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Stefura T, Mulek R, Krefft M, Wysocki M, Zając M, Rusinek J, Wierdak M, Pędziwiatr M, Major P. Comparison of revisional surgeries after OAGB versus RYGB: Results from the multicenter Polish Revision Obesity Surgery Study (PROSS). POLISH JOURNAL OF SURGERY 2024; 96:63-68. [PMID: 38940250 DOI: 10.5604/01.3001.0054.2678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
<br><b>Introduction:</b> Roux-en-Y gastric bypass (RYGB) is a leading bariatric surgery globally. One-anastomosis gastric bypass (OAGB), a modification of RYGB, ranks as the third most common bariatric procedure in Poland. While clinical trials show that OAGB outcomes are comparable to those of RYGB regarding weight loss, remission of comorbidities, and hormonal impact, there is limited data on long-term outcomes and complications.</br><br><b>Aim:</b> The aim of the study was to compare the outcomes of revisional surgeries conducted after OAGB <i>versus</i> RYGB.</br> <br><b>Material and methods:</b> This retrospective study analyzed patients undergoing revisional bariatric surgeries from January 2010 to January 2020 across 12 Polish centers. The inclusion criteria were an age of at least 18 years and prior OAGB or RYGB surgery. Those with incomplete primary surgery data and follow-up post-revision were excluded. Data were collected regarding parameters for anthropometrics, comorbidities, and perioperative details. The patients were categorized based on their initial surgery: OAGB or RYGB. The primary endpoints were the reasons for and types of revisional surgery and weight changes; the secondary endpoints were postoperative complications and length of hospital stay (LOS).</br> <br><b>Results:</b> In total, 27 patients participated, with a mean age of 38.18 7 years. Differences between the OAGB (13 patients) and RYGB (14 patients) groups included median initial body weight (100 kg <i>vs.</i> 126 kg, p<0.016), number of postoperative complications (9 <i>vs.</i> 3, p = 0.021), and median LOS (3 <i>vs.</i> 4.5 days, p = 0.03). GERD was the primary reason for OAGB revisions (69.2%), whereas insufficient weight loss led to the most RYGB revisions (42.9%).</br><br><b>Conclusions:</b> The RYGB patients commonly needed revisions due to weight issues, whereas reoperations in the OAGB patients were conducted due to postoperative complications. The postoperative complications and LOS were similar between the groups.</br> <br><b>The importance of research for the development of the field:</b> The results may influence clinical surgeons' choice of surgical technique.</br>.
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Affiliation(s)
- Tomasz Stefura
- Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland, Malopolska Burn and Plastic Centre, Ludwik Rydygier's Specialist Hospital in Krakow, Poland
| | - Rafał Mulek
- EuroMediCare Specialist Hospital and Clinic, Wroclaw, Poland
| | - Michał Krefft
- EuroMediCare Specialist Hospital and Clinic, Wroclaw, Poland
| | - Michał Wysocki
- Department of General Surgery and Surgical Oncology, Ludwik Rydygier Memorial Hospital in Krakow, Krakow, Poland
| | - Maciej Zając
- Students' Scientific Group at the II Department of Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Rusinek
- Students' Scientific Group at the II Department of Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Wierdak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
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Sista F, Carandina S, Soprani A, Rivkine E, Montana L, Fiasca F, Cappelli S, Grasso A, Nedelcu M, Tucceri Cimini I, Clementi M. Roux-en-Y Gastric Bypass after Laparoscopic Sleeve Gastrectomy Failure: Could the Number of Previous Operations Influence the Outcome? J Clin Med 2024; 13:293. [PMID: 38202300 PMCID: PMC10779909 DOI: 10.3390/jcm13010293] [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: 10/18/2023] [Revised: 12/22/2023] [Accepted: 12/31/2023] [Indexed: 01/12/2024] Open
Abstract
After a failed laparoscopic adjustable gastric band (LAGB), laparoscopic sleeve gastrectomy (LSG) has been proposed as revisional surgery. Those patients that receive a second restrictive procedure fall into a small subgroup of patients with more than one restrictive procedure (MRP). If also the second restrictive procedure fails, the correct surgical strategy is a challenge for the surgeon. Roux-en-Y gastric bypass (RYGB) may be an option but there is no evidence in the literature on whether the procedure is effective in treating failures after MRP. This study aims to evaluate the influence of the previous number of restrictive interventions (MRP vs single LSG) in the results of RYGB as revisional surgery. We have retrospectively analyzed patients who underwent conversion from laparoscopic sleeve gastrectomy (LSG), or from multiple restrictive procedures (MRP), to RYGB for weight regain (WR) or insufficient weight loss (IWL) between 2009 and 2019. The number of patients analyzed was 69 with conversion to RYGB after LSG and 44 after MRP. The reduction of excess weight (%TWL) at 3, 6, 12, 24 RYGB postoperative months was respectively of 11.03%, 16.39%, 21.43%, and 24.22% in the MRP group, and of 10.97%, 16.4%, 21.22%, and 22.71% in the LSG group. No significant difference was found in %TWL terms after RYGB for the MRP group and the LSG group with an overall %TWL, which was 11.00 ± 6.03, 16.40 ± 8.08, 21.30 ± 9.43, and 23.30 ± 9.91 respectively at 3, 6, 12, and 24 months. The linear regression model highlighted a positive relationship between the %EWL post-bypass at 24 months and the time elapsed only between the LSG and RYGB in the MRP group patients (p < 0.001). RYGB has proved to be a reliable technique with good results in terms of weight loss after failed bariatric surgery both in patients who previously underwent MRP and in those who underwent exclusively LSG. RYGB showed better results in patients who experienced WR than in those who had IWL from previous techniques.
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Affiliation(s)
- Federico Sista
- Hepatic Pancreatic and Biliary Surgical Unit, San Salvatore Hospital, Department of Biothecnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Sergio Carandina
- ELSAN, Clinique Saint Michel, Centre de Chirurgie de l’Obésité (CCO), 83100 Toulon, France
- Department of Digestive and Bariatric Surgery, Clinica Madonna della Salute, 45014 Porto Viro, Italy
| | - Antoine Soprani
- Clinique Geoffroy-Saint Hilaire, Générale de Santé (GDS), Department of Digestive and Bariatric Surgery, 75005 Paris, France;
| | - Emmanuel Rivkine
- Department of Digestive and Bariatric Surgery, Centre Hospitalier Universitaire de Martinique, 97261 Fort-de-France, France
| | - Laura Montana
- Department of Digestive and Metabolic Surgery, Groupe Hospitalier Diaconesses Croix Saint-Simon, 75012 Paris, France
| | - Fabiana Fiasca
- Public Health Unit, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Sonia Cappelli
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Antonella Grasso
- General Surgical Unit, San Salvatore Hospital, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy (I.T.C.)
| | - Marius Nedelcu
- ELSAN, Clinique Saint Michel, Centre de Chirurgie de l’Obésité (CCO), 83100 Toulon, France
- Department of Digestive and Bariatric Surgery, Clinica Madonna della Salute, 45014 Porto Viro, Italy
| | - Irene Tucceri Cimini
- General Surgical Unit, San Salvatore Hospital, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy (I.T.C.)
| | - Marco Clementi
- General Surgical Unit, San Salvatore Hospital, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy (I.T.C.)
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