Efficacy and Safety of Sleeve Gastrectomy with Jejunoileal Bypass Compared with Roux-en-Y Gastric Bypass: Results from a Cohort Study.

Background: We previously described sleeve gastrectomy with jejunoileal bypass (SGJIB) as promising novel technique for the surgical treatment of obesity Methods: A retrospective analysis of a prospective database in a Private Practice of Alimentary Tract Surgery in São Paulo, Brazil. We analyzed 176 patients with 60 months of follow-up, 74 of whom underwent Vertical Sleeve Gastrectomy with Jejunoileal Bypass (VSG-JIB) (50 women and 24 men) with a mean age of 38 years and a mean body mass index (BMI) of 40 kg/m2, and 102 patients underwent Roux-en-Y gastric bypass (RYGB) (90 women and 12 men) with a mean age of 36.5 years and a mean BMI of 39.73 kg/m2. Results: There was no statistically significant difference in long-term weight loss between the two groups. The rate of postoperative complications immediately after surgery was similar, but there was a tendency toward less severe complications in the SGJIB cohort. Conclusion: Sleeve gastrectomy with jejunoileal bypass is a novel surgical procedure for weight loss with comparable efficacy and safety compared with laparoscopic RYGB.

Compression pre-stapler firing and post-ignition wait during sleeve gastrectomy: a prospective randomized trial

ABSTRACT BACKGROUND: Insufficient research exists on the stapling technique in and duration of laparoscopic sleeve gastrectomy (LSG). OBJECTIVES: This study aimed to assess the clinical outcomes using a 30-second precompression and post-firing waiting time without extra support for the stapling line. DESIGN AND SETTINGS: Randomized controlled prospective study at a university hospital. METHODS: This study included 120 patients treated between January 2022 and February 2023. The patients were divided into the non-waiting group (T0) and waiting group (T1), each with 60 patients. Perioperative complications were analyzed using statistical tests. RESULTS: The waiting group (T1) showed a significant reduction in the number of intraoperative bleeding points requiring intervention compared with the non-waiting group (T0) (81 versus 134, P < 0.05). In T0, postoperative C-reactive protein (CRP) levels increased (P < 0.05) and hemoglobin levels decreased significantly (P <0.05). The study recorded 22 postoperative complications, accounting for 18.3% of all cases during the 30-day postoperative period. CONCLUSIONS: The study concluded that the 30 sec + 30 sec stapling technique reduces perioperative bleeding, length of stay, and serious complication rates and is practical and effective for LSG. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov with registration code NCT05703035; link: https://clinicaltrials.gov/ct2/show/NCT05703035.

Intragastric balloon.

The intragastric balloon is a temporary and minimally invasive therapy for weight loss, currently being the main choice for mild obesity. As a space-occupying device, it reduces stomach capacity, resulting in decreased hunger and food intake. There are different balloon models, filled with liquid or air. The most used is the non-adjustable liquid-filled balloon, due to its lower rate of complications. The mechanism of action is multifactorial, involving physiological and neurohormonal changes. The device functions as an artificial bezoar, filling the stomach and leading to early satiety. In the Brazilian Intragastric Balloon Consensus Statement, there was a mean excess weight loss of 18.4%, showing effective weight loss and good safety profile. It is a valid option for overweight and obese patients unresponsive to clinical therapy or who are either not candidates for surgery or who do not wish to undergo a definitive procedure. Besides weight loss, recent studies have shown a positive effect on metabolic parameters. New devices have been developed, such as procedureless and adjustable balloons, with promising results.

Sedation in a patient with super obesity: Case report.

Obesity is associated with increased morbidity and mortality. Sedation of the procedure for these patients can pose significant challenges. Conscious sedation is the cause of many potentially serious unplanned events during endoscopy. A case report of sedation with propanidid in a patient with super obesity for endoscopic procedure is presented. Propanidid has demonstrated its safety and efficacy in short procedures in obese people.

La obesidad se asocia con mayor morbimortalidad. La sedación en procedimientos para estos pacientes puede implicar desafíos importantes. La sedación consciente es la causa de muchos eventos no planificados potencialmente graves durante la endoscopia. Se presenta el reporte de un caso de sedación con propanidido en un paciente con superobesidad para un procedimiento endoscópico. El propanidido ha demostrado su seguridad y eficacia en procedimientos cortos en personas obesas.

Intususcepción como complicación de bypass en Y de Roux en pacientes embarazadas, una complicación infrecuente. Reporte de caso y revisión de la literatura.

La obesidad es actualmente un problema de salud pública de ámbito internacional. Es considerada como la segunda causa de muerte prevenible en México, después del tabaquismo, según la Organización Mundial de la Salud. Actualmente, las opciones quirúrgicas son la gastrectomía en manga, el bypass gástrico o derivación gástrica, la banda gástrica y el bypass gástrico en omega, cada una con sus indicaciones. Se presenta el caso clínico de una paciente con intususcepción yeyuno-yeyunal secundaria a bypass gástrico en el embarazo.Obesity is currently an international public health problem. It is considered the second preventable cause of death in Mexico, after smoking, according to the World Health Organization. Currently, surgical options are sleeve gastrectomy, gastric bypass or gastric derivation, gastric banding, and omega gastric bypass, each with specific indications. The objective of the article is to present the clinical case of a patient with jejuno-jejunal intussusception secondary to gastric bypass in pregnancy.

Laparoscopic Roux-en-Y Gastric Bypass After Gastroesophageal Reflux Disease Surgical Procedure: Analysis of 85 Consecutive Patients with Pre- and Post-Operative Endoscopy Control.

Background: Most of the obese patients undergoing an anti-reflux operation experience recurrence of gastroesophageal reflux disease (GERD). Laparoscopic Roux-en-Y gastric bypass (LRNYGB) has been accepted as the bariatric surgery of choice for a previous GERD-operated obese patients. Methods: We present 85 consecutive patients from a single institution, previously submitted to antireflux surgery and then to LRNYGB. Preoperative endoscopy was carried out in all patients; 49 (57.64%) patients had findings of fundoplication failure or signs of persistent GERD, of those 20 (40.81%) with esophagitis. Results: From the bypass, per or postoperative minor to moderate complications occurred in 12 patients (14.11%): 2 (2.35%) conversions to laparotomy, 1 (1.17%) melena, 8 (9.41%) stenosis of gastrojejunostomy, treated by a simple endoscopic dilatation with a balloon, and 1 (1.17%) gastrogastric fistula. A follow-up endoscopy of 79 of 85 (92.9%) patients was carried out after 6 months of LRNYGB. Eight of 79 (10.12%) patients had persistent esophagitis that represented 40% (8 of 20 patients) of persistent reflux esophagitis even after LRNYGB. All of them were men. Conclusion: LRNYGB after laparoscopic fundoplication is a feasible procedure with an excepted higher rate of complications because of the complexity of the procedure. Nevertheless esophagitis still persisted in many of those patients.

Low-Cost Incisionless Liver Retraction for Laparoscopic Sleeve Gastrectomy: A Prospective Controlled Trial.

Background: Laparoscopic bariatric surgery has been performed safely since 1991. In a persistent search for fewer and smaller scars, single port, needlescopic surgery, and other approaches have been implemented. Our goal was to analyze the safety and feasibility of using incisionless autostatic liver retraction for sleeve gastrectomy. Materials and Methods: Candidates for sleeve gastrectomy were selected, excluding those <18 and having had prior upper left quadrant surgery. Patients were randomized 1:1 to either a standard five-port technique with a fan-type liver retractor (Group A); or a four-port technique with the liver retracted using a polypropylene 1 suture passed through the right crura and retrieved at the epigastrium employing a fascial closure needle (Group B). All surgeries were performed by the same surgeon. The primary endpoint was surgery duration. Secondary outcomes were quality of surgical-field visualization, complications inherent to liver retraction, and postoperative morbidity. Results: One hundred patients were recruited (n = 50/group). The groups (both 90% females) were demographically and anthropomorphically comparable. Surgery duration was 30.4 ± 4.6 and 29.6 ± 4.7 minutes for Groups A and B, respectively (P = .41). Visualization was considered very good in 80% versus 82%, good in 16% versus 12%, and poor in 4% versus 6% (P = NS). Two patients from each group (4%) had self-limited minor bleeding from the liver attributed to the retraction technique. No 30-day morbidity was observed. Conclusions: Liver retraction using a polypropylene suture was both effective and inexpensive. Visualization and the duration of surgery were comparable to a standard liver retractor. This low-cost alternative may diminish the need for expensive instruments and reduce the number of scars without jeopardizing the safety and quality of sleeve gastrectomy.

Endoscopic Treatment of Weight Regain Following Roux-en-Y Gastric Bypass: a Systematic Review and Meta-analysis.

Roux-en-Y gastric bypass (RYGB) is the most commonly performed bariatric procedure. Despite its high efficacy, some patients regain part of their lost weight. Several endoscopic therapies have been introduced as alternatives to treat weight regain, but most of the articles are relatively small with unclear long-term data. To systematically assess the efficacy of endoscopic therapies for weight regain after RYGB. We searched MEDLINE, EMBASE, Scopus, Web of Science, Cochrane, OVID, CINAHL/EBSCo, LILACS/Bireme, and gray literature. Primary outcomes were absolute weight loss (AWL), excess weight loss (EWL), and total body weight loss (TBWL). Thirty-two studies were included in qualitative analysis. Twenty-six described full-thickness (FT) endoscopic suturing and pooled AWL, EWL, and TBWL at 3 months were 8.5 ± 2.9 kg, 21.6 ± 9.3%, and 7.3 ± 2.6%, respectively. At 6 months, they were 8.6 ± 3.5 kg, 23.7 ± 12.3%, and 8.0 ± 3.9%, respectively. At 12 months, they were 7.63 ± 4.3 kg, 16.9 ± 11.1%, and 6.6 ± 5.0%, respectively. Subgroup analysis showed that all outcomes were significantly higher in the group with FT suturing combined with argon plasma coagulation (APC) (p < 0.0001). Meta-analysis included 15 FT studies and showed greater results. Three studies described superficial-thickness suturing with pooled AWL of 3.0 ± 3.8, 4.4 ± 0.07, and 3.7 ± 7.4 kg at 3, 6, and 12 months, respectively. Two articles described APC alone with mean AWL of 15.4 ± 2.0 and 15.4 ± 9.1 kg at 3 and 6 months, respectively. Full-thickness suturing is effective at treating weight regain after RYGB. Performing APC prior to suturing seems to result in greater weight loss. Head-to-head studies are needed to confirm our results. Few studies adequately assess effectiveness of other endoscopic techniques.

Experiencia de gastrectomía vertical en manga en el Hospital Carlos Andrade Marín / Vertical sleeve gastrectomy experience in the Carlos Andrade Marin Hospital

Introducción: la obesidad se ha convertido en un problema a nivel mundial. Ecuador no podía ser la excepción y según el INEC, 4 millones de personas en el país padecen de sobrepeso. La cirugía bariátrica ha sido reconocida como un método seguro y eficaz en el tratamiento de la obesidad y sus comorbilidades. Materiales y métodos: con el objetivo de analizar los resultados y complicaciones de la manga gástrica (LSG, por sus siglas en inglés) en el Hospital Carlos Andrade Marín, se realiza un estudio descriptivo retrospectivo, de los pacientes operados entre 2008 y 2013 en el Servicio de Cirugía General del Hospital Carlos Andrade Marín, se realiza un estudio descriptivo retrospectivo, de los pacientes operados entre 2008 y 2013 en el Servicio de Cirugía General del Hospital Carlos Andrade Marín (HCAM). Del total, 309 sujetos, se evaluaron características demográfcas y complicaciones perioperatorias. De un grupo más pequeño, 162 pacientes que tuvieron un seguimiento posoperatorio de al menos un año, se analizó la reducción de peso y resolución de comorbilidades asociadas a la obesidad. Resultados: el 87% de los pacientes tienen un índice de masa corporal (IMC) entre 30 y 40. El promedio de reducción de peso al año de la cirugía fue de 9.5 puntos de IMC. La morbilidad general relacionada al procedimiento fue de 7.2%, con una tasa de fístulas de 4.5%. Se reoperaron 14 pacientes, ya sea por fístula o por sangrado. En cuanto a la morbilidad que se relaciona a la obesidad, más del 60% de pacientes presentaron mejoría. Conclusión: el resultado de este estudio demuestra que la manga gástrica es un excelente procedimiento aplicado al tipo de obesidad que maneja este servicio, la gran mayoría tipo I y II. Se ha logrado llevar a estos pacientes a valores casi normales de IMC al año del procedimiento, con una aceptable morbilidad y con un adecuado manejo de las complicaciones.

Introduction: obesity has become a worldwide problem. Ecuador is not the exception an according to the INEC, 4 million people in the country have overweight. The bariatric surgery has been recognized as a safe and effective treatment for obesity and its comorbidities. Materials and methods: in order to analyze the results and complications of the laparoscopic sleeve gastrectomy (LSG) at the Carlos Andrade Marín Hospital, a descriptive study of patients operated between 2008 and 2013 in the Department of Surgery at the Carlos Andrade Marin Hospital was performed. Of the 309 subjects, demographics and perioperative complications were evaluated. In a smaller group, 162 patients who had a postoperative follow-up of at least one year, weight loss and resolution of comorbidities associated with obesity was analyzed. Results: eighty seven percent (87%) of patients have a body mass index (BMI) between 30 and 40. The average weight loss at one year after surgery was 9.5 BMI points. The overall procedure -related morbidity was 7.2 %, with a 4.5% rate of gastric sleeve fstula. Fourteen patients were operated again due to gastric sleeve bleeding. There were no deaths related to surgery. Regarding morbidity associated with obesity, more than 60% of patients showed improvement. Conclusion: the result of this study shows that gastric sleeve is an excellent procedure applied to the type of obesity of this service, most type I and II. It has managed to bring these patients to near normal values of BMI within a year of the procedure, with acceptable morbidity and proper management of complications.

Manga gástrica laparoscópica. Revisión detallada / Laparoscopic sleeve gastrectomy

Resumen La cirugía bariátrica es una rama de la medicina que se dedica al tratamiento de la obesidad y sus posibles comorbilidades a través de procedimientos quirúrgicos. Presentamos la historia y varios aspectos de la manga gástrica laparoscópica a través de 20 años. La reducción de peso se logra aquí por varios mecanismos: uno es la reducción del volumen estomacal y otro es la menor secreción de la hormona ghrelina; lo que promueve una saciedad más rápida y una reducción del apetito. Karamankos S.N. encontraron un mayor porcentaje en la apérdida del exceso de peso con manga gástrica que con bypass gástrico en un seguimiento a 1 año (69,7 ± 14,6% contra 60,5 ± 10,7%). En un metaanálisis publicado en 2011, Padwal R. y cols. concluyeron que existe una mayor disminución de índice de masa corporal en pacientes sometidos a manga gástrica que en bypass gástrico de −10,1 kg/m2 y -9 kg/m2 respectivamente.

Abstract Bariatric surgery is a medical specialty dedicated to the treatment of obesity and its comorbidities through surgical procedures. We present a detailed collection on the history and evolution of laparoscopic sleeve gastrectomy over the course of 20 years. The gastric sleeve induces weight loss by several mechanisms. It significantly reduces gastric chamber size and decreases the secretion of the hormone called ghrelin, thus promoting quicker satiety and decreasing appetite. Karamankos S.N. found a greater percentage of excess-weight loss with gastric sleeve than with bypass in a 1-year follow-up (69,7% ± 14,6% versus 60,5% ± 10,7%). A 2011 meta-analysis by Padwal R. et al. concluded that there is a greater decrease in body mass index in patients undergoing sleeve gastrectomy than with gastric bypass, -10,1 kg/m2 and -9 kg/m2, respectively.

Cirugía bariátrica endoscópica para el tratamiento de la obesidad mórbida: presentación de 3 casos / Endoscopic bariatrics surgery for treatment of morbid obesity: presentation of three cases

La obesidad es un importante problema de salud por el riesgo aumentado de morbilidad y de mortalidad cardiovascular y global. Cuando han fracasado los tratamientos convencionales, la cirugía bariátrica es un tratamiento eficaz, pues consigue normalizar las comorbilidades en un elevado número de pacientes. Se presentan los casos de 3 pacientes con obesidad mórbida (IMC ≥ 40 kg/m²), operadas por vía endoscópica (derivación gástrica), para identificar las enfermedades asociadas antes y después del tratamiento, valorar los análisis de laboratorio antes y después de la cirugía, evaluar la pérdida de peso después de la operación e identificar las complicaciones perioperatorias(AU)

The obesity is an important health problem due to the increased risk of global and cardiovascular morbidity and mortality. When conventional treatments fail, the bariatrics surgery is an effective treatment since normalizes the comorbidities in a significant number of patients. This is the presentation of three female cases presenting with morbid obesity (CMI) ≥ 40 kg/m²), operated on via endoscopy (gastric bypass) to identify the associated diseases before and after treatment, to assess the laboratory analyses before and after surgery, to assess the weight loss after surgery and to identify the perioperative complications(AU)

Cirugía bariátrica endoscópica para el tratamiento de la obesidad mórbida: presentación de 3 casos / Endoscopic bariatrics surgery for treatment of morbid obesity: presentation of three cases

La obesidad es un importante problema de salud por el riesgo aumentado de morbilidad y de mortalidad cardiovascular y global. Cuando han fracasado los tratamientos convencionales, la cirugía bariátrica es un tratamiento eficaz, pues consigue normalizar las comorbilidades en un elevado número de pacientes. Se presentan los casos de 3 pacientes con obesidad mórbida (IMC ≥ 40 kg/m2), operadas por vía endoscópica (derivación gástrica), para identificar las enfermedades asociadas antes y después del tratamiento, valorar los análisis de laboratorio antes y después de la cirugía, evaluar la pérdida de peso después de la operación e identificar las complicaciones perioperatorias(AU)

The obesity is an important health problem due to the increased risk of global and cardiovascular morbidity and mortality. When conventional treatments fail, the bariatrics surgery is an effective treatment since normalizes the comorbidities in a significant number of patients. This is the presentation of three female cases presenting with morbid obesity (CMI ≥ 40 kg/m²), operated on via endoscopy (gastric bypass) to identify the associated diseases before and after treatment, to assess the laboratory analyses before and after surgery, to assess the weight loss after surgery and to identify the perioperative complications(AU)

Conservative management of esophageal perforation following obesity surgery

CONTEXT: Laparoscopic adjustable silicone gastric banding (LASGB) is one of the several surgical techniques for treating patients with morbid obesity. Erosion and perforation in the gastric chamber caused by LASGB are rare complications that have already been described. There have not yet been any reports of perforation of the middle esophagus during this procedure. CASE REPORT: The authors describe the case of a patient who presented the complication of very extensive perforation of the middle third of the esophagus following LASGB. This was successfully managed using conservative treatment.

CONTEXTO: Banda gástrica laparoscópica ajustável de silicone (LASGB) é uma das várias técnicas cirúrgicas para o tratamento de pacientes com obesidade mórbida. A erosão e a perfuração para o interior da câmara gástrica causados pela LASGB são complicações raras já descritas. Não se encontram relatos de perfuração do esôfago médio durante esse procedimento. RELATO DE CASO: Descrevemos o caso de uma paciente que apresentou como complicação, uma perfuração extensa do esôfago médio após LASGB, submetida a tratamento conservador com sucesso absoluto.