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Keywords = biliopancreatic diversion with duodenal switch

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25 pages, 345 KiB  
Review
Impact of Bariatric Surgery and Endoscopic Therapies on Liver Health in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Review
by Dana Tasabehji, Sanaz Saleh and Mohamad Mokadem
J. Clin. Med. 2025, 14(12), 4012; https://doi.org/10.3390/jcm14124012 - 6 Jun 2025
Viewed by 1032
Abstract
This review examines the effectiveness of various surgical and endoscopic bariatric interventions in improving several components of metabolic dysfunction-associated steatotic liver disease (MASLD). Roux-en-Y gastric bypass (RYGB) consistently showed substantial long-term reductions in liver fat, inflammation, and fibrosis, achieving resolution of steatosis in [...] Read more.
This review examines the effectiveness of various surgical and endoscopic bariatric interventions in improving several components of metabolic dysfunction-associated steatotic liver disease (MASLD). Roux-en-Y gastric bypass (RYGB) consistently showed substantial long-term reductions in liver fat, inflammation, and fibrosis, achieving resolution of steatosis in up to 95% of cases. Vertical sleeve gastrectomy (VSG) provided comparable hepatic benefits, significantly reducing liver fibrosis and steatosis in approximately 60% of patients. Adjustable gastric banding (AGB) demonstrated meaningful though comparatively modest hepatic improvements, with steatosis resolution in about 42% of patients. More aggressive procedures like biliopancreatic diversion with duodenal switch (BPD-DS) showed profound metabolic effects, though with increased nutritional risk. Endoscopic therapies, including intragastric balloon (IGB) and endoscopic sleeve gastroplasty (ESG), offered notable short- to medium-term hepatic improvements, significantly reducing steatosis and fibrosis markers. Newer therapies like duodenal mucosal resurfacing (DMR) and the duodenal-jejunal bypass liner showed promising preliminary results, warranting further investigation. Overall, surgical interventions remain superior for sustained liver health improvements, while endoscopic therapies present viable alternatives for patients requiring less invasive interventions. Full article
14 pages, 434 KiB  
Article
Outcomes Comparison Between Primary and Revisional Duodenal Switch in Patients with a BMI Greater than 55 kg/m2
by Lorna A. Evans, Jorge Cornejo and Enrique F. Elli
J. Clin. Med. 2025, 14(10), 3426; https://doi.org/10.3390/jcm14103426 - 14 May 2025
Viewed by 405
Abstract
Background: Revisional bariatric surgery for recurrent weight gain is becoming more common, though it carries higher risks and may be less effective than primary bariatric surgery. This study compares clinical outcomes between primary and revisional duodenal switch (DS) in patients with a [...] Read more.
Background: Revisional bariatric surgery for recurrent weight gain is becoming more common, though it carries higher risks and may be less effective than primary bariatric surgery. This study compares clinical outcomes between primary and revisional duodenal switch (DS) in patients with a body mass index (BMI) > 55 kg/m2. Methods: A retrospective cohort study was conducted on 20 patients who underwent either primary or revisional duodenal switch (DS) surgeries, including biliopancreatic diversion with duodenal switch (BPDDS) and Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-s), between January 2015 and December 2023. Revisional DS was defined as the conversion from Sleeve Gastrectomy (SG) to either BPDDS (C-BPDDS) or SADI-S (C-SADI-S). Perioperative and postoperative variables were analyzed. A statistical analysis was performed using chi-square and McNemar tests for categorical variables and Student’s t-test for continuous variables. A p-value of <0.05 was considered significant. Results: Eleven primary DS patients (six BPDDS, five SADI-s) and nine revisional DS patients (five C-BPDDS, four C-SADI-s) were included. The revisional group had a slightly higher preoperative BMI (57.56 ± 5.92 kg/m2 vs. 55.93 kg/m2 ± 6.91 kg/m2). Although operative times were shorter in the revisional group (153.20 ± 53.26 vs. 193.27 ± 46.79 min), the length of stay was longer (2.70 ± 1.25 vs. 2.18 ± 1.16 days). Primary DS patients experienced three minor late complications (dehydration, nephrolithiasis), whereas the revisional group had one major complication (internal hernia requiring reoperation). At the 12-month follow-up, both groups demonstrated similar outcomes in terms of percentage of total weight loss (%TWL) (primary DS: 25.25% ± 12.38 vs. revisional DS: 30.31% ± 10.79) and percentage of excess weight loss (%EWL) (primary DS: 48.41% ± 22.93 vs. revisional DS: 53.24% ± 14.48). Conclusions: Revisional DS was associated with shorter operation times and similar weight loss to primary DS. Additionally, it was accomplished safely and led to adequate and sustained weight loss in patients with a BMI greater than 55 kg/m2. Full article
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13 pages, 2154 KiB  
Article
Circulating Amino Acid Changes Three Years After Bariatric Surgery
by Ina Maltais-Payette, Fannie Lajeunesse-Trempe, Mélanie Nadeau, Léonie Bouvet-Bouchard, Frédéric Simon Hould, Laurent Biertho and André Tchernof
Metabolites 2025, 15(5), 297; https://doi.org/10.3390/metabo15050297 - 30 Apr 2025
Cited by 1 | Viewed by 636
Abstract
Background and objective: Studies using metabolomics to study bariatric surgery have shown that amino acids are one of the most changed groups of metabolites after the intervention. However, the surgery-related variation in individual amino acids, as well as the long-term impact and the [...] Read more.
Background and objective: Studies using metabolomics to study bariatric surgery have shown that amino acids are one of the most changed groups of metabolites after the intervention. However, the surgery-related variation in individual amino acids, as well as the long-term impact and the differences between the types of surgeries, have been poorly studied. The aim of this study was to investigate the changes in circulating amino acids after three types of bariatric surgery up to 36 months after the intervention. Methods: We studied 63 participants diagnosed with T2D at baseline, who received either a sleeve gastrectomy, a Roux-en-Y gastric bypass or a biliopancreatic diversion with duodenal switch. We measured the concentrations of 16 circulating amino acids in fasting plasma before the surgery as well as after 4, 12, 24 and 36 months via liquid chromatography coupled with mass spectrometry (LC-MS/MS). Results: Eleven circulating amino acids were significantly modified by bariatric surgery. Glutamate, leucine and isoleucine showed the greatest decrease. Most of the changes in circulating amino acids occurred within 1 year of the operations. Only one measured plasmatic amino acid (threonine) had a significantly different change pattern according to surgery types. In repeated-measure correlations, changes in circulating amino acids were significantly associated with changes in adiposity and metabolic markers. Conclusions: Bariatric surgery changes the levels of most circulating amino acids, and the effect occurs in the short term without major differences between surgery types. The mechanisms explaining these changes are not elucidated but likely include modifications in amino acid metabolism. Full article
(This article belongs to the Special Issue Obesity and Metabolic Health)
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18 pages, 1100 KiB  
Review
Hypoabsorption in Bariatric Surgery: Is the Benefit Worth the Risk?
by Tala Abedalqader, Noura Jawhar, Aryan Gajjar, Ray Portela, Gerardo Perrotta, Nour El Ghazal, Simon J. Laplante and Omar M. Ghanem
Medicina 2025, 61(3), 398; https://doi.org/10.3390/medicina61030398 - 25 Feb 2025
Viewed by 1002
Abstract
Metabolic and bariatric surgery has been well described in the existing literature to be an effective and safe modality for weight loss in patients with obesity. Recently, hypoabsorptive procedures such as one-anastomosis gastric bypass (OAGB), biliopancreatic diversion with duodenal switch (BPD-DS), and single-anastomosis [...] Read more.
Metabolic and bariatric surgery has been well described in the existing literature to be an effective and safe modality for weight loss in patients with obesity. Recently, hypoabsorptive procedures such as one-anastomosis gastric bypass (OAGB), biliopancreatic diversion with duodenal switch (BPD-DS), and single-anastomosis duodenoileostomy with sleeve (SADI-S) have gained traction, particularly among patients with severe obesity. These procedures combine restrictive and hypoabsorptive mechanisms, resulting in significant and sustainable weight loss, especially in those with severe obesity and associated comorbidities. However, the risk of malnutrition and nutritional deficiency following these procedures has been a deterrent for surgeons in their adoption. This review evaluates the existing literature on the safety, efficacy, and long-term outcomes of OAGB, BPD-DS, and SADI-S. While these hypoabsorptive procedures represent highly effective options for treating obesity, the associated nutritional complications necessitate the need for long-term follow-up and supplementation and highlight the need for careful patient selection. Full article
(This article belongs to the Section Surgery)
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24 pages, 999 KiB  
Review
Preventing and Managing Pre- and Postoperative Micronutrient Deficiencies: A Vital Component of Long-Term Success in Bariatric Surgery
by Claudia Reytor-González, Evelyn Frias-Toral, Cristina Nuñez-Vásquez, Juan Marcos Parise-Vasco, Raynier Zambrano-Villacres, Daniel Simancas-Racines and Luigi Schiavo
Nutrients 2025, 17(5), 741; https://doi.org/10.3390/nu17050741 - 20 Feb 2025
Cited by 9 | Viewed by 3448
Abstract
Bariatric surgery (BS) is an effective treatment for severe obesity and its related comorbidities, such as type 2 diabetes and hypertension. However, the anatomical and physiological changes associated with these procedures significantly increase the risk of preoperative and postoperative micronutrient deficiencies, which can [...] Read more.
Bariatric surgery (BS) is an effective treatment for severe obesity and its related comorbidities, such as type 2 diabetes and hypertension. However, the anatomical and physiological changes associated with these procedures significantly increase the risk of preoperative and postoperative micronutrient deficiencies, which can lead to severe complications such as anemia, osteoporosis, and neurological disorders. This narrative review examines the prevalence and clinical implications of micronutrient deficiencies in BS patients, as well as evidence-based strategies for their prevention and management. The most common deficiencies include iron, vitamin B12, folate, calcium, vitamin D, and fat-soluble vitamins (A, E, and K). Procedures with a hypoabsorptive component, such as Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD/DS), pose higher risks of deficiencies compared to restrictive procedures like sleeve gastrectomy (SG). Effective strategies involve the preoperative correction of deficiencies, continuous monitoring, and tailored supplementation. However, long-term adherence to supplementation tends to decrease over time, influenced by behavioral and socioeconomic factors. Hence, preventing and managing micronutrient deficiencies are crucial for the long-term success of BS. While current guidelines provide valuable recommendations, many are based on low-certainty evidence, underscoring the need for more robust studies. A multidisciplinary approach, combined with innovative strategies, such as telemedicine, can enhance adherence and achieve sustainable clinical outcomes. Full article
(This article belongs to the Section Clinical Nutrition)
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39 pages, 2158 KiB  
Review
Integrated Insights into Metabolic and Bariatric Surgery: Improving Life Quality and Reducing Mortality in Obesity
by Ruxandra-Cristina Marin, Andrei-Flavius Radu, Paul Andrei Negru, Ada Radu, Denisa Negru, Raluca Anca Corb Aron, Teodora Maria Bodog, Ruxandra Florina Bodog, Paula Bianca Maghiar and Roxana Brata
Medicina 2025, 61(1), 14; https://doi.org/10.3390/medicina61010014 - 26 Dec 2024
Cited by 1 | Viewed by 2748
Abstract
Metabolic and bariatric surgery (MBS) is an effective intervention for patients with severe obesity and metabolic comorbidities, particularly when non-surgical weight loss methods prove insufficient. MBS has shown significant potential for improving quality of life and metabolic health outcomes in individuals with obesity, [...] Read more.
Metabolic and bariatric surgery (MBS) is an effective intervention for patients with severe obesity and metabolic comorbidities, particularly when non-surgical weight loss methods prove insufficient. MBS has shown significant potential for improving quality of life and metabolic health outcomes in individuals with obesity, yet it carries inherent risks. Although these procedures offer a multifaceted approach to obesity treatment and its clinical advantages are well-documented, the limited understanding of its long-term outcomes and the role of multidisciplinary care pose challenges. With an emphasis on quality-of-life enhancements and the handling of postoperative difficulties, the present narrative review seeks to compile the most recent findings on MBS while emphasizing the value of an integrated approach to maximize patient outcomes. Effective MBS and patients’ management require a collaborative team approach, involving surgeons, dietitians, psychologists, pharmacists, and other healthcare providers to address not only physiological but also psychosocial patient needs. Comparative studies demonstrate the efficacy of various MBS methods, including Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy that may considerably decrease morbidity and mortality in individuals with obesity. Future studies should target long-term patient treatment, and decision making should be aided by knowledge of obesity, comorbidity recurrence rates, and permanence of benefits. Full article
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8 pages, 434 KiB  
Review
Bariatric Surgery in Patients with Previous Cardiac Revascularization: Review of Literature
by Dan Bandea, Ramon Vilallonga, Anamaria Nedelcu, Laura Gabriela Gavril, Marius Nedelcu and Bogdan Andrei Suciu
J. Clin. Med. 2024, 13(16), 4779; https://doi.org/10.3390/jcm13164779 - 14 Aug 2024
Viewed by 1511
Abstract
Background: The diet and physical activity of the world’s population determine the increase in the number of bariatric surgeries. The most common types of bariatric surgery are laparoscopic sleeve gastrectomy (LSG) and Roux-Y gastric bypass (RYGB). Surgical interventions are carried out in [...] Read more.
Background: The diet and physical activity of the world’s population determine the increase in the number of bariatric surgeries. The most common types of bariatric surgery are laparoscopic sleeve gastrectomy (LSG) and Roux-Y gastric bypass (RYGB). Surgical interventions are carried out in patients with numerous comorbidities, among which the most common are cardiovascular diseases. The aim of the present study was to review the literature regarding the safety and results of surgical treatment in patients with cardiac revascularization prior to surgery. Methods: We performed an online search in Pubmed in September 2023 to identify articles that reported cardiac revascularization prior to bariatric surgery. The extracted information included details of the working method, number of patients, types of cardiovascular disease—heart failure (HF) and cardiac artery disease (CAD), types of revascularization—coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI) or both CABG + PCI, demographic data (age, gender, race), clinical characteristics (body mass index—BMI, smoking status), comorbidities (diabetes mellitus, hypertension, prior myocardial infarction), postoperative complications, and postoperative results. Results: A total of 171 records were identified by the initial search, and 165 papers were excluded after applying the exclusion criteria (types of cardiovascular disease, types of revascularization, and demographic data). We evaluated a group of 9479 patients of which 730 had HF, 2621 CAD, and 1426 underwent prior cardiac revascularization. The analysis of the demographic data showed an average age of 55.5 years and a fluctuation of the male gender between 39% and 71.1%, and the female gender between 28.9% and 61%. The main types of bariatric interventions were RYGB (3659 cases) and LSG (659 cases), to which adjustable gastric band (AGB) and bilio-pancreatic diversion—duodenal switch (BPD-DS) were added. Among the most postprocedural complications were ST-segment elevation myocardial infarction (2 patients), gastro-intestinal bleeding (51 cases), pulmonary embolism (1 patient), arrhythmia (3 patients) and pacemaker insertion (1 patient). The recorded postoperative mortality rate was 0.42% (6 cases). Conclusions: Bariatric surgery remains safe in patients with cardiac revascularization. These finding need to be confirmed in more large-scale randomized trials. Full article
(This article belongs to the Section General Surgery)
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16 pages, 311 KiB  
Review
The Trajectory of Revisional Bariatric Surgery: Open to Laparoscopic to Robotic
by Noura Jawhar, Jack W. Sample, Marita Salame, Katie Marrero, Daniel Tomey, Suraj Puvvadi and Omar M. Ghanem
J. Clin. Med. 2024, 13(7), 1878; https://doi.org/10.3390/jcm13071878 - 25 Mar 2024
Cited by 2 | Viewed by 2056
Abstract
Metabolic and bariatric surgery (MBS) is the most effective therapeutic intervention for patients with obesity, with sleeve gastrectomy (SG) being the most commonly performed primary MBS procedure. Long-term studies have demonstrated that 15–20% of patients require revisional bariatric surgery (RBS) due to weight-related [...] Read more.
Metabolic and bariatric surgery (MBS) is the most effective therapeutic intervention for patients with obesity, with sleeve gastrectomy (SG) being the most commonly performed primary MBS procedure. Long-term studies have demonstrated that 15–20% of patients require revisional bariatric surgery (RBS) due to weight-related issues or surgical complications. Despite the gold standard being laparoscopic revision, there are other available approaches such as open or robotic-assisted. An extensive literature review was performed for articles from their inception to February 2024. A descriptive review of MBS procedures (SG, Roux-en-Y gastric bypass (RYGB), single anastomosis duodeno-ileostomy (SADI) and biliopancreatic diversion-duodenal switch (BPD-DS)) was carried out to report and compare outcomes between primary and revisional bariatric surgery. A similar review was conducted to compare outcomes of revisional approaches (open, laparoscopic, robotic). RYGB remains the dominant RBS with a similar safety profile compared to revisional SADI and BPD-DS. In terms of the RBS surgical approach, all three options showed comparable short and long-term outcomes, with robotic RBS being associated with longer operative time and variable length of stay. Additional long-term studies are required to further validate our conclusions. Full article
(This article belongs to the Special Issue New Challenges in Laparoscopic, Robotic and Endoscopic Surgery)
12 pages, 323 KiB  
Review
Association of Obesity and Bariatric Surgery on Hair Health
by Katarzyna Smolarczyk, Blazej Meczekalski, Ewa Rudnicka, Katarzyna Suchta and Anna Szeliga
Medicina 2024, 60(2), 325; https://doi.org/10.3390/medicina60020325 - 14 Feb 2024
Cited by 6 | Viewed by 5101
Abstract
Obesity and obesity-related conditions today constitute a public health problem worldwide. Obesity is an “epidemic” chronic disorder, which is defined by the WHO as normal or excessive fat accumulation that may impair health. It is also defined for adults as a BMI that [...] Read more.
Obesity and obesity-related conditions today constitute a public health problem worldwide. Obesity is an “epidemic” chronic disorder, which is defined by the WHO as normal or excessive fat accumulation that may impair health. It is also defined for adults as a BMI that is greater than or equal to 30. The most common obesity-related diseases are type 2 diabetes mellitus, cardiovascular diseases, metabolic syndrome, chronic kidney disease, hyperlipidemia, hypertension, nonalcoholic fatty liver disease, and certain types of cancer. It has been also proven that obesity can have a negative effect on hair. It can lead to hair thinning. Patients with obesity can undergo bariatric surgery if they meet the inclusion criteria. The four common types of weight loss surgery include a duodenal switch with biliopancreatic diversion, laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass, and sleeve gastrectomy. Bariatric surgery can affect skin and hair and is associated with telogen effluvium due to weight loss, microelement deficiency, anesthesia, low calorie intake, and low protein intake. Patients who undergo bariatric surgery can experience post-bariatric surgery depression. Hair loss can have a major impact on self-esteem, negatively affecting one’s self-image. The purpose of this narrative review is to critically review how obesity, obesity-related diseases, and bariatric surgery affect hair health in general and the hair development cycle, and how they influence hair loss. Full article
(This article belongs to the Special Issue Clinical Guidelines for Bariatric Surgery)
11 pages, 552 KiB  
Article
Revisional Procedures after Sleeve Gastrectomy for Weight Recurrence or Inadequate Weight Loss: An Analysis of the MBSAQIP Database
by Karl Hage, Juan S. Barajas-Gamboa, Gustavo Romero-Velez, Matthew Allemang, Salvador Navarrete, Ricard Corcelles, John Rodriguez, Omar M. Ghanem, Matthew Kroh and Jerry T. Dang
J. Clin. Med. 2023, 12(18), 5975; https://doi.org/10.3390/jcm12185975 - 15 Sep 2023
Cited by 12 | Viewed by 1595
Abstract
Introduction: The safety of conversional bariatric procedures after sleeve gastrectomy (SG) for weight recurrence (WR) or inadequate weight loss (IWL) is debated due to limited evidence. Conversion options include Roux-en-Y gastric bypass (RYGB), single anastomosis duodeno-ileal bypass (SADI), and biliopancreatic diversion with duodenal [...] Read more.
Introduction: The safety of conversional bariatric procedures after sleeve gastrectomy (SG) for weight recurrence (WR) or inadequate weight loss (IWL) is debated due to limited evidence. Conversion options include Roux-en-Y gastric bypass (RYGB), single anastomosis duodeno-ileal bypass (SADI), and biliopancreatic diversion with duodenal switch (BPD-DS). We aimed to compare serious complications and mortality rates between these procedures within 30 days. Methods: Using the 2020 and 2021 MBSAQIP databases, we identified patients who underwent a conversion from SG to RYGB, SADI, or BPD-DS. We performed a multivariable logistic regression to assess predictors of 30-day complications and mortality. Results: Among 7388 patients (77.6% RYGB, 8.7% SADI, 13.7% BPD-DS), those undergoing SADI and BPD-DS had higher preoperative body mass index. Conversion reasons included WR (63.0%) and IWL (37.0%). SADI and BPD-DS patients had longer operative times (p < 0.001) and higher leak rates (p = 0.001). Serious complications, reoperations, readmissions, and 30-day mortality were similar across groups. Conversion procedure type was not an independent predictor of complications. Conclusion: RYGB was the most performed conversional procedure after SG. The study indicated a similar safety profile for revisional RYGB, SADI, and BPD-DS, with comparable 30-day complications and mortality rates. However, SADI and BPD-DS patients had longer operative time and higher leak rates. Full article
(This article belongs to the Special Issue Complications in Bariatric Surgery (Aftermath and Comorbidities))
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8 pages, 685 KiB  
Article
Marginal Ulcer and Dumping Syndrome in Patients after Duodenal Switch: A Multi-Centered Study
by Marita Salame, Andre F. Teixeira, Romulo Lind, Gilberto Ungson, Muhammad Ghanem, Kamal Abi Mosleh, Muhammad A. Jawad, Barham K. Abu Dayyeh, Michael L. Kendrick and Omar M. Ghanem
J. Clin. Med. 2023, 12(17), 5600; https://doi.org/10.3390/jcm12175600 - 28 Aug 2023
Cited by 7 | Viewed by 2959
Abstract
Background: The current design of biliopancreatic diversion with duodenal switch (BPD/DS) and single anastomosis duodenal–ileal bypass with sleeve (SADI-S) emphasizes the importance of the pylorus’ preservation to reduce the incidence of marginal ulcer (MU) and dumping. However, no institutional studies have yet reported [...] Read more.
Background: The current design of biliopancreatic diversion with duodenal switch (BPD/DS) and single anastomosis duodenal–ileal bypass with sleeve (SADI-S) emphasizes the importance of the pylorus’ preservation to reduce the incidence of marginal ulcer (MU) and dumping. However, no institutional studies have yet reported data on their prevalence. We aimed to assess the incidence of MU and dumping after duodenal switch (DS) and identify the associative factors. Methods: A multi-center review of patients who underwent BPD/DS or SADI-S between 2008 and 2022. Baseline demographics, symptoms, and management of both complications were collected. Fisher’s exact test was used for categorical variables and the independent t-test for continuous variables. Results: A total of 919 patients were included (74.6% female; age 42.5 years; BMI 54.6 kg/m2) with mean follow-up of 31.5 months. Eight patients (0.9%) developed MU and seven (0.8%) had dumping. Patients who developed MU were more likely to be using non-steroidal anti-inflammatory drugs (NSAID) (p = 0.006) and have a longer operation time (p = 0.047). Primary versus revisional surgery, and BDP/DS versus SADI-S were not associated with MU or dumping. Conclusions: The incidences of MU and dumping after DS were low. NSAID use and a longer operation time were associated with an increased risk of MU, whereas dumping was attributed to poor dietary habits. Full article
(This article belongs to the Special Issue Clinical Advances in Obesity and Bariatric Surgery)
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13 pages, 1737 KiB  
Review
Bariatric Surgery–How Much Malabsorption Do We Need?—A Review of Various Limb Lengths in Different Gastric Bypass Procedures
by Daniel Moritz Felsenreich, Felix Benedikt Langer, Jakob Eichelter, Julia Jedamzik, Lisa Gensthaler, Larissa Nixdorf, Mahir Gachabayov, Aram Rojas, Natalie Vock, Marie Louise Zach and Gerhard Prager
J. Clin. Med. 2021, 10(4), 674; https://doi.org/10.3390/jcm10040674 - 10 Feb 2021
Cited by 30 | Viewed by 8229
Abstract
The number of obese individuals worldwide continues to increase every year, thus, the number of bariatric/metabolic operations performed is on a constant rise as well. Beside exclusively restrictive procedures, most of the bariatric operations have a more or less malabsorptive component. Several different [...] Read more.
The number of obese individuals worldwide continues to increase every year, thus, the number of bariatric/metabolic operations performed is on a constant rise as well. Beside exclusively restrictive procedures, most of the bariatric operations have a more or less malabsorptive component. Several different bypass procedures exist alongside each other today and each type of bypass is performed using a distinct technique. Furthermore, the length of the bypassed intestine may differ as well. One might add that the operations are performed differently in different parts of the world and have been changing and evolving over time. This review evaluates the most frequently performed bariatric bypass procedures (and their variations) worldwide: Roux-en-Y Gastric Bypass, One-Anastomosis Gastric Bypass, Single-Anastomosis Duodeno-Ileal Bypass + Sleeve Gastrectomy, Biliopancreatic Diversion + Duodenal Switch and operations due to weight regain. The evaluation of the procedures and different limb lengths focusses on weight loss, remission of comorbidities and the risk of malnutrition and deficiencies. This narrative review does not aim at synthesizing quantitative data. Rather, it provides a summary of carefully selected, high-quality studies to serve as examples and to draw tentative conclusions on the effects of the bypass procedures mentioned above. In conclusion, it is important to carefully choose the procedure and small bowel length excluded from the food passage suited best to each individual patient. A balance has to be achieved between sufficient weight loss and remission of comorbidities, as well as a low risk of deficiencies and malnutrition. In any case, at least 300 cm of small bowel should always remain in the food stream to prevent the development of deficiencies and malnutrition. Full article
(This article belongs to the Special Issue Recent Advances in Minimally Invasive Surgery)
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