Pouch volume and pouch migration after Roux-en-Y gastric bypass: a comparison of gastroscopy and 3 D-CT volumetry: is there a “migration crisis”?

Arnoldner, Michael A.; Felsenreich, Daniel Moritz; Langer, Felix B.; Weber, Michael; Mang, Thomas; Kulinna-Cosentini, Christiane; Prager, Gerhard

doi:10.1016/j.soard.2020.07.024

Cited by 18 publications

(5 citation statements)

References 37 publications

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“…Looking for answers, we have noticed that the “migration crisis” is affecting other bariatric procedures, too. Arnoldner et al studied prospectively thirty patients who underwent RYGBP and discovered CT evidence for ITM in 66.7% of them, whereas gastroscopy did not correctly identify any herniation and symptomatic reflux in one third of the patients [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

“…The reconstruction of phreno-esophageal ligament is here proposed as an innovative, safe, efficient, and relatively simple method to prevent and control the ITM after LSG. The simple revision of gastric sleeve to RYGBP for reflux issues is not a guaranty for the GERD and ITM control [ 44 ] R-PEL may be successfully and efficiently used for other types of bariatric procedures, such as gastric bypass also at the risk of ITM. The potential mechanism of postoperative ITM has been clearly described in this paper while R-PEL may be a revolutionary concept aiming to improve the antireflux surgery and prevent some of the long-term complications.…”

Section: Strength and Limits Of The Studymentioning

confidence: 99%

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Reconstruction of the phreno-esophageal ligament (R-PEL) prevents the intrathoracic migration (ITM) after concomitant sleeve gastrectomy and hiatal hernia repair

Hutopilă

Ciocoiu²,

Paunescu³

et al. 2023

Surg Endosc

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Background Laparoscopic Sleeve Gastrectomy (LSG) is the most attractive bariatric procedure, but the postoperative intrathoracic gastric migration (ITM) and “de novo” GERD are major concerns. The main objective of our study was to evaluate the efficiency of the concomitant HHR with or without partial reconstruction of phreno-esophageal ligament (R-PEL) to prevent ITM after LSG. The secondary objectives focused on procedure’s metabolic and GERD-related outcomes. Patients and method Consecutive patients who underwent primary LSG and concomitant HHR were included in a single-center prospective study. According to the HHR surgical technique, two groups were analyzed and compared: Group A included patients receiving crura approximation only and Group B patients with R-PEL. The patients’ evolution of co-morbidities, GERD symptoms, radiologic, and endoscopic details were prospectively analyzed. Results Two hundred seventy-three patients undergoing concurrent HHR and LSG were included in the study (Group A and B, 146 and 127 patients) The mean age and BMI were 42.6 ± 11.3 and 43.4 ± 6.8 kg/m 2 . The 12-month postoperative ITM was radiologically found in more than half of the patients in Group A, while in group B, the GEJ’s position appeared normal in 91.3% of the patients, meaning that R-PEL reduced 7 times the rate of ITM. The percentage of no-improvement and “de novo” severe esophagitis (Los Angeles C) was 4 times higher in group A 3.4% vs. 0.8% with statistical significance, and correlated to ITM. The GERD symptoms were less frequent in Group B vs Group A, 21.3% vs 37%, with statistical significance. No Barrett’s esophagus and no complication were recorded in any of the patients. Conclusion Concurrent LSG and HHR by crura approximation only has a very high rate of ITM in the first postoperative year (over 50%). R-PEL is an innovative technique which proved to be very efficient in preventing the ITM after HHR.

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Section: Discussionmentioning

confidence: 99%

Section: Strength and Limits Of The Studymentioning

confidence: 99%

Reconstruction of the phreno-esophageal ligament (R-PEL) prevents the intrathoracic migration (ITM) after concomitant sleeve gastrectomy and hiatal hernia repair

Hutopilă

Ciocoiu²,

Paunescu³

et al. 2023

Surg Endosc

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“…No consensus was achieved for cruroplasty and hiatal hernia repair. It is important to evidence intrathoracic gastric pouch migration, a newly described entity, which may be addressed in redo-surgery [22,31]. Further studies are necessary to underline its significance.…”

Section: Symptomatic Gerd After Sg and Inadequate Weight Loss/weight ...mentioning

confidence: 99%

Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus

Kermansaravi

Parmar

Chiappetta³

et al. 2023

Surg Endosc

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Background Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgical (MBS) procedure worldwide. Despite the desired effect of SG on weight loss and remission of obesity-associated medical problems, there are some concerns regarding the need to do revisional/conversional surgeries after SG. This study aims to make an algorithmic clinical approach based on an expert-modified Delphi consensus regarding redo-surgeries after SG, to give bariatric and metabolic surgeons a guideline that might help for the best clinical decision. Methods Forty-six recognized bariatric and metabolic surgeons from 25 different countries participated in this Delphi consensus study in two rounds to develop a consensus on redo-surgeries after SG. An agreement/disagreement ≥ 70.0% on statements was considered to indicate a consensus. Results Consensus was reached for 62 of 72 statements and experts did not achieve consensus on 10 statements after two rounds of online voting. Most of the experts believed that multi-disciplinary team evaluation should be done in all redoprocedures after SG and there should be at least 12 months of medical and supportive management before performing redo-surgeries after SG for insufficient weight loss, weight regain, and gastroesophageal reflux disease (GERD). Also, experts agreed that in case of symptomatic GERD in the presence of adequate weight loss, medical treatment for at least 1 to 2 years is an acceptable option and agreed that Roux-en Y gastric bypass is an appropriate option in this situation. There was disagreement consensus on efficacy of omentopexy in rotation and efficacy of fundoplication in the presence of a dilated fundus and GERD. Conclusion Redo-surgeries after SG is still an important issue among bariatric and metabolic surgeons. The proper time and procedure selection for redo-surgery need careful considerations. Although multi-disciplinary team evaluation plays a key role to evaluate best options in these situations, an algorithmic clinical approach based on the expert's consensus as a guideline can help for the best clinical decision-making.

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“…Mittels CT-Diagnostik können eine Migration des Pouches sowie eine Vergrößerung des Pouches und Erweiterung der Anastomose zuverlässig detektiert werden [28,29].…”

Section: Diagnostikunclassified

Therapieoptionen bei Weight-Regain nach Bariatrischer Operation

et al. 2022

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Zusammenfassung Hintergrund Die Intention dieses Artikels ist, einen Überblick über die Diagnosestellung und Therapiemöglichkeiten bei erneuter Gewichtszunahme (WR) oder unzureichendem Gewichtsverlust (IWL) nach bariatrischer Operation (BS) zu geben. Bei weiter steigenden Zahlen der BS gewinnt WR immer mehr an Relevanz. Methoden Eine ausgiebige Literaturrecherche wurde mit persönlichen Erfahrungen kombiniert, um eine mögliche Handlungsempfehlung bei WR oder IWL zu geben. Ergebnisse Im Falle einer anatomischen Ursache für WR ist der chirurgische Therapieansatz derzeit am effektivsten. Bei idiopathischem WR oder IWL ist ein multimodales Therapiekonzept für eine erfolgreiche Therapie notwendig. Abhängig von der vorangegangenen OP ist eine Kombination von Lebensstilinterventionen, medikamentöser und chirurgischer Therapie ein wirksames Vorgehen. Schlussfolgerungen Eine ausgiebige Diagnostik ist vor Indikationsstellung einer chirurgischen Revision notwendig. Bei idiopathischem WR und IWL nach Roux-Y-Magenbypass (RYGB) schlagen wir die Verlängerung des biliopankreatischen Schenkels bei gleichzeitiger Verkürzung des Common Channels vor. Nach Schlauchmagen (Sleeve-Gastrektomie, SG) sehen wir derzeit die Umwandlung in RYGB bei Patienten mit gleichzeitiger Refluxösophagitis und den SADI-S bei fehlendem Vorliegen eines Refluxes als sinnvollste Therapie an.

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Pouch volume and pouch migration after Roux-en-Y gastric bypass: a comparison of gastroscopy and 3 D-CT volumetry: is there a “migration crisis”?

Cited by 18 publications

References 37 publications

Reconstruction of the phreno-esophageal ligament (R-PEL) prevents the intrathoracic migration (ITM) after concomitant sleeve gastrectomy and hiatal hernia repair

Reconstruction of the phreno-esophageal ligament (R-PEL) prevents the intrathoracic migration (ITM) after concomitant sleeve gastrectomy and hiatal hernia repair

Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus

Therapieoptionen bei Weight-Regain nach Bariatrischer Operation

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