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Laparoscopic Revision for Gastric Clipping: a Single Center Experience and Taiwan Database Review

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Ting-Wei Chang at Kaohsiung Medical University
Ting-Wei Chang
Po-Chih Chang
Po-Chih Chang
Po-Chih Chang
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Kai-Hua Chen at Kaohsiung Medical University Chung-Ho Memorial Hospital
Kai-Hua Chen
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Abstract and Figures

Purpose Laparoscopic gastric clipping (LGC) is a relatively novel restrictive bariatric surgery wherein a horizontal metallic clip is applied to the gastric fundus. Its intraoperative complications or the difficulties associated with the applied gastric clip (GC) during revisional procedures have seldom been mentioned. Herein, the experience of revisional procedures after initial gastric clipping is reported. Materials and Methods A retrospective cohort review of LGC based on the Taiwan Bariatric Registry of Taiwan Society Metabolic and Bariatric Surgery was performed. Six patients with severe obesity presented for revisional surgery after initial LGC by other surgeons. Patients’ characteristics, indications, and details of revisional surgery were recorded. Results Between 2012 and 2019, 39 patients who underwent pure LGC and six patients with previous LGC history were referred for revisional surgery. Their mean age and the mean body mass index were 34.7 ± 9.5 years and 38.4 ± 10.5 kg/m2, respectively. Three, two, and one patient underwent revisional surgery for insufficient weight loss, weight recidivism, and intractable belching, respectively. The mean interval between initial LGC and revisional surgery was 40.5 ± 22.4 months. Laparoscopic removal of the GC with concomitant revisional surgeries were collected, including a revision to sleeve gastrectomy (n = 5) and revision to Roux-en-Y gastric bypass (n = 1). Moreover, the mean operative time was 286.8 ± 78.2 min. All patients had uneventful recovery postoperatively but experienced significant adhesion around the GC and the left liver. Conclusion Laparoscopic revisional surgery with concomitant GC removal for patients with severe obesity after gastric clipping could be feasibly conducted by experienced bariatric surgeons.
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ORIGINAL CONTRIBUTIONS
Laparoscopic Revision for Gastric Clipping: a Single Center
Experience and Taiwan Database Review
Po-Chih Chang
1,2,3,4
&Kai-Hua Chen
5
&Ivy Ya-Wei Huang
2,6
&Chih-Kun Huang
7
&Chung-Yen Chen
8
&Ming-Yu Wang
9
&
Ting-Wei Chang
5
Received: 2 February 2021 /Revised: 28 April 2021 /Accepted: 5 May 2021
#The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021
Abstract
Purpose Laparoscopic gastric clipping (LGC) is a relatively novel restrictive bariatric surgery wherein a horizontal metallic clip
is applied to the gastric fundus. Its intraoperative complications or the difficulties associated with the applied gastric clip (GC)
during revisional procedures have seldom been mentioned. Herein, the experience of revisional procedures after initial gastric
clipping is reported.
Materials and Methods A retrospective cohort review of LGC based on the Taiwan Bariatric Registry of Taiwan Society
Metabolic and Bariatric Surgery was performed. Six patients with severe obesity presented for revisional surgery after initial
LGC by other surgeons. Patients’characteristics, indications, and details of revisional surgery were recorded.
Results Between 2012 and 2019, 39 patients who underwent pure LGC and six patients with previous LGC history were referred
for revisional surgery. Their mean age and the mean body mass index were 34.7 ± 9.5 years and 38.4 ± 10.5 kg/m
2
,respectively.
Three, two,and one patient underwent revisional surgery for insufficient weight loss, weight recidivism, andintractable belching,
respectively. The mean interval between initial LGC and revisional surgery was 40.5 ± 22.4 months. Laparoscopic removal of the
GC with concomitant revisional surgeries were collected, including a revision to sleevegastrectomy (n= 5) and revision to Roux-
en-Y gastric bypass (n= 1). Moreover, the mean operative time was 286.8 ± 78.2 min. All patients had uneventful recovery
postoperatively but experienced significant adhesion around the GC and the left liver.
Conclusion Laparoscopic revisional surgery with concomitant GC removal for patients with severe obesity after gastric clipping
could be feasibly conducted by experienced bariatric surgeons.
Keywords Gastric clip .Laparoscopic gastric clipping .Morbid obesity .Revisional bariatric surgery
*Ting-Wei Chang
drchangtingwei@gmail.com
1
Division of Thoracic Surgery, Department of Surgery, Kaohsiung
Medical University Hospital/Kaohsiung Medical University,
Kaohsiung City, Taiwan
2
Weight Management Center, Kaohsiung Medical University
Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan
3
PhD Program in Biomedical Engineering, College of Medicine,
Kaohsiung Medical University, Kaohsiung City, Taiwan
4
Department of Sports Medicine, College of Medicine, Kaohsiung
Medical University, Kaohsiung City, Taiwan
5
Department of Surgery, Kaohsiung Medical University Hospital/
Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung
City 80756, Taiwan
6
Department of Nursing, Kaohsiung Medical University Hospital/
Kaohsiung Medical University, Kaohsiung City, Taiwan
7
Body Science & Metabolic Disorders International Medical Center,
China Medical University Hospital, Taichung City, Taiwan
8
Division of General Surgery, Department of Surgery, E-Da Hospital/
I-Shou University, Kaohsiung City, Taiwan
9
Department of Surgery, Park One International Hospital, Kaohsiung
City, Taiwan
https://doi.org/10.1007/s11695-021-05466-y
/ Published online: 12 May 2021
Obesity Surgery (2021) 31:3653–3659
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Due to its attachment to the stomach via the gastrosplenic ligament, erosion and injury with significant bleeding are possible during primary or revisional laparoscopic bariatric surgery [1,2]. Therefore, it is crucial to conduct a thorough preoperative survey and perform cautious manipulation during revisional laparoscopic bariatric surgery [3,4]. Laparoscopic gastric clipping (LGC) with associated bariatric procedures was proposed as a relatively novel technique that could produce notable weight loss while preserving anatomic integrity by applying a metallic clip horizontally over the gastric cardia [5,6]. ...
... Laparoscopic gastric clipping (LGC) with associated bariatric procedures was proposed as a relatively novel technique that could produce notable weight loss while preserving anatomic integrity by applying a metallic clip horizontally over the gastric cardia [5,6]. However, its revisional surgery or related complications have seldom been reported [3,4]. Herein, we present a rare case of occult splenic erosion caused by retained gastric clip after LGC. ...
... It is assumed that the reactive capsule around the band could defer erosion of the adjacent spleen by the implanted adjustable gastric band [8]. Nevertheless, severe adhesion between the left liver and gastric serosa was the most common finding after LGC [3,4]. Moreover, the gastric clip, which has a rigid edge owing to its metallic material (which is tougher than the adjustable silicone gastric bands), was placed horizontally over the gastric cardia and near the spleen; hence, the edge of the metallic clip would be prone to eroding the adjacent spleen gradually. ...
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... Horizontally applying a stainless steel clip over the gastric cardia is the core surgical step in laparoscopic gastric clipping (LGC), which has a promising weight loss effect by limiting food intake and maintaining the integrity of the gastrointestinal tract [1,2]. Some patients who receive LGC may occasionally experience significant dysphagia during solid food ingestion, which is related to the narrow gastric outlet because of the implanted gastric clip (GC) [3,4]. Such a complication has ever been reported with other clip gastroplasties, and removal of the GC would be the definite treatment to relieve patients of this intractable problem [3][4][5][6][7]. ...
... Some patients who receive LGC may occasionally experience significant dysphagia during solid food ingestion, which is related to the narrow gastric outlet because of the implanted gastric clip (GC) [3,4]. Such a complication has ever been reported with other clip gastroplasties, and removal of the GC would be the definite treatment to relieve patients of this intractable problem [3][4][5][6][7]. Thus, we herein present the case of a patient with a protracted course of symptomatic gastric outlet stenosis after GC removal that resolved spontaneously during follow-up. ...
... A metallic GC made of stainless steel, different from the GCs for vertical gastro-clip gastroplasties, was horizontally placed on the gastric cardia [5][6][7]. Regarding its relative novelty, only a few scientific reports have mentioned its short-or long-term complications, such as gastrointestinal bleeding, weight recidivism, intractable belching, or reactive left pleural effusion [1][2][3][4]. Transverse partition with restriction that causes gastric outlet stenosis by the implanted GCs might defer the patients from solid food ingestion [1,2,4]. Hence, revision to sleeve gastrectomy or Roux-en-Y gastric bypass with GC removal could be the mainstay solution to resolve this problem after failed conservative management with modification of dietary content or eating habits [3,4]. ...
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... band erosion occurs in up to 3% of cases in certain cohorts, necessitating both endoscopic and surgical interventions for removal [2]. Similar complications have been documented following the use of metallic gastric clips [3], and in banded sleeve gastrectomies [4], affecting both long-and short-term outcomes. Therefore, the limited follow-up duration increases the risk of underreporting significant adverse events, which is particularly concerning for newer interventions such as MSA. ...
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... Moreover, I have started organizing the cases and data of my attendings and my department, and I have published them as a scientific documentation. For instance, I have described my revision surgery experience regarding gastric clip treatment in patients with morbid obesity in detail, and our perspectives on different sizes of boogie calibration for laparoscopic sleeve gastrectomy [3,4]. ...
A Reflection of a Taiwanese Resident of Surgery in COVID-19 Pandemic
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In March 2020, the coronavirus disease 2019 (COVID-19) outbreak was declared as a pandemic by the World Health Organization. The COVID-19 breached the Taiwanese government’s defense, and the Central Epidemic Command Center (CECC) announced a Nationwide Level 3 Alert on May 19, 2021. In summary, the residency training has been afected as follows: less exposure to elective surgeries and decreased training time. In the COVID-19 pandemic era, both my life and career as a surgical resident have been deeply afected. Worries, anxiety, and fear about insufcient training, unfulflled career development, and unknown future have been prevalent daily. However, surgeons have always managed to confront and overcome difculties and challenges with courage and fearlessness. Hence, it is also important that we face the COVID-19 pandemic situation and adapt wisely.
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... More than one arrow indicates inconsistent data; blank means unknown data. Chang et al., 2021). Furthermore, gastric clip has been used to assist with SG, but a gastrectomy was still performed to achieve metabolic improvements in mice (Schlager et al., 2011;Wei et al., 2020). ...
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  • Oct 2021
Obesity is a chronic disease that affects over 795 million people worldwide. Bariatric surgery is an effective therapy to combat the epidemic of clinically severe obesity, but it is only performed in a very small proportion of patients because of the limited surgical indications, the irreversibility of the procedure, and the potential postoperative complications. As an alternative to bariatric surgery, numerous medical devices have been developed for the treatment of morbid obesity and obesity-related disorders. Most devices target restriction of the stomach, but the mechanism of action is likely more than just mechanical restriction. The objective of this review is to integrate the underlying mechanisms of gastric restrictive bariatric devices in obesity and comorbidities. We call attention to the need for future studies on potential mechanisms to shed light on how current gastric volume-restriction bariatric devices function and how future devices and treatments can be further improved to combat the epidemic of obesity.
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Revisional Single Anastomosis Sleeve Ileal (SASI) Bypass for Failed Gastric Clipping and Proximal Jejunal Bypass (GC-PJB) (Video Report)
Article
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  • Dec 2021
  • OBES SURG
Background Bariatric surgery, the most effective strategy to manage morbid obesity, has increased rapidly in the face of expanding obese population in the twenty-first century. Hence, it is reasonable to expect a rise in the need for revisional bariatric surgery (RBS), especially due to weight recidivism. Method In this video report, the patient was a 28-year-old Asian female with an initial BMI of 42.6 kg/m² and underwent primary bariatric surgery of laparoscopic gastric clipping with proximal jejunal bypass (GC-PJB) in January 2018. She had the nadir BMI of 35.2 kg/m² in August 2019. However, she regained weight and her BMI rebounded to 43.7 kg/m² at the time of consultation for RBS in 2021. After a multidisciplinary team evaluation, laparoscopic procedures of removal of gastric clip and single anastomosis sleeve ileal (SASI) bypass with preservation of previous jejunojejunal anastomosis were performed. Results The operative time was 216 min and blood loss was 25 ml. There were no intraoperative or postoperative complications. The patient had an uneventful postoperative course and was discharged 4 days after surgery. At the 3-month follow-up after RBS, the patient had lost 25 kg (weight dropped from 119 to 94 kg), and the corresponding BMI was 34.5 kg/m². Conclusion Laparoscopic removal of gastric clip and SASI bypass with preservation of previous jejunojejunal anastomosis is technically feasible and promising as a revisional procedure for failed GC-PJB.
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Laparoscopic Removal of a Displaced Vertical Gastric Clip Causing Gastric Outlet Obstruction
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  • Jul 2020
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Introduction: Recently, some surgical teams have used a laparoscopic vertical clip gastroplasty to treat morbid obesity. This approach mimics the principle of laparoscopic sleeve gastrectomy, but using a completely reversible mechanism. Displacement of the device has been reported in 7.7% of cases. The manner of its withdrawal has not been described to date. Methods: A 50-year-old woman with a body mass index (BMI) of 36.3 kg/m2 underwent a laparoscopic calibrated tubular gastroplasty at another hospital with an 38-F orogastric tube by a B-CLAMP® gastric clip on January 11, 2019. The patient came to the Emergency Department 8 months later due to complete oral intolerance, with continuous vomiting of 5 days of evolution. Physical examination: BMI 28.9 kg/m2, dehydration; depressed abdomen, with mainly supraumbilical pain and distension, and significant tympanism on palpation. No guarding or signs of peritoneal irritation. Simple abdominal x-ray showed gastric distension and gastric clip. The nasogastric tube drained 2500 cc of gastrobiliary contents. The computed tomography showed the gastric clip displaced and located medially to the esophagogastric junction, the lesser curvature, and the antropyloric region. Results: A laparoscopic approach was performed using 4 trocars. Signs of gastric suffering in the antral region. The clip was located to the right of the lesser curvature covered by a layer of fibrosis. The clip was removed by a 12-mm trocar. There were no postoperative complications. Conclusion: This video demonstrates a form to extract a displaced gastric clip used to create a calibrated tubular gastroplasty using a laparoscopic approach.
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Laparoscopic Conversion to Sleeve Gastrectomy After Gastric Clipping for Morbid Obesity—Video Presentation
Article
Full-text available
  • Apr 2019
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Purpose Laparoscopic gastric clipping is a relatively novel bariatric surgical procedure, which can yield significant weight loss via a restriction of gastric expansion. Medical literature regarding the postoperative complications of this procedure is currently scarce. To this end, we submit here a video presentation of a corrective laparoscopic gastric sleeve procedure performed after an initial gastric clipping that failed to provide adequate weight loss and led to intractable belching. Materials and Methods A 40-year-old, morbidly obese woman (initial body mass index is 35.3 kg/m²) presented with intractable belching and minimal weight loss 6 months after initial laparoscopic gastric clipping at another institution. A laparoscopic revisional procedure with gastric clip removal and conversion to sleeve gastrectomy was conducted to relieve her condition. Results The procedure took 270 min without any intraoperative complications. Blood loss was recorded at 100 mL. The patient had an uneventful postoperative course with a postoperative hospital stay of 2 days. The patient’s symptoms were relieved successfully after this revisional surgery. Conclusion Laparoscopic removal of gastric clip with concomitant revision to sleeve gastrectomy is technically feasible in our patient.
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Proximal Jejunal Bypass Improves the Outcome of Gastric Clip in Patients with Obesity and Type 2 Diabetes Mellitus
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Full-text available
  • Apr 2019
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Background Laparoscopic gastric clip (GC), a novel pure restrictive procedure, is a safe and effective treatment for morbid obesity. However, whether adding a proximal jejunal bypass (PJB) to this procedure might increase the efficacy is unknown. Methods Outcomes of 74 (43 women and 31male) obese patients who had undergone PJB-GC (41) or GC (33) for the treatment of type 2 diabetes mellitus (T2D) with 1 year follow-up were assessed. GC consists of creating a transverse gastric partition with a metallic clip. PJB consists of a jejuno-ileostomy between 20 and 320 cm distal to the ligament of Treitz. Postoperative body mass index (BMI) reduction, total weight loss (TWL), and remission rates of T2D were evaluated. Results The preoperative clinical characters in both groups were similar. The mean operative time was significantly longer in the PJB-GC group than in the GC group. At 24 months after surgery, the BMI was lower (32.5 ± 6.2 vs. 37.0 ± 5.9 kg/m², p = 0.002) and weight loss higher in PJB-GC than GC (TWL 31.3 ± 14.8 vs. 23.5 ± 10.4%, p = 0.011). Remission of T2D was greater in the PJB-GC group (90.2 vs. 57.2%; p < 0.001). Conclusions In this study, PJB-GC was superior to GC in weight loss and T2D remission at 1 and 2 years after surgery. Adding PJB to GC increased the effect of weight loss and diabetic control.
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IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures
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Full-text available
  • Dec 2018
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Background and Aim The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), being a Federation of 62 national societies, is the ideal network to monitor the number and type of procedures at a global level. The IFSO survey, enriched with a special section on revisional procedures, aims to report the number and types of bariatric procedures performed worldwide in 2016 and analyzes the surgical trends from 2008 to 2016. Methods The 2016 IFSO Survey form was emailed to all IFSO societies. Each Society was requested to indicate the number and type of bariatric procedures performed in the country. Trend analyses from 2008 to 2016 were also performed. Results The total number of bariatric/metabolic procedures performed in 2016 was 685,874; 634,897 (92.6%) of which were primary and 50,977 were revisional (7.4%). Among the primary interventions, 609,897 (96%) were surgical and 25,359 (4%) were endoluminal. The most performed primary surgical bariatric/metabolic procedure was sleeve gastrectomy (SG) (N = 340,550; 53.6%), followed by Roux-en-Y gastric bypass (N = 191,326; 30.1%), and one-anastomosis gastric bypass (N = 30,563; 4.8%). Conclusions In 2016, there was an increase in the total number both of surgical and endoluminal bariatric/metabolic procedures. Revisional procedures represent about 7% of the total bariatric interventions. SG remains the most performed surgical procedure in the world.
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30-Day Outcomes of Revisional Bariatric Stapling Procedures: First Report Based on MBSAQIP Data Registry
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Introduction: The number of bariatric revisional cases has nearly doubled since 2011, and now comprises 13.6% of the total number of cases. The objective of this study is to evaluate the outcomes and safety of the two most common stapling revisional procedures, namely, sleeve and gastric bypass in comparison to primary stapling procedures using the MBSAQIP data registry. Methods: We reviewed all the sleeve and gastric bypass cases entered between January 1, 2015, and December 31, 2015, in the MBSAQIP data registry. We, then, identified sleeve and bypass patients who have had a previous bariatric procedure. Demographics and 30 day outcomes of all sleeve and gastric bypass patients were analyzed. We conducted within group comparisons comparing primary sleeve gastrectomy (PS) and primary gastric bypass (PB) patients to revisional sleeve (RS) and revisional gastric bypass (RB) patients, respectively. We, then, conducted group comparisons comparing RS to RB patients. Results: The total number of patients analyzed was 141,577 (98,292 or 69% sleeve patients and 43,285 or 31% gastric bypass patients). Among the sleeve patients, 92,666 (94%) had a PS and 5626 (6%) had RS. Among the bypass patients, 39,567 (91%) had a PB and 3718 patients (9%) had RB. 30-day readmission rate of RS was significantly higher as compared to PS (4.1 vs 0.4%, p < 0.05). The incidence of at least one complication requiring reoperation or reintervention within 30 days following RS was twice as high as compared to PS (1.9 and 2% for RS vs 0.9 and 1.1% for PS respectively, p < 0.05). Length of stay and 30 day mortality rates for PS and RS were the same. 30-day readmission rate of RB as compared to PB was 8.3 vs 6.3% (p < 0.05). Also, the incidence of at least one complication requiring reoperation or reintervention following RB was 3.9 and 4%, respectively vs 2.4 and 2.7% for PB (p < 0.05). In addition, readmission rates and unplanned admission rates to the ICU were significantly higher for RB compared to RS (8.3 and 2% for RB vs 4.1 and 0.9% for RS respectively, p < 0.05). The incidence of at least one reoperation or one intervention following RB were also significantly higher compared to RS (3.9 vs 1.9% and 4 vs 2% respectively, p < 0.05). Conclusion: Revisional stapling procedures are safe but the rates of complications following RS and RB are twice as high compared to PS and PB. Also, RB are more likely to develop complications compared to RS.
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Revisional Bariatric Surgery for Weight Regain and Refractory Complications in a Single MBSAQIP Accredited Center: What Are We Dealing with?
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Full-text available
  • Sep 2018
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Background: Revisional surgery is the fastest growing area in bariatric surgery, constituting 13.6% of all procedures performed as of 2015. This reflects a rising need to treat adverse sequelae of primary bariatric procedures. Despite the increase in revisions, their safety and efficacy remain controversial. The objective of this study is to review the experience of revisional bariatric surgery in our center and the relevant literature to date. Methods: We performed an IRB-approved review of prospectively collected data from all patients undergoing revisional bariatric surgery between 2012 and 2015. Due to patient heterogeneity, we divided subjects into two groups: patients who underwent surgery for weight regain (WR) and those who underwent surgery to address refractory complications (RC) related to their primary bariatric procedure. Demographics, indications, and outcomes of each group were compared using Fisher's exact test, Mann-Whitney rank sums, and chi-square tests. We also divided WR patients based on their primary index procedure and analyzed them separately. Results: We performed a total of 84 procedures over 4 years. Forty-three patients (53.6%) underwent surgery for WR and 41 (46.4%) for RC. The variety and distribution of primary bariatric procedures were gastric band (40%), gastric bypass (35.4%), sleeve gastrectomy (22%), and vertical banded gastroplasty (3.7%). The indications for revisional surgery due to RC included gastroesophageal reflux disease, internal hernia, gastro-gastric fistula, marginal ulcer, excess weight loss, and pain. Overall complication rate was 14.3% (three early, nine late); there was one leak. Five patients required a reoperation (5.9%; two early, three late). Excess weight loss varied from 31.5-79.1% 12 months after revision. Conclusion: Patients presenting to our center for revisional surgery do so for either WR or RC, most commonly following gastric banding. Revisional bariatric surgery can be performed with low complication rates and with acceptable 12-month weight loss, though not with the same safety as primary procedures.
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Perioperative Outcomes of Laparoscopic and Robotic Revisional Bariatric Surgery in a Complex Patient Population
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  • Jul 2018
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Background: Utilization of the robotic platform has become more common in bariatric applications. We aim to show that robotic revisional bariatric surgery (RRBS) can be safely performed in a complex patient population with perioperative outcomes equivalent to laparoscopic revisional bariatric surgery (LRBS). Methods: Retrospective review was conducted of adult patients undergoing laparoscopic revisional bariatric surgery (LRBS) or robotic revisional bariatric surgery (RRBS) at our institution from September 2007 to December 2016. Patients undergoing planned two-stage bariatric procedures were excluded. Results: A total of 84 patients who underwent LRBS (n = 66) or RRBS (n = 18) were included. The index operation was adjustable gastric banding (AGB) in 39/84 (46%), sleeve gastrectomy (VSG) in 23/84 (27%), Roux-en-Y gastric bypass (RYGB) in 13/84 (16%), and vertical banded gastroplasty (VBG) in 9/84 (11%). For patients undergoing conversion from AGB (n = 39), there was no difference in operative time, length of stay, or complications by surgical approach. For patients undergoing conversion from a stapled procedure (n = 45), the robotic approach was associated with a shorter length of stay (5.8 ± 3.3 vs 3.7 ± 1.7 days, p = 0.04) with equivalent operative time and post-operative complications. There were three leaks in the LRBS group and none in the RRBS group (p = 0.36). Major complications occurred in 3/39 (8%) of patients undergoing conversion from AGB and 2/45 (4%) of patients undergoing conversion from a stapled procedure (p = 0.53) with no difference by surgical approach. Conclusions: RRBS is associated with a shorter length of stay than LRBS in complex procedures and has at least an equivalent safety profile. Long-term follow-up data is needed.
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A Vertically Placed Clip for Weight Loss: a 39-Month Pilot Study
Article
Full-text available
  • May 2017
  • OBES SURG
Background: Morbid obesity remains one of society's significant medical dilemmas. It is rapidly worsening and expected to affect 35% of the US population by the year 2020. Common current bariatric procedures exist and include, but not limited to, the adjustable gastric band, gastric bypass, and the sleeve gastrectomy. Although beneficial to morbidly obese patients, they also alter the patient's anatomy and involve resections, or require maintenance. The goal of the trial is to show a new minimally invasive vertical gastric clip technique that produces significant weight loss but requires no resection, no change in anatomy, and is reversible. Methods: From November 2012 to February 2016, prospective collected data from 117 patients was included in the gastric clip trial. The clip consists of a silicone-covered titanium backbone with an inferior hinged opening that separates a medial lumen from an excluded lateral gastric pouch. The inferior opening allows the gastric juices to empty from the fundus and the body of the stomach into the distal antrum. Results: Weight loss and comorbidities were evaluated among 117 patients over a 39-month period. 66.7% excess weight loss was seen with minimal adverse events. Average length of surgery was 69 min. Average length of stay was 1.3 days. Fifteen of the originally implanted clips were electively removed based on the original protocol, and the other two were removed for displacement of the device. Conclusion: The vertical, gastric clip trial has shown that excellent weight loss can be achieved without some of the complications seen with historical bariatric procedures. This clip is placed without requiring stapling, resection, malabsorption, change in anatomy, or maintenance. It is also easily reversible.
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Trends in revisional bariatric surgery using the MBSAQIP database 2015-2017
Article
  • Apr 2020
  • SURG OBES RELAT DIS
Background The third most common bariatric surgery is revisional bariatric surgery. The American College of Surgeons tracks outcomes using the Metabolic and Bariatric Surgery Accreditation Quality Initiative Program database. We used this database to examine trends in revisional bariatric surgery. Objective To evaluate how trends in bariatric revisional surgery have changed in recent years. Setting University Hospital, United States. Methods The Metabolic and Bariatric Surgery Accreditation Quality Initiative Program database for 2015 to 2017 was examined for revisions of bariatric surgery. Patients who underwent revisional bariatric surgery were identified by the primary Current Procedural Terminology code, the REVCONV and PREVIOUS_SURGERY field as well as secondary Current Procedural Terminology codes. There is no exact code for sleeve gastrectomy (SG) to laparoscopic Roux-en-Y gastric bypass (LRYGB), so we used 43644 (GB)+REVCONV+PREVIOUS_SURGERY for this. Results For the years 2015 to 2017 there were 57,683 revisions/conversions of 528,081 patients. The number of revisions increased over the study period by 5213 cases. The most common revision was laparoscopic adjustable gastric band (LAGB) to SG with 15,433 cases and the second was LAGB to LRYGB with 10,485 cases. There were 14,715 LAGB removals. It is more difficult to track SG to LRYGB but there were 8491 unlisted cases, which may have been sleeve to bypass. Conclusion LAGBs are being taken out or converted, and this group makes up the largest portion of revisions and conversions. It is difficult to track SG to LRYGB, but the number of unlisted cases continues to climb. This will likely surpass LAGB conversions with time. The Metabolic and Bariatric Surgery Accreditation Quality Initiative Program should be modified to capture revisions/conversions of SG.
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