lmproving Procedure Selection and Surgical Technique in Bariatric Surgery

Abstract

Bariatric surgery is currently the most effective treatment for obesity and its metabolic comorbidities. There are, however, unexplored differences between surgical methods regarding outcomes and suitability for the individual patient. There are also variations in surgical techniques, where the association between differences in outcomes are not fully explored. The overall aim of this thesis is to improve outcomes in bariatric surgery by optimizing procedure selection and refining surgical technique. Paper I describes the design and rationale of the Bypass Equipoise Sleeve Trial (BEST), a large registry-based randomized multicenter trial comparing sleeve gastrectomy and Roux-en-Y gastric bypass (RYGB). In Paper II, the perioperative outcome of BEST is presented. Paper III is a retrospective study identifying, describing, and proposing a treatment option for postprandial symptoms due to a dysfunctional jejunojejunostomy after RYGB. Paper IV is a large observational registry study comparing surgical variations in the construction of the jejunojejunostomy regarding the association with post-operative small bowel obstruction. In this thesis it is concluded that: 1) Sleeve gastrectomy and RYGB can both be performed safely and with low perioperative risk in adult patients undergoing primary bariatric surgery; 2) Many patients having postprandial pain, nausea, and/or vomiting after RYGB, improve or become symptom-free after surgical revision of the jejunojejunostomy; and 3) The risk of small bowel obstruction varies with the type of surgical technique used for the jejunojejunostomy, both in the short and long term.