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Obesity Surgery Sep 2016Laparoscopic gastric bypass is a commonly performed bariatric surgery for the treatment of morbid obesity. Revision surgery for patients who have gastric bypass...
BACKGROUND
Laparoscopic gastric bypass is a commonly performed bariatric surgery for the treatment of morbid obesity. Revision surgery for patients who have gastric bypass complications is a challenge for bariatric surgeon. Our aim is to present the early results of the conversions of gastric bypass complications to sleeve gastrectomies.
METHODS
From January 2001 to April 2015, 49 of 2382 gastric bypasses underwent revisional surgery to convert gastric bypasses to sleeve gastrectomies. The demographic data, surgical parameters, and outcomes were studied.
RESULTS
The mean age of the study group was 35.0 years (range 20 to 55), and the average body mass index (BMI) prior to the reoperation was 25.3 kg/m(2). Seven patients had previous laparoscopic Roux-en-Y gastric bypasses (LRYGBs), and 42 had laparoscopic single anastomosis (mini-) gastric bypasses (LSAGBs). The main reasons for the revisions were malnutrition (58 %), weight regain (10 %), intolerance (18 %), and others (14 %). The revisional surgeries had longer operative times, greater blood loss, and longer flatus passage times than the primary gastric bypass surgeries. Four patients (8.1 %) developed major complications during revisional surgery, including three (6.1 %) cases of leakage and one (2.0 %) case of internal bleeding. No mortality was noted. After conversion to sleeve gastrectomy, the body weights of the patients remained stable, and all patients improved in terms of malnutrition, including anemia, hypoalbuminemia, and secondary hyperparathyroidism.
CONCLUSIONS
Conversion to sleeve gastrectomy is an effective and safe option for patients with gastric bypass complications. The conversions to sleeve gastrectomy resulted in significant improvements in malnutrition and maintained weight loss at the early follow-ups.
Topics: Adult; Female; Gastrectomy; Gastric Bypass; Humans; Laparoscopy; Male; Middle Aged; Obesity, Morbid; Reoperation; Retrospective Studies; Treatment Failure; Treatment Outcome; Weight Loss; Young Adult
PubMed: 26781694
DOI: 10.1007/s11695-016-2066-7 -
Archives of Medical Science : AMS 2021The long-term outcomes of percutaneous coronary interventions (PCIs) within coronary artery bypasses are still poor as compared to those within native coronary arteries....
INTRODUCTION
The long-term outcomes of percutaneous coronary interventions (PCIs) within coronary artery bypasses are still poor as compared to those within native coronary arteries. Thus, we aimed to assess predictors of long-term clinical outcomes after PCIs of coronary bypasses.
MATERIAL AND METHODS
We enrolled 194 patients after PCIs of coronary artery bypasses at the mean age of 69.5 ±8.3 years (73.2% male). The primary study endpoint was a combination of target-vessel revascularization (TVR), target-lesion revascularization (TLR), myocardial infarction (MI), stroke, coronary artery bypass grafting (CABG) and death. The mean follow-up was 964 ±799.1 days and was completed among 156 patients. Multivariate analysis was used to assess determinants of study endpoints during follow-up. Moreover, we compared survival curves according to the type of PCI and presence of anti-embolic protection.
RESULTS
The primary endpoint of the study occurred in 59.7% of patients after the mean time of 669.6 ±598.7 days. The TVR occurred in 37.9% of individuals, TLR in 24.2%, MI in 26.3%, stroke in 4.2%, CABG in 2.1% and death in 30.5% of patients. In Cox multivariate analysis, PCI of two or more bypasses ( < 0.01), post-dilatation ( < 0.05) and no-reflow ( < 0.05) were the independent determinants of the primary study endpoint. No significant impact of anti-embolic protection devices on long-term outcomes was observed.
CONCLUSIONS
Percutaneous coronary interventions of two or more bypasses, post-dilatation and no-reflow are predictors of worse outcome in patients undergoing PCI within coronary artery bypass grafts.
PubMed: 34025832
DOI: 10.5114/aoms.2018.75608 -
World Neurosurgery: X Jul 2024The fluorescein videoangiography (FL-VAG) has become a valuable adjunct tool in vascular neurosurgery. This work describes using the FL-VAG during bypass surgery and...
BACKGROUND
The fluorescein videoangiography (FL-VAG) has become a valuable adjunct tool in vascular neurosurgery. This work describes using the FL-VAG during bypass surgery and proposes a classification method for evaluating surgical results.
METHODS
We analyzed 26 patients with 50 cerebral bypasses from September 2018 to September 2022. We used a three grades classification method based on the pass of intravenous fluorescein through the anastomosis. Grade 1 represents the synchronous and total filling of the "T" shape ("green T″) formed by the donor and recipient vessel, Grade 2, the asynchronous filling of the anastomosis (incomplete/asynchronous "green T″), and Grade 3, a non-patent anastomosis (absence of "green T″).
RESULTS
Of the 26 patients, 8 underwent one bypass, 14 underwent double bypass, 2 underwent three bypasses, and 2 underwent four bypasses in two different interventions. The type of bypass was end-to-side anastomosis in 47 (94%) cases, internal maxillary artery to middle cerebral artery bypass with a radial artery graft (IMax-MCA anastomosis) in 2 (4%), and PICA-VA transposition in one (2%). We made 24 (48%) bypasses on the right side and 26 (52%) on the left side. After the initial surgery, thirty-nine (78%) bypasses were considered as Grade 1, 5 (10%) as Grade 2, and 6 (12%) as Grade 3. After intraoperative bypass patency assessment (IBPA), 45 (90%) of the bypasses were considered Grade 1 and remained patent on CTA.
CONCLUSIONS
Using FL-VAG and a three-tier classification method is a reliable tool to predict bypass patency. It is safe, low-risk, and available worldwide.
PubMed: 38516026
DOI: 10.1016/j.wnsx.2024.100287 -
Neurosurgery Oct 2009Bypass surgery for brain aneurysms is evolving from extracranial-intracranial (EC-IC) to intracranial-intracranial (IC-IC) bypasses that reanastomose parent arteries,...
OBJECTIVE
Bypass surgery for brain aneurysms is evolving from extracranial-intracranial (EC-IC) to intracranial-intracranial (IC-IC) bypasses that reanastomose parent arteries, revascularize efferent branches with in situ donor arteries or reimplantation, and reconstruct bifurcated anatomy with grafts that are entirely intracranial. We compared results with these newer IC-IC bypasses to conventional EC-IC bypasses.
METHODS
During a 10-year period, 82 patients underwent bypass surgery as part of their aneurysm management. A quarter of the patients presented with ruptured aneurysms and two-thirds presented with compressive symptoms from unruptured aneurysms. Most aneurysms (82%) had non-saccular morphology and 56% were giant sized. Common locations included the cavernous internal carotid artery (23%), middle cerebral artery (20%), and posteroinferior cerebellar artery (12%).
RESULTS
Forty-seven patients (57%) received EC-IC bypasses and 35 patients (43%) received IC-IC bypasses, including 9 in situ bypasses, 6 reimplantations, 11 reanastomoses, and 9 intracranial grafts. Aneurysm obliteration rates were comparable in EC-IC and IC-IC bypass groups (97.9% and 97.1%, respectively), as were bypass patency rates (94% and 89%, respectively). Three patients died (surgical mortality, 3.7%), and 4 patients were permanently worse as a result of bypass occlusions (neurological morbidity, 4.9%). At late follow-up (mean duration, 41 months), good outcomes (Glasgow Outcome Scale score 5 or 4) were measured in 68 patients (90%) overall, and were similar in EC-IC and IC-IC bypass groups (91% and 89%, respectively). Changes in Glasgow Outcome Scale score were slightly more favorable with IC-IC bypass (6% worse or dead after IC-IC bypass versus 14% with EC-IC bypass).
CONCLUSION
IC-IC bypasses compare favorably to EC-IC bypasses in terms of aneurysm obliteration rates, bypass patency rates, and neurological outcomes. IC-IC bypasses can be more technically challenging to perform, but they do not require harvest of extracranial donor arteries, spare patients a neck incision, shorten interposition grafts, are protected inside the cranium, use caliber-matched donor and recipient arteries, and are not associated with ischemic complications during temporary arterial occlusions. IC-IC bypass can replace conventional EC-IC bypass with more anatomic reconstructions for selected aneurysms involving the middle cerebral artery, posteroinferior cerebellar artery, anterior cerebral artery, and basilar apex.
Topics: Adolescent; Adult; Aged; Carotid Artery, Internal; Carotid Artery, Internal, Dissection; Cerebral Arteries; Cerebral Revascularization; Child; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Mortality; Postoperative Complications; Radiography; Retrospective Studies; Temporal Arteries; Treatment Outcome; Vertebral Artery Dissection; Young Adult
PubMed: 19834371
DOI: 10.1227/01.NEU.0000348557.11968.F1 -
Journal of Reconstructive Microsurgery Apr 2007The treatment of neuroma-in-continuity is controversial. To bypass neuroma-in-continuity with a nerve graft using end-to-side neurorrhaphy is considered to be...
The treatment of neuroma-in-continuity is controversial. To bypass neuroma-in-continuity with a nerve graft using end-to-side neurorrhaphy is considered to be theoretically a good option. To test this therapeutic modality, we performed a nerve bypass graft in a neuroma-in-continuity rat model. An obstructive neuroma-in-continuity was created in a transected peroneal nerve by interposition using the aponeurosis of the spinal muscles. In the experimental animals, (1) immediate, (2) 3-week delayed, or (3) no ulnar nerve bypass graft was performed. The peroneal functional index (PFI), conduction velocity, tibialis anterior muscle weight, and histomorphometric analyses were performed and compared with control (simply cut and repair) animals. On postoperative day 70, the recoveries of the PFI values, conduction velocity, and tibialis anterior muscle weight in the bypassed animals showed no significant differences as compared with the control animals, and the extent of these recoveries in the bypassed animals were significantly superior to those in the no-graft animals. In the histomorphometric analysis, the mean percent nerve in the bypassed animals was significantly larger than that in the no-graft animals. In conclusion, this technique may be a good alternative to the current therapeutic techniques for neuroma-in-continuity when there is a significant retained function.
Topics: Animals; Disease Models, Animal; Male; Muscle, Skeletal; Nerve Fibers; Neural Conduction; Neuroma; Organ Size; Peripheral Nervous System Neoplasms; Peroneal Nerve; Rats; Rats, Sprague-Dawley; Ulnar Nerve; Walking
PubMed: 17479455
DOI: 10.1055/s-2007-974652 -
Surgery For Obesity and Related... 2015For patients with poor weight loss (WL) after Roux-en-Y gastric bypass (RYGB) there are few well-tolerated and effective surgical options. Revision to distal bypass by...
BACKGROUND
For patients with poor weight loss (WL) after Roux-en-Y gastric bypass (RYGB) there are few well-tolerated and effective surgical options. Revision to distal bypass by shortening of the common channel (CC) induces significant WL but often produces protein calorie malnutrition (PCM) and severe diarrhea.
OBJECTIVE
The aim of this study was to identify a safe and effective threshold for distal small bowel bypass when done for revision of gastric bypass.
SETTING
Academic Institution, United States.
METHODS
We performed revision of RYGB for WL in 20 patients by shortening the CC to a new length of 120-300 cm. The Roux limb length was unchanged. WL and PCM were monitored. A threshold for percent of small bowel bypassed at which PCM was avoided was retrospectively determined. WL was then compared in patients above and below this threshold. Five patients completed a 250-kcal mixed meal challenge before and 3 months after revision to determine selected gut hormone responses.
RESULTS
Bypassing ≥70% small bowel resulted in PCM in 4 of 10 patients but in none of 10 patients below that threshold. PCM was observed as late as 2 years after revision and necessitated rerevision by lengthening of the CC in 3 patients. Additionally, nocturnal diarrhea was more common and more intractable when ≥70% bypass was done. Both groups had significant excess body WL over 2 years, but it was greater in patients with ≥70% bypass (47±19 versus 26±17; P<.05). A favorable gut hormone response was observed with 3-hour decrease in glucose-dependent insulinotropic peptide (GIP) by 25% and increase in glucagon-like peptide-1 (GLP-1) by 25%, whereas fasting peptide-YY (PYY) increased by 71% (P<.05 for all).
CONCLUSIONS
Revision of RYGB to distal bypass when it is <70% of a patient's small bowel length results in an acceptable balance of WL and a positive safety profile. WL may be mediated through an enhanced gut hormone effect, an aversion to ingested fat, and possibly other mechanisms.
Topics: Adult; Anastomosis, Surgical; Female; Follow-Up Studies; Gastric Bypass; Humans; Intestine, Small; Male; Obesity, Morbid; Reoperation; Retrospective Studies; Time Factors; Weight Gain
PubMed: 26499355
DOI: 10.1016/j.soard.2015.08.001 -
Journal of Hepatology Aug 1987The objective of this study was to investigate whether alcohol administration exerts a synergistic effect on jejunoileal bypass-induced liver dysfunction in rats. Male...
The objective of this study was to investigate whether alcohol administration exerts a synergistic effect on jejunoileal bypass-induced liver dysfunction in rats. Male Wistar rats were subjected to 90% jejunoileal bypass or sham operation. For 10 weeks, subgroups were pair-fed either an alcohol-containing (36% of total calories) liquid diet or a liquid diet where alcohol was replaced isocalorically by starch. Alcohol feeding in rats with jejunoileal bypass increased hepatic triglyceride content about 6-fold as compared with bypassed rats receiving control diet. Neither jejunoileal bypass nor alcohol feeding led to significant changes in hepatic DNA and protein contents. Alcohol feeding increased cytochrome P-450 levels both in operated and in sham-operated rats. The administration of alcohol-containing diet decreased the activity of succinic dehydrogenase, the decrease being distinctly more pronounced in rats with jejunoileal bypass than in the sham-operated controls. Light microscopy revealed no significant morphological alterations in liver sections of rats fed the control diet after jejunoileal bypass or of rats receiving either the alcohol-containing diet or the control diet after sham operation. Alcohol feeding in bypassed rats, however, produced marked diffuse accumulation of fat, and regularly led to other histological abnormalities in the liver. These abnormalities included ballooning of hepatocytes and disarray of the trabecular structure of the liver lobule, hyalin inclusions resembling megamitochondria, single-cell necrosis and focal clustering of necrosis, increased number of mitotic figures, and infiltrates with inflammatory cells. The histological lesions of the liver of bypassed rats receiving alcohol exhibited no obvious zonal distribution. The results demonstrate that alcohol feeding to rats subjected to jejunoileal bypass leads to marked liver injury which mimics, at least in part, that of alcohol-induced liver disease in man. Rats subjected to jejunoileal bypass may, therefore, provide a new model for the study of alcoholic liver disease.
Topics: Animals; Body Weight; Cytochrome P-450 Enzyme System; DNA; Diet; Ethanol; Fatty Liver; Jejunoileal Bypass; Liver Diseases; Organ Size; Proteins; Rats; Triglycerides
PubMed: 3655313
DOI: 10.1016/s0168-8278(87)80064-8 -
American Journal of Cardiovascular... 2023This study aimed to investigate the correlation between the number of bypassed vessels, the duration of Cardiopulmonary bypass, blood transfusion requirements, revision...
OBJECTIVE
This study aimed to investigate the correlation between the number of bypassed vessels, the duration of Cardiopulmonary bypass, blood transfusion requirements, revision rates, and mortality outcomes. The objective was to get insights into the potential challenges that may arise during the postoperative phase.
METHODS
Our study covered a total of 677 patients from January 2015 to January 2021. The study and analysis focused on many factors including the surgical procedure, the number of bypassed vessels, transfusion requirements, comorbidities, revision rates, the administration of blood thinners, and early mortality.
RESULTS
Male patients numbered 513 and female patients 164. The combined coronary artery bypass grafting surgeries were 187, whereas the isolated ones were 490. Combination procedures traditionally used one- and two-vessel bypass grafting. 30.9% of patients had three vessels, while 31.6% had four. The typical blood transfusion has 4.2 erythrocytes. Fresh frozen plasma averaged 2.9 units, platelets 2.4 units, and whole fresh blood 2.6 units. The average cardiopulmonary bypass time was 145.1 and cross-clamp time was 89.3.
CONCLUSION
Six vessel bypasses have the highest revision rate. Transfusion rises with longer cardiopulmonary bypass and cross-clamp periods. Using acetylsalicylic acid before surgery increases the need for fresh frozen plasma and platelets. However, warfarin sodium increases the need for fresh frozen plasma and increases mortality. The revision highly linked with total CPB, cross-clamp times, all blood transfusions, and mortality.
PubMed: 38026113
DOI: No ID Found -
Journal of Vascular Surgery Nov 1987The results of 60 femorofemoral, 27 axillobifemoral, and 15 axillounifemoral bypasses were analyzed. Considered in this order, the operative mortality rate was zero,...
The results of 60 femorofemoral, 27 axillobifemoral, and 15 axillounifemoral bypasses were analyzed. Considered in this order, the operative mortality rate was zero, 11%, and 13%, respectively; initial hemodynamic failure was 7%, 13%, and 9%, respectively; 5-year overall primary patency rate was 67%, 62%, and 19%, respectively; and the secondary patency rate was 74%, 82%, and 37%, respectively. However, axillobifemoral patency was made to seem better by including six cases (12 graft limbs) performed because of nonocclusive disease (aneurysm or failure of graft performed for aneurysm). Excluding these, axillobifemoral primary and secondary patency decreased to 47% and 69%, respectively. Femorofemoral bypass results were made worse by cases performed because of unilateral failure of an aortic bifurcation graft. Exclusion of these bypasses increased primary and secondary patency rates to 74% and 82%, respectively. Occlusion of the major outflow artery (superficial femoral) markedly affected long-term patency of all three bypasses. Thus, "good" and "poor" runoff primary patencies were, respectively, for femorofemoral bypass 79% and 53%, for axillobifemoral bypass 92% and 41%, respectively (occlusive disease only), and for axillounifemoral bypass 54% and zero, respectively. This detailed breakdown of results explains the wide variances in the reported results for these extra-anatomic bypasses and provides a better perspective for their application in different clinical settings.
Topics: Analysis of Variance; Arterial Occlusive Diseases; Axillary Artery; Femoral Artery; Humans; Methods; Prognosis; Retrospective Studies; Risk Factors; Vascular Patency
PubMed: 3669194
DOI: No ID Found -
Archives of Surgery (Chicago, Ill. :... May 1987Since 1977, we have managed 56 patients (36 Payne and 20 Scott bypasses) with late (one to 18 years) complications resulting from a jejunoileal bypass. All patients...
Since 1977, we have managed 56 patients (36 Payne and 20 Scott bypasses) with late (one to 18 years) complications resulting from a jejunoileal bypass. All patients underwent a one-stage conversion of the jejunoileal bypass to a gastric bypass. Patients were classified according to postbypass weight, the need for nutritional support, the type and severity of complication, and the time interval between jejunoileal bypass and the onset of the complication and correction of the complication. There were no operative deaths; one patient died 18 months after surgery of cirrhosis. The complication rate was 34%; however, most complications were minor. Our experience with this procedure has shown it to be highly effective in correcting complications other than polyarthritis. When coupled with nutritional support, it is safe even in malnourished patients.
Topics: Adult; Body Weight; Female; Follow-Up Studies; Humans; Jejunoileal Bypass; Kidney Diseases; Liver Diseases; Male; Middle Aged; Nutritional Status; Postoperative Complications; Reoperation; Stomach
PubMed: 3579571
DOI: 10.1001/archsurg.1987.01400170116017