Incidence and treatment of leak at the gastrojejunostomy in Roux-en-Y gastric bypass: a cohort study of 40,844 patients.

Incidence and treatment of leak at the gastrojejunostomy in Roux-en-Y gastric bypass: a cohort study of 40,844 patients. Surg Obes Relat Dis. 2019 May 13;: Authors: Vidarsson B, Sundbom M, Edholm D Abstract BACKGROUND: Leak at the gastrojejunostomy (GJ) after Roux-en-Y gastric bypass is a rare but life-threatening complication. OBJECTIVES: To assess incidence, risk factors, treatment, and outcome of leaks at the GJ after Roux-en-Y gastric bypass in a nationwide cohort. SETTING: Sweden. METHODS: Leaks at GJ within 30 days postoperatively in 40,844 patients (age 41 yr, females 76%, and body mass index of 42.4 kg/m2) between 2007 and 2014 in the Scandinavian Obesity Surgery Registry were assessed. Register data and outcomes were verified by reviewing patient charts. Logistic regression was done to estimate odds ratios (ORs) for significant risk factors. RESULTS: Leak at the GJ was registered in 262 (.6%) patients, with 44% diagnosed within the first 3 postoperative days. Risk factors were male sex (OR 1.5 [1.1-1.9]), age ≥49 years (OR 1.9 [1.3-2.7]), diabetes (OR 1.4 [1.1-1.9]), conversion to open surgery (OR 3.9 [2.2-6.9]), and operative time ≥90 minutes (OR 2.6 [1.8-3.8]). In most patients, the leak resulted in a severe complication. Reoperative surgery was done in 85%, with the placement of a feeding gastrostomy in 24%. Stents were used at some time point in 31% of leaks. Of all patients with leaks, 25% required intensive care, ...
Source: Surgery for Obesity and Related Diseases : official journal of the American Society for Bariatric Surgery - Category: Surgery Authors: Tags: Surg Obes Relat Dis Source Type: research

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ConclusionA high-level of suspicion is required to suspect, diagnose and treat post-RYGB complications. A bariatric on-call rota with appropriately trained personnel is essential.
Source: Obesity Surgery - Category: Surgery Source Type: research
Conclusionclinicians should be aware of such condition in patients with history of bariatric surgery who present with long-standing, intermittent abdominal pain.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
Conclusion Taken together, evidence from animal and human studies demonstrates that the brain detects levels of circulating nutrients and hormones and consequently organizes an outward response that contributes to the regulation of whole-body glucose homeostasis. However, there are major knowledge gaps about the exact nature of this response and its relative importance compared to peripheral processes. As we have seen, animal studies have provided an anatomical map of CNS glucose regulation and have identified important neurons and neural circuits involved. Additionally, the CNS sensing of key nutrients and hormones has b...
Source: Frontiers in Physiology - Category: Physiology Source Type: research
Abstract BACKGROUND: Mechanisms of metabolic improvement after bariatric surgery remain incompletely understood. Intestinal glucose uptake is increased after gastric bypass in rodents, potentially contributing to reduced blood glucose and type 2 diabetes remission. OBJECTIVE: We assessed whether intestinal glucose uptake is increased in humans after gastric surgery. SETTING: University Hospital, United States. METHODS: In a retrospective, case-control cohort study, positron emission tomography-computerized tomography scans performed for clinical indications were analyzed to quantify intestinal gluco...
Source: Surgery for Obesity and Related Diseases : official journal of the American Society for Bariatric Surgery - Category: Surgery Authors: Tags: Surg Obes Relat Dis Source Type: research
Publication date: Available online 9 January 2018 Source:The Lancet Diabetes & Endocrinology Author(s): Martin Neovius, Gustaf Bruze, Peter Jacobson, Kajsa Sjöholm, Kari Johansson, Fredrik Granath, Johan Sundström, Ingmar Näslund, Claude Marcus, Johan Ottosson, Markku Peltonen, Lena M S Carlsson Background Bariatric surgery reduces mortality, but might have adverse effects on mental health. We assessed the risk of suicide and self-harm after bariatric surgery compared with non-surgical obesity treatment. Methods Suicide and non-fatal self-harm events retrieved from nationwide Swedish registers were exam...
Source: The Lancet Diabetes and Endocrinology - Category: Endocrinology Source Type: research
CONCLUSIONS: It was demonstrated that a current mix of bariatric surgery methods was cost-effective at ten years post-surgery and cost-saving over the lifetime of the Belgian patient cohort considered in this analysis. PMID: 29271279 [PubMed - as supplied by publisher]
Source: Journal of Medical Economics - Category: Health Management Tags: J Med Econ Source Type: research
AbstractIntroductionNonalcoholic fatty liver disease (NAFLD) is an epidemic in the obese population. Bariatric surgery is known to reverse multiple metabolic complications of obesity such as diabetes, dyslipidemia, and NAFLD, but the timing of liver changes has not been well described.Materials and MethodsThis was an IRB-approved, two-institutional prospective study. Bariatric patients received MRIs at baseline and after a pre-operative liquid diet. Liver biopsies were performed during surgery and if NAFLD positive, the patients received MRIs at 1, 3, and 6  months. Liver volumes and proton-density fat fraction (PDFF)...
Source: Surgical Endoscopy - Category: Surgery Source Type: research
ConclusionIn a majority of patients, no deterioration of DRP following GBP was observed. Screening for DRP before planned surgery is recommended for all diabetic patients about to undergo bariatric surgery to identify any pre‐existing DRP.
Source: Acta Ophthalmologica - Category: Opthalmology Authors: Tags: Original Article Source Type: research
n J Abstract BACKGROUND: Intraoperative adverse events are known to be associated with postoperative complications; however, little is known about whether or not blood loss during laparoscopic gastric bypass surgery affects the outcome. OBJECTIVE: To see if intraoperative bleeding was associated with a less favorable outcome, and to identify patient-specific risk factors for intraoperative bleeding. SETTING: Nationwide, Sweden. METHODS: Patients who underwent laparoscopic gastric bypass surgery between January 8, 2007, and September 15, 2015, were included in the study. The volume of intraoperative ...
Source: Surgery for Obesity and Related Diseases : official journal of the American Society for Bariatric Surgery - Category: Surgery Authors: Tags: Surg Obes Relat Dis Source Type: research
Authors: Webb DL, Abrahamsson N, Sundbom M, Hellström PM Abstract Obesity with a body mass index (BMI) over 30 kg/m(2) represents a significant risk for increased morbidity and mortality, with reduced life expectancy of about 10 years. Until now, surgical treatment has been the only effective longterm intervention. The currently standardized method of bariatric surgery, gastric bypass, means that many gastrointestinal peptide hormones are activated, yielding net reductions in appetite and food intake. Among the most important gut peptide hormones in this perspective is glucagon-like peptide-1 (GLP-1), w...
Source: Scandinavian Journal of Gastroenterology - Category: Gastroenterology Tags: Scand J Gastroenterol Source Type: research
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