Abstract
Dietary and behavioral modifications have resulted in limited long-term success in curing morbidly obese patients, and surgery remains the only effective treatment. Of the surgical procedures that are the most commonly offered, Roux-en-Y gastric bypass (RYGB) appears to offer the best long-term results. However 5–15% of patients will not achieve successful weight loss after RYGB. There are many reports showing that the patients who underwent gastric bypass surgeries regain weight over time. The cause for this remains unclear. Several factors may contribute, including dilation of the gastric pouch and the gastrojejunal anastomosis. However, the data to support the link is sparse. The objective of this paper is to describe the surgical technique of wrapping the gastric pouch with a polytetrafluoroethylene (PTFE) mesh to prevent gastric pouch dilatation. In specific, we created a 20–30 ml gastric pouch and subsequently, the gastrojejunostomy was performed with a circular stapler. Afterwards, the mesentery was dissected and the gastric pouch was wrapped with the PTFE mesh. We have performed this procedure on three cadavers with an average operative time of 75 minutes.
We found that the procedure of wrapping the gastric pouch was not particularly difficult. As a result, the gastric pouch, gastrojejunal anastomosis and the stump of the jejunum are all totally wrapped within the mesh. It may be effective in the prevention of dilatation.
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References
Abdel-Galil E, Sabry AA (2002) Laparoscopic Roux-en-Y gastric bypass – evaluation of three different techniques. Obes Surg 12: 639–642
Benotti PN, Forse RA (1995) The role of gastric surgery in the multidisciplinary management of severe obesity. Am J Surg 361–367
Brent D. Matthews, Gamal Mostafa, Alfredo M, et al. (2005) Evaluation of adhesion formation and host tissue response to intra-abdominal polytetrafluoroethylene mesh and composite. Prosthetic Mesh JSR 123: 227–234
Bryan G, Wooduard MPH, LCEP (2003) Bariatric surgery options Crit Care Nurs Q 26: 89–100
Buchwald H, Williams SE (2004) Bariatric surgery worldwide 2003. Obes Surg 14: 1157–1164
David Nocca, Michel Gagner, Federico Cuenca Abente, et al. (2005) Laparoscopic gastric bypass with silicone band in a pig model: prevention of anastomotic dilatation - feasibility study. Obes Surg 15: 523–527
Flegal KM, Carroll MD, Ogden CL, et al. (2002) Prevalence and trends in Obesity among US adults, 1999–2000. JAMA 288: 1723–1727
Gonzatez R, Lin E, Venkatcsh KR, et al. (2003) Gastrojejunostomy during laparoscopic gastric bypass: analysis of 3 techniques. Arch Surg 138: 181–184
Hedley AA, Ogden CL, Johnson CL, et al. (2004) Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA 291: 2847–2850
Heniford BT, Park A, Ramshaw BJ, et al. (2000) Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg 190: 645–650
Holzwarth R, Huber D, Majkrzak A, et al. (2002) Outcome of gastric bypass patients. Obes Surg 12: 261–264
Kazuki Ueda, Michel Gagner, Luca Milone, et al. (2006) Sleeve gastrectomy with wrapping using PTFE mesh to prevent gastric enlargement in a porcine model. Surgical Endoscopy. Special Abstract Issue 20(suppl 1): S312
Koehler RH, Begos D, Berger D, et al. (2003) Minimal adhesions to ePTFE mesh After laparoscopic ventral incisional hernia repair: reoperative findings in 65 cases. JSLS 7: 335–340
Koehler RH, Voeller G (1999) Recurrences in laparoscopic incisional hernia repairs: a personal series and review of the literature. JSLS 3: 293–304
Mason EE, Ito C (1967) Gastric bypass in obesity. Surg Clin North Am 47: 1345–1352
Mathews BD, Sing RE, Delegge MH (2000) Initial results with a stapled gastriojejunostomy for the laparoscopic isolated Roux-en-Y gastric bypass. Am J Surg 179: 476–481
Mathias A L, Fobi, Hoil Lee, Basil Felahy, et al. (2005) Choosing an operation for weight control, and the transected banded gastric bypass. Obes Surg 15: 114–121
Morris E Franklin, Itzel Vela, John J Gonzalez, et al. (2006) Use of porcine small intestinal submucosa as a prosthetic material for laparoscopic hernia repair in infected and potentially contaminated fields: 5 years follow-up. Surgical Endoscopy. Special Abstract Issue 20(suppl 1): S378
National Heart, Lung and Blood Institute (1998) Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults: the evidence report. Bethesda, MD: National Heart, Lung and Blood Institute, NIH publication 98–4083
Sapala JA, Wood MH, Sapala MA, et al. (2001) The micropouch gastric bypass: technical considerations in primary and revisionary operations. Obes Surg 11(1): 3–17
Schweitzer M (2004) Endoscopic intraluminal suture plication of the gastric pouch and stoma in postoperative Roux-en-Y gastric bypass patients. J Laparoendosc Adv Tech A 14(4): 223–226
Scott A. Shikora, Julie J. Kim, Michael E. Tarnoff, et al. (2005) Laparoscopic Roux-en-Y gastric bypass results and learning curve of a high-volume academic program. Arch Surg 140: 362–367
Sugerman HJ, Kellum JM, Engle KM, et al. (1992) Gastric bypass for treating severe obesity. Am J Clin Nutr 55: 560S–566S
Sugerman HJ (2000) The epidemic of severe obesity: the value of surgical treatment. Mayo Clin Proc 75: 669–672
Thompson CC, Slattery J, Bundga ME, et al. (2006) Peroral endoscopic reduction of dilated gastrojejunal anastomosis after Roux-en-Y gastric bypass: a possible new option for patients with weight regain. Surg Endosc [Epub ahead of print]
Tomas R. Rossi, Danuta Z. Dynda, Norman C. Estes (2005) Stricture dilation after laparoscopic Roux-en-Y gastric bypass. Am J Surg 189: 357–360
Wysocki A, Kulawik J, Pozniczek M, et al. (2006) Is the Lichtenstein operation of strangulated groin hernia a safe procedure? World J Surg [Epub ahead of print]
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Gong, K., Gagner, M., Bardaro, S. et al. The procedure of mesh wrapping the gastric pouch in cadaver study. Surg Endosc 21, 2244–2247 (2007). https://doi.org/10.1007/s00464-007-9357-y
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DOI: https://doi.org/10.1007/s00464-007-9357-y