Revision/Conversion Surgeries After One Anastomosis Gastric Bypass-An Experts' Modified Delphi Consensus.

PURPOSE: There is a lack of evidence for treatment of some conditions including complication management, suboptimal initial weight loss, recurrent weight gain, or worsening of a significant obesity complication after one anastomosis gastric bypass (OAGB). This study was designed to respond to the existing lack of agreement and to provide a valuable resource for clinicians by employing an expert-modified Delphi consensus method. METHODS: Forty-eight recognized bariatric surgeons from 28 countries participated in the modified Delphi consensus to vote on 64 statements in two rounds. An agreement/disagreement among ≥ 70.0% of the experts was regarded to indicate a consensus. RESULTS: A consensus was achieved for 46 statements. For recurrent weight gain or worsening of a significant obesity complication after OAGB, more than 85% of experts reached a consensus that elongation of the biliopancreatic limb (BPL) is an acceptable option and the total bowel length measurement is mandatory during BPL elongation to preserve at least 300-400 cm of common channel limb length to avoid nutritional deficiencies. Also, more than 85% of experts reached a consensus on conversion to Roux-en-Y gastric bypass (RYGB) with or without pouch downsizing as an acceptable option for the treatment of persistent bile reflux after OAGB and recommend detecting and repairing any size of hiatal hernia during conversion to RYGB. CONCLUSION: While the experts reached a consensus on several aspects regarding revision/conversion surgeries after OAGB, there are still lingering areas of disagreement. This highlights the importance of conducting further studies in the future to address these unresolved issues.

Comparison of Outcomes Between Banded and Non-banded Sleeve Gastrectomy: a Systematic Review and Meta-analysis.

BACKGROUND: Sleeve gastrectomy (SG) is the most common bariatric procedure performed worldwide. It accounts for more than 50% of primary bariatric surgeries performed each year. Recent long-term data has shown an alarming trend of weight recidivism. Some authors have proposed the concurrent use of a non-adjustable gastric band to decrease long-term sleeve failure. OBJECTIVE: To compare the outcomes (weight loss) and safety (rate of complication and presence of upper GI symptoms) between SG and BSG. METHODS: A systematic search with no language or time restrictions was performed to identify relevant observational studies and randomized controlled trials (RCT) evaluating people with morbid obesity undergoing SG or SGB for weight loss. An inverse-of-the-variance meta-analysis was performed by random effects model. Heterogeneity was assessed using Cochrane X2 and I2 analysis. RESULTS: A total of 7 observational studies and 3 RCT were included in the final analysis. There were 911 participants pooled from observational studies and 194 from RCT. BSG showed a significant higher excess of weight loss (% EWL). The difference among groups was clinically relevant after the third year where the weighted mean difference (SMD) was 16.8 (CI 95% 12.45, 21.15, p < 0.0001), while at 5 years, a SMD of 25.59 (16.31, 34.87, p < 0.0001) was noticed. No differences related to overall complications were noticed. Upper GI symptoms were up to three times more frequent in the BSG group (OR 3.26. CI 95% 1.96, 5.42, p < 0.0001). CONCLUSIONS: According to the results, BSG is superior to SG in weight loss at 5 years but is associated with a higher incidence of upper GI symptoms. However, these conclusions are based mainly on data obtained from observational studies. Further RCT are needed to evaluate the effect and safety of BSG.

Placement of the GaBP ring system in the banded gastric bypass operation.

Currently, bariatric surgeons fashion the band or ring reinforcement prosthesis, to control the stoma in the vertical banded gastroplasty and gastric bypass operations for morbid obesity. To meet this need, the GaBP Ring system has been developed in various sizes, and consists of 4 main parts to provide a means for inserting a ring around the gastric pouch in the banded gastric bypass or the vertical banded gastroplasty. The pre-manufactured and sterilized device provides for better standardization and quality control than individually surgeon-fashioned devices. The GaBP Ring system is described, and the technique of placement and the pertinent initial clinical results are presented.

Choosing an operation for weight control, and the transected banded gastric bypass.

Obesity and particularly morbid obesity is a lifelong problem that currently cannot be cured but can be controlled. Attempted control of obesity non-surgically results in 98% recividism. Weight loss is readily attainable, but weight loss maintenance is recalcitrant. Surgery currently provides the only long-term control of obesity. Surgery at best is a tool that the patient can use to effect the weight loss and weight loss maintenance. We have celebrated the golden anniversary of bariatric surgery in 2004. Obesity surgery is thus a relatively young field which is evolving. Operations currently used for the treatment of obesity fall into 3 categories: 1) restrictive operations such as vertical banded gastroplasty, silastic ring gastroplasty and gastric banding; 2) malabsorptive operations which include all the variations of the intestinal bypass; and 3) combined operations which utilize both restriction and malabsorption which include all the variations of short-limb gastric bypass, long-limb or distal gastric bypass and biliopancreatic diversion. The choice of the operation will be guided by the extent of the patient's obesity, the age of the patient, other co-morbid conditions of the patient, the cost of the operation, the patient's choice, and the surgeon's choice based on training, experience and geographical location. First and foremost, the operation chosen should be effective in causing weight loss and providing long-term weight loss maintenance with acceptable morbidity and mortality. Recommendations are made for choosing an operation for weight control based on effectiveness and safety.

Fifty consecutive patients with the GaBP ring system used in the banded gastric bypass operation for obesity with follow up of at least 1 year.

BACKGROUND: The premanufactured GaBP ring system can be used in the banded gastric bypass operation instead of a surgeon-fashioned ring or band in current use. METHODS: The GaBP ring system was used in 50 consecutive patients, and the outcomes were reviewed after 1 year of follow-up. Data were kept prospectively. RESULTS: The GaBP ring system was used in 50 patients undergoing gastric bypass surgery, 9 with an open procedure and 41 with a laparoscopic approach. Placement took an average of < 5 minutes, and there were no GaBP ring system-related complications at the 1-year follow-up. The outcomes in terms of weight loss and resolution of comorbidities are similar to those previously reported for banded gastric bypass. CONCLUSION: The GaBP ring system provides a premanufactured standardized ring for use in the banded gastric bypass operation.