Functional Roux-en-Y Gastric Bypass (F-RYGB), with Preservation of Duodenal Access: Report of Two Revisional Cases of Sleeve Gastrectomy — Oak Academic Publishing
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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
Victor Dib Institute, Manaus, Brazil
,
Gastrobese Clinic, Passo Fundo, Brazil
,
Paulo Reis Institute of Bariatric Surgery, Goiânia, Brazil
,
Lusíadas Amadora Hospital, Lisboa, Portugal
,
Integrated Center for Advanced Medicine (CIMAMED), São Paulo, Brazil
,
Integrated Center for Advanced Medicine (CIMAMED), São Paulo, Brazil
,
Alfredo Nasser University Center (UNIFAN), Goiânia, Brazil
1 Victor Dib Institute, Manaus, Brazil
2 Gastrobese Clinic, Passo Fundo, Brazil
3 Paulo Reis Institute of Bariatric Surgery, Goiânia, Brazil
4 Lusíadas Amadora Hospital, Lisboa, Portugal
5 Integrated Center for Advanced Medicine (CIMAMED), São Paulo, Brazil
6 Integrated Center for Advanced Medicine (CIMAMED), São Paulo, Brazil
7 Alfredo Nasser University Center (UNIFAN), Goiânia, 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 gastrec tomy (SG) is one of the most frequently performed bariatric operations world wide. 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 shortcom ing 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 was obtained in both cases, confirmed by endoscopic and functional esophageal assessment, together with symptoms questionnaire. Conclusion: The association of Latarjet nerves sectioning or truncal vagotomy with re-sleeve gastrectomy plus gastrointestinal anastomosis (antrojejunal), in a revision for a failed sleeve, can represent a technical approach, to reproduce RYGB results, without exclusions and with duodenum endoscopic accessibility maintenance. It maybe could be applied for primary surgeries. Additional studies are necessary to confirm this hypothes i s.
Blüher, M. (2019) Obesity: Global Epidemiology and Pathogenesis. Nature Reviews Endocrinology, 15, 288-298. https://doi.org/10.1038/s41574-019-0176-8
Guerreiro, V., Neves, J.S., Salazar, D., Ferreira, M.J., Oliveira, S.C., Souteiro, P., Pedro, J., Magalhães, D., Varela, A., Belo, S., Freitas, P., Carvalho, D., et al. (2019) Long-Term Weight Loss and Metabolic Syndrome Remission after Bariatric Surgery: The Effect of Sex, Age, Metabolic Parameters and Surgical Technique—A 4-Year Follow-Up Study. Obesity Facts, 12, 639-652. https://doi.org/10.1159/000503753
Aarts, E.O. and Mahawar, K. (2020) From the Knife to the Endoscope—A History of Bariatric Surgery. Current Obesity Reports, 9, 348-363. https://doi.org/10.1007/s13679-020-00382-1
Welbourn, R., Hollyman, M., Kinsman, R., et al. (2019) Bariatric Surgery Worldwide: Baseline Demographic Description and One-Year Outcomes from the Fourth IFSO Global Registry Report 2018. Obesity Surgery, 29, 782-795. https://doi.org/10.1007/s11695-018-3593-1
English, W.J., Demaria, E., Hutter, M., et al. (2020) American Society for Metabolic and Bariatric Surgery 2018 Estimate of Metabolic and Bariatric Procedures Performed in the United States. Surgery for Obesity and Related Diseases, 16, 457-463. https://doi.org/10.1016/j.soard.2019.12.022
Quero, G., Fiorillo, C., Dallemagne, B., et al. (2020) The Causes of Gastroesophageal Reflux after Laparoscopic Sleeve Gastrectomy: Quantitative Assessment of the Structure and Function of the Esophagogastric Junction by Magnetic Resonance Imaging and High-Resolution Manometry. Obesity Surgery, 30, 2108-2117. https://doi.org/10.1007/s11695-020-04438-y
Rebecchi, F., Allaix, M.E., Giaccone, C., Ugliono, E., Scozzari, G. and Morino, M. (2014) Gastroesophageal Reflux Disease and Laparoscopic Sleeve Gastrectomy: A Physiopathologic Evaluation. Annals of Surgery, 260, 909-914. https://doi.org/10.1097/SLA.0000000000000967
Braghetto, I., Csendes, A., Korn, O., Valladares, H., Gonzalez, P. and Henríquez, A. (2010) Gastroesophageal Reflux Disease after Sleeve Gastrectomy. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 20, 148-153. https://doi.org/10.1097/SLE.0b013e3181e354bc
Kheirvari, M., Nikroo, N.D., Jaafarinejad, H., et al. (2020) The Advantages and Disadvantages of Sleeve Gastrectomy; Clinical Laboratory to Bedside Review. Heliyon, 6, e03496. https://doi.org/10.1016/j.heliyon.2020.e03496
Clapp, B., Wynn, M., Martyn, C., Foster, C., O’Dell, M. and Tyroch, A. (2018) Long term (7 or More Years) Outcomes of the Sleeve Gastrectomy: A Meta-Analysis. Surgery for Obesity and Related Diseases, 14, 741-747. https://doi.org/10.1016/j.soard.2018.02.027
Vagus Nerve
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Guan, B., Chong, T.H., Peng, J., Chen, Y., Wang, C. and Yang, J. (2019) Mid-Long-Term Revisional Surgery after Sleeve Gastrectomy: A Systematic Review and Meta-Analysis. Obesity Surgery, 29, 1965-1975. https://doi.org/10.1007/s11695-019-03842-3
Deguines, J.B., Verhaeghe, P., Yzet, T., Robert, B., Cosse, C. and Regimbeau, J.M. (2013) Is the Residual Gastric Volume after Laparoscopic Sleeve Gastrectomy an Objective Criterion for Adapting the Treatment Strategy after Failure? Surgery for Obesity and Related Diseases, 9, 660-666. https://doi.org/10.1016/j.soard.2012.11.010
Cesana, G., Uccelli, M., Ciccarese, F., Carrieri, D., Castello, G. and Olmi, S. (2014) Laparoscopic Re-Sleeve Gastrectomy as a Treatment of Weight Regain after Sleeve Gastrectomy. World Journal of Gastrointestinal Surgery, 6, 101-106. https://doi.org/10.4240/wjgs.v6.i6.101
Lacy, A., Ibarzabal, A., Pando, E., Adelsdorfer, C., Delitala, A., Corcelles, R., Delgado, S. and Vidal, J. (2010) Revisional Surgery after Sleeve Gastrectomy. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 20, 351-356. https://doi.org/10.1097/SLE.0b013e3181f62895
Nedelcu, M., Noel, P., Iannelli, A. and Gagner, M. (2015) Revised Sleeve Gastrectomy (Re-Sleeve). Surgery for Obesity and Related Diseases, 11, 1282-1288. https://doi.org/10.1016/j.soard.2015.02.009
Angelis, D.F., Avallone, M., Albanese, A., Foletto, M. and Silecchia, G. (2018) Re-Sleeve Gastrectomy 4 Years Later: Is It Still an Effective Revisional Option? Obesity Surgery, 28, 3714-3716. https://doi.org/10.1007/s11695-018-3481-8
Gu, L., Fu, R., Chen, P., et al. (2020) In Terms of Nutrition, the Most Suitable Method for Bariatric Surgery: Laparoscopic Sleeve Gastrectomy or Roux-en-Y Gastric Bypass? A Systematic Review and Meta-Analysis. Obesity Surgery, 30, 2003-2014. https://doi.org/10.1007/s11695-020-04488-2
Hassan zadeh, M., Farsani, M.G. and Zamaninour, N. (2019) Selenium Status after Roux-en-Y Gastric Bypass: Interventions and Recommendations. Obesity Surgery, 29, 3743-3748. https://doi.org/10.1007/s11695-019-04148-0
Cheng, Q., Hort, A., Yoon, P., et al. (2021) Review of the Endoscopic, Surgical and Radiological Techniques of Treating Choledocholithiasis in Bariatric Roux-en-Y Gastric Bypass Patients and Proposed Management Algorithm. Obesity Surgery, 31, 4993-5004. https://doi.org/10.1007/s11695-021-05627-z
Kumar, P., Yau, H.-C.V., Trivedi, A., et al. (2020) Global Variations in Practices Concerning Roux-en-Y Gastric Bypass—An Online Survey of 651 Bariatric and Metabolic Surgeons with Cumulative Experience of 158,335 Procedures. Obesity Surgery, 30, 4339-4351. https://doi.org/10.1007/s11695-020-04796-7
Chemaly, R., Diab, S., Khazen, G., et al. (2022) Gastroesophageal Cancer after Gastric Bypass Surgeries: A Systematic Review and Meta-Analysis. Obesity Surgery, 32, 1300-1311. https://doi.org/10.1007/s11695-022-05921-4
Ravacci, G.R., Ishida, R., Torrinhas, R.S., et al. (2019) Potential Premalignant Status of Gastric Portion Excluded after Roux en-Y Gastric Bypass in Obese Women: A Pilot Study. Scientific Reports, 9, Article No. 5582. https://doi.org/10.1038/s41598-019-42082-4
Dib, V.R.M., Madalosso, C.A.S., Domene, C.E., de Melo, P.R.E., Ribeiro, R., Scortegagna, G.T. and Chaim, E.A. (2023) Sleeve Gastrectomy Associated with Antral Lesion Resection and Roux-en-Y Antrojejunal Reconstruction. Surgical Science, 14, 360-376. https://doi.org/10.4236/ss.2023.145041
Sharples, A.J. and Mahawar, K. (2020) Systematic Review and Meta-Analysis of Randomised Controlled Trials Comparing Long-Term Outcomes of Roux-En-Y Gastric Bypass and Sleeve Gastrectomy. Obesity Surgery, 30, 664-672. https://doi.org/10.1007/s11695-019-04235-2
Oraby, E.M., Harb, O.A. and Bahbah, M.A. (2022) Concomitant Obesity and GERD: Is Laparoscopic Sleeve Gastrectomy Still Considered the Best Option? A Clinical and Endoscopic Evaluation. World Journal of Laparoscopic Surgery, 15, 266-271.
Elkassem, S. (2021) Gastroesophageal Reflux Disease, Esophagitis, and Barrett’s Esophagus 3 to 4 Years Post Sleeve Gastrectomy. Obesity Surgery, 31, 5148-5155. https://doi.org/10.1007/s11695-021-05688-0
Kermansaravi, M., Amr, B., Kabir, A., et al. (2023) Endoscopic Evaluation of de Novo Esophagitis and Barrett’s Esophagus, 5 Years after Sleeve Gastrectomy. Obesity Surgery, 33, 256-262. https://doi.org/10.1007/s11695-022-06403-3
Raj, P.P., Bhattacharya, S., Misra, S., Kumar, S.S., Khan, M.J., Gunasekaran, S.C. and Palanivelu, C. (2019) Gastroesophageal Reflux-Related Physiologic Changes after Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: A Prospective Comparative Study. Surgery for Obesity and Related Diseases, 15, 1261-1269. https://doi.org/10.1016/j.soard.2019.05.017
Navarini, D., Madalosso, C.A.S., Tognon, A.P., et al. (2020) Predictive Factors of Gastroesophageal Reflux Disease in Bariatric Surgery: A Controlled Trial Comparing Sleeve Gastrectomy with Gastric Bypass. Obesity Surgery, 30, 1360-1367. https://doi.org/10.1007/s11695-019-04286-5
da Silva, J.-T.D., Santa-Cruz, F., Cavalcanti, J.M.S., et al. (2023) Incidence of Abnormalities of the Gastric Tube Following Sleeve Gastrectomy and Its Role on Esophagitis Progression. Obesity Surgery, 33, 263-267. https://doi.org/10.1007/s11695-022-06375-4
Alvarez, R., Youssef, J., Zadeh, J., et al. (2023) Sleeve Gastrectomy Morphology and Long-Term Weight-Loss and Gastroesophageal Reflux Disease Outcomes. Surgical Endoscopy, 37, 5652-5664. https://doi.org/10.1007/s00464-022-09555-6
Chern, T.Y., Chan, D.L., Maani, J., Ferguson, J.S. and Talbot, M.L. (2021) High-Resolution Impedance Manometry and 24-hour Multichannel Intraluminal Impedance with pH Testing before and after Sleeve Gastrectomy: De Novo Reflux in a Prospective Series. Surgery for Obesity and Related Diseases, 17, 329-337. https://doi.org/10.1016/j.soard.2020.09.030
Keidar, A., Appelbaum, L., Schweiger, C., Elazary, R. and Baltasar, A. (2010) Dilated Upper Sleeve Can be Associated with Severe Postoperative Gastroesophageal Dysmotility and Reflux. Obesity Surgery, 20, 140-147. https://doi.org/10.1007/s11695-009-0032-3
Stier, C., Parmar, C., Koschker, A.C., Bokhari, M., Stier, R. and Chiappetta, S. (2020) Computed Tomography-3D-Volumetry: A Valuable Adjunctive Diagnostic Tool after Bariatric Surgery. Mini-Invasive Surgery, 4, Article 18. https://doi.org/10.20517/2574-1225.2019.75
Baumann, T., Grueneberger, J., Pache, G., et al. (2011) Three-Dimensional Stomach Analysis with Computed Tomography after Laparoscopic Sleeve Gastrectomy: Sleeve Dilation and Thoracic Migration. Surgical Endoscopy, 25, 2323-2329. https://doi.org/10.1007/s00464-010-1558-0
Felsenreich, D.M., Langer, F.B., Kefurt, R., Panhofer, P., Schermann, M., Beckerhinn, P., Sperker, C. and Prager, G. (2016) Weight Loss, Weight Regain, and Conversions to Roux-en-Y Gastric Bypass: 10-Year Results of Laparoscopic Sleeve Gastrectomy. Surgery for Obesity and Related Diseases, 12, 1655-1662. https://doi.org/10.1016/j.soard.2016.02.021
Suter, M., Dorta, G., Giusti, V. and Calmes, J.M. (2004) Gastro-Esophageal Reflux and Esophageal Motility Disorders in Morbidly Obese Patients. Obesity Surgery, 14, 959-966. https://doi.org/10.1381/0960892041719581
Brunaldi, V.O., Abboud, D.M., Abusaleh, R.R., Annan, K.A., Razzak, F.A., Ravi, K., Valls, E.J.V., Storm, A.C., Ghanem, O.M. and Abu Dayyeh, B.K. (2024) Post-Bariatric Surgery Changes in Secondary Esophageal Motility and Distensibility Parameters. Obesity Surgery, 34, 347-354. https://doi.org/10.1007/s11695-023-06959-8
Sudan, R. and Jain-Spangler, K. (2018) Tailoring Bariatric Surgery: Sleeve Gastrectomy, Roux-en-Y Gastric Bypass and Biliopancreatic Diversion with Duodenal Switch. Journal of Laparoendoscopic & Advanced Surgical Techniques and Videoscopy, 28, 956-961 https://doi.org/10.1089/lap.2018.0397
Aghajani, E., Schou, C., Gislason, H. and Nergaard, B.J. (2023) Mid-Term Outcomes after Single Anastomosis Sleeve Ileal (SASI) Bypass in Treatment of Morbid Obesity. Surgical Endoscopy, 37, 6220-6227. https://doi.org/10.1007/s00464-023-10112-y
Wang, M., Widjaja, J., Dolo, P.R., Yao, L., Hong, J. and Zhu, X. (2022) The Protective Effect of Transit Bipartition and Its Modification Against Sleeve Gastrectomy-Related Esophagitis in a Rodent Model. Obesity Surgery, 32, 1149-1156. https://doi.org/10.1007/s11695-022-05907-2
Parmar, C.D., Mahawar, K.K., Boyle, M., Schroeder, N., Balupuri, S. and Small, P.K. (2017) Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass is Effective for Gastro-Oesophageal Reflux Disease but not for Further Weight Loss. Obesity Surgery, 27, 1651-1658. https://doi.org/10.1007/s11695-017-2542-8
Frankel, A., Thomson, I., Shah, A., Chen, C., Zahir, S.F., Barbour, A., Holtmann, G. and Smithers, B.M. (2022) Laparoscopic Fundoplication versus Laparoscopic Roux-en-Y Gastric Bypass for Gastro-Oesophageal Reflux Disease in Obese Patients: Protocol for a Randomized Clinical Trial. BJS Open, 6, zrac132. https://doi.org/10.1093/bjsopen/zrac132
Mejía-Rivas, M.A., Herrera-López, A., Hernández-Calleros, J., et al. (2008) Gastroesophageal Reflux Disease in Morbid Obesity: The Effect of Roux-en-Y Gastric Bypass. Obesity Surgery, 18, 1217-1224. https://doi.org/10.1007/s11695-008-9474-2
Gu, L., Chen, B., Du, N., et al. (2019) Relationship Between Bariatric Surgery and Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis. Obesity Surgery, 29, 4105-4113. https://doi.org/10.1007/s11695-019-04218-3
Zhou, K., Wolski, K., Malin, S.K., Aminian, A., Schauer, P.R., Bhatt, D.L. and Kashyap, S.R. (2019) Impact of Weight Loss Trajectory Following Randomization to Bariatric Surgery on Long-Term Diabetes Glycemic and Cardiometabolic Parameters. Endocrine Practice, 25, 572-579. https://doi.org/10.4158/EP-2018-0522
Zorrilla-Nunez, L.F., Campbell, A., Giambartolomei, G., Lo Menzo, E., Szomstein, S. and Rosenthal, R.J. (2019) The Importance of the Biliopancreatic Limb Length in Gastric bypass: A Systematic Review. Surgery for Obesity and Related Diseases, 15, 43-49. https://doi.org/10.1016/j.soard.2018.10.013
Kamocka, A., Chidambaram, S., Erridge, S., et al. (2022) Length of Biliopancreatic Limb in Roux-en-Y Gastric Bypass and its Impact on Post-Operative Outcomes in Metabolic and Obesity Surgery—Systematic Review and Meta-Analysis. International Journal of Obesity, 46, 1983-1991. https://doi.org/10.1038/s41366-022-01186-0
Kwon, Y., Lee, S., Kim, D., ALRomi, A., Park, S.-H., Lee, C.M., Kim, J.H. and Park, S. (2022) Biliopancreatic Limb Length as a Potential Key Factor in Superior Glycemic Outcomes after Roux-en-Y Gastric Bypass in Patients with Type 2 Diabetes: A Meta-Analysis. Diabetes Care, 45, 3091-3100. https://doi.org/10.2337/dc22-0835
Murad Jr., A.J., Cohen, R.V., de Godoy, E.P., Scheibe, C.L., Campelo, G.P., Ramos, A.C., de Lima, R.C., Pinto, L.E.V., Coelho, D., Costa, H.B.F., Pinto, í.M.P., Pereira, T., Teófilo, F.R.S. and Valadão, J.A. (2018) A Prospective Single-Arm Trial of Modified Long Biliopancreatic and Short Alimentary Limbs Roux-En-Y Gastric Bypass in Type 2 Diabetes Patients with Mild Obesity. Obesity Surgery, 28, 599-605. https://doi.org/10.1007/s11695-017-2933-x
Wilczyński, M., Spychalski, P., Proczko-Stepaniak, M., Bigda, J., Szymański, M., Dobrzycka, M., Rostkowska, O. and Kaska, Ł. (2022) Comparison of the Long-Term Outcomes of RYGB and OAGB as Conversion Procedures after Failed LSG—A Case-Control Study. Journal of Gastrointestinal Surgery, 26, 2255-2265. https://doi.org/10.1007/s11605-022-05395-w
Edholm, D., Ottosson, J. and Sundbom, M. (2016) Importance of Pouch Size in Laparoscopic Roux-en-Y Gastric Bypass: A Cohort Study of 14,168 Patients. Surgical Endoscopy, 30, 2011-2015. https://doi.org/10.1007/s00464-015-4432-2
Ribeiro, R., Pouwels, S., Parmar, C., Pereira, J., Manaças, L., Guerra, A., Borges, N., Ribeiro, J. and Viveiros, O. (2019) Outcomes of Long Pouch Gastric Bypass (LPGB): 4-Year Experience in Primary and Revision Cases. Obesity Surgery, 29, 3665-3671. https://doi.org/10.1007/s11695-019-04051-8
Santoro, S., Castro, L.C., Velhote, M.C., Malzoni, C.E., Klajner, S., Castro, L.P., Lacombe, A. and Santo, M.A. (2012) Sleeve Gastrectomy with Transit Bipartition: A Potent Intervention for Metabolic Syndrome and Obesity. Annals of Surgery, 256, 104-110. https://doi.org/10.1097/SLA.0b013e31825370c0
Pazouki, A. and Kermansaravi, M. (2019) Single Anastomosis Sleeve-Jejunal Bypass: A New Method of Bariatric/Metabolic Surgery. Obesity Surgery, 29, 3769-3770. https://doi.org/10.1007/s11695-019-04016-x
Sewefy, A.M. and Saleh, A. (2021) The Outcomes of Single Anastomosis Sleeve Jejunal Bypass as a Treatment for Morbid Obesity (Two-Year Follow-Up). Surgical Endoscopy, 35, 5698-5704. https://doi.org/10.1007/s00464-020-08029-x
Thompson, J.C., Lowder, W.S., Peurifoy, J.T., Swierczek, J.S. and Rayford, P.L. (1978) Effect of Selective Proximal Vagotomy and Truncal Vagotomy on Gastric Acid and Serum Gastrin Responses to a Meal in Duodenal Ulcer Patients. Annals of Surgery, 188, 431-438. https://doi.org/10.1097/00000658-197810000-00001
Poon, R., Chow, L., Lim, B. and Gertsch, P. (1997) Thoracoscopic Vagotomy For Recurrent Ulcer after Previous Gastric Operation. Australian and New Zealand Journal of Surgery, 67, 177-180. https://doi.org/10.1111/j.1445-2197.1997.tb01935.x
Connell, M., Sun, W.Y.L., Mocanu, V., et al. (2022) Management of Choledocholithiasis after Roux-en-Y Gastric Bypass: A Systematic Review and Pooled Proportion Meta-Analysis. Surgical Endoscopy, 36, 6868-6877. https://doi.org/10.1007/s00464-022-09018-y
Alimadadi, M., Seyedmajidi, S., Safamanesh, S., Zanganeh, E., Hosseini, S.A., Hajiebrahimi, S. and Seyyedmajidi, M. (2022) Preoperative Esophagogastroduodenoscopy Findings and Effects on Laparoscopic Roux-en-Y Gastric Bypass in Area with High Prevalence of Helicobacter Pylori Infection: Multi-Center Experience in Iran. Gastroenterology and Hepatology from Bed to Bench, 15, 53-58.
Goligher, J.C., Pulvertaft, C.N., Irvin, T.T., Johnston, D., Walker, B., Hall, R.A., et al. (1972) Five- to Eight-Year Results of Truncal Vagotomy and Pyloroplasty for Duodenal Ulcer. The British Medical Journal, 1, 7-13. https://doi.org/10.1136/bmj.1.5791.7
Kronborg, O. and Madsen, P. (1975) A Controlled, Randomized Trial of Highly Selective Vagotomy versus Selective Vagotomy and Pyloroplasty in the Treatment of Duodenal Ulcer. Gut, 16, 268-271. https://doi.org/10.1136/gut.16.4.268
Russell, R.C., Thomson, J.P. and Bloom, S.R. (1974) The Effect of Truncal and Selective Vagotomy on the Release of Pancreatic Glucagon, Insulin and Enteroglucagon. British Journal of Surgery, 61, 821-824. https://doi.org/10.1002/bjs.1800611017
Kennedy, T., Connell, A.M., Love, A.H., MacRae, K.D. and Spencer, E.F. (1973) Selective or Truncal Vagotomy? Five-Year Results of a Double-Blind, Randomized, Controlled Trial. British Journal of Surgery, 60, 944-948. https://doi.org/10.1002/bjs.1800601208
Craft, I.L. and Venables, C.W. (1968) Antiperistaltic Segment of Jejunum for Persistent Diarrhea Following Vagotomy. Annals of Surgery, 167, 282-286. https://doi.org/10.1097/00000658-196802000-00020
Herrington Jr., J.L., Edwards, W.H., Carter, J.H. and Sawyers, J.L. (1968) Treatment of Severe Postvagotomy Diarrhea by Reversed Jejunal Segment. Annals of Surgery, 168, 522-541. https://doi.org/10.1097/00000658-196809000-00017
Greco, F. (2017) Conversion of Vertical Sleeve Gastrectomy to a Functional Single-Anastomosis Gastric Bypass: Technique and Preliminary Results Using a Non-Adjustable Ring Instead of Stapled Division. Obesity Surgery, 27, 896-901. https://doi.org/10.1007/s11695-016-2392-9
Obeid, N.R., Malick, W., Concors, S.J., Fielding, G.A., Kurian, M.S. and Ren-Fielding, C.J. (2016) Long-Term Outcomes after Roux-en-Y Gastric Bypass: 10- to 13-Year Data. Surgery for Obesity and Related Diseases, 12, 11-20. https://doi.org/10.1016/j.soard.2015.04.011