Percutaneous gastric remnant gastrostomy following Roux-en-Y gastric bypass surgery: a single tertiary center’s 13-year experience

Shaikh, Shehbaz; Stenz, J.; McVinnie, D.; Morrison, James R.; Getzen, T.M.; Carlin, Arthur M.; Mir, F.R.

doi:10.1007/s00261-017-1313-2

Cited by 13 publications

(9 citation statements)

References 17 publications

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“…LAPEG is a minimally invasive and safe procedure. Several studies showed a 100% surgical technic success rate and no postoperative complications, although one study reported an intraoperative small bowel lesion [11][12][13].…”

Section: Discussionmentioning

confidence: 99%

“…In a series of 41 procedures reported covering 13 years’ period by Shaikh et al [13], clear windows of puncture were achieved in 85%, the success rate for the procedure was 95%, and 4 patients reported major complications (9.8%); major complications including early tube dislodgement with peritonitis, intractable pain, and upper gastrointestinal bleeding [9, 10] series showed a 100% success rate, but 7 out of 10 reported cases required needle insufflation through either small bowel, colon, or liver [11].…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic Insertion of a Percutaneous Gastrostomy Prevented Malnutrition in a Patient with Previous Roux-en-Y Gastric Bypass

Pintar

Salobir

2022

Obes Facts

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Bariatric surgery is a highly effective treatment option for morbid obesity. Short- and long- term effects of bariatric surgery are not limited to weight loss but include resolution of type 2 diabetes, arterial hypertension, improvement of cardiovascular health, and overall mortality1. The long-life expectancy of patients undergoing bariatric procedures means many of these patients will succumb to other diseases. Altered GI anatomy after bariatric procedures could prove an obstacle in treatment. We present our management of one such occurrence. The patient, who had 5 years previously undergone a Roux-en-Y gastric bypass (RYGB), presented after a massive subarachnoid hemorrhage which resulted in spastic tetraplegia. He was unable to consume food and was at risk of malnutrition. A decision was made to laparoscopically create a percutaneous gastrostomy (PEG) into the excluded stomach, allowing for the use of standard feeding formula and avoiding the need for parenteral nutrition and prolonged hospitalization due to metabolic complications. The growing number of patients following bariatric procedures directs the need for novelty treatment options suited to the altered anatomy and physiology of the patient post-bariatric surgery. Prompt evaluation of long-term complications after cardiovascular events in patients operated with bariatric surgical technics reduced nutritional complications, rate hospital stay, and improve quality of life. In those patients who, due to the localization of the brain defect, are expected to be unable to feed independently due to the consequences of the latter and have either long-term or lifelong feeding through feeding tubes, it is necessary to establish an enteral feeding pathway through which the patient can receive a standard nutritional formula. This prevents the patient from developing metabolic complications and related complications. At the same time, we enable inpatient accommodation without the risk of dietary complications associated with bariatric surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Laparoscopic Insertion of a Percutaneous Gastrostomy Prevented Malnutrition in a Patient with Previous Roux-en-Y Gastric Bypass

Pintar

Salobir

2022

Obes Facts

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“…4 RYGB anatomy is a lot more technically challenging, however no significant increase in overall rate of major complications was evident in the few reported studies. 5 Few data is available in interventional radiology literature about the techniques for the access of the excluded stomach. 3 The type of imaging guidance utilized depends on pre-procedural imaging, anatomy and operator comfort.…”

Section: Discussionmentioning

confidence: 99%

“…The use of fluoroscopy and ultrasound, helps in reducing radiation does with CT. Inappropriate visualization of under distended stomach by ultrasound and fluoroscopy mandates the use of CT guidance to allow safe access of the stomach. 5 Delayed gastric remnant emptying and biliopancreatic limb obstruction may develop in the early or late postsurgical period. In the early postsurgical period, this may result from mechanical obstruction or ileus caused by internal hernia, adhesions, hemorrhage or edema at the entero-enterostomy.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous gastrostomy tube placement of the excluded gastric remnant after laparoscopic bariatric surgery in three patients

Ali

Aly

Ahmed

et al. 2021

Int J Gastrointest Interv

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Roux-en-Y gastric bypass (RYGB) is the most common bariatric surgery in the United States. RYGB is a successful and safe procedure that promotes weight loss, improves medical comorbidities and overall quality of life. Following RYGB, endoscopic access to the biliopancreatic limb and the excluded stomach is limited due to altered anatomy. Access to the excluded stomach maybe needed for management of complications following RYGB as gastric remnant decompression duo to biliopancreatic limb obstruction or nutritional support due to postoperative malnutrition. We report three cases of RYGB complications that necessitated percutaneous gastrostomy.

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“…The management of common bile duct stones (CBDS) in these patients is also complicated by the fact that the bypassed segment is not readily available for endoscopic or radiographic examination following a Roux-en-Y gastric bypass (2). Several approaches have been suggested for extracting common bile duct stones in patients with a Roux-en-Y limb, including transcystic extraction, laparoscopic cholangiotomy (3), transgastric endoscopic cholangiopancreatography (ERCP) (4)(5)(6)(7)(8)(9) and overtube-assisted ERCP (9). Each of these methods are technically complicated, require specific resources, and have certain limitations.…”

Section: Introductionmentioning

confidence: 99%

Management of Common Bile Duct Stones Encountered During Cholecystectomy in Patients With Previous Gastric Bypass

et al. 2021

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Background: Rapid weight loss following gastric bypass (GBP) predisposes to the development of gallstones, and in those who develop gallstone disease there is a high prevalence of common bile duct stones (CBDS). Furthermore, in these patients, CBDS are difficult to extract due to the altered upper gastrointestinal anatomy following GBP. The aim of the present study was to assess outcome after various management methods applied in the counties of Stockholm and Uppsala, Sweden.Methods: Data from the Swedish Register for Gallstone Surgery and ERCP (GallRiks) and the Swedish Obesity Surgery Register (SoReg) were crossmatched to identify all patients who had undergone gallstone surgery after GBP, where CBDS were found at intraoperative cholangiography, in the Stockholm and Uppsala counties 2009–2013. A retrospective review of patient records was performed for all patients identified.Results: In all, 55 patients were identified. These were managed as follows: expectancy (N = 11); transgastric ERCP (N = 2); laparoscopic choledochotomy (N = 3); open choledochotomy (N = 5); transcystic stone extraction (N = 12); and other approach (N = 13). In nine cases, data on management could not be found. There were nine cases of minor postoperative complication. No retained stones were registered. The operation time was longer for transgastric ERCP (p = 0.002), and the postoperative stay was longer following open and laparoscopic choledochotomy (p < 0.001). There was no statistically significant difference between any of the methods regarding the incidence of postoperative complications (p = 0.098).Discussion: Further development of techniques for managing CBDS discovered in patients undergoing cholecystectomy after previous GBP are needed, as well as more comparative studies with greater statistical power.

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Percutaneous gastric remnant gastrostomy following Roux-en-Y gastric bypass surgery: a single tertiary center’s 13-year experience

Cited by 13 publications

References 17 publications

Laparoscopic Insertion of a Percutaneous Gastrostomy Prevented Malnutrition in a Patient with Previous Roux-en-Y Gastric Bypass

Laparoscopic Insertion of a Percutaneous Gastrostomy Prevented Malnutrition in a Patient with Previous Roux-en-Y Gastric Bypass

Percutaneous gastrostomy tube placement of the excluded gastric remnant after laparoscopic bariatric surgery in three patients

Management of Common Bile Duct Stones Encountered During Cholecystectomy in Patients With Previous Gastric Bypass

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