Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 2nd International Conference on Metabolic and Bariatric Surgery Rome, Italy.

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Scientific Program Day 1
Scientific Program Day 2

Day 16 :

  • Bariatric surgery for obesity and metabolic disorder | Obesity
Location: 1

Session Introduction

Marek Benes

Institute of Clinical and Experimental Medicine, Czech Republic

Title: Final Results of Multi-Center, Prospective, Controlled Trial of the Duodeno-Jejunal Bypass Liner for the Treatment of Type 2 Diabetes Mellitus in Obese Patients: Efficacy and Factors Predicting a Suboptimal Effect

Time : 15:40-16:05

Speaker
Biography:

Marek Benes M.D., born 1976 in Prague, where also graduated on 3rd Medical Faculty of Charles University in 2001, in this year started as physician on department of gastroenterology and hepatology in Institute of clinical and experimental medicine in Prague. Main subjects of interest are endoscopy and specially bariatric endoscopy. In present time we have biggest group of patients treated with gastro-jejunal bypass sleeve - Endobarrier in Europe.

Abstract:

Introduction: The global increase in obesity incidence results in an increase of type-2 diabetes mellitus (T2DM). Surgical treatment has proven to be effective; however it carries a high risk of complications. The duodenaljejunal bypass liner (EndoBarrier®, GI Dynamics and EB) is an endoscopic implant that mimics the intestinal bypass portion of the Roux-en-Y gastric bypass. It results in weight loss and improvements in glucose control in obese patients with T2 diabetes mellitus (T2DM).

Aims & Methods: This is a final report of a prospective, controlled, multi-centre study aimed to determine the effectiveness of EB and to identify factors associated with a sub-optimal outcome of EB.

Results: Seventy (70) subjects (45 with an implant, 25 controls) were included in the study. The groups were comparable with respect to age, gender, BMI (mean 41.7 vs. 39.5 kg/m2), T2DM duration (7.8 vs. 8.3 years), HbA1c level (88 vs. 86 mmol/mol) and T2DM treatment. In the EB group, all devices were successfully implanted. Only 6 devices had to be explanted prior to the end of the 10 months study period (bleeding, dislocation and need for ERCP because of choledocholithiasis). The mean procedure time was 17 minutes for an implantation and 16 minutes for an explanation. At 10 months there was significantly greater weight loss and %EWL (19% vs. 7% and 43 vs. 12) and significantly improved long-term compensation of T2DM marker HbA1c (decreased by 25 vs. 10 mmol/mol) in the EB group. T2DM medicinal treatment could be reduced in more device subjects than controls. There was no serious adverse event. Mild abdominal pain and nausea after implantation were experienced by 60% of patients during first 14 days after implantation, 30% of patients during the first month and 10% of patients after one month. Lower initial BMI and lower body height were identified as negative prognostic factors for pain, but positive for efficacy of EB.

Conclusion: The EB is safe when implanted for 10 months and results in significant weight loss and HbA1c reduction. This suggests that this novel device is a candidate for the primary therapy of morbid obesity and T2DM. Lower initial BMI and lower body height could be negative prognostic factor for pain, but positive for efficacy.

Reshma Ramracheya

University of Oxford, UK

Title: Unravelling the role of the gut hormone PYY in diabetes remission and pancreatic islet function following Roux-En-Y gastric bypass

Time : 16:30-16:55

Speaker
Biography:

Dr. Reshma Ramracheya investigate the regulation and failure of the insulin-secreting beta-cell and glucagon-secreting alpha-cell in normal health and diabetes respectively. As an islet physiologist, She intrigued by how pancreatic islet cells, despite being biochemically similar, are able to respond to nutrients and drugs differently. Type 2 diabetes is a global epidemic with over 300 million sufferers worldwide. It results from a combination of insufficient insulin secretion and over-secretion of glucagon but the role of glucagon as a counter-regulatory hormone in diabetes has been largely overlooked.Her group is investigating the effects of weight-loss surgery and the appetite-regulating hormone peptide tyrosine tyrosine (PYY) on pancreatic islet secretion and in human diabetes. In parallel, they are also studying the mechanism by which the gut hormone glucagon-like peptide 1 (GLP-1) inhibits glucagon secretion in human isolated islets.

Abstract:

Roux-En-Y gastric bypass (RYGB) results in long-lasting remission from type-2 diabetes (T2D) in most cases. Improvements in glucose homeostasis occur within days of surgery, but the mechanisms involved remain unclear. Although pancreatic islets play a fundamental role in glucose homeostasis, the impact of RYGB on islet architecture and secretory properties has not been studied thoroughly. T2D is a bihormonal disease characterised by both insufficient insulin secretion and impairment in glucagon regulation. Whether RYGB can correct both hormonal secretory defects remain unexplored.

Using the Goto-Kakizaki (GK) rat model of T2D, we have explored whether RYGB affects islet structure and glucose-stimulated insulin secretion (GSIS) and glucagon release. RYGB restored ‘distorted’ islets from diabetic rats to spheroidal shape as in healthy animals. Compared to the sham-operated animals, RYGB normalised glucose-dependent glucagon and insulin secretion. Thus, islets from RYGB rats exhibited markedly enhanced insulin secretion at 20mM glucose and complete restoration of glucose-induced suppression of glucagon release.

Culture of isolated islets with serum from RYGB animals resulted in improved insulin and glucagon secretion, in support of a humoral factor which remains conserved in serum. These effects were reversed following immuno-neutralization of the gut hormone peptide tyrosine tyrosine (PYY) but persisted in the presence of a glucagon-like peptide-1 (GLP-1) receptor antagonist. Chronic (60-72h) treatment of islets with synthetic PYY enhanced GSIS in a NPY1-receptor-dependent manner. PYY application also restored GSIS and normalised impaired glucose-induced glucagon release in islets from severely diabetic GK rats and human donors with T2D. These data provide a novel mechanistic insight on the effect of RYGB in diabetes and highlight that the mechanism behind the improvement of islet function is dependent on PYY, and not GLP-1.

These findings imply that a pharmacological agent enhancing PYY release or its action could provide an effective and non-surgical therapy for T2D.

Sukaina Jaffar

Department of Surgery, Nepean Hospital

Title: Multi-dimensional validated reporting of dysphagia post sleeve gastrectomy
Speaker
Biography:

Sukaina Jaffar is working as a Surgeon in Nepean Hospital, Australia. Sukaina Jaffar has participated in National and International conferences in the field of bariatric surgery and she has published many research articles in various International and National journals

Abstract:

Background: Few studies have reported the prevalence of dysphagia, as its own clinical entity in the bariatric population; without being examined under the umbrella of gastro-oesophageal reflux disease. This is compounded by studies not outlining methodologies used to assess dysphagia. Moreover, varying follow-up periods and different bariatric procedures have led to conflicting results.

Objectives: To assess the prevalence of dysphagia using a statistically robust patient-reported tool, Dysphagia Handicap Index (DHI) post Laparoscopic Sleeve Gastrectomy (LSG). DHI is a validated tool which additionally measures the handicapping effects of dysphagia on emotional and functional domains of living. Methods: DHI questionnaire was administered to 124 patients who underwent LSG at least 1 year prior. Post-operative weight, change in BMI, percent Total Weight Loss (%TWL) and percent Excess Weight Loss (%EWL) were calculated. Physical, emotional and functional subscales were analyzed separately and altogether. Three additional questions were added to the DHI to delineate oesophageal dysphagia.

Results: Average pre-operative weight and BMI is 123.8 kg and 43 kg/m2, respectively. Median %TWL and %EWL are 32% and 76.2%, respectively. An average reduction in BMI value of 14 kg/m2 was found. 41% of our cohort reported to mild dysphagia and 54% reported moderate to severe dysphagia based on the Modified DHI Score (DHI+Oesophageal Specific Dysphagia Score). No patient required corrective intervention. Patients reporting higher DHI scores were less likely to achieve the median TWL of 35.4 kg (OR 0.40, 95% CI 0.17-0.91). Dysphagia is a common symptom reported in our cohort and was found to have an impact on weight loss outcomes.

Conclusion: Prospective, single-institution analysis using a validated tool reveals post-operative dysphagia to be a common clinical entity in our population with functional and psychological influences.

Attila A Seyhan

Florida Hospital, USA

Title: Gastric bypass surgery with exercise alters plasma microRNAs that predict improvements in cardiometabolic risk
Biography:

Attila Seyhan was an Assoc. Prof. at the Translational Research Institute for Metabolism and Diabetes, Florida Hospital, an Adjunct Prof. at Sanford-Burnham Prebys Medical Discovery Institute, Orlando, FL and a Research Affiliate with the Department of Chemical Engineering, MIT.

Previously he was in pharmaceutical (Pfizer, Wyeth) and biotech (OpenBiosystems, Dharmacon, Somagenics) in leading positions. He has 16+ years of experience in drug/target/ biomarker discovery and development, preclinical/clinical Translational Research in metabolic diseases/diabetes, cancer, inflammation & immunology, and viral pathogens (HCV, HIV, Semliki forest virus) in leading positions. He has published 35+ scientific articles and book chapters and is an inventor/co-inventor of more than 9 issued US patents and several pending applications. He has successfully authored/co-authored over 14 grant proposals totaling $6.2 million, including a Biodefense grant from the US Department of Defense, NIH and Pharma. He has earned several awards including a doctoral fellowship from NATO, Pfizer Excellence Award for contributions towards Biomarkers of Lupus Disease Study

Abstract:

Statement of the Problem: Roux-en-Y gastric bypass (RYGB) surgery improves insulin sensitivity (SI) and β-cell function in obese non-diabetic subjects. Exercise also improves SI and may be an effective adjunct therapy to RYGB surgery. However, the mechanisms by which exercise or weight loss improve peripheral SI after RYGB surgery are unclear. We hypothesized that microRNAs (miRNAs) mediate at least some of the regulatory processes driving such mechanisms. Consequently, this work aimed at profiling plasma miRNAs in participants of the Physical Activity Following Surgery Induced Weight Loss study (NCT00692367), to assess whether miRNA levels track with improvements in SI and cardiometabolic risk factors.
 
Methodology & Theoretical Orientation: Ninety-four (94) miRNAs implicated in metabolism were profiled in plasma samples from 22 severely obese subjects who were recruited 1-3 months after RYGB surgery and followed for 6 months of RYGB surgeryinduced weight loss with (exercise program (EX), N=11) or without (CON, N=11) an exercise training intervention. The subjects were selected, considering a priori sample size calculations, among the participants in the parent study. Mixed-effect modeling for repeated measures and partial correlation analysis was implemented in the R environment for statistical analysis.
 
Results: Mirroring results in the parent trial, both groups experienced significant weight loss and improvements in cardiometabolic risk. In the CON group, weight loss significantly altered the pattern of circulating miR-7, miR-15a, miR-34a, miR-106a, miR-122 and miR-221. In the EX group, a distinct miRNA signature was altered: miR-15a, miR-34a, miR-122, miR-135b, miR-144, miR-149 and miR-206. Several miRNAs were significantly associated with improvements in acute insulin response, SI and other cardiometabolic
risk factors.
 
Conclusion & Significance: These findings present novel insights into the RYGB surgery-induced molecular changes and the effects of mild exercise to facilitate and/or maintain the benefits of a comprehensive weight-loss intervention with concomitant improvements in cardiometabolic functions. Notably, we show a predictive value for miR-7, miR-15a, miR-106b and miR-135b.

  • Young Researchers Forum

Session Introduction

Maryam Pishsaraeian

Meshkat School, Iran

Title: The evolution of aerobic activity on the level of IgA immunoglobulin in female teenager students

Time : 16:45-17:10

Speaker
Biography:

M Pishsaraeian has completed her MS degree in Exercise Physiology from University of Mazandaran, Babolsar. Iran. She is a teacher of Sport Science in High School of Tehran city and her field of interest is the evaluation of effects of sport and exercise on psychological and physiological factors.

Abstract:

Obesity is a major problem in many societies. One of the proposed solutions for the treatment of obesity is exercise. Exercise has complex effects on immune system. One of most important immunoglobulins in mucus is IgA that protect the body against microorganisms. The aim of this study was to evaluate the effect of aerobic exercise on the levels of IgA and total protein in salivary of female teenager students. 20 female healthy volunteer students (age 12-13) without any infection, using drug, cardiovascular diseases and with healthy diet randomly divided into control (n=10) and aerobic activity (n=10) groups. Before the exercise saliva samples were taken from each student and kept in suitable condition. Aerobic activity group performs the Shuttle Run Test for exercise and control group has no activity. After finishing the exercise the samples were collected and sent to laboratory for analysis. For detection of IgA the ELISA kit essay was used and the Bradford protein essay was used for the detection of total protein. Our results have indicated that in comparison with pre-test and post-test of aerobic activity group, the level of IgA concentration was significantly (P≤0/05) decreased but the total protein was increased (P≤0/05) significantly. There has been no significant change in the level of IgA between two groups. It is recommended that duration, type and intensity of physical activity be considered for prevention of infection.

  • Obesity

Session Introduction

Sandra Jumbe

Doctor

Title: Post-surgical cliff after bariatric surgery: accounts of patients and their health care professionals
Speaker
Biography:

Sandra is a health psychologist with research interests in chronic disease management and smoking cessation. She recently completed her doctorate in health psychology at the University of the West of England in Bristol, UK. She previously worked in the National Health Service (NHS) as a primary care and mental health researcher, an assistant psychologist and in research governance. She has also delivered consultancy work developing tailored stress management interventions within organisations and group settings. Alongside her research work, Sandra also works as a general advisor for the London Research Design Service team based at Queen Mary University, which involves supporting health professionals and research teams within the North East London area to develop their research ideas into full funding applications to the NIHR and other peer reviewed funders

Abstract:

Statement of the problem: The superiority of bariatric surgery for improving medical outcomes in severely obese individuals when compared to other weight loss interventions remains undisputed. However, knowledge about the psychological impact of the procedure on people’s lives is limited. Recent systematic reviews have shown persisting disordered psychosocial wellbeing after surgery when compared to control groups, especially after long-term monitoring, suggesting need for psychological support and longer term postoperative research on psychological outcomes. Research literature infers limited understanding regarding the postoperative lived experience from the patient perspective. This may form a barrier in health professionals’ understanding of this patient group’s postoperative ongoing needs. This study aimed to capture patients and health professionals’ accounts of the postoperative bariatric surgery experience, exploring concordance between the two groups to gauge awareness of patients’ subsequent health needs

  • Bariatric surgery for obesity and metabolic disorder
Location: Olimpica 4

Session Introduction

Sukaina Jaffar

Nepean Hospital, Australia

Title: Correlation between Laparoscopic Sleeve Gastrectomy outcomes and Mental Health

Time : 15:50-16:15

Speaker
Biography:

Sukaina Jaffar is working as a Surgeon in Nepean Hospital, Australia. Sukaina Jaffar has participated in National and International conferences in the field of
bariatric surgery and she has published many research articles in various International and National journals.

Abstract:

Background: High incidence of depression in obese populations is well-reported. While several studies examined the impact of weight loss outcomes after bariatric surgery on post-operative psychological well-being and vice-versa, fewer have analyzed influence of preoperative depression on post-operative weight loss outcomes. Furthermore, this question has been limitedly applied to Laparoscopic Sleeve Gastrectomy (LSG) versus other bariatric procedures.
 
Aim: Given the increasing utilization of LSG, we aim to evaluate the relationship between pre-operative Beck’s Depression Index (BDI) scores and post-operative weight outcomes.
 
Method: 117 patients underwent LSG. BDI, a validated tool for assessing psychometric properties was completed pre-operatively. Additional psychological history and medications were obtained during patient interview. Pre and post-operative BMI, percent Total Weight Loss (%TWL) and percent Excess Weight Loss (%EWL) were recorded.
 
Results: Among the 88 females and 29 males, the mean pre-operative weight and BMI is 123 kg and 42.7 kg/m2, respectively. Mean reduction in BMI post operatively at one year is 14 kg/m2. This equates to a median %TWL of 32%. The median BDI score is 14 (Range 0-52), correlating to ‘mild’ depression. Females reported a higher average BDI score. 39.6% and 33.3% of patients reported minimal and mild depression, respectively. Patients classified with severe BDI score, were less likely to lose more than the median TWL of 35.4 kg found in our cohort (OR: 0.32 95% CI 0.06-1.66).
 
Conclusion: In our cohort, an important association was found between pre-operative BDI scores and weight loss post LSG.
This highlights the significance of pre-operative assessment for depression and makes implications for the involvement of early
psychological services to improve both bariatric-specific and psychosocial outcomes.

Sukaina Jaffar

Nepean Hospital, Australia

Title: Correlation between Laparoscopic Sleeve Gastrectomy outcomes and Mental Health
Speaker
Biography:

Sukaina Jaffar is working as a Surgeon in Nepean Hospital, Australia. Sukaina Jaffar has participated in National and International conferences in the field of
bariatric surgery and she has published many research articles in various International and National journals.

Abstract:

Background: High incidence of depression in obese populations is well-reported. While several studies examined the impact of weight
loss outcomes after bariatric surgery on post-operative psychological well-being and vice-versa, fewer have analyzed influence of preoperative
depression on post-operative weight loss outcomes. Furthermore, this question has been limitedly applied to Laparoscopic
Sleeve Gastrectomy (LSG) versus other bariatric procedures.
Aim: Given the increasing utilization of LSG, we aim to evaluate the relationship between pre-operative Beck’s Depression Index
(BDI) scores and post-operative weight outcomes.
Method: 117 patients underwent LSG. BDI, a validated tool for assessing psychometric properties was completed pre-operatively.
Additional psychological history and medications were obtained during patient interview. Pre and post-operative BMI, percent Total
Weight Loss (%TWL) and percent Excess Weight Loss (%EWL) were recorded.
Results: Among the 88 females and 29 males, the mean pre-operative weight and BMI is 123 kg and 42.7 kg/m2, respectively. Mean
reduction in BMI post operatively at one year is 14 kg/m2. This equates to a median %TWL of 32%. The median BDI score is 14
(Range 0-52), correlating to ‘mild’ depression. Females reported a higher average BDI score. 39.6% and 33.3% of patients reported
minimal and mild depression, respectively. Patients classified with severe BDI score, were less likely to lose more than the median
TWL of 35.4 kg found in our cohort (OR: 0.32 95% CI 0.06-1.66).
Conclusion: In our cohort, an important association was found between pre-operative BDI scores and weight loss post LSG.
This highlights the significance of pre-operative assessment for depression and makes implications for the involvement of early
psychological services to improve both bariatric-specific and psychosocial outcomes.

  • Obesity
Location: Olimpica 4

Session Introduction

Dr. Sandra Jumbe

Queen Mary University of London, UK

Title: Post-surgical cliff after bariatric surgery: accounts of patients and their health care professionals
Speaker
Biography:

Sandra is a health psychologist with research interests in chronic disease management and smoking cessation. She recently completed her doctorate in health psychology at the University of the West of England in Bristol, UK. She previously worked in the National Health Service (NHS) as a primary care and mental health researcher, an assistant psychologist and in research governance. She has also delivered consultancy work developing tailored stress management interventions within organisations and group settings. Alongside her research work, Sandra also works as a general advisor for the London Research Design Service team based at Queen Mary University, which involves supporting health professionals and research teams within the North East London area to develop their research ideas into full funding applications to the NIHR and other peer reviewed funders

Abstract:

Statement of the problem: The superiority of bariatric surgery for improving medical outcomes in severely obese individuals when compared to other weight loss interventions remains undisputed. However, knowledge about the psychological impact of the procedure on people’s lives is limited. Recent systematic reviews have shown persisting disordered psychosocial wellbeing after surgery when compared to control groups, especially after long-term monitoring, suggesting need for psychological support and longer term postoperative research on psychological outcomes. Research literature infers limited understanding regarding the postoperative lived experience from the patient perspective. This may form a barrier in health professionals’ understanding of this patient group’s postoperative ongoing needs. This study aimed to capture patients and health professionals’ accounts of the postoperative bariatric surgery experience, exploring concordance between the two groups to gauge awareness of patients’ subsequent health needs.
 
Methodology and theoretical orientation: Ten individuals who had bariatric surgery two or more years ago and eight bariatric surgery practitioners were recruited within UK public hospital settings and individually interviewed by the researcher. The audio recorded interviews were transcribed and examined using thematic analysis.
 
Findings: Thematic analysis of the interviews elicited a key finding around ‘postsurgical cliffs in patient care’ within a heavily structured service. This permeated through three themes; (1) navigating health changes (2) contrasting perspectives and (3) perceived prejudice. Participants reported some unmet needs; namely psychological aftercare to facilitate adjustment following physical and psychological changes. Issues with excess skin, acceptance of non-obese self and perceived prejudice were prominent. Impact of differing views of success between patients and professionals on postoperative care within the service context was highlighted.
 
Conclusion & Significance: Bariatric surgery is a great catalyst for weight loss in severe obesity. However, lack of psychological aftercare may threaten weight loss outcomes over the longer term. Findings infer postoperative psychological support as a potential facilitator for optimising results. Recommendations from a health psychology perspective are given. 

 

  • Types of bariatric surgery
Location: Olimpica 4

Session Introduction

Matteo Catanzano

Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK

Title: Stapless laparoscopic sleeve gastrectomy: reasoning and technical insights
Biography:

Dr. Matteo Catanzano has completed his MBChB, at the University of Glasgow, where he started carrying out research, something he has continued now that he is in his second year of foundation training, as a part of the Bariatric Surgery team in the Aberdeen Royal Infirmary. 

Abstract:

Introduction: Laparoscopic sleeve gastrectomy (LSG) with staple line reinforcement (SLR) is a popular and safe treatment option for morbid obesity, yet its benefits remain inaccessible to many, especially in developing  countries, due to the high cost of the equipment required.

Objective: Devise and describe a modified, stapless laparoscopic sleeve gastrectomy that is as safe as standard LSG with SLR, but costs less.

Methods: Analysis of the influence of technical adaptations  on the outcome of LSG was performed in a case–series of 3 patients. The main modification adapted was performing the closure of the stomach stapless. The primary outcome was the occurrence of leak post-op. The secondary outcomes were: operative time, prolonged hospital stay, % excess weight loss at 6 months and 12 months.

Results: Median operative time and hospital stay were 132 min and 2 days. No post-op leaks were recorded. The median excess weight loss at 6 months was 39% and at 1 year 57.7%.

Conclusion: Stapless LSG is an affordable alternative to the standard LSG techniques, both in terms of financial costs and complications rate

  • Gastric Bypass Surgery
Location: Olimpica 4

Session Introduction

Mohos Elemer

Veszprem County Hospital, Hungary

Title: Single centre results after 588 laparoscopic Roux –en-Y gastric bypass and 57 laparoscopic gastric sleeve resections performed in Hungary between 2010 and 2017
Biography:

Mohos Elemer is currently working Veszprem County Hospital, Hungary. He published many articles about his field of Bariatric Surgery in different Journals.

Abstract:

Introduction:  The incidence of severe obesity and its comorbidities (diabetes mellitus type-2 DMT2, hypertension, chronic joint disease, etc.) is growing dramatically all over the world. At present the only long term and effective solution is the metabolic surgery.
 
Patients & Methods: 645 patients were operated on between 02/2010 and 02/2017.
 
Preoperative data: Mean weight: 148 (92-231) kg, mean BMI: 46 (35-71) kg/m2, mean age 43 (17-70) years. 16% of the patients suffered from DMT2, 35% from hypertension and 21% from gastro-esophageal reflux. BMI above 40 kg/m2 was indication for metabolic surgery (with DMT2 above 35 kg/m2). Laparoscopic Roux-en-Y gastric bypass was our first choice operation (588 cases), when it was technically impossible laparoscopic gastric sleeve
resection (57 cases) was performed.
 
Results: Postoperative data: Mean weight loss: 51 kg, mean reduction in BMI: 17 kg/m2 , mean extra weight loss: 85 %. 91 % of DMT2 and 74 % of hypertension were resolved. Inhospital mortality : 1 patient (0,2%; caused by gastrografin pneumonitis on the 5th postop.day). 4 patients (0,6 %) developed deep vein thrombosis, two of them were complicated with pulmonal embolism of mild clinical symptoms. In early postop. period 8 patients of us (1,2 %) were reoperated (2 patients had relaparoscopy because of intra-abdominal bleeding, 1 patient needed laparotomy due to bleeding from the Y anastomosis and another 5 jejunostomy). In the late postop. period 31 cases (5 %) of us had relaparoscopy and closure patients had relaparoscopy, suture and drainage indicated by leakage of the gastroof Petersen's defect because of symptomatic Petersen's hernia. Five patients after sleeve resection were laparoscopically transformed to Roux Y gastric bypass as a consequences of weight regain.
 
Conclusion: Metabolic surgery is an effective and long term method for severe obesity, resulting efficient weight loss and resolution of the high proportion of co-morbidities. Our gold standard intervention is the laparoscopic Roux-en-Y gastric bypass. The high risk of the patients and the technically complex intervention can result different complications; that is why the correct patient selection, the regular control and performing the operations in high-volume centers are advised

Dr. Aly Elbahrawy

Surgeon, McGill University Health Center Montreal General Hospital.

Title: Laparoscopic wedge resection of gastrojejunostomy for weight recidivism after gastric bypass
Biography:

Dr. Ely Elbahrawy is working in Department of Surgery, and Division of General Surgery, Center for Bariatric Surgery, McGill University Health Center Montreal General Hospital, 1650 Cedar Avenue, Canada. 

Abstract:

Background & Aim: Weight recidivism after Roux-en-Y gastric bypass (RYGB) is a common problem. Often, this weight loss failure or regain may be due to a wide gastrojejunostomy (GJ). We evaluated the feasibility and safety of a novel approach of laparoscopic wedge resection of gastrojejunostomy (LWGJ) for a wide stoma after RYGB associated with weight recidivism.

Methods: This is a single-center retrospective study of a prospectively-collected database. We analyzed outcomes of patients with weight recidivism after RYGB and a documented wide GJ (>2 cm) on imaging, who underwent LWGJ between 11/2013-05/2016.

Results: Nine patients underwent LWGJ for dilated stomas. All patients were female with a mean±SD age of 53±7 years. Mean interval between RYGB and LWGJ was 9±3 years. All cases were performed laparoscopically with no conversions. Mean operative time and hospital stay were 86±9 minutes and 1.2±0.4 days, respectively. The median (IQR) follow-up time was 14 (12-18) months. During follow-up, there were no deaths, postoperative complications or unplanned readmissions or reoperations. The mean and median (IQR) BMI before RYGB and LWGJ were 55.4±8.1 kg/m2 and 56.1 (47.9-61.7) and 43.4±8.6 kg/m2 and 42.1 (38.3-47.1), respectively. One year after LWGJ, mean and median (IQR) BMI significantly decreased to 34.9±7.3 kg/m2 and 33.3 (31.7-35.0) corresponding to a mean %EWL of 64.6±19.9 (P<0.05).

Conclusion: LWGJ is safe and can lead to further weight loss in patients experiencing weight recidivism after RYGB with a wide GJ (>2 cm). Long-term follow-up is needed to determine the efficacy and durability of LWGJ and compare its outcomes with other endoscopic/surgical approaches for weight recidivism after RYGB with a documented wide GJ.