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Results for “Gastric Bypass”

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At least 19 recordsLinked to original sources

PubMed1986

Gastric emptying after gastric bypass.

Gastric emptying of two test meals, consisting of ground beef and water and ground beef with 25 percent dextrose was measured with a scintigraphic technique in patients after gastric bypass surgery and in control subjects. Solid emptying was slower and liquid emptying was more rapid after gastric bypass and 25 percent dextrose emptied as rapidly as water. The pattern of gastric emptying after gastric bypass would favour more rapid initial absorption with liquid calories and may also be implicated in the dumping syndromes sometimes seen after gastric bypass.

Adult↗

PubMed2006

Cancer in the excluded stomach 4 years after gastric bypass.

Gastric bypass is the preferred operation for treatment of morbid obesity on many services. The evaluation of the excluded stomach is always difficult and a matter of concern for the attending physician. There are only four reported cases of gastric cancer in the distal stomach after gastric bypass. We report a 57-year-old man who had intestinal metaplasia at the time of the Roux-en-Y gastric bypass 4 years ago and now developed an aggressive carcinoma in the bypassed stomach.

Fatal Outcome↗

PubMed1982

The effectiveness of gastric bypass over gastric partition in morbid obesity: consequence of distal gastric and duodenal exclusion.

Eighty-seven morbidly obese patients were prospectively randomized to two operations: gastric bypass was performed on 42 and gastric partition on 45. Gastric bypass proved to be more effective; gastric bypass patients lost 15% more of their original weight at 12 months and 21% more at 18 months. There were no failures in the gastric bypass group; 28 of the 45 operations failed in the gastric partition group. An additional 60 patients underwent gastric bypass since the completion of the study. In the total series of 147 patients who underwent gastric bypass or gastric partition, there was no mortality, and the surgical complication rate was 12%. Because the gastric pouches and the anastomoses were similar in the two operations, the superiority of the gastric bypass may well be due to a heretofore unexplained effect of distal gastric and duodenal exclusion.

Adult↗

PubMed2006

Effect of gastric bypass and gastric banding on proneurotensin levels in morbidly obese patients.

CONTEXT: Neurotensin is produced mainly in the N cells of the ileum and has a role in appetite regulation; levels are decreased in obese subjects and increase after bariatric surgery. Mature neurotensin is very unstable, with a short half-life. OBJECTIVE: The objective of this study was to compare baseline and postoperative levels of the more stable neurotensin precursor, proneurotensin/neuromedin (pro-NT/NMN), in patients after gastric banding, gastric bypass, and nonoperated controls, respectively, during long-term follow-up. DESIGN AND SETTING: This was a prospective observational study in a university hospital. PARTICIPANTS AND MAIN OUTCOME MEASURES: Overnight fasting plasma pro-NT/NMN concentrations were measured with a new sandwich immunoassay in morbidly obese subjects at baseline and 6, 12, and 24 months after gastric banding (n = 8), Roux-en-Y gastric bypass (n = 5), and in nonoperated controls (n = 7). RESULTS: After gastric bypass and banding, body weight decreased by (mean +/- sd) 29.5 +/- 5.5 and 22.8 +/- 5.9 kg, respectively. The decrease after 3 and 6 months was more pronounced after gastric bypass compared with gastric banding (P < 0.05). Plasma pro-NT/NMN levels in patients after gastric bypass increased from 246.3 +/- 174.3 pmol/liter on admission to 748.3 +/- 429.6 pmol/liter after 24 months (P < 0.01). In contrast, in patients with gastric banding, pro-NT/NMN concentrations remained stable (207.3 +/- 60.5 pmol/liter at admission, 226.6 +/- 116.8 pmol/liter after 24 months). Neither body weight nor plasma pro-NT/NMN levels changed in nonoperated controls. CONCLUSION: Plasma pro-NT/NMN levels show a more pronounced increase after gastric bypass compared with gastric banding, suggesting that specific bariatric surgical procedures result in distinct alterations of gastrointestinal hormone metabolism. The more stable precursor pro-NT/NMN provides a new tool to quantify neurotensin levels in clinical practice.

Adult↗

PubMed1981

Experiences with conversion of jejunoileal bypass to gastric bypass: its use for maintenance of weight loss.

Jejunoileal bypass for morbid obesity has been associated with a variety of long-term adverse sequelae, including excess diarrhea, electrolyte imbalance, kidney dysfunction, liver abnormalities, and polyarthropathy. Takedown of the bypass without providing a means of maintenance of weight reduction will lead to recurrence of morbid obesity. We studied 32 patients who underwent conversion of jejunoileal bypass to gastric bypass either in one procedure (27 patients) or more than one procedure (five patients). There were no operative deaths, but significant morbidity. Nevertheless, the conversion has maintained weight reduction and reversed the adverse effects of the small-bowel bypass. We concluded that conversion of the jejunoileal bypass to the gastric bypass, particularly with a Roux-en-Y anastomosis, in a single procedure is relatively safe, simple, and effective.

Adolescent↗

PubMed1982

Metabolic consequences from conversion of jejunoileal bypass to gastric bypass.

Conversion of jejunoileal bypass to gastric bypass was performed in 11 patients because of metabolic problems and physical discomforts, and in three patients because of insufficient weight loss. There was no mortality and little morbidity after operation. An additional mean weight loss of 6% occurred, and weight stabilized satisfactorily in most patients. Two patients regained significant weight. Serum cholesterol levels rose within a month in most patients, with a mean increase of 61%. However, levels remained within normal limits. Serum triglyceride levels did not change significantly, especially in patients whose weight remained stabilized. Plasma glucose levels remained normal in all patients, including four patients who had been clinically diabetic before jejunoileal bypass. These patients had become normoglycemic immediately after jejunoileal bypass, and remained normal after conversion to gastric bypass.

Blood Glucose↗

PubMed1975

Optimizing results of gastric bypass.

Gastric bypass is an extensive gastric exclusion operation used in patients who are more than twice their ideal weight. Most of the early postoperative deaths observed in 3% of 442 patients during the initial 9 years, could have been prevented by more attention to operative technique and early recognition and correction of leaks when they occurred. The best weight loss can be produced by adherence to three components of the operation: 1) Bypass of stomach and duodenum, 2) a small fundic segment and 3) a small (12 mm diameter) gastroenterostomy stoma. The average patient of 142 kg can expect to have a weight of around 107 kg at 1 year 103 kg at 5 years. Revision of a large stoma to a smaller (9 mm) diameter can induce further weight loss in some patients whose loss has been inadequate. The 1.8% incidence of stoma ulceration may be lowered with the present emphasis on a smaller fundic pouch, but could increase with longer observation. Presently stoma ulcers occur once in every 140 patient years at risk.

Adolescent↗

PubMedDate not supplied

Laparoscopic resection of gastric diverticulum presenting after Roux-en-Y gastric bypass.

Gastric diverticula are extremely rare and may be congenital or acquired. Postgastrectomy formation of gastric diverticula has been attributed to outpouching through the weakened wall of the stomach. When symptomatic, gastric diverticula may cause pain, nausea, dysphagia, and vomiting. Gastric diverticula may also be associated with ectopic mucosa, ulcers, and neoplastic changes. We report a case of gastric cardia diverticulum that became symptomatic after laparoscopic Roux-en-Y gastric bypass. The patient was successfully treated with laparoscopic resection.

Adult↗

PubMed2006

Gastric bezoar after laparoscopic Roux-en-Y gastric bypass.

Gastric bezoar is an uncommon complication following Roux-en-Y gastric bypass (RYGBP). We report two cases of bezoar formation that occurred following laparoscopic RYGBPs. In both cases, the patients presented with abdominal pain, nausea, and "frothy" vomiting. The patients were successfully treated by endoscopic fragmentation and removal of the bezoar.

Abdominal Pain↗

PubMed1976

Effect of gastric bypass on gastric secretion.

Gastric bypass as a 90 per cent gastric exclusion operation was used in 393 patients with massive obesity to limit food intake. Stomal ulcer has occurred in 1.8 per cent of such patients or one ulcer per 140 man years of observation. The studies of indwelling fundic pH and of gastric acid secretion from the excluded stomach indicate that acid secretion is reduced after gastric bypass but that the acid, unbuffered by food in the excluded stomach, results in a lowered gastrin secretion after a meal. Thus, gastric bypass in inhibitory to acid secretion in most morbidly obese patients who do not have known acid peptic disease.

Achlorhydria↗

PubMedDate not supplied

Conversion of proximal to distal gastric bypass for failed gastric bypass for superobesity.

The purpose of this study was to analyze outcome following malabsorptive distal gastric bypass (D-GBP) in superobese patients who were reoperated for recurrent obesity comorbidity after a failed standard gastric bypass (S-GBP). Twenty-seven formerly superobese patients with a failed S-GBP converted to a D-GBP were studied. The small bowel was anastomosed 250 cm from the ileocecal valve to the disconnected Roux limb; the bypassed small intestine was connected to the ileum 50 cm from the ileocecal valve in five patients between 1985 and 1986 and 150 cm from the ileocecal valve in 22 patients thereafter. Comorbidity was reassessed yearly following conversion to D-GBP. Malnutrition occurred in all five patients with a 50 cm "common tract"; all required further revision and two died of hepatic failure. Three of 22 patients with a 150 cm common tract were reoperated with bowel lengthening because of malnutrition. Initial body mass index was 57+/-2 kg/m2 and fell from 46+/-2 kg/m2 before revision to 37+/-2 kg/m2 at 1 year and 32+/-2 kg/m2 at 5 years after revision; the percentage of excess weight lost went from 30+/-4% to 61+/-4% at 1 year and 69+/-5% at 5 years after revision. Preoperative comorbidity in patients undergoing revision included 14 with insulin-dependent type II diabetes mellitus, 11 with sleep apnea, 14 with hypoventilation, 13 with hypertension, and two with venous stasis ulcers. Obesity comorbidity was corrected within 1 year in all but two patients with hypertension and remained stable in all patients followed for 5 years. Revision of a failed S-GBP to a 150 cm common tract D-GBP corrects failed weight loss and severe obesity comorbidity but requires nutritional support to prevent protein-calorie malnutrition, iron and fat-soluble vitamin deficiencies, and further revision in some patients to correct malnutrition. A 50 cm common tract has an unacceptable morbidity and mortality.

Adult↗

PubMed1976

Gastric bypass.

Gastric bypass in the very obese is a technically difficult and tedious procedure done in the attic of the peritoneal cavity. However, with careful attention to pre-, intra-, and postoperative detail, it is reasonably safe, effective, and relatively free from unmanageable complications.

Female↗

PubMed2003

Metabolic outcomes of gastric bypass.

Gastric bypass surgery may be the most successful treatment for morbid obesity. However, postoperative patients are susceptible to deficiencies of several nutrients, including iron, vitamin B(12), and folate. Careful monitoring and supplementation are recommended to prevent negative outcomes of nutrient deficiencies. Metabolic benefits, on the other hand, include improvements in glycemic control and biochemical risk factors for cardiovascular disease. Pursuing surgery as an option for treating morbid obesity requires long-term dedication from the patient and the healthcare team.

Journal Article↗

PubMed2005

Laparoscopic gastric bypass for gastric outlet obstruction is associated with smoother, faster recovery and shorter hospital stay compared with open surgery.

BACKGROUND/PURPOSE: Laparoscopic gastric bypass for relief of gastric outlet obstruction (GOO) is feasible and safe. However, comparative data to confirm the benefits of the laparoscopic approach remain scarce. METHODS: Between 1998 and 2003, 26 patients underwent 15 laparoscopic (surgeon A) and 12 open (surgeon B) gastrojejunostomies (GJs) for GOO. The indications for surgery included malignant (n = 17) and benign (n = 10) diseases. RESULTS: There were no conversions to open surgery in the laparoscopic group, and no operative mortality occurred in either group. The groups were comparable for age, sex, American Society of Anesthesiology (ASA) score, frequencies of previous abdominal surgery and of malignant or benign disease, and type of GJ fashioned. There were no differences between the laparoscopic and open groups with regard to the operating time (median, 90 vs 111 min; P = 0.113), and patients receiving intraoperative blood transfusion. However, laparoscopic surgery was associated with significantly shorter durations of postoperative intravenous hydration (60 vs 234 h; P = 0.001), opiate analgesia (49 vs 128 h; P = 0.025), and hospital stay (3 vs 15 days; P = 0.005). Operative morbidity occurred more frequently following open surgery (33% vs 13%; P = 0.219). CONCLUSIONS: Laparoscopic GJ for the relief of GOO is associated with a smoother and more rapid postoperative recovery and shorter hospital stay compared with open surgery. In experienced hands, the laparoscopic approach to GJ should become the new gold standard.

Female↗

PubMed1978

Vagal innervation of the bypassed stomach following gastric bypass.

Gastric bypass, a 90% gastric exclusion, has been used successfully for surgical treatment of morbid obesity since 1967. Early concern as to its ulcerogenic potential has not materialized, but the physiological activity of the excluded stomach has not been studied fully. To determine whether the excluded segment retained any vagal innervation, 25 patients underwent preoperative Hollander tests of their intact stomachs. The test was repeated after operation, after the patients had resumed normal oral intake. Postoperative specimens were collected from a gastrostomy placed in the excluded stomach at the time of the gastric bypass. Percentage changes in volume and total acid for both the intact and excluded stomachs followed the same pattern with insulin injection after 45 minutes at both testings, pH values were identical. These observations, which indicate vagal innervation of the excluded stomach, together with previously published histalog acid-response data and the observed marginal ulcer incidence of one per 193 years of patient follow-up, demonstrate that normal gastric physiology is maintained after bypass and confirm that it is not an ulcerogenic procedure.

Gastric Acidity Determination↗

PubMed1980

Conversion of malfunctioning intestinal bypass to gastric bypass.

Of 150 patients in whom jejunoileal bypass was performed for the treatment of morbid obesity, the intestinal bypass was converted to a gastric bypass in nine individuals. The indications for conversion have been weight regain, inadequate weight loss or pathologic hyperoxaluria with recurrent kidney stone formation. In all of our patients, dismantling of the jejunoileostomy and the gastric procedure was done simultaneously.

Humans↗

PubMed1978

Conversion of jejunoileal bypass to gastric bypass to maintain weight loss.

We have performed jejunoileal bypass procedures in 114 patients during the last nine years. Seven of these patients have had complications develop that required restoration of normal gastrointestinal continuity. In the last four patients in our series, we have performed a gastric exclusion operation at the same time that normal anatomy of the small intestine was restored. These operations lasted only three and one-half hours and were performed without difficulty and without postoperative coomplication. The metabolic derangements have been corrected and weight loss has been maintained. We believe that the gastric bypass provides the surgeon with an effective additional option in managing patients with serious complications of their jejunoileal bypass that necessitates restoration of intestinal continuity.

Adult↗

PubMed1989

Perforated duodenal ulcer after gastric bypass surgery.

Gastric bypass procedures have been used widely in the surgical therapy of morbid obesity. Evidence exists that the bypassed gastric segment retains its ability to secrete acid. Acid-related ulceration and obstruction of the proximal gastric pouch after surgery have been well documented, but duodenal ulceration after gastric bypass has yet to be reported. We present the first reported case of duodenal ulceration and perforation after gastric bypass surgery for morbid obesity. This case demonstrates that acid-related gastroduodenal disease may occur in the bypassed gastrointestinal tract. Consideration should be given to this area in evaluating upper gastrointestinal bleeding and abdominal pain after gastric bypass. Because barium contrast studies may not adequately evaluate bypassed segments, and standard gastroscopes are not long enough to reach these areas, the use of longer endoscopes may be necessary to confirm the presence of gastroduodenal disease after gastric bypass.

Adolescent↗