Roux‐en‐Y Versus One Anastomosis Gastric Bypass as Redo‐Operations Following Sleeve Gastrectomy: A Retrospective Study

Rheinwalt, Karl Peter; Schipper, Sandra; Plamper, Andreas; Alizai, Patrick H.; Trebicka, Jonel; Brol, Maximilian Joseph; Kroh, Andreas; Schmitz, Sophia; Parmar, Chetan; Neumann, Ulf; Ulmer, Tom Florian

doi:10.1007/s00268-021-06424-6

Cited by 20 publications

(13 citation statements)

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“…Despite intraoperative methylene blue test and postoperative Rx-esophagogram were negative for leak in all patients and the ICG-FA score was evaluated “satisfactory and adequate” in all patients, one patient in their series developed symptomatic leak on the fifth post-operative day ( 24 ). Therefore, the leak detection rate of the various tests would seem to be comparable, but not reliable probably because the main causes of gastric leak arise not during the procedure or in the early postoperative course, but, as confirmed by the literature, later ( 5 , 8 ). This data suggests the poor role of the ICG-FA, as well as other leak tests, during LSG probably because the ischemic theory alone is not able to explain the onset of the leakage, emphasizing once again its multifactorial etiology ( 8 , 10 , 11 , 24 ).…”

Section: Discussionmentioning

confidence: 91%

“…Laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LGB) are among the most commonly performed bariatric procedures worldwide ( 1 – 4 ). Re-do laparoscopic gastric bypass (RLGB) proved to be an effective conversional procedure after LSG, in terms of total body weight loss, body mass index (BMI) loss and high remission rates of comorbidities ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

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Indocyanine Green Fluorescence Angiography During Laparoscopic Bariatric Surgery: A Pilot Study

et al. 2022

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AimsIndocyanine green (ICG) fluorescence angiography (FA) is used for several purposes in general surgery, but its use in bariatric surgery is still debated. The objective of the present pilot study is to evaluate the intraoperative utility of ICG-FA during bariatric surgery in order to focus future research on a reliable tool to reduce the postoperative leak rate.MethodsThirteen patients (4 men, 30.8%, 9 women, 69.2%) with median age of 52 years (confidence interval, CI, 95% 46.2–58.7 years) and preoperative median body mass index of 42.6 kg/m2 (CI, 95% 36 to 49.3 kg/m2) underwent bariatric surgery with ICG-FA in our center. Three mL of ICG diluted with 10 cc sterile water were intravenously injected after gastric tube creation during laparoscopic sleeve gastrectomy (LSG) and after the gastric pouch and gastro-jejunal anastomosis creation during laparoscopic gastric by-pass (LGB). For the ICG-FA, Karl Storz Image 1S D-Light system (Karl Storz Endoscope GmbH & C. K., Tuttlingen, Germany) placed at a fixed distance of 5 cm from the structures of interest and zoomed vision modality were used to identify the vascular supply. The perfusion pattern was assessed by the surgical team according to a score. The score ranged from 1 (poor vascularization) to 5 (excellent vascularization) based on the intensity and timing of fluorescence of the vascularized structures.ResultsFom January 2021 to February 2022, six patients underwent LSG (46.2%), three patients underwent LGB (23.1%), and four patients underwent re-do LGB after LSG (30.8%). No adverse effects to ICG were observed. In 11 patients (84.6%) ICG-FA score was 5. During two laparoscopic re-do LGB, the vascular supply was not satisfactory (score 2/5) and the surgical strategy was changed based on ICG-FA (15.4%). At a median follow-up of five months postoperatively, leaks did not occur in any case.ConclusionsICG-FA during bariatric surgery is a safe, feasible and promising procedure. It could help to reduce the ischemic leak rate, even if standardization of the procedure and objective fluorescence quantification are still missing. Further prospective studies with a larger sample of patients are required to draw definitive conclusions.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Indocyanine Green Fluorescence Angiography During Laparoscopic Bariatric Surgery: A Pilot Study

et al. 2022

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“…Guidelines recommend that the provision 7 BioMed Research International of nutritional supplementation and close monitoring can be effective in improving nutritional deficiencies and generating good pregnancy outcomes [18,28]. Starting in 2019, new keywords such as "celiac disease" [29], "vitamin D supplementation" [30][31][32], "single anastomosis gastric bypass" [33][34][35][36], and "healthy nutrition guidelines" [15] are gradually appearing more frequently in studies on nutritional deficiencies in BS. This indicates that researchers are not only concerned about macronutrient deficiencies but also about micronutrient deficiencies; at the same time, they are actively exploring surgical procedures that are simpler and less invasive and avoid postoperative complications such as nutritional deficiencies.…”

Section: Discussionmentioning

confidence: 99%

Visual Analysis of Nutrient Deficiency and Treatment Protocols in Bariatric Surgery Based on VOSviewer

Tang

et al. 2022

BioMed Research International

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Objective. To analyze the global literature on nutritional deficiencies in bariatric surgery (BS) since January 1, 1985, and to discuss the current status of research, research hotspots, and new development trend and treatment of nutritional deficiency in bariatric surgery. It provides ideas and basis for promoting the development of bariatric surgery and new alternative therapy or treatment protocols. Methods. The Web of Science (WOS) database core collection was used as the data source, and VOSviewer 1.6.17 software was used to search the literature on the topic of “nutritional deficiencies in bariatric surgery.” The number of published literature, the distribution of authors, institutions, and countries, keyword cooccurrences, and journal cocitations were visualized and analyzed. Results. A total of 1015 relevant publications was obtained after searching and screening, and the overall trend of literature published was on the rise. The most published countries, institutions, and authors were USA, University of Sao Paulo, Ramalho, Andrea; Obesity Surgery has been the most frequently cited journal (7943 citations), and the top 10 journals had high impact factors. Keyword cooccurrence analysis showed that “bariatric surgery” and “nutritional deficiencies” are the hot topics of research in this field. Conclusion. There is an urgent need for bariatric surgery issuing institutions and authors to strengthen cross-institutional, cross-team, and multicenter and multidisciplinary cooperation, to promote and facilitate the exchange and cooperation in the field of bariatric surgery between developed countries in Europe and America and developing countries in Asia, Africa, and Latin America, to draw the attention of developing countries to the health problems caused by obesity, and to encourage and support the development of developing countries in this field. Bariatric surgery, obesity, weight loss, Y-type gastric bypass, gastric bypass, and nutritional deficiency are the hot research topics in the field of nutritional deficiency in bariatric surgery, and metabolic surgery, single anastomosis gastric bypass, micronutrient supplementation, micronutrient deficiency, intestinal microbiology, and guidelines are the new trends in this field.

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“…Our criteria for eligibility for revisional surgery have been published previously: IWL and WR were thereby defined according to Reinhold’s criteria (BMI ≥ 35m 2 and/or %EWL < 50%), while complicated reflux disease was defined as (acid or biliary or combined) reflux symptoms non-responsive to medical treatment and/or endoscopically proven esophagitis. 24 , 25 Two patients with a bypass (0.2%) required shortening of the biliopancreatic (BP) limb because of persisting ND and one patient specifically demanded a complete reversal of the bypass situation.…”

Section: Resultsmentioning

confidence: 99%

“…The above-listed perioperative parameters and the evolution of comorbidities were defined as secondary endpoints. Our definition of remission or improvement of comorbidities that is adopted to the Buchwald criteria has been published previously 23 , 24 : hypertension (normal blood pressure values without any or with reduced medication), T2DM (HbA1 < 6.0%, FPG > 100 mg/dl without any special diet or medication/under control with reduced need for medication), sleep apnea (no further need for CPAP therapy or improved results in somnography), osteoarthritis (symptoms resolved or improved).…”

Section: Methodsmentioning

confidence: 99%

A Long-Term Comparative Study Between One Anastomosis Gastric Bypass and Sleeve Gastrectomy

Plamper

Lingohr

Nadal

et al. 2023

Journal of Gastrointestinal Surgery

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Background One anastomosis gastric bypass (OAGB) has become increasingly accepted in bariatric surgery and meanwhile represents the third most common procedure worldwide. While it shows promising weight loss results and comorbidity resolution, questions about issues such as reflux or nutritional deficiencies (ND) persist in the long term. On the other hand, the most frequently performed sleeve gastrectomy (SG) has to accept growing criticism regarding long-term results and reflux issues. There is a particular lack of long-term comparative data for both procedures. This study presents our long-term experience. Methods We evaluated OAGB and SG patients retrospectively comparing for weight loss and resolution of comorbidities as well as perioperative and long-term complications in a follow-up period of 5 years. Results Nine hundred eleven OAGB and 241 SG were included in the study. OAGB had a shorter operation time and hospital stay. Overall complication rate did not differ in both groups. Ulcers were more frequent in OAGB (7.7% vs. 1.7%, p = 0.001), whereas insufficient weight loss (IWL)/weight regain (WR) proved to be more prevalent in SG (25.7% vs. 6.4%, p < 0.001). The same held true for reflux (17.8% vs. 8.3%, p < .001). On the other hand, ND were more common in OAGB (20.0% vs. 12.0%, p = 0.005). Revisional surgery was more often indicated after SG. Analysis by linear mixed model showed that OAGB achieved a lower BMI/higher loss of BMI. Improvement of T2DM (94.6% vs. 85.2%, p = 0.008) and sleep apnea (88.8% vs. 78.8%, p = 0.01) was superior in OAGB. Conclusions OAGB had a superior effect on weight loss as well as improvement of T2DM and sleep apnea. Furthermore, long-term problems such as IWL/WR and reflux were more related to SG. On the other hand, a malabsorptive procedure such as OAGB showed a higher risk for ND. Our findings support the available data in the literature.

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Roux‐en‐Y Versus One Anastomosis Gastric Bypass as Redo‐Operations Following Sleeve Gastrectomy: A Retrospective Study

Cited by 20 publications

References 67 publications

Indocyanine Green Fluorescence Angiography During Laparoscopic Bariatric Surgery: A Pilot Study

Indocyanine Green Fluorescence Angiography During Laparoscopic Bariatric Surgery: A Pilot Study

Visual Analysis of Nutrient Deficiency and Treatment Protocols in Bariatric Surgery Based on VOSviewer

A Long-Term Comparative Study Between One Anastomosis Gastric Bypass and Sleeve Gastrectomy

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