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Functional Roux-en-Y gastric bypass (F-RYGB), with Preservation of Duodenal Access: Report of Two Revisional Cases of Sleeve Gastrectomy

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Surgical Science 2024年第3期15卷 135-158页

作者： Victor Ramos Mussa Dib Carlos Augusto Scussel Madalosso Paulo Reis Esselin de Melo Rui Ribeiro Paula Volpe Carlos Eduardo Domene Victor Dib Institute Manaus Brazil Gastrobese Clinic Passo Fundo Brazil Paulo Reis Institute of Bariatric Surgery Goi&#226nia Brazil Alfredo Nasser University Center (UNIFAN) Goi&#226nia Brazil Lusíadas Amadora Hospital Lisboa Portugal Integrated Center for Advanced Medicine (CIMAMED) S&#227o Paulo Brazil

Objective: This case report aimed to demonstrate a possible neuromuscular effect of Latarjet nerves transection or truncal vagotomy, in association with sleeve gastrectomy plus antrojejunostomy, in order to reproduce a Roux-en-Y gastric bypass (RYGB) mechanistic principles, in patients with previous Sleeve Gastrectomy (SG) who had had weight regain, with or without concomitant gastroesophageal reflux disease (GERD). Background: Sleeve gastrectomy (SG) is one of the most frequently performed bariatric operations worldwide. Nevertheless, weight regain and gastroesophageal reflux disease (GERD) have been consistently demonstrated, in association with this technique, which may require a revisional procedure. RYGB is an option in such a situation but, implies in gastrointestinal exclusions, which represents a shortcoming of this revision. Surpassing this inconvenient would be of great value for the patients. Methods: We describe herein two cases of SG revision for weight regain and GERD, with a follow-up of one year. Gastroesophageal reflux disease was evaluated by validated questionnaire, upper endoscopy, seriography, high resolution manometry (HRM) and impedance pHmetry (I-pHmetry), in the pre and postoperative periods. A re-Sleeve Gastrectomy with antrojejunal anastomosis was done in both cases, after informed consents. The Latarjet nerves were transected in one case, due to a bleeding in the left gastric vessels and a truncal vagotomy was required in the other, to appropriately treat an associated hiatal hernia. Results: In the postoperative evaluation it was observed a pyloric spasm in both cases, during seriography and endoscopy, kept until the one-year follow-up. There was unidirectional contrast flow to the gastrointestinal anastomosis, filling the jejunal limb, in radiologic contrast study. No contrast passed through the pylorus. Nonetheless, the duodenum was kept endoscopically accessible. In the one-year evaluation, weight loss was adequate and GERD resolution

关键词： Roux-en-Y gastric bypass Sleeve Gastrectomy jejuno gastric bypass Vagus Nerve Vagotomy Bariatric Surgery

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