patient (0.1%). There was no mortality. CONCLUSIONS In the very early term, OAGB was a safe primary and revisional metabolic/bariatric surgery operation. Consistent performance of a standardized OAGB procedure contributed to low rates of morbidity and mortality in the hands of metabolic/bariatric surgeons with good laparoscopic skills at a high-volume center.
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Affiliation(s)
- Nasser Sakran
- Department of Surgery, Holy Family Hospital, Nazareth
- The Azrieli, Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Bassel Haj
- Department of Surgery, Holy Family Hospital, Nazareth
- The Azrieli, Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
- Department of Surgery, Agaplesion Bethanien Krankenhaus, Frankfurt am Main, Hessen, Germany
| | - Jane N Buchwald
- Division of Scientific Research Writing, Medwrite Medical Communications, WI
| | | | - Chetan Parmar
- Department of Surgery, Whittington Health NHS Trust, London, UK
| | - Ali Awad
- Department of Surgery, Holy Family Hospital, Nazareth
| | - Jabra Arraf
- Department of Surgery, Holy Family Hospital, Nazareth
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11
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Jaworski P, Binda A, Barski K, Wawiernia K, Kudlicka E, Wąsowski M, Jankowski P, Tarnowski W. OAGB with shortened excluded ileal loop as an effective treatment for type 2 diabetes mellitus in the cases of Caucasian men and women with obesity of the first degree (BMI 30-35 kg/m 2). Langenbecks Arch Surg 2023; 408:84. [PMID: 36773074 PMCID: PMC9922227 DOI: 10.1007/s00423-023-02785-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 12/12/2022] [Indexed: 02/12/2023]
Abstract
INTRODUCTION The aim of the study is to assess the effect of shortening the excluded loop of the small intestine to 150 cm on the effectiveness of one anastomosis gastric bypass (OAGB) in remission of type 2 diabetes with Io obesity. MATERIAL AND METHODS The study included 25 patients with a body mass index (BMI) 30-35 kg/m2, with a diagnosis of diabetes mellitus type 2 (T2DM), and undergoing OAGB with excluded 150 cm of the small intestine. RESULTS There were no deaths in the study group, bleeding during the postoperative period requiring reoperation, anastomotic leakage/leakage throught mechanical stitching. The mean a glycated haemoglobin (HbA1C) level 12 months after surgery was 6.16 ± 0.96%, corresponding to a 2.29 ± 3.3% decrease. In more than 85% of the patients taking insulin before surgery, the insulin was discontinued in the postoperative period. Additionally, the level of glycaemia was assessed in patients on the day of surgery (163 ± 58 mg/dl) and on the day of discharge from the hospital (4.7 ± 1.3 days)-it was lower by over 18% (133 ± 39.2 mg). Over the period of 12 months following OAGB, there was a reduction in the mean BMI value from 33.5 ± 2 to 25.5 ± 2.5 kg/m2 and improvement in lipid parameters and mean values of blood pressure. CONCLUSION OAGB with excluded 150 cm of the small intestine has beneficial effect on the remission of T2DM in patients with a BMI of 30-35kg/m2 and is associated with an acceptable level of complications. The achieved weight loss after surgery is satisfactory.
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Affiliation(s)
- Paweł Jaworski
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland.
| | - Artur Binda
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland
| | - Krzysztof Barski
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland
| | - Karolina Wawiernia
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland
| | - Emilia Kudlicka
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland
| | - Michał Wąsowski
- Department of General Medicine and Gerontocardiology, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland
| | - Piotr Jankowski
- Department of General Medicine and Gerontocardiology, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland
| | - Wiesław Tarnowski
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland
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12
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AlSabah S, Al Haddad E, Al-Subaie S, Ekrouf S, Almulla A, Alhaddad M, Aljabal MS, Alenezi K. Long-term outcomes of revisional one anastomosis gastric bypass post laparoscopic sleeve gastrectomy. Langenbecks Arch Surg 2023; 408:43. [PMID: 36656465 DOI: 10.1007/s00423-023-02787-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/27/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE Revisional bariatric surgeries following laparoscopic sleeve gastrectomy (LSG) have demonstrated a dramatic increase worldwide. Recently, one-anastomosis gastric bypass (OAGB) has become a contender as an appropriate revisional procedure; however, no long-term data currently exist on the effectiveness of it as a revisional surgery post-LSG. METHODS A retrospective analysis was performed on all patients who underwent LSG at a public hospital in Kuwait from 2008 to 2017. A list was obtained of those who underwent revisional OAGB surgery after initial LSG, after which a phone survey was performed and demographics were analyzed. RESULTS A total of 29 patients underwent revisional OAGB post-initial LSG, of which 89.7% were female. Prior to LSG, the mean weight of the patients was 127.5 kg, and the mean BMI was 49.0 kg/m2. The mean weight loss after initial LSG was 43.8 kg, while the average duration until patients underwent revisional OAGB was 5.3 years. The cause for revision was weight regain (86.2%) or inadequate weight loss (13.8%). Prior to undergoing revisional OAGB, the weight and BMI of the patients was 110.9 kg and 42.4 kg/m2, respectively. Revisional OAGB demonstrated a %excess weight loss of 14.5%, 31.9%, 48.0%, 56.3%, 57.2%, and 54.7% at 2 weeks, 3 months, 6 months, 1 year, 4 years, and 5 years, respectively. Twelve morbidities were reported during the follow-up period. CONCLUSION Revisional bariatric surgery is technically demanding and may be associated with a high complication rate. However, OAGB as a revisional procedure has proven to be safe and effective in the long-term outcomes of revisional OAGB patients post-LSG.
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13
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Najjari K, Samimi M, Jangjoo A, Pakzad M, Zabihi-Mahmoudabadi H, Kor F, Rahimpour E, Hajebi R, Talebpour M. Perforation as the First Manifestation of Marginal Ulcer Following One Anastomosis Gastric Bypass: a Multicenter Case Series and Review of Literature. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03234-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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14
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The Assessment of Food Addiction and the Yale Food Addiction Scale in Bariatric Surgery Populations. BEHAVIOUR CHANGE 2021. [DOI: 10.1017/bec.2021.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Food addiction (FA) appears among bariatric weight loss surgery candidates who struggle to control the intake of hyperpalatable/refined foods have high rates of psychopathology and related health problems. Despite this, prevalence rates of FA in the bariatric sector are reported as low or variable. We investigated the prevalence of FA and the applicability of conventionally used metrics for 166 pre-surgery candidates from a weight management centre (USA) and a major metropolitan hospital (Australia). Self-report measures assessed FA (Yale Food Addiction Scale (YFAS)), body mass index (BMI), disordered eating, addictive personality, psychopathology, and diet. Consistent with prior research, standard YFAS scoring, requiring the endorsement of a distress/impairment (D/I) criterion (FA + D/I), yielded a FA prevalence rate of 12.7%, compared to 37.3% when D/I was omitted (FA − D/I). We compared profiles for those with FA using each scoring method against those ‘without’, who did not meet a minimum of three YFAS symptoms (non-FA ≤ 2). Both methods differentiated those with and without FA on addictive traits, disordered eating and hyperpalatable food consumption. Only FA + D/I differentiated markers of psychological distress or impairment, including depression, anxiety and quality of life. Results indicate a need for further FA research in bariatric settings.
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15
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Khitaryan AG, Mezhunts AV, Starzhinskaya OB, Orekhov AA, Voronova OV, Sarkisyan AV, Melnikov DA, Amegninou MJC, Adizov SA, Rogut AA. Pathological and Histological Aspects of Biliary Reflux After Mini-Gastric Bypass. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexander G. Khitaryan
- NHI “Railway Clinical Hospital at the “Rostov-Glavnyi” Station, Russian Railways, OJSC” Rostov-on-Don, Russian Federation
- Department of General Surgery, Rostov State Medical University, Rostov-on-Don, Russian Federation
| | - Arut V. Mezhunts
- NHI “Railway Clinical Hospital at the “Rostov-Glavnyi” Station, Russian Railways, OJSC” Rostov-on-Don, Russian Federation
- Department of General Surgery, Rostov State Medical University, Rostov-on-Don, Russian Federation
| | - Olesya B. Starzhinskaya
- Department of General Surgery, Rostov State Medical University, Rostov-on-Don, Russian Federation
| | - Alexey A. Orekhov
- NHI “Railway Clinical Hospital at the “Rostov-Glavnyi” Station, Russian Railways, OJSC” Rostov-on-Don, Russian Federation
- Department of General Surgery, Rostov State Medical University, Rostov-on-Don, Russian Federation
| | - Olga V. Voronova
- NHI “Railway Clinical Hospital at the “Rostov-Glavnyi” Station, Russian Railways, OJSC” Rostov-on-Don, Russian Federation
- Department of General Surgery, Rostov State Medical University, Rostov-on-Don, Russian Federation
| | - Aram V. Sarkisyan
- Department of General Surgery, Rostov State Medical University, Rostov-on-Don, Russian Federation
| | - Denis A. Melnikov
- Department of General Surgery, Rostov State Medical University, Rostov-on-Don, Russian Federation
| | | | - Suleyman A. Adizov
- NHI “Railway Clinical Hospital at the “Rostov-Glavnyi” Station, Russian Railways, OJSC” Rostov-on-Don, Russian Federation
| | - Alexander A. Rogut
- NHI “Railway Clinical Hospital at the “Rostov-Glavnyi” Station, Russian Railways, OJSC” Rostov-on-Don, Russian Federation
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16
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Outcomes of the One Anastomosis Gastric Bypass with Various Biliopancreatic Limb Lengths: a Retrospective Single-Center Cohort Study. Obes Surg 2021; 31:4236-4242. [PMID: 34283379 PMCID: PMC8458216 DOI: 10.1007/s11695-021-05555-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/17/2021] [Accepted: 06/24/2021] [Indexed: 12/15/2022]
Abstract
Introduction One anastomosis gastric bypass (OAGB) is an effective and safe treatment for morbidly obese patients. Longer biliopancreatic (BP) limb length is suggested to result in better weight loss outcomes, but to date, no data are available for the OAGB to substantiate this. We hypothesized that applying a longer BP-limb length in the higher BMI classes would result in more weight reduction so that the attained BMI would be comparable to patients with a lower BMI, thereby compensating for differences in baseline BMI. Method A retrospective cohort study in patients who underwent a primary OAGB at a teaching hospital in the Netherlands between January 2015 and December 2016. BP-limb length was tailored based on preoperative BMI. Patients were divided into three different groups depending on the length of the BP-limb: 150, 180, and 200 cm. Weight loss outcomes after 1 and 3 years and resolution of comorbidities were compared between these groups. Results Of the 632 included patients, a BP-limb length of 150 cm was used in 172 (27.2%), 180 cm in 388 (61.4%), and 200 cm in 72 (11.4%) patients. Despite more BMI loss, %EWL was lower and attained BMI remained higher in the groups with longer BP-limb lengths. After adjustment for the confounder preoperative BMI, longer BP-limb lengths were not associated with higher BMI loss. There was no difference in remission rates of comorbidities. Conclusion Attained BMI remained higher in spite of tailoring BP-limb length according to baseline BMI with no differences in remission rates of comorbidities. Graphical Abstract ![]()
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17
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Elyasinia F, Jalali SM, Zarini S, Sadeghian E, Sorush A, Pirouz A. The Effect of Laparoscopic Sleeve Gastrectomy and Gastric Bypass Surgery on Non-Alcoholic Steatohepatitis in Iranian Patients with Obesity. Middle East J Dig Dis 2021; 13:200-207. [PMID: 36606220 PMCID: PMC9489465 DOI: 10.34172/mejdd.2021.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/07/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Non-alcoholic steatohepatitis (NASH) is a serious comorbidity in patients with obesity and because of the high risk of cirrhosis and the extreme mortality rate of NASH, approaching effective treatment methods, and improvements are crucial. Following few studies comparing the impact of laparoscopic gastric bypass (LGB) and laparoscopic sleeve gastrectomy (LSG) surgery on NASH, our study was conducted to assess the effect of these two surgical methods separately in patients with NASH through ultrasonography, and concurrently, on other factors such as lipid profiles and blood pressure to reduce the complications of complex obesity surgeries on patients and also provide a solution to prevent NASH-related cirrhosis. METHODS This study was performed at Imam Khomeini Hospital Complex; Vali-e-Asr Hospital affiliated to Tehran University of Medical Sciences.All patients with obesity who had undergone bariatric surgery at Vali-e-Asr Hospital during 2017 and 2018 were included in this prospective cohort study. Weight, body mass index (BMI), blood pressure, Alanine transaminase(ALT), Aspartate transaminase(AST),lipid profile and Fasting blood sugar(FBS)were evaluated before and one year after surgery. The patients underwent an ultrasound examination before surgery to determine the fatty liver grade. The type of operation (sleeve or bypass) was governed by the patient him/herself after receiving thorough clarifications about the available methods, their complications, and expected outcomes. In addition, by the separation of fatty liver grading with ultrasound modality, the correlation between ultrasound grading, laboratory results, and the rate of weight loss in patients who undergone both sleeve and bypass surgeries were evaluated and compared during a one-year follow-up. RESULTS In this study, 44 patients were included. 22 patients underwent laparoscopic sleeve gastrectomy (LSG), and 22 patients underwent laparoscopic gastric bypass (LGB) surgery. The mean age of the patients was 40.45 ± 12.01 years. 35 patients (79.5%) were women, and 9 patients (20.5%) were men. Most patients (81.8%) had grade I and II in terms of preoperative liver ultrasonography results. Bariatric surgery (LSG and LGB) greatly enhanced NASH's hepatic status in liver ultrasonography. Since the liver status of patients with preoperative ultrasonography was not significantly different between the two groups, there was no substantial distinction among the two groups in this regard, postoperatively. Weight and BMI, lipid profile, liver enzymes, FBS, and mean arterial blood pressure (MAP) were significantly reduced individually in both groups and all patients one year after surgery. None of the postoperative variables and their modifications had a prominent difference between the two groups except for High-density lipoprotein(HDL)level after surgery. The postoperative HDL was considerably higher in the LGB group (p = 0.014). However, the changes in HDL were not statistically different between both groups. The levels of AST, ALT, total cholesterol, LDL, and FBS were associated with the NASH grade. CONCLUSION Both types of LSG and LGB bariatric surgeries have been shown to significantly reduce BMI and improve lipid profiles, liver enzymes, and blood glucose levels in patients one year after surgery. The NASH status was also ameliorated considerably. The two types of surgery were not remarkably different in these modifications. Besides, there was a significant correlation between AST, ALT, total cholesterol, LDL, and FBS levels with the NASH grade.
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Affiliation(s)
- Fezzeh Elyasinia
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mehdi Jalali
- Department of Surgery, Vali-E-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soroush Zarini
- Department Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences
| | - Ehsan Sadeghian
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
,Corresponding Author: Ehsan Sadeghian, MD Shariati Hospital, Jalal-e-Al-e-Ahmad Hwy, Tehran, Iran Tel: + 98 21 84902455 Fax: + 98 21 88633039
| | - Ahmadreza Sorush
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Pirouz
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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18
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Ansar H, Zamaninour N, Pazouki A, Kabir A. Weight Loss After One Anastomosis Gastric Bypass-Mini Gastric Bypass (OAGB-MGB): Patient-Related Perioperative Predictive Factors. Obes Surg 2021; 30:1316-1323. [PMID: 31820407 DOI: 10.1007/s11695-019-04270-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM The aim of this study was to find independent perioperative factors predicting unsuccessful weight loss following one anastomosis gastric bypass-mini gastric bypass (OAGB-MGB), a recently developed technique of bariatric surgery. METHODS Using regression analysis, this prospective cohort study assessed the role of demographic and socioeconomic factors, clinical features, body composition, length of biliopancreatic limb (LBL), nutritional habits, comorbidities, and early post-operative weight reduction values, in predicting 1-year weight loss after OAGB-MGB. All patients at the center who underwent laparoscopic OAGB-MGB between October 2010 and May 2017 were included. The dependent variable was the percent of excess weight loss (%EWL) after 12-month follow-up. Weight loss outcome was defined as successful EWL (≥ 50%) or unsuccessful EWL (< 50%). RESULTS Follow-up data at 1 year was available for 1309 (77%) patients. Mean EWL and BMI reduction were 81.63% and 16.82 ± 4.37 kg/m2 at 1 year. In addition, 48 (3.7%) patients had unsuccessful weight loss. Pre-operative higher BMI (OR, 1.34; p = 0.001), type 2 diabetes (OR, 4.26; p = 0.039), pre-surgery volume eating habit (OR, 0.12; p = 0.003), weight reduction value in the first month after surgery (OR, 0.80; p = 0.002), and length of biliopancreatic limb (LBL) (OR, 1.05; p = 0.017) were independently associated with unsuccessful weight loss at 1-year follow-up. CONCLUSIONS OAGB-MGB provides considerable weight loss for most patients. Initial lower BMI, absence of diabetes, being volume eater, and higher first month weight loss are independently associated with successful weight loss after 1 year.
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Affiliation(s)
- Hastimansooreh Ansar
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Negar Zamaninour
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.,Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-e Rasool Hospital, Tehran, Iran
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Bhandari M, Kosta S, Khurana M, Mathur W, Reddy MK, Fobi M. Emerging Procedures in Bariatric Metabolic Surgery. Surg Clin North Am 2021; 101:335-353. [PMID: 33743973 DOI: 10.1016/j.suc.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Bariatric/metabolic surgery has emerged as an option for significant and durable weight loss in the treatment of clinically severe obesity; there is increasing demand for bariatric/metabolic surgery worldwide. New procedures have been developed and changed the face of modern bariatric surgery. Gastrointestinal metabolic surgery is a new treatment modality for obesity-related type 2 diabetes mellitus for patients with body mass index greater than 35 kg/m2. Providing safe bariatric/metabolic surgery, training qualified bariatric surgeons, and developing better techniques are important issues. This article discusses emerging procedures; a multitude of bariatric metabolic procedures enables surgeons to tailor treatment to patients' needs.
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Affiliation(s)
- Mohit Bhandari
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India.
| | - Susmit Kosta
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Manoj Khurana
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Winni Mathur
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Manoj Kumar Reddy
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Mathias Fobi
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
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20
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Rayman S, Assaf D, Azran C, Sroka G, Assalia A, Beglaibter N, Elazary R, Eldar SM, Romano-Zelekha O, Goitein D. Sleeve Gastrectomy Failure-Revision to Laparoscopic One-Anastomosis Gastric Bypass or Roux-n-Y Gastric Bypass: a Multicenter Study. Obes Surg 2021; 31:2927-2934. [PMID: 33765292 DOI: 10.1007/s11695-021-05334-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) is the most popular bariatric procedure performed worldwide. However, many patients undergo secondary surgery due to either weight-related and complication-related reasons or both. Conversional options vary with one-anastomosis gastric bypass (OAGB) and Roux-n-Y gastric bypass (RYGB) being the most common. The aim of the study was to assess the safety and efficacy of converting failed LSG to either OAGB or RYGB, and compare weight-related results and post-conversion complications. METHODS Retrospective review of hospital records of patients who underwent conversion from LSG to either RYGB or OAGB due to insufficient weight loss or weight regain in 7 bariatric centers between 2013 and 2019. Data retrieved included demographics, anthropometrics, comorbidities, indication for conversion, conversion type, complications, and weight loss. RESULTS During the study period, 396 patients were included in the study. Eighty-four (21%) patients were lost to follow-up. RYGB and OAGB were performed in 119 and 144 patients, respectively. Mean age and body mass index (BMI) at revision were 44.2 years (range 19-72) and 40.6 ± 5.9 kg/m2 (range 35-71), respectively. Of these, 191 (73%) were female. Percent total body weight loss (%TWL) was 16% ± 1% for the RYGB group vs. 23% ± 12% for the OAGB group (p = 0.0007) at a median follow-up of 29 months (range 7-78 months) following conversion. Gastroesophageal reflux disease (GERD) was significantly higher 1 year following conversion to OAGB vs. RYGB occurring in 25 (17.4%) and 9 (7.6%) patients, respectively (p = 0.018). CONCLUSIONS Conversion of LSG to OAGB, compared to RYGB, results in increased weight loss but a higher rate of GERD and potential nutritional deficiencies.
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Affiliation(s)
- Shlomi Rayman
- Department of Surgery C, Chaim Sheba Medical Center, 2 Sheba Rd., 52610, Ramat Gan, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Dan Assaf
- Department of Surgery C, Chaim Sheba Medical Center, 2 Sheba Rd., 52610, Ramat Gan, Israel
| | - Carmil Azran
- Bariatric Center, Herzliya Medical Center, 7 Ramat Yam St, 4685107, Herzliya, Israel
| | - Gideon Sroka
- Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel
| | - Ahmad Assalia
- Department of General Surgery, Rambam Health Care Campus and the Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Nahum Beglaibter
- Department of Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, 91240, Jerusalem, Israel
| | - Ram Elazary
- Department of Surgery, Hadassah-Hebrew University Medical Center, Ein-Kerem Campus, Jerusalem, Israel
| | - Shai Meron Eldar
- Department of General Surgery, The Tel-Aviv Sourasky Medical Center of Medicine, Tel Aviv University, Tel-Aviv-Yafo, Israel
| | - Orly Romano-Zelekha
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer Campus, 56261, Ramat Gan, Israel
| | - David Goitein
- Department of Surgery C, Chaim Sheba Medical Center, 2 Sheba Rd., 52610, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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One Anastomosis/Mini-Gastric Bypass (OAGB/MGB) as Revisional Surgery Following Primary Restrictive Bariatric Procedures: a Systematic Review and Meta-Analysis. Obes Surg 2020; 31:370-383. [PMID: 33118133 PMCID: PMC7809003 DOI: 10.1007/s11695-020-05079-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 10/31/2022]
Abstract
One anastomosis gastric bypass (OAGB/MGB) has gained popularity in the past decade. International databases were searched for articles published by September 10, 2020, on OAGB/MGB as a revisional procedure after restrictive procedures. Twenty-six studies examining a total of 1771 patients were included. The mean initial BMI was 45.70 kg/m2, which decreased to 31.52, 31.40, and 30.54 kg/m2 at 1, 3, and 5-year follow-ups, respectively. Remission of type-2 diabetes mellitus (T2DM) following OAGB/MGB at 1-, 3-, and 5-year follow-up was 65.16 ± 24.43, 65.37 ± 36.07, and 78.10 ± 14.19%, respectively. Remission/improvement rate from gastroesophageal reflux disease (GERD). Also, 7.4% of the patients developed de novo GERD following OAGB/MGB. Leakage was the most common major complication. OAGB/MGB appears to be feasible and effective as a revisional procedure after failed restrictive bariatric procedures.
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22
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Kaniel O, Szold A, Sakran N, Kessler Y, Langer P, Ben-Porat T, Moran-Gilad J, Sherf-Dagan S. The rise of one anastomosis gastric bypass: insights from surgeons and dietitians. Updates Surg 2020; 73:649-656. [PMID: 32451836 DOI: 10.1007/s13304-020-00805-7] [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] [Received: 03/23/2020] [Accepted: 05/16/2020] [Indexed: 11/29/2022]
Abstract
One anastomosis gastric bypass/Mini Gastric Bypass (OAGB/MGB) is an emerging bariatric surgery (BS) technique. We evaluated and compared attitudes of bariatric surgeons and dietitians towards the considerations for choosing BS-type ("Decision-making"), the contributing factors to the rise of OAGB/MGB in Israel ("OAGB/MGB-rise") and notions regarding the occurrence of gastrointestinal (GI) symptoms and nutritional deficiencies following OAGB/MGB. Anonymous online surveys were distributed. The participants were asked to rate by a 10-point Likert scale (0 = not at all; 100 = very much/often) their attitudes towards "Decision-making", "OAGB/MGB-rise" and occurrence of GI symptoms and nutritional deficiencies following OAGB/MGB. For "Decision-making" and "OAGB/MGB-rise", items were considered prioritized where ≥ 50% of the group considered them as 'very-important' (rating ≥ 80). Data on age, sex, years-in-practice and main workplace were also collected. A total of 106 professionals participated in the survey (42 surgeons; 64 dietitians). The respective mean age, years-in-practice and sex were 52.3 ± 8.7 vs. 42.3 ± 9.0 years, 21.0 ± 10.8 vs. 15.5 ± 9.2 years and 85.7% vs. 3.1% males. The inter-observer agreement for prioritized items related to "Decision-making" was fair (Kappa = 0.250; P = 0.257) and both groups prioritized patient's BMI, comorbidities and compliance. The inter-observer agreement for prioritized items related to "OAGB/MGB-rise" was moderate (Kappa = 0.550; P = 0.099) and both groups prioritized ease of performance, shorter operation duration and failure of former restrictive BS. Surgeons reported lower occurrence of nutritional deficiencies and GI symptoms as adverse effects of OAGB/MGB (P ≤ 0.033). The study highlights the views of bariatric surgeons and dietitians concerning factors that underpin the rise of OABG/MGB in Israel and possible rates of GI symptoms and nutritional deficiencies associated with this modality.
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Affiliation(s)
- Osnat Kaniel
- Department of Health Systems Management, Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Amir Szold
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel
| | - Nasser Sakran
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel.,Department of Surgery A, Emek Medical Center, Afula, Israel.,Rappaport, Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Yafit Kessler
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel
| | - Peter Langer
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel
| | - Tair Ben-Porat
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Ein-Kerem Campus, Jerusalem, Israel.,Department of Human Metabolism and Nutrition, Braun School of Public Health, Hebrew University, Jerusalem, Israel
| | - Jacob Moran-Gilad
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shiri Sherf-Dagan
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel. .,Department of Nutrition, Assuta Medical Center, Tel Aviv, Israel.
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A Clinical Decision Support System for Predicting the Early Complications of One-Anastomosis Gastric Bypass Surgery. Obes Surg 2020; 29:2276-2286. [PMID: 31028626 DOI: 10.1007/s11695-019-03849-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND/OBJECTIVE One of the most effective treatments for patients with obesity, albeit with some complications, is obesity surgery. The aim of this study was to develop a clinical decision support system (CDSS) to predict the early complications of one-anastomosis gastric bypass (OAGB) surgery. SUBJECTS/METHODS This study was conducted in Tehran, Iran on patients who underwent OAGB surgery in 2011-2014 in five hospitals. Initially, variables affecting the OAGB early complications were identified using the literature review. Patients' data were extracted from an existing database of obesity surgery. Then, different artificial neural networks (ANNs) (multilayer perceptron (MLP) network) were developed and evaluated for prediction of 10-day, 1-month, and 3-month complications. RESULTS Factors including age, BMI, smoking status, intra-operative complications, comorbidities, laboratory tests, sonography results, and endoscopy results were considered important factors for predicting early complications of OAGB. A CDSS was developed with these variables. The accuracy, specificity, and sensitivity of the 10-day prediction system in the test data were 98.4%, 98.6%, and 98.3%, respectively. These figures for 1-month system were 96%, 93%, and 98.4% and for the 3-month system were 89.3%, 86.6%, and 91.5%, respectively. CONCLUSIONS Using the CDSS designed, we could accurately predict the early complications of OAGB surgery.
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Liagre A, Queralto M, Juglard G, Anduze Y, Iannelli A, Martini F. Multidisciplinary Management of Leaks After One-Anastomosis Gastric Bypass in a Single-Center Series of 2780 Consecutive Patients. Obes Surg 2020; 29:1452-1461. [PMID: 30726544 DOI: 10.1007/s11695-019-03754-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Few data exist in the literature concerning leaks after one-anastomosis gastric bypass (OAGB). Our aim was to describe the incidence, presentation, and management of leaks after OAGB. SETTING A private clinic in France. METHODS Between May 2010 and December 2017, 2780 consecutive patients underwent OAGB. A retrospective chart review was performed on the 46 patients (1.7%) who experienced postoperative leaks. RESULTS Leaks arose from the anastomosis in 6 cases (13%) and from the gastric pouch in 27 cases (59%), while the remaining 13 patients (28%) had leaks from an undetermined origin. Management followed a standardized algorithm taking into consideration the clinical situation and findings on an oral contrast computed tomography (CT) scan. All patients were treated by fasting, total parenteral nutrition, and antimicrobial therapy. Nine patients (20%) could be managed by medical treatment only, 13 patients (28%) underwent laparoscopic management (washout and drainage plus T-tube placement in 5 cases or conversion to Roux-en-Y gastric bypass (RYGB) in one case). The remaining 23 patients (50%) were managed by percutaneous drainage and/or endoscopy. No mortality was observed; the major morbidity rate was 20%. The median length of a hospital stay was 17 days (5-80). CONCLUSION Management of leaks after OAGB depends on clinical conditions and presence, size, and location of an abscess and/or a fistula. If endoscopy and interventional radiology are available, reoperation can be avoided in most patients. In most leaks at the gastrojejunal anastomosis, inserting a T-tube in the leak orifice avoids the necessity for conversion to RYGB.
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Affiliation(s)
- Arnaud Liagre
- Digestive and Bariatric Surgery Unit, Clinique des Cedres, Cornebarrieu, France
| | - Michel Queralto
- Gastrointestinal Endoscopy Unit, Clinique des Cedres, Cornebarrieu, France
| | - Gildas Juglard
- Digestive and Bariatric Surgery Unit, Clinique des Cedres, Cornebarrieu, France
| | - Yves Anduze
- Digestive and Bariatric Surgery Unit, Clinique des Cedres, Cornebarrieu, France
| | - Antonio Iannelli
- Université Côte d'Azur, Nice, France.,Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Nice, France.,Inserm, U1065, Team 8 "Hepatic complications of obesity", Nice, France
| | - Francesco Martini
- Digestive and Bariatric Surgery Unit, Hôpital Joseph Ducuing, 15 Rue Varsovie, 31027, Toulouse, France.
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25
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Aleman R, Lo Menzo E, Szomstein S, Rosenthal RJ. Efficiency and risks of one-anastomosis gastric bypass. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:S7. [PMID: 32309411 PMCID: PMC7154323 DOI: 10.21037/atm.2020.02.03] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The single-anastomosis gastric bypass has been proposed as a simpler and efficient weight loss reducing surgery. Postoperative outcomes are comparable to those of contemporary popular procedures. There are, however, controversies regarding the efficiency and risks of one-anastomosis gastric bypass (OAGB). The purpose of this review is to define the role of OAGB in metabolic surgery via its operative outcomes. A review of English language literature was performed using the PubMed database, basing the search on the following keywords: “one-anastomosis gastric bypass” AND “outcomes”. A total of 238 articles were considered for review. Following thorough screening and selection criteria, 7 articles were considered sufficient for assessment. The nature of the available evidence of this technique poses a challenge to OAGB in its establishment as a standard of care procedure. The anatomical configuration following surgery, as well as the metabolic implications of its hypo-absorptive nature, raises controversial and ongoing concerns that are yet to be addressed. Hence, prospective studies with long-term follow-up (>5 years) can bypass these concerns and allow the progression of the clinical practice of OAGB.
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Affiliation(s)
- Rene Aleman
- Department of General Surgery, Section of Minimally Invasive Surgery, The Bariatric & Metabolic Institute, Cleveland Clinic Florida, Weston, FL, USA
| | - Emanuele Lo Menzo
- Department of General Surgery, Section of Minimally Invasive Surgery, The Bariatric & Metabolic Institute, Cleveland Clinic Florida, Weston, FL, USA
| | - Samuel Szomstein
- Department of General Surgery, Section of Minimally Invasive Surgery, The Bariatric & Metabolic Institute, Cleveland Clinic Florida, Weston, FL, USA
| | - Raul J Rosenthal
- Department of General Surgery, Section of Minimally Invasive Surgery, The Bariatric & Metabolic Institute, Cleveland Clinic Florida, Weston, FL, USA
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26
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Trends in Bariatric Surgery: a 5-Year Analysis of the Israel National Bariatric Surgery Registry. Obes Surg 2020; 30:1761-1767. [DOI: 10.1007/s11695-020-04426-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) claims its place among bariatric operations, proving itself a safe and effective procedure. METHODS This is a retrospective analysis of prospectively collected data regarding 94 patients who underwent surgery in a single surgical unit. Tailoring of the biliopancreatic limb length decided upon preoperative BMI was applied. Patients' excess weight loss and resolution of comorbidities were evaluated. Data on patients' nutritional status is also presented. RESULTS Mean BMI reduction at 36 months postoperatively was 21.7 ± 6.3 kg/m2. Mean excess weight loss (%EWL) was 83.6%, 91.8%, and 92.5% at 12, 24, and 36 months postoperatively, respectively. When controlling for preoperative BMI, a 36-month %EWL of 89.1% for the 2-m subgroup, a 95.3% for the 2.5-m subgroup, and a 104.7% for the 3-m subgroup were found. Operation's success, defined as %EWL greater than 50%, was 97.9% 36 months postoperatively. All patients suffering from hypertension, diabetes, and dyslipidemia achieved full remission. Furthermore, the percentage of patients with obstructive sleep apnea and gastroesophageal reflux disease, achieving full remission was 91.7% and 86.7%, respectively. An incidence of 5.3% new onset regurgitation was noted. Iron deficiency presented in 26 (27.7%) patients postoperatively, vitamin B12 deficiency in 13 (13.8%), folic acid deficiency in 18 (19.1%), and mild hypoalbuminemia in 7 (7.4%). Major early postoperative complications (Clavien-Dindo grade ≥ 3) were reported in 1.7% of our patients. One (1.1%) patient developed marginal ulcer and two (2.2) patients had late dumping. CONCLUSIONS OAGB is a safe and efficient technique; however, careful selection of patients and postoperative surveillance with respect to weight regain and nutritional deficiencies are mandatory for optimal results.
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Abstract
BACKGROUND Management of failed laparoscopic gastric plication (LGP), defined as weight regain or inadequate weight loss, is a challenging issue. METHODS This prospective investigation was conducted in individuals with morbid obesity who had undergone LGP from 2000 to 2016. Patients with weight loss failure, weight regain, and regain-prone cases were indicated for reoperation. Re-plication, laparoscopic one anastomosis gastric bypass (LOAGB), and modified jejunoileal bypass were done as revisional surgery. RESULTS Revisional surgery was performed in 102 of 124 patients who needed reoperation. Overall, 39 re-plication, 38 LOAGB, and 25 malabsorptive procedures were performed. Re-plication was the shortest surgery and had the shortest length of hospital stay. The percentage of TWL at 6, 12, and 24 months of follow-up was 20.5%, 25%, and 26.8% for re-plication; 20.2%, 27%, and 30.5% for LOAGB; and 22.9%, 28.9%, and 32.6% for the malabsorptive procedure, respectively. In addition, the percentage of EWL at 6, 12, and 24 months of follow-up was 62%, 74.6%, and 79.6% for re-plication; 51.6%, 68.2%, and 75.9% for LOAGB; and 55.4%, 70.1%, and 79.1% for malabsorptive procedure, respectively. In long-term follow-up, according to %TWL, LOAGB and malabsorptive procedure had better outcome compared to re-plication, whereas there was no statistically significant difference in %EWL among the three surgical approaches. CONCLUSIONS In terms of weight loss, reoperation on failed LGP was completely successful and no treatment failure was reported. All three revisional procedures, including re-plication, LOAGB, and malabsorptive procedure showed promising results and provided substantial weight loss. Since there is little information about the long-term efficacy and safety of revisional surgery on failed LGP, we highly recommend further investigations to confirm our results.
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29
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Godoy EPD, Pereira SSDS, Coelho D, Pinto IMDM, Luz VFD, Coutinho JL, Palitot TRDC, Costa HBDF, Campos JM, Brandt CT. Isolated intestinal transit bipartition: a new strategy for staged surgery in superobesity. ACTA ACUST UNITED AC 2019; 46:e20192264. [PMID: 31859724 DOI: 10.1590/0100-6991e-20192264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/15/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE biliopancreatic diversion with duodenal switch is a complex, malabsorptive procedure, associated with improved weight loss and metabolic control. Staged surgery with sleeve gastrectomy as the first stage is an option for reducing complications in superobese patients. However, some problems persist: large livers can hamper the surgical approach and complications such as leaks can be severe. Intestinal transit bipartition is a modified and simplified model of biliopancreatic diversion that complements sleeve gastrectomy. It is similar to the duodenal switch, but with less complexity and fewer nutritional consequences. This study assessed the feasibility and safety of isolated transit bipartition as the initial procedure in a two-step surgery to treat superobesity. METHODS this prospective study included 41 superobese patients, with mean BMI 54.5±3.5kg/m2. We performed a laparoscopic isolated transit bipartition as the first procedure in a new staged approach. We analyzed weight loss and complications during one year of follow-up. RESULTS we completed all the procedures by laparoscopy. After six months, the mean percent excess weight loss was 28%, remaining stable until the end of the study. There were no intraoperative difficulties. Half of the patients experienced early diarrhea, and three had marginal ulcers. There were no major surgical complications or deaths. CONCLUSION isolated laparoscopic transit bipartition is a new option for a staged approach in superobesity, which can provide a safer second procedure after effective weight loss over six months. It may be useful particularly in the management of patients with severe obesity.
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Affiliation(s)
- Eudes Paiva de Godoy
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Serviço de Cirurgia Geral, Natal, RN, Brasil
| | | | - Daniel Coelho
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Serviço de Cirurgia Geral, Natal, RN, Brasil
| | | | - Vinícius Fernando da Luz
- Universidade Federal do Rio Grande do Norte, Maternidade Escola Januário Cicco, Serviço de Anestesiologia, Natal, RN, Brasil
| | - Jorge Landivar Coutinho
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Serviço de Cirurgia Geral, Natal, RN, Brasil
| | | | - Hamilton Belo de França Costa
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Serviço de Cirurgia Geral, Natal, RN, Brasil
| | - Josemberg Marins Campos
- Universidade Federal de Pernambuco, Centro de Ciências da Saúde, Faculdade de Medicina, Departamento de Cirurgia, Recife, PE, Brasil
| | - Carlos Teixeira Brandt
- Universidade Federal de Pernambuco, Centro de Ciências da Saúde, Faculdade de Medicina, Departamento de Cirurgia, Recife, PE, Brasil
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30
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Clinical Outcomes of One Anastomosis Gastric Bypass Versus Sleeve Gastrectomy for Morbid Obesity. Obes Surg 2019; 30:1021-1031. [PMID: 31797208 DOI: 10.1007/s11695-019-04303-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) and sleeve gastrectomy (SG) are popular bariatric surgeries for morbid obesity. Reports on the safety and effectiveness of SG and OAGB are inconsistent. This meta-analysis investigated the clinical outcomes of SG versus those of OAGB for morbid obesity. METHODS Based on PRISMA guidelines, we searched the published articles in English from Scopus, PubMed (Medline), Central (Cochrane), and Embase databases. Articles were retrieved from the start date of each database to February 13, 2019. Statistical analysis of this meta-analysis was conducted in Stata 14.0, and the most appropriate effect model was chosen based on heterogeneity. RESULTS A total of 20 articles examining 4064 OAGB patients and 3733 SG patients were included in this meta-analysis. Compared with SG, OAGB showed a higher percentage excess weight loss (%EWL) at 6 months (weighted mean difference (WMD) = 11.32; 95% CI 6.00-16.64), 12 months (WMD = 8.22; 95% CI 3.78-12.66), 24 months (WMD = 10.19; 95% CI 0.88-21.25), 36 months (WMD = 7.93; 95% CI 3.37-12.48), 48 months (WMD = 17.22; 95% CI 7.37-27.06), and 60 months (WMD = 16.43; 95% CI 8.96-23.90). In addition, OAGB was associated with a lower rate of postoperative leak, gastroesophageal reflux disease, revisions, mortality, and dyslipidemia remission rates. However, OAGB increased the incidence of ulcers, malnutrition, and bile reflux. CONCLUSION OAGB is more effective for %EWL and dyslipidemia remission than SG. In addition, OAGB may lower the risk of postoperative leak, gastroesophageal reflux disease, revision, and mortality. Further comparisons of the clinical outcomes of OAGB versus SG for morbid obesity would benefit from more high-quality controlled studies.
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31
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Long-Term Outcomes After One-Anastomosis Gastric Bypass (OAGB) in Morbidly Obese Patients. Obes Surg 2019; 30:1379-1384. [DOI: 10.1007/s11695-019-04287-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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32
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Deitel M, Rutledge R. Mini-gastric bypass: Prevention and management of complications in performance and follow–up. Int J Surg 2019; 71:119-123. [DOI: 10.1016/j.ijsu.2019.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/02/2019] [Accepted: 09/09/2019] [Indexed: 12/31/2022]
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33
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Landreneau JP, Barajas-Gamboa JS, Strong AT, Corcelles R, Kroh MD. Conversion of one-anastomosis gastric bypass to Roux-en-Y gastric bypass: short-term results from a tertiary referral center. Surg Obes Relat Dis 2019; 15:1896-1902. [DOI: 10.1016/j.soard.2019.09.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/10/2019] [Accepted: 09/03/2019] [Indexed: 12/27/2022]
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Tessier R, Ribeiro-Parenti L, Bruneau O, Khodorova N, Cavin JB, Bado A, Azzout-Marniche D, Calvez J, Le Gall M, Gaudichon C. Effect of different bariatric surgeries on dietary protein bioavailability in rats. Am J Physiol Gastrointest Liver Physiol 2019; 317:G592-G601. [PMID: 31460792 DOI: 10.1152/ajpgi.00142.2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Bariatric surgery may induce protein malabsorption, although data are scarce. This study aims at evaluating dietary protein bioavailability after different bariatric surgeries in rats. Diet-induced obese Wistar rats were operated for vertical sleeve gastrectomy (VSG) or Roux-en-Y gastric bypass (RYGB). The control group was composed of pair-fed, sham-operated rats (Sham). Two weeks after surgery, rats were fed a 15N protein meal. Protein bioavailability was assessed by determination of 15N recovery in the gastrointestinal tract and organs 6 h after the meal. Fractional protein synthesis rate (FSR) was assessed using a flooding dose of 13C valine. Weight loss was the highest in RYGB rats and the lowest in Sham rats. Surprisingly, RYGB (95.6 ± 0.7%) improved protein digestibility (P = 0.045) compared with Sham (93.5 ± 0.5%) and VSG (93.8 ± 0.6%). In contrast, 15N retained in the liver (P = 0.001) and plasma protein (P = 0.037) was lower than in Sham, with a similar trend in muscle (P = 0.052). FSR was little altered by bariatric surgery, except for a decrease in the kidney of RYGB (P = 0.02). The 15N distribution along the small intestinal tissue suggests that dietary nitrogen was considerably retained in the remodeled mucosa of RYGB compared with Sham. This study revealed that in contrast to VSG, RYGB slightly improved protein digestibility but altered peripheral protein bioavailability. This effect may be ascribed to a higher uptake of dietary amino acids by the remodeled intestine.NEW & NOTEWORTHY Using a sensitive 15N meal test, we found that gastric bypass slightly improved protein digestibility compared with sleeve gastrectomy or control but, in contrast, lowered protein retention in the liver and muscles. This paradox can be due to a higher uptake of dietary nitrogen by the intestinal mucosa that was hypertrophied. This study provides new insight on the digestive and metabolic fate of dietary protein in different models of bariatric surgery in rats.
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Affiliation(s)
- Romain Tessier
- UMR Physiology of Nutrition and Ingestive Behavior (PNCA), AgroParisTech, INRA, Université Paris-Saclay, Paris, France.,INSERM UMRS 1149, UFR de Médecine Paris Diderot, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lara Ribeiro-Parenti
- INSERM UMRS 1149, UFR de Médecine Paris Diderot, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France.,Department of General and Digestive Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ouafa Bruneau
- UMR Physiology of Nutrition and Ingestive Behavior (PNCA), AgroParisTech, INRA, Université Paris-Saclay, Paris, France.,INSERM UMRS 1149, UFR de Médecine Paris Diderot, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nadezda Khodorova
- UMR Physiology of Nutrition and Ingestive Behavior (PNCA), AgroParisTech, INRA, Université Paris-Saclay, Paris, France
| | - Jean-Baptiste Cavin
- INSERM UMRS 1149, UFR de Médecine Paris Diderot, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - André Bado
- INSERM UMRS 1149, UFR de Médecine Paris Diderot, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dalila Azzout-Marniche
- UMR Physiology of Nutrition and Ingestive Behavior (PNCA), AgroParisTech, INRA, Université Paris-Saclay, Paris, France
| | - Juliane Calvez
- UMR Physiology of Nutrition and Ingestive Behavior (PNCA), AgroParisTech, INRA, Université Paris-Saclay, Paris, France
| | - Maude Le Gall
- INSERM UMRS 1149, UFR de Médecine Paris Diderot, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Claire Gaudichon
- UMR Physiology of Nutrition and Ingestive Behavior (PNCA), AgroParisTech, INRA, Université Paris-Saclay, Paris, France
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35
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One Anastomosis Gastric Bypass–Mini Gastric Bypass with Tailored Biliopancreatic Limb Length Formula Relative to Small Bowel Length: Preliminary Results. Obes Surg 2019; 29:3062-3070. [DOI: 10.1007/s11695-019-04019-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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36
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Kessler Y, Adelson D, Mardy-Tilbor L, Ben-Porat T, Szold A, Goitein D, Sakran N, Raziel A, Sherf-Dagan S. Nutritional status following One Anastomosis Gastric Bypass. Clin Nutr 2019; 39:599-605. [PMID: 30922792 DOI: 10.1016/j.clnu.2019.03.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/04/2019] [Accepted: 03/10/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS One Anastomosis Gastric Bypass (OAGB) has been accepted as an effective treatment for morbid obesity. However, data are scarce regarding nutritional implications of this procedure. Thus, our aim was to describe the health and nutritional status 12-20 months following OAGB surgery. METHODS A prospective cohort study on patients who underwent OAGB surgery from January 2016 to May 2017 in a large, multi-disciplinary, bariatric clinic. Pre-surgery data including demographic details, anthropometrics, co-morbidities, blood tests and lifestyle habits were obtained from the patients' medical records. Follow-up evaluations were performed 12-20 months post-surgery and data collected included anthropometrics, blood tests, eating and lifestyle parameters, adherence to follow-up regime and gastrointestinal (GI) related side effects. In addition, patients were asked to rate their overall state of health (OSH) from 0 to 100 using a visual analogue scale (VAS). RESULTS Eighty-six OAGB patients (72.1% women) were tested 14.7 ± 2.0 months post-operatively. Their mean age and BMI preoperatively were 46.1 ± 11.4 years and 42.0 ± 4.9 kg/m2, respectively. The mean % excess weight loss at 12-20 months postoperatively was 88.4 ± 19.3%. Lipid and glucose profiles were significantly improved at 12-20 months postoperatively compared to baseline (P < 0.001 for all). Relatively high proportions of nutritional deficiencies were found pre-operatively and postoperatively for iron (33.9% vs. 23.7%, P = 0.238), folate (30.9% vs. 11.8%, P = 0.004), vitamin D (56.6% vs. 17.0%, P < 0.001) and hemoglobin (16.7% vs. 42.9%, P < 0.001). Postoperatively, most participants reported taking multivitamin, calcium, vitamin D and vitamin B12 supplementation (≥62.8%), having participated in at least 6 meetings with a dietitian (51.8%) and presently doing physical activity (69.4%). The mean postoperative OSH VAS score was 88.2 ± 12.3, but most participants reported on flatulence (67.4%) and some reported on diarrhea (25.6%) as GI side effects of the surgery. CONCLUSIONS Substantial improvements in health and anthropometric parameters are found in the short-term follow-up after OAGB, with a satisfactory reported quality of life and adherence to recommendations. However, a high prevalence of some GI side effects, nutritional deficiencies and specially anemia is a matter of concern.
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Affiliation(s)
- Yafit Kessler
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel.
| | - Dana Adelson
- Faculty of Health Sciences, Joyce & Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheba, Israel.
| | | | - Tair Ben-Porat
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Amir Szold
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel.
| | - David Goitein
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel; Department of Surgery C, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Nasser Sakran
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel; Department of Surgery A, Emek Medical Center, Afula, Israel; Rappaport, Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
| | - Asnat Raziel
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel.
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Protein-Calorie Malnutrition Requiring Revisional Surgery after One-Anastomosis-Mini-Gastric Bypass (OAGB-MGB): Case Series from the Tehran Obesity Treatment Study (TOTS). Obes Surg 2019; 29:1714-1720. [DOI: 10.1007/s11695-019-03741-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Rutledge R, Kular K, Manchanda N. The Mini-Gastric Bypass original technique. Int J Surg 2019; 61:38-41. [DOI: 10.1016/j.ijsu.2018.10.042] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 11/16/2022]
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Alghamdi HM, AlShammary S, Lardhi H, AlDhafeeri W, AlLababidi N. Cecal volvulus following mini gastric bypass: A case report and review of literature. Int J Surg Case Rep 2018; 53:461-463. [PMID: 30567069 PMCID: PMC6275162 DOI: 10.1016/j.ijscr.2018.11.024] [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: 10/21/2018] [Accepted: 11/10/2018] [Indexed: 11/25/2022] Open
Abstract
Cecal volvulus is one of the differential diagnosis of post Mini-gastric bypass acute intestinal obstruction. and pain. Urgent intervention in acute presentation post gastric bypass is the key to saving the patient life and lower morbidity. Conversion of Mini-gastric bypass to Roux-en-Y gastric bypass in any complication surgery is recommended when feasible.
Introduction: With the rising worldwide obesity epidemic, bariatric surgeries are gaining popularity as the most effective modality for achieving long term results in weight loss and reducing its metabolic sequels. Case presentation: A 36-year-old female presented with a sudden onset of severe abdominal pain for 6 h. The patient underwent Mini gastric bypass (MGB) 2 years prior to presentation. Computed tomography (CT) scan revealed a 14-cm dilatation of the cecum occupying the left upper quadrant of the abdomen with the swirling appearance of the mesentery. These findings were confirmed through emergency exploratory laparotomy to be cecal volvulus. a right hemicolectomy and conversion of MGB to a conventional Roux-en-Y gastric bypass. Discussion: a modification of the classical gastric bypass surgery the MGB considered by its advocates to be a safer, simpler, and more effective option. However, serious complications can take place especially in the early learning curve of the procedure. Conclusions We present a unexpected acute in top of chronic cecal volvulus in patient two years post MGB. The uncommon serious complication should be considered one of the differential diagnosis of acute surgical abdomen in those patients.
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Affiliation(s)
- Hanan M Alghamdi
- King Fahad Hospital of the University, Department of Surgery, College of Medicine, University of Imam Abdurahman Bin Faisal, Saudi Arabia.
| | - Shadi AlShammary
- King Fahad Hospital of the University, Department of Surgery, College of Medicine, University of Imam Abdurahman Bin Faisal, Saudi Arabia
| | - Haitham Lardhi
- King Fahad Hospital of the University, Department of Surgery, College of Medicine, University of Imam Abdurahman Bin Faisal, Saudi Arabia
| | - Wafa AlDhafeeri
- King Fahad Hospital of the University, Department of Surgery, College of Medicine, University of Imam Abdurahman Bin Faisal, Saudi Arabia
| | - Noor AlLababidi
- King Fahad Hospital of the University, Department of Surgery, College of Medicine, University of Imam Abdurahman Bin Faisal, Saudi Arabia
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Kroh A, Eickhoff RM, Heise D, Alizai PH, Rheinwalt KP, Neumann UP, Ulmer FT. A New Physiologic Mouse Model of One Anastomosis Gastric Bypass. Eur Surg Res 2018; 59:320-328. [PMID: 30419555 DOI: 10.1159/000493385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/30/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) is a modern metabolic operation that has been demonstrated to be a rapid, safe, and effective procedure. As for other bariatric operations, the mechanisms and long-term effects of this procedure remain largely unknown and are difficult to address in human studies. Here, we present a new physiologic mouse model for mechanistic and long-term investigations. METHODS Six-week-old C57Bl/6 mice were fed a high-fat diet for 12 weeks and scheduled for OAGB or sham operation. Mice were observed for 2 weeks after the operation, and weight and metabolic condition were monitored. RESULTS Six mice were used to adapt the surgical technique. Afterwards, another 7 mice were scheduled for OAGB without further complications. The newly established OAGB procedure resulted in significant weight loss and improvement of glucose metabolism 2 weeks after the operation. CONCLUSIONS The operation presented here is an easy-to-learn and physiologic mouse model of OAGB that can be used for further studies in mice.
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Affiliation(s)
- Andreas Kroh
- Department of General, Visceral, and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany,
| | - Roman M Eickhoff
- Department of General, Visceral, and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Daniel Heise
- Department of General, Visceral, and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Patrick H Alizai
- Department of General, Visceral, and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Karl P Rheinwalt
- Department for Bariatric and Metabolic Surgery, St. Franziskus Hospital, Cologne, Germany
| | - Ulf P Neumann
- Department of General, Visceral, and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany.,Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Florian T Ulmer
- Department of General, Visceral, and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany.,Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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Deitel M, Rheinwalt KP, Musella M, Weiner R, Kular KS, Peraglia C, Prasad A, Luciani RC, Sakran N, Plamper A. Comment on: Acid and non-acid gastroesophageal reflux after single anastomosis gastric bypass. Surg Obes Relat Dis 2018; 14:1419-1420. [PMID: 30268322 DOI: 10.1016/j.soard.2018.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- M Deitel
- SFASMBS, CRCSC Director MGB-OAGB Club, Toronto, Canada.
| | | | - M Musella
- Advanced Biomedical Sciences Department, "Federico II" University, Naples, Italy
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Abtar HK, Mhana TM, Zbibo R, Mneimneh M, Asmar AE. First case report of bile leak from the duct of Luschka in a patient with mini-gastric bypass: The challenge of management. Ann Med Surg (Lond) 2018; 35:29-32. [PMID: 30263115 PMCID: PMC6156743 DOI: 10.1016/j.amsu.2018.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 09/06/2018] [Accepted: 09/18/2018] [Indexed: 01/24/2023] Open
Abstract
Introduction The incidence of Bile duct injury after laparoscopic cholecystectomy approaches 0.11%–1.4%. Ducts of Luschka are the second most common site of bile leaks. The rarity of these ducts with cases of anatomical alterations in the gastrointestinal tract such as mini-gastric bypass makes the management a challenging option. Presentation of case Hereby we present a unique case of 28 year old female patient with mini-gastric bypass who had done uneventful cholecystectomy. Day 3 postoperatively patient complained of diffuse abdominal pain. Computed tomography showed free fluid in the abdomen. Liver enzymes were normal. Relaparoscopy showed leaking bile duct of Luschka, which was closed by surgical clips and drains left in the spaces. However bile leak continued for 4 weeks then stopped. Patient did well after all. Discussion Endoscopic retrograde cholangiopancreatography with sphincterotomy played a crucial role for diagnosis and treatment of bile leaks with success rate near 94%. However no data were available using this method in a patient with Mini-gastric bypass procedure. Many authors have argued the role of relaparoscopy, but it is still an important way for adequate drainage and control of bile leakage. The only significant factor in determining clinical outcome in cases of non-surgical management is the type of bile duct injury. Conclusion To the best of our knowledge, this is the first case report of bile leak from duct of Luschka after mini-gastric bypass treated successfully with relaparoscopy and drainage. Herein we will discuss all the available options of treatment and the challenge of it. The combination of Duct of Luschka in a patient with mini-gastric bypass is unique in the literature. The challenge of management especially endoscopic one puts a great pressure on both surgeons and gastroenterologists. NO single data available in the literature in doing ERCP by any method in a patient with mini-gastric bypass.
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Affiliation(s)
- Houssam Khodor Abtar
- Makassed General Hospital, Department of Surgery, Beirut, Lebanon
- Corresponding author. Makassed General Hospital, P.O. Box: 11-6301, Riad EI-Solh, 11072210, Beirut, Lebanon.
| | | | - Riad Zbibo
- Makassed General Hospital, Department of Surgery, Beirut, Lebanon
| | | | - Antoine el Asmar
- Sahel General Hospital, Department of Radiology, Beirut, Lebanon
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Fahmy MH, Sarhan MD, Salman MA, Fathy E. Gastro-Esophageal Reflux Disease After Laparoscopic Mini-Gastric Bypass and Roux-en-Y Gastric Bypass: Is There a Difference? Bariatr Surg Pract Patient Care 2018. [DOI: 10.1089/bari.2018.0018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mohamed Hassan Fahmy
- Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohammed Diaa Sarhan
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Ehab Fathy
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
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Was macht den Mini‑/One-anastomosis-gastric-Bypass zu einem Standardverfahren? – Evidenz zur Einschlingenrekonstruktion. Chirurg 2018; 89:589-596. [DOI: 10.1007/s00104-018-0663-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Parikh M, Eisenberg D, Johnson J, El-Chaar M. American Society for Metabolic and Bariatric Surgery review of the literature on one-anastomosis gastric bypass. Surg Obes Relat Dis 2018; 14:1088-1092. [PMID: 29907540 DOI: 10.1016/j.soard.2018.04.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 04/27/2018] [Indexed: 12/31/2022]
Abstract
The following review is being published by the American Society for Metabolic and Bariatric Surgery in response to numerous inquiries made to the Society by patients, physicians, society members, hospitals, and others regarding one-anastomosis gastric bypass as a primary treatment for obesity or metabolic disease. The review is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time. The review is not intended as, and should not be construed as, stating or establishing a local, regional, or national standard of care.
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Affiliation(s)
- Manish Parikh
- Department of Surgery NYU Langone Medical Center/Bellevue Hospital Center, New York, New York.
| | - Dan Eisenberg
- Department of Surgery, Stanford School of Medicine, Stanford, California; Department of Surgery, Palo Alto VA Healthcare System, Palo Alto, California
| | - Jason Johnson
- Department of General Surgery, Spartanburg Regional Healthcare System, Spartanburg, South Carolina
| | - Maher El-Chaar
- Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, Medical School of Temple University/St. Luke's University Health Network, Allentown, Pennsylvania
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Short-Term Results of Revisional Single-Anastomosis Gastric Bypass After Sleeve Gastrectomy for Weight Regain. Obes Surg 2018. [DOI: 10.1007/s11695-018-3158-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Conversion of One-Anastomosis Gastric Bypass (OAGB) Is Rarely Needed if Standard Operative Techniques Are Performed. Obes Surg 2018; 26:1588-91. [PMID: 27067910 DOI: 10.1007/s11695-016-2172-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Stomach Intestinal Pylorus Sparing (SIPS) Surgery for Morbid Obesity: Retrospective Analyses of Our Preliminary Experience. Obes Surg 2018; 26:2098-2104. [PMID: 26932811 DOI: 10.1007/s11695-016-2077-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although the duodenal switch (DS) has been the most effective weight loss surgical procedure, it is a small minority of the total bariatric surgical cases performed. Modifications that can make the operation technically simpler and reduce a long-term risk of short bowel syndrome would be of benefit. The aim of this study was to detail our initial experience with a modified DS called stomach intestinal pylorus sparing (SIPS) procedure. METHODS Data from patients who underwent a primary SIPS procedure performed by two surgeons at two centers from January 2013 to August 2014 were retrospectively analyzed. All revisions of prior bariatric procedures were excluded. Regression analyses were performed for all follow-up weight loss data. RESULTS One hundred twenty-three patients were available. One hundred two patients were beyond 1 year postoperative, with data available for 64 (62 % followed up). The mean body mass index (BMI) was 49.4 kg/m(2). Two patients had diarrhea (1.6 %), four had abdominal hematoma (3.2 %), and one had a stricture (0.8 %) in the gastric sleeve. Two patients (1.6 %) were readmitted within 30 days. One patient (0.8 %) was reoperated due to an early postoperative ulcer. At 1 year, patients had an average change in BMI of 19 units (kg/m(2)), which was compared to an average of 38 % of total weight loss or 72 % of excess weight loss. CONCLUSIONS Modification of the classic DS to one with a single anastomosis and a longer common channel had effective weight loss results. Morbidity seems comparable to other stapling reconstructive procedures. Future analyses are needed to determine whether a SIPS procedure reduces the risk of future small bowel obstructions and micronutrient deficiencies.
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Musella M, Bocchetti A. Late Complications of MGB: Prevention and Treatment. ESSENTIALS OF MINI ‒ ONE ANASTOMOSIS GASTRIC BYPASS 2018:81-86. [DOI: 10.1007/978-3-319-76177-0_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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