Complication Of Gastric Bypass Research Articles

BS SO10 - Predictive Factors in the Development of Dumping Syndrome After Bariatric Surgery

Abstract Background Dumping syndrome (DS) is a recognised complication of Roux En-Y Gastric Bypass (RYGB) and rarely Sleeve Gastrectomy (SG). The prevalence of DS is unclear, with current literature ranging from 10-50%. The condition is characterised by gastrointestinal and vasomotor symptoms resulting in a significant impact on quality of life. This study aimed to prospectively utilise Sigstad scoring to evaluate post-operative patients, investigating the timing of symptom onset and its correlation with pre-existing diabetes, revision surgery, and percentage of Total Body Weight Loss (TBWL). Method We used the Sigstad scoring questionnaire, administered by our bariatric Clinical Nurse Specialists (CNS) at outpatient clinics to assess patients for DS between January to May 2024. Data collected included patient demographics, surgery type and date, TBWL, Body Mass Index (BMI), and whether the patient had a diagnosis of Diabetes Mellitus type II (DMII). A diagnosis of DS was confirmed if a patients score ³7 points on the Sigstad questionnaire. We explored factors influencing the development of DS. Results In total, 64 patients were evaluated for DS of whom 86% were female and the median age was 44 years (IQR: 35-45). Most patients (67%) had undergone primary RYGB, 19% SG, 11% conversion from SG to RYGB and 70% were assessed within one year of surgery. DS symptoms emerged in 25% of patients, predominantly within the first-year post-operation (60%). The median TBWL was 12% (IQR: 9-22%), showing no correlation to DS onset. Patients with DMII exhibited a higher propensity for DS (66% vs 20%, p=0.029). Patients undergoing revisional surgery also had a higher incidence of DS (33% vs 6%, p=0.117). Conclusion A quarter of patients undergoing bariatric surgery will develop DS, most of whom within the first-year post-surgery. Revisional surgery and pre-existing DMII are the primary predictors in developing DS. There was no observed association between TBWL and DS onset. Further extensive studies are needed to confirm these observations.

Intestinal intussusception as a postoperative complication of gastric bypass

Intestinal intussusception as a postoperative complication of gastric bypass

A case study of an acute internal hernia: The complex diagnostic challenges of Roux-en-Y gastric bypass complications.

Obesity remains a global health challenge linked to several comorbidities, such as obstructive sleep apnea, hypertension, hyperlipidemia, and diabetes. The prevalence of bariatric surgeries being performed is steadily increasing because it is a highly effective surgical tool used to achieve significant permanent weight loss. However, with all weight loss surgeries, several complications may not present for months to years after the initial procedure. In particular, the anatomical changes that occur after the Roux-en-Y gastric bypass (RNYGB) make the risk of internal hernias high. This particular complication is rare but lethal if unrecognized and not treated promptly. This clinical case study aims to provide readers with an overview of diagnosing and recognizing an internal hernia in the setting of previous laparoscopic RNYGB surgical history. Because of the sheer increase in the volume of patients undergoing bariatric surgery worldwide, health care providers must be well educated on the insidious presentations of this late complication and be prepared to act quickly to diagnose and treat these acute abdomen scenarios.

Revisional one-anastomosis gastric bypass for failed laparoscopic sleeve gastrectomy.

The study aimed to evaluate the mid-term weight loss outcomes and complications of revisional one-anastomosis gastric bypass (OAGB) following failed laparoscopic sleeve gastrectomy (LSG). A total of 586 patients underwent LSG from January 2010 to February 2018. Revisional OAGB (rOAGB) was performed in 22 (3.8%) patients. A retrospective analysis of prospectively collected data from 20 patients with at least 12months of follow-up after the revisional OAGB was carried out. The indications for revisional surgery were as follows: insufficient weight loss-4 (20%), weight regain-13 (65%), weight regain and symptoms of gastroesophageal reflux disease (GERD)-2 (10%), and dysphagia with gastroesophageal reflux-1 (5%). The mean interval between the LSG and rOAGB was 35.3 ± 15.4months (range 4-64). The mean follow-up time after rOAGB was 45.5 ± 17.1months (range 12-54). At the end of the follow-up after rOAGB, %TWL was 26.4 ± 8.9%, and %EWL was 58.5 ± 21.6%, based on pre-LSG body weight. In all three patients with intractable GERD, the clinical symptoms of reflux retreated after revisional OAGB. The overall complication rate was 20%. In conclusion, the main indications for revision after LSG are weight regain, insufficient weight loss, and intractable GERD. Revisional OAGB emerges as a viable surgical alternative for unsuccessful LSG, presenting notable weight loss outcomes; however, it may be linked to an increased incidence of complications.

Gastric Bypass versus Sleeve Gastrectomy in Morbid Obesity Management

Abstract Background Obesity is caused by a combination of excessive food energy intake, lack of physical activity, and genetic susceptibility, although a few cases are caused primarily by genes, endocrine disorders, medications, or psychiatric illness. The main aim of obesity therapy is weight loss and maintenance by dietary interventions and increased physical activity. Aim of the Work to review two of the most commonly performed modalities of weight loss namely Sleeve Gastrectomy, Gastric Bypass, and to study their early post-operative complications, outcomes, effects regarding excess body weight loss (EBWL), life style changes and sustainability. Patients and Methods This is a prospective comparative randomize study included 40 patients presented with morbid obesity with BMI range between (40 to 60 kg/m2) were treated 20 cases by laparoscopic sleeve Gastrectomy and 20 cases by laparoscopic Gastric Bypass (15 cases one anastomosis gastric bypass – 5 cases Roux-en-Y bypass) in Ain Shams Hospital during the period from October 2017 till May 2018. Cases were followed up monthly for 6 months and after 1 year. Results Laparoscopic sleeve gastrectomy has higher incidence of complications (15%) than the incidence of complications of Laparoscopic Gastric Bypass (5%). Conclusion Laparoscopic Sleeve Gastrectomy and Laparoscopic Gastric Bypass are both safe and effective procedures for the surgical management of morbid obesity. Laparoscopic Gastric Bypass has slightly higher mean of (EBWL%) than Laparoscopic sleeve gastrectomy at 6 months, and a higher mean of (EBWL%) than Laparoscopic sleeve gastrectomy at 1 year follow up.

A novel mutation of porphyria variegate with predominant painful sensorimotor peripheral neuropathy disclosed by post gastric by-pass complications: A case report

Porphyrias are a group of rare genetic diseases due to various mostly autosomal dominant mutations causing enzymatic deficiency in heme biosynthesis. As a result, neuro-toxic porphyrin precursors and light-sensitizing porphyrins accumulate, while their targets determine the disease symptoms. Porphyria variegate (VP), one of the acute hepatic porphyrias, is caused by a PPOX mutation. During acute crisis triggered by drugs, stressors or fasting, an increase of porphobilinogen (PBG), aminolaevulinic acid (ALA) and porphyrins in urine and stool occur, damaging the autonomous, peripheral and central nervous system.

1793-P: C-Peptide Kinetics: The Van Cauter Population Model May Not Be Applicable to Post–Gastric Bypass Adults with Postprandial Hyperinsulinemic Hypoglycemia

Insulin secretion is key to understand postprandial hyperinsulinemic hypoglycemia (PHH), an increasingly recognized and potentially debilitating complication of gastric bypass (GB) surgery. To assess it noninvasively, the Oral C-peptide Minimal Model (OCMM) can be used. This requires to know C-peptide (CP) metabolic clearance rate (MCR) usually fixed to the values predicted by the Van Cauter (VC) population model, but this has never been assessed in PHH individuals. Here, the aim is to fill this gap. Two groups of post-GB adults with PHH underwent either a 75g oral glucose (11F/5M; age=43±8 y; BMI=28.2±7.1kg/m2) or a 60g mixed-meal (9F/3M; age=44±10y; BMI=27.4±3.9kg/m2) tolerance test with sampling for plasma glucose and CP over 3.5 and 3h, respectively. The OCMM was used to describe CP concentration with CP kinetics fixed to VC or estimated based on data (DB). Model performance was assessed by its ability to predict CP data. In both groups, the VC approach underestimated CP-peak and overestimated CP-tail, while the DB one well predicted CP data in all subjects (Figure 1A). As a consequence, MCR resulted significantly higher with DB than VC approach (Figure 1B). The present findings question the validity of the VC population model to predict CP kinetics in PHH patients and call for CP bolus experiments to develop a reliable kinetic model in this population. Disclosure M. Schiavon: None. D. Herzig: None. M. Hepprich: None. M.Y. Donath: Advisory Panel; Self; AstraZeneca, Bayer Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Merck Sharp & Dohme Corp., Novo Nordisk Inc., Roche Pharma, Sanofi-Aventis. C. Stettler: None. L. Bally: None. C. Dalla Man: Research Support; Self; Sanofi-Aventis Deutschland GmbH. Funding Italian Ministry of Education (232/2016); Swiss National Science Foundation (PCEGP3_186978); University of Padova

Endoscopic treatment of early leaks and strictures after laparoscopic one anastomosis gastric bypass

BackgroundLaparoscopic one anastomosis gastric bypass has become a prominent bariatric procedure. Yet, early and late complications, primarily leaks and strictures, are not uncommon. This study summarizes our experience with endoscopic treatment of laparoscopic one anastomosis gastric bypass complications.MethodsThis is a retrospective study of consecutive patients referred to our hospital from 2015 to 2017 with post laparoscopic one anastomosis gastric bypass complications. Therapy was tailored to each case, including fully covered self-expandable metal stents, fibrin glue, septotomy, internal drainage with pigtail stents, through-the-scope and pneumatic dilation. Success was defined as resuming oral nutrition without enteral or parenteral support or further surgical intervention.ResultsNine patients presented with acute or early leaks: 5 (56%) had staple-line leaks, 3 (33%) had anastomotic leaks and 1 (11%) had both. All were treated with stents. Adjunctive endoscopic drainage was applied in 4 patients (44%). Overall 5 patients (56%) with acute/ early leaks recovered completely, including all 3 patients with anastomotic leak and the patient with both leaks but only 1/5 with staple line leak (20%). Complication rate in the leak group reached 22%. Eight patients presented with strictures, 7 at the anastomosis and one due to remnant stomach misalignment. All anastomotic strictures were dilated successfully. However, the patient with the pouch stricture required conversion to Roux-en-Y gastric bypass after 3 failed attempts of dilation.ConclusionEndoscopic treatments of laparoscopic one anastomosis gastric bypass complications are relatively effective and safe. Anastomosis-related complications are more amenable to endoscopic treatment compared to staple line leaks.

A659 Revisional surgery for early gastric leak after Roux-en-Y gastric bypass (RYGB)

Gastric leak occurs in 1-6% of patients who undergo Roux-en Y gastric bypass (RYGB) for morbid obesity. The pathophysiology may be related to gastric ischemia, fistula, or ulcer.Gastric leak is a severe complication of gastric bypass (GBP) that is associated with significant morbidity and mortality. Fistula may have several clinical impacts, depending on patient-related factors, fistula characteristics, onset time, and therapy proposal. Abdominal drainage, gastrostomy, and revisional surgery constitute the traditional approaches to dehiscence and fistula closure, with variable results.

2409 A Rare Complication of Gastric Bypass in the Setting of Chronic Liver Disease

INTRODUCTION: Porto-mesenteric venous thrombosis (PMVT) is a known and potentially fatal complication of general surgery. However, it has been rarely reported as a complication of worsening liver disease after undergoing bariatric surgery. This is a case of a patient who presented with mesenteric thrombosis following Roux-en-y gastric bypass (RYGB). CASE DESCRIPTION/METHODS: Patient is a 42-year-old African American female with a history of RYGB who presented with episodes of post-operative abdominal pain for 5 years. She was found to have recurrent high-grade small bowel obstruction's (SBO) necessitating a small bowel resection. Her course was further complicated by intra-abdominal abscesses requiring computed tomography (CT)-guided drainage, and wound dehiscence requiring open surgical intervention and debridement. Four months after discharge, she presented with right-sided abdominal pain and acute encephalopathy. Liver enzymes were elevated. Abdominal ultrasound revealed portal vein thrombosis (PVT). Dual-phase CT of the abdomen revealed sub-acute to chronic complete diffuse mesenteric thrombosis with collateralizations involving the portal, splenic, and distal superior mesenteric veins. Given that previous imaging suggested steatosis and hepatomegaly, sub-acute liver injury secondary to thrombosis was established in the setting of chronic liver disease. The patient's underlying non-alcoholic fatty liver disease was likely worsened by severe malnutrition and short gut syndrome following the RYGB. Her hepatic encephalopathy resolved after initiating lactulose and rifaximin. Outpatient hematology evaluation for all causes of thrombophilia remained inconclusive and the patient had no recurrences of thrombosis. DISCUSSION: RYGB remains the gold standard for bariatric surgery as it results in the most durable weight loss. However, complications may occur such as gastrointestinal leak, fistulas, marginal ulcers, SBO, and dumping syndrome. Mechanisms of thrombosis formation in this setting could be related to intra-operative vascular manipulation, increased intra-abdominal pressure, venous stasis, and possibly deteriorating liver function secondary to rapid weight loss and malnutrition. PMVT hasn't been reported consistently as a complication in various bariatric surgery studies, which leads us to conclude that it's either under or mis-diagnosed. It is extremely important to consider PMVT as a complication of RYGB in patients who have evidence of underlying liver disease prior to undergoing RYGB.

A Clinical Decision Support System for Predicting the Early Complications of One-Anastomosis Gastric Bypass Surgery.

One of the most effective treatments for patients with obesity, albeit with some complications, is obesity surgery. The aim of this study was to develop a clinical decision support system (CDSS) to predict the early complications of one-anastomosis gastric bypass (OAGB) surgery. This study was conducted in Tehran, Iran on patients who underwent OAGB surgery in 2011-2014 in five hospitals. Initially, variables affecting the OAGB early complications were identified using the literature review. Patients' data were extracted from an existing database of obesity surgery. Then, different artificial neural networks (ANNs) (multilayer perceptron (MLP) network) were developed and evaluated for prediction of 10-day, 1-month, and 3-month complications. Factors including age, BMI, smoking status, intra-operative complications, comorbidities, laboratory tests, sonography results, and endoscopy results were considered important factors for predicting early complications of OAGB. A CDSS was developed with these variables. The accuracy, specificity, and sensitivity of the 10-day prediction system in the test data were 98.4%, 98.6%, and 98.3%, respectively. These figures for 1-month system were 96%, 93%, and 98.4% and for the 3-month system were 89.3%, 86.6%, and 91.5%, respectively. Using the CDSS designed, we could accurately predict the early complications of OAGB surgery.

Comparative Study between the Complications of Sleeve Gastrectomy versus the Complications of Gastric Bypass

Background: obesity means having too much body fat. Causes of obesity includes: diet, sugar overload, genetics, insufficient sleep, social determinants, environment, and stress. Complications of obesity includes: type II diabetes mellitus, heart diseases, metabolic syndrome, hyperlipidemia, respiratory diseases, male sexual dysfunction, neurological diseases, gastrointestinal diseases, rheumatic diseases, urological diseases, psychological abnormalities, trauma, pancreatic diseases, gall bladder diseases, diverticulitis and hernia. Sleeve gastrectomy is an excellent procedure for management of morbid obesity. Complications of Sleeve gastrectomy includes: Hemorrhage, leakage, nutritional deficiencies, ineffective EWL and weight regain, cholelithiasis, stenosis, gastroesophageal reflux disease GERD and hiatus hernia, gastric torsion, gastro-bronchial fistula and venous thrombosis. Complications with Roux-en-Y Gastric Bypass includes: Hemorrhage, leakage, nutritional deficiencies, ineffective excess weight loss EWL and weight regain, trocar site hernia, cholelithiasis, dumping syndrome, Internal hernia, obstruction of the biliopancreatic limb, intussusceptions volvulous, gastrogastric fistula, marginal ulceration and gastrojejunostomy anastomotic stricture. Aim:To compare complications associated with Sleeve Gastrectomy versus complications associated with open or laparoscopic Gastric Bypass and its effects on patients' life and to know which procedure is better. Patients and Methods: group (A): includes 15 cases underwent sleeve gastrectomy. With inclusion criteria of obese patients with body mass index (BMI) ≥ 40 kg/m2 or BMI ≥ 35 kg/m2with associated co morbidity (hypertension, Diabetes mellitus, hyperlipidemia, arthritis, cardiac diseases, etc.) and exclusion criteria of patients with previous bariatric surgery, previous upper gastrointestinal surgery, hiatus hernias, heavy sweet eaters, drug and/or alcohol addiction, psychiatric disorders and patients >60 years old or 40 kg/m2 or BMI > 35 kg/m2 with associated comorbidity (hypertension, Diabetes mellitus, hyperlipidemia, arthritis, cardiac diseases, etc.) and heavy sweet eaters and exclusion criteria of patients with previous bariatric surgery, previous upper gastrointestinal surgery apart from laparoscopic cholecystectomy. Patients with hiatus hernias, drug and/or alcohol addiction, psychiatric disorders and patients >60 years old or <18 years old were excluded. Results: three complications developed with sleeve gastrectomy 20% as follows 1 case of hemorrhage 6.6% , 1 case of leakage 66% and one case of gall bladder stones while gastric bypass complications resembles 2 cases 13.3% as follows:1case of deep venous thrombosis 6.6% and one case of gall bladder stones 6.6%. Conclusion: obesity is a common disease affecting more than 300 million adults worldwide. It is defined as a body mass index greater than 30 kg/m2. The laparoscopic sleeve gastrectomy was adopted as a primary procedure and over time it has become the most popular bariatric operation worldwide and it is effective for weight loss and results in improvement and even resolution of co-morbidities like type 2 diabetes. Laparoscopic gastric bypass surgery is another safe and simple surgical intervention for treating morbid obesity and diabetes mellitus and is now being performed more frequently Recommendations: both sleeve gastrectomy SG and roux-en-y gastric bypass RYGB are safe, short, simple and effective bariatric operations. Our study showed Roux-en-y gastric bypass has less complication than Sleeve gastrectomy. Further prospective studies have to be applied to a larger number of patients for longer periods of follow up are needed.

Comparative Study between the Complications of Sleeve Gastrectomy versus the Complications of Gastric Bypass

Comparative Study between the Complications of Sleeve Gastrectomy versus the Complications of Gastric Bypass

Evidence of unrestrained beta-cell proliferation and neogenesis in a patient with hyperinsulinemic hypoglycemia after gastric bypass surgery

ABSTRACTHyperinsulinemic hypoglycemia syndrome (HIHG) is a rare complication of roux-en-Y gastric bypass surgery. The pathology is associated with an excessive function of pancreatic beta-cells, and requires pancreas resection in patients that are recalcitrant to nutritional and pharmacological interventions. The exact prevalence is not clearly understood and the underlying mechanisms not yet fully characterized. We herein sought to perform histological and molecular examination of pancreatic sections obtained from a patient who developed HIHG as a complication of gastric bypass compared to 3 weight-matched controls. We studied markers of cellular replication and beta-cell differentiation by immunohistochemistry and immunofluorescence. HIHG after gastric bypass was characterized by a profound increase in beta-cell mass. Cellular proliferation was increased in islets and ducts compared to controls, suggesting unrestrained proliferation in HIHG. We also detected beta-cell differentiation markers in duct cells and occasional duct cells displaying both insulin and glucagon immunoreactivity. These histological observations suggest that beta-cell differentiation from ductal progenitor cells could also underly beta-cell mass expansion in HIHG. Altogether, our results can be construed to demonstrate that HIHG after gastric bypass is characterized by abnormal beta-cell mass expansion, resulting from both unrestrained beta-cell replication and neogenesis.

Early and Late Complications in Laparoscopic Gastric Bypass: Comparative Study between Manual and Stapled Anastomosis

The aim of this study is to evaluate the early and late complications of laparoscopic gastric bypass (GBP) with manual versus stapled gastrojejunal anastomosis. Eighty-two patients with morbid obesity and body mass index (35-56 kg/m2) who underwent GBP were divided into two groups: manual gastrojejunal anastomosis (Group 1) and stapled anastomosis (Group 2). Early and late complications were evaluated. No differences were found between both groups in age, sex, body mass index, American Society of Anesthesia classification, and comorbidity. The mean operative time was 184.8 minutes [standard deviation (SD) = 61]; 203.5 minutes (SD = 51.9) in Group 1 and 167.4 minutes (SD = 64.2) in Group 2 (P = 0.001). The average length of stay was 5.9 days (SD = 3.9) in Group 1 and 5 days (SD = 2.1) in Group 2 (P = 0.039). Early complications were recorded in 9.7 per cent of the cases, without any differences between the two groups: 12.2 per cent in Group 1 and 7.3 per cent in Group 2 (P > 0.05). Late complication rate was 8.5 per cent, significantly higher in Group 1 (14.6%) than in Group 2 (2.4%; P < 0.05). However, in the logistic regression analysis these differences were not statistically significant (OR 0.48; 95% CI 0.03-8.37; P = 0.61). In our series, the GBP with stapled gastrojejunal anastomosis has shown lower hospital length of stay and operative time than the hand-sewn anastomosis. We have not found significant differences between both groups in early complications or in the need for reoperation. Fewer late complications were found in the group of stapled anastomosis; however, this has not been confirmed in the logistic regression analysis.

Predictive Factors for the Migration of Endoscopic Self-Expanding Metal Stents Placed in the Foregut

With recent advancements in endoscopy, self-expandable metal stents (SEMS) have been used to treat gastrointestinal leaks, perforations, and strictures. Stent migration frequently complicates management and often requires additional treatments to reach resolution. Our study aimed to determine predictive factors for stent migration. Consecutive procedures involving SEMS placed with and without fixation after upper gastrointestinal surgery between 2009 and 2014 were retrospectively reviewed. Demographic, surgical history, rate of stent migration, and stent characteristic data were collected. Rates of stent migration were compared. We reviewed 214 consecutive procedures involving stents placed in the foregut. Median duration of stent placement was 4.0 ± 10.3 weeks. Forty-three (20%) stents migrated after placement. Of those, 27 (63%) required stent replacement. Eleven (5%) procedures utilized stent fixation and 203 (95%) did not. Fixation techniques included endoscopic clips (9%), endoscopic sutures (73%), and transnasal sutures (18%). Stent migration rate was not different between those with and those without fixation ( P = .2). Rate of migration was significantly higher in procedures involving fully covered stents ( P < .001). Migration occurred after esophagectomy and gastric bypass ( P < .001 and P < .05, respectively) and in patients with diabetes ( P < .01). A challenge with SEMS use is stent migration. Diabetes and using fully covered stents were associated with migration as were SEMS used to treat complications of esophagectomy and gastric bypass. Stent fixation was not associated with the prevention of stent migration. No pattern was found that favors an approach to reduce stent migration.

Sleeve Gastrectomy in Canine: Effect on Weight Loss, Inflammation and Oxidative Stress Markers while Leaving Blind Intestinal Loop in Place

The aim of this study was to modify the current Sleeve gastrectomy surgical procedure by leaving behind the blind intestinal loop, with the purpose to overcome the complications of gastric bypass. Accordingly, we evaluated in Canine, the effectiveness of this approach, on the weight loss and markers of inflammation and oxidative stress. Our results suggest that this type of bypass surgery in Canine resulted in significant weight loss that was maintained up to six months. There was no evidence of post-operative leaks, infection or organ adhesion. However, oxidative stress and inflammation markers were elevated in the post-operative stomach but not in the nonfunctional blind intestinal loop, six months after surgery. Elevation of these markers, post surgically in the target organ suggesting that it may take longer time for these markers to come back to healthy pre-operative levels. The purpose of leaving behind the blind intestinal loop may allow reversing the bypass in future date due to any unintended complications such as excessive weight loss.

A118 - Laparoscopic Conversion to Sleeve Gasterectomy for Failed Gastric Bypass: Report Of 50 Cases

Laparoscopic gastric bypass is a commonly performed bariatric surgery for the treatment of morbid obesity. Revision surgery for patients who have gastric bypass complications is a challenge for bariatric surgeon. Our aim is to present the early results of the conversions of gastric bypass complications to sleeve gastrectomies.

Post Roux-en-Y gastric bypass complications: A comparative study assessing the clinical effectiveness of oesophagogastroduodenoscopy and oral-contrast swallow

IntroductionAnastomotic strictures at the gastrojejunal anastomosis have been reported to occur in 3–20% of patients following a Roux-en-Y gastric bypass (RYGB). Patients commonly present with dysphagia, vomiting and post-prandial pain. Clearly using the appropriate investigations to diagnose the potential complications have both clinical and economical benefits. The reported study compared whether Oesophagogastroduodenoscopy (OGD) or oral-contrast swallow should be employed in patient presenting with post-operative complications following RYGB. MethodsA retrospective study was conducted on 112 patients between 2008 and 2012; at a level 4 bariatric surgery hospital. Patients who had ≥1 OGD to investigate a post-operative complication were included for analysis. Oral-contrast swallow radiology reports performed <28 days prior to an OGD were included for analysis. Patient demographics, OGD, oral-contrast swallow and additional interventions reports were collated from electronic records, pathology and radiology results. Results112 patients underwent 1 or more OGD. 75% (n = 67) of patients were diagnosed with a post-operative complication with the most common, 51% (n = 57) being a gastrojejunal anastomotic stricture. 82% (n = 47) of patients presented with dysphagia + - vomiting prior to the diagnosis of gastrojejunal anastomotic strictures. 96% (n = 55) of patients with gastrojejunal anastomotic strictures were successfully treated with balloon dilation. 48% (n = 54) of patients had an oral-contrast swallow as a first line investigation for post-operative symptoms prior to the OGD. 15% (n = 8) of oral-contrast swallow were reported with a significant pathology, with only 1 stricture identified. 70% (n = 38) of oral-contrast swallows reported as normal had a pathology identified at OGD, including 28 strictures. ConclusionWe recommend that an OGD should be performed in patients presenting with symptoms consistent with a stricture following RYGB. The urgency of the OGD will be dictated by clinical correlation. The use of a water-soluble contrast swallow should be reserved for a suspected anastomotic leak.

Laparoscopic Conversion of Gastric Bypass Complication to Sleeve Gastrectomy: Technique and Early Results.

Laparoscopic gastric bypass is a commonly performed bariatric surgery for the treatment of morbid obesity. Revision surgery for patients who have gastric bypass complications is a challenge for bariatric surgeon. Our aim is to present the early results of the conversions of gastric bypass complications to sleeve gastrectomies. From January 2001 to April 2015, 49 of 2382 gastric bypasses underwent revisional surgery to convert gastric bypasses to sleeve gastrectomies. The demographic data, surgical parameters, and outcomes were studied. The mean age of the study group was 35.0years (range 20 to 55), and the average body mass index (BMI) prior to the reoperation was 25.3kg/m(2). Seven patients had previous laparoscopic Roux-en-Y gastric bypasses (LRYGBs), and 42 had laparoscopic single anastomosis (mini-) gastric bypasses (LSAGBs). The main reasons for the revisions were malnutrition (58%), weight regain (10%), intolerance (18%), and others (14%). The revisional surgeries had longer operative times, greater blood loss, and longer flatus passage times than the primary gastric bypass surgeries. Four patients (8.1%) developed major complications during revisional surgery, including three (6.1%) cases of leakage and one (2.0%) case of internal bleeding. No mortality was noted. After conversion to sleeve gastrectomy, the body weights of the patients remained stable, and all patients improved in terms of malnutrition, including anemia, hypoalbuminemia, and secondary hyperparathyroidism. Conversion to sleeve gastrectomy is an effective and safe option for patients with gastric bypass complications. The conversions to sleeve gastrectomy resulted in significant improvements in malnutrition and maintained weight loss at the early follow-ups.