Revisional Surgery for Insufficient Loss or Regain of Weight After Roux-en-Y Gastric Bypass: Biliopancreatic Limb Length Matters

Kraljević, Marko; Köstler, Thomas; Süsstrunk, Julian; Lazaridis, Ioannis; Taheri, Amy; Zingg, Urs; Delko, Tarik

doi:10.1007/s11695-019-04348-8

Cited by 35 publications

(40 citation statements)

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“…The Role of Bariatric Surgery in Fatty Liver DOI: http://dx.doi.org/10.5772/intechopen.96975 the drawback of using a long BPL with a shorter alimentary limb lenght (TALL). Recent data suggests that at least 350-400 cm of TALL must remain [40,41].…”

Section: Liver Failure As a Results Of Prior Bariatric Surgerymentioning

confidence: 99%

The Role of Bariatric Surgery in Fatty Liver

Geerts¹,

Lefere²

2021

Advances in Hepatology

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Non-alcoholic fatty liver disease (NAFLD) is a crucial health problem with a prevalence that is increasing concurrently with the obesity epidemic on a global scale. Steatosis, nonalcoholic steatohepatitis (NASH), hepatocellular carcinoma (HCC), cirrhosis, and advanced fibrosis constitute the disease spectrum covered by NAFLD. NASH-related cirrhosis and HCC is currently the second most common indication for liver transplantation. Although lifestyle modifications, especially weight loss, effectively reduces the liver injury in NASH, adherence in the clinical setting is low. Potential treatments for NASH are still under investigation in phase 2–3 studies. Bariatric surgery can improve metabolic components and cause great weight loss. Therefore, bariatric surgery may reverse the pathological liver changes in NAFLD and NASH patients. However, complications such as liver failure after bariatric surgery can occur. This chapter will give an overview of the benefits and pitfalls of bariatric surgery in patients with NAFLD, liver transplant candidates and post-liver transplant patients.

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Section: Liver Failure As a Results Of Prior Bariatric Surgerymentioning

confidence: 99%

The Role of Bariatric Surgery in Fatty Liver

Geerts¹,

Lefere²

2021

Advances in Hepatology

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“…As previously reported, revisional malabsorptive procedures were chosen for patients with a higher mean pre-revisional BMI of 41.7 ± 4.4 kg/m 2 . 41 Another selection criterion for revisional LAGB was the pouch anatomy; after thorough pre-operative endoscopic and radiological examination, secondary LAGB was performed only in patients presenting with a normal pouch size. In case of a dilated pouch, pouch resizing was performed.…”

Section: Discussionmentioning

confidence: 99%

Revisional Adjustable Gastric Band in Roux-en-Y Gastric Bypass—Is It Worth It?

Lazaridis¹,

Kraljević²,

Süsstrunk

et al. 2021

Journal of Gastrointestinal Surgery

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Purpose A subset of patients undergoing Roux-en-Y gastric bypass (RYGB) presents with either insufficient weight loss or weight regain. Data on the revisional restrictive options including laparoscopic adjustable gastric band (LAGB) is scarce. This study analyzes the mid-term efficacy and safety of LAGB as a revisional procedure after RYGB. Methods Data of all patients with revisional LAGB after primary RYGB between January 2011 and May 2019 were retrospectively reviewed. Outcomes included assessment of weight changes, resolution of comorbidities, and early and late complications during the study period. Results Twenty patients were included. The median Body Mass Index (BMI) before revisional LAGB was 34.8 (interquartile range [IQR] 31.9–38.1) kg/m2. After a median follow-up of 33.5 (IQR 19.5–76.5) months, the median BMI was 28.7 (IQR 26.1–32.2) kg/m2. The median additional Excess Weight Loss (EWL) was 37.6% (IQR 23–44.4), leading to a median total EWL of 79.5% (IQR 54.4–94.6). BMI and EWL post-LAGB improved significantly compared to BMI and EWL pre-LAGB (p<0.001 and p<0.001, respectively). Obstructive sleep apnea syndrome resolved 6 months after LAGB in one patient. Three band deflations occurred during the follow-up. Six patients underwent band removal after a median time of 19 (IQR 15.8–26) months. Overall, thirteen patients underwent a reoperation. There was no loss of follow-up until 5 years. After that, two patients were lost to follow-up. Conclusion LAGB may be a salvage option after failed RYGB. However, the high rate of revisions after secondary LAGB needs to be taken into consideration.

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“…Severe malnutrition was observed in the 21.4% of patients who required reoperation. 37 In a retrospective study of 65 patients, weight loss after 1 year of surgery showed a decrease from a mean prerevisional BMI of 41.9 to 34.6 kg/m 2 , which corresponded with an absolute weight loss of À20 kg. Complications such as wound infections, leaks, and small bowel obstruction were reported in 9.2, 3.1, and 1.5% of patients, respectively.…”

Section: Laparoscopic Biliopancreatic Limb Lengtheningmentioning

confidence: 97%

Interventions for Weight Regain after Bariatric Surgery

Muñóz

Soto

2021

Digestive Disease Interventions

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Bariatric surgery is the most effective available treatment for obesity, inducing a significant and durable weight loss, and improving several obesity-associated diseases. However, as the number of bariatric surgeries performed increases, so does the prevalence of patients who experience either insufficient weight loss or weight regain, accompanied by relapse or the emergence of new obesity-related diseases. Endoscopic and surgical bariatric revisional procedures are used to promote weight loss and improve metabolic function to address these problems. After a psychological, nutritional, medical, and anatomical evaluation of the gastrointestinal anatomy has been completed, patient candidacy to a revisional procedure must be defined. In those patients with insufficient weight loss or weight regain associated with relapse, the emergence of new obesity-related diseases, or quality-of-life deterioration, a revisional procedure must be selected. Although current evidence comes mainly from observational and retrospective studies, with a limited number of patients and short follow-up times, the available data indicate that revisional procedures are useful to induce a significant weight loss and/or promote remission of obesity-associated diseases, albeit an increased risk of surgical and/or nutritional complications. Thus, careful selection of patients is needed to minimize risk and maximize the benefit of these procedures.

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Revisional Surgery for Insufficient Loss or Regain of Weight After Roux-en-Y Gastric Bypass: Biliopancreatic Limb Length Matters

Cited by 35 publications

References 35 publications

The Role of Bariatric Surgery in Fatty Liver

The Role of Bariatric Surgery in Fatty Liver

Revisional Adjustable Gastric Band in Roux-en-Y Gastric Bypass—Is It Worth It?

Interventions for Weight Regain after Bariatric Surgery

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