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Elghadban H, Shoma A, Abdallah E, Negm A, Abdullah E, Hamed H, Ghareeb S, Lotfy A, Taki-Eldin A. Laparoscopic One Anastomosis Gastric Bypass as a Revisional Procedure After Failed Vertical Banded Gastroplasty: Our Center Experience. J Obes 2025; 2025:4161005. [PMID: 40196444 PMCID: PMC11972859 DOI: 10.1155/jobe/4161005] [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: 01/22/2025] [Accepted: 03/11/2025] [Indexed: 04/09/2025] Open
Abstract
Background: Vertical banded gastroplasty (VBG) was historically a popular restrictive bariatric procedure, but long-term failure rates due to weight regain, stenosis, and gastroesophageal reflux have necessitated revisional interventions. One anastomosis gastric bypass (OAGB), also known as mini-gastric bypass, has emerged as a viable revisional option due to its technical simplicity, lower complication rates, and promising metabolic outcomes. This study evaluates the safety, efficacy, and outcomes of OAGB as a revisional procedure following failed VBG, based on our center's experience and a review of the current literature. Methods: Seventy-one patients who underwent revisional OAGB after failed open VBG between February 2014 and February 2020 were included in this retrospective study. Three years outcomes regarding weight loss (the percentage of excess body weight loss (EBWL %) and change in body mass index (BMI)), co-morbidities resolution, morbidity, and mortality were assessed. Results: The EBWL % after revisional OAGB was 68.2 ± 9.4%, 65.9 ± 2.5%, and 59.6 ± 7.4% after 1, 2, and 3 years, respectively. The mean BMI before revisional surgery was 41.8 ± 3.7 kg/m2,which decreased to 31.9 ± 4.2 kg/m2 3 years after the revisional surgery. After 1 year, there was a remarkable resolution of obesity-related co-morbidities, the remission of type 2 diabetes mellitus was 85.7%, and of hypertension was 80%. Remission of other comorbidities was also observed. Bile reflux was encountered in 6 cases (8.5%), two of them required surgical intervention. Conclusions: OAGB is a feasible and effective revisional procedure after failed open VBG. However, the risk of bile reflux should be considered to justify these findings; further prospective randomized controlled trials are required.
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Affiliation(s)
- Hosam Elghadban
- General Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Ashraf Shoma
- General Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Emad Abdallah
- General Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Ahmed Negm
- General Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Elsayed Abdullah
- General Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Hossam Hamed
- General Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Sameh Ghareeb
- Anesthesia Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Ahmed Lotfy
- General Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Ahmed Taki-Eldin
- General Surgery Department, Faculty of Medicine, Horus University-Egypt, New Damietta, Egypt
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Bang GA, Oumarou BN, Savom EP, Nketcha JJM, Essomba A. [Sleeve gastrectomy for the surgical management of obesity at the Essos Hospital Center (Yaoundé, Cameroon): a retrospective case series study evaluating medium-term weight loss]. Pan Afr Med J 2024; 49:49. [PMID: 39867550 PMCID: PMC11760207 DOI: 10.11604/pamj.2024.49.49.32728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 10/01/2024] [Indexed: 01/28/2025] Open
Abstract
While the prevalence of overweight and obesity is rising in Africa, the practice of bariatric surgery remains limited in our country, Cameroon. Weight loss outcomes following sleeve gastrectomy (SG), the most widely used bariatric surgery technique worldwide, have not yet been studied in our context. The medical records of all patients who underwent SG in our surgery department between January 1, 2016, and September 30, 2020, were reviewed retrospectively. The primary outcome studied was medium-term weight loss, one year after surgery. Weight loss was calculated using the postoperative body mass index (BMI) and the percentage of excess weight loss (%EWL). Reinhold criteria were used to assess the %EWL. We collected data from the medical records of 21 patients, of whom 19 (90.5%) were female. The average age of patients was 40.3±10.8 years, with a mean BMI of 44.9±7.4 kg/m2. All patients had at least one obesity-related comorbidity. All procedures were performed laparoscopically, without conversion, with a mean duration of 192.2±52.8 min. One year after surgery, the mean BMI was 32.51±3.7 kg/m2 and the mean %EWL was 63.35±6.5%. According to Reinhold's criteria, the %EWL was considered satisfactory. In our context, SG provides satisfactory results for medium-term weight loss.
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Affiliation(s)
- Guy Aristide Bang
- Service de Chirurgie Viscérale et Laparoscopique, Département de Chirurgie et Spécialités, Faculté de Médecine et des Sciences Biomédicales de l'Université de Yaoundé I, Yaoundé, Cameroun
- Département de Chirurgie et Spécialités, Faculté de Médecine et des Sciences Biomédicales de l'Université de Yaoundé I, Yaoundé, Cameroun
| | - Blondel Nana Oumarou
- Service de Chirurgie Viscérale et Laparoscopique, Département de Chirurgie et Spécialités, Faculté de Médecine et des Sciences Biomédicales de l'Université de Yaoundé I, Yaoundé, Cameroun
| | - Eric Patrick Savom
- Département de Chirurgie et Spécialités, Faculté de Médecine et des Sciences Biomédicales de l'Université de Yaoundé I, Yaoundé, Cameroun
- Service de Chirurgie, Hôpital Général de Yaoundé, Yaoundé, Cameroun
| | - Johanna Joyce Mbianda Nketcha
- Service de Chirurgie Viscérale et Laparoscopique, Département de Chirurgie et Spécialités, Faculté de Médecine et des Sciences Biomédicales de l'Université de Yaoundé I, Yaoundé, Cameroun
| | - Arthur Essomba
- Département de Chirurgie et Spécialités, Faculté de Médecine et des Sciences Biomédicales de l'Université de Yaoundé I, Yaoundé, Cameroun
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Chen L, Chen Y, Yu X, Liang S, Guan Y, Yang J, Guan B. Long-term prevalence of vitamin deficiencies after bariatric surgery: a meta-analysis. Langenbecks Arch Surg 2024; 409:226. [PMID: 39030449 DOI: 10.1007/s00423-024-03422-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 07/14/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Bariatric surgery can lead to short-mid-term vitamin deficiencies, but the long-term vitamin deficiencies is unclear. This study aimed to conduct a meta-analysis regarding the long-term prevalence (≥ 5 years) of vitamin deficiencies after bariatric surgery. METHODS We searched the EMBASE, PubMed, and CENTRAL databases for clinical studies until June 2023. Meta-analysis, sensitivity, subgroup, and meta-regression analyses were performed. RESULTS This meta-analysis included 54 articles with follow-up duration ranging from 5 to 17 years. The most prevalent vitamin deficiencies after surgery were vitamin D (35.8%), followed by vitamin E (16.5%), vitamin A (13.4%), vitamin K (9.6%), and vitamin B12 (8.5%). Subgroup analyses showed that the prevalence of vitamin A and folate deficiencies increased with the follow-up time. Roux-en-Y gastric bypass had a higher rate of vitamin B12 deficiency than sleeve gastrectomy and biliopancreatic diversion with duodenal switch (BPD-DS). Studies conducted in Europe had higher vitamin A deficiency (25.8%) than in America (0.8%); Asian studies had more vitamin B12 but less vitamin D deficiency than European and American studies. Meta-regression analysis displayed that publication year, study design, preoperative age, BMI, and quality assessment score were not associated with vitamin A, B12, D, and folate deficiencies rate. CONCLUSION A high prevalence of vitamin deficiencies was found after bariatric surgery in the long-term follow-up, especially vitamin D, E, A, K, and B12. The variation in study regions, surgical procedures, and follow-up time are associated with different postoperative vitamin deficiencies; it is necessary to develop more targeted vitamin supplement programs.
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Affiliation(s)
- Lu Chen
- School of Health, Dongguan Polytechnic, Dongguan, 523808, China
| | - Yanya Chen
- College of Nursing, Jinan University, Guangzhou, 510632, China
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, 999077, China
| | - Xuefen Yu
- Comprehensive Special Diagnosis Department, First Affiliated Hospital of Jinan University, Guangzhou, 5106305, China
| | - Sihua Liang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Yuejie Guan
- Department of General Practice Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China.
| | - Jingge Yang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
| | - Bingsheng Guan
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
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van Dam KAM, Jense MTF, de Witte E, Fransen S, Boerma EJG, Greve JWM. Laparoscopic Conversion of Vertical Banded Gastroplasty to Roux-en-Y Gastric Bypass Gives Better Result Compared to an Open Approach. Obes Surg 2023:10.1007/s11695-023-06574-7. [PMID: 37043139 DOI: 10.1007/s11695-023-06574-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Vertical banded gastroplasty (VBG) has a relatively high failure rate in the long run, requiring revisional surgery in 30-65%. A common conversion option is to Roux-en-Y gastric bypass (RYGB), which can be performed laparoscopically or open. Current literature contains small cohorts and inconclusive results. Therefore, we set out to compare our series of open and laparoscopic VBG to RYGB conversions. METHODS All conversions performed between 1996 and 2020 were included. Patients were divided into 3 groups based on conversion indication: weight recurrence (group 1), excessive weight loss (group 2), and eating/pouch difficulties (group 3). The primary outcome was postoperative complications according to the Clavien-Dindo (CD) classification. Secondary outcome was %total weight loss (%TWL) 1 to 5 years after revisional surgery. RESULTS We included 205 patients (84.9% female) of whom 105 underwent laparoscopic and 100 open VBG to RYGB conversion. Twenty-three short-term complications occurred in the laparoscopic group, with 16 > CD3a. In the open group, 33 complications occurred with 12 > CD3a. Overall complications were 33.3% in laparoscopic and 64% in open patients. There were no significant differences between the laparoscopic and open group in BMI (p = 0.76) and %TWL (p = 0.694) after 5 years. After 5 years, lost to follow-up was 97% in the open group. Twenty-eight percent of patients who reached follow-up in the laparoscopic group had available data. CONCLUSIONS We demonstrate that the overall complication rate is lower in the laparoscopic group compared to the open group. Regarding BMI, an improvement was achieved in both groups after 5 years.
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Affiliation(s)
- Kayleigh A M van Dam
- Bariatric Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419, PC, Heerlen, The Netherlands.
| | - Marijn T F Jense
- Bariatric Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419, PC, Heerlen, The Netherlands
- Dutch Obesity Clinic South, John F, Kennedylaan 301, 6419, XZ, Heerlen, The Netherlands
| | - Evelien de Witte
- Bariatric Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419, PC, Heerlen, The Netherlands
- Dutch Obesity Clinic South, John F, Kennedylaan 301, 6419, XZ, Heerlen, The Netherlands
| | - Sofie Fransen
- Dutch Obesity Clinic South, John F, Kennedylaan 301, 6419, XZ, Heerlen, The Netherlands
| | - Evert-Jan G Boerma
- Bariatric Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419, PC, Heerlen, The Netherlands
- Dutch Obesity Clinic South, John F, Kennedylaan 301, 6419, XZ, Heerlen, The Netherlands
| | - Jan Willem M Greve
- Bariatric Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419, PC, Heerlen, The Netherlands
- Dutch Obesity Clinic South, John F, Kennedylaan 301, 6419, XZ, Heerlen, The Netherlands
- NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
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Mahajna A, Dubin D, Obeid M, Sakran N, Assalia A. Short-Term (30-Day) Morbidity of Biliopancreatic Diversion Compared to Roux-en-Y Gastric Bypass as Revisional Procedures for Failed Vertical Banded Gastroplasty. Obes Surg 2023; 33:761-768. [PMID: 36630053 DOI: 10.1007/s11695-022-06441-x] [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: 05/01/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Silastic ring vertical gastroplasty (SRVG) and vertical banded gastroplasty (VBG) are associated with a high failure rate due to weight regain and complications at long-term follow-up. Consequently, surgical correction for such procedures is warranted. Controversy exists as to which surgical procedure is the ideal choice for such correction. Our aim is to compare short-term outcome of Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) repair for failed VBG/SRVG bariatric procedures. METHODS The medical records of patients with failed SRVG who underwent corrective procedures at our institute between 2004 and 2018 were retrospectively reviewed. Patients characteristics, surgical approaches, and intraoperative and post-operative complications were examined and compared. RESULTS Sixty patients in total underwent a surgical corrective procedure for failed SRVG. Thirty-one patients underwent RYGB, and 29 patients underwent BPD. Major complications were seen more in the RYGB group (35% = 11) compared to the BPD (6.9% = 2). Even though anastomotic leak rates were not statistically significant (p = 0.053), an apparent tendency for such a complication was noted in the RYGB group. RYGB procedure had an increased 30-day complication rate (p = 0.055) compared to RYGB. Laparoscopic approach had statistically fewer complications than open approach. No mortality was observed in either group. CONCLUSION Our study showed that BPD is a safe option with less complication rates than RYGB in the short-term period for surgical correction of failed VBG/SRVG procedures.
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Affiliation(s)
- Ahmad Mahajna
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel. .,Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Daniel Dubin
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel.,Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Miriam Obeid
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Nasser Sakran
- Department of General Surgery, Holy Family Hospital, Nazareth, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Ahmad Assalia
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel.,Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Mirhashemi SH, Hakakzadeh A, Fateh A. Severe malnutrition after single anastomosis sleeve jejunal bypass (SASJ) surgery due to a rare surgical complication: Report of the case. Int J Surg Case Rep 2022; 92:106824. [PMID: 35176582 PMCID: PMC8857433 DOI: 10.1016/j.ijscr.2022.106824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/05/2022] [Accepted: 02/10/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Bariatric procedures rates are increased due to the epidemic in obesity. Up to 50% of patients operated with vertical banded gastroplasty (VBG) procedures experience failure or complications in the mid- and long-term and present for revision bariatric surgery. Despite the increase in revisions, their safety and efficacy remain controversial. Case presentation A 44-year-old female patient with severe malnutrition after single anastomosis sleeve jejunal bypass (SASJ) surgery was referred to this center. SASJ was the chosen bariatric procedure for her after the first failed VBG. She was unable to swallow anything. Upper GI endoscopy was done and the laparoscopic prolene mesh used in the first bariatric surgery (VBG) was seen inside the gastric lumen. Total parental nutrition was initiated and continued for 12 days in this medical center and then she was candidate for exploratory laparoscopy. Clinical discussion Using prophylactic preperitoneal Prolene mesh during wound closure in bariatric surgery is safe and effective in preventing incisional hernia development. During the revision bariatric surgeries, surgeons should be careful about the used mesh in the first bariatric surgery. Conclusion Surgeons should be aware of the management of rare surgical complications that might lead to malnutrition which is insidious. Level of evidence V
Bariatric surgeries have increased life expectancy and reduced the complications of obesity. Up to 50% of patients operated with vertical banded gastroplasty (VBG) procedures experience failure or complications and present for revision bariatric surgery. During the revision bariatric surgeries, surgeons should be careful about the used mesh in the first bariatric surgery.
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Affiliation(s)
- Seyed Hadi Mirhashemi
- Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Azadeh Hakakzadeh
- Department of Sports and Exercise Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Physiotherapy Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Fateh
- Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Carmona MN, Santos-Sousa H, Lindeza L, Sousa-Pinto B, Nogueiro J, Pereira A, Carneiro S, Costa-Pinho A, Lima-da-Costa E, Preto J. Comparative Effectiveness of Bariatric Surgeries in Patients with Type 2 Diabetes Mellitus and BMI ≥ 25 kg/m 2: a Systematic Review and Network Meta-Analysis. Obes Surg 2021; 31:5312-5321. [PMID: 34611827 DOI: 10.1007/s11695-021-05725-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE In patients with type 2 diabetes mellitus (T2DM), bariatric surgery appears to be more effective than medical treatment (MT) at improving glycaemic control and decreasing cardiovascular risk. However, long-term effectiveness has not been systematically assessed using randomised controlled trials. In this study, we aimed to systematically assess randomised controlled trials, with at least 5 years of follow-up, on bariatric surgery in patients with T2DM and BMI ≥ 25 kg/m2, as well as to compare different bariatric procedures. MATERIAL AND METHODS PubMed, SCOPUS and Web of Science were searched. We performed a network meta-analysis to evaluate the comparative effectiveness of the different procedures and MT in terms of full T2DM remission, weight loss, complications and cardiometabolic biomarkers. The quality of evidence was assessed using the Cochrane Risk of Bias Tool and CINeMA. RESULTS We included 11 primary studies. Laparoscopic one-anastomosis gastric bypass (LOAGB) was found to be one of the most effective treatments for full remission of T2DM (I2 = 0, inconsistency p value = 0.9223). Biliopancreatic diversion without duodenal switch was found to be more effective than laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding regarding percent total cholesterol and low-density lipoprotein change. Regarding percent high-density lipoprotein and weight change, all analysed surgical treatments were shown to be more effective than MT. The confidence rating in our results was overall moderate, but most studies had high risk of performance and detection bias. CONCLUSION Bariatric surgery seems to be effective for T2DM remission. LOAGB appears to be a good option in this context, and a possible alternative to laparoscopic duodenal switch, but the included primary studies in our review are not sufficiently powered to establish a more definitive conclusion. More studies with longer follow-up times are needed to comprehensively assess bariatric surgery in T2DM.
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Affiliation(s)
- Maria Neves Carmona
- Faculty of Medicine, University of Porto - Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Hugo Santos-Sousa
- Faculty of Medicine, University of Porto - Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - Luís Lindeza
- Faculty of Medicine, University of Porto - Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal
- CINTESIS - Center for Health Technologies and Services Research, University of Porto, Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal
| | - Jorge Nogueiro
- Faculty of Medicine, University of Porto - Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Surgery Department, São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - André Pereira
- Faculty of Medicine, University of Porto - Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Surgery Department, São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Silvestre Carneiro
- Faculty of Medicine, University of Porto - Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Surgery Department, São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - André Costa-Pinho
- Faculty of Medicine, University of Porto - Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Eduardo Lima-da-Costa
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - John Preto
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
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Musella M, Berardi G, Velotti N, Schiavone V, Vitiello A. Ten-Year Results of Laparoscopic Sleeve Gastrectomy: Retrospective Matched Comparison with Laparoscopic Adjustable Gastric Banding-Is There a Significant Difference in Long Term? Obes Surg 2021; 31:5267-5274. [PMID: 34601648 PMCID: PMC8595233 DOI: 10.1007/s11695-021-05735-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The laparoscopic sleeve gastrectomy (LSG) is the most common bariatric procedure performed worldwide while the laparoscopic adjustable gastric banding (LAGB) has been almost abandoned. Aim of this study was to retrospectively assess 10-year outcomes of LSG through a matched comparison with LAGB. MATERIALS AND METHODS Retrospective search of prospectively maintained database of our university was carried out to find all patients that underwent LSG before December 2010. Each subject with LSG was matched one-to-one with a patient that had undergone LAGB in the same period with correspondent preoperative age, BMI, and sex. RESULTS A total of 76 patients underwent LSG before 2010 and were all included in this study; a matched group of 76 out of 178 LAGB patients with 10-year follow-up was retrieved from our database. Comparison between the two groups showed better outcomes after LSG at 1 and 5 years but weight loss was comparable with the LAGB group at 10 years (%TWL 22.2 ± 13 vs 21.2 ± 16.1; p = 0.89). No significant difference was found in conversion/removal rate (15.8% vs 18.4%; p = 0.67). CONCLUSION LSG is an effective stand-alone bariatric procedure with better outcomes than LAGB in medium term, but results are comparable at 10 years. Subjects undergoing LSG should be informed that conversion to RYGB or OAGB may be necessary to achieve further weight loss or to treat reflux.
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Affiliation(s)
- Mario Musella
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”, Via S. Pansini 5, 80131 Naples, Italy
| | - Giovanna Berardi
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”, Via S. Pansini 5, 80131 Naples, Italy
| | - Nunzio Velotti
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”, Via S. Pansini 5, 80131 Naples, Italy
| | - Vincenzo Schiavone
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”, Via S. Pansini 5, 80131 Naples, Italy
| | - Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”, Via S. Pansini 5, 80131 Naples, Italy
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Vadalà di Prampero SF, Bulajic M, Giustacchini P, Manzoni G, Costamagna G. Endoscopic revision for weight regain after open vertical-banded gastroplasty. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2021; 6:404-406. [PMID: 34527837 PMCID: PMC8430376 DOI: 10.1016/j.vgie.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Video 1Technical feasibility, safety, and efficacy of a novel endoscopic approach to treating weight regain after open vertical-banded gastroplasty using an endoscopic suturing device.
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Affiliation(s)
- Salvatore F Vadalà di Prampero
- Gastroenterology and GI Endoscopy Unit, Mater Olbia Hospital, Qatar Foundation Endowment & Gemelli Foundation, Olbia, Italy
| | - Milutin Bulajic
- Gastroenterology and GI Endoscopy Unit, Mater Olbia Hospital, Qatar Foundation Endowment & Gemelli Foundation, Olbia, Italy
| | - Piero Giustacchini
- Endocrine and Metabolic Surgery Unit, Mater Olbia Hospital, Qatar Foundation Endowment & Gemelli Foundation, Olbia, Italy
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gabriella Manzoni
- Department of Radiology, Mater Olbia Hospital, Qatar Foundation Endowment & Gemelli Foundation, Olbia, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy
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Di Lorenzo N, Antoniou SA, Batterham RL, Busetto L, Godoroja D, Iossa A, Carrano FM, Agresta F, Alarçon I, Azran C, Bouvy N, Balaguè Ponz C, Buza M, Copaescu C, De Luca M, Dicker D, Di Vincenzo A, Felsenreich DM, Francis NK, Fried M, Gonzalo Prats B, Goitein D, Halford JCG, Herlesova J, Kalogridaki M, Ket H, Morales-Conde S, Piatto G, Prager G, Pruijssers S, Pucci A, Rayman S, Romano E, Sanchez-Cordero S, Vilallonga R, Silecchia G. Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP. Surg Endosc 2020; 34:2332-2358. [PMID: 32328827 PMCID: PMC7214495 DOI: 10.1007/s00464-020-07555-y] [Citation(s) in RCA: 285] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/07/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Surgery for obesity and metabolic diseases has been evolved in the light of new scientific evidence, long-term outcomes and accumulated experience. EAES has sponsored an update of previous guidelines on bariatric surgery. METHODS A multidisciplinary group of bariatric surgeons, obesity physicians, nutritional experts, psychologists, anesthetists and a patient representative comprised the guideline development panel. Development and reporting conformed to GRADE guidelines and AGREE II standards. RESULTS Systematic review of databases, record selection, data extraction and synthesis, evidence appraisal and evidence-to-decision frameworks were developed for 42 key questions in the domains Indication; Preoperative work-up; Perioperative management; Non-bypass, bypass and one-anastomosis procedures; Revisional surgery; Postoperative care; and Investigational procedures. A total of 36 recommendations and position statements were formed through a modified Delphi procedure. CONCLUSION This document summarizes the latest evidence on bariatric surgery through state-of-the art guideline development, aiming to facilitate evidence-based clinical decisions.
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Affiliation(s)
- Nicola Di Lorenzo
- Department of Surgical Sciences, University of Rome "Tor Vergata", Rome, Italy
| | - Stavros A Antoniou
- Department of Surgery, European University of Cyprus, Nicosia, Cyprus
- Department of Surgery, Mediterranean Hospital of Cyprus, Limassol, Cyprus
| | - Rachel L Batterham
- Centre for Obesity Research, University College London, London, UK
- Biomedical Research Centre, National Institute of Health Research, London, UK
| | - Luca Busetto
- Internal Medicine 3, Department of Medicine, DIMED, Center for the Study and the Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
| | - Daniela Godoroja
- Department of Anesthesiology, Ponderas Academic Hospital Regina Maria, Bucharest, Romania
| | - Angelo Iossa
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, "La Sapienza" University of Rome-Polo Pontino, Bariatric Centre of Excellence IFSO-EC, Via F. Faggiana 1668, 04100, Latina, Italy
| | - Francesco M Carrano
- Department of Endocrine and Metabolic Surgery, University of Insubria, Ospedale di Circolo and Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | | | - Isaias Alarçon
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocío", 41010, Sevilla, Spain
| | | | - Nicole Bouvy
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Maura Buza
- Department of General Surgery, Ponderas Academic Hospital Regina Maria, Bucharest, Romania
| | - Catalin Copaescu
- Department of General Surgery, Ponderas Academic Hospital Regina Maria, Bucharest, Romania
| | - Maurizio De Luca
- Division of General Surgery, Castelfranco and Montebelluna Hospitals, Treviso, Italy
| | - Dror Dicker
- Department of Internal Medicine D, Hasharon Hospital, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Angelo Di Vincenzo
- Internal Medicine 3, Department of Medicine, DIMED, Center for the Study and the Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
| | - Daniel M Felsenreich
- Division of General Surgery, Department of Surgery, Vienna Medical University, Vienna, Austria
| | - Nader K Francis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
| | - Martin Fried
- Center for Treatment of Obesity and Metabolic Disorders, OB Klinika, Prague, Czech Republic
| | | | - David Goitein
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery C, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Jason C G Halford
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Jitka Herlesova
- Center for Treatment of Obesity and Metabolic Disorders, OB Klinika, Prague, Czech Republic
| | | | - Hans Ket
- VU Amsterdam, Amsterdam, Netherlands
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocío", 41010, Sevilla, Spain
| | - Giacomo Piatto
- Division of General Surgery, Castelfranco and Montebelluna Hospitals, Treviso, Italy
| | - Gerhard Prager
- Division of General Surgery, Department of Surgery, Vienna Medical University, Vienna, Austria
| | - Suzanne Pruijssers
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Andrea Pucci
- Centre for Obesity Research, University College London, London, UK
- Biomedical Research Centre, National Institute of Health Research, London, UK
| | - Shlomi Rayman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery C, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Eugenia Romano
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | | | - Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall D'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gianfranco Silecchia
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, "La Sapienza" University of Rome-Polo Pontino, Bariatric Centre of Excellence IFSO-EC, Via F. Faggiana 1668, 04100, Latina, Italy.
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11
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Vertical Banded Gastroplasty Revision to Gastric Bypass Leads to Effective Weight Loss and Comorbidity and Dysphagia Symptom Resolution. Obes Surg 2020; 30:3453-3458. [DOI: 10.1007/s11695-020-04587-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Khewater T, Yercovich N, Grymonprez E, Debergh I, Dillemans B. Conversion of both Versions of Vertical Banded Gastroplasty to Laparoscopic Roux-en-Y Gastric Bypass: Analysis of Short-term Outcomes. Obes Surg 2020; 29:1797-1804. [PMID: 30756295 DOI: 10.1007/s11695-019-03768-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Conversional bariatric surgery has relatively high rates of complications. We aimed to analyze our single-center experience with patients requiring conversional laparoscopic Roux-en-Y gastric bypass (LRYGB) following a failed primary open or laparoscopic vertical banded gastroplasty (OVBG or LVBG, respectively). METHODS The records of patients who underwent LRYGB as a conversional procedure after VBG between November 2004 and December 2017 were reviewed. Characteristics, body mass index (BMI), operation time, intraoperative problems, length of hospitalization, and early (< 30 days) morbidity and mortality were analyzed. Data were expressed as mean ± standard deviation or frequency. RESULTS A total of 329 patients (81.76% females) who underwent conversional RYGB were included. For the LVBG group (224 patients) and OVBG group (105 patients), respectively, BMI was 34.15 ± 6.38 and 37.79 ± 6.31 kg/m2 (p < 0.05), the operation time was 96.00 ± 31.40 and 123.15 ± 40.26 min (p < 0.05), hospitalization duration was 2.96 ± 1.13 and 3.20 ± 1.20 days (p = 0.08), the early complication rate was 7.14 and 11.43% (p = 0.19), and the reoperation rate was 2.23 and 2.86% (p = 0.73). There were no major intraoperative problems. Three patients with OVBG were converted to open RYGB (2.86%). There was no mortality. CONCLUSION The conversion of OVBG and LVBG to laparoscopic RYGB is technically feasible and provides comparably low early morbidity rates and length of hospitalization. However, compared to LVBG, conversional laparoscopic RYGB following OVBG is technically more challenging and time-consuming, with a slightly higher risk of conversion to open surgery. We support the use of such conversional bariatric surgery in specialized, high-volume bariatric centers.
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Affiliation(s)
- Talal Khewater
- Department of Surgery, AZ Sint-Jan Brugge-Oostende AV, Campus Sint-Jan, Ruddershove 10, 8000, Bruges, Belgium.
| | - Nathalie Yercovich
- Department of Surgery, AZ Sint-Jan Brugge-Oostende AV, Campus Sint-Jan, Ruddershove 10, 8000, Bruges, Belgium
| | - Edouard Grymonprez
- Student at Faculty of Medicine, KU Leuven University, Herestraat 49, 3000, Leuven, Belgium
| | - Isabelle Debergh
- Department of Surgery, AZ Sint-Jan Brugge-Oostende AV, Campus Sint-Jan, Ruddershove 10, 8000, Bruges, Belgium
| | - Bruno Dillemans
- Department of Surgery, AZ Sint-Jan Brugge-Oostende AV, Campus Sint-Jan, Ruddershove 10, 8000, Bruges, Belgium
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13
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Bekheit M, Ibrahim MY, Tobar W, Galal I, Elward AS. Correlation Between the Total Small Bowel Length and Anthropometric Measures in Living Humans: Cross-Sectional Study. Obes Surg 2019; 30:681-686. [PMID: 31686382 DOI: 10.1007/s11695-019-04238-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Variation in the outcome of bariatric surgery is still an unraveled phenomenon. This variation could be multifactorial. Several reports implicate the total small bowel length (TSBL) in this process. However, the basic information regarding the normal bowel length and its relation to the anthropometric parameters of the living subject is scarce. This study aims at reporting the normal total bowel length in living adult humans and its correlation with the anthropometric parameters. METHODS This study included 606 participants (380 females and 226 males). Their mean age was 39.8 ± 11 years, weight = 135.7 ± 29.7 kg, height = 165 ± 9 cm, and BMI = 49.5 ± 7.5 kg/m2. The mean TSBL was 630 ± 175 cm. There was a statistically significant but very weak positive correlation but between the TSBL and both weight and height. Males had significantly higher weight and were significantly taller compared with females. TSBL was significantly longer in males at 661.5 ± 186 cm versus 612 ± 164 cm in females. CONCLUSION The study reports an average TSBL greater than what is reported in the literature from living humans with a greater range of variation. There is no clinically important correlation between the TSBL and the weight and height of the individual participants in this series.
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Affiliation(s)
- Mohamed Bekheit
- Department of Surgery, Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, AB25 2ZN, UK. .,Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK. .,Department of Surgery, El-Kabbary Hospital, Alexandria, Egypt.
| | - Mohamed Y Ibrahim
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Wael Tobar
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ibrahim Galal
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Athar S Elward
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
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14
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Chang DM, Lee WJ, Chen JC, Ser KH, Tsai PL, Lee YC. Thirteen-Year Experience of Laparoscopic Sleeve Gastrectomy: Surgical Risk, Weight Loss, and Revision Procedures. Obes Surg 2019; 28:2991-2997. [PMID: 29931481 DOI: 10.1007/s11695-018-3344-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has been validated as a safe and effective treatment for morbid obesity. However, data of the long-term outcome remains lacking. METHODS A total of 1759 LSG was performed as primary bariatric procedure from 2005 to 2017 with mean age of 35.2 ± 10.3 years old (14-71), female 69.7%, mean body mass index (BMI) 37.9 ± 7.7 kg/m2, and mean waist width 113.7 ± 17.9 cm. All patients were evaluated and managed under a strict multidisciplinary team approach. A retrospective analysis of a prospective bariatric database and telephone interview of patients who defaulted clinic follow-up at 10 years was conducted. RESULTS The mean operating time, intraoperative blood, and hospital stay of LSG were 121.5 ± 36.5 min, 40.8 ± 69.7 ml, and 2.8 ± 2.7 days, respectively. The 30-day postoperative major complication occurred in 25 (1.4%) patients. The major complication rate was 15% at first year and 0% at the last year. The follow-up rate at 1, 5 and 10 years were 89.3%, 52.1 and 64.4%. At postoperative 1, 5, and 10 years, the mean percentage of total weight loss (%TWL) and excess weight loss (EWL%) of LSG patients were 33.4, 28.3, and 26.6% and 92.2, 80.1, and 70.5%, respectively. The mean BMI became 27, 26.2, and 27.1 kg/m2 at postoperative 1, 5, and 10 years. At follow-up, a total 69 patients needed surgical revision due to reflux disease (n = 45), weight regain (n = 19), persistent diabetes (n = 2), and chronic fistula (n = 3). The type of revision procedures were hiatal repair and gastropexy (n = 29), Roux-en Y gastric bypass (RYGB) (n = 23), and single anastomosis bypass (n = 17) with median time to revision 33 months (range 3-62). At 10 years, the overall revision rate was 21.5% (14/65) and 11(16.9%) of 65 patients were converted to RYGB. The other 54 patients remained at LSG anatomy, but 45% of them required proton pump inhibitor for reflux symptoms. CONCLUSIONS Our results showed that primary LSG is a durable primary bariatric procedure with sustained weight loss and a high resolution of comorbidities at 10 years, but about half the patients had de novo GERD. The need for conversion to RYGB was 16.9% at 10 years.
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Affiliation(s)
- Der-Ming Chang
- Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Tauoyan, Taiwan, Republic of China.,Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan, Republic of China
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Tauoyan, Taiwan, Republic of China.
| | - Jung-Chien Chen
- Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Tauoyan, Taiwan, Republic of China
| | - Kong-Han Ser
- Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Tauoyan, Taiwan, Republic of China
| | - Pei-Ling Tsai
- Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Tauoyan, Taiwan, Republic of China
| | - Yi-Chih Lee
- Department of International Business, Chien Hsin University of Science and Technology, Tauoyan, Taiwan, Republic of China
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15
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Alsabah S, Elabd R, Vaz JD. Endoscopic versus laparoscopic management of an eroded mesh in vertical banded gastroplasty: video case series and literature review. J Surg Case Rep 2019; 2019:rjz060. [PMID: 30886696 PMCID: PMC6413378 DOI: 10.1093/jscr/rjz060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/13/2019] [Indexed: 12/05/2022] Open
Abstract
Vertical banded gastroplasty (VBG) was one of the most common bariatric surgeries worldwide in the beginning of the 21st century. However, recently we have increasingly encountered its long-term complications. We present two cases of VBG mesh erosion, alongside videos for their management. The first is of a 35-year-old female that presented 10 years after her VBG, while the second is of a 38-year-old female presenting 9-years post hers. Patient one presented with weight regain, regurgitation, epigastric pain, and dysphagia. CT imaging showed staple-line dehiscence and foreign body inside the stomach. Patient 2's presentation was of weight regain. Upon further workup, she was diagnosed with mesh erosion. In case 1, an endoscopic approach was taken using Soehendra lithotriptor device, while for case 2, a laparoscopic approach was undertaken. Endoscopic management of mesh erosion post-VBG is not only safe and feasible but also less invasive and time-consuming than the laparoscopic technique.
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Affiliation(s)
- Salman Alsabah
- Department of Surgery, Kuwait University, Faculty of Medicine, Jabriya, Kuwait
| | - Rawan Elabd
- Faculty of Medicine, Kuwait University, Jabriya, Kuwait
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16
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A 5-Year History of Laparoscopic Gastric Band Removals: an Analysis of Complications and Associated Comorbidities. Obes Surg 2019; 29:1202-1206. [PMID: 30652244 DOI: 10.1007/s11695-018-03677-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Almalki OM, Lee WJ, Chen JC, Ser KH, Lee YC, Chen SC. Revisional Gastric Bypass for Failed Restrictive Procedures: Comparison of Single-Anastomosis (Mini-) and Roux-en-Y Gastric Bypass. Obes Surg 2018; 28:970-975. [PMID: 29101719 DOI: 10.1007/s11695-017-2991-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Ten to 50% of patients who received restrictive bariatric operations may require reoperation for unsatisfactory weight loss or weight regain. Failed restrictive procedures are usually managed with conversion to another bariatric procedure with a favor of conversion to laparoscopic gastric bypass. Our aim is to evaluate two different bypass techniques, laparoscopic RY gastric bypass (RYGB) versus single-anastomosis (mini-) gastric bypass (SAGB) as a revision option (R-RYGB and R-SAGB) for failed restrictive bariatric operations. MATERIAL AND METHODS From May 2001 to December 2015, a total of 116 patients with failed restrictive bariatric operations underwent laparoscopic revisional bypass surgery (81 R-SAGB and 35 R-RYGB). Among them, 81 were failed after vertical banded gastroplasty (VBG) and 35 were after adjustable gastric band (AGB). The demographic data, surgical parameters, and outcomes were studied. RESULTS The average age at revision surgery was 35.7 years (range 22-56), and the average body mass index (BMI) before reoperation was 37.2 kg/m2 (29.0-51.8). Revision surgery was performed after 58.8 months from the primary surgery on average (14-180 months). The main reasons for the revisions were weight regain (50.9%), inadequate weight loss (31%), and intolerance (18.1%). All of the procedures were completed laparoscopically as one-stage procedure. R-RYGB had significantly longer operative times than R-SAGB. Major complication occurred in 12 (10%) patients without significant difference between R-SAGB group and R-RYGB group. At 1 year follow-up, weight loss was better in R-SAGB than R-RYGB (76.8 vs. 32.9% EWL; p = 0.001). At 5 year follow-up, a significantly lower hemoglobin level was found in R-SAGB group (p = 0.03). CONCLUSION Both SAGB and RYGB are acceptable options for revising a restrictive type of bariatric procedures with equal safety profile. R-SAGB was shown to be a simpler procedure with better weight reduction than R-RYGB but anemia is a considerable complication at long-term follow-up.
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Affiliation(s)
- Owaid M Almalki
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan.,Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan.
| | - Jung-Chien Chen
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Kong-Han Ser
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Yi-Chih Lee
- Department of International Business, ChienHsin University of Science and Technology, Taoyuan, Taiwan
| | - Shu-Chun Chen
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan
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18
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Karimi M, Kabir A, Nejatifar M, Pazouki A. Trend of Changes in Serum Albumin and Its Relation with Sex, Age, and BMI Following Laparoscopic Mini-gastric Bypass Surgery in Morbid Obese Cases. Obes Surg 2018; 28:671-680. [PMID: 28944432 DOI: 10.1007/s11695-017-2912-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The aim of this study is to investigate the pattern of changes in serum albumin level after mini-gastric bypass (MGB) and its association with gender, age, and body mass index (BMI) of the patients. METHODS This cohort study was conducted on 196 morbidly obese patients undergoing MGB followed for 1 year. The data on BMI, serum albumin level, demographic, anthropometric, biochemical variables and comorbidities were gathered before and after (3, 6, and 12 months) surgery. The trend of changes in BMI and serum albumin of the patients was investigated by repeated measures tests using general linear model (GLM) and generalized estimating equations (GEE) approaches. RESULTS The mean age, baseline median BMI, and albumin of the patients were 41.34 ± 11.03 years, 44.54 kg/m2, and 4.00 g/dl, respectively. There was a chronologically significant trend of decline in BMI (P < 0.001). GEE demonstrated no chronologically significant trend in serum albumin (P = 0.278). The trend of changes in albumin was significantly associated only with age grouping and baseline serum albumin level (P = 0.017 and 0.001, respectively). This trend had fluctuations in patients older than 40 years with baseline serum albumin level of 3.50-3.90 g/dl. For patients with any age and baseline serum albumin level of 4.00-4.90 g/dl, this trend was stable in all periods of follow-up. CONCLUSION MGB is an effective technique to lose weight. The trend of changes in serum albumin level was affected by its baseline levels and age.
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Affiliation(s)
- Mehrdad Karimi
- Department of Surgery, Shahrekord University of Medical Sciences, Sharekord, Iran.,Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Room 255, Central Building, Hemmat Expway, Tehran, Iran
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Room 255, Central Building, Hemmat Expway, Tehran, Iran.
| | - Masoumeh Nejatifar
- Faculty of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Room 255, Central Building, Hemmat Expway, Tehran, Iran.,Center of Excellence for Minimally Invasive Surgery Training, Iran University of Medical Sciences, Tehran, Iran.,Center of Excellence of European Branch of International Federation for Surgery of Obesity, Tehran, Iran
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Juo YY, Khrucharoen U, Sanaiha Y, Chen Y, Dutson E. Postoperative Care Fragmentation Is Associated with Increased 30-Day Mortality after Bariatric Surgery. Obes Surg 2018; 28:3795-3800. [PMID: 30109668 DOI: 10.1007/s11695-018-3419-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Compromised access following bariatric centers-or-excellence designations may have led to increased incidence of non-index readmissions and worsened care fragmentation. We seek to evaluate risk factors and impact of non-index readmissions on short-term mortality during readmission using a national bariatric registry data from 2015. METHODS A retrospective cohort study was performed using a national clinical database. Multivariate logistic regression models were developed to quantify association between non-index readmissions and 30-day mortality among bariatric patients with 30-day readmissions. RESULTS A total of 4704 patients were identified as undergoing bariatric surgery and readmitted within 30 days. Of these, 325 (6.9%) patients were readmitted to a non-index facility while the rest were hospitalized at the original hospital. Patient characteristics were largely similar between the two comparison groups, although patients with in-hospital complications and non-home disposition during the initial stay were more likely to experience non-index readmissions. Multivariate regression demonstrated that non-index readmission was associated with an adjusted odds ratio of 4.4 for 30-day mortality (95% confidence interval 2.6-9.2, p < 0.01). The most common reason for mortality for both index and non-index readmissions was pulmonary embolism. CONCLUSIONS Care fragmentation may lead to increased 30-day mortality during readmissions following bariatric surgery. Heightened vigilance and longitudinal follow-up planning is recommended for patients with elevated risk for venous thromboembolism.
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Affiliation(s)
- Yen-Yi Juo
- Center for Advanced Surgical and Interventional Technology (CASIT), University of California Los Angeles, Los Angeles, CA, USA
- Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Usah Khrucharoen
- Center for Advanced Surgical and Interventional Technology (CASIT), University of California Los Angeles, Los Angeles, CA, USA
- Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Yas Sanaiha
- Center for Advanced Surgical and Interventional Technology (CASIT), University of California Los Angeles, Los Angeles, CA, USA
| | - Yijun Chen
- Center for Advanced Surgical and Interventional Technology (CASIT), University of California Los Angeles, Los Angeles, CA, USA
- Center for Obesity and METabolic Health (COMET), University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Erik Dutson
- Center for Advanced Surgical and Interventional Technology (CASIT), University of California Los Angeles, Los Angeles, CA, USA.
- Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA.
- Center for Obesity and METabolic Health (COMET), University of California Los Angeles (UCLA), Los Angeles, CA, USA.
- Department of Surgery, Division of General Surgery, David Geffen School of Medicine at UCLA, Box 956904, 72-251 Center for Health Sciences, Los Angeles, CA, 90095-6904, USA.
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20
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Revision Procedures After Failed Adjustable Gastric Banding: Comparison of Efficacy and Safety. Obes Surg 2018; 27:2861-2867. [PMID: 28569358 DOI: 10.1007/s11695-017-2716-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding (LAGB) was one of the commonly performed bariatric operations; however, it carries a high revision rate. The aim of the present study was to report the long-term outcomes of LAGB and compare the outcomes between the different revision procedures. METHODS All patients who underwent LAGB in a large bariatric center in Asia between May 2002 and April 2011 were included. Interval between primary LAGB to the revision operation, the reason and type of revision surgery were identified and analyzed. RESULTS A total of 275 consecutive patients were included. All of the procedures were completed laparoscopically with no major complications. The percentage of excess weight loss (%EWL) at 10-year follow-up was 45%. In this study, 53 patients (19.3%) had revision surgery, including with 26 single anastomosis (mini-) gastric bypass (R-LSAGB) (49%), 17 sleeve gastrectomy (R-LSG) (32.1%), 9 Roux-en-Y gastric bypass (R-LRYGB) (17%), and 1 other procedure (1.9%). A major complication occurred in 6 patients (11.3%). All of the follow-up patients with revision surgeries had %EWL > 50% at the 2-year follow-up. R-LSAGB patients achieved better weight loss than those who underwent R-LSG and R-LRYGB (p = 0.001). CONCLUSIONS The long-term result for weight loss after LAGB is unsatisfactory. The revision of failed LAGB to other bariatric surgeries is safe and can be performed in one stage with a low complication rate. Patients who underwent R-LSAGB had better weight loss results than the R-LSG or R-LRYGB patients.
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Koch TR, Shope TR, Gostout CJ. Organization of future training in bariatric gastroenterology. World J Gastroenterol 2017; 23:6371-6378. [PMID: 29085186 PMCID: PMC5643262 DOI: 10.3748/wjg.v23.i35.6371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/18/2017] [Accepted: 09/05/2017] [Indexed: 02/06/2023] Open
Abstract
A world-wide rise in the prevalence of obesity continues. This rise increases the occurrence of, risks of, and costs of treating obesity-related medical conditions. Diet and activity programs are largely inadequate for the long-term treatment of medically-complicated obesity. Physicians who deliver gastrointestinal care after completing traditional training programs, including gastroenterologists and general surgeons, are not uniformly trained in or familiar with available bariatric care. It is certain that gastrointestinal physicians will incorporate new endoscopic methods into their practice for the treatment of individuals with medically-complicated obesity, although the long-term impact of these endoscopic techniques remains under investigation. It is presently unclear whether gastrointestinal physicians will be able to provide or coordinate important allied services in bariatric surgery, endocrinology, nutrition, psychological evaluation and support, and social work. Obtaining longitudinal results examining the effectiveness of this ad hoc approach will likely be difficult, based on prior experience with other endoscopic measures, such as the adenoma detection rates from screening colonoscopy. As a long-term approach, development of a specific curriculum incorporating one year of subspecialty training in bariatrics to the present training of gastrointestinal fellows needs to be reconsidered. This approach should be facilitated by gastrointestinal trainees’ prior residency training in subspecialties that provide care for individuals with medical complications of obesity, including endocrinology, cardiology, nephrology, and neurology. Such training could incorporate additional rotations with collaborating providers in bariatric surgery, nutrition, and psychiatry. Since such training would be provided in accredited programs, longitudinal studies could be developed to examine the potential impact on accepted measures of care, such as complication rates, outcomes, and costs, in individuals with medically-complicated obesity.
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Affiliation(s)
- Timothy R Koch
- Center for Advanced Laparoscopic General and Bariatric Surgery, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC 20010, United States
| | - Timothy R Shope
- Center for Advanced Laparoscopic General and Bariatric Surgery, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC 20010, United States
| | - Christopher J Gostout
- Professor Emeritus, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
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Sabench Pereferrer F, Domínguez-Adame Lanuza E, Ibarzabal A, Socas Macias M, Valentí Azcárate V, García Ruiz de Gordejuela A, García-Moreno Nisa F, González Fernández J, Vilallonga Puy R, Vilarrasa García N, Sánchez Santos R. Quality Criteria in Bariatric Surgery: Consensus Review and Recommendations of the Spanish Association of Surgeons and the Spanish Society of Bariatric Surgery. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.cireng.2016.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Sabench Pereferrer F, Domínguez-Adame Lanuza E, Ibarzabal A, Socas Macias M, Valentí Azcárate V, García Ruiz de Gordejuela A, García-Moreno Nisa F, González Fernández J, Vilallonga Puy R, Vilarrasa García N, Sánchez Santos R. Quality criteria in bariatric surgery: Consensus review and recommendations of the Spanish Association of Surgeons and the Spanish Society of Bariatric Surgery. Cir Esp 2016; 95:4-16. [PMID: 27979315 DOI: 10.1016/j.ciresp.2016.09.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 09/16/2016] [Accepted: 09/22/2016] [Indexed: 12/19/2022]
Abstract
Bariatric surgery has proven to be highly effective in controlling obesity and metabolic syndrome; the results of this surgery are not only expressed in terms of weight loss, but also in terms of resolution of comorbidities, improved quality of life and complications. The different parameters used to measure these outcomes require uniformity and reference patterns. Therefore, it is essential to identify those indicators and quality criteria that are helpful in defining the «best practice» principles in bariatric surgery. In this regard, the Section of Obesity of the Spanish Association of Surgeons, in collaboration with the Spanish Society for Bariatric Surgery (SECO), present as an objective to identify the key points that define «quality» in this type of surgery. We describe the main indicators based on the published literature as well as the criteria for referral of the main comorbidities according to the evidence found and grades of recommendation.
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Affiliation(s)
- Fátima Sabench Pereferrer
- General and Digestive Surgery Department, University Hospital of Sant Joan, Pere Virgili Health's Institute, Faculty of Medicine, Reus (Tarragona), España; Section of Morbid Obesity, Spanish Association of Surgeons
| | - Eduardo Domínguez-Adame Lanuza
- Metabolic and Gastroesophageal Surgery Unit, Virgen de la Macarena University Hospital, Sevilla, España; Section of Morbid Obesity, Spanish Association of Surgeons
| | - Ainitze Ibarzabal
- Clinical Institute of Digestive and Metabolic Diseases, Hospital Clínic de Barcelona, Barcelona, España; Section of Morbid Obesity, Spanish Association of Surgeons
| | - María Socas Macias
- General and Digestive Surgery Department, Bariatric and Gastroesophageal Surgery Innovation Unit, University Hospital Virgen del Rocío, Sevilla, España; Section of Morbid Obesity, Spanish Association of Surgeons
| | - Víctor Valentí Azcárate
- Department of Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, CIBER Pathophysiology of Obesity and Nutrition (CIBERobn), Carlos III Health's Institut, Health Research Institute of Navarra, Pamplona, España; Section of Morbid Obesity, Spanish Association of Surgeons
| | - Amador García Ruiz de Gordejuela
- Bariatric Surgery Unit, Surgery Department, Bellvitge University Hospital, L'Hospitalet de Llobregat (Barcelona), España; Section of Morbid Obesity, Spanish Association of Surgeons
| | - Francisca García-Moreno Nisa
- Surgery Department, Ramón y Cajal University Hospital, Madrid, España; Section of Morbid Obesity, Spanish Association of Surgeons
| | - Jesús González Fernández
- Metabolic, Bariatric and General Surgery Department, Asturias Medical Center, Oviedo, España; Section of Morbid Obesity, Spanish Association of Surgeons
| | - Ramón Vilallonga Puy
- Endocrine, Metabolic and Bariatric Surgery Unit, Center of Excellence for the EAC-BC, General Surgery Department, Vall d'Hebron University Hospital, Barcelona, España; Section of Morbid Obesity, Spanish Association of Surgeons
| | - Nuria Vilarrasa García
- Endocrinology and Nutrition Department, Bellvitge University Hospital, L'Hospitalet de Llobregat (Barcelona), España; Section of Morbid Obesity, Spanish Association of Surgeons
| | - Raquel Sánchez Santos
- General and Digestive Surgery Department, Complejo Hospitalario de Pontevedra, Pontevedra, España; Section of Morbid Obesity, Spanish Association of Surgeons.
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Long-Term Results after Bariatric Surgery: A Patient-Centered Analysis. Bariatr Surg Pract Patient Care 2016. [DOI: 10.1089/bari.2016.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Conversion of Open Vertical Banded Gastroplasty to Roux-en-Y Gastric Bypass: a Single-Center, Single-Surgeon Experience with 6 Years of Follow-up. Obes Surg 2016. [PMID: 26205217 DOI: 10.1007/s11695-015-1818-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of this study is to assess feasibility, relief of complications and mid- and long-term weight loss results following the conversion of open vertical banded gastroplasty (VBG) to Roux-en-Y gastric bypass (RYGB). MATERIALS AND METHODS Retrospective analysis of patients undergoing conversion of open VBG to RYGB (open and laparoscopic) between 1 April 2000 and 1 January 2015 was performed. (Post)operative complications were listed. Weight loss was assessed using excess weight (EW), percentage excess weight loss (%EWL) and body mass index (BMI) at 1-year intervals after surgery. Ideal weight was determined by recalculating individual lengths to a BMI of 25 kg/m(2). Application of polynomial regression models was used to quantify weight loss over time. RESULTS Ninety patients were identified in the database. Mean time between bariatric interventions was 9.6 years. Reasons for conversion were insufficient weight loss (82.2%) and outlet obstruction (17.8%). Early complications were encountered in eight patients of which three were reoperated. Patients who underwent conversion for inadequate weight loss after VBG were retrospectively analyzed regarding weight loss: 78.0% EWL after 1 year, 71.4% after 2 years, 62.1% after 3 years, 64.1% after 4 years, 70.2% after 5 years, and 68.9% after 6 years. Outlet obstruction was relieved in 94%. Patient satisfaction was assessed by telephone: 86.4% would repeat the conversion. CONCLUSIONS Conversion of open VBG to RYGB is feasible and safe and can be performed with an acceptable complication rate. It gives excellent weight loss results and relief of outlet obstruction.
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Garg T, Rosas U, Rogan D, Hines H, Rivas H, Morton JM, Azagury D. Characterizing Readmissions After Bariatric Surgery. J Gastrointest Surg 2016; 20:1797-1801. [PMID: 27613733 DOI: 10.1007/s11605-016-3247-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/10/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Readmissions are an important quality metric for surgery. Here, we compare characteristics of readmissions across laparoscopic Roux-en-Y gastric bypass (LRYGB), sleeve gastrectomy (LSG), and adjustable gastric band (LAGB). METHODS Demographic, intraoperative, anthropometric, and laboratory data were prospectively obtained for 1775 patients at a single academic institution. All instances of readmissions within 1 year were recorded. Data were analyzed using STATA, release 12. RESULTS For the 1775 patients, 113 (6.37 %) were readmitted. Mean time to readmission was 52.1 days. Of all the readmissions, 64.6 % were within 30 days, 22.1 % from 30 to 90 days, 1.77 % from 90 to 180 days, and 11.5 % from 180 to 365 days. Incidence of 30-day readmissions varied across surgeries (LRYGB: 7.17 %; LAGB: 3.05 %; LSG: 4.25 %, p = 0.04). Time to readmission varied as well, with 90.0 % of LSG and 80.0 % of LABG patients within the first 30 days, versus 60.8 % of LRYGB (p = 0.02). The most common causes of readmissions were gastrointestinal issues related to index procedure (34.5 %) and did not vary across surgeries. In multivariable logistic regression, index hospital length of stay (LOS) was associated with readmission (OR = 1.07, 95 % CI 1.02-1.13, p = 0.01). CONCLUSIONS Readmissions after bariatric surgery are associated with high index hospital LOS, and a measureable proportion of procedure-related readmissions can occur up to 1 year, especially for LRYGB.
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Affiliation(s)
- Trit Garg
- Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, USA
| | - Ulysses Rosas
- Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, USA
| | - Daniel Rogan
- Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, USA
| | - Harrison Hines
- Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, USA
| | - Homero Rivas
- Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, USA
| | - John M Morton
- Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, USA.
- , 300 Pasteur Drive, H3680, Stanford, CA, 94305, USA.
| | - Dan Azagury
- Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, USA
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van Wezenbeek MR, van Hout GC, Nienhuijs SW. Medical and Psychological Predictors for Long-Term Bariatric Success Using Primary Vertical-Banded Gastroplasty as a Model. Bariatr Surg Pract Patient Care 2016. [DOI: 10.1089/bari.2016.0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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van Wezenbeek MR, Smulders FJF, de Zoete JPJGM, Luyer MD, van Montfort G, Nienhuijs SW. Long-term results after revisions of failed primary vertical banded gastroplasty. World J Gastrointest Surg 2016; 8:238-245. [PMID: 27022451 PMCID: PMC4807325 DOI: 10.4240/wjgs.v8.i3.238] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 11/19/2015] [Accepted: 01/11/2016] [Indexed: 02/07/2023] Open
Abstract
AIM: To compare the results after revision of primary vertical banded gastroplasty (Re-VBG) and conversion to sleeve gastrectomy (cSG) or gastric bypass (cRYGB).
METHODS: In this retrospective single-center study, all patients with a failed VBG who underwent revisional surgery were included. Medical charts were reviewed and additional postal questionnaires were sent to update follow-up. Weight loss, postoperative complications and long-term outcome were assessed.
RESULTS: A total 152 patients were included in this study, of which 21 underwent Re-VBG, 16 underwent cSG and 115 patients underwent cRYGB. Sixteen patients necessitated a second revisional procedure. No patients were lost-to-follow-up. Two patients deceased during the follow-up period, 23 patients did not return the questionnaire. Main reasons for revision were dysphagia/vomiting, weight regain and insufficient weight loss. Excess weight loss (%EWL) after Re-VBG, cSG and cRYGB was, respectively, 45%, 57% and 72%. Eighteen patients (11.8%) reported postoperative complications and 27% reported long-term complaints.
CONCLUSION: In terms of additional weight loss, postoperative complaints and reintervention rate, Roux-en-Y gastric bypass seems feasible as a revision for a failed VBG.
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Garg T, Rosas U, Rivas H, Azagury D, Morton JM. National prevalence, causes, and risk factors for bariatric surgery readmissions. Am J Surg 2016; 212:76-80. [PMID: 27133197 DOI: 10.1016/j.amjsurg.2016.01.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 01/03/2016] [Accepted: 01/05/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Readmissions are often used as a quality metric particularly in bariatric surgery. METHODS Laparoscopic Roux en Y gastric bypass, laparoscopic adjustable gastric banding, and laparoscopic sleeve gastrectomy were identified using Current Procedure Terminology codes in the 2012 National Surgical Quality Improvement Program public use file. RESULTS A total of 18,296 patients were included, 10,080 (55.1%) were laparoscopic Roux en Y gastric bypass, 1,829 (10.0%) were laparoscopic adjustable gastric banding, and 6,387 (34.9%) were laparoscopic sleeve gastrectomy. Among all patients, 955 (5.22%) were readmitted. Patients with readmissions had a higher proportion of body mass index greater than 50 (30.2% vs 24.6%, P < .001), higher index operative time (132 minutes vs 115, P < .001) and greater proportion with length of stay greater than 4 days (9.57% vs 3.36%, P < .001). Readmitted patients were more likely to have diabetes (31.1% vs 27.7%, P = .02), chronic obstructive pulmonary disease (2.63% vs 1.72%, P = .04), and hypertension (54.5% vs 50.8%, P = .03). Overall, 40.6% of readmitted patients had a complication. Common readmissions were gastrointestinal-related (45.0%), dietary (33.5%), and bleeding (6.57%). Readmission was independently associated with African-American race (odds ratio [OR] = 1.53, P = .02), complication (OR = 11.3, 95%, P < .001), and resident involvement (OR = .53, P = .04). CONCLUSIONS A 30-day readmission after bariatric surgery is prevalent and closely associated with complications.
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Affiliation(s)
- Trit Garg
- Department of Surgery, Section of Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, 300 Pasteur Drive, H3680, Stanford, CA 94305, USA
| | - Ulysses Rosas
- Department of Surgery, Section of Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, 300 Pasteur Drive, H3680, Stanford, CA 94305, USA
| | - Homero Rivas
- Department of Surgery, Section of Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, 300 Pasteur Drive, H3680, Stanford, CA 94305, USA
| | - Dan Azagury
- Department of Surgery, Section of Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, 300 Pasteur Drive, H3680, Stanford, CA 94305, USA
| | - John M Morton
- Department of Surgery, Section of Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, 300 Pasteur Drive, H3680, Stanford, CA 94305, USA.
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Abstract
BACKGROUND The vertical banded gastroplasty (VBG) used to be a common restrictive bariatric procedure but has been abandoned by many due to a high failure rate, a high incidence of long-term complications, and the newer adjustable gastric band (AGB) and sleeve. However, potential favorable long-term results and the upcoming banded gastric bypass, with a similar mechanical outlet restriction and control of the pouch size, renewed our interest in the VBG. Therefore, we investigated the long-term outcome of primary VBG at the Catharina Hospital in the Netherlands. METHODS Patients that underwent a primary VBG between 1998 and 2008 were included. Patients' characteristics, operative details, evolution on weight and comorbidities, complications, and outcome of revisions were reviewed. RESULTS A total of 392 patients (80 % female) were reviewed with a mean age of 40 ± 9 years and body mass index of 44 ± 5 kg/m(2). Mean follow-up after VBG was 66 ± 50 months and showed a mean excess weight loss (EWL) of 53 ± 27 % and comorbidity reduction of 54 %. One hundred fifty-two patients (39 %) out of 227 patients (58 %) with long-term complaints underwent revisional surgery. Main reasons for revision were weight regain and vomiting/food intolerance. Analysis before revision showed an outlet dilatation (17 %), pouch dilatation (16 %), and outlet stenosis (10 %). After revision, an additional EWL of 23 % and 33 % further reduction in comorbidities was seen. CONCLUSIONS Primary VBG has an acceptable EWL of 53 % and 55 % of comorbidities were improved. However, the high complication rate, often necessitating revision, underlines the limits of this procedure.
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Hasani M, Mirahmadian M, Taheri E, Qorbani M, Talebpour M, Hosseni S. The Effect of Laparoscopic Gastric Plication Surgery on Body Composition, Resting Energy Expenditure, Thyroid Hormones, and Physical Activity in Morbidly Obese Patients. Bariatr Surg Pract Patient Care 2015. [DOI: 10.1089/bari.2015.0031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Motahareh Hasani
- Department of Nutrition and Biochemistry, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehri Mirahmadian
- Department of Nutrition and Biochemistry, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsaneh Taheri
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Department of Community Medicine School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Science, Tehran, Iran
| | | | - Saeed Hosseni
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Clinical Nutrition, School Dietetic, Tehran University of Medical Science, Tehran, Iran
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Long-term effects of bariatric surgery on type II diabetes, hypertension and hyperlipidemia: a meta-analysis and meta-regression study with 5-year follow-up. Obes Surg 2015; 25:397-405. [PMID: 25240392 DOI: 10.1007/s11695-014-1442-4] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The first aim of the study was to estimate weight loss and major modifiable risk factors after bariatric surgery. The second aim was to investigate the relationship between the reduction in cardiovascular risk and weight loss over time. METHODS A random effect of meta-analysis and dose-response meta-regression was used to evaluate weight loss and the risk of type II diabetes, hypertension and hyperlipidemia, 2-5 years after surgery. RESULTS A search of the literature led to the selection of 22 papers. The body mass index (BMI) at the end of the observation period was 31.7 (95 % CI = 29.7-33.7; I(2) = 6 %). The risk of type II diabetes, hypertension and hyperlipidemia decreased after bariatric surgery, with relative risks of, respectively, 0.33 (95 % CI = 0.26-0.41; I(2) = 42 %), 0.54 (95 % CI = 0.46-0.64; I(2) = 68 %) and 0.33 (95 % CI = 0.22-0.46; I(2) = 74 %). Nonlinear meta-regression revealed different patterns of risk: Hypertension risk reached a minimum when the BMI fell 10 units. The risks of all cardiovascular outcomes reached a plateau, 20-40 months after surgery. CONCLUSIONS The reduction in arterial hypertension reached a nadir earlier than the risk of diabetes and hyperlipidemia, thus indicating a possible link between weight reduction and positive hemodynamic effects.
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Influence of excess weight loss and weight regain on biochemical indicators during a 4-year follow-up after Roux-en-Y gastric bypass. Obes Surg 2015; 25:279-84. [PMID: 24996801 DOI: 10.1007/s11695-014-1349-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Bariatric surgery produces a substantial weight loss and improves the comorbidities associated with obesity such as diabetes mellitus and dyslipidemia, although inability to lose weight or weight regain has been estimated to occur in 20 % of cases. The objective of the present study was to assess the influence of weight variations on biochemical indicators during a 4-year period after bariatric surgery. METHODS A 4-year retrospective longitudinal study was conducted on 138 patients with grade III obesity submitted to Roux-en-Y gastric bypass, with the assessment of anthropometric measurements and biochemical indicators. The patients were divided into two groups according to percent excess weight loss (%EWL): %EWL > 50 % and %EWL < 50 %, and into two groups according to weight regain: <10 % and >10 %. The Student t test for independent samples was used to assess the differences in biochemical indicators between groups (p ≤ 0.05). RESULTS Four years after surgery, there was a weight loss of 49.4 ± 21.8 kg and %EWL of 61 ± 21.2 %, with 73.2 % (n = 101) of the patients showing %EWL of 50 % or more. Significant weight regain occurred in 24.6 % of the sample. There was a difference in weight, BMI, total cholesterol, LDL-cholesterol, triglycerides, and albumin between patients with different %EWL. No difference in biochemical indicators was observed between subjects with and without regain. CONCLUSION Four years after surgery, greater %EWL was associated with a better lipid profile. In addition, weight regain did not change the biochemical indicators of this patient series.
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Ahluwalia JS, Kuo HC, Chang PC, Sun PL, Hung KC, Huang CK. Standardized Technique of Laparoscopic Adjustable Gastric Banded Plication with 4-Year Results. Obes Surg 2015; 25:1756-7. [DOI: 10.1007/s11695-015-1756-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Lin YH, Lee WJ, Ser KH, Chen SC, Chen JC. 15-year follow-up of vertical banded gastroplasty: comparison with other restrictive procedures. Surg Endosc 2015; 30:489-494. [PMID: 26045096 DOI: 10.1007/s00464-015-4230-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 05/08/2015] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Vertical banded gastroplasty (VBG) has been the procedure of choice for bariatric surgeries since the 1980s. However, long-term results of VBG have been reported with different opinions, and new restrictive procedures have been innovated and showing variable results. The aim of this study is to analyze the long-term results of our VBG patients. PATIENT AND METHODS Between June 1998 and May 2002, 652 morbidly obese patients received VBG, with the initial 40 patients having open procedures and the subsequent 612 patients using a laparoscopic approach. Operative complications, weight loss, and late complications were followed and compared with groups of laparoscopic adjustable gastric banding (LAGB) and sleeve gastrectomy (LSG). RESULTS Mean age, preoperative weight, and body mass index (BMI) were 30.96 years, 108.83 kg, and 40.63 kg/m(2), respectively. The overall early postoperative complication rate was 3.4% (22/652). The excess weight loss percentages at 1, 2, 5, and 10 years were 61.04, 59.70, 51.11, and 42.0%, respectively. BMI at 1, 2, 5, and 10 years were 29.64, 29.71, 31.33, and 31.73 kg/m(2), respectively. This result is inferior to the 67% excess weight loss in the LSG group, but is higher than the 38% excess weight loss of the LAGB group. The revision rate is 13.19% (86/652) up to now. Revision surgery was required in 28 (14.0%) patients in the LAGB group and 8 (1.3%) in the LSG group. CONCLUSION VBG was an operation with acceptable outcome for treating morbid obesity and metabolic disorders. It sets a standard for new restrictive procedures.
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Affiliation(s)
- Yu-Hung Lin
- Department of Surgery, Min-Sheng General Hospital, National Taiwan University, No. 168, Chin Kuo Road, Taoyuan, Taiwan, Roc.,Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Road, Niaosong District, Kaohsiung, Taiwan, Roc
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, National Taiwan University, No. 168, Chin Kuo Road, Taoyuan, Taiwan, Roc.
| | - Kong-Han Ser
- Department of Surgery, Min-Sheng General Hospital, National Taiwan University, No. 168, Chin Kuo Road, Taoyuan, Taiwan, Roc
| | - Shu-Chun Chen
- Department of Surgery, Min-Sheng General Hospital, National Taiwan University, No. 168, Chin Kuo Road, Taoyuan, Taiwan, Roc
| | - Jung-Chien Chen
- Department of Surgery, Min-Sheng General Hospital, National Taiwan University, No. 168, Chin Kuo Road, Taoyuan, Taiwan, Roc
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Major Esophageal Dilation After Laparoscopic Adjustable Gastric Banding in Symptomatic Patients: Does It Prevent Effective Weight Loss and How Should It be Treated? World J Surg 2015; 39:2000-5. [DOI: 10.1007/s00268-015-3036-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Amorim ACRD, Souza AFOD, Nascimento ALV, Maio R, Burgos MGPDA. Use of alcohol before and after bariatric surgery. Rev Col Bras Cir 2015; 42:3-8. [DOI: 10.1590/0100-69912015001002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 04/15/2015] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE: to assess alcohol intake in the bariatric surgery pre and postoperative periods. METHODS: Patients were interviewed atSurgery Clinic of the Hospital das Clínicas da Universidade Federal de Pernambuco - HC/UFPE (Brazil) from July 2011 to March 2012. We analyzed socioeconomic, anthropometric and clinical variables. We used the Alcohol Use Disorders Identification Test (AUDIT C). RESULTS: One hundred nineteen patients were enrolled (mean age: 41.23+11.30 years), with a predominance of the female gender (83.2%), non-Caucasian race (55%), married individuals or in a stable union (65.5%), with a high school education (40.3%)and active in the job market (37%). Weight and body mass index (BMI) were 128.77+25.28Kg and 49.09+9.26Kg/m2,respectively in the preoperative period (class II obesity) and 87.19+19.16Kg and 33.04+6.21Kg/m2, respectively in the postoperative period (class I obesity) (p<0.001). Hypertension was the most frequent disease in the pre (66.6%) and postoperative (36.5%) periods. The prevalence of alcohol use was 26.6% in the preoperative period, of which 2.2% of high risk, and 35.1% in the postoperative period, of which 1.4% of probable dependence; this difference did not achieve statistical significance (p=0.337). CONCLUSION: The prevalence of abusive alcohol intake and/or probable dependence was low in both the pre and postoperative periods, with little evidence of risky consumption among the patients submitted to bariatric surgery.
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Conventional versus fast track anaesthesia in an unselected group of patients undergoing revisional bariatric surgery. INTERNATIONAL JOURNAL OF SURGERY OPEN 2015. [DOI: 10.1016/j.ijso.2016.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Mesenteric defect closure in laparoscopic Roux-en-Y gastric bypass: a randomized controlled trial. Surg Endosc 2014; 29:2486-90. [DOI: 10.1007/s00464-014-3970-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 10/25/2014] [Indexed: 01/17/2023]
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Liu XZ, Yin K, Fan J, Shen XJ, Xu MJ, Wang WH, Zhang YG, Zheng CZ, Zou DJ. Long-Term outcomes and experience of laparoscopic adjustable gastric banding: one center's results in China. Surg Obes Relat Dis 2014; 11:855-9. [PMID: 25862180 DOI: 10.1016/j.soard.2014.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/11/2014] [Accepted: 09/21/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding (LAGB), as one major bariatric surgery for treatment of obesity, results in ineffective long-term weight loss and a high reoperation rate. The objective of this study was to evaluate the long-term effects of LAGB on the weight loss outcomes and reoperation rates of obese patients with different body mass index (BMI) levels in China. METHODS A retrospective study was performed to review the follow-up data of obese patients who underwent LAGB at Shanghai Changhai Hospital between November 2003 and May 2013. The main outcomes included weight loss, percentage excess weight loss (%EWL), reoperation rate, and reasons for reoperation. RESULTS A total of 254 LAGB procedures were performed in our hospital. By the end of May 2013, 145 Chinese patients (57.8%) were followed up, 99 patients with BMI ≥ 35 kg/m(2) (high BMI group) and 46 patients with BMI < 35 kg/m(2) (low BMI group). In the high BMI group, the mean %EWL was > 25% within 5 years postoperatively, but it decreased to less than 25% after 5 years. However, in the low BMI group, the mean %EWL at each time point was over 50%. The reoperation rate was 33.1%; it was 17.4% in the low BMI group and 34.3% in the high BMI group. CONCLUSION LAGB is more effective with a lower reoperation rate for obese patients with a BMI < 35 kg/m(2) compared to BMI ≥ 35 kg/m(2) in our population.
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Affiliation(s)
- Xing Zhen Liu
- The First Department of Recovery, Hangzhou Sanatorium of Nanjing Military Command Region, Hangzhou 310007, China; Department of Endocrinology, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Kai Yin
- Department of General Surgery, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Jie Fan
- The First Department of Recovery, Hangzhou Sanatorium of Nanjing Military Command Region, Hangzhou 310007, China
| | - Xiao Jun Shen
- Department of General Surgery, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Mao Jin Xu
- Department of Endocrinology, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Wen Hui Wang
- Department of Pathology, The 117 Hospital of PLA, Hangzhou 310007, China
| | - Yan Gao Zhang
- The First Department of Recovery, Hangzhou Sanatorium of Nanjing Military Command Region, Hangzhou 310007, China
| | - Cheng Zhu Zheng
- Department of General Surgery, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China.
| | - Da Jin Zou
- Department of Endocrinology, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China.
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Abstract
Obesity is a leading preventable cause of death worldwide, with increasing prevalence in adults and children, and authorities view it as one of the most serious public health problems of the 21st century. Sixty-two percent of the Hungarian adult population has overweight and 27% is morbidly obese and, therefore, it is a significant interest to treat this condition. The authors review the diagnosis and the associated diseases of morbid obesity. The initial enthusiasm with the gastric band has settled now, as the long-term outcome showed only very limited reduction in the excess body weight and the complication rate was as high as 50%. The sleeve gastrectomy may induce 60-70% of excess weight loss, however, the long term follow-up data is very limited. The Roux-en-Y gastric bypass is the gold-standard of the bariatric procedures, with proven 60-75% excess weight loss and 80% type 2 diabetes remission. The body image usually changes with weight loss, and frequently a body contouring procedure is required to improve it. Multi-disciplinary team of super-specialised doctors is required to perform these procedures.
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Affiliation(s)
- Péter Vasas
- Royal Derby Hospital, Derby Bariatric Surgery Department Uttoxeter Road Derby DE22 3NE Egyesült Királyság BodyContour Clinic London-Budapest
| | - Ferenc Pór
- Perfect-Form Kft. Budapest BodyContour Clinic London-Budapest
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Abstract
BACKGROUND Bariatric (weight loss) surgery for obesity is considered when other treatments have failed. The effects of the available bariatric procedures compared with medical management and with each other are uncertain. This is an update of a Cochrane review first published in 2003 and most recently updated in 2009. OBJECTIVES To assess the effects of bariatric surgery for overweight and obesity, including the control of comorbidities. SEARCH METHODS Studies were obtained from searches of numerous databases, supplemented with searches of reference lists and consultation with experts in obesity research. Date of last search was November 2013. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing surgical interventions with non-surgical management of obesity or overweight or comparing different surgical procedures. DATA COLLECTION AND ANALYSIS Data were extracted by one review author and checked by a second review author. Two review authors independently assessed risk of bias and evaluated overall study quality utilising the GRADE instrument. MAIN RESULTS Twenty-two trials with 1798 participants were included; sample sizes ranged from 15 to 250. Most studies followed participants for 12, 24 or 36 months; the longest follow-up was 10 years. The risk of bias across all domains of most trials was uncertain; just one was judged to have adequate allocation concealment.All seven RCTs comparing surgery with non-surgical interventions found benefits of surgery on measures of weight change at one to two years follow-up. Improvements for some aspects of health-related quality of life (QoL) (two RCTs) and diabetes (five RCTs) were also found. The overall quality of the evidence was moderate. Five studies reported data on mortality, no deaths occurred. Serious adverse events (SAEs) were reported in four studies and ranged from 0% to 37% in the surgery groups and 0% to 25% in the no surgery groups. Between 2% and 13% of participants required reoperations in the five studies that reported these data.Three RCTs found that laparoscopic Roux-en-Y gastric bypass (L)(RYGB) achieved significantly greater weight loss and body mass index (BMI) reduction up to five years after surgery compared with laparoscopic adjustable gastric banding (LAGB). Mean end-of-study BMI was lower following LRYGB compared with LAGB: mean difference (MD) -5.2 kg/m² (95% confidence interval (CI) -6.4 to -4.0; P < 0.00001; 265 participants; 3 trials; moderate quality evidence). Evidence for QoL and comorbidities was very low quality. The LRGYB procedure resulted in greater duration of hospitalisation in two RCTs (4/3.1 versus 2/1.5 days) and a greater number of late major complications (26.1% versus 11.6%) in one RCT. In one RCT the LAGB required high rates of reoperation for band removal (9 patients, 40.9%).Open RYGB, LRYGB and laparoscopic sleeve gastrectomy (LSG) led to losses of weight and/or BMI but there was no consistent picture as to which procedure was better or worse in the seven included trials. MD was -0.2 kg/m² (95% CI -1.8 to 1.3); 353 participants; 6 trials; low quality evidence) in favour of LRYGB. No statistically significant differences in QoL were found (one RCT). Six RCTs reported mortality; one death occurred following LRYGB. SAEs were reported by one RCT and were higher in the LRYGB group (4.5%) than the LSG group (0.9%). Reoperations ranged from 6.7% to 24% in the LRYGB group and 3.3% to 34% in the LSG group. Effects on comorbidities, complications and additional surgical procedures were neutral, except gastro-oesophageal reflux disease improved following LRYGB (one RCT). One RCT of people with a BMI 25 to 35 and type 2 diabetes found laparoscopic mini-gastric bypass resulted in greater weight loss and improvement of diabetes compared with LSG, and had similar levels of complications.Two RCTs found that biliopancreatic diversion with duodenal switch (BDDS) resulted in greater weight loss than RYGB in morbidly obese patients. End-of-study mean BMI loss was greater following BDDS: MD -7.3 kg/m² (95% CI -9.3 to -5.4); P < 0.00001; 107 participants; 2 trials; moderate quality evidence). QoL was similar on most domains. In one study between 82% to 100% of participants with diabetes had a HbA1c of less than 5% three years after surgery. Reoperations were higher in the BDDS group (16.1% to 27.6%) than the LRYGB group (4.3% to 8.3%). One death occurred in the BDDS group.One RCT comparing laparoscopic duodenojejunal bypass with sleeve gastrectomy versus LRYGB found BMI, excess weight loss, and rates of remission of diabetes and hypertension were similar at 12 months follow-up (very low quality evidence). QoL, SAEs and reoperation rates were not reported. No deaths occurred in either group.One RCT comparing laparoscopic isolated sleeve gastrectomy (LISG) versus LAGB found greater improvement in weight-loss outcomes following LISG at three years follow-up (very low quality evidence). QoL, mortality and SAEs were not reported. Reoperations occurred in 20% of the LAGB group and in 10% of the LISG group.One RCT (unpublished) comparing laparoscopic gastric imbrication with LSG found no statistically significant difference in weight loss between groups (very low quality evidence). QoL and comorbidities were not reported. No deaths occurred. Two participants in the gastric imbrication group required reoperation. AUTHORS' CONCLUSIONS Surgery results in greater improvement in weight loss outcomes and weight associated comorbidities compared with non-surgical interventions, regardless of the type of procedures used. When compared with each other, certain procedures resulted in greater weight loss and improvements in comorbidities than others. Outcomes were similar between RYGB and sleeve gastrectomy, and both of these procedures had better outcomes than adjustable gastric banding. For people with very high BMI, biliopancreatic diversion with duodenal switch resulted in greater weight loss than RYGB. Duodenojejunal bypass with sleeve gastrectomy and laparoscopic RYGB had similar outcomes, however this is based on one small trial. Isolated sleeve gastrectomy led to better weight-loss outcomes than adjustable gastric banding after three years follow-up. This was based on one trial only. Weight-related outcomes were similar between laparoscopic gastric imbrication and laparoscopic sleeve gastrectomy in one trial. Across all studies adverse event rates and reoperation rates were generally poorly reported. Most trials followed participants for only one or two years, therefore the long-term effects of surgery remain unclear.
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Affiliation(s)
- Jill L Colquitt
- University of SouthamptonSouthampton Health Technology Assessments CentreFirst Floor, Epsilon House, Enterprise Road, Southampton Science Park, ChilworthSouthamptonHampshireUKSO16 7NS
| | - Karen Pickett
- University of SouthamptonSouthampton Health Technology Assessments CentreFirst Floor, Epsilon House, Enterprise Road, Southampton Science Park, ChilworthSouthamptonHampshireUKSO16 7NS
| | - Emma Loveman
- University of SouthamptonSouthampton Health Technology Assessments CentreFirst Floor, Epsilon House, Enterprise Road, Southampton Science Park, ChilworthSouthamptonHampshireUKSO16 7NS
| | - Geoff K Frampton
- University of SouthamptonSouthampton Health Technology Assessments CentreFirst Floor, Epsilon House, Enterprise Road, Southampton Science Park, ChilworthSouthamptonHampshireUKSO16 7NS
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Shimizu H, Annaberdyev S, Motamarry I, Kroh M, Schauer PR, Brethauer SA. Revisional bariatric surgery for unsuccessful weight loss and complications. Obes Surg 2014; 23:1766-73. [PMID: 23828032 DOI: 10.1007/s11695-013-1012-1] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND There are growing numbers of patients who require revisional bariatric surgery due to the undesirable results of their primary procedures. The aim of this study was to review our experience with bariatric patients undergoing revisional surgery. METHODS We conducted a retrospective analysis to review the indications for revisional bariatric procedures and assess their postoperative outcomes. RESULTS From 04/04 to 01/11, 2,918 patients underwent bariatric surgery at our institution. A total of 154 patients (5.3%) of these cases were coded as revisional procedures. The mean age at revision was 49.1 ± 11.3 and the mean BMI was 44.0 ± 13.7 kg/m2. Revisional surgery was performed laparoscopically in 121 patients (78.6%). Laparoscopic revisions had less blood loss, shorter length of hospital stay, and fewer complications compared to open revisions. Two groups (A and B) were defined by the indication for revision: patients with unsuccessful weight loss (group A, n = 106) and patients with complications of their primary procedures (group B, n = 48). In group A, 74.5% of the patients were revised to a bypass procedure and 25.5% to a restrictive procedure. Mean excess weight loss was 53.7 ± 29.3% after revision of primary restrictive procedures and 37.6 ± 35.1% after revision of bypass procedures at >1-year follow-up (p < 0.05). In group B, the complications prompting revision were effectively treated by revisional surgery. CONCLUSIONS Revisional bariatric surgery effectively treated the undesirable results from primary bariatric surgery. Laparoscopic revisional surgery can be performed after both failed open and laparoscopic bariatric procedures without a prohibitive complication rate. Carefully selected patients undergoing revision for weight regain have satisfactory additional weight loss.
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Affiliation(s)
- Hideharu Shimizu
- Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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Wilhelm SM, Young J, Kale-Pradhan PB. Effect of Bariatric Surgery on Hypertension. Ann Pharmacother 2014; 48:674-682. [DOI: 10.1177/1060028014529260] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Purpose: Obesity is a growing epidemic leading to worldwide public health concerns. Bariatric surgery is an option for patients with a body mass index (BMI) >40 kg/m2 or BMI of >35 kg/m2 with serious comorbid conditions. This meta-analysis examines the effect of bariatric surgery on the improvement or resolution of hypertension. Methods: Two independent investigators conducted a literature search of PubMed (1990-2013) and Cochrane databases using the terms bariatric surgery and hypertension to identify appropriate human adult studies published in English. Studies were included if they reported the number of patients with hypertension prior to undergoing any bariatric surgery procedure and whether the hypertension improved or resolved postsurgery. The number of patients with hypertension and their response rates were extracted and analyzed using RevMan 5.2.5. Results: In all, 31 prospective and 26 retrospective studies met all criteria. The types of bariatric surgery performed included Roux-en-Y, gastric banding, laparoscopic adjustable gastric banding, vertical gastric banding, sleeve gastrectomy, duodenal switch, and biliopancreatic diversion. The time to first follow-up after surgery varied from 1 week to 7 years. Of the 57 studies, 32 reported improvement of hypertension in 32 628 of 51 241 patients (odds ratio [OR] = 13.24; 95% CI = 7.73, 22.68; P < 0.00001); 46 studies reported the resolution of hypertension in 24 902 of 49 844 patients (OR = 1.70; 95% CI = 1.13, 2.58; P = 0.01). A random-effects model was used because the heterogeneity between the studies was high ( I2 = 97%). Conclusion: The results of this meta-analysis indicate that patients who undergo bariatric surgery experience improvement and resolution of their hypertension.
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Affiliation(s)
- Sheila M. Wilhelm
- Wayne State University, Detroit, MI, USA
- Harper University Hospital, Detroit, MI, USA
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Bekheit M, Katri K, Salam WNA, Ezzat T, El Kayal ES. Rejecting the demise of vertical-banded gastroplasty: a long-term single-institute experience. Obes Surg 2014; 23:1604-10. [PMID: 23636993 DOI: 10.1007/s11695-013-0969-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Surgical interventions have proven to be more effective than other measures in the treatment of morbid obesity. The short-term outcomes of the various surgical interventions have been well documented in the literature, with fewer reports on long-term outcomes. The reported long-term outcome of the vertical-banded gastroplasty (VBG) is conflicting. The aim of the present study was to evaluate our long-term experience with VBG. A retrospective review of a prospectively maintained database was conducted. Records of patients who underwent VBG five or more years ago were retrieved. An analysis of the long-term weight changes and reported complications was conducted. The study included 150 patients: 43 males (29%) and 107 females (71%). Their mean age was 30 years old (12-53), and the mean body mass index (BMI) was 47 ± 8.4 kg/m2. Patients were followed up for an average of 8 years (5-11). More than 60 % of patients had good long-term weight loss (EWL > 50%). A significant negative correlation was found between the excess weight loss percent (EWL%) and the pre-operative BMI (p < 0.05). The differences in EWL% between males and females were not significant (p = 0.061). Nevertheless, the change in EWL% over time for both males and females was significant (p = 0.004). Revision surgery was required in seven patients (4.7%). Five patients had conversion of VBG to gastric bypass (3.3%), while two patients (1.3%) had reversal of the procedure. Late complications included mesh erosion in three cases, staple line dehiscence in two patients, and stomal stenosis in six patients. VBG could be a long-term effective intervention for the treatment of morbid obesity. Good selection is the cornerstone for long-term success. Late complication rate is acceptable after VBG. VBG is a specifically useful tool under stringent financial circumstances.
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Affiliation(s)
- Mohamed Bekheit
- HBP Surgery Unit, Department of Surgery, Faculty of medicine, Alexandria Main University Hospital, Alexandria, Egypt,
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Bekheit M, Katri K, Ashour MH, Sgromo B, Abou-ElNagah G, Abdel-Salam WN, Catheline JM, El Kayal ES. Gender influence on long-term weight loss after three bariatric procedures: gastric banding is less effective in males in a retrospective analysis. Surg Endosc 2014; 28:2406-11. [PMID: 24648106 DOI: 10.1007/s00464-014-3489-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 02/14/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Identifying factors that influence weight loss after bariatric surgery is one way to predict a successful surgical outcome. Knowledge of the effect of gender on weight loss after bariatric surgery has not been well demonstrated in the literature despite being noted in every day practice. The aim of this study was to find the influence of gender on long-term weight loss after bariatric surgery. METHODS A retrospective analysis of data retrieved from a prospectively maintained bariatric database was conducted. RESULTS The study included 640 consecutive patients. Their mean age was 38 ± 10 years, mean preoperative body mass index was 44.9 ± 8.4 kg/m2, and mean preoperative excess weight (EW %) was 108.3 ± 38.4%. The mean of the average excess weight loss (EWL %) was 43.3 ± 42.4%. Three procedures were utilized: Roux-en-Y gastric bypass (RYGB), vertical banded gastroplasty (VBG), and gastric banding (GB). Both VBG and RYGB induced significantly more EWL % than GB (d = 22.1%, p < 0.001 and d = 16, p = 0.02, respectively). In patients who underwent VBG and GB, males had significantly lower preoperative EW % (Student t = -4.86, p < 0.001, and Student t = 4.69, p < 0.001, respectively), and postoperative mean of the average EWL % (Student t = -2.43, p = 0.016, and Student t = -3.33, p = 0.002, respectively) than females. In patients who underwent RYGB, there were no differences in the preoperative EW % (t = -1.03, p = 0.309) or the mean of the average EWL % (t = 0.406, p = 0.688). The simple linear regression model used to explain the variability in EWL %, accounted for by the variability in the preoperative EW %, was significant (F = 180, p < 0.001). Analysis of the residual errors in predicting the EWL % revealed no significant difference between males and females after VBG and after RYGB (t = 0.117, p = 0.907 and t = 1.052, p = 0.3, respectively), while it was significant after GB (t = -2.999, p = 0.003). CONCLUSION From our experience, we suggest that GB not to be offered as a first choice for obese male patients.
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Affiliation(s)
- Mohamed Bekheit
- Minimal Invasive Surgery Unit, Department of Surgery, El Kabbary General Hospital, El Kabbary, Alexandria, Egypt,
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Prevalence and risk factors of urinary incontinence and bladder retention in gastric bypass surgery: a cross-sectional study. Obes Surg 2014; 23:760-3. [PMID: 23306798 DOI: 10.1007/s11695-012-0863-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Morbid obesity is a known risk factor for developing symptoms of urinary incontinence. However, it is not known if this leads to a high prevalence of perioperative incontinence and bladder retention after bariatric surgery because routine use of bladder catheterization is usual during this kind of surgery. The study was conducted at a general hospital in the Netherlands. Sixty morbidly obese female patients undergoing laparoscopic gastric bypass surgery were included in the present study. Preoperative urinary incontinence and risk factors were investigated by use of questionnaires. The following perioperative parameters were collected: operation time, total amount of intravenous fluids, preoperative urinary retention on the ward measured by bladder scan, postoperative urinary incontinence on the recovery room, postoperative urinary retention on the ward after passing urine measured by bladder scan, and observed urination on the ward. The prevalence of preoperative incontinence was 43 %. Nine patients (15 %) had postoperative urinary incontinence including four patients with known incontinence and five patients without. There were no differences between the patients with and without postoperative incontinence with relation to age, body mass index, diabetes mellitus, operation time, received amount of intravenous fluids and pre- and postoperative bladder scan residual volumes. Although the prevalence of urinary incontinence is high among morbidly obese female patients seeking bariatric surgery, postoperative incontinence was only present in 15 % of patients, and there was no need for catheterization for bladder retention. Preoperative risk factors for developing this kind of complications could not be identified.
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Hassanian M, Al-Mulhim A, Al-Sabhan A, Al-Amro S, Bamehriz F, Abdo A, Al Khalidi H, Aldoheyan TA. The effect of bariatric surgeries on nonalcoholic fatty liver disease. Saudi J Gastroenterol 2014; 20:270-8. [PMID: 25253361 PMCID: PMC4196341 DOI: 10.4103/1319-3767.141684] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
A review of published data addressing hepatic histopathological, metabolical, and functional changes following gastric banding, sleeve gastrectomy, gastric bypass surgery, and biliopancreatic with duodenal switch surgeries on nonalcoholic fatty liver disease (NAFLD). NAFLD is currently the most common chronic liver disease. Owing to the strong relationship between obesity and NAFLD, the idea of weight reduction as a method to treat NAFLD has rapidly emerged. Bariatric surgery has proved to be the most efficient method for weight reduction; hence, their beneficial effects on NAFLD have been evaluated by several studies. A literature review of published data was performed during the years 2012-2014 using PubMed with the following key words: Bariatric, NAFLD, steatosis, sleeve gastrectomy, gastric bypass, gastric banding, biliopancreatic diversion with duodenal switch, obesity, and insulin resistance (IR). Exclusion criteria were non-English articles and inherited NAFLD, pregnancy-induced NAFLD, and children. The majority of published data are in favor of indicating that bariatric surgeries improve the histologic and metabolic changes associated with NAFLD. The suggested mechanisms are: The reversal of IR, reduction of inflammatory markers, and improved histological features of NAFLD. Accordingly, bariatric surgeries are potentially one of the future methods in treating patients with morbid obesity and NAFLD. However, some questions remain unanswered, such as whether timing of surgery, type of surgery most effective, and whether bariatric surgeries are capable of curing the disease. Long-term and well-designed prospective studies are needed to address these issues.
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Affiliation(s)
- Mazen Hassanian
- Department of Surgery, College of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia,Address for correspondence: Dr. Mazen Hassanian, Department of Surgery, College of Medicine, King Saud University, PO Box 25179, Riyadh 11466, Saudi Arabia. E-mail:
| | - Amnah Al-Mulhim
- Department of Surgery, College of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Atheer Al-Sabhan
- Department of Surgery, College of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Shaden Al-Amro
- Department of Surgery, College of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Fahad Bamehriz
- Department of Surgery, College of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Ayman Abdo
- Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia
| | - Hisham Al Khalidi
- Department of Surgery, College of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia
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Aarts EO, Dogan K, Koehestanie P, Janssen IMC, Berends FJ. What happens after gastric band removal without additional bariatric surgery? Surg Obes Relat Dis 2013; 10:1092-6. [PMID: 24462304 DOI: 10.1016/j.soard.2013.10.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 10/14/2013] [Accepted: 10/19/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The laparoscopic adjustable gastric band (LAGB) is widely used for the treatment of morbid obesity. Many patients benefit from this procedure initially, but experience complications after a few years. The treatment for many complications is revisional bariatric surgery. A number of patients, however, request only band removal without secondary bariatric surgery. The aim of this study was to assess the perioperative and medium term outcomes of patients who had their LAGB removed without secondary bariatric surgery. METHODS Patients were retrospectively selected using a prospectively collected database. The LAGB had to be in situ for at least 1 year, and minimum postoperative follow-up had to be 12 months. RESULTS Thirty-eight patients who had their LAGB laparoscopically removed between 2000 and 2010 were included. Median follow-up after LAGB removal was 3.0 (1.4 to 8.9) years. Only 2 complications (5%) and no mortality occurred perioperatively. In the 21 patients who did not undergo additional bariatric surgery, the median excess weight loss (EWL) decreased from 41% (-12% to -100%) at band removal to 9% (-10% to 90%), 0% (-20% to 78%), and -11% (-12% to 56%) after 1, 2, and 5 years, respectively. Percentage weight loss (%WL) was 17% (-54% to -5%), 4% (-47% to -9%), 0% (-41% to 11%), and -5% (-29% to 9%) after these same time intervals, respectively. After a median 2.1 (.5 to 9.9) years, 17 patients underwent either a Roux-en-Y gastric bypass (14 patients) or a Scopinaro (3 patients) all because of weight regain. The current EWL and %WL in these patients is 67% (24% to 113%) and 30% (12% to 53%), respectively compared with -11% (-33% to 57%) and -4% (-14% to 34%) in patients without a secondary bariatric procedure (P< .001). CONCLUSION Patients who have their LAGB removed are guaranteed to suffer from weight regain. It is inadvisable to only remove the LAGB without performing an additional bariatric procedure when deemed technically feasible and safe. In this study, no patient was able to maintain the weight loss achieved with the LAGB after its removal.
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Affiliation(s)
- Edo O Aarts
- Department of Surgery Rijnstate Hospital, The Netherlands.
| | - Kemal Dogan
- Department of Surgery Rijnstate Hospital, The Netherlands
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Nakamura T, Mamary E. A Qualitative Assessment of the My True Body Bariatric Surgery Preparation Program. AMERICAN JOURNAL OF HEALTH EDUCATION 2013. [DOI: 10.1080/19325037.2013.811363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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