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Trujillo AB, Sagar D, Amaravadhi AR, Muraleedharan D, Malik MZ, Effa-Ababio K, Nsengiyumva M, Tesfaye T, Walędziak M, Różańska-Walędziak A. Incidence of Post-operative Gastro-esophageal Reflux Disorder in Patients Undergoing Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-analysis. Obes Surg 2024; 34:1874-1884. [PMID: 38483740 DOI: 10.1007/s11695-024-07163-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 04/20/2024]
Abstract
Gastroesophageal reflux disease (GERD) is a common concern following laparoscopic sleeve gastrectomy (LSG). This paper aimed to assess the incidence of reflux disease following these bariatric procedures. A literature search was conducted to identify observational studies and clinical trials reporting patients developed GERD disease after LSG. Twenty-two studies included in the analysis, involve 20,495 participants, indicated that the estimated proportion of patients who developed post-surgery GERD was 0.35 (95% CI 0.30-0.41). Subgroup analysis revealed a proportion of 0.33 (95% CI 0.27-0.38) in observational studies and 0.58 (95% CI 0.39-0.75) in clinical trials. High heterogeneity was noted across studies (I2 = 98%). Sensitivity analyses and publication bias assessments were performed to enhance the robustness of the results. Our findings highlight a moderate to high risk of developing GERD following LSG surgery.
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Affiliation(s)
| | - Drishti Sagar
- Aakash Healthcare Superspeciality Hospital, Sector-3, Dwarka, Delhi, 110075, India
| | - Amoolya Rao Amaravadhi
- Internal Medicine, Malla Reddy Institute of Medical Sciences, GHMC Quthbullapur, Jeedimetla, Hyderabad, 500055, India
| | | | | | - Kofi Effa-Ababio
- University of Texas MD Anderson Cancer Center, Holcombe Boulevard, Houston, TX, 77030-4009, USA
| | | | - Tadele Tesfaye
- CareHealth Medical Practice, Jimma Road, Addis Ababa, Ethiopia
| | - Maciej Walędziak
- Department of General, Oncologic, Metabolic, and Thoracic Surgery, Military Institute of Medicine - National Research Institute, 04-141, Warsaw, Poland.
| | - Anna Różańska-Walędziak
- Department of Human Physiology and Patophysiology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938, Warsaw, Poland
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Joseph S, Vandruff VN, Amundson JR, Che S, Zimmermann C, Ishii S, Kuchta K, Denham W, Linn J, Hedberg HM, Ujiki MB. Roux-en-Y gastric bypass versus fundoplication for gastroesophageal reflux disease in patients with obesity results in comparable outcomes. Surgery 2024; 175:587-591. [PMID: 38154997 DOI: 10.1016/j.surg.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/11/2023] [Accepted: 10/24/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass and fundoplication are effective treatments for gastroesophageal reflux disease, though the optimal procedure of choice in obesity is unknown. We hypothesize that Roux-en-Y gastric bypass is non-inferior to fundoplication for symptomatic control of gastroesophageal reflux disease in patients with obesity. METHODS We conducted a retrospective review of a prospectively maintained quality database. Patients with a body mass index ≥of 35 who presented for gastroesophageal reflux disease and subsequently underwent Roux-en-Y gastric bypass or fundoplication were included. Perioperative outcomes and pH testing data were reviewed. Patient-reported outcomes included Reflux Symptom Index, Dysphagia, Gastroesophageal Reflux Disease-Health Related Quality of Life, and Short Form-36 scores. Data were analyzed using the Wilcoxon rank sum test. RESULTS Ninety-five patients underwent fundoplication (n = 72, 75.8%) or Roux-en-Y gastric bypass (n = 23, 24.2%) during the study period. All patients saw an improvement in gastroesophageal reflux disease symptoms and overall quality of life. There were no significant differences in postoperative Reflux Symptom Index, Dysphagia, or Short-Form-36 scores. Significant differences in gastroesophageal reflux disease-Health Related Quality of Life scores were seen at preoperative, 1, 2, and 5 years postoperative (P < .05), with better symptom control in the fundoplication group. No significant difference was noted in postoperative DeMeester scores or percent time pH <4. Weight loss was significantly higher in the Roux-en-Y gastric bypass group at all postoperative time points up to 5 years (P < .05). CONCLUSION Roux-en-Y gastric bypass and fundoplication both decrease gastroesophageal reflux disease symptoms. Subjective data shows that patients undergoing Roux-en-Y gastric bypass may complain of worse symptoms compared to patients undergoing fundoplication. Objective data notes no significant difference in postoperative pH testing. Despite previous data, offering fundoplication or Roux-en-Y gastric bypass to patients with a body mass index of ≥35 kg/m2 is appropriate. The choice of surgical approach should be more directed to patient needs and desired goals at the time of the initial clinic visit.
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Affiliation(s)
- Stephanie Joseph
- Department of Surgery, Wayne State University/Detroit Medical Center, Detroit, MI; Department of Surgery, NorthShore University Health System, Evanston, IL.
| | - Vanessa N Vandruff
- Department of Surgery, NorthShore University Health System, Evanston, IL; Department of Surgery, NorthShore University HealthSystem, University of Chicago Medical Center, Chicago, IL
| | - Julia R Amundson
- Department of Surgery, NorthShore University Health System, Evanston, IL; Department of Surgery, NorthShore University HealthSystem, University of Chicago Medical Center, Chicago, IL
| | - Simon Che
- Department of Surgery, NorthShore University Health System, Evanston, IL
| | | | - Shun Ishii
- Department of Surgery, NorthShore University Health System, Evanston, IL
| | - Kristine Kuchta
- Department of Surgery, NorthShore University Health System, Evanston, IL
| | - Woody Denham
- Department of Surgery, NorthShore University Health System, Evanston, IL
| | - John Linn
- Department of Surgery, NorthShore University Health System, Evanston, IL
| | - H Mason Hedberg
- Department of Surgery, NorthShore University Health System, Evanston, IL
| | - Michael B Ujiki
- Department of Surgery, NorthShore University Health System, Evanston, IL
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Monrabal Lezama M, Bras Harriott C, Herbella FAM, Schlottmann F. Gastroesophageal Reflux Disease After Roux-en-Y Gastric Bypass: Pathophysiology and Management. J Laparoendosc Adv Surg Tech A 2024; 34:167-172. [PMID: 38153398 DOI: 10.1089/lap.2023.0289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Introduction: Patients with obesity are often affected by gastroesophageal reflux disease (GERD). Roux-en-Y gastric bypass (RYGB) is considered the ideal operation for patients with severe obesity and GERD. Although the majority of patients improve their reflux with the operation, some might persist symptomatic and others can even develop de novo GERD. The aim of this study was to determine pathophysiologic factors involved in the development of GERD after RYGB surgery and define potential treatments for this condition. Materials and Methods: Studies including patients with GERD before and after RYGB and/or analyzing possible GERD therapies were analyzed by the authors. Searches were conducted in PubMed, Cochrane Library, and Embase databases. Results: GERD can persist, worsen, or develop after RYGB. There are certain technical elements of the operation identified as potential risk factors for GERD. Medical therapy is effective in the majority of patients. Both endoscopic and surgical procedures can also help resolving GERD after RYGB. Conclusions: Although the majority of patients with GERD after RYGB can be effectively managed with medical therapy, some may require endoscopic or surgical treatment. Critical technical elements of RYGB should be considered to reduce the risk of postoperative GERD.
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Affiliation(s)
| | | | - Fernando A M Herbella
- Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Francisco Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
- Department of Surgery, University of Illinois, Chicago, Illinois, USA
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MacVicar S, Mocanu V, Jogiat U, Verhoeff K, Dang J, Birch D, Karmali S, Switzer N. Revisional bariatric surgery for gastroesophageal reflux disease: characterizing patient and procedural factors and 30-day outcomes for a retrospective cohort of 4412 patients. Surg Endosc 2024; 38:75-84. [PMID: 37907658 DOI: 10.1007/s00464-023-10500-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/24/2023] [Indexed: 11/02/2023]
Abstract
INTRODUCTION Gastroesophageal reflux disease (GERD) is a well-established potential consequence of bariatric surgery and can require revisional surgery. Our understanding of the population requiring revision is limited. In this study, we aim to characterize patients requiring revisional surgery for GERD to understand their perioperative risks and identify strategies to improve their outcomes. METHODS Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) registry, a retrospective cohort of patients who required revisional surgery for GERD in 2020 was identified. Multivariable logistic regression modelling was used to assess correlations between baseline characteristics and morbidity. RESULTS 4412 patients required revisional surgery for GERD, encompassing 24% of all conversion procedures. In most cases, patients underwent sleeve gastrectomy (SG) as their original surgery (n = 3535, 80.1%). The revisional surgery for most patients was a Roux-en-Y gastric bypass (RYGB) (n = 3722, 84.4%). Major complications occurred in 527 patients (11.9%) and 10 patients (0.23%) died within 30 days of revisional surgery. Major complications included anastomotic leak in 31 patients (0.70%) and gastrointestinal bleeding in 38 patients (0.86%). Multivariable analyses revealed that operative length, pre-operative antacid use, and RYGB were predictors of major complications. CONCLUSION GERD is the second most common indication for revisional surgery in patients who have undergone bariatric surgery. Patients who underwent SG as their initial procedure were the primary group who required revisional surgery for GERD; most underwent revision via RYGB. Further inquiry is needed to tailor operative approaches and pre-operative optimization for revisional surgery patients.
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Affiliation(s)
- Sarah MacVicar
- Department of Surgery, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, USA.
| | - Valentin Mocanu
- Department of Surgery, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, USA
| | - Uzair Jogiat
- Department of Surgery, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, USA
| | - Kevin Verhoeff
- Department of Surgery, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, USA
| | - Jerry Dang
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel Birch
- Department of Surgery, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, USA
| | - Shahzeer Karmali
- Department of Surgery, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, USA
| | - Noah Switzer
- Department of Surgery, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, USA
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Colvin JS, Jalilvand AD, Um P, Noria SF, Needleman BJ, O'Neill SM, Perry KA. Mid-term Outcomes of Nissen Fundoplication Versus Roux-en-y Gastric Bypass for Primary Management of Gastroesophageal Reflux Disease in Patients With Obesity. Surg Laparosc Endosc Percutan Tech 2023; 33:627-631. [PMID: 37671561 DOI: 10.1097/sle.0000000000001215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/18/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION The efficacy and outcomes of laparoscopic Nissen fundoplication (LNF) in patients with obesity is controversial. Specifically, concerns regarding long-term outcomes and recurrence in the setting of obesity has led to interest in laparoscopic Roux-en-Y gastric bypass (RYGB). METHODS In this retrospective cohort study, we studied patients with obesity who underwent either LNF or RYGB for gastroesophageal reflux disease. Baseline demographics, clinical variables, operative outcomes, and symptom severity scores were compared. RESULTS Baseline demographics, operative outcomes, and quality-of-life scores were similar. Proton pump inhibitor usage, quality-of-life, symptom severity scores, and satisfaction with the operation were similar between groups at mid-term follow-up. DISCUSSION RYGB and LNF produced similar improvements in disease-specific quality of life with similar rates of complications, side effects, and need for reoperation. This demonstrates that RYGB and LNF represent possible options for surgical management of gastroesophageal reflux disease in obese patients.
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Affiliation(s)
| | | | - Phoebe Um
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Sabrena F Noria
- Department of Surgery, The Ohio State University Wexner Medical Center
| | | | - Sean M O'Neill
- Division of Minimally Invasive Surgery, University of Michigan, Ann Arbor, MI
| | - Kyle A Perry
- Department of Surgery, The Ohio State University Wexner Medical Center
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Davarpanah Jazi AH, Shahabi S, Sheikhbahaei E, Tolone S, Skalli ME, Kabir A, Valizadeh R, Kermansaravi M. A systematic review and meta-analysis on GERD after OAGB: rate, treatments, and success. Expert Rev Gastroenterol Hepatol 2023; 17:1321-1332. [PMID: 38148703 DOI: 10.1080/17474124.2023.2296992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 12/15/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION This review aims to investigate the gastroesophageal reflux disease (GERD) as one of the important concerns for both surgeons and patients after one anastomosis gastric bypass (OAGB). METHOD PubMed, Scopus, Embase, Web of Science, and Cochrane were reviewed by the end of the 2021 with keywords relating to GERD, OAGB, and their equivalents. Data regarding OAGB, number of patients with GERD, treatment for GERD, endoscopy findings, the interval between GERD and OAGB were retrieved by two independent investigators. The primary effect/effect size measure was prevalence. RESULTS 40 studies examining 17,299 patients were included revealing that 2% of patients experience GERD following OAGB. Reflux after revisional OAGB is six times higher than primary OAGB. Despite being unclear, medical and surgical treatments for GERD after OAGB were used in 60% and 41% of patients with estimated success rate of 85% and 100%, respectively. CONCLUSION Based on how GERD was identified after OAGB, its rate ranged from 0 to 55%; the pooled rate of 2% is near to Roux-en-Y gastric bypass. GERD symptoms can be mild to be tolerated without medical treatment, moderate that respond to acid-reducing agents, or severe enough that are categorized as interactable and would need a surgical intervention.
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Affiliation(s)
- Amir Hossein Davarpanah Jazi
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Shahab Shahabi
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Erfan Sheikhbahaei
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Salvatore Tolone
- Division of General and Bariatric Surgery, Department of Surgery, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mehdi El Skalli
- Centre Hospitalier Universitaire Montpellier, Université de Montpellier 1, Montpellier, France
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram University Hospital, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity (IFSO), Hazrat-E Rasool University Hospital, Tehran, Iran
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Chiappetta S, de Falco N, Lainas P, Kassir R, Valizadeh R, Kermansaravi M. Safety and efficacy of Roux-en-Y gastric bypass as revisional bariatric surgery after failed anti-reflux surgery: a systematic review. Surg Obes Relat Dis 2023; 19:1317-1325. [PMID: 37507338 DOI: 10.1016/j.soard.2023.05.028] [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: 03/04/2023] [Revised: 05/06/2023] [Accepted: 05/27/2023] [Indexed: 07/30/2023]
Abstract
This systematic review evaluates the safety and efficacy of Roux-en-Y gastric bypass (RYGB) on weight loss and anti-reflux outcomes when used as a revisional bariatric surgical procedure after failed anti-reflux surgery. A systematic literature search next to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed for articles published by 30 Mar 2022. After examining 416 papers, 23 studies were included (n = 874 patients). Primary anti-reflux surgery included mainly Nissen fundoplication (16 studies). Reasons for revisional surgery included predominantly gastroesophageal reflux disease (GERD) (reported by 18 studies), obesity (reported by 6 studies), and hiatal hernia (reported by 6 studies). Interval to surgical revision was 5.58 ± 2.46 years (range, 1.5-9.4 yr). Upper endoscopy at revision was performed for all patients; esophageal manometry and pH monitoring were reported in 6 and 4 studies, respectively. Mean body mass index (BMI) at revision was 37.56 ± 5.02 kg/m2 (range, 31.4-44 kg/m2). Mean excess weight loss was 69.74% reported by 12 studies. Delta BMI reported by 7 studies was 10.41 kg/m2. The rate of perioperative complications was 16.7%, including mostly stenosis, leakage, ventral hernia, and small bowel obstruction. Mean improvement rate of GERD was 92.62% with a mean follow-up of 25.64 ± 16.59 months reported in 20 studies. RYGB seems to be an efficient surgical treatment option in failed anti-reflux procedures, but should be performed in experienced centers for selected patients, since the rate of perioperative and long-term complications must be minimized. Cooperation between bariatric and reflux surgeons is essential to offer patients with obesity and GERD the best long-term outcome.
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Affiliation(s)
- Sonja Chiappetta
- Bariatric and Metabolic Surgery Unit, Department of General Surgery, Ospedale Evangelico Betania, Naples, Italy.
| | - Nadia de Falco
- Bariatric and Metabolic Surgery Unit, Department of General Surgery, Ospedale Evangelico Betania, Naples, Italy
| | - Panagiotis Lainas
- Department of Digestive Surgery, Metropolitan Hospital, HEAL Academy, Athens, Greece; Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Paris-Saclay University, Clamart, France
| | - Radwan Kassir
- Digestive Surgery Unit, University Hospital of La Réunion -Félix Guyon Hospital, Saint-Denis, La Réunion, France; Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), INSERM, UMR 1188, Université de La Réunion, Saint Denis, France
| | | | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Mackey EE, Dore FJ, Kelly JF, Crawford AS, Cohen P, Czerniach D, Perugini R, Kelly JJ, Cherng NB. Ligamentum teres cardiopexy for post vertical sleeve gastrectomy gastroesophageal reflux. Surg Endosc 2023; 37:7247-7253. [PMID: 37407712 DOI: 10.1007/s00464-023-10239-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/11/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE Vertical sleeve gastrectomy (VSG) evolved in the early 2000s into the standalone weight loss procedure we see today. While numerous studies highlight VSG's durability for weight loss, and improvements co-morbidities such as type 2 diabetes mellitus and cardiovascular disease, patients with gastroesophageal reflux disease (GERD) have been counseled against VSG due to the concern for worsening reflux symptoms. When considering anti-reflux procedures, VSG patients are unable to undergo traditional fundoplication due to lack of gastric cardia redundancy. Magnetic sphincter augmentation lacks long-term safety data and endoscopic approaches have undetermined longitudinal benefits. Until recently, the only option for patients with a history of VSG with medically refractory GERD has been conversion to roux en Y gastric bypass (RNYGB), however, this poses other risks including marginal ulcers, internal hernias, hypoglycemia, dumping syndrome, and nutritional deficiencies. Given the risks associated with conversion to RNYGB, we have adopted the ligamentum teres cardiopexy as an option for patients with intractable GERD following VSG. METHODS A retrospective chart review was conducted of patients who had prior laparoscopic or robotic VSG and subsequently GERD symptoms refectory to pharmacological management who underwent ligamentum teres cardiopexy between 2017 and 2022. Pre-operative GERD disease burden, intraoperative cardiopexy characteristics, post-operative GERD symptomatology and changes in H2 blocker or PPI requirements were reviewed. RESULTS Of the study's 60 patients the median age was 50 years old, and 86% were female. All patients had a diagnosis of GERD through pre-operative assessments and were taking antisecretory medication. Of the 36 patients who have completed their one year follow up, 81% of patients had either a decrease in dosage or cessation of the antisecretory medication at one year following ligamentum teres cardiopexy. CONCLUSION Ligamentum teres cardiopexy is a viable alternative to RNYGB in patients with a prior vertical sleeve gastrectomy with medical refractory GERD.
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Affiliation(s)
- Emily E Mackey
- Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Fiona J Dore
- Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - John F Kelly
- Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Allison S Crawford
- Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Philip Cohen
- Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Donald Czerniach
- Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Richard Perugini
- Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - John J Kelly
- Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Nicole B Cherng
- Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA, USA.
- Division of Minimally Invasive Surgery, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
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Wong WG, Perez Holguin RA, Butt M, Rigby A, Rogers AM, Shen C. Racial Differences in Bariatric Surgical Approach: a Cross-Sectional National Inpatient Sample Analysis. Obes Surg 2022; 32:3359-3367. [PMID: 35930116 DOI: 10.1007/s11695-022-06227-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 01/08/2023]
Abstract
PURPOSE Although racial inequalities in referral and access to bariatric surgical care have been well reported, racial difference in the selection of surgical techniques is understudied. This study examined factors associated with the utilization of the two main bariatric surgical techniques: laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). MATERIALS AND METHODS The National Inpatient Sample database was queried for patients who underwent elective LSG or LRYGB for the treatment of severe obesity. Chi-square tests and multivariable logistic regression assessed associations of surgical approach with patient and facility characteristics. Sensitivity analyses examined the following body mass index (BMI) subgroups: < 40.0 kg/m2, 40.0-44.9 kg/m2, 45.0-49.9 kg/m2, and ≥ 50.0 kg/m2. RESULTS Within the final cohort (N = 86,053), 73.0% (N = 62,779) underwent LSG, and 27.0% (N = 23,274) underwent LRYGB. Patients with BMI 45.0-49.9 kg/m2 (OR = 0.85) and BMI ≥ 50.0 kg/m2 (OR = 0.80) were less likely to undergo LSG than patients with BMI 40.0-45.0 kg/m2 (all p < 0.001). However, Black (OR = 1.74) and White Hispanic patients (OR = 1.30) were more likely to undergo LSG than White non-Hispanic patients (all p < 0.005). In the BMI ≥ 50.0 kg/m2 group, Black patients were still more likely to undergo LSG compared to White non-Hispanic patients (OR = 1.69, p < 0.001), while Asians/Pacific Islanders were less likely to receive LSG than White non-Hispanic patients (OR = 0.41, p < 0.05). CONCLUSION In this observational study, we identified racial differences in the selection of common bariatric surgical approaches across various BMI categories. Future investigations are warranted to study and to promote awareness of the racial/ethnic influence in attitudes on obesity, weight loss, financial support, and surgical risks during bariatric discussions with minorities.
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Affiliation(s)
- William G Wong
- Department of General Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Rolfy A Perez Holguin
- Department of General Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Melissa Butt
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA.,Department of Public Health Sciences, Division of Health Services and Behavioral Research, Penn State College of Medicine, Hershey, PA, USA
| | - Andrea Rigby
- Division of Minimally Invasive Surgery, Department of Surgery, Penn State Health, Hershey, PA, USA
| | - Ann M Rogers
- Division of Minimally Invasive Surgery, Department of Surgery, Penn State Health, Hershey, PA, USA
| | - Chan Shen
- Department of Public Health Sciences, Division of Health Services and Behavioral Research, Penn State College of Medicine, Hershey, PA, USA. .,Division of Outcomes Research and Quality, Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA.
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10
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A Technique of Preserving Preexisting Fundoplication When Converting to Roux-en-Y Gastric Bypass. Obes Surg 2022; 32:2914-2920. [PMID: 35788953 DOI: 10.1007/s11695-022-06185-8] [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: 05/15/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND The standard surgical treatment of gastro-esophageal reflux disease (GERD) consists of either 360° (Nissen, NFP) or 270° (Toupet, TFP) fundoplication. On some occasions, such as recurrent GERD and/or severe overweight, patients may benefit from conversion to Roux-en-Y gastric bypass (RYGB), which is however technically difficult. Most techniques of conversion involve unwrapping of the fundoplication. We developed a laparoscopic technique that includes preservation of the wrap, while constructing a standard small-pouch RYGB. We describe the surgical technique and report the short-term outcomes of our technique. METHODS Consecutive patients underwent conversion of NFP to RYGB by our fundoplication preserving technique as described in surgical technique. Perioperative outcomes were assessed by analysis of the electronic patient records; progression of GERD symptoms and patient satisfaction were evaluated by an on-line questionnaire. RESULTS Fourteen patients underwent the conversion. There were no peroperative complications and no conversions. Short-term complications were registered in 4 patients (Clavien-Dindo grade 1, n = 2; grade 2, n = 1 and grade 3a, n = 1). No long-term complications were reported. None of the participants reported significant GERD symptoms Patient satisfaction was good. CONCLUSION We developed a laparoscopic technique of NFP to RYGB conversion, with preservation of fundoplication integrity, which appears to add to the safety and efficacy of the procedure.
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11
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Role of Obesity, Physical Exercise, Adipose Tissue-Skeletal Muscle Crosstalk and Molecular Advances in Barrett's Esophagus and Esophageal Adenocarcinoma. Int J Mol Sci 2022; 23:ijms23073942. [PMID: 35409299 PMCID: PMC8999972 DOI: 10.3390/ijms23073942] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 02/07/2023] Open
Abstract
Both obesity and esophageal adenocarcinoma (EAC) rates have increased sharply in the United States and Western Europe in recent years. EAC is a classic example of obesity-related cancer where the risk of EAC increases with increasing body mass index. Pathologically altered visceral fat in obesity appears to play a key role in this process. Visceral obesity may promote EAC by directly affecting gastroesophageal reflux disease and Barrett’s esophagus (BE), as well as a less reflux-dependent effect, including the release of pro-inflammatory adipokines and insulin resistance. Deregulation of adipokine production, such as the shift to an increased amount of leptin relative to “protective” adiponectin, has been implicated in the pathogenesis of BE and EAC. This review discusses not only the epidemiology and pathophysiology of obesity in BE and EAC, but also molecular alterations at the level of mRNA and proteins associated with these esophageal pathologies and the potential role of adipokines and myokines in these disorders. Particular attention is given to discussing the possible crosstalk of adipokines and myokines during exercise. It is concluded that lifestyle interventions to increase regular physical activity could be helpful as a promising strategy for preventing the development of BE and EAC.
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DuCoin C, Wasselle J, Kayastha A, Zuercher H, Wilensky A, Sujka J, Mhaskar R, Kuo P, Velanovich V. Massive Paraesophageal Hernia Repair in the Obese Patient Population: Antireflux Gastric Bypass Versus Fundoplication. J Laparoendosc Adv Surg Tech A 2022; 32:1038-1042. [PMID: 35333616 DOI: 10.1089/lap.2022.0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction: Obesity is a risk factor for gastroesophageal reflux disease (GERD) and hiatal hernia (HH). Fundoplication is the standard operation for GERD with HH. Roux-en-Y gastric bypass (RYGB) is the procedure of choice for obese patients with either GERD or a large HH, but neither are indications for RYGB. To delineate bypass surgery as a treatment option for obese patients with HH and GERD, we propose new terminology, antireflux gastric bypass (ARGB). ARGB differs from RYGB by utilizing varying efferent limb lengths for GERD treatment. We hypothesized that ARGB would have higher GERD resolution, lower HH recurrence, and improves weight loss when compared with fundoplication. Methods: A retrospective cohort study was performed, evaluating patients undergoing repair of large HH (>5 cm) with obesity from January 2013 to February 2021. The primary outcome was GERD resolution, secondary outcomes include HH recurrence and weight loss. Multivariate logistic regression adjusted for age, body mass index (BMI), and hernia size by nonlinear mixed modeling. Results: Forty patients underwent fundoplication, and 16 patients underwent ARGB. Fundoplication patients had a larger mean hernia size (8.7 × 6.3 cm versus 6.6 × 6.4 cm), whereas ARGB patients had a higher BMI (39.2 versus 34.2 kg/m2). Recurrence showed nonstatistically significant lower incidence with ARGB and no significant difference in GERD resolution. Weight (P < .0001) and excess body weight (P < .0001) loss were superior with ARGB. Conclusions: Obese patients with large HHs and GERD treated with ARGB had similar GERD resolution, lower HH recurrence, and improved weight loss when compared with fundoplication. ARGB is an acceptable treatment option for obese patients with a massive paraesophageal hernia in the setting of GERD.
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Affiliation(s)
- Christopher DuCoin
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Joseph Wasselle
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Ahan Kayastha
- University of South Florida Health Morsani College of Medicine, Tampa, Florida, USA
| | - Hannah Zuercher
- University of South Florida Health Morsani College of Medicine, Tampa, Florida, USA
| | - Adam Wilensky
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Joseph Sujka
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Paul Kuo
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Vic Velanovich
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
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13
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Eldredge TA, Bills M, Ting YY, Dimitri M, Watson MM, Harris MC, Myers JC, Bartholomeusz DL, Kiroff GK, Shenfine J. Once in a Bile — the Incidence of Bile Reflux Post-Bariatric Surgery. Obes Surg 2022; 32:1428-1438. [PMID: 35226339 PMCID: PMC8883020 DOI: 10.1007/s11695-022-05977-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/08/2022] [Accepted: 02/17/2022] [Indexed: 12/11/2022]
Abstract
Purpose Excellent metabolic improvement following one anastomosis gastric bypass (OAGB) remains compromised by the risk of esophageal bile reflux and theoretical carcinogenic potential. No ‘gold standard’ investigation exists for esophageal bile reflux, with diverse methods employed in the few studies evaluating it post-obesity surgery. As such, data on the incidence and severity of esophageal bile reflux is limited, with comparative studies lacking. This study aims to use specifically tailored biliary scintigraphy and upper gastrointestinal endoscopy protocols to evaluate esophageal bile reflux after OAGB, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Methods Fifty-eight participants underwent OAGB (20), SG (15) or RYGB (23) between November 2018 and July 2020. Pre-operative reflux symptom assessment and gastroscopy were performed and repeated post-operatively at 6 months along with biliary scintigraphy. Results Gastric reflux of bile was identified by biliary scintigraphy in 14 OAGB (70%), one RYGB (5%) and four SG participants (31%), with a mean of 2.9% (SD 1.5) reflux (% of total radioactivity). One participant (OAGB) demonstrated esophageal bile reflux. De novo macro- or microscopic gastroesophagitis occurred in 11 OAGB (58%), 8 SG (57%) and 7 RYGB (30%) participants. Thirteen participants had worsened reflux symptoms post-operatively (OAGB, 4; SG, 7; RYGB, 2). Scintigraphic esophageal bile reflux bore no statistical association with de novo gastroesophagitis or reflux symptoms. Conclusion Despite high incidence of gastric bile reflux post-OAGB, esophageal bile reflux is rare. With scarce literature of tumour development post-OAGB, frequent low-volume gastric bile reflux likely bears little clinical consequence; however, longer-term studies are needed. Clinical Trial Registry Australian New Zealand Clinical Trials Registry number ACTRN12618000806268. Graphical abstract ![]()
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Affiliation(s)
- Thomas A Eldredge
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia.
- Department of Surgery, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, Adelaide, South Australia, 5011, Australia.
| | - Madison Bills
- Department of Nuclear Medicine, PET and Bone Densitometry, Royal Adelaide Hospital and SA Medical Imaging, Adelaide, South Australia, Australia
| | - Ying Yang Ting
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
- Department of Surgery, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, Adelaide, South Australia, 5011, Australia
| | - Mikayla Dimitri
- Department of Nuclear Medicine, PET and Bone Densitometry, Royal Adelaide Hospital and SA Medical Imaging, Adelaide, South Australia, Australia
| | - Matthew M Watson
- Department of Surgery, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, Adelaide, South Australia, 5011, Australia
| | - Mark C Harris
- Department of Surgery, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, Adelaide, South Australia, 5011, Australia
| | - Jennifer C Myers
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
- Department of Surgery, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, Adelaide, South Australia, 5011, Australia
| | - Dylan L Bartholomeusz
- Department of Nuclear Medicine, PET and Bone Densitometry, Royal Adelaide Hospital and SA Medical Imaging, Adelaide, South Australia, Australia
- Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - George K Kiroff
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
- Department of Surgery, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, Adelaide, South Australia, 5011, Australia
| | - Jonathan Shenfine
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
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14
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Hussain A. Esophageal Cancer After Bariatric Surgery: Increasing Prevalence and Treatment Strategies. Obes Surg 2022; 32:1360-1361. [PMID: 35088251 DOI: 10.1007/s11695-021-05843-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/08/2021] [Accepted: 12/13/2021] [Indexed: 01/16/2023]
Affiliation(s)
- Abdulzahra Hussain
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK.
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15
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Chemaly R, Diab S, Khazen G, Al-Hajj G. Gastroesophageal Cancer After Gastric Bypass Surgeries: a Systematic Review and Meta-analysis. Obes Surg 2022; 32:1300-1311. [PMID: 35084611 DOI: 10.1007/s11695-022-05921-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 12/11/2022]
Abstract
Data comparing the occurrence of gastroesophageal cancer after gastric bypass procedures are lacking and are only available in the form of case reports. We perform in this study a systematic review and a meta-analysis of all the reported cases of gastroesophageal cancer following Roux-en-Y gastric bypass (RYGB) and loop gastric bypass-one anastomosis gastric bypass/mini gastric bypass (LGB-OAGB/MGB). We conducted a systematic review of all the reported cases in articles referenced in PubMed/Medline, Cochrane, and Scholar Google. Only cases of gastro-esophageal adenocarcinoma following RYGB or LGB-OAGB/MGB are included. Statistical analysis was done accordingly. Fifty cases were identified, along with 2 reported in this paper. Sixty-one percent (27/44) of the cancers after RYGB were in the gastric tube compared to 37.5% (3/8) after LGB-OAGB/MGB. This resulted in an odds ratio of 0.38 (p-value = 0.26), which failed to prove an increase in cancer occurrence in the gastric tube after LGB-MGB/OAGB compared to RYGB. The most common symptoms were dysphagia for cancers occurring in the gastric tube (15/30) and abdominal pain for those occurring in the excluded stomach (10/22). Twenty-nine/thirty of the cancers in the gastric tube were diagnosed by gastroscopy and 13/22 of the cancers in the excluded stomach were diagnosed by CT scan. Gastroesophageal cancers after gastric bypass procedures occur commonly in the excluded stomach where many are not identified by conventional means. Physician awareness and patient education as well as lifelong follow-up are essential for maintaining bypass surgeries on the beneficial side.
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Affiliation(s)
- Rodrigue Chemaly
- Department of General Surgery, Lebanese American University Medical Center - Rizk Hospital, LAU Gilbert and Rose-Marie Chagoury School of Medicine, Beirut, Lebanon. .,Department of General Surgery, Middle East Institute of Health (MEIH), Bsalim, Lebanon.
| | - Samer Diab
- Department of General Surgery, Lebanese American University Medical Center - Rizk Hospital, LAU Gilbert and Rose-Marie Chagoury School of Medicine, Beirut, Lebanon
| | - Georges Khazen
- Department of Computer Science and Mathematical, Lebanese American University, Beirut, Lebanon
| | - Georges Al-Hajj
- Department of General Surgery, Lebanese American University Medical Center - Rizk Hospital, LAU Gilbert and Rose-Marie Chagoury School of Medicine, Beirut, Lebanon.,Department of General Surgery, Middle East Institute of Health (MEIH), Bsalim, Lebanon
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16
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Winckelmann LA, Gribsholt SB, Madsen LR, Richelsen B, Svensson E, Jørgensen NB, Kristiansen VB, Pedersen SB. Roux-en-Y gastric bypass versus sleeve gastrectomy: nationwide data from the Danish quality registry for treatment of severe obesity. Surg Obes Relat Dis 2021; 18:511-519. [DOI: 10.1016/j.soard.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/10/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
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17
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Eskandaros MS, Abbass A, Zaid MH, Darwish AA. Laparoscopic One Anastomosis Gastric Bypass Versus Laparoscopic Roux-en-Y Gastric Bypass Effects on Pre-existing Mild-to-Moderate Gastroesophageal Reflux Disease in Patients with Obesity: a Randomized Controlled Study. Obes Surg 2021; 31:4673-4681. [PMID: 34406598 DOI: 10.1007/s11695-021-05667-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients with obesity having GERD usually undergo Roux-en-Y gastric bypass (RYGB) as the procedure of choice. However, the emergence of one anastomosis gastric bypass (OAGB) as a less time-consuming operation with fewer complications offers a potential option for these patients. STUDY DESIGN This randomized controlled trial included 80 patients (out of 457 screened) with mild-to-moderate GERD that were equally divided into two groups for OAGB and RYGB. GERD was diagnosed by 20-item questionnaire, upper endoscopy, 24-h pH monitoring, and manometry. Follow-up at 6 and 12 months was done. RESULTS No significant differences were found between the two groups regarding demographic data, comorbidities, and weight loss. OAGB had less operative time and fewer complications. Both procedures had comparable favorable effects in reducing the GERD symptoms evidenced by upper endoscopy, 24-h pH monitoring, and manometry. CONCLUSION OAGB is a promising bariatric procedure in weight loss for patients with obesity having mild-to-moderate GERD (up to grade B esophagitis by Los Angeles score). Furthermore, wide-scale studies and on more severe degrees of GERD are required to fully understand its benefits in GERD patients with obesity.
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Affiliation(s)
- Moheb S Eskandaros
- General Surgery, Faculty of Medicine, Ain Shams University, Cairo, 11591, Egypt.
| | | | - Mohamed H Zaid
- General Surgery, Faculty of Medicine, Ain Shams University, Cairo, 11591, Egypt
| | - Ahmed A Darwish
- General Surgery, Faculty of Medicine, Ain Shams University, Cairo, 11591, Egypt
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18
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Feng TY, Feng AC, Lin CH, Hsu FC, Wang SC, Chan DC, Chen TW, Hsu KF. Combined Nissen Fundoplication and Single Anastomosis Sleeve Ileal Bypass (N-SASI) as a Practical Modality of Bariatric Surgery (Video Report). Obes Surg 2021; 31:5104-5106. [PMID: 34403079 DOI: 10.1007/s11695-021-05670-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 11/26/2022]
Abstract
Sleeve gastrectomy is one of the most common bariatric procedures because of its simplicity and effectiveness. Gastro-esophageal reflux disease (GERD) symptoms and weight regain after SG are common issues. Roux-en-Y gastric bypass (RYGB) is currently the most promising approach to achieve satisfying weight loss and GERD remission; however, remnant gastric cancer is still a major concern for patients. We present a video case that individualized procedure of Nissen fundoplication, and SASI bypass (N-SASI) was designed and applied to the patient with class III obesity and severe GERD. This is a 37-year-old man with obesity (BMI: 41.8 kg/m2, categorized as class III obesity) and associated disease of stage 1 hypertension, hyperlipidemia, obstructive sleep apnea syndrome, and non-alcoholic steatohepatitis as well as severe symptoms of GERD. Esophageal-gastro-duodenal scope revealed GERD grade C, hiatal hernia, and duodenal ulcer. He refused RYGB recommended initially due to serious concern about remnant gastric cancer. We therefore performed Nissen fundoplication for his GERD symptoms and adapted SASI bypass instead of RYGB as the individualized bariatric surgery to achieve the optimal surgical outcome. The postoperative course was smooth, and the patient was discharged on postoperative day 8.
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Affiliation(s)
- Ting-Yuan Feng
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
- Division of General Surgery, Department of Surgery, Cardinal Tien Hospital, Taipei, Taiwan
| | - An-Chieh Feng
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Chien-Hua Lin
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
- IRCAD Taiwan, Department of Surgery, Chang-Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Fang-Chin Hsu
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Sheng-Chun Wang
- Division of General Surgery, Department of Surgery, Cardinal Tien Hospital, Taipei, Taiwan
| | - De-Chuan Chan
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Teng-Wei Chen
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Kuo-Feng Hsu
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.
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19
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Petrucciani N, Etienne JH, Sebastianelli L, Iannelli A. Roux-en-Y gastric bypass as revisional surgery. Minerva Surg 2021; 76:8-16. [PMID: 33754587 DOI: 10.23736/s2724-5691.20.08493-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Roux-en-Y gastric bypass (RYGB) is a worldwide-performed procedure as primary surgery, and as conversional procedure after complications and/or failure of other bariatric procedures. RYGB can be performed as revisional surgery after adjustable gastric banding, vertical banded gastroplasty, sleeve gastrectomy and one anastomosis gastric bypass. Each of these revisional procedures may be technically challenging, and accurate preoperative work-up and operative planning is required. If correctly performed, RYGB as revisional procedure is associated with satisfying outcomes and is indicated in the treatment of insufficient weight loss and postoperative complications of a primary bariatric procedure - such as chronic leak or gastroesophageal reflux after sleeve gastrectomy. The present article analyzes the most important indications, technical points and tips and tricks to safely perform RYGB as a secondary procedure.
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Affiliation(s)
- Niccolò Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Jean H Etienne
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, Sapienza University, Rome, Italy.,Université Côte d'Azur, Nice, France
| | - Lionel Sebastianelli
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, Sapienza University, Rome, Italy.,Université Côte d'Azur, Nice, France
| | - Antonio Iannelli
- Université Côte d'Azur, Nice, France - .,Unit of Digestive Surgery and Liver Transplantation, University Hospital of Nice, Nice, France.,Inserm U1065, Nice, France
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20
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Winstanley J, Ahmed S, Courtney M, Sam M, Mahawar K. One Anastomosis Gastric Bypass in Patients with Gastrooesophageal Reflux Disease and/or Hiatus Hernia. Obes Surg 2021; 31:1449-1454. [PMID: 33405182 DOI: 10.1007/s11695-020-05149-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/25/2020] [Accepted: 12/02/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION One anastomosis gastric bypass (OAGB) offers favourable weight loss outcomes and is associated with reduced morbidity and mortality when compared to other mainstream bariatric procedures. However, a randomised trial reported a conversion rate to roux-en-Y configuration (RYC) of 3.1%, and some surgeons consider the procedure unsuitable for patients with a preoperative hiatus hernia (HH) or symptoms of gastrooesophageal reflux disease (GORD). METHODS We carried out a retrospective review of patients undergoing OAGB in our institution. Included were all patients on PPI for symptoms of GORD preoperatively, as well as patients with HH or oesophagitis on preoperative endoscopy. We recorded GORD outcomes as well as rates of conversion to RYC in patients. RESULTS Medium term follow up data at 23-28 months was available for 89 patients. Of these, 63 had HH, 34 had preoperative GORD requiring PPI and 9 had confirmed oesophagitis. The conversion rate to RYC was nil (0/63) in patients with HH. At the same time, 14.7% (5/34) of patients with preop GORD on PPI required conversion to RYC at a median time interval of 16 months. In patients already on PPI preoperatively, 16/34 (47.1%) needed to continue on PPI long term. In patients with HH, 20.6% (13/63) suffered de novo GORD symptoms. CONCLUSION OAGB can be offered to patients with HH with acceptable GORD outcomes but caution is advised in patients with preoperative GORD symptoms. Larger prospective and randomised studies are required to further assess this subgroup.
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Affiliation(s)
| | - Salman Ahmed
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
| | - Michael Courtney
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
| | - Miraheal Sam
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
| | - Kamal Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
- University of Sunderland, Sunderland, UK
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21
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Abstract
Based on the available publications, the article presents an analysis of the studies on the simultaneous implementation of cholecystectomy, ventral and paraesophageal hernia repair during a bariatric intervention. If there is a clinical picture of chronic calculous cholecystitis, simultaneous cholecystectomy is justified and does not lead to a significant increase in the number of complications. In the case of asymptomatic gallstones, the optimal tactics remains controversial, both a surgical treatment and observation are possible. In the absence of gallstone disease, all patients after the surgical correction of the excess weight are prescribed ursodeoxycholic acid, while performing preventive cholecystectomy is not recommended. A simultaneous ventral hernia repair is justified only for small defects ( 10 cm) of the anterior abdominal wall. If a paraesophageal hernia is detected in patients with morbid obesity, bariatric surgery may be combined with cruroraphy.
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22
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Palma R, Angrisani L, Santonicola A, Fierro F, Iovino P. Late-term hiatal hernia after gastric bypass: an emerging problem. "What came first, the chicken or the egg?". Surg Obes Relat Dis 2020; 16:1623-1624. [PMID: 32800522 DOI: 10.1016/j.soard.2020.06.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Rossella Palma
- Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Luigi Angrisani
- Department of Public Health, "Federico II" University of Naples, Naples, Italy
| | - Antonella Santonicola
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Francesca Fierro
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Paola Iovino
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
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23
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Ahuja A, Mahawar K. Bariatric surgery in patients with gastroesophageal reflux disease and/or hiatus hernia. MINERVA CHIR 2020; 75:345-354. [PMID: 32773756 DOI: 10.23736/s0026-4733.20.08486-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Gastroesophageal reflux disease (GERD) and hiatus hernia (HH) are frequently encountered comorbidities in patients seeking bariatric and metabolic surgery (BMS) for obesity. sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB) are the three commonest bariatric procedures performed worldwide. The purpose of this review was to analyze and compare the data on outcomes of these three procedures in patients with GERD and/or HH. EVIDENCE ACQUISITION We examined published English language scientific literature available on PubMed for data comparing SG, RYGB, and OAGB with specific focus on GERD outcomes and outcomes in those with GERD and/or HH. EVIDENCE SYNTHESIS Several authors have addressed the outcome of GERD after bariatric surgery. There have been randomized control trials and comparative studies in the literature comparing the results of these procedure. But very few studies have exclusively looked into the outcome of different procedures in patients with pre-existing GERD and/or HH. In this narrative review, we evaluate pros and cons of three commonest bariatric procedures worldwide in this subgroup of patients seeking BMS. We also suggest an algorithm on the basis of our experience and the available data in scientific literature. CONCLUSIONS Though RYGB is the best anti reflux procedure it is associated with significant higher morbidity/mortality as compared to SG and OAGB. These two procedures can be used in the majority of patients with GERD and/or HH seeking BMS with an acceptance that some patients will need conversion to RYGB in the long term.
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Affiliation(s)
- Anmol Ahuja
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, New Delhi, India -
| | - Kamal Mahawar
- Bariatric Unit, Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK.,Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
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