Christina Richards

The incidence of complications associated with loop duodeno-ileostomy after single-anastomosis duodenal switch procedures among 1328 patients: a multicenter experience

BACKGROUND The single-anastomosis duodenal switch procedure is a type of duodenal switch that involves a loop anastomosis rather than traditional Roux-en-Y reconstruction. To date, there have been no multicenter studies looking at the complications associated with post-pyloric loop reconstruction. OBJECTIVES The aim of the study was to report the incidence of complications associated with loop duodeno-ileostomy (DI) following single-anastomosis duodenal switch (SADS) procedures. SETTING Mixed of private and teaching facilities. METHODS The medical records of 1328 patients who underwent primary SADS procedure (single-anastomosis duodeno-ileal bypass with sleeve gastrectomy or stomach intestinal pylorus-sparing surgery) by 17 surgeons from 3 countries (United States, Spain, and Australia) at 9 centers over a 6-year period were retrospectively reviewed, and their results were compared with articles in the literature. RESULTS Mean preoperative body mass index was 51.6 kg/m2. Of 1328 patients, 123 patients received a linear stapled duodeno-ileostomy (DI) and 1205 patients a hand-sewn DI. In the overall series, the anastomotic leak, ulcer, and bile reflux occurred in .6% (9/1328), .1% (2/1328), and .1% (2/1328), respectively. None of our patients experienced volvulus at the DI or an internal hernia. Overall, 5 patients (.3%) (3/123 [2.4%] with linear stapled DI versus 2/1205 [.1%] with hand-sewn DI [P<.05]) experienced stricture at the DI in this series. CONCLUSIONS The overall incidence of complications associated with loop DI was lower than the reported incidence of anastomotic complications after Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch. SADS procedures may cause much fewer anastomotic complications compared with Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch.

Laparoscopic adjustable gastric banding versus laparoscopic adjustable gastric banding with gastric plication: midterm outcomes in terms of weight loss and short term complications

BACKGROUND Laparoscopic adjustable gastric banding (LAGB) is a safe procedure with variable outcomes and large standard deviations. LAGB with gastric plication (LAGBP) is a new restrictive procedure that combines the lap band with gastric plication. This procedure, with its mechanism being below the band anatomically, should augment the weaknesses of the lap band: slips and inadequate weight loss. OBJECTIVE Compare the weight loss results and complication rates between the LAGB and LAGBP. SETTING Private practice. METHODS Data was analyzed data from 120 patients retrospectively from 2 surgeons at a single private institution. Seventy-six patients underwent LAGB, and 44 other patients underwent LAGBP between February 2011 and July 2013. All 120 patients are beyond the 1-year postoperative mark and 110 patients are beyond the 2-year postoperative mark. A subset analysis was performed comparing data from both procedures to evaluate weight loss and complications. RESULTS There were no significant differences between preoperative age, weight, and body mass index between the patients who underwent either procedure. We had 47.4% and 52.3% follow-up at 1 year for LAGB and LAGBP, respectively, with 91.5% and 92.3% follow-up at 2 year for LAGB and LAGBP, respectively. Complications were low with LAGBP; however, it was not statistically significant (P = .54). The LAGBP had a greater percent excess weight loss, percent total weight loss, and percent excess body mass index lost compared with the LAGB at 3, 6, 9, 12, and 24 months, and these differences were statistically significant. Mean percent excess weight loss for LAGB and LAGBP was 28.3% and 34.5% (P<.05) at 1 year and 32.1% and 39.2% (P<.05) at 2 years, respectively. CONCLUSION LAGBP is a safe, feasible, and reproducible bariatric procedure. The LAGBP performs significantly better than the LAGB for weight loss. The complication and revision rates were slightly higher with LAGB than LAGBP. However, it was not statistically significant.

Does the future of laparoscopic sleeve gastrectomy lie in the outpatient surgery center? A retrospective study of the safety of 3162 outpatient sleeve gastrectomies

BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a safe and effective procedure that can be performed as an outpatient procedure. OBJECTIVES The aim of the study was to determine whether same-day discharge LSG is safe when performed in an outpatient surgery center. SETTING Outpatient surgery centers. METHODS The medical records of 3162 patients who underwent primary LSG procedure by 21 surgeons at 9 outpatient surgery centers from January 2010 through February 2018 were retrospectively reviewed. RESULTS Three thousand one hundred sixty-two patients were managed with enhanced recovery after surgery protocol and were included in this analysis. The mean age and preoperative body mass index were 43.1 ± 10.8 years and 42.1 ± 7.1 kg/m2, respectively. Sleep apnea, type 2 diabetes, gastroesophageal reflux disease, hypertension, and hyperlipidemia were seen in 14.4%, 13.5%, 24.7%, 30.4%, and 17.6% patients, respectively. The mean total operative time was 56.4 ± 16.9 minutes (skin to skin). One intraoperative complication (.03%) occurred. The hospital transfer rate was .2%. The 30-day follow-up rate was 85%. The postoperative outcomes were analyzed based on the available data. The 30-day readmission, reoperation, reintervention, and emergency room visit rates were .6%, .6%, .2%, and .1%, respectively. The 30-day mortality rate was 0%. The total short-term complication rate was 2.5%. CONCLUSIONS Same-day discharge seems to be safe when performed in an outpatient surgery center in selected patients. It would appear that outpatient surgery centers are a viable option for patients with minimal surgical risks.

Laparoscopic stomach intestinal pylorus-sparing surgery as a revisional option after failed adjustable gastric banding: a report of 27 cases with 36-month follow-up

BACKGROUND Inadequate weight loss, weight recidivism, and device-related complications after an adjustable gastric banding (AGB) can be treated by a laparoscopic conversion to stomach intestinal pylorus-sparing surgery (SIPS). OBJECTIVE The aim of the study was to analyze the midterm outcomes of revision SIPS surgery after failed AGB. SETTING Private practice, United States. METHODS This is a retrospective review of our prospectively collected data of patients who underwent laparoscopic conversion from AGB to SIPS surgery from June 2013 and February 2017 by a single surgeon in a single institution. RESULTS Twenty-seven patients (1 stage: 22 and 2 stage: 5) underwent a laparoscopic revision of AGB to SIPS surgery. The mean ± standard deviation preoperative body mass index (BMI) before AGB was 47.5 ± 6.8 kg/m2, while the mean nadir BMI after AGB was 36 ± 7.7 kg/m2. The overall time to reoperation was 9.3 ± 8.7 and 5.6 ± 2.5 years in 1- and 2-stage conversion patients, respectively. The mean preoperative BMI before revision SIPS surgery was 46.7 ± 7 kg/m2. At 36 months, the patients had an average change in BMI of 20.9 units with 90% excess weight loss. A major complication occurred in 4 patients. Postoperatively, the fasting blood glucose, insulin, low-density lipoprotein, triglyceride, and most of the co-morbidities were resolved or improved. CONCLUSION This study demonstrates that conversion of failed AGB to SIPS surgery is an effective approach to AGB failure.

A video presentation on technique of laparoscopic redo of stenotic gastrojejunostomy with hiatal hernioplasty and right crural release in a patient with previous Roux-en-Y gastric bypass

The Roux-en-Y gastric bypass (RYGB) is the most studied bariatric procedure worldwide [1]. Anastomotic strictures and marginal ulcers are a common complication after RYGB [2–4]. Most anastomotic strictures can be effectively managed by endoscopic dilations [5]. However, in the rare instance of failure of the endoscopic technique, an operative approach may be justified. Additionally, while gastroesophageal reflux disease (GERD) resolves in most patients following RYGB, patients with hiatal hernia often experience severe GERD months to years after their primary bypass. In this video, we present step by step the laparoscopic redo of gastrojejunostomy (GJA) with mesh-augmented hiatoplasty. This is a first video case of its kind in the literature.

Adjustable Gastric Banded Plication versus Sleeve Gastrectomy: The Role of Gastrectomy in Weight Loss

BACKGROUND Laparoscopic adjustable gastric banded plication (LAGBP) is a procedure that has a stomach volume similar to the sleeve gastrectomy (SG). It has shown promising results but has not been adopted widely. OBJECTIVE To determine the difference gastrectomy has on weight loss and complications. SETTING Private practice, United States. METHODS A retrospective, matched-cohort analysis of LAGBP and SG patients was found through matching body mass index and sex for each LAGBP to a SG patient. Body mass index, percentage excess weight loss, and total weight loss percentage were analyzed. Complication data were also collected on a short- (<30 d) and long- (>30 d) term basis. Complication rates were then compared. Data were analyzed through descriptive statistics. RESULTS Patients who received SG lost more body mass index, percentage excess weight loss, and total weight loss percentage at 1 year and started to gain weight between 1 and 2 years. LAGBP patients weight loss also peaked at 1 year but maintained their weight loss to year 2. SG patients lost more weight at all time points, and the difference was statistically significant (P<.05). LAGBP and SG patients had statistically similar rates of short- and long-term complication rates. In the LAGBP group (57 patients) 5, 9, 13, 14, 14, and 17 patients were lost to follow-up at 3, 6, 9, 12, 18, and 24 months, respectively. In the SG group (57 patients) 11, 10, 11, 13, 20, and 29 patients were lost to follow-up at 3, 6, 9, 12, 18, and 24 months, respectively. CONCLUSION Both procedures have peak weight loss at 1 year with acceptable complication rates. However, the SG starts to regain weight while the LAGBP shows weight stability. More time is needed to see if the weight loss curves will intersect or if the late band complications will also happen with the LAGBP as they have with band placement without plication.