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Gadiot RPM, Biter LU, Feskens PG, Dunkelgrun M, Apers JA, 't Hof GV, Mannaerts GHH. Long-term Outcome of the Dutch Common Channel Trial (DUCATI): Preservation of Superior Weight Loss Results Without Significant Malnutrition Side Effects. Obes Surg 2024:10.1007/s11695-024-07424-w. [PMID: 39356397 DOI: 10.1007/s11695-024-07424-w] [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: 03/14/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 10/03/2024]
Abstract
PURPOSE The optimal bowel limb lengths for laparoscopic Roux-en-Y gastric bypass (LRYGB) to maximize weight loss while minimizing nutritional deficiencies in severe obesity treatment remain a topic of debate. The multi-center Dutch Common Channel Trial (DUCATI) aims to compare the outcomes of a very long Roux Limb Roux-en-Y gastric bypass (VLRL-LRYGB) with a standard Roux-en-Y gastric bypass (S-LRYGB). METHODS A total of 444 patients were randomly assigned in a 1:1, double-blind manner to undergo either VLRL-RYGB or S-LRYGB. Five-year follow-up data were assessed, concentrating on weight loss, obesity-related medical conditions, complications, re-operations, and malnutrition. RESULTS Both groups had comparable total alimentary lengths (RL + CC). The VLRL-LRYGB group demonstrated significantly greater %TWL (32.2% vs. 28.6%, p = 0.002) and %EWL (81.2% vs. 70.3%, p = 0.002) at 5 years. Eight (3.6%) patients in the VLRL-LRYGB group versus 2 (0.9%) in the S-LRYGB group (p = 0.055) needed modification surgery for malabsorption. Suboptimal clinical response rate was significantly higher (22.0% vs. 8.3%) in S-LRYGB group. No significant differences for nutrient deficiencies in favor of the S-LRYGB group were found. CONCLUSION A 100-cm common channel with a relatively long Roux limb provides superior, sustainable weight loss over 5 years, without significantly increased rate of malabsorption-related re-operations. These results suggest that a longer Roux limb can still ensure adequate micronutrient uptake in the total alimentary tract. These findings should be considered in discussions regarding the optimal Roux-en-Y limb length for severe obesity treatment.
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Affiliation(s)
- Ralph P M Gadiot
- Department of Surgery, Fundashon Mariadal, Kaya Soeur Bartola 2, Kralendijk, Bonaire, the Netherlands.
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
| | - L Ulas Biter
- Department of Surgery, Tulp Medisch Centrum, Zwijndrecht, The Netherlands
| | - Pierre G Feskens
- Department of Bariatric Surgery, Bravis Hospital, Bariatric Center South-West Netherlands, Bergen Op Zoom, the Netherlands
| | - Martin Dunkelgrun
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Jan A Apers
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Gerhard van 't Hof
- Department of Bariatric Surgery, Bravis Hospital, Bariatric Center South-West Netherlands, Bergen Op Zoom, the Netherlands
| | - Guido H H Mannaerts
- Department of Surgery, Al Ain Abu Dhabi, Mediclinic, United Arab Emirates
- Department of Surgery, Gulf Specialized Hospital, Muscat, Oman
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Zayed MF, Awis RR. A Comparison of the Health Benefits of Customized Multivitamins and Standard Supplementation Post-bariatric Surgery: A Systematic Review. Cureus 2024; 16:e63253. [PMID: 39070472 PMCID: PMC11282354 DOI: 10.7759/cureus.63253] [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] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
Rates of obesity increase worldwide year after year. This review explored if customized multivitamins (CMV) resulted in less micronutrient deficiency and higher serum levels of vitamins and minerals when compared to standard multivitamins (SMV) post-bariatric surgery in adults. Vitamins investigated were vitamins B1, B6, B12, D, parathyroid hormone (PTH), calcium, iron, hemoglobin, ferritin, folic acid, zinc, and magnesium. In Roux-en-Y gastric bypass (RYGB) patients weight loss surgeries (WLS) Forte or chewable CMV were studied, while in sleeve gastrectomy (SG) patients, WLS Optimum 1.0 (Opt. 1.0) or WLS Optimum 2.0 (Opt. 2.0) multivitamins were studied. An electronic search was performed on three databases (PubMed (n=28), Embase (n=120), and Cochrane (n=106)) to identify clinical trials and cohort studies. The inclusion criteria focused on studies since 2011 for adults ≥18 years old post-GB and SG. The keywords included bypass, sleeve, WLS, and multivitamins. Four clinical trials and three cohort studies were included. Jadad Scale was used to assess the quality and the bias risk in the clinical trials and the Newcastle-Ottawa scale (NOS) was used for the cohort studies. The PICO model and PRISMA rules were followed, where the outcomes targeted certain vitamin serum levels and the levels of deficiencies. The results of WLS Forte were better than SMV. The chewable CMV and Opt. 1.0 results were comparable to SMV. Opt. 2.0 was slightly better than Opt. 1.0. Further modifications would enhance the CMV presented in this systemic review. SMV would still be recommended until CMV are modified and tested. Multi-center trials that monitor the effect of the modified CMV on the serum levels of vitamins and minerals in the longer term in different wider populations are needed.
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Affiliation(s)
- Mohamed F Zayed
- Pharmaceutical Sciences, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Rana R Awis
- Clinical Nutrition, University of Nottingham, Nottingham, GBR
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Chalmers KA, Cousins SE, Blazeby JM. Randomized controlled trials comparing gastric bypass, gastric band, and sleeve gastrectomy: A systematic review examining validity and applicability to wider clinical practice. Obes Rev 2024; 25:e13718. [PMID: 38346786 DOI: 10.1111/obr.13718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 01/17/2024] [Accepted: 01/17/2024] [Indexed: 04/18/2024]
Abstract
Consideration of how applicable the results of surgical trials are to clinical practice is important to inform decision-making. Randomized controlled trials comparing at least two surgical interventions (of gastric bypass, gastric band, and sleeve gastrectomy) for severe and complex obesity were examined using the PRagmatic Explanatory Continuum Indicator Summary-2 tool, to consider how applicable the trial results are to clinical practice, and the Risk of Bias 2 tool, to examine validity. MEDLINE, Embase, and CENTRAL databases were searched for studies published between November 2013 and June 2021, and 15 were identified. Using the PRagmatic Explanatory Continuum Indicator Summary-2 tool, three were classified as pragmatic, with good applicability to clinical practice. Ten had more explanatory domains but did include some pragmatic characteristics, and two were predominantly explanatory. This was due to some trial design features that would not be considered applicable to the wider clinical setting, including being single-centered, having prescribed intervention delivery methods, and intensive follow-up regimens. Only two trials had low risk of bias, of which one was considered pragmatic. Three had high risk of bias. Overall, few trials in bariatric surgery are pragmatic with low risk of bias. Well-designed pragmatic trials are needed to inform practice and reduce research waste.
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Affiliation(s)
- Katy A Chalmers
- National Institute of Health and Care Research (NIHR) Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Surgical Innovation Theme and the Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Sian E Cousins
- National Institute of Health and Care Research (NIHR) Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Surgical Innovation Theme and the Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Jane M Blazeby
- National Institute of Health and Care Research (NIHR) Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Surgical Innovation Theme and the Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
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Gao Z, Liang Y, Huang S, Wu Z, Li M, Yang J. Prevalence and associated factors of vitamin D deficiency after Roux-en-Y gastric bypass: a systematic review and meta-analysis. Int J Surg 2023; 109:4273-4285. [PMID: 37738003 PMCID: PMC10720807 DOI: 10.1097/js9.0000000000000732] [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: 05/08/2023] [Accepted: 08/19/2023] [Indexed: 09/23/2023]
Abstract
OBJECTS To estimate the prevalence and associated factors of vitamin D deficiency (VDD) after Roux-en-Y gastric bypass (RYGB). METHODS PubMed, EMBASE, and CENTRAL were searched for relevant records from inception to 17 March 2023, using search terms: vitamin D, vitamin D3, vitamin D deficiency, hypovitaminosis D, gastric bypass, and RYGB. Studies were eligible for inclusion if they provided related data on VDD prevalence after RYGB. RESULTS Of the 1119 screened studies, 72 studies involving 7688 individuals were enrolled in the final analysis. The prevalence estimates of VDD after RYGB were 42%. Subgroup analyses suggested the pooled prevalence of postoperative VDD was 35% for follow-up duration less than or equal to 1 year, 43% for greater than 1 and less than or equal to 5 years, and 54% for greater than 5 years. Meta-regression showed that VDD prevalence was positively correlated with follow-up time. Also, the prevalence was higher in studies with inadequate vitamin D supplementation than in those with adequate supplementation and in Asia population than in those from South America, Europe, and North America. Other factors associated with high VDD prevalence after RYGB included high presurgical VDD prevalence, noncompliant patients, and black populations. No significant association existed between VDD and alimentary length. CONCLUSION VDD presented a high prevalence in patients following RYGB. It occurred more frequently with longer postoperative follow-up time. Population-specific vitamin D supplementation measures, targeted treatment for presurgical VDD, improved patient compliance, and periodical follow-ups were necessary to reduce VDD and other adverse outcomes.
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Affiliation(s)
| | - Yuzhi Liang
- Department of medical imaging, Dongguan Songshan Lake Central Hospital, Affiliated Dongguan Shilong People’s Hospital of Southern Medical University, Dongguan
| | - Shifang Huang
- Department of Intensive Care Medicine, First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | | | - Min Li
- Department of Gastrointestinal Surgery
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Aleassa EM, Papasavas P, Augustin T, Khorgami Z, Benson-Davies S, Ghiassi S, Carter J, Nimeri A. American Society for Metabolic and Bariatric Surgery literature review on the effect of Roux-en-Y gastric bypass limb lengths on outcomes. Surg Obes Relat Dis 2023; 19:755-762. [PMID: 37268517 DOI: 10.1016/j.soard.2023.04.298] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 04/02/2023] [Indexed: 06/04/2023]
Abstract
This literature review is issued by the American Society for Metabolic and Bariatric Surgery regarding limb lengths in Roux-en-Y gastric bypass (RYGB) and their effect on metabolic and bariatric outcomes. Limbs in RYGB consist of the alimentary and biliopancreatic limbs and the common channel. Variation of limb lengths in primary RYGB and as a revisional option for weight recurrence after RYGB are described in this review.
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Affiliation(s)
- Essa M Aleassa
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
| | | | - Toms Augustin
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma College of Community Medicine, Tulsa, Oklahoma
| | - Sue Benson-Davies
- Department of Surgery, Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota
| | - Saber Ghiassi
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Jonathan Carter
- Department of Surgery, University of California, San Francisco, California
| | - Abdelrahman Nimeri
- Department of Surgery, Carolinas Medical Center, University of North Carolina, Charlotte, North Carolina
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Eskandaros MS, Abbass A. Standard Biliopancreatic Limb (50 cm) Roux-en-Y Gastric Bypass Versus Long Biliopancreatic Limb (100 cm) Roux-en-Y Gastric Bypass in Patients with Body Mass Index 40-50 kg/m 2: a Randomized Prospective Study. Obes Surg 2022; 32:577-586. [PMID: 34981324 DOI: 10.1007/s11695-021-05868-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is a widely performed procedure worldwide especially with the presence of associated medical conditions. Patients with body mass index (BMI) 40-50 kg/m2 are at more risk of weight regain and relapse of comorbidities. There is a controversy on the optimum alimentary (AL) and biliopancreatic (BPL) limb lengths to be used in RYGB to achieve weight loss and remission of comorbidities without causing nutritional deficiencies in those patients. STUDY DESIGN hundred-and-fifty patients with BMI between 40 and 50 kg/m2 were divided equally into 2 groups undergoing standard RYGB (S-RYGB) with AL:150 cm and BPL: 50 cm and long biliopancreatic RYGB (L-RYGB) with AL: 100 cm and BPL: 100 cm. BMI, % of total weight loss (%TWL), effect on diabetes (DM), hypertension (HTN), dyslipidemia, and nutritional statuses were recorded at 1, 2, and 3 years. RESULTS Only 64/75 patients in S-RYGB and 57/75 patients in L-RYGB completed the study. L-RYGB had faster weight loss, higher %TWL, and less BMI than S-RYGB with the maintenance of achieved weight. L-RYGB had better control of DM and dyslipidemia than S-RYGB. There were no significant differences in nutritional status between S-RYGB and L-RYGB rather than lower levels of calcium and Hb and higher levels of PTH in L-RYGB yet they remain within the normal range. CONCLUSION The application of L-RYGB helps in achieving faster weight loss for a longer period with better remission of associated comorbidities as DM, HTN, and dyslipidemia in patients with BMI 40-50 kg/m2 but with effects on the nutritional status.
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Affiliation(s)
| | - Alaa Abbass
- Faculty of Medicine, Ain Shams University, Cairo, 11591, Egypt
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Middleton ALO, Byrne JP, Calder PC. The Influence of Bariatric (Metabolic) Surgery on Blood Polyunsaturated Fatty Acids: A Systematic Review. Clin Nutr ESPEN 2022; 48:121-140. [DOI: 10.1016/j.clnesp.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 11/15/2022]
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Salte OBK, Svanevik M, Risstad H, Hofsø D, Blom-Høgestøl IK, Johnson LK, Fagerland MW, Kristinsson J, Hjelmesæth J, Mala T, Sandbu R. Standard versus distal Roux-en-Y gastric bypass in patients with BMI 50-60 kg/m2: 5-year outcomes of a double-blind, randomized clinical trial. BJS Open 2021; 5:6429825. [PMID: 34791048 PMCID: PMC8599874 DOI: 10.1093/bjsopen/zrab105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 12/26/2022] Open
Abstract
Background The optimal surgical weight loss procedure for patients with a BMI of 50 kg/m2 or more is uncertain. This study compared distal Roux-en-Y gastric bypass (RYGB) with standard RYGB. Methods In this double-blind RCT, patients aged 18–60 years with a BMI of 50–60 kg/m2 were allocated randomly to receive standard (150 cm alimentary, 50 cm biliopancreatic limb) or distal (150 cm common channel, 50 cm biliopancreatic limb) RYGB. The primary outcome (change in BMI at 2 years) has been reported previously. Secondary outcomes 5 years after surgery, such as weight loss, health-related quality of life, and nutritional outcomes are reported. Results Between May 2011 and April 2013, 123 patients were randomized, 113 received an intervention, and 92 attended 5-year follow-up. Mean age was 40 (95 per cent c.i. 38 to 41) years and 73 patients (65 per cent) were women; 57 underwent standard RYGB and 56 distal RYGB. BMI was reduced by 15.1 (95 per cent c.i. 13.9 to 16.2) kg/m2 after standard and 15.7 (14.5 to 16.9) kg/m2 after distal RYGB; the between-group difference was −0.64 (−2.3 to 1.0) kg/m2 (P = 0.447). Total cholesterol, low-density lipoprotein cholesterol, and haemoglobin A1c levels declined more after distal than after standard RYGB. High-density lipoprotein cholesterol levels increased more after standard RYGB. Vitamin A and vitamin D levels were lower after distal RYGB. Changes in bone mineral density, resting metabolic rate, and total energy intake were comparable. Conclusion Distal RYGB did not enable greater weight loss than standard RYGB. Differences in other outcomes favouring distal RYGB may not justify routine use of this procedure in patients with a BMI of 50–60 kg/m2. Registration number: NCT00821197 (http://www.clinicaltrials.gov). Presented in part as abstract to the IFSO (International Federation for the Surgery of Obesity and Metabolic disorders) conference, Madrid, Spain, August 2019.
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Affiliation(s)
- Odd Bjørn Kjeldaas Salte
- Department of Gastrointestinal and Paediatric Surgery, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Marius Svanevik
- Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Norway
| | - Hilde Risstad
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Dag Hofsø
- Morbid Obesity Centre, Vestfold Hospital Trust, Norway
| | | | | | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Jon Kristinsson
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Jøran Hjelmesæth
- Morbid Obesity Centre, Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway
| | - Tom Mala
- Department of Gastrointestinal and Paediatric Surgery, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Rune Sandbu
- Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Norway
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Gadiot RPM, Biter LU, Feskens PG, Dunkelgrun M, Apers JA, van 't Hof G, Mannaerts GHH. Midterm Results from the Dutch Common Channel Trial (DUCATI): Superior Weight Loss Results of the Long Roux Limb Gastric Bypass in Comparison to the Standard Bypass at 3-Year Follow-Up. Obes Surg 2021; 31:5132-5140. [PMID: 34476726 DOI: 10.1007/s11695-021-05690-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022]
Abstract
In the multi-center Dutch Common Channel Trial (DUCATI), a very long Roux limb Roux-en-Y gastric bypass (VLRL-RYGB: BP-limb 60 cm, Roux limb variable, and common channel 100 cm) was compared to a standard Roux-en-Y gastric bypass (S-LRYGB: BP-limb 60 cm, Roux limb 150 cm, and common channel variable) in the treatment of morbidly obese patients. As all trial patients are beyond 3-year follow-up a midterm analysis was performed to investigate the effect of the VLRL-RYGB. METHODS A total of 444 patients were randomized (1:1) to receive either a VLRL-RYGB or a S-LRYGB. Follow-up results for weight loss, effect on obesity-related comorbid conditions, complications, reoperation, and malnutrition are investigated. RESULTS At 3-year follow-up a significant difference in %TWL (34.0% vs. 31.4%, p = 0.017) and %EWL (84.7% vs. 76.6%, p = 0.043) was observed in favor of VLRL-LRYGB group. Overall complication rate 3-years after surgery was 15.8% in the VLRL-LRYGB group vs. 9% in the S-LRYGB group (p = 0.031). Eight (3.6%) patients in the VLRL-LRYGB group versus 2 (0.9%) in the S-LRYGB group (p = 0.055) required revisional surgery for malabsorption. In the VLRL-LRYGB group 71.9% of patients had resolution of T2DM versus 48.9% in the S-LRYGB group (p = 0.044). CONCLUSION At midterm FU a considerable, significantly increased effect on weight loss of the VLRL-LRYGB was observed compared to the S-LRYGB, with a higher risk of overall complications, but no significant nutritional side effects. These results might impact the current view on the value of the Roux limb in the discussion on optimum limb lengths in Roux-en-Y gastric bypass surgery.
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Affiliation(s)
- Ralph P M Gadiot
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, Rotterdam, 3045 PM, the Netherlands.
| | - L Ulas Biter
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, Rotterdam, 3045 PM, the Netherlands
| | - Pierre G Feskens
- Department of Bariatric Surgery, Bariatric Center South-West Netherlands, Bravis Hospital, Bergen op Zoom, the Netherlands
| | - Martin Dunkelgrun
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, Rotterdam, 3045 PM, the Netherlands
| | - Jan A Apers
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, Rotterdam, 3045 PM, the Netherlands
| | - Gerhard van 't Hof
- Department of Bariatric Surgery, Bariatric Center South-West Netherlands, Bravis Hospital, Bergen op Zoom, the Netherlands
| | - Guido H H Mannaerts
- Department of Surgery, Tawam Hospital, Al Ain Abu Dhabi, United Arab Emirates
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Comparing a Short Biliopancreatic Limb to a Long Biliopancreatic Limb in Patients with a Roux-en-Y Gastric Bypass with 4 Years Follow-up. Obes Surg 2021; 31:4846-4852. [PMID: 34368902 DOI: 10.1007/s11695-021-05651-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In order to design the most effective weight loss procedure, the ideal biliopancreatic limb (BPL) and alimentary limb (AL) length in Roux-en-Y gastric bypass (RYGB) have been discussed extensively. Yet, no consensus has been reached. The aim of this study was to compare weight loss after a short and long BPL in patients who underwent a RYGB with a minimum of 4 years follow-up. METHODS This retrospective cohort study consisted of 574 patients who underwent a primary RYGB procedure between March 2015 and January 2017. Patients were divided in two groups based on the surgical procedure performed: a short BPL group (BPL of 50 cm with an AL of 150 cm) and long BPL group (BPL of 150 cm with an AL of 75 cm). The percentage total weight loss (%TWL) between groups was compared up to 4 years after surgery. Secondary outcomes were 30-day postoperative complications and health-related quality of life (RAND-36). RESULTS The short BPL group consisted of 286 patient and the long BPL group of 288 patients. Follow-up rates of both groups at the first, second, third, and fourth year after surgery were comparable. The long BPL group showed significantly more %TWL compared to the short BP limb group starting at 6 months (p = 0.004) until 4 years after surgery (p < 0.001). Thirty-day complications and health-related quality of life did not differ. CONCLUSION The results showed significantly more %TWL in patients receiving a long BPL compared to the short BPL up to 4 years after surgery.
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Süsstrunk J, Lazaridis II, Köstler T, Kraljević M, Delko T, Zingg U. Long-Term Outcome of Proximal Versus Very-Very Long Limb Roux-en-Y Gastric Bypass: the Roux-Limb to Common Channel Ratio Determines the Long-Term Weight Loss. Obes Surg 2020; 31:994-1003. [PMID: 33196977 DOI: 10.1007/s11695-020-05109-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/29/2020] [Accepted: 11/10/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The influence of the Roux limb (RL) length on weight loss in Roux-en-Y (RYGB)-type gastric bypass procedures is still unclear. This study analyzes the true impact of RL length by comparing the long-term outcomes of proximal RYGB (PRYGB) and very-very long limb RYGB (VVLL-RYGB). METHODS RL length in PRYGB was 150 cm. In VVLL-RYGB, common channel length was 100 cm. In both groups, biliopancreatic limbs measured 50-60 cm, resulting in equal total alimentary limb lengths. To adjust for pre-operative differences between groups, and to predict the long-term outcome, a mixed model analysis was performed. RESULTS Two hundred thirty-two patients with VVLL-RYGB (73.7% female, mean age 41.1 ± 10 years, initial BMI 45.8 ± 6.3 kg/m2) and 223 with PRYGB (83.9% female, mean age 38.5 ± 11 years, initial BMI 42.9 ± 4.9 kg/m2) were included. Mean follow-up was 9.4 ± 4 years in VVLL-RYGB and 5.3 ± 1.9 years in PRYGB. After 5 years, mean BMI reduction was 15.7 ± 5.9 kg/m2 in VVLL-RYGB and 11.9 ± 4.1 kg/m2 in PRYGB (p < 0.001), and mean %EWL was 78.3 ± 23.1% and 70.2 ± 23.7% (p = 0.002) with a follow-up rate of 78% and 75.9%, respectively. The mixed model analysis showed a significantly higher weight rebound after PRYGB. Frequency of revisional surgery (i.e., limb length alteration, pouch banding) was similar between VVLL-RYGB and PRYGB (25 vs. 29 revisions, p = 0.463). CONCLUSION The VVLL-RYGB has a significantly higher long-term BMI reduction and a significantly lower weight rebound. The length of the Roux limb significantly influences long-term outcome.
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Affiliation(s)
- Julian Süsstrunk
- Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland.
| | - Ioannis I Lazaridis
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - Thomas Köstler
- Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
| | - Marko Kraljević
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - Tarik Delko
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - Urs Zingg
- Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
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Glaysher MA, Ward J, Aldhwayan M, Ruban A, Prechtl CG, Fisk HL, Chhina N, Al-Najim W, Smith C, Klimowska-Nassar N, Johnson N, Falaschetti E, Goldstone AP, Miras AD, Byrne JP, Calder PC, Teare JP. The effect of a duodenal-jejunal bypass liner on lipid profile and blood concentrations of long chain polyunsaturated fatty acids. Clin Nutr 2020; 40:2343-2354. [PMID: 33131909 DOI: 10.1016/j.clnu.2020.10.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/16/2020] [Accepted: 10/16/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Duodenal-jejunal bypass liners (DJBLs) prevent absorption in the proximal small intestine, the site of fatty acid absorption. We sought to investigate the effects of a DJBL on blood concentrations of essential fatty acids (EFAs) and bioactive polyunsaturated fatty acids (PUFAs). METHODS Sub-study of a multicentre, randomised, controlled trial with two treatment groups. Patients aged 18-65 years with type-2 diabetes mellitus and body mass index 30-50 kg/m2 were randomised to receive a DJBL for 12 months or best medical therapy, diet and exercise. Whole plasma PUFA concentrations were determined at baseline, 10 days, 6 and 11.5 months; data were available for n = 70 patients per group. RESULTS Weight loss was significantly greater in the DJBL group compared to controls after 11.5 months: total body weight loss 11.3 ± 5.3% versus 6.0 ± 5.7% (mean difference [95% CI] = 5.27% [3.75, 6.80], p < 0.001). Absolute concentrations of both EFAs, linoleic acid and α-linolenic acid, and their bioactive derivatives, arachidonic acid, eicosapentaenoic acid, docosapentaenoic acid and docosahexaenoic acid, were significantly lower in the DJBL group than in the control group at 6 and 11.5 months follow-up. Total serum cholesterol, LDL-cholesterol and HDL-cholesterol were also significantly lower in the DJBL group. CONCLUSION One year of DJBL therapy is associated with superior weight loss and greater reductions in total serum cholesterol and LDL-cholesterol, but also depletion of EFAs and their longer chain derivatives. DJBL therapy may need to be offset by maintaining an adequate dietary intake of PUFAs or by supplementation. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02459561.
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Affiliation(s)
| | - James Ward
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Madhawi Aldhwayan
- Imperial College London, London, UK; Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Helena L Fisk
- School of Human Development & Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Werd Al-Najim
- Imperial College London, London, UK; Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | | | | | | | | | | | | | - James P Byrne
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Philip C Calder
- School of Human Development & Health, Faculty of Medicine, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
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Ormanji MS, Rodrigues FG, Heilberg IP. Dietary Recommendations for Bariatric Patients to Prevent Kidney Stone Formation. Nutrients 2020; 12:nu12051442. [PMID: 32429374 PMCID: PMC7284744 DOI: 10.3390/nu12051442] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/09/2020] [Accepted: 05/13/2020] [Indexed: 12/12/2022] Open
Abstract
Bariatric surgery (BS) is one of the most common and efficient surgical procedures for sustained weight loss but is associated with long-term complications such as nutritional deficiencies, biliary lithiasis, disturbances in bone and mineral metabolism and an increased risk of nephrolithiasis, attributed to urinary metabolic changes resultant from low urinary volume, hypocitraturia and hyperoxaluria. The underlying mechanisms responsible for hyperoxaluria, the most common among all metabolic disturbances, may comprise increased intestinal oxalate absorption consequent to decreased calcium intake or increased dietary oxalate, changes in the gut microbiota, fat malabsorption and altered intestinal oxalate transport. In the current review, the authors present a mechanistic overview of changes found after BS and propose dietary recommendations to prevent the risk of urinary stone formation, focusing on the role of dietary oxalate, calcium, citrate, potassium, protein, fat, sodium, probiotics, vitamins D, C, B6 and the consumption of fluids.
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Affiliation(s)
- Milene S. Ormanji
- Nephrology Division, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil; (M.S.O.); (F.G.R.)
| | - Fernanda G. Rodrigues
- Nephrology Division, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil; (M.S.O.); (F.G.R.)
- Department of Nutrition, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil
| | - Ita P. Heilberg
- Nephrology Division, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil; (M.S.O.); (F.G.R.)
- Department of Nutrition, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil
- Correspondence: ; Tel.: +55-(11)-5576-4848 (ext. 2465)
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