Gastric Bypass Research Articles

Distinctive enhancement of cholesterol metabolism following Roux-en-Y gastric bypass in a subset of women with obesity and type 2 diabetes mellitus

Distinctive enhancement of cholesterol metabolism following Roux-en-Y gastric bypass in a subset of women with obesity and type 2 diabetes mellitus

S2096 Influence of Insulin Dosage on Type 2 Diabetes Remission After Metabolic and Bariatric Surgery: A Comparative Analysis of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy

S2096 Influence of Insulin Dosage on Type 2 Diabetes Remission After Metabolic and Bariatric Surgery: A Comparative Analysis of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy

Gut microbiota species post-Roux-en-Y gastric bypass might correlated with dietetic and clinical characteristics

Gut microbiota species post-Roux-en-Y gastric bypass might correlated with dietetic and clinical characteristics

Weight loss and health status 10 years after laparoscopic adjustable gastric band insertion in adolescents: a follow-up report from Teen-LABS

BackgroundMetabolic and bariatric surgery is a safe and effective treatment strategy for severe childhood obesity, affecting 10% of US adolescents. ObjectivesThis prospective observational study addresses knowledge gaps related to changes in weight, cardiometabolic risk, and weight-related quality of life (WRQOL) in adolescents 10 years after laparoscopic adjustable gastric band (LAGB) insertion. SettingFive Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) US centers. MethodsAnthropometric, micronutrient, cardiometabolic risk, and WRQOL data were collected on 274 adolescents undergoing metabolic and bariatric surgery, of which 14 participants underwent LAGB insertion (2008–2011). Descriptive analyses compared outcomes from baseline to 10 years. ResultsParticipants were mostly female (86%), White (71%), with a median age of 18.5 years and preoperative median BMI of 49. Baseline prevalence of type 2 diabetes, hypertension, and dyslipidemia were 1 of 14 (7%), 8 of 14 (57%), and 8 of 13 (62%), respectively, versus 10-year prevalence of 1 of 8 (13%), 4 of 10 (40%), and 3 of 9 (33%), respectively. Two participants underwent LAGB removal (years 2 and 3), whereas two converted from LAGB to Roux-en-Y gastric bypass (years 2 and 6). Following initial BMI reduction (−10%) at year 1, 10-year median BMI in the LAGB retention group was 51, representing a 9.2% increase versus baseline. Micronutrient abnormalities and WRQOL remained similar between baseline and 10 years. One participant (1 of 14) withdrew from the study at year 7. ConclusionsLong-term follow-up of this cohort reveals that LAGB had minimal impact on BMI, cardiometabolic risk factors, and WRQOL among adolescents. These results confirm the limited efficacy of LAGB in the pediatric population.

National trends in using revisional surgeries post-sleeve gastrectomy due to reflux and weight recurrence: a matched case-control analysis

BackgroundSeveral options exist for surgical conversion after sleeve gastrectomy (SG), but a definitive safety profile for each option by indication for conversion remains unclear. ObjectivesTo determine and compare 30-day risk profiles of SG conversion to Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD-DS), and single-anastomosis duodenoileostomy (SADI). MethodsMetabolic and Bariatric Surgery Accreditation and Quality Improvement Program national database entries from 2020 to 2022 were used to identify 25,760 adult patients who underwent SG conversion to RYGB, BPD-DS, or SADI. Subgroup analyses were performed among 6106 conversions completed for weight-related complications (RYGB: 3053 patients; BPD-DS: 1826 patients; SADI: 1227 patients). Multivariable analysis and 1:1 nearest-neighbor matching were used to further characterize the 30-day risk profile of each conversion. ResultsPatients with RYGB conversions had a lower preoperative body mass index compared with those with BPD-DS + SADI conversions (39.8 versus 46.1, P < .001) and significantly lower rates of medical comorbidities. The distribution of conversion indication for each MBS configuration varied, where most RYGB conversions were for reflux (56.1%) whereas most BPD-DS + SADI conversions were for weight-related complications (87.3%; P < .001). On 1:1 matched analysis of conversions for weight recurrence, odds of 30-day complications (odds ratio .73, P = .019) and readmission (odds ratio .77, P = .031) were lower in BPD-DS + SADI conversions compared with RYGB. There were no significant differences in odds of 30-day reintervention or reoperation between conversion to RYGB and BPD-DS + SADI. Major differing drivers of complications between conversion types included hemorrhage (RYGB 1.98% versus BPD-DS + SADI .87%; P = .001). ConclusionsFor weight recurrence after SG, conversion to BPD-DS + SADI does not have greater 30-day complications than RYGB and may be a safe conversion option.

Challenges With Robot-Assisted Surgery Setup for Complex Minimally Invasive Upper Gastrointestinal Surgery.

The utilization of robot-assisted approaches to surgery has increased significantly over the last two decades. This has introduced novel complexities into the operating room environment, requiring management of new challenges and workflow adaptation. This study aimed to analyze challenges in the surgical setup for complex upper gastrointestinal robot-assisted surgery (UGI-RAS) and identify opportunities for solutions. Direct observations of surgical setup processes for UGI-RAS were performed by a trained Human Factors researcher at a non-profit academic medical center in Southern California. Setup tasks were subdivided into five phases: (1) before wheels-in; (2) patient transfer and anesthesia induction; (3) patient preparation; (4) surgery preparation; and (5) robot docking. Start/end times for each phase/task were documented along with workflow disruption (FD) narratives and timestamps. Setup tasks and FDs were analyzed using descriptive statistics. Twenty UGI-RAS setup procedures were observed between May-November 2023: sleeve gastrectomy +/- hiatal hernia repair (n = 9, 45.00%); para-esophageal hernia repair +/- fundoplication (n = 8, 40.00%); revision to Roux-en-Y gastric bypass (n = 2, 10.00%); and gastric band removal (n = 1, 5.00%). Frequent FDs included planning breakdowns (n = 20, 29.85%), equipment/supply management (n = 17, 25.37%), patient care coordination (n = 8, 11.94%), and equipment challenges (n = 8, 11.94%). Eleven of 20 observations were first-start cases, of which 10 experienced delayed starts. Interventions aimed at improving workflows during UGI-RAS setup include performing pre-operative team huddles and conducting trainings aimed at team coordination and equipment challenges. These solutions could result in improved teamwork, efficiency, and communication while reducing case start delays and turnover time.

S1618 Efficacy of Endoscopic Transoral Outlet Reduction (TORe) on Weight Loss Outcomes in Diabetic vs Non-Diabetic Patients Following Roux-en-Y Gastric Bypass

S1618 Efficacy of Endoscopic Transoral Outlet Reduction (TORe) on Weight Loss Outcomes in Diabetic vs Non-Diabetic Patients Following Roux-en-Y Gastric Bypass

S4085 Endoscopic Ultrasound-Directed Transgastric ERCP (EDGE) in a Patient With a Prior Gastric Sleeve Converted to Roux-en-Y Gastric Bypass

S4085 Endoscopic Ultrasound-Directed Transgastric ERCP (EDGE) in a Patient With a Prior Gastric Sleeve Converted to Roux-en-Y Gastric Bypass

A high adherence level to nutritional recommendations minimizes protein and minerals loss while maximizes visceral fat loss in bariatric surgery patients

BackgroundMetabolic bariatric surgeries are considered the finest and most appropriate treatment option for patients with severe obesity. Besides the surgical procedure, many factors appear to be associated with improved postoperative outcomes such as compliance to the postoperative diet and supplementation, regular physical activity, medical and nutritional follow-up, and modifications in dietary habits. The objectives of this study were to investigate the effect of adherence to post-operative recommendations on anthropometric measurements and body composition and assess the percentage of total weight loss (%TWL) and excess weight loss (%EWL) 3 months post-operative. Material and MethodsFifty-two participants who underwent a Roux-en-Y gastric bypass or sleeve gastrectomy were included. Participants have filled out a pre-operative questionnaire. Anthropometric measurements were obtained pre-operative and 3 months post-operative using a Body Impedance Analyzer (Inbody 270). The adherence to post-operative recommendations was assessed by the Bariatric Surgery Self-management Questionnaire 3 months post-operative and classified to three adherence levels. ResultsMost anthropometric measurements decreased 3 months post-operative in the three adherence groups (p≤0.05). No significant differences were observed between groups in anthropometric measurements and body composition, except for minerals and visceral fat levels. The mineral loss has decreased in both the high and intermediate adherence groups (-0.09 ± 0.22 kg, and -0.09 ± 0.18 kg, respectively). Also, the high adherence group showed less loss in protein amount post-operatively (p=0.06). Visceral fat level decreased in the high adherence group (p≤ 0.05). ConclusionAdherence to post-operative behavioral and nutritional recommendations was associated with less protein and mineral loss and enhanced visceral fat reduction post-operatively.

Changes in C-reactive protein are associated with improvements in fasting blood glucose 12 months after gastric bypass

Changes in C-reactive protein are associated with improvements in fasting blood glucose 12 months after gastric bypass

Subjective Improvement of Reflux Symptoms After Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass and Concomitant Repair of Hiatal Hernia

BackgroundSymptoms of reflux after SG are common and may be refractory to medical treatment. ObjectivesTo assess outcomes of conversion of SG to RYGB with concomitant repair of hiatal hernias on symptoms of reflux. SettingTertiary Community Hospital MethodsWe reviewed data from all consecutive patients (2018-21) who underwent conversion from SG to RYGB for refractory reflux symptoms. Concomitant hiatal hernias were diagnosed endoscopically or radiographically. Improvement in reflux symptoms, nausea, vomiting, dysphagia, or abdominal pain and post-op PPI use were compared with McNemar statistical test. Data are mean± standard deviation. Results64 patients (92% female; 48±10 years) underwent conversion from SG to RYGB and repair of concomitant hiatal hernias 4±3 years after the index SG. A hiatal hernia was detected preoperatively in 57/64 patients (89%) by either UGI, CT scan or EGD.At 29±14 months post-conversion to RYGB, TBWL was 14±9%, EWL was 37±29%, BMI decreased from 37±7 to 32±6 Kg/m2. Symptoms of reflux and use of PPI improved during the early follow up period (median: 14 months; p<0.001) and was sustained at late follow up (median: 32 months; p<0.01). Improvement of nausea and dysphagia reached statistical significance at late follow up (median: 32 months; p<0.01). Vomiting and abdominal pain decreased with time but did not reach statistical significance.Post-op complications were deep surgical site infection (n=3), pulmonary embolism (n=1), bleeding (n=5), reoperation (n=3), and 30-day readmission (n=6). ConclusionsConversion of SG to RYGB and repair of concomitant hiatal hernia improves reflux symptoms, nausea, and dysphagia, reduces PPI use, and confers additional weight loss.

Venous Thromboembolic Events Following Revisional Gastric Bypass: An Analysis of the MBSAQIP Database from 2015 to 2019 Using Propensity Matching.

Primary bariatric surgery is associated with moderate-to-high risk of venous thromboembolic events (VTE); however, the risk for revisional surgery lacks granularity. Our primary objective was to define the risk of VTE following revisional Roux-en-Y gastric bypass (RYGB) compared to primary RYGB. Adults who underwent primary or revision/conversion RYGB between January 1, 2015, and December 31, 2019, with a BMI ≥ 35kg/m2 were identified in a bariatric specific database. VTE was defined as pulmonary embolus and/or deep venous thrombosis. Thirty-day VTE and transfusion rates were compared between the two groups using propensity score matching of 3:1. Primary RYGB was performed in 197,186 (92.4%) patients compared to 16,144 (7.6%) in the revisional group. Patients in the revisional group had fewer comorbidities than those undergoing primary RYGB. In the matched cohort of 64,258 procedures, there were 48,116 (74.9%) primary RYGB cases compared to 16,142 (25.1%) RYGB revisions. The rate of VTE was similar in the revisional surgery group compared to the propensity matched primary RYGB group (0.4% vs. 0.3%, p > 0.580); however, transfusion was more common in the revisional group (1.4% vs. 1.0%, p = 0.005). Revisional group had higher rates of readmission, reoperation, increased length of stay, and operation length ≥ 180min compared to matched primary RYGB group (p < 0.001). VTE rates for both primary and revisional RYGB are similar. Revisional RYGB cases impose increased risk of bleeding among other outcomes. Thus, identifying those at higher risk of complications is critical.

S1598 Efficacy of Transoral Outlet Reduction for Weight Regain Following Roux-en Y Gastric Bypass: A Comparison of Pre and Post COVID-19 Pandemic

S1598 Efficacy of Transoral Outlet Reduction for Weight Regain Following Roux-en Y Gastric Bypass: A Comparison of Pre and Post COVID-19 Pandemic

S191 Characteristics and Predictors of Adverse Post ERCP Outcomes in Patients With Roux-en-Y Gastric Bypass (RYGB) Surgery

S191 Characteristics and Predictors of Adverse Post ERCP Outcomes in Patients With Roux-en-Y Gastric Bypass (RYGB) Surgery

12211 Roux-en-y Gastric Bypass And Vertical Sleeve Gastrectomy Showed Similar Efficacy In Achieving Cardiometabolic Composite Target In Subject With Type 2 Diabetes Undergoing Bariatric Surgery

12211 Roux-en-y Gastric Bypass And Vertical Sleeve Gastrectomy Showed Similar Efficacy In Achieving Cardiometabolic Composite Target In Subject With Type 2 Diabetes Undergoing Bariatric Surgery

Comparative study between sleeve gastrectomy and gastric bypass regarding postoperative hyperparathyroidism

Comparative study between sleeve gastrectomy and gastric bypass regarding postoperative hyperparathyroidism

Assessment and medical management of weight regain after adolescent metabolic and bariatric surgery: a narrative review

BackgroundMetabolic and bariatric surgery (MBS) in adolescents results in durable treatment of severe obesity and related complications for most. However, substantial weight regain can undermine long-term health benefits. There is no evidence-based standard of care for the medical management of weight regain after MBS in pediatrics or adults. ObjectivesThis narrative review summarizes current pediatric evidence pertaining to the assessment and medical management of post-MBS weight regain, identify gaps, and offer recommendations. MethodsA PubMed search was conducted through March 2024 and focused on adolescents after sleeve gastrectomy or Roux-en-Y gastric bypass. Domains included nutrition, activity, mental health, anti-obesity medications (AOMs), type 2 diabetes, hypothalamic obesity, and transition of care. In total, 600 articles were screened and 61 were included in this review. ResultsRecent consensus definitions for post-MBS weight regain have been established for adults, but have not been validated in pediatrics. Limited, high-quality evidence was identified in the nutrition domain, where targets that may mitigate weight regain include adequate protein intake (>=60g/day), absence of loss of control eating, and micronutrient sufficiency. Emerging data for post-MBS AOMs in adults with/without diabetes and in adolescents with persistent obesity is promising. Large gaps include post-MBS interventions focused on physical activity and mental health. ConclusionsThe overall quality of pediatric-specific evidence for the assessment and medical management of post-MBS weight regain is low. A standard definition of weight regain associated with health outcomes in pediatrics would be valuable. Clarifying risk and protective factors for weight regain can guide more precise risk stratification and treatment.

S4862 Multifaceted Diagnostic Approach for Unexplained Anemia in a Post Liver Transplant Patient With Metastatic Adenocarcinoma and Roux-en-Y Gastric Bypass

S4862 Multifaceted Diagnostic Approach for Unexplained Anemia in a Post Liver Transplant Patient With Metastatic Adenocarcinoma and Roux-en-Y Gastric Bypass

S5111 Menetrier Disease Following Gastric Bypass: A Case Report and Literature Review

S5111 Menetrier Disease Following Gastric Bypass: A Case Report and Literature Review

S2075 Assessing PPI Administration Strategies to Minimize Marginal Ulceration Complications Following Roux-en-Y Gastric Bypass

S2075 Assessing PPI Administration Strategies to Minimize Marginal Ulceration Complications Following Roux-en-Y Gastric Bypass