Abdominal Pain After Roux-en-Y Gastric Bypass: Semiotic Aspects Suggestive of Internal Hernias

Introduction: Abdominal pain is the most frequent cause of hospital admission after Roux en y gastric bypass (RYGB) Among numerous possible underlying causes, internal hernia represents one of the most peculiar and insidious circumstances, setting challenging diagnostic and therapeutic problems for the surgeon. Objectives: The aim of this study is to analyze abdominal pain incidence and characteristics after RYGB, discriminating peculiar aspects suggestive of internal hernias. Methods: 9 patients submitted to internal hernia repair after RYGB and a group of 49 controls (non complicated RYGB) were evaluated using 2 types of abdominal pain questionnaires (Roma III and Roma III modified). Overall abdominal pain incidence (controls) and specific characteristics of internal hernias (cases) were analyzed. Results: 32% of controls presented aspecific (no diagnosed cause) abdominal pain after RYGB - mainly deep, remittent, colic, located in the upper left abdomen, postprandial. 78% of the cases presented prodromic algic episodes similar to those of the controls, differing from the acute episode only in pain intensity. Excess weight loss, mainly at 3 months and after one year, showed the most significant correlation with internal hernia (p: 0.043 and p: 0,026, respectively). Conclusion: Based on abdominal pain characteristics (angina abdominis-like) we can reasonably postulate the presence of remittent bowel torsions (remittent internal hernias) in many patients, occasionally complicating. Therapeutic management of such cases remains controversial, laparoscopic exploration being a good option when symptomatology is suggestive

Road Racing After Gastric Bypass for Morbid Obesity: Final Results of a New Protocol

Introduction: In recent years, the pandemic explosion of obesity has led to the definition of a pre-eminent therapeutic role for bariatric surgery, confining physical activity to a success parameter of surgery rather than a primary prevention measure. Objectives: The aim of this study was to re-define a role for aerobic physical activity (road running) in strengthening the metabolic and psycho-social effects of bariatric surgery. Methods: 10 patients who underwent gastric bypass (RYGB) for morbid obesity were submitted to an intensive program of road running training. After a preparatory trimester, a six-month intensive training program started, aimed at completing a 10.5 km competition in September 2013. Inclusion criteria included age (<50), BMI (<35), suitability for sporting activity and good compliance. A cohort of 10 patients excluded for logistical issues were enrolled as a control group. During the training period patients were submitted to biometrical measurements, sport performance tests (Cooper), and cardio-pulmonary, metabolic and psychiatric evaluations. Results: Protocol compliance was 70%. Completing the protocol resulted in an impressive increase in cardiopulmonary and athletic performance (from 1050 to 1800 m at Cooper test). Weight loss was higher in the cases, with a variation in waist circumference and body fat percentage significantly higher than in the control group. Psychiatric evaluation attested to an improvement in mood, drive and volition for the runners. Conclusion: Road running appears to have an important supporting role in boosting bariatric surgery results. The utilization of monitorized and regulated training programs represents a fundamental prerequisite to achieving satisfactory results and adequate patient complianc

Road Running After Gastric Bypass for Morbid Obesity: Rationale and Results of a New Protocol

Background: In recent years, the pandemic explosion of obesity has led to the definition of a pre-eminent therapeutic role for bariatric surgery, confining physical activity to a success parameter of surgery rather than a primary prevention measure. The aim of this study is to evaluate the role for aerobic physical activity (road running) in strengthening the metabolic and psychosocial effects of bariatric surgery. Methods: Ten patients who underwent gastric bypass for morbid obesity were submitted to an intensive program of road running training, aimed at completing a 10.5-km competition in September 2013. Inclusion criteria included age (<50), BMI (<35), suitability for sport activity, and good compliance. A cohort of 10 patients excluded for logistical issues were enrolled as a control group. During the training period, patients were submitted to biometrical, sport performance, cardiopulmonary, metabolic, and psychiatric evaluations. Results: Protocol adherence was 70 %; no physical injury was registered among participants. More than weight loss (BMI 29.3 to 27.1), the runners experienced a redistribution of body mass with significant differences in fat percentage and waist/hip ratio. Participants had a significant running performance improvement and, differently from the controls, a significant amelioration of echocardiographic and cardiopulmonary parameters, predicting a reduction in cardiovascular risk. Psychiatric evaluation underlined a tendency to a reduction in anxiety, depression, and general psychopathology symptoms. Conclusions: Road running seems to have an important supporting role in boosting bariatric surgery results. The utilization of monitored and regulated training programs represents a fundamental prerequisite to achieving satisfactory results and patient compliance