Gastro-Gastric Fistulas and Marginal Ulcers in Gastric Bypass Procedures for Weight Reduction

Capella, Joseph F.; Capella, Rafael F.

doi:10.1381/096089299765553674

Cited by 179 publications

(85 citation statements)

References 6 publications

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“…Overall, our incidence of MU was 7.5% which is consistent with others studies published [1][2][3][4][5][6][7][8][9][10][11][12]. The present study focused on the potential relationship between MU and the technique of RYGB employed.…”

Section: Discussionsupporting

confidence: 90%

“…The symptoms can range from minimal abdominal discomfort to life threatening bleeding or perforation [1]. The reported incidence of MU has varied widely in the literature from 1% to 16% [1][2][3][4][5][6][7][8][9][10]. These differences may be related to differences in surgical technique and patient factors, but also vary depending on definition, method of detection and follow-up.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Technique Affects the Incidence of Marginal Ulceration after Roux-en-Y in Gastric Bypass

Lee¹,

McBride²,

Shostrom³

et al. 2013

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Background: Marginal ulceration (MU) is a recognized complication of Roux-en-Y gastric bypass (RYGB) surgery. While several possible risk factors have been reported, the mechanism of MU remains incompletely understood. The aim of this study was to compare the effect of surgical technique on the incidence of MU. Methods and Material: This was a retrospective study of 749 patients undergoing RYGB over a ten-year period with at least one year of follow-up. The diagnosis of MU was made based on clinical symptoms and confirmed by postoperative endoscopy (POE). We assessed four different gastric bypass (GBP) techniques: T1-Open, non-divided stomach, circular stapler, non-vagotomy (n = 332); T2-Open, divided stomach, circular stapler, vagotomy (n = 91); T3-Laparoscopic, divided, circular stapler, vagotomy (n = 152); T4-Laparoscopic, divided, linear stapler, vagotomy (n = 174). Results: The four groups were similar with respect to age and mean BMI. The frequency of POE was 16%, 25%, 28% and 27% in groups T1-T4 respectively (NS). The incidence of MU was significantly lower in T1 (2.1%) compared to T2 (5.5%), T3 (15.1%) and T4 (12.6%), p < 0.05. MU occurred significantly more frequently with an antecolic Roux limb versus retrocolic (14.5% vs 5.6%, p < 0.05). Conclusion: The incidence of MU after RYGB surgery is influenced by surgical technique. The lowest incidence of MU was with a non-divided stomach, no vagotomy, transverse staple line, and circular stapled anastomosis. A retrocolic Roux limb was protective. There was no difference in the incidence of MU using laparoscopic versus open bypass if a similar technique was employed or using linear versus circular stapler for the gastrojejunostomy.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Surgical Technique Affects the Incidence of Marginal Ulceration after Roux-en-Y in Gastric Bypass

Lee¹,

McBride²,

Shostrom³

et al. 2013

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“…Although hand-sewn anastomoses may take longer to perform, they result in a lower hospital cost, less anastomotic bleeding, fewer stricture complications, and a lower incidence of wound infection [24][25][26]. In addition, the use of absorbable suture to create the gastrojejunostomy reduces the risk of gastrogastric fistula and marginal ulceration [27]. Nevertheless, the laparoscopic hand-sewn anastomosis is a challenging technique, and the learning curve can be very long.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted gastrojejunal anastomosis does not improve the results of the laparoscopic Roux-en-Y gastric bypass

et al. 2010

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Background Traditional laparoscopic surgery presents some difficulties for morbidly obese patients due to limited motion of instruments related to a thick abdominal wall, intraabdominal fat, and a large hepatic left lobe, with consequent loss of dexterity and greater musculoskeletal discomfort. Robotic technique could potentially overcome these limitations. This study aimed to evaluate robot-assisted laparoscopic Roux-en-Y gastric bypass in morbidly obese patients and to compare the results of robotic assistance with those of traditional laparoscopic technique. Methods Between September 2006 and June 2009, 110 morbidly obese patients underwent laparoscopic Roux-en-Y gastric bypass with robot-assisted hand-sewn gastrojejunal anastomosis using the da Vinci Surgical System. The data for these patients was compared with the data for 423 consecutive patients treated in a standard laparoscopic manner during the same period. Results The patients had a mean preoperative age of 42.6 years, a mean weight of 127.5 kg, and a mean body mass index (BMI) of 46.7 kg/m 2 . The total mean operative time was 247.5 min. The robotic setup time was 10.1 min, and the robotic operative time was 54.5 min. The conversion rate was nil. The intraoperative complication rate was 4.5%. The early and late major postoperative complication rates were 3.6 and 6.4% respectively. The cost per patient was 5777.76 €. For the standard laparoscopy, the operative time was significantly shorter (187 min; p < 0.001), and the costs per patient were significantly lower (4658.28 €; p < 0.001), whereas no differences were found in terms of the intra-or postoperative complication rates, revisional surgery, or hospital length of stay. Conclusions Although safe and intuitive, the robotic approach was burdened by a longer operative time and higher equipment costs. Moreover, it did not seem to provide a real advantage over standard laparoscopy in terms of hospital length of stay and complications rates. Keywords Bariatric surgery Gastrojejunal anastomosis Morbid obesity Robot-assisted gastric bypass Robotic surgery Roux-en-Y gastric bypass To date, bariatric surgery is the only long-term effective therapy available for the morbidly obese population [1][2][3]. Over recent decades, laparoscopic surgical techniques have become the gold standard in bariatric surgery due to advantages such as less postoperative pain, shorter hospital stay, faster postoperative recovery, and minimal scarring [4][5][6]. Moreover, for the obese patient, the mini-invasive approach has demonstrated its ability to reduce postoperative mortality [7,8]. However, the inherent limitations of traditional laparoscopic surgery may cause some technical difficulties due to the limited freedom of motion for the instruments related to the thick abdominal wall and hepatomegaly, with consequent loss of dexterity and greater musculoskeletal discomfort for the surgeon [9].

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“…Observa-se como regra geral, uma perda de peso em média de 35 a 40% do peso pré-operatório após 12 à 24 meses de cirurgia. Capella 21 na sua casuística, com "follow-up" de cinco anos, teve uma redução ponderal em torno de 40% do peso pré-operatório. Nossos resultados podem ser comparados com esses grupos, já que obtivemos uma redução percentual média de 36,5% no peso corporal, com um "follow-up" de no mínimo 12 meses.…”

Section: Valezi Et Alunclassified

Gastroplastia vertical com bandagem em y-de-roux: análise de resultados

Valezi

Júnior

Brito

et al. 2004

Rev. Col. Bras. Cir.

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Resultados: A incidência de complicações operatórias que exigiram reoperação foi de 2 %. Não houve óbito na presente série. Após um a três anos de "follow-up", observamos uma redução do peso pré-operatório em média de 37,5%. Acompanhando a perda de peso, detectamos uma importante melhora nas comorbidades, e, em alguns casos, controle total da doença associada com a obesidade. Conclusões: A gastroplastia vertical com bandagem em Y-de-Roux foi,em nosso serviço, efetiva em produzir perda de peso intensa e duradoura associada à baixa taxa de morbi-mortalidade.Descritores: Gastroplastia; Obesidade mórbida. Professor Adjunto Doutor do

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Gastro-Gastric Fistulas and Marginal Ulcers in Gastric Bypass Procedures for Weight Reduction

Cited by 179 publications

References 6 publications

Surgical Technique Affects the Incidence of Marginal Ulceration after Roux-en-Y in Gastric Bypass

Surgical Technique Affects the Incidence of Marginal Ulceration after Roux-en-Y in Gastric Bypass

Robot-assisted gastrojejunal anastomosis does not improve the results of the laparoscopic Roux-en-Y gastric bypass

Gastroplastia vertical com bandagem em y-de-roux: análise de resultados

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