Bariatric surgeries, such as Roux-en-Y gastric bypass (RYGB) or vertical sleeve gastrectomy (VSG)... more Bariatric surgeries, such as Roux-en-Y gastric bypass (RYGB) or vertical sleeve gastrectomy (VSG), are the most effective approaches to resolve type 2 diabetes in obese individuals. Alimentary glucose absorption and intestinal disposal of blood glucose have not been directly compared between individuals or animals that underwent RYGB vs VSG. We evaluated in rats and humans how the gut epithelium adapts following surgery and the consequences on alimentary glucose absorption and intestinal disposal of blood glucose. Obese male rats underwent RYGB, VSG, or sham (control) surgeries. We collected intestine segments from all rats; we performed histologic analyses and measured levels of mRNAs encoding the sugar transporters SGLT1, GLUT1, GLUT2, GLUT3, GLUT4 and GLUT5. Glucose transport and consumption were assayed using ex vivo jejunal loops. Histologic analyses were also performed on Roux limb sections from patients who underwent RYGB, 1-5 years after surgery. Roux limb glucose consumptio...
ABSTRACT IntroductionVictim of medical imaging technologies (VOMIT) is a term coined by a pediatr... more ABSTRACT IntroductionVictim of medical imaging technologies (VOMIT) is a term coined by a pediatric neurosurgeon to describe anxiety-inducing false-positive results on radiologic imaging [1]. Morbidly obese patients have a low functional physiological reserve that constrains to a fast diagnostic work-up, and an aggressive and early treatment of potential complications [2]. Upper gastrointestinal contrast study (UGI) is a useful modality to detect functional and surgical complications after sleeve gastrectomy (SG) [3]. However, in some cases, the residual gastric tube is floppy, and the findings are hard to interpret. In this paper, we present a simple trick which aims to prevent SG patients from suffering physically as well as mentally and from undergoing unnecessary further diagnostic interventions due to a false-positive UGI finding.DiscussionIdeally, in SG patients, an UGI helps to rule out surgical (staple-line leak, abscess, twist of the gastric tube, mid-gastric stenosis) or functional (h ...
ABSTRACT Thromboembolic episodes and septic surgical complications are the most life-threatening ... more ABSTRACT Thromboembolic episodes and septic surgical complications are the most life-threatening postoperative issues following bariatric surgery.Bariatric surgery (BS) is now a common and usually uneventful treatment for morbid obesity. However, a growing number of postoperative adverse outcomes have been reported over the last decade. As a result of the widespread diffusion of these techniques, many intensivists outside of specialist BS centres will be required to address these complex issues. Most of these complications occur during the first postoperative weeks [1]. One of the major threats remains a septic surgical complication often marked by misleading symptoms.The paucity of information concerning the management of BS cases is a key issue. Most of our medical concepts in relation to this new paradigm are based on extrapolations from management in non-obese cases. Reports comprising experiences of supportive ICU care, such as nursing management, mechanical ventilation, monitoring systems ...
Roux-en-Y gastric bypass procedure is an effective treatment for morbid obesity. One of the most ... more Roux-en-Y gastric bypass procedure is an effective treatment for morbid obesity. One of the most frequent complications after this operation is the appearance of a gastrojejunal anastomotic stricture. Mechanisms underlying the development of such complication are unclear. The aim of the present retrospective study was to compare the rates of gastrojejunostomy stricture between the antecolic and retrocolic technique in a large cohort of patients undergoing Roux-en-Y gastric bypass for morbid obesity, with the same gastrojejunal anastomotic technique. University Hospital, France. From November 2000 to March 2012, 1500 patients underwent laparoscopic Roux-en-Y gastric bypass. The antecolic and the retrocolic technique were used in respectively 572 and 928 consecutive patients. All procedures were performed using a circular stapled gastrojejunostomy and absorbable sutures. There was no significant difference with respect to gender, age, body mass index, and obesity related co-morbidities between both groups. Patients were followed for 24-146 months (mean 67.5 mo). Fifty-one patients developed a gastrojejunal stricture (3.4%), 37 in the antecolic group (6.5%) and 14 in the retrocolic group (1.5%). The difference was significant (P< .0001). The mean time to onset of gastrojejunal stricture symptoms after surgery was 1 month, ranging from 1 to 3 months. All patients were successfully treated using Savary-Gilliard dilatators. All patients with a gastrojejunal stricture were followed up for a minimum of 36 months. No recurrence was observed and no revisional surgery was needed. Weight loss was similar in patients who developed an anastomotic stricture compared with those without stricture. In the antecolic group internal hernia occurred in 12 of the 110 with no closure of mesenteric defects and in 8 of the 462 (1.7%) with defects closed. In the retrocolic group, 11 patients (1.2%) developed an internal hernia. A significant lower gastrojejunal stricture rate was observed in the retrocolic group, with no increased risk of internal hernia, when mesenteric defects were closed. The antecolic technique seems to be a risk factor for gastrojejunal stricture development after laparoscopic gastric bypass.
Marginal ulcer can be a serious complication after laparoscopic gastric bypass surgery. The aim o... more Marginal ulcer can be a serious complication after laparoscopic gastric bypass surgery. The aim of this study was to compare the rates of marginal ulcer between the antecolic and the retrocolic technique, in a large cohort of patients. Over a near 10-year period, 1,142 patients underwent laparoscopic gastric bypass surgery. The antecolic and the retrocolic technique were used in respectively 572 and 570 consecutive patients. All procedures were performed using a circular stapled gastrojejunostomy. Patients were followed for 18 to 99 months (mean 48.8 months). During follow-up, 46 patients developed a marginal ulcer (4 %), 32 in the antecolic group (5.6 %) and 14 in the retrocolic group (2.5 %). Nineteen patients (3.3 %) in the antecolic group and eight patients in the retrocolic group (1.4 %) developed early marginal ulcer (i.e., within 3 months after surgery). The mean time to onset of anastomotic ulcer symptoms after surgery was 11 months (range 0.25-72). Forty-four patients were ...
... Reprint requests to: AR Ahmed, MD, University of Rochester Medical Center, Department of Bari... more ... Reprint requests to: AR Ahmed, MD, University of Rochester Medical Center, Department of Bariatric Surgery, Highland Hospital, 1000 South Ave., Rochester NY ... routine, the small bowel was divided approx-imately 30 cm distal to the ligament of Treitz with the GIA-45 stapler. ...
Bariatric surgeries, such as Roux-en-Y gastric bypass (RYGB) or vertical sleeve gastrectomy (VSG)... more Bariatric surgeries, such as Roux-en-Y gastric bypass (RYGB) or vertical sleeve gastrectomy (VSG), are the most effective approaches to resolve type 2 diabetes in obese individuals. Alimentary glucose absorption and intestinal disposal of blood glucose have not been directly compared between individuals or animals that underwent RYGB vs VSG. We evaluated in rats and humans how the gut epithelium adapts following surgery and the consequences on alimentary glucose absorption and intestinal disposal of blood glucose. Obese male rats underwent RYGB, VSG, or sham (control) surgeries. We collected intestine segments from all rats; we performed histologic analyses and measured levels of mRNAs encoding the sugar transporters SGLT1, GLUT1, GLUT2, GLUT3, GLUT4 and GLUT5. Glucose transport and consumption were assayed using ex vivo jejunal loops. Histologic analyses were also performed on Roux limb sections from patients who underwent RYGB, 1-5 years after surgery. Roux limb glucose consumptio...
ABSTRACT IntroductionVictim of medical imaging technologies (VOMIT) is a term coined by a pediatr... more ABSTRACT IntroductionVictim of medical imaging technologies (VOMIT) is a term coined by a pediatric neurosurgeon to describe anxiety-inducing false-positive results on radiologic imaging [1]. Morbidly obese patients have a low functional physiological reserve that constrains to a fast diagnostic work-up, and an aggressive and early treatment of potential complications [2]. Upper gastrointestinal contrast study (UGI) is a useful modality to detect functional and surgical complications after sleeve gastrectomy (SG) [3]. However, in some cases, the residual gastric tube is floppy, and the findings are hard to interpret. In this paper, we present a simple trick which aims to prevent SG patients from suffering physically as well as mentally and from undergoing unnecessary further diagnostic interventions due to a false-positive UGI finding.DiscussionIdeally, in SG patients, an UGI helps to rule out surgical (staple-line leak, abscess, twist of the gastric tube, mid-gastric stenosis) or functional (h ...
ABSTRACT Thromboembolic episodes and septic surgical complications are the most life-threatening ... more ABSTRACT Thromboembolic episodes and septic surgical complications are the most life-threatening postoperative issues following bariatric surgery.Bariatric surgery (BS) is now a common and usually uneventful treatment for morbid obesity. However, a growing number of postoperative adverse outcomes have been reported over the last decade. As a result of the widespread diffusion of these techniques, many intensivists outside of specialist BS centres will be required to address these complex issues. Most of these complications occur during the first postoperative weeks [1]. One of the major threats remains a septic surgical complication often marked by misleading symptoms.The paucity of information concerning the management of BS cases is a key issue. Most of our medical concepts in relation to this new paradigm are based on extrapolations from management in non-obese cases. Reports comprising experiences of supportive ICU care, such as nursing management, mechanical ventilation, monitoring systems ...
Roux-en-Y gastric bypass procedure is an effective treatment for morbid obesity. One of the most ... more Roux-en-Y gastric bypass procedure is an effective treatment for morbid obesity. One of the most frequent complications after this operation is the appearance of a gastrojejunal anastomotic stricture. Mechanisms underlying the development of such complication are unclear. The aim of the present retrospective study was to compare the rates of gastrojejunostomy stricture between the antecolic and retrocolic technique in a large cohort of patients undergoing Roux-en-Y gastric bypass for morbid obesity, with the same gastrojejunal anastomotic technique. University Hospital, France. From November 2000 to March 2012, 1500 patients underwent laparoscopic Roux-en-Y gastric bypass. The antecolic and the retrocolic technique were used in respectively 572 and 928 consecutive patients. All procedures were performed using a circular stapled gastrojejunostomy and absorbable sutures. There was no significant difference with respect to gender, age, body mass index, and obesity related co-morbidities between both groups. Patients were followed for 24-146 months (mean 67.5 mo). Fifty-one patients developed a gastrojejunal stricture (3.4%), 37 in the antecolic group (6.5%) and 14 in the retrocolic group (1.5%). The difference was significant (P< .0001). The mean time to onset of gastrojejunal stricture symptoms after surgery was 1 month, ranging from 1 to 3 months. All patients were successfully treated using Savary-Gilliard dilatators. All patients with a gastrojejunal stricture were followed up for a minimum of 36 months. No recurrence was observed and no revisional surgery was needed. Weight loss was similar in patients who developed an anastomotic stricture compared with those without stricture. In the antecolic group internal hernia occurred in 12 of the 110 with no closure of mesenteric defects and in 8 of the 462 (1.7%) with defects closed. In the retrocolic group, 11 patients (1.2%) developed an internal hernia. A significant lower gastrojejunal stricture rate was observed in the retrocolic group, with no increased risk of internal hernia, when mesenteric defects were closed. The antecolic technique seems to be a risk factor for gastrojejunal stricture development after laparoscopic gastric bypass.
Marginal ulcer can be a serious complication after laparoscopic gastric bypass surgery. The aim o... more Marginal ulcer can be a serious complication after laparoscopic gastric bypass surgery. The aim of this study was to compare the rates of marginal ulcer between the antecolic and the retrocolic technique, in a large cohort of patients. Over a near 10-year period, 1,142 patients underwent laparoscopic gastric bypass surgery. The antecolic and the retrocolic technique were used in respectively 572 and 570 consecutive patients. All procedures were performed using a circular stapled gastrojejunostomy. Patients were followed for 18 to 99 months (mean 48.8 months). During follow-up, 46 patients developed a marginal ulcer (4 %), 32 in the antecolic group (5.6 %) and 14 in the retrocolic group (2.5 %). Nineteen patients (3.3 %) in the antecolic group and eight patients in the retrocolic group (1.4 %) developed early marginal ulcer (i.e., within 3 months after surgery). The mean time to onset of anastomotic ulcer symptoms after surgery was 11 months (range 0.25-72). Forty-four patients were ...
... Reprint requests to: AR Ahmed, MD, University of Rochester Medical Center, Department of Bari... more ... Reprint requests to: AR Ahmed, MD, University of Rochester Medical Center, Department of Bariatric Surgery, Highland Hospital, 1000 South Ave., Rochester NY ... routine, the small bowel was divided approx-imately 30 cm distal to the ligament of Treitz with the GIA-45 stapler. ...
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