Standard Gastric Bypass Research Articles

Effect of different limb lengths on quality of life, eating patterns and gastrointestinal symptoms after Roux-en-Y gastric bypass in superobese patients: randomized study.

BackgroundDistal Roux‐en‐Y gastrojejunal bypass (DRYGJB) gives better weight reduction than standard Roux‐en‐Y gastric bypass (RYGB) but at the risk of increased malnutrition side‐effects. This study compared the effects of RYGB and DRYGJB on gastrointestinal symptoms, eating patterns and health‐related quality of life (QoL).MethodsThis was a single‐blind RCT from a university‐affiliated obesity centre. Patients with a BMI of 50 kg/m2 or above were invited to participate. Treatment arms were standard gastric bypass with an alimentary limb of 150 cm and a biliopancreatic limb of 60 cm, with a variable common channel length, or DRYGJB with biliopancreatic limb of 200 cm, common channel limb of 150 cm and variable alimentary limb length. Baseline and follow‐up data to 5 years on quality of life, obesity‐related problems and gastrointestinal symptoms were collected using prospectively created and validated questionnaires.ResultsSome 140 patients were included. Those with a DRYGJB had better weight loss at 5 years (mean(s.d.) 68·3(21·8) kg versus 55·7(19·8) kg for standard RYGB; P = 0·011). Eating patterns improved, with no difference between the groups. Gastrointestinal symptoms (diarrhoea, indigestion) worsened significantly in both groups, but only patients with DRYGJB had significantly worse diarrhoea at the end of the study than at baseline (P = 0·006). Both groups had improved perceived generic QoL over baseline, and obesity‐related problems were markedly reduced.ConclusionStandard RYGB and both improved generic and disease‐specific QoL and eating behavioural pattern. Diarrhoea was increased more following DRYGJB than after RYGB. Registration number: NCT 01514799 (https://clinicaltrials.gov).

Бесстеплерное и стандартное бариатрическое гастрошунтирование (клинико-экономический анализ)

Бесстеплерное и стандартное бариатрическое гастрошунтирование (клинико-экономический анализ)

The treatment of the metabolic syndrome with stapleless one-anastomotic gastric bypass: a randomized clinical trial compared to stapler method

BACKGROUND: The authors have developed an original method of laparoscopic gastric bypass significantly reducing financial costs when conducting this surgical treatment of obesity. In the presented article for the first time describes the evaluation of the effectiveness of the proposed to introduce a new type of staplerless gastric bypass compared to the standard stapler method.
 AIMS: to evaluate the effectiveness of the authors method of laparoscopic gastric bypass for the treatment of metabolic syndrome with obesity.
 MATERIALS AND METHODS: This prospective, randomized controlled trial presents the results of surgical treatment of 80 patients with metabolic syndrome. Patients were randomized into two groups of 40 people. In the first group, the authors method of laparoscopic mini-gastric bypass with a band-separated pouch was implemented, and in the second group, the standard laparoscopic mini-gastric bypass with a standard (stapler-separated) gastric pouch was used. Procedures were performed in the period from 2015 to 2016 with an average follow up period of 3 years. The postoperative change of weight loss and the changes of the main manifestations of the metabolic syndrome, as well as the change in the cardiovascular risk index in the comparison groups were assessed.
 RESULTS: In both groups there were no significant differences by sex and age. In the first group there were 39 women and 1 man, and in the second group 36 women and 4 men aged 36.758.6 years and 40.4711.0 years, respectively (p=0.097). Three years after surgery, all 80 patients were examined using analysis of variance. At the same time, it was revealed that the change in body mass index after operations, which was 14.025.05 kg/m2 in the first group, and 12.385.7 kg/m2 (p=0.170) in the second group, was found equally good bariatric effect of two compared methods of gastric bypass.
 The main indicators of blood pressure, as well as laboratory data reflecting the state of carbohydrate and fat metabolism, statistically significantly decreased in both groups to normal values, which suggests a pronounced metabolic effect of both gastric bypass methods. It was established that cardiovascular risk in the first group decreased from 5.40.9 to 2.90.4 (p0.001), and in the second group from 5.11.1 to 3.10.32 (p0.001).
 CONCLUSIONS: The results of the use of various types of laparoscopic gastric bypass in the surgical treatment of metabolic syndrome after three years indicate a significant reduction in body weight, normalization of carbohydrate and fat metabolism.
 In a comparative aspect, the authors and standard gastric bypass techniques equally positively affect the elimination of the main manifestations of the metabolic syndrome, but the proposed authors method has insignificant advantages in terms of weight loss.

The life expectancy of patients with metabolic syndrome after weight loss: study protocol for a randomized clinical trial (LIFEXPE-RT)

BackgroundTo date, surgeons and physicians have found positive results treating metabolic syndrome with surgical and non-surgical weight loss therapies. The purpose of this study was to evaluate changes in telomere length in patients with metabolic syndrome after weight loss.Methods/designThis study is a three-arm randomized controlled trial. The first group is composed of patients who have undergone stapleless bypass surgery (one anastomosis gastric bypass with an obstructive stapleless pouch and anastomosis (LOAGB-OSPAN)). The second group of patients underwent standard gastric bypass surgery (laparoscopic mini-gastric bypass-one anastomosis gastric bypass (LMGB-OAGB). The patients in the third group received non-surgical weight loss therapy, including a hypocaloric diet with energy restriction (− 500 kcal/day).The aim is to compare changes—telomere length, body mass index, comorbidities, and quality of life—in patients with metabolic syndrome after weight loss.DiscussionTo the best of our knowledge, this is the first randomized study to simultaneously compare the effects of surgical and non-surgical weight loss on changes in telomere length. It could provide a solution to the growing problem of metabolic syndrome. Normalization of the body mass index results in improvements in the health of patients with metabolic syndrome.Trial registrationClinicalTrials.gov, NCT03667469. Registered on 11 September 2018.

A5034 - Banded Gastric Bypass VS Standard Gastric Bypass: Weight loss and maintenance after four years

Banding the gastric bypass operation has been reported to result in better weight loss and weight loss maintenance. A retrospective comparative study of banded versus nonbanded gastric bypass was done to see if there is a difference in the weight loss after four years follow up.

Patient-Reported Outcome Measures 2\xa0Years After Standard and Distal Gastric Bypass\u2014a Double-Blind Randomized Controlled Trial

BackgroundThe preferred surgical procedure for treating morbid obesity is debated. Patient-reported outcome measures (PROMs) are relevant for evaluation of the optimal bariatric procedure.MethodsA total of 113 patients with BMI from 50 to 60 were randomly assigned to standard (n = 57) or distal (n = 56) Roux-en-Y gastric bypass (RYGB). Validated PROMS questionnaires were completed at baseline and 2 years after surgery. Data were analyzed using mixed models for repeated measures and the results are expressed as estimated means and mean changes.ResultsObesity-related quality of life improved significantly after both procedures, without significant between-group differences (− 0.4 (95% CI = − 8.4, 7.2) points, p = 0.88, ES = 0.06). Both groups had significant reductions in the number of weight-related symptoms and symptom distress score, with a mean group difference (95% CI) of 1.4 (− 0.3, 3.3) symptoms and 5.0 (2.9. 12.8) symptom distress score points. There were no between-group differences for uncontrolled eating (22.0 (17.2–26.7) vs. 28.9 (23.3–34.5) points), cognitive restraint (57.4 (52.0–62.7) vs. 62.1 (57.9–66.2) points), and emotional eating (26.8 (20.5–33.1) vs. 32.6 (25.5–39.7) points).The prevalence of anxiety was 33% after standard and 25% after distal RYGB (p = 0.53), and for depression 12 and 9%, respectively (p = 0.76).ConclusionsThere were no statistically significant differences between standard and distal RYGB 2 years post surgery regarding weight loss, obesity-related quality of life, weight-related symptoms, anxiety, depression, or eating behavior.Trial RegistrationClinical Trials.gov number NCT00821197

MODIFIED METHOD OF LAPAROSCOPIC GASTRIC BYPASS SURGERY

OBJECTIVE. The study aimed to improve the results of gastric bypass surgery. MATERIALS AND METHODS. The article analyzed the results of surgical treatment of 342 patients with metabolic syndrome who underwent operation at the period from 2008 to 2016.The patients were divided into 2 groups according to the type of operation. The first group included 224 (65,4 %) patients who underwent standard surgery LGB using Lontron procedure. The second group numbered 118 (34,5 %) patients whom LGB operation with ARC (the original method) were performed. The efficacy of operation was evaluated in different terms (after 3-month, one year and 3 years). The article described in detail and showed the technique of proposed modified operation of gastric bypass surgery. RESULTS. The proposed method of operative treatment was validated by researches performed. There was demonstrated higher efficacy of operations compared with the standard gastric bypass surgery. CONCLUSIONS. The operation of modified laparoscopic gastric bypass with formation of antireflux valve allowed clinicians to improve the results, decrease the number of complications and have a strong influence on main components of metabolic syndrome.

Standard vs Distal Roux-en-Y Gastric Bypass in Patients With Body Mass Index 50 to 60

Up to one-third of patients undergoing bariatric surgery have a body mass index (BMI) of more than 50. Following standard gastric bypass, many of these patients still have a BMI greater than 40 after peak weight loss. To assess the efficacy and safety of standard gastric bypass vs distal gastric bypass in patients with a BMI of 50 to 60. Double-blind, randomized clinical parallel-group trial at 2 tertiary care centers in Norway (Oslo University Hospital and Vestfold Hospital Trust) between May 2011 and April 2013. The study included 113 patients with a BMI of 50 to 60 aged 20 to 60 years. The 2-year follow-up was completed in May 2015. Standard gastric bypass (alimentary limb, 150 cm) and distal gastric bypass (common channel, 150 cm), both with a biliopancreatic limb of 50 cm and a gastric pouch of about 25 mL. Primary outcome was the change in BMI from baseline until 2 years after surgery. Secondary outcomes were cardiometabolic risk factors, nutritional outcomes, adverse events, gastrointestinal symptoms, and health-related quality of life. At baseline, the mean age of the patients was 40 years (95% CI, 38-41 years), 65% were women, mean BMI was 53.5 (95% CI, 52.9-54.0), and mean weight was 158.8 kg (95% CI, 155.3-162.3 kg). The mean reduction in BMI was 17.8 (95% CI, 16.9-18.6) after standard gastric bypass and 17.2 (95% CI, 16.3-18.0) after distal gastric bypass, and the mean between-group difference was 0.6 (95% CI, -0.6 to 1.8; P = .32). Reductions in mean levels of total and low-density lipoprotein cholesterol were greater after distal gastric bypass than standard gastric bypass, and between-group differences were 19 mg/dL (95% CI, 11-27 mg/dL ) and 28 mg/dL (95% CI, 21 to 34 mg/dL), respectively (P < .001 for both). Reductions in fasting glucose levels and hemoglobin A1c were greater after distal gastric bypass. Secondary hyperparathyroidism and loose stools were more frequent after distal gastric bypass. The number of adverse events and changes in health-related quality of life did not differ between the groups. Importantly, 1 patient developed liver failure and 2 patients developed protein-caloric malnutrition treated by elongation of the common channel following distal gastric bypass. Distal gastric bypass was not associated with a greater BMI reduction than standard gastric bypass 2 years after surgery. However, we observed different changes in cardiometabolic risk factors and nutritional markers between the groups. Clinicaltrials.gov Identifier: NCT00821197.

Laparoscopic Band-Separated One Anastomosis Gastric Bypass.

This video demonstrates laparoscopic band-separated one anastomosis gastric bypass-combining the advantages of banding and gastric bypass without stapler and cutter use. This is basically a gastrojejunal loop bypass above an obstructive band in the upper stomach. An adjustable low pressure "Medsil" gastric band was introduced in the abdomen and retracted through the retrogastric tunnel. The front wall of the stomach below the band was displaced in the upward direction through the ring band, increasing the size of the anterior portion of the stomach pouch so that a gastroenteroanastomosis could be created at this point. Gastro-gastric sutures were placed to create a gastro-gastric plication around the band and hold it in position. The band tubing was exteriorized and connected to a special port, which was secured to the abdominal wall fascia. A jejunal loop was created about 200cm from the ligament of Treitz and anastomosed to the gastric pouch by hand using Vicryl 2/0 sutures. Between November 2015 and February 2016, the study was performed on 10 patients. The average operating time for all cases was 75min (range 63-87). There was no morbidity or mortality. No complications were observed, including band erosion and band infection. Operation costs were about $2000 lower with this method than with standard gastric bypass surgery. Postop the patients lost weight by 3-4kg per month. Preliminary results show that laparoscopic band-separated one anastomosis gastric bypass have feasibility, safety, efficacy, and reduced operating costs.

A matched cohort analysis of single anastomosis loop duodenal switch versus Roux-en-Y gastric bypass with 18-month follow-up.

The Roux-en-Y gastric bypass (GBP) has been considered the gold standard for many years. The loop duodenal switch (LDS) is a relatively new procedure that simplifies the complexity of the duodenal switch (BPDDS) by making it a single anastomosis procedure while at the same time giving it more intestinal absorption to reduce the rates of malnutrition associated with traditional BPDDS. This paper seeks to compare the 18-month weight loss outcomes and complications of the more standard GBP with the newer LDS in a single US center. A retrospective matched cohort was analyzed on 108 patients who had either GBP (54 patients) or LDS (54 patients). Regression analysis was used to compare weight loss outcomes as measured by BMI and weight loss percentages. Complications gathered included bleeds, reoperations, diagnostic or therapeutic endoscopy (EGD), ulcers and chronic nausea. GBP and LDS have statistically similar weight loss at 18months (39.6 vs 41% weight loss, respectively). However, there were significantly more nausea complaints (26 vs 5), diagnostic endoscopies (EGD) (21 vs 3) and ulcers (6 vs 0) with the GBP than the LDS. LDS has comparable weight loss results to GBP. However, LDS has fewer 30-day and 18-month complications and patients suffer from less nausea postoperatively.

Water with food intake does not influence caloric intake after gastric bypass (GBP): a cross-over trial.

Bariatric patients seeking information meet very different recommendations on postoperative diet and eating behaviour. A reason for variability may be lack of hard evidence. A national survey on current dietary advice was conducted to serve as background for the present study on how drinking during a meal influenced caloric consumption. A standardised questionnaire was sent to all units in the Scandinavian Obesity surgery registry (SOReg) in order to obtain information regarding current diet advice after gastric bypass. Twenty-eight patients, 14 in each group, were studied either 2 months or 1 year after a standard gastric bypass (GBP). A standardised lunch was served on two separate days with or without water in randomised order. Meal and water weights were measured before and after. Hunger/satiety scores were obtained using visual analogue scales. Response rate for surgeons was low, for dieticians 75 %. No clear consensus for liquid intake during meals was found; few surgeons advised patients whether or not to drink with meals. All patients ate to full satiety. Two months post-GBP, 7/14 patients consumed more solid food when allowed drinking water; the increase in caloric consumption was not significant. One year post-GBP, 5/14 patients consumed more solid food when allowed drinking water, the difference not reaching statistical significance. Our study does not indicate that patients should refrain from drinking during meals the first year after a GBP, at least not from a caloric intake point of view.

P-127: Initial report of prospective evaluation of banded gastric bypass vs. standard gastric bypass

P-127: Initial report of prospective evaluation of banded gastric bypass vs. standard gastric bypass

PL-211: Prospective randomized trial of banded vs. non-banded gastric bypass for the super obese: Five year outcomes

The banded gastric bypass (Capella Procedure) adds an additional restrictive component to the traditional Roux-en-Y gastric bypass. Early preliminary data showed this to result in superior weight loss compared with standard gastric bypass. We report on long-term comparison of these two procedures.

Prospective randomized trial of banded versus nonbanded gastric bypass for the super obese: early results

Banded gastric bypass has been reported to result in superior weight loss compared with standard nonbanded gastric bypass. However, an adequate comparison of these procedures has not yet been reported. A total of 90 patients were enrolled in this prospective randomized double-blind trial comparing banded and nonbanded open gastric bypass for the treatment of super obesity. The banding technique involved placement of a 1.5 x 5.5-cm polypropylene band around the proximal gastric pouch of a standard gastric bypass procedure using the technique of Capella. Chi-square testing and analysis of variance were performed to find any differences in patient characteristics (gender, age, and initial body mass index), percentage of excess weight lost at 6, 12, 24, and 36 months postoperatively, improvement or resolution of co-morbidities, and complications in the banded versus nonbanded gastric bypass groups. As expected, no differences were present in the patient characteristics or incidence of co-morbidities between the banded (n = 46) and nonbanded (n = 44) groups. The body mass index, percentage of women, and mean age was 59.5 and 56.5 kg/m2, 64% and 73.8% (P = .09), and 40.6 +/- 7.4 and 42.6 +/- 7.2 years for the banded and nonbanded groups, respectively; all differences were nonsignificant. No significant differences were found in the resolution of co-morbidities. No significant difference was present in the percentage of excess weight loss at 6, 12, and 24 months (43.1% versus 24.7%, 64.0% versus 57.4%, and 64.2% versus 57.2%, respectively) postoperatively; however, the banded patients had achieved a significantly greater percentage of excess weight loss at 36 months (73.4% versus 57.7%; P <.05). The incidence of intolerance to meat and bread was greater in the banded patients. The overall number of complications was 12 (26%) in the banded and 13 (29.5%) in the nonbanded group, a nonsignficant difference. No band erosions had occurred at the last follow-up visit, and no patients in either group died. These results suggest that although the initial weight loss was not significantly different between the 2 groups, the banded patients continued to lose weight for < or = 3 years. The polypropylene band appeared to be well tolerated. We plan longer follow-up to confirm the possibility of additional weight loss and the prevention of weight regain in the banded group, as well as to document any long-term band complications.

63: Prospective randomized double blinded trial of banded versus standard gastric bypass in patients with superobesity - early results

63: Prospective randomized double blinded trial of banded versus standard gastric bypass in patients with superobesity - early results

Bariatric Surgery for Severely Obese Adolescents

A 1991 National Institutes of Health Consensus Conference concluded that severely obese adults could be eligible for bariatric surgery if they had a body mass index (BMI) ≥35 kg/m 2 with or ≥40 kg/m 2 without obesity comorbidity. It was thought at that time that there were inadequate data to support bariatric surgery in severely obese adolescents. An estimated 25% of children in the United States are obese, a number that has doubled over a 30-year period. Very little information has been published on the subject of obesity surgery in adolescents. Therefore we reviewed our 20-year database on bariatric surgery in adolescents. Severely obese adolescents, ranging from 12 to less than 18 years of age, were considered eligible for bariatric surgery according to the National Institutes of Health adult criteria. Gastroplasty was the procedure of choice in the initial 3 years of the study followed by gastric bypass, which was found to be significantly more effective for weight loss in adults. Distal gastric bypass (D-GBP) was used in extremely obese patients (BMI ≥60 kg/m 2) before 1992 and long-limb gastric bypass (LL-GBP) was used for superobese patients (BMI ≥50 kg/m 2) after 1992. Laparoscopic gastric bypass was used after 2000. Thirty-three adolescents (27 white, 6 black; 19 females, 14 males) underwent the following bariatric operations between 1981 and June 2001: horizontal gastroplasty in one, vertical banded gastroplasty in two, standard gastric bypass in 17 (2 laparoscopic), LL-GBP in 10, and D-GBP in three. Mean BMI was 52 ± 11 kg/m 2 (range 38 to 91 kg/m 2), and mean age was 16 ± 1 years (range 12.4 to 17.9 years). Preoperative comorbid conditions included the following: type II diabetes mellitus in two patients, hypertension in 11, pseudotumor cerebri in three, gastroesophageal reflux in five, sleep apnea in six, urinary incontinence in two, polycystic ovary syndrome in one, asthma in one, and degenerative joint disease in 11. There were no operative deaths or anastomotic leaks. Early complications included pulmonary embolism in one patient, major wound infection in one, minor wound infections in four, stomal stenoses (endoscopically dilated) in three, and marginal ulcers (medically treated) in four. Late complications included small bowel obstruction in one and incisional hernias in six patients. There were two late sudden deaths (2 years and 6 years postoperatively), but these were unlikely to have been caused by the bariatric surgical procedure. Revision procedures included one D-GBP to gastric bypass for malnutrition and one gastric bypass to LL-GBP for inadequate weight loss. Regain of most or all of the lost weight was seen in five patients at 5 to 10 years after surgery; however, significant weight loss was maintained in the remaining patients for up to 14 years after surgery. Comorbid conditions resolved at 1 year with the exception of hypertension in two patients, gastroesophageal reflux in two, and degenerative joint disease in seven. Self-image was greatly enhanced; eight patients have married and have children, five patients have completed college, and one patient is currently in college. Severe obesity is increasing rapidly in adolescents and is associated with significant comorbidity and social stigmatization. Bariatric surgery in adolescents is safe and is associated with significant weight loss, correction of obesity comorbidity, and improved self-image and socialization. These data strongly support obesity surgery for those unfortunate individuals who may have difficulty obtaining insurance coverage based on the 1991 National Institutes of Health Consensus Conference statement. ( J Gastrointest Surg 2003;7:102–108.)

Conversion of proximal to distal gastric bypass for failed gastric bypass for superobesity

The purpose of this study was to analyze outcome following malabsorptive distal gastric bypass (D-GBP) in superobese patients who were reoperated for recurrent obesity comorbidity after a failed standard gastric bypass (S-GBP). Twenty-seven formerly superobese patients with a failed S-GBP converted to a D-GBP were studied. The small bowel was anastomosed 250 cm from the ileocecal valve to the disconnected Roux limb; the bypassed small intestine was connected to the ileum 50 cm from the ileocecal valve in five patients between 1985 and 1986 and 150 cm from the ileocecal valve in 22 patients thereafter. Comorbidity was reassessed yearly following conversion to D-GBP. Malnutrition occurred in all five patients with a 50 cm “common tract”; all required further revision and two died of hepatic failure. Three of 22 patients with a 150 cm common tract were reoperated with bowel lengthening because of malnutrition. Initial body mass index was 57 ± 2 kg/m 2 and fell from 46 ± 2 kg/m 2 before revision to 37 ± 2 kg/m 2 at 1 year and 32 ± 2 kg/m 2 at 5 years after revision; the percentage of excess weight lost went from 30 ± 4% to 61 ± 4% at 1 year and 69 ± 5% at 5 years after revision. Preoperative comorbidity in patients undergoing revision included 14 with insulin-dependent type II diabetes mellitus, 11 with sleep apnea, 14 with hypoventilation, 13 with hypertension, and two with venous stasis ulcers. Obesity comorbidity was corrected within 1 year in all but two patients with hypertension and remained stable in all patients followed for 5 years. Revision of a failed S-GBP to a 150 cm common tract D-GBP corrects failed weight loss and severe obesity comorbidity but requires nutritional support to prevent protein-calorie malnutrition, iron and fat-soluble vitamin deficiencies, and further revision in some patients to correct malnutrition. A 50 cm common tract has an unacceptable morbidity and mortality.

Retrograde endoscopy of the bypassed stomach segment after gastric bypass surgery: unexpected lesions.

Surgical measures for the treatment of morbid obesity include gastric bypass of the stomach and duodenum. We endoscopically evaluated the bypassed segments in 51 patients three to 24 months after a standard gastric bypass procedure. Retrograde endoscopy was successful in 33 of the patients (65%). There was significantly more gastritis by endoscopic grading in the distal bypassed segment than in the proximal part of the stomach. The gastritis in the bypassed segment was associated with pooled bile in 97% of the patients. The severity of gastritis did not appear to be related to the time after surgery and was as severe three months after surgery as it was at 24 months. Histologically, the gastritis was nonconfluent, and often the histologic and endoscopic findings were at variance. There was intestinal metaplasia in biopsy specimens from the distal pouch in four of the 33 patients. The mechanism for the high incidence of gastritis is unknown, but may be related to decreased antral motility due to distention of the proximal pouch with food. These patients require close observation for changes in the bypassed segment of stomach that may occur as a consequence of chronic inflammation.