Open Roux-en-Y gastric bypass vs. laparoscopic: A comparative study of over 25,000 cases and major laparoscopic bariatric reported series

Jones, Kenneth B.; Afram, Joseph D.; Benotti, Peter N.; Capella, Rafael F.; Cooper, C. Gary; Flanagan, Latham; Hendrick, S.; Howell, L. Michael; Jaroch, Mark T.; Kole, Kerry; Lirio, Oscar C; Sapala, James A.; Schuhknecht, Michael P; Shaprio, Robert P.; Sweet, William A.; Wood, Michael

doi:10.1016/j.soard.2005.03.045

Cited by 5 publications

(9 citation statements)

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“…A literatura registra controvérsias a respeito da melhor forma de realização da sutura laparoscópica, mas até mesmo o uso de sutura mecânica pode cursar com o aparecimento de isquemia e posterior ocorrência de fístula 7 . A comparação entre cirurgia laparotômica e laparoscópica mostrou significativa diferença a favor da técnica aberta: em mais de 25.000 pacientes submetidos a procedimento em Y de Roux, 2% do grupo laparoscópico desenvolveram fístula, em oposição ao grupo aberto (0.4%) 5 . No entanto, outras séries têm mostrado que esta diferença não é significativa, desde que seja superada a curva de aprendizado na cirurgia laparoscópica, cujo período é mais longo e necessita de maior número de operações 2 .…”

Section: Discussionunclassified

Bypass gástrico laparoscópico com uso reduzido de suturas mecânicas

Campos

Godoy

Siqueira

et al. 2008

ABCD, arq. bras. cir. dig.

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EP, Siqueira LT, Evangelista LFL, Vasconcelos CS, Ferraz AAB, Ferraz EM. Bypass gástrico laparoscópico com uso reduzido de suturas mecânicas. ABCD Arq Bras Cir Dig. 2008;21(2):73-6 RESUMO -Racional -A execução de bypass gástrico laparoscópico em hospital universitário público tem sido difícil devido ao elevado custo dos grampeadores cirúrgicos que prejudica o treinamento de médicos residentes e tem motivado a busca por técnicas alternativas, de baixo custo, mantendo a eficácia. Objetivo -Apresentar a viabilidade de um método com menor uso de suturas mecânicas. Métodos -Foram operados 63 pacientes em 2 hospitais universitários, sendo 12 homens e 51 mulheres (81%), com média de 33,5 anos de idade e IMC médio de 43. Aplicou-se a seguinte padronização técnica: Secção da alça com bisturi elétrico a 50 cm do ângulo duodeno-jejunal, anastomose término-lateral, passagem da alça retrocólica e retrogástrica, confecção da parede lateral da bolsa gástrica com 1 carga azul de 45 e outra de 60 mm após a secção horizontal com bisturi elétrico, sutura do estômago excluso e anastomose gastrojejunal. As anastomoses foram manuais e contínuas com fio absorvível. Resultados -O tempo operatório médio foi de 5,5 horas. As complicações precoces foram: fístula no ângulo de esôfago-gástrico (1,6%), estenose (1,6%) e fístula na anastomose gastrojejunal (1,6%) e torção da anastomose intestinal (1,6%). A estenose foi tratada por dilatação endoscópica e as outras complicações através de 3 re-operações (2 laparoscópicas e 1 laparotômica). O tempo de internação variou de 2 a 20 dias, com média de 4 dias, não havendo óbito. Conclusão -Este método é viável e com baixo custo operacional; todavia, é complexo e requer habilidade principalmente em suturas laparoscópicas. DESCRITORES -Cirurgia bariátrica. Bypass gástrico laparoscópico. Suturas mecânicas. Custo. ABCD Arq Bras Cir Dig InTRODUçãOO bypass gástrico sem grampeador ou usando menor número de cargas é procedimento que já foi descrito em poucas séries na literatura, e apresenta a vantagem de diminuir custos e complicações associadas ao uso de grampeador, tal como sangramento e fístula. Por outro lado, o tempo cirúrgico é maior, há risco de lesão térmica e a curva de aprendizado é mais longa 1 .Assim, objetiva-se com a proposta deste trabalho apresentar alternativa de método com baixo custo operacional. , com as seguintes co-morbidades: hipertensão arterial sistêmica (9,5%), diabetes mellitus (5,7%), hipotireoidismo (2,5%) e colecistolitíase (1,8%). Os pacientes apresentavam as seguintes operações prévias: colecistectomia (3,8%), cesárea e laqueadura tubária (3,8%), e histerectomia (1,6%). Foram executadas os seguintes procedimentos associados: colecistectomia (4,7%) e gastrostomia (3,2%). MÉTODOSUtilizou-se número reduzido de cargas de grampeador na confecção da bolsa gástrica, que variou de 2 a 4 cargas, enquanto que as anastomoses sempre foram manuais, apesar de algumas terem sido inicialmente confeccionadas látero-lateralmente. Paulatinamente, a experiência propiciou a redução do número de...

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Section: Discussionunclassified

Bypass gástrico laparoscópico com uso reduzido de suturas mecânicas

Campos

Godoy

Siqueira

et al. 2008

ABCD, arq. bras. cir. dig.

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“…In these reports, adequate flap mobility was achieved with good flap perfusion by arterial perforators. [12][13][14] However, in patients being referred for abdominoplasty after GBP, a long transverse supraumbilical or subcostal scar is occasionally encountered 15 that compromises blood supply from the superior epigastric arteries. In a study by De Castro et al 5 on full abdominoplasties on previously scarred abdomens, the authors claimed that the supraumbilical scar is a significant problem, and they considered it to be a considerable limitation for abdominoplasty due to a higher rate of postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Perforator-Sparing Abdominoplasty Technique in the Presence of Bilateral Subcostal Scars after Gastric Bypass

et al. 2007

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Background: The number of patients after gastric bypass being referred to plastic surgery units for secondary plastic surgery procedures is increasing. The characteristic abdominal deformity includes a draping apron of panniculus, occasionally associated with previous transverse surgical scars in the upper abdomen. Often a limited abdominoplasty of the low transverse type with limited undermining only up to the level of the umbilicus is performed in order not to compromise blood supply in the zone between the old transverse and the new transverse scar.Method: We propose a new, modified and safe surgical technique to perform a complete abdominoplasty with wide undermining up to the xiphoid process in patients with preexisting transverse subcostal scars after gastric bypass surgery, by selectively dissecting and preserving one to three periumbilical abdominal wall perforator vessels to secure flap blood supply. Vessel tunnelling through the rectus sheath and muscle and ligation of the cephalad branch of the perforator provide sufficient flap mobility without perforator tension or traction. Flap undermining is performed around these perforator vessels. To match dissected flap perforators with blood-flow, we performed postoperative color-flow duplex scanning.Results: We treated two patients according to this new technique. In both cases the postoperative course was uneventful and a good aesthetic result was achieved.Conclusion: We conclude from our experience that with this perforator-sparing abdominoplasty technique, safe and complete abdominoplasty can be performed with no additional risk of complications and that a good cosmetic result can be achieved in patients after open gastric bypass surgery.

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“…The most common leak location is at the gastrojejunal anastomosis, but any anastomosis or staple line can leak (gastric remnant or jejunojejunostomy). 5,25 Leaks may present as florid peritonitis and sepsis (uncontained) or with subacute symptoms of pain, fever, tachycardia, and nausea with or without emesis (usually contained). Signs of an uncontained leak should prompt immediate surgical exploration; otherwise, radiologic imaging should be rapidly obtained.…”

Section: Common Complications and Practical Management Advice General...mentioning

confidence: 99%

“…The RYGB was long considered the criterion standard bariatric operation for its reliable weight loss and comorbidity resolution but is now the second most commonly performed procedure following the SG 5 . It entails the formation of a very small proximal gastric pouch that is separated from the remainder of the stomach (usually labeled as the “gastric remnant” or “excluded stomach”) using linear staplers (Fig.…”

Section: Overview and Surgically Relevant Anatomymentioning

confidence: 99%

Common postbariatric surgery emergencies for the acute care surgeon: What you need to know

Cheng,

Samakar,

Dobrowolsky

et al. 2023

J Trauma Acute Care Surg

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The field of bariatric and metabolic surgery has changed rapidly over the past two decades, with an exponential increase in case volumes being performed because of its proven efficacy for morbid obesity and obesity-related comorbidities. Although this increased volume of procedures has been accompanied by significant decrease in postoperative complication rates, there are numerous potential complications after bariatric surgery that may require urgent or emergent surgical evaluation or interventions. Many of these risks extend well beyond the early postoperative period and can present months to years after the index procedure. Acute care surgeons are increasingly covering most or all of the emergency general surgery services at many centers and must be familiar with the numerous bariatric surgical procedures being performed and their individual complication profile to provide optimal care for these frequently challenging patients. This article provides a focused and concise review of the common bariatric procedures being performed, their early and late complication profiles, and a practical guide to the optimal diagnostic evaluations, surgical interventions, and perioperative management options. The author group includes both acute care surgeons and bariatric surgeons with significant experience in the emergency management of the complicated postbariatric surgical patient. LEVEL OF EVIDENCE Literature Synthesis and Expert Opinion; Level V.

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Open Roux-en-Y gastric bypass vs. laparoscopic: A comparative study of over 25,000 cases and major laparoscopic bariatric reported series

Cited by 5 publications

References 0 publications

Bypass gástrico laparoscópico com uso reduzido de suturas mecânicas

Bypass gástrico laparoscópico com uso reduzido de suturas mecânicas

Perforator-Sparing Abdominoplasty Technique in the Presence of Bilateral Subcostal Scars after Gastric Bypass

Common postbariatric surgery emergencies for the acute care surgeon: What you need to know

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