Skip to main content
Erschienen in: Obesity Surgery 8/2017

07.03.2017 | Original Contributions

Vertical Gastric Bypass with Fundectomy: Feasibility and 2-Year Follow-Up in a Series of Morbidly Obese Patients

verfasst von: Marco Antonio Zappa, Alberto Aiolfi, Cinzia Musolino, Maria Paola Giusti, Giovanni Lesti, Andrea Porta

Erschienen in: Obesity Surgery | Ausgabe 8/2017

Einloggen, um Zugang zu erhalten

Abstract

Background

Roux-en-Y gastric bypass (RYGB) is the gold standard procedure for morbid obesity and its results are well known and largely discussed. The major limitation of the procedure is the difficult exploration of the excluded gastric pouch and duodenum. The vertical gastric bypass with fundectomy was recently introduced in attempt to overcome these limitations. To date, its effectiveness is debated and outcomes still unclear. The purposes of this study were to describe the vertical gastric bypass with fundectomy and to analyse its outcomes in term of weight loss, complications, and comorbid resolutions.

Material and Methods

Since January 2012 to July 2014, 30 consecutive patients were enrolled and prospectively followed for a 24-month period. All patients underwent the vertical gastric bypass with fundectomy. Follow-up visits were scheduled at 7 days, 1, 6, 12, and 24 months, or whenever necessary.

Results

Overall, 24 women and six men were enrolled in the study. Mean preoperative BMI was 38.2 ± 8.5 kg/m2. No intraoperative complications were reported. Postoperative overall complication rate was 10%. Compliance to the 24-month follow-up was 100%. Mean BMI and excess weight loss (EWL%) were significantly lower compared to baseline (p < 0.05). Comorbid improvement or resolution was recorded in the 80% of the patients.

Conclusions

Vertical gastric bypass with fundectomy is feasible and effective with similar results in terms of weight loss, complications, and comorbid improving compared to the classic RYGB. Complete evaluation of the gastric anatomy and easy access to the main duodenal papilla are unquestionable advantages.
Literatur
1.
Zurück zum Zitat Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.CrossRefPubMed Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.CrossRefPubMed
2.
Zurück zum Zitat Svane MS, Jørgensen NB, Bojsen-Møller KN, et al. Peptide YY and glucagon-like peptide-1 contribute to decreased food intake after Roux-en-Y gastric bypass surgery. Int J Obes. 2016;40:1699–706.CrossRef Svane MS, Jørgensen NB, Bojsen-Møller KN, et al. Peptide YY and glucagon-like peptide-1 contribute to decreased food intake after Roux-en-Y gastric bypass surgery. Int J Obes. 2016;40:1699–706.CrossRef
3.
Zurück zum Zitat Lesti G, Tidona V, Lanci C, et al. Bypass gastrico laparoscopico con fundectomia e stomaco esplorabile secondo Lesti. Tecnica e follow-up a sei anni. Ospedali D’Italia. 2009;15:440. Lesti G, Tidona V, Lanci C, et al. Bypass gastrico laparoscopico con fundectomia e stomaco esplorabile secondo Lesti. Tecnica e follow-up a sei anni. Ospedali D’Italia. 2009;15:440.
6.
Zurück zum Zitat Facchiano E, Quartararo G, Pavoni V, et al. Laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography (ERCP) after Roux-en-Y-gastric bypass: technical features. Obes Surg. 2015;25:373–6.CrossRefPubMed Facchiano E, Quartararo G, Pavoni V, et al. Laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography (ERCP) after Roux-en-Y-gastric bypass: technical features. Obes Surg. 2015;25:373–6.CrossRefPubMed
7.
Zurück zum Zitat Papasavas PK, Yeaney WW, Caushaj PF, et al. Perforation in the bypassed stomach following laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13:797–9.CrossRefPubMed Papasavas PK, Yeaney WW, Caushaj PF, et al. Perforation in the bypassed stomach following laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13:797–9.CrossRefPubMed
8.
Zurück zum Zitat Gypen BJ, Hubens GJ, Hartman V, et al. Perforated duodenal ulcer after laparoscopic gastric bypass. Obes Surg. 2008;18:1644–6.CrossRefPubMed Gypen BJ, Hubens GJ, Hartman V, et al. Perforated duodenal ulcer after laparoscopic gastric bypass. Obes Surg. 2008;18:1644–6.CrossRefPubMed
9.
Zurück zum Zitat Harper JL, Beech D, Tichansky DS, et al. Cancer in the bypassed stomach presenting early after gastric bypass. Obes Surg. 2007;17:1268–71.CrossRefPubMed Harper JL, Beech D, Tichansky DS, et al. Cancer in the bypassed stomach presenting early after gastric bypass. Obes Surg. 2007;17:1268–71.CrossRefPubMed
10.
Zurück zum Zitat Orlando G, Pilone V, Vitiello A, et al. Gastric cancer following bariatric surgery: a review. Surg Laparosc Endosc Percutan Tech. 2014;24:400–5.CrossRefPubMed Orlando G, Pilone V, Vitiello A, et al. Gastric cancer following bariatric surgery: a review. Surg Laparosc Endosc Percutan Tech. 2014;24:400–5.CrossRefPubMed
11.
Zurück zum Zitat Leuratti L, Di Simone MP, Cariani S. Unexpected changes in the gastric remnant in asymptomatic patients after Roux-en-Y gastric bypass on vertical banded gastroplasty. Obes Surg. 2013;23:131–9.CrossRefPubMed Leuratti L, Di Simone MP, Cariani S. Unexpected changes in the gastric remnant in asymptomatic patients after Roux-en-Y gastric bypass on vertical banded gastroplasty. Obes Surg. 2013;23:131–9.CrossRefPubMed
12.
Zurück zum Zitat Schneider BE, Villegas L, Blackburn GL, et al. Laparoscopic gastric bypass surgery: outcomes. J Laparoendosc Adv Surg Tech A. 2003;13:247–55.CrossRefPubMed Schneider BE, Villegas L, Blackburn GL, et al. Laparoscopic gastric bypass surgery: outcomes. J Laparoendosc Adv Surg Tech A. 2003;13:247–55.CrossRefPubMed
13.
Zurück zum Zitat Bastouly M, Arasaki CH, Ferreira JB, et al. Early changes in postprandial gallbladder emptying in morbidly obese patients undergoing Roux-en-Y gastric bypass: correlation with the occurrence of biliary sludge and gallstones. Obes Surg. 2009;19:22–8.CrossRefPubMed Bastouly M, Arasaki CH, Ferreira JB, et al. Early changes in postprandial gallbladder emptying in morbidly obese patients undergoing Roux-en-Y gastric bypass: correlation with the occurrence of biliary sludge and gallstones. Obes Surg. 2009;19:22–8.CrossRefPubMed
14.
Zurück zum Zitat Al-Jiffry BO, Shaffer EA, Saccone GT, et al. Changes in gallbladder motility and gallstone formation following laparoscopic gastric banding for morbid obesity. Can J Gastroenterol. 2003;17:169–74.CrossRefPubMed Al-Jiffry BO, Shaffer EA, Saccone GT, et al. Changes in gallbladder motility and gallstone formation following laparoscopic gastric banding for morbid obesity. Can J Gastroenterol. 2003;17:169–74.CrossRefPubMed
15.
Zurück zum Zitat Shiffman ML, Sugerman HJ, Kellum JM, et al. Gallstone formation after rapid weight loss: a prospective study in patients undergoing gastric bypass surgery for treatment of morbid obesity. Am J Gastroenterol. 1991;86:1000–5.PubMed Shiffman ML, Sugerman HJ, Kellum JM, et al. Gallstone formation after rapid weight loss: a prospective study in patients undergoing gastric bypass surgery for treatment of morbid obesity. Am J Gastroenterol. 1991;86:1000–5.PubMed
16.
Zurück zum Zitat Shiffman ML, Sugerman HJ, Kellum JM, et al. Changes in gallbladder bile composition following gallstone formation and weight reduction. Gastroenterology. 1992;103:214–21.CrossRefPubMed Shiffman ML, Sugerman HJ, Kellum JM, et al. Changes in gallbladder bile composition following gallstone formation and weight reduction. Gastroenterology. 1992;103:214–21.CrossRefPubMed
17.
Zurück zum Zitat Ross AS, Semrad C, Alverdy J, et al. Use of double balloon enteroscopy to perform PEG in the excluded stomach after Roux-en-Y gastric bypass. Gastrointestinal Endosc. 2006;64:797–800.CrossRef Ross AS, Semrad C, Alverdy J, et al. Use of double balloon enteroscopy to perform PEG in the excluded stomach after Roux-en-Y gastric bypass. Gastrointestinal Endosc. 2006;64:797–800.CrossRef
18.
Zurück zum Zitat Cariani S, Vittimberga G, Grani S, et al. A functional Roux-en-Y gastric bypass to avoid gastric exclusion: 1-year results. Obes Surg. 2003;13:788–91.CrossRefPubMed Cariani S, Vittimberga G, Grani S, et al. A functional Roux-en-Y gastric bypass to avoid gastric exclusion: 1-year results. Obes Surg. 2003;13:788–91.CrossRefPubMed
19.
Zurück zum Zitat Cariani S, Palandri P, Della Valle E, et al. Italian multicenter experience of Roux-en Y gastric bypass on vertical banded gastroplasty: four-year results of effective and safe innovative procedure enabling traditional endoscopic and radiographic study of bypassed stomach and biliary tract. Surg Obes Relat Dis. 2008;4:16–25.CrossRefPubMed Cariani S, Palandri P, Della Valle E, et al. Italian multicenter experience of Roux-en Y gastric bypass on vertical banded gastroplasty: four-year results of effective and safe innovative procedure enabling traditional endoscopic and radiographic study of bypassed stomach and biliary tract. Surg Obes Relat Dis. 2008;4:16–25.CrossRefPubMed
20.
Zurück zum Zitat Mozzi E, Lattuada E, Zappa MA, et al. Failure of gastric bypass following several gastrointestinal hemorrhages. Obes Surg. 2010;20:523–5.CrossRefPubMed Mozzi E, Lattuada E, Zappa MA, et al. Failure of gastric bypass following several gastrointestinal hemorrhages. Obes Surg. 2010;20:523–5.CrossRefPubMed
21.
Zurück zum Zitat Lucchese M, Cariani S, Amenta E, et al. Other bariatric procedures. In: Angrisani L, editor. Bariatric and metabolic surgery. Berlin: Springer; 2016. p. 195–206. Lucchese M, Cariani S, Amenta E, et al. Other bariatric procedures. In: Angrisani L, editor. Bariatric and metabolic surgery. Berlin: Springer; 2016. p. 195–206.
22.
Zurück zum Zitat Cariani S, Agostinelli L, Giorgini E, et al. Roux-en-Y gastric bypass on vertical banded gastroplasty: 6 years of experience of modified gastric bypass which allows endoscopic and radiological investigation of the excluded stomach [abstract]. Obes Surg. 2009;19:1048–9. Cariani S, Agostinelli L, Giorgini E, et al. Roux-en-Y gastric bypass on vertical banded gastroplasty: 6 years of experience of modified gastric bypass which allows endoscopic and radiological investigation of the excluded stomach [abstract]. Obes Surg. 2009;19:1048–9.
23.
Zurück zum Zitat Giordano S, Salminen P, Biancari F, et al. Linear stapler technique may be safer than circular in gastro-iejunal anastomosis for laparoscopic Roux en y gastric bypass: a meta-analysis of comparative studies. Obes Surg. 2011;21:1958–64.CrossRefPubMed Giordano S, Salminen P, Biancari F, et al. Linear stapler technique may be safer than circular in gastro-iejunal anastomosis for laparoscopic Roux en y gastric bypass: a meta-analysis of comparative studies. Obes Surg. 2011;21:1958–64.CrossRefPubMed
24.
25.
Zurück zum Zitat Peterli R, Steinert RE, Woelnerhanssen B, et al. Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial. Obes Surg. 2012;22:740–8.CrossRefPubMedPubMedCentral Peterli R, Steinert RE, Woelnerhanssen B, et al. Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial. Obes Surg. 2012;22:740–8.CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Christou NV, Look D, Maclean LD. Pre-and post-prandial ghrelin levels do not related with satiety or failure to achieve a successful outcome after Roux-en-Y gastric bypass. Obes Surg. 2005;15:1017–23.CrossRefPubMed Christou NV, Look D, Maclean LD. Pre-and post-prandial ghrelin levels do not related with satiety or failure to achieve a successful outcome after Roux-en-Y gastric bypass. Obes Surg. 2005;15:1017–23.CrossRefPubMed
27.
Zurück zum Zitat Chronaiou A, Tsoli M, Kehagias I, et al. Lower ghrelin levels and exaggerated postprandial peptite YY, glucacon-like peptide-1 and insulin responses after gastric fundus resection in patients undergoing roux-en-Y gastric bypass: a randomized clinical trial. Obes Surg. 2012;22:1761–70.CrossRefPubMed Chronaiou A, Tsoli M, Kehagias I, et al. Lower ghrelin levels and exaggerated postprandial peptite YY, glucacon-like peptide-1 and insulin responses after gastric fundus resection in patients undergoing roux-en-Y gastric bypass: a randomized clinical trial. Obes Surg. 2012;22:1761–70.CrossRefPubMed
28.
Zurück zum Zitat Braley SC, Nguyen NT, Wolfe BM. Late gastrointestinal hemorrhage after gastric bypass. Obes Surg. 2002;12:404–7.CrossRefPubMed Braley SC, Nguyen NT, Wolfe BM. Late gastrointestinal hemorrhage after gastric bypass. Obes Surg. 2002;12:404–7.CrossRefPubMed
29.
Zurück zum Zitat Mehran A, Szomstein S, Zundel N, et al. Management of acute bleeding after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13:842–7.CrossRefPubMed Mehran A, Szomstein S, Zundel N, et al. Management of acute bleeding after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13:842–7.CrossRefPubMed
30.
Zurück zum Zitat Kellogg TA, Swan T, Leslie DA, et al. Patterns of readmission and reoperation within 90 days after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2009;5:416–23.CrossRefPubMed Kellogg TA, Swan T, Leslie DA, et al. Patterns of readmission and reoperation within 90 days after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2009;5:416–23.CrossRefPubMed
31.
Zurück zum Zitat O'Brien PE, McPhail T, Chaston TB, et al. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006;16:1032–40.CrossRefPubMed O'Brien PE, McPhail T, Chaston TB, et al. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006;16:1032–40.CrossRefPubMed
32.
Zurück zum Zitat Magro DO, Geloneze B, Delfini R, et al. Long-term weight regain after gastric bypass: a 5 years prospective study. Obes Surg. 2008;8:648–51.CrossRef Magro DO, Geloneze B, Delfini R, et al. Long-term weight regain after gastric bypass: a 5 years prospective study. Obes Surg. 2008;8:648–51.CrossRef
33.
Zurück zum Zitat Li JF, Lai DD, Lin ZH, et al. Comparison of the long-term results of Roux-en-Y gastric bypass and sleeve gastrectomy for morbid obesity: a systematic review and meta-analysis of randomized and nonrandomized trials. Surg Laparosc Endosc Percutan Tech. 2014;24:1–11.CrossRefPubMed Li JF, Lai DD, Lin ZH, et al. Comparison of the long-term results of Roux-en-Y gastric bypass and sleeve gastrectomy for morbid obesity: a systematic review and meta-analysis of randomized and nonrandomized trials. Surg Laparosc Endosc Percutan Tech. 2014;24:1–11.CrossRefPubMed
34.
Zurück zum Zitat Ribeiro-Parenti L, De Courville G, Daikha A, Arapis K, Chosidow D, Marmuse JP. Classification, surgical management and outcomes of patients with gastrogastric fistula after Roux-En-Y gastric bypass. Surg Obes Relat Dis. 2016 Sep 28. pii: S1550–7289(16)30726–2. Ribeiro-Parenti L, De Courville G, Daikha A, Arapis K, Chosidow D, Marmuse JP. Classification, surgical management and outcomes of patients with gastrogastric fistula after Roux-En-Y gastric bypass. Surg Obes Relat Dis. 2016 Sep 28. pii: S1550–7289(16)30726–2.
Metadaten
Titel
Vertical Gastric Bypass with Fundectomy: Feasibility and 2-Year Follow-Up in a Series of Morbidly Obese Patients
verfasst von
Marco Antonio Zappa
Alberto Aiolfi
Cinzia Musolino
Maria Paola Giusti
Giovanni Lesti
Andrea Porta
Publikationsdatum
07.03.2017
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 8/2017
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-017-2620-y

Weitere Artikel der Ausgabe 8/2017

Obesity Surgery 8/2017 Zur Ausgabe

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 Ablationstherapie Nachrichten

Nach der Katheterablation von Vorhofflimmern kommt es bei etwa einem Drittel der Patienten zu Rezidiven, meist binnen eines Jahres. Wie sich spätere Rückfälle auf die Erfolgschancen einer erneuten Ablation auswirken, haben Schweizer Kardiologen erforscht.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Ureterstriktur: Innovative OP-Technik bewährt sich

19.04.2024 EAU 2024 Kongressbericht

Die Ureterstriktur ist eine relativ seltene Komplikation, trotzdem bedarf sie einer differenzierten Versorgung. In komplexen Fällen wird dies durch die roboterassistierte OP-Technik gewährleistet. Erste Resultate ermutigen.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.