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de Souza Bastos EL. The Early Days of Laparoscopic Sleeve Gastrectomy: A Narrative Review. Obes Surg 2025:10.1007/s11695-025-07859-9. [PMID: 40208512 DOI: 10.1007/s11695-025-07859-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Revised: 03/30/2025] [Accepted: 04/05/2025] [Indexed: 04/11/2025]
Abstract
Laparoscopic sleeve gastrectomy (LSG) is recognized as a safe and effective stand-alone metabolic and bariatric surgery (MBS). Several appealing features of the procedure have made LSG the most performed MBS over the past decade. The current popularity of LSG can be traced back to the vision of pioneering surgeons who believed in the potential of the procedure. They deserve acknowledgment for their contributions, and doing so is timely and fair. Therefore, this narrative review aims to recount the early days of LSG.
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Östberg AL, Wallenius V, Taghat N, Jonasson G. Mandibular trabecular bone pattern before and two years after medical or surgical obesity treatment in young Swedish women. Clin Oral Investig 2025; 29:57. [PMID: 39799550 PMCID: PMC11725539 DOI: 10.1007/s00784-024-06142-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Accepted: 12/29/2024] [Indexed: 01/15/2025]
Abstract
OBJECTIVE To investigate if changes in body mass index (BMI) result in changes of the mandibular trabecular bone structure. MATERIALS AND METHODS Females (18-35 years at baseline, mean BMI 42,3) were followed from before (n = 117) until two years (n = 66) after obesity treatment (medical or surgical). The mandibular bone trabeculation was classified as sparse, dense, or mixed on intraoral radiographs (Lindh's index). A digitized method (Jaw-X) assessed the size and intensities of intertrabecular spaces. The main predictor variable was BMI reduction over the period. RESULTS Before treatment, the group with a high BMI (≥ 45) had a significantly denser bone than those with a lower BMI (p = 0.035). Two years after treatment, fewer were classified with sparse bone (Lindh's index p = 0.001, Jaw-X p = 0.009). The physical activity increased with fewer having a sedentary lifestyle (40% before, 17% after treatment). The association between BMI reduction and the difference in Jaw-X was significant in regression models and not influenced by obesity treatment method but by baseline factors as age, trabecular bone pattern and level of ionized calcium. CONCLUSIONS Before obesity treatment, high BMI was associated with dense bone trabeculation in the jaw. The group with sparse bone had decreased at follow-up. The association between BMI reduction and bone trabeculation was influenced by individual and medical factors. CLINICAL RELEVANCE Bone trabeculation in the mandible was maintained during the first years after obesity treatment but new health habits should be encouraged, and patients need to be monitored and followed up further.
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Affiliation(s)
- Anna-Lena Östberg
- Department of Behavioral and Community Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, P.O. Box 450, Gothenburg, SE-40530, Sweden.
| | - Ville Wallenius
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Negin Taghat
- Department of Behavioral and Community Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, P.O. Box 450, Gothenburg, SE-40530, Sweden
| | - Grethe Jonasson
- Department of Behavioral and Community Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, P.O. Box 450, Gothenburg, SE-40530, Sweden
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Thomopoulos T, Mantziari S, Joliat GR. Long-term results of Roux-en-Y gastric bypass (RYGB) versus single anastomosis duodeno-ileal bypass (SADI) as revisional procedures after failed sleeve gastrectomy: a systematic literature review and pooled analysis. Langenbecks Arch Surg 2024; 409:354. [PMID: 39579238 PMCID: PMC11585492 DOI: 10.1007/s00423-024-03557-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Accepted: 11/18/2024] [Indexed: 11/25/2024]
Abstract
PURPOSE Revisional bariatric surgery (RBS) has flourished during the last decades in many countries, due to suboptimal weight loss or long-term complications of primary bariatric surgery. Restrictive procedures, and in particular sleeve gastrectomy (SG), although widely performed as primary bariatric surgery, seems particularly prone to need surgical revision for the above-mentioned reasons during long-term follow-up. The aim of this systematic review was to compare the long-term (5-year) safety and efficacy between Roux-en-Y gastric bypass (RYGB) and single anastomosis duodeno-ileal bypass (SADI) after 'failed' SG. METHODS A systematic review was performed from 2007 to September 2024. Articles were included if SADI or RYGB were performed as RBS after 'failed SG' with follow-up at least 5 years. Pooled analysis was performed to summarize the data. RESULTS Among the seven studies eligible and included in this review, the SADI procedure showed comparable results to RYGB in terms of weight loss, nutritional deficiencies, and resolution of comorbidities during the long-term follow-up. However, RYGB proved superior in terms of remission of reflux disease and other functional problems after SG. CONCLUSIONS The present review found that SADI seems to be a promising and suitable method for suboptimal weight loss after SG, with comparable or even better results to RYGB after 5-year follow-up.
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Affiliation(s)
- Theodoros Thomopoulos
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, Lausanne, 1011, Switzerland.
| | - Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, Lausanne, 1011, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Gaëtan-Romain Joliat
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, Lausanne, 1011, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
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Gagner M. Comment on: The effect of routine division of the greater omentum on small bowel obstruction after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2023; 19:e8-e9. [PMID: 36918328 DOI: 10.1016/j.soard.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 02/04/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Michel Gagner
- Hôpital du Sacre Coeur, Montréal, Québec, Canada; Department of Surgery, Westmount Square Surgical Center, Westmount, Québec, Canada
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The effect of routine division of the greater omentum on small bowel obstruction after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2023; 19:178-183. [PMID: 36207233 DOI: 10.1016/j.soard.2022.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/21/2022] [Accepted: 09/05/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND It remains unknown whether routine division of the greater omentum during laparoscopic Roux-en-Y gastric bypass (LRYGB) influences the risk for small bowel obstruction (SBO) after RYGB. OBJECTIVE To evaluate the effect of omental division on SBO after LRYGB stratified by handling of the mesenteric defects. SETTING Nationwide, registry-based. METHODS In this registry-based cohort study, 40,517 patients who underwent LRYGB in Sweden within the period from January 1, 2007, to December 31, 2019, with data from the Scandinavian Obesity Surgery Registry (SOReg) were included. The study was based on combined data from the SOReg, the National Patient Register, the Swedish Prescribed Drugs Register, and the Total Population Registry. The main outcome was reoperation for SBO. RESULTS During a follow-up period of 5.9 ± 2.6 years, the cumulative incidence of SBO was 11.2% in the nondivision group compared with 9.7% among patients with divided omentum (hazard ratio [HR] = .83, 95% confidence interval [CI]: .77-.89, P < .001). The association was seen in patients without mesenteric defects closure (HR = .69, 95% CI: .61-.78, P < .001) as well as patients with closed mesenteric defects (HR = .80, 95% CI: .74-.87, P < .001). CONCLUSION Division of the greater omentum is associated with reduced risk for SBO after antecolic, antegastric LRYGB and should be considered as a complement to mesenteric defects closure to further reduce the risk for SBO after LRYGB.
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Zaigham H, Ekelund M, Lee D, Ekberg O, Regnér S. Intussusception After Roux-en-Y Gastric Bypass: Correlation Between Radiological and Operative Findings. Obes Surg 2023; 33:475-481. [PMID: 36474098 PMCID: PMC9889503 DOI: 10.1007/s11695-022-06377-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/20/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Intussusceptions diagnosed on computed tomography (CT) scans in Roux-en-Y gastric bypass (RYGB) patients could cause serious small bowel obstruction (SBO) or be an incidental finding. The objective of this study was to correlate radiological findings with clinical outcomes to differentiate intussusceptions requiring emergent surgery for SBO. METHODS A search for acute abdominal CT scans reporting intussusceptions in RYGB patients between 2012 and 2019 at Skåne University Hospital, Malmö, Sweden, retrieved 35 scans. These were independently reevaluated by two radiologists for the length and location of the intussusception, whether oral contrast passed through, proximal bowel dilatation, and signs of internal herniation. Clinical outcome in terms of emergency surgery and the diagnosis was determined through chart review. RESULTS Out of 35 acute patients, 9 patients required emergency surgery within 24 h. Intussusception caused SBO in five patients, and one patient had an internal herniation, while three patients had unremarkable findings. Eight patients were evaluated for intermittent pain with five unremarkable laparoscopies, while 18 patients had intussusceptions as incidental findings. Intussusception length on CT as measured by radiologists O.E. and D.L. predicted acute bowel obstruction (p = .014 and p < .001). A 100 mm threshold predicted bowel obstruction with a sensitivity of 80% and 100% and a specificity of 93% and 86% by radiologists O.E. and D.L., respectively. Proximal bowel dilatation predicted SBOs of any cause as well as SBO caused by an intussusception (all p < .05). CONCLUSION Intussusception length > 100 mm on CT in RYGB patients is an easy and valuable sign indicating SBO that may require emergent surgery.
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Affiliation(s)
- Hassan Zaigham
- Department of Clinical Sciences, Malmö, Section of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden.
| | - Mikael Ekelund
- Department of Clinical Sciences, Malmö, Section of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Daisy Lee
- Department of Translational Medicine, Diagnostic Radiology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Olle Ekberg
- Department of Translational Medicine, Diagnostic Radiology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Sara Regnér
- Department of Clinical Sciences, Malmö, Section of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
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Transition from a circular to a linear stapling protocol in laparoscopic Roux-en-Y gastric bypass surgery and its impact on quality of life: a 5-year outcome study. Langenbecks Arch Surg 2022; 407:3341-3348. [PMID: 35947218 DOI: 10.1007/s00423-022-02635-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/29/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Surgical technique in bariatric surgery has been refined over the past decades. This study analysed the effect of changing the stapling protocol on the quality of life (QoL) at a midterm follow-up. METHODS The retrospective cohort study included patients undergoing Roux-en-Y gastric bypass between June 2012 and March 2016. Patients were stratified into the circular stapling protocol (CSP, n = 117) or the linear stapling protocol (LSP, n = 118). QoL was quantified by the Moorehead score at 12, 24 and 60 months. Multivariate testing was used to identify confounders. RESULTS The age was 42.8 ± 11.5 years and the body mass index (BMI) was 43.8 ± 6.2 kg/m2, with no baseline intergroup differences. Overall baseline Moorehead score was 0.42 ± 1.1 and improved in both groups after 12 months (1.97 ± 0.74, p < 0.001), 24 months (1.86 ± 0.79, p < 0.001) and 60 months (1.71 ± 0.9, p < 0.001). LSP was associated with improved Moorehead score after 60 months (odds ratio [OR] 1.251, 95% confidence interval [CI] 1.06-1.48, p = 0.010). Overall, a drop of mean BMI occurred and this effect lasted throughout the observation period (- 12.48 kg/m2, p < 0.001). More profound BMI reduction was further positively associated with Moorehead scores after 24 and after 60 months (OR 0.97, p = 0.028; OR 0.96, p = 0.007). Complications, rehospitalisations and reoperations were more frequent in the CSP group (50% vs 23.7%, p < 0.001; 39.7% vs 22.9%, p = 0.009; 37.1% vs 18.6%, p = 0.003). CONCLUSION The CSP and LSP achieve a long-lasting increase in QoL, although the LSP is associated with fewer complications, persistent weight loss and improved Moorehead score. Therefore, the LSP might be considered the favourable protocol in Roux-en-Y gastric bypass.
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Eckharter C, Heeren N, Mongelli F, Sykora M, Fenner H, Scheiwiller A, Metzger J, Gass JM. Effects of short or long biliopancreatic limb length after laparoscopic Roux-en-Y gastric bypass surgery for obesity: a propensity score-matched analysis. Langenbecks Arch Surg 2022; 407:2319-2326. [PMID: 35536386 PMCID: PMC9468033 DOI: 10.1007/s00423-022-02537-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022]
Abstract
Purpose Although recent studies reported superior weight reduction in patients undergoing Roux-en-Y gastric bypass (RYGB) with long biliopancreatic limb (BPL), no recommendation regarding limb lengths exists. This study compares weight loss and resolution of obesity-related comorbidities in patients undergoing RYGB with either long or short BPL. Methods A retrospective data search from medical records was performed. A total of 308 patients underwent laparoscopic RYGB with a BPL length of either 100 cm or 50 cm. Data was analyzed before and after propensity score matching. Results No statistically significant difference in weight reduction between long and short BPL RYGB in terms of percentage of excess weight loss (%EWL) (86.4 ± 24.5 vs. 83.4 ± 21.4, p = 0.285) and percentage of total weight loss (%TWL) (32.4 ± 8.4 vs. 33.0 ± 8.3, p = 0.543) was found 24 months after surgery. Propensity score–matched analysis did not show any statistically significant difference between groups in both %EWL and %TWL. No significant difference between long and short BPL RYGB in the resolution of obesity-related comorbidities was noted 24 months after surgery. Conclusion Weight loss and resolution of obesity-related comorbidities were not significantly different between long and short BPL RYGB 24 months after surgery.
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Affiliation(s)
- Christoph Eckharter
- Department of General and Visceral Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Nickolaus Heeren
- Department of General and Visceral Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | | | - Martin Sykora
- Department of General and Visceral Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.,Department of Surgery, Nidwalden Cantonal Hospital, Stans, Switzerland
| | - Hartwig Fenner
- Department of General and Visceral Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Andreas Scheiwiller
- Department of General and Visceral Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Jürg Metzger
- Department of General and Visceral Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Jörn-Markus Gass
- Department of General and Visceral Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland. .,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
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Prevalence of and Risk Factors Associated with Alcohol Overconsumption at 2 Years After Bariatric Surgery. Obes Surg 2022; 32:1-6. [PMID: 35469080 PMCID: PMC9276548 DOI: 10.1007/s11695-022-06060-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 12/25/2022]
Abstract
Abstract
Introduction
Alcohol overconsumption remains one of the adverse effects associated with bariatric surgery. Many previous studies have used subjective methods to evaluate the prevalence of alcohol overconsumption. In 2018, Örebro University Hospital started to use phosphatidylethanol 16:0/18:1 (PEth) as a screening tool pre- and postbariatric surgery. Research exploring alcohol use after bariatric surgery assessed with PEth is scarce.
Aim
The aim of this study is to evaluate the prevalence of alcohol overconsumption in bariatric surgery patients measured 2 years postoperatively with PEth and to identify possible risk factors associated with alcohol overconsumption.
Methods
This was a register-based retrospective, observational cohort study with PEth results collected from medical records at Örebro University Hospital. Patients who underwent bariatric surgery between January 2016 and June 2019 and who were registered in the Scandinavian Obesity Surgery Registry (SOReg) were included.
Results
PEth results from 410 bariatric surgery patients were identified. PEth values significantly increased from baseline to the postoperative follow-up (from 3.0% before surgery to 8.3% at the 2-year follow-up). In a univariate logistic regression analysis, the associated risk factors were found to be male sex (odds ratio, OR 2.14), older age (OR 1.06), and hypertension (OR 3.32).
Conclusion
The prevalence of alcohol overconsumption measured with PEth 2 years after bariatric surgery was 8.3% and was associated with male sex, older age, and hypertension. More studies are needed to validate the results of this study because it is not known whether PEth values are affected by bariatric surgery.
Graphical abstract
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Jin T, Liu HD, Chen ZH, Hu JK, Yang K. Linear Stapler versus Circular Stapler for Patients Undergoing Anastomosis for Laparoscopic Gastric Surgery: A Meta-Analysis. J INVEST SURG 2022; 35:1434-1444. [PMID: 35435081 DOI: 10.1080/08941939.2022.2058126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Tao Jin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Han-Dong Liu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Jintang Hospital, Chengdu, Sichuan, China
| | - Ze-Hua Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jian-Kun Hu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kun Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Jintang Hospital, Chengdu, Sichuan, China
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Stenberg E, Cao Y, Jernberg T, Näslund E. Major cardiovascular events after metabolic surgery in patients with previous heart disease with or without type 2 diabetes - a nationwide cohort study. Surg Obes Relat Dis 2022; 18:935-942. [DOI: 10.1016/j.soard.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/28/2022] [Accepted: 04/09/2022] [Indexed: 01/12/2023]
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Improved Clinical and Financial Outcomes in Proximal Gastric Bypass Surgery Following the Transition from a Conventional Circular Stapling to an Augmented Linear Stapling Protocol. Obes Surg 2022; 32:1601-1609. [PMID: 35296966 DOI: 10.1007/s11695-022-05993-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
Bariatric techniques for bypass surgery evolve constantly. Switching from one well-established protocol to another in a running surgical teaching program is challenging. We analyzed clinical and financial outcomes at a single bariatric center transitioning from circular to an augmented linear bypass protocol. MATERIALS AND METHODS Between 2011 and 2018, 454 patients were included in this retrospective study. The circular bypass protocol (CIRC; n = 177) was used between 2011 and 2012. Between 2013 and 2015 the transition occurred. Thereafter, the augmented linear protocol (aLIN; n = 277) was primarily utilized. RESULTS Overall, the mean preoperative BMI dropped from 42.2 to 29.6 kg/m2 after 5 years with no difference between groups. Operation times were significantly shorter in the aLIN vs. CIRC group at 108 (± 32) vs. 120 (± 34) min (P < 0.001), respectively. The reoperation rate was significantly higher in the CIRC vs. aLIN group at n = 65 (36%) vs. n = 35 (13%; P < 0.001), respectively. Specifically, revision due to internal hernia occurred much more frequently in the CIRC-group, n = 36 (20%) vs. n = 12 (4%; P < 0.001). Moreover, reoperation rates for gastrojejunostomy leakage and endoscopic dilatations for anastomotic stenosis were higher in the CIRC vs. aLIN group (P < 0.001). Adjusted overall mean cost per case was lower in aLIN-patients at 15,403 (± 7848) vs. CIRC-patients at 18,525 (± 7850) Swiss francs (P < 0.001). Overall profit was 2555 ± 4768 vs. 1455 ± 5638 Swiss francs in the aLIN vs. CIRC-group, respectively (P = 0.026). CONCLUSION This study shows improved clinical and financial outcomes after a gradual transition from a circular stapling protocol to an augmented linear stapling protocol in proximal gastric bypass surgery.
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Conversion of One Anastomosis Gastric Bypass to Roux-en-Y Gastric Bypass: Results of a Retrospective Multicenter Study. Obes Surg 2022; 32:1842-1848. [PMID: 35212908 DOI: 10.1007/s11695-022-05963-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) may expose the patient to certain specific complications. Here, we report the results of conversion of OAGB to Roux-en-Y gastric bypass (RYGB) in terms of outcomes and weight loss. METHODS Between January 2009 and January 2019, all patients undergoing conversion of OAGB to RYGB because of complications due to OAGB (n = 23) were included. The primary efficacy endpoint was the effectiveness of converting OAGB to RYGB. The secondary endpoints were overall mortality and morbidity during the first 3 postoperative months, specific morbidity, reoperation, length of hospitalization, weight loss, and progression of comorbidities related to obesity at 2-year follow-up. RESULTS Indications for conversion were bile reflux (n = 14; 60.9%), severe malnutrition (n = 3; 13%), gastro-gastric fistula (n = 4; 17.4%), and anastomotic leak (n = 2; 8.7%). The median time interval between OAGB and conversion to RYGB was 34 months (0-158). At the time of RYGB, median body mass index (BMI) was 28.0 kg/m2 (18.2-50.7), representing a median BMI change of 14.0 (- 1.7-43.5). Fifteen surgeries (65.1%) were completed laparoscopically. Five complications (21.7%) were recorded, including 2 major ones (8.7%). Reoperation rate was 4.3% (n = 1). At 24 months of follow-up (n = 18; 78.3%), median BMI was 28.7 kg/m2 (19.4-35.4), representing a median BMI change of 19.5 (12.2-43.1). No patient complained of bile reflux or persistent malnutrition. CONCLUSION RYGB performed as revisional surgery for complications after OAGB is an effective procedure with no major weight regain at 2 years of follow-up.
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Schneider R, Schulenburg M, Kraljević M, Klasen JM, Peters T, Wölnerhanssen B, Peterli R. Does the non-absorbable suture closure of the jejunal mesenteric defect reduce the incidence and severity of internal hernias after laparoscopic Roux-en-Y gastric bypass? Langenbecks Arch Surg 2021; 406:1831-1838. [PMID: 34021417 PMCID: PMC8481144 DOI: 10.1007/s00423-021-02180-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/21/2021] [Indexed: 12/31/2022]
Abstract
Purpose Internal hernias (IH) are frequent complications after laparoscopic Roux-en-Y gastric bypass (LRYGB). Closure of the jejunal mesenteric and the Petersen defect reduces IH incidence in prospective and retrospective trials. This study investigates whether closing the jejunal mesenteric space alone by non-absorbable suture and splitting the omentum can be beneficial to prevent IH after LRYGB. Methods Observational cohort study of 785 patients undergoing linear LRYGB including omental split at a single institution, with 493 patients without jejunal mesenteric defect closure and 292 patients with closure by non-absorbable suture, and a minimal follow-up of 2 years. Patients were assessed for appearance and severity of IH. Additionally, open mesenteric gaps without herniated bowel as well as early obstructions due to kinking of the entero-enterostomy (EE) were explored. Results Through primary mesenteric defect closure, the rate of manifest jejunal mesenteric and Petersen IH could be reduced from 6.5 to 3.8%, but without reaching statistical significance. The most common location for an IH was the jejunal mesenteric space, where defect closure during primary surgery reduced the rate of IH from 5.3 to 2.4%. Higher weight loss seemed to increase the risk of developing an IH. Conclusion The closure of the jejunal mesenteric defect by non-absorbable suture may reduce the rate of IH at the jejunal mesenteric space after LRYGB. However, the beneficial effect in our collective is smaller than expected, particularly in patients with good weight loss. The Petersen IH rate remained low by consequent T-shape split of the omentum without suturing of the defect.
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Affiliation(s)
- Romano Schneider
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Claraspital and University Hospital Basel, CH-4002, Basel, Switzerland
| | - Michaela Schulenburg
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Claraspital and University Hospital Basel, CH-4002, Basel, Switzerland
| | - Marko Kraljević
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Claraspital and University Hospital Basel, CH-4002, Basel, Switzerland
| | - Jennifer M Klasen
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Claraspital and University Hospital Basel, CH-4002, Basel, Switzerland
| | - Thomas Peters
- Interdisciplinary Center of Nutritional and Metabolic Diseases, St. Claraspital, CH-4058, Basel, Switzerland
| | | | - Ralph Peterli
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Claraspital and University Hospital Basel, CH-4002, Basel, Switzerland.
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15
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Tankel J, Ahmed AR. Gastrojejunostomy in Roux-En-Y Gastric Bypass for Morbid Obesity: Linear Stapler Length Does Not Affect Mid-term Outcomes. Surg Laparosc Endosc Percutan Tech 2021; 31:794-798. [PMID: 33973943 DOI: 10.1097/sle.0000000000000947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to compare whether different linear stapler lengths used to form the gastrojejunostomy during laparoscopic Roux-En-Y gastric bypass affects mid-term weight loss outcomes. MATERIALS AND METHODS A retrospective single center analysis was performed. Surgical technique was identical other than either a 35 or 45 mm linear stapler being used to form the gastrojejunostomy. Multivariate regression was used to assess the relationship between the different stapler lengths and weight loss outcomes 2 years following surgery. RESULTS Of the 97 patients identified, 67 (69.1%) were included in the study. There were 30 patients in the 35 mm group and 37 in the 45 mm group. The groups were comparable in terms of basic demographic data and preoperative weight characteristics. There was no significant difference in weight loss outcomes 2 years following surgery when comparing between the different linear stapler lengths. CONCLUSION Thirty-five versus 45 mm linear stapler lengths does not affect mid-term weight loss outcomes.
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Affiliation(s)
- James Tankel
- Imperial College Weight Loss Centre, Imperial College Healthcare Trust, St Mary's Hospital, London, UK
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16
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Höskuldsdóttir G, Sattar N, Miftaraj M, Näslund I, Ottosson J, Franzén S, Svensson AM, Eliasson B. Potential Effects of Bariatric Surgery on the Incidence of Heart Failure and Atrial Fibrillation in Patients With Type 2 Diabetes Mellitus and Obesity and on Mortality in Patients With Preexisting Heart Failure: A Nationwide, Matched, Observational Cohort Study. J Am Heart Assoc 2021; 10:e019323. [PMID: 33754795 PMCID: PMC8174344 DOI: 10.1161/jaha.120.019323] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Obesity and diabetes mellitus are strongly associated with heart failure (HF) and atrial fibrillation (AF). The benefits of bariatric surgery on cardiovascular outcomes are known in people with or without diabetes mellitus. Surgical treatment of obesity might also reduce the incidence of HF and AF in individuals with obesity and type 2 diabetes mellitus (T2DM). Methods and Results In this register‐based nationwide cohort study we compared individuals with T2DM and obesity who underwent Roux‐en‐Y gastric bypass surgery with matched individuals not treated with surgery. The main outcome measures were hospitalization for HF and/or AF and mortality in patients with preexisting HF. We identified 5321 individuals with T2DM and obesity who had undergone Roux‐en‐Y gastric bypass surgery between January 2007 and December 2013 and 5321 matched controls. The individuals included were 18 to 65 years old and had a body mass index >27.5 kg/m2. The follow‐up time for hospitalization was until the end of 2015 (mean 4.5 years) and the end of 2016 for death. Our results show a 73% lower risk for HF (hazard ratio [HR], 0.27; CI, 0.19–0.38), 41% for AF (HR, 0.59; CI, 0.44–0.78), and 77% for concomitant AF and HF (HR, 0.23; CI, 0.12–0.46) in the surgically treated group. In patients with preexisting HF we observed significantly lower mortality in the group who underwent surgery (HR, 0.23; 95% CI, 0.12–0.43). Conclusions Bariatric surgery may reduce risk for HF and AF in patients with T2DM and obesity, speculatively via positive cardiovascular and renal effects. Obesity treatment with surgery may also be a valuable alternative in selected patients with T2DM and HF.
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Affiliation(s)
- Gudrún Höskuldsdóttir
- Department of Molecular and Clinical Medicine University of Gothenburg Sweden.,Department of Medicine Sahlgrenska University Hospital Gothenburg Sweden
| | - Naveed Sattar
- The Institute of Cardiovascular and Medical Sciences University of Glasgow United Kingdom
| | - Mervete Miftaraj
- Centre of Registers National Diabetes Register Gothenburg Sweden
| | - Ingmar Näslund
- Department of Surgery Faculty of Medicine and Health Örebro University Örebro Sweden
| | - Johan Ottosson
- Department of Surgery Faculty of Medicine and Health Örebro University Örebro Sweden
| | - Stefan Franzén
- Centre of Registers National Diabetes Register Gothenburg Sweden.,Health Metrics Unit Sahlgrenska AcademyUniversity of Gothenburg Sweden
| | - Ann-Marie Svensson
- Department of Molecular and Clinical Medicine University of Gothenburg Sweden.,Centre of Registers National Diabetes Register Gothenburg Sweden
| | - Björn Eliasson
- Department of Molecular and Clinical Medicine University of Gothenburg Sweden.,Department of Medicine Sahlgrenska University Hospital Gothenburg Sweden
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17
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Höskuldsdóttir G, Ekelund J, Miftaraj M, Wallenius V, Ottosson J, Näslund I, Gudbjörnsdottir S, Sattar N, Svensson AM, Eliasson B. Potential Benefits and Harms of Gastric Bypass Surgery in Obese Individuals With Type 1 Diabetes: A Nationwide, Matched, Observational Cohort Study. Diabetes Care 2020; 43:3079-3085. [PMID: 33023988 DOI: 10.2337/dc20-0388] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 09/13/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To study the potential long-term benefits and possible complications of bariatric surgery in patients with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS In this register-based nationwide cohort study, we compared individuals with T1D and obesity who underwent Roux-en-Y gastric bypass (RYGB) surgery with patients with T1D and obesity matched for age, sex, BMI, and calendar time that did not undergo surgery. By linking the Swedish National Diabetes Register and Scandinavian Obesity Surgery Registry study individuals were included between 2007 and 2013. Outcomes examined included all-cause mortality, cardiovascular disease, stroke, heart failure, and hospitalization for serious hypo- or hyperglycemic events, amputation, psychiatric disorders, changes in kidney function, and substance abuse. RESULTS We identified 387 individuals who had undergone RYGB and 387 control patients. Follow-up for hospitalization was up to 9 years. Analysis showed lower risk for cardiovascular disease (hazard ratio [HR] 0.43; 95% CI 0.20-0.9), cardiovascular death (HR 0.15; 95% CI 0.03-0.68), hospitalization for heart failure (HR 0.32; 95% CI 0.15-0.67), and stroke (HR 0.18; 95% CI 0.04-0.82) for the RYGB group. There was a higher risk for serious hyperglycemic events (HR 1.99; 95% CI 1.07-3.72) and substance abuse (HR 3.71; 95% CI 1.03-3.29) after surgery. CONCLUSIONS This observational study suggests bariatric surgery may yield similar benefits on risk for cardiovascular outcomes and mortality in patients with T1D and obesity as for patients with type 2 diabetes. However, some potential serious adverse effects suggest need for careful monitoring of such patients after surgery.
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Affiliation(s)
- Gudrun Höskuldsdóttir
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden .,Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jan Ekelund
- National Diabetes Register, Centre of Registers, Gothenburg, Sweden
| | - Mervete Miftaraj
- National Diabetes Register, Centre of Registers, Gothenburg, Sweden
| | - Ville Wallenius
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institution of Clinical Sciences, Department of Surgery, University of Gothenburg, Gothenburg, Sweden
| | - Johan Ottosson
- Department of Surgery, Örebro University, Örebro, Sweden
| | - Ingmar Näslund
- Department of Surgery, Örebro University, Örebro, Sweden
| | | | - Naveed Sattar
- The Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | | | - Björn Eliasson
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
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18
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Abdominal pain after gastric bypass in the acute general surgical care setting. Surg Obes Relat Dis 2020; 16:2058-2067. [DOI: 10.1016/j.soard.2020.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/14/2020] [Accepted: 07/04/2020] [Indexed: 12/18/2022]
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19
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Näslund E, Stenberg E, Hofmann R, Ottosson J, Sundbom M, Marsk R, Svensson P, Szummer K, Jernberg T. Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Previous Myocardial Infarction and Severe Obesity: A Nationwide Cohort Study. Circulation 2020; 143:1458-1467. [PMID: 33103469 DOI: 10.1161/circulationaha.120.048585] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The number of patients with myocardial infarction and severe obesity is increasing and there is a lack of evidence how these patients should be treated. The aim of this study was to investigate the association between metabolic surgery (Roux-en-Y gastric bypass and sleeve gastrectomy) and major adverse cardiovascular events in patients with previous myocardial infarction (MI) and severe obesity. METHODS Of 566 patients with previous MI registered in the SWEDEHEART registry (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) undergoing metabolic surgery and registered in the nationwide Scandinavian Obesity Surgery Registry, 509 patients (Roux-en-Y gastric bypass n=465; sleeve gastrectomy n=44) could be matched 1:1 to a control with MI from SWEDEHEART, but no subsequent metabolic surgery regarding sex, age (±3 years), year of MI (±3 years), and body mass index (±3). The 2 groups were well matched, except for a lower proportion of reduced ejection fraction after MI (7% versus 12%), previous heart failure (10% versus 19%), atrial fibrillation (6% versus 10%), and chronic obstructive pulmonary disease (4% versus 7%) in patients undergoing metabolic surgery. RESULTS The median (interquartile range) follow-up time was 4.6 (2.7-7.1) years. The 8-year cumulative probability of major adverse cardiovascular events was lower in patients undergoing metabolic surgery (18.7% [95% CI, 15.9-21.5%] versus 36.2% [33.2-39.3%], adjusted hazard ratio, 0.44 [95% CI, 0.32-0.61]). Patients undergoing metabolic surgery had also a lower risk of death (adjusted HR, 0.45 [95% CI, 0.29-0.70]; MI, 0.24 [0.14-0.41]) and new onset heart failure, but there were no significant differences regarding stroke (0.91 [0.38-2.20]) and new onset atrial fibrillation (0.56 [0.31-1.01]). CONCLUSIONS In severely obese patients with previous MI, metabolic surgery is associated with a low risk for serious complications, lower risk of major adverse cardiovascular events, death, new MI, and new onset heart failure. These findings need to be confirmed in a randomized, controlled trial.
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Affiliation(s)
- Erik Näslund
- Division of Surgery (E.N., R.M.), Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Sweden (E.S., J.O.)
| | - Robin Hofmann
- Department of Clinical Science and Education, Division of Cardiology (R.H., P.S.), Karolinska Institutet, Stockholm, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Sweden (E.S., J.O.)
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Sweden (M.S.)
| | - Richard Marsk
- Division of Surgery (E.N., R.M.), Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Per Svensson
- Department of Clinical Science and Education, Division of Cardiology (R.H., P.S.), Karolinska Institutet, Stockholm, Sweden
| | - Karolina Szummer
- Department of Medicine, Huddinge, Section of Cardiology (K.S.), Karolinska Institutet, Stockholm, Sweden
| | - Tomas Jernberg
- Division of Cardiovascular Medicine (T.J.), Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
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20
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Ekberg NR, Falhammar H, Näslund E, Brismar K. Predictors of normalized HbA1c after gastric bypass surgery in subjects with abnormal glucose levels, a 2-year follow-up study. Sci Rep 2020; 10:15127. [PMID: 32934313 PMCID: PMC7492212 DOI: 10.1038/s41598-020-72141-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/24/2020] [Indexed: 12/18/2022] Open
Abstract
Clinical biomarkers can predict normalization of HbA1c after Roux-en-Y gastric bypass (RYGB) surgery, but it is unclear which are the most predictive.The aim of this study was to compare biomarkers for insulin sensitivity and other clinical parameters in the prediction of normalization of HbA1c after RYGB surgery. This study included 99 (23 men) obese subjects (BMI > 35 kg/m2) undergoing a laparoscopic RYGB. Clinical and biochemical examinations were performed pre-operatively and up to 2 years after surgery. Pre-operatively, normal fasting glucose levels were found in 25 individuals (NG), prediabetes in 46 and type 2 diabetes (T2DM) in 28. At baseline IGF-I (SD), IGFBP-1 and adiponectin levels were low while leptin was high. Weight loss was observed in all three groups, most in the prediabetes group. After 2 years HbA1c was decreased in prediabetes and T2DM. In all three groups insulin, HOMA-IR, lipids and blood pressure improved, IGFBP-1 and adiponectin increased and leptin decreased. IGF-I (SD) increased only in T2DM. In those with prediabetes or T2DM (n = 74), HbA1c at 2 years correlated to baseline BMI (r = -0.27, p = 0.028), age (r = 0.43, p < 0.001), HbA1c (r = 0.37, p = 0.001) and IGFBP-1 (r = 0.25, p = 0.038), and was normalized in 45/74 (61%) at 1 year and in 36 subjects (49%) at 2 years. These responders were younger, had higher BMI, larger waist circumference, lower HbA1c and lower IGFBP-1 levels at baseline. In a multiple regression model age (negative, p = 0.021) and waist circumference (positive, p = 0.047) were the only predictors for normalized HbA1c. RYGB normalized HbA1c in 49% at two years follow-up, which was predicted by low baseline IGFBP-1 level, a marker of hepatic insulin sensitivty and insulin secretion. However,. younger age and larger waist circumference were the only predictors of normalized HbA1c in multivariate analysis.
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Affiliation(s)
- Neda Rajamand Ekberg
- Centrum of Diabetes, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, D02:04, Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, D02:04, Karolinska Institutet, 171 76, Stockholm, Sweden. .,Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.
| | - Erik Näslund
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Brismar
- Department of Molecular Medicine and Surgery, D02:04, Karolinska Institutet, 171 76, Stockholm, Sweden
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21
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Bonouvrie DS, Beamish AJ, Leclercq WKG, van Mil EGAH, Luijten AAPM, Hazebroek EJ, Vreugdenhil ACE, Olbers T, van Dielen FMH. Laparoscopic roux-en-Y gastric bypass versus sleeve gastrectomy for teenagers with severe obesity - TEEN-BEST: study protocol of a multicenter randomized controlled trial. BMC Surg 2020; 20:117. [PMID: 32493359 PMCID: PMC7268239 DOI: 10.1186/s12893-020-00778-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/18/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Recent data support the use of bariatric surgery in adolescents with severe obesity following unsuccessful non-surgical treatments. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) have demonstrated reasonably similar weight loss and reduction of obesity related comorbidities in randomized trials in adults. SG has internationally become the most commonly used procedure in adolescents, yet long-term outcome data are lacking. No randomized controlled trial comparing SG and RYGB has been performed in adolescents. OBJECTIVE Determine whether SG is non-inferior to RYGB in terms of total body weight (TBW) loss in adolescents with severe obesity. METHODS A multicenter randomized controlled non-inferiority trial. Two hundred sixty-four adolescents aged 13-17 (Tanner stage ≥IV) with severe obesity (corrected for age and sex) will be included. Adolescents agreeing to participate will be randomized to either RYGB or SG. The primary outcome is the proportion of participants achieving 20% TBW loss at 3 years postoperatively. Secondary outcomes include (i) change in body weight, body mass index (BMI) and BMI standard deviation score, (ii) incidence of adverse health events and need for additional surgical intervention, (iii) resolution of obesity-related comorbidities, (iv) prevalence of cardio metabolic risk factor measures, (v) bone health measures and incidence of bone fractures, (vi) quality of life including psychosocial health, patient satisfaction and educational attainment and (vii) body composition. Follow-up will extend into the long term. RESULTS Not applicable. DISCUSSION This study will, to our knowledge, be the first randomized controlled trial comparing SG and RYGB in adolescents with severe obesity. TRIAL REGISTRATION The trial is registered at the Netherlands Trial Register on July 26th, 2018 - NTR7191 - https://www.trialregister.nl/trial/7191 (protocol version 5.0 - February 3th 2020).
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Affiliation(s)
| | - Andrew J. Beamish
- Department of Gastrosurgical Research and Education – Institute of Clinical Sciences, Gothenburg University, Gothenburg, Sweden
- Department of Research, Royal College of Surgeons of England, London, United Kingdom
| | | | | | | | | | | | - Torsten Olbers
- Department of Biomedical and Clinical Sciences and Wallenberg Center for Molecular Medicine, Linköping University, Linköping, Sweden
- Department of Surgery – Vrinnevi hospital, Norrköping, Sweden
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22
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Björklund P, Fändriks L. The pros and cons of gastric bypass surgery - The role of the Roux-limb. Best Pract Res Clin Gastroenterol 2019; 40-41:101638. [PMID: 31594646 DOI: 10.1016/j.bpg.2019.101638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 07/18/2019] [Indexed: 01/31/2023]
Abstract
The prevalence of overweight and obesity has exploded in the post-industrial era. Life style interventions like dieting and exercise can induce a marked weight loss, but the main problem for most patients is to maintain the reduced body weight over time. Gastric bypass surgery is a commonly performed and very effective method for achieving a pronounced and sustained weight loss including metabolic improvements in obese patients. Despite the therapeutic successfulness there are known side-effects like chronic postprandial nausea and pain that in some patients become intractable. The pathophysiology is complex and partly unexplored. The physician or surgeon handling a patient with "post-bariatric symptoms" must be aware of the risk for symptom aggravations due to iatrogenic opioid-associated intestinal dysmotility. The present paper gives a brief overview of obesity surgery and its associated postsurgical conditions with a focus on the unexplored role of the Roux-limb following gastric bypass surgery.
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Affiliation(s)
- Per Björklund
- Institute of Clinical Sciences, Department of Gastrosurgical Research and Education, The Sahlgrenska Academy at the University of Gothenburg, Sweden.
| | - Lars Fändriks
- Institute of Clinical Sciences, Department of Gastrosurgical Research and Education, The Sahlgrenska Academy at the University of Gothenburg, Sweden.
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23
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Roux Limb Motility in Gastric Bypass Patients with Chronic Abdominal Pain-Is There an Association to Prescribed Opioids? Obes Surg 2019; 29:3860-3867. [PMID: 31290106 DOI: 10.1007/s11695-019-04056-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND/AIM A number of patients continue to suffer from chronic abdominal pain of unknown origin, which may also lead to a prolonged use of opioid analgesics. Symptoms of abdominal pain, nausea and vomiting in this patient group resemble the characteristics of the Roux stasis Syndrome. The aim was to elucidate relationships between chronic abdominal pain, Roux limb motor activity and opioid analgesics. METHODS Roux limb high-resolution manometry and ratings of abdominal pain and quality of life were analysed in 15 gastric bypass patients reporting abdominal pain of unknown origin. Effect of acute opiate administration (morphine i.v.) on fasting Roux limb motor activity was assessed in asymptomatic and morphine-naïve gastric bypass patients (n = 9) and compared with an untreated control group (n = 11). RESULTS In the symptomatic patient group, we found disturbed Roux limb motor patterns in 10 out of 15 examinations, but no signs of Roux stasis syndrome. A high prevalence of prescribed opioid analgesics as well as a high number of reoperations in this group. The worst quality of life and the highest number of pain-killing medications were observed among the patients with distal pacemaker activity in Roux limb. In the morphine-naïve and asymptomatic patients, morphine increased the muscular tone in the Roux limb during phase III-like motor activity. A majority of the RYGBP patients with chronic abdominal pain had a disturbed Roux limb fasting motility, and there was a high prevalence of prescribed opioid analgesics. In opiate-naïve RYGBP patients, acute morphine intravenously increased the muscular tone of the Roux limb.
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24
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Senellart P, Saint-Jalmes G, Mfam WS, Abou-Mrad A. Laparoscopic versus full robotic Roux-en-Y gastric bypass: retrospective, single-center study of the feasibility and short-term results. J Robot Surg 2019; 14:291-296. [DOI: 10.1007/s11701-019-00976-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 05/21/2019] [Indexed: 01/06/2023]
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25
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Abstract
PURPOSE Mechanical gastro-intestinal anastomosis using stapler is a critical step in laparoscopic Roux-en-Y gastric bypass (RYGB). To date the effect of the direction of staples on anastomotic leak has not been investigated. The study aim was to investigate the impact of the direction of staples on the integrity of the gastro-jejunal anastomosis. MATERIALS AND METHODS Eight gastro-jejunostomy (GJ) models were performed using porcine stomach and small intestine. Specimens were divided into group A where the cartridge was in the gastric lumen with the anvil in the jejunal lumen and vice versa in group B. Enterotomy was closed and gastric and jejunal ends were stapled off. Burst pressure (BP) was measured by infusion of methylene blue saline into the GJ model until leak occurred. Site of leak, BP, and total volume (TV) infused were recorded. Compliance (C) was calculated from the equation ΔTV/ΔBP. RESULTS The BP was greater in group A compared to group B (18 mmHg (range 15-25) versus 11 mmHg (range 8-15); p = 0.045) despite similar TV between the groups 60.00 mL (range 55.00-65.00) versus 51.25 mL (range 40.00-60.00); p = 0.11). The compliance did not significantly differ between groups A and B (6.38 mL/mmHg (range 4.34-8.59) versus 5.61 mL/mmHg (range 3.93-7.21); p = 0.48). CONCLUSION BP recorded when the stapler cartridge was introduced in the gastric lumen was higher than when it was introduced from the jejunal lumen. The lack of difference in compliance between groups suggests that the difference in BP was due to the difference in the direction of staples.
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26
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Three-Year Outcomes of Revisional Laparoscopic Gastric Bypass after Failed Laparoscopic Sleeve Gastrectomy: a Case-Matched Analysis. Obes Surg 2018; 27:2324-2330. [PMID: 28265961 DOI: 10.1007/s11695-017-2631-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND While previous studies suggest laparoscopic Roux-en-Y gastric bypass (LRYGB) as a reasonable treatment approach to address weight loss failure after laparoscopic sleeve gastrectomy (LSG), data focusing on long-term outcomes are still lacking. The purpose of this study was to evaluate weight and comorbidity outcomes comparing revisional LRYGB (rLRYGB) with primary LRYGB (pLRYGB). METHODS Retrospective single-centre case-matched analysis was conducted at a bariatric tertiary referral centre. Between January 2009 and July 2013, 239 patients were entered into a prospective database, and 32 patients undergoing rLRYGB (cases) were matched with 32 patients undergoing pLRYGB (controls) for sex, age and BMI. The end point was data at 3 years of follow-up. Thirty-one patients (12.9%) were lost to follow-up during the study period. RESULTS There were no significant differences in patient demographics or median BMI (kg/m2) for pLRYGB or rLRYGB (42.8 ± 12.1 vs. 42.3 ± 11.5, respectively; p = 0.748). Coexisting comorbidities were rated similarly in both groups. At 3 years, the percentage of excess weight loss (74.4 ± 23.3 vs 52.0 ± 26, respectively; p = 0.007) was higher for pLRYGB than rLRYGB, while similar improvements of coexisting comorbidities could be observed. CONCLUSION rLRYGB is a feasible and practical surgical approach that allows effective weight loss at 3 years of follow-up and alleviates refractory reflux symptoms. Although weight loss is lower compared to pLRYGB, resolution or improvement of coexisting comorbidities appears similar. Therefore, rLRYGB seems to be a reliable procedure to address failure after LSG.
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27
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Genser L, Torcivia A, Helmy N, Vaillant J, Siksik J. Laparoscopic Roux-en-Y gastric bypass with hand-sewn gastro-jejunostomy. J Visc Surg 2017; 154:37-45. [DOI: 10.1016/j.jviscsurg.2017.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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28
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Consalvo V, Salsano V, Sarno G. Intraoperative iodinated contrast swallow with CT-scan delayed control for detection of early complications in laparoscopic gastric bypass: A case series of 260 cases. INTERNATIONAL JOURNAL OF SURGERY OPEN 2017. [DOI: 10.1016/j.ijso.2017.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Management of super–super obese patients: comparison between one anastomosis (mini) gastric bypass and Roux-en-Y gastric bypass. Surg Endosc 2016; 31:3504-3509. [PMID: 27981383 DOI: 10.1007/s00464-016-5376-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 11/25/2016] [Indexed: 12/19/2022]
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30
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Perioperative Outcomes of Proximal and Distal Gastric Bypass in Patients with BMI Ranged 50-60 kg/m(2)--A Double-Blind, Randomized Controlled Trial. Obes Surg 2016; 25:1788-95. [PMID: 25761943 PMCID: PMC4559572 DOI: 10.1007/s11695-015-1621-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Proximal Roux-en-Y gastric bypass may not ensure adequate weight loss in superobese patients. Bypassing a longer segment of the small bowel may increase weight loss. The objective of the study was to compare the perioperative outcomes of laparoscopic proximal and distal gastric bypass in a double-blind randomized controlled trial of superobese patients. The study was conducted at two public tertiary care obesity centers in Norway. Methods Patients with body mass index (BMI) 50–60 kg/m2 were randomly assigned to a proximal (150 cm alimentary limb) or a distal (150 cm common channel) gastric bypass. The biliopancreatic limb was 50 cm in both operations. Patients and follow-up personnel were blinded to the type of procedure. Thirty-day outcomes including complications are reported. Results We operated on 115 patients, of whom two were excluded at surgery, leaving 56 and 57 patients in the proximal group and distal group, respectively. The median (range) operating time was 72 (36–151) and 101 (59–227) min, respectively (p < 0.001). Two distal procedures were converted to laparotomy during the primary procedure. Median length of hospital stay was 2 (1–4) days in the proximal group and 2 (1–24) days in the distal group. The number of patients with complications and complications categorized according to the Contracted Accordion classification did not differ significantly. However, all six reoperations were performed in the distal group, of which three were completed by laparoscopy (p = 0.01 between groups). There were no deaths. Conclusions In superobese patients with BMI between 50 and 60 kg/m2, distal gastric bypass was associated with longer operating time and more severe complications resulting in reoperation than proximal gastric bypass.
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Schneider R, Gass JM, Kern B, Peters T, Slawik M, Gebhart M, Peterli R. Linear compared to circular stapler anastomosis in laparoscopic Roux-en-Y gastric bypass leads to comparable weight loss with fewer complications: a matched pair study. Langenbecks Arch Surg 2016; 401:307-13. [PMID: 27001683 DOI: 10.1007/s00423-016-1397-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 03/01/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE In the course of laparoscopic Roux-en-Y gastric bypass (LRYGB), a tight gastroenterostomy (GE) may lead to higher weight loss but possibly to an increase of local complications such as strictures and ulcers. Different operative techniques for Roux-en-Y reconstruction may also influence the rate of internal hernias, a typical late complication of LRYGB. The objective of this study was to compare weight loss, rates of strictures, internal hernias, and ulcerations of linear versus circular stapler anastomosis. METHODS Retrospective analysis of prospectively collected data in a 3:1-matched pair study. A total of 228 patients with a minimal follow-up of 2 years were matched according to BMI at baseline, age, and gender. The follow-up rate was 100 % at 1 and 2 years postoperatively; the mean follow-up time was 3.8 ± 1.63 years. In group C (circular), 57 patients were operated with a 25-mm circular stapler technique (average BMI 44.7 ± 5.18 kg/m(2), age 44.1 ± 10.8 years, 80.7 % female). In group L (linear), 171 patients were operated using a linear stapler (approximately 30 mm, average BMI 43.8 ± 5.24 kg/m(2), age 43.7 ± 12.5 years, 70.8 % female). A propensity score matching and a logrank test were used for statistical analysis. RESULTS The average excessive BMI loss (EBMIL) after 1 year was not statistically different (70.6 ± 20.2 % in group C vs 72.5 ± 20.4 % in group L) as well as after 2 years (71.6 ± 22.5 % in group C vs 74.6 ± 19.6 % in group L). The average operation time was 155 ± 53 min in group C and 109 ± 57 min in group L (p = 0.0001). In group L, patients had significantly lower overall stricture rates at the GE compared to group C (0 [0 %] vs. 4 [7 %], p = 0.0004), a lower rate and severity of internal hernias (10 [5.8 %] vs. 7 [12.3 %] p = 0.466), and equal local ulcerations rates (3 [1.8 %] vs. 1 [1.8 %] p = 0.912). CONCLUSION Linear stapler anastomosis in LRYGB compared to circular anastomosis leads to equal weight loss and less strictures. The lower rate of internal hernias in linear stapler anastomosis was not significantly different.
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Affiliation(s)
- Romano Schneider
- Department of Surgery, St. Claraspital AG, Kleinriehenstrasse 30, CH-4058, Basel, Switzerland
| | - Jörn-Markus Gass
- Department of Surgery, St. Claraspital AG, Kleinriehenstrasse 30, CH-4058, Basel, Switzerland
| | - Beatrice Kern
- Department of Surgery, St. Claraspital AG, Kleinriehenstrasse 30, CH-4058, Basel, Switzerland
| | - Thomas Peters
- Interdisciplinary Center of Nutritional and Metabolic Diseases, St. Claraspital AG, Kleinriehenstrasse 30, CH-4058, Basel, Switzerland
| | - Marc Slawik
- Interdisciplinary Center of Nutritional and Metabolic Diseases, St. Claraspital AG, Kleinriehenstrasse 30, CH-4058, Basel, Switzerland.,Endocrine Research Unit, Medizinische Klinik-Innenstadt, Ludwig-Maximilians University, Munich, Germany
| | - Martina Gebhart
- Interdisciplinary Center of Nutritional and Metabolic Diseases, St. Claraspital AG, Kleinriehenstrasse 30, CH-4058, Basel, Switzerland
| | - Ralph Peterli
- Department of Surgery, St. Claraspital AG, Kleinriehenstrasse 30, CH-4058, Basel, Switzerland.
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Chevallier JM, Arman GA, Guenzi M, Rau C, Bruzzi M, Beaupel N, Zinzindohoué F, Berger A. One thousand single anastomosis (omega loop) gastric bypasses to treat morbid obesity in a 7-year period: outcomes show few complications and good efficacy. Obes Surg 2015; 25:951-8. [PMID: 25585612 DOI: 10.1007/s11695-014-1552-z] [Citation(s) in RCA: 184] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND A short-term randomized controlled trial shows that the one anastomosis gastric bypass (OAGB) is a safe and effective alternative to the Roux-en-Y gastric bypass (RYGB). OBJECTIVE The aim of this study is to evaluate the OAGB at our University Hospital between 2006 and 2013. PATIENTS One thousand patients have undergone an OAGB. Data were collected on all consecutive patients. The mean follow-up period was 31 months (SD, 26.3; range, 12-82.9), and complete follow-up was available in 126 of 175 patients (72 %) at 5 years after surgery. RESULTS Mortality rate was 0.2 %. Overall morbidity was 5.5 %; 34 required reoperations: i.e., 6 leaks, 5 obstructions, 5 incisional hernias, 7 biliary refluxes, 2 perforated ulcers, 2 bleeds, 2 abscesses, and 1 anastomotic stricture. Four patients were reoperated for weight regain. Overall rate of marginal ulcers was 2 % (n = 20), all in heavy smokers. Conversion from an OAGB to a RYGB was required in nine cases (0.9 %): seven for intractable biliary reflux, two for a marginal ulcer. At 5 years, percent excess body mass index loss was 71.6 ± 27 %. One hundred patients with type-2 diabetes, with a mean preoperative HbA1C of 7.7 ± 1.9 %, were followed for >2 years; the total resolution rate was 85.7 %. CONCLUSION This study confirms that the OAGB is an effective procedure for morbid obesity with comparable outcomes to RYGB; in addition, it seems to be safer with lower morbidity. Its technical simplicity represents a real advantage and makes it an option that should be considered by all bariatric surgeons.
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Affiliation(s)
- Jean Marc Chevallier
- Department of Surgery, Hôpital Européen Georges Pompidou, AP-HP-Paris Descartes 5 University, Paris, France,
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Kassir R, Blanc P, Lointier P, Breton C, Debs T, Tiffet O. Laparoscopic Revision of an Omega Loop Gastric Bypass to Treat Afferent Loop Syndrome. Obes Surg 2015. [DOI: 10.1007/s11695-015-1805-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Disse E, Pasquer A, Espalieu P, Poncet G, Gouillat C, Robert M. Greater weight loss with the omega loop bypass compared to the Roux-en-Y gastric bypass: a comparative study. Obes Surg 2015; 24:841-6. [PMID: 24442421 DOI: 10.1007/s11695-014-1180-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Despite similar initial results on weight loss and metabolic control, with a better feasibility than the Roux-en-Y gastric bypass (RYGBP), the omega loop bypass (OLB) remains controversial. The aim of this study was to compare the short-term outcomes of the laparoscopic OLB versus the RYGBP in terms of weight loss, metabolic control, and safety. METHODS Two groups of consecutive patients who underwent laparoscopic gastric bypass surgery were selected: 20 OLB patients and 61 RYGBP patients. Patients were matched for age, gender, and initial body mass index (BMI). Data concerning weight loss, metabolic outcomes, and complications were collected prospectively. RESULTS Mean duration of the surgical procedure was shorter in the OLB group (105 vs. 152 min in the RYGBP group; p < 0.001). Mean excess BMI loss percent (EBL%) at 6 months and at 1 year was greater in the OLB group (76.3 vs. 60.0%, p = 0.001, and 89.0 vs. 71.0%, p = 0.002, respectively). After adjustment for age, sex, initial BMI, and history of previous bariatric surgery, the OLB procedure was still associated with a significantly greater 1-year EBL%. Diabetes improvement at 6 months was similar between both groups. The early and late complication rates were not statistically different. There were three anastomotic ulcers in the OLB group, in smokers, over 60 years old, who were not taking proton pump inhibitor medication. CONCLUSIONS In this short-term study, we observed a greater weight loss with OLB and similar efficiency on metabolic control compared to RYGBP. Long-term evaluation is necessary to confirm these outcomes.
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Affiliation(s)
- E Disse
- Department of Endocrinology, Diabetology and Nutrition, Specialized and Integrated Center for Obesity Management, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165, Chemin du Grand Revoyet, 69495, Pierre Bénite, France
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Sima E, Hedberg J, Sundbom M. Gastrointestinal symptoms, weight loss and patient satisfaction 5 years after gastric bypass: a study of three techniques for the gastrojejunal anastomosis. Surg Endosc 2015; 30:1553-8. [PMID: 26162421 DOI: 10.1007/s00464-015-4374-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/23/2015] [Indexed: 10/25/2022]
Abstract
BACKGROUND The optimal operative technique in gastric bypass (RYGB) is still under debate. We have studied patient-reported gastrointestinal symptoms and weight loss 5 years after RYGB performed with three different stapling techniques for the gastrojejunal anastomosis (GJ). METHODS Out of 593 patients operated with RYGB, 489 patients [80.2% women, body mass index (BMI) 44.9 (33-68) kg/m(2)] answered our 5-year follow-up questionnaire concerning gastrointestinal symptoms (vomiting, reflux, dumping, abdominal pain or diarrhea), weight loss, need for postoperative endoscopic interventions and overall satisfaction with the procedure. We compared the results for three different GJ techniques: linear stapler (LS, n = 103), 21-mm circular stapler (C21, n = 88) and 25-mm circular stapler (C25, n = 298). RESULTS Dumping was the most commonly reported symptom (14.1% of all patients on a weekly to daily basis), however, less frequently reported in the C25 group (p < 0.05). Vomiting, prevalent in 2.9% of all patients, was more frequently reported in the C21 group (p < 0.01). No group consistently showed greater weight loss compared to the other two groups. A higher incidence of endoscopic dilatations due to strictures was reported in the C21 group (12.5% compared to 4.5% of all patients, p < 0.05). Overall patient satisfaction was high (88%). CONCLUSION Our data suggest that the technique for the construction of the GJ in RYGB affects gastrointestinal symptoms 5 years postoperatively. The difference is moderate but indicates that a narrow GJ results in increased frequency of vomiting and need for endoscopic interventions without improving the weight result.
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Affiliation(s)
- E Sima
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - J Hedberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - M Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Hernández-Miguelena L, Maldonado-Vázquez A, Cortés-Romano P, Rios-Cruz D, Marín-Domínguez R, Castillo-González A. Carta al editor. CIR CIR 2015; 83:89. [PMID: 25982617 DOI: 10.1016/j.circir.2015.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 03/16/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Luis Hernández-Miguelena
- Clínica de Obesidad, Hospital Ángeles del Pedregal y Hospital San Ángel Inn, México Distrito Federal, México.
| | - Angélica Maldonado-Vázquez
- Clínica de Obesidad, Hospital Ángeles del Pedregal y Hospital San Ángel Inn, México Distrito Federal, México
| | - Pablo Cortés-Romano
- Clínica de Obesidad, Hospital Ángeles del Pedregal y Hospital San Ángel Inn, México Distrito Federal, México
| | - Daniel Rios-Cruz
- Clínica de Obesidad, Hospital Ángeles del Pedregal y Hospital San Ángel Inn, México Distrito Federal, México
| | - Raúl Marín-Domínguez
- Clínica de Obesidad, Hospital Ángeles del Pedregal y Hospital San Ángel Inn, México Distrito Federal, México
| | - Armando Castillo-González
- Clínica de Obesidad, Hospital Ángeles del Pedregal y Hospital San Ángel Inn, México Distrito Federal, México
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Zerrweck-López C. [The origin of the "simplified gastric bypass"]. CIR CIR 2015; 83:87-8. [PMID: 25982616 DOI: 10.1016/j.circir.2015.04.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 10/20/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Carlos Zerrweck-López
- Director de la Clínica Integral de Cirugía para la Obesidad y Enfermedades Metabólicas, Hospital General Tláhuac, GDF, México DF, México.
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Manometry of the Upper Gut Following Roux-en-Y Gastric Bypass Indicates That the Gastric Pouch and Roux Limb Act as a Common Cavity. Obes Surg 2015; 25:1833-41. [DOI: 10.1007/s11695-015-1639-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Sundbom M. Laparoscopic revolution in bariatric surgery. World J Gastroenterol 2014; 20:15135-15143. [PMID: 25386062 PMCID: PMC4223247 DOI: 10.3748/wjg.v20.i41.15135] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 04/08/2014] [Accepted: 05/26/2014] [Indexed: 02/06/2023] Open
Abstract
The history of bariatric surgery is investigational. Dedicated surgeons have continuously sought for an ideal procedure to relieve morbidly obese patients from their burden of comorbid conditions, reduced life expectancy and low quality of life. The ideal procedure must have low complication risk, both in short- and long term, as well as minimal impact on daily life. The revolution of laparoscopic techniques in bariatric surgery is described in this summary. Advances in minimal invasive techniques have contributed to reduced operative time, length of stay, and complications. The development in bariatric surgery has been exceptional, resulting in a dramatic increase of the number of procedures performed world wide during the last decades. Although, a complex bariatric procedure can be performed with operative mortality no greater than cholecystectomy, specific procedure-related complications and other drawbacks must be taken into account. The evolution of laparoscopy will be the legacy of the 21st century and at present, day-care surgery and further reduction of the operative trauma is in focus. The impressive effects on comorbid conditions have prompted the adoption of minimal invasive bariatric procedures into the field of metabolic surgery.
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Robert M, Pechoux A, Marion D, Laville M, Gouillat C, Disse E. Relevance of Roux-en-Y gastric bypass volumetry using 3-dimensional gastric computed tomography with gas to predict weight loss at 1 year. Surg Obes Relat Dis 2014; 11:26-31. [PMID: 25500226 DOI: 10.1016/j.soard.2014.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 04/21/2014] [Accepted: 05/18/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Causes of Roux-en-Y gastric bypass (RYGB) failures are still controversial. Literature data suggest that gastric pouch or gastrojejunal anastomosis distentions over time could be a key factor. Making the hypothesis that progressive distention of RYGB volumes is 1 of the main factors of weight loss failure, the aim of our study was to evaluate bypass volumes changes using repeated 3-dimensional gastric computed tomography with gas and the possible negative correlation with weight loss results at 1 year. METHODS Thirty-nine patients eligible for RYGB were prospectively included. Gastric bypass volumes were assessed at 3 and 12 months postsurgery performing 3-dimensional gastric computed tomography with gas and weight loss outcomes were recorded during the first postoperative year. RESULTS There was no loss to follow up. Mean % excess body mass index lost (%EBMIL) at 1 year was 66.7%. Seven patients (17.9%) did not reach Reinhold criteria and were considered as RYGB failures. We found no linear correlation between the 1 year %EBMIL and mean values of the gastric pouch (r=.01; P=.94), and the neo stomach (r=.09 ; P=.57) at 3 months. Revisional surgery was correlated negatively with %EBMIL at 1 year. CONCLUSION Weight loss at 1 year does not seem to be correlated to RYGB volume changes. Behavioral factors probably play a major role in weight loss failure.
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Affiliation(s)
- Maud Robert
- Department of Digestive Surgery, Center of Bariatric Surgery, Hospital Edouard Herriot, Hospices Civils de Lyon, F69437, Lyon cedex 03, France; Centre Intégré et Spécialisé de L'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, F69495 Pierre Bénite, France; Université Claude Bernard Lyon 1, Lyon, France.
| | - Albane Pechoux
- Department of Digestive Surgery, Center of Bariatric Surgery, Hospital Edouard Herriot, Hospices Civils de Lyon, F69437, Lyon cedex 03, France
| | - Denis Marion
- Department of Radiology, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, F69495 Pierre Bénite, France
| | - Martine Laville
- Centre Intégré et Spécialisé de L'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, F69495 Pierre Bénite, France; Université Claude Bernard Lyon 1, Lyon, France; Department of Endocrinology, Diabetology and Nutrition, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, F69495 Pierre Bénite, France
| | - Christian Gouillat
- Department of Digestive Surgery, Center of Bariatric Surgery, Hospital Edouard Herriot, Hospices Civils de Lyon, F69437, Lyon cedex 03, France; Centre Intégré et Spécialisé de L'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, F69495 Pierre Bénite, France; Université Claude Bernard Lyon 1, Lyon, France
| | - Emmanuel Disse
- Centre Intégré et Spécialisé de L'Obésité de Lyon, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, F69495 Pierre Bénite, France; Université Claude Bernard Lyon 1, Lyon, France; Department of Endocrinology, Diabetology and Nutrition, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, F69495 Pierre Bénite, France
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Robert M, Pasquer A, Espalieu P, Laville M, Gouillat C, Disse E. Gastric Bypass for Obesity in the Elderly: Is It as Appropriate as for Young and Middle-Aged Populations? Obes Surg 2014; 24:1662-9. [DOI: 10.1007/s11695-014-1247-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Anatomical basis for the low incidence of internal hernia after a laparoscopic Roux-en-Y gastric bypass without mesenteric closure. Obes Surg 2013; 23:2110-1. [PMID: 24130041 DOI: 10.1007/s11695-013-1095-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Barbed unidirectional V-Loc 180 suture in laparoscopic Roux-en-Y gastric bypass: a study comparing unidirectional barbed monofilament and multifilament absorbable suture. Surg Endosc 2013; 27:3846-51. [PMID: 23722892 DOI: 10.1007/s00464-013-2993-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 04/18/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND This study aimed primarily to evaluate the safety of digestive running suture (in gastrojejunal and antecolic jejunojejunal anastomosis closure) using unidirectional absorbable barbed suture (V-Loc 180) in laparoscopic Roux-en-Y gastric bypass (LRYGB) and secondarily to assess the efficacy of V-Loc 180 in reducing operative time. METHODS A prospective cohort study of 315 consecutive patients who underwent LRYGB was performed between October 2009 and October 2012 using an identical procedure technique. For the first 76 patients, a multifilament absorbable suture was used to assess the gastrojejunal anastomosis and the antecolic jejunal suture. For the following 239 patients, a unidirectional barbed monofilament suture was used. Data including operative time, time required for gastric pouch creation, time spent in both anastomoses constructions, conversion rate, and complications were prospectively recorded. RESULTS The postoperative complications did not differ significantly between the two groups. Early complications were observed for 1 patient (1.3%) in the multifilament group and for 14 patients (5.8%) in the barbed procedure group (p > 0.05). Late complications were observed for 1 patient (1.3%) in the multifilament group and for 5 patients (2%) in the barbed procedure group (p > 0.05). A shortened operative time was achieved in the barbed suture group. The mean operative time was 74.3 ± 15.3 min in the Vicryl group versus 62.7 ± 15.5 min in the V-Loc group (p < 0.05). The mean operative time required to fashion the gastrojejunal anastomosis was 21.3 ± 6.3 min in the Vicryl group versus 17.4 ± 5.1 min in the V-Loc group (p < 0.05). The mean operative time required to fashion the jejunojejunal anastomosis was 21.4 ± 4.9 min in the Vicryl group versus 15.2 ± 5.5 min in the V-Loc group (p < 0.05). CONCLUSIONS The authors' experience has demonstrated that the use of interlocked V-Loc suture during LRYGB anastomosis appears to be safe and efficient. The findings show a shortened total operative time in terms of single gastrojejunal or jejunojejunal anastomosis time. No statistically significant differences in early or late postoperative complications were observed between the V-Loc and multifilament absorbable suture patients.
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Meesters B, Latten G, Timmermans L, Schouten R, Greve JW. Roux-en-Y gastric bypass as revisional procedure after gastric banding: leaving the band in place. Surg Obes Relat Dis 2012; 8:717-22. [DOI: 10.1016/j.soard.2011.11.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 11/10/2011] [Accepted: 11/28/2011] [Indexed: 01/06/2023]
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Laparoscopic gastric bypass for failure of adjustable gastric banding: a review of 85 cases. Obes Surg 2012; 21:1513-9. [PMID: 21479765 DOI: 10.1007/s11695-011-0391-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Laparoscopic adjustable gastric banding (LAGB) is the first bariatric procedure in Europe and is becoming more and more popular in North America. However, the failure rate at 5 years can reach 50%. Although there is still no consensus on revisional surgery, the trend seems to be in favor of conversion to gastric bypass (GBP) with encouraging results. The aim of this study was to assess the results, the risks of conversion into GBP after failure of gastric banding. From January 2003 to July 2010, 85 patients had a revisional GBP after failure of LAGB, performed by two experienced surgeons. Post-operative morbidity, functional results, and weight loss were analyzed. The conversion rate was 2.3%. The mean operative time was 166 min. The mean length of stay was 5.2 days. The early morbidity rate was 7% and the mortality rate was nil. The mean body mass index (BMI) at the time of LAGB was 47.2 kg/m(2) with the lowest BMI reached at 35. The mean BMI at conversion into GBP was 42.9 and the final BMI after a mean follow-up of 22 months was 34.8. Of the patients, 57.7% had a final BMI inferior to 35 and 15.3% had a final BMI superior to 40 and these were super obese and older patients. Super-obesity and advanced age appear to be factors of failure of LAGB and revisional GBP. However, conversion into GBP currently remains the choice procedure in case of gastric banding failure with satisfactory results and acceptable morbidity.
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Brunaud L, Reibel N, Ayav A. Pancreatic, endocrine and bariatric surgery: the role of robot-assisted approaches. J Visc Surg 2011; 148:e47-53. [PMID: 21978931 DOI: 10.1016/j.jviscsurg.2011.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- L Brunaud
- Service de chirurgie digestive, hépato-biliaire et endocrinienne, hôpital Brabois-Adultes, CHU de Nancy, 11, allée du Morvan, 54511 Vandoeuvre-les-Nancy, France.
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Pregnancy after laparoscopic bariatric surgery: comparative study of adjustable gastric banding and Roux-en-Y gastric bypass. Surg Obes Relat Dis 2011; 8:429-33. [PMID: 21955747 DOI: 10.1016/j.soard.2011.06.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 04/27/2011] [Accepted: 06/12/2011] [Indexed: 01/08/2023]
Abstract
BACKGROUND Approximately 80% of patients undergoing bariatric surgery are women, and about one half of these are of reproductive age. The purpose of the present study was to compare laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in a series of morbidly obese women with respect to maternal and neonatal outcomes at a university hospital in France. METHODS From January 2004 to December 2008, the data from women who had undergone LAGB or LRYGB at our center and were pregnant were collected, including age, parity, gravidity, weight, body mass index (BMI) before surgery and at scheduled intervals after surgery (1, 3, 6, 12, and 18 mo and yearly thereafter), interval from surgery to conception, weight and BMI at conception, weight and weight gain during pregnancy, weight and BMI at 2 weeks after pregnancy, complications during pregnancy, gestational age, method of delivery, fetal birth weight, and fetal outcome. RESULTS There were 42 pregnancies in 36 women, 22 in women who had undergone LAGB and 20 who had undergone LRYGB. The LAGB and LRYGB groups were comparable for all analyzed variables, except that the preoperative weight and BMI were greater in the LRYGB group. No differences in weight or BMI were found at conception or after pregnancy. No difference was found between the 2 groups in terms of obstetric complications or neonatal outcomes. A high frequency of cesarean deliveries was necessary in both groups. CONCLUSIONS The results of the present study have shown that no significant difference exists in the obstetric and birth outcomes between women who have undergone LRYGB and those who have undergone LAGB.
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Myers SR, Rothermel WS, Shaffer L. The effect of tissue compression on circular stapler line failure. Surg Endosc 2011; 25:3043-9. [PMID: 21487874 DOI: 10.1007/s00464-011-1667-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 03/11/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Anastomotic leak after gastrointestinal anastomosis is a well-known and serious complication, yet there is no standardized approach to reliably create an anastomosis with sufficient mechanical properties to consistently avoid an anastomotic leak. The purpose of this study was to evaluate the relationships among combined tissue thickness, tissue compression, closed staple limb length, and mechanical strength of an anastomosis created with a circular stapler, as measured by maximum intraluminal pressure obtained at the time of leakage. METHODS Using 27 porcine stomachs and 27 porcine small-intestine segments, we measured tissue thickness and assessed the tissue compression at three different anvil closure distances created by a circular stapling device. Maximum intraluminal pressure was determined by infusing colored water into the porcine materials and increasing the pressure until leakage from the anastomosis occurred. RESULTS Tissue compression increased as the closure distance narrowed between the anvil and circular stapler (p < .0001). A tissue compression of ≥6 PSI correlated strongly with a maximum intraluminal pressure of ≥18 mmHg (43% for <6 PSI vs. 90% for ≥6 PSI; p = .02); tissue compression ≥12 PSI was necessary to obtain an acute maximum intraluminal pressure of ≥22 mmHg in 13 of 15 of our samples (p = .04). CONCLUSIONS Maximum intraluminal pressure of an anastomosis in this porcine model correlated most strongly with the compression of the tissue involved in the anastomosis. This experimental model provides a framework for constructing a systematic approach to creating an anastomosis with sufficient mechanical strength. However, this study was not intended to establish the upper range of tissue compression beyond which a permanent tissue injury may occur.
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Affiliation(s)
- Stephan R Myers
- Department of Surgery, Riverside Methodist Hospital, Columbus, OH 43214, USA.
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