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Deycies Gaete L, Attila Csendes J, Tomás González A, Álvaro Morales P, Panza B. Long-term (11 Years) Results of Laparoscopic Gastric Bypass: Changes in Weight, Blood Levels of Sugar and Lipids, and Late Adverse Effects : Laparoscopic Gastric Bypass Results. Obes Surg 2024; 34:3266-3274. [PMID: 38760651 DOI: 10.1007/s11695-024-07249-7] [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: 09/26/2023] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/19/2024]
Abstract
PURPOSE Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) remains the most effective procedure to treat severe obesity with proven short- and intermediate-term benefits. The main goal is to describe the effects on weight and biochemical laboratory tests after long-term follow-up (11 years). MATERIALS AND METHODS A prospective cohort of adults with obesity treated with LRYGB between 2004 and 2010 in one center were studied. Patients with prior bariatric or upper digestive tract surgery, hiatal hernia >4 cm, alcoholism, or decompensated conditions were excluded. The study enrolled 123 patients, with a mean follow-up of 133±29 months and a 14% loss of participants. RESULTS The percentage of Total Weight Loss (%TWL) at one, five, and eleven years was 30.3±8.4%, 29.1±6.9%, and 23.4±7%, respectively. Of the patients, 61.3% (65/106) maintained a %TWL≥20 after eleven years. Recurrent Weight Gain (RWG) at five and eleven years was 2.6±11.4% and 11 ±11.5%, respectively. At the end of the follow-up, 31.1% (33/106) of patients had RWG≥15%. Hypercholesterolemia and hypertriglyceridemia improved in 85.7% (54/63) and 90.2% (7/61) of the cohort, respectively. Remission of diabetes occurred in 80% of this subgroup. Gallstones developed in 28% of patients, and bowel obstruction due to internal hernia occurred in 9.4%. Anemia due to iron deficiency appeared in 25 patients. CONCLUSION After surgery, there is a significant and durable loss of weight, with a tendency for late Recurrent Weight Gain. Furthermore, the improvement in biochemical parameters is sustained over time, but surgery's adverse effects may appear later.
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Affiliation(s)
- L Deycies Gaete
- Department of Surgery, University Hospital, University of Chile, Carlos Lorca Tobar #999, Independencia, Región Metropolitana, 8380000, Santiago, Chile
| | - J Attila Csendes
- Department of Surgery, University Hospital, University of Chile, Carlos Lorca Tobar #999, Independencia, Región Metropolitana, 8380000, Santiago, Chile.
| | - A Tomás González
- Department of Surgery, University Hospital, University of Chile, Carlos Lorca Tobar #999, Independencia, Región Metropolitana, 8380000, Santiago, Chile
| | - P Álvaro Morales
- Department of Surgery, University Hospital, University of Chile, Carlos Lorca Tobar #999, Independencia, Región Metropolitana, 8380000, Santiago, Chile
| | - Benjamín Panza
- Faculty de Medicine, University Los Andes, Monseñor Álvaro del Portillo #12455, Las Condes, Región Metropolitana, 8380000, Santiago, Chile
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Braghetto I, Czwiklitzer G, Korn O, Brante P, Burgos A. RESULTS OF MECHANIC VERSUS MOTORIZED STAPLER USED IN GASTRIC SURGERY: PROSPECTIVE STUDY. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2024; 37:e1818. [PMID: 39230118 PMCID: PMC11363907 DOI: 10.1590/0102-6720202400025e1818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/02/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND Mechanic sutures represent an enormous benefit for digestive surgery in decreasing postoperative complications. Currently, the advantages of motorized stapler are under evaluation. AIMS To compare the efficacy of mechanic versus motorized stapler in gastric surgery, analyzing rate of leaks, bleeding, time of stapling, and postoperative complications. METHODS Ninety-eight patients were submitted to gastric surgery, divided into three groups: laparoscopic sleeve gastrectomy (LSG) (n=47), Roux-en-Y gastric bypass (LRYGB) (n=30), and laparoscopic distal gastrectomy (LDG) (n=21). Motorized staplers were employed in 61 patients. The number of firings, number of clips, time of total firings, total time to complete the surgery, and postoperative outcome were recorded in a specific protocol. RESULTS Patients submitted to LSG, LRYGB, and LDG recorded a shorter time to complete the procedure and a smaller number of firings were observed using motorized stapler (p<0.0001). No differences were identified regarding the number of clips used in patients submitted to LSG. In the group that used mechanic stapler to complete gastrojejunostomy, jejuno-jejuno-anastomosis, and jejunal transection, it was observed more prolonged time of firing and total time for finishing the procedure (p=0.0001). No intraoperative complications were found comparing the two devices used. Very similar findings were noted in the group of patients undergoing LDG. CONCLUSIONS The motorized stapler offers safety and efficacy as demonstrated in prior reports and is relevant since less total time of surgical procedure without intraoperative or postoperative complications were confirmed.
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Affiliation(s)
- Italo Braghetto
- Digestive and Bariatric Surgical Unit, Redsalud Providencia, Santiago, Chile
| | - Gustavo Czwiklitzer
- Digestive and Bariatric Surgical Unit, Redsalud Providencia, Santiago, Chile
| | - Owen Korn
- Digestive and Bariatric Surgical Unit, Redsalud Providencia, Santiago, Chile
| | - Percy Brante
- Digestive and Bariatric Surgical Unit, Redsalud Providencia, Santiago, Chile
| | - Ana Burgos
- Digestive and Bariatric Surgical Unit, Redsalud Providencia, Santiago, Chile
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Capaverde LH, Trindade EN, Leite C, Cerski CTS, Trindade MRM. Marginal Ulcer Incidence and the Population of Gastrin Producing G cells Retained in the Gastric Pouch after Roux-en-Y Gastric Bypass: Is There a Relationship? Obes Surg 2024; 34:1152-1158. [PMID: 38351199 DOI: 10.1007/s11695-024-07078-8] [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: 02/19/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Marginal ulcers are the most prevalent endoscopic abnormality after RYGB. The etiology is still poorly understood; however, an increase in acid secretion has been strongly implicated as a causal agent. Although gastrin is the greatest stimulant of acid secretion, to date, the presence of gastrin producing G cells retained in the gastric pouch, related to the occurrence of marginal ulcers, has not been evaluated. OBJECTIVE Evaluate the density of G cells and parietal cells in the gastric pouch of RYGB patients with a diagnosis of marginal ulcer on the post-op EGD. METHOD We retrospectively evaluated 1104 gastric bypasses performed between 2010 and 2020. Patients with marginal ulcer who met the inclusion criteria and controls were selected from this same population. Endoscopic gastric pouch biopsies were evaluated using immunohistochemical study and HE staining to assess G cell and parietal cell density. RESULTS In total, 572 (51.8%) of the patients performed endoscopic follow-up after RYGB. The incidence of marginal ulcer was 23/572 (4%), and 3 patients required revision surgery due to a recalcitrant ulcer. The mean time for ulcer identification was 24.3 months (2-62). G cell count per high-power field (× 400) was statistically higher in the ulcer group (p < 0.05). There was no statistical difference in parietal cell density between groups (p 0.251). CONCLUSION Patients with a marginal ulcer after gastric bypass present a higher density of gastrin-producing G cells retained in the gastric pouch.
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Affiliation(s)
- Luiz H Capaverde
- Department of Digestive Surgery, Hospital São Lucas da PUC-RS, Centro Clínico Sala 506, Av Ipiranga 6690, Porto Alegre, RS, CEP: 90610-000, Brazil.
| | - Eduardo N Trindade
- Department of Digestive Surgery, Hospital de Clínicas de Porto Alegre and Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Carine Leite
- Department of Gastroenterology and Endoscopy, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Carlos T S Cerski
- Department of Pathology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Manoel R M Trindade
- Department of Digestive Surgery, Hospital de Clínicas de Porto Alegre and Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
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Apostolou KG, Lazaridis II, Kanavidis P, Triantafyllou M, Gkiala A, Alexandrou A, Ntourakis D, Delko T, Schizas D. Incidence and risk factors of symptomatic Petersen's hernias in bariatric and upper gastrointestinal surgery: a systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:49. [PMID: 36662172 DOI: 10.1007/s00423-023-02798-4] [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: 09/19/2022] [Accepted: 11/29/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE The aim of this study was to investigate the actual incidence of symptomatic Petersen's hernias (PH) as well as identify risk factors for their occurrence. METHODS Search was performed in Medline (via PubMed), Web of Science, and Cochrane library, using the keywords "Petersen Or Petersen's AND hernia" and "Internal hernia." Only studies of symptomatic PH were eligible. Fifty-three studies matched our criteria and were included. Risk of bias for each study was independently assessed using the checklist modification by Hoy et al. Analysis was performed using random-effects models, with subsequent subgroup analyses. RESULTS A total of 81,701 patients were included. Mean time interval from index operation to PH diagnosis was 17.8 months. Total small bowel obstruction (SBO) events at Petersen's site were 737 (0.7%). SBO incidence was significantly higher in patients without defect closure (1.2% vs 0.3%, p < 0.01), but was not significantly affected by anastomosis fashion (retrocolic 0.7% vs antecolic 0.8%, p = 0.99). SBO incidence was also not significantly affected by the surgical approach (laparoscopic = 0.7% vs open = 0.1%, p = 0.18). However, retrocolic anastomosis was found to be associated with marginally, but not significantly, increased SBO rate in patients with Petersen's space closure, compared with the antecolic anastomosis (p = 0.09). CONCLUSION PH development may occur after any gastric operation with gastrojejunal anastomosis. Contrary to anastomosis fashion and surgical approach, defect closure was demonstrated to significantly reduce SBO incidence. Limitations of this study may include the high heterogeneity and the possible publication bias across the included studies.
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Affiliation(s)
- Konstantinos G Apostolou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece.
| | - Ioannis I Lazaridis
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Prodromos Kanavidis
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece
| | - Margarita Triantafyllou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece
| | - Anastasia Gkiala
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece
| | - Andreas Alexandrou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece
| | | | - Tarik Delko
- Chirurgie Zentrum St. Anna, St. Anna-Strasse 32, 6006, Lucerne, Switzerland
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece
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J Csendes A, L Gaete D, M Carreño B, Panza B. Clinical Endoscopic and Histologic Findings of a Long-Term Follow-Up (10.7 Years) After Roux-en-Y Laparoscopic Gastric Bypass: a Prospective Study. Obes Surg 2022; 32:2930-2937. [PMID: 35776241 DOI: 10.1007/s11695-022-06172-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: 04/26/2022] [Revised: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Bariatric surgery, with laparoscopic Roux-en-Y gastric bypass (LYGB), is one of the most effective treatments for long-term weight loss. However, there are few publications concerning endoscopic evaluations at late control. The purpose was to evaluate the macroscopic and histological findings at the distal esophagus, gastric pouch, jejunal limb and the evolution of Barrett's esophagus (BE) in the long term. METHODS Cohort of 110 patients with obesity underwent LYGB in a university hospital. Several clinical, endoscopic and histological evaluations were performed after surgery. Exclusion criteria were previous bariatric procedure, hiatal hernia > 4 cm, BE with histological dysplasia and body mass index (BMI) > 50 kg/m2. RESULTS Average age was 38.7 ± 9 years with 70% females. BMI averaged 39.6 ± 6 kg/m2. Follow-up was 10.7 ± 2 years, and 18 patients (16.4%) were lost. The total weight loss was 23.4 ± 7 kg. Erosive esophagitis, present in 33% of patients, decreased to 5%. After surgery, intestinal metaplasia regressed to cardial mucosa in 5 of 8 patients. One patient developed a short-segment BE. The level of control to gastroesophageal reflux disease (GERD) symptom control was 87% to responders (Visick I-II) and 13% to non-responders (Visick III-IV). An increase in dilated cardia type III was observed (p < 0.001). The length of the gastric pouch increased significantly after surgery (p < 0.001). Anastomotic ulcers healed at 6 months with proton pump inhibitor (PPI) use, without recurrence. CONCLUSION LYGB is a very effective surgical procedure to control symptoms of GERD and/or endoscopic erosive esophagitis. Besides, regression of Barrett's mucosa to carditis occurred in 62%.
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Affiliation(s)
- Attila J Csendes
- Department of Surgery, University Hospital, University of Chile, , Carlos Lorca Tobar#999, Independencia, Región Metropolitana, 8380000, Santiago, Chile.
| | - Deycies L Gaete
- Department of Surgery, University Hospital, University of Chile, , Carlos Lorca Tobar#999, Independencia, Región Metropolitana, 8380000, Santiago, Chile
| | - Bárbara M Carreño
- Department of Surgery, University Hospital, University of Chile, , Carlos Lorca Tobar#999, Independencia, Región Metropolitana, 8380000, Santiago, Chile
| | - Benjamín Panza
- Faculty de Medicine, University Los Andes, Monseñor Álvaro del Portillo #12455, Las Condes, Región Metropolitana, 8380000, Santiago, Chile
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IAROSESKI J, GROSSI JV, MARSALA GM, CAPAVERDE LH, ROSSI LF. Obesity and achalasia: challenges in diagnosing and treating them. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.21.05301-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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IAROSESKI J, MACHADO GROSSI JV, ROSSI LF. Acute abdomen and pneumoperitoneum: complications after gastric bypass in Candy Cane syndrome. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.21.05263-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bigolin AV, Iaroseski J, Rodrigues AP, De Lima JNC. Roux-en-O: How It Happens and How to Fix It. Obes Surg 2022; 32:223-224. [PMID: 34665442 DOI: 10.1007/s11695-021-05752-9] [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: 07/08/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
The Roux-en-Y gastric bypass surgery improper technique can cause complications such as Roux-en-O, which is caused by an inadvertent anastomosis of the biliopancreatic limb to the gastric pouch, creating an "O" form to the bypass. We present intraoperative images of a mistaken Roux-en-Y's technique that caused the "O" anatomy and its successful reconstruction.
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Affiliation(s)
- André V Bigolin
- Digestive Surgery Department, Hospital Santa Casa de Misericórdia, Porto Alegre, Rio Grande Do Sul, 90035-000, Brazil
| | - Júlia Iaroseski
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande Do Sul, 90050-170, Brazil.
| | - André P Rodrigues
- Digestive Surgery Department, Hospital Santa Casa de Misericórdia, Porto Alegre, Rio Grande Do Sul, 90035-000, Brazil
| | - Juliano N C De Lima
- Digestive Surgery Department, Hospital Santa Casa de Misericórdia, Porto Alegre, Rio Grande Do Sul, 90035-000, Brazil
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Influence of Gastric Bypass on Obese Women Sexual Function-a Prospective Study. Obes Surg 2021; 31:3793-3798. [PMID: 34106400 DOI: 10.1007/s11695-021-05509-4] [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: 02/09/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Obesity may lead to hyperandrogenia and affect female sexual function. The study aims to evaluate female sexual function and androgenic profile in obese women after laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS Forty obese women with a mean age of 34 years were prospectively studied. Diabetes and psychiatric and pelvic disorders were the exclusion criteria. All patients underwent LRYGB. Total (TT) and free (FT) testosterone, androstenedione (AD), dehydroepiandrosterone (DHEA) and the Sexual Quotient - Female Version were evaluated, preoperatively, 6 and 12 months after the operation. RESULTS Preoperative incidence of sexual dysfunction was 10% and hyperandrogenia was 40%. At 6 months, sexual function was not different; and FT (0.49-0.33 ng/dl) and AD (2.0-1.3 ng/dl) decreased significantly. At 12 months, there was an improvement in female sexual function (77-84 points), related to desire and interest (22-25 points) and comfort (15.9-17.3 points) without case of sexual dysfunction at 12 months. Hyperandrogenia (40-8%), FT levels (0.5-0.3 ng/dl), and AD (2.0-1.4 ng/dl) decreased, while DHEA levels (3.4-4.2 ng/dl) increased. The percentage of weight loss was 22% and 31% at 6 and 12 months, respectively. Sexual function did not correlate with BMI, weight, or androgen levels in any period. CONCLUSION Female sexual function in obese women with no diabetes and psychiatric and pelvic disorders improved in patients undergoing LRYGB, especially in desire, interest, and sexual comfort, and this occured after 6 months of the operation and unrelated to BMI, percentage of weight loss, or androgen levels. KEY POINTS • In obese women with no diabetes and psychiatric and pelvic disorders the FSD improvement after LRYGB. • FSD no correlation with weight loss and BMI. • FSD no correlation with androgens levels.
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Povoas HP, Vilas-Bôas ML. Retrocolic retrogastric ROUX-EN-Y gastric bypass: how I do it. Langenbecks Arch Surg 2021; 406:2059-2065. [PMID: 34023942 DOI: 10.1007/s00423-021-02187-9] [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: 11/09/2020] [Accepted: 05/03/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Technical variations of the laparoscopic Roux-en-Y gastric bypass may influence the incidence of complications such as fistulas, marginal ulcers, stenosis, and internal hernias. METHODS We described the technical aspects of a retrocolic, retrogastric, laparoscopic gastric bypass procedure with manual gastrojejunostomy and the closure technique for the three mesenteric defects generated by the Roux-en-Y limb reconstruction. RESULTS We summarized the data from 587 patients concerning complications directly related to the surgical technique. There were no internal hernias in patients followed, and in only 2 cases, small bowel obstruction related to defect closure occurred. CONCLUSIONS The retrocolic, retrogastric gastric bypass performed with a meticulous closure of all three mesenteric defects reflects a low incidence of internal hernias and low complication rates related to the closure itself. The technique also allows less tension at the gastrojejunostomy.
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Affiliation(s)
- Heitor P Povoas
- BAROS - Cirurgia Bariátrica e Metabólica, Av. Prof. Magalhães Neto, 1541, sala 4012/13, Salvador, BA, 41810-011, Brazil.
| | - Marcos Leão Vilas-Bôas
- BAROS - Cirurgia Bariátrica e Metabólica, Av. Prof. Magalhães Neto, 1541, sala 4012/13, Salvador, BA, 41810-011, Brazil
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Bastos ELDS, Liberatore AMA, Tedesco RC, Koh IHJ. Gut Microbiota Imbalance Can Be Associated with Non-malabsorptive Small Bowel Shortening Regardless of Blind Loop. Obes Surg 2019; 29:369-375. [PMID: 30293133 DOI: 10.1007/s11695-018-3540-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Some traditional bariatric surgery procedures may lead to functional gut shortening, which may unsettle the fine-tuned gastrointestinal physiology and affect gut microbiota balance. PURPOSE Evaluate the gut microbiota behavior in rat models facing gut shortening due to intestinal bypass. MATERIALS AND METHODS Wistar rats (n = 17) were randomly distributed in three groups: (1) sham group (n = 5); (2) blind loop group (n = 6); and (3) resection group (n = 6). Intestinal samples and feces were analyzed to measure bacterial concentrations (small intestinal bacterial overgrowth-SIBO) 12 weeks after the experimental procedures. Bacterial translocation (BT) was investigated in the mesenteric lymph node (MLN), liver, spleen, and lung of the animals. In addition, inflammatory aspects were investigated in their liver and small bowel through histological analysis. RESULTS Regardless of blind loop, gut shortening groups recorded similar high level of bacterial concentrations in intestine compartments, greater than that of the sham group (p ≤ 0.05). BT was only observed in the MLN of gut shortening models, with higher percentage in the blind loop group (p ≤ 0.05). The gut and liver histopathological analysis showed similar low-grade chronic inflammation in both gut shortening groups, likely associated with SIBO/BT events. CONCLUSION Sustained SIBO/BT was associated with proximal gut shortening in half regardless of blind loop, whereas the GI tract's ability to restore gut microbiota balance after a surgical challenge on the small bowel appears to be linked to the functional remaining gut.
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Affiliation(s)
- Eduardo Lemos de Souza Bastos
- Department of Gastrointestinal Surgery, Marilia Medicine School, 12 Santa Helena St., Marilia, Sao Paulo, 17515-410, Brazil.
| | | | - Roberto Carlos Tedesco
- Department of Morphology and Genetics, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Ivan Hong Jun Koh
- Department of Surgery and Experimental Research Laboratory, Federal University of Sao Paulo, Sao Paulo, Brazil
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Effect of the closure of mesenteric defects in laparoscopic Roux-en-Y gastric bypass: a prospective study. Surg Obes Relat Dis 2019; 15:1903-1907. [DOI: 10.1016/j.soard.2019.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/30/2019] [Accepted: 08/03/2019] [Indexed: 11/23/2022]
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Guimarães M, Monteiro MP. Comment on: Internal hernias in pregnant females with Roux-en-Y gastric bypass: a systematic review. Surg Obes Relat Dis 2019; 15:1640-1642. [PMID: 31427221 DOI: 10.1016/j.soard.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/08/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Marta Guimarães
- Clinical and Experimental Endocrinology, Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal; Department of General Surgery, Hospital de São Sebastião, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Mariana P Monteiro
- Clinical and Experimental Endocrinology, Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
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Ribeiro R, Pouwels S, Parmar C, Pereira J, Manaças L, Guerra A, Borges N, Ribeiro J, Viveiros O. Outcomes of Long Pouch Gastric Bypass (LPGB): 4-Year Experience in Primary and Revision Cases. Obes Surg 2019; 29:3665-3671. [PMID: 31267476 DOI: 10.1007/s11695-019-04051-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND One of the most important complications of the one anastomosis gastric bypass (OAGB) is enterobilio acid reflux (EBAR). We report the concept of the long pouch Roux-en-Y gastric bypass (LPRYGB) meaning a Roux-en-Y with a long pouch and a 100-cm alimentary limb to avoid EBAR, with a long biliopancreatic limb to increase metabolic effects. METHODS A total of 300 LPRYGB cases in a 4-year period, with a 90% follow-up rate, were analysed. Anthropometric, technical feasibility, morbidity, weight loss and comorbidity outcomes were analysed. RESULTS The percentage total weight loss (%TWL) was 30.5% at 4 years of follow-up (32.3% in primary and 28.3% in revisions). Six intra-operative (2%) and 28 postoperative complications (9.3%) were seen. Out of this 28 complications, 11 (3.6%) were late complications. Reoperations were performed in 15 patients (5.0%). Clinically relevant EBAR was present in 3 cases only (1%) 4 years after the operation. CONCLUSIONS The LPRYGB combines the main advantages of the OAGB (light restriction and moderate malabsorption) with the anti-reflux effect from the Roux-en-Y diversion.
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Affiliation(s)
- Rui Ribeiro
- Clínica de Santo António, Metabolic Patient Multidisciplinary Centre, Reboleira, Lisbon, Portugal
| | - Sjaak Pouwels
- Department of Surgery, Haaglanden Medical Center, Lijnbaan 32, P.O. Box 432, 2501 CK, The Hague, The Netherlands.
| | | | - João Pereira
- Obesity and Endocrine Diseases Unit, Department of Surgery, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Leonor Manaças
- Obesity and Endocrine Diseases Unit, Department of Surgery, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Anabela Guerra
- Obesity and Endocrine Diseases Unit, Department of Surgery, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Nuno Borges
- Obesity and Endocrine Diseases Unit, Department of Surgery, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - João Ribeiro
- Clínica de Santo António, Metabolic Patient Multidisciplinary Centre, Reboleira, Lisbon, Portugal
| | - Octávio Viveiros
- Obesity and Endocrine Diseases Unit, Department of Surgery, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
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Chaim EA, Ramos AC, Cazzo E. MINI-GASTRIC BYPASS: DESCRIPTION OF THE TECHNIQUE AND PRELIMINARY RESULTS. ACTA ACUST UNITED AC 2018; 30:264-266. [PMID: 29340551 PMCID: PMC5793145 DOI: 10.1590/0102-6720201700040009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/28/2017] [Indexed: 12/31/2022]
Abstract
Background: In recent years, a surgical technique known as single-anastomosis gastric
bypass or mini-gastric bypass has been developed. Its frequency of
performance has increased considerably in the current decade. Aim: To describe the mini-gastric bypass technique, its implementation and
preliminary results in a university hospital. Methods: This is an ongoing prospective trial to evaluate the long-term effects of
mini-gastric bypass. The main features of the operation were: a gastric
pouch with about 15-18 cm (50-150 ml) with a gastroenteric anastomosis in
the pre-colic isoperistaltic loop 200 cm from the duodenojejunal angle
(biliopancreatic loop). Results: Seventeen individuals have undergone surgery. No procedure needed to be
converted to open approach. The overall 30-day morbidity was 5.9% (one
individual had intestinal obstruction caused by adhesions). There was no
mortality. Conclusion: Mini-gastric bypass is a feasible and safe bariatric surgical procedure.
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Affiliation(s)
- Elinton Adami Chaim
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas - UNICAMP, Campinas
| | | | - Everton Cazzo
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas - UNICAMP, Campinas
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Oliveira LSFD, Mazini Filho ML, Castro JBPD, Touguinha HM, Silva PCR, Ferreira MEC. Repercussões da cirurgia bariátrica na qualidade de vida, no perfil bioquímico e na pressão arterial de pacientes com obesidade mórbida. FISIOTERAPIA E PESQUISA 2018. [DOI: 10.1590/1809-2950/17017725032018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A indicação da cirurgia bariátrica (CB) para perda de peso e redução de comorbidades associadas à obesidade é crescente. O objetivo do presente estudo foi analisar as repercussões da CB na qualidade de vida (QV), no perfil bioquímico e na pressão arterial (PA) de indivíduos obesos mórbidos em três momentos distintos: um mês antes, três meses depois e seis meses após a CB. Participaram da pesquisa 42 indivíduos com obesidade mórbida do programa de CB de um hospital da cidade de Juiz de Fora - MG, os quais foram aleatoriamente divididos em grupo intervenção (GI, n=21) e grupo controle (GC, n=21). O GI sofreu intervenção cirúrgica e o GC foi orientado a manter os afazeres diários usuais durante todo período do estudo, além de receberem acompanhamento nutricional. Foram avaliados a QV, o perfil bioquímico e a PA através do instrumento SF-36, do exame laboratorial de sangue obtido no prontuário dos pacientes e do esfigmomanômetro e estetoscópio, respectivamente. Os resultados demonstraram redução nas variáveis bioquímicas High-density lipoproteins (HDL), Low-density lipoproteins (LDL), Very Low-Density Lipoprotein (VLDL), colesterol, triglicerídeos, hemoglobina glicada, glicose, pressão arterial sistólica e pressão arterial diastólica no GI, após 6 meses de cirurgia. Houve melhora significativa nas variáveis relacionadas à QV, exceto nos aspectos emocionais. Conclui-se que a CB pode repercutir positivamente na maioria dos domínios da QV, na melhora do perfil bioquímico e na PA de pacientes obesos mórbidos após 3 e 6 meses de CB.
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Kaijser MA, van Ramshorst GH, Emous M, Veeger NJGM, van Wagensveld BA, Pierie JPEN. A Delphi Consensus of the Crucial Steps in Gastric Bypass and Sleeve Gastrectomy Procedures in the Netherlands. Obes Surg 2018; 28:2634-2643. [PMID: 29633151 PMCID: PMC6132743 DOI: 10.1007/s11695-018-3219-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Bariatric procedures are technically complex and skill demanding. In order to standardize the procedures for research and training, a Delphi analysis was performed to reach consensus on the practice of the laparoscopic gastric bypass and sleeve gastrectomy in the Netherlands. METHODS After a pre-round identifying all possible steps from literature and expert opinion within our study group, questionnaires were send to 68 registered Dutch bariatric surgeons, with 73 steps for bypass surgery and 51 steps for sleeve gastrectomy. Statistical analysis was performed to identify steps with and without consensus. This process was repeated to reach consensus of all necessary steps. RESULTS Thirty-eight participants (56%) responded in the first round and 32 participants (47%) in the second round. After the first Delphi round, 19 steps for gastric bypass (26%) and 14 for sleeve gastrectomy (27%) gained full consensus. After the second round, an additional amount of 10 and 12 sub-steps was confirmed as key steps, respectively. Thirteen steps in the gastric bypass and seven in the gastric sleeve were deemed advisable. Our expert panel showed a high level of consensus expressed in a Cronbach's alpha of 0.82 for the gastric bypass and 0.87 for the sleeve gastrectomy. CONCLUSIONS The Delphi consensus defined 29 steps for gastric bypass and 26 for sleeve gastrectomy as being crucial for correct performance of these procedures to the standards of our expert panel. These results offer a clear framework for the technical execution of these procedures.
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Affiliation(s)
- Mirjam A. Kaijser
- University of Groningen, University Medical Centre Groningen, Post Graduate School of Medicine, Groningen, The Netherlands
- Medical Centre Leeuwarden, Department of Surgery, Leeuwarden, The Netherlands
| | - Gabrielle H. van Ramshorst
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Marloes Emous
- University of Groningen, University Medical Centre Groningen, Post Graduate School of Medicine, Groningen, The Netherlands
| | - Nic J. G. M. Veeger
- Department of Epidemiology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Bart A. van Wagensveld
- QURO Obesity Centers – Middle East, Dubai, United Arab Emirates
- Department of Surgery, OLVG West, Amsterdam, The Netherlands
| | - Jean-Pierre E. N. Pierie
- University of Groningen, University Medical Centre Groningen, Post Graduate School of Medicine, Groningen, The Netherlands
- Medical Centre Leeuwarden, Department of Surgery, Leeuwarden, The Netherlands
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Rolim FFDA, Cruz FS, Campos JM, Ferraz ÁAB. Long-term repercussions of Roux-en-Y gastric bypass in a low-income population: assessment ten years after surgery. ACTA ACUST UNITED AC 2018; 45:e1916. [PMID: 30156602 DOI: 10.1590/0100-6991e-20181916] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 06/21/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE to evaluate the weight, nutritional and quality of life of low-income patients after ten years of Roux-en-Y gastric bypass (RYGB). METHODS we conducted a longitudinal, retrospective and descriptive study evaluating the excess weight loss, weight regain, arterial hypertension, type 2 diabetes mellitus, anemia and hypoalbuminemia in 42 patients of social classes D and E submitted to RYGB. We assessed quality of life through the Bariatric Analysis and Reporting Outcome System (BAROS). RESULTS of the 42 patients, 68.3% defined themselves as doing non-regular physical activity, and only 44.4% and 11.9% had regular medical and nutritional follow-up, respectively. We found a mean excess weight loss of 75.6%±12 (CI=71.9-79.4), and in only one patient there was insufficient weight loss. The mean weight loss was 22.3%±16.2 (CI=17.2-27.3) with 64.04% of the sample presenting regain greater than 15% of the minimum weight; 52.3% of the sample presented anemia after ten years of surgery and 47.6%, iron deficiency. We found hypoalbuminemia in 16.6% of the sample. There was remission of hypertension in 66%, and of type 2 diabetes mellitus, in 50%. BAROS showed an improvement in the quality of life of 85.8% of the patients. CONCLUSION in a population with different socioeconomic limitations, RYGB maintained satisfactory results regarding weight loss, but inefficient follow-up may compromise the final result, especially with regard to nutritional deficiencies.
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Cavalcanti MGDO, Andrade LB, Santos PCPD, Lucena LRR. NON-INVASIVE PREVENTIVE VENTILATION WITH TWO PRESSURE LEVELS IN THE POSTOPERATIVE PERIOD OF ROUX-EN-Y GASTRIC BYPASS: RANDOMIZED TRIAL. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2018; 31:e1361. [PMID: 29947695 PMCID: PMC6049999 DOI: 10.1590/0102-672020180001e1361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/08/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Obesity is characterized by excessive accumulation of body fat, which causes damage to the health of individuals, such as breathing difficulties. AIM To verify the results of non-invasive ventilation as a preventive strategy on the decline of respiratory function and postoperative complications in patients undergoing Roux-en-Y gastric bypass. METHODS This is a randomized trial, according to CONSORT standards, with obese adults aged 18-40 years. Randomized control group (n=25) only received guidelines regarding posture, early ambulation and cough stimuli, and in the NIV group (n=25), in addition to the aforementioned group, non-invasive ventilation was performed with two pressure levels, once day for 60 min, from the 1st to the 3rd postoperative day (POD). Both groups were evaluated in the preoperative period and in the 1st and 3rd POD for respiratory function, which were: slow vital capacity (VC), inspiratory capacity (IC), minute volume (MV), tidal volume maximal inspiratory muscle strength (Pimax) and peak expiratory flow (PEF). The length of hospital stay and the episodes of postoperative complications were recorded. RESULTS Of the 50 patients the majority were young adults with degrees of obesity between III and IV. In the intergroup analysis, there was an improvement in the CVL and MV only in the 1st POD in the NIV group, CI in the three moments evaluated in the NIV group and the PFE in the 1st and 3rd PDO also in this group. The most frequent complications were pneumonia, followed by operative wound infection and atelectasis. There was a significant difference between groups, showing a higher occurrence in pneumonia and atelectasis in the control group. The days of hospitalization and intensive care unit were similar. CONCLUSION It was observed a faster recovery until the 3rd POD in the IC and PEF variables in the NIV group; in addition, there were fewer complications in this group.
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Smeenk RM, van 't Hof G, Elsten E, Feskens PGBM. The Results of 100 Robotic Versus 100 Laparoscopic Gastric Bypass Procedures: a Single High Volume Centre Experience. Obes Surg 2018; 26:1266-73. [PMID: 26467691 DOI: 10.1007/s11695-015-1933-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The introduction of robotics in bariatric surgery is a novel development since the beginning of this century. The aim of this study is to compare surgical outcome of the robotic gastric bypass with the laparoscopic counterpart. METHODS A retrospective study was conducted to compare the results of 100 fully robotic gastric bypasses (RGB) and 100 laparoscopic gastric bypasses (LGB) performed by a single surgeon. Surgical outcome was analysed by evaluating operation room time and surgical time, morbidity and mortality, and length of hospital stay. RESULTS In the RGB and LGB group, respectively, 92 and 80 % of operated patients were female (p = 0.024). Mean age was 39 (range 20-62, SD 10.21) and 42 years (range 18-65, SD 11.87), respectively (p = 0.158). Mean BMI was 40 (range 35-47, SD 2.66) and 42 (range 35-56, SD 4.75), respectively (p < 0.05). Mean surgical time was 67 (range 39-210, SD 22.46) and 31 min (range 18-62, SD 9.12), respectively (p < 0.05). Mean operation room time was 117 (range 80-257, SD 30.13) and 66 min (range 38-101, SD 12.68), respectively (p < 0.05). The surgery-related 30-day morbidity rate was 5 % in both groups. Major morbidity (Clavien-Dindo class 3-4) was 3 and 1 %, respectively (p = 0.62). There was no mortality. Median hospital stay was two postoperative days in both groups. A learning curve developed after 25 procedures. CONCLUSIONS The RGB is a feasible procedure. Although more time is needed, a standardized technique results in fair operation times in the hands of an experienced surgeon.
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Affiliation(s)
- R M Smeenk
- Department of Bariatric Surgery, Bariatric Centre South-West Netherlands, Bravis Hospital, Bergen op Zoom, The Netherlands.
| | - G van 't Hof
- Department of Bariatric Surgery, Bariatric Centre South-West Netherlands, Bravis Hospital, Bergen op Zoom, The Netherlands
| | - E Elsten
- Department of Bariatric Surgery, Bariatric Centre South-West Netherlands, Bravis Hospital, Bergen op Zoom, The Netherlands
| | - P G B M Feskens
- Department of Bariatric Surgery, Bariatric Centre South-West Netherlands, Bravis Hospital, Bergen op Zoom, The Netherlands
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Rate of Death and Complications in Laparoscopic and Open Roux-en-Y Gastric Bypass. A Meta-analysis and Meta-regression Analysis on 69,494 Patients. Obes Surg 2017; 26:1956-63. [PMID: 27189352 DOI: 10.1007/s11695-016-2231-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Morbid obesity is a life threatening condition. Currently, surgery represents the only effective and durable therapeutic option to treat it. The first aim of the study was to estimate and compare the major surgical complications and the 30-day rate of mortality between laparoscopic and open Roux-en-Y gastric bypass (LRYGB and RYGB). The second aim was to evaluate the change in outcomes, complications, and deaths, with increased experience over the time period of the review. A random effect of the meta-analysis and meta-regression was used to evaluate surgical complications (i.e., reoperation, stenosis, bleeding, surgical site infection, fistula, internal hernia, and incisional ventral hernia) and the rate of mortality after LRYGB and RYGB over time. A search of literature from 2000 to 2014 led to the selection of 17 papers. When looking at surgical techniques separately, we observed a higher rate of mortality for open surgery (death rate 0.82 %, 95 % CI = 0.49-1.23) compared to laparoscopic surgery (death rate 0.22 %, 95 % CI = 0.09-0.40). This difference resulted highly significant when the two techniques were formally compared (p < 0.001). The improving of surgery technique resulted in a mean rate of mortality reduction of 0.069 %. Laparoscopy represents the approach of choice for bariatric surgery. Contemporary reports of LRYGB show low mortality rates and progressive decline in postoperative complications. Laparoscopic bariatric surgery requires advanced laparoscopic skills, and probably an extended learning curve is not accounted for by current mortality statistics.
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Quevedo MDP, Palermo M, Serra E, Ackermann MA. Metabolic surgery: gastric bypass for the treatment of type 2 diabetes mellitus. Transl Gastroenterol Hepatol 2017; 2:58. [PMID: 28713862 DOI: 10.21037/tgh.2017.05.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/15/2017] [Indexed: 12/19/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is one of the largest health emergencies of the 21st century given the worldwide increase of obesity during the last decades and its close association. T2DM is an inherited, polygenic and chronic disease caused by the interaction between several genetic variants in genes and the environment. The continuous search for new and more effective tools to achieve appropriate glycemic control became imperative in order to reduce long-term complications and mortality rates related to T2DM. Treatment options includes lifestyle modifications and several pharmacotherapies as first step in the therapeutical algorithm, but high corps of evidence have shown that gastrointestinal (GI) operations, especially those that involve food rerouting through the GI tract, are safe interventions and achieve superior outcomes for improvement in glucose metabolism when comparing with optimal medical and lifestyle changes. GI Surgery, specially Roux-en-Y gastric bypass (RYGB), is currently the most accepted surgical procedure to treat T2DM, and has also demonstrated to reduce significantly other cardiovascular risk factors (lipids and blood pressure control) when compared with optimal medical treatment, with good long-term effects on cardiovascular risks and mortality. Although the most effective technique in achieving diabetes remission is biliopancreatic diversion, the effectiveness-adverse effects balance is superior for RYGB. For these reasons, metabolic surgery (which was defined as "the operative manipulation of a normal organ or organ system to achieve a biological result for a potential health gain") has been considered and accepted as a new step in the therapeutic algorithm for T2DM when optimal lifestyle and medical interventions don't achieve optimal glycemic goals.
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Affiliation(s)
- Maria Del Pilar Quevedo
- Division of Bariatric Surgery Centro CIEN, Diagnomed, Affiliated Institution to the University of Buenos Aires, Buenos Aires, Argentina
| | - Mariano Palermo
- Division of Bariatric Surgery Centro CIEN, Diagnomed, Affiliated Institution to the University of Buenos Aires, Buenos Aires, Argentina
| | - Edgardo Serra
- Division of Bariatric Surgery Centro CIEN, Diagnomed, Affiliated Institution to the University of Buenos Aires, Buenos Aires, Argentina
| | - Marianela A Ackermann
- Division of Bariatric Surgery Centro CIEN, Diagnomed, Affiliated Institution to the University of Buenos Aires, Buenos Aires, Argentina
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Abstract
BACKGROUND The laparoscopic Roux-en-Y gastric bypass (LRYGB) has been considered a reference procedure in the bariatric surgery. The linear-stapled gastrojejunostomy (GJ) has proved to be safe and effective, but its optimal size referred to postoperative weight loss remains poorly understood. OBJECTIVES Evaluate the role of the linear-stapled GJ size in the mid-term post-LRYGB weight loss and occurrence of complications. MATERIALS AND METHODS From January to April 2014, 128 patients underwent LRYGB with linear-stapled GJ in a 2-year follow-up. The LRYGB were carried out with the same technical steps, except for the length of the GJ. In GJ-15-mm group (n = 64), the GJ was constructed with white 45-mm cartridge in an extension of only 15 mm whereas in GJ-45-mm group (n = 64), the GJ was achieved using full extension of the cartridge. The body mass index (BMI) reduction was recorded for 24 months after procedure. RESULTS The mean ages were 38 ± 10.6 and 41.3 ± 12.3 years, and there were 45 (70.3%) and 51 (79.7%) females in the GJ-15-mm and GJ-45-mm groups, respectively. The analysis on raw BMI data showed that both groups had significant reduction of BMI over time (p ≤ 0.05); however, reduction was greater in the GJ-15-mm group from 18 months onwards (p ≤ 0.05). The only complication observed was a case (1.56%) of stenosis in the group GJ-15 mm. CONCLUSION The global analysis of BMI reduction indicated that the narrower GJ used (GJ-15-mm group) represented a favoring factor decreasing significantly more the BMI when compared to the wider one (GJ-45-mm group).
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Cazzo E, Gestic MA, Utrini MP, Chaim FDM, Geloneze B, Pareja JC, Chaim EA, Magro DO. GLP-2: A POORLY UNDERSTOOD MEDIATOR ENROLLED IN VARIOUS BARIATRIC/METABOLIC SURGERY-RELATED PATHOPHYSIOLOGIC MECHANISMS. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2017; 29:272-275. [PMID: 28076485 PMCID: PMC5225870 DOI: 10.1590/0102-6720201600040014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/02/2016] [Indexed: 12/31/2022]
Abstract
Introduction: Glucagon-like peptide-2 (GLP-2) is a gastrointestinal hormone whose effects are predominantly trophic on the intestinal mucosa. Aim: Critically evaluate the current literature on the influence of bariatric/metabolic surgery on the levels of GLP-2 and its potential clinical implications. Method s: Narrative review through online research on the databases Medline and Lilacs. There were six prospective human studies, two cross-sectional human studies, and three experimental animal studies selected. Results: There is evidence demonstrating significant increase in the levels of GLP-2 following gastric bypass, Scopinaro operation, and sleeve gastrectomy. There are no differences between gastric bypass and sleeve gastrectomy in regards to the increase in the GLP-2 levels. There is no correlation between the postoperative levels of GLP-2 and the occurrence of adequate or insufficient postoperative weight loss. Conclusion: GLP-2 plays significant roles on the regulation of nutrient absorption, permeability of gut mucosa, control of bone resorption, and regulation of satiety. The overall impact of these effects potentially exerts a significant adaptive or compensatory effect within the context of varied bariatric surgical techniques.
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Affiliation(s)
| | | | | | | | - Bruno Geloneze
- Research Laboratory in Metabology and Diabetes (Limed), State University of Campinas - Unicamp, Campinas, SP, Brazil
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Ramos AC, Bastos ELDS, Ramos MG, Bertin NTS, Galvão TD, de Lucena RTF, Campos JM. MEDIUM-TERM FOLLOW-UP RESULTS WITH LAPAROSCOPIC SLEEVE GASTRECTOMY. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2016; 28 Suppl 1:61-4. [PMID: 26537277 PMCID: PMC4795310 DOI: 10.1590/s0102-6720201500s100017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/16/2015] [Indexed: 12/19/2022]
Abstract
Background : The indications for sleeve gastrectomy in the surgical treatment of morbid
obesity have increased worldwide. Despite this, several aspects related to results
at medium and long term remain in constant research. Aim : To present the experience of sleeve gastrectomy in a center of excellence in
bariatric surgery by analyzing clinical outcomes, complications and follow-up in
the medium term. Methods : The study included 120 morbidly obese patients who underwent sleeve gastrectomy
and who were followed for at least 24 months. Aspects related to surgical
technique, surgical complications and clinical outcome were analyzed. Results : Seventy-five patients were women (62.5%) and the average age was 36 years. The
body mass index preoperatively ranged from 35.5 to 58 kg/m2(average of
40.2 kg/m2). The length of stay ranged from 1 to 4 days (mean 2.1
days). Comorbidities observed were hypertension (19%), type 2 diabetes mellitus
(6.6%), dyslipidemia (7.5%), sleep apnea (16.6%), reflux esophagitis (10%) and
orthopedic diseases (7.5%). The mean body mass index and total weight loss
percentage with 3, 12, 18 and 24 months were 32.2 kg/m2-19,9%; 29.5
kg/m2-26,5%; 28.2 kg/m2-30,3% and 26.9
kg/m2-32,7%, respectively. Remission of diabetes and dyslipidemia
occurred in all patients. In relation to hypertension, there was improvement or
remission in 86%. There were only two complications (bronchial pneumonia and
dehydration), with good response to clinical treatment. There was no evidence
digestive fistula and mortality was zero. Eleven patients (9.1%) had regained
weighing more than 5 kg. Conclusion : The sleeve gastrectomy is surgical technique that has proven safe and effective
in the surgical treatment of obesity and control of their comorbidities in
postoperative follow-up for two years.
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Czeczko LEA, Cruz MA, Klostermann FC, Czeczko NG, Nassif PAN, Czeczko AEA. CORRELATION BETWEEN PRE AND POSTOPERATIVE UPPER DIGESTIVE ENDOSCOPY IN PATIENTS WHO UNDERWENT ROUX-EN-Y GASTROJEJUNAL BYPASS. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2016; 29:33-7. [PMID: 27120737 PMCID: PMC4851148 DOI: 10.1590/0102-6720201600010009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/24/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Bariatric operations have variable range of complications and postoperative benefits. Gastroesophageal reflux is considered potential factor that may result in damage to the esophageal mucosa and this subject is quite controversial in the literature. AIM To evaluate patients who underwent to Roux-en-Y gastrojejunal bypass correlating epidemiologic and endoscopic findings in pre and postoperative periods. METHOD A retrospective, paired study which evaluated 110 patients. Inclusion criteria were formal indication for bariatric surgery and patients with pre and postoperative endoscopy. Exclusion criteria were previous bariatric surgery, patients subjected to other types of bariatric surgery and those who had no pre or postoperative upper digestive endoscopy. The epidemiological variables were: sex, age, body mass index, type 2 diabetes mellitus or impaired glucose tolerance, and preoperative dyslipidemia. RESULTS The preoperative upper endoscopy was normal in 26.4% of the patients. Among endoscopic alterations, the hiatus hernia was the most prevalent followed by non-erosive gastritis. The postoperative upper endoscopy was normal in 40.9% and stenosis was the most prevalent followed by marginal ulcer. Correlation on pre and postoperative endoscopies, was found 100% reduction of hiatal hernias and 88% of esophagitis. There was no statistical significance in relationship to anastomotic stenosis with preoperative other variables. Conclusions . There was significant decrease in postoperative hiatus hernia, erosive esophagitis, non-erosive esophagitis, erosive gastritis and non-erosive gastritis with the operation. Stenosis of the gastrojejunostomy anastomosis was the most prevalent postoperative complication with no correlation with preoperative variables.
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Acquafresca PA, Palermo M, Rogula T, Duza GE, Serra E. Early surgical complications after gastric by-pass: a literature review. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2016; 28:74-80. [PMID: 25861076 PMCID: PMC4739251 DOI: 10.1590/s0102-67202015000100019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 11/11/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Gastric bypass is today the most frequently performed bariatric procedure,but, despite of it, several complications can occur with varied morbimortality. Probably all bariatric surgeons know these complications, but, as bariatric surgery continues to spread, general surgeon must be familiarized to it and its management. Gastric bypass complications can be divided into two groups: early and late complications, taking into account the two weeks period after the surgery. This paper will focus the early ones. METHOD Literature review was carried out using Medline/PubMed, Cochrane Library, SciELO, and additional information on institutional sites of interest crossing the headings: gastric bypass AND complications; follow-up studies AND complications; postoperative complications AND anastomosis, Roux-en-Y; obesity AND postoperative complications. Search language was English. RESULTS There were selected 26 studies that matched the headings. Early complications included: anastomotic or staple line leaks, gastrointestinal bleeding, intestinal obstruction and incorrect Roux limb reconstruction. CONCLUSION Knowledge on strategies on how to reduce the risk and incidence of complications must be acquired, and every surgeon must be familiar with these complications in order to achieve an earlier recognition and perform the best intervention.
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Affiliation(s)
| | | | - Tomasz Rogula
- Cleveland Clinic Foundation, Bariatric and Metabolic Institute, Cleveland, OH, USA
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Gebelli JP, Gordejuela AGRD, Ramos AC, Nora M, Pereira AM, Campos JM, Ramos MG, Bastos ELDS, Marchesini JB. SADI-S WITH RIGHT GASTRIC ARTERY LIGATION: TECHNICAL SYSTEMATIZATION AND EARLY RESULTS. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2016; 29Suppl 1:85-90. [PMID: 27683784 PMCID: PMC5064262 DOI: 10.1590/0102-6720201600s10021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 05/23/2016] [Indexed: 12/31/2022]
Abstract
Background Bariatric surgery is performed all over the world with close to 500.000 procedures per year. The most performed techniques are Roux-en-Y gastric bypass and sleeve gastrectomy. Despite this data, the most effective procedure, biliopancreatic diversion with or without duodenal switch, represents only no more than 1.5% of the procedures. Technical complexity, morbidity, mortality, and severe nutritional adverse effects related to the procedure are the main fears that prevent most universal acceptance. Aim To explain the technical aspects and the benefits of the SADI-S with right gastric artery ligation as an effective simplification from the original duodenal switch. Methods Were included all patients undergoing this procedure from the November 2014 to May 2016, describing and analysing aspects of this technique, the systematization and early complications associated with the procedure. Results A series of 67 patients were operated; 46 were women (68.7%); mean age of the group was 44 years old (33-56); and an average BMI of 53.5 kg/m2 (50-63.5). Surgical time was 115 min (80-180). A total of five patients (7.5%) had any complication and two (2.9%) had to be reoperated. There were two patients with leak, one at the duodenal stump and other at the esophagogastric angle. There was no mortality. Patients stayed at the hospital a median of 2.5 days (1-25). Conclusions SADI-S with right gastric artery ligation is a safe procedure with few preliminary complications. The technical variations introduced to the classical duodenal switch are reproducible and may allow this procedure to be more popular. All the complications in this series were not related to the ligation of the right gastric artery.
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Affiliation(s)
| | | | | | - Mario Nora
- Centro Hospitalar Entre Douro e Vouga, Portugal
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Stoll A, Rosin L, Dias MF, Marquiotti B, Gugelmin G, Stoll GF. EARLY POSTOPERATIVE COMPLICATIONS IN ROUX-EN-Y GASTRIC BYPASS. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2016; 29Suppl 1:72-74. [PMID: 27683781 PMCID: PMC5064270 DOI: 10.1590/0102-6720201600s10018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 06/07/2016] [Indexed: 12/27/2022]
Abstract
Background Roux-en-Y gastric bypass is one of the most common bariatric surgery and leads to considerable weight loss in the first months. Aim To quantify the main early postoperative complications in patients submitted to the gastric bypass. Method Observational retrospective cohort. Data of 1051 patients with class II obesity associated with comorbidities or class III obesity submitted to the gastric bypass with 30 days of follow-up starting from the date of the surgery. Results The age average was 36 years with a predominance of females (81.1%). The mean preoperative body mass index was 43 kg/m². The major complication was fistula (2.3%), followed by intestinal obstruction (0.5%) and pulmonary embolism (0.5%). Death occurred in 0.6% of the cases. Conclusion In the period of 30 days after surgery the overall complication rate was 3.8%; reoperation was necessary in 2.6% and death occurred in 0.6%. Fistula was the main complication and the leading cause of hospitalization in intensive care unit, reoperation and death.
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Affiliation(s)
- Aluisio Stoll
- UNIMED Hospital Center and Dona Helena Hospital, Joinville, SC, Brazil
| | - Leandro Rosin
- UNIMED Hospital Center and Dona Helena Hospital, Joinville, SC, Brazil
| | | | - Bruna Marquiotti
- UNIMED Hospital Center and Dona Helena Hospital, Joinville, SC, Brazil
| | - Giovana Gugelmin
- UNIMED Hospital Center and Dona Helena Hospital, Joinville, SC, Brazil
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30
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Palermo M, Serra E. SIMPLIFIED LAPAROSCOPIC GASTRIC BYPASS WITH GASTROJEJUNAL LINEAR MECHANICAL ANASTOMOSIS: TECHNICAL ASPECTS. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2016; 29Suppl 1:91-94. [PMID: 27683785 PMCID: PMC5064258 DOI: 10.1590/0102-6720201600s10022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/12/2016] [Indexed: 01/06/2023]
Abstract
Background Gastric bypass is a restrictive and malabsorptive surgery. The restrictive part consists in the creation of a small gastric pouch. The gastrointestinal bypass serves as the malabsorptive element. Aim To describe a simplified gastric bypass approach for morbid obese patients, showing our results, and also remarking the importance of this technique for reducing the learning curve. Method The patient is positioned in a split legs position and carefully strapped to the operating room table, with the surgeon between the patient's legs. Five trocars are inserted after pneumoperitoneum at the umbilicus. Dissection of the esophagogastric angle and lesser curvature is mandatory before the gastric pouch manufacturing. This pouch is done with two blue load staplers. Using a blue load linear stapler inserted only half way into the hole in the pouch is used to perform the gastrojejunal anastomosis and in order to create an anastomosis that is about 2 cm in length. A side-to-side jejunojejunostomy is done with a white load linear stapler. The last step of the gastric bypass consists in the cut of the jejunum between the two anastomosis with a white load linear stapler. Blue test is performed in order to detect leaks. Results From January 2012 to December 2015, 415 simplified RYGB were performed. Gender: 67% female and 33 % males. Average of BMI 44.7. Mean age was 42 years old. Mean operative time 79 min. 39 % of this sample had T2 diabetes. Regarding complications were observed, one fistula, one gastrojejunal stenosis and one obstruction due to a bezoar. Conclusion The described technique is a simplified approach in which all the anastomosis are performed in the upper part of the abdomen, allowing the surgeons to be more systematized and avoiding them to make mistakes in the confection of the Roux-en-Y anastomosis. This simplified gastric bypass is a safe and reproducible technique.
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Affiliation(s)
- Mariano Palermo
- Division of Bariatric Surgery, Centro CIEN - Diagnomed, Affiliated to the University of Buenos Aires, Buenos Aires, Argentina
| | - Edgardo Serra
- Division of Bariatric Surgery, Centro CIEN - Diagnomed, Affiliated to the University of Buenos Aires, Buenos Aires, Argentina
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31
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Carilli S, Arısoy M, Alper A. A rare complication following laparoscopic Roux & Y gastric bypass: intussusception-case report. SPRINGERPLUS 2015; 4:603. [PMID: 26543738 PMCID: PMC4628016 DOI: 10.1186/s40064-015-1377-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 09/25/2015] [Indexed: 11/28/2022]
Abstract
Obesity is a growing health problem in most parts of the world. Currently only proven long term effective treatment of obesity is bariatric surgery. Roux & Y gastric bypass together with sleeve gastrectomy are the most employed surgical techniques with acceptable metabolic and surgical complication rates. In this paper we would like to present an unexpected complication of Roux & Y gastric bypass: a retrograde intussusception located in the common limb 17 months after the surgery. As intussusception in adults usually originates from a leading point, there is no such an explanation following Roux & Y gastric bypass.
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Affiliation(s)
- Senol Carilli
- General Surgery Department, American Hospital, Guzelbahce Sokak No 20, Nisantasi, 34365 Istanbul, Turkey
| | - Mustafa Arısoy
- General Surgery Department, American Hospital, Guzelbahce Sokak No 20, Nisantasi, 34365 Istanbul, Turkey
| | - Aydin Alper
- General Surgery Department, American Hospital, Guzelbahce Sokak No 20, Nisantasi, 34365 Istanbul, Turkey
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PALERMO M, ACQUAFRESCA PA, ROGULA T, DUZA GE, SERRA E. Late surgical complications after gastric by-pass: a literature review. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2015; 28:139-43. [PMID: 26176254 PMCID: PMC4737339 DOI: 10.1590/s0102-67202015000200014] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 11/27/2014] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Gastric bypass is today the most frequently performed bariatric procedure, but, despite of it, several complications can occur with varied morbimortality. Probably all bariatric surgeons know these complications, but, as bariatric surgery continues to spread, general surgeon must be familiarized to it and its management. Gastric bypass complications can be divided into two groups: early and late complications, taking into account the two weeks period after the surgery. This paper will focus the late ones. METHOD Literature review was carried out using Medline/PubMed, Cochrane Library, SciELO, and additional information on institutional sites of interest crossing the headings: gastric bypass AND complications; follow-up studies AND complications; postoperative complications AND anastomosis, Roux-en-Y; obesity AND postoperative complications. Search language was English. RESULTS There were selected 35 studies that matched the headings. Late complications were considered as: anastomotic strictures, marginal ulceration and gastrogastric fistula. CONCLUSION Knowledge on strategies on how to reduce the risk and incidence of complications must be acquired, and every surgeon must be familiar with these complications in order to achieve an earlier recognition and perform the best intervention.
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Affiliation(s)
- Mariano PALERMO
- Division of Bariatric Surgery - CIEN-DIAGNOMED - affiliated to the
University of Buenos Aires, Buenos Aires, Argentina
| | - Pablo A. ACQUAFRESCA
- Division of Bariatric Surgery - CIEN-DIAGNOMED - affiliated to the
University of Buenos Aires, Buenos Aires, Argentina
| | - Tomasz ROGULA
- Cleveland Clinic Foundation, Bariatric and Metabolic Institute,
Cleveland, OH, USA
| | - Guillermo E. DUZA
- Division of Bariatric Surgery - CIEN-DIAGNOMED - affiliated to the
University of Buenos Aires, Buenos Aires, Argentina
| | - Edgardo SERRA
- Division of Bariatric Surgery - CIEN-DIAGNOMED - affiliated to the
University of Buenos Aires, Buenos Aires, Argentina
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