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Background: A gastric pouch in Roux-en-Y gastric bypass (RYGB) surgery can be created after transection of the perigastric neurovascular bundle or by preserving these structures. Some surgeons choose to transect the neurovascular bundle (NBT), containing branches of the vagus nerve, because this might be related to additional weight loss, whereas others advocate preservation (NBP) to reduce postoperative complications., Objectives: This study assessed the effect of both techniques after primary RYGB., Setting: All patients undergoing primary RYGB in a large bariatric center in the Netherlands between January 2010 and December 2013 were included., Methods: Patient demographic characteristics, operative details, postoperative complications and weight loss after 1 year were retrospectively analyzed., Results: A total of 773 consecutive patients were included (85.5% female). NBT was performed in 407 patients (52.7%), whereas NBP was performed in 366 patients. There were no missing data and 81.2% of patients completed the 1-year follow-up. Postoperative complications were found in 66 patients (8.5%). A total of 49 patients (6.3%) either had an anastomotic leakage, postoperative bleeding, or intraabdominal abscess (NBT 8.8% versus NBP 3.6%, P = .003). Percentage total weight loss (NBT 34.5%±6.9% versus NBP 33.4%±6.9%; P = .011) differed to a lesser extent between groups, although this was significant. Neurovascular bundle transection was identified as independent factor among others for occurrence of leakage, bleeding, and abscess development (OR 2.886; 95% CI [1.466-5.683]; P = .002)., Conclusions: Transection of the neurovascular bundle in RYGB is associated with more complications. Furthermore, weight loss is not relevantly increased. Further research is necessitated to substantiate these findings., (Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Obesity is a chronic, multifactorially caused disease with serious somatic and psychosocial comorbidity as well as economical consequences. In the Netherlands, between 1993 and 1997, the prevalence of morbid obesity was 0.2% for men and 0.6% for women. Although bariatric surgery generally is an effective intervention, it does not lead to equal results in every patient. The long-term efficacy is predominantly determined by compliance to adequate dietary rules in which psychosocial factors can play a major role., Methods: Questionnaires were sent to the surgery departments of all hospitals in the Netherlands. Subsequently, a second questionnaire was sent to clinical psychology departments of hospitals which perform bariatric surgery., Results: In 28 Dutch hospitals (19%), bariatric surgery is being performed, mostly using restrictive procedures. Almost all hospitals have a multidisciplinary selection-process, and all surgeons and psychologists use multiple selection-criteria. Regarding these criteria, there is more consensus between surgeons than between psychologists. In most hospitals, patients are psychologically assessed prior to surgery. However, postoperative assessment is relatively rare, as is preoperative and postoperative psychological treatment., Conclusion: In the Netherlands, bariatric surgery is still relatively uncommon and mostly limited to restrictive procedures. Irrespective of BMI and eating behavior, the majority of patients will be offered a restrictive procedure. The involvement by the psychological and/or psychiatric discipline is not optimal yet; especially, postoperative assessment and pre- and postoperative treatment are not frequently performed, in spite of the fact that these programs can enhance the success rate of bariatric surgery.

Background: Obesity is an increasing disease worldwide. Bariatric surgery is the only effective therapy to induce sufficient long-term weight loss for morbidly obese patients. Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is the gold standard surgical technique. Laparoscopic Sleeve Gastrectomy (LSG) is a new promising bariatric procedure which has the advantage of maintaining an intact gastrointestinal tract. The aim of this study is to evaluate the efficiency of both techniques. Our hypothesis is that LSG has a similar percentage excess BMI loss (%EBMIL) after 5 years compared to LRYGB. Methods/Design: The Sleeve Bypass Trial is a randomized multicentre clinical trial: patients eligible for bariatric surgery are randomized to either LSG or LRYGB. Patients with a body mass index (BMI) = 40 kg/m² or BMI 35 kg/m² with obesity related comorbidity (T2 DM, sleep apnoea, hypertension) are eligible for randomization. At randomization patients are stratified for centre, sex, T2 DM and BMI ≥ = 50 kg/m². A total number of 620 patients will be enrolled and equally (1:1) randomized to both treatment arms. Only surgeons experienced in both operation techniques will participate in the Sleeve Bypass trial. The primary endpoint is the 5-year weight loss (%EBMIL) of LSG and LRYGB. Secondary endpoints are resolution of obesity related comorbidity, complications, revision bariatric surgery and quality of life (QOL) defined in various questionnaires. Discussion: Long-term %EBMIL between the two treatment strategies used to be in favour of LRYGB, but more recent results throughout the world show similar %EBMIL in both techniques. If weight loss is comparable, obesity-related comorbidity and QOL after bariatric procedures should be taken into account when deciding on which surgical technique is to be preferred for certain subgroups in the future. Trial registration: Dutch Trial Register: NTR 4741. [ABSTRACT FROM AUTHOR]