Is Revisional Gastric Bypass as Effective as Primary Gastric Bypass for Weight Loss and Improvement of Comorbidities?

Background Revisional gastric bypass (R-RYGB) surgery is utilized for the management of inadequate weight loss or weight regain observed after some cases of bariatric surgeries. Data on the mid-term effectiveness of primary gastric bypass (P-RYGB) compared with R-RYGB (e.g., post sleeve gastrectomy/gastric banding) are controversial. Methods Retrospective chart review of all patients who received P-RYGB and R-RYGB (January 2011–June 2015) at our center. One hundred twenty patients who underwent P-RYGB and 34 R-RYGB who completed 18 months follow-up were included. We compared the effectiveness of P-RYGB with R-RYGB by assessing four anthropometric, two glycemic, and four lipid parameters, as well as the control of type 2 diabetes (T2DM), hypertension, dyslipidemia (remission, improvement, persistence, relapse, de novo), mortality and complications rates. Results A comparison of the effectiveness of P-RYGB with R-RYGB at 18 months revealed no significant differences in patients’ age, gender, and preoperative BMI between groups. However, patients who received P-RYGB had lower mean weight (P = 0.001) and BMI (P < 0.001), reflected by a higher mean delta BMI (P = 0.02), total weight loss percentage (TWL%) (P < 0.0001) and excess weight loss percentage (EWL%) (P < 0.0001). No differences in glycemic parameters, lipid profiles, control of T2DM, hypertension, and dyslipidemia were observed. No death is reported and complication rates were comparable. Conclusions Although R-RYGB effectively addressed inadequate weight loss, weight regain, and recurrence of comorbidities after restrictive bariatric surgery, R-RYGB resulted in inferior weight loss compared with P-RYGB. Neither procedure differed in their clinical control of T2DM, hypertension, and dyslipidemia. Both procedures exhibited comparable complication rates.

Contemporary Role of Robotics in Bariatric Surgery: Experience of CUF Infante Santo Hospital

INTRODUCTION: The use of robotics in bariatric surgery is increasing worldwide, with the main objective of reducing complications and optimising surgical outcome. This study presents a single centre 1.5-year experience and clinical outcome with robotic gastric bypass. METHODS: A retrospective review was performed of 42 consecutive patients who underwent a robotic gastric bypass. Patient files were analysed to obtain patient characteristics, weight loss results and per- and postoperative morbidity. RESULTS: In 32/42 patients, a primary gastric bypass was performed, the remaining 10 procedures were revision cases. Mean start weight was 111.1 (+/- 20.5) kg, mean start BMI was 39.7 (+/- 5.6) kg/m2. Almost half of the patients presented with pre-existing comorbidities. After a mean follow-up of 9.1 (+/-5.2) months, mean body mass index was 30.16 (+/-5.3) kg/m2 with a percentage excess weight loss of 66.16 (+/- 43.6)%. There were no conversions, no leaks and no mortality. Two patients presented with minor complications; one infected hematoma and one anastomotic ulcer. Mean length of stay in the hospital was 2.8 (2-5) days. All but one patients were satisfied with the weight loss result. CONCLUSION: The robotic gastric bypass is a safe and reproducible approach to treat morbid obesity. A secure handsewn gastrojejunal anastomosis, quick recovery and better ergonomics are the main advantages of this technique.