Biliopancreatic Diversion with Roux-en-Y Gastric Bypass and Long Limbs: Advances in Surgical Treatment for Super-obesity

Kalfarentzos, Fotis; Skroubis, George; Karamanakos, Stavros; Αργέντου, Μαρία-Ιωάννα; Mead, Nancy; Kehagias, Ioannis; Alexandrides, Theodore K.

doi:10.1007/s11695-011-0532-9

Cited by 48 publications

(22 citation statements)

References 34 publications

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“…The online version of this article (https://doi.org/10.1007/s11695-018-03686-3) contains supplementary material, which is available to authorized users. pouch, there are two limb characteristics of RYGB: one is the alimentary limb where food passes and the other is the biliopancreatic limb which permits biliopancreatic secretion [5]. Despite of its effectiveness, the underlying mechanisms resulting in weight loss and metabolic improvements remain not adequately understood.…”

Section: Electronic Supplementary Materialsmentioning

confidence: 99%

Systematic Review and Meta-analysis of the Change in Ghrelin Levels After Roux-en-Y Gastric Bypass

Pang

Chen

et al. 2019

OBES SURG

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Background Roux-en-Y gastric bypass (RYGB) is considered effective for weight loss and for treatment of many obesity-related metabolic diseases. Ghrelin is an essential orexigenic peptide that plays an indispensable role in controlling body weight and energy homeostasis of post-operative patients. This systematic review and meta-analysis aimed to investigate changes in the level of fasting total ghrelin following RYGB. Methods A systematic literature search of PubMed, EMBASE, and the Cochrane Library until April 2018 with keywords Bghrelin^and Bgastric bypass^was performed in accordance with the MOOSE guidelines and PRISMA statement. Three reviewers independently selected the studies and extracted data. Quality assessment of the included studies was undergone. A random effects model was employed to calculate overall effect sizes. Subgroup analyses and meta-regression were subsequently performed. Results Sixteen studies with 325 patients were included. We found ghrelin levels had an increasing tendency (SMD = 0.30; 95% CI = 0.04 to 0.57) despite moderate heterogeneity (I 2 = 58%). Subsequent subgroup analysis indicated that ghrelin levels decreased (SMD = − 0.49; 95% CI = − 0.98 to 0.00) in the short term (≤ 3 months) and increased (SMD = 0.46; 95% CI = 0.22 to 0.69) in the long term (> 3 months) after RYGB. Meta-regression showed that gastric pouch volume, alimentary limb length and biliopancreatic limb length were not associated with changes in ghrelin levels. Conclusion Fasting total ghrelin levels decreased in the short term (≤ 3 months) and increased in the long term (> 3 months) after RYGB.

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Section: Electronic Supplementary Materialsmentioning

confidence: 99%

Systematic Review and Meta-analysis of the Change in Ghrelin Levels After Roux-en-Y Gastric Bypass

Pang

Chen

et al. 2019

OBES SURG

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“…It is thought that the length of the common limb affects the malabsorption and herewith the amount of weight loss (18)(19)(20)(21) , but possibly also leading to nutrient and vitamin deficiencies (22)(23)(24)(25) . A systematic review by Orci et al in 2011 identified a trend supporting that the construction of a longer Roux limb was more effective in super obese patients in terms of weight loss, and no differences were found regarding nutritional outcomes between groups (26) .…”

Section: Discussionmentioning

confidence: 99%

Effects of standard v. very long Roux limb Roux-en-Y gastric bypass on nutrient status: a 1-year follow-up report from the Dutch Common Channel Trial (DUCATI) Study

et al. 2020

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Laparoscopic Roux-en-Y gastric bypass (RYGB) is considered the ‘gold standard’ for surgical treatment of morbid obesity. It is hypothesised that reducing the length of the common limb positively affects the magnitude and preservation of weight loss but may also impose a risk of malnutrition. The aim of this study was to compare patients’ nutrient and vitamin deficiencies in standard RYGB with a very long Roux limb RYGB (VLRL-RYGB). This study was part of the multicentre randomised controlled trial (Dutch Common Channel Trial), including 444 patients undergoing an RYGB or a VLRL-RYGB. Laboratory results, use of multivitamin supplements and reoperations were collected at baseline and 1 year postoperative. Primary outcome measure was nutrient deficiency after 1 year postoperative. Secondary outcome measure was the reoperation rate due to malabsorption. In total, 227 patients underwent RYGB and 196 patients underwent VLRL-RYGB. Most common deficiencies at 1 year postoperative were ferritin (17·2–18·2 %), Fe (23·4–35·6 %), K (7·4–15·2 %), vitamin B12 (9·0–9·9 %) and vitamin D (22·7–34·5 %). Patients undergoing VLRL-RYGB had slightly but significantly lower levels of Ca, Fe and vitamin D compared with those undergoing RYGB at 1 year postoperative, but significantly higher levels of folic acid and Na. Reoperation rates due to malabsorption were not significantly different between RYGB (2/227, 0·9 %) and VLRL-RYGB (7/196, 3·6 %) (P = 0·088). We concluded that patients undergoing VLRL-RYGB had significantly lower levels of Ca, Fe and vitamin D compared with those undergoing RYGB at 1 year postoperative, but higher levels of folic acid and Na. Reoperation rates did not differ. Close monitoring on nutrient deficiencies should be performed in patients undergoing VLRL-RYGB.

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“…This is particularly important given that higher PA levels and positive PA attitudes and beliefs preoperatively are associated with higher PA levels postoperatively (1,3,29) . Moreover, previous studies involving use of similar objective PA measures show that postoperative patients, despite the benefits of bariatric surgery, do not reach the level of bout-related MVPA achieved by the intervention participants in the current preoperative study (4,5) .…”

Section: Discussionmentioning

confidence: 99%

Bari-Active: a randomized controlled trial of a preoperative intervention to increase physical activity in bariatric surgery patients

Bond

Vithiananthan

Thomas

et al. 2015

Surgery for Obesity and Related Diseases

144

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Background: Habitual physical activity (PA) may help to optimize bariatric surgery outcomes; however objective PA measures show that most patients have low PA preoperatively and make only modest PA changes postoperatively. Patients require additional support to adopt habitual PA. Objectives: Test the efficacy of a preoperative PA intervention (PAI) versus standard pre-surgical care (SC) for increasing daily moderate-to-vigorous PA (MVPA) in bariatric surgery patients. Setting: University Hospital, United States. Methods: Outcomes analysis included 75 participants (86.7% women; 46.0±8.9 years; Body Mass Index [BMI]=45.0±6.5 kg/m2) who were randomly assigned preoperatively to 6 weeks of PAI (n=40) or SC (n=35). PAI received weekly individual face-to-face sessions with tailored instruction in behavioral strategies (e.g., self-monitoring, goal-setting) to increase home-based walking exercise. The primary outcome, pre- to post-intervention change in daily bout-related (≥10-min bouts) and total (≥1-minute bouts) MVPA minutes, was assessed objectively via a multi-sensor monitor worn for 7 days at baseline- and post-intervention. Results: Retention was 84% at the post-intervention primary end point. In intent-to-treat analyses with baseline value carried forward for missing data and adjusted for baseline MVPA, PAI achieved a mean increase of 16.6±20.6 minutes/day in bout-related MVPA (baseline: 4.4±5.5 to post-intervention: 21.0±21.4 minutes/day) compared to no change (−0.3±12.7 minutes/day; baseline: 7.9±16.6 to post-intervention: 7.6±11.5 minutes/day) for SC (p=0.001). Similarly, PAI achieved a mean increase of 21.0±26.9 minutes/day in total MVPA (baseline: 30.9±21.2 to post-intervention: 51.9±30.0 minutes/day), whereas SC demonstrated no change (− 0.1±16.3 minutes/day; baseline: 33.7±33.2 to post-intervention: 33.6±28.5 minutes/day) (p=0.001). Conclusions: With behavioral intervention, patients can significantly increase MVPA before bariatric surgery compared to SC. Future studies should determine whether preoperative increases in PA can be maintained postoperatively and contribute to improved surgical outcomes.

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Biliopancreatic Diversion with Roux-en-Y Gastric Bypass and Long Limbs: Advances in Surgical Treatment for Super-obesity

Abstract: Our variant of biliopancreatic diversion (BPD-RYGB-LL) results in substantial and sustained weight loss in super-obese, without compromising safety.

Cited by 48 publications

References 34 publications

Systematic Review and Meta-analysis of the Change in Ghrelin Levels After Roux-en-Y Gastric Bypass

Systematic Review and Meta-analysis of the Change in Ghrelin Levels After Roux-en-Y Gastric Bypass

Effects of standard v. very long Roux limb Roux-en-Y gastric bypass on nutrient status: a 1-year follow-up report from the Dutch Common Channel Trial (DUCATI) Study

Bari-Active: a randomized controlled trial of a preoperative intervention to increase physical activity in bariatric surgery patients

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