Gastric Bypass For Morbid Obesity Research Articles

620 Outcomes of One Anastomosis Gastric Bypass Conversion to Roux-en-Y Gastric Bypass for Morbid Obesity: A Systematic Review and Meta-Analysis

Abstract Introduction One anastomosis or ‘mini’ gastric bypass (OAGB) is a highly effective procedure to treat morbid obesity. However, conversion to Roux-en-Y gastric bypass (RYGB) for OAGB-related complications such as bile reflux is increasing. We therefore conducted the first systematic review to determine the weight outcomes, safety and efficacy associated with OAGB-RYGB conversion surgery. Method A systematic search was conducted by three independent reviewers using Medline, Embase and the Cochrane library following PRISMA guidelines. Data extracted included patient demographics, weight, and reflux outcomes. Risk of bias was assessed using the Newcastle-Ottawa scale. The mean BMI difference was analysed using a random effects model. This study was registered on PROSPERO (Registration ID: CRD42022379759). Results 6 studies were selected which included data from 134 patients undergoing OAGB-RYGB conversion surgery. Follow-up ranged from 6-60 months. Patients' baseline BMI at conversion was 30.2 (S.D. 2.85). Common indications for conversion surgery were reflux (47.8%), malnutrition (31.3%) and inadequate weight loss (8.2%). Biliopancreatic limb length ranged from 50-200cm. Weighted mean of study outcomes demonstrated biliary reflux symptoms resolved in 90.9% cases (95 % CI 78.8-n100%). Studies reporting BMI at >24 months reported overall stable medium-term weight (mean BMI difference -0.71 (-4.03-2.61)) with moderate study heterogeneity (I2 = 82%). The rate of major post-op complications was 14.7% (6.25%-23.1%). Conclusions OAGB to RYGB conversion surgery is associated with a high resolution of reflux symptoms. However, it is associated with weight regain, albeit this may be acceptable to patients to treat biliary reflux as the weight gain is small and stable over the long-term.

COMPARISON OF LONG-TERM WEIGHT LOSS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY AND LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS IN ASIA

BackgroundLaparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the two most bariatric procedures in Asia. However, a comparison of long-term outcomes is still limited. ObjectivesTo compare the degree of long-term weight loss, remission of co-morbidities and complication rates after LRYGB and LSG procedures. MethodsA retrospective analysis was conducted for all patients who underwent LSG or LRYGB between May 2005 and May 2018 at a single institute with at least 1 to 5 years of follow up. Demographic data were collected. ResultsOf the total 342 patients, 159 underwent primary LSG and 183 patients underwent LRYGB. Preoperative BMI in the LSG group was significantly higher than the LRYGB group (54.7 ± 12.6 kg/m2 vs 48.2 ± 8.2 kg/m2, P = 0.001). Co-morbidities between LSG and LRYGB groups were similar. Mean percentage of total weight loss (%TWL) at 5 years after was 23.6±1.7% in the LSG group vs. 29.9±1.3% in the LRYGB group (P = 0.005) and LRYGB resulted in greater weight loss than LSG at all time points. Overall complications were 35.2% in the LSG group vs. 20.8% in the LRYGB group (P = 0.003). ConclusionsOur center revealed that LRYGB had better results than LSG in terms of percentage total weight loss at all time points. In the long term, LSG showed a higher overall complication rate compared to LRYGB.

Bariatric patient: what is the key to success? Case from practice

Surgical treatment in the scope of laparoscopic gastric bypass for morbid obesity and type 2 diabetes mellitus (DM 2) with careful preoperative preparation, a gradual expansion of the diet with the obligatory observance of the recommendations of a nutritionist on the balance of micro- and macronutrients, a gradual increase in the amount of available physical activity in the postoperative period allows not only significantly reduce body weight, but also achieve compensation for obesity-related diseases. The expected development of micro- and macronutrient deficiencies requires an active search for and compensation for these conditions both at the pre- and postoperative stages. The development of postbariatric hypoglycemia confirms the need to comply with dietary recommendations not only at the stage of conservative treatment of obesity and DM 2, but also, no less important, after bariatric surgery.

S377 Laparoscopic Assisted ERCP for Choledocolithiasis After Gastric Bypass

Introduction: Choledocolithiasis can occur after gastric bypass. Access to the biliary is endoscopically complicated given the altered anatomy. Laparoscopic access to the distal gastric remnant can be utilized for endoscopic access to the ampulla and biliary tree for endoscopic sphincterotomy and clearance of the biliary tree without disruption of the gastric bypass. Case Description/Methods: This video demonstrates the procedure of a laparoscopic assisted ERCP following gastric bypass for morbid obesity. The patient presented with increased bilirubin and a dilated biliary tree. MRCP revealed gallstones and common bile duct stones with biliary obstruction. Laparoscopic access to the distal stomach is obtained. A cholecystectomy is performed and the distal stomach is cannulated with a 15 mm. laparoscopic trochar. An ERCP endoscope is passed through the abdominal wall, through the trochar into the distal stomach. The ampulla is identified and cannulated. A sphincterotomy was performed and the biliary tree is cleared of stones. The endoscope is withdrawn and the gastric cannulation site is surgically closed. Discussion: Laparoscopic assisted ERCP following gastric bypass for morbid obesity is a safe and effective approach for choledocolithiasis. This approach does not sacrifice or disrupt the gastric bypass. This approach is needed. Watch the video at https://tinyurl.com/ACGAbstractS377

Operative management of recalcitrant marginal ulcers following laparoscopic Roux-en-Y gastric bypass for morbid obesity: a systematic review.

One of the short- and long-term complications following Roux-en-Y gastric bypass (RYGB) for morbid obesity is the development of marginal ulcers (MUs). Although chronic and recalcitrant/recurrent marginal ulcers (rMUs) are common, there is no consensus on their optimal management. The objective of this study was to perform a systematic review of the elective operative management of rMUs. A systematic search of the literature was conducted. Relevant databases were searched up to May 16, 2020. Articles were included if they met the following inclusion criteria: (1) bariatric patients were included as the study population, (2) laparoscopic RYGB was performed as the index operation, (3) study patients developed rMUs, and (4) MUs required elective operative (surgical, endoscopic) interventions. Quality of articles was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The search identified 3470 citations; of these, 16 observational studies were included. Elective management of rMUs consisted of endoscopic (oversewing ± stents) and surgical interventions (gastrojejunostomy revision, vagotomy, conversion to sleeve gastrectomy, subtotal/total gastrectomy, reversal to normal anatomy). Quality of the studies as assessed by the GRADE system was low to very low. Recalcitrant/recurrent MUs are challenging complications both for bariatric patients and for their treating surgeons. There are no established algorithms for the management of rMUs, and the currently available evidence in the literature is limited both in quantity and in quality. Future multicentre, multisurgeon, randomized, controlled trials are needed to address this issue.

Gastrojejunostomy in Roux-En-Y Gastric Bypass for Morbid Obesity: Linear Stapler Length Does Not Affect Mid-term Outcomes.

The purpose of this study was to compare whether different linear stapler lengths used to form the gastrojejunostomy during laparoscopic Roux-En-Y gastric bypass affects mid-term weight loss outcomes. A retrospective single center analysis was performed. Surgical technique was identical other than either a 35 or 45 mm linear stapler being used to form the gastrojejunostomy. Multivariate regression was used to assess the relationship between the different stapler lengths and weight loss outcomes 2 years following surgery. Of the 97 patients identified, 67 (69.1%) were included in the study. There were 30 patients in the 35 mm group and 37 in the 45 mm group. The groups were comparable in terms of basic demographic data and preoperative weight characteristics. There was no significant difference in weight loss outcomes 2 years following surgery when comparing between the different linear stapler lengths. Thirty-five versus 45 mm linear stapler lengths does not affect mid-term weight loss outcomes.

Severe Protein-Calorie Malnutrition-Associated Hepatic Steatosis in a Woman Who Had Roux-en-Y Gastric Bypass for Morbid Obesity Thirteen Years Ago

Hepatic steatosis is common in everyday liver pathology practice. There are many etiologies leading to hepatic steatosis. These etiologies include metabolic syndrome, alcohol, medications, monogenetic disease, infectious diseases, and malnutrition. Correct diagnosis of underlying etiology through clinicopathological correlation is key to adequate treatment and optimal outcome for the patient. In this case report, we describe severe protein-calorie malnutrition as an etiology for hepatic steatosis in a middle-aged woman who presented with lethargy, low body mass index (15.8 kg/m2), abdominal distention and bilateral lower extremity edema, hyperammonemia, and hypoalbuminemia, 13 years after Roux-en-Y gastric bypass for morbid obesity. Laboratory tests revealed hyperammonemia, hypoalbuminemia, and low ceruloplasmin levels. Hemodynamic measurement demonstrated high hepatic venous pressure gradient of 12 mm Hg. Transjugular liver biopsy showed moderate macrovesicular steatosis, mild siderosis, and abundant lipofuscin but no evidence of fibrosis, cirrhosis, or steatohepatitis. This patient was treated with lactulose and enteral feeding, however, the patient died of progressive liver failure 3 weeks after admission. We also review relevant literature to help diagnose protein-calorie malnutrition (kwashiorkor) and hepatic steatosis as a possible late complication of Roux-en-Y gastric bypass. In patients with hepatic steatosis, encephalopathy, hyperammonemia and portal hypertension, malnutrition should be considered as an etiology and diagnosed with a synthesis of clinical, pathological, and laboratory information. Kwashiorkor is a severe disease and should be treated promptly as it may be fatal as in our case.

Petersen's space hernia.

Petersen´s Space Hernia was first described in 1900 by Walther Petersen MD. It is an internal hernia, arising after any type of gastrojejunostomy, in particular, after Roux-en-Y anastomosis. A 49-years-old Caucasian woman was admitted to Emergency Room of our institution complaining of epigastric abdominal crampy pain and alimentary vomiting. Her past medical history highlighted Roux-Y Gastric Bypass for morbid obesity and weight loss of 60kg. Her abdominal physical examination revealed Blumberg sign. Vital signs were normal. White blood tests were in normal range. Body temperature was 36.2°C. CT scan demonstrated a “twist” in the mesentery with “whirlpool sign” of the jejunum. The patient was referred to operating theatre. We performed an exploratory laparotomy, disclosing an incarcerated Petersen´s space Hernia of the common limb, with obstruction of the jejunum. The incarcerated bowel was repositioned and there was no irreversible ischemia, no resection being required. The Petersen´s space was closed with a suture. The post-operative period was unremarkable and the patient was discharged at the fourth post-operative day.

Long-term results of laparoscopic Roux-en-Y gastric bypass for morbid obesity: 105 patients with minimum follow-up of 15 years.

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the second most frequently performed bariatric procedure worldwide; however, long-term results are not frequently reported. To evaluate the outcomes of LRYGB on weight loss and co-morbidities in a single center 15 years after the operation. Tertiary-care referral hospital. From February 2000 to December 2003, 105 patients (86 women; mean age 39.9 ± 17.4; mean body mass index [BMI] 47.2 ± 6.4 kg/m2; 78 with BMI < 50 kg/m2 and 27 with BMI ≥ 50 kg/m2) underwent LRYGB. Retrospective analyses of a prospectively maintained database were carried out to evaluate weight loss; resolution of co-morbidities, including type 2 diabetes mellitus (T2D), hypertension (HTN), and dyslipidemia; complications; and nutritional status. The follow-up rate at 15 years was 87.6%. Mean excess weight loss was 58.6 ± 27%, with 74.1% of patients achieving a total weight loss ≥ 20%. According to the Biron etal. criteria, an inadequate outcome was found in 11/21 (52.4%) of patients with an initial BMI ≥ 50 kg/m2 versus 21/64 (32.8%) of patients with a preoperative BMI < 50 kg/m2 (P = .001). Both groups experienced gradual weight regain (WR); specifically, 34.1% of patients regained more than 15% of their lowest postoperative weight. The rates of reoperations due to early and late surgical complications were 3.8% and 9.5%, respectively. T2D was resolved in 50% of patients, HTN in 61.1%, and dyslipidemia in 58.3%. Iron deficiency anemia (53%) was the most common postoperative nutritional finding. LRYGB provides satisfactory weight loss and resolution of co-morbidities up to 15 years. WR was a common finding. A significant proportion of patients with a preoperative BMI ≥ 50 kg/m2 did not achieve a favorable weight loss outcome. Indications to perform LRYGB in this group of patientsshould be definitively reconsidered.

Lactose after Roux-en-Y gastric bypass for morbid obesity, is it a problem?

Background Roux-en-Y gastric bypass (RYGB) can cause multiple food intolerances and gastrointestinal complaints are frequently reported after dairy consumption. We aimed to determine the prevalence of lactose malabsorption and intolerance, and complaints associated with dairy consumption in daily life, before and after RYGB. Method The lactose breath test (LBT) and lactose tolerance test (LTT) was performed in 84 patients awaiting RYGB surgery and 84 patients after surgery. Gastrointestinal symptoms at baseline and after testing were recorded. Lactose malabsorption was defined as a positive LBT and/or LTT. Lactose intolerance as a positive test combined with an increase of gastrointestinal complains. Dairy consumption in daily life and successive gastrointestinal complaints were registered via a questionnaire. Results of preoperative and postoperative patients were compared. Results Lactose malabsorption was present in 15 (17.9%) of the preoperative patients and in 25 (29.8%) of the postoperative patients (OR 2.46; 95%CI: 1.08–5.59; p = .03). Of the preoperative patients 6 (7.1%) patients met the criteria for lactose intolerance, compared to 8 (9.5%) patients in the postoperative group (OR 1.48; 95%CI 0.48–4.57; p = .50). Twelve (14.3%) preoperative patients indicated to have gastrointestinal complaints after dairy consumption in daily life versus 45 (53.6%) postoperative patients (p < .01). Conclusion This study shows no increase in patients with proven lactose intolerance after RYGB compared to preoperative patients. Gastrointestinal complaints after dairy consumption in daily life were far more frequently reported by RYGB patients. It is unlikely that all reported gastrointestinal complaints are actually caused by lactose. Other ingredients in dairy, like fat, are possibly contributory.

Postoperative Clinical-Endoscopic Follow-up for GERD and Gastritis After One Anastomosis Gastric Bypass for Morbid Obesity: How, When, and Why.

The one anastomosis gastric bypass (OAGB) is a widely diffused surgical procedure for morbid obesity. Several studies considered OAGB at risk for biliary reflux and anastomotic ulcers. The aim of the study was to evaluate gastro-esophageal reflux disease (GERD) and esophagitis/gastritis rate after OAGB diagnosed by upper endoscopy (UE), comparing the results with GERD-Health-Related Quality of Life (HRQL) score. From July 2014 to February 2019, patients underwent OAGB with at least 12-month follow-up were retrospectively evaluated. Clinical evaluation was associated with GERD-HRQL scoring. UE with a mucosal biopsy was also performed. A comparison among clinical scores and endoscopic findings was performed. Two hundred forty-one patients were analyzed in the study. Anthropometric features (BMI, %Excess weight loss, %Total weight loss) were significantly improved. Only 30% of patients with GERD-HQRL>30 showed esophagitis at UE: 11/181 (6.1%) showed grade A erosive esophagitis, 2/181 (1.1%) grade B esophagitis, whereas no patient resulted in grade C/D. Fifty-two patients (28.7%) showed endoscopic remnant gastritis of at least grade 1, with histological gastritis of at least mild grade in 70/181 patients (38.7%). OAGB is a feasible and effective procedure in terms of weight reduction and comorbidities control, but controversies remain about the long-term onset of GERD and bile reflux. The incidence of esophagitis was increased after OAGB. However, the severity and incidence were lower compared to sleeve gastrectomy. Conversely, the incidence of gastritis, ileo-gastric anastomotic inflammation, and HP positivity were not negligible, suggesting the potential benefits of endoscopic surveillance after OAGB.

Petersen's space hernia - An expanding diagnosis after bariatric surgery: A case report and review of literature

Petersen's hernia refers to an internal herniation of small bowel through the potential space between the transverse mesocolon and the Roux limb of gastrojejunal anastomosis. The incidence of this is increasing with the widespread practice of bariatric surgery in the last decade. In this report, we present the case of a 44-year-old male who had undergone a laparoscopic Roux-en-Y gastric bypass for morbid obesity and presented after 14 months with a history of nonspecific abdominal pain. The examination of his abdomen was unremarkable. The computed tomography scan revealed the suspicious features of internal herniation of the small bowel and a twist in the mesentery. On diagnostic laparoscopy, he was found to have Petersen's space hernia. His clinical presentation, investigations, and treatment have been highlighted in this case report with a review of the literature. Although rare, Petersen's hernia could lead to a disastrous complication of small bowel strangulation if not intervened early. Hence, if suspected, the threshold to perform a diagnostic laparoscopy should be low.

Petersen's hernia after gastric bypass for morbid obesity: a diagnostic challenge

Petersen's hernia after gastric bypass for morbid obesity: a diagnostic challenge

One Anastomosis Gastric Bypass Versus Roux-en-Y Gastric Bypass for Morbid Obesity: an Updated Meta-Analysis.

We aim to review the available literature on morbidly obese patients treated with one anastomosis gastric bypass (OAGB) or Roux-en-Y gastric bypass (RYGB) in order to compare the clinical outcomes of the two methods. A literature search was performed in PubMed, Cochrane Library, and Scopus, in accordance with the PRISMA guidelines. Sixteen studies were included in the qualitative analysis, and 11 studies were included in the quantitative analysis (meta-analysis), incorporating 12,445 patients. OAGB was associated with shorter mean operative time. The length of hospital stay was comparable between the two procedures. The incidence of leaks, marginal ulcer, dumping, bowel obstruction, revisions, and mortality was similar between the two approaches. The incidence of malnutrition was increased in patients treated with OAGB, while the incidence of internal hernia and bowel obstruction was greater in the RYGB group. In addition, the OAGB was associated with greater % excess weight loss (%EWL) at 1, 2, and 5years postoperatively. The rate of diabetes remission was greater in the OAGB group. Nonetheless, the rate of hypertension and dyslipidemia remission was similar between OAGB and RYGB. The present meta-analysis is the best currently available evidence on the topic and demonstrates the superiority of OAGB compared with RYGB, in terms of weight loss and diabetes remission. However, the OAGB was associated with a significantly higher incidence of malnutrition, thus indicating the significant malabsorptive traits of this operation.

Mo2033 – High Rates of Remission of Barrett's Esophagus Post Roux-Eny Gastric Bypass for Morbid Obesity: A Systematic Review and Meta-Analysis

Mo2033 – High Rates of Remission of Barrett's Esophagus Post Roux-Eny Gastric Bypass for Morbid Obesity: A Systematic Review and Meta-Analysis

Long-term outcomes of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass for morbid obesity: Results from a meta-analysis of randomized controlled trials

BackgroundLaparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass (LRYGB) are 2 widely used procedures performed in bariatric surgery. However, their long-term weight loss effects have not been well compared. ObjectivesTo evaluate the long-term outcome of 2 procedures for treating morbid obesity. SettingThe gastrointestinal surgery center, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital. MethodsThree electronic databases, PubMed, CNKI, and EMBASE, were searched ending in September 2018. Eligible studies were prospective randomized controlled trials. ResultsOf 15 randomized controlled trials studies, 1381 cases were included, 697 were randomly divided into the laparoscopic sleeve gastrectomy group and 684 to the LRYGB group. A statistically significant percent excess weight loss reduction in weighted mean difference was observed in LRYGB group at 5 years (weighted mean difference = −8.9, 95% confidence interval [CI] = −13.08 to −4.73, P < .0001), and at 3 years (weighted mean difference = −11.96, 95% CI = −17.62 to −6.30, P < .0001). However, there was not any statistically difference between the 2 procedures in <3 years. The total complication of the LSC group were less than that of the LRYGB groups (odds ratio = .52, 95%CI = .35–.76, P = .0007). This meta-analysis showed that the LRYGB procedure could reduce gastrointestinal reflux disease (odds ratio = .26, 95%CI = .11–.61, P = .002); however, no statistically significant differences were found in type 2 diabetes, hypertension, dyslipidemia, and sleep apnea. ConclusionsThis meta-analysis showed that significantly greater in percent excess weight loss after 5 years of LRYGB treatment; however, it seems to have a higher incidence of total complications.

Laparoscopic gastric bypass for morbid obesity in a patient with situs inversus totalis

Situs inversus totalis (SIT) is a rare congenital disorder that is characterized by a complete reversal of abdominal and thoracic organs. Laparoscopic gastric surgery may pose a challenge in patients with the condition due to mirror-image anatomy. Further studies are required to assess the impact of surgery on those afflicted with this disorder. We report a case of 22-year-old female with SIT who successfully underwent laparoscopic Roux-en-Y gastric bypass. Laparoscopic surgery is feasible in patients with SIT once anatomical considerations are taken into account.

Recurrent Gastric Bezoar after Roux-en-Y Gastric Bypass for Morbid Obesity

In this paper, we described the first case of recurrent gastric bezoar after bariatric surgery. A 66-year-old patient, who had diabetes mellitus (DM) and hypertension (HT) and had LRYGB operation 3 years ago, underwent the first endoscopic bezoar evacuation 26 months after the operation due to the diagnosis of gastric bezoar following the examination due to the nausea-vomiting and inability to eat. The patient applied again 36 months after LRYGB with similar complaints. A 3-cm gastric bezoar, which was detected with the endoscopic examination at the anastomosis site, was evacuated after disintegration. The possibility of a bezoar formation should be kept in mind in patients with Roux-en-Y gastric bypass, who complain of nausea and vomiting. The removal of the bezoar leads to a dramatic improvement in the complications. These patients should follow strictly their diets, chew their food thoroughly, take vitamin supplements, and solve their psychological problems in the postoperative period. Otherwise, gastric bezoar may recur.

A315 - Chylous Ascites Associated With Internal Hernia Following Roux-en-y Gastric Bypass for Morbid Obesity

A315 - Chylous Ascites Associated With Internal Hernia Following Roux-en-y Gastric Bypass for Morbid Obesity

A274 - Factors related to morbidity after laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass for morbid obesity at the tertiary hospital

A274 - Factors related to morbidity after laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass for morbid obesity at the tertiary hospital