One Anastomosis Gastric Bypass –Mini-Gastric Bypass (OAGB-MGB) Versus Roux-en-Y Gastric Bypass (RYGB)—a Mid-Term Cohort Study with 612 Patients
AbstractBackgroundOAGB-MGB emerged as a standard procedure, albeit RYGB remains the most frequently performed gastric bypass. Comparative studies are scarce.MethodsProspectively collected data (July 2006 to November 2017) from a large sample size and adequate follow-up were analyzed using logistic regression and linear mixed models. Total weight loss (TWL) within the first 3 years was defined as primary outcome and duration of operation, perioperative, and late complications and comorbidity remission as secondary outcomes.ResultsThree hundred twenty-four OAGB-MGBs (age 42.51 ± 11.36 years, 74.69% females) presented with higher preoperative BMI (53.75 ± 6.51 kg/m2 vs. 44.53 ± 3.65 kg/m2,p
Gastroesophageal reflux disease (GERD) is common in the morbidly obese population, and hiatal hernias are encountered in 20% to 52% of patients. Primary surgical repair of hiatal hernias, in particular the paraesophageal type, is associated with a higher recurrence rate in obese patients. Concomitant weight loss surgery may be advisable. Combined sleeve gastrectomy and paraesophageal hiatal hernia repair is feasible but can induce or worsen preexisting GERD. A Roux-en-Y gastric bypass offers advantages of more pronounced excess weight loss and better symptom control, albeit with a potentially higher rate of morbidity compa...
CONCLUSION: LVG mildly increases GER, which is likely related to the development of hiatal hernias and a decrease in LES pressure and esophageal sweep. However, LVG should not be contraindicated for patients with preoperative pH-metric GER, as this may clear after the procedure. PMID: 31257899 [PubMed - as supplied by publisher]
AbstractBackgroundCurrent literature is conflicted regarding the efficacy of laparoscopic anti-reflux surgery (LARS) among obese patients complaining of pathologic reflux or otherwise symptomatic hiatal hernias. Controlling for other factors, this study examined the influence of preoperative body mass index (BMI) on clinical and subjective quality of life (QOL) outcomes following LARS.MethodsPatients who underwent LARS between February 2012 and April 2018 were subdivided into four BMI stratified categories according to CDC definitions: normal (18.5 to
AbstractBackgroundIncreasing prevalence of obesity has shown an associated increase in gastroesophageal reflux disease (GERD)-related diseases. Proton pump inhibitor (PPI) therapy has been demonstrated to reduce the incidence of such diseases. The study ’s aim was to analyze the Clinical Practice Research Datalink (CPRD) to determine factors that increase the propensity of obese patients on PPIs to develop Barrett’s esophagus (BE) and esophageal carcinoma.MethodA case-control population study was carried out, including patients from the CPRD. Clinicopathological factors were extracted for each patient alongside...
Laparoscopic sleeve gastrectomy (LSG) is becoming an increasingly popular form of bariatric surgery . Given this popularity, more is being understood about the management of the complications associated with LSG, including gastroesophageal reflux disease (GERD) and hiatal hernias. As per followed practice, LSG predisposes patients to GERD and should not be performed in obese patients with preexisting GERD or hiatal hernia . In these patients, surgical reinforcement of the lower esophageal sphincter at the gastroesophageal junction (GEJ) to restore function is necessary to prevent acid reflux.
Both hiatal hernias (HH) and morbid obesity significantly contribute to gastroesophageal reflux disease which increases the risk for esophagitis and esophageal cancer. Therefore, concomitant HH repair is recommended during bariatric surgery procedures. Unfortunately, recurrence of HH following repair is not uncommon and the optimal surgical technique has yet to be established.
ConclusionsThis study shows a high incidence of Barrett ’s esophagus and hiatal hernias at more than 10 years after SG. Its results therefore suggest maintaining pre-existing large hiatal hernia, GERD, and Barrett’s esophagus as relative contraindications to SG. The limitations of this study—its small sample size as well as the fact that it was ba sed on early experience with SG—make drawing any general conclusions about this procedure difficult.
We present two cases of MSA for the treatment of persistent GERD after LRYGB. Since this is an off-label use of this procedure, both patients underwent extensive evaluation before proceeding with surgery. Excellent results were obtained with a significant improvement in symptoms as well as their GERD Health-Related Quality of Life scores.
Obesity is known to be an independent risk factor for gastroesophageal reflux disease (GERD), as well as a contributing cause of hiatal hernias (HH). Laparoscopic sleeve gastrectomy (LSG) is considered a viable surgical option for weight loss; however, some surgeons suggest avoiding this procedure in patients with preexisting gastroesophageal reflux disease symptoms (GERDS) because of concern for worsening of these symptoms. The effect of LSG on GERDS is unclear, with studies reporting conflicting results.
Obesity is a major risk factor for hiatal hernias. High recurrence rates are reported following Nissen fundoplication in morbidly obese patients. Following a failed fundoplication, an acid diverting procedure (i.e. RYGB) is highly successful in reflux remission and weight loss.