Simplified gastric bypass: 13 years of experience and 12,000 patients operated

Abstract

BackgroundObesity is increasingly prevalent disease worldwide and bariatric surgery is the most effective treatment for the most severe cases. The Roux-en-Y gastric bypass is still the most used technique all over the world and the laparoscopic approach has been preferred by surgeons with different approaches, propositions and techniques in performing the procedure.AimTo report the surgical aspects of the systematization and results of the simplified laparoscopic gastric bypass (Brazilian technique).MethodsWere included all patients undergoing this procedure from January 2001 to July 2014; were described and analyzed aspects of this technique, the systematization and complications associated with the procedure.ResultsA total of 12,000 patients (72% women) were included, with a mean age of 43 years (14-76) and a mean BMI of 44.5 (35-90 kg/m2). Mean total operative time was 72 minutes (36-270) and the mean hospital stay was 36 hours. There were 303 cases of gastrojejunostomy stenosis (2.5%), 370 patients had gastrointestinal bleeding (3%) with only one lap revision due to a enteroanastomosis bleeding and six revisions related to intestinal obstruction caused by impacted clots in the jejunojenunostomy. Blood transfusion was needed in 32 patients (0.3%); Petersen hernia was diagnosed in 18 (0.15%) and digestive fistula in 54 (0.45%), which led to reoperation in 43 of them (67%). The overall mortality was 0.1% (fistula with sepsis=8, pulmonary thromboembolism=3; intestinal obstruction associated with sepsis=1).ConclusionThe simplified laparoscopic gastric bypass is a feasible and safe option with low complication rate and easy reproducibility for education and training in bariatric surgery.

Metabolic surgery: gastric bypass for the treatment of type 2 diabetes mellitus

“…Durable remission has been seen early stage of T2DM (41), loss of a large percentage of excess bodyweight, young age and low BMI (25-35 kg/m 2 ). Duration of diabetes, usage of insulin and duration of insulin usage have all been reported to negatively predict the likelihood of diabetes remission after surgery (39,40). The DiaRem scoring system is a method that uses four preoperative clinical variables (use of insulin before surgery, age, HbA1c and diabetes drugs before surgery) to predict the probability of remission of T2DM after RYGB surgery.…”

“…The approximated size should be about 4×7 cm. The stomach is transected firing blue load linear staplers, to disconnect the small upper stomach from the remaining portion of the stomach (Figure 2) (27,38,39).…”

“…Several trials demonstrated that the duodenum and jejunum sense nutrients and initiate a feedback response through the gut-brain-liver axis to regulate hepatic glucose production. When nutrients are delivered to medium jejunum led a greater insulin sensitivity for glucose and fatty acids (20,26,(31)(32)(33)(34)(35)(36)(37)(38)(39). …”

“…The approximated size should be about 4×7 cm. The stomach is transected firing blue load linear staplers, to disconnect the small upper stomach from the remaining portion of the stomach (Figure 2) (27,38,39).Gastrojejunostomy is recommended a hybrid technique (manual-mechanic), although it can be performed fully hand sewn. It should be always calibrated with a 34-36 Fr boogie.…”

“…This anastomosis is 2 cm in diameter (Figure 3). A running suture is used to close the defect (Figure 4) (27,39).It is recommended a biliary limb of 100-cm of length from duodenojejunal flexure; a 150-cm alimentary limb: from gastrojejunostomy and a jejunojejunostomy with hybrid mechanic-manual techniques ( Figure 5). It's also suggested the antecolic/antegastric loop ascent to decrease the risk of vowel obstruction.…”