RESUMEN
BACKGROUND: This study aimed to assess the endoscopic burden of bariatric surgical procedures at our trust. This is an enhanced parallel study to "The Hidden Endoscopic burden of Roux-en-Y Gastric Bypass" published in Frontline Gastroenterology in 2013 incorporating the data for sleeve gastrectomy and comparison with Roux-en-Y gastric bypass (RYGB). METHODS: This is a retrospective study that included 211 patients undergoing sleeve gastrectomy over a 34-month period. We utilized previously collected data for the RYGB patient cohort which included 553 patients over a 29-month period. We searched our hospital endoscopic database for patients who underwent post-operative endoscopy for indications related to their surgery. RESULTS: 16.6% of the sleeve gastrectomy patients required post-operative endoscopy, of whom 11.4% underwent therapeutic procedures. This compares to 20.4% of the RYGB cohort of whom 50.4% needed therapeutic procedures (P<0.001). 1.9% of sleeve gastrectomy patients encountered a post-operative staple line leak and collectively required 29 endoscopic procedures. One patient also developed stricturing (0.47%) requiring 18 pneumatic dilatations. 11.4% of the RYGB cohort developed an anastomotic stricture requiring 57 balloon dilatation procedures. To date, these procedures have accumulated an equivalent cost of 159,898 in endoscopy tariffs, or 177 per RYGB and 373 per sleeve gastrectomy performed. CONCLUSIONS: Bariatric surgery can have significant implications in terms of patient morbidity and financial cost. Having a local bariatric surgery service increases the demand for endoscopic procedures in our hospital, both in investigating for and dealing with post-operative complications. Provision of extra resources and expertise needs to be taken into account.
RESUMEN
BACKGROUND AND AIMS: Complication rates of Roux-en-Y gastric bypass (RYGB) vary from centre to centre, but anastomotic stricture is the commonest, and is managed in the majority by endoscopic pneumatic dilatation. The aim of this study was to assess the endoscopic burden of RYGB surgery. PATIENTS AND METHODS: All patients undergoing RYGB surgery over a 29-month period were included and were followed-up retrospectively and prospectively for a minimum of 180â days to monitor for endoscopic procedures performed in relation to the RYGB at Walsall Manor Hospital, UK. Five hundred and fifty-three patients underwent RYGB surgery during the study period. RESULTS: One hundred and thirteen patients had 147 endoscopic procedures, including 65 pneumatic dilatations, at a cost to the NHS of £58â 077 over a 29-month study period, with an average cost of £2003 a month. or £105 per RYGB operation performed. The anastomotic stricture rate for the group was 11.39%. The complication rate for dilatation of anastomotic strictures was 0%. CONCLUSIONS: RYGB anastomotic strictures can be safely managed by dilatation. If bariatric surgery is performed locally, then endoscopy departments must expect to factor in, not only the burden of dealing with actual complications, but also the burden of investigating for potential complications.
RESUMEN
Laparoscopic adjustable gastric banding (LAGB) is the most common bariatric surgical procedure done currently. It is the preferred choice as it is adjustable, minimally invasive, easily reversible, and does not cause metabolic complications. However, complications like slippage, leakage, erosion-causing perforation, pouch dilatation, pouch herniation, oesophageal dilatation/dysmotility, port disconnection, and migration of band have been reported. We report a rare case of LAGB who presented with life-threatening upper gastrointestinal hemorrhage due to erosion of band into celiac axis 4 months after the operation. An urgent laparotomy was necessary to control the hemorrhage from the celiac axis.