Laparoszkópos gastroplicatio pylorusmegőrző duodenoilealis bypassműtéttel a kóros elhízás kezelésében

Bariatric surgery is more effective in the management of morbid obesity and related comorbidities than conservative therapy. There are two main groups, restrictive and malabsorptive procedures. Laparoscopic gastric plication with pylorus-preserving loop duodenoileal bypass is classified into the latter group. It should be considered as the modernized variant of the classical Scopinaro procedure. In this article, the method is presented by a case report. Orv Hetil. 2019; 160(43): 1714–1718.

Single-Anastomosis Malabsorptive Procedures

Malabsorptive interventions are recognized as the procedure of choice in metabolic surgery and as the best strategy for re-do surgery when restriction fails. This chapter describes the most recently published single-anastomosis malabsorptive procedures: the one-anastomosis gastric bypass (OAGB), the single-anastomosis duodenoileal anastomosis with sleeve (SADIS), the duodenojejunal omega switch (DJOS), the duodenoileal omega switch (DIOS), the ileal food diversion (IFD), and the sleeve gastrectomy with loop bipartition (SG + LB). These procedures are effective and safe and may be regarded as an option, although no consensus exists as to which procedure offers the best option overall, nor is there an established criterion or algorithm for a made-to-measure procedure for a given patient. The use of a single anastomosis is the most important part of the techniques. All the procedures are relatively new and their safety should be evaluated in bigger randomized trials.

Liver failure following biliopancreatic diversions: a narrative review

ABSTRACT CONTEXT AND OBJECTIVE: Occurrences of liver failure following jejunoileal bypass were extensively reported in the past and were one of the main factors that led to abandonment of this procedure. The newer predominantly malabsorptive procedures called biliopancreatic diversions (BPDs) have also been implicated in several cases of acute and subacute liver failure. The aim here was to review the current available evidence on occurrences of liver failure following BPDs. DESIGN AND SETTING: Narrative review; bariatric surgery service of a public university hospital. METHODS: A review of the literature was conducted through an online search of medical databases. RESULTS: Associations between BPDs and liver failure have only infrequently been reported in the literature. However, they appear to be more than merely anecdotal. The pathophysiological mechanisms remain obscure, but they seem to be related to rapid weight loss, protein malnutrition, deficits of hepatotrophic factors, high circulating levels of free fatty acids and bacterial overgrowth in the bypassed bowel segments. Reversal of the BPD may ameliorate the liver impairment. CONCLUSIONS: Although infrequent, liver failure remains a concern following BPDs. Careful follow-up is required in individuals who undergo any BPD.

Invazív módszerek az elhízás kezelésében

Treatment of obesity and concomitant diseases have a significant burden on the health care system. Due to the lack of efficacy of conservative treatment methods, attention has shifted towards invasive methods. Surgical and endoscopic treatments of obesity are based on two different methods: restrictive and malabsorptive procedures or their combination. The author reviews the most effective surgical and endoscopic procedures in the treatment of obesity. Orv. Hetil., 2016, 157(19), 728–732.

Preservation of Fat-free Mass after Bariatric Surgery: A Comparison of Malabsorptive and Restrictive Procedures

The Roux-en-Y gastric bypass (RYGB) has been shown to cause significant weight loss. However, fat-free mass (FFM) is often lost with this rapid weight change. It is suggested that the loss of FFM is minimized with restrictive-only procedures, such as the vertical sleeve gastrectomy (VSG), when compared with malabsorptive surgery. The purpose of the study was to determine the difference in the postoperative loss of FFM between RYBG and VSG patients. We reviewed all patients who underwent RYGB or VSG between May 2012 and January 2013. Patients were evaluated one month before their procedure and 12 months after for comparison of results. Preoperative and postoperative body analysis data were procured using a body composition analysis device. Within the study period, 33 patients underwent a RYGB procedure and 20 patients a VSG. After 12 months, RYGB patients had an average increase of 38.15 per cent in their proportion of FFM, whereas VSG patients had an average FFM increase of 22.09 per cent, a statically significant difference ( P = 0.004). The RYGB helps preserve overall FFM as compared with the VSG. These findings are unexpected because malabsorptive procedures require increased protein intake, resulting in a stronger likelihood of inadequate protein intake, which may lead to protein malnutrition.