Unsolved issues related to multivitamin and multimineral support for patients following bariatric surgery

In the review article the authors discuss unsolved issues regarding vitamin and mineral support of patients undergoing bariatric/metabolic operations. Many patients refer for the surgery already having deficiencies of macro- and micronutrients and need preoperative preparation for improving of vitamin-mineral status. Vitamin-mineral support is indicated after each bariatric operation, however the volume of nutritive support and the choice and doses of vitamins and minerals can be varied depending on type of surgery. Hypoabsorptive procedures such as duodenal switch or SADI-S (Single anastomosis duodenoileal bypass with sleeve gastrectomy) usually demand more significant protein, calcium and iron supplementations together with administration of multivitamin complexes containing fat-soluble vitamins. Existing standard vitamin-mineral complexes may not contain necessary doses of iron, calcium, fat-soluble and other vitamins as well as some microelements like cooper, zink, selenium etc. Thus, sufficient vitamin-mineral support may need up to 10 tablets or pills daily depending on kind of surgery. That can influence on patients compliance, lead to refusal of supplementations and thus to undesirable metabolic consequences after surgery. The authors have concluded about necessity of working out of cost-effective domestic series of vitamin-mineral combinations with high bio-availability specially adapted to every class of bariatric/metabolic operation. To authors opinion this can lead to better patients compliance and can prevent undesirable side effects after metabolic surgery.

Case of insulinoma detected in a patient after bariatric operation for morbid obesity

The prevalence of insulinomas is 13 cases per million population per year of which 414% tumor is malignant. Weight gain is one of the symptoms of the disease, often resulting in morbid obesity with indications for surgical treatment. The presented clinical case demonstrates the successful treatment of malignant insulinoma with the manifestation of hypoglycemic syndrome after carrying out biliopancreatic bypass with longitudinal gastrectomy for morbid obesity.

Prestenotic dilation of proximal parts of stomach as a predictor for development of gastro-esophageal reflux in late period after laparoscopic gastroplication

Objective. Estimation of immediate and late results of laparoscopic gastroplication (LGP) and analysis of predictors of unfavorable outcomes of bariatric operation. Маterials and methods. The investigation was conducted on background of results of examination and surgical treatment on 79 patients, suffering obesity and metabolic syndrome, to whom LGP was accomplished on the cathedral bases of the Shupyk NMAPE Department of Surgery and Vascular Surgery in 2015 - 2018 yrs. Results. In accordance to secondary investigations, done in one year after the operative intervention, the body mass index lowering/ improvement of the glycemia and lipidogram indices, as well as the arterial pressure normalization and reduction of the apnoe rate while sleeping were registered. In accordance to data of secondary roentgenoscopy with contrasting of the foregut, conducted in 6 mo after LGP, in 20 (25.3%) patients irregular narrowing of a gastric tube higher than gastric angle was registered. In 12 mo roentgenological signs of significant widening of the gastric tube, formatted of fundus and cardia were seen, as well as the angle of His enhancement, presence of gastro-esophageal reflux of the contrast, аnd 2 patients have had the signs of axial cardial hiatal hernia. Simultaneously in 20.2% patients the symptoms of gastro-esophageal reflux disease with essential lowering of the patients’ quality of life were observed. Conclusion. LGP constitutes a potentially secure and effective bariatric operation, after which the body mass reduces significantly and constantly. But in 20.2% patients the morbidity occur: through 12 mo after the operation GERD and reflux-esophagitis evolves. The origin of this late complications is a partial stenosis in the gastric angle region, what causes the development of prestenotic dilation of proximal gastric parts.

Laparoscopic sleeve gastrectomy in a superobese patient with restenosis of the trachea

Introduction. Super obese group of patients with body mass index (BMI) ? 50kg/m2 have higher technical intraoperative problems, higher morbidity and mortality. Indications for the metabolic procedure are widening and minimally invasive operation dictate both patients and surgeons to face with previously assumed ?general contraindication? for surgical bariatric/metabolic procedure. Case outline. We present a super obese patient with restenosis of the trachea, chronic obstructive pulmonary disease, sleep apnea and cardiomyopathy with panniculus grade IV, in whom as a multidisciplinary team we did simultaneously permanent tracheostomy, laparoscopic sleeve gastrectomy and panniculectomy. Conclusion. Quality of life after the bariatric operation is a factor which must be leading in concern how to approach a difficult patient, with operation adaptable to fit all demands.

Intestinal Complications of Roux-en-Y Gastric Bypass

Roux-en-Y gastric bypass is a commonly performed bariatric operation, but it is a formidable procedure performed in technically challenging, medically high-risk patients. Although it is highly successful for achieving meaningful and durable weight loss, a variety of intestinal complications may occur. These include small bowel obstructions from a number of sources (internal hernias, adhesions, intussusception, incisional hernias, intestinal volvulus), anastomotic strictures, dumping syndrome, portal vein thrombosis, Roux-en-O construction, and small bowel diverticulitis. This chapter reviews several of the more commonly occurring postoperative intestinal complications. Clinicians need to understand the signs and symptoms of these complications and must be able to quickly diagnose the condition and initiate treatment.

Conversion of sleeve Gastrectomy to Roux-en-Y Gastric bypass for weight loss failure

Background: Obesity is a global health issue. Laparoscopic sleeve gastrectomy has progressively become the most popular procedure among the surgical community as a definitive bariatric operation. The increasing number of surgeries performed will be likely be followed by increasing reports of patients experiencing weight loss failure.Objectives: To determine the effectiveness of conversion from laparoscopic sleeve gastrectomy to Roux-en-Y gastric bypass in cases with weight loss failure.Patient &methods: The retrospective review of patients who had operated with laparoscopic sleeve gastrectomy from October 2009 to January 2016 at Saint Raphael hospital, 21 patients included in this study had insufficient weight loss after Sleeve Gastrectomy and converted to Roux-en-Y gastric bypass.Results: Fifteen patients (71.4%) had LSG as their single bariatric operation before conversion to roux en Y gastric bypass, 2 patients (9.5%) had Intragastric balloon and 4 (19.1%) patients had the laparoscopic adjustable gastric band before to their sleeve gastrectomy. Fourteen patients (66.6%) were female and 7 (33.4%) were males, At 6, 12, 18 months after bypass ,mean BMI was 37.2 (32.7-44.3),32.5(28.7-39.1) and 30.2 kg/m2 (24.3-37.9 kg/m2) respectively , reflecting a %EWL (percentage weight loss) at 18 month of 61.7%.Conclusion: insufficient weight loss after Sleeve Gastrectomy can be safely and effectively treated by conversion to Roux-en-Y gastric bypass to control weight loss failure or weight regain.Keywords: weight loss failure, weight regain, failed Sleeve Gastrectomy تحويل عملية قص المعدة الى عملية تحويل مسار المعدة للمرضى الذين فشلوا في فقدان الوزن د. محمد قاسم عبدالجبار د. رامز سامي مختار د. مصطفى عادل عباس الخلاصة: خلفية: البدانة لا تزال تمثل مصدر قلق كبير في جميع أنحاء العالم. وقد اكتسبت استئصال و تكميم المعدة بالمنظار شعبية كبيرة بين المجتمع الجراحي باعتباره إجراء جراحي مستقل. ومن المرجح أن يتبع العدد المتزايد في اجراء قَص وتكميم المعدة بوجود إعداد متزايدة من المرضى الذين يعانون من فشل في فقدان الوزن ، وتعرف بأن فقدان الوزن غير كافي أو اكتساب الوزن من جديد. الهدف من الدراسة: لتقييم فعالية تحويل قَص وتكميم المعدة الى عملية تحويل مسار المعدة في موضوع فشل فقدان الوزن المرضى والطرق: استعراض بأثر رجعي للمرضى الذين خضعوا لقص وتكميم المعدة بالمنظار من تشرين الاول ٢٠٠٩ حتى كانون الاول ٢٠١٦في مستشفى القديس رافائيل(الراهبات)، خضع ٢١ مريضا يعانون من فشل في فقدان الوزن بعد عملية قَص وتكميم المعدة الى عملية تحويل مسار المعدة بالناظور وتمت متابعة فقدان الوزن لدى المرضى لمدة ١٨ شهر أو اكثر. النتائج: خضع سبعة عشر مريضا (٨٠.٩٪) لعملية قَص وتكميم المعدة كإجراء وحيد ، وخضع ٤ (١٩.١٪) من المرضى لعملية قرص المعدة قبل اجراء قَص وتكميم المعدة. وكان ١٤ مريضا (٦٦.٦٪) من الإناث و ٧ (٣٣.٤٪) من الذكور، في الشهر السادس و والاثنا عشر والثامن عشر شهرا بعد بعد تحويل مسار المعدة، كان متوسط ​​مؤشر كتلة الجسم ٣٧.٢ (٣٢.٧-٤٤.٣)، ٣٢.٥ (٢٨.٧-٣٩.١) و ٣٠.٢ كجم / م ٢ (٢٤.٣ -٣٧.٩ كغ / م ٢) على التوالي، مما يعكس (نسبة فقدان الوزن) في الشهر الثامن عشر ٦١.٧٪. الاستنتاج: عملية تحويل مسار المعدة بالناظور بعد فشل فقدان الوزن بعد عملية قَص وتكميم المعدة هو اجراء أمن وفعال. كلمات البحث: فشل في فقدان الوزن ،استعادة الوزن، فشل قَص وتكميم المعدة