Remnant Gastrectomy and Gastric Bypass: A Systematic Review of Indications and Outcomes of Resectional Gastric Bypass.

BACKGROUND: In this systematic review, we aim to evaluate the reasons and outcomes behind remnant gastrectomy with or after gastric bypass procedures. RESULTS: A total of 66 studies examining 1918 patients were included in this study with 70% of female predominance. Twenty studies reported RGB on 1751 patients and 46 studies reported remnant gastrectomy after gastric bypass in 167 patients. The most common etiology of RGB was related to the in situ remnant stomach neoplasia in 10 studies on 981 patients; mostly for preventive intentions in high prevalence areas. Remnant gastrectomy after gastric bypass was performed to treat a complication such as GGF, retrograde bile reflux gastritis, cancer mostly adenocarcinoma. Studies revealed that RGB has similar weight loss in comparison to standard Roux-en-Y gastric bypass.

A Case of Accidentally Found Gastrointestinal Stromal Tumor in a 57-Year-Old Candidate of Gastric Bypass Surgery.

INTRODUCTION: GIST tumors are the most common mesenchymal tumors in the alimentary tract but are rather rare compared to other GI tract tumors and are usually found incidentally. Studies about cases of GIST tumor in bariatric surgery are scarce and there is no specific guideline for treatment. Most of previous cases were managed by sleeve gastrectomy due to their location which were usually in the body and greater curvature. METHODS: This patient had a GIST on lesser curvature and therefore underwent laparoscopic Roux-en-Y bypass. The follow-up was done with imaging studies and CT scan since the location of the tumor was no longer accessible to endoscopy after the gastric bypass. RESULTS: The post-operative course was uneventful and after 2 years the patient is still in good health and had no other complications. The patient has been followed up by imaging studies. DISCUSSION: There are pros and cons to this compared with sleeve gastrectomy. The most important advantage for this approach is that we have the stomach preserved; thus, our operation has the reversibility potential in case of any complication which requires revision operations. However, on the flip side, the limitation of such intervention is that we are not able to use the EGD to monitor and follow up our patient. Based on the relevant literature, for following up and monitoring the postoperative condition of these patients with relatively small GISTs, imaging studies specially abdominal computed tomography scan (CT scan) would be highly beneficial. It is also worth of mentioning that performing a EGD before a bariatric surgery, which is well noted in IFSO position statements and is well explained and discussed in other literature, had a major role in diagnosing this patient's GIST tumor and is proved to be beneficial and essential, once again.