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Santos-Sousa H, Nogueiro J, Lindeza L, Carmona MN, Amorim-Cruz F, Resende F, Costa-Pinho A, Preto J, Sousa-Pinto B, Carneiro S, Lima-da-Costa E. Roux-en-Y gastric bypass and sleeve gastrectomy as revisional bariatric procedures after adjustable gastric banding: a retrospective cohort study. Langenbecks Arch Surg 2023; 408:441. [PMID: 37987830 PMCID: PMC10663205 DOI: 10.1007/s00423-023-03174-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION The frequency of revisional bariatric surgery is increasing, but its effectiveness and safety are not yet fully established. The aim of our study was to compare short-term outcomes of primary (pRYGB and pSG) and revisional bariatric surgeries (rRYGB and rSG). METHODS We performed a retrospective cohort study assessing all patients submitted to primary and revisional (after a failed AGB) RYGB and SG in 2019. Each patient was followed-up at 6 months and 12 months after surgery. We compared pRYGB vs. rRYGB, pSG vs. rSG and rRYGB vs. rSG on weight loss, surgical complications, and resolution of comorbidities. RESULTS We assessed 494 patients, of which 18.8% had undergone a revisional procedure. Higher weight loss at 6 and 12 months was observed in patients undergoing primary vs. revisional procedures. Patients submitted to rRYGB lost more weight than those with rSG (%EWL 12 months = 82.6% vs. 69.0%, p < 0.001). Regarding the resolution of obesity-related comorbidities, diabetes resolution was more frequent in pRYGB than rRYGB (54.2% vs. 25.0%; p = 0.038). Also, 41.7% of the patients who underwent rRYGB had dyslipidemia resolution vs. 0% from the rSG group (p = 0.035). Dyslipidemia resolution was also more common in pSG vs. rSG (68.6% vs. 0.0%; p = 0.001). No significant differences in surgical complications were found. CONCLUSION Revisional bariatric surgery is effective and safe treating obesity and related comorbidities after AGB. Primary procedures appear to be associated with better weight loss outcomes. Further prospective studies are needed to better understand the role of revisional bariatric surgery.
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Affiliation(s)
- Hugo Santos-Sousa
- Faculty of Medicine, University of Porto - Alameda Prof.Hernâni Monteiro, 4200-319, Porto, Portugal.
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200- 319, Porto, Portugal.
| | - Jorge Nogueiro
- Faculty of Medicine, University of Porto - Alameda Prof.Hernâni Monteiro, 4200-319, Porto, Portugal
- Surgery Department, São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Luis Lindeza
- Faculty of Medicine, University of Porto - Alameda Prof.Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Maria Neves Carmona
- Faculty of Medicine, University of Porto - Alameda Prof.Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Filipe Amorim-Cruz
- Faculty of Medicine, University of Porto - Alameda Prof.Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Fernando Resende
- Faculty of Medicine, University of Porto - Alameda Prof.Hernâni Monteiro, 4200-319, Porto, Portugal
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200- 319, Porto, Portugal
| | - André Costa-Pinho
- Faculty of Medicine, University of Porto - Alameda Prof.Hernâni Monteiro, 4200-319, Porto, Portugal
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200- 319, Porto, Portugal
| | - John Preto
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200- 319, Porto, Portugal
| | - Bernardo Sousa-Pinto
- Faculty of Medicine, University of Porto - Alameda Prof.Hernâni Monteiro, 4200-319, Porto, Portugal
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal
- CINTESIS - Center for Health Technologies and Services Research, University of Porto, Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal
| | - Silvestre Carneiro
- Faculty of Medicine, University of Porto - Alameda Prof.Hernâni Monteiro, 4200-319, Porto, Portugal
- Surgery Department, São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Eduardo Lima-da-Costa
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200- 319, Porto, Portugal
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Pfister M, Teuben MPJ, Teuber H, Nocito A, Probst P, Muller MK. Mid-term quality of life after gastric band removal and single-stage conversion to gastric bypass: a single-center cohort study. Langenbecks Arch Surg 2022; 407:2755-2762. [PMID: 35896813 DOI: 10.1007/s00423-022-02618-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/18/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Revision surgeries in patients with failed gastric banding including band removal are increasingly necessary. However, long-term outcomes after band removal alone are unsatisfactory due to weight regain and limited improvement in quality of life. This study aimed to report mid-term quality of life outcomes after gastric band removal and single-stage conversion to Roux-en-Y gastric bypass. METHODS Data of 108 patients who underwent conversion surgery from 2011 to 2017 were extracted from a prospective database and retrospectively analyzed. During follow-up visits, physical and laboratory data as well as quality of life questionnaires were obtained. RESULTS Postoperative mean Moorehead score increased significantly after 1 year (1.62 ± 0.86, p < 0.001) and after 5 years (1.55 ± 0.84, p < 0.001) compared to baseline values (0.72 ± 1.1). The mean follow-up time was 53 months. Moorehead scores at 1, 2, and 5 years postoperative were available in 75% (n = 81), 71% (n = 77), and 42% (n = 45) of cases, respectively. Mixed ANOVA analysis showed a significantly superior increase in Moorehead score in males (p = 0.024). No other significant predictors were identified. Lasting BMI reduction (- 4.6 to 33.0 ± 6.7 kg/m2, p < 0.001) and weight loss (- 12.9% (- 13.6 kg), p < 0.001) 5 years after conversion surgery were seen. Postoperative complications occurred in 35% (n = 38) of patients with a re-operation rate of 30.5% (n = 33). CONCLUSION The current study shows that band removal with single-stage gastric bypass in patients with failed gastric banding leads to a lasting improvement in quality of life and may be the rescue procedure of choice in this setting.
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Affiliation(s)
- M Pfister
- Department of Surgery, Cantonal Hospital Thurgau, Pfaffenholzstrasse 4, CH-8501, Frauenfeld, Switzerland
| | - M P J Teuben
- Department of Surgery, Cantonal Hospital Thurgau, Pfaffenholzstrasse 4, CH-8501, Frauenfeld, Switzerland
| | - H Teuber
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - A Nocito
- Department of Surgery, Cantonal Hospital Baden, Im Ergel 1, CH-5404, Baden, Switzerland
| | - P Probst
- Department of Surgery, Cantonal Hospital Thurgau, Pfaffenholzstrasse 4, CH-8501, Frauenfeld, Switzerland
| | - M K Muller
- Department of Surgery, Cantonal Hospital Thurgau, Pfaffenholzstrasse 4, CH-8501, Frauenfeld, Switzerland.
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Abdulrazzaq S, Elhag W, El Ansari W, Mohammad AS, Sargsyan D, Bashah M. Is Revisional Gastric Bypass as Effective as Primary Gastric Bypass for Weight Loss and Improvement of Comorbidities? Obes Surg 2021; 30:1219-1229. [PMID: 31865551 DOI: 10.1007/s11695-019-04280-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Revisional gastric bypass (R-RYGB) surgery is utilized for the management of inadequate weight loss or weight regain observed after some cases of bariatric surgeries. Data on the mid-term effectiveness of primary gastric bypass (P-RYGB) compared with R-RYGB (e.g., post sleeve gastrectomy/gastric banding) are controversial. METHODS Retrospective chart review of all patients who received P-RYGB and R-RYGB (January 2011-June 2015) at our center. One hundred twenty patients who underwent P-RYGB and 34 R-RYGB who completed 18 months follow-up were included. We compared the effectiveness of P-RYGB with R-RYGB by assessing four anthropometric, two glycemic, and four lipid parameters, as well as the control of type 2 diabetes (T2DM), hypertension, dyslipidemia (remission, improvement, persistence, relapse, de novo), mortality and complications rates. RESULTS A comparison of the effectiveness of P-RYGB with R-RYGB at 18 months revealed no significant differences in patients' age, gender, and preoperative BMI between groups. However, patients who received P-RYGB had lower mean weight (P = 0.001) and BMI (P < 0.001), reflected by a higher mean delta BMI (P = 0.02), total weight loss percentage (TWL%) (P < 0.0001) and excess weight loss percentage (EWL%) (P < 0.0001). No differences in glycemic parameters, lipid profiles, control of T2DM, hypertension, and dyslipidemia were observed. No death is reported and complication rates were comparable. CONCLUSIONS Although R-RYGB effectively addressed inadequate weight loss, weight regain, and recurrence of comorbidities after restrictive bariatric surgery, R-RYGB resulted in inferior weight loss compared with P-RYGB. Neither procedure differed in their clinical control of T2DM, hypertension, and dyslipidemia. Both procedures exhibited comparable complication rates.
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Affiliation(s)
- Sama Abdulrazzaq
- Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, 3050, Doha, Qatar
| | - Wahiba Elhag
- Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, 3050, Doha, Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, 3050, Doha, Qatar. .,College of Medicine, Qatar University, Doha, Qatar. .,Schools of Health and Education, University of Skovde, Skövde, Sweden.
| | | | - Davit Sargsyan
- Department of Metabolic and Bariatric Surgery, Hamad General Hospital, 3050, Doha, Qatar.,Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Moataz Bashah
- Department of Metabolic and Bariatric Surgery, Hamad General Hospital, 3050, Doha, Qatar.,Weill Cornell Medicine-Qatar, Doha, Qatar
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Askari A, Dai D, Taylor C, Chapple C, Halai S, Patel K, Mamidanna R, Munasinghe A, Rashid F, Al-Taan O, Jain V, Whitelaw D, Jambulingam P, Adil MT. Long-Term Outcomes and Quality of Life at More than 10 Years After Laparoscopic Roux-en-Y Gastric Bypass Using Bariatric Analysis and Reporting Outcome System (BAROS). Obes Surg 2020; 30:3968-3973. [DOI: 10.1007/s11695-020-04765-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Revisional Roux-en-Y Gastric Bypass: a Safe Surgical Opportunity? Results of a Case-Matched Study. Obes Surg 2020; 29:903-910. [PMID: 30467707 DOI: 10.1007/s11695-018-3606-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of revisional Roux-en-Y gastric bypass (RYGB) after adjustable gastric banding (AGB) or sleeve gastrectomy (SG) compared with primary RYGB, in regard to early and late morbidity, weight, and resolution of obesity-related comorbidities. METHODS The group of patients undergoing revisional RYGB was matched in a 1:1 ratio with control patient who underwent a primary RYGB, based on age, gender, American Society of Anesthesiologist (ASA) score, preoperative body mass index (BMI), and diabetes mellitus. Demographics, anthropometrics, preoperative work-up, and perioperative data were retrieved. RESULTS One hundred fifteen patients (16 males and 99 females) with a mean age of 45.5 ± 1.5 years underwent revisional RYGB following either LAGB in 82 patients (71.3%) or laparoscopic sleeve gastrectomy (LSG) in 33 patients (28.7%). There was no conversion and no mortality in either group. Revisional RYGB was associated with similar early (16.5 vs 15.6%, ns) and late (42.6% vs 32.2%, ns) morbidity rates with a mean follow-up of 25.3 ± 16.6 months compared to primary laparoscopic Roux-en-Y gastric bypass. The revisional RYGB group had significantly less weight loss (mean %EWL 67.4 ± 20.7 vs 72.7 ± 22.9, p = 0.023 and mean %EBMI 68.1 ± 22 vs 78.3 ± 25.7, p = 0.01) at the time of 1 year. Improvement of comorbidities including hypertension (62.5 vs 70.5%; p > 0.05), diabetes (73.7 vs 79%; p > 0.05), and obstructive sleep apnea syndrome (100 vs 97%; p > 0.05) was similar. CONCLUSION This large case-matched study suggests that conversion of SG or AGB to RYGB is feasible with early and late comparable morbidity in an accredited center; even weight results might be inferior.
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Gonzalez-Heredia R, Sanchez-Johnsen L, Quadri P, Bindal V, Bernstein K, Masrur M, Elli E. Reduction in Medication Use for Postrobot-Assisted Roux-en-Y Gastric Bypass as a Revisional Bariatric Procedure. Bariatr Surg Pract Patient Care 2019. [DOI: 10.1089/bari.2018.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Lisa Sanchez-Johnsen
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
- Department of Psychology, University of Illinois at Chicago, Chicago, Illinois
| | - Pablo Quadri
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Vivek Bindal
- Institute of Minimal Access, Metabolic and Bariatric Surgery, Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Karen Bernstein
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Mario Masrur
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Enrique Elli
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
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Novel Technique of Distal Roux-en-Y Gastric Bypass for Insufficient Weight Loss After Primary Procedure: Personal Experience and Primary Results at 12 Months. Surg Laparosc Endosc Percutan Tech 2018; 28:e83-e87. [DOI: 10.1097/sle.0000000000000537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Common Limb Length Does Not Influence Weight Loss After Standard Laparoscopic Roux-En-Y Gastric Bypass. Obes Surg 2018; 26:1705-9. [PMID: 26660489 DOI: 10.1007/s11695-015-1992-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although Roux-en-Y gastric bypass (RYGBP) has proven its reliability over time in terms of weight loss and resolution of comorbidities, there continues to be a significant controversy in terms of used limb lengths. In the classical RYGBP, most surgeons have reported an alimentary limb length (ALL) of 100 to 150 cm and a bilio-pancreatic limb length (BPLL) of 50 to 75 cm. On the other hand, the common limb length (CLL) remains unknown in all the patients. As it is theoretically related to the level of malabsorption, CLL could influence weight loss after RYGBP. MATERIALS AND METHODS We performed a laparoscopic RYGBP in 90 patients with a mean preoperative body mass index (BMI) of 44.8. ALL and BPLL were respectively fixed at 150 and 75 cm. A systematic intraoperative measurement of CLL was performed. RESULTS As expected, we found a great variation of the jejuno-ileal length and also of the CLL. We created three subgroups of patients: one with the entire population, one excluding the super-obese patients (BMI > 50) and the third one excluding the revisions. There was no statistically significant correlation between CLL and excess BMI loss (EBMIL) at 1, 3, 6 and 12 months of follow-up in each group. We also found a linear correlation between the jejuno-ileal length and the height of individuals. CONCLUSION With a fixed 150-cm ALL and a 75-cm BPLL, there is no evidence that the anatomical variations of CLL could influence weight loss after classical RYGBP.
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Bergeat D, Lechaux D, Ghaina A, Thibault R, Bouygues V. Postoperative Outcomes of Laparoscopic Bariatric Surgery in Older Obese Patients: a Matched Case-Control Study. Obes Surg 2017; 27:1414-1422. [PMID: 28035521 DOI: 10.1007/s11695-016-2517-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic bariatric surgery (LBS) in older obese patients remains debated regarding postoperative outcomes. OBJECTIVES The aim of this case-control study is to evaluate global results of LBS in patients ≥60 years (yr) with a matched case control study. METHODS All patients ≥60 years who benefited from LBS in our center between January 2009 and January 2014 were included in this retrospective study. They were matched (1:2) to patients <40 and 40-59 years on BMI, surgical procedure and year, and history of previous LBS. Postoperative complications in the first 90 days following LBS, micronutrient and mineral deficiencies, and Bariatric Analysis and Reporting Outcome System (BAROS) were analyzed. RESULTS Fifty-five patients ≥60 year (40 sleeve gastrectomy, 14 one anastomosis gastric bypass, 1 gastric bypass revision) were matched to patients <40 year and patients 40-59 year (n = 55 each). Patients ≥60 year presented more obesity-related comorbidities at baseline. Except for bleeding complications (P = 0.01), no difference in major complication rate was observed (P = 0.43). At 24 months, %EWL was lower in older patients compared to others (76.3, 82.2 and 89.7, respectively, P = 0.009). Iron and vitamin B12 deficiencies were less prevalent in patients ≥60 year After a mean follow-up of 27 months, BAROS score (filled in by 82% of patients) was lower in patients ≥60 years (P = 0.01). CONCLUSION Despite less weight loss, postoperative complications rate, and lower BAROS results, LBS keeps an acceptable benefit-risk balance in selected older patients and should not be rejected on the sole argument of age. Additional studies are needed to assess the long-term benefits of LBS in older patients.
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Affiliation(s)
- Damien Bergeat
- Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Rennes, France.
- Université de Rennes 1, Rennes, France.
- UMR NuMeCan (Nutrition, Métabolismes, Cancer), INRA, ALICE, St Gilles, France.
| | - David Lechaux
- Service de Chirurgie Digestive, Hôpital Yves-le-Foll, Saint Brieuc, France
| | - Adil Ghaina
- Service de Chirurgie Digestive, Hôpital Yves-le-Foll, Saint Brieuc, France
| | - Ronan Thibault
- Université de Rennes 1, Rennes, France
- UMR NuMeCan (Nutrition, Métabolismes, Cancer), INRA, ALICE, St Gilles, France
- Unité de Nutrition, Service d'Endocrinologie-Diabétologie-Nutrition, INSERM U991, CHU Rennes, Université Rennes 1, F-35000, Rennes, France
| | - Vianney Bouygues
- Service de Chirurgie Digestive, Hôpital Yves-le-Foll, Saint Brieuc, France
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[Quality indicators for metabolic and bariatric surgery in Germany : Evidence-based development of an indicator panel for the quality of results, indications and structure]. Chirurg 2017; 89:4-16. [PMID: 29209749 DOI: 10.1007/s00104-017-0563-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
An expert committee was appointed by the German Society for General and Visceral Surgery to develop a panel of appropriate quality indicators to collate the quality of results, indications and structure in metabolic and bariatric surgery. This entailed assimilating the available evidence (systematic literature search), results from the national registry of the society (StuDoQ|MBE) and specific socioeconomic aspects (e. g. severely limited access to metabolic and bariatric surgery in Germany). These quality parameters were to be incorporated into the national guidelines and the rules of procedure for certification in the future. The committee concluded that mortality, MTL30 and severe complications needing intervention (Clavien-Dindo ≥ 3b) are suitable indicators to measure surgical outcome quality due to their relevance, scientific soundness and practicability. As a systematic follow-up is mandatory after bariatric surgery, a minimum follow-up quota is now required using reported quality of life data as an indicator of process quality. As intestinal bypass procedures have been shown to be superior in the treatment of type 2 diabetes, these procedures should be offered to eligible patients and also be performed. The proposed threshold values based on the results of the available literature and StuDoQ registry are to be considered as preliminary and need to be validated and adjusted if necessary in the future. The StuDoQ|MBE is considered a valuable tool to gather this information and also represents the appropriate infrastructure for the collation of relevant risk adjustors.
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Yan J, Cohen R, Aminian A. Reoperative bariatric surgery for treatment of type 2 diabetes mellitus. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.04.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Axer S, Szabo E, Näslund I. Weight loss and alterations in co-morbidities after revisional gastric bypass: A case-matched study from the Scandinavian Obesity Surgery Registry. Surg Obes Relat Dis 2017; 13:796-800. [DOI: 10.1016/j.soard.2017.01.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 01/17/2017] [Accepted: 01/20/2017] [Indexed: 01/07/2023]
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Choi Y. Comment on: Weight loss and alterations in co-morbidities after revisional gastric bypass: a case-matched study from the Scandinavian Obesity Surgery Registry. Surg Obes Relat Dis 2017; 13:801. [PMID: 28330792 DOI: 10.1016/j.soard.2017.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 02/17/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Yong Choi
- Dwight D. Eisenhower Army Medical Center Augusta, Georgia
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Evaluation of the obesity surgery mortality risk score for the prediction of postoperative complications after primary and revisional laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2016; 12:1504-1512. [PMID: 27425830 DOI: 10.1016/j.soard.2016.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 02/03/2016] [Accepted: 04/01/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND The Obesity Surgery Mortality Risk Score (OS-MRS) is a validated instrument for mortality risk prediction in patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures classifying patients into low risk (class A), intermediate risk (class B), and high risk (class C). OBJECTIVES The primary aim of this study was to evaluate the accuracy of the OS-MRS in predicting postoperative complications after LRYGB. Secondarily, the postoperative complication rate between primary and revisional LRYGB was systematically analyzed. SETTING The Obesity Center Amsterdam, located in a large teaching hospital, in Amsterdam, The Netherlands. METHODS The OS-MRS was applied to a consecutive database of patients who underwent LRYGB from November 2007 onwards. Postoperative complications were scored according to the Clavien-Dindo classification. Revisional LRYGB was separately analyzed. RESULTS LRYGB was performed in 1667 patients either as a primary (81.5%) or revisional (18.5%) procedure. The majority (n = 1371, 82.2%) were female, mean age 44.6 (standard deviation 14.4) years and mean body mass index 44.2 (6.5) kg/m2. Nine hundred and four (54.2%) were OS-MRS class A, 642 class B (38.5%), and 121 (7.3%) class C. Complications occurred in 143 (10.5%) and 44 (14.2%) patients after primary and revisional surgery, respectively. In both primary and revisional LRYGB, there was no association between complications and the OS-MRS classification. Subanalysis comparing primary with revisional LRYGB found a significant association between revisional surgery and the development of severe complications (Clavien-Dindo≥3) (P = .003) and mortality (P = .017). CONCLUSION The OS-MRS was not an accurate predictor for postoperative complications in patients who underwent primary or revisional LRYGB. As in other studies, revisional surgery is an independent risk factor for the development of severe complications.
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Revisional Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: a Systematic Review of Comparative Outcomes with Respective Primary Procedures. Obes Surg 2016; 25:1271-80. [PMID: 25893649 DOI: 10.1007/s11695-015-1670-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Though primary bariatric surgery is now firmly established as the first-line treatment for morbid obesity, this is not the case with revisional bariatric surgery. Despite proven benefits and patient demand, revisional bariatric surgery continues to attract controversy. Even though it is widely believed to be riskier and less effective than primary bariatric surgery, there is currently no systematic review in literature addressing this point. This review aims to establish outcomes after revisional bariatric surgery in comparison with those after primary bariatric surgery. Since Roux-en-Y gastric bypass or sleeve gastrectomy is currently the commonest anatomy achieved after revisional bariatric surgery, this review focuses on the outcome of revisional Roux-en-Y gastric bypass and revisional sleeve gastrectomy in comparison with respective primary procedures.
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Costa JM, Soares JB. Bariatric Analysis and Reporting Outcome System (BAROS): Toward the Uniform Assessment of Bariatric Surgery Outcomes. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 22:85-86. [PMID: 28868383 PMCID: PMC5579996 DOI: 10.1016/j.jpge.2015.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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