A604 Improvement in Hemoglobin A1c after Laparoscopic Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in an Ethnically Diverse Population (original) (raw)
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Obesity Surgery, 2020
Objective To evaluate the impact of laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) on gastroesophageal reflux disease (GERD) in patients with obesity. Methods Patients with class II or III obesity were treated with LSG or LRYGB. Procedure choice was based on patients and surgeon preferences. GERD symptoms, endoscopy, barium swallow X-ray, esophageal manometry, and 24-h pH monitoring were obtained before and 1 year after surgery. Results Seventy-five patients underwent surgery (83% female, 39.3 ± 12.1 years, BMI of 41.5 ± 5.1 kg/m 2): 35 (46.7%) had LSG and 40 (53.3%) LRYGB. LSG patients had lower BMI (40.3 ± 4.0 kg/m 2 vs. 42.7 ± 5.7 kg/m 2 ; p = 0.041) and trend toward lower prevalence of GERD (20% vs. 40%; p = 0.061). One year after surgeries, GERD was more frequent in LSG patients (74% vs. 25%; p < 0.001) and all LSG patients with preoperative GERD continue to have GERD postoperatively. De novo GERD occurred in 19 of 28 (67.9%) of LSG patients and 4 of 24 (16.7%) patients treated with LRYGB (OR 10.6, 95%CI 2.78-40.1). Independent predictors for post-operative GERD were as follows: LSG (OR 12.3, 95%CI 2.9-52.5), preoperative esophagitis (OR 8.5, 95% CI 1.6-44.8), and age (OR 2.0, 95%CI 1.1-3.4). Conclusions One year after surgery, persistent or de novo GERD were substantially more frequent in patients treated with LSG compared with LRYGB. LSG was the strongest predictor for GERD in our trial. Preoperative counseling and choice of bariatric surgical options must include a detailed assessment and discussion of GERD-related surgical outcomes.
Biomedical Journal of Scientific and Technical Research, 2020
Purpose: GERD is one of the complications of bariatric operations that my affect quality of life. Our aim is to perform a retrospective cohort study to determine the incidence of symptomatic GERD following different types of bariatric surgery and which operations are considered a contraindication of GERD. In addition, we are attempting to identify the risk factors of GERD after bariatric surgery. Materials and Methods: Medical records of 729 patients hospitalized for bariatric surgery between January 2010 and June 2019 in Shamir (Assaf Harofeh) Medical Center were reviewed. Results: There were significant difference between the type of the bariatric procedure and the incidence of GERD symptoms after the operation. The incidence of symptomatic GERD in patients who underwent SG was 39.9% (p =0.0131). This was significantly higher comparing to 16.4% following roux en y gastric bypass, 23.4% following LAGB, and 11% following OAGB. 113 patients out of 718 had a positive swallow test and of these patient 71 developed GERD symptoms post-operatively without correlation to the degree of reflux at the swallow test but with statistically significant correlation to the type of operation especially for SG (P value <0.001) and to our knowledge this was never reported in the literature. Conclusion: SG is a good bariatric procedure option but should be contraindicated in asymptomatic reflux contrast swallow study and symptomatic GERD patients preoperatively because of high levels of symptomatic GERD post-operatively. Asymptomatic reflux at contrast swallow study pre-operatively should be considered a risk factor for GERD after the operation.
Surgery for Obesity and Related Diseases, 2019
Background: The development of gastroesophageal reflux disease (GERD) after laparoscopic sleeve gastrectomy (LSG) is a major concern as it affects the quality of life of the patients and potentially exposes them to the complications of GERD. The reported incidence of GERD after LSG is up to 35%. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the procedure of choice for patients with morbid obesity with GERD but objective evidence based on physiologic studies for the same are limited. Objective: The objectives of the study were to determine the physiologic changes related to gastroesophageal reflux based on symptoms index, 24-hour pH study, impedance, and manometry after LSG and LRYGB. Settings: Tertiary care teaching hospital, India. Methods: This registered study (CTRI/2017/06/008834) is a prospective, nonrandomized, openlabel clinical trial comparing the incidence of GERD after LSG and LRYGB. In this study, non-GERD patients were evaluated for GERD based on clinical questionnaires, 24-hour pH study, and impedance manometry preoperatively and 6 months postoperatively. Results: Thirty patients underwent LSG, and 16 patients underwent LRYGB. The mean DeMeester score increased from 10.9 6 11.8 to 40.2 6 38.6 (P 5 .006) after LSG. The incidence of GERD after LSG was 66.6%. The increase in DeMeester score from 9.5 6 4.6 to 12.2 6 17.2 after LRYGB was not significant (P 5 .7). There was a significant increase in the nonacid reflux both after LSG and LRYGB. Conclusion: The incidence of GERD after LSG is high, making it a contraindication for LSG. LRYGB remains the preferred procedure for patients with GERD. However, more studies are needed to understand the physiologic changes in patients with preexisting GERD. (Surg Obes Relat Dis 2019;-:1-9.
Surgery for Obesity and Related Diseases, 2014
Background: Roux-Y Gastric Bypass is a frequently used technique in bariatric surgery. Postoperative anatomy is altered by exclusion of the stomach, which makes this organ inaccessible for future esophagogastroduodenoscopy (EGD). The value of preoperative assessment of the stomach is unclear. Some institutions choose to investigate the future remnant stomach by EGD, others do not. Aim of the present study is to quantify the yield of preoperative EGD in our institution. Methods: Patients, planned for primary laparoscopic Roux-Y Gastric Bypass (LRYGB) or laparoscopic sleeve gastrectomy from December 2007 until August 2012, were screened by EGD in advance. Results of EGD and patient characteristics were retrospectively analyzed and categorized according to a classification system based on intervention needed. Results: 523 patients (122 male, 401 female, mean age 44.3 years, average BMI 46.6) underwent preoperative EGD. In 257 patients (48.9%) no abnormality was found (group A), 117 patients (17.2%) had abnormalities without treatment consequences (B1), 84 patients (of the 326 tested [comment #1, reviewer #1, 26.8%] were H. Pylori positive (B2), in 75 (14.3%) treatment with proton pump inhibitors was required (B3), 6 (1.1%) required follow up EGD before surgery (C). For1 patient (0.2%) the operation was canceled because preoperative EGD presented with Barrett's esophagus with carcinoma (D). When all abnormalities were taken into account, baselines did show a significant difference for age, gender and reflux symptoms. Conclusion: Standard preoperative assessment by EGD in patients who are planned for bariatric surgery is not indicated. The number needed to screen to find clinically significant abnormalities is high. (Surg Obes Relat Dis 2014;10:411-418.) r Obesity, defined as a body mass index (BMI) of 430 kg/ m², is an increasing problem in the Western World. In the United States, the prevalence is around 30% in the adult population [1]. The incidence is increasing and predictions of the World Health Organization indicate that by 2015, approximately 2.3 billion adults will be overweight and 4700 million will be obese . Bariatric surgery offers the only long lasting treatment with excellent effects on co-morbidity and weight loss for (morbid) obesity (BMI 440 or BMI 435 with co-morbidity) .
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2021
Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the treatment of choice for obesity with gastroesophageal reflux disease (GERD). There are few reports showing objective data based on esophageal function tests (EFTs). The aim of our study was to evaluate the influence of LRYGB on GERD. Methods: Candidates for laparoscopic sleeve gastrectomy (LSG) underwent preoperative esophageal manometry (EM) and 24-hour pH monitoring. Based on the negative influence of LSG on GERD, patients with abnormal pH were offered LRYGB. Those patients repeated EFTs, esophagogastroduodenoscopy, and symptom questionnaire 1 year after surgery. Results: Two hundred fifty LSG candidates underwent preoperative EFTs; 38% were redirected to LRYGB due to abnormal pH and 13 (18%) completed EFTs postoperatively. In ten women, age: 40-7 years, body mass index: 41-1 kg/m 2. EM: lower esophageal sphincter (LES) length increased from 2.6 to 2.9 cm (P = not statistically significant [NS]), and LES pressure decreased from 15 to 14.2 mmHg (P = NS). Preoperatively, LES was normotensive in 12 (92%) patients and postoperatively in 11 (85%) (P = NS). DeMeester score decreased from 35.7 to 11 (P < .001). Postoperatively, 9 (69%) patients resolved their GERD, 3 (23%) improved, and 1 (8%) remained the same (P < .001). Symptoms decreased significantly after surgery. Two patients (15%) had Grade A esophagitis. One of them was able to resolve it, while the other 1 remained the same. Conclusions: Our preliminary data showed that after LRYGB, LES pressure remained the same and DeMeester score decreased, while 69% of patients resolved their GERD. Therefore, LRYGB seems to be an excellent option for obesity and GERD.
Gastro-Esophageal Reflux Disease Outcomes After Vertical Sleeve Gastrectomy and Gastric Bypass
Annals of Surgery, 2021
Objective: The objective of this study is to assess whether vertical sleeve gastrectomy (VSG) increases the incidence of gastroesophageal reflux disease (GERD), esophagitis and Barrett esophagus (BE) relative to patients under- going Roux-en-Y gastric bypass (RYGB) in patients with and without preoperative GERD. Summary of Background Data: Concerns for potentiation of GERD, sup- ported by multiple high-quality retrospective studies, have hindered greater adoption of the VSG. Methods: From the OptumLabs Data Warehouse, VSG and RYGB patients with 2 years enrollment were identified and matched by follow-up time. GERD [reflux esophagitis, prescription for acid reducing medication (Rx) and/or diagnosis of BE], upper endoscopy (UE), and re-admissions were evaluated beyond 90 days. Results: A total of 8362 patients undergoing VSG were matched 1:1 to patients undergoing RYGB, on the basis of post-operative follow-up interval. Age, sex, and follow-up time were similar between the 2 groups (P > 0.05). Among all patients, postoperative GERD was more frequently observed in VSG patients relative to RYGB patients (60.2% vs 55.6%, respectively; P < 0.001), whereas BE was more prevalent in RYGB patients (0.7% vs 1.1%; P 1⁄4 0.007). Postoperatively, de novo esophageal reflux symptomatology was more common in VSG patients (39.3% vs 35.3%; P < 0.001), although there was no difference in development of the histologic diagnoses reflux esophagitis and BE. Further- more, postoperative re-admission was higher in the RYGB cohort (38.9% vs 28.9%; P < 0.001). Conclusions: Compared to RYGB, VSG may not have inferior long-term GERD outcomes, while also leading to fewer re-hospitalizations. These data challenge the prevailing opinion that patients with GERD should undergo RYGB instead of VSG.
Purpose Assess the subjective impact of GERD symptoms on patients undergoing revision from LSG to OAGB using the Diagnostic Questionnaire for GERD (DRQ) and the GERD-health related quality of life score (GERD-HRQL), prior to- and following conversion. Methods Patients undergoing revision from LSG to OAGB were prospectively followed between May 2015 and December 2020. Data retrieved included demographics, anthropometrics, previous bariatric history, time interval between LSG and OAGB, weight loss and co-morbidities. Pre- and post-OAGB DRQ and GERD-HRQL questionnaires were obtained. In case of sleeve dilatation, a partial gastrectomy was performed. Results During the study period, 37 patients underwent revision from LSG to OAGB. Mean age at LSG and pre-OAGB were 38 ± 11.74 and 46 ± 12.75, respectively. Median follow-up time was 21.5 months (range 3–65). DRQ and GERD-HRQL scores were obtained at a median of 14 months (range 3–51) between pre- and post-OAGB. Median RDQ score pre-OAGB vs...
Surgical Endoscopy, 2020
Background Recent reports have demonstrated that de novo reflux and worsening of pre-existing symptoms occur after SG; concerns are still expressed about the risk of symptomatic biliary reflux gastritis and oesophagitis. The aim of our study was to investigate and compare the rate of postoperative acid and non-acid reflux following Mini-/One anastomosis gastric bypass (MGB/OAGB) and laparoscopic sleeve gastrectomy (LSG). Study design A prospective randomized open-label, controlled trial registered on clinicaltrial.gov (NCT number: NCT02987673) has been carried out to evaluate esophagogastric junction exposure to reflux in the first year after MGB/OAGB and LSG using high impedance manometry, endoscopy, and a validated questionnaire. Results A total of 58 individuals were eventually enrolled in this trial and represented the per-protocol population (n = 28 MGB/OAGB, n = 30 LSG). No difference was found between the two groups in terms of demographic characteristics, PAGI-SYM score, aci...
Madalosso The Impact of Gastric Bypass on Gastroesophageal Reflux Disease ann surg 2010
To assess the impact of gastric bypass (GBP) on gastroesophageal reflux disease (GERD) based on Montreal Consensus. Methods: In this study, 86 patients (25 men; aging 38 Ϯ 12 years; body mass index 45 ͓35-68 kg/m 2 ͔) were investigated for GERD before GBP and 6 months later. Esophageal and extraesophageal syndromes were assessed based on Montreal Consensus. Esophageal acid exposure and gastric pouch acidity were also evaluated. Results: Overall prevalence of GERD was 64% before GBP and 33% after GBP (P Ͻ 0.0001). Typical reflux syndrome (TRS) was present in 47 patients (55%) preoperatively and disappeared in 39 of them (79%) post-GBP. Out of 39 patients with no symptoms, 4 (10%) developed TRS postoperatively (P Ͻ 0.0001). The chief TRS complaint changed from heartburn pre-GBP (96%) to regurgitation post-GBP (64%). Esophageal mucosa improved in 27, was unchanged in 51, and worsened in 8 patients (P ϭ 0.001) in regard of esophagitis. Extraesophageal syndromes were present in 16 patients preoperatively and in none but one post-GBP (P ϭ 0.0003). GERD-related well being and use of proton pump inhibitors were both improved after GBP. Total acid exposure decreased from a median (interquartile range, 25%-75%) of 5.1% (range, 2-8.2) to 1.1% (range, 0.2-4.8), P ϭ 0.0002. Most patients (86%) showed and acid gastric pouch in fasting conditions post-GBP. Conclusions: GBP ameliorated GERD syndromes in most patients 6 months after the procedure, resulting in quality of life improvement and less proton pump inhibitors usage. Whether regurgitation post-GBP corresponds to reflux disease or bad eating behavior deserves further studies.
Surgery for Obesity and Related Diseases, 2020
Background: Laparoscopic Roux-en-Y (LRYGB) gastric bypass is an effective treatment for morbid obesity. Acid-related complications after LRYGB could be prevented by prophylactic proton pump inhibition (PPI). Objective: To identify the effect of PPI prophylaxis on short-term, acid-related complications in a large cohort. Setting: National Registry, Sweden. Methods: A total of 37,301 patients who underwent LRYGB in Sweden from 2009 to 2014 were identified in the Scandinavian Obesity Surgery Registry. Patient-specific factors were cross matched with socioeconomic variables and information on PPI dispensation. A logistic regression model was used to analyze acid-related complications (e.g., marginal ulcer, stricture, and perforation) within 30 days and at 1 year postoperatively. Results: PPI prophylaxis did not reduce the rate of acid-related complications. Instead, prolonged operation time (odds ratio [OR] 2.19 [1.53-3.13]) and immigrant background (OR 1.72 [1.17-2.53]) increased the risk of marginal ulcer within 30 days. At 1 year, medical treatment for diabetes (OR 1.75 [1.14-2.67]) and dyspepsia (OR 1.71 [1.06-2.75]), larger gastric pouch (OR 2.19 [1.528-3.248]), longer operation time (OR 1.67 [1.11-2.51]), smoking (OR 2.59 [1.77-3.78]), and immigrant background (OR 1.60 [1.08-2.36]) increased the risk for marginal ulcer, while older age (OR 2.20 [1.05-4.63]) predisposed for stricture. Inferior weight loss was associated with marginal ulcer at 1 year (OR 1.50 [1.04-2.15]). Conclusion: PPI prophylaxis did not reduce the risk for marginal ulcer and stricture. The risk for these complications was increased by several co-morbidities, smoking, immigrant background, and surgical factors. Routine use of PPI prophylaxis cannot be recommended, but smoking cessation and optimal surgery could be important.