RESUMO
One-anastomosis gastric bypass (OAGB) complications include inadequate weight loss, recurrent weight gain (RWG), and gastroesophageal reflux disease (GERD). Conversion to distal Roux-en-Y gastric bypass (D-RYGB) may be an effective conversional approach. A 38-year-old female underwent OAGB with a body mass index (BMI) of 53 kg/m2 and 43% initial total weight loss but had RWG to BMI of 44 kg/m2 over 5 years with refractory GERD symptoms. She underwent D-RYGB conversion, creating a 330 cm biliopancreatic limb, 75 cm Roux limb, and 400 cm total alimentary limb length to decrease the chance of malnutrition. At 2 weeks, GERD symptoms were resolved completely. By 12 months, 42% total weight loss was achieved with normal nutritional parameters. For RWG and refractory GERD after OAGB, conversion to D-RYGB can promote weight loss and GERD symptom control while preventing nutritional deficiencies.
Assuntos
Derivação Gástrica , Refluxo Gastroesofágico , Aumento de Peso , Humanos , Feminino , Derivação Gástrica/efeitos adversos , Adulto , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/cirurgia , Obesidade Mórbida/cirurgia , Obesidade Mórbida/complicações , Recidiva , Reoperação , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgiaRESUMO
BACKGROUND: Childhood obesity is an important worldwide issue of serious medical and social concern. One anastomosis gastric bypass (OAGB) is an approved, effective, and long-lasting procedure for weight loss and the remission of obesity-associated medical problems in the adult patients, but its efficacy and safety in children and adolescents are still on debate. This study aimed to evaluate safety and efficacy of OAGB compare to SG and RYGB during a 5-year follow-up. METHODS: A retrospective cohort study on children and adolescents with severe obesity who underwent primary OAGB, sleeve gastrectomy (SG), and Roux-e-Y gastric bypass (RYGB) at an academic hospital, between March 2016 and December 2020. RESULTS: Two hundred twenty-eight patients with 24 to 60 months of follow-up including 107 SG, 37 RYGB, and 84 OAGB were included in the final analysis. The mean age, preoperative weight, and BMI were 15.71 ± 2.09 years (range, 9-18 years), 126.3 ± 22.0 kg (74.5-215 kg), and 45.1 ± 6.9 kg/ m2 (36.4-79.3 kg/m2), respectively. The mean of follow-up was 30.05 ± 19.98 months. The mean of ∆BMI was 30.2 ± 5.1, 30.0 ± 5.4, and 31.1 ± 6.8 at 12th, 36th, and 60th months postoperative. At the 60-month follow-up, there were statistically significant differences in ΔBMI between SG and OAGB and SG and RYGB. CONCLUSION: OAGB is a safe and effective procedure for the treatment of obesity in children and adolescents in 24 to 60 months follow-ups.
Assuntos
Derivação Gástrica , Obesidade Mórbida , Obesidade Infantil , Adulto , Humanos , Criança , Adolescente , Derivação Gástrica/métodos , Obesidade Mórbida/cirurgia , Estudos de Coortes , Estudos Retrospectivos , Obesidade Infantil/cirurgia , Obesidade Infantil/complicações , Gastrectomia/métodos , Resultado do TratamentoRESUMO
BACKGROUND: Weight regain (WR) and insufficient weight loss (IWL) after sleeve gastrectomy (SG) are challenging issues. This study aimed to evaluate the predictors of WR and IWL after SG. METHODS: In this retrospective analytical study, 568 patients who underwent SG at Hazrat-e Rasool General Hospital, Tehran, Iran, between January 2015 and April 2022 were evaluated. A total of 333 patients were included. WR and IWL were evaluated by multiple criteria such as a BMI of > 35 kg/m2, an increase in BMI of > 5 kg/m2 above nadir, an increase in weight of > 10 kg above nadir, percentage of excess weight loss (%EWL) < 50% at 18 months, an increase in weight of > 25% of EWL from nadir at 36 months, and percentage of total weight loss (%TWL) < 20% at 36 months. All participants were followed up for 36 months. RESULT: The univariate analysis showed that preoperative BMI, obstructive sleep apnea, metformin consumption, and grades 2 and 3 fatty liver disease were associated with WR and IWL (P < 0.05). WR or IWL incidence varied (0-19.3%) based on different definitions. The multivariate analysis showed that a preoperative BMI of > 45 kg/m2 [odds ratioAdjusted (ORAdj) 1.77, 95% CI: 1.12-4.11, P = 0.038] and metformin consumption [ORAdj: 0.48, 95% CI: 0.19-0.78, P = 0.001] were associated with WR and IWL after SG, regardless of the definition of WR or IWL. CONCLUSION: This study showed that preoperative BMI of > 45 kg/m2, obstructive sleep apnea, metformin consumption, and grades 2 and 3 of fatty liver disease were associated with WR or IWL.
Assuntos
Laparoscopia , Hepatopatias , Metformina , Obesidade Mórbida , Apneia Obstrutiva do Sono , Humanos , Estudos Retrospectivos , Obesidade Mórbida/cirurgia , Resultado do Tratamento , Irã (Geográfico)/epidemiologia , Gastrectomia , Redução de Peso , Aumento de Peso , Apneia Obstrutiva do Sono/cirurgia , Hepatopatias/cirurgiaRESUMO
B1 deficiency is a very prevalent complication of bariatric surgery. This study reviews prevalence and symptoms of B1 vitamin deficiency after bariatric surgery. PubMed, Scopus, and Web of Science published were searched up to 10 Feb 2022, with the following keywords: Roux-en-Y gastric bypass, one anastomosis gastric bypass, Omega bypass, Mini bypass, Bariatric surgery OR Bariatric surgery, metabolic surgery, Weight loss surgery, Classic gastric bypass, Loop gastric bypass, Gastric Bypass, thiamine OR thiamin, beriberi, B1. A total of 11 studies examining 1494 patients were included in this meta-analysis. Twenty-seven percent of patients who underwent bariatric surgeries experience vitamin B1 deficiency. Thiamine supplements should be prescribed for the patients for the rest of their lives, and also standard post-surgery follow-ups are necessary in terms of monitoring dietary factors.