Effective Bariatric Procedure Research Articles

Anemia and iron metabolism disorders after single anastomosis sleeve ileal (SASI) bypass. Is it a real problem?

PurposeSASI (single anastomosis sleeve ileal) bypass can lead to nutritional deficiencies, including disorders of iron metabolism and anemia. This study aims to evaluate the effect of SASI bypass on weight loss, anemia, and iron deficiency in patients with obesity during the follow-up period.MethodsThis study is a retrospective analysis of prospectively collected data from patients who underwent SASI bypass at our hospital between January 2020 and February 2022.ResultsThe mean age of the patients was 42 years (range 22–58). The average duration of the follow-up period was 26 months. The mean percentage of excess weight loss (%EWL) was 90.1%, and total weight loss (%TWL) was 30.5%. During the postoperative observation period, anemia was identified in ten patients (25%), comprising 70% with normocytic anemia, 10% with microcytic anemia, and two macrocytic anemia cases (20%). Iron deficiency was observed in two patients (5%).ConclusionSASI bypass is an effective bariatric procedure in weight loss outcomes. However, there may be an increased risk of anemia and iron metabolism disruptions associated with this procedure. The common limb length (250 vs. 300 cm) did not significantly impact hemoglobin, iron, TIBC, ferritin levels, or anemia incidence among patients undergoing SASI bypass. The decrease in postoperative ferritin levels signifies a depletion in tissue iron reserves, thereby emphasizing the necessity for surveillance of iron homeostasis parameters following SASI bypass.

Canagliflozin or acarbose versus placebo to ameliorate post-bariatric hypoglycaemia - The HypoBar I randomized clinical trial protocol.

Post-bariatric hypoglycaemia (PBH) is a rare yet disabling clinical condition, mostly reported after Roux-en-Y gastric bypass (RYGB) surgery. RYGB is one of the most widely used and effective bariatric procedures. The pathophysiology of PBH remains unclear, and treatment options are limited in effectiveness and/or carry significant side effects. Acarbose slows carbohydrates digestion and absorption and is generally considered first-line pharmacological treatment for PBH but its gastrointestinal side effects limit patient compliance. Canagliflozin inhibits intestinal and renal sodium-dependent glucose absorption and reduces postprandial excursions of glucose, insulin and incretins after RYGB - effects that could be beneficial in ameliorating PBH. The trial aims to investigate how blood glucose levels are affected during daily living in subjects with PBH during treatment with canagliflozin or acarbose compared with placebo, and to study the meal-induced entero-endocrine mechanisms implied in the treatment responses. In a double-blinded, randomized, crossover clinical trial, HypoBar I will investigate the effectiveness in reducing the risk of PBH, safety, ambulatory glucose profile and entero-endocrine responses when PBH is treated with canagliflozin 300 mg twice daily during a 4-week intervention period, compared with acarbose 50 mg thrice daily or placebo. HypoBar I is approved by the Local regulatory entities. Results will be published in peer-reviewed journals. If effective, well-tolerated and safe, canagliflozin could be a novel treatment for people with PBH. HypoBar I might also unravel new mechanisms underlying PBH, potentially identifying new treatment targets. EudraCT number 2022-000157-87.

Laparoscopic single anastomosis sleeve ileal bypass in the surgical management of morbid obesity: A single‐centre experience

AbstractBackgroundSingle anastomosis sleeve ileal (SASI) bypass is a recently developed two‐step bariatric operation that involves a sleeve gastrectomy followed by a side‐to‐side sleeve‐ileal anastomosis. While the primary outcomes are promising, more evidence is required before SASI can be considered a standard bariatric procedure.ObjectiveThis study aims to evaluate short‐term outcomes of SASI bypass regarding safety, efficacy and complications.MethodsThis retrospective study involved the analysis of 75 patients who underwent SASI between January 2019 and January 2022. The study examined patients’ characteristics, comorbidities, surgical technique, operative details, post‐operative weight loss and complications.ResultsOf the 88 patients who underwent SASI, 13 were excluded, leaving 75 participants for analysis. The mean age was 36.9 ± 8.3 years, and the mean body mass index was 49.23 ± 5.5 kg/m2. Among the participants, 19 patients (25.3%) had diabetes and 8 patients (10.6%) had hypertension. The mean operative time was 78.42 ± 13.18 min. The mean excess weight loss percentage was 25.53 ± 3.63, 43.33 ± 8.78, 63.51 ± 10.85, 82.11 ± 11.42 and 88.95 ± 8.69 at 1, 3, 6, 12 and 24 months, respectively. The diabetic remission rate was 100%, and the hypertension remission rate was 75%. Post‐operative complications were observed in 12 patients (16%), with most being minor. Notably, two patients underwent SASI reversal to sleeve gastrectomy due to excessive weight loss, and one patient experienced weight regain in the second post‐operative year.ConclusionSASI bypass emerges as a straightforward and highly effective bariatric procedure, with an acceptable complication rate. It is easy to perform and revise, offering not only excellent and sustained weight loss outcomes during short‐term follow‐up but also the resolution or improvement of obesity‐associated comorbidities.

571 Squamous Cell Carcinoma After Adjustable Gastric Banding - a Case Report

Abstract Laparoscopic adjustable gastric banding (LAGB) is a widely accepted and effective bariatric procedure. Gastric cancer following bariatric surgery is uncommon, with only a few occurrences reported. There are nine incidences of gastric adenocarcinoma after gastric banding recorded in the literature. Squamous cell carcinoma (SCC) by comparison, is encountered far less in overall stomach malignancies. We describe the case of a 69-year-old woman who, seven years after having a gastric band placed, developed squamous cell cancer at the site of the band. The patient initially presented with epigastric pain, and on endoscopy there was evidence of an ulcer at the gastric cardia. Extensive adhesions were also visualised around the gastroesophageal junction as a result of the band. Biopsies and staging laparoscopy confirmed a T3 N0, M0 R0 SCC of the stomach. This is the first case report to document this rare sequela of events. We postulate that the squamous cell cancer developed secondary to chronic irritation at the site of the gastric band. Whilst rare, and symptoms vague, there is an argument to maintain a high index for suspicion of gastric cancer even following bariatric procedures.

SP7.1 Effect of gastrojejunal anastomosis diameter in laparoscopic one-anastomosis gastric bypass for the treatment of morbid obesity and related disorders: a comparative study

Abstract Background One-anastomosis gastric bypass (OAGB) is a safe and effective bariatric procedure that employs a long gastric pouch with antecolic loop gastrojejunal (GJ) anastomosis. The optimum anastomosis diameter is still unclear, as there are many differences in the literature. Aim This study aims to evaluate the short-term effect of different GJ anastomosis diameters in patients offered laparoscopic OAGB regarding weight loss, bile reflux, and nutritional and metabolic effect. Patients and methods A total of 59 patients were included in this study, and they were divided into two groups: group A included patients with GJ anastomosis made by a 45-mm stapler reload, and group B included patients with GJ anastomosis made by 20 mm of the stapler reload. Results There was no statistically significant difference between groups regarding postoperative mean BMI at 3, 6, 9 months, and 1 year; excess weight loss (EWL%); remission of comorbidities; and bile reflux (P>0.05). Hypoalbuminemia was significantly more evident in group B at 3, 9 months, and 1 year, with P values of less than 0.001, 0.035, and 0.031, respectively. Moreover, group B patients had more iron-deficiency anemia, which was statistically significant at 3, 6, and 9 months (P<0.05), whereas there was no significant difference at 1 year (P=0.128). Conclusion OAGB is an effective bariatric procedure, but the use of a 45-mm stapler reload for GJ anastomosis may be associated with less nutritional deficiencies than using 20 mm of the reload. Further studies are needed on a larger number of patients with long-term follow-up.

Mid-term outcomes after single anastomosis sleeve ileal (SASI) bypass in treatment of morbid obesity

BackgroundAccording to several short-term studies, single-anastomosis sleeve ileal (SASI) bypass offers similar weight loss to Roux-en-Y Gastric Bypass (RYGB) with fewer complication and better comorbidity reduction/resolution. Long-term data on this operation is lacking in the literature. The purpose of this study was to analyze the outcomes of SASI bypass up to 4 years.MethodsThis study is a retrospective cohort analysis of 366 patients with morbid obesity who underwent primary SASI bypass from January 2018 to February 2022.ResultsThe mean age and preoperative body mass index (BMI) were 41 years (range 22–71 years) and 43.9 ± 6.5 kg/m2, respectively. Follow-up was available for 229 patients at 1-year (89%), 112 patients at 2-year (75%), 61 patients at 3-year (75%), and 35 patients at 4-year (71%). The intraoperative, short-term, and long-term complication rates were 0%, 2.5%, 4.6%, respectively. After 4 years, mean percentage excess weight loss (%EWL) was 93.3% and total weight loss (%TWL) was 41.2%. Remission of comorbidities was 93% for type 2 diabetes mellitus, 73% for hypertension, 83% for hyperlipidemia, 79% for sleep apnea, and 25% for gastroesophageal reflux disease (GERD). Biliary gastritis and ulcers are seldom. Eight patients developed de novo GERD symptoms requiring proton pump inhibitor treatment. None of the patients in our study had hypoalbuminemia or malabsorption that did not respond to increased protein intake and vitamin or mineral supplementation.ConclusionSASI bypass appears to be safe, and one of the most effective bariatric procedures regarding weight loss and obesity related comorbidities. The double-outlet created in this procedure seemingly minimizes nutritional complications.Graphical abstract

One Anastomosis Gastric Bypass Versus Single Anastomosis Duodenoileostomy with Sleeve: Comparative Analysis of 30-Day Outcomes Using the MBSAQIP.

One anastomosis gastric bypass (OAGB) and single anastomosis duodenoileostomy with sleeve (SADI-S) are two highly effective bariatric procedures that have been recently endorsed by the American Society of Metabolic and Bariatric Surgery (ASMBS). We compared the outcomes and safety profiles of SADI-S and OAGB using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Retrospective analysis on patients who underwent SADI-S or OAGB obtained from the MBSAQIP database 2020-2021. Patients who underwent concurrent procedures (besides EGD) or had missing data were removed. Variables included age, sex, body mass index, American Society of Anesthesiologists (ASA) class, and pertinent medical comorbidities. Data were analyzed for 30-day postoperative morbidity, mortality, reoperation, reintervention, and readmissions. p values were calculated using Student's t-test or Fisher analysis. A total of 694 and 1068 patients respectively underwent SADI-S or OAGB. Statistically significant comorbidities included age (42.2 ± 10.8 vs. 43.7 ± 12.2), BMI (50.6 ± 9.1 vs. 45.3 ± 7.1), ASA 2 (66 (9.5%) vs. 165 (15.4%)), ASA 4 [69 (9.9%) vs. 20 (1.9%)], and immunosuppressive therapy [24 (3.5%) vs. 17 (1.6%)]. Clavien-Dindo-based analysis highlighted that SADI-S had higher grade 2 (p = 0.005) and grade 4b (p = 0.001) complications. Patients who underwent SADI-S were twice as likely to be readmitted within 30days (3.7% vs. 1.9%; p = 0.021). SADI-S had higher readmission rates and higher Clavien-Dindo grade 2 and 4b complications. To note, SADI-S patients had higher BMIs. Further studies are needed to determine the long-term complications and efficacy of both operations.

Short-term outcomes of sleeve gastrectomy plus uncut jejunojejunal bypass (SG-uncut JJB) in patients with obesity: a preliminary prospective cohort study.

To compare the safety, weight loss, and metabolic outcomes of patients with obesity with sleeve gastrectomy (SG) or sleeve gastrectomy plus uncut jejunojejunal bypass (SG-uncut JJB). This prospective study included patients with BMIs ≥ 32.5kg/m2 or refractory metabolic disorders undergoing SG or SG-uncut JJB between January and December 2020 in our hospital (NCT04534504). Weight loss, metabolic outcomes, surgical results, and complaints during 1-year follow-up were compared between two groups. Forty-seven patients were enrolled, 26 in the SG and 21 in the SG-uncut JJB groups. A longer operative time was observed in the SG-uncut JJB than in the SG group (140 (110-180) min vs. 90 (70-180) min, P = 0.001). No significant differences were found in complications. Total weight loss (TWL%) and excess weight loss (EWL%) in both groups increased with the duration of follow-up (P = 0.001). TWL% was greater at 1month ((11.1 ± 2.4)% vs. (8.2 ± 4.4)%, P = 0.011] and 12months [(29.7 ± 6.9)% vs. (20.3 ± 7.2)%, P = 0.001) with SG-uncut JJB than with SG. SG-uncut JJB and SG had similar metabolic outcomes and complaints during the 1-year follow-up, but less nausea was reported with SG-uncut JJB (9.2% vs. 46.2%, P = 0.006). In short-term follow-up, SG-uncut JJB was a safe and effective bariatric surgery procedure in patients with obesity.

Sex-specific differences in bone mineral density loss after sleeve gastrectomy

Sleeve gastrectomy is an effective bariatric procedure; however, sleeve gastrectomy-related adverse skeletal outcomes have been increasingly reported. High levels of sex hormone-binding globulin (SHBG) have been documented to be a risk factor of bone mineral density (BMD) loss with different effects observed between sexes. The aim of this study was to identify sex-specific changes in BMD following sleeve gastrectomy and to evaluate the role of SHBG in this process. This retrospective study included 19 middle-aged men and 30 non-menopausal women with obesity who underwent sleeve gastrectomy in China. Anthropometrics, bone turnover markers, calciotropic hormones, BMD, SHBG, and gonadal steroids were measured preoperatively and at 6 and 12 months postoperatively. Longitudinal changes in BMD, bone turnover markers and SHBG were compared between sexes by linear mixed models. Multiple stepwise regression analysis was used to identify the predictors of BMD loss at the investigated bone sites. Over the 12-month study period, total hip and femoral neck BMD decreased, while lumbar spine BMD remained largely unchanged in both sexes. Linear mixed models revealed significant sex × time interaction effects in total hip BMD and SHBG, showing that men had a significantly greater reduction in total hip BMD and less increase in SHBG after sleeve gastrectomy than women. In the multivariate model, SHBG was significantly associated with total hip BMD loss in men (adjusted β = -0.533, P = 0.019) but not women while total estrogen was significantly associated with total hip BMD loss in women (adjusted β = 0.508, P = 0.01) but not men. Significant sex-specific BMD changes were observed after sleeve gastrectomy in the current study. Sleeve gastrectomy-related increase in SHBG may be a specific risk factor for total hip BMD loss in men. Our results indicate that sex-specific screening may be warranted to facilitate personalized postoperative bone care in this population.

Metabolomics analysis of stool in rats with type 2 diabetes mellitus after single-anastomosis duodenal-ileal bypass with sleeve gastrectomy.

BackgroundSingle-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) is one of the most effective bariatric procedures in the treatment of type 2 diabetes mellitus (T2DM). However, the mechanisms by which SADI-S improves T2DM are not well-known.ObjectiveTo explore the effects of SADI-S on metabolites in the stool of rats with T2DM.MethodsTwenty rats were fed on high-fat diet and administered with a low-dose (30mg/kg) of streptozotocin to establish T2DM models. The rats were then randomly assigned to the SADI-S group (n=10) and sham operation group (n=9). Stool samples were collected from all rats at 8 weeks after surgery and stored at -80 °C. Metabolomics analysis was performed to identify differential metabolites through ultra- performance liquid chromatography-mass spectrometry.ResultsAt 8-week after surgery, rats of the SADI-S group showed significantly decreased fasting blood glucose, glucose tolerance test 2-hour, glycated haemoglobin, and body weight compared with those of the sham group. A total of 245 differential metabolites were identified between the two groups. Among them, 16 metabolites such as branched-chain amino acids (valine), aromatic amino acid (phenylalanine), bile acid (cholic acid, lithocholic acid, and β-muricholic acid), short-chain fatty acid (isobutyric acid), and phospholipid [lysoPE(17:0), lysoPE(20:3) and lysoPS(16:0)] were associated to the T2DM remission after SADI-S.ConclusionSADI-S improves T2DM in rats by regulating phenylalanine biosynthesis, valine, phenylalanine, alanine, glutamate, proline, bile acid, and phospholipid metabolism pathways.

Nutritional Status after Roux-En-Y (Rygb) and One Anastomosis Gastric Bypass (Oagb) at 6-Month Follow-Up: A Comparative Study.

Introduction: Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) are two effective bariatric surgical procedures with positive outcomes in terms of weight loss, comorbidities remission, and adverse events profiles. OAGB seems to carry a higher risk of malnutrition, but existing data are controversial. The aim of this study is to objectively evaluate and compare malnutrition in patients undergoing RYGB and OAGB. Methods: Retrospective monocentric study of obese patients undergoing RYGB or OAGB between the 15 September 2020 and the 31 May 2021. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score and compared between groups. The primary outcome was the mean CONUT score at 6 months. The secondary outcomes included the incidence of malnutrition, comorbidities, including hypertension, insulin resistance and type II diabetes mellitus, and weight loss. Results: 78 patients were included: 30 underwent RYGB and 48 underwent OAGB. At 6-Month Follow-Up there was no difference between groups in the mean CONUT score nor in incidence of malnutrition. In both groups, the nutritional status significantly worsened 6 months after surgery (preoperative and postoperative score of 0.48 ± 0.9 and 1.38 ± 1.5; p = 0.0066 for RYGB and of 0.86 ± 1.5 and 1.45 ± 1.3; p = 0.0422 for OAGB). Type II Diabetes mellitus (DMII) and hypertension remission were significant in the OAGB group with a 100% relative remission in the DMII-OAGB group (p = 0.0265), and a 67% relative remission in the hypertension-OAGB group (p = 0.0031). Conclusions: No difference in nutritional status has been detected between patients undergoing RYGB or OAGB at the 6-Month Follow-Up. Both procedures may have significant mal-absorptive effects leading to decline in nutritional status. OAGB may be more efficacious in inducing DMII and hypertension remission. Larger prospective studies dedicated specifically to nutritional status after gastric bypass are needed to confirm the impact of different bypass procedures on nutritional status.

Long-term outcome after biliopancreatic diversion type duodenal switch: A single-center experience with up to 20 years follow-up

Abstract Objective Biliopancreatic diversion type duodenal switch (BPD-DS) is the most effective bariatric procedure in terms of weight loss and remission of comorbidities but carries the risk of severe long-term side effects. The aim of this study was to analyze the long-term effects of BPD-DS on weight loss, comorbidities and reoperation rate. Methods This is a retrospective single-center study of prospectively collected data of all patients who underwent BPD-DS from 1999 to 2011 at a single institution. Results 116 patients (83.6% female) underwent BPD-DS with a mean initial body mass index (BMI) of 47 ± 6.5 kg/m2. 68% of the procedures were performed in open technique and 32% laparoscopically. Common channel length was routinely 1 m, mean alimentary limb length (AL) was 1.8 ± 0.6 m and mean bilio-pancreatic limb length (BPL) was 4.9 ± 1.6 m. 76.7% of patients had laparoscopic adjustable gastric banding (LAGB) prior to BPD-DS. Mean follow-up time was 14 ± 4.4 years and follow-up rate at 5, 10 and 14 years was 95.6% (n = 108), 90% (n = 98) and 75.3% (n = 70). Mean excess BMI loss (%EBMIL) at 5, 10 and 14 years was 78% ± 24.1, 76.5% ± 26.7 and 77.8% ± 33.8, respectively. The highest %EBMIL was reached two years postoperatively with 84% ± 23.6. Complete (n = 22) or partial remission (n = 4) of type 2 diabetes mellitus was observed in 92.8% of patients. Reoperation was necessary in 33 patients (28.4%) due to malnutrition or refractory diarrhea (10), excessive weight loss (1), insufficient weight loss or weight rebound (7), reflux or stenosis (7), oxalate nephropathy (2), liver cirrhosis (1) and various/combined indications (5). Mean time to reoperation was 7.7 ± 5 years. The predominant deficiencies were vitamin D (99.1%), zinc (86.9%), iron (83.5%) and calcium (71.3%). The were no procedure-related deaths in the short- or long-term. Conclusion BPD-DS leads to sustainable long-term weight loss with an acceptable reoperation rate. Nevertheless, regular follow-up is necessary to detect and treat malnutrition and vitamin deficiencies.

Duodenal Switch Combined with Systematic Post-operative Supplementation and Regular Patient Follow-up Results in Good Nutritional Outcomes.

The duodenal switch is the most effective bariatric surgical procedure. Due to technical demands of the surgery and concerns regarding high rates of post-operative nutritional sequelae, many surgeons remain hesitant to adopt this technique. Sixty-five patients undergoing duodenal switch surgery at our hospital between 2008 and 2015 were followed up for 5years. All patients were provided with a thorough post-operative nutritional supplementation regimen. Nutritional deficiencies as evidenced by blood testing, excess body weight loss, and remission rates from type 2 diabetes, hypertension, and dyslipidaemia were studied. The average excess body weight loss 5years post-operatively was 62% ± 23.03%. Remission rates for type 2 diabetes, hypertension, and dyslipidaemia were 96%, 77% and 84% respectively. Patients achieved good nutritional outcomes. After 5years, deficiencies in fat-soluble vitamins A and D occurred in 3.3% and 1.6% of patients respectively. The rate of ferritin deficiency at the 5-year post-operative mark was 19.4%. No predictors of nutritional deficiency were identified on univariate analysis. Patients undergoing a duodenal switch achieve good long-term excess body weight loss and high obesity-related co-morbidity remission rates. The rates of post-operative nutritional deficiencies in patients who are subjected to a thorough post-operative nutritional supplementation regimen are lower than what was historically expected.

One Anastomosis Gastric Bypass Versus Long Biliopancreatic Limb Roux-en-Y Gastric Bypass

BackgroundRoux-en-Y gastric bypass (RYGB) is one of the most effective bariatric procedures. The study aimed to explore the value of lengthening the biliopancreatic limb (BPL) in RYGB compared to the outcome of one-anastomosis gastric bypass (OAGB). MethodsThis prospective study included morbidly obese patients divided into two groups. The RYGB group (n = 36) was subjected to long biliary limb Roux-en-Y gastric bypass (LPRYGB), and the OAGB Group (n = 36) had one anastomosis gastric bypass. During follow-up, weight, BMI, percentage of excess body weight loss (%EBWL), resolution of obesity-related comorbidities, and quality of life (QoL) were evaluated.ResultsThere was no significant difference in weight and BMI after 3 and 6 months. At 12-month follow-up, weight loss was significantly higher in the OAGB group. After 12 months, the two groups showed significant improvement of comorbid conditions without significant difference between the two groups. The Qol was significantly higher in the LPRYGB group 3, 6, and 12 months after surgery compared to the OAGB group.ConclusionsExtending the BPL length in RYGB to 150 cm is as effective as OAGB in remission of comorbidities, including diabetes. It was also equally effective in weight reduction in the short term. OAGB was more efficient in weight reduction and a significantly faster operation. LPRYGB showed a better QoL of life 1 year after surgery.Graphical abstract

Medium-Term outcomes after Roux-en-Y-Gastric Bypass: Experience from a Tertiary Healthcare Center from India

Background: Roux en Y gastric bypass (RYGB) has been highly effective in weight loss and it has been the procedure of choice for patients suffering from diabetes. There is a high attrition rate in long-term follow-up. Hence, limited long-term data are available. Methodology: We collected retrospectively data from a prospectively maintained institutional database. To increase the long-term follow-up rate, a telephonic interview was conducted with patients who had not come for long-term follow-up. Standard definitions were used for weight loss, weight regain, comorbidities, comorbidity resolution, and nutritional parameters. Results: Of 142 patients who underwent laparoscopic RYGB between 2008 and 2018, 125 patients (M: 33, F: 92; Age: 42.4 ± 5.2 years) were included in the study. The mean % weight loss at 1, 3, 5, and 7 years was 28.9, 31.8, 31.3, and 31.7, respectively. Mean % excess body mass index loss (% EBMIL) at 1, 3, 5, and 7 years was 67.6 ± 18, 73.7 ± 17.9, 71.7 ± 20.7, and 69.5 ± 24.6, respectively. Median weight regain at 3, 5, and 7 years was 8.4%, 12.7%, and 24% of weight lost. Significant weight regain was seen in 1 patient at 3 years and 3 patients at 5 and 7 years of follow-up. Among patients suffering from diabetes, 50.9% had remission and 45.3% had improvement at 1 year. At 5 years, this was 56% and 40%, respectively. Among patients suffering from hypertension, at 5 years, remission was seen in 11 (64.7%) out of 17. Significant improvements were seen in hypothyroidism, OSA, gastroesophageal reflux disease, and lipid profile. There was a statistically significant decrease in mean levels of fasting blood sugar, glycated hemoglobin (HbA1c), hemoglobin, serum calcium, insulin, c-peptide, serum albumin, and total protein and there was an increase in mean Vitamin D levels at 1 year follow-up. There was a decrease in mean levels of folate, total iron-binding capacity, parathyroid hormone, and alkaline phosphatase and an increase in mean Vitamin B12, iron, and ferritin postsurgery. However, this was statistically not significant. Nutritional deficiencies were noted. Seven complications were noted out of 142 procedures and no surgery-related mortality. Three patients had significant weight regain beyond 5 years. Conclusion: RYGB is a safe and effective bariatric procedure with well-sustained results in long run. Nutritional supplementation is required to correct deficiencies.

Outcomes of 75 consecutive cases of laparoscopic one-anastomosis gastric bypass: A prospective study

Background: Obesity is increasing at an alarming rate in India along with rest of the world. In the National Family and Health survey - IV conducted in 2015-16; 31.3% women and 26.6% men in urban area were obese or over weight. Bariatric surgery has long been introduced for weight control and is well established measure and superior to other weight control measures. Procedures like laparoscopic Roux en Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are more commonly performed than Laparoscopic One Anastomosis Gastric Bypass (LOAGB). Although sufficient data has accumulated in literature regarding the safety and efficacy of LOAGB, some of standard textbooks still mention it as an experimental procedure and not the mainstream procedure. Aims and Objective: The present study was conducted with objective to find out changes in pre-operative and post-operative status of diabetes mellitus, hypertension, dyslipidemia, obstructive sleep apnoea, osteoarthritis, GERD and quality of life after laparoscopic one anastomosis gastric bypass along with its safety and efficacy in Indian population. Material and Methods: The study was conducted at a tertiary care bariatric surgical centre and included 75 consecutive individual operated between January 2016 to December 2017 who underwent Laparoscopic One Anastomosis Gastric Bypass and followed prospectively for minimum 1 year (mean 18 months) and statistical analysis was done using SPSS 21 software. Result: One Anastomosis Gastric Bypass was completed laparoscopically in all the patients without need for conversion to an open procedure. The overall complication with Laparoscopic One Anastomosis Gastric Bypass was 1.3% without any mortality. Mean percentage of excess weight loss (% EWL) achieved was 72.73. 93.9 % patients with diabetes, 67.43% patients with hypertension, 87.1% patient with hyperlipidemia, all the patient with obstructive sleep apnoea and osteoarthritis of knee showed improvement in their disease status. None of the patient showed worsening of gastroesophageal reflux or development of new symptoms of gastro esophageal reflux. All patients had improvement in their quality of life as seen in the improvement of their SF 36 scores. Conclusion: Laparoscopic One Anastomosis Gastric Bypass is a safe and effective bariatric procedure. The post procedure improvement in diabetes, hypertension, hyperlipidemia, obstructive sleep apnoea, osteoarthritis of knee and quality of life is significant in Indian context.

Gastric remnant shape following laparoscopic sleeve gastrectomy correlates with weight loss: A retrospective cohort study

Background: Laparoscopic sleeve gastrectomy (LSG) is a safe and effective bariatric surgical procedure. Sleeve configuration is believed to be an important outcome of good operative technique, yet the relationship of sleeve shape to clinical outcomes including weight loss and postoperative symptoms is not clearly defined. This study aims to identify whether gastric remnant anatomical shape is associated with short-term postoperative weight loss or symptoms of reflux, regurgitation, or dysphagia. Methods: 207 LSG patients were identified from a prospective, multicentre unit database who had surgery between June 2015 and June 2019. Routine postoperative upper gastrointestinal gastrograffin contrast studies were performed between postoperative days one to five and analyzed using a standardized protocol. Gastric remnant shape was classified as either tubular, proximal pouch or distal pouch consistent with previous studies. ANOVA Kruskal − Wallis and Mann − Whitney U-tests were performed to determine the effect of gastric remnant anatomy on weight loss. Descriptive statistics examined the symptoms of reflux, regurgitation, and dysphagia. Results: Gastric remnant anatomy was classified as tubular in 159/207 (78%), proximal pouch in 15/207 (7%), and distal pouch in 33/207 (16%). Patients with a tubular shape had a significantly greater reduction in median body mass index at 12 months postoperatively compared to those with a proximal pouch (11.3 kg/m2 vs. 10.2 kg/m2, P = 0.01). There was no relationship identified between gastric remnant shape and postoperative reflux, regurgitation, or dysphagia. Conclusion: A tubular-shaped gastric remnant is associated with increased weight loss. This suggests that tubular shape should be considered the desired LSG shape for greatest weight loss.

Pancreaticoduodenectomy after Roux-en-Y Gastric Bypass: a novel reconstruction technique.

The obesity epidemic continues to increase around the world with its attendant complications of metabolic syndrome and increased risk of malignancies, including pancreatic malignancy. The Roux-en-Y gastric bypass (RYGB) is an effective bariatric procedure for obesity and its comorbidities. We describe a report wherein a patient with previous RYGB was treated with a novel reconstruction technique following a pancreaticoduodenectomy (PD). A 59-year-old male patient with previous history of RYGB was admitted with painless progressive jaundice. Imaging revealed a distal common bile duct stricture and he underwent PD. There are multiple options for reconstruction after PD in patients with previous RYGB. The two major decisions for pancreatic surgeon are: (I) resection/preservation of remnant stomach and (II) resection/preservation of original biliopancreatic limb. This has to be tailored to the patient based on the intraoperative findings and anatomical suitability. In our patient, the gastric remnant was preserved, and distal part of original biliopancreatic limb was anastomosed to the stomach as a venting anterior gastrojejunostomy. A distal loop of small bowel was used to reconstruct the pancreaticojejunostomy and hepaticojejunostomy and further distally a new jejunojejunostomy performed. The post-operative course was uneventful, and the patient was discharged on 7th day. With the increase in number of bariatric procedures performed worldwide, pancreatic surgeons should be aware of the varied surgical reconstruction options for PD following RYGB. This should be tailored to the patient and there is no "one-size-fits-all".

Comparison between Early Results of Laparoscopic Mini Gastric Bypass and Sleeve Gastrectomy regarding Weight Loss, Remission of Type II Diabetes Mellitus and Hypertension

Abstract Background Bariatric Surgery leads to a dramatic improvement in morbid obesity and associated type 2 Diabetes Mellitus (T2DM) and hypertension. Objectives The aim of the study was to compare between early results of Laparoscopic Mini Gastric Bypass and Sleeve gastrectomy regarding excess weight loss, remission of Type II diabetes mellitus and hypertension. Patients and Methods Type of the study, retrospective study. study setting, Our study was carried out at The General Surgery Department Ain Shams University Hospitals. study period,. All cases were operated during the period February and march 2019. Follow up of patients 6 months after operation was done (retrospective study). Last follow up was done on September 2019. The study included 50 patients aged 18-60 years with Type II Diabetes Mellitus and hypertension of at least 6 months duration, BMI 35 65 kg/m2 for at least 5 years. Results In this study There was no statistical significant difference between studied groups as regard age,gender,and baseline clinical data. there was a statistical significant difference between patients in LMGB group as well as between patients in LGS group before and six months after surgery as regard weight in kg, BMI and HbA1C and.remission of hypertention (P value 0.000). there was high statistical significant difference between studied groups as regard percentage of change of weight and BMI(P value 0.000) However, there was no statistical significant difference between studied groups as regard percent of change of HbA1C. (P value 0.613),remission of T2DM.(p value 0.123 ) and control of hypertension. (p value 0.136 ). Further results and data could be reached on long-term follow up of patients involved in this study. Conclusion Patients receiving mini-gastric bypass had more advantageous indexes than patients receiving sleeve gastrectomy, such as higher six months EWL% (excess weight loss), higher T2DM remission rate and higher hypertension remission rate. Especially on long term follow up and that was proved by meta analysis of previous studies but on short term follow up there is no statistical singnificant difference between both studied groups except in percentage of change of weight and BMI. Mini-gastric bypass is simple, safe and more effective bariatric procedure than laparoscopic sleeve gastrectomy.

Laparoscopic Gastric Plication; Comparative Study between Modified Enteric Bypass and Loop Bipartition

Background: Laparoscopic gastric plication (LGP) is emerging as a safe and effective bariatric procedure. A comparative study between the efficacy and complications of LGP with modified enteric bypass and LGP with loop bipartition, which are still an investigational bariatric procedure. The objective of this study to compare safety and efficacy of LGP with enteric bypass and LGP with loop bipartition in the treatment of morbid obesity in a one-year follow-up study. Methods: A prospective study between February 2016 to December 2017, conducted on 80 morbid obese patients who were candidates for laparoscopic gastric plication, with either loop bipartition or modified enteric bypass surgery were randomly assigned to receive either LGP modified enteric bypass (n = 40) or LGP with loop bipartition (n = 40). Early and late complications, body mass index (BMI), excess weight loss, and obesityrelated co-morbidities were determined at the 1-year follow-up. Results: Operative time and mean length of hospitalization were shorter in the LGP with modified enteric bypass group than LGP with loop bipartition; (110 minutes versus 120 minutes, P<.001, and 2 days versus 3 days; P<.001, respectively). The mean percentage of excess weight loss (%EWL) at 12 months follow-up was (79.5%) in the LGB with modified enteric bypass group and (74.1%) in the LGP group (P = 0.03). Improvement was observed in all co-morbidities in both groups. Conclusion: Both LGP and LGB are effective weight loss procedures. LGP enteric bypass proved to be a simpler and less costly procedure compared with LGP with loop bipartition with a lower risk of stomal ulcer during one year follow up.