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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

Abstract

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/m2] 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.

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References

  1. Bray GA, Bellanger T (2006) Epidemiology, trends, and morbidities of obesity and the metabolic syndrome. Endocrine 29:109–117

    CAS  Article  PubMed  Google Scholar 

  2. Gloy VL, Briel M, Bhatt DL, Kashyap SR, Schauer PR, Mingrone G, Bucher HC, Nordmann AJ (2013) Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ 347:f5934

    Article  PubMed  PubMed Central  Google Scholar 

  3. Dombrowski SU, Knittle K, Avenell A, Araújo-Soares V, Sniehotta FF (2014) Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials. BMJ 348:g2646

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  4. Karlsen TI, Lund RS, Roislien J, Tonstad S, Natvig GK, Sandbu R, Hjelmesaeth J (2013) Health related quality of life after gastric bypass or intensive lifestyle intervention: a controlled clinical study. Health Qual Life Outcomes 11:17

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sears D, Fillmore G, Bui M, Rodriguez J (2008) Evaluation of gastric bypass patients 1 year after surgery: changes in quality of life and obesity-related conditions. Obes Surg 18:1522–1525

    Article  PubMed  Google Scholar 

  6. Sima E, Hedberg J, Ehrenborg A, Sundbom M (2013) Differences in early complications between circular and linear stapled gastrojejunostomy in laparoscopic gastric bypass. Obes Surg 24(4):599–603

    Article  Google Scholar 

  7. SOReg (2015) Scandinavian obesity surgery registry (SOReg) (homepage on the Internet). Year report 2014 (in Swedish), Sweden. Cited 2015 March. Available from: http://www.ucr.uu.se/soreg/index.php/dokument/doc_download/117-arsrapport-soreg-2014-del-1

  8. Giordano S, Salminen P, Biancari F, Victorzon M (2011) Linear stapler technique may be safer than circular in gastrojejunal anastomosis for laparoscopic Roux-en-Y gastric bypass: a meta-analysis of comparative studies. Obes Surg 21:1958–1964

    Article  PubMed  Google Scholar 

  9. Giordano S, Tolonen P, Victorzon M (2010) Comparision of linear versus circular stapling techniques in laparoscopic gastric bypass surgery—a pilot study. Scand J Surg 99:127–131

    CAS  PubMed  Google Scholar 

  10. Sundbom M, Gustavsson S (2000) Hand-assisted laparoscopic Roux-en-y gastric bypass: aspects of surgical technique and early results. Obes surg 10:420–427

    CAS  Article  PubMed  Google Scholar 

  11. Gonzalez R, Lin E, Venkatesh KR, Bowers SP, Smith CD (2003) Gastrojejunostomy during laparoscopic gastric bypass: analysis of 3 techniques. Archives Surg 138:181–184

  12. Wittgrove AC, Clark GW, Tremblay LJ (1994) Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg 4:353–357

    Article  PubMed  Google Scholar 

  13. Lonroth H, Dalenback J, Haglind E, Lundell L (1996) Laparoscopic gastric bypass. Another option in bariatric surgery. Surg Endosc 10:636–638

    CAS  Article  PubMed  Google Scholar 

  14. Sapala JA, Wood MH, Sapala MA, Schuhknecht MP, Flake TM Jr (2001) The micropouch gastric bypass: technical considerations in primary and revisionary operations. Obes Surg 11:3–17

    CAS  Article  PubMed  Google Scholar 

  15. Fobi MA (2005) Placement of the GaBP ring system in the banded gastric bypass operation. Obes Surg 15:1196–1201

    Article  PubMed  Google Scholar 

  16. Capella RF, Capella JF (1997) Reducing early technical complications in gastric bypass surgery. Obes Surg 7:149–156; discussion 157

  17. Capella RF, Iannace VA, Capella JF (2008) An analysis of gastric pouch anatomy in bariatric surgery. Obesity surgery 18:782–790

    Article  PubMed  Google Scholar 

  18. Edholm D, Naslund I, Anders Karlsson F, Rask E, Sundbom M (2014) Twelve-year results for revisional gastric bypass after failed restrictive surgery in 131 patients. Surg Obes Relat Dis 10:44–48

    Article  PubMed  Google Scholar 

  19. Edholm D, Svensson F, Naslund I, Karlsson FA, Rask E, Sundbom M (2013) Long-term results 11 years after primary gastric bypass in 384 patients. Surg Obes Relat Dis 9:708–713

    Article  PubMed  Google Scholar 

  20. Peterli R, Borbely Y, Kern B, Gass M, Peters T, Thurnheer M, Schultes B, Laederach K, Bueter M, Schiesser M (2013) Early results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS): a prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Ann Surg 258:690–694; discussion 695

  21. Markar SR, Penna M, Venkat-Ramen V, Karthikesalingam A, Hashemi M (2012) Influence of circular stapler diameter on postoperative stenosis after laparoscopic gastrojejunal anastomosis in morbid obesity. Surg Obes Relat Dis 8:230–235

    Article  PubMed  Google Scholar 

  22. Sczepaniak JP, Owens ML (2009) Results of gastrojejunal anastomotic technique designed to reduce stricture. Surg Obes Relat Dis 5:77–80

    Article  PubMed  Google Scholar 

  23. Lee S, Davies AR, Bahal S, Cocker DM, Bonanomi G, Thompson J, Efthimiou E (2014) Comparison of gastrojejunal anastomosis techniques in laparoscopic Roux-en-Y gastric bypass: gastrojejunal stricture rate and effect on subsequent weight loss. Obes Surg 24(9):1425–1429

    Article  PubMed  Google Scholar 

  24. Banerjee A, Ding Y, Mikami D, Needleman B (2013) The role of dumping syndrome in weight loss after gastric bypass surgery. Surg Endos 27:1573–1578

    Article  Google Scholar 

  25. Mallory G, Macgregor A, Rand C (1996) The influence of dumping on weight loss after gastric restrictive surgery for morbid obesity. Obes Surg 6:474–478

    Article  PubMed  Google Scholar 

  26. Dar MS, Chapman WH 3rd, Pender JR, Drake AJ 3rd, O’Brien K, Tanenberg RJ, Dohm GL, Pories WJ (2012) GLP-1 response to a mixed meal: what happens 10 years after Roux-en-Y gastric bypass (RYGB)? Obes Surg 22:1077–1083

    Article  PubMed  Google Scholar 

  27. Borg CM, le Roux CW, Ghatei MA, Bloom SR, Patel AG, Aylwin SJ (2006) Progressive rise in gut hormone levels after Roux-en-Y gastric bypass suggests gut adaptation and explains altered satiety. Brit J Surg 93:210–215

    CAS  Article  PubMed  Google Scholar 

  28. Christian NJ, King WC, Yanovski SZ, Courcoulas AP, Belle SH (2013) Validity of self-reported weights following bariatric surgery. JAMA 310:2454–2456

    CAS  Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to E. Sima.

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Disclosure

Dr. Jakob Hedberg did some consultant work for Astra Zeneca during the past 2 years. Drs. Magnus Sundbom and Eduardo Sima have no conflicts of interest or financial ties to disclose.

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Sima, E., Hedberg, J. & Sundbom, M. Gastrointestinal symptoms, weight loss and patient satisfaction 5 years after gastric bypass: a study of three techniques for the gastrojejunal anastomosis. Surg Endosc 30, 1553–1558 (2016). https://doi.org/10.1007/s00464-015-4374-8

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  • DOI: https://doi.org/10.1007/s00464-015-4374-8

Keywords

  • Gastric bypass
  • Gastrojejunostomy
  • Stapling technique
  • Weight loss
  • Gastrointestinal symptoms
  • Long-term results