RESUMO
The most accepted procedures as conversion for poor weight changes after sleeve gastrectomy (SG), are malabsorptive surgeries. This study was designed to evaluate the 5-year outcomes of One Anastomosis Gastric Bypass (OAGB) following SG due to weight loss failure and weight regain. From September 2014 to January 2017, totally 23 patients with a history of SG conversion to OAGB in terms of weight loss failure or weight regain who had completed their 5-year follow-ups were studied. Some obesity related co-morbidities containing type-2 diabetes (DM), hypertension (HTN), dyslipidemia, obstructive sleep apnea (OSA) and gastroesophageal reflux disease (GERD) were also investigated at 1, 2, 3 and 5 years after conversional surgery. All cases had remission/improvement in DM, DLP, HTN and OSA 1 year after conversional OAGB. Analysis showed statistically significant (P < 0.001) change in trend of BMI. Mean BMI before conversional surgery, at 1, 2, 3and 5 years were 46.3 ± 10.4, 34.5 ± 8.5, 34.1 ± 8.6, 35.7 ± 8.7 and 37.5 ± 11.6, respectively. Mean percent excess weight loss (%EWL) at 1, 2, 3 and 5 years was 51.6 ± 11.0, 52.9 ± 13.1, 45.5 ± 16.4 and 41.0 ± 18.0, respectively. Mean percent total weight loss (%TWL) at 1, 2, 3 and 5 years was 26.6 ± 5.9, 27.4 ± 7.2, 23.9 ± 9.2 and 20.9 ± 9.3, respectively. OAGB is an effective conversional procedure for insufficient weight loss and weight regain following failed SG and lead to satisfactory changes in obesity associated medical problems. The optimal weight loss results are obtained at 2-year follow-ups and these effects are then reduced.
Assuntos
Derivação Gástrica , Hipertensão , Laparoscopia , Obesidade Mórbida , Apneia Obstrutiva do Sono , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Derivação Gástrica/métodos , Humanos , Hipertensão/cirurgia , Laparoscopia/métodos , Obesidade/cirurgia , Obesidade Mórbida/cirurgia , Reoperação/métodos , Estudos Retrospectivos , Apneia Obstrutiva do Sono/cirurgia , Resultado do Tratamento , Aumento de Peso , Redução de PesoRESUMO
BACKGROUND: De novo gastroesophageal reflux disease (GERD) is one of the complications that may occur after laparoscopic sleeve gastrectomy (LSG). This study was conducted to examine whether omentopexy can be effective in reducing the incidence of GERD after LSG. METHODS: A total of 201 patients (145 females) were compared in this retrospective cohort study, including Group A (n = 100) and Group B (n = 101), consisting of patients undergoing LSG with omentopexy and LSG without omentopexy, respectively. One year after surgery, the patients were evaluated by GERD-Q; those obtaining a score of eight or above also underwent upper endoscopy to confirm their de novo GERD. RESULTS: Thirty-seven patients had a GERD-Q score ≥ 8 and therefore underwent upper endoscopy. Seventeen patients had fully normal endoscopy results, and no significant differences was observed between the two groups in terms of the incidence of de novo GERD (P = 0.966). There were also no significant differences between the groups in terms of age (P = 0.517), sex (P = 0.193), diabetes (P = 0.979), and GERD-Q score (P = 0.880). The pre-operative mean weight (P = 0.003) and total weight loss (TWL) showed significant intergroup differences (P = 0.001). The mean body mass index (BMI) showed significant differences between the groups before the operation (P = 0.001) and 1 year after the surgery (P = 0.009). Excess BMI loss (EBMIL) was also significantly higher in Group A 1 year after the surgery (P = 0.004). Even after omitting confounder effect of BMI between two groups with and without omentopexy, GerdQ was not significantly different. CONCLUSION: Omentopexy does not have a significant effect on reducing the incidence of de novo GERD after LSG, even in individuals with higher BMI and weight.