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Memon MA, Osland E, Yunus RM, Alam K, Hoque Z, Khan S. Gastroesophageal reflux disease following laparoscopic vertical sleeve gastrectomy and laparoscopic roux-en-Y gastric bypass: meta-analysis and systematic review of 5-year data. Dis Esophagus 2024; 37:doad063. [PMID: 37935430 DOI: 10.1093/dote/doad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/14/2023] [Indexed: 11/09/2023]
Abstract
To compare 5-year gastroesophageal reflux outcomes following Laparoscopic Vertical Sleeve Gastrectomy (LVSG) and Laparoscopic Roux-en-Y gastric bypass (LRYGB) based on high quality randomized controlled trials (RCTs). We conducted a sub-analysis of our systematic review and meta-analysis of RCTs of primary LVSG and LRYGB procedures in adults for 5-year post-operative complications (PROSPERO CRD42018112054). Electronic databases were searched from January 2015 to July 2021 for publications meeting inclusion criteria. The Hartung-Knapp-Sidik-Jonkman random effects model was utilized to estimate weighted mean differences where meta-analysis was possible. Bias and certainty of evidence was assessed using the Cochrane Risk of Bias Tool 2 and GRADE. Four RCTs were included (LVSG n = 266, LRYGB n = 259). An increase in adverse GERD outcomes were observed at 5 years postoperatively in LVSG compared to LRYGB in all outcomes considered: Overall worsened GERD, including the development de novo GERD, occurred more commonly following LVSG compared to LRYGB (OR 5.34, 95% CI 1.67 to 17.05; p = 0.02; I2 = 0%; (Moderate level of certainty); Reoperations to treat severe GERD (OR 7.22, 95% CI 0.82 to 63.63; p = 0.06; I2 = 0%; High level of certainty) and non-surgical management for worsened GERD (OR 3.42, 95% CI 1.16 to 10.05; p = 0.04; I2 = 0%; Low level of certainty) was more common in LVSG patients. LVSG is associated with the development and worsening of GERD symptoms compared to LRYGB at 5 years postoperatively leading to either introduction/increased pharmacological requirement or further surgical treatment. Appropriate patient/surgical selection is critical to minimize these postoperative risks.
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Affiliation(s)
- Muhammed A Memon
- School of Mathematics, Physics and Computing and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
- Sunnybank Obesity Centre & South & East Queensland Surgery (SEQS), McCullough Centre, Suite 9, 259 McCullough Street, Sunnybank, QLD, Australia
- Mayne Medical School, School of Medicine, University of Queensland, Brisbane, QLD, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
- Faculty of Health and Social Science, Bolton University, Bolton, Lancashire, UK
| | - Emma Osland
- Department of Dietetics and Food Services, Royal Brisbane and Women's Hospital, Herston, QLD 4019, Australia
- Department of Human Movements and Nutrition, University of Queensland, Brisbane, QLD, Australia
| | - Rossita M Yunus
- Institute of Mathematical Sciences, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Khorshed Alam
- School of Business, and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD 4350, Australia
| | - Zahirul Hoque
- School of Mathematics, Physics and Computing, University of Sourthern Queensland, Toowoomba, QLD, Australia
| | - Shahjahan Khan
- School of Mathematics, Physics and Computing and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
- School of Science and Engineering, Asian University of Bangladesh, Dhaka, Bangladesh
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Sleeve gastrectomy morphology and long-term weight-loss and gastroesophageal reflux disease outcomes. Surg Endosc 2023:10.1007/s00464-022-09555-6. [PMID: 36645483 DOI: 10.1007/s00464-022-09555-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/08/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND The relationship between sleeve gastrectomy (SG) morphology and long-term weight-loss and gastroesophageal reflux disease (GERD) outcomes is unknown. METHODS All patients (n = 268) undergoing SG performed by 3 surgeons at a single academic institution from January 1, 2010 to December 31, 2012 were included. Long-term weight-loss and GERD outcomes were available for 90 patients which were incorporated in analyses. SG morphology was determined from postoperative day 1 upper gastrointestinal series (UGIS) available from 50 patients. Images were independently categorized using previously published methodology as Dumbbell (38%), Lower Pouch (22%), Tubular (26%), or Upper Pouch (14%) by Radiologist and Surgeon. Radiologist categorization was used when disagreement occurred (8%). Univariable analyses were conducted to explore potential associations between SG morphology, weight loss, and GERD outcomes. RESULTS Follow-up was 8.2 ± 0.9 years. Population characteristics included age of 45.1 ± 10.8 years, female sex in 83.3%, and hiatal hernia repair (HHR) performed at index SG in 17.8%. Surgeons did not preferentially achieve a specific SG morphology. Changes from preoperative obesity and associated diseases comprised body mass index (BMI) (49.5 ± 7.6 vs. 39.2 ± 9.4 kg/m2; p < 0.0001), diabetes mellitus (30.0 vs. 12.2%; p = 0.0006), hypertension (70.0 vs. 54.4%; p = 0.0028), hyperlipidemia (42.2 vs. 24.2%;p = 0.0017), obstructive sleep apnea (41.1 vs. 15.6%; p < 0.0001), osteoarthritis (48.9 vs. 13.3%; p < 0.0001), back pain (46.5 vs. 28.9%; p = 0.0035), and medications (4.8 ± 3.3 vs. 3.7 ± 3.5; p < 0.0001). Dumbbell SG morphology was associated with lesser reduction in BMI at follow-up (--6.8 ± 7.2 vs. -12.4 ± 8.3 kg/m2; p = 0.0196) while greater BMI change was appreciated with Lower Pouch SG shape (-16.9 ± 9.9 vs. -8.4 ± 6.8 kg/m2; p = 0.0017). GERD was more prevalent at follow-up than baseline (67.8 vs. 47.8%; p < 0.0001). GERD-specific outcomes included de novo (51.1%), persistent (27.9%), worsened (58.1%), and resolved (14.0%) disease. Ten patients underwent reoperation for refractory GERD with SG morphology corresponding to Dumbbell (n = 5) and Upper Pouch (n = 1) for those with available UGIS. Univariable analyses showed that patients with GERD experienced a larger reduction in BMI compared with patients without GERD (-11.8 ± 7.7 vs. -7.0 ± 5.1 kg/m2; p = 0.0007). Patient age, surgeon, morphology category, and whether a HHR was done at index SG were not associated with the presence of any, de novo, or worsened GERD. Female sex was associated with worsened GERD (96.0 vs. 4.0%; p = 0.0455). Type of calibration device, distance from staple line to pylorus, and whether staple line reinforcement was used were not associated with SG morphology classification. CONCLUSION This is the first study assessing the impact of SG morphology on long-term weight loss and GERD. Our data suggest an association between SG morphology and long-term weight loss but not with GERD outcomes. Current technical standards may be limited in reproducing the same SG morphology. This information may help guide the technical optimization and standardization of SG. Surgeons did not favor a specific SG morphology (1). Our results signal to a relationship between radiographic assessment of SG morphology and long-term weight-loss outcomes with Dumbbell classification correlated with lesser reduction in BMI (2a) and Lower Pouch morphology associated with superior weight loss (2b). SG, sleeve gastrectomy; BMI, body mass index.
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Misra S, Balasubramanian S, Srikanth B, Kumar S, Christinajoice S, Nandhini D, Raj PP. Is there a role for upper gastrointestinal contrast study to predict the outcomes of sleeve gastrectomy? Lessons learnt from a prospective study. J Minim Access Surg 2022; 18:97-104. [PMID: 35017399 PMCID: PMC8830558 DOI: 10.4103/jmas.jmas_186_20] [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] [Indexed: 11/29/2022] Open
Abstract
Context: The importance of upper gastrointestinal (UGI) contrast study following sleeve gastrectomy (SG) is equivocal. It can, however, yield anatomical and functional details, the significance of which mostly remains unknown. Settings and Design: This prospective, single-center study included SG patients between January 2018 and January 2019. Materials and Methods: UGI contrast study was done on post-operative day 1. The findings of the study namely gastroesophageal junction (GEJ) holdup time, presence of fundus, gastroduodenal emptying (GDE) time, and sleeve shape were compared with weight loss, improvement of glycosylated hemoglobin (HbA1c) and gastroesophageal reflux disease (GERD) symptoms at 3, 6, and 12 months follow-up. Results: There were 138 patients with 100% follow-up. Radiological sleeve patterns observed were: tubular (62.3%), superior (16.0%), and inferior (21.7%) pouches. GEJ holdup time had no effect on percentage total weight loss (%TWL) (P = 0.09) or HbA1c improvement (P = 0.077). The absence of fundus led to greater %TWL at 6 months (P = 0.048). GDE time <15 s led to higher %TWL (P = 0.028) and lower HbA1c (P = 0.010) at 12 months. Antrum size <2 cm was associated with higher %TWL (P = 0.022) and lower HbA1c level (P = 0.047) at 12 months. Vomiting and regurgitation were common with tubular sleeves. Conclusion: UGI contrast study can predict weight loss, HbA1c improvement, and GERD symptoms. The absence of fundus, small antrum, and rapid GDE are associated with better weight loss. HbA1c improvement is better with small antrum and rapid GDE. Tubular sleeve predisposes to vomiting and regurgitation.
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Affiliation(s)
- Shivanshu Misra
- Department of Bariatric and Metabolic Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - Shankar Balasubramanian
- Department of Bariatric and Metabolic Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - B Srikanth
- Department of Radiodiagnosis, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - Saravana Kumar
- Department of Bariatric and Metabolic Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - S Christinajoice
- Department of Bariatric and Metabolic Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - Deepa Nandhini
- Department of Bariatric and Metabolic Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - P Praveen Raj
- Department of Bariatric and Metabolic Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
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Gjeorgjievski M, Imam Z, Cappell MS, Jamil LH, Kahaleh M. A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks. J Clin Gastroenterol 2021; 55:551-576. [PMID: 33234879 DOI: 10.1097/mcg.0000000000001451] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bariatric surgery leaks result in significant morbidity and mortality. Experts report variable therapeutic approaches, without uniform guidelines or consensus. OBJECTIVE To review the pathogenesis, risk factors, prevention, and treatment of gastric sleeve leaks, with a focus on endoscopic approaches. In addition, the efficacy and success rates of different treatment modalities are assessed. DESIGN A comprehensive review was conducted using a thorough literature search of 5 online electronic databases (PubMed, PubMed Central, Cochrane, EMBASE, and Web of Science) from the time of their inception through March 2020. Studies evaluating gastric sleeve leaks were included. MeSH terms related to "endoscopic," "leak," "sleeve," "gastrectomy," "anastomotic," and "bariatric" were applied to a highly sensitive search strategy. The main outcomes were epidemiology, pathophysiology, diagnosis, treatment, and outcomes. RESULTS Literature search yielded 2418 studies of which 438 were incorporated into the review. Shock and peritonitis necessitate early surgical intervention for leaks. Endoscopic therapies in acute and early leaks involve modalities with a focus on one of: (i) defect closure, (ii) wall diversion, or (iii) wall exclusion. Surgical revision is required if endoscopic therapies fail to control leaks after 6 months. Chronic leaks require one or more endoscopic, radiologic, or surgical approaches for fluid collection drainage to facilitate adequate healing. Success rates depend on provider and center expertise. CONCLUSION Endoscopic management of leaks post sleeve gastrectomy is a minimally invasive and effective alternative to surgery. Their effect may vary based on clinical presentation, timing or leak morphology, and should be tailored to the appropriate endoscopic modality of treatment.
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Affiliation(s)
- Mihajlo Gjeorgjievski
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical Center, New Brunswick, NJ
| | - Zaid Imam
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Mitchell S Cappell
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Laith H Jamil
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Michel Kahaleh
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical Center, New Brunswick, NJ
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Imaging after laparoscopic sleeve gastrectomy - literature review with practical recommendations. Pol J Radiol 2021; 86:e325-e334. [PMID: 34136051 PMCID: PMC8186309 DOI: 10.5114/pjr.2021.106795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/06/2020] [Indexed: 11/17/2022] Open
Abstract
In the XXI century obesity has become one of the most demanding epidemiological threats worldwide. At the same time, bariatric surgery has established itself as an effective treatment for morbidly obese patients, with laparoscopic sleeve gastrectomy (LSG) emerging as the most popular bariatric procedure. This paper reviews the role of imaging studies of patients after LSG. Computed tomography is widely considered as the method of choice in detection of complications in early postoperative period. The dynamic character of upper gastrointestinal examination allows for the assessment of passage through the gastric remnant. The paper also discusses evaluation of the shape and volume of the gastric remnant assessed by imaging studies.
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Borbély Y, Schaffner E, Zimmermann L, Huguenin M, Plitzko G, Nett P, Kröll D. De novo gastroesophageal reflux disease after sleeve gastrectomy: role of preoperative silent reflux. Surg Endosc 2018; 33:789-793. [PMID: 30003346 DOI: 10.1007/s00464-018-6344-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/06/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has become the most frequently performed bariatric procedure to date. However, LSG is known to worsen pre-operative and result in de novo gastroesophageal reflux disease (GERD). Pre-operative evaluation reveals a high percentage of silent GERD of so far unknown influence on post-operative GERD. METHODS Prospective data of patients undergoing primary LSG between 01/2012 and 12/2015 were evaluated. Pre-operative GERD-specific evaluation consisted of validated questionnaires, upper endoscopy, 24 h-pH-manometry, and esophagograms. Patients were followed-up with questionnaires every 6 months, upper endoscopies after 1 year and 24 h-pH-metry after 2 years. Silent GERD was defined as esophagitis grade > B and/or abnormal esophageal acid exposure in absence of symptoms. LSG was performed over a 32F bougie, hiatal hernias > 1 cm were addressed with posterior hiatoplasty. Excluded were patients with hiatal hernias > 4 cm, patients with incorrect anatomy (stenosis, fundus too large) and conversion to RYGB for early leaks. RESULTS 222 patients were included. Mean follow-up was 32 ± 16 months, mean preoperative body mass index 49.6 ± 7.2 kg/m2. 116 patients (52%) presented with post-operative GERD-symptoms, of which 85 (73%) had de novo symptoms. Of those, 48 (of 85, 56%) had no preoperative GERD and 37 (of 85, 44%) silent GERD. 57 patients (26%) had neither pre- nor post-operative GERD, 7 (3%) had silent pre-operative and no postop GERD, and in 19 patients (9%) GERD was cured with LSG. 31 patients (14%) stayed symptomatic. Of 56 patients (25%) with pre-operative silent GERD, 37 (of 54, 66%) became symptomatic. CONCLUSION LSG leads to a considerable rate of post-operative GERD. De novo-GERD consist of around half of pre-operative silent GERD and completely de novo-GERD. Most patients with pre-operative silent GERD became symptomatic.
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Affiliation(s)
- Yves Borbély
- Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
| | - Esther Schaffner
- Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Lara Zimmermann
- Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Michael Huguenin
- Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Gabriel Plitzko
- Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Philipp Nett
- Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Dino Kröll
- Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
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Alban EAD, García CA, Ospina LM, Munevar HE. Imaging after Bariatric Surgery: When Interpretation Is a Challenge, from Normal to Abnormal. Obes Surg 2018; 28:2923-2931. [DOI: 10.1007/s11695-018-3334-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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An Algorithmic Approach to the Management of Gastric Stenosis Following Laparoscopic Sleeve Gastrectomy. Obes Surg 2018; 27:2628-2636. [PMID: 28470488 DOI: 10.1007/s11695-017-2689-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gastric stenosis (GS) is a potential adverse event post-laparoscopic sleeve gastrectomy (LSG). Endoscopic management is preferred; however, there is significant variation in therapeutic strategies with no defined algorithm. This study aims to describe the safety and efficacy of a predefined step-wise algorithm for endoscopic management of GS post-LSG. METHODS Consecutive patients with symptomatic GS post-LSG, presenting between July 2015 and August 2016, were subjected to a predefined treatment algorithm of serial dilations using achalasia balloons, followed by a fully covered self-expanding metal stent (FCSEMS) if dilations were inadequate. Patients who did not respond or opted out of ongoing endoscopic therapy were offered revision Roux-en-Y gastric bypass (RYGB). RESULTS Total of 17 patients underwent a median of 2 (range 1-4) balloon dilations. Twelve patients (70.6%) reported clinical improvement with balloon dilation alone, while 3 (17.6%) required subsequent FCSEMS placement. One patient suffered a tear to the muscularis propria with balloon dilation, which was managed conservatively. Overall, 15 (88.2%) reported clinical improvement with endoscopic management. PAGI-SYM scores revealed that the strongest response to therapy, based on mean reduction of score ± SD, was in the following items: nausea (3 ± 1.9, P < 0.001), heartburn during day (2.8 ± 1.5, P = 0.003), heartburn on lying down (3.4 ± 1.4, P < 0.001), reflux during day (2.8 ± 1.9, P < 0.001), and reflux on lying down (3.0 ± 1.9, P < 0.001). Two (11.8%) patients failed endoscopic therapy and underwent RYGB. CONCLUSIONS Endoscopic management of GS using the described algorithmic approach is safe and effective post-LSG. Patients with severe stenosis or helical stenosis are likely to require revision RYGB.
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Zidan S, Tantawy HI, Wafdy Algebally AM. MDCT as the modality of choice in diagnosis of postoperative complications after laparoscopic sleeve gastrectomy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Delhom E, Nougaret S, Nocca D, Skali M, Pierredon MA, Guiu B, Gallix B. Routine postoperative upper gastrointestinal fluoroscopy after laparoscopic sleeve gastrectomy: Is there still a utility? Diagn Interv Imaging 2015; 96:947-51. [PMID: 25686774 DOI: 10.1016/j.diii.2014.11.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 03/17/2014] [Accepted: 11/20/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess the performance of routine esophagogastric transit studies (OGT) performed between day 2 (D2) and day 4 (D4) following sleeve gastrectomy for the diagnosis of gastric fistula. PATIENTS AND METHODS Single center study including 736 patients undergoing surgery for sleeve gastrectomy including 32 of whom developed gastric fistula. Seven hundred and twenty OGT on D2 and 86 abdominal and pelvic CT scans were performed to investigate for a fistula and whether or not a blood collection was present. Sensitivity, specificity, positive and negative predictive values, Youden index (YI) and dosimetry were calculated for both investigations. RESULTS The sensitivity and specificity of OGT for the diagnosis of fistula were 7% and 98% respectively with a PPV of 18%, an NPV of 96% and YI of 0.06. The mean DSP was 5500μGy.m(2). Sensitivity, specificity, positive and negative predictive values and Youden index for CT were 55%, 100%, 100%, 81%, 0.55, respectively for the presence of a fistula; and 96%, 86%, 78%, 98%, 0.83 for the presence of a non-blood collection and; 100%, 86%, 78%, 100%, 0.86 for the presence of a non-blood collection and/or fistula. The mean DLP was 3700 mGy.cm. CONCLUSION Because of its very poor sensitivity for the diagnosis of gastric fistula, the OGT on D2 needs to be reconsidered. CT performed on clinical suspicion appears to be a better diagnostic tool.
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Affiliation(s)
- E Delhom
- Department of medical imaging, Saint-Éloi, Montpellier university hospital, 80, avenue Augustin-Fliche, 34000 Montpellier, France.
| | - S Nougaret
- Department of medical imaging, Saint-Éloi, Montpellier university hospital, 80, avenue Augustin-Fliche, 34000 Montpellier, France
| | - D Nocca
- Department of gastrointestinal surgery A, Saint-Éloi, Montpellier university hospital, 80, avenue Augustin-Fliche, 34000 Montpellier, France
| | - M Skali
- Department of gastrointestinal surgery A, Saint-Éloi, Montpellier university hospital, 80, avenue Augustin-Fliche, 34000 Montpellier, France
| | - M-A Pierredon
- Department of medical imaging, Saint-Éloi, Montpellier university hospital, 80, avenue Augustin-Fliche, 34000 Montpellier, France
| | - B Guiu
- Department of medical imaging, Saint-Éloi, Montpellier university hospital, 80, avenue Augustin-Fliche, 34000 Montpellier, France
| | - B Gallix
- Department of medical imaging, Saint-Éloi, Montpellier university hospital, 80, avenue Augustin-Fliche, 34000 Montpellier, France; MUHC, department of medical imaging, Mc Gill university, Montpellier, Canada
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Ni Mhuircheartaigh J, Abedin S, Bennett AE, Tyagi G. Imaging Features of Bariatric Surgery and Its Complications. Semin Ultrasound CT MR 2013; 34:311-24. [DOI: 10.1053/j.sult.2013.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Laparoscopic sleeve gastrectomy: imaging of normal anatomic features and postoperative gastrointestinal complications. Diagn Interv Imaging 2013; 94:823-34. [PMID: 23707144 DOI: 10.1016/j.diii.2013.03.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Morbid obesity is a public health problem in the United States and Europe and its prevalence is on the increase. Despite certain progress the efficacy of medical treatment remains limited. Bariatric surgery has consequently become an effective alternative for patients with morbid obesity. The bariatric operations most frequently performed are laparoscopic adjustable gastric banding (LAGB) and Roux-en-Y gastric bypass (LGB), but laparoscopic sleeve gastrectomy (LSG) is increasingly popular with both bariatric surgeons and patients due to its simplicity, rapidity and decreased morbidity. The purpose of this pictorial essay is to familiarize radiologists with the normal postoperative anatomic features and the imaging findings of postoperative gastrointestinal complications of laparoscopic sleeve gastrectomy because little literature exists on this subject.
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Usefulness of X-Ray in the Detection of Complications and Side Effects After Laparoscopic Sleeve Gastrectomy. Obes Surg 2013; 23:456-9. [DOI: 10.1007/s11695-012-0799-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Farías C, Fernández JI, Ovalle C, Cabrera C, de la Maza J, Kosiel K, Molina AM. Transumbilical Sleeve Gastrectomy with an Accessory Lateral Port: Surgical Results in 237 Patients and 1-Year Follow-up. Obes Surg 2012; 23:325-31. [DOI: 10.1007/s11695-012-0812-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Parikh A, Alley JB, Peterson RM, Harnisch MC, Pfluke JM, Tapper DM, Fenton SJ. Management options for symptomatic stenosis after laparoscopic vertical sleeve gastrectomy in the morbidly obese. Surg Endosc 2011; 26:738-46. [PMID: 22044967 DOI: 10.1007/s00464-011-1945-1] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 08/31/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND This study aimed to determine the incidence, etiology, and management options for symptomatic stenosis (SS) after laparoscopic sleeve gastrectomy (LSG). METHODS A retrospective study reviewed morbidly obese patients who underwent LSG between October 2008 and December 2010 to identify patients treated for SS. RESULTS In this study, 230 patients (83% female) with a mean age of 49.5 years and a mean body mass index (BMI) of 43 kg/m(2) underwent LSG. In 3.5% of these patients (100% female; mean age, 42 years; mean BMI, 42.6 kg/m(2)), SS developed. The LSG procedure was performed using a 36-Fr. bougie and tissue-reinforced staplers. Four patients had segmental staple-line imbrication, and seven patients underwent contrast study, with 71.4% demonstrating a fixed narrowing. Endoscopy confirmed short-segment stenoses: seven located at mid-body and one located near the gastroesophageal junction. Endoscopic management was 100% successful. The mean number of dilations was 1.6, and the median balloon size was 15 mm. The mean time from surgery to initial endoscopic intervention was 48.8 days, and the mean time from the first dilation to toleration of a solid diet was 49.6 days. Two patients were referred to our institution after undergoing LSG at another facility. The mean time to the transfer was 28.5 days. The two patients had a mean age of 35 years and a mean BMI of 42.3 kg/m(2). Both patients experienced immediate SS after perioperative complications comprising one staple-line hematoma and one leak. Contrast studies demonstrated minimal passage of contrast through a long-segment stenosis. Both patients underwent multiple endoscopic dilation procedures and endoluminal stenting, ultimately requiring laparoscopic conversion to Roux-en-Y gastric bypass. The mean time from the initial surgery to the surgical revision was 77 days, and the mean time after the first intervention to tolerance of a solid diet was 82 days. CONCLUSION Symptomatic short-segment stenoses after LSG may be treated successfully with endoscopic balloon dilation. Long-segment stenoses that do not respond to endoscopic techniques may ultimately require conversion to Roux-en-Y gastric bypass.
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Affiliation(s)
- Amit Parikh
- Department of Surgery, University of Texas Health Sciences Center at San Antonio, Mail Code 7842, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
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16
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Tutuian R. Obesity and GERD: pathophysiology and effect of bariatric surgery. Curr Gastroenterol Rep 2011; 13:205-12. [PMID: 21424733 DOI: 10.1007/s11894-011-0191-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Epidemiologic, endoscopic, and pathophysiologic studies document the relationship between obesity and gastroesophageal reflux disease (GERD). Increased body mass index and accumulation of visceral fat are associated with a two- to threefold increased risk of developing reflux symptoms and esophageal lesions. Given this association, many studies were designed to evaluate the outcome of reflux symptoms following conventional and surgical treatment of obesity. Among bariatric procedures, gastric sleeve and banded gastroplasty were shown to have no effect or even worsen reflux symptoms in the postoperative setting. Gastric banding improves reflux symptoms and findings (endoscopic and pH-measured distal esophageal acid exposure) in many patients, but is associated with de novo reflux symptoms or lesions in a considerable proportion of patients. To date, Roux-en-Y gastric bypass is the most effective bariatric procedure that consistently leads to weight reduction and improvement of GERD symptoms in patients undergoing direct gastric bypass and among those converted from restrictive bariatric procedures to gastric bypass.
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Affiliation(s)
- Radu Tutuian
- Division of Gastroenterology, University Clinics of Visceral Surgery and Medicine, Bern University Hospital, Inselspital Bern, Bern, Switzerland.
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17
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Triantafyllidis G, Lazoura O, Sioka E, Tzovaras G, Antoniou A, Vassiou K, Zacharoulis D. Anatomy and complications following laparoscopic sleeve gastrectomy: radiological evaluation and imaging pitfalls. Obes Surg 2011; 21:473-8. [PMID: 20652760 DOI: 10.1007/s11695-010-0236-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND To evaluate the post-operative gastric anatomy depicted by upper gastrointestinal gastrografin swallow studies (UGI) and report radiological work-up and management of complications following laparoscopic sleeve gastrectomy (LSG). METHODS The study included 85 consecutive patients who underwent LSG for the treatment of morbid obesity. In all patients, a UGI was routinely performed on POD 3 to exclude early complications. In patients with suspected complications, further radiological evaluation with computed tomography (CT) was performed. The anatomy of the gastric remnant depicted by UGI was retrospectively evaluated in all patients. RESULTS The patterns of the gastric remnant identified were the tubular (65.9%), the superior pouch (25.9%), and the inferior pouch pattern (8.2%). Three patients had small superior pouches that resembled leaks, and the diagnosis was based on clinical symptoms. Post-operative complications were observed in 12.9% and included leaks (3.5%), hemorrhages (3.5%), strictures (2.3%), pulmonary embolism (1.2%), trocar site hernia (1.2%), and hematoma of the rectus abdominal muscle (1.2%). No mortality was noted. CONCLUSIONS Post-operative radiological evaluation by UGI and CT is important for diagnosis and management of complications following LSG. Familiarity with the anatomy of the gastric remnant at UGI is essential for correct image interpretation.
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Affiliation(s)
- George Triantafyllidis
- Department of Radiology, University Hospital of Larissa, University of Thessalia, Larissa, Greece
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18
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Lazoura O, Zacharoulis D, Triantafyllidis G, Fanariotis M, Sioka E, Papamargaritis D, Tzovaras G. Symptoms of gastroesophageal reflux following laparoscopic sleeve gastrectomy are related to the final shape of the sleeve as depicted by radiology. Obes Surg 2011; 21:295-9. [PMID: 21165778 DOI: 10.1007/s11695-010-0339-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is gaining popularity as a primary procedure in selected morbidly obese patients. Like most other bariatric procedures LSG results in alterations of the upper GI anatomy that might affect gastroesophageal reflux postoperatively. The study was conducted to assess the presence of reflux symptoms in patients before and after laparoscopic sleeve gastrectomy and any possible relation of these symptoms to the postoperative gastric anatomy as depicted by gastrografin swallow studies. METHODS The study included 85 consecutive morbidly obese patients who underwent LSG as a primary bariatric procedure. Patients were evaluated for symptoms of gastroesophageal reflux (heartburn, regurgitation, and vomiting) preoperatively and at 1 and 6 months and 1 year postoperatively. To assess the postoperative gastric anatomy, the gastrografin studies that were routinely performed in all patients on the third postoperative day were retrospectively evaluated. Changes of each one of the reflux symptoms were assessed in relation to the radiological pattern of the gastric sleeve. RESULTS Three radiological patterns of the gastric sleeve were identified: (a) the tubular (65.9%), (b) the superior pouch (25.9%), and (c) the inferior pouch pattern (8.2%). Patients showed an overall tendency towards relief of heartburn and increase of regurgitation and vomiting postoperatively. However, only changes in regurgitation and vomiting were found to be statistically significant (p < 0.01); interestingly, those were observed in patients with the tubular gastric pattern. CONCLUSIONS The final shape of the gastric sleeve as depicted by radiological studies seems to have an impact on reflux symptoms after laparoscopic sleeve gastrectomy.
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Affiliation(s)
- Olga Lazoura
- Department of Radiology, University Hospital of Larissa, Larissa, Greece
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19
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Katz DP, Lee SR, Nachiappan AC, Willis MH, Bray CD, Farinas CA, Whigham CJ, Spiegel F. Laparoscopic sleeve gastrectomy: a guide to postoperative anatomy and complications. ACTA ACUST UNITED AC 2011; 36:363-71. [DOI: 10.1007/s00261-011-9742-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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