November 27, 2021

Transit Bipartition: An Attractive Revision Alternative When Sleeve Gastrectomy Fails

For patients that couldn’t lose adequate weight or regain weight after laparoscopic sleeve gastrectomy (LSG), second step revisional bariatric surgical treatment in the form of transportation bipartition is an effective next step, say clinicians in Germany.

In Annals of Surgery Open, they note that "Laparoscopic sleeve gastrectomy has obtained global acceptance as a first-line bariatric surgical procedure for the treatment of morbid obesity. Nevertheless, long-lasting results vary with reported rates of primary failure or weight regain between 25% and 50% at five years depending on the definitions used."

Transit bipartition (TB) may be "an attractive revisional surgery strategy after LSG given the formidable weight reductions of 27% overall weight reduction at one year as a first-line intervention," state Dr. Markus Reiser with Klinikum-Vest GmbH, Paracelsus-klinik Marl, in Marl, as well as coworkers.

In their paper, they report results in 100 morbidly obese patients (79 ladies) who undertook revisional TB for inadequate weightloss or weight regain after LSG, with follow-up bent on twelve month.

Mean BMI before LSG was 49.9 kg/m2 as well as reduced to an optimum of 32.7 kg/m2 at 22.1 months after LSG, representing an excess-weight loss of 70.0%.

The mean time in between sleeve and transit bipartition was 52.2 months, at which time imply BMI had enhanced to 37.6 kg/m2, representing 49.4% excess-weight loss.

Following TB, BMI lowered continually to 31.4 kg/m2 after twelve month with an equivalent increase in excess-weight loss to 74.7% and overall weight reduction reaching 36.3%.

Nevertheless, the length of the common channel (CC) had a considerable effect on TB results; after 12 months, weight loss was significantly higher for CC length of 250 centimeters versus 300 cm (BMI, 29.4 vs. 33.0 kg/m2, P= 0.002; as well as excess-weight loss of 79.8% vs. 70.4%; P= 0.009).

" Improvement of comorbidities was observed in a high percentage of people. Major complications were observed in 3% of people and handled without fatalities," the medical professionals report.

In addition to weight management, a lot of people saw resolution of obesity-related comorbidities such as high blood pressure, obstructive sleep apnea as well as type-2 diabetes, in addition to stubborn or new onset signs and symptoms of gastroesophageal reflux condition (GERD).

" Complete satisfaction concerning the mixed endpoints of weight loss and resolution of reflux symptoms was high with 83% of clients reporting to be extremely or on the whole satisfied," the medical professionals record.

A power of this study is the big number of patients from a prospective windows registry, every one of whom were followed up at year.

A constraint is the detailed style which does not permit straight contrast of TB to other RBS treatments. In addition, the one year follow-up is short, "leaving the verification of a long term influence unanswered."

SOURCE: Annals of Surgery Open, on the internet October 1, 2021.

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