The first consensus statement on revisional bariatric surgery using a modified Delphi approach

ConclusionExperts achieved consensus on a number of aspects of RBS. Though expert opinion can only be regarded as low-quality evidence, the findings of this exercise should help improve the outcomes of RBS while we develop robust evidence to inform future practice.
Source: Surgical Endoscopy - Category: Surgery Source Type: research

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Sleeve gastrectomy (SG) is associated with significant rates of de novo and worsened gastroesophageal reflux disease (GERD) and thus, Roux-en-Y gastric bypass is typically the preferred bariatric surgery in patients with symptomatic GERD. Patients with silent reflux symptoms, may however still undergo SG, which could put patients at risk for complications such as Barrett ’s esophagus (BE). We aimed to determine the incidence rate of BE in patients who have undergone SG and to assess the use of EGD pre- and post-surgery using a large database.
Source: Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Tags: Poster abstracts Source Type: research
Sleeve Gastrectomy (SG) is the most common bariatric surgery performed in the United States. While effective in weight loss with low complication rate, SG can be associated with weight regain in up to 50% of patients. Surgical options for those with weight regain include surgical re-sleeve (SRS) or conversion to Roux-en-Y Gastric Bypass (RYGB), both of which can be technically challenging and are associated with postoperative complications. Endoscopic sleeve revision or sleeve-in-sleeve (SIS) has emerged as a less invasive but effective modality for the treatment of these patients.
Source: Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Tags: Poster abstracts Source Type: research
AbstractBackgroundThere is limited data examining specific annual surgeon procedural volumes associated with improvement of postoperative outcomes following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).ObjectivesEffect of surgeon volume on procedural outcomes.MethodsUsing the SPARCS Administrative database, patients undergoing laparoscopic RYGB or SG between 2010 –2014 were analyzed. Multivariable generalized linear mixed regression models were first used to analyze the influences of 3 yearly mean volumes (combined, RYGB and SG mean volumes) on each of three surgical outcomes: 30-day readmission, ...
Source: Surgical Endoscopy - Category: Surgery Source Type: research
ConclusionsIntraluminal indocyanine green is an alternative for intraoperative detection of staple line integrity during bariatric surgical procedures with comparable specificity to intraoperative gastroscopy.
Source: Surgical Endoscopy - Category: Surgery Source Type: research
The global obesity epidemic over the past decade has led to the development of several surgical therapeutic options for severe obesity, defined as a body mass index (BMI) of 40 kg/m2.1 Patients with BMI of 35 to 39.9 kg/m2 with an obesity-related comorbidity such as diabetes or hypertension and patients with a BMI of>30 kg/m2 and metabolic syndrome, or difficult-to-control diabetes, are also suitable for bariatric surgical procedures.1 Bariatric surgical procedures can be classified into restrictive procedures such as sleeve gastrectomy, malabsorptive procedures such as jejunoileal bypass and biliopancreatic diversion, ...
Source: Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Tags: Editorial Source Type: research
ConclusionsThis is the first report of cognitive improvements following VSG and the first direct comparison of cognitive improvements following RYGB and VSG. Short-term improvements in specific domains of cognitive function are observed at the beginning of the active weight loss phase following bariatric surgery that persisted to 3  months. The anatomical distinction between the two surgeries and resulting differential metabolic profiles may be responsible for the improvements in attention observed following RYGB but not following VSG.
Source: Surgical Endoscopy - Category: Surgery Source Type: research
AbstractBackgroundEnhanced recovery after surgery (ERAS) protocols have been extensively proven in lower gastrointestinal surgery to decrease postoperative physiologic stress and length of stay (LOS). ERAS in bariatric surgery (ERABS) varies immensely from each program with inconsistent results with a predominant goal of reducing LOS. Our focus in implementing enhanced recovery after bariatric surgery (ERABS) protocols is aimed at reducing postoperative pain and opioid use.MethodsThis is a retrospective review of patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (VSG) at a single hig...
Source: Surgical Endoscopy - Category: Surgery Source Type: research
ConclusionsForegut pathology is common in bariatric patients with subjective symptoms of GERD. Implementing a comprehensive protocol to objectively assess these patients leads to a significant clinical impact on which procedure these patients ultimately undergo.
Source: Surgical Endoscopy - Category: Surgery Source Type: research
AbstractBackgroundAccelerated bone loss is a known complication after bariatric surgery. Bone mineral density has been shown to decrease significantly after Laparoscopic Roux-en-Y gastric bypass (RYGB). Laparoscopic sleeve gastrectomy (SG) effects on bone density are largely unknown. This should be considered for those with increased preoperative risk for bone loss, such as postmenopausal females.MethodsThis prospective clinical trial included postmenopausal patients, with BMI  ≥ 35 k/m2, being evaluated for either RYGB or SG. Patients with history of osteoporosis, estrogen hormone replacement therapy...
Source: Surgical Endoscopy - Category: Surgery Source Type: research
This study included patients who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG). The primary outcome of interest was incisional SSI occurring within 30  days. Surgeries performed in 2015 were used in a derivation cohort and the predictive tool was validated against the 2016 cohort. A forward selection algorithm was used to build a logistic regression model predicting probability of SSI.ResultsA total of 274,187 patients were included with 71.7% being LSG and 28.3% LRYGB. 0.7% of patients had a SSI in which 71.0% had an incisional SSI, and 29.9% had an organ/spa...
Source: Surgical Endoscopy - Category: Surgery Source Type: research
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