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Hany M, Ibrahim M, Zidan A, Abouelnasr AA, Torensma B. The Reversal of Roux en Y Gastric Bypass: Utilizing the Roux Limb in Response to Chronic Diarrhea in a Patient with Previous Multiple Bariatric Metabolic Surgeries. Obes Surg 2024; 34:2276-2279. [PMID: 38700609 PMCID: PMC11127874 DOI: 10.1007/s11695-024-07242-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/07/2024] [Accepted: 04/16/2024] [Indexed: 05/27/2024]
Affiliation(s)
- Mohamed Hany
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, 21561, Alexandria, Egypt.
- Madina Women's Hospital, Alexandria University, Hadara, Egypt.
| | - Mohamed Ibrahim
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, 21561, Alexandria, Egypt
| | - Ahmed Zidan
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, 21561, Alexandria, Egypt
| | - Anwar Ashraf Abouelnasr
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, 21561, Alexandria, Egypt
| | - Bart Torensma
- Leiden University Medical Center (LUMC), Leiden, Netherlands
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Sadiku F, Alceste D, Serra M, Hehl SJ, Gero D, Thalheimer A, Bueter M, Widmer J. Comparative analysis of linear- and circular-stapled gastrojejunostomies in Roux-en-Y gastric bypass: a focus on postoperative morbidity using the comprehensive complication index. Langenbecks Arch Surg 2024; 409:120. [PMID: 38602565 PMCID: PMC11009775 DOI: 10.1007/s00423-024-03303-1] [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: 11/05/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE The linear-stapled (LSA) and the circular-stapled anastomosis (CSA) are the two most commonly performed techniques for the gastrojejunostomy (GJ) during laparoscopic Roux-en-Y gastric bypass (RYGB). This study compared the outcome after both techniques with special focus on postoperative morbidity using the comprehensive complication index (CCI). METHODS Five hundred eighty-eight patients operated between 01/2010 and 12/2019 were included in the final analysis and divided in two cohorts according to the surgical technique of the GJ (LSA (n = 290) or CSA (n = 298)). Before 09/2016, the CSA was exclusively performed for the GJ, while after 09/2016, the LSA was solely used. RESULTS The mean CCI for patients with Clavien-Dindo complication grade ≥ 2 within the first 90 days after RYGB was 31 ± 9.1 in the CSA and 25.7 ± 6.8 in the LSA group (p < 0.001), both values still below the previously published benchmark cutoff (≤ 33.73). The C-reactive Protein (CRP)-levels on postoperative days (POD) 1 and 3 as well as the use of opioids on POD 1 were significantly higher in the CSA- than in the LSA-group (all p < 0.001). There were significantly more internal herniations in the CSA group during the first 24 postoperative months (p < 0.001). CONCLUSION Patients after RYGB with CSA were found to have higher CCI values during the first 90 PODs compared to patients in which the LSA was applied. To achieve optimal outcomes in terms of patient morbidity, the LSA seems to be the superior technique for GJ in RYGB.
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Affiliation(s)
- Floni Sadiku
- Department of Surgery, Maennedorf Hospital, Maennedorf Zurich, Zurich, Switzerland
- Department of Urology, Kantonsspital Aarau, Aarau, Switzerland
| | - Daniela Alceste
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8006, Zurich, Switzerland
| | - Michele Serra
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8006, Zurich, Switzerland
| | - Stefanie Josefine Hehl
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8006, Zurich, Switzerland
| | - Daniel Gero
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8006, Zurich, Switzerland
- Department of Surgery, Maennedorf Hospital, Maennedorf Zurich, Zurich, Switzerland
| | - Andreas Thalheimer
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8006, Zurich, Switzerland
- Department of Surgery, Maennedorf Hospital, Maennedorf Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8006, Zurich, Switzerland.
- Department of Surgery, Maennedorf Hospital, Maennedorf Zurich, Zurich, Switzerland.
| | - Jeannette Widmer
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8006, Zurich, Switzerland
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Edholm D, Hofgård JO, Andersson E, Stenberg E, Olbers T. Very low risk of short bowel after Roux-en-Y gastric bypass - a large nationwide Swedish cohort study. Surg Obes Relat Dis 2024; 20:362-366. [PMID: 38114384 DOI: 10.1016/j.soard.2023.10.014] [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: 06/19/2023] [Revised: 09/28/2023] [Accepted: 10/29/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is one of the most common bariatric procedures. Internal herniation may lead to small bowel ischemia requiring small bowel resection, resulting in short bowel syndrome. OBJECTIVE To determine the incidence of extensive small bowel resection in patients operated with RYGB. We also aimed to look for early clinical warning signs among patients requiring extensive small bowel resection. SETTING Cohort from national quality registers. METHODS All patients having undergone RYGB between January 2007 to June 2019 were analyzed in the Scandinavian Obesity Surgery Registry (SOReg). We identified patients with small bowel obstruction (SBO) for whom small bowel resection was necessary. Additionally, we assessed clinical signs in these patients. RESULTS The study included 57,255 patients having undergone RYGB. Closure of the mesenteric openings was performed in 78%. Surgery for SBO was required in 3659 (6%) of patients, and small bowel resection in 188 (.3%). Extensive small bowel resection, resulting in less than 1.5 meters of remaining small bowel, was required in 7 patients (.01%). All patients with extensive small bowel resection presented with abdominal pain and had confirmed internal herniation as the cause of the small bowel resection, and 2 of 7 patients died. Closure of mesenteric defects was not associated with a reduction in overall small bowel resection rates (P = .89) CONCLUSION: Surgery for SBO after RYGB was common (6%). The risk of extensive small bowel resection leading to short bowel was low (.01%). Patients with abdominal pain after RYGB should be assessed for internal hernia, as it can be devastating.
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Affiliation(s)
- David Edholm
- Department of Surgery, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Johan Olsson Hofgård
- Department of Surgery, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ellen Andersson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Torsten Olbers
- Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden; Department of Biomedical and Clinical Sciences and Wallenberg Centre for Molecular Medicine, Department of Biomedical and Clinical sciences, Linköping University, Linköping, Sweden
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Bossen MF, Gormsen J, Kristensen SD, Helgstrand F. Smoking Is Correlated to Internal Hernia After Gastric Bypass Surgery: a Post hoc Analysis of Data from a Randomized Clinical Trial. Obes Surg 2024; 34:1097-1101. [PMID: 38376637 PMCID: PMC11026284 DOI: 10.1007/s11695-024-07097-5] [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: 11/28/2023] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Internal herniation is a well-known complication of laparoscopic Roux-en-Y gastric bypass (L-RYGB). The aim of this study was to evaluate smoking as an independent risk factor for internal herniation after L-RYGB. MATERIALS AND METHODS This study was performed as an exploratory post hoc analysis of data from a previous published randomized controlled trial (RCT) designed to compare closure and non-closure of mesenteric defects in patients undergoing L-RYGB. The primary outcome of this study was to assess the significance of smoking as a risk factor for internal herniation after L-RYGB. Secondary outcome was early postoperative complications defined as Clavien-Dindo grade ≥ 2. RESULTS Four hundred one patients were available for post hoc analysis. The risk of internal herniation was significantly higher among patients who were smoking preoperatively (hazard ratio (HR) 2.4, 95% confidence interval (c.i.) 1.3 to 4.5; p = 0.005). This result persisted after adjusting for other patient characteristics (HR 2.2, 1.2 to 4.2; p = 0.016). 6.0% of the patients had postoperative complications within the first 30 days. 4.9% of these patients were smoking and 6.3% were not smoking, p = 0.657. 11.0% of the patients underwent surgery due to internal herniation by 5 years after the primary procedure. CONCLUSION Smoking is a significant risk factor for internal herniation but did not increase risk for 30 days postoperative complications.
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Affiliation(s)
- Marlene F Bossen
- Department of Gastrointestinal and Hepatic Diseases, Surgical Section, Herlev Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
| | - Johanne Gormsen
- Department of Surgery, Zealand University Hospital, 4600, Koege, Denmark
| | - Sara D Kristensen
- Department of Surgery, Zealand University Hospital, 4600, Koege, Denmark
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Bruinsma FFE, van der Burg SJC, El Adel S, Schouten R, Smeets SJM. Quality of stapled mesenteric defect closure influences the chance of reopening after laparoscopic Roux-en-Y gastric bypass surgery. Updates Surg 2024:10.1007/s13304-024-01751-4. [PMID: 38332391 DOI: 10.1007/s13304-024-01751-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 12/31/2023] [Indexed: 02/10/2024]
Abstract
Internal herniation (IH) is a common problem after laparoscopic Roux-en-Y gastric bypass surgery (RYGB). Routine closure of the mesenteric defects (MDs) reduces the risk of IH. Only very few articles report on risk factors for IH or describe detailed closing techniques. There is no consensus yet on the best closing method. The objective of this study is to determine the optimal stapling method for closure of MDs after RYGB. All performed RYGB procedures in our high-volume bariatric institute were included. Quality of the closure was scored in the categories poor, sub-optimal, and optimal, to see if the quality of the closure would predict the chance of reopening of the MDs and, therefore, the chance of IH. During any type of laparoscopy in the follow-up of the patient, the conditions of the MDs were stated, for example during diagnostic laparoscopy in symptomatic patients suspicious for IH or during laparoscopic cholecystectomy. Technically well-executed closure of Petersen's space (PS) with two rows of staples had a greater chance of still being closed upon re-inspection compared to closure with one row (odds ratio = 8.1; 95% confidence interval [1.2-53.2], p = 0.029). Optimal closure of the MD at the jejuno-jejunostomy (JJ-space, JJS) resulted in more closed JJSs upon re-inspection compared to sub-optimal closure (odds ratio = 3.6 [CI 95% 0.8-16.1], p = 0.099). Non-optimally closed MDs had higher reopening rates and, therefore, pose an additional risk for IH. Our classification provides a quality assessment of MD closure during RYGB and gives insight into how to optimize surgical technique.
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Affiliation(s)
- F F E Bruinsma
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands.
| | - S J C van der Burg
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - S El Adel
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - R Schouten
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - S J M Smeets
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
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Sundbom M, Näslund I, Ottosson J, Stenberg E, Näslund E. Results from the Scandinavian Obesity Surgery Registry: A narrative review. Obes Rev 2024; 25:e13662. [PMID: 37962040 DOI: 10.1111/obr.13662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 11/15/2023]
Abstract
In 2007, the Scandinavian Obesity Surgery Registry (SOReg) was started by the profession to monitor the results of bariatric surgery and to provide a high-quality database for research. In the end of August 2023, SOReg contains 88,379 patients (body mass index [BMI] 41.7 kg/m2 , 41.2 years, 77.1% females, gastric bypass 76.8%). In this narrative review, we demonstrate that preoperative weight loss is of value and that the laparoscopic double omega-loop technique is highly suitable for gastric bypass. Closing the mesenteric openings is, however, important. Swedish bariatric surgery has low mortality, and our results are comparative to those of other countries. Significant long-term improvements are found in common obesity-related diseases such as diabetes, hypertension, and sleep apnea. Furthermore, the risk for cardiac failure and major adverse cardiovascular events is significantly reduced. Pregnancy-related outcomes are also improved. Gastric bypass results in significant improvements in quality of life and seems to be cost saving. We have revealed that low socioeconomic status is associated with reduced chance of undergoing bariatric surgery and inferior outcomes. Of note, we have performed several randomized clinical trials within the registry database. In conclusion, high-quality national registry databases, such as SOReg, are important for maintaining high-quality care and present a platform for extensive research.
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Affiliation(s)
- Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Ingmar Näslund
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Johan Ottosson
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Erik Stenberg
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Erik Näslund
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Geroldinger M, Verbeeck J, Thiel KE, Molenberghs G, Bathke AC, Laimer M, Zimmermann G. A neutral comparison of statistical methods for analyzing longitudinally measured ordinal outcomes in rare diseases. Biom J 2024; 66:e2200236. [PMID: 36890631 DOI: 10.1002/bimj.202200236] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 12/27/2022] [Accepted: 01/30/2023] [Indexed: 03/10/2023]
Abstract
Ordinal data in a repeated measures design of a crossover study for rare diseases usually do not allow for the use of standard parametric methods, and hence, nonparametric methods should be considered instead. However, only limited simulation studies in settings with small sample sizes exist. Therefore, starting from an Epidermolysis Bullosa simplex trial with the above-mentioned design, a rank-based approach using the R package nparLD and different generalized pairwise comparisons (GPC) methods were compared impartially in a simulation study. The results revealed that there was not one single best method for this particular design, because a trade-off exists between achieving high power, accounting for period effects, and for missing data. Specifically, nparLD as well as the unmatched GPC approaches do not address crossover aspects, and the univariate GPC variants partly ignore the longitudinal information. The matched GPC approaches, on the other hand, take the crossover effect into account in the sense of incorporating the within-subject association. Overall, the prioritized unmatched GPC method achieved the highest power in the simulation scenarios, although this may be due to the specified prioritization. The rank-based approach yielded good power even at a sample size ofN = 6 $N=6$ , whereas the matched GPC method could not control the type I error.
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Affiliation(s)
- Martin Geroldinger
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
- Department of Research and Innovation, Paracelsus Medical University, Salzburg, Austria
| | - Johan Verbeeck
- Data Science Institute (DSI), Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), Hasselt University, Hasselt, Belgium
| | - Konstantin E Thiel
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
- Department of Research and Innovation, Paracelsus Medical University, Salzburg, Austria
| | - Geert Molenberghs
- Data Science Institute (DSI), Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), Hasselt University, Hasselt, Belgium
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), KULeuven, Leuven, Belgium
| | - Arne C Bathke
- Intelligent Data Analytics (IDA) Lab Salzburg, Department of Artificial Intelligence and Human Interfaces, Faculty of Digital and Analytical Sciences, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Martin Laimer
- Department of Dermatology and Allergology, Paracelsus Medical University, Salzburg, Austria
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
- Department of Research and Innovation, Paracelsus Medical University, Salzburg, Austria
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Ende V, Devas N, Zhang X, Yang J, Pryor AD. Internal hernia trends following gastric bypass surgery. Surg Endosc 2023; 37:7183-7191. [PMID: 37349593 DOI: 10.1007/s00464-023-10206-7] [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: 04/04/2023] [Accepted: 06/11/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Internal hernia is a well-known complication of laparoscopic Roux-en-Y gastric bypass (LRYGB), with reported rates ~ 5% within three months to three years after surgery. Internal hernia through a mesenteric defect can lead to small bowel obstruction. Mesenteric defects began to be more routinely closed, often considered standard practice by 2010. To our knowledge, there are no large population-based studies looking at rates of internal hernia post-LRYGB. This study utilizes a statewide database to characterize the trends of internal hernia post-LRYGB over the last two decades in multiple centers. METHODS LRYGB procedure records between January 2005 and September 2015 were extracted from the New York SPARCS database. Exclusion criteria included age < 18, in-hospital deaths, bariatric revision procedures, and internal hernia repair during the same hospitalization as LRYGB. Time to internal hernia was calculated from initial LRYGB hospital stay to admission date of the first internal hernia repair record. A multivariable proportional sub-distribution hazards model was utilized to analyze the trend of internal hernia incidence within three-year post-LRYGB. RESULTS 46,918 patients were identified between 2005 and 2015, with 2950 (6.29) undergoing internal hernia repair post-LRYGB by the end of 2018. The cumulative incidence of internal hernia repair at the 3rd-year post-LRYGB was 4.80% (95% CI: 4.59%-5.02%). By the end of the 13th year, the longest follow-up period, the cumulative incidence was 12.00% (95% CI: 11.30%-12.70%). Overall, there was a decreasing trend over time of undergoing internal hernia repair within three-year post-LRYGB (HR = 0.94, 95% CI: 0.93-0.96), after adjusting for confounding factors. CONCLUSION This multicenter study maintains the rate of internal hernia following LRYGB reported in smaller studies and provides a longer follow-up period demonstrating decreasing occurrences of internal hernia after bypass as a function of year of index operation. This data is important as internal hernia continues to be a complication post-LRYGB.
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Affiliation(s)
- Victoria Ende
- Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA.
| | - Nina Devas
- Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Xiaoyue Zhang
- Department of Family, Population & Preventive Medicine, Stony Brook School of Medicine, Stony Brook, NY, USA
| | - Jie Yang
- Department of Family, Population & Preventive Medicine, Stony Brook School of Medicine, Stony Brook, NY, USA
| | - Aurora D Pryor
- Department of Surgery, Northwell Health, New Hyde Park, NY, USA
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Vu AH, Chiang J, Qian Y, Tursunova N, Nha J, Ferzli G. Do all roads lead to Rome?: A retrospective analysis on surgical technique in Roux-en-Y gastric bypass. Surg Endosc 2023; 37:7254-7263. [PMID: 37415013 DOI: 10.1007/s00464-023-10257-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: 04/03/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND New York University Langone Health has three accredited bariatric centers, with altogether ten different bariatric surgeons. This retrospective analysis compares individual surgeon techniques in laparoscopic or robotic Roux-en-Y gastric bypass (RYGB) to identify potential associations with perioperative morbidity and mortality. METHODS All adult patients who underwent RYGB between 2017 and 2021 at NYU Langone Health campuses were evaluated via electronic medical records and MBSAQIP 30-day follow-up data. We surveyed all ten practicing bariatric surgeons to analyze the relationship between their techniques and total adverse outcomes. Bleeding, SSI, mortality, readmission, and reoperation were specifically sub-analyzed via logistic regression. RESULTS 54 (7.59%) out of 711 patients who underwent laparoscopic or robotic RYGB encountered an adverse outcome. Lower adverse outcomes were observed with laparoscopic approach, creating the JJ anastomosis first, flat positioning, division of the mesentery, Covidien™ laparoscopic staplers, gold staples, unidirectional JJ anastomosis, hand-sewn common enterotomy, 100-cm Roux limb, 50-cm biliopancreatic limb, and routine EGD. Lower bleeding rates were observed with flat positioning, gold staples, hand-sewn common enterotomy, 50-cm biliopancreatic limb, and routine EGD. Lower readmission rates were observed in laparoscopic, flat positioning, Covidien™ staplers, unidirectional JJ anastomosis, and hand-sewn common enterotomy. Gold staples had lower reoperation rates. Otherwise, there was no statistically significant difference in SSI. CONCLUSION Certain surgical techniques in RYGB within our bariatric surgery group had significant effects on the rates of total adverse outcomes, bleeding, readmission, and reoperation. Our findings warrant further investigation into the aforementioned techniques via multivariate regression models or prospective study design. LIMITATIONS This study was limited by the inherent nature of its retrospective and univariate statistical design. We did not account for the interaction between techniques. The sample size of surgeons was small, and follow-up of 30 days was relatively short. We did not include patient characteristics in the model or control for surgeon skill.
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Affiliation(s)
- Alexander Hien Vu
- Department of General Surgery, New York University Langone Health, 150 55th Street, Brooklyn, NY, 11220, USA.
| | - Jessica Chiang
- Department of General Surgery, New York University Langone Health, 150 55th Street, Brooklyn, NY, 11220, USA
| | - Yunzhi Qian
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Nilufar Tursunova
- Department of General Surgery, New York University Langone Health, 150 55th Street, Brooklyn, NY, 11220, USA
| | - Jaein Nha
- Department of General Surgery, New York University Langone Health, 150 55th Street, Brooklyn, NY, 11220, USA
| | - George Ferzli
- Department of General Surgery, New York University Langone Health, 150 55th Street, Brooklyn, NY, 11220, USA.
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Kollmann L, Lock JF, Kollmann C, Vladimirov M, Germer CT, Seyfried F. Surgical treatment of internal hernia after Roux-en-Y gastric bypass - impact of institutional standards and surgical approach. Langenbecks Arch Surg 2023; 408:318. [PMID: 37589915 PMCID: PMC10435621 DOI: 10.1007/s00423-023-03049-2] [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: 05/02/2023] [Accepted: 08/08/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Internal hernia is one of the most frequent long-term complications after laparoscopic gastric bypass surgery (RYGB). Surgical treatment of an internal hernia itself has risks that can largely be avoided by the implementation of institutional standards and a structured approach. MATERIAL AND METHODS From 2012 until 2022, we extracted all consecutive bariatric cases from the prospectively collected national database (StuDoQ). Data from all patients undergoing internal hernia repair were then collected from our hospital information management system and retrospectively analyzed. We compared patient characteristics and surgical outcome of patients before and after the implementation of standard operating procedures for institutional and perioperative aspects (first vs. second time span). RESULTS Overall, 37 patients were identified (median age 43 years, 86.5% female). Internal hernia was diagnosed after substantial weight loss (17.2 kg/m2) and on average about 34 months after RYGB. Baseline characteristics (age, sex, BMI, achieved total weight loss% and time interval to index surgery were comparable between the two groups). After local standardization, the conversion rate decreased from 52.6 to 5.6% (p = 0.007); duration of surgery from 92 to 39 min (p = 0.003), and length of stay from 7.7 to 2.8 days (p = 0.019). CONCLUSION In this study, we could demonstrate that the surgical therapy of internal hernia after gastric bypass can be significantly improved by implementing institutional and surgical standards. The details described (including a video) may provide valuable information for non-specialized surgeons to avoid pitfalls and improve surgical outcomes.
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Affiliation(s)
- Lars Kollmann
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Würzburg, Würzburg, Germany
| | - Johan F Lock
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Würzburg, Würzburg, Germany
| | - Cathérine Kollmann
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Würzburg, Würzburg, Germany
| | - Miljana Vladimirov
- Department of General, Visceral and Thoracic Surgery, Hospital of Nuernberg, Nuernberg, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Würzburg, Würzburg, Germany
| | - Florian Seyfried
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Würzburg, Würzburg, Germany.
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Zaigham H, Ekelund M, Regnér S. Long-Term Follow-up and Risk of Recurrence of Internal Herniation after Roux-en-Y Gastric Bypass. Obes Surg 2023; 33:2311-2316. [PMID: 37266865 PMCID: PMC10344975 DOI: 10.1007/s11695-023-06653-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE Internal herniation (IH) is the most common complication after Roux-en-Y gastric bypass surgery (RYGB). Although primary closure has reduced the incidence, recurrences are a continued problem. This study aimed to investigate long-term follow-up and recurrence risk of IH surgery. METHODS A retrospective cohort study of laparoscopic RYGB operated patients operated for a first IH between April 2012 and April 2015 at Skåne University Hospital in Malmö, Sweden. Status of primary closure of mesenteric gaps, time since RYGB, and findings at IH surgery were retrieved from medical records. Follow-up until December 31st, 2019, included recurrences of IH, number of computed tomography (CT) scans, emergency visits, readmissions, and other acute surgeries. RESULTS IH (n = 44) occurred almost equally in Petersen's space (n = 24) and beneath the jejunojejunostomy (n = 20). Long-term follow-up (median 75 months) of 43 patients registered an IH recurrence rate of 14% (n = 6). All recurrences occurred in the other mesenteric gap. One patient suffered a third IH, and one patient had four IH events. During follow-up, 56% (n = 24) had ER visits for abdominal pain, 47% (n = 20) had ≥ 1 abdominal CT scan, and 40% (n = 17) were readmitted. A third of readmitted (6/17) patients suffered a recurrence of internal herniation. Two other patients were readmitted ≥ 10 times for chronic abdominal pain. CONCLUSION Surgery for IH had a low risk of recurrence at the treated mesenteric gap, but a 14% recurrence risk at the other mesenteric gap, emphasizing the importance of carefully investigating weaknesses or gaps at the other mesenteric defect during surgery for IH.
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Affiliation(s)
- Hassan Zaigham
- Surgery Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
- Department of Surgery and Gastroenterology, Skåne University Hospital, Malmö, Sweden.
| | - Mikael Ekelund
- Surgery Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Surgery and Gastroenterology, Skåne University Hospital, Malmö, Sweden
| | - Sara Regnér
- Surgery Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Surgery and Gastroenterology, Skåne University Hospital, Malmö, Sweden
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12
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Muir D, Choi B, Clements C, Ratnasingham K, Irukulla S, Humadi S. Mesenteric Defect Closure and the Rate of Internal Hernia in Laparoscopic Roux-en-Y Gastric Bypass: A Systematic Review and Meta-analysis. Obes Surg 2023; 33:2229-2236. [PMID: 37162714 DOI: 10.1007/s11695-023-06597-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 05/11/2023]
Abstract
Internal hernias are a worrying complication from laparoscopic Roux-en-Y gastric bypass (LRGB), with potential small bowel necrosis and obstruction. An electronic database search of Medline, Embase, and Pubmed was performed. All studies investigating the internal hernia rates in patients whose mesenteric defects were closed vs. not closed during LRGB were analysed. Odds ratios were calculated to assess the difference in internal hernia rate. A total of 14 studies totalling 20,553 patients undergoing LRGB were included. Internal hernia rate (220/12,445 (2%) closure vs. 509/8108 (6%) non-closure) and re-operation for small bowel obstruction (86/5437 (2%) closed vs. 300/3132 (10%) non-closure) were reduced when defects were closed. There was no difference observed when sutures were used to close the defects compared to clips/staples.
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Affiliation(s)
- Duncan Muir
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK.
| | - Byung Choi
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | | | | | - Shashi Irukulla
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - Samer Humadi
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
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13
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Stenberg E, Ottosson J, Magnuson A, Szabo E, Wallén S, Näslund E, Thorell A, Näslund I. Long-term Safety and Efficacy of Closure of Mesenteric Defects in Laparoscopic Gastric Bypass Surgery: A Randomized Clinical Trial. JAMA Surg 2023; 158:709-717. [PMID: 37163240 PMCID: PMC10173104 DOI: 10.1001/jamasurg.2023.1042] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/30/2022] [Indexed: 05/11/2023]
Abstract
Importance Short-term and midterm data suggest that mesenteric defects closure during laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery reduces the risk of internal herniation with small bowel obstruction (SBO) but may increase risk of kinking of the jejunojejunostomy in the early postoperative period. However, to our knowledge, there are no clinical trials reporting long-term results from this intervention in terms of risk for SBO or opioid use. Objective To evaluate long-term safety and efficacy outcomes of closure of mesenteric defects during LRYGB. Design, Setting, and Participants This randomized clinical trial with a 2-arm, parallel, open-label design included patients with severe obesity scheduled for LRYGB bariatric surgery at 12 centers in Sweden from May 1, 2010, through November 14, 2011, with 10 years of follow-up after the intervention. Interventions During the operation, patients were randomly assigned 1:1 to closure of mesenteric defects beneath the jejunojejunostomy and at the Petersen space using nonabsorbable running sutures during LRYGB or to nonclosure. Main Outcome and Measures The primary outcome was reoperation for SBO. New incident, chronic opioid use was a secondary end point as a measure of harm. Results A total of 2507 patients (mean [SD] age, 41.7 [10.7] years; 1863 female [74.3%]) were randomly assigned to closure of mesenteric defects (n = 1259) or nonclosure (n = 1248). After censoring for death and emigration, 1193 patients in the closure group (94.8%) and 1198 in the nonclosure group (96.0%) were followed up until the study closed. Over a median follow-up of 10 years (IQR, 10.0-10.0 years), a reoperation for SBO from day 31 to 10 years after surgery was performed in 185 patients with nonclosure (10-year cumulative incidence, 14.9%; 95% CI, 13.0%-16.9%) and in 98 patients with closure (10-year cumulative incidence, 7.8%; 95% CI, 6.4%-9.4%) (subhazard ratio [SHR], 0.42; 95% CI, 0.32-0.55). New incident chronic opioid use was seen among 175 of 863 opioid-naive patients with nonclosure (10-year cumulative incidence, 20.4%; 95% CI, 17.7%-23.0%) and 166 of 895 opioid-naive patients with closure (10-year cumulative incidence, 18.7%; 95% CI, 16.2%-21.3%) (SHR, 0.90; 95% CI, 0.73-1.11). Conclusions and Relevance This randomized clinical trial found long-term reduced risk of SBO after mesenteric defects closure in LRYGB. The findings suggest that routine use of this procedure during LRYGB should be considered. Trial Registration ClinicalTrials.gov Identifier: NCT01137201.
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Affiliation(s)
- Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Eva Szabo
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Stefan Wallén
- Pharmacology and Therapeutic Department, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Erik Näslund
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Anders Thorell
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Ersta Hospital, Stockholm, Sweden
| | - Ingmar Näslund
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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14
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Altieri MS, Carter J, Aminian A, Docimo S, Hinojosa MW, Cheguevara A, Campos GM, Eisenberg D. American Society for Metabolic and Bariatric Surgery literature review on prevention, diagnosis, and management of internal hernias after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2023; 19:763-771. [PMID: 37268518 DOI: 10.1016/j.soard.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 06/04/2023]
Affiliation(s)
- Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Jonathan Carter
- Department of General Surgery, University of California, San Francisco, California
| | - Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Salvatore Docimo
- Department of Surgery, University of South Florida, Tampa, Florida
| | | | - Afaneh Cheguevara
- New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | | | - Dan Eisenberg
- Department of Surgery, Stanford School of Medicine, Stanford, California
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15
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Dos Santos S, Lallemand L, Blanchard C. Double origin of an occlusion after gastric bypass: Intestinal intussusception contained in a Petersen hernia. J Visc Surg 2023:S1878-7886(23)00110-8. [PMID: 37328318 DOI: 10.1016/j.jviscsurg.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Roux-en-Y gastric bypass (RYGB) is a surgical technique described in 1970 and performed laparoscopically since 1993. Occlusions are late complications that most often occur more than 6 months after surgery. Internal hernias and intussusception are the two clinical situations that can occur after RYGB. The presentation is that of an occlusion or chronic abdominal pain. Diagnosis can be made by imaging, including abdominal and pelvic CT scans, with ingestion and injection of contrast agents if possible. Treatment is based on surgical exploration.
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Affiliation(s)
- S Dos Santos
- Cancer, Digestive and Endocrine Surgery, Institute of Digestive Tract Diseases, University Hospital Center of Nantes, Nantes, France; Hepatobiliary and Digestive Surgery Department, University Hospital Center of Rennes, Rennes 1 University, Rennes, France
| | - L Lallemand
- Cancer, Digestive and Endocrine Surgery, Institute of Digestive Tract Diseases, University Hospital Center of Nantes, Nantes, France
| | - C Blanchard
- Cancer, Digestive and Endocrine Surgery, Institute of Digestive Tract Diseases, University Hospital Center of Nantes, Nantes, France; Nantes University, l'institut du thorax, University Hospital Center of Nantes, CNRS, Inserm, 44000 Nantes, France.
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16
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Wu QL, Liu QZ, Xi YY, Deng XQ, Xu TS, Xie ZC, Chen JA, Yuan Y. Closed or Unclosed Mesentery? A Meta-analysis of Internal Herniation After Laparoscopic Roux-en-Y Gastric Bypass. Obes Surg 2023:10.1007/s11695-023-06594-3. [PMID: 37081253 DOI: 10.1007/s11695-023-06594-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
During the laparoscopic Roux-en-Y gastric bypass procedure, closing mesentery or not was still controversial according to preexisted studies. So, the current meta-analysis aimed to compare the outcome of closure versus non-closure of mesenteric defects in laparoscopic Roux-en-Y gastric bypass. Fifteen studies were included, enrolling 53,488 patients. Based on the outcome of analysis, regarding internal hernia, Petersen space's IH, jejunal mesenteric's IH, hospital days, and reoperation, closure of the mesentery was better than non-closure. Besides, small bowel obstruction, anastomosis ulcer, stenosis, leakage, bleeding, gastrointestinal perforation, and postoperative BMI of patients show no difference between non-closure and closure.
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Affiliation(s)
- Qian-Long Wu
- Guangzhou Medical University, Guangzhou, 510180, China.
| | - Quan-Zhen Liu
- Guangzhou Medical University, Guangzhou, 510180, China
| | - Ying-Yun Xi
- Guangzhou Medical University, Guangzhou, 510180, China
| | | | - Tong-Shan Xu
- Guangzhou Medical University, Guangzhou, 510180, China
| | - Zi-Chun Xie
- Guangzhou Medical University, Guangzhou, 510180, China
| | - Jin-An Chen
- Guangzhou Medical University, Guangzhou, 510180, China
| | - Yi Yuan
- Guangzhou Medical University, Guangzhou, 510180, China
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17
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Comment on: The impact of routine division of the greater omentum on small bowel obstruction after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2023; 19:184-185. [PMID: 36610865 DOI: 10.1016/j.soard.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/03/2022] [Indexed: 12/13/2022]
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18
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The effect of routine division of the greater omentum on small bowel obstruction after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2023; 19:178-183. [PMID: 36207233 DOI: 10.1016/j.soard.2022.09.006] [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: 07/05/2022] [Revised: 08/21/2022] [Accepted: 09/05/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND It remains unknown whether routine division of the greater omentum during laparoscopic Roux-en-Y gastric bypass (LRYGB) influences the risk for small bowel obstruction (SBO) after RYGB. OBJECTIVE To evaluate the effect of omental division on SBO after LRYGB stratified by handling of the mesenteric defects. SETTING Nationwide, registry-based. METHODS In this registry-based cohort study, 40,517 patients who underwent LRYGB in Sweden within the period from January 1, 2007, to December 31, 2019, with data from the Scandinavian Obesity Surgery Registry (SOReg) were included. The study was based on combined data from the SOReg, the National Patient Register, the Swedish Prescribed Drugs Register, and the Total Population Registry. The main outcome was reoperation for SBO. RESULTS During a follow-up period of 5.9 ± 2.6 years, the cumulative incidence of SBO was 11.2% in the nondivision group compared with 9.7% among patients with divided omentum (hazard ratio [HR] = .83, 95% confidence interval [CI]: .77-.89, P < .001). The association was seen in patients without mesenteric defects closure (HR = .69, 95% CI: .61-.78, P < .001) as well as patients with closed mesenteric defects (HR = .80, 95% CI: .74-.87, P < .001). CONCLUSION Division of the greater omentum is associated with reduced risk for SBO after antecolic, antegastric LRYGB and should be considered as a complement to mesenteric defects closure to further reduce the risk for SBO after LRYGB.
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19
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Establishing Methods of Defect Closure in Roux-en-Y Gastric Bypass: an International Survey. Obes Surg 2023; 33:1049-1059. [PMID: 36609742 DOI: 10.1007/s11695-022-06420-2] [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: 09/01/2022] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Internal herniation (IH) can be a life-threatening complication of Roux-en-Y gastric bypass (RYGB). Randomised controlled trials support the routine closure of mesenteric spaces at RYGB. However, there is currently no consensus on the method of closure in clinical practice. The purpose of this survey is to understand bariatric surgeons' practice in this regard. METHODS We conducted an international survey, whereby questions were created through collaboration of a consensus group of bariatric surgeons and hosted on the SurveyMonkey platform. The survey was distributed among British Obesity and Metabolic Surgery Society (BOMSS) members and international professional channels including The Upper Gastrointestinal Society (TUGS) and social media. RESULTS One hundred and thirty-six surgeons from 34 countries completed the survey. Of these, 49 respondents were UK-based surgeons with a cumulative experience of approximately 2500 RYGB per annum. Forty-five (91.8%) respondents reported always closing mesenteric defects, of whom 57.8% elected to use non-absorbable non-barbed sutures, followed by staples/clips in 28.9% and a selection of other methods. Most respondents used more than one method. A total of 2 UK and 14 non-UK participants reported never closing mesenteric spaces. CONCLUSIONS This survey has shown heterogeneity among defect closure and no consensus on preferred type. Additionally, there remains a practice of non-closure of mesenteric defects. We hope these findings help to inform further needed research and consensus building among experts.
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20
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Hedberg S, Thorell A, Engström M, Stenberg E, Olbers T. Surgical Technique in Constructing the Jejuno-jejunostomy and the Risk of Small Bowel Obstruction after Roux-en-Y Gastric Bypass. Surg Obes Relat Dis 2022; 18:1151-1159. [DOI: 10.1016/j.soard.2022.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/29/2022] [Accepted: 05/14/2022] [Indexed: 12/01/2022]
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21
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Amanda D, Elin P, Eva N, Stenberg E. The Influence of Mesenteric Defects Closure on the Use of Computed Tomography for Abdominal Pain 5 Years After Laparoscopic Gastric Bypass-a Post Hoc Analysis of a Randomized Clinical Trial. Obes Surg 2021; 32:266-272. [PMID: 34813038 PMCID: PMC8794995 DOI: 10.1007/s11695-021-05778-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/13/2021] [Accepted: 11/03/2021] [Indexed: 11/24/2022]
Abstract
Background Abdominal pain after laparoscopic Roux-en-Y gastric bypass (LRYGB) is a common and unwanted complication that typically leads to further exploration through radiology. Concerns have been raised regarding the consequences of this radiation exposure and its correlation with the lifetime risk of cancer. The aim of this study was to evaluate the differences in computed tomography (CT) use between LRYGB patients with open and closed mesenteric defects and to assess the radiological findings and radiation doses. Methods This subgroup analysis included 300 patients randomized to either closure (n = 150) or nonclosure (n = 150) of mesenteric defects during LRYGB. The total number of CT scans performed due to abdominal pain in the first 5 postoperative years was recorded together with the radiological findings and radiation doses. Results A total of 132 patients (44%) underwent 281 abdominal CT scans, including 133 scans for 67 patients with open mesenteric defects (45%) and 148 scans for 65 patients with closed mesenteric defects (43%). Radiological findings consistent with small bowel obstruction or internal hernia were found in 31 (23%) of the scans for patients with open defects and in 18 (12%) of the scans for patients with closed defects (p = 0.014). The other pathological and radiological findings were infrequent and not significantly different between groups. At the 5-year follow-up, the total radiation dose was 82,400 mGy cm in the nonclosure group and 85,800 mGy cm in the closure group. Conclusion Closure of mesenteric defects did not influence the use of CT to assess abdominal pain. Graphical abstract ![]()
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Affiliation(s)
- Demir Amanda
- Department of Surgery, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden
| | - Påhlson Elin
- Department of Surgery, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden
| | - Norrman Eva
- Department of Medical Physics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden.
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22
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Pan T, Ding Z, Yan J, Zhao P. Comment on: Randomized clinical trial on closure versus non-closure of mesenteric defects during laparoscopic gastric bypass surgery. Br J Surg 2021; 108:e276. [PMID: 34009310 DOI: 10.1093/bjs/znab144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022]
Affiliation(s)
- T Pan
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital & Research Institute, School of Medicine, University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Z Ding
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital & Research Institute, School of Medicine, University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - J Yan
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital & Research Institute, School of Medicine, University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - P Zhao
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital & Research Institute, School of Medicine, University of Electronic Science and Technology of China (UESTC), Chengdu, China
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23
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Mala T. Finding the sweet spot in the surgical treatment of diabetes in obesity. Br J Surg 2021; 108:1011-1013. [PMID: 33914072 DOI: 10.1093/bjs/znab179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/23/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Tom Mala
- Dep. Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Ullevål, Institute of Clinical Medicine, University of Oslo
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24
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Magouliotis DE, Fergadi MP, Zacharoulis D. Comment on: Randomized clinical trial on closure versus non-closure of mesenteric defects during laparoscopic gastric bypass surgery. Br J Surg 2021; 108:e254. [PMID: 33729444 DOI: 10.1093/bjs/znab100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/23/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Dimitrios E Magouliotis
- Division of Surgery and Interventional Sciences, UCL, London.,Department of Surgery, University of Thessaly, Biopolis, Larissa, Greece
| | - Maria P Fergadi
- Department of Radiology, University of Thessaly, Biopolis, Larissa, Greece
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