1
|
't Hart JWH, Noordman BJ, Palsgraaf-Huisbrink J, Dunkelgrun M, Zengerink HF, Birnie E, van Det MJ, Boerma EJG, de Castro SMM, Hazebroek EJ, Langenhoff BS, Verhoef C, Apers JA. Peroperative administration of tranexamic acid in Roux-en-Y and one-anastomosis gastric bypass to reduce haemorrhage in patients with morbid obesity: protocol for randomised controlled trial (PATRY trial). BMJ Open 2024; 14:e078853. [PMID: 38719323 PMCID: PMC11086189 DOI: 10.1136/bmjopen-2023-078853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/01/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION By implementation of Enhanced Recovery After Bariatric Surgery protocols and day-care surgery, early discharge poses a challenge if excessive bleeding occurs after bariatric surgery. Tranexamic acid (TXA) has demonstrated efficacy in other surgical fields and in bariatric pilot studies. This trial aims to assess the efficacy of peroperative administration of TXA in reducing haemorrhage in patients undergoing gastric bypass surgery. METHOD AND ANALYSIS This is a multicentre, phase III, double-blind randomised controlled trial in six high-volume bariatric centres in the Netherlands. A total of 1524 eligible patients, aged 18 years or older, undergoing primary gastric bypass surgery (either Roux-en-Y gastric bypass or one-anastomosis gastric bypass) will be randomised between TXA and placebo (1:1, variable block, stratified for centre, day-care/overnight stay and type of surgery) after obtaining informed consent (2.5% less haemorrhage, power 80%, 2-sided-α 0.05 and 10% dropout). Exclusion criteria are pregnancy, amedical history of acute bleeding (without cause), venous thrombotic events (VTEs), epilepsy, anticoagulant use and iatrogenic bleeding during surgery (aside from staple line). The primary outcome is postoperative haemorrhage requiring intervention within 30 days postoperatively. Secondary outcome measures are staple line reinforcement, blood loss, duration of surgery, postoperative haemoglobin, vital parameters, minor and major complications, side effects of TXA (nausea, hypotension and VTE), length of hospital stay and directly made costs. ETHICS AND DISSEMINATION Written informed consent will be obtained from all participants. The protocol has been approved by the Medical Research Ethics Committees United, Nieuwegein, on 7 February 2023 (registration number: R22.102). Results will be disseminated through peer-reviewed publications and conferences. TRIAL REGISTRATION NUMBER NCT05464394.
Collapse
Affiliation(s)
- Judith W H 't Hart
- Department of Surgery, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Department of Surgery, Franciscus Gasthuis en Vlietland, Rotterdam, Zuid-Holland, The Netherlands
| | - Bo J Noordman
- Department of Surgery, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Department of Surgery, Franciscus Gasthuis en Vlietland, Rotterdam, Zuid-Holland, The Netherlands
| | | | - Martin Dunkelgrun
- Department of Surgery, Franciscus Gasthuis en Vlietland, Rotterdam, Zuid-Holland, The Netherlands
| | - Hans F Zengerink
- Department of Surgery, Franciscus Gasthuis en Vlietland, Rotterdam, Zuid-Holland, The Netherlands
| | - Erwin Birnie
- Statistics and Education, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
- Surgery, University Medical Centre Groningen, Groningen, Groningen, The Netherlands
| | - Marc J van Det
- Surgery, Ziekenhuisgroep Twente, Almelo, Overijssel, The Netherlands
| | - Evert-Jan G Boerma
- Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
| | | | - Eric J Hazebroek
- Surgery, Rijnstate Hospital, Arnhem, Gelderland, The Netherlands
- Department of Surgery, Wageningen University and Research, Wageningen, Gelderland, The Netherlands
| | - Barbara S Langenhoff
- Department of Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Noord-Brabant, The Netherlands
| | - Cornelis Verhoef
- Department of Surgery, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Jan A Apers
- Department of Surgery, Franciscus Gasthuis en Vlietland, Rotterdam, Zuid-Holland, The Netherlands
| |
Collapse
|
2
|
Jin T, Liu HD, Chen ZH, Hu JK, Yang K. Linear Stapler versus Circular Stapler for Patients Undergoing Anastomosis for Laparoscopic Gastric Surgery: A Meta-Analysis. J INVEST SURG 2022; 35:1434-1444. [PMID: 35435081 DOI: 10.1080/08941939.2022.2058126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Tao Jin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Han-Dong Liu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Jintang Hospital, Chengdu, Sichuan, China
| | - Ze-Hua Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jian-Kun Hu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kun Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Jintang Hospital, Chengdu, Sichuan, China
| |
Collapse
|
3
|
Billroth-II with Braun versus Roux-en-Y reconstruction in totally laparoscopic distal gastrectomy for gastric cancer. Wideochir Inne Tech Maloinwazyjne 2021; 16:664-668. [PMID: 34950260 PMCID: PMC8669982 DOI: 10.5114/wiitm.2021.103965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/16/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Totally laparoscopic distal gastrectomy (TLDG) has been increasingly adopted for the treatment of gastric cancer. Both Billroth-II with Braun (B-IIB) reconstruction and Roux-en-Y (R-Y) reconstruction are commonly performed in TLDG; however, which of these reconstruction techniques is better remains unclear. Aim To compare the efficacy of B-IIB reconstruction and R-Y reconstruction in TLDG for gastric cancer. Material and methods A total of 105 gastric cancer patients who underwent TLDG with B-IIB or R-Y reconstruction were reviewed from January 2019 to July 2020. Clinicopathological characteristics and perioperative data of the B-IIB and R-Y groups were compared. Results Clinicopathological characteristics were not significantly different between the B-IIB and R-Y groups. The average total operative time for the R-Y group (161.9 ±20.7 min) was significantly longer than that for the B-IIB group (141.9 ±16.7 min). The average anastomosis time for the R-Y group (25.5 ±4.1 min) was also significantly longer than that for the B-IIB group (18.9 ±3.3 min). Blood loss volume, number of retrieved lymph nodes, time to first flatus, average length of postoperative hospital stay, inflammatory parameters and postoperative complications did not differ between the two groups. Conclusions Both B-IIB reconstruction and R-Y reconstruction are safe and effective in TLDG. B-IIB reconstruction is easier and faster to perform than R-Y reconstruction in TLDG.
Collapse
|
4
|
van Olst N, van Rijswijk AS, Mikdad S, Schoonmade LJ, van de Laar AW, Acherman YIZ, Bruin SC, van der Peet DL, de Brauw LM. Long-term Emergency Department Visits and Readmissions After Laparoscopic Roux-en-Y Gastric Bypass: a Systematic Review. Obes Surg 2021; 31:2380-2390. [PMID: 33813682 PMCID: PMC8113200 DOI: 10.1007/s11695-021-05286-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE There is considerable evidence on short-term outcomes after laparoscopic Roux-en-Y gastric bypass (LRYGB), but data on long-term outcome is scarce, especially on postoperative emergency department (ED) visits and readmissions. We aim to systematically review evidence on the incidence, indications, and risk factors of ED visits and readmissions beyond 30 days after LRYGB. MATERIALS AND METHODS A systematic search in PubMed, Scopus, Embase.com , Cochrane Library, and PsycINFO was performed. All studies reporting ED visits and readmissions > 30 days after LRYGB, with ≥ 50 patients, were included. PRISMA statement was used and the Newcastle-Ottawa Scale for quality assessment. RESULTS Twenty articles were included. Six studies reported on ED visits (n = 2818) and 19 on readmissions (n = 276,543). The rate of patients with an ED visit within 90 days after surgery ranged from 3.9 to 32.6%. ED visits at 1, 2, and 3 years occurred in 25.6%, 30.0%, and 31.1% of patients. Readmissions within 90 days and at 1-year follow-up ranged from 4.1 to 20.5% and 4.75 to 16.6%, respectively. Readmission was 29% at 2 years and 23.9% at 4.2 years of follow-up. The most common reason for ED visits and readmissions was abdominal pain. CONCLUSION Emergency department visits and readmissions have been reported in up to almost one in three patients on the long-term after LRYGB. Both are mainly indicated for abdominal pain. The report on indications and risk factors is very concise. A better understanding of ED visits and readmissions after LRYGB is warranted to improve long-term care, in particular for patients with abdominal pains.
Collapse
Affiliation(s)
- N van Olst
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands.
| | - A S van Rijswijk
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - S Mikdad
- Department of Surgery, Amsterdam UMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - L J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, De Boelelaan 1117, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - A W van de Laar
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - Y I Z Acherman
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - S C Bruin
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - D L van der Peet
- Department of Surgery, Amsterdam UMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - L M de Brauw
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| |
Collapse
|
5
|
Sundaresan N, Sullivan M, Hiticas BA, Hui BY, Poliakin L, Thompson KJ, McKillop IH, Barbat S, Kuwada TS, Gersin KS, Nimeri A. Impacts of Gastrojejunal Anastomotic Technique on Rates of Marginal Ulcer Formation and Anastomotic Bleeding Following Roux-en-Y Gastric Bypass. Obes Surg 2021; 31:2921-2926. [PMID: 33939060 DOI: 10.1007/s11695-021-05292-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/06/2021] [Accepted: 02/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Marginal ulceration (MU) and bleeding are possible complications following laparoscopic Roux-en-Y gastric bypass (RYGB). Our institution utilizes three techniques for performing the gastrojejunal anastomosis (GJA), providing a means to compare postoperative MU and bleeding as it relates to GJA technique. OBJECTIVES We sought to analyze the incidence of MU and bleeding between the 25-mm end-to-end anastomosis (EEA) stapler, linear stapler (LS), and robotic hand-sewn (RHS) GJA techniques. METHODS Electronic health records for all patients who had an upper endoscopy (EGD) after RYGB were queried (2010-2014). Charts were retrospectively reviewed for type of GJA, complications, endoscopic interventions, and smoking and NSAID use. RESULTS Out of 1112 RYGBs, the GJA was created using an EEA, LS, or RHS approach in 58.6%, 33.6%, and 7.7% of patients, respectively. 17.4% had an EGD (19.9% EEA, 13.9% LS, and 14.0% RHS). Incidence of MU was 7.3% (9.3% EEA, 4.8% LS, and 5.8% RHS). Rates of EGD and MU were significantly higher after EEA vs. LS GJA (p<0.05). The bleeding rate was 1.5%, [1.1% EEA, 2.1% LS, and 2.3% RHS (p=NS)]. MU within 90 days of RYGB occurred in 4.1%, 0.8%, and 4.7%, respectively (p<0.05 for EEA vs LS only). NSAID and cigarette use were identified in 29.3%, 38.9%, and 60% and 17.2%, 22.2%, and 20%, respectively, for the EEA, LS, and RHS GJA (p=NS). CONCLUSION The method of GJA has an impact on rate of MU formation. A GJA fashioned with a 25-mm EEA stapler tends to have higher rates of EGD and MU.
Collapse
Affiliation(s)
- Naresh Sundaresan
- Atrium Health Weight Management, Section of Bariatric and Metabolic Surgery, Department of Surgery, Atrium Health, 2630 E 7th St Suite 100, Charlotte, NC, 28204, USA
| | - Mariel Sullivan
- Division of Research, Department of Surgery, Carolinas Medical Center, Atrium Health, 1025 Morehead Medical Dr #300, Charlotte, NC, 28204, USA
| | - B Amy Hiticas
- Carolinas Medical Center-Mercy, Atrium Health, 2001 Vail Ave, Charlotte, NC, 28207, USA
| | - Benedict Y Hui
- Atrium Health Weight Management, Section of Bariatric and Metabolic Surgery, Department of Surgery, Atrium Health, 2630 E 7th St Suite 100, Charlotte, NC, 28204, USA
| | - Lauren Poliakin
- Atrium Health Weight Management, Section of Bariatric and Metabolic Surgery, Department of Surgery, Atrium Health, 2630 E 7th St Suite 100, Charlotte, NC, 28204, USA
| | - Kyle J Thompson
- Division of Research, Department of Surgery, Carolinas Medical Center, Atrium Health, 1025 Morehead Medical Dr #300, Charlotte, NC, 28204, USA
| | - Iain H McKillop
- Division of Research, Department of Surgery, Carolinas Medical Center, Atrium Health, 1025 Morehead Medical Dr #300, Charlotte, NC, 28204, USA
| | - Selwan Barbat
- Atrium Health Weight Management, Section of Bariatric and Metabolic Surgery, Department of Surgery, Atrium Health, 2630 E 7th St Suite 100, Charlotte, NC, 28204, USA
| | - Timothy S Kuwada
- Atrium Health Weight Management, Section of Bariatric and Metabolic Surgery, Department of Surgery, Atrium Health, 2630 E 7th St Suite 100, Charlotte, NC, 28204, USA
| | - Keith S Gersin
- Atrium Health Weight Management, Section of Bariatric and Metabolic Surgery, Department of Surgery, Atrium Health, 2630 E 7th St Suite 100, Charlotte, NC, 28204, USA
| | - Abdelrahman Nimeri
- Atrium Health Weight Management, Section of Bariatric and Metabolic Surgery, Department of Surgery, Atrium Health, 2630 E 7th St Suite 100, Charlotte, NC, 28204, USA.
| |
Collapse
|
6
|
Romeijn MM, van Hoef S, Janssen L, van de Pas KGH, van Dielen FMH, Luijten AAPM, Göttgens KWA, Greve JWM, Leclercq WKG. Comparison of Linear versus Circular-Stapled Gastroenterostomy in Roux-en-Y Gastric Bypass: A Nationwide Population-Based Cohort Study. Obes Surg 2021; 31:3579-3587. [PMID: 33905068 PMCID: PMC8270800 DOI: 10.1007/s11695-021-05436-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 01/13/2023]
Abstract
Background When performing a Roux-en-Y gastric bypass (RYGB), the gastroenterostomy can be constructed with a circular stapled or linear stapled technique. The size of the gastroenterostomy depends on the stapling method and this may affect weight loss outcomes. The aim of this study was to examine the impact of the stapling technique on weight loss outcomes after RYGB. Methods This is a nationwide population-based cohort study of patients that received a RYGB. Data were derived from the Dutch Audit of Treatment of Obesity. Primary outcome was the impact of stapling technique on the rate of non-response defined as significant weight regain (≥20% of a patients’ lost weight) 2–4 years post-surgery, after initial successful weight loss (≥20% total weight loss, TWL). Secondary outcomes were the rate of response, defined as successful weight loss (≥20% TWL) within 1.5 years post-surgery, the incidence of complications and the progression of comorbidities. Results In a cohort of 12,468 patients, non-response was equally distributed between both groups (circular 18.0% vs. linear 17.6%). No differences in response rate (circular 97.0% vs. linear 96.5%) or %TWL were observed up to 4 years post-surgery. Patients in the circular stapled group experienced more complications, specifically major bleedings (2.4% vs. 1.2%; p=0.002) within 30 days postoperatively. No differences were found in deteriorated comorbidities, neither in de novo developed comorbidities. Conclusion When comparing stapling technique in RYGB, weight loss outcomes did not differ during a 4-year follow-up period. The linear stapled gastroenterostomy could pose an advantage due to its lower complication rate. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s11695-021-05436-4.
Collapse
Affiliation(s)
- Marleen M Romeijn
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands. .,Research School NUTRIM, Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Stijn van Hoef
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Loes Janssen
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Kelly G H van de Pas
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.,Research School NUTRIM, Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | | | - Kevin W A Göttgens
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Jan Willem M Greve
- Research School NUTRIM, Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | | |
Collapse
|
7
|
Incidence and Prognostic Factors for the Development of Symptomatic and Asymptomatic Marginal Ulcers After Roux-en-Y Gastric Bypass Procedures. Obes Surg 2021; 31:3005-3014. [PMID: 33761070 DOI: 10.1007/s11695-021-05363-4] [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] [Received: 01/04/2021] [Revised: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Marginal ulcer (MU) is a serious complication after Roux-en-Y gastric bypass (RYGB) procedures. This study reports the incidence, risk factors, and treatment outcomes of symptomatic and incidentally, at routine endoscopy diagnosed, MU. METHODS All patients undergoing RYGB procedures between 2013 and 2018 at a single center were included. Upper endoscopy was performed in case of symptoms and/or routinely 2 and 5 years postoperatively. RESULTS In total, 568 patients (83.3% female) underwent RYGB procedure with a median age of 40 years and median initial body mass index of 41 kg/m2. The median time to follow-up was 2.99 years. Routine 2- and 5-year upper endoscopy was performed in 256 (55.3%) and 65 (38.0%) eligible patients, respectively. In 86 (15.1%) patients, MU was diagnosed at a median time of 14.2 months (4.58-26.2) postoperatively and 24.4% of patients with MU were asymptomatic. In total, 76.7% of MUs were located on the side of the Roux limb. 88.4% of MUs were treated conservatively; re-operation was necessary in 10 (11.6%) patients. Smoking and type 2 diabetes mellitus were the only independent risk factors for MU development in multivariate analysis with a hazard ratio of 2.65 and 1.18 (HbA1c per unit >6.0), respectively. CONCLUSION MU is a common complication after gastric bypass surgery with 25% of patients being asymptomatic. Follow-up routine endoscopy is recommended for early MU detection and subsequent accurate therapy, especially in patients with the independent risk factors smoking and type 2 diabetes mellitus.
Collapse
|
8
|
Nastałek P, Polok K, Celejewska-Wójcik N, Kania A, Sładek K, Małczak P, Major P. Impact of bariatric surgery on obstructive sleep apnea severity and continuous positive airway pressure therapy compliance-prospective observational study. Sci Rep 2021; 11:5003. [PMID: 33654165 PMCID: PMC7925607 DOI: 10.1038/s41598-021-84570-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 02/18/2021] [Indexed: 12/22/2022] Open
Abstract
To evaluate association between bariatric surgery and changes in obstructive sleep apnea (OSA) severity and sleep architecture was as well as to asses continuous positive airway pressure (CPAP) effectiveness and compliance. We enrolled patients undergoing bariatric surgery. Polysomnography was performed in each patient preoperatively and 12 months after the procedure in a subgroup of patients diagnosed with OSA. STOP-BANG, Epworth Sleepiness Scale (ESS) and Berlin questionnaire scores were obtained pre- and postoperatively. CPAP compliance data was recorded during follow-up hospitalization. Among 44 patients with median age of 49.5 years, predominantly women (68.2%) pre- and postoperative polysomnography was performed. We observed significant improvement in STOP-BANG (6.0 vs. 3.0, p < 0.001) and ESS (12.0 vs. 5.0, p < 0.001) scores, apnea–hypopnea index (44.9 vs. 29.2, p < 0.001), oxygen desaturation index (43.6 vs. 18.3, p < 0.001) and sleep architecture parameters. CPAP compliance was poor with a median percentage of days with CPAP use accounting to 49.3%. Bariatric surgery is associated with a significant decrease in the number of sleep-related respiratory disturbances, as well as improvement of sleep efficiency. Postoperative CPAP therapy compliance was poor despite low rate of OSA resolution. This study suggests that patients with OSA undergoing bariatric surgery require postoperative reassessment.
Collapse
Affiliation(s)
- Paweł Nastałek
- Department of Pulmonology, 2nd Department of Internal Medicine, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688, Kraków, Poland.
| | - Kamil Polok
- Department of Pulmonology, 2nd Department of Internal Medicine, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688, Kraków, Poland
| | - Natalia Celejewska-Wójcik
- Department of Pulmonology, 2nd Department of Internal Medicine, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688, Kraków, Poland
| | - Aleksander Kania
- Department of Pulmonology, 2nd Department of Internal Medicine, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688, Kraków, Poland
| | - Krzysztof Sładek
- Department of Pulmonology, 2nd Department of Internal Medicine, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688, Kraków, Poland
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688, Kraków, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688, Kraków, Poland
| |
Collapse
|
9
|
Munoz-Flores F, Rodriguez-Quintero JH, Pechman D, Creange C, Zenilman A, Choi J, Moran-Atkin E, Lima DL, Camacho D. Weight loss one year after laparoscopic roux-en-Y gastric bypass is not dependent on the type of gastrojejunal anastomosis. Surg Endosc 2021; 36:787-792. [PMID: 33523274 DOI: 10.1007/s00464-021-08288-2] [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] [Received: 09/19/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Laparoscopic roux-en-Y gastric bypass (LRYGB) is the gold standard weight-loss procedure. There are different techniques to perform the gastrojejunal (GJ) anastomosis, but there is no consensus as to which one is superior for weight loss. Our goal in this study was to assess one-year weight loss after LRYGB comparing the three different techniques at our tertiary care center. METHODS The American college of surgeons (ACS) Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®) data for Montefiore Medical Center for years 2014-2017 were analyzed. Three surgeons were included in this study; each type of anastomosis was performed by a single surgeon. Patients were included if they underwent primary LRYGB. Patients were designated to one of three different groups depending of the type of gastrojejunal anastomosis performed: hand sewn, circular stapled, or linear stapled. One-year weight loss was assessed as primary endpoint of the study. A descriptive analysis of perioperative variables for each group was included as well. RESULTS A total of 1011 patients underwent primary LRYGB. 429 (42.1%) were performed with circular-stapled GJ anastomosis, 433 (42.5%) with a hand-sewn GJ anastomosis, and 149 (14.6%) linear-stapled GJ anastomosis. The median BMI was 46.08 ± 6.43, with no difference between groups (p = .405). Procedure time was 106.70 ± 28.23 min for the circular group, 108.27 ± 28.59 min for the hand-sewn group, and 115.78 ± 36.11 min for the linear group (p > 0.005). There were no significant differences in complications except for the need of postoperative transfusions (p < 0.002). There was no statistically significant difference in %EWL one year after surgery: %EWL was 58.81 ± 16.54 kg for hand sewn, 58.86 ± 14.84 kg for circular, and 59.20 ± 17.58Kg for linear. (p = .595). CONCLUSION There is no difference in weight loss one year after LRYGB based on the type of gastrojejunal anastomosis performed.
Collapse
Affiliation(s)
- Fernando Munoz-Flores
- Montefiore Medical Center, University Hospital of the Albert Einstein College of Medicine, New York, USA.
| | | | - David Pechman
- Montefiore Medical Center, University Hospital of the Albert Einstein College of Medicine, New York, USA
| | - Collin Creange
- Montefiore Medical Center, University Hospital of the Albert Einstein College of Medicine, New York, USA
| | - Ariela Zenilman
- Montefiore Medical Center, University Hospital of the Albert Einstein College of Medicine, New York, USA
| | - Jenny Choi
- Montefiore Medical Center, University Hospital of the Albert Einstein College of Medicine, New York, USA
| | - Erin Moran-Atkin
- Montefiore Medical Center, University Hospital of the Albert Einstein College of Medicine, New York, USA
| | - Diego L Lima
- Montefiore Medical Center, University Hospital of the Albert Einstein College of Medicine, New York, USA
| | - Diego Camacho
- Montefiore Medical Center, University Hospital of the Albert Einstein College of Medicine, New York, USA.
| |
Collapse
|
10
|
Comparison of gastrojejunostomy techniques and anastomotic complications: a systematic literature review. Surg Endosc 2020; 35:6489-6496. [PMID: 33159295 DOI: 10.1007/s00464-020-08142-x] [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] [Received: 06/22/2020] [Accepted: 10/27/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND There are several ways to perform the gastrojejunostomy (GJ) anastomosis in laparoscopic Roux-en-Y gastric bypass (LRYGB). Surgeons typically use a variation of three techniques: Hand-sewn anastomosis (HSA), Linear stapled (LS) and Circular stapled anastomosis (CSA). The purpose of this literature review is to determine which of the GJ techniques, if any, is superior and results in the least amount of postoperative complications, with a specific focus on rates of marginal ulcers, postoperative bleeding, and strictures. METHODS PubMed, Embase, and Cochrane electronic databases were consulted for studies on LRYGB procedures utilizing a GJ anastomosis, from January 1, 2015 to December 31, 2019. Cochrane and PRISMA screening methods were used to select the studies. RESULTS Eleven studies published between 2015 and 2019 were selected and included 135,899 patients that underwent LRYGB with a GJ anastomosis. Sample sizes ranged from 114 to 49,331 patients. Four studies reported that CSA had statistically significant higher rates of marginal ulcers when compared to HSA and LS techniques. Three studies concluded that CSA had statistically significant higher rates of postoperative bleeding when compared to HSA and LS. Five studies observed that CSA had statistically significant higher rates of strictures when compared to HSA and LS techniques. There was no consensus whether HSA or LS was superior in terms of reduced postoperative complications. CONCLUSION This study revealed statistically significant increases in rates of postoperative bleeding, marginal ulcer, and strictures with the use of mechanical circular staplers at the GJ anastomosis in LRYGB. Based on our results, avoiding the use of mechanical circular staplers can result in fewer postoperative complications. Nevertheless, there are limitations to retrospective studies which may influence the results and therefore a randomized controlled trial directly comparing HSA, CSA, and LS should be performed to truly determine which technique is superior.
Collapse
|
11
|
Systematic Review and Meta-analysis of Circular- and Linear-Stapled Gastro-jejunostomy in Laparoscopic Roux-en-Y Gastric Bypass. Obes Surg 2020; 29:1946-1953. [PMID: 30864104 DOI: 10.1007/s11695-019-03803-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
To compare circular stapler (CS) with linear stapler (LS) in a meta-analysis concerning operative time, anastomotic leaks, wound infections, strictures, and length of stay. Pubmed, Medline, and Scopus were searched for articles published since 2006. Four hundred and five articles were assessed, and 13 articles of which only one was a randomized controlled trial were included in all 49,331 patients from different regions of the world. The pooled analysis shows that operative time was shorter in LS than in CS (weighted mean difference 36.2 min; 95% CI 34.7-37.6.; p < 0.0001). No difference was seen concerning leaks or strictures. The relative risk (RR) of leakage after LS was 80% of the risk after CS; however, the 95% confidence interval (CI) showed overlap (0.58-1.11). The RR of anastomotic stricture after LS was 74% of the risk after CS; however, 95% CI (0.52-1.05) showed overlap. Wound infections were less common after LS than after CS; RR was 27% (95% CI 0.21-0.33). Length of stay (LOS) was 0.65 days shorter after LS than after CS (95% CI 0.51-0.78). LS compared with CS results in shorter operative time, less wound infections, and shorter length of stay, but no difference was seen concerning risks of leaks or strictures.
Collapse
|
12
|
Karampinis I, Lion E, Grilli M, Hetjens S, Weiss C, Vassilev G, Seyfried S, Otto M. Trocar Site Hernias in Bariatric Surgery-an Underestimated Issue: a Qualitative Systematic Review and Meta-Analysis. Obes Surg 2020; 29:1049-1057. [PMID: 30659465 DOI: 10.1007/s11695-018-03687-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The reported incidence of trocar site hernias in bariatric surgery ranges between 0.5 and 3%. The best available evidence derives from retrospective studies analysing prospective databases, thus including only patients who presented with symptoms or received surgical treatment due to trocar site hernias after a laparoscopic bariatric procedure. A systematic literature research was conducted up until September 2017. Search strategies included proper combinations of the MeSH terms 'laparoscopy' and 'bariatric surgery', 'trocar/port' and 'hernia'. Searches were not limited by publication type or language. The review was registered in PROSPERO (ID 85102) and performed according to the PRISMA guidelines. Sixty-eight publications were included. Pooled hernia incidence was 3.22 (range 0-39.3%). Thirteen trials reported systematic closure of the fascia; 12 trials reported no closure. Data availability did not allow for pooling to calculate relative risk. Higher BMI and specific hernia examination using imaging modalities were associated with a significantly higher incidence of trocar site hernias. Studies dedicated to detection of TsH reported a pooled incidence of 24.5%. Trocar site hernias are an underestimated complication of minimally invasive multiportal bariatric surgery. While high-quality trials are not available allowing for a precise calculation of the incidence, existing data are indicative of very high incidence rates. Risk factors for developing a trocar site hernia in bariatric surgery have not yet been systematically analysed. Prospective studies in this field are necessary.
Collapse
Affiliation(s)
| | - Eliette Lion
- Department of Surgery, Heidelberg University, Mannheim, Germany
| | - Maurizio Grilli
- Department of Library and Information Sciences, Heidelberg University, Mannheim, Germany
| | - Svetlana Hetjens
- Institute of Medical Statistic and Biomathematics, Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christel Weiss
- Institute of Medical Statistic and Biomathematics, Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Georgi Vassilev
- Department of Surgery, Heidelberg University, Mannheim, Germany
| | | | - Mirko Otto
- Department of Surgery, Heidelberg University, Mannheim, Germany.
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| |
Collapse
|
13
|
Continuous Glucose Monitoring in Bariatric Patients Undergoing Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-En-Y Gastric Bypass. Obes Surg 2020; 29:1317-1326. [PMID: 30737761 DOI: 10.1007/s11695-018-03684-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Few investigations have been conducted that compared blood glucose in patients with diabetes mellitus (DM2) and morbid obesity who had undergone laparoscopic sleeve gastrectomy (LSG) or gastric bypass (LRYGB). We aimed to compare the effects of these procedures using continuous glucose monitoring (CGM). METHODS We prospectively studied patients that had qualified for LSG or LRYGB. The inclusion criteria were DM2 of ≤ 5 years, for which patients were taking oral anti-diabetic drugs, or no glucose metabolism disorder; and morbid obesity. CGM was performed between admission and the 10th postoperative day. RESULTS We studied 16 patients with DM2 and 16 without. Eighteen patients underwent LSG and 14 underwent LRYGB. The median hemoglobin A1c was 5.5% (5.4-5.9%) in DM2 patients, which did not differ from control (p = 0.460). Preoperative mean daily glucose concentration was similar between DM2 and control patients (p = 0.622). For patients with DM2, LRYGB was associated with more frequent low glucose status, and these episodes lasted longer than in DM2 patients that underwent LSG (p = 0.035 and 0.049, respectively). DM2 patients that underwent LRYGB demonstrated lower glucose concentrations from third postoperative day than those that underwent LSG. Patients without DM2 did not demonstrate differences in daily mean glucose concentrations, or in incidence nor duration of hypoglycemia throughout the observation period. CONCLUSION A significantly larger reduction in interstitial glucose concentration is present from third day in patients with DM2 who undergo LRYGB vs. LSG, accompanied by a lower incidence and shorter duration of low glucose episodes.
Collapse
|
14
|
Impact of Adherence to the ERAS® Protocol on Short-term Outcomes after Bariatric Surgery. Obes Surg 2020; 30:1498-1505. [DOI: 10.1007/s11695-019-04349-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
15
|
Rogula T, Koprivanac M, Janik MR, Petrosky JA, Nowacki AS, Dombrowska A, Kroh M, Brethauer S, Aminian A, Schauer P. Does Robotic Roux-en-Y Gastric Bypass Provide Outcome Advantages over Standard Laparoscopic Approaches? Obes Surg 2019; 28:2589-2596. [PMID: 29637410 PMCID: PMC6132787 DOI: 10.1007/s11695-018-3228-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective The aim was to compare clinical outcomes of patients treated with totally robotic Roux-en-Y gastric bypass (TRRYGB) with those treated with the different laparoscopic Roux-en-Y gastric bypass (LRYGB) techniques. Summary Background Data The clinical benefit of the robotic approach to bariatric surgery compared to the standard laparoscopic approach is unclear. There are no studies directly comparing outcomes of TRRYGB with different LRYGB techniques. Methods Outcomes of 578 obese patients who underwent RYGB between 2011 and 2014 at an academic center were assessed. Multivariable analysis and propensity matching were used for comparing TRRYGB to different LRYGB techniques, including 21-mm EEA circular-stapled gastrojejunal anastomosis (GJA, LRYGB-21CS), linear-stapled GJA (LRYGB-LS), and hand-sewn GJA (LRYGB-HS). Results The TRRYGB technique required a longer mean operative time compared to the other groups, respectively 204 ± 46 vs. 139 ± 30 min (LRYGB-21CS), 206 ± 37 vs. 158 ± 30 min (LRYGB-LS), and 210 ± 36 vs. 167 ± 30 min (LRYGB-HS). TRRYGB experienced a lower stricture rate (2 vs. 17%, P = 0.003), shorter hospital stay (2.6 ± 1.2 vs. 4.3 ± 5.5 days, P = 0.008), and lower readmission rate (12 vs. 28%, P = 0.009). No significant differences in outcomes were observed when comparing RRYGB to LRYGB-LS or LRYGB-HS. Conclusions TRRYGB increases operative time compared to all LRYGB techniques. TRRYGB was superior to LRYGB-21CS in terms of significantly shorter hospital stay, lower readmission rate, and less frequent GJA stricture formation. TRRYGB provides no clinical advantages over the LRYGB-LS and LRYGB-HS techniques. Electronic supplementary material The online version of this article (10.1007/s11695-018-3228-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tomasz Rogula
- University Hospital Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | | | - Michał Robert Janik
- University Hospital Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, USA. .,Department of General, Oncologic, Metabolic and Thoracic Surgery, Military Institute of Medicine, Szaserów 128, 04-141, Warszawa, Poland.
| | - Jacob A Petrosky
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amy S Nowacki
- Department of Quantitative Health Sciences in the Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Matthew Kroh
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Stacy Brethauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Philip Schauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
16
|
Major P, Stefura T, Walędziak M, Janik M, Pędziwiatr M, Wysocki M, Rubinkiewicz M, Witowski J, Szeliga J, Budzyński A. What Makes Bariatric Operations Difficult-Results of a National Survey. ACTA ACUST UNITED AC 2019; 55:medicina55060218. [PMID: 31141961 PMCID: PMC6631593 DOI: 10.3390/medicina55060218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/23/2019] [Indexed: 01/12/2023]
Abstract
Background and objective: The most commonly performed bariatric procedures include laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), and one anastomosis gastric bypass-mini gastric bypass (OAGB-MGB). A study comparing the degree of difficulty among those procedures could serve as a guide for decision making in bariatric surgery and further improve training programs for general surgery trainees. The aim of this study was to compare the subjective level of technical difficulty of LSG, LRYGB, and OAGB-MGB as perceived by surgeons and surgical residents. Materials and Methods: An anonymous internet-based survey was designed to evaluate the subjective opinions of surgeons and surgical residents in training in Poland. It covered baseline characteristics of the participants, difficulty of LSG, OAGB-MGB, LRYGB and particular stages of each operation assessed on a 1-5 scale. Results: Overall, 70 surgeons and residents participated in our survey. The mean difficulty degree of LSG was 2.34 ± 0.89. The reinforcing staple line with sutures was considered most difficult stage of this operation (3.17 ± 1.19). The LRYGB operation had an average difficulty level of 3.87 ± 1.04. Creation of the gastrojejunostomy was considered the most difficult stage of LRYGB with a mean difficulty level (3.68 ± 1.16). Responders to our survey assessed the mean degree of difficulty of OAGB-MGB as 2.34 ± 0.97. According to participating surgeons, creating the gastrojejunostomy is the most difficult phase of this operation (3.68 ± 1.16). Conclusion: The LSG is perceived by surgeons as a relatively easy operation. The LRYGB was considered to be the most technically challenging procedure in our survey. Operative stages, which require intra-abdominal suturing with laparoscopic instruments, seem to be the most difficult phases of each operation.
Collapse
Affiliation(s)
- Piotr Major
- nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Krakow, Poland.
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), 31-501 Krakow, Poland.
| | - Tomasz Stefura
- Students' Scientific Group at 2nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Krakow, Poland.
| | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, 04-141 Warsaw, Poland.
| | - Michał Janik
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, 04-141 Warsaw, Poland.
| | - Michał Pędziwiatr
- nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Krakow, Poland.
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), 31-501 Krakow, Poland.
| | - Michał Wysocki
- nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Krakow, Poland.
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), 31-501 Krakow, Poland.
| | - Mateusz Rubinkiewicz
- nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Krakow, Poland.
| | - Jan Witowski
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), 31-501 Krakow, Poland.
- Students' Scientific Group at 2nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Krakow, Poland.
| | - Jacek Szeliga
- Department of General, Gastroenterological, and Oncological Surgery Collegium Medicum, Nicolaus Copernicus University, 87-100 Torun, Poland.
| | - Andrzej Budzyński
- nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Krakow, Poland.
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), 31-501 Krakow, Poland.
| |
Collapse
|
17
|
Barr AC, Lak KL, Helm MC, Kindel TL, Higgins RM, Gould JC. Linear vs. circular-stapled gastrojejunostomy in Roux-en-Y gastric bypass. Surg Endosc 2019; 33:4098-4101. [PMID: 30805785 DOI: 10.1007/s00464-019-06712-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/19/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Various surgical techniques exist to create the gastrojejunostomy during laparoscopic Roux-en-Y gastric bypass (LRYGB). Linear-stapled anastomosis (LSA) and circular-stapled anastomosis (CSA) are two commonly employed techniques. We hypothesized that CSA is associated with an increased rate of surgical site infection (SSI) and gastrojejunostomy stenosis when compared to LSA. METHODS This study is a retrospective review of patients who underwent LRYGB for morbid obesity at a single institution between 2012 and 2016. Three bariatric surgeons contributed patients to this series. Clinical information and perioperative outcomes were collected through 90 days after surgery. RESULTS 171 patients met the inclusion criteria. Two patients did not complete 90-day follow-up and were excluded from the analysis (88 patients CSA, 81 LSA; 99% 90-day follow-up). Patient demographics did not differ between groups. The LSA technique was associated with a significantly reduced rate of SSI (0 (0%) vs. 6 (6.8%), p = 0.02) and stenosis (2 (2.5%) vs. 17 (19.3%), p < 0.01). The CSA technique demonstrated a greater number of endoscopic dilations per stenotic event (1.5 ± 0.8 vs. 1.0 ± 0, p = 0.03). CONCLUSION In our experience, a gastrojejunostomy constructed with an LSA technique was associated with a significantly reduced rate of stenosis and SSI compared to the CSA technique. LSA is currently our anastomotic technique of choice in LRYGB.
Collapse
Affiliation(s)
- Alexander C Barr
- Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, HUB, 6th floor, Milwaukee, WI, 53226, USA
| | - Kathleen L Lak
- Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, HUB, 6th floor, Milwaukee, WI, 53226, USA
| | - Melissa C Helm
- Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, HUB, 6th floor, Milwaukee, WI, 53226, USA
| | - Tammy L Kindel
- Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, HUB, 6th floor, Milwaukee, WI, 53226, USA
| | - Rana M Higgins
- Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, HUB, 6th floor, Milwaukee, WI, 53226, USA
| | - Jon C Gould
- Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, HUB, 6th floor, Milwaukee, WI, 53226, USA.
| |
Collapse
|
18
|
Postoperative nausea and vomiting in bariatric surgery in comparison to non-bariatric gastric surgery. Wideochir Inne Tech Maloinwazyjne 2018; 14:90-95. [PMID: 30766634 PMCID: PMC6372858 DOI: 10.5114/wiitm.2018.77629] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 07/13/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction Postoperative nausea and vomiting (PONV) are complications of general anesthesia. Patient-specific factors, type of surgery and a variety of drugs determine the frequency. Clinical experience shows nausea and vomiting to be very frequent in morbidly obese patients undergoing bariatric surgery. Aim To detect the onset and extent of nausea and vomiting in the group of morbidly obese patients undergoing laparoscopic bariatric surgery. Material and methods We conducted a retrospective data bank analysis (since 2004) of all patients with body mass index > 35 kg/m2 undergoing laparoscopic bariatric surgery in comparison to patients with a body mass index < 35 kg/m2 undergoing gastric surgery. Propensity score matching was applied to minimize bias effects. The frequency of postoperative nausea was defined as the primary outcome parameter. Results One hundred and thirty-eight patients were included. There was a significant difference between the morbidly obese group and the control group concerning the frequency of postoperative nausea (15.9% vs. 55.1%; p < 0.001). In patients receiving volatile anesthetics a significant difference between groups concerning frequency of PONV was not observed. Intravenous anesthetics were suitable to reduce PONV in the control group but not in the morbidly obese group (12.5% vs. 56.8%, p < 0.001). With given prophylaxis PONV events still occurred in 15.6% vs. 48.8% (p = 0.003). Conclusions Morbidly obese patients undergoing laparoscopic bariatric surgery are at higher risk of suffering from PONV than non-morbidly obese patients. To reduce the PONV incidence in morbidly obese patients, further research, especially focusing on more efficient use of antiemetic drugs, seems to be necessary.
Collapse
|
19
|
Dual Ring Wound Protector Reduces Circular Stapler Related Surgical Site Infections in Patients Undergoing Laparoscopic Roux-En-Y Gastric Bypass. Obes Surg 2018; 28:3352-3359. [PMID: 30030727 DOI: 10.1007/s11695-018-3394-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND While there are various techniques to create the gastrojejunostomy during a laparoscopic Roux-en-Y gastric bypass (LRYGB), many surgeons prefer using a circular stapler. One drawback of this method, however, is the higher incidence of surgical site infections (SSIs). To investigate the effect of a dual ring wound protector on SSIs during LRYGB. METHODS In April 2016, our bariatric surgical group implemented an intervention whereby a dual ring wound protector in conjunction with a conical EEA stapler introducer was used when creating the gastrojejunostomy. SSIs from pre- and post-intervention were compared using Fisher's exact test. Only LRYGBs performed with a circular stapler were included in our analysis. Student's t test and χ2 were used to compare pre- and post-intervention groups with respect to demographics and co-morbidities. RESULTS Between April 2015 and January 31st, 2017, our surgeons performed 158 LRYGBs using a circular stapler for the gastrojejunostomy. There were 84 patients (53%) in the pre-intervention group and 74 (47%) in the post-intervention group. The pre- and post-intervention groups were not statistically different. The SSI rate for the pre-intervention group was 9.5% while the SSI rate was 1.35% in the post-intervention group (p = 0.0371). The use of a dual ring wound protector for LRYGBs with circular stapled gastrojejunostomy was associated with an 86% relative risk reduction in SSIs. CONCLUSION Using a dual ring wound protector in conjunction with a conical EEA introducer for LRYGBs with circular stapled gastrojejunostomy significantly decreased SSIs.
Collapse
|