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Kostov S, Selçuk I, Watrowski R, Dineva S, Kornovski Y, Slavchev S, Ivanova Y, Dzhenkov D, Yordanov A. Surgical Anatomy of the Liver-Significance in Ovarian Cancer Surgery. Diagnostics (Basel) 2023; 13:2371. [PMID: 37510115 PMCID: PMC10378601 DOI: 10.3390/diagnostics13142371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Ovarian cancer is the leading cause of death among all gynecological malignancies. Most patients present with an advanced stage of the disease. The routes of spread in ovarian cancer include peritoneal dissemination, direct invasion, and lymphatic or hematogenous spread, with peritoneal and lymphatic spread being the most common among them. The flow direction of the peritoneal fluid makes the right subphrenic space a target site for peritoneal metastases, and the most frequently affected anatomical area in advanced cases is the right upper quadrant. Complete cytoreduction with no macroscopically visible disease is the most important prognostic factor. METHODS We reviewed published clinical anatomy reports associated with surgery of the liver in cases of advanced ovarian cancer. RESULTS The disease could disseminate anatomical areas, where complex surgery is required-Morrison's pouch, the liver surface, or porta hepatis. The aim of the present article is to emphasize and delineate the gross anatomy of the liver and its surgical application for oncogynecologists. Moreover, the association between the gross and microscopic anatomy of the liver is discussed. Additionally, the vascular supply and variations of the liver are clearly described. CONCLUSIONS Oncogynecologists performing liver mobilization, diaphragmatic stripping, and porta hepatis dissection must have a thorough knowledge of liver anatomy, including morphology, variations, functional status, potential diagnostic imaging mistakes, and anatomical limits of dissection.
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Affiliation(s)
- Stoyan Kostov
- Department of Gynecology, Hospital "Saint Anna", Medical University-"Prof. Dr. Paraskev Stoyanov", 9002 Varna, Bulgaria
- Research Institute, Medical University Pleven, 5800 Pleven, Bulgaria
| | - Ilker Selçuk
- Department of Gynecologic Oncology, Ankara Bilkent City Hospital, Maternity Hospital, 06800 Ankara, Turkey
| | - Rafał Watrowski
- Department of Obstetrics and Gynecology, Helios Hospital Müllheim, 79379 Müllheim, Germany
- Faculty Associate, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Svetla Dineva
- Diagnostic Imaging Department, Medical University of Sofia, 1431 Sofia, Bulgaria
- National Cardiology Hospital, 1309 Sofia, Bulgaria
| | - Yavor Kornovski
- Department of Gynecology, Hospital "Saint Anna", Medical University-"Prof. Dr. Paraskev Stoyanov", 9002 Varna, Bulgaria
| | - Stanislav Slavchev
- Department of Gynecology, Hospital "Saint Anna", Medical University-"Prof. Dr. Paraskev Stoyanov", 9002 Varna, Bulgaria
| | - Yonka Ivanova
- Department of Gynecology, Hospital "Saint Anna", Medical University-"Prof. Dr. Paraskev Stoyanov", 9002 Varna, Bulgaria
| | - Deyan Dzhenkov
- Department of General and Clinical Pathology, Forensic Medicine and Deontology, Faculty of Medicine, Medical University-"Prof. Dr. Paraskev Stoyanov", 9002 Varna, Bulgaria
| | - Angel Yordanov
- Department of Gynecologic Oncology, Medical University Pleven, 5800 Pleven, Bulgaria
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D'hoedt A, Vanuytsel T. Dumping syndrome after bariatric surgery: prevalence, pathophysiology and role in weight reduction - a systematic review. Acta Gastroenterol Belg 2023; 86:417-427. [PMID: 37814558 DOI: 10.51821/86.3.11476] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Background Dumping syndrome is a frequent and wellknown adverse event after bariatric surgery and covers a dynamic spectrum of early and late dumping. Accelerated gastric emptying is generally considered to be the cause of gastrointestinal and vasomotor complaints. However, there is much uncertainty regarding the exact pathophysiology of dumping. It has been speculated that the syndrome is a desired consequence of bariatric surgery and contributes to more efficient weight loss, but supporting data are scarce. Methods A systematic search was conducted in PubMed in July-August 2021. The prevalence of dumping after the most frequently performed bariatric procedures was analyzed, as well as underlying pathophysiology and its role in weight reduction. Results Roux-en-Y gastric bypass (RYGB) is associated with the highest postoperative prevalence of dumping. The fast transit induces neurohumoral changes which contribute to an imbalance between postprandial glucose and insulin levels, resulting in hypoglycemia which is the hallmark of late dumping. Early dumping can, when received in a positive way, become a tool to maintain a strict dietary pattern, but no significant relationship to the degree of weight loss has been shown. However, late dumping is detrimental and promotes overall higher caloric intake. Conclusion Dumping syndrome is common after bariatric surgery, especially after RYGB. The pathophysiology is complex and ambiguous. Currently available data do not support dumping as a necessary condition to induce weight loss after bariatric surgery.
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Affiliation(s)
- A D'hoedt
- Faculty of Medicine, KULeuven, Leuven, Belgium
| | - T Vanuytsel
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium. Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (ChroMeta) KULeuven, Leuven, Belgium
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Elbanna MR, Abdel Samee KS, Elghandour AM. The Effect of Vagus Nerve Preservation on Gastrointestinal Function After One Anastomosis/Mini Gastric Bypass. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mohey R. Elbanna
- Department of General and Bariatric Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Karim S. Abdel Samee
- Department of General and Bariatric Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Abdelrahman M. Elghandour
- Department of General and Bariatric Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Hu S, Tang H, Wang H, Dong Z, Jiang S, Wang C, Chen X, Yang W. Hyperinsulinemic Hypoglycemia after Bariatric Surgery. JOURNAL OF METABOLIC AND BARIATRIC SURGERY 2020; 9:1-6. [PMID: 36686896 PMCID: PMC9847643 DOI: 10.17476/jmbs.2020.9.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/08/2020] [Accepted: 05/19/2020] [Indexed: 06/13/2023]
Abstract
Postprandial hyperinsulinemic hypoglycemia (PHH) is one of the serious complications after bariatric surgery, it can lead life-threatening neuroglycopenic symptoms, such as seizures, disorientation, impairment of version and loss of consciousness without any premonitory. The presentation, prevalence, diagnosis, pathology and treatment are reviewed in this summary.
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Affiliation(s)
- Songhao Hu
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Hanlin Tang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Huaxi Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhiyong Dong
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shuwen Jiang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaomei Chen
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- State Key Laboratory of Pharmaceutical Biotechnology, LKS Faculty of Medicine, The University of Hong Kong, China
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Heterogeneity in the Definition and Clinical Characteristics of Dumping Syndrome: a Review of the Literature. Obes Surg 2019; 29:1984-1989. [DOI: 10.1007/s11695-019-03818-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Emous M, Wolffenbuttel BH, van Dijk G, Totté E, van Beek AP. Long-term self-reported symptom prevalence of early and late dumping in a patient population after sleeve gastrectomy, primary, and revisional gastric bypass surgery. Surg Obes Relat Dis 2018; 14:1173-1181. [DOI: 10.1016/j.soard.2018.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/08/2018] [Accepted: 04/18/2018] [Indexed: 12/19/2022]
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Thompson JS, Langenfeld SJ, Hewlett A, Chiruvella A, Crawford C, Armijo P, Oleynikov D. Surgical treatment of gastrointestinal motility disorders. Curr Probl Surg 2016; 53:503-549. [PMID: 27765162 DOI: 10.1067/j.cpsurg.2016.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 08/22/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Jon S Thompson
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE.
| | - Sean J Langenfeld
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Alexander Hewlett
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | | | | | | | - Dmitry Oleynikov
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
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Malik S, Mitchell JE, Steffen K, Engel S, Wiisanen R, Garcia L, Malik SA. Recognition and management of hyperinsulinemic hypoglycemia after bariatric surgery. Obes Res Clin Pract 2015; 10:1-14. [PMID: 26522879 DOI: 10.1016/j.orcp.2015.07.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 06/17/2015] [Accepted: 07/06/2015] [Indexed: 02/06/2023]
Abstract
Hyperinsulinemic hypoglycemia with neuroglycopenia is an increasingly recognized complication of Roux-en-Y gastric bypass (RYGB) due to the changes in gut hormonal milieu. Physicians should be aware of this complication to ensure timely and effective treatment of post-RYGB patients, who present to them with hypoglycemic symptoms. Possible causes of hypoglycemia in these patients include late dumping syndrome, nesidioblastosis and rarely insulinoma. Systematic evaluation including history, biochemical analysis, and diagnostic testing might help in distinguishing among these diagnoses. Continuous glucose monitoring is also a valuable tool, revealing the episodes in the natural environment and can also be used to monitor treatment success. Treatment should begin with strict low carbohydrate diet, followed by medication therapy. Therapy with diazoxide, acarbose, calcium channel blockers and octreotide have been proven to be beneficial, but the response apparently is highly variable. When other treatment options fail, surgical options can be considered.
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Affiliation(s)
- Sarah Malik
- Neuropsychiatric Research Institute, Fargo, ND, United States; University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States
| | - James E Mitchell
- Neuropsychiatric Research Institute, Fargo, ND, United States; University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States.
| | - Kristine Steffen
- Neuropsychiatric Research Institute, Fargo, ND, United States; North Dakota State University, United States
| | - Scott Engel
- Neuropsychiatric Research Institute, Fargo, ND, United States; University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States
| | | | | | - Shahbaz Ali Malik
- University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States
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Emous M, Ubels FL, van Beek AP. Diagnostic tools for post-gastric bypass hypoglycaemia. Obes Rev 2015; 16:843-56. [PMID: 26315925 DOI: 10.1111/obr.12307] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 06/10/2015] [Accepted: 06/15/2015] [Indexed: 12/15/2022]
Abstract
In spite of its evident success, several late complications can occur after gastric bypass surgery. One of these is post-gastric bypass hypoglycaemia. No evidence-based guidelines exist in the literature on how to confirm the presence of this syndrome. This study aims to describe and compare the tests aimed at making a diagnosis of post-gastric bypass hypoglycaemia and to provide a diagnostic approach based upon the available evidence. A search was conducted in PubMed, Cochrane and Embase. A few questionnaires have been developed to measure the severity of symptoms in post-gastric bypass hypoglycaemia but none has been validated. The gold standard for provocation of a hypoglycaemic event is the oral glucose tolerance test or the liquid mixed meal tolerance test. Both show a high prevalence of hypoglycaemia in post-gastric bypass patients with and without hypoglycaemic complaints as well as in healthy volunteers. No uniformly established cut-off values for glucose concentrations are defined in the literature for the diagnosis of post-gastric bypass hypoglycaemia. For establishing an accurate diagnosis of post-gastric bypass hypoglycaemia, a validated questionnaire, in connection with the diagnostic performance of provocation tests, is the most important thing missing. Given these shortcomings, we provide recommendations based upon the current literature.
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Affiliation(s)
- M Emous
- Department of Bariatric and Metabolic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - F L Ubels
- Department of Endocrinology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - A P van Beek
- Department of Bariatric and Metabolic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands.,Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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van Wezenbeek MR, van Oudheusden TR, Smulders JF, Nienhuijs SW, Luyer MD. Transection versus preservation of the neurovascular bundle of the lesser omentum in primary Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis 2015; 12:283-9. [PMID: 26686306 DOI: 10.1016/j.soard.2015.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/03/2015] [Accepted: 07/30/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND A gastric pouch in Roux-en-Y gastric bypass (RYGB) surgery can be created after transection of the perigastric neurovascular bundle or by preserving these structures. Some surgeons choose to transect the neurovascular bundle (NBT), containing branches of the vagus nerve, because this might be related to additional weight loss, whereas others advocate preservation (NBP) to reduce postoperative complications. OBJECTIVES This study assessed the effect of both techniques after primary RYGB. SETTING All patients undergoing primary RYGB in a large bariatric center in the Netherlands between January 2010 and December 2013 were included. METHODS Patient demographic characteristics, operative details, postoperative complications and weight loss after 1 year were retrospectively analyzed. RESULTS A total of 773 consecutive patients were included (85.5% female). NBT was performed in 407 patients (52.7%), whereas NBP was performed in 366 patients. There were no missing data and 81.2% of patients completed the 1-year follow-up. Postoperative complications were found in 66 patients (8.5%). A total of 49 patients (6.3%) either had an anastomotic leakage, postoperative bleeding, or intraabdominal abscess (NBT 8.8% versus NBP 3.6%, P = .003). Percentage total weight loss (NBT 34.5%±6.9% versus NBP 33.4%±6.9%; P = .011) differed to a lesser extent between groups, although this was significant. Neurovascular bundle transection was identified as independent factor among others for occurrence of leakage, bleeding, and abscess development (OR 2.886; 95% CI [1.466-5.683]; P = .002). CONCLUSIONS Transection of the neurovascular bundle in RYGB is associated with more complications. Furthermore, weight loss is not relevantly increased. Further research is necessitated to substantiate these findings.
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Affiliation(s)
| | | | - J Frans Smulders
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Misha D Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
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Abstract
BACKGROUND Dumping syndrome is a common complication after surgery of the upper gastrointestinal tract with symptoms ranging from mild gastrointestinal discomfort and moderate vasomotor disturbances, to severe hyperinsulinemic hypoglycemia. Due to the increasing number of bariatric procedures being performed worldwide, bariatric surgery has become the most common cause for this disease entity. OBJECTIVE The aim of this review is to highlight the evidence for the physiological mechanisms contributing to dumping syndrome after the two most common bariatric surgery procedures, Roux-en-Y gastric bypass and sleeve gastrectomy, to discuss technical aspects of the procedures underlying the development of the syndrome, patient-related predictive factors and other differential diagnoses, together with diagnostic and therapeutic algorithms.
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12
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Lynch A, Bisogni CA. Gastric bypass patients’ goal-strategy-monitoring networks for long-term dietary management. Appetite 2014; 81:138-51. [DOI: 10.1016/j.appet.2014.06.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 05/09/2014] [Accepted: 06/05/2014] [Indexed: 12/28/2022]
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Kassir R, Lointier P, Tiffet O, Breton C, Blanc P. Laparoscopic Roux-en-Y Gastric Bypass: Creation of the Neogastric Pouch. Obes Surg 2014; 25:131-2. [DOI: 10.1007/s11695-014-1406-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Valezi AC, Herbella F, Mali-Junior J, Marson AC, Biazin CCC. [Esophageal motility, symptoms, food intake and weight loss after Roux-en-Y gastric bypass]. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2013; 26:120-3. [PMID: 24000024 DOI: 10.1590/s0102-67202013000200010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 02/05/2013] [Indexed: 01/10/2023]
Abstract
BACKGROUND Abnormal manometry findings can be found in the obese population. It is controversial if the manometry should be used to choose the adequate operation or if the motility status could predict symptomatic outcomes. AIM To correlate the esophageal motility with postoperative symptoms, alimentary outcome and weight loss after Roux-en-Y gastric bypass. METHODS One hundred and fourteen patients were submitted to the operation and were prospectively studied. They had no GERD symptoms or diseases that might interfere with esophageal motor function. One year after surgery patients were interviewed regarding current symptoms and eating habits. RESULTS Excess weight loss was 66.2 %. Sixty (52.6%) patients had an abnormal manometry. Hypertensive lower esophageal sphincter was found in 18 (16%) patients and hypotonic sphincter in 31 (27%). Dumping syndrome was mentioned by 27 (23.6%) patients and 21 (18.4%) complained of regurgitation. Excellent, good, moderate and poor alimentary outcome was present in 32 (28%), 31 (27.2%), 39 (34.2%), 12 (11.6%) patients, respectively. Sphincter pressure and esophageal amplitude did not correlate with excess weight loss. Its average was significantly higher for patients with hypertensive esophageal amplitude. Regurgitation was more frequent in patients with a hypotensive sphincter. There is no correlation between dumping and sphincter pressure status; between dumping or regurgitation and esophageal amplitude; between alimentary outcomes and sphincter pressure status or esophageal amplitude. CONCLUSION Esophageal manometry before Roux-en-Y gastric bypass is of limited clinical significance.
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Affiliation(s)
- Antonio Carlos Valezi
- Departamento de Cirurgia da Universidade Estadual de Londrina, Londrina – PR, Brasil.
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Morbid obesity-the new pandemic: medical and surgical management, and implications for the practicing gastroenterologist. Clin Transl Gastroenterol 2013; 4:e35. [PMID: 23739585 PMCID: PMC3696938 DOI: 10.1038/ctg.2013.6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The gastroenterologist, whether in academic or clinical practice, must face the reality that an increasingly large percentage of adult patients are morbidly obese. Morbid obesity is associated with significant morbidity and mortality including enhanced morbidity from cardiovascular, cerebrovascular, hepatobiliary and colonic diseases. Most of these associated diseases are actually preventable. Based on the 1991 NIH consensus conference criteria, for most patients with a body mass index (BMI=weight in kilograms divided by the height in meters squared) of 40 or more, or for patients with a BMI of 35 or more and significant health complications, surgery may be the only reliable option. Currently in the United States, over 250,000 bariatric surgical procedures are being performed annually. The practicing gastroenterologist in every community, large and small, must be familiar with the various surgical procedures together with their associated anatomic changes. These changes may dramatically increase the prevalence of nutritional deficiencies and profoundly alter the clinical and endoscopic approaches to diagnosis and management.
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Alterations of sucrose preference after Roux-en-Y gastric bypass. Physiol Behav 2011; 104:709-21. [DOI: 10.1016/j.physbeh.2011.07.025] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 07/24/2011] [Accepted: 07/26/2011] [Indexed: 12/25/2022]
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