Biliopancreatic Bypass Research Articles

Оцінка впливу периопераційного супроводжування жінок із морбідним ожирінням на якість їхнього життя

Aim - to assess eating disorders (ED) in female patients who are candidates for bariatric surgery (BS) and to establish psychological features of the course of the postoperative period in them. Materials and methods. The nature of ED disorders in 51 women with morbid obesity (MO) and accompanying metabolic syndrome (MS), aged from 22 to 55 years, who underwent BS was analyzed. Women with a higher body mass (BMI) underwent biliopancreatic bypass (BPS) in the Hess–Marceau modification (the group I - 21 women), patients with a lower body mass index (BMI) - sleeve gastrectomy (SG) - the group II (30 female patients). The duration of observation in the postoperative period ranged from 3 to 7 years. The BMI of women ranged from 29.2 to 62.1 kg/m2 and averaged 44.0±1.0 kg/m2. The experience of obesity varied from 5 to 21 years. A diagnostic interview using the Dutch Eating Behavior Questionnaire (DEBQ) was performed to assess ED. With the help of the questionnaire "Life satisfaction index (LSI) test (adaptation by N.V. Panina)" the degree of psychological comfort of women was assessed. Results. The average age of patients in the group I was 37.9±2.1 years, in the group II - 41.3±1.7 of the year. 20 (39.2%) women each had external eating behavior (EB) and emotiogenic disorder of EB, of which 5 (25%) cases showed a combination of external and emotiogenic EB. Compulsive EB disorder was registered in 4 (7.8%) cases of emotogenic EB disorder, "night eating" syndrome - in 16 (80%) out of 20. Restrictive EB disorder was found in 16 (31.4%) patients. In 6 (11.8%) cases, this type of ED replaced external ED. All these patients noted the fact of dietary depression. In 45 (88.2%) cases, patients had a score below 25 points, which indicated low life satisfaction; and only in 6 (11.8%) cases it was about average satisfaction. In all 6 (11.8%) cases, we were talking about women with BMI < 40 kg/m2. Conclusions. In patients with obesity, anxiety-neurotic tendencies and psychosocial maladjustment, relatively low tolerance to stress is revealed. Food, in their case, serves as a tool to fight anxiety and depression and further closes the "vicious circle" of obesity. During the initial survey, special attention should be paid to the attitude of the patient with MO to alcohol, because alcohol addiction is a contraindication for performing BPS. The indicator of the "Index of satisfaction with life" directly correlates with the indicators of a woman's body weight. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Attitudes and Behaviors towards Food and Weight in Late Pregnancy: A Comparative Approach between Individuals with and without Previous Bariatric Surgery

The aims of this study were to compare, between pregnant individuals with and without bariatric surgery: (1) eating behaviors, (2) intuitive eating components and, (3) attitudes towards weight gain. This retrospective study included data collected in healthy pregnant individuals with and without previous bariatric surgery who were recruited at the Centre Hospitalier Universitaire (CHU) de Québec-Université Laval. Pregnant individuals who underwent bariatric surgery (biliopancreatic bypass with duodenal switch [n = 14] or sleeve gastrectomy [n = 5]) were individually matched, for age (±0.4 years) and body mass index (BMI) (±0.3 kg/m2), with pregnant individuals who have not received bariatric surgery. In the second trimester, participants completed the Three Factor Eating Questionnaire (TFEQ) and the Intuitive Eating Scale 2 (IES-2). In the third trimester, participants completed the French version of the Pregnancy Weight Gain Attitude Scale assessing attitudes towards weight gain. Pregnant individuals who have had bariatric surgery had a higher score for flexible restraint and a lower score for situational susceptibility to disinhibition compared to individuals who have not had undergone bariatric surgery (2.89 ± 1.15 vs. 1.95 ± 1.31; p = 0.04 and 1.11 ± 1.29 vs. 2.79 ± 1.44, respectively; p < 0.001). Regarding intuitive eating, pregnant individuals who experienced bariatric surgery had a higher score for reliance on internal hunger and satiety cues and a lower one for unconditional permission to eat compared with those who had not experienced bariatric surgery (3.99 ± 0.81 vs. 3.30 ± 1.03; p = 0.02 and 3.28 ± 0.54 vs. 3.61 ± 0.68, respectively; p = 0.03). No difference in attitudes towards weight gain was observed between groups. Overall, pregnant individuals who had undergone bariatric surgery had different eating behaviors and intuitive eating components compared to pregnant individuals without bariatric surgery. These results need to be confirmed in further studies with larger sample sizes.

Results of the first All-Russian consensus conference on bariatric surgery

Until now, there has not been organized consensus for standardization in bariatric surgery In Russia. We present the results of the first Bariatric Surgery Consensus Conference conducted in Barnaul (March, 2023). A list of questions was proposed within 6 blocks: 1) general issues of bariatric surgery, 2) sleeve gastrectomy, 3) one-anastomosis gastric bypass («mini-gastric bypass»), 4) Roux-en-Y Gastric Bypass, 5) Single Anastomosis Duodenal Switch and other options for biliopancreatic bypass, 6) rare procedures. Consensus (>70% agreement) was reached for 51 out of 96 statements. Stratification by the level of expertise was carried out, and responses of the expert group were compared with responses of all participants.

IBC-Oxford University2023_BJSOral_3Tailored Bilio-Pancreatic Limb Length and Haemoglobin A1c Levels 10 years following Mini-Gastric Bypass Original Technique of One Anastomosis Gastric Bypass

Abstract Introduction The need for or the ideal length of the Biliopancreatic Bypass limb (BPL) length is a controversial topic. The Mini Gastric Bypass original technique (MGB-OT) version of the One Anastomosis Gastric Bypass (OAGB) includes a “Tailored” BPL length. This study aimed to investigate the 1 to 10-year outcomes of the “Tailored’ BPL length in patients undergoing MGB-OT in diabetic patients with Class III obesity. Methods The study is a retrospective chart review of 114 patients who underwent the Mini Gastric Bypass original technique (MGB-OT) with a tailored Biliopancreatic Limb length as described by Rutledge et al. These cases were performed between June 2008 and December 2009. The study investigated the relationship between the length of the BPLL and glycaemic control, primarily as measured by the change in (Delta) HbA1c levels, in morbidly obese diabetic patients undergoing the MGB-OT. The mean BPL length in the study was 185 cms, with a range of 120-350 cms. The study analysed preoperative, post-operative, and Delta HbA1c levels as the primary outcomes. The critical outcome goal for the study was HbA1c levels of less than 7%, which is a commonly used target for glycaemic control in diabetic patients. Results Only 89 of 114 (78%) patients completed the 10-year follow-up. The mean preoperative HbA1c was 9.2+/-1.6 (range 6.8-14.7). Longer BPL length were selected for patients based on a variety of patient factors including the patient’s preoperative HbA1c levels. Patients with longer BPL length had greater weight loss (R2 0.8.) The mean HbA1c levels were 5.50+/-0.36, 5.65+/-0.35, and 5.82+/-0.41 at 1, 5, and 10 years post-op. 100% of patients evaluated at 1 and 5 years had HbA1c levels below 7%, and only 1 out of 89 patients at 10 years had HbA1c levels above 7%. The correlation between BPL length and the 10-year Delta HbA1c was high, with a correlation coefficient (r) of 0.8. The Delta HbA1c was significantly greater in the patients with BPL length > 150 cm (3.99 +/- 1.87 vs 2.08 +/- 0.71 in the BP150 patients difference 1.91, SEM 0.40, 95% CI 1.12 to 2.69, P < 0.0001) i.e., longer BPL length (> 150cms) had significantly greater Delta HbA1c than 150 cm BPL length. Conclusions The study suggests that individualized tailoring of the biliopancreatic limb length in the OAGB procedure can potentially lead to a combination of excellent weight loss and near-complete normalization of HbA1c levels for up to 10 years. However, this a small and incomplete study and the optimal length may vary based on individual patient factors. Further research is needed to confirm these findings and establish standardized guidelines for determining the appropriate BPL length. Overall, the study highlights the importance and potential value of continued research and individualized treatment approaches for patients with obesity and diabetes.

Atuais técnicas em cirurgia bariátrica e seus benefícios: Uma revisão da literatura

Introduction: Bariatric, restrictive and mixed (predominantly restrictive or malabsorptive) surgery is a therapy to reduce weight and control associated diseases. This literature review discusses the relevance of procedures approved by the Federal Council of Medicine (CFM) according to bibliographic references of significant scientific evidence. Objectives: To review the techniques currently used in bariatric surgery, advantages and disadvantages. Methods: Literature review of the techniques employed in bariatric surgery, by descriptors in Portuguese (techniques in bariatric surgery, gastric banding, vertical gastrectomy, Roux-en-Y gastric bypasses and biliopancreatic bypass). Results: Gastric banding is a silicone prosthesis wrapped around the stomach, which generates weight regain. Vertical gastroplasty reduces the stomach by a ring-mediated suture with good results but high recurrence. The intragastric balloon is the introduction of a silicone prosthesis with methylene blue, which must be removed after 6 months. Gastric bypass has low mortality and high efficacy, being the most used in Brazil. Vertical gastrectomy preserves the small intestine and partially the stomach, and its low postoperative mortality determines its frequent indication. The Scopinaro technique is 5% of the procedures performed in Brazil, the duodenal switch or vertical gastrectomy with intestinal detour generates nutritional deficiency. Conclusion: Comparing the surgical methods, it is up to the surgeon and the team, the particular analysis to decide which fits best for the patient. However, regardless of the technique used, scientifically it is the conduct with more positive results in the long term, compared to clinical approaches.

Аналіз ефективності впливу баріатричних втручань у жінок із морбідним ожирінням і відновлення в них менструальної та репродуктивної функції

Purpose - to evaluate the effectiveness of weight loss after bariatric surgery (BS) in women with morbid obesity (MO) on the recovery of menstruation and the realization of reproductive functions. Materials and methods. Changes in menstrual and reproductive functions were analyzed in 51 women with MO and accompanying metabolic syndrome (MS), aged 22 to 55 years, who underwent BV. Women with a higher body mass (BMI) underwent biliopancreatic bypass (BPS) in the Hess-Marceau modification (I clinical group - 21 women), patients with a lower body mass index (BMI) - longitudinal gastric resection (LGR) - II clinical group (30 patients). The duration of observation in the postoperative period ranged from 3 to 7 years. The BMI of women ranged from 29.2 kg/m2 to 62.1 kg/m2 and averaged 44.0±1.0 kg/m2. The experience of obesity varied from 5 to 21 years. Results. Menstrual cycle disorders (MC) were observed in 100% of cases. 16 out of 24 (66.7%) women under the age of 40 had reproductive plans (RP) in the postoperative period. In 18 (75.0%) of them, we were talking about chronic anovulatory cycles. Endometrial and myometrial pathology was noted in 14 (27.5%) women. Analysis of the dynamics of MO indicators during the first 3 years after BS showed general trends towards a probable (p<0.001) decrease in BM and BMI indicators in patients of all clinical groups already after 3 months from the start of treatment. Regular MC in women under 40 years of age was restored within 1.5 years against the background of a decrease in MT without medical intervention. Spontaneous pregnancy occurred in 7 (43.8%) women with RP 3 years after BS and in 5 (31.3%) - with the help of assisted reproductive technologies. Conclusions. An intense decrease in body weight and, accordingly, BMI, is observed within 12 months after operative treatment using the combined BPS method and in the period of 3-6 months in patients after PRS. Achieving statistical comparability of BMI indicators in both groups (p>0.05) occurs already after 6 months. Stabilization of average BMI indicators in subsequent years occurs in the range (95% CI) of 25.7 - 32.1 kg/m2, regardless of the method of surgical intervention. Weight loss improved reproductive potential in women with MS by 42%. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

150-cm Versus 200-cm Biliopancreatic Limb One-Anastomosis Gastric Bypass: Propensity Score-Matched Analysis.

It has been suggested that shortening the length of the biliopancreatic limb (BPL) to 150cm in one anastomosis gastric bypass (OAGB) would reduce nutritional complication rates without impairing weight loss outcomes. The aim of this study is to compare patients who underwent OAGB with a 200-cm BPL (OAGB-200) to patients with OAGB with a 150-cm BPL (OAGB-150) in terms of weight loss and late morbidity. This is a monocentric retrospective matched cohort study including patients with a body mass index between 35 and 50kg/m2 who underwent an OAGB-150 or an OAGB-200. Patients were matched 1:1 based on age, sex, and body mass index, prior to bariatric surgery. In total, 784 patients who underwent OAGB were included (OAGB-150 n = 392 and OAGB-200 (n = 392). There was no significant difference in terms of early morbidity. Regarding late morbidity in patients with an OAGB-150, significantly lower rates for marginal ulcer (OR = 0.4, CI 95% [0.2; 0.8], p = 0.006), incisional hernia (OR = 0.5, CI 95% [0.3; 1], p = 0.041), and bowel obstruction (OR = 0.3, CI 95% [0.1; 0.9], p = 0.039) were reported. Likewise, regarding late nutritional deficiencies, post-OAGB-150, a significantly lower number of patients with hypoalbuminemia (OR = 0.3, CI 95% [0.2; 0.7], p = 0.006), low vitamin B9 (OR = 0.5, CI 95% [0.2; 1], p = 0.044), and low ferritin (OR = 0.5, CI 95% [0.3; 0.8], p = 0.005) were observed. There was no significant difference in the percentage of excess BMI loss at 1, 2, 3, 4, and 5years. Compared to OAGB-200 in patients with BMI ≤ 50kg/m2, OAGB-150 results in fewer nutritional deficiency rates long term, without impairing weight loss.

Long versus short biliopancreatic limb in Roux-en-Y gastric bypass: short-term results of a randomized clinical trial.

The Roux-en-Y gastric bypass continues to be one of the most performed bariatric surgeries because of its adequate balance of outcomes, complications, and durability. Recently, the role of the biliopancreatic limb on weight loss and co-morbidity control has gained attention because it seems to have a positive impact based on limb length. To compare results at 12 months of a "standard" (group 1) versus a long (group 2) biliopancreatic limb bypass. Biliopancreatic limbs were 50 cm and 200 cm, and alimentary limbs were 150 cm and 50 cm, respectively. Academic Referal Center; Mexico City; Public Seeting. Randomized study with patients undergoing both types of surgeries at a single academic center from 2016 to 2018. The analysis included weight loss, co-morbidity control (diabetes and hypertension), biochemical panel, operative outcomes, and complications. Two-hundred ten patients were included (105 in each group). Almost all data were homogenous at baseline. Female sex comprised 86.1% of cases, with a mean body mass index of 43.5 kg/m2. Excess weight loss (77.6 ± 15.7% versus 83.6 ± 16.7%; P = .011) and total weight loss (33.5 ± 6.4% versus 37.1 ± 7.1%; P < .001) was higher in group 2; better HbA1C levels were also observed. Co-morbidity outcomes, operative data, and complications were similar between groups. The Roux-en-Y gastric bypass with 200 cm of biliopancreatic limb length induces more weight loss at 12 months than a 50 cm limb length. Better HbA1C levels were also observed, but similar effects on co-morbidities and complications were noted.

Short or Long Biliopancreatic Limb Bypass as a Secondary Procedure After Failed Laparoscopic Sleeve Gastrectomy.

Laparoscopic sleeve gastrectomy (SG) may be associated with long-term problems such as insufficient weight loss or weight regain, persistence or relapse of comorbidities, and gastroesophageal reflux disease (GERD). This study analyzes the outcome of patients that underwent conversion of SG to a gastric bypass procedure. All patients that underwent conversion from SG to the following four different gastric bypass procedures were analyzed: short biliopancreatic limb (BPL) bypass types such as proximal Roux-en-Y gastric bypass (PRYGB) or type 2 distal Roux-en-Y gastric bypass (type 2 DRYGB) and long BPL types such as long BPL RYGB or one anastomosis gastric bypass (OAGB). Between 2012 and 2016, 52 patients received the following revisional procedures after primary SG: proximal RYGB (n = 12, 23.1%), type 2 DRYGB (n = 8, 15.4%), long BPL RYGB (n = 20, 38.5%), and OAGB (n = 12, 23.1%). The long BPL type procedures (long BPL RYGB, OAGB) resulted in a significant long-term additional %EWL (33.8%; 33.2%) at 3years. In the PRYGB, the effect lasted only for 2years. In all patients with GERD and dysphagia as the dominant post-SG symptoms, the conversion to a bypass procedure resulted in the complete resolution of these. In case of weight regain or insufficient weight loss after SG, revisional surgery with a long BPL should be considered. The OAGB provides effective additional weight loss, with low morbidity and malnutrition rates, respectively. Conversion to the malabsorptive long BPL RYGB with a total alimentary limb length below 400cm should be avoided. Patients that suffer primarily from post-SG GERD or dysphagia should undergo conversion to PRYGB.

The effectiveness of new bariatric surgery in the type 2 diabetes treatment

The aim — to compare the efficacy of Santoro biliopancreatic shunting with a new bariatric operation: sleeve gastrectomy with one gastroileal anastomosis in the treatment of patients with type 2 diabetes mellitus, and with morbid obesity.Materials and methods. А retrospective cohort study enrolled 32 patients (21 women and 11 men) with morbid obesity and type 2 diabetes who underwent bariatric surgery (Santoro biliopancreatic bypass surgery (first group) and sleeve gastrectomy with one gastroileal anastomosis (second group)) was conducted from 2013 to 2018. Exclusion criteria included the presence of previous bariatric surgeries, previous upper middle laparotomy, severe concomitant diseases (ASA III — IV), and the presence of psychological instability. Patients’ age ranged from 25 to 65 years (mean age 42.6 years). Average preoperative body weight — 107.5 kg (92.0 — 189.5 kg), average body mass index — 41.2 kg/m2 (36.7 — 65.0 kg/m2), average excess body weight — 50, 8 kg (28 — 106 kg). The average duration of metabolic disease before surgery was 7.5 years (3 — 21 years). Only 2 patients monitored the disease with diet, 15 received oral hypoglycemic medications, and 15 received insulin.Results and discussion. The duration of laparoscopic bariatric surgery ranged from 92 to 180 minutes. The average duration of Santoro biliopancreatic shunting surgery was significantly longer than the operations of sleeve gastrectomy with one gastroileal anastomosis (158 ± 28 minutes compared with 112 ± 16 minutes (p &lt; 0.05)). There were no serious intraoperative complications or mortality in both groups of patients. The average length of stay in the hospital was 7.2 days (6 to 9 days) in the first group and 5.6 days (5 to 8 days) in the second (p &gt; 0.05). The follow‑up period was 6 to 48 months. The lipid profile improved significantly in both groups. In the first year after surgery, 90 % of patients had normal cholesterol, 85 % had normal triglycerides. Arterial hypertension was cured in 13 patients, improved — in 2. There were no statistically significant differences in the normalization of comorbidities between groups.Conclusions. Santoro bariatric surgery, as well as sleeve gastrectomy with one gastroileal anastomosis, have the same effect on overweight, metabolic disturbances, and the frequency of complications. At the same time, sleeve gastrectomy with one gastroileal anastomosis is an effective and gentle surgical operation for the treatment of patients with morbid obesity and type 2 diabetes.

A220 A comparison between short vs. long biliopancreatic limb gastric bypass: early outcomes of a prospective study

It has been well documented that gastric bypass achieves sustained long-term results with impact in comorbidities. Lengthening the biliopancreatic limb could improve results.

Effect of biliopancreatic loop length mini gastric bypass on metabolic disorders resolution and nutritional deficiency

Recently, the International Federation of Obesity Surgery (IFSO) has recognized gastric bypass surgery as one of the major bariatric / metabolic surgeries. However, the issue of nutritional deficiency after mini-shunting, which leads to repeated surgical interventions for deficient states, remains debatable. Efforts to balance the loss of excess body weight, compensation for concomitant metabolic disorders and nutritional insufficiency make the issue of the “ideal” length of the biopancreatic loop relevant. Therefore, the purpose of the study was to compare the bariatric and metabolic effects of mini-shunting of the stomach depending on the length of the biliary pancreatic loop. The study included 42 patients (24 women (57.1%) and 18 men (42.9%)), aged 24 to 65 years, with a body mass index (BMI) of 40 kg / m2 and above, with a mini-gastric bypass with minimally invasive access. The operation consisted of forming a long gastric reservoir along the small curvature of the stomach with the imposition of a semi-manual anastomosis with a loop of the small intestine 200–250 cm from the ligament of the Trinity. The length of the biopancreatic loop was selected according to the body mass index (200 cm — &lt;45 kg / m2 (23 patients), 250+ cm — ˃45 kg / m2 (15 patients)) and the nature of the concomitant metabolic disorders. Anthropometric, laboratory and instrumental research methods were used. The level of HbA1c and the level of triglycerides were determined. The results were evaluated at 1, 3, 6, 9 and 12 months after surgery. Statistical processing of data was performed using StatPlus 6 Profesional. Postoperative complications were diagnosed in 3 (7.2%) patients. An early complication of Twisted pouch, which required repeated surgery, was observed in 1 (2.4%) patient. Late complications (peptic ulcer of gastroenteroanastomosis and insufficient weight loss) were found in 2 (4.8%) patients. The average percentage of excess body weight loss in the 200 cm and 250 cm group was 70.1 ± 0.8% and 71.8 ± 0.6% (p&gt;0.05), respectively; type 2 diabetes mellitus was diagnosed in 5 (83.3%) and 7 (87.5%) patients, respectively; dyslipidemia compensation was achieved in 3 (50%) and 5 (71.4%) patients, respectively; hypocalcaemia was detected in 1 (12.5%) and 3 (27.3%) patients, respectively; decreased levels of iron were diagnosed in 1 (12.5%) and 2 (18.2%) patients, respectively. Thus, the results obtained indicate that as the length of the loop increases, the metabolic effect increases, but the risk of electrolyte exchange disorders may increase.

Case of insulinoma detected in a patient after bariatric operation for morbid obesity

The prevalence of insulinomas is 13 cases per million population per year of which 414% tumor is malignant. Weight gain is one of the symptoms of the disease, often resulting in morbid obesity with indications for surgical treatment. The presented clinical case demonstrates the successful treatment of malignant insulinoma with the manifestation of hypoglycemic syndrome after carrying out biliopancreatic bypass with longitudinal gastrectomy for morbid obesity.

POST-BARIATRIC SURGERY NUTRITIONAL REQUIREMENTS – Part 2 (Recommendation of macro and micronutrients and Nutritional Therapy)

In order to minimize nutritional complications and create conditions for greater long-term success, it is important to predict, prevent and correct nutritional changes in pre-post surgery, with careful monitoring and nutritional supplementation according to guidelines. Priorities are the nutritional education of the patient/family, aiming at good eating habits, within their lifestyle and socioeconomic and cultural conditions. Nutrients Regular follow-up with a specialized nutritionist is essential to facilitate adequate weight loss and to assess the intake of micronutrients that may be inadequate due to the gastric restriction of the gastric band (BG) and sleeve gastrectomy (GV) techniques; of gastric restriction and dysabsorption in gastric bypass (BGYR) and minor gastric restriction and major dysabsorption in biliopancreatic bypass (BPD) and duodenal switch (BPD-DS). The latter 2 carry greater risk for protein malnutrition and micronutrient deficiencies. In all techniques except BG, there are functional and hormonal changes involved in the control of hunger and appetite, food intake, satiety, metabolic glucose change and changes in intestinal hormones such as ghrelin, GLP-1 and PYY.

Long-Term Outcomes After Bariatric Surgery: a Systematic Review and Meta-analysis of Weight Loss at 10 or More Years for All Bariatric Procedures and a Single-Centre Review of 20-Year Outcomes After Adjustable Gastric Banding

IntroductionDurability is a key requirement for the broad acceptance of bariatric surgery. We report on durability at and beyond 10 years with a systematic review and meta-analysis of all reports providing data at 10 or more years and a single-centre study of laparoscopic adjustable gastric banding (LAGB) with 20 years of follow-up.MethodsSystematic review with meta-analysis was performed on all eligble reports containing 10 or more years of follow-up data on weight loss after bariatric surgery. In addition, a prospective cohort study of LAGB patients measuring weight loss and reoperation at up to 20 years is presented.ResultsSystematic review identified 57 datasets of which 33 were eligible for meta-analysis. Weighted means of the percentage of excess weight loss (%EWL) were calculated for all papers included in the systematic review. Eighteen reports of gastric bypass showed a weighted mean of 56.7%EWL, 17 reports of LAGB showed 45.9%EWL, 9 reports of biliopancreatic bypass +/− duodenal switch showed 74.1%EWL and 2 reports of sleeve gastrectomy showed 58.3%EWL. Meta-analyses of eligible studies demonstrated comparable results. Reoperations were common in all groups. At a single centre, 8378 LAGB patients were followed for up to 20 years with an overall follow-up rate of 54%. No surgical deaths occurred. Weight loss at 20 years (N = 35) was 30.1 kg, 48.9%EWL and 22.2% total weight loss (%TWL). Reoperation rate was initially high but reduced markedly with improved band and surgical and aftercare techniques.ConclusionAll current procedures are associated with substantial and durable weight loss. More long-term data are needed for one-anastomosis gastric bypass and sleeve gastrectomy. Reoperation is likely to remain common across all procedures.

Biliopancreatic Diversion Versus Gastric Bypass in the Surgical Treatment of Type 2 Diabetes Mellitus in Patients with Body Mass Index Below 35

AbstractBackground: Type 2 Diabetes Mellitus (T2DM) is an important health problem worldwide with about 23% of patients with morbid obesity have type 2 DM. Bariatric surgery originally developed solely as a weight-reduction therapy, but has been found to improve T2DM and to reduce rates of chronic vascular disease and death. The International Diabetes Federation have recommended consideration of bariatric surgery for control of T2DM.Methods: A total number of 45 patients were randomized into two groups, the first group with 26 patients (n=26) were submitted for Biliopancreatic Diversion (BPD) and the second group with 19 patients (n=19) were planned for Roux-en-Y Gastric Bypass (RYGBP). The main objective was to compare the efficacy of bariatric surgery in inducing clinical remission of T2DM mellitus in patients with body mass index less than 35 in both groups.Results: The operations were performed laparoscopically in all patients. There were no conversions, operative compli-cations or mortality. Data were collected during a two-year follow-up period and were analyzed at the following periods; pre-operatively and post-operatively at 1 months, 4 months, at 8 months, at 1 year and 2 years. The analyzed parameters included the levels of BMI, FBG, HbA1c, Triglycerides and cholesterol. There were no statistical significant difference between the two groups regarding the BMI, mean glucose levels, and HbA1c levels. However the levels of triglycerides were higher in the BPD group, while the levels of cholesterol were higher in the RYGBP group during most of the follow-up periods.Regarding the diabetes outcome, there was significant reduction of patients who showed diabetes remission at one year and those who remains remittent at 2 year, while the number of patients who showed diabetes failure tripled at 2 years follow-up.Conclusions: Although, BPD is known to have a better effect on type 2 DM in the higher BMI group. There was no difference regarding glycemic control between BPD and RYGBP. And both operations failed to maintain glycemic control at long term follow-up periods.

BARIATRIC SURGERY:COSMESIS OR THERAPY

BARIATRIC SURGERY:COSMESIS OR THERAPY

Evolution of biliopancreatic diversion in the treatment of morbid obesity and type 2 diabetes mellitus

The prevalence of morbid obesity is on the rise. Surgical intervention for the treatment of morbid obesity has been shown to provide high metabolic efficiency, acquiring a special role in the treatment of type 2 diabetes mellitus. Various surgical procedures are used in treating morbid obesity. These include gastric-bypass surgery and biliopancreatic bypass diversion (BPD), each with various advantages of its own. In recent years, BPD (also referred to as the Scopinaro procedure) has evolved and been modified into the single anastomosis duodeno-ileal (SADI) procedure. Like other types of BPD, the SADI procedure effectively reduces excess body weight and promotes normalisation of carbohydrate and lipid metabolism, leading to a reduced frequency of insulin therapy and use of antidiabetic drugs. The potential benefits of the procedure include reduced operative time and a reduced incidence of internal hernias. Studies have also shown that the SADI procedure results in fewer early and late post-operative complications. Given the effectiveness of the procedure, it is necessary to increase the number and duration of observations made to enable further insight into the long-term efficacy and use of the SADI procedure.

Timeline of Intestinal Adaptation After Malabsortive Surgery: Effect of Luminal Nutrients, Biliopancreatic Secretion, and Glutamine Supplementation.

The aim of this study was to study the process of intestinal adaptation in the three limbs of the small intestine after malabsorptive bariatric surgery: the biliopancreatic limb, the alimentary limb, and the common channel. These limbs are exposed to different stimuli, namely, gastrointestinal transit and nutrients in the alimentary limb, biliopancreatic secretions in the biliopancreatic limb, and a mix of both in the common channel. We also wished to investigate the effect of glutamine supplementation on the adaptation process. Three types of surgery were performed using a porcine model: biliopancreatic bypass (BPBP), massive (75%) short bowel resection as the positive control, and a sham operation (transection) as the negative control. We measured the height and width of intestinal villi, histidine decarboxylase (HDC) activity, and amount of HDC messenger RNA (mRNA) (standard diet or a diet supplemented with glutamine). An increase in HDC activity and mRNA expression was observed in the BPBP group. This increase coincided with an increase in the height and width of the intestinal villi. The increase in villus height was observed immediately after surgery and peaked at 2weeks. Levels remained higher than those observed in sham-operated pigs for a further 4weeks. The intestinal adaptation process in animals that underwent BPBP was less intense than in those that underwent massive short bowel resection and more intense than in those that underwent transection only. Supplementation with glutamine did not improve any of the parameters studied, although it did appear to accelerate the adaptive process.

Revision Roux-en-Y Gastric Bypass to Biliopancreatic Long-Limb Gastric Bypass for Inadequate Weight Response: Case Series and Analysis.

The long-limb Roux-en-Y gastric bypass (LLRYGB) was introduced in 1987 as a salvage operation for inadequate weight loss after a standard Roux-en-Y gastric bypass (RYGB). We report on 53 consecutive patients (44 females) with conversion of a failed RYGB to a LLRYGB performed by a single surgeon between 2002 and 2014. No patient had an ascertainable anatomic abnormality to explain his/her weight regain. LLRYGB revision consisted of a 75-cm to 100-cm alimentary Roux limb and a 75-cm to 100-cm common channel; after 2011, in suitable patients, the Roux limb was lengthened to greater than 250cm. Average values for weight (lbs) were as follows: pre-original RYGB=329; lowest measured after RYGB=196; at time of LLRYGB=285; and at 1, 2, 3, 4, >5years post LLRYGB=225, 207, 199, 197, 195, for a sustained weight loss >90 lbs. Average values for BMI (kg/m2) were as follows: pre-original RYGB=54.3; lowest measured after RYGB=32.3; at time of LLRYGB=47.2; and at 1, 2, 3, 4, >5years post LLRYGB=37.1, 34.4, 33.0, 32.8, 31.4, for a sustained BMI reduction >16.5kg/m2. Zero operative mortality; 3 (5.7%) late deaths; 7 (13.2%) 30-day complications; 33 (62.3%) long-term complications with 23 (43.4%) needing TPN; and 14 (26.4%) requiring operative revision. A salvage LLRYGB procedure can be performed safely and is weight successful, but fraught with long-term nutritional problems and a high necessity for revision. A Roux segment over 250cm may improve outcomes.