S1992 Endoscopic Anti-Reflux Remodeling of the Gastric Pouch for Management of Candy Cane Syndrome

BACKGROUND: After Roux-en-Y gastric bypass to avoid rapid gastric emptying, dumping syndrome and regained weight due to possible dilation of the gastric pouch, was proposed to place a ring around the gastric pouch. AIM: To compare weight loss, consumption of macronutrients and the frequency of vomiting among patients who underwent Roux-en-Y gastric bypass with and without the placement of a constriction ring around the pouch. METHOD: A retrospective study, in which an analysis of medical records was carried out, collecting data of two groups of patients: those who underwent the operation with the placement of a constriction ring (Ring Group) and those who underwent without the placement of a ring (No-Ring Group). The food intake data were analyzed using three 24-hour recalls collected randomly in postoperative nutritional accompaniment. Data on the percentage of excess weight loss and the occurrence of vomiting were collected using the weight corresponding to the most recent report at the time of data collection. RESULTS: Medical records of 60 patients were analyzed: 30 from the Ring Group (women: 80%) and 30 from the No-Ring Group (women: 87%). The average time since the Ring Group underwent the operation was 88±17.50 months, and for the No-Ring Group 51±15.3 months. The percentage of excess weight loss did not differ between the groups. The consumption of protein (g), protein/kg of weight, %protein and fiber (g) were higher in the No-Ring Group. The consumption of lipids (g) was statistically higher in the Ring Group. The percentage of patients who never reported any occurrence was statistically higher in the No-Ring Group (80%vs.46%). The percentage who frequently reported the occurrence was statistically higher in the Ring Group (25%vs.0%). CONCLUSION: The placement of a ring seems to have no advantages in weight loss, favoring a lower intake of protein and fiber and a higher incidence of vomiting, factors that have definite influence in the health of the bariatric patient.

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Preventing Peterson’s space Hernia Using a Bio Synthetic Mesh

10.21203/rs.2.17099/v1 ◽

2019 ◽

Author(s):

Adam Peter Skidmore ◽

Edo O Aarts

Keyword(s):

Internal Hernia ◽

Controlled Trial ◽

Gastric Pouch ◽

Synthetic Mesh ◽

First Year ◽

Absorbable Suture ◽

Private Hospitals ◽

Randomized Controlled ◽

Mesenteric Defects ◽

Ideal Technique

Abstract Introduction Up to 30% of all Bariatric procedures performed worldwide still are Roux-en-Y Gastric Bypasses (RYGB). Internal hernia’s occur when small bowel herniates into the intermesenteric spaces created when the roux limb is mobilised for anastomosis to the gastric pouch. To prevent internal hernia’s to occur many surgeons nowadays close the mesenteric defects during primary RYGB. Using a non-resorbable double layered suture, this risk can be significantly reduced from 8.9 to 2.5% in the first three postoperative years. However the technique of closure seems to be related to these reduced internal hernia risks outcomes while for example closure with staples does reduce the amount of internal hernia’s but in a much lesser extent. Setting Two large private hospitals specialized in bariatric surgeryMethods All patients receiving a RYGB for (morbid) obesity between 2014 and 2018 were included in this retrospective study. In the first year Peterson’s space was closed using glue, the years hereafter it was closed using a double layered non absorbable suture combined with a piece of glued BIO Mesh.Results The first group of glued RYGB patients showed 15% of patients with an internal hernia through Peterson’s space compared to 0% of patients (p<0.001) who had a combined sutured and BIO Mesh Closure of their Peterson’s space defect. Although an ideal technique for Peterson’s space, it led to 1% of entero-enterostomy kinking due to firm adhesions.Conclusion Closing this defect with clips or sutures partially reduces the chances on herniation, but not completely. Gluing this defect is not beneficial, but placing a BIO Mesh in Peterson’s space is a promising new technique to induce local adhesions. It is at least safe, effective and led to a complete reduction of Peterson’s internal herniations. In the future, a randomized controlled trial comparing this technique to a double layered, non-absorbable suture would give more insights in which is the optimal closure technique.

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Successful revision surgery for very late-onset stomal obstruction following Gomez gastroplasty: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01293-6 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yudai Hojo ◽

Yasunori Kurahashi ◽

Toshihiko Tomita ◽

Tsutomu Kumamoto ◽

Tatsuro Nakamura ◽

...

Keyword(s):

Revision Surgery ◽

Preoperative Diagnosis ◽

Late Onset ◽

Staple Line ◽

Weight Loss Surgery ◽

Wedge Resection ◽

Gastric Pouch ◽

Sudden Onset ◽

Gastric Body ◽

Greater Curvature

Abstract Background Gomez gastroplasty, which was developed in the 1970s as one of the gastric restrictive surgeries for severe obesity, partitions the stomach using a stapler from the lesser towards the greater curvature at the upper gastric body, leaving a small channel. This procedure is no longer performed due to poor outcomes, but surgeons can encounter late-onset complications even decades after the surgery. Here, we report a case of very late-onset stomal obstruction following Gomez gastroplasty which was successfully treated by revision surgery. Case presentation A 58-year-old man was referred to our institution with sudden-onset nausea and vomiting. He underwent weight loss surgery in the USA in 1979, but the details of the surgery were unclear. Esophagogastroduodenoscopy demonstrated a stoma at the greater curvature of the upper gastric body, and fluoroscopy showed retention of contrast medium in the fundus and poor outflow through the stoma. Abdominal computed tomography revealed a staple line partitioning the stomach. Considering these preoperative investigation findings and the period during which the surgery was performed, the patient was diagnosed with very late-onset stomal obstruction following Gomez gastroplasty. Supporting the preoperative diagnosis, the surgical findings revealed a staple line extending from the lesser towards the greater curvature of the upper gastric body and a channel reinforced by a running seromuscular suture on the greater curvature. Moreover, gastric torsion caused by the enlarged proximal gastric pouch was found. Re-gastroplasty involving wedge resection of the original channel was performed followed by construction of a new channel. Postoperative course was uneventful, and the patient no longer had symptoms of stomal obstruction after revision surgery. Conclusions Re-gastroplasty was safe and feasible for very late-onset stomal obstruction following Gomez gastroplasty. Accurate preoperative diagnosis based on the patient’s interview and the investigation findings was important for surgical planning. A careful follow-up is required to prevent excessive weight regain after revision surgery.

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INFLAMMATORY DISORDERS ASSOCIATED WITH HELICOBACTER PYLORI IN THE ROUX-EN-Y BYPASS GASTRIC POUCH

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-6720201600s10009 ◽

2016 ◽

Vol 29 (suppl 1) ◽

pp. 31-34 ◽

Cited By ~ 2

Author(s):

Luiz Claudio Lopes CHAVES ◽

Isabela Klautau Leite Chaves BORGES ◽

Maíra Danielle Gomes de SOUZA ◽

Ian Passos SILVA ◽

Lyz Bezerra SILVA ◽

...

Keyword(s):

Bariatric Surgery ◽

Helicobacter Pylori ◽

Gastric Pouch ◽

Obese Patients ◽

Inflammatory Lesions ◽

Low Incidence ◽

H Pylori ◽

A Prospective Study ◽

Grade Iii

ABSTRACT Background: The prevalence of Helicobacter pylori in obese candidates for bariatric surgery and its role in the emergence of inflammatory lesions after surgery has not been well established. Aim: To identify the incidence of inflammatory lesions in the stomach after bariatric surgery and to correlate it with H. pylori infection. Methods: This is a prospective study with 216 patients undergoing Roux-en-Y gastric bypass. These patients underwent histopathological endoscopy to detect H. pylori prior to surgery. Positive cases were treated with antibiotics and a proton inhibitor pump followed by endoscopic follow-up in the 6th and 12th month after surgery. Results: Most patients were female (68.1%), with grade III obesity (92.4%). Preoperative endoscopy revealed gastritis in 96.8%, with H. pylori infection in 40.7% (88/216). A biopsy was carried out in 151 patients, revealing H. pylori in 60/151, related to signs of inflammation in 90% (54/60). In the 6th and 12th month after surgery, the endoscopy and the histopathological exam showed a normal gastric pouch in 84% of patients and the incidence of H. pylori was 11% and 16%, respectively. The presence of inflammation was related to H. pylori infection (p<0,001). Conclusion: H. pylori has a similar prevalence in both obese patients scheduled to undergo bariatric surgery and the general population. There is a low incidence of it in the 6th and 12th months after surgery, probably owing to its eradication when detected prior to surgery. When inflammatory disease is present in the new gastric reservoir it is directly related to H. pylori infection.

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