Gastric bypass is often revised for ulcer disease, including gastrojejunal ulcers that can develop when patients start smoking as adults, leading to stenosis, ulcers, pain, bleeding, and food intolerance.
Janey Pratt, MD and David Lanning, MD - 2024 Pediatric Bariatric Surgery Update Course
▶Ep 25 · 1:05
epidemiologicalAccording to 2022 MBSAQIP database, 90% of primary bariatric procedures in children are sleeve gastrectomies, 9% are laparoscopic gastric bypass, with some biliopancreatic diversions.↗
▶Ep 25 · 2:30
clinicalThe most common revisional procedure is sleeve to bypass, done for inadequate weight loss or bile reflux.↗
▶Ep 25 · 3:00
epidemiologicalIn the US, 90% of pediatric bariatric cases are sleeve gastrectomies, but this is not necessarily true around the world.↗
▶Ep 25 · 3:20
clinicalFor sleeve gastrectomy, the top reason for revision is inadequate weight loss, followed by bile reflux and then stenosis or kinking.↗
▶Ep 25 · 4:20
clinicalFor gastric bypass with inadequate weight loss, revision is ineffective—lengthening limbs or making the pouch smaller doesn't work, with no evidence supporting these approaches.↗
clinicalIn one anastomosis gastric bypass (OAGB), the small intestine is measured from the ligament of Treitz at 150 to 200 centimeters, leaving at least 300 centimeters in the common channel.↗
▶Ep 25 · 4:50
clinicalConverting bypass to BPD for inadequate weight loss is extremely difficult due to the anatomy.↗
▶Ep 25 · 5:10
clinicalGastric bypass is often revised for ulcer disease, including gastrojejunal ulcers that can develop when patients start smoking as adults, leading to stenosis, ulcers, pain, bleeding, and food intolerance.↗
▶Ep 25 · 5:20
clinicalIn biliopancreatic diversion, approximately 100 centimeters is left from the gastric anastomosis to the terminal ileum, with intestinal length split between the other two limbs.↗
▶Ep 25 · 5:40
quoteI cannot give you data. I cannot give you numbers.↗
▶Ep 25 · 5:40
clinicalRe-sleeving is fairly effective in a moderate number of patients with large antrum, inadequate weight loss, or non-bile reflux from retained fundus, though there is data in adults but no data in children.↗
▶Ep 25 · 5:50
clinicalIn SADI (single anastomosis duodenoileal bypass with sleeve), the anastomosis is made 300 centimeters from the ileocecal valve.↗
▶Ep 25 · 13:36
clinicalWhen performing revision surgery on 20-year-olds who had sleeves, bypasses result in significant weight loss.↗
▶Ep 25 · 13:36
clinicalIn the adult population, if patients have BMI over 50 or childhood onset obesity, sleeve to SADI is typically performed for revision.↗
▶Ep 25 · 13:36
opinionKids respond differently to revisional surgery than adults, and more research is needed.↗
▶Ep 25 · 14:05
quoteKids are different, need more research. Kids are different, need more research. That's yes, that's my answer.↗
