In 1955, nutrient malabsorption following upper gut surgery was shown to be related to altered upper gut microbiome. In individuals with abdominal symptoms after Roux-en-Y gastric bypass, we have reported that small intestinal glucose malabsorption is associated with upper gut bacterial overgrowth. We hypothesize that individuals with abdominal symptoms after vertical sleeve gastrectomy have glucose malabsorption associated with upper gut bacterial overgrowth, and to test this hypothesis, bacterial overgrowth and potential glucose malabsorption are examined after sleeve gastrectomy. This is a retrospective study of individuals with medically-complicated obesity who underwent sleeve gastrectomy from 2013 to 2016 with subsequent glucose hydrogen breath testing to evaluate abdominal symptoms. A fasting breath hydrogen or methane of ≥10 PPM or rise of ≥8 PPM ≤45 minutes after oral glucose is bacterial overgrowth, while glucose malabsorption is a second rise of ≥8 PPM at >45 minutes. Seven females (mean age: 48.0 years; mean body mass index at surgery: 45.7 kg/m2) are described. Five subjects (71%) have an early rise in hydrogen or methane, while three (43%) have a second rise in hydrogen or methane >45 minutes after glucose. The mean percent excess weight loss at one year was 40% in three individuals with a second peak and 46% in four subjects without a second peak. After sleeve gastrectomy, subjects have glucose malabsorption associated with the presence of bacterial overgrowth. Completion of a larger prospective study is needed to confirm and expanding upon these findings. Further work should examine the potential effects of bacterial overgrowth on expression of intestinal glucose transporters.
Background: To date, the scientific community has mainly focused on outcomes of obesity surgery such as weight loss and resolution of associated complications. Adverse post-operative events and reoperation rates have been poorly reported even if they are a marker of surgical safety and therefore of great importance in guiding patients and surgeons in the choice of the more suitable operation.
Methods: This retrospective multicenter observational study is based on the data extracted from the Italian Society of Bariatric Surgery and Metabolic Disorders (S.I.C.OB.) database, which covers almost all the bariatric operations performed in Italy. We analysed the 30 days post-operative complications occurring, in the period from 2009 to 2015, after Roux-en-Y Gastric Bypass (RYGB), Sleeve Gastrectomy (SG) and Mini Gastric Bypass/One Anastomosis Gastric Bypass (MGB/OAGB) qualitatively, quantitatively and on the basis of the Clavien-Dindo classification of surgical complications. Complications following surgeries were tested using the 95% confidence interval. Statistical analysis was performed with Statistical Analysis System (SAS).
Results: In the 2009-2015 time frame, a total of 31,624 operations were performed of which 6,864 RYGB, 10,833 SG and 992 MGB/OAGB. The complication rate was 4.39 %, 4.04 % and 3.83% respectively. The most frequent complications were hemoperitoneum (0.9%) and perforation, fistula and dehiscence (1%) which were higher in SG when compared with RYGB (with a statistical significance) and when compared with MGB/OAGB (without a statistical significance). When dividing the complications by the different grades of the Clavien-Dindo classification, the only significant difference encountered, from a statistical standpoint, was between MGB/OAGB and SG. MGB/OAGB was associated with a lower grade I Clavien-Dindo complication rate (1.31% versus 2.34%).
Conclusion: This study supports a safe profile of obesity surgey in Italy, along with positive bariatric outcomes. The rate of 30 days post-operative complications is progressively lower after MGB/OAGB (3.83%), SG (4.04%) and RYGB (4.39%) respectively. In particular, MGB/OAGB records statistically less low-grade Clavien-Dindo complications compared to SG and RYGB.
Background: Laparoscopic sleeve gastrectomy (LSG) is becoming more popular in the treatment of obesity. LSG is safe with a low morbidity. The complications rarely result in morbidity and even mortality. Leaks are the major complication associated with LSG with a reported prevalence between 1.9% and 2.4%.
Objective: To compare surgical intervention and endoscopic stenting for treatment of gastric leakage after sleeve gastrectomy.
Patients and method: Our study included 30 patients presented with post sleeve leaks discovered by routine postoperative imaging or during the follow up period. Patients were recruited from October 6th university hospital during the period from August 2017 to August 2019. Patients were divided to the following groups: 1) Endoscopy group: This included 15 patients with post sleeve leakage undergoing endoscopic stent insertion. 2) Surgery group: which included 15 patients with post sleeve leak age undergoing surgical management. This division was random.
Results: Our study showed that Endoscopic stenting for management of post sleeve gastrectomy leakage is an effective method with lower morbidity and shorter post-operative hospital stay than surgical management. Some patients may be good candidates for early surgical intervention in type 1 leakage if managed early before dissemination of leakage and before tissues become friable. Complications of stents include stent migration (26%), stent related ulcer (13%) and stricture (13%). while the surgical intervention carries more complications (DVT, chest infection, wound infection and stricture) and longer postoperative hospital stay.
Conclusion: endoscopic management of post-sleeve gastrectomy leakage with stenting is recommended because it successfully manages the leaks and avoids invasive procedures with less risk, with shorter hospital stay and early return of function.
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