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Duodenogastric bile reflux after gastric bypass: a cholescintigraphic study
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
2002 In: Digestive Diseases and Sciences, ISSN 0163-2116, Vol. 47, no 8, 1891-1896 p.Article in journal (Refereed) Published
Place, publisher, year, edition, pages
2002. Vol. 47, no 8, 1891-1896 p.
Identifiers
URN: urn:nbn:se:uu:diva-90563OAI: oai:DiVA.org:uu-90563DiVA: diva2:162953
Available from: 2003-04-28 Created: 2003-04-28Bibliographically approved
In thesis
1. Roux-en-Y Gastric Bypass: Hand-assisted Laparoscopy and Investigation of the Excluded Stomach
Open this publication in new window or tab >>Roux-en-Y Gastric Bypass: Hand-assisted Laparoscopy and Investigation of the Excluded Stomach
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. 62 p.
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1251
Keyword
Surgery, gastric bypass, morbid obesity, laparoscopy, Kirurgi
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-3468 (URN)91-554-5604-9 (ISBN)
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

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