Roux-en-Y gastric bypass versus one anastomosis-mini gastric bypass as a rescue procedure following failed restrictive bariatric surgery. A systematic review of literature with metanalysis

Abstract Introduction Obesity increases the risk of pelvic floor disorders in individuals with obesity, including faecal incontinence. Faecal incontinence (FI) is a condition with important clinical and psychosocial consequences. Though it is associated with obesity, the effect of bariatric surgery on the prevalence and severity of FI is not well reported. Objective To assess the effect of bariatric surgery on the prevalence and severity of FI in adult patients with obesity. Methods This systematic review was conducted in accordance with the PRISMA statement. Two independent reviewers performed a literature search in MEDLINE, PubMed, Cochrane and Embase from 1 January 1980 to 12 January 2019. We included published English-language randomized control trials and observational studies assessing pre- and post-bariatric surgery prevalence or severity of FI. Random-effects models with DerSimonian and Laird’s variance estimator were used for meta-analysis. Results Thirteen studies were included, eight assessing prevalence (678 patients) and 11 assessing severity of FI (992 patients). There was no significant difference in prevalence post-operatively overall, though it trended towards a reduction [pooled OR=0.55; =0.075]. There was a significant reduction of FI prevalence in women post-bariatric surgery [95% CI 0.22 to 0.94, p=0.034]. There was a statistically significant reduction in FI prevalence following Roux-en-Y gastric bypass and one anastomosis gastric bypass [0.46, 95% CI 0.26 to 0.81; p=0.007]. There was no significant reduction of incontinence episodes post-operatively [pooled mean difference =−0.17, 95% CI −0.90 to 0.56; p=0.65]. Quality of life (QOL) was not significantly improved post-bariatric surgery [mean differences for the following facets of QOL: behaviour −0.35, 95% CI −0.94 to 0.24; depression 0.04, 95% CI −0.12 to 0.2; lifestyle −0.33, 95% CI −0.98 to 0.33; p values of 0.25, 0.61 and 0.33, respectively]. Discussion There was a significant reduction in FI prevalence in women and those who underwent Roux-en-Y or one anastomosis gastric bypass. Our results for FI prevalence overall, FI severity and impact on quality of life were not statistically significant. Larger studies are needed in this under-researched area to determine the true effect of bariatric surgery on FI. Graphical abstract

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Anesthesia for restrictive bariatric surgery (gastric bypass not included): laparoscopic vs open procedures

International Journal of Obesity ◽

10.1038/sj.ijo.0802709 ◽

2004 ◽

Vol 28 (9) ◽

pp. 1157-1162 ◽

Cited By ~ 10

Author(s):

T Ezri ◽

G Muzikant ◽

B Medalion ◽

P Szmuk ◽

I Charuzi ◽

...

Keyword(s):

Bariatric Surgery ◽

Gastric Bypass ◽

Restrictive Bariatric Surgery

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Pregnancy as a cause of gastroesophageal reflux after mini-gastric bypass bariatric surgery (MGB-OAGB). A clinical case

Obstetrics Gynecology and Reproduction ◽

10.17749/2313-7347.2018.12.2.076-079 ◽

2018 ◽

Vol 12 (2) ◽

pp. 76-79

Author(s):

V. S. Samoylov ◽

V. V. Novomlinskiy ◽

N. А. Malkina

Keyword(s):

Bariatric Surgery ◽

Gastric Bypass ◽

Gastroesophageal Reflux ◽

Clinical Symptoms ◽

Late Complications ◽

Mini Gastric Bypass ◽

Major Type ◽

Abdominal Pressure ◽

Complete Relief ◽

Bariatric Patients

The number of post-bariatric patients is increasing from year to year; any medical specialist can see consequences and sometimes complications of these interventions. The variety of different scenarios associated with such patients is not well studied. Mini-gastric bypass (MGB-OAGB) is a major type of primary or recurrent bariatric surgery in obese patients. Biliary reflux (BR) is one of the most significant late complications of this operation. An increase in the intra-abdominal pressure during pregnancy can lead to the development of BR with its typical clinical symptoms, which may sometimes puzzle an obstetrician-gynecologist. In these cases, there are limitations in using traditional diagnostic approaches and regular medications for conservative treatment of BR. This report presents a clinical observation on a patient who underwent MGB-OAGB as a recurrent bariatric intervention for her morbid obesity. With no signs of gastroesophageal reflux before surgery, soon after it or in the I trimester of pregnancy, a typical clinical picture of BR developed in the II and III trimesters. A complete relief of the BR symptoms after the childbirth (confirmed by gastro-esophago-scopy) suggested a direct connection between the BR and the increase in intra-abdominal pressure during pregnancy.

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