Is Adherence to Follow-Up After Bariatric Surgery Necessary? A Systematic Review and Meta-Analysis

The association of adherence to follow-up (FU) after laparoscopic gastric bypass — and gastric sleeve with weight loss (WL) is unclear. The aim of this study was to evaluate this association. Fourteen full text articles were included in the systematic review. Eight studies were included in the meta-analysis concerning FU up to 3 years postoperatively and 3 for the FU between 3 and 10 years postoperatively. Results showed a significant association between adherence to FU 0.5 to 3 years postoperatively and percentage excess WL (%EWL) but did not demonstrate a significant association between FU > 3 years postoperatively and total WL (%TWL). In conclusion, adherence to FU may not be associated with WL and therefore stringent lifelong FU in its current form should be evaluated.

Gastric Bypass versus Sleeve Gastrectomy in Morbid Obesity Management

Background Obesity is caused by a combination of excessive food energy intake, lack of physical activity, and genetic susceptibility, although a few cases are caused primarily by genes, endocrine disorders, medications, or psychiatric illness. The main aim of obesity therapy is weight loss and maintenance by dietary interventions and increased physical activity. Aim of the Work to review two of the most commonly performed modalities of weight loss namely Sleeve Gastrectomy, Gastric Bypass, and to study their early post-operative complications, outcomes, effects regarding excess body weight loss (EBWL), life style changes and sustainability. Patients and Methods This is a prospective comparative randomize study included 40 patients presented with morbid obesity with BMI range between (40 to 60 kg/m2) were treated 20 cases by laparoscopic sleeve Gastrectomy and 20 cases by laparoscopic Gastric Bypass (15 cases one anastomosis gastric bypass – 5 cases Roux-en-Y bypass) in Ain Shams Hospital during the period from October 2017 till May 2018. Cases were followed up monthly for 6 months and after 1 year. Results Laparoscopic sleeve gastrectomy has higher incidence of complications (15%) than the incidence of complications of Laparoscopic Gastric Bypass (5%). Conclusion Laparoscopic Sleeve Gastrectomy and Laparoscopic Gastric Bypass are both safe and effective procedures for the surgical management of morbid obesity. Laparoscopic Gastric Bypass has slightly higher mean of (EBWL%) than Laparoscopic sleeve gastrectomy at 6 months, and a higher mean of (EBWL%) than Laparoscopic sleeve gastrectomy at 1 year follow up.

Laparoscopic choledochoduodenal anastomosis after bile duct injury in a patient with previous laparoscopic gastric bypass

Bile duct injuries after laparoscopic cholecystectomy remain a major problem in gastrointestinal surgery. Twenty five to thirty percent of bariatric patients could develop gallstone disease. However, laparoscopic cholecystectomy in this group may result challenging due to the presence of a previous Roux-en-Y reconstruction. We documented the successful case of 66 year old female with story of non-supplemented laparoscopic gastric bypass, with subsequent injury of bile duct during laparoscopic cholecystectomy treated with a laparoscopic choledochoduodenal anastomosis. This technique offers an excellent alternative to solve highly complex cases in a single surgical time, allowing the patient to restore his original functionality prior to the biliary duct lesion.

Low Health Literate State Does Not Negatively Affect Final Weight Loss After a Laparoscopic Gastric Bypass Procedure

Weight loss surgery is an effective treatment in patients with morbid obesity, but its benefit depends on self-care management afterwards Self-care management is partly influenced by individual’s health literacy. The level of individual’s health literate state (HLS) could determine the person’s health behavior with a subsequent effect on final weight loss We therefore hypothesized that a low HLS may result in a worse post-bariatric surgery outcome (final weight loss) compared to them with a high HLS. A retrospective study was performed including 78 patients (male vs female: 23% vs 77%, respectively; mean age 43 years (SD 12)) who underwent a laparoscopic gastric bypass (LGB) procedure. All patients were invited to perform in a review in which HLS was estimated using Rapid Estimate of Adult Literacy in Medicine- Dutch (REALM-D) and Newest Vital Sign- Dutch (NVS-D) questionnaires. Anthropometric information, such as weight at 0, 3, 6 9 and 12 months after surgery, was collected. Mean preoperative weight was 128.0 kg (SD 21.1) and patients had an average weight loss of 42.2 kg (SD 12.0) after 12 months. Almost half of the population (49%) was low educated, 38% had medium education and 13% was high educated. Of all patients, 22% had an inadequate HLS, according to the REALM-D. Following the NVS-D, 14% was characterized with an inadequate HLS. Patients with an inadequate HLS had an average weight loss of 40.2 kg (SD 13.8) or 31.5% (SD 8.1), while patients with an adequate HLS had an average weight loss of 42.8 kg (SD 11.4 or 33.3 % (SD 6.6). Following the NVS-D, preoperative weight was 123.6 (SD 20.5) for patients with an inadequate HLS and 128.7 (SD 21.1) for patients with an adequate HLS. Patients with an inadequate HLS had an average weight loss of 39.8 kg (SD 14.2) or 31.5% (SD 8.5), patients with an adequate HLS had an average weight loss of 42.6 kg (SD 11.6) or 33.1 % (SD 6.7). This reduce after 12 months did not significantly differ between patients with an inadequate and adequate HLS according to the REALM-D (B = - 1.806, P = 0.350) and NVS-D (B= -0.357, P = 0.885) after correction for age, gender and preoperative weightWeight reduction did not significantly differ between patients with inadequate or adequate health literacy levels, one year after LGB.

Operative approach to intestinal malrotation encountered during laparoscopic gastric bypass

Congenital anomalies of midgut rotation are uncommon with a 0.2–0.5% incidence. Intestinal malrotation (IM) presents a unique challenge in bariatric surgery during laparoscopic gastric bypass (LRYGB), and familiarity with alternatives allows for safe laparoscopic intervention. IM was encountered in 5 of 1183 (0.4%) patients undergoing surgery. Once IM was suspected, a standardized approach was applied: rightward shift of ports, confirmation of IM by the absence of the ligament of Treitz, identification of the duodenojejunal junction, lysis of Ladd’s bands, mirror-image construction of the Roux limb and construction of the gastrojejunal anastomosis. Forty percent were male, age 33 ± 8 years, with body mass index 50 kg/m2 (37–75 kg/m2). IM was identified preoperatively in two patients (40%). All operations were completed laparoscopically. Despite the finding of IM, successful laparoscopic completion of gastric bypass can be anticipated if the surgeon has an understanding of the anatomic alterations and a strategy for intraoperative management.