Mide, duodenum ve safra yollarına erişimden ödün vermeden, seçilmiş hastalarda etkili kilo kaybını sağlayan bir yöntem: Vertikal bantlı gastroplasti – Roux-en-Y gastrojejunostomi

Amaç: Bu çalışmada, oluşturulan gastro-gastrik yol ile bariatrik cerrahi sonrası mide duodenum ve safra yollarının değerlendirilmesine olanak sağlayan vertikal bantlı gastroplasti ve Roux-en-Y gastrojejunostomi tekniğinin kilo kaybı üzerine etkilerinin değerlendirilmesi amaçlandı.Yöntemler: Kliniğimizde 2003-2016 yılları arasında vertikal bantlı gastroplasti-Roux-en-Y gastrojejunostomi yapılmış ve 7 yıllık takiplerini tamamlayan toplam 24 hasta (ortalama yaş: 36.8 yıl (18 - 58 yıl), % 62.5 kadın) çalışmaya dahil edildi. Yapılan ameliyatın özellikleri, hastaların hastanede kalış süreleri, ameliyat sonrası komplikasyonlar ve kilo kaybı ile ilgili veriler kaydedildi.Bulgular: Ortalama ameliyat süresi 180±45 dakika ve hastanede kalış süresi 6.0±1.0 gündü. Mortalite olmadı, sadece bir hasta (% 4,2) ameliyat sonrası birinci günde kanama nedeniyle tekrar ameliyat edildi. Hastaların en sık görülen şikayetleri, ameliyat sonrası ikinci ayda kaybolan erken bulantı ve kusma idi, 11 hastada (%45,83) görülmüştür. 24 hastanın 7'sinde (%29,2) operasyonun erken döneminde disfaji şikayeti vardı. Hastalarımızın takibinde gelişmiş marjinal ülser veya anastomoz ülseri tespit edilmedi. Vertikal bantlı gastroplasti-Roux En Y Gastroenterostomi yapılan hastalarımızın birinci, ikinci, üçüncü, beşinci ve yedinci yıllarının sonunda kaydedilen ortalama fazla kiloların kaybı yüzdesi sırası ile 68,1 ± 13,8, 71,3 ± 8,8, 70,8 ± 14,6, 68,2 ± 11,3 ve 61,4 ± 13,3’dür. Sonuç: Bulgularımız üst gastrointestinal sistemin değerlendirilmesine, oluşturulan gastro-gastrik yol ile olanak sağlayan vertikal bantlı gastroplasti- Roux-en-Y gastrojejunostomi’nin kabul edilebilir düzeyde kilo kaybı sağlayarak, seçilmiş bazı hastalarda uygulanabilir bir cerrahi yöntem olduğunu ortaya koymaktadır.

Anahtar Kelimeler:

Obezite cerrahisi, vertikal bantlı gastroplasti, gastrik by-pass, endoskopik girişimler

Vertical banded gastroplasty combined with Roux-en-Y gastrojejunostomy to enable effective weight loss without compromising access to stomach, duodenum and biliary tract for selected patients

Aim: To evaluate the feasibility of vertical banded gastroplasty combined with Roux-en-Y gastric bypass as an operational gastro-gastric outlet technique with the potential to allow appropriate management of whole biliary and upper gastrointestinal tract after bariatric surgery without compromising weight loss. Methods: This study included 24 patients (mean age: 36.8 years, range 18 to 58 years, 62.5% female) who had undergone vertical banded gastroplasty combined with Roux-en-Y gastric bypass between 2003 and 2016 in our clinic and had completed a 7-year postoperative follow up. Data on operative characteristics, length of hospital stay and follow up data on postoperative complications and weight loss were recorded for each patient. Results: Mean operative time was 180±45 minutes while length of hospital stay was 6.0±1.0 days. There was no mortality, and only one patient (4.2%) was reoperated for hemorrhage on the first postoperative day. The most common patient complaints were early nausea and vomiting in 11 patients (45.83%), which disappeared in the second postoperative month, while 7 patients (29.2%) had dysphagia in the early postoperative period. No marginal ulcers or ulcers on anastomosis were found. Mean percentage of excess weight loss values recorded at the end of the first, second, third, fifth and seventh year following vertical banded gastroplasty combined with Roux-en-Y gastric bypass were 68.1±13.8 71.3±8.8 70.8±14.6, 68.2±11.3 and 61.4±13.3, respectively. Conclusions: Our findings indicate the feasibility of vertical banded gastroplasty combined with Roux-en-Y gastric bypass as a bariatric surgical procedure providing better postoperative evaluation and management of the whole upper gastrointestinal system through the stomach window created with the band along with acceptable weight loss in selected patients.

Keywords:

Obesity surgery, vertical banded gastroplasty, gastric bypass, endoscopic interventions,

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1. Wysoker A. The lived experience of choosing bariatric surgery to lose weight. J Am Psychiatr Nurses Assoc. 2005;11:26-34.
2. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: A systematic review and meta-analysis. JAMA. 2004;292:1724-37.
3. Altieri MS, Wright B, Peredo A, Pryor AD. Common weight loss procedures and their complications. Am J Emerg Med. 2018;36:475-79.
4. Blackburn G. Solutions in weight control: Lessons from gastric surgery. Am J Clin Nutr. 2005;82:248-52.
5. Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683-93.
6. 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;183:117-23.
7. Deitel M, Shahi B. Morbid obesity: selection of patients for surgery. J.Am. Coll. Nutr. 1992;11:457-62.
8. Buchwald H. A bariatric surgery algorithm. Obes. Surg. 2002;12:733–46.
9. Scopinaro N, Adami GF, Marinari GM, et al. Biliopancreatic diversion: two decades of experience. In Deitel M., Cowan Jr. GSM, editors, Update: Surgery for the Morbidly Obese Patient, Toronto, FD Communications, 2000; pp. 227–58.
10. Cariani S, Palandri P, Della Valle E, Della Valle A, Di Cosmo L, Vassallo C, et al. Italian multicenter experience of Roux-en-Y gastric bypass on vertical banded gastroplasty: four-year results of effective and safe innovative procedure enabling traditional endoscopic and radiographic study of bypassed stomach and biliary tract.Surg Obes Relat Dis. 2008;4:16-25.
11. Wattchow DA, Hall JC, Whiting MJ, Bradley B, Iannos J, Watts JM. Prevalence and treatment of gall stones after gastric bypass surgery for morbid obesity. BMJ. 1983;286:763.
12. Bastouly M, Arasaki CH, Ferreira JB, Zanoto A, Borges FG, Del Grande JC. Early changes in postprandial gallbladder emptying in morbidly obese patients undergoing Roux-en-Y gastric bypass: correlation with the occurrence of biliary sludge and gallstones. Obesity Surg. 2009;19:22–28.
13. Falcao M, Campos JM, Galvao Neto M. Transgastric endoscopic retrograde cholangiopancreatography for the management of biliary tract disease after Roux-en-Y gastric bypass treatment for obesity. Obesity Surg. 2012;22:872–76.
14. Baron TH, Vickers SM. Surgical gastrostomy placement as access for diagnostic and therapeutic ERCP. Gastrointest Endosc. 1998;48:640–1.
15. Koshitani T, Matsuda S, Takai K. Direct cholangioscopy combined with double-balloon enteroscope-assisted endoscopic retrograde cholangiopancreatography. WJG. 2012;18(28):3765–69.
16. Baron TH, Song LM, Ferreira LE, Smyrk TC. Novel approach to therapeutic ERCP after long limb Roux en Y gastric bypass surgery using transgastric self-expandable metal stents: experimental outcomes and first human case study. Gastrointest Endosc. 2012;75:1258–63.
17. Dario Martinez-Baena, Pablo Parra-Membrives, Daniel Diaz-Gomez, Lorente-Herce JM. Laparoscopic common bile duct exploration and antegrade biliary stenting: leaving behind the Kehr tube. Rev Esp Enferm Dig. 2013;105:125–30.
18. Cariani S, Amenta E. Three-year results of Roux-en-Y gastric bypass-on-vertical banded gastroplasty: an effective and safe procedure which enables endoscopy and X-ray study of the stomach and biliary tract. Obes Surg. 2007;17:1312-8.
19. Cariani S, Agostinelli L, Leuratti L, Giorgini E, Biondi P, Amenta E. Bariatric Revisionary Surgery for Failed or Complicated Vertical Banded Gastroplasty (VBG): Comparison of VBG Reoperation (re-VBG) versus Roux-en-Y Gastric Bypass-on-VBG (RYGB-on-VBG). J Obes. 2010;2010. pii: 206249.
20. Yang P, Zhou Y, Chen B, Wan HW, Jia GQ, Bai HL, et al. Overweight, obesity and gastric cancer risk: Results from a meta-analysis of cohort studies. Eur J Cancer. 2009;45:2867-73.
21. Erim T, Cruz-Correa MR, Szomstein S, Velis E, Rosenthal R, et al. Prevalence of Helicobacter pylori seropositivity among patients undergoing bariatric surgery: A preliminary study. World J Surg. 2008;32:2021-5.
22. Kubo A, Corley DA. Body mass index and adenocarcinomas of the esophagus or gastric cardia: A systematic review and metaanalysis. Cancer Epidemiol Biomarkers Prev. 2006;15:872-8.
23. Menendez P, Padilla D, Villarejo P, Menéndez JM, Lora D, et al. Does bariatric surgery decrease the gastric cancer risk? Hepatogastroenterology. 2012;59:409-12.
24. Braley SC, Nguyen NT, Wolfe BM. Late gastrointestinal hemorrhage after gastric bypass. Obes Surg. 2002;12:404-7.
25. Kuga R, Safatle-Ribeiro AV, Sakai P, Ishida RK, Faintuch J, Furuya Jr CK, et al. Usefulness of the Double-Balloon Enteroscope for Endoscopic Evaluation of the Bypassed Stomach After Vertical Banded Gastroplasty with Roux-En-Y Gastric Bypass for Morbid Obesity. GIE. 2006; 63:AB162. DOI: https://doi.org/10.1016/j.gie.2006.03.327