scholarly journals Biliary reflux after laparoscopic modified antireflux monoanastomotic gastric bypass surgery

Pathologia ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. 311-320
Author(s):  
M. V. Nikolaiev

Aim. Determination of biliary reflux in patients with morbid obesity after a single-anastomotic gastric bypass operation performed in the clinic's modification and according to the classical Roux-en-Y gastric bypass technique. Development of diagnostic criteria for biliary reflux Materials and methods. The results of treatment of 36 patients with morbid obesity who underwent bypass surgery were studied. The patients are divided into two groups. Clinically modified laparoscopic monoanastomotic gastric bypass surgery was performed in 25 patients (main group). The control group included 11 patients after the standard technique of Roux-en-Y laparoscopic gastric bypass. Inclusion criteria were: persons of both sexes aged 18-60 years with morbid obesity and a body mass index of 40 or more, as well as 35 or more in the presence of comorbid diseases (type 2 diabetes mellitus, arterial hypertension, dyslipidemia, sleep apnea syndrome). In both groups, impedance pH measurements were performed in the postoperative period. Statistical processing was performed using the Statistica 13.0 software package using parametric and nonparametric statistical methods.  Results: Clinical manifestations of the enterogastric biliary reflex were found in both groups; in addition, clinical manifestations of the corresponding symptoms were noted by patients of both groups. The analysis of daily pH-metry in the studied groups showed that in the esophagus the time with pH <4 in the main group 2.83 (1.55; 3.95)% 3.00 (2.30; 3.50)% in the control group, time with pH 4-6.9 (physiological for the esophagus) 92.40 (90.65; 94.20)% and 94.10 (89.80; 95.50)%, respectively, time with pH> 7 (weak alkaline) was 4.80 (3.45; 5.85)% and in the control group 2.90 (1.20; 7.20)%. There was no statistically significant difference in these indicators (p> 0.05). Conclusions. Monoanastomotic gastric bypass surgery in the modification of the clinic has the same positive properties as the Rouen-Wye technique, allowing you to avoid the risks associated with possible pathological reflux of bile into the esophagus. Patients who have undergone mini-gastric bypass surgery require a thorough examination with fibrogastroscopy in combination with pH impedance measurement at least 1 time per year in order to determine biliary reflux and morphological changes both in the lumen of the esophagus and in the stomach stump. The level of quality of life of patients after surgery in the control group and the main group does not significantly differ, as evidenced by the results of the questionnaire survey using the GERG Q questionnaire, which indicates the effectiveness of the methodology of laparoscopic monoanastomotic gastric bypass surgery modified in the clinic. Key words: morbid obesity, gastric bypass surgery, surgical treatment, mini-gastric bypass, biliary reflux.

2020 ◽  
Vol 9 (11) ◽  
pp. 3430
Author(s):  
Karl Peter Rheinwalt ◽  
Uta Drebber ◽  
Robert Schierwagen ◽  
Sabine Klein ◽  
Ulf Peter Neumann ◽  
...  

Background. Bariatric surgery is a widely used treatment for morbid obesity. Prediction of postoperative weight loss currently relies on prediction models, which mostly overestimate patients’ weight loss. Data about the influence of Non-alcoholic fatty liver disease (NAFLD) on early postoperative weight loss are scarce. Methods. This prospective, single-center cohort study included 143 patients receiving laparoscopic gastric bypass surgery (One Anastomosis-Mini Gastric Bypass (OAGB-MGB) or Roux-en-Y Gastric Bypass (RYGB)). Liver biopsies were acquired at surgery. NAFLD activity score (NAS) assigned patients to “No NAFLD”, “NAFL” or “NASH”. Follow up data were collected at 3, 6 and 12 months. Results. In total, 49.7% of patients had NASH, while 41.3% had NAFL. Compared with the No NAFLD group, NAFL and NASH showed higher body-mass-index (BMI) at follow-up (6 months: 31.0 kg/m2 vs. 36.8 kg/m2 and 36.1 kg/m2, 12 months: 27.0 kg/m2 vs. 34.4 and 32.8 kg/m2) and lower percentage of total body weight loss (%TBWL): (6 months: 27.1% vs. 23.3% and 24.4%; 12 months: 38.5% vs. 30.1 and 32.6%). Linear regression of NAS points significantly predicts percentage of excessive weight loss (%EWL) after 6 months (Cologne-weight-loss-prediction-score). Conclusions. Histopathological presence of NAFLD might lead to inferior postoperative weight reduction after gastric bypass surgery. The mechanisms underlying this observation should be further studied.


2011 ◽  
Vol 2011 (10) ◽  
pp. 2-2 ◽  
Author(s):  
R Anasiudu ◽  
K Gajjar ◽  
O Osoba ◽  
N Soliman

1983 ◽  
Vol 53 (4) ◽  
pp. 321-324 ◽  
Author(s):  
John C. Hall ◽  
Kim Horne ◽  
Paul E. O'Brien ◽  
James McK. Watts

2003 ◽  
Vol 13 (1) ◽  
pp. 49-57 ◽  
Author(s):  
D.R. Cottam ◽  
P.A. Schaefer ◽  
G.W. Shaftan ◽  
L.D.G. Angus

PEDIATRICS ◽  
1990 ◽  
Vol 86 (5) ◽  
pp. 777-778 ◽  
Author(s):  
WILLIAM S. MARTENS ◽  
LOUIS F. MARTIN ◽  
CHESTON M. BERLIN

A breast-fed 4-month-old infant girl observed since birth had gained only 1230 g (2 lb 11 oz). The mother had three older children with birth weights of 3440 g (7 lb 9 oz), 4000 g (8 lb 13 oz), and 4895 g (10 lb 13 oz). All were exclusively breast-fed and thrived, eventually growing between the 25th and 50th percentiles on the National Center for Health Statistics growth charts. The mother also had five miscarriages during these 7 years. She had gastric bypass surgery for morbid obesity between her third and fourth children. She had lost 49 kg (109 lb) (114 kg to 65 kg) [254 lb to 145 lb]) in the first 12 months after surgery and had been stable at her new weight for 4 months prior to becoming pregnant with this baby.


2005 ◽  
Vol 11 (6) ◽  
pp. 622-624 ◽  
Author(s):  
Lynne B Ahn ◽  
Christopher S Huang ◽  
Armour R Forse ◽  
Donald T Hess ◽  
Charles Andrews ◽  
...  

1989 ◽  
Vol 34 (8) ◽  
pp. 1238-1242 ◽  
Author(s):  
S. P. Marcuard ◽  
D. R. Sinar ◽  
M. S. Swanson ◽  
J. F. Silverman ◽  
J. S. Levine

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