scholarly journals Laparoscopic Fundoplication Using the Excluded Stomach as a Novel Management Option for Refractory Bile Reflux Following One Anastomosis Gastric Bypass (OAGB)

2021 ◽  
Author(s):  
Senarath Bandara Werapitiya ◽  
Senarath Pradeep Ruwanpura ◽  
Tanya Rochelle Coulson
Keyword(s):  
Gastric Bypass ◽  
Bile Reflux ◽  
One Anastomosis Gastric Bypass ◽  
Short Term ◽  
Hrql Score ◽  
Global Satisfaction ◽  
Excluded Stomach ◽  
The Mean ◽  
Esophageal Sphincter

Abstract Background One anastomosis gastric bypass (OAGB) is now a mainstream bariatric procedure. Refractory gastroesophageal reflux is a significant complication following OAGB, and conversion to Roux-en-Y has long been the treatment of choice for this issue. Strengthening the lower esophageal sphincter by Nissen fundoplication (NF) has been reported as an effective anti-reflux surgery. Here we report the short-term outcomes of a modified NF procedure using the excluded stomach (excluded stomach fundoplication—ESF) to treat refractory bile reflux in post-OAGB patients. Methods Thirteen post-OAGB patients underwent ESF for refractory bile reflux during the study, as detailed in the surgical technique. This paper reports the 12 patients whose follow-up data are available. Results Following ESF, the GERD-HRQL heartburn score improved from 22.7 ± 3.9 to 1.8 ± 3.5 (p < 0.05). The mean aggregate GERD-HRQL score improved from 27.9 ± 5.3 to 5.7 ± 5.9 (p < 0.05). The GERD-HRQL global satisfaction score showed that 100% of patients were satisfied with the improvement of symptoms. The mean VISICK score improved from 3.8 ± 0.39 to 1.2 ± 0.39 (p < 0.05). One patient was returned to the operating theatre to have the wrap loosened due to dysphagia. Eleven patients did not require PPIs after surgery. Conclusions ESF significantly improved the VISICK score and GERD-HRQL of post-OAGB patients with refractory bile reflux in the short term. The current study is being continued to increase the sample size and the follow-up period.

Short-Term Results of Single-Anastomosis Gastric Bypass After Failed Sleeve Gastrectomy

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Alaa Abbas Sabry ◽  
Karim Sabry Abd-Elsamee ◽  
Mohamed Ibrahim Mohamed ◽  
Mohammed Mohamed Ahmed Abd-Elsalam
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Weight Regain ◽  
Revisional Surgery ◽  
One Anastomosis Gastric Bypass ◽  
Short Term ◽  
Multicenter Studies ◽  
Metabolic Outcomes

Abstract Background It is already known that Laparoscopic sleeve gastrectomy (LSG) has gained popularity as a stand-alone procedure with good short-term results for weight loss. However, in the long-term, weight regain is considered as a complication. Demand for secondary surgery is rising, partly for this reason, but through that study we try to discover the efficacy of conversion of failed sleeve gastrectomy to one anastomosis gastric bypass (OAGB) regarding weight loss and metabolic outcomes. Objective To asses the efficacy and safety of one anastomosis gastric bypass (OAGB) as a conversion surgery post Sleeve Gastrectomy failure as regard weight loss and metabolic outcomes. Patients and Methods This study is a retrospective cohort study which included 20 patients underwent one anastomosis gastric bypass at Ain-Shams University El-Demerdash Hospital, Cairo, Egypt and specialized bariatric center, Cairo, Egypt From February 2019 to July 2019 with 6 months of postoperative follow up till January 2019. Results In this study, we reviewed and analyzed the outcomes from the revision of the SG due to either inadequate weight loss or weight regain to one anastomosis gastric bypass (OAGB) with %EBWL of 6.65% at 1 month, 13.61 % at 3 months and 20.86% at 6 months. Conclusion OAGB appears to be an effective and safe therapeutic technique as a revisional surgery for failed primary SG with good short-term results for treating morbid obesity and its associated comorbidities with a significantly low rate of complications. However the EBWL was less than what is reported after primary OAGB weight. Multicenter studies with larger series of patients and longer term follow up after SG revisions to OAGB are warranted.

scholarly journals Bile Reflux is a Common Finding in the Gastric Pouch After One Anastomosis Gastric Bypass

2019 ◽  
Vol 30 (3) ◽  
pp. 875-881 ◽  
Author(s):  
Tuure Saarinen ◽  
Kirsi H. Pietiläinen ◽  
Antti Loimaala ◽  
Toni Ihalainen ◽  
Henna Sammalkorpi ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
De Novo ◽  
Bile Reflux ◽  
Gastric Pouch ◽  
Total Activity ◽  
One Anastomosis Gastric Bypass ◽  
Common Finding ◽  
Upper Gastrointestinal Endoscopy ◽  
Long Term Effects

Abstract Introduction Data on postoperative bile reflux after one anastomosis gastric bypass (OAGB) is lacking. Bile reflux scintigraphy (BRS) has been shown to be a reliable non-invasive tool to assess bile reflux after OAGB. We set out to study bile reflux after OAGB with BRS and endoscopy in a prospective series (RYSA Trial). Methods Forty patients (29 women) underwent OAGB between November 2016 and December 2018. Symptoms were reported and upper gastrointestinal endoscopy (UGE) was done preoperatively. Six months after OAGB, bile reflux was assessed in UGE findings and as tracer activity found in gastric tube and esophagus in BRS (follow-up rate 95%). Results Twenty-six patients (68.4%) had no bile reflux in BRS. Twelve patients (31.6%) had bile reflux in the gastric pouch in BRS and one of them (2.6%) had bile reflux also in the esophagus 6 months postoperatively. Mean bile reflux activity in the gastric pouch was 5.2% (1–21%) of total activity. De novo findings suggestive of bile reflux (esophagitis, stomal ulcer, foveolar inflammation of gastric pouch) were found for 15 patients (39.5%) in postoperative UGE. BRS and UGE findings were significantly associated (P = 0.022). Eight patients experienced de novo reflux symptoms at 6 months, that were significantly associated with BRS and de novo UGE findings postoperatively (P = 0.033 and 0.0005, respectively). Conclusion Postoperative bile reflux in the gastric pouch after OAGB is a common finding in scintigraphy and endoscopy. The long-term effects of bile exposure will be analyzed in future reports after a longer follow-up. Trial registration Clinical Trials Identifier NCT02882685

scholarly journals Single Anastomosis Duodeno-ileostomy (SADI-S) Versus One Anastomosis Gastric Bypass (OAGB-MGB) as Revisional Procedures for Patients with Weight Recidivism After Sleeve Gastrectomy: a Comparative Analysis of Efficacy and Outcomes

2020 ◽  
Vol 30 (12) ◽  
pp. 4715-4723
Author(s):  
Moataz Bashah ◽  
Ammar Aleter ◽  
Jawher Baazaoui ◽  
Ayman El-Menyar ◽  
Antonio Torres ◽  
...  
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Bile Reflux ◽  
One Anastomosis Gastric Bypass ◽  
Nutritional Deficiencies ◽  
Gastrointestinal Complications ◽  
Weight Recidivism ◽  
Single Anastomosis

Abstract Purpose Many revisional procedures are available for unsuccessful laparoscopic sleeve gastrectomy (LSG) in patients with complications or weight recidivism. Single anastomosis duodeno-ileal bypass (SADI-S) and one anastomosis gastric bypass (OAGB-MGB) are two revisional procedures to address the problem of weight recidivism. We aimed to evaluate the efficacy and outcomes of the 2 revisional approaches (SADI-S vs. OAGB-MGB). Materials and Methods A retrospective analysis of prospectively collected database of patients who underwent SADI-S or OAGB-MGB as a revisional procedure for weight recidivism after primary LSG with a minimum 1-year follow-up. Weight loss, comorbidities, nutritional deficiencies, complications, and outcomes were compared in the 2 procedures. Results Ninety-one patients were included in the study (42 SADI-S and 49 OAGB-MGB). There was a significant weight loss (total weight loss percentage, TWL%) at 1-year follow-up observed for SADI-S when compared to OAGB-MGB (23.7 ± 5.7 vs. 18.7 ± 8.5, p = 0.02). However, this difference was not statistically significant at 18 months (26.4 ± 7.3 vs. 21.2 ± 11.0, p = 0.25). Remission of comorbidities (diabetes mellitus and hypertension) was comparable. Although OAGB-MGB had higher complication rate than SADI-S, the difference was not statistically significant (p = 0.39). No mortality was reported in the study groups. Conclusion Both SADI-S and OAGB-MGB are effective and safe revisional procedures for weight regain after LSG. The short-term outcomes are comparable; however, SADI-S is associated with less upper gastrointestinal complications and could be a better option for patients suffering from GERD post-LSG. Moreover, the underlying bile reflux may get worse with OAGB-MGB. However, further prospective larger studies are needed.

OP270 Why The Haute Autorité de Santé Rejects the Widespread Use Of “Mini-Bypass”/One Anastomosis Gastric Bypass For Obesity In France

2020 ◽  
Vol 36 (S1) ◽  
pp. 4-4
Author(s):  
Jean-Charles Lafarge ◽  
Denis-Jean David ◽  
Cédric Carbonneil
Keyword(s):  
Esophageal Cancer ◽  
Gastric Bypass ◽  
Adverse Events ◽  
Severe Obesity ◽  
One Anastomosis Gastric Bypass ◽  
Close Monitoring ◽  
Efficacy And Safety ◽  
Multicenter Rct ◽  
Nutritional Complications

IntroductionOne anastomosis gastric bypass (OAGB) has become a widespread technique over the last few years in France, without any prior assessment and despite existing controversies among bariatric surgeons. An older bypass technique for treating obesity, the Roux-en-Y gastric bypass (RYGB), is available and reimbursed, having been assessed and approved for use in 2005. In 2019, the French Haute Autorité de Santé (HAS) assessed OAGB for the treatment of severe and massive obesity. This assessment, the first in the world, was undertaken for OAGBs carried out with a 200- or 150-centimeter biliopancreatic-limb (BP-limb) length.MethodsA systematic review (SR) of the literature and consultation of a working group consisting of both healthcare professionals (clinician and surgeons) and patients were carried out. The primary aim of our assessment was to determine whether the OAGB technique can replace RYGB. The efficacy and safety profile of OAGB was compared with RYGB in adult patients with massive, severe obesity. Complications and postoperative follow up specific to OAGB were identified.ResultsThe three selected randomized controlled trials (RCTs) could not confirm the superiority or the non-inferiority of OAGB, compared with RYGB, on the selected efficacy endpoints of weight loss, resolution of comorbidities, and quality of life. Adverse events reported for OAGB included severe nutritional complications and bile reflux that could potentially lead to lower esophageal cancer. In one RCT, the frequency of serious adverse events in the OAGB group was almost two times higher than in the RYGB group.ConclusionsHAS considered that OAGB carried out with a longer (200 centimeter) BP-limb is not a validated technique for the surgical treatment of massive, severe obesity. Thus, it cannot be considered an alternative to RYGB. There were insufficient data available on OAGB performed with a 150-centimeter BP-limb. Thus, HAS recommended undertaking a multicenter RCT to assess the efficacy and safety of OAGB. Patients who have already undergone OAGB should receive the same follow up as patients who have received RYGB, including close monitoring for nutritional complications and lower esophageal cancer and an endoscopic examination five years after surgery.

scholarly journals Is One Anastomosis Gastric Bypass with a Biliopancreatic Limb of 150 cm Effective in the Treatment of People with Severe Obesity with BMI > 50?

2021 ◽  
Author(s):  
Arnaud Liagre ◽  
Francesco Martini ◽  
Radwan Kassir ◽  
Gildas Juglard ◽  
Celine Hamid ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Severe Obesity ◽  
Postoperative Mortality ◽  
One Anastomosis Gastric Bypass ◽  
Sustained Weight Loss ◽  
Biliopancreatic Limb ◽  
Percentage Excess Weight Loss

Abstract Purpose The treatment of people with severe obesity and BMI > 50 kg/m2 is challenging. The present study aims to evaluate the short and mid-term outcomes of one anastomosis gastric bypass (OAGB) with a biliopancreatic limb of 150 cm as a primary bariatric procedure to treat those people in a referral center for bariatric surgery. Material and Methods Data of patients who underwent OAGB for severe obesity with BMI > 50 kg/m2 between 2010 and 2017 were collected prospectively and analyzed retrospectively. Follow-up comprised clinical and biochemical assessment at 1, 3, 6, 12, 18, and 24 months postoperatively, and once a year thereafter. Results Overall, 245 patients underwent OAGB. Postoperative mortality was null, and early morbidity was observed in 14 (5.7%) patients. At 24 months, the percentage total weight loss (%TWL) was 43.2 ± 9, and percentage excess weight loss (%EWL) was 80 ± 15.7 (184 patients). At 60 months, %TWL was 41.9 ± 10.2, and %EWL was 78.1 ± 18.3 (79 patients). Conversion to Roux-en-Y gastric bypass was needed in three (1.2%) patients for reflux resistant to medical treatment. Six patients (2.4%) had reoperation for an internal hernia during follow-up. Anastomotic ulcers occurred in three (1.2%) patients. Only two patients (0.8%) underwent a second bariatric surgery for insufficient weight loss. Conclusion OAGB with a biliopancreatic limb of 150 cm is feasible and associated with sustained weight loss in the treatment of severe obesity with BMI > 50 kg/m2. Further randomized studies are needed to compare OAGB with other bariatric procedures in this setting. Graphical abstract

scholarly journals Resultats A Court Terme De La Trabeculoplastie Selective Au Laser Chez Les Patients Togolais

2017 ◽  
Vol 13 (30) ◽  
pp. 271
Author(s):  
Dzidzinyo Kossi ◽  
Djagnikpo Akouete ◽  
Ayena Koffi Didier ◽  
Vonor Kokou ◽  
Maneh, Nidain ◽  
...  
Keyword(s):  
Selective Laser Trabeculoplasty ◽  
Treatment Results ◽  
Short Term ◽  
Laser Trabeculoplasty ◽  
The Mean ◽  
Laser Control ◽  
Pre Treatment ◽  
Primary Glaucoma ◽  
Reduction Percentage

Aim: To check the short-term tonometric results of SLT in the treatment of primary glaucoma at the open angle and in charge of ocular hypertonias in Togolese people. Methods: A retrospective study was carried out in an ophthalmology center. The first 130 eyes of 72 patients benefited from the SLT laser procedure. The tonometric controls work object focus on follow-up at 1, 3, and 6 months post laser treatment. Results: 130 eyes of 72 patients were collected. The average age of the patients was 49.74 years (± 17.45) and the ages vary between 10 and 85 years. The average IOP of the laser before the laser (J0) was (24.99 ± 8.41) mm Hg. The mean IOP at the post-laser control at 1 month was (18.79 ± 3.73) mm Hg. The average IOP for the post-laser control at 3 months was (18.44 ± 3.81) mm Hg. The mean IOP at the post-laser control at 6 months was (18.13 ± 3.63) mm Hg. The percentage reduction in intraocular pressure compared to IOP was pretreated from 20.2% to 1 month; 22.1% at 3 months; and 23.3% at 6 months. In 1 month, 49.2% of the eyes we treated showed a reduction in IOP of less than 20% compared to IOP pretreatment. After 3 months and 6 months, it was 55.4% higher. Also, 52.3% have a PIO reduction percentage which is greater than or equal to 20% compared to pre-treatment IOP. Discussion: Selective laser trabeculoplasty, most especially, is interesting in ocular hypertonies. Treatment of over 180 ° allows one patient out of two to have a pressure reduction that is greater than or equal to 20%. Conclusion: The SLT presents a significant advantage for our glaucomatous patients.

Boneloc versus Simplex Cement for Fixation of Femoral Components. An Interim Report of a Prospective Randomized Study of THRs with a 2,5 Year Mean Follow-Up Time

1996 ◽  
Vol 6 (3) ◽  
pp. 112-118 ◽  
Author(s):  
H. Klyver ◽  
K Jacobsen ◽  
H. Kofoed
Keyword(s):  
Femoral Component ◽  
Randomized Study ◽  
Femoral Stem ◽  
Prospective Randomized Study ◽  
Bone Cements ◽  
Interim Report ◽  
Short Term ◽  
Cement Interface ◽  
The Mean

A prospective randomized study of femoral stem fixation comparing Boneloc and Simplex cements was carried out. A collarless double-tapered femoral component was used in all cases. The material consisted of 94 patients representing 97 THRs (3 bilateral cases). Their mean age was 76 years (range 58-88). Clinico-radiographic follow-ups were carried out after 3 months, 12 months and 2 to 3 years. The mean follow up time was 2.5 years. Clinically there was no difference between the groups. Radiolucencies at the bone-cement interface and metal-cement interface, cement cracks, and subsidence of the femoral component were compared. No significant differences could be proven between the fixation patterns of the bone cements during this short-term follow-up.

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