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Comment on: Secondary surgery after sleeve gastrectomy: Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch
Secondary Surgery after Gastric Sleeve / Surgery for Obesity and Related Diseases 11 (2015) 771–778 [10] Shimizu H, Annaberdyev S, Motamarry I, Kroh M, Schauer PR, Brethauer SA. Revisional bariatric surgery for unsuccessful weight loss and complications. Obes Surg 2013;23:1766–73. [11] Langer FB, Bohdjalian A, Shakeri-Leidenmuhler S, Schoppmann SF, Zacherl J, Prager G. Conversion from sleeve gastrectomy to Roux-enY gastric bypass–indications and outcome. Obes Surg 2010;20: 835–40. [12] Weiner RA, Theodoridou S, Weiner S. Failure of laparoscopic sleeve gastrectomy–further procedure? Obes Facts 2011;4(Suppl 1):42–6. [13] Langer FB, Shakeri-Leidenmuhler S, Bohdjalian A, et al. Strategies for weight regain after sleeve gastrectomy. Surg Laparosc Endosc Percutan Tech 2010;20:159–61. [14] Lacy A, Ibarzabal A, Pando E, et al. Revisional surgery after sleeve gastrectomy. Surg Laparosc Endosc Percutan Tech 2010;20:351–6. [15] van Rutte PW, Smulders JF, de Zoete JP, Nienhuijs SW. Indications and short-term outcomes of revisional surgery after failed or complicated sleeve gastrectomy. Obes Surg 2012;22:1903–8. [16] Iannelli A, Schneck AS, Topart P, Carles M, Hebuterne X, Gugenheim J. Laparoscopic sleeve gastrectomy followed by duodenal switch in selected patients versus single-stage duodenal switch for superobesity: case-control study. Surg Obes Relat Dis 2013;9:531–8. [17] Regan JP, Inabnet WB, Gagner M, Pomp A. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg 2003;13:861–4. [18] Dapri G, Cadiere GB, Himpens J. Laparoscopic repeat sleeve gastrectomy versus duodenal switch after isolated sleeve gastrectomy for obesity. Surg Obes Relat Dis 2011;7:38–43. [19] Braghetto I, Cortes C, Herquinigo D, et al. Evaluation of the radiological gastric capacity and evolution of the BMI 2-3 years after sleeve gastrectomy. Obes Surg 2009;19:1262–9. [20] Weiner RA, Weiner S, Pomhoff I, Jacobi C, Makarewicz W, Weigand G. Laparoscopic sleeve gastrectomy–influence of sleeve size and resected gastric volume. Obes Surg 2007;17:1297–305. [21] Karamanakos SN, Vagenas K, Kalfarentzos F, Alexandrides TK. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg 2008;247:401–7. [22] Lin E, Gletsu N, Fugate K, et al. The effects of gastric surgery on systemic ghrelin levels in the morbidly obese. Arch Surg 2004;139:780–4. [23] Sovik TT, Aasheim ET, Taha O, et al. Weight loss, cardiovascular risk factors, and quality of life after gastric bypass and duodenal switch: a randomized trial. Ann Inter Med 2011;155:281–91. [24] Botella Romero F, Milla Tobarra M, Alfaro Martinez JJ, et al. Cirugia bariatrica mediante la tecnica del cruce duodenal: evolucion ponderal y deficiencias nutricionales asociadas. [Bariatric surgery in duodenal switch procedure: weight changes and associated nutritional deficiencies]. Endocrinologia y nutricion : organo de la Sociedad Espanola de Endocrinologia y Nutricion 2011;58:214–8.
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[25] Dapri G, Cadiere GB, Himpens J. Superobese and super-superobese patients: 2-step laparoscopic duodenal switch. Surg Obes Relat Dis 2011;7:703–8. [26] Baltasar A, Serra C, Perez N, Bou R, Bengochea M. Re-sleeve gastrectomy. Obes Surg 2006;16:1535–8. [27] Greenstein AJ, Jacob BP. Placement of a laparoscopic adjustable gastric band after failed sleeve gastrectomy. Surg Obes Relat Dis 2008;4:556–8. [28] Dorman RB, Rasmus NF, al-Haddad BJ, et al. Benefits and complications of the duodenal switch/biliopancreatic diversion compared to the Roux-en-Y gastric bypass. Surgery 2012;152:758–65. [29] Prachand VN, Davee RT, Alverdy JC. Duodenal switch provides superior weight loss in the super-obese (BMI 4 or ¼ 50 kg/m2) compared with gastric bypass. Ann Surgery 2006;244:611–9. [30] De Groot NL, Burgerhart JS, Van De Meeberg PC, de Vries DR, Smout AJ, Siersema PD. Systematic review: the effects of conservative and surgical treatment for obesity on gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2009;30:1091–102. [31] Aarts EO, van Wageningen B, Janssen IM, Berends FJ. Prevalence of anemia and related deficiencies in the first year following laparoscopic gastric bypass for morbid obesity. J Obes 2012;2012:193–705. [32] Bloomberg RD, Fleishman A, Nalle JE, Herron DM, Kini S. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg 2005;15:145–54. [33] Decker GA, Swain JM, Crowell MD, Scolapio JS. Gastrointestinal and nutritional complications after bariatric surgery. Am J Gastroenterol 2007;102:2571–80. [34] Skroubis G, Sakellaropoulos G, Pouggouras K, Mead N, Nikiforidis G, Kalfarentzos F. Comparison of nutritional deficiencies after Rouxen-Y gastric bypass and after biliopancreatic diversion with Roux-enY gastric bypass. Obes Surg 2002;12:551–8. [35] Marceau P, Biron S, Hould FS, et al. Duodenal switch: long-term results. Obes Surg 2007;17:1421–30. [36] Fok JS, Li JY, Yong TY. Visual deterioration caused by vitamin A deficiency in patients after bariatric surgery. Eat Weight Disord 2012;17:e144–6. [37] Garg MK, Tandon N, Marwaha RK, Menon AS, Mahalle N. The relationship between serum 25-hydroxy vitamin D, parathormone and bone mineral density in Indian population. Clin Endocrinol 2014;80: 41–6. [38] Dolan K, Hatzifotis M, Newbury L, Lowe N, Fielding G. A clinical and nutritional comparison of biliopancreatic diversion with and without duodenal switch. Ann Surg 2004;240:51–6. [39] Blume CA, Boni CC, Casagrande DS, Rizzolli J, Padoin AV, Mottin CC. Nutritional profile of patients before and after Roux-en-Y gastric bypass: 3-year follow-up. Obes Surg 2012;22:1676–85. [40] Pajecki D, Dalcanalle L, Souza de Oliveira CP, et al. Follow-up of Roux-en-Y gastric bypass patients at 5 or more years postoperatively. Obes Surg 2007;17:601–7.
Editorial comment
Comment on: Secondary surgery after sleeve gastrectomy: Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch The authors are to be commended for addressing an issue that is certain to be more prominent as more and more sleeve gastrectomies (SG) are done. One key aspect of this
article is the authors distinguish between secondary surgeries done for weight reasons and those done because of complications of the SG, namely dysphagia and
778
J. Homan et al. / Surgery for Obesity and Related Diseases 11 (2015) 771–778
gastroesophageal reflux disease. Because the biliopancreatic diversion-duodenal switch (BPD-DS) involves a SG, there is no revision operation for these complaints other than a Roux-en-Y gastric bypass (RYGB). The 5 patients who underwent RYGB for this did well. The second group of patients consists of those who underwent a planned second surgery for super morbid obesity (body mass index [BMI] 460 kg/m2). Thirteen patients were in this group. The median interval between surgeries (23 mo), median percent excess weight loss (43%), and median BMI (55) all represent good success and standard results from a SG. Interestingly, the average BMI went from 70 to 55, which represents significant improvement between the planned procedures. Although the patients were not likely to lose more weight from the SG, they did have significant success from it. In this subgroup, patients had a good response from both the BPD-DS and the RYGB surgery. Although it was more in the former, there were only 2 patients in the RYGB group. The crux of this article lies in the results of the BPD-DS and RYGB after SG for weight recidivism or inadequate weight loss. For those 25 patients who underwent a revision for these reasons, those who had the BPD-DS did better in terms of weight loss but had a higher complication rate, which is consistent with the data reported in the literature. The groups are too small to draw any real conclusions other than revision for this reason is safe. Interestingly, though, in the RYGB group, 27% of the patients actually gained
weight, suggesting that the poor initial weight loss was not likely from surgical reasons but more likely to be behavioral. All of the patients underwent repeat psychological evaluations before the secondary surgery. Even in the BPDDS group, the range of percent excess weight loss range was wide at 15–113% and the percent total weight loss was 7–50%, meaning some patients lost very little weight at least 1 year after the secondary surgery despite having the best bariatric operation in terms of weight loss. Clearly, more work must be done to evaluate the weight regain/poor weight loss situation after a SG. Behavioral issues must be considered a significant component of this issue as even with a secondary surgery that includes a malabsorptive component, some patients do not lose significant weight. Proper patient selection is probably paramount for patients undergoing a revision for poor weight loss or recidivism; but as of yet, the best behavioral screening tool for this has not been elucidated. This article highlights that although secondary surgery is safe and effective, it is not universally successful and more research should be done to find out what factors contribute to a highly variable amount of weight loss after secondary surgery. Robert Lim, M.D. Section of General Surgery, Tripler Army Medical Center Honolulu, Hawaii
777
[25] Dapri G, Cadiere GB, Himpens J. Superobese and super-superobese patients: 2-step laparoscopic duodenal switch. Surg Obes Relat Dis 2011;7:703–8. [26] Baltasar A, Serra C, Perez N, Bou R, Bengochea M. Re-sleeve gastrectomy. Obes Surg 2006;16:1535–8. [27] Greenstein AJ, Jacob BP. Placement of a laparoscopic adjustable gastric band after failed sleeve gastrectomy. Surg Obes Relat Dis 2008;4:556–8. [28] Dorman RB, Rasmus NF, al-Haddad BJ, et al. Benefits and complications of the duodenal switch/biliopancreatic diversion compared to the Roux-en-Y gastric bypass. Surgery 2012;152:758–65. [29] Prachand VN, Davee RT, Alverdy JC. Duodenal switch provides superior weight loss in the super-obese (BMI 4 or ¼ 50 kg/m2) compared with gastric bypass. Ann Surgery 2006;244:611–9. [30] De Groot NL, Burgerhart JS, Van De Meeberg PC, de Vries DR, Smout AJ, Siersema PD. Systematic review: the effects of conservative and surgical treatment for obesity on gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2009;30:1091–102. [31] Aarts EO, van Wageningen B, Janssen IM, Berends FJ. Prevalence of anemia and related deficiencies in the first year following laparoscopic gastric bypass for morbid obesity. J Obes 2012;2012:193–705. [32] Bloomberg RD, Fleishman A, Nalle JE, Herron DM, Kini S. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg 2005;15:145–54. [33] Decker GA, Swain JM, Crowell MD, Scolapio JS. Gastrointestinal and nutritional complications after bariatric surgery. Am J Gastroenterol 2007;102:2571–80. [34] Skroubis G, Sakellaropoulos G, Pouggouras K, Mead N, Nikiforidis G, Kalfarentzos F. Comparison of nutritional deficiencies after Rouxen-Y gastric bypass and after biliopancreatic diversion with Roux-enY gastric bypass. Obes Surg 2002;12:551–8. [35] Marceau P, Biron S, Hould FS, et al. Duodenal switch: long-term results. Obes Surg 2007;17:1421–30. [36] Fok JS, Li JY, Yong TY. Visual deterioration caused by vitamin A deficiency in patients after bariatric surgery. Eat Weight Disord 2012;17:e144–6. [37] Garg MK, Tandon N, Marwaha RK, Menon AS, Mahalle N. The relationship between serum 25-hydroxy vitamin D, parathormone and bone mineral density in Indian population. Clin Endocrinol 2014;80: 41–6. [38] Dolan K, Hatzifotis M, Newbury L, Lowe N, Fielding G. A clinical and nutritional comparison of biliopancreatic diversion with and without duodenal switch. Ann Surg 2004;240:51–6. [39] Blume CA, Boni CC, Casagrande DS, Rizzolli J, Padoin AV, Mottin CC. Nutritional profile of patients before and after Roux-en-Y gastric bypass: 3-year follow-up. Obes Surg 2012;22:1676–85. [40] Pajecki D, Dalcanalle L, Souza de Oliveira CP, et al. Follow-up of Roux-en-Y gastric bypass patients at 5 or more years postoperatively. Obes Surg 2007;17:601–7.
Editorial comment
Comment on: Secondary surgery after sleeve gastrectomy: Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch The authors are to be commended for addressing an issue that is certain to be more prominent as more and more sleeve gastrectomies (SG) are done. One key aspect of this
article is the authors distinguish between secondary surgeries done for weight reasons and those done because of complications of the SG, namely dysphagia and
778
J. Homan et al. / Surgery for Obesity and Related Diseases 11 (2015) 771–778
gastroesophageal reflux disease. Because the biliopancreatic diversion-duodenal switch (BPD-DS) involves a SG, there is no revision operation for these complaints other than a Roux-en-Y gastric bypass (RYGB). The 5 patients who underwent RYGB for this did well. The second group of patients consists of those who underwent a planned second surgery for super morbid obesity (body mass index [BMI] 460 kg/m2). Thirteen patients were in this group. The median interval between surgeries (23 mo), median percent excess weight loss (43%), and median BMI (55) all represent good success and standard results from a SG. Interestingly, the average BMI went from 70 to 55, which represents significant improvement between the planned procedures. Although the patients were not likely to lose more weight from the SG, they did have significant success from it. In this subgroup, patients had a good response from both the BPD-DS and the RYGB surgery. Although it was more in the former, there were only 2 patients in the RYGB group. The crux of this article lies in the results of the BPD-DS and RYGB after SG for weight recidivism or inadequate weight loss. For those 25 patients who underwent a revision for these reasons, those who had the BPD-DS did better in terms of weight loss but had a higher complication rate, which is consistent with the data reported in the literature. The groups are too small to draw any real conclusions other than revision for this reason is safe. Interestingly, though, in the RYGB group, 27% of the patients actually gained
weight, suggesting that the poor initial weight loss was not likely from surgical reasons but more likely to be behavioral. All of the patients underwent repeat psychological evaluations before the secondary surgery. Even in the BPDDS group, the range of percent excess weight loss range was wide at 15–113% and the percent total weight loss was 7–50%, meaning some patients lost very little weight at least 1 year after the secondary surgery despite having the best bariatric operation in terms of weight loss. Clearly, more work must be done to evaluate the weight regain/poor weight loss situation after a SG. Behavioral issues must be considered a significant component of this issue as even with a secondary surgery that includes a malabsorptive component, some patients do not lose significant weight. Proper patient selection is probably paramount for patients undergoing a revision for poor weight loss or recidivism; but as of yet, the best behavioral screening tool for this has not been elucidated. This article highlights that although secondary surgery is safe and effective, it is not universally successful and more research should be done to find out what factors contribute to a highly variable amount of weight loss after secondary surgery. Robert Lim, M.D. Section of General Surgery, Tripler Army Medical Center Honolulu, Hawaii