Laparoscopic reversal of mini-gastric bypass to original anatomy for severe postoperative malnutrition

Genser, Laurent; Soprani, Antoine; Tabbara, Malek; Siksik, Jean-Michel; Cady, J; Carandina, Sergio

doi:10.1007/s00423-017-1615-4

Cited by 48 publications

(44 citation statements)

References 28 publications

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“…One area of specific concern following MGB-OAGB revision was the potential for jejunal stenosis at the previous GJ site. Genser et al [23] reported increased risk of jejunal stenosis following horizontal division of the GJ anastomosis without resection of the jejunal loop. They found that this could be ameliorated with resection of the jejunal section at risk and performing a primary anastomosis of the two resected ends.…”

Section: Discussionmentioning

confidence: 99%

“…Reversal to original anatomy following MGB-OAGB was considered a technically more challenging option, involving two primary steps: (1) reestablishment of continuity between gastric pouch and remnant stomach via gastro-gastrostomy (GG) and (2) reversal of prior established GJ. Genser et al [23] had reported the largest case series (n = 26) of this surgical technique. To restore the original gastric anatomy, a linear endostapler was used to create GG anastomosis.…”

Section: Revision To the Original Anatomymentioning

confidence: 99%

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Indications, Operative Techniques, and Outcomes for Revisional Operation Following Mini-Gastric Bypass-One Anastomosis Gastric Bypass: a Systematic Review

et al. 2020

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In addition to being a relatively reversible and less complex operation, mini-gastric bypass-one anastomosis gastric bypass (MGB-OAGB) has demonstrated comparable weight loss and metabolic improvement rates with Roux-en-Y gastric bypass (RYGB). However, surgical strategies for managing its failures and late complications were poorly defined. This article aims to review the indications, operative techniques, and outcomes for revisional surgery following MGB-OAGB. A systematic review was performed using the PubMed database from 1997 to 2019. Of 179 included patients, 89 underwent revision to RYGB; 52 to sleeve gastrectomy (SG); 32 reversal to original anatomy; and 6 underwent partial revision with gastro-gastrostomy alone. Most common indications were severe malnutrition, chronic bile reflux, intractable marginal ulcerations, and insufficient weight loss. Postoperative complication rates ranged from 5 to 35%.

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Section: Discussionmentioning

confidence: 99%

Section: Revision To the Original Anatomymentioning

confidence: 99%

Indications, Operative Techniques, and Outcomes for Revisional Operation Following Mini-Gastric Bypass-One Anastomosis Gastric Bypass: a Systematic Review

et al. 2020

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“…На даний час існує настороженість щодо нутритивної недостатності після міні-шунтування, яка недостатньо описана в літературі. Існують повідомлення про повторні оперативні втручання з приводу дефіцитних станів [13,21,23].…”

Section: вступunclassified

Effect of biliopancreatic loop length mini gastric bypass on metabolic disorders resolution and nutritional deficiency

Tyvonchyk

Moskalenko

Vinogradov

2019

Rep. of Vinnytsia Nation. Med. Univ.

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Recently, the International Federation of Obesity Surgery (IFSO) has recognized gastric bypass surgery as one of the major bariatric / metabolic surgeries. However, the issue of nutritional deficiency after mini-shunting, which leads to repeated surgical interventions for deficient states, remains debatable. Efforts to balance the loss of excess body weight, compensation for concomitant metabolic disorders and nutritional insufficiency make the issue of the “ideal” length of the biopancreatic loop relevant. Therefore, the purpose of the study was to compare the bariatric and metabolic effects of mini-shunting of the stomach depending on the length of the biliary pancreatic loop. The study included 42 patients (24 women (57.1%) and 18 men (42.9%)), aged 24 to 65 years, with a body mass index (BMI) of 40 kg / m2 and above, with a mini-gastric bypass with minimally invasive access. The operation consisted of forming a long gastric reservoir along the small curvature of the stomach with the imposition of a semi-manual anastomosis with a loop of the small intestine 200–250 cm from the ligament of the Trinity. The length of the biopancreatic loop was selected according to the body mass index (200 cm — <45 kg / m2 (23 patients), 250+ cm — ˃45 kg / m2 (15 patients)) and the nature of the concomitant metabolic disorders. Anthropometric, laboratory and instrumental research methods were used. The level of HbA1c and the level of triglycerides were determined. The results were evaluated at 1, 3, 6, 9 and 12 months after surgery. Statistical processing of data was performed using StatPlus 6 Profesional. Postoperative complications were diagnosed in 3 (7.2%) patients. An early complication of Twisted pouch, which required repeated surgery, was observed in 1 (2.4%) patient. Late complications (peptic ulcer of gastroenteroanastomosis and insufficient weight loss) were found in 2 (4.8%) patients. The average percentage of excess body weight loss in the 200 cm and 250 cm group was 70.1 ± 0.8% and 71.8 ± 0.6% (p>0.05), respectively; type 2 diabetes mellitus was diagnosed in 5 (83.3%) and 7 (87.5%) patients, respectively; dyslipidemia compensation was achieved in 3 (50%) and 5 (71.4%) patients, respectively; hypocalcaemia was detected in 1 (12.5%) and 3 (27.3%) patients, respectively; decreased levels of iron were diagnosed in 1 (12.5%) and 2 (18.2%) patients, respectively. Thus, the results obtained indicate that as the length of the loop increases, the metabolic effect increases, but the risk of electrolyte exchange disorders may increase.

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“…Revisions for complications have been reported in about 1%–2% patients for GERD,[ 9 10 11 ] 0%–2% for MUs,[ 6 12 ] 0%–1.01% for severe malnutrition, and about 0.5% for incomplete weight loss and weight regain. [ 1 5 6 11 12 13 14 15 16 17 ]…”

Section: Introductionmentioning

confidence: 99%

Revisional surgery after one anastomosis/mini gastric bypass: A narrative review

Kermansaravi¹,

Mahawar²,

Jazi³

et al. 2020

J Res Med Sci

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One anastomosis gastric bypass (OAGB)/mini gastric bypass is now considered to be a safe and efficient method for morbidly obese patients but has complications and adverse events such as other surgical procedures. The present paper outlines the need for and the nature of revisional surgery in the long-term following OAGB in accordance with the preferred reporting items for systematic reviews and meta-analysis guidelines. A literature search was carried out in PubMed. All articles on OAGB for which the authors described a patient needing revisional surgery in the long term after OAGB were examined.

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Laparoscopic reversal of mini-gastric bypass to original anatomy for severe postoperative malnutrition

Abstract: Post-MGB SRMS and its related comorbidities are rare but dreaded conditions. Although burdened by a significant postoperative morbidity and weight regain, RMGB remains an effective option to consider, when intensive nutritional support fails.

Cited by 48 publications

References 28 publications

Indications, Operative Techniques, and Outcomes for Revisional Operation Following Mini-Gastric Bypass-One Anastomosis Gastric Bypass: a Systematic Review

Indications, Operative Techniques, and Outcomes for Revisional Operation Following Mini-Gastric Bypass-One Anastomosis Gastric Bypass: a Systematic Review

Effect of biliopancreatic loop length mini gastric bypass on metabolic disorders resolution and nutritional deficiency

Revisional surgery after one anastomosis/mini gastric bypass: A narrative review

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