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Roux-en-Y Gastric Bypass: Hand-assisted Laparoscopy and Investigation of the Excluded Stomach
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Roux-en-Y gastric bypass (RYGBP) sustains weight loss and ameliorates diseases common in the morbid obese (BMI>40 kg/m2), but leaves the stomach and duodenum inaccessible. Morbidly obese patients have increased operative risks and in other fields minimal surgery is known to facilitate the postoperative course.

The aim of this thesis was to evaluate hand-assisted laparoscopy in RYGBP and develop techniques to study the excluded stomach.

The hand-assisted technique was developed in 13 patients and subsequently compared to open surgery in a blinded, prospective, randomised trial of 50 patients.

Hand-assistance was feasible with a low need for conversions or re-operations. The duration of surgery was longer (150 versus 85 minutes) and postoperative results were similar to those in open surgery. Thus, the patients did not appear to derive benefits from hand-assisted laparoscopy. Interventional radiology accessed the excluded stomach and allowed endoscopy, barium studies and acid measurements. Chronic gastritis and low acid production were found. After RYGBP, 8 of 22 patients (36%) had duodenogastric bile reflux (DGBR), when studied by HIDA-scintigraphy. No DGBR was seen among controls. The gastric mucosa was evaluated by serology

(pepsinogen I (PGI), H. pylori and H,K-ATPase) in 64 patients before and 1-4 years after operation. RYGBP, in contrast to gastric restriction, had reduced PGI levels postoperatively. According to serology, the mucosa is atrophic or in a resting state.

This study focuses on safety in RYGBP. Hand-assisted laparoscopy was feasible, but not favourable compared to an optimised open procedure. The excluded stomach is no longer inaccessible and characterised by chronic gastritis, low acid production and frequent bile reflux.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2003. , p. 62
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1251
Keywords [en]
Surgery, gastric bypass, morbid obesity, laparoscopy
Keywords [sv]
Kirurgi
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-3468ISBN: 91-554-5604-9 (print)OAI: oai:DiVA.org:uu-3468DiVA, id: diva2:162955
Public defence
2003-05-23, Grönwallsalen, Ingång 70, Akademiska sjukhuset, Uppsala, 13:15
Opponent
Supervisors
Available from: 2003-04-28 Created: 2003-04-28Bibliographically approved
List of papers
1. Hand-assisted laparoscopic Roux-en-y gastric bypass: aspects of surgical technique and early results
Open this publication in new window or tab >>Hand-assisted laparoscopic Roux-en-y gastric bypass: aspects of surgical technique and early results
2000 In: Obesity Surgery, ISSN 0960-8923, Vol. 10, no 5, p. 420-427Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-90560 (URN)
Available from: 2003-04-28 Created: 2003-04-28Bibliographically approved
2. Hand-assisted laparoscopic versus open Roux-en-Y gastric bypass: a prospective, randomised study
Open this publication in new window or tab >>Hand-assisted laparoscopic versus open Roux-en-Y gastric bypass: a prospective, randomised study
(English)Article in journal (Refereed) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-90561 (URN)
Available from: 2003-04-28 Created: 2003-04-28 Last updated: 2013-08-15Bibliographically approved
3. Investigation of the excluded stomach after Roux-en-Y gastric bypass
Open this publication in new window or tab >>Investigation of the excluded stomach after Roux-en-Y gastric bypass
2001 In: Obesity Surgery, ISSN 0960-8923, Vol. 11, no 1, p. 25-27Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-90562 (URN)
Available from: 2003-04-28 Created: 2003-04-28Bibliographically approved
4. Duodenogastric bile reflux after gastric bypass: a cholescintigraphic study
Open this publication in new window or tab >>Duodenogastric bile reflux after gastric bypass: a cholescintigraphic study
2002 In: Digestive Diseases and Sciences, ISSN 0163-2116, Vol. 47, no 8, p. 1891-1896Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-90563 (URN)
Available from: 2003-04-28 Created: 2003-04-28Bibliographically approved
5. Reduction in serum pepsinogen I after Roux-en-Y gastric bypass
Open this publication in new window or tab >>Reduction in serum pepsinogen I after Roux-en-Y gastric bypass
Show others...
2003 (English)In: Journal of Gastrointestinal Surgery, ISSN 1091-255X, E-ISSN 1873-4626, Vol. 7, no 4, p. 529-535Article in journal (Refereed) Published
Abstract [en]

The excluded stomach after Roux-en-Y gastric bypass (RYGBP) cannot be readily examined by endoscopy for obvious anatomic reasons. Thus it is difficult to monitor possible changes in the gastric mucosa. However, the type and severity of gastritis can now be assessed by a combination of serologic tests: pepsinogen I and antibodies to Helicobacter pylori and H,K-ATPase. Morbidly obese patients were examined before and 1 to 4 years after surgery. A group of 34 patients (mean age 39 years, BMI 44 kg/m(2)) underwent RYGBP; another group of 30 patients (mean age 42 years, BMI 44 kg/m(2)) had simple gastric restriction and served as control subjects. All patients, except one in the control group, had normal titers of pepsinogen I before surgery. One year after RYGBP, pepsinogen I levels were significantly reduced, as compared to the control group (P<0.0001), and remained low throughout the study. The control group had stable pepsinogen I levels. In both groups, few patients had increased titers of H. pylori or H,K-ATPase antibodies, but these abnormalities remained unchanged. Low pepsinogen I levels, similar to those we observed in our RYGBP patients, have been linked to chronic atrophic gastritis. However, the absence of food stimulation in the excluded stomach could also be a reason for the low pepsinogen I levels.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-90564 (URN)10.1016/S1091-255X(03)00063-5 (DOI)12763411 (PubMedID)
Available from: 2003-04-28 Created: 2003-04-28 Last updated: 2017-12-14Bibliographically approved

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