Prospective evaluation of biliopancreatic diversion with Roux-en-Y gastric bypass in the super obese

Kalfarentzos, Fotis; Papadoulas, Spyros; Skroubis, George; Kehagias, Ioannis; Loukidi, Aggeliki; Mead, Nancy

doi:10.1016/j.gassur.2003.11.022

Cited by 37 publications

(22 citation statements)

References 31 publications

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“…Recently, it has been increasingly recognised that RYGB may have an effect on appetite and eating behaviour, which, in turn, may improve long-term results. These effects may be related to changes in the circulating levels of the gastrointestinal hormones known to influence appetite including PYY [7,[23][24][25][26][27][28] , and this may play a role in the overall success of the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…The type of procedure performed is based on specific selection criteria according to an algorithm developed by our center, whereby patients with body mass index (BMI) over 50 kg/m 2 undergo biliopancreatic diversion with RYGB (BPD-RYGB), as modified in our center [7] , while patients with BMI < 50 kg/m 2 undergo RYGB with long limb (RYGB-LL) or sleeve gastrectomy (SG) depending on comorbidities and eating habits. Sweet consumers and patients with diabetes mellitus undergo RYGB-LL whereas volume consumers may undergo SG.…”

Section: Methodsmentioning

confidence: 99%

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Prospective evaluation of laparoscopic Roux en Y gastric bypass in patients with clinically severe obesity

Vagenas¹,

Panagiotopoulos²,

Kehagias³

et al. 2008

WJG

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AIM:To evaluate and present our experience with laparoscopic Roux en Y gastric bypass (RYGB) in a selected patient population. METHODS: A cohort of 130 patients with a body mass index (BMI) between 35 and 50 kg/m 2 were evaluated in relation to postoperative morbidity, weight loss and resolution of co-morbidities for a period of 4 years following laparoscopic RYGB. RESULTS: Early morbidity was 10.0%, including 1 patient with peritonitis who was admitted to Intensive Care Unit (ICU) and 1 conversion to open RYGB early in the series. There was no early or late mortality. Maximum weight loss was achieved at 12 mo postoperatively, with mean BMI 30 kg/m 2 , mean percentage of excess weight loss (EWL%) 66.4% and mean percentage of initial weight loss (IWL%) 34.3% throughout the follow-up period. The majority of preexisting comorbidities were resolved after weight loss and no major metabolic disturbances or nutritional deficiencies were observed. CONCLUSION: Laparoscopic RYGB appears to be a safe and effective procedure for patients with BMI 35-50 kg/m 2 with results that are comparable to previously published data mostly from the USA but from Europe as well.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Prospective evaluation of laparoscopic Roux en Y gastric bypass in patients with clinically severe obesity

Vagenas¹,

Panagiotopoulos²,

Kehagias³

et al. 2008

WJG

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“…The surgical technique of BPD-RYGBP has been previously described [12]. This is a variant of biliopancreatic diversion with BPD-RYGBP performed in all patients through a midline supraumbilical incision.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Early histological changes in the kidney of people with morbid obesity

Goumenos

Kawar

Nahas

et al. 2009

Nephrology Dialysis Transplantation

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Background. Morbid obesity represents a major health problem with increasing incidence worldwide. The clinical manifestation of renal involvement in obesity is proteinuria, and the histological feature is glomerulomegaly with or without focal and segmental glomerulosclerosis (FSGS). In this study, we have investigated the very early histological changes in kidneys of people with morbid obesity and no proteinuria. Patients and methods. Eighteen patients with body mass index (BMI) >50 kg/m 2 who underwent a variant of biliopancreatic diversion with Roux-en-Y reconstruction (BPD-RYGBP) and consented to undergo a renal biopsy during the surgical procedure were included in the study. The estimation of early histological changes was performed on light (n = 18) and electron microscopy (n = 13). Results. The mean glomerular cross-sectional area was 30 943 ± 10 984 µm 2 that is higher than that observed in non-obese individuals. In 21% of the examined glomeruli, the glomerular planar surface area (GPSA) was >40 000 µm 2 . Thickening of the glomerular basement membrane (GBM) and scattered paramesangial deposits were identified in 9 of 13 patients (70%) whose renal tissue was examined by electron microscopy. A reduction in the slit pore frequency was observed in obese patients due to extensive foot process effacement. Significant positive correlations between mean GPSA and body weight (r = 0.462, P = 0.05), and between GBM thickness and HbA1c, serum total cholesterol and triglyceride levels (r = 0.60, P = 0.05; r = 0.789, P = 0.004; r = 0.70, P = 0.016, respectively), were observed. Conclusions. Glomerulomegaly as well as histological lesions resembling those of early diabetic nephropathy are observed in kidney biopsies of patients with morbid obesity even before the appearance of microalbuminuria. The potential regression of these changes after weight loss needs to be clarified.

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“…Based on our data, BPD-RYGBP appears to be effective for this patient group as it provides adequate weight loss with resolution of major comorbidities. Nevertheless, the procedure is associated with higher morbidity and mortality rates in this patient population when compared to that seen in patients with lower BMI [6,9]. Therefore, a two-stage operative approach, consisting of sleeve gastrectomy followed by the definitive malabsorptive procedure or even a regular BPD may be considered in these patients [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

“…The surgical technique of BPD-RYGBP has previously been described in detail [9]. Briefly, the main characteristics of the procedure are a 15±5 ml gastric pouch, biliopancreatic limb of 150-200 cm distal to the ligament of Treitz depending on the full length of the small intestine, common limb of 100 cm, and alimentary limb, the remainder of the small intestine (Fig.…”

Section: Surgical Technique and Perioperative Managementmentioning

confidence: 99%

A Prospective Evaluation of a Variant of Biliopancreatic Diversion with Roux-en-Y Reconstruction in Mega-obese Patients (BMI ≥ 70 kg/m2)

et al. 2008

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Prospective evaluation of biliopancreatic diversion with Roux-en-Y gastric bypass in the super obese

Cited by 37 publications

References 31 publications

Prospective evaluation of laparoscopic Roux en Y gastric bypass in patients with clinically severe obesity

Prospective evaluation of laparoscopic Roux en Y gastric bypass in patients with clinically severe obesity

Early histological changes in the kidney of people with morbid obesity

A Prospective Evaluation of a Variant of Biliopancreatic Diversion with Roux-en-Y Reconstruction in Mega-obese Patients (BMI ≥ 70 kg/m2)

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