Influence of pouch and stoma size on weight loss after gastric bypass

BackgroundEnlargement of the gastric pouch and/or gastrojejunostomy after Roux-en-Y gastric bypass (RYGB) is postulated to be the antecedent to suboptimal weight loss or weight regain. The present study evaluated the gastric pouch and stoma dimensions in RYGB patients and correlated them with the weight loss outcomes.MethodsPatients who underwent upper endoscopy for investigation of gastrointestinal symptoms or weight regain after RYGB were identified. The stoma was considered enlarged if >2 cm in diameter and the pouch was considered enlarged if >6 cm long or >5 cm wide. Successful weight loss was defined as excess weight loss >50% or a body mass index decrease to ≤30 kg/m².ResultsA total of 380 patients had nondiagnostic upper endoscopy findings at a mean post-RYGB interval of 5.9 ± 4.0 years. Among these were 175 patients (group A; 87% women) who had successful weight loss and 205 patients (group B; 86% women) who were referred for investigation of weight regain. The pouch and stoma size were normal in most of the patients in group A (63.4%) compared with 28.8% of the patients in group B (P <.001). The most common abnormality was an enlarged stoma. The pouch length, pouch volume, and stoma diameter correlated inversely with excess weight loss. Multivariate analysis identified that the stoma diameter was independently associated with weight regain after RYGB.ConclusionThe current definition of a “normal” size pouch/stoma is associated with optimal weight loss after RYGB, although this might need to be reviewed. Patients who regain weight are likely to have abnormal anatomy, in particular, stoma enlargement. The surgical RYGB technique and methods of evaluating the gastric anatomy in RYGB patients need to be standardized, intraoperatively and postoperatively.     

Adjustable gastric band placed around gastric bypass pouch as revision operation for failed gastric bypass

BackgroundThe failure rate after gastric bypass surgery for weight loss has been reported at 10–20%. To date, no reliably safe and effective salvage operation is available. This pilot study was conducted to determine whether restriction of the Roux-en-Y gastric bypass (RYGB) pouch using the adjustable gastric band (AGB) is an effective revision operation.MethodsA prospectively accrued group of patients who underwent revisional surgery using the AGB placed around the RYGB pouch by our bariatric surgical group from October 2004 to October 2006 was analyzed.ResultsOf the 10 patients accrued during this period, 2 were lost to follow-up, leaving 8 patients for analysis. Of the 8 patients, 1 was a man and 7 were women. The mean prerevision weight was 135.75 kg (range 105–165), and the body mass index was 48.42 kg/m² (range 38.92–55). The mean weight loss at 1 year of follow-up was 17.03 kg (range 0.2–42), with a mean percentage of excess weight loss of 24.29% (range 0.2–49.2%). The mean weight loss of the 5 patients with 2 years of follow-up was 36.4 kg (range 20–58), with a mean percentage of excess weight loss of 48.7% (range 21.8–98.1%). One patient with 3 years of follow-up had a weight loss of 56 kg and a percentage of excess weight loss of 66.2%. Three minor complications developed: 2 AGB port-related complications requiring port revision and 1 postoperative wound hematoma requiring evacuation. No band erosions or band slippages occurred, and no major complications developed.ConclusionIn our study, an AGB placed around the RYGB pouch was a safe and effective revision operation for a failed RYGB operation.     

Surgical therapy of weight regain after Roux-en-Y gastric bypass

BackgroundRoux-en-Y gastric bypass (RYGB) is a well-established surgical method for morbid obesity; however, weight regain (WR) after initially good results may be considered an issue, the treatment of which has found no consensus yet.ObjectivesThe aim of this study was to compare the different surgical methods treating WR after RYGB that are used at the Vienna Medical University in a larger number of patients, concerning further weight loss, complications, and reoperations.SettingUniversity hospital, Austria.MethodsThis study includes all patients with RYGB who were reoperated due to WR at the Vienna Medical University by December 2016 (n = 84). The follow-up rate was 93%. The following 4 approaches to treating WR after RYGB were taken: (1) pouch resizing, (2) pouch banding, (3) pouch resizing plus pouch banding, and (4) common limb shortening (i.e., distalization).ResultsThe mean maximum excess weight loss referring to the WR procedure in the 4 groups was as follows: group 1: 69.0% ± 35.2%, group 2: 62.8% ± 39.5%, group 3: 83.1% ± 30.9%, and group 4: 81.5% ± 41.6%. Reoperations occurred in the following different groups: group 1 had 2 balloon dilations (20%), groups 2 (n = 13) and 3 (n = 29) had 5 (38% and 17%) band removals each, and group 4 had 9 reversal procedures due to malnutrition (30%).ConclusionsThere are nonsignificant differences in terms of additional weight loss between the different methods. However, differences lay in the areas of adverse symptoms and further reoperations. While there was no risk of malnutrition with pouch resizing, there was with distalization. Pouch banding (with or without resizing) poses a higher risk of dysphagia.     

Incisionless revision of post-Roux-en-Y bypass stomal and pouch dilation: multicenter registry results

BackgroundSurgical revision for weight regain after Roux-en-Y gastric bypass (RYGB) has been tempered by the high complication rates associated with standard approaches. Endoluminal revision of stoma and pouch dilation should intuitively confer a better risk profile. However, questions of clinical safety, durability, and weight loss need to be answered. We report our multicenter intraoperative experience and postoperative follow-up to date using the Incisionless Operating Platform for this patient subset.MethodsThe patients who had regained significant weight ≥2 years after RYGB after losing ≥50% of excess body weight after RYGB were endoscopically screened for stomal and/or pouch dilation. Qualified patients underwent incisionless revision using the Incisionless Operating Platform to reduce the stoma and pouch size by placing anchors to create tissue plications. Data on the safety, intraoperative performance, postoperative weight loss, and anchor durability were recorded to date as a part of 2 years of postoperative follow-up.ResultsA total of 116 consecutive patients were prospectively studied. Anchors were successfully placed in 112 (97%) of 116 patients, with an average intraoperative stoma diameter and pouch length reduction of 50% and 44%, respectively. The operating room time averaged 87 minutes. No significant complications occurred. At 6 months after the procedure (n = 96), an average of 32% of weight regain that had occurred after RYGB had been lost. The percentage of excess weight loss averaged 18%. The 12-month esophagogastroduodenoscopy results confirmed the presence of the anchors and durable tissue folds.ConclusionsIncisionless revision of stoma and pouch dilation using the Incisionless Operating Platform can be performed safely. The data to date have demonstrated mild-to-moderate weight loss, and the early 12-month endoscopic images have confirmed anchor durability. Patients were actively followed up to document the long-term durability of this intervention in the entire patient subset.     

Laparoscopic conversion of failed gastric bypass to duodenal switch: technical considerations and preliminary outcomes

BACKGROUND: Weight loss failure after Roux-en-Y gastric bypass (RYGB) is a challenging problem facing bariatric surgeons today. Conversion from RYGB to biliopancreatic diversion with duodenal switch (BPD-DS) might provide the most durable weight loss of all revision procedures currently available. Revision to BPD-DS can be done laparoscopically in 1 or 2 stages and involves 4 anastomoses: gastrogastrostomy, duodenoileostomy, ileoileostomy, and jejunojejunostomy (to reconnect the old Roux limb). This study reports on our early outcomes after laparoscopic conversion from RYGB to BPD-DS. METHODS: The data from all patients undergoing conversion from failed RYGB to BPD-DS were retrospectively reviewed. The data analyzed included age, body mass index, excess weight loss, method of gastrogastrostomy, and morbidity/mortality. RESULTS: Twelve patients were identified for analysis. The mean age and body mass index before conversion was 41 years and 41 kg/m(2), respectively. Of these 12 patients, 4 (33%) had undergone revision surgery (lengthening of the Roux limb, resizing the gastric pouch, adjustable band on pouch, or distal gastric bypass) before conversion; 8 (66%) had obesity-related co-morbidities; 7 (58%) underwent conversion to BPD-DS in 1 stage. Most gastrogastrostomies were performed using the 25-mm circular stapler. No patient died and no leaks developed. One patient required laparotomy, and 4 developed stricture at the gastrogastrostomy. The patients lost a dramatic amount of weight after conversion to BPD-DS, with a mean body mass index and excess weight loss of 31 kg/m(2) and 63%, respectively, at 11 months postoperatively. All co-morbidities resolved completely with the weight loss. CONCLUSION: Our preliminary results indicate that laparoscopic conversion to BPD-DS from failed RYGB is highly effective with an acceptable morbidity. Using a linear stapler to construct the gastrogastrostomy might reduce the stricture rate.     

Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial

BackgroundRoux-en-Y gastric bypass surgery is the leading surgical treatment of morbid obesity in the United States. The role of preoperative weight loss in gastric bypass surgery remains controversial. We performed a prospective randomized trial to determine whether preoperative weight loss results in better outcomes after laparoscopic gastric bypass.MethodsA total of 100 patients undergoing laparoscopic gastric bypass surgery from May 2004 to October 2005 were randomized preoperatively to either a weight loss group with a 10% weight loss requirement or a group that had no weight loss requirements. The patients were followed prospectively. The variables analyzed included perioperative complications, operative time, postoperative weight loss, and resolution of co-morbidities.ResultsData were available for 26 patients in the weight loss group and 35 in the nonweight loss group. The 2 groups had similar preoperative characteristics, conversion and complication rates, and resolution of co-morbidities. The initial body mass index was 48.7 kg/m² and 49.3 kg/m² for the weight loss group and nonweight loss group, respectively (P = NS). The preoperative body mass index was 44.5 kg/m² and 50.7 kg/m² for the weight loss group and nonweight loss group, respectively (P = 0.0027). The operative time was 220.2 and 257.6 minutes for the 2 groups (P = 0.0084). The percentage of excess weight loss at 3 and 6 months for the weight loss group and nonweight loss group was 44.1% and 33.1% (P = 0.0267) and 53.9% and 50.9% (P = NS), respectively. The interval to surgery from the initial consultation was 5.4 months and 5.2 months for the 2 groups (P = NS).ConclusionsPreoperative weight loss before laparoscopic Roux-en-Y gastric bypass was associated with a decrease in the operating room time and an improved percentage of excess weight loss in the short term. Preoperative weight loss, however, did not affect the major complication or conversion rates, and its long-term effects were not apparent through this study. Also, preoperative weight loss did not have any bearing on the resolution of co-morbidities.     

Roux-en-Y gastric bypass decreases serum inflammatory markers and cardiovascular risk factors in obese diabetics

BackgroundObesity and type 2 diabetes mellitus are associated with elevated levels of inflammatory markers. This chronic inflammation is known to contribute to increased risk of cardiovascular disease in these populations. Laparoscopic Roux-en-Y gastric bypass is associated with a high rate of diabetes remission. We hypothesize that laparoscopic Roux-en-Y gastric bypass decreases systemic inflammatory markers and cardiovascular disease risk factors in obese diabetics.MethodsThis was a single-institution prospective cohort study of 61 obese patients with type 2 diabetes mellitus. A total of 30 patients underwent laparoscopic Roux-en-Y gastric bypass surgery, and 31 patients underwent standard medical therapy with diabetes support and education. Collected data included preoperative and postoperative inflammatory biomarkers and clinical parameters.ResultsTwelve months after undergoing laparoscopic Roux-en-Y gastric bypass, controlling for sex and age, there was a significant correlation between a change in interleukin-6 and a change in systolic blood pressure (Spearman r = 0.41, P = .03). Similarly, when sex and age were controlled for in the laparoscopic Roux-en-Y gastric bypass group, a statistically significant relationship remained between percent excess weight loss and change in interleukin-6 (P = .001).ConclusionA significant relationship exists between decreased systemic interleukin-6 levels and both excess weight loss and lowered systolic blood pressure after laparoscopic Roux-en-Y gastric bypass in obese patients with diabetes mellitus. These correlations may explain the decreased risk of cardiovascular disease after surgical weight reduction in this patient population.     

Stoma size critical to 12-month outcomes in endoscopic suturing for gastric bypass repair

BackgroundRoux-en-Y gastric bypass (RYGB) is the most frequently performed bariatric procedure. However, weight regain after RYGB is common and often associated with pouch and stoma dilation. Historically, revision surgery has a greater risk of morbidity and mortality than the primary procedure. Endoscopic repair appears to be a safer option; however, current knowledge is limited regarding the longer term outcomes. Our objective was to prospectively collect the 12-month post-RYGB outcomes data after repair of dilated gastric tissue with an incisionless tissue approximation system in an open-label, single-group study at 9 U.S. sites.MethodsAdults ≥2 years after RYGB, with weight regain and pouch and/or stoma dilation underwent tissue plication with an endolumenal anchoring system to tighten dilated gastric tissue. The outcomes were captured, with statistical modeling used to identify the predictors of success.ResultsOf the 116 subjects, 112 (97%) had anchors successfully placed (mean 5.9 anchors/subject). The mean stoma diameter and pouch length after the procedure was 11.5 mm (50% reduction) and 3.3 cm (44% reduction), respectively. At 12 months after repair (n = 73), the mean weight loss and percentage of excess weight loss was 5.9 ± 1.1 kg and 14.5% ± 3.1%, respectively. Anchor presence was confirmed endoscopically in 61 (92%) of 66 patients at 1 year. Those with a dilated stoma (>12 mm) who had a postrepair diameter of <10 mm (n = 22, 30% of 66) had more than double the excess weight loss compared with the rest of the cohort (24% versus 10%, P = .03). No serious adverse events occurred.ConclusionThe 12-month outcomes have demonstrated the safety and durability of this method of gastric bypass repair. Aggressive reduction of stoma dilation was associated with superior weight loss.     

Adjustable gastric banding as revisional bariatric procedure after failed gastric bypass—intermediate results

BackgroundAlthough gastric bypass is the most common bariatric procedure in the United States, it is has been associated with a failure rate of 15% (range 5–40%). The addition of an adjustable gastric band to Roux-en-Y gastric bypass has been reported to be a useful revision strategy in a small series of patients with inadequate weight loss after proximal gastric bypass.MethodsWe report on 22 patients who presented with inadequate weight loss or significant weight regain after proximal gastric bypass. All patients underwent revision with the placement of an adjustable silicone gastric band around the proximal gastric pouch. The bands were adjusted at 6 weeks postoperatively and beyond, as needed. Complications and weight loss at the most recent follow-up visit were evaluated.ResultsThe mean age and body mass index at revision was 41.27 years (range 25–58) and 44.8 ± 6.34 kg/m², respectively. Patients had experienced a loss of 19%, 27%, 47.3%, 42.3%, 43%, and 47% of their excess weight at 6, 12, 24, 36, 48, and 60 months after the revisional procedure, respectively. Three major complications occurred requiring reoperation. No band erosions have been documented.ConclusionThe results from this larger series of patients have also indicated that the addition of the adjustable silicone gastric band causes significant weight loss in patients with poor weight loss outcomes after gastric bypass. That no anastomosis or change in absorption is required makes this an attractive revisional strategy. As with all revisional procedures, the complication rates appear to be increased compared with a similar primary operation.     

Laparoscopic Conversion of Laparoscopic Gastric Banding to Roux-en-Y Gastric Bypass: a Review of 70 Patients

Background: The feasibility and outcomes of conversion of laparoscopic adjustable gastric banding (LAGB) to laparoscopic Roux-en-Y gastric bypass (LRYGBP) was evaluated. Methods: From November 2000 to March 2004, all patients who underwent laparoscopic conversion of LAGB to LRYGBP were retrospectively analyzed. The procedure included adhesiolysis, resection of the previous band, creation of an isolated gastric pouch, 100-cm Roux-limb, side-to-side jejuno-jejunostomy, and end-to-end gastro-jejunostomy. Results: 70 patients (58 female, mean age 41) with a median BMI of 45±11 (27-81) underwent attempted laparoscopic conversion of LAGB to an RYGBP. Indications for conversion were insufficient weight loss or weight regain after band deflation for gastric pouch dilatation in 34 patients (49%), inadequate weight loss in 17 patients (25%), symptomatic proximal gastric pouch dilatation in 15 patients (20%), intragastric band migration in 3 patients (5%), and psychological band intolerance in 1 patient. 3 of 70 patients (4.3%) had to be converted to a laparotomy because of severe adhesions. Mean operative time was 240±40 SD min (210-280). Mean hospital length of stay was 7.2 days. Early complication rate was 14.3% (10/70). Late major complications occurred in 6 patients (8.6%). There was no mortality. Median excess body weight loss was 70±20%. 60% of patients achieved a BMI of <33 with mean follow-up 18 months. Conclusion: Laparoscopic conversion of LAGB to RYGBP is a technically challenging procedure that can be safely integrated into a bariatric treatment program with good results. Short-term weight loss is very good.     

Heterogeneity of weight loss after gastric bypass,sleeve gastrectomy,and adjustable gastric banding

Background

Laparoscopic Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, and laparoscopic adjustable gastric banding all lead to substantial weight loss in obese patients. Long-term weight loss can be highly variable beyond 1-year postsurgery. This study examines and compares the frequency distribution of weight loss and lack of treatment effect rates after laparoscopic Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, and laparoscopic adjustable gastric banding.

Early results of conversion of laparoscopic adjustable gastric band to Roux-en-Y gastric bypass

BackgroundAs the number of laparoscopic adjustable gastric bands (LAGBs) placed has increased, the number of patients requiring removal of the device has also increased.MethodsThe data from our institution, a U.S. university medical center, were reviewed to determine the feasibility, patient characteristics, and early results of converting patients from LAGB to laparoscopic Roux-en-Y gastric bypass.ResultsA total of 350 patients underwent LAGB placement at our institution from 2001 to 2008. Of these, 26 required conversion to laparoscopic Roux-en-Y gastric bypass for the following reasons: slippage, poor weight loss, LAGB intolerance, esophageal dilation, infection, and gastric ischemia. All conversions were completed laparoscopically. The average operating time and length of stay was 160 minutes and 3 days, respectively. Three complications developed. The average interval to conversion was 29 months. The average follow-up after conversion was 18 months. The average percentage of excess body weight loss at conversion was 23%. At 12 months after conversion, the patients had achieved an average percentage of excess body weight loss of 56% from their pre-LAGB weight.ConclusionThe increasing popularity of the LAGB has led to a considerable number of revisions of the device. Our early experience has shown that converting patients from LAGB to laparoscopic Roux-en-Y gastric bypass is feasible and safe and can offer patients substantial additional weight loss.     

Size matters: gastric pouch size correlates with weight loss after laparoscopic Roux-en-Y gastric bypass

Background Over the past 20 years, there has been an ongoing discussion about the importance of gastric pouch size as a key factor influencing weight loss after bariatric surgery. This analysis aimed to determine the relationship between initial gastric pouch size and excess weight loss (EWL) after laparoscopic Roux-en-Y gastric bypass (LRYGB). Methods Between August 2002 and March 2005, 320 LRYGB were performed at Yale New Haven Hospital. The patients’ demographics were entered into a longitudinal, prospective database. Upper gastrointestinal series were routinely performed on postoperative day 1. Pouch size was measured as area (cm²) on an anteroposterior radiograph at maximum pouch distention. Linear regression analysis was performed to determine the association between pouch size and weight loss at 6 and 12 months postoperatively. Adjustments were made for age, gender, and preoperative body mass index (BMI). Results The mean age of the patients was 41.2 years. Of the 320 study patients, 261 were women (81.6%) and 59 were men (18.4%). The mean preoperative BMI was 51.1 kg/m²; the mean 6-month EWL was 50.5%; the mean 12-month EWL was 62.5%; and the mean pouch size was 63.9 cm². A statistically significant, negative correlation between pouch size and EWL was found at 6 months (β = –0.241; p < 0.01) and at 12 months (β = –0.302; p < 0.02). The findings show that male gender (β = 0.147; p < 0.04) and preoperative BMI (β = 0.190; p < 0.01) are positively correlated with pouch size. Conclusion The analysis demonstrates that initial gastric pouch size is not the only significant component for successful weight loss after LRYGB. Male gender and increased preoperative BMI were identified as factors predicting pouch size. Efforts to standardize small pouch size for all patients seems important to the success of surgical therapy for morbid obesity.     

Roux limb obstruction secondary to constriction at transverse mesocolon rent after laparoscopic Roux-en-Y gastric bypass

BackgroundPartial small bowel obstruction can occur as a result of circumferential extrinsic compression of the Roux limb as it traverses the transverse mesocolic rent from thickened cicatrix formation in this area. The aim of this study is to examine the incidence of Roux limb compression with particular attention to the timing of presentation and associated weight loss in the setting of a university hospital in the United States.MethodsA retrospective chart review was performed of all patients undergoing laparoscopic Roux-en-Y gastric bypass who developed symptomatic small bowel obstruction requiring operative intervention from January 1, 2000 and September 15, 2006.ResultsOf 2215 patients, 20 (.9%) developed symptomatic Roux limb compression. The mean time to presentation was 48 days after LRYGB. By this stage, the mean percentage of excess body weight loss was 29%. Of the 20 patients, 19 underwent an upper gastrointestinal contrast study, the results of which confirmed the diagnosis. In all cases, laparoscopic intervention was successful in freeing the constricted Roux limb by dividing the cicatrix formation between the Roux limb and mesocolic window. Switching from continuous to interrupted closure of the space between Roux limb and mesocolic window appeared to reduce the incidence of this complication (P <.05).ConclusionNarrowing at the transverse mesocolon rent is an uncommon cause of small bowel obstruction after retrocolic laparoscopic Roux-en-Y gastric bypass. Unlike internal hernias, which tend to occur later in the clinical course and are associated with significant weight loss, Roux limb obstruction occurs earlier after gastric bypass and is not associated with significant weight loss. Interrupted closure of the mesocolic window might reduce the risk of Roux compression.     

The procedure of mesh wrapping the gastric pouch in cadaver study

Dietary and behavioral modifications have resulted in limited long-term success in curing morbidly obese patients, and surgery remains the only effective treatment. Of the surgical procedures that are the most commonly offered, Roux-en-Y gastric bypass (RYGB) appears to offer the best long-term results. However 5–15% of patients will not achieve successful weight loss after RYGB. There are many reports showing that the patients who underwent gastric bypass surgeries regain weight over time. The cause for this remains unclear. Several factors may contribute, including dilation of the gastric pouch and the gastrojejunal anastomosis. However, the data to support the link is sparse. The objective of this paper is to describe the surgical technique of wrapping the gastric pouch with a polytetrafluoroethylene (PTFE) mesh to prevent gastric pouch dilatation. In specific, we created a 20–30 ml gastric pouch and subsequently, the gastrojejunostomy was performed with a circular stapler. Afterwards, the mesentery was dissected and the gastric pouch was wrapped with the PTFE mesh. We have performed this procedure on three cadavers with an average operative time of 75 minutes. We found that the procedure of wrapping the gastric pouch was not particularly difficult. As a result, the gastric pouch, gastrojejunal anastomosis and the stump of the jejunum are all totally wrapped within the mesh. It may be effective in the prevention of dilatation.     

Pilot study evaluating technical feasibility and early outcomes of second-generation endosurgical platform for treatment of weight regain after gastric bypass surgery

BackgroundFor some gastric bypass patients, dilation of the gastrojejunal anastomosis (GJA) and/or gastric pouch is believed to contribute to weight regain. The present study had 2 objectives: (1) to assess the technical feasibility and safety of a novel endoscopic procedure called “revision obesity surgery endoscopic” (ROSE) using a second-generation, prototype endoscopic operating system that creates tissue plications to reduce the diameter of the GJA and the size of the gastric pouch; and (2) to assess the early outcomes regarding weight loss at a university hospital in the United States.MethodsThis was a prospective study of 5 patients who had regained a mean of 14.7 kg after gastric bypass with a dilated pouch and GJA on screening endoscopy. The gastric pouch and the GJA were measured before and after the procedure. The patients were followed up for a minimum of 3 months after the procedure. Weight changes were recorded.ResultsTechnical success was achieved in all 5 patients (100%). The mean weight loss in the successful cases was 7.8 kg at 3 months. No major complications developed.ConclusionThe results of our study have shown that the ROSE procedure using this second-generation prototype endoscopic operating system is technically feasible and appears safe. Our preliminary results suggest that the ROSE procedure is effective in reducing the size of both the GJA and the gastric pouch and could therefore be an alternative therapy for weight regain in postgastric bypass patients.     

Lack of correlation between variation in small-volume gastric pouch size and weight loss after laparoscopic Roux-en-Y gastric bypass

BACKGROUND: Controversy exists in published reports regarding the influence of gastric pouch size on weight loss after gastric bypass (GB). The purpose of this study was to determine whether variations in the anatomic size of small-volume (相似文献   

Utility of Divided Omentum for Preventing Complications Associated with Laparoscopic Gastric Bypass

Background Laparoscopic Roux-en-Y gastric bypass has emerged as a standard surgical treatment for morbid obesity. However, prevention of postoperative complications associated with bariatric surgery is an important consideration. Methods To reduce postoperative complications and achieve adequate body weight loss, we introduce a simple procedure using a divided omentum during laparoscopic Roux-en-Y gastric bypass. The actual aim of this procedure is to prevent leakage from the gastric pouch or anastomosis and the gastro-gastric fistula because of reentry of the alimentary tract. Between February 2002 and April 2007, we performed laparoscopic Roux-en-Y gastric bypass for morbid obesity in 94 patients. In the most recent 83 cases, our simple procedure using a divided omentum was employed. Results These patients comprised 20 males and 63 females, with a mean age of 38 years, and a mean body mass index of 44.1 kg/m². At surgery, the omentum is routinely divided using laparoscopic coagulating shears before performing gastrojejunostomy to reduce the tension on the anastomosis caused by the route of reconstruction. After performing hand-sewn gastrojejunostomy, the left side of the divided omentum is moved cranially and interposed between the gastric pouch and the excluded stomach. The omentum is then sutured from the posterior aspect of the gastric pouch to the anterior side of the anastomosis. Conclusion Our procedure using a divided omentum during bariatric surgery is feasible and safe for obtaining better outcomes without artificial materials. Although the long-term outcome of this technique is still unclear, we believe that it will contribute to decreasing the particular complications related to laparoscopic Roux-en-Y gastric bypass for morbid obesity.     

Revisional bariatric surgery is more effective for improving obesity-related co-morbidities than it is for reinducing major weight loss

BackgroundPatients having previous bariatric surgery are at risk for weight regain and return of co-morbidities. If an anatomic basis for the failure is identified, many surgeons advocate revision or conversion to a Roux-en-Y gastric bypass. The aim of this study was to determine whether revisional bariatric surgery leads to sufficient weight loss and co-morbidity remission.Patients and MethodsFrom 2005-2012, patients undergoing revision were entered into a prospectively maintained database. Perioperative outcomes, including complications, weight loss, and co-morbidity remission, were examined for all patients with a history of a previous vertical banded gastroplasty (VBG) or Roux-en-Y gastric bypass (RYGB).ResultsTwenty-two patients with a history of RYGB and 56 with a history of VBG were identified. Following the revisional procedure, the RYGB group experienced 35.8% excess weight loss (%EWL) and a 31.8% morbidity rate. For the VBG group, patients experienced a 46.2% %EWL from their weight before the revisional operation with a 51.8% morbidity rate. Co-morbidity remission rate was excellent. Diabetes (VBG:100%, RYGB: 85.7%), gastroesophageal reflux disease (VBG: 94.4%, RYGB: 80%), and hypertension (VBG: 74.2%, RYGB:60%) demonstrated significant improvement.ConclusionRevision of a failed RYGB or conversion of a VBG to a RYGB provides less weight loss and a higher complication rate than primary RYGB but provides an excellent opportunity for co-morbidity remission.