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Gastric bypass: Technical aspects and long-term results
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Roux-en-Y gastric bypass (RYGBP) achieves superior short- and long-term weight loss compared to other weight loss modalities. Different operative techniques have been developed to technically facilitate the surgical procedure, with consequences in the form of an array of postoperative complications and gastrointestinal symptoms. Furthermore, as our follow-up on operated patients extends beyond the first postoperative years, it becomes apparent that a significant number of patients experience unsatisfactory weight result. Current research is just starting to chart factors associated with postoperative long-term weight regain with the ultimate goal of preventing it.

In Paper I it is found that the linear stapled technique for the gastrojejunostomy in laparoscopic RYGBP is associated with shorter operative time, in-hospital stay and a lower incidence of surgical site infections and anastomotic strictures compared to the circular stapled technique. Paper II demonstrates that, despite no differences in weight result, the 21-mm circular stapled technique for the gastrojejunostomy is associated with a higher incidence of vomiting and endoscopic anastomotic dilatations compared to the 25-mm circular stapled technique and the linear stapled technique in the long-term after RYGBP. Paper III shows that despite differences in body composition, long-term weight responders and non-responders after RYGBP did not differ in resting, glucose-induced or activity-related energy expenditure. Lastly Paper IV shows long-term weight result is associated with fasting levels of leptin and ghrelin, and that the response of these hormones to a glucose load might contribute to perpetuate obesity.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. , 67 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1324
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-319510ISBN: 978-91-554-9889-4 (print)OAI: oai:DiVA.org:uu-319510DiVA: diva2:1087127
Public defence
2017-05-27, Enghoffsalen, Akademiska sjukhuset, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2017-05-04 Created: 2017-04-05 Last updated: 2017-06-08
List of papers
1. Differences in Early Complications between Circular and Linear Stapled Gastrojejunostomy in Laparoscopic Gastric Bypass
Open this publication in new window or tab >>Differences in Early Complications between Circular and Linear Stapled Gastrojejunostomy in Laparoscopic Gastric Bypass
2014 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, no 4, 599-603 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND

Laparoscopic gastric bypass (LGBP) is the most common bariatric procedure worldwide. The gastrojejunostomy can be stapled with a circular or linear stapler, each with their own specific advantages. We have evaluated differences in postoperative complications between the two techniques.

METHODS

We studied operative data and postoperative complications in 560 patients (79.8 % females, median age 42, BMI 42.5) operated with LGBP between 2008 and 2012 at our center. The gastrojejunostomy was initially performed using a circular stapler (CS) in 288 patients and later by linear stapler (LS) in 272. Complications, operative time, and length of stay were retrieved from our database. The risk of developing a port site infection was evaluated with multivariate logistic regression.

RESULTS

Port site infections were more common with CS than LS, 5.2 and 0.4 %, respectively (p < 0.01). Multivariate analysis demonstrated CS to be an independent risk factor for port site infections (OR 16.3 (2.09-126), p < 0.01), as well as for stomal ulcers (OR 10.1, 1.15-89, p = 0.04). Major postoperative complications remained unchanged (anastomotic leak 1.0 vs. 1.1 %, abscess 0.7 vs. 0.4 %), while operative time and length of stay were found to be shorter using the LS (122 vs. 83 min, p < 0.001 and 4 vs. 3 days, p < 0.001).

CONCLUSIONS

The linear stapled technique yielded lower incidence of port site infections, probably by avoiding the passage of a contaminated circular stapler through the abdominal wall. No difference in major complications was seen, but operative time was shorter using a linear stapler instead of a circular stapler.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-216391 (URN)10.1007/s11695-013-1139-0 (DOI)000334174500015 ()24323525 (PubMedID)
Available from: 2014-01-21 Created: 2014-01-21 Last updated: 2017-04-05Bibliographically approved
2. Gastrointestinal symptoms, weight loss and patient satisfaction 5 years after gastric bypass: a study of three techniques for the gastrojejunal anastomosis.
Open this publication in new window or tab >>Gastrointestinal symptoms, weight loss and patient satisfaction 5 years after gastric bypass: a study of three techniques for the gastrojejunal anastomosis.
2016 (English)In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 30, no 4, 1553-1558 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The optimal operative technique in gastric bypass (RYGB) is still under debate. We have studied patient-reported gastrointestinal symptoms and weight loss 5 years after RYGB performed with three different stapling techniques for the gastrojejunal anastomosis (GJ).

METHODS: Out of 593 patients operated with RYGB, 489 patients [80.2 % women, body mass index (BMI) 44.9 (33-68) kg/m(2)] answered our 5-year follow-up questionnaire concerning gastrointestinal symptoms (vomiting, reflux, dumping, abdominal pain or diarrhea), weight loss, need for postoperative endoscopic interventions and overall satisfaction with the procedure. We compared the results for three different GJ techniques: linear stapler (LS, n = 103), 21-mm circular stapler (C21, n = 88) and 25-mm circular stapler (C25, n = 298).

RESULTS: Dumping was the most commonly reported symptom (14.1 % of all patients on a weekly to daily basis), however, less frequently reported in the C25 group (p < 0.05). Vomiting, prevalent in 2.9 % of all patients, was more frequently reported in the C21 group (p < 0.01). No group consistently showed greater weight loss compared to the other two groups. A higher incidence of endoscopic dilatations due to strictures was reported in the C21 group (12.5 % compared to 4.5 % of all patients, p < 0.05). Overall patient satisfaction was high (88 %).

CONCLUSION: Our data suggest that the technique for the construction of the GJ in RYGB affects gastrointestinal symptoms 5 years postoperatively. The difference is moderate but indicates that a narrow GJ results in increased frequency of vomiting and need for endoscopic interventions without improving the weight result.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-290410 (URN)10.1007/s00464-015-4374-8 (DOI)000373022200042 ()26162421 (PubMedID)
Available from: 2016-04-29 Created: 2016-04-29 Last updated: 2017-04-05Bibliographically approved
3. Non-responders after gastric bypass surgery for morbid obesity: long-term weight result and energy expenditure
Open this publication in new window or tab >>Non-responders after gastric bypass surgery for morbid obesity: long-term weight result and energy expenditure
Show others...
(English)Manuscript (preprint) (Other academic)
Keyword
gastric bypass; REE; energy expenditure; RQ; insulin resistance; weight loss; long-term results
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-319509 (URN)
Available from: 2017-04-05 Created: 2017-04-05 Last updated: 2017-04-05
4. Non-responders after gastric bypass surgery for morbid obesity: Hormone response and glucose homeostasis during an oral glucose tolerance test
Open this publication in new window or tab >>Non-responders after gastric bypass surgery for morbid obesity: Hormone response and glucose homeostasis during an oral glucose tolerance test
(English)Manuscript (preprint) (Other academic)
Keyword
gastric bypass; incretins; leptin; weight loss; long-term results
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-319508 (URN)
Available from: 2017-04-05 Created: 2017-04-05 Last updated: 2017-04-05

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