Advertisement

LRYGB: Current Controversies

  • Kelvin D. HigaEmail author
  • Amit K. Taggar

Abstract

The laparoscopic gastric bypass technique, invented 20 years ago, is currently the benchmark for all other operations. It has the advantages of long-term success and direct metabolic activity, but it is one of the most difficult operations to master. Consensus on the optimal anatomic construct remains elusive; many controversies exist regarding the achievement of optimal results.

Keywords

Laparoscopic gastric bypass Controversies Internal hernia RYGB Complications 

References

  1. 1.
    Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg. 1994;4:353–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Pelligrini C. The surgeon of the future: anchoring innovation and science with moral values. ACS Bulletin. 2014;98(12). Available from: http://www.acssurgerynews.com/single-view/the-surgeon-of-the-future-anchoring-innovation-and-science-with-moral-values/d47ee58b5a5797366782460fc34ad3b1.html. Cited: 02 July 2014.
  3. 3.
    Cummings DE, Weigle DS, Frayo RS, Breen PA, Ma MK, Dellinger EP, et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med. 2002;346(21):1623–30.CrossRefPubMedGoogle Scholar
  4. 4.
    Fobi MAL, Lee H, Fleming A. The surgical technique of the banded Roux-Y gastric bypass. J Obes Weight Regulation. 1989;8:99–102.Google Scholar
  5. 5.
    Heneghan H, Annaberdyev S, Eldar S, Rogula T, Brethauer S, Schauer P. Banded Roux-en-Y gastric bypass for the treatment of morbid obesity. Surg Obes Relat Dis. 2014;10(2):210–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Pedersen SD. The role of hormonal factors in weight loss and recidivism after bariatric surgery. Gastroenterol Res Pract. 2013;2013:528450.PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Moizé V, Andreu A, Flores L, Torres F, Ibarzabal A, Delgado S, et al. Long-term dietary intake and nutritional deficiencies following sleeve gastrectomy or Roux-En-Y gastric bypass in a mediterranean population. J Acad Nutr Diet. 2013;113(3):400–10.CrossRefPubMedGoogle Scholar
  8. 8.
    Sloth B, Holst JJ, Flint A, Gregersen NT, Astrup A. Effects of PYY1–36 and PYY3–36 on appetite, energy intake, energy expenditure, glucose and fat metabolism in obese and lean subjects. Am J Physiol Endocrinol Metab. 2007;292(4):E1062–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Pournaras DJ, Glicksman C, Vincent RP, Kuganolipava S, Alaghband-Zadeh J, Mahon D, et al. The role of bile after Roux-en-Y gastric bypass in promoting weight loss and improving glycemic control. Endocrinology. 2012;153(8):3613–9.PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Le Roux CW, Welbourn R, Werling M, Osborn A, Kokkinos A, Laurenius A, et al. Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass. Ann Surg. 2007;246(5):780–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Kong LC, Tap J, Aron-Wisnewsky J, Pelloux V, Basdevant A, Bouillot JL, et al. Gut microbiota after gastric bypass in human obesity: increased richness and associations of bacterial genera with adipose tissue genes. Am J Clin Nutr. 2013;98(1):1624.CrossRefGoogle Scholar
  12. 12.
    Masoomi H, Nguyen NT, Stamos MJ, Smith BR. Overview of outcomes of laparoscopic and open Roux-–en-Y gastric bypass in the United States. Surg Technol Int. 2012;22:72–6.PubMedGoogle Scholar
  13. 13.
    Nguyen NT, Goldman C, Rosenquist CJ, Arango A, Cole CJ, Lee SJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234(3):279–89.PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Madan AK, Harper JL, Tichansky DS. Techniques of laparoscopic gastric bypass: on-line survey of American society for bariatric surgery practicing surgeons. Surg Obes Relat Dis. 2008;4(2):166–72.CrossRefPubMedGoogle Scholar
  15. 15.
    Wittgrove AC, Clark GW. Combined laparoscopic/endoscopic anvil placement for the performance of the gastroenterostomy. Obes Surg. 2001;11(5):565–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Jacob BP, Gagner M. New developments in gastric bypass procedures and physiological mechanisms. Surg Technol Int. 2003;11:119–26.PubMedGoogle Scholar
  17. 17.
    de la Torre RA, Scott JS. Laparoscopic Roux-en-Y gastric bypass: a totally intra-abdominal approach-technique and preliminary report. Obes Surg. 1999;9(5):492–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Alasfar F, Sabnis A, Liu R, Chand B. Reduction of circular stapler-related wound infection in patients undergoing laparoscopic Roux-en-Y gastric bypass, Cleveland clinic technique. Obes Surg. 2010;20(2):168–72.CrossRefPubMedGoogle Scholar
  19. 19.
    Williams MD, Champion JK. Linear technique of laparoscopic Roux-en-Y gastric bypass. Surg Technol Int. 2004;13:101–5.PubMedGoogle Scholar
  20. 20.
    Schauer PR, Ikramuddin S, Hamad G, Eid GM, Mattar S, Cottam D, Ramanathan R, Gourash W. Laparoscopic gastric bypass surgery: current technique. J Laparoendosc Adv Surg Tech A. 2003;13(4):229–39.CrossRefPubMedGoogle Scholar
  21. 21.
    Higa KD, Boone KB, Ho T, Davies OG. Laparoscopic Roux-en-Y gastric bypass for morbid obesity: technique and preliminary results of our first 400 patients. Arch Surg. 2000;135(9):1029–33.CrossRefPubMedGoogle Scholar
  22. 22.
    Bendewald FP, Choi JN, Blythe LS, Selzer DJ, Ditslear JH, Mattar SG. Comparison of hand-sewn, linear-stapled, and circular-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2011;21(11):1671–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Wang G, Agenor K, Pizot J, Kotler DP, Harel Y, Van Der Schueren BJ, et al. Accelerated gastric emptying but no carbohydrate malabsorption 1 year after gastric bypass surgery (GBP). Obes Surg. 2012;22(8):1263–7.PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Dirksen C, Damgaard M, Bojsen-Møller KN, Jørgensen NB, Kielgast U, Jacobsen SH, et al. Fast pouch emptying, delayed small intestinal transit, and exaggerated gut hormone responses after Roux-en-Y gastric bypass. Neurogastroenterol Motil. 2013;25(4):346–e255.CrossRefPubMedGoogle Scholar
  25. 25.
    Flanagan L. Measurement of functional pouch volume following the gastric bypass procedure. Obes Surg. 1996;6:38–43.CrossRefPubMedGoogle Scholar
  26. 26.
    Heneghan HM, Yimcharoen P, Brethauer SA, Kroh M, Chand B. Influence of pouch and stoma size on weight loss after gastric bypass. Surg Obes Relat Dis. 2012;8:408–15.CrossRefPubMedGoogle Scholar
  27. 27.
    Iannelli A, Schneck A-S, Hebuterne X, Guggenheim J. Gastric pouch resizing for Roux-en-Y gastric bypass failure in patients with dilated pouch. Surg Obes Relat Dis. 2013;9:260–7.CrossRefPubMedGoogle Scholar
  28. 28.
    O’Connor EA, Carlin AM. Lack of correlation between variation in small-volume gastric pouch size and weight loss after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;3:399–403.CrossRefGoogle Scholar
  29. 29.
    Coblijn UK, Goucham AB, Lagarde SM, Kuiken SD, van Wagensveld BA. Development of ulcer disease after Roux-en-Y gastric bypass, incidence, risk factors, and patient presentation: a systematic review. Obes Surg. 2014;24(2):299–309.CrossRefPubMedGoogle Scholar
  30. 30.
    Higa K, Ho T, Tercero F, Yunus T, Boone K. Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up. Surg Obes Relat Dis. 2011;7(4):516–25.CrossRefPubMedGoogle Scholar
  31. 31.
    Gilmore MM, Kallies KJ, Mathiason MA, Kothari SN. Varying marginal ulcer rates in patients undergoing laparoscopic roux-en-Y gastric bypass for morbid obesity versus gastroesophageal reflux disease: is the acid pocket to blame? Surg Obes Relat Dis. 2013;9(6):862–6.CrossRefPubMedGoogle Scholar
  32. 32.
    O’Brien PE, McPhail T, Chaston TB, Dixon JB. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006;16(8):1032–40.CrossRefPubMedGoogle Scholar
  33. 33.
    Zarate X, Arceo-Olaiz R, Montalvo Hernandez J, García-García E, Pablo Pantoja J, Herrera MF. Long-term results of a randomized trial comparing banded versus standard laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2013;9(3):395–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Orci L, Chilcott M, Huber O. Short versus long Roux-limb length in Roux-en-Y gastric bypass surgery for the treatment of morbid and super obesity: a systematic review of the literature. Obes Surg. 2011;21(6):797–804.CrossRefPubMedGoogle Scholar
  35. 35.
    Swartz DE, Mobley E, Felix EL. Bile reflux after Roux-en-Y gastric bypass: an unrecognized cause of postoperative pain. Surg Obes Relat Dis. 2009;5(1):27–30.CrossRefPubMedGoogle Scholar
  36. 36.
    Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg. 2003;13(3):350–4.CrossRefPubMedGoogle Scholar
  37. 37.
    Obeid A, McNeal S, Breland M, Stahl R, Clements RH, Grams J. Internal hernia after laparoscopic Roux-en-Y gastric bypass. J Gastrointest Surg. 2014;18(2):250–5.CrossRefPubMedGoogle Scholar
  38. 38.
    Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.CrossRefPubMedGoogle Scholar
  39. 39.
    Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76.PubMedCentralCrossRefPubMedGoogle Scholar
  40. 40.
    Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Leccesi L, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.CrossRefPubMedGoogle Scholar
  41. 41.
    Laurenius A, Taha O, Maleckas A, Lönroth H, Olbers T. Laparoscopic biliopancreatic diversion/duodenal switch or laparoscopic Roux-en-Y gastric bypass for super-obesity-weight loss versus side effects. Surg Obes Relat Dis. 2010;6(4):408–14.CrossRefPubMedGoogle Scholar
  42. 42.
    Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.CrossRefPubMedGoogle Scholar
  43. 43.
    El-Kadre L, Tinoco AC, Tinoco RC, Aguiar L, Santos T. Overcoming the learning curve of laparoscopic Roux-en-Y gastric bypass: a 12-year experience. Surg Obes Relat Dis. 2013;9(6):867–72.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Clinical Professor of Surgery, UCSF – Fresno, Advanced Laparoscopic Surgery Associates, Director of Minimally Invasive and Bariatric SurgeryFresno Heart and Surgical HospitalFresnoUSA
  2. 2.Department of General SurgeryUniversity of California San Francisco – FresnoFresnoUSA

Personalised recommendations