Functional Laparoscopic Roux-en-Y Gastric Bypass with Fundectomy and Gastric Remnant Exploration (LRYGBfse)-a Video Vignette.

BACKGROUND: The laparoscopic Roux en-Y gastric bypass (LRYGB) is performed worldwide and is considered by many the gold standard treatment for morbid obesity. However, the difficult access to the gastric remnant and duodenum represents intrinsic limitations. The functional laparoscopic gastric bypass with fundectomy and gastric remnant exploration (LRYGBfse) is a new technique described in attempt to overcome the limitations of the LRYGB. The purpose of this video was to demonstrate the LRYGBfse in a 48-year-old man with type II diabetes and hypertension. METHODS: An intraoperative video has been anonymized and edited to demonstrate the feasibility of LRYGBfse. RESULTS: The operation started with the opening of the gastrocolic ligament. Staying close to the gastric wall, the stomach is prepared up to the angle of His. After the placement of a 36-Fr orogastric probe, gastric fundectomy is completed in order to create a 30cc gastric pouch. A polytetrafluoroethylene banding (ePTFE) is placed at the gastro-gastric communication, 7cm below the cardia, and gently closed after bougie retraction. The bypass is completed by the creation of an antecolic Roux-en-Y 150cm alimentary and 150cm biliopancreatic limb. CONCLUSION: The LRYGBfse is a feasible and safe technique. The possibility to endoscopically explore the excluded stomach with an easy access to the Vater's papilla is a major advantage. Further studies are warranted to deeply explore and compare outcomes with the standard LRYGB.

Resleeve for failed laparoscopic sleeve gastrectomy: systematic review and meta-analysis.

Despite excellent long-term results, insufficient weight loss, weight regain, and pathologic gastroesophageal reflux disease may require revisional procedures after laparoscopic sleeve gastrectomy (LSG). Resleeve gastrectomy (ReSG) for failed LSG, has been proposed as an alternative to more complex malabsorptive procedures. The aim of this systematic review and meta-analysis was to examine the current evidence on the therapeutic role and outcomes of ReSG for failed LSG. PubMed, EMBASE, and Web of Science data sets were consulted. A systematic review and Frequentist meta-analysis were performed. Ten studies published between 2010 and 2019 met the inclusion criteria for a total of 300 patients. The age of the patient population ranged from 20 to 66 years old and 80.5% were females. The elapsed time between the LSG and ReSG ranged from 9 to 132 months. The estimated pooled prevalence of postoperative leak and overall complications were 2.0% (95% confidence interval [CI] = .5%-4.7%) and 7.6% (95%CI = 3.1%-13.4%). The estimated pooled mean operative time and hospital length of stay were 51 minutes (95%CI = 49.4-52.6) and 3.3 days (95%CI = 3.13-3.51). The postoperative follow-up ranged from 12 to 36 months and the estimated pooled mean percentage excess weight loss was 61.46% (95%CI = 55.9-66.9). The overall mortality ranged from 0% to 2.2%. ReSG after failed LSG seems feasible and safe with acceptable postoperative leak rate, overall complications, and mortality. The effectiveness of ReSG in term of weight loss seems promising in the short-term but further studies are warranted to explore its effect on patients' quality of life, postoperative gastroesophageal reflux disease, and long-term weight loss.

Impact of Functional Laparoscopic Gastric Bypass with Fundectomy and Gastric Remnant Exploration (LRYGBfse) on Patients' Quality of Life: Trajectory and 5-Year Follow-up Result.

PURPOSE: Morbid obesity is associated with reduced patients' perception quality of life (QoL). The health benefit of Laparoscopic Roux-en-Y gastric bypass (LRYGB) is well established with long-term weight control and QoL improvement. The laparoscopic functional gastric bypass with fundectomy and gastric remnant exploration (LRYGBfse) has been described with promising results in terms of weight loss and comorbid resolution. The purpose of this study was to investigate its contribution on patients' QoL at 5-year follow-up. MATERIAL AND METHODS: Multicenter prospective study (2009-2018). QoL was assessed at baseline and annually with the Gastrointestinal Quality of Life Index (GIQLI), Moorehead-Ardelt Quality of Life Questionnaire II (M-A-QoLQII), and Short-Form 36 (SF-36). RESULTS: Overall, 752 patients underwent the LRYGBfse. Three-hundred forty-four patients completed the 5-year follow-up. Median postoperative %TBWL at 1, 2, 3, and 5 years were 33.6, 33.9, 33.7, and 31.4%, respectively. Median GIQLI total score before and at 1, 2, 3, and 5 years after LRYGBfse was 82.6, 96.1, 113.1, 112.5, and 108.4. Median M-A-QoLQII total score before and at 1, 2, 3, and 5 years after surgery was 0.6, 1.6, 2.1, 2.0, and 1.6. Compared with baseline, the 5-year follow-up improvement was statistically significant for the GIQLI and M-A-QoLQII (p < 0.001). Similarly, all eight SF-36 items and both the Physical and Mental component scores were significantly improved (p < 0.001). CONCLUSIONS: The functional LRYGBfse seems associated with a long-standing weight loss and QoL improvement. This seems driven by better gastrointestinal symptoms and physical and social functions combined with improved emotional aspects.

Laparoscopic Gastric Bypass with Fundectomy and Gastric Remnant Exploration (LRYGBfse): Results at 5-Year Follow-up.

BACKGROUND: The laparoscopic Roux-en-Y gastric bypass (LRYGB) is the gold standard treatment for morbid obesity. After LRYGB, the endoscopic access to the gastric remnant and pancreaticobiliary system is challenging. The laparoscopic gastric bypass with fundectomy and exploration of the gastric remnant (LRYGBfse) was introduced in an attempt to overcome this limitation. The purpose of this study was to analyze the medium-term outcomes and safety of LRYGBfse. METHODS: Observational prospective single-arm multicenter cohort study. Patients with BMI > 35 kg/m2 were included. Previous open abdominal surgery was an exclusion criterion. Postoperative 1, 2, 3, and 5-year weight loss, BMI decrease, and percentage of excess weight loss (%EWL) were recorded. Wilcoxon signed rank sum test was used for paired data. RESULTS: Among 653 enrolled patients, 229 completed the 5-year follow-up. Preoperative median body weight (kg) and BMI (kg/m2) were 133.4 kg (interquartile range (IQR) = 12.0) and 48.2 kg/m2 (IQR = 10.1), respectively. Median 5-year body weight, BMI, and %EWL were 83.7 (IQR = 17.3), 31.2 (IQR = 7.7), and 74.8 (IQR = 23.4), respectively, all significantly improved compared to baseline (p = 0.002, p = 0.001, and p = 0.012, respectively). Comorbid improvement or resolution was observed in 88% of the patients. No major intraoperative complications were reported. Postoperative overall morbidity and mortality rates were 1 and 0%, respectively. Banding removal was necessary in one patient 62 months after the index operation. CONCLUSIONS: The LRYGBfse seems safe and effective with durable results at 5-year follow-up. Endoscopic exploration of the gastric remnant is an additional valuable tool.

Vertical Gastric Bypass with Fundectomy: Feasibility and 2-Year Follow-Up in a Series of Morbidly Obese Patients.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) is the gold standard procedure for morbid obesity and its results are well known and largely discussed. The major limitation of the procedure is the difficult exploration of the excluded gastric pouch and duodenum. The vertical gastric bypass with fundectomy was recently introduced in attempt to overcome these limitations. To date, its effectiveness is debated and outcomes still unclear. The purposes of this study were to describe the vertical gastric bypass with fundectomy and to analyse its outcomes in term of weight loss, complications, and comorbid resolutions. MATERIAL AND METHODS: Since January 2012 to July 2014, 30 consecutive patients were enrolled and prospectively followed for a 24-month period. All patients underwent the vertical gastric bypass with fundectomy. Follow-up visits were scheduled at 7 days, 1, 6, 12, and 24 months, or whenever necessary. RESULTS: Overall, 24 women and six men were enrolled in the study. Mean preoperative BMI was 38.2 ± 8.5 kg/m2. No intraoperative complications were reported. Postoperative overall complication rate was 10%. Compliance to the 24-month follow-up was 100%. Mean BMI and excess weight loss (EWL%) were significantly lower compared to baseline (p < 0.05). Comorbid improvement or resolution was recorded in the 80% of the patients. CONCLUSIONS: Vertical gastric bypass with fundectomy is feasible and effective with similar results in terms of weight loss, complications, and comorbid improving compared to the classic RYGB. Complete evaluation of the gastric anatomy and easy access to the main duodenal papilla are unquestionable advantages.