Importance of pouch size in laparoscopic Roux-en-Y gastric bypass: a cohort study of 14,168 patients

Edholm, David; Ottosson, Johan; Sundbom, Magnus

doi:10.1007/s00464-015-4432-2

Cited by 77 publications

(27 citation statements)

References 19 publications

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“…This points to suboptimal surgery as a risk factor for marginal ulcer [18,19], especially considering that longer stapling length more than doubled the risk for marginal ulcer at 1 year. This concurs with a recent paper on 14,168 primary LRYGB, where we demonstrated that the relative risk for marginal ulcer increased with the size of the gastric pouch (14% for each additional centimeter of stapling used for the gastric pouch [20]). These surgical factors represent important steps that the surgeon can take to reduce future complications.…”

Section: Discussionsupporting

confidence: 93%

Acid-related complications after laparoscopic Roux-en-Y gastric bypass: risk factors and impact of proton pump inhibitors

Wennerlund

Gunnarsson

Strigård

et al. 2020

Surgery for Obesity and Related Diseases

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Background: Laparoscopic Roux-en-Y (LRYGB) gastric bypass is an effective treatment for morbid obesity. Acid-related complications after LRYGB could be prevented by prophylactic proton pump inhibition (PPI). Objective: To identify the effect of PPI prophylaxis on short-term, acid-related complications in a large cohort. Setting: National Registry, Sweden. Methods: A total of 37,301 patients who underwent LRYGB in Sweden from 2009 to 2014 were identified in the Scandinavian Obesity Surgery Registry. Patient-specific factors were cross matched with socioeconomic variables and information on PPI dispensation. A logistic regression model was used to analyze acid-related complications (e.g., marginal ulcer, stricture, and perforation) within 30 days and at 1 year postoperatively. Results: PPI prophylaxis did not reduce the rate of acid-related complications. Instead, prolonged operation time (odds ratio [OR] 2.19 [1.53-3.13]) and immigrant background (OR 1.72 [1.17-2.53]) increased the risk of marginal ulcer within 30 days. At 1 year, medical treatment for diabetes (OR 1.75 [1.14-2.67]) and dyspepsia (OR 1.71 [1.06-2.75]), larger gastric pouch (OR 2.19 [1.528-3.248]), longer operation time (OR 1.67 [1.11-2.51]), smoking (OR 2.59 [1.77-3.78]), and immigrant background (OR 1.60 [1.08-2.36]) increased the risk for marginal ulcer, while older age (OR 2.20 [1.05-4.63]) predisposed for stricture. Inferior weight loss was associated with marginal ulcer at 1 year (OR 1.50 [1.04-2.15]). Conclusion: PPI prophylaxis did not reduce the risk for marginal ulcer and stricture. The risk for these complications was increased by several co-morbidities, smoking, immigrant background, and surgical factors. Routine use of PPI prophylaxis cannot be recommended, but smoking cessation and optimal surgery could be important.

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Section: Discussionsupporting

confidence: 93%

Acid-related complications after laparoscopic Roux-en-Y gastric bypass: risk factors and impact of proton pump inhibitors

Wennerlund

Gunnarsson

Strigård

et al. 2020

Surgery for Obesity and Related Diseases

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“…Regarding the characteristics of the surgical technique, the inferior weight loss observed in the R-RYGB group may be due to the lack of precise measurements of the stomach pouch size during revisional surgery, resulting in a larger stomach pouch [16]. However, recent study suggests that pouch size does not play a critical role in weight regain unless the pouch is very large [33]. There is also a growing evidence suggesting that the differences in the total alimentary limb length (TALL) and the length of the biliopancreatic (BPL) could play a role [34,35].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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.

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“…Many patients may have other work up including CT scan, right upper quadrant ultrasound, and laboratory blood work to rule out other causes of abdominal pain. In addition to 8 ruling out fistulas, stenosis, hernias, gastric pouch ulcers, and gallbladder disease, surgeons should always consider "Candy Cane Syndrome". In our experience, the classic findings for "Candy Cane Syndrome" include, an UGI filling of afferent blind limb first before "spilling" into the roux limb ( figure 2).…”

Section: Methodsmentioning

confidence: 98%

“…Patients in this series were 3 to 11 years out from their original RYGB. From the bariatric literature, we could hypothesize that after gastric bypass surgery, the gastric pouch/ blind limb could gradually enlarge from passive stretching with overeating or pouch hyperplasia (7)(8)(9) , thus causing unsatisfying weight regain, nausea, vomiting, abdominal pain and other symptoms.…”

Section: Methodsmentioning

confidence: 99%

“Candy cane syndrome:” an underappreciated cause of abdominal pain and nausea after Roux-en-Y gastric bypass surgery

Aryaie

Fayezizadeh

Wen

et al. 2017

Surgery for Obesity and Related Diseases

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Importance of pouch size in laparoscopic Roux-en-Y gastric bypass: a cohort study of 14,168 patients

Abstract: A smaller pouch reduces the risk of marginal ulcers, but does not predict better weight loss at 1 year. Additional stapling should be avoided as each extra centimeter increases the relative risk of marginal ulcers by 14 %.

Cited by 77 publications

References 19 publications

Acid-related complications after laparoscopic Roux-en-Y gastric bypass: risk factors and impact of proton pump inhibitors

Acid-related complications after laparoscopic Roux-en-Y gastric bypass: risk factors and impact of proton pump inhibitors

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

“Candy cane syndrome:” an underappreciated cause of abdominal pain and nausea after Roux-en-Y gastric bypass surgery

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