Roux-en-Y Gastric Bypass Research Articles

Is glucose‐induced hypersecretion of glicentin after the revision surgery using Roux‐en‐Y gastric bypass related to improved glycemic control due to insulin hypersecretion in a type 2 diabetes patient without diabetes remission after laparoscopic sleeve gastrectomy?

ABSTRACTWe report case details of a morbidly obese patient with type 2 diabetes mellitus (T2DM) who became a failure of diabetes remission after laparoscopic sleeve gastrectomy (LSG). He had a marked improvement of hyperglycemia after the revision surgery using Roux‐en‐Y gastric bypass (RYGB), where passage failure of a solid food intake at the gastric angle portion disappeared after the revision surgery. Interestingly, he showed improvements of insulin and a marked glicentin secretions with minor changes in glucagon related peptide 1 (GLP‐1) and glucose‐dependent insulinotropic polypeptide (GIP) secretions in the oral glucose tolerance test OGTT after the RYGB surgery compared with post‐LSG. Although a marked increase in glucose‐induced glicentin secretion after RYGB surgery with increased insulin secretion, further studies are needed to confirm if the increased glicentin secretion after RYGB surgery is linked to stimulation of insulin secretion.

Increased COX6A2 promotes pancreatic β-cell apoptosis and is suppressed in diabetic GK rats after Roux-en-Y gastric bypass.

Roux-en-Y gastric bypass (RYGB) has been shown to inhibit β-cell apoptosis, but the underlying mechanisms are not yet fully understood. Cytochrome c oxidase subunit 6A2 (COX6A2) is expressed in β-cells. Here, we sought to investigate the role of COX6A2 in β-cell apoptosis, especially following RYGB. We found that RYGB significantly reduced β-cell apoptosis, accompanied by decreased COX6A2 expression in islets from diabetic Goto-Kakizaki (GK) rats. It is noteworthy that overexpression of COX6A2 promoted β-cell apoptosis, whereas COX6A2 deficiency suppressed it, suggesting the pro-apoptotic role of COX6A2 in β-cells. Mechanistically, increased COX6A2 interacted with and upregulated the expression of cyclophilin D (CypD), facilitating the release of cytochrome c from mitochondria to the cytoplasm, thereby promoting β-cell apoptosis. Furthermore, high-glucose-activated ChREBP epigenetically regulated COX6A2 expression by recruiting histone acetyltransferase p300 to augment histone H3 acetylation at the Cox6a2 promoter, a process inhibited by GLP-1 signaling. Given that RYGB enhances GLP-1 signaling, RYGB is likely to deactivate ChREBP by boosting GLP-1/PKA signaling, thereby reducing COX6A2 expression in islets from GK rats. These findings highlight the crucial role of the GLP-1/PKA/ChREBP axis-controlled COX6A2 in β-cell apoptosis, revealing a previously unrecognized mechanism underlying the reduction in β-cell apoptosis induced by RYGB.

BS O01 - Comparison of Roux-en-Y Gastric Bypass(RYGBP) and Laparoscopic Sleeve Gastrectomy(LSG) in patients with obesity and diabetes mellitus: Meta-analysis and systemic review

Abstract Background Laparoscopic Sleeve gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB) are the two procedures used to treat patients with obesity and type 2 diabetes mellitus(T2DM). However, it is still unclear which of the two procedures is better for T2DM remission. This study aims to compare the effectiveness of LSG and RYGB considering important comparison outcomes including diabetes remission, and overall glycemic and metabolic control. Method We conducted a comprehensive search of Medline, PubMed, the Cochrane Library, Scopus, the Web of Science, Clinical Key, Ovid, and Wiley from their inceptions through August 2022 for randomized controlled trials (RCTs) comparing LSG with RYGB for patients with morbid obesity and T2DM. The data were extracted and pooled using Review Manager software (RevMan5.4). Results Eighteen RCTs including 1360 patients were found. After one year, two years, and five years, the RYGB group's BMI was significantly lower than the LSG group's as follows respectively (MD = -1.58, P < 0.0001), (MD = -1.64, P=0.03), and (MD = -2.26, P= 0.0004). Moreover, the LSG group had a higher incidence of diabetes remission than the RYGP group after five years. Although there was no significant difference in terms of safety outcomes between both groups, GERD was significantly higher in the LSG group, and dumping syndrome was significantly higher in the RYGB group. Conclusion RYGB is more effective in achieving weight loss and reducing BMI, while LSG shows better improvement in diabetes remission, notably for those with high BMI. Both surgeries have similar complication rates, but RYGB has a higher incidence of dumping syndrome and lower rates of GERD compared to LSG.

Increased Risk of Hypoglycemia Following Roux-en-Y Gastric Bypass Surgery in Patients Without Diabetes: a Propensity Score-Matched Analysis.

Roux-en-Y gastric bypass (RYGB) surgery is an effective treatment for obesity. However, the incidence and long-term risk of hypoglycemia after surgery in patients without diabetes remains unclear. This study aimed to investigate the prevalence of hypoglycemia following RYGB surgery in patients with obesity and without diabetes. A retrospective cohort study was conducted using the TriNetX database. The study population included 15,085 patients with obesity (BMI ≥ 30kg/m2) who underwent RYGB surgery and 3,200,074 non-surgical controls, all without a history of diabetes or GLP-1 receptor agonist use. Propensity score matching was performed to balance baseline characteristics. The primary outcome was the incidence of hypoglycemia, defined by ICD-10-CM codes or laboratory values (glucose ≤ 70mg/dL). Cox regression analysis was employed to calculate hazard ratios (HR) and 95% confidence intervals (CI). In the overall study population, the risk of hypoglycemia was significantly higher in the RYGB group (18.70%, n = 2,810) compared to the control group (3.80%, n = 120,923; HR 4.3, 95% CI 4.14-4.46, p < 0.001). After propensity score matching (n = 14,916 per group), RYGB patients maintained an elevated risk (18.70%, n = 2,795) compared to matched controls (5.0%, n = 749; HR 3.7, 95% CI 3.44-4.05, p < 0.001). Time-series analysis revealed consistently higher hypoglycemia risk in the RYGB group, with hazard ratios ranging from 5.37 (95% CI 4.09-7.03) at 1week to 3.75 (95% CI 3.45-4.06) at 10years post-surgery (all p < 0.001). Subgroup analysis of RYGB patients who developed hypoglycemia showed a 30-day hospitalization rate of 21.3% and a mortality rate of 0.71%. RYGB surgery is associated with a significantly increased risk of hypoglycemia in patients with obesity and without diabetes, both in the short-term and long-term follow-up. These findings underscore the importance of monitoring and managing hypoglycemia in patients undergoing RYGB surgery, even in the absence of preexisting diabetes.

A02 - BS Ethnic and Social Deprivation Influence Weight Regain Following Roux En-Y Gastric Bypass

Abstract Background Weight regain is a prevalent issue following Roux-En-Y Gastric Bypass (RYGB) surgery for obesity. This study aims to assess the impact of ethnicity and social deprivation on the likelihood of weight regain post-RYGB. Method We analysed data from Luton &amp; Dunstable Hospital. Key variables included patient demographics such as sex, age, ethnicity, social deprivation (Indices of Multiple Deprivation – IMD), American Society of Anesthesiologists (ASA) classification, and weight and Body Mass Index (BMI) at the time of surgery. Weight regain was defined as the regaining of more than 25% of the Total Body Weight Loss (TBWL) achieved after RYGB. Results Out of 1,346 patients who underwent RYGB, 80% were female. The median age was 48 years (IQR: 39-55), and the median BMI was 44.7 kg/m^2 (IQR: 40.6-50.1). At a median follow-up of 39 months, 20.7% experienced weight regain. Multivariable analysis showed that patients from Black (HR: 1.63, 95% CI: 1.33-1.81, p=0.009) and Asian (HR: 1.40, 95% CI: 1.23-1.71, p=0.011) ethnic groups, as well as those from more socially deprived backgrounds (HR: 2.39, 95% CI: 1.99 – 3.13, p&amp;lt;0.001), were more likely to experience weight regain compared to their White and more affluent counterparts. Conclusion Ethnicity and social deprivation significantly influence the likelihood of weight regain following RYGB. The factors contributing to these disparities are likely multifaceted, encompassing genetic, social, and educational elements. Early identification of patients at increased risk of weight regain and the provision of tailored resources can help mitigate this risk and enhance surgical outcomes.

BS SO10 - Predictive Factors in the Development of Dumping Syndrome After Bariatric Surgery

Abstract Background Dumping syndrome (DS) is a recognised complication of Roux En-Y Gastric Bypass (RYGB) and rarely Sleeve Gastrectomy (SG). The prevalence of DS is unclear, with current literature ranging from 10-50%. The condition is characterised by gastrointestinal and vasomotor symptoms resulting in a significant impact on quality of life. This study aimed to prospectively utilise Sigstad scoring to evaluate post-operative patients, investigating the timing of symptom onset and its correlation with pre-existing diabetes, revision surgery, and percentage of Total Body Weight Loss (TBWL). Method We used the Sigstad scoring questionnaire, administered by our bariatric Clinical Nurse Specialists (CNS) at outpatient clinics to assess patients for DS between January to May 2024. Data collected included patient demographics, surgery type and date, TBWL, Body Mass Index (BMI), and whether the patient had a diagnosis of Diabetes Mellitus type II (DMII). A diagnosis of DS was confirmed if a patients score ³7 points on the Sigstad questionnaire. We explored factors influencing the development of DS. Results In total, 64 patients were evaluated for DS of whom 86% were female and the median age was 44 years (IQR: 35-45). Most patients (67%) had undergone primary RYGB, 19% SG, 11% conversion from SG to RYGB and 70% were assessed within one year of surgery. DS symptoms emerged in 25% of patients, predominantly within the first-year post-operation (60%). The median TBWL was 12% (IQR: 9-22%), showing no correlation to DS onset. Patients with DMII exhibited a higher propensity for DS (66% vs 20%, p=0.029). Patients undergoing revisional surgery also had a higher incidence of DS (33% vs 6%, p=0.117). Conclusion A quarter of patients undergoing bariatric surgery will develop DS, most of whom within the first-year post-surgery. Revisional surgery and pre-existing DMII are the primary predictors in developing DS. There was no observed association between TBWL and DS onset. Further extensive studies are needed to confirm these observations.

BS SO20 - The impact of Ethnicity and Social Deprivation on Weight Loss following Roux-En-Y Gastric Bypass Surgery

Abstract Background Long-term weight loss and weight regain are markers of success following bariatric surgery. The aim of this study was to determine whether there are differences amongst various ethnic and social deprivation groups in terms of weight loss following Roux-En-Y Gastric Bypass (RYGB) at 24 months post-surgery. Method Data from a single high-volume UK Bariatric centre (Luton &amp; Dunstable Hospital) were analysed. Relevant variables such as patient demographics, weight and Body Mass Index (BMI) at surgery, were included. Failure to lose sufficient weight was defined as failure to lose ³20% TBWL at 24 months post-surgery. Results A total of 1,427 patients underwent RYGB during this time, of whom 80.2% were female. The median age was 48 years old (IQR: 39-55) and the median BMI was 44.7Kg/m2 (IQR: 40.6-50.1). At 24 months post-surgery, 39.3% of patients had failed to lose 20% TBWL. Multivariable analyses demonstrated that the most socially deprived patients were less likely to achieve a TBWL of ³20% at 24 months post-surgery (OR: 0.71 95% CI: 0.56-0.89, p=0.023) as were those from Black (OR: 0.69, 95% CI: 0.50-0.83, p=0.019) and Asian backgrounds (OR: 0.73, 95% CI: 0.61-0.88, p=0.013) compared to patients from a White background. Conclusion Ethnicity and social deprivation serve as key indicators of predicting weight loss at 24 months following bariatric surgery. These findings suggest the possible need for tailored care and treatment strategies to optimise long-term outcomes for diverse populations. Understanding these differences is crucial for developing personalized treatment plans and improving the efficacy of bariatric surgery across various ethnic groups. Future research should focus on identifying the underlying causes of these disparities and evaluating interventions to mitigate them.

Gastric Pouch Resizing for Recurrent Weight Gain After Roux-en-Y Gastric Bypass-Does It Have Its Rational?

The most effective treatment for obesity and associated comorbidities is metabolic-bariatric surgery (MBS). Nevertheless, recurrent weight gain is reported in up to 40% of patients after Roux-en-Y gastric bypass (RYGB), eventually with a recurrence of obesity-associated comorbidities. Gastric pouch resizing (GPR) is performed as a low-risk secondary surgery to cease weight regain. We herewith analyzed the effect of GPR after primary RYGB on long-term weight loss, course of comorbidities, safety, and patient satisfaction. Forty-eight patients undergoing GPR between 2016 and 2020 at the University Hospital of Zurich were included. Data were collected from a prospective database. GPR was performed laparoscopically and included a resection of the enlarged gastric pouch and a redo of the gastrojejunostomy. Additionally, 37 patients participated in a survey to evaluate PROMs (patient-reported outcome measures). GPR followed RYGB after a mean time of 106.2 ± 45.5months at a mean BMI of 39 ± 5.4kg/m2. Mean follow-up was 55.9 ± 18.5months with a mean BMI 1- and 5-years postoperative of 37 ± 5.5kg/m2 and 35 ± 7.5kg/m2, respectively. Obesity-associated comorbidities were resolved in 53% of patients at follow-up (p < 0.05). Minor postoperative complications occurred in 12.5% while major complications occurred in 10.4% of patients. The PROMs showed high levels of satisfaction after GPR. GPR for recurrent weight gain after primary RYGB is a safe procedure resulting in weight stabilization and resolution of obesity-associated comorbidities. It is thus a valuable surgical option in well-selected patients.

Comparative Effects of Sleeve Gastrectomy vs. Roux-en-Y Gastric Bypass on Phase Angle and Bioelectrical Impedance Analysis Measures: A Systematic Review and Meta-Analysis

Background/Objectives: The objective of this meta-analysis was to determine the impact of bariatric surgery on phase angle (PhA) and other bioimpedance measures among adults with obesity, comparing the effects of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines, including studies up to May 2024 from MEDLINE, Scopus, Cochrane Library, and Web of Science. Eligible studies assessed PhA changes pre- and post-bariatric surgery in adults with BMI ≥ 30 kg/m2. Data on PhA, fat mass (FM), fat-free mass (FFM), body cell mass (BCM), weight, and BMI were extracted and analyzed. Results: Thirteen studies with a total of 1124 patients were included. Significant PhA reductions were observed at 6 months post-surgery (effect size: −1.00; 95% CI: −1.11 to −0.89; p &lt; 0.001), with a more substantial reduction in RYGB patients compared to SG. FM and FFM decreased significantly at 12 months (FM: −27.58; 95% CI: −32.58 to −22.57; p &lt; 0.001; FFM: −10.51; 95% CI: −12.81 to −8.94; p &lt; 0.001). Weight and BMI showed marked reductions at 6 months (Weight: −31.42 kg; 95% CI: −37.28 to −25.26; p &lt; 0.001; BMI: −11.39; 95% CI: −12.60 to −10.18; p &lt; 0.001), with sustained decreases at 12 and 24 months. Conclusions: Bariatric surgery significantly reduces PhA, FM, FFM, weight, and BMI, with initial greater impacts observed in RYGB compared to SG. PhA shows potential as a marker for monitoring post-surgical recovery and nutritional status. Further long-term studies and standardized measurement protocols are recommended to optimize patient management.

Comparative study of midterm outcomes between Roux-en-Y gastric bypass (RYGB), diverted one-anastomosis gastric bypass (D-OAGB), and one anastomosis gastric bypass (OAGB)

PurposeDiverted one anastomosis gastric bypass (D-OAGB) is a new procedure that entails performing Roux-en-Y diversion during OAGB to preclude post-OAGB bile reflux. This study aimed to compare the mid-term outcomes of Roux-en-Y gastric bypass (RYGB) and OAGB versus D-OAGB.MethodsThis is a retrospective study that encompassed the analysis of data from patients undergoing bypass surgeries from 2015 to May 2021. The patients’ data until 2 years of follow-up were compared.ResultsThis study included 140 patients who underwent OAGB (n = 64), RYGB (n = 24), and D-OAGB (n = 52). In the OAGB, RYGB, and D-OAGB groups, complication rates were 3.1%, 8.3%, and 5.8%, respectively. At the 3-month and 6-month follow-ups, the OAGB and D-OAGB groups showed a statistically significant higher percentage of excess weight loss (EWL%). Otherwise, the weight measures and weight loss outcome were comparable among the three groups in the other follow-up visits (p > 0.05). There was a significantly lower number of gastroesophageal reflux disease (GERD) remission cases and a higher number of de novo GERD cases in the OAGB group.ConclusionD-OAGB demonstrated favorable outcomes, including lower early adverse events and superior weight loss results in the first 6 months post-surgery when compared to RYGB. The D-OAGB group also showed higher rates of GERD remission and lower de novo GERD occurrence than OAGB. Further research is warranted to validate these findings and expand our understanding of this innovative surgical approach.

Efficacy of One-Anastomosis Gastric Bypass Versus Roux-en-Y Gastric Bypass for Gastroesophageal Reflux Disease: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

This study aimed to investigate the efficacy of one-anastomosis gastric bypass (OAGB) on gastroesophageal reflux disease (GERD) compared with Roux-en-Y gastric bypass (RYGB) in patients with obesity. Three databases (Medline, Cochrane Central, and Scopus) were searched for relevant articles published until August 12, 2024. A total of nine randomized controlled trials, including 643 patients, were selected. OAGB was statistically significantly associated with a higher risk of GERD than RYGB (OR = 3.14, 95% CI 1.23-8.03, p < 0.05). The odds for de novo GERD after OAGB are almost six times higher than after RYGB (OR = 5.65, 95% CI 1.53-20.82, p < 0.05). RYGB has a lower incidence of de novo GERD cases and is more effective than OAGB in reducing GERD.

Long-Term Cancer Outcomes Following Bariatric Surgery: A Comparative Analysis of Surgical Procedures

Background/Objectives: Metabolic and bariatric surgery (MBS) is known to reduce cancer risk. However, the association between specific bariatric procedures and cancer incidence is not well-studied. This study examined the association between four different MBS procedures and cancer incidence. Methods: Bariatric surgery registry data were linked with statewide cancer registry data from 1979 to 2018. The study included 27,092 adult subjects (aged ≥ 18 years old at surgery) who underwent MBS (BMI ≥ 30 kg/m2 at surgery) from 1979 to 2017. Cancer records were linked to MBS patient records, resulting in 1547 cancer cases. Cox proportional hazards regression was used to examine the association between MBS procedure types and cancer incidence. Results: Of all patients, 75% underwent Roux-en-Y gastric bypass (RYGB), 9% adjustable gastric banding (AGB), 10% sleeve gastrectomy (SG), and 6% duodenal switch (BPD-DS). The overall cancer incidence during the follow-up period was 6.4% for RYGB, 4.6% for AGB, 1.6% for SG, and 5.9% for BPD-DS. The mean follow-up duration from surgery to cancer incidence or censoring was 167 months (standard deviation = 121 months). Compared to RYGB, patients who underwent AGB (Hazard Ratio [HR] = 1.26, p = 0.03) and BPD-DS (HR = 1.91, p &lt; 0.01) had a significantly higher hazard of developing cancer, while SG (HR = 1.17, p = 0.33) showed no significant difference. Conclusions: These findings suggest that AGB and BPD-DS may be associated with higher cancer risks compared to RYGB. Additional large population studies are needed to better understand the long-term cancer risks and mechanisms associated with different MBS types.

Efficacy of One Anastomosis Gastric Bypass Versus Sleeve Gastrectomy and Roux-en-Y Gastric Bypass for the Treatment of Type 2 Diabetes Mellitus: a Systematic Review and Meta-Analysis of Randomized Clinical Trials.

The worldwide prevalence of type 2 diabetes mellitus (T2DM) is increasing in parallel with obesity. One anastomosis gastric bypass (OAGB) is considered effective to treat both T2DM and obesity. The aim of this study was to evaluate the efficacy of OAGB versus sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for treatment of T2DM, analyzing data exclusively from randomized control trials (RCTs). Α systematic review of published RCTs comparing OAGB versus RYGB or SG (control groups) in T2DM patients regarding diabetes remission and weight loss was performed. Primary endpoints were T2DM remission rate and 1-year and 5-year % weight loss postoperatively. Initial search identified 39 references, of which 8 RCTs were considered eligible for meta-analysis inclusion, comprising 636 patients (311 OAGB, 122 RYGB, 203 SG patients). Main meta-analysis findings were: i) higher 1-year %EWL for OAGB than control group (p = 0.04); ii) higher 5-year %EWL for OAGB than control group (p < 0.01); iii) no difference in 1-year remission rate of T2DM between OAGB and control group (p = 0.14); iv) 28% higher 5-year remission rate of T2DM for OAGB than control group (p < 0.01). OAGB had statistically significant better outcomes compared to RYGB and SG regarding T2DM remission and %EWL at 5years. Further pathophysiologic studies are needed to indicate the most potent bariatric procedure in patients with T2DM and obesity.

Safety and Efficacy of Lumen-Apposing Metal Stents for Management of Late Refractory Gastro-jejunal Structures in Patients with Roux-en-Y Gastric Bypass (with Video).

Roux-en-Y gastric bypass (RYGB) related late gastro-jejunal (GJ) strictures are often resistant to endoscopic balloon dilations. Lumen-apposing metal stents (LAMSs) have been used to treat benign strictures with favorable results. However, the data remains limited to justify LAMS use for management of post-RYGB late GJ strictures. We aim to evaluate the safety and efficacy of LAMS placement for the management of late GJ strictures that are refractory to balloon dilations in post-RYGB patients. This was a single center retrospective study that included all post-RYGB patients who underwent LAMS placement for management of late GJ strictures that had previously failed balloon dilations. Primary outcomes were technical and clinical success, and secondary outcomes were LAMS-related adverse events. A total of 28 patients underwent LAMS placement for management of GJ strictures. Median age was 60.5 (IQR 50.5, 67.0) years and majority were females (27, 96.4%). Median interval between surgery and first diagnosis of GJ stricture was 13 years (IQR 7, 17.5). 20 × 10 mm LAMS was the most used stent (n = 24, 85.7%). The median procedure time was 23.5 (IQR 14.5, 32.0) minutes. Technical and short-term clinical success of LAMS placement was 100% (95% CI 87.9-100.0). Long-term success was achieved in 19 out of 25 patients (76.0%, 95% CI 56.6-88.5) that had over 3 months follow-up after LAMS removal. Stent migration was noted in 2 (7.1%) patients, and 1 (3.6%) patient each experienced pain and minor bleeding without the need for additional interventions. No patient in our cohort required surgical revision of GJ anastomosis. Placement of LAMS is safe, technically feasible, and associated with a high clinical success rate in patients with late GJ strictures after RYGB who have failed prior balloon dilations. Placement of LAMS can be considered early in patients requiring multiple balloon dilations.

Endoscopic ultrasound-directed transgastric percutaneous endoscopic gastrostomy for long-term enteral feeding in patients with Roux-en-Y Gastric Bypass anatomy

Background and AimsIn patients with Roux-en-Y gastric bypass (RYGB) anatomy who require long-term enteral feeding, a percutaneous endoscopic jejunostomy (PEJ) tube is usually placed. However, jejunal feeding requires slower, continuous feeds compared with the physiologic bolus feeding with gastric feeds. This case series details a novel approach we term endoscopic ultrasound-directed transgastric percutaneous endoscopic gastrostomy (EDG-PEG) whereby endoscopic ultrasound (EUS)-guided gastrogastrostomy is performed using a lumen-apposing stent (LAMS) followed by a traditional percutaneous gastrostomy placement (PEG) via the newly created connection to allow for bolus gastric feeds in patients with Roux-en-Y anatomy. MethodsWe describe 3 cases in which an endoscopic ultrasound EUS-guided gastrogastrostomy was performed using a LAMS followed by the usual placement of a PEG tube into the excluded stomach. ResultsProcedure was technically and clinically successful in all 3 cases. ConclusionsEDG-PEG is an option for long-term enteral feeding in patients with a history of RYGB to allow for more convenient bolus gastric feeding rather than longer, continuous feeds required with a jejunal feeding tube.

Rates and Risk Factors for 30-Day Morbidity After One-Stage Vertical Banded Gastroplasty Conversions: A Retrospective Analysis.

Background: The vertical banded gastroplasty (VBG) is a historic restrictive bariatric operation often requiring further surgery. In this investigation utilizing the 2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) national dataset, we aim to better define the outcomes of VBG conversions.Methods: We queried the 2021 MBSAQIP dataset for patients who underwent a conversion from a VBG to Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Demographics, comorbidities, laboratory values, and additional patient factors were examined. Rates of key consequential outcome measures 30-day readmission, reoperation, reintervention, mortality, and a composite endpoint (at least 1 of the 4) were further calculated.Results: We identified 231 patients who underwent conversion from VBG to SG (n = 23), RYGB (n = 208), or other anatomy (n = 6), of which 93% of patients were female, and 22% of non-white race. The median age was 56years and body-mass index (BMI) was 43kg/m2. The most common surgical indications included weight considerations (48%), reflux (25%), anatomic causes (eg, stricture, fistula, and ulcer; 10%), and dysphagia (6.5%). Thirty-day morbidity rates included reoperation (7.8%), readmission (9.1%), reintervention (4.3%), mortality (.4%), and the composite endpoint (15%). Upon bivariate analysis, we did not identify any specific risk factor for the 30-day composite endpoint.Discussion: One-stage VBG conversions to traditional bariatric anatomy are beset with higher 30-day morbidity relative to primary procedures. Additional MBSAQIP data will be required for aggregation, to better characterize the risk factors inherent in these operations.

Gastrointestinal complaints after Roux-en-Y gastric bypass surgery. Impact of microbiota and its metabolites

Unexplainable gastrointestinal complaints occasionally occur after Roux-en-Y Gastric Bypass (RYGB) surgery. We therefor investigated the impact of microbiota composition and metabolites on gastrointestinal complaints after RYGB. In the BARICO study (Bariatric surgery Rijnstate and Radboudumc neuroimaging and Cognition in Obesity), microbiota and metabolites were measured before surgery, and 6, and 24 months after surgery. Gastrointestinal complaints were assessed with the Irritable Bowel Syndrome Severity Scoring System (IBS-SSS) questionnaire 24 months after surgery. 65 participants (86.2 % female) with a mean age of 46.2 ± 6.0 years, and mean BMI of 41.2 ± 3.6 kg/m2 were included. According to the IBS-SSS questionnaire, 32.3 % had moderate/severe gastrointestinal complaints 24 months after surgery. Microbiota alpha diversity remained stable, while beta diversity significantly changed over time. Bile acids and short-chain fatty acids were significantly higher, and inflammatory markers significantly lower after surgery. Barnesiella sp., Escherichia/Shigella sp., and Faecalibacterium prausnitzii correlated positively, while Akkermansia sp correlated inversely with gastrointestinal complaints. Patients with mild and moderate/severe gastrointestinal complaints showed higher levels of GLC-3S. These findings suggest involvement of microbiota and metabolite changes in gastrointestinal complaints after surgery. However, it remains unclear whether bacteria influence gastrointestinal complaints directly or indirectly. Further exploration is required for development of interventions against gastrointestinal symptoms after surgery.

Predictors of Successful Weight Loss in Extremely Obese Individuals Undergoing Roux-en-Y Gastric Bypass Surgery.

Roux-en-Y gastric bypass (RYGB) is a standard treatment for severe obesity, but some patients do not achieve the expected success in weight loss. The aim of this study was to evaluate possible predictors of weight loss after RYGB. Sixty-three patients were included. Pre- and postoperative data were collected from medical records, including comorbidities, anthropometry, energy/macronutrient intake, and physical activity level (PAL). Variants in the brain-derived neurotrophic factor (BDNF; rs6265) and lysophospholipase like 1 (LYPLAL1; rs4846567) genes were investigated. Excess weight loss (EWL) >50% was considered to be successful weight loss (SWL). Logistic regression models were used to verify predictor variables. Participants' median preoperative body mass index (BMI) was 53 kg/m2 (interquartile range, 46 to 58). At 12 and 24 months after surgery, EWL was 63% and 67%, and the failure rate was 19% and 16%, respectively. The individuals with insufficient weight loss (IWL) after 12 months had higher preoperative weight, BMI, and overweight. At 24 months, lowest frequency of individuals with SWL in the first year was found in the IWL group. No significant differences were found between the groups in dietary intake and PAL. In the logistic regression, high initial BMI was a predictor of the worst response in both periods, and high initial total weight loss was a predictor of a better response at 24 months. The polymorphism analysis did not show differences between groups in either gene. Lower preoperative BMI and greater weight loss at 12 months were predictors of SWL after RYGB.

Do Abdominoplasties in Patients with Prior Sleeve Gastrectomy Impact De Novo Gastroesophageal Reflux Disorderand the Need for Conversion to Roux-en-Y Gastric Bypass?

Introduction: The sleeve gastrectomy (SG) often requires conversion to Roux-en-Y gastric bypass (RYGB) due to gastroesophageal reflux disorder (GERD). Many postbariatric patients seek body-contouring surgery such as abdominoplasty to remove unwanted skin and fat. Although the number of abdominoplasties performed in postbariatric patients is increasing each year, the number of conversion surgeries is increasing in accordance. This study evaluates the impact of abdominoplasties in patients with prior SG on the development of GERD and the need for conversion to RYGB. Methods: A retrospective study was conducted with 630 patients who underwent conversions from SG to RYGB at our institution between January 2014 and December 2023. Outcomes were stratified for comparison between patients with GERD as an indication for conversion and patients with inadequate weight loss as an indication for conversion. Between the two groups we compared the number of patients with post-SG abdominoplasty and the number of hiatal hernias (HH) seen during conversion surgery. A logistic regression analysis was performed to identify factors independently associated with GERD. Results: There was a statistically significant higher number of abdominoplasties in patients who underwent conversion to RYGB for GERD (29 patients, 8.6%) compared to inadequate weight loss (12 patients, 4.1%), P value .034. However, these patients also had statistically significantly more HH (98 patients, 28.9%) compared to patients with inadequate weight loss as an indication for conversion (46 patients, 15.8%), P value <.001. In the logistic regression comparing these two variables, only the presence of HH seen during surgery was found to be a significant predictor of GERD (odds ratio 2.7, confidence interval 1.7-4.1, P < .001). Conclusion: Our data shows that abdominoplasty surgery does not directly influence the development of GERD in post-SG patients. However, the presence of HH in this population significantly impacts the development of GERD, often necessitating conversion to RYGB.

The Relevance of Gastroscopy in the Diagnostic Work-up for Marginal Ulceration in Patients Presenting with Abdominal Pain Following Laparoscopic Roux-en-Y Gastric Bypass.

It is unknown what the incidence of gastroscopy-diagnosed marginal ulceration is, while gastroscopy is a frequently chosen diagnostic modality in patients presenting with abdominal pain with a Roux-en-Y gastric bypass (RYGB) in history. The aim of this study was to examine the incidence and treatment of gastroscopy-diagnosed marginal ulceration in patients presenting with the first episode of abdominal pain after RYGB, in which gastroscopy is chosen as the first step in the diagnostic work-up. A post hoc analysis was performed of a prospective cohort of 2273 patients undergoing RYGB between 2014 and 2019 in a large non-academic hospital with a dedicated bariatric unit. All patients presenting with abdominal pain > 30days postoperatively were included. Primary outcome was gastroscopy identified marginal ulceration and treatment. One hundred two out of 498 patients presenting with abdominal pain after RYGB (20%) underwent gastroscopy as the first diagnostic step. In 84% of these patients, no marginal ulcer was found. Marginal ulceration was observed in 16/102 patients (16%). All patients underwent optimization of PPI treatment and lifestyle advises. Seven patients underwent revisional surgery, at a median of 163days (range 80-1287) after diagnosis. In a minority of patients undergoing gastroscopy for abdominal pain post-RYGB, a marginal ulceration is identified. Revisional surgery is rarely needed in all patients undergoing gastroscopy and only performed after several months when complaints persist despite PPI optimization. Only performing gastroscopy when symptoms persist safely reduces the number of gastroscopy for abdominal pain after RYGB.