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Murakami K, Hoshino N, Hida K, Obama K, Sakai Y, Watanabe N. Closure of mesenteric defects for prevention of internal hernia after Roux-en-Y gastric bypass in bariatric surgery. Cochrane Database Syst Rev 2025; 4:CD014612. [PMID: 40197535 PMCID: PMC11977045 DOI: 10.1002/14651858.cd014612.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2025]
Abstract
RATIONALE Internal hernia is one of the most severe complications observed in people undergoing Roux-en-Y gastric bypass (RYGB). There are some who advocate for the closure of defects to prevent internal hernias. However, the closure of these defects might be associated with an increased risk of small bowel obstruction, resulting from a kink in the anastomosis of the small intestines. Currently, there is a lack of robust evidence demonstrating the benefits of defect closure. OBJECTIVES To assess the benefits and harms of defect closure for prevention of internal hernia after Roux-en Y gastric bypass in bariatric surgery. SEARCH METHODS We searched CENTRAL, MEDLINE, and Embase to August 2024. We reviewed the reference lists of included studies and reached out to the study authors to obtain any missing data. We also searched PubMed, grey literature in the OpenGrey database, Clinical Trials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). ELIGIBILITY CRITERIA We included randomised controlled trials (RCTs) that included people with obesity (defined as a body-mass index (BMI) ≥ 35 kg/m²) who underwent laparoscopic or robotic RYGB in bariatric surgery, and compared the closure of defects with the non-closure of defects. We excluded quasi-randomised trials, cluster-RCTs, and cross-over trials. OUTCOMES The critical outcomes assessed were the incidence of internal hernia with bowel obstruction within 10 years, the incidence of postoperative overall complications within 30 days, and the incidence of postoperative mortality within 30 days. The important outcomes included the incidence of intraoperative overall complications, length of hospital stay, and the postoperative pain resulting from gastric bypass surgery, assessed using a visual analogue scale (VAS) two years after surgery. RISK OF BIAS Two review authors independently evaluated the risk of bias for each included study using the Cochrane RoB 2 tool. SYNTHESIS METHODS Two review authors independently assessed the methodological quality and extracted data from the included trials. We performed a random-effects meta-analysis for data synthesis. We calculated risk ratios (RR) with 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) with 95% CIs for continuous outcomes. We assessed the certainty of evidence based on the GRADE approach. INCLUDED STUDIES We identified three RCTs with 3010 participants, which met our inclusion criteria. The closure of mesenteric defects used non-absorbable, interrupt closure in one study, and non-absorbable running sutures in two studies. SYNTHESIS OF RESULTS The closure of defects during RYGB may reduce the incidence of internal hernia with bowel obstruction within 10 years compared with non-closure (RR 0.32, 95% CI 0.24 to 0.42; P < 0.00001, I² = 0 %; 3 studies, 3010 participants; low-certainty evidence). The closure of defects may result in little to no difference in the incidence of postoperative overall complications within 30 days compared to non-closure (RR 1.13, 95% CI 0.87 to 1.47; P = 0.35, I² = 0 %; 2 studies, 2609 participants; low-certainty evidence). The closure of defects may result in little to no difference in the incidence of postoperative mortality within 30 days compared to non-closure (RR 2.97, 95% CI 0.12 to 72.93; P = 0.50, I² not applicable; 2 studies, 2908 participants; very low-certainty evidence). The closure of defects may result in little to no difference in the incidence of intraoperative overall complications compared to non-closure (RR 0.87, 95% CI 0.54 to 1.42; P = 0.59, I² not applicable; 1 study, 2507 participants; very low-certainty evidence). Closure defects may lead to the longer length of hospital stay; however, the evidence is very uncertain (MD 0.27 days, 95% CI 0.15 to 0.38; P < 0.00001; I² = 93%; 2 studies, 2609 participants; very low-certainty evidence). Postoperative pain from gastric bypass surgery was not assessed because there was not enough information available for analysis. AUTHORS' CONCLUSIONS The closure of defects may be more effective than the non-closure of defects for prevention of internal hernia after RYGB. However, the small number of trials limited our confidence in the evidence. There is little to no difference between the closure and non-closure of defects in the incidence of postoperative overall complications, the incidence of postoperative mortality, and the incidence of intraoperative overall complications. The length of hospital stay may be longer for those undergoing defect closure than for those who did not have the defects closed. The evidence is very uncertain about the incidence of postoperative mortality, the incidence of intraoperative overall complications, and the length of hospital stay. Additional evidence based on trials designed to be at low risk of bias and with an adequate sample size is imperative. FUNDING This Cochrane review had no dedicated funding. REGISTRATION The protocol was registered in the Cochrane Library on 9 May 2023.
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Affiliation(s)
| | - Nobuaki Hoshino
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Koya Hida
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Kazutaka Obama
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Norio Watanabe
- Department of Psychiatry, Soseikai General Hospital, Kyoto, Japan
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Rouillard NA, Barnett SD, Zhang X, Kam L, Manikat R, Cheung R, Nguyen MH. Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic liver disease and cirrhosis. Clin Mol Hepatol 2025; 31:227-239. [PMID: 39541951 PMCID: PMC11791598 DOI: 10.3350/cmh.2024.0564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 10/25/2024] [Accepted: 11/14/2024] [Indexed: 11/17/2024] Open
Abstract
BACKGROUND/AIMS With the obesity pandemic, metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common liver disease and a leading cause of end-stage liver disease and liver-related deaths in the USA. Therefore, we aimed to compare the long-term outcomes of patients with MASLD and cirrhosis with and without bariatric surgery. METHODS Patients were retrospectively identified from the California Department of Healthcare Access and Information database, 2005 to 2019, for a population-based cohort study. Propensity score matching (PSM) was used to balance background risks between patients with cirrhosis who underwent bariatric surgery and those who did not. Overall, liver-related and non-liver-related mortality were analyzed. RESULTS Of 91,708 eligible patients with MASLD and cirrhosis, PSM yielded 2,107 patients who underwent bariatric surgery and 8,428 non-bariatric controls. Compared to matched controls, patients who underwent bariatric surgery had lower 5-year overall (24.9% vs. 37.1%; p<0.0001), liver-related (3.3% vs. 14%; p<0.0001), and non-liver-related mortality (22.3% vs. 26.9%; p=0.046). In multivariable analysis, bariatric surgery was associated with decreased overall mortality (adjusted hazard ratio [aHR]=0.63; p<0.0001), liver-related (aHR=0.24; p<0.0001), and non-liverrelated (aHR=0.81; p=0.0026) mortality. However, only laparoscopic surgeries were associated with lower overall mortality (aHR=0.39; p<0.0001) whereas open surgeries were associated with higher overall mortality (aHR=1.24; p=0.022). CONCLUSION Patients with MASLD and cirrhosis who underwent bariatric surgery, specifically laparoscopic approaches, had significantly lower mortality risk than non-surgical counterparts.
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Affiliation(s)
- Nicholas A. Rouillard
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Scott D. Barnett
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Xinrong Zhang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Leslie Kam
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Richie Manikat
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Mindie H. Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
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Farooqi S, Montrief T, Koyfman A, Long B. High risk and low incidence diseases: Bariatric surgery complications. Am J Emerg Med 2025; 87:113-122. [PMID: 39561500 DOI: 10.1016/j.ajem.2024.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 10/22/2024] [Accepted: 10/31/2024] [Indexed: 11/21/2024] Open
Abstract
INTRODUCTION Bariatric surgery complications carry a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of bariatric surgery complications, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Bariatric surgeries include restrictive procedures (e.g., adjustable gastric banding, endoscopic gastric balloon insertion, and sleeve gastrectomy) and mixed restrictive and malabsorptive procedures (e.g., roux-en-y gastric bypass and duodenal switch-biliopancreatic diversion). Several complications may occur, which may be associated with severe morbidity and mortality. These complications include anastomotic/staple line leaks, small bowel obstruction and internal hernia, marginal ulceration, biliary disease, and device-specific issues. History concerning the type of surgery, when and where it was performed, prior complications, changes in weight, and systemic symptoms is essential. Many signs and symptoms are subtle, but fever, tachycardia, and persistent vomiting are concerning for a severe complication. If there is concern for a complication, emergent consultation with the bariatric surgeon is recommended (preferably the patient's surgeon). Imaging studies can assist in the evaluation, including computed tomography with oral and intravenous contrast. Resuscitation in the ED and early intervention by a bariatric surgeon provide the best opportunity to reduce morbidity and mortality for patients with intra-abdominal pathology. CONCLUSION Understanding bariatric surgery complications can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Samia Farooqi
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Timothy Montrief
- DeWitt Daughtry Family Department of Surgery, Department of Emergency Medicine, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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Aeschbacher P, Garoufalia Z, Rogers P, Dourado J, Liang H, Pena A, Szomstein S, Lo Menzo E, Rosenthal RJ. Laparoscopic versus robotic-assisted primary bariatric-metabolic surgery. Are we still expecting to overcome the learning curve? A propensity score-matched analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Surg Obes Relat Dis 2024; 20:831-839. [PMID: 39084914 DOI: 10.1016/j.soard.2024.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/07/2024] [Accepted: 03/16/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Robotic surgery is becoming increasingly popular in bariatric-metabolic surgery. However, its superiority regarding postoperative outcomes compared with conventional laparoscopy has not been clearly proven. With growing adoption of robotic surgery and improved technologies, benefits should become more evident. OBJECTIVES Evaluate readmission and reoperation rates after bariatric-metabolic surgery performed by conventional laparoscopy versus robotic-assisted from 2015 to 2021. SETTING Academic institution. METHODS The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) was reviewed for primary bariatric operations performed with conventional laparoscopy versus robotic-assisted. Postoperative outcomes were compared in a propensity score-matched sample. RESULTS Of 1,059,348 cases meeting inclusion criteria, 921,322 (87%) were conventional laparoscopic bariatric-metabolic surgeries, which were matched 1:1 with robotic-assisted cases (138,026). Reoperation (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.00-1.15, P = .0463), postoperative morbidity (OR 1.07; 95% CI 1.01-1.12, P = .0193), readmission (OR 1.14; 95% CI 1.09-1.18, P < .0001), and emergency department visits (OR 1.06; 95% CI 1.03-1.09, P = .0003) at 30 days postoperatively were significantly greater for robotic-assisted cases. Robotic-assisted cases had a similar mortality rate at 30 days postoperatively and length of stay >3 days when compared with conventional laparoscopic cases. Similar results were observed in cases from 2020 to 2021, except for reoperation and emergency department visits, which showed no difference between groups and length of stay >3 days, which was greater in robotic-assisted cases. CONCLUSIONS Our results show a greater readmission and reoperation rate and greater morbidity at 30 days postoperatively in robotic-assisted bariatric-metabolic surgery compared with conventional laparoscopy. Analyzing only cases performed between 2020 and 2021, robotic surgery also does not show superiority over conventional laparoscopy.
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Affiliation(s)
- Pauline Aeschbacher
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida; Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Diseases Centre, Cleveland Clinic Florida, Weston, Florida
| | - Peter Rogers
- Ellen Leifer Shulman and Steven Shulman Digestive Diseases Centre, Cleveland Clinic Florida, Weston, Florida
| | - Justin Dourado
- Ellen Leifer Shulman and Steven Shulman Digestive Diseases Centre, Cleveland Clinic Florida, Weston, Florida
| | - Hong Liang
- Department of Clinical Research, Cleveland Clinic Florida, Weston, Florida
| | - Ana Pena
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Samuel Szomstein
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Emanuele Lo Menzo
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Raul J Rosenthal
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida.
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Lo HC, Hsu SC, Soong RS, Huang SK. Unraveling Postoperative Bleeding Dynamics in Laparoscopic Roux-en-Y Gastric Bypass: Insights from a Single-Center Tranexamic Acid Study. Obes Surg 2024; 34:3012-3020. [PMID: 39037676 DOI: 10.1007/s11695-024-07411-1] [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: 02/20/2024] [Revised: 07/17/2024] [Accepted: 07/17/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND The efficacy of postoperative tranexamic acid (TXA) administration in mitigating bleeding after primary laparoscopic Roux-en-Y gastric bypass (RYGB), a prevalent complication associated with significant morbidities and mortality, and the use of sequential laboratory parameter changes in bleeding screening and TXA impact tracking were investigated. METHODS This retrospective analysis included RYGB patients (aged 18-65 years, with a body mass index of 35-50 kg/m2) over 5 years who were categorized into three groups by evolving treatment regimens: Group A (n = 42) received standard pre- and postoperative enoxaparin (30 mg) every 12 h; Group B (n = 160) received enoxaparin and postoperative TXA (250 mg every 6 h); and Group C (n = 73) received TXA alone. Postoperative bleeding-related adverse events, vital signs, and laboratory changes were compared. RESULTS Postoperative hemorrhage occurred in 3.6% (10/275) of patients, with no significant intergroup differences. Patients who experienced bleeding had greater decreases in hemoglobin (∆Hb) (2.1 vs. 1.4; p = 0.003), greater ∆Hb > 2 (50% vs. 15%; p = 0.013), and greater use of staples than did those who did not experience bleeding (8 vs. 7; p = 0.001). The ∆Hb values were lower in Groups B (1.4) and C (1.3) than in Group A (1.7, p = 0.011). No significant difference was noted between Groups C and B. CONCLUSION This study emphasizes the potential of TXA to mitigate postoperative bleeding after RYGB, with no added benefit from excluding enoxaparin. Monitoring patients with a ∆Hb > 2 mg/dl and increased stapler usage is crucial. Further research is needed to validate routine TXA use across different procedures.
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Affiliation(s)
- Hung-Chieh Lo
- Division of Trauma and Emergency Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Shih-Chang Hsu
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ruey-Shyang Soong
- Division of General Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, No.111 Sec.3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan
- College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei City, 110, Taiwan
- Division of Transplantation Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- TMU Research Center for Organ Transplantation, Taipei Medical University, College of Medicine, Medical University, Taipei, Taiwan
- Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan
| | - Shau-Ku Huang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
- Johns Hopkins Asthma and Allergy Center, Johns Hopkins University School of Medicine, Baltimore, USA
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Liang L, Gu R, Zheng R, Sun Y, Yang H, Zhou X, Fu L, Zhao X. Comparative Study of Laparoscopic Sleeve Gastrectomy With or Without Jejunal Bypass. Obes Surg 2024; 34:2888-2896. [PMID: 38904731 DOI: 10.1007/s11695-024-07327-w] [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: 01/06/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE We evaluated the weight loss effect of laparoscopic sleeve gastrectomy (LSG) and jejunal bypass (JJB) in treating obesity by analyzing and comparing the effects of LSG with or without JJB. METHODS A retrospective analysis was performed on the data of 150 patients with obesity who underwent bariatric metabolic surgery in Affiliated Xiaolan Hospital,Southern Medical University from October 2014 to April 2019. The patients were divided into two groups, LSG and LSG + JJB, according to the different surgical methods. The differences in the percentage of excess weight loss (%EWL) and total weight loss (TWL) between the two groups were statistically analyzed. RESULTS The %EWL of the patients in the LSG group reached the maximum value at one year and six months post-surgery and steadily decreased after two years post-surgery. In contrast, the %EWL of the patients in the LSG + JJB group gradually increased after two years post-surgery; however, no significant difference between the two groups was observed. The TWL in the LSG + JJB group was significantly greater than that in the LSG group at each follow-up point. CONCLUSION Postoperative %EWL was similar in both groups. The TWL in the LSG + JJB group was greater than that in the LSG group, and the postoperative recurrent weight gain rate in the LSG + JJB group was lower than that in the LSG group.
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Affiliation(s)
- Luansheng Liang
- Department of Bariatric and Metabolic Diseases Surgery, Affiliated Xiaolan HospitalSouthern Medical University, No.65, Jucheng Rd. Xiaolan Dist., 528415, Zhongshan, Guangdong Prov., Guangdong, P. R. China
| | - Rong Gu
- Department of Maternal and Child Operating Room, Affiliated Xiaolan Hospital, Southern Medical University, Zhongshan, Guangdong, China
| | - Ruibin Zheng
- Department of Bariatric and Metabolic Diseases Surgery, Affiliated Xiaolan HospitalSouthern Medical University, No.65, Jucheng Rd. Xiaolan Dist., 528415, Zhongshan, Guangdong Prov., Guangdong, P. R. China
| | - Yi Sun
- Department of Bariatric and Metabolic Diseases Surgery, Affiliated Xiaolan HospitalSouthern Medical University, No.65, Jucheng Rd. Xiaolan Dist., 528415, Zhongshan, Guangdong Prov., Guangdong, P. R. China
| | - Huiying Yang
- Department of Bariatric and Metabolic Diseases Surgery, Affiliated Xiaolan HospitalSouthern Medical University, No.65, Jucheng Rd. Xiaolan Dist., 528415, Zhongshan, Guangdong Prov., Guangdong, P. R. China
| | - Xia Zhou
- Department of Bariatric and Metabolic Diseases Surgery, Affiliated Xiaolan HospitalSouthern Medical University, No.65, Jucheng Rd. Xiaolan Dist., 528415, Zhongshan, Guangdong Prov., Guangdong, P. R. China
| | - Liping Fu
- Department of Bariatric and Metabolic Diseases Surgery, Affiliated Xiaolan HospitalSouthern Medical University, No.65, Jucheng Rd. Xiaolan Dist., 528415, Zhongshan, Guangdong Prov., Guangdong, P. R. China
| | - Xiangwen Zhao
- Department of Bariatric and Metabolic Diseases Surgery, Affiliated Xiaolan HospitalSouthern Medical University, No.65, Jucheng Rd. Xiaolan Dist., 528415, Zhongshan, Guangdong Prov., Guangdong, P. R. China.
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Santos-Sousa H, Amorim-Cruz F, Nogueiro J, Silva A, Amorim-Cruz I, Ferreira-Santos R, Bouça-Machado R, Pereira A, Resende F, Costa-Pinho A, Preto J, Lima-da-Costa E, Barbosa E, Carneiro S, Sousa-Pinto B. Preoperative risk factors for early postoperative bleeding after Roux-en-Y gastric bypass surgery: a systematic review and meta-analysis. Langenbecks Arch Surg 2024; 409:163. [PMID: 38775865 PMCID: PMC11111548 DOI: 10.1007/s00423-024-03346-4] [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: 01/28/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Although bariatric surgery is an effective intervention for obesity, it comes with risks such as early postoperative bleeding (EPB). Identifying preoperative risk factors for this complication can help patients' risk stratification and optimization. We performed a systematic review and meta-analysis to find predictors for early postoperative bleeding after Roux-en-Y gastric bypass (RYGB). METHODS We conducted a systematic review, searching PubMed, Cochrane Library, and Web of Science until November 2023. We performed a random-effects meta-analysis to explore preoperative risk factors associated with early postoperative bleeding after RYGB. Sources of heterogeneity were explored by leave-one-out analyses. RESULTS 23 studies were included, comprising 232,488 patients. Male gender (meta-analytical RR = 1.42, 95%CI = 1.21-1.66, I2 = 18%, Q Cochran test p-value = 0.29) and revisional surgery (meta-analytical RR = 1.35, 95%CI = 1.12-1.62, I2 = 22%, Q Cochran test p = 0.21) were associated with higher risk of EPB. On average, patients with EPB were older than the remainder (MD for the mean age = 2.82 years, 95%CI = 0.97-4.67, I2 = 0.00%, Q Cochran test p = 0.46). Except for hypertension (meta-analytical RR = 1.33, 95%CI = 1.02-1.73, I2 = 66%, Q Cochran test p < 0.0001), comorbidities were not associated with a higher risk of EPB. CONCLUSION Preoperative risk factors, including age, gender, hypertension, and revisional bariatric surgery, are associated with early postoperative bleeding after RYGB. Further primary studies, with higher methodological quality, are required to detail more risk factors.
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Affiliation(s)
- Hugo Santos-Sousa
- Obesity Integrated Responsability Unit (CRI-O), São João University Medical Center, Porto, Portugal.
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal.
| | - Filipe Amorim-Cruz
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
- Surgery Department, São João University Medical Center, Porto, Portugal
| | - Jorge Nogueiro
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
- Surgery Department, São João University Medical Center, Porto, Portugal
| | - Alexandre Silva
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
| | - Inês Amorim-Cruz
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
| | | | | | - André Pereira
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
- Surgery Department, São João University Medical Center, Porto, Portugal
| | - Fernando Resende
- Obesity Integrated Responsability Unit (CRI-O), São João University Medical Center, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
| | - André Costa-Pinho
- Obesity Integrated Responsability Unit (CRI-O), São João University Medical Center, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
| | - John Preto
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
| | - Eduardo Lima-da-Costa
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
- Surgery Department, São João University Medical Center, Porto, Portugal
| | - Elisabete Barbosa
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
- Surgery Department, São João University Medical Center, Porto, Portugal
| | - Silvestre Carneiro
- Obesity Integrated Responsability Unit (CRI-O), São João University Medical Center, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
| | - Bernardo Sousa-Pinto
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, MEDCIDS, University of Porto, Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
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Ding X, Che J, Xu S, Chen D, Zha T, Abudurousuli G, Liang H, Gui B. A nomogram to predict postoperative nausea and vomiting in the ward following laparoscopic bariatric surgery. Surg Endosc 2023; 37:9217-9227. [PMID: 37872426 DOI: 10.1007/s00464-023-10483-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/17/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) is a common and distressing complication of laparoscopic bariatric surgery (LBS). However, there is a lack of effective integrated prediction models for preventing and treating PONV in patients after LBS. METHODS Based on a randomized controlled trial conducted between November 1, 2021, and May 13, 2022, we included 334 participants who underwent LBS according to the inclusion criteria. The database was divided randomly into training and validation cohorts in a ratio of 7:3. Least absolute shrinkage and selection operator plus multivariable logistic regression were used to identify independent predictors and construct a nomogram. The performance of the nomogram was assessed and validated by the area under the receiver operating characteristic curve (AUC), the concordance index (C-index), calibration plots, and a decision curve analysis (DCA). We also explored specific risk factors for PONV in patients with diabetes. RESULTS The subjects were divided randomly into training (n = 234) and validation (n = 100) cohorts. Age, history of diabetes, type of surgery, and sugammadex use were incorporated to construct a nomogram prediction model. In the training cohort, the AUC and the optimism-corrected C-index were 0.850 [95% confidence interval (CI) 0.801-0.899] and 0.848, while in the validation cohort they were 0.847 (95% CI 0.768-0.925) and 0.844, respectively. The calibration plots showed good agreement between the predicted and actual observations. The DCA results demonstrated that the nomogram was clinically useful. The type of surgery, sugammadex use, and insulin level at 120 min were predictors of PONV in patients with diabetes with an AUC of 0.802 (95% CI 0.705-0.898). CONCLUSIONS We developed and validated a prediction model for PONV in patients after LBS. A risk factor analysis of PONV in patients with diabetes provides clinicians with a more precise prophylactic protocol.
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Affiliation(s)
- Xiahao Ding
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
- Department of Anesthesiology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jinxing Che
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
- Department of Anesthesiology, Huai'an Maternity and Child Healthcare Hospital, Huai'an, China
| | - Siyang Xu
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
- Department of Anesthesiology, Jiangsu Province Official Hospital, Nanjing, China
| | - Dapeng Chen
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Tianming Zha
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Gulibositan Abudurousuli
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Hui Liang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bo Gui
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
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9
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de Oliveira VL, Bestetti AM, Trasolini RP, de Moura EGH, de Moura DTH. Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas: Basic principles and recommendations. World J Gastroenterol 2023; 29:1173-1193. [PMID: 36926665 PMCID: PMC10011956 DOI: 10.3748/wjg.v29.i7.1173] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/28/2022] [Accepted: 01/30/2023] [Indexed: 02/21/2023] Open
Abstract
Post-surgical leaks and fistulas are the most feared complication of bariatric surgery. They have become more common in clinical practice given the increasing number of these procedures and can be very difficult to treat. These two related conditions must be distinguished and characterized to guide the appropriate treatment. Leak is defined as a transmural defect with communication between the intra and extraluminal compartments, while fistula is defined as an abnormal communication between two epithelialized surfaces. Traditionally, surgical treatment was the preferred approach for leaks and fistulas and was associated with high morbidity with significant mortality rates. However, with the development of novel devices and techniques, endoscopic therapy plays an increasingly essential role in managing these conditions. Early diagnosis and endoscopic therapy initiation after clinical stabilization are crucial to success since clinical success rates are higher for acute leaks and fistulas when compared to late and chronic leaks and fistulas. Several endoscopic techniques are available with different mechanisms of action, including direct closure, covering/diverting or draining. The treatment should be individualized by considering the characteristics of both the patient and the defect. Although there is a lack of high-quality studies to provide standardized treatment algorithms, this narrative review aims to provide a summary of the current scientific evidence and, based on this data and our extensive experience, make recommendations to help choose the best endoscopic approach for the management of post-bariatric surgical leaks and fistulas.
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Affiliation(s)
- Victor Lira de Oliveira
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403010, Brazil
| | - Alexandre Moraes Bestetti
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403010, Brazil
| | - Roberto Paolo Trasolini
- Division of Gastroenterology, Hepatology and Endoscopy, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 021115, United States
| | - Eduardo Guimarães Hourneaux de Moura
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403010, Brazil
| | - Diogo Turiani Hourneaux de Moura
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403010, Brazil
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10
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Gallop MR, Tobin SY, Chaix A. Finding balance: understanding the energetics of time-restricted feeding in mice. Obesity (Silver Spring) 2023; 31 Suppl 1:22-39. [PMID: 36513496 PMCID: PMC9877167 DOI: 10.1002/oby.23607] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/17/2022] [Accepted: 09/06/2022] [Indexed: 12/15/2022]
Abstract
Over the course of mammalian evolution, the ability to store energy likely conferred a survival advantage when food became scarce. A long-term increase in energy storage results from an imbalance between energy intake and energy expenditure, two tightly regulated parameters that generally balance out to maintain a fairly stable body weight. Understanding the molecular determinants of this feat likely holds the key to new therapeutic development to manage obesity and associated metabolic dysfunctions. Time-restricted feeding (TRF), a dietary intervention that limits feeding to the active phase, can prevent and treat obesity and metabolic dysfunction in rodents fed a high-fat diet, likely by exerting effects on energetic balance. Even when body weight is lower in mice on active-phase TRF, food intake is generally isocaloric as compared with ad libitum fed controls. This discrepancy between body weight and energy intake led to the hypothesis that energy expenditure is increased during TRF. However, at present, there is no consensus in the literature as to how TRF affects energy expenditure and energy balance as a whole, and the mechanisms behind metabolic adaptation under TRF are unknown. This review examines our current understanding of energy balance on TRF in rodents and provides a framework for future studies to evaluate the energetics of TRF and its molecular determinants.
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Affiliation(s)
- Molly R Gallop
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT
| | - Selene Y Tobin
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT
| | - Amandine Chaix
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT
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11
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Beamish AJ, Pournaras DJ, Barry JD. Mortality Following Metabolic and Bariatric Surgery. OBESITY, BARIATRIC AND METABOLIC SURGERY 2023:1037-1048. [DOI: 10.1007/978-3-030-60596-4_105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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12
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Shetye B, Hamilton FR, Bays HE. Bariatric surgery, gastrointestinal hormones, and the microbiome: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. OBESITY PILLARS 2022; 2:100015. [PMID: 37990718 PMCID: PMC10661999 DOI: 10.1016/j.obpill.2022.100015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 03/26/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians an overview of bariatric surgery (i.e., bariatric procedures that improve metabolic disease are often termed "metabolic and bariatric surgery"), gastrointestinal hormones, and the microbiome as they relate to patients with obesity. Methods The scientific information for this CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results This CPS includes the pros and cons of the most common types of bariatric procedures; the roles of gastrointestinal (GI) hormones in regulating hunger, digestion, and postabsorptive nutrient metabolism; and the microbiome's function and relationship with body weight. This CPS also describes patient screening for bariatric surgery, patient care after bariatric surgery, and treatment of potential nutrient deficiencies before and after bariatric surgery. Finally, this CPS explores the interactions between bariatric surgery, GI hormones, and the microbiome. Conclusions This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) regarding bariatric surgery, gastrointestinal hormones, and the microbiome is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity. Implementation of appropriate care before and after bariatric surgery, as well as an awareness of GI hormones and the microbiome, may improve the health of patients with obesity, especially patients with adverse fat mass and adiposopathic metabolic consequences.
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Affiliation(s)
- Bharti Shetye
- Diplomate American Board of Obesity Medicine, Medical Director, Dr. Abby's Weight Management Clinic, 6101 Webb Road, Suite 207, Tampa, FL, 33615, USA
| | - Franchell Richard Hamilton
- Diplomate American Board of Obesity Medicine, A Better Weigh Center, 8865 Davis Blvd Ste 100, Keller, TX, 76248, USA
| | - Harold Edward Bays
- Diplomate American Board of Obesity Medicine, Louisville Metabolic and Atherosclerosis Research Center, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville, KY, 40213, USA
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Early Postoperative Bleeding After Laparoscopic Roux-En-Y Gastric Bypass: a Single Center Analysis. Obes Surg 2022; 32:1902-1908. [PMID: 35201569 DOI: 10.1007/s11695-022-05973-6] [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: 07/20/2021] [Revised: 02/08/2022] [Accepted: 02/17/2022] [Indexed: 12/20/2022]
Abstract
PURPOSE Early postoperative bleeding is a common complication after laparoscopic Roux-en-Y gastric bypass (LRYGB) and is associated with significant morbidity. We aimed to identify predictors of early postoperative bleeding after LRYGB and characterize hemorrhagic events and 30-day postoperative outcomes. MATERIAL AND METHODS We conducted a retrospective cohort study regarding all patients submitted to LRYGB in 2019 at a high-volume obesity center. Early postoperative bleeding was defined as any clinically significant evidence of hemorrhage in the early postoperative period. Demographic, preoperative, and intraoperative factors were evaluated for associations with postoperative bleeding. Postoperative outcomes were compared between patients with and without hemorrhage. RESULTS Of 340 patients submitted to LRYGB, 14 (4.1%) had early postoperative bleeding. Patients with bleeding had an increased preoperative left hepatic lobe diameter (8.4 vs. 7.3 cm, p = 0.048). Prior cholecystectomy (28.6 vs. 14.5%) and previous bariatric surgery (35.7 vs. 23.9%) tended to be more prevalent among these patients. Bleeding occurred at a median time of 31.2 [IQR 19.7-38.5] h. Thirteen patients presented with intraluminal bleeding and one with extraluminal bleeding. Melena was the most common symptom. All hemorrhages were clinically diagnosed, and 92.9% were managed conservatively. Postoperative bleeding was associated with longer hospital stay (3.5 vs. 2.0 days), higher reintervention (7.1 vs. 0%), and readmission (14.3 vs. 0%), all p < 0.05. CONCLUSIONS Bleeding was the most frequent early complication after LRYGB. Patients with hepatomegaly and prior surgeries may have technically challenging LRYGB and should be carefully assessed. Perioperative strategies should be encouraged in high-risk patients to prevent bleeding.
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Minimally invasive versus open duodenal switch: a nationwide retrospective analysis. Surg Endosc 2022; 36:7000-7007. [DOI: 10.1007/s00464-022-09020-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/03/2022] [Indexed: 11/25/2022]
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Robertson AGN, Wiggins T, Robertson FP, Huppler L, Doleman B, Harrison EM, Hollyman M, Welbourn R. Perioperative mortality in bariatric surgery: meta-analysis. Br J Surg 2021; 108:892-897. [PMID: 34297806 DOI: 10.1093/bjs/znab245] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/02/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Bariatric surgery is an established treatment for severe obesity; however, fewer than 1 per cent of eligible patients undergo surgery. The perceived risk of surgery may contribute to the low uptake. The aim of this study was to determine perioperative mortality associated with bariatric surgery, comparing different operation types and data sources. METHODS A literature search of Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was conducted to identify studies published between 1 January 2014 and 31 July 2020. Inclusion criteria were studies of at least 1000 patients reporting short-term mortality after bariatric surgery. Data were collected on RCTs. Meta-analysis was performed to establish overall mortality rates across different study types. The primary outcome measure was perioperative mortality. Different operation types were compared, along with study type, in subgroup analyses. The study was registered at PROSPERO (2019: CRD 42019131632). RESULTS Some 4356 articles were identified and 58 met the inclusion criteria. Data were available on over 3.6 million patients. There were 4707 deaths. Pooled analysis showed an overall mortality rate of 0.08 (95 per cent c.i. 0.06 to 0.10; 95 per cent prediction interval 0 to 0.21) per cent. In subgroup analysis, there was no statistically significant difference between overall, 30-day, 90-day or in-hospital mortality (P = 0.29). There was no significant difference in reported mortality for RCTs, large studies, national databases or registries (P = 0.60). The pooled mortality rates by procedure type in ascending order were: 0.03 per cent for gastric band, 0.05 per cent for sleeve gastrectomy, 0.09 per cent for one-anastomosis gastric bypass, 0.09 per cent for Roux-en-Y gastric bypass, and 0.41 per cent for duodenal switch (P < 0.001 between operations). CONCLUSION Bariatric surgery is safe, with low reported perioperative mortality rates.
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Affiliation(s)
| | - T Wiggins
- Heartlands Hospital, Birmingham, Birmingham, UK
| | | | | | - B Doleman
- University of Nottingham, Nottingham, UK
| | - E M Harrison
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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16
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Small bowel obstruction following laparoscopic Roux-en-Y gastric bypass: is it always necessary to operate? A 5-year, high volume center experience. Langenbecks Arch Surg 2021; 406:1839-1846. [PMID: 34259917 DOI: 10.1007/s00423-021-02262-1] [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: 01/04/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aims to describe the incidence, associated factors, etiology, and management of small bowel obstructions following laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS A retrospective analysis was conducted between January 15 and December 19 using the surgery database of our hospital. Included LRYGB patients were those that evolved with a prolonged length of stay; readmission; emergency room consult; and re-intervention due to small bowel obstruction (SBO) related symptoms with compatible radiological or intraoperative findings. The LRYGB technique implied an antecolic alimentary limb reconstruction and systematic closure of mesenteric defects. Descriptive and analytical statistics were carried out, using a parametric or non-parametric approach as needed. RESULTS Nine hundred forty-one LRYGB were performed. 9.9% were revisional surgeries of patients with a laparoscopic sleeve gastrectomy. During the study period, 36 SBOs occurred, representing 3.8% of operated patients, with no mortality. 58.3% had successful non-operative management, while 41.7% required surgical exploration, of which 73.3% were treated laparoscopically and 20% needed conversion to open surgery. Etiologies of SBO were jejuno-jejunostomy (JJO) related stenosis (22, 61.1%), internal hernias (6, 16.7%), adherences (3, 8.3%), and other diagnoses (5, 13.9%). Regarding JJO stenosis and internal hernias, median time to diagnosis was 8 days (IQR 7-11) and 12 months (IQR 8.7-16) respectively. Previous sleeve gastrectomy, age, or sex was not associated to the incidence of small bowel obstruction. CONCLUSIONS LRYGB is safe when performed by experienced surgeons. SBO due to internal hernias were scarce in this series. JJO stenosis could explain most cases of SBO; under this diagnosis, non-surgical management was successful frequently.
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Guimarães M, Osório C, Silva D, Almeida RF, Reis A, Cardoso S, Pereira SS, Monteiro MP, Nora M. How Sustained is Roux-en-Y Gastric Bypass Long-term Efficacy? : Roux-en-Y Gastric Bypass efficacy. Obes Surg 2021; 31:3623-3629. [PMID: 34021884 PMCID: PMC8270797 DOI: 10.1007/s11695-021-05458-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/21/2021] [Accepted: 04/27/2021] [Indexed: 11/28/2022]
Abstract
Purpose The rate of weight regain after Roux-en-Y Gastric Bypass (RYGB) can hamper the procedure long-term efficacy for obesity treatment and related comorbidities. To evaluate the rate of weight loss and comorbidity remission failure 10 years or more after RYGB surgery. Materials and methods Retrospective observational cohort study. Patients submitted to RYGB for obesity treatment at a single centre with 10 years or more after surgery underwent a clinical reassessment. Results Among the subjects invited for clinical revaluation (n = 585), only those who performed RYGB and attended the hospital visit were included in the study (n = 281). The pre-operative mean body mass index (BMI) was 44.4 ± 6.1 kg/m2. Mean post-operative time was 12.2 ± 1.1 years. After surgery, mean BMI was significantly lower 33.4 ± 5.8 kg/m2 (p < 0.0001), 29.5% with a BMI < 30 kg/m2. Mean Total Weight Lost (%TWL) was 24.3 ± 11.4%, reaching a %TWL ≥ 20% in 70.1% with a mean %TWL of 30.0 ± 7.0%. Co-morbidities remission rate was 54.2% for type 2 diabetes, 34.1% for hypertension, 52.4% for hyperlipidemia and 50% for obstructive sleep apnea. Early complications rate was 13.2% and revision surgery occurred in 2.8% of patients. Four patients died of RYGB complications within the first 90 days after surgery. Conclusion RYGB has a high rate of long-term successful weight loss and obesity-associated comorbidity improvement. Weight loss failure requiring revision surgery occurs in a small proportion of patients. Our data confirms the long-term effectiveness of RYGB as primary bariatric intervention. Graphical abstract ![]()
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Affiliation(s)
- Marta Guimarães
- Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal. .,Department of Anatomy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Jorge Viterbo Ferreira 228, Building 1.3, 4050-313, Porto, Portugal. .,Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Cândido Pinho, Santa Maria da Feira, Portugal.
| | - Catarina Osório
- Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Cândido Pinho, Santa Maria da Feira, Portugal
| | - Diogo Silva
- Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Cândido Pinho, Santa Maria da Feira, Portugal
| | - Rui F Almeida
- Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Cândido Pinho, Santa Maria da Feira, Portugal
| | - António Reis
- Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Cândido Pinho, Santa Maria da Feira, Portugal
| | - Samuel Cardoso
- Department of Anatomy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Jorge Viterbo Ferreira 228, Building 1.3, 4050-313, Porto, Portugal
| | - Sofia S Pereira
- Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal.,Department of Anatomy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Jorge Viterbo Ferreira 228, Building 1.3, 4050-313, Porto, Portugal
| | - Mariana P Monteiro
- Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal.,Department of Anatomy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Jorge Viterbo Ferreira 228, Building 1.3, 4050-313, Porto, Portugal
| | - Mário Nora
- Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal.,Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Cândido Pinho, Santa Maria da Feira, Portugal
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Indications and Long-Term Outcomes of Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass. Obes Surg 2021; 31:3410-3418. [PMID: 33932190 DOI: 10.1007/s11695-021-05444-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE Long-term results on sleeve gastrectomy (SG) with more than 10 years report patients needing sleeve revision for weight loss failure, de novo gastroesophageal reflux (GERD), or sleeve complications. The aim of this study was to analyze the results of laparoscopic conversion of failed SG to Roux-en-Y gastric bypass (RYGB). MATERIALS AND METHODS Retrospective review of a prospectively institutional maintained database to identify patients who underwent conversion of SG to RYGB between 2012 and June 2020. RESULTS Sixty patients(50 females) underwent conversion to RYGB. Average time to conversion was 5.6 years (2-11). Mean %WL and TWL after SG were respectively 26±8.8% and 33.2±14.1kg. Mean BMI at the time of RYGB was 38.1±7.1 kg/m2. Mean follow-up was 30.4±16.8 months (6-84). Available patients at each time of follow-up: 1 year 59 (98.3%); 2 years 47 (78.3%); 3 years 39 (71.6%); and 5 years 33 (55%). Patients were divided according to indication for revision in weight regain/insufficient weight loss (30 patients) group 1 and GERD/complications (25 patients) group 2. Percentage of excess weight loss at 1, 3, and 5 years follow-up after bypass was for group 1 40.3±17.6, 34.3±19.5, and 23.2±19.4 and for group 2 90.4±37, 62.6±28.2, and 56±35.02. Total weight loss at last follow-up since sleeve was respectively 31kg in group 1 and 46.7kg in group 2 (p=0.002). No mortality was observed. Thirty-day complication rate was 3.3%. CONCLUSION RYGB after SG is a safe and effective revisional procedure to manage weight regain and de novo GERD, to address complications, and to improve comorbidities.
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Risk factors for readmission for early small bowel obstruction following laparoscopic Roux-en-Y gastric bypass: an MBSAQIP analysis. Surg Obes Relat Dis 2021; 17:1041-1048. [PMID: 33965351 DOI: 10.1016/j.soard.2021.02.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/27/2021] [Accepted: 02/27/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Small bowel obstruction (SBO) following laparoscopic Roux-en-Y gastric bypass (LRYGB) is associated with significant morbidity. OBJECTIVES To evaluate the rate of and risk factors for readmission for SBO within 30 days of LRYGB. SETTING Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-accredited centers. METHODS This is a retrospective study using the MBSAQIP database. A query was performed from 2015-2018 for patients who underwent LRYGB and required readmission for SBO. Those who had a reoperation, intervention, readmission, or expired from causes other than SBO were excluded. Descriptive, bivariate, and binary logistic regression analyses were performed. RESULTS Among 184,660 patients undergoing LRYGB, 1189 (.64%) required readmission due to SBO. Among the readmission cases, 978 (82.5%) were identified as having intestinal obstruction (unspecified), 108 (9.1%) incisional hernia, and 100 (8.4%) internal hernia. Among these cases, 69% had a reoperation and 1.3% expired during the 30-day period. From a logistic regression model, parameters independently associated with an increased risk for readmission for early SBO include being female (adjusted odds ratio [AOR], 1.53) or black (AOR, 1.41) and having gastroesophageal reflux (AOR, 1.35), a history of myocardial infarction (AOR, 1.76), a history of deep vein thrombosis (AOR, 1.73), previous obesity surgery/foregut surgery (AOR, 1.79), a robotic-assisted procedure (AOR, 1.23), concurrent hiatal hernia repair (AOR, 1.66) and adhesiolysis (AOR, 1.42). CONCLUSION The rate of readmission for early SBO following LRYGB was less than 1%. The majority of these cases required reoperation. The increased intraoperative complexity of LRYGB is associated with an increased risk of readmission due to early SBO.
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Cohen RV, Nishikawa AM, Ribeiro RA, Oliveira FM, Andrade PC, Junqueira SM, Toldo B. Surgical Management of Obesity in Brazil: Proposal for a Value-Based Healthcare Model and Preliminary Results. Value Health Reg Issues 2021; 26:10-14. [PMID: 33550039 DOI: 10.1016/j.vhri.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To describe the implementation and 1-year results of a value-based bariatric surgery program in Brazil. METHODS The study was conducted at a private hospital in São Paulo, Brazil (Hospital Alemão Oswaldo Cruz). A value-based healthcare program was implemented by designing an episode of care for eligible patients and developing a bundled payment model in which a single payment was made for the bariatric surgery covering the preoperative workup and ending 30 days after discharge. Assessment of outcomes included complication rate, hospital length of stay, intensive care admissions, reoperations, readmissions, and visits to the emergency department in the 30-day postoperative period. The results were compared with real-world evidence retrieved from a Brazilian private insurance database containing information on bariatric procedures performed in similar institutions (benchmark group). RESULTS Eighty-three patients were enrolled in the value-based healthcare program (80.7% women; 18.0% with type 2 diabetes mellitus; 31.0% with high blood pressure). The mean age was 40.9 years, and body mass index was 42.1 kg/m2. The outcomes recorded in the benchmark group versus the value-based healthcare group involved complication rate, 2.6% versus 1.4% (P = 0.69); length of stay, 2.5 versus 2.0 days (P = 0.0001); intensive care admissions, 4.0% versus 1.2% (P = 0.31); emergency care visits, 15.0% versus 6.0% (P = 0.04); and readmissions, 2.3% versus 0 (P = 0.35), with an estimated cost reduction of 7.1%. CONCLUSIONS These initial results showed favorable surgical and 30-day outcomes, demonstrating the benefits of a value-based approach for the surgical management of obesity and its comorbidities.
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Affiliation(s)
- Ricardo Vitor Cohen
- Oswaldo Cruz German Hospital, Center for the Treatment of Obesity and Diabetes, São Paulo, São Paulo, Brazil.
| | | | | | - Fernanda Maria Oliveira
- Johnson and Johnson Medical Devices, Health Economics and Market Access São Paulo, São Paulo, Brazil
| | - Priscila Caldeira Andrade
- Johnson and Johnson Medical Devices, Health Economics and Market Access São Paulo, São Paulo, Brazil
| | - Silvio Mauro Junqueira
- Johnson and Johnson Medical Devices, Health Economics and Market Access São Paulo, São Paulo, Brazil
| | - Bruno Toldo
- Oswaldo Cruz German Hospital, São Paulo, São Paulo, Brazil
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Davrieux CF, Palermo M, Serra E, Acquafresca P, Giménez ME. Acute Gastric Dilation of the Post-Roux-en-Y Gastric Bypass Remnant Stomach: Image-Guided Surgery Approach. J Laparoendosc Adv Surg Tech A 2021; 31:166-170. [DOI: 10.1089/lap.2020.0729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Carlos Federico Davrieux
- Department of Percutaneous Surgery, DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina
- Department of General Surgery, Sanatorio de la Mujer, Rosario, Argentina
| | - Mariano Palermo
- Department of Percutaneous Surgery, DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina
- Department of Bariatric Surgery, Diagnomed, Buenos Aires, Argentina
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Edgardo Serra
- Department of Percutaneous Surgery, DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina
- Department of Bariatric Surgery, CIEN Center, Corrientes, Argentina
| | - Pablo Acquafresca
- Department of Percutaneous Surgery, DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina
| | - Mariano E. Giménez
- Department of Percutaneous Surgery, DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
- IRCAD (Institute for Research on Cancer of the Digestive System), Strasbourg, France
- IHU-Strasbourg, (Institute Hopitalo-Universitaire), Strasbourg, France
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22
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Trends in Utilization and Perioperative Outcomes in Robotic-assisted Bariatric surgery using the MBSAQIP database: A 4-Year Analysis. Obes Surg 2020; 31:854-861. [PMID: 33165753 DOI: 10.1007/s11695-020-05055-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Robotic-assisted surgery has become increasingly popular across surgical subspecialties. We aimed to analyze trends in the national utilization and outcomes in bariatric surgery. MATERIALS AND METHODS The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®) data for 2015-2018 was queried. We included robotic-assisted sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), adjustable gastric band (AGB), biliopancreatic diversion with duodenal switch (BPD-DS), and revisional cases. The Kruskal-Wallis test or Wilcoxon rank-sum were used for comparing continuous variables and Cochran-Armitage trend analysis for categorical variables when comparing years, or with Fisher's Exact Test when directly comparing categories. RESULTS Of 760,076 bariatric cases performed between 2015 and 2018, 7.4% with robotic and 90.4% with laparoscopic approach. SG constituted 61.3% of robotic volume. Utilization of robotic surgery increased 1.96-fold; SG represented the most substantial increase of 2.16-fold, followed by a 1.53-fold in RYGB. The 30-day readmission and re-intervention rates decreased from 5.63% to 4.78% (p<0.01), and 2.31% to 1.46% (p<0.01), respectively. The overall leak rate improved from 0.64% to 0.39% (p=0.01). Mortality and re-operations remained statistically unchanged. When compared to laparoscopic approach, the operative time were significantly longer in the robotic group. Regarding postoperative outcomes, when adjusted for patient characteristics, there were no differences between two approaches except a higher leak rate in robotic group in 2015. CONCLUSION A steady increase in robotic bariatric surgery is apparent. While the operative time remains significantly longer in the robotic group, trends indicate improvement in key quality metrics and patient outcomes as utilization increases.
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Davrieux CF, Palermo M, Cúneo T, Zanutini D, Giménez ME. What is the Role of Image-Guided Endovascular Surgery in Postbariatric Surgery Bleeding Complications? J Laparoendosc Adv Surg Tech A 2020; 31:146-151. [PMID: 32936031 DOI: 10.1089/lap.2020.0696] [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: 12/14/2022] Open
Abstract
Background: Obesity treatment requires surgical procedures included in bariatric surgery. Bleeding complications are reported in 1%-4%. Image-guided surgery (IGS) includes minimally invasive procedures that have the advantage of less aggression to the patient, fewer complications, and a quick recovery. Endovascular therapy by interventional radiology (IR) is a minimally invasive image-guided procedure widely used in central, peripheral, and splanchnic vascular pathology. Treatment of postoperative bleeding in bariatric surgery can be aided by image-guided endovascular procedures. Objectives: The aim of this study is to carry out an update on the application of IR in bariatric surgery bleeding complications. Bleeding Complications: General rate of postoperative complications in bariatric surgery is 0%-10%. Postoperative bleeding (1%-4%) can be gastrointestinal (endoscopic treatment) or intra-abdominal (surgical treatment/relaparoscopy). In the case of arterial vascular lesions that cannot be resolved either endoscopically or surgically, the option of endovascular treatment with IR should be considered. Conclusions: Endovascular approach through IR and IGS in bleeding complications after bariatric surgery is presented as a valid minimally invasive therapy option in this group of patients.
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Affiliation(s)
- Carlos Federico Davrieux
- DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina.,Department of Surgery, Sanatorio de la Mujer, Rosario, Argentina
| | - Mariano Palermo
- DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina.,Department of Bariatric Surgery, Diagnomed, Buenos Aires, Argentina.,School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Tomás Cúneo
- Department of Interventional Radiology, Sanatorio Británico, Rosario, Argentina
| | - Daniel Zanutini
- Department of Interventional Radiology, Sanatorio Británico, Rosario, Argentina
| | - Mariano E Giménez
- DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina.,School of Medicine, University of Buenos Aires, Buenos Aires, Argentina.,IRCAD (Institute for Research on Cancer of the Digestive System), Strasbourg, France.,IHU-Strasbourg (Hospital-University Institute), Strasbourg, France
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24
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Poelemeijer YQM, Liem RSL, Våge V, Mala T, Sundbom M, Ottosson J, Nienhuijs SW. Gastric Bypass Versus Sleeve Gastrectomy: Patient Selection and Short-term Outcome of 47,101 Primary Operations From the Swedish, Norwegian, and Dutch National Quality Registries. Ann Surg 2020; 272:326-333. [PMID: 32675546 DOI: 10.1097/sla.0000000000003279] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of this study was to compare the use and short-term outcome of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in Sweden, Norway, and the Netherlands. BACKGROUND Although bariatric surgery is performed in high volumes worldwide, no consensus exists regarding the choice of bariatric procedure for specific groups of patients. METHODS Data from 3 national registries for bariatric surgery were used. Patient selection, perioperative data (severe complications, mortality, and rate of readmissions within 30 days), and 1-year results (follow-up rate and weight loss) were studied. RESULTS A total of 47,101 primary operations were registered, 33,029 (70.1%) RYGB and 14,072 (29.9%) SG. Patients receiving RYGB met international guidelines for having bariatric surgery more often than those receiving SG (91.9% vs 83,0%, P < 0.001). The 2 procedures did not differ in the rate of severe complications (2.6% vs 2.4%, P = 0.382), nor 30-day mortality (0.04% vs 0.03%, P = 0.821). Readmission rates were higher after RYGB (4.3% vs 3.4%, P < 0.001).One-year post surgery, less RYGB-patients were lost-to follow-up (12.1% vs 16.5%, P < 0.001) and RYGB resulted in a higher rate of patients with total weight loss of more than 20% (95.8% vs 84.6%, P < 0.001). While the weight-loss after RYGB was similar between hospitals, there was a great variation in weight loss after SG. CONCLUSION This study reflects the pragmatic use and short-term outcome of RYGB and SG in 3 countries in North-Western Europe. Both procedures were safe, with RYGB having higher weight loss and follow-up rates at the cost of a slightly higher 30-day readmission rate.
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Affiliation(s)
- Youri Q M Poelemeijer
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, Netherlands
- Leiden University Medical Center, Department of Surgery, Leiden, Netherlands
| | - Ronald S L Liem
- Groene Hart Hospital, Department of Surgery, Gouda, Netherlands
- Dutch Obesity Clinic, The Hague, Netherlands
| | - Villy Våge
- Scandinavian Obesity Surgery Registry, Bergen, Norway
| | - Tom Mala
- Oslo University Hospital, Department of Gastrointestinal Surgery, Oslo, Norway
| | - Magnus Sundbom
- Uppsala University, Department of Surgical Sciences, Uppsala, Sweden
| | - Johan Ottosson
- Örebro University Hospital, Department of Surgery, Örebro, Sweden
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25
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Histological grading evaluation of non-alcoholic fatty liver disease after bariatric surgery: a retrospective and longitudinal observational cohort study. Sci Rep 2020; 10:8496. [PMID: 32444690 PMCID: PMC7244764 DOI: 10.1038/s41598-020-65556-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/30/2020] [Indexed: 12/22/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a chronic disease with several degrees of histological features which may progress to cirrhosis. Obesity is an important risk factor and although NAFLD has no specific pharmacological treatment, bariatric surgery has been associated with NAFLD regression in severely obese patients. However, few longitudinal histological studies support this finding. Therefore, firstly, a retrospective study was performed including clinical and histological data of 895 obese patients who underwent bariatric surgery. In addition, histological analyses of 30 patient’s liver biopsies were evaluated at two timepoints (T1 and T2). The retrospective analysis of the total number of patients revealed that the average body mass index (BMI) was 35.91 ± 2.81 kg/m2. The liver biopsies during bariatric surgery showed that 53.52% did not present NAFLD, 30.16% had NASH, 15.98% isolated steatosis and 0.34% liver cirrhosis. The median BMI of the longitudinal cohort decreased from 37.9 ± 2.21 kg/m2 at the time of bariatric surgery (T1) to 25.69 ± 3.79 kg/m2 after 21 ± 22 months after the procedure (T2). The prevalence of NAFLD in T1 was 50%, and 16.67% in T2. The histological area of collagen fiber was lower in T2 compared to T1 (p = 0.0152) in the majority of patients, which was also illustrated by immunohistochemistry for Kupffer cell and myofibroblast formation markers. These findings confirmed the NAFLD regression after bariatric surgery and, for the first time, showed the amelioration of these features using more accurate histopathological techniques.
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27
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Mechanick JI, Apovian C, Brethauer S, Timothy Garvey W, Joffe AM, Kim J, Kushner RF, Lindquist R, Pessah-Pollack R, Seger J, Urman RD, Adams S, Cleek JB, Correa R, Figaro MK, Flanders K, Grams J, Hurley DL, Kothari S, Seger MV, Still CD. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Obesity (Silver Spring) 2020; 28:O1-O58. [PMID: 32202076 DOI: 10.1002/oby.22719] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 10/09/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. METHODS Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. RESULTS New or updated topics in this CPG include: contextualization in an adiposity-based chronic disease complications-centric model, nuance-based and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). CONCLUSIONS Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.
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Affiliation(s)
- Jeffrey I Mechanick
- Guideline Task Force Chair (AACE); Professor of Medicine, Medical Director, Marie-Josée and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart; Director, Metabolic Support Divisions of Cardiology and Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York; Past President, AACE and ACE
| | - Caroline Apovian
- Guideline Task Force Co-Chair (TOS); Professor of Medicine and Director, Nutrition and Weight Management, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Stacy Brethauer
- Guideline Task Force Co-Chair (ASMBS); Professor of Surgery, Vice Chair of Surgery, Quality and Patient Safety; Medical Director, Supply Chain Management, Ohio State University, Columbus, Ohio
| | - W Timothy Garvey
- Guideline Task Force Co-Chair (AACE); Butterworth Professor, Department of Nutrition Sciences, GRECC Investigator and Staff Physician, Birmingham VAMC; Director, UAB Diabetes Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Aaron M Joffe
- Guideline Task Force Co-Chair (ASA); Professor of Anesthesiology, Service Chief, Otolaryngology, Oral, Maxillofacial, and Urologic Surgeries, Associate Medical Director, Respiratory Care, University of Washington, Harborview Medical Center, Seattle, Washington
| | - Julie Kim
- Guideline Task Force Co-Chair (ASMBS); Harvard Medical School, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Robert F Kushner
- Guideline Task Force Co-Chair (TOS); Professor of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Richard Lindquist
- Guideline Task Force Co-Chair (OMA); Director, Medical Weight Management, Swedish Medical Center; Director, Medical Weight Management, Providence Health Services; Obesity Medicine Consultant, Seattle, Washington
| | - Rachel Pessah-Pollack
- Guideline Task Force Co-Chair (AACE); Clinical Associate Professor of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, New York
| | - Jennifer Seger
- Guideline Task Force Co-Chair (OMA); Adjunct Assistant Professor, Department of Family and Community Medicine, Long School of Medicine, UT Health Science Center, San Antonio, Texas
| | - Richard D Urman
- Guideline Task Force Co-Chair (ASA); Associate Professor of Anesthesia, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stephanie Adams
- Writer (AACE); AACE Director of Clinical Practice Guidelines Development, Jacksonville, Florida
| | - John B Cleek
- Writer (TOS); Associate Professor, Department of Nutrition Sciences, University of Alabama, Birmingham, Alabama
| | - Riccardo Correa
- Technical Analysis (AACE); Assistant Professor of Medicine and Endocrinology, Diabetes and Metabolism Fellowship Director, University of Arizona College of Medicine, Phoenix, Arizona
| | - M Kathleen Figaro
- Technical Analysis (AACE); Board-certified Endocrinologist, Heartland Endocrine Group, Davenport, Iowa
| | - Karen Flanders
- Writer (ASMBS); Massachusetts General Hospital Weight Center, Boston, Massachusetts
| | - Jayleen Grams
- Writer (AACE); Associate Professor, Department of Surgery, University of Alabama at Birmingham; Staff Surgeon, Birmingham VA Medical Center, Birmingham, Alabama
| | - Daniel L Hurley
- Writer (AACE); Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Shanu Kothari
- Writer (ASMBS); Fellowship Director of MIS/Bariatric Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Michael V Seger
- Writer (OMA); Bariatric Medical Institute of Texas, San Antonio, Texas, Clinical Assistant Professor, University of Texas Health Science Center, Houston, Texas
| | - Christopher D Still
- Writer (TOS); Medical Director, Center for Nutrition and Weight Management Director, Geisinger Obesity Institute; Medical Director, Employee Wellness, Geisinger Health System, Danville, Pennsylvania
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28
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Scavone G, Caltabiano DC, Gulino F, Raciti MV, Giarrizzo A, Biondi A, Piazza L, Scavone A. Laparoscopic mini/one anastomosis gastric bypass: anatomic features, imaging, efficacy and postoperative complications. Updates Surg 2020; 72:493-502. [PMID: 32189194 DOI: 10.1007/s13304-020-00743-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 03/09/2020] [Indexed: 12/31/2022]
Abstract
Laparoscopic mini/one anastomosis gastric bypass (MGB/OAGB) is an increasingly used bariatric surgical procedure. This surgical technique is effective in terms of both weight loss and the resolution of comorbidities, but it is not without complications. To report our experience in MGB/OAGB, assessing comorbidities and complications, and to illustrate post-surgical anatomy and radiological appearance of complications, a single-centre retrospective study of 953 patients undergoing MGB/OAGB between January 2005 and September 2018 was done. The inclusion criteria: body mass index (BMI) of 40 kg/m2 or higher or BMI between 35 and 40 kg/m2 with significant comorbidities not responsive to medical therapies. In the postoperative period, all patients were evaluated with clinical and laboratory tests and radiological examinations (upper gastrointestinal series, computed tomography and magnetic resonance imaging). Median weight was 126.69 kg and mean BMI was 49.4 kg/m2. Regarding comorbidities, 37.2%, 52.8%, 46.7% and 43.2% of patients presented with preoperatively diagnosed type 2 diabetes mellitus (T2DM), hypertensive disease, dyslipidaemia and obstructive sleep apnoea syndrome (OSAS), respectively. Median excess weight loss at 6, 12, 24 and 60 months after surgery was 33.45%, 53.81%, 68.75% and 68.80%, respectively. The remission of comorbidities was 91.4% for T2DM, 93.7% for hypertensive disease, 90.3% for dyslipidemia and 93.4% for OSAS. Early and late complication rates identified with radiological examinations were 1.5% and 1.6%, respectively. MGB/OAGB was effective for weight loss and comorbidities remission. Complications occurred at lower rate than with other surgical procedures were identified with imaging; CT was the main radiological technique.
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Affiliation(s)
- Giovanni Scavone
- Department of Diagnostic Radiology, Neuroradiology and Interventional Radiology, "Garibaldi Centro" Hospital, Piazza Santa Maria Di Gesù, 5, 95124, Catania, CT, Italy.
| | | | - Fabrizio Gulino
- General and Emergency Surgery Department, "Garibaldi Centro" Hospital, Piazza Santa Maria Di Gesù, 5, 95124, Catania, CT, Italy
| | - Maria Vittoria Raciti
- Radiodiagnostic Unit, University I.R.C.C.S. Policlinico "San Matteo", Viale Camillo Golgi, 19, 27100, Pavia, PV, Italy
| | - Amy Giarrizzo
- General and Emergency Surgery Department, "Garibaldi Centro" Hospital, Piazza Santa Maria Di Gesù, 5, 95124, Catania, CT, Italy
| | - Antonio Biondi
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123, Catania, Italy
| | - Luigi Piazza
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123, Catania, Italy
| | - Antonio Scavone
- Department of Diagnostic Radiology, Neuroradiology and Interventional Radiology, "Garibaldi Centro" Hospital, Piazza Santa Maria Di Gesù, 5, 95124, Catania, CT, Italy
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29
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Rausa E, Kelly ME, Galfrascoli E, Aiolfi A, Cavalcoli F, Turati L, Bonavina L, Sgroi G. Quality of Life and Gastrointestinal Symptoms Following Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy: a Systematic Review. Obes Surg 2020; 29:1397-1402. [PMID: 30693417 DOI: 10.1007/s11695-019-03737-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are the most common bariatric operations performed worldwide. Quality of life (QoL) is a crucial outcome metric. An electronic systematic search using PubMed, EMBASE, and Web of Science of studies comparing QoL after LSG and LRYGB was performed. QoL after both LSG and LRYGB considerably improves regardless the type of surgery. The QoL has a slight downward trend from the second to the fifth year postoperatively, but it remains higher than the baseline. LSG patients are more likely to suffer from gastroesophageal symptoms (GES). GES represent the only significant difference between the two procedures. A routine screening with gastroscopy and 24 h pH metry to help tailor the most appropriate surgical approach is advised.
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Affiliation(s)
- Emanuele Rausa
- Surgical Oncology Unit, Treviglio Hospital, Piazzale Ospedale 1, 24047, Treviglio, Bergamo, Italy.
| | - Michael E Kelly
- Department of Colorectal Surgery, Connolly Hospital, Dublin, Ireland
| | - Elisa Galfrascoli
- Division of General Surgery, Fatebenefratelli Hospital, Milan, Italy
| | - Albero Aiolfi
- Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences of Health, University of Milan Medical School, San Donato Milanese, Milan, Italy
| | - Federica Cavalcoli
- Diagnostic and Therapeutic Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luca Turati
- Surgical Oncology Unit, Treviglio Hospital, Piazzale Ospedale 1, 24047, Treviglio, Bergamo, Italy
| | - Luigi Bonavina
- Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences of Health, University of Milan Medical School, San Donato Milanese, Milan, Italy
| | - Giovanni Sgroi
- Surgical Oncology Unit, Treviglio Hospital, Piazzale Ospedale 1, 24047, Treviglio, Bergamo, Italy
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30
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Brinkman DJ, Van Hilst J, Luyer MD. Internal herniation following laparoscopic pancreatoduodenectomy. BMJ Case Rep 2020; 13:e232475. [PMID: 31996382 PMCID: PMC7021176 DOI: 10.1136/bcr-2019-232475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2019] [Indexed: 12/02/2022] Open
Abstract
Laparoscopic pancreatoduodenectomy (LPD) is increasingly performed worldwide as an alternative to the open conventional method, with the aim of advancing recovery. Because of its recent introduction, little is known about late surgical complications from this procedure. Here, we describe a case of a 76-year-old woman who underwent LPD with end-to-side gastrojejunostomy and presented with pain in the right upper quadrant of the abdomen 6 months thereafter. CT showed signs of an internal herniation. Elective diagnostic laparoscopy demonstrated a hernia of the efferent loop in Petersen's space. The loop was repositioned and Petersen's space was closed. The patient was discharged on the same day. Apart from a short readmission for nausea and vomiting, which were managed conservatively, the patient recovered without any further complications. Internal herniation should be considered in patients with abdominal complaints following LPD.
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Affiliation(s)
| | - Jony Van Hilst
- Department of Surgery, Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
| | - Misha D Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
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31
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Mechanick JI, Apovian C, Brethauer S, Garvey WT, Joffe AM, Kim J, Kushner RF, Lindquist R, Pessah-Pollack R, Seger J, Urman RD, Adams S, Cleek JB, Correa R, Figaro MK, Flanders K, Grams J, Hurley DL, Kothari S, Seger MV, Still CD. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Surg Obes Relat Dis 2019; 16:175-247. [PMID: 31917200 DOI: 10.1016/j.soard.2019.10.025] [Citation(s) in RCA: 282] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The development of these updated clinical practice guidelines (CPG) was commissioned by the American Association of Clinical Endocrinologists, The Obesity Society, the American Society of Metabolic and Bariatric Surgery, the Obesity Medicine Association, and the American Society of Anesthesiologists boards of directors in adherence to the American Association of Clinical Endocrinologists 2017 protocol for standardized production of CPG, algorithms, and checklists. METHODS Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. RESULTS New or updated topics in this CPG include contextualization in an adiposity-based, chronic disease complications-centric model, nuance-based, and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current healthcare arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). CONCLUSIONS Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence-based within the context of a chronic disease. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.
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Affiliation(s)
- Jeffrey I Mechanick
- Marie-Josée and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, New York, New York; Metabolic Support Divisions of Cardiology and Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Caroline Apovian
- Nutrition and Weight Management, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | | | - W Timothy Garvey
- Department of Nutrition Sciences, Birmingham VA Medical Center, Birmingham, Alabama; UAB Diabetes Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Aaron M Joffe
- University of Washington, Harborview Medical Center, Seattle, Washington
| | - Julie Kim
- Harvard Medical School, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Robert F Kushner
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Rachel Pessah-Pollack
- Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, New York
| | - Jennifer Seger
- Department of Family and Community Medicine, Long School of Medicine, UT Health Science Center, San Antonio, Texas
| | | | - Stephanie Adams
- American Association of Clinical Endocrinologists, Jacksonville, Florida
| | - John B Cleek
- Department of Nutrition Sciences, Birmingham VA Medical Center, Birmingham, Alabama
| | | | | | - Karen Flanders
- Massachusetts General Hospital Weight Center, Boston, Massachusetts
| | - Jayleen Grams
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama; Birmingham VA Medical Center, Birmingham, Alabama
| | - Daniel L Hurley
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | | | - Michael V Seger
- Bariatric Medical Institute of Texas, San Antonio, Texas, University of Texas Health Science Center, Houston, Texas
| | - Christopher D Still
- Center for Nutrition and Weight Management Director, Geisinger Obesity Institute, Danville, Pennsylvania; Employee Wellness, Geisinger Health System, Danville, Pennsylvania
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Abstract
BACKGROUND Trans-oral endoscopic access to the pancreaticobiliary system is challenging after Roux-en-Y gastric bypass (RYGB). Trans-gastric ERCP (TG-ERCP) has emerged as a viable option to manage patients with symptomatic post-RYBG choledocolithiasis. The aim of this systematic review and meta-analysis was to examine the outcomes of TG-ERCP to better define the risk-benefit ratio of this procedure and to guide clinical decision-making. METHODS A literature search was conducted to identify all reports on ERCP after RYGB. Pubmed, MEDLINE, Embase, and Cochrane databases were thoroughly consulted matching the terms "ERCP" AND "gastric bypass." Pooled prevalence of ERCP success rate, ERCP-related morbidity, post-procedural infectious complications, and overall morbidity were calculated using Freeman-Tukey double arcsine transformation and DerSimonian-Laird estimator in random effect meta-analysis. Heterogeneity among studies was evaluated using I2-index and Cochrane Q test. Meta-regression was used to address the effect of potential confounders. RESULTS Thirteen papers published between 2009 and 2017 matched the inclusion criteria. Eight hundred fifty patients undergoing 931 procedures were included. The most common clinical indications for TG-ERCP were biliary (90%) and pancreatic (10%). The majority of patients underwent an initial laparoscopic approach (90%). Same-day ERCP was successfully achieved in 703 cases (75.5%). Pooled prevalence of ERCP success rate, ERCP-related morbidity, post-procedural infectious complications, and overall morbidity were 99% (95% CI = 98-100%), 3.1% (95% CI = 1.0-5.8%), 3.4% (95% CI = 1.7-5.5%), and 14.2% (95% CI = 8.5-20.8%), respectively. CONCLUSION TG-ERCP is a safe and effective therapeutic option in patients with symptomatic post-RYGB choledocolithiasis.
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An Analysis of Mid-Term Complications, Weight Loss, and Type 2 Diabetes Resolution of Stomach Intestinal Pylorus-Sparing Surgery (SIPS) Versus Roux-En-Y Gastric Bypass (RYGB) with Three-Year Follow-Up. Obes Surg 2019; 28:2894-2902. [PMID: 29790130 DOI: 10.1007/s11695-018-3309-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND For many years, the Roux-en-Y Gastric Bypass (RYGB) was considered a good balance of complications and weight loss. According to several short-term studies, single anastomosis duodenal switch or stomach intestinal pylorus sparing surgery (SIPS) offers similar weight loss to RYGB with fewer complications and better diabetes resolution. No one has substantiated mid-term complication and nutritional differences between these two procedures. This paper seeks to compare complication and nutritional outcomes between RYGB and SIPS. METHODS A retrospective analysis of 798 patients who either had SIPS or RYGB from 2010 to 2016. Complications were gathered for each patient. Nutritional outcomes were measured for each group at 1, 2, and 3 years. Regression analysis was applied to interpolate each patient's weight at 3, 6, 9, 12, 18, 24, and 36 months. These were then compared with t tests, Fisher's exact tests, and chi-squared tests. RESULTS RYGB and SIPS have statistically similar weight loss at 3, 6, 9, 12, and 36 months. They statistically differ at 18 and 24 months. At 36 months, there is a trend for weight loss difference. There were only statistical differences in nutritional outcomes between the two procedures with calcium at 1 and 3 years and vitamin D at 1 year. There were statistically significantly more long-term class IIIb-V complications, class I-IIIa complications, reoperations, ulcers, small bowel obstructions, nausea, and vomiting with the RYGB than the SIPS. CONCLUSION With comparable weight loss and nutritional outcomes, SIPS has fewer short- and long-term complications than RYGB and better type 2 diabetes resolution rates.
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Incidence and Risk Factors for Mortality Following Bariatric Surgery: a Nationwide Registry Study. Obes Surg 2019; 28:2661-2669. [PMID: 29627947 DOI: 10.1007/s11695-018-3212-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although bariatric surgery (BS) is considered safe, concern remains regarding severe post-operative adverse events and mortality. Using a national BS registry, the aim of this study was to assess the incidence, etiologies, and risk factors for mortality following BS. METHODS Prospective data from the National Registry of Bariatric Surgery in Israel (NRBS) including age, gender, BMI, comorbidities, and surgical procedure information were collected for all patients who underwent BS in Israel between June 2013 and June 2016. The primary study outcome was the 3.5-year post-BS mortality rate, obtained by cross-referencing with the Israel population registry. RESULTS Of the 28,755 patients analyzed (67.3% females, mean age 42.0 ± 12.5 years, and preoperative BMI 42.14 ± 5.21 kg/m2), 76% underwent sleeve gastrectomy (SG), 99.1% of the surgeries were performed laparoscopically, and 50.8% of the surgeries were performed in private medical centers. Overall, 95 deaths occurred during the study period (146.9/100,000 person years). The 30-day rate of post-operative mortality was 0.04% (n = 12). Male gender (HR = 1.94, 95%CI 1.16-3.25), age (HR = 1.06, 95%CI 1.04-1.09), BMI (HR = 1.08, 95%CI 1.05-1.11), and depression (HR = 2.38, 95%CI 1.25-4.52) were independently associated with an increased risk of all-cause 3.5-year mortality, while married status (HR = 0.43, 95%CI 0.26-0.71) was associated with a decreased risk. CONCLUSION Mortality after BS is low. Nevertheless, a variety of risk factors including male gender, advanced age, unmarried status, higher BMI, and preoperative depressive disorder were associated with higher mortality rates. Special attention should be given to these "at-risk" BS patients.
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Aiolfi A, Tornese S, Bonitta G, Rausa E, Micheletto G, Bona D. Roux-en-Y gastric bypass: systematic review and Bayesian network meta-analysis comparing open, laparoscopic, and robotic approach. Surg Obes Relat Dis 2019; 15:985-994. [PMID: 31104958 DOI: 10.1016/j.soard.2019.03.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 02/06/2019] [Accepted: 03/01/2019] [Indexed: 01/08/2023]
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Stenberg E, Persson C, Näslund E, Ottosson J, Sundbom M, Szabo E, Näslund I. The impact of socioeconomic factors on the early postoperative complication rate after laparoscopic gastric bypass surgery: A register-based cohort study. Surg Obes Relat Dis 2019; 15:575-581. [PMID: 30826242 DOI: 10.1016/j.soard.2019.01.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/23/2018] [Accepted: 01/28/2019] [Indexed: 12/24/2022]
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Dandapani HG, Tieu K. The contemporary role of robotics in surgery: A predictive mathematical model on the short-term effectiveness of robotic and laparoscopic surgery. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2019. [DOI: 10.1016/j.lers.2018.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Yu J, Zhou CJ, Wang P, Wei SJ, He JS, Tang J. Endoscopic titanium clip closure of gastric fistula after splenectomy: A case report. World J Clin Cases 2018; 6:1047-1052. [PMID: 30568962 PMCID: PMC6288501 DOI: 10.12998/wjcc.v6.i15.1047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/08/2018] [Accepted: 11/15/2018] [Indexed: 02/05/2023] Open
Abstract
This report describes a 52-year-old male patient with blunt abdominal traumatic rupture of the spleen due to injuries sustained in an automobile accident. Following splenectomy, the patient developed a gastric fistula. He underwent a long period of conservative treatment, including antibiotics and total parenteral nutrition, which was ineffective. The fistula could not be closed and titanium clip closure using a gastroscopy was then performed in order to close the fistula. After endoscopic therapy and clipping surgery, the patient’s general condition improved significantly, and he had no post-procedural abdominal complications. On post-clipping day 6, the gastric fistula was completely closed as shown by X-ray examination of the upper digestive tract. The patient was discharged from hospital and no complications were observed during the six-month follow-up period. Our report suggests that titanium clip closure using endoscopy may be the choice of treatment in patients with a gastric fistula.
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Affiliation(s)
- Jing Yu
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Sichuan Key Laboratory of Medical Imaging, Nanchong 637000, Sichuan Province, China
| | - Cheng-Ji Zhou
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Sichuan Key Laboratory of Medical Imaging, Nanchong 637000, Sichuan Province, China
| | - Pan Wang
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Sichuan Key Laboratory of Medical Imaging, Nanchong 637000, Sichuan Province, China
| | - Shou-Jiang Wei
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Jin-Song He
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Jin Tang
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
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Laparoscopic Sleeve Gastrectomy has a Lower Risk of Postoperative Bleeding Than Laparoscopic Roux-en-Y Gastric Bypass. Surg Laparosc Endosc Percutan Tech 2018; 29:53-57. [PMID: 30499889 DOI: 10.1097/sle.0000000000000598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Measures to reduce postoperative bleeding (POB) after bariatric surgery is skewed toward laparoscopic sleeve gastrectomy (LSG). We use 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) to characterize the differences in bleeding rates between LSG and laparoscopic Roux-en-Y gastric bypasses (LRYGB). Propensity score matching and multivariable logistic regressions tested for independent differences in POB rates. A total of 168,093 patients from 742 centers were identified in the data set. After selection 36,925 patients with LRYGB and 20,020 patients with LSG were included in the analysis. A total of 710 (1.25%) patient suffered a POB. The independent odds of POB were 38% lower for patients having LSG compared with those having LRYGB (odds ratio, 0.62; 95% confidence interval=0.51-0.76). This difference is more pronounced with intraoperative securing of the staple line. Appropriate measures to reduce POB after each type of bariatric procedure is warranted.
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40
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Bariatric Surgery to Reduce Mortality in US Adults. A Public Health Perspective from the Analysis of the American National Health and Nutrition Examination Survey Linked to the US Mortality Register. Obes Surg 2018; 28:900-906. [PMID: 29080041 DOI: 10.1007/s11695-017-2981-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Type II obesity represents a major pandemic and public health threat in high-income countries. Type II obesity increases the risk of all-cause and specific-cause mortality, and it is widely acknowledged that bariatric surgery represents the only effective therapeutic option in these patients. The aim of the present study was to estimate US population attributable risk for all-cause and cause-specific mortality in type II obese subjects undergoing weight loss as resulting from bariatric surgery alone and supplemented with behavioral intervention. METHODS The American National Health and Nutrition Examination Survey linked to the US death registry updated to 2011 was used to estimate type II obesity prevalence and all-cause and specific cause of death for type II obese adults undergoing weight loss. Multivariate adjusted proportional hazard Cox models were used to estimate mortality risks. Statistical analyses were performed on the most updated version of the database (June 2017). RESULTS A monotone positive trend for type II obesity was observed during the period 1999-2014 (p < 0.001). According to trend analysis, the rate of type II obesity in US adults is expected to rise up to 8.5%. Two- to sevenfold increased risk of all-cause and specific-cause mortality was observed for type II obese participants when compared to type I obese and overweight participants. Population attributable risk for all-cause and specific-cause mortality for type II obese subjects undergoing weight loss was ranging between 6 and 34%. CONCLUSIONS Bariatric surgery supplemented with behavioral intervention can result in a relevant reduction of mortality if extensively applied to the US population.
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Rausa E, Kelly ME, Asti E, Aiolfi A, Bonitta G, Winter DC, Bonavina L. Extended versus conventional thromboprophylaxis after major abdominal and pelvic surgery: Systematic review and meta-analysis of randomized clinical trials. Surgery 2018; 164:1234-1240. [PMID: 30190110 DOI: 10.1016/j.surg.2018.05.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/11/2018] [Accepted: 05/18/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Venous thromboembolism, presenting as deep vein thrombosis or pulmonary embolism, can be associated with considerable morbidity after major abdominal and pelvic surgery. Perioperative thromboprophylaxis with low-molecular-weight heparin is well established, but the duration of treatment remains debated. We aimed to assess the efficacy and safety of extended (4-week) versus conventional (1-week) thromboprophylaxis with low-molecular-weight heparin in patients undergoing abdominopelvic surgery. METHODS Using MEDLINE databases (PubMed, EMBASE, and Web of Science), we conducted an electronic, systematic search of randomized controlled trials comparing post-operative extended versus conventional low-molecular-weight heparin on venous thromboembolism, deep vein thrombosis, and pulmonary embolism rates. RESULTS Four randomized controlled trials met the predefined criteria. Extended prophylaxis with low-molecular-weight heparin after major abdominal and pelvic surgery decreased rates of postoperative venous thromboembolism, deep vein thrombosis, and proximal deep vein thrombosis without increased postoperative bleeding. Numbers needed to treat to prevent venous thromboembolism, overall deep vein thrombosis, and proximal deep vein thrombosis were 14, 14, and 44, respectively. Rates of postoperative symptomatic PE were rare, and the incidence was similar in both groups. CONCLUSION Extended prophylaxis with low-molecular-weight heparin is associated with a decrease in asymptomatic venous thromboembolism. There remains sparse evidence regarding its impact on pulmonary embolism because of the overall low incidence. Extended prophylaxis should be considered in high-risk patients.
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Affiliation(s)
- Emanuele Rausa
- Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences of Health, University of Milan Medical School, San Donato Milanese, Milan, Italy.
| | - Michael E Kelly
- Department of Colorectal Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Emanuele Asti
- Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences of Health, University of Milan Medical School, San Donato Milanese, Milan, Italy
| | - Alberto Aiolfi
- Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences of Health, University of Milan Medical School, San Donato Milanese, Milan, Italy
| | - Gianluca Bonitta
- Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences of Health, University of Milan Medical School, San Donato Milanese, Milan, Italy
| | - Desmond C Winter
- Department of Colorectal Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Luigi Bonavina
- Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences of Health, University of Milan Medical School, San Donato Milanese, Milan, Italy
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Wang L, Yao L, Yan P, Xie D, Han C, Liu R, Yang K, Guo T, Tian L. Robotic Versus Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity: a Systematic Review and Meta-Analysis. Obes Surg 2018; 28:3691-3700. [DOI: 10.1007/s11695-018-3458-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Ederveen JC, van Berckel MMG, Nienhuijs SW, Weber RJP, Nederend J. Predictive value of abdominal CT in evaluating internal herniation after bariatric laparoscopic Roux-en-Y gastric bypass. Br J Surg 2018; 105:1623-1629. [DOI: 10.1002/bjs.10886] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/29/2017] [Accepted: 04/04/2018] [Indexed: 12/11/2022]
Abstract
Abstract
Background
Internal herniation, a serious complication after bariatric surgery, is challenging to diagnose. The aim of this study was to determine the accuracy of abdominal CT in diagnosing internal herniation.
Methods
The study included consecutive patients who had undergone laparoscopic gastric bypass surgery between 1 January 2011 and 1 January 2015 at a bariatric centre of excellence. To select patients suspected of having internal herniation, reports of abdominal CT and reoperations up to 1 January 2017 were screened. CT was presumed negative for internal herniation if no follow-up CT or reoperation was performed within 90 days after the initial CT, or no internal herniation was found during reoperation. The accuracy of abdominal CT in diagnosing internal herniation was calculated using two-way contingency tables.
Results
A total of 1475 patients were included (84·7 per cent women, mean age 46·5 years, median initial BMI 41·8 kg/m2). CT and/or reoperation was performed in 192 patients (13·0 per cent) in whom internal herniation was suspected. Internal herniation was proven laparoscopically in 37 of these patients. The incidence of internal herniation was 2·5 per cent. An analysis by complaint included a total of 265 episodes, for which 247 CT scans were undertaken. CT was not used to investigate 18 episodes, but internal herniation was encountered in one-third of these during reoperation. Combining the follow-up and intraoperative findings, the accuracy of CT for internal herniation had a sensitivity of 83·8 (95 per cent c.i. 67·3 to 93·2) per cent, a specificity of 87·1 (81·7 to 91·2) per cent, a positive predictive value of 53·4 (40·0 to 66·5) per cent and a negative predictive value of 96·8 (92·9 to 98·7) per cent.
Conclusion
Abdominal CT is an important tool in diagnosing internal herniation, with a high specificity and a high negative predictive value.
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Affiliation(s)
- J C Ederveen
- Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands
| | - M M G van Berckel
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - S W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - R J P Weber
- Department of Radiology, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - J Nederend
- Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands
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Okazaki O, Bernardo WM, Brunaldi VO, Junior CCDC, Minata MK, de Moura DTH, de Souza TF, Campos JM, Santo MA, de Moura EGH. Efficacy and Safety of Stents in the Treatment of Fistula After Bariatric Surgery: a Systematic Review and Meta-analysis. Obes Surg 2018; 28:1788-1796. [PMID: 29654447 DOI: 10.1007/s11695-018-3236-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Fistula development is a serious complication after bariatric surgery. We performed a systematic review and meta-analysis to assess the efficacy of fistula closure and complications associated with endoscopic stent treatment of fistulas, developed after bariatric surgeries, particularly Roux-en-Y gastric bypass (RYGB) and gastric sleeve (GS). Studies involving patients with fistula after RYGB or GS and those who received stent treatment only were selected. The analyzed outcomes were overall success rate of fistula closure, mean number of stents per patient, mean stent dwelling time, and procedure-associated complications. Current evidence from identified studies demonstrates that, in selected patients, endoscopic stent treatment of fistulas after GS or RYGB can be safe and effective.
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Affiliation(s)
- Ossamu Okazaki
- Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of São Paulo Medical School, Dr. Arnaldo Av, 255., São Paulo, 01246-903, Brazil.
| | - Wanderley M Bernardo
- Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of São Paulo Medical School, Dr. Arnaldo Av, 255., São Paulo, 01246-903, Brazil
| | - Vitor O Brunaldi
- Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of São Paulo Medical School, Dr. Arnaldo Av, 255., São Paulo, 01246-903, Brazil
| | - Cesar C de Clemente Junior
- Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of São Paulo Medical School, Dr. Arnaldo Av, 255., São Paulo, 01246-903, Brazil
| | - Maurício K Minata
- Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of São Paulo Medical School, Dr. Arnaldo Av, 255., São Paulo, 01246-903, Brazil
| | - Diogo T H de Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of São Paulo Medical School, Dr. Arnaldo Av, 255., São Paulo, 01246-903, Brazil
| | - Thiago F de Souza
- Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of São Paulo Medical School, Dr. Arnaldo Av, 255., São Paulo, 01246-903, Brazil
| | | | - Marco Aurélio Santo
- Bariatric and Metabolic Surgery Unit, Hospital das Clinicas, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Eduardo G H de Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of São Paulo Medical School, Dr. Arnaldo Av, 255., São Paulo, 01246-903, Brazil
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Inaba CS, Koh CY, Sujatha-Bhaskar S, Silva JP, Chen Y, Nguyen DV, Nguyen NT. One-Year Mortality after Contemporary Laparoscopic Bariatric Surgery: An Analysis of the Bariatric Outcomes Longitudinal Database. J Am Coll Surg 2018; 226:1166-1174. [PMID: 29551698 DOI: 10.1016/j.jamcollsurg.2018.02.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 02/19/2018] [Accepted: 02/19/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Contemporary mortality after bariatric surgery is low and has been decreasing over the past 2 decades. Most studies have reported inpatient or 30-day mortality, which may not represent the true risk of bariatric surgery. The objective of this study was to examine 1-year mortality and factors predictive of 1-year mortality after contemporary laparoscopic bariatric surgery. STUDY DESIGN Using the 2008 to 2012 Bariatric Outcomes Longitudinal Database (BOLD), data from 158,606 operations were analyzed, including 128,349 (80.9%) laparoscopic Roux-en-Y gastric bypass (LRYGB) and 30,257 (19.1%) laparoscopic sleeve gastrectomy (LSG) operations. Multivariate logistic regression was used to determine independent risk factors associated with 1-year mortality for each type of procedure. RESULTS The 30-day and 1-year mortality rates for LRYGB were 0.13% and 0.23%, respectively, and for LSG were 0.06% and 0.11%, respectively. Risk factors for 1-year mortality included older age (LRYGB: adjusted odds ratio [AOR] 1.05 per year, p < 0.001; LSG: AOR 1.08 per year, p < 0.001); male sex (LRYGB: AOR 1.88, p < 0.001); higher BMI (LRYGB: AOR 1.04 per unit, p < 0.001; LSG: AOR 1.05 per unit, p = 0.009); and the presence of 30-day leak (LRYGB: AOR 25.4, p < 0.001; LSG: AOR 35.8, p < 0.001), 30-day pulmonary embolism (LRYGB: AOR 34.5, p < 0.001; LSG: AOR 252, p < 0.001), and 30-day hemorrhage (LRYGB: AOR 2.34, p = 0.001). CONCLUSIONS Contemporary 1-year mortality after laparoscopic bariatric surgery is much lower than previously reported, at <0.25%. It is important to continually refine techniques and perioperative management in order to minimize leaks, hemorrhage, and pulmonary embolus after bariatric surgery because these complications contribute to a higher risk of mortality.
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Affiliation(s)
- Colette S Inaba
- Department of Surgery, University of California Irvine Medical Center, Orange, CA
| | - Christina Y Koh
- Department of Surgery, University of California Irvine Medical Center, Orange, CA
| | | | - Jack P Silva
- Department of Surgery, University of California Irvine Medical Center, Orange, CA
| | - Yanjun Chen
- Institute for Clinical and Translational Science, University of California Irvine, Orange, CA
| | - Danh V Nguyen
- Department of Medicine, University of California Irvine Medical Center, Orange, CA; Institute for Clinical and Translational Science, University of California Irvine, Orange, CA
| | - Ninh T Nguyen
- Department of Surgery, University of California Irvine Medical Center, Orange, CA.
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Musella M, Susa A, Manno E, De Luca M, Greco F, Raffaelli M, Cristiano S, Milone M, Bianco P, Vilardi A, Damiano I, Segato G, Pedretti L, Giustacchini P, Fico D, Veroux G, Piazza L. Complications Following the Mini/One Anastomosis Gastric Bypass (MGB/OAGB): a Multi-institutional Survey on 2678 Patients with a Mid-term (5 Years) Follow-up. Obes Surg 2017; 27:2956-2967. [PMID: 28569357 DOI: 10.1007/s11695-017-2726-2] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND In recent years, several articles have reported considerable results with the Mini/One Anastomosis Gastric Bypass (MGB/OAGB) in terms of both weight loss and resolution of comorbidities. Despite those positive reports, some controversies still limit the widespread acceptance of this procedure. Therefore, a multicenter retrospective study, with the aim to investigate complications following this procedure, has been designed. PATIENTS AND METHODS To report the complications rate following the MGB/OAGB and their management, and to assess the role of this approach in determining eventual complications related especially to the loop reconstruction, in the early and late postoperative periods, the clinical records of 2678 patients who underwent MGB/OAGB between 2006 and 2015 have been studied. RESULTS Intraoperative and early complications rates were 0.5 and 3.1%, respectively. Follow-up at 5 years was 62.6%. Late complications rate was 10.1%. A statistical correlation was found for perioperative bleeding both with operative time (p < 0.001) or a learning curve of less than 50 cases (p < 0.001). A statistical correlation was found for postoperative duodenal-gastro-esophageal reflux (DGER) with a preexisting gastro-esophageal-reflux disease (GERD) or with a gastric pouch shorter than 9 cm, (p < 0.001 and p = 0.001), respectively. An excessive weight loss correlated with a biliopancreatic limb longer than 250 cm (p < 0.001). CONCLUSIONS Our results confirm MGB/OAGB to be a reliable bariatric procedure. According to other large and long-term published series, MGB/OAGB seems to compare very favorably, in terms of complication rate, with two mainstream procedures as standard Roux-en-Y gastric bypass (RYGBP) and laparoscopic sleeve gastrectomy (LSG).
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Affiliation(s)
- Mario Musella
- Advanced Biomedical Sciences Department, "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Building, 12 80131, Naples, Italy.
| | | | | | | | | | - Marco Raffaelli
- Department of Surgery, Catholic Sacred Heart University, Rome, Italy
| | | | - Marco Milone
- Advanced Biomedical Sciences Department, "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Building, 12 80131, Naples, Italy
| | - Paolo Bianco
- Advanced Biomedical Sciences Department, "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Building, 12 80131, Naples, Italy
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Małczak P, Pisarska M, Piotr M, Wysocki M, Budzyński A, Pędziwiatr M. Enhanced Recovery after Bariatric Surgery: Systematic Review and Meta-Analysis. Obes Surg 2017; 27:226-235. [PMID: 27817086 PMCID: PMC5187372 DOI: 10.1007/s11695-016-2438-z] [Citation(s) in RCA: 204] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Enhanced recovery after surgery (ERAS) protocol is well established in many surgical disciplines and leads to a decrease in the length of hospital stay and morbidity. Multimodal protocols have also been introduced to bariatric surgery. This review aims to evaluate the current literature on ERAS in obesity surgery and to conduct a meta-analysis of primary and secondary outcomes. MEDLINE, Embase, Scopus and Cochrane Library were searched for eligible studies. Key journals were hand-searched. We analysed data up to May 2016. Eligible studies had to contain four described ERAS protocol elements. The primary outcome was the length of hospital stay; the secondary outcomes included overall morbidity, specific complications, mortality, readmissions and costs. Random effect meta-analyses were undertaken. The initial search yielded 1151 articles. Thorough evaluation resulted in 11 papers, which were analysed. The meta-analysis of the length of stay presented a significant reduction standard mean difference (Std. MD) = −2.39 (−3.89, −0.89), p = 0.002. The analysis of overall morbidity, specific complications and Clavien-Dindo classification showed no significant variations among the study groups. ERAS protocol in bariatric surgery leads to the reduction of the length of hospital stay while maintaining no or low influence on morbidity.
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Affiliation(s)
- Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland
| | - Magdalena Pisarska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland
| | - Major Piotr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland. .,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland.
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Silecchia G, Iossa A. Complications of staple line and anastomoses following laparoscopic bariatric surgery. Ann Gastroenterol 2017; 31:56-64. [PMID: 29333067 PMCID: PMC5759613 DOI: 10.20524/aog.2017.0201] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/08/2017] [Indexed: 12/12/2022] Open
Abstract
With over 600 million people being obese, and given the scientific demonstration of the advantages of surgical treatment, bariatric surgery is on the rise. The promising long-term results in terms of weight loss, and particularly in relation to comorbidities and the control/cure rate, mean that the number of procedures performed in all countries remains high. However, the risk of potentially complex or fatal complications, though small, is present and is related to the procedures per se. This review is a guide for bariatric and/or general surgeons, offering a complete overview of the pathogenesis of anastomosis and staple line following the most common laparoscopic bariatric procedures: sleeve gastrectomy, gastric bypass, and mini-gastric bypass. The review is divided according to the procedure and the complications (leak, bleeding and stenosis), and evaluates all the factors that can potentially improve or worsen the complication rate, representing a “unicum” in the present literature on bariatric surgery.
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Affiliation(s)
- Gianfranco Silecchia
- Department of Medical-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Centre of Excellence, University of Rome "La Sapienza", Rome, Italy
| | - Angelo Iossa
- Department of Medical-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Centre of Excellence, University of Rome "La Sapienza", Rome, Italy
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Kafalı ME, Şahin M, Ece İ, Acar F, Yılmaz H, Alptekin H, Ateş L. The effects of bariatric surgical procedures on the improvement of metabolic syndrome in morbidly obese patients: Comparison of laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass. Turk J Surg 2017; 33:142-146. [PMID: 28944323 DOI: 10.5152/turkjsurg.2017.3865] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/12/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate patients who underwent laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy in terms of weight loss, metabolic parameters, and postoperative complications. MATERIAL AND METHODS Data on patients who underwent laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy with a diagnosis of morbid obesity between January 2012 and June 2014 were retrospectively evaluated. Patients were compared in terms of age, sex, body mass index, duration of operation, American Society of Anesthesiologists score, perioperative complications, length of hospital stay, and long term follow-up results. RESULTS During the study period, 91 patients (45 laparoscopic Roux-en-Y gastric bypass and 46 laparoscopic sleeve gastrectomy) underwent bariatric surgery. There was no difference between the two groups in terms of preoperative patient characteristics. Both groups showed statistically significant weight loss and improvement in co-morbidities when compared with the preoperative period. Weight loss and improvement in metabolic parameters were similar in both groups. The duration of operation and hospital stay was longer in the laparoscopic Roux-en-Y gastric bypass group. Furthermore, the rate of total complications was significantly lower in the laparoscopic sleeve gastrectomy group. CONCLUSION Laparoscopic sleeve gastrectomy is a safe and effective method with a significantly lower complication rate and length of hospital stay than laparoscopic Roux-en-Y gastric bypass, with similar improvement rates in metabolic syndrome.
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Affiliation(s)
| | - Mustafa Şahin
- Department of General Surgery, Selçuk University School of Medicine, Konya, Turkey
| | - İlhan Ece
- Department of General Surgery, Selçuk University School of Medicine, Konya, Turkey
| | - Fahrettin Acar
- Department of General Surgery, Selçuk University School of Medicine, Konya, Turkey
| | - Hüseyin Yılmaz
- Department of General Surgery, Selçuk University School of Medicine, Konya, Turkey
| | - Hüsnü Alptekin
- Department of General Surgery, Selçuk University School of Medicine, Konya, Turkey
| | - Leyla Ateş
- Department of General Surgery, Selçuk University School of Medicine, Konya, Turkey
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Popov VB, Ou A, Schulman AR, Thompson CC. The Impact of Intragastric Balloons on Obesity-Related Co-Morbidities: A Systematic Review and Meta-Analysis. Am J Gastroenterol 2017; 112:429-439. [PMID: 28117361 DOI: 10.1038/ajg.2016.530] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 10/02/2016] [Indexed: 02/07/2023]
Abstract
ObjectivesTherapies less invasive than surgery and more effective than lifestyle and pharmacotherapy are needed to contend with the obesity epidemic. Intragastric balloons (IGBs) are a minimally invasive endoscopic weight loss method recently approved for use in the US. The purpose of the study is to assess the effect of IGBs on metabolic outcomes associated with obesity.MethodsMEDLINE, Embase, and Cochrane Database were searched through July 2016. Dual extraction and quality assessment of studies using Cochrane risk of bias tool were performed independently by two authors. Primary outcomes included the change from baseline in metabolic parameters. Secondary outcomes included resolution and/or improvement in metabolic co-morbidities and association with baseline parameters.Results10 randomized controlled trials (RCT) and 30 observational studies including 5,668 subjects were analyzed. There was moderate-quality evidence for improvement in most metabolic parameters in subjects assigned to IGB therapy as compared to conventional non-surgical therapy in RCTs: mean difference (MD) in fasting glucose change: -12.7 mg/dl (95% confidence interval (CI) -21.5, -4); MD in triglycerides: -19 mg/dl (95% CI -42, 3.5); MD in waist circumference: -4.1 cm (95% CI -6.9, -1.4); MD in diastolic blood pressure: -2.9 mm Hg (95% CI -4.1, -1.8). The odds ratio for diabetes resolution after IGB therapy was 1.4 (95% CI 1.3, 1.6). The rate of serious adverse events was 1.3%.ConclusionsIGBs are more effective than diet in improving obesity-related metabolic risk factors with a low rate of adverse effects, however the strength of the evidence is limited given the small number of participants and lack of long-term follow-up.
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Affiliation(s)
- Violeta B Popov
- NYU Langone Medical Center and VA NY Harbor Healthcare System, New York University School of Medicine, New York, USA
| | - Amy Ou
- NYU Langone Medical Center and VA NY Harbor Healthcare System, New York University School of Medicine, New York, USA
| | - Allison R Schulman
- Brigham and Women's Hospital, Harvard Medical School, Massachusetts, USA
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