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Contival N, Menahem B, Gautier T, Le Roux Y, Alves A. Guiding the non-bariatric surgeon through complications of bariatric surgery. J Visc Surg 2017; 155:27-40. [PMID: 29277390 DOI: 10.1016/j.jviscsurg.2017.10.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Complications in bariatric surgery are varied; they are severe at times but infrequent. They may be surgical or non-surgical, and may occur early or late. The goal of this systematic review is to inform and help the attending physician, the emergency physician and the non-bariatric surgeon who may be called upon to manage surgical complications that arise after adjustable gastric band (AGB), sleeve gastrectomy (SG), or gastric bypass (GBP). Data from evidence-based medicine were extracted from the literature by a review of the Medline database and also of the most recent recommendations of the learned societies implicated. The main complications were classified for each intervention, and a distinction was made between early and late complications. Early complications after AGB include prosthetic slippage or perforation; SG can be complicated early by staple line leak or fistula, and BPG by fistula, stenosis and postoperative hemorrhage. Delayed complications of AGB include intragastric migration of the prosthesis, late prosthetic slippage and infection, while SG can be complicated by gastro-esophageal reflux, and BPG by anastomotic ulcer and internal hernia. The analysis of available data allowed us to develop decisional algorithms for the management of each of these complications.
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Affiliation(s)
- N Contival
- Département de chirurgie digestive, Caen University Hospital, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
| | - B Menahem
- Département de chirurgie digestive, Caen University Hospital, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
| | - T Gautier
- Département de chirurgie digestive, Caen University Hospital, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
| | - Y Le Roux
- Département de chirurgie digestive, Caen University Hospital, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
| | - A Alves
- Département de chirurgie digestive, Caen University Hospital, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
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The bariatric surgery and weight losing: a meta-analysis in the long- and very long-term effects of laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy on weight loss in adults. Surg Endosc 2017; 31:4331-4345. [PMID: 28378086 DOI: 10.1007/s00464-017-5505-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/08/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Several studies have been investigated to find the long-term effect of bariatric surgery on weight loss; nevertheless, a meta-analysis can detailedly demonstrate the effect of bariatric surgery on weight in morbidly obese patients. This study aimed to assess the long- and very long-term effects of laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB), and laparoscopic sleeve gastrectomy (LSG) on weight loss in adults. METHODS An electronic search using PubMed, Scopus, and Google scholar databases was performed for all English-language articles up to May 15, 2016 with no publication date restriction. Outcome was long-term (≥5-10 years) and very long-term (≥10 years) weight reduction that reported as the mean %EWL and changes in BMI from baseline. RESULTS Eighty articles with 87 arms were included in this meta-analysis. The excess weight loss percentage (%EWL) was 47.94% and 47.43% after LAGB at ≥5 and ≥10 years, respectively. After LRYGB the %EWL was 62.58% at ≥5 years and 63.52% at ≥10 years. It was 53.25% at ≥5 years after LSG. Results of subgroup analyses have indicated that LRYGB leads to higher %EWL in America and Asia compared with Europe. Meta-regression analyses have shown that there is no significant association between %EWL and baseline age, BMI and length of follow-up after three procedures. However, there is a positive association between gender and %EWL after LRYGB (β = 1.24). No publication bias was found. CONCLUSIONS These findings suggest that LRYGB is an effective procedure in morbidly obese patients that leads to sustainable weight loss over the long- and very long-term periods in compared with LAGB and LSG.
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A short or a long Roux limb in gastric bypass surgery: does it matter? Surg Endosc 2016; 31:1882-1890. [PMID: 27553795 DOI: 10.1007/s00464-016-5188-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/13/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND The Roux-en-Y gastric bypass (RYGB) still remains the gold standard in bariatric surgery. However, no consensus exists on the optimal limb lengths to induce maximum weight reduction. The aim of the present study was to assess the effect of a longer alimentary limb (AL) length on weight reduction after RYGB. METHODS A retrospective analysis of a prospectively collected database of patients who underwent a primary laparoscopic RYGB between January 2001 and March 2011 was performed. Patients received a short AL (SAL; 100 cm) or a long AL (LAL; 150 cm). Primary outcome was weight loss, and secondary outcomes were short- and long-term complication rates. RESULTS A total of 768 patients received a RYGB during the study period. Of these, 730 consecutive patients were included for long-term analysis and had a mean follow-up (FU) of 37 ± 26 [range 0-120] months; 360 (47 %) patients received a SAL RYGB. Overall %TBWL was 33 ± 9 % after 2 years (FU 74 %) and 28 ± 12 % after 5 years (FU 20 %). No significant differences in %TBWL were found between SAL RYGB and LAL RYGB during the study period. The 30-day mortality rate was 0.13, 9 % overall short-term complication rate and 19 % cumulative long-term complication rate. No differences in complications were found between SAL and LAL RYGB patients. CONCLUSION Lengthening of the alimentary limb from 100 to 150 cm did not affect post-RYGB weight loss. Overall complication rates were low and comparable in this series of RYGB patients.
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Navez J, Dardamanis D, Thissen JP, Navez B. Laparoscopic Roux-en-Y gastric bypass for morbid obesity: comparison of primary versus revisional bypass by using the BAROS score. Obes Surg 2015; 25:812-7. [PMID: 25366292 DOI: 10.1007/s11695-014-1473-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vertically banded gastroplasty or adjustable gastric banding often result in weight regain, complications, or side effects. Failed restrictive bariatric procedures can be converted in revisional laparoscopic Roux-en-Y gastric bypass (LRYGB). This study aimed to compare weight loss, evolution of comorbidities, and quality of life (QOL) between primary versus revisional LRYGB. METHODS Between 2004 and 2012, 374 patients underwent LRYGB as primary or revisional surgery performed by a single surgeon. Patient data were retrospectively reviewed; questionnaires of QOL were sent to all patients. Outcomes were evaluated according to Bariatric Analysis and Reporting Outcome System (BAROS) taking into account excess body mass index loss (EBMIL), correction of comorbidities, improvement in QOL, and complications. RESULTS Two hundred thirty-two patients (62%) responded to the questionnaire, 163 patients in the primary group and 69 in the revisional group. Median follow-up was 36 months (12-108). Median percentages of EBMIL were, respectively, 74% (26.8-126.8) and 50% (-31.6-124.2) in the primary and the revisional groups (p < 0.01). Median BAROS score reached 6.5 (-2-9) in the primary group, against 4.3 (-1.8-9) in the revisional group (p < 0.01). There were significantly less "fair" and more "excellent" scores in the primary group, considering initial BMI before gastroplasty. Arterial hypertension and sleep apnea syndrome resolved, respectively, in 51 and 56% in the primary group and only in 29 and 33% in the revisional group (p < 0.01). CONCLUSIONS According to BAROS score, revisional LRYGB for failed restrictive procedures provided poorer results than primary LRYGB in terms of weight loss, resolution of comorbidities and QOL.
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Affiliation(s)
- Julie Navez
- Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, 1200, Brussels, Belgium,
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Reslan S, Saules KK, Greenwald MK, Schuh LM. Substance misuse following Roux-en-Y gastric bypass surgery. Subst Use Misuse 2014; 49:405-17. [PMID: 24102253 DOI: 10.3109/10826084.2013.841249] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Post-bariatric surgery patients are overrepresented in substance abuse treatment, particularly those who have had the Roux-en-Y gastric bypass (RYGB) procedure. The severity of the substance use disorder (SUD; i.e., warranting inpatient treatment) and related consequences necessitate a better understanding of the variables associated with post-RYGB SUDs. This investigation assessed factors associated with post-RYGB substance misuse. Post-RYGB patients (N = 141; at least 24 months postsurgery) completed an online survey assessing variables hypothesized to contribute to post-RYGB SUDs. Fourteen percent of participants met criteria for postoperative substance misuse. Those with a lower percent total weight loss (%TWL) were more likely to endorse substance misuse. Family history of substance misuse was strongly associated with postoperative substance misuse. Eating-related variables including presurgical food addiction and postsurgical nocturnal eating, subjective hunger, and environmental responsiveness to food cues were also associated with a probable postoperative SUD. These findings have clinical utility in that family history of substance misuse can be easily assessed, and at-risk patients can be advised accordingly. In addition, those who endorse post-RYGB substance misuse appear to have stronger cognitive and behavioral responses to food, providing some support for the theory of behavioral substitution (or "addiction transfer").
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Affiliation(s)
- Summar Reslan
- 1Department of Psychology, Eastern Michigan University, Ypsilanti, Michigan, USA
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Whitlock KA, Gill RS, Ali T, Shi X, Birch DW, Karmali S. Early Outcomes of Roux-en-Y Gastric Bypass in a Publically Funded Obesity Program. ISRN OBESITY 2013; 2013:296597. [PMID: 24533219 PMCID: PMC3901974 DOI: 10.1155/2013/296597] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 07/16/2013] [Indexed: 11/17/2022]
Abstract
Background. There is limited literature assessing the outcomes of bariatric surgery in a publically funded, North American, multidisciplinary bariatric program. Our objective was to assess outcomes of roux-en-Y gastric bypass (RYGB) in a publically funded bariatric program through a retrospective review of patient records. Methods. 293 patients spent a median of 13 months attending a multidisciplinary obesity clinic prior to undergoing laparoscopic RYGB surgery. The hospital was a Canadian, publically funded, level 2 trauma center with university teaching services. Results. 79% of the patients were female and the average BMI at first visit to clinic was 55.3 kg/m2. The average decrease in BMI was 19.2 ± 0.9 kg/m(2). This was an average absolute weight loss of 56.1 kg or 35.5% of initial weight. The average excess weight loss was 63.4 ± 20.4%. Improvement or resolution of obesity related comorbidities occurred in 65.9% of type 2 diabetics and in 50% of hypertensive patients. Conclusion. Despite this being an unconventional setting of a publically funded program in a large Canadian teaching hospital, early outcomes following RYGB were appropriate in severely obese patients. Ongoing work will identify areas of improvement for enhanced efficiencies within this system.
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Affiliation(s)
- Kevin A. Whitlock
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada T6G 2R7
| | - Richdeep S. Gill
- Department of Surgery, University of Alberta, Edmonton, AB, Canada T6G 2B7
| | - Talal Ali
- Department of Surgery, University of Alberta, Edmonton, AB, Canada T6G 2B7
| | - Xinzhe Shi
- Center for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandia Hospital, Edmonton, AB, Canada T5H 3V9
| | - Daniel W. Birch
- Center for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandia Hospital, Edmonton, AB, Canada T5H 3V9
| | - Shahzeer Karmali
- Center for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandia Hospital, Edmonton, AB, Canada T5H 3V9
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Abstract
Is bariatric surgery as primary therapy for type 2 diabetes mellitus (T2DM) with body mass index (BMI) <35 kg/m(2) justified? Open-label studies have shown that bariatric surgery causes remission of diabetes in some patients with BMI <35 kg/m(2). All such patients treated had substantial weight loss. Diabetes remission was less likely in patients with lower BMI than those with higher BMI, in patients with longer than shorter duration and in patients with lesser than greater insulin reserve. Relapse of diabetes increases with time after surgery and weight regain. Deficiencies of data are lack of randomized long-term studies comparing risk/benefit of bariatric surgery to contemporary intensive medical therapy. Current data do not justify bariatric surgery as primary therapy for T2DM with BMI <35 kg/m(2).
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Affiliation(s)
- Harold E Lebovitz
- Department of Medicine, State University of New York Health Science Center at Brooklyn, Brooklyn, NY, USA.
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Abstract
PURPOSE OF REVIEW Bariatric surgery is an important option for the treatment of severe (type III) obesity. Its role in the management of type 2 diabetes in overweight and obese patients needs to be defined. RECENT FINDINGS Intensified medical therapy can achieve target metabolic goals in many but not all patients with type 2 diabetes. Bariatric surgery can normalize or improve glycemia in severely obese patients with type 2 diabetes. The complications of bariatric surgery are significant and include operative mortality, early and late surgical complications and late nutritional deficiencies. Comparative studies of bariatric surgery versus intensive medical therapy in the management and clinical outcomes of patients with type 2 diabetes are needed to evaluate relative risk/benefit of each. Bariatric surgery studies in type 2 diabetes are lacking long-term follow-up metabolic and clinical outcomes data. SUMMARY Current data are insufficient to recommend bariatric surgery as a primary treatment for type 2 diabetes. However, it can be recommended for patients whose target metabolic control cannot be achieved by intensive glycemic control because of intolerance or inadequate responses to nutritional and pharmacologic treatments.
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Affiliation(s)
- Harold E Lebovitz
- State University of New York Health Science Center at Brooklyn, Brooklyn, New York 11203, USA.
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Victorzon M, Peromaa-Haavisto P, Tolonen P. Perioperative Morbidity, Mortality and Early Outcome of the First 360 Gastric Bypass Operations Performed in a District Hospital. Scand J Surg 2012; 101:184-9. [DOI: 10.1177/145749691210100308] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background and Aims: We report the results for the first consecutive 360 Roux-en-Ygastric bypass (RYGB) operations performed in a district hospital in Finland. Material and Methods: Demographic data, perioperative characteristics, and follow-up data were entered prospectively in the hospital's database for bariatric patients. Results: We performed 325 primary laparoscopic Roux-en-Ygastric bypass (LRYGB) operations, one open RYGB, and 34 revisions. Mean BMI before the operations was 47.5 ± 7.8 kg/m2 (31.5–91.0 kg/m2). The percentage of patients with type 2 diabetes mellitus (T2DM) was high; 52.3% (170 patients). The mean operative time decreased from 110 minutes during the first 108 operations to 82 minutes for the second 108 operations, and to 74 minutes for the last 109 operations (P < 0.001). Postoperative hospital stay was significantly reduced (P < 0.001) for the last 109 patients compared to the first and second group of patients. Overall morbidity averaged 19.1% (62/325). Severe complications were detected in 15 patients (4.6%). There was a tendency to more serious complications in the first group of patients. There was one death (mortality 0.3%). With a follow-up rate of 97% at 3 months T2DM had resolved in 48.2%, and had resolved or improved in a minimum of 92.9% of the diabetic patients. Weight loss (WL) and excess weight loss (EWL) averaged 20% and 46% respectively. Conclusions: Operative time and postoperative hospital stay decrease significantly with increasing experience. The first one hundred patients may be at higher risk for complications. LRYGB operations may have an important impact on the resolution of T2DM in the operated population.
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Affiliation(s)
- M. Victorzon
- Department of Gastrointestinal Surgery, Vaasa Central Hospital, Vaasa, Finland
| | - P. Peromaa-Haavisto
- Department of Gastrointestinal Surgery, Hatanpää District Hospital, Tampere, Finland
| | - P. Tolonen
- Department of Gastrointestinal Surgery, Vaasa Central Hospital, Vaasa, Finland
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Avriel A, Warner E, Avinoach E, Avnon LS, Shteinberg M, Shteinberg D, Heimer D, Yona S, Maimon N. Major respiratory adverse events after laparascopic gastric banding surgery for morbid obesity. Respir Med 2012; 106:1192-8. [PMID: 22673900 DOI: 10.1016/j.rmed.2012.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 02/20/2012] [Accepted: 05/10/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding surgery has become one of the most common restrictive surgical procedures for treatment of morbid obesity worldwide. Although short-term respiratory complications are well known, long-term data is scarce. We investigated the manifestations of major pulmonary complications showed at least six months after the procedure. METHODS A retrospective cohort study was conducted at a tertiary university medical center in the five years period of 2006-2010. We included every patient who had had major respiratory complication who needed hospitalization, at least 6 months after laparoscopic adjustable gastric banding procedure. Demographic, pre-operative and post-operative clinical data were collected. We documented respiratory symptoms, results of physical examination, pulmonary function tests, and imaging as well as therapies given and outcome. RESULTS Out of 2100 patients who underwent LAGB, thirty subjects, mean age of 45.7 (range 29-64) with an equal number of males and females were included. Mean interval between operation and onset of respiratory symptoms was 51.5 months (range 10-150 months). All had dyspeptic complaints which included: regurgitation, fullness after meals, dysphagia and food aspiration with esophageal dilatation. Major respiratory complications included aspiration pneumonia (19) including pulmonary abscess (4) and empyema (2), exacerbation of asthma (3) and hemoptysis (1). Additionally we documented the emergence of chronic diseases such as interstitial lung disease (5) and bronchiectasis (3). One patient developed acute respiratory distress syndrome due to aspiration pneumonia and eventually died in the intensive care unit. The main mode of therapy was deflation of the gastric band. Those who refused to deflate or remove the gastric banding continued to suffer from dyspeptic and respiratory symptoms including recurrent pulmonary abscess. CONCLUSION Although laparoscopic adjustable gastric banding surgery has few short-term risks and is highly effective at achieving weight reduction, we found an increased risk for major respiratory complications in the long-term period. The obesity epidemic and the increased use of surgical techniques to treat obesity will most likely lead to an increase in the incidence of long-term post-operative respiratory complications. This entity is probably under-reported and needs further research into how to reduce its incidence and morbidity.
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Affiliation(s)
- Avital Avriel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Department of Internal Medicine, Pulmonology Institute, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 84000, Israel
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Khawali C, Ferraz MB, Zanella MT, Ferreira SRG. Evaluation of quality of life in severely obese patients after bariatric surgery carried out in the public healthcare system. ACTA ACUST UNITED AC 2012; 56:33-8. [DOI: 10.1590/s0004-27302012000100006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 12/27/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVES: To assess QoL of obese patients in the Brazilian public healthcare system, before and after bariatric surgery, and to determine the appropriateness of the Moorehead-Ardelt Questionnaire II (M-A-QoLQII) compared with the Short-Form Health Survey (SF-36). SUBJECTS AND METHODS: Forty-one severe obese patients in a waiting-list, and 84 patients who underwent bariatric surgery were included. Correlations were tested and reliability determined by the Cronbach's coefficient. RESULTS: BMI differed between the pre- and post-surgery groups (52.3 ± 8.3 kg/m² vs. 32.5 ± 6.4 kg/m², p < 0.001). The latter showed better scores in the SF-36 domains than in the pre-surgery. SF-36 and M-A-QoLQII categories were correlated (r = 0.53, 0.49 and 0.47, for vitality, mental health, and general health domains, p < 0.001). In the logistic regression, age, previous BMI, and loss of excess weight were associated with functional capacity. CONCLUSIONS: The outcomes of bariatric surgery obtained in a Brazilian public healthcare center were successful. M-A-QoLII represents a useful tool to assess surgery outcomes, including QoL.
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Food quality, physical activity, and nutritional follow-up as determinant of weight regain after Roux-en-Y gastric bypass. Nutrition 2012; 28:53-8. [DOI: 10.1016/j.nut.2011.01.011] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 01/24/2011] [Accepted: 01/28/2011] [Indexed: 01/08/2023]
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Laparoscopic Roux-en-Y gastric bypass: significant long-term weight loss, improvement of obesity-related comorbidities and quality of life. Ann Surg 2011; 254:267-73. [PMID: 21772127 DOI: 10.1097/sla.0b013e3182263b66] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To present long-term results of a large series of patients submitted to laparoscopic Roux-en-Y gastric bypass (RYGBP) for morbid obesity. BACKGROUND Reports on long-term results of RYGBP are scarce and focus primarily on weight loss. Our aim is to provide mid- to long-term data of RYGBP, with detailed results on weight loss, evolution of comorbidities and quality of life, also using the BAROS score. METHODS All patients who underwent a primary RYGBP for morbid obesity in our 2 hospitals between 1999 and August 2008 were included. Data were collected prospectively in a computerized database, and reviewed for the purpose of this study. RESULTS A total of 379 patients were included in the analysis of long-term results, 282 women, and 97 men, with a mean BMI of 46.3 kg/m². After 5 years, 74.9% of the patients achieved an excess weight loss of at least 50%, with a mean of 62.7% and 76.8% achieved a BMI <35 kg/m². The corresponding figures after 7 years were 64.9, 58.1, and 71.9, respectively. There was a small but significant long-term weight regain. All comorbidities improved markedly in the vast majority of patients, with no significant difference between the 3- and 5-year terms. Quality of life also improved markedly, and more than 95% of the patients had a good to excellent 5-year overall result according to the BAROS score. CONCLUSIONS Laparoscopic RYGBP for morbid obesity results in good and maintained weight loss up to 7 years in the majority of patients, improves quality of life and markedly improves all the evaluated comorbidities, resulting in good to excellent overall 5-year results in 97% of the patients according to the BAROS score.
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Xavier MAF, Ceneviva R, Terra Filho J, Sankarankutty AK. Pulmonary function and quality of life in patients with morbid obesity six months after bariatric surgery. Acta Cir Bras 2011; 25:407-15. [PMID: 20877950 DOI: 10.1590/s0102-86502010000500005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 05/18/2010] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To investigate the body weight, pulmonary function and quality of life of twenty patients with morbid obesity six months after the Fobi-Capella operation. METHODS Patients were evaluated before and six months after surgery. The patients were mainly female (75%), the average age was 40.5 ± 10.27 years; average weight 110.11 kg ± 21.77 and average body mass index (BMI) 39.93 ± 7.13 kg/m² in the postoperative evaluation. Pulmonary function was assessed by spirometry using a Pulmonet/Godart NV Bilt Vetr Hotland spirometer and quality of life was assessed by applying the Moorehead-Ardelt questionnaire. The pre- and postoperative spirometry values were compared by the paired Student t test and the correlation between weight loss and pulmonary function was determined by linear regression, with the level of significance set at p < 0.05. RESULTS The spirometry variables Respiratory Frequency (RF), Expiratory Reserve Volume (ERV) and Functional Residual Capacity (FRC) differed significantly between the pre- and postoperative periods, whereas Residual Volume (RV), Vital Capacity (VC), Total Lung Capacity (TLC), FEF25-75 (Forced Expiratory Flow between 25 and 75% FVC) and FEV1/FVC% (Forced Expiratory Volume in the 1st second/ Forced Vital Capacity ratio) did not differ between periods. Only one patient reported worsening of quality of life. There was a positive correlation between weight loss and ERV (p=0.0117, r=0.5514), but no correlations were observed for the other variables. CONCLUSIONS There was a significant weight loss and an improvement of pulmonary function as seen by respiratory frequency, reduction and increased expiratory reserve volume and functional residual capacity. The quality of life of the patients also improved after the Fobi-Capella operation.
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Affiliation(s)
- Márcia Arruda Fajardo Xavier
- Department of Surgery and Anatomy, Faculty of Medicine of Ribeirao Preto, University Hospital, USP, Sao Paulo, Brazil.
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Sommer T, Larsen JF, Raundahl U. Eliminating Learning Curve–Related Morbidity in Fast Track Laparoscopic Roux-en-Y Gastric Bypass. J Laparoendosc Adv Surg Tech A 2011; 21:307-12. [DOI: 10.1089/lap.2010.0569] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
BACKGROUND The aggressive pursuit of weight loss in the elderly remains a controversial objective. In this series of 113 patients over 60 years of age who underwent laparoscopic gastric banding surgery, we report on complications, co-morbidity change, quality-of-life improvement and changes in medication use over a median follow-up period of 25.5 months. METHODS A prospectively kept database was reviewed from January 1999 to September 2008 identifying patients over 60 who underwent gastric banding surgery. Baseline and follow-up SF-36® survey scores were compared longitudinally. Co-morbidity change and medication use were assessed by questionnaire and electronic record review. RESULTS Major complications were experienced by 7.1% over the follow-up period with a re-operation rate of 15.0%. Excess BMI loss was 44.1% after 5 years and combined mean SF-36® quality-of-life scores (out of 100) improved 22.1 points, achieving parity with age-matched norms for the general population. Diabetes improved in 74.2% with hypertension, hyperlipidaemia and depression improving in 57.1, 51.1 and 35.9% of cases. A significant drop in medication use was not seen, and cancer was responsible for three deaths over the follow-up period. No surgical mortality was incurred. CONCLUSION Laparoscopic gastric banding can markedly improve quality of life for morbidly obese over 60s. Health gains are significant, but medication use is not substantially altered. Gastric banding is an ideal weight loss operation for this age group due to its safety and efficacy, and the primary goal should be quality-of-life improvement.
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Däster S, Borbély Y, Peterli R. Acute pancreatitis after Roux-en-Y gastric bypass surgery due to reflux into biliopancreatic limb. Surg Obes Relat Dis 2011; 8:e37-9. [PMID: 21459684 DOI: 10.1016/j.soard.2011.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 02/09/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Silvio Däster
- Department of Surgery, St. Claraspital, Basel, Switzerland.
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Marsicano JA, Grec PGDM, Belarmino LB, Ceneviva R, Peres SHDCS. Interfaces between bariatric surgery and oral health: a longitudinal survey. Acta Cir Bras 2011; 26 Suppl 2:79-83. [DOI: 10.1590/s0102-86502011000800015] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE: To evaluate oral changes, such as dental caries, periodontal disease, dental wear and salivary flow in bariatric patients. Fifty four obese patients who underwent bariatric surgery were studied before (n=54), up after 3 months (n=24) and 6 months (n=16). METHODS: Indices for evaluating oral conditions were: DMFT, CPI, DWI and salivary flow. OIDP questionnaire was used to assess the impact of oral health on quality of life. ANOVA and Spearman correlation were used (p<0.05). RESULTS: DMFT was 17.6±5.7, 18.4±4.1 and 18.3±5.5 (P>0.05), presence of periodontal pockets in 50%, 58% and 50% of patients (p>0.05), tooth wear in dentin present in 81.5%, 87.5% and 87.5% before, 3 and 6 months after surgical treatment respectively. There were differences between the three periods for prevalence and severity of dental wear (p = 0.012). Salivary flow was 0.8±0.5 ml/min before surgery, 0.9±0.5 ml/min for 3 months and 1.1±0.5m/min for 6 months (p>0.05). The impact of oral health on quality of life decreased with time after bariatric surgery (p= 0.029). CONCLUSION: The lifestyle changes after bariatric surgery and these changes may increase the severity of pre-existing dental problems. However, these alterations in oral health did not influence the quality of life.
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10-year follow-up of laparoscopic vertical banded gastroplasty: good results in selected patients. Ann Surg 2010; 252:831-9. [PMID: 21037439 DOI: 10.1097/sla.0b013e3181fd35b0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the long-term results of laparoscopic vertical banded gastroplasty (VBG) for morbid obesity. BACKGROUND Laparoscopic VBG, a safe and straightforward bariatric procedure characterized by good short-term results, has been progressively replaced by other more complex procedures on the basis of a presumed high rate of long-term failure. Nevertheless, some authors have recently reported long-term efficacy in selected patients. METHODS All patients who underwent laparoscopic VBG were included in a prospective database. Patients reaching 10-year follow-up received a complete evaluation including clinical, endoscopic, and biochemical examinations. RESULTS Between January 1996 and March 1999, 266 morbidly obese patients underwent bariatric procedures. Among them, 213 were selected for laparoscopic VBG; exclusion criteria were as follows: contraindications to pneumoperitoneum, gastroesophageal reflux disease, and psychological contraindications to restrictive procedures. Mean age, preoperative weight, and body mass index were 36.9 years, 123.6 kg, and 45.4 kg/m, respectively. Intraoperative complication rate and conversion rate were 0.9% and 0.9%, respectively. Early postoperative complication rate was 4.2% and early reoperation rate was 0.5%. Mean hospital length of stay was 6.3 days. Mortality was nil. The 10-year follow-up rate was 70.4% (150 patients). Late postoperative complication rate was 14.7%, and 10-year revisional surgery rate was 10.0%. The excess weight loss percentages at 3, 5, and 10 years were 65.0%, 59.9%, and 59.8%, respectively. The resolution and/or improvement rate for comorbidity were 47.5% for hypertension, 55.6% for diabetes, 75% for sleep apnea, and 47.4% for arthritis. Mean Moorehead-Ardelt Quality of Life Questionnaire and BAROS values were 1.4 and 3.8, respectively. CONCLUSIONS The present study demonstrates that laparoscopic VBG in carefully selected patients leads to long-term results comparable with more complex and invasive procedures. Given the low postoperative morbidity for laparoscopic VBG, its present clinical role should be, in our opinion, reevaluated.
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Naef M, Mouton WG, Wagner HE. Small-bowel volvulus in late pregnancy due to internal hernia after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2010; 20:1737-9. [PMID: 19184255 DOI: 10.1007/s11695-009-9802-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 01/08/2009] [Indexed: 12/25/2022]
Abstract
Internal hernias are a specific cause of acute abdominal pain and are a well-known complication after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Although internal hernias are a rare cause of intestinal obstruction, they may evolve towards serious complications, such as extensive bowel ischemia and gangrene, with the need for bowel resection and sometimes for a challenging reconstruction of intestinal continuity. The antecolic position of the Roux limb is associated with a decrease in the incidence of small-bowel obstruction and internal hernias. The best prevention of the formation of these hernias is probably by closure of potential mesenteric defects at the initial operation with a non-absorbable running suture. We present a patient in late pregnancy with a small-bowel volvulus following laparoscopic Roux-en-Y gastric bypass for morbid obesity and discuss the available literature. For a favorable obstetric and neonatal outcome, it is crucial not to delay surgical exploration and an emergency operation usually is mandatory.
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Affiliation(s)
- Markus Naef
- Department of Surgery, Spital STS AG Thun, Thun, Switzerland.
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23
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Al Harakeh AB, Larson CJ, Mathiason MA, Kallies KJ, Kothari SN. BAROS results in 700 patients after laparoscopic Roux-en-Y gastric bypass with subset analysis of age, gender, and initial body mass index. Surg Obes Relat Dis 2010; 7:94-8. [PMID: 21126928 DOI: 10.1016/j.soard.2010.09.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 07/20/2010] [Accepted: 09/24/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND The Bariatric Analysis and Reporting Outcome System (BAROS) uses a point scale (maximal score of 9) to evaluate weight loss, complications, improvement in medical conditions, and quality of life among postoperative bariatric patients. The BAROS was originally developed to address the need for a standardized method of reporting open gastric bypass outcomes and has been shown to be both valid and reliable. BAROS scores >7 are considered "excellent." Our objective was to assess the overall BAROS scores in patients undergoing laparoscopic Roux-en-Y gastric bypass at each postoperative follow-up interval and to examine the effect of age and gender on BAROS scores. METHODS A total of 700 patients who had undergone LRYGB were asked to complete a BAROS questionnaire at their postoperative visits. The BAROS scores were recorded in a prospective database. The patients were stratified by their initial age and body mass index. The statistical analysis included analysis of variance. P <.05 was considered significant. RESULTS The mean BAROS score peaked at 7.29 at the 18-month appointment. More than one half of the patients presenting for follow-up visits at 12, 18, 24, and 36 months had BAROS scores in the "excellent" range. Age stratification (20-29, 30-39, 40-49, and ≥ 50 years) resulted in significant differences at 3, 6, 9, 12, and 18 months postoperatively. When stratified by the initial body mass index, differences were seen at 3 weeks and 3, 6, 9, and 12 months postoperatively. CONCLUSION Patients with a lower initial body mass index had greater BAROS scores at many of the follow-up intervals. Laparoscopic Roux-en-Y gastric bypass effectively improved the overall health and quality of life of patients.
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Affiliation(s)
- Ayman B Al Harakeh
- Minimally Invasive Bariatric and Advanced Laparoscopic Fellowship, Department of Medical Education, Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin 54601, USA
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Chang CY, Huang CK, Chang YY, Tai CM, Lin JT, Wang JD. Prospective study of health-related quality of life after Roux-en-Y bypass surgery for morbid obesity. Br J Surg 2010; 97:1541-6. [PMID: 20645295 DOI: 10.1002/bjs.7179] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the effects of Roux-en-Y gastric bypass for morbid obesity on health-related quality of life (QOL) during the first year of follow-up. METHODS The World Health Organization Quality of Life-Brief (WHOQOL-BREF) was administered 1 month before operation, and at 1, 3, 6 and 12 months after surgery. Body mass index, co-morbidities and operation-related complications were measured at these times. A mixed-effect model was constructed to analyse repeated measurements and determine the relationships between body mass index, WHOQOL-BREF scores and other variables. RESULTS A total of 102 patients were enrolled. The mixed-effect model showed that the physical, psychological and social domains improved after bariatric surgery, with simultaneous reduction in weight and improvement in co-morbidities. There was a dip in scores in physical and psychological domains 3-6 months after surgery, significantly related to complications. All patients gradually improved between 6 and 12 months after surgery, reaching levels similar to those of healthy subjects. CONCLUSION Health-related QOL improved dramatically after bariatric surgery, dipped slightly between 3 and 6 months, and improved again up to the end of the first year.
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Affiliation(s)
- C-Y Chang
- Department of Internal Medicine, I-Shou University, Kaohsiung, Taiwan
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Spector D, Perry Z, Konobeck T, Mooradian D, Shikora S. Comparison of hemostatic properties between collagen and synthetic buttress materials used in staple line reinforcement in a swine splenic hemorrhage model. Surg Endosc 2010; 25:1148-52. [PMID: 20835722 DOI: 10.1007/s00464-010-1331-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 08/07/2010] [Indexed: 01/26/2023]
Abstract
INTRODUCTION The use of staplers in gastrointestinal surgery is widespread, especially in advanced laparoscopic procedures. Staple line reinforcement with a buttress reduces bleeding and associated complications through a combination of factors. The intrinsic hemostatic properties of buttress materials have not been examined. This study examined the intrinsic hemostatic properties of two different types of material used in buttressing in an accepted hemostasis model that does not involve stapling or its effects by compression. MATERIALS An acellular collagen buttress (Veritas) and a synthetic polymer buttress (Duet) were compared to two commonly used hemostatic agents, Syvek and Surgicel, with gauze as control. METHODS In a swine capsular stripping hemostasis model, a 1 × 1 cm section of spleen capsule was removed and used as a source of bleeding, with one patch of material tested per bleeding site. A total of 51 wounds were created in five pigs (each patch n = 10, control n = 11). Hemostatic efficacy was assessed by quantitating the number of applications and total time needed for bleeding to stop. RESULTS The mean time needed for hemostasis for Syvek and Veritas patches was significantly less than gauze, Duet and Surgicel (4.02, 4.51 vs. 8.97, 9.22, and 10.30 min respectively; p < 0.05). The Syvek and Veritas patches required significantly fewer applications than gauze, Duet™ and Surgicel (1.7, 2.2 vs. 4.1, 4.6, and 4.9 respectively; p < 0.01). CONCLUSIONS The intrinsic hemostatic properties of different buttressing materials vary widely. In this study, a collagen buttress was significantly better at promoting hemostasis than the synthetic buttress material in a nonstapling model. This could be another factor to consider when choosing a buttress for staple line reinforcement.
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Affiliation(s)
- David Spector
- Department of Surgery, Tufts Medical Center, 800 Washington St, Box # 437, Boston, MA 02111, USA.
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Graft Survival and Complications after Laparoscopic Gastric Banding for Morbid Obesity—Lessons Learned from a 12-Year Experience. Obes Surg 2010; 20:1206-14. [DOI: 10.1007/s11695-010-0205-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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27
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Chiu CC. Randomized clinical trial of laparoscopic gastric bypass versus laparoscopic duodenal switch for superobesity (Br J Surg 2010; 97: 160-166). Br J Surg 2010; 97:960; author reply 960-1. [PMID: 20474012 DOI: 10.1002/bjs.7142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Laurenius A, Taha O, Maleckas A, Lönroth H, Olbers T. Laparoscopic biliopancreatic diversion/duodenal switch or laparoscopic Roux-en-Y gastric bypass for super-obesity-weight loss versus side effects. Surg Obes Relat Dis 2010; 6:408-14. [PMID: 20655023 DOI: 10.1016/j.soard.2010.03.293] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 02/27/2010] [Accepted: 03/25/2010] [Indexed: 01/01/2023]
Abstract
BACKGROUND Laparoscopic biliopancreatic diversion/duodenal switch (LDS) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the main surgical options for super-obese patients (body mass index >50 kg/m(2)). METHODS We performed a medium long-term evaluation of 13 super-obese patients who had undergone LDS compared with a control group of 19 patients who had undergone LRYGB. The patients were assessed 31 months (range 17-38) and 34 months (range 26-62) after LDS and LRYGB, respectively, for body mass index changes, relief of co-morbidities, nutrition, quality of life, postoperative bowel function, and accumulated healthcare consumption. RESULTS The mean body mass index decreased from 54.9 to 30.0 kg/m(2) in the LDS group and 57.8 to 39.8 kg/m(2) in the LRYGB group (P = .005). The hemoglobin A1c level was lower in the LDS group than in the LRYGB group (3.8 +/- .31% versus 4.3 +/- .43%, respectively; P = .01). The LDS patients reported greater energy intake than the LRYGB patients (3132 +/- 1392 kcal versus 2014 +/- 656 kcal, respectively; P = .021). The number of stools daily was 4.1 +/- 3.3 in the LDS group and 1.9 +/- 1.1 in the LRYGB group, P = .0482). Of the 12 patients in the LDS group, 6 reported fecal incontinence or soiling compared with 2 of 16 in the LRYGB group (P = .034). The number of outpatient visits was 5.6 +/- 4.6 for the LDS group and 2.0 +/- 1.9 for the LRYGB group (P = .016), and the number of telephone consultations was 5.0 +/- 5.6 and 1.4 +/- 1.6 for the LDS and LRYGB groups, respectively (P = .043). CONCLUSION LDS resulted in greater weight loss than LRYGB in super-obese patients. However, the LDS patients in our series had more frequent gastrointestinal side effects, required greater doses of calcium and vitamin supplementation, and required more postoperative monitoring. Patient satisfaction was high in both groups.
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Affiliation(s)
- Anna Laurenius
- Department of Clinical Nutrition, Sahlgrenska University Hospital, Gastrosurgical Research, Sahlgrenska Academy, Gothenburg, Sweden.
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Søvik TT, Taha O, Aasheim ET, Engström M, Kristinsson J, Björkman S, Schou CF, Lönroth H, Mala T, Olbers T. Randomized clinical trial of laparoscopic gastric bypass versus laparoscopic duodenal switch for superobesity. Br J Surg 2010; 97:160-6. [PMID: 20035530 DOI: 10.1002/bjs.6802] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic biliopancreatic diversion with duodenal switch (LDS) are surgical options for superobesity. A randomized trial was conducted to evaluate perioperative (30-day) safety and 1-year results. METHODS Sixty patients with a body mass index (BMI) of 50-60 kg/m(2) were randomized to LRYGB or LDS. BMI, percentage of excess BMI lost, complications and readmissions were compared between groups. RESULTS Patient characteristics were similar in the two groups. Mean operating time was 91 min for LRYGB and 206 min for LDS (P < 0.001). One LDS was converted to open surgery. Early complications occurred in four patients undergoing LRYGB and seven having LDS (P = 0.327), with no deaths. Median stay was 2 days after LRYGB and 4 days after LDS (P < 0.001). Four and nine patients respectively had late complications (P = 0.121). Mean BMI at 1 year decreased from 54.8 to 38.5 kg/m(2) after LRYGB and from 55.2 to 32.5 kg/m(2) after LDS; percentage of excess BMI lost was greater after LDS (74.8 versus 54.4 per cent; P < 0.001). CONCLUSION LRYGB and LDS can be performed with comparable perioperative safety in superobese patients. LDS provides greater weight loss in the first year.
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Affiliation(s)
- T T Søvik
- Departments of Gastrointestinal Surgery, Oslo University Hospital Aker, Oslo, Norway.
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30
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Three Hundred Laparoscopic Roux-en-Y Gastric Bypasses: Managing the Learning Curve in Higher Risk Patients. Obes Surg 2009; 20:290-4. [DOI: 10.1007/s11695-009-9914-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 06/24/2009] [Indexed: 10/20/2022]
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Lim CSH, Liew V, Talbot ML, Jorgensen JO, Loi KW. Revisional bariatric surgery. Obes Surg 2008; 19:827-32. [PMID: 18972173 DOI: 10.1007/s11695-008-9750-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2008] [Accepted: 10/08/2008] [Indexed: 01/14/2023]
Abstract
BACKGROUND Revisional surgery is required in a significant number of patients because of failure to lose weight, loss of quality of life, weight regain, or complications of the previous procedure. It has traditionally been associated with higher complication rates, and there appears to be no standardized surgical approach to revisional surgery. The aim of the study was to review the revisional procedures performed at St George Private Hospital and analyze the outcomes of the different types of revisional surgery. METHODS We performed a retrospective review of 75 patients who underwent revisional surgery between December 2003 and October 2007. Demographic, anthropometric, perioperative, and clinical follow-up data were collected, and statistical analyses were performed using SPSS version 14.0. RESULTS Sixty-six of the 75 patients were female. The mean age at the time of revision was 46.32 (22-68) years. Mean initial weight was 119.08 kg, and body mass index (BMI) was 43.42 kg/m(2). The lowest BMI and excess weight loss (EWL) recorded after primary surgery was 36.9% and 53.5%, respectively. At the time of revision, the mean EWL was 24.79. The EWL at 3 months and 6 months were 41.7% and 47.8%, respectively. Revision was performed laparoscopically in 51 patients and via laparotomy in 24 patients. There was no mortality in the cohort, but there were 17.3% minor and 4.0% major perioperative morbidities. CONCLUSION Our study suggests that revision can be performed safely. Weight loss is satisfactory, and complications of the previous operations were all reversed. Furthermore, revisions may be done laparoscopically, including those who had previous open procedures.
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Affiliation(s)
- C S H Lim
- Department of Upper Gastrointestinal, Advanced Laparoscopic and Bariatric Surgery, St George Hospital, New South Wales, 2217, Australia.
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Vagenas K, Panagiotopoulos S, Kehagias I, Karamanakos SN, Mead N, Kalfarentzos F. Prospective evaluation of laparoscopic Roux en Y gastric bypass in patients with clinically severe obesity. World J Gastroenterol 2008; 14:6024-9. [PMID: 18932281 PMCID: PMC2760188 DOI: 10.3748/wjg.14.6024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate and present our experience with laparoscopic Roux en Y gastric bypass (RYGB) in a selected patient population.
METHODS: A cohort of 130 patients with a body mass index (BMI) between 35 and 50 kg/m2 were evaluated in relation to postoperative morbidity, weight loss and resolution of co-morbidities for a period of 4 years following laparoscopic RYGB.
RESULTS: Early morbidity was 10.0%, including 1 patient with peritonitis who was admitted to Intensive Care Unit (ICU) and 1 conversion to open RYGB early in the series. There was no early or late mortality. Maximum weight loss was achieved at 12 mo postoperatively, with mean BMI 30 kg/m2, mean percentage of excess weight loss (EWL%) 66.4% and mean percentage of initial weight loss (IWL%) 34.3% throughout the follow-up period. The majority of preexisting comorbidities were resolved after weight loss and no major metabolic disturbances or nutritional deficiencies were observed.
CONCLUSION: Laparoscopic RYGB appears to be a safe and effective procedure for patients with BMI 35-50 kg/m2 with results that are comparable to previously published data mostly from the USA but from Europe as well.
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Laparoscopic totally stapled entero-enterostomy: a safe and reproducible new technique. Obes Surg 2008; 18:513-6. [PMID: 18347884 DOI: 10.1007/s11695-007-9272-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 06/07/2007] [Indexed: 01/11/2023]
Abstract
BACKGROUND Laparoscopic gastric bypass for morbid obesity is a technically demanding procedure partially because of the necessity to construct two anastomoses. In this study, a new technique to perform the entero-enterostomy is presented. METHODS We evaluated the procedure in a consecutive series of 100 patients who underwent laparoscopic gastric bypass. Intra- and postoperative complications were analyzed. RESULTS No complications in relation to the construction of the entero-enterostomy occurred. No leakage, kinking, or stenosis was observed during a mean follow-up of 13.5 months (range 6-20 months). CONCLUSION This new technique for a totally stapled entero-enterostomy can be recommended.
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Perathoner A, Weiss H, Santner W, Brandacher G, Laimer E, Höller E, Aigner F, Klaus A. Vagal nerve dissection during pouch formation in laparoscopic Roux-Y-gastric bypass for technical simplification: does it matter? Obes Surg 2008; 19:412-7. [PMID: 18704604 DOI: 10.1007/s11695-008-9657-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 06/27/2008] [Indexed: 01/11/2023]
Abstract
BACKGROUND In Roux-Y gastric bypass surgery pouch formation is the most demanding part of the operation. The vagal nerve is usually tempted to be preserved although results reporting beneficial effects are lacking. Dividing the perigastric tissue including the anterior vagal trunk may technically alleviate gastric pouch formation. We evaluated the clinical outcome in patients with and without vagal nerve dissection in patients after Roux-Y gastric bypass (RY-BP). METHODS In this study 40 morbidly obese patients undergoing RY-BP have been included. Patients were divided into two groups according to vagal nerve preservation (Group 1, n = 25) or vagal nerve dissection (Group 2, n = 22). Clinical parameters (weight loss, complications, gastrointestinal symptoms), esophageal endoscopy, and motility data (manometry, pH-metry) and a satiety score were assessed. Serum values of ghrelin and gastrin were measured. RESULTS All procedures were performed by laparoscopy with a 0% mortality rate. One patient of each groups necessitated redo-laparoscopy (bleeding and a lost drainage). All patients significantly reduced body weight (p < 0.01 compared to preoperative) during a median follow-up of 36.1 months. Two patients of Group 2 showed acid reflux demonstrated by pathologic postoperative DeMeester scores. Esophageal body peristalsis and barium swallows did not reveal statistically significant differences between the two groups. Parameters of satiety assessment did not differ between the two groups as did serum values of gastrin and ghrelin. CONCLUSION Pouch formation during RY-BP may be alleviated by simply dissecting the perigastric fatty tissue. In this way the anterior vagal trunk is dissected, however, no influence on clinical, functional and laboratory results occur.
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Affiliation(s)
- A Perathoner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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Conversion of failed laparoscopic gastric banding to gastric bypass as safe and effective as primary gastric bypass in morbidly obese patients. Surg Obes Relat Dis 2008; 4:735-9. [PMID: 18586570 DOI: 10.1016/j.soard.2008.03.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Revised: 02/26/2008] [Accepted: 03/06/2008] [Indexed: 11/22/2022]
Abstract
BACKGROUND To determine whether the medium-term outcome of secondary gastric bypass (SGB) after laparoscopic adjustable gastric banding (LAGB) is comparable to the outcome of primary gastric bypass (PGB) in morbidly obese patients in terms of complications and weight loss. Controversy exists among bariatric surgeons regarding the choice of primary operation for morbid obesity. Some prefer to start with LAGB as a low-risk operation for all patients and perform revisional surgery in the case of failure. Others prefer to tailor the primary operation to the individual patient. METHODS A total of 55 patients who had undergone SGB after failed LAGB from 2002 to 2006 were compared with 81 patients who had undergone PGB for morbid obesity during the same period in our hospital by a single surgeon. RESULTS The mean operative time in the PGB group was shorter (73 +/- 22 min, range 50-100) compared with the SGB group (99 +/- 32 min, range 55-180; P <.001). The median length of admission did not differ significantly between the PGB and SGB groups (4 +/- 6.6 d, range 3-55, versus 4 +/- 2.9 d, range 3-16, respectively; P = .13). No significant differences were found in the occurrence of complications between the PGB and SGB groups (29.6% versus 30.9%, respectively, P = .87). No patient died. At 2 and 3 years postoperatively, no significant difference was found in percentage of patients treated with good or excellent outcomes using the criteria of MacLean (2 y, PGB 60.0% versus SGB 58.8%, P = .94; 3 y, PGB 75.0% versus SGB 72.7%, P = .91). CONCLUSION In this series, gastric bypass as a secondary procedure after failed LAGB was as safe and effective as PGB. Conversion to gastric bypass appears to be the treatment of choice after failed LAGB.
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Søvik TT, Aasheim ET, Kristinsson J, Schou CF, Diep LM, Nesbakken A, Mala T. Establishing laparoscopic Roux-en-Y gastric bypass: perioperative outcome and characteristics of the learning curve. Obes Surg 2008; 19:158-165. [PMID: 18566869 DOI: 10.1007/s11695-008-9584-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Accepted: 05/23/2008] [Indexed: 01/14/2023]
Abstract
BACKGROUND Bariatric surgery was established at several Norwegian hospitals in 2004. This study evaluates the perioperative outcome and the learning curves for two surgeons while introducing laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS Morbidly obese patients undergoing primary LRYGB were included. Lengths of surgery and postoperative hospital stay, and 30-day rates of morbidity, reoperations, and readmissions were set as indicators of the learning curve. Learning effects were evaluated by graphical analyses and comparing the first and last 40 procedures for both surgeons. RESULTS The 292 included patients had a mean age of 40.0 +/- 9.5 years and a mean body mass index (BMI) of 46.7 +/- 5.3 kg/m(2). The mean length of surgery was 101 +/- 55 min. Complications occurred in 43 patients (14.7%), with no conversions to open surgery in the primary procedure and no mortality. Reoperations were performed in 14 patients (4.8%), of which five patients required open surgery. The median length of stay was 3 days (range 1-77), and 19 patients (6.5%) were readmitted. High patient age, but not high BMI, was associated with an increased risk of complication. For both surgeons, lengths of surgery and hospital stay were significantly reduced (p < 0.001), leveling out after 100 procedures. Reductions in the rates of morbidity, reoperations and readmissions were not found. CONCLUSION LRYGB was introduced with an acceptable morbidity rate and no mortality. Only the length of surgery and postoperative hospital stay were suitable indicators of a learning curve, which comprised about 100 cases.
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Affiliation(s)
| | - Erlend T Aasheim
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Medicine, Aker University Hospital, Trondheimsveien 235, 0514, Oslo, Norway
| | - Jon Kristinsson
- Department of Gastrointestinal Surgery, Aker University Hospital, Trondheimsveien 235, 0514, Oslo, Norway
| | - Carl Fredrik Schou
- Department of Gastrointestinal Surgery, Aker University Hospital, Trondheimsveien 235, 0514, Oslo, Norway
| | - Lien My Diep
- Aker University Hospital Research Center, Trondheimsveien 235, 0514, Oslo, Norway
| | | | - Tom Mala
- Department of Gastrointestinal Surgery, Aker University Hospital, Trondheimsveien 235, 0514, Oslo, Norway
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Laparoscopic Roux-en-Y gastric bypass for morbidly obese Chinese patients: learning curve, advocacy and complications. Obes Surg 2008; 18:776-81. [PMID: 18483835 DOI: 10.1007/s11695-007-9373-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Accepted: 11/14/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (LRYGB) involves a combination of both restrictive and mal-absorptive mechanisms and has become the procedure of choice for patients with morbid obesity in Western countries. However, its efficacy remains uncertain in Asian populations. We report our pilot experience with LRYGB in a Chinese population. METHODS Between August 2005 and February 2007, 100 morbidly obese patients received LRYGB. We evaluated the learning curve for the operation, its efficacy in weight reduction, and its postoperative complications. RESULTS Surgical time reached a plateau after about 50 cases, decreasing from 216 min for the initial 50 patients to 105 min for the final 50. The conversion rate from laparoscopic to open surgery was 2%. The mean percent body mass index loss was 33.9% after 12 months. Twenty-four complications occurred in 18 patients, but most resolved with conservative treatment without mortality. Patients with advanced age (P = 0.04) or hypertension (P = 0.03) were at increased risk for complications leading to prolonged surgical times and hospital stays. The complication rate declined as technical expertise increased. CONCLUSION In Chinese patients with morbid obesity, LRYGB is promising procedure because of its acceptable learning curve, good efficacy, and low complication rate.
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Buttressing staples with cholecyst-derived extracellular matrix (CEM) reinforces staple lines in an ex vivo peristaltic inflation model. Obes Surg 2008; 18:1418-23. [PMID: 18459017 DOI: 10.1007/s11695-008-9518-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Accepted: 03/25/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Staple line leakage and bleeding are the most common problems associated with the use of surgical staplers for gastrointestinal resection and anastomotic procedures. These complications can be reduced by reinforcing the staple lines with buttressing materials. The current study reports the potential use of cholecyst-derived extracellular matrix (CEM) in non-crosslinked (NCEM) and crosslinked (XCEM) forms, and compares their mechanical performance with clinically available buttress materials [small intestinal submucosa (SIS) and bovine pericardium (BP)] in an ex vivo small intestine model. METHODS Three crosslinked CEM variants (XCEM0005, XCEM001, and XCEM0033) with different degree of crosslinking were produced. An ex vivo peristaltic inflation model was established. Porcine small intestine segments were stapled on one end, using buttressed or non-buttressed surgical staplers. The opened, non-stapled ends were connected to a peristaltic pump and pressure transducer and sealed. The staple lines were then exposed to increased intraluminal pressure in a peristaltic manner. Both the leak and burst pressures of the test specimens were recorded. RESULTS The leak pressures observed for non-crosslinked NCEM (137.8 +/- 22.3 mmHg), crosslinked XCEM0005 (109.1 +/- 14.1 mmHg), XCEM001 (150.1 +/- 16.0 mmHg), XCEM0033 (98.8 +/- 10.5 mmHg) reinforced staple lines were significantly higher when compared to non-buttressed control (28.3 +/- 10.8 mmHg) and SIS (one and four layers) (62.6 +/- 11.8 and 57.6 +/- 12.3 mmHg, respectively) buttressed staple lines. NCEM and XCEM were comparable to that observed for BP buttressed staple lines (138.8 +/- 3.6 mmHg). Only specimens with reinforced staple lines were able to achieve high intraluminal pressures (ruptured at the intestinal mesentery), indicating that buttress reinforcements were able to withstand pressure higher than that of natural tissue (physiological failure). CONCLUSIONS These findings suggest that the use of CEM and XCEM as buttressing materials is associated with reinforced staple lines and increased leak pressures when compared to non-buttressed staple lines. CEM and XCEM were found to perform comparably with clinically available buttress materials in this ex vivo model.
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Laparoscopic Totally Stapled Entero-Enterostomy: A Safe and Reproducible New Technique. Obes Surg 2008; 18:631-4. [DOI: 10.1007/s11695-007-9363-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 11/07/2007] [Indexed: 10/22/2022]
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Ballesta C, Berindoague R, Cabrera M, Palau M, Gonzales M. Management of anastomotic leaks after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2008; 18:623-30. [PMID: 18392906 DOI: 10.1007/s11695-007-9297-6] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Accepted: 08/19/2007] [Indexed: 12/13/2022]
Abstract
BACKGROUND Anastomotic leaks after bariatric surgery carry high morbidity and mortality. We aimed to describe our experience of the diagnosis and management of gastrointestinal anastomotic leaks in patients undergoing laparoscopic gastric bypass in a single institution. METHODS Of 1,200 patients who underwent laparoscopic Roux-en-Y gastric bypass with manual gastrojejunal anastomosis for morbid obesity from January 2002 to January 2007, we retrospectively analyzed 59 patients with anastomotic leak. The location of the leak, day of diagnosis, diagnostic methods, clinical manifestations, treatment modalities, associated complications, and length of hospital stay were analyzed. RESULTS Leaks were located as follows: 67.8% in the gastrojejunostomy, 10.2% in the gastric pouch, 3.4% in the excluded stomach, 5.1% in the jejunojejunal anastomosis, 3.4% in the gastrojejunostomy plus pouch, 3.4% in the pouch plus excluded stomach, and 6.8% in undetermined sites. Routine upper gastrointestinal series revealed contrast extravasation in nine patients (15.3%). Leaks were asymptomatic at diagnosis in 29 patients (49.2%). Surgical reintervention was carried out in 23 patients, and conservative treatment was provided in the remaining 36. Transfer to the intensive care unit was required in 11 patients, with five deaths (0.4%). CONCLUSION In our experience, most anastomotic leaks can be managed with conservative measures alone. In many patients, abdominal drains are effective in the management of leaks, obviating the need for reintervention. Nasoenteral nutrition was effective in the non-operative management of gastrojejunal leaks in patients without signs of systemic toxicity.
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Affiliation(s)
- Carlos Ballesta
- Centro Laparoscópico de Barcelona, Centro Médico Teknon, Barcelona, Spain
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Ballantyne GH, Belsley S, Stephens D, Saunders JK, Trivedi A, Ewing DR, Iannace V, Davis D, Capella RF, Wasielewski A, Moran S, Schmidt HJ. Bariatric surgery: low mortality at a high-volume center. Obes Surg 2008; 18:660-7. [PMID: 18386110 DOI: 10.1007/s11695-007-9357-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Accepted: 08/18/2007] [Indexed: 12/15/2022]
Abstract
BACKGROUND The American Society of Bariatric Surgery has initiated a Bariatric Surgery Center of Excellence Program and the American College of Surgeons has followed with their Bariatric Surgery Center Network Accreditation Program. These programs postulate that concentration of weight loss operations in high-volume centers will decrease surgical mortality and improve outcomes. METHODS The purpose of this study was to calculate the in-hospital mortality for bariatric operations accomplished at the highest volume bariatric surgery center in the state of New Jersey. After receiving Institutional Revew Board approval, the revised surgical schedule was used to identify all patients undergoing weight loss surgery (WLS) at Hackensack University Medical Center from 1998 through June, 2006. Data for these patients were then harvested from the hospital's electronic medical record. Step-wise and univariate logistic regression analysis tested the impact of various factors on hospital length of stay and in-hospital mortality. RESULTS Between 1998 and June, 2006, 5,365 patients underwent WLS surgery: 2,099 open vertical banded gastroplasty-Roux en Y gastric bypass (VBG-RYGB); 2,177 laparoscopic Roux en Y gastric bypass (LRYGB); and 1,089 laparoscopic adjustable gastric banding (LAGB). 75.5% of patients were women. Median age was 41 years old (13-79), median weight 128 kg (81.2-290.3), and median body mass index 46.1 kg/m2 (35.0-92.6). Median total operating room time for VBG-RYGB was 115 min (33-328); LRYGB 155 min (53-493), and LAGB 92 min (33-274). Median length of stay for VBG-RYGB was 3 days (1-39 days), LRYGB 2 days (1-46 days), and LAGB 1 day (1-20). Seven patients died in hospital after the 5,365 WLS operations (0.13%): four after VBG-RYGB (0.19%); three after LRYGB (0.14%); and none after LAGB (0%). The characteristics of the patients who died did not significantly differ from the group as a whole. CONCLUSION Surgeons at Hackensack University Medical Center, a high volume, accredited 1A American College of Surgeons Bariatric Surgery Center, achieved a 0.13% mortality among 5,365 patients undergoing weight loss operations between 1998 and June, 2006. This study supports the concept that high-volume centers perform bariatric operations with low mortalities.
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Affiliation(s)
- Garth H Ballantyne
- Bariatric Surgery Center, Hackensack University Medical Center, Hackensack, NJ, USA.
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Small Bowel Obstruction after Laparoscopic Roux-En-Y Gastric Bypass: A Review of 9,527 Patients. J Am Coll Surg 2008; 206:571-84. [PMID: 18308230 DOI: 10.1016/j.jamcollsurg.2007.10.008] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 10/19/2007] [Accepted: 10/19/2007] [Indexed: 01/29/2023]
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Noun R, Zeidan S. [Laparoscopic mini-gastric bypass: an effective option for the treatment of morbid obesity]. ACTA ACUST UNITED AC 2008; 144:301-4. [PMID: 17925734 DOI: 10.1016/s0021-7697(07)91957-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate laparoscopic Mini-Gastric Bypass in the treatment of morbid obesity. PATIENTS AND METHODS Thirty patients with a mean BMI of 41.84.5 Kg/M2 underwent a laparoscopic Mini-Gastric Bypass between March 2005 and February 2006. A laparoscopic approach with five trocar incisions was used to create a long narrow gastric tube; this was then anastomosed ante-colically to a loop of jejunum 200 cm. distal to the ligament of Treitz Peri-operative and short-term follow-up results up to May 2006 are reported. RESULTS Conversion to open mini-gastric bypass was necessary in one case (3.3%). Mean operative time was 135 45 minutes. There were no deaths. There were no anastomotic leakages. Two patients developed obstruction at the gastrojejunostomy requiring laparoscopic correction in one case and accounting for an overall morbidity of 6.6%. Mean hospital stay was 3 0.25 days. One patient developed marginal ulcer which resolved with medical treatment; no patients developed symptoms of reflux esophagitis. Mean loss of excess weight was 67.6% at one year and was accompanied by resolution of obesity-associated medical illness in 85% of patients. CONCLUSION Laparoscopic Mini-Gastric Bypass is a technically simple, safe, and effective procedure in the treatment of morbid obesity and its associated medical illnesses. Moreover, the procedure is easily reversible laparoscopically when post-operative complication occurs.
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Affiliation(s)
- R Noun
- Département de Chirurgie Digestive, Hôtel Dieu de France, Université Saint Joseph - Beyrouth, Liban.
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Coupaye M, Bouillot JL, Poitou C, Schutz Y, Basdevant A, Oppert JM. Is lean body mass decreased after obesity treatment by adjustable gastric banding? Obes Surg 2007; 17:427-33. [PMID: 17608251 DOI: 10.1007/s11695-007-9072-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is concern that surgically-induced weight loss in obese subjects is associated with a disproportionate decrease in lean body mass (LBM) and in skeletal muscle mass (SMM), a major constituent of LBM. To address this issue, 1) we measured total and regional body composition following gastric banding in a group of obese subjects, and 2) we compared these data to those of a non-surgical control group of similar age and body size. METHODS Body composition was assessed by dual-energy X-ray absorptiometry (DEXA) before and after laparoscopic adjustable silicone gastric banding (LAGB) in 32 women (after 1 year: age 43.7+/-8.4 years, BMI 36.4+/-5.9 kg/m2, mean+/-SD), and in 117 control women (age 44.5+/-7.5 years; BMI 36.7+/-5.5 kg/m2) referred for non-surgical weight management, prior to weight loss. SMM was estimated using a published equation based on LBM of the extremities (appendicular LBM). RESULTS 1 year after LAGB, body weight loss (-23.7+/-11.6 kg, P<10(-6)) was mainly due to decreased fat mass (-21.2+/-11.2 kg, P<10(-6)), and total LBM was modestly, although significantly, decreased (-2.1+/-4.2 kg, P=0.01). Appendicular LBM (-0.7+/-2.7 kg) and total SMM (-0.9+/-3.0 kg) were not significantly modified. None of the body composition variables was significantly decreased in weight-reduced subjects compared to the control group, especially appendicular LBM and total SMM. CONCLUSIONS Results provide no evidence for a decrease in appendicular LBM and total SMM with weight loss following LAGB. Follow-up of these obese patients revealed a very favorable pattern of change in total and regional body composition, with preservation of muscle mass.
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Affiliation(s)
- Muriel Coupaye
- Department of Nutrition, Hbtel-Dieu Hospital (AP-HP), University Pierre et Marie Curie-Paris 6, Human Nutrition Research Center (CRNH-Ile de France), Paris, France
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Choudhary AK, Donnelly LF, Racadio JM, Strife JL. Diseases Associated with Childhood Obesity. AJR Am J Roentgenol 2007; 188:1118-30. [PMID: 17377057 DOI: 10.2214/ajr.06.0651] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Radiologists can play an active role in children's health by increasing awareness of diseases associated with obesity. This article reviews key imaging findings in obesity-related diseases, current issues in imaging obese children, and treatment strategies. CONCLUSION There has been a well-documented pediatric obesity epidemic and a dramatic increase in clinical diseases associated with it. These serious health consequences affect nearly every organ system. Despite the increasing prevalence of obesity and the associated health hazards, pediatric obesity as a diagnosis is often overlooked by health care providers.
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Affiliation(s)
- Arabinda K Choudhary
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3030, USA
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Naef M, Naef U, Mouton WG, Wagner HE. Outcome and Complications after Laparoscopic Swedish Adjustable Gastric Banding: 5-Year Results of a Prospective Clinical Trial. Obes Surg 2007; 17:195-201. [PMID: 17476872 DOI: 10.1007/s11695-007-9034-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Bariatric surgery is currently the only effective treatment for morbid obesity in terms of inducing and maintaining satisfactory weight loss and decreasing weight-related co-morbidities. A study was conducted to assess the effects, complications and outcome after laparoscopic Swedish adjustable gastric banding (SAGB) to 5 years. METHODS Between June 1998 and December 2005, all patients with implantation of a SAGB were enrolled in a prospective clinical trial. Results were recorded and classified, with special regard to long-term complications and re-operation rate. RESULTS SAGB was performed in 128 patients (87 female, 41 male). Mean age was 40.2 +/- 5.3 years, with mean preoperative BMI 44.5 +/- 3.9 kg/m2. Overall mortality was 0%. Patient follow-up was 94.5%. BMI after 1, 2 and 5 years was 35.7 +/- 3.7 kg/m2 (P < 0.005), 33.7 +/- 3.8 kg/m2 (P < 0.001) and 31.8 +/- 3.8 kg/m2 (P < 0.001), respectively. Mean EWL after 1, 2 and 5 years was 33.3 +/- 6.8% (P < 0.005), 45.5 +/- 6.4% (P < 0.001) and 57.4 +/- 6.5% (P < 0.001), respectively. The nonresponder rate (EWL < 30%) after 2 and 5 years was 17.0% and 6.8%, respectively. The early complication rate (< 30 d) was 6.25% (8/128), with 5 minor and 3 major complications. Late complications (> 30 d) occurred in 10.9% (14/128), of whom 2 were minor and 12 were major complications. The overall re-operation rate was 11.7% (15/128). CONCLUSIONS At 5-year follow-up, laparoscopic SAGB is a safe and effective surgical treatment for morbid obesity. Our results appear to confirm that SAGB is a safer surgical treatment regarding rate and severity of complications compared with gastric bypass and malabsorptive procedures.
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Affiliation(s)
- Markus Naef
- Department of Surgery, Spital Thun-Simmental AG, Thun, Switzerland.
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