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Jawhar N, Sample JW, Salame M, Marrero K, Tomey D, Puvvadi S, Ghanem OM. The Trajectory of Revisional Bariatric Surgery: Open to Laparoscopic to Robotic. J Clin Med 2024; 13:1878. [PMID: 38610643 PMCID: PMC11012271 DOI: 10.3390/jcm13071878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/16/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Metabolic and bariatric surgery (MBS) is the most effective therapeutic intervention for patients with obesity, with sleeve gastrectomy (SG) being the most commonly performed primary MBS procedure. Long-term studies have demonstrated that 15-20% of patients require revisional bariatric surgery (RBS) due to weight-related issues or surgical complications. Despite the gold standard being laparoscopic revision, there are other available approaches such as open or robotic-assisted. An extensive literature review was performed for articles from their inception to February 2024. A descriptive review of MBS procedures (SG, Roux-en-Y gastric bypass (RYGB), single anastomosis duodeno-ileostomy (SADI) and biliopancreatic diversion-duodenal switch (BPD-DS)) was carried out to report and compare outcomes between primary and revisional bariatric surgery. A similar review was conducted to compare outcomes of revisional approaches (open, laparoscopic, robotic). RYGB remains the dominant RBS with a similar safety profile compared to revisional SADI and BPD-DS. In terms of the RBS surgical approach, all three options showed comparable short and long-term outcomes, with robotic RBS being associated with longer operative time and variable length of stay. Additional long-term studies are required to further validate our conclusions.
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Affiliation(s)
- Noura Jawhar
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA; (N.J.)
| | - Jack W. Sample
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA; (N.J.)
| | - Marita Salame
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA; (N.J.)
| | - Katie Marrero
- Carle Foundation Hospital General Surgery Residency, Champaign, IL 61801, USA
| | - Daniel Tomey
- Department of General Surgery, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Suraj Puvvadi
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
| | - Omar M. Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA; (N.J.)
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Giannopoulos S, Li WS, Kalantar Motamedi SM, Embry M, Stefanidis D. Outcome comparison between primary and revisional bariatric surgery: A propensity-matched analysis. Surgery 2024; 175:592-598. [PMID: 37730514 DOI: 10.1016/j.surg.2023.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/09/2023] [Accepted: 07/08/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Revisional bariatric procedures for weight recurrence are rising but are considered higher risk and less effective than primary bariatric procedures. This study aimed to compare clinical outcomes between primary and revisional bariatric surgery for weight recurrence. METHODS Prospectively collected data from adult patients who underwent revisional or primary bariatric surgery from 2016 to 2020 in an academic institution were reviewed. Roux-en-Y gastric bypass and sleeve gastrectomy were performed primarily or as conversion procedures after laparoscopic adjustable gastric band, vertical banded gastroplasty, and sleeve gastrectomy. 1:1 propensity score matching was performed between revisional bariatric surgery and primary bariatric surgery, and logistic regression analysis was used to compare up to 2-year weight loss and comorbidity resolution outcomes. RESULTS A total of172 cases (86 revisional bariatric surgery versus 86 primary bariatric surgery) were included. Groups were matched for age, sex, preoperative body mass index, bariatric procedure, diabetes, hypertension, and obstructive sleep apnea. Procedure duration (203 ± 78 vs 154 ± 69 minutes; P < .001) and length of stay (2.3 ± 2.1 vs 1.7 ± 1 days; P = .02) were longer for revisional bariatric surgery versus primary bariatric surgery, respectively. Total weight loss was less in revisional bariatric surgery compared with primary bariatric surgery at 1 year (23 ± 10% vs 32 ± 9%; P < .001) and 2 years (21 ± 12.% vs 32 ± 10%; P < .001) of follow-up; however, no differences were detected in postoperative occurrences, emergency department visits, readmissions, reintervention and reoperation rates, and comorbidity resolution. CONCLUSION Although revisional bariatric surgery was associated with longer operation times, prolonged hospitalization, and lower weight loss than primary bariatric surgery, it was accomplished safely and led to substantial weight loss and comorbidity resolution. This information can guide patient counseling before revisional surgery for weight recurrence.
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Affiliation(s)
- Spyridon Giannopoulos
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. https://twitter.com/sgianno_MD
| | - Wendy S Li
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. https://twitter.com/md_wendyli
| | | | - Marisa Embry
- Section of Bariatric Surgery, Indiana University Health North Hospital, Carmel, Indianapolis, IN
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Scott AW, Amateau SK, Leslie DB, Ikramuddin S, Wise ES. Prediction of 30-Day Morbidity and Mortality After Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass: Use of an Artificial Neural Network. Am Surg 2024:31348241227182. [PMID: 38197867 DOI: 10.1177/00031348241227182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass is indicated primarily for unsatisfactory weight loss or gastroesophageal reflux disease (GERD). This study aimed to use a comprehensive database to define predictors of 30-day reoperation, readmission, reintervention, or mortality. An artificial neural network (ANN) was employed to optimize prediction of the composite endpoint (occurrence of 1+ morbid event). METHODS Areview of 8895 patients who underwent conversion for weight-related or GERD-related indications was performed using the 2021 MBSAQIP national dataset. Demographics, comorbidities, laboratory values, and other factors were assessed for bivariate and subsequent multivariable associations with the composite endpoint (P ≤ .05). Factors considered in the multivariable model were imputed into a three-node ANN with 20% randomly withheld for internal validation, to optimize predictive accuracy. Models were compared using receiver operating characteristic (ROC) curve analysis. RESULTS 39% underwent conversion for weight considerations and 61% for GERD. Rates of 30-day reoperation, readmission, reintervention, mortality, and the composite endpoint were 3.0%, 7.1%, 2.1%, .1%, and 9.1%, respectively. Of the nine factors associated with the composite endpoint on bivariate analysis, only non-white race (P < .001; odds ratio 1.4), lower body-mass index (P < .001; odds ratio .22), and therapeutic anticoagulation (P = .001; odds ratio 2.0) remained significant upon multivariable analysis. Areas under ROC curves for the multivariable regression, ANN training, and validation sets were .587, .601, and .604, respectively. DISCUSSION Identification of risk factors for morbidity after conversion offers critical information to improve patient selection and manage postoperative expectations. ANN models, with appropriate clinical integration, may optimize prediction of morbidity.
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Affiliation(s)
- Adam W Scott
- School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Stuart K Amateau
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Daniel B Leslie
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Sayeed Ikramuddin
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Eric S Wise
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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Castillo-Larios R, Cornejo J, Gunturu NS, Cheng YL, Elli EF. Experience of Robotic Complex Revisional Bariatric Surgery in a High-Volume Center. Obes Surg 2023; 33:4034-4041. [PMID: 37919532 DOI: 10.1007/s11695-023-06916-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE A revisional bariatric surgery (RBS) is necessary in about 28% of the patients. The role of robotic surgery in RBS is still a subject of debate. We aim to report the outcomes of robotic-assisted RBS at our institution. MATERIALS AND METHODS We identified patients who underwent robotic-assisted RBSs between January 1, 2016, and May 31, 2022. We analyzed patient demographics and indications for surgery. Measured outcomes included peri- and postoperative morbidity, comorbidity management, and weight loss outcomes. RESULTS A total of 106 patients were included. Primary procedures were adjustable gastric band 44 (41.5%), sleeve gastrectomy 42 (39.6%), Roux-en-Y gastric bypass (RYGB) 18 (17%), duodenal switch (DS) 1 (0.9%), and vertical banded gastroplasty 1 (0.9%). RBSs performed included 85 (78.7%) RYGB, 16 (14.8%) redo-gastrojejunostomy, and 5 (4.6%) DS. The median time to revision was 8 (range 1-36) years, and the main indication was insufficient weight loss (49%). Median length of hospital stay was 2 (range 1-16) days, and 9 (8.5%) patients were readmitted during the first 30 days. Only 4 (3.7%) patients had early Clavien-Dindo grade III or higher adverse events. No anastomotic leaks were documented. Median excess weight loss was 35.1%, 42.23%, and 45.82% at the 6-, 12-, and 24-month follow-up. Of 57 patients with hypertension, 29 (50.9%) reduced their medication dosage, and 20/27 (74.1%) reduced their diabetes mellitus medication dosage. Finally, of the 75 patients with symptoms, 64 (85.3%) reported an improvement after the RBS. CONCLUSION Robotic-assisted RBS is feasible, significantly improves patients' comorbidities and symptoms, and leads to considerable weight loss.
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Affiliation(s)
- Rocio Castillo-Larios
- Department of General Surgery, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Jorge Cornejo
- Department of General Surgery, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Naga Swati Gunturu
- Department of General Surgery, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Yilon Lima Cheng
- Department of General Surgery, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Enrique F Elli
- Department of General Surgery, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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Santos-Sousa H, Nogueiro J, Lindeza L, Carmona MN, Amorim-Cruz F, Resende F, Costa-Pinho A, Preto J, Sousa-Pinto B, Carneiro S, Lima-da-Costa E. Roux-en-Y gastric bypass and sleeve gastrectomy as revisional bariatric procedures after adjustable gastric banding: a retrospective cohort study. Langenbecks Arch Surg 2023; 408:441. [PMID: 37987830 PMCID: PMC10663205 DOI: 10.1007/s00423-023-03174-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION The frequency of revisional bariatric surgery is increasing, but its effectiveness and safety are not yet fully established. The aim of our study was to compare short-term outcomes of primary (pRYGB and pSG) and revisional bariatric surgeries (rRYGB and rSG). METHODS We performed a retrospective cohort study assessing all patients submitted to primary and revisional (after a failed AGB) RYGB and SG in 2019. Each patient was followed-up at 6 months and 12 months after surgery. We compared pRYGB vs. rRYGB, pSG vs. rSG and rRYGB vs. rSG on weight loss, surgical complications, and resolution of comorbidities. RESULTS We assessed 494 patients, of which 18.8% had undergone a revisional procedure. Higher weight loss at 6 and 12 months was observed in patients undergoing primary vs. revisional procedures. Patients submitted to rRYGB lost more weight than those with rSG (%EWL 12 months = 82.6% vs. 69.0%, p < 0.001). Regarding the resolution of obesity-related comorbidities, diabetes resolution was more frequent in pRYGB than rRYGB (54.2% vs. 25.0%; p = 0.038). Also, 41.7% of the patients who underwent rRYGB had dyslipidemia resolution vs. 0% from the rSG group (p = 0.035). Dyslipidemia resolution was also more common in pSG vs. rSG (68.6% vs. 0.0%; p = 0.001). No significant differences in surgical complications were found. CONCLUSION Revisional bariatric surgery is effective and safe treating obesity and related comorbidities after AGB. Primary procedures appear to be associated with better weight loss outcomes. Further prospective studies are needed to better understand the role of revisional bariatric surgery.
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Affiliation(s)
- Hugo Santos-Sousa
- Faculty of Medicine, University of Porto - Alameda Prof.Hernâni Monteiro, 4200-319, Porto, Portugal.
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200- 319, Porto, Portugal.
| | - Jorge Nogueiro
- Faculty of Medicine, University of Porto - Alameda Prof.Hernâni Monteiro, 4200-319, Porto, Portugal
- Surgery Department, São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Luis Lindeza
- Faculty of Medicine, University of Porto - Alameda Prof.Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Maria Neves Carmona
- Faculty of Medicine, University of Porto - Alameda Prof.Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Filipe Amorim-Cruz
- Faculty of Medicine, University of Porto - Alameda Prof.Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Fernando Resende
- Faculty of Medicine, University of Porto - Alameda Prof.Hernâni Monteiro, 4200-319, Porto, Portugal
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200- 319, Porto, Portugal
| | - André Costa-Pinho
- Faculty of Medicine, University of Porto - Alameda Prof.Hernâni Monteiro, 4200-319, Porto, Portugal
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200- 319, Porto, Portugal
| | - John Preto
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200- 319, Porto, Portugal
| | - Bernardo Sousa-Pinto
- Faculty of Medicine, University of Porto - Alameda Prof.Hernâni Monteiro, 4200-319, Porto, Portugal
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal
- CINTESIS - Center for Health Technologies and Services Research, University of Porto, Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal
| | - Silvestre Carneiro
- Faculty of Medicine, University of Porto - Alameda Prof.Hernâni Monteiro, 4200-319, Porto, Portugal
- Surgery Department, São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Eduardo Lima-da-Costa
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200- 319, Porto, Portugal
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Bhandarkar S, Kalikar V, Nasta A, Goel R, Patankar R. Post-laparoscopic sleeve gastrectomy, intrathoracic sleeve migration and its management: A case series and review of literature. J Minim Access Surg 2023; 19:544-547. [PMID: 36861531 PMCID: PMC10695314 DOI: 10.4103/jmas.jmas_149_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/15/2022] [Accepted: 09/13/2022] [Indexed: 02/16/2023] Open
Abstract
De novo or persistent gastro-oesophageal reflux disease which may or may not be associated with injury of the oesophageal mucosa is now a known complication in post-sleeve gastrectomy patients. Repair of hiatal hernias to avoid such circumstances has been commonly performed, although recurrences may occur resulting in migration of gastric sleeve into the thorax, which is now a well-known complication. We report four cases of post-sleeve gastrectomy patients who presented with reflux symptoms, with their contrast-enhanced computed tomography abdomen showing intrathoracic sleeve migration and had hypotensive lower oesophageal sphincter with normal body motility on their oesophageal manometry. A laparoscopic revision Roux-en-Y gastric bypass surgery with hiatal hernia repair was performed for all four of them. No post-operative complications were seen at 1-year follow-up. Laparoscopic reduction of migrated sleeve with posterior cruroplasty and conversion to Roux-en-Y gastric bypass surgery can be safely performed for patients presenting with reflux symptoms in cases of intra-thoracic sleeve migration with good short-term outcomes.
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Affiliation(s)
- Sanatan Bhandarkar
- Department of Digestive Diseases, Zen Hospital, Mumbai, Maharashtra, India
| | - Vishakha Kalikar
- Department of Digestive Diseases, Zen Hospital, Mumbai, Maharashtra, India
| | - Amrit Nasta
- Department of Digestive Diseases, Zen Hospital, Mumbai, Maharashtra, India
| | - Ramen Goel
- Department of Digestive Diseases, Zen Hospital, Mumbai, Maharashtra, India
| | - Roy Patankar
- Department of Digestive Diseases, Zen Hospital, Mumbai, Maharashtra, India
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Perez SC, Ericksen F, Thaqi M, Richardson N, Wheeler AA. Concurrent paraesophageal hernia repair in revisional/conversional laparoscopic Roux-en-Y gastric bypass: propensity score-matched analysis of the MBSAQIP database. Surg Endosc 2023; 37:7955-7963. [PMID: 37439821 DOI: 10.1007/s00464-023-10268-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/29/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Patients requiring concurrent paraesophageal hernia repair (CPHR) have been shown to have favorable outcomes in primary bariatric surgery. However, patients requiring revisional or conversional surgery represent a group of patients with higher perioperative risk. Currently, few reports on concurrent paraesophageal hernia repair utilizing the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database are available. The primary aim of this study was to determine perioperative complications associated with CPHR and the Roux-en-Y gastric bypass (RYGB) as a revisional/conversional operation. METHODS In this study, patients undergoing revisional/conversional RYGB between 2015 and 2020 were accessed via the MBSAQIP database. Patients were categorized based on the presence of a paraesophageal hernia as a concurrent procedure. Patients who underwent revisional/conversional surgery without additional procedures were utilized for controls. A propensity score-matched cohort was generated and E-analysis utilized to assess unmeasured confounding. RESULTS After exclusions, 35,698 patients were available. Patients receiving CPHR were more likely to be female (90.79% vs 87.37%; p < 0.001) and have increased frequency of gastroesophageal reflux disease (69.20% vs 51.69%; p < 0.001). However, these patients had lower frequencies of sleep apnea (24.12% vs 30.13%; p < 0.001), hypertension requiring medication (38.51% vs 42.59%; p < 0.001), and decreased frequency of hyperlipidemia (19.44% vs 21.60%;p < 0.001). After matching, 6,231 patient pairs were developed and showed that patients undergoing CPHR were at increased risk of readmission (9.44% vs 7.58%; p < 0.001), intervention (3.56% vs 2.79%; p = 0.018), increased requirement for outpatient dehydration treatment (5.87% vs 4.67%;p = 0.004), and overall increased operation time (169.3 min ± 76.0 vs 153.5 ± 73.3; p < 0.001). However, there were no significant increases in the rates of reoperation, death, postoperative leak complications, or bleeding complications after CPHR. CONCLUSION Patients undergoing revisional/conversional RYGB with CPHR may be at higher risk for a small number of rare postoperative complications. CPHR is a safe procedure in patients undergoing revisional/conversional RYGB in the short-term postoperative period.
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Affiliation(s)
- Samuel C Perez
- Department of Surgery, University of Missouri School of Medicine, Columbia, MO, USA.
| | - Forrest Ericksen
- Department of Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Milot Thaqi
- Department of Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Norbert Richardson
- Department of Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Andrew A Wheeler
- Department of Surgery, University of Missouri School of Medicine, Columbia, MO, USA
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Mongelli F, Garofalo F, Giacopelli P, Munini M, Volontè F, Marengo M. Assessment of gastric pouch blood supply with indocyanine green fluorescence in conversional and revisional bariatric surgery: a prospective comparative study. Sci Rep 2023; 13:9152. [PMID: 37280278 PMCID: PMC10244382 DOI: 10.1038/s41598-023-36442-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/03/2023] [Indexed: 06/08/2023] Open
Abstract
Our study aimed to evaluate the usefulness of indocyanine green (ICG) angiography during conversional or revisional bariatric surgery. We prospectively enrolled all patients scheduled for reoperative bariatric surgery with gastric pouch resizing and ICG assessment and we compared them with a retrospective series of similar patients who did not receive ICG. The primary outcome was the rate of intraoperative change in the surgical strategy due to the ICG test. We included 32 prospective patients receiving intraoperatively an ICG perfusion test and 48 propensity score-matched controls. The mean age was 50.7 ± 9.7 years, 67 (83.7%) patients were female, and the mean BMI was 36.8 ± 5.3 kg/m2. The patient characteristics were similar in both groups. The ICG angiography was successfully conducted in all patients, and no change of the surgical strategy was necessary. Postoperative complications were similar in both groups (6.2% vs. 8.3%, p = 0.846), as well as operative time (125 ± 43 vs. 133 ± 47 min, p = 0.454) and length of hospital stay (2.8 ± 1.0 vs. 3.3 ± 2.2 days, p = 0.213). Our study suggested that ICG fluorescence angiography might not have been useful for assessing the blood supply of the gastric pouch in patients who underwent reoperative bariatric surgery. Therefore, it remains uncertain whether the application of this technique is indicated.
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Affiliation(s)
- Francesco Mongelli
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland.
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, 6500, Lugano, Switzerland.
| | - Fabio Garofalo
- Department of Surgery, Lugano Regional Hospital, EOC, 6900, Lugano, Switzerland
| | - Pietro Giacopelli
- Department of Surgery, Mendrisio Regional Hospital, EOC, 6850, Mendrisio, Switzerland
| | - Martino Munini
- Department of Surgery, Lugano Regional Hospital, EOC, 6900, Lugano, Switzerland
| | | | - Michele Marengo
- Department of Surgery, Locarno Regional Hospital, EOC, 6600, Locarno, Switzerland
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Perdomo CM, Cohen RV, Sumithran P, Clément K, Frühbeck G. Contemporary medical, device, and surgical therapies for obesity in adults. Lancet 2023; 401:1116-1130. [PMID: 36774932 DOI: 10.1016/s0140-6736(22)02403-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 02/11/2023]
Abstract
The goal of obesity management is to improve health. Sustained weight loss of more than 10% overall bodyweight improves many of the complications associated with obesity (eg, prevention and control of type 2 diabetes, hypertension, fatty liver disease, and obstructive sleep apnoea), as well as quality of life. Maintenance of weight loss is the major challenge of obesity management. Like all chronic diseases, managing obesity requires a long-term, multimodal approach, taking into account each individual's treatment goals, and the benefit and risk of different therapies. In conjunction with lifestyle interventions, anti-obesity medications and bariatric surgery improve the maintenance of weight loss and associated health gains. Most available anti-obesity medications act on central appetite pathways to reduce hunger and food reward. In the past 5 years, therapeutic advances have seen the development of targeted treatments for monogenic obesities and a new generation of anti-obesity medications. These highly effective anti-obesity medications are associated with weight losses of more than 10% of overall bodyweight in more than two-thirds of clinical trial participants. Long-term data on safety, efficacy, and cardiovascular outcomes are awaited. Long-term studies have shown that bariatric surgical procedures typically lead to a durable weight loss of 25% and rapid, sustained improvements in complications of obesity, although they have not yet been compared with new-generation highly effective anti-obesity medications. Further work is required to determine optimal patient-specific treatment strategies, including combinations of lifestyle interventions, anti-obesity medications, endoscopic and bariatric surgical procedures, and to ensure equitable access to effective treatments.
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Affiliation(s)
- Carolina M Perdomo
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain; Metabolic Research Laboratory, CIBEROBN, ISCIII, IdiSNA, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ricardo V Cohen
- The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Priya Sumithran
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia; Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
| | - Karine Clément
- Sorbonne Université, INSERM, Nutrition and obesities: systemic approach research group, Nutriomics, Paris, France; Assistance Publique-Hôpitaux de Paris, Nutrition Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Gema Frühbeck
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain; Metabolic Research Laboratory, CIBEROBN, ISCIII, IdiSNA, Clínica Universidad de Navarra, Pamplona, Spain.
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Dang JT, Vaughan T, Mocanu V, Mubashir H, Barajas-Gamboa JS, Codina RC, Rodriguez J, Karmali S, Kroh M. Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass: Indications, Prevalence, and Safety. Obes Surg 2023; 33:1486-1493. [PMID: 36922465 PMCID: PMC10017068 DOI: 10.1007/s11695-023-06546-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) frequently requires conversion to Roux-en-Y gastric bypass (RYGB) due to gastroesophageal reflux disease (GERD) or weight recurrence. Current evidence evaluating the safety of conversion from SG to RYGB and its indications is limited to single centers. METHODS The objective was to determine the rate of serious complications and mortality of conversion of SG to RYGB (SG-RYGB) compared to primary RYGB (P-RYGB). This was a retrospective analysis of the MBSAQIP database which includes 30-day outcomes. Individuals undergoing P-RYGB or SG-RYGB were included. Multivariable logistic regression was performed to determine if revisional surgery was an independent predictor of serious complications or mortality. RESULTS In 2020 and 2021, 84,543 (86.3%) patients underwent P-RYGB and 13,432 (13.7%) underwent SG-RYGB. SG-RYGB cohort had lower body mass index, lower rates of diabetes and hypertension, and higher rates of GERD. GERD was the most common indication for revision (55.3%) followed by weight regain (24.4%) and inadequate weight loss (12.7%). SG-RYGB had longer operative times (145 vs. 125 min, p < 0.001) and a higher rate of serious complications (7.2 vs. 5.0%, p < 0.001). This included higher rates of anastomotic leak (0.5 vs. 0.4%, p = 0.002), bleeding (2.0 vs. 1.6%, p < 0.001), and reoperation (3.0 vs. 1.9%, p < 0.001) but not death (0.1 vs. 0.1%, p = 0.385). On multivariable analysis, SG-RYGB was independently predictive of serious complications (OR 1.21, 95%CI 1.12 to 1.32, p < 0.001) but not mortality (p = 0.316). CONCLUSIONS While SG-RYGB is safe with a low complication rate, SG-RYGB was associated with a higher rate of serious complications compared to P-RYGB.
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Affiliation(s)
- Jerry T Dang
- Digestive Diseases & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Tiffany Vaughan
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Valentin Mocanu
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Hadika Mubashir
- Digestive Diseases & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Juan S Barajas-Gamboa
- Digestive Diseases Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - John Rodriguez
- Digestive Diseases Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Shahzeer Karmali
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Matthew Kroh
- Digestive Diseases & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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11
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Rampp N, Sudan R. Robotic Bariatric Surgery: An Update. Curr Surg Rep 2023. [DOI: 10.1007/s40137-023-00353-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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12
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Nazari M, Jameson C, Ryan B, Brancatisano A. Efficacy and Safety of Sleeve Gastrectomy or One Anastomosis Gastric Bypass Conversion Following Adjustable Gastric Banding. Obes Surg 2023; 33:426-433. [PMID: 36480102 DOI: 10.1007/s11695-022-06374-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Given revision or conversion surgery is required in up to 60% of patients who had adjustable gastric band (LAGB), we compared safety and efficacy of sleeve gastrectomy (SG) and one anastomosis gastric bypass (OAGB) as conversion surgical procedures in patients with suboptimal response or weight recurrence following LAGB. METHODS Conversion surgery was performed in 335 patients between 2016 and 2020. Weight loss, early and late-stage complications, and comorbidity outcomes were reviewed and analyzed. RESULTS One hundred and sixty-three patients underwent cSG (BMI: 38.3 ± 8.3 kg/m2), and 172 patients underwent cOAGB (BMI: 45.2 ± 9.3 kg/m2). Percent total body weight loss (%TWL) was 28.7 ± 9.9% at 12 months, 30.3 ± 12.8% at 2 years, 31.0 ± 14.5% at 3 years, and 31.1 ± 14.7% at 4 years following OAGB, which was significantly higher than SG; 18.4 ± 8.7%, 18.8 ± 9.8%, 19.3 ± 11.1%, and 16.9 ± 10.9%, respectively (p < 0.0001). Remission of comorbidities, regardless of conversion procedure type, was 20.8% for hypertension (HT), 52% for dyslipidemia (DLD), 60% for type 2 diabetes (DM), 64% for non-alcoholic steatohepatitis (NASH), and 76% for insulin resistance (IR).There were no leaks or deaths following SG or OAGB. A twofold greater frequency of complications was seen in the OAGB group vs SG group (15.1% and 6.7%, respectively). CONCLUSION Significant weight loss, acceptable complication rates, and similar remission of comorbidities were seen regardless of the type of conversion procedure. Prospective randomized clinical trials are recommended for further elucidation of long-term outcomes.
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Affiliation(s)
- Mojgan Nazari
- Sydney Bariatric Clinic, Westmead, New South Wales, 2145, Australia. .,Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, 2145, Australia.
| | - Carolyn Jameson
- Sydney Bariatric Clinic, Westmead, New South Wales, 2145, Australia.,School of Medicine, University of Notre Dame, Darlinghurst, New South Wales, 2010, Australia
| | - Brendan Ryan
- Sydney Bariatric Clinic, Westmead, New South Wales, 2145, Australia
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Kenawy DM, Breslin LM, Chen JC, Tamimi MM, North JK, Abdel-Rasoul M, Noria SF. Impact of post-discharge phone calls on non-urgent hospital returns < 90 days following primary bariatric surgery. Surg Endosc 2023; 37:1222-1230. [PMID: 36167872 PMCID: PMC9514683 DOI: 10.1007/s00464-022-09647-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/13/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Quality of care delivery may improve patient outcomes post-bariatric surgery. We examined the quality of post-discharge phone calls (PhDC) to determine the impact on early (< 90 day) non-urgent hospital returns (NUHR) following primary bariatric surgery. METHODS A retrospective review was performed on patients who underwent Roux-en-Y-gastric bypass (RYGB) or sleeve gastrectomy (SG) in 2019. Patients were compared between presence of care coaching (Jan-June 2019) versus no care coaching (July-Dec 2019). Baseline demographics, comorbidities, psychiatric history, and PhDC were collected. Index PhDCs were coded for completeness using a scoring system and rated by call quality. Patients were stratified into NUHR versus control group (Never returns [NR]). Primary analysis examined the impact of PhDC on NUHR. Sub-analysis examined the impact of call quality. Univariate analysis was performed using Chi-square or Fisher's exact tests. Multivariate analysis (MVA) was used to determine predictors of NUHR. A p-value of ≤ 0.05 was statistically significant. RESULTS A total of 359 patients were included. Compared to the NR group (n = 294), NUHRs (n = 65) were more likely to be younger (41.3 + 12.1 versus 45.0 + 10.8 years, p = 0.024), with baseline anxiety (41.5% versus 23.5%, p = 0.003), and undergo RYGB (73.3% versus 57.8%, p = 0.031). There was a significant difference in number of PhDC in the NUHR and NR groups (p = 0.0206). Care-coached patients had significantly higher rates of high-quality phone calls (p < 0.0001) compared to non-care-coached patients. MVA demonstrated younger age (OR = 0.97, CI: 0.95-1.00; p = 0.023), anxiety (OR = 2.09, CI: 1.17-3.73; p = 0.012), RYGB (OR = 1.88, CI: 1.02-3.45; p = 0.042), and > 50% call quality versus no PhDC (OR = 0.45, CI: 0.25-0.83; p = 0.010) were independently associated with NUHRs. CONCLUSION High-quality PhDCs may play a role in mitigating NUHRs. Care coaching represents a potential intervention to decrease high rates of NUHR in primary bariatric surgery patients.
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Affiliation(s)
- Dahlia M. Kenawy
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Lindsay M. Breslin
- Department of Research Information Technology, The Ohio State University, Columbus, OH USA
| | - J. C. Chen
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Muna M. Tamimi
- College of Medicine, The Ohio State University, Columbus, OH USA
| | - Joann K. North
- The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Mahmoud Abdel-Rasoul
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Sabrena F. Noria
- Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, N718 Doan Hall, 410 W 10th Avenue, Columbus, OH 43210 USA
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Lautenbach A, Wernecke M, Huber TB, Stoll F, Wagner J, Meyhöfer SM, Meyhöfer S, Aberle J. The Potential of Semaglutide Once-Weekly in Patients Without Type 2 Diabetes with Weight Regain or Insufficient Weight Loss After Bariatric Surgery-a Retrospective Analysis. Obes Surg 2022. [PMID: 35879524 DOI: 10.1007/s11695-022-06211-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 07/10/2022] [Accepted: 07/14/2022] [Indexed: 12/02/2022]
Abstract
Purpose About 20–25% of patients experience weight regain (WR) or insufficient weight loss (IWL) after bariatric metabolic surgery (BS). Therefore, we aimed to retrospectively assess the effectiveness of adjunct treatment with the GLP-1 receptor agonist semaglutide in non-diabetic patients with WR or IWL after BS. Materials and Methods Post-bariatric patients without type 2 diabetes (T2D) with WR or IWL (n = 44) were included in the analysis. The primary endpoint was weight loss 3 and 6 months after initiation of adjunct treatment. Secondary endpoints included change in BMI, HbA1c, lipid profile, hs-CRP, and liver enzymes. Results Patients started semaglutide 64.7 ± 47.6 months (mean ± SD) after BS. At initiation of semaglutide, WR after post-bariatric weight nadir was 12.3 ± 14.4% (mean ± SD). Total weight loss during semaglutide treatment was − 6.0 ± 4.3% (mean ± SD, p < 0.001) after 3 months (3.2 months, IQR 3.0–3.5, n = 38) and − 10.3 ± 5.5% (mean ± SD, p < 0.001) after 6 months (5.8 months, IQR 5.8–6.4, n = 20). At 3 months, categorical weight loss was > 5% in 61% of patients, > 10% in 16% of patients, and > 15% in 2% of patients. Triglycerides (OR = 0.99; p < 0.05), ALT (OR = 0.87; p = 0.05), and AST (OR = 0.89; p < 0.05) at baseline were negatively associated with weight loss of at least 5% at 3 months’ follow-up (p < 0.05). Conclusion Treatment options to manage post-bariatric excess weight (regain) are scarce. Our results imply a clear benefit of adjunct treatment with semaglutide in post-bariatric patients. However, these results need to be confirmed in a prospective randomized controlled trial to close the gap between lifestyle intervention and revision surgery in patients with IWL or WR after BS. Graphical abstract ![]()
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15
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Romaen IFL, Jense MTF, Palm-Meinders IH, de Witte E, Fransen SAF, Greve JWM, Boerma EJG. Higher Preoperative Weight loss Is Associated with Greater Weight Loss up to 12 Months After Bariatric Surgery. Obes Surg 2022; 32:2860-2868. [PMID: 35788954 DOI: 10.1007/s11695-022-06176-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 06/18/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Prior research suggested presurgical weight loss is associated with greater total weight loss, resulting in a more effective bariatric intervention. We aimed to assess whether preoperative weight loss is a predictor for total weight loss, and which patient factors are associated with successful weight loss. METHODS All patients (N = 773) that underwent primary bariatric surgery between June 2017 and August 2019 were included in this single-center retrospective study. Outcome measures were preoperative weight loss (%preopWL) and total weight loss (%TWL) up to 1 year postoperatively. Patients were divided into 4 groups based on quartiles of %preopWL. RESULTS Total weight loss after 1, 6, and 12 months for the upper quartile was 16.9%, 33.4%, and 37.8%, and for the lower quartile 11.8%, 28.9%, and 35.2%, respectively (p < 0.001). Seven hundred fourteen patients (92.4%) were available for the 1-year follow-up. Preoperative weight loss was not associated with the incidence of complications. Independent factors predicting increased %preopWL were mandated preoperative weight loss program (MWP) (p < 0.001), older age (p = 0.005), weight measurement in the week before surgery (p = 0.031), and non-diabetic status (p = 0.010). Predictors for superior %TWL were MWP (p = 0.014), younger age (p = 0.001), non-diabetic status (p = 0.005), female gender (p = 0.001), higher Body Mass Index (p = 0.006), and banded gastric bypass (p = 0.001). CONCLUSION Higher preoperative weight loss is associated with persisting greater weight loss up to at least 12 months post-surgery. In order to optimize preoperative weight loss, we recommend extra preoperative support to younger and diabetic patients. We advise nutritional counseling and additional weight measurement in the week before surgery.
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Affiliation(s)
- Ine F L Romaen
- Surgical Department, Zuyderland Medical Center, 6419 PC, Heerlen/Sittard, the Netherlands
| | - Marijn T F Jense
- Surgical Department, Zuyderland Medical Center, 6419 PC, Heerlen/Sittard, the Netherlands
| | | | - Evelien de Witte
- Surgical Department, Zuyderland Medical Center, 6419 PC, Heerlen/Sittard, the Netherlands
- Dutch Obesity Clinic South, 6419 XZ, Heerlen, the Netherlands
| | - Sofie A F Fransen
- Surgical Department, Zuyderland Medical Center, 6419 PC, Heerlen/Sittard, the Netherlands
- Dutch Obesity Clinic South, 6419 XZ, Heerlen, the Netherlands
| | - Jan Willem M Greve
- Surgical Department, Zuyderland Medical Center, 6419 PC, Heerlen/Sittard, the Netherlands
- Dutch Obesity Clinic South, 6419 XZ, Heerlen, the Netherlands
- Research School, NUTRIM University of Maastricht, 6229 ER, Maastricht, the Netherlands
| | - Evert-Jan G Boerma
- Surgical Department, Zuyderland Medical Center, 6419 PC, Heerlen/Sittard, the Netherlands.
- Dutch Obesity Clinic South, 6419 XZ, Heerlen, the Netherlands.
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De Luca M, Piatto G, Sartori A, Zese M, Lunardi C, Targa S, Giardiello C, Gentileschi P, Himpens J. Single Anastomosis Jejuno-ileal (SAJI): a New Model of Malabsorptive Revisional Procedure for Insufficient Weight Loss or Weight Regain After Roux-en-Y Gastric Bypass. Obes Surg 2022. [PMID: 35763129 DOI: 10.1007/s11695-022-06174-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 03/13/2022] [Accepted: 03/18/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND In case of insufficient weight loss or weight regain or relapse of weight-related comorbidities after Roux-en-Y gastric bypass (RYGB), other procedures such as reduction of a large gastric pouch and stoma, lengthening of the Roux limb, conversion to sleeve gastrectomy and/or bilio-pancreatic diversion with duodenal switch have been advocated. Single anastomosis jejuno-ileal (SAJI) is a new revisional simple operation performed after RYGB failure which adds malabsorption to the previous gastric bypass. METHODS SAJI includes a single jejuno-ileal anastomosis specifically joining the ileum 250-300 cm proximal to the ileo-caecal valve and the jejunum 30 cm below the gastro-jejunal anastomosis on the Roux limb of the previous RYGB. Thirty-one patients underwent SAJI for insufficient weight loss and/or weight regain after RYGB. The percent total weight loss (%TWL) after RYGB and before SAJI was 21.8 ± 7.8. All SAJI operations were performed laparoscopically. The SAJI mean operating time was 145 min. RESULTS Regarding weight loss after SAJI, %TWL is 27.2 ± 7.4, 31.2 ± 6.4, 33.7 ± 5.9 and 32.9 ± 5.2 at 12, 24, 36 and 48 months, respectively. Our series recorded a low rate of peri-operative and medium-term complications with a low grade of severity (Clavien-Dindo classification grade). One patient required reoperation 36 days after SAJI for epigastrium incarcerated incisional hernia at the previous RYGB laparotomy site. Mortality was 0. Comorbidity reduction/resolution after SAJI is 83.2% for type 2 diabetes mellitus, 42.8% for arterial hypertension, 72.8% for dyslipidemia and 45.3% for OSA. CONCLUSIONS Treatment of failed RYGB is challenging. SAJI is a less complicated, purely low invasive malabsorptive operation that should reach satisfactory %TWL and comorbidity reduction/resolution.
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Sewefy AM, Atyia AM, H Kayed T, Hamza HM. Single-Anastomosis Sleeve Jejunal (SAS-J) Bypass as Revisional Surgery After Primary Restrictive Bariatric Procedures. Obes Surg 2022; 32:2807-2813. [PMID: 35665877 PMCID: PMC9273534 DOI: 10.1007/s11695-022-06123-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/21/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Abstract
Purpose Single-anastomosis sleeve jejunal (SAS-J) bypass is the modification of a single-anastomosis sleeve ileal (SASI) bypass with a short biliary limb. SAS-J bypass is reported to be a good primary bariatric procedure. This study aimed to evaluate the results of SAS-J bypass as a revisional surgery after failed primary restrictive bariatric procedures. Material and Methods This was a prospective cohort study including 43 patients who underwent SAS-J bypass as a revisional surgery for weight regain after laparoscopic sleeve gastrectomy (LSG), laparoscopic adjustable gastric band (LAGB), or laparoscopic gastric plication. Results Of the total patients, 35 (81.4%) were female, and 8 (18.6%) were male. The mean BMI was 46.3 kg/m2. The mean age was 41 years. Thirty-two patients (74.4%) had a failed sleeve, 9 (20.9%) had a failed LAGB, and 2 (4.7%) had a failed gastric plication. The mean operative time was 104 min. Intra-abdominal bleeding occurred in 1 case (2.3%), and intraluminal bleeding occurred in 3 cases (7%). No case (0%) developed a leak. The percentage of excess weight loss (%EWL) reached 76.5% after 1 year. Type 2 diabetes mellitus remission occurred in all diabetic patients, hypertension remitted in 80%, hyperlipidemia remitted in 83.3%, and obstructive sleep apnea syndrome improved in all cases. Gastroesophageal reflux disease (GERD) symptoms were improved in 86.7% of patients. Significant biliary gastritis occurred in 4 patients (9.3%). Dumping syndrome was reported in 4 patients (9.3%). Conclusions SAS-J bypass was effective as a salvage surgery after failed restrictive bariatric procedures, but long-term follow-up is needed. Graphical abstract ![]()
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Affiliation(s)
- Alaa M Sewefy
- Department of Surgery, Minia University Hospital, Minia, postal code: 61511, Egypt.
| | - Ahmed M Atyia
- Department of Surgery, Minia University Hospital, Minia, postal code: 61511, Egypt
| | - Taha H Kayed
- Department of Surgery, Minia University Hospital, Minia, postal code: 61511, Egypt
| | - Hosam M Hamza
- Department of Surgery, Minia University Hospital, Minia, postal code: 61511, Egypt
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Fantola G, Moroni E, Runfola M, Lai E, Pintus S, Gallucci P, Pennestrì F, Raffaelli M. Controversial Role of Robot in Primary and Revisional Bariatric Surgery Procedures: Review of the Literature and Personal Experience. Front Surg 2022; 9:916652. [PMID: 35711697 PMCID: PMC9194091 DOI: 10.3389/fsurg.2022.916652] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/02/2022] [Indexed: 11/25/2022] Open
Abstract
Laparoscopy is the surgical standard of care for bariatric procedures; however, during the last two decades, the robotic approach has gained increasing interest. It is currently considered a safe and effective alternative to laparoscopy. This literature review investigates the role of the robotic approach for primary and revisional bariatric procedures, with the particular aim of comparing this technique with the standard-of-care laparoscopic approach. The feasibility of robotic dissection and suturing could have potential advantages: robotics may prevent the risk of leak and bleeding and other surgical complications, determining potential benefits in terms of operative time, length of hospital stay, and learning curve. Considering primary procedures, the literature reveals no advantages in robotic versus the laparoscopic approach for adjustable gastric banding and sleeve gastrectomy. Robotic Roux-en-Y gastric bypass is associated with a longer operative time and a shorter hospital length of stay than laparoscopy. The robotic approach in revisional surgery has been proven to be safe and effective. Despite the longer operative time, the robotic platform could achieve a lower bleeding rate compared with laparoscopy. The surgeon’s selection criteria related to referrals to the robotic approach of difficult-perceived cases could represent a bias. In conclusion, robotic surgery can be considered a safe and effective approach in both primary and revisional bariatric surgery, despite the lack of evidence to support its routine use in primary bariatric surgery. However, in revisional bariatric surgery and in surgical complex procedures, the robotic approach could have potential benefits in terms of surgical complications and learning curves.
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Affiliation(s)
- Giovanni Fantola
- Obesity Surgery Unit, Department of Surgery, ARNAS G. Brotzu, Cagliari, Italy
- Correspondence: Giovanni Fantola
| | - Enrico Moroni
- Obesity Surgery Unit, Department of Surgery, ARNAS G. Brotzu, Cagliari, Italy
| | - Matteo Runfola
- Emergency Surgery Unit, Department of Surgery, ARNAS G. Brotzu, Cagliari, Italy
| | - Emanuele Lai
- Obesity Surgery Unit, Department of Surgery, ARNAS G. Brotzu, Cagliari, Italy
| | - Stefano Pintus
- Obesity Surgery Unit, Department of Surgery, ARNAS G. Brotzu, Cagliari, Italy
| | - Pierpaolo Gallucci
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Pennestrì
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Raffaelli
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Vanetta C, Dreifuss NH, Schlottmann F, Mangano A, Cubisino A, Valle V, Baz C, Bianco FM, Hassan C, Gangemi A, Masrur MA. Current Status of Robot-Assisted Revisional Bariatric Surgery. J Clin Med 2022; 11:jcm11071820. [PMID: 35407426 PMCID: PMC9000174 DOI: 10.3390/jcm11071820] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 02/01/2023] Open
Abstract
Bariatric surgery has been demonstrated to be effective in achieving significant weight loss and remission of obesity-related comorbidities. However, a percentage of patients fail to lose enough weight, regain weight, or experience postoperative complications, requiring additional interventions. Revisional bariatric surgeries (RBS) involve the wide spectrum of procedures that aim to treat complications of the index operation or achieve further weight loss. These are technically challenging procedures due to adhesions of the internal organs, reduced working space, and a distorted anatomy. Indications, timing, and type of operation for RBS are not standardized, and there is no consensus on the best surgical approach. Some authors claim a robotic platform could be advantageous in these types of procedures that are performed in reduced, deep operating fields, or those requiring precision and accuracy. This review examines the most current and representative literature on the outcomes of robot-assisted RBS. Included studies demonstrate the safety and feasibility of the robotic approach for RBS. However, long operative times and high costs remain major drawbacks of the device. Finally, if we consider that many centers have not yet completed the learning curve for robot-assisted RBS, the potential for improved outcomes seems promising.
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Wang A, Wang H, Abdurakhmanov A, Vijayanagar V, Thompson KJ, Mckillop IH, Barbat S, Bauman R, Gersin KS, Kuwada TS, Nimeri A. Safety of Primary Versus Revisional Biliopancreatic Diversion with Duodenal Switch in Patients with Super Obesity Using the MBSAQIP database. Obes Surg 2022; 32:1459-1465. [PMID: 35137289 DOI: 10.1007/s11695-022-05953-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION For patients with super obesity (BMI > 50 kg/m2), biliopancreatic diversion/duodenal switch (BPD/DS) can be an effective bariatric operation. Technical challenges and patient safety concerns, however, have limited its use as a primary procedure. This study sought to assess the safety of primary versus revisional BPD/DS. MATERIALS AND METHODS The MBSAQIP database was queried for primary and revisional BPD/DS (2015-2018). Inclusion criteria were patients ≥ 18 years of age, BMI > 50 kg/m2, and with no concurrent procedures. Preoperative variables were compared using a chi-square test or Wilcoxon two-sample tests. Multivariate logistic or robust linear regression models were used to compare outcomes. RESULTS There were 3,378 primary BPD/DS and 487 revisional BPD/DS patients. Primary BPD/DS patients had higher BMI (56.5 [IQR4.4] versus 54.8 [IQR4] kg/m2, p < 0.0001) and had more diabetes mellitus type II (29.1% versus 17.2%, p < 0.0001). Intraoperatively, revisional BPD/DS had longer operative time (165 [IQR47] min versus 139 [IQR100] min, p < 0.0001). After adjusting for preoperative characteristics, there was no difference in 30-day readmission or ED visits (primary 12.9% versus revisional 14.6%), reoperation or reintervention (primary 5.7% versus revisional 7.8%), or mortality (primary 0.4% versus revisional 0.6%). In contrast, the revisional BPD/DS patients had higher odds of major morbidity (primary 3.4% versus revisional 5.3%, OR 1.9, CI 1.1-3.2, p = 0.019). CONCLUSIONS Revisional BPD/DS is associated with higher morbidity than primary BPD/DS in patients with super obesity. These patients should thus be counselled appropriately when choosing a primary or revisional bariatric procedure.
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Affiliation(s)
- Alice Wang
- Department of Surgery, Wright State University, Dayton, OH, 45324, USA
| | - Huaping Wang
- Division of Research, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, 28204, USA
| | | | | | - Kyle J Thompson
- Division of Research, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, 28204, USA
| | - Iain H Mckillop
- Division of Research, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, 28204, USA
| | - Selwan Barbat
- Atrium Health Weight Management, Section of Bariatric & Metabolic Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, 2630 East 7th Street, Charlotte, NC, 28204, USA
| | - Roc Bauman
- Atrium Health Weight Management, Section of Bariatric & Metabolic Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, 2630 East 7th Street, Charlotte, NC, 28204, USA
| | - Keith S Gersin
- Atrium Health Weight Management, Section of Bariatric & Metabolic Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, 2630 East 7th Street, Charlotte, NC, 28204, USA
| | - Timothy S Kuwada
- Atrium Health Weight Management, Section of Bariatric & Metabolic Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, 2630 East 7th Street, Charlotte, NC, 28204, USA
| | - Abdelrahman Nimeri
- Atrium Health Weight Management, Section of Bariatric & Metabolic Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, 2630 East 7th Street, Charlotte, NC, 28204, USA.
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21
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‘t Hart JW, Leeman M, Mourik BC, Pouw N, Biter LU, Apers JA, Castro Cabezas M, Dunkelgrün M. Neutrophil-to-Lymphocyte Ratio as an Early Predictor for Major Complications After Metabolic Surgery. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2021.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Judith W.H. ‘t Hart
- Department of Surgery, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - Marjolijn Leeman
- Department of Surgery, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - Bas C. Mourik
- Department of Clinical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nadine Pouw
- Department of Clinical Chemistry and Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - Laser U. Biter
- Department of Surgery, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - Jan A. Apers
- Department of Surgery, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - Manuel Castro Cabezas
- Department of Internal Medicine, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - Martin Dunkelgrün
- Department of Surgery, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
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22
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Vilallonga R, Fort JM, Rodríguez Luna MR, García Ruiz de Gordejuela A, Gonzalez O, Caubet E, Cirera de Tudela A, Palermo M, Ciudin A, Armengol M. The Panoramic View of Revisional Bariatric Surgery. J Laparoendosc Adv Surg Tech A 2021. [PMID: 34492201 DOI: 10.1089/lap.2021.0506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction: Obesity remains a major public chronic disease, and the multifactorial components of its relapse in many patients remain inevitable. Methods: This article provides a panoramic view of the most commonly performed revisional bariatric surgery (RBS). RBS is a complex procedure; thus, primary procedures should be well chosen and performed to avoid the increasing number of RBS cases. Results: Bariatric surgery is the only successful long-term treatment for obesity. However, a proportion of primary bariatric surgeries has failed during the follow-up period. In recent decades, the solution for these complications is by performing RBS. It is mandatory to understand obesity as a chronic disease to appropriately treat patients. Treatment strategies are needed to determine the indications for revision. RBS requires a meticulous evaluation to facilitate good long-term results. Conclusions: Treatment strategies will be a fundamental pillar to wisely determine the indications for revision and identify the factors influencing failure by prudently and rationally evaluating the revisional procedure that the patient will benefit from and acquiring a high level of surgical skills.
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Affiliation(s)
- Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Amador García Ruiz de Gordejuela
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oscar Gonzalez
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Enric Caubet
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arturo Cirera de Tudela
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Andrea Ciudin
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain
- Endocrinology and Nutrition Department, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Manel Armengol
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
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23
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Bertoni MV, Marengo M, Garofalo F, Volontè F, La Regina D, Gass M, Mongelli F. Robotic-Assisted Versus Laparoscopic Revisional Bariatric Surgery: a Systematic Review and Meta-analysis on Perioperative Outcomes. Obes Surg 2021; 31:5022-5033. [PMID: 34410582 DOI: 10.1007/s11695-021-05668-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 12/13/2022]
Abstract
This systematic review and meta-analysis investigated the role of robotic-assisted surgery in patients undergoing revisional bariatric surgery (RBS). According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search of PubMed, Cochrane Library, Web of Science, and Google Scholar was performed: (("sleeve"AND "gastr*")OR "bariatric"OR "gastric bypass")AND("robot*"OR "DaVinci"OR "Da Vinci")AND("revision*"OR "conversion*"). In this review, six studies with 29,890 patients were included (2459 in the robotic group). No difference in postoperative complications (RR 1.070, 95%CI 0.930-1.231, p = 0.950), conversions to open surgery (RR 1.339, 95%CI 0.736-2.438, p = 0.339), length of stay (SMD - 0.041, 95%CI - 0.420-0.337, p = 0.831) or operative time (RR 0.219, 95%CI - 0.539-0.977, p = 0.571) was found. This systematic review and meta-analysis showed no significant advantage of robotic-assisted RBS; on the other hand, it showed a non-inferior efficacy compared to standard laparoscopy.
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Affiliation(s)
- Maria Vittoria Bertoni
- Department of Surgery, Lugano Regional Hospital, via Tesserete 46, 6900, Lugano, Switzerland
| | - Michele Marengo
- Department of Surgery, Bellinzona e Valli Regional Hospital, via Ospedale 10, 6500, Bellinzona, Switzerland
| | - Fabio Garofalo
- Department of Surgery, Lugano Regional Hospital, via Tesserete 46, 6900, Lugano, Switzerland
| | - Francesco Volontè
- Department of Surgery, Lugano Regional Hospital, via Tesserete 46, 6900, Lugano, Switzerland.,Department of Surgery, Sant'Anna Clinic, Via Sant'Anna 1, 6924, Lugano, Switzerland
| | - Davide La Regina
- Department of Surgery, Bellinzona e Valli Regional Hospital, via Ospedale 10, 6500, Bellinzona, Switzerland
| | - Markus Gass
- Department of Surgery, Cantonal Hospital of Lucerne, Spitalstrasse , 6000, Lucerne , Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, 6000, Lucerne, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Lugano Regional Hospital, via Tesserete 46, 6900, Lugano, Switzerland.
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24
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Dijkhorst PJ, Al Nawas M, Heusschen L, Hazebroek EJ, Swank DJ, Wiezer RMJ, Aarts EO. Single Anastomosis Duodenoileal Bypass or Roux-en-Y Gastric Bypass After Failed Sleeve Gastrectomy: Medium-Term Outcomes. Obes Surg 2021. [PMID: 34398380 DOI: 10.1007/s11695-021-05609-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 11/08/2022]
Abstract
Background Although the sleeve gastrectomy (SG) has good short-term results, it comes with a significant number of patients requiring revisional surgery because of insufficient weight loss or functional complications. Objective To investigate the effectiveness of the single anastomosis duodenoileal bypass (SADI-S) versus the Roux-en-Y gastric bypass (RYGB) on health outcomes in (morbidly) obese patients who had previously undergone SG, with up to 5 years of follow-up. Methods Data from patients who underwent revisional SADI-S or RYGB after SG were retrospectively compared on indication of surgery, weight loss, quality of life, micronutrient deficiencies, and complications. Results From 2007 to 2017, 141 patients received revisional laparoscopic surgery after SG in three specialized Dutch bariatric hospitals (SADI-S n=63, RYGB n=78). Percentage total weight loss following revisional surgery at 1, 2, 3, 4, and 5 years was 22%, 24%, 22%, 18%, and 15% for SADI-S and 10%, 9%, 7%, 8%, and 2% for RYGB (P<.05 for 1–4 years). Patients who underwent RYGB surgery for functional complications experienced no persistent symptoms of GERD or dysphagia in 88% of cases. No statistical difference was found in longitudinal analysis of change in quality of life scores or cross-sectional analysis of complication rates and micronutrient deficiencies. Conclusion Conversion of SG to SADI-S leads to significantly more total weight loss compared to RYGB surgery with no difference in quality of life scores, complication rates, or micronutrient deficiencies. When GERD in sleeve patients has to be resolved, RYGB provides adequate outcomes. Graphical abstract ![]()
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25
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Super J, Charalampakis V, Tahrani AA, Kumar S, Bankenahally R, Raghuraman G, Jambulingam PS, Kelly J, Ammori BJ, Singhal R. Safety and feasibility of revisional bariatric surgery following Laparoscopic Adjustable Gastric Band - Outcomes from a large UK private practice. Obes Res Clin Pract 2021; 15:381-386. [PMID: 34147378 DOI: 10.1016/j.orcp.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 05/25/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Revisional bariatric surgery is unavoidable in a proportion of patients. Despite its need, the development of this speciality has been hampered by its complexity and preferred delivery in institutional set ups. Although primary bariatric surgery can be delivered in the private sector; safety and feasibility of revisional bariatric surgery remains unexplored in this setting. MATERIALS AND METHODS Patients undergoing revisional bariatric surgery following previous Laparoscopic Adjustable Gastric Band (LAGB) between 2008 and 2019 at a single private bariatric unit with a minimum follow up of at least 6 months were included. The primary aim was safety outcomes and 30-day morbidity. RESULTS 178 patients with BMI of 45.6 ± 8.2 kg/m2 underwent revisional bariatric surgery. One stage conversion was performed for 86.5% of the cases. At 9.5 ± 5.3 months follow up, BMI and percentage excess BMI loss were 31.8 ± 6.2 kg/m2 and 62.6 ± 40% respectively. There was no mortality, and the major complication rate was 2.8%. There was no statistically significant difference in the incidence of complications based on one-stage vs. two-stage conversion (p = 0.52). There were no differences in weight loss outcomes post-revisional surgery according to the indication for revision (p = 0.446) or weight loss following primary surgery (p = 0.12). CONCLUSION Revisional bariatric surgery can be delivered safely in the private sector with good outcomes. One-stage conversions are feasible and do not detrimentally affect the morbidity of the procedure or the weight loss outcomes. More importantly, success following revisional surgery is independent of the indication for revision and weight loss outcomes following primary surgery.
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Affiliation(s)
- Jonathan Super
- Department of Surgery, St Mary's Hospital, Imperial College Healthcare NHS Trust, UK
| | - Vasileios Charalampakis
- Department of General and GI Surgery, Warwick Hospital, South Warwickshire NHS Foundation Trust, UK; Healthier Weight, UK
| | - Abd A Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Diabetes and Weight Management, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Healthier Weight, UK
| | - Sajith Kumar
- Department of Anaesthesia, Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK; Healthier Weight, UK
| | - Rajneesh Bankenahally
- Department of Anaesthesia, Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK; Healthier Weight, UK
| | - Govindan Raghuraman
- Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital King's Lynn, UK; Healthier Weight, UK
| | - P S Jambulingam
- Department of Upper GI & Bariatric Surgery, Bedfordshire Hospitals NHS Foundation Trust, Luton and Dunstable University Hospital, UK; Healthier Weight, UK
| | - Jamie Kelly
- Dept. of Surgery, University Hospital Southampton, UK; Healthier Weight, UK
| | - Basil J Ammori
- Department of Surgery, Salford Royal Hospital, Manchester, UK; Burjeel Hospital, Abu Dhabi, United Arab Emirates; Healthier Weight, UK
| | - Rishi Singhal
- Department of Bariatric Surgery, Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK; Healthier Weight, UK.
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26
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Meunier H, Menahem B, Le Roux Y, Bion AL, Marion Y, Vallois A, Contival N, Gautier T, Lubrano J, Briant A, Parienti JJ, Alves A. Development of the "OS-SEV90 Score" to Predict Severe Postoperative Complications at 90 Days Following Bariatric Surgery. Obes Surg 2021; 31:3053-3064. [PMID: 33907969 DOI: 10.1007/s11695-021-05367-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Bariatric surgery may be associated with severe postoperative complications (SPC). Factors associated with the risk of SPC have not been fully investigated. OBJECTIVES This study aimed to identify preoperative risk factors of SPC within 90 days and to develop a risk prediction model based on these factors. METHODS We conducted a retrospective single-center cohort study based on a prospectively maintained database of obese patients undergoing laparoscopic bariatric surgery from October 2005 to May 2019. All SPC occurring up to the 90th postoperative day were recorded according to the Dindo-Clavien classification. Associations between potential risk factors and SPC were analyzed using a logistic regression model, and the risk prediction ("OS-SEV90 score") was computed. Based on the OS-SEV90 score, the patients were grouped into 3 categories of risk: low, intermediate, and high. RESULTS Among 1963 consecutive patients, no patient died and 82 (4.2%) experienced SPC within 90 days. History of gastric or esophageal surgery (adjusted odds ratio (aOR) 3.040, 95% confidence interval; CI 1.78-5.20, p< 0.0001), past of thromboembolic event aOR 2.26, 95%; CI 1.12-4.55, p = 0.0225), and surgery performed by a junior surgeon (aOR 1.99, 95%; CI 1.26-3.13, p = 0.003) were all independently associated with risk for SPC, adjusting for ASA physical status system (ASA) score ≥ 3, severe OSA, psychiatric disease, asthma, a history of abdominal surgery, alcohol, cardiac disease, and dyslipidemia. "the OS-SEV90 score" based on these factors was constructed to classify patients into 3 risk groups: low (≤2), intermediate (3-4), and high (≥5). According to "the OS-SEV90 score," SPC increased significantly from 2.9% in the low-risk group, 7.7% in the intermediate-risk group, and 23.3% in the high-risk group. CONCLUSIONS A predictive model of SPC within 90 days "the OS-SEV90 score" has been developed using 9 baseline risk factors. The use of the OS-SEV90 score may help the multidisciplinary team to identify the specific risk of each patient and inform them about and optimize the comorbidities before the surgery. Further studies are warranted to validate this score in a new independent cohort before using it in clinical practice.
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Affiliation(s)
- Hugo Meunier
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen cedex, France
| | - Benjamin Menahem
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen cedex, France.
- UMR INSERM 1086 "Cancers et préventions", Centre François Baclesse, 3 avenue du Général Harris, 14045, Caen cedex, France.
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen cedex, France.
| | - Yannick Le Roux
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen cedex, France
| | - Adrien Lee Bion
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen cedex, France
| | - Yoann Marion
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen cedex, France
| | - Antoine Vallois
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen cedex, France
| | - Nicolas Contival
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen cedex, France
| | - Thomas Gautier
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen cedex, France
| | - Jean Lubrano
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen cedex, France
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen cedex, France
| | - Anaïs Briant
- Department of Biostatistics, University Hospital of Caen, Caen, France
| | - Jean-Jacques Parienti
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen cedex, France
- Department of Biostatistics, University Hospital of Caen, Caen, France
| | - Arnaud Alves
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen cedex, France
- UMR INSERM 1086 "Cancers et préventions", Centre François Baclesse, 3 avenue du Général Harris, 14045, Caen cedex, France
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen cedex, France
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Abdulrazzaq S, Elhag W, El Ansari W, Mohammad AS, Sargsyan D, Bashah M. Is Revisional Gastric Bypass as Effective as Primary Gastric Bypass for Weight Loss and Improvement of Comorbidities? Obes Surg 2021; 30:1219-1229. [PMID: 31865551 DOI: 10.1007/s11695-019-04280-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Revisional gastric bypass (R-RYGB) surgery is utilized for the management of inadequate weight loss or weight regain observed after some cases of bariatric surgeries. Data on the mid-term effectiveness of primary gastric bypass (P-RYGB) compared with R-RYGB (e.g., post sleeve gastrectomy/gastric banding) are controversial. METHODS Retrospective chart review of all patients who received P-RYGB and R-RYGB (January 2011-June 2015) at our center. One hundred twenty patients who underwent P-RYGB and 34 R-RYGB who completed 18 months follow-up were included. We compared the effectiveness of P-RYGB with R-RYGB by assessing four anthropometric, two glycemic, and four lipid parameters, as well as the control of type 2 diabetes (T2DM), hypertension, dyslipidemia (remission, improvement, persistence, relapse, de novo), mortality and complications rates. RESULTS A comparison of the effectiveness of P-RYGB with R-RYGB at 18 months revealed no significant differences in patients' age, gender, and preoperative BMI between groups. However, patients who received P-RYGB had lower mean weight (P = 0.001) and BMI (P < 0.001), reflected by a higher mean delta BMI (P = 0.02), total weight loss percentage (TWL%) (P < 0.0001) and excess weight loss percentage (EWL%) (P < 0.0001). No differences in glycemic parameters, lipid profiles, control of T2DM, hypertension, and dyslipidemia were observed. No death is reported and complication rates were comparable. CONCLUSIONS Although R-RYGB effectively addressed inadequate weight loss, weight regain, and recurrence of comorbidities after restrictive bariatric surgery, R-RYGB resulted in inferior weight loss compared with P-RYGB. Neither procedure differed in their clinical control of T2DM, hypertension, and dyslipidemia. Both procedures exhibited comparable complication rates.
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Affiliation(s)
- Sama Abdulrazzaq
- Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, 3050, Doha, Qatar
| | - Wahiba Elhag
- Department of Bariatric Surgery/Bariatric Medicine, Hamad General Hospital, 3050, Doha, Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, 3050, Doha, Qatar. .,College of Medicine, Qatar University, Doha, Qatar. .,Schools of Health and Education, University of Skovde, Skövde, Sweden.
| | | | - Davit Sargsyan
- Department of Metabolic and Bariatric Surgery, Hamad General Hospital, 3050, Doha, Qatar.,Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Moataz Bashah
- Department of Metabolic and Bariatric Surgery, Hamad General Hospital, 3050, Doha, Qatar.,Weill Cornell Medicine-Qatar, Doha, Qatar
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28
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Termine P, Boru CE, Iossa A, Ciccioriccio MC, Campanelli M, Bianciardi E, Gentileschi P, Silecchia G. Transhiatal Migration After Laparoscopic Sleeve Gastrectomy: Myth or Reality? A Multicenter, Retrospective Study on the Incidence and Clinical Impact. Obes Surg 2021; 31:3419-3426. [PMID: 33834373 DOI: 10.1007/s11695-021-05340-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/24/2021] [Accepted: 03/04/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Only anecdotally reported, intrathoracic migration (ITM) represents an unacknowledged complication after sleeve gastrectomy (LSG) contributing to gastroesophageal reflux disease (GERD) development, both recurrent and de novo. The primary endpoint of this study was to evaluate the incidence of postoperative ITM ≥ 2 cm; the secondary endpoint was to determine the relationships between ITM, GERD, endoscopic findings, and percentage of patients requiring surgical revision. MATERIALS AND METHODS A retrospective, multicenter study on prospective databases was conducted, analyzing LSGs performed between 2013 and 2018. Inclusion criteria consisted of primary operation; BMI ranging 35-60 kg/m2; age 18-65 years; minimum follow-up 24 months; and postoperative UGIE, excluding concomitant hiatal hernia repair. Esophageal manometry and 24-h pH-metry were indicated, based on postoperative questionnaires and UGIE; patients with GERD due to ITM, and non-responders to medical therapy, were converted to R-en-Y gastric bypass (RYGB). RESULTS An ITM ≥ 2cm was postoperatively diagnosed in 94 patients (7% of 1337 LSGs), after mean 24.16 ± 13.6 months. Postoperative esophagitis was found in 29 patients vs. 15 initially (p=0.001), while GERD was demonstrated in 75 (vs. 20 preoperatively, p< 0.001). Fifteen patients (16%) underwent revision to RYGB with posterior cruroplasty. Seventeen patients with severe GERD presented improvement of endoscopic findings and clinical symptoms as a result of conservative therapy. CONCLUSIONS ITM after LSG is not a negligible complication and represents an important pathogenic factor in the development or worsening of GERD. Postoperative UGIE plays a fundamental role in the diagnosis of esophageal mucosal lesions.
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Affiliation(s)
- Pietro Termine
- Division of General Surgery & Bariatric Center of Excellence-IFSO EC, Department of Medico- Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Rome, Italy
| | - Cristian Eugeniu Boru
- Division of General Surgery & Bariatric Center of Excellence-IFSO EC, Department of Medico- Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Rome, Italy.
| | - Angelo Iossa
- Division of General Surgery & Bariatric Center of Excellence-IFSO EC, Department of Medico- Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Rome, Italy
| | - Maria Chiara Ciccioriccio
- Division of General Surgery & Bariatric Center of Excellence-IFSO EC, Department of Medico- Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Rome, Italy
| | - Michela Campanelli
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital, Rome, and "Tor Vergata" University of Rome, Rome, Italy
| | - Emanuela Bianciardi
- Department of Systems Medicine, "Tor Vergata" University of Rome, Rome, Italy
| | - Paolo Gentileschi
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital, Rome, and "Tor Vergata" University of Rome, Rome, Italy
| | - Gianfranco Silecchia
- Division of General Surgery & Bariatric Center of Excellence-IFSO EC, Department of Medico- Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Rome, Italy
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Holtestaul T, Kuckelman J, Derickson M, Vigueras V, Reyes A, Bingham J, Sebesta J. Efficacy and safety of bariatric revisions in patients older than 65 years old. Am J Surg 2021; 221:1221-1227. [PMID: 33840444 DOI: 10.1016/j.amjsurg.2021.03.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/04/2021] [Accepted: 03/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bariatric surgery in advanced age patients (>65-years-old) has been proven safe and effective. Revisional bariatric surgery is infrequently required for cases of refractory obesity. However, there is a paucity of data regarding revisional surgery for the elderly. We hypothesize that revisional bariatric surgery is viable and safe in elderly patients. METHODS Retrospective chart review of all bariatric revisions performed at two high-volume bariatric centers of excellence between 2011 and 2018. Perioperative and long-term outcomes were compared between patients >65 and those <65-years-old. RESULTS 145 bariatric revisions were performed for weight loss. 10% (N = 15) were >65 years old. There were no differences in mortality between the two groups There was a longer median length of stay in the younger cohort (2 vs 1 day, p = 0.001). Percent excess weight loss was similar at 12-months, as was resolution of comorbidities. CONCLUSIONS Bariatric revisions in elderly patients appears to be safe and effective. Revisional surgery in this population was not shown to have increased morbidity or mortality with similar excess body weight loss when compared to a younger cohort.
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Affiliation(s)
| | | | | | | | - Angel Reyes
- Madigan Army Medical Center, Tacoma, WA, USA
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Spaniolas K, Yang J, Zhu C, Maria A, Bates AT, Docimo S, Talamini M, Pryor AD. Conversion of Adjustable Gastric Banding to Stapling Bariatric Procedures: Single- or Two-stage Approach. Ann Surg 2021; 273:542-547. [PMID: 30998539 DOI: 10.1097/sla.0000000000003332] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to compare the safety of single- versus two-stage conversion of adjustable gastric band (AGB) to gastric bypass (RYGB) or sleeve gastrectomy (SG). SUMMARY BACKGROUND DATA AGB patients often present for conversion to RYGB or SG. The impact of single- or two-stage approach of such conversion remains unclear. METHODS A statewide database was used to identify all patients who underwent AGB removal and concurrent (single-stage) or interval (two-stage) RYGB or SG. Propensity score matching schemes were constructed to account for differences in baseline comorbidities and demographics, allowing for matched pairs available for comparisons. RESULTS A total of 4330 patients underwent AGB conversion. Complications, readmissions, and ED visits were noted in 394 (9.1%), 278 (6.42%), and 589 (13.6%) patients, respectively. Three hundred sixty-seven matched pairs underwent RYGB; single-stage patients experienced shorter length of stay (LOS) (median difference -1 d, P < 0.0001), less complications [risk difference (RD): -8.4%, 95% confidence interval (CI), -13.4% to -3.5%], readmissions (RD: -5.2%, 95% CI, -9.6% to -0.8%), and ED visits (RD: -5.7%, 95% CI, -11.3% to -0.2%). Eight hundred seventy-five matched pairs underwent SG; single-stage patients experienced improved outcomes in all measures examined. For single-stage procedures (809 pairs), RYGB was associated with longer LOS, and more complications (RD: 3.3%, 95% CI, 0.9%-5.8%), with similar readmissions, and ED visits. CONCLUSIONS AGB conversion procedures have low morbidity. Single-stage conversion is associated with lower morbidity compared with the two-stage approach. Conversion to SG seems to be safer than RYGB.
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Affiliation(s)
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY
| | - Chencan Zhu
- Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY
| | - Altieri Maria
- Section of Minimally Invasive Surgery, Washington University, St Louis, MO
| | - Andrew T Bates
- Department of Surgery, Stony Brook University, Stony Brook, NY
| | | | - Mark Talamini
- Department of Surgery, Stony Brook University, Stony Brook, NY
| | - Aurora D Pryor
- Department of Surgery, Stony Brook University, Stony Brook, NY
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Cheng YL, Elli EF. Role of Robotic Surgery in Complex Revisional Bariatric Procedures. Obes Surg 2021; 31:2583-9. [PMID: 33646519 DOI: 10.1007/s11695-021-05272-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 01/27/2021] [Accepted: 02/03/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Revisional bariatric surgery (RBS) is becoming more common, with an estimated increase of more than 300% from 2017 to 2018. For these complex procedures, the role of robotics is still debated. The purpose of our study is to report the safety and effectiveness of robotic-assisted RBSs. MATERIALS AND METHODS A retrospective review of electronic medical records was conducted for robotic-assisted RBSs performed at the Mayo Clinic in Florida, between January 1, 2016, and January 1, 2020. Peri- and postoperative data were analyzed, reviewing patient characteristics, indications for surgery, and outcomes. RESULTS From 160 RBSs performed during the study period, 67 were robotic-assisted and met inclusion criteria. Primary procedures included sleeve gastrectomy (26 [38.8%]), adjustable gastric band (24 [35.8%]), Roux-en-Y gastric bypass (14 [20.9%]), vertical-banded gastroplasty (2 [3.0%]), and duodenal switch (1 [1.5%]). RBSs performed were Roux-en-Y gastric bypass (49 [73.1%]), redo gastrojejunostomy (14 [20.9%]), and duodenal switch (4 [6.0%]). Rate of conversion to open procedure and rate of readmission 1 month after surgery were 6.0% and 7.5%, respectively. Rate of 30-day Clavien-Dindo grade III or higher adverse events was 4.5%. No anastomotic leaks were documented. Fifty-two patients presented with preoperative symptoms, and 69.2% reported improvement after RBS. Mean (SD) excess weight loss was 57.62% (23.80) 12 months after RBS. CONCLUSION Robotic-assisted RBSs are safe with low major adverse event rates. Symptom resolution and weight loss outcomes are acceptable.
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Pereira A, Pinho AC, Sousa HS, da Costa EL, Rodrigues S, Barbosa E, Preto J. How Far Can Our Expectations Go on Revisional Bariatric Surgery After Failed Adjustable Gastric Banding? Obes Surg 2021; 31:1603-1611. [PMID: 33438161 DOI: 10.1007/s11695-020-05167-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 12/05/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Bariatric surgery has proven its effectiveness in the treatment of obesity and related comorbidities. However, several procedures may be required to treat this chronic disease and/or complications after bariatric surgery. The most frequent revisional surgeries performed after failed laparoscopic adjustable gastric banding (AGB) have been Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). The aim of this study is to compare medium-term outcomes of primary and revisional bariatric procedures. MATERIAL AND METHODS Single institution, matched case-control study of obese patients submitted to bariatric surgery, divided into four groups of 50 patients: (A) primary RYGB; (B) primary SG; (C) revisional Roux-en-Y gastric bypass (rRYGB) after failed laparoscopic AGB; (D) revisional sleeve gastrectomy (rSG) after failed laparoscopic AGB. Demographic variables, surgical procedures characteristics and complications, weight loss outcomes and resolution of comorbidities were compared. RESULTS Mortality and morbidity were comparable between primary and revisional procedures. Weight loss outcomes were inferior in patients submitted to rRYGB when compared to those submitted to RYGB, with no significant differences found when comparing the other groups. Regarding comorbidities' outcomes, only patients submitted to rSG had lower odds of comorbidities' improvement. Patients submitted to rRYGB had an odd 7 times higher of comorbidities' improvement than those submitted to rSG, independent of weight loss outcomes. CONCLUSION Revisional surgeries are safe procedures with adequate weight loss outcomes in this difficult set of patients. The choice of revisional procedure may not influence weight loss outcomes, but rRYGB seems to be a better option regarding comorbidities' resolution.
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Affiliation(s)
- André Pereira
- General Surgery Department, São João University Medical Center, Porto, Portugal. .,Faculty of Medicine of University of Porto, São João University Medical Center, Porto, Portugal.
| | - André Costa Pinho
- Faculty of Medicine of University of Porto, São João University Medical Center, Porto, Portugal.,Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Porto, Portugal
| | - Hugo Santos Sousa
- Faculty of Medicine of University of Porto, São João University Medical Center, Porto, Portugal.,Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Porto, Portugal
| | - Eduardo Lima da Costa
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Porto, Portugal
| | - Sara Rodrigues
- General Surgery Department, São João University Medical Center, Porto, Portugal.,Faculty of Medicine of University of Porto, São João University Medical Center, Porto, Portugal
| | - Elisabete Barbosa
- General Surgery Department, São João University Medical Center, Porto, Portugal.,Faculty of Medicine of University of Porto, São João University Medical Center, Porto, Portugal
| | - John Preto
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Porto, Portugal
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Dreifuss NH, Mangano A, Hassan C, Masrur MA. Robotic Revisional Bariatric Surgery: a High-Volume Center Experience. Obes Surg 2021; 31:1656-63. [PMID: 33392998 DOI: 10.1007/s11695-020-05174-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/07/2020] [Accepted: 12/16/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The number of bariatric revisional procedures is growing. Scarce evidence is available regarding the role and postoperative outcomes of robotic-assisted revisional bariatric surgery (RRBS). The aim of this study is to evaluate the safety and postoperative outcomes of RRBS. MATERIALS AND METHODS A retrospective analysis of a prospectively collected database of patients who underwent RRBS between 2012 and 2019 was performed. Primary outcomes of interest were 30-day major morbidity, mortality, length of hospital stay (LOS), urgent reoperation rates, and percentage of total weight loss (%TWL). RESULTS RRBS was performed in 76 patients; among these 60 (78.9%) underwent conversion to Roux-en-Y gastric bypass (C-RYGB). Failed weight loss (76%) and gastroesophageal reflux (9.2%) were the main indications for revision. Primary bariatric procedures included gastric band (LAGB) (50%), sleeve gastrectomy (SG) (40.8%), and RYGB (6.6%). Major morbidity and mortality rates were 3.9% and 1.3%, respectively. Mean LOS was 2.1 days, and 3 patients (3.9%) required urgent reoperation. The %TWL at 3, 6, 12, and 24 months was 10.2%, 16.6%, 18.3%, and 22.4% respectively. Comparative analysis of C-RYGB after failed LAGB and SG showed similar morbidity. Higher readmission rates (SG: 22.2% vs. LAGB: 0%, p = 0.007) and lower %EWL at 3, 6, 12, and 24 months were found in C-RYGB after SG. CONCLUSION This is one of the largest single-center series of RRBS published in the literature; the data indicate that robotic approach for revisional bariatric surgery is safe and helps achieving further weight loss. RRBS outcomes might be influenced by the primary procedure.
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Hawasli A, Foster R, Lew D, Peck L. Laparoscopic Ligamentum Teres cardiopexy to the rescue; an old procedure with a new use in managing reflux after sleeve gastrectomy. Am J Surg 2020; 221:602-605. [PMID: 33384153 DOI: 10.1016/j.amjsurg.2020.12.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/30/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Severe reflux after sleeve-gastrectomy (SG) often requires conversion to Roux-en-Y-Gastric Bypass (RYGB). We performed laparoscopic Ligamentum Teres Cardiopexy (LLTC) as an alternative operation. MATERIALS & METHODS Ten patients had LLTC between June 2019-June 2020. Pre-operative work-up included Barium swallow, upper endoscopy with pH monitoring. The percent excess body mass index (%EBMI) loss before LLTC was 70 ± 0.2%. RESULTS Pre-operative DeMeester score was 69 ± 50 (normal = 14.72). All patients underwent repair of hiatal hernia and gastric plication in addition to LLTC. The average operative-time was 110 ± 26 min. The follow up was 7 ± 3 months. Eight patients had resolution of their reflux. Two patients resumed medication for recurrent mild reflux. CONCLUSION LLTC is a safe technique and may be considered a rescue operation in lieu of conversion to RYGB in managing severe reflux after SG. Long term results are needed to confirm its durable effectiveness.
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Affiliation(s)
- Abdelkader Hawasli
- Department of Surgery, Ascension St. John Hospital, 22101 Moross Rd, Detroit, MI, 48236, USA; Beaumont Hospital Grosse Pointe, 468 Cadieux Rd. Grosse Pointe, MI, 48230, USA.
| | - Robert Foster
- Department of Surgery, Ascension St. John Hospital, 22101 Moross Rd, Detroit, MI, 48236, USA
| | - David Lew
- Department of Surgery, Ascension St. John Hospital, 22101 Moross Rd, Detroit, MI, 48236, USA; Beaumont Hospital Grosse Pointe, 468 Cadieux Rd. Grosse Pointe, MI, 48230, USA
| | - Laura Peck
- Department of Surgery, Ascension St. John Hospital, 22101 Moross Rd, Detroit, MI, 48236, USA
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Iranmanesh P, Fam J, Nguyen T, Talarico D, Chandwani KD, Bajwa KS, Felinski MM, Katz LV, Mehta SS, Myers SR, Snyder BE, Walker PA, Wilson TD, Rivera AR, Klein CL, Shah SK, Wilson EB. Outcomes of primary versus revisional robotically assisted laparoscopic Roux-en-Y gastric bypass: a multicenter analysis of ten-year experience. Surg Endosc 2020; 35:5766-5773. [PMID: 33026516 PMCID: PMC8437846 DOI: 10.1007/s00464-020-08061-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/29/2020] [Indexed: 01/06/2023]
Abstract
Background Postoperative morbidity after laparoscopic bariatric surgery is considered higher for patients undergoing revisional versus primary procedures. The objective of this retrospective cohort study was to compare outcomes between patients undergoing primary versus revisional robotically assisted laparoscopic (RAL) Roux-en-Y gastric bypass (RYGB). Methods Data of all patients who underwent RAL primary and revisional RYGB between 2009 and 2019 at two accredited, high-volume bariatric surgery centers—the Memorial Hermann – Texas Medical Center, Houston, TX, and the Tower Health, Reading Hospital, Reading, PA, were analyzed. Primary outcomes were early (< 30 days) and overall postoperative complications. Secondary outcomes included intraoperative complications, operative times, conversions to laparotomy, length of hospital stay, early (< 30 days) postoperative readmissions and deaths. Results Data of 1072 patients were analyzed, including 806 primary and 266 revisional RAL RYGB procedures. Longer operative times (203 versus 154 min, P < 0.001), increased number of readmissions for oral intolerance (10.5% versus 6.7%, P = 0.046) and higher rate of gastrojejunal stricture (6.4% versus 2.7%, P = 0.013) were found in the revisional group. Gastrointestinal leak rates were 0.2% for the primary versus 1.1% for the revisional group (P = 0.101). Early (< 30 days) reoperations rates were 2.2% for the primary versus 1.1% for the revisional group (P = 0.318). There were no statistically significant differences between groups in overall and severe complication rates. Conclusion Patients undergoing RAL primary and revisional RYGB had comparable overall outcomes, with a non-significant higher early complication rate in the revisional group. Despite the study being underpowered to detect differences in specific complication rates, the morbidity seen in the revisional RYGB group remains markedly below literature reports of revisional laparoscopic RYGB and might suggest a benefit of robotic assistance. Further prospective studies are needed to confirm these results.
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Affiliation(s)
- Pouya Iranmanesh
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA.
| | - John Fam
- Weight Loss Surgery and Wellness Center, Tower Health, Reading Hospital, Reading, PA, USA
| | - Thomas Nguyen
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
| | - David Talarico
- Weight Loss Surgery and Wellness Center, Tower Health, Reading Hospital, Reading, PA, USA
| | - Kavita D Chandwani
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Kulvinder S Bajwa
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Melissa M Felinski
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Leon V Katz
- Weight Loss Surgery and Wellness Center, Tower Health, Reading Hospital, Reading, PA, USA
| | | | - Stephan R Myers
- Weight Loss Surgery and Wellness Center, Tower Health, Reading Hospital, Reading, PA, USA
| | - Brad E Snyder
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
| | | | - Todd D Wilson
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Angielyn R Rivera
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Connie L Klein
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Shinil K Shah
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA.,Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, TX, USA
| | - Erik B Wilson
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
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Lim CH, Lee PC, Lim E, Eng A, Chan WH, Tan HC, Ho E, Kovalik JP, Ganguly S, Tan J. Resolution of Erosive Esophagitis After Conversion from Vertical Sleeve Gastrectomy to Roux-en-Y Gastric Bypass. Obes Surg 2020; 30:4751-9. [PMID: 32803710 DOI: 10.1007/s11695-020-04913-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/03/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has become the preferred bariatric procedure in many countries. However, there is one shortcoming of LSG in the long-term follow-up, and this is the onset of gastro-esophageal reflux disease (GERD) and erosive esophagitis (EE). Conversion to Roux-en-Y gastric bypass (RYGB) is considered an option in patients unresponsive to medical therapy. Currently, there is no evidence of EE improvement or resolution after conversion surgery. In this study, we objectively evaluate the effectiveness of RYGB in management of EE with upper endoscopy (EGD) to identify the significant variables in patients with GERD symptoms post LSG refractory to medical therapy and require conversion surgery. METHODS Over a period of 11 years (2008-2019) at Singapore General Hospital, we retrospectively reviewed a prospectively collected database of a cohort of patients whom had conversion surgery to RYGB for refractory GERD and EE after LSG. Patient's endoscopic findings and demographic and anthropometric data were analyzed. RESULTS We identified a total of 14 patients who underwent LSG to RYGB conversions for endoscopic proven erosive esophagitis in our unit during the study period. Eight patients (57.1%) had concurrent hiatal hernia repaired. Nine (64.3%) patients were females. The median age of patients in this cohort was 44 (range 30-61) years. Mean weight and BMI were 87.7 kg (± 19.2) and 32.8 (± 3.09) kg/m2, respectively, on the day of conversion surgery. The median time between LSG and revision to RYGB was 36 (range 6-68) months. Seven patients (50%) had complete resolution of GERD symptoms after conversion, and 6 patients (42.9%) had partial resolution. Six out of 7 patients had complete resolution of EE. There were 4 anastomotic strictures (28.6%). Older patients, Indian ethnicity, present of hiatal hernia and lower weight loss after initial LSG were more likely to undergo conversion surgery. CONCLUSION Conversion to RYGB after LSG is clinically relevant and may be a feasible solution if patients have ongoing GERD refractory to medical therapy. Ninety-three percent of our patients achieved complete resolution of their GERD symptoms and significant improvement of erosive esophagitis with significant weight loss after conversion. This study has important implications as LSG is increasingly being performed and a proportion of these will need revision surgery for various reasons, particularly GERD which is extremely prevalent.
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Okida LF, Henrique J, Sarmiento-Cobos M, Lo Menzo E, Szomstein S, Rosenthal RJ. Is bariatric surgery safe in patients with history of cardiac revascularization? Surg Obes Relat Dis 2020; 16:1757-1763. [PMID: 32782121 DOI: 10.1016/j.soard.2020.06.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The number of patients undergoing bariatric surgery with prior cardiac revascularization (CR) is rising. However, scarce data exist regarding the safety of bariatric procedures in these patients. OBJECTIVES The aim of this study is to compare postoperative cardiovascular and noncardiovascular outcomes among patients with different CR procedures. SETTING Academic hospital, United States. METHODS We retrospectively reviewed 2884 patients undergoing bariatric surgery from 2009-2018. Patients with prior CR were included and stratified into groups: coronary artery bypass graft (CABG), percutaneous coronary intervention with stent (PCI), and CABG + PCI. We described patient demographic characteristics, co-morbidities, smoking status, history of myocardial infarction, type of bariatric surgery, number of vessels grafted/stents, time from CR to bariatric surgery, length of stay, and cardiovascular and noncardiovascular 30-day outcomes. A control group composed of patients without prior CR undergoing bariatric surgery was used to compare the rate of complications to the total patients with prior CR. For continuous and categorical variables, t test and χ2 tests were performed, respectively. RESULTS We identified 76 patients with prior CR undergoing bariatric surgery. The mean patient age was 61.4 ± 7.9 years, the mean body mass index was 41.7 ± 6.5 kg/m2, and male sex was predominant (71.1%). Among these, 50% (n = 38) had PCI, 39.4% (n = 30) had CABG, and 10.5% (n = 8) had CABG + PCI. Early cardiovascular complications rate included ST-segment-elevation myocardial infarction (n = 2), pulmonary embolism (n = 1), supraventricular arrhythmia (n = 2), ventricular arrhythmia (n = 1), and pacemaker/defibrillator-insertion (n = 1). The overall rate of cardiovascular and noncardiovascular complications was 9.2% (n = 7) and 10.5% (n = 8) during the 30 days. Mortality rate was 0%. Comparison of rate of complications between groups did not show any statistical difference; no significant difference was found when comparing patients with prior CR to the 76 patients in the control group (P > .05). CONCLUSIONS Although revascularized individuals have severe co-morbidities and are high-risk patients, bariatric surgery remains safe in this population when outcomes are compared with bariatric patients without prior CR.
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Affiliation(s)
- Luis Felipe Okida
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Juliana Henrique
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Mauricio Sarmiento-Cobos
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Emanuele Lo Menzo
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Samuel Szomstein
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Raul J Rosenthal
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida.
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Hornock S, Ellis O, Dilday J, Bader J, Clapp B, Ahnfeldt E. The safety of additional procedures at the time of revisional bariatric surgery. Surg Endosc 2020; 35:3940-3948. [PMID: 32780241 DOI: 10.1007/s00464-020-07856-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/28/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The third most common bariatric operation is revisions of previous bariatric surgeries. Patients may require revisional bariatric surgery for inadequate weight loss or complications. Patients undergoing revisional bariatric surgery may also have other conditions that require surgery. This study evaluates the 30-day postoperative outcomes of patients undergoing revisional bariatric surgery and additional procedures. METHODS A retrospective review of the 2005-2017 ACS NSQIP database identified 7249 patients who underwent revisional bariatric surgery with 3115 (48%) occurring with additional procedures. A 1:1 propensity score matching analysis was completed for 13 patient demographics and comorbidities. Postoperative variables were then analyzed as available in the NSQIP database. Subgroup analyses were completed for those undergoing paraesophageal hernia repair and abdominal wall hernia repair at the time of revisional bariatric surgery. RESULTS The most common bariatric surgery that was converted or revised was the AGB (57%) and the most common additional procedure was paraesophageal hernia repair (n = 181, 15%). When additional procedures were completed at the time of revisional bariatric surgery, overall complications (p < 0.001), major systemic complications (p = 0.009) and mortality/major complications (p = 0.018) were all significantly increased. After matching for operative time, only postoperative sepsis remained significant with additional procedures (p = 0.042). In the subgroup analyses on paraesophageal and abdominal wall hernias there were no differences in postoperative complications after matching for operative time. CONCLUSIONS Additional procedures, including paraesophageal and abdominal wall hernia repairs at the time of revisional bariatric surgery increase postoperative complications. Operative time was longer when additional procedures were performed. Postoperative sepsis was the only complication which remained significant after propensity matching when additional procedures are completed at the time of revisional bariatric surgery.
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Affiliation(s)
- Sasha Hornock
- Department of Surgery, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX, 79930, USA.
| | - Oriana Ellis
- Department of Surgery, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX, 79930, USA
| | - Joshua Dilday
- Department of Surgery, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX, 79930, USA
| | - Julia Bader
- Department of Surgery, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX, 79930, USA
| | - Benjamin Clapp
- Department of Surgery, Texas Tech Health Sciences Center, El Paso, TX, USA
| | - Eric Ahnfeldt
- Department of Surgery, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX, 79930, USA
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Ortega-Serrano J, Kraus-Fischer G, Alfonso-Ballester R, Cassinello-Fernández N. Shortening of the Common Channel as a Rescue Surgery After Gastric Bypass Failure. Obes Surg 2020; 30:4760-4767. [PMID: 32691399 DOI: 10.1007/s11695-020-04854-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND After Roux-en-Y gastric bypass (RYGB), up to 30% failures in weight loss have been reported. Among multiple solutions available, we report our experience with shortening of the common channel (SCC) by performing a limb distalization of the alimentary or the biliopancreatic limb. SETTINGS University Hospital. METHODS We reviewed data from 23 patients that underwent limb distalization between 2001 and 2019 due to inadequate weight loss after an initial RYGB in our center. All patients who failed to achieve an excess weight loss reduction of > 50% or maintained a body mass index (BMI) above 35 kg/m2 were included. Multiple variables were analyzed during the follow-up at five time points: initial, after RYGB, before SCC, after SCC, and current. RESULTS The mean BMI prior to the RYGB was 51.8 kg/m2, after RYGB was 37.6 kg/m2, before SCC was 43.6 kg/m2, after SCC was 36.1 kg/m2, and the final BMI was 36.3 kg/m2. No morbidity was seen after SCC. Long-term associated nutritional deficiencies were only identified in 3 patients which had iron deficiency and 1 patient with vitamin D deficiency. Patients with associated comorbidities significantly improved or were withdrawn from medications after the RYGB, with minor variations after SCC. CONCLUSIONS Limb distalization with SCC is a safe and effective technique for patients who failed to achieve an adequate weight loss after RYGB. There is a slight increase in excess of weight loss after the SCC compared with RYGB. In addition, no further weight regain was documented.
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Affiliation(s)
- Joaquin Ortega-Serrano
- Endocrine and Bariatric Surgery Unit, Hospital Clinico Universitario, Valencia, Spain. .,Department of Surgery, University of Valencia, Av. Blasco Ibanez, 17, 46010, Valencia, Spain.
| | - Gabriel Kraus-Fischer
- Endocrine and Bariatric Surgery Unit, Hospital Clinico Universitario, Valencia, Spain
| | - Raquel Alfonso-Ballester
- Endocrine and Bariatric Surgery Unit, Hospital Clinico Universitario, Valencia, Spain.,Department of Surgery, University of Valencia, Av. Blasco Ibanez, 17, 46010, Valencia, Spain
| | - Norberto Cassinello-Fernández
- Endocrine and Bariatric Surgery Unit, Hospital Clinico Universitario, Valencia, Spain.,Department of Surgery, University of Valencia, Av. Blasco Ibanez, 17, 46010, Valencia, Spain
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Haskins IN, DeAngelis EJ, Lambdin J, Amdur RL, Jackson HT, Vaziri K. Patient Risk Factors Associated with Increased Morbidity and Mortality Following Revisional Laparoscopic Bariatric Surgery for Inadequate Weight Loss or Weight Recidivism: an Analysis of the ACS-MBSAQIP Database. Obes Surg 2020; 30:4774-84. [PMID: 32691398 DOI: 10.1007/s11695-020-04861-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 07/08/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Revisional bariatric operations are associated with increased morbidity and mortality compared with primary bariatric operations. The purpose of this study was to determine if preoperative patient variables are associated with an increased risk of 30-day morbidity and mortality following revisional laparoscopic bariatric surgery for inadequate weight loss or weight recidivism and to generate expected model probabilities in order to risk stratify individual patients undergoing these operations. MATERIALS AND METHODS All patients undergoing revisional laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) from 2015 to 2016 were identified with the American College of Surgeons Metabolic and Bariatric Surgery Quality Improvement Program (ACS-MBSAQIP) database. The association of preoperative patient variables with 30-day morbidity and mortality was investigated using multivariable logistic regression analysis. Predictive outcome models were developed for each outcome of interest. RESULTS A total of 13,551 patients met inclusion criteria; 5310 (39.2%) underwent revisional RYGB. Each of the available preoperative variables was associated with one or more of the 30-day morbidity and mortality outcomes of interest. The strength of the predictive models, as reflected by the area under the curve, ranged from 0.63 for 30-day unplanned hospital readmission to 0.92 for cardiac events. CONCLUSION Preoperative patient and surgical variables are associated with an increased risk of 30-day morbidity and mortality following laparoscopic revisional bariatric surgery. With these results, we have built a risk calculator that can be used as a resource for prehabilitation and patient counseling prior to revisional bariatric surgery.
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Beckmann JH, Mehdorn AS, Kersebaum JN, von Schönfels W, Taivankhuu T, Laudes M, Egberts JH, Becker T. Pros and Cons of Robotic Revisional Bariatric Surgery. Visc Med 2020; 36:238-245. [PMID: 32775356 DOI: 10.1159/000507742] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/03/2020] [Indexed: 01/06/2023] Open
Abstract
Introduction Revisional procedures in bariatric surgery are regarded as technically more demanding and riskier than primary interventions. While the use of the surgical robot has not yet proven to be advantageous in primary bariatric interventions, the question remains whether its use is justified for more complex revisional procedures. Objective To show that revisional bariatric surgery can be performed safely using the da Vinci® Xi surgical system. Methods We performed a retrospective analysis of prospectively recorded data for revisional bariatric procedures between January 2016 and November 2019. Results Of 78 revision operations, four (5.1%) were performed by open surgery, 30 (38.5%) by laparoscopic surgery, and 44 (56.4%) by robotic surgery. A comparative analysis of robotic (n = 41) versus laparoscopic (n = 18) revisional Roux-en-Y gastric bypasses (rRYGB) revealed significant differences favoring the robotic approach for operative time (130.7 vs. 167.6 min), C-reactive protein values at days 1 (27.9 vs. 49.1 mg/L) and 2 (48.2 vs. 83.6 mg/L) after surgery, and length of stay (4.9 vs. 6.2 days). Lower complication rates (Clavien-Dindo II-V) were found after rRRYGB (7.3 vs. 22.2%, not significant). Conclusions Revisional bariatric surgery using a robotic system is safe. The operative time performing rRRYGB is significantly shorter than rLRYGB in our experience. Otherwise, results were largely comparable. Due to different indications, different index operations and a wide range of revisional procedures, further studies are necessary to confirm these results.
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Affiliation(s)
- Jan Henrik Beckmann
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Anne-Sophie Mehdorn
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jan-Niclas Kersebaum
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Witigo von Schönfels
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Terbish Taivankhuu
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Matthias Laudes
- I. Department of Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jan-Hendrik Egberts
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thomas Becker
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Vallois A, Menahem B, Le Roux Y, Bion AL, Meunier H, Gautier T, Contival N, Mulliri A, Lubrano J, Parienti JJ, Alves A. Revisional Roux-en-Y Gastric Bypass: a Safe Surgical Opportunity? Results of a Case-Matched Study. Obes Surg 2019; 29:903-10. [PMID: 30467707 DOI: 10.1007/s11695-018-3606-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of revisional Roux-en-Y gastric bypass (RYGB) after adjustable gastric banding (AGB) or sleeve gastrectomy (SG) compared with primary RYGB, in regard to early and late morbidity, weight, and resolution of obesity-related comorbidities. METHODS The group of patients undergoing revisional RYGB was matched in a 1:1 ratio with control patient who underwent a primary RYGB, based on age, gender, American Society of Anesthesiologist (ASA) score, preoperative body mass index (BMI), and diabetes mellitus. Demographics, anthropometrics, preoperative work-up, and perioperative data were retrieved. RESULTS One hundred fifteen patients (16 males and 99 females) with a mean age of 45.5 ± 1.5 years underwent revisional RYGB following either LAGB in 82 patients (71.3%) or laparoscopic sleeve gastrectomy (LSG) in 33 patients (28.7%). There was no conversion and no mortality in either group. Revisional RYGB was associated with similar early (16.5 vs 15.6%, ns) and late (42.6% vs 32.2%, ns) morbidity rates with a mean follow-up of 25.3 ± 16.6 months compared to primary laparoscopic Roux-en-Y gastric bypass. The revisional RYGB group had significantly less weight loss (mean %EWL 67.4 ± 20.7 vs 72.7 ± 22.9, p = 0.023 and mean %EBMI 68.1 ± 22 vs 78.3 ± 25.7, p = 0.01) at the time of 1 year. Improvement of comorbidities including hypertension (62.5 vs 70.5%; p > 0.05), diabetes (73.7 vs 79%; p > 0.05), and obstructive sleep apnea syndrome (100 vs 97%; p > 0.05) was similar. CONCLUSION This large case-matched study suggests that conversion of SG or AGB to RYGB is feasible with early and late comparable morbidity in an accredited center; even weight results might be inferior.
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Spann MD, Harrison NJ, English WJ, Bolduc AR, Aher CV, Williams DB, Hawkins AT. Efficacy and Safety of Recurrent Paraesophageal Hernia Repair with Roux-en-Y Gastric Bypass. Am Surg 2020. [DOI: 10.1177/000313482008600336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Roux-en-Y gastric bypass (RYGB) has been explored as a revisional option to failed paraesophageal hernia (PEH) repair with fundoplication, particularly in patients suffering from obesity. However, few studies have assessed long-term outcomes of RYGB with revisional PEH repairin regard to acid-suppressing medication use. We retrospectively identified 19 patients who underwent revisional PEH repair with RYGB between 2011 and 2018. The median operative time was 232 minutes with a median hospital length of stay of two days. The median length of follow-up was 24 months. Two patients (10.5%) had complications in the first 30 days, and five patients (26.3%) had complications within one year. Of the 12 patients on preoperative acid suppression, 6 (50%) were either off medication or on reduced dose at 12 months. The median BMI decrease was 14.4 kg/m2at 12 months and did not change significantly afterward. Although rates of acid-suppression medication use did not change overall after revisional PEH repair with RYGB, patients experienced successful long-term management of morbid obesity and sustained weight loss. Revisional PEH repair with RYGB is a safe and effective option, with a complication rate comparable with the reported rates after revisional foregut procedures such as revisional Nissen fundoplication.
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Affiliation(s)
- Matthew D. Spann
- Department of Surgery, Section of Bariatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Noah J. Harrison
- Vanderbilt University School of Medicine, Nashville, Tennessee; and
| | - Wayne J. English
- Department of Surgery, Section of Bariatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aaron R. Bolduc
- Department of Surgery, Section of Bariatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chetan V. Aher
- Department of Surgery, Section of Bariatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - D. Brandon Williams
- Department of Surgery, Section of Bariatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alexander T. Hawkins
- Department of Surgery, Section of Colon and Rectal Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Younis F, Shnell M, Gluck N, Abu-Abeid S, Eldar S, Fishman S. Endoscopic treatment of early leaks and strictures after laparoscopic one anastomosis gastric bypass. BMC Surg 2020; 20:33. [PMID: 32085769 PMCID: PMC7035723 DOI: 10.1186/s12893-020-0686-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/22/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Laparoscopic one anastomosis gastric bypass has become a prominent bariatric procedure. Yet, early and late complications, primarily leaks and strictures, are not uncommon. This study summarizes our experience with endoscopic treatment of laparoscopic one anastomosis gastric bypass complications. METHODS This is a retrospective study of consecutive patients referred to our hospital from 2015 to 2017 with post laparoscopic one anastomosis gastric bypass complications. Therapy was tailored to each case, including fully covered self-expandable metal stents, fibrin glue, septotomy, internal drainage with pigtail stents, through-the-scope and pneumatic dilation. Success was defined as resuming oral nutrition without enteral or parenteral support or further surgical intervention. RESULTS Nine patients presented with acute or early leaks: 5 (56%) had staple-line leaks, 3 (33%) had anastomotic leaks and 1 (11%) had both. All were treated with stents. Adjunctive endoscopic drainage was applied in 4 patients (44%). Overall 5 patients (56%) with acute/ early leaks recovered completely, including all 3 patients with anastomotic leak and the patient with both leaks but only 1/5 with staple line leak (20%). Complication rate in the leak group reached 22%. Eight patients presented with strictures, 7 at the anastomosis and one due to remnant stomach misalignment. All anastomotic strictures were dilated successfully. However, the patient with the pouch stricture required conversion to Roux-en-Y gastric bypass after 3 failed attempts of dilation. CONCLUSION Endoscopic treatments of laparoscopic one anastomosis gastric bypass complications are relatively effective and safe. Anastomosis-related complications are more amenable to endoscopic treatment compared to staple line leaks.
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Affiliation(s)
- Fadi Younis
- Obesity Service, Department of Gastroenterology and Liver Disease, Tel Aviv Sourasky Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
| | - Mati Shnell
- Obesity Service, Department of Gastroenterology and Liver Disease, Tel Aviv Sourasky Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
| | - Nathan Gluck
- Obesity Service, Department of Gastroenterology and Liver Disease, Tel Aviv Sourasky Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel
| | - Subhi Abu-Abeid
- Bariatric Unit, Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shai Eldar
- Bariatric Unit, Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sigal Fishman
- Obesity Service, Department of Gastroenterology and Liver Disease, Tel Aviv Sourasky Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel.
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Abstract
Over the past decade, outcomes data have demonstrated the benefit of bariatric surgery in achieving both sustained weight loss and reversal of co-morbidities. Comparing these data to contemporary known risks of adolescent bariatric surgery informs the patients and providers considering bariatric procedures and provides insight into potential ways to reduce and manage complications. The goal of this article is to review the common surgical and postoperative complications following bariatric procedures and discuss approaches to improve their safety. A systematic review identifying bariatric surgery complications in adolescents was conducted. The review focused on the data relevant to adolescent bariatric surgery. However, when necessary, adult studies were used to address the gaps in available pediatric information. The data pertaining to the intraoperative, short term, and long term surgically related and nutritional related complications show that complication are declining with increasing experience. Specific recommendations and strategies to avoid major complications of bariatric surgery in adolescents are offered.
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Affiliation(s)
- Abdulrouf Lamoshi
- Oishei Children's Hospital, Pediatric Surgery Department, Buffalo, NY, USA
| | - Artur Chernoguz
- Floating Hospital for Children at Tufts Medical Center, Pediatric Surgery Division, Boston, MA, USA
| | - Carroll M Harmon
- Oishei Children's Hospital, Pediatric Surgery Department, Buffalo, NY, USA
| | - Michael Helmrath
- Cincinnati Children's Hospital Medical Center, Pediatric Surgery Division, Cincinnati, OH, USA.
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Amiki M, Seki Y, Kasama K, Hashimoto K, Kitagawa M, Umezawa A, Kurokawa Y. Revisional Bariatric Surgery for Insufficient Weight Loss and Gastroesophageal Reflux Disease: Our 12-Year Experience. Obes Surg 2020; 30:1671-1678. [DOI: 10.1007/s11695-019-04374-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Marti-Fernandez R, Cassinello-Fernandez N, Cuenca-Ramirez MD, Lapeña-Rodriguez M, Fernandez-Moreno MC, Alfonso-Ballester R, Ortega-Serrano J. Roux-en-Y Gastric Bypass as an Effective Bariatric Revisional Surgery after Restrictive Procedures. Obes Facts 2020; 13:367-374. [PMID: 32492679 PMCID: PMC7445544 DOI: 10.1159/000507710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/02/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Revisional surgery must be considered when insufficient weight loss is attained or weight is subsequently regained. This study aimed to investigate the value of Roux-en-Y gastric bypass (RYGB) as a revisional procedure after restrictive surgery. MATERIALS AND METHODS An observational, retrospective study including patients initially operated on for morbid obesity with restrictive techniques (vertical-banded gastroplasty [VBG], adjustable gastric band [AGB], and sleeve gastrectomy) and reoperated with RYGB in our centre between December 1994 and January 2019. Demographic and anthropometric data, associated comorbidities (diabetes mellitus type II, arterial hypertension, dyslipidaemia, and chronic obstructive pulmonary disease) and surgery-related data (approach, complications, and hospital stay) were evaluated at 5 different time points: initial (prior to first intervention), after the first surgical intervention, before the second intervention (gastric bypass), after the gastric bypass, and at present. RESULTS A total of 63 patients were included. VBG was the most frequent initial procedure (n = 33). The mean age was 39 ± 9.52 years, and the average initial weight was 143.53 ± 28.6 kg. Weight loss was achieved in all groups, with a median excess weight loss of 58% after the first surgery and 40.3% after gastric bypass. In terms of weight loss, the best results after the second surgery were obtained when the first surgery was AGB, with statistically significant differences. CONCLUSIONS RYGB is effective as a conversion procedure after a previous restrictive surgery, obtaining a significant reduction in weight and BMI. It has an acceptable morbidity rate and is more effective after an AGB.
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Affiliation(s)
- Rosa Marti-Fernandez
- Department of General and Digestive Surgery, Hospital Clinico Universitario, Valencia, Spain
| | - Norberto Cassinello-Fernandez
- Department of General and Digestive Surgery, Hospital Clinico Universitario, Valencia, Spain
- Department of Surgery, University of Valencia, Valencia, Spain
| | | | - Maria Lapeña-Rodriguez
- Department of General and Digestive Surgery, Hospital Clinico Universitario, Valencia, Spain
| | | | | | - Joaquin Ortega-Serrano
- Department of General and Digestive Surgery, Hospital Clinico Universitario, Valencia, Spain,
- Department of Surgery, University of Valencia, Valencia, Spain,
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Kindel TL. Comment on: Predictive factors of complications in revisional gastric bypass surgery: results from the Scandinavian Obesity Surgery Registry: "Roping In" the Wild West. Surg Obes Relat Dis 2019; 16:e3-e4. [PMID: 31796296 DOI: 10.1016/j.soard.2019.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Tammy L Kindel
- Department of Surgery, Medical College of Wisconsin Milwaukee, Wisconsin.
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49
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Bademci R, Vilallonga R, Piero A, Renato R, Yuhamy C, Posadas Ramirez LA. Is the Primary Obesity Surgery Endolumenal as Effective and Reliable as the Surgical Procedures? Bariatr Surg Pract Patient Care 2019. [DOI: 10.1089/bari.2019.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Refik Bademci
- Quirobes, Integral Obesity Care, Barcelona, Spain
- SCIAS, Hospital de Barcelona, Barcelona, Spain
| | - Ramon Vilallonga
- Quirobes, Integral Obesity Care, Barcelona, Spain
- SCIAS, Hospital de Barcelona, Barcelona, Spain
- ELSAN, Clinique St-Michel, Toulon, France
| | - Alberti Piero
- Quirobes, Integral Obesity Care, Barcelona, Spain
- SCIAS, Hospital de Barcelona, Barcelona, Spain
| | - Roriz Renato
- Quirobes, Integral Obesity Care, Barcelona, Spain
- SCIAS, Hospital de Barcelona, Barcelona, Spain
| | - Curbero Yuhamy
- Quirobes, Integral Obesity Care, Barcelona, Spain
- SCIAS, Hospital de Barcelona, Barcelona, Spain
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Mora Oliver I, Cassinello Fernández N, Alfonso Ballester R, Cuenca Ramírez MD, Ortega Serrano J. Cirugía bariátrica de conversión por fallo de la técnica inicial: 25 años de experiencia en una Unidad especializada de Cirugía de la Obesidad en España. Cir Esp 2019; 97:568-574. [DOI: 10.1016/j.ciresp.2019.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/28/2019] [Accepted: 07/25/2019] [Indexed: 10/25/2022]
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