bluuebunny/crossref_metadata_2025_split huggingface dataset:
IBC-Oxford University2023_BJSOral_3Tailored Bilio-Pancreatic Limb Length and Haemoglobin A1c Levels 10 years following Mini-Gastric Bypass Original Technique of One Anastomosis Gastric Bypass
Authors: Rutledge R , Kular K S , Manchanda N , Illan J 
Published: December 2023

Abstract

Introduction
The need for or the ideal length of the Biliopancreatic Bypass limb (BPL) length is a controversial topic. The Mini Gastric Bypass original technique (MGB-OT) version of the One Anastomosis Gastric Bypass (OAGB) includes a “Tailored” BPL length. This study aimed to investigate the 1 to 10-year outcomes of the “Tailored’ BPL length in patients undergoing MGB-OT in diabetic patients with Class III obesity.

Methods
The study is a retrospective chart review of 114 patients who underwent the Mini Gastric Bypass original technique (MGB-OT) with a tailored Biliopancreatic Limb length as described by Rutledge et al. These cases were performed between June 2008 and December 2009. The study investigated the relationship between the length of the BPLL and glycaemic control, primarily as measured by the change in (Delta) HbA1c levels, in morbidly obese diabetic patients undergoing the MGB-OT. The mean BPL length in the study was 185 cms, with a range of 120-350 cms. The study analysed preoperative, post-operative, and Delta HbA1c levels as the primary outcomes. The critical outcome goal for the study was HbA1c levels of less than 7%, which is a commonly used target for glycaemic control in diabetic patients.

Results
Only 89 of 114 (78%) patients completed the 10-year follow-up. The mean preoperative HbA1c was 9.2+/-1.6 (range 6.8-14.7). Longer BPL length were selected for patients based on a variety of patient factors including the patient’s preoperative HbA1c levels. Patients with longer BPL length had greater weight loss (R2 0.8.) The mean HbA1c levels were 5.50+/-0.36, 5.65+/-0.35, and 5.82+/-0.41 at 1, 5, and 10 years post-op. 100% of patients evaluated at 1 and 5 years had HbA1c levels below 7%, and only 1 out of 89 patients at 10 years had HbA1c levels above 7%. The correlation between BPL length and the 10-year Delta HbA1c was high, with a correlation coefficient (r) of 0.8. The Delta HbA1c was significantly greater in the patients with BPL length &gt; 150 cm (3.99 +/- 1.87 vs 2.08 +/- 0.71 in the BP150 patients difference 1.91, SEM 0.40, 95% CI 1.12 to 2.69, P &lt; 0.0001) i.e., longer BPL length (&gt; 150cms) had significantly greater Delta HbA1c than 150 cm BPL length.

Conclusions
The study suggests that individualized tailoring of the biliopancreatic limb length in the OAGB procedure can potentially lead to a combination of excellent weight loss and near-complete normalization of HbA1c levels for up to 10 years. However, this a small and incomplete study and the optimal length may vary based on individual patient factors. Further research is needed to confirm these findings and establish standardized guidelines for determining the appropriate BPL length. Overall, the study highlights the importance and potential value of continued research and individualized treatment approaches for patients with obesity and diabetes.
IBC-Oxford University2023_BJSOral_5Comparative Effectiveness of Bupivacaine-Dexamethasone and Liposomal Bupivacaine for Autonomic Neural Blockade in Laparoscopic Sleeve Gastrectomy: A Study on Pain, Postoperative Nausea and Vomiting and Analgesic Consumption
Authors: Daes J , Rocha J , Luque E , Hanssen A 
Published: December 2023

Abstract

Background
Pain is increasingly recognised as a syndrome not merely a symptom, emphasizing the importance of pain management. Visceral pain impacts up to 75% of bariatric patients during recovery. Concurrently, postoperative nausea and vomiting (PONV) persist as challenges after laparoscopic sleeve gastrectomy (LSG). An earlier RCT demonstrated the safety and effectiveness of para-gastric autonomic neural blockade (ANB) as a novel strategy to manage these issues in the first 24 hours after a laparoscopic sleeve gastrectomy. A limitation of using bupivacaine for ANB is its half-life, with clinical effects limited to 14 to 18 hours. This study compares the effectiveness of ANB using a combination of bupivacaine and Dexamethasone with that of liposomal bupivacaine.

Methods
This research represents a secondary analysis of an earlier RCT titled "Impact on Anaesthetic Agents Consumption Following Autonomic Neural Blockade as Part of a Combined Anaesthesia Protocol," currently under review. This secondary analysis focuses on two patient groups; one where ANB was performed with a mix of 5% bupivacaine and Dexamethasone (47 patients), and another with liposomal bupivacaine (25 patients). Data on pain, PONV, and analgesic requirements at 1, 8, and 24 hour post-surgery were recorded and analysed.

Results
Both treatment groups demonstrated low levels of pain, PONV incidence, and analgesic usage. No significant differences in pain scores or analgesic use were found between the groups at the selected postoperative time points. However, the liposomal bupivacaine group exhibited a reduced incidence of PONV, statistically significant only for vomiting.

Discussion
Visceral pain and PONV significantly affects patients' quality of life, recovery time, nursing time allocation, the risk of opioid abuse and readmission rates. Various strategies have been explored to manage visceral pain and associated symptoms. ANB has proven safe and effective in reducing pain, PONV, and analgesic consumption post-LSG. This study confirms that application of either 5 % bupivacaine plus Dexamethasone or liposomal bupivacaine during ANB results in very low levels of pain, PONV incidence, and analgesic use, outperforming the results of the original RCT using only 5% bupivacaine. These results may be attributed to the local anaesthetic used or the improved proficiency in performing the ANB. The similar low pain level and analgesic needs in both groups may render any statistical difference undetected due to the sample size. However, liposomal bupivacaine demonstrated a clinical advantage in reducing PONV after LSG.

Conclusion
ANB utilizing 5% bupivacaine plus Dexamethasone or liposomal bupivacaine effectively mitigates pain, PONV, and analgesic use following LSG. Liposomal bupivacaine appears more effective in managing nausea and vomiting.
IBC-Oxford University2023_BJSOral_6Five years Follow up after Surgical Treatment of Type 2 Diabetes with Laparoscopic Sleeve Gastrectomy associated with a Duodenal Ileal Interposition
Authors: Tinoco A , Netto M , Benedito H , El-Kadre L 
Published: December 2023

Abstract

Introduction
Type 2 diabetes mellitus (T2D) is a chronic disease, primarily caused by a combination of defective insulin secretion and the inability of insulin-sensitive tissues to respond to insulin. Laparoscopic sleeve gastrectomy associated with duodenal ileal interposition (SGDII) has been shown to be a feasible treatment option for patients with T2D, as it provides improvement and control of glycaemia, dyslipidaemia and arterial hypertension. The aim of this study was to evaluate the mid and long-term results of SGDII for the treatment of diabetic patients, considering diabetic remission, weight loss and postoperative complications.

Materials and Methods
Retrospective study with 96 patients with T2D submitted to SGDII, between 2010 and 2016. The glycated haemoglobin (HbA1c) value &lt; 6.5%, without the use of hypoglycaemic agents, was considered as remission of T2D.

Results
The five years follow up demonstrated that 80% of patients had T2D remission at one year, 74.5% at three years and 61.8% at five years. The average duration of the disease was nine years and the mean glycated haemoglobin before surgery was 8.95%. Sixty-one patients (62.8%) were male, and 36 patients (37.2%) were female. The average age was 50.9 years. Median BMI was 33.43 kg/m2. The incidence of major postoperative complications in the first 30 days was 2.1%, with no mortality. Dyslipidaemia control was sustained, after five years, in 62% of the patients.

Conclusion
SGDII resulted in good glycaemic control at 5-years follow-up and represents a valid alternative for the treatment of T2D.
IBC-Oxford University2023_BJSOral_9Calcitonin as a satiety inducer; normalizes in one year after LSG in morbidly obese patients.
Authors: Alasfar F S , Al Ozaiti E , Shinde G J , Arefanian H 
Published: December 2023

Abstract
Laparoscopic Sleeve Gastrectomy (LSG) is the commonest bariatric procedure done worldwide for morbid obesity. LSG benefits extend beyond it being just a restrictive procedure. Hormonal effects after LSG are well documented in literature. Calcitonin has been ascribed to induction of satiety in mammals. We studied calcium homeostasis in patients(N=21) suffering with morbid obesity who underwent LSG and compared them with non-obese candidates (N=15) who were age and sex matched. Blood samples were collected from patients on day before LSG (day-0), day-180, and day-360 after LSG. Blood sample was collected from non-obese group for comparison. We found that there was no significant difference of calcium in the patients compared to non-obese candidates. We observed that mean serum vitamin D increased on day-180 (M=55.33nM, SD=34.72, p=0.059) and day-360 (M=58.24nM, SD=36.19, p=0.038) from values on day-0 (M=29.48nM, SD=21.03, p=0.423) compared to non-obese candidates (M=35.4nM, SD=22.36). Decrease in mean parathyroid hormone (PTH) on day-180 (M=4.19pM, SD=1.8, p=0.83) and on day-360 (M=4.9pM, SD=2, p=0.31) from day-0 (M=6.19pM, SD=3.53, p=0.06) was observed, compared to non-obese candidates (M=4.31pM, SD=1.2). However, normalization of mean calcitonin was noted on day-180 (M=0.4pM, SD=0.8, p=0.22) and day-360 (M=0.8pM, SD=1.1, p=0.74) from day-0 (M=0.34pM, SD=0.4, p=0.02) compared to non-obese candidates (M=0.7pM, SD=0.41). Results of this study showed normalization of calcitonin, which may have role in satiety after LSG. Larger study is recommended to ascertain the trend of calcitonin after LSG.
IBC-Oxford University2023_BJSOral_12Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass: Indications, Management and Results
Authors: Crozet J , Robert M 
Published: December 2023

Abstract

Introduction
Sleeve gastrectomy (SG) represents more than 60% of bariatric procedures worldwide. Conversion of SG to Roux-en-Y gastric bypass (RYGB) for weight loss failure (WLF) or gastro-oesophageal reflux disease (GERD) is increasing. Intrathoracic migration of the sleeve often seems associated.

Aim
The aim of our study was to analyse the relevance of the indications, the prevalence of an associated de novo hiatal hernia, and the outcomes of the conversion of SG to RYGB.

Methods
This is a retrospective study of prospectively collected data including all the patients who underwent a conversion of SG to RYGB from August 2013 to December 2022. 2 groups were compared: patients operated on because of weight loss failure (WLF group) and those operated on for GERD (GERD group).

Results
We analysed in both groups demographic data, the incidence of an associated hiatal hernia, morbidity, weight loss outcomes and resolution of symptoms. 59 patients were included with an average follow-up of 30.5 months: 46 patients in the GERD group (78%) were compared to 13 patients (22%) in the WLF group. Groups were comparable regarding age (47) and gender (women: 74%); BMI at conversion and prevalence of comorbidities were significantly higher in the WLF group (41.8 kg/m² vs 33.3, p=0.0001). In the GERD group: on preoperative gastroscopy, 30% (14/46) had a grade B esophagitis, 48% (22/46) had a significant hiatal hernia which required a posterior crural closure versus 23% (3/13) in the WLF group, not requiring a surgical treatment (p = 0.02). Conversion was very effective on GERD symptoms (93% of improvement), 52% of the patients stopped proton pump inhibitor treatment. In the WLF group, mean percentage total weight loss (% TWL) was 15.3%, significantly greater than in the GERD group (% TWL=4.6%, p = 0.01). The complication rate was 10% at 30 days and 3.4% after 30 days, not significantly different between groups (p = 1 and 1 respectively).

Conclusions
The main indication of conversion of SG to RYGB was because of GERD: in these indications, the incidence of intrathoracic migration of the sleeve is high requiring a surgical treatment with a very good efficacy on resolution of symptoms. Weight loss results were disappointing.
IBC-Oxford University2023_BJSOral_13Efficiency and Safety of Single Anastomosis Sleeve Ileal (SASI) Bypass in the Treatment of Obesity and associated Co-morbidities: A Systematic Review and Meta-analysis
Authors: Rodrigues Oliveira C , Santos-Sousa H , Pinho Costa M , Amorim-Cruz F , Bouça-Machado R , Resende F , Costa-Pinho A , Preto J , Lima-da-Costa E , Carneiro S , Sousa-Pinto B 
Published: December 2023

Abstract

Introduction
The Single Anastomosis Sleeve Ileal (SASI) bypass is a new bariatric surgery corresponding to an adaptation of the Santoro approach, consisting of a sleeve gastrectomy (SG) followed by loop gastro-ileostomy. Therefore, we aimed to systematically assess all the current literature on SASI bypass in terms of safety, weight loss, improvement in associated comorbidities, and complications.

Methods
Following the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) recommendations, we conducted a systematic review and meta- analysis by searching three databases (PubMed, Scopus, and Web of Science). We performed a meta-analysis of risk ratios and mean differences to compare SASI bypass with SG and One-Anastomosis Gastric Bypass (OAGB) for percentage excessive weight loss, improvement/remission in type 2 diabetes mellitus (T2DM), hypertension (HT), dyslipidaemia (DL), obstructive sleep apnoea (OSA) and complications. Heterogeneity was assessed using the I2 statistic.

Results
Eighteen studies were included in the qualitative analysis and four in the quantitative analysis. Compared to SG, the SASI bypass was associated with improved weight loss (MD=11.32; 95% confidence interval (95%CI) [7.89;14.76]; p&lt; 0.0001), and improvement or remission in T2DM (RR=1.35; 95%CI [1.07;1.69]; p=0.011), DL (RR=1.41; 95%CI [1.00;1.99]; p=0.048) and OSA (RR=1.50; 95%CI [1.01;2.22]; p=0.042). No statistically significant differences in any of the assessed outcomes was observed when compared with OAGB.

Conclusion
Although studies with longer follow-up periods are needed, this systematic review and meta-analysis showed that SASI bypass has a significant effect on weight loss and metabolic variables. Variations in outcomes between studies reinforce the need for standardisation.
IBC-Oxford University2023_BJSOral_18The Use of Indocyanine Green (ICG) Fluorescence Angiography in Laparoscopic Roux-en-Y Gastric Bypass for Perfusion Assessment and Structure Visualisation
Authors: Latif J , Awan A 
Published: December 2023

Abstract

Introduction
Indocyanine green (ICG) fluorescence angiography (FA) has been utilised in bariatric surgery for assessment of tissue perfusion and blood supply in laparoscopic sleeve gastrectomy (LSG). However, there is limited literature on its use in laparoscopic Roux-en-Y gastric bypass (LRYGB). The aim of this study was to evaluate the use of ICG-FA in LRYGB for qualitative assessment of tissue perfusion and structure identification. These are the first cases utilising ICG-FA in LRYGB to be performed in the United Kingdom.

Methods
Thirty-five patients (12 male, 34%, 23 females, 66%) with median (IQR) age of 45 (38 – 52) years and preoperative median (IQR) BMI 45 (37 – 49) kg/m2 underwent LRYGB with ICG-FA. ICG was administered intravenously according to an agreed protocol. Karl Storz® Image 1 Rubina system with overlay and monochromatic modes was utilised for perfusion assessment. ICGFA was utilised for qualitative assessment of gastric pouch perfusion before and after linear stapled gastro-jejunal anastomosis and visualisation of key anatomical landmarks. The perfusion pattern was assessed by the operating team based on a ICG scoring system (ICG-S), which ranged from 1 (no perfusion) to 4 (excellent perfusion) based on timing following ICG injection and intensity of fluorescence detected in the anatomical structures.

Results
From April 2021 to August 2022, 34 patients underwent primary LRYGB with use of ICG- FA. ICG was utilised in one revisional case. No adverse effects to ICG were observed. ICG-S was 4 in 33 patients. (94%). In two patients (6%), operative strategy was modified based on focal area of no perfusion (ICG score 1) in gastric pouch. ICG-FA helped improve operative safety during division of omentum and in recognition of duodeno-jejunal flexure with fluorescence detection in epiploic vessels and inferior mesenteric vein (IMV) respectively. There were no leaks at a median follow up of 9 months.

Conclusion
ICGFA imaging allows for qualitative assessment of perfusion and identification of critical anatomical landmarks during LRYGB. The technology is safe and its utilisation in LRYGB provides a “real-time image” of gastric pouch perfusion, helping to demonstrate ischaemic or poorly perfused areas with an opportunity to modify operative strategy.
IBC-Oxford University2023_BJSOral_19Prospective Non-Randomized Study comparing the outcomes of Single Anastomosis Sleeve Jejunal Bypass (SASJ) with One Anastomosis Gastric Bypass (OAGB)
Authors: Elbanna M , Abdelsamee K S , Zaher A S , Essam I 
Published: December 2023

Abstract

Background
Single anastomosis Sleeve Jejunal Bypass (SASJ) is a relatively new bariatric/metabolic procedure. It is the single anastomosis modification of the Sleeve Gastrectomy with Bipartition operation developed by Santoro in 2012. Few studies have been published on its efficacy and safety, and fewer studies have been performed comparing its outcome with recognized bariatric procedures.

Patients and Methods
This is a prospective nonrandomized comparative study. Eighty patients were included in the study, 40 patients underwent SASJ and 40 underwent OAGB, in Ain Shams University Hospitals over 12 months between June 2021 and June 2022. Patients were followed up for at least one year. Both groups are compared for operative time, complications, costs, postoperative weight loss, resolution of co-morbidities, and complications.

Results
The one year follow up was completed by 34 patients in the SASJ group, and 38 patients in the OAGB group. The difference in operative time was not statistically significant. Intraoperative bleeding occurred in 3 cases in the OAGB group, one was successfully managed by conservative management and 2 required re-laparoscopy for successful control of bleeding. No leakage occurred in both groups. There was no statistically significant difference in EWL%, as it was 68.6 % ± 7.2 one year after SASJ and 71.3 % ± 5.7 % after OAGB. TWL% was 35.9 % ± 4.2 one year after SASJ and 36.2 % ± 3.8 % after OAGB, with no statistical difference. T2 DM resolution took place in 100% of patients after both procedures. However, bile reflux was higher after SASJ (17.6%, 6/34 patients), as compared to OAGB (13.2 %, 5/38 patients), yet statistically, the difference was not significant.

Conclusion
SASJ is an effective and safe bariatric/metabolic operation. Its outcome is comparable to that of OAGB. It deserves further study.
IBC-Oxford University2023_BJSOral_23Video Presentation: Gastric Clip Bariclip as A New Technique in Bariatric Robotic Surgery
Authors: Maldonado Pintado D G 
Published: December 2023

Abstract
Robotic Bariatric Surgery is a safe and effective way to perform surgical procedures in the obese patient. The gastric Clíp (Bariclip) is a device implemented as a new bariatric technique to treat obesity accepted for the patients since lower BMI. Between many advantages of this procedure, it is a reversible procedure, avoiding to change the anatomy of the stomach and it can be performed as an ambulatory procedure. We present the first Ambulatory Bariatric Robotic Bariclip Procedure in Mexico City Mexico in August 15th, 2022 at Angeles Pedregal Hospital.
IBC-Oxford University2023_BJSOral_25Early outcomes of Long Biliopancreatic Limb Roux-En-Y Gastric Bypass Versus One-Anastomosis Gastric Bypass
Authors: Salman M A , Aboul-Enein M S , Abelsalam A , Nashed G A , Yacoub M , Abdalla A 
Published: December 2023

Abstract

Background
Roux-en-Y gastric bypass (RYGB) is the gold standard in bariatric surgery. The one-anastomosis gastric bypass (OAGB) procedure, first introduced by Dr. Rutledge, has demonstrated a 25% greater weight loss efficiency than the traditional Roux-en-Y gastric bypass (RYGB) procedure due to the substantially longer biliopancreatic limb (BPL).

Aim of the study
The current work aimed to compare the outcomes of OAGB and long BPL RYGB regarding weight loss and comorbidity resolution.

Patients and methods
This randomized controlled trial was done at our institution between September 2019 and January 2021. Patients who were candidates for bariatric surgery were randomly and equally allocated to two groups. Group A underwent OAGB, while group B underwent long BPL RYGB. Patients were followed up for 6 months postoperatively.

Results
This study included 62 patients equally allocated to OAGB or long BPL RYGB, with no dropouts during follow-up. At 6 months, there was no statistically significant difference between the two groups regarding postoperative BMI (P = 0.313) and the EBWL (P = 0.238). There was comparable remission of diabetes mellitus (P = 0.708), hypertension (P = 0.999), OSA (P = 0.999), joint pain (P = 0.999), and low back pain (P = 0.999). Seven patients in the OAGB group experienced reflux symptoms (P = 0.011), which were managed by proton pump inhibitors.

Conclusion
Extending the BPL in RYGB provides weight loss and comorbidity remission comparable to that of OAGB. Some OAGB-related reflux cases remain a concern. However, they were sufficiently controlled with PPIs. Due to OAGB superior technical simplicity, long BPL RYGB should be preserved for cases who at higher risk for bile reflux.
IBC-Oxford University2023_BJSOral_26A Novel Classification for Gastric Migration after Sleeve Gastrectomy and a Proposed Algorithm for its Management Based on CT 3D Reconstructions.
Authors: Hanssen A , Sabbag D , Rada A , Marroquin L , Thorné H , Jaramillo M , Hanssen R , Daes J 
Published: December 2023

Abstract

Introduction
Sleeve gastrectomy has become a primary bariatric procedure for obesity treatment, but it is associated with the development of hiatal hernias and gastric migration. This migration can lead to complications such as gastro-oesophageal reflux disease. The study aims to classify and analyse gastric migration patterns after sleeve gastrectomy using 3D reconstructed images and propose an algorithm for management.

Methods
A standardized protocol for assessing post-bariatric surgery anatomy was implemented at Clinica Portoazul, Colombia. CT with 3D reconstruction was performed on 100 patients who had undergone sleeve gastrectomy. Images were analysed for gastric migration, and cases were classified based on the extent and type of herniation.

Results
Out of 100 patients reviewed, 28 (34.1%) had hiatal hernias with varying degrees of gastric migration. Among these patients, 22 (26.8%) had Type 1 hernias (sliding with &lt;1/3 gastric tube herniation), 2 (2.4%) had Type 2 hernias (&gt;1/3 stomach herniated), and 4 (4.9%) had Type 3 hernias (paraesophageal migration).

Discussion
Gastric migration after sleeve gastrectomy is a rare complication with potential serious symptoms. Risk factors include history of hiatal hernia, severe obesity, large gastric pouch, and surgical errors. The proposed classification, based on 3D reconstructed images, provides insight into migration patterns and aids in planning revisional surgery.

Conclusion
Gastric migration after sleeve gastrectomy can be assessed using 3D reconstructed CT images. The proposed classification helps categorize migration types, informing treatment decisions. We used this classification to design an algorithm for gastric migration management after sleeve gastrectomy, considering the identified patterns. Further research is needed to validate the classification and determine its role in treatment planning.