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Endolumenal revision obesity surgery results in weight loss and closure of gastric-gastric fistula.
Surg Obes Relat Dis. 2011 May-Jun; 7(3):304-8.SO

Abstract

BACKGROUND

Approximately 20-50% of patients regain weight 3-5 years after Roux-en-Y gastric bypass (RYGB) surgery. Gastric-gastric fistulas and dilation of the gastrojejunostomy and gastric pouch have been reported in these patients. Traditional revision surgery after RYGB has greater morbidity and mortality compared with the index bariatric procedure. We studied our initial results with revision of obesity surgery using an endoscopic platform in a community hospital setting.

METHODS

A retrospective review was performed of patients who had undergone this endoscopic revisional procedure secondary to significant weight regain with or without gastric-gastric fistula. All patients underwent revision of the gastrojejunostomy and/or closure of the gastric-gastric fistula using this minimally invasive approach.

RESULTS

A total of 37 consecutive patients (36 women) with a mean age of 45 years and mean weight regain of 15.1 ± 10.0 kg were included in the present study. The mean interval between RYGB and revision was 5.2 years (range 1-11). The mean preoperative and postoperative stomal size was 21.5 and 10 mm, respectively. Anchors were successfully placed in all patients. The mean follow-up period was 4.69 months (range 2-10). The mean percentage of excess body weight loss was 23.5% ± 66.4%. No immediate complications developed. Two patients underwent endoscopic dilation of the stoma because of persistent meal intolerance. Three gastric-gastric fistulas were successfully closed.

CONCLUSION

Revision of gastrojejunostomy after RYGB can be safely undertaken using this endoscopic platform. The short-term follow-up results showed clinically significant weight loss. Long-term follow-up is needed. Closure of gastric-gastric fistulas can also be achieved using this procedure.

Authors+Show Affiliations

Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, New York 10457, USA. shankarrraman@gmail.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

21474389

Citation

Raman, Shankar R., et al. "Endolumenal Revision Obesity Surgery Results in Weight Loss and Closure of Gastric-gastric Fistula." Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 7, no. 3, 2011, pp. 304-8.
Raman SR, Holover S, Garber S. Endolumenal revision obesity surgery results in weight loss and closure of gastric-gastric fistula. Surg Obes Relat Dis. 2011;7(3):304-8.
Raman, S. R., Holover, S., & Garber, S. (2011). Endolumenal revision obesity surgery results in weight loss and closure of gastric-gastric fistula. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 7(3), 304-8. https://doi.org/10.1016/j.soard.2011.01.045
Raman SR, Holover S, Garber S. Endolumenal Revision Obesity Surgery Results in Weight Loss and Closure of Gastric-gastric Fistula. Surg Obes Relat Dis. 2011 May-Jun;7(3):304-8. PubMed PMID: 21474389.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endolumenal revision obesity surgery results in weight loss and closure of gastric-gastric fistula. AU - Raman,Shankar R, AU - Holover,Spencer, AU - Garber,Shawn, Y1 - 2011/02/22/ PY - 2010/05/13/received PY - 2010/11/14/revised PY - 2011/01/13/accepted PY - 2011/4/9/entrez PY - 2011/4/9/pubmed PY - 2011/12/13/medline SP - 304 EP - 8 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 7 IS - 3 N2 - BACKGROUND: Approximately 20-50% of patients regain weight 3-5 years after Roux-en-Y gastric bypass (RYGB) surgery. Gastric-gastric fistulas and dilation of the gastrojejunostomy and gastric pouch have been reported in these patients. Traditional revision surgery after RYGB has greater morbidity and mortality compared with the index bariatric procedure. We studied our initial results with revision of obesity surgery using an endoscopic platform in a community hospital setting. METHODS: A retrospective review was performed of patients who had undergone this endoscopic revisional procedure secondary to significant weight regain with or without gastric-gastric fistula. All patients underwent revision of the gastrojejunostomy and/or closure of the gastric-gastric fistula using this minimally invasive approach. RESULTS: A total of 37 consecutive patients (36 women) with a mean age of 45 years and mean weight regain of 15.1 ± 10.0 kg were included in the present study. The mean interval between RYGB and revision was 5.2 years (range 1-11). The mean preoperative and postoperative stomal size was 21.5 and 10 mm, respectively. Anchors were successfully placed in all patients. The mean follow-up period was 4.69 months (range 2-10). The mean percentage of excess body weight loss was 23.5% ± 66.4%. No immediate complications developed. Two patients underwent endoscopic dilation of the stoma because of persistent meal intolerance. Three gastric-gastric fistulas were successfully closed. CONCLUSION: Revision of gastrojejunostomy after RYGB can be safely undertaken using this endoscopic platform. The short-term follow-up results showed clinically significant weight loss. Long-term follow-up is needed. Closure of gastric-gastric fistulas can also be achieved using this procedure. SN - 1878-7533 UR - https://www.unboundmedicine.com/medline/citation/21474389/Endolumenal_revision_obesity_surgery_results_in_weight_loss_and_closure_of_gastric_gastric_fistula_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(11)00075-X DB - PRIME DP - Unbound Medicine ER -