ABSTRACT
Background: Increased popularity of one-anastomosis gastric bypass (OAGB) is associated with increased reports on the procedure-related complications. Protein-energy malnutrition (PEM) is a serious complication that may mandate reversal. The primary outcome of this study is the outcome of surgical management of PEM after OAGB. Methods: A retrospective cohort study of patients presented with PEM after OAGB between January 2014 and December 2018. Patients with a biliopancreatic limb (BPL) >200 cm were excluded. PEM was diagnosed based on the Global Leadership Initiative on Malnutrition criteria. Indications for reversal of OAGB due to PEM included failure of conservative measures, intolerable symptoms, and hepatic decompensation. Results: Eight patients presented with PEM and were reversed to normal anatomy or Roux-en-Y gastric bypass. The incidence of postoperative 30-day complications in this series was 37.5% (n: 3/7). Postoperative mortality due to hepatic cell failure occurred in 1 patient. Two patients deceased before reversal, one secondary to severe soft tissue infection, whereas the cause of death could not be confirmed for the second. Conclusion: Socioeconomic status and thorough preoperative counselling are important to predict patient commitment to postoperative supplementations and laboratory investigations. Bariatric teams should apply innovative methods as telemedicine to make patient compliance easier. The etiology of PEM cannot be purely explained by the BPL length. Revisional surgery is mandatory for resistant, recurrent, or complicated PEM.
Subject(s)
Gastric Bypass/methods , Obesity, Morbid/surgery , Postoperative Complications/epidemiology , Protein-Energy Malnutrition/epidemiology , Adult , Egypt/epidemiology , Female , Humans , Incidence , Male , Middle Aged , Postoperative Complications/etiology , Protein-Energy Malnutrition/etiology , Reoperation , Retrospective Studies , Weight LossABSTRACT
BACKGROUND: Laparoscopic Heller cardiomyotomy (LHM) with Dor fundoplication represents the most commonly accepted surgical management for achalasia. The ideal extent of myotomy on the gastric side remains a matter of continuous debate. The aim of this study was to compare the impact of the extent of myotomy on the gastric side on the outcome of LHM. PATIENTS AND METHODS: Patients with achalasia who underwent LHM included in the study. The patients were classified according to the length of the gastric myotomy into 3 groups (group I: <1.5 cm, group II: 1.5 to 2.5 cm, and group III: >2.5 cm). RESULTS: In total, 212 patients (94 males and 118 females) with achalasia treated by LHM and Dor fundoplication included in the study. No statistically significant differences were found among the 3 groups as regards preoperative data, intraoperative mucosal perforation, operative time, blood loss, and hospital stay. The incidence of persistent dysphagia was significantly higher in the group I. Postoperative GERD symptoms were significantly higher in group III (23.3%, P<0.0001). Recurrent achalasia was significantly higher in group I with 11 patients (15.9%), 8 patients in group II (7.1%), and nil in group III (P<0.02). CONCLUSIONS: Longer myotomy on the gastric side (>2.5 cm) ensures complete division of the LES with better outcomes in term of resolution of dysphagia but may be associated with higher postoperative GERD. Therefore, a myotomy length of 1.5 to 2.5 cm on the gastric side provides a balance between relieve of dysphagia and development of postoperative GERD.
