Optimizing Results of Gastric Bypass

Mason, Edward E.; Printen, Kenneth J.; Hartford, Charles E.; Boyd, William C.

doi:10.1097/00000658-197510000-00006

Cited by 168 publications

(49 citation statements)

References 9 publications

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“…The 2 limbs are joined downstream by a jejunojejunal anastomosis, where ingested food is mixed with bile acids and digestive enzymes as they enter the "common channel" of small intestine (1). Originally, the Roux limb was 30 cm long, and the procedure was presumed to restrict food intake but not to induce malabsorption (2). This operation produced satisfactory weight loss in patients with modest obesity but not in those with severe obesity.…”

Section: Introductionmentioning

confidence: 99%

The contribution of malabsorption to the reduction in net energy absorption after long-limb Roux-en-Y gastric bypass

Odstrcil

Martı́nez

Ana

et al. 2010

The American Journal of Clinical Nutrition

182

105

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Background: Roux-en-Y gastric bypass (RYGB) restricts food intake, and when the Roux limb is elongated to 150 cm, the procedure is believed to induce malabsorption. Objective: Our objective was to measure total reduction in intestinal absorption of combustible energy after RYGB and the extent to which this was due to restriction of food intake or malabsorption of ingested macronutrients. Design: Long-limb RYGB was performed in 9 severely obese patients. Dietary intake and intestinal absorption of fat, protein, carbohydrate, and combustible energy were measured before and at 2 intervals after bypass. By using coefficients of absorption to measure absorptive function, equations were developed to calculate the daily gram and kilocalorie quantities of ingested macronutrients that were not absorbed because of malabsorption or restricted food intake. Results: Coefficients of fat absorption were 92 6 1.3% before bypass, 72 6 5.5% 5 mo after bypass, and 68 6 8.7% 14 mo after bypass. There were no statistically significant effects of RYGB on protein or carbohydrate absorption coefficients, although protein coefficients decreased substantially in some patients. Five months after bypass, malabsorption reduced absorption of combustible energy by 124 6 57 kcal/d, whereas restriction of food intake reduced energy absorption by 2062 6 271 kcal/d. Fourteen months after bypass, malabsorption reduced energy absorption by 172 6 60 kcal/d compared with 1418 6 171 kcal/d caused by restricted food intake. Conclusion: On average, malabsorption accounted for '6% and 11% of the total reduction in combustible energy absorption at 5 and 14 mo, respectively, after this gastric bypass procedure. Am J Clin Nutr 2010;92:704-13.

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Section: Introductionmentioning

confidence: 99%

The contribution of malabsorption to the reduction in net energy absorption after long-limb Roux-en-Y gastric bypass

Odstrcil

Martı́nez

Ana

et al. 2010

The American Journal of Clinical Nutrition

182

105

View full text Add to dashboard Cite

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“…It may be performed with several technical variables, such as the pouch capacity, the presence or not of a contention band in the pouch exit, the length of the alimentary and biliopancreatic loops, and the use of conventional or videolaparoscopic access (6,9,15,22,24) (Figures 1 and 2). …”

Section: Introductionmentioning

confidence: 99%

Early marginal ulcer following Roux-en-Y gastric bypass under proton pump inhibitor treatment: prospective multicentric study

Garrido¹,

Rossi²,

Lima³

et al. 2010

Arq. Gastroenterol.

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-Context -Causal factors of gastrojejunal ulcers after Roux-en-Y gastric bypass include peptic acid secretion from the gastric pouch. Esomeprazole is a potent inhibitor of acid secretion. Objective -To assess the occurrence of dyspepsia and gastrojejunal ulcers within the first 2 months after Roux-en-Y gastric bypass during the use of esomeprazole. Methods -One hundred eighteen morbid obese subjects were submitted to Roux-en-Y gastric bypass. Preoperative upper gastrointestinal tract endoscopy was negative for H. pylori. All subjects received esomeprazole for 60 days after surgery. Results -Two weeks after surgery only 13 mild symptoms were reported. After 2 months, 17 also moderate complaints were registered. Endoscopy around the 60th day showed esophagitis in 10 (8.5%), hiatal hernia in 2 (1.7%), foreign body in the anastomotic line in 12 (10.2%) and gastrojejunal ulcers was observed in 9 (7.6%) subjects, 2 of which had a suture material or metallic staple granuloma in the gastrojejunostomy. Ten subjects took nonsteroidal anti-inflammatory drugs at least once during study, but none of them developed ulcer. None of the subjects with ulcer had dyspeptic symptoms. Conclusion -The incidence of ulcer in the gastrojejunal anastomosis within the first 2 months following Rouxen-Y gastric bypass under proton pump inhibitors is considerable. It was not related to the use of non-steroidal anti-inflammatory drugs, highlighting the possibility of ischemia and foreign body as causal factors. The ulcers were asymptomatic, and all post-surgical dyspeptic symptoms were moderate in severity.

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“…The two limbs are joined by a jejuno-jejunal anastomosis, where ingested food is mixed with bile acids and digestive enzymes as they enter the ‘common channel’ of small intestine [5]. Originally, the Roux limb was 30 cm long [6], and the procedure was presumed to restrict food intake [7]. Subsequently, the Roux limb was lengthened to 150 cm to induce malabsorption that would act synergistically with restricted intake to promote weight loss [8,9].…”

Section: Roux-en-y Gastric Bypassmentioning

confidence: 99%

Medical Complications of Bariatric Surgery: Focus on Malabsorption and Dumping Syndrome

Hammer

2012

Dig Dis

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Gastroenterologists increasingly see patients with symptoms after bariatric surgery. A number of gastrointestinal or extra-gastrointestinal symptoms should raise the suspicion of malabsorption or dumping syndrome. Little is known about long-term consequences of disordered intestinal anatomy and physiology resulting from bariatric surgical procedures. The latency phase of clinical problems is unknown, but may potentially be long, and postoperative courses over many decades have to be considered regarding the consequences of surgical alterations of gastrointestinal structure and function. Long-term nutritional requirements in patients with bariatric procedures are incompletely understood. This review focuses on the pathophysiology of long-limb Roux-en-Y gastric bypass (RYGB) because it has become the most common bariatric procedure in many parts of the world. Although several potential mechanisms for nutritional deficiencies after RYGB like deficiency of dietary intake, lack of gastric secretions, exclusion of proximal duodenum and jejunum, or asynergia between food bolus and biliopancreatic secretions have been postulated, it was only very recently that in-depth studies have been carried out to measure the extent to which the long-limb RYGB causes malabsorption. In order to improve care for these patients, specialists who are trained in understanding pathophysiological changes in digestion and absorption after bariatric surgery and who recognize and treat clinical symptoms and nutritional deficits after bariatric surgery are needed. In addition, clinical researchers should take advantage of the experimental setups provided by standardized surgical procedures, and scientific societies should design courses and scientific meetings which combine the expertise in gastroenterology, surgery and nutrition.

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Optimizing Results of Gastric Bypass

Cited by 168 publications

References 9 publications

The contribution of malabsorption to the reduction in net energy absorption after long-limb Roux-en-Y gastric bypass

The contribution of malabsorption to the reduction in net energy absorption after long-limb Roux-en-Y gastric bypass

Early marginal ulcer following Roux-en-Y gastric bypass under proton pump inhibitor treatment: prospective multicentric study

Medical Complications of Bariatric Surgery: Focus on Malabsorption and Dumping Syndrome

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