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Upper GI Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Nicola C Tanner, Chris Collins
What other early and late complications can occur after a laparoscopic Roux-en-Y gastric bypass?Bleeding from the staple lines and anastomoses can occur as an early complication in up to 4%. This usually presents as melaena and typically settles with non-operative measures.Late complications includes strictures at the pouch-enterostomy in up to 5% (managed with endoscopic dilatation), vitamin and mineral deficiencies (due to unavailability of duodenum/proximal jejunum for absorption) and internal hernias.There are several potential sites of internal hernias following LRYGB. (Petersen defect, mesocolic defect, jejuno-jejunostomy defect). The rate of internal hernia and potential bowel ischaemia is at least 2% over the initial 1–2 years. It is important to be aware of this late complication as the potential spaces following bypass surgery become larger as weight loss progresses.
Surgical management of diabetes
Published in Janet Titchener, Diabetes Management, 2020
Roux-en-Y gastric bypass This is the most frequently performed bariatric surgery. As illustrated in Figure 6.1, RYGB begins with the surgical formation of a small stomach pouch. The small intestine is then cut about 75 cm below the stomach. The distal cut end of the small intestine is pulled up and connected to the small stomach pouch (forming one arm of the ‘Y’) so that ingested food bypasses most of the stomach and part of the small intestine, reducing nutrient absorption. The proximal cut end of the small intestine is then connected to the distal segment of the small intestine (forming the second arm of the ‘Y’) so that gastric juices, bile and pancreatic exocrine products can enter the duodenum.
Reproductive effects of obesity in adolescents
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Whitney Wellenstein, Nichole Tyson
Bariatric surgery in adolescents will likely increase as the prevalence and severity of childhood obesity rises. The specific indications and patient criteria for bariatric surgery in adolescents are still being developed. However, it is generally agreed that those with severe obesity (BMI >40) with obesity-related health conditions who have unsuccessfully attempted weight loss with nonsurgical options are good candidates.55 Surgery timing is ideally delayed until mid to late teen years, when skeletal maturity is reached. The risks of bariatric surgery vary depending on which procedure is used. Laparoscopic sleeve gastrectomy and adjustable gastric band are both restrictive procedures. The sleeve gastrectomy carries risks of bleeding, ulcers, gastroesophageal reflux disease, and staple disruption, while the adjustable band can have band slippage and/or erosion.55 The Roux-en-Y gastric bypass surgery is a restrictive and malabsorptive procedure. It is the most effective for weight loss but carries more risks. Short-term risks include anastomotic leak and bowel obstruction, while long-term risks include nutritional deficiencies, dumping syndrome, and complications of the caliber of the bowel anastomosis.55
Endoscopic ultrasound‑guided biliary drainage in patients with surgically altered anatomy: a systematic review and Meta‑analysis
Published in Scandinavian Journal of Gastroenterology, 2023
Yuki Tanisaka, Masafumi Mizuide, Akashi Fujita, Ryuhei Jinushi, Rie Shiomi, Takahiro Shin, Dai Hirata, Rie Terada, Tomoaki Tashima, Yumi Mashimo, Shomei Ryozawa
Figure 1 shows the flow diagram for the selection of studies. The initial search identified 1195 articles, of which 24 studies were retained for full-text review. Of these, 18 studies met our inclusion criteria for analysis [22–39]. The details of these studies are provided in Table 1. These 18 studies provided a total sample of 409 patients with SAA and a sample of 881 patients including both individuals with a normal anatomy and SAA. The proportions of SAA ranged from 14.5% to 100%, with a pooled SAA proportion of 55.8% (95% CI, 39.9–71.6%) (Figure 2). The percentage of variability attributable to heterogeneity was 98.8% (I2 = 98.8%), indicative of high heterogeneity. Roux-en-Y anatomy (e.g., Roux-en-Y gastrectomy, Roux-en-Y gastric bypass and epaticojejunostomy with Roux-en-Y) occupied the most among SAA, as long as the data were extracted. Three studies used a prospective cohort design [23,26,37], whereas the others were retrospective cohort studies. Among the retrospective cohort studies, a multicenter cohort was used in six studies [25,28,30,35–37]. Although most studies included both patients with SAA and normal anatomy, five studies included only patients with SAA [25,33,34,36,37]. There was one international study comparing EUS-BD and balloon enteroscopy-assisted ERCP in patients with SAA [25]. Supplementary Table 1 provides the details of the Newcastle–Ottawa score of the quality of the cohort studies included, with an average overall quality score of 6.9 (range, 6–8).
Continuous Jejunal Pouch and Residual Stomach Anastomosis Combined with Jejunal Lateral Anastomosis: An Improved Method of Gastrointestinal Reconstruction following Distal Gastrectomy
Published in Journal of Investigative Surgery, 2022
JiaQing Gong, Bin Wang, JunQing Wang, YunMing Li, YongKuan Cao, Wei Li, Min Shang, Ling Huang
Although Billroth II is a simple procedure that maintains jejunal continuity, the large amount of alkaline intestinal fluid may freely flow back into the stomach cavity, which is the biggest drawback of this surgical technique, and may cause many consequences such as reflux gastritis and anastomotic ulcer.14,15 Roux-en-Y reconstruction is a relatively complicated procedure; however, it overcomes the problem of alkaline intestinal reflux. Moreover, Roux-en-Y reconstruction also interrupts jejunal continuity, which may cause many intractable long-term complications, such as anastomotic ulcer bleeding.4 Our innovative digestive tract reconstruction, Contin-L procedure, successfully discarded the deficiencies of both Billroth II and Roux-en-Y procedures. Moreover, it combined the advantages of both surgical methods, thereby significantly reducing surgical complications.
Current and emerging gluconeogenesis inhibitors for the treatment of Type 2 diabetes
Published in Expert Opinion on Pharmacotherapy, 2021
The most direct approach to improve lipid metabolism is by promoting loss of adipose tissue through weight loss. Bariatric surgery has been the most effective weight loss treatment. The Roux en Y gastric bypass procedure has been the most successful long-term procedure resulting in an approximate 30% reduction in the initial body weight after four years [142]. Reduction in gluconeogenesis following a bariatric procedure is rapid, not strictly related to progressive loss of adipose tissue, with reduced expression of key gluconeogenic enzymes [143–146]. The rapid reduction in hepatic gluconeogenesis is accompanied by an increase in intestinal gluconeogenesis [6,145,146]. Bariatric surgery results in a significant post-operative increase in gut peptides, notably GLP-1, which stimulates insulin secretion and reduces post-prandial glucagon levels, further suppressing gluconeogenesis [147].