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Gastrointestinal symptoms, weight loss and patient satisfaction 5 years after gastric bypass: a study of three techniques for the gastrojejunal anastomosis.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
2016 (English)In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 30, no 4, 1553-1558 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The optimal operative technique in gastric bypass (RYGB) is still under debate. We have studied patient-reported gastrointestinal symptoms and weight loss 5 years after RYGB performed with three different stapling techniques for the gastrojejunal anastomosis (GJ).

METHODS: Out of 593 patients operated with RYGB, 489 patients [80.2 % women, body mass index (BMI) 44.9 (33-68) kg/m(2)] answered our 5-year follow-up questionnaire concerning gastrointestinal symptoms (vomiting, reflux, dumping, abdominal pain or diarrhea), weight loss, need for postoperative endoscopic interventions and overall satisfaction with the procedure. We compared the results for three different GJ techniques: linear stapler (LS, n = 103), 21-mm circular stapler (C21, n = 88) and 25-mm circular stapler (C25, n = 298).

RESULTS: Dumping was the most commonly reported symptom (14.1 % of all patients on a weekly to daily basis), however, less frequently reported in the C25 group (p < 0.05). Vomiting, prevalent in 2.9 % of all patients, was more frequently reported in the C21 group (p < 0.01). No group consistently showed greater weight loss compared to the other two groups. A higher incidence of endoscopic dilatations due to strictures was reported in the C21 group (12.5 % compared to 4.5 % of all patients, p < 0.05). Overall patient satisfaction was high (88 %).

CONCLUSION: Our data suggest that the technique for the construction of the GJ in RYGB affects gastrointestinal symptoms 5 years postoperatively. The difference is moderate but indicates that a narrow GJ results in increased frequency of vomiting and need for endoscopic interventions without improving the weight result.

Place, publisher, year, edition, pages
2016. Vol. 30, no 4, 1553-1558 p.
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-290410DOI: 10.1007/s00464-015-4374-8ISI: 000373022200042PubMedID: 26162421OAI: oai:DiVA.org:uu-290410DiVA: diva2:925134
Available from: 2016-04-29 Created: 2016-04-29 Last updated: 2017-04-05Bibliographically approved
In thesis
1. Gastric bypass: Technical aspects and long-term results
Open this publication in new window or tab >>Gastric bypass: Technical aspects and long-term results
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Roux-en-Y gastric bypass (RYGBP) achieves superior short- and long-term weight loss compared to other weight loss modalities. Different operative techniques have been developed to technically facilitate the surgical procedure, with consequences in the form of an array of postoperative complications and gastrointestinal symptoms. Furthermore, as our follow-up on operated patients extends beyond the first postoperative years, it becomes apparent that a significant number of patients experience unsatisfactory weight result. Current research is just starting to chart factors associated with postoperative long-term weight regain with the ultimate goal of preventing it.

In Paper I it is found that the linear stapled technique for the gastrojejunostomy in laparoscopic RYGBP is associated with shorter operative time, in-hospital stay and a lower incidence of surgical site infections and anastomotic strictures compared to the circular stapled technique. Paper II demonstrates that, despite no differences in weight result, the 21-mm circular stapled technique for the gastrojejunostomy is associated with a higher incidence of vomiting and endoscopic anastomotic dilatations compared to the 25-mm circular stapled technique and the linear stapled technique in the long-term after RYGBP. Paper III shows that despite differences in body composition, long-term weight responders and non-responders after RYGBP did not differ in resting, glucose-induced or activity-related energy expenditure. Lastly Paper IV shows long-term weight result is associated with fasting levels of leptin and ghrelin, and that the response of these hormones to a glucose load might contribute to perpetuate obesity.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. 67 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1324
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-319510 (URN)978-91-554-9889-4 (ISBN)
Public defence
2017-05-27, Enghoffsalen, Akademiska sjukhuset, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2017-05-04 Created: 2017-04-05 Last updated: 2017-06-08

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