scholarly journals Recurrent internal hernias after Roux-en-Y gastric bypass: An observational study in 1219 patients over 20 years

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
Y Fringeli ◽  
R Steffen ◽  
U Kessler ◽  
J Zehetner
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Small Bowel ◽  
Laparoscopic Group ◽  
Small Bowel Resection ◽  
Median Percentage ◽  
Internal Hernias ◽  
Mesenteric Defects ◽  
Time Of Operation

Abstract Objective Internal hernia (IH) represents a well-known complication and the major cause of bowel obstruction after Roux-en-Y gastric bypass (RYGB) for morbid obesity. With the worldwide rise of performed RYGB, IH will become more frequent in the coming years. Lots of studies already addressed this issue to prevent its occurrence and improve its management. The aim of this study is to assess incidence and patterns of recurrence of IH. Methods A retrospective single-centre analysis was performed of prospectively collected follow-up data from patients who underwent a RYGB between January 2000 and December 2017 and who developed IH thereafter. Follow-up data were reviewed until December 2020. Both open (51) and laparoscopic procedures (1168) were included. All RYGB were performed using the antecolic technique with routine closure of the Petersen’s space (PS) and the mesenteric defect beneath the jejunojejunostomy (JJ). Only open mesenteric defects with incarcerated small bowel at the time of operation were considered as IH. Results One hundred thirty four patients presented with IH and all events occurred in the laparoscopic group (11.5%). Among the 134 patients with IH, a recurrence was observed in 35 patients (26.1%) after a median time of 13 months (range, 0-124) since the first IH. Seven patients presented more than 2 episodes of IH, among them one patient with 7 episodes. The median weight loss between the first and the second episode of IH was 0.0kg (range, -11.5-19.0) and the median percentage of excess weight loss achieved since the RYGB at the occurrence of the second IH was 97.2% (range, 55.3-111.2). Location of IH was PS in 70 patients (52.2%) at the time of the first IH and in 23 patients (65.7%) at the time of the second IH. Recurrence of IH at the same location was more frequent at the PS (22.9%) than at the JJ (10.9%). Overall, 185 operations for IH were performed, among them 132 (71.4%) laparoscopically. Only once, a small bowel resection was mandatory (0.5%). Conclusion For patients with laparoscopic RYGB, internal hernias represent a potential complication over a lifetime and have to be suspected even years after the index operation. One quarter of patients will develop a recurrence of IH and Petersen’s space is mostly involved.

Intestinal Complications of Roux-en-Y Gastric Bypass

2018 ◽  
Author(s):  
Kevin D. Helling ◽  
Scott A. Shikora
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Small Bowel ◽  
Signs And Symptoms ◽  
Bariatric Operation ◽  
Intestinal Volvulus ◽  
Vein Thrombosis ◽  
Internal Hernias ◽  
Anastomotic Strictures ◽  
Risk Patients

Roux-en-Y gastric bypass is a commonly performed bariatric operation, but it is a formidable procedure performed in technically challenging, medically high-risk patients. Although it is highly successful for achieving meaningful and durable weight loss, a variety of intestinal complications may occur. These include small bowel obstructions from a number of sources (internal hernias, adhesions, intussusception, incisional hernias, intestinal volvulus), anastomotic strictures, dumping syndrome, portal vein thrombosis, Roux-en-O construction, and small bowel diverticulitis. This chapter reviews several of the more commonly occurring postoperative intestinal complications. Clinicians need to understand the signs and symptoms of these complications and must be able to quickly diagnose the condition and initiate treatment.

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

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 Improved heart rate recovery after marked weight loss induced by gastric bypass surgery: Two-year follow up in the Utah Obesity Study

Heart Rhythm ◽  
2011 ◽  
Vol 8 (1) ◽  
pp. 84-90 ◽  
Author(s):  
Stephen L. Wasmund ◽  
Theophilus Owan ◽  
Frank G. Yanowitz ◽  
Ted D. Adams ◽  
Steven C. Hunt ◽  
...  
Keyword(s):  
Heart Rate ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Bypass Surgery ◽  
Heart Rate Recovery ◽  
Gastric Bypass Surgery ◽  
Marked Weight

scholarly journals Determinants of Adequate Response of Patient Undergoing Roux-en-y Gastric Bypass Surgery

2020 ◽  
Author(s):  
Thales Philipe Rodrigues Silva ◽  
Flávia Moraes Silva ◽  
Larissa Loures Mendes ◽  
Alexandra Dias Moreira D'assunção ◽  
Lauro Pinheiro Ferreira de Araujo ◽  
...  
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Logistic Regression ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Inadequate Response ◽  
Post Surgery ◽  
Adequate Response ◽  
Follow Up Care

Abstract INTRODUCTION: Roux-en-Y gastric bypass surgery (RYGB) is known to induce, on average,60 to 75% excess body weight loss between 18 and 24 months post-surgery. However, several studies have shown weight regain after two years post-surgery, thus patients must have adequate follow-up in order to guarantee and/or maintain response to RYGB. AIM: To evaluate the determinants of adequate response in patients who underwent RYGB. METHODS: A longitudinal study with 193 adults who underwent RYGB between 2012 and 2014. Adequate response to RYGB was determined by Excess Weight Loss (%EWL). Logistic regression models were constructed to verify the degree of association between adequate response of patient after RYGB and determinants of variable risk based on estimate Odds Ratios (OR). RESULTS: RYGB improves Systemic arterial hypertension (SAH), Diabetes Mellitus (DM) and body mass index (BMI). From the multivariate logistic regression model, being female and not having SAH and DM reduce the chance of inadequate RYGB response. Regarding preoperative BMI, an increase in one unit of kg/m2 was associated with increased odds of inadequate response after RYGB. And patients who did not receive follow-up care with a psychologist or psychiatrist in the postoperative period presented higher odds of inadequate response to RYGB. CONCLUSION: The findings of this study contribute to the effective planning of interventions by multi-professional teams involved in RYGB, aimed at offering a better follow-up care focused mainly on post-surgery changes and adequate RYGB response.

scholarly journals Imaging appearance on CT post laparoscopic Roux-en-Y gastric bypass using bioabsorbable prosthesis with fibrin glue fixation to prevent a Petersen’s space hernia

2019 ◽  
Vol 5 (3) ◽  
pp. 20180111
Author(s):  
Mark Page ◽  
James Drummond ◽  
Mark Magdy ◽  
John Vedelago ◽  
Vytauras Kuzinkovas
Keyword(s):  
Gastric Bypass ◽  
Small Bowel ◽  
Surgical Technique ◽  
Fibrin Glue ◽  
Subsequent Treatment ◽  
Open Approach ◽  
Internal Hernias ◽  
Haemostatic Agents ◽  
Petersen’S Hernia ◽  
Post Bariatric Surgery

Imaging post bariatric surgery is becoming more common over the past decade due to increasing incidence of obesity in the population and subsequent treatment. In recent years, the use of topical haemostatic agents and bioabsorbable prostheses has increased leading to higher likelihood of encountering these agents on post-operative imaging. Imaging in the post-operative period is occasionally performed to assess for complications such as obstruction, leak and abscess formation. Familiarity with these agents is crucial in preventing incorrect diagnosis. Laparoscopic Roux-en-Y gastric bypass (RYGB) is favoured over the open approach as it is safer and more effective, with a mortality rate of 0.5% and morbidity around 7–14 %. The main cause of late post-RYGB complications is the development of internal hernias such as a Petersen’s hernia. During the procedure, a space between the alimentary loop of the small bowel and the transverse mesocolon is created and is called the Petersen’s defect. Subsequently, a part of the small bowel can herniate through this orifice. As this operation is becoming more common, the incidence of internal herniation has been increasing. This case report describes a new bariatric surgical technique and the associated post-operative radiological appearances on CT. The surgical technique has been pioneered in Sydney, Australia and involves a laparoscopic RYGB using bioabsorbable prosthesis with fibrin glue fixation to prevent a Petersen’s space hernia.

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