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Dirnberger AS, Süsstrunk J, Schneider R, Poljo A, Klasen JM, Slawik M, Billeter AT, Müller-Stich BP, Peterli R, Kraljević M. Mid-Term Outcomes After Conversion Procedures Following Laparoscopic Sleeve Gastrectomy. Obes Surg 2023; 33:2679-2686. [PMID: 37515694 PMCID: PMC10435413 DOI: 10.1007/s11695-023-06734-9] [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: 05/08/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE In the long term, laparoscopic sleeve gastrectomy (SG) may be associated with insufficient weight loss (IWL), gastroesophageal reflux disease (GERD), and persistence or relapse of associated medical problems. This study's objective is to present mid-term results regarding weight loss (WL), evolution of associated medical problems, and reoperation rate of patients who underwent a conversion after SG. METHODS Retrospective single-center analysis of patients with a minimal follow-up of 2 years after conversion. RESULTS In this series of 549 SGs, 84 patients (15.3%) underwent a conversion, and 71 met inclusion criteria. They were converted to short biliopancreatic limb Roux-en-Y gastric bypass (short BPL RYGB) (n = 28, 39.4%), biliopancreatic diversion with duodenal switch (BPD/DS) (n = 19, 26.8%), long biliopancreatic limb Roux-en-Y gastric bypass (long BPL RYGB) (n = 17, 23.9%), and re-sleeve gastrectomy (RSG) (n = 7, 9.9%). Indications were GERD (n = 24, 33.8%), IWL (n = 23, 32.4%), IWL + GERD (n = 22, 31.0%), or stenosis/kinking of the sleeve (n = 2, 2.8%). The mean pre-revisional body mass index (BMI) was 38.0 ± 7.5 kg/m2. The mean follow-up time after conversion was 5.1 ± 3.1 years. The overall percentage of total weight loss (%TWL) was greatest after BPD/DS (36.6%) and long BPL RYGB (32.9%) compared to RSG (20.0%; p = 0.004; p = 0.049). In case of GERD, conversion to Roux-en-Y gastric bypass (RYGB) led to a resolution of symptoms in 79.5%. 16.9% of patients underwent an additional revisional procedure. CONCLUSION In the event of IWL after SG, conversion to BPD/DS provides a significant and sustainable additional WL. Conversion to RYGB leads to a reliable symptom control in patients suffering from GERD after SG.
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Affiliation(s)
- Amanda S Dirnberger
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
| | - Julian Süsstrunk
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
| | - Romano Schneider
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
| | - Adisa Poljo
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
| | - Jennifer M Klasen
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
| | - Marc Slawik
- Interdisciplinary Center of Nutritional and Metabolic Diseases, St. Clara Hospital, CH-4058, Basel, Switzerland
| | - Adrian T Billeter
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
| | - Beat P Müller-Stich
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
- Department of Clinical Research, University of Basel, CH-4031, Basel, Switzerland
| | - Ralph Peterli
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland.
- Department of Clinical Research, University of Basel, CH-4031, Basel, Switzerland.
| | - Marko Kraljević
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
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Bennett WC, Garbarine IC, Mostellar M, Lipman J, Sanchez-Casalongue M, Farrell T, Zhou R. Comparison of early post-operative complications in primary and revisional laparoscopic sleeve gastrectomy, gastric bypass, and duodenal switch MBSAQIP-reported cases from 2015 to 2019. Surg Endosc 2023; 37:3728-3738. [PMID: 36653536 DOI: 10.1007/s00464-022-09796-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 11/27/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) is now the most performed bariatric surgery, though gastric bypass (GB) and duodenal switch (DS) remain common, especially as conversion/revision (C/R) procedures. This analysis compared early postoperative outcomes of primary and C/R laparoscopic SG to DS and GB; and primary procedures of each vs C/R counterparts. METHODS The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) dataset was queried for SG, GB, and DS cases from 2015 to 2019. Multivariable logistic regression calculated crude and adjusted odds ratios for surgical site infection (SSI), reoperation, and readmission at 30 days in two initial comparisons: (1) primary SG vs DS or GB and (2) C/R SG vs DS or GB. A secondary analysis compared primary GS, GB, or DS with C/R counterparts. Models were adjusted for confounding demographics and comorbidities. RESULTS Of 755,968 primary cases, most were SG (72.8%), followed by GB (26.3%), then DS (0.9%). Compared to SG, GB and DS demonstrated higher odds of SSI (aOR 3.02 [2.84, 3.2]), readmission (aOR 1.97 [1.92, 2.03]), and reoperation (aOR 2.74 [2.62, 2.86]), respectively. Of 68,716 C/R cases, SG was most common (43.2%), followed by GB (37.5%), then DS (19.2%). C/R GB and DS demonstrated greater risk of SSI (aOR 2.28 [1.98, 2.62]), readmission (aOR 2.10 [1.94, 2.27]), and reoperation (aOR 2.3 [2.04, 2.59]) vs SG, respectively. C/R SG and DS demonstrated greater risk of SSI (OR 2.09 [1.66, 2.63]; 1.63 [1.24, 2.14), readmission (OR 1.13 [1.02, 1.26]), and reoperation (OR 1.27 [1.06, 1.52]; 1.58 [1.24, 2.0]), vs primary procedures. C/R DS demonstrated greater risk of SSI (OR 1.23 [1.66, 2.63]). CONCLUSIONS Early complications are comparable between GB and DS, and greater than SG. In C/R procedures, GB and DS demonstrate greater risk than SG. Overall, C/R procedures demonstrate greater risk of most, but not all, early postoperative complications.
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Affiliation(s)
- William C Bennett
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC, USA. .,Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Ian C Garbarine
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC, USA.,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Murphy Mostellar
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC, USA
| | - Jeffrey Lipman
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC, USA.,Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA.,Hernia Center, NYC Health + Hospitals / Bellevue, New York, NY, USA
| | - Manuel Sanchez-Casalongue
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC, USA.,Rush Copley Medical Center, Rush University, Aurora, IL, USA
| | - Timothy Farrell
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC, USA
| | - Randal Zhou
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC, USA.,Division of Bariatric and Minimally Invasive Surgery, Yale School of Medicine, New Haven, CT, USA
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Youk KM, Kim J, Cho YS, Park DJ. Gastric Cancer After Bariatric Surgeries. JOURNAL OF METABOLIC AND BARIATRIC SURGERY 2022; 11:20-29. [PMID: 36926673 PMCID: PMC10011677 DOI: 10.17476/jmbs.2022.11.2.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 03/18/2023]
Abstract
Bariatric surgery has been covered by medical insurance in Korea, since January 2019; and its number is steadily increasing. Representative bariatric surgeries include adjustable gastric banding, sleeve gastrectomy, and Roux-en-Y gastric bypass. Each surgical method can be applied according to the patient's condition; however, there are other issues to consider in Korea. Because of the high incidence of gastric cancer in Korea, gastroscopy is recommended every two years after the age of 40. Therefore, it is difficult to perform conventional gastroscopy after Roux-en-Y gastric bypass. In this review, the incidence of gastric cancer after representative bariatric surgery was investigated through a literature review, so that it could be used as a reference for the selection of bariatric surgery in Korea.
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Affiliation(s)
- Kang Min Youk
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jeesun Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yo-Seok Cho
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Role of Endoscopic Internal Drainage in Treating Gastro-Bronchial and Gastro-Colic Fistula After Sleeve Gastrectomy. Obes Surg 2021; 32:342-348. [PMID: 34780026 DOI: 10.1007/s11695-021-05794-z] [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: 08/30/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Gastro-bronchial and gastro-colic fistulas (GB-GC) represent a rare, but serious complication after laparoscopic sleeve gastrectomy (LSG). The aim of this study is to evaluate the efficacy of endoscopic first-line approach with endoscopic internal drainage (EID) by inserting double pigtail stents (DPS) METHODS: We retrospectively analyzed data from 40 consecutive patients referred at two tertiary centers for gastro-bronchial (N=30) and gastrocolic (N=10) fistulas following LSG. Nineteen patients previously experienced emergency surgical drainage. The mean interval between the index surgery and endoscopic fistula treatment was 265.6±521 days. RESULTS Healing of the fistulous tract was achieved in 19 patients (47.5%), with complete resolution at an average follow-up of 16 months. Mean time of treatment duration was 157.8±141 days with 5.0±2.9 endoscopic sessions. No major adverse events were registered. CONCLUSIONS Despite complete fistula healing was achieved in less than 50% of our population, EID for GB/GC fistula after LSG still represents the most conservative approach with low complications rate. Previous surgical drainage seems to be a positive prognostic factor for endoscopic healing. While the longer the interval between the index surgery and endoscopic treatment, the lower was the rate of treatment success.
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Chung Y, Park DG, Kim YJ. Endoscopic Management of Staple Line Leak after Bariatric Surgery: Surgeon's Perspective. Clin Endosc 2021; 54:805-809. [PMID: 33975425 PMCID: PMC8652167 DOI: 10.5946/ce.2020.298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/20/2021] [Indexed: 11/14/2022] Open
Abstract
Laparoscopic sleeve gastrectomy (LSG) has become a standalone primary procedure as a bariatric metabolic surgery since the early 2000s. The overall complication rate of LSG is reported to range from 2% to 15%. Staple line leakage (SLL) remains a major adverse event and occurs in approximately 1–6% of patients. Choosing the optimal treatment modality is a complex process. Clinicians must understand that nutritional support and drainage of fluid collection are essential for initial management. Conservative endoscopic management and sufficient drainage can resolve approximately 70% of SLLs. Endoscopic management of bariatric complications has been rapidly evolving in recent years and can be considered in all patients who are hemodynamically stable. We will review the available endoscopic management techniques, including stent placement (self-expanding stents and bariatric-specific stents), clipping, tissue sealant application, and internal drainage (double-pigtail stents [DPS] placement, endoscopic vacuum therapy, and septotomy). Stent placement remains the mainstream treatment for SLLs. However, healing with stents requires multiple sessions/stents and a long course of recovery. Endoscopic internal drainage is gaining popularity and has the potential to be a superior method. The importance of early intervention and combined endoscopic methods should be recognized.
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Affiliation(s)
- Yoona Chung
- Bariatric and Metabolic Surgery Center, H+ Yangji Hospital, Seoul, Korea
| | - Dae Geun Park
- Bariatric and Metabolic Surgery Center, H+ Yangji Hospital, Seoul, Korea
| | - Yong Jin Kim
- Bariatric and Metabolic Surgery Center, H+ Yangji Hospital, Seoul, Korea
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Chatterjee A, Ramanan RV, Mukhopadhyay S. Imaging Postoperative Abdominal Hernias: A Review with a Clinical Perspective. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2020. [DOI: 10.1055/s-0040-1715772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractPostoperative internal hernia is a challenging but critical diagnosis in postoperative patients presenting with acute abdomen. Postoperative internal hernias are increasingly being recognized after Roux-en-Y gastric bypass (RYGB) and bariatric surgeries. These internal hernias have a high risk of closed-loop obstruction and bowel ischemia; therefore, prompt recognition is necessary. Computed tomography (CT) is the imaging modality of choice in cases of postoperative acute abdomen. Understanding the types of postoperative internal hernia and their common imaging features on CT is crucial for the abdominal radiologist. Postoperative external hernias are usually a result of defect or weakness of the abdominal wall created because of the surgery. CT helps in the detection, delineation, diagnosis of complications, and surgical planning of an external hernia. In this article, the anatomy, pathophysiology, and CT features of common postoperative hernias are discussed. Afterreading this review, the readers should be able to (1) enumerate the common postoperative internal and external abdominal hernias, (2) explain the pathophysiology and surgical anatomy of Roux-en-Y gastric bypass-related hernia, (3) identify the common imaging features of postoperative hernia, and (4) diagnose the complications of postoperative hernias.
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Affiliation(s)
- Argha Chatterjee
- Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
| | | | - Sumit Mukhopadhyay
- Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
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Seyit H, Alis H. Five-year outcomes for laparoscopic sleeve gastrectomy from a single center in Turkey. Ann Saudi Med 2020; 40:310-315. [PMID: 32757987 PMCID: PMC7410219 DOI: 10.5144/0256-4947.2020.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There are no long-term results for laparoscopic sleeve gastrectomy (LSG) from Turkey. OBJECTIVES Assess the outcomes of LSG at 5 years. DESIGN Retrospective. SETTING Training and research hospital. PATIENTS AND METHODS The study included patients with LSG performed from August 2012 to December 2013. The data was prospectively collected with the aim of providing 5-year outcomes. MAIN OUTCOME MEASURES Changes in percentage excessive weight loss (%EWI) and BMI. Changes in the pharmacological treatment status of patients with type 2 diabetes mellitus and hypertension. SAMPLE SIZE AND CHARACTERISTICS 120 patients (89 female) completed follow up; mean age 37 years (range, 19-63 years), mean preoperative BMI 48.3 kg/m2 (range 40-80.4 kg/m2). RESULTS After a mean 5.6-year follow-up, the mean (SD) postoperative weight loss was 43.5 (11.8) kg and the mean (SD) BMI loss was 16.1 (4.4). The mean %EWL value was 62.9% (range, 30-101%). Most patients (87.5%, n=105) achieved satisfactory %EWL values. The major complication rate was 6.6%. After surgery, 74.2% of patients taking medication for hypertension were able to stop treatment, while 12.9% reduced the dose, of patients that took medication for diabetes, all had a dosage reduction. CONCLUSIONS We showed that LSG is an acceptable bariatric procedure, but in the long-term there may be weight gain and frequent reflux symptoms. We think renewed weight gain can be partially prevented by close clinical follow-up. There is a need for long-term randomized controlled studies with long-term follow-up to clearly define the indications for LSG. LIMITATIONS Retrospective, incomplete clinical visits, GERD symptoms not objectively assessed. CONFLICT OF INTEREST None.
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Affiliation(s)
- Hakan Seyit
- From the Department of General Surgery, Bakirkoy Dr. SadiKonuk Training and Research Hospital, Istanbul, Turkey
| | - Halil Alis
- From the Department of General Surgery, Istanbul Aydin University Medical School, Istanbul, Turkey
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Martines G, Musa N, Aquilino F, Picciariello A, Altomare DF. Sleeve Gastrectomy Combined with Nissen Fundoplication as a Single Surgical Procedure, Is It Really Safe? A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923543. [PMID: 32572016 PMCID: PMC7327731 DOI: 10.12659/ajcr.923543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Patient: Male, 40-year-old Final Diagnosis: Gastric perforation Symptoms: Abdominal pain Medication:— Clinical Procedure: Sleeve gastrectomy Nissen fundoplication Specialty: Surgery
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Affiliation(s)
- Gennaro Martines
- Department of General Surgery, "M. Rubino" University Hospital Polyclinic of Bari, Bari, Italy
| | - Nicola Musa
- Department of General Surgery, "M. Rubino" University Hospital Polyclinic of Bari, Bari, Italy
| | - Fabrizio Aquilino
- Department of General Surgery, "M. Rubino" University Hospital Polyclinic of Bari, Bari, Italy
| | - Arcangelo Picciariello
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
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Bhalla S, Yu JX, Varban OA, Schulman AR. Upper gastrointestinal series after sleeve gastrectomy is unnecessary to evaluate for gastric sleeve stenosis. Surg Endosc 2020; 35:631-635. [DOI: 10.1007/s00464-020-07426-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/10/2020] [Indexed: 01/07/2023]
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Lewis KH, Arterburn DE, Callaway K, Zhang F, Argetsinger S, Wallace J, Fernandez A, Ross-Degnan D, Wharam JF. Risk of Operative and Nonoperative Interventions Up to 4 Years After Roux-en-Y Gastric Bypass vs Vertical Sleeve Gastrectomy in a Nationwide US Commercial Insurance Claims Database. JAMA Netw Open 2019; 2:e1917603. [PMID: 31851344 PMCID: PMC6991222 DOI: 10.1001/jamanetworkopen.2019.17603] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
IMPORTANCE There are few nationwide studies comparing the risk of reintervention after contemporary bariatric procedures. OBJECTIVE To compare the risk of intervention after Roux-en-Y gastric bypass (RYGB) vs vertical sleeve gastrectomy (VSG). DESIGN, SETTING, AND PARTICIPANTS This cohort study used a nationwide US commercial insurance claims database. Adults aged 18 to 64 years who underwent a first RYGB or VSG procedure between January 1, 2010, and June 30, 2017, were matched on US region, year of surgery, most recent presurgery body mass index (BMI) category (based on diagnosis codes), and baseline type 2 diabetes. The prematch pool included 4496 patients undergoing RYGB and 8627 patients undergoing VSG, and the final weighted matched sample included 4476 patients undergoing RYGB and 8551 patients undergoing VSG. EXPOSURES Bariatric surgery procedure type (RYGB vs VSG). MAIN OUTCOMES AND MEASURES The primary outcome was any abdominal operative intervention after the index procedure. Secondary outcomes included the following subtypes of operative intervention: biliary procedures, abdominal wall hernia repair, bariatric conversion or revision, and other abdominal operations. Nonoperative outcomes included endoscopy and enteral access. Time to first event was compared using multivariable Cox proportional hazards regression modeling. RESULTS Among 13 027 patients, the mean (SD) age was 44.4 (10.3) years, and 74.1% were female; 13.7% had a preoperative BMI between 30 and 39.9, 45.8% had a preoperative BMI between 40 and 49.9, and 24.2% had a preoperative BMI of at least 50. Patients were followed up for up to 4 years after surgery (median, 1.6 years; interquartile range, 0.7-3.2 years), with 41.9% having at least 2 years of follow-up and 16.3% having at least 4 years of follow-up. Patients undergoing VSG were less likely to have any subsequent operative intervention than matched patients undergoing RYGB (adjusted hazard ratio [aHR], 0.80; 95% CI, 0.72-0.89) and similarly were less likely to undergo biliary procedures (aHR, 0.77; 95% CI, 0.67-0.90), abdominal wall hernia repair (aHR, 0.60; 95% CI, 0.47-0.75), other abdominal operations (aHR, 0.71; 95% CI, 0.61-0.82), and endoscopy (aHR, 0.54; 95% CI, 0.49-0.59) or have enteral access placed (aHR, 0.58; 95% CI, 0.39-0.86). Patients undergoing VSG were more likely to undergo bariatric conversion or revision (aHR, 1.83; 95% CI, 1.19-2.80). CONCLUSIONS AND RELEVANCE In this nationwide study, patients undergoing VSG appeared to be less likely than matched patients undergoing RYGB to experience subsequent abdominal operative interventions, except for bariatric conversion or revision procedures. Patients considering bariatric surgery should be aware of the increased risk of subsequent procedures associated with RYGB vs VSG as part of shared decision-making around procedure choice.
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Affiliation(s)
- Kristina H. Lewis
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David E. Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Katherine Callaway
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts
| | - Fang Zhang
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts
| | - Stephanie Argetsinger
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts
| | - Jamie Wallace
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts
| | - Adolfo Fernandez
- Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Dennis Ross-Degnan
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts
| | - James F. Wharam
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts
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Musella M, Cantoni V, Green R, Acampa W, Velotti N, Maietta P, Cuocolo A. Efficacy of Postoperative Upper Gastrointestinal Series (UGI) and Computed Tomography (CT) Scan in Bariatric Surgery: a Meta-analysis on 7516 Patients. Obes Surg 2019. [PMID: 29516397 DOI: 10.1007/s11695-018-3172-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND To demonstrate the lack of utility and efficacy of routine early postoperative upper gastrointestinal study (UGI) in obese patients undergoing bariatric surgery and to show the higher efficacy of CT scan in cases of clinical suspicion of a leakage, a meta-analysis was performed. MATERIALS AND METHODS A literature search including articles published in last 18 years was performed. For both UGI and CT scan, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. A first analysis considered overall patients, and a second analysis considered only symptomatic patients. RESULTS Starting from 1233 eligible citations, 18 articles, including 7516 patients, were left. The pooled sensitivity was 54% for UGI (95% CI 34-74) with a high heterogeneity (I2 = 99.8%, p < .001), whereas CT scan showed a pooled sensitivity of 91% (95% CI 89-93) significantly higher than sensitivity of UGI series (p < 0.01), with a high heterogeneity (I2 = 98.9%, p < .001). In symptomatic patients the pooled sensitivity of UGI series was significantly lower than sensitivity of CT scan [49% (95% CI 31-68) vs 94% (95% CI 92-96), p < 0.01]. PPV showed a significant difference between UGI series and CT scan (54 vs 100%, p < 0.01). Specificity for UGI series was 98.6%, and specificity for CT scan was 99.7% (p = ns); the mean NPV was 96 and 98% for UGI series and CT scan (p = ns). CONCLUSIONS According to our results, a CT scan triggered by clinical suspicion must be considered the first-line procedure to detect a postoperative leak following primary sleeve gastrectomy or Roux-en-Y gastric bypass.
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Affiliation(s)
- Mario Musella
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy.
| | - Valeria Cantoni
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy
| | - Roberta Green
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy
| | - Wanda Acampa
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy
| | - Nunzio Velotti
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy
| | - Paola Maietta
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy
| | - Alberto Cuocolo
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - Via S. Pansini 5 Buildings 10/12, 80131, Naples, Italy
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Sousa P, Noronha Ferreira C, Coutinho J, Carepa F, Rosa R, Barão A, Marques Ferreira C, Girao J, Ruivo A, Bicha Castelo H, Lopes J, Almeida A, Carrilho Ribeiro L, Velosa J. Fistula Recurrence: A Clinical Reality after Successful Endoscopic Closure of Laparoscopic Sleeve Gastrectomy Fistulas. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2019; 26:242-250. [PMID: 31328138 DOI: 10.1159/000492637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/31/2018] [Indexed: 11/19/2022]
Abstract
Background and Aims Laparoscopic sleeve gastrectomy (LSG)-related fistulas are important and potentially fatal complications. We aimed at determining the incidence, predictive factors, and management of recurrence of post-LSG fistulas. Methods This is a retrospective cohort study of 12 consecutive patients with LSG fistulas managed endoscopically between 2008 and 2013. We analyzed factors associated with recurrence of post-LSG fistulas and the efficacy of a primarily endoscopic approach to manage fistula recurrence. Results The average age at fistula detection after LSG was 43.3 ± 10.9 years, and 10 (83%) patients were female. The median interval between surgery and initial fistula detection was 14 (4-145) days. Fistulas were located at the gastric cardia in 9/12 patients. A median of 4 (1-10) endoscopies were performed per patient until all fistulas were successfully closed. The median follow-up was 30.5 (15-72) months. Fistula recurrence was detected in 3 (25%) female patients with an average age of 31.7 ± 7.9 years after a median of 119 (50-205) days of the initial fistula closure. Fistulas in all 3 patients recurred at the gastric cardia and were successfully managed endoscopically. There was a second recurrence in 1 patient after 6 months, and she was re-operated with anastomosis of a jejunal loop at the site of the fistula orifice at the gastric cardia. We did not find any factors at initial fistula detection that were significantly associated with fistula recurrence. There were no deaths related to initial fistula after LSG and fistula recurrence. Conclusions A primarily endoscopic approach is an effective and safe method for the management of fistulas after LSG. Fistula recurrence occurred in 25% of patients and was managed endoscopically. Key Messages Although we could not define predictive factors of post-LSG fistula recurrence, it is a clinical reality and can be managed endoscopically.
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Affiliation(s)
- Patricia Sousa
- Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Carlos Noronha Ferreira
- Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - João Coutinho
- Serviço de Cirurgia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Fátima Carepa
- Serviço de Cirurgia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Rosário Rosa
- Serviço de Cirurgia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Andreia Barão
- Serviço de Cirurgia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Carlos Marques Ferreira
- Serviço de Cirurgia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - José Girao
- Serviço de Cirurgia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - António Ruivo
- Serviço de Cirurgia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Henrique Bicha Castelo
- Serviço de Cirurgia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - João Lopes
- Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Amélia Almeida
- Serviço de Anestesiologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Luís Carrilho Ribeiro
- Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - José Velosa
- Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
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Metabolic Surgery: Weight Loss, Diabetes, and Beyond. J Am Coll Cardiol 2019; 71:670-687. [PMID: 29420964 DOI: 10.1016/j.jacc.2017.12.014] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/13/2017] [Accepted: 12/15/2017] [Indexed: 12/16/2022]
Abstract
The alarming rise in the worldwide prevalence of obesity is paralleled by an increasing burden of type 2 diabetes mellitus. Metabolic surgery is the most effective means of obtaining substantial and durable weight loss in individuals with obesity. Randomized trials have recently shown the superiority of surgery over medical treatment alone in achieving improved glycemic control, as well as a reduction in cardiovascular risk factors. The mechanisms seem to extend beyond the magnitude of weight loss alone and include improvements in incretin profiles, insulin secretion, and insulin sensitivity. Moreover, observational data suggest that the reduction in cardiovascular risk factors translates to better patient outcomes. This review describes commonly used metabolic surgical procedures and their current indications and summarizes the evidence related to weight loss and glycemic outcomes. It further examines their potential effects on cardiovascular outcomes and mortality and discusses future perspectives.
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One Anastomosis Gastric Bypass in Morbidly Obese Patients with BMI ≥ 50 kg/m2: a Systematic Review Comparing It with Roux-En-Y Gastric Bypass and Sleeve Gastrectomy. Obes Surg 2019; 29:3039-3046. [DOI: 10.1007/s11695-019-04034-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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15
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Gagner M, Kemmeter P. Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review. Surg Endosc 2019; 34:396-407. [PMID: 30993513 PMCID: PMC6946737 DOI: 10.1007/s00464-019-06782-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/04/2019] [Indexed: 12/19/2022]
Abstract
Background Staple-line leaks following laparoscopic sleeve gastrectomy (LSG) remain a concerning complication. Staple-line buttressing is largely adopted as an acceptable reinforcement but data regarding leaks have been equivocal. This study compared staple-line leaks in five reinforcement options during LSG: no reinforcement (NO-SLR), oversewing (suture), nonabsorbable bovine pericardial strips (BPS), tissue sealant or fibrin glue (Seal), or absorbable polymer membrane (APM). Methods This systematic review study of articles published between 2012 and 2016 regarding LSG leak rates aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Variables of interest included leak rates, bleeding, and complications in addition to surgical and population parameters. An independent Fisher’s exact test was used to compare the number of patients with and without leaks for the different reinforcement options. Results Of the 1633 articles identified, 148 met inclusion criteria and represented 40,653 patients. Differences in age (older in APM; p = 0.001), starting body mass index (lower in Suture; p = 0.008), and distance from pylorus (closer in BPS; p = 0.04) were observed between groups, but mean bougie size was equivalent. The overall leak rate of 1.5% (607 leaks) ranged from 0.7% for APM (significantly lower than all groups; p ≤ 0.007 for next lowest leak rate) to 2.7% (BPS). Conclusions This systematic review of staple-line leaks following LSG demonstrated a significantly lower rate using APM staple-line reinforcement as compared to oversewing, use of sealants, BPS reinforcement, or no reinforcement. Variation in surgical technique may also contribute to leak rates. Electronic supplementary material The online version of this article (10.1007/s00464-019-06782-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michel Gagner
- Department of Surgery, Hopital du Sacré Coeur, 315 Place D’Youville, Suite 191, Montréal, QC H2Y 0A4 Canada
- Herbert Wertheim School of Medicine, Florida International University, Miami, FL USA
- Westmount Square Surgical Center, Westmount, QC Canada
| | - Paul Kemmeter
- Department of Surgery, Mercy Health Saint Mary’s, 2060 E Paris Ave SE #100, Grand Rapids, MI USA
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Pareek M, Bhatt DL, Schiavon CA, Schauer PR. Metabolic Surgery for Hypertension in Patients With Obesity. Circ Res 2019; 124:1009-1024. [DOI: 10.1161/circresaha.118.313320] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Manan Pareek
- From the Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (M.P., D.L.B.)
- Department of Cardiology, Nephrology, and Endocrinology, North Zealand Hospital, Hillerød, Denmark (M.P.)
| | - Deepak L. Bhatt
- From the Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (M.P., D.L.B.)
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Rates of reoperation and nonoperative intervention within 30 days of bariatric surgery. Surg Obes Relat Dis 2019; 15:431-440. [DOI: 10.1016/j.soard.2018.12.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/29/2018] [Accepted: 12/20/2018] [Indexed: 01/06/2023]
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18
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Mizrahi I, Abubeih A, Rachmuth J, Plotkin Y, Beglaibter N, Grinbaum R, Greenstein I, Cohain NL. Routine Upper Gastrointestinal Fluoroscopy Before Laparoscopic Sleeve Gastrectomy: Is It Necessary? Obes Surg 2019; 29:1704-1708. [DOI: 10.1007/s11695-019-03777-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Basbug A, Ellibeş Kaya A, Dogan S, Pehlivan M, Goynumer G. Does pregnancy interval after laparoscopic sleeve gastrectomy affect maternal and perinatal outcomes? J Matern Fetal Neonatal Med 2018; 32:3764-3770. [PMID: 29712482 DOI: 10.1080/14767058.2018.1471678] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: Obesity is a global health epidemic and is associated with many maternal and neonatal complications. Laparoscopic sleeve gastrectomy (LSG) is among the surgical treatments for obesity. The appropriate timing of pregnancy following LSG remains controversial and few studies have evaluated this public health issue. Objective: To evaluate the effect of pregnancy timing after LSG on maternal and perinatal outcomes. Study design: We performed a retrospective observational study of 23 pregnant women who underwent LSG at a tertiary hospital in Turkey. Women who became pregnant within 18 months of undergoing LSG were included in the early pregnancy after LSG group, and those who became pregnant after 18 months were included the late pregnancy after LSG group. Maternal and perinatal outcomes were evaluated, including gestational diabetes mellitus (GDM), pregnancy-associated hypertensive disorders, preterm birth, mode of delivery, small and large for gestational age births (small for gestational age (SGA), large for gestational age (LGA)), birth injury, and congenital malformations. Results: Body mass index (BMI) at conception was higher in the early pregnancy after LSG group than in the late pregnancy after LSG group (30.48 versus 27.25, respectively; p = .03). Pregnancy interval after LSG did not impact maternal-fetal complications or mode of delivery. After a 75 g oral glucose tolerance test (OGTT) for GDM, 75% (n = 6) of the early pregnancy group presented with early dumping syndrome, compared to only 13.3% (n = 2) of the late pregnancy after LSG group (p = .009). Conclusions: LSG may reduce obesity-related gestational complications, such as GDM and LGA. The interval between LSG and conception did not impact maternal or neonatal outcomes. Screening for GDM can result in dumping syndrome in pregnancies after LSG.
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Affiliation(s)
- Alper Basbug
- a Department of Obstetrics and Gynecology , Duzce University, Faculty of Medicine , Duzce , Turkey
| | - Aşkı Ellibeş Kaya
- a Department of Obstetrics and Gynecology , Duzce University, Faculty of Medicine , Duzce , Turkey
| | - Sami Dogan
- b Department of General Surgery , Duzce University, Faculty of Medicine , Duzce , Turkey
| | - Mevlut Pehlivan
- b Department of General Surgery , Duzce University, Faculty of Medicine , Duzce , Turkey
| | - Gokhan Goynumer
- c Department of Obstetrics and Gynecology , SB Istanbul Medeniyet University Goztepe Education and Research Hospital , Istanbul , Turkey
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Belligoli A, Sanna M, Serra R, Fabris R, Pra' CD, Conci S, Fioretto P, Prevedello L, Foletto M, Vettor R, Busetto L. Incidence and Predictors of Hypoglycemia 1 Year After Laparoscopic Sleeve Gastrectomy. Obes Surg 2018; 27:3179-3186. [PMID: 28547566 DOI: 10.1007/s11695-017-2742-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Hypoglycemia is a known adverse event following gastric bypass. The incidence of hypoglycemia after laparoscopic sleeve gastrectomy (LSG) is still under investigation. The aim of our study was to verify the presence of oral glucose tolerance test (OGTT)-related hypoglycemia after LSG and to identify any baseline predictors of its occurrence. METHODS We analyzed 197 consecutive non-diabetic morbid obese patients that underwent LSG. All patients were studied before and 12 months after LSG. Evaluation included anthropometric parameters, 3-h OGTT for blood glucose (BG), insulin and c-peptide, lipid profile, interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), highly sensitive C-reactive protein (hsCRP), and leptin. Hypoglycemia was defined as BG ≤ 2.7 mmol/l. RESULTS After surgery, 180 patients completed the OGTT. Eleven patients did not complete the test for gastric intolerance, and in six patients, the test was stopped earlier for the onset of severe symptomatic hypoglycemia. Of the patients, 61/186 (32.8%) had at least one OGTT-related hypoglycemia. The highest frequency of hypoglycemic events occurred 150' after glucose load (20.2%). At baseline, patients with hypoglycemic events after surgery (Hypo) were younger (40 ± 11 vs 46 ± 10 years; p < 0.001), less obese (BMI 46 ± 5.7 vs 48.4 ± 7.9 kg/m2; p < 0.05), and had a worse lipid profile as compared to patients without hypoglycemic events (N-Hypo). Moreover, after LSG, Hypo patients compared with N-Hypo presented a higher weight loss (%EBMIL 80 ± 20 vs 62 ± 21%; p < 0.001). Low age, low fasting glucose, and high triglyceride levels before LSG were independent predictors of hypoglycemia development after surgery (r 2 = 0.131). CONCLUSION These findings confirm the high incidence of post-prandial hypoglycemia 1 year after LSG. Hypoglycemia is more frequent in younger patients with lower fasting glucose and higher triglyceride levels before surgery.
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Affiliation(s)
- Anna Belligoli
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padova, Padova, Italy. .,Clinica Medica 3, Azienda Ospedaliera di Padova, Via Giustiniani 2, 35100, Padova, Italy.
| | - Marta Sanna
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padova, Padova, Italy
| | - Roberto Serra
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padova, Padova, Italy
| | - Roberto Fabris
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padova, Padova, Italy
| | - Chiara Dal Pra'
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padova, Padova, Italy
| | - Scilla Conci
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padova, Padova, Italy
| | - Paola Fioretto
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padova, Padova, Italy
| | - Luca Prevedello
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padova, Padova, Italy
| | - Mirto Foletto
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padova, Padova, Italy
| | - Roberto Vettor
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padova, Padova, Italy
| | - Luca Busetto
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padova, Padova, Italy
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Complications Following the Mini/One Anastomosis Gastric Bypass (MGB/OAGB): a Multi-institutional Survey on 2678 Patients with a Mid-term (5 Years) Follow-up. Obes Surg 2018; 27:2956-2967. [PMID: 28569357 DOI: 10.1007/s11695-017-2726-2] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND In recent years, several articles have reported considerable results with the Mini/One Anastomosis Gastric Bypass (MGB/OAGB) in terms of both weight loss and resolution of comorbidities. Despite those positive reports, some controversies still limit the widespread acceptance of this procedure. Therefore, a multicenter retrospective study, with the aim to investigate complications following this procedure, has been designed. PATIENTS AND METHODS To report the complications rate following the MGB/OAGB and their management, and to assess the role of this approach in determining eventual complications related especially to the loop reconstruction, in the early and late postoperative periods, the clinical records of 2678 patients who underwent MGB/OAGB between 2006 and 2015 have been studied. RESULTS Intraoperative and early complications rates were 0.5 and 3.1%, respectively. Follow-up at 5 years was 62.6%. Late complications rate was 10.1%. A statistical correlation was found for perioperative bleeding both with operative time (p < 0.001) or a learning curve of less than 50 cases (p < 0.001). A statistical correlation was found for postoperative duodenal-gastro-esophageal reflux (DGER) with a preexisting gastro-esophageal-reflux disease (GERD) or with a gastric pouch shorter than 9 cm, (p < 0.001 and p = 0.001), respectively. An excessive weight loss correlated with a biliopancreatic limb longer than 250 cm (p < 0.001). CONCLUSIONS Our results confirm MGB/OAGB to be a reliable bariatric procedure. According to other large and long-term published series, MGB/OAGB seems to compare very favorably, in terms of complication rate, with two mainstream procedures as standard Roux-en-Y gastric bypass (RYGBP) and laparoscopic sleeve gastrectomy (LSG).
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Ruiz de Gordejuela AG, Ramos AC, Neto MG, Nora M, Torres García AJ, Sánchez Pernaute A, Gebelli JP. Live surgery courses: retrospective safety analysis after 11 editions. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2017.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Bariatric Surgery Among Obese Veterans: a Retrospective Review of Complications and Intermediate Term Results from a Single Institution. Obes Surg 2018; 26:1906-11. [PMID: 26712493 DOI: 10.1007/s11695-015-2033-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose of this study was to compare the results and complications among obese veterans undergoing sleeve gastrectomy and gastric bypass at a low-volume center. MATERIALS AND METHODS This is a retrospective review of bariatric procedures performed by a single surgeon from 2009-2013. Outcomes of interest were mortality, complications, and length of stay. Weight loss and comorbidity resolution were compared between sleeve gastrectomy (SG) and Roux-y gastric bypass (RYGB). Length of stay and distance traveled to receive services were analyzed. Distributed groups were compared with Student's t test. Welch's correction was used where variances were unequal via ANOVA. Complications were compared using Fisher's exact test. RESULTS Eighty-five patients (SG = 51, RYGB = 34) were analyzed. Postoperatively, patients were seen in clinic, contacted by phone or email, and their electronic health care records were reviewed. Average length of follow-up was 114.3 weeks. Mortality was 0 %. Complication rates were comparable between groups. The percent total weight loss was 22.6 % for the SG and 27.5 % for the RYGB (p = 0.02). The percent excess weight loss was 49 % for SG and 55 % for RYGB (p = 0.149). Percent excess body mass index (BMI) loss was 54 and 61 % (p = 0.197) for SG and RYGB, respectively. Comorbidity resolution was similar between groups except for diabetes which was superior for RYGB (p = 0.03). Veterans lived an average of 141.3 miles from our VA, and all 85 patients were able to be contacted for follow-up. CONCLUSIONS Despite long travel distances for high-risk veterans, bariatric surgery can be performed safely even at a low-volume VA hospital with acceptable morbidity and mortality and excellent follow-up. There was no difference in morbidity or mortality between patients undergoing SG vs RYGB.
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Khoraki J, Moraes MG, Neto AP, Funk LM, Greenberg JA, Campos GM. Long-term outcomes of laparoscopic adjustable gastric banding. Am J Surg 2018; 215:97-103. [DOI: 10.1016/j.amjsurg.2017.06.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/07/2017] [Accepted: 06/13/2017] [Indexed: 02/03/2023]
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The Regulations and Mechanisms of Laparoscopic Sleeve Gastrectomy (LSG) for Obesity and Type 2 Diabetes: A Systematic Review. Surg Laparosc Endosc Percutan Tech 2017; 27:e122-e126. [PMID: 28945696 DOI: 10.1097/sle.0000000000000468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Obesity and diabetes mellitus are becoming 2 of the most leading risk factors that threaten public health worldwide. Obesity is a very strong but preventable risk factor for getting type 2 diabetes. Laparoscopic sleeve gastrectomy (LSG) has been a main approach to the surgical management of morbid obesity and type 2 diabetes but its role remains undefined. Here, we overviewed the clinical outcomes and regulatory mechanisms of LSG, aiming at providing thorough theoretical supports and effective technical guidance to the pathogenesis, prognosis, treatment and prevention of type 2 diabetes with obesity. Futher more, the prospectives and main drawbacks (such as considerable heterogeneity and unicity, little comparability and relevance) of LSG are also discussed.
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Outcomes after bariatric surgery according to large databases: a systematic review. Langenbecks Arch Surg 2017; 402:885-899. [PMID: 28780622 DOI: 10.1007/s00423-017-1613-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/27/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE The rapid development of technological tools to record data allows storage of enormous datasets, often termed "big data". In the USA, three large databases have been developed to store data regarding surgical outcomes: the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) and the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). We aimed to evaluate the clinical impact of studies found in these databases concerning outcomes of bariatric surgery. METHODS We performed a systematic review using the Meta-analysis of Observational Studies in Epidemiology guidelines. Research carried out using the PubMed database identified 362 papers. All outcomes related to bariatric surgery were analysed. RESULTS Fifty-four studies, published between 2005 and February 2017, were included. These articles were divided into (1) outcomes related to surgical techniques (12 articles), (2) morbidity and mortality (12), (3) 30-day hospital readmission (10), (4) outcomes related to specific diseases (11), (5) training (2) and (6) socio-economic and ethnic observations in bariatric surgery (7). Forty-two papers were based on data from ACS-NSQIP, nine on data from NIS and three on data from MBSAQIP. CONCLUSIONS This review provides an overview of surgical management and outcomes of bariatric surgery in the USA. Large databases offer useful complementary information that could be considered external validation when strong evidence-based medicine data are lacking. They also allow us to evaluate infrequent situations for which randomized control trials are not feasible and add specific information that can complement the quality of surgical knowledge.
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Koh CY, Inaba CS, Sujatha-Bhaskar S, Hohmann S, Ponce J, Nguyen NT. Laparoscopic Adjustable Gastric Band Explantation and Implantation at Academic Centers. J Am Coll Surg 2017; 225:532-537. [PMID: 28754410 DOI: 10.1016/j.jamcollsurg.2017.06.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/02/2017] [Accepted: 06/22/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The laparoscopic adjustable gastric band (LAGB) was approved for use in the US in 2001 and has been found to be a safe and effective surgical treatment for morbid obesity. However, there is a recent trend toward reduced use of LAGB nationwide. The objective of this study was to examine the prevalence and outcomes of primary LAGB implantation compared with revision and explantation at academic centers. STUDY DESIGN Data were obtained from the Vizient database from 2007 through 2015. The ICD-9-Clinical Modification and ICD-10-Clinical Modification were used to select patients with a primary diagnosis of obesity who had undergone LAGB implantation, revision, or explantation. Prevalence and outcomes of primary LAGB implantation compared with revision or explantation were analyzed. Outcomes measures included length of stay, ICU admission, morbidity, mortality, and cost. RESULTS From 2007 through 2015, a total of 28,202 patients underwent LAGB implantation for surgical weight loss. The annual number of LAGB implantation procedures decreased steadily after 2010. In the same time period, 12,157 patients underwent LAGB explantation. In 2013, the number of LAGB explantation procedures exceeded that of implantation. Laparoscopic adjustable gastric band revision rates remained stable throughout the study period. Mean length of stay, serious morbidity, and proportion of patients requiring ICU admission were higher for gastric band revision and explantation cases compared with primary LAGB implantation cases. There was no statistically significant difference in mortality or mean cost between the 2 groups. CONCLUSIONS Since 2013, the number of gastric band explantation procedures has exceeded that of implantation procedures at academic centers. Laparoscopic adjustable gastric band revision or explantation is associated with longer length of stay, higher rate of postoperative ICU admissions, and higher overall morbidity compared with LAGB implantation.
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Affiliation(s)
- Christina Y Koh
- Department of Surgery, University of California Irvine Medical Center, Orange, CA
| | - Colette S Inaba
- Department of Surgery, University of California Irvine Medical Center, Orange, CA
| | | | - Samuel Hohmann
- Department of HealthSystems Management, Rush University, Chicago, IL; Vizient, Chicago, IL
| | - Jaime Ponce
- Bariatric Surgery Program, CHI Memorial Hospital, Chattanooga, TN
| | - Ninh T Nguyen
- Department of Surgery, University of California Irvine Medical Center, Orange, CA.
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Gadiot RPM, Biter LU, van Mil S, Zengerink HF, Apers J, Mannaerts GHH. Long-Term Results of Laparoscopic Sleeve Gastrectomy for Morbid Obesity: 5 to 8-Year Results. Obes Surg 2017; 27:59-63. [PMID: 27178407 DOI: 10.1007/s11695-016-2235-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Although long-term results of sleeve gastrectomy (LSG) remain scarce in the literature, its popularity as a stand-alone procedure has accounted for a global increase in LSG performance. In this retrospective study, the authors present 5 to 8-year follow-up results in terms of weight loss, failure/revision rate, and comorbidity resolution from a single center. MATERIALS AND METHODS A prospectively maintained database was reviewed for patients who underwent LSG between 2007 and 2010. Data analysis on weight loss, comorbid conditions, revision surgery, and mortality was conducted. RESULTS Median percentage excess BMI loss (%EBMIL) was 59.0, and 53.9 %, and median percentage total weight loss (%TWL) was 25.1, and 22.9 % at 5 and 8 years, respectively. Revision to gastric bypass due to insufficient weight loss or gastroesophageal reflux disease (GERD) was performed in 42 patients (15.2 %). Resolution of comorbid condition was achieved in 91 % of patients with obstructive sleep apnea syndrome (OSAS), 68 % of patients with type 2 diabetes (T2DM), 53 % of patients with hypertension, and 25 % of patients with dyslipedemia. Loss to follow-up rate was 45 % at 5 years, 28 % at 6 years, 23 % at 7 years, and 13 % at 8 years. CONCLUSION This study adds to the currently available data confirming the LSG to be a safe and effective procedure at long term. Data from high-volume studies are needed to establish the definite role of the LSG in the spectrum of bariatric procedures.
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Affiliation(s)
| | - L Ulas Biter
- Sint Fransiscus Gasthuis, Rotterdam, Netherlands
| | | | | | - J Apers
- Sint Fransiscus Gasthuis, Rotterdam, Netherlands
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Fegelman E, Knippenberg S, Schwiers M, Stefanidis D, Gersin KS, Scott JD, Fernandez AZ. Evaluation of a Powered Stapler System with Gripping Surface Technology on Surgical Interventions Required During Laparoscopic Sleeve Gastrectomy. J Laparoendosc Adv Surg Tech A 2016; 27:489-494. [PMID: 27991838 PMCID: PMC5421590 DOI: 10.1089/lap.2016.0513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Transection of gastric tissue during laparoscopic sleeve gastrectomy (LSG) can be challenging. Reinforcing the staple line may decrease the incidence of issues requiring intervention. Methods: The objective of this study was to compare the number of intraoperative surgical interventions for a surgical stapler and reload system with Gripping Surface Technology (GST) to standard reloads in patients who underwent LSG. Patients who underwent elective LSG were enrolled. The study was conducted in two stages. For Stage 1, procedures were performed using a powered stapler and standard reloads. For Stage 2, a reload system with GST was used. The primary endpoint was surgical interventions for bleeding and/or staple line issues during transection of the greater curvature of the stomach. Propensity score matching was applied to create two groups similar in baseline characteristics and risk factors. Results: A total of 111 subjects were enrolled across four centers. Propensity-matched procedures were completed with the standard (n = 38) or GST reloads (n = 38). The mean number of interventions in the standard group was 1.9 (1.29) versus 1.1 (1.45) in the GST group. Nonparametric comparisons were statistically significant, indicating a reduction in the distribution of interventions for GST subjects (P = .0036 for matched pair data). Tissue slippage during transection was low for both groups. Intraoperative leak testing was negative in all procedures, and no procedures were converted to open. Conclusions: Use of the GST stapling system reduces the need for staple line interventions in LSG. Both stapling systems had an acceptable safety profile.
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Affiliation(s)
| | | | | | - Dimitrios Stefanidis
- Division of Bariatric Surgery, Department of Surgery, Carolinas Healthcare System, Charlotte, North Carolina
| | - Keith S. Gersin
- Division of Bariatric Surgery, Department of Surgery, Carolinas Healthcare System, Charlotte, North Carolina
| | - John D. Scott
- Division of Bariatric and Metabolic Surgery, Greenville Health System, University of South Carolina School of Medicine—Greenville, Greenville, South Carolina
| | - Adolfo Z. Fernandez
- Department of General Surgery, Wake Forest University School of Medicine, Winston Salem, North Carolina
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Lemaître F, Léger P, Nedelcu M, Nocca D. Laparoscopic sleeve gastrectomy in the South Pacific. Retrospective evaluation of 510 patients in a single institution. Int J Surg 2016; 30:1-6. [DOI: 10.1016/j.ijsu.2016.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/13/2016] [Accepted: 04/05/2016] [Indexed: 02/06/2023]
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Chang J, Sharma G, Boules M, Brethauer S, Rodriguez J, Kroh MD. Endoscopic stents in the management of anastomotic complications after foregut surgery: new applications and techniques. Surg Obes Relat Dis 2016; 12:1373-1381. [PMID: 27317605 DOI: 10.1016/j.soard.2016.02.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 01/21/2016] [Accepted: 02/25/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Anastomotic complications after foregut surgery include leaks, fistulas, and late strictures. The management of these complications can be challenging, and it may be desirable to avoid complex reoperation. OBJECTIVES We aim to describe the indications and outcomes of the use of esophageal self-expanding metal stents in the management of postoperative anastomotic complications after foregut surgery. SETTING Tertiary-referral academic medical center. METHODS We performed a retrospective review of a prospectively managed database. Data was collected on patient demographic characteristics, work-up, intraprocedure findings, and outcomes. RESULTS From October of 2009 to November of 2014, 47 patients (mean age 51.1, 36 women and 11 men) underwent endoscopic stent placement for anastomotic complications following upper gastrointestinal (UGI) surgery. The median time from index operation to endoscopic stent placement was 52 days (range 1-5280 days). Indications were sleeve leak or stenosis, gastrojejunal leak or stenosis after Roux-en-Y gastric bypass (RYGB), pouch staple-line leak after RYGB, enterocutaneous fistula, perforation after endoscopic dilation, upper gastrointestinal bleeding after peroral endoscopic myotomy (POEM), and peptic stricture after POEM. Symptomatic improvement occurred in 76.6% of patients, and early oral intake was initiated in 66% of patients. 14 patients (29.8%) went on to require definitive surgical intervention for persistent symptomatology. The average follow-up was 354.1 days (range 25-1912 days). CONCLUSION This paper describes the use of endoscopic stent therapy for a variety of pathologies after upper gastrointestinal surgery. We demonstrate that, in the appropriate setting, it is an effective and less-invasive therapeutic approach.
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Affiliation(s)
| | | | - Mena Boules
- Cleveland Clinic Foundation, Cleveland, Ohio
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Thirty-Day Readmission After Laparoscopic Sleeve Gastrectomy—a Predictable Event? J Gastrointest Surg 2016; 20:244-52. [PMID: 26487330 DOI: 10.1007/s11605-015-2978-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/05/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Thirty-day readmission post-bariatric surgery is used as a metric for surgical quality and patient care. We sought to examine factors driving 30-day readmissions after laparoscopic sleeve gastrectomy (LSG). METHODS We reviewed 1257 LSG performed between March 2012 and June 2014. Readmitted and nonreadmitted patients were compared in their demographics, medical histories, and index hospitalizations. Multivariable regression was used to identify risk factors for readmission. RESULTS Forty-five (3.6 %) patients required 30-day readmissions. Forty-seven percent were readmitted with malaise (emesis, dehydration, abdominal pain) and 42 % with technical complications (leak, bleed, mesenteric vein thrombosis). Factors independently associated with 30-day readmission include index admission length of stay (LOS) ≥3 days (OR 2.54, CI = [1.19, 5.40]), intraoperative drain placement (OR 3.11, CI = [1.58, 6.13]), postoperative complications (OR 8.21, CI = [2.33, 28.97]), and pain at discharge (OR 8.49, CI = [2.37, 30.44]). Patients requiring 30-day readmissions were 72 times more likely to have additional readmissions by 6 months (OR 72.4, CI = [15.8, 330.5]). CONCLUSIONS The 30-day readmission rate after LSG is 3.6 %, with near equal contributions from malaise and technical complications. LOS, postoperative complications, drain placement, and pain score can aid in identifying patients at increased risk for 30-day readmissions. Patients should be educated on postoperative hydration and pain management, so readmissions can be limited to technical complications requiring acute inpatient management.
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Dogan K, Gadiot RPM, Aarts EO, Betzel B, van Laarhoven CJHM, Biter LU, Mannaerts GHH, Aufenacker TJ, Janssen IMC, Berends FJ. Effectiveness and Safety of Sleeve Gastrectomy, Gastric Bypass, and Adjustable Gastric Banding in Morbidly Obese Patients: a Multicenter, Retrospective, Matched Cohort Study. Obes Surg 2016; 25:1110-8. [PMID: 25408433 DOI: 10.1007/s11695-014-1503-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic adjustable gastric band (LAGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the most performed procedures worldwide (92 %) nowadays. However, comparative clinical trials are scarce in literature. The objective of this study was to compare the effectiveness and safety of the three most performed bariatric procedures. METHODS A multicenter, retrospective, matched cohort study was conducted. Patients were eligible for analysis when a primary procedure was performed between 2007 and 2010 in one of the two specialized bariatric centers. Primary outcome was weight loss, expressed in the percentage excess weight loss (%EWL). Secondary outcome parameters are hospital stay, complication rate, and revisional surgery. RESULTS In total, 735 patients, 245 in each group, were included for analysis. The groups were comparable for age and gender after matching. Mean postoperative follow-up was 3.1 ± 1.2 years. LAGB patients showed less %EWL compared to LSG and LRYGB at all postoperative follow-up visits. LRYGB showed a %EWL of 71 ± 20 % compared to LSG (76 ± 23 %; p=0.008) after 1-year follow-up; thereafter, no significant difference was observed. After 3 years of follow-up, LAGB showed a higher complication rate compared to LSG and LRYGB (p<0.05). Revisional surgery after LAGB was needed in 21 %, while 9 % of the LSG underwent conversion to RYGB. CONCLUSIONS LRYGB is a safe and effective treatment in morbid obese patients with good long-term outcomes. LSG seems to be an appropriate alternative as a definitive procedure, in terms of weight reduction and complication rate. LAGB is inferior to both LRYGB and LSG.
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Affiliation(s)
- Kemal Dogan
- Department of Surgery, Rijnstate Hospital, Postal number 1190, PO box 9555, 6800 TA, Arnhem, The Netherlands,
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Gagner M, Hutchinson C, Rosenthal R. Fifth International Consensus Conference: current status of sleeve gastrectomy. Surg Obes Relat Dis 2016; 12:750-756. [PMID: 27178618 DOI: 10.1016/j.soard.2016.01.022] [Citation(s) in RCA: 199] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 01/21/2016] [Accepted: 01/21/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND For the purpose of building best practice guidelines, an international expert panel was surveyed in 2014 and compared with the 2011 Sleeve Gastrectomy Consensus and with survey data culled from a general surgeon audience. OBJECTIVES To measure advancement on aspects of laparoscopic sleeve gastrectomy and identify current best practices. SETTING International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) 2014, Fifth International Summit for Laparoscopic Sleeve Gastrectomy, Montréal, Canada. METHODS In August 2014, expert surgeons (based on having performed>1000 cases) completed an online anonymous survey. Identical survey questions were then administered to general surgeon attendees. RESULTS One hundred twenty bariatric surgeons completed the expert survey, along with 103 bariatric surgeons from IFSO 2014 general surgeon audience. The following indications were endorsed: as a stand-alone procedure (97.5%); in high-risk patients (92.4%); in kidney and liver transplant candidates (91.6%); in patients with metabolic syndrome (83.8%); body mass index 30-35 with associated co-morbidities (79.8%); in patients with inflammatory bowel disease (87.4%); and in the elderly (89.1%). Significant differences existed between the expert and general surgeons groups in endorsing several contraindications: Barrett's esophagus (80.0% versus 31.3% [P<.001]), gastroesophageal reflux disease (23.3% versus 52.5% [P<.001]), hiatal hernias (11.7% versus 54.0% [P<.001]), and body mass index>60 kg/m(2) (5.0% versus 28.0% [P<.001]). Average reported weight loss outcomes 5 years postoperative were significantly higher for the expert surgeons group (P = .005), as were reported stricture (P = .001) and leakage (P = .005) rates. The following significant differences exist between 2014 and 2011 expert surgeons: Patients with gastroesophageal reflux disease should have pH and manometry study pre-laparoscopic sleeve gastrectomy (32.8% versus 50.0%; P = .033); it is important to take down the vessels before resection (88.1% versus 81.8%; P = .025); it is acceptable to buttress (81.4% versus 77.3%; P<.001); the smaller the bougie size and tighter the sleeve, the higher the incidence of leaks (78.8% versus 65.2%; P = .006). CONCLUSION This study highlights areas of new and improved best practices on various aspects of laparoscopic sleeve gastrectomy performance among experts from 2011 and 2014 and among the current general surgeon population.
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Affiliation(s)
- Michel Gagner
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; Department of Surgery, Hopital du Sacre Coeur, Montreal, Quebec, Canada
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Rebibo L, Dhahri A, Maréchal V, Fumery M, Delcenserie R, Regimbeau JM. Gastric leaks after sleeve gastrectomy: no impact on weight loss, co-morbidities, and satisfaction rates. Surg Obes Relat Dis 2015; 12:502-510. [PMID: 26656670 DOI: 10.1016/j.soard.2015.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/03/2015] [Accepted: 07/27/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND No data are available concerning the results on weight loss, correction of co-morbidities, and satisfaction rates in patients with healed gastric leak (GL) after sleeve gastrectomy (SG). OBJECTIVE Evaluate weight loss, correction of co-morbidities, and satisfaction rate of patients with healed GL after SG. SETTING University hospital, France, public practice. METHODS Between March 2004 and October 2012, all patients managed for GL after SG with a minimum of 1 year follow-up were included. These patients (GL group) were matched in terms of preoperative data and type of surgical procedure (first- or second-line SG) on a 1:2 basis with 74 patients without GL (control group) selected from a population of 899 SGs. Primary endpoint was the weight change over a 1-year period after performing SG. Secondary endpoints were GL data, co-morbidities data, and satisfaction rates 1 year after SG. RESULTS The GL group consisted of 37 patients (27 first-line SG [73%]). The mean EWL in the GL group was 52.2% and 68.8% at 6 and 12 months, whereas the mean EWL in the control group was 58.9% and 72.2%, respectively (P = .12; P = .46). No significant difference was observed between the 2 groups in terms of correction of co-morbidities. At 12 months follow-up, mean BAROS score was 6.02 in the GL group and 7.14 in the control group (P = .08). No significant difference was observed between the 2 groups in terms of the SF-36 questionnaire. CONCLUSION Despite the morbidity associated with GL, the results on weight loss, correction of co-morbidities, and satisfaction rates were similar in patients with healed GL and in patients without GL.
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Affiliation(s)
- Lionel Rebibo
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - Abdennaceur Dhahri
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - Virginie Maréchal
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - Mathurin Fumery
- Department of Psychiatry, Amiens University Hospital, Amiens, France
| | | | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France; Department of Gastro-Enterology, Amiens University Hospital, Amiens, France; Jules Verne University of Picardie, Amiens, France; Clinical Research Center, Amiens University Hospital, Amiens, France.
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Alvarenga ES, Lo Menzo E, Szomstein S, Rosenthal RJ. Safety and efficacy of 1020 consecutive laparoscopic sleeve gastrectomies performed as a primary treatment modality for morbid obesity. A single-center experience from the metabolic and bariatric surgical accreditation quality and improvement program. Surg Endosc 2015; 30:2673-8. [DOI: 10.1007/s00464-015-4548-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 09/01/2015] [Indexed: 12/19/2022]
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Long-term effects of bariatric surgery on type II diabetes, hypertension and hyperlipidemia: a meta-analysis and meta-regression study with 5-year follow-up. Obes Surg 2015; 25:397-405. [PMID: 25240392 DOI: 10.1007/s11695-014-1442-4] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The first aim of the study was to estimate weight loss and major modifiable risk factors after bariatric surgery. The second aim was to investigate the relationship between the reduction in cardiovascular risk and weight loss over time. METHODS A random effect of meta-analysis and dose-response meta-regression was used to evaluate weight loss and the risk of type II diabetes, hypertension and hyperlipidemia, 2-5 years after surgery. RESULTS A search of the literature led to the selection of 22 papers. The body mass index (BMI) at the end of the observation period was 31.7 (95 % CI = 29.7-33.7; I(2) = 6 %). The risk of type II diabetes, hypertension and hyperlipidemia decreased after bariatric surgery, with relative risks of, respectively, 0.33 (95 % CI = 0.26-0.41; I(2) = 42 %), 0.54 (95 % CI = 0.46-0.64; I(2) = 68 %) and 0.33 (95 % CI = 0.22-0.46; I(2) = 74 %). Nonlinear meta-regression revealed different patterns of risk: Hypertension risk reached a minimum when the BMI fell 10 units. The risks of all cardiovascular outcomes reached a plateau, 20-40 months after surgery. CONCLUSIONS The reduction in arterial hypertension reached a nadir earlier than the risk of diabetes and hyperlipidemia, thus indicating a possible link between weight reduction and positive hemodynamic effects.
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Thompson E, Ferrigno L, Grotts J, Knox J, Sobelman S, Thoman D, Bounoua F, Zerey M. Causes and Timing of Nonelective Reoperations after Bariatric Surgery: A Review of 1304 Cases at a Single Institution. Am Surg 2015. [DOI: 10.1177/000313481508101012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As the number of patients undergoing bariatric procedures for weight loss increases, an understanding of the causes and timing of complications requiring reoperation is critical. The aim of our study was to characterize the type and timing of nonelective (NE) reoperations in these patients. Over five years, 1304 patients undergoing index procedures were identified: 769 laparoscopic Roux-en-Y gastric bypasses (LRYGB), 301 laparoscopic sleeve gastrectomies, and 234 laparoscopic adjustable gastric bands. We identified 117 NE reoperations, which were grouped by index procedure as well as whether they occurred early (≤90 days) or late (>90 days). In the laparoscopic adjustable gastric bands group, slipped gastric band was the most common indication for early (n = 2) and late (n = 2) reoperations. Biliary disease was the most common cause for early reoperations (n = 4), and the only cause for late reoperations (n = 2) after laparoscopic sleeve gastrectomies. For LRYGB, diagnoses differed between the early and late groups, with the most common early indications being bowel obstruction (n = 8) and anastomotic leak (n = 4) of the 18 early reoperations, and internal hernia (n = 36) and biliary disease (n = 17) of the 82 late reoperations. The vast majority of NE reoperations were performed laparoscopically (92%), with conversions and primarily open procedures only occurring in the LRYGB group.
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Affiliation(s)
- Erin Thompson
- From Santa Barbara Cottage Hospital, Santa Barbara, California
| | - Lisa Ferrigno
- From Santa Barbara Cottage Hospital, Santa Barbara, California
| | - Jonathon Grotts
- From Santa Barbara Cottage Hospital, Santa Barbara, California
| | - Jenna Knox
- From Santa Barbara Cottage Hospital, Santa Barbara, California
| | | | - David Thoman
- From Santa Barbara Cottage Hospital, Santa Barbara, California
| | - Farida Bounoua
- From Santa Barbara Cottage Hospital, Santa Barbara, California
| | - Marc Zerey
- From Santa Barbara Cottage Hospital, Santa Barbara, California
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Sethi M, Magrath M, Somoza E, Parikh M, Saunders J, Ude-Welcome A, Schwack B, Kurian M, Fielding G, Ren-Fielding C. The utility of radiological upper gastrointestinal series and clinical indicators in detecting leaks after laparoscopic sleeve gastrectomy: a case-controlled study. Surg Endosc 2015; 30:2266-75. [PMID: 26416376 DOI: 10.1007/s00464-015-4516-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/06/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Leak after laparoscopic sleeve gastrectomy (LSG) often presents after hospital discharge, making timely diagnosis difficult. This study evaluates the utility of radiological upper gastrointestinal (UGI) series and clinical indicators in detecting leak after LSG. METHODS A retrospective case-controlled study of 1762 patients who underwent LSG from 2006 to 2014 was performed. All patients with radiographically confirmed leaks were included. Controls consisted of patients who underwent LSG without leak, selected using a 10:1 case-match. Data included baseline patient characteristics, surgical characteristics, and UGI series results. Clinical indicators including vital signs, SIRS criteria, and pain score were compared between patients who developed leak and controls. RESULTS Of 1762 LSG operations, 20 (1.1 %) patients developed leaks and were compared with 200 case-matched controls. Three patients developed leak during their index admission [mean = 1.3 days, range (1, 2)], while the majority (n = 17) were discharged and developed symptoms at a mean of 17.1 days [range (4, 63)] postoperatively. Patients diagnosed with leak were similar to controls in baseline and surgical characteristics. Contrast extravasation on routine postoperative UGI identified two patients with early leaks, but was negative in the remainder (89 %). Patients with both early and delayed leaks demonstrated significant clinical abnormalities at the time of leak presentation, prior to confirmatory radiographic study. In multiple regression analysis, independent clinical factors associated with leak included fever [OR 16.6, 95 % CI (4.04, 68.10), p < 0.0001], SIRS criteria [OR 7.0, 95 % CI (1.47, 33.26), p = 0.014], and pain score ≥9 [OR 19.1, 95 % CI (1.38, 263.87), p = 0.028]. CONCLUSIONS Contrast extravasation on routine postoperative radiological UGI series may detect early leaks after LSG, but the vast majority of leaks demonstrate normal results and present 2-3 weeks after discharge. Therefore, clinical indicators (specifically fever, SIRS criteria, and pain score) are the most useful factors to raise concern for leaks prior to confirmatory radiographic study and may be used as criteria to selectively obtain UGI studies after LSG.
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Affiliation(s)
- Monica Sethi
- Division of Bariatric Surgery, Department of Surgery, New York University School of Medicine, 530 First Avenue, Suite 10S, New York, NY, 10016, USA.
| | - Melissa Magrath
- Division of Bariatric Surgery, Department of Surgery, New York University School of Medicine, 530 First Avenue, Suite 10S, New York, NY, 10016, USA
| | - Eduardo Somoza
- Division of Bariatric Surgery, Department of Surgery, New York University School of Medicine, 530 First Avenue, Suite 10S, New York, NY, 10016, USA
| | - Manish Parikh
- Division of Bariatric Surgery, Department of Surgery, New York University School of Medicine, 530 First Avenue, Suite 10S, New York, NY, 10016, USA
| | - John Saunders
- Division of Bariatric Surgery, Department of Surgery, New York University School of Medicine, 530 First Avenue, Suite 10S, New York, NY, 10016, USA
| | - Aku Ude-Welcome
- Division of Bariatric Surgery, Department of Surgery, New York University School of Medicine, 530 First Avenue, Suite 10S, New York, NY, 10016, USA
| | - Bradley Schwack
- Division of Bariatric Surgery, Department of Surgery, New York University School of Medicine, 530 First Avenue, Suite 10S, New York, NY, 10016, USA
| | - Marina Kurian
- Division of Bariatric Surgery, Department of Surgery, New York University School of Medicine, 530 First Avenue, Suite 10S, New York, NY, 10016, USA
| | - George Fielding
- Division of Bariatric Surgery, Department of Surgery, New York University School of Medicine, 530 First Avenue, Suite 10S, New York, NY, 10016, USA
| | - Christine Ren-Fielding
- Division of Bariatric Surgery, Department of Surgery, New York University School of Medicine, 530 First Avenue, Suite 10S, New York, NY, 10016, USA
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Zak Y, Petrusa E, Gee DW. Laparoscopic Roux-en-Y gastric bypass patients have an increased lifetime risk of repeat operations when compared to laparoscopic sleeve gastrectomy patients. Surg Endosc 2015; 30:1833-8. [DOI: 10.1007/s00464-015-4466-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 07/22/2015] [Indexed: 01/07/2023]
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Benedix F, Benedix DD, Knoll C, Weiner R, Bruns C, Manger T, Stroh C. Are there risk factors that increase the rate of staple line leakage in patients undergoing primary sleeve gastrectomy for morbid obesity? Obes Surg 2015; 24:1610-6. [PMID: 24748473 DOI: 10.1007/s11695-014-1257-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is currently being performed with increasing frequency worldwide. It offers an excellent weight loss and resolution of comorbidities in the short term with a very low incidence of complications. However, the ever present risk of a staple line leak is still a major concern. METHODS Since 2005, data from obese patients that undergo bariatric procedures in Germany are prospectively registered in an online database and analyzed at the Institute of Quality Assurance in Surgical Medicine. For the current analysis, all patients that had undergone primary sleeve gastrectomy for morbid obesity within a 7-year period were considered. RESULTS Using the GBSR, data from 5.400 LSGs were considered for analysis. Staple line leak rate decreased during the study period from 6.5 to 1.4 %. Male gender, higher BMI, concomitant sleep apnea, conversion to laparotomy, longer operation time, use of both buttresses and oversewing, and the occurrence of intraoperative complications were associated with a significantly higher leakage rate. On multivariate analysis, operation time and year of procedure only had a significant impact on staple line leak rate. CONCLUSIONS The results of the current study demonstrated that there are factors that increase the risk of a leakage which would enable surgeons to define risk groups, to more carefully select patients, and to offer a closer follow-up during the postoperative course with early recognition and adequate treatment. All future efforts should be focused on a further reduction of serious complications to make the LSG a widely accepted and safer procedure.
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Affiliation(s)
- Frank Benedix
- Department of Surgery, University Hospital Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany,
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Sethi M, Zagzag J, Patel K, Magrath M, Somoza E, Parikh MS, Saunders JK, Ude-Welcome A, Schwack BF, Kurian MS, Fielding GA, Ren-Fielding CJ. Intraoperative leak testing has no correlation with leak after laparoscopic sleeve gastrectomy. Surg Endosc 2015; 30:883-91. [PMID: 26092015 DOI: 10.1007/s00464-015-4286-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 05/25/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Staple line leak is a serious complication of sleeve gastrectomy. Intraoperative methylene blue and air leak tests are routinely used to evaluate for leak; however, the utility of these tests is controversial. We hypothesize that the practice of routine intraoperative leak testing is unnecessary during sleeve gastrectomy. METHODS A retrospective cohort study was designed using a prospectively collected database of seven bariatric surgeons from two institutions. All patients who underwent sleeve gastrectomy from March 2012 to November 2014 were included. The performance of intraoperative leak testing and the type of test (air or methylene blue) were based on surgeon preference. Data obtained included BMI, demographics, comorbidity, presence of intraoperative leak test, result of test, and type of test. The primary outcome was leak rate between the leak test (LT) and no leak test (NLT) groups. SAS version 9.4 was used for univariate and multivariate analyses. RESULTS A total of 1550 sleeve gastrectomies were included; most were laparoscopic (99.8%), except for one converted and two open cases. Routine intraoperative leak tests were performed in 1329 (85.7%) cases, while 221 (14.3%) did not have LTs. Of the 1329 cases with LTs, there were no positive intraoperative results. Fifteen (1%) patients developed leaks, with no difference in leak rate between the LT and NLT groups (1 vs. 1%, p = 0.999). After adjusting for baseline differences between the groups with a propensity analysis, the observed lack of association between leak and intraoperative leak test remained. In this cohort, leaks presented at a mean of 17.3 days postoperatively (range 1-67 days). Two patients with staple line leaks underwent repeat intraoperative leak testing at leak presentation, and the tests remained negative. CONCLUSION Intraoperative leak testing has no correlation with leak due to laparoscopic sleeve gastrectomy and is not predictive of the later development of staple line leak.
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Affiliation(s)
- Monica Sethi
- Department of Surgery, New York University School of Medicine, 530 First Ave., Suite 10S, New York, NY, 10016, USA.
| | - Jonathan Zagzag
- Department of Surgery, New York University School of Medicine, 530 First Ave., Suite 10S, New York, NY, 10016, USA
| | - Karan Patel
- Department of Surgery, New York University School of Medicine, 530 First Ave., Suite 10S, New York, NY, 10016, USA
| | - Melissa Magrath
- Department of Surgery, New York University School of Medicine, 530 First Ave., Suite 10S, New York, NY, 10016, USA
| | - Eduardo Somoza
- Department of Surgery, New York University School of Medicine, 530 First Ave., Suite 10S, New York, NY, 10016, USA
| | - Manish S Parikh
- Department of Surgery, New York University School of Medicine, 530 First Ave., Suite 10S, New York, NY, 10016, USA
| | - John K Saunders
- Department of Surgery, New York University School of Medicine, 530 First Ave., Suite 10S, New York, NY, 10016, USA
| | - Aku Ude-Welcome
- Department of Surgery, New York University School of Medicine, 530 First Ave., Suite 10S, New York, NY, 10016, USA
| | - Bradley F Schwack
- Department of Surgery, New York University School of Medicine, 530 First Ave., Suite 10S, New York, NY, 10016, USA
| | - Marina S Kurian
- Department of Surgery, New York University School of Medicine, 530 First Ave., Suite 10S, New York, NY, 10016, USA
| | - George A Fielding
- Department of Surgery, New York University School of Medicine, 530 First Ave., Suite 10S, New York, NY, 10016, USA
| | - Christine J Ren-Fielding
- Department of Surgery, New York University School of Medicine, 530 First Ave., Suite 10S, New York, NY, 10016, USA
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Morbidity, mortality, cost, and survival estimates of gastrointestinal anastomotic leaks. J Am Coll Surg 2014; 220:195-206. [PMID: 25592468 DOI: 10.1016/j.jamcollsurg.2014.11.002] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/16/2014] [Accepted: 11/04/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Anastomotic leak, a potentially deadly postoperative occurrence, particularly interests surgeons performing gastrointestinal procedures. We investigated incidence, cost, and impact on survival of anastomotic leak in gastrointestinal surgical procedures at an academic center. STUDY DESIGN We conducted a chart review of American College of Surgeons NSQIP operative procedures with gastrointestinal anastomosis from January 1, 2003 through April 30, 2006. Each case with an American College of Surgeons NSQIP 30-day postoperative complication was systematically reviewed for evidence of anastomotic leak for 12 months after the operative date. We tracked patients for up to 10 years to determine survival. Morbidity, mortality, and cost for patients with gastrointestinal anastomotic leaks were compared with patients with anastomoses that remained intact. RESULTS Unadjusted analyses revealed significant differences between patients who had anastomotic leaks develop and those who did not: morbidity (98.0% vs. 28.4%; p < 0.0001), length of stay (13 vs. 5 days; p ≤ 0.0001), 30-day mortality (8.4% vs. 2.5%; p < 0.0001), long-term mortality (36.4% vs. 20.0%; p ≤ 0.0001), and hospital costs (chi-square [2] = 359.8; p < 0.0001). Multivariable regression demonstrated that anastomotic leak was associated with congestive heart failure (odds ratio [OR] = 31.5; 95% CI, 2.6-381.4; p = 0.007), peripheral vascular disease (OR = 4.6; 95% CI, 1.0-20.5; p = 0.048), alcohol abuse (OR = 3.7; 95% CI, 1.6-8.3; p = 0.002), steroid use (OR = 2.3; 95% CI: 1.1-5.0; p = 0.027), abnormal sodium (OR = 0.4; 95% CI, 0.2-0.7; p = 0.002), weight loss (OR = 0.2; 95% CI, 0.06-0.7; p = 0.011), and location of anastomosis: rectum (OR = 14.0; 95% CI, 2.6-75.5; p = 0.002), esophagus (OR = 13.0; 95% CI, 3.6-46.2; p < 0.0001), pancreas (OR = 12.4; 95% CI, 3.3-46.2; p < 0.0001), small intestine (OR = 6.9; 95% CI, 1.8-26.4; p = 0.005), and colon (OR = 5.2; 95% CI, 1.5-17.7; p = 0.009). CONCLUSIONS Significant morbidity, mortality, and cost accompany gastrointestinal anastomotic leaks. Patients who experience an anastomotic leak have lower rates of survival at 30 days and long term.
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Laparoscopic surgical technique for gastric fistula after sleeve gastrectomy with video. J Visc Surg 2014; 151:411-2. [DOI: 10.1016/j.jviscsurg.2014.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
BACKGROUND AND AIMS Bariatric surgery is considered the only long-lasting treatment for morbid obesity. Techniques and procedures have changed dramatically. We report on some of the major changes in the field. MATERIALS AND METHODS We reviewed some of the major changes in trends in bariatric surgery based on some landmark paper published in the literature. RESULTS We identified three major phases in the evolution of bariatric surgery. The pioneer phase was mostly characterized by discovery of weight loss procedures serendipitously from procedures done for other purposes. The second phase can be identified with the advent of laparoscopic techniques. This is considered the phase of greatest expansion of bariatric surgery. The metabolic phase derives from the improved understanding of the mechanisms of actions of the bariatric operations at the hormonal and molecular level. CONCLUSIONS Bariatric surgery has changed significantly over the years. The safety of the laparoscopic approach, along with the better understanding of the metabolic changes obtained postoperatively, has led to a more individualized approach and also an attempt to expand the indications for these procedures.
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Affiliation(s)
- E Lo Menzo
- The Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Department of General Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - S Szomstein
- The Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Department of General Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - R J Rosenthal
- The Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Department of General Surgery, Cleveland Clinic Florida, Weston, FL, USA
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Moon RC, Shah N, Teixeira AF, Jawad MA. Management of staple line leaks following sleeve gastrectomy. Surg Obes Relat Dis 2014; 11:54-9. [PMID: 25547056 DOI: 10.1016/j.soard.2014.07.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/13/2014] [Accepted: 07/06/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Leaks after laparoscopic sleeve gastrectomy (LSG) are not very frequent but are a difficult complication that can become chronic. Various treatment options have been suggested but no definitive treatment regimen has been established. The aim of our study is to report leak complications after LSG, their management, and outcomes. METHODS Between June 2008 and October 2013, a total of 539 patients underwent laparoscopic and robot-assisted laparoscopic sleeve gastrectomy at our institution. A retrospective review of a prospectively collected database was performed for all LSG patients, noting the outcomes and complications of the procedure. RESULTS Fifteen (2.8%) patients presented with a leak after LSG. The diagnosis was made at a mean of 27.2±29.9 days (range, 1-102) after LSG. Eight (53.3%) patients underwent conservative treatment initially and 6 (75.0%) of these patients required stenting as secondary treatment. Although leaks from 3 patients resolved with stenting, the other 3 required restenting and 2 eventually underwent conversion to gastric bypass. Five (33.3%) patients underwent endoscopic intervention, closing the leak with fibrin glue (n=3) or hemoclips (n=2). Two (13.3%) patients who were diagnosed with a leak immediately after LSG before discharge had their leak oversewn laparoscopically with an omental patch. Leaks in 9 (60.0%) patients did not heal after the first intervention, and the mean number of intervention required was 2.3±1.7 times (range, 1-7) for the treatment of this condition. CONCLUSION Management of leaks after LSG can be challenging. Early diagnosis and treatment is important in the management of a leak. However, it can be treated safely via various management options depending on the time of diagnosis and size of the leak.
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Affiliation(s)
- Rena C Moon
- Department of Bariatric Surgery, Orlando Regional Medical Center and Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida
| | - Nimesh Shah
- Department of Bariatric Surgery, Orlando Regional Medical Center and Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida
| | - Andre F Teixeira
- Department of Bariatric Surgery, Orlando Regional Medical Center and Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida
| | - Muhammad A Jawad
- Department of Bariatric Surgery, Orlando Regional Medical Center and Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida.
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Readmissions after bariatric surgery: Does operative technique and procedure choice matter? Surg Obes Relat Dis 2014; 10:385-6. [DOI: 10.1016/j.soard.2014.02.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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The Utility of Routine Postoperative Upper Gastrointestinal Swallow Studies Following Laparoscopic Sleeve Gastrectomy. Obes Surg 2014; 24:1415-9. [DOI: 10.1007/s11695-014-1243-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Fischer L, Nickel F, Sander J, Ernst A, Bruckner T, Herbig B, Büchler MW, Müller-Stich BP, Sandbu R. Patient expectations of bariatric surgery are gender specific--a prospective, multicenter cohort study. Surg Obes Relat Dis 2014; 10:516-23. [PMID: 24951069 DOI: 10.1016/j.soard.2014.02.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 01/29/2014] [Accepted: 02/17/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND The effect of bariatric surgery on weight loss and improvement of co-morbidities is no longer doubted. However, little attention has been given to the treatment goals from the patient's point of view (patient expectations). The objective of this study was to examine patients' expectations of bariatric surgery and identify gender differences. METHODS Bariatric patients were asked to complete a questionnaire. Statistical analysis was performed using chi-square, Pearson correlation coefficient, and Wilcoxon rank sum test. RESULTS Overall, 248 patients participated in this study (69.4% females). The male patients (45.2 yr, SD±11.1) were significantly older than the female (41.8 yr, SD±12.0; P = .04) and suffered significantly more often from diabetes, hypertension, hypercholesterolemia, and sleep apnea. One hundred thirty patients (52.4%) expected to lose at least 45 kg and 39 patients (15.7%)>70 kg. The mean expected excess weight loss was 71.8%. Females expected significantly more often that surgery alone would induce weight loss (P = .03). "Improved co-morbidity" was by far the highest ranked parameter. CONCLUSION The male bariatric surgery patients were older and suffered from more co-morbidities. Most of the patients had unrealistic weight loss goals and overestimated the effect of the surgical intervention. However, for both female and male patients, "improved co-morbidity" was the most important issue.
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Affiliation(s)
- Lars Fischer
- Department of Surgery, University of Heidelberg, Heidelberg, Germany.
| | - Felix Nickel
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - Johannes Sander
- Obesity Clinic, Schoen Klinik Hamburg Eilbek, Hamburg, Germany
| | - Alexander Ernst
- Department of General and Visceral Surgery, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Thomas Bruckner
- Institute for Medical Biometry and Informatics, Heidelberg, Germany
| | - Beate Herbig
- Obesity Clinic, Schoen Klinik Hamburg Eilbek, Hamburg, Germany
| | - Markus W Büchler
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | | | - Rune Sandbu
- Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway
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