Showing 3 results for Roux-En-Y Gastric Bypass
Volume 8, Issue 1 (2-2019)
Abstract
Introduction
A possible complication that may present late after Roux-en-Y gastric bypass is the development of marginal ulcer at the gastrojejunostomy site. We discuss here an emergency presentation of a case with a delayed perforation at the anastomosis 5 months after surgery which dealt successfully with the laparoscopic approach.
Case Presentation
A 45-year-old female presented to the emergency department for evaluation of severe upper abdominal pain. Her past history was significant for laparoscopic Roux-en-Y gastric bypass surgery for weight loss done in Oct 2016 and further denied any history of chronic medication, alcoholism, smoking or any co-morbidity. She was examined and found to have a tenderness all over the abdomen with sluggish bowel sounds and decreased air entry at bases bilaterally, more so on the left side. Portable CXR revealed air under the diaphragm and an obliterated left costophrenic angle. A repeat CT scan with gastrograffin contrast was carried out and findings confirmed a perforation at the site of gastrojejunal anastomosis with free fluid in the pelvis and flanks. She underwent laparoscopic exploration and repair of anastomotic perforation with omental patch and was discharged in a healthy fashion on her 7th postoperative day.
Conclusions
This case report corroborates with literature available from many sources that marginal ulcer perforation is one of the serious complications after Roux-en-Y gastric bypass and may present early in the first few months or as a delayed entity years after the surgery. Once diagnosed, urgent intervention is required and laparoscopic repair has shown itself a safe and effective treatment strategy where facilities are available.
Ali Sheidaei, Seyed Amin Setaredan, Fatemeh Soleimany, Kimiya Gohari, Amirhossein Aliakbar, Negar Zamaninour, Abdolreza Pazouki, Ali Kabir,
Volume 8, Issue 2 (12-2019)
Abstract
Background: According to the IFSO worldwide survey report in 2014, 579517 bariatric operations have been performed in a year, of which nearly half the procedures were SG followed by RYGB. This procedure is a proven successful treatment of patients with morbid obesity which induces considerable weight loss and improvement of type 2 diabetes mellitus, insulin resistance, inflammation, and vascular function. In the present study, we aimed to build a machine based on a decision tree to mimics the surgeons pathway to select the type of bariatric surgery for patients.
Material and methods: We used patient’s data from the National Bariatric Surgery registry between March 2009 and October 2020. A decision tree was constructed to predict the type of surgery. The validation of the decision tree confirmed using 4-folds cross-validation.
Results: We rich a decision tree with a depth of 5 that is able to classify 77% of patients into correct surgery groups. In addition, using this model we are able to predict 99% of bypass cases (Sensitivity) correctly. The waist circumference less than 126 cm and BMI equal to or more than 43 kg/m2, age equal to or greater than 30 years old, and being hypertensive or diabetes are the most important separators.
Discussion: The effects of all nodes have been studied before and the references confirmed the relations of them and surgery type.
Mohammadreza Abdolhosseini, Parynaz Parhizgar, Mehdi Tavallaei,
Volume 10, Issue 1 (6-2021)
Abstract
Background: Roux-en-Y gastric bypass (RYGBP) has received a lot of attention with the prevalence of obesity. However, some patients report more weight loss and more malnutrition, which is thought to be due to differences in common Limb length (CLL) in patients. Surgeons reported alimentary limb length (ALL) and biliopancreatic limb length (BPLL), and CLL is generally unknown.
Methods: During 2015-2017, this study was conducted among 600 patients to evaluate CLL and excessive weight loss (EWL) and malnutrition in patients undergoing RYGBP. To measure the length of the small intestine, 30 minutes after the start of the surgery, the measurement was performed by micro forceps and grasping the midpart of the small intestine and, the average measurement time was 7 minutes.
Results: the median length of the small bowel was 712 cm. The results of this study showed that patients with CLL ˂650 cm had more EWL% and malnutrition than CLL >750 cm.
Conclusion: Since 0.5% and 2% of the participants in this study had a small bowel length of fewer than 4 m and 4.5 m, respectively, and assuming that the ALL + CLL should be more than 3 m, the length of the small bowel was usually bypassed in these people is 2 meters. If the BPLL is less than 125 cm, small bowel measurement is not necessary, but if it is higher than 125 cm, 2% of people will have the chance of shortness of small bowel and it is better to measure the length of the intestine.
