Impact of Roux-En-Y Gastric Bypass on Vitamin D and Iron Metabolism a Systematic Review Literature

There has been a steady rise in the number of individuals who are morbidly obese. The divided RYGB is the most commonly performed bariatric surgical procedure in the world and is considered the gold standard. Physicians need to be aware of the important peri-operative complications that can occur after gastric bypass. In addition, gastrointestinal physicians are seeing patients who seek advice and care for symptoms that develop or persist after RYGB. Physicians should be able to predict and manage most postoperative medical and nutritional disorders related to RYGB and should be prepared to assess patients for potential referral for surgical intervention or revision

Magnetic Sphincter Augmentation for Hiatus Hernia and De Novo Gerd after Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy (LSG) has become the most popular bariatric surgical procedure owing to its safety, reproducibility and effectiveness. However, gastroesophageal reflux disease (GERD) with or without hiatal hernia is diagnosed at an alarming rate after LSG. Revisional surgery and conversion to Roux-en-Y gastric bypass (RYGB) does not guarantee total reflux control and is associated with morbidity. Magnetic sphincter augmentation (MSA) combined with crural repair is an alternative therapeutic option as a concurrent or remedial procedure in LSG, but current clinical evidence is still limited.

Sex Differences of Kidney Stone Urine Risk Factors after Roux-en-Y Gastric Bypass

<b><i>Introduction:</i></b> Roux-en-Y gastric bypass (RYGB) is a bariatric surgical procedure that is associated with higher risk of kidney stones after surgery. We examined urine composition in 18 men and women before and after RYGB to examine differences in kidney stone risk. <b><i>Methods:</i></b> Three 24-h urine collections were performed before and 1 year after RYGB. We analyzed mean urinary values for pre- and post-RYGB collections and compared men and women. <b><i>Results:</i></b> Seven men and eleven women completed pre- and post-RYGB urine collections. Pre-RYGB, men had higher calcium oxalate supersaturation (CaOx SS) (7.0 vs. 5.0, <i>p</i> = 0.04) compared with women. Post-RYGB, women had higher urine CaOx SS (13.1 vs. 4.6, <i>p</i> = 0.002), calcium phosphate supersaturation (1.04 vs. 0.59, <i>p</i> = 0.05), and lower urine volumes (1.7 vs. 2.7L, <i>p</i> &#x3c; 0.001) compared with men. <b><i>Discussion/Conclusion:</i></b> There are important differences in urine composition by sex that may contribute to higher kidney stone risk in women after RYGB compared with men.

Reversal to Normal Anatomy (With Sleeve Gastrectomy) for Severe Hypoglycemia

Background. Laparoscopic Roux-en-Y gastric bypass (GBP) is an essential bariatric surgical procedure which is globally performed because of the associated effective weight loss and resolution of metabolic comorbidities, such as diabetes and dyslipidemia. Although some complications may occur, hypoglycemia is a rare complication, which can lead to lethal consequences. We aimed to describe the technical aspects and surgical results after reversal to normal anatomy (RNA). Methods. We conducted a retrospective data analysis including 16 patients who underwent laparoscopic RNA from 2011 to 2018. All data were archived in a prospective database. Previous bariatric surgery and postoperative outcomes were analyzed. Results. Sixteen patients underwent RNA, most of them after GBP, and 15 patients required sleeve gastrectomy. Among them, 80% were women; 5 patients presented with postoperative complications, such as colitis with intra-abdominal collection (n = 1), gastric leak (n = 2) treated with an endoprosthesis, mesenteric venous thrombosis (n = 1), and intra-abdominal bleeding (n = 1). Mean length of hospital stay was 5.93 (3-30). All patients recovered from their initial condition although 3 patients presented with mild hypoglycemia during follow-up. Seven patients regained weight (43.75%), and another 4 developed gastroesophageal reflux disease (25%). Conclusions. These laparoscopic RNA results are acceptable, indicating a clinical improvement in the hypoglycemic syndrome in all patients.

Laparoscopic adjustable gastric banding’s multiple complications: when complications arise even after 30 years, a case report.

Laparoscopic adjustable gastric banding (LAGB) is a popular bariatric surgical procedure. The introduction of laparoscopy has increased the use of this procedure, making it the most commonly performed bariatric surgery. Patients undergoing LAGB have achieved satisfactory results in terms of weight loss, a reduction in co-morbidities, and improved quality of life. Nonetheless, complications with LAGB are well documented and include migration, erosion, prolapse, infection, pouch dilation, gastric perforation, and most commonly, lack of weight loss following the failure of the procedure. This case report presents a patient with slippage and pouch dilation, erosion of the stomach, and port site problems, including infection, occurring 28 years after LAGB.

Review of pathological findings in laparoscopic sleeve gastrectomy specimens performed for morbid obesity

BackgroundBariatric surgical procedures are employed when there is a failure of lifestyle modification in arresting obesity. Laparoscopic sleeve gastrectomy (LSG) is quickly becoming the bariatric surgical procedure of choice. LSG results in a gastric remnant that is subject to pathological examination. The objective of this paper is to review the literature in regard to histological findings identified in gastric remnants post-LSG and identify the most pertinent histological findings.Materials and methodsA literature search was performed to identify relevant case series. Data gathered from relevant case series then underwent statistical analysis.ResultsThe most common histological findings in an LSG specimen were clinically indolent findings such as no pathological abnormalities identified followed by non-specific gastritis. A minority of cases demonstrated clinically actionable findings for which Helicobacter pylori represented the majority of these findings.ConclusionThere is a broad spectrum of pathological findings in LSG specimens, ranging from clinically indolent to clinically actionable. The most common histological findings are clinically indolent and only a small portion are of clinical significance and, hence, actionable.

A Comparative Study of Machine Learning Algorithms in Predicting Severe Complications after Bariatric Surgery

Background: Severe obesity is a global public health threat of growing proportions. Accurate models to predict severe postoperative complications could be of value in the preoperative assessment of potential candidates for bariatric surgery. So far, traditional statistical methods have failed to produce high accuracy. We aimed to find a useful machine learning (ML) algorithm to predict the risk for severe complication after bariatric surgery. Methods: We trained and compared 29 supervised ML algorithms using information from 37,811 patients that operated with a bariatric surgical procedure between 2010 and 2014 in Sweden. The algorithms were then tested on 6250 patients operated in 2015. We performed the synthetic minority oversampling technique tackling the issue that only 3% of patients experienced severe complications. Results: Most of the ML algorithms showed high accuracy (>90%) and specificity (>90%) in both the training and test data. However, none of the algorithms achieved an acceptable sensitivity in the test data. We also tried to tune the hyperparameters of the algorithms to maximize sensitivity, but did not yet identify one with a high enough sensitivity that can be used in clinical praxis in bariatric surgery. However, a minor, but perceptible, improvement in deep neural network (NN) ML was found. Conclusion: In predicting the severe postoperative complication among the bariatric surgery patients, ensemble algorithms outperform base algorithms. When compared to other ML algorithms, deep NN has the potential to improve the accuracy and it deserves further investigation. The oversampling technique should be considered in the context of imbalanced data where the number of the interested outcome is relatively small.

A comparative study of machine learning algorithms in predicting severe complications after bariatric surgery

Accurate models to predict severe postoperative complications could be of value in the preoperative assessment of potential candidates for bariatric surgery. Traditional statistical methods have so far failed to produce high accuracy. To find a useful algorithm to predict the risk for severe complication after bariatric surgery, we trained and compared 29 supervised machine learning (ML) algorithms using information from 37,811 patients operated with a bariatric surgical procedure between 2010 and 2014 in Sweden. The algorithms were then tested on 6,250 patients operated in 2015. Most ML algorithms showed high accuracy (>90%) and specificity (>0.9) in both the training and test data. However, none achieved an acceptable sensitivity in the test data. ML methods may improve accuracy of prediction but we did not yet identify one with a high enough sensitivity that can be used in clinical praxis in bariatric surgery. Further investigation on deeper neural network algorithms is needed.