Outcome of revisional bariatric surgery for insufficient weight loss after laparoscopic Roux-en-Y gastric bypass: an observational study

Abstract Background Roux Y Gastric Bypass (RYGB) is the preferred primary bariatric surgical option in patients with preoperative gastro oesophageal reflux disease (GERD). It is also the preferred revisional bariatric surgery after when GERD develops after an alternate primary bariatric surgery. However reflux after RYGB although uncommon can present due to a variety of factors. Management can be challenging. Aim/Hypothesis A modified version of the Belsey IV fundoplication can be done laparoscopically to reconstitute the antireflux barrier in the absence of a Fundal remnant in the gastric pouch after RYGB. Methods We present a single patient experience/case study where there was evidence of recurrent GERD in spite of a successful RYGB in terms of weight loss and comorbidity resolution. A 42 year old female with a BMI > 40 and metabolic co-morbidities and GERD was deemed fit for RYGB. After a technically uneventful RYGB with standard limb lengths ( Roux 120cms and BP limb 70 cms) there was significant weight loss ( > 70% EBWL) and co-morbidity resolution. However her symptoms of GERD persisted. An gastroscopy confimed esophagitis and a barium swallow showed evidence of GERD with a small hiatal hernia and a 3-4 cms Candy cane limb. There was no evidence of a gastrogastric fistula. Revisonal surgery was done which revealed no significant candy cane limb. A small (<2cms) hiatal hernia was found. Complete esophageal mobilization and a hiatal hernia repair was done in a standard fashion. Furthermore the anterior wall of the long gastric pouch was invaginated to obtain an approximate coverage of 200 degrees in a single layer Belsey technique. The procedure was completed laparoscopically. Results The post-operative period was uneventful. Patient reported complete absence of reflux after surgery and remains off PPI in the short term. Temporary dysphagia was noticed in the first few weeks after surgery which improved with expectant treatment. Conclusion A Laparoscopic modified Belsey type fundoplication serves as an effective method to treat GERD after a RYGB if other potential causes of GERD are excluded.

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Thyroid function and weight loss after Roux-en-Y gastric bypass: observational study

Endocrine Abstracts ◽

10.1530/endoabs.49.ep1244 ◽

2017 ◽

Author(s):

de Carvalho Gisah Amaral ◽

Cleo Mesa ◽

Rodrigo Strobel ◽

Paula Carolina Dambros Granzotto

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Observational Study ◽

Thyroid Function

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

Obesity Surgery ◽

10.1007/s11695-021-05499-3 ◽

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

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Comment on: Revisional Bariatric Surgery to Single Anastomosis Gastric Bypass: A Large Multi-Institution Series

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2021.01.036 ◽

2021 ◽

Author(s):

Ashraf Haddad

Keyword(s):

Bariatric Surgery ◽

Gastric Bypass ◽

Revisional Bariatric Surgery ◽

Single Anastomosis Gastric Bypass ◽

Single Anastomosis

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Management of Banded Gastric Bypasses: Revisional Bariatric Surgery After a Fobi–Capella-Banded Gastric Bypass

Revisional Foregut Surgery ◽

10.1007/978-3-030-28273-8_4 ◽

2019 ◽

pp. 45-49

Author(s):

John N. Afthinos ◽

Indraneil Mukherjee ◽

Karen E. Gibbs

Keyword(s):

Bariatric Surgery ◽

Gastric Bypass ◽

Revisional Bariatric Surgery ◽

Banded Gastric Bypass

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Evaluation of the Effects of Bariatric Surgery in Terms of Weight Loss and Diabetes Remission in the Indian Population

Dubai Diabetes and Endocrinology Journal ◽

10.1159/000518856 ◽

2021 ◽

pp. 1-7

Author(s):

Manish Khaitan ◽

Riddhish Gadani ◽

Koshish Nandan Pokharel

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Gastric Bypass ◽

Complete Remission ◽

Predictive Factors ◽

Indian Population ◽

Diabetes Remission ◽

Obese Patients ◽

Sustained Weight Loss

Objectives: The growing prevalence of obesity rates worldwide is associated with an upsurge in its comorbidities, particularly type 2 diabetes mellitus (T2DM). Bariatric surgery is a proven treatment modality for producing sustained weight loss and resolution of associated T2DM providing marked improvement in quality of life with rapid recovery. This study aims to investigate the effects of laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), and mini-gastric bypass (MGB) on obese patients suffering from T2DM in the Indian population and their long-term association with regard to diabetes remission, resolution of comorbidities, and percentage EWL. Methods: Retrospective data of obese patients with T2DM (preoperative BMI 45.37 ± 8.1) who underwent bariatric surgery (RYGB, LSG, and MGB) were analyzed in this study over a period of 9 years. The mean follow-up period was 2.2 years. Following surgery, the clinical outcome on BMI, resolution of percentage weight loss, and T2DM were studied. The predictive factors of diabetic remission after surgery were determined. Student’s t test and ANOVA and McNemar’s test were applied. Results: Out of a total of 274 patients, complete remission of T2DM was achieved in 52.9% (n = 145) with mean fasting blood glucose and glycated hemoglobin values being 6.1 ± 0.769 (p = 0.00) at 1 year after surgery. The independent predictive factors of remission were age, gender, BMI, preoperative comorbidities, and % EWL. Gender had no correlation with the chance of achieving disease remission. Conclusion: Based on our results, bariatric surgery proves to be a successful treatment option resulting in sustained weight loss in obese patients suffering from T2DM. It is found to be beneficial for the long-term resolution of T2DM and improving comorbidities such as hypertension and dyslipidemia. The outcome of the different surgical methods is found to be similar for all patients irrespective of the independent predictors of complete remission.

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The bariatric surgery and weight losing: a meta-analysis in the long- and very long-term effects of laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy on weight loss in adults

Surgical Endoscopy ◽

10.1007/s00464-017-5505-1 ◽

2017 ◽

Vol 31 (11) ◽

pp. 4331-4345 ◽

Cited By ~ 66

Author(s):

Mahdieh Golzarand ◽

Karamollah Toolabi ◽

Roya Farid

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Gastric Bypass ◽

Sleeve Gastrectomy ◽

Gastric Banding ◽

Laparoscopic Adjustable Gastric Banding ◽

Adjustable Gastric Banding ◽

Meta Analysis ◽

Long Term Effects

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The association between socioeconomic factors and weight loss 5 years after gastric bypass surgery

International Journal of Obesity ◽

10.1038/s41366-020-0637-0 ◽

2020 ◽

Vol 44 (11) ◽

pp. 2279-2290

Author(s):

Erik Stenberg ◽

Ingmar Näslund ◽

Carina Persson ◽

Eva Szabo ◽

Magnus Sundbom ◽

...

Keyword(s):

Bariatric Surgery ◽

Socioeconomic Status ◽

Weight Loss ◽

Gastric Bypass ◽

Socioeconomic Factors ◽

First Generation ◽

First Generation Immigrants ◽

Preoperative Body Mass Index ◽

Postoperative Weight Loss ◽

The Mean

Abstract Introduction Patients with low socioeconomic status have been reported to have poorer outcome than those with a high socioeconomic status after several types of surgery. The influence of socioeconomic factors on weight loss after bariatric surgery remains unclear. The aim of the present study was to evaluate the association between socioeconomic factors and postoperative weight loss. Materials and methods This was a retrospective, nationwide cohort study with 5-year follow-up data for 13,275 patients operated with primary gastric bypass in Sweden between January 2007 and December 2012 (n = 13,275), linking data from the Scandinavian Obesity Surgery Registry, Statistics Sweden, the Swedish National Patient Register, and the Swedish Prescribed Drugs Register. The assessed socioeconomic variables were education, profession, disposable income, place of residence, marital status, financial aid and heritage. The main outcome was weight loss 5 years after surgery, measured as total weight loss (TWL). Linear regression models, adjusted for age, preoperative body mass index (BMI), sex and comorbid diseases were constructed. Results The mean TWL 5 years after surgery was 28.3 ± 9.86%. In the adjusted model, first-generation immigrants (%TWL, B −2.4 [95% CI −2.9 to −1.9], p < 0.0001) lost significantly less weight than the mean, while residents in medium-sized (B 0.8 [95% CI 0.4–1.2], p = 0.0001) or small towns (B 0.8 [95% CI 0.4–1.2], p < 0.0001) lost significantly more weight. Conclusions All socioeconomic groups experienced improvements in weight after bariatric surgery. However, as first-generation immigrants and patients residing in larger towns (>200,000 inhabitants) tend to have inferior weight loss compared to other groups, increased support in the pre- and postoperative setting for these two groups could be of value. The remaining socioeconomic factors appear to have a weaker association with postoperative weight loss.

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