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Aderinto N, Olatunji G, Kokori E, Olaniyi P, Isarinade T, Yusuf IA. Recent advances in bariatric surgery: a narrative review of weight loss procedures. Ann Med Surg (Lond) 2023; 85:6091-6104. [PMID: 38098582 PMCID: PMC10718334 DOI: 10.1097/ms9.0000000000001472] [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: 08/23/2023] [Accepted: 10/25/2023] [Indexed: 12/17/2023] Open
Abstract
Bariatric surgery has emerged as a highly effective option for individuals with obesity, offering significant and sustainable weight loss outcomes. This surgical approach involves various procedures that alter the anatomy of the gastrointestinal tract, leading to reduced food intake and nutrient absorption. Established procedures such as sleeve gastrectomy, gastric bypass, adjustable gastric banding, and biliopancreatic diversion with duodenal switch have proven track records. In contrast, emerging options like intragastric balloons, AspireAssist devices, and endoscopic sleeve gastroplasty show promise but require further investigation. Numerous studies have highlighted the remarkable benefits of bariatric surgery, not only in weight loss but also in the resolution of obesity-related comorbidities and significant improvements in quality of life. However, successful outcomes rely on a multidisciplinary approach, encompassing preoperative evaluation, patient selection, comprehensive postoperative care, nutritional support, and psychological counseling. Regular follow-up and adherence to postsurgical recommendations are crucial for sustained weight loss and positive long-term results. As bariatric surgery continues to evolve, tailored procedures based on individual needs and ongoing research hold the potential for even more refined and effective approaches. Through this ongoing advancement, bariatric surgery is poised to offer improved patient outcomes, transforming lives for those grappling with the challenges of obesity.
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Affiliation(s)
- Nicholas Aderinto
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomoso, Oyo State
| | | | - Emmanuel Kokori
- Department of Medicine and Surgery, University of Ilorin, Ilorin
| | - Peter Olaniyi
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomoso, Oyo State
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Salame M, Teixeira AF, Lind R, Ungson G, Ghanem M, Abi Mosleh K, Jawad MA, Abu Dayyeh BK, Kendrick ML, Ghanem OM. Marginal Ulcer and Dumping Syndrome in Patients after Duodenal Switch: A Multi-Centered Study. J Clin Med 2023; 12:5600. [PMID: 37685666 PMCID: PMC10488365 DOI: 10.3390/jcm12175600] [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: 07/17/2023] [Revised: 08/15/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND The current design of biliopancreatic diversion with duodenal switch (BPD/DS) and single anastomosis duodenal-ileal bypass with sleeve (SADI-S) emphasizes the importance of the pylorus' preservation to reduce the incidence of marginal ulcer (MU) and dumping. However, no institutional studies have yet reported data on their prevalence. We aimed to assess the incidence of MU and dumping after duodenal switch (DS) and identify the associative factors. METHODS A multi-center review of patients who underwent BPD/DS or SADI-S between 2008 and 2022. Baseline demographics, symptoms, and management of both complications were collected. Fisher's exact test was used for categorical variables and the independent t-test for continuous variables. RESULTS A total of 919 patients were included (74.6% female; age 42.5 years; BMI 54.6 kg/m2) with mean follow-up of 31.5 months. Eight patients (0.9%) developed MU and seven (0.8%) had dumping. Patients who developed MU were more likely to be using non-steroidal anti-inflammatory drugs (NSAID) (p = 0.006) and have a longer operation time (p = 0.047). Primary versus revisional surgery, and BDP/DS versus SADI-S were not associated with MU or dumping. CONCLUSIONS The incidences of MU and dumping after DS were low. NSAID use and a longer operation time were associated with an increased risk of MU, whereas dumping was attributed to poor dietary habits.
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Affiliation(s)
- Marita Salame
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Romulo Lind
- Department of Surgery, Orlando Health, Orlando, FL 32806, USA
| | - Gilberto Ungson
- Department of Surgery, Cima Hospital, Hermosillo 83280, Mexico
| | - Muhammad Ghanem
- Department of Surgery, Orlando Health, Orlando, FL 32806, USA
| | | | | | - Barham K. Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Omar M. Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
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Süsstrunk J, Schneider R, Gebhart M, Peterli R. [Bariatric Surgery in 2022 - What Is Important for the General Practitioner?]. PRAXIS 2022; 111:389-395. [PMID: 35611480 DOI: 10.1024/1661-8157/a003861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Bariatric Surgery in 2022 - What Is Important for the General Practitioner? Abstract. Bariatric surgery is the most efficient treatment for obesity and associated diseases. Basic knowledge about the indications, common procedures, follow-up and possible complications has become essential for primary care practice. This article explains the current standards of care in Switzerland with a focus on relevant information for the practice: nutritional aspects after bariatric surgery, necessary clinical and laboratory examinations, early detection of complications. Only intense interdisciplinary and interprofessional collaboration leads to a treatment success in morbid obesity.
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Affiliation(s)
- Julian Süsstrunk
- Clarunis, Universitäres Bauchzentrum Basel, Viszeralchirurgie, St. Claraspital und Universitätsspital, Basel, Schweiz
- Gemeinsame Erstautorenschaft
| | - Romano Schneider
- Clarunis, Universitäres Bauchzentrum Basel, Viszeralchirurgie, St. Claraspital und Universitätsspital, Basel, Schweiz
- Gemeinsame Erstautorenschaft
| | - Martina Gebhart
- Innere Medizin/Endokrinologie mit Ernährungszentrum, St. Claraspital, Basel, Schweiz
| | - Ralph Peterli
- Clarunis, Universitäres Bauchzentrum Basel, Viszeralchirurgie, St. Claraspital und Universitätsspital, Basel, Schweiz
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Effects of intraoperative leak testing on postoperative leak-related outcomes after primary bariatric surgery: an analysis of the MBSAQIP database. Surg Obes Relat Dis 2019; 15:1530-1540. [DOI: 10.1016/j.soard.2019.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/30/2019] [Accepted: 06/01/2019] [Indexed: 11/23/2022]
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Hong CS, Bergen MA, Watters TS. Transient osteoporosis of the hip after bariatric surgery. Arthroplast Today 2019; 5:32-37. [PMID: 31020018 PMCID: PMC6475654 DOI: 10.1016/j.artd.2018.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/27/2018] [Accepted: 10/30/2018] [Indexed: 12/04/2022] Open
Abstract
Transient osteoporosis is a rare manifestation of acute hip pain which typically resolves with weight-bearing restrictions and pain management. Our case report presents a patient who experienced atraumatic right hip pain a few weeks after an uncomplicated bariatric surgery and was diagnosed with transient osteoporosis of the hip. Her condition resolved after weeks of protected weight-bearing restrictions and nonsteroidal anti-inflammatories. Transient osteoporosis should be considered in the differential diagnosis of hip pain in patients who have undergone previous bariatric surgery.
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Affiliation(s)
- Cierra S. Hong
- Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Michael A. Bergen
- Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA
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Sudan R, Jain-Spangler K. Tailoring Bariatric Surgery: Sleeve Gastrectomy, Roux-en-Y Gastric Bypass and Biliopancreatic Diversion with Duodenal Switch. J Laparoendosc Adv Surg Tech A 2018; 28:956-961. [DOI: 10.1089/lap.2018.0397] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Ranjan Sudan
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Werling M, Fändriks L, Olbers T, Mala T, Kristinsson J, Stenlöf K, Wallenius V, Docherty NG, le Roux CW. Biliopancreatic Diversion is associated with greater increases in energy expenditure than Roux-en-Y Gastric Bypass. PLoS One 2018; 13:e0194538. [PMID: 29617391 PMCID: PMC5884508 DOI: 10.1371/journal.pone.0194538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 03/05/2018] [Indexed: 01/14/2023] Open
Abstract
Objective The greater weight loss achieved following Biliopancreatic Diversion with Duodenal Switch (BPDS) versus Roux-en-Y Gastric Bypass (RYGB) has been attributed to the malabsorptive effects of BPDS. Increased weight loss after BPDS could also be underpinned by larger increases in energy expenditure. Hypothetically, the more radical reconfiguration of the small intestine in BPDS could result in an accentuated increase in meal associated thermogenesis (MAT). Design Female subjects (baseline mean age 40 years, mean BMI-55kg/m2) were assessed four years after randomization to BPDS (n = 6) or RYGB (n = 6). Energy expenditure (EE) and respiratory quotient (RQ) were measured by indirect calorimetry over 24 hours. A detailed protocol allowed for discrimination of basal metabolic rate (BMR), fasting EE and MAT as components of total energy expenditure (TEE) normalised for total and lean tissue by dual-energy x-ray absorptiometry. Results Median weight loss at follow-up was 1.5-fold higher following BPDS relative to RYGB, resulting in respective median BMIs of 29.5 kg/m2 (21.7 to 36.7) after BPDS and 37.8 kg/m2 (34.1 to 45.7) after RYGB (p = 0.015). The BPDS group had a lower fat:lean ratio compared to the RYGB group (p = 0.009). Overall 24-hour TEE adjusted for total tissue was higher in the BPDS group, as were BMR, fasting EE and MAT (all p<0.05). Differences between RYGB and BPDS in BMR and TEE were nullified when normalised for lean mass. Postprandial RQ increased significantly but to a similar extent in both groups. Conclusion Enhanced and prolonged MAT and lower fat:lean mass ratios after BPDS may explain relative increases in total energy expenditure as compared to RYGB.
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Affiliation(s)
- Malin Werling
- Department of Gastrosurgical Research and Education, Sahlgrenska academy, University of Gothenburg, Department of Surgery, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
| | - Lars Fändriks
- Department of Gastrosurgical Research and Education, Sahlgrenska academy, University of Gothenburg, Department of Surgery, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
| | - Torsten Olbers
- Department of Gastrosurgical Research and Education, Sahlgrenska academy, University of Gothenburg, Department of Surgery, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
| | - Tom Mala
- Department of Morbid Obesity and Bariatric Surgery and Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - Jon Kristinsson
- Department of Morbid Obesity and Bariatric Surgery and Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - Kaj Stenlöf
- Gothia Forum, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ville Wallenius
- Department of Gastrosurgical Research and Education, Sahlgrenska academy, University of Gothenburg, Department of Surgery, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
| | - Neil G. Docherty
- Department of Gastrosurgical Research and Education, Sahlgrenska academy, University of Gothenburg, Department of Surgery, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
- * E-mail:
| | - Carel W. le Roux
- Department of Gastrosurgical Research and Education, Sahlgrenska academy, University of Gothenburg, Department of Surgery, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
- Investigative Science, Imperial College London, London, United Kingdom
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Rashti F, Gupta E, Ebrahimi S, Shope TR, Koch TR, Gostout CJ. Development of minimally invasive techniques for management of medically-complicated obesity. World J Gastroenterol 2014; 20:13424-13445. [PMID: 25309074 PMCID: PMC4188895 DOI: 10.3748/wjg.v20.i37.13424] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/15/2014] [Accepted: 07/16/2014] [Indexed: 02/06/2023] Open
Abstract
The field of bariatric surgery has been rapidly growing and evolving over the past several decades. During the period that obesity has become a worldwide epidemic, new interventions have been developed to combat this complex disorder. The development of new laparoscopic and minimally invasive treatments for medically-complicated obesity has made it essential that gastrointestinal physicians obtain a thorough understanding of past developments and possible future directions in bariatrics. New laparoscopic advancements provide patients and practitioners with a variety of options that have an improved safety profile and better efficacy without open, invasive surgery. The mechanisms of weight loss after bariatric surgery are complex and may in part be related to altered release of regulatory peptide hormones from the gut. Endoscopic techniques designed to mimic the effects of bariatric surgery and endolumenal interventions performed entirely through the gastrointestinal tract offer potential advantages. Several of these new techniques have demonstrated promising, preliminary results. We outline herein historical and current trends in the development of bariatric surgery and its transition to safer and more minimally invasive procedures designed to induce weight loss.
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Systematic review on reoperative bariatric surgery: American Society for Metabolic and Bariatric Surgery Revision Task Force. Surg Obes Relat Dis 2014; 10:952-72. [PMID: 24776071 DOI: 10.1016/j.soard.2014.02.014] [Citation(s) in RCA: 239] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 02/09/2014] [Accepted: 02/10/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Reoperative bariatric surgery has become a common practice in many bariatric surgery programs. There is currently little evidence-based guidance regarding specific indications and outcomes for reoperative bariatric surgery. A task force was convened to review the current evidence regarding reoperative bariatric surgery. The aim of the review was to identify procedure-specific indications and outcomes for reoperative procedures. METHODS Literature search was conducted to identify studies reporting indications for and outcomes after reoperative bariatric surgery. Specifically, operations to treat complications, failed weight loss, and weight regain were evaluated. Abstract and manuscript reviews were completed by the task force members to identify, grade, and categorize relevant studies. RESULTS A total of 819 articles were identified in the initial search. After review for inclusion criteria and data quality, 175 articles were included in the systematic review and analysis. The majority of published studies are single center retrospective reviews. The evidence supporting reoperative surgery for acute and chronic complications is described. The evidence regarding reoperative surgery for failed weight loss and weight regain generally demonstrates improved weight loss and co-morbidity reduction after reintervention. Procedure-specific outcomes are described. Complication rates are generally reported to be higher after reoperative surgery compared to primary surgery. CONCLUSION The indications and outcomes for reoperative bariatric surgery are procedure-specific but the current evidence does support additional treatment for persistent obesity, co-morbid disease, and complications.
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Successful orthotopic liver transplantation after biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis 2013; 9:e46-8. [PMID: 23433752 DOI: 10.1016/j.soard.2012.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 12/17/2012] [Accepted: 12/18/2012] [Indexed: 12/25/2022]
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Antanavicius G, Sucandy I. Robotically-assisted laparoscopic biliopancreatic diversion with duodenal switch: the utility of the robotic system in bariatric surgery. J Robot Surg 2012; 7:261-6. [PMID: 27000921 DOI: 10.1007/s11701-012-0372-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 07/14/2012] [Indexed: 12/15/2022]
Abstract
Biliopancreatic diversion with duodenal switch (BPD/DS) is considered the most effective surgical option for morbidly obese patients. Several techniques have been described: open, laparoscopic, and the combination of open and laparoscopic. Only a few centers in the world perform robotically-assisted laparoscopic BPD/DS and the published literature is limited. We describe our experience using this technique as a safe alternative for treatment of morbid obesity. A review of a prospectively maintained database from 2008 to 2011 was conducted. A total of 107 consecutive patients (F:M = 83:24) were included in this series. Average age was 44.76 years (range 20-67), body mass index 49.97 kg/m(2) (range 37-70), and the number of preoperative comorbidities was 6.24 (range 3-11). The mean operative time for a typical BPD/DS with or without an appendectomy was 264 min (range 192-413), which increased to 298 min (range 210-463) when lysis of adhesion or additional procedures were performed. All study cases were completed using a minimally invasive approach. There were no intraoperative or 30-day major postoperative complications. Two patients returned to the operating room: one for endoscopic release of an inadvertently-sutured nasogastric tube during creation of the duodeno-ileal anastomosis and another patient for a port-site infection. Minor postoperative complications included carpal tunnel syndrome exacerbation (n = 1), which did not require surgical intervention. The median length of stay was 3.0 days (range 2-13). Two patients were readmitted within 30 day due to fluid retention and incarcerated umbilical hernia. The percentages of excess body weight loss (EBWL) at 1, 3, 6, 9, 12, and 18 months were 18.9, 36.4, 54.5, 67.4, 73.9, and 82.42 %, respectively. No mortality occurred in this study. Robotically-assisted laparoscopic technique for BPD/DS is a feasible, safe, and effective alternative for weight loss surgery with excellent outcomes.
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Affiliation(s)
- Gintaras Antanavicius
- Department of Surgery, Abington Memorial Hospital, 1200 Old York Road, Abington, PA, 19001, USA
| | - Iswanto Sucandy
- Department of Surgery, Abington Memorial Hospital, 1200 Old York Road, Abington, PA, 19001, USA.
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