Re-sleeve gastrectomy as revisional bariatric procedure after biliopancreatic diversion with duodenal switch.

BACKGROUND Re-sleeve gastrectomy (re-SG) is a possible option to increase weight loss after biliopancreatic diversion with duodenal switch (BPD-DS). We report the feasibility, efficacy and safety of re-SG in patients presenting with long-term weight regain after BPD-DS. METHODS From October 2010 to December 2013, a total of 17 patients (12 female, 5 male) with a mean age of 42.1 ± 19.4 years underwent re-SG, mainly because of weight regain after BPD-DS. Re-SG was performed laparoscopically over a 32 French stomach tube. RESULTS At the time of BPD-DS, the mean weight and BMI of all patients were 130.1 ± 17.9 kg and 46.1 ± 6.5 kg/m(2), respectively. The mean time interval between BPD-DS and re-SG was 63.1 ± 20.3 months. At the time of re-SG, the mean weight and BMI were 115.4 ± 14.2 kg and 39.8 ± 5.3 kg/m(2), and the %EWL after BPD-DS was 22.9 ± 17.4 %. Three conversions (17.6 %) to open surgery were required. No mortality occurred. One patient (5.9 %) developed a leak within the first week after re-SG that was treated conservatively with an endoluminal stent. The mean follow-up was 37.2 ± 7.1 months after re-SG. One- and three-year follow-up showed a mean weight, BMI, and cumulative %EWL of 96.0 ± 17.1 kg, 33.8 ± 7.3 kg/m(2), and 53.1 ± 18.3 % (17/17 patients; 100 %), and 100.3 ± 21.1 kg, 35.1 ± 8.3 kg/m(2), and 47.2 ± 19.7 % (13/17 patients; 76 %) after re-SG, respectively. CONCLUSIONS This study shows that re-SG in patients with weight regain after BPD-DS is a feasible, effective and safe option as a revisional bariatric procedure. However, patients have to be carefully considered for revisional surgery since re-SG is associated with the potential risk of surgical complications

Micronutrient Supplementation after Biliopancreatic Diversion with Duodenal Switch in the Long Term

Background Malabsorptive bariatric surgery requires lifelongmicronutrientsupplementation.Basedontherecommendations, we assessed the number of adjustments of micronutrientsupplementationandtheprevalenceofvitaminandmineral deficiencies at a minimum follow-up of 5 years after biliopancreatic diversion with duodenal switch (BPD-DS). Methods Between October 2010 and December 2013, a total of 51 patients at a minimum follow-up of 5 years after BPDDS were invited for a clinical check-up with a nutritional blood screening test for vitamins and minerals. Results Forty-three of fifty-one patients (84.3 %) completed the blood sampling with a median follow-up of 71.2 (range 60–102) monthsafter BPD-DS. At that time,all patientswere supplemented with at least one multivitamin. However, 35 patients (81.4 %) showed either a vitamin or a mineral deficiencyoracombinationofit.Nineteenpatients(44.1%)were anemic,and17patients(39.5%)hadanirondeficiency.High deficiency rates for fat-soluble vitamins were also present in 23.2 % for vitamin A, in 76.7 % for vitamin D, in 7.0 % for vitamin E, and in 11.6 % for vitamin K. Conclusions Theresultsofourstudyshowthattheprevalence ofvitaminandmineraldeficienciesafterBPD-DSis81.4%at a minimum follow-up of 5 years. The initial prescription of micronutrientsupplementationandfurtheradjustmentsduring thefirstfollow-upwereinsufficient toavoidlong-term micronutrient deficiencies. Life-long monitoring of micronutrients at a specialized bariatric center and possibly a better micronutrient supplementation, is crucial to avoid a deficient micronutrient status at every stage after malabsorptive bariatric surger

Pouch Reshaping for Significant Weight Regain after Roux-en-Y Gastric Bypass.

BACKGROUND Significant weight regain after Roux-en-Y gastric bypass (RYGB) occurs in around 20 % of patients in the long term. Anatomical reasons include dilatation of the gastric pouch and/or the pouch-jejunal anastomosis, leading to loss of restriction. Pouch reshaping (PR) aims at reestablishing restriction with a subsequent feeling of satiety. This study reports the outcome of PR embedded in a multidisciplinary treatment pathway. METHODS Twenty-six patients after PR for weight regain >30 % following RYGB in a university hospital between October 2010 and March 2016 were analyzed. Excluded were patients with PR for gastro-gastric fistulae, hypoglycemia, candy cane syndrome, and concomitant alteration of limb lengths. PR consisted in laparoscopic lateral resection of the gastric pouch, the anastomosis and the proximal 5 cm of the alimentary limb over a 32F bougie. RESULTS Median follow-up after PR was 48 months (range 24-60). Median BMI at PR was 39.1 kg/m(2) (32.7-59.1). Median operation time was 85 min (25-190), and median length of stay was 3 days (1-35). Minor complications (grade ≤ 2) occurred in seven (27 %) patients and major complications (grade ≥ 3) in four patients (15 %). Nadir BMI and %EBMIL after PR were 32.9 kg/m(2) and 43.3 %, reached after a median of 12 months (3-48). Comorbidities were resolved in 81 %. After 48 months, median BMI was 33.8 kg/m(2) (20.4-49.2) and %EBMIL was 61.4 (39.1-121.2). CONCLUSIONS Used selectively in a multidisciplinary treatment pathway, PR leads to prolonged weight stabilization around the previous nadir. However, its associated perioperative morbidity must not be disregarded

Nachsorge nach bariatrischen Operationen

Mit der stetigen Zunahme an bariatrisch operierten Patienten wird die langfristige Nachsorge dieser Patientengruppe zu einer Herausforderung. Bariatrische Patienten bedürfen einer regelmäßigen und lebenslangen Nachkontrolle, damit die erzielten Erfolge nachhaltig positiv beeinflusst zu werden. Deswegen soll die Nachbetreuung von bariatrisch operierten Patienten in der ersten Phase von einem multidisziplinären Team übernommen werden, was bei stabiler Situation und unter Berücksichtigung einiger grundsätzlichen Überlegungen in der Betreuung der postbariatrischen Patienten auch durch niedergelassene Ärzte außerhalb eines Kompetenzzentrums durchgeführt werden können

Bilateral chylothorax following neck dissection: a case report.

BACKGROUND Chylothorax is an extremely rare but potentially life-threatening complication after radical neck dissection. We report the case of a bilateral chylothorax after total thyroidectomy and cervico-central and cervico-lateral lymphadenectomy for thyroid carcinoma. CASE PRESENTATION A 40-year-old European woman underwent total thyroidectomy and neck dissection for papillary thyroid carcinoma. Postoperatively she developed dyspnoea and pleural effusion. A chylothorax was found and the initial conservative therapy was not successful. She had to be operated on again and the thoracic duct was legated. CONCLUSION The case presentation reports a very rare complication after total thyroidectomy and neck dissection, but it has to be kept in mind to prevent dangerous complications