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Queiroz S, Gadelha JG, Husain N, Gutu CS. Effect of Gastric Bypass vs Sleeve Gastrectomy on Remission of Type 2 Diabetes Mellitus Among Patients with Severe Obesity: A Meta-Analysis. Obes Surg 2025:10.1007/s11695-025-07858-w. [PMID: 40377815 DOI: 10.1007/s11695-025-07858-w] [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: 06/30/2024] [Revised: 03/19/2025] [Accepted: 04/04/2025] [Indexed: 05/18/2025]
Abstract
BACKGROUND Obesity and type 2 diabetes mellitus (T2DM) are global health crises, with bariatric surgery emerging as a key intervention. However, the comparative efficacy of Roux-en-Y gastric bypass (RYGB) versus sleeve gastrectomy (SG) in achieving diabetes remission remains debated. METHODS This PRISMA-compliant meta-analysis included three randomized controlled trials (RCTs, n = 613 patients) comparing RYGB and SG in adults with severe obesity (BMI ≥30 kg/m²) and T2DM. PRIMARY OUTCOME diabetes remission (HbA1c 6.0%). Risk of bias was assessed via Cochrane RoB-2 tool; statistical analysis used fixed-effect models (I²=0%). RESULTS RYGB demonstrated superior diabetes remission rates vs. SG (OR 2.77, 95% CI 1.83-4.20, p0.001), with no heterogeneity. Subgroup analyses confirmed consistency across studies. Mean follow-up was ≤5 years; baseline demographics were comparable (mean age 46.2 years, 53.4% male). CONCLUSION RYGB significantly outperforms SG in achieving T2DM remission, likely due to its combined restrictivemalabsorptive mechanisms and metabolic hormonal effects. These findings support RYGB as the preferred surgical option for obese patients with T2DM, though long-term studies are needed to assess durability.
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Affiliation(s)
| | | | - Noor Husain
- Indira Gandhi Institute of Medical Sciences, Patna, India
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Grinlinton ME, Elliott D, Pearless LA, Booth MWC. Banded One Anastomosis Gastric Bypass: 15 Year Results from a Single Centre. Obes Surg 2025:10.1007/s11695-025-07876-8. [PMID: 40249418 DOI: 10.1007/s11695-025-07876-8] [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: 12/03/2024] [Revised: 03/14/2025] [Accepted: 04/10/2025] [Indexed: 04/19/2025]
Abstract
BACKGROUND Banded one anastomosis gastric bypass (BOAGB) is an efficacious surgical option for patients with obesity. OAGB has a high percentage excess weight loss reported in the literature, and the addition of a silastic ring (SR) otherwise known as a band, helps to reduce recurrent weight gain. METHODS 156 patients from a single centre between 2005-2008 underwent a BOAGB. A questionnaire, blood test results and electronic records were utilised at 15 years post-operatively to identify patient outcomes. RESULTS At 15 years, the average percentage excess weight loss (%EWL) was 82.0%, the average percentage total weight loss (%TWL) was 35.9%, and the average body mass index (BMI) had reduced from 46.3 kg/m2 to 29.7 kg/m2. 106/114 (93.0%) of patients had adequate weight loss at 15 years. 27/114 (23.7%) of patients had recurrent weight gain at 15 years. Antihypertensives, lipid lowering therapy and hypoglycaemic medications had all reduced, and proton pump inhibitor medications had increased. There were 11 (7.1%) deaths by 15 years, and none were directly related to the initial operation. Silastic rings were removed in 12 patients (7.7%). 21 (13.5%) patients had a conversion to a Roux-en-Y gastric bypass over 15 years, of which 14 (9.0%) were due to reflux. There were no conversions for malnutrition. Patient satisfaction was high, with an average Likert satisfaction score of 8.4. CONCLUSIONS BOAGB continues to show good results as an effective operation at 15 years, with a high %EWL and %TWL, low conversion rate, and significant reduction in medication use for hypertension, hyperlipidaemia, and T2D. There was an increase in proton pump inhibitor use at 15 years. The operation is durable and weight loss remains excellent. The addition of a SR is effective in reducing long-term recurrent weight gain.
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Okkema S, Boerboom A, den Hengst W, Aarts E, Berends F, Hazebroek E. Five-year outcomes of a randomized controlled trial evaluating a non-adjustable ring in Roux-en-Y gastric bypass. Surg Endosc 2025; 39:2324-2334. [PMID: 39953277 PMCID: PMC11933145 DOI: 10.1007/s00464-025-11545-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2024] [Accepted: 01/08/2025] [Indexed: 02/17/2025]
Abstract
BACKGROUND Several retrospective studies suggest that adding a non-adjustable silicone ring to a Roux-en-Y gastric bypass (RYGB) results in more weight loss and prevents weight regain in the long term. The aim of this study was to evaluate the effect of a banded Roux-en-Y gastric bypass (B-RYGB) on weight loss outcomes in a randomized controlled trial (RCT). METHODS In this single center RCT, 130 patients were divided into two groups: a standard Roux-en-Y gastric bypass (S-RYGB) or a B-RYGB using a Minimizer® ring. Subsequently, weight loss, morbidity, reduction of obesity-associated medical conditions, quality of life (QoL), and complication rates were measured during a follow-up period of five years. A two-sided p < 0.05 (with 95% confidence interval) indicated statistical significance. RESULTS After five years, mean percentage total body weight loss (%TBWL) was 30.5% in the S-RYGB versus 31.8% in the B-RYGB group (p > 0.05). The follow-up percentage was 81%. Overall, no significant differences in complication rates, resolution of obesity-associated medical conditions, and QoL were found between the two groups. In the B-RYGB group, 8 (12%) silicone rings were removed due to symptoms of dysphagia. CONCLUSION B-RYGB is a safe procedure showing similar comorbidity when compared to a S-RYGB. However, B-RYGB led to a higher rate of postoperative dysphagia which poses a risk of ring removal over time. The results from this RCT do not support the hypothesis that implantation of a non-adjustable silicone ring improves long-term weight loss outcomes.
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Affiliation(s)
- Sietske Okkema
- Department of Surgery, Rijnstate Hospital, Postal Number 1190, 6800TA, Arnhem, The Netherlands
| | - Abel Boerboom
- Department of Surgery, Rijnstate Hospital, Postal Number 1190, 6800TA, Arnhem, The Netherlands
| | - Willem den Hengst
- Department of Surgery, Rijnstate Hospital, Postal Number 1190, 6800TA, Arnhem, The Netherlands
| | - Edo Aarts
- Weight Works Clinics, Amersfoort, the Netherlands
| | | | - Eric Hazebroek
- Department of Surgery, Rijnstate Hospital, Postal Number 1190, 6800TA, Arnhem, The Netherlands.
- Wageningen University and Research, Wageningen, The Netherlands.
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Jense MTF, Bruinsma FFE, Nienhuijs SW, Liem RSL, de Mheen PJMV, Greve JWM, Boerma EJG. Ring Augmentation of the Roux-en-Y Gastric Bypass: A Propensity Score Matched Analysis of 5-Year Follow-Up Results. Obes Surg 2025; 35:884-893. [PMID: 39883395 PMCID: PMC11906517 DOI: 10.1007/s11695-025-07706-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Revised: 01/15/2025] [Accepted: 01/18/2025] [Indexed: 01/31/2025]
Abstract
BACKGROUND The ring-augmented Roux-en-Y gastric bypass (raRYGB) has been reported to result in higher long-term weight loss compared to regular Roux-en-Y gastric bypass (RYGB). However, the type of ring used varied within studies, leading to heterogeneity in reported results. Therefore, this study compares the 5-year results of RYGB with and without ring augmentation using a specific prefabricated gastric ring. METHODS All consecutive patients from a single center who received primary raRYGB between June 1, 2016, and May 31, 2018, with complete 5-year follow-up data were included and compared to a propensity score matched cohort receiving RYGB in the same period from the Dutch Audit for Treatment of Obesity. To ensure fair effect estimation of placing a ring, only RYGB procedures with alimentary and biliopancreatic limb lengths similar to those of the raRYGB were considered eligible. The primary outcome was percentage total weight loss (%TWL). Secondary outcomes included recurrent weight gain (RWG), obesity complication improvement, and complications. RESULTS In total, 592 matched patients were analyzed. raRYGB was associated with higher %TWL at 5 years (31.5% versus 28.0%, β = 3.59, 95% CI [2.09-5.09], p < 0.01) and lower odds on RWG (odds ratio = 0.56, 95% CI [0.38-0.83], p < 0.01). Improvement of obesity complications and short-term complication rates were comparable in both groups. After 5 years, 13 patients (4%) had experienced ring-related complications needing reoperation. CONCLUSIONS At 5 years, raRYGB was associated with higher %TWL and lower odds on RWG. The occurrence of ring-related complications was limited.
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Affiliation(s)
- Marijn T F Jense
- Zuyderland Medisch Centrum, Sittard, Netherlands.
- Maastricht University, Maastricht, Netherlands.
| | - Floris F E Bruinsma
- Maastricht University, Maastricht, Netherlands
- Dutch Institute for Clinical Auditing, Leiden, Netherlands
| | - Simon W Nienhuijs
- Dutch Institute for Clinical Auditing, Leiden, Netherlands
- Catharina Ziekenhuis, Eindhoven, Netherlands
| | - Ronald S L Liem
- Groene Hart Ziekenhuis, Gouda, Netherlands
- Nederlandse Obesitas Kliniek, Zeist, Netherlands
| | | | | | - Evert-Jan G Boerma
- Zuyderland Medisch Centrum, Sittard, Netherlands
- Nederlandse Obesitas Kliniek, Zeist, Netherlands
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Pavone G, Chierici A, Drai C, Alromayan M, Alamri A, Tartaglia N, Liddo G, Iannelli A. Banded versus non-banded Roux-en-Y gastric bypass: short, mid, and long-term surgical outcomes - a systematic review and meta-analysis. Surg Obes Relat Dis 2024; 20:880-889. [PMID: 38960827 DOI: 10.1016/j.soard.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 04/29/2024] [Accepted: 05/17/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND The Roux-en-Y gastric bypass (RYGB) is considered as one of the most effective treatments for people with obesity. A variant of this procedure, the banded-RYGB, may present several advantages over the standard technique. These potential benefits include enhanced weight loss, decreased recurrent weight gain, a lower incidence of dumping syndrome, and less distention of the jejunum below the gastrojejunostomy. OBJECTIVES The objective of this meta-analysis is to compare the surgical outcomes of RYGB procedures with a band (banded-RYGB) and without a band (RYGB) in the management of individuals with obesity. SETTING A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane protocol (PROSPERO ID: CRD42023439874). METHOD The systematic review process led to the identification of 13 comparative studies involving 3230 patients who underwent banded-RYGB and 5302 who received RYGB, all of which were eligible for inclusion and meta-analysis. RESULTS Four studies reported data on 1-year postoperative percent excess weight loss (%EWL), demonstrating a significant increase of 6.03 %EWL in patients who underwent banded-RYGB. Four studies reported the 2-year postoperative %EWL, showing that patients who had banded-RYGB experienced a 5.32 greater %EWL compared to those who received RYGB, even if this was not statistically significant. For 5-year %EWL after bariatric surgery, 5 studies were included for continuous outcome meta-analysis. The average 5-years %EWL difference was 7.6 in favor of banded-RYGB. Patients who had banded-RYGB presented a nonsignificant 1.45 OR of developing postoperative complications compared to patients receiving RYGB. CONCLUSION This meta-analysis demonstrates that, compared to RYGB, patients who underwent banded-RYGB surgery showed a statistically significant increase in the %EWL at 1, 2, and 5 years postoperatively. Moreover, the banding procedure does not significantly increase the risk of postoperative complications.
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Affiliation(s)
- Giovanna Pavone
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France
| | - Andrea Chierici
- Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France
| | - Céline Drai
- Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France; Université Côte d'Azur, Nice, France
| | - Mohamed Alromayan
- Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France; Security Forces Medical City, Riyadh, Saudi Arabia
| | - Abdelrhamane Alamri
- Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France; Department of Surgery, Medical College, Najran University, Najran, Saudi Arabia
| | - Nicola Tartaglia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Guido Liddo
- Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France
| | - Antonio Iannelli
- Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France; Université Côte d'Azur, Nice, France; Inserm, U1065, Team 8 "Hepatic Complications of Obesity and Alcohol" Nice, France.
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Ferreira EVB, Queiroz GT, Corrêa ALC, Annelli GL, Ribeiro GR, Salgado W. Long-term Comparative Evaluation of Weight Loss and Complications of Banded and Non-banded Roux-en-Y Gastric Bypass. Obes Surg 2024; 34:2923-2929. [PMID: 38884901 DOI: 10.1007/s11695-024-07354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/04/2024] [Accepted: 06/04/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE The use of a nonadjustable silicone band around the gastric pouch of Roux-en-Y gastric bypass (RYGB) to reduce the recurrence of obesity is still being debated in the literature. The primary objective of this study was to evaluate banded and non-banded RYGB regarding % total weight loss (%TWL) and complications up to 10 years postoperatively and regarding the removal rate of the silicone band. MATERIAL AND METHODS A retrospective study of the medical records of all patients submitted to banded and non-banded RYGB between 2000 and 2020 was conducted. Clinical data (age, gender, weight, body mass index-BMI, comorbidities, %TWL, and the prevalence of vomiting) and laboratory data (hemoglobin, serum iron, albumin, and vitamin B12) were obtained preoperatively and at 6 months, 1, 2, 3, 5, 7, and 10 years for both groups and at 12, 15, and 20 years after banded RYGB. RESULTS In total, 858 patients underwent RYGB: 409 underwent banded RYGB and 449 underwent non-banded RYGB. In the preoperative period, banded RYGB patients were heavier and had higher rates of hypertension and dyslipidemia. The %TWL was higher in the banded RYGB group up to 7 years. The prevalence of vomiting is much higher in this group, which also had lower laboratory test values. Of the banded RYGB patients, 9.53% had to have the silicone ring removed after presenting complications. CONCLUSION Banded RYGB promotes significantly higher rates of TWL at the expense of a higher frequency of food intolerance and vomiting.
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Affiliation(s)
- Emmanuel V B Ferreira
- Department of Surgery and Anatomy, Clinical Hospital, Faculty of Medicine, University of São Paulo, Ribeirao Preto, Brazil
| | - Gabriele T Queiroz
- Department of Surgery and Anatomy, Clinical Hospital, Faculty of Medicine, University of São Paulo, Ribeirao Preto, Brazil
| | - Ana-Luisa C Corrêa
- Department of Surgery and Anatomy, Clinical Hospital, Faculty of Medicine, University of São Paulo, Ribeirao Preto, Brazil
| | - Guilherme L Annelli
- Department of Surgery and Anatomy, Clinical Hospital, Faculty of Medicine, University of São Paulo, Ribeirao Preto, Brazil
| | - Gabriel R Ribeiro
- Department of Surgery and Anatomy, Clinical Hospital, Faculty of Medicine, University of São Paulo, Ribeirao Preto, Brazil
| | - Wilson Salgado
- Department of Surgery and Anatomy, Clinical Hospital, Faculty of Medicine, University of São Paulo, Ribeirao Preto, Brazil.
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Quint E, Perry ZH, Elkrinawi N, Kukeev I, Czeiger D, Vakhrushev A, Sebbag G, Dukhno O. Banded One-Anastomosis Gastric Bypass (BOAGB) for Patients Living with Obesity and Extreme Obesity: A Single Institution's Experience. Obes Surg 2024; 34:1756-1763. [PMID: 38557949 DOI: 10.1007/s11695-024-07194-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The prevalence of patients suffering from extreme obesity (body mass index (BMI) ≥ 50) has significantly increased over the past three decades, surpassing the rise in the general population of overweight patients. Weight loss outcomes after bariatric surgery in patients suffering from extreme obesity are less favorable, with a higher incidence of weight regain. Variations of existing bariatric procedures have been proposed to address this issue. One such variation is adding a gastric band to limit the expansion of the newly created pouch. Limited data exist regarding the effectiveness of this procedure, called the banded one-anastomosis gastric bypass (BOAGB) procedure, compared to other bariatric procedures. METHOD In this retrospective study, we compared all patients who underwent the BOAGB procedure at the Bariatric Surgery Unit in our Medical Center with a postoperative follow-up of at least 1 year with patients who underwent a one-anastomosis gastric bypass (OAGB) or sleeve gastrectomy (SG) procedures. Data collected included demographics, comorbidities, surgical outcomes, complications, and postoperative quality-of-life assessments. RESULTS One hundred eleven patients were enlisted to our study during the relevant study period-24 patients underwent the BOAGB procedure, 43 underwent OAGB, and 44 underwent a SG. Lost to follow-up beyond 30 days was 9% (at 1-year post-surgery, we were able to establish contact with 101 patients). The pre-op BMI was significantly higher in the BOAGB group compared to the other procedures. Additionally, a higher prevalence of diabetes was observed in the BOAGB group. The duration of surgery was significantly longer for the BOAGB procedure. No significant differences were found in surgical complications. Overall, all procedures resulted in significant excess weight loss (EWL) or change in BMI, improvement in comorbidities, and improved quality of life postoperatively. CONCLUSIONS The BOAGB procedure, like OAGB and SG, demonstrated favorable weight loss outcomes and weight maintenance 1 year postoperatively without significant differences between the procedures. The BOAGB procedure is relatively new, with good bariatric outcomes and a favorable safety profile. Long-term study is needed to evaluate these various bariatric procedures' efficacy further.
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Affiliation(s)
- Elchanan Quint
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
| | - Zvi H Perry
- Bariatric Surgery Unit, Soroka University Medical Center, The Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel.
- Department of General Surgery A, Soroka University Medical Center, Beer Sheba, Israel.
| | - Nur Elkrinawi
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
| | - Ivan Kukeev
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
| | - David Czeiger
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
| | - Alex Vakhrushev
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
- Bariatric Surgery Unit, Soroka University Medical Center, The Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
| | - Gilbert Sebbag
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
| | - Oleg Dukhno
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
- Bariatric Surgery Unit, Soroka University Medical Center, The Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
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Murphy R, Plank LD, Clarke MG, Evennett NJ, Tan J, Kim DDW, Cutfield R, Booth MWC. Effect of Banded Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy on Diabetes Remission at 5 Years Among Patients With Obesity and Type 2 Diabetes: A Blinded Randomized Clinical Trial. Diabetes Care 2022; 45:1503-1511. [PMID: 35554515 PMCID: PMC9274222 DOI: 10.2337/dc21-2498] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/25/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether silastic ring laparoscopic Roux-en-Y gastric bypass (SR-LRYGB) or laparoscopic sleeve gastrectomy (LSG) produces superior diabetes remission at 5 years. RESEARCH DESIGN AND METHODS In a single-center, double-blind trial, 114 adults with type 2 diabetes and BMI 35-65 kg/m2 were randomly assigned to SR-LRYGB or LSG (1:1; stratified by age-group, BMI group, ethnicity, diabetes duration, and insulin therapy) using a web-based service. Diabetes and other metabolic medications were adjusted according to a prespecified protocol. The primary outcome was diabetes remission assessed at 5 years, defined by HbA1c <6% (42 mmol/mol) without glucose-lowering medications. Secondary outcomes included changes in weight, cardiometabolic risk factors, quality of life, and adverse events. RESULTS Diabetes remission after SR-LRYGB versus LSG occurred in 25 (47%) of 53 vs. 18 (33%) of 55 patients (adjusted odds ratios 4.5 [95% CI 1.6, 15.5; P = 0.009] and 4.2 [1.3, 13.4; P = 0.015] in the intention-to-treat analysis). Percent body weight loss was greater after SR-LRYGB than after LSG (absolute difference 10.7%; 95% CI 7.3, 14.0; P < 0.001). Improvements in cardiometabolic risk factors were similar, but HDL cholesterol increased more after SR-LRYGB. Early and late complications were similar in both groups. General health and physical functioning improved after both types of surgery, with greater improvement in physical functioning after SR-LRYGB. People of Māori or Pacific ethnicity (26%) had lower incidence of diabetes remission than those of New Zealand European or other ethnicities (2 of 25 vs. 41 of 83; P < 0.001). CONCLUSIONS SR-LRYGB provided superior diabetes remission and weight loss compared with LSG at 5 years, with similar low risks of complications.
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Affiliation(s)
- Rinki Murphy
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lindsay D Plank
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michael G Clarke
- Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Nicholas J Evennett
- Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - James Tan
- Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - David D W Kim
- Department of Endocrinology, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Richard Cutfield
- Department of Endocrinology, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Michael W C Booth
- Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
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9
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Jense MTF, Palm-Meinders IH, Sigterman-Nelissen R, Boerma EJG, Liem RSL, Swank DJ, Greve JWM. The Benefits of Banded over Non-banded Roux-en-Y Gastric Bypass in Patients with Morbid Obesity: a Multi-center Study. Obes Surg 2022; 32:1856-1863. [PMID: 35366739 PMCID: PMC9072269 DOI: 10.1007/s11695-022-06024-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 11/06/2022]
Abstract
Background
Roux-en-Y gastric bypass (RYGB) has proven to be an effective treatment for obesity with excellent long-term results, even though weight regain can occur. A method to improve the results of RYGB and minimize chance of weight regain is banded RYGB. Better sustained weight loss is also related to higher remission of comorbidities. The aim of this study was to evaluate the effect of banded and non-banded RYGB on long-term weight loss results and comorbidities. Method A retrospective comparative data study was performed. Patients who underwent a primary RYGB between July 2013 and December 2014 and followed a 5-year follow-up program in the Dutch Obesity Clinic were included. Comorbidities were assessed during screening and follow-up. Results The study included 375 patients with mean weight and body mass index (BMI) of 128.9 (± 21.2) kg and 44.50 (± 5.72) kg/m2. Of this group, 184 patients underwent RYGB and 191 banded RYGB. During follow-up (3 months, 1–5 years) % Total Weight Loss (%TWL) was superior in the banded group (32.6% vs 27.6% at 5 years post-operative, p < 0.001). Complication rates in both groups were similar. Comorbidity improvement or remission did not significantly differ between the two groups (p = 0.14–1.00). After 5 years of follow-up, 79 patients (20.5%) were lost to follow-up. Conclusion Banded RYGB does show superior weight loss compared to non-banded RYGB. No difference in effect on comorbidity improvement or remission was observed. Since complication rates are similar, while weight loss is significantly greater, we recommend performing banded RYGB over non-banded RYGB. Graphical abstract ![]()
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Abstract
PURPOSE OF REVIEW Current bariatric surgical practice has developed from early procedures, some of which are no longer routinely performed. This review highlights how surgical practice in this area has developed over time. RECENT FINDINGS This review outlines early procedures including jejuno-colic and jejuno-ileal bypass, initial experience with gastric bypass, vertical banded gastroplasty and biliopancreatic diversion with or without duodenal switch. The role laparoscopy has played in the widespread utilization of surgery for treatment of obesity will be described, as will the development of procedures which form the mainstay of current bariatric surgical practice including gastric bypass, sleeve gastrectomy and adjustable gastric banding. Endoscopic therapies for the treatment of obesity will be described. By outlining how bariatric surgical practice has developed over time, this review will help practicing surgeons understand how individual procedures have evolved and also provide insight into potential future developments in this field.
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Affiliation(s)
- T Wiggins
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - M S Majid
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - S Agrawal
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK.
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11
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The effect of stoma size on the mid-term weight loss outcome of one anastomosis gastric bypass (OAGB): a single-blinded prospective randomized trial. Surg Endosc 2020; 35:1691-1695. [PMID: 32277357 DOI: 10.1007/s00464-020-07553-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) is gaining wide spread acceptance among bariatric surgeons all over the world because of its technical simplicity and documented efficacy. However, the relation between stoma size in OAGB and magnitude of weight loss has not been addressed. OBJECTIVES To evaluate the effect of stoma size on the mid-term weight loss outcome for patients with obesity after OAGB. SETTING University Hospital. MATERIALS AND METHODS This is a single-blinded prospectively randomized trial. From March 2014 to September 2016, 83 patients, eligible for bariatric surgery, were included in the study. OAGB was carried out with the same technical steps, except for the size of the gastrojejunostomy (GJ). Patients were randomly allocated into two equal groups; narrow GJ group (30 mm) and wide GJ group (45 mm). The percentage of total weight loss (%TWL) and the percentage of excess weight loss (%EWL) were recorded at 6, 12 and 24 months after procedure. RESULTS At 6 months follow-up, patients with 30 mm GJ had better %EWL (53.3) and %TWL (23.4) than other patients with 45 mm GJ (42.6 and 18.2 respectively). However, at 12 and 24 months the %TWL and %EWL difference between the two groups have disappeared. CONCLUSION Patients with narrower stoma size (30 mm) of OAGB tend initially to lose more weight than patients with wider stoma (45 mm). However, this difference disappears at mid-term follow-up after 2 years.
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Weight Loss and Vomiting 1 Year After Banded Versus Non-banded One Anastomosis Gastric Bypass: a Prospective Randomized Trial. Obes Surg 2020; 30:1719-1725. [PMID: 31942688 DOI: 10.1007/s11695-020-04393-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The weight loss outcomes after banded one-anastomosis gastric bypass (OAGB) remain to be determined. OBJECTIVE To compare weight loss and vomiting 1 year after banded versus non-banded OAGB. METHODS This is a prospective, open-label, randomized study, which evaluated 33 individuals with morbid obesity, which underwent banded (16 individuals) and non-banded OAGB (17 individuals) and were followed up for 12 months. Weight loss (percentages of total weight loss-%TWL-and excess weight loss-%EWL) and occurrence of vomiting were assessed and compared before surgery and after 6 and 12 months. RESULTS At baseline, there were no differences between groups in regard to age, gender, and body mass index (BMI). At 6 and 12 months post-op, and the overall mean %TWL regardless of band use was 22.4 ± 7% and 29 ± 6.9%, respectively, and the overall average %EWL regardless of band use was 66.8 ± 22.9% and 86.3 ± 24%, respectively. %TWL did not differ between the banded and non-banded groups at 6 (21.8 ± 6.8% vs. 23.1 ± 7.4%; p = 0.7) and 12 months post-op (27.5 ± 6.6% vs. 30.4 ± 7.1%; p = 0.3), as well as %EWL at 6 (67 ± 22.9% vs. 67.6 ± 23.6%; p = 0.6) and 12 months post-op (83.5 ± 24.4% vs. 89 ± 24.1%; p = 0.4). The occurrence of vomiting did not significantly differ between banded and non-banded OAGB at 6 (12.5% vs. 11.8%; p = 0.9) and 12 months post-op (12.5% vs. 5.9%; p = 0.5). CONCLUSION OAGB led to an overall satisfactory weight loss after 1 year, regardless of band use. Banded OAGB did not lead to neither significantly higher weight loss nor more vomiting than non-banded OAGB 1 year after surgery.
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Galal AM, Boerma EJ, Fransen S, Meesters B, Olde-Damink S, Abdelmageed MK, Sabry AA, Elsuity AHM, Greve JW. Impact of Laparoscopic Banded Gastric Bypass on Weight Loss Surgery Outcomes: 5 Years' Experience. Obes Surg 2019; 30:630-639. [PMID: 31643030 DOI: 10.1007/s11695-019-04229-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Evaluate 5-year outcomes of banded gastric bypass (BRYGB) as a primary and conversion bariatric procedure. METHODS Retrospective review of BRYGB between January 2011and March 2013. Outcomes included percentage of total weight loss (%TWL), weight loss maintenance, and band-related complications. RESULTS One hundred forty-two patients underwent BRYGB, 106 primary and 36 conversions. Indications for conversion to BRYGB were complications of the primary procedure (n = 19), insufficient weight loss (n = 5), and weight regain (n = 12). In the primary group, mean preoperative BMI was 44.8 kg/m2 (± 6.9 kg/m2). Compared with preoperative weight, mean %TWL was 33.9% (n = 95), 34.1% (n = 82), 34.0% (n = 70), 33.9% (n = 62), and 31.8% (n = 75) after 1, 2, 3, 4, and 5 years, respectively. In conversions secondary to failed primary procedure (insufficient WL and weight regain), mean preoperative BMI was 40.8 kg/m2 (± 6.01 kg/m2). Despite one patient gaining weight, mean %TWL was 25.7% (n = 13), 28% (n = 11), 23.9% (n = 8), 18.3% (n = 8), and 15.1% (n = 12) after 1, 2, 3, 4, and 5 years, respectively. In conversions secondary to primary procedure complications (n = 19), mean preoperative BMI was 28.4 kg/m2 (± 3.5 kg/m2). After 1, 2, 3, 4, and 5 years, mean BMI was 28.1 (n = 15), 29 (n = 10), 29.8 (n = 9), 30.6 (n = 10), and 30.9 (n = 12) kg/m2, respectively. Band-related complications after 5 years: three erosion and five patients complained of persistent dysphagia. One band needed reposition. Perioperative surgical complications: two bleeding, one leakage, one port-site hernia, and one food impaction. CONCLUSION Banded gastric bypass has good results in terms of weight loss and weight loss maintenance in both primary and conversional bariatric procedures with acceptable incidence of band-related complications.
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Affiliation(s)
- Abdelrahman Mohammad Galal
- Surgery Department, Zuyderland Medical Center, Heerlen, The Netherlands. .,Dutch Obesity Clinic South, Heerlen, The Netherlands. .,Metabolic and Bariatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. .,General Surgery Department, Sohag Faculty of Medicine, Sohag University Hospitals, Sohag, Egypt.
| | - Evert-Jan Boerma
- Surgery Department, Zuyderland Medical Center, Heerlen, The Netherlands.,Dutch Obesity Clinic South, Heerlen, The Netherlands
| | - Sofie Fransen
- Surgery Department, Zuyderland Medical Center, Heerlen, The Netherlands.,Dutch Obesity Clinic South, Heerlen, The Netherlands
| | - Berry Meesters
- Surgery Department, Zuyderland Medical Center, Heerlen, The Netherlands.,Dutch Obesity Clinic South, Heerlen, The Netherlands
| | - Steven Olde-Damink
- Metabolic and Bariatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Alaa Abass Sabry
- Surgery department, Ainshams Faculty of Medicine, Ainshams University Hospital, Cairo, Egypt
| | | | - Jan Willem Greve
- Surgery Department, Zuyderland Medical Center, Heerlen, The Netherlands. .,Dutch Obesity Clinic South, Heerlen, The Netherlands. .,Metabolic and Bariatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
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Bhandari M, Ponce de Leon-Ballesteros G, Kosta S, Bhandari M, Humes T, Mathur W, Fobi M. Surgery in Patients with Super Obesity: Medium-Term Follow-Up Outcomes at a High-Volume Center. Obesity (Silver Spring) 2019; 27:1591-1597. [PMID: 31479206 DOI: 10.1002/oby.22593] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/15/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE There is a need to determine which bariatric operations are the most effective for patients with super obesity and super-super obesity. METHODS A retrospective cohort study was performed on patients with super obesity and super-super obesity at Mohak Bariatrics and Robotics Surgery Center in Indore, India. RESULTS Five hundred fourteen patients with super obesity and super-super obesity had surgery at our center from January 2010 through December 2013. The baseline characteristics were different in different operations. The initial average age, weight, and BMI were 44.4 (SD 11.9) years, 145.4 (SD 24.2) kg, and 55.48 (SD 5.32) kg/m2 , respectively. Sleeve gastrectomy (SG) (227 [44.2%]) was the most common procedure, followed by one-anastomosis gastric bypass (OAGB) (124 [24.1%]), Roux-en-Y gastric bypass (RYGB) (102 [19.8%]), banded sleeve gastrectomy (BSG) (33 [6.4%]), and banded Roux-en-Y gastric bypass (BRYGB) (28 [5.4%]). After 3 years, the percentages of excess body weight loss (%EBWL) for SG, OAGB, RYGB, BSG, and BRYGB were 62.38%, 78.59%, 69.55%, 85.11%, and 75.77% (P < 0.0001), respectively. Failure to achieve BMI < 35 kg/m2 was more frequent in the group who underwent SG (67.9%), followed by RYGB (29.16%), BRYGB (22.2%), OAGB (9.87%), and none in the BSG group. CONCLUSIONS BSG, OAGB, and BRYGB have very good to excellent midterm outcomes for patients with super obesity and super-super obesity, whereas RYGB and SG have average outcomes at 3 years. There is a need for multicenter, long-term, and prospective studies to be performed to confirm these findings.
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Affiliation(s)
- Mohit Bhandari
- Mohak Bariatrics and Robotics Surgery Center, Indore, India
| | | | - Susmit Kosta
- Mohak Bariatrics and Robotics Surgery Center, Indore, India
| | - Mahak Bhandari
- Mohak Bariatrics and Robotics Surgery Center, Indore, India
| | - Terrel Humes
- Mohak Bariatrics and Robotics Surgery Center, Indore, India
| | - Winni Mathur
- Mohak Bariatrics and Robotics Surgery Center, Indore, India
| | - Mathias Fobi
- Mohak Bariatrics and Robotics Surgery Center, Indore, India
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Bhandari M, Nautiyal HK, Mathur W, Kosta S. OAGB vs BGBP: A retrospective comparative study of a cohort of patients who had bariatric surgery in 2012 at one centre by a single surgeon. Clin Obes 2019; 9:e12308. [PMID: 30957418 DOI: 10.1111/cob.12308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 12/17/2022]
Abstract
Two modifications of Roux-en-Y gastric bypass (RYGB), one anastomosis gastric bypass (OAGB) and Roux-en-Y banded gastric bypass (BGBP), are gaining popularity in use because the OAGB is reported to be a simpler operation, and the BGBP is reported to have sustained weight loss compared to standard RYGB. A retrospective review and analysis of data comparing outcomes up to 5 years after BGBP and OAGB from a prospectively maintained database of all bariatric metabolic operations in 2012 was performed. Eighty-two patients underwent a BGBP and 90 an OAGB. The average age and body mass index were 44.12 and 43.97 and 43.57 and 45.79 in the BGBP and OAGB groups, respectively. Postoperative nutrient deficiencies were similar in both groups but were more prominent in the OAGB group. The % excess body weight loss (%EBWL) was 78% and 71.5% at 5 years in the OAGB and BGBP groups, respectively. The % total weight loss (%TWL) was also higher in OAGB compared to the BGBP group, 34.72% and 30.49%, respectively. Resolution of type 2 diabetes (T2DM) was significantly higher in the OAGB group, 79.16%, than in the BGBP group, 71.42%. The resolution of dyslipidaemia and hypertension were similar in both groups, but sleep apnoea resolution was higher in OAGB group. Both operations produced excellent weight loss in the intermediate term. The %EBWL and resolution of T2DM were significantly higher after the OAGB operation at the expense of increased incidence of nutrient deficiencies and hypoproteinemia. Quality of life improvement and patient satisfaction were high after both operations. Long-term follow up and multicentre prospective studies are needed to confirm these intermediate outcomes.
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Affiliation(s)
- Mohit Bhandari
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore, India
| | | | - Winni Mathur
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore, India
| | - Susmit Kosta
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore, India
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Banded versus nonbanded Roux-en-Y gastric bypass: a systematic review and meta-analysis of randomized controlled trials. Surg Obes Relat Dis 2019; 15:688-695. [PMID: 31255232 DOI: 10.1016/j.soard.2019.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/16/2019] [Accepted: 02/20/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Bariatric surgery is remarkably effective in achieving weight loss and improving obesity-related co-morbidities; however, efforts still continue to improve its long-term outcomes. Particularly, banded Roux-en-Y gastric bypass (RYGB) has been scrutinized in comparison to standard (nonbanded) RYGB in terms of benefits and postoperative complications. OBJECTIVES This study aims to compare the safety and efficacy of banded versus nonbanded RYGB. SETTING Meta-analysis of randomized controlled trials (RCTs). METHODS A meta-analysis of high-quality studies that compared banded and nonbanded RYGB was conducted through February 2019 by systematically searching multiple electronic databases. Published RCTs comparing these 2 procedures were included to pool the data on excess weight loss, food tolerability, and postoperative complications. RESULTS Three RCTs were eligible to be included in this meta-analysis, comprising a total of 494 patients (247 in each group). Two of the RCTs provided 2-year postoperative data, and 1 study reported 5-year outcome. Age ranged from 21 to 50 years, and body mass index ranged from 42 to 65 kg/m2. Percentage of excess weight loss was significantly greater with banded RYGB than with nonbanded RYGB (mean difference 5.63%; 95% CI 3.26-8.00; P < .05). Postoperative food intolerance, emesis, and dysphagia were more common after banded RYGB (odds ratio 3.76; 95% CI 2.27-6.24; P < .001). Nevertheless, major postoperative complications did not significantly differ between the 2 groups. CONCLUSION Findings of this meta-analysis of RCTs indicate that in a medium-term follow-up, excess weight loss with banded RYGB would be 5% greater than that with the nonbanded RYGB (about 1 point difference in body mass index) at the expense of more food intolerance and postoperative vomiting; however, the frequency of postoperative complications would not be significantly different.
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Magouliotis DE, Tasiopoulou VS, Svokos KA, Svokos AA, Sioka E, Tzovaras G, Zacharoulis D. Banded vs. non-banded Roux-en-Y gastric bypass for morbid obesity: a systematic review and meta-analysis. Clin Obes 2018; 8:424-433. [PMID: 30144284 DOI: 10.1111/cob.12274] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/11/2018] [Accepted: 06/21/2018] [Indexed: 01/05/2023]
Abstract
We aim to review the available literature on patients with morbid obesity treated with banded (BRYGB) or non-banded Roux-en-Y gastric bypass (NBRYGB), in order to compare the clinical outcomes and intraoperative parameters of the two methods. A systematic literature search was performed in PubMed, Cochrane library and Scopus databases, in accordance with the PRISMA guidelines. Eight studies met the inclusion criteria incorporating 3899 patients. This study reveals similar rates of complications, mortality, remission of type 2 diabetes, hypertension, dyslipidaemia, gastroesophageal reflux and obstructive sleep apnoea, along with similar % excess weight loss (%EWL) at 1 and 2 years postoperatively. In contrast, according to an analysis of two eligible studies the BRYGB procedure was associated with increased %EWL at 5 years postoperatively. These results should be interpreted with caution due to the small number of statistical arms and randomized controlled studies. However, the present article represents the best available evidence in the field. Well-designed, randomized controlled studies, comparing BRYGB to NBRYGB, are necessary to further assess their clinical outcomes.
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Affiliation(s)
- D E Magouliotis
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - V S Tasiopoulou
- School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - K A Svokos
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - A A Svokos
- Department of Obstetrics and Gynecology, Riverside Regional Medical Center, Newport News, VA, USA
| | - E Sioka
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - G Tzovaras
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - D Zacharoulis
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
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Borisenko O, Lukyanov V, Debergh I, Dillemans B. Cost-effectiveness analysis of bariatric surgery for morbid obesity in Belgium. J Med Econ 2018; 21:365-373. [PMID: 29271279 DOI: 10.1080/13696998.2017.1419958] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS This study presents the cost-effectiveness analysis of bariatric surgery in Belgium from a third-party payer perspective for a lifetime and 10-year horizon. MATERIALS AND METHODS A decision analytic model incorporating Markov process was developed to compare the cost-effectiveness of gastric bypass, sleeve gastrectomy, and adjustable gastric banding against conventional medical management (CMM). In the model, patients could undergo surgery, or experience post-surgery complications, type 2 diabetes, cardiovascular diseases, or die. Transition probabilities, costs, and utilities were derived from the literature. The impact of different surgical methods on body mass index (BMI) level in the base-case analysis was informed by the Scandinavian Obesity Surgery Registry and the Swedish Obese Subject (SOS) study. Healthcare resource use and costs were obtained from Belgian sources. A base-case analysis was performed for the population, the characteristics of which were obtained from surgery candidates in Belgium. RESULTS In the base-case analysis over a 10-year time horizon, the increment in quality-adjusted life-years (QALYs) gained from bariatric surgery vs CMM was 1.4 per patient, whereas the incremental cost was €3,788, leading to an incremental cost-effectiveness ratio (ICER) of €2,809 per QALY. Over a lifetime, bariatric surgery produced savings of €9,332, an additional 1.1 life years and 5.0 QALYs. Bariatric surgery was cost-effective at 10 years post-surgery and dominant over conventional management over a lifetime horizon. LIMITATIONS The model did not include the whole scope of obesity-related complications, and also did not account for variation in surgery outcomes for different populations of diabetic patients. Also, the data about management of patients after surgery was based on assumptions and the opinion of a clinical expert. CONCLUSIONS It was demonstrated that a current mix of bariatric surgery methods was cost-effective at 10 years post-surgery and cost-saving over the lifetime of the Belgian patient cohort considered in this analysis.
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Affiliation(s)
- Oleg Borisenko
- a Health Economics and Market Access , Synergus AB , Danderyd ( Stockholm ), Sweden
| | - Vasily Lukyanov
- b Health Economics , Synergus AB , Danderyd (Stockholm) , Sweden
| | - Isabelle Debergh
- c Dienst Algemene, Vaat- en Kinderheelkunde, AZ Sint-Jan Brugge-Oostende AV, campus Sint-Jan , Ruddershove 10 , 8000 Brugge , Belgium
| | - Bruno Dillemans
- c Dienst Algemene, Vaat- en Kinderheelkunde, AZ Sint-Jan Brugge-Oostende AV, campus Sint-Jan , Ruddershove 10 , 8000 Brugge , Belgium
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Laparoscopic Silastic Ring Mini-Gastric Bypass (SR-MGBP): Up to 11-Year Results from a Single Centre. Obes Surg 2018; 27:2229-2234. [PMID: 28378207 DOI: 10.1007/s11695-017-2659-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Bariatric surgery is well established as an effective method for treating obesity and its related comorbidities. The laparoscopic mini-gastric bypass (MGBP) represents a simpler alternative to a Roux-en-Y gastric bypass (RYGBP). The placement of a silastic ring (SR) may enhance excess weight loss and minimize weight regain. This study reports long-term results from a cohort of patients undergoing a SR-MGBP in a single centre. METHODS Long-term outcomes (up to 11 years) in a cohort of 156 patients undergoing surgery between August 2005 and January 2008 were analysed. A combination of follow-up questionnaires and electronic hospital records were used to assess weight loss, comorbidity resolution and complications. RESULTS A total of 156 patients (mean body mass index 46 kg/m2) underwent surgery. Ninety-two patients responded to the follow-up questionnaires. Computer-based hospital information was available on a total of 139 patients. Mean percent excess weight loss (%EWL) at 11 years was 84.3%. Comorbidity resolution, determined by medication use, showed a reduction in diabetes (21.8% to 7.1%), hypertension (37.2% to 21.4%) and hypercholesterolaemia (40.4% to 13.4%). Five of 139 patients (3.6%) had SR problems needing removal. Two other patients had the SR changed to a bigger size and a further two had endoscopic removal of the SR for erosion. Of the 139 patients, 9.4% required conversion to a Roux-en-Y gastric bypass (RYGBP). The number of patients on anti-reflux medications increased from 5.1% to 44.6% at 11 years. There were two deaths unrelated to surgery. CONCLUSIONS SR-MGBP appears to be a safe and effective operation for the morbidly obese. It is durable, with good weight loss at up to 11 years post-surgery. The SR can easily be removed or exchanged for another size and is reasonable to consider when performing a MGBP. Concerns about bile reflux appear to be well founded, and some patients who are poorly controlled medically will require revision.
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Cardoso L, Rodrigues D, Gomes L, Carrilho F. Short- and long-term mortality after bariatric surgery: A systematic review and meta-analysis. Diabetes Obes Metab 2017; 19:1223-1232. [PMID: 28244626 DOI: 10.1111/dom.12922] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/14/2017] [Accepted: 02/22/2017] [Indexed: 12/16/2022]
Abstract
AIMS The objective of this study was to investigate short- (≤ 30 days) and long-term (≥ 2 years) all-cause mortality after bariatric surgery among adult patients with obesity. MATERIALS AND METHODS For short-term mortality, eligible studies comprised randomized controlled trials (RCTs) reporting perioperative mortality. For long-term mortality, eligible studies comprised RCTs and observational studies comparing mortality between obese patients after bariatric surgery and non-operated controls. Random-effects models using a Bayesian or frequentist approach were used to pool effect estimates of short- and long-term mortality, respectively. RESULTS Short-term all-cause mortality based on 38 RCTs involving 4030 patients was 0.18% (95% CI, 0.04%-0.38%) and was higher for open surgeries (0.31%; 95% CI, 0.03%-0.97%) and similar in mixed surgeries (0.17%; 95% CI, 0.03%-0.43%) and restrictive surgeries (0.17%; 95% CI, 0.03%-0.45%). For long-term mortality, 12 observational studies involving 27 258 operated patients and 97 154 non-operated obese controls were included. Of these, 8 studies were eligible for the meta-analysis, which showed a reduction of 41% in all-cause mortality (hazard ratio, 0.59; 95% CI, 0.52-0.67; P < .001). Additionally, operated patients were 0.42 times as likely (95% CI, 0.25-0.72, P < .001) and 0.47 times as likely (95% CI, 0.36-0.63, P < .001) as non-operated obese controls to die from cardiovascular diseases and cancer, respectively. CONCLUSIONS Bariatric surgery is associated with low short-term mortality and may be associated with long-term reductions in all-cause, cardiovascular and cancer-related mortality.
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Affiliation(s)
- Luís Cardoso
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Dírcea Rodrigues
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Leonor Gomes
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Francisco Carrilho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Laparoscopic Sleeve Gastrectomy Versus Banded Roux-en-Y Gastric Bypass for Diabetes and Obesity: a Prospective Randomised Double-Blind Trial. Obes Surg 2017; 28:293-302. [PMID: 28840525 DOI: 10.1007/s11695-017-2872-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Borisenko O, Mann O, Duprée A. Cost-utility analysis of bariatric surgery compared with conventional medical management in Germany: a decision analytic modeling. BMC Surg 2017; 17:87. [PMID: 28774333 PMCID: PMC5543597 DOI: 10.1186/s12893-017-0284-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/26/2017] [Indexed: 12/15/2022] Open
Abstract
Background The objective was to evaluate cost-utility of bariatric surgery in Germany for a lifetime and 10-year horizon from a health care payer perspective. Methods State-transition Markov model provided absolute and incremental clinical and monetary results. In the model, obese patients could undergo surgery, develop post-surgery complications, experience diabetes type II, cardiovascular diseases or die. German Quality Assurance in Bariatric Surgery Registry and literature sources provided data on clinical effectiveness and safety. The model considered three types of surgeries: gastric bypass, sleeve gastrectomy, and adjustable gastric banding. The model was extensively validated, and deterministic and probabilistic sensitivity analyses were performed to evaluate uncertainty. Cost data were obtained from German sources and presented in 2012 euros (€). Results Over 10 years, bariatric surgery led to the incremental cost of €2909, generated additional 0.03 years of life and 1.2 quality-adjusted life years (QALYs). Bariatric surgery was cost-effective at 10 years with an incremental cost-effectiveness ratio of €2457 per QALY. Over a lifetime, surgery led to savings of €8522 and generated an increment of 0.7 years of life or 3.2 QALYs. The analysis also depicted an association between surgery and a reduction of obesity-related adverse events (diabetes, cardiovascular disorders). Delaying surgery for up to 3 years, resulted in a reduction of life years and QALYs gained, in addition to a moderate reduction in associated healthcare costs. Conclusions Bariatric surgery is cost-effective at 10 years post-surgery and may result in a substantial reduction in the financial burden on the healthcare system over the lifetime of the treated individuals. It is also observed that delays in the provision of surgery may lead to a significant loss of clinical benefits.
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Affiliation(s)
| | - Oliver Mann
- University Medical Center Hamburg, Hamburg, Germany
| | - Anna Duprée
- University Medical Center Hamburg, Hamburg, Germany
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Comparison of Banded Versus Non-banded Roux-en-Y Gastric Bypass: a Series of 1150 Patients at a Single Institution. Obes Surg 2017; 28:212-217. [DOI: 10.1007/s11695-017-2832-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
BACKGROUND The laparoscopic Roux-en-Y gastric bypass (LRYGB) has been considered a reference procedure in the bariatric surgery. The linear-stapled gastrojejunostomy (GJ) has proved to be safe and effective, but its optimal size referred to postoperative weight loss remains poorly understood. OBJECTIVES Evaluate the role of the linear-stapled GJ size in the mid-term post-LRYGB weight loss and occurrence of complications. MATERIALS AND METHODS From January to April 2014, 128 patients underwent LRYGB with linear-stapled GJ in a 2-year follow-up. The LRYGB were carried out with the same technical steps, except for the length of the GJ. In GJ-15-mm group (n = 64), the GJ was constructed with white 45-mm cartridge in an extension of only 15 mm whereas in GJ-45-mm group (n = 64), the GJ was achieved using full extension of the cartridge. The body mass index (BMI) reduction was recorded for 24 months after procedure. RESULTS The mean ages were 38 ± 10.6 and 41.3 ± 12.3 years, and there were 45 (70.3%) and 51 (79.7%) females in the GJ-15-mm and GJ-45-mm groups, respectively. The analysis on raw BMI data showed that both groups had significant reduction of BMI over time (p ≤ 0.05); however, reduction was greater in the GJ-15-mm group from 18 months onwards (p ≤ 0.05). The only complication observed was a case (1.56%) of stenosis in the group GJ-15 mm. CONCLUSION The global analysis of BMI reduction indicated that the narrower GJ used (GJ-15-mm group) represented a favoring factor decreasing significantly more the BMI when compared to the wider one (GJ-45-mm group).
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Carbajo MA, Luque-de-León E, Jiménez JM, Ortiz-de-Solórzano J, Pérez-Miranda M, Castro-Alija MJ. Laparoscopic One-Anastomosis Gastric Bypass: Technique, Results, and Long-Term Follow-Up in 1200 Patients. Obes Surg 2017; 27:1153-1167. [PMID: 27783366 PMCID: PMC5403902 DOI: 10.1007/s11695-016-2428-1] [Citation(s) in RCA: 222] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Excellent results have been reported with mini-gastric bypass. We adopted and modified the one-anastomosis gastric bypass (OAGB) concept. Herein is our approach, results, and long-term follow-up (FU). METHODS Initial 1200 patients submitted to laparoscopic OAGB between 2002 and 2008 were analyzed after a 6-12-year FU. Mean age was 43 years (12-74) and body mass index (BMI) 46 kg/m2 (33-86). There were 697 (58 %) without previous or simultaneous abdominal operations, 273 (23 %) with previous, 203 (17 %) with simultaneous, and 27 (2 %) performed as revisions. RESULTS Mean operating time (min) was as follows: (a) primary procedure, 86 (45-180); (b) with other operations, 112 (95-230); and (c) revisions, 180 (130-240). Intraoperative complications led to 4 (0.3 %) conversions. Complications prompted operations in 16 (1.3 %) and were solved conservatively in 12 (1 %). Long-term complications occurred in 12 (1 %). There were 2 (0.16 %) deaths. Thirty-day and late readmission rates were 0.8 and 1 %. Cumulative FU was 87 and 70 % at 6 and 12 years. The highest mean percent excess weight loss was 88 % (at 2 years), then 77 and 70 %, 6 and 12 years postoperatively. Mean BMI (kg/m2) decreased from 46 to 26.6 and was 28.5 and 29.9 at those time frames. Remission or improvement of comorbidities was achieved in most patients. The quality of life index was satisfactory in all parameters from 6 months onwards. CONCLUSIONS Laparoscopic OAGB is safe and effective. It reduces difficulty, operating time, and early and late complications of Roux-en-Y gastric bypass. Long-term weight loss, resolution of comorbidities, and degree of satisfaction are similar to results obtained with more aggressive and complex techniques. It is currently a robust and powerful alternative in bariatric surgery.
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Affiliation(s)
- Miguel A. Carbajo
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Calle Estacion, No. 12, 1°, 47004 Valladolid, Spain
| | - Enrique Luque-de-León
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Calle Estacion, No. 12, 1°, 47004 Valladolid, Spain
| | - José M. Jiménez
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Calle Estacion, No. 12, 1°, 47004 Valladolid, Spain
| | - Javier Ortiz-de-Solórzano
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Calle Estacion, No. 12, 1°, 47004 Valladolid, Spain
| | - Manuel Pérez-Miranda
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Calle Estacion, No. 12, 1°, 47004 Valladolid, Spain
| | - María J. Castro-Alija
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Calle Estacion, No. 12, 1°, 47004 Valladolid, Spain
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Abstract
BACKGROUND While gastric bypass has been the treatment of choice for morbid obesity, insufficient weight loss and even weight regain has been observed in a sub-group of patients. Dilatation of the pouch, pouch outlet, and proximal alimentary limb have been suggested to cause weight regain on the long term. The banded gastric bypass surgery has been introduced to overcome this problem. METHODS Four hundred thirty-two patients (n = 254, non-banded/n = 178, banded-GaBP Ring™) were followed-up for 5 years. Patients were evaluated for weight loss, % excess weight loss (%EWL), weight regain and BMI. RESULTS No significant differences between groups in the first year following surgery were observed in terms of weight loss and %EWL. %EWL at 5 years was as follows: non-banded 65.2 ± 20.0 %; banded 74.0 ± 15.1 %. At 5 years, the banded group showed more weight loss (non-banded 35.4 ± 12.5; banded 43.9 ± 11.9 kg, P < 0.0001); weight regain was significantly higher in the non-banded group (P < 0.0001). Only minor complications were reported; no signs of ring migration or slippage were reported. CONCLUSION Although, following the first year after surgery, no differences in treatment groups were observed in terms of weight loss, 5 years following surgery, patients who received banded surgery maintained better weight loss and had less weight regain compared to the non-banded group. These results suggest that laparoscopic banded gastric bypass using a silastic ring was effective in maintaining weight loss on the long term, while the complication rate was low. The banded gastric bypass is regarded by us as the new gold standard.
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Affiliation(s)
- Luc Lemmens
- Abdominal Surgery, AZ Nikolaas, Campus Sint-Niklaas, Moerlandstraat 1, 9100, Sint-Niklaas, Belgium.
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Reconstruction of leaking gastric pouch after redo Rouxen-Y gastric bypass - revisionary surgery strategy. Wideochir Inne Tech Maloinwazyjne 2017; 11:9-13. [PMID: 28133494 PMCID: PMC4840183 DOI: 10.5114/wiitm.2016.57485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/14/2015] [Indexed: 11/17/2022] Open
Abstract
With the rapid development of the knowledge and techniques in bariatric surgery, as well as extensive expansion of indications for metabolic operations, surgeons have started to realize that the procedures they choose are not always suited to the needs and behavior of patients. Second and very frequently third revisional procedures are thus necessary in order to achieve desired outcomes and fulfill patients' expectations. Restoration of restriction is commonly the first procedure, but not all may benefit from it. We hence want to illustrate the decision-making process by presenting a patient with the background of initial Rouxen-Y gastric bypass (RYGB) and redo-RYGB, who then underwent a further revision by a 2-stage approach due to weight regain. The first stage involved shortening of the common channel and the second one reconstruction of his gastric pouch with duodenal switch (DS). Consequently we wish to focus here on a discussion about operative techniques and strategies to improve outcomes in such patients.
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Lucchese M, Borisenko O, Mantovani LG, Cortesi PA, Cesana G, Adam D, Burdukova E, Lukyanov V, Di Lorenzo N. Cost-Utility Analysis of Bariatric Surgery in Italy: Results of Decision-Analytic Modelling. Obes Facts 2017; 10:261-272. [PMID: 28601866 PMCID: PMC5644931 DOI: 10.1159/000475842] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 04/13/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the cost-effectiveness of bariatric surgery in Italy from a third-party payer perspective over a medium-term (10 years) and a long-term (lifetime) horizon. METHODS A state-transition Markov model was developed, in which patients may experience surgery, post-surgery complications, diabetes mellitus type 2, cardiovascular diseases or die. Transition probabilities, costs, and utilities were obtained from the Italian and international literature. Three types of surgeries were considered: gastric bypass, sleeve gastrectomy, and adjustable gastric banding. A base-case analysis was performed for the population, the characteristics of which were obtained from surgery candidates in Italy. RESULTS In the base-case analysis, over 10 years, bariatric surgery led to cost increment of EUR 2,661 and generated additional 1.1 quality-adjusted life years (QALYs). Over a lifetime, surgery led to savings of EUR 8,649, additional 0.5 life years and 3.2 QALYs. Bariatric surgery was cost-effective at 10 years with an incremental cost-effectiveness ratio of EUR 2,412/QALY and dominant over conservative management over a lifetime. CONCLUSION In a comprehensive decision analytic model, a current mix of surgical methods for bariatric surgery was cost-effective at 10 years and cost-saving over the lifetime of the Italian patient cohort considered in this analysis.
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Affiliation(s)
- Marcello Lucchese
- Bariatric, General Surgery and Metabolic Department, Santa Maria Nuova Hospital, Florence, Italy
| | - Oleg Borisenko
- Synergus AB, Danderyd, Sweden
- *Oleg Borisenko, MD, PhD, Health Economy, Synergus AB, Kevinge strand 20, Danderyd, 18257, Sweden,
| | | | - Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Milan, Italy
| | - Giancarlo Cesana
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Milan, Italy
| | | | | | | | - Nicola Di Lorenzo
- Applied Experimental Medicine and Surgery Department, University of Tor Vergata, Rome, Italy
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A Comparative, Prospective and Randomized Evaluation of Roux-en-Y Gastric Bypass With and Without the Silastic Ring: A 2-Year Follow Up Preliminary Report on Weight Loss and Quality of Life. Obes Surg 2016; 26:762-8. [PMID: 26314349 DOI: 10.1007/s11695-015-1851-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Currently, Roux-en-Y gastric bypass (RYGB) is one of the most widely used bariatric surgeries. Banding the pouch forms a banded gastric bypass operation, an accepted and frequently used variant. Placing a silastic ring around the pouch to band the gastric bypass operation increases the restriction mechanism. However, the ubiquitous use of the banded gastric bypass remains controversial. One of the controversies is the effect of the silastic ring on patients' perception of their well being after surgery because of the frequency of vomiting. A prospective, blindly randomized, comparative trial was undertaken to resolve this controversy. METHOD Four hundred subjects scheduled for gastric bypass surgery were randomized into two arms of the trial, 200 with a silastic ring (WR) and 200 without (NR). After 2-year follow-up, the variables associated with the scores of Bariatric Analysis and Reporting Outcome System (BAROS) were analyzed. RESULTS The initial median weight (125 kg), BMI (47), and age (36 years) were the same in both the NR and WR groups. The median excess weight loss, weight regain, and incidence of vomiting were 71, 10.5, and 7.75%, respectively, in the NR group vs. 75.4 and 1.1, and 24.4% in the WR group. The mean QOL score was 79% in the NR group vs. 80% in the WR group. CONCLUSION After 2-year follow-up, silastic ring placement in the RYGB resulted in greater weight loss and weight stability and a threefold greater incidence of vomiting. There was no difference in the scores in the quality of life analysis.
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Comparison Between Banded and Nonbanded Roux-En-Y Gastric Bypass with 2-Year Follow-Up: a Preliminary Retrospective Analysis. Obes Surg 2016; 26:213-8. [PMID: 26482162 DOI: 10.1007/s11695-015-1929-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is one of the most widely used bariatric surgeries for treatment of moderate and severe obesity. Placing a band around the pouch to band the gastric bypass operation has been reported to increase the restriction resulting in better weight loss and weight loss maintenance. A retrospective comparative study of banded versus nonbanded gastric bypass was done to see if banding the pouch made a difference in the weight loss and quality of life outcome in the patients. METHODS Data from all patients who had a gastric bypass in the year 2012 at our centre were reviewed. They were divided into two groups the banded and the nonbanded groups. Patients with complete 2-year follow-up were analysed in terms of weight loss, weight regain and quality of life changes. RESULTS Two hundred ten patients had gastric bypass in 2012; 165 had complete 2-year follow-up; 64 were banded and 101 nonbanded. The preoperative patient profile in terms of weight, gender and comorbid conditions was similar in both groups except the body mass index (BMI) was significantly higher in the banded group. The perioperative and postoperative complication rates were similar. The weight, BMI and percentage excess weight loss (PEWL) at 2 years were 80.93 kg, 29.45 kg/m2 and 60.76 % in the nonbanded group and 77.06 kg, 27.66 kg/m2 and 71.45 % in the banded group, respectively. Resolution of comorbid conditions was the same in both groups. The overall Gastrointestinal Quality of Life Index went from 88.98 preoperatively to 109.33 postoperatively in the nonbanded group and 92.5 to 112.81 in the banded group, respectively. CONCLUSIONS The patients with banded gastric bypass had significantly better results in terms of weight loss, weight stability and Gastrointestinal Quality of Life Index scores at 2 years.
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Murphy R, Evennett NJ, Clarke MG, Robinson SJ, Humphreys L, Jones B, Kim DD, Cutfield R, Plank LD, Hammodat H, Booth MWC. Sleeve gastrectomy versus Roux-en-Y gastric bypass for type 2 diabetes and morbid obesity: double-blind randomised clinical trial protocol. BMJ Open 2016; 6:e011416. [PMID: 27377635 PMCID: PMC4947793 DOI: 10.1136/bmjopen-2016-011416] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Type 2 diabetes (T2D) in association with obesity is an increasing disease burden. Bariatric surgery is the only effective therapy for achieving remission of T2D among those with morbid obesity. It is unclear which of the two most commonly performed types of bariatric surgery, laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB), is most effective for obese patients with T2D. The primary objective of this study is to determine whether LSG or LRYGB is more effective in achieving HbA1c<6% (<42 mmol/mol) without the use of diabetes medication at 5 years. METHODS AND ANALYSIS Single-centre, double-blind (assessor and patient), parallel, randomised clinical trial (RCT) conducted in New Zealand, targeting 106 patients. Eligibility criteria include age 20-55 years, T2D of at least 6 months duration and body mass index 35-65 kg/m(2) for at least 5 years. Randomisation 1:1 to LSG or LRYGB, used random number codes disclosed to the operating surgeon after induction of anaesthesia. A standard medication adjustment schedule will be used during postoperative metabolic assessments. Secondary outcomes include proportions achieving HbA1c<5.7% (39 mmol/mol) or HbA1c<6.5% (48 mmol/mol) without the use of diabetes medication, comparative weight loss, obesity-related comorbidity, operative complications, revision rate, mortality, quality of life, anxiety and depression scores. Exploratory outcomes include changes in satiety, gut hormone and gut microbiota to gain underlying mechanistic insights into T2D remission. ETHICS AND DISSEMINATION Ethics approval was obtained from the New Zealand regional ethics committee (NZ93405) who also provided independent safety monitoring of the trial. Study commenced in September 2011. Recruitment completed in October 2014. Data collection is ongoing. Results will be reported in manuscripts submitted to peer-reviewed journals and in presentations at national and international meetings. TRIAL REGISTRATION NUMBERS ACTRN12611000751976, NCT01486680; Pre-results.
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Affiliation(s)
- Rinki Murphy
- Faculty of Medical and Health Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Nicholas J Evennett
- Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Michael G Clarke
- Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Steven J Robinson
- Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Lee Humphreys
- Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Bronwen Jones
- Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - David D Kim
- Department of Endocrinology, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Richard Cutfield
- Department of Endocrinology, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Lindsay D Plank
- Faculty of Medical and Health Sciences, Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Hisham Hammodat
- Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Michael W C Booth
- Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
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Endoluminal Revision (OverStitch TM , Apollo Endosurgery) of the Dilated Gastroenterostomy in Patients with Late Dumping Syndrome After Proximal Roux-en-Y Gastric Bypass. Obes Surg 2016; 26:1978-84. [DOI: 10.1007/s11695-016-2266-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Borisenko O, Adam D, Funch-Jensen P, Ahmed AR, Zhang R, Colpan Z, Hedenbro J. Bariatric Surgery can Lead to Net Cost Savings to Health Care Systems: Results from a Comprehensive European Decision Analytic Model. Obes Surg 2015; 25:1559-68. [PMID: 25639648 PMCID: PMC4522026 DOI: 10.1007/s11695-014-1567-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The objective of the present study was to evaluate the cost-utility of bariatric surgery in a lifetime horizon from a Swedish health care payer perspective. METHODS A decision analytic model using the Markov process was developed covering cardiovascular diseases, type 2 diabetes, and surgical complications. Clinical effectiveness and safety were based on the literature and data from the Scandinavian Obesity Surgery Registry. Gastric bypass, sleeve gastrectomy, and gastric banding were included in the analysis. Cost data were obtained from Swedish sources. RESULTS Bariatric surgery was cost saving in comparison with conservative management. It also led to a substantial reduction in lifetime risk of events: from a 16 % reduction in the risk of transient ischaemic attacks to a 62 % reduction in the incidence of type 2 diabetes. Over a lifetime, surgery led to savings of euro 8408 and generated an additional 0.8 years of life and 4.1 quality-adjusted life years (QALYs) per patient, which translates into gains of 32,390 quality-adjusted person-years and savings of euro 66 million for the cohort, operated in 2012. Analysis of the consequences of a 3-year delay in surgery provision showed that the overall lifetime cost of treatment may be increased in patients with diabetes or a body mass index >40 kg/m(2). Delays in surgery may also lead to a loss of clinical benefits: up to 0.6 life years and 1.2 QALYs per patient over a lifetime. CONCLUSION Bariatric surgery, over a lifetime horizon, may lead to significant cost savings to health care systems in addition to the known clinical benefits.
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Affiliation(s)
| | - Daniel Adam
- Synergus AB, Svardvagen 19, 182 33 Danderyd, Sweden
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35
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Abstract
Primary banding of Roux-en-Y gastric bypass remains controversial. Though there are surgeons who believe it should be the standard practice as it results in superior weight loss and prevents weight regain in the long term, there are others who are concerned about the risk of food intolerance and complications related to band. This review investigates published English language literature systematically to find out the advantages and disadvantages of primary banding of a Roux-en-Y gastric bypass.
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Karcz WK, Karcz-Socha I, Marjanovic G, Kuesters S, Goos M, Hopt UT, Szewczyk T, Baumann T, Grueneberger JM. To band or not to band--early results of banded sleeve gastrectomy. Obes Surg 2015; 24:660-5. [PMID: 24464518 DOI: 10.1007/s11695-014-1189-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Laparoscopic sleeve gastrectomy (LSG) is the procedure with the fastest growing numbers worldwide. Although excellent weight loss can be achieved, one major obstacle of LSG is weight regain due to sleeve dilatation. Banded sleeve gastrectomy (BLSG) has been described as an option to counteract sleeve dilatation and ameliorate weight loss over time. In a retrospective study, we analysed 25 patients who underwent BLSG using a MiniMizer® ring. Twenty five patients who had previously undergone a conventional LSG were selected for matched-pair analysis. Patient follow-up was 12 months in both groups. Mean preoperative BMI was 56.1 ± 7.2 kg/m(2) for BLSG and 57.0 ± 6.3 kg/m(2) for LSG, P = 0.522. Operative time was significantly shorter for BLSG (53 ± 27 min vs. 68 ± 20 min, P = 0.0025). Excess weight loss (%EWL) was equal in both groups with %EWL at 12 months of 58.0 ± 14.6 % for BSLG patients vs. 58.4 ± 19.2 % for LSG patients. There was no procedure-related mortality in either group. At 12 months postoperative, vomiting was significantly increased in BSLG patients (OR 6.75, P = 0.035). New onset reflux was equal in both groups (OR 0.67, P = 0.469). Ring implantation does not increase the duration of surgery or early surgical complications. Weight loss in the first follow-up year is not influenced, but the incidence of vomiting is raised after 12 months when patients start to increase eating volume.
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Affiliation(s)
- W Konrad Karcz
- Department of General Surgery, University of Schleswig-Holstein, Campus, Lübeck, Germany
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Leibel RL, Seeley RJ, Darsow T, Berg EG, Smith SR, Ratner R. Biologic Responses to Weight Loss and Weight Regain: Report From an American Diabetes Association Research Symposium. Diabetes 2015; 64:2299-309. [PMID: 26106187 DOI: 10.2337/db15-0004] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Rudolph L Leibel
- Division of Molecular Genetics and Naomi Berrie Diabetes Center, Columbia University, New York, NY
| | - Randy J Seeley
- Department of Surgery, North Campus Research Complex, University of Michigan School of Medicine, Ann Arbor, MI
| | - Tamara Darsow
- Division of Science and Medicine, American Diabetes Association, Alexandria, VA
| | - Erika Gebel Berg
- Division of Science and Medicine, American Diabetes Association, Alexandria, VA
| | - Steven R Smith
- Translational Research Institute for Metabolism and Diabetes, Sanford-Burnham Institute, Florida Hospital, Winter Park, FL
| | - Robert Ratner
- Division of Science and Medicine, American Diabetes Association, Alexandria, VA
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Metabolic effects of bariatric surgery in mouse models of circadian disruption. Int J Obes (Lond) 2015; 39:1310-8. [PMID: 25869599 PMCID: PMC4526404 DOI: 10.1038/ijo.2015.54] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/14/2015] [Accepted: 04/04/2015] [Indexed: 01/07/2023]
Abstract
Background/Objectives Mounting evidence supports a link between circadian disruption and metabolic disease. Humans with circadian disruption (e.g., night-shift workers) have an increased risk of obesity and cardiometabolic diseases compared to the non-disrupted population. However, it is unclear if the obesity and obesity-related disorders associated with circadian disruption respond to therapeutic treatments as well as individuals with other types of obesity. Subjects/Methods Here, we test the effectiveness of the commonly used bariatric surgical procedure, Vertical Sleeve Gastrectomy (VSG) in mouse models of genetic and environmental circadian disruption. Results VSG led to a reduction in body weight and fat mass in both ClockΔ19 mutant and constant-light mouse models (P < .05), resulting in an overall metabolic improvement independent of circadian disruption. Interestingly, the decrease in body weight occurred without altering diurnal feeding or activity patterns (P > .05). Within circadian-disrupted models, VSG also led to improved glucose tolerance and lipid handling (P < .05). Conclusions Together these data demonstrate that VSG is an effective treatment for the obesity associated with circadian disruption, and that the potent effects of bariatric surgery are orthogonal to circadian biology. However, since the effects of bariatric surgery are independent of circadian disruption, VSG cannot be considered a cure for circadian disruption. These data have important implications for circadian-disrupted obese patients. Moreover, these results reveal new information about the metabolic pathways governing the effects of bariatric surgery as well as of circadian disruption.
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Daigle CR, Corcelles R, Schauer PR. Primary silicone-banded laparoscopic sleeve gastrectomy: a pilot study. J Laparoendosc Adv Surg Tech A 2015; 25:94-7. [PMID: 25650501 DOI: 10.1089/lap.2014.0378] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Some degree of inadequate weight loss or recidivism is seen with all bariatric surgical approaches. To combat this, some authors have suggested placing a reinforcing ring around gastric bypass pouches or gastric sleeves. The aim of this study was to assess the initial feasibility and efficacy of silicone-banded laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS All cases of silicone-banded LSG performed at our center were retrospectively identified. Patient demographics, perioperative parameters, and postoperative outcomes were extracted and analyzed. RESULTS Thirteen patients (7 females, 6 males) were identified and analyzed. Preoperatively, patients had a mean age of 56.0 ± 8.3 years, a mean body mass index (BMI) of 53.7 ± 8.5 kg/m(2), and a median of seven comorbidities. All cases were completed laparoscopically by one surgeon, with a mean operative time of 140.7 ± 25.7 minutes and a mean estimated blood loss of 56.9 ± 30.6 mL. There were no mortalities. The only intraoperative complication was a respiratory arrest after extubation, and this patient recovered fully. Postoperatively, 2 patients (15.4%) experienced a complication: one had a pulmonary embolism requiring brief re-admission, and the other had a syncopal episode from a second-degree atrioventricular block. No long-term complications were encountered. One patient was lost to follow-up. At a median follow-up of 16 months (range, 6-27 months), the mean BMI of the cohort was 38.7 ± 7.9 kg/m(2), which corresponded to a mean excess weight loss (EWL) of 54.8 ± 19.6%. CONCLUSIONS This report provides initial evidence that silicone-banded LSG is feasible and can be performed with minimal morbidity and significant EWL at short-term follow-up.
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Lemmens L, Karcz WK, Bukhari W, Fink J, Kuesters S. Banded gastric bypass - four years follow up in a prospective multicenter analysis. BMC Surg 2014; 14:88. [PMID: 25391401 PMCID: PMC4236457 DOI: 10.1186/1471-2482-14-88] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 10/17/2014] [Indexed: 12/21/2022] Open
Abstract
Background The gastric bypass is the gold standard of bariatric surgery. Nevertheless some patients show insufficient weight loss or weight regain. Dilation of the pouch or the pouch outlet may be the cause. The banded gastric bypass tries to overcome dilation by placing an implant around the pouch or pouch outlet. In this study we describe our results using the GaBP™ ring system in banded gastric bypass operations in 3 bariatric centers. Methods 183 patients in 3 bariatric reference centers received a banded gastric bypass operation using the GaBP™ ring system. Up to 4 years follow up was evaluated including weight loss and complications. Results Mean EWL after 6 Months was 60% with a mean BMI of 30.1 kg/m2. After one year mean EWL reached 75.3% with a mean BMI of 27 kg/m2 (110 patients). After two and three years the EWL was 78.8% (n = 49) and 79.9% (n = 35). There was a mean EWL of 85% after 4 years. Thirteen patients finished a 4 year follow up period and mean BMI after 4 years was 25.2 kg/m2. In the perioperative and early postoperative period there was a low complication rate (4.3%). Stenosis or dysphagia was observed in only one patient. There was only one ring related complication. Conclusion Banded gastric bypass using the GaBP™ ring system allows good weight loss with no regain of weight in a four year follow up. The complication rate is low. A randomized controlled trial is currently underway to compare banded and conventional gastric bypass.
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Affiliation(s)
| | - W Konrad Karcz
- Department of Surgery, University of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
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Stubbs RS, Sarvepalli R. What makes a gastric bypass a good gastric bypass? Opinion and hypothesis. World J Surg Proced 2014; 4:48-54. [DOI: 10.5412/wjsp.v4.i2.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 03/04/2014] [Accepted: 06/03/2014] [Indexed: 02/06/2023] Open
Abstract
Gastric bypass is widely accepted as the gold standard bariatric operation. It was first reported 1967 and has been the subject of many technical alterations and variations since that time. Each of these variations has the potential to confer different outcomes, in terms of such things as weight loss, ease of surgery, risk, complications and durability of weight loss. All variations being performed these days should be accomplished with high levels of safety, in which case the primary interest of those undergoing surgery is the degree of weight loss that can be expected and the durability of that weight loss. Broadly speaking these two features will also determine the degree to which all co-morbidities are improved, which is also a goal of those undergoing surgery. In this article the authors describe the features of the Fobi Pouch gastric bypass which make it the most predictable and reliable variant of gastric bypass and report such evidence in the literature as exists for their contentions.
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Systematic Review and Meta-analysis of Medium-Term Outcomes After Banded Roux-en-Y Gastric Bypass. Obes Surg 2014; 24:1536-51. [DOI: 10.1007/s11695-014-1311-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Expert Panel Report: Guidelines (2013) for the management of overweight and obesity in adults. Obesity (Silver Spring) 2014; 22 Suppl 2:S41-410. [PMID: 24227637 DOI: 10.1002/oby.20660] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Executive summary: Guidelines (2013) for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society published by the Obesity Society and American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Based on a systematic review from the The Obesity Expert Panel, 2013. Obesity (Silver Spring) 2014; 22 Suppl 2:S5-39. [PMID: 24961825 DOI: 10.1002/oby.20821] [Citation(s) in RCA: 186] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
BACKGROUND Laparoscopic mini-gastric bypass (MGBP) represents a simpler alternative to Roux-en-Y gastric bypass. The placement of a silastic ring (SR) may enhance excess weight loss and minimize weight regain. This study reports on the results of a consecutive cohort of patients undergoing SR-MGBP in a single centre. METHODS Short- and medium-term outcomes of 156 consecutive patients undergoing surgery between August 2005 and January 2008 were analysed. Weight loss, comorbidity resolution and morbidity/mortality were assessed. RESULTS A total of 156 patients (78% female, 22% male) with a mean (range) age of 44 years (18-63), pre-operative weight of 129 kg (83-197) and body mass index of 46 kg/m(2) (35-64) underwent surgery. Eighty-seven percent had pre-operative comorbidities, and median (range) follow-up was 35 months (6-72). Mean (SD) % excess weight loss (EWL) at 6, 12, 24, 36 and 60 months was 74.6 (19.5), 93.4 (21.1), 98.8 (27.6), 93.5 (20.1) and 89 (16.1) respectively. Thirty-seven percent had complete resolution of comorbidities and 67.3% required vitamin/mineral supplementation. Overall, 10.3% patients suffered early complications, of which 7.7% were minor and 2.6% were major. A total of 45.5% patients suffered late complications, of which 34.6% were minor and 10.9% were major. Food intolerance/vomiting, bile reflux and stomal ulcer were seen in 18.6, 10.3 and 7.7% of patients, respectively. Surgical re-intervention was required in 12.8% of patients. There were no deaths. CONCLUSIONS Whilst SR-MGBP achieves excellent EWL with low mortality, there is a high incidence of food intolerance/vomiting likely related to the silastic ring. The majority of complications were managed with pharmacological and endoscopic intervention, although 13% required reoperation within 5 years.
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Ferraz A, Campos J, Dib V, Silva LB, de Paula PS, Gordejuela A, Rolim F, Siqueira L, Galvão Neto M. Food intolerance after banded gastric bypass without stenosis: aggressive endoscopic dilation avoids reoperation. Obes Surg 2014; 23:959-64. [PMID: 23471676 DOI: 10.1007/s11695-013-0900-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGBP) controls obesity and comorbidities. However, there is no consensus on ring placement due to its complications. Surgical ring removal has been the standard approach, despite its inherent morbidity risks. Endoscopic dilation with achalasia balloon is a novel and minimally invasive option. We aimed to evaluate safety and efficacy of aggressive dilation as an outpatient procedure to treat food intolerance after banded RYGBP without stenosis; we also analyzed long-term weight regain. METHODS This prospective study included 63 patients presenting with more than four vomiting episodes per week. Therapeutic endoscopy with a 30-mm balloon (Rigiflex®) was performed with radioscopic guidance in the first 16 patients (25.4 %). Four dilation sessions were performed in 12 patients (19 %), three in 14 (22.2 %), two in 24 (38 %), and one in 13 (20.6 %). RESULTS Complete symptom improvement was achieved in 59 patients (93.6 %), partial improvement in 2 (3.2 %), and failure in 2, leading to ring removal by laparotomy. Complications rate was 9.5 %, including three cases of bleeding, two intragastric ring erosions, and one pneumoperitoneum; all treated clinically with no need for reintervention. Mean preoperative body mass index (BMI) was 42.4 kg/m(2) and postoperative (before endoscopic treatment) BMI was 25.3 kg/m(2). At a mean follow-up of 46.1 months after endoscopic intervention, mean BMI was 27.8 kg/m(2). CONCLUSIONS Aggressive endoscopic dilation for food intolerance is a safe and minimally invasive method that promotes symptom improvement. It avoided reoperation in 96.8 % of patients and led to a low rate of weight regain.
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Affiliation(s)
- Alvaro Ferraz
- Departamento de Cirurgia, Universidade Federal de Pernambuco, Rua Vigário Barreto, 127/802-Graças, 52020-140, Recife, PE, Brazil
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Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, Hu FB, Hubbard VS, Jakicic JM, Kushner RF, Loria CM, Millen BE, Nonas CA, Pi-Sunyer FX, Stevens J, Stevens VJ, Wadden TA, Wolfe BM, Yanovski SZ. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol 2013; 63:2985-3023. [PMID: 24239920 DOI: 10.1016/j.jacc.2013.11.004] [Citation(s) in RCA: 1490] [Impact Index Per Article: 124.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Heneghan HM, Annaberdyev S, Eldar S, Rogula T, Brethauer S, Schauer P. Banded Roux-en-Y gastric bypass for the treatment of morbid obesity. Surg Obes Relat Dis 2013; 10:210-6. [PMID: 24462315 DOI: 10.1016/j.soard.2013.10.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 10/09/2013] [Accepted: 10/10/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the most effective treatment for morbid obesity. The additional benefit of placing a nonadjustable band around the pouch remains to be determined. The objective of this study was to compare outcomes between banded and nonbanded LRYGB patients in a single bariatric center. METHODS A matched cohort analysis was performed between patients who had undergone banded and nonbanded (standard) LRYGB. In the banded bypass cohort, an 8 F, 6.5 cm silastic ring was placed around the proximal gastric pouch. Both cohorts were matched for age, body mass index (BMI), and anastomotic technique. Endpoints included percentage excess weight loss (%EWL), postoperative morbidity, and band-related complications. RESULTS Between January 2007 and July 2010, 134 banded LRYGB were performed (55% female, mean age 45 years). They were compared with a matched cohort of 134 concurrent nonbanded LRYGB patients (67% female, mean age 45.4 years). Mean preoperative BMI was 54.6 and 52.8 kg/m(2), respectively (P = .084). At 24 months postoperatively, the average %EWL was 58.6% in banded bypass patients and 51.4% in the nonbanded group (P = .015). The difference in EWL was more pronounced in super-obese patients than in those with BMI<50 (among super-obese, 57.5% versus 47.6%, P = .003; among those with BMI<50, 62.9% versus 57.9%, P = .406]. There was no difference in early (19.4% versus 19.4%) or late complications (10.4% versus 13.4%, P = .451) between banded and nonbanded LRYGB patients. CONCLUSION Banding the pouch during LRYGB can be performed safely and may provide better weight loss, particularly in super-obese patients. Further prospective and long-term comparative studies of this technique are warranted.
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Affiliation(s)
- Helen M Heneghan
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
| | | | - Shai Eldar
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Tomasz Rogula
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stacy Brethauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Philip Schauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
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Moon R, Teixeira A, Jawad MA. Pericardial patch ring Roux-en-Y gastric bypass: a preliminary report. Obes Surg 2013; 23:480-5. [PMID: 23239032 DOI: 10.1007/s11695-012-0838-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (RYGB) is an effective treatment for morbid obesity. Failure of weight loss has been reported in 10 to 30% of RYGB patients. Silastic ring RYGB was introduced to minimize failure rate, however, with higher complication rate. The aim of our study is to evaluate the safety of utilizing pericardial patch as a ring on RYGB patients. METHODS Between March 2010 and June 2011, a total of 189 patients underwent pericardial patch ring RYGB at the Bariatric and Laparoscopy Center. A retrospective review of a prospectively collected database was performed for all pericardial patch ring RYGB patients, noting the outcomes and complications of the procedure. RESULTS Pericardial patch ring RYGB patients demonstrated a mean percentage of excess weight loss of 57.4% at a mean follow-up of 11 months. Out of 164 patients with follow-up, five (3.0%) patients required endoscopic balloon dilation due to dysphagia, abdominal pain, and/or gastric outlet obstruction. All patients did well after the procedure. Three (1.8%) patients underwent diagnostic laparoscopy for abdominal pain. Of these patients, one (0.6%) had dilated and enlarged blind limb, and two (1.2%) patients had partial small bowel obstruction. No patient was readmitted or reoperated due to pericardial patch ring. CONCLUSIONS Longer follow-up is needed to prove the true efficacy of this procedure in reducing weight gain. Pericardial patch ring RYGB seems to be a safe alternative for banded RYGB of other materials.
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Affiliation(s)
- Rena Moon
- Department of Bariatric Surgery, Orlando Regional Medical Center, Bariatric and Laparoscopy Center, Orlando Health, 89 Copeland Ave, 1st Floor, Orlando, FL 32806, USA
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