Protein Intake, Adherence to Vitamin-Mineral Supplementation, and Dumping Syndrome in Patients Undergoing One Anastomosis Gastric Bypass.

INTRODUCTION: One anastomosis gastric bypass (OAGB) is an effective bariatric procedure. However, nutritional deficiencies or dumping syndrome (DS) may occur. The aim of this study was to assess adherence to nutritional recommendations and development of DS in a 3-year OAGB patient follow-up. METHODS: For 150 OAGB patients, in our center, data were collected through the electronic platform and by an individual telephone interview. The inclusion criterion is OAGB as a primary bariatric procedure, no revisional surgery, or no pregnancy. The adequacy of daily protein intake cutoff was defined as 60 g. Adherence to micronutrient supplementation protocol was considered if a minimum of 5 takes/week were reported. To evaluate the occurrence of DS, the Sigstad score questionnaire was used. For statistical analysis, a significance level less than 5% (p < 0.05) was considered. RESULTS: A total of 150 patients (80% females), BMI 44.3 ± 21.3 kg/m2, were subjected to the OAGB procedure. Of those, 128 fulfilled the study inclusion criteria. After 3 years, the mean %EBMIL was 78.4 ± 14.4. During the 3-year follow-up, the average protein intake was 60 g/day, and 48% reported an adequate daily protein intake. Adherence to the micronutrient supplementation protocol was reported by 70%. According to the Sigstad score questionnaire, DS was present in 24% of patients. CONCLUSION: A significant part of OAGB patients does not comply with the nutrition prescription assessed, emphasizing the need to improve team/patient communication strategies. Long-term studies are needed to characterize and assess the health impact of protein, vitamin, and mineral malnutrition in patients undergoing OAGB.

Basics of Compounding: Providing Pharmacy Services to Bariatric Surgery Patients.

With the rise in obesity, more individuals are choosing bariatric surgery as a means to successfully lose weight and resolve co-morbidities. These patients need lifelong support from friends, family, and healthcare providers. Pharmacists need to be knowledgeable of the unique needs of these patients in order to provide information and recommendations on drug therapies and supplements. When a patient is wheeled out of the operating room following bariatric surgery, his or her life instantly changes. Like an infant, the patient has to slowly learn how to eat and drink again. Physical activity significantly increases. Taste perception changes. Serious medical problems, such as hypertension, type II diabetes, and hypercholesterolemia completely resolve within a couple of months. The patient has to be disciplined and follow the instructions of the bariatric team and other healthcare providers. Since the patient's gastrointestinal tract has been significantly altered, drug therapies may require some modifications too. Bariatric or weight loss surgery is definitely not the easy way to lose weight, but it is a very powerful tool for the patient. Weight loss, and maintaining that weight loss, is a lifelong journey for the patient that requires support from the bariatric team, healthcare provider(s), co-workers, friends, and family. Pharmacists may also provide support for these patients through counseling about their supplements, medications, and compounding medications to meet their specific needs.

[Many complications after Roux-en-Y gastric bypass surgery can be prevented and treated].

A wide range of complications may occur after Roux-en-Y gastric bypass (RYGB) surgery, including surgical, medical/nutritional, and psychiatric complications. Some of the nutritional complications such as anaemia, dumping and hypoglycaemia may present rather unspecific symptoms that may easily not be diagnosed as complications after RYGB. Focus on diagnosis and treatment of these complications is important.

Durable Flap-Valve Mitigation of Duodenogastric Reflux, Remnant Gastritis and Dumping Syndrome Following Billroth I Reconstruction.

BACKGROUND: We have reported the short-term results of pylorus reconstruction gastrectomy (PRG) that prevents duodenogastric reflux (DGR) and remnant gastritis after distal gastrectomy. We herein report the long-term results of the PRG. PATIENTS AND METHODS: PRG was performed in 37 patients (age 31 to 86 [mean 67.8 ± 12.3] years, male:female = 22:15) with gastric cancer from June 2006 through December 2013. We examined the long-term outcome in 28 patients (age 41 to 86 [mean 67.0 ± 10.7] years, male:female = 18:10) that passed over 3 years after surgery (LTR 44.1 ± 11.7 months), and compared with their short-term result after the operation (STR 13.1 ± 6.9 months). The adverse events of gastric surgery evaluated in this study consisted of the degree of remnant gastritis, the presence of dumping syndrome, and degree of weight loss (%). RESULTS: There was no difference in the degree of DGR and remnant gastritis by gastroscopic finding between LTR and STR after PRG (P = 0.21). Statistically, there was no difference in the bile acid concentration of remnant gastric juice between LTR and STR (108.4 ± 254.1 vs. 94.0 ± 208.6 µmol/L, P = 0.33), and weight loss of LTR was the same as that of STR (5.67 ± 7.08 vs. 4.59 ± 5.63%, P = 0.34). There were few morphological changes in the reconstructed pylorus by the long-term course, but 2 patients showed mild atrophy. CONCLUSION: The form of reconstructed pylorus and the effect that reduces side effects of Billroth I seem to last for a long time.

ASSESSMENT OF THE GASTRO-JEJUNO-DUODENAL TRANSIT AFTER JEJUNAL POUCH INTERPOSITION / AVALIAÇÃO DO TRÂNSITO GASTROJEJUNODUODENAL APÓS INTERPOSIÇÃO DE ALÇA JEJUNAL

Background : The jejunal pouch interposition between the gastric body and the duodenum after the gastrectomy, although not frequent in the surgical practice today, has been successfully employed for the prevention and treatment of the postgastrectomy syndromes. In the latter, it is included the dumping syndrome, which affects 13-58% of the patients who undergo gastrectomy. Aim : Retrospective assessment of the results of this procedure for the prevention of the dumping syndrome. Methods : Fourty patients were selected and treatetd surgically for peptic ulcer, between 1965 and 1970. Of these, 29 underwent vagotomy, antrectomy, gastrojejunalduodenostomy at the lesser curvature level, and the 11 remaining were submitted to vagotomy, antrectomy, gastrojejunal-duodenostomy at the greater curvature level. The gastro-jejuno-duodenal transit was assessed in the immediate or late postoperative with the contrasted study of the esophagus, stomach and duodenum. The clinical evolution was assessed according to the Visick grade. Results : Of the 40 patients, 28 were followed with the contrast evaluation in the late postoperative. Among those who were followed until the first month (n=22), 20 (90%) had slow gastro-jejuno-duodenal transit and in two (10%) the transit was normal. Among those who were followed after the first month (n=16), three (19%) and 13 (81%) had slow and normal gastric emptying, respectively. None had the contrasted exam compatible with the dumping syndrome. Among the 40 patients, 22 underwent postoperative clinical evaluation. Of these, 19 (86,5%) had excellent and good results (Visick 1 and 2, respectively). Conclusions : The jejunal pouch interposition showed to be a very effective surgical procedure for the prevention of the dumping syndrome in gastrectomized patients.

Racional : A interposição de alça jejunal entre o corpo gástrico e o duodeno após a antrectomia, apesar de pouco frequente na prática cirúrgica atual, tem sido empregada com sucesso na prevenção e tratamento das síndromes pós-gastrectomias. Entre estas se inclui a síndrome de dumping, que acomete 13-58% dos pacientes gastrectomizados. Objetivo : Avaliação retrospectiva dos resultados desse procedimento na prevenção da síndrome de dumping. Métodos : Foram selecionados 40 pacientes todos encaminhados para tratamento cirúrgico de úlcera cloridropéptica entre 1965 e 1970. Destes, 29 foram submetidos à vagotomia, antrectomia, gastrojejunoduodenostomia no nível da pequena curvatura, e os 11 restantes à vagotomia, antrectomia, gastrojejunoduodenostomia no nível da grande curvatura. O trânsito gastrojejunoduodenal foi avaliado no pós-operatório imediato ou tardio por meio do estudo contrastado de esôfago, estômago e duodeno. A evolução clínica no pós-operatório foi avaliada segundo a classificação de Visick. Resultados : Dos 40 pacientes, 28 foram acompanhados com o estudo contrastado no pós-operatório tardio. Entre aqueles de até o 1º mês de pós-operatório (n=22), 20 (90%) apresentaram o trânsito gastrojejunoduodenal lento e dois (10%) tiveram o trânsito normal. Entre os que puderam ser acompanhados após o 1º mês (n=16), três (19%) e 13 (81%) mostraram o esvaziamento gástrico lento e normal, respectivamente. Nenhum apresentou o estudo contrastado compatível com a síndrome de dumping. Entre os 40 doentes, 22 foram submetidos à avaliação clínica pós-operatória. Destes, 19 (86,5%) apresentaram excelentes e bons resultados (Visick 1 e 2, respectivamente). Conclusões : A interposição de alça jejunal mostrou-se procedimento cirúrgico bastante eficaz na prevenção da síndrome de dumping em pacientes gastrectomizados.

Second-stage robot-assisted biliopancreatic diversion with duodenal switch after sleeve gastrectomy.

Biliopancreatic diversion (BPD) was initially described in 1979 and consisted of a distal gastrectomy with a 250-mL stomach pouch and a distal intestinal bypass with a 50 to 100-cm common channel resulting in malabsorption of dietary fat (Scopinaro et al. Br J Surg. 66(9):618-20, 1979). Later, several modifications (sleeve gastrectomy, pylorus preservation, and duodenal switch) were proposed to improve incidence of postoperative dumping syndrome, diarrhea, and anastomotic ulcerations (Lagacé et al. Obes Surg. 5(4):411-8, 1995). Gagner et al. developed a simplified and reproducible approach for laparoscopic BPD with duodenal switch (BPD-DS) after sleeve gastrectomy (Ren et al. Obes Surg. 10(6): 514-23, 2000). BPD-DS has been considered as one of the most difficult bariatric procedures for its surgical complexity and postoperative metabolic complications management. In this regard, the number of BPD-DS has remained extremely low (<4 %). We hypothesize that robotic approach could facilitate the feasibility of BPD-DS procedure. In this multimedia video (8 min), we present a step-by-step robotic BPD-DS.

ASSESSMENT OF THE GASTRO-JEJUNO-DUODENAL TRANSIT AFTER JEJUNAL POUCH INTERPOSITION.

BACKGROUND: The jejunal pouch interposition between the gastric body and the duodenum after the gastrectomy, although not frequent in the surgical practice today, has been successfully employed for the prevention and treatment of the postgastrectomy syndromes. In the latter, it is included the dumping syndrome, which affects 13-58% of the patients who undergo gastrectomy. AIM: Retrospective assessment of the results of this procedure for the prevention of the dumping syndrome. METHODS: Fourty patients were selected and treatetd surgically for peptic ulcer, between 1965 and 1970. Of these, 29 underwent vagotomy, antrectomy, gastrojejunalduodenostomy at the lesser curvature level, and the 11 remaining were submitted to vagotomy, antrectomy, gastrojejunal-duodenostomy at the greater curvature level. The gastro-jejuno-duodenal transit was assessed in the immediate or late postoperative with the contrasted study of the esophagus, stomach and duodenum. The clinical evolution was assessed according to the Visick grade. RESULTS: Of the 40 patients, 28 were followed with the contrast evaluation in the late postoperative. Among those who were followed until the first month (n=22), 20 (90%) had slow gastro-jejuno-duodenal transit and in two (10%) the transit was normal. Among those who were followed after the first month (n=16), three (19%) and 13 (81%) had slow and normal gastric emptying, respectively. None had the contrasted exam compatible with the dumping syndrome. Among the 40 patients, 22 underwent postoperative clinical evaluation. Of these, 19 (86,5%) had excellent and good results (Visick 1 and 2, respectively). CONCLUSIONS: The jejunal pouch interposition showed to be a very effective surgical procedure for the prevention of the dumping syndrome in gastrectomized patients.

Bariatric surgery – An update for the endocrinologist / Cirurgia bariátrica – Uma atualização para o endocrinologista

Obesity is a major public health problem, is associated with increased rates of mortality risk and of developing several comorbidities, and lessens life expectancy. Bariatric surgery is the most effective treatment for morbidly obese patients, reducing risk of developing new comorbidities, health care utilization and mortality. The establishment of centers of excellence with interdisciplinary staff in bariatric surgery has been reducing operative mortality in the course of time, improving surgical safety and quality. The endocrinologist is part of the interdisciplinary team. The aim of this review is to provide endocrinologists, physicians and health care providers crucial elements of good clinical practice in the management of morbidly obese bariatric surgical candidates. This information includes formal indications and contraindications for bariatric operations, description of usual bariatric and metabolic operations as well as endoscopic treatments, preoperative assessments including psychological, metabolic and cardiorespiratory evaluation and postoperative dietary staged meal progression and nutritional supplementation follow-up with micronutrient deficiencies monitoring, surgical complications, suspension of medications in type 2 diabetic patients, dumping syndrome and hypoglycemia. Arq Bras Endocrinol Metab. 2014;58(9):875-88.

A obesidade é um problema de saúde pública, está associada com aumento do risco de mortalidade e de desenvolver diversas comorbidades e diminui a expectativa de vida. A cirurgia bariátrica é o tratamento mais eficaz para pacientes com obesidade mórbida, reduzindo o desenvolvimento de novas comorbidades, a utilização dos cuidados de saúde e a mortalidade. A criação de centros de excelência com equipes interdisciplinares em cirurgia bariátrica vem reduzindo a mortalidade operatória no decorrer do tempo, melhorando a segurança e a qualidade cirúrgica. O endocrinologista faz parte da equipe interdisciplinar. O objetivo desta revisão é fornecer aos endocrinologistas, médicos e prestadores de cuidados de saúde elementos cruciais de boas práticas clínicas no tratamento de pacientes com obesidade mórbida candidatos à cirurgia bariátrica. Essas informações incluem indicações formais e contraindicações para as operações bariátricas, descrição das operações bariátricas e metabólicas habituais, bem como tratamentos endoscópicos, avaliação pré-operatória, incluindo avaliação cardiorrespiratória psicológica, metabólica e no pós-operatório, dieta com refeições progressivamente estagiadas e seguimento com suplementação nutricional e monitoramento de deficiências de micronutrientes, complicações cirúrgicas, suspensão de medicamentos em pacientes diabéticos tipo 2, síndrome de dumping e hipoglicemia. Arq Bras Endocrinol Metab. 2014;58(9):875-88.

Bariatric surgery--an update for the endocrinologist.

Obesity is a major public health problem, is associated with increased rates of mortality risk and of developing several comorbidities, and lessens life expectancy. Bariatric surgery is the most effective treatment for morbidly obese patients, reducing risk of developing new comorbidities, health care utilization and mortality. The establishment of centers of excellence with interdisciplinary staff in bariatric surgery has been reducing operative mortality in the course of time, improving surgical safety and quality. The endocrinologist is part of the interdisciplinary team. The aim of this review is to provide endocrinologists, physicians and health care providers crucial elements of good clinical practice in the management of morbidly obese bariatric surgical candidates. This information includes formal indications and contraindications for bariatric operations, description of usual bariatric and metabolic operations as well as endoscopic treatments, preoperative assessments including psychological, metabolic and cardiorespiratory evaluation and postoperative dietary staged meal progression and nutritional supplementation follow-up with micronutrient deficiencies monitoring, surgical complications, suspension of medications in type 2 diabetic patients, dumping syndrome and hypoglycemia.

Preservation versus non-preservation of the duodenal passage following total gastrectomy: a systematic review.

BACKGROUND: Various reconstruction procedures have been proposed for restoring the alimentary tract continuity after total gastrectomy. However, so far there is no consensus on the ideal post-gastrectomy reconstruction procedure. The necessity of preserving the duodenal passage is one of the major focuses of the debate concerning gastrointestinal reconstruction and is the objective of this study. METHODS: A systematic literature search of PubMed, EMBASE, the Cochrane Library, SCI, and Chinese Biomedical Literature Database (CBM) was carried out before March 2012 to obtain studies of randomized controlled trials (RCT). Analysis was performed using RevMan 5.0 software. RESULTS: Nine RCTs involving 642 participants met the selection criteria. The results of the meta-analyses showed that operative mortality and morbidity were not significantly different between the two procedures (preservation vs. non-preservation of duodenum). However, operative time was considerably prolonged by preserving the duodenal passage. Patients in the preservation group had an improved nutritional parameters (body weight, levels of serum iron and hemoglobin) in the short term (<6 months) after surgery. Beneficial effect on preventing postgastrectomy symptom (heartburn, dumping syndrome) was not found by maintaining the duodenal passage throughout a 2-year follow-up. Moreover, a qualitative measurement showed that no significant quality of life improvement for patients with a preserved duodenal passage. CONCLUSION: This systematic review failed to demonstrate obvious advantage in preserving duodenal passage after total gastrectomy.

Changes in eating behaviour and meal pattern following Roux-en-Y gastric bypass.

BACKGROUND: Little is known about eating behaviour and meal pattern subsequent to Roux-en-Y gastric bypass (RYGB), knowledge important for the nutritional care process. The objective of the study was to obtain basic information of how meal size, eating rate, meal frequency and eating behaviour change upon the RYGB surgery. MATERIALS AND METHODS: Voluntary chosen meal size and eating rate were measured in a longitudinal, within subject, cohort study of 43 patients, 31 women and 12 men, age 42.6 (s.d. 9.7) years, body mass index (BMI) 44.5 (4.9) kg m(-2). Thirty-one non-obese subjects, 37.8 (13.6) years, BMI 23.7 (2.7) kg m(-2) served as a reference group. All subjects completed a meal pattern questionnaire and the Three-Factor Eating Questionnaire (TFEQ-R21). RESULTS: Six weeks postoperatively meal size was 42% of the preoperative meal size, (P<0.001). After 1 and 2 years, meal size increased but was still lower than preoperative size 57% (P<0.001) and 66% (P<0.001), respectively. Mean meal duration was constant before and after surgery. Mean eating rate measured as amount consumed food per minute was 45% of preoperative eating rate 6 weeks postoperatively (P<0.001). After 1 and 2 years, eating rate increased to 65% (P<0.001) and 72% (P<0.001), respectively, of preoperative rate. Number of meals per day increased from 4.9 (95% confidence interval, 4.4,5.4) preoperatively to 6 weeks: 5.2 (4.9,5.6), (not significant), 1 year 5.8 (5.5,6.1), (P=0.003), and 2 years 5.4 (5.1,5.7), (not significant). Emotional and uncontrolled eating were significantly decreased postoperatively, (both P<0.001 at all-time points), while cognitive restraint was only transiently increased 6 weeks postoperatively (P=0.011). CONCLUSIONS: Subsequent to RYGB, patients display markedly changed eating behaviour and meal patterns, which may lead to sustained weight loss.

Early dumping syndrome and reflux esophagitis prevention with pouch reconstruction.

BACKGROUND: Total gastrectomy causes numerous disorders, such as reflux esophagitis, dumping syndrome, malabsorption, and malnutrition. To minimize the consequences, different variants of reconstruction are performed. The aim of our study is the comparison of two reconstructive methods: the standard Roux-en-Y and a new modality of pouch interposition, preduodenal-pouch interposition. This study aims to investigate the advantage of bile reflux prevention and to reduce symptoms of dumping syndrome after 3- and 6-mo follow-up. MATERIALS AND METHODS: A total of 60 patients were divided in two groups: (A) 30 patients with Roux-en-Y reconstruction, and (B) 30 patients with the preduodenal-pouch (PDP) type of reconstruction. Endoscopic examination and endoluminal jejunal limb pressure measurements were performed. Scintigraphic measurements of half-emptying time were performed to evaluate meal elimination in the context of reflux esophagitis and early dumping syndrome. The Japan Society of Gastrointestinal Surgery has provided guidelines with which to classify the symptoms of early dumping syndrome. Patients were followed up for periods of 3 and 6 mo after the surgery. RESULTS: Our study groups did not differ with regard to the level of reflux esophagitis (P = 0.688). Average values of pressure at 10 and 15 cm below the esophago-jejunal junction were significantly lower in the PDP group (P < 0.001). Elimination of the test meal between two groups was not significant (P = 0.222). Evaluation of early dumping syndrome symptoms revealed a significant reduction among PDP patients after 3 and 6 mo. CONCLUSION: Our study showed significant superiority of the new pouch reconstruction over the standard Roux-en-Y approach in the treatment of early dumping syndrome.

Acarbose improves hypoglycaemia following gastric bypass surgery without increasing glucagon-like peptide 1 levels.

BACKGROUND: Postprandial hypoglycaemia is a severe complication of Roux-en-Y gastric bypass (RYGBP). Acarbose, an α-glucosidase inhibitor (AGI), is employed in its treatment. Several studies have shown that AGIs increase the postprandial levels of glucagon-like peptide 1 (GLP-1). However, an excessive level of GLP-1 is one of the factors involved in the physiopathology of this condition. We analysed the effect of acarbose oral administration in eight RYBGP patients with clinically significant hypoglycaemia or dumping syndrome. METHODS: Glucose, insulin and GLP-1 plasma levels in fasting and after ingestion of a standard meal (Ensure Plus®; 13 g protein, 50 g carbohydrate, 11 g fat) were measured. The test was repeated the following week with the oral administration of 100 mg of acarbose 15 min prior to the meal. RESULTS: Five patients developed asymptomatic hypoglycaemia during the test (glucose level <50 mg/dl) with inappropriately high insulin levels and exaggerated GLP-1 response. Acarbose ingestion avoided hypoglycaemia in all of the patients and increased the lowest plasma glucose level (46.4 ± 4.8 vs. 59.0 ± 2.6 mg/dl, p < 0.01). Acarbose ingestion decreased the area under the curve for serum insulin and GLP-1 levels at 15 min after the meal. CONCLUSIONS: Acarbose avoided postprandial hypoglycaemia following RYGBP by decreasing the hyperinsulinemic response. This was associated with a decrease in early GLP-1 secretion, in contrast to that observed in non-surgical subjects. This finding could be explained by the reduction of glucose load in the jejunum produced by the α-glucosidase inhibition, which is the main stimulus for GLP-1 secretion.

[Postgastrectomy symptoms following total gastrectomy with or without preservation of the duodenal passage]. / Postgastrectomiás tünetek totális gastrectomia után a duodenalis passage-t megorzo és kizáró rekonstrukciók mellett.

INTRODUCTION: Total gastrectomy leads to decreased quality of life, which is characterized by different symptoms of the postgastrectomy syndrome. Aim of this study was to investigate the correlation of different alimentary symptoms and habits in correlation with the reconstruction type after total gastrectomy. PATIENTS AND METHODS: Between 2005-2009 34 patients after total gastrectomy for gastric cancer were evaluated with questionnaires. Twenty two had a standard Roux-en-Y reconstruction, while 12 Longmire type jejunal interposition. Early dumping syndrome was investigated with the Sigstad score. RESULTS: Most of the investigated parameters were similar in Roux-en-Y and Jejunal Interposition patients. Early dumping syndrome however occurred significantly less frequantly after jejunal interposition. CONCLUSION: Preservation of the duodenal passage after total gastrectomy reduces the prevalence of early dumping.

Optimal size of jejunal pouch as a reservoir after total gastrectomy: a single-center prospective randomized study.

BACKGROUND: In order to improve a patient's quality of life after total gastrectomy, jejunal pouch reconstruction has been employed. However, little information exists regarding the optimal size of the jejunal pouch after total gastrectomy. METHODS: The study was designed as a single-center randomized trial in which the results of double-tract reconstruction with pouches of two different sizes were compared, i.e., short and long pouch double tract (SPDT and LPDT, respectively). We conducted a clinical assessment with standard questionnaire after surgery. The amount of residual food in the jejunal pouch was determined by endoscopy. RESULTS: No demographic differences were noted between the two groups. The eating capacity per meal was higher in the SPDT group than in the LPDT group. The postoperative weight loss 24 months after surgery was lower in SPDT group than that in the LPDT group. Although the incidence of early dumping symptoms was higher in the SPDT group, no difference was noted in the other postprandial abdominal symptoms between the two groups. CONCLUSIONS: We conclude that the optimal pouch should be relatively short, as a short pouch improves the eating capacity per meal and the weight loss ratio to the preoperative value.

Efficacy of celiac branch preservation in Roux-en-y reconstruction after laparoscopy-assisted distal gastrectomy.

BACKGROUND: The present study investigated the efficacy of preserving the celiac branch of the vagus nerve after laparoscopy-assisted distal gastrectomy (LADG) with Roux-en-Y (R-Y) reconstruction. METHODS: Between January 2004 and September 2008, a total of 159 consecutive patients who underwent LADG for gastric carcinoma were classified into groups according to preservation of the celiac branch of the vagus nerve-preservation group (P-LADG; n = 70) and the resection group (R-LADG; n = 89). The parameters analyzed included patient and tumor characteristics, operative details, postoperative outcomes, and nutritional state. The endoscopic findings of the gastric remnant and lower esophagus were evaluated at 12 months postoperatively. RESULTS: In regard to postoperative complications, no significant differences were found between groups. With R-LADG, 14 patients suffered from dumping syndrome (15.7%), compared with only 2 patients with P-LADG (2.9%; P = .007). The amount of meal consumption compared with the preoperative value and the rate of weight reduction at 12 months postoperatively did not differ significantly between groups. Endoscopic findings showed significantly more residue with P-LADG (34.3%) than with R-LADG (16.9%; P = .011). CONCLUSION: The celiac branch is useful in regulating gastrointestinal motility by maintaining postoperative physiologic function. Celiac branch preservation seems to represent a feasible and beneficial method for LADG.

Effects of reconstruction methods on a patient's quality of life after a proximal gastrectomy: subjective symptoms evaluation using questionnaire survey.

BACKGROUND AND AIMS: Proximal gastrectomy is typically indicated in early gastric cancer of the upper third of the stomach. Esophagogastrostomy (EG) and jejunum interposition (JI) are often selected as reconstruction methods, although the more appropriate method of the two is unknown. MATERIALS AND METHODS: One hundred and seven patients, who underwent a proximal gastrectomy followed by either an EG or a JI, were sent a questionnaire of 33 questions about subjective symptoms. Eighty-three patients (45 in the JI group and 38 in the EG group) returned the questionnaire. Results were compared between the two groups to identify the appropriate reconstruction method after a proximal gastrectomy. Also, changes in a patient's body weight after surgery were compared. RESULTS: Early and late dumping syndromes and gastroesophageal reflux associated symptoms were equally observed between the two groups. However, abdominal discomfort after meals (P = 0.008), continuous gastric fullness (P = 0.028), and hiccups between meals (P = 0.022) were often observed in the JI group. The loss of body weight was not significantly different between the two groups. CONCLUSION: EG is a better reconstruction method compared to a JI after a proximal gastrectomy when evaluating subjective symptoms. Prospective study is warranted to clarify the better reconstruction method following proximal gastrectomy in terms of both subjective and objective symptoms.

Physical activity predicts weight loss following gastric bypass surgery: findings from a support group survey.

BACKGROUND: Patient adherence to recommended eating and physical activity behaviors is considered important to weight loss outcomes following gastric bypass surgery, but there has been little systematic research in this area to investigate behavioral predictors of weight loss. METHOD: We developed a measure of postsurgical behaviors, the bariatric surgery self-management questionnaire (BSSQ). A survey was conducted of 200 patients attending postsurgical support groups (mean time since surgery 14 months, mean age 40 years, 85% female, presurgical weight 150 kg). Patients completed the BSSQ and measures of treatment regimen distress, perceived benefits of weight loss, and weight-related physical symptoms. RESULTS: Mean BSSQ adherence was in the 70% range, with subscale scores varying considerably. Distress levels associated with the new lifestyle were consistently low (approximately equal to 20%) and perceived benefits of weight loss were high early on and maintained consistently (70-90%). A final predictive model showed premorbid weight, time since surgery, and BSSQ physical activity subscale were significant predictors of weight loss, accounting for 73% of variance. CONCLUSIONS: Physical activity adherence was the sole significant behavioral predictor of weight loss, although maladaptive dietary habits and patient selection issues were identified for future research. It will be important to replicate the current study in prospective, longitudinal studies with representative patient cohorts. A challenge for researchers will be to develop novel, intensive recruiting and retention strategies to allow closer examination of these issues.