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Gallanis AF, Bowden C, Sharma D, Rodriguez GV, Lopez R, Payne C, Joyce S, Broesamle R, Blakely AM, Hernandez JM, Korman L, Heller T, Davis JL. Roux limb revision for recalcitrant bile reflux after total gastrectomy. Surgery 2025; 181:109214. [PMID: 39956091 PMCID: PMC12040590 DOI: 10.1016/j.surg.2025.109214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Revised: 01/02/2025] [Accepted: 01/20/2025] [Indexed: 02/18/2025]
Abstract
BACKGROUND Bile reflux is a postgastrectomy syndrome that impacts quality of life. Management includes lifestyle modifications and medical therapy; however, the efficacy of operative intervention for refractory bile reflux is unknown. We aimed to characterize outcomes of Roux limb lengthening for management of recalcitrant bile reflux after total gastrectomy. METHODS Retrospective analysis of 159 individuals with germline CDH1 mutations who underwent prophylactic total gastrectomy with Roux-en-Y reconstruction. Patient demographics, frequency of recalcitrant bile reflux, type of medical management, operative details, and clinical outcomes were measured. RESULTS Fourteen (8.8%, 14/159) individuals developed bile reflux recalcitrant to medical therapy after prophylactic total gastrectomy and elected for operative Roux limb lengthening of 20-25 cm. Median time from prophylactic total gastrectomy to Roux limb revision was 2.6 years (interquartile range, 2.1-2.9). After revisional surgery, all patients self-reported improvement in bile reflux symptoms. Post-Roux limb revision, almost all (86%, 12/14) patients reported rare or no bile reflux symptoms. Bile reflux severity scores improved to no symptoms in 3 patients (21%), followed by mild (50%, 7/14) or moderate (29%, 4/14) symptoms after Roux limb revision. All individuals (100%, 14/14) who underwent Roux limb revision reported "major improvement" in bile reflux symptoms with a median follow-up of 16 months (interquartile range, 7.5-21.5). Most patients regained weight post-Roux limb revision (+3.3 kg, standard deviation 4.7, P = .02) with a mean percentage weight gain of 5.9% (standard deviation, 7.4). There were no intraoperative or postoperative complications with revisional surgery. CONCLUSION Roux limb revision is effective for management of recalcitrant bile reflux. Additional study to identify potential risk factors for bile reflux after total gastrectomy is warranted.
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Affiliation(s)
- Amber F Gallanis
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD. https://twitter.com/AmberFGallanis
| | - Cassidy Bowden
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Disha Sharma
- Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD. https://twitter.com/DishaSharma1994
| | - Gracia Viana Rodriguez
- Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Rachael Lopez
- Clinical Center Nutrition Department, National Institutes of Health, Bethesda, MD. https://twitter.com/Rachael_C_Lopez
| | - Charlotte Payne
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Stacy Joyce
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Riema Broesamle
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Andrew M Blakely
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD. https://twitter.com/AMBlakely
| | - Jonathan M Hernandez
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD. https://twitter.com/JMHernandez_MD
| | - Louis Korman
- Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Theo Heller
- Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Jeremy L Davis
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD.
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Albaugh VL, Weinberg JL, Yu D, Spann MD, Williams DB, Samuels JM, Flynn CR, English WJ. Total Alimentary Limb Length Is Not Associated with Weight Loss Following Proximal Roux-en-Y Gastric Bypass. Obes Surg 2025; 35:1693-1701. [PMID: 40146457 DOI: 10.1007/s11695-025-07817-5] [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: 01/25/2025] [Revised: 02/28/2025] [Accepted: 03/18/2025] [Indexed: 03/28/2025]
Abstract
BACKGROUND Standard Roux-en-Y gastric bypass (RYGB) typically manipulates the proximal portion of the small intestine, leaving a variable and unknown common channel and total alimentary limb length (TALL). Despite high variability in postoperative weight loss, the factors contributing to this variability remain unknown. Given the known variability in small intestinal length, this unmeasured variability in TALL may be associated with weight loss responses. OBJECTIVE To test the hypothesis that TALL is associated with postoperative weight loss following primary laparoscopic Roux-en-Y gastric bypass (RYGB). SETTING Vanderbilt University Medical Center; Nashville, Tennessee, USA. METHODS A total of 329 patients were recruited for this observational study and consented to laparoscopic measurement of the entire small intestinal length at the time of primary RYGB. Of these patients, 208 had successful measurement of the small bowel length (SBL) and underwent RYGB with a fixed biliopancreatic limb length (BPL, 50 cm). Common channel length (CCL) was allowed to vary normally to test the association between TALL and postoperative weight loss. RESULTS Follow-up rates were 77% at 6 months and 41% at 24 months. Average SBL was 592 cm (min = 390 cm, max = 910 cm), with a standard deviation of 107 cm that led to significant variation in CCL (shortest 190 cm, longest 730 cm). Regression was used to model weight loss and body mass index, as well as percent change from baseline, for each patient given the measured TALL and CCL. Despite significant variation in TALL, there were no clinically significant effects of TALL or CCL on weight loss up to 24 months. CONCLUSIONS With a fixed BPL, normal variation in TALL does not significantly contribute to weight loss variability following RYGB. Future studies are needed to better understand the importance of intestinal limb lengths in primary and revisional RYGB surgery.
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Affiliation(s)
- Vance L Albaugh
- Metamor Institute, Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA.
- Department of Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, 70112, USA.
| | - Jacob L Weinberg
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Danxia Yu
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37203, USA
| | - Matthew D Spann
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - D Brandon Williams
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Jason M Samuels
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Charles Robb Flynn
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
| | - Wayne J English
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
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Süsstrunk J, Zingg L, Köstler T, Wilhelm A, Lazaridis II, Delko T, Zingg U. Revisional Roux-en-Y gastric bypass after gastric banding leads to sustainable and significant additional weight loss regardless of Roux limb length. Am J Surg 2025; 245:116359. [PMID: 40339207 DOI: 10.1016/j.amjsurg.2025.116359] [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: 01/06/2025] [Revised: 04/01/2025] [Accepted: 04/22/2025] [Indexed: 05/10/2025]
Abstract
INTRODUCTION The aim of this study is to compare the outcomes between patients undergoing very-very long limb RYGB (VVLL-RYGB) and proximal RYGB (PRYGB) after adjustable gastric banding (LAGB). METHODS All patients undergoing conversion from LAGB to RYGB in a bariatric reference center between 2010 and 2016 were analyzed. RESULTS Sixty-six patients (80 % female, mean age 44.5 ± 9 years, pre-revisional BMI 40.2 ± 7.4 kg/m2) underwent conversion from LAGB to VVLL-RYGB, and 26 patients (88 % female, mean age 46.9 ± 7.6 years, pre-revisional BMI 37.2 ± 5.3 kg/m2) to PRYGB. ΔBMI 5 years after conversion was 8.2 ± 6.1 kg/m2 in VVLL-RYGB compared to 6.7 ± 5.1 kg/m2 in PRYGB (p = 0.35). There was no significant difference in long-term morbidity. Further revisional procedures after VVLL-RYGB occurred in 10 (15.1 %) and 8 (30.8 %) after PRYGB (p = 0.136). CONCLUSION VVLL-RYGB and PRYGB after LAGB are safe and lead to significant and sustainable additional weight loss without difference in BMI loss between the procedures after 5 years.
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Affiliation(s)
- Julian Süsstrunk
- Department of Surgery, Obesity & Bariatric Surgery Centre, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland; Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia; Clarunis, Department of Visceral Surgery, University Digestive Health Care Center, St. Clara Hospital and University Hospital Basel, Basel, Switzerland.
| | - Liv Zingg
- Department of Surgery, Obesity & Bariatric Surgery Centre, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland.
| | - Thomas Köstler
- Department of Surgery, Obesity & Bariatric Surgery Centre, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland.
| | - Alexander Wilhelm
- Clarunis, Department of Visceral Surgery, University Digestive Health Care Center, St. Clara Hospital and University Hospital Basel, Basel, Switzerland.
| | - Ioannis I Lazaridis
- Department of Surgery, Obesity & Bariatric Surgery Centre, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland.
| | - Tarik Delko
- Department of Surgery, Hirslanden Hospital, St. Anna-Strasse 32, 6006, Lucerne, Switzerland.
| | - Urs Zingg
- Department of Surgery, Obesity & Bariatric Surgery Centre, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland.
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Benson-Davies S. Bariatric nutrition and evaluation of the metabolic surgical patient: Update to the 2022 Obesity Medicine Association (OMA) bariatric surgery, gastrointestinal hormones, and the microbiome clinical practice statement (CPS). OBESITY PILLARS 2025; 13:100154. [PMID: 39758884 PMCID: PMC11697792 DOI: 10.1016/j.obpill.2024.100154] [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: 08/21/2024] [Revised: 12/02/2024] [Accepted: 12/02/2024] [Indexed: 01/07/2025]
Abstract
Background In 2022, the Obesity Medicine Association (OMA) published a Clinical Practice Statement (CPS) which provided an overview of bariatric surgery and related procedures, a discussion on gastrointestinal hormones and a review of the microbiome as it relates to patients with obesity. This update to the 2022 OMA CPS provides a focus on nutrition as it relates to the adult bariatric surgery patient, incorporating a detailed discussion on how to conduct a bariatric nutrition assessment and manage patients seeking metabolic and bariatric surgery (MBS) and postoperative nutrition care. In particular, the section on macronutrients, micronutrients, and bariatric surgery has been updated, highlighting practical approaches to nutrient deficiencies typically encountered in the bariatric surgery patient. Also included is a section on how to envision and develop an interdisciplinary team of medical providers with evidence-based nutrition knowledge and consistent information that improves the quality of nutrition care provided to MBS patients. This CPS adds to the series of OMA CPSs meant to provide guidance to clinicians in their care of patients with obesity. Methods The foundation of this paper is supported by scientific evidence in the medical literature and expert opinion derived from several bariatric nutrition resources, as well as from the 2022 OMA CPS focused on bariatric surgery. Results This OMA Clinical Practice Statement provides an overview of the current bariatric nutrition clinical guidelines and nutrition tools adapted for clinicians who may not have access to an MBS team or a registered dietitian knowledgeable about bariatric nutrition. Conclusions This evidence-based review of the literature includes an overview of current bariatric nutrition recommendations. It is intended to provide clinicians with more advanced knowledge and skills in nutrition assessment and management of the preoperative and post-surgical MBS patients. This CPS also addresses macronutrient and micronutrient deficiencies common in MBS patients, and treatment recommendations designed to help the clinician with clinical decision making.
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Affiliation(s)
- Sue Benson-Davies
- Sanford School of Medicine, University of South Dakota, 1400 W 22nd St, Sioux Falls, SD 57105, USA
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5
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Estrada A, Rodriguez Quintero JH, Pereira X, Zhou Y, Moran-Atkin E, Choi J, Camacho D. Addressing recurrent weight gain after Roux-en-Y gastric bypass: efficacy of a dual surgical approach-short-term results of a single-center cohort study. Surg Obes Relat Dis 2025:S1550-7289(25)00075-9. [PMID: 40087128 DOI: 10.1016/j.soard.2025.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2024] [Revised: 01/29/2025] [Accepted: 02/01/2025] [Indexed: 03/16/2025]
Abstract
BACKGROUND There is no gold standard for recurrent weight gain following Roux-en-Y gastric bypass (RYGB). Combining jejuno-jejunostomy distalization type 1 (JJD1) and sleeve resection of the gastrojejunostomy and gastric pouch (GJ-P) may be a potential approach for these patients. OBJECTIVES To describe 1-year perioperative and nutritional outcomes of patients who underwent JJD1 with sleeve resection of the GJ-P. SETTING High-volume academic bariatric center of excellence. METHODS Patients with recurrent weight gain after RYGB who underwent JJD1 with sleeve resection of the GJ-P from 2020 to 2022 were included and studied for 1 year postoperatively. During the procedure, we aimed for a total alimentary limb length (TALL) of 350-500 cm, a new common channel (CC) of 200-350 cm, and a gastrojejunostomy <2 cm in diameter. RESULTS A total of 61 patients underwent this combined revisional procedure. The median preoperative body mass index (BMI) was 42.59 kg/m2. The median lengths of the biliopancreatic limb (BPL) before and after distalizatiovn were 50 cm (interquartile range [IQR]: 42.5-75) and 175 cm (IQR: 150-200), respectively. After revision, the median new CC was 270 cm (IQR: 250-300) and the median TALL was 400 cm (interquartile range [IQR]: 362.5-450). The median total small bowel length (TSBL) was 580 cm (IQR 550-640 cm), and the median BPL/TSBL ratio was .32 (IQR .29-.34). At 1, 6, and 12 months, the median BMI of the cohort was reduced to 39.14, 35.55, and 32.9 kg/m2, respectively. At 1 year, the total weight loss (%TWL) was 22.18%. Only 3 (n = 3) patients developed major complications at 1 year. After distalization, the resolution of all obesity-related co-morbidities improved, including type 2 diabetes (3.2%), sleep apnea (13.1%), hypertension (HTN) (11.4%), and hyperlipidemia (HLD) (1.6%). CONCLUSIONS The combination of JJD1 and sleeve resection of the GJ-P for RYGB revision was safe and effective, with substantial improvement in weight loss at 1 year.
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Affiliation(s)
- Arturo Estrada
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Xavier Pereira
- Division of General Surgery, New York University Langone Medical Center, New York City, New York, USA
| | - Ya Zhou
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Erin Moran-Atkin
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jenny Choi
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Diego Camacho
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
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Gadiot RPM, Biter LU, Feskens PG, Dunkelgrun M, Apers JA, 't Hof GV, Mannaerts GHH. Long-term Outcome of the Dutch Common Channel Trial (DUCATI): Preservation of Superior Weight Loss Results Without Significant Malnutrition Side Effects. Obes Surg 2024; 34:4136-4145. [PMID: 39356397 DOI: 10.1007/s11695-024-07424-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 10/03/2024]
Abstract
PURPOSE The optimal bowel limb lengths for laparoscopic Roux-en-Y gastric bypass (LRYGB) to maximize weight loss while minimizing nutritional deficiencies in severe obesity treatment remain a topic of debate. The multi-center Dutch Common Channel Trial (DUCATI) aims to compare the outcomes of a very long Roux Limb Roux-en-Y gastric bypass (VLRL-LRYGB) with a standard Roux-en-Y gastric bypass (S-LRYGB). METHODS A total of 444 patients were randomly assigned in a 1:1, double-blind manner to undergo either VLRL-RYGB or S-LRYGB. Five-year follow-up data were assessed, concentrating on weight loss, obesity-related medical conditions, complications, re-operations, and malnutrition. RESULTS Both groups had comparable total alimentary lengths (RL + CC). The VLRL-LRYGB group demonstrated significantly greater %TWL (32.2% vs. 28.6%, p = 0.002) and %EWL (81.2% vs. 70.3%, p = 0.002) at 5 years. Eight (3.6%) patients in the VLRL-LRYGB group versus 2 (0.9%) in the S-LRYGB group (p = 0.055) needed modification surgery for malabsorption. Suboptimal clinical response rate was significantly higher (22.0% vs. 8.3%) in S-LRYGB group. No significant differences for nutrient deficiencies in favor of the S-LRYGB group were found. CONCLUSION A 100-cm common channel with a relatively long Roux limb provides superior, sustainable weight loss over 5 years, without significantly increased rate of malabsorption-related re-operations. These results suggest that a longer Roux limb can still ensure adequate micronutrient uptake in the total alimentary tract. These findings should be considered in discussions regarding the optimal Roux-en-Y limb length for severe obesity treatment.
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Affiliation(s)
- Ralph P M Gadiot
- Department of Surgery, Fundashon Mariadal, Kaya Soeur Bartola 2, Kralendijk, Bonaire, the Netherlands.
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
| | - L Ulas Biter
- Department of Surgery, Tulp Medisch Centrum, Zwijndrecht, The Netherlands
| | - Pierre G Feskens
- Department of Bariatric Surgery, Bravis Hospital, Bariatric Center South-West Netherlands, Bergen Op Zoom, the Netherlands
| | - Martin Dunkelgrun
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Jan A Apers
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Gerhard van 't Hof
- Department of Bariatric Surgery, Bravis Hospital, Bariatric Center South-West Netherlands, Bergen Op Zoom, the Netherlands
| | - Guido H H Mannaerts
- Department of Surgery, Al Ain Abu Dhabi, Mediclinic, United Arab Emirates
- Department of Surgery, Gulf Specialized Hospital, Muscat, Oman
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Lin H, Baker JW, Meister K, Lak KL, Martin Del Campo SE, Smith A, Needleman B, Nadzam G, Ying LD, Varban O, Reyes AM, Breckenbridge J, Tabone L, Gentles C, Echeverri C, Jones SB, Gould J, Vosburg W, Jones DB, Edwards M, Nimeri A, Kindel T, Petrick A. American society for metabolic and bariatric surgery: intra-operative care pathway for minimally invasive Roux-en-Y gastric bypass. Surg Obes Relat Dis 2024; 20:895-909. [PMID: 39097472 DOI: 10.1016/j.soard.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Clinical care pathways help guide and provide structure to clinicians and providers to improve healthcare delivery and quality. The Quality Improvement and Patient Safety Committee (QIPS) of the American Society for Metabolic and Bariatric Surgery (ASMBS) has previously published care pathways for the performance of laparoscopic sleeve gastrectomy (LSG) and pre-operative care of patients undergoing Roux-en-Y gastric bypass (RYGB). OBJECTIVE This current RYGB care pathway was created to address intraoperative care, defined as care occurring on the day of surgery from the preoperative holding area, through the operating room, and into the postanesthesia care unit (PACU). METHODS PubMed queries were performed from January 2001 to December 2019 and reviewed according to Level of Evidence regarding specific key questions developed by the committee. RESULTS Evidence-based recommendations are made for care of patients undergoing RYGB including the pre-operative holding area, intra-operative management and performance of RYGB, and concurrent procedures. CONCLUSIONS This document may provide guidance based on recent evidence to bariatric surgeons and providers for the intra-operative care for minimally invasive RYGB.
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Affiliation(s)
- Henry Lin
- Department of Surgery, Signature Healthcare, Brockton, Massachusetts.
| | - John W Baker
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Kathleen L Lak
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - April Smith
- Department of Pharmacy, Creighton University School of Pharmacy and Health Professions, Omaha, Nebraska
| | | | - Geoffrey Nadzam
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Lee D Ying
- Department of Surgery, Yale New Haven Hospital, New Haven, Connecticut
| | - Oliver Varban
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Angel Manuel Reyes
- Department of General Surgery, St. Michael Medical Center, Silverdale, Washington
| | - Jamie Breckenbridge
- Department of General Surgery, Fort Belvoir Community Hospital, Fort Belvoir, Virginia
| | - Lawrence Tabone
- Department of Surgery, West Virginia University, Morgantown, West Virginia
| | - Charmaine Gentles
- Department of Surgery, Northshore University Hospital, Manhasset, New York
| | | | - Stephanie B Jones
- Department of Anesthesiology, Northwell Health, New Hyde Park, New York
| | - Jon Gould
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Wesley Vosburg
- Department of Surgery, Grand Strand Medical Center, Myrtle Beach, South Carolina
| | - Daniel B Jones
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Abdelrahman Nimeri
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tammy Kindel
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anthony Petrick
- Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania
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8
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Poljo A, Peterli R, Kraljević M. Effects of limb lengths in gastric bypass surgery. Br J Surg 2024; 111:znae220. [PMID: 39190791 DOI: 10.1093/bjs/znae220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/11/2024] [Accepted: 08/07/2024] [Indexed: 08/29/2024]
Affiliation(s)
- Adisa Poljo
- Division of Metabolic Bariatric Surgery, Department of Visceral Surgery, Clarunis-University Digestive Healthcare Center Basel, University Hospital Basel and St. Clara Hospital, Basel, Switzerland
| | - Ralph Peterli
- Division of Metabolic Bariatric Surgery, Department of Visceral Surgery, Clarunis-University Digestive Healthcare Center Basel, University Hospital Basel and St. Clara Hospital, Basel, Switzerland
| | - Marko Kraljević
- Division of Metabolic Bariatric Surgery, Department of Visceral Surgery, Clarunis-University Digestive Healthcare Center Basel, University Hospital Basel and St. Clara Hospital, Basel, Switzerland
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9
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Hage K, Sawma T, Jawhar N, Bartosiak K, Vargas EJ, Abu Dayyeh BK, Ghanem OM. Revisional Bariatric Surgery After Roux-en-Y Gastric Bypass for Bile Reflux: a Single-Center Long-Term Cohort Study. Obes Surg 2024; 34:2420-2430. [PMID: 38861123 DOI: 10.1007/s11695-024-07355-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE Revisional bariatric surgery (RBS) after primary Roux-en-Y gastric bypass (RYGB) is indicated for the efficient management of specific complications such as bile reflux. Published literature on this topic remains scarce as we aim to evaluate the long-term outcomes (10 years) of RBS for bile reflux after RYGB. MATERIAL AND METHODS We conducted a single-center retrospective study of patients who underwent primary RYGB complicated by bile reflux and had RBS between 2008 and 2023. Our cohort was divided into two groups based on the etiology of bile reflux. Long-term surgical outcomes and nutritional status were reported and compared between the groups. RESULTS A total of 41 patients (100% primary RYGB; 90.2% female, 97.6% white) were included. 56.1% (n = 23) of patients underwent Roux limb lengthening and the remaining 43.9% (n = 18) had a gastrogastric fistula takedown, with no significant differences in terms of intraoperative complications, estimated blood loss (p = 0.616), length of hospital stay (p = 0.099), and postoperative complications between the two groups. Long-term resolution of obesity-related medical conditions was demonstrated for all the evaluated comorbidities. Lastly, there was no reported mortality, bile reflux recurrence, or micro- and macro-nutrient deficiencies over the total follow-up period of 10 years. CONCLUSION In our cohort, RBS after a primary RYGB for bile reflux management demonstrated safe and efficient short- and long-term surgical outcomes without any reported bile reflux recurrence or mortality. Adequate supplementation and close patient follow-up remain essential to decrease the morbidity and mortality associated with RBS as further studies are required to support our findings.
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Affiliation(s)
- Karl Hage
- Metabolic and Abdominal Wall Reconstructive Surgery, Department of Surgery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA
| | - Tedy Sawma
- Metabolic and Abdominal Wall Reconstructive Surgery, Department of Surgery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA
| | - Noura Jawhar
- Metabolic and Abdominal Wall Reconstructive Surgery, Department of Surgery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA
| | - Katarzyna Bartosiak
- Metabolic and Abdominal Wall Reconstructive Surgery, Department of Surgery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, National Research Institute, 04-141, Warsaw, Poland
| | - Eric J Vargas
- Department of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, MN, 55905, USA
| | - Barham K Abu Dayyeh
- Department of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, MN, 55905, USA
| | - Omar M Ghanem
- Metabolic and Abdominal Wall Reconstructive Surgery, Department of Surgery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA.
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10
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Delko T, Kraljević M, Lazaridis II, Köstler T, Jomard A, Taheri A, Lutz TA, Osto E, Zingg U. Laparoscopic Roux-Y-gastric bypass versus laparoscopic one-anastomosis gastric bypass for obesity: clinical & metabolic results of a prospective randomized controlled trial. Surg Endosc 2024; 38:3875-3886. [PMID: 38831218 DOI: 10.1007/s00464-024-10907-7] [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: 01/22/2024] [Accepted: 05/05/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) has been proposed as an effective alternative to the current standard procedure in Switzerland, Roux-en-Y gastric bypass (RYGB). Prospective data comparing both procedures are scarce. Therefore, we performed a non-inferiority randomized controlled trial assessing the effectiveness and safety of these 2 operative techniques. METHOD Eighty patients were randomized 1:1. OAGB consisted of a very long gastric pouch with a 200 cm biliopancreatic limb, RYGB of a 150 cm ante-colic alimentary and a 60 cm biliopancreatic limb, respectively. Primary endpoint was the percent excess weight loss (%EWL) at 12 months after surgery. RESULTS Mean %EWL at 12 months was 87.9% (SD24.4) in the RYGB group and 104.1% (SD24.6) in the OAGB group (p = 0.006). There was no mortality. The rate of marginal ulcers was higher in patients with OAGB compared to those with RYGB (p = 0.011), while the total number of late complications did not statistically differ between the two groups. Except for the remission of GERD, which was higher in the RYGB group compared to OAGB, there was no difference between the groups regarding the remission of comorbidities. OAGB showed improved glucose control compared to the RYGB after 1 year (p = 0.001). Furthermore, glucagon-like peptide-1 increase was significantly higher in OAGB at 6 weeks (p = 0.041) and 1 year after surgery (p = 0.029). Quality of life improved after both surgeries, without differences between the groups. CONCLUSIONS %EWL 1 year after surgery was higher in OAGB than in RYGB. A better glycemic control with a higher increase in GLP-1 was observed after OAGB compared to RYGB. TRIAL REGISTRATION This trial is registered on ClinicalTrials.gov under the identifier NCT02601092.
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Affiliation(s)
- Tarik Delko
- Department of Surgery, Obesity & Bariatric Surgery Centre, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland.
- University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
- Department of Surgery, Hirslanden Hospital, St. Anna-Strasse 32, 6006, Lucerne, Switzerland.
| | - Marko Kraljević
- Department of Surgery, Obesity & Bariatric Surgery Centre, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
| | - Ioannis I Lazaridis
- Department of Surgery, Obesity & Bariatric Surgery Centre, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
- University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Thomas Köstler
- Department of Surgery, Obesity & Bariatric Surgery Centre, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
| | - Anne Jomard
- Institute of Clinical Chemistry, University of Zurich and University Hospital Zurich, Wagistrasse 14, 8952, Schlieren, Switzerland
- IFNH Laboratory of Translational Nutrition Biology, ETH Zürich, 8603, Schwerzenbach, Switzerland
| | - Amy Taheri
- Institute of Clinical Chemistry, University of Zurich and University Hospital Zurich, Wagistrasse 14, 8952, Schlieren, Switzerland
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, 8057, Zurich, Switzerland
| | - Thomas A Lutz
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, 8057, Zurich, Switzerland
| | - Elena Osto
- Institute of Clinical Chemistry, University of Zurich and University Hospital Zurich, Wagistrasse 14, 8952, Schlieren, Switzerland
- IFNH Laboratory of Translational Nutrition Biology, ETH Zürich, 8603, Schwerzenbach, Switzerland
- Department of Physiology & Pathophysiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Urs Zingg
- Department of Surgery, Obesity & Bariatric Surgery Centre, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
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Dang JT, Hider AM, Barajas-Gamboa JS, Mocanu V, Shin T, Romero-Velez G, Lee Y, Navarrete S, Rodriguez J, Kroh M. Safety of limb lengthening after Roux-en-Y gastric bypass: an analysis of the MBSAQIP database. Surg Obes Relat Dis 2024; 20:564-570. [PMID: 38316579 DOI: 10.1016/j.soard.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/29/2023] [Accepted: 12/25/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) effectively treats severe obesity, but some patients may require revisional surgery like limb lengthening (LL) for postoperative weight gain. OBJECTIVES This study aims to compare 30-day serious complications and mortality rates between LL and primary RYGB, given limited safety data on LL. METHODS Patients who underwent LL and RYGB were identified from the 2020 and 2021 MBSAQIP databases, the only years in which LL data were available. Baseline characteristics and 30-day rates of serious complications and mortality were analyzed. RESULTS A total of 86,990 patients underwent RYGB and 455 underwent LL. Patients undergoing RYGB were younger (44.4 versus 49.8 yr, P < .001), had a higher body mass index (BMI) (45.5 versus 41.8 kg/m2, P < .001) and higher rates of comorbidities including diabetes (30.0 versus 13.6%, P < .001). RYGB and LL had similar operative duration (125.3 versus 123.2 min, P = .5). There were no statistical differences between cohorts for length of stay (LOS) (1.6 RYGB versus 1.6 LL d, P = .6). After LL, there were higher 30-day rates of reoperation (3.3 versus 1.9%, P = .03) and deep surgical site infections (1.3 versus .5%, P = .03) compared to RYGB. There were no differences in overall serious complications (5.1 LL versus 5.0% RYGB, P = 1.0) and mortality (.2 LL versus .1% RYGB, P = .5). Multivariable logistic regression adjustment found that previous venous thromboembolism was associated with serious complications after LL. CONCLUSIONS When compared to primary RYGB, LL has a favorable safety profile with similar 30-day rates of serious complications and mortality.
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Affiliation(s)
- Jerry T Dang
- Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Ahmad M Hider
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Juan S Barajas-Gamboa
- Digestive Diseases Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Valentin Mocanu
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Thomas Shin
- Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Yung Lee
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - John Rodriguez
- Digestive Diseases Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Matthew Kroh
- Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
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12
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Hur KY. Enteroendocrine Reprogramming by Altered Epithelial-Mesenchymal Crosstalk in Metabolic Surgery. JOURNAL OF METABOLIC AND BARIATRIC SURGERY 2024; 13:1-7. [PMID: 38974890 PMCID: PMC11224006 DOI: 10.17476/jmbs.2024.13.1.1] [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: 05/17/2024] [Revised: 05/25/2024] [Accepted: 05/30/2024] [Indexed: 07/09/2024]
Abstract
Metabolic surgery is an effective treatment option for type 2 diabetes. However, the therapeutic scope has been limited by unexpected inconsistent outcomes. This study aims to overcome these obstacles by determining fundamental mechanisms from a novel perspective by analyzing and comparing the surgical anatomy, clinical characteristics, and outcomes of metabolic surgery, including duodenal-jejunal bypass, Roux-en-Y gastric bypass, biliopancreatic diversion, one anastomosis gastric bypass, and their modified procedures, predominantly focusing on nonobese patients to mitigate confounding effects from overweighted type 2 diabetes. Regional epithelial cell growth and unique villus formation along the anterior-posterior axis of the small intestine depend on crosstalk between the epithelium and the underlying mesenchyme. Due to altered crosstalk between the epithelium and the opposite mesenchyme at the anastomotic site, the enteroendocrine lineage of the distal intestine is replaced by the proximal epithelium after the bypass procedure. Subsequent intestinal compensatory proliferation accelerates the expansion of the replaced epithelium, including enteroendocrine cells. The primary reasons for unsatisfactory results are incomplete duodenal exclusion and insufficient biliopancreatic limb length. We anticipate that this novel mechanism will have a significant impact on metabolic surgery outcomes and provide valuable insight into optimizing its effectiveness in type 2 diabetes.
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Affiliation(s)
- Kyung Yul Hur
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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13
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Pazouki A, Shahabi S, Yarigholi F, Fathi M. Previous Body-Contouring Surgery Before Metabolic and Bariatric Surgery: Does It Matter? Obes Surg 2023; 33:4168-4169. [PMID: 37833488 DOI: 10.1007/s11695-023-06873-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023]
Affiliation(s)
- Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Center of Excellence for Minimally Invasive Surgery Training, Iran University of Medical Sciences, Mansouri St., Niyayesh Ave., Sattarkhan St., Rasoule-Akram Hospital, Tehran, Iran
| | - Shahab Shahabi
- Minimally Invasive Surgery Research Center, Center of Excellence for Minimally Invasive Surgery Training, Iran University of Medical Sciences, Mansouri St., Niyayesh Ave., Sattarkhan St., Rasoule-Akram Hospital, Tehran, Iran
| | - Fahime Yarigholi
- Minimally Invasive Surgery Research Center, Center of Excellence for Minimally Invasive Surgery Training, Iran University of Medical Sciences, Mansouri St., Niyayesh Ave., Sattarkhan St., Rasoule-Akram Hospital, Tehran, Iran
| | - Mohammad Fathi
- Minimally Invasive Surgery Research Center, Center of Excellence for Minimally Invasive Surgery Training, Iran University of Medical Sciences, Mansouri St., Niyayesh Ave., Sattarkhan St., Rasoule-Akram Hospital, Tehran, Iran.
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