Laparoscopic Roux-En-Y Gastric Bypass

Suter, Michel; Donadini, Andrea; Romy, Sébastien; Demartines, Nicolas; Giusti, Vittorio

doi:10.1097/sla.0b013e3182263b66

Cited by 136 publications

(27 citation statements)

References 40 publications

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“…These rates are very comparable to previously published results on revisional RYGBP after failed VBG, AGB or SG [6,[20][21][22]. The complication rate of the FT group is even comparable with some studies on the outcome after primary RYGBP [23,24]. Whether the reduction in rate of complication is caused purely by this implementation is arguable, as many factors may have influenced the occurrence of postoperative complications.…”

Section: Discussionsupporting

confidence: 89%

Conventional versus fast track anaesthesia in an unselected group of patients undergoing revisional bariatric surgery

Wezenbeek

Pouwels

Buise

et al. 2015

International Journal of Surgery Open

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Introduction:Fast track care has proven to be safe and effective in primary bariatric procedures. The number of more complex revisional procedures is expected to rise over the next years. The aim was to evaluate the potential benefits and safety of a fast-track protocol in an unselected group of patients undergoing Roux-en-Y Gastric Bypass (rRYGBP) as revision. Method: For this retrospective study, all patients undergoing rRYGBP between January 2005 and December 2013 were included and categorized between conventional care (CC) and fast track care (FT). Patient characteristics, operative details and intra-and early postoperative complications < 30 days were analysed. Results: A total of 407 patients were included for analysis. 303 patients (74.4%) received peri-and postoperative treatment according to the fast track protocol. Mean age of the study population was 44.0 ± 8.9 years; mean pre-primary procedure BMI was 45.7 ± 7.0 kg/m 2 . A total of 54 (13.3%) postoperative complications were registered (CC 19.2% vs FT 11.2%; p = 0.038). Both operative time (CC 135.3 ± 42.6 minutes vs FT 79.3 ± 29.3 minutes; p < 0.001) as well as hospital stay (CC 5.1 ± 6.3 days vs FT 3.1 ± 5.3 days; p < 0.001) were significantly shorter in the FT group. A multivariate analysis on postoperative complications showed that fast track was not predictive for the occurrence of complications (OR = 0.853; 95% CI [0.403-1.804]; p = 0.677). Conclusion:Fast track care appears to be safe and efficient for patients undergoing revisional Rouxen-Y gastric bypass, but postoperative outcome may be highly dependent on surgical experience.

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Section: Discussionsupporting

confidence: 89%

Conventional versus fast track anaesthesia in an unselected group of patients undergoing revisional bariatric surgery

Wezenbeek

Pouwels

Buise

et al. 2015

International Journal of Surgery Open

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“…3 In sensitivity analyses, we used a threshold of 50% EWL based on the Reinhold Classification and other long-term studies. 4,5,11 Mean mortality risks for WLS range widely, but even in high-risk populations the risk is generally less than 5%. 2,7,8 We considered patients who were willing to accept risks of 10% or higher as willing to accept unreasonably high risk.…”

Section: Methodsmentioning

confidence: 99%

“…3 Nevertheless, WLS leads to improvement in comorbidities, especially diabetes mellitus, 9,10 even after accounting for weight regain. 3,11 In the Swedish Obese Subjects Study, the mean sustained weight loss at 10 years was 25% to 26% of initial weight for subjects undergoing gastric bypass and 14% to 18% for those undergoing gastric banding; however, about one-quarter of patients undergoing gastric bypass and three-fourths of those undergoing gastric banding sustained less than 20% weight loss. Moreover, 9% of the gastric bypass patients and 25% of the gastric banding patients sustained less than a 5% weight loss at 10 years.…”

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confidence: 99%

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Expectations for Weight Loss and Willingness to Accept Risk Among Patients Seeking Weight Loss Surgery

Wee¹,

Hamel²,

Apovian³

et al. 2013

JAMA Surg

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Importance Weight loss surgery (WLS) has been shown to produce long-term weight loss but is not risk free or universally effective. The weight loss expectations and willingness to undergo perioperative risk among patients seeking WLS remain unknown. Objectives To examine the expectations and motivations of WLS patients and the mortality risks they are willing to undertake and to explore the demographic characteristics, clinical factors, and patient perceptions associated with high weight loss expectations and willingness to assume high surgical risk. Design We interviewed patients seeking WLS and conducted multivariable analyses to examine the characteristics associated with high weight loss expectations and the acceptance of mortality risks of 10% or higher. Setting Two WLS centers in Boston. Participants Six hundred fifty-four patients. Main Outcome Measures Disappointment with a sustained weight loss of 20% and willingness to accept a mortality risk of 10% or higher with WLS. Results On average, patients expected to lose as much as 38% of their weight after WLS and expressed disappointment if they did not lose at least 26%. Most patients (84.8%) accepted some risk of dying to undergo WLS, but only 57.5% were willing to undergo a hypothetical treatment that produced a 20% weight loss. The mean acceptable mortality risk to undergo WLS was 6.7%, but the median risk was only 0.1%; 19.5% of all patients were willing to accept a risk of at least 10%. Women were more likely than men to be disappointed with a 20% weight loss but were less likely to accept high mortality risk. After initial adjustment, white patients appeared more likely than African American patients to have high weight loss expectations and to be willing to accept high risk. Patients with lower quality-of-life scores and those who perceived needing to lose more than 10% and 20% of weight to achieve “any” health benefits were more likely to have unrealistic weight loss expectations. Low quality-of-life scores were also associated with willingness to accept high risk. Conclusions and Relevance Most patients seeking WLS have high weight loss expectations and believe they need to lose substantial weight to derive any health benefits. Educational efforts may be necessary to align expectations with clinical reality.

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“…It is well known that very few individuals are able to intentionally lose weight and sustain weight loss. Bariatric surgery is known to be an effective long term weight loss option for morbidly-obese individuals [32], for whom other methods of weight loss have not been effective. Studies are also now beginning to confirm the expected lowering of cancer risk following bariatric surgery [33].…”

Section: Introductionmentioning

confidence: 99%

Longitudinal evaluation of cancer-associated biomarkers before and after weight loss in RENEW study participants: Implications for cancer risk reduction

Linkov

Maxwell

Felix

et al. 2012

Gynecologic Oncology

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Introduction Obesity is a major risk factor for the development of endometrial cancer (EC). An improved understanding of biologic mechanisms associated with weight loss, including alteration in inflammation, hormonal balance, and cancer antigens expression may lead to the development of effective cancer prevention strategies. The goal of this study was to explore longitudinal biomarker changes in obese women who underwent weight loss intervention, testing the hypothesis biomarker levels can be altered through intentional weight loss. Methods Serum samples from 89 participants with Class II and Class III obesity and 43 non morbidly obese comparisons were obtained in Re-Energize with Nutrition, Exercise and Weight Loss (RENEW) study as previously reported. Twenty-one bead-based xMAP immunoassays were utilized, including cancer-associated antigens, cytokines, chemokines, and hormones. One-way repeated measures ANOVA was used to examine the association between changes in biomarker expression levels over time (baseline, 6 months and 12 months). Linear mixed effects models were used to examine longitudinal relationships between biomarker expression levels. Results Mean levels of VEGF, soluble E-selectin, GH, adiponectin, IL-6, IL-7, CA-125, and IGFBP-1 significantly differed between time periods. In adjusted mixed linear models, decreasing BMI was significantly associated with lower levels of soluble E-selectin and IL-6 and increases in GH, adiponectin, and IGFBP-1. Conclusions This is one of the first efforts to explore changes in cancer-associated biomarkers in a cohort of weight loss research participants at high risk for EC development. Our findings demonstrate that changes in the expression of markers can be achieved with weight loss intervention.

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Laparoscopic Roux-En-Y Gastric Bypass

Cited by 136 publications

References 40 publications

Conventional versus fast track anaesthesia in an unselected group of patients undergoing revisional bariatric surgery

Conventional versus fast track anaesthesia in an unselected group of patients undergoing revisional bariatric surgery

Expectations for Weight Loss and Willingness to Accept Risk Among Patients Seeking Weight Loss Surgery

Longitudinal evaluation of cancer-associated biomarkers before and after weight loss in RENEW study participants: Implications for cancer risk reduction

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