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Liang Y, Wang C, Yang L, Yang K, Zhang S, Xie W. Nonsurgical risk factors for marginal ulcer following Roux-en-Y gastric bypass for obesity: a systematic review and meta-analysis of 14 cohort studies. Int J Surg 2024; 110:1793-1799. [PMID: 38320087 PMCID: PMC10942228 DOI: 10.1097/js9.0000000000001042] [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: 09/15/2023] [Accepted: 12/20/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUNDS Marginal ulcer (MU) is a common complication of Roux-en-Y Gastric Bypass (RYGB). The primary goal of this meta-analysis was to identify potential risk factors for MU post-RYGB. METHODS A comprehensive literature search was conducted on four databases (PubMed, Embase, Web of Science, and the Cochrane Library) to identify articles published from inception to 23 May 2023 that reported risk factors linked to ulcer occurrence post-RYGB. Hazard Ratio (HR) and Odds Ratio (OR) with respective 95% CI were calculated to estimate the impact of selected risk factors on MU. The risk factors were evaluated through multivariate analyses. The estimated risk factors were subjected to a random-effects model. Subgroup analysis based on study baseline characteristics and leave-one-out sensitivity analysis were also performed to investigate the potential sources of heterogeneity and assess the robustness of the findings. RESULT Herein, 14 observational studies involving 77 250 patients were included. Diabetes, smoking, and steroid use were identified to be risk factors of MU, with pooled ORs of (1.812; 95% CI: 1.226-2.676; P =0.003), (3.491; 95% CI: 2.204-5.531; P< 0.001), and (2.804; 95% CI: 1.383-5.685; P =0.004), respectively. Other risk factors, such as alcohol consumption, male sex, and PPI use, were deemed not significant due to differences in data acquisition and effect estimates. CONCLUSION Diabetes, smoking, and steroid use were identified as independent risk factors of MU. Enhancing awareness of these identified risk factors will lead to more effective preoperative prevention and targeted postoperative interventions for patients undergoing RYGB.
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Affiliation(s)
| | | | | | | | | | - Wenbiao Xie
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, People’s Republic of China
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2
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Park SH, Hur H, Park JH, Lee CM, Son YG, Jung MR, Lee HH, Hwang SH, Lee MS, Seo SH, Jeong IH, Son MW, Kim CH, Yoo MW, Oh SJ, Hwang SH, Il Choi S, Choi HS, Keum BR, Yang KS, Park S. Reappraisal of optimal reconstruction after distal gastrectomy - a study based on the KLASS-07 database. Int J Surg 2024; 110:32-44. [PMID: 37755373 PMCID: PMC10793744 DOI: 10.1097/js9.0000000000000796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/09/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUNDS This study aimed to compare the incidence of bile reflux, quality of life (QoL), and nutritional status among Billroth II (BII), Billroth II with Braun anastomosis (BII-B), and Roux-en-Y (RY) reconstruction after laparoscopic distal gastrectomy (LDG). MATERIALS AND METHODS We reviewed the prospective data of 397 patients from a multicentre database who underwent LDG for gastric cancer between 2018 and 2020 at 20 tertiary teaching hospitals in Korea. Postoperative endoscopic findings, QoL surveys using the European Organization for Research and Treatment of Cancer questionnaire (C30 and STO22), and nutritional and surgical outcomes were compared among groups. RESULTS In endoscopic findings, bile reflux was the lowest in the RY group ( n =67), followed by the BII-B ( n =183) and BII groups ( n =147) at 1 year (3.0 vs. 67.8 vs. 84.4%, all P <0.05). The anti-reflux capability of BII-B was statistically better than that of BII, but not as perfect as that of RY. From the perspective of QoL, BII-B was not inferior to RY, but better than BII reconstruction in causing fewer STO22 reflux symptoms at 6 and 12 months. However, only RY caused fewer C30 nausea symptoms than BII at 6 and 12 months, but not BII-B. Nutritional status and morbidities were similar among the three groups, and the operative time did not differ between the BII-B and RY groups. CONCLUSIONS BII-B cannot substitute for RY in preventing bile reflux, shortening the operative time, or reducing morbidities. Regarding short-term QoL, BII-B was sufficient to reduce STO22 reflux symptoms but failed to reduce C30 nausea symptoms postoperatively.
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Affiliation(s)
- Shin-Hoo Park
- Division of Foregut Surgery, Korea University College of Medicine, Seoul
- Division of Foregut Surgery, Korea University Anam Hospital, Seoul
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon
| | - Jong-Hyun Park
- Division of Foregut Surgery, Korea University College of Medicine, Seoul
| | - Chang-Min Lee
- Division of Foregut Surgery, Korea University College of Medicine, Seoul
- Department of Surgery, Korea University Ansan Hospital, Ansan
| | - Young-Gil Son
- Department of Surgery, Keimyung University Dongsan Medical Centre, Daegu
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Medical School, Jeollanam-do
| | - Han Hong Lee
- Department of Surgery, Catholic University of Seoul St Mary’s Hospital, Seoul, Republic of Korea
| | - Sun-Hwi Hwang
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Moon-Soo Lee
- Department of Surgery, Eulji University Hospital, Daejeon
| | - Sang Hyuk Seo
- Department of Surgery, Busan Paik Hospital, Inje University
| | - In Ho Jeong
- Department of Surgery, Jeju National University School of Medicine, Jeju
| | - Myoung Won Son
- Department of Surgery, Soonchunhyang University Hospital Cheonan, Cheonan
| | - Chang Hyun Kim
- Department of Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Moon-Won Yoo
- Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul
| | - Sung Jin Oh
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan
| | - Seong Ho Hwang
- Department of Surgery, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea
| | - Sung Il Choi
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul
| | - Hyuk Soon Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul
| | - Bo-Ra Keum
- Department of Internal Medicine, Korea University College of Medicine, Seoul
| | - Kyung Sook Yang
- Department of Biostatistics, Korea University College of Medicine, Seoul
| | - Sungsoo Park
- Division of Foregut Surgery, Korea University College of Medicine, Seoul
- Division of Foregut Surgery, Korea University Anam Hospital, Seoul
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3
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Patel K, Perdue J, Varre J, Serapiglia V, Rizzo A, Sonnanstine T. Operative technique for a successful laparoscopic en-bloc resection of gastrogastric fistula following roux-en-Y gastric bypass. J Surg Case Rep 2023; 2023:rjad569. [PMID: 37854523 PMCID: PMC10581709 DOI: 10.1093/jscr/rjad569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/11/2023] [Indexed: 10/20/2023] Open
Abstract
Gastrogastric fistulas are rare complications following Roux-en-Y gastric bypass surgery and are characterized by a fistulous connection between the gastric pouch and the remnant stomach. The presentation is often variable and a high-index of suspicion must be maintained for accurate and timely diagnosis. In this case report, we provide a detailed review of the technical steps taken to successfully resect a gastrogastric fistula en-bloc laparoscopically with an unremarkable post-operative course.
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Affiliation(s)
- Krishna Patel
- General Surgery, OhioHealth Riverside Methodist Hospital, Columbus 43214, United States
| | - Jordyn Perdue
- General Surgery, OhioHealth Riverside Methodist Hospital, Columbus 43214, United States
| | - Jaya Varre
- General Surgery, OhioHealth Riverside Methodist Hospital, Columbus 43214, United States
| | - Vinnie Serapiglia
- General Surgery, OhioHealth Riverside Methodist Hospital, Columbus 43214, United States
| | - Anthony Rizzo
- General Surgery, OhioHealth Riverside Methodist Hospital, Columbus 43214, United States
| | - Thomas Sonnanstine
- General Surgery, OhioHealth Riverside Methodist Hospital, Columbus 43214, United States
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4
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Wynn M, Tecson KM, Provost D. Marginal ulcers and associated risk factors after Roux-en-Y gastric bypass. Proc AMIA Symp 2023; 36:171-177. [PMID: 36876264 PMCID: PMC9980672 DOI: 10.1080/08998280.2022.2137362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
As the prevalence of morbid obesity continues to climb in America, so does the popularity of the Roux-en-Y gastric bypass (RYGB) to achieve weight loss goals; however, a long-term risk of RYGB is marginal ulceration, which requires urgent surgery if perforated. We sought to identify characteristics associated with elective vs urgent presentation for marginal ulcer following RYGB. Retrospective data for consecutive cases with marginal ulcers that required surgical intervention from May 2016 to February 2021 were queried from our institution's bariatric database, and differences in patient characteristics and clinical course were assessed according to presentation. Forty-three patients underwent surgery for marginal ulcer during the study timeframe. Twenty-four (56%) patients presented electively and were treated with resection of the gastroenterostomy and reanastomosis; the remaining 19 (44%) presented urgently with perforation and were treated with omental patch repair. Demographics, comorbidities, and medications were similar between groups. Patients with urgent presentations were less likely to have bleeds (0% vs. 33%, P = 0.0056) and strictures (16% vs. 46%, P = 0.0368), but were more likely to require admission to the intensive care unit (32% vs. 4%, P = 0.0325) and have a longer median length of stay (2 vs. 5 days, P < 0.0001). Bariatric surgeons must properly counsel patients about the risk of marginal ulcer development to prevent dangerous perforation, intensive care unit stays, and long hospitalizations.
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Affiliation(s)
- Matthew Wynn
- Department of Surgery, Baylor Scott & White Medical Center - Temple, Temple, Texas
| | | | - David Provost
- Department of Surgery, Baylor Scott & White Medical Center - Temple, Temple, Texas
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5
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Varvoglis DN, Sanchez-Casalongue M, Baron TH, Farrell TM. "Orphaned" Stomach-An Infrequent Complication of Gastric Bypass Revision. J Clin Med 2022; 11:7487. [PMID: 36556106 PMCID: PMC9782235 DOI: 10.3390/jcm11247487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
While generally safe, bariatric operations have a variety of possible complications. We present an uncommon complication after gastric bypass revision, namely the creation of an "orphaned" segment of remnant stomach that was left inadvertently in discontinuity, leading to recurrent intra-abdominal abscesses. Sinogram ultimately proved the diagnosis, and the issue was successfully treated using a combination of surgical and endoscopic methods to control the abscess and to allow internal drainage.
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Affiliation(s)
- Dimitrios N. Varvoglis
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | | | - Todd H. Baron
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Timothy M. Farrell
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
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6
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Pina L, Wood GC, Richardson S, Obradovic V, Petrick A, Parker DM. Bariatric revisional surgery for gastrogastric fistula following Roux-en-Y gastric bypass positively impacts weight loss. Surg Obes Relat Dis 2022; 19:626-631. [PMID: 36646542 DOI: 10.1016/j.soard.2022.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/15/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Gastrogastric fistula (GGF) is a rare complication from Roux-en-Y gastric bypass (RYGB). It is a known risk factor associated with weight recidivism and an indication for Bariatric Revisional Surgery (BRS). OBJECTIVES The primary outcome of this study is to evaluate perioperative outcomes and the long-term total body weight loss (TBWL) outcomes following revision. SETTING Single Academic Institution, Center of Bariatric Excellence. METHODS We selected patients who had primary bariatric surgery and BRS from 2003 to 2020, followed by BRS for GGF. Patients' demographics, perioperative outcomes, and TBWL were analyzed. RESULTS One hundred five patients underwent BRS for GGF. Mean body mass index (BMI) at index operation and revision was 51.6 ± 10.1, and 42.4 ± 11.2 respectively. Ninety percent of patients had open primary RYGB, and 69% had open revisional surgery. The median length of stay after BRS was 3 days. The 30-day reintervention rate was 19%. The 30-day readmission rate was 34%. Of the 77 patients included for weight loss analysis, the mean %TBWL after primary RYGB was 34% ± 14. The total mean %TBWL at the time of revision was 18.8%, translating into a weight regain of 13.6% ± 9.5. The total mean %TBWL after revision was 37.6% ± 11.4, translating into TBWL of 18.8% ± 9.4 after revision when compared to TBWL at revision time. CONCLUSIONS Our results demonstrate that revision for GGF can be safely performed, however is associated with higher morbidity than primary bariatric surgery. Revision for GGF results in significant long-term weight loss.
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Affiliation(s)
- Luis Pina
- Division of Bariatric and Foregut Surgery and the Obesity Institute, Geisinger Health System, Danville, Pennsylvania
| | - G Craig Wood
- Division of Bariatric and Foregut Surgery and the Obesity Institute, Geisinger Health System, Danville, Pennsylvania
| | - Sharma Richardson
- Division of Bariatric and Foregut Surgery and the Obesity Institute, Geisinger Health System, Danville, Pennsylvania
| | - Vladan Obradovic
- Division of Bariatric and Foregut Surgery and the Obesity Institute, Geisinger Health System, Danville, Pennsylvania
| | - Anthony Petrick
- Division of Bariatric and Foregut Surgery and the Obesity Institute, Geisinger Health System, Danville, Pennsylvania
| | - David M Parker
- Division of Bariatric and Foregut Surgery and the Obesity Institute, Geisinger Health System, Danville, Pennsylvania.
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7
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Akavia L, Dotan I, Aguila G, Shamah S. A novel endoscopic technique for closure of two gastro-gastric fistulas in a single session using an endoscopic helix tacking device. Endoscopy 2022; 54:E845-E846. [PMID: 35613915 PMCID: PMC9735336 DOI: 10.1055/a-1838-3306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Lidor Akavia
- Rabin Medical Center, Division of Gastroenterology, Petah Tikva, Israel
| | - Iris Dotan
- Rabin Medical Center, Division of Gastroenterology, Petah Tikva, Israel,Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Gerard Aguila
- Rabin Medical Center, Division of Gastroenterology, Petah Tikva, Israel
| | - Steven Shamah
- Rabin Medical Center, Division of Gastroenterology, Petah Tikva, Israel
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8
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Wei MT, Ahn JY, Friedland S. Over-the-Scope Clip in the Treatment of Gastrointestinal Leaks and Perforations. Clin Endosc 2021; 54:798-804. [PMID: 34872236 PMCID: PMC8652163 DOI: 10.5946/ce.2021.250] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/08/2021] [Indexed: 12/18/2022] Open
Abstract
While perforations, postoperative fistulas, and leaks have traditionally led to surgical or interventional radiology consultation for management, the introduction of the over-the-scope clip has allowed increased therapeutic possibilities for endoscopists. While primarily limited to case reports and series, the over-the-scope clip successfully manages gastrointestinal bleeding, perforations, as well as postoperative leaks and fistulas. Retrospective studies have demonstrated a relatively high success rate and a low complication rate. Given the similarity to variceal banding equipment, the learning curve with the over-the-scope clip is rapid. However, given the higher risk of procedures involving the use of the over-the-scope clip, it is essential to obtain the scope in a stable position and grasp sufficient tissue with the cap using a grasping tool and/or suction. From our experience, while closure may be successful in lesions sized up to 3 cm, successful outcomes are obtained for lesions sized <1 cm. Ultimately, given the limited available data, prospective randomized trials are needed to better evaluate the utility of the over-the-scope clip in various clinical scenarios, including fistula and perforation management.
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Affiliation(s)
- Mike T Wei
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ji Yong Ahn
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Shai Friedland
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
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9
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Papasavas P, Docimo S, Oviedo RJ, Eisenberg D. Biliopancreatic access following anatomy-altering bariatric surgery: a literature review. Surg Obes Relat Dis 2021; 18:21-34. [PMID: 34688572 DOI: 10.1016/j.soard.2021.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/19/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Pavlos Papasavas
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, Connecticut.
| | - Salvatore Docimo
- Division of Bariatric, Foregut, and Advanced GI Surgery, Stony Brook Medicine, Stony Brook, New York
| | | | - Dan Eisenberg
- Department of Surgery, Stanford University and Palo Alto VA Health Care Center, Palo Alto, California
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10
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Denoël C, Denoël A, Coimbra C, Heymans O. Lesser Curvature Roux-en-Y Gastric Bypass as an Alternative Procedure to Failed Vertical Banded Gastroplasty : Surgical Technique and Short Term Results. Acta Chir Belg 2020. [DOI: 10.1080/00015458.2001.12098612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C. Denoël
- Department of Abdominal Surgery, Centre Hospitalier Régional de la Citadelle (CHR) de Liège, Liège, Belgium
- Department of Plastic and Reconstructive Surgery, CHU Sart-Tilman, Liège, Belgium
| | - A. Denoël
- Department of Abdominal Surgery, Centre Hospitalier Régional de la Citadelle (CHR) de Liège, Liège, Belgium
| | - C. Coimbra
- Department of Abdominal Surgery, Centre Hospitalier Régional de la Citadelle (CHR) de Liège, Liège, Belgium
| | - O. Heymans
- Department of Plastic and Reconstructive Surgery, CHU Sart-Tilman, Liège, Belgium
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11
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Alyaqout K, Almazeedi S, Alhaddad M, Efthimiou E, Loureiro MDP. GASTROGASTRIC FISTULA AFTER ROUX-EN-Y GASTRIC BYPASS: A CASE REPORT AND REVIEW OF LITERATURE. ACTA ACUST UNITED AC 2020; 33:e1509. [PMID: 32844882 PMCID: PMC7448858 DOI: 10.1590/0102-672020190001e1509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/23/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Khaled Alyaqout
- Chelsea and Westminster Hospital Trust, London, United Kingdom
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12
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Rizk S, El Hajj Moussa W, Assaker N, Makhoul E, Chelala E. Case report about the management of a late Gastro-Gastric Fistula after Laparoscopic Gastric Bypass, with the finding of an unexpected foreign body. Int J Surg Case Rep 2020; 67:117-119. [PMID: 32062113 PMCID: PMC7016345 DOI: 10.1016/j.ijscr.2020.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/26/2019] [Accepted: 01/08/2020] [Indexed: 12/12/2022] Open
Abstract
Anemia & Weight Regain are possible signs of Gastrogastric fistula post RYGB. Preventive Gastrectomy is indicated in presence of Dysplasia in the Gastric Remnant. Orogastric Tube Stapling can be immediately detected or discovered years after RYGB. A series of protocols should be respected to avoid Orogastric Tube Stapling.
Background Gastro-Gastric Fistula is a rare but potentially serious complication of Roux-en-Y Gastric Bypass. Orogastric tube stapling is an adverse bariatric surgery iatrogenic complication that surgeons should be aware of and that has rarely been described. Clinical case A 51-year-old patient, operated in our University Hospital Center of a Gastric Bypass 3 years ago, presented on consultation with anemia and weight regain (BMI 36). An upper Gastrointestinal (GI) endoscopy showed a Gastro-Gastric Fistula and visualized the tip of a Faucher tube fixed in the blind pouch and an erosive ulceration on the gastrojejunal anastomosis. Multiple biopsies showed a low-grade dysplasia in the remnant stomach. A subtotal gastrectomy was performed with refashioning of the gastrojejunal anastomosis. Discussion Anemia and weight regain, with or without the association of marginal ulcers are the most common signs of Gastro-Gastric Fistula after Gastric Bypass (1–6%). Surgical treatment remains the standard of care and should be tailored to the size and location of the fistula and the status of the gastrojejunal anastomosis. Orogastric tube perioperative complications are rare occurrences during bariatric surgery and not reported at a later stage. They can be associated with significant morbidity. Prevention strategies must be taken and standardized to prevent such events. Conclusion The surgical option remains the standard of treatment and can be performed safely in Gastro-Gastric Fistula Type II. Orogastric tube accidental complications should be identified preferably perioperatively and measures of prevention should be implied to avoid such events.
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Affiliation(s)
- Simon Rizk
- Department of General Surgery, University Hospital Notre Dame des Secours, Byblos-Lebanon affiliated to Faculty of Medicine and Medical Sciences of the Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Wissam El Hajj Moussa
- Department of General Surgery, University Hospital Notre Dame des Secours, Byblos-Lebanon affiliated to Faculty of Medicine and Medical Sciences of the Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Nidal Assaker
- Department of General Surgery, University Hospital Notre Dame des Secours, Byblos-Lebanon affiliated to Faculty of Medicine and Medical Sciences of the Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Elias Makhoul
- Department of Gastroenterology, University Hospital Notre Dame des Secours, Byblos-Lebanon affiliated to Faculty of Medicine and Medical Sciences of the Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Elie Chelala
- Department of General Surgery, University Hospital Notre Dame des Secours, Byblos-Lebanon affiliated to Faculty of Medicine and Medical Sciences of the Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
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13
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Weight Loss Surgery Reduces Healthcare Resource Utilization and All-Cause Inpatient Mortality in Morbid Obesity: a Propensity-Matched Analysis. Obes Surg 2019; 28:3213-3220. [PMID: 29931480 DOI: 10.1007/s11695-018-3345-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AIMS There is a lack of population studies evaluating the impact of bariatric surgery (BRS) on all-cause inpatient mortality. We sought to determine the impact of prior BRS on all-cause mortality and healthcare utilization in hospitalized patients. METHODS We analyzed the National Inpatient Sample database from 2007 to 2013. Participants were adult (≥ 18 years) inpatients admitted with a diagnosis of morbid obesity or a history of BRS. Propensity score-matched analyses were performed to compare mortality and healthcare resource utilization (hospital length of stay and cost). RESULTS There were 9,044,103 patient admissions with morbid obesity and 1,066,779 with prior BRS. A propensity score-matched cohort analysis demonstrated that prior BRS was associated with decreased mortality (OR = 0.58; 95% CI [0.54, 0.63]), shorter length of stay (0.59 days; P < 0.001), and lower hospital costs ($2152; P < 0.001) compared to morbid obesity. A subgroup of propensity score-matched analysis among patients with high-risk of mortality (leading ten causes of mortality in morbid obesity) revealed a consistently significant reduction in odds of mortality for patients with prior BRS (OR = 0.82; 95% CI [0.72, 0.92]). CONCLUSION AND RELEVANCE Hospitalized patients with a history of BRS have lower all-cause mortality and healthcare resource utilization compared to those who are morbidly obese. These observations support the continued application of BRS as an effective and resource-conscious treatment for morbid obesity.
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14
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Jafri SA, Jay Roberts DO, Smith A. Successful management of early gastrogastric fistula using fully covered esophageal stent. Surg Obes Relat Dis 2018; 14:1911-1913. [PMID: 30545597 DOI: 10.1016/j.soard.2018.09.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Saad A Jafri
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Forth Worth, Texas
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15
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Gupta A, Shah MM, Kalaskar SN, Kroh M. Late postoperative bleeding after Roux-en-Y gastric bypass: management and review of literature. BMJ Case Rep 2018; 11:11/1/e226271. [PMID: 30567217 DOI: 10.1136/bcr-2018-226271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Gastrointestinal (GI) bleeding is a catastrophic complication of gastric bypass. Bleeding can occur during the early or late phase after the operation. Though bleeding after gastric bypass is infrequent, late bleeding is exceedingly rare. We present two patients with late bleeding following Roux-en-Y gastric bypass (RYGB). The first patient, a 65-year-old woman, presented with life-threatening upper GI bleeding almost 5 years after laparoscopic RYGB. The second patient, a 62-year-old woman, presented with upper GI bleeding after almost 14 years following RYGB. Both, due to an eroding marginal ulcer. We discuss here the management of a rare and catastrophic complication of late GI bleeding and review the various reports in the literature describing the late bleeding as a complication of gastric bypass. Late GI bleeding after RYGB presents a diagnostic and interventional challenge. High index of suspicion and adequate management strategies may lessen morbidity and mortality.
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Affiliation(s)
- Alisha Gupta
- General Internal Medicine and Geriatrics, Northwestern University, Chicago, Illinois, USA
| | - Mihir M Shah
- Surgical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sudhir N Kalaskar
- General Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Matthew Kroh
- General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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16
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Chahine E, Kassir R, Dirani M, Joumaa S, Debs T, Chouillard E. Surgical Management of Gastrogastric Fistula After Roux-en-Y Gastric Bypass: 10-Year Experience. Obes Surg 2018; 28:939-944. [PMID: 28983751 DOI: 10.1007/s11695-017-2949-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Gastrogastric fistula (GGF) occurs in 1-6% of patients who undergo Roux-en-Y gastric bypass (RYGB) for morbid obesity. The pathophysiology may be related to gastric ischemia, fistula, or ulcer. OBJECTIVES The purposes of the study are to describe the principles of management and to review the literature of this uncommon complication. SETTING The setting of this study is University Hospital, France. MATERIALS AND METHODS We conducted a retrospective review of all patients' records with a diagnosis of GGF after RYGB between January 2004 and November 2014. RESULTS During the study period, 1273 patients had RYGB for morbid obesity. Fifteen patients presented with a symptomatic GGF (1.18%). The average interval from surgery to presentation was 28 months (22-62). A history of marginal ulcer or anastomotic leak was present in nine patients (60%). The most common presentation was weight regain (80%), followed by pain (73.3%). Two types of fistulas were identified, an exclusively GGF (high) and a gastro-jejuno-gastric fistula (low). High GGF, frequently associated with dilatation of the gastric pouch, was treated by a sleeve of the pouch and sleeve resection of the remnant stomach (nine patients). Low GGF was treated with gastric resection coupled with a revision of the gastrojejunal anastomosis (six patients). All patients were treated laparoscopically with no conversion to laparotomy. The average length of postoperative hospital stay was 5.2 days (range 3-10). CONCLUSION GGF after RYGB is a rare complication. Its pathophysiology remains unclear. Surgical management is the definitive treatment.
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Affiliation(s)
- Elias Chahine
- Department of General and Minimally Invasive Surgery, Paris Poissy Medical Center, Poissy, France
| | - Radwan Kassir
- Department of General Surgery, CHU Nord Hospital, Jean Monnet University, Avenue Albert Raimond, 42270, Saint Etienne, France.
| | - Mazen Dirani
- Department of General and Minimally Invasive Surgery, Paris Poissy Medical Center, Poissy, France
| | - Saadeddine Joumaa
- Department of General and Minimally Invasive Surgery, Paris Poissy Medical Center, Poissy, France
| | - Tarek Debs
- Department of General Surgery, CHU Archet, Nice, France
| | - Elie Chouillard
- Department of General and Minimally Invasive Surgery, Paris Poissy Medical Center, Poissy, France
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17
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Ghunaim M, Laroye C, Pattou F, Caiazzo R. Video Revisional Gastric Bypass After Vertical Banded Gastroplasty by a Hybrid Technique: Robotic and Laparoscopic. Obes Surg 2018; 28:2985-2986. [PMID: 29926356 DOI: 10.1007/s11695-018-3339-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The video shows, step-by-step, the hybrid laparoscopic conversion of vertical banded gastroplasty (VBG) to Roux-en-Y gastric bypass (RYGB) with a robotic-assisted hand-sewn technique (HST) for gastrojejunal anastomosis (GJA).
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Affiliation(s)
- Mohammed Ghunaim
- General and Endocrine Surgery Department, C. Huriez Hospital, Lille University Hospital, 59037, Lille Cedex, France.,Université de Lille, Lille, France.,Department of Surgery, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Constance Laroye
- General and Endocrine Surgery Department, C. Huriez Hospital, Lille University Hospital, 59037, Lille Cedex, France.,Université de Lille, Lille, France
| | - Francois Pattou
- General and Endocrine Surgery Department, C. Huriez Hospital, Lille University Hospital, 59037, Lille Cedex, France.,Université de Lille, Lille, France.,Diabetes Cell Therapy, French National Institute of Health and Medical Research-INSERM U1190, Lille, France
| | - Robert Caiazzo
- General and Endocrine Surgery Department, C. Huriez Hospital, Lille University Hospital, 59037, Lille Cedex, France. .,Université de Lille, Lille, France. .,Diabetes Cell Therapy, French National Institute of Health and Medical Research-INSERM U1190, Lille, France.
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18
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Abstract
OBJECTIVE To determine if the attenuation of contrast material in the excluded stomach compared with the gastric pouch is helpful in diagnosing gastrogastric (GG) fistula. MATERIALS AND METHODS In a retrospective study, 13 CT scans in 12 patients (age 43.2 ± 9.2, 10 females) who had undergone Roux-en-Y gastric bypass and who had oral contrast in both the gastric pouch and excluded stomach were qualitatively and quantitatively evaluated for GG fistula by two radiologists, using upper GI series (UGI) as the gold standard. Quantitative analysis was performed by computing the relative attenuation (RA) ratio (HU in excluded stomach/HU in gastric pouch). Statistical analysis was performed to determine if the RA ratio values correlated with the UGI findings of GG fistula. RESULTS 46.2% (6/13) of UGI studies demonstrated a GG fistula. Statistical analysis demonstrated a significant difference in RA ratio (P < 0.05) between the fistula group (1.12 ± 0.29) and the reflux group (0.56 ± 0.19). A receiver operating characteristic analysis identified an RA ratio of 0.8 that maximized sensitivity (100%), at the expense of specificity (78.6%), for diagnosing GG fistula. In contrast, the initial qualitative evaluation for GG fistula yielded a lower sensitivity (45.8%) and a higher specificity (89.2%). After taking RA ratios into account, radiologists' final conclusions achieved higher sensitivity (58.3%) and specificity (100%). CONCLUSION The relative attenuation ratio of oral contrast in the excluded stomach versus the gastric pouch can be a reliable tool in differentiating GG fistula from oral contrast reflux up the biliopancreatic limb on CT.
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19
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Jirapinyo P, Thompson AC, Kröner PT, Chan WW, Thompson CC. Metabolic Effect of Foregut Exclusion Demonstrated by the Impact of Gastrogastric Fistula on Recurrence of Diabetes. J Am Coll Surg 2018; 226:259-266.e1. [PMID: 29274838 PMCID: PMC5826850 DOI: 10.1016/j.jamcollsurg.2017.12.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/10/2017] [Accepted: 12/11/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) resolves in >80% of patients after Roux-en-Y gastric bypass (RYGB). It has been hypothesized that foregut exclusion is mechanistically important to this observation. This study aimed to determine whether gastrogastric (GG) fistula, with a loss of foregut exclusion, is associated with T2DM relapse, and to assess whether closure of GG fistula is associated with T2DM resolution. STUDY DESIGN A matched cohort study of patients who experienced T2DM remission after RYGB. Cases (patients with GG fistula) were matched to controls (patients without GG fistula) based on age, BMI, weight regain, and duration from RYGB. Primary end point was T2DM relapse. Time-to-event analysis was performed to identify an association between GG fistula and time to T2DM resolution. RESULTS One hundred and twenty-six patients (42 cases and 84 controls) were included. Cases experienced a higher rate of T2DM relapse than controls (48% vs 13%; odds ratio 18; p < 0.0001). On multivariable analysis, GG fistula remained a significant predictor of T2DM relapse after controlling for sex and insulin use (odds ratio 6.3; p = 0.02). Of the 42 cases, 20 experienced T2DM relapse, with 1 spontaneous resolution. Of 19, thirteen underwent fistula revision and experienced a higher rate of T2DM resolution than the nonrevision group (69% vs 0%; odds ratio 27; p = 0.036). Time to T2DM resolution was shorter in the revision group compared with the nonrevision group (p = 0.006). CONCLUSIONS The RYGB patients with GG fistula have a higher rate of T2DM relapse, compared with those without GG fistula with similar BMI and weight regain. Successful fistula revision is associated with resolution of T2DM.
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Affiliation(s)
- Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Andrew C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Paul T Kröner
- Department of Medicine, Mount Sinai St. Luke's, Mount Sinai West Hospitals, New York, NY
| | - Walter W Chan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
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20
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Altieri MS, Wright B, Peredo A, Pryor AD. Common weight loss procedures and their complications. Am J Emerg Med 2018; 36:475-479. [DOI: 10.1016/j.ajem.2017.11.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 11/03/2017] [Accepted: 11/20/2017] [Indexed: 01/01/2023] Open
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21
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Meister KM, Schauer PR, Brethauer SA, Aminian A. Effect of Gastrogastric Fistula Closure in Type 2 Diabetes. Obes Surg 2017; 28:1086-1090. [PMID: 29090378 DOI: 10.1007/s11695-017-2976-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Roux-en-Y gastric bypass (RYGB) has been shown to significantly improve glucose control in patients with type 2 diabetes (T2DM). The formation of a gastrogastric fistula (GGF) allows nutrients to pass through the native route, rather than bypassing the duodenum in typical RYGB configuration. We sought to evaluate the effect of revisional bariatric surgery for known GGF on control of diabetes. METHODS A retrospective chart review of a single academic institution was performed to identify patients who had T2DM at the time of corrective surgery for a GGF. Baseline characteristics, and postoperative outcomes including changes in body mass index (BMI), glycated hemoglobin, fasting blood glucose (FBG), and diabetes medications were assessed. RESULTS Ten patients were identified with GGF who had T2DM at the time of corrective surgery. Patients had a male-to-female ratio of 2:3, a mean age of 59.2 ± 10 years, a mean baseline BMI of 38.1 ± 17.6 kg/m2, and a median duration of 9 years (interquartile range 6-14) from initial RYGB to revision. At a mean follow-up of 14.9 ± 8.5 months, a mean reduction in BMI of 4.9 ± 6 kg/m2 was associated with a significant mean reduction in FBG (167.1 ± 88.2 vs. 106.1 ± 20.4 mg/dL, p = 0.04) and number of diabetes medications (1.4 ± 0.8 vs. 0.7 ± 0.7, p = 0.04). CONCLUSION In patients with diabetes and GGF, a corrective surgery for closure of fistula and restoration of bypass anatomy results in improvement of glucose control and status of diabetes medications. This finding can highlight the potential metabolic significance of duodenal exclusion.
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Affiliation(s)
- Katherine M Meister
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA
| | - Philip R Schauer
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA
| | - Stacy A Brethauer
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA
| | - Ali Aminian
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA.
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22
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Celiker H. A new proposed mechanism of action for gastric bypass surgery: Air hypothesis. Med Hypotheses 2017; 107:81-89. [PMID: 28915970 DOI: 10.1016/j.mehy.2017.08.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/02/2017] [Accepted: 08/08/2017] [Indexed: 02/07/2023]
Abstract
Roux-en-Y gastric bypass (RYGB) surgery is one of the most effective treatments for obesity and type II diabetes. RYGB was originally believed to work by mechanically restricting caloric intake or causing macronutrient malabsorption. However, such mechanical effects play no role in the remarkable efficacy of gastric bypass. Instead, mounting evidence shows that altered neuroendocrine signaling is responsible for the weight reducing effects of RYGB. The exact mechanism of this surgical response is still a mystery. Here, we propose that RYGB leads to weight loss primarily by inducing a functional shift in the gut microbiome, manifested by a relative expansion of aerobic bacteria numbers in the colon. We point to compelling evidence that gastric bypass changes the function of the microbiome by disrupting intestinal gas homeostasis, causing excessive transit of swallowed air (oxygen) into the colon.
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Affiliation(s)
- Hasan Celiker
- Xeno Biosciences Inc., 12 Mt Auburn St #7, Cambridge, MA, USA.
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23
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Saeed S, Alothman S, Persaud A, Gray S, Ahmed L. Successful laparoscopic repair of gastro-gastric fistula following Roux-en-Y gastric bypass at Harlem Community Hospital. J Surg Case Rep 2017; 2017:rjx134. [PMID: 28721194 PMCID: PMC5508543 DOI: 10.1093/jscr/rjx134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 06/17/2017] [Indexed: 11/14/2022] Open
Abstract
Gastro-gastric fistula is a communication between the gastric remnant and gastric pouch. It is a rare complication of Roux-en-Y gastric bypass. It is caused by anastomotic leak, marginal ulcers, distal obstruction or erosion from foreign body. In this case report, we are presenting a successful laparoscopic repair of gastro-gastric fistula in a patient who presented with weight gain after initial loss.
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Affiliation(s)
| | - Sara Alothman
- Department of Surgery, Harlem Hospital Center, New York, NY 10037, USA
| | - Amrita Persaud
- Department of Surgery, Harlem Hospital Center, New York, NY 10037, USA
| | - Sanjiv Gray
- Department of Surgery, Harlem Hospital Center, New York, NY 10037, USA
| | - Leaque Ahmed
- Department of Surgery, Harlem Hospital Center, New York, NY 10037, USA
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24
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Valli PV, Gubler C. Review article including treatment algorithm: endoscopic treatment of luminal complications after bariatric surgery. Clin Obes 2017; 7:115-122. [PMID: 28199050 DOI: 10.1111/cob.12182] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/19/2016] [Accepted: 12/29/2016] [Indexed: 02/06/2023]
Abstract
The worldwide number of performed bariatric surgeries is increasing continuously, whereas laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy are conducted most frequently. Alongside with the usual post-operative and metabolic complications, luminal complications such as anastomotic bleeding, ulceration, leakage, fistula formation, enlargement and stenosis of the anastomosis may occur. Evolution of interventional endoscopy frequently allows endoscopic management of complications, avoiding surgical interventions in most cases. Here, we review the various luminal complications after bariatric surgery with a focus on their endoscopic management.
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Affiliation(s)
- P V Valli
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - C Gubler
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
- Department of Internal Medicine, Division of Gastroenterology, Kantonsspital Winterthur, Winterthur, Switzerland
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25
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Abstract
Weight regain after bariatric surgery is common and can be managed with surgical interventions or less morbid endoscopic techniques. These endoscopic approaches target structural postoperative changes that are associated with weight regain, most notably dilation of the gastrojejunal anastomosis aperture. Purse string suture placement, as well as argon plasma coagulation application to the anastomosis, may result in significant and durable weight loss. Furthermore, various endoscopic approaches may be used to safely and effectively manage other complications of bariatric surgery that may result in poor weight loss or weight regain after surgery, including fistula formation.
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Affiliation(s)
- Andrew C Storm
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02215, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02215, USA.
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26
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Chang PC, Huang CK, Tai CM, Huang IYW, Hsin MC, Hung CM. Revision using totally hand-sewn gastrojejunostomy and truncal vagotomy for refractory marginal ulcer after laparoscopic Roux-en-y gastric bypass: a case series. Surg Obes Relat Dis 2017; 13:588-593. [DOI: 10.1016/j.soard.2016.09.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 09/06/2016] [Accepted: 09/23/2016] [Indexed: 12/12/2022]
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27
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Ribeiro-Parenti L, De Courville G, Daikha A, Arapis K, Chosidow D, Marmuse JP. Classification, surgical management and outcomes of patients with gastrogastric fistula after Roux-En-Y gastric bypass. Surg Obes Relat Dis 2017; 13:243-248. [DOI: 10.1016/j.soard.2016.09.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 09/14/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
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28
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Nogueira TDB, Artigiani R, Herani B, Waisberg J. H. PYLORI INFECTION, ENDOSCOPIC, HISTOLOGICAL ASPECTS AND CELL PROLIFERATION IN THE GASTRIC MUCOSA OF PATIENTS SUBMITTED TO ROUX-EN-Y GASTRIC BYPASS WITH CONTENTION RING: a cross sectional endoscopic and immunohistochemical study. ARQUIVOS DE GASTROENTEROLOGIA 2017; 53:55-60. [PMID: 27281506 DOI: 10.1590/s0004-28032016000100011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 11/25/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Morbid obesity treatment through vertical gastroplasty Roux-en-Y gastric bypass initially used a contention ring. However, this technique may create conditions to the development of potentially malign alterations in the gastric mucosa. Although effective and previously performed in large scale, this technique needs to be better evaluated in long-term studies regarding alterations caused in the gastric mucosa. OBJECTIVE To analyze the preoperative and postoperative endoscopic, histological and cell proliferation findings in the gastric antrum and body mucosa of patients submitted to the Roux-en-Y gastric bypass with a contention ring. METHODS We retrospectively evaluated all patients submitted to Roux-en-Y gastric bypass with a contention ring with more than 60 months of postoperative follow-up. We compared the preoperative (gastric antrum and body) and postoperative (gastric pouch) gastric mucosa endoscopic findings, cell proliferation index and H. pylori prevalence. We evaluated cell proliferation through Ki-67 antibody immunohistochemical expression. RESULTS In the study period, 33 patients were operated with the Roux-en-Y gastric bypass using a contention ring. We found a chronic gastritis rate of 69.7% in the preoperative period (gastric antrum and body) and 84.8% in the postoperative (gastric pouch). H. pylori was present in 18.2% of patients in the preoperative period (gastric antrum and body) and in 57.5% in the postoperative (gastric pouch). Preoperative cell proliferation index was 18.1% in the gastric antrum and 16.2% in the gastric body, and 23.8% in the postoperative gastric pouch. The postoperative cell proliferation index in the gastric pouch was significantly higher (P=0.001) than in the preoperative gastric antrum and body. Higher cell proliferation index and chronic gastritis intensity were significantly associated to H. pylori presence (P=0.001 and P=0.02, respectively). CONCLUSION After Roux-en-Y gastric bypass with contention ring, there was a higher chronic gastritis incidence and higher cell proliferation index in the gastric pouch than in the preoperative gastric antrum and body. Mucosa inflammation intensity and cell proliferation index in the postoperative gastric pouch were associated to H. pylori presence and were higher than those found in the preoperative gastric antrum and body mucosa.
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Affiliation(s)
- Thiago De Bortoli Nogueira
- Departamento de Gastroenterologia Cirúrgica, Universidade Federal de São Paulo, São Paulo, SP, Brasil., Universidade Federal de São Paulo, Departamento de Gastroenterologia Cirúrgica, Universidade Federal de São Paulo, São Paulo SP , Brazil
| | - Ricardo Artigiani
- Departamento de Gastroenterologia Cirúrgica, Universidade Federal de São Paulo, São Paulo, SP, Brasil., Universidade Federal de São Paulo, Departamento de Gastroenterologia Cirúrgica, Universidade Federal de São Paulo, São Paulo SP , Brazil
| | - Benedito Herani
- Departamento de Gastroenterologia Cirúrgica, Universidade Federal de São Paulo, São Paulo, SP, Brasil., Universidade Federal de São Paulo, Departamento de Gastroenterologia Cirúrgica, Universidade Federal de São Paulo, São Paulo SP , Brazil
| | - Jaques Waisberg
- Departamento de Gastroenterologia Cirúrgica, Universidade Federal de São Paulo, São Paulo, SP, Brasil., Universidade Federal de São Paulo, Departamento de Gastroenterologia Cirúrgica, Universidade Federal de São Paulo, São Paulo SP , Brazil
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29
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Ojea AR, Madi O, Neto RML, Lima SE, de Carvalho BT, Ojea MJM, Marcos RL, da Silva FS, Zamuner SR, Chavantes MC. Beneficial Effects of Applying Low-Level Laser Therapy to Surgical Wounds After Bariatric Surgery. Photomed Laser Surg 2016; 34:580-584. [DOI: 10.1089/pho.2016.4149] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alecsander R. Ojea
- Graduation and Post-Graduation in Medicine, University Nove de Julho, Sao Paulo, Brazil
- Conjunto Hospitalar do Mandaqui, São Paulo, Brazil
| | - Otavio Madi
- Graduation and Post-Graduation in Medicine, University Nove de Julho, Sao Paulo, Brazil
| | | | | | | | | | - Rodrigo L. Marcos
- Graduation and Post-Graduation in Medicine, University Nove de Julho, Sao Paulo, Brazil
| | | | - Stella R. Zamuner
- Graduation and Post-Graduation in Medicine, University Nove de Julho, Sao Paulo, Brazil
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30
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Boules M, Chang J, Haskins IN, Sharma G, Froylich D, El-Hayek K, Rodriguez J, Kroh M. Endoscopic management of post-bariatric surgery complications. World J Gastrointest Endosc 2016; 8:591-599. [PMID: 27668069 PMCID: PMC5027029 DOI: 10.4253/wjge.v8.i17.591] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/02/2016] [Accepted: 07/22/2016] [Indexed: 02/05/2023] Open
Abstract
Understanding the technical constructs of bariatric surgery is important to the treating endoscopist to maximize effective endoluminal therapy. Post-operative complication rates vary widely based on the complication of interest, and have been reported to be as high as 68% following adjustable gastric banding. Similarly, there is a wide range of presenting symptoms for post-operative bariatric complications, including abdominal pain, nausea and vomiting, dysphagia, gastrointestinal hemorrhage, and weight regain, all of which may provoke an endoscopic assessment. Bleeding and anastomotic leak are considered to be early (< 30 d) complications, whereas strictures, marginal ulcers, band erosions, and weight loss failure or weight recidivism are typically considered late (> 30 d) complications. Treatment of complications in the immediate post-operative period may require unique considerations. Endoluminal therapies serve as adjuncts to surgical and radiographic procedures. This review aims to summarize the spectrum and efficacy of endoscopic management of post-operative bariatric complications.
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31
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Roberts KE, Duffy AJ, Bell RL. Laparoscopic Transgastric Repair of a Gastrogastric Fistula After Gastric Bypass. Surg Innov 2016; 14:18-23. [PMID: 17442875 DOI: 10.1177/1553350606298966] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gastrogastric fistulas are an uncommon complication following laparoscopic Roux-Y gastric bypass surgery (LRYGB) and may be caused by staple-line dehiscence or leak. Described here is a novel technique to treat these fistulae via a laparoscopic transgastric approach and closure of the fistulous tract with an Endo Stitch™ device. The 33-year-old patient, post LRYGB in 2002, with documented gastrogastric fistula, had failed non-operative management. A transoral endoscope was passed into the cephalad portion of the gastrogastric fistula; a glidewire was passed from the gastric pouch into the gastric remnant. Laparoscopically, 2 gastrotomies were made and a “pneumogastrium” created with carbon dioxide. Under direct, transgastric visualization, the distal portion of the gastrogastric fistula was closed using an Endo Stitch™ device. This technique is safe and reproducible when performed by an experienced laparoscopic surgeon and could be modified for other scenarios requiring alternate access to the stomach.
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Affiliation(s)
- Kurt E Roberts
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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32
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Sverdén E, Mattsson F, Sondén A, Leinsköld T, Tao W, Lu Y, Lagergren J. Risk Factors for Marginal Ulcer After Gastric Bypass Surgery for Obesity. Ann Surg 2016; 263:733-7. [PMID: 26106845 DOI: 10.1097/sla.0000000000001300] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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33
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The influence of prophylactic proton pump inhibitor treatment on the development of symptomatic marginal ulceration in Roux-en-Y gastric bypass patients: a historic cohort study. Surg Obes Relat Dis 2016; 12:246-52. [DOI: 10.1016/j.soard.2015.04.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/28/2015] [Accepted: 04/30/2015] [Indexed: 12/25/2022]
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34
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Essential bariatric emergencies for the acute care surgeon. Eur J Trauma Emerg Surg 2015; 42:571-584. [PMID: 26669688 DOI: 10.1007/s00068-015-0621-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/07/2015] [Indexed: 12/19/2022]
Abstract
Bariatric surgery is the most effective treatment for morbid obesity. Due to the high volume of weight loss procedures worldwide, the general surgeon will undoubtedly encounter bariatric patients in his or her practice. Liberal use of CT scans, upper endoscopy and barium swallow in this patient population is recommended. Some bariatric complications, such as marginal ulceration and dyspepsia, can be effectively treated non-operatively (e.g., proton pump inhibitors, dietary modification). Failure of conservative management is usually an indication for referral to a bariatric surgery specialist for operative re-intervention. More serious complications, such as perforated marginal ulcer, leak, or bowel obstruction, may require immediate surgical intervention. A high index of suspicion must be maintained for these complications despite "negative" radiographic studies, and diagnostic laparoscopy performed when symptoms fail to improve. Laparoscopic-assisted gastric band complications are usually approached with band deflation and referral to a bariatric surgeon. However, if acute slippage that results in gastric strangulation is suspected, the band should be removed immediately. This manuscript provides a high-level overview of all essential bariatric complications that may be encountered by the acute care surgeon.
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Araaya GH, Desta KG, Gebremeskel WW, Wasihun AG. Gastrojejunocolic fistula after gastrojejunostomy in Ayder referral hospital Northern Ethiopia: A report of two cases. Ann Med Surg (Lond) 2015; 4:448-51. [PMID: 26693276 PMCID: PMC4660275 DOI: 10.1016/j.amsu.2015.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 10/03/2015] [Accepted: 10/22/2015] [Indexed: 11/30/2022] Open
Abstract
Background Gastrojejunocolic fistula (GJCF) is a late and severe complication of a stomal ulcer after gastrojejunostomy, which develops as a result of inadequate resection of stomach or incomplete vagotomy. The occurrence of perforation in a GJCF is even more a rare complication because long evolution time or latent period is required for its appearance. Patients with this condition usually present with diarrhea, weight loss, feculent vomiting, under-nutrition and features of peritonitis that require immediate surgical intervention. Case presentation We described two cases of gastrojejunocolic fistula in men aged 60 and 40, first cases of gastrojejunocolic fistula seen in our referral hospital and in the whole region following more than a decade after gastrojejunostomy. Both patients initially presented with watery diarrhea, vomiting of fecal materials, poor appetite and weight loss. Upper GI series or barium enema studies allowed a conclusive diagnosis to be made. Both patients underwent one-stage en bloc resection, and their postoperative course and outcome was one cure and one death. Conclusion As it is rare phenomenon, high clinical suspicion is very important in the diagnosis of GJCF on patients who manifest with chronic diarrhea, vomiting of fecal matter, abdominal pain and features of malnutrition. Careful preoperative preparation is mandatory before any type of surgical procedure is carried out. Pre-operative nutritional status should be evaluated in patients undergoing corrective surgery. Adequate resection of the stomach after Gastrojejunostomy and complete vagotomy is important to prevention development of GJCF. High Nasal carriage of Staphylococcus aureus. Vancomycin, Gentamicin and Ceftriaxone were 100% effective. Isolated bacteria showed high resistance to penicillin and Ampicillin. Low MRSA prevalence arte. Food handlers should train on personal hygiene.
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Affiliation(s)
- Girmay Hagos Araaya
- Department of Surgery, School of Medicine, College of Health Sciences, Ayder Referral Hospital, Mekelle University, Ethiopia
| | - Kibrom Gebresilasie Desta
- Department of Surgery, School of Medicine, College of Health Sciences, Ayder Referral Hospital, Mekelle University, Ethiopia
| | - Weldehawaria Weldu Gebremeskel
- Department of Surgery, School of Medicine, College of Health Sciences, Ayder Referral Hospital, Mekelle University, Ethiopia
| | - Araya Gebreyesus Wasihun
- Department of Medical Microbiology and Immunology, Biomedical Institute, College of Health Sciences, Mekelle University, Ethiopia
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Coblijn UK, Lagarde SM, de Castro SMM, Kuiken SD, van Wagensveld BA. Symptomatic marginal ulcer disease after Roux-en-Y gastric bypass: incidence, risk factors and management. Obes Surg 2015; 25:805-11. [PMID: 25381115 DOI: 10.1007/s11695-014-1482-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND One of the long-term complications of laparoscopic Roux-and-Y gastric bypass (LRYGB) is the development of marginal ulcers (MU). The aim of the present study is to assess the incidence, risk factors, symptomatology and management of patients with symptomatic MU after LRYGB surgery. METHODS A consecutive series of patients who underwent a LRYGB from 2006 until 2011 were evaluated in this study. Signs of abdominal pain, pyrosis, nausea or other symptoms of ulcer disease were analysed. Acute symptoms of (perforated) MU such as severe abdominal pain, vomiting, melena and haematemesis were also collected. Patient baseline characteristics, medication and intoxications were recorded. Statistical analysis was performed to identify risk factors associated with MU. RESULTS A total of 350 patients underwent a LRYGB. Minimal follow-up was 24 months. Twenty-three patients (6.6%) developed a symptomatic MU of which four (1.1%) presented with perforation. Smoking, the use of corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) was significantly associated with the development of MU. Five out of 23 patients (22%) underwent surgery. All other patients could be treated conservatively. CONCLUSIONS Marginal ulcers occurred in 6.6% of the patients after a LRYGB. Smoking, the use of corticosteroids and the use of NSAIDs were associated with an increased risk of MU. Most patients were managed conservatively.
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Affiliation(s)
- Usha K Coblijn
- Department of Surgery, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands,
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Corcelles R, Jamal MH, Daigle CR, Rogula T, Brethauer SA, Schauer PR. Surgical management of gastrogastric fistula. Surg Obes Relat Dis 2015; 11:1227-32. [DOI: 10.1016/j.soard.2015.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 02/02/2015] [Accepted: 03/06/2015] [Indexed: 02/08/2023]
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An evidence-based algorithm for the management of marginal ulcers following Roux-en-Y gastric bypass. Obes Surg 2015; 24:1520-7. [PMID: 24851857 DOI: 10.1007/s11695-014-1293-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
As the demand for obesity surgery grows, Roux-en-Y gastric bypass remains the most commonly performed procedure associated with low complication rates and good long-term co-morbidity resolution and weight loss. Marginal ulcers remain a cause of significant morbidity in medium and long term and are reported in every large series of this operation. Marginal ulceration is a complex problem with unclear aetiology and lack of clear consensus on its prevention and management. A clearer understanding of the available evidence regarding the prevention and treatment of marginal ulcers is needed to improve patient care. We propose an algorithm for management of patients with marginal ulcers based on the best available evidence in the literature.
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Comment on: Is esophagogastroduodenoscopy before Roux-en-Y gastric bypass or sleeve gastrectomy mandatory? Surg Obes Relat Dis 2015; 11:1192-3. [PMID: 26183301 DOI: 10.1016/j.soard.2015.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 06/02/2015] [Indexed: 01/28/2023]
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Pauli EM, Beshir H, Mathew A. Gastrogastric fistulae following gastric bypass surgery-clinical recognition and treatment. Curr Gastroenterol Rep 2015; 16:405. [PMID: 25113040 DOI: 10.1007/s11894-014-0405-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Gastrogastric fistula (GGF) formation is an uncommon but well-recognized complication following Roux-en-Y gastric bypass for morbid obesity. Patients with GGF may be asymptomatic or have nonspecific problems of abdominal pain, weight regain, or ulcer formation at the gastrojejunal anastomosis. Maintaining a high index of suspicion is the key to diagnosis. Flexible upper endoscopy and upper gastrointestinal fluoroscopy are complementary imaging modalities for securing the diagnosis of GGF. Surgical repair of GGF is generally the most definitive management but is invasive and has the potential for morbidity. Endoscopic methods of closure have gained favor in recent years due to their noninvasive nature despite the lack of long-term data regarding their success. Novel methods of endoscopic closure, including endoscopic suturing, more closely resemble the surgical paradigm and will likely supplant traditional surgical methods for the management of GGF.
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Affiliation(s)
- Eric M Pauli
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Hershey Medical Center, 500 University Drive, MC HU33, Hershey, PA, 17033, USA
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Abu Dayyeh BK, Thompson CC, Gostout C. Endoscopic Retrograde Cholangiopancreatography After Roux-en-Y Gastric Bypass: Challenges and Cautions. Gastroenterology 2015; 148:858-9. [PMID: 25726737 DOI: 10.1053/j.gastro.2014.11.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 11/14/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | - Christopher Gostout
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Management of anastomotic ulcers after Roux-en-Y gastric bypass: results of an international survey. Obes Surg 2015; 24:741-6. [PMID: 24347350 DOI: 10.1007/s11695-013-1152-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Anastomotic ulcers (AUs) after Roux-en-Y gastric bypass (RYGB) occur in up to 16% of patients. In an international survey among members of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), current preventative and therapeutic strategies in AU were analyzed. METHODS An Internet-based survey was performed. RESULTS One hundred eighty-nine surgeons completed the survey. Preoperative screening for Helicobacter pylori is performed by 65%. Eighty-eight percent of them prophylactically prescribe antacids for 3 months after surgery (interquartile range (IQR) 1-6). In case of AU, 99% of participants opt for proton pump inhibitors (PPIs) either alone (60%) or in combination with sucralfate (39%). After ulcer resolution, 52% continue PPI for 6 (3-6) months. In case of AU recurrence, 56% continue with conservative treatment. In contrast, 41% of them favor a renewal of the gastrojejunal anastomosis either combined with truncal vagotomy (18%) or with gastric remnant resection (13%), and only 2% choose to resect both gastric pouch and gastric remnant with subsequent reconstruction by esophagojejunostomy. In case of recurrence after surgical revision, 46% of participants opt again for a conservative approach, while 36% chose to redo the gastrojejunostomy once again. CONCLUSIONS The majority of bariatric surgeons recommend preoperative screening and eradication of H. pylori as well as prophylactic use of PPI. If an AU is diagnosed, the role of PPI as a first-line treatment seems to be undisputed. However, dosage and duration of therapy remain unclear. In refractory AU, there is no consensus among bariatric surgeons whether conservative treatment or surgical revision should be performed.
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Chau E, Youn H, Ren-Fielding CJ, Fielding GA, Schwack BF, Kurian MS. Surgical management and outcomes of patients with marginal ulcer after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2014; 11:1071-5. [PMID: 25868835 DOI: 10.1016/j.soard.2014.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 11/09/2014] [Accepted: 12/12/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Marginal ulcers (MUs) are potentially complex complications after Roux-en-Y gastric bypass. Although most resolve with medical management, some require surgical intervention. Many surgical options exist, but there is no standardized approach, and few reports of outcomes have been documented in the literature. The objective of this study was to determine the outcomes of surgical management of marginal ulcers. METHODS Data from all patients who underwent surgical intervention between 2004 and 2012 for treatment of MU after previous Roux-en-Y gastric bypass were reviewed. RESULTS Twelve patients with MUs underwent reoperation. Nine patients had associated gastrogastric fistulae (75%). The median time to reoperation was 43 months. Ten patients underwent subtotal gastrectomy, of which 9 had a revision of the gastrojejunal anastomosis and 1 did not. One underwent total gastrectomy with esophagojejunal anastomosis for ulcer after previous revisional partial gastrectomy, and 1 patient underwent video-assisted thoracoscopic truncal vagotomy for persistent ulcer-related bleeding in the early postoperative period. Three patients (25%) experienced postoperative complications associated with revisional surgery requiring reoperation. At median follow-up time of 35 months, 7 patients (58%) had chronic abdominal pain, and 4 patients (33%) had intermittent diarrhea. Three patients (25%) were lost to recent follow-up. None had recurrence of MU. CONCLUSION Patients can undergo one of several available surgical interventions, including laparoscopic subtotal gastrectomy with gastrojejunostomy revision. Though this appears to offer definitive treatment of MU, its benefits must be weighed against the increased risk of significant postoperative complications and chronic symptoms related to revisional surgery.
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Affiliation(s)
- Edward Chau
- Department of Surgery, NYU School of Medicine, New York, New York.
| | - Heekoung Youn
- Department of Surgery, NYU School of Medicine, New York, New York
| | | | | | | | - Marina S Kurian
- Department of Surgery, NYU School of Medicine, New York, New York
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Elrazek AEMAA, Elbanna AEM, Bilasy SE. Medical management of patients after bariatric surgery: Principles and guidelines. World J Gastrointest Surg 2014; 6:220-228. [PMID: 25429323 PMCID: PMC4241489 DOI: 10.4240/wjgs.v6.i11.220] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 09/06/2014] [Accepted: 10/29/2014] [Indexed: 02/06/2023] Open
Abstract
Obesity is a major and growing health care concern. Large epidemiologic studies that evaluated the relationship between obesity and mortality, observed that a higher body-mass index (BMI) is associated with increased rate of death from several causes, among them cardiovascular disease; which is particularly true for those with morbid obesity. Being overweight was also associated with decreased survival in several studies. Unfortunately, obese subjects are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior. All obese patients (BMI ≥ 30 kg/m2) should receive counseling on diet, lifestyle, exercise and goals for weight management. Individuals with BMI ≥ 40 kg/m2 and those with BMI > 35 kg/m2 with obesity-related comorbidities; who failed diet, exercise, and drug therapy, should be considered for bariatric surgery. In current review article, we will shed light on important medical principles that each surgeon/gastroenterologist needs to know about bariatric surgical procedure, with special concern to the early post operative period. Additionally, we will explain the common complications that usually follow bariatric surgery and elucidate medical guidelines in their management. For the first 24 h after the bariatric surgery, the postoperative priorities include pain management, leakage, nausea and vomiting, intravenous fluid management, pulmonary hygiene, and ambulation. Patients maintain a low calorie liquid diet for the first few postoperative days that is gradually changed to soft solid food diet within two or three weeks following the bariatric surgery. Later, patients should be monitored for postoperative complications. Hypertension, diabetes, dumping syndrome, gastrointestinal and psychosomatic disorders are among the most important medical conditions discussed in this review.
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Coblijn UK, Goucham AB, Lagarde SM, Kuiken SD, van Wagensveld BA. Development of ulcer disease after Roux-en-Y gastric bypass, incidence, risk factors, and patient presentation: a systematic review. Obes Surg 2014; 24:299-309. [PMID: 24234733 DOI: 10.1007/s11695-013-1118-5] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the gold standard in bariatric surgery. A long-term complication can be marginal ulceration (MU) at the gastrojejunostomy. The mechanism of development is unclear and symptoms vary. Management and prevention is a continuous subject of debate. The aim was to assess the incidence, mechanism, symptoms, and management of MU after LRYGB by means of a systematic review. Forty-one studies with a total of 16,987 patients were included, 787 (4.6%) developed MU. The incidence of MU varied between 0.6 and 25%. The position and size of the pouch, smoking, and nonsteroidal inflammatory drugs usage are associated with the formation of MU. In most cases, MU is adequately treated with proton pump inhibitors, sometimes reoperation is required. Laparoscopic approach is safe and effective.
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Abstract
Obesity is considered a worldwide health problem of epidemic proportions. Bariatric surgery remains the most effective treatment for patients with severe obesity, resulting in improved obesity-related co-morbidities and increased overall life expectancy. However, weight recidivism has been observed in a subset of patients post-bariatric surgery. Weight recidivism has significant medical, societal and economic ramifications. Unfortunately, there is a very limited understanding of how to predict which bariatric surgical patients are more likely to regain weight following surgery and how to appropriately treat patients who have regained weight. The objective of this paper is to systematically review the existing literature to assess the incidence and causative factors associated with weight regain following bariatric surgery. An electronic literature search was performed of the Medline, Embase and Cochrane library databases along with the PubMed US national library from January 1950 to December 2012 to identify relevant articles. Following an initial screen of 2,204 titles, 1,437 abstracts were reviewed and 1,421 met exclusion criteria. Sixteen studies were included in this analysis: seven case series, five surveys and four non-randomized controlled trials, with a total of 4,864 patients for analysis. Weight regain in these patients appeared to be multi-factorial and overlapping. Aetiologies were categorized as patient specific (psychiatric, physical inactivity, endocrinopathies/metabolic and dietary non-compliance) and operation specific. Weight regain following bariatric surgery varies according to duration of follow-up and the bariatric surgical procedure performed. The underlying causes leading to weight regain are multi-factorial and related to patient- and procedure-specific factors. Addressing post-surgical weight regain requires a systematic approach to patient assessment focusing on contributory dietary, psychologic, medical and surgical factors.
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Laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy as revisional procedure after adjustable gastric band--a systematic review. Obes Surg 2014; 23:1899-914. [PMID: 23982182 DOI: 10.1007/s11695-013-1058-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The adjustable gastric band (L)AGB gained popularity as a weight loss procedure. However, long-term results are disappointing; many patients need revision to laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (LSG). The purpose of this study was to assess morbidity, mortality, and results of these two revisional procedures. Fifteen LRYGB studies with a total of 588 patients and eight LSG studies with 286 patients were included. The reason for revision was insufficient weight loss or weight regain in 62.2 and 63.9% in LRYGB and LSG patients. Short-term complications occurred in 8.5 and 15.7% and long-term complications in 8.9 and 2.5%. Reoperation was performed in 6.5 and 3.5%. Revision to LRYGB or LSG after (L)AGB is feasible and relatively safe. Complication rate is higher than in primary procedures.
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Coblijn UK, Lagarde SM, Tuynman JB, van Meyel JJM, van Wagensveld BA. Delayed massive bleeding two years after Roux-en-Y gastric bypass. JSLS 2014; 17:476-80. [PMID: 24018091 PMCID: PMC3771773 DOI: 10.4293/108680813x13693422518470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Delayed massive bleeding from an ischemic ulcer after Roux-en-Y gastric bypass is a rare and challenging event for the gastroenterologist as well as the bariatric surgeon. Introduction: Delayed massive bleeding from an ischemic ulcer is a complication after Roux-en-Y gastric bypass (RYGB). Ischemic ulcers that present with massive bleeding are rare and challenging for the gastroenterologist as well as the bariatric surgeon. Case Description: This report reviews the case of a 63-year-old man who underwent an uncomplicated laparoscopic RYGB for morbid obesity and experienced two episodes of massive hemorrhage after the procedure, almost 1 year apart. Conclusion: To our knowledge, there are only a few such specific cases reported. Here, we describe the treatment and outcome for such a case and present a review of the literature.
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Affiliation(s)
- Usha K Coblijn
- Department of Surgery, St. Lucas Andreas Hospital, Amsterdam, The Netherlands
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Systematic review on reoperative bariatric surgery: American Society for Metabolic and Bariatric Surgery Revision Task Force. Surg Obes Relat Dis 2014; 10:952-72. [PMID: 24776071 DOI: 10.1016/j.soard.2014.02.014] [Citation(s) in RCA: 239] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 02/09/2014] [Accepted: 02/10/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Reoperative bariatric surgery has become a common practice in many bariatric surgery programs. There is currently little evidence-based guidance regarding specific indications and outcomes for reoperative bariatric surgery. A task force was convened to review the current evidence regarding reoperative bariatric surgery. The aim of the review was to identify procedure-specific indications and outcomes for reoperative procedures. METHODS Literature search was conducted to identify studies reporting indications for and outcomes after reoperative bariatric surgery. Specifically, operations to treat complications, failed weight loss, and weight regain were evaluated. Abstract and manuscript reviews were completed by the task force members to identify, grade, and categorize relevant studies. RESULTS A total of 819 articles were identified in the initial search. After review for inclusion criteria and data quality, 175 articles were included in the systematic review and analysis. The majority of published studies are single center retrospective reviews. The evidence supporting reoperative surgery for acute and chronic complications is described. The evidence regarding reoperative surgery for failed weight loss and weight regain generally demonstrates improved weight loss and co-morbidity reduction after reintervention. Procedure-specific outcomes are described. Complication rates are generally reported to be higher after reoperative surgery compared to primary surgery. CONCLUSION The indications and outcomes for reoperative bariatric surgery are procedure-specific but the current evidence does support additional treatment for persistent obesity, co-morbid disease, and complications.
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Hussain A, EL-Hasani S. Bariatric emergencies: current evidence and strategies of management. World J Emerg Surg 2013; 8:58. [PMID: 24373182 PMCID: PMC3923426 DOI: 10.1186/1749-7922-8-58] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 12/26/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The demand for bariatric surgery is increasing and the postoperative complications are seen more frequently. The aim of this paper is to review the current outcomes of bariatric surgery emergencies and to formulate a pathway of safe management. METHODS The PubMed and Google search for English literatures relevant to emergencies of bariatric surgery was made, 6358 articles were found and 90 papers were selected based on relevance, power of the study, recent papers and laparoscopic workload. The pooled data was collected from these articles that were addressing the complications and emergency treatment of bariatric patients. 830,998 patients were included in this review. RESULTS Bariatric emergencies were increasingly seen in the Accident and Emergency departments, the serious outcomes were reported following complex operations like gastric bypass but also after gastric band and the causes were technical errors, suboptimal evaluation, failure of effective communication with bariatric teams who performed the initial operation, patients factors, and delay in the presentation. The mortality ranged from 0.14%-2.2% and increased for revisional surgery to 6.5% (p = 0.002). Inspite of this, mortality following bariatric surgery is still less than that of control group of obese patients (p = value 0.01). CONCLUSIONS Most mortality and catastrophic outcomes following bariatric surgery are preventable. The awareness of bariatric emergencies and its effective management are the gold standards for best outcomes. An algorithm is suggested and needs further evaluation.
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Affiliation(s)
- Abdulzahra Hussain
- Minimal access and bariatric unit, King’s College Hospital NHS Foundation Trust, Princess Royal University Hospital, Orpington, London BR6 8ND, UK
- Honorary Senior Lecturer at King’s College Medical School, London, UK
| | - Shamsi EL-Hasani
- Minimal access and bariatric unit, King’s College Hospital NHS Foundation Trust, Princess Royal University Hospital, Orpington, London BR6 8ND, UK
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