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Ulcers After Bariatric Surgery
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Ulcers After Bariatric Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (15 January 2025) | Viewed by 6339

Special Issue Editors

Prof. Dr. Vincenzo Pilone

E-Mail Website
Guest Editor
Department of Public Health, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
Interests: bariatric surgery; gastrectomy; ulcers
Special Issues, Collections and Topics in MDPI journals
Dr. Antonio Vitiello

E-Mail Website1 Website2
Guest Editor
Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via S. Pansini, 5, 80131 Naples, Italy
Interests: gastric bypass; bariatric surgery; sleeves
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Metabolic bariatric surgery is currently considered the best treatment for morbid obesity. Sleeve gastrectomy and Roux-en-Y gastric bypass are the most common interventions, but new procedures have spread worldwide. Marginal ulcers (MU) are a well-known complication following new and old metabolic interventions. Even if most of these ulcers respond to medical treatment, recurrent or chronic MU may require revisional intervention. The etiology is multifactorial, and non-steroidal anti-inflammatory drug (NSAID) use, smoking, and Helicobacter pylori infection have been advocated as risk factors for MU. However, mechanisms beyond the formation of recalcitrant ulcers have not yet been clarified, nor has the best treatment.

The aim of this Special Issue is to report the rate of MU after new bariatric procedures such as one anastomosis gastric bypass, single anastomosis sleeve-ileal bypass, or single anastomosis duodeno-ileal bypass and to further investigate the relationship between known risk factors and marginal ulcer (MU) formation, especially after revisional procedures.

Prof. Dr. Vincenzo Pilone
Dr. Antonio Vitiello
Guest Editors

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Keywords

  • marginal ulcer
  • sleeve gastrectomy
  • Roux-en-Y gastric bypass
  • one anastomosis gastric bypass
  • single anastomosis sleeve-ileal bypass
  • single anastomosis duodeno-ileal bypass
  • LSG
  • RYGB
  • OAGB
  • SASI
  • SADI

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Published Papers (4 papers)

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Research

11 pages, 412 KiB  
Article
Development of the International Federation for Surgery of Obesity and Metabolic Disorders-European Chapter (IFSO-EC) Grade-Based Guidelines on the Surgical Treatment of Obesity Using Multimodal Strategies: Design and Methodological Aspects
by Maurizio De Luca, Amanda Belluzzi, Paulina Salminen, Marco Bueter, Juan Pujol-Rafols, Nasser Sakran, Christine Stier, Halit Eren Taskin, Sonja Chiappetta, Francesco Maria Carrano, Nicola Di Lorenzo, Simon Nienhuijs, Ramón Vilallonga Puy, Erik Stenberg, Marloes Emous, Gerhard Prager, Jacques Himpens, Daniel Moritz Felsenreich, Antonio Iannelli, Chetan Parmar, Catalin Copaescu, Martin Fried, Elena Ruiz-Úcar, Ricardo V. Cohen, Stefano Olmi, Luigi Angrisani, Rui Ribeiro, Giulia Bandini, Daniele Scoccimarro, Benedetta Ragghianti and Matteo Monamiadd Show full author list remove Hide full author list
J. Clin. Med. 2024, 13(17), 5106; https://doi.org/10.3390/jcm13175106 - 28 Aug 2024
Cited by 2 | Viewed by 1566
Abstract
Background: The prevalence of obesity is already a worldwide health concern. The development of straightforward guidelines regarding the whole available armamentarium (i.e., medical, endoscopic, and surgical interventions in conjunction with a guidance program) is paramount to offering the best multimodal approach to [...] Read more.
Background: The prevalence of obesity is already a worldwide health concern. The development of straightforward guidelines regarding the whole available armamentarium (i.e., medical, endoscopic, and surgical interventions in conjunction with a guidance program) is paramount to offering the best multimodal approach to patients with obesity. Methods: The International Federation for Surgery of Obesity and Metabolic Disorders-European Chapter (IFSO-EC) identified a panel of experts to develop the present guidelines. The panel formulated a series of clinical questions (based on the patient, intervention, comparison, and outcome conceptual framework), which have been voted on and approved. A GRADE methodology will be applied to assess the quality of evidence and formulate recommendations employed to minimize selection and information biases. This approach aims to enhance the reliability and validity of recommendations, promoting greater adherence to the best available evidence. Results: These guidelines are intended for adult patients with a body mass index (BMI) ≥ 30 kg/m2 who are candidates for metabolic bariatric surgery (MBS). The expert panel responsible for developing these guidelines comprised 25 panelists (92% were bariatric surgeons) and 3 evidence reviewers, with an average age of 50.1 ± 10.2 years. The panel focused on 3 key questions regarding the combined use of structured lifestyle interventions, approved obesity management medications, and endoscopic weight loss procedures with MBS. Conclusions: The complexity of obesity as a chronic disease requires a comprehensive knowledge of all the available and feasible therapeutic options. The IFSO-EC society felt the urgent need to develop methodologically valid guidelines to give a full picture and awareness of the possible surgical and non-surgical therapeutic strategies employed with a multimodal approach. Full article
(This article belongs to the Special Issue Ulcers After Bariatric Surgery)
12 pages, 787 KiB  
Article
Does Antrum Size Matter in Sleeve Gastrectomy? Volume II—A Retrospective Multicentric Study with Long-Term Follow-Up
by Claudio Gambardella, Simona Parisi, Salvatore Tolone, Francesco Saverio Lucido, Gianmattia del Genio, Luigi Brusciano, Rosetta Esposito, Domenico de Vito, Ludovico Docimo and Francesco Pizza
J. Clin. Med. 2024, 13(13), 3912; https://doi.org/10.3390/jcm13133912 - 3 Jul 2024
Cited by 1 | Viewed by 1495
Abstract
Background: Laparoscopic sleeve gastrectomy (LSG) is the most widespread bariatric procedure due to its safety and efficacy. Despite continuous refinement, achieving a globally standardized procedure remains challenging. Moreover, due to its wide adoption, numerous studies have focused on complications associated with the technique, [...] Read more.
Background: Laparoscopic sleeve gastrectomy (LSG) is the most widespread bariatric procedure due to its safety and efficacy. Despite continuous refinement, achieving a globally standardized procedure remains challenging. Moreover, due to its wide adoption, numerous studies have focused on complications associated with the technique, such as gastroesophageal reflux disease (GERD). This study evaluates the impact of antrum size (wide antrectomy versus small antrectomy) in LSG on long-term anthropometric outcomes and complications in patients with morbid obesity. Methods: Body mass index (BMI), percentage of excess weight loss (%EWL) at a 5-year follow-up, GERD Health-Related Quality-of-Life (GERD-HRQL) scores, and obesity-related diseases of patients undergoing LSG with gastric resections starting 2 cm and 6 cm from the pylorus were retrospectively evaluated. Results: Between January 2015 and November 2019, 597 patients who met the criteria for LSG were included in the study. Group A (241 patients) underwent wide antrectomy, while Group B (356 patients) underwent small antrectomy. Weight, BMI, %EWL, and %TWL significantly improved at 6 and 12 months in the wide-antrectomy group. However, these differences diminished by 24 months, with no significant long-term differences in weight loss outcomes between the two groups at 5 years. Conversely, GERD-HRQL scores were significantly better in the small-antrectomy group until 24 months; thereafter, results were comparable between groups over the long term. Conclusions: Therefore, while wide antrectomy may offer superior short-term anthropometric outcomes, both techniques yield similar long-term results regarding weight management and GERD incidence. Larger prospective studies are needed to further address this issue. Full article
(This article belongs to the Special Issue Ulcers After Bariatric Surgery)
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7 pages, 522 KiB  
Article
Staple Line Reinforcement during Sleeve Gastrectomy with SeamGuard: Single-Center Retrospective Case-Control Study over a 5-Year Period
by Antonio Vitiello, Jessica Mok, Mohamed Elkalaawy, Andrea Pucci, Andrew Jenkinson, Rachel Battheram, Vincenzo Pilone and Marco Adamo
J. Clin. Med. 2024, 13(12), 3410; https://doi.org/10.3390/jcm13123410 - 11 Jun 2024
Viewed by 1231
Abstract
Introduction: Various techniques and reinforcements have been proposed over the years in order to prevent leaks and bleeding after sleeve gastrectomy (LSG). The aim of this study was to retrospectively compare the staple line complication (SLC) rate in patients who underwent LSG with [...] Read more.
Introduction: Various techniques and reinforcements have been proposed over the years in order to prevent leaks and bleeding after sleeve gastrectomy (LSG). The aim of this study was to retrospectively compare the staple line complication (SLC) rate in patients who underwent LSG with the use of bioabsorbable membrane (GORE® SEAMGUARD®, GoR) for staple line versus those who received no reinforcement. Methods: Data on all consecutive patients undergoing LSG between 1 January 2014 and 31 December 2018 were retrospectively reviewed. Patients were divided into two groups: the GoR+ group if the SeamGuard (GoR) was used and the GoR− group if no reinforcement was applied on the staple line. Preoperative demographics and rate of SLC were compared between groups. All cases of SLC coming from other centers were also reviewed. Results: A total number of 626 LSGs were performed at our institution during the study period. GoR was applied in 450 (71.9%) cases (GoR+ group), while NR was used in 176 (28.1%) patients (GoR− group). Two (1.13%) cases of leaking and two (1.13%) cases of bleeding occurred in the GoR− group, while no SLC was recorded in patients who received GoR (p < 0.05). Thirteen cases of SLC coming from other institutions were treated at our hospital; all these cases were performed without any SLR. Conclusion: In our case series, the use of GoR reduced the rate of SLC after LSG. In all cases of SLC coming from other institutions, no reinforcement had been applied on the staple line during LSG. Full article
(This article belongs to the Special Issue Ulcers After Bariatric Surgery)
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10 pages, 521 KiB  
Article
Marginal Ulcer Perforation after One Anastomosis Gastric Bypass: Surgical Treatment and Two-Year Outcomes
by Adam Abu-Abeid, Adi Litmanovich, Jonathan Benjamin Yuval, Jawad Tome, Andrei Keidar and Shai Meron Eldar
J. Clin. Med. 2024, 13(11), 3075; https://doi.org/10.3390/jcm13113075 - 24 May 2024
Cited by 4 | Viewed by 1514
Abstract
Background: Marginal ulcer (MU) perforation is a chronic complication after One-anastomosis Gastric Bypass (OAGB). This study’s purpose was to analyze patients undergoing OAGB revision due to MU perforation and describe the two-year outcomes. Methods: A retrospective analysis of a database in a single-tertiary [...] Read more.
Background: Marginal ulcer (MU) perforation is a chronic complication after One-anastomosis Gastric Bypass (OAGB). This study’s purpose was to analyze patients undergoing OAGB revision due to MU perforation and describe the two-year outcomes. Methods: A retrospective analysis of a database in a single-tertiary hospital. All patients undergoing surgical revision due to MU perforation were included. Results: During the study period, 22 patients underwent OAGB revision due to MU perforation. The rate of MU perforation was 0.98%. The median age was 48 years and there were 13 men (59%). The median time from OAGB to MU perforation was 19 months with a median total weight loss of 31.5%. Nine patients (41%) were smokers. Omental patch (±primary closure) was performed in 19 patients (86%) and three patients (14%) underwent conversion to Roux-en-Y gastric bypass (RYGB). At a median follow-up of 48 months, three patients (14%) had recurrent MU diagnosis, of which one had a recurrent MU perforation. Four patients (18%) underwent conversion to RYGB during follow-up. Conclusions: MU perforation is a chronic complication after OAGB. In this cohort, most patients were men and likely to be smokers. Omental patch was effective in most cases. Recurrent MU rates at two years follow-up were acceptable. Full article
(This article belongs to the Special Issue Ulcers After Bariatric Surgery)
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