Outcomes Of Laparoscopic Roux-en-Y Gastric Bypass Research Articles

Mid-Term Remission of Type 2 Diabetes Mellitus After Laparoscopic Roux En-Y Gastric Bypass.

Laparoscopic Roux en-Y gastric bypass (LRYGB) is an established therapeutic modality for type 2 diabetes mellitus (T2DM). However, there is paucity of data on the outcomes of LRYGB on T2DM beyond 2years. This study aimed to examine the medium-term effects of LRYGB on T2DM and determine the predictors of T2DM resolution. Prospective data were collected for all consecutive LRYGB performed from September 2009 to November 2010. The American Diabetes Association guidelines were used to define complete (CR) or partial (PR) remission of diabetes. Diabetes status was considered improved when there was >50% reduction in the dose of medications or when glycaemic control was achieved after stopping insulin. The effects of baseline characteristics, diabetes data and weight loss data at 4 years on T2DM remission were studied. Forty-six patients with T2DM underwent LRYGB with mean±SD age and body mass index (BMI) of 48.6±9.6 years and 50.4±6.5kg/m2, respectively. Median (IQR, interquartile range) duration of T2DM preoperatively was 60 (36-126) months. Median (IQR) follow-up was 52 (50-57) months. T2DM remission was achieved in 64% of patients (44% CR, 20% PR), and a further 28% of patients had improvement in their diabetes status. Multivariate analyses demonstrated significant excess weight loss (EWL) [P=0.008] and lower BMI [P=0.04] at 4 years to be the only independent predictors of T2DM medium-term outcomes. The medium-term effects of LRYGB on T2DM remission/improvement were maintained in 92% of patients. EWL and lower BMI at 4years were independent predictors of T2DM remission.

The Impact of Preoperative Weight Loss Before Laparoscopic Gastric Bypass

The impact of preoperative weight loss on outcomes following laparoscopic Roux-en-Y gastric bypass (LRYGB) is a controversial issue. We evaluated our outcomes of LRYGB in patients who lost different amount of weight prior to surgery. Patients who underwent primary LRYGB were divided in three groups on the basis of preoperative weight loss percentage. Group A comprised 166 patients, who lost <5% of their weight preoperatively; group B comprised 239 patients who lost >5 to 10% and group C included 143 patients who lost >10%. Intra- and postoperative complications at 30 days, hospital stay, and outcomes were evaluated. Significant difference was found in operative (mean ± SD) time [104.43 ± 36.40 min in group A, 80.08 ± 23.07 min in group B, and 76.99 ± 23.23 min in group C; p < 0.001 in group A versus group B or group C; p = 0.210 in group B versus group C]. Difference in hospital stay was significant (3.33 ± 3.22 days in group A, 2.10 ± 2.77 in group B, and 1.87 ± 1.44 in group C; p < 0.001 in group A versus groups B or C). Overall postoperative morbidity rate was 33.13% in group A, 19.25% in group B, and 11.89% in group C, with significant difference in group A versus groups B or C (p = 0.002 and p < 0.001). Mean excess weight loss was significantly higher (72.7%) in group C versus group A (63.1%) (p = 0.015) at 12 months. Weight loss >5% prior to LRYGB may reduce morbidity, and preoperative weight loss >10% may improve weight loss outcomes at 1-year follow-up.

Laparoscopic Roux‐En‐Y Gastric Bypass is Effective and Safe in Over 55‐year‐old Patients: A Comparative Analysis

Controversy exists regarding the effectiveness and safety of laparoscopic Roux-en-Y gastric bypass (LRYGB) in elderly patients. We evaluated our outcomes of LRYGB in patients aged ≥ 55 years. A total of 549 consecutive patients underwent LRYGB as primary operation and 132 were ≥ 55 years old. Patients were divided in two groups: group <55 years comprised 417 patients, with mean age (± SD) of 41.15 ± 8.47 years; group ≥ 55 years comprised 132 patients, with mean age of 59.43 ± 3.81 years. Mean preoperative body mass index was 47.01 ± 7.47 and 46.21 ± 7.47 respectively, whereas mean excess weight loss percent (EW%) was 88.06 ± 30.28 and 84.86 ± 29.87 %. Early morbidity (30 days) and outcomes at 6, 12, and 24 months follow-up were evaluated. Significant difference was found in operative time (84.19 ± 29.05 vs. 90.89 ± 30.95 min, p = 0.03). One conversion to open procedure occurred in group <55 years, whereas three occurred in group ≥ 55 years (p = 0.04). Intraoperative complications occurred in 22 patients (5.27 %) in group <55 years versus 19 in group ≥ 55 years (14.39 %), which was statistically significant (p = 0.001). One case of death occurred in the younger group. Overall postoperative morbidity rate was 18.7 % in group <55 years and 25.76 % in group ≥ 55 years, with no significant difference (p = 0.08). Mean EWL% at 12 months in group <55 years was 65.95.05 ± 26.96 versus 62.61 ± 41.78 in group ≥ 55 years, whereas at 24 months it was 65.08 ± 29.68 versus 64.48 ± 18.44 with no significant difference between the groups (p = 0.51; p = 0.92). LRYGB for patients ≥ 55 years achieves outcomes and complications rates comparable to the younger population. Patients should not be denied bariatric surgery for the age alone.

Metabolic and Hormonal Changes After Laparoscopic Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: a Randomized, Prospective Trial

BackgroundThe mechanisms of amelioration of glycemic control early after laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) are not fully understood.MethodsIn this prospective, randomized 1-year trial, outcomes of LRYGB and LSG patients were compared, focusing on possibly responsible mechanisms. Twelve patients were randomized to LRYGB and 11 to LSG. These non-diabetic patients were investigated before and 1 week, 3 months, and 12 months after surgery. A standard test meal was given after an overnight fast, and blood samples were collected before, during, and after food intake for hormone profiles (cholecystokinin (CCK), ghrelin, glucagon-like peptide 1 (GLP-1), peptide YY (PYY)).ResultsIn both groups, body weight and BMI decreased markedly and comparably leading to an identical improvement of abnormal glycemic control (HOMA index). Post-surgery, patients had markedly increased postprandial plasma GLP-1 and PYY levels (p < 0.05) with ensuing improvement in glucose homeostasis. At 12 months, LRYGB ghrelin levels approached preoperative values. The postprandial, physiologic fluctuation returned, however, while LSG ghrelin levels were still markedly attenuated. One year postoperatively, CCK concentrations after test meals increased less in the LRYGB group than they did in the LSG group, with the latter showing significantly higher maximal CCK concentrations (p < 0.012 vs. LRYGB).ConclusionsBypassing the foregut is not the only mechanism responsible for improved glucose homeostasis. The balance between foregut (ghrelin, CCK) and hindgut (GLP-1, PYY) hormones is a key to understanding the underlying mechanisms.