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Grüter AA, Sijmons JM, Coblijn UK, Toorenvliet BR, Tanis PJ, Tuynman JB. Best Evidence for Each Surgical Step in Minimally Invasive Right Hemicolectomy: A Systematic Review. Ann Surg Open 2023; 4:e343. [PMID: 38144490 PMCID: PMC10735091 DOI: 10.1097/as9.0000000000000343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/17/2023] [Indexed: 12/26/2023] Open
Abstract
Objective The aim of this study was to systematically review the literature for each surgical step of the minimally invasive right hemicolectomy (MIRH) for non-locally advanced colon cancer, to define the most optimal procedure with the highest level of evidence. Background High variability exists in the way MIRH is performed between surgeons and hospitals, which could affect patients' postoperative and oncological outcomes. Methods A systematic search using PubMed was performed to first identify systematic reviews and meta-analyses, and if there were none then landmark papers and consensus statements were systematically searched for each key step of MIRH. Systematic reviews were assessed using the AMSTAR-2 tool, and selection was based on highest quality followed by year of publication. Results Low (less than 12 mmHg) intra-abdominal pressure (IAP) gives higher mean quality of recovery compared to standard IAP. Complete mesocolic excision (CME) is associated with lowest recurrence and highest 5-year overall survival rates, without worsening short-term outcomes. Routine D3 versus D2 lymphadenectomy showed higher LN yield, but more vascular injuries, and no difference in overall and disease-free survival. Intracorporeal anastomosis is associated with better intra- and postoperative outcomes. The Pfannenstiel incision gives the lowest chance of incisional hernias compared to all other extraction sites. Conclusion According to the best available evidence, the most optimal MIRH for colon cancer without clinically involved D3 nodes entails at least low IAP, CME with D2 lymphadenectomy, an intracorporeal anastomosis and specimen extraction through a Pfannenstiel incision.
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Affiliation(s)
- Alexander A.J. Grüter
- From the Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Julie M.L. Sijmons
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Usha K. Coblijn
- From the Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Pieter J. Tanis
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Jurriaan B. Tuynman
- From the Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Grüter AAJ, Coblijn UK, Toorenvliet BR, Tanis PJ, Tuynman JB. National implementation of an optimal standardised technique for right-sided colon cancer: protocol of an interventional sequential cohort study (Right study). Tech Coloproctol 2023; 27:1083-1090. [PMID: 37097330 PMCID: PMC10562307 DOI: 10.1007/s10151-023-02801-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Minimally invasive right hemicolectomy (MIRH) is the cornerstone of treatment for patients with right-sided colon cancer. This operation has evolved during recent decades, with many innovations and improvements but this has also resulted in high variability of uptake with subsequent substantial variableness. The aim of this ongoing study is to identify current surgical variations, determine the most optimal and standardised MIRH and nationally train and implement that technique to improve short-term clinical and long-term oncological outcomes. METHODS The Right study is a national multicentre prospective interventional sequential cohort study. Firstly, current local practice was evaluated. Subsequently, a standardised surgical technique for right-sided colon cancer was determined using the Delphi consensus method, and this procedure was trained during hands-on courses. The standardised MIRH will be implemented with proctoring (implementation cohort), after which the performance will be monitored (consolidation cohort). Patients who will receive a minimally invasive (extended) right hemicolectomy for cT1-3N0-2M0 colon cancer will be included. The primary outcome is patient safety reflected in the 90-day overall complication rate according to the Clavien-Dindo classification. Secondary outcomes will include intraoperative complications, 90-day mortality rate, number of resected tumour-positive lymph nodes, completeness of mesocolic excision, surgical quality score, locoregional and distant recurrence and 5-year overall survival. A total number of 1095 patients (365 per cohort) will be included. DISCUSSION The Right study is designed to safely implement the best surgical practice concerning patients with right-sided colon cancer aiming to standardise and improve the surgical quality of MIRH at a national level. TRIAL REGISTRATION ClinicalTrials.gov: NCT04889456, May 2021.
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Affiliation(s)
- Alexander A J Grüter
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands.
| | - Usha K Coblijn
- Department of Surgery, Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam, The Netherlands
| | | | - Pieter J Tanis
- Department of Surgery, UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Surgery, Erasmus MC, Dr. Molewaterplein 40, Rotterdam, The Netherlands
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
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Coblijn UK, Franken RJ. Comment on: predicting complications following bariatric surgery, the diagnostic accuracy of available tools. Surg Obes Relat Dis 2022; 18:886-887. [DOI: 10.1016/j.soard.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/01/2022] [Indexed: 11/30/2022]
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Meekel JP, Coblijn UK, Flens MJ, Muller S, Boer den FC. Small bowel obstruction caused by 18FDG-negative ileocecal metastasis of lobular breast carcinoma. J Surg Case Rep 2020; 2020:rjaa167. [PMID: 32760483 PMCID: PMC7394128 DOI: 10.1093/jscr/rjaa167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/09/2020] [Indexed: 12/21/2022] Open
Abstract
Breast carcinoma is the most frequently diagnosed cancer in women. In up to 30%, distant metastases will occur; however, ileocecal metastases are rare. Although there have been cases reported that demonstrate ileocecal metastases of breast carcinoma, PET/CT-negative cases have never been described. We present a patient with a small bowel obstruction, preoperatively complicated by pulmonary embolisms. The patient underwent placement of an inferior vena cava filter followed by hemicolectomy. Pathological examination revealed ileocecal lobular breast carcinoma metastases and adjacent peritoneal carcinomatosis, which had shown no intestinal 18FDG uptake 7 weeks prior to presentation. Subsequently, symptoms of metastases and the paraneoplastic syndrome progressed, and the patient was referred to the medical oncologist for palliative therapy. Although uncommon, physicians should be aware of potential presence of 18FDG-negative gastrointestinal metastases of breast cancer.
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Affiliation(s)
- Jorn P Meekel
- Department of Surgery, Zaans Medisch Centrum, Zaandam, The Netherlands.,Department of Vascular Surgery, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Usha K Coblijn
- Department of Surgery, Zaans Medisch Centrum, Zaandam, The Netherlands.,Department of Vascular Surgery, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Marcel J Flens
- Department of Pathology, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Sandra Muller
- Department of Surgery, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Frank C Boer den
- Department of Surgery, Zaans Medisch Centrum, Zaandam, The Netherlands.,Department of Vascular Surgery, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
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Kalff MC, de Raaff CA, de Vries CE, Coblijn UK, Willink MT, Fauquenot-Nollen JM, Jensch S, de Castro SM, van Veen RN. Diagnostic value of computed tomography for detecting anastomotic or staple line leakage after bariatric surgery. Surg Obes Relat Dis 2018; 14:1310-1316. [DOI: 10.1016/j.soard.2018.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/03/2018] [Accepted: 05/11/2018] [Indexed: 11/29/2022]
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de Vries CE, Dekker AC, van Veen R, van der Zeeuw FT, Coblijn UK, Brölmann FE, van Wagensveld BA. Trocar port scar quality in morbidly obese patients after bariatric surgery. Surg Obes Relat Dis 2018; 14:616-622. [DOI: 10.1016/j.soard.2018.01.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/08/2018] [Accepted: 01/25/2018] [Indexed: 12/29/2022]
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de Raaff CA, Kalff MC, Coblijn UK, de Vries CE, de Vries N, Bonjer HJ, van Wagensveld BA. Influence of continuous positive airway pressure on postoperative leakage in bariatric surgery. Surg Obes Relat Dis 2018; 14:186-190. [DOI: 10.1016/j.soard.2017.10.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/10/2017] [Accepted: 10/25/2017] [Indexed: 10/18/2022]
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Abstract
BACKGROUND The decision to undergo bariatric surgery is multifactorial and made both by patient and doctor. Information is of the utmost importance for this decision. OBJECTIVE To investigate the bariatric surgery patient's preferences regarding information provision in bariatric surgery. SETTING A teaching hospital, bariatric center of excellence in Amsterdam, the Netherlands. METHODS All patients who underwent a primary laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy between September 2013 and September 2014 were approached by mail to participate. A questionnaire was used to elicit patient preferences for the content and format of information. Sociodemographic characteristics, clinicopathologic factors, and psychologic factors were explored as predictors for specific preferences. RESULTS Of the 356 eligible patients, 112 (31.5%) participated. The mean age was 49.2 (±10.7) years, and 91 (81.3%) patients were female. Patients deemed the opportunity to ask questions (96.4%) the most important feature of the consult, followed by a realistic view on expectations-for example, results of the procedure (95.5%) and information concerning the consequences of surgery for daily life (89.1%). Information about the risk of complications on the order of 10% was desired by 93% of patients; 48% desired information about lower risks (.1%). Only 25 patients (22.3%) desired detailed information concerning their weight loss after surgery. CONCLUSION Bariatric patients wished for information about the consequences of surgery on daily life, whereas the importance of information concerning complications decreased when their incidence lessened.
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Affiliation(s)
- Usha K Coblijn
- Department of Surgery, Vrije Universiteit Medical Center, Amsterdam, the Netherlands.
| | - Sjoerd M Lagarde
- Department of Surgery, Erasmus Medical Center, Amsterdam, the Netherlands
| | | | | | - Ellen M A Smets
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
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Pierik AS, Coblijn UK, de Raaff CA, van Veen R, van Tets WF, van Wagensveld BA. Unexplained abdominal pain in morbidly obese patients after bariatric surgery. Surg Obes Relat Dis 2017; 13:1743-1751. [DOI: 10.1016/j.soard.2017.05.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/16/2017] [Accepted: 05/27/2017] [Indexed: 11/29/2022]
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de Raaff CA, Gorter-Stam MA, de Vries N, Sinha AC, Jaap Bonjer H, Chung F, Coblijn UK, Dahan A, van den Helder RS, Hilgevoord AA, Hillman DR, Margarson MP, Mattar SG, Mulier JP, Ravesloot MJ, Reiber BM, van Rijswijk AS, Singh PM, Steenhuis R, Tenhagen M, Vanderveken OM, Verbraecken J, White DP, van der Wielen N, van Wagensveld BA. Perioperative management of obstructive sleep apnea in bariatric surgery: a consensus guideline. Surg Obes Relat Dis 2017; 13:1095-1109. [DOI: 10.1016/j.soard.2017.03.022] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 12/31/2022]
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de Raaff CAL, Coblijn UK, de Klerk ESM, Ravesloot MJL, de Vries N, van Wagensveld BA. Impact of obstructive sleep apnea on quality of life after laparoscopic Roux-en-Y gastric bypass. Surgeon 2017; 16:151-155. [PMID: 28549529 DOI: 10.1016/j.surge.2017.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND To examine the influence of obstructive sleep apnea (OSA) on the quality of life (QoL) in bariatric surgery. METHODS All patients who underwent a laparoscopic Roux-and-Y gastric bypass (LRYGB), preoperative poly(somno)graphy and completed an Impact of Weight on QoL-Lite questionnaire before and after surgery were included. RESULTS A total of 276 patients were included. OSA was diagnosed in 150 (53.3%) patients. All subscale scores improved 15 months post-surgery (p < 0.01). Total score improved from 51.2 (SD 19.1) to 89.7 (SD 13.9). Lower postoperative scores were seen in OSA patients on subscales Public Distress (90.4 SD 18.8 versus 95.7 SD 10.2; p = 0.003) and Work (92.9 SD 15 versus 96.1 SD 9.7; p = 0.031). All postoperative subscale scores were negatively correlated with OSA severity (p < 0.01). CONCLUSIONS After LRYGB, QoL improved in both OSA and non-OSA patients. OSA patients, especially patients with severe OSA, have lower postoperative scores on subscales Public Distress and Work after LRYGB.
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Affiliation(s)
- C A L de Raaff
- Department of Surgery, OLVG West, Amsterdam, The Netherlands.
| | - U K Coblijn
- Department of Surgery, VU Medical Center, Amsterdam, The Netherlands
| | - E S M de Klerk
- Department of Epidemiology and Biostatistics, VU Medical Center, Amsterdam, The Netherlands
| | - M J L Ravesloot
- Department of Otolaryngology, OLVG West, Amsterdam, The Netherlands
| | - N de Vries
- Department of Otolaryngology, OLVG West, Amsterdam, The Netherlands; Department of Oral Kinesiology, ACTA, Amsterdam, The Netherlands; Department of Otolaryngology, Head and Neck Surgery, UZA, Antwerp, Belgium
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Coblijn UK, Karres J, de Raaff CAL, de Castro SMM, Lagarde SM, van Tets WF, Bonjer HJ, van Wagensveld BA. Predicting postoperative complications after bariatric surgery: the Bariatric Surgery Index for Complications, BASIC. Surg Endosc 2017; 31:4438-4445. [PMID: 28364156 PMCID: PMC5666042 DOI: 10.1007/s00464-017-5494-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 02/24/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Around 20% of bariatric surgery patients develop a short- or long-term complication. OBJECTIVE Aim of this study was to develop a risk model predicting complications: the Bariatric Surgery Index for Complications (BASIC). SETTING The Obesity Center Amsterdam, located in a large teaching hospital, in Amsterdam, The Netherlands. METHODS A prospective consecutive database including patients operated between November 2007 and February 2015 was used. For the BASIC, analysis according to the TRIPOD statement was performed to identify risk factors for complications. Class I included patients with zero to one risk factor, class II patients with two risk factors, and class III patients with three or more risk factors. RESULTS Of 1709 analyzed patients, mean age was 45 years (±SD 10.7), 1393 (81.5%) were female; mean body mass index was 44.5 kg/m2 (6.8). Overall, 271 (15.9%) patients developed a complication of which 197 (72.5%) occurred within 30 days. Predictors in multivariable analysis were use of anticoagulants (odd's ratio (OR) 1.5); chronic obstructive pulmonary disease (OR 2.3); dyslipidemia (OR 1.4); gender (OR 1.4); psychiatric history (OR 1.3); and revisional surgery (OR 1.5). In class I, 13.5% (181 out of 1338) experienced complications, in class II 58 (21.6%) of the 269 patients and in class III 32 (31.4%) of the 102 patients, respectively. There was a significant difference (p < 0.001) in both overall and 30 day complications. CONCLUSION The BASIC uses six preoperative variables to classify patients in a low-, intermediate-, or high-risk group for postoperative complications after bariatric surgery.
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Affiliation(s)
- Usha K Coblijn
- Departments of Surgery, Onze Lieve Vrouwe Gasthuis, locatie West (Prevoiusly Sint Lucas Andreas Ziekenhuis, Amsterdam), Jan Tooropstraat 161, 1064 AE, Amsterdam, The Netherlands.
| | - Julian Karres
- Departments of Surgery, Tergooi Ziekenhuizen, Blaricum, The Netherlands
| | - Christel A L de Raaff
- Departments of Surgery, Onze Lieve Vrouwe Gasthuis, locatie West (Prevoiusly Sint Lucas Andreas Ziekenhuis, Amsterdam), Jan Tooropstraat 161, 1064 AE, Amsterdam, The Netherlands
| | - Steve M M de Castro
- Departments of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Sjoerd M Lagarde
- Departments of Surgery, Erasmus Medisch Centrum, Rotterdam, The Netherlands
| | - Willem F van Tets
- Departments of Surgery, Onze Lieve Vrouwe Gasthuis, locatie West (Prevoiusly Sint Lucas Andreas Ziekenhuis, Amsterdam), Jan Tooropstraat 161, 1064 AE, Amsterdam, The Netherlands
| | - H Jaap Bonjer
- Departments of Surgery, Vrije Universiteit Medisch Centrum, Amsterdam, The Netherlands
| | - Bart A van Wagensveld
- Departments of Surgery, Onze Lieve Vrouwe Gasthuis, locatie West (Prevoiusly Sint Lucas Andreas Ziekenhuis, Amsterdam), Jan Tooropstraat 161, 1064 AE, Amsterdam, The Netherlands
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de Raaff CAL, Coblijn UK, de Vries N, Heymans MW, van den Berg BTJ, van Tets WF, van Wagensveld BA. Predictive Factors for Insufficient Weight Loss After Bariatric Surgery: Does Obstructive Sleep Apnea Influence Weight Loss? Obes Surg 2016. [PMID: 26220241 DOI: 10.1007/s11695-015-1830-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Important endpoints of bariatric surgery are weight loss and improvement of comorbidities, of which obstructive sleep apnea (OSA) is the highest accompanying comorbidity (70%). This study aimed to evaluate the influence of OSA on weight loss after bariatric surgery and to provide predictive factors for insufficient weight loss (defined as ≤50% excess weight loss (EWL)) at 1 year follow-up. METHODS All consecutive patients, who underwent primary laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy between 2006 and 2014 were retrospectively reviewed. Patients with data on preoperative apnea-hypopnea index (AHI) and pre- and postoperative body mass index (BMI) were included. After surgery, the percentage excess weight loss (%EWL) and BMI changes were compared between preoperatively diagnosed OSA-, subdivided in mild, moderate, and severe OSA, and non-OSA patients. Multivariable logistic regression analysis evaluated predictive factors for ≤50% EWL. RESULTS A total of 816 patients, 522 (64%) with and 294 (36%) without OSA, were included. After 1 year, OSA patients achieved less %EWL than non-OSA patients (65.5 SD 20.7 versus 70.3 SD 21.0; p < 0.01). The lowest %EWL was seen in severe OSA patients (61.7 SD 20.2). However, when adjusted for waist circumference, BMI, and age, no effect of OSA was seen on %EWL or changes in BMI. Although AHI, gender, age, BMI, type of surgery, and type II diabetes were predictive factors for ≤50% EWL (area under the curve 0.778), the AHI as variable was of little importance. CONCLUSIONS The presence of OSA does not individually impair weight loss after bariatric surgery.
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Affiliation(s)
| | - Usha K Coblijn
- Department of Surgery, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - Nico de Vries
- Department of Otolaryngology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands.,Department of Otolaryngology, University of Antwerp, Antwerp, Belgium
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, VU Medical Center, Amsterdam, The Netherlands.,Department of Methodology and Applied Biostatistics, Faculty of Health and Life Sciences, VU Amsterdam, Amsterdam, The Netherlands
| | - Bob T J van den Berg
- Department of Pulmonology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - Willem F van Tets
- Department of Surgery, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
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de Raaff CA, Coblijn UK, Ravesloot MJ, de Vries N, de Lange-de Klerk ES, van Wagensveld BA. Persistent moderate or severe obstructive sleep apnea after laparoscopic Roux-en-Y gastric bypass: which patients? Surg Obes Relat Dis 2016; 12:1866-1872. [DOI: 10.1016/j.soard.2016.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/14/2016] [Accepted: 03/15/2016] [Indexed: 01/12/2023]
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Coblijn UK, de Castro SMM. Response to: "Letter to the Editor: Trocar Site Hernia Prevention in Laparoscopic Bariatric Surgery". Obes Surg 2016; 26:2229-2230. [PMID: 27395010 DOI: 10.1007/s11695-016-2286-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Usha K Coblijn
- VU Medisch Centrum, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands.
| | - S M M de Castro
- Onze Lieve Vrouw Gasthuis, Location West, Jan Tooropstraat 164, 1061 AE, Amsterdam, Netherlands
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de Raaff CA, Coblijn UK, de Vries N, van Wagensveld BA. Is fear for postoperative cardiopulmonary complications after bariatric surgery in patients with obstructive sleep apnea justified? A systematic review. Am J Surg 2016; 211:793-801. [DOI: 10.1016/j.amjsurg.2015.10.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 10/02/2015] [Accepted: 10/12/2015] [Indexed: 01/14/2023]
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Coblijn UK, Lagarde SM, de Castro SMM, Kuiken SD, van Wagensveld BA. Symptomatic marginal ulcer disease after Roux-en-Y gastric bypass: incidence, risk factors and management. Obes Surg 2015; 25:805-11. [PMID: 25381115 DOI: 10.1007/s11695-014-1482-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND One of the long-term complications of laparoscopic Roux-and-Y gastric bypass (LRYGB) is the development of marginal ulcers (MU). The aim of the present study is to assess the incidence, risk factors, symptomatology and management of patients with symptomatic MU after LRYGB surgery. METHODS A consecutive series of patients who underwent a LRYGB from 2006 until 2011 were evaluated in this study. Signs of abdominal pain, pyrosis, nausea or other symptoms of ulcer disease were analysed. Acute symptoms of (perforated) MU such as severe abdominal pain, vomiting, melena and haematemesis were also collected. Patient baseline characteristics, medication and intoxications were recorded. Statistical analysis was performed to identify risk factors associated with MU. RESULTS A total of 350 patients underwent a LRYGB. Minimal follow-up was 24 months. Twenty-three patients (6.6%) developed a symptomatic MU of which four (1.1%) presented with perforation. Smoking, the use of corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) was significantly associated with the development of MU. Five out of 23 patients (22%) underwent surgery. All other patients could be treated conservatively. CONCLUSIONS Marginal ulcers occurred in 6.6% of the patients after a LRYGB. Smoking, the use of corticosteroids and the use of NSAIDs were associated with an increased risk of MU. Most patients were managed conservatively.
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Affiliation(s)
- Usha K Coblijn
- Department of Surgery, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands,
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Coblijn UK, Goucham AB, Lagarde SM, Kuiken SD, van Wagensveld BA. Development of ulcer disease after Roux-en-Y gastric bypass, incidence, risk factors, and patient presentation: a systematic review. Obes Surg 2014; 24:299-309. [PMID: 24234733 DOI: 10.1007/s11695-013-1118-5] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the gold standard in bariatric surgery. A long-term complication can be marginal ulceration (MU) at the gastrojejunostomy. The mechanism of development is unclear and symptoms vary. Management and prevention is a continuous subject of debate. The aim was to assess the incidence, mechanism, symptoms, and management of MU after LRYGB by means of a systematic review. Forty-one studies with a total of 16,987 patients were included, 787 (4.6%) developed MU. The incidence of MU varied between 0.6 and 25%. The position and size of the pouch, smoking, and nonsteroidal inflammatory drugs usage are associated with the formation of MU. In most cases, MU is adequately treated with proton pump inhibitors, sometimes reoperation is required. Laparoscopic approach is safe and effective.
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Abstract
Delayed massive bleeding from an ischemic ulcer after Roux-en-Y gastric bypass is a rare and challenging event for the gastroenterologist as well as the bariatric surgeon. Introduction: Delayed massive bleeding from an ischemic ulcer is a complication after Roux-en-Y gastric bypass (RYGB). Ischemic ulcers that present with massive bleeding are rare and challenging for the gastroenterologist as well as the bariatric surgeon. Case Description: This report reviews the case of a 63-year-old man who underwent an uncomplicated laparoscopic RYGB for morbid obesity and experienced two episodes of massive hemorrhage after the procedure, almost 1 year apart. Conclusion: To our knowledge, there are only a few such specific cases reported. Here, we describe the treatment and outcome for such a case and present a review of the literature.
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Affiliation(s)
- Usha K Coblijn
- Department of Surgery, St. Lucas Andreas Hospital, Amsterdam, The Netherlands
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Coblijn UK, de Meij TGJ, Heij HA, Kneepkens CMFF. [Perianal fistulae and abscesses in children: consider Crohn's disease]. Ned Tijdschr Geneeskd 2013; 157:A6561. [PMID: 24063673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
While perianal fistulae and abscesses in infants usually occur as an isolated phenomenon, in older children Crohn's disease might be the underlying etiologic factor. We present four children of different ages with recurrent perianal fistulae and abscesses. Only after the diagnosis Crohn's disease was established and adequate treatment was initiated, the perianal lesions disappeared without further surgical treatment. Perianal fistulae and abscesses in older children should raise the suspicion of Crohn's disease, in which case therapy is indicated to induce and maintain remission of the underlying disease instead of surgical intervention.
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Affiliation(s)
- Usha K Coblijn
- AMC en VUmc, Kinderchirurgisch Centrum Amsterdam, Amsterdam
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