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Chen JY, Shah S, Lloyd SJA, Pandya YK, Wooldridge J, Hage K, Kurian MS, Ghanem OM, Husain F, Kroh M. The SAGES masters program presents the 10 seminal articles for laparoscopic sleeve gastrectomy. Surg Endosc 2024; 38:5557-5566. [PMID: 39080061 DOI: 10.1007/s00464-024-11044-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/30/2024] [Indexed: 10/08/2024]
Abstract
BACKGROUND The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Masters Program includes eight distinct clinical pathways. The Bariatric Surgery Pathway focuses on three anchoring procedures, including the laparoscopic sleeve gastrectomy (LSG) which is the most commonly performed bariatric procedure in the United States. In this article, we present and discuss the top 10 seminal articles regarding the LSG. METHODS The literature was systematically searched to identify the most cited papers on LSG. The SAGES Metabolic and Bariatric Surgery committee reviewed the most cited article list, and using expert consensus elected the seminal articles deemed most pertinent to LSG. These articles were reviewed in detail by committee members and are presented here. RESULTS The top 10 most cited sentinel papers on LSG focus on operative safety, outcomes, surgical technique, and physiologic changes after the procedure. A summary of each paper is presented, including expert appraisal and commentary. CONCLUSIONS The seminal articles presented support the widespread acceptance and use of the LSG by bolstering the understanding of its mechanism of action and by demonstrating its safety and excellent patient outcomes. All bariatric surgeons should be familiar with these 10 landmark articles.
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Affiliation(s)
- Judy Y Chen
- Department of Surgery, University of Washington, Seattle, WA, USA.
| | - Sajani Shah
- Department of Surgery, Tufts Medical Center, Boston, MA, USA
| | | | - Yagnik K Pandya
- Department of Surgery, MetroWest Medical Center, Framingham, MA, USA
| | | | - Karl Hage
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Marina S Kurian
- Department of Surgery, NYU Langone Health, New York, NY, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Farah Husain
- Banner Health University Medical Center, Tucson, USA
| | - Matthew Kroh
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
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Wickremasinghe AC, Leang YJ, Johari Y, Laurie C, Nadebaum D, Yue H, Yap KS, Hebbard GS, Brown WA, Burton PR. Modified One Anastomosis Gastric Bypass Following Sleeve Gastrectomy for Severe Reflux and Delayed Gastric Emptying: A Prospective Trial with Clinical and Physiological Outcome Measures. Obes Surg 2024; 34:2940-2953. [PMID: 38935261 PMCID: PMC11289068 DOI: 10.1007/s11695-024-07362-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/04/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Gastro-esophageal reflux (GORD) following sleeve gastrectomy (SG) is a central challenge, and precise indications for revisional surgery or the physiology have not been precisely defined. We aimed to determine whether OAGB performed for reflux post-SG (1) accelerates gastric emptying half-time, (2) reduces the frequency and severity of reflux events, and (3) improves reflux symptoms. METHODS We undertook a prospective trial (ACTRN12616001089426). There were 22 participants who underwent measurement before and after revisional surgery with 29 optimal SG (patients with optimal outcome from their primary surgery) as controls. All participants underwent a protocolized nuclear scintigraphy, 24-h pH monitoring, and gastroscopy and completed objective questionnaires. RESULTS Trial patients were 90.9% female, age 44.4 years. Conversion from SG to OAGB was at a median of 45.2 ± 19.6 months. Scintigraphy showed an increased rate of gastric emptying post-OAGB 34 (IQR 14) vs 24 (IQR 10.3) min, p-value 0.008, with decreased number of reflux events post-prandially (39 (IQR 13) vs 26 (IQR 7), p-value 0.001). This data correlated with the pH analysis; total acid events substantially reduced post-OAGB 58.5 (IQR 88) vs 12 (IQR 9.4) events, p-value 0.017. Endoscopic findings indicated a reduction in incidence of bile stasis 72.7% vs 40.9% post-OAGB, p-value < 0.00010. Post-OAGB, patients experienced less frequent regurgitation (12 ± 4.1 vs. 5.5 ± 3, p-value 0.012) and reflux (37.1 ± 15.7 vs. 16.8 ± 12.6, p-value 0.003). CONCLUSIONS We found OAGB is an effective treatment for reflux associated with delayed gastric emptying post-SG. The likely mechanisms is by, an increase in the rate of gastric clearance and reduced reflux events and overall esophageal acid exposure. This suggests that some forms of post-SG reflux are driven by slower emptying of the residual stomach and are amenable to treatment with drainage above the incisura.
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Affiliation(s)
- Anagi C Wickremasinghe
- Monash University Department of Surgery, Central Clinical School, Monash University, Level 6, Alfred Centre, 99 Commercial Rd, Melbourne, 3004 VIC, Australia.
| | - Yit J Leang
- Monash University Department of Surgery, Central Clinical School, Monash University, Level 6, Alfred Centre, 99 Commercial Rd, Melbourne, 3004 VIC, Australia
- Oesophago-Gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Yazmin Johari
- Monash University Department of Surgery, Central Clinical School, Monash University, Level 6, Alfred Centre, 99 Commercial Rd, Melbourne, 3004 VIC, Australia
- Oesophago-Gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Cheryl Laurie
- Monash University Department of Surgery, Central Clinical School, Monash University, Level 6, Alfred Centre, 99 Commercial Rd, Melbourne, 3004 VIC, Australia
| | - David Nadebaum
- Department of Nuclear Medicine and PET, The Alfred Hospital, Melbourne, Australia
| | - Helen Yue
- Department of Nuclear Medicine and PET, The Alfred Hospital, Melbourne, Australia
| | - Kenneth S Yap
- Department of Nuclear Medicine and PET, The Alfred Hospital, Melbourne, Australia
- Department of Medicine, Monash University, Alfred Hospital Campus, Melbourne, 3004, Australia
| | - Geoffrey S Hebbard
- Department of Gastroenterology, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Wendy A Brown
- Monash University Department of Surgery, Central Clinical School, Monash University, Level 6, Alfred Centre, 99 Commercial Rd, Melbourne, 3004 VIC, Australia
- Oesophago-Gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Paul R Burton
- Monash University Department of Surgery, Central Clinical School, Monash University, Level 6, Alfred Centre, 99 Commercial Rd, Melbourne, 3004 VIC, Australia
- Oesophago-Gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
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Jiang Z, Zhang Z, Feng T, Cheng Y, Zhang G, Zhong M, Hu S. Trocar number and placement for laparoscopic sleeve gastrectomy and comparison of single-incision and conventional laparoscopic sleeve gastrectomy: a systematic review and meta-analysis. Int J Surg 2023; 109:1783-1795. [PMID: 37068794 PMCID: PMC10389429 DOI: 10.1097/js9.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/06/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Conventional laparoscopic sleeve gastrectomy (CLSG) has been conducted in multiple centers for treating morbid obesity, however, there are no standard criteria for (1) placing the trocar; and (2) how many trocars should be used. Single-incision laparoscopic sleeve gastrectomy (SLSG), a newly emerged technique in 2008, has been proposed as an alternative to CLSG in recent years, however, there is no definite evidence for this. MATERIALS AND METHODS A systematic literature search was performed using the PubMed, Embase, Web of Science, and Cochrane Library databases for laparoscopic sleeve gastrectomy cases from January 2006 to October 2022. We then summarized the trocar numbers and placement patterns among these studies. A meta-analysis was conducted to compare the difference between SLSG and CLSG in the perioperative and postoperative indices. RESULTS A total of 61 studies involving 20 180 patients who underwent laparoscopic sleeve gastrectomy for treating morbid obesity were included in the systematic review, including 11 on SLSG, 35 on CLSG, and 15 studies comparing SLSG and CLSG. A systematic review showed that the trocar number varied in different CLSG studies, mainly using four or five trocars. The trocars were mainly placed in position, presenting an inverted trapezoid pattern and a left-predominant pattern. Meta-analysis showed that the operative time in the SLSG was significantly higher than that in the CLSG, and the pain Visual Analog Scale rating on postoperative day 1 in the CLSG was significantly higher than in the SLSG. There were no statistical significances in the other complications or surgical efficiency. CONCLUSIONS In the CLSG, the majority of the trocars were arranged in an inverted trapezoid pattern and were of the left-predominant type. Although SLSG is a feasible technique in selected patients, there is insufficient evidence to recommend its widespread use compared with CLSG. High-quality randomized controlled trials with large study populations and long follow-up periods will be required in the future.
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Affiliation(s)
- Zhengchen Jiang
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
| | - Zhao Zhang
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
| | - Tianyi Feng
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
| | - Yugang Cheng
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
| | - Guangyong Zhang
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
| | - Mingwei Zhong
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
| | - Sanyuan Hu
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
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Meimand FE, Pazouki A, Setaredan SA, Shahsavan M, Kermansaravi M. The effect of antral resection start point on post sleeve gastrectomy gastroesophageal reflux symptoms and weight loss outcomes. Surg Endosc 2023:10.1007/s00464-023-10011-2. [PMID: 36947225 DOI: 10.1007/s00464-023-10011-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/09/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE Sleeve gastrectomy (SG) has gained worldwide popularity by surgeons due to acceptable results in weight loss and obesity-associated medical problems. Distance from the pylorus during antral resection in SG may be effective in decreasing the occurrence of gastroesophageal reflux disease (GERD). The aim of this study was to evaluate GERD symptoms and weight loss outcomes in two groups of SG patients with different start points of antral resection. METHODS This is a prospective cohort study on 220 patients who underwent SG between June 2019 and July 2021, aged 18 and above, BMI ≥ 40 kg/m2, or BMI > 35 kg/m2 with at least one obesity-associated medical problem. According to the start point of antral resection the patients were divided in two groups (group A: from 2 cm of pylorus and group B: from 4 cm of pylorus). Evaluation of GERD was performed using GerdQ questionnaire at 12-month follow up. RESULTS Mean age and BMI of all patients were 37.6 ± 10 year and 44.8 ± 5.7 kg/m2 at the time of SG. Totally 153(69.5%) of the patients were female. De novo GERD after 12 months in the groups A and B was found in 18 (20%) and 19 (21%) patients. TWL% at 12-month follow ups, were 33.9% and 32.5% in group A and B, respectively. CONCLUSION Antral resection's start point has no statistically significant effect on the excess and total weight loss indices, resolution of the obesity-related medical problems and De novo GERD between 2 and 4 cm start point for antral resection during SG.
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Affiliation(s)
| | - Abdolreza Pazouki
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat_e Rasool Hospital, Tehran, Iran.
| | - Seyed Amin Setaredan
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Shahsavan
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat_e Rasool Hospital, Tehran, Iran.
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Sleeve gastrectomy morphology and long-term weight-loss and gastroesophageal reflux disease outcomes. Surg Endosc 2023:10.1007/s00464-022-09555-6. [PMID: 36645483 DOI: 10.1007/s00464-022-09555-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/08/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND The relationship between sleeve gastrectomy (SG) morphology and long-term weight-loss and gastroesophageal reflux disease (GERD) outcomes is unknown. METHODS All patients (n = 268) undergoing SG performed by 3 surgeons at a single academic institution from January 1, 2010 to December 31, 2012 were included. Long-term weight-loss and GERD outcomes were available for 90 patients which were incorporated in analyses. SG morphology was determined from postoperative day 1 upper gastrointestinal series (UGIS) available from 50 patients. Images were independently categorized using previously published methodology as Dumbbell (38%), Lower Pouch (22%), Tubular (26%), or Upper Pouch (14%) by Radiologist and Surgeon. Radiologist categorization was used when disagreement occurred (8%). Univariable analyses were conducted to explore potential associations between SG morphology, weight loss, and GERD outcomes. RESULTS Follow-up was 8.2 ± 0.9 years. Population characteristics included age of 45.1 ± 10.8 years, female sex in 83.3%, and hiatal hernia repair (HHR) performed at index SG in 17.8%. Surgeons did not preferentially achieve a specific SG morphology. Changes from preoperative obesity and associated diseases comprised body mass index (BMI) (49.5 ± 7.6 vs. 39.2 ± 9.4 kg/m2; p < 0.0001), diabetes mellitus (30.0 vs. 12.2%; p = 0.0006), hypertension (70.0 vs. 54.4%; p = 0.0028), hyperlipidemia (42.2 vs. 24.2%;p = 0.0017), obstructive sleep apnea (41.1 vs. 15.6%; p < 0.0001), osteoarthritis (48.9 vs. 13.3%; p < 0.0001), back pain (46.5 vs. 28.9%; p = 0.0035), and medications (4.8 ± 3.3 vs. 3.7 ± 3.5; p < 0.0001). Dumbbell SG morphology was associated with lesser reduction in BMI at follow-up (--6.8 ± 7.2 vs. -12.4 ± 8.3 kg/m2; p = 0.0196) while greater BMI change was appreciated with Lower Pouch SG shape (-16.9 ± 9.9 vs. -8.4 ± 6.8 kg/m2; p = 0.0017). GERD was more prevalent at follow-up than baseline (67.8 vs. 47.8%; p < 0.0001). GERD-specific outcomes included de novo (51.1%), persistent (27.9%), worsened (58.1%), and resolved (14.0%) disease. Ten patients underwent reoperation for refractory GERD with SG morphology corresponding to Dumbbell (n = 5) and Upper Pouch (n = 1) for those with available UGIS. Univariable analyses showed that patients with GERD experienced a larger reduction in BMI compared with patients without GERD (-11.8 ± 7.7 vs. -7.0 ± 5.1 kg/m2; p = 0.0007). Patient age, surgeon, morphology category, and whether a HHR was done at index SG were not associated with the presence of any, de novo, or worsened GERD. Female sex was associated with worsened GERD (96.0 vs. 4.0%; p = 0.0455). Type of calibration device, distance from staple line to pylorus, and whether staple line reinforcement was used were not associated with SG morphology classification. CONCLUSION This is the first study assessing the impact of SG morphology on long-term weight loss and GERD. Our data suggest an association between SG morphology and long-term weight loss but not with GERD outcomes. Current technical standards may be limited in reproducing the same SG morphology. This information may help guide the technical optimization and standardization of SG. Surgeons did not favor a specific SG morphology (1). Our results signal to a relationship between radiographic assessment of SG morphology and long-term weight-loss outcomes with Dumbbell classification correlated with lesser reduction in BMI (2a) and Lower Pouch morphology associated with superior weight loss (2b). SG, sleeve gastrectomy; BMI, body mass index.
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Misra S, Balasubramanian S, Srikanth B, Kumar S, Christinajoice S, Nandhini D, Raj PP. Is there a role for upper gastrointestinal contrast study to predict the outcomes of sleeve gastrectomy? Lessons learnt from a prospective study. J Minim Access Surg 2022; 18:97-104. [PMID: 35017399 PMCID: PMC8830558 DOI: 10.4103/jmas.jmas_186_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Context: The importance of upper gastrointestinal (UGI) contrast study following sleeve gastrectomy (SG) is equivocal. It can, however, yield anatomical and functional details, the significance of which mostly remains unknown. Settings and Design: This prospective, single-center study included SG patients between January 2018 and January 2019. Materials and Methods: UGI contrast study was done on post-operative day 1. The findings of the study namely gastroesophageal junction (GEJ) holdup time, presence of fundus, gastroduodenal emptying (GDE) time, and sleeve shape were compared with weight loss, improvement of glycosylated hemoglobin (HbA1c) and gastroesophageal reflux disease (GERD) symptoms at 3, 6, and 12 months follow-up. Results: There were 138 patients with 100% follow-up. Radiological sleeve patterns observed were: tubular (62.3%), superior (16.0%), and inferior (21.7%) pouches. GEJ holdup time had no effect on percentage total weight loss (%TWL) (P = 0.09) or HbA1c improvement (P = 0.077). The absence of fundus led to greater %TWL at 6 months (P = 0.048). GDE time <15 s led to higher %TWL (P = 0.028) and lower HbA1c (P = 0.010) at 12 months. Antrum size <2 cm was associated with higher %TWL (P = 0.022) and lower HbA1c level (P = 0.047) at 12 months. Vomiting and regurgitation were common with tubular sleeves. Conclusion: UGI contrast study can predict weight loss, HbA1c improvement, and GERD symptoms. The absence of fundus, small antrum, and rapid GDE are associated with better weight loss. HbA1c improvement is better with small antrum and rapid GDE. Tubular sleeve predisposes to vomiting and regurgitation.
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Affiliation(s)
- Shivanshu Misra
- Department of Bariatric and Metabolic Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - Shankar Balasubramanian
- Department of Bariatric and Metabolic Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - B Srikanth
- Department of Radiodiagnosis, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - Saravana Kumar
- Department of Bariatric and Metabolic Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - S Christinajoice
- Department of Bariatric and Metabolic Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - Deepa Nandhini
- Department of Bariatric and Metabolic Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
| | - P Praveen Raj
- Department of Bariatric and Metabolic Surgery, GEM Hospital and Research Center, Coimbatore, Tamil Nadu, India
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Tartaglia N, Pavone G, Germano MP, Russo G, Pacilli M, Ambrosi A. Relationship between residual gastric area and weight loss after sleeve gastrectomy: A Cohort study. Ann Med Surg (Lond) 2022; 73:103177. [PMID: 35070275 PMCID: PMC8767233 DOI: 10.1016/j.amsu.2021.103177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The aim of this study is to evaluate the impact of the actual size and area of the remnant stomach, as measured by Upper gastrointestinal tract radiography, on weight loss after sleeve gastrectomy. MATERIALS AND METHODS From May 2017 to December 2019, 56 patients with morbid obesity were admitted to the Department of Medical and Surgical Sciences, University of Foggia and underwent laparoscopic sleeve gastrectomy. RESULTS 56 patients underwent sleeve gastrectomy with a mean age of 43,5 ± 11 years of which 40 were female. The mean Excess Weight Loss (EWL) at 1 month was 24,09 ± 15,04%, at 6 months was 27,07 ± 19,55% and at 12 months was 69,9 ± 23,7%. The mean Excess Body Mass Index Loss (EBMIL) at 1 month was 23,1 ± 12,5%, at 6 months was 56,6 ± 19,7% and at 12 months was 69,7 ± 23,7%.The EWL % was correlated with the residual stomach area (RSA) at 1 month (r = -0,242 p = 0,072), at 6 months (r = -0,249 p = 0,064) and at 12 months (r = -0,451 p = 0,0005).The EBMIL % was correlated with the RSA at 1 month (r = -0,270; p = 0,043), at 6 months (r = -0,270; p = 0,043) andat 12 months (r = -0,46; p = 0,0004). CONCLUSION A greater postoperative EWL % was correlated with a smaller RSA and this resulted in a statistically significant change at 12 months after surgery.
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Affiliation(s)
- Nicola Tartaglia
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122, Foggia, Italy
| | - Giovanna Pavone
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122, Foggia, Italy
| | - Mario Pio Germano
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122, Foggia, Italy
| | - Giovanni Russo
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122, Foggia, Italy
| | - Mario Pacilli
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122, Foggia, Italy
| | - Antonio Ambrosi
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122, Foggia, Italy
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Tobin EC, Knotts C, Tsai J, Austin J, Thompson S, Attia CG, Richmond BK, Monnett S. Management of the Crura During Laparoscopic Sleeve Gastrectomy. Am Surg 2021; 88:704-709. [PMID: 34772283 DOI: 10.1177/00031348211050285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
METHODS This is a retrospective cohort study that evaluated patients undergoing LSG performed by a single surgeon in a 7-year period. Data were collected via chart review. The primary endpoint was hiatal hernia presence at 5 years post-operatively. Secondary endpoints included post-procedural complications (nausea, vomiting, dysphagia, or reflux) at 30 days post-operatively. RESULTS A total of 361 patients were included in the analysis: 154 without crural closure, 164 primary crural closure, and 43 primary crural closure with mesh reinforcement. Rates of hiatal hernia occurrence at 5 years were 9.7% (no closure), 14.0% (primary closure), and 16.3% (closure with mesh reinforcement), respectively, and did not differ significantly among the 3 cohorts (P = .37). Overall rates of 30-day complications were 11.5%, 21.5%, and 28.6%, respectively (P = .015). CONCLUSION Rates of hiatal hernia after sleeve gastrectomy do not differ, regardless of management of the crura. In addition, and perhaps more significantly, avoidance of crural closure was associated with fewer 30-day complications. In fact, the highest rate of 30-day complications was seen in the group that received closure with mesh reinforcement. These data suggest that crural closure during LSG should be avoided. Further prospective study of these findings is warranted.
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Affiliation(s)
- Edward C Tobin
- 20205Charleston Area Medical Center, Charleston, WV, USA
| | - Chelsea Knotts
- 20205Charleston Area Medical Center, Charleston, WV, USA
| | - Jonathon Tsai
- 20205Charleston Area Medical Center, Charleston, WV, USA
| | - Jeffrey Austin
- 20205Charleston Area Medical Center, Charleston, WV, USA
| | - Stephanie Thompson
- Institute for Academic Medicine, Charleston Area Medical Center, Charleston, WV, USA
| | - Christina G Attia
- 12355West Virginia University/Charleston Division, Charleston, WV, USA
| | - Bryan K Richmond
- Department of Surgery, 37297West Virginia University/Charleston Division, Charleston, WV, USA
| | - Shane Monnett
- Department of Surgery, 37297West Virginia University/Charleston Division, Charleston, WV, USA
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Sano A, Seki Y, Kasama K, Nabekura T, Kurokawa Y, Ubukata Y, Nakazawa N, Hara K, Sakai M, Sohda M, Shirabe K, Saeki H. Impact of the Hepatic Branch of the Vagus Nerve Transection in Laparoscopic Sleeve Gastrectomy for Patients with Obesity and Type 2 Diabetes Mellitus. Obes Surg 2021; 31:3926-3935. [PMID: 34081275 DOI: 10.1007/s11695-021-05510-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND An increase in gastroesophageal reflux disease (GERD) after laparoscopic sleeve gastrectomy (LSG) has been reported, and concomitant hiatal hernia repair (HHR) during LSG is expected to reduce the incidence of post-LSG GERD. In HHR, the hepatic branch of the vagus nerve is anatomically transected. Recent experimental animal models suggest that vagotomy may affect glycemic control and weight loss through a neuroendocrine response. OBJECTIVES To examine whether LSG with/without hepatic branch vagotomy (HV) has a clinical impact on glycemic control in patients with obesity and type 2 diabetes mellitus (T2DM). Furthermore, the impact on weight loss and post-LSG GERD were evaluated. METHODS A total of 204 Japanese patients with obesity and T2DM, who underwent LSG and completed 1-year follow-up, were retrospectively analyzed. Operative outcomes, weight loss, glycemic, and GERD-related parameters were compared between the LSG/HHR/HV group (n = 89) and the LSG group (n = 115). RESULTS There was no significant difference in the background factors in terms of anthropometric and T2DM-related parameters between the groups. The median operation times in the LSG/HHR/HV and LSG groups were 133 and 124 minutes, respectively (p = 0.236). At 1 year, the diabetes remission rate, HbA1c, fasting glucose, and C-peptide levels were all comparable between the groups. The weight loss effect was also comparable. The patients in the LSG/HHR/HV group achieved significant improvement and prevention of GERD and hiatus hernia (p < 0.001). CONCLUSION HV does not appear to have a clinical impact on glycemic control and weight loss. Concomitant HHR with LSG serves to reduce post-LSG GERD.
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Affiliation(s)
- Akihiko Sano
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan.,Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Yosuke Seki
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan.
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Taiki Nabekura
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Yoshimochi Kurokawa
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Yasunari Ubukata
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Nobuhiro Nakazawa
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Keigo Hara
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Makoto Sakai
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Makoto Sohda
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hiroshi Saeki
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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10
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Choi SI. Is the Sleeve Gastrectomy Sufficient or Does it Require Additional Surgical Procedures? JOURNAL OF METABOLIC AND BARIATRIC SURGERY 2021; 10:9-13. [PMID: 36687753 PMCID: PMC9847646 DOI: 10.17476/jmbs.2021.10.1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 06/17/2023]
Abstract
Laparoscopic sleeve gastrectomy is a relatively simple procedure and has become the most well-known bariatric surgical procedure in Korea and Western countries. However, this procedure has several disadvantages in terms of long-term weight loss and metabolic disease control. Laparoscopic sleeve gastrectomy and additional bypass (sleeve plus) procedures were recently introduced into bariatric surgery in order to combine the physiologic advantages of pyloric-saving reconstruction and the bypass effect. A sleeve gastrectomy was performed first, followed by a bypass procedure. This review describes sleeve plus procedures reported in the literature and compares their outcomes with the most frequently performed techniques.
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Affiliation(s)
- Sung Il Choi
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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11
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Gundogan E, Gokler C, Sumer F, Kayaalp C. Effect of Abdominal Drain on Patient Comfort in Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Study. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ersin Gundogan
- Department of Surgery, Inonu University, Malatya, Turkey
| | - Cihan Gokler
- Department of Surgery, Inonu University, Malatya, Turkey
| | - Fatih Sumer
- Department of Surgery, Inonu University, Malatya, Turkey
| | - Cuneyt Kayaalp
- Department of Surgery, Inonu University, Malatya, Turkey
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12
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Guzman-Pruneda FA, Brethauer SA. Gastroesophageal Reflux After Sleeve Gastrectomy. J Gastrointest Surg 2021; 25:542-550. [PMID: 32935271 DOI: 10.1007/s11605-020-04786-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/03/2020] [Indexed: 01/31/2023]
Abstract
Sleeve gastrectomy continues to be the most commonly performed bariatric operation worldwide. Development or worsening of pre-existing GERD has been recognized as a significant issue postoperatively. There is a paucity of information concerning the most appropriate preoperative workup and the technical and anatomical factors that may or may not contribute to the occurrence of reflux symptoms. Contemporary data quality is deficient given the predominantly retrospective nature, limited follow-up time, and heterogeneous outcome measures across studies. This has produced mixed results regarding the postoperative incidence and severity of GERD. Ultimately, better-constructed investigations are needed in order to offer evidence-based recommendations that may guide preoperative workup and improved patient selection criteria.
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Affiliation(s)
- Francisco A Guzman-Pruneda
- Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stacy A Brethauer
- Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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13
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Laparoscopic Sleeve Gastrectomy under Awake Paravertebral Blockade Versus General Anesthesia: Comparison of Short-Term Outcomes. Obes Surg 2021; 31:1921-1928. [PMID: 33417101 DOI: 10.1007/s11695-020-05197-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 12/11/2022]
Abstract
AIMS This study aimed at comparing the pre-, intra-, and early postoperative outcomes, between patients who underwent PVB vs general anesthesia (GA) during LSG. Follow-up of weight loss at least 1 year postoperatively was also evaluated. METHODS A cohort study was conducted by selecting all patients who underwent LSG under PVB and GA at Makassed General Hospital between 2010 and 2016. Demographic, social, pre-op health status, body mass index (BMI), operative time, postoperative pain and pain medication consumption, postoperative complications and length of hospital stay, all were studied. Follow-up weight loss was collected up to 5 years postoperatively. Data entry, management, and descriptive and inferential statistics were performed using SPSS. RESULTS A total of 210 participants were included in this study of which 48 constituted the PVB group and 162 patients composed the GA group. Both groups were similar in baseline demographic factors, with patients in PVB suffering from higher number and advanced stage of comorbidities than the GA group. Mean operative time was similar in between the two groups with 80 ± 20 min for PVB and 82 ± 18 min for GA group. Intraoperative complications were scarce among both study groups. GA group requested a second dose of analgesia earlier than PVB group. After at least 1 year postoperatively, the mean percentage of excess weight loss was 81.35 ± 15.5% and 77.89 ± 14.3% for the PVB and GA groups, respectively, P value 0.45. CONCLUSION Outcomes of LSG under both types of anesthesia (PVB alone and GA alone) were found to be comparable. However, the need for analgesia was significantly less in the PVB group compared to GA group.
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14
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Kankaya B, Buyukasik S, Alis H. Review of Metabolic Efficiency of Sleeve Gastrectomy. Bariatr Surg Pract Patient Care 2020. [DOI: 10.1089/bari.2020.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Burak Kankaya
- Departmant of General Surgery, İstanbul Aydin University Faculty of Medicine, İstanbul, Turkey
| | - Suleyman Buyukasik
- Departmant of General Surgery, İstanbul Aydin University Faculty of Medicine, İstanbul, Turkey
| | - Halil Alis
- Departmant of General Surgery, İstanbul Aydin University Faculty of Medicine, İstanbul, Turkey
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15
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Emile SH, Elshobaky A, Elbanna HG, Elkashef W, Abdel-Razik MA. Helicobacter pylori, Sleeve Gastrectomy, and Gastroesophageal Reflux Disease; Is there a Relation? Obes Surg 2020; 30:3037-3045. [PMID: 32358686 DOI: 10.1007/s11695-020-04648-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Sleeve gastrectomy (SG) is an effective bariatric procedure, yet can be associated with complications as gastroesophageal reflux disease (GERD). The present study aimed to investigate the prevalence of Helicobacter pylori (H. pylori) in SG specimens, its relation with GERD, and its impact on postoperative outcomes. METHODS All SG specimens received in the pathology laboratory were reviewed. The prevalence of H. pylori in SG specimens was recorded. Patients with H. pylori infection who received triple therapy were compared with patients without H pylori in terms of baseline characteristics, preoperative GERD and its outcome postoperatively, development of new-onset GERD, staple line complications, and weight loss. RESULTS The records of 176 patients were reviewed; 69 (39.2%) were positively tested on H. pylori infection. Patients with H. pylori had higher body mass index (BMI) (RR = 1.51), greater incidence of preoperative GERD (RR = 1.67), and complained more of dyspepsia (RR = 1.87). Eradication of H. pylori was achieved in 67 (97.1%) of 69 patients. Postoperative improvement in GERD symptoms (44.4% Vs 19%, p = 0.036) and dyspepsia (85.7% Vs 51.7%, p = 0.007) was higher in patients with H. pylori with confirmed eradication of infection than patients without H. pylori. Both groups had similar operation time, postoperative BMI, excess weight loss, staple line complications, and new-onset GERD. CONCLUSIONS More than one-third of patients with morbid obesity had H. pylori infection. Morbidly obese patients with H. pylori infection may be more prone to develop GERD symptoms; yet after eradication of the infection, they may also experience better improvement in symptoms after SG.
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Affiliation(s)
- Sameh H Emile
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt.
| | - Ayman Elshobaky
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - Hosam G Elbanna
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - Wagdi Elkashef
- Pathology Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - Mohamed A Abdel-Razik
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
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16
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The role of preoperative upper endoscopy in adolescents undergoing laparoscopic vertical sleeve gastrectomy. Surg Obes Relat Dis 2020; 16:1212-1217. [PMID: 32576512 DOI: 10.1016/j.soard.2020.04.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/17/2020] [Accepted: 04/21/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Vertical sleeve gastrectomy (VSG) has been associated with gastroesophageal reflux symptoms and, in adults, with a development of Barrett's esophagus. Adults with Barrett's esophagus identified at baseline before bariatric operation are generally advised against VSG operations. The role of preoperative esophagogastroduodenoscopy (EGD) in adolescents preparing for bariatric surgery is not clearly defined. OBJECTIVE The goal of this study was to report the frequency of abnormalities identified on EGD performed at baseline in adolescents undergoing VSG for severe obesity. SETTING Free-standing academic children's hospital. United States. METHODS A retrospective chart review was conducted to describe findings of EGD performed just before VSG in a cohort of 40 adolescents and young adults (age range 14-25 yr) immediately before VSG. Review of findings from gross and histopathological evaluation of the esophagus, resected stomach, and duodenum was performed. RESULTS Five individuals reported preoperative symptoms of gastroesophageal reflux. Anatomic findings at EGD were normal in 98% of individuals. Histopathology of the esophagus, stomach, and duodenum was normal in 88%, 70%, and 95%, respectively. Abnormal findings of gastritis (18%), esophagitis (13%), and/or Helicobacter pylori (10%) infection were most common. Those with evidence of H. pylori in gastric resection specimens were treated appropriately with eradication therapy postoperatively. With the exception of 2 patients with incidentally detected esophageal mucosal eosinophilia, EGD findings did not lead to additional changes in medical or surgical management. There were no complications of the EGD procedure. CONCLUSIONS Routine EGD at the time of VSG was safe but resulted in low yield of abnormal findings requiring a change in clinical management.
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Stefura T, Kacprzyk A, Droś J, Chłopaś K, Wysocki M, Rzepa A, Pisarska M, Małczak P, Pędziwiatr M, Nowakowski M, Budzyński A, Major P. The hundred most frequently cited studies on sleeve gastrectomy. Wideochir Inne Tech Maloinwazyjne 2020; 15:249-267. [PMID: 32489485 PMCID: PMC7233154 DOI: 10.5114/wiitm.2019.89392] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/21/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Sleeve gastrectomy (SG) is one of the most popular bariatric operations and one of the most frequently studied areas in bariatric surgery. AIM To summarise the characteristics of the most frequently cited studies focusing on SG. MATERIAL AND METHODS We used the Web of Science database to identify all studies focused on SG published from 2000 to 2018. The term "sleeve gastrectomy" and synonyms were used to reveal the 100 most cited records. RESULTS The most frequently cited publication had 493 citations. The highest mean number of citations per year was 73.00. Studies were most frequently published in the years 2010 and 2012. Articles were most commonly published in bariatric surgery-oriented journals. CONCLUSIONS Our study indicates an increase in medical researchers' interest in the subject of SG and underlines the need to perform studies with a higher level of evidence to further analyse the outcomes and basic science behind SG.
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Affiliation(s)
- Tomasz Stefura
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Artur Kacprzyk
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Droś
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Chłopaś
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Wysocki
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Anna Rzepa
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Pisarska
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Piotr Małczak
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Michał Pędziwiatr
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Michał Nowakowski
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Budzyński
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Piotr Major
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
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Abstract
PURPOSE Sleeve gastrectomy (SG) is an effective bariatric procedure, yet can be associated with complications as gastroesophageal reflux disease (GERD). The present study aimed to investigate the prevalence of Helicobacter pylori (H. pylori) in SG specimens, its relation with GERD, and its impact on postoperative outcomes. METHODS All SG specimens received in the pathology laboratory were reviewed. The prevalence of H. pylori in SG specimens was recorded. Patients with H. pylori infection who received triple therapy were compared with patients without H pylori in terms of baseline characteristics, preoperative GERD and its outcome postoperatively, development of new-onset GERD, staple line complications, and weight loss. RESULTS The records of 176 patients were reviewed; 69 (39.2%) were positively tested on H. pylori infection. Patients with H. pylori had higher body mass index (BMI) (RR = 1.51), greater incidence of preoperative GERD (RR = 1.67), and complained more of dyspepsia (RR = 1.87). Eradication of H. pylori was achieved in 67 (97.1%) of 69 patients. Postoperative improvement in GERD symptoms (44.4% Vs 19%, p = 0.036) and dyspepsia (85.7% Vs 51.7%, p = 0.007) was higher in patients with H. pylori with confirmed eradication of infection than patients without H. pylori. Both groups had similar operation time, postoperative BMI, excess weight loss, staple line complications, and new-onset GERD. CONCLUSIONS More than one-third of patients with morbid obesity had H. pylori infection. Morbidly obese patients with H. pylori infection may be more prone to develop GERD symptoms; yet after eradication of the infection, they may also experience better improvement in symptoms after SG.
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19
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Khalifa IG, Tobar WL, Hegazy TO, Balamoun HA, Mikhail S, Salman MA, Elsayed EA. Food Tolerance After Laparoscopic Sleeve Gastrectomy with Total Antral Resection. Obes Surg 2020; 29:2263-2269. [PMID: 30895506 DOI: 10.1007/s11695-019-03840-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Among the controversial points in laparoscopic sleeve gastrectomy (LSG) is how much of the antrum to be resected. This study aimed to evaluate food tolerance after preservation or resection of the antrum during LSG. METHODS Prospective randomized study included 50 patients scheduled for LSG. Participants were randomly allocated into one of two groups. In antral resection (AR-LSG) group (n = 25), resection started 2 cm from the pylorus. In antral sparing (AS-LSG) group (n = 25), it started 6 cm from the pylorus. Percentage of excess weight loss (%EWL) and percentage of excess BMI loss (%EBL) were evaluated after 3 and 6 months. Quality of life (QOL) was evaluated by using the Bariatric Analysis and Reporting Outcome System (BAROS). Food tolerance was assessed using the Quality of Alimentation questionnaire. Primary outcome measure was food tolerance and %EWL. RESULTS Food tolerance was significantly better in the antral sparing group compared to the antral resection group after 3 and 6 months. The two groups were comparable in %EWL and BMI change after 3 and 6 months. Six months after surgery, the majority of patients had a very good quality of life, with no significant difference between the two groups (p = 0.877). There was no significant difference between the two groups in operative time, intraoperative blood loss, and hospital stay. CONCLUSIONS Preservation of the pyloric antrum during LSG is associated with significantly better food tolerance and comparable effect of weight loss up to 6 months postoperatively when compared with total antral resection.
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Affiliation(s)
- Ibrahim G Khalifa
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | - Wael L Tobar
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | - Tarek O Hegazy
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | - Hany A Balamoun
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt.
| | - Sameh Mikhail
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | | | - Elsayed A Elsayed
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
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Karampinis I, Lion E, Grilli M, Hetjens S, Weiss C, Vassilev G, Seyfried S, Otto M. Trocar Site Hernias in Bariatric Surgery-an Underestimated Issue: a Qualitative Systematic Review and Meta-Analysis. Obes Surg 2020; 29:1049-1057. [PMID: 30659465 DOI: 10.1007/s11695-018-03687-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The reported incidence of trocar site hernias in bariatric surgery ranges between 0.5 and 3%. The best available evidence derives from retrospective studies analysing prospective databases, thus including only patients who presented with symptoms or received surgical treatment due to trocar site hernias after a laparoscopic bariatric procedure. A systematic literature research was conducted up until September 2017. Search strategies included proper combinations of the MeSH terms 'laparoscopy' and 'bariatric surgery', 'trocar/port' and 'hernia'. Searches were not limited by publication type or language. The review was registered in PROSPERO (ID 85102) and performed according to the PRISMA guidelines. Sixty-eight publications were included. Pooled hernia incidence was 3.22 (range 0-39.3%). Thirteen trials reported systematic closure of the fascia; 12 trials reported no closure. Data availability did not allow for pooling to calculate relative risk. Higher BMI and specific hernia examination using imaging modalities were associated with a significantly higher incidence of trocar site hernias. Studies dedicated to detection of TsH reported a pooled incidence of 24.5%. Trocar site hernias are an underestimated complication of minimally invasive multiportal bariatric surgery. While high-quality trials are not available allowing for a precise calculation of the incidence, existing data are indicative of very high incidence rates. Risk factors for developing a trocar site hernia in bariatric surgery have not yet been systematically analysed. Prospective studies in this field are necessary.
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Affiliation(s)
| | - Eliette Lion
- Department of Surgery, Heidelberg University, Mannheim, Germany
| | - Maurizio Grilli
- Department of Library and Information Sciences, Heidelberg University, Mannheim, Germany
| | - Svetlana Hetjens
- Institute of Medical Statistic and Biomathematics, Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christel Weiss
- Institute of Medical Statistic and Biomathematics, Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Georgi Vassilev
- Department of Surgery, Heidelberg University, Mannheim, Germany
| | | | - Mirko Otto
- Department of Surgery, Heidelberg University, Mannheim, Germany.
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Gemici E, Kones O, Seyit H, Surek A, Cikot M, Bozkurt MA, Alis H. Outcomes of laparoscopic sleeve gastrectomy by means of esophageal manometry and pH-metry, before and after surgery. Wideochir Inne Tech Maloinwazyjne 2020; 15:129-135. [PMID: 32117496 PMCID: PMC7020704 DOI: 10.5114/wiitm.2019.83198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/03/2019] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Gastroesophageal reflux is a major problem after sleeve gastrectomy. There is still insufficient understanding of how it occurs and whether it is due to the sphincter length, relaxation, or pressure differences. AIM This study evaluates the effect on the lower esophageal sphincter of the laparoscopic sleeve gastrectomy (LSG) technique applied in surgery in cases of morbid obesity using ambulatory 24-h pH monitoring (APM) and esophageal manometry (EM). MATERIAL AND METHODS A retrospective examination was carried out on the APM and EM tests performed preoperatively and postoperatively in cases of LSG. The parameters examined were the body mass index (BMI), amplitude pressure of the esophagus (AP), total length of the lower esophageal segment (LESL), resting pressure of the LES (LESP), residual pressure of the LES (LESR), relaxation time of the LES, intragastric pressure, and the DeMeester score. RESULTS A total of 62 cases with available data were evaluated. A statistically significant difference was determined between the preoperative values and the 3-month postoperative values of BMI, LESP, and relaxation time of the LES. A statistically significant increase was determined in the DeMeester score, and the increase in the total number of reflux episodes longer than 5 min was found to be the most responsible for this increase. No significant difference was determined in the other parameters. CONCLUSIONS The LSG was found to cause a reduction in LESP, and an increase in acid reflux causing an extended relaxation time of the LES. This was confirmed by the increase seen in the DeMeester score.
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Affiliation(s)
- Eyup Gemici
- Department of General Surgery, Faculty of Medicine, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Health Practice & Research Center, Istanbul, Turkey
| | - Osman Kones
- Department of General Surgery, Faculty of Medicine, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Health Practice & Research Center, Istanbul, Turkey
| | - Hakan Seyit
- Department of General Surgery, Faculty of Medicine, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Health Practice & Research Center, Istanbul, Turkey
| | - Ahmet Surek
- Department of General Surgery, Faculty of Medicine, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Health Practice & Research Center, Istanbul, Turkey
| | - Murat Cikot
- Department of General Surgery, Faculty of Medicine, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Health Practice & Research Center, Istanbul, Turkey
| | - Mehmet Abdussamet Bozkurt
- Department of General Surgery, Faculty of Medicine, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Health Practice & Research Center, Istanbul, Turkey
| | - Halil Alis
- Department of General Surgery, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
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22
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Bhandari M, Humes T, Kosta S, Bhandari M, Mathur W, Salvi P, Fobi M. Revision operation to one-anastomosis gastric bypass for failed sleeve gastrectomy. Surg Obes Relat Dis 2019; 15:2033-2037. [PMID: 31711949 DOI: 10.1016/j.soard.2019.09.064] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/09/2019] [Accepted: 09/11/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are few publications on revising sleeve gastrectomy (SG) to one-anastomosis gastric bypass (OAGB). OBJECTIVE This study was undertaken to determine outcomes in terms of weight loss and resolution of co-morbidities in patients who had SG revised to OAGB. SETTINGS A high-volume university-affiliated bariatric surgery center in India. METHOD Information was collected from patients identified in a prospectively maintained database of patients who had a revision from SG to OAGB. An analysis of outcomes in terms of weight loss and maintenance with up to 3-years follow-up is reported. RESULTS Thirty-two patients were revised from SG to OAGB. Of the 32 revised patients, 9 (28%) had type 2 diabetes, 15 (47%) had hypertension, and 2 (6%) had sleep apnea at the time of the initial SG. At the time of revision only 2 of 32 (6.25%) had type 2 diabetes, 3 (9.4%) had hypertension, and none had sleep apnea. The average initial weight in this study before SG was 118 kg and body mass index was 44.04 kg/m2. The average weight at the nadir and at revision was 92.1 and 103.5 kg, respectively. Average weight was 93.5, 94.3, and 100.6 kg (P < .002) at 1-, 2-, and 3-year follow-up, respectively. There was reoccurrence of type 2 diabetes in 1 patient at 3 years after revision due to weight regain. There were no complications in this study. CONCLUSION In this study, revision of SG to OAGB because of inadequate weight loss or significant weight regain was safe and effective at 2-year follow-up; however, there was a tendency toward weight regain at 3 years. Multicenter studies with larger series of patients and longer-term follow-up after SG revision to OAGB are needed.
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Affiliation(s)
- Mohit Bhandari
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Madhya Pradesh, India.
| | - Terrel Humes
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Madhya Pradesh, India
| | - Susmit Kosta
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Madhya Pradesh, India
| | - Mahak Bhandari
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Madhya Pradesh, India
| | - Winni Mathur
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Madhya Pradesh, India
| | - Prashant Salvi
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Madhya Pradesh, India
| | - Mathias Fobi
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Madhya Pradesh, India
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Mirhashemi S, Malekpour Alamdari N, Jaberi N, Shahrbaf MA. Prevalence of Anastomotic Leaks and Diagnostic Methods in Sleeve Gastrectomy. Bariatr Surg Pract Patient Care 2019. [DOI: 10.1089/bari.2018.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Seyedhadi Mirhashemi
- Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasser Malekpour Alamdari
- Department of General Surgery, Modarres, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Najmeh Jaberi
- Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Carandina S, Zulian V, Nedelcu A, Sista F, Danan M, Nedelcu M. Laparoscopic sleeve gastrectomy follow-up: use of connected devices in the postoperative period. Surg Obes Relat Dis 2019; 15:1058-1065. [PMID: 31153891 DOI: 10.1016/j.soard.2019.03.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/17/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND During the last decade, laparoscopic sleeve gastrectomy (LSG) has become the most performed bariatric procedure worldwide. OBJECTIVES To evaluate the feasibility of the use of connected devices in monitoring patients operated on by LSG and discharged 24 hours after surgery under the enhanced recovery after surgery protocol. SETTING Private hospital, France. METHODS This is a prospective pilot study designed to assess the risk and benefit of using connected devices in the postoperative follow-up of patients operated on by LSG. Patients operated on with LSG were discharged 24 hours after surgery, and vital signs such as blood pressure, heart rate, peripheral capillary oxygen saturation, and temperature were monitored via connected devices with data sent to an internet platform to make them immediately viewable by the surgeon. RESULTS The study population consisted of 82 women and 18 men. The mean body mass index was 43.4 kg/m2, and the mean age was 39.6 years. Two patients were reoperated on for bleeding and, consequently, were excluded from the study. At postoperative day 8, 1 patient presented with tachycardia, fever, and mild abdominal discomfort. After the alert was received from the internet platform, the patient was immediately contacted, admitted to the ward, and promptly reoperated on. At 1 year after the surgery, the mean percentage of excess weight loss and total weight loss were 68.1 ± 18.1% and 36 ± 9.8 kg, respectively. For the patients not available for follow-up at the 1-year control, weight loss data were extrapolated from the internet platform. Globally, 92% of patients felt safe when they returned home, and 92% of patients would recommend this way of managing the postoperative period. CONCLUSIONS In conclusion, this study shows that the early postoperative follow-up to an intervention such as LSG can be done at the patient's home under the monitoring of connected devices without a risk of increase in the rate of complications and rehospitalization. The role of the connected devices in the long-term postoperative follow-up seems promising.
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Affiliation(s)
- Sergio Carandina
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obesité (CCO), 83100 Toulon, France.
| | - Viola Zulian
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obesité (CCO), 83100 Toulon, France
| | - Anamaria Nedelcu
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obesité (CCO), 83100 Toulon, France
| | - Federico Sista
- Dipartimento di Scienze Cliniche Applicate e Biotecnologie -Ospedale civile San Salvatore, University of L'Aquila, L'Aquila, Italy
| | - Marc Danan
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obesité (CCO), 83100 Toulon, France
| | - Marius Nedelcu
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obesité (CCO), 83100 Toulon, France
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Bhandari M, Reddy M, Kosta S, Mathur W, Fobi M. Laparoscopic sleeve gastrectomy versus laparoscopic gastric bypass: A retrospective cohort study. Int J Surg 2019; 67:47-53. [PMID: 31121327 DOI: 10.1016/j.ijsu.2019.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND There are many reports on short-term outcomes following sleeve gastrectomy, which demonstrate that it has comparable efficacy to gastric bypass. However, there are very few long-term comparative reports. This study compared the outcomes from laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LGB) in a cohort of patients who had surgery in 2011 with a six-year follow up. MATERIALS AND METHODS Data on patients who had either LSG or LGB at a single centre in Mohak Bariatric and Robotic Surgery Centre, Indore, M.P. India in 2011 were identified from a database of routinely collected data. This retrospective cohort was analysed for weight loss, resolution of comorbidities and nutritional status over six years. Patients who had revision operations or for whom six-year follow-up data were not available were excluded from the analysis. RESULTS 154 patients had LGB and 152 had LSG. The six-year follow up rate was 61.7% (n = 95) and 64.5% (n = 98) respectively for LGB and LSG. Percentage of excess bodyweight loss (%EWL) peaked at approximately 70% after two years in the LSG group and after three years in the LGB group. However, after six years %EWL was 61% for LGB and 50% for LSG (p = 0.001). Resolution of type-2 diabetes was more common in the LGB group compared to the LSG group (79% vs 62%, p = 0.126). Resolution of hypertension and dyslipidaemia was similar in both groups at approximately half of patients in each group for each condition. Nutrient deficiencies were found in both groups but were generally more pronounced in the LGB group. CONCLUSION LGB is a better operation for weight loss, weight loss maintenance, and resolution of type-2 diabetes than LSG. This is at the expense of an increased incidence of nutrient deficiencies. LSG appears to have greater treatment failure by six years follow up and this should be further investigated.
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Affiliation(s)
- Mohit Bhandari
- Mohak Bariatric and Robotic Surgery Center, Mohak Hi-tech Specialty Hospital, Indore, M.P., India.
| | - Manoj Reddy
- Mohak Bariatric and Robotic Surgery Center, Mohak Hi-tech Specialty Hospital, Indore, M.P., India.
| | - Susmit Kosta
- Mohak Bariatric and Robotic Surgery Center, Mohak Hi-tech Specialty Hospital, Indore, M.P., India.
| | - Winni Mathur
- Mohak Bariatric and Robotic Surgery Center, Mohak Hi-tech Specialty Hospital, Indore, M.P., India.
| | - Mathias Fobi
- Mohak Bariatric and Robotic Surgery Center, Mohak Hi-tech Specialty Hospital, Indore, M.P., India.
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26
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Hughes D, Hughes I, Khanna A. Management of Staple Line Leaks Following Sleeve Gastrectomy—a Systematic Review. Obes Surg 2019; 29:2759-2772. [PMID: 31062278 DOI: 10.1007/s11695-019-03896-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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27
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Hegazy T, Salman M, Kandeel A, Maher A, Abugabal M. Assessment of Gastric Emptying in Sleeve Gastrectomy in Comparison to Hybrid (Adding a Gastrojejunostomy to the Sleeved Stomach): A Randomized Study. Bariatr Surg Pract Patient Care 2019. [DOI: 10.1089/bari.2018.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tarek Hegazy
- General Surgery, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Mohammed Salman
- General Surgery, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Ahmed Kandeel
- Nuclear Medicine, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Ahmed Maher
- General Surgery, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Mahasen Abugabal
- Nuclear Medicine, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
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28
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Smith CR, Gardner JT, Vaughn LH, Kelly RJ, Whipple OC. Nissen Fundoplication–Preserving Laparoscopic Sleeve Gastrectomy. Am Surg 2019. [DOI: 10.1177/000313481908500224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Gastroesophageal reflux disease (GERD) is significantly more prevalent in obese patients. Nissen fundoplication alleviates symptoms in those refractory to dietary changes and optimal medical management. The need for concomitant treatment of GERD and obesity is becoming more prevalent. The objective of this study was to determine whether Nissen-preserving laparoscopic sleeve gastrectomy (SG) is a safe and effective weight loss option for patients with pre-existing Nissen fundoplication. The study was conducted at the Hospital Corporation of America, Memorial Health, Savannah, Georgia, academic institution. We retrospectively reviewed five patients who underwent laparoscopic Nissen-preserving SG between 2011 and 2017. We compared pre- and postoperative subjective GERD symptoms, occurrence of any immediate postoperative complications, change in BMI, and excess weight loss. Of the five patients, four were female and one was male. The mean age was 50.6 years. The mean preoperative BMI was 44.8 ± 5.4, one-month postoperative BMI was 41.2 ± 6.1 (P < 0.001), and six-month postoperative BMI was 37.5 ± 8.1 (P < 0.009), with mean excess weight loss at six months of 33.9 ± 23 per cent. There were no immediate postoperative complications. Subjective GERD symptoms were unchanged in two patients and improved in the other three. We demonstrate the early feasibility of Nissen-preserving SG for surgical weight loss in patients with existing Nissen fundoplication. Although our results are early, we feel encouraged by mean excess weight loss to date and control of GERD symptoms.
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Affiliation(s)
- Craig R. Smith
- From the Bariatric Center of Excellence, Division of General Surgery, Memorial Health, Hospital Corporation of America, Savannah, Georgia
| | - Jeffrey T. Gardner
- From the Bariatric Center of Excellence, Division of General Surgery, Memorial Health, Hospital Corporation of America, Savannah, Georgia
| | - Lexie H. Vaughn
- From the Bariatric Center of Excellence, Division of General Surgery, Memorial Health, Hospital Corporation of America, Savannah, Georgia
| | - Robert J. Kelly
- From the Bariatric Center of Excellence, Division of General Surgery, Memorial Health, Hospital Corporation of America, Savannah, Georgia
| | - Oliver C. Whipple
- From the Bariatric Center of Excellence, Division of General Surgery, Memorial Health, Hospital Corporation of America, Savannah, Georgia
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29
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Elbanna H, Emile S, El-Hawary GES, Abdelsalam N, Zaytoun HA, Elkaffas H, Ghanem A. Assessment of the Correlation Between Preoperative and Immediate Postoperative Gastric Volume and Weight Loss After Sleeve Gastrectomy Using Computed Tomography Volumetry. World J Surg 2019; 43:199-206. [PMID: 30094637 DOI: 10.1007/s00268-018-4749-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has achieved excellent results in treatment of morbid obesity. The present study aimed to evaluate the impact of the preoperative gastric volume, volume of the remaining gastric pouch, and volume of the resected stomach on weight loss after LSG. METHODS Patients with morbid obesity who underwent LSG were investigated by CT volumetry before and 1 week after LSG to measure the volume of the stomach before and after the procedure, and the volume of the resected stomach was also calculated. The percentage of excess weight loss (EWL) and decrease in body mass index (BMI) at 6 months postoperatively were measured and correlated with preoperative and postoperative gastric volumes. RESULTS Forty-seven patients (44 females) were included to the study. A significant decrease in the gastric volume and BMI after LSG was noted. Preoperative gastric volume was positively correlated with preoperative BMI (r = 0.723, p < 0.00001) but not correlated with %EWL at 6 months. The volume of the remaining gastric pouch was positively correlated with BMI at 6 months postoperatively (r = 0.597, p < 0.00001) and negatively correlated with %EWL (r = -0.7495, p < 0.00001). The correlation between the size of resected stomach and %EWL was statistically insignificant, yet the mean percentage of the resected stomach was directly correlated to %EWL. CONCLUSION The preoperative volume of the stomach was positively correlated with baseline BMI, but not correlated with %EWL. The size of the remaining gastric pouch and the percentage of the resected stomach had significant impact on %EWL after LSG.
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Affiliation(s)
- Hosam Elbanna
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Faculty of Medicine, Mansoura University, Mansoura City, Egypt
| | - Sameh Emile
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Faculty of Medicine, Mansoura University, Mansoura City, Egypt.
| | - Galal El-Sayed El-Hawary
- Radiology Department, Tanta University Hospitals, Faculty of Medicine, Tanta University, Tanta City, Egypt
| | - Noha Abdelsalam
- Rheumatology and Immunology Unit, Internal Medicine Department, Mansoura University Hospitals, Faculty of Medicine, Mansoura University, Mansoura City, Egypt
| | - Hossam Abdelhafiz Zaytoun
- Radiology Department, Tanta University Hospitals, Faculty of Medicine, Tanta University, Tanta City, Egypt
| | - Haitham Elkaffas
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Faculty of Medicine, Mansoura University, Mansoura City, Egypt
| | - Ahmed Ghanem
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Faculty of Medicine, Mansoura University, Mansoura City, Egypt
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30
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Examination of the Effectiveness of a Brief, Adapted Dialectical Behavior Therapy-Skills Training Group for Bariatric Surgical Candidates. Obes Surg 2018; 29:252-261. [DOI: 10.1007/s11695-018-3515-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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31
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Rebibo L, Msika S. Les nouvelles indications de chirurgie laparoscopique ambulatoire – la sleeve gastrectomie. LE PRATICIEN EN ANESTHÉSIE RÉANIMATION 2018; 22:218-224. [DOI: 10.1016/j.pratan.2018.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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32
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Prevalence of All-Cause Mortality and Suicide among Bariatric Surgery Cohorts: A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071519. [PMID: 30021983 PMCID: PMC6069254 DOI: 10.3390/ijerph15071519] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 07/13/2018] [Accepted: 07/13/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Prior meta-analysis has reported mortality rates among post-operative bariatric patients, but they have not considered psychiatric factors like suicide contributing to mortality. OBJECTIVES The current meta-analysis aims to determine the pooled prevalence for mortality and suicide amongst cohorts using reported suicides post bariatric surgery. It is also the aim of the current meta-analytical study to determine moderators that could account for the heterogeneity found. RESULTS In our study, the pooled prevalence of mortality in the studies which reported suicidal mortality was 1.8% and the prevalence of suicide was 0.3%. Mean body mass index (BMI) and the duration of follow-up appear to be significant moderators. CONCLUSIONS Given the prevalence of suicide post bariatric surgery, it is highly important for bariatric teams to consider both the medical and psychiatric well-being of individuals pre- and post-operatively.
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33
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Abd Ellatif ME, Abbas A, El Nakeeb A, Magdy A, Salama AF, Bashah MM, Dawoud I, Gamal MA, Sargsyan D. Management Options for Twisted Gastric Tube after Laparoscopic Sleeve Gastrectomy. Obes Surg 2018; 27:2404-2409. [PMID: 28361494 DOI: 10.1007/s11695-017-2649-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE This study aims to determine the incidence, etiology, and management options for symptomatic gastric obstruction caused by axially twisted sleeve gastrectomy. METHODS In this retrospective study, we reviewed medical charts of all morbidly obese patients who underwent laparoscopic sleeve gastrectomy. Patients who developed gastric obstruction symptoms and were diagnosed with twisted sleeve gastrectomy were identified and included in this study. RESULTS From October 2005 to December 2015, there are 3634 morbidly obese patients who underwent laparoscopic sleeve gastrectomy (LSG). Eighty-six (2.3%) patients developed symptoms of gastric obstruction. Forty-five (1.23%) patients were included in this study. The mean time of presentation was 59.8 days after surgery. Upper GI contrast study was done routinely, and it was positive for axial twist in 37 (82%) patients. Abdominal CT with oral and IV contrast was done in eight (18%) when swallow study was equivocal. Endoscopic treatment was successful in 43 patients (95.5%). Sixteen patients were successfully managed by endoscopic stenting, and 29 patients had balloon dilation. The average numbers of dilation sessions were 1.7. Out of these 29 patients, 18 responded well to a single session of dilatation and did not require any further dilatation sessions. Two patients who failed to respond to three subsequent sessions of balloon dilation underwent laparoscopic adhesiolysis and gastropexy. CONCLUSIONS Endoscopic stenting is an effective tool in management of axial rotation of sleeved stomach. Balloon dilation can also be effective in selected cases. Few cases might require laparoscopic adhesiolysis and gastropexy.
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Affiliation(s)
- Mohamed E Abd Ellatif
- Department of Surgery, Mansoura University Hospital, Gihan El Sadat St, Mansoura, Dakahlia, 35511, Egypt. .,Department of Surgery, Hafar Albatin Central Hospital, Hafar Al-Batin, Saudi Arabia.
| | - Ashraf Abbas
- Department of Surgery, Mansoura University Hospital, Gihan El Sadat St, Mansoura, Dakahlia, 35511, Egypt
| | - Ayman El Nakeeb
- Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, 35511, Egypt
| | - Alaa Magdy
- Department of Surgery, Hafar Albatin Central Hospital, Hafar Al-Batin, Saudi Arabia
| | - Asaad F Salama
- Department of Surgery, Theodore Bilharz Research Institute, Cairo, Egypt.,Bariatric and Metabolic Surgery Center, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Moataz M Bashah
- Bariatric and Metabolic Surgery Center, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ibrahim Dawoud
- Department of Surgery, Mansoura University Hospital, Gihan El Sadat St, Mansoura, Dakahlia, 35511, Egypt
| | - Maged Ali Gamal
- Department of Surgery, Jahra Hospital, 01753, Al-Jahra, Kuwait
| | - Davit Sargsyan
- Bariatric and Metabolic Surgery Center, Hamad Medical Corporation (HMC), Doha, Qatar
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Abstract
Sleeve gastrectomy (SG) is a commonly performed bariatric procedure. Weight regain following SG is a significant issue. Yet the defining, reporting and understanding of this phenomenon remains largely neglected. Systematic review was performed to locate articles reporting the definition, rate and/or cause of weight regain in patients at least 2 years post-SG. A range of definitions employed to describe weight regain were identified in the literature. Rates of regain ranged from 5.7 % at 2 years to 75.6 % at 6 years. Proposed causes of weight regain included initial sleeve size, sleeve dilation, increased ghrelin levels, inadequate follow-up support and maladaptive lifestyle behaviours. Bariatric literature would benefit from standardising definitions used to report weight regain and its rate in clinical series. Larger prospective studies are required to further understand mechanisms of weight regain following SG.
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35
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Lauti M, Kularatna M, Hill AG, MacCormick AD. Weight Regain Following Sleeve Gastrectomy-a Systematic Review. Obes Surg 2018; 26:2724-2731. [PMID: 27048439 DOI: 10.1007/s11695-016-2178-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sleeve gastrectomy (SG) is a commonly performed bariatric procedure. Weight regain following SG is a significant issue. Yet the defining, reporting and understanding of this phenomenon remains largely neglected. Systematic review was performed to locate articles reporting the definition, rate and/or cause of weight regain in patients at least 2 years post-SG. A range of definitions employed to describe weight regain were identified in the literature. Rates of regain ranged from 5.7 % at 2 years to 75.6 % at 6 years. Proposed causes of weight regain included initial sleeve size, sleeve dilation, increased ghrelin levels, inadequate follow-up support and maladaptive lifestyle behaviours. Bariatric literature would benefit from standardising definitions used to report weight regain and its rate in clinical series. Larger prospective studies are required to further understand mechanisms of weight regain following SG.
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Affiliation(s)
- Melanie Lauti
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Auckland, New Zealand.
| | - Malsha Kularatna
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Auckland, New Zealand
| | - Andrew G Hill
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Auckland, New Zealand
| | - Andrew D MacCormick
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Auckland, New Zealand
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Mandeville Y, Van Looveren R, Vancoillie PJ, Verbeke X, Vandendriessche K, Vuylsteke P, Pattyn P, Smet B. Moderating the Enthusiasm of Sleeve Gastrectomy: Up to Fifty Percent of Reflux Symptoms After Ten Years in a Consecutive Series of One Hundred Laparoscopic Sleeve Gastrectomies. Obes Surg 2018; 27:1797-1803. [PMID: 28190216 DOI: 10.1007/s11695-017-2567-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has become a popular one-stage bariatric procedure with a proven efficacy on weight loss. However, the relationship between LSG and gastroesophageal reflux disease (GERD) remains a subject of debate. The objective is to determine the long-term effect of LSG on weight loss and reflux disease. METHODS A retrospective analysis of 100 consecutive patients who underwent an LSG between January 2005 and March 2009 was performed. The effect of LSG on weight evolution and the relationship between preoperative and postoperative GERD symptoms and PPI dependency was analyzed. RESULTS A mean follow-up of 8.48 years (range 6.1-10.3) was achieved. We observed a long-term % excess weight loss (%EWL) of 60%. A significant increase in reflux symptoms and use of PPIs was seen. Seventeen percent suffered from reflux disease preoperatively versus 50% at the end of the postoperative follow-up (RR = 2.5882, 95% CI [1.6161-4.1452], p value = 0.0001). The chance of developing de novo reflux after LSG was 47.8% (32/67). Reflux disease was present in 7 of the 26 patients who underwent a secondary Roux-en-Y gastric bypass (RYGB). In four of these seven patients, reflux disease disappeared completely after the secondary RYGB (57.1%). CONCLUSIONS A satisfactory long-term effect on weight loss was achieved. However, a significant increase in GERD and PPI dependency after LSG was noted. New onset GERD was seen in more than 40% of the study population. Conversion to RYGB is a good option in patients with refractory reflux disease after LSG.
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Affiliation(s)
| | | | | | | | | | | | - Paul Pattyn
- AZ Delta Ziekenhuis, Wilgenstraat 2, Roeselare, Belgium
| | - Bart Smet
- AZ Delta Ziekenhuis, Wilgenstraat 2, Roeselare, Belgium
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37
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Predicted Coronary Heart Disease Risk Decreases in Obese Patients After Laparoscopic Sleeve Gastrectomy. World J Surg 2017; 42:2173-2182. [DOI: 10.1007/s00268-017-4416-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Does hiatal repair affect gastroesophageal reflux symptoms in patients undergoing laparoscopic sleeve gastrectomy? Surg Endosc 2017; 32:2373-2380. [PMID: 29234942 DOI: 10.1007/s00464-017-5935-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/13/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has gained popularity as a treatment of choice for morbid obesity and associated comorbidities. There has been a concern about new onset or worsening of gastroesophageal reflux (GERD) following LSG. OBJECTIVE The objective of the study was to evaluate the effect of surgically treating hiatal weakness on GERD symptoms in patients undergoing LSG. SETTING Single tertiary referral institution, Sydney, Australia. METHODS A prospective observational cohort study was conducted with consecutive patients undergoing LSG. Hiatal findings, patient demographics, medications and reflux score were recorded prospectively. Patients were followed up post-operatively for a minimum of 12 months and assessed using GERD-HRQL score to quantify reflux symptoms. RESULTS Data from 100 patients with a minimum of 1-year follow-up were analysed. Mean follow-up was 18.9 months. Overall, GERD-HRQL improved from mean 4.5 ± 5.8 pre-operatively to 0.76 ± 1.5 after 18.9 months (p = 0.0001). For those with pre-operative reflux, GERD-HRQL improved from mean (SD) 8.43 ± 6.26 pre-operatively to 0.94 ± 1.55 (p = 0.0001). All the nine patients with troublesome daily reflux significantly improved. For those without pre-operative reflux, GERD-HRQL improved from 0.88 ± 1.37 to 0.47 ± 1.25 (p-ns) post-operatively. On multivariate analysis, higher pre-operative reflux and dysphagia/bloat scores, younger age and lower percentage excess weight loss after 18.9 months were associated with GERD-HRQL improvement. CONCLUSION In the medium term, GERD-HRQL improves following sleeve gastrectomy with meticulous hiatal assessment and repair of hiatal laxity and herniation.
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3D Volumetry and its Correlation Between Postoperative Gastric Volume and Excess Weight Loss After Sleeve Gastrectomy. Obes Surg 2017; 28:775-780. [DOI: 10.1007/s11695-017-2927-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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40
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Khalifa IG, Hegazy TO, Refaat A, Mohsen A. The Effects of Adding Gastrojejunostomy to Sleeve Gastrectomy on GERD, Food Tolerance, and Weight Loss: A Randomized Study. Bariatr Surg Pract Patient Care 2017. [DOI: 10.1089/bari.2017.0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
| | - Tarek Osama Hegazy
- Department of General Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Ahmed Refaat
- Department of General Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Amr Mohsen
- Department of General Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
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41
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Long-term outcome of laparoscopic sleeve gastrectomy from a single center in mainland China. Asian J Surg 2017; 41:285-290. [PMID: 28689733 DOI: 10.1016/j.asjsur.2017.04.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/30/2017] [Accepted: 04/17/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/OBJECTIVE Laparoscopic sleeve gastrectomy (LSG) is at present the most popular bariatric procedure due to its significant weight loss, remission of co-morbidities, and acceptable morbidity. But, there are not many studies showing its long term efficacy and safety in Chinese patients. The aim of this study is to give five results of LSG in terms of weight loss, co-morbidity (Type 2 diabetes mellitus) resolution and possible complications from a single center in mainland China. MATERIAL AND METHODS This is a retrospective study of 218 obese patients who underwent LSG by a single surgeon from June 2011 to June 2016. Patients were subjected to standardized perioperative evaluation and education program. Patients were followed up after 1, 3, 6, 12, 18, and 24 months and yearly thereafter. Long term outcomes in terms of weight loss in kg, % of total weight loss (%TWL), % excess weight loss (%EWL), % resolution of type 2 diabetes mellitus (T2DM) and % complication rate are studied. RESULTS The %TWL was 33.8 ± 5.9, 28.8 ± 8.9, 26.6 ± 6.9, 18.0 ± 7.6, 15.0 ± 7.1 and %EWL was 62.8 ± 16.9 (n-96), 49.5 ± 18.5 (n-43), 39.8 ± 13.1 (n-15), 32.2 ± 2.1 (n-13), 19.5 ± 8.7 (n-2) at 1, 2, 3, 4 and 5 years, respectively. T2DM remission rate was 72.9% at one year. There were no major complications like leak, stricture, staple line bleeding, port site herniation and gastro-esophageal reflux disease (GERD). There was no mortality. Most common early complication was port site dehiscence (10%), managed conservatively; none requiring readmission. No reoperation was done for weight regain. CONCLUSION LSG is a safe and effective procedure with good five year results. Weight regain remains a concern two years post surgery. Standardization of LSG is important to reduce major complications.
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Rebecchi F, Allaix ME, Patti MG, Schlottmann F, Morino M. Gastroesophageal reflux disease and morbid obesity: To sleeve or not to sleeve? World J Gastroenterol 2017; 23:2269-2275. [PMID: 28428706 PMCID: PMC5385393 DOI: 10.3748/wjg.v23.i13.2269] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/15/2017] [Accepted: 03/15/2017] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic sleeve gastrectomy (LSG) has reached wide popularity during the last 15 years, due to the limited morbidity and mortality rates, and the very good weight loss results and effects on comorbid conditions. However, there are concerns regarding the effects of LSG on gastroesophageal reflux disease (GERD). The interpretation of the current evidence is challenged by the fact that the LSG technique is not standardized, and most studies investigate the presence of GERD by assessing symptoms and the use of acid reducing medications only. A few studies objectively investigated gastroesophageal function and the reflux profile by esophageal manometry and 24-h pH monitoring, reporting postoperative normalization of esophageal acid exposure in up to 85% of patients with preoperative GERD, and occurrence of de novo GERD in about 5% of cases. There is increasing evidence showing the key role of the surgical technique on the incidence of postoperative GERD. Main technical issues are a relative narrowing of the mid portion of the gastric sleeve, a redundant upper part of the sleeve (both depending on the angle under which the sleeve is stapled), and the presence of a hiatal hernia. Concomitant hiatal hernia repair is recommended. To date, either medical therapy with proton pump inhibitors or conversion of LSG to laparoscopic Roux-en-Y gastric bypass are the available options for the management of GERD after LSG. Recently, new minimally invasive approaches have been proposed in patients with GERD and hypotensive LES: the LINX® Reflux Management System procedure and the Stretta® procedure. Large studies are needed to assess the safety and long-term efficacy of these new approaches. In conclusion, the recent publication of pH monitoring data and the new insights in the association between sleeve morphology and GERD control have led to a wider acceptance of LSG as bariatric procedure also in obese patients with GERD, as recently stated in the 5th International Consensus Conference on sleeve gastrectomy.
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Kalinowski P, Paluszkiewicz R, Wróblewski T, Remiszewski P, Grodzicki M, Bartoszewicz Z, Krawczyk M. Ghrelin, leptin, and glycemic control after sleeve gastrectomy versus Roux-en-Y gastric bypass-results of a randomized clinical trial. Surg Obes Relat Dis 2017; 13:181-188. [PMID: 27692906 DOI: 10.1016/j.soard.2016.08.025] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/22/2016] [Accepted: 08/13/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) cause weight loss and metabolic improvement, but results of published studies are contradictory. OBJECTIVES The aim of this study was to compare the effects of SG and RYGB on ghrelin, leptin, and glucose homeostasis in a randomized controlled trial. SETTING University hospital, Poland. METHODS Seventy-two morbidly obese patients were randomly selected to undergo either SG (n = 36) or RYGB (n = 36). Fasting ghrelin, leptin, glucose, insulin, C-peptide, glucagon, glycated hemoglobin, and homeostasis model assessment of insulin resistance were assessed preoperatively and at 1, 6, and 12 months postoperatively. No differences were found in anthropometric and biochemical parameters between the study groups at baseline. RESULTS Sixty-nine (95.8%) patients completed the study. Percentage of excess weight loss at 12 months was 67.6±19.3% after SG and 64.2±18.5% after RYGB (P>.05). Fasting ghrelin levels decreased 1 month after SG (from 76.8 pmol/L to 35.3 pmol/L; P<.05) and remained reduced until 12 months (41.6 pmol/L; P<.05) but increased 12 months after RYGB from 74.6 pmol/L to 130.2 pmol/L (P<.05). Leptin, glucose, insulin, and C-peptide concentrations and glycated hemoglobin and homeostasis model assessment of insulin resistance values decreased significantly in both groups during 12 months. CONCLUSIONS RYGB and SG induce comparable weight loss and improvement in metabolism of glucose. Ghrelin levels decrease after SG and increase after RYGB, but this difference does not affect similar outcomes of these procedures during 1-year follow-up. The contribution of ghrelin to weight loss or metabolic benefits after bariatric surgery is not straightforward, but rather influenced by multiple factors.
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Affiliation(s)
- Piotr Kalinowski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
| | - Rafał Paluszkiewicz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Tadeusz Wróblewski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Remiszewski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Grodzicki
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Zbigniew Bartoszewicz
- Department of Internal Diseases and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Marek Krawczyk
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
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Gärtner D, Ernst A, Fedtke K, Jenkner J, Schöttler A, Reimer P, Blüher M, Schön MR. [Routine fluoroscopic investigations after primary bariatric surgery]. Chirurg 2017; 87:241-6. [PMID: 26251036 DOI: 10.1007/s00104-015-0063-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Staple line and anastomotic leakages are life-threatening complications after bariatric surgery. Upper gastrointestinal (GI) tract X-ray examination with oral administration of a water-soluble contrast agent can be used to detect leaks. The aim of this study was to evaluate the impact of routine upper GI tract fluoroscopy after primary bariatric surgery. METHODS Between January 2009 and December 2014 a total of 658 bariatric interventions were carried out of which 442 were primary bariatric operations. Included in this single center study were 307 sleeve gastrectomies and 135 Roux-en-Y gastric bypasses. Up to December 2012 upper GI tract fluoroscopy was performed routinely between the first and third postoperative days and the detection of leakages was evaluated. RESULTS In the investigation period 8 leakages (2.6 %) after sleeve gastrectomy, 1 anastomotic leakage in gastrojejunostomy and 1 in jejunojejunostomy after Roux-en-Y gastric bypass occurred. All patients developed clinical symptoms, such as abdominal pain, tachycardia or fever. In one case the leakage was detected by upper GI fluoroscopy and in nine cases radiological findings were unremarkable. No leakages were detected in asymptomatic patients. CONCLUSION Routine upper GI fluoroscopy is not recommended for uneventful postoperative courses after primary bariatric surgery.
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Affiliation(s)
- D Gärtner
- Klinik für Allgemein- und Visceralchirurgie, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland.
| | - A Ernst
- Klinik für Allgemein- und Visceralchirurgie, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland
| | - K Fedtke
- Klinik für Allgemein- und Visceralchirurgie, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland
| | - J Jenkner
- Klinik für Gefäß- und Thoraxchirurgie, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
| | - A Schöttler
- Klinik für Allgemein- und Visceralchirurgie, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland
| | - P Reimer
- Institut für diagnostische und interventionelle Radiologie, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
| | - M Blüher
- Klinik und Poliklinik für Endokrinologie und Nephrologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - M R Schön
- Klinik für Allgemein- und Visceralchirurgie, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland
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Maïmoun L, Lefebvre P, Jaussent A, Fouillade C, Mariano-Goulart D, Nocca D. Body composition changes in the first month after sleeve gastrectomy based on gender and anatomic site. Surg Obes Relat Dis 2017; 13:780-787. [PMID: 28283436 DOI: 10.1016/j.soard.2017.01.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/03/2017] [Accepted: 01/06/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) induces acute weight loss, but its impact on the very early postoperative changes in body composition (BC) is less clear. OBJECTIVES This longitudinal study examined the BC changes in the first month after SG according to gender and anatomic site. METHODS BC (lean tissue mass [LTM] and fat mass [FM]) were determined by dual-energy x-ray absorptiometry in 41 obese patients (33 women, 80.5%) just before SG and 1 month later. SETTING University hospital of Montpellier, France. RESULTS One month after SG, mean weight loss was -9.8±2.6 kg, with a significant decrease in LTM and FM (kg) ranging from -7.3% to 9.5%, depending on site. FM (kg) loss in men exceeded that in women at whole body, upper limbs, and trunk. FM (%) and the LTM/FM ratio decreased only in the trunk in men and the lower limbs in women, but the gender difference was only observed for the trunk. In women, age was positively correlated with relative FM variation (% and kg) in the lower limbs and negatively correlated with LTM and LTM/FM. In men, weight was negatively correlated with the relative LTM and FM (kg) variations in the upper limbs. CONCLUSION SG induces acute weight loss, but this loss comprises losses in both FM and LTM. Because excessive LTM loss can have deleterious consequences, preventive strategies should be implemented soon after bariatric surgery. The specific changes in BC are highlighted according to gender and anatomic site.
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Affiliation(s)
- Laurent Maïmoun
- Service de Médecine Nucléaire, Hôpital Lapeyronie, Centre Hospitalier Régional Universitaire (CHRU) Montpellier et Université Montpellier (UM), Montpellier, France; Physiologie et Médecine Expérimentale du Cœur et des Muscles (PhyMedExp), U1046 INSERM, UMR9214 CNRS, University of Montpellier, Montpellier, France.
| | - Patrick Lefebvre
- Departement d'Endocrinology, Diabetes, Nutrition, Hôpital Lapeyronie, CHRU, Montpellier, France
| | - Audrey Jaussent
- Unité de recherche clinique, biostatistiques et épidémiologie, Département de l'Information Médicale, CHRU, Montpellier, France
| | - Clémence Fouillade
- Service de Chirurgie Digestive A, Hôpital Saint Eloi, CHRU, Montpellier, France
| | - Denis Mariano-Goulart
- Service de Médecine Nucléaire, Hôpital Lapeyronie, Centre Hospitalier Régional Universitaire (CHRU) Montpellier et Université Montpellier (UM), Montpellier, France; Physiologie et Médecine Expérimentale du Cœur et des Muscles (PhyMedExp), U1046 INSERM, UMR9214 CNRS, University of Montpellier, Montpellier, France
| | - David Nocca
- Service de Chirurgie Digestive A, Hôpital Saint Eloi, CHRU, Montpellier, France
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Philouze G, Voitellier E, Lacaze L, Huet E, Gancel A, Prévost G, Bubenheim M, Scotté M. Excess Body Mass Index Loss at 3 Months: A Predictive Factor of Long-Term Result after Sleeve Gastrectomy. J Obes 2017; 2017:2107157. [PMID: 28250984 PMCID: PMC5303591 DOI: 10.1155/2017/2107157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/21/2016] [Accepted: 12/28/2016] [Indexed: 12/13/2022] Open
Abstract
Introduction. Laparoscopic Sleeve Gastrectomy (SG) is considered as successful if the percentage of Excess Body Mass Index Loss (% EBMIL) remains constant over 50% with long-term follow-up. The aim of this study was to evaluate whether early % EBMIL was predictive of success after SG. Methods. This retrospective study included patients who had SG with two years of follow-up. Patients had follow-up appointments at 3 (M3), 6, 12, and 24 months (M24). Data as weight and Body Mass Index (BMI) were collected systematically. We estimated the % EBMIL necessary to establish a correlation between M3 and M24 compared to % EBMIL speeds and calculated a limit value of % EBMIL predictive of success. Results. Data at operative time, M3, and M24 were available for 128 patients. Pearson test showed a correlation between % EBMIL at M3 and that at M24 (r = 0.74; p < 0.0001). % EBMIL speed between surgery and M3 (p = 0.0011) was significant but not between M3 and M24. A linear regression analysis proved that % EBMIL over 20.1% at M3 (p < 0.0001) predicted a final % EBMIL over 50%. Conclusions. % EBMIL at M3 after SG is correlated with % EBMIL in the long term. % EBMIL speed was significant in the first 3 months. % EBMIL over 20.1% at M3 leads to the success of SG.
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Affiliation(s)
- Guillaume Philouze
- Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, 76031 Rouen, France
| | - Eglantine Voitellier
- Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, 76031 Rouen, France
| | - Laurence Lacaze
- Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, 76031 Rouen, France
| | - Emmanuel Huet
- Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, 76031 Rouen, France
| | - Antoine Gancel
- Department of Endocrinology, Bois-Guillaume Hospital, 76230 Bois-Guillaume, France
| | - Gaëtan Prévost
- Department of Endocrinology, Bois-Guillaume Hospital, 76230 Bois-Guillaume, France
| | - Michael Bubenheim
- Department of Biostatistics, Rouen University Hospital, 1 rue de Germont, 76031 Rouen, France
| | - Michel Scotté
- Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, 76031 Rouen, France
- *Michel Scotté:
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Five-year results of laparoscopic sleeve gastrectomy for the treatment of severe obesity. Surg Endosc 2016; 31:3251-3257. [DOI: 10.1007/s00464-016-5355-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/12/2016] [Indexed: 12/15/2022]
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Dang JT, Switzer NJ, Wu J, Gill RS, Shi X, Thereaux J, Birch DW, de Gara C, Karmali S. Gastric Band Removal in Revisional Bariatric Surgery, One-Step Versus Two-Step: a Systematic Review and Meta-analysis. Obes Surg 2016; 26:866-73. [PMID: 26843080 DOI: 10.1007/s11695-016-2082-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We aimed to systematically review the literature comparing the safety of one-step versus two-step revisional bariatric surgery from laparoscopic adjustable gastric banding (LAGB) to Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). There is debate on the safety of removing the gastric band and performing revisional surgery immediately or in a delayed, two-step fashion due to potential higher complications in one-step revisions. A systematic and comprehensive search of the literature was conducted. Included studies directly compared one-step and two-step revisional surgery. Eleven studies were included with 1370 patients. Meta-analysis found comparable rates of complications, morbidity, and mortality between one-step and two-step revisions for both RYGB and SG groups. This suggests that immediate or delayed revisional bariatric surgeries are both safe options for LAGB revisions.
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Affiliation(s)
- Jerry T Dang
- Department of Surgery, University of Alberta, 8440 112 Street NW, Edmonton, Alberta, Canada, T6G 2B7.
| | - Noah J Switzer
- Department of Surgery, University of Alberta, 8440 112 Street NW, Edmonton, Alberta, Canada, T6G 2B7
| | - Jeremy Wu
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Richdeep S Gill
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Xinzhe Shi
- Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Jérémie Thereaux
- Department of General, Digestive and Metabolic Surgery, La Cavale Blanche University Hospital, Brest, France
| | - Daniel W Birch
- Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Christopher de Gara
- Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Shahzeer Karmali
- Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alberta, Canada
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Impact of a prophylactic combination of dexamethasone–ondansetron on postoperative nausea and vomiting in obese adult patients undergoing laparoscopic sleeve gastrectomy during closed-loop propofol–remifentanil anaesthesia. Eur J Anaesthesiol 2016; 33:898-905. [DOI: 10.1097/eja.0000000000000427] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Poghosyan T, Lazzati A, Moszkowicz D, Danoussou D, Vychnevskaia K, Azoulay D, Czernichow S, Carette C, Bouillot JL. Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: an audit of 34 patients. Surg Obes Relat Dis 2016; 12:1646-1651. [DOI: 10.1016/j.soard.2016.02.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/25/2016] [Accepted: 02/25/2016] [Indexed: 01/07/2023]
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