Biliary reflux after laparoscopic modified antireflux monoanastomotic gastric bypass surgery
DOI:
https://doi.org/10.14739/2310-1237.2021.3.239911Keywords:
morbid obesity, gastric bypass, surgical treatment, biliary refluxAbstract
Aim. Determination of biliary reflux in patients with morbid obesity after a single-anastomotic gastric bypass operation performed in the clinic's modification and according to the classical Roux-en-Y gastric bypass technique. Development of diagnostic criteria for biliary reflux
Materials and methods. The results of treatment of 36 patients with morbid obesity who underwent bypass surgery were studied. The patients are divided into two groups. Clinically modified laparoscopic monoanastomotic gastric bypass surgery was performed in 25 patients (main group). The control group included 11 patients after the standard technique of Roux-en-Y laparoscopic gastric bypass. Inclusion criteria were: persons of both sexes aged 18-60 years with morbid obesity and a body mass index of 40 or more, as well as 35 or more in the presence of comorbid diseases (type 2 diabetes mellitus, arterial hypertension, dyslipidemia, sleep apnea syndrome). In both groups, impedance pH measurements were performed in the postoperative period. Statistical processing was performed using the Statistica 13.0 software package using parametric and nonparametric statistical methods.
Results: Clinical manifestations of the enterogastric biliary reflex were found in both groups; in addition, clinical manifestations of the corresponding symptoms were noted by patients of both groups. The analysis of daily pH-metry in the studied groups showed that in the esophagus the time with pH <4 in the main group 2.83 (1.55; 3.95)% 3.00 (2.30; 3.50)% in the control group, time with pH 4-6.9 (physiological for the esophagus) 92.40 (90.65; 94.20)% and 94.10 (89.80; 95.50)%, respectively, time with pH> 7 (weak alkaline) was 4.80 (3.45; 5.85)% and in the control group 2.90 (1.20; 7.20)%. There was no statistically significant difference in these indicators (p> 0.05). Conclusions. Monoanastomotic gastric bypass surgery in the modification of the clinic has the same positive properties as the Rouen-Wye technique, allowing you to avoid the risks associated with possible pathological reflux of bile into the esophagus. Patients who have undergone mini-gastric bypass surgery require a thorough examination with fibrogastroscopy in combination with pH impedance measurement at least 1 time per year in order to determine biliary reflux and morphological changes both in the lumen of the esophagus and in the stomach stump. The level of quality of life of patients after surgery in the control group and the main group does not significantly differ, as evidenced by the results of the questionnaire survey using the GERG Q questionnaire, which indicates the effectiveness of the methodology of laparoscopic monoanastomotic gastric bypass surgery modified in the clinic. Key words: morbid obesity, gastric bypass surgery, surgical treatment, mini-gastric bypass, biliary reflux.
References
Fried, M., Yumuk, V., Oppert, J. M., Scopinaro, N., Torres, A. J., Weiner, R., Yashkov, Y., Frühbeck, G., European Association for the Study of Obesity, & International Federation for the Surgery of Obesity - European Chapter (2013). Interdisciplinary European Guidelines on metabolic and bariatric surgery. Obesity facts, 6(5), 449-468. https://doi.org/10.1159/000355480
Altieri, M. S., Pryor, A., Bates, A., Docimo, S., Talamini, M., & Spaniolas, K. (2018). Bariatric procedures in adolescents are safe in accredited centers. Surgery for obesity and related diseases, 14(9), 1368-1372. https://doi.org/10.1016/j.soard.2018.04.004
Rutledge R. (2001). The mini-gastric bypass: experience with the first 1,274 cases. Obesity surgery, 11(3), 276-280. https://doi.org/10.1381/096089201321336584
Deitel, M., Hargroder, D. & Peraglie, C. (2016). Mini-Gastric Bypass for Bariatric Surgery Increasing Worldwide. Austin Journal of Surgery, 3(3), 1092-1096. https://doi.org/10.26420/austinjsurg.2016.1092
Mahawar, K. K., Carr, W. R., Balupuri, S., & Small, P. K. (2014). Controversy surrounding 'mini' gastric bypass. Obesity surgery, 24(2), 324-333. https://doi.org/10.1007/s11695-013-1090-0
Georgiadou, D., Sergentanis, T. N., Nixon, A., Diamantis, T., Tsigris, C., & Psaltopoulou, T. (2014). Efficacy and safety of laparoscopic mini gastric bypass. A systematic review. Surgery for obesity and related diseases, 10(5), 984-991. https://doi.org/10.1016/j.soard.2014.02.009
Mahawar, K. K., Kumar, P., Carr, W. R., Jennings, N., Schroeder, N., Balupuri, S., & Small, P. K. (2016). Current status of mini-gastric bypass. Journal of minimal access surgery, 12(4), 305-310. https://doi.org/10.4103/0972-9941.181352
Tolone, S., Cristiano, S., Savarino, E., Lucido, F. S., Fico, D. I., & Docimo, L. (2016). Effects of omega-loop bypass on esophagogastric junction function. Surgery for obesity and related diseases, 12(1), 62-69. https://doi.org/10.1016/j.soard.2015.03.011
Mion, F., Tolone, S., Garros, A., Savarino, E., Pelascini, E., Robert, M., Poncet, G., Valette, P. J., Marjoux, S., Docimo, L., & Roman, S. (2016). High-resolution Impedance Manometry after Sleeve Gastrectomy: Increased Intragastric Pressure and Reflux are Frequent Events. Obesity surgery, 26(10), 2449-2456. https://doi.org/10.1007/s11695-016-2127-y
Rutledge, R., Deitel, M., Carbajo, M. A., Luque-de-Leon, E., Chiappetta, S., Inam, A., Rheinwalt, K., Prasad, A., Hargroder, D. E., Samoylov, V., Ozmen, M. M., Parmar, C., Albuquerque, A., Jammu, G., Ustun, M., Sakran, N., Aktimur, R., Khan, A., Hamza, Y., Rotundo, A., … Abbas, I. (2020). Commentary: Cancer after the OAGB-MGB. Obesity surgery, 30(2), 755-758. https://doi.org/10.1007/s11695-019-04313-5
Angrisani, L., Santonicola, A., Iovino, P., Vitiello, A., Higa, K., Himpens, J., Buchwald, H., & Scopinaro, N. (2018). IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures. Obesity surgery, 28(12), 3783-3794. https://doi.org/10.1007/s11695-018-3450-2
Parmar, C. D., & Mahawar, K. K. (2018). One Anastomosis (Mini) Gastric Bypass Is Now an Established Bariatric Procedure: a Systematic Review of 12,807 Patients. Obesity surgery, 28(9), 2956-2967. https://doi.org/10.1007/s11695-018-3382-x
Bruzzi, M., Chevallier, J. M., & Czernichow, S. (2017). One-Anastomosis Gastric Bypass: Why Biliary Reflux Remains Controversial?. Obesity surgery, 27(2), 545-547. https://doi.org/10.1007/s11695-016-2480-x
Klymenko, A. V., Klymenko, V. M., Bilai, A. I., & Nikolaiev, M. V. (2020). Modifitsirovannoe antireflyuksnoe monoanastomoznoe laparoskopicheskoe shuntirovanie zheludka v khirurgii morbidnogo ozhireniya [Modified antireflux monoanastomotic laparoscopic gastric bypass in morbid obesity surgery]. Zaporozhye medical journal, 22(5), 676-681. [in Russian]. https://doi.org/10.14739/2310-1210.2020.5.214741
Keleidari, B., Dehkordi, M. M., Shahraki, M. S., Ahmadi, Z. S., Heidari, M., Hajian, A., & Nasaj, H. T. (2021). Bile reflux after one anastomosis gastric bypass surgery: A review study. Annals of medicine and surgery, 64, 102248. https://doi.org/10.1016/j.amsu.2021.102248
Saarinen, T., Räsänen, J., Salo, J., Loimaala, A., Pitkonen, M., Leivonen, M., & Juuti, A. (2017). Bile Reflux Scintigraphy After Mini-Gastric Bypass. Obesity surgery, 27(8), 2083-2089. https://doi.org/10.1007/s11695-017-2608-7
Richter, J. E., Pandolfino, J. E., Vela, M. F., Kahrilas, P. J., Lacy, B. E., Ganz, R., Dengler, W., Oelschlager, B. K., Peters, J., DeVault, K. R., Fass, R., Gyawali, C. P., Conklin, J., DeMeester, T., & Esophageal Diagnostic Working Group (2013). Utilization of wireless pH monitoring technologies: a summary of the proceedings from the esophageal diagnostic working group. Diseases of the esophagus, 26(8), 755-765. https://doi.org/10.1111/j.1442-2050.2012.01384.x
Sifrim D. (2013). Management of bile reflux. Gastroenterology & hepatology, 9(3), 179-180.
Jones, R., Junghard, O., Dent, J., Vakil, N., Halling, K., Wernersson, B., & Lind, T. (2009). Development of the GerdQ, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care. Alimentary pharmacology & therapeutics, 30(10), 1030-1038. https://doi.org/10.1111/j.1365-2036.2009.04142.x
Musella, M., Susa, A., Manno, E., De Luca, M., Greco, F., Raffaelli, M., Cristiano, S., Milone, M., Bianco, P., Vilardi, A., Damiano, I., Segato, G., Pedretti, L., Giustacchini, P., Fico, D., Veroux, G., & Piazza, L. (2017). Complications Following the Mini/One Anastomosis Gastric Bypass (MGB/OAGB): a Multi-institutional Survey on 2678 Patients with a Mid-term (5 Years) Follow-up. Obesity surgery, 27(11), 2956-2967. https://doi.org/10.1007/s11695-017-2726-2
Vaezi, M. F., & Richter, J. E. (2001). Duodenogastroesophageal reflux and methods to monitor nonacidic reflux. The American journal of medicine, 111 Suppl 8A, 160S-168S. https://doi.org/10.1016/s0002-9343(01)00827-0
Scozzari, G., Trapani, R., Toppino, M., & Morino, M. (2013). Esophagogastric cancer after bariatric surgery: systematic review of the literature. Surgery for obesity and related diseases, 9(1), 133-142. https://doi.org/10.1016/j.soard.2012.10.002
Nau, P., Rattner, D. W., & Meireles, O. (2014). Linitis plastica presenting two years after elective Roux-en-Y gastric bypass for treatment of morbid obesity: a case report and review of the literature. Surgery for obesity and related diseases, 10(2), e15-e17. https://doi.org/10.1016/j.soard.2013.06.015
Scheepers, A. F., Schoon, E. J., & Nienhuijs, S. W. (2011). Esophageal carcinoma after sleeve gastrectomy. Surgery for Obesity and Related Diseases, 7(4), 11-12. https://doi.org/10.1016/j.soard.2010.09.019
Angrisani, L., Santonicola, A., & Iovino, P. (2014). Gastric cancer: a de novo diagnosis after laparoscopic sleeve gastrectomy. Surgery for obesity and related diseases, 10(1), 186-187. https://doi.org/10.1016/j.soard.2013.09.009
Sifrim, D., Castell, D., Dent, J., & Kahrilas, P. J. (2004). Gastro-oesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux. Gut, 53(7), 1024-1031. https://doi.org/10.1136/gut.2003.033290
Yadlapati, R., Pandolfino, J. E., Lidder, A. K., Shabeeb, N., Jaiyeola, D. M., Adkins, C., Agrawal, N., Cooper, A., Price, C. P., Ciolino, J. D., Gawron, A. J., Smith, S. S., Bove, M., & Tan, B. K. (2016). Oropharyngeal pH Testing Does Not Predict Response to Proton Pump Inhibitor Therapy in Patients with Laryngeal Symptoms. The American journal of gastroenterology, 111(11), 1517-1524. https://doi.org/10.1038/ajg.2016.145
Dulery, C., Lechot, A., Roman, S., Bastier, P. L., Stoll, D., de Gabory, L., & Zerbib, F. (2017). A study with pharyngeal and esophageal 24-hour pH-impedance monitoring in patients with laryngopharyngeal symptoms refractory to proton pump inhibitors. Neurogastroenterology and motility, 29(1), 10.1111/nmo.12909. https://doi.org/10.1111/nmo.12909
Frazzoni, M., Savarino, E., de Bortoli, N., Martinucci, I., Furnari, M., Frazzoni, L., Mirante, V. G., Bertani, H., Marchi, S., Conigliaro, R., & Savarino, V. (2016). Analyses of the Post-reflux Swallow-induced Peristaltic Wave Index and Nocturnal Baseline Impedance Parameters Increase the Diagnostic Yield of Impedance-pH Monitoring of Patients With Reflux Disease. Clinical gastroenterology and hepatology, 14(1), 40-46. https://doi.org/10.1016/j.cgh.2015.06.026
Patel, A., Wang, D., Sainani, N., Sayuk, G. S., & Gyawali, C. P. (2016). Distal mean nocturnal baseline impedance on pH-impedance monitoring predicts reflux burden and symptomatic outcome in gastro-oesophageal reflux disease. Alimentary pharmacology & therapeutics, 44(8), 890-898. https://doi.org/10.1111/apt.13777
Frazzoni, M., de Bortoli, N., Frazzoni, L., Furnari, M., Martinucci, I., Tolone, S., Farioli, A., Marchi, S., Fuccio, L., Savarino, V., & Savarino, E. (2017). Impairment of chemical clearance and mucosal integrity distinguishes hypersensitive esophagus from functional heartburn. Journal of gastroenterology, 52(4), 444-451. https://doi.org/10.1007/s00535-016-1226-9
Frazzoni, M., de Bortoli, N., Frazzoni, L., Tolone, S., Furnari, M., Martinucci, I., Mirante, V. G., Marchi, S., Savarino, V., & Savarino, E. (2017). The added diagnostic value of postreflux swallow-induced peristaltic wave index and nocturnal baseline impedance in refractory reflux disease studied with on-therapy impedance-pH monitoring. Neurogastroenterology and motility, 29(3), 10.1111/nmo.12947. https://doi.org/10.1111/nmo.12947
Chernobrovyi, V. N., Melashchenko, S. G., Ksenchin, O. A., & Zaluzhnaya, E. V. (2015). Diagnostika gastroezofageal'nykh reflyuksov pri pomoshchi sistemy kombinirovannogo rN-monitoringa pishchevoda i zheludka vysokogo razresheniya [Diagnostics of gastroesophageal refluxes using the system of combined pH-monitoring of the esophagus and stomach high resolution]. Rossiiskii zhurnal gastroenterologii, gepatologii, koloproktologii, 25(5, Suppl 4), 14. [in Russian].
Salama, T., & Hassan, M. I. (2017). Incidence of Biliary Reflux Esophagitis After Laparoscopic Omega Loop Gastric Bypass in Morbidly Obese Patients. Journal of laparoendoscopic & advanced surgical techniques. Part A, 27(6), 618-622. https://doi.org/10.1089/lap.2016.0401
Robert, M., Espalieu, P., Pelascini, E., Caiazzo, R., Sterkers, A., Khamphommala, L., Poghosyan, T., Chevallier, J. M., Malherbe, V., Chouillard, E., Reche, F., Torcivia, A., Maucort-Boulch, D., Bin-Dorel, S., Langlois-Jacques, C., Delaunay, D., Pattou, F., & Disse, E. (2019). Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for obesity (YOMEGA): a multicentre, randomised, open-label, non-inferiority trial. Lancet (London, England), 393(10178), 1299-1309. https://doi.org/10.1016/S0140-6736(19)30475-1
Lee, W. J., Yu, P. J., Wang, W., Chen, T. C., Wei, P. L., & Huang, M. T. (2005). Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial. Annals of surgery, 242(1), 20-28. https://doi.org/10.1097/01.sla.0000167762.46568.98
Lee, W. J., Almalki, O. M., Ser, K. H., Chen, J. C., & Lee, Y. C. (2019). Randomized Controlled Trial of One Anastomosis Gastric Bypass Versus Roux-En-Y Gastric Bypass for Obesity: Comparison of the YOMEGA and Taiwan Studies. Obesity surgery, 29(9), 3047-3053. https://doi.org/10.1007/s11695-019-04065-2
Mahawar, K. K., Borg, C. M., Kular, K. S., Courtney, M. J., Sillah, K., Carr, W., Jennings, N., Madhok, B., Singhal, R., & Small, P. K. (2017). Understanding Objections to One Anastomosis (Mini) Gastric Bypass: A Survey of 417 Surgeons Not Performing this Procedure. Obesity surgery, 27(9), 2222-2228. https://doi.org/10.1007/s11695-017-2663-0
Parmar, C. D., & Mahawar, K. K. (2018). One Anastomosis (Mini) Gastric Bypass Is Now an Established Bariatric Procedure: a Systematic Review of 12,807 Patients. Obesity surgery, 28(9), 2956-2967. https://doi.org/10.1007/s11695-018-3382-x
Saarinen, T., Räsänen, J., Salo, J., Loimaala, A., Pitkonen, M., Leivonen, M., & Juuti, A. (2017). Bile Reflux Scintigraphy After Mini-Gastric Bypass. Obesity surgery, 27(8), 2083-2089. https://doi.org/10.1007/s11695-017-2608-7
Saarinen, T., Pietiläinen, K. H., Loimaala, A., Ihalainen, T., Sammalkorpi, H., Penttilä, A., & Juuti, A. (2020). Bile Reflux is a Common Finding in the Gastric Pouch After One Anastomosis Gastric Bypass. Obesity surgery, 30(3), 875-881. https://doi.org/10.1007/s11695-019-04353-x
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