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Quint E, Perry ZH, Elkrinawi N, Kukeev I, Czeiger D, Vakhrushev A, Sebbag G, Dukhno O. Banded One-Anastomosis Gastric Bypass (BOAGB) for Patients Living with Obesity and Extreme Obesity: A Single Institution's Experience. Obes Surg 2024; 34:1756-1763. [PMID: 38557949 DOI: 10.1007/s11695-024-07194-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The prevalence of patients suffering from extreme obesity (body mass index (BMI) ≥ 50) has significantly increased over the past three decades, surpassing the rise in the general population of overweight patients. Weight loss outcomes after bariatric surgery in patients suffering from extreme obesity are less favorable, with a higher incidence of weight regain. Variations of existing bariatric procedures have been proposed to address this issue. One such variation is adding a gastric band to limit the expansion of the newly created pouch. Limited data exist regarding the effectiveness of this procedure, called the banded one-anastomosis gastric bypass (BOAGB) procedure, compared to other bariatric procedures. METHOD In this retrospective study, we compared all patients who underwent the BOAGB procedure at the Bariatric Surgery Unit in our Medical Center with a postoperative follow-up of at least 1 year with patients who underwent a one-anastomosis gastric bypass (OAGB) or sleeve gastrectomy (SG) procedures. Data collected included demographics, comorbidities, surgical outcomes, complications, and postoperative quality-of-life assessments. RESULTS One hundred eleven patients were enlisted to our study during the relevant study period-24 patients underwent the BOAGB procedure, 43 underwent OAGB, and 44 underwent a SG. Lost to follow-up beyond 30 days was 9% (at 1-year post-surgery, we were able to establish contact with 101 patients). The pre-op BMI was significantly higher in the BOAGB group compared to the other procedures. Additionally, a higher prevalence of diabetes was observed in the BOAGB group. The duration of surgery was significantly longer for the BOAGB procedure. No significant differences were found in surgical complications. Overall, all procedures resulted in significant excess weight loss (EWL) or change in BMI, improvement in comorbidities, and improved quality of life postoperatively. CONCLUSIONS The BOAGB procedure, like OAGB and SG, demonstrated favorable weight loss outcomes and weight maintenance 1 year postoperatively without significant differences between the procedures. The BOAGB procedure is relatively new, with good bariatric outcomes and a favorable safety profile. Long-term study is needed to evaluate these various bariatric procedures' efficacy further.
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Affiliation(s)
- Elchanan Quint
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
| | - Zvi H Perry
- Bariatric Surgery Unit, Soroka University Medical Center, The Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel.
- Department of General Surgery A, Soroka University Medical Center, Beer Sheba, Israel.
| | - Nur Elkrinawi
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
| | - Ivan Kukeev
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
| | - David Czeiger
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
| | - Alex Vakhrushev
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
- Bariatric Surgery Unit, Soroka University Medical Center, The Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
| | - Gilbert Sebbag
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
| | - Oleg Dukhno
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
- Bariatric Surgery Unit, Soroka University Medical Center, The Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
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Kermansaravi M, Shahmiri SS, Kow L, Gawdat K, Abbas SI, Aly A, Bashir A, Bhandari M, Haddad A, ElFawal MH, Inam A, Kasama K, Kim SH, Kular KS, Lakdawala M, Layani LA, Lee WJ, Pazouki A, Prasad A, Safadi B, Wang C, Yang W, Adib R, Jazi AHD, Shabbir A. Technical Variations and Considerations around OAGB in IFSO-APC and IFSO-MENAC Chapters, an Expert Survey. Obes Surg 2024:10.1007/s11695-024-07239-9. [PMID: 38662251 DOI: 10.1007/s11695-024-07239-9] [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: 03/06/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE This study aimed to evaluate the technical variations of one-anastomosis gastric bypass (OAGB) among IFSO-APC and MENAC experts. BACKGROUND The multitude of technical variations and patient selection challenges among metabolic and bariatric surgeons worldwide necessitates a heightened awareness of these issues. Understanding different perspectives and viewpoints can empower surgeons performing OAGB to adapt their techniques, leading to improved outcomes and reduced complications. METHODS The scientific team of IFSO-APC, consisting of skilled bariatric and metabolic surgeons specializing in OAGB, conducted a confidential online survey. The survey aimed to assess technical variations and considerations related to OAGB within the IFSO-APC and IFSO-MENAC chapters. A total of 85 OAGB experts participated in the survey, providing their responses through a 35-question online format. The survey took place from January 1, 2024, to February 15, 2024. RESULTS Most experts do not perform OAGB for children and adolescents younger than 18 years. Most experts create the gastric pouch over a 36-40-F bougie and prefer to create a gastrojejunostomy, at the posterior wall of the gastric pouch. An anti-reflux suture during OAGB is performed in all patients by 51.8% of experts. Most experts set a common limb length of > 4 m in revisional and conversional OAGBs to prevent nutritional complications. CONCLUSION The ongoing debate among metabolic and bariatric surgeons regarding the technical variations and patient selection in OAGB remains a significant point of discussion. This survey demonstrated the variations in technical aspects and patient selection for OAGB among MBS surgeons in the IFSO-APC and IFSO-MENAC chapters. Standardizing the OAGB technique is crucial to ensure optimal safety and efficacy in this procedure.
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Affiliation(s)
- Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat‑E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Shahab Shahabi Shahmiri
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat‑E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Lilian Kow
- Adelaide Bariatric Centre, Flinders University of South Australia, Adelaide, Australia
| | - Khaled Gawdat
- Bariatric Surgery Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Ahmad Aly
- Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia
- University of Melbourne, Melbourne, Australia
| | - Ahmad Bashir
- Minimally Invasive and Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC), Jordan Hospital, Amman, Jordan
| | | | - Ashraf Haddad
- Minimally Invasive and Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC), Jordan Hospital, Amman, Jordan
| | | | - Atif Inam
- Metabolic, Thoracic & General Surgery Unit III, Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Sang Hyun Kim
- Department of Surgery, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | | | | | | | - Wei-Jei Lee
- Medical Weight Loss Center, China Medical University Hsinchu Hospital, Zhubei, Taiwan
| | - Abdolreza Pazouki
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat‑E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Reza Adib
- The Wesley Hospital, Auchenflower, Queensland, Australia
| | - Amir Hossein Davarpanah Jazi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat‑E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Asim Shabbir
- National University of Singapore, Singapore, Singapore
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Ghiassi S, Nimeri A, Aleassa EM, Grover BT, Eisenberg D, Carter J. American Society for Metabolic and Bariatric Surgery position statement on one-anastomosis gastric bypass. Surg Obes Relat Dis 2024; 20:319-335. [PMID: 38272786 DOI: 10.1016/j.soard.2023.11.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 01/27/2024]
Abstract
The following position statement is issued by the American Society for Metabolic and Bariatric Surgery in response to inquiries made to the society by patients, physicians, society members, hospitals, health insurance payors, and others regarding one-anastomosis gastric bypass as a treatment for obesity and metabolic disease. This statement is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time. The statement may be revised in the future as more information becomes available.
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Affiliation(s)
- Saber Ghiassi
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
| | - Abdelrahman Nimeri
- Department of Surgery, Brigham and Women's Hospital, Harvard School of Medicine, Boston, Massachusetts
| | - Essa M Aleassa
- Digestive Disease Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Brandon T Grover
- Department of Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Dan Eisenberg
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Jonathan Carter
- Department of Surgery, University of California, San Francisco, California
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Carandina S, Soprani A, Sista F, De Palma M, Murcia S, Sartori A, Silvia F, Nedelcu A, Zulian V, Nedelcu M. Conversion of one-anastomosis gastric bypass (OAGB) to Roux-en-Y gastric bypass (RYGB) for gastroesophageal reflux disease (GERD): who is more at risk? A multicenter study. Surg Endosc 2024; 38:1163-1169. [PMID: 38082009 DOI: 10.1007/s00464-023-10611-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/26/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Although gastroesophageal reflux disease (GERD) affects 0.6% to 10% of patients operated on for one-anastomosis gastric bypass (OAGB), only about 1% require surgery to convert to Roux-en-Y gastric bypass (RYGB) [3-5]. The aim of the present study was to analyze the characteristics of OAGB patients converted to RYGB for GERD not responding to medical treatment. METHODS This retrospective multicenter study included patients who underwent conversion from OAGB to RYGB for severe GERD. The conversion was performed with resection of the previous gastro-jejunal anastomosis and the use of the afferent loop as a new biliary loop. RESULTS A total of 126 patients were included in the study. Of these patients, 66 (52.6%) had a past medical history of bariatric restrictive surgery (gastric banding, sleeve gastrectomy). A hiatal hernia (HH) was present in 56 patients (44.7%). The association between previous restrictive surgery and HH was recorded in 33 (26.2%) patients. Three-dimensional gastric computed tomography showed an average gastric pouch volume of 242.4 ± 55.1 cm3. Conversion to RYGB was performed on average 60 ± 35.6 months after OAGB. Seven patients (5.5%) experienced an early postoperative complication (4 patients grade IIIb and 3 grade IIb), and 3 (2.4%) a late complication. Patients showed further weight loss after RYGB conversion and an average of 24.8 ± 21.7 months after surgery, with a mean % of total weight loss (%TWL) of 6.9 ± 13.6 kg. From a clinical point of view, the problem of GERD was definitively solved in more than 90% of patients. CONCLUSIONS Situations that weaken the esogastric junction appear to be highly frequent in patients operated on for OAGB and converted to RYGB for severe reflux. Similarly, the correct creation of the gastric pouch could play an important role in reducing the risk of conversion to RYGB for GERD.
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Affiliation(s)
- Sergio Carandina
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité (CCO), 4, place du 4 septembre, 83100, Toulon, France.
- Department of Digestive and Bariatric Surgery, Clinica Madonna della Salute, 45014, Porto Viro, Italy.
| | - Antoine Soprani
- Department of Digestive and Bariatric Surgery, Clinique Geoffroy-Saint Hilaire, Générale de Santé (GDS), 75005, Paris, France
| | - Federico Sista
- Department of Surgery, Ospedale Civile San Salvatore L'Aquila, UOC di Chirurgia Epato-Bilio- Pancreatica, L'Aquila, Italy
| | - Massimiliano De Palma
- Department of Digestive and Bariatric Surgery, Clinica Madonna della Salute, 45014, Porto Viro, Italy
| | - Sebastien Murcia
- Department of Digestive and Bariatric Surgery, Clinique de Villeneuve, Villeneuve Sur Lot, France
| | - Andrea Sartori
- Department of Digestive and Bariatric Surgery, Clinica Madonna della Salute, 45014, Porto Viro, Italy
| | - Ferro Silvia
- Department of Digestive and Bariatric Surgery, Clinica Madonna della Salute, 45014, Porto Viro, Italy
| | - Anamaria Nedelcu
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité (CCO), 4, place du 4 septembre, 83100, Toulon, France
| | - Viola Zulian
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité (CCO), 4, place du 4 septembre, 83100, Toulon, France
| | - Marius Nedelcu
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité (CCO), 4, place du 4 septembre, 83100, Toulon, France
- ELSAN, Clinique Bouchard, Centre Chirurgical de l'Obésité (CCO), 13006, Marseille, France
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Davarpanah Jazi AH, Mehrnia N, Yarigholi F, Shahabi Shahmiri S. Laparoscopic Conversion of One-Anastomosis Gastric Bypass (OAGB) to Long-Limb Roux-en-Y Gastric Bypass (RYGB) Due Weight Regain and Bile Reflux. Obes Surg 2024; 34:698-699. [PMID: 38151555 DOI: 10.1007/s11695-023-06994-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 12/29/2023]
Affiliation(s)
- Amir Hossein Davarpanah Jazi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Nariman Mehrnia
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Fahime Yarigholi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shahab Shahabi Shahmiri
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Singla V, Gupta A, Gupta A, Monga S, Kumar A, Chekuri R, Gupta M, Kashyap L, Shalimar, Aggarwal S. Outcomes of Laparoscopic Sleeve Gastrectomy (LSG) vs One-Anastomosis Gastric Bypass (OAGB) in Patients with Super-Super Obesity (BMI ≥ 60 kg/m 2). Obes Surg 2024; 34:43-50. [PMID: 37996770 DOI: 10.1007/s11695-023-06960-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION The data comparing laparoscopic sleeve gastrectomy (LSG) and one-anastomosis gastric bypass (OAGB) in patients with BMI ≥ 60 kg/m2 is scarce. METHODS Prospectively collected data of patients with BMI ≥ 60 kg/m2 undergoing LSG or OAGB from January 2008 until June 2022 was analyzed retrospectively. Weight loss outcomes, impact on comorbidities, and complications were compared in both groups. RESULTS Fifty-six patients underwent LSG and 13 patients underwent OAGB. The median age and BMI were 37 (34-44) years and 63 (61.3-64.6) kg/m2 respectively. Both the groups had similar baseline demographic parameters. The percentage excess BMI loss (%EBMIL) was statistically similar in LSG and OAGB groups at 1 year (46.2% vs 46.1%), 3 years (52.9% vs 56.7%), and 5 years (51.1% vs 62.3%). The percentage excess BMI regain was lower (although statistically similar) following OAGB at 3 years (5.3% vs 0.1%) and 5 years (12.9% vs 4.4%). OAGB was found to correlate positively with weight loss and negatively with weight regain (p > 0.05). There was one 30-day mortality due to postoperative lower respiratory infection in the LSG group. CONCLUSION OAGB has a trend towards better weight loss outcomes as compared to LSG in patients with a BMI ≥ 60 kg/m2 with lesser complication rates and might be a preferred option. LSG also has acceptable weight loss and should be considered a standalone procedure if OAGB is not feasible technically.
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Affiliation(s)
- Vitish Singla
- Department of Surgical Disciplines, India Institute of Medical Sciences, Room No. 5034, New Delhi, India
| | - Aishwary Gupta
- Department of Surgical Disciplines, India Institute of Medical Sciences, Room No. 5034, New Delhi, India
| | - Aishwary Gupta
- Department of Surgical Disciplines, India Institute of Medical Sciences, Room No. 5034, New Delhi, India
| | - Sukhda Monga
- Department of Surgical Disciplines, India Institute of Medical Sciences, Room No. 5034, New Delhi, India
| | - Arun Kumar
- Department of Surgical Disciplines, India Institute of Medical Sciences, Room No. 5034, New Delhi, India
| | - Ritvik Chekuri
- Department of Surgical Disciplines, India Institute of Medical Sciences, Room No. 5034, New Delhi, India
| | - Mehul Gupta
- Department of Surgical Disciplines, India Institute of Medical Sciences, Room No. 5034, New Delhi, India
| | - Lokesh Kashyap
- Department of Anesthesiology, India Institute of Medical Sciences, New Delhi, India
| | - Shalimar
- Department of Gastroenterology, India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Aggarwal
- Department of Surgical Disciplines, India Institute of Medical Sciences, Room No. 5034, New Delhi, India.
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Hany M, Ibrahim M, Samir M, Agayby ASS, Torensma B. Management of Leak by Intraoperative Megastent Insertion During Revisional Bariatric Metabolic Surgery: a Case Report. Obes Surg 2024; 34:293-294. [PMID: 38062343 PMCID: PMC10781870 DOI: 10.1007/s11695-023-06943-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 01/11/2024]
Abstract
We describe gastric tube continuity restoration (gastrogastrostomy) in a patient who underwent revisional laparoscopic one-anastomosis gastric bypass (OAGB) due to weight recurrence after laparoscopic sleeve gastrectomy (SG). The patient sought restoration to SG due to poor quality of life. A postoperative 11-mm leak at the site of the gastrogastrostomy, attributed to adhesions and edema from a marginal ulcer, complicated the procedure. As a result, laparoscopic exploration was performed, followed by insertion of a megastent. We hereby present video documentation of this case report as well as megastent insertion technique for the treatment of such complications.
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Affiliation(s)
- Mohamed Hany
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt.
- Madina Women's Hospital, Alexandria, Egypt.
| | - Mohamed Ibrahim
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Mohamed Samir
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Ann Samy Shafiq Agayby
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Bart Torensma
- Leiden University Medical Center (LUMC), Leiden, the Netherlands
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Sakran N, Raziel A, Hod K, Azaria B, Goitein D, Kaplan U. Early outcomes of one-anastomosis gastric bypass in the elderly population at high-volume bariatric centers. Updates Surg 2024; 76:187-191. [PMID: 38012431 DOI: 10.1007/s13304-023-01697-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/03/2023] [Indexed: 11/29/2023]
Abstract
The increasing rate of obesity and life expectancy will lead to increasing numbers of bariatric procedures in the elderly. We aim to report the early (≤ 30 days) adverse events of One-Anastomosis Gastric Bypass (OAGB) in this patient population. Assuta Bariatric Centers in Israel. Retrospective review of perioperative OAGB outcomes between elderly group (≥ 65 years) and non-elderly group (18-64 years) at high-volume bariatric centers between January 2017-December 2021. Operative time, length of stay (LOS), and overall ≤ 30 days complication rates, as ranked by the Clavien-Dindo Classification (CDC) were compared. There were 6618 patients (non-elderly group) and 104 (elderly group) who underwent OAGB. Gender and preoperative BMI were comparable between the two age groups. The elderly group had significantly higher rate of ischemic heart disease and chronic renal failure. The number of patients with LOS ≥ 3 days was significantly higher in the elderly group [19.4% (n = 20) vs. 6.6% (n = 331), respectively; p < 0.001]. The total early adverse events were higher in the elderly group with no statistical significance [7.7% (n = 8) vs. 3.8% (n = 250), respectively; p = 0.062]. The rate of minor and major adverse events and reoperation rate was comparable between the two groups. The rate of readmissions was significantly higher in the elderly group 5.8% (n = 6) vs. 1.9% (n = 124), respectively p = 0.015. There was 0.06% mortality (n = 2) in the non-elderly group. OAGB is a relatively safe metabolic and bariatric surgery for elderly obese patients with early (≤ 30 days) morbidity rates similar to the non-elderly population.
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Affiliation(s)
- Nasser Sakran
- Assuta Medical Center, Tel Aviv, Israel.
- Department of General Surgery, Holy Family Hospital, P.O. Box 8, Nazareth, Israel.
- The Azrieli Faculty of Medicine Safed, Bar-Ilan University, Ramat Gan, Israel.
| | | | - Keren Hod
- Assuta Medical Center, Tel Aviv, Israel
| | | | - David Goitein
- Assuta Medical Center, Tel Aviv, Israel
- Department of Surgery C, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Kaplan
- Assuta Medical Center, Tel Aviv, Israel
- Department of Surgery, Emek Medicl Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Bandlamudi N, Holt G, Graham Y, O'Kane M, Singhal R, Parmar C, Sakran N, Mahawar K, Pouwels S, Potluri S, Madhok B. Malnutrition Following One-Anastomosis Gastric Bypass: a Systematic Review. Obes Surg 2023; 33:4137-4146. [PMID: 37917389 DOI: 10.1007/s11695-023-06907-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Abstract
Severe malnutrition following one-anastomosis gastric bypass (OAGB) remains a concern. Fifty studies involving 49,991 patients were included in this review. In-hospital treatment for severe malnutrition was needed for 0.9% (n = 446) of patients. Biliopancreatic limb (BPL) length was 150 cm in five (1.1%) patients, > 150 cm in 151 (33.9%), and not reported in 290 (65%) patients. OAGB was revised to normal anatomy in 126 (28.2%), sleeve gastrectomy in 46 (10.3%), Roux-en-Y gastric bypass in 41 (9.2%), and shortening of BPL length in 17 (3.8%) patients. One hundred fifty-one (33.8%) patients responded to treatment; ten (2.2%) did not respond and was not reported in 285 (63.9%) patients. Eight (0.02%) deaths were reported. Standardisation of the OAGB technique along with robust prospective data collection is required to understand this serious problem.
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Affiliation(s)
- Nanda Bandlamudi
- East Midlands Bariatric and Metabolic Institute, University Hospital of Derby and Burton NHS Foundation Trust, Derby, DE22 3NE, UK.
| | - Guy Holt
- East Midlands Bariatric and Metabolic Institute, University Hospital of Derby and Burton NHS Foundation Trust, Derby, DE22 3NE, UK
| | - Yitka Graham
- Bariatric Surgical Unit, South Tyneside and Sunderland NHS Trust, Sunderland, SR4 7TP, UK
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, SR1 3SD, UK
- Faculty of Psychology, University of Anahuac, Huixquilucan Municipality, 01840, Anahuac, Mexico
- Department of Biomedical Sciences, Austral University, 1629, Buenos Aires, Argentina
| | - Mary O'Kane
- Dietetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - Rishi Singhal
- Bariatric and Upper GI Unit, Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, B9 5SS, UK
| | - Chetan Parmar
- Department of Surgery, Whittington Health NHS Trust, London, N19 5NF, UK
| | - Nasser Sakran
- Department of Surgery, Holy Family Hospital, Nazareth, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Kamal Mahawar
- Bariatric Surgical Unit, South Tyneside and Sunderland NHS Trust, Sunderland, SR4 7TP, UK
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, SR1 3SD, UK
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
- Department of General, Abdominal and Minimally Invasive Surgery, Helios Klinikum Krefeld, Krefeld, NRW, Germany
| | - Sudha Potluri
- Queens Hospital Burton, University Hospital of Derby and Burton NHS Foundation Trust, Burton, DE13 0RB, UK
| | - Brijesh Madhok
- East Midlands Bariatric and Metabolic Institute, University Hospital of Derby and Burton NHS Foundation Trust, Derby, DE22 3NE, UK
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Esparham A, Ahmadyar S, Zandbaf T, Dalili A, Rezapanah A, Rutledge R, Khorgami Z. Does One-Anastomosis Gastric Bypass Expose Patients to Gastroesophageal Reflux: a Systematic Review and Meta-analysis. Obes Surg 2023; 33:4080-4102. [PMID: 37880462 DOI: 10.1007/s11695-023-06866-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023]
Abstract
This systematic review and meta-analysis aimed to investigate the incidence of new-onset gastroesophageal reflux, reflux change, esophagitis, Barrett's esophagus, and revision due to reflux, gastritis, and marginal ulcer after one-anastomosis gastric bypass (OAGB). We performed subgroup analyses based on primary and revisional OAGB and time of follow-up. Meta-analysis of 87 studies with 27,775 patients showed a 6% rate of new-onset reflux after OAGB. Preoperative reflux status did not change significantly after OAGB. The rate of esophagitis and Barrett's esophagus was 15% and 1%, respectively. The new-onset reflux rate after OAGB was significantly higher than gastric bypass but not different with sleeve gastrectomy. The current study showed a relatively low rate of reflux and its complications after OAGB, but it was significantly higher than Roux-en-Y gastric bypass.
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Affiliation(s)
- Ali Esparham
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Soheil Ahmadyar
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Tooraj Zandbaf
- Department of General Surgery, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran
| | - Amin Dalili
- Department of General Surgery, School of Medicine, Surgical Oncology Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Rezapanah
- Department of General Surgery, School of Medicine, Surgical Oncology Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Robert Rutledge
- Center for Laparoscopic Obesity Surgery, 6240 N Durango Dr STE 120, Las Vegas, NV, 89149, USA
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma School of Community Medicine, 1919 S. Wheeling Avenue, Suite 600, Tulsa, OK, 74104-5638, USA.
- Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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11
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Vitiello A, Berardi G, Peltrini R, Calabrese P, Pilone V. One-anastomosis gastric bypass (OAGB) versus Roux-en-Y gastric bypass (RYGB) as revisional procedures after failed laparoscopic sleeve gastrectomy (LSG): systematic review and meta-analysis of comparative studies. Langenbecks Arch Surg 2023; 408:440. [PMID: 37980292 PMCID: PMC10657303 DOI: 10.1007/s00423-023-03175-x] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/07/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION The aim of this study was to compare weight loss and gastroesophageal reflux disease (GERD) remission after one-anastomosis gastric bypass (OAGB) versus Roux-en-Y gastric bypass (RYGB) as revisional procedures after laparoscopic sleeve gastrectomy (LSG). METHODS In PubMed, Embase, and Cochrane Library, a search was performed using the terms "Roux-en-Y gastric bypass versus one anastomosis gastric bypass," "revisional surgery," and "sleeve gastrectomy." Only original articles in English language comparing OAGB and RYGB were included. No temporal interval was set. The primary outcome measure was weight loss (%TWL). The secondary endpoints were leak, bleeding, marginal ulcer, and GERD. PRISMA flowchart was used. Differences in continuous and dichotomous outcome variables were expressed as mean difference (MD) and risk difference (RD) with 95% CI, respectively. Heterogeneity was assessed by using I2 statistic. RESULTS Six retrospective comparative articles were included in the present meta-analysis. Weight loss analysis showed a MD = 5.70 (95% CI 4.84-6.57) in favor of the OAGB procedure with a statistical significance (p = 0.00001) and no significant statistical heterogeneity (I2 = 0.00%). There was no significant RD for leak, bleeding, or marginal ulcer after the two revisional procedures. After conversion to OAGB, remission from GERD was 68.6% (81/118), and it was 80.6% (150/186) after conversion to RYGB with a RD = 0.10 (95% CI -0.04, 0.24), no statistical significance (p = 0.19), and high heterogeneity (I2 = 96%). De novo GERD was 6.3% (16/255) after conversional OAGB, and it was 0.5% (1/180) after conversion to RYGB with a RD = -0.23 (95% CI -0.57, 0.11), no statistical significance (p = 0.16), and high heterogeneity (I2 = 92%).
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Affiliation(s)
- Antonio Vitiello
- Advanced Biomedical Sciences Department, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy.
| | - Giovanna Berardi
- Advanced Biomedical Sciences Department, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Roberto Peltrini
- Public Health Department, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Pietro Calabrese
- Public Health Department, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Vincenzo Pilone
- Public Health Department, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
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12
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Hart JWH', Takken R, Hogewoning CRC, Biter LU, Apers JA, Zengerink H, Dunkelgrün M, Verhoef C. Markers for Major Complications at Day-One Postoperative in Fast-Track Metabolic Surgery: Updated Metabolic Checklist. Obes Surg 2023; 33:3008-3016. [PMID: 37610699 PMCID: PMC10514089 DOI: 10.1007/s11695-023-06782-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/31/2023] [Accepted: 08/10/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION In fast-track metabolic surgery, the window to identify complications is narrow. Postoperative checklists can be useful tools in the decision-making of safe early discharge. The aim of this study was to evaluate the predictive value of a checklist used in metabolic surgery. METHODS Retrospective data from June 2018 to January 2021 was collected on all patients that underwent metabolic surgery in a high-volume bariatric hospital in the Netherlands. Patients without an available checklist were excluded. The primary outcome was major complications and the secondary outcomes were minor complications, readmission, and unplanned hospital visits within 30 days postoperatively. RESULTS Major complications within 30 days postoperatively occurred in 62/1589 (3.9%) of the total included patients. An advise against early discharge was significantly more seen in patients with major complications compared to those without major complications (90.3% versus 48.1%, P < 0.001, respectively), and a negative checklist (advice for discharge) had a negative predictive value of 99.2%. The area under the curve for the total checklist was 0.80 (P < 0.001). Using a cut-off value of ≥3 positive points, the sensitivity and specificity were 65% and 82%, respectively. Individual parameters from the checklist: oral intake, mobilization, calf pain, willingness for discharge, heart rate, drain (>30 ml/24 h), hemoglobin, and leukocytes count were also significantly different between groups. CONCLUSION This checklist is a valuable tool to decide whether patients can be safely discharged early. Heart rate appeared to be the most predictive parameter for the development of major complications. Future studies should conduct prediction models to identify patients at risk for major complications.
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Affiliation(s)
- J W H 't Hart
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045, PM, Rotterdam, The Netherlands.
| | - R Takken
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045, PM, Rotterdam, The Netherlands
| | - C R C Hogewoning
- Department of Surgery, St. Antonius Hospital, Utrecht, The Netherlands
| | - L U Biter
- Department of Surgery, Tulp Medisch Centrum, Zwijndrecht, The Netherlands
| | - J A Apers
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045, PM, Rotterdam, The Netherlands
| | - H Zengerink
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045, PM, Rotterdam, The Netherlands
| | - M Dunkelgrün
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045, PM, Rotterdam, The Netherlands
| | - C Verhoef
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
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Ferrer-Márquez M, García-Redondo M, Maturana-Ibáñez V, Estébanez-Ferrero B, Fernández-Alonso A, Rubio-Gil F, Zamora Soler JA, Ferrer-Ayza M. Bile reflux and marginal ulcers after one-anastomosis gastric bypass (OAGB). A narrative review. Cir Esp 2023; 101 Suppl 4:S69-S75. [PMID: 37085133 DOI: 10.1016/j.cireng.2023.04.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/24/2022] [Accepted: 12/11/2022] [Indexed: 04/23/2023]
Abstract
One-anastomosis gastric bypass has now become the third most commonly performed bariatric technique worldwide. However, as a consequence of the configuration of this surgery, it can present some chronic complications (anastomotic mouth ulcers and biliary reflux) that physicians must come to better understand and assess. In this narrative review, we aimed to update our knowledge of both the diagnosis and treatment of these two complications in the context of bariatric surgeries. We concluded that a series of pre-, intra-, and postoperative preventive strategies should be considered by surgeons to help reduce the appearance of these complications.
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Affiliation(s)
- Manuel Ferrer-Márquez
- Departamento de Cirugía Bariátrica, Hospital Universitario Torrecárdenas, Almería, Spain; Departamento de Cirugía Bariátrica (Obesidad Almería), Hospital Mediterráneo, Almería, Spain.
| | - Manuel García-Redondo
- Departamento de Cirugía Bariátrica, Hospital Universitario Torrecárdenas, Almería, Spain.
| | | | | | - Ana Fernández-Alonso
- Departamento de Obstetricia y Ginecología, Hospital Universitario Torrecárdenas, Almería, Spain.
| | - Francisco Rubio-Gil
- Departamento de Cirugía Bariátrica (Obesidad Almería), Hospital Mediterráneo, Almería, Spain.
| | - José A Zamora Soler
- Clinical Nursing Research Group, Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Alicante, Alicante, Spain.
| | - Manuel Ferrer-Ayza
- Departamento de Cirugía Bariátrica (Obesidad Almería), Hospital Mediterráneo, Almería, Spain.
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14
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Chang YC, Hsu CN, Chong K, Yang PJ, Ser KH, Lee PC, Chen SC, Hsuan CF, Lee YC, Hsu CC, Lee HL, Liao KCW, Hsieh ML, Chuang GT, Yang WS, Chu SL, Li WY, Chuang LM, Lee WJ. Roux-en-Y and One-Anastomosis Gastric Bypass Surgery Are Superior to Sleeve Gastrectomy in Lowering Glucose and Cholesterol Levels Independent of Weight Loss: a Propensity-Score Weighting Analysis. Obes Surg 2023; 33:3035-3050. [PMID: 37612578 DOI: 10.1007/s11695-023-06656-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND The superior effects of gastric bypass surgery in preventing cardiovascular diseases compared with sleeve gastrectomy are well-established. However, whether these effects are independent of weight loss is not known. METHODS In this retrospective cohort study, we compared the change in cardiometabolic risks of 1073 diabetic patients undergoing Roux-en-Y gastric bypass (RYGB) (n = 265), one-anastomosis gastric bypass (OAGB) (n = 619), and sleeve gastrectomy (SG) (n = 189) with equivalent weight loss from the Min-Shen General Hospital. Propensity score-weighting, multivariate regression, and matching were performed to adjust for baseline differences. RESULTS After 12 months, OAGB and, to a lesser extent, RYGB exhibited superior effects on glycemic control compared with SG in patients with equivalent weight loss. The effect was significant in patients with mild-to-modest BMI reduction but diminished in patients with severe BMI reduction. RYGB and OAGB had significantly greater effects in lowering total and low-density lipoprotein cholesterol than SG, regardless of weight loss. The results of matching patients with equivalent weight loss yielded similar results. The longer length of bypassed biliopancreatic (BP) limbs was correlated with a greater decrease in glycemic levels, insulin resistance index, lipids, C-reactive protein (CRP) levels, and creatinine levels in patients receiving RYBG. It was correlated with greater decreases in BMI, fasting insulin, insulin resistance index, and C-reactive protein levels in patients receiving OAGB. CONCLUSION Diabetic patients receiving OAGB and RYGB had lower glucose and cholesterol levels compared with SG independent of weight loss. Our results suggest diabetic patients with cardiovascular risk factors such as hypercholesterolemia to receive bypass surgery.
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Affiliation(s)
- Yi-Cheng Chang
- Graduate Institute of Medical Genomics and Proteomics, National Taiwan University, Taipei, 100, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, 115, Taiwan
- Center for Obesity, Lifestyle, and Metabolic Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan
- Graduate Institute of Molecular Medicine, National Taiwan University, Taipei, 100, Taiwan
| | - Chih-Neng Hsu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, 640, Taiwan
| | - Keong Chong
- Department of Medicine, Min-Sheng General Hospital, Taoyuan, 330, Taiwan
| | - Po-Jen Yang
- Center for Obesity, Lifestyle, and Metabolic Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan
- Department of Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan
- Department of Surgery, College of Medicine, National Taiwan University, Taipei, 100, Taiwan
| | - Kong-Han Ser
- Department of Surgery, Ten-Chen General Hospital, Taoyuan, 326, Taiwan
| | - Po-Chu Lee
- Department of Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Shu-Chun Chen
- Department of Nursing, Ming-Sheng General Hospital, Taoyuan, 330, Taiwan
| | - Chin-Feng Hsuan
- Department of Internal Medicine, Division of Cardiology, E-Da Hospital, Kaohsiung, 824, Taiwan
- Department of Internal Medicine, Division of Cardiology, E-Da Dachang Hospital, Kaohsiung, 824, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 840, Taiwan
| | - Yi-Chih Lee
- Department of International Business, Chien Hsin University of Science and Technology, Taoyuan, 320, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, 350, Taiwan
| | - Hsiao-Lin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Karen Chia-Wen Liao
- Biological Sciences Division, University of Chicago, Chicago, IL, 60637, USA
| | - Meng-Lun Hsieh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, 32610, USA
| | - Gwo-Tsann Chuang
- Graduate Institute of Medical Genomics and Proteomics, National Taiwan University, Taipei, 100, Taiwan
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, 100, Taiwan
| | - Wei-Shun Yang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, 302, Taiwan
| | - Shao-Lun Chu
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, 100, Taiwan
| | - Wen-Yi Li
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, 640, Taiwan
| | - Lee-Ming Chuang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan.
- Graduate Institute of Molecular Medicine, National Taiwan University, Taipei, 100, Taiwan.
- Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, 100, Taiwan.
| | - Wei-Jei Lee
- Department of Medicine, Min-Sheng General Hospital, Taoyuan, 330, Taiwan.
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, 330, Taiwan.
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15
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Mouawad C, Dahboul H, Kazan D, Chamaa B, Osseis M, Noun R, Chakhtoura G. Adenocarcinoma of the Gastro-jejunal Anastomosis After One Anastomosis Gastric Bypass. J Gastrointest Cancer 2023:10.1007/s12029-023-00968-7. [PMID: 37690067 DOI: 10.1007/s12029-023-00968-7] [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] [Accepted: 09/03/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION One anastomosis gastric bypass (OAGB) is mainly criticized for the supposed carcinogenic effect of bile reflux on the gastric pouch mucosa. CASE PRESENTATION A 56-year-old male patient presented 12 years after OAGB with a 10-month history of gradual dysphagia and vomiting. He was diagnosed with a tumor of the gastro-jejunal anastomosis, and underwent total gastrectomy with D2 lymphadenectomy. Specimen examination showed a diffuse isolated cell-type adenocarcinoma. To our knowledge, we report the first case in literature of adenocarcinoma of the gastro-jejunal anastomosis post-OAGB, and the second reported case if we include the Mason loop gastric bypass, which was the earlier version of OAGB with a different conceptual and physiological aspect. CONCLUSION The carcinogenic effect of bile reflux in OAGB will remain hypothetical until a detailed controlled study may prove the causality between bile reflux and gastric pouch malignancies in patients with a history of OAGB.
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Affiliation(s)
- Christian Mouawad
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Beirut, Lebanon.
| | - Houssam Dahboul
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Daniel Kazan
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Bilal Chamaa
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Michael Osseis
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Roger Noun
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Ghassan Chakhtoura
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Beirut, Lebanon
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16
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Lange UG, Mehdorn M, Dietrich A. [Anastomotic techniques in minimally invasive bariatric surgery]. Chirurgie (Heidelb) 2023; 94:768-774. [PMID: 37367961 DOI: 10.1007/s00104-023-01907-9] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Recommendations for the use of specific anastomotic techniques are not available in laparoscopic bariatric surgery. Recommendation criteria should consider the rate of insufficiency, bleeding, tendency to stricture or ulceration as well as the impact on weight loss or dumping. OBJECTIVE This article gives a review of the available evidence on the anastomotic techniques of typical surgical procedures in laparoscopic bariatric surgery. MATERIAL AND METHODS The current literature was reviewed and is discussed regarding anastomotic techniques for Roux-en‑Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB), single anastomosis sleeve ileal (SASI) bypass and biliopancreatic diversion with duodenal switch (BPD-DS). RESULTS Few comparative studies exist, except for the RYGB. In RYGB gastrojejunostomy, a complete manual suture was shown to be equivalent to a mechanical anastomosis. In addition, the linear staple suture showed slight advantages over the circular stapler in terms of wound infections and bleeding. The anastomosis technique of the OAGB and SASI can be performed entirely with a linear stapler or with suture closure of the anterior wall defect. There seems to be an advantage of manual anastomosis in BPD-DS. CONCLUSION Due to the lack of evidence, no recommendations can be made. Only in RYGB was there an advantage of the linear stapler technique with hand closure of the stapler defect compared to the linear stapler. In principle, prospective, randomized studies should be strived for.
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Affiliation(s)
- Undine Gabriele Lange
- Klinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Matthias Mehdorn
- Klinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Arne Dietrich
- Klinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
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17
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van Olst N, Reiber BMM, Vink MRA, Gerdes VEA, Galenkamp H, van der Peet DL, van Rijswijk AS, Bruin SC. Are male patients undergoing bariatric surgery less healthy than female patients? Surg Obes Relat Dis 2023; 19:1013-1022. [PMID: 36967264 DOI: 10.1016/j.soard.2023.02.015] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/06/2023] [Accepted: 02/15/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Male patients are underrepresented in bariatric surgery (BS) despite a relatively equal proportion of men and women experiencing obesity. OBJECTIVES Differences in frequency and severity of obesity-associated medical problems (OAMPs) between men and women undergoing BS or in a control group (HELIUS [HEalthy Life In an Urban Setting]) were evaluated. The hypothesis was that men undergoing BS are less healthy than women. SETTING A cross-sectional study of 2 cohorts undergoing BS in 2013 (BS2013) and 2019 (BS2019) and a control group of patients with severe obesity from a general population (HELIUS). METHODS Characteristics concerning weight and OAMPs, medication usage, intoxications, postoperative complications (for BS2019) were compared between men and women. Members of the HELIUS cohort were tested for eligibility for BS. RESULTS Of 3244 patients included, the majority were female (>78.4%). Median (interquartile range) age and body mass index (kg/m2) in male versus female patients were 47.0 (41.0-53.8) versus 43.0 (36.0-51.0) years and 41.5 (38.4-45.2) versus 42.3 (40.2-45.9), respectively, in BS2013, and 52.0 (39.8-57.0) versus 45.0 (35.0-53.0) years and 40.4 (37.4-43.8) versus 41.3 (39.0-44.1) in BS2019 (P < .05). The rates of men with OAMPs were 71.4% and 82.0% compared with 50.2% and 56.9% of women in BS2013 and BS2019, respectively. Overall medication usage was higher in male patients (P = .014). In BS2019, male patients exhibited a higher median HbA1C (P < .001) and blood pressure (P = .003) and used more antihypertensives and antidiabetics (P = .004). Postoperative complications did not differ between men and women. In the control cohort, 66.5% of men and 66.6% of women were eligible for BS. CONCLUSION Men undergoing BS more often experience OAMPs than women, and OAMPs are more advanced in men.
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Affiliation(s)
- Nienke van Olst
- Department of Bariatric Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands; Department of Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
| | - Beata M M Reiber
- Department of Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Marjolein R A Vink
- Department of Bariatric Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Victor E A Gerdes
- Department of Bariatric Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands; Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Health Behaviors and Chronic Diseases, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Donald L van der Peet
- Department of Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - Sojoerd C Bruin
- Department of Bariatric Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
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18
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Lee S, Supparamaniam S, Varghese C, Mahawar K. Marginal Ulcers Following One-Anastomosis Gastric Bypass: a Systematic Review and Meta-analysis. Obes Surg 2023; 33:2884-2897. [PMID: 37526816 DOI: 10.1007/s11695-023-06762-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Marginal ulcer (MU) is an uncommon but significant complication following one-anastomosis gastric bypass (OAGB). Our study aims to understand the incidence rates, risk factors, and management of MU following OAGB. METHODS MEDLINE, Scopus, and Cochrane Library databases were examined to identify all studies on OAGB where authors had reported on MU. Data were collected on basic demographics, incidence rates, risk factors, and management of this condition. RESULTS Thirty-two studies involving 8868 patients were analysed. The mean age and body mass index (BMI) of patients in these studies were 40.9 ± 4.5 years and 47.6 ± 5.6 kg/m2, respectively. Among the patient cohort, approximately 72% were female, and 20.6% had preoperative gastroesophageal reflux disease (GERD). The authors described prescribing proton-pump inhibitors (PPI) prophylaxis to 14.1% of patients after surgery. Two hundred twenty-eight patients were reported to have MU. The incidence of MU was 2.59% (95% CI 1.89-3.52), of which 53 patients presented within 12 months, 24 patients presented after 31 months, and five patients after 6 years. One hundred forty-six patients did not have presentation time documented. Sixty-five patients were described to have MU diagnosed on endoscopy, of which 54 were symptomatic and 11 were asymptomatic. The authors were, however, not specific on the choice of investigation for the remaining 163 patients. Of patients, 89.7% were treated conservatively with PPIs, whilst 10.3% had surgery to treat MU. CONCLUSIONS Marginal ulcer is an uncommon complication following OAGB. The majority of patients are treated conservatively with PPIs. Larger, well-designed studies reporting on risk factors, investigation, and management of MU following OAGB are warranted.
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Affiliation(s)
- Shiela Lee
- Bariatric Unit, Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK.
| | | | - Chris Varghese
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kamal Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK
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19
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Jedamzik J, Bichler C, Felsenreich DM, Brugger J, Eichelter J, Nixdorf L, Krebs M, Itariu B, Langer FB, Prager G. The male patient with obesity undergoing metabolic and bariatric surgery: changes in testosterone levels correlate with weight loss after one-anastomosis gastric bypass and Roux-en-Y gastric bypass. Surg Obes Relat Dis 2023; 19:699-705. [PMID: 36740523 DOI: 10.1016/j.soard.2022.12.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/10/2022] [Accepted: 12/17/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Male obesity secondary hypogonadism (MOSH) is a common disease among men with obesity and can be associated with metabolic syndrome and a variety of metabolic problems ultimately leading to androgen deficiency. Metabolic and bariatric surgery is a well-established treatment option associated with significant weight loss and reduction in metabolic co-morbidities. OBJECTIVES To evaluate the impact of surgery on plasma levels of sexual hormones and their effect on weight loss comparing 2 surgical methods (one-anastomosis gastric bypass [OAGB] and Roux-en-Y gastric bypass [RYGB]) in male patients with obesity. SETTING University hospital, Austria. METHODS Patients undergoing OAGB and RYGB between 2012 and 2017 were analyzed retrospectively. Follow-up in this study was up to 24 months. Systemic levels of sexual hormones (luteinizing hormone [LH]), follicle stimulating hormone [FSH], total testosterone [TT], sexual hormone binding globin [SHBG], 17 beta-estradiol [17bE], androstenedione [AS]) were retrieved at each visit. A linear mixed model was used to assess the correlation between changes in testosterone levels and percent excess weight loss (%EWL). RESULTS In 30.8% of all patients, MOSH was present preoperatively. A significant increase of TT was observed postoperatively that led to a complete resolution of hypogonadism within the period observed. Bioavailable testosterone (bTT) and FSH levels significantly increased each month of follow-up after surgery (all P < .01). Levels of 17bE did not change significantly after surgery. The overall change of TT, comparing preoperative and 1-year postoperative TT levels (ΔTT), significantly correlated with %EWL. Changes in TT levels were not affected by the choice of surgical method. CONCLUSIONS Serum plasma testosterone levels rise significantly after metabolic and bariatric surgery in male patients. The change of testosterone levels seems to play a role in continued weight loss after surgery. This is true irrespective of the surgical method used.
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Affiliation(s)
- Julia Jedamzik
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Bichler
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniel Moritz Felsenreich
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Jonas Brugger
- Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Section for Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Jakob Eichelter
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Larissa Nixdorf
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Michael Krebs
- Division of Endocrinology, Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | - Bianca Itariu
- Division of Endocrinology, Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | - Felix B Langer
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Gerhard Prager
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
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20
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Ospanov O, Yeleuov G, Buchwald JN, Zharov N, Yelembayev B, Sultanov K. A Randomized Controlled Trial of Acid and Bile Reflux Esophagitis Prevention by Modified Fundoplication of the Excluded Stomach in One-Anastomosis Gastric Bypass: 1-Year Results of the FundoRing Trial. Obes Surg 2023; 33:1974-1983. [PMID: 37099252 DOI: 10.1007/s11695-023-06618-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/14/2023] [Accepted: 04/19/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND The advantages and disadvantages of one-anastomosis gastric bypass (OAGB) with primary modified fundoplication using the excluded stomach ("FundoRing") is unclear. We aimed to assess the impact of this operation in a randomized controlled trial (RCT) and answer the next questions: (1) What the impact of wrapping the fundus of the excluded part of the stomach in OAGB on protection in the experimental group against developing de novo reflux esophagitis? (2) If preoperative RE could be improved in the experimental group? (3) Can preoperative acid reflux as measured by PH impedance, be treated by the addition of the "FundoRing"? METHODS The study design was a single-center prospective, interventional, open-label (no masking) RCT (FundoRing Trial) with 1-year follow-up. Endpoints were body mass index (BMI, kg/m2) and acid and bile RE assessed endoscopically by Los Angeles (LA) classification and 24-h pH impedance monitoring. Complications were graded by Clavien-Dindo classification (CDC). RESULTS One hundred patients (n = 50 FundoRingOAGB (f-OAGB) vs n = 50 standard OAGB (s-OAGB)) with complete follow-up data were included in the study. During OAGB procedures, patients with hiatal hernia underwent cruroplasty (29/50 f-OAGB; 24/50 s-OAGB). There were no leaks, bleeding, or deaths in either group. At 1 year, BMI in the f-OAGB group was 25.3 ± 2.77 (19-30) vs 26.48 ± 2.8 (21-34) s-OAGB group (p = 0.03). In f-OAGB vs s-OAGB groups, respectively, acid RE was seen in 1 vs 12 patients (p = 0.001) and bile RE in 0 vs 4 patients (p < 0.05). CONCLUSION Routine use of a modified fundoplication of the OAGB-excluded stomach to treat patients with obesity decreased acid and prevented bile reflux esophagitis significantly more effectively than standard OAGB at 1 year in a randomized controlled trial. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04834635.
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Affiliation(s)
- Oral Ospanov
- Department of Surgical Disease and Bariatric Surgery, Astana Medical University, Beybitshilik Street 49A, 010000, Astana, Kazakhstan.
- Surgery Center of Professor Oral Ospanov, Astana, Kazakhstan.
| | - Galymzhan Yeleuov
- Department of Surgical Disease and Bariatric Surgery, Astana Medical University, Beybitshilik Street 49A, 010000, Astana, Kazakhstan
| | - J N Buchwald
- Division of Scientific Research Writing, Medwrite Medical Communications, Maiden Rock, WI, USA
| | - Nurlan Zharov
- Department of Surgical Disease and Bariatric Surgery, Astana Medical University, Beybitshilik Street 49A, 010000, Astana, Kazakhstan
| | | | - Kassymkhan Sultanov
- Department of Surgical Disease, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
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21
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Rayman S, Staierman M, Assaf D, Rachmuth J, Carmeli I, Keidar A. Clinical influence of conversion of laparoscopic sleeve gastrectomy to one anastomosis gastric bypass on gastroesophageal reflux disease. Langenbecks Arch Surg 2023; 408:163. [PMID: 37103604 DOI: 10.1007/s00423-023-02892-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/10/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE Assess the subjective impact of gastro-esophageal reflux disease (GERD) symptoms on patients undergoing revision from laparoscopic sleeve gastrectomy (LSG) to one-anastomosis gastric bypass (OAGB) using the Reflux Disease Questionnaire for GERD (RDQ) and the GERD-health related quality of life score (GERD-HRQL), prior to- and following conversion. METHODS Patients undergoing revision from LSG to OAGB were prospectively followed between May 2015 and December 2020. Data retrieved included demographics, anthropometrics, previous bariatric history, time interval between LSG and OAGB, weight loss, and co-morbidities. Pre- and post-OAGB RDQ and GERD-HRQL questionnaires were obtained. In the case of sleeve dilatation, sleeve resizing was performed. RESULTS During the study period, 37 patients underwent revision from LSG to OAGB. Mean ages at LSG and pre-OAGB were 38 ± 11.74 and 46 ± 12.75, respectively. Median follow-up time was 21.5 months (range 3-65). All patients underwent sleeve resizing. RDQ and GERD-HRQL scores were obtained at a median of 14 months (range 3-51) between pre- and post-OAGB. Median RDQ score pre-OAGB vs post-OAGB was significantly reduced (30 (range 12-72) vs 14 (range 12-60), p = 0.007). All 3 parts of the GERD- HRQL questionnaires were significantly reduced between pre-OAGB and post-OAGB: Symptoms (20; 62.5% vs 10; 31.3%, p = 0.012), overall score (15 (0-39) vs 7 (0-28), p = 0.04) and subjective improvement (10; 31% vs 20; 62.5%, p = 0.025). CONCLUSION Conversion of LSG to OAGB showed subjective improvement of GERD symptoms both in RDQ and in GERD-HRQL.
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Affiliation(s)
- Shlomi Rayman
- Department of General Surgery, Assuta Ashdod Public Hospital, affiliated with the Faculty of Health and Science at Ben-Gurion University, Ha-Refu'a St 7, 7747629, Ashdod, Israel.
| | - Maor Staierman
- Department of General Surgery, Assuta Ashdod Public Hospital, affiliated with the Faculty of Health and Science at Ben-Gurion University, Ha-Refu'a St 7, 7747629, Ashdod, Israel
| | - Dan Assaf
- Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Israel, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Derech Sheba 2, 52662, Ramat-Gan, Israel
| | - Jacob Rachmuth
- Department of General Surgery, Assuta Ashdod Public Hospital, affiliated with the Faculty of Health and Science at Ben-Gurion University, Ha-Refu'a St 7, 7747629, Ashdod, Israel
| | - Idan Carmeli
- Department of General Surgery, Assuta Ashdod Public Hospital, affiliated with the Faculty of Health and Science at Ben-Gurion University, Ha-Refu'a St 7, 7747629, Ashdod, Israel
| | - Andrei Keidar
- Department of General Surgery, Assuta Ashdod Public Hospital, affiliated with the Faculty of Health and Science at Ben-Gurion University, Ha-Refu'a St 7, 7747629, Ashdod, Israel
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22
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Zhang F, Xu B, Mao Z. One-anastomosis gastric bypass versus sleeve gastrectomy for patients with BMI>50 kg/m 2 or >60 kg/m 2: A systematic review and meta-analysis. Asian J Surg 2023:S1015-9584(23)00277-4. [PMID: 36914473 DOI: 10.1016/j.asjsur.2023.02.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/22/2023] [Indexed: 03/13/2023] Open
Affiliation(s)
- Fan Zhang
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Boqi Xu
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Zhongqi Mao
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
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23
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Ebadinejad A, Shahshahani M, Hosseinpanah F, Ghazy F, Khalaj A, Mahdavi M, Valizadeh M, Barzin M. Comparison of hypertension remission and relapse after sleeve gastrectomy and one-anastomosis gastric bypass: a prospective cohort study. Hypertens Res 2023; 46:1287-1296. [PMID: 36670229 DOI: 10.1038/s41440-023-01180-7] [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: 09/11/2022] [Revised: 11/27/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023]
Abstract
This study aimed to assess the remission and relapse of hypertension (HTN) in hypertensive individuals who underwent sleeve gastrectomy (SG) and one-anastomosis gastric bypass (OAGB) and identify the predictors of HTN remission and relapse following bariatric surgery. A prospective cohort study with a follow-up of 3 years was conducted on severely obese patients between 2013 and 2018. Hypertension remission was defined as the normalization of blood pressure (BP) with the discontinuation of medical treatment, and HTN relapse was defined as the need for the onset of antihypertensive drugs or the occurrence of BP impairment. A total of 787 hypertensive patients were included in this study. The cumulative incidence of HTN remission and relapse were 83.9% (95% CI: 81.6-86.5) and 31.4% (95% CI: 25.6-38.2), respectively. Remission and relapse were not significantly different among the patients undergoing either surgery (SG or OAGB). A higher remission rate was linked to a younger age and the use of fewer antihypertensive medications pre-operation. However, failure to successfully lose weight during the first year postoperative and weight regain predicted a higher risk of HTN relapse after 3 years. Following bariatric surgery, BP drops initially but then gradually rises. These alterations are responsible for about 31% relapse after 3 years in those who initially achieve remission. Patients who are younger and use less antihypertensive medications before surgery may benefit the most from bariatric surgery in terms of HTN. First-year successful weight loss and control of weight regain may prevent HTN relapse in the following years.
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Affiliation(s)
- Amir Ebadinejad
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahbod Shahshahani
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faranak Ghazy
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Khalaj
- Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Maryam Mahdavi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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24
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Felsenreich DM, Arnoldner MA, Wintersteller L, Mrekva A, Jedamzik J, Eichelter J, Langer FB, Prager G. Intrathoracic pouch migration in one-anastomosis gastric bypass with and without hiatoplasty: A 3-dimensional-computed tomography volumetry study. Surg Obes Relat Dis 2022; 19:492-499. [PMID: 36566133 DOI: 10.1016/j.soard.2022.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/25/2022] [Revised: 10/14/2022] [Accepted: 11/13/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Currently, 4.8% of bariatric operations worldwide are one-anastomosis gastric bypass (OAGB) procedures. If a hiatal hernia is detected in a preoperative gastroscopy, OAGB can be combined with hiatoplasty. Intrathoracic pouch migration (ITM) is common after bypass procedures because the fundus, a natural abutment, is separated from the pouch. OBJECTIVE The aim of this study was to find out whether OAGB or OAGB combined with hiatoplasty carries a higher risk of ITM and, therefore, also gastroesophageal reflux disease (GERD). SETTING University hospital. METHODS Fifty patients (group 1: 25× primary OAGB; group 2: 25× primary OAGB with hiatoplasty) were included in this study. History of weight, GERD, and quality of life were recorded in patient interviews and pouch volume and ITM were evaluated using 3-dimensional-computed tomography volumetry. RESULTS There were no differences in terms of patient characteristics, history of weight, pouch volume, or quality of life between both groups. ITM was found in group 1 in 60% (n = 15) and group 2 in 76% (n = 19) of all patients (P = .152). The ITM mean length was significantly lower in group 1 with .9 ± 1.1 cm than in group 2 with 1.8 ± 1.2 cm (P = .007). Regarding GERD, there was no difference between both groups; nevertheless, significantly more patients with ITM (38.2%; n = 13) had GERD compared with patients without ITM (6.3%; n = 1). CONCLUSION In primary OAGB, an additional hiatoplasty was not associated with higher rates of ITM or GERD; nevertheless, the length of ITM was higher after hiatoplasty. If ITM occurs, patients have a risk of developing GERD.
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Affiliation(s)
- Daniel M Felsenreich
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Michael A Arnoldner
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Lukas Wintersteller
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Arpad Mrekva
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Julia Jedamzik
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Jakob Eichelter
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Felix B Langer
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Gerhard Prager
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
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25
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van Rijswijk A, van Olst N, Meijnikman AS, Acherman YIZ, Bruin SC, van de Laar AW, van Olden CC, Aydin O, Borger H, Beuers UHW, Herrema H, Verheij J, Apers JA, Bäckhed F, Gerdes VEA, Nieuwdorp M, de Brauw LM. The effects of laparoscopic Roux-en-Y gastric bypass and one-anastomosis gastric bypass on glycemic control and remission of type 2 diabetes mellitus: study protocol for a multi-center randomized controlled trial (the DIABAR-trial). Trials 2022; 23:900. [PMID: 36273149 PMCID: PMC9588204 DOI: 10.1186/s13063-022-06762-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 05/04/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Metabolic surgery induces rapid remission of type 2 diabetes mellitus (T2DM). There is a paucity of high level evidence comparing the efficacy of the laparoscopic Roux-en-Y gastric bypass (RYGB) and the laparoscopic one-anastomosis gastric bypass (OAGB) in glycemic control. Also, the mechanisms that drive the conversion of T2DM in severe obese subjects to euglycemia are poorly understood. Methods The DIABAR-trial is an open, multi-center, randomized controlled clinical trial with 10 years follow-up which will be performed in 220 severely obese patients, diagnosed with T2DM and treated with glucose-lowering agents. Patients will be randomized in a 1:1 ratio to undergo RYGB or OAGB. The primary outcome is glycemic control at 12 months follow-up. Secondary outcome measures are diverse and include weight loss, surgical complications, psychologic status and quality of life, dietary behavior, gastrointestinal symptoms, repetitive bloodwork to identify changes over time, glucose tolerance and insulin sensitivity as measured by mixed meal tests, remission of T2DM, presence of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis in liver biopsy, oral and fecal microbiome, cardiovascular performance, composition of bile acids, and the tendency to develop gallstones. Discussion The DIABAR-trial is one of the few randomized controlled trials primarily aimed to evaluate the glycemic response after the RYGB and OAGB in severe obese patients diagnosed with T2DM. Secondary aims of the trial are to contribute to a deeper understanding of the mechanisms that drive the remission of T2DM in severe obese patients by identification of microbial, immunological, and metabolic markers for metabolic response and to compare complications and side effects of RYGB and OAGB. Trial registration ClinicalTrials.gov NCT03330756; date first registered: October 13, 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06762-3.
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Affiliation(s)
- A van Rijswijk
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands
| | - N van Olst
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands.,Department of Vascular Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - A S Meijnikman
- Department of Vascular Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.,Department of Internal Medicine, 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
| | - A W van de Laar
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands
| | - C C van Olden
- Department of Vascular Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - O Aydin
- Department of Vascular Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.,Department of Internal Medicine, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands
| | - H Borger
- Department of Internal Medicine, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands
| | - U H W Beuers
- Department of Gastroenterology and Hepatology and Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - H Herrema
- Department of Vascular Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - J Verheij
- Department of Pathology, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - J A Apers
- Department of Surgery, Franciscus Gasthuis, Kleiweg 500, 3045 PM, Rotterdam, the Netherlands
| | - F Bäckhed
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine, University of Gothenburg, SE-413 45, Gothenburg, Sweden.,Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, Building 7, DK-2200, Copenhagen, Denmark
| | - V E A Gerdes
- Department of Vascular Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.,Department of Internal Medicine, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands.,Department of Internal Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - M Nieuwdorp
- Department of Vascular Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.,Wallenberg Laboratory, Department of Molecular and Clinical Medicine, University of Gothenburg, SE-413 45, Gothenburg, Sweden.,Department of Internal Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.,Institute for Cardiovascular research, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - L M de Brauw
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands.
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26
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Novljan U, Pintar T. Small Intestinal Bacterial Overgrowth in Patients with Roux-en-Y Gastric Bypass and One-Anastomosis Gastric Bypass. Obes Surg 2022; 32:4102-4109. [PMID: 36197573 DOI: 10.1007/s11695-022-06299-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 08/29/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Small intestinal bacterial overgrowth (SIBO) is defined as an excessive growth and/or changed composition of bacteria in the small bowel. Obese patients are at increased risk of SIBO and related complications. The purpose of this study is to evaluate the incidence of SIBO after bariatric bypass procedures, connection between SIBO, symptoms, comorbidities, and liver pathology. METHODS Patients underwent a hydrogen breath test with glucose substrate (25 g/200 ml of water). The demographic, anthropometric data, comorbidities, and symptoms were analysed with a questionnaire. In 45 patients, the NAFLD Activity Score was evaluated in liver biopsies. RESULTS Glucose breath test was positive in 24/56 (43%) of patients and was associated with higher frequency of defecation (p = 0.022), lactose intolerance (p = 0.047), scleroderma (p = 0.042), irritable bowel syndrome (p = 0.018), and diabetes (p = 0.002). Mean NAFLD Activity Score in SIBO patients (n = 18) was 3.33 and 3.00 in non-SIBO patients (n = 27). In SIBO-positive cohort of patients, a statistically important trend in difference between NAS and difference to range value anti-Xa 4 h after subtherapeutic dose application was calculated. CONCLUSIONS The incidence of SIBO after bariatric surgery bypass procedures is alarmingly high (43%). The results of our study conclude that diagnosis cannot be set based on specific symptom and SIBO is related to reduced response to the application of LMWH. Mandatory SIBO screening and appropriate treatment would affect the clinical outcome of the underlying disease, improve it significantly, and prevent the development of its complications.
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Affiliation(s)
- Urška Novljan
- Medical Faculty Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tadeja Pintar
- Medical Faculty Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia. .,Abdominal Surgery Department, University Medical Centre Ljubljana, Ljubljana, Slovenia. .,University of Ljubljana, Medical Faculty, Ljubljana, Slovenia.
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27
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Liagre A, Benois M, Queralto M, Boudrie H, Van Haverbeke O, Juglard G, Martini F, Petrucciani N. Ten-year outcome of one-anastomosis gastric bypass with a biliopancreatic limb of 150 cm versus Roux-en-Y gastric bypass: a single-institution series of 940 patients. Surg Obes Relat Dis 2022; 18:1228-1238. [PMID: 35760675 DOI: 10.1016/j.soard.2022.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 01/29/2022] [Revised: 05/08/2022] [Accepted: 05/13/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Long-term outcomes of one-anastomosis gastric bypass (OAGB) need to be compared with those of Roux-en-Y gastric bypass (RYGB). OBJECTIVE The present study evaluates the long-term outcomes at 10-year follow-up of OAGB with a biliopancreatic limb of 150 cm versus RYGB. SETTING Private practice, France. METHODS Data of patients who underwent OAGB or RYGB as primary or secondary procedures between 2010 and 2011 at a referral center were collected prospectively and analyzed retrospectively. RESULTS A total of 940 patients underwent OAGB (n = 405) or RYGB (n = 535). Operative time was significantly shorter in the OAGB group. Postoperative morbidity occurred in 17.2% of patients after RYGB versus 8.1% after OAGB (P ≤ .0001). Patients in the RYGB group had a significantly higher rate of kinking of the jejuno-jejunal anastomosis, stenosis of the gastrojejunal anastomosis, and dysphagia for early ulcers. At long term, no differences were found in the rate of severe malnutrition. Cumulated morbidity was significantly higher after RYGB, with higher incidence of internal hernia, anastomotic ulcer, blind-loop syndrome, and hypoglycemia. Conversion to RYGB and laparoscopic exploration for chronic pain were more frequent after OAGB. Surgery for weight regain was significantly more frequent after RYGB. Patients in the OAGB group had significantly lower weight, body mass index, and greater percentage excess, and total weight losses at 120 months. No significant differences were detected in co-morbidity outcomes. CONCLUSION After 10 years, both RYGB and OAGB are effective procedures. However, OAGB is associated with shorter operative times and better results in short- and long-term morbidity and weight loss outcomes.
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Affiliation(s)
- Arnaud Liagre
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Marine Benois
- Department of Digestive Surgery, CHU Félix Guyon, Saint-Denis, France
| | - Michel Queralto
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Hubert Boudrie
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Olivier Van Haverbeke
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Gildas Juglard
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Francesco Martini
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Niccolo Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, Sapienza University, Rome, Italy.
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Bertrand T, Rives-Lange C, Jannot AS, Baratte C, de Castelbajac F, Lu E, Krivan S, Le Gall M, Carette C, Czernichow S, Chevallier JM, Poghosyan T. 150-cm Versus 200-cm Biliopancreatic Limb One-Anastomosis Gastric Bypass: Propensity Score-Matched Analysis. Obes Surg 2022. [PMID: 35804236 DOI: 10.1007/s11695-022-06203-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND It has been suggested that shortening the length of the biliopancreatic limb (BPL) to 150 cm in one anastomosis gastric bypass (OAGB) would reduce nutritional complication rates without impairing weight loss outcomes. The aim of this study is to compare patients who underwent OAGB with a 200-cm BPL (OAGB-200) to patients with OAGB with a 150-cm BPL (OAGB-150) in terms of weight loss and late morbidity. METHODS This is a monocentric retrospective matched cohort study including patients with a body mass index between 35 and 50 kg/m2 who underwent an OAGB-150 or an OAGB-200. Patients were matched 1:1 based on age, sex, and body mass index, prior to bariatric surgery. RESULTS In total, 784 patients who underwent OAGB were included (OAGB-150 n = 392 and OAGB-200 (n = 392). There was no significant difference in terms of early morbidity. Regarding late morbidity in patients with an OAGB-150, significantly lower rates for marginal ulcer (OR = 0.4, CI 95% [0.2; 0.8], p = 0.006), incisional hernia (OR = 0.5, CI 95% [0.3; 1], p = 0.041), and bowel obstruction (OR = 0.3, CI 95% [0.1; 0.9], p = 0.039) were reported. Likewise, regarding late nutritional deficiencies, post-OAGB-150, a significantly lower number of patients with hypoalbuminemia (OR = 0.3, CI 95% [0.2; 0.7], p = 0.006), low vitamin B9 (OR = 0.5, CI 95% [0.2; 1], p = 0.044), and low ferritin (OR = 0.5, CI 95% [0.3; 0.8], p = 0.005) were observed. There was no significant difference in the percentage of excess BMI loss at 1, 2, 3, 4, and 5 years. CONCLUSION Compared to OAGB-200 in patients with BMI ≤ 50 kg/m2, OAGB-150 results in fewer nutritional deficiency rates long term, without impairing weight loss.
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Li Y, Gu Y, Jin Y, Mao Z. What Is the Efficacy of Short Length of Biliopancreatic Limb in One-Anastomosis Gastric Bypass? A Systematic Review and Meta-analysis of Short-Term Results. Obes Surg 2022; 32:1-9. [PMID: 35461404 DOI: 10.1007/s11695-022-06048-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 03/30/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To systematically review the efficacy of short length of biliopancreatic limb (BPL) in laparoscopic one anastomosis gastric bypass (OAGB). METHODS By thoroughly investigating in PubMed, Embase, and the Cochrane Library, each research containing the comparison between short BPL and 200-cm BPL was included, inception in July 2021. The research followed the guidance of Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) recommendations. RESULT A total of 1288 patients were included for meta-analysis. Results showed that in the short term, compared with 200-cm BPL, percentage excess weight loss (%EWL) did not show significant reduction (p = 0.91), neither did the incidence of vitamin D deficiency (p = 0.87) nor hypoalbuminemia (p = 0.06), while percentage total weight loss (%TWL) was significantly higher in the 200-cm BPL group (p = 0.0005). At 1, 2, and 8 years postoperatively, patients with short BPL still obtained significantly reduced body mass index (BMI). CONCLUSION Short BPL shows significant effect of weight loss; however, it seems no significantly lower rates of adverse events in the short term are found. More research with randomized controlled design is encouraged to further address the incidence of adverse events in the long term.
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Affiliation(s)
- Yichen Li
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215123, People's Republic of China
| | - Yijie Gu
- Department of Gastrointestinal Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215123, People's Republic of China
| | - Yujia Jin
- Department of Pulmonology and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215123, People's Republic of China
| | - Zhongqi Mao
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215123, People's Republic of China.
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30
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Poghosyan T, Tarhini A, Chevallier JM. Reply to Letter to the Editor " One-Anastomosis Gastric Bypass Revision for Gastroesophageal Reflux Disease: Long Versus Short Biliopancreatic Limb Roux-en-Y Gastric Bypass". Obes Surg 2022. [PMID: 35672597 DOI: 10.1007/s11695-022-06142-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 05/28/2022] [Accepted: 06/02/2022] [Indexed: 10/18/2022]
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Tarhini A, Rives-Lange C, Jannot AS, Baratte C, Beaupel N, Guillet V, Krivan S, Le Gall M, Carette C, Czernichow S, Chevallier JM, Poghosyan T. One-Anastomosis Gastric Bypass Revision for Gastroesophageal Reflux Disease: Long Versus Short Biliopancreatic Limb Roux-en-Y Gastric Bypass. Obes Surg 2022; 32:970-978. [PMID: 35037131 DOI: 10.1007/s11695-022-05892-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 07/14/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 12/19/2022]
Abstract
PURPOSE One-anastomosis gastric bypass (OAGB) may be associated with refractory gastroesophageal reflux disease (GERD). The nature of this GERD remains unclear. This complication can be treated either with an additional enteroenterostomy without shortening of gastric pouch (long biliopancreatic limb Roux-en-Y gastric bypass (L-BPL-RYGB)) or revision to conventional short biliopancreatic limb Roux-en-Y gastric bypass (S-BPL-RYGB). The objective of this study is to compare the aforementioned procedures in terms of efficacy on GERD symptoms. MATERIALS AND METHODS Retrospective analysis between October 2012 and June 2020. RESULTS Fifty-two patients underwent OAGB revision to S-BPL-RYGB (n = 21) or L-BPL-RYGB (n = 31) secondary to GERD. Investigation with pH impedance prior to revision was performed in 15 patients showing biliary reflux (BR) in 7 (46.6%), acid reflux (AR) in 6 (40%), and no confirmation in 2. Patients with AR had a revision to S-BPL-RYGB, whereas patients with BR underwent L-BPL-RYGB. Among the patients without pH metry results (n = 37), S-BPL-RYGB was performed for associated disabling digestive disorders or nutritional deficiencies. GERD was treated in 68% of patients with L-BPL-RYGB versus 95% of patients after S-BPL-RYGB. Patients, whose decision for revisional procedure was based on the results of pH impedance testing, did not reveal refractory GERD. CONCLUSION L-BPL-RYGB seems appropriate in patients with BR, whereas conversion to S-BPL-RYGB should be preferred if AR is present.
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Affiliation(s)
- Ahmad Tarhini
- Université de Paris, 75015, Paris, France.,Service de Chirurgie Digestive, Oncologique et Bariatrique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France
| | - Claire Rives-Lange
- Université de Paris, 75015, Paris, France.,Service de Nutrition, Centre Spécialisé Obésité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France
| | - Anne-Sophie Jannot
- Université de Paris, 75015, Paris, France.,Service d'informatique Médicale, Biostatistiques et Santé Publique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France
| | - Clement Baratte
- Université de Paris, 75015, Paris, France.,Service de Chirurgie Digestive, Oncologique et Bariatrique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France
| | | | - Vincent Guillet
- Université de Paris, 75015, Paris, France.,Service de Chirurgie Digestive, Oncologique et Bariatrique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France
| | - Sylvia Krivan
- Department of Digestive Surgery, Royal Derby Hospital, Derby, UK
| | - Maude Le Gall
- Université de Paris, 75015, Paris, France.,Inserm UMRS 1149, Paris, France
| | - Claire Carette
- Université de Paris, 75015, Paris, France.,Service de Nutrition, Centre Spécialisé Obésité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France
| | - Sebastien Czernichow
- Université de Paris, 75015, Paris, France.,Service de Nutrition, Centre Spécialisé Obésité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France.,Inserm, Information Sciences To Support Personalized Medicine, Cordeliers Research Center, Paris, France
| | - Jean-Marc Chevallier
- Université de Paris, 75015, Paris, France.,Service de Chirurgie Digestive, Oncologique et Bariatrique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France
| | - Tigran Poghosyan
- Université de Paris, 75015, Paris, France. .,Service de Chirurgie Digestive, Oncologique et Bariatrique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France. .,Inserm UMRS 1149, Paris, France.
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32
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Felsenreich DM, Steinlechner K, Langer FB, Vock N, Eichelter J, Bichler C, Jedamzik J, Mairinger M, Kristo I, Prager G. Outcome of Sleeve Gastrectomy Converted to Roux-en-Y Gastric Bypass and One-Anastomosis Gastric Bypass. Obes Surg 2022. [PMID: 35028871 DOI: 10.1007/s11695-021-05866-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 11/19/2022]
Abstract
Purpose Sleeve gastrectomy (SG) is the commonest bariatric procedure worldwide but there is also a high conversion rate mainly due to weight regain and gastroesophageal reflux disease (GERD) reported in studies with long-term follow-up. The aim of this study is to highlight benefits and limitations of converting SG patients to Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB). Setting Retrospective cross-sectional-study, medical university clinic setting. Methods This study includes all patients converted from primary SG to RYGB or OAGB by 12/2018 at the Medical University of Vienna. Patients were examined using gastroscopy, esophageal manometry, 24-h pH-metry, and questionnaires. Results Fifty-eight patients were converted from SG to RYGB (n = 45) or OAGB (n = 13). Total weight loss of patients converted to RYGB and OAGB was 41.5% and 44.8%, respectively, at nadir. Six patients had Barrett’s esophagus (BE) after SG. In four out of these six patients, a complete remission of BE after conversion to RYGB was observed; nevertheless, two patients after RYGB and one after OABG newly developed BE. Clinical GERD improved at a higher rate after RYGB than after OAGB. Both revisional procedures improved associated medical problems. Conclusion Conversion to RYGB is probably the best option for patients with GERD after SG. OAGB has shown a low potential to cure patients from GERD symptoms after SG. In terms of additional weight loss and remission of associated medical problems, both procedures studied were equal. Surveillance gastroscopies every 5 years after SG revisions are recommended. Graphical abstract ![]()
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Katayama RC, Arasaki CH, Herbella FAM, Neto RA, Filho GDJL. One-Anastomosis and Roux-en-Y Gastric Bypass Promote Similar Weight Loss, Patient Satisfaction, Quality of Life, Inflammation Grade, and Cellular Damage in the Esophagus and Gastric Pouch in a Short-term Follow-up. J Obes Metab Syndr 2021; 30:396-402. [PMID: 34903679 PMCID: PMC8735828 DOI: 10.7570/jomes21040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 09/04/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022] Open
Abstract
Background One-anastomosis gastric bypass (OAGB) is a simpler procedure than Roux-en-Y gastric bypass (RYGB); however, biliary reflux can occur and impair outcomes. This study aimed to compare outcomes of OAGB and RYGB. Methods Twenty patients with morbid obesity were randomized prospectively into two groups: OAGB (n=10) or RYGB (n=10). Quality of life (36-item short-form health survey [SF-36]), satisfaction (Visick scale), and body mass index (BMI) were evaluated before and 6 months after the operation. All patients underwent esophagogastroduodenoscopy with gastric and esophageal mucosal biopsies at 3 and 6 months after their operation. Results The study found no significant difference in BMI before surgery (OAGB, 43.2 kg/m2; RYGB, 43.1 kg/m2; P=0.90) or at 6 months postoperative (OAGB, 32.1 kg/m2; RYGB, 31.8 kg/m2; P=0.91). There was no significant difference in improvement of quality of life (four SF-36 domains) or satisfaction (P=0.08) between groups at 6 months. There was no statistical difference between gastric (P=0.10) and esophageal (P=0.76) inflammation grade at three or 6 months between the two groups. Conclusion OAGB and RYGB are equally effective in terms of weight loss, patient satisfaction, and quality of life improvement at 6 months after the procedures. Inflammation grade and cellular damage in the gastric pouch and in the esophagus were similar.
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Affiliation(s)
- Rafael C Katayama
- Department of Surgery, Division of Surgical Gastroenterology, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
| | - Carlos H Arasaki
- Department of Surgery, Division of Surgical Gastroenterology, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
| | | | - Ricardo A Neto
- Department of Pathology, Escola Paulista de Medicina-EPM, São Paulo, Brazil
| | - Gaspar de Jesus Lopes Filho
- Department of Surgery, Division of Surgical Gastroenterology, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
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Haggag M, Salem A, Sultan AM, Elghawalby AN, Eldesoky RT, Eldegwi SA, Gad Elhak N, Shehta A. Early and intermediate term outcomes after laparoscopic one-anastomosis gastric bypass for morbidly obese patients: a single center experience. Turk J Surg 2021; 37:324-335. [PMID: 35677485 PMCID: PMC9130952 DOI: 10.47717/turkjsurg.2021.5274] [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: 03/30/2021] [Accepted: 10/06/2021] [Indexed: 11/23/2022]
Abstract
Objectives To evaluate our outcomes of laparoscopic one-anastomosis gastric bypass (LOAGB) as a primary weight loss procedure. We evaluated the impact of biliary reflux by combination of upper endoscopy (UGIE), ambulatory pH metry, and ambulatory biliary reflux monitoring. Material and Methods We reviewed the data of patients who underwent LOAGB during the period between July 2015 till August 2018. Results Forty consecutive patients were included in the study. Thirty-seven patients (92.5%) had obesity related comorbidities. The median follow-up duration was 18 months (6-36 months). The 1-, 2-, and 3-years excess weight loss percentages were 53.1%, 60.4%, and 62.3%. At three years follow-up, complete remission of diabetes mellitus occurred in 7/7 patients (100%) and of hypertension in 4/7 patients (57.1%). Eighteen patients (45%) accepted to undergo UGIE with routine biopsies and evaluation of acidic and biliary reflux. All examined patients had negative acid reflux results according to ambulatory PH metry with median DeMeester score of 2 (0.3-8.7). According to ambulatory biliary reflux monitoring, 17/18 patients (94.1%) had posi- tive result. Only 6/18 patients (33.3%) had symptoms of biliary reflux and had positive symptom index on bilimetric study. Regarding UGIE, all patients had just gastritis and reflux esophagitis with no evidence of gross mucosal changes. Pathological examination of all routine biopsies did not show any sign of faveolar hyperplasia, atypia or malignancy. Conclusion LOAGB is a safe and efficient bariatric procedure with acceptable morbidity rate. LOAGB is not associated with significant biliary reflux or pathological changes in the esophagogastric mucosa.
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Affiliation(s)
- Mahmoud Haggag
- Department of General Surgery, Gastrointestinal Surgery Center, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Ali Salem
- Department of General Surgery, Gastrointestinal Surgery Center, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Ahmad M. Sultan
- Department of General Surgery, Gastrointestinal Surgery Center, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Ahmed N. Elghawalby
- Department of General Surgery, Gastrointestinal Surgery Center, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Rehab T. Eldesoky
- Department of Clinical Pathology, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Sara A. Eldegwi
- Department of Clinical Pathology, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Nabil Gad Elhak
- Department of General Surgery, Gastrointestinal Surgery Center, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Ahmed Shehta
- Department of General Surgery, Gastrointestinal Surgery Center, Mansoura University Faculty of Medicine, Mansoura, Egypt
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Barzin M, Heidari Almasi M, Mahdavi M, Khalaj A, Valizadeh M, Hosseinpanah F. Body Composition Changes Following Sleeve Gastrectomy Vs. One-Anastomosis Gastric Bypass: Tehran Obesity Treatment Study (TOTS). Obes Surg 2021; 31:5286-5294. [PMID: 34637105 DOI: 10.1007/s11695-021-05722-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/16/2021] [Revised: 09/04/2021] [Accepted: 09/22/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE This study aimed to evaluate body composition changes and the determinants of fat-free mass loss (FFML) up to 3 years after sleeve gastrectomy (SG) and one-anastomosis gastric bypass (OAGB). MATERIALS AND METHODS A prospective study was conducted on 3864 patients with severe obesity who underwent either SG (2746, 76.1% women, mean age: 39.2 ± 11.6 years, and BMI: 44.3 ± 5.6 kg/m2) or OAGB (1118, 82.2% women, age: 39.9 ± 10.7 years, BMI: 45.6 ± 6.3 kg/m2). Body composition parameters were measured by bioelectrical impedance analysis preoperatively and 1, 3, 6, 9, 12, 18, 24, and 36 months after surgery. Changes in body composition were assessed using the propensity matched generalized estimated equation (GEE) method. The determinants of fat-free mass loss/weight loss (FFML/WL%) were defined using a mixed-model GEE analysis. RESULTS Means of FM, FFM, and FFML/WL% decreased significantly in both study groups (Ptrend < 0.001). Changes in BMI, EWL%, FM, and FFML/WL% were different between the two groups (Pbetween < 0.05). The results showed a better FFM preservation and a greater FM loss over time in the OAGB group compared to the SG group (Pinteraction < 0.05). FFML during the first 3 months was greater in the SG compared to the OAGB group (P < 0.001). SG surgery, higher preoperative BMI, and female gender were associated with greater FFML/WL%. CONCLUSION In the SG compared to the OAGB group, FFML was greater, especially early after the surgery, emphasizing the need for therapeutic interventions such as regular exercise programs and dietary intake modifications.
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Affiliation(s)
- Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box, 19395-476, Tehran, Iran
| | - Minoo Heidari Almasi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box, 19395-476, Tehran, Iran
| | - Maryam Mahdavi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box, 19395-476, Tehran, Iran
| | - Alireza Khalaj
- Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box, 19395-476, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box, 19395-476, Tehran, Iran.
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36
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Gholizadeh B, Hajsadeghi S, Makhsosi BR, Kimia F, Mokhber S, Pazouki A. One Anastomosis Gastric Bypass in a Morbidly Obese Patient with Heart Failure: a Case Report. Obes Surg 2021; 32:194-196. [PMID: 34402000 DOI: 10.1007/s11695-021-05597-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/10/2021] [Accepted: 07/14/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Barmak Gholizadeh
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of General Surgery, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shokoufeh Hajsadeghi
- Department of Cardiology, Rasoul-e-Akram Hospital, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Behnam Reza Makhsosi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of General Surgery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fereshteh Kimia
- Anesthesiology Department, Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayyeh Mokhber
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran. .,Center of Excellence of International Federation for Surgery of Obesity, Hazrat e Rasool Hospital, Tehran, Iran.
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37
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Pakiet A, Haliński ŁP, Rostkowska O, Kaska Ł, Proczko-Stepaniak M, Śledziński T, Mika A. The Effects of One-Anastomosis Gastric Bypass on Fatty Acids in the Serum of Patients with Morbid Obesity. Obes Surg 2021; 31:4264-4271. [PMID: 34255274 PMCID: PMC8458202 DOI: 10.1007/s11695-021-05531-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/27/2021] [Revised: 06/05/2021] [Accepted: 06/09/2021] [Indexed: 12/22/2022]
Abstract
Purpose Obesity is associated with alterations in serum fatty acid profiles. One-anastomosis gastric bypass is a type of bariatric surgery used in the treatment of morbid obesity. The aim of this study was to establish if, between 6 and 9 months after this procedure, the fatty acid composition in the serum of patients normalizes to values similar to the healthy, lean population. Materials/Methods The study included 46 patients that underwent surgical treatment for obesity with one-anastomosis gastric bypass. The serum fatty acid composition was determined using gas chromatography-mass spectrometry. Principal component analysis was conducted to detect the differences between fatty acid profiles in patients pre- and post-surgery, and in 29 control nonobese subjects. Results Patients with morbid obesity were characterized by lowered levels of beneficial odd- and branched-chain fatty acids and polyunsaturated fatty acids. While the odd- and branched-chain fatty acid amounts normalized 6–9 months after bariatric treatment, the polyunsaturated fatty acid levels did not. Moreover, the total fatty acid profiles of patients pre- and post-bariatric surgery were still markedly different than those of lean, healthy controls. Conclusion Following one-anastomosis gastric bypass, there are some beneficial changes in serum fatty acids in treated patients, possibly due to weight loss and dietary regimen changes. However, they may be insufficient to restore the proper levels of other fatty acids, which may need to be additionally supplemented. Graphical abstract ![]()
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Affiliation(s)
- Alicja Pakiet
- Department of Environmental Analysis, Faculty of Chemistry, University of Gdańsk, Wita Stwosza 63, 80-309, Gdańsk, Poland
| | - Łukasz P Haliński
- Department of Environmental Analysis, Faculty of Chemistry, University of Gdańsk, Wita Stwosza 63, 80-309, Gdańsk, Poland
| | - Olga Rostkowska
- Department of General, Endocrine and Transplant Surgery, Faculty of Medicine, Medical University of Gdańsk, Smoluchowskiego 17, 80-214, Gdańsk, Poland
| | - Łukasz Kaska
- Department of General, Endocrine and Transplant Surgery, Faculty of Medicine, Medical University of Gdańsk, Smoluchowskiego 17, 80-214, Gdańsk, Poland
| | - Monika Proczko-Stepaniak
- Department of General, Endocrine and Transplant Surgery, Faculty of Medicine, Medical University of Gdańsk, Smoluchowskiego 17, 80-214, Gdańsk, Poland
| | - Tomasz Śledziński
- Department of Pharmaceutical Biochemistry, Faculty of Pharmacy, Medical University of Gdańsk, Debinki 1, 80-211, Gdańsk, Poland
| | - Adriana Mika
- Department of Pharmaceutical Biochemistry, Faculty of Pharmacy, Medical University of Gdańsk, Debinki 1, 80-211, Gdańsk, Poland.
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Nehmeh WA, Baratte C, Rives-Lange C, Martineau C, Boullenois H, Krivan S, Guillet V, Le Gall M, Cellier C, Carette C, Czernichow S, Chevallier JM, Poghosyan T. Acid Reflux Is Common in Patients With Gastroesophageal Reflux Disease After One-Anastomosis Gastric Bypass. Obes Surg 2021. [PMID: 34232446 DOI: 10.1007/s11695-021-05542-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Patients with one-anastomosis gastric bypass (OAGB) can develop gastroesophageal reflux disease (GERD). The nature of this GERD (acid or biliary) remains unclear. OBJECTIVE To assess the nature of GERD via impedance pH testing in patients presenting with reflux post OAGB. METHODS Retrospective analysis of a prospectively collected database of 43 patients with OAGB backgrounds who developed postoperative GERD and were investigated with impedance pH monitoring between 2006 and 2019. RESULTS Mean age was 52.48 ± 9 years. Mean body mass index (BMI) prior to OAGB was 46.82 kg/m2. None of these patients had clinical GERD before surgery. The median time interval between surgery and investigation with 24-h impedance pH monitoring was 64 (56) months. The mean BMI at the time of investigations was 32.67 ± 6.9 kg/m2. The type of reflux was acid in 13 (30.2%), non-acid (biliary) in 12 (27.9%), and mixed (acid and biliary) in 5 (11.6%) patients. However, it remained not confirmed in 13 (30.2%). Median DeMeester score was 48.95 (27.67) in patients with acid, 2.8 (7.4) in patients with biliary, and 28.7 (5.6) in patients with mixed reflux. Median percent of time spent with pH < 4 was 9.65 (8) in patients with acid, 0.6 (1.75) in patients with biliary, and 7.7 (3.9) in patients with mixed reflux. CONCLUSION Acid reflux seems to be as common as bile reflux in patients presenting with GERD after OAGB. In case of revisional surgery for severe GERD post OAGB, 24-h impedance pH monitoring could be essential to determine the surgical procedure of choice.
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Kermansaravi M, Shahmiri SS, Davarpanah Jazi AH, Valizadeh R, Weiner RA, Chiappetta S. Reversal to normal anatomy after one-anastomosis/mini gastric bypass, indications and results: a systematic review and meta-analysis. Surg Obes Relat Dis 2021; 17:1489-96. [PMID: 34045165 DOI: 10.1016/j.soard.2021.04.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/13/2021] [Accepted: 04/17/2021] [Indexed: 01/11/2023]
Abstract
This review evaluates the indications and outcomes of one-anastomosis/mini gastric bypass (OAGB/MGB) reversal to normal anatomy. A systematic literature search and meta-analysis was performed in PubMed, Web of Science, and Scopus for articles published by October 1, 2020, including the keywords "one anastomosis gastric bypass," "OAGB," "mini gastric bypass," "MGB," "reversal," "reverse," "malnutrition," and "reversal bariatric surgery". After examining 182 papers involving 11,578 patients, 14 studies were included. A reversal was performed in 119 patients on average 23.6 months after the primary OAGB/MGB surgery. The mean body mass index (BMI) was 22.92 ± 3.47 kg/m2 and the mean albumin level was 25.17 ± 4.21 g/L at reversal. The mean length of the common channel (CC) was 383.57 ± 159.35 cm, with a mean biliopancreatic limb (BPL) length of 214.21 ± 48.45 cm. Pooled estimation of the meta-analysis of prevalence studies reported a prevalence of 1% for reversal. The major signs and symptoms of protein-energy malnutrition were the leading causes of the reversal of OAGB/MGB. Bleeding, leakage, and death due to severe liver failure were the most reported complications after reversal, with an overall incidence of 10.9%. In conclusion, OAGB/MGB reversal has a prevalence of 1% and has a complication rate of 10.9%. Protein-energy malnutrition with hypoalbuminemia was the most common etiology. The mean lengths of BPL and CC were reported as 215 cm and 380 cm, respectively, in the cases. Therefore, special attention should be paid to malnutrition in all OAGB/MGB patients during follow-up to prevent severe malnutrition and subsequent increase in reversal procedures.
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Wysocki M, Małczak P, Wierdak M, Walędziak M, Hady HR, Diemieszczyk I, Proczko-Stepaniak M, Szymański M, Dowgiałło-Wnukiewicz N, Szeliga J, Pędziwiatr M, Major P. Utility of Inflammatory Markers in Detection of Perioperative Morbidity After Laparoscopic Sleeve Gastrectomy, Laparoscopic Roux-en-Y Gastric Bypass, and One-Anastomosis Gastric Bypass-Multicenter Study. Obes Surg 2021; 30:2971-2979. [PMID: 32347517 PMCID: PMC7305064 DOI: 10.1007/s11695-020-04636-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Indexed: 12/19/2022]
Abstract
Background The most commonly performed bariatric operations are laparoscopic sleeve gastrectomy (LSG) and bypass surgeries (laparoscopic one-anastomosis gastric bypass (OAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB)), and predicting perioperative morbidity is crucial for early, safe patient discharge. We aimed to determine whether C-reactive protein (CRP) and white blood count (WBC) measured on the first postoperative day predicts perioperative morbidity in the first 30-days after LSG and bypass surgeries. Methods We retrospectively analyzed data for 1400 patients who underwent bariatric surgery in seven bariatric centers from 2014 to 2018. Patients were divided into a complicated group (patients with postoperative complications) and a non-complicated group. We also performed separate analyses for LSG and bypass surgeries. Results Patients were 929 women (66%) and 471 men (34%) with a median age of 42 years (range, 35–51 years); 1192 patients underwent LSG (85%), 120 underwent LRYGB (9%), and 80 underwent OAGB (6%). We performed ROC analyses to set cut-off points, followed by multivariate logistic regressions. CRP > 33.32 mg/L increased the odds ratio (OR) of perioperative complications after LSG 2.27 times, while WBC > 12.15 × 103/μL on postoperative day 1 was associated with a 3.34-times greater or of developing complications. WBC > 13.78 × 103/μL was associated with a 13.34-times higher or of perioperative morbidity in patients undergoing bypass surgeries. Conclusion Even slightly elevated CRP and WBC on postoperative day 1 should alert surgeons to the potential risk of perioperative morbidity.
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Affiliation(s)
- Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 St., 30-688, Cracow, Poland
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 St., 30-688, Cracow, Poland
| | - Mateusz Wierdak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 St., 30-688, Cracow, Poland
| | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Hady Razak Hady
- First Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Inna Diemieszczyk
- First Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Monika Proczko-Stepaniak
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Michał Szymański
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Jacek Szeliga
- Department of General, Gastroenterological, and Oncological Surgery, Collegium Medicum Nicolaus Copernicus University, Torun, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 St., 30-688, Cracow, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 St., 30-688, Cracow, Poland.
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Ramos AC, Chevallier JM, Mahawar K, Brown W, Kow L, White KP, Shikora S; IFSO Consensus Conference Contributors. IFSO (International Federation for Surgery of Obesity and Metabolic Disorders) Consensus Conference Statement on One-Anastomosis Gastric Bypass (OAGB-MGB): Results of a Modified Delphi Study. Obes Surg 2020; 30:1625-34. [PMID: 32152841 DOI: 10.1007/s11695-020-04519-y] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND One-anastomosis gastric bypass (OAGB-MGB) is currently the third performed primary bariatric surgical procedure worldwide. However, the procedure is hampered by numerous controversies and there is considerable variability in surgical technique, patient selection, and pre- and postoperative care among the surgeons performing this procedure. This paper reports the results of a modified Delphi consensus study organized by the International Federation for Surgery of Obesity and Metabolic Disorders (IFSO). METHODS Fifty-two internationally recognized bariatric experts from 28 countries convened for voting on 90 consensus statements over two rounds to identify those on which consensus could be reached. Inter-voter agreement of ≥ 70% was considered consensus, with voting participation ≥ 80% considered a robust vote. RESULTS At least 70% consensus was achieved for 65 of the 90 questions (72.2% of the items), 61 during the first round of voting and an additional four in the second round. Where consensus was reached on a binary agree/disagree or yes/no item, there was agreement with the statement presented in 53 of 56 instances (94.6%). Where consensus was reached on a statement where options favorable versus unfavorable to OAGB-MGB were provided, including statements in which OAGB-MGB was compared to another procedure, the response option favorable to OAGB-MGB was selected in 13 of 23 instances (56.5%). CONCLUSION Although there is general agreement that the OAGB-MGB is an effective and usually safe option for the management of patients with obesity or severe obesity, numerous areas of non-consensus remain in its use. Further empirical data are needed.
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Marc-Hernández A, Ruiz-Tovar J, Jimenez JM, Carbajo MA, Lopez M, Cao MJ, Castro MJ. Short-Term Changes on Body Composition and Bone Mass After One-Anastomosis Gastric Bypass: a Prospective Observational Study. Obes Surg 2020; 30:3514-21. [PMID: 32314255 DOI: 10.1007/s11695-020-04603-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Bariatric surgery generates a large weight loss. It is considered a successful surgery when 50% of the excess weight loss is reached. However, this measure does not include some variables that may have a direct impact on a patient's health, such as fat-free mass (FFM) or bone mass. Therefore, the aim of this study is to evaluate body composition and bone mass in patients undergoing one-anastomosis gastric bypass (OAGB). METHODS A prospective observational study was performed in patients undergoing OAGB. Body composition and bone mass were evaluated by bioelectrical impedance analysis at baseline (1 day prior to surgery), at 6 and 12 months after surgery. RESULTS A total of 94 patients (67% females and 33% males) were included in the study. The excess BMI loss at 6 and 12 months after surgery was 97.9 ± 20.1% and 110.2 ± 30.5% respectively. The FFM showed a reduction of 6.6 ± 4.8 kg (p < 0.01) 6 months after surgery and of 7.9 ± 4.9 kg (p < 0.01) at 12 months, meaning a decrease of 10.5 ± 7.3% and a 12.9 ± 6.6% respectively. The bone mass decrease was 10.1 ± 6.9% (p < 0.01) and 12.9 ± 6.5% (p < 0.01) at 12 months after OAGB. CONCLUSIONS OAGB obtains a relevant weight loss in patients with morbid obesity, mainly, due to fat mass reductions. However, this procedure also provokes FFM and bone mass decreases, especially in females, but not significantly greater than other restrictive or mixed procedures.
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Ferrer-Márquez M, Ibáñez VM, Gil FR, Salmerón MJS, Sánchez MJT, Martínez Amo-Gámez A, Ferrer-Ayza M. Missing Jejunal Perforation During Small Bowel Measurement in Patient Operated by Laparoscopic One-Anastomosis Gastric Bypass. Obes Surg 2021; 31:2841-2842. [PMID: 33825151 DOI: 10.1007/s11695-021-05365-2] [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: 02/02/2021] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obesity surgery is justified as it produces sustained weight loss, increases life expectancy, and reduces the complications of obesity. For this reason, increasing numbers of patients are undergoing this surgery [1]. Complications following surgical treatment of severe obesity vary based upon the procedure performed and, although it is currently below 7% in more experienced centers, it may increase in more complex surgeries (such as revision surgery) and can be as high as 40% [2, 3]. Patients with early postoperative complications may be managed in specialist centers by the bariatric surgeon during the hospital stay [4]. Missing bowel injury may occur primarily during insertion of a Veress needle and trocar, use of electrosurgery and laser beams, suturing, and adhesiolysis [5]. Less frequently, the bowel perforation is due to the measurement of the loop and goes unnoticed. Perforation of the intestines due to any reason is a severe condition that can clinically present with free intraabdominal air, purulent or even fecal peritonitis, and abdominal compartment syndrome [6]. High clinical suspicion is crucial for early diagnosis. Early recognition of bowel injury and early intervention is crucial to reduce its morbidity and mortality [5]. METHODS We present a case of a 50-year-old male patient with a BMI of 36.1 kg/m2, hypertension, and dyslipidemia who was proposed for bariatric surgery. A laparoscopic one-anastomosis gastric bypass (OAGB) was performed with no intraoperative incidents. Few hours after the surgery, the patient manifests intense abdominal pain and tachycardia (120 bpm) so we decided to order an abdominal CT scan that showed signs of jejunal perforation (pneumoperitoneum, oral contrast extravasation, and small air bubbles next to the jejunum wall). RESULTS Emergency laparoscopy was done and showed generalized peritonitis caused by a 4-mm perforation in the mesenteric border of the jejunum with everted mucosa that was located 150 cm from the loop of Treitz. We decided to place three infraumbilical trocars to help us with washing, viewing, and surgical repair. We performed a 2-0 barbed simple suture of the perforation and extensive washing of the entire cavity with 10 L of serum. We left three drains. The patient made an uneventful recovery and was discharged 72 h after surgery with an established oral diet. CONCLUSIONS Missing intestinal perforation is an uncommon injury during bariatric surgery, but its early diagnosis is important to avoid endangering the patient's life. Simple postoperative tachycardia in obese patients should be taken seriously as it is a warning signal. Laparoscopic reoperation in these early diagnosed cases is safe and effective, since it allows visualization and washing of the entire cavity. Bowel injuries, which may occur as a result of the insertion of an insufflation needle or trocar, are a rare complication of laparoscopy. In the case we present, the perforation occurred during the small bowel measurement so we insist on the extreme caution that surgeons must take during every detail of the surgical technique. The use of atraumatic forceps, handling of the bowel strictly at the antimesenteric side, and the infusion of sufficient methylene blue in the anastomosis testing are gestures that can help reduce the risk.
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Affiliation(s)
- Manuel Ferrer-Márquez
- Department of Bariatric Surgery (ObesidadAlmería), General Surgery, Hospital Mediterráneo, Almería, Spain.
| | - Vanesa Maturana Ibáñez
- Department of Bariatric Surgery, General Surgery, Hospital Vistahermosa, Alicante, Spain
| | - Francisco Rubio Gil
- Department of Bariatric Surgery (ObesidadAlmería), General Surgery, Hospital Mediterráneo, Almería, Spain
| | - María José Solvas Salmerón
- Department of Bariatric Surgery (ObesidadAlmería), General Surgery, Hospital Mediterráneo, Almería, Spain
| | | | | | - Manuel Ferrer-Ayza
- Department of Bariatric Surgery (ObesidadAlmería), General Surgery, Hospital Mediterráneo, Almería, Spain
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Khogeer A, Ilczyszyn A, Adamo M, Elkalaawy M. Internal Hernia After Laparoscopic One-Anastomosis (Mini) Gastric Bypass: Video Case Series of a Single-Center Experience. Obes Surg 2021; 31:2839-2840. [PMID: 33788159 DOI: 10.1007/s11695-021-05362-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 11/30/2022]
Abstract
Internal hernia (IH) after one-anastomosis gastric bypass (OAGB) was thought to have an extremely low incidence. In this video, we report three cases of post-OAGB symptomatic internal herniation. The first case is a 45-year-old female who presented 4 months after her OAGB with crampy abdominal pain and reflux symptoms. An exploratory laparoscopy showed Petersen's hernia; the hernia was reduced with no ischemia and the defect was closed. The second case is a 40-year-old male who presented 7 months after his surgery with abdominal pain and reflux. An exploratory laparoscopy showed Petersen's hernia; bowel was reduced and defect was closed through a laparotomy. The third case is a 64-year-old male who presented with refractory biliary reflux after OAGB. An elective diagnostic laparoscopy showed Petersen's hernia; the hernia was reduced and defect was closed. All patients recovered well with no recurrence of symptoms on follow-up. Internal hernia after OAGB is more common than the reported incidence. The threshold for diagnostic laparoscopy should be lowered for a OAGB patient with symptoms suggestive of IH.
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Affiliation(s)
- Alwahhaj Khogeer
- Department of Bariatric and Metabolic Surgery, University College London Hospitals, London, UK
- Department of Bariatric Surgery, Specialized Surgery Center, King Abdullah Medical City, Mecca, Saudi Arabia
| | - Andrei Ilczyszyn
- Department of Bariatric and Metabolic Surgery, University College London Hospitals, London, UK
| | - Marco Adamo
- Department of Bariatric and Metabolic Surgery, University College London Hospitals, London, UK
| | - Mohamed Elkalaawy
- Department of Bariatric and Metabolic Surgery, University College London Hospitals, London, UK.
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Sumer A, Mahawar K, Aktokmakyan TV, Savas OA, Peksen C, Barbaros U, Mercan S. Bridged one-anastomosis gastric bypass: technique and preliminary results. Surg Today 2021; 51:1371-1378. [PMID: 33738583 DOI: 10.1007/s00595-021-02264-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/26/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE One-anastomosis gastric bypass (OAGB) is an established bariatric procedure performed worldwide. We developed a modification of OAGB leaving a bridge at the cranial 2 cm of the fundus as a gastro-gastric fistula to allow for endoscopic access to the bypassed stomach. We present the preliminary results of 44 patients who underwent this technique in our hospital. METHODS We analyzed, retrospectively, data collected prospectively on 44 patients who underwent our bridged one-anastomosis gastric bypass (BOAGB) procedure between September, 2018 and November, 2020. RESULTS The mean age of the patients was 45.2 ± 9.3 years (range 20-66 years). The mean preoperative body mass index (BMI), weight, and HbA1c values were 41.5 ± 6.4 kg/m2 (range 35-59), 116 ± 22.7 kg, and 8.2 ± 2.1%, respectively. After a median follow-up period of 18 months (11-26 months), the mean postoperative BMI was 28.4 ± 3.2 kg/m2 (range 21-38), the mean total weight loss was 35.8 ± 13.5 kg (range 20-80 kg), and the mean percentage of excess weight loss (%EWL) and the percentage of total weight loss (%TWL) were 79.8 ± 16.1% (range 47-109) and 30.6 ± 6.9% (range 19-48), respectively. The mean postoperative HbA1c level was 6.3 ± 0.9%. There were two early complications (stenosis and bleeding) and one late complication (marginal ulcer). CONCLUSION Patients who underwent BOAGB lost weight similarly to those who underwent OABG as reported in the literature, without an apparent increase in complications related to the technique. Randomized studies with longer term follow-up are needed.
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Affiliation(s)
- Aziz Sumer
- School of Medicine, Istinye University, Istanbul, Turkey
| | | | | | | | - Caghan Peksen
- School of Medicine, Istinye University, Istanbul, Turkey
| | - Umut Barbaros
- Atasehir Florence Nightingale Hospital, Istanbul, Turkey
| | - Selcuk Mercan
- School of Medicine, Istanbul University, Istanbul, Turkey
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Vitiello A, Berardi G, Velotti N, Schiavone V, Musella M. Impact of COVID-19 Lockdown on Short-term Weight Loss in a Single Italian Institution. Obes Surg 2021; 31:3365-3368. [PMID: 33721193 PMCID: PMC7957453 DOI: 10.1007/s11695-021-05343-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/01/2020] [Revised: 02/24/2021] [Accepted: 03/04/2021] [Indexed: 01/10/2023]
Abstract
Italy was the first European country to have a major outbreak of COVID-19. Bariatric procedures were stopped and telemedicine had to be implemented. A large percentage of patients struggled to follow postoperative diet and to start physical activity due to social restrictions. We have compared short-term outcomes of patients who had bariatric procedures prior to lockdown with subjects that had undergone obesity surgery in the same period of the previous year at our institution. A total number of 63 patients were included in this study. Weight loss at 1, 3 and 6 postoperative months in the 2019 group was significantly higher at any point of follow-up when compared to 2020. Social limitations and nonattendance of clinical appointments may have compromised early results.
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Affiliation(s)
- Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy.
| | - Giovanna Berardi
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Nunzio Velotti
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Vincenzo Schiavone
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Mario Musella
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy
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Zerrweck C, Rodríguez NR, Sánchez H, Zurita LC, Márquez M, Herrera MF. Bariatric surgery in Mexico: training, practice and surgical trends. Updates Surg 2021; 73:1509-1514. [PMID: 33687693 DOI: 10.1007/s13304-021-01013-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/22/2021] [Indexed: 01/12/2023]
Abstract
Bariatric surgery is extremely safe and effective, but several factors need to be addressed to obtain such results. Patient selection, type of training, accreditation, type of practice, and surgical trends and technique are involved in this process. Local and global standardization are ill-advised, especially in countries with high obesity prevalence, and where the bariatric practice is fast growing.An online survey with 22 questions was sent to bariatric surgeons in Mexico. Only participants with the active practice were included, and the aim was to obtain for the first time insight in bariatric surgery training, characteristics of current practice and surgical trends.Complete responses from 114 surgeons were obtained. Most were male, under 50 years-old, ≤ 10 years of experience, and practice in low-volume hospitals. Less than half had a 12-month formal training. Gastric bypass and sleeve gastrectomy were the most common procedures. Practice trends like leak tests, use of drains, preoperative weight loss, routine endoscopy, and pharmacological tromboprofilaxis are common. In surgical technique, the gastric bypass and sleeve gastrectomy confection was more homogenic when compared to the one-anastomosis gastric bypass.Complete responses from 114 surgeons were obtained. Most were male, under 50 years-old, ≤ 10 years of experience, and practice in low-volume hospitals. Less than half had a 12-month formal training. Gastric bypass and sleeve gastrectomy were the most common procedures. Practice trends like leak tests, use of drains, preoperative weight loss, routine endoscopy, and pharmacological tromboprofilaxis are common. In surgical technique, the gastric bypass and sleeve gastrectomy confection was more homogenic when compared to the one-anastomosis gastric bypass. An important number of bariatric surgeons in Mexico are young, male, and with < 10 years of practice. The most common techniques performed are gastric bypass and sleeve gastrectomy. Several practices and technique trends are similar to global consensus. Fellowship programs and Board Certification in bariatric surgery are major advances in our country, thus standardization and high-quality practice can be achieved.
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Affiliation(s)
| | | | - Hugo Sánchez
- Hospital General de Zona 1, IMSS, Mexico City, Mexico
| | | | | | - Miguel F Herrera
- Instituto Nacional de La Nutrición Salvador Zubirán, Vasco de Quiroga #15, Tlalpan 14, 000, Mexico City, Mexico.
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Sohrabi Maralani M, Azadnajafabad S, Elyasinia F, Abolhasani M, Bagheri M, Kor F, Ashrafi A, Talebpour M. Postoperative Outcomes and Advantages of Hand-Sewn Laparoscopic One-Anastomosis Gastric Bypass: Experience on 805 Patients. Obes Surg 2021; 31:627-633. [PMID: 33047292 DOI: 10.1007/s11695-020-04981-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE One-anastomosis gastric bypass (OAGB) is a novel laparoscopic approach. The anastomosis of OAGB can be sewn either with a stapler or manually. The aim of this study is to determine the outcome of hand-sewn OAGB. MATERIALS AND METHODS A total of 805 consecutive patients were retrospectively enrolled in this study. Data collection included change in weight, body mass index (BMI), symptoms, and complications before surgery and continued during annual follow-up visits up to 5 years. Inclusion criteria were patients with a BMI of higher than 40 kg/m2 or higher than 35 kg/m2 with one severe comorbidity. Patients with BMI > 50 kg/m2 were referred to dieticians. RESULTS The follow-up rate ranged from 93 to 50% at the 1-year and 5-year visits after surgery, respectively. Mean weight and BMI of patients before surgery were 121.93 kg (± 22.92) and 44.79 kg/m2 (± 6.07), respectively. Mean of annual BMI in 5 years of follow-up were 27.83, 27.26, 28.90, 29.45, and 29.56 kg/m2. Excess weight loss (EWL) in 5 years of follow-up were 85.7%, 89.5%, 78.9%, 77.7%, and 76.0%. Reflux was present in 202 patients (25.1%) before surgery and resolved in 153 cases (75.7%) 1 year after surgery. Procedure-specific early complication was an anastomosis leak in one patient, which led to death. Two cases of malnutrition necessitating reversal and two severe reflux disorders leading to Roux-en-Y bypass surgery were remarkable late complications. CONCLUSION Hand-sewn anastomosis could represent an efficient and safe technique in the management of patients undergoing OAGB surgery with acceptable outcomes and rare adverse complications.
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Affiliation(s)
- Mehran Sohrabi Maralani
- Department of Surgery, Laparoscopic Ward, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Azadnajafabad
- Department of Surgery, Laparoscopic Ward, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fezzeh Elyasinia
- Department of Surgery, Laparoscopic Ward, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Abolhasani
- Primary Prevention of Cardiovascular Diseases Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadjavad Bagheri
- Department of Surgery, Laparoscopic Ward, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Kor
- Department of Surgery, Laparoscopic Ward, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Ashrafi
- Department of Surgery, Laparoscopic Ward, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Talebpour
- Department of Surgery, Laparoscopic Ward, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Mahdy T, Gado W, Alwahidi A, Schou C, Emile SH. Sleeve Gastrectomy, One-Anastomosis Gastric Bypass (OAGB), and Single Anastomosis Sleeve Ileal (SASI) Bypass in Treatment of Morbid Obesity: a Retrospective Cohort Study. Obes Surg 2021; 31:1579-1589. [PMID: 33409970 DOI: 10.1007/s11695-020-05159-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 09/08/2020] [Revised: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Bariatric surgery is the most effective treatment for morbid obesity. The present study aimed to assess three bariatric procedures with different mechanisms of actions; sleeve gastrectomy (SG), one-anastomosis gastric bypass (OAGB), and single anastomosis sleeve ileal (SASI) bypass, in terms of efficacy and safety. METHODS This was a retrospective cohort study on patients with morbid obesity who underwent SG, OAGB, or SASI bypass. The main outcome measures were weight loss and improvement in comorbidities at 6 and 12 months postoperatively, and complications. RESULTS A total of 264 patients (186 female) with mean preoperative body mass index (BMI) of 43.6 ± 9.9 kg/m2were included to the study. Significant weight loss was recorded at 6 and 12 months after the three procedures. At 6 and 12 months postoperatively, body weight and BMI were significantly lower after SASI bypass than after SG and OAGB. The %total weight loss (%TWL) and %excess weight loss (%EWL) were significantly higher after SASI bypass than after SG and OAGB. SASI bypass was associated with a significantly higher rate of improvement in DM than SG and OAGB (97.7% vs 71.4% vs 86.7%; p = 0.04) whereas improvement in other comorbidities was similar. The short-term complication rate was similar between the three procedures, yet SASI bypass was followed by higher long-term complication rate. CONCLUSION Based on retrospective review of data, SASI bypass was associated with more reduction in body weight and BMI, higher %TWL and %EWL, better improvement in T2DM, and more long-term nutritional complications than SG and OAGB.
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Affiliation(s)
- Tarek Mahdy
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura University, 60 El-Gomhouria Street, Mansoura, Dakahlia, 35516, Egypt.,AlQassimi Hospital, Sharjah, UAE
| | - Waleed Gado
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura University, 60 El-Gomhouria Street, Mansoura, Dakahlia, 35516, Egypt
| | | | | | - Sameh Hany Emile
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura University, 60 El-Gomhouria Street, Mansoura, Dakahlia, 35516, Egypt.
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Kruschitz R, Wakolbinger M, Schindler K, Prager G, Hoppichler F, Marculescu R, Ludvik B. Effect of one-anastomosis gastric bypass on cardiovascular risk factors in patients with vitamin D deficiency and morbid obesity: A secondary analysis. Nutr Metab Cardiovasc Dis 2020; 30:2379-2388. [PMID: 32981799 DOI: 10.1016/j.numecd.2020.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/20/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Bariatric patients often suffer from vitamin D (VD) deficiency, and both, morbid obesity and VD deficiency, are related to an adverse effect on cardiovascular disease (CVD) risk. Therefore, we assessed the change of known CVD risk factors and its associations during the first 12 months following one-anastomosis gastric bypass (OAGB). METHODS AND RESULTS In this secondary analysis, CVD risk factors, medical history and anthropometric data were assessed in fifty VD deficient (25-hydroxy-vitamin D (25(OH)D) <75 nmol/l) patients, recruited for a randomized controlled trial of VD supplementation. Based on previous results regarding bone-mass loss and the association between VD and CVD risk, the study population was divided into patients with 25(OH)D ≥50 nmol/l (adequate VD group; AVD) and into those <50 nmol/l (inadequate VD group; IVD) at 6 and 12 months (T6/12) postoperatively. In the whole cohort, substantial remission rates for hypertension (38%), diabetes (30%), and dyslipidaemia (41%) and a significant reduction in CVD risk factors were observed at T12. Changes of insulin resistance markers were associated with changes of total body fat mass (TBF%), 25(OH)D, and ferritin. Moreover, significant differences in insulin resistance markers between AVD and IVD became evident at T12. CONCLUSION These findings show that OAGB leads to a significant reduction in CVD risk factors and amelioration of insulin resistance markers, which might be connected to reduced TBF%, change in 25(OH)D and ferritin levels, as an indicator for subclinical inflammation, and an adequate VD status. REGISTERED AT CLINICALTRIALS.GOV: (Identifier: NCT02092376) and EudraCT (Identifier: 2013-003546-16).
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Affiliation(s)
- Renate Kruschitz
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Austria; Division of Internal Medicine, General Public Hospital of the Order of Saint Elisabeth, Klagenfurt, Austria
| | - Maria Wakolbinger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Austria; Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Austria.
| | - Karin Schindler
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Austria
| | - Gerhard Prager
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Austria
| | - Friedrich Hoppichler
- Special Institute for Preventive Cardiology and Nutrition - SIPCAN, Salzburg, Austria; Division of Internal Medicine, General Public Hospital of the Brothers of Saint John of God Salzburg, Austria
| | - Rodrig Marculescu
- Clinical Institute for Medical and Chemical Laboratory Diagnostics, Department of Laboratory Medicine, Medical University of Vienna, Austria
| | - Bernhard Ludvik
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Austria; Department of Medicine 1, Karl Landsteiner Institute for Obesity and Metabolic Disorders, Rudolfstiftung Hospital, Vienna, Austria
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