Complications of the Laparoscopic Roux-en-Y Gastric Bypass: 1,040 Patients - What Have We Learned?

Higa, Kelvin; Boone, Keith; Ho, Tienchin

doi:10.1381/096089200321593706

Cited by 547 publications

(301 citation statements)

References 11 publications

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“…30 Gastric obstruction associated with gastric bypass or sleeve gastrectomy is due to stenosis of the gastric outlet secondary to scar tissue and may be treated with endoscopic dilation. 31 Intestinal obstruction can occur after gastric bypass and malabsorptive operations and requires urgent surgical intervention. 32 Marginal ulceration between the stomach pouch and the small intestine after gastric bypass surgery is relatively rare but when present is a frequent source of abdominal pain and anemia.…”

Section: Late Complicationsmentioning

confidence: 99%

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Bariatric Surgery and Cardiovascular Risk Factors

Poirier¹,

Cornier²,

Mazzone³

et al. 2011

Circulation

297

134

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T he rate of obesity is rising logarithmically, especially in those with severe obesity (body mass index [BMI] Ͼ40 kg/m 2 ). Cardiologists, endocrinologists, internists, family practitioners, and most healthcare professionals are increasingly confronted with the severely obese patient and with postoperative bariatric patients because obesity is associated with significant morbidity and increased mortality. In addition, more adolescents these days are severely obese. Substantial long-term successes of lifestyle modifications and drug therapy have been disappointing in this population. The National Institutes of Health has suggested that surgical therapy be proposed to those patients with BMI Ͼ40 kg/m 2 or Ͼ35 kg/m 2 with serious obesity-related comorbidities such as systemic hypertension, type 2 diabetes mellitus, and obstructive sleep apnea. When indicated, surgical intervention leads to significant improvements in decreasing excess weight and comorbidities that can be maintained over time. These include diabetes mellitus, dyslipidemia, liver disease, systemic hypertension, obstructive sleep apnea, and cardiovascular dysfunction. Recent prospective, nonrandomized, observational, or case-control population studies have also shown bariatric surgery to prolong survival in the severely obese. Different types of bariatric procedures are being performed. Historically, operative mortality was between 0.1% and 2.0% with more recent data not exceeding 1%. Early complications include pulmonary embolus (0.5%), anastomotic leaks (1.0% to 2.5%), and bleeding (1.0%). Late complications include anastomotic stricture, anastomotic ulcers, hernias, band slippage, and behavioral maladaptation. The number of bariatric operations being performed is increasing tremendously as a result of increasing medical need and the evolution of safer surgical techniques and guidelines. Currently, bariatric surgery should be reserved for patients who have severe obesity in whom efforts at medical therapy have failed and an acceptable operative risk is present.

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Section: Late Complicationsmentioning

confidence: 99%

“…Tobacco, aspirin, and anti-inflammatory nonsteroidal medications should be avoided after gastric operations. 31 Incisional hernias are common after open bariatric surgery and require subsequent surgical intervention. The increased use of minimally invasive techniques have significantly decreased the incidence of this complication.…”

Section: Late Complicationsmentioning

confidence: 99%

Bariatric Surgery and Cardiovascular Risk Factors

Poirier¹,

Cornier²,

Mazzone³

et al. 2011

Circulation

297

134

View full text Add to dashboard Cite

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“…Anastomotic leaks are another cause of morbidity and mortality occurring in w0.5-3% (52,63,71,75,(79)(80)(81)(82)(83)(84). Leaks are difficult to diagnose, a heart rate above 120 beats/min and respiratory distress/failure are the most common manifestations of anastomotic leak (68,70,85).…”

Section: Postoperative Complications and Difficultiesmentioning

confidence: 99%

Surgical treatment of obesity

Bult¹,

Dalen²,

Müller³

2008

European Journal of Endocrinology

235

141

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More than half of the European population are overweight (body mass index (BMI) O25 and !30 kg/m 2 ) and up to 30% are obese (BMIR30 kg/m 2 ). Being overweight and obesity are becoming endemic, particularly because of increasing nourishment and a decrease in physical exercise. Insulin resistance, type 2 diabetes, dyslipidemia, hypertension, cholelithiasis, certain forms of cancer, steatosis hepatis, gastroesophageal reflux, obstructive sleep apnea, degenerative joint disease, gout, lower back pain, and polycystic ovary syndrome are all associated with overweight and obesity. The endemic extent of overweight and obesity with its associated comorbidities has led to the development of therapies aimed at weight loss. The long-term effects of diet, exercise, and medical therapy on weight are relatively poor. With respect to durable weight reduction, bariatric surgery is the most effective long-term treatment for obesity with the greatest chances for amelioration and even resolution of obesity-associated complications. Recent evidence shows that bariatric surgery for severe obesity is associated with decreased overall mortality. However, serious complications can occur and therefore a careful selection of patients is of utmost importance. Bariatric surgery should at least be considered for all patients with a BMI of more than 40 kg/m 2 and for those with a BMI of more than 35 kg/m 2 with concomitant obesity-related conditions after failure of conventional treatment. The importance of weight loss and results of conventional treatment will be discussed first. Currently used operative treatments for obesity and their effectiveness and complications are described. Proposed criteria for bariatric surgery are given. Also, some attention is devoted to more basic insights that bariatric surgery has provided. Finally we deal with unsolved questions and future directions for research. European Journal of Endocrinology 158 135-145

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“…A realização de colangiopancreatografia endoscópica retrógrada terapêutica em pacientes que foram submetidos à cirurgia com derivação em Y-de-Roux é trabalhosa, principalmente quando uma longa alça exclusa de intestino delgada foi criada 5 . O primeiro caso de confecção cirúrgica de gastrostomia com o propósito único de acessar a papila para o tratamento endoscópico de doença do trato bilio-pancreático após bypass gástrico em obeso mórbido foi descrito por Baron et al 3 , em 1998.…”

Section: Discussionunclassified

Colangiopancreatografia endoscópica retrógrada transgástrica laparoscópica após cirurgia bariátrica

Filho

Noda

Kondo

et al. 2008

Rev. Col. Bras. Cir.

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Trabalho realizado no Departamento de Cirurgia Geral do Hospital Vita, Curitiba-PR. INTRODUÇÃOO número de pacientes submetidos à cirurgia bariátrica aumentou dramaticamente nos últimos anos, uma vez que a maioria das opções de tratamento conservador para a obesidade mórbida (dieta, exercício físico, alterações comportamentais e medicações) não é capaz de manter uma perda de peso efetiva a longo prazo 1 . Atualmente a cirurgia de bypass gástrico é o procedimento mais comumente realizado para o tratamento da obesidade mórbida nos Estados Unidos, seja por via aberta ou por laparoscopia 1 . No entanto, as alterações anatômicas criadas por esta cirurgia representam um grande desafio aos endoscopistas quando o acesso à árvore biliar ou ao estôma-go excluso é necessário 2 . Há poucos relatos na literatura internacional que descrevem o manejo endoscópico de doenças do trato biliar com sucesso nesses pacientes 2,4 . Este artigo relata o acesso laparoscópico transgástrico para o tratamento endoscópico de coledocolitíase em paciente previamente submetido a bypass gástrico em Y-de-Roux para obesidade mórbida. RELATO DO CASOPaciente de 52 anos, sexo masculino, submetido a bypass gástrico em Y-de-Roux por via aberta em abril de 2001 para o tratamento de obesidade mórbida (Peso = 140kg; altura = 1,80m; índice de massa corporal, IMC = 43,2kg/m 2 ), procurou nosso serviço em dezembro de 2005 com queixa de dor abdominal em hipocôndrio direito, febre, náuseas e vômitos. Na ocasião seu peso era de 95kg, com IMC de 29,3kg/m 2 . Ao exame físico apresentava-se em regular estado geral e ictérico, com dor à palpação na região subcostal direita, com sinal de Murphy positivo. Os exames laboratoriais demonstraram quadro clínico compatível com icterícia obstrutiva, com aumento dos valores de fosfatase alcalina, gama-glutamil transferase e bilirrubinas (predomínio de bilirrubina direta).A operação proposta foi uma colecistectomia laparoscópica com colangiografia intra-operatória. A colecistectomia foi realizada utilizando duas punções de 10mm, uma em região supra-umbilical para a ótica de 30º e outra em hipocôndrio esquerdo, e duas punções de 5mm, em região subcostal direita na linha hemiclavicular e em flanco direito. Após identificação do ducto cístico, um clipe foi posicionado proximalmente e o ducto foi aberto parcialmente para a introdução de um cateter para a realização da colangiografia intraoperatória, que demonstrou uma obstrução sugestiva de litíase no colédoco terminal, sem passagem do contraste para o duodeno (Figura 1A).Como o paciente havia sido submetido a bypass gástrico, a colangiografia endoscópica retrógrada transoral não pôde ser realizada. Optou-se por realização de colangiopancreatografia endoscópica retrógrada e papilotomia por acesso transgástrico.O estômago excluso foi mobilizado e levado à parede abdominal. A exteriorização gástrica foi realizada através da ampliação do orifício da punção subcostal esquerda de 10mm. A abertura da parede gástrica a céu aberto (Figura 2A) permitiu a passagem do coledocoscópio e o aces...

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Complications of the Laparoscopic Roux-en-Y Gastric Bypass: 1,040 Patients - What Have We Learned?

Cited by 547 publications

References 11 publications

Bariatric Surgery and Cardiovascular Risk Factors

Bariatric Surgery and Cardiovascular Risk Factors

Surgical treatment of obesity

Colangiopancreatografia endoscópica retrógrada transgástrica laparoscópica após cirurgia bariátrica

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