Magnetic liver retraction in bariatric surgery: Is it possible?

One of the recent advances in bariatric surgery is the use of magnetic devices. This research paper describes magnetic liver retraction in morbidly obese patients during bariatric surgery. A descriptive, prospective and observational study was carried out, analyzing 100 patients in whom magnetic retraction was used. Mean and SD body mass index was 46.1 ± 5.09 kg/m2. The magnetic system was successfully used for liver retraction in 95% of cases; in only 5% of cases was its use not possible due to hepatomegaly and severe hepatic steatosis. According to the results, magnetic liver retraction can be safe and used in bariatric surgery, regardless of body mass index and with a low percentage of complications.

Magnetic-Assisted Reduced-Port Sleeve Gastrectomy Versus Laparoscopic Sleeve Gastrectomy: a Comparative Study.

BACKGROUND: Sleeve gastrectomy is one of the most popular bariatric surgeries. With the advent of new technologies, a reduced-port approach assisted by magnets for sleeve gastrectomy (RPSG-MA) has been developed. The aim of our study is to compare the short-term results of RPSG-MA vs conventional laparoscopic SG (CLSG). METHODS: A comparative study was performed. We compared two groups who underwent RPSG-MA (n=150) and CLSG (n=135) between January 2020 and January 2022. RESULTS: Both groups were similar in body mass index, age, sex, and type of comorbidities. The operative time was similar in both groups (RPSG-MA, 52.5 min vs CLSG, 52.9 min; p = 0.829). Length of hospital (1.07 days) stay was significantly shorter in the RPSG-MA group (p = 0.00) than in the CLSG group (1.51 days). There were no conversions to open surgery in any patient or any fatal event. Complications encountered were similar in both groups postoperative. There were minor adverse events directly related to the magnetic device in 3 cases, these being mild hepatic lacerations, resolved with hemostatic measures. CONCLUSION: The magnet-assisted reduced-port gastric sleeve compared to the conventional technique has proven to be safe, technically feasible and with multiple benefits.

Magnetic device in reduced port and single port bariatric surgery: First 170 cases experience / Dispositivo magnético en cirugía bariátrica por puerto reducidos y puerto único: Primera experiencia de 170 casos

Introduction: Magnetic devices have been successfully used in bariatric surgery. To the date, the only reported use of the magnet was for liver retraction. Our purpose in this study is to demonstrate the safety and viability of using a magnetic system in different steps in single port and reduced port bariatric surgery.MethodsProspective and observational study was performed. Patients older than 18 years, undergoing primary laparoscopic sleeve gastrectomy (SG), one-anastomosis gastric bypass (OAGB), and Roux-en-Y gastric bypass (RYGB) or revisional surgery by single-port or reduced-port approach between July 2020 and June 2021 were included.ResultsA total of 170 patients (mean BMI, 41.47kg/m2; mean age 36.92 yrs) completed laparoscopic bariatric surgery (54 single-port sleeve gastrectomy [SPSG], 16 reduced-port SG, 83 RYGB, 4 OAGB and 14 revision surgeries), using the magnetic surgical system in different steps of the surgery. Mean surgical time for SPSG and reduced-port SG was 65.52min and 59.36min respectively; and for RYGB 74.19min, OAGB 70.98min, and revisional surgeries 88.38min. As for intraoperative complications, 2.94% mild liver laceration without significant bleeding was reported. There were no 30-day mortalities and no major complications.ConclusionMagnetic assistance in single-port and reduced-port bariatric surgery is an innovative technique. With this prospective study we attempt to demonstrate the safety profile and potential uses that may improve the implementation of new surgical approaches in bariatric surgery (AU)

Introducción: Los dispositivos magnéticos se han usado satisfactoriamente en cirugía bariátrica. Hasta la fecha, el único uso reportado de los imanes ha sido para la retracción hepática. Nuestro propósito con este estudio es demostrar la seguridad y viabilidad de usar dispositivos magnéticos en diferentes pasos de la cirugía bariátrica por puerto único y por puerto reducido.MétodosSe realizó un estudio prospectivo y observacional. Se incluyeron pacientes mayores de 18 años que fueron sometidos a cirugía laparoscópica primaria de manga gástrica (MG), bypass gástrico de una sola anastomosis (BAGUA), bypass gástrico en Y de Roux (BGYR) y cirugía de revisión por abordaje de puerto único o puerto reducido entre los meses de julio de 2020 y junio de 2021.ResultadosA un total de 170 pacientes (media IMC, 41,47 kg/m2; media edad 36,92 años) se les realizó una cirugía bariátrica laparoscópica (54 MG por puerto único, 16 MG por puerto reducido, 4 BAGUA y 14 cirugías de revisión) utilizando el dispositivo magnético en diferentes pasos del proceso quirúrgico. El tiempo promedio de la MG por puerto único y MG por puerto reducido fueron 65,52 min y 59,36 min, respectivamente; mientras que para BGYR 74,19 min, BAGUA 70,98 min y cirugías de revisión 88,38 min. Entre las complicaciones intraoperatorias se reportaron 2,94% de laceraciones hepáticas leves sin sangrado significante. No hubo ningún porcentaje de mortalidad ni de complicaciones mayores a los 30 días.ConclusionesLa asistencia magnética en cirugía bariátrica por puerto único y por puerto reducido es una técnica innovadora. Con este estudio prospectivo intentamos demostrar el perfil de seguridad y los usos potenciales que pueden mejorar la implementación de nuevos abordajes quirúrgicos en cirugía bariátrica (AU)

Magnetic device in reduced port and single port bariatric surgery: First 170 cases experience.

INTRODUCTION: Magnetic devices have been successfully used in bariatric surgery. To the date, the only reported use of the magnet was for liver retraction. Our purpose in this study is to demonstrate the safety and viability of using a magnetic system in different steps in single port and reduced port bariatric surgery. METHODS: Prospective and observational study was performed. Patients older than 18 years, undergoing primary laparoscopic sleeve gastrectomy (SG), one-anastomosis gastric bypass (OAGB), and Roux-en-Y gastric bypass (RYGB) or revisional surgery by single-port or reduced-port approach between July 2020 and June 2021 were included. RESULTS: A total of 170 patients (mean BMI, 41.47kg/m2; mean age 36.92 yrs) completed laparoscopic bariatric surgery (54 single-port sleeve gastrectomy [SPSG], 16 reduced-port SG, 83 RYGB, 4 OAGB and 14 revision surgeries), using the magnetic surgical system in different steps of the surgery. Mean surgical time for SPSG and reduced-port SG was 65.52min and 59.36min respectively; and for RYGB 74.19min, OAGB 70.98min, and revisional surgeries 88.38min. As for intraoperative complications, 2.94% mild liver laceration without significant bleeding was reported. There were no 30-day mortalities and no major complications. CONCLUSION: Magnetic assistance in single-port and reduced-port bariatric surgery is an innovative technique. With this prospective study we attempt to demonstrate the safety profile and potential uses that may improve the implementation of new surgical approaches in bariatric surgery.

Hybrid revisional surgery: biliary limb distalization plus endoscopic transoral outlet reduction (eTOR).

Roux-en-Y gastric bypass (RYGB) is one of the best procedures for the treatment of obesity and associated comorbidities. However, the percent of revisional procedures after a gastric bypass by weight regain has been increased, therefore several surgical options are available for the treatment of weight regain. In this case report, we combined a biliary limb distalization with endoscopic transoral outlet reduction (eTOR). The purpose of this case report is to expose the viability to perform combined procedures such as the distalization of the biliopancreatic limb plus eTOR increasing malabsorptive and restrictive components that would represent a secure and efficient weight loss in our patient. We could demonstrate the technical feasibility of the combination of both procedures to increase the restrictive and malabsorptive components at the same time with a low-risk range.

Magnetic device in reduced port and single port bariatric surgery: First 170 cases experience.

INTRODUCTION: Magnetic devices have been successfully used in bariatric surgery. To the date, the only reported use of the magnet was for liver retraction. Our purpose in this study is to demonstrate the safety and viability of using a magnetic system in different steps in single port and reduced port bariatric surgery. METHODS: Prospective and observational study was performed. Patients older than 18 years, undergoing primary laparoscopic sleeve gastrectomy (SG), one-anastomosis gastric bypass (OAGB), and Roux-en-Y gastric bypass (RYGB) or revisional surgery by single-port or reduced-port approach between July 2020 and June 2021 were included. RESULTS: A total of 170 patients (mean BMI, 41.47kg/m2; mean age 36.92 yrs) completed laparoscopic bariatric surgery (54 single-port sleeve gastrectomy [SPSG], 16 reduced-port SG, 83 RYGB, 4 OAGB and 14 revision surgeries), using the magnetic surgical system in different steps of the surgery. Mean surgical time for SPSG and reduced-port SG was 65.52min and 59.36min respectively; and for RYGB 74.19min, OAGB 70.98min, and revisional surgeries 88.38min. As for intraoperative complications, 2.94% mild liver laceration without significant bleeding was reported. There were no 30-day mortalities and no major complications. CONCLUSION: Magnetic assistance in single-port and reduced-port bariatric surgery is an innovative technique. With this prospective study we attempt to demonstrate the safety profile and potential uses that may improve the implementation of new surgical approaches in bariatric surgery.

Gastric bypass with weight regain - Biliary limb distalization plus endoscopic transjejunal A.P.C. pouch therapy in one step: Case report.

INTRODUCTION: In recent years there has been a significant growth in the percentage of patients with weight regain after Roux-en-Y gastric bypass (RYGB). Approximately 20% RYGB patients may experience weight regain 24 months after the intervention. PRESENTATION OF CASE: A 53 yr male patient who underwent RYGB in 2011 with an initial weight of 140 kg and BMI of 44.19 kg/m who consults in 2019 for a weight regain of 45.9%. Transoperative endoscopy assessment revealed a gastric pouch and gastrojejunal anastomosis with a diameter of 7 cm and 2.5 cm respectively. During the procedure we found a common channel of 725 cm, it is decided to shorten it through the distalization of the biliopancreatic limb. Afterward using the same laparoscopic ports to introduce the endoscope through jejunal cane to realize the APC therapy. He was discharged on the 2nd-day, without any complaint. DISCUSSION: The purpose of this case report is to expose the viability to perform a combined surgical technique such as the distalization of the biliopancreatic limb with endoscopic techniques of argon plasma coagulation (APC) via transjejunal in the same operative course. Using this combined technique we can increase hypoabsortive and restrictive components that would represent a secure and efficient weight loss in our patient. CONCLUSIONS: This innovative technique can represent a viable alternative that is secure and reproducible in revisional surgery for weight regain context.

Results of The Comparative Study of 200 Cases: One Anastomosis Gastric Bypass vs Roux-en-Y Gastric Bypass.

INTRODUCTION: Obesity has experienced worldwide increase and surgery has become the treatment that has achieved the best results. Several techniques have been described; the most popular are vertical gastrectomy (GV) and the Roux-en-Y gastric bypass (RYGB). However, mini-gastric bypass/one anastomosis gastric bypass (MGB/OAGB) has gained popularity due to its simplicity and good results. OBJECTIVE: To comparatively evaluate the results of MGB/OAGB with those of RYGB with 1-year follow-up. METHODS: The paper presents a comparative case and control study of 100 patients that underwent MGB/OAGB surgery and another 100 with RYGB surgery, operated between 2008 and 2016. Patients were not submitted to revision surgery and had the following pre-operative variables: age 40.46 ± 12.4 vs. 39.43 ± 10.33 years; sex 64 and 54 women, 36 and 46 men; BMI 44.8 ± 12.06 and 45.29 ± 8.82 kg/m2; 50 and 54 cases with comorbidities, respectively, these being non-significant differences. RESULTS: The surgical time was 69.01 ± 4.62 (OAGB) vs. 88.98 ± 3.44 min; the time of hospitalization was 2 days, reaching a BMI of 27.7 ± 7.85 and 29 ± 4.52 kg/m2, with an excess weight loss 1 year after surgery of 89.4 vs. 85.9%, respectively. The morbidity rates are 9% for OAGB and 11% for the RYGB. There was a comorbidity resolution of 84.4 and 83.7% respectively, without mortality. CONCLUSIONS: The results show the benefits of both techniques, OAGB being the easiest to perform and with less surgical time.