Revisional Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: a Systematic Review of Comparative Outcomes with Respective Primary Procedures

Mahawar, Kamal; Graham, Yitka; Carr, William; Jennings, Neil; Schroeder, Norbert; Balupuri, S.; Small, Peter

doi:10.1007/s11695-015-1670-2

Cited by 80 publications

(42 citation statements)

References 35 publications

(41 reference statements)

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“…This is a meaningful difference for patients in their choice of procedure. That banding helps in maintaining weight loss is further supported by the fact that patients experience weight gain when bands need to be removed for any reason [18]. …”

Section: Discussionmentioning

confidence: 99%

Banded Gastric Bypass: Better Long-Term Results? A Cohort Study with Minimum 5-Year Follow-Up

Lemmens

2016

OBES SURG

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BackgroundWhile gastric bypass has been the treatment of choice for morbid obesity, insufficient weight loss and even weight regain has been observed in a sub-group of patients. Dilatation of the pouch, pouch outlet, and proximal alimentary limb have been suggested to cause weight regain on the long term. The banded gastric bypass surgery has been introduced to overcome this problem.MethodsFour hundred thirty-two patients (n = 254, non-banded/n = 178, banded-GaBP Ring™) were followed-up for 5 years. Patients were evaluated for weight loss, % excess weight loss (%EWL), weight regain and BMI.ResultsNo significant differences between groups in the first year following surgery were observed in terms of weight loss and %EWL. %EWL at 5 years was as follows: non-banded 65.2 ± 20.0 %; banded 74.0 ± 15.1 %. At 5 years, the banded group showed more weight loss (non-banded 35.4 ± 12.5; banded 43.9 ± 11.9 kg, P < 0.0001); weight regain was significantly higher in the non-banded group (P < 0.0001). Only minor complications were reported; no signs of ring migration or slippage were reported.ConclusionAlthough, following the first year after surgery, no differences in treatment groups were observed in terms of weight loss, 5 years following surgery, patients who received banded surgery maintained better weight loss and had less weight regain compared to the non-banded group. These results suggest that laparoscopic banded gastric bypass using a silastic ring was effective in maintaining weight loss on the long term, while the complication rate was low. The banded gastric bypass is regarded by us as the new gold standard.

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Section: Discussionmentioning

confidence: 99%

Banded Gastric Bypass: Better Long-Term Results? A Cohort Study with Minimum 5-Year Follow-Up

Lemmens

2016

OBES SURG

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“…As noted earlier, this lesser weight loss, compared to RYGB, has led to a substantial reduction in the application of LAGB as treatment for severe obesity. The weight loss following biliopancreatic diversion/duodenal switch tends to be slightly greater than that following RYGB while weight loss following sleeve gastrectomy is comparable or is slightly less than RYGB in several reports 30-33 . Those studies with non-surgical comparator groups, primarily the Swedish Obese Subjects trial and a prospective clinical trial with a population base comparator from Utah, indicate that the non-surgical patients do not experience long-term weight loss.…”

Section: Weight Loss Following Bariatric Surgerymentioning

confidence: 94%

“…As expected the amount of weight reduction was only ~4.0% in the medical group vs. 22-24% in the surgical groups. In 4 randomized trials wherein RYGB was further compared with sleeve gastrectomy, there was no significant difference between procedures with the reduction in HbA1c or fasting plasma glucose or the in change in weight, BMI or the number or type of drugs used to treat type 2 diabetes 30,31 . Overall, the amounts of weight loss have been a definite predictor of diabetes remission.…”

Section: Expected Benefit On Cvd Risk Factorsmentioning

confidence: 99%

Treatment of Obesity

Wolfe

Kvach

Eckel

2016

Circulation Research

444

192

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This review focuses on the mechanisms underlying, and indications for, bariatric surgery in the reduction of cardiovascular disease (CVD) as well as other expected benefits of this intervention. The fundamental basis for bariatric surgery for the purpose of accomplishing weight loss is the determination that severe obesity is a disease associated with multiple adverse effects on health which can be reversed or improved by successful weight loss in patients who have been unable to sustain weight loss by non-surgical means. An explanation of possible indications for weight loss surgery as well as specific bariatric surgical procedures is presented, along with review of the safety literature of such procedures. Procedures that are less invasive or those that involve less gastrointestinal rearrangement accomplish considerably less weight loss but have substantially lower perioperative and longer-term risk. The ultimate benefit of weight reduction relates to the reduction of the co-morbidities, quality of life and all-cause mortality. With weight loss being the underlying justification for bariatric surgery in ameliorating CVD risk, current evidence-based research is discussed concerning body fat distribution, dyslipidemia, hypertension, diabetes, inflammation, obstructive sleep apnea and others. The rationale for bariatric surgery reducing CVD events is discussed and juxtaposed with impacts on all-cause mortalities. Given the improvement of established obesity-related CVD risk factors following weight loss, it is reasonable to expect a reduction of CVD events and related mortality following weight loss in populations with obesity. The quality of the current evidence is reviewed and future research opportunities and summaries are stated.

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“…Several studies have reported excellent results in terms of improvement or resolution of reflux symptoms[57-61]. Revisional minimally invasive gastric gastric bypass is highly effective in controlling GERD related symptoms and is currently the standard option in these patients[62]. Very recently, new minimally invasive approaches have been proposed in patients with GERD and hypotensive LES: the LINX ® Reflux Management System procedure and the Stretta ® procedure.…”

Section: Treatment Options Of Gerd In Patients After Lsg: the Presentmentioning

confidence: 99%

Gastroesophageal reflux disease and morbid obesity: To sleeve or not to sleeve?

Rebecchi

Allaix

Patti

et al. 2017

WJG

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Laparoscopic sleeve gastrectomy (LSG) has reached wide popularity during the last 15 years, due to the limited morbidity and mortality rates, and the very good weight loss results and effects on comorbid conditions. However, there are concerns regarding the effects of LSG on gastroesophageal reflux disease (GERD). The interpretation of the current evidence is challenged by the fact that the LSG technique is not standardized, and most studies investigate the presence of GERD by assessing symptoms and the use of acid reducing medications only. A few studies objectively investigated gastroesophageal function and the reflux profile by esophageal manometry and 24-h pH monitoring, reporting postoperative normalization of esophageal acid exposure in up to 85% of patients with preoperative GERD, and occurrence of de novo GERD in about 5% of cases. There is increasing evidence showing the key role of the surgical technique on the incidence of postoperative GERD. Main technical issues are a relative narrowing of the mid portion of the gastric sleeve, a redundant upper part of the sleeve (both depending on the angle under which the sleeve is stapled), and the presence of a hiatal hernia. Concomitant hiatal hernia repair is recommended. To date, either medical therapy with proton pump inhibitors or conversion of LSG to laparoscopic Roux-en-Y gastric bypass are the available options for the management of GERD after LSG. Recently, new minimally invasive approaches have been proposed in patients with GERD and hypotensive LES: the LINX® Reflux Management System procedure and the Stretta® procedure. Large studies are needed to assess the safety and long-term efficacy of these new approaches. In conclusion, the recent publication of pH monitoring data and the new insights in the association between sleeve morphology and GERD control have led to a wider acceptance of LSG as bariatric procedure also in obese patients with GERD, as recently stated in the 5th International Consensus Conference on sleeve gastrectomy.

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Revisional Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: a Systematic Review of Comparative Outcomes with Respective Primary Procedures

Cited by 80 publications

References 35 publications

Banded Gastric Bypass: Better Long-Term Results? A Cohort Study with Minimum 5-Year Follow-Up

Banded Gastric Bypass: Better Long-Term Results? A Cohort Study with Minimum 5-Year Follow-Up

Treatment of Obesity

Gastroesophageal reflux disease and morbid obesity: To sleeve or not to sleeve?

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