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Komorniak N, Pawlus J, Gaweł K, Hawryłkowicz V, Stachowska E. Cholelithiasis, Gut Microbiota and Bile Acids after Bariatric Surgery-Can Cholelithiasis Be Prevented by Modulating the Microbiota? A Literature Review. Nutrients 2024; 16:2551. [PMID: 39125429 PMCID: PMC11314327 DOI: 10.3390/nu16152551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 07/28/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Cholelithiasis is one of the more common complications following bariatric surgery. This may be related to the rapid weight loss during this period, although the exact mechanism of gallstone formation after bariatric surgery has not been fully elucidated. METHODS The present literature review focuses on risk factors, prevention options and the impact of the gut microbiota on the development of gallbladder stones after bariatric surgery. RESULTS A potential risk factor for the development of cholelithiasis after bariatric surgery may be changes in the composition of the intestinal microbiota and bile acids. One of the bile acids-ursodeoxycholic acid-is considered to reduce the concentration of mucin proteins and thus contribute to reducing the formation of cholesterol crystals in patients with cholelithiasis. Additionally, it reduces the risk of both asymptomatic and symptomatic gallstones after bariatric surgery. Patients who developed gallstones after bariatric surgery had a higher abundance of Ruminococcus gnavus and those who did not develop cholelithiasis had a higher abundance of Lactobacillaceae and Enterobacteriaceae. CONCLUSION The exact mechanism of gallstone formation after bariatric surgery has not yet been clarified. Research suggests that the intestinal microbiota and bile acids may have an important role in this.
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Affiliation(s)
- Natalia Komorniak
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland; (V.H.); (E.S.)
| | - Jan Pawlus
- Department of General Mini-Invasive and Gastroenterological Surgery, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland;
| | - Katarzyna Gaweł
- Department of Gastroenterology, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland;
| | - Viktoria Hawryłkowicz
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland; (V.H.); (E.S.)
| | - Ewa Stachowska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland; (V.H.); (E.S.)
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Shikora SA, Edgerton C, Harris D, Buchwald H. Metabolic surgery. Curr Probl Surg 2021; 59:101059. [DOI: 10.1016/j.cpsurg.2021.101059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022]
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Long-Term Manometric Impact of the Adjustable Gastric Band on Esophageal Motility: a Prospective Case-Control Study. Obes Surg 2021; 31:3333-3336. [PMID: 33770361 DOI: 10.1007/s11695-021-05361-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/05/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
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Clinical Outcomes of Sleeve Gastrectomy Versus Roux-En-Y Gastric Bypass After Failed Adjustable Gastric Banding. Obes Surg 2020; 29:3252-3263. [PMID: 31292884 DOI: 10.1007/s11695-019-03988-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Over recent decades, laparoscopic adjustable gastric banding (LAGB) has been among the most common bariatric surgeries. Nowadays, many patients require revision surgery due to insufficient weight loss and band-related complications. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the two most common revision surgeries for failed LAGB, but the conclusions about their efficacy and safety have been inconsistent. This meta-analysis aimed to review the clinical outcomes of SG and RYGB after failed LAGB. METHODS In accordance with the PRISMA guidelines, the PubMed, Embase, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were systematically searched for articles that had studied the efficacy and safety of SG and RYGB. The most appropriate effects model was chosen based on the heterogeneity of the articles included in this meta-analysis. Statistical analysis was conducted using Stata 14.0. RESULTS Of 586 articles that were retrieved, 16 articles which examined 2141 SG and 2990 RYGB patients met the inclusion criteria. The patients in RYGB groups showed increased percent excess weight loss (%EWL) at 12 and 24 months after revision surgery but no statistically significant change was found about %EWL after 3, 6, or 36 months. In addition, RYGB was associated with a higher rate of complications, interventions, and readmission in addition to being of more operative time. CONCLUSIONS This review suggested that RYGB was more effective at demonstrating weight loss after 12 and 24 months, but comparisons of the long-term efficacy of RYGB with that of SG remain inconclusive. In addition, RYGB was accompanied by a greater number of post-operative complications, interventions, and readmissions. Thus, surgeons should consider the overall status of the patients and their comorbidities as crucial factors when selecting a form of revision surgery. Additional high-quality randomized controlled studies are required to further compare the efficacy and safety of these treatments with longer follow-up times.
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Creange C, Jenkins M, Pergamo M, Fielding G, Ren-Fielding C, Schwack B. Gastric band conversion to Roux-en-Y gastric bypass shows greater weight loss than conversion to sleeve gastrectomy: 5-year outcomes. Surg Obes Relat Dis 2018; 14:1531-1536. [PMID: 30449510 DOI: 10.1016/j.soard.2018.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are often used as revisional surgeries for a failed laparoscopic adjustable gastric band (LAGB). There is debate over which procedure provides better long-term weight loss. OBJECTIVE To compare the weight loss results of these 2 surgeries. SETTING University hospital, United States. METHODS A retrospective review was conducted of all LAGB to RYGB and LAGB to LSG surgeries performed at a single institution. Primary outcomes were change in body mass index (BMI), percent excess BMI lost, and percent weight loss. Secondary outcomes included 30-day complications and reoperations. RESULTS The cohort included 192 conversions from LAGB to RYGB and 283 LAGB to LSG. The baseline age and BMI were similar in the 2 groups. Statistical comparisons made between the 2 groups at 24 months postconversion were significant for BMI (RYGB = 32.93, LSG = 38.34, P = .0004), percent excess BMI lost (RYGB = 57.8%, LSG = 29.3%, P < .0001), and percent weight loss (RYGB = 23.4%, LSG = 12.6%, P < .0001). However, the conversion to RYGB group had a higher rate of reoperation (7.3% versus 1.4%, P = .0022), longer operating room time (RYGB = 120.1 min versus LSG = 115.5 min, P < .0001), and longer length of stay (RYGB = 3.33 d versus LSG = 2.11 d, P < .0001) than the LAGB to LSG group. Although not significant, the conversion to RYGB group had a higher rate of readmission (7.3% versus 3.5%, P = .087). CONCLUSION Weight loss is significantly greater for patients undergoing LAGB conversion to RYGB than LAGB to LSG. However, those undergoing LAGB conversion to RYGB had higher rates of reoperation and readmission. Patients looking for the most effective weight loss surgery after failed LAGB should be advised to have RYGB performed, while also understanding the increased risks of the procedure.
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Affiliation(s)
- Collin Creange
- Department of General Surgery, NYU Langone Medical Center, New York, New York.
| | - Megan Jenkins
- Department of General Surgery, NYU Langone Medical Center, New York, New York
| | - Matthew Pergamo
- Department of General Surgery, NYU Langone Medical Center, New York, New York
| | - George Fielding
- Department of General Surgery, NYU Langone Medical Center, New York, New York
| | | | - Bradley Schwack
- Department of General Surgery, NYU Langone Medical Center, New York, New York
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Revision Procedures After Failed Adjustable Gastric Banding: Comparison of Efficacy and Safety. Obes Surg 2018; 27:2861-2867. [PMID: 28569358 DOI: 10.1007/s11695-017-2716-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding (LAGB) was one of the commonly performed bariatric operations; however, it carries a high revision rate. The aim of the present study was to report the long-term outcomes of LAGB and compare the outcomes between the different revision procedures. METHODS All patients who underwent LAGB in a large bariatric center in Asia between May 2002 and April 2011 were included. Interval between primary LAGB to the revision operation, the reason and type of revision surgery were identified and analyzed. RESULTS A total of 275 consecutive patients were included. All of the procedures were completed laparoscopically with no major complications. The percentage of excess weight loss (%EWL) at 10-year follow-up was 45%. In this study, 53 patients (19.3%) had revision surgery, including with 26 single anastomosis (mini-) gastric bypass (R-LSAGB) (49%), 17 sleeve gastrectomy (R-LSG) (32.1%), 9 Roux-en-Y gastric bypass (R-LRYGB) (17%), and 1 other procedure (1.9%). A major complication occurred in 6 patients (11.3%). All of the follow-up patients with revision surgeries had %EWL > 50% at the 2-year follow-up. R-LSAGB patients achieved better weight loss than those who underwent R-LSG and R-LRYGB (p = 0.001). CONCLUSIONS The long-term result for weight loss after LAGB is unsatisfactory. The revision of failed LAGB to other bariatric surgeries is safe and can be performed in one stage with a low complication rate. Patients who underwent R-LSAGB had better weight loss results than the R-LSG or R-LRYGB patients.
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Long-term (>10 Yrs) Outcome of the Laparoscopic Biliopancreatic Diversion With Duodenal Switch. Ann Surg 2017; 264:1029-1037. [PMID: 26764870 DOI: 10.1097/sla.0000000000001622] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The aim of the study was to report 10+ year outcome of laparoscopic biliopancreatic diversion with duodenal switch (LDS), with special focus on quality of life. BACKGROUND: Reports on long-term morbidity and quality of life after LDS are rare. METHODS Records of all patients who underwent LDS 10+ years ago were analyzed. Patients were contacted to answer a questionnaire based on Bariatric Analysis and Reporting Outcome System. Blood work was reported when performed within the past year. RESULTS Of the 153 patients who underwent LDS, follow-up was available for 113 patients (78.5%). Mean follow-up was 130.2 ± 4.6 months. Percentage total weight loss was 40.7 ± 10.8%. Weight loss was greatest in the super obese category (BMI > 50 kg/m). Remission rate for type 2 diabetes was 87.5% (21/24) and for arterial hypertension 80.9% (38/47). Dyslipidemia remission rates were 93.3% (28/30) for total cholesterol, 89.7% (26/29) for triglycerides, and 95.0% (19/20) for low-density lipoprotein cholesterol. However, 42.5% of the patients needed reoperation, including 10.6% for correction of protein malnutrition, the latter exclusively in non-super obese individuals. Most common deficiencies concerned vitamin A and D, iron, and zinc. De novo gastroesophageal reflux disease was reported in 43.8%. The Bariatric Analysis and Reporting Outcome System score was good at 4.9 ± 2.2, and 82.3% of participants would choose the procedure again. CONCLUSIONS LDS is a very effective metabolic procedure, at the cost of occasional protein and other nutritional deficiencies. Outcome in the long term is best in super obese patients. Overall quality of life is good. The high reoperation rate and incidence of gastroesophageal reflux disease are concerning.
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Zaveri H, Surve A, Cottam D, Summerhays C, Cottam A, Richards C, Belnap L, Medlin W. A comparison of outcomes of bariatric surgery in patient greater than 70 with 18 month of follow up. SPRINGERPLUS 2016; 5:1740. [PMID: 27795883 PMCID: PMC5055526 DOI: 10.1186/s40064-016-3392-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 09/26/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is a scarcity of data available to determine the safety and effectiveness of bariatric surgery in the elderly population. Additionally, there are no studies showing the effect of the single anastomosis duodenal switch (SADS) has on the elderly obese, in comparison with other more popular procedures. Here we compare laparoscopic gastric band surgery (LAGB), Laparoscopic Roux-en-Y gastric bypass surgery (LRYGB), and the SADS to analyze the weight loss, perioperative and postoperative morbidity in the patients >70 years of age at a single US center. METHODS A retrospective analysis was performed on 53 consecutive patients ≥70 years old who underwent weight loss surgery from 2009 to 2015.Weight loss in terms of the percentage excess body mass index lost (%EBMIL), percentage excess weight lost (%EWL) and body mass index (BMI) points lost, resolution of comorbidities, length of stay, early (30-day) and late complication rates were compared using descriptive statistics and non-linear regression analysis. RESULTS Of 53 patients, 24 underwent LAGB, 14 underwent LRYGB and 15 underwent SADS. The average patient age was 72.7 ± 2.5 years (range, 70-81.4) and 66 % were females. There was no statistical difference in the demographic data between three groups except for age and sleep apnea. There were no operative or early deaths. There were differences in complication rates between the surgical arms; however, with our small data set statistical significance was not achieved. There was 1 patient who lost to follow up in SADS group. Follow up time period was 18 months. % EBMIL and BMI reduction showed a statistically significant difference between the procedures, where the SADS had the highest loss of %EBMIL and BMI points. Comorbidities prevalence decreased post-operatively with SADS having higher percentage of patients who had resolution of their comorbidities. CONCLUSION Each of the three procedures can be performed on patients older than 70 with low morbidity rate. However, when the focus is weight loss alone, the SADS procedure is the most effective of the three procedures in regards to weight loss in the short term for patients older than 70. The SADS is as safe as RYGB but LAGB with all its limitations is still the safest bariatric procedure.
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Affiliation(s)
- Hinali Zaveri
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT 84102 USA
| | - Amit Surve
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT 84102 USA
| | - Daniel Cottam
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT 84102 USA
| | | | - Austin Cottam
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT 84102 USA
| | - Christina Richards
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT 84102 USA
| | - LeGrand Belnap
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT 84102 USA
| | - Walter Medlin
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT 84102 USA
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Navez J, Dardamanis D, Thissen JP, Navez B. Laparoscopic Roux-en-Y gastric bypass for morbid obesity: comparison of primary versus revisional bypass by using the BAROS score. Obes Surg 2015; 25:812-7. [PMID: 25366292 DOI: 10.1007/s11695-014-1473-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vertically banded gastroplasty or adjustable gastric banding often result in weight regain, complications, or side effects. Failed restrictive bariatric procedures can be converted in revisional laparoscopic Roux-en-Y gastric bypass (LRYGB). This study aimed to compare weight loss, evolution of comorbidities, and quality of life (QOL) between primary versus revisional LRYGB. METHODS Between 2004 and 2012, 374 patients underwent LRYGB as primary or revisional surgery performed by a single surgeon. Patient data were retrospectively reviewed; questionnaires of QOL were sent to all patients. Outcomes were evaluated according to Bariatric Analysis and Reporting Outcome System (BAROS) taking into account excess body mass index loss (EBMIL), correction of comorbidities, improvement in QOL, and complications. RESULTS Two hundred thirty-two patients (62%) responded to the questionnaire, 163 patients in the primary group and 69 in the revisional group. Median follow-up was 36 months (12-108). Median percentages of EBMIL were, respectively, 74% (26.8-126.8) and 50% (-31.6-124.2) in the primary and the revisional groups (p < 0.01). Median BAROS score reached 6.5 (-2-9) in the primary group, against 4.3 (-1.8-9) in the revisional group (p < 0.01). There were significantly less "fair" and more "excellent" scores in the primary group, considering initial BMI before gastroplasty. Arterial hypertension and sleep apnea syndrome resolved, respectively, in 51 and 56% in the primary group and only in 29 and 33% in the revisional group (p < 0.01). CONCLUSIONS According to BAROS score, revisional LRYGB for failed restrictive procedures provided poorer results than primary LRYGB in terms of weight loss, resolution of comorbidities and QOL.
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Affiliation(s)
- Julie Navez
- Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, 1200, Brussels, Belgium,
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Davies SW, Efird JT, Guidry CA, Penn RI, Sawyer RG, Schirmer BD, Hallowell PT. Twenty-first century weight loss: banding versus bypass. Surg Endosc 2015; 29:947-54. [PMID: 25106724 PMCID: PMC4699425 DOI: 10.1007/s00464-014-3758-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 07/13/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The two most commonly performed procedures for bariatric surgery include Roux-en-Y gastric bypass (RYGB) and adjustable gastric banding (AGB). While many studies have commented on short-term, postoperative outcomes of these procedures, few have reported long-term data. The purpose of this study was to compare long-term, postoperative outcomes between RYGB and AGB. METHODS This was a retrospective, cohort comparing all patients undergoing RYGB or AGB at our institution, from 01/1998 to 08/2012. Patients were followed at 1-, 3-, and 5-year intervals. Adjusted, Cox proportional hazard regression and mixed effects repeated measures modeling were performed to generate cure ratios (CR) and 95 % confidence intervals (CI). RESULTS Two thousand four hundred twenty bariatric surgery patients (380 AGB, 2,040 RYGB) were identified by CPT code. Median (range) follow-up for patients was 3 (1-5) years. Preoperatively, RYGB patients were significantly younger, more obese, had higher hemoglobin A1c, and less often suffered from hypertension (HTN), dyslipidemia, and asthma as compared to AGB patients. Postoperatively, RYGB patients experienced significantly longer operating room times, higher incidences of intensive care unit admissions, longer hospital lengths of stay, and increased incidence of small bowel obstruction compared to AGB patients. After adjusting for statistically significant and clinically relevant factors [e.g., age, gender, body mass index, degenerative joint disease (DJD), diabetes, HTN, dyslipidemia, heart disease, apnea, and asthma], RYGB was independently associated with a significantly greater percentage of total body weight loss (p = 0.0065) and greater CR (95 % CI) regarding gastroesophageal reflux disease [2.1(1.4-3.0)], DJD [3.4(2.0-5.6)], diabetes [3.4(2.2-5.4)], apnea [3.1(1.9-5.3)], HTN [5.5(3.4-8.8)], and dyslipidemia [6.3(3.5-11)] compared to AGB. CONCLUSION Our results support previous studies that have observed a greater weight loss associated with RYGB as compared to AGB and provide further evidence toward the long-term sustainability of this weight loss. Additionally, RYGB appears to result in a greater reduction of medical comorbidity.
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Affiliation(s)
- Stephen W Davies
- Department of General Surgery, School of Medicine, University of Virginia, PO Box 800679, Charlottesville, VA, 22908-0679, USA,
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Emous M, Apers J, Hoff C, van Beek AP, Totté E. Conversion of failed laparoscopic adjustable gastric banding to Roux-en-Y gastric bypass is safe as a single-step procedure. Surg Endosc 2014; 29:2217-23. [PMID: 25318370 DOI: 10.1007/s00464-014-3928-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 09/16/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Several different procedures have been proposed as a revisional procedure for treatment of failed laparoscopic adjustable gastric banding (LAGB). Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been advocated as the procedure of choice for revision. In this study, we compare the single- and two-step approaches for the revision of failed LAGB to LRYGB. METHOD All patients who underwent bariatric surgery were included in a prospective database. For the purpose of this study, patients who underwent revisional surgery from LAGB to LRYGB were selected. Records for individual patients were completed by data review. Complication rates and weight development were recorded until 2 years postoperatively. Data were compared between both procedures and with complications rates reported in literature. RESULTS Revisional gastric bypass surgery was performed in 257 patients. This was done as a planned single-step procedure in 220 (86 %) patients without indications for acute band removal and in 32 patients as a planned 2 step procedure. Five patients were planned as a single-step procedure but were intraoperatively converted to a 2-step procedure based on poor pouch tissue quality. No postoperative mortality occurred in both groups. No differences in early major morbidity and stricture formation were seen between the two groups. Gastric ulceration was more frequently observed after 2-steps procedure (8.5 vs. 1.7 %, p < 0.05). In comparison with data reported in literature, the single-step procedure had similar to lower complication rates. Percentage excess weight loss two years after revisional gastric bypass procedure was, respectively, 53 versus 67 % (p = 0.147) for single- and two-step procedure. CONCLUSION In patients without indications for acute band removal, the planned conversion of gastric banding to Roux-Y gastric bypass can be safely done in a single-step procedure without increase in morbidity and no difference in postoperative weight loss.
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Affiliation(s)
- M Emous
- Department of Bariatric and Metabolic Surgery, Medisch Centrum Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands,
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Bekheit M, Katri K, Ashour MH, Sgromo B, Abou-ElNagah G, Abdel-Salam WN, Catheline JM, El Kayal ES. Gender influence on long-term weight loss after three bariatric procedures: gastric banding is less effective in males in a retrospective analysis. Surg Endosc 2014; 28:2406-2411. [PMID: 24648106 DOI: 10.1007/s00464-014-3489-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 02/14/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Identifying factors that influence weight loss after bariatric surgery is one way to predict a successful surgical outcome. Knowledge of the effect of gender on weight loss after bariatric surgery has not been well demonstrated in the literature despite being noted in every day practice. The aim of this study was to find the influence of gender on long-term weight loss after bariatric surgery. METHODS A retrospective analysis of data retrieved from a prospectively maintained bariatric database was conducted. RESULTS The study included 640 consecutive patients. Their mean age was 38 ± 10 years, mean preoperative body mass index was 44.9 ± 8.4 kg/m2, and mean preoperative excess weight (EW %) was 108.3 ± 38.4%. The mean of the average excess weight loss (EWL %) was 43.3 ± 42.4%. Three procedures were utilized: Roux-en-Y gastric bypass (RYGB), vertical banded gastroplasty (VBG), and gastric banding (GB). Both VBG and RYGB induced significantly more EWL % than GB (d = 22.1%, p < 0.001 and d = 16, p = 0.02, respectively). In patients who underwent VBG and GB, males had significantly lower preoperative EW % (Student t = -4.86, p < 0.001, and Student t = 4.69, p < 0.001, respectively), and postoperative mean of the average EWL % (Student t = -2.43, p = 0.016, and Student t = -3.33, p = 0.002, respectively) than females. In patients who underwent RYGB, there were no differences in the preoperative EW % (t = -1.03, p = 0.309) or the mean of the average EWL % (t = 0.406, p = 0.688). The simple linear regression model used to explain the variability in EWL %, accounted for by the variability in the preoperative EW %, was significant (F = 180, p < 0.001). Analysis of the residual errors in predicting the EWL % revealed no significant difference between males and females after VBG and after RYGB (t = 0.117, p = 0.907 and t = 1.052, p = 0.3, respectively), while it was significant after GB (t = -2.999, p = 0.003). CONCLUSION From our experience, we suggest that GB not to be offered as a first choice for obese male patients.
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Affiliation(s)
- Mohamed Bekheit
- Minimal Invasive Surgery Unit, Department of Surgery, El Kabbary General Hospital, El Kabbary, Alexandria, Egypt,
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Nguyen NQ, Game P, Bessell J, Debreceni TL, Neo M, Burgstad CM, Taylor P, Wittert GA. Outcomes of Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding. World J Gastroenterol 2013; 19:6035-6043. [PMID: 24106404 PMCID: PMC3785625 DOI: 10.3748/wjg.v19.i36.6035] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 03/31/2013] [Accepted: 06/19/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate weight loss and surgical outcomes of Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric band (LAGB).
METHODS: Data relating to changes in body mass index (BMI) and procedural complications after RYGB (1995-2009; n = 609; 116M: 493F; 42.4 ± 0.4 years) or LAGB (2004-2009; n = 686; 131M: 555F; 37.2 ± 0.4 years) were extracted from prospective databases.
RESULTS: Pre-operative BMI was higher in RYGB than LAGB patients (46.8 ± 7.1 kg/m2vs 40.4 ± 4.2 kg/m2, P < 001); more patients with BMI < 35 kg/m2 underwent LAGB than RYGB (17.1% vs 4.1%, P < 0.0001). BMI decrease was greater after RYGB. There were direct relationships between weight loss and pre-operative BMI (P < 0.001). Although there was no difference in weight loss between genders during the first 3-year post-surgery, male LAGB patients had greater BMI reduction than females (-8.2 ± 4.3 kg/m2vs -3.9 ± 1.9 kg/m2, P = 0.02). Peri-operative complications occurred more frequently following RYGB than LAGB (8.0% vs 0.5%, P < 0.001); majority related to wound infection. LAGB had more long-term complications requiring corrective procedures than RYGB (8.9% vs 2.1%, P < 0.001). Conversion to RYGB resulted in greater BMI reduction (-9.5 ± 3.8 kg/m2) compared to removal and replacement of the band (-6.0 ± 3.0 kg/m2). Twelve months post-surgery, fasting glucose, total cholesterol and low density lipoprotein levels were significantly lower with the magnitude of reduction greater in RYGB patients.
CONCLUSION: RYGB produces substantially greater weight loss than LAGB. Whilst peri-operative complications are greater after RYGB, long-term complication rate is higher following LAGB.
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Abstract
Is bariatric surgery as primary therapy for type 2 diabetes mellitus (T2DM) with body mass index (BMI) <35 kg/m(2) justified? Open-label studies have shown that bariatric surgery causes remission of diabetes in some patients with BMI <35 kg/m(2). All such patients treated had substantial weight loss. Diabetes remission was less likely in patients with lower BMI than those with higher BMI, in patients with longer than shorter duration and in patients with lesser than greater insulin reserve. Relapse of diabetes increases with time after surgery and weight regain. Deficiencies of data are lack of randomized long-term studies comparing risk/benefit of bariatric surgery to contemporary intensive medical therapy. Current data do not justify bariatric surgery as primary therapy for T2DM with BMI <35 kg/m(2).
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Affiliation(s)
- Harold E Lebovitz
- Department of Medicine, State University of New York Health Science Center at Brooklyn, Brooklyn, NY, USA.
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15
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Laparoscopic Adjustable Gastric Banding Connecting Tube Causing Small Bowel Obstruction and Perforation. Case Rep Surg 2013; 2013:296037. [PMID: 24368962 PMCID: PMC3867925 DOI: 10.1155/2013/296037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 09/25/2013] [Indexed: 12/04/2022] Open
Abstract
Background. Laparoscopic adjustable gastric banding (LAGB) is an effective method of reducing excess weight in obese patients. We report a patient who developed a bowel obstruction caused by the connecting tube between the gastric band and the injection port. Case Presentation. The patient was a 42-year-old Caucasian female who had undergone LAGB 19 months earlier. She presented with dehydration, low-grade fever, tachycardia, and mild abdominal tenderness. Laparotomy revealed that the connecting tube was looped around the mesentery, and a loop of small bowel was incarcerated between the tube and the mesentery. The incarcerated small bowel loop was perforated in two places. Conclusion. Surgeons should be aware of the possibility of obstruction caused by the connecting tube in patients who have undergone LAGB.
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16
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Pfeiffer JD, Grant J, Lutfi RE. Transanal protrusion of gastric band tubing: a rare complication of laparoscopic adjustable gastric banding. Surg Obes Relat Dis 2012; 9:e23-4. [PMID: 22959471 DOI: 10.1016/j.soard.2012.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 07/30/2012] [Accepted: 07/30/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Joshua D Pfeiffer
- University of Illinois at Chicago, Metropolitan Group Hospitals, Chicago, Illinois 60657, USA.
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