Derivações gástricas em y- de- roux com anel de silicone para o tratamento da obesidade: estudo das complicações relacionadas com o anel

Banded RYGB Ring Slippage Endoscopic Removal with Self-expandable Stents: a Comparative Study Between Metallic and Plastic One

PURPOSE

Banded Roux-en-Y gastric bypass (RYGB) was a common bariatric procedure in the 2000s, and the ring slippage is one of its late adverse events. Both plastic and metallic stents have been reported as adjunct methods to induce erosion and facilitate endoscopic removal of the ring.

OBJECTIVE

To compare the safety and effectiveness of self-expanding metallic stents (SEMS) and plastic stents (SEPS) to treat ring slippage.

MATERIALS AND METHODS

We conducted a retrospective longitudinal study analyzing consecutive patients with ring dysfunction treated with stents plus endoscopic removal.

RESULTS

Ninety patients were enrolled (36 SEMS vs. 54 SEPS). The mean age was 48.56 ± 13.07 and 45.6 ± 12.1 in the SEMS and SEPS groups, respectively. All patients had band slippage, but 24 from SEMS group and 23 from SEPS group had further complications. There were more complications in metallic stent concerning mean absolute number of therapy-related adverse events (1.33 ± 0.48 vs. 1.72 ± 0.5, p > 0.05) and time until erosion (14.9 ± 1.6 vs. 13.8 ± 1.4 days, p > 0.05). Female sex and age > 41 years old correlated with longer time to band erosion and higher incidence of adverse events in SEMS patients. In SEPS group, only female sex was a risk factor for adverse events.

CONCLUSION

Both procedures were efficient at inducing band erosion with similar safety profiles. Older and female patients are at a higher risk of treatment-related adverse events, especially those receiving SEMS.

Gastric Emptying and Food Tolerance Following Banded and Non-banded Roux-en-Y Gastric Bypass

INTRODUCTION

Gastric emptying (GE) and food tolerance (FT) can be altered after Roux-en-Y gastric bypass (RYGB) has been performed, especially when it involved the use of a restrictive mechanism (such as a silastic ring).

AIM

To assess GE and FT in patients who underwent banded (BRYGB) or non-banded Roux-en-Y gastric bypass (RYGB).

METHODS

Forty-seven BRYGB patients and 47 RYGB patients underwent gastric emptying scintigraphy (GES) and FT assessment (by means of a questionnaire) between 6 months and 2 years postoperatively.

RESULTS

GES was performed on average 11.7 ± 5.0 months (6 to 24) postoperatively. T½ medians (time taken for the gastric radioactivity to decrease to half of the original value in the gastric pouch) in the RYGB and BRYGB groups were 48.7 min (40.6-183.0 min) and 56.3 min (41.1-390.9 min), respectively (p = 0.031). The median of total questionnaire scores was 24 points (18-27) in the RYGB group and 20 points (13-27) in the BRYBG group (p < 0.001).

CONCLUSIONS

The band (silastic ring) delays GE time and does not affect patient satisfaction or food tolerance to vegetables, bread, or rice, but does affect tolerance to the intake of meat, salad, and pasta. The best tolerated foods are vegetables, salad, and fish. Banded patients are more likely to regurgitate and vomit. Gastric emptying does not affect FT.

Silastic band erosion in the bypassed stomach after Fobi-Pouch operation for obesity: Case report

INTRODUCTION

Worldwide, one of the most commonly performed bariatric surgeries is the laparoscopic Roux-en-Y gastric bypass (LRYGP). Access to the bypassed stomach in patients who have undergone this procedure, for evaluation and/or management in different clinical situations remains a challenge for the physician. In order to facilitate the entrance to the gastric remnant, a silastic marker is left in place during the Fobi-Pouch operation, a modified laparoscopic gastric bypass surgery technique.

PRESENTATION OF CASE

We present the case of a 56-year old female who presented 10 years after a Fobi-pouch operation, complaining of severe upper gastrointestinal bleeding. An enteroscopy revealed several marginal ulcers and erosion of the silastic ring marker in the excluded stomach. A partial gastric sleeve resection including the silastic ring was performed without any complications, preventing further bleeding due to the eroded ring.

DISCUSSION

Physicians must be familiarized with the different bariatric procedures in order to associate the patient's symptomatology and possible surgery-related complications. Gastric ulceration and bleeding related to the presence of a foreign body have been previously described; however, to the best of our knowledge this is the first article reporting the concomitant erosion and bleeding of the silastic marker in the excluded stomach.

CONCLUSION

Silastic marker erosion in the bypassed stomach is a rare but possible complication not reported in the literature before. Different approaches for this complication are possible including laparoscopic management, with excellent results.

IMPACT ON QUALITY OF LIFE, WEIGHT LOSS AND COMORBIDITIES: a study comparing the biliopancreatic diversion with duodenal switch and the banded Roux-en-Y gastric bypass

Context Few studies have evaluated the results of different types of bariatric surgery using the Medical Outcome Study 36 - Health Survey Short-Form (SF-36) quality of life questionnaire, the Bariatric and Reporting Outcome System (BAROS) and the reviewed Moorehead-Ardelt Quality of Life II Questionnaire (M-A QoLQ II) that is part of BAROS. The Roux-en-Y gastric bypass (RYGB) is the most common morbid obesity surgery worldwide. However, there is evidence indicating that a biliopancreatic diversion with duodenal switch (DS) is more effective than RYGB in weight loss terms. Objectives To evaluate the impact of different types of bariatric surgery on quality of life, comorbidities and weight loss. Methods Two groups of patients who underwent bariatric surgery conventional Banded Roux-en-Y gastric bypass (BRYGB) or DS were evaluated through monitoring at 12 to 36 months after surgery, as well as a control group of obese patients who had not undergone surgery. The tools used for this were SF-36, BAROS and M-A QoLQ II. The DS group consisted of 17 patients and the BRYGB group consisted of 20. The control group comprised 20 independent, morbidly obese individuals. Results The mean age of the patients in the groups was 45.18 in the DS group, 49.75 in the BRYGB group and 44.25 in the control group, with no significant difference. There was no difference in the ratio of men to women in the groups. The patients that had surgery showed a significant improvement in all domains of quality of life vs the control group. Comparing the two groups that underwent surgery, the DS group achieved better quality of life results in terms of “general state of health” and “pain”, according to responses to the SF-36 tool, and in terms of “sexual interest”, according to responses to the M-A QoLQ II tool. There was no significant difference among the three groups regarding the ratio of occurrence of comorbidities. In the groups that had surgery, the resolution of comorbidities was similar. The final classification according to the BAROS Protocol was excellent for the DS group and very good for the BRYGB group, with a statistical difference in favor of the DS group (P = 0.044*). There was no difference in the percentages of excess weight loss between the DS group (82.1%) and the BRYGB group (89.4%) (P = 0.376). Conclusions A comparison of the performance of the groups, which were monitored from 12 to 36 months after surgery, showed that the two types of surgery are effective to improve quality of life, comorbidities and weight loss. The DS surgery produced better results in the quality of life evaluations regarding 2 of 8 domains according to the SF-36, and “sexual interest” according to the M-A QoLQ II. In the groups that had surgery, the patients showed high rates of comorbidity resolution. Weight loss was similar for the two surgical groups.

Ring influence on ponderal evolution after four years of laparoscopic Roux-en-Y gastric bypass

BACKGROUND

Use of ring in Roux-en-Y gastric bypass is still a matter of controversy among bariatric surgeons. There is no consensus on its impact in relation to weight loss and weight maintenance in the long term.

AIM

To evaluate the influence of the ring on the evolution of body weight over four years after bariatric surgery.

METHODS

Retrospective analyzis of 143 women who underwent laparoscopic Roux-en-Y gastric bypass paired on the use or not use of Silastic® ring. Follow-up time was 48 months. Inclusion criteria were age over 18 years, primary bariatric operation and regular attendance at the clinic during the period of interest for research. The technique kept small gastric reservoir estimated in a volume of 30 ml. The food limb had in average 150 cm and the bile one 40 cm from the duodenojejunal angle. The group "ring" used Silastic® device with length of 6.5 cm, placed 2 cm from gastrojejunal anastomosis. The ring was closed for five polypropylene surgical thread sutures. In the morning after surgery the patients received isotonic fluids; on the second day salty liquid diet and were discharged on the third day. Semisolid diet started from the 20th day and solid on the 30th, with daily tablet of polivitamins.

RESULTS

The weight loss was larger on the ring than without ring groups in all periods, respectively 10% and only 5% in the third postoperative year. The proportion of not having reached the 50% excess weight loss expectative was significantly higher in the group without ring than in the group with the ring (31% and 8% respectively in the fourth year). There was no difference between groups in delayed recovery of weight lost with the operation.

CONCLUSIONS

The results were favorable to use the ring exclusively when it is analyzed only the weight loss.