Gastrointestinal symptoms, weight loss and patient satisfaction 5 years after gastric bypass: a study of three techniques for the gastrojejunal anastomosis

Sima, Eduardo; Hedberg, Jakob; Sundbom, Magnus

doi:10.1007/s00464-015-4374-8

Cited by 25 publications

(14 citation statements)

References 28 publications

(32 reference statements)

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“…Many series have shown that the use of a 21-mm circular stapler is associated with higher rates of stricture. Our 17% stricture rate with the 21-mm circular stapler is consistent with previous reports revealing high stricture rates in the range of 12.5 to 27% [ 3 , 14 , 15 ]. Sima et al reported a greater incidence of vomiting and need for endoscopic dilation over a 5-year follow-up period in those patients for whom the C21 technique was used for GJA [ 14 ].…”

Section: Discussionsupporting

confidence: 92%

“…Our 17% stricture rate with the 21-mm circular stapler is consistent with previous reports revealing high stricture rates in the range of 12.5 to 27% [ 3 , 14 , 15 ]. Sima et al reported a greater incidence of vomiting and need for endoscopic dilation over a 5-year follow-up period in those patients for whom the C21 technique was used for GJA [ 14 ]. However, some authors have demonstrated low rates of GJ stricture with the 21-mm staplers (0.8–5.9%) [ 16 , 17 ].…”

Section: Discussionsupporting

confidence: 92%

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Does Robotic Roux-en-Y Gastric Bypass Provide Outcome Advantages over Standard Laparoscopic Approaches?

et al. 2018

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ObjectiveThe aim was to compare clinical outcomes of patients treated with totally robotic Roux-en-Y gastric bypass (TRRYGB) with those treated with the different laparoscopic Roux-en-Y gastric bypass (LRYGB) techniques.Summary Background DataThe clinical benefit of the robotic approach to bariatric surgery compared to the standard laparoscopic approach is unclear. There are no studies directly comparing outcomes of TRRYGB with different LRYGB techniques.MethodsOutcomes of 578 obese patients who underwent RYGB between 2011 and 2014 at an academic center were assessed. Multivariable analysis and propensity matching were used for comparing TRRYGB to different LRYGB techniques, including 21-mm EEA circular-stapled gastrojejunal anastomosis (GJA, LRYGB-21CS), linear-stapled GJA (LRYGB-LS), and hand-sewn GJA (LRYGB-HS).ResultsThe TRRYGB technique required a longer mean operative time compared to the other groups, respectively 204 ± 46 vs. 139 ± 30 min (LRYGB-21CS), 206 ± 37 vs. 158 ± 30 min (LRYGB-LS), and 210 ± 36 vs. 167 ± 30 min (LRYGB-HS). TRRYGB experienced a lower stricture rate (2 vs. 17%, P = 0.003), shorter hospital stay (2.6 ± 1.2 vs. 4.3 ± 5.5 days, P = 0.008), and lower readmission rate (12 vs. 28%, P = 0.009). No significant differences in outcomes were observed when comparing RRYGB to LRYGB-LS or LRYGB-HS.ConclusionsTRRYGB increases operative time compared to all LRYGB techniques. TRRYGB was superior to LRYGB-21CS in terms of significantly shorter hospital stay, lower readmission rate, and less frequent GJA stricture formation. TRRYGB provides no clinical advantages over the LRYGB-LS and LRYGB-HS techniques.Electronic supplementary materialThe online version of this article (10.1007/s11695-018-3228-6) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Does Robotic Roux-en-Y Gastric Bypass Provide Outcome Advantages over Standard Laparoscopic Approaches?

et al. 2018

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“…As a result, RYGB markedly accelerates gastric emptying of liquids and solids (although emptying of small, solid meals with volumes not exceeding the pouch volume may be slower) (213,244,339,518,536,802,808). This, in turn, often leads to bloating, nausea, and dumping in RYGB patients (307,377,545,695,745). Glucose solutions, as used in glucose-tolerance tests, may empty almost immediately in RYGB patients, leading to the appearance of ϳ300 kcal in the jejunum within 1-2 min (544).…”

Section: G Rygbmentioning

confidence: 99%

Ghrelin, CCK, GLP-1, and PYY(3–36): Secretory Controls and Physiological Roles in Eating and Glycemia in Health, Obesity, and After RYGB

Steinert

Feinle‐Bisset

Asarian

et al. 2017

Physiological Reviews

446

415

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The efficacy of Roux-en-Y gastric-bypass (RYGB) and other bariatric surgeries in the management of obesity and type 2 diabetes mellitus and novel developments in gastrointestinal (GI) endocrinology have renewed interest in the roles of GI hormones in the control of eating, meal-related glycemia, and obesity. Here we review the nutrient-sensing mechanisms that control the secretion of four of these hormones, ghrelin, cholecystokinin (CCK), glucagon-like peptide-1 (GLP-1), and peptide tyrosine tyrosine [PYY(3-36)], and their contributions to the controls of GI motor function, food intake, and meal-related increases in glycemia in healthy-weight and obese persons, as well as in RYGB patients. Their physiological roles as classical endocrine and as locally acting signals are discussed. Gastric emptying, the detection of specific digestive products by small intestinal enteroendocrine cells, and synergistic interactions among different GI loci all contribute to the secretion of ghrelin, CCK, GLP-1, and PYY(3-36). While CCK has been fully established as an endogenous endocrine control of eating in healthy-weight persons, the roles of all four hormones in eating in obese persons and following RYGB are uncertain. Similarly, only GLP-1 clearly contributes to the endocrine control of meal-related glycemia. It is likely that local signaling is involved in these hormones' actions, but methods to determine the physiological status of local signaling effects are lacking. Further research and fresh approaches are required to better understand ghrelin, CCK, GLP-1, and PYY(3-36) physiology; their roles in obesity and bariatric surgery; and their therapeutic potentials.

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“…In one series, 87.4% of the patients felt better or much better although 67.6% had been in contact with health care due to symptoms, most commonly abdominal pain (11). In another study, 31% of the patients reported abdominal pain, but 88% were satisfied or very satisfied with the procedure, and 92% would recommend RYGB to an acquaintance (6). These findings should be interpreted with care, but well-being and the acceptance of symptoms may depend in part on improvement or resolution of other symptoms.…”

Section: Discussionmentioning

confidence: 99%

Abdominal Pain After Roux-En-Y Gastric Bypass for Morbid Obesity

Mala

Høgestøl

2018

Scand J Surg

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Gastrointestinal symptoms, weight loss and patient satisfaction 5 years after gastric bypass: a study of three techniques for the gastrojejunal anastomosis

Cited by 25 publications

References 28 publications

Does Robotic Roux-en-Y Gastric Bypass Provide Outcome Advantages over Standard Laparoscopic Approaches?

Does Robotic Roux-en-Y Gastric Bypass Provide Outcome Advantages over Standard Laparoscopic Approaches?

Ghrelin, CCK, GLP-1, and PYY(3–36): Secretory Controls and Physiological Roles in Eating and Glycemia in Health, Obesity, and After RYGB

Abdominal Pain After Roux-En-Y Gastric Bypass for Morbid Obesity

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