Background: Laparoscopic proximal gastric bypass Roux-en-Y (LPGBRY) has been regarded for a long time as the gold standard treatment for morbid obesity and its comorbidities. With the presence of the newer strong options, like the gastric sleeve and the mini gastric bypass, refinements in technique are taking place to avoid its current problems. Early and late gastric dumping are known problems after proximal gastric bypass. Modifications in the technique by providing the patient with a long and narrow pouch might help the problem by slowing the gastric emptying time, also should it keep the weight loss in the acceptable range. Aim: The aim of this study is to evaluate whether constructing a long and narrow pouch can decrease the incidence of early and late dumping after laparoscopic proximal gastric bypass and to evaluate the likely impact of such a long and narrow pouch on the weight loss rates. Patients and methods: The study included 79 morbidly obese patients who received primary LPGBRY for treatment of their morbid obesity. They were divided into two groups; 42 patients who received LPGBRY with a long and narrow pouch (the [LN] group), and 37 patients who received LPGBRY with a classic globular pouch (the [G] group). Their 6 and 12 months’ percentage of excess weight loss (%EWL) were recorded. Also, one year after surgery, all patients were required to fill in an Arabic translation of the Sigstad dumping score questionnaire, followed one hour later by an Arabic translation of the Arts score symptoms of late dumping, only if they scored 7 or more. Results: No significant differences were found in the %EWL between both groups. In the Sigstad questionnaire, the most commonly recorded symptoms were the need to lie down and frequent eructation, followed by dizziness, and distension. Frequent eructation was significantly higher in the [LN] group, while dizziness and palpitation were significantly more common in the [G] group (p < 0.05). Similar over all rates of dumping were observed in both groups (p > 0.05). Half the dumping patients in group [G] had late dumping symptoms. The incidence of late symptoms in the [G] group was significantly higher than in the long and narrow pouch [LN] group (p < 0.05). Conclusion: Long and narrow pouches in LPGBRY achieve similar weight loss rates as in the classic globular pouches. Constructing a long and narrow pouch produces similar overall dumping rate, but added significantly more eructation, less dizziness, less palpitation and less late dumping symptoms when compared to the classic globular pouches.
| Published in |
Journal of Surgery (Volume 5, Issue 3-1)
This article belongs to the Special Issue Minimally Invasive and Minimally Access Surgery |
| DOI | 10.11648/j.js.s.2017050301.24 |
| Page(s) | 76-82 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2024. Published by Science Publishing Group |
Laparoscopic Proximal Gastric Bypass, Long and Narrow Pouches, Classic Globular Pouches, Weight Loss and Dumping
| [1] | Tinaco RC, Tinaco AC. Laparoscopic Gastric Bypass: Trans-Oral Circular Stapler. In: Obesity Surgery Principles and Practice. Editor: Cid Pitombo. Mc Graw Hill Inc. 2008: 183-187. |
| [2] | Coupay M, Sabaté J M, Castel B, et al. Predictive Factors of Weight Loss 1 Year after Laparoscopic Gastric Bypass in Obese Patients. Obes Surg 2010; 20:1671–1677. |
| [3] | O’Connor EA, Carlin AM. Lack of correlation between variation in small-volume gastric pouch size and weight loss after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2008; 4:399 – 403. |
| [4] | Capella RF, Iannace VA, Capella JF. An Analysis of Gastric Pouch Anatomy in Bariatric Surgery. Obes Surg 2008; 18:782–790. |
| [5] | Tack J, Arts J, Caenepeel P, et al. Pathophysiology, diagnosis and management of postoperative dumping syndrome. Nat Rev Gastroenterol Hepatol 2009; 6: 583–590. |
| [6] | Tack J. Gastric motor disorders. Best Pract Res Clin Gastroenterol 2007; 21: 633–644. |
| [7] | Mayer EA, Thompson JB, Jehn D, et al. Gastric emptying and sieving of solid food and pancreatic and biliary secretion after solid meals in patients with truncal vagotomy and antrectomy. Gastroenterology 1982; 83: 184–192. |
| [8] | Sirinek KR, O’Dorisio TM, Howe B, et al. Neurotensin, vasoactive intestinal peptide, and Roux-en-Y gastrojejunostomy. Their role in the dumping syndrome. Arch Surg 1985; 120: 605–609. |
| [9] | Nielsen M, Madsbad S, HolstJ J. Exaggerated secretionof glucagon-like peptide-1 (GLP-1) could cause reactive hypoglycaemia. Diabetologia 1998; 41: 1180–1186. |
| [10] | Salehi M, Gastaldelli A, D’Alessio DA. Blockade of glucagon- like peptide 1 receptor corrects postprandial hypoglycemia after gastric bypass. Gastroenterology 2014; 146: 669–680. |
| [11] | Lawaetz O, Blackburn AM, Bloom SR, et al. Gut hormone profile and gastric emptying in the dumping syndrome. A hypothesis concerning the pathogenesis. Scand J Gastroenterol 1983; 18: 73–80. |
| [12] | Deitel M, Khanna RK, Hagan J. Vertical banded gastroplasty as an antireflux procedure. Am J Surg. 1988; 155:512–6. |
| [13] | Sigstad H. A clinical diagnostic index in the diagnosis of the dumping syndrome. Changes in plasma volume and blood sugar after a test meal. Acta Med Scand 1970; 188: 479–486. |
| [14] | Laurenius A, Olbers T, Naslund I, et al. Dumping syndrome following gastric bypass: validation of the dumping symptom rating scale. Obes Surg 2013; 23: 740–755. |
| [15] | Papamargaritis D, Koukoulis G, Sioka E et al. Dumping symptoms and incidence of hypoglycaemia after provocation test at 6 and 12months after laparoscopic sleeve gastrectomy. Obes Surg 2012; 22: 1600–1606. |
| [16] | Arts J, Caenepeel P, Bisschops R et al. Efficacy of the long- acting repeatable formulation of the somatostatin analogue octreotide in postoperative dumping. Clin Gastroenterol Hepatol 2009; 7: 432–437. |
| [17] | Capella JF, Capella RF. An Assessment of vertical banded gastroplasty-Roux-en-Y gastric bypass for the treatment of morbid obesity. Am J Surg 2002; 183:117-123. |
| [18] | Higa KD, Tienchin HO, Boone KB. Laparoscopic Roux-en-Y gastric bypass: technique and 3-year follow-up. J Laparoendosc. 2001;11:377–82. |
| [19] | Fobi MAL, Lee H, Felahy B, et al. Fifty consecutive patients with the GaBP ring system in the banded gastric bypass operation for obesity with follow up of at least 1 year. Surg Obes Relat Disease 2005; 1:569–72. |
| [20] | Burgerhart JS, Van de Meeberg PC, Mauritz FA, et al. Increased Belching After Sleeve Gastrectomy. Obes Surg 2016; 26: 132–137. |
| [21] | M. Ramadan, M. Loureiro, K. Laughlan, et al. Risk of Dumping Syndrome after Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: Early Results of a Multicentre Prospective Study. Gastroenterol Res Pract 2016; 2016: 2570237. |
| [22] | Loss AB, Souza AAP, Pitombo CA et al. Analysis of the dumping syndrome on morbid obese patients submitted to roux en Y gastric bypass. Rev Col Bras Cir 2009; 36(5). |
APA Style
Ashraf A. El-attar, Taha A. Esmail, Wael Abdel Salam. (2017). Long and Narrow Gastric Pouch versus Classic Globular Pouch in Laparoscopic Proximal Gastric Bypass: Effect on Weight Loss and Dumping Syndrome. Journal of Surgery, 5(3-1), 76-82. https://doi.org/10.11648/j.js.s.2017050301.24
ACS Style
Ashraf A. El-attar; Taha A. Esmail; Wael Abdel Salam. Long and Narrow Gastric Pouch versus Classic Globular Pouch in Laparoscopic Proximal Gastric Bypass: Effect on Weight Loss and Dumping Syndrome. J. Surg. 2017, 5(3-1), 76-82. doi: 10.11648/j.js.s.2017050301.24
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Download@article{10.11648/j.js.s.2017050301.24,
author = {Ashraf A. El-attar and Taha A. Esmail and Wael Abdel Salam},
title = {Long and Narrow Gastric Pouch versus Classic Globular Pouch in Laparoscopic Proximal Gastric Bypass: Effect on Weight Loss and Dumping Syndrome},
journal = {Journal of Surgery},
volume = {5},
number = {3-1},
pages = {76-82},
doi = {10.11648/j.js.s.2017050301.24},
url = {https://doi.org/10.11648/j.js.s.2017050301.24},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.s.2017050301.24},
abstract = {Background: Laparoscopic proximal gastric bypass Roux-en-Y (LPGBRY) has been regarded for a long time as the gold standard treatment for morbid obesity and its comorbidities. With the presence of the newer strong options, like the gastric sleeve and the mini gastric bypass, refinements in technique are taking place to avoid its current problems. Early and late gastric dumping are known problems after proximal gastric bypass. Modifications in the technique by providing the patient with a long and narrow pouch might help the problem by slowing the gastric emptying time, also should it keep the weight loss in the acceptable range. Aim: The aim of this study is to evaluate whether constructing a long and narrow pouch can decrease the incidence of early and late dumping after laparoscopic proximal gastric bypass and to evaluate the likely impact of such a long and narrow pouch on the weight loss rates. Patients and methods: The study included 79 morbidly obese patients who received primary LPGBRY for treatment of their morbid obesity. They were divided into two groups; 42 patients who received LPGBRY with a long and narrow pouch (the [LN] group), and 37 patients who received LPGBRY with a classic globular pouch (the [G] group). Their 6 and 12 months’ percentage of excess weight loss (%EWL) were recorded. Also, one year after surgery, all patients were required to fill in an Arabic translation of the Sigstad dumping score questionnaire, followed one hour later by an Arabic translation of the Arts score symptoms of late dumping, only if they scored 7 or more. Results: No significant differences were found in the %EWL between both groups. In the Sigstad questionnaire, the most commonly recorded symptoms were the need to lie down and frequent eructation, followed by dizziness, and distension. Frequent eructation was significantly higher in the [LN] group, while dizziness and palpitation were significantly more common in the [G] group (p < 0.05). Similar over all rates of dumping were observed in both groups (p > 0.05). Half the dumping patients in group [G] had late dumping symptoms. The incidence of late symptoms in the [G] group was significantly higher than in the long and narrow pouch [LN] group (p < 0.05). Conclusion: Long and narrow pouches in LPGBRY achieve similar weight loss rates as in the classic globular pouches. Constructing a long and narrow pouch produces similar overall dumping rate, but added significantly more eructation, less dizziness, less palpitation and less late dumping symptoms when compared to the classic globular pouches.},
year = {2017}
}
TY - JOUR T1 - Long and Narrow Gastric Pouch versus Classic Globular Pouch in Laparoscopic Proximal Gastric Bypass: Effect on Weight Loss and Dumping Syndrome AU - Ashraf A. El-attar AU - Taha A. Esmail AU - Wael Abdel Salam Y1 - 2017/04/15 PY - 2017 N1 - https://doi.org/10.11648/j.js.s.2017050301.24 DO - 10.11648/j.js.s.2017050301.24 T2 - Journal of Surgery JF - Journal of Surgery JO - Journal of Surgery SP - 76 EP - 82 PB - Science Publishing Group SN - 2330-0930 UR - https://doi.org/10.11648/j.js.s.2017050301.24 AB - Background: Laparoscopic proximal gastric bypass Roux-en-Y (LPGBRY) has been regarded for a long time as the gold standard treatment for morbid obesity and its comorbidities. With the presence of the newer strong options, like the gastric sleeve and the mini gastric bypass, refinements in technique are taking place to avoid its current problems. Early and late gastric dumping are known problems after proximal gastric bypass. Modifications in the technique by providing the patient with a long and narrow pouch might help the problem by slowing the gastric emptying time, also should it keep the weight loss in the acceptable range. Aim: The aim of this study is to evaluate whether constructing a long and narrow pouch can decrease the incidence of early and late dumping after laparoscopic proximal gastric bypass and to evaluate the likely impact of such a long and narrow pouch on the weight loss rates. Patients and methods: The study included 79 morbidly obese patients who received primary LPGBRY for treatment of their morbid obesity. They were divided into two groups; 42 patients who received LPGBRY with a long and narrow pouch (the [LN] group), and 37 patients who received LPGBRY with a classic globular pouch (the [G] group). Their 6 and 12 months’ percentage of excess weight loss (%EWL) were recorded. Also, one year after surgery, all patients were required to fill in an Arabic translation of the Sigstad dumping score questionnaire, followed one hour later by an Arabic translation of the Arts score symptoms of late dumping, only if they scored 7 or more. Results: No significant differences were found in the %EWL between both groups. In the Sigstad questionnaire, the most commonly recorded symptoms were the need to lie down and frequent eructation, followed by dizziness, and distension. Frequent eructation was significantly higher in the [LN] group, while dizziness and palpitation were significantly more common in the [G] group (p < 0.05). Similar over all rates of dumping were observed in both groups (p > 0.05). Half the dumping patients in group [G] had late dumping symptoms. The incidence of late symptoms in the [G] group was significantly higher than in the long and narrow pouch [LN] group (p < 0.05). Conclusion: Long and narrow pouches in LPGBRY achieve similar weight loss rates as in the classic globular pouches. Constructing a long and narrow pouch produces similar overall dumping rate, but added significantly more eructation, less dizziness, less palpitation and less late dumping symptoms when compared to the classic globular pouches. VL - 5 IS - 3-1 ER -
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