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Schaefer M, Garrote F, Junquera P. Reduced Bioavailability of Antidepressants for the Management of Generalized Anxiety Disorder Following Bariatric Surgery: A Case Study. Cureus 2024; 16:e56373. [PMID: 38633979 PMCID: PMC11022812 DOI: 10.7759/cureus.56373] [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: 02/23/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Bariatric surgery is a commonly performed procedure for patients who have failed to achieve weight loss through medical and lifestyle interventions. However, the altered gastrointestinal anatomy resulting from the surgery can significantly impact the bioavailability of antidepressants in patients with generalized anxiety disorder, potentially leading to uncontrolled anxiety symptoms. This case report describes a patient with generalized anxiety disorder who underwent Roux-en-Y gastric bypass surgery and subsequently experienced increased anxiety symptoms due to poor antidepressant bioavailability. The patient's medication was adjusted to a sublingual formulation, resulting in improved anxiety control and reduced side effects. Healthcare providers should be aware of the potential impact of bariatric surgery on medication absorption and closely monitor patients with generalized anxiety disorder for potential psychiatric medication-related complications postoperatively. The use of alternative routes of administration, such as sublingual medication, may be beneficial in improving drug bioavailability and managing anxiety symptoms. Creating awareness in primary care offices about poor drug absorption and using alternatives such as the sublingual route of administration to achieve optimal systemic delivery requires a multifaceted approach involving education and training for healthcare providers as well as patient education to ensure they are informed and engaged in their own care. By implementing these strategies, primary care providers can improve patient outcomes and prevent unnecessary referrals to specialists.
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Affiliation(s)
- Matthew Schaefer
- Neurosurgery, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Fabio Garrote
- Anesthesiology, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Patricia Junquera
- Psychiatry and Behavioral Sciences, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
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2
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Park SH, Hur H, Park JH, Lee CM, Son YG, Jung MR, Lee HH, Hwang SH, Lee MS, Seo SH, Jeong IH, Son MW, Kim CH, Yoo MW, Oh SJ, Hwang SH, Il Choi S, Choi HS, Keum BR, Yang KS, Park S. Reappraisal of optimal reconstruction after distal gastrectomy - a study based on the KLASS-07 database. Int J Surg 2024; 110:32-44. [PMID: 37755373 PMCID: PMC10793744 DOI: 10.1097/js9.0000000000000796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/09/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUNDS This study aimed to compare the incidence of bile reflux, quality of life (QoL), and nutritional status among Billroth II (BII), Billroth II with Braun anastomosis (BII-B), and Roux-en-Y (RY) reconstruction after laparoscopic distal gastrectomy (LDG). MATERIALS AND METHODS We reviewed the prospective data of 397 patients from a multicentre database who underwent LDG for gastric cancer between 2018 and 2020 at 20 tertiary teaching hospitals in Korea. Postoperative endoscopic findings, QoL surveys using the European Organization for Research and Treatment of Cancer questionnaire (C30 and STO22), and nutritional and surgical outcomes were compared among groups. RESULTS In endoscopic findings, bile reflux was the lowest in the RY group ( n =67), followed by the BII-B ( n =183) and BII groups ( n =147) at 1 year (3.0 vs. 67.8 vs. 84.4%, all P <0.05). The anti-reflux capability of BII-B was statistically better than that of BII, but not as perfect as that of RY. From the perspective of QoL, BII-B was not inferior to RY, but better than BII reconstruction in causing fewer STO22 reflux symptoms at 6 and 12 months. However, only RY caused fewer C30 nausea symptoms than BII at 6 and 12 months, but not BII-B. Nutritional status and morbidities were similar among the three groups, and the operative time did not differ between the BII-B and RY groups. CONCLUSIONS BII-B cannot substitute for RY in preventing bile reflux, shortening the operative time, or reducing morbidities. Regarding short-term QoL, BII-B was sufficient to reduce STO22 reflux symptoms but failed to reduce C30 nausea symptoms postoperatively.
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Affiliation(s)
- Shin-Hoo Park
- Division of Foregut Surgery, Korea University College of Medicine, Seoul
- Division of Foregut Surgery, Korea University Anam Hospital, Seoul
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon
| | - Jong-Hyun Park
- Division of Foregut Surgery, Korea University College of Medicine, Seoul
| | - Chang-Min Lee
- Division of Foregut Surgery, Korea University College of Medicine, Seoul
- Department of Surgery, Korea University Ansan Hospital, Ansan
| | - Young-Gil Son
- Department of Surgery, Keimyung University Dongsan Medical Centre, Daegu
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Medical School, Jeollanam-do
| | - Han Hong Lee
- Department of Surgery, Catholic University of Seoul St Mary’s Hospital, Seoul, Republic of Korea
| | - Sun-Hwi Hwang
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Moon-Soo Lee
- Department of Surgery, Eulji University Hospital, Daejeon
| | - Sang Hyuk Seo
- Department of Surgery, Busan Paik Hospital, Inje University
| | - In Ho Jeong
- Department of Surgery, Jeju National University School of Medicine, Jeju
| | - Myoung Won Son
- Department of Surgery, Soonchunhyang University Hospital Cheonan, Cheonan
| | - Chang Hyun Kim
- Department of Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Moon-Won Yoo
- Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul
| | - Sung Jin Oh
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan
| | - Seong Ho Hwang
- Department of Surgery, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea
| | - Sung Il Choi
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul
| | - Hyuk Soon Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul
| | - Bo-Ra Keum
- Department of Internal Medicine, Korea University College of Medicine, Seoul
| | - Kyung Sook Yang
- Department of Biostatistics, Korea University College of Medicine, Seoul
| | - Sungsoo Park
- Division of Foregut Surgery, Korea University College of Medicine, Seoul
- Division of Foregut Surgery, Korea University Anam Hospital, Seoul
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McCague A, Patterson B, Taggart T. Management of Complex Duodenal Injuries After Penetrating Trauma. Cureus 2023; 15:e40431. [PMID: 37456438 PMCID: PMC10348394 DOI: 10.7759/cureus.40431] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
Penetrating injuries to the duodenum can present a complex case for trauma or acute care surgeons. The associated injuries and complications can have devastating results. This report presents the case of a 41-year-old male who presented with a gunshot wound to his abdomen and suffered a gastric injury, transverse colon injury, duodenal injury, renal injury, and pancreatic tail injury. In this case, the patient underwent a complex Roux-en-Y reconstruction. The patient had a good outcome and continues to recover at home.
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Affiliation(s)
- Andrew McCague
- Trauma, Desert Regional Medical Center, Palm Springs, USA
| | | | - Tracy Taggart
- Trauma, Desert Regional Medical Center, Palm Springs, USA
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4
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Tagliaferri AR, Patel D, Cavanagh Y. Gastric Adenocarcinoma of the Remnant Stomach After Roux-en-Y Diagnosed by Endoscopic Ultrasound-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography (EDGE). Cureus 2023; 15:e37697. [PMID: 37206515 PMCID: PMC10191448 DOI: 10.7759/cureus.37697] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
It can be difficult to evaluate for pathology with traditional endoscopic modalities following a Roux-en-Y gastric bypass. This is due to the truncated gastrointestinal tract and excluded distal stomach formed during a Roux-en-Y procedure. In these circumstances, a modified endoscopic procedure, known as endoscopic ultrasound (EUS)-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP) (EDGE) is used. Although the Roux-en-Y procedure slightly increases the risk of gastric adenocarcinoma in the general population, the occurrence of gastric adenocarcinoma in the excluded stomach, specifically, is uncommon. Herein, we present a case of gastric adenocarcinoma of the excluded stomach, diagnosed 20 years after a Roux-en-Y procedure. This case is unique because after an extensive five-year workup for melena and iron deficiency anemia, the malignancy was ultimately diagnosed utilizing the innovative EDGE procedure.
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Affiliation(s)
| | - Dhruv Patel
- Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA
| | - Yana Cavanagh
- Gastroenterology, St. Joseph's Regional Medical Center, Paterson, USA
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5
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Hughes L, Morris M, Que B, Rai G, Jorge J, Tiesenga F. Perforated Duodenal Ulcer Post- Roux-en-Y Gastric Bypass: A Case Report. Cureus 2023; 15:e35112. [PMID: 36945278 PMCID: PMC10024948 DOI: 10.7759/cureus.35112] [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] [Accepted: 02/17/2023] [Indexed: 02/19/2023] Open
Abstract
Obesity is a growing health concern worldwide, with bariatric surgeries such as gastric bypass providing an effective treatment choice. However, a rare complication of gastric bypass is a duodenal ulcer. Currently, there is no exact incidence of this complication, and only a few case reports have been published in the literature. Presented is a case of a 32-year-old patient, eight years status post gastric bypass, who was evaluated for surgical repair of a large anterior perforated duodenal ulcer. This case report explores the relationship between patient history and gastric bypass surgery in the case of duodenal ulcer formation and perforation, as well as the diagnostic difficulty and modalities for duodenal ulcers in post-gastric bypass patients.
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Affiliation(s)
- Lauren Hughes
- Medical School, Saint James School of Medicine - Anguilla Campus, The Quarter, AIA
- General Surgery, West Suburban Hospital Center, Oak Park, USA
| | | | - Bryton Que
- Medical School, Saint James School of Medicine - Anguilla Campus, The Quarter, AIA
| | - Geetan Rai
- Surgery, Avalon University School of Medicine, Chicago, USA
| | - Juaquito Jorge
- General and Bariatric Surgery, West Suburban Hospital, Oak Park, USA
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Muacevic A, Adler JR, Figueira ER. First Robotic Roux-en-Y Gastric Bypass for the Treatment of Refractory Gastroesophageal Reflux Disease in a Patient With Systemic Sclerosis. Cureus 2023; 15:e33861. [PMID: 36819430 PMCID: PMC9933002 DOI: 10.7759/cureus.33861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
Systemic sclerosis (SSc) is an immune-mediated disease that results in fibrosis of the skin and internal organs. Refractory gastroesophageal reflux disease (GERD) associated with severe esophageal dysmotility is common in SSc patients, and surgical treatment with usual anti-reflux procedures such as fundoplications is associated with dismal symptomatic relief and postoperative dysphagia. We report the first robotic short-limb Roux-en-Y gastric bypass (RYGB) with a short Roux limb for the treatment of GERD in a patient with SSc with intense esophageal dysmotility. The operative time was two hours. The procedure and postoperative course were uneventful. The patient presented complete relief of gastroesophageal reflux symptoms and no postoperative dysphagia in a two-year follow-up. Therefore, short-limb RYGB is a safe and very effective alternative for the treatment of severe GERD in patients with SSc. The robotic surgical platform may have some advantages compared to conventional laparoscopy.
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7
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Voong CM, Vega KJ, Alkaddour A. An Unusual Long-Term Complication of Bariatric Surgery. Cureus 2022; 14:e23931. [PMID: 35547455 PMCID: PMC9085714 DOI: 10.7759/cureus.23931] [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] [Accepted: 04/07/2022] [Indexed: 11/05/2022] Open
Abstract
Roux-en-Y gastric bypass (RNYGB) has become the standard of care in treating obesity, a global health concern with associated comorbidities contributing to rising health care costs [1]. The positive outcomes of RNYGB have been well documented along with adverse effects such as nutrient deficiencies, hernia, postprandial dumping syndrome, chronic kidney disease and hypoglycemia. A lesser-known long term complication of RNYGB is liver failure. Here, we present a case where RNYGB performed 10 years prior contributed to acute liver failure.
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Affiliation(s)
- Cassandra M Voong
- Internal Medicine, Medical College of Georgia - Augusta University, Augusta, USA
| | - Kenneth J Vega
- Gastroenterology and Hepatology, Medical College of Georgia - Augusta University, Augusta, USA
| | - Ahmad Alkaddour
- Gastroenterology and Hepatology, Medical College of Georgia - Augusta University, Augusta, USA
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Tourky M, Issa M, Salman MA, Salman A, Shaaban HED, Safina A, Elias AAK, Elewa A, Noureldin K, Mahmoud AA, Dorra A, Farah M, Gebril M, Gasemelseed Fadlallah Elhaj M, Barbary H. Nutritional Complications After Laparoscopic Roux-en-Y Gastric Bypass and One-Anastomosis Gastric Bypass: A Comparative Systematic Review and Meta-Analysis. Cureus 2022; 14:e21114. [PMID: 35036236 PMCID: PMC8752406 DOI: 10.7759/cureus.21114] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 12/29/2022] Open
Abstract
A systematic review and meta-analysis were carried out involving studies that compared the nutritional complications of Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB); these included the incidence of malnutrition as well as deficiencies of other nutritional elements, such as total protein, albumin, calcium and iron. A comprehensive search strategy was implemented in PubMed, Embase, and the Cochrane Library. Effect sizes included the pooled odds ratios (ORs) and 95% confidence intervals (95% CIs), as well as mean differences (MDs) and 95% CIs of the percentage total weight loss (%TWL) and excess weight loss percentage (%EWL). Thirteen studies were included (12,964 patients, 66.27% females, 53.82% underwent OAGB). At the longest follow-up period (≥3 years), OAGB was associated with significantly higher %TWL (MD=5.41%, 95%CI, 1.52 to 9.29) and %EWL (MD=13.81%, 95%CI, 9.60 to 18.02) compared to RYGB. However, OAGB procedures were associated with malnutrition (OR=3.00, 95%CI, 1.68 to 5.36, p<0.0001), hypoalbuminemia (OR=2.38, 95%CI, 1.65 to 3.43, p<0.0001), hypoproteinemia (OR=1.85, 95%CI, 1.09 to 3.14, p=0.022), anemia (OR=1.38, 95%CI, 1.08 to 1.77, p=0.011), and hypocalcemia (OR=1.78, 95%CI, 1.01 to 3.12, p=0.046). On subgroup analyses, the proportions of anemia and hypoalbuminemia remained significantly higher at longer follow-up periods and in studies published in Asia. Despite the favorable weight loss profile, the unfavorable nutritional consequences of OAGB merits further investigations to explore the malabsorptive element, ethnic variation, and the role of biliopancreatic limb length.
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Affiliation(s)
- Mohamed Tourky
- General Surgery, Great Western Hospital, NHS Foundation Trust, Swindon, GBR
| | - Mohamed Issa
- Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, GBR.,Surgery, Prince Charles Hospital, Myrther Tydfil, GBR
| | - Mohamed A Salman
- Surgery, KasrAlainy School of Medicine, Cairo University, Cairo, EGY
| | - Ahmed Salman
- Internal Medicine, KasrAlainy School of Medicine, Cairo University, Cairo, EGY
| | - Hossam El-Din Shaaban
- Gastroenterology and Hepatology, National Hepatology and Tropical Medicine Research Institute, Cairo, EGY
| | - Ahmed Safina
- General Surgery, KasrAlainy School of Medicine, Cairo University, Cairo, EGY
| | - Abd Al-Kareem Elias
- General Surgery, Faculty of Medicine, Al-Azhar University, Assuit Branch, Kafr El-Sheikh, EGY
| | - Ahmed Elewa
- General Laparoscopic and Hepato-Pancreatico-Biliary (HBP) Surgery, National Hepatology and Tropical Medicine Research Institute, Cairo, EGY
| | - Khaled Noureldin
- General Surgery, KasrAlainy School of Medicine, Cairo University, Cairo, EGY.,Colorectal Surgery, Southend University Hospital, Mid and South Essex NHS Foundation Trust, Essex, GBR
| | | | - Ahmed Dorra
- Surgery, Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, GBR
| | - Mohamed Farah
- Urology, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, GBR
| | - Mahmoud Gebril
- General and Laparoscopic Surgery, Al Qabary Specialized Oncology Center, Alexandria, EGY
| | | | - Hesham Barbary
- General and Laparoscopic Surgery, El Zaitoun Specialized Hospital, Cairo, EGY
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McEachron KR, Yang Y, Hodges JS, Beilman GJ, Pruett TL, Kirchner VA, Dunn TB, Freeman ML, Trikudanathan G, Mulier KE, Ptacek P, Bellin MD. Alterations in Enteroendocrine Hormones After Total Pancreatectomy With Islet Autotransplantation. Pancreas 2020; 49:806-11. [PMID: 32541637 DOI: 10.1097/MPA.0000000000001582] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE When total pancreatectomy with islet autotransplantation (TPIAT) is performed for chronic pancreatitis, the pancreas and most of the duodenum are removed, with Roux-en-Y reconstruction of the gastrointestinal tract. Enteroendocrine cells in the intestines and pancreas secrete hormones coordinating digestion and motility, but anatomic reconstruction alters transit of nutrients to these cells. We hypothesized that TPIAT leads to changes in enteroendocrine hormones. METHODS Glucagon-like peptide 1 (GLP-1), peptide YY (PYY), and pancreatic polypeptide (PP) were measured from mixed-meal tolerance tests of 34 clinical trial participants before and 18 months after TPIAT. Area under the curve of GLP-1 and PYY-stimulated responses were calculated by trapezoidal method, and the PP response was measured as the stimulated max minus baseline (ΔPP). RESULTS Area under the curve of GLP-1 and PYY increased significantly after TPIAT (GLP-1 average +553.1 pg/mL per minute, P = 0.004; PYY average +4647.9 pg/mL per minute, P = 0.02). ΔPP trended toward lower after TPIAT (average, -52.2 pg/mL, P = 0.06). CONCLUSIONS In this novel study of enteroendocrine hormones in TPIAT patients, stimulated levels of GLP-1 and PYY were significantly higher after versus before TPIAT. ΔPP was lower after TPIAT, but not significantly. These hormone changes have potential clinical implications that warrant further research.
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10
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He L, Zhao Y. Is Roux-en-Y or Billroth-II reconstruction the preferred choice for gastric cancer patients undergoing distal gastrectomy when Billroth I reconstruction is not applicable? A meta-analysis. Medicine (Baltimore) 2019; 98:e17093. [PMID: 31770192 PMCID: PMC6890286 DOI: 10.1097/md.0000000000017093] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although Billroth II and Roux-en-Y procedures are the two most commonly performed types of reconstruction techniques following distal stomach resection, there is yet no consensus on which reconstruction is the best choice. This meta-analysis aims to compare the perioperative safety and long-term complications of Billroth-II and Roux-en-Y reconstruction. METHOD We searched the databases of the PubMed, the Cochrane Library, Web of Science, EMBASE, and the Chinese Biomedicine Database from January 2000 to January 2018 and included studies that compared Roux-en-Y with Billroth-II reconstruction after distal gastrectomy for gastric cancer. The meta-analyses were performed using RevMan 5.0 software. RESULT Four randomized controlled trials (RCTs) and eight non-randomized observational clinical studies (OCS) were included. Billroth-II anastomosis was more beneficial than Roux-en-Y in reducing the operation time (OR = 34.14, 95%CI = 24.19-44.08, P < .00001, I = 54%) and intraoperative blood loss (OR = 54.32, 95%CI = 50.29-58.36, P < .00001, I = 36%). However, Roux-en-Y anastomosis was more beneficial than Billroth-II in reducing the incidence of remnant gastritis (OR = 0.12; 95% CI = 0.08-0.17; P < .00001; I = 8%), reflux esophagitis (OR = 0.26; 95%CI = 0.15-0.44; P < .00001; I = 0%), dumping symptoms (OR = 0.31; 95%CI = 0.13-0.73; P = .008; I = 0%), reflux symptoms (OR = 0.20; 95% CI = 0.10-0.42; P < .0001; I = 0%). No differences were found between the two groups with respect to anastomotic leakage (OR = 1.56, 95%CI = 0.66-3.64, P = .59, I = 0%); postoperative mortality (OR = 1.15, 95%CI = 0.38-3.51, P = .80, I = 0%); overall postoperative morbidity (OR = 0.92, 95%CI = 0.6-1.42, P = .72, I = 0%); and delayed gastric emptying (OR = 0.84, 95%CI = 0.40-1.77, P = .65, I = 0%). CONCLUSION Roux-en-Y reconstruction does not carry greater postoperative complications than the Billroth II reconstruction. Additionally, it can improve the postoperative quality of life owing to less remnant gastritis, reflux esophagitis, dumping symptoms, and reflux symptoms. Considering the long-term postoperative outcomes, Roux-en-Y reconstruction appears to be a better choice following distal stomach resection.
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11
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James TW, Fan YC, Baron TH. EUS-guided hepaticoenterostomy as a portal to allow definitive antegrade treatment of benign biliary diseases in patients with surgically altered anatomy. Gastrointest Endosc 2018; 88:547-54. [PMID: 29729226 DOI: 10.1016/j.gie.2018.04.2353] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 04/24/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS EUS-guided hepaticoenterostomy (EUS-HE) usually is reserved for palliation of malignant biliary obstruction after failed endoscopic retrograde cholangiography (ERC) or inaccessible biliary tree in surgically altered anatomy (SAA). We describe the outcome of EUS-HE and antegrade therapy for benign biliary disease in patients with SAA. METHODS Retrospective review of 20 consecutive patients with surgically altered anatomy and benign biliary obstruction who underwent EUS-HE performed by 1 endoscopist at a tertiary-care center over a 3-year period. RESULTS During the study period, 37 patients underwent EUS-HE; 24 for benign disease. Of these, 20 patients had SAA and were analyzed (15 women, mean age, 62 years). SAA consisted of 9 Roux-en-Y gastric bypasses, 6 Roux-en-Y hepaticojejunostomy, 2 Billroth II procedures, and 3 Whipple procedures. Indications for ERC were common bile duct stones (n = 8), benign postoperative strictures (n = 7), chronic pancreatitis (n = 3), inflammatory stricture (n = 1), and treatment of a bile leak (n = 1). Five patients had previously failed balloon enteroscopy-assisted ERCs. The approach was transgastric in 15 and transjejunal in 5. In all cases, a branch of the left hepatic duct with a mean diameter of 7.8 mm was accessed. Median stent length was 80 mm, with diameters of 8 or 10 mm. Antegrade, definitive endoscopic therapy via the HE was performed in 18 patients, with an average of 2.7 procedures performed for resolution of stones and/or downstream strictures. HE stents were removed in 17 patients after a mean of 91 days without adverse events. Three patients experienced mild adverse events (1 with postprocedural pancreatitis after placement of a 10F transpapillary stent, 1 with postprocedural abdominal pain, and 1 with postprocedural cholangitis) requiring hospitalization for fewer than 3 nights; no severe adverse events occurred. The average postprocedural hospital stay was 1.3 days. No deaths occurred during follow-up. CONCLUSIONS EUS-HE is safe and effective in the management of benign biliary obstruction in patients with surgically altered anatomy. It creates a portal to allow definitive, antegrade therapy and is a viable alternative to other endoscopic methods in this patient population.
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Haddad FG, Zaraket V, Barakat I, Deeb L. Retrograde Jejuno-jejunal Intussusception after Roux-en-Y Gastric Bypass: A Potential à la Mode Complication. Cureus 2018; 10:e3045. [PMID: 30271694 PMCID: PMC6157651 DOI: 10.7759/cureus.3045] [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] [Indexed: 11/05/2022] Open
Abstract
Intussusception is a form of bowel obstruction caused by telescoping of a bowel segment into the adjacent part. Small bowel (SB) intussusception was previously considered a rare long-term complication of Roux-en-Y gastric bypass surgery (REYGB). However, with the rapid increase in the number of bariatric surgeries, the incidence of SB intussusception has been significantly increasing. This condition is potentially life-threatening if not recognized in a timely fashion. Herein, we report a case of retrograde jejuno-jejunal intussusception occurring six years after REYGB.
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Affiliation(s)
- Fady G Haddad
- Gastroenterology and Hepatology, Staten Island University Hospital, New York, USA
| | - Vera Zaraket
- Gastroenterology, Staten Island University Hospital, New York, USA
| | - Iskandar Barakat
- Gastroenterology, Staten Island University Hospital, New York, USA
| | - Liliane Deeb
- Gastroenterology and Hepatology, Staten Island University Hospital, New York, USA
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13
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Schulman AR, Kumar N, Thompson CC. Transoral outlet reduction: a comparison of purse-string with interrupted stitch technique. Gastrointest Endosc 2018; 87:1222-1228. [PMID: 29108984 PMCID: PMC5899924 DOI: 10.1016/j.gie.2017.10.034] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 10/13/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Weight regain after Roux-en-Y gastric bypass (RYGB) correlates with dilated gastrojejunal anastomosis (GJA). Endoscopic sutured transoral outlet reduction (TORe) is a safe and effective management and has predominantly been performed by either placing interrupted sutures at the GJA or the creation of a purse-string suture. The aim of the current study was to compare these techniques. METHODS All patients undergoing TORe for weight regain after RYGB were prospectively enrolled. Primary outcome was mean percent total weight loss (%TWL) at 3 and 12 months. Secondary outcomes included percent excess weight loss (%EWL), percent regained weight lost (%RWL), and total weight loss. Proportions were compared using the Fisher exact test and continuous variables using the Student t test. A P = .05 was significant. Multivariable regression analysis was performed. RESULTS Two hundred forty-one patients were enrolled (purse string = 187, interrupted = 54). There was no statistical difference between the purse-string and interrupted groups at 3 months in %TWL (8.6 vs 8.0, P = .41), %EWL (20.5 vs 16.7, P = .39), % RWL (44.7 vs 33.3, P = .56), and total weight loss (9.5 vs 11.3, P = .32). At 12 months the purse-string group achieved statistically significant improvement in %TWL (8.6 vs 6.4, P = .02), %EWL (19.8 vs 11.7, P < .001), %RWL (40.2 vs 27.8, P = .02), and total weight loss (9.5 vs 7.8, P = .04). Multivariable regression showed that technique (P = .006) was an independent predictor of %TWL at 12 months. CONCLUSIONS TORe is effective in treatment of weight regain after failed gastric bypass. The purse-string technique results in greater weight loss at 12 months than the traditional interrupted suture pattern.
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Affiliation(s)
- Allison R. Schulman
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA
| | - Nitin Kumar
- Bariatric Endoscopy Institute, Addison, Illinois, USA
| | - Christopher C. Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA
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Cai Z, Zhou Y, Wang C, Yin Y, Yin Y, Shen C, Yin X, Chen Z, Zhang B. Optimal reconstruction methods after distal gastrectomy for gastric cancer: A systematic review and network meta-analysis. Medicine (Baltimore) 2018; 97:e10823. [PMID: 29768387 PMCID: PMC5976285 DOI: 10.1097/md.0000000000010823] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The choice of anastomosis methods including Billroth I, Billroth II, and Roux-en-Y after a distal gastrectomy is still controversial. The conventional meta-analyses assessing 2 alternative treatments were not powered to compare differences in clinical outcomes. To guide treatment decisions in patients with gastric cancer (GC) after distal gastrectomy, we did a systematic review and network meta-analysis to identify the best reconstruction method. METHODS We systematically searched PubMed, EMBASE, the Cochrane Library for randomized controlled trials comparing the outcomes of Billroth I, Billroth II, or Roux-en-Y reconstruction after distal subtotal gastrectomy for patients with GC, then we performed a direct meta-analysis and Bayesian network meta-analysis to pooled odds ratios (OR) or weighted mean differences (WMD) with 95% credible intervals (CrI) with random effects model. The node-splitting method was used to assess the inconsistency. We estimated the potential ranking probability of treatments by calculating the surface under the cumulative ranking curve for each intervention. RESULTS Nine studies involving 1161 patient were included in the network meta-analysis. Statistical significance was reached for the comparisons of Roux-en-Y versus Billroth I reconstruction (WMD 37, 95% Crl: 22-51) and Billroth II versus Billroth I reconstruction (WMD 25, 95% Crl: 5.8-43) for operation time; and Roux-en-Y versus Billroth I reconstruction (WMD 26, 95% Crl: 2.1-68) for intraoperative blood loss; and Roux-en-Y versus Billroth I reconstruction (OR 3.4, 95% Crl: 1.1-13) for delayed gastric emptying. Roux-en-Y reconstruction was superior to Billroth I and Billroth II reconstruction in terms of frequency of bile reflux (OR 0.095, 95% Crl: 0.010-0.63; OR 0.064, 95% Crl: 0.0037-0.84, respectively) and the incidence of remnant gastritis (OR 0.33, 95% Crl: 0.16-0.58; OR 0.40, 95% Crl: 0.17-0.92, respectively). CONCLUSION Roux-en-Y reconstruction is superior to Billroth I and Billroth II reconstruction in terms of preventing bile reflux and remnant gastritis, Billroth I and Billroth II anastomosis could be considered as the substitute in consideration of technical simplicity. As for postoperative morbidity and the advantage of physiological food passage, Billroth I method is the choice.
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Affiliation(s)
- Zhaolun Cai
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Ye Zhou
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai
| | - Chenxiao Wang
- West China School of Preclinical Medicine and Forensic Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yiqiong Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Yuan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Chaoyong Shen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Xiaonan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Zhixin Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan
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Bindal V, Bhatia P, Dudeja U, Kalhan S, Khetan M, John S, Wadhera S. Review of contemporary role of robotics in bariatric surgery. J Minim Access Surg 2015; 11:16-21. [PMID: 25598594 PMCID: PMC4290112 DOI: 10.4103/0972-9941.147673] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 07/17/2014] [Indexed: 01/07/2023] Open
Abstract
With the rise in a number of bariatric procedures, surgeons are facing more complex and technically demanding surgical situations. Robotic digital platforms potentially provide a solution to better address these challenges. This review examines the published literature on the outcomes and complications of bariatric surgery using a robotic platform. Use of robotics to perform adjustable gastric banding, sleeve gastrectomy, roux-en-y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch and revisional bariatric procedures (RBP) is assessed. A search on PubMed was performed for the most relevant articles in robotic bariatric surgery. A total of 23 articles was selected and reviewed in this article. The review showed that the use of robotics led to similar or lower complication rate in bariatric surgery when compared with laparoscopy. Two studies found a significantly lower leak rate for robotic gastric bypass when compared to laparoscopic method. The learning curve for RYGB seems to be shorter for robotic technique. Three studies revealed a significantly shorter operative time, while four studies found a longer operative time for robotic technique of gastric bypass. As for the outcomes of RBP, one study found a lower complication rate in robotic arm versus laparoscopic and open arms. Most authors stated that the use of robotics provides superior visualisation, more degrees of freedom and better ergonomics. The application of robotics in bariatric surgery seems to be a safe and feasible option. Use of robotics may provide specific advantages in some situations, and overcome limitations of laparoscopic surgery. Large and well-designed randomised clinical trials with long follow-up are needed to further define the role of digital platforms in bariatric surgery.
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Affiliation(s)
- Vivek Bindal
- Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Parveen Bhatia
- Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Usha Dudeja
- Department of Biochemistry, University College of Medical Sciences, New Delhi, India
| | - Sudhir Kalhan
- Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Mukund Khetan
- Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Suviraj John
- Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Sushant Wadhera
- Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Al-Saeed O, Fahmy D, Kombar O, Hasan A. Sixty-four-slice multidetector computerized tomography in the evaluation of transmesenteric internal hernias following Roux-en-Y bariatric surgery. Med Princ Pract 2013; 22:540-4. [PMID: 23942306 PMCID: PMC5586795 DOI: 10.1159/000351616] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 04/25/2013] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the accuracy of 64-slice multidetector computerized tomography (MDCT) in the detection of transmesenteric internal hernias in patients following Roux-en-Y gastric bypass (RYGB) for bariatric surgery patients. SUBJECTS AND METHODS This retrospective study was performed on post-bariatric RYGB patients presenting with signs and symptoms suggestive of internal hernias at our institution from the period of April 2010 until March 2012. The patients who had symptoms suggestive of internal hernia had undergone 64-slice MDCT. All the patients who on CT examination were found to have features suggestive of internal hernia were subjected to laparoscopic exploration. RESULTS Of the 102 patients who had undergone laparoscopic RYGB, 42 (41.2%) were suspected of having internal hernia. Of these, 23 (55%) had CT findings of hernia while the remaining 19 (45%) were considered normal. Of the 23, 21 (91%) patients were confirmed for internal hernia at laparoscopy. The 19 (45%) patients that did not reveal any signs for internal hernia on CT and the 2 patients that were considered normal on laparoscopy were treated conservatively. The sensitivity, specificity and positive and negative predictive values for MDCT in the diagnosis of internal hernias were 100, 90.5, 91 and 91.3% respectively. CONCLUSION The 64-slice MDCT was accurate in the diagnosis of transmesenteric internal hernias in post-RYGB for bariatric surgery patients. The presence of clustered loops with mesenteric swirl is a reliable indicator of transmesenteric internal hernia.
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Affiliation(s)
- Osama Al-Saeed
- Department of Radiology, Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait
- *Dr. Osama Al-Saeed, ABR, Associate Professor and Consultant Radiologist, Radiology Department, Faculty of Medicine, Health Sciences Centre, Kuwait University, PO Box 24923, Safat 13110 Kuwait (Kuwait), E-Mail
| | - Dalia Fahmy
- Department of Radiology, Mansoura University, Mansoura, Kuwait City, Kuwait
| | - Osama Kombar
- Department of Radiology, Mansoura University, Mansoura, Kuwait City, Kuwait
- Departments of Radiology, Kuwait City, Kuwait
| | - Ali Hasan
- Surgery, Amiri Hospital, Kuwait City, Kuwait
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Laje P, Stanley CA, Palladino AA, Becker SA, Adzick NS. Pancreatic head resection and Roux-en-Y pancreaticojejunostomy for the treatment of the focal form of congenital hyperinsulinism. J Pediatr Surg 2012; 47:130-5. [PMID: 22244405 PMCID: PMC3595012 DOI: 10.1016/j.jpedsurg.2011.10.032] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 10/06/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE To determine the outcome of patients who underwent pancreatic head resection and Roux-en-Y pancreaticojejunostomy to the remaining normal pancreatic body and tail for the treatment of a focal lesion in the pancreatic head causing congenital hyperinsulinism (HI). METHODS One hundred thirty-eight patients underwent pancreatic resection for focal HI between 1998 and 2010. Twenty-three patients in the group underwent pancreatic head resection and Roux-en-Y pancreaticojejunostomy. RESULTS There were 13 females and 10 males. Median age and weight at surgery were 8 weeks and 5.8 kg, respectively. Twenty-one patients had a near-total pancreatic head resection, and 2 patients had a pylorus-preserving Whipple procedure. The pancreaticojejunostomy anastomosis was performed with interrupted fine monofilament sutures such that the transected end of the pancreatic body was tucked within the end of the Roux-en-Y jejunal limb. Median hospital stay was 22 days. All patients were cured of HI. CONCLUSION We conclude that pancreatic head resection with Roux-en-Y pancreaticojejunostomy is a safe and effective procedure for the treatment of the HI patient with a large focal lesion in the pancreatic head that is not amenable to local resection alone.
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Affiliation(s)
| | | | | | | | - N. Scott Adzick
- Corresponding author. Tel.: +1 215 590 2727; fax: +1 215 590 4875. (N. Scott Adzick)
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