Relationship of Food Intolerance 2 Years After Roux-en-Y Gastric Bypass Surgery for Obesity with Masticatory Efficiency and Protein Consumption.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) is among the most performed bariatric surgery techniques. One known complication of RYGB surgery is food intolerance, which may limit the intake of protein. OBJECTIVE: To investigate the relationship of food intolerance after RYGB surgery with masticatory efficiency, chewing time and cycles, and consumption of protein and red meat. METHODS: A case-control study in subjects with and without food intolerance (regurgitation and/or vomiting more than once a week) aged over 18 years old who had undergone RYGB more than 2 years prior, with an absence of no more than 2 dental units and normal oral motor system evaluation. Masticatory efficiency was evaluated by the granulometry of red meat chewed by the study subject according to a predefined protocol using a sieving technique and classified from very poor to excellent. Protein and red meat consumption were evaluated by usual food recall and a 3-day dietary diary. RESULTS: The study population consisted of 24 cases (37.7 ± 7.57 years old, 79.2% females) and 68 controls (38.0 ± 8.75 years old, 61.8% females). There was a statistically significant association (p = 0.001 by the ranksum test) between food intolerance and masticatory efficiency, with 58.3% of cases and 23.5% of controls showing very poor masticatory efficiency. No evidence was found of an association of food intolerance with chewing time, chewing cycles, low protein or red meat consumption. CONCLUSION: Masticatory inefficiency is a contributing factor to food intolerance after RYGB, regardless of time and chewing cycles. No relationship was found between food intolerance and consumption of red meat and protein.

Food Tolerance and Eating Behavior After Roux-en-Y Gastric Bypass Surgery.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) surgery often leads to food intolerance, especially protein intake. AIM: This is to investigate the association of food intolerance with protein intake and chewing parameters in patients who underwent RYGB surgery 2 years prior. METHODS: An observational study was carried out in 30 patients aged between 18 and 60 years old with at least a 2-year postoperative period since undergoing RYGB surgery. A specific questionnaire was applied to obtain a food tolerance score; a masticatory efficiency, chewing cycles, and time were evaluated with a standard test based on the size of the fragmentation of almonds and of meat after a certain chewing time. Protein intake was evaluated by 24-h dietary recall. RESULTS: Mean age was 42.3 ± 11.2 years; mean body mass index was 33 ± 6 kg/m2; and mean time since surgery was 4.9 years. The food tolerance score was 23.4 ± 3.3 points. There was no evidence of an association between food tolerance and chewing efficiency for meat (p = 0.28) nor between food tolerance and protein intake (Spearman correlation coefficient 0.03, p = 0.86). Regarding chewing efficiency with almonds, tolerance was higher in patients with optimal efficiency than among those with good and acceptable efficiency (p = 0.01). CONCLUSIONS: In the evaluation of mastication using almonds, food tolerance increased with the number of chewing cycles and with greater chewing efficiency; the same association was not found in the evaluation using red meat.

A Prospective Single-Arm Trial of Modified Long Biliopancreatic and Short Alimentary Limbs Roux-En-Y Gastric Bypass in Type 2 Diabetes Patients with Mild Obesity.

BACKGROUND: Type-2 diabetes (T2D) patients with body mass index (BMI) below 35 kg/m2 carry lower remission rates than severely obese T2D individuals submitted to "standard limb lengths" Roux-en-Y gastric bypass (RYGB). Mild-obese patients appear to have more severe forms of T2D, where the mechanisms of glycemic control after a standard-RYGB may be insufficient. The elongation of the biliopancreatic limb may lead to greater stimulation of the distal intestine, alterations in bile acids and intestinal microbiota, among other mechanisms, leading to better metabolic outcomes. The aim of this study is to evaluate the safety and efficacy of the RYGB with a biliopancreatic limb of 200 cm in the control of T2D in patients with BMI 30-35 kg/m2. METHODS: From January 2011 to May 2015, 102 T2D patients with BMI from 30 to 34.9 kg/m2 underwent laparoscopic RYGB with the biliopancreatic-limb of 200 cm and the alimentary-limb of 50 cm. RESULTS: There were no deaths or reoperations. The mean follow-up was 28.1 months. The mean BMI dropped from 32.5 to 25.1 kg/m2, while the mean fasting glucose decreased from 182.9 to 89.8 mg/dl and the mean glycated hemoglobin (HbA1c) went from 8.7 to 5.2%. During follow-up, 92.2% had their T2D under complete control (HbA1c < 6%, no anti-diabetic medications), while 7.8% were under partial control. Control of hypertension and dyslipidemia were 89.4 and 85.5%, respectively. No patient developed hypoalbuminemia, and there were mild micronutrient deficiencies. CONCLUSIONS: RYGB with long-biliopancreatic and short-alimentary limbs is safe and seems effective in achieving complete control of T2D in patients with BMIs between 30 and 35 kg/m2.

Gastric sleeve fixation strategy in laparoscopic vertical sleeve gastrectomy.

INTRODUCTION: Initially conceived as the first of two stages in operations such as gastric bypass or duodenal switch in high-risk patients, laparoscopic vertical sleeve gastrectomy has increasingly become the definitive procedure for treating obesity and its comorbidities. Although it is associated with excellent results and postoperative quality of life, a number of complications related to improper position and/or gastric tube deformities, resulting from loss of natural fixation, may be associated to symptoms of persistent food intolerance and/or gastroesophageal reflux. AIM: To present the gastric fixation strategy in vertical sleeve gastrectomy for the treatment of obesity and related diseases. TECHNIQUE: The gastric suture line along the "new greater curvature" is divided into two parts. Using non-absorbable 2.0 polyester thread, a continuous suture fixation is made in the proximal part attaching it to the free edge of the gastrocolic ligament with invagination. Separate sutures were applied to the distal part, including the transverse mesocolon near the lower edge of the pancreas. CONCLUSION: The stomach fixation strategy is easy to use, safe and can reduce complications arising from improper positioning and gastric tube alterations in laparoscopic vertical sleeve gastrectomy, particularly symptoms related to food intolerance and gastroesophageal reflux.

Profile of the obese patients submitted to Roux-en-Y gastric bypass whithout diabetes melittus type 2 remission and/or insufficient weight loss.

BACKGROUND: The literature reports that gastrojejunal derivation with Roux-en-Y gastric bypass is highly efficient in controlling weight and resolving; but studies have shown worsened glycemic control in a considerable number of patients and associated factors that have not been fully elucidated. AIM: To analyze the profile of patients submitted to gastric bypass that did not achieve satisfactory weight loss or complete diabetes remission. METHODS: Case-control study of 32 patients submitted to gastric bypass with at least two years postoperative time, unsatisfactory results in terms of weight loss or absence of complete diabetes remission. The control group was composed of another 32 patients submitted to the same operation at the same facility, matched for age and postoperative time. A structured questionnaire was applied and clinical and laboratory data were analyzed. RESULTS: Among the cases and controls, BMI was 38.9 kg/m² and 29.5 kg/m2, excess weight loss was 56.1% and 77.2%, % excess weight regain of initial excess weight loss, was 20.2% and 7.7%, respectively. Family history of type 2 diabetes mellitus, hypertension and food intolerance showed a significant relationship between cases and controls. CONCLUSION: Food intolerance and family history of hypertension and diabetes were associated to lower loss and weight regain or less likelihood of complete diabetes remission after gastric bypass.