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Michael G. Sarr - One of the best experts on this subject based on the ideXlab platform.
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all strictures are not alike laparoscopic removal of nonadjustable silastic bands after banded roux en y Gastric Bypass
2012Co-Authors: James M Swain, Paul Scott, Elizabeth M Nesset, Michael G. SarrAbstract:Abstract Background The concept of a nonadjustable Silastic band (NASB) has been used to promote surgically induced weight loss for >30 years. Vertical banded Roux-en- Y Gastric Bypass is an example. Some patients develop serious, band-related complications requiring treatment. Narrowing at the NASB will lead to refractory nausea, vomiting, regurgitation, and, even, malnutrition, requiring revision of their bariatric operation. We report on the evaluation, diagnosis, and laparoscopic treatment of proximal obstructive symptoms secondary to a NASB. Methods From February 2005 to January 2009, we retrospectively reviewed the preoperative and perioperative data for 6 patients who had presented with proximal obstructive symptoms after undergoing banded Roux-en- Y Gastric Bypass. Results The mean interval from primary NASB placement to surgery was 58 months (range 25–110). The mean duration of symptoms was 29 months (range 8–70). All patients presented with multiple symptoms, but all had nausea, vomiting, regurgitation, and dysphagia to liquids and solids. The patients had undergone multiple upper endoscopies (mean 4, range 3–6) and dilations (mean 1.3, range 1–2) without relief of their symptoms. All patients underwent successful laparoscopic removal of the NASB. Their mean hospital stay was 1 day (range 0–2). No operative or postoperative complications occurred. The reflux and obstructive symptoms had resolved immediately postoperatively in all patients. Conclusion Patients with a NASB in place can experience proximal obstructive symptoms. Endoscopy is deceptive in judging the stomal size, because the endoscope can be pushed through the band area. Moreover, endoscopic dilation will offer no benefit in most patients with symptomatic banded Roux-en- Y Gastric Bypass. Laparoscopic removal of the NASB is safe, relieves the symptoms immediately, and can be applied to patients who have undergone both open and laparoscopic Silastic banded bariatric procedures.
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osteomalacia after roux en y Gastric Bypass
2004Co-Authors: Maria L Collazoclavell, Antonio Jimenez, Stephen F Hodgson, Michael G. SarrAbstract:Objective: To emphasize the potential for Roux-en-Y Gastric Bypass treatment of morbid obesity to result in late development of metabolic bone disease and to illustrate the error of treating a low ...
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gastroesophageal reflux after intact vertical banded gastroplasty correction by conversion to roux en y Gastric Bypass
2000Co-Authors: Bruno M Balsiger, Michel M Murr, Jane Mai, Michael G. SarrAbstract:Symptomatic gastroesophageal reflux disease is common in our experience after vertical banded gastroplasty. Our aim was to determine the safety and efficacy of Roux-en-Y Gastric Bypass in the treatment of symptomatic gastroesophageal reflux disease complicating vertical banded gastroplasty. We evaluated prospectively collected data on 25 patients who underwent revisional bariatric surgery because of severe gastroesophageal reflux disease after vertical banded gastroplasty. Only 4 of 25 patients had gastroesophageal reflux disease symptoms prior to vertical banded gastroplasty. Endoscopic findings in 24 patients included esophagitis (58%), Barrett's esophagus (28%), pouchitis (29%), and gastritis (21%);7 (28%) of 25 patients had evidence of stenosis at the pouch outlet. Mean follow-up (complete in all 25) after Roux-en-Y Gastric Bypass was 37 +/- 7 months (range 3 to 102 months). There were no deaths. Postoperative complications occurred in six patients: pneumonia in two, wound infection in two, prolonged drainage of the defunctionalized stomach via gastrostomy in one, and fever in one. Median hospitalization was 7 days (range 5 to 43 days). At follow-up (37 +/- 7 months), 24 (96%) of 25 are completely or almost completely symptom free. Body mass index was 33 +/- 2 kg/m(2) before and 28 +/- 2 kg/m(2) after Roux-en-Y Gastric Bypass (P = 0. 001). Symptoms of gastroesophageal reflux disease are common after vertical banded gastroplasty. Conversion to Roux-en-Y Gastric Bypass is safe, relieves gastroesophageal reflux disease, and promotes further weight loss. Moreover, maladaptive eating (vomiting, and so forth) induced by vertical banded gastroplasty is relieved.
Daniel J Gagne - One of the best experts on this subject based on the ideXlab platform.
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perforation in the Bypassed stomach following laparoscopic roux en y Gastric Bypass
2003Co-Authors: Pavlos K Papasavas, Philip F Caushaj, Woodrow W Yeaney, Robert J Keenan, Rodney J Landreneau, Daniel J GagneAbstract:Access to the Bypassed stomach is difficult following laparoscopic Roux-en-Y Gastric Bypass (LRYGBP). The Bypassed stomach is not readily available for endoscopic or radiographic evaluation. Diagnosis and treatment of peptic ulcer disease and its complications in the excluded stomach becomes difficult. We present a case of perforation in the Bypassed stomach following LRYGBP secondary to peptic ulcer disease.
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laparoscopic transGastric endoscopic retrograde cholangiopancreatography for benign common bile duct stricture after roux en y Gastric Bypass
2002Co-Authors: M Peters, Pavlos K Papasavas, Philip F Caushaj, R J Kania, Daniel J GagneAbstract:Access to the Gastric remnant and duodenum is lost after laparoscopic Roux-en-Y Gastric Bypass for morbid obesity. Traditionally, a percmaneous transhepatic access to the common bile duct has been used to manage choledocholithiasis and duct strictures. We present a novel method of laparoscopic transGastric endoscopic retrograde cholangiopancreatography for managing a benign biliary stricture after a Roux-en-Y Gastric Bypass
Moucef Damhan - One of the best experts on this subject based on the ideXlab platform.
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laparoscopic conversion of vertical banded gastroplasty mason maclean into roux en y Gastric Bypass
2008Co-Authors: Antonio Iannelli, Daniela Amato, Pietro Addeo, Massimo Senni Buratti, Moucef DamhanAbstract:Background Revision of bariatric procedures is required in 10 to 25% of patients either for insufficient weight loss or for complications. Patients undergoing vertical banded gastroplasty (VBG; Mason MacLean) may require revision in up to half of the cases in the long term. Roux-en-Y Gastric Bypass (RYGBP) is considered the procedure of choice for revision of VBG gastroplasty.
Keith Boone - One of the best experts on this subject based on the ideXlab platform.
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laparoscopic roux en y Gastric Bypass 10 year follow up
2011Co-Authors: Kelvin Higa, Francisco M Tercero, Tahir E Yunus, Keith BooneAbstract:Abstract Background The short-term benefits of bariatric surgery are well documented; however, few reports with data beyond 10 years exist. Those that have been published have described only open procedures. We present our 10-year follow-up results with laparoscopic Roux-en-Y Gastric Bypass with hand-sewn gastrojejunal anastomosis in a group private practice. Methods We performed an institutional review board-approved retrospective review of a prospectively maintained database, combined with office visits and telephone questionnaires, for patients who underwent laparoscopic Roux-en-Y Gastric Bypass between February 1998 and April 1999. Results A total of 242 patients underwent surgery from February 1998 to April 1999. The office follow-up rate was 33% at 2 years and 7% at 10 years. An additional 19% had telephone follow-up at 10 years. The mean excess weight loss was 57% at 10 years. Of the 242 patients, 65 (33.2%) failed to achieve an excess weight loss of >50%; 86 (35%) had ≥1 complication during follow-up. However, 83%, 87%, 67%, and 76% of patients with diabetes, hypertension, dyslipidemia, and obstructive sleep apnea, respectively, experienced improvement or resolution. The internal hernia rate was 16%, and the gastrojejunal stenosis rate was 4.9%. No surgery-related deaths occurred. Of the 242 patients, 136 (51%) had nutritional testing at least once after postoperative year 1. Of these 136 patients, only 24 (18%) had remained nutritionally intact during follow-up. Conclusion The obstacles to follow-up have continued to impede the collection of accurate long-term data. Of the 26% of patients with data, laparoscopic Roux-en-Y Gastric Bypass provided sustainable weight loss and resolution of co-morbidities. However, nutritional deficiencies presented sporadically over time and underscore the importance of routine testing.
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complications of the laparoscopic roux en y Gastric Bypass 1 040 patients what have we learned
2000Co-Authors: Kelvin Higa, Keith BooneAbstract:Background:The Roux-en-Y Gastric Bypass (RYGBP) is one of the most common operations for morbid obesity. Laparoscopic techniques have been reported, but suffer from small numbers of patients, longer operative times and seemingly higher initial complication rates as compared to the traditional "open" procedure. The minimally invasive approach continues to be a challenge even to the most experienced laparoscopic surgeons.The purpose of this study is to describe our experience and complications of the laparoscopic Roux-en-Y Gastric Bypass with a totally hand-sewn gastrojejunostomy. Methods: 1,040 consecutive laparoscopic procedures were evaluated prospectively. Only patients who had a previous open Gastric procedure were excluded initially. Eventually, even patients with failed "open" bariatric procedures and other Gastric procedures were revised laparoscopically to the RYGBP. All patients met NIH criteria for consideration for weight reductive surgery. Results:There were no anastomotic leaks from the hand-sewn gastrojejunostomy. Early complications and open conversions were related to sub-optimal exposure and bowel fixation techniques. Several staple failures were attributed to a manufacturer redesign of an instrument. Average hospital stay was 1.9 days for all patients and 1.5 days for patients without complications. Operative times consistently approach 60 minutes. Average excess weight loss was 70% at 12 months.There were 5 deaths: perioperative pulmonary embolism (1), late pulmonary embolism (2), asthma (1), and suicide (1). Conclusions: The laparoscopic Roux-en-Y Gastric Bypass for morbid obesity with a totally hand-sewn gastrojejunostomy can be safely performed by the bariatric surgeon with advanced laparoscopic skills in the community setting. Fixation and closure of all potential hernia sites with non-absorbable sutures is essential. Stenosis of the hand-sewn gastrojejunal anastomosis is amenable to endoscopic balloon dilation. Meticulous attention must be paid to the operative and perioperative care of the patient.
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laparoscopic roux en y Gastric Bypass for morbid obesity technique and preliminary results of our first 400 patients
2000Co-Authors: Kelvin Higa, Keith Boone, Orland G DaviesAbstract:Hypothesis A technique of the laparoscopic Roux-en-Y Gastric Bypass can be developed that is safe, effective, and practical in the community setting. Design A case series of 400 morbidly obese and superobese individuals who underwent the laparoscopic Roux-en-Y Gastric Bypass over a 22-month period. Setting Community private practice in Fresno, Calif. Patients A consecutive sample of 400 patients (70 males and 330 females) who met National Institutes of Health criteria for recommendation of a bariatric procedure. Only patients who had a previous Gastric or bariatric procedure were excluded from this sample. Intervention Laparoscopic Roux-en-Y Gastric Bypass with a hand-sewn gastrojejunal anastomosis. Main Outcome Measures Weight loss, complications, length of hospital stay, successful completion of the operation, and operative times were measured. Results Open conversion was required in 12 patients (6 males and 6 females) and a secondary operation for incomplete division of the stomach was required in 2 patients early in the case series. Alternative exposure and fixation techniques greatly reduced these occurrences. There were 6 staple-line failures owing to a change in the manufacture of the instrument. There were no leaks at the gastrojejunal anastomosis, but 21 patients required endoscopic balloon dilation for significant stenosis. The average hospital stay was 1.6 days for the patients who underwent laparoscopy and 2.7 days for patients requiring open conversion. Average excessive weight loss was 69% at 12 months. Operative times are between 60 and 90 minutes. Other complications are described. Conclusion The Roux-en-Y Gastric Bypass can be safely and effectively performed in the community setting using advanced laparoscopic techniques.
Christoph Beglinger - One of the best experts on this subject based on the ideXlab platform.
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effect of laparoscopic sleeve gastrectomy vs laparoscopic roux en y Gastric Bypass on weight loss in patients with morbid obesity the sm boss randomized clinical trial
2018Co-Authors: Ralph Peterli, Diana Vetter, Dino Kroll, Yves Michael Borbely, Bernd Schultes, Bettina K Wolnerhanssen, Thomas Peters, Jürgen Drewe, Christoph Beglinger, Marc SchiesserAbstract:Importance Sleeve gastrectomy is increasingly used in the treatment of morbid obesity, but its long-term outcome vs the standard Roux-en-Y Gastric Bypass procedure is unknown. Objective To determine whether there are differences between sleeve gastrectomy and Roux-en-Y Gastric Bypass in terms of weight loss, changes in comorbidities, increase in quality of life, and adverse events. Design, Setting, and Participants The Swiss Multicenter Bypass or Sleeve Study (SM-BOSS), a 2-group randomized trial, was conducted from January 2007 until November 2011 (last follow-up in March 2017). Of 3971 morbidly obese patients evaluated for bariatric surgery at 4 Swiss bariatric centers, 217 patients were enrolled and randomly assigned to sleeve gastrectomy or Roux-en-Y Gastric Bypass with a 5-year follow-up period. Interventions Patients were randomly assigned to undergo laparoscopic sleeve gastrectomy (n = 107) or laparoscopic Roux-en-Y Gastric Bypass (n = 110). Main Outcomes and Measures The primary end point was weight loss, expressed as percentage excess body mass index (BMI) loss. Exploratory end points were changes in comorbidities and adverse events. Results Among the 217 patients (mean age, 45.5 years; 72% women; mean BMI, 43.9) 205 (94.5%) completed the trial. Excess BMI loss was not significantly different at 5 years: for sleeve gastrectomy, 61.1%, vs Roux-en-Y Gastric Bypass, 68.3% (absolute difference, −7.18%; 95% CI, −14.30% to −0.06%; P = .22 after adjustment for multiple comparisons). Gastric reflux remission was observed more frequently after Roux-en-Y Gastric Bypass (60.4%) than after sleeve gastrectomy (25.0%). Gastric reflux worsened (more symptoms or increase in therapy) more often after sleeve gastrectomy (31.8%) than after Roux-en-Y Gastric Bypass (6.3%). The number of patients with reoperations or interventions was 16/101 (15.8%) after sleeve gastrectomy and 23/104 (22.1%) after Roux-en-Y Gastric Bypass. Conclusions and Relevance Among patients with morbid obesity, there was no significant difference in excess BMI loss between laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y Gastric Bypass at 5 years of follow-up after surgery. Trial Registration clinicaltrials.gov Identifier:NCT00356213
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effect of laparoscopic sleeve gastrectomy vs laparoscopic roux en y Gastric Bypass on weight loss in patients with morbid obesity
2018Co-Authors: Ralph Peterli, Diana Vetter, Dino Kroll, Yves Michael Borbely, Bernd Schultes, Bettina K Wolnerhanssen, Thomas Peters, Jürgen Drewe, Christoph Beglinger, Marc SchiesserAbstract:Importance Sleeve gastrectomy is increasingly used in the treatment of morbid obesity, but its long-term outcome vs the standard Roux-en-Y Gastric Bypass procedure is unknown. Objective To determine whether there are differences between sleeve gastrectomy and Roux-en-Y Gastric Bypass in terms of weight loss, changes in comorbidities, increase in quality of life, and adverse events. Design, Setting, and Participants The Swiss Multicenter Bypass or Sleeve Study (SM-BOSS), a 2-group randomized trial, was conducted from January 2007 until November 2011 (last follow-up in March 2017). Of 3971 morbidly obese patients evaluated for bariatric surgery at 4 Swiss bariatric centers, 217 patients were enrolled and randomly assigned to sleeve gastrectomy or Roux-en-Y Gastric Bypass with a 5-year follow-up period. Interventions Patients were randomly assigned to undergo laparoscopic sleeve gastrectomy (n = 107) or laparoscopic Roux-en-Y Gastric Bypass (n = 110). Main Outcomes and Measures The primary end point was weight loss, expressed as percentage excess body mass index (BMI) loss. Exploratory end points were changes in comorbidities and adverse events. Results Among the 217 patients (mean age, 45.5 years; 72% women; mean BMI, 43.9) 205 (94.5%) completed the trial. Excess BMI loss was not significantly different at 5 years: for sleeve gastrectomy, 61.1%, vs Roux-en-Y Gastric Bypass, 68.3% (absolute difference, −7.18%; 95% CI, −14.30% to −0.06%; P = .22 after adjustment for multiple comparisons). Gastric reflux remission was observed more frequently after Roux-en-Y Gastric Bypass (60.4%) than after sleeve gastrectomy (25.0%). Gastric reflux worsened (more symptoms or increase in therapy) more often after sleeve gastrectomy (31.8%) than after Roux-en-Y Gastric Bypass (6.3%). The number of patients with reoperations or interventions was 16/101 (15.8%) after sleeve gastrectomy and 23/104 (22.1%) after Roux-en-Y Gastric Bypass. Conclusions and Relevance Among patients with morbid obesity, there was no significant difference in excess BMI loss between laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y Gastric Bypass at 5 years of follow-up after surgery. Trial Registration clinicaltrials.gov Identifier: NCT00356213
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metabolic and hormonal changes after laparoscopic roux en y Gastric Bypass and sleeve gastrectomy a randomized prospective trial
2012Co-Authors: Ralph Peterli, Robert E Steinert, Bettina Woelnerhanssen, Thomas G Peters, Caroline Christoffelcourtin, Markus Gass, Beatrice Kern, Markus Von Fluee, Christoph BeglingerAbstract:Background The mechanisms of amelioration of glycemic control early after laparoscopic Roux-en-Y Gastric Bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) are not fully understood.
