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Moga A, Bălănescu R, Bălănescu L, Cîmpeanu P, Andriescu M, Vasile ME, Caragata R. Factors Associated with Postoperative Complications After Congenital Duodenal Obstruction Surgery: A Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1722. [PMID: 39459509 PMCID: PMC11509180 DOI: 10.3390/medicina60101722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 10/02/2024] [Accepted: 10/11/2024] [Indexed: 10/28/2024]
Abstract
Background and Objectives: Duodenal atresia and stenosis are common causes of intestinal obstruction. Associated anomalies significantly influence early postoperative mortality, while postoperative complications impact long-term survival. Materials and Methods: Over a 13-year period from January 2010 to August 2023, a total of 74 infants and children with congenital duodenal obstruction were treated at "Grigore Alexandrescu" Children's Emergency Hospital and met the inclusion criteria. All patients diagnosed with duodenal obstruction (both instrinsic and extrinsic causes) were included. Analysed data included congenital anomalies, Apgar scores, birth weights, surgical techniques, and complications. Results: The associated anomalies included cardiac (n = 33), Down syndrome (n = 13), neurological (n = 11), pulmonary (n = 7), renal (n = 4), skeletal (n = 1), and gastrointestinal and hepatobiliopancreatic anomalies (n = 25). In total, 12 patients experienced perioperative ventilation problems. Early postoperative complications (within 30 days) occurred in 21 patients, while 6 had late postoperative complications (after 30 days). Among non-surgical complications, we noted ventilation problems, sepsis (n = 7), and pneumothorax (n = 1). Surgical complications included adhesive bowel obstruction (n = 7), incisional hernia (n = 3), peritonitis (n = 3), dysfunctional duodenoduodenostomy or duodenojejunostomy (n = 3), pneumoperitoneum (n = 5), enteric fistula (n = 3), and volvulus (n = 4). Conclusions: Surprisingly, this retrospective study revealed that an Apgar score below 8, along with neurological and pulmonary abnormalities, is associated with postoperative complications. Conversely, other congenital anomalies, low birth weight, and age at admission do not serve as prognostic factors.
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Affiliation(s)
- Andreea Moga
- Department of Pediatric Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (A.M.); (L.B.); (P.C.); (M.A.); (M.E.V.); (R.C.)
- Department of Pediatric Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Radu Bălănescu
- Department of Pediatric Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (A.M.); (L.B.); (P.C.); (M.A.); (M.E.V.); (R.C.)
- Department of Pediatric Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Laura Bălănescu
- Department of Pediatric Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (A.M.); (L.B.); (P.C.); (M.A.); (M.E.V.); (R.C.)
- Department of Pediatric Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Patricia Cîmpeanu
- Department of Pediatric Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (A.M.); (L.B.); (P.C.); (M.A.); (M.E.V.); (R.C.)
| | - Mircea Andriescu
- Department of Pediatric Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (A.M.); (L.B.); (P.C.); (M.A.); (M.E.V.); (R.C.)
- Department of Pediatric Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Mirela Elena Vasile
- Department of Pediatric Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (A.M.); (L.B.); (P.C.); (M.A.); (M.E.V.); (R.C.)
| | - Ruxandra Caragata
- Department of Pediatric Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (A.M.); (L.B.); (P.C.); (M.A.); (M.E.V.); (R.C.)
- Department of Pediatric Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Qin JM. Hemorrhage after pancreaticoduodenectomy: Causes and diagnosis and treatment strategies. WORLD CHINESE JOURNAL OF DIGESTOLOGY 2024; 32:457-467. [DOI: 10.11569/wcjd.v32.i7.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2024]
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Capaverde LH, Trindade EN, Leite C, Cerski CTS, Trindade MRM. Marginal Ulcer Incidence and the Population of Gastrin Producing G cells Retained in the Gastric Pouch after Roux-en-Y Gastric Bypass: Is There a Relationship? Obes Surg 2024; 34:1152-1158. [PMID: 38351199 DOI: 10.1007/s11695-024-07078-8] [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: 02/19/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Marginal ulcers are the most prevalent endoscopic abnormality after RYGB. The etiology is still poorly understood; however, an increase in acid secretion has been strongly implicated as a causal agent. Although gastrin is the greatest stimulant of acid secretion, to date, the presence of gastrin producing G cells retained in the gastric pouch, related to the occurrence of marginal ulcers, has not been evaluated. OBJECTIVE Evaluate the density of G cells and parietal cells in the gastric pouch of RYGB patients with a diagnosis of marginal ulcer on the post-op EGD. METHOD We retrospectively evaluated 1104 gastric bypasses performed between 2010 and 2020. Patients with marginal ulcer who met the inclusion criteria and controls were selected from this same population. Endoscopic gastric pouch biopsies were evaluated using immunohistochemical study and HE staining to assess G cell and parietal cell density. RESULTS In total, 572 (51.8%) of the patients performed endoscopic follow-up after RYGB. The incidence of marginal ulcer was 23/572 (4%), and 3 patients required revision surgery due to a recalcitrant ulcer. The mean time for ulcer identification was 24.3 months (2-62). G cell count per high-power field (× 400) was statistically higher in the ulcer group (p < 0.05). There was no statistical difference in parietal cell density between groups (p 0.251). CONCLUSION Patients with a marginal ulcer after gastric bypass present a higher density of gastrin-producing G cells retained in the gastric pouch.
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Affiliation(s)
- Luiz H Capaverde
- Department of Digestive Surgery, Hospital São Lucas da PUC-RS, Centro Clínico Sala 506, Av Ipiranga 6690, Porto Alegre, RS, CEP: 90610-000, Brazil.
| | - Eduardo N Trindade
- Department of Digestive Surgery, Hospital de Clínicas de Porto Alegre and Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Carine Leite
- Department of Gastroenterology and Endoscopy, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Carlos T S Cerski
- Department of Pathology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Manoel R M Trindade
- Department of Digestive Surgery, Hospital de Clínicas de Porto Alegre and Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
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Hider AM, Johanson H, Bonham AJ, Ghaferi AA, Finks J, Ehlers AP, Carlin AM, Varban OA. Evaluating outcomes among surgeons who changed their technique for gastric bypass: a state-wide analysis from 2011 to 2021. Surg Endosc 2023; 37:8464-8472. [PMID: 37740112 DOI: 10.1007/s00464-023-10434-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: 07/02/2023] [Accepted: 08/31/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION Technical variation exists when performing the gastrojejunostomy during Roux-en-Y gastric bypass (RYGB). However, it is unclear whether changing technique results in improved outcomes or patient harm. METHODS Surgeons participating in a state-wide bariatric surgery quality collaborative who completed a survey on how they perform a typical RYGB in 2011 and again in 2021 were included in the analysis (n = 31). Risk-adjusted 30-day complication rates and case characteristics for cases in 2011 were compared to those in 2021 among surgeons who changed their gastrojejunostomy technique from end-to-end anastomosis (EEA) to either a linear staple or handsewn anastomosis (LSA/HSA). In addition, case characteristics and outcomes among surgeons who maintained an EEA technique throughout the study period were assessed. RESULTS A total of 15 surgeons (48.3%) changed their technique from EEA to LSA/HSA while 7 surgeons (22.3%) did not. Nine surgeons did LSA or HSA the entire period and therefore were not included. Surgeons who changed their technique had significantly lower rates of surgical complications in 2021 when compared to 2011 (1.9% vs 5.1%, p = 0.0015), including lower rates of wound complications (0.5% vs 2.1%, p = 0.0030) and stricture (0.1% vs 0.5%, p = 0.0533). Likewise, surgeons who did not change their EEA technique, also experienced a decrease in surgical complications (1.8% vs 5.8%, p < 0.0001), wound complications (0.7% vs 2.1%, p < 0.0001) and strictures (0.2% vs 1.2%, p = 0.0006). Surgeons who changed their technique had a significantly higher mean annual robotic bariatric volume in 2021 (30.0 cases vs 4.9 cases, p < 0.0001) when compared to those who did not. CONCLUSIONS Surgeons who changed their gastrojejunostomy technique from circular stapled to handsewn demonstrated greater utilization of the robotic platform than those who did not and experienced a similar decrease in adverse events during the study period, despite altering their technique. Surgeons who chose to modify their operative technique may be more likely to adopt newer technologies.
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Affiliation(s)
- Ahmad M Hider
- Department of Surgery, Michigan Medicine, University of Michigan Medical School, 1500 E Medical Center Drive, 2210 Taubman Center, Ann Arbor, MI, 48109, USA.
| | | | - Aaron J Bonham
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Amir A Ghaferi
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jonathan Finks
- Department of Surgery, Michigan Medicine, University of Michigan Medical School, 1500 E Medical Center Drive, 2210 Taubman Center, Ann Arbor, MI, 48109, USA
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Anne P Ehlers
- Department of Surgery, Michigan Medicine, University of Michigan Medical School, 1500 E Medical Center Drive, 2210 Taubman Center, Ann Arbor, MI, 48109, USA
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health, Detroit, MI, USA
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Oliver A Varban
- Department of Surgery, Henry Ford Health, Detroit, MI, USA
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
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Rijal S, Awal S, Basukala S, Shah KB. Perforated marginal ulcer following Whipple procedure: A case report. Clin Case Rep 2023; 11:e7581. [PMID: 37361658 PMCID: PMC10288009 DOI: 10.1002/ccr3.7581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023] Open
Abstract
Marginal ulcers are rare complications of pancreatoduodenectomy. Patient can present with varying symptoms such as epigastric discomfort, pain, dysphagia, or can present in emergency department with complications like bleeding and perforation.
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Affiliation(s)
| | - Shila Awal
- Suryabinayak Municipal HospitalBhaktapurNepal
| | - Sunil Basukala
- Department of SurgeryNepalese Army Institute of Health Science (NAIHS)KathmanduNepal
| | - Kunda Bikram Shah
- Department of SurgeryNepalese Army Institute of Health Science (NAIHS)KathmanduNepal
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Brito Y, Kayode O, Peters D, Nair A, James M, Tiesenga F. Repair of a Perforated Marginal Ulcer Seven Years After Roux-en Y Gastric Bypass: A Case Report and Review of Literature. Cureus 2023; 15:e40750. [PMID: 37485184 PMCID: PMC10361540 DOI: 10.7759/cureus.40750] [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] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Marginal ulcers can be a rare but fatal post-surgical complication of Roux-en-Y gastric bypass (RYGB). In this report, we will describe the case of a 70-year-old female, with a seven-year status post-gastrojejunostomy who presented with a perforated marginal ulcer and showed significant improvement in her symptoms after a revisional operation for the marginal ulcer. The goal of this case report is to make clinicians aware of the unique complications of RYGB and outline the appropriate workup for patients presenting with post-bariatric abdominal pain.
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Affiliation(s)
- Yesenia Brito
- General Surgery, St. George's University School of Medicine, True Blue, GRD
| | - Omobolanle Kayode
- General Surgery, St. George's University School of Medicine, True Blue, GRD
| | - Dominique Peters
- General Surgery, St. George's University School of Medicine, True Blue, GRD
| | - Ameya Nair
- General Surgery, Saint James School of Medicine, Arnos Vale, VCT
| | - Melyssa James
- General Surgery, St. George's University School of Medicine, True Blue, GRD
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Holt BL, Rice WV. A prospective single-center study evaluating the efficacy of the stomach, intestinal, and pylorus-sparing procedure. Surg Obes Relat Dis 2022; 19:612-618. [PMID: 36641352 DOI: 10.1016/j.soard.2022.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/17/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The stomach, intestinal, and pylorus-sparing (SIPS) procedure is a single-anastomosis duodeno-intestinal bypass used in obesity management. OBJECTIVE Weight and metabolic outcomes in patients with severe obesity who underwent the SIPS procedure were evaluated in a community hospital-based study. SETTING Community hospital. METHODS This single-site prospective study of patients who underwent the SIPS procedure evaluated outcomes at 12 and 24 months. Mean changes in total weight loss and body mass index (BMI) and resolution of gastroesophageal reflux disease (GERD), obstructive sleep apnea (OSA), hypertension, type 2 diabetes (T2D), and hyperlipidemia were evaluated. RESULTS At baseline, 185 patients were enrolled; mean weight and BMI were 144.0 kg and 52.2 kg/m2, respectively. Data for 88 (47.6%) and 29 (15.7%) patients who completed follow-up at 12 and 24 months, respectively, were available. At 12 months, mean total weight loss was 35.6% (weight reduction of 51.3 kg) and BMI reduction of 17.8 points were achieved and were maintained for the 29 patients who completed 24-month follow-up. No leaks or infections occurred. Complications occurred in 8 patients (.4%) and were not serious. Resolution of GERD, OSA, hypertension, T2D, and hyperlipidemia achieved in 87.1%, 59.2%, 32.7%, 93.1%, and 87.6% of patients, respectively, at 12 months was maintained at 24 months. Nutritional deficiency was absent. CONCLUSIONS Patients who underwent the SIPS procedure had meaningful reductions in weight and BMI, and many had resolution of metabolic co-morbidities; procedural complication rates were low. Our results support that the SIPS procedure is a safe and effective primary treatment for clinically severe obesity in a community-based hospital setting.
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Affiliation(s)
- Brian L Holt
- Presbyterian Bariatric Center, Rio Rancho, New Mexico.
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Martinino A, Bhandari M, Abouelazayem M, Abdellatif A, Koshy RM, Mahawar K. Perforated Marginal Ulcer After Gastric Bypass for Obesity: A Systematic Review. Surg Obes Relat Dis 2022; 18:1168-1175. [PMID: 35810084 DOI: 10.1016/j.soard.2022.05.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/11/2022] [Accepted: 05/22/2022] [Indexed: 10/18/2022]
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Pennestrì F, Sessa L, Prioli F, Salvi G, Gallucci P, Ciccoritti L, Greco F, De Crea C, Raffaelli M. Single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S): experience from a high-bariatric volume center. Langenbecks Arch Surg 2022; 407:1851-1862. [PMID: 35352174 PMCID: PMC9399205 DOI: 10.1007/s00423-022-02501-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/21/2022] [Indexed: 12/14/2022]
Abstract
Abstract
Purpose
Biliopancreatic diversion with duodenal switch and single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) are technically demanding hypo-absorptive bariatric procedures generally indicated in super-obese patients (BMI ≥ 50 kg/m2). Data from the literature prove the procedure to be safe and effective, with promising bariatric and metabolic effects. Anyway, international societies support the creation of multicentric national and international registries to obtain more homogeneous data over the long period. We aimed to report our experience with this procedure.
Methods
Among 2313 patients who underwent bariatric procedures at our institution, between July 2016 and August 2021, 121 (5.2%) consenting patients were scheduled for SADI-S as primary (SADIS) or revisional procedure after sleeve gastrectomy (SADI) (respectively 87 and 34 patients). Early and late post-operative complications, operative time, post-operative stay, and follow-up data were analyzed.
Results
Overall, the median preoperative BMI was 52.3 (48.75–57.05) kg/m2 with a median age of 44 (39–51) years, the median operative time was 120 (100–155) min. Complications at 30th-day post-op were registered in 4 (3.3%) patients and late complications in 4 (3.3%) patients. At a median follow-up of 31 (14–39) months, the median percentage excess weight loss was 79.8 (55.15–91.45)%, and the median total weight loss was 57.0650 (43.3925–71.3475)%.
Conclusion
Our data, coherently with the literature, confirm that SADI-S is a safe, effective procedure with acceptable complications rate. Larger studies with longer follow-ups are necessary to draw definitive conclusions.
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Affiliation(s)
- Francesco Pennestrì
- U.O.C. Chirurgia Endocrina E Metabolica, Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Sessa
- U.O.C. Chirurgia Endocrina E Metabolica, Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
- Centro Malattie Endocrine E Obesità, Fondazione Gemelli Giglio Cefalù, Cefalù (Palermo), L.go A. Gemelli 8, 00168, Rome, Italy.
| | - Francesca Prioli
- U.O.C. Chirurgia Endocrina E Metabolica, Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giulia Salvi
- U.O.C. Chirurgia Endocrina E Metabolica, Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pierpaolo Gallucci
- U.O.C. Chirurgia Endocrina E Metabolica, Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luigi Ciccoritti
- U.O.C. Chirurgia Endocrina E Metabolica, Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Greco
- U.O.C. Chirurgia Endocrina E Metabolica, Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carmela De Crea
- U.O.C. Chirurgia Endocrina E Metabolica, Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Raffaelli
- U.O.C. Chirurgia Endocrina E Metabolica, Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Luesma MJ, Fernando J, Cantarero I, Lucea P, Santander S. Surgical Treatment of Obesity. Special Mention to Roux-en-Y Gastric Bypass and Vertical Gastrectomy. Front Endocrinol (Lausanne) 2022; 13:867838. [PMID: 35432187 PMCID: PMC9010401 DOI: 10.3389/fendo.2022.867838] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/01/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The prevalence of obesity has increased exponentially in recent decades, being one of the diseases that most affects global health. It is a chronic disease associated with multiple comorbidities, which lead to a decrease in life expectancy and quality of life. It requires a multidisciplinary approach by a specialized medical team. Obesity can be treated with conservative or with surgical treatments that will depend on the characteristics of the patient. OBJECTIVE/METHODOLOGY The referenced surgery can be performed using different surgical techniques that are analyzed in the present work through an exhaustive narrative bibliographic review in the PubMed and Cochrane databases, as well as in UpToDate. RESULTS Currently, those most used are restrictive techniques, specifically vertical gastrectomy and mixed techniques, with gastric bypass being the "gold standard". CONCLUSIONS In order to choose one technique or another, the characteristics of each patient and the experience of the surgical team must be taken into account.
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Affiliation(s)
- María José Luesma
- Department of Human Anatomy and Histology, School of Medicine, University of Zaragoza, Zaragoza, Spain
- *Correspondence: Sonia Santander, ; María José Luesma,
| | - José Fernando
- General Surgery and Digestive System Service, Royo Villanova Hospital, Zaragoza, Spain
| | - Irene Cantarero
- Department of Morphological and Social Health Sciences, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - Pilar Lucea
- Department of Human Anatomy and Histology, School of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Sonia Santander
- Department of Pharmacology and Physiology, School of Medicine, University of Zaragoza, Zaragoza, Spain
- *Correspondence: Sonia Santander, ; María José Luesma,
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Lye TJY, Eng AKH. Late Stricture from Marginal Ulceration after Roux-en-Y Gastric Bypass: Endoscopic Complications and Surgical Management. Obes Surg 2021; 31:5508-5509. [PMID: 34570307 DOI: 10.1007/s11695-021-05716-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/03/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Tiffany Jian Ying Lye
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Outram Road, 169608, Singapore, Singapore.
| | - Alvin K H Eng
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Outram Road, 169608, Singapore, Singapore
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12
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Phlegmon Formation due to Perforated Marginal Ulcer After One Anastomosis Gastric Bypass; Conversion to Roux-en-Y Gastric Bypass: a Video Case Report. Obes Surg 2021; 31:5102-5103. [PMID: 34398382 DOI: 10.1007/s11695-021-05602-8] [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: 02/22/2021] [Revised: 07/10/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
One anastomosis gastric bypass is now an accepted bariatric procedure in many countries. A rare but serious complication of OAGB is perforation of marginal ulcer with 0.5-1% incidence that needs urgent diagnosis and intervention. In cases of complicated or refractory ulcers, conversion to RYGB could be a definitive therapy.
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Peetermans M, Vellemans J, Jutten G, D’hooge P, Delvaux P, Huysentruyt F, Van Hootegem A, Callens J, Peetermans O. Perforation of the excluded segment without pneumoperitoneum following Roux-en-Y gastric bypass surgery: case report and literature review. Acta Chir Belg 2021; 121:115-121. [PMID: 31333071 DOI: 10.1080/00015458.2019.1642017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Because of the increasing prevalence of obesity and bariatric surgery (Roux-en-Y gastric bypass (RYGB) as the gold standard), there is a still growing population of people with altered post-operative anatomy. Although the most common early and late complications following RYGB are well known, they can still be difficult to diagnose. The altered anatomy after RYGB can create a real diagnostic and therapeutic challenge since routine examinations can be negative. CASE REPORT We present a rare case of a 38-year-old woman with acute abdominal pain and a history of RYGB who proved to have a duodenal perforation in the absence of free air on radiologic examination. The perforation was closed laparoscopically and proton pump inhibitors were administered. CONCLUSIONS Perforations of the excluded segment in RYGB patients are rare and represent a diagnostic challenge, as pneumoperitoneum is usually absent and the excluded segment is difficult to access. Despite negative diagnostic findings, laparoscopic exploration should always be considered.
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Affiliation(s)
- Maxime Peetermans
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Jana Vellemans
- Trainee Abdominal Surgery, AZ Klina, Brasschaat, Belgium
| | - Guido Jutten
- Department of Abdominal Surgery, AZ Klina, Brasschaat, Belgium
| | - Pieter D’hooge
- Department of Abdominal Surgery, AZ Klina, Brasschaat, Belgium
| | - Peter Delvaux
- Department of Abdominal Surgery, AZ Klina, Brasschaat, Belgium
| | | | | | - Jos Callens
- Department of Gastroenterology and Hepatology, AZ Klina, Brasschaat, Belgium
| | - Olivier Peetermans
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Athanasiadis DI, Christodoulides A, Monfared S, Hilgendorf W, Embry M, Stefanidis D. High Rates of Nicotine Use Relapse and Ulcer Development Following Roux-en-Y Gastric Bypass. Obes Surg 2020; 31:640-645. [PMID: 32959330 DOI: 10.1007/s11695-020-04978-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/05/2020] [Accepted: 09/11/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Given that smoking is known to contribute to gastrojejunal anastomotic (GJA) ulcers, cessation is recommended prior to laparoscopic Roux-en-Y gastric bypass (LRYGB). However, smoking relapse rates and the exact ulcer risk remain unknown. This study aimed to define smoking relapse, risk of GJA ulceration, and complications after LRYGB. MATERIALS AND METHODS We performed a retrospective cohort study of patients who underwent primary LRYGB during 2011-2015. Initially, three patient categories were identified: lifetime non-smokers, patients who were smoking during the initial visit at the bariatric clinic or within the prior year (recent smokers), and patients who had ceased smoking more than a year prior to their initial clinic visit (former smokers). Smoking relapse, GJA ulcer occurrences, reinterventions, and reoperations were recorded and compared. RESULTS A total of 766 patients were included in the analysis. After surgery, 53 (64.6%) recent smokers had resumed smoking. Out of these relapsed smokers, 51% developed GJA ulcers compared with 14.8% in non-relapsed recent smokers, 16.1% in former smokers, and 6% in lifetime nonsmokers (p < 0.001). Furthermore, relapsed smokers required more frequently endoscopic reinterventions (60.4%) compared with non-relapsed smokers (20.8%, p < 0.001), former smokers (20.7%, p < 0.001), and lifetime non-smokers (15.4%, p < 0.001). Additionally, relapsed smokers required a reoperation (18.9%) more often than non-relapsed recent smokers (5.7%, p < 0.001) and lifetime non-smokers (1.3%, p < 0.001). CONCLUSION Smokers relapse frequently after LRYGB, and the majority experience GJA complications. They should be counseled about this risk preoperatively and directed towards less ulcerogenic procedures when possible. Alternatively, longer periods of preoperative smoking abstinence might be needed.
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Affiliation(s)
- Dimitrios I Athanasiadis
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 130, Indianapolis, IN, 46202, USA
| | | | - Sara Monfared
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 130, Indianapolis, IN, 46202, USA
| | | | - Marisa Embry
- Department of Surgery, Indiana University Health, Indianapolis, IN, USA
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 130, Indianapolis, IN, 46202, USA. .,Department of Surgery, Indiana University Health, Indianapolis, IN, USA.
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Hussain A, El-Hasani S. Anastomotic Gastrojejunal Ulcer Perforation Following One Anastomosis Gastric Bypass. Obes Surg 2020; 31:1334-1335. [PMID: 32948999 DOI: 10.1007/s11695-020-04979-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 06/24/2020] [Accepted: 09/11/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Abdulzahra Hussain
- Bariatric Unit, Doncaster and Bassetlaw Teaching Hospitals, Doncaster, UK.
| | - Shamsi El-Hasani
- Bariatric Unit, Princess Royal University Hospital, King's College Hospitals NHS Foundation Trust, London, UK
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16
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Which Factors Correlate with Marginal Ulcer After Surgery for Obesity? Obes Surg 2020; 30:4821-4827. [DOI: 10.1007/s11695-020-04960-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 12/28/2022]
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Dittrich L, Schwenninger MV, Dittrich K, Pratschke J, Aigner F, Raakow J. Marginal ulcers after laparoscopic Roux-en-Y gastric bypass: analysis of the amount of daily and lifetime smoking on postoperative risk. Surg Obes Relat Dis 2020; 16:389-396. [DOI: 10.1016/j.soard.2019.11.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 10/25/2019] [Accepted: 11/24/2019] [Indexed: 01/16/2023]
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18
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De Simone B, Ansaloni L, Sartelli M, Kluger Y, Abu-Zidan FM, Biffl WL, Heyer A, Coccolini F, Baiocchi GL, Catena F. The Operative management in Bariatric Acute abdomen (OBA) Survey: long-term complications of bariatric surgery and the emergency surgeon's point of view. World J Emerg Surg 2020; 15:2. [PMID: 32005129 PMCID: PMC6945511 DOI: 10.1186/s13017-019-0281-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/16/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The number of bariatric procedures is increasing worldwide. No consensus or guidelines about the emergency management of long-term complications following bariatric surgery are currently available. The aim of this study is to investigate by a web survey how an emergency surgeon approaches this unique group of patients in an emergency medical scenario and to report their personal experience. METHOD An international web survey was sent to 197 emergency surgeons with the aim to collect data about emergency surgeons' experience in the management of patients admitted in the emergency department for acute abdominal pain after bariatric surgery. The survey was conceived as a questionnaire composed by 26 (multiple choice and open) questions and approved by a steering committee. RESULTS One hundred seventeen international emergency surgeons decided to join the project and answered to the web survey with a response rate of 59.39%. CONCLUSIONS The aim of this WSES web survey was to highlight the current management of patients previously submitted to bariatric surgical procedures by ES. Emergency surgeons must be mindful of postoperative bariatric surgery complications. CT scan with oral intestinal opacification may be useful in making a diagnosis if carefully interpreted by the radiologist and the surgeon. In case of inconclusive clinical and radiological findings, when symptoms fail to improve, surgical exploration for bariatric patients presenting acute abdominal pain, by laparoscopy if expertise is available, is mandatory in the first 12-24 h, to have good outcomes and decrease morbidity rate.
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Affiliation(s)
- Belinda De Simone
- Department of General and Emergency Surgery, Azienda Usl Reggio Emilia IRCCS, Reggio Emilia, Italy
| | - Luca Ansaloni
- Department of Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Massimo Sartelli
- Department of General Surgery, Macerata’s Hospital, Macerata, Italy
| | - Yoram Kluger
- Department of Emergency and Trauma Surgery, Rambam Health Campus, Haifa, Israel
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Walter L. Biffl
- Department of Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, California USA
| | - Arianna Heyer
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania USA
| | | | | | - Fausto Catena
- Department of Emergency and Trauma Surgery, Parma University Hospital, Parma, Italy
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19
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Hussain A, Van den Bossche M, Kerrigan DD, Alhamdani A, Parmar C, Javed S, Harper C, Darrien J, Singhal R, Yeluri S, Vasas P, Balchandra S, El-Hasani S. Retrospective cohort study of 925 OAGB procedures. The UK MGB/OAGB collaborative group. Int J Surg 2019; 69:13-18. [PMID: 31299430 DOI: 10.1016/j.ijsu.2019.07.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/23/2019] [Accepted: 07/04/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Mini-One Anastomosis Gastric Bypass is a new operation that provides comparable outcomes to the common bariatric procedures. Revisional surgery is still needed after a number of MGB-OAGB procedures. The aim of this study is to report the causes and management of these revisions. METHODS From 2010 to 2018, 925 MGB-OAGB operations were performed at 7 bariatric units across the United Kingdom and included in this retrospective cohort study. The data was retrospectively collected and analysed. The primary end point was the identification of the causes and management of revisions. Follow up ranged from 6 months to 3 years. RESULTS Twenty-two patients [2.3%] required revisional surgery after MGB-OAGB. Five patients [0.5%] developed severe diarrhoea managed by shortening the bilio-pancreatic limb to 150 cm. Four patients [0.4%] developed afferent loop syndrome and bile reflux was reported in another 3 [0.3%] cases; all were managed by either conversion to Roux en Y Gastric Bypass or a Braun anastomosis. Postoperative bleeding was controlled laparoscopically in 3 patients [0.3%]. Liver decompensation that was reported in 2 patients [0.2%] was treated by shortening the BPL in one patient and a reversal to normal anatomy in another. The liver failure resolved in both patients. Other indications for revision included two gastro-jejunal stenosis [0.2%], one perforated ulcer [0.1%], one patient [0.1%] with excessive weight loss and one case [0.1%] of protein malnutrition. None of the 22 patients undergoing revisional surgery after MGB-OAGB died. Lost to follow up rate was 0.2%. CONCLUSION Complications requiring revisional surgery after MGB-OAGB are uncommon [2.3%] and the majority can be managed by bilio-pancreatic limb shortening, the addition of a Braun side-to-side anastomosis or conversion to RYGB. Bilio-pancreatic limb length of 200 cm or more resulted in serious complications of liver failure, protein malnutrition, excessive weight loss and diarrhoea.
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Affiliation(s)
- A Hussain
- Doncaster and Bassetlaw Teaching Hospitals, Doncaster, United Kingdom.
| | | | | | - A Alhamdani
- Whittington Hospital, London, United Kingdom
| | - C Parmar
- Whittington Hospital, London, United Kingdom
| | - S Javed
- Phoenix Health, Chester, United Kingdom
| | - C Harper
- Phoenix Health, Chester, United Kingdom
| | - J Darrien
- Phoenix Health, Chester, United Kingdom
| | - R Singhal
- Heart of England Hospital, Birmingham, United Kingdom
| | - S Yeluri
- Doncaster and Bassetlaw Teaching Hospitals, Doncaster, United Kingdom
| | - P Vasas
- Doncaster and Bassetlaw Teaching Hospitals, Doncaster, United Kingdom
| | - S Balchandra
- Doncaster and Bassetlaw Teaching Hospitals, Doncaster, United Kingdom
| | - S El-Hasani
- King's College Hospitals, London, United Kingdom; Chelsfield Park Hospital, United Kingdom
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20
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Hariri K, Dong M, Edwards ED, Kini SU, Inabnet WB, Herron DM, Fernandez-Ranvier G. Why Are Patients Readmitted? An Analysis of Adverse Events Leading to Readmission, Reintervention, or Reoperation After Bariatric Surgery. Bariatr Surg Pract Patient Care 2018. [DOI: 10.1089/bari.2018.0024] [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)
- Kamyar Hariri
- The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Matthew Dong
- The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Eric D. Edwards
- The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Subhash U. Kini
- The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - William B. Inabnet
- The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Daniel M. Herron
- The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Gustavo Fernandez-Ranvier
- The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
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21
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Evaluation of the rate of marginal ulcer formation after bariatric surgery using the MBSAQIP database. Surg Endosc 2018; 33:1890-1897. [PMID: 30251139 DOI: 10.1007/s00464-018-6468-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/20/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Marginal ulcer (MU) formation is a known problem after gastric bypass. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database contains data from all US and Canadian Centers of Excellence including complication rates. We hypothesized that the short-term rate of ulceration is low. METHODS We queried the MBSAQIP database for the year 2015. We searched patients with primary gastric bypass who developed MU. We then compared preoperative, operative, and postoperative characteristics with patients who did not develop MU. RESULTS The incidence of MU in the entire cohort of GB patients was 155 of 44,379 (0.35%, 95% CI 0.297%, 0.409%). Among the 155 patients with an ulcer, 88 (57%) patients had only one procedure, 69 had an intervention (therapeutic or diagnostic endoscopy), 16 had readmission, and 3 had reoperation. 65 patients (42%) had two procedures with the majority having both readmissions and endoscopy (n = 59); and two patients (1%) had three procedures. Ulcer formation was most common in the intervention group (11.4%). The occurrence of ulcer formation was associated with unplanned ICU admissions (6.45%), transfusions (5.16%), postoperative UTI (3.87%), sepsis (1.94%), and myocardial infarction (0.65%). Death occurred in 76 patients with no related cases to MUs. The risk of ulcer was associated with increased BMI (OR 1.02, p = 0.01), presence of percutaneous transluminal cardiac catheterization (PTC) (2.17, p = 0.038), histories of DVT (1.72, p = 0.085), and pulmonary embolism (2.84, p = 0.002). CONCLUSIONS In a nationally reported database, symptomatic MUs rarely occur in the first month. The large majority are diagnosed and treated endoscopically with minimal need for surgical intervention. The risk of anastomotic ulcer was increased with increased BMI, need for PTC, and history of DVT/PE.
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22
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Mansoor MS, Tejada J, Parsa NA, Yoon E, Hida S. Off label use of lumen-apposing metal stent for persistent gastro-jejunal anastomotic stricture. World J Gastrointest Endosc 2018; 10:117-120. [PMID: 29988884 PMCID: PMC6033719 DOI: 10.4253/wjge.v10.i6.117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/30/2018] [Accepted: 04/19/2018] [Indexed: 02/06/2023] Open
Abstract
We are reporting a novel “off-label” use of lumen apposing metal stent (LAMS) for management of refractory gastro-jejunal (GJ) anastomotic stricture after Roux-en-y gastric bypass (RYGB). With increasing prevalence of obesity, bariatric surgery is performed more frequently than ever. RYGB is one of the most commonly performed bariatric procedures. GJ anastomotic stricture is a late complication of this procedure. Our patient, seven years after RYGB developed GJ anastomotic ulcer and subsequently a stricture not amendable to repeated pneumatic dilations. Instead of using the conventional fully covered self-expanding metal stent (fcSEMS) we deployed the relatively new LAMS keeping in mind its novel dumbbell shaped design. Our patient’s symptoms were controlled successfully and she remained asymptomatic on follow-up. Despite initial approval for pancreatic pseudocyst drainage, LAMS has been used with increased frequency at various locations within gastrointestinal tract including GJ anastomotic strictures. Future randomized control trials are warranted to compare the efficacy of fcSEMS to LAMS.
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Affiliation(s)
| | - Juan Tejada
- Department of Gastroenterology, Albany Medical Center, Albany, NY 12047, United States
| | - Nour A Parsa
- Department of Gastroenterology, Albany Medical Center, Albany, NY 12047, United States
| | - Eric Yoon
- Department of Gastroenterology, Albany Medical Center, Albany, NY 12047, United States
| | - Sven Hida
- Department of Gastroenterology, Albany Medical Center, Albany, NY 12047, United States
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23
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The incidence of complications associated with loop duodeno-ileostomy after single-anastomosis duodenal switch procedures among 1328 patients: a multicenter experience. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.01.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Ruiz-Tovar J, González J, García A, Levano-Linares DC, Durán M. Conversion of primary endoluminal endoscopic surgery to laparoscopic Roux-en-Y gastric bypass. Appearance of anastomotic ulcer 3 months after surgery. Cir Esp 2018. [PMID: 29526472 DOI: 10.1016/j.ciresp.2017.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jaime Ruiz-Tovar
- Unidad de Cirugía Bariátrica, Servicio de Cirugía General, Hospital Rey Juan Carlos, Móstoles, Madrid, España.
| | - Juan González
- Unidad de Cirugía Bariátrica, Servicio de Cirugía General, Hospital Rey Juan Carlos, Móstoles, Madrid, España
| | - Alejandro García
- Unidad de Cirugía Bariátrica, Servicio de Cirugía General, Hospital Rey Juan Carlos, Móstoles, Madrid, España
| | - Dennis Cesar Levano-Linares
- Unidad de Cirugía Bariátrica, Servicio de Cirugía General, Hospital Rey Juan Carlos, Móstoles, Madrid, España
| | - Manuel Durán
- Unidad de Cirugía Bariátrica, Servicio de Cirugía General, Hospital Rey Juan Carlos, Móstoles, Madrid, España
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Horkoff M, Purich K, Switzer N, Prasad S, Church N, Shi X, Mitchell P, Debru E, Karmali S, Gill R. A Shorter Circular Stapler Height at the Gastrojejunostomy during a Roux-En-Y Gastric Bypass Results in Less Strictures and Bleeding Complications. J Obes 2018; 2018:6959786. [PMID: 30002927 PMCID: PMC5996411 DOI: 10.1155/2018/6959786] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 04/16/2018] [Accepted: 05/02/2018] [Indexed: 11/18/2022] Open
Abstract
The laparoscopic Roux-en-Y gastric bypass (LRYGB) is prone to a number of complications, most notably at the gastrojejunostomy (GJ) staple line. The circular stapler technique is a common method used to create the GJ anastomosis. Although recent studies have shown a decreased rate of anastomotic strictures with shorter stapler heights, the optimal circular stapler height to use remains controversial. We therefore completed a retrospective cohort study within the Alberta Provincial Bariatric Program (APBP) to compare outcomes between the 3.5 mm and 4.8 mm stapler heights. We identified 215 patients who had a LRYGB done between the years 2015 and 2017. 143 patients had the GJ constructed with a 3.5 mm circular stapler height, with the remaining 72 patients having the GJ fashioned with a 4.8 mm stapler height. The rate of anastomotic stricturing was lower in the 3.5 mm stapler group compared to the other cohort (3.5 versus 13.9%, resp., p=0.008). Likewise, the overall rate of bleeding complications was lower in the 3.5 mm stapler group compared to the 4.8 mm group (6.3 versus 15.3%, resp., p=0.04). The rate of anastomotic stricturing and postoperative bleeding is lower with the use of a 3.5 mm circular stapler compared to a 4.8 mm circular stapler when forming the GJ.
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Affiliation(s)
- Michael Horkoff
- Department of Surgery, University of Calgary, 1023 North Tower, 1403–29 Street NW, Calgary, AB, Canada T2N 2T9
| | - Kieran Purich
- Faculty of Medicine and Dentistry, 2J2.00 WC Mackenzie Health Sciences Centre, University of Alberta, 8440 112 Street NW, Edmonton, AB, Canada T6G 2R7
| | - Noah Switzer
- Department of Surgery, 2D WC Mackenzie Health Sciences Centre, University of Alberta, 8440 112 Street NW, Edmonton, AB, Canada T6G 2B7
| | - Shalvin Prasad
- Department of Surgery, University of Calgary, 1023 North Tower, 1403–29 Street NW, Calgary, AB, Canada T2N 2T9
| | - Neal Church
- Department of Surgery, University of Calgary, 1023 North Tower, 1403–29 Street NW, Calgary, AB, Canada T2N 2T9
| | - Xinzhe Shi
- Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, 5th Floor, 10240 Kingsway Ave., Edmonton, AB, Canada T5H 3V9
| | - Philip Mitchell
- Department of Surgery, University of Calgary, 1023 North Tower, 1403–29 Street NW, Calgary, AB, Canada T2N 2T9
| | - Estifanos Debru
- Department of Surgery, University of Calgary, 1023 North Tower, 1403–29 Street NW, Calgary, AB, Canada T2N 2T9
| | - Shahzeer Karmali
- Faculty of Medicine and Dentistry, 2J2.00 WC Mackenzie Health Sciences Centre, University of Alberta, 8440 112 Street NW, Edmonton, AB, Canada T6G 2R7
- Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, 5th Floor, 10240 Kingsway Ave., Edmonton, AB, Canada T5H 3V9
| | - Richdeep Gill
- Department of Surgery, University of Calgary, 1023 North Tower, 1403–29 Street NW, Calgary, AB, Canada T2N 2T9
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Silecchia G, Iossa A. Complications of staple line and anastomoses following laparoscopic bariatric surgery. Ann Gastroenterol 2017; 31:56-64. [PMID: 29333067 PMCID: PMC5759613 DOI: 10.20524/aog.2017.0201] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/08/2017] [Indexed: 12/12/2022] Open
Abstract
With over 600 million people being obese, and given the scientific demonstration of the advantages of surgical treatment, bariatric surgery is on the rise. The promising long-term results in terms of weight loss, and particularly in relation to comorbidities and the control/cure rate, mean that the number of procedures performed in all countries remains high. However, the risk of potentially complex or fatal complications, though small, is present and is related to the procedures per se. This review is a guide for bariatric and/or general surgeons, offering a complete overview of the pathogenesis of anastomosis and staple line following the most common laparoscopic bariatric procedures: sleeve gastrectomy, gastric bypass, and mini-gastric bypass. The review is divided according to the procedure and the complications (leak, bleeding and stenosis), and evaluates all the factors that can potentially improve or worsen the complication rate, representing a “unicum” in the present literature on bariatric surgery.
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Affiliation(s)
- Gianfranco Silecchia
- Department of Medical-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Centre of Excellence, University of Rome "La Sapienza", Rome, Italy
| | - Angelo Iossa
- Department of Medical-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Centre of Excellence, University of Rome "La Sapienza", Rome, Italy
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27
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Abstract
Weight regain after bariatric surgery is common and can be managed with surgical interventions or less morbid endoscopic techniques. These endoscopic approaches target structural postoperative changes that are associated with weight regain, most notably dilation of the gastrojejunal anastomosis aperture. Purse string suture placement, as well as argon plasma coagulation application to the anastomosis, may result in significant and durable weight loss. Furthermore, various endoscopic approaches may be used to safely and effectively manage other complications of bariatric surgery that may result in poor weight loss or weight regain after surgery, including fistula formation.
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Affiliation(s)
- Andrew C Storm
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02215, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02215, USA.
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Chagot C, Blonski M, Machu JL, Bracard S, Lacour JC, Richard S. Idiopathic Intracranial Hypertension: Prognostic Factors and Multidisciplinary Management. J Obes 2017; 2017:5348928. [PMID: 28884026 PMCID: PMC5572623 DOI: 10.1155/2017/5348928] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 07/03/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) mostly affects young obese women and can lead to permanent visual impairment. However, prognostic factors and therapeutic strategy remain unclear. METHODS We retrospectively collected data from all patients diagnosed and managed for IIH in our university center from January 2001 to December 2016. RESULTS Seventy-nine patients were diagnosed with IIH. Bilateral transverse sinus stenosis (TSS) was found in 74% of the population. Visual outcome at 6 months was poor for 46% of patients, including all patients presenting weight gain of at least 5% since diagnosis (p < 0.001), whereas mean body mass index at diagnosis was not different between patients with poor versus good outcome (32.9 ± 7.7 versus 34.6 ± 9.4 kg·m-2). Other significant factors of poor prognosis were bilateral TSS (OR = 5.2; 95 CI: 1.24-24.9; p = 0.024). Thirteen patients with poor outcome after 6-month assessment underwent unilateral TSS stenting leading to visual improvement in 11 cases. CONCLUSION Weight gain, rather than initial weight, emerged as the leading factor of poor visual outcome in patients with IIH, followed by presence of bilateral TSS. Consequently, first-line treatment must include dietary measures to control weight. Unilateral stenting appears to be a safe second-line treatment option for patients with bilateral TSS.
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Affiliation(s)
- Claire Chagot
- Department of Neurology, Stroke Unit, University Hospital of Nancy, 54035 Nancy, France
| | - Marie Blonski
- Department of Neurology, Stroke Unit, University Hospital of Nancy, 54035 Nancy, France
| | - Jean-Loup Machu
- Centre d'Investigation Clinique Plurithématique (CIC-P 1433), INSERM U1116, University Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France
| | - Serge Bracard
- Department of Neuroradiology, University Hospital of Nancy, 54035 Nancy, France
| | | | - Sébastien Richard
- Department of Neurology, Stroke Unit, University Hospital of Nancy, 54035 Nancy, France
- Centre d'Investigation Clinique Plurithématique (CIC-P 1433), INSERM U1116, University Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France
- *Sébastien Richard:
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