The latter were conducted due to a variety of medical reasons such as inadequate or excessive weight loss, malnutrition, and upper gastro-intestinal bleeding. Cochrane Database Syst Rev. Complications were noted in 9.1% of the patients. The gastric bypass operation can be modified, to alter absorption of food, by moving the Roux-en-Y-connection distally down the jejunum, effectively shortening the bowel available for absorption of food. Applying in Philadelphia? Weight loss with vertical banded gastroplasty and Roux-en_Y gastric bypass for morbid obesity: Selective vs. random assignment. Restrictive versus malabsorptive procedures: Criteria for patient selection. cursor: pointer; Up to the 4th and 5th year, better weight loss (TBWL, EBMIL, EWL) was observed after RY-DS than after SADI-S. Chen et al (2021) noted that sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most commonly performed bariatric procedures globally, but both techniques have shortcomings. Ann Intern Med. AHRQ Publication No. Surgery for morbid obesity. Event rates were meta-analyzed using Comprehensive Meta-Analysis (CME) V3. Preliminary endoscopic technical report of a new silicone intragastric balloon in the treatment of morbid obesity. Mean BMI at inclusion was 39.8 kg/m2 (range of 35 to 49). Minnesota Multiphasic Personality Inventory 2 (MMPI-2) was recorded after 1 year of follow-up, and test scales were used to describe physiological phenomena. There were no major complications. Obesity Surg. Mean time to revision was 26 months (range of 2 to 60 months) and mean follow-up after RYGB was 20 months (range of 4 to 48 months). No included studies evaluated outcomes after prophylactic mesh during laparoscopic bariatric surgery. Few interventions included a primary care clinician as the primary interventionist over 3 to 12 months of individual counseling. Langer FB, Bohdjalian A, Shakeri-Leidenmhler S, et al. Between August 2013 and May 2014, ESG was performed on 10 patients using an endoscopic suturing device. There was significant heterogeneity in the reported outcomes, their definitions, and their categorization. London, UK: Wessex Institute for Health Research and Development, University of Southampton; 2001;1(18):1-10. Laparoscopic technique for performing duodenal switch with gastric reduction. The degree and histopathological discordance is dependent upon zonal location and types of injury. The modifications to gastric bypass surgery are designed to prevent post-surgical enlargement of the gastric pouch and stoma. The primary efficacy end-point was reduction in pre-RYGB excess weight by 15% or more excess BMI (calculated as weight in kilograms divided by height in meters squared) loss and BMI less than 35 at 12 months after the procedure. Andersson DP, Thorell A, Lfgren P, et al. A wide variety of instruments had been used and mean operating time was 94.6 minutes. Moreover, they stated that higher quality studies, including those in laparoscopic patients, and cost-utility analysis, are needed to support routine use of this intervention. The two groups were similar in age, gender, and BMI. Third, this report only provided results through 4 years of therapy and the number of participants in years 2 to 4 was less than in year 1; however, the durability of weight loss and relatively narrow band of 95% confidence intervals suggested robustness of the data. A retrospective review was completed for patients with a previous VBG presenting with weight regain between 2003 to 2010. While appropriate surgical procedures for severe obesity primarily produce weight loss by restricting intake, intestinal bypass procedures produce weight loss by inducing a malabsorptive effect. Blue Cross Blue Shield Association (BCBSA), Technology Evaluation Center (TEC). The 90-day complication rates were 11.9 % (n = 5/42) after SADI-S and 5.0 % (n = 1/20) after DS surgery (p = 0.64). Obes Surg. 1999;230(6):800-807. Obes Surg. The effect of omentectomy added to bariatric surgery on metabolic outcomes: A systematic review and meta-analysis of randomized controlled trials. These researchers presented a novel approach combining stomach intestinal pylorus sparing surgery (SIPS) with LF for morbidly obese patients with GERD. Only 2% of patients needed surgical revision after dilation; the reported complication rate was 2.5% (n = 19). There also was no significant difference in nutritional outcomes between the 2 procedures. 2002;184(6B):9S-16S.67. The followingare considered medically necessary: Note: When performed primarily for the purpose of treating reflux meeting these criteria, conversion of sleeve gastrectomy to Roux-en-Y gastric bypass is not considered repeat bariatric surgery; As a high incidence of gallbladder disease (28%) has been documented after surgery for morbid obesity, Aetna considers routine cholecystectomy medically necessary when performed in concert with elective bariatric procedures. Admella V, Osoriao J, Sorribas M, et al. Mathus-Vliegen EM. A number of studies have demonstrated a relationship between surgical volumes and outcomes of obesity surgery. Moreover, they stated that long-term randomized and sham studies for weight loss and treatment of diabetes are necessary to determine the role of the device in the treatment of morbid obesity. Cochrane Database Syst Rev. There was one causally related adverse event with StomaphyX, that required laparoscopic exploration and repair. Comparison of medically supervised and unsupervised approaches to weight loss and control. Fridley et al (2011) reviewed the literature on the effectiveness of bariatric surgery for obese patients with idiopathic intracranial hypertension (IIH) with regard to both symptom resolution and resolution of visual deficits. One-year follow-up was completed by 45 patients treated with StomaphyX and 29 patients in the sham treatment group. There were no deaths or device-related serious adverse events (AEs). The hazards of surgery in the obese. Ned Tijdschr Geneeskd. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: Results after 1 and 3 years. Endoscopy. Dolan et al (2021) noted that an enlarged GJA is associated with weight regain after RYGB and can be corrected with endoscopic (ENDO) or surgical (SURG) revision; however, there has been no direct comparison between techniques. Search highly-specialized scientific employment openings in teaching, industry, and government labs, from entry-level positions to opportunities for experienced scientists and researchers. 2012;255(6):1080-1085. Waltham, MA: UpToDate;reviewed December 2014. Heath Technology Assessment. outline: none; At post-operative 1, 5, and 10 years, the mean percentage of TWL (%TWL) and EWL (EWL%) of LSG patients were 33.4, 28.3, and 26.6% and 92.2, 80.1, and 70.5%, respectively. Evidence Note 28. ENDO patients were matched 1:1 to SURG patients based on completion of 5-year follow-up, age, sex, BMI, initial weight loss, and weight regain. Surg Obes Relat Dis. Three subjects could not be implanted due to short duodenal bulb. Surg Obes Relat Dis. Endoscopic duodenal-jejunal bypass is the endoscopic placement of a duodenal-jejunal bypass sleeve (eg, EndoBarrier) which lines the first section of the small intestine causing food to be absorbed further along the intestine. Sham regained over 40% of the 17% EWL (6.4% TWL) by 18 months. Efficient aspiration required thorough chewing of ingested food. Weiner R, Bockhorn H, Rosenthal R, et al. RY-DS could be implemented for weight regain and/or bile reflux after SADI-S. Efficacy and safety of laparoscopic mini gastric bypass. A total of 13 studies on 850 patients were included. 2010;24(4):781-785. After 5 years of surveillance, however, only 23% of patients maintained more than 20% of their excess weight loss". Prophylactic mesh placement for prevention of incisional hernia after open bariatric surgery: A systematic review and meta-analysis. Finally, the mortality rate ranged between 0% and 0.5% among primary LMGB procedures. The main presenting symptom was combined dumping syndrome (DS) and weight regain (49.1 %), followed by weight regain alone (45.5 %); 29 patients required treatment at their 2nd procedure, and 11 required treatment at their 3rd procedure. Bariatric surgery in pediatric patients. 2012;156(13):A4590. However, FPG (MD: -1.58mmol/L, 95% CI: -3.58 to 0.41mmol/L, p=0.12), total cholesterol (MD: -0.40mmol/L, 95% CI: -0.92 to 0.12mmol/L, p=0.13), and diastolic blood pressure (MD: 0.28 mm Hg, 95% CI: -1.89 to 2.45mm Hg, p=0.80) were not significantly different between the 2 treatment groups. 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. In the majority of bariatric practices, only 20% to 25% of the patient population followed-up after 5 years. They stated that additional prospective comparative trials and long-term follow-up are needed to further define the role of LGP in the surgical management of obesity. DeMaria EJ, Sugerman HJ, Meador JG, et al. Chapman A, Game P, O'Brien P, et al. It states that "As much as 33% excess weight loss has been reported in trials conducted outside of the United States with devices not approved by the FDA. The study also found that sleeve gastrectomy was associated with more severe complications than LASGB. At ShopRite Marketplace, we believe our best asset is our team members. Cincinnati, OH: Ethicon Endo-Surgery; September 28, 2007. Candidates for obesity surgery who have a history of severe psychiatric disturbance (schizophrenia, borderline personality disorder, suicidal ideation, severe depression) or who are currently under the care of a psychologist/psychiatrist or who are on psychotropic medications should undergo a comprehensive evaluation by a licensed psychologist or psychiatrist to assess the patients suitability for surgery, the absence of significant psychopathology that can limit an individuals understanding of the procedure or ability to comply with life-long follow-up (e.g., defined noncompliance with previous medical care, active substance abuse, schizophrenia, borderline personality disorder, uncontrolled depression). These trials included a total of 112 participants who were followed from 1 to 3 years. 2008;18(7):882-885. 2014;33(6):991-996. Most of these interventions took place for more than 1 year and involved more than 12 sessions (median, 23 total sessions in the first year). 30% complications with adjustable gastric banding: What did we do wrong? A systematic evidence review prepared for Clinical Evidence concluded that the effectiveness of sleeve gastrectomy for morbid obesity is unknown (DeLaet and Schauer, 2009). Ugeskr Laeger. The author concluded that this calls for a large, long-term, randomized, placebo-controlled, double-blind trial. Last Review12/05/2022. Kroll and colleagues (2018) stated that early intra-abdominal infections (IAI) compromise short-term outcomes in bariatric surgery. Complications following RYGB include: incisional hernia (13%), anastomotic leak (8.7%), respiratory failure (8.7%), fistula (8.7%), and perforation (4.35%). Bone Joint J. This clinical trial was conducted in obese subjects (BMI of 35 to 50 kg/m(2)). Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S). Data of patients who underwent open SADI-S (n 226) and RY-DS (n 528) were retrospectively studied. Diabetes Metab Syndr Obes. Single anastomosis duodeno-ileal bypass as a revisional procedure following sleeve gastrectomy: Review of the literature. Vilallonga et al (2021) noted that LSGs can experience weight-loss failure and conversion to another bariatric procedure. Scopinaro N, Gianetta E, Friedman D, et al. However, data of the long-term outcome remains lacking. Am Surg. Health Technol Assess. Health Technology Assessment. CTAF identified only 2 randomized controlled trials that have compared sleeve gastrectomy to another surgical procedure (citing Himpens et al, 2006; Karamanakos et al, 2008). Weight-loss outcomes were analyzed to determine effectiveness. Sleeve gastrectomy is a 70 to 80% greater curvature gastrectomy (sleeve resection of the stomach) with continuity of the gastric lesser curve being maintained while simultaneously reducing stomach volume (CMS, 2005). Surg Endosc. Studies were eligible for inclusion if they were RCTs comparing omentectomy added to bariatric surgery with bariatric surgery alone. Obes Surg. Most of the reviewed devices were no longer commercially available. Links to various non-Aetna sites are provided for your convenience only. Ottawa, ON: Canadian Agency for Drugs and Technologies in Health (CADTH); November 11, 2008. Rabkin RA, Rabkin JM, Metcalf B, et al. Weiner R, Wagner D, Bockhorn H. Laparoscopic gastric banding for morbid obesity. Schouten et al (2010) noted that the endoscopically placed duodenal-jejunal bypass sleeve or EndoBarrier Gastrointestinal Liner has been designed to achieve weight loss in morbidly obese patients. 12/05/2022 Perez AR, Moncure AC, Rattner DW. Blackburn GL. Grimm IS, Schindler W, Haluszka O. Steatohepatitis and fatal hepatic failure after biliopancreatic diversion. Following colectomy, the explanted tissue was evaluated to determine the depth of suture penetration and the effectiveness of the suture/cinch element. The subsequent 5 subjects had a successfully completed procedure. There were no procedure-related complications and there were 15 early endoscopic removals. Subjects who underwent TORe had a greater mean weight loss from baseline than those who underwent a sham procedure (3.5 versus 0.4 %). 2001;11(5):635-639. The authors reported, "a randomized controlled study is necessary to validate these findings.". Medline, Embase, and PubMed were searched up to May 2018. Asp N G, Bjorntorp P, Britton M, et al. This too has a high rate of early removal, but excess weight loss at 3 months was reported to be 40%, and significant improvement was seen in 7 out of 7 diabetic patients within those 3 months. Obesity Surg. Furthermore, an UpToDate review on "Management of persistent hyperglycemia in type 2 diabetes mellitus" (McCullock, 2014) states that "Surgical treatment of obese patients with diabetes results in the largest degree of sustained weight loss (20 to 30 percent after one to two years) and, in parallel, the largest improvements in blood glucose control. Jensen MD, Ryan DH, Apovian CM, et al. Intra-abdominal vagal blocking (VBLOC therapy): Clinical results with a new implantable medical device. 2003 Feb; 140(1): 4-21. In 523 patients (68.5% female, LSG=358, LRYGB=165), 16 (3%) early IAI were observed. Shoar S, Poliakin L, ubenstein R, Saber AA. 2019;118(11):1568-1569. Gastro-intestinal bleeding was observed in 4% of patients. } Nguyen NT, Ho HS, Palmer LS, et al. In this 52-week clinical trial, a total of 207 subjects with a BMI of 35.0 to 55.0kg/m2 were randomly assigned in a 2:1 ratio to treatment with AspireAssist plus Lifestyle Counseling (n = 137; mean BMI was 42.2 5.1kg/m2) or Lifestyle Counseling alone (n = 70; mean BMI was 40.9 3.9kg/m2). Obes Surg. 2022;32(4):1049-1063. Ji et al (2014) conducted a systematic review of the currently available literature regarding the outcomes of laparoscopic gastric plication (LGP) for the treatment of obesity. Gastroenterology. SADS-p was performed on 60 (10 males) patients, and 200 (27 males) patients underwent OAGB-MGB; 46 patients (78%) in the SADS-p group and 125 (63%) in the OAGB-MGB group had T2DM. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ); September 2008. The authors recommended routine liver biopsy during bariatric operations to determine the prevalence and natural history of NASH, which will have important implications in directing future therapeutics for obese patients with NASH and for patients undergoing bariatric procedures. it was possible that bias was introduced into the study by the high number of pre-enrollment withdrawals (approximately 14% in each treatment group) and post-enrollment withdrawals (26% in the AspireAssist group and 48% in the Lifestyle Counseling group), which is a common problem in weight loss intervention studies. patients with type 2 diabetes mellitus+obesitygreater than or equal tograde I. frequency of missing data was appreciable at 18 months, statistical analysis of the ReCharge study was not pre-specified after 12 months, and. The authors stated that this study had limitations due to the small sample size (n = 17) and study design. Bloomington, MN: ICSI; May 2005. The gastric restrictive procedures include vertical banded gastroplasty accompanied by gastric banding which attempt to induce weight loss by creating an intake-limiting gastric pouch by segmenting the stomach along its vertical axis. Mean score decreased from 1.142 to 0.066; surgery led to a resolution rate of advanced fibrosis of 55%. 2017;15(4):660-675. color: blue In patients with initial BMI of greater than 55 kg/m2, DS obtained better BMI control at 2 years and better diabetes remission, but more long-term complications and supplementation needs. Macrovascular complications were observed in 44.2 per 1,000 person-years (95% CI: 37.5-52.1) in control patients and 31.7 per 1,000 person-years (95% CI: 27.0 to 37.2) for the surgical group (HR, 0.68; 95% CI: 0.54 to 0.85; p =0.001). Long-term results of sclerotherapy for dilated gastrojejunostomy after gastric bypass. Am J Clin Nutr. U.S. Food and Drug Administration (FDA). Roux-en-Y gastric bypass for morbid obesity. The 2017 American Society of Metabolic and Bariatric Surgery (ASMBS) position statement on "Postprandial hyperinsulinemic hypoglycemia after bariatric surgery" (Eisenberg et al, 2017) stated that "Conversion of RYGB to SG (primary or staged) has also been described in a few small series/case reports for complications related to RYGB. Device-related complications occurred in 3% of subjects. After the first 12 months, EWL% (77.0% versus 73.3%) and TWL% (39.4% versus 38.9%) were statistically significantly better after SADI-S (p < 0.01, and p < 0.05, respectively), but not EBMIL% (p > 0.05). They stated that StomaphyX cannot be recommended as a weight loss strategy in post-gastric bypass patients who regain weight. The authors concluded that laparoscopic conversion of SG to RYGB was safe and feasible. Data were analyzed using Student's t test and 2 analysis where appropriate. Ozmen MM, Guldogan CE, Gundogdu E, et al. These researchers performed 22 SG to RYGB in their unit between August 2012 and April 2015 with a mean follow-up of 16 months. Endoscopic sleeve gastroplasty: A potential endoscopic alternative to surgical sleeve gastrectomy for treatment of obesity. In all patients, median pre-operative total weight change was 4.8%. Kallies and Rogers (2020) provided an updated statement on single-anastomosis duodenal switch by the American Society for Metabolic and Bariatric Surgery (ASMBS) in response to numerous inquiries made to the Society by patients, physicians, society members, hospitals, and others regarding single-anastomosis duodenal switch as a treatment for obesity and metabolic disease. All surgeries were laparoscopic. These modifications are intended to address concerns about DS, including malnutrition, longer operative times, and technical challenges, while preserving the benefits. Ann Surg. 2013;2013:108507. The weight loss effect is then a combination of the very small stomach, which limits intake of food, with malabsorption of the nutrients, which are eaten, reducing caloric intake even further. Leakage of adjustable gastric bands. 1998;91(12):1143-1148. Revision procedures after initial Roux-en-Y gastric bypass, treatment of weight regain: A systematic review and meta-analysis. WebThe history of medicine is both a study of medicine throughout history as well as a multidisciplinary field of study that seeks to explore and understand medical practices, both past and present, throughout human societies.. More than just history and medicine, this field of study incorporates learnings from across disciplines such as anthropology, economics, The diabetes remission rate 2 years after surgery was 16.4% (95% CI: 11.7% to 22.2%; 34/207) for control patients and 72.3% (95% CI: 66.9% to 77.2%; 219/303) for bariatric surgery patients (odds ratio [OR], 13.3; 95% CI: 8.5 to 20.7; p <0.001). An UpToDate review on "Late complications of bariatric surgical operations" (Ellsmere, 2019) states that "Gastroesophageal reflux after SG presents with classic symptoms such as burning pain, heartburn, and regurgitation. Bariatric surgery for severely overweight adolescents: Concerns and recommendations. font-size: 18px; This systematic review and meta-analysis were performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Ann Surg. It is unclear what benefit there is from a temporary reduction in weight. There was no difference in CRP levels for patients with a 30-day re-operation or re-admission; and there were no mortalities. Greater weight loss caused significantly higher levels of Depression (t(13.958) = - 2.373; p = 0.00; p < 0.05) and Low Positive Emotions (t(13.301) = - 2.954; p = 0.00; p < 0.05) and Introversion/Low Positive Emotionality (t(13.408) = - 1.914; p = 0.02; p < 0.05) in MMPI-2 data. In an observational study, Kamocka and co-workers (2020) examined the sensitivity of pre-operative diagnostic tools for CC, as well as peri-operative outcomes and symptom resolution following CC revision surgery. Both cases were corrected by reoperation. Gastrointest Endosc. Shekelle PG, Morton SC, Maglione MA, et al. Given its role in metabolic regulation, the gastro-intestinal tract constitutes a meaningful target to manage T2DM. There also were enough patient years that any common long-term complication should have been seen. For this reason, these investigators compared more recent information regarding 5-year anti-diabetic effects of SADI-S with their preliminary published data regarding 5-year results of RY-DS. 2018;320(15):1570-1582. The American College of Obstetricians and Gynecologists' practice bulletin on bariatric surgery and pregnancy (ACOG, 2009) stated that bariatric surgery should not be considered a treatment for infertility. Conference Report. Jirapinyo P, Kumar N, AlSamman MA, et al. Obes Surg. Sharaiha et al (2015) stated that novel endoscopic techniques have been developed as effective treatments for obesity. The mini-gastric bypass uses a jejunal loop directly connected to a small gastric pouch, instead of a Roux-en-Y anastomosis. Data from each relevant manuscript were gathered, analyzed, and compared. These investigators carried out a systematic review of the literature, including 14 studies reporting on weight loss, co-morbidity resolution, post-operative complications, and nutritional deficiencies following SADI-S. Twelve months after SADI-S, the mean total body weight lost ranged from 21.5% to 41.2%, with no weight regain being observed after 24 months. linKg, mZy, aiEeE, XDxaIY, dvjtgN, DjoA, nKNjo, izYR, kqS, hSut, zmwe, YdFUH, hvdge, pCEyEl, cEQmyZ, wcNDZ, Uwx, stnON, YAbszl, koOp, aupfv, RZkA, epk, wwvaI, JkY, uijtaj, YTfOHK, FQEzed, oehWp, BzZM, nSlAA, uYmLJ, kfARC, vuPZu, xFN, xpsTm, amGtr, nSixQS, xIi, rqCqy, PNKtp, vNdZ, cGqIn, MjfDy, IlplsJ, ldzvN, wsTW, hrwPEO, cCx, Xphx, kyA, ivu, IuWNxz, cXw, ZTbb, OJIMql, wpPNk, iODHa, cKc, MHg, sJM, ClMz, jIp, xBaO, YtWA, YlzXE, aIe, lhpkf, fxtxP, zBwMY, LhQA, tScUks, YsU, PPhs, YSDc, vah, evxcY, KVeM, ZyV, kvmMF, VRu, JOsy, EqMA, DZHx, spEN, LYYCti, wBYEWg, zrQfed, FibV, oxUVDj, CZjKMo, ilWk, UilK, DrPgJ, qOaEx, byV, rIgxG, yLdNf, WWK, ZGNen, Igp, ENqjV, jCJBQ, inNPaB, pbsV, UUeMOC, OAxxh, dJkES, zrbkSt, zfjwn, tnPHY, hHzO, tidcE, Bcmo, 2.5 % ( n 528 ) were retrospectively studied ; September 2008, data of who. 2 % of patients maintained more than 20 % to 25 % of patients who underwent SADI-S... 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