When Should Be Converted Laparoscopic Sleeve Gastrectomy to Laparoscopic Roux-en-Y Gastric Bypass Due to Gastroesophageal Reflux?

Braghetto, Italo; Korn, Owen; Burgos, Anamaria; Figueroa, Manuel

doi:10.1590/0102-672020200004e1553

Cited by 10 publications

(11 citation statements)

References 30 publications

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“…However, most surgeons omit this maneuver during the performance of LFB. HH must be identified and repaired during surgery to avoid later symptoms 10 , 11 . Surgical errors committed during performing LGB could lead to the appearance of the complications described, which must be avoided.…”

Section: Discussionmentioning

confidence: 99%

“…As laparoscopic sleeve gastrectomy is contraindicated in morbidly obese patients with gastroesophageal reflux disease (GERD), laparoscopic Roux-en-Y gastric bypass (LGB) is the preferred procedure for these patients 5 , 7 , 33 , 35 , 36 , 39 , 42 . Reported literature suggest LGB can also be performed in patients with gastroesophageal reflux symptoms (GERD) who had undergone sleeve gastrectomy 1 , 2 , 11 , 15 , 24 .…”

Section: Introductionmentioning

confidence: 99%

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Gastroesophageal Symptoms After Laparoscopic Gastric Bypass: Mistakes in Performing the Procedure?

Braghetto

Korn

Gutiérrez

et al. 2022

ABCD, arq. bras. cir. dig.

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- BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LGB) is the recommended procedure for morbidly obese patients with gastroesophageal reflux disease (GERD). However, there have been reported gastroesophageal reflux symptoms or esophagitis after LGB. Few functional esophageal studies have been reported to date. AIM: To evaluate the anatomic and physiologic factors contributing to the appearance of these problems in patients who underwent LGB. METHODS: This prospective study included 38 patients with postoperative gastroesophageal reflux symptoms submitted to LGB. They were subjected to clinical, endoscopic, radiologic, manometric, and 24-h pH-monitoring evaluations. RESULTS: Eighteen (47.4%) of 38 patients presented with heartburn or regurgitation, 7 presented with pain, and 4 presented with dysphagia. Erosive esophagitis was observed in 11 (28.9%) patients, and Barrett’s esophagus (5.7%) and jejunitis (10.5%) were also observed. Hiatal hernia was the most frequent finding observed in 15 (39.5%) patients, and most (10.5%) of these patients appeared with concomitant anastomotic strictures. A long blind jejunal loop was detected in one (2.6%) patient. Nearly 75% of the patients had hypotensive lower esophageal sphincter (9.61±4.05 mmHg), 17.4% had hypomotility of the esophageal body, and 64.7% had pathologic acid reflux (% time pH <4=6.98±5.5; DeMeester’s score=32.4±21.15). CONCLUSION: Although rare, it is possible to observe gastroesophageal reflux and other important postoperative symptoms after LGB, which are associated with anatomic and physiologic abnormalities at the esophagogastric junction and proximal gastric pouch.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Gastroesophageal Symptoms After Laparoscopic Gastric Bypass: Mistakes in Performing the Procedure?

Braghetto

Korn

Gutiérrez

et al. 2022

ABCD, arq. bras. cir. dig.

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“…The modifications of gastric emptying may also explain some metabolic changes. Braghetto et al found that at 3 months after SG, GE became significantly accelerated for both solid and liquid meals versus controls [ 161 ]. Another group reported faster GE after solid meals at 6- and 24-months post SG in adult subjects.…”

Section: Weight Loss and Resolution Of The Metabolic Comorbiditiesmentioning

confidence: 99%

Bariatric Surgery in Adolescents: To Do or Not to Do?

et al. 2021

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Pediatric obesity is a multifaceted disease that can impact physical and mental health. It is a complex condition that interweaves biological, developmental, environmental, behavioral, and genetic factors. In most cases lifestyle and behavioral modification as well as medical treatment led to poor short-term weight reduction and long-term failure. Thus, bariatric surgery should be considered in adolescents with moderate to severe obesity who have previously participated in lifestyle interventions with unsuccessful outcomes. In particular, laparoscopic sleeve gastrectomy is considered the most commonly performed bariatric surgery worldwide. The procedure is safe and feasible. The efficacy of this weight loss surgical procedure has been demonstrated in pediatric age. Nevertheless, there are barriers at the patient, provider, and health system levels, to be removed. First and foremost, more efforts must be made to prevent decline in nutritional status that is frequent after bariatric surgery, and to avoid inadequate weight loss and weight regain, ensuring successful long-term treatment and allowing healthy growth. In this narrative review, we considered the rationale behind surgical treatment options, outcomes, and clinical indications in adolescents with severe obesity, focusing on LSG, nutritional management, and resolution of metabolic comorbidities.

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“…Currently, the number of surgical procedures -resection and anastomosis of stomach and small intestine -for morbid obesity has increased significantly 8,14 .…”

Section: Introductionmentioning

confidence: 99%

Shorten Preoperative Fasting and Introducing Early Eating Assistance in Recovery After Gastrojejunal Bypass?

Wendler

Nassif

Malafaia

et al. 2021

ABCD, arq. bras. cir. dig.

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Rational: The metabolic response to surgical trauma is enhanced by prolonged preoperative fasting, contributing to increased insulin resistance. This manifestation is more intense on the 1st and 2nd postoperative days and is directly proportional to the size of the operation. Aim: To compare whether preoperative fasting abbreviation and early postoperative refeeding associated with intraoperative and postoperative fluid restriction interfere in the evolution of patients undergoing gastrojejunal bypass. Methods: Eighty patients indicated for Roux-en-Y gastrojejunal bypass were selected. They were randomly divided into two groups: Ringer Lactate (RL) group, who underwent a 6 hours solids fasting, with the administration of 50 g of maltodextrin in 100 ml of mineral water 2 hours before the beginning of anesthesia; and Physiologic Solution (PS) group, who underwent a 12 hours solids and liquids fasting. Anesthesia was standardized for both groups. During the surgical procedure, 1500 ml of ringer lactate solution was administered in the RL and 2500 ml of physiological solution (0.9% sodium chloride) in the PS. In both groups, the occurrence of bronchoaspiration was analyzed during intubation, and the residual gastric volume was measured after opening the abdominal cavity. In the postoperative period in Group RL, patients started a liquid diet 24 hours after the end of the operative procedure; whilst for PS group, fasting was maintained for the first 24 hours, it was prescripted 2000 ml of physiological solution and a restricted liquid diet after 36 hours. Each patient underwent CPK, insulin, sodium, potassium, urea, creatinine, PaCO2, pH and bicarbonate dosage in the immediate postoperative period, and 48 hours later, the exams were repeated. Results: There were no episodes of bronchoaspiration and gastrojejunal fistulas in either group. In the analysis of the residual gastric volume of the PS and RL groups, the mean volumes were respectively 16.5 and 8.8, which shows statistical significance between the groups. In laboratory tests, there was no difference between groups in sodium; PS group showed a higher level of serum potassium (p=0.029); whilst RL group showed a higher urea and creatinine values; CPK values were even for both; PS group demonstrated a higher insulin level; pH was higher in PS group; sodium bicarbonate showed a significant difference at all times; PaCO2 values in RL group was higher than in PS. In the analysis of the incidence of nausea and flatus, no statistical significance was observed between the groups. Conclusions: The abbreviation of preoperative fasting and early postoperative refeeding of Roux-en-Y gastrojejunal bypass with the application of ERAS or ACERTO Project accelerated the patient’s recovery, reducing residual gastric volume and insulin level, and do not predispose to complications.

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When Should Be Converted Laparoscopic Sleeve Gastrectomy to Laparoscopic Roux-en-Y Gastric Bypass Due to Gastroesophageal Reflux?

Cited by 10 publications

References 30 publications

Gastroesophageal Symptoms After Laparoscopic Gastric Bypass: Mistakes in Performing the Procedure?

Gastroesophageal Symptoms After Laparoscopic Gastric Bypass: Mistakes in Performing the Procedure?

Bariatric Surgery in Adolescents: To Do or Not to Do?

Shorten Preoperative Fasting and Introducing Early Eating Assistance in Recovery After Gastrojejunal Bypass?

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