post-RYGB Patients Research Articles

Influence of Activity Levels and Energy Intake on Percent Excess Weight Loss After Roux-en-Y Gastric Bypass

Gastric bypass is a successful medical intervention for weight loss for obesity. Weight loss is substantial after this surgery. Predictors of the most successful weight loss are not yet fully known. The purpose of this study was to define variables that improve percent excess weight loss (%EWL) in this post-surgical population. All patients who underwent the Roux-en-Y gastric bypass (RYGB) during the 5years preceding the study in one surgical practice (n = 805; respondents = 265; 33%) received the Arizona Activity Frequency Questionnaire and the Arizona Food Frequency Questionnaire. Analysis through ANOVA testing to determine relationships between selected behaviors and %EWL was performed. Comparisons of differences in mean %EWL were analyzed using the variables of energy consumption/day (energy consumption), hours of activity/day (hours in activity), and energy expended in activity/day (energy expended). Patients with more energy expended, and hours in activity demonstrated significantly better %EWL (p = 0.05) when compared to those with less energy expended or hours in activity. Reported energy consumption did not significantly influence %EWL in this study. This research suggests that in this sample of post-RYGB patients, energy expended in activity, as either energy expended or hours in activity improved their %EWL over those persons not expending as much energy in activity. Increasing the hours in activity improved the maintenance of %EWL in these respondents. Energy consumption did not have a statistically significant effect on %EWL or maintenance of %EWL in these subjects.

Effects of CPAP on Gastric Pouch Pressure After Bariatric Surgery

The purpose of this study was to determine if the routine use of postoperative continuous positive airway pressure (CPAP) in patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) is associated with an increase in transmural gastric pouch pressure, which may create the risk for anastomotic leak. Transmural gastric pressures (difference between gastric pouch and bladder pressures) were measured postoperatively [post-anesthesia recovery care unit (PACU) arrival (prior to initiation of CPAP), 5min, 30min, and PACU discharge] in 28 patients (19 patients used CPAP, 9 patients did not) following laparoscopic RYGB. Changes in pressure over time were assessed using a generalized estimating equation, taking into account the repeated measurements obtained for each subject. In all cases, two-tailed P values ≤0.05 were considered statistically significant. Among patients that used CPAP, there were no changes in transmural pouch pressure from baseline at any point in time (P = 0.628). However, in patients that did not use CPAP, there was a trend towards increased transmural gastric/pouch pressure (P = 0.053), which could be attributed to a transient decrease in bladder pressure at the 5-min measurement interval. Application of CPAP did not increase transmural gastric pouch pressure in our bariatric patients; therefore, its use in the post-RYGB patients does not pose a risk for pouch distension, which could lead to the disruption of anastomotic integrity.

Impaired Alcohol Metabolism after Gastric Bypass Surgery: A Case-Crossover Trial

Severe obesity remains the leading public health crisis of the industrialized world, with bariatric surgery the only effective and enduring treatment. Poor psychological adjustment has been occasionally reported postoperatively. In addition, evidence suggests that patients can metabolize alcohol differently after gastric bypass. Preoperatively and at 3 and 6 months postoperatively, 19 Roux-en-Y gastric bypass (RYGB) patients' breath alcohol content (BAC) was measured every 5 minutes after drinking 5 oz red wine to determine peak BAC and time until sober in a case-crossover design preoperatively and at 6 months postoperatively. Patients reported symptoms experienced when intoxicated and answered a questionnaire of drinking habits. The peak BAC in patients after RYGB was considerably higher at 3 months (0.059%) and 6 months (0.088%) postoperatively than matched preoperative levels (0.024%). Patients also took considerably more time to return to sober at 3 months (61 minutes) and 6 months (88 minutes) than preoperatively (49 minutes). Postoperative intoxication was associated with lower levels of diaphoresis, flushing, and hyperactivity and higher levels of dizziness, warmth, and double vision. Postoperative patients reported drinking considerably less alcohol, fewer preferred beer, and more preferred wine than before surgery. This is the first study to match preoperative and postoperative alcohol metabolism in gastric bypass patients. Post-RYGB patients have much higher peak BAC after ingesting alcohol and require more time to become sober. Patients who drink alcohol after gastric bypass surgery should exercise caution.

Endoscopic foreign body removal for treatment of chronic abdominal pain in patients after Roux-en- Y gastric bypass

Background Common endoscopic findings in patients who have undergone Roux-en- Y gastric bypass (RYGB) with chronic abdominal pain have included marginal ulceration, gastrogastric fistula, and jejunal erosion. However, suture or staples eroding into the gastric pouch can also contribute to abdominal pain. Redundant suture is typically regarded as a normal part of the postoperative anatomy. The objectives of the present study were to assess the effects of endoscopic foreign body removal of partially exposed sutures and staples in post-RYGB patients with chronic abdominal pain at a university hospital in the United States. Methods We performed a retrospective study of consecutive patients from January 2006 to July 2007. Post-RYGB patients with chronic abdominal pain underwent endoscopic foreign body removal of exposed sutures/staples. Pain scores were obtained before the procedure, immediately after the procedure, and at the telephone follow-up (median 7.2 months). Results Of 21 patients, 15 (71%) reported immediate symptomatic improvement. Specific endoscopic accessories were found to be more useful than others in managing the various foreign materials. Of the 21 patients, 15 (71%) were available for telephone follow-up. Of these 15 patients, 13 (87%) reported continued symptomatic improvement, with 9 (60%) reporting complete pain resolution and 4 (27%) reporting partial improvement. Eroded foreign material was seen in association with marginal ulcers in 3 patients (14%), gastritis in 7 patients (33%), and an inflammatory polyp in 1 patient (5%). Conclusions Eroded suture and staples can cause chronic abdominal pain in post-RYGB patients. In symptomatic patients, visible suture or staples should be considered a potential etiology of chronic pain, instead of normal postoperative findings. Endoscopic foreign body removal might be of therapeutic benefit in these patients.