Search

Background The long-term outcomes of primary single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) have never been reported in the literature. Objectives The study aimed to evaluate the long-term outcomes after primary laparoscopic SADI-S (LSADI-S). Setting Single, private institute, United States. Methods Data from 750 patients who underwent a primary LSADI-S from June 2013 through November 2019 by 3 surgeons were retrospectively analyzed. Results Seven hundred fifty patients were included in the study. The mean age and preoperative body mass index were 49.3 ± 13.1 years and 50 ± 12.6 kg/m2, respectively. Follow-up was available on 109 patients (61%) at 5 years and on 87 patients (53%) at 6 years. Six patients did not have any follow-up. The average operative time and length of stay were 67.6 ± 27.4 minutes and 1.5 ± .8 days, respectively. The intraoperative, short-term, and long-term complication rates were 0%, 7.8%, 11.7%, respectively. The 30-day emergency room visit, readmission, and reoperation rates were .4%, 1.1%, and 1.1%, respectively. In total, there were 15 (2%) grade IIIb long-term complications unique to LSADI-S. Complete remission of type 2 diabetes was seen in 77% of the diabetic population. At 5 and 6 years, the mean change in body mass index was 17.5 ± 6.9 and 17.6 ± 6.4 kg/m2, respectively. The mortality rate was .5%. Conclusions LSADI-S is effective in this retrospective review in achieving good initial weight loss and weight maintenance. Although our data show acceptable nutritional complications, questions still remain because of the retrospective nature of the study.

Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) surgery is a modification of the traditional duodenal switch (DS) surgery. SADI-S is relatively a new bariatric surgical procedure and has gone by many names depending on the length of the common channel. In this study, we report our initial experience with this novel technique in the Australian population. The medical records of 91 patients who underwent laparoscopic primary SADI-S surgery by one surgeon at a single Australian center from January 2017 through May 2019 were retrospectively studied. Ninety-one patients were identified for analysis. The mean age and preoperative body mass index (BMI) was 46.2 ± 9 years and 43.2 ± 5.7 kg/m2, respectively. The mean operative time and length of stay were 121.8+/- 25 minutes and 1.4 ± 0.8 days, respectively. At 12 and 24 months, the patients lost an average BMI of 15.2 ± 5.2 kg/m2 and 17.2 ± 5.9 kg/m2, respectively. The short-term and long-term complication rates were 4.3% and 0%, respectively. The mortality rate was 0%. Postoperatively, the obstructive sleep apnea, type 2 diabetes, hyperlipidemia, hypertension, and gastroesophageal reflux disease resolution rates were 94, 94, 75, 68, and 13%, respectively. There was no statistically significant difference between most of the preoperative and postoperative nutritional data. SADI-S appears to be a safe bariatric surgical procedure with favorable outcomes at 2 years in the Australian population.

The sleeve gastrectomy (SG) is the most popular weight loss procedure in the USA. Despite its popularity, little is definitively known about the variables that correlate with weight loss. We performed a literature search to find studies that reported variables that correlated with weight loss following SG. Forty-eight articles were identified and included. These articles covered 36 different factors predictive of weight loss while only including five predictive models. Only 12.5% of multivariate analyses evaluated sufficiently reported their results. The factors that predict weight loss following SG cannot be concluded due to the inconsistency in reporting and the methodological flaws in analysis. Reporting factors that predict weight loss should be standardized, and methods should be changed to allow physicians to use the data presented.

Laparoscopic adjustable gastric band with plication (LAGBP) is a novel bariatric procedure, which combines the adjustability of the laparoscopic adjustable gastric band (LAGB) with the restrictive nature of the vertical sleeve gastrectomy (VSG). The addition of plication of the stomach to LAGB should provide better appetite control, more effective weight loss, and greater weight loss potential. The purpose of the study was to analyze the outcomes of LAGBP at 18 months. Data from all patients who underwent a primary LAGBP procedure from December 2011 through June 2016 were retrospectively analyzed. Data collected from each patient included age, gender, weight, body mass index (BMI), and excess weight loss (EWL). Sixty-six patients underwent LAGBP. The mean age and BMI were 44.6 ± 12.7 years and 42.1 ± 5.1 kg/m2, respectively. The patients lost an average of 49% and 46.8% EWL at 12 months (77.2% follow-up) and 18 months (66.1% follow-up), respectively. The mean band adjustments were 2.1 ± 1.7 (range, 0–7) per patient in 1 year. The mean additional adjustment volume (infusion and withdrawal of saline) was 0.6 ± 1 cc. Dysphagia was the most common long-term complication. The band removal rate was 7.5%. The mortality rate was 0%. LAGBP is a relatively safe and effective bariatric procedure. In light of recent studies demonstrating poor outcomes following LAGB, LAGBP may prove to be the future for patients desiring a bariatric procedure without resection of the stomach.

Background Inadequate weight loss, weight recidivism, and device-related complications after an adjustable gastric banding (AGB) can be treated by a laparoscopic conversion to stomach intestinal pylorus-sparing surgery (SIPS). Objective The aim of the study was to analyze the midterm outcomes of revision SIPS surgery after failed AGB. Setting Private practice, United States. Methods This is a retrospective review of our prospectively collected data of patients who underwent laparoscopic conversion from AGB to SIPS surgery from June 2013 and February 2017 by a single surgeon in a single institution. Results Twenty-seven patients (1 stage: 22 and 2 stage: 5) underwent a laparoscopic revision of AGB to SIPS surgery. The mean ± standard deviation preoperative body mass index (BMI) before AGB was 47.5 ± 6.8 kg/m2, while the mean nadir BMI after AGB was 36 ± 7.7 kg/m2. The overall time to reoperation was 9.3 ± 8.7 and 5.6 ± 2.5 years in 1- and 2-stage conversion patients, respectively. The mean preoperative BMI before revision SIPS surgery was 46.7 ± 7 kg/m2. At 36 months, the patients had an average change in BMI of 20.9 units with 90% excess weight loss. A major complication occurred in 4 patients. Postoperatively, the fasting blood glucose, insulin, low-density lipoprotein, triglyceride, and most of the co-morbidities were resolved or improved. Conclusion This study demonstrates that conversion of failed AGB to SIPS surgery is an effective approach to AGB failure.

Loop duodenal switch (LDS) can result in fat and starch malabsorption. In a small percentage of patients, a relevant qualitative and quantitative change in stools happens usually characterized by steatorrhea-like diarrhea. Bismuth subgallate (BS) has been marketed as a way to eliminate the odor associated with flatulence and bowel movements. The objective of this study is to see the efficacy and effect of BS on the quality of life (QOL) in patients undergoing LDS. A prospective, randomized, double-blinded, placebo-controlled, crossover study was designed. Thirty-six patients who reported flatus and/or stool odor changes and have completed at least 6 months post-LDS were included. Patients participated in two treatment periods, each lasting for 1 week, separated by 1-week washout. Patients received 200 mg BS, 2 capsules per meal, or placebo for 1 week each. The Gastrointestinal Quality of Life Index (GIQLI) questionnaire was used to compare the QOL before the initiation of the therapy and after each treatment completion. Of 36 patients, 5 patients were lost to follow-up and 2 were withdrawn from the study. And 29 patients were included for final analysis. GIQLI scores obtained with BS treatment completion were significantly higher both overall (P = 0.007) and in the digestive domain (P

Single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) is a modification of Roux-en-Y duodenal switch (RYDS). Long-term data on this operation is lacking in the literature. We reviewed our mid-term data of this RYDS modification. To analyze the outcomes with SADI-S at 4 years. Data from patients who underwent a primary SADI-S procedure performed by three surgeons at a single institution from June 2013 through February 2018 were retrospectively reviewed. All revision bariatric surgeries were excluded. Regression analyses were performed for all follow-up weight loss data. There were 437 patients in our database. The pre-operative mean body mass index (BMI) was 49.8 ± 8.8 kg/m2. The 30-day complication rate was 7.7%. The 30-day readmission, reoperation, and mortality rates were 1.8, 1.3, and 0.2%, respectively. The long-term complication rate was 10.9%. Seventy-nine patients were 4 years post SADI-S surgery and follow-up was possible for 44 patients (55.7%). At 4 years, patients had an average change in BMI of 18.1 ± 6 units with an excess weight loss (EWL) of 85.7 ± 27.3%. At 4 years, 97.6% patients were able to maintain HbA1c

Laparoscopic adjustable gastric banded plication (LAGBP) is a procedure that has a stomach volume similar to the sleeve gastrectomy (SG). It has shown promising results but has not been adopted widely.To determine the difference gastrectomy has on weight loss and complications.Private practice, United States.A retrospective, matched-cohort analysis of LAGBP and SG patients was found through matching body mass index and sex for each LAGBP to a SG patient. Body mass index, percentage excess weight loss, and total weight loss percentage were analyzed. Complication data were also collected on a short- (30 d) and long- (30 d) term basis. Complication rates were then compared. Data were analyzed through descriptive statistics.Patients who received SG lost more body mass index, percentage excess weight loss, and total weight loss percentage at 1 year and started to gain weight between 1 and 2 years. LAGBP patients weight loss also peaked at 1 year but maintained their weight loss to year 2. SG patients lost more weight at all time points, and the difference was statistically significant (P.05). LAGBP and SG patients had statistically similar rates of short- and long-term complication rates. In the LAGBP group (57 patients) 5, 9, 13, 14, 14, and 17 patients were lost to follow-up at 3, 6, 9, 12, 18, and 24 months, respectively. In the SG group (57 patients) 11, 10, 11, 13, 20, and 29 patients were lost to follow-up at 3, 6, 9, 12, 18, and 24 months, respectively.Both procedures have peak weight loss at 1 year with acceptable complication rates. However, the SG starts to regain weight while the LAGBP shows weight stability. More time is needed to see if the weight loss curves will intersect or if the late band complications will also happen with the LAGBP as they have with band placement without plication.

For many years, the Roux-en-Y Gastric Bypass (RYGB) was considered a good balance of complications and weight loss. According to several short-term studies, single anastomosis duodenal switch or stomach intestinal pylorus sparing surgery (SIPS) offers similar weight loss to RYGB with fewer complications and better diabetes resolution. No one has substantiated mid-term complication and nutritional differences between these two procedures. This paper seeks to compare complication and nutritional outcomes between RYGB and SIPS. A retrospective analysis of 798 patients who either had SIPS or RYGB from 2010 to 2016. Complications were gathered for each patient. Nutritional outcomes were measured for each group at 1, 2, and 3 years. Regression analysis was applied to interpolate each patient’s weight at 3, 6, 9, 12, 18, 24, and 36 months. These were then compared with t tests, Fisher’s exact tests, and chi-squared tests. RYGB and SIPS have statistically similar weight loss at 3, 6, 9, 12, and 36 months. They statistically differ at 18 and 24 months. At 36 months, there is a trend for weight loss difference. There were only statistical differences in nutritional outcomes between the two procedures with calcium at 1 and 3 years and vitamin D at 1 year. There were statistically significantly more long-term class IIIb-V complications, class I-IIIa complications, reoperations, ulcers, small bowel obstructions, nausea, and vomiting with the RYGB than the SIPS. With comparable weight loss and nutritional outcomes, SIPS has fewer short- and long-term complications than RYGB and better type 2 diabetes resolution rates.

Background The traditional duodenal switch is performed using a Roux-en-Y configuration. This procedure has proven to be the most effective procedure for long-term weight loss and co-morbidity reduction. Recently, stomach intestinal pylorus sparing surgery (SIPS) has been introduced as a simpler and potentially safer variation of the duodenal switch (DS). It is a single anastomosis end-to-side proximal duodeno-ileal bypass with a sleeve gastrectomy. In this study, we compare our outcomes between biliopancreatic diversion with duodenal switch (BPD-DS) and SIPS at 2 years. Setting This is a retrospective analysis from a single surgeon at a single private institution. Methods We analyzed data from 182 patients retrospectively, 62 patients underwent BPD-DS while 120 other patients underwent SIPS between September 2011 and March 2015. A subset analysis was performed comparing data from both procedures to evaluate weight loss and complications. Results Of 182 patients, 156 patients were beyond 1 year postoperative mark and 99 patients were beyond 2 year postoperative mark. Five patients were lost to follow-up. None of our patients had complications resulting in death. BPD-DS and SIPS had statistically similar weight loss at 3 months but percent excess weight loss (%EWL) was more with BPD-DS than SIPS at 6, 9, 12, 18, and 24 months. Patient lost a mean body mass index (BMI) of 23.3 (follow-up: 69%) and 20.3 kg/m 2 (follow-up: 71%) at 2 years from the BPD-DS and SIPS surgery, respectively. However, patients who had undergone SIPS procedure had significantly shorter operative time, shorter length of stay, fewer perioperative and postoperative complications than BPD-DS ( P P Conclusion The SIPS is a simplified DS procedure. The SIPS eliminates one anastomosis and compared with BPD-DS has fewer perioperative and postoperative complications, shorter operative time and length of stay, and similar nutritional results at 2 years. However, weight loss was more with BPD-DS. A fair criticism is that the vast majority of BPD-DS cases were done before the SIPS cases. As a result, experience and learning curve cannot be completely dismissed when viewing postoperative complications.

The number of bariatric surgical operations performed in the United States has been steadily increasing for the last 5 years. It is estimated that 228,000 weight-loss surgeries were performed in 2017. Of those, 59% were sleeve gastrectomy, 18% were gastric bypass, 3% were gastric band, and 1% were biliopancreatic diversion with duodenal switch. The remaining 14% were revisional procedures.

The single anastomosis duodeno-ileostomy (SADI) was introduced to eliminate the complications seen with Roux limb formation. It involves a loop anastomosis rather than traditional Roux-en-Y reconstruction. The procedure has been used as a primary, staged, or revision procedure to treat morbid obesity as well as obesity-related coexisting conditions.

The single-anastomosis duodenal ileostomy with sleeve gastrectomy (SADI-S) is gaining popularity in the United States as an alternative to the gastric bypass for patients with a high body mass index (BMI) or who are less likely to succeed with a sleeve. While SADI-S has similar weight loss to the gastric bypass, the complication rate is significantly lower, allowing surgeons to perform SADI-S in an ambulatory surgical center with a 23-hour stay.To determine if SADI-S can be safely performed in an ambulatory surgical setting.Private practice.All SADI-S procedures performed from August 2015 to March 2019 at 2 bariatric centers were included in this study. Patients selection for SADI-S in the ambulatory surgical center required no end organ damage, no evidence of severe sleep apnea, and BMI55 for males and BMI60 for females. All data were gathered retrospectively from prospectively kept databases. Thirty-day complication rates were analyzed using the Clavien-Dindo scale to assess the safety of performing SADI-S in an ambulatory surgical center.Eighty-two patients were included in this study. The sample was 72% female with an average age of 46 and BMI of 45. All patients received planned intravenous fluid within 3 days after the procedure. There were 2 (2.4%) grade IIIb to V complications. There were no mortalities in this series.SADI-S can be performed safely in an ambulatory surgery 23-hour setting with appropriate patient selection, perioperative support, and enhanced recovery after surgery protocols.

Single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) is a modification of the biliopancreatic diversion with duodenal switch (BPD-DS) surgery. A concern with SADI-S is chronic diarrhea and hypoproteinemia. Common channel lengthening (CCL) is a surgical procedure to increase absorption in the small intestine to decrease diarrhea. The aim of this study was to assess the occurrence and treatment of hypoproteinemia and chronic diarrhea with CCL following SADI-S surgery. Private practice in the USA. Patients were included if they underwent SADI-S from September 2013 to March 2018 and following surgery underwent CCL. Average operating time for laparoscopic CCL is 56.5 ± 4.6 min. The average bowel movements for the eight patients before laparoscopic CCL were 9.1 ± 4.7 a day. After the surgery, the bowel movements were reduced to 2.6 ± 0.4 a day. This difference was found to be statistically significantly different (p = .002). The two patients experiencing hypoproteinemia improved protein levels following CCL. CCL is an effective way to treat symptomatic chronic diarrhea after SADI-S when conservative treatments have failed.

Background The sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and single-anastomosis duodenal-ileal bypass with SG (SADI-S) are recognized bariatric procedures. A comparison has never been made between these 3 procedures and especially in different body mass index (BMI) categories. Objective The study aimed to analyze a large cohort of patients undergoing either laparoscopic (L) SG, LRYGB, or LSADI-S to evaluate and compare weight loss and glycosylated hemoglobin level. The secondary aim was to compare the nutritional outcomes between LRYGB and LSADI-S. Setting Private practice, United States. Methods This is a retrospective review of 878 patients who underwent LSG, LRYGB, or LSADI-S from April 2014 through October 2015 by 5 surgeons in a single institution. For weight loss analysis, the patients were categorized into 4 different categories as follows: patients regardless of their preoperative BMI, patients with preoperative BMI 55 kg/m2. Results A total of 878 patients were identified for analysis. Of 878 patients, 448 patients, 270 patients, and 160 patients underwent LSG, LRYGB, and LSADI-S, respectively. Overall, at 12 and 24 months, the weight loss was highest with LSADI-S, followed by LRYGB and LSG in all 4 categories. At 2 years, the patients lost 19.5, 16.1, and 11.3 BMI points after LSADI-S, LRYGB, and LSG, respectively. In addition, the weight loss was highest in patients with preoperative BMI 55 kg/m2 at 12 and 24 months. Also, there were no statistically significant differences between the nutritional outcomes between LRYGB and LSADI-S. The LSADI-S had significantly lower rates of abnormal glycosylated hemoglobin than LRYGB and LSG at 12 months (P Conclusions The weight loss outcomes and glycosylated hemoglobin rates were better with LSADI-S than LRYGB or LSG. The nutritional outcomes between LRYGB and LSADI-S were similar.

Background Laparoscopic sleeve gastrectomy (LSG) is a safe and effective procedure that can be performed as an outpatient procedure. Objectives The aim of the study was to determine whether same-day discharge LSG is safe when performed in an outpatient surgery center. Setting Outpatient surgery centers. Methods The medical records of 3162 patients who underwent primary LSG procedure by 21 surgeons at 9 outpatient surgery centers from January 2010 through February 2018 were retrospectively reviewed. Results Three thousand one hundred sixty-two patients were managed with enhanced recovery after surgery protocol and were included in this analysis. The mean age and preoperative body mass index were 43.1 ± 10.8 years and 42.1 ± 7.1 kg/m2, respectively. Sleep apnea, type 2 diabetes, gastroesophageal reflux disease, hypertension, and hyperlipidemia were seen in 14.4%, 13.5%, 24.7%, 30.4%, and 17.6% patients, respectively. The mean total operative time was 56.4 ± 16.9 minutes (skin to skin). One intraoperative complication (.03%) occurred. The hospital transfer rate was .2%. The 30-day follow-up rate was 85%. The postoperative outcomes were analyzed based on the available data. The 30-day readmission, reoperation, reintervention, and emergency room visit rates were .6%, .6%, .2%, and .1%, respectively. The 30-day mortality rate was 0%. The total short-term complication rate was 2.5%. Conclusions Same-day discharge seems to be safe when performed in an outpatient surgery center in selected patients. It would appear that outpatient surgery centers are a viable option for patients with minimal surgical risks.

Background The single-anastomosis duodenal switch procedure is a type of duodenal switch that involves a loop anastomosis rather than traditional Roux-en-Y reconstruction. To date, there have been no multicenter studies looking at the complications associated with post-pyloric loop reconstruction. Objectives The aim of the study was to report the incidence of complications associated with loop duodeno-ileostomy (DI) following single-anastomosis duodenal switch (SADS) procedures. Setting Mixed of private and teaching facilities. Methods The medical records of 1328 patients who underwent primary SADS procedure (single-anastomosis duodeno–ileal bypass with sleeve gastrectomy or stomach intestinal pylorus-sparing surgery) by 17 surgeons from 3 countries (United States, Spain, and Australia) at 9 centers over a 6-year period were retrospectively reviewed, and their results were compared with articles in the literature. Results Mean preoperative body mass index was 51.6 kg/m 2 . Of 1328 patients, 123 patients received a linear stapled duodeno-ileostomy (DI) and 1205 patients a hand-sewn DI. In the overall series, the anastomotic leak, ulcer, and bile reflux occurred in .6% (9/1328), .1% (2/1328), and .1% (2/1328), respectively. None of our patients experienced volvulus at the DI or an internal hernia. Overall, 5 patients (.3%) (3/123 [2.4%] with linear stapled DI versus 2/1205 [.1%] with hand-sewn DI [ P Conclusions The overall incidence of complications associated with loop DI was lower than the reported incidence of anastomotic complications after Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch. SADS procedures may cause much fewer anastomotic complications compared with Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch.

Currently, there is a debate whether the laparoscopic gastric imbrication (LGI) offers similar weight loss when compared to the laparoscopic sleeve gastrectomy (LSG). On the surface, they seem to offer similar-sized stomachs after the procedures are performed. We chose to perform a randomized double-blinded trial to see if similar-sized pouches result in similar types of weight loss. Our belief was that sleeve gastrectomy would offer at least a 10 % better weight loss over a 3-year period. Thirty patients were randomized to one of two arms. The patients and the third party administrator following the patients were blinded as to which procedure was chosen. The surgeon had full knowledge of the patients’ surgery throughout the treatment. The decision of which arm to place them was made by a single employee of the third party administrator and not shared with the employees following the patients. Patients were then followed for 3 years. There were no differences in weight, age, or BMI preoperatively. There were no differences between the two groups at any follow-up time point from 6 months to 3 years. Follow-up was 100 %. Due to the large standard deviations present in both groups, there was no statistical difference between either of the groups in terms of weight loss.

In bariatric surgery, the procedure with the highest average weight loss is the biliopancreatic diversion with duodenal switch (BPDDS). A new simplified duodenal switch called the stomach intestinal pylorus sparing (SIPS) surgery with less malabsorption and one fewer anastomosis claims to have similar outcomes when compared to the BPDDS. A retrospective matched cohort analysis of SIPS versus BPDDS patients in a single private practice was obtained by matching every BPDDS to a SIPS patient of the same gender and BMI. Excess weight loss percentage (EWL), BMI, and percentage total weight loss (%TWL) were compared. Additionally, comorbidity resolution, nutritional data, and complications were also compared. Data was analyzed using both descriptive and comparative statistics. Over 2 years, there was no statistical difference in weight loss between BPDDS and SIPS. There also was no difference in nutritional data between the two procedures pre- and post-op. Complication rates were lower in SIPS however, due to the small sample sizes this is not statistically significant. Weight loss and nutritional results between SIPS and BPDDS are similar at 2 years. However, there are fewer complications with SIPS.

Background Laparoscopic adjustable gastric banding (LAGB) is a safe procedure with variable outcomes and large standard deviations. LAGB with gastric plication (LAGBP) is a new restrictive procedure that combines the lap band with gastric plication. This procedure, with its mechanism being below the band anatomically, should augment the weaknesses of the lap band: slips and inadequate weight loss. Objective Compare the weight loss results and complication rates between the LAGB and LAGBP. Setting Private practice. Methods Data was analyzed data from 120 patients retrospectively from 2 surgeons at a single private institution. Seventy-six patients underwent LAGB, and 44 other patients underwent LAGBP between February 2011 and July 2013. All 120 patients are beyond the 1-year postoperative mark and 110 patients are beyond the 2-year postoperative mark. A subset analysis was performed comparing data from both procedures to evaluate weight loss and complications. Results There were no significant differences between preoperative age, weight, and body mass index between the patients who underwent either procedure. We had 47.4% and 52.3% follow-up at 1 year for LAGB and LAGBP, respectively, with 91.5% and 92.3% follow-up at 2 year for LAGB and LAGBP, respectively. Complications were low with LAGBP; however, it was not statistically significant ( P = .54). The LAGBP had a greater percent excess weight loss, percent total weight loss, and percent excess body mass index lost compared with the LAGB at 3, 6, 9, 12, and 24 months, and these differences were statistically significant. Mean percent excess weight loss for LAGB and LAGBP was 28.3% and 34.5% ( P P Conclusion LAGBP is a safe, feasible, and reproducible bariatric procedure. The LAGBP performs significantly better than the LAGB for weight loss. The complication and revision rates were slightly higher with LAGB than LAGBP. However, it was not statistically significant.

Despite being the most common surgery in the United States, little is known about predicting weight loss success and failure with sleeve gastrectomy (SG). Papers that have been published are inconclusive. We decided to use multivariate analysis from 2 practices to design a model to predict weight loss outcomes using data widely available to any surgical practice at 3 months to determine weight loss outcomes at 1 year.Two private practices in the United States.A retrospective review of 613 patients from 2 bariatric institutions were included in this study. Co-morbidities and other preoperative characteristics were gathered, and %EWL was calculated for 1, 3, and 12 months. Excess weight loss (%EWL)55% at 1 year was defined as weight loss failure. Multiple variate analysis was used to find factors that affect %EWL at 12 months.Preoperative sleep apnea, preoperative diabetes, %EWL at 1 month, and %EWL at 3 months all affect %EWL at 1 year. The positive predictive value and negative predictive value of our model was 72% and 91%, respectively. Sensitivity and specificity were 71% and 91%, respectively.One-year results of the SG can be predicted by diabetes, sleep apnea, and weight loss velocity at 3 months postoperatively. This can help surgeons direct surgical or medical interventions for patients at 3 months rather than at 1 year or beyond.

Although the duodenal switch (DS) has been the most effective weight loss surgical procedure, it is a small minority of the total bariatric surgical cases performed. Modifications that can make the operation technically simpler and reduce a long-term risk of short bowel syndrome would be of benefit. The aim of this study was to detail our initial experience with a modified DS called stomach intestinal pylorus sparing (SIPS) procedure.Data from patients who underwent a primary SIPS procedure performed by two surgeons at two centers from January 2013 to August 2014 were retrospectively analyzed. All revisions of prior bariatric procedures were excluded. Regression analyses were performed for all follow-up weight loss data.One hundred twenty-three patients were available. One hundred two patients were beyond 1 year postoperative, with data available for 64 (62 % followed up). The mean body mass index (BMI) was 49.4 kg/m(2). Two patients had diarrhea (1.6 %), four had abdominal hematoma (3.2 %), and one had a stricture (0.8 %) in the gastric sleeve. Two patients (1.6 %) were readmitted within 30 days. One patient (0.8 %) was reoperated due to an early postoperative ulcer. At 1 year, patients had an average change in BMI of 19 units (kg/m(2)), which was compared to an average of 38 % of total weight loss or 72 % of excess weight loss.Modification of the classic DS to one with a single anastomosis and a longer common channel had effective weight loss results. Morbidity seems comparable to other stapling reconstructive procedures. Future analyses are needed to determine whether a SIPS procedure reduces the risk of future small bowel obstructions and micronutrient deficiencies.

Roux-en-Y gastric bypass (RYGB) is one of the best-known and most commonly performed bariatric procedures. However, this procedure carries infrequent but serious long-term complications, which may require revisional procedures. This study reports the indications and outcomes of gastric bypass reversal that have not been described well in the literature. A multicenter retrospective study of 50 patients who underwent reversal of RYGB conducted between 2006 and 2015 was reviewed to describe the usual indications and outcomes of gastric bypass reversal surgeries. Of 50 patients, 7 (14 %) were males and 43 (86 %) were females. The mean age of the patient population was 40.4 ± 11.6 years (range 19–66). Reasons for reversal included anastomotic ulcers (n = 27), anastomotic complications (n = 9), malnutrition (n = 2), and functional disorder (n = 12). The mean BMI before the reversal was 29 ± 9.4 kg/m2 (range 16–60). The mean time between the primary procedure and reversal was 60 ± 65.5 months (range 2–300). Fourteen of the reversals were done via laparotomy. Mean hospital stay was 8.4 ± 7.3 days (range 3–34 days). There was no peri-operative death 30 days after reversal. Following gastric bypass reversal, 92.6 % (n = 25) of the patient population had resolution from ulcers, 77.8 % (n = 7) of the patient population had resolution from anatomic complications, 100 % (n = 2) of the patient population had resolution from malnutrition, and 66.7 % (n = 8) of the patient population had resolution from functional disorders. Gastric bypass reversal is a reasonable and safe treatment for complications arising from the GBP surgery. A laparoscopic approach is feasible in select patients.

Background and objective The Roux-en-Y duodenal switch (RYDS) is one of the most efficient forms of bariatric surgery. However, diarrhea, malnutrition, ulcers, and internal hernias have hampered its widespread adoption. The stomach intestinal pylorus-sparing (SIPS) procedure was developed to alleviate these sequelae while retaining the same weight loss as the RYDS. In this study, we report our midterm experience with this novel technique. Methods Retrospective analysis was performed on data from 225 patients who underwent a primary SIPS procedure by 2 surgeons at a single center from October 2013 through December 2016. Results Two hundred twenty-five patients were identified for analysis. The mean preoperative body mass index (BMI) was 52.4 ± 9.1 kg/m2. Forty-eight patients were beyond 2 years after surgery, with data available for 30 patients (62.5% follow-up). Three patients were lost to follow-up. At 2 years, the patients had an average change in BMI of 26.6 U (kg/m2) with an average of 88.7% of excess weight loss. Three deaths were related to the surgery. The most common short-term complication was a leak (2.2%), whereas the most common long-term complication was diarrhea (2.2%). Conclusion In conclusion, SIPS surgery is a safe procedure with favorable weight loss outcomes at 2 years.

The increase in the prevalence of obesity and gastroesophageal reflux disease (GERD) has paralleled one another. Laparoscopic fundoplication (LF) (Nissen or Toupet) is a minimally invasive form of anti-reflux surgery. The duodenal switch is a highly effective weight loss surgery with a proven record of long term weight loss success. However, fundoplication alone does not give satisfactory results when used for GERD in morbidly obese patients. Here we present a novel approach combining stomach intestinal pylorus sparing surgery (SIPS) with LF for morbidly obese patients with GERD. The data from patients who underwent the SIPS procedure along with LF in past year was retrospectively analyzed. The variables collected were age, sex, height, weight, intra-operative and post-operative complications, length of stay, operative time, and estimated blood loss. All revisions were excluded. Descriptive statistics such as mean and standard deviation were used to analyze the data. The total sample size of the study was 5 patients, with a mean age of 59.6 ± 16.4 years, a mean weight of 292.1 ± 73.6 lbs., and a mean body mass index (BMI) of 43.4 ± 6.3. Weight loss patterns were the same as those without LF. All the 5 patients had resolution or improvement in their GERD symptoms within 6 months. SIPS with LF provides substantial and sustained weight loss and GERD resolution. Long term follow ups and further study on this novel surgical technique is recommended.