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Chen S, Chiang J, Ghanem O, Ferzli G. Decision-making Considerations in Revisional Bariatric Surgery. Surg Laparosc Endosc Percutan Tech 2024; 34:400-406. [PMID: 38963277 DOI: 10.1097/sle.0000000000001296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 05/16/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE With drastic variations in bariatric practices, consensus is lacking on an optimal approach for revisional bariatric surgeries. MATERIALS AND METHODS The authors reviewed and consolidated bariatric surgery literature to provide specific revision suggestions based on each index surgery, including adjustable gastric band (AGB), sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD-DS), single anastomosis duodenal-ileal bypass with sleeve (SADI-S), one anastomosis gastric bypass (OAGB), and vertical banded gastroplasty (VBG). RESULTS AGB has the highest weight recurrence rate and can be converted to RYGB, SG, and BPD-DS. After index SG, common surgical options include a resleeve or RYGB. The RYGB roux limb can be distalized and pouch resized in context of reflux, and the entire anatomy can be revised into BPD-DS. Data analyzing revisional surgery after a single anastomosis duodenal-ileal bypass with sleeve was limited. In patients with one anastomosis gastric bypass and vertical banded gastroplasty anatomy, most revisions were the conversion to RYGB. CONCLUSIONS As revisional bariatric surgery becomes more common, the best approach depends on the patient's indication for surgery and preexisting anatomy.
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Affiliation(s)
- Sheena Chen
- Department of General Surgery, New York University Langone Health, Brooklyn, NY
| | - Jessica Chiang
- Department of General Surgery, New York University Langone Health, Brooklyn, NY
| | - Omar Ghanem
- Department of General Surgery, Mayo Clinic, Rochester, MN
| | - George Ferzli
- Department of General Surgery, New York University Langone Health, Brooklyn, NY
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Santos-Sousa H, Amorim-Cruz F, Nogueiro J, Silva A, Amorim-Cruz I, Ferreira-Santos R, Bouça-Machado R, Pereira A, Resende F, Costa-Pinho A, Preto J, Lima-da-Costa E, Barbosa E, Carneiro S, Sousa-Pinto B. Preoperative risk factors for early postoperative bleeding after Roux-en-Y gastric bypass surgery: a systematic review and meta-analysis. Langenbecks Arch Surg 2024; 409:163. [PMID: 38775865 PMCID: PMC11111548 DOI: 10.1007/s00423-024-03346-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Although bariatric surgery is an effective intervention for obesity, it comes with risks such as early postoperative bleeding (EPB). Identifying preoperative risk factors for this complication can help patients' risk stratification and optimization. We performed a systematic review and meta-analysis to find predictors for early postoperative bleeding after Roux-en-Y gastric bypass (RYGB). METHODS We conducted a systematic review, searching PubMed, Cochrane Library, and Web of Science until November 2023. We performed a random-effects meta-analysis to explore preoperative risk factors associated with early postoperative bleeding after RYGB. Sources of heterogeneity were explored by leave-one-out analyses. RESULTS 23 studies were included, comprising 232,488 patients. Male gender (meta-analytical RR = 1.42, 95%CI = 1.21-1.66, I2 = 18%, Q Cochran test p-value = 0.29) and revisional surgery (meta-analytical RR = 1.35, 95%CI = 1.12-1.62, I2 = 22%, Q Cochran test p = 0.21) were associated with higher risk of EPB. On average, patients with EPB were older than the remainder (MD for the mean age = 2.82 years, 95%CI = 0.97-4.67, I2 = 0.00%, Q Cochran test p = 0.46). Except for hypertension (meta-analytical RR = 1.33, 95%CI = 1.02-1.73, I2 = 66%, Q Cochran test p < 0.0001), comorbidities were not associated with a higher risk of EPB. CONCLUSION Preoperative risk factors, including age, gender, hypertension, and revisional bariatric surgery, are associated with early postoperative bleeding after RYGB. Further primary studies, with higher methodological quality, are required to detail more risk factors.
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Affiliation(s)
- Hugo Santos-Sousa
- Obesity Integrated Responsability Unit (CRI-O), São João University Medical Center, Porto, Portugal.
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal.
| | - Filipe Amorim-Cruz
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
- Surgery Department, São João University Medical Center, Porto, Portugal
| | - Jorge Nogueiro
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
- Surgery Department, São João University Medical Center, Porto, Portugal
| | - Alexandre Silva
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
| | - Inês Amorim-Cruz
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
| | | | | | - André Pereira
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
- Surgery Department, São João University Medical Center, Porto, Portugal
| | - Fernando Resende
- Obesity Integrated Responsability Unit (CRI-O), São João University Medical Center, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
| | - André Costa-Pinho
- Obesity Integrated Responsability Unit (CRI-O), São João University Medical Center, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
| | - John Preto
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
| | - Eduardo Lima-da-Costa
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
- Surgery Department, São João University Medical Center, Porto, Portugal
| | - Elisabete Barbosa
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
- Surgery Department, São João University Medical Center, Porto, Portugal
| | - Silvestre Carneiro
- Obesity Integrated Responsability Unit (CRI-O), São João University Medical Center, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
| | - Bernardo Sousa-Pinto
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, MEDCIDS, University of Porto, Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
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Oyefule O, Do T, Karthikayen R, Portela R, Dayyeh BA, McKenzie T, Kellogg T, Ghanem OM. Secondary Bariatric Surgery-Does the Type of Index Procedure Affect Outcomes After Conversion? J Gastrointest Surg 2022; 26:1830-1837. [PMID: 35715643 DOI: 10.1007/s11605-022-05385-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/04/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although revisions account for 17% of cases performed at bariatric centers of excellence, scarce data exists on whether index operation type influences outcomes after secondary operations. OBJECTIVE We designed a study investigating the effect of primary procedure type on weight loss and perioperative complications after conversion bariatric surgery. SETTING Tertiary Referral Hospital, USA. METHODS We performed a retrospective review of patients undergoing conversion from sleeve gastrectomy (SG) or adjustable gastric band (AGB) to Roux-en-Y gastric bypass (RYGB) from 2009 to 2019. Post-operatively, we measured short- and medium-term complications and changes in body weight at various time points. Univariate and regression analyses were performed. RESULTS Forty-two (SG) patients and 116 (AGB) patients underwent conversion to RYGB, most commonly for GERD (57.1%) in SG patients vs. weight regain (77.6%) in AGB patients. Mean pre-conversion BMI was 36.7 kg/m2 (SG) vs 43.8 kg/m2 (AGB). Mean time to conversion (months) was 52.9 (SG) vs 94.7 (AGB). Complication rate was 9.5% (SG) vs 6% (AGB) at 30 days (p = 0.48) and 31%(SG) vs 14.5% (AGB) (p = 0.02) at 2 years. Mean post conversion %TWL was 11.6% (SG) vs 24.6% (AGB) in patients with GERD/dysphagia (p = 0.014) and 20.7% (SG) vs 27.6% (AGB) in patients converted for weight-related reasons (p = 0.027) at 1 year. Overall mean %TWL was 13.2% (SG) vs 24.7% (AGB) at 2 years (p < 0.0035). CONCLUSION After conversion to RYGB, patients with AGB experience better short- and medium-term weight loss than those with SG, even after accounting for conversion indications. SG to RYGB conversions have a higher resolution of reflux disease.
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Affiliation(s)
- Omobolanle Oyefule
- Department of Surgery, Emory University School of Medicine, 550 Peachtree Street NE, Atlanta, GA, 30308, USA
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Timothy Do
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Raveena Karthikayen
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ray Portela
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Barham Abu Dayyeh
- Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Travis McKenzie
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Todd Kellogg
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Major P, Stefura T, Dziurowicz B, Radwan J, Wysocki M, Małczak P, Pędziwiatr M. Quality of Life 10 Years After Bariatric Surgery. Obes Surg 2020; 30:3675-3684. [PMID: 32535784 PMCID: PMC7467960 DOI: 10.1007/s11695-020-04726-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Improvement of the quality of life after bariatric surgery is an important outcome of the treatment. Assessing the long-term QoL results provides better insights into the effectiveness of bariatric surgery. MATERIALS AND METHODS This is a cohort study including patients who underwent bariatric surgery between June 2009 and May 2010 in one academic center. Patients underwent either laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB). Overall, 34 patients underwent LSG (52.3%) and 31 patients underwent LRYGB (47.7%). Preoperatively, and after 1 and 10 years, QoL was assessed using two standardized questionnaires: SF-36 and MA-QoLII. After 10 years, 72% of patients filled out these questionnaires. RESULTS The global QoL score before surgery was 48.3 ± 20.6. At the 1-year follow-up, the global total QoL score was 79.7 ± 9.8. At the 10-year follow-up, the global total QoL score was 65.1 ± 21.4. There was a significant increase in total QoL between measurements before the operation and 10 years after surgery in the whole study group (p = 0.001) and for patients who underwent LSG (p = 0.001). There was no significant difference between total QoL prior to surgery and 10 years after for patients who underwent LRYGB (p = 0.450). CONCLUSION LSG led to significant improvement in QoL.
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Affiliation(s)
- Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 st., 30-688, Cracow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Cracow, Poland
| | - Tomasz Stefura
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 st., 30-688, Cracow, Poland.
| | - Błażej Dziurowicz
- Students' Scientific Group at 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Joanna Radwan
- Students' Scientific Group at 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 st., 30-688, Cracow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Cracow, Poland
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 st., 30-688, Cracow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Cracow, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 st., 30-688, Cracow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Cracow, Poland
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Pędziwiatr M, Małczak P, Wierdak M, Rubinkiewicz M, Pisarska M, Major P, Wysocki M, Karcz WK, Budzyński A. Revisional Gastric Bypass Is Inferior to Primary Gastric Bypass in Terms of Short- and Long-term Outcomes-Systematic Review and Meta-Analysis. Obes Surg 2019; 28:2083-2091. [PMID: 29748735 PMCID: PMC6018598 DOI: 10.1007/s11695-018-3300-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose Although Roux-en-Y gastric bypass (RYGB) is the main primary bariatric procedure, it has also been utilized as revisional bariatric surgery. Our aim is to compare revisionary gastric bypass with primary gastric bypass through systematic review with meta-analysis. Methods Available literature was searched for eligible studies up to December 2017. Inclusion criteria were reports on morbidity, %EWL, or diabetes remission. Secondary outcomes involved mortality, anastomotic leakage, operative time, and length of hospital stay. Random effect meta-analyses were undertaken. Results Initial search yielded 1164 references. Final meta-analysis involved 21 studies and revealed significant differences in terms of morbidity (RR1.54, p < 0.001) and EWL (WMD-19.9, p < 0.001). There were no differences in diabetes remission. Conclusion Revisionary RYGB has worse weight loss effect with greater morbidity rate than primary RYGB. Electronic supplementary material The online version of this article (10.1007/s11695-018-3300-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland. .,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland.
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Mateusz Wierdak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Mateusz Rubinkiewicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Pisarska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - W Konrad Karcz
- Department of General-, Abdominal-, Vascular-, Thoracic- and Transplantation Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
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Making sense of gastric/intestinal bypass surgeries: forget the name and remember the degree of restriction and malabsorption the surgeries provide. Surg Obes Relat Dis 2017; 13:716-719. [DOI: 10.1016/j.soard.2017.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/03/2017] [Indexed: 12/23/2022]
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Long-Term Outcomes of Roux-en-Y Gastric Bypass Conversion of Failed Laparoscopic Gastric Band. Obes Surg 2017; 27:1401-1408. [DOI: 10.1007/s11695-016-2529-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Ramly EP, Safadi BY, Aridi HD, Kantar R, Mailhac A, Alami RS. Concomitant Removal of Gastric Band and Gastric Bypass: Analysis of Outcomes and Complications from the ACS-NSQIP Database. Obes Surg 2016; 27:462-468. [DOI: 10.1007/s11695-016-2348-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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