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Published in: Obesity Surgery 8/2017

01-08-2017 | Original Contributions

Vertical Gastric Bypass with Fundectomy: Feasibility and 2-Year Follow-Up in a Series of Morbidly Obese Patients

Authors: Marco Antonio Zappa, Alberto Aiolfi, Cinzia Musolino, Maria Paola Giusti, Giovanni Lesti, Andrea Porta

Published in: Obesity Surgery | Issue 8/2017

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Abstract

Background

Roux-en-Y gastric bypass (RYGB) is the gold standard procedure for morbid obesity and its results are well known and largely discussed. The major limitation of the procedure is the difficult exploration of the excluded gastric pouch and duodenum. The vertical gastric bypass with fundectomy was recently introduced in attempt to overcome these limitations. To date, its effectiveness is debated and outcomes still unclear. The purposes of this study were to describe the vertical gastric bypass with fundectomy and to analyse its outcomes in term of weight loss, complications, and comorbid resolutions.

Material and Methods

Since January 2012 to July 2014, 30 consecutive patients were enrolled and prospectively followed for a 24-month period. All patients underwent the vertical gastric bypass with fundectomy. Follow-up visits were scheduled at 7 days, 1, 6, 12, and 24 months, or whenever necessary.

Results

Overall, 24 women and six men were enrolled in the study. Mean preoperative BMI was 38.2 ± 8.5 kg/m2. No intraoperative complications were reported. Postoperative overall complication rate was 10%. Compliance to the 24-month follow-up was 100%. Mean BMI and excess weight loss (EWL%) were significantly lower compared to baseline (p < 0.05). Comorbid improvement or resolution was recorded in the 80% of the patients.

Conclusions

Vertical gastric bypass with fundectomy is feasible and effective with similar results in terms of weight loss, complications, and comorbid improving compared to the classic RYGB. Complete evaluation of the gastric anatomy and easy access to the main duodenal papilla are unquestionable advantages.
Literature
1.
go back to reference Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.CrossRefPubMed Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.CrossRefPubMed
2.
go back to reference Svane MS, Jørgensen NB, Bojsen-Møller KN, et al. Peptide YY and glucagon-like peptide-1 contribute to decreased food intake after Roux-en-Y gastric bypass surgery. Int J Obes. 2016;40:1699–706.CrossRef Svane MS, Jørgensen NB, Bojsen-Møller KN, et al. Peptide YY and glucagon-like peptide-1 contribute to decreased food intake after Roux-en-Y gastric bypass surgery. Int J Obes. 2016;40:1699–706.CrossRef
3.
go back to reference Lesti G, Tidona V, Lanci C, et al. Bypass gastrico laparoscopico con fundectomia e stomaco esplorabile secondo Lesti. Tecnica e follow-up a sei anni. Ospedali D’Italia. 2009;15:440. Lesti G, Tidona V, Lanci C, et al. Bypass gastrico laparoscopico con fundectomia e stomaco esplorabile secondo Lesti. Tecnica e follow-up a sei anni. Ospedali D’Italia. 2009;15:440.
6.
go back to reference Facchiano E, Quartararo G, Pavoni V, et al. Laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography (ERCP) after Roux-en-Y-gastric bypass: technical features. Obes Surg. 2015;25:373–6.CrossRefPubMed Facchiano E, Quartararo G, Pavoni V, et al. Laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography (ERCP) after Roux-en-Y-gastric bypass: technical features. Obes Surg. 2015;25:373–6.CrossRefPubMed
7.
go back to reference Papasavas PK, Yeaney WW, Caushaj PF, et al. Perforation in the bypassed stomach following laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13:797–9.CrossRefPubMed Papasavas PK, Yeaney WW, Caushaj PF, et al. Perforation in the bypassed stomach following laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13:797–9.CrossRefPubMed
8.
go back to reference Gypen BJ, Hubens GJ, Hartman V, et al. Perforated duodenal ulcer after laparoscopic gastric bypass. Obes Surg. 2008;18:1644–6.CrossRefPubMed Gypen BJ, Hubens GJ, Hartman V, et al. Perforated duodenal ulcer after laparoscopic gastric bypass. Obes Surg. 2008;18:1644–6.CrossRefPubMed
9.
go back to reference Harper JL, Beech D, Tichansky DS, et al. Cancer in the bypassed stomach presenting early after gastric bypass. Obes Surg. 2007;17:1268–71.CrossRefPubMed Harper JL, Beech D, Tichansky DS, et al. Cancer in the bypassed stomach presenting early after gastric bypass. Obes Surg. 2007;17:1268–71.CrossRefPubMed
10.
go back to reference Orlando G, Pilone V, Vitiello A, et al. Gastric cancer following bariatric surgery: a review. Surg Laparosc Endosc Percutan Tech. 2014;24:400–5.CrossRefPubMed Orlando G, Pilone V, Vitiello A, et al. Gastric cancer following bariatric surgery: a review. Surg Laparosc Endosc Percutan Tech. 2014;24:400–5.CrossRefPubMed
11.
go back to reference Leuratti L, Di Simone MP, Cariani S. Unexpected changes in the gastric remnant in asymptomatic patients after Roux-en-Y gastric bypass on vertical banded gastroplasty. Obes Surg. 2013;23:131–9.CrossRefPubMed Leuratti L, Di Simone MP, Cariani S. Unexpected changes in the gastric remnant in asymptomatic patients after Roux-en-Y gastric bypass on vertical banded gastroplasty. Obes Surg. 2013;23:131–9.CrossRefPubMed
12.
go back to reference Schneider BE, Villegas L, Blackburn GL, et al. Laparoscopic gastric bypass surgery: outcomes. J Laparoendosc Adv Surg Tech A. 2003;13:247–55.CrossRefPubMed Schneider BE, Villegas L, Blackburn GL, et al. Laparoscopic gastric bypass surgery: outcomes. J Laparoendosc Adv Surg Tech A. 2003;13:247–55.CrossRefPubMed
13.
go back to reference Bastouly M, Arasaki CH, Ferreira JB, et al. Early changes in postprandial gallbladder emptying in morbidly obese patients undergoing Roux-en-Y gastric bypass: correlation with the occurrence of biliary sludge and gallstones. Obes Surg. 2009;19:22–8.CrossRefPubMed Bastouly M, Arasaki CH, Ferreira JB, et al. Early changes in postprandial gallbladder emptying in morbidly obese patients undergoing Roux-en-Y gastric bypass: correlation with the occurrence of biliary sludge and gallstones. Obes Surg. 2009;19:22–8.CrossRefPubMed
14.
go back to reference Al-Jiffry BO, Shaffer EA, Saccone GT, et al. Changes in gallbladder motility and gallstone formation following laparoscopic gastric banding for morbid obesity. Can J Gastroenterol. 2003;17:169–74.CrossRefPubMed Al-Jiffry BO, Shaffer EA, Saccone GT, et al. Changes in gallbladder motility and gallstone formation following laparoscopic gastric banding for morbid obesity. Can J Gastroenterol. 2003;17:169–74.CrossRefPubMed
15.
go back to reference Shiffman ML, Sugerman HJ, Kellum JM, et al. Gallstone formation after rapid weight loss: a prospective study in patients undergoing gastric bypass surgery for treatment of morbid obesity. Am J Gastroenterol. 1991;86:1000–5.PubMed Shiffman ML, Sugerman HJ, Kellum JM, et al. Gallstone formation after rapid weight loss: a prospective study in patients undergoing gastric bypass surgery for treatment of morbid obesity. Am J Gastroenterol. 1991;86:1000–5.PubMed
16.
go back to reference Shiffman ML, Sugerman HJ, Kellum JM, et al. Changes in gallbladder bile composition following gallstone formation and weight reduction. Gastroenterology. 1992;103:214–21.CrossRefPubMed Shiffman ML, Sugerman HJ, Kellum JM, et al. Changes in gallbladder bile composition following gallstone formation and weight reduction. Gastroenterology. 1992;103:214–21.CrossRefPubMed
17.
go back to reference Ross AS, Semrad C, Alverdy J, et al. Use of double balloon enteroscopy to perform PEG in the excluded stomach after Roux-en-Y gastric bypass. Gastrointestinal Endosc. 2006;64:797–800.CrossRef Ross AS, Semrad C, Alverdy J, et al. Use of double balloon enteroscopy to perform PEG in the excluded stomach after Roux-en-Y gastric bypass. Gastrointestinal Endosc. 2006;64:797–800.CrossRef
18.
go back to reference Cariani S, Vittimberga G, Grani S, et al. A functional Roux-en-Y gastric bypass to avoid gastric exclusion: 1-year results. Obes Surg. 2003;13:788–91.CrossRefPubMed Cariani S, Vittimberga G, Grani S, et al. A functional Roux-en-Y gastric bypass to avoid gastric exclusion: 1-year results. Obes Surg. 2003;13:788–91.CrossRefPubMed
19.
go back to reference Cariani S, Palandri P, Della Valle E, et al. Italian multicenter experience of Roux-en Y gastric bypass on vertical banded gastroplasty: four-year results of effective and safe innovative procedure enabling traditional endoscopic and radiographic study of bypassed stomach and biliary tract. Surg Obes Relat Dis. 2008;4:16–25.CrossRefPubMed Cariani S, Palandri P, Della Valle E, et al. Italian multicenter experience of Roux-en Y gastric bypass on vertical banded gastroplasty: four-year results of effective and safe innovative procedure enabling traditional endoscopic and radiographic study of bypassed stomach and biliary tract. Surg Obes Relat Dis. 2008;4:16–25.CrossRefPubMed
20.
go back to reference Mozzi E, Lattuada E, Zappa MA, et al. Failure of gastric bypass following several gastrointestinal hemorrhages. Obes Surg. 2010;20:523–5.CrossRefPubMed Mozzi E, Lattuada E, Zappa MA, et al. Failure of gastric bypass following several gastrointestinal hemorrhages. Obes Surg. 2010;20:523–5.CrossRefPubMed
21.
go back to reference Lucchese M, Cariani S, Amenta E, et al. Other bariatric procedures. In: Angrisani L, editor. Bariatric and metabolic surgery. Berlin: Springer; 2016. p. 195–206. Lucchese M, Cariani S, Amenta E, et al. Other bariatric procedures. In: Angrisani L, editor. Bariatric and metabolic surgery. Berlin: Springer; 2016. p. 195–206.
22.
go back to reference Cariani S, Agostinelli L, Giorgini E, et al. Roux-en-Y gastric bypass on vertical banded gastroplasty: 6 years of experience of modified gastric bypass which allows endoscopic and radiological investigation of the excluded stomach [abstract]. Obes Surg. 2009;19:1048–9. Cariani S, Agostinelli L, Giorgini E, et al. Roux-en-Y gastric bypass on vertical banded gastroplasty: 6 years of experience of modified gastric bypass which allows endoscopic and radiological investigation of the excluded stomach [abstract]. Obes Surg. 2009;19:1048–9.
23.
go back to reference Giordano S, Salminen P, Biancari F, et al. Linear stapler technique may be safer than circular in gastro-iejunal anastomosis for laparoscopic Roux en y gastric bypass: a meta-analysis of comparative studies. Obes Surg. 2011;21:1958–64.CrossRefPubMed Giordano S, Salminen P, Biancari F, et al. Linear stapler technique may be safer than circular in gastro-iejunal anastomosis for laparoscopic Roux en y gastric bypass: a meta-analysis of comparative studies. Obes Surg. 2011;21:1958–64.CrossRefPubMed
24.
25.
go back to reference Peterli R, Steinert RE, Woelnerhanssen B, et al. Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial. Obes Surg. 2012;22:740–8.CrossRefPubMedPubMedCentral Peterli R, Steinert RE, Woelnerhanssen B, et al. Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial. Obes Surg. 2012;22:740–8.CrossRefPubMedPubMedCentral
26.
go back to reference Christou NV, Look D, Maclean LD. Pre-and post-prandial ghrelin levels do not related with satiety or failure to achieve a successful outcome after Roux-en-Y gastric bypass. Obes Surg. 2005;15:1017–23.CrossRefPubMed Christou NV, Look D, Maclean LD. Pre-and post-prandial ghrelin levels do not related with satiety or failure to achieve a successful outcome after Roux-en-Y gastric bypass. Obes Surg. 2005;15:1017–23.CrossRefPubMed
27.
go back to reference Chronaiou A, Tsoli M, Kehagias I, et al. Lower ghrelin levels and exaggerated postprandial peptite YY, glucacon-like peptide-1 and insulin responses after gastric fundus resection in patients undergoing roux-en-Y gastric bypass: a randomized clinical trial. Obes Surg. 2012;22:1761–70.CrossRefPubMed Chronaiou A, Tsoli M, Kehagias I, et al. Lower ghrelin levels and exaggerated postprandial peptite YY, glucacon-like peptide-1 and insulin responses after gastric fundus resection in patients undergoing roux-en-Y gastric bypass: a randomized clinical trial. Obes Surg. 2012;22:1761–70.CrossRefPubMed
28.
go back to reference Braley SC, Nguyen NT, Wolfe BM. Late gastrointestinal hemorrhage after gastric bypass. Obes Surg. 2002;12:404–7.CrossRefPubMed Braley SC, Nguyen NT, Wolfe BM. Late gastrointestinal hemorrhage after gastric bypass. Obes Surg. 2002;12:404–7.CrossRefPubMed
29.
go back to reference Mehran A, Szomstein S, Zundel N, et al. Management of acute bleeding after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13:842–7.CrossRefPubMed Mehran A, Szomstein S, Zundel N, et al. Management of acute bleeding after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13:842–7.CrossRefPubMed
30.
go back to reference Kellogg TA, Swan T, Leslie DA, et al. Patterns of readmission and reoperation within 90 days after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2009;5:416–23.CrossRefPubMed Kellogg TA, Swan T, Leslie DA, et al. Patterns of readmission and reoperation within 90 days after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2009;5:416–23.CrossRefPubMed
31.
go back to reference O'Brien PE, McPhail T, Chaston TB, et al. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006;16:1032–40.CrossRefPubMed O'Brien PE, McPhail T, Chaston TB, et al. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006;16:1032–40.CrossRefPubMed
32.
go back to reference Magro DO, Geloneze B, Delfini R, et al. Long-term weight regain after gastric bypass: a 5 years prospective study. Obes Surg. 2008;8:648–51.CrossRef Magro DO, Geloneze B, Delfini R, et al. Long-term weight regain after gastric bypass: a 5 years prospective study. Obes Surg. 2008;8:648–51.CrossRef
33.
go back to reference Li JF, Lai DD, Lin ZH, et al. Comparison of the long-term results of Roux-en-Y gastric bypass and sleeve gastrectomy for morbid obesity: a systematic review and meta-analysis of randomized and nonrandomized trials. Surg Laparosc Endosc Percutan Tech. 2014;24:1–11.CrossRefPubMed Li JF, Lai DD, Lin ZH, et al. Comparison of the long-term results of Roux-en-Y gastric bypass and sleeve gastrectomy for morbid obesity: a systematic review and meta-analysis of randomized and nonrandomized trials. Surg Laparosc Endosc Percutan Tech. 2014;24:1–11.CrossRefPubMed
34.
go back to reference Ribeiro-Parenti L, De Courville G, Daikha A, Arapis K, Chosidow D, Marmuse JP. Classification, surgical management and outcomes of patients with gastrogastric fistula after Roux-En-Y gastric bypass. Surg Obes Relat Dis. 2016 Sep 28. pii: S1550–7289(16)30726–2. Ribeiro-Parenti L, De Courville G, Daikha A, Arapis K, Chosidow D, Marmuse JP. Classification, surgical management and outcomes of patients with gastrogastric fistula after Roux-En-Y gastric bypass. Surg Obes Relat Dis. 2016 Sep 28. pii: S1550–7289(16)30726–2.
Metadata
Title
Vertical Gastric Bypass with Fundectomy: Feasibility and 2-Year Follow-Up in a Series of Morbidly Obese Patients
Authors
Marco Antonio Zappa
Alberto Aiolfi
Cinzia Musolino
Maria Paola Giusti
Giovanni Lesti
Andrea Porta
Publication date
01-08-2017
Publisher
Springer US
Published in
Obesity Surgery / Issue 8/2017
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-017-2620-y

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