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Ivano VK, Hatto M, Teramoto F, Macedo PRAD, Gestic MA, Utrini MP, Chaim FDM, Ramos AC, Callejas-Neto F, Chaim EA, Cazzo E. Effects of bariatric surgery on renal function: a retrospective cohort study comparing one-year outcomes between one-anastomosis gastric bypass and Roux-en-Y gastric bypass. SAO PAULO MED J 2024; 142:e2023161. [PMID: 38836818 DOI: 10.1590/1516-3180.2023.0161.r1.08022024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 02/08/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Evidence on the effect of one-anastomosis gastric bypass (OAGB) on renal function is limited. OBJECTIVE To compare the evolution of estimated renal function observed 1 year after OAGB and Roux-en-Y gastric bypass (RYGB) in individuals with obesity. DESIGN AND SETTING Observational, analytical, and retrospective cohort study. Tertiary-level university hospital. METHODS This study used a prospectively collected database of individuals who consecutively underwent bariatric surgery. Renal function was assessed by calculating the estimated glomerular filtration rate (eGFR), according to the Chronic Kidney Disease Epidemiology Collaboration. The one-year variation in the eGFR was compared between the procedures. RESULTS No significant differences in age, sex, obesity-associated conditions, or body mass index were observed among individuals who underwent either OAGB or RYGB. OAGB led to a significantly higher percentage of total (P = 0.007) and excess weight loss (P = 0.026). Both OAGB and RYGB led to significantly higher values of eGFR (103.9 ± 22 versus 116.1 ± 13.3; P = 0.007, and 102.4 ± 19 versus 113.2 ± 13.3; P < 0.001, respectively). The one-year variation in eGFR was 11 ± 16.2% after OAGB and 16.7 ± 26.3% after RYGB (P = 0.3). Younger age and lower baseline eGFR were independently associated with greater postoperative improvement in renal function (P < 0.001). CONCLUSION Compared with RYGB, OAGB led to an equivalent improvement in renal function 1 year after the procedure, along with greater weight loss.
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Affiliation(s)
- Victor Kenzo Ivano
- MD. Postgraduate Student, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Marcelo Hatto
- MD. Postgraduate Student, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Fernanda Teramoto
- MD. Medical Resident, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Paolla Ravida Alves de Macedo
- MD. Medical Resident, Department of Surgery School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Martinho Antonio Gestic
- MD, MSc. Assistant lecturer, Department of Surgery, School of Medical Sciences, Universidade State University of Campinas (UNICAMP), Campinas (SP), Brazil
| | - Murillo Pimentel Utrini
- MD. Assistant Lecturer, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Felipe David Mendonça Chaim
- MD, PhD. Assistant Lecturer, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Almino Cardoso Ramos
- MD, PhD. Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Francisco Callejas-Neto
- MD, MSc. Assistant Professor, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Elinton Adami Chaim
- MD, PhD. Full Professor, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Everton Cazzo
- MD, PhD. Associate Professor, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
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Moosavi D, Taherzadeh M, Mokhber S, Riazi S, Pazouki A. Presentation of portomesenteric thrombosis after one-anastomosis gastric bypass: Case report. Int J Surg Case Rep 2023; 111:108900. [PMID: 37820484 PMCID: PMC10570941 DOI: 10.1016/j.ijscr.2023.108900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION Obesity is a serious situation that leads to non-communicable diseases like diabetes, hypertension, and others. The prevalence of obesity is growing very fast worldwide, so follow the results bariatric surgery, the most effective treatment of obesity, is increasing. Portomesentric vein thrombosis (PMVT) is one of the rare, fatal post-bariatric complications seen most commonly in sleeve gastrectomy and Roux-en-Y gastric bypass. PRESENTATION OF CASE A 50-year-old menopausal female with a body mass index (BMI) of 38 was admitted with acute abdominal pain 10 days after one-anastomosis gastric bypass (OAGB). Her lab tests were normal, but in her abdominal CT scan with IV contrast, subacute complete intraluminal thrombosis with luminal expansion at the left branch of the portal vein and its segmental branches was seen. Her diagnostic laparoscopy was normal, and she was discharged with no symptoms and a prescription for rivaroxaban. DISCUSSION PMVT is one of the complications after bariatric surgery that is very uncommon and fetal. It has been seen more in laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass, and early diagnosis of PMVT is essential due to its high mortality rate and cause of gastrointestinal ischemia. CONCLUSION In this case report, we saw that PMVT could happen after OAGB, and it is important to consider PMVT as one of the complications after OAGB to not miss the cases.
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Affiliation(s)
- Delaram Moosavi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Rasoule-Akram Hospital, Mansouri st., Niyayesh Ave., Sattarkhan St., Tehran, Iran
| | - Mahsa Taherzadeh
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Rasoule-Akram Hospital, Mansouri st., Niyayesh Ave., Sattarkhan St., Tehran, Iran
| | - Somayeh Mokhber
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Rasoule-Akram Hospital, Mansouri st., Niyayesh Ave., Sattarkhan St., Tehran, Iran
| | - Sajedeh Riazi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Rasoule-Akram Hospital, Mansouri st., Niyayesh Ave., Sattarkhan St., Tehran, Iran.
| | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Rasoule-Akram Hospital, Mansouri st., Niyayesh Ave., Sattarkhan St., Tehran, Iran
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Braga JGR, Ramos AC, Callejas-Neto F, Chaim EA, Cazzo E. WEIGHT LOSS AND QUALITY OF LIFE AFTER ONE ANASTOMOSIS GASTRIC BYPASS: A 2-YEAR FOLLOW-UP STUDY. ARQUIVOS DE GASTROENTEROLOGIA 2023; 60:241-246. [PMID: 37585942 DOI: 10.1590/s0004-2803.202302023-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/27/2023] [Indexed: 08/18/2023]
Abstract
•One anastomosis gastric bypass (OAGB) led to significant weight loss after 2 years. •OAGB associated was well-succeeded in regards to weight loss in most individuals. •OAGB led to significant improvement of quality of life (QoL) assessed by the BAROS system. •"Self-steem" and "work capacity" were the most positively affected QoL domains after OAGB. Background - Studies assessing quality of life (QoL) after one anastomosis gastric bypass (OAGB) are currently scarce. Objective - To analyze the main weight loss outcomes and QoL in individuals undergoing OAGB during a 2-year follow-up. Methods - This is a retrospective study based on a prospectively collected database including individuals which underwent OAGB at a tertiary-level university hospital. After 2-years, excess weight loss was assessed, and post-surgical therapeutical success was determined using Reinhold's criteria. QoL was assessed through the Bariatric Analysis and Reporting Outcomes System (BAROS). Results - Out of 41 participants, 90.2% were female and the average age was 38±8.3 years old. The average body mass index significantly decreased from 37.1±5.6 kg/m2 to 27±4.5 kg/m2 after 2-years (P< 0.001). The mean percentage of excess weight loss was 84.6±32.5%. Regarding weight loss outcomes, 61% were considered "excellent", while 26.8% were "good" according to Reinhold's criteria. With regards to QoL assessed by BAROS, most individuals achieved a score classified as either "excellent" (26.8%), "very good" (36.6%), or "good" (31.7%). The highest degrees of satisfaction achieved were in the domains "self-esteem" and "work capacity", in which 75.6% and 61%, respectively, were classified as "much better". Conclusion - OAGB associated with significant weight loss and resolution of obesity-related medical conditions, as well as relevant QoL improvement assessed by the BAROS system.
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Affiliation(s)
| | - Almino Cardoso Ramos
- Universidade Estadual de Campinas, Departamento de Cirurgia, Campinas, SP, Brasil
| | | | - Elinton Adami Chaim
- Universidade Estadual de Campinas, Departamento de Cirurgia, Campinas, SP, Brasil
| | - Everton Cazzo
- Universidade Estadual de Campinas, Departamento de Cirurgia, Campinas, SP, Brasil
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Endoscopic and histopathological assessment of individuals undergoing one anastomosis gastric bypass: a 2-year follow-up. Surg Endosc 2023; 37:3720-3727. [PMID: 36650354 DOI: 10.1007/s00464-023-09884-0] [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: 10/02/2022] [Accepted: 01/08/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND There is much debate over the occurrence of biliary reflux to the gastric pouch after one anastomosis gastric bypass (OAGB) and its potential risks. OBJECTIVE To assess endoscopic and histopathological findings following a standardized protocol of biopsy collection two years after OAGB. METHODS A historical cohort study was conducted, based on a prospectively collected database, which involved 39 participants who underwent OAGB. Participants underwent clinical evaluation and esophagogastroduodenoscopy at the time of surgery and 24 months afterward. Post-operatively, biopsy specimens in esophagogastric junction, pouch, and anastomosis were systematically collected. RESULTS 92.3% of the participants were female and the mean age was 37 ± 8.5 years. The mean body mass index (BMI) significantly decreased from 37.6 ± 5.7 kg/m2 to 27 ± 4.1 kg/m2 after 2 years (p < 0.001). The mean %TWL was 27.2 ± 10.5%. The prevalence of non-erosive gastritis significantly increased from 25.6 to 51.3% (p = 0.02). Erosive gastritis significantly decreased from 28.2 to 10.3% (p = 0.04). Four cases of marginal ulcers were identified (10.3%). The commonest histopathological finding was mild inflammation in 74.3% (esophagogastric junction), 58.9% (pouch), and 71.8% (anastomosis). There was one case of focal intestinal metaplasia in each site of interest and no cases of dysplasia or severe inflammation. CONCLUSIONS Using a standardized protocol of post-operative biopsy collection, low rates of severe endoscopic and histopathological abnormalities were observed two years after OAGB. Nevertheless, as most patients have histologically proven inflammation, bile in the gastric pouch, and endoscopic gastritis, long-term surveillance is essential because of the uncertain risk of these abnormalities.
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Maselli DB, Hoff AC, Kucera A, Waseem A, Wooley C, Donnangelo LL, Coan B, McGowan CE. Endoscopic revision of one-anastomosis gastric bypass (ER-OAGB) for weight recurrence: a case series of 17 adults. Ther Adv Gastrointest Endosc 2023; 16:26317745231210120. [PMID: 38026683 PMCID: PMC10666552 DOI: 10.1177/26317745231210120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Weight recurrence after one-anastomosis gastric bypass (OAGB), the third most common metabolic and bariatric surgery performed worldwide, is observed in a subset of patients due to the chronic, progressive nature of obesity. Endoscopic revision of the OAGB (ER-OAGB) through full-thickness suturing to reduce the gastrojejunal anastomosis and gastric pouch is a potential alternative to surgical revision. Here, we present a case series of ER-OAGB and long-term nutritional support at two international centers with expertise in bariatric endoscopy. Data were retrospectively evaluated from a prospectively maintained database. The primary outcome was total body weight loss (TBWL) at 12 months. Secondary outcomes included TBWL at 3, 6, and 15 months; excess weight loss (EWL) at 3, 6, 12, and 15 months; frequency of new/worsening symptoms of gastroesophageal reflux disease (GERD); and the frequency of serious adverse events. In this series, 17 adults (70.6% female, mean age 46.8 years, mean BMI 39.1 kg/m2) successfully underwent ER-OAGB an average of 8 years (range 2-21 years) after OAGB for a mean weight recurrence of 43.2% (range 10.9-86.9%). TBWL from ER-OAGB was 9.7 ± 1.8% at 3 months, 13.4 ± 3.5% at 6 months, 18.5 ± 2.1% at 12 months, and 18.1 ± 2.2% at 15 months. EWL from ER-OAGB was 30.5 ± 14.7% at 3 months, 42.6 ± 16.2% at 6 months, 54.2 ± 11.3% at 12 months, and 54.2 ± 11.7% at 15 months. There were no instances of new/worsening GERD symptoms or serious adverse events. In this small series of adults who experienced weight recurrence after OAGB, ER-OAGB facilitated safe and clinically meaningful weight loss, without new or worsening GERD symptoms, when performed by experienced bariatric endoscopists in concert with longitudinal nutritional support.
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Affiliation(s)
| | | | | | | | | | | | | | - Christopher E. McGowan
- Medical Director and Research Director, True You Weight Loss, 2001 Weston Parkway, Cary, NC 27513, USA
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Guzel K. The Efficacy of Mini-Gastric Bypass Surgery in Diabetic and Prediabetic Obese Patients. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2021.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kerim Guzel
- Department of General Surgery, Faculty of Medicine, Biruni University, İstanbul, Turkey
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Ansar H, Zamaninour N, Pazouki A, Kabir A. Weight Loss After One Anastomosis Gastric Bypass-Mini Gastric Bypass (OAGB-MGB): Patient-Related Perioperative Predictive Factors. Obes Surg 2021; 30:1316-1323. [PMID: 31820407 DOI: 10.1007/s11695-019-04270-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM The aim of this study was to find independent perioperative factors predicting unsuccessful weight loss following one anastomosis gastric bypass-mini gastric bypass (OAGB-MGB), a recently developed technique of bariatric surgery. METHODS Using regression analysis, this prospective cohort study assessed the role of demographic and socioeconomic factors, clinical features, body composition, length of biliopancreatic limb (LBL), nutritional habits, comorbidities, and early post-operative weight reduction values, in predicting 1-year weight loss after OAGB-MGB. All patients at the center who underwent laparoscopic OAGB-MGB between October 2010 and May 2017 were included. The dependent variable was the percent of excess weight loss (%EWL) after 12-month follow-up. Weight loss outcome was defined as successful EWL (≥ 50%) or unsuccessful EWL (< 50%). RESULTS Follow-up data at 1 year was available for 1309 (77%) patients. Mean EWL and BMI reduction were 81.63% and 16.82 ± 4.37 kg/m2 at 1 year. In addition, 48 (3.7%) patients had unsuccessful weight loss. Pre-operative higher BMI (OR, 1.34; p = 0.001), type 2 diabetes (OR, 4.26; p = 0.039), pre-surgery volume eating habit (OR, 0.12; p = 0.003), weight reduction value in the first month after surgery (OR, 0.80; p = 0.002), and length of biliopancreatic limb (LBL) (OR, 1.05; p = 0.017) were independently associated with unsuccessful weight loss at 1-year follow-up. CONCLUSIONS OAGB-MGB provides considerable weight loss for most patients. Initial lower BMI, absence of diabetes, being volume eater, and higher first month weight loss are independently associated with successful weight loss after 1 year.
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Affiliation(s)
- Hastimansooreh Ansar
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Negar Zamaninour
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.,Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-e Rasool Hospital, Tehran, Iran
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Gastric Remnant Perforation Caused by Peterson's Hernia Following One Anastomosis Gastric Bypass: a Rare Complication. Obes Surg 2021; 30:3229-3232. [PMID: 32144635 DOI: 10.1007/s11695-020-04524-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION One anastomosis gastric bypass (OAGB) has gained popularity over the recent years; it appears to be an effective bariatric procedure with acceptable weight loss, co-morbidity resolution, and complication rates in the short and medium term. However, it still continues to have concerns in the bariatric community due to a spectrum of potential complications. To our knowledge, there are few published cases of internal hernia, but no published reports of gastric remnant perforation following OAGB. CASE PRESENTATION We report a case of a 32-year-old female who developed a perforation of the remnant stomach along the gastric fundus secondary to bowel obstruction 5 years after OAGB. The perforation was managed by stapled resection of the perforated fundus and closure of Peterson's space for potential hernia as a causative factor, and the patient had a smooth postoperative recovery. DISCUSSION Early diagnosis is crucial in post bariatric emergencies with a low threshold of early intervention. Gastric remnant perforation was previously described in some reports following Roux-en-Y gastric bypass (RYGB) but not after OAGB. Etiology of perforation can be rationalized to primary gastric remnant pathology or secondary to external factors such as back pressure of mechanical/functional bowel obstruction. CONCLUSION Peterson's hernia and gastric remnant perforation are rare, yet serious, complications that need to be kept in mind while dealing with post-OAGB patients presenting with abdominal pain. Early diagnosis and treatment are essential for a better outcome.
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Pereira Gonçalves MM, Daldegan F, Iannuzzi GC, Rodrigues MM, Jesus-Silva SGD. Association between weight loss and reduced use of antihypertensive, hypoglycemic, psychotropic, and lipid-lowering drugs in patients undergoing bariatric surgery. REVISTA CIÊNCIAS EM SAÚDE 2021. [DOI: 10.21876/rcshci.v11i1.940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives: To analyze whether the weight reduction observed in bariatric surgery (Roux-en-Y gastric bypass; BGYR) is accompanied by a reduction in the use of antihypertensive, hypoglycemic, antilipidemic, and psychotropic drugs after 6 and 12 months. Methods: Longitudinal, retrospective study of 100 adult patients undergoing RYGB from May 2015 to January 2019, by laparotomy or laparoscopy. Data on age, body mass index (BMI), and the number of drugs used were recorded 6 and 12 months after surgery. Results: The mean age was 39.7 ± 9.7 years, and the majority were female (n = 78). The mean preoperative BMI was 43.7 ± 5.1 kg/m2, and the mean reduction in BMI after 6 months was 12.1 kg/m2 and 14.9 kg/m2 after 12 months. The reduction in antihypertensive drugs was 65.2% after 6 months and 96% after 12 months. The reduction in 6 months of hypoglycemic agents was 84.3%, and in 12 months, 98.3%. The average reduction in antidyslipidemic drugs was 86.7% in 6 months, and there was no record of using this medication after 12 months. Psychotropics showed a temporary reduction in use after 6 months with a return to levels close to the baseline after 1 year.There was no correlation between the variation in BMI and the use of drugs. Conclusions: there was a significant reduction in the use of drugs after 6 and 12 m, except for psychotropic drugs. The reduction in the use of drugs was not correlated with a reduction in BMI.
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Girishekar B, Rawat S, Ananthasivan R, Reddy P, Patil P, Kaushik K. Role of Imaging in Bariatric Surgery: A Review of the Various Surgical Techniques and Their Complications. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0041-1725240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractAccording to the World Health Organization, obesity has reached epidemic proportions globally, with at least 2.8 million people dying each year as a result of being overweight or obese. Bariatric surgery is being increasingly used as a form of treatment, particularly in those patients where lifestyle modifications are deemed insufficient. With the role of radiologists transitioning from a medical to a surgical evaluation in obesity, it is becoming increasingly important to familiarize oneself with the various imaging techniques used in the preoperative and postsurgical evaluation in such cases. This article aims to review the various surgeries performed, their normal imaging appearance, and the various complications that could be encountered.
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Affiliation(s)
| | - Sudarshan Rawat
- Department of Radiology, Manipal Hospital, Bengaluru, Karnataka, India
| | - Rupa Ananthasivan
- Department of Radiology, Manipal Hospital, Bengaluru, Karnataka, India
| | - Pramesh Reddy
- Department of Radiology, Manipal Hospital, Bengaluru, Karnataka, India
| | - Pooja Patil
- Department of Radiology, Manipal Hospital, Bengaluru, Karnataka, India
| | - Kavya Kaushik
- Department of Radiology, Manipal Hospital, Bengaluru, Karnataka, India
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Abdallah E, Emile SH, Zakaria M, Fikry M, Elghandour M, AbdelMawla A, Rady O, Abdelnaby M. One-anastomosis gastric bypass (OAGB) with fixed bypass of the proximal two meters versus tailored bypass of the proximal one-third of small bowel: short-term outcomes. Surg Endosc 2021; 36:328-335. [PMID: 33479836 DOI: 10.1007/s00464-020-08284-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/31/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND One-anastomosis gastric bypass (OAGB) is an effective bariatric procedure that confers satisfactory weight loss and improvement in comorbidities. The present study aimed to compare OAGB with fixed bypass of the proximal 200 cm of small bowel and tailored bypass of the proximal 1/3 of bowel. METHODS Patients with class II/III obesity underwent OAGB with either fixed bypass of the proximal two meters or tailored bypass of the proximal 1/3 of bowel. The main outcomes of the study were weight loss, improvement in comorbidities, complications, and changes in nutritional parameters after each technique. RESULTS The present study included 80 patients (62 female) of a mean age of 41 years and mean body mass index (BMI) of 50.9 kg/m2. The tailored bypass group was followed by a significantly lower BMI and significantly higher excess weight loss and total weight loss at 6 and 12 months postoperatively. There was no significant difference between the two groups in terms of improvement in comorbidities. The fixed bypass group was associated with a significantly higher complication rate than the tailored bypass group (22.5 vs. 5%, P = 0.04). Both groups were associated with similar changes in the nutritional parameters at 12 months postoperatively, except for the higher serum albumin levels after the tailored bypass than the fixed bypass. CONCLUSIONS OAGB with tailored bypass of the proximal one-third of bowel was associated with greater weight loss and comparable improvement in comorbidities as compared to fixed bypass of the proximal two meters of intestine.
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Affiliation(s)
- Emad Abdallah
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Elgomhuoria Street, Mansoura, Egypt
| | - Sameh Hany Emile
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Elgomhuoria Street, Mansoura, Egypt.
| | - Mahmoud Zakaria
- General Surgery Department, Ain Shams University Hospitals, Ain Shams University, Cairo, Egypt
| | - Mohamed Fikry
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Elgomhuoria Street, Mansoura, Egypt
| | - Mohamed Elghandour
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Elgomhuoria Street, Mansoura, Egypt
| | - Ahmed AbdelMawla
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Elgomhuoria Street, Mansoura, Egypt
| | - Omar Rady
- General Surgery Department, Mansoura General Hospital, Mansoura, Egypt
| | - Mahmoud Abdelnaby
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Elgomhuoria Street, Mansoura, Egypt
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Gupta N, Agrawal H. Dr. Edward E. Mason: Father of Bariatric Surgery. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02700-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Anxiety and Depression Affect Early Postoperative Pain Dimensions after Bariatric Surgery. J Clin Med 2020; 10:jcm10010053. [PMID: 33375765 PMCID: PMC7801948 DOI: 10.3390/jcm10010053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 12/15/2022] Open
Abstract
Uncontrolled postoperative pain and prolonged immobilization after bariatric surgery have been associated with increased postoperative complications and prolonged hospitalization. The aim of our study was to evaluate the postoperative pain that follows bariatric surgery and identify any psychological factors that may affect the early postoperative perception of pain. The study included 100 patients with obesity (women, n = 61; age 37.4 ± 9.9 years, mean ± standard deviation; Body Mass Index (BMI) 47.6 ± 6.5 kg/m2) who underwent bariatric surgery. Preoperative anxiety and depression were evaluated by the Hospital Anxiety and Depression Scale (HADS), and the quantitative and qualitative dimension of early postoperative pain were evaluated by the McGill Pain Questionnaire Short Form (MPQ-SF). Furthermore, the postoperative analgesia protocol was recorded for each patient. Pain declined gradually during the first 24 h postoperative. Although preoperative anxiety had no correlation with the overall pain of postoperative Day 0, patients with a higher level of preoperative anxiety had significantly more intense and more unpleasant pain at 1 h post operation. In addition, depression influences both the intensity and unpleasantness of pain at different time points (1 h, 4 h and 24 h postoperative). Preoperative pain correlated with educational level, but not with age, BMI, gender, marital status, smoking and surgery type. In conclusion, preoperative anxiety and depression influence the early postoperative pain after bariatric surgery, and their preoperative identification is of major importance to enhance the implementation of fast-track postoperative protocols to prevent complications and prolonged hospitalization.
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A Clinical Decision Support System for Predicting the Early Complications of One-Anastomosis Gastric Bypass Surgery. Obes Surg 2020; 29:2276-2286. [PMID: 31028626 DOI: 10.1007/s11695-019-03849-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND/OBJECTIVE One of the most effective treatments for patients with obesity, albeit with some complications, is obesity surgery. The aim of this study was to develop a clinical decision support system (CDSS) to predict the early complications of one-anastomosis gastric bypass (OAGB) surgery. SUBJECTS/METHODS This study was conducted in Tehran, Iran on patients who underwent OAGB surgery in 2011-2014 in five hospitals. Initially, variables affecting the OAGB early complications were identified using the literature review. Patients' data were extracted from an existing database of obesity surgery. Then, different artificial neural networks (ANNs) (multilayer perceptron (MLP) network) were developed and evaluated for prediction of 10-day, 1-month, and 3-month complications. RESULTS Factors including age, BMI, smoking status, intra-operative complications, comorbidities, laboratory tests, sonography results, and endoscopy results were considered important factors for predicting early complications of OAGB. A CDSS was developed with these variables. The accuracy, specificity, and sensitivity of the 10-day prediction system in the test data were 98.4%, 98.6%, and 98.3%, respectively. These figures for 1-month system were 96%, 93%, and 98.4% and for the 3-month system were 89.3%, 86.6%, and 91.5%, respectively. CONCLUSIONS Using the CDSS designed, we could accurately predict the early complications of OAGB surgery.
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Weight Loss and Vomiting 1 Year After Banded Versus Non-banded One Anastomosis Gastric Bypass: a Prospective Randomized Trial. Obes Surg 2020; 30:1719-1725. [PMID: 31942688 DOI: 10.1007/s11695-020-04393-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The weight loss outcomes after banded one-anastomosis gastric bypass (OAGB) remain to be determined. OBJECTIVE To compare weight loss and vomiting 1 year after banded versus non-banded OAGB. METHODS This is a prospective, open-label, randomized study, which evaluated 33 individuals with morbid obesity, which underwent banded (16 individuals) and non-banded OAGB (17 individuals) and were followed up for 12 months. Weight loss (percentages of total weight loss-%TWL-and excess weight loss-%EWL) and occurrence of vomiting were assessed and compared before surgery and after 6 and 12 months. RESULTS At baseline, there were no differences between groups in regard to age, gender, and body mass index (BMI). At 6 and 12 months post-op, and the overall mean %TWL regardless of band use was 22.4 ± 7% and 29 ± 6.9%, respectively, and the overall average %EWL regardless of band use was 66.8 ± 22.9% and 86.3 ± 24%, respectively. %TWL did not differ between the banded and non-banded groups at 6 (21.8 ± 6.8% vs. 23.1 ± 7.4%; p = 0.7) and 12 months post-op (27.5 ± 6.6% vs. 30.4 ± 7.1%; p = 0.3), as well as %EWL at 6 (67 ± 22.9% vs. 67.6 ± 23.6%; p = 0.6) and 12 months post-op (83.5 ± 24.4% vs. 89 ± 24.1%; p = 0.4). The occurrence of vomiting did not significantly differ between banded and non-banded OAGB at 6 (12.5% vs. 11.8%; p = 0.9) and 12 months post-op (12.5% vs. 5.9%; p = 0.5). CONCLUSION OAGB led to an overall satisfactory weight loss after 1 year, regardless of band use. Banded OAGB did not lead to neither significantly higher weight loss nor more vomiting than non-banded OAGB 1 year after surgery.
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Landreneau JP, Barajas-Gamboa JS, Strong AT, Corcelles R, Kroh MD. Conversion of one-anastomosis gastric bypass to Roux-en-Y gastric bypass: short-term results from a tertiary referral center. Surg Obes Relat Dis 2019; 15:1896-1902. [DOI: 10.1016/j.soard.2019.09.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/10/2019] [Accepted: 09/03/2019] [Indexed: 12/27/2022]
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Zilberstein B, Santo MA, Carvalho MH. CRITICAL ANALYSIS OF SURGICAL TREATMENT TECHNIQUES OF MORBID OBESITY. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2019; 32:e1450. [PMID: 31644670 PMCID: PMC6812144 DOI: 10.1590/0102-672020190001e1450] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 01/16/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Obesity is a disease of high prevalence in Brazil and in the world, and bariatric surgery, with its different techniques, is an alternative treatment. OBJECTIVE To compare techniques: adjustable gastric band (AGB), sleeve gastrectomy), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) analyzing leaks, bleeding, death, weight loss, resolution of type 2 diabetes, systemic arterial hypertension, dyslipidemia and obstructive sleep apnea. METHODS Were selected studies in the PubMed database from 2003 to 2014 using the descriptors: obesity surgery; bariatric surgery; biliopancreatic diversion; sleeve gastrectomy; Roux-en-Y gastric bypass and adjustable gastric banding. Two hundred and forty-four articles were found with the search strategy of which there were selected 116 studies through the inclusion criteria. RESULTS Excess weight loss (EWL) after five years in AGB was 48.35%; 52.7% in SG; 71.04% in RYGB and 77.90% in BPD. The postoperative mortality was 0.05% in the AGB; 0.16% on SG; 0.60% in RYGB and 2.52% in BPD. The occurrence of leak was 0.68% for GBA; 1.93% for SG; 2.18% for RYGB and 5.23% for BPD. The incidence of bleeding was 0.44% in AGB; 1.29% in SG; 0.81% in RYGB and 2.09% in BPD. The rate of DM2 resolved was 46.80% in AGB, 79.38% in SG, 79.86% in RYGB and 90.78% in BPD. The rate of dyslipidemia, apnea and hypertension resolved showed no statistical differences between the techniques. CONCLUSION The AGB has the lowest morbidity and mortality and it is the worst in EWL and resolution of type 2 diabetes. The SG has low morbidity and mortality, good resolution of comorbidities and EWL lower than in RYGB and BPD. The RYGB has higher morbidity and mortality than AGB, good resolution of comorbidities and EWL similar to BPD. The BPD is the worst in mortality and bleeding and better in EWL and resolution of comorbidities.
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Affiliation(s)
- Bruno Zilberstein
- Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Marco Aurélio Santo
- Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Marnay Helbo Carvalho
- Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Cazzo E, Valerini FG, Chaim FHM, Soares PFDC, Ramos AC, Chaim EA. EARLY WEIGHT LOSS OUTCOMES AND GLUCOSE METABOLISM PARAMETERS AFTER BANDED VERSUS NON-BANDED ONE ANASTOMOSIS GASTRIC BYPASS: A PROSPECTIVE RANDOMIZED TRIAL. ARQUIVOS DE GASTROENTEROLOGIA 2019; 56:15-21. [PMID: 31141062 DOI: 10.1590/s0004-2803.201900000-14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/25/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The influence of the placement of a band on the outcomes of one anastomosis gastric bypass (OAGB) has not been appropriately studied yet. OBJECTIVE To compare early weight loss and glucose metabolism parameters following banded versus non-banded OAGB. METHODS A prospective randomized study, which evaluated 20 morbidly obese individuals who underwent banded and non-banded OAGB and were followed-up for three months. Weight loss (percentage of excess weight loss - %EWL and percentage of body mass index loss - %BMIL) and glucose metabolism outcomes (glucose, insulin and homeostasis model assessment - HOMA) were compared. RESULTS The banded group presented a significantly higher %EWL at one month (29.6±5.5% vs 17.2±3.4%; P<0.0001) and two months post-surgery (46±7% vs 34.2±9%; P=0.004544), as well as a significantly higher %BMIL at one month (9.7±1.1% vs 5.8±0.8%; P<0.0001), two months (15±1.4% vs 11.5±2.1; P=0.000248), and three months (18.8±1.8% vs 15.7±3.2%; P=0.016637). At three months, banded OAGB led to significant decreases of insulin (14.4±4.3 vs 7.6±1.9; P=0.00044) and HOMA (3.1±1.1 vs 1.5±0.4; P=0.00044), whereas non-banded OAGB also led to significant decreases of insulin (14.8±7.6 vs 7.8±3.1; P=0.006) and HOMA (3.2±1.9 vs 1.6±0.8; P=0.0041). The percent variation of HOMA did not significantly differ between banded and non-banded OAGB (P=0.62414); overall, the percent variation of HOMA was not correlated with %EWL (P=0.96988) or %BMIL (P=0.82299). CONCLUSION Banded OAGB led to a higher early weight loss than the standard technique. Banded and non-banded OAGB led to improvements in insulin resistance regardless of weight loss.
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Affiliation(s)
- Everton Cazzo
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
| | - Felipe Gilberto Valerini
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
| | - Fábio Henrique Mendonça Chaim
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
| | - Pedro França da Costa Soares
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
| | - Almino Cardoso Ramos
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
| | - Elinton Adami Chaim
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
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