Results of Gastrojejunal Plication for Inadequate Weight Loss follow Roux-en-Y Gastric Bypass

Background Obesity is a serious global epidemic and poses a significant health threat to humans. The prevalence of obesity is increasing not only in adults, but also among children and adolescents. Non-operative treatment of obesity has commonly been ineffective, and bariatric surgery has been shown to be effective in achieving substantial weight loss and improving obesity related comorbidities in the long-term. Aim of the Work Our objective in this study is to assess the effectiveness of Gastro-jejunal stomal plication (GJP) for inadequate weight loss follow Roux-en-Y gastric bypass surgery (RYGB). Patients and Methods The study will use the following search tools and databases: PubMed, Google Scholar, Cochrane Clinical Trials Database, Cochrane Review Database, EMBASE, and Allied and Complementary Medicine. Search terms included Revisional Surgery, inadequate weight loss And Roux en Y gastric bypass, then gastro-jejunal plication. These studies were published from (2009-2017). Results Eleven studies were included and these studies worked on 420 patients. Comparisons between these were done according to age, sex, time interval between (RYGB) & GJP, weight loss after GJP, laparoscopic vs open technique and overall complications of revisional surgery (GJP). Conclusion The exact reasons for weight loss failure after RYGB remain incompletely elucidated and are probably multifactorial. Pouch resizing could be a valuable option for weight loss failure or regain in selected patients with a dilated gastric pouch after RYGB in the short term. Careful selection of candidates for this procedure through psychiatric and nutritional evaluations and volumetric measures of the gastric pouch, preferably using CT, is mandatory to identify those patients most likely to benefit from revision.

Bariatric Surgery in Adolescents: To Do or Not to Do?

Pediatric obesity is a multifaceted disease that can impact physical and mental health. It is a complex condition that interweaves biological, developmental, environmental, behavioral, and genetic factors. In most cases lifestyle and behavioral modification as well as medical treatment led to poor short-term weight reduction and long-term failure. Thus, bariatric surgery should be considered in adolescents with moderate to severe obesity who have previously participated in lifestyle interventions with unsuccessful outcomes. In particular, laparoscopic sleeve gastrectomy is considered the most commonly performed bariatric surgery worldwide. The procedure is safe and feasible. The efficacy of this weight loss surgical procedure has been demonstrated in pediatric age. Nevertheless, there are barriers at the patient, provider, and health system levels, to be removed. First and foremost, more efforts must be made to prevent decline in nutritional status that is frequent after bariatric surgery, and to avoid inadequate weight loss and weight regain, ensuring successful long-term treatment and allowing healthy growth. In this narrative review, we considered the rationale behind surgical treatment options, outcomes, and clinical indications in adolescents with severe obesity, focusing on LSG, nutritional management, and resolution of metabolic comorbidities.

Is Revisional Gastric Bypass as Effective as Primary Gastric Bypass for Weight Loss and Improvement of Comorbidities?

Background Revisional gastric bypass (R-RYGB) surgery is utilized for the management of inadequate weight loss or weight regain observed after some cases of bariatric surgeries. Data on the mid-term effectiveness of primary gastric bypass (P-RYGB) compared with R-RYGB (e.g., post sleeve gastrectomy/gastric banding) are controversial. Methods Retrospective chart review of all patients who received P-RYGB and R-RYGB (January 2011–June 2015) at our center. One hundred twenty patients who underwent P-RYGB and 34 R-RYGB who completed 18 months follow-up were included. We compared the effectiveness of P-RYGB with R-RYGB by assessing four anthropometric, two glycemic, and four lipid parameters, as well as the control of type 2 diabetes (T2DM), hypertension, dyslipidemia (remission, improvement, persistence, relapse, de novo), mortality and complications rates. Results A comparison of the effectiveness of P-RYGB with R-RYGB at 18 months revealed no significant differences in patients’ age, gender, and preoperative BMI between groups. However, patients who received P-RYGB had lower mean weight (P = 0.001) and BMI (P < 0.001), reflected by a higher mean delta BMI (P = 0.02), total weight loss percentage (TWL%) (P < 0.0001) and excess weight loss percentage (EWL%) (P < 0.0001). No differences in glycemic parameters, lipid profiles, control of T2DM, hypertension, and dyslipidemia were observed. No death is reported and complication rates were comparable. Conclusions Although R-RYGB effectively addressed inadequate weight loss, weight regain, and recurrence of comorbidities after restrictive bariatric surgery, R-RYGB resulted in inferior weight loss compared with P-RYGB. Neither procedure differed in their clinical control of T2DM, hypertension, and dyslipidemia. Both procedures exhibited comparable complication rates.