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1.
Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is associated with a relatively high incidence of internal hernias
(IH) when compared to the open operation. Methods: A search in PubMed MEDLINE from January 1994 through January 2006 was performed
(keywords: obesity, laparoscopy, gastric bypass and internal hernia). Results: 26 studies with a total of 11,918 patients were considered. 300 cases of IH occurred (rate 2.51%). IH occurred
116 times at the level of the transverse colon mesentery (69%), 30 at the Petersen's space (18%), and 22 at the entero-enterostomy
site (13%). 142 re-operations were performed laparoscopically (85.6%), and 24 by laparotomy (14.4%). Bowel resection was done
in 5 cases (4.7%). Mortality was 1.17%. Conclusions: IH after LRYGBP has an incidence of 2.51%. Closure of mesenteric defects
with non-absorbable running suture and antecolic Roux limb are recommended. Surgical exploration for suspicion of IH after
LRYGBP should be first done by laparoscopy. 相似文献
2.
Improvement of Hypothyroidism after Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity 总被引:1,自引:1,他引:0
Raftopoulos Y Gagné DJ Papasavas P Hayetian F Maurer J Bononi P Caushaj PF 《Obesity surgery》2004,14(4):509-513
Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been very effective in managing a broad range of morbid obesity-related
co-morbidities. We report a beneficial effect of LRYGBP that has not been previously observed. Methods: Between December 1999
and September 2002, 224 patients underwent LRYGBP. Preoperative assessment for hypothyroidism and follow-up data were prospectively
collected in our database. Improved thyroid function (ITF) or unchanged thyroid function (UTF) was determined by comparison of preoperative and postoperative thyroxine requirements. Results: 23
of 224 patients (10.3%) were treated preoperatively for hypothyroidism. During a median follow-up of 17 months, hypothyroidism
was improved in 10/23 patients (43.5%). 2 patients had complete resolution, and the remaining 8 had reduction (14%-50%) of
their thyroxine requirements. ITF occurred at a mean follow-up of 8.9 months and at a mean excess weight loss (EWL) of 57%.
6 of the 8 patients (75%) with ITF ≥ 25% had EWL >90% at last follow-up, compared to 1 out of 15 patients (6.6%) with UTF
or <25% improvement (P =0.001). Comparison of patients with ITF and UTF over time during a 20-month follow-up, showed no significant difference
in mean body mass index (BMI) and mean percentage of EWL. Conclusion: Improvement of hypothyroidism may be an additional benefit
of bariatric surgery that has not been previously reported. Reduction of thyroxine requirements is most likely the result
of the decrease in the BMI. 相似文献
3.
Yong Zhang Hongzhi Zhao Zhanguo Cao Xiangyu Sun Chen Zhang Wang Cai Rong Liu Sanyuan Hu Mingfang Qin 《Obesity surgery》2014,24(10):1617-1624
Background
No randomized comparative trials have presented long-term outcomes for laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). The present study was designed to compare the efficacy and safety of these two procedures.Methods
From January 2007 to July 2008, 64 eligible patients were randomly assigned to LSG or LRYGB. During the 5-year follow-up, we compared morbidity rate, body mass index (BMI), percent of excess weight loss (%EWL), Moorehead-Ardelt (M-A) II quality of life, and resolution or improvement rate of obesity-related comorbidities between the groups.Results
Both groups were matched with respect to age, gender, and BMI. Slightly more major complications were observed in patients undergoing LRYGB (P?>?0.05). Weight loss was significantly better with LRYGB except during the first postoperative year. At 5 years, %EWL for LSG and LRYGB was 63.2?±?24.5 % and 76.2?±?21.7 % (P?=?0.02), respectively. No statistical difference was observed in quality of life between the groups at all intervals (P?>?0.05). At the last follow-up, most comorbidities in both groups were resolved or improved, with no difference between the groups (P?>?0.05).Conclusion
LRYGB and LSG are equally safe and effective in quality of life and improvement or resolution of comorbidities, and LRYGB possesses the superiority in terms of weight loss. Further studies are needed to evaluate micronutrient deficiencies of these procedures. 相似文献4.
Superior Mesenteric Artery Syndrome after Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity 总被引:1,自引:0,他引:1
Goitein D Gagné DJ Papasavas PK Dallal R Quebbemann B Eichinger JK Johnston D Caushaj PF 《Obesity surgery》2004,14(7):1008-1011
Gastrointestinal obstructive complications after laparoscopic Roux-en-Y gastric bypass (LRYGBP) are not uncommon. Their usual
causes are strictures, internal hernias and adhesions. Superior mesenteric artery (SMA) syndrome is a rare disorder caused
by compression of the third portion of the duodenum by the SMA that can occur after rapid weight loss. This has been reported
in patients with scoliosis, burns, immobilization in body casts, and idiopathic weight loss. SMA syndrome following bariatric
surgery has not been reported. We present 3 cases of SMA syndrome after LRYGBP and extensive weight loss. Two patients underwent
laparoscopic duodenojejunostomy and the third patient was treated with intravenous hyperalimentation. All three are symptom
free at 4-18 months follow-up. The diagnosis of SMA syndrome should be considered in bariatric surgery patients with rapid
weight loss who develop atypical, recurrent obstructive symptoms not attributable to other common causes. 相似文献
5.
Jose Luis Leyba Salvador Navarrete Aulestia Salvador Navarrete Llopis 《Obesity surgery》2011,21(2):212-216
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most widely used bariatric procedures today, and laparoscopic
sleeve gastrectomy (LSG) as a single-stage procedure for the treatment of morbid obesity is becoming increasingly popular.
In this study, we prospectively compared both techniques in order to establish whether there is any superiority of one over
the other based on morbidity and effectiveness. From January 2008 to December 2008, 117 obese patients with indication for
bariatric surgery were assigned by patient choice after informed consent to either a LRYGB procedure (n = 75) or a LSG procedure (n = 42). We determined operative time, length of stay, morbidity, co-morbidity outcomes, and excess weight loss at 1 year postoperative.
Both groups were comparable in age, sex, body mass index, and co-morbidities. Mean operative time of LSG was 82 min while
LRYGB was 98 min (p < 0.05). Differences in length of stay, major complications, improvement in co-morbidities, and excess weight loss were not
significant (p > 0.05). One year after surgery, average excess weight loss was 86% in LRYGB and 78.8% in LSG (p > 0.05). In the short term, both techniques are comparable regarding safety and effectiveness, so not one procedure is clearly
superior to the other. 相似文献
6.
Literature search was performed for bariatric surgery from inception to September 2013, in which the effects of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) on body mass index (BMI), percentage of excess weight loss (EWL%), and diabetes mellitus (DM) were compared 2 years post-surgery. A total of 9,756 cases of bariatric surgery from 16 studies were analyzed. Patients receiving LRYGB had significantly lower BMI and higher EWL% compared with those receiving LSG (BMI mean difference (MD)?=??1.38, 95 % confidence interval (CI)?=??1.72 to ?1.03; EWL% MD?=?5.06, 95 % CI?=?0.24 to 9.89). Improvement rate of DM was of no difference between the two types of bariatric surgeries (RR?=?1.05, 95 % CI?=?0.90 to 1.23). LRYGB had better long-term effect on body weight, while both LRYGB and LSG showed similar effects on DM. 相似文献
7.
Anastomotic Leak following Antecolic versus Retrocolic Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity 总被引:1,自引:0,他引:1
Background Laparoscopic Roux-en-Y gastric bypass(LRYGBP) is the most commonly performed operation for the treatment of morbid obesity
in the United States. Previous reports suggest that postoperative complications may be influenced by Roux limb orientation
(antecolic versus retrocolic), although thisremains controversial. The aim of this study was toanalyze our experience with
anastomotic leaks following LRYGBP with an antecolic- versus retrocolicrouted Roux limb.
Methods During the 2-year period of June 2003 to June 2005, 353 patients underwent a LRYGBP. 135 were antecolic and 218 retrocolic.
All cases were performedby one of three bariatric surgeons. The decisionto perform antecolic versus retrocolic LRYGBP was
left to the surgeon’s preference. The primary outcome measure was anastomotic leak.
Results Mean follow-up was 28 weeks. There wereno perioperative deaths. Overall complication rate was 16.9%. 17 gastrojejunal leaks
(4.8%) were identified, consisting of 12 intraoperative leaks (3.4%) and 5 postoperative leaks (1.4%). Postoperative gastrojejunal
leak rate was higher in the antecolic group (P = 0.04).
Conclusion Mortality and complication rates were consistent with reported benchmarks on the efficacy and safety of LRYGBP. Our review
suggests that anastomotic leak may be more common after antecolic than after retrocolic LRYGBP for morbid obesity. A prospective
randomized study is needed to determine whether antecolically-routed Roux limb is an independent predictor for anastomotic
leak following LRYGBP. 相似文献
8.
Background
Laparoscopic mini-gastric bypass (MGBP) represents a simpler alternative to Roux-en-Y gastric bypass. The placement of a silastic ring (SR) may enhance excess weight loss and minimize weight regain. This study reports on the results of a consecutive cohort of patients undergoing SR-MGBP in a single centre.Methods
Short- and medium-term outcomes of 156 consecutive patients undergoing surgery between August 2005 and January 2008 were analysed. Weight loss, comorbidity resolution and morbidity/mortality were assessed.Results
A total of 156 patients (78% female, 22% male) with a mean (range) age of 44 years (18–63), pre-operative weight of 129 kg (83–197) and body mass index of 46 kg/m2 (35–64) underwent surgery. Eighty-seven percent had pre-operative comorbidities, and median (range) follow-up was 35 months (6–72). Mean (SD) % excess weight loss (EWL) at 6, 12, 24, 36 and 60 months was 74.6 (19.5), 93.4 (21.1), 98.8 (27.6), 93.5 (20.1) and 89 (16.1) respectively. Thirty-seven percent had complete resolution of comorbidities and 67.3% required vitamin/mineral supplementation. Overall, 10.3% patients suffered early complications, of which 7.7% were minor and 2.6% were major. A total of 45.5% patients suffered late complications, of which 34.6% were minor and 10.9% were major. Food intolerance/vomiting, bile reflux and stomal ulcer were seen in 18.6, 10.3 and 7.7% of patients, respectively. Surgical re-intervention was required in 12.8% of patients. There were no deaths.Conclusions
Whilst SR-MGBP achieves excellent EWL with low mortality, there is a high incidence of food intolerance/vomiting likely related to the silastic ring. The majority of complications were managed with pharmacological and endoscopic intervention, although 13% required reoperation within 5 years. 相似文献9.
Roberto M. Tacchino Francesco Greco Daniele Matera Giada Diflumeri 《Obesity surgery》2010,20(8):1154-1160
Background
Single-incision laparoscopic surgery (SILS) has been developed with the aim of reducing the invasiveness of traditional laparoscopy. 相似文献10.
11.
BACKGROUND: Morbid obesity is associated with significant co-morbid illnesses and mortality. Hyperlipidemia is strongly associated with atherosclerosis and cardiovascular disease. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a proven and effective procedure for the treatment of morbid obesity and its related co-morbid illnesses. In a randomized prospective clinical trial, partial ileal bypass showed sustained control of hyperlipidemia and reduced comorbidities. Given risks of surgery, pharmacologic agents are the current primary therapy for hyperlipidemia. However, a morbidly obese patient with medically refractory hyperlipidemia may benefit from a combined laparoscopic Roux-en-Y gastric bypass and partial ileal bypass. We are describing the first case of a totally laparoscopic approach. METHODS: A 56-year-old female patient with morbid obesity (BMI 45.2 kg/m(2)) and medically refractive hyperlipidemia underwent a combined LRYGB and partial ileal bypass in 2002. She was continuously followed for 5 years for weight profile, hyperlipidemia, post-operative complications, and morbidity. RESULTS: Five-year follow-up of the patient showed sustained excess body weight loss. Her lipid profile has approached normal ranges with less medication. She experienced no comorbidities related to surgery or hyperlipidemia. CONCLUSIONS: Laparoscopic Roux-en-Y gastric bypass and partial ileal bypass may be the best option for the patient who has morbid obesity and medically refractory hyperlipidemia and should be considered for select patients. 相似文献
12.
13.
Background: Laparoscopic Roux-en-Y gastric bypass (RYGBP) is being performed widely as a treatment of choice for morbid obesity.
We present our method and experience with the first 150 consecutive cases of laparoscopic RYGBP with a 2-m long biliopancreatic
limb (BP-limb). Methods: Between November 2001 and November 2003, a prospective analysis of 150 patients was performed identifying
technical success and complications. Before surgery, patients underwent a strict multidisciplinary behavioral program. At
operation the stomach was transected proximally with a linear stapler (60-mm, Endo-GIA) to create a prolongation of the esophagus
(gastric tube) along the lesser curvature, resulting in a 40-50 ml pouch. Two meters of the proximal jejunum were bypassed
(BP-limb), creating an antecolic Roux-en-Y gastro-jejunostomy to the posterior wall of the gastric tube using a 45-mm linear
Endo-GIA stapler. The entero-anastomosis was created 50 cm below the gastro-jejunostomy, also with a 45-mm linear Endo-GIA.
Results: Mean BMI was 50.0, and 78% of patients were females. With 100% follow-up, we found an EWL of 50% 6 months after surgery,
gradually rising to 80% after 18 months. The mean operating time was 116 min for the first 50 cases and decreased to 82 min
for the last 50 cases. Intestinal leakage occurred in 5 patients (3%) and bleeding in 5 (3%). Most of these complications
occurred in the first 50 cases, and all but one were treated successfully with an early laparoscopic re-operation. Marginal
ulcers were found in 16.6% of patients. No internal hernias have occurred. Conclusion: The operation demands advanced laparoscopic
skills, but technically it is relatively simple and has an acceptable complication rate. Short-term results regarding excess
weight loss are at least comparable to the RYGBP with a long alimentary limb. 相似文献
14.
Stoopen-Margain E Fajardo R España N Gamino R González-Barranco J Herrera MF 《Obesity surgery》2004,14(2):201-205
Background: Morbid obesity requires life-long treatment, and bariatric surgery provides the best results. Among the bariatric
procedures, laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been considered to be superior. However, it requires advanced
laparoscopic skills and a learning curve. We analyzed our results in an initial series of 100 patients. Methods: Data of 100
consecutive patients who underwent LRYGBP for morbid obesity in a 2.5-year period were prospectively collected and analyzed
with emphasis on results and complications. Results: Mean age was 31±5 years. There were 63 woman and 37 men. Preoperative
BMI was 50±9 kg/m2. 33 patients were considered super-obese (BMI>50). Mean operative time was 3.8 ± 0.7 hours. Two patients required conversion
to open surgery. Mean hospital stay was 6 days. Complications occurred in 10 patients. Mortality rate was 2%. Excess body
weight loss was as follows: 33 ± 8% at 3 months (n=92), 47 ± 2% at 6 months (n=82), 62 ± 4% at 1 year (n= 70), 66 ± 5% at
18 months (n= 63) and 67 ± 8% at 2 years (n= 35). There was significant improvement in several co-morbid conditions, such
as diabetes and hypertension. Conclusion: LRYGBP is a reproducible technique. It requires the combination of bariatric and
laparoscopic expertise. 相似文献
15.
Background: Roux-en-Y gastric bypass (RYGBP) has long been associated with the possible development of internal hernias, with
a reported incidence of 1-5%. Because it induces fewer adhesions than laparotomy, the laparoscopic approach to this operation
appears to increase the rate of this complication, which can present dramatically. Methods: Data from all patients undergoing
bariatric surgery are introduced prospectively in a data-base. Patients who were reoperated for symptoms or signs suggestive
of an internal hernia were reviewed retrospectively, with special emphasis on clinical and radiological findings, and surgical
management. Results: Of 607 patients who underwent laparoscopic primary or reoperative RYGBP in our two hospitals between
June 1999 and January 2006, 25 developed symptoms suggestive of an internal hernia, 2 in the immediate postoperative period,
and 23 later on, after a mean of 29 months and a mean loss of 14.5 BMI units. 9 of the latter presented with an acute bowel
obstruction, of which 1 required small bowel resection for necrosis. Recurrent colicky abdominal pain was the leading symptom
in the others. Reoperation confirmed the diagnosis of internal hernia in all but 1 patient. The most common location was the
meso-jejunal mesenteric window (16 patients, 56%), followed by Petersen's window (8 patients, 27%), and the mesocolic window
(5 patients, (17%). Patients in whom the mesenteric windows had been closed using running non-absorbable sutures had fewer
hernias than patients treated with absorbable sutures at the primary procedure (1.3% versus 5.6%, P=0.03). Except in the acute setting, clinical and radiological findings were of little help in the diagnosis. Conclusions:
Except in the setting of acute obstruction, clinical and radiological findings usually do not help in the diagnosis of internal
hernia. A high index of suspicion, based mainly on the clinical history of recurrent colicky abdominal pain, is the only means
to reduce the number of acute complications leading to bowel resection by offering the patient an elective laparoscopic exploration
with repair of all the defects. Prevention by carefully closing all potential mesenteric defects with running non-absorbable
sutures during laparoscopic RYGBP, which we consider mandatory, seems appropriate in reducing the incidence of this complication. 相似文献
16.
O. N. Tucker S. Szomstein R. J. Rosenthal 《Journal of gastrointestinal surgery》2007,11(12):1673-1679
Background Gastro–gastric fistula (GGF) formation is uncommon after divided laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid
obesity. Optimal surgical management remains controversial.
Methods A retrospective review was performed of a prospectively maintained database of patients undergoing LRYGB from January 2001
to October 2006.
Results Of 1,763 primary procedures, 27 patients (1.5%) developed a GGF and 10 (37%) resolved with medical management, whereas 17
(63%) required surgical intervention. An additional seven patients requiring surgical intervention for GGF after RYGB were
referred from another institution. Indications for surgery included weight regain, recurrent, or non-healing gastrojejunal
anastomotic (GJA) ulceration with persistent abdominal pain and/or hemorrhage, and/or recurrent GJA stricture. Remnant gastrectomy
with GGF excision or exclusion was performed in 23 patients (96%) with an average in-hospital stay of 7.5 days (range, 3–27).
Morbidity in six patients (25%) was caused by pneumonia, n = 2; wound infection, n = 2; staple-line bleed, n = 1; and subcapsular splenic hematoma, n = 1. There were no mortalities. Complete resolution of symptoms and associated ulceration was seen in the majority of patients.
Conclusion Although uncommon, GGF formation can complicate divided LRYGB. Laparoscopic remnant gastrectomy with fistula excision or exclusion
can be used to effectively manage symptomatic patients who fail to respond to conservative measures.
This paper was presented at the SSAT Poster Presentation session on May 21st 2007 at the SSAT Annual Meeting at Digestive
Disease Week, Washington (poster ID M1590). 相似文献
17.
Background Gastric bypass surgery is an effective and long-lasting treatment of morbidly obese patients. However, the bypass limb may
need to be tailored in morbidly obese patients with a wide range of obesity. The aim of the present study was to report clinical
result of tailored bypass limb in a group of patients receiving laparoscopic mini-gastric bypass surgery.
Methods From Jan 2002 to Dec 2006, laparoscopic mini-gastric bypass was performed in 644 patients [469 women, 175 men: mean age 30.5 ± 8.1 years;
mean body mass index (BMI) 43.1 ± 6.0] in our department. The gastric bypass limb was tailored according to the preoperative
BMI. The clinical data and outcomes were analyzed. All the clinical data were prospectively collected and stored.
Results Two hundred eighty-six patients belonged to lower BMI (BMI < 40; mean 36.0), 286 patients moderate BMI (BMI 40–50; mean 43.2),
and 72 patients higher BMI (BMI > 50; mean 55.4). All procedures were completed laparoscopically. Mean operative time was
130 min, and mean hospital stay was 5.0 days. Twenty-three minor early complications (4.3%) and 13 major complications (2.0%)
were encountered, with one death occurred (0.016%). There was no significant difference in operation time and complication
rate between the groups. The mean bypass limb was 150 cm for the lower BMI group, 250 cm for moderate BMI group, and 350 cm
for the higher BMI group. The mean BMI reduction 2 years after surgery was 10.7, 15.5, and 23.3 for the lower, moderate, and
higher BMI group. The weight loss curves and resolution of obesity related comorbidities were compatible with the tailored
bypass limbs between the groups. However, the lower BMI patients had more severe anemia than the other two groups.
Conclusion Morbidly obese patients receiving gastric bypass surgery may need to tailor the bypass limb according to BMI. The application
of gastric bypass in lower BMI patients should be more carefully. 相似文献
18.
Background: Laparoscopic gastric bypass (LGBP) is a well-established procedure for the surgical management of morbid obesity.
Most surgeons create the gastroenteral anastomosis by using the circular EEA stapler. We describe an alternative laparoscopic
anastomotic technique using the EndoGIA linear stapling device. Methods: The stomach was proximally transected with a linear
stapler (45 mm, Endo-GIA) to create a 15 to 20 ml pouch. Next, an antecolic Roux-en-Y gastroenterostomy was performed, using
the 45 mm Endo-GIA. The proximal loop of the intestine was then separated from the anastomotic site by the Endo-GIA. Finally,
the Endo-GIA was used for the intraabdominal creation of a side-to-side enteroenterostomy. Results: Between June and August
2001, 5 patients with mean BMI 56.7 kg/m2±7.3 underwent LGBP. All patients were seen 6 months post-surgery. Operating time was 7.5 and 6.5 hours for the first 2 operations,
but was under 4.5 h for the next 3 cases. 1 patient suffered from perioperative hypoxia leading to long-term artificial respiration.
6 weeks after surgery, 1 patient developed obstruction due to torsion of the enteroenterostomy and required open revision.
The 3 remaining patients made an uneventful recovery. All patients lost considerable weight (mean 36.5 kg; [range 32 to 45]
after 6 months). No stenosis or anastomotic leakage was noted. Conclusions: A linear stapled anastomosis is an alternative
to the use of the circular stapler. 相似文献
19.
Jejunoileal Bypass in the Treatment of Morbid Obesity: a 25-Year Follow-up Study of 36 Patients 总被引:1,自引:1,他引:0
Background: Induction of intestinal malabsorption by jejunoileal (JI) bypass was a widely performed procedure for morbid obesity
in the 1970's.The purpose of this study was to evaluate the long-term results. Methods: A total of 36 patients underwent JI
bypass from November 1971 to September 1976. At operation the median age was 33 years and median BMI 42 kg/m2. Shunt lengths varied between 45 and 60 cm. The present check-up of the 28 patients still alive included clinical examination,
biochemical tests, bone density measurement and measurement of fecal fat excretion. Results: 10 patients (28%) had had their
shunt reversed. With one exception these patients quickly regained weight, and 5 (50%) of them were dead. 23 patients with
an intact JI shunt are alive, but 5 of them have had the shunt shortened due to weight gain.Their median age today is 56 years,
and median BMI is 30. None of these patients were known to have coronary heart disease or diabetes mellitus at follow-up.
Malabsorption of fat is still present. Blind loop syndrome, flatulence, foul fecal smell and diarrhea are the most troublesome
long-term sequelae. Vitamin and mineral deficiencies are common. 2 of 21 patients (age 80 and 57 years) have osteoporosis.
Conclusion: When the optimal shunt length for the individual patient is found, JI bypass maintains a substantially reduced
weight for 25 years. Vitamin and mineral deficiencies are common, but no serious clinical deficiency states are seen. 相似文献
20.
Elias Chahine Radwan Kassir Mazen Dirani Saadeddine Joumaa Tarek Debs Elie Chouillard 《Obesity surgery》2018,28(4):939-944