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Ullah R, Nazir M, Shahana N, Shuja I, Fazal MA, Nazir K, Khan FR. Frequency of Early Complications of Laparoscopic Sleeve Gastrectomy Using Four Ports. Cureus 2024; 16:e65613. [PMID: 39205724 PMCID: PMC11357724 DOI: 10.7759/cureus.65613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2024] [Indexed: 09/04/2024] Open
Abstract
Background Laparoscopic sleeve gastrectomy (LSG) has become a widely accepted bariatric procedure for treating morbid obesity and associated comorbidities due to its relatively straightforward technique and positive outcomes in terms of weight loss and metabolic improvement. Objective To investigate the frequency and types of early complications following LSG using four ports. Methods This prospective observational study was conducted at Al Hadi International Hospital, Swabi, Pakistan, from January 2022 to December 2022. A total of 369 patients aged 25-65 years with a BMI of 35-55 kg/m2 were included. Data on demographic characteristics, surgery duration, intraoperative blood loss, and hospital stay were collected. Early complications within 30 days post-surgery, including bleeding, infection, and leakage, were documented. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). Results The mean age of patients was 43.6 years (SD = 11.8) and the mean BMI was 42.3 kg/m2 (SD = 6.5). The average surgery duration was 92 minutes (SD = 22) and the mean intraoperative blood loss was 100 mL (SD = 50). Early complications occurred in 18% of patients with bleeding, infection, and leakage each accounting for 5%, 4%, and 3%, respectively. Reoperation was required in 5% of patients due to these complications. Higher BMI (45.2 vs. 41.8 kg/m2, p = 0.04) and longer surgery duration (105 vs. 88 minutes, p = 0.03) were significantly associated with increased complication rates. Comorbidities were present in 60% of patients with complications compared to 34% without complications (p = 0.03). Conclusion The four-port technique in LSG is associated with an 18% early complication rate with significant risk factors being higher BMI and longer surgery duration. Careful patient selection, standardized surgical techniques, and robust postoperative care are essential to minimize complications and improve outcomes in LSG.
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Affiliation(s)
- Rahman Ullah
- Surgical and Allied, Bacha Khan Medical Complex, Swabi, PAK
| | - Mashal Nazir
- Surgical and Allied, Bacha Khan Medical Complex, Swabi, PAK
| | | | - Ibrahim Shuja
- Surgical and Allied, Bacha Khan Medical Complex, Swabi, PAK
| | | | - Kainat Nazir
- Surgery, Khyber Teaching Hospital, Peshawar, PAK
| | - Fahad R Khan
- Cardiology, Lady Reading Hospital, Peshawar, PAK
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Durin T, Marchese U, Sauvanet A, Dokmak S, Cherkaoui Z, Fuks D, Laurent C, André M, Ayav A, Magallon C, Turrini O, Sulpice L, Robin F, Bachellier P, Addeo P, Souche FR, Bardol T, Perinel J, Adham M, Tzedakis S, Birnbaum DJ, Facy O, Gagniere J, Gaujoux S, Tribillon E, Roussel E, Schwarz L, Barbier L, Doussot A, Regenet N, Iannelli A, Regimbeau JM, Piessen G, Lenne X, Truant S, El Amrani M. Defining Benchmark Outcomes for Distal Pancreatectomy: Results of a French Multicentric Study. Ann Surg 2023; 278:103-109. [PMID: 35762617 DOI: 10.1097/sla.0000000000005539] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Defining robust and standardized outcome references for distal pancreatectomy (DP) by using Benchmark analysis. BACKGROUND Outcomes after DP are recorded in medium or small-sized studies without standardized analysis. Therefore, the best results remain uncertain. METHODS This multicenter study included all patients undergoing DP for resectable benign or malignant tumors in 21 French expert centers in pancreas surgery from 2014 to 2018. A low-risk cohort defined by no significant comorbidities was analyzed to establish 18 outcome benchmarks for DP. These values were tested in high risk, minimally invasive and benign tumor cohorts. RESULTS A total of 1188 patients were identified and 749 low-risk patients were screened to establish Benchmark cut-offs. Therefore, Benchmark rate for mini-invasive approach was ≥36.8%. Benchmark cut-offs for postoperative mortality, major morbidity grade ≥3a and clinically significant pancreatic fistula rates were 0%, ≤27%, and ≤28%, respectively. The benchmark rate for readmission was ≤16%. For patients with pancreatic adenocarcinoma, cut-offs were ≥75%, ≥69.5%, and ≥66% for free resection margins (R0), 1-year disease-free survival and 3-year overall survival, respectively. The rate of mini-invasive approach in high-risk cohort was lower than the Benchmark cut-off (34.1% vs ≥36.8%). All Benchmark cut-offs were respected for benign tumor group. The proportion of benchmark cases was correlated to outcomes of DP. Centers with a majority of low-risk patients had worse results than those operating complex cases. CONCLUSION This large-scale study is the first benchmark analysis of DP outcomes and provides robust and standardized data. This may allow for comparisons between surgeons, centers, studies, and surgical techniques.
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Affiliation(s)
- Thibault Durin
- Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France
| | - Ugo Marchese
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Teaching Hospital, AP-HP, Université de Paris, Paris, France
| | - Alain Sauvanet
- Department of HBP Surgery, AP-HP, Hôpital Beaujon, University of Paris, Clichy, France
| | - Safi Dokmak
- Department of HBP Surgery, AP-HP, Hôpital Beaujon, University of Paris, Clichy, France
| | - Zineb Cherkaoui
- Department of HBP Surgery, AP-HP, Hôpital Beaujon, University of Paris, Clichy, France
| | - David Fuks
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Teaching Hospital, AP-HP, Université de Paris, Paris, France
| | - Christophe Laurent
- Department of Digestive Surgery, Centre Magellan-CHU Bordeaux, Bordeaux, France
| | - Marie André
- Department of HPB Surgery, Nancy University Hospital, Nancy, France
| | - Ahmet Ayav
- Department of HPB Surgery, Nancy University Hospital, Nancy, France
| | - Cloe Magallon
- Department of Oncological Surgery, Institut Paoli Calmettes, Marseille University, Marseille, France
| | - Olivier Turrini
- Department of Oncological Surgery, Institut Paoli Calmettes, Marseille University, Marseille, France
| | - Laurent Sulpice
- Department of Hepatobiliary and Digestive Surgery, University Hospital, Rennes 1 University, Rennes, France
| | - Fabien Robin
- Department of Hepatobiliary and Digestive Surgery, University Hospital, Rennes 1 University, Rennes, France
| | - Philippe Bachellier
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
| | - Pietro Addeo
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
| | | | - Thomas Bardol
- Department of Surgery, Hopital Saint Eloi, Montpellier, France
| | - Julie Perinel
- Department of Digestive Surgery, Hopital Edouard Herriot, Lyon, France
| | - Mustapha Adham
- Department of Digestive Surgery, Hopital Edouard Herriot, Lyon, France
| | - Stylianos Tzedakis
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Teaching Hospital, AP-HP, Université de Paris, Paris, France
| | - David J Birnbaum
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Olivier Facy
- Department of Digestive and Surgical Oncology, University Hospital, Dijon, France
| | - Johan Gagniere
- Department of Digestive and Hepatobiliary Surgery-Liver transplantation, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Sébastien Gaujoux
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Ecoline Tribillon
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, Paris, France
| | - Edouard Roussel
- Department of Digestive Surgery, Rouen University Hospital and Université de Rouen Normandie, Rouen, France
| | - Lilian Schwarz
- Department of Digestive Surgery, Rouen University Hospital and Université de Rouen Normandie, Rouen, France
| | - Louise Barbier
- Department of Liver Transplant and Surgery, Hopital Trousseau, Tours, France
| | - Alexandre Doussot
- Department of Digestive Surgical Oncology, University Hospital of Besançon, Besançon, France
| | - Nicolas Regenet
- Department of Digestive Surgery, Nantes Hospital, Nantes, France
| | - Antonio Iannelli
- Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Nice, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Medical Center and Jules Verne University of Picardie, Amiens Cedex, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
| | - Xavier Lenne
- Department of Medical Information, Lille University Hospital, Lille, France
| | - Stéphanie Truant
- Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France
| | - Mehdi El Amrani
- Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France
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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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Hassan LS, Fahmy MH, Elmonim AMA, Elshal M. Effect of post-gastric sleeve pyloric length on control of type II diabetes mellitus. THE EGYPTIAN JOURNAL OF SURGERY 2023; 42:464-472. [DOI: 10.4103/ejs.ejs_89_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Background
Although the effectiveness and safety of laparoscopic sleeve gastrectomy (LSG) have been demonstrated, there is still debate about the best surgical method, with the resection distance from pylorus (DP) being among the most contentious topics. In patients who had LSG for morbid obesity, the effect of the resection distance from the pylorus on the management of type II diabetes mellitus during the postoperative phase was examined.
Patients and methods
After receiving each patient’s agreement, a total of 46 obese individuals were enrolled. Patients were prospectively randomized into two groups, group A (‘AP group’) and group B (‘AR group’), based on the distance between the initial reload firing and the pylorus (4 cm for group A and 2 cm for group B, respectively). Blood sugar levels were measured three, six months, and one year following LSG. After a year of follow-up, the percentage of excess weight loss (%EWL) was calculated.
Results
Postoperative weight was statistically significant lower and EWL% was statistically significant higher in group B: LSG ‘2 cm’ compared to group A: LSG ‘4 cm’. As regard outcomes of type 2 diabetes mellitus after LSG, in spite of nonsignificant statistical value, we reported that there was higher frequency of complete remission after 3, 6 and 12 months in group B: LSG ‘2 cm’ compared to group A: LSG ‘4 cm’ and cases with complete remission were associated with significant higher EWL%.
Conclusion
Patients undergoing laparoscopic sleeve gastrectomy are recommended to have shorter resection distance from pylorus (DP) done. It has been linked to superior surgical results, weight reduction, and diabetes mellitus management with no problems recorded.
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Affiliation(s)
| | - Mohamed H. Fahmy
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Mohamed Elshal
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
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Chang FC, Huang YT, Wu VCC, Tu HT, Lin CP, Yeh JK, Cheng YT, Chang SH, Chu PH, Chou AH, Chen SW. Surgical volume and outcomes of surgical ablation for atrial fibrillation: a nationwide population-based cohort study. BMC Cardiovasc Disord 2023; 23:84. [PMID: 36774460 PMCID: PMC9922454 DOI: 10.1186/s12872-023-03101-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Atrial fibrillation is the most common cardiac arrythmia and causes many complications. Sinus rhythm restoration could reduce late mortality of atrial fibrillation patients. The Maze procedure is the gold standard for surgical ablation of atrial fibrillation. Higher surgical volume has been documented with favorable outcomes of various cardiac procedures such as mitral valve surgery and aortic valve replacement. We aimed to determine the volume-outcome relationship (i.e., association between surgical volume and outcomes) for the concomitant Maze procedure during major cardiac surgeries. METHODS This nationwide population-based cohort study retrieved data from the Taiwan National Health Insurance Research Database. Adult patients undergoing concomitant Maze procedures during 2010-2017 were identified; consequently, 2666 patients were classified into four subgroups based on hospital cumulative surgery volumes. In-hospital outcomes and late outcomes during follow-up were analyzed. Logistic regression and Cox proportional hazards model were used to analyze the volume-outcome relationship. RESULTS Patients undergoing Maze procedures at lower-volume hospitals tended to be frailer and had higher comorbidity scores. Patients in the highest-volume hospitals had a lower risk of in-hospital mortality than those in the lowest-volume hospitals [adjusted odds ratio, 0.30; 95% confidence interval (CI), 0.15-0.61; P < 0.001]. Patients in the highest-volume hospitals had lower rates of late mortality than those in the lowest-volume hospitals, including all-cause mortality [adjusted hazard ratio (aHR) 0.53; 95% CI 0.40-0.68; P < 0.001] and all-cause mortality after discharge (aHR 0.60; 95% CI 0.44-0.80; P < 0.001). CONCLUSIONS A positive hospital volume-outcome relationship for concomitant Maze procedures was demonstrated for in-hospital and late follow-up mortality. The consequence may be attributed to physician skill/experience, experienced multidisciplinary teams, and comprehensive care processes. We suggest referring patients with frailty or those requiring complicated cardiac surgeries to high-volume hospitals to improve clinical outcomes. TRIAL REGISTRATION the institutional review board of Chang Gung Memorial Hospital approved all data usage and the study protocol (registration number: 202100151B0C502).
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Affiliation(s)
- Feng-Cheng Chang
- grid.145695.a0000 0004 1798 0922Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Tung Huang
- grid.145695.a0000 0004 1798 0922Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Victor Chien-Chia Wu
- grid.145695.a0000 0004 1798 0922Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Hui-Tzu Tu
- grid.145695.a0000 0004 1798 0922Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Chia-Pin Lin
- grid.145695.a0000 0004 1798 0922Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Jih-Kai Yeh
- grid.145695.a0000 0004 1798 0922Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Ting Cheng
- grid.145695.a0000 0004 1798 0922Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 33305 Taiwan
| | - Shang-Hung Chang
- grid.145695.a0000 0004 1798 0922Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan ,grid.145695.a0000 0004 1798 0922Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Pao-Hsien Chu
- grid.145695.a0000 0004 1798 0922Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - An-Hsun Chou
- grid.145695.a0000 0004 1798 0922Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Shao-Wei Chen
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan. .,Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan. .,Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 33305, Taiwan.
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Assessing the hospital volume-outcome relationship in surgery: a scoping review. BMC Med Res Methodol 2021; 21:204. [PMID: 34627143 PMCID: PMC8502281 DOI: 10.1186/s12874-021-01396-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Many recent studies have investigated the hospital volume-outcome relationship in surgery. In some cases, the results have prompted the centralization of surgical activity. However, the methodologies and interpretations differ markedly from one study to another. The objective of the present scoping review was to describe the various features used to assess the volume-outcome relationship: the analyzed datasets, study population, outcome, covariates, confounders, volume modalities, and statistical methods. Methods and analysis The review was conducted according to a study protocol published in BMJ Open in 2020. Two authors (both of whom had helped to design the study protocol) screened publications independently according to the title, the abstract and then the full text. To ensure exhaustivity, all the papers included by each reviewer went through to the next step. Interpretation The 403 included studies covered 90 types of surgery, 61 types of outcome, and 72 covariates or potential confounders. 191 (47.5%) studies focussed on oncological surgery and 37.8% focussed visceral or digestive tract surgery. Overall, 86.6% of the studies found a statistically significant volume-outcome relationship, although the findings differed from one type of surgery to another. Furthermore, the types of outcome and the covariates were highly diverse. The majority of studies were performed in Western countries, and oncological and visceral surgical procedures were over-represented; this might limit the generalizability and comparability of the studies’ results. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01396-6.
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Iran Obesity and Metabolic Surgery (IOMS) Cohort Study: Rationale and Design. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02789-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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8
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Fass OZ, Mashimo H. The Effect of Bariatric Surgery and Endoscopic Procedures on Gastroesophageal Reflux Disease. J Neurogastroenterol Motil 2021; 27:35-45. [PMID: 33380553 PMCID: PMC7786084 DOI: 10.5056/jnm20169] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Obesity is a global epidemic posing a significant burden on patients and healthcare systems. Gastroesophageal reflux disease is associated with obesity and its prevalence is also growing worldwide. Numerous bariatric surgeries and endoscopic procedures have arisen to assist with weight loss and management of obesity-related conditions. However, the effect of these interventions on reflux is variable and the evidence is often conflicting. To date, Roux-en-Y gastric bypass remains the gold-standard for attaining both reflux and weight loss management, however novel endoscopic techniques are quickly becoming more prevalent as an alternative to surgery. This review aims to summarize currently available endoscopic and surgical weight loss procedures and their impact on reflux symptoms while emphasizing areas requiring additional investigation.
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Affiliation(s)
- Ofer Z Fass
- Department of Medicine, New York University Langone Health, New York, NY, USA
| | - Hiroshi Mashimo
- epartment of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA
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The role of the surgical resection distance from the pylorus after laparoscopic sleeve gastrectomy: a prospective cohort study from an academic medical center in Egypt. Patient Saf Surg 2020; 14:42. [PMID: 33292433 PMCID: PMC7672815 DOI: 10.1186/s13037-020-00270-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/09/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy was recently described as an effective approach for the operative treatment of obesity, but the ideal procedure remains controversial. One of the most debated issues is the resection distance from the pylorus. We conducted this study to elucidate any potential differences in the short-term outcomes between 2 and 6 cm distance from the pylorus in laparoscopic sleeve gastrectomy. METHODS A prospective observational cohort study in a selected cohort of 96 patients was conducted from January 2018 to March 2019 in morbidly obese patients who had laparoscopic sleeve gastrectomy performed at Suez Canal University Hospital. Outcome was expressed by excess weight loss percentage, resolution of comorbidities, improvement of quality of life, and incidence of complications after laparoscopic sleeve gastrectomy. The morbidly obese patients (body mass index [BMI] > 40 kg/m2 or > 35 kg/m2 with obesity-related comorbidities) in the study were divided into two equal groups: (1) Group 1 (48 patients) underwent laparoscopic sleeve gastrectomy with a 2 cm distance from the pylorus resection distance and (2) Group 2 (48 patients) underwent laparoscopic sleeve gastrectomy with a 6 cm distance from the pylorus resection distance. Body weight, BMI, bariatric quality of life, lipid profile, and comorbidities were evaluated pre- and post-operatively for a duration of 12 months. RESULTS Statistically, no significant differences between the two study groups regarding the excess weight loss percentage, comorbidity resolution throughout the postoperative follow-up, enhancement of the quality of life score throughout the postoperative follow-up, or incidence of complications (25% in Group 1 versus 25% in Group 2, p > 0.05) were found. CONCLUSION Laparoscopic sleeve gastrectomy was an effective and safe management for morbid obesity and obesity-related comorbidities with significant short-term weight loss; it also improved weight-related quality of life and had an acceptable complication rate. The distance from the pylorus resection distance did not affect the short-term effects of laparoscopic sleeve gastrectomy regarding excess weight loss percentage, resolution of comorbidities, change in quality of life, or occurrence of complications.
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Levaillant M, Marcilly R, Levaillant L, Vallet B, Lamer A. Assessing the hospital volume-outcome relationship in surgery: a scoping review protocol. BMJ Open 2020; 10:e038201. [PMID: 33028556 PMCID: PMC7539612 DOI: 10.1136/bmjopen-2020-038201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Even if a positive volume-outcome correlation in surgery is mostly admitted in many surgical fields, the various ways to assess this relationship make it difficult for researchers and policymakers to use it. Our aim is therefore to provide an overview of the way hospital volume-outcome relationship was assessed. Through this overview, our goal is to identify potential gaps in the assessment of this relationship, to help researchers who want to pursue work in this field and, ultimately, to help policy makers interpret such analyses. METHODS AND ANALYSIS This review will be conducted using the six stages of the scoping review method: identifying the research question, searching for relevant studies, selecting studies, data extraction, collating, summarising and reporting the results and concluding. This review will address all the key questions used to assess the volume-outcome relationship in surgery.Primary research papers investigating the hospital volume-outcome relationship from 2009 will be included. Studies only looking at surgeons' volume-outcome relationship or studies were the volume variable is not individualisable will be excluded.Both MEDLINE and Scopus will be searched along with grey literature. Two researchers will perform all the stages of the review: screen the titles and abstracts, review the full text of selected articles to determine final inclusions and extract the data. The results will be summarised quantitatively using numerical counts. ETHICAL CONSIDERATIONS AND DISSEMINATION Reviews of published articles are considered secondary analysis and do not need ethical approval. The findings will be disseminated through multiple channels like conferences and peer-reviewed journals.
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Affiliation(s)
- Mathieu Levaillant
- Univ. Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - Romaric Marcilly
- Univ. Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, INSERM-CIC-IT 1403/Evalab, F-59000 Lille, France
| | - Lucie Levaillant
- Department of Pediatric Endocrinology and Diabetology, University Hospital Centre Angers, Angers, Pays de la Loire, France
| | - Benoît Vallet
- Univ. Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - Antoine Lamer
- Univ. Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
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11
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Mohammed EA, Hajji SA, Aljenaee K, Ghanbar MI. Wernicke's encephalopathy-induced hearing loss complicating sleeve gastrectomy. BMJ Case Rep 2020; 13:13/9/e233144. [PMID: 32933905 DOI: 10.1136/bcr-2019-233144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 25-year-old woman brought to the hospital with symptoms of acute confusion, disorientation, diplopia, hearing loss and unsteady gait which started 4 days prior to her presentation with rapid worsening in its course until the day of admission. She had a surgical history of laparoscopic sleeve gastrectomy 2 months earlier which was complicated by persistent vomiting around one to three times per day. She lost 30 kg of her weight over 2 months and was not compliant to vitamin supplementation. CT of the brain was unremarkable. Brain MRI was done which showed high signal intensity lesions involving the bilateral thalamic regions symmetrically with restricted diffusion on fluid-attenuated inversion recovery imaging. Other radiological investigations, such as magnetic resonance venography and magnetic resonance angiography of the brain were unremarkable. An official audiogram confirmed the sensorineural hearing loss. A diagnosis of Wernicke's encephalopathy due to thiamin deficiency post-sleeve gastrectomy was made based on the constellation of her medical background, clinical presentation and further supported by the distinct MRI findings. Consequently, serum thiamin level was requested and intravenous thiamin 500 mg three times per day for six doses was started empirically, then thiamin 250 mg intravenously once daily given for 5 more days. Marked improvement in cognition, eye movements, strength and ambulation were noticed soon after therapy. She was maintained on a high caloric diet with calcium, magnesium oxide, vitamin D supplements and oral thiamin with successful recovery of the majority of her neurological function with normal cognition, strength, reflexes, ocular movements, but had minimal resolution of her hearing deficit. Serum thiamin level later was 36 nmol/L (67-200).
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Affiliation(s)
| | | | - Khaled Aljenaee
- Endocrine and Diabetes, Al Adan Hospital, Kuwait, Al Asimah, Kuwait
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12
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Bagante F, Ruzzenente A, Beal EW, Campagnaro T, Merath K, Conci S, Akgül O, Alexandrescu S, Marques HP, Lam V, Shen F, Poultsides GA, Soubrane O, Martel G, Iacono C, Guglielmi A, Pawlik TM. Complications after liver surgery: a benchmark analysis. HPB (Oxford) 2019; 21:1139-1149. [PMID: 30718185 DOI: 10.1016/j.hpb.2018.12.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/25/2018] [Accepted: 12/11/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The best achievable short-term outcomes after liver surgery have not been identified. Several factors may influence the post-operative course of patients undergoing hepatectomy increasing the risk of post-operative complications. We sought to identify risk-adjusted benchmark values [BMV] for liver surgery. METHODS The National Surgery Quality Improvement Program (NSQIP) database was used to develop Bayesian models to estimate risk-adjusted BMVs for overall and liver related (post-hepatectomy liver failure [PHLF], biliary leakage [BL]) complications. A separate international multi-institutional database was used to validate the risk-adjusted BMVs. RESULTS Among the 11,243 patients included in the NSQIP database, the incidence of complications, PHLF, and BL was 36%, 5%, and 8%, respectively. The risk-adjusted BMVs for complication (range, 16-72%), PHLF (range, 1%-20%), and BL (range, 4%-22%) demonstrated a high variability based on patients characteristics. When tested using an international database including nine institutes, the risk-adjusted BMVs for complications ranged from 26% (Institute-4) to 43% (Institute-1), BMVs for PHLF between 3% (Institute-3) and 12% (Institute-5), while BMVs for BL ranged between 5% (Institute-4) and 9% (Institute-7). CONCLUSIONS Multiple factors influence the risk of complications following hepatectomy. Risk-adjusted BMVs are likely much more applicable and appropriate in assessing "acceptable" benchmark outcomes following liver surgery.
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Affiliation(s)
- Fabio Bagante
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Surgery, University of Verona, Verona, Italy
| | | | - Eliza W Beal
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Katiuscha Merath
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Simone Conci
- Department of Surgery, University of Verona, Verona, Italy
| | - Ozgür Akgül
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Hugo P Marques
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | - Vincent Lam
- Department of Surgery, Westmead Hospital, Sydney, Australia
| | - Feng Shen
- Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | | | - Olivier Soubrane
- Department of Hepatobiliopancreatic Surgery, AP-HP, Beaujon Hospital, Clichy, France
| | - Guillaume Martel
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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13
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Lee Y, Dang JT, Switzer N, Malhan R, Birch DW, Karmali S. Bridging interventions before bariatric surgery in patients with BMI ≥ 50 kg/m 2: a systematic review and meta-analysis. Surg Endosc 2019; 33:3578-3588. [PMID: 31399947 DOI: 10.1007/s00464-019-07027-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bariatric surgery on patients with body mass index (BMI) ≥ 50 kg/m2, historically known as superobesity, is technically challenging and carries a higher risk of complications. Bridging interventions have been introduced for weight loss before bariatric surgery in this population. This systematic review and meta-analysis aims to assess the efficacy and safety of bridging interventions before bariatric surgery in patients with BMI ≥ 50 kg/m2. METHODS MEDLINE, EMBASE, Web of Science, and Scopus were searched from database inception to September 2018. Studies were eligible for inclusion if they conducted any bridging intervention for weight loss in patients with BMI greater than 50 kg/m2 prior to bariatric surgery. Primary outcome was the change in BMI before and after bridging intervention. Secondary outcomes included comorbidity status after bridging interventions and resulting complications. Pooled mean differences (MD) were calculated using random effects meta-analysis. RESULTS 13 studies including 550 patients met inclusion criteria (mean baseline BMI of 61.26 kg/m2). Bridging interventions included first-step laparoscopic sleeve gastrectomy (LSG), intragastric balloon (IGB), and liquid low-calorie diet program (LLCD). There was a reduction of BMI by 12.8 kg/m2 after a bridging intervention (MD 12.8, 95% CI 9.49-16.1, P < 0.0001). Specifically, LSG demonstrated a BMI reduction of 15.2 kg/m2 (95% CI 12.9-17.5, P < 0.0001) and preoperative LLCD by 9.8 kg/m2 (95% CI 9.82-15.4, P = 0.0006). IGB did not demonstrate significant weight loss prior to bariatric surgery. There was remission or improvement of type 2 diabetes, hypertension, and sleep apnea in 62.8%, 74.6%, and 74.6% of patients, respectively. CONCLUSIONS First-step LSG and LLCD are both safe and appropriate bridging interventions which can allow for effective weight loss prior to bariatric surgery in patients with BMI greater than 50 kg/m2.
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Affiliation(s)
- Yung Lee
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jerry T Dang
- Department of Surgery, University of Alberta, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada.
| | - Noah Switzer
- Department of Surgery, University of Alberta, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada.,Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Roshan Malhan
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Daniel W Birch
- Department of Surgery, University of Alberta, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada.,Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Shahzeer Karmali
- Department of Surgery, University of Alberta, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada.,Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada
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14
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Chaturvedi A, Nath G, Yadav VB, Antiwal M, Shakya N, Swathi C, Singh JP. A clinical study on Virechana Karma (therapeutic purgation) over the gut flora with special reference to obesity. Ayu 2019; 40:179-184. [PMID: 33281395 PMCID: PMC7685265 DOI: 10.4103/ayu.ayu_302_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/09/2020] [Accepted: 04/11/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Altered gut flora is associated with the pathogenesis of both intestinal and extra‑intestinal disorders. Aetiology of obesity is associated with mechanisms such as short chain fatty acid production, stimulation of hormones, chronic low‑grade inflammation, lipoprotein and bile acid metabolism and increased endocannabinoid. Receptor system tone have been suggested to explain the role of gut microbiota of obesity. The Panchakarma (Ayurvedic purification methods) claims the management of metabolic disorders hence this work provides the target specific evidence for the clinical studies. The proposed project is aimed to explore the particular molecular mechanism and, to make this therapy more evidence based. Hence, it was hypothesized that Panchakarma‑based intervention such as Virechana Karma (therapeutic purgation) may influence microbiota and help in the management of the obesity. MATERIALS AND METHODS The study was conducted to explore the effect of Virechana Karma over the gut flora; therefore, total of 19 patients with Madhyama Koshtha diagnosed with obesity were included and received the intervention. Before and after Virechana, a stool sample was collected and processed for the enterobacterial repetitive intergenic consensus ‑polymerase chain reaction to find the changes over the facultative aerobic bacteria. RESULTS It was found that Virechana is effective in the management of the obesity as it helps to reduce colonization of aerobic bacteria. After Virechana and after follow‑up also, it showed the correction of the gut flora dysbiosis, thus initiated the weight loss mechanism in the body, resulting in diminution in the signs and symptoms of obesity. CONCLUSION Virechana is effective in the management of the obesity due to reduction in the Escherichia coli colonization and is effective over the gut flora dysbiosis.
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Affiliation(s)
- Ashutosh Chaturvedi
- Department of Kayachikitsa and Panchakarma and, Azamgarh, Uttar Pradesh, India
| | - Gopal Nath
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Azamgarh, Uttar Pradesh, India
| | - Virender Bhadur Yadav
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Azamgarh, Uttar Pradesh, India
| | - Meera Antiwal
- Department of Kayachikitsa, Shivalik Ayurvedic Medical College, Azamgarh, Uttar Pradesh, India
| | | | - C. Swathi
- Department of Prasuti Tantra, Faculty of Ayurveda, Azamgarh, Uttar Pradesh, India
| | - Jai Prakash Singh
- Department of Kayachikitsa and Panchakarma and, Azamgarh, Uttar Pradesh, India
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15
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Chang HW, Yang PY, Han TI, Meng NH. Wernicke encephalopathy concurrent with polyradiculoneuropathy in a young man after bariatric surgery: A case report. Medicine (Baltimore) 2019; 98:e14808. [PMID: 30855500 PMCID: PMC6417542 DOI: 10.1097/md.0000000000014808] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
RATIONALE Bariatric surgery is the recommended treatment for morbid obesity because of its rapid and sustained body weight loss effect. Nutrient deficiency-related neurological complications after bariatric surgery are often disabling. Thus, early recognition of these complications is important. Neurological complications involving the central and peripheral nerve system after bariatric surgery were reported. However, the report on the clinical course of the concurrent involvement of central and peripheral nervous system is limited. We present a rare case of a patient who developed Wernicke encephalopathy concurrent with polyradiculoneuropathy after receiving bariatric surgery. PATIENT CONCERNS A 22-year-old man with a history of morbid obesity presented progressive bilateral lower limbs weakness, blurred vision, and gait disturbance 2 months after receiving laparoscopic sleeve gastrectomy. Bilateral lower limb numbness and cognition impairment were also noted. DIAGNOSIS Brain magnetic resonance imaging and electrophysiologic studies confirmed the diagnosis of Wernicke encephalopathy concurrent with acute polyradiculoneuropathy. INTERVENTIONS Vitamin B and folic acid were given since admission. He also received regular intensive rehabilitation program. OUTCOMES The subject's cognitive impairment and diplopia improved 1 week after admission under medical treatments, yet lower limb weakness and gait disturbance were still noted. After a month of intensive inpatient rehabilitation, he was able to ambulate with a walker for 30 munder supervision. LESSONS Nutrient deficiency-related neurological complications after bariatric surgery are often disabling and even fatal. Prevention of neurological complications can be improved through close postsurgical follow-up of the nutritional status. Recognizing the signs and symptoms and evaluating the medical history are critical to the early diagnosis and treatment of this potentially serious yet treatable condition.
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Affiliation(s)
- Heng-Wei Chang
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital
| | - Pei-Yu Yang
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Ting-I Han
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital
| | - Nai-Hsin Meng
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital
- School of Medicine, China Medical University, Taichung, Taiwan
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16
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Froylich D, Sadeh O, Mizrahi H, Kafri N, Pascal G, Daigle CR, Geron N, Hazzan D. Midterm outcomes of sleeve gastrectomy in the elderly. Surg Obes Relat Dis 2018; 14:1495-1500. [PMID: 30177427 DOI: 10.1016/j.soard.2018.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/24/2018] [Accepted: 07/22/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The increase in life expectancy presents health systems with a growing challenge in the form of elderly obesity. Bariatric surgery has been shown to be a safe and effective treatment for obesity with reduction of excess weight and improvement in obesity-related co-morbidities. However, only recently have surgeons begun performing these operations on elderly patients on a larger scale, making data regarding mid- and long-term outcomes scarce. The objective of this study was to evaluate the safety and midterm efficacy of laparoscopic sleeve gastrectomy (LSG) in patients aged ≥60 years. METHODS All patients aged ≥60 years who underwent LSG between 2008 and 2014 and achieved ≥24-month follow-up were retrospectively reviewed. Demographic characteristics and perioperative data were analyzed. Weight loss parameters and co-morbidity resolution rates were compared with preoperative data. RESULTS In total 55 patients aged ≥60 years underwent LSG. Mean patient age was 63.9 ± 3.2 years (range, 60-75.2), and mean preoperative body mass index was 43 ± 6.0 kg/m2. Perioperative morbidity included 5 cases of hemorrhage necessitating operative exploration, 2 cases of reduced hemoglobin levels treated with blood transfusion, and 1 case of portal vein thrombosis managed with anticoagulation. There were no mortalities. Mean follow-up time was 48.6 (range, 25.6-94.5) months. Mean percentage of excess weight loss was 66.4 ± 19.7, 67.5 ±1 6.4, 61.4 ± 18.3, 66.7 ± 25.6, 50.7 ± 21.4 at 12, 24, 36, 37 to 60, and 61 to 96 months, respectively. Statistically significant improvement of type 2 diabetes, hypertension, and dyslipidemia were observed at the latest follow-up (P < .01). CONCLUSION LSG offers an effective treatment of obesity and its co-morbidities in patients aged ≥60 years, albeit with a high perioperative bleeding rate at our center; efficacy is maintained for at least 4.5 years.
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Affiliation(s)
- Dvir Froylich
- Surgery B Department, Carmel Medical Center, Haifa, Israel.
| | - Omer Sadeh
- Surgery B Department, Carmel Medical Center, Haifa, Israel
| | - Hagar Mizrahi
- General Surgery Department, The Baruch Padeh Medical Center, Poriya, Israel
| | - Naama Kafri
- Surgery B Department, Carmel Medical Center, Haifa, Israel
| | - Guy Pascal
- Surgery B Department, Carmel Medical Center, Haifa, Israel
| | | | - Nisim Geron
- General Surgery Department, The Baruch Padeh Medical Center, Poriya, Israel
| | - David Hazzan
- Surgery B Department, Carmel Medical Center, Haifa, Israel
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17
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Updated panel report: best practices for the surgical treatment of obesity. Surg Endosc 2018; 32:4158-4164. [PMID: 29602992 DOI: 10.1007/s00464-018-6160-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/21/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND During the 2004 annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), a panel of experts convened to provide updated information on best practices in bariatric surgery. The rapid evolution of endoluminal technologies, surgical indications, and training in bariatric surgery since 2004 has led to new questions and concerns about optimal treatment algorithms, patient selection, and the preparation of our current and future bariatric workforce. METHODS An expert panel was convened at the SAGES 2017 annual meeting to provide a summative update on current practice patterns, techniques, and training in bariatric surgery in order to review and establish best practices. This was a joint effort by SAGES, International Society for the Perioperative Care of the Obese Patient, and the American Society for Metabolic and Bariatric Surgery. RESULTS On March 23, 2017, seven expert faculty convened to address current areas of controversy in bariatric surgery and provide updated guidelines and practice recommendations. Areas addressed included the expanded indications for use of metabolic surgery in the treatment of diabetes, the safety and efficacy of new and investigational endoluminal procedures, updates on new guidelines for the management of airway and sleep apnea in the obese patient, the development of clinical pathways to reduce variation in the management of the bariatric patient, and new guidelines for training, credentialing, and bariatric program accreditation. The following article is a summary of this panel. CONCLUSION Bariatric surgery is a field that continues to evolve. A timely, systematic approach, such as described here, that coalesces data and establishes best practices on the current body of available evidence is imperative for optimal patient care and to inform provider, insurer, and policy decisions.
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18
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Capristo E, Panunzi S, De Gaetano A, Raffaelli M, Guidone C, Iaconelli A, L'Abbate L, Birkenfeld AL, Bellantone R, Bornstein SR, Mingrone G. Intensive lifestyle modifications with or without liraglutide 3mg vs. sleeve gastrectomy: A three-arm non-randomised, controlled, pilot study. DIABETES & METABOLISM 2017; 44:235-242. [PMID: 29398254 DOI: 10.1016/j.diabet.2017.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 12/04/2017] [Accepted: 12/19/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND/OBJECTIVES As only 1% of clinically eligible subjects choose to undergo surgical treatment for obesity, other options should be investigated. This study aimed to assess the effects of intensive lifestyle modification (ILM) with or without 3-mg liraglutide daily vs. sleeve gastrectomy (SG) on BMI after 1 year. SUBJECTS/METHODS In this study performed at an Italian university hospital, non-diabetic patients eligible for bariatric surgery were recruited from a weight-loss clinic and had the option to choose from three possible weight-loss programmes up to an allocation of 25 subjects in each arm matched by BMI and age. ILM consisted in 813kcal of a very low-calorie diet (VLCD) for 1 month, followed by a diet of 12kcal/kg body weight of high protein and high fat for 11 months plus 30min of brisk walking daily and at least 3h of aerobic exercise weekly. SG patients followed a VLCD for 1 month and a free diet thereafter. Patients were evaluated at baseline and at 1, 3, 6, 9 and 12 months. RESULTS A total of 75 patients were enrolled; retention was 100% in the SG and 85% in the two medical arms. SG reduced BMI by 32% (P<0.001 vs. medical arm), while ILM+liraglutide and ILM led to BMI reductions of 24% and 14%, respectively (P<0.001). More women allocated themselves to the ILM+liraglutide group. Weight loss was 43kg with SG, 26kg with ILM+liraglutide and 15kg with ILM alone. Lean body mass reductions were -11.6kg with SG, -6.3kg with ILM and -8.3kg with ILM+liraglutide. Prevalence of prediabetes was significantly lower with ILM+liraglutide, and insulin resistance was reduced by about 70% by both ILM+liraglutide and SG vs. 39% by ILM alone. Cardiometabolic risk factors were greatly reduced in all three groups. DISCUSSION At least in the short-term, liraglutide 3.0mg once daily associated with drastic calorie-intake restriction and intensive physical activity promoted a 24% weight loss, which was almost two times greater than ILM alone and only about 25% less than with SG, while preserving lean body mass. Although this study was non-randomised, it was designed to explore the efficacy of medical treatments for obesity in everyday clinical practice.
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Affiliation(s)
- E Capristo
- Department of Internal Medicine, Catholic University, Rome, Italy
| | - S Panunzi
- CNR-Institute of Systems Analysis and Computer Science (IASI), BioMatLab, Rome, Italy
| | - A De Gaetano
- CNR-Institute of Systems Analysis and Computer Science (IASI), BioMatLab, Rome, Italy
| | - M Raffaelli
- Department of Surgery, Catholic University, Rome, Italy
| | - C Guidone
- Department of Internal Medicine, Catholic University, Rome, Italy
| | - A Iaconelli
- Department of Internal Medicine, Catholic University, Rome, Italy
| | - L L'Abbate
- CNR-Institute of Systems Analysis and Computer Science (IASI), BioMatLab, Rome, Italy
| | - A L Birkenfeld
- Department of Medicine III, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany; Diabetes and Nutritional Sciences, Hodgkin Building, Guy's Campus, King's College London, London, United Kingdom; Paul Langerhans Institute Dresden of the Helmholtz Centre Munich at University Hospital Dresden, a member of the German Centre for Diabetes Research (DZD e.V.), Dresden, Germany
| | - R Bellantone
- Department of Surgery, Catholic University, Rome, Italy
| | - S R Bornstein
- Department of Medicine III, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany; Diabetes and Nutritional Sciences, Hodgkin Building, Guy's Campus, King's College London, London, United Kingdom
| | - G Mingrone
- Department of Internal Medicine, Catholic University, Rome, Italy; Diabetes and Nutritional Sciences, Hodgkin Building, Guy's Campus, King's College London, London, United Kingdom.
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Zappa MA, Aiolfi A, Musolino C, Giusti MP, Lesti G, Porta A. Vertical Gastric Bypass with Fundectomy: Feasibility and 2-Year Follow-Up in a Series of Morbidly Obese Patients. Obes Surg 2017; 27:2145-2150. [PMID: 28271378 DOI: 10.1007/s11695-017-2620-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is the gold standard procedure for morbid obesity and its results are well known and largely discussed. The major limitation of the procedure is the difficult exploration of the excluded gastric pouch and duodenum. The vertical gastric bypass with fundectomy was recently introduced in attempt to overcome these limitations. To date, its effectiveness is debated and outcomes still unclear. The purposes of this study were to describe the vertical gastric bypass with fundectomy and to analyse its outcomes in term of weight loss, complications, and comorbid resolutions. MATERIAL AND METHODS Since January 2012 to July 2014, 30 consecutive patients were enrolled and prospectively followed for a 24-month period. All patients underwent the vertical gastric bypass with fundectomy. Follow-up visits were scheduled at 7 days, 1, 6, 12, and 24 months, or whenever necessary. RESULTS Overall, 24 women and six men were enrolled in the study. Mean preoperative BMI was 38.2 ± 8.5 kg/m2. No intraoperative complications were reported. Postoperative overall complication rate was 10%. Compliance to the 24-month follow-up was 100%. Mean BMI and excess weight loss (EWL%) were significantly lower compared to baseline (p < 0.05). Comorbid improvement or resolution was recorded in the 80% of the patients. CONCLUSIONS Vertical gastric bypass with fundectomy is feasible and effective with similar results in terms of weight loss, complications, and comorbid improving compared to the classic RYGB. Complete evaluation of the gastric anatomy and easy access to the main duodenal papilla are unquestionable advantages.
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Affiliation(s)
- Marco Antonio Zappa
- Department of General and Emergency Surgery, University of Milan, Ospedale Fatebenefratelli "Sacra Famiglia", Via Fatebenefratelli n.20, Erba, CO, Italy.
| | - Alberto Aiolfi
- Department of General and Emergency Surgery, University of Milan, Ospedale Fatebenefratelli "Sacra Famiglia", Via Fatebenefratelli n.20, Erba, CO, Italy
| | - Cinzia Musolino
- Department of General and Emergency Surgery, University of Milan, Ospedale Fatebenefratelli "Sacra Famiglia", Via Fatebenefratelli n.20, Erba, CO, Italy
| | - Maria Paola Giusti
- Department of General and Emergency Surgery, University of Milan, Ospedale Fatebenefratelli "Sacra Famiglia", Via Fatebenefratelli n.20, Erba, CO, Italy
| | - Giovanni Lesti
- Department of General Surgery, Fondazione Salus Clinica Di Lorenzo, Via Vittorio Veneto n 37, Avezzano, AQ, Italy
| | - Andrea Porta
- Department of General and Emergency Surgery, University of Milan, Ospedale Fatebenefratelli "Sacra Famiglia", Via Fatebenefratelli n.20, Erba, CO, Italy
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20
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Is bariatric surgery safe in the elderly population? Surg Endosc 2016; 31:1538-1543. [PMID: 28039650 DOI: 10.1007/s00464-016-5050-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/13/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Bariatric surgery has proven to be the most effective treatment for morbid obesity in all age groups and is considered superior to medical treatment. The aim of our study was to report the outcomes of bariatric surgery in patients over 65 years of age at our institution. METHODS A retrospective review of a prospectively collected database was conducted of all patients > 65 years who underwent a bariatric procedure between 2005 and 2015 at our institution. We compared this group to a control group of patients < 65 years of age who were operated on during the last 5 years, from 2011 to 2015. Data analyzed included age, preoperative BMI, postoperative complications, and comorbidities. RESULTS Of 1613 patients studied, 1220 patients were under 65 years of age, and in Group B, 393 were >65 years of age at time of surgery. There was a significant difference in proportion of male patients among groups; 42 % in Group B were male compared to 30 % in Group A (p < 0.001). Caucasians represented the majority in both groups. Both groups had comparable preoperative BMI 42.27 kg/m2 for the younger Group A population versus 41.64 kg/m2 for Group B (p = 0.074). Group B had more comorbidities than Group A: hypertension (p < 0.001), sleep apnea (p < 0.001), and hypercholesterolemia (p < 0.001). No difference was found between groups in history of depression (p = 0.409) or type II diabetes (p = 0.961). Distribution of procedures was significantly different between groups, with more LSG in Group A (p < 0.001). Elderly patients had longer length of stay (LOS) by one day on average (LOS = 3 days, p < 0.001), but a lower readmission rate (10 % vs. 7 %) (p = 0.023). Complication rates were comparable in both groups, except for incidence of de novo GERD, which was higher in Group B (5 % vs. 8 %) (p = 0.005). CONCLUSIONS Elderly patients are usually sicker in terms of comorbidities than the younger population. However, age does not seem to represent a risk of surgical complications after bariatric surgery.
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Preventing Long-term Poor Outcomes in the Bariatric Patient Postoperatively. Dimens Crit Care Nurs 2016; 36:30-35. [PMID: 27902660 DOI: 10.1097/dcc.0000000000000223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The obesity epidemic in America continues to rise. People are desperately trying to find ways to lose weight successfully and keep the weight off, and many people are turning to bariatric surgery as the only remaining option for morbid obesity. Bariatric surgery is considered to be a viable treatment option for morbid obesity. However, long-term data are revealing that many postsurgical bariatric patients are regaining the weight after 5 years. The purpose of lifelong follow-up appointments in the bariatric patient is to prevent weight regain and poor outcomes. A case study is used as an example for a poor outcome in a postsurgical bariatric patient. The author of this article provides definitions related to postsurgical bariatric patients, explains the value of early detection and prevention, provides an example of a poor outcome, and concludes with a discussion of evidence-based practice changes that prevent poor outcomes.
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Liu W, Zhou M. A Comparative Study on the Transareola Single-Site Versus Three-Port Endoscopic Thyroidectomy. J Laparoendosc Adv Surg Tech A 2016; 27:242-246. [PMID: 27705097 DOI: 10.1089/lap.2016.0333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To explore the feasibility, safety, and advantages of transareola single-site endoscopic thyroidectomy. METHODS From January 2014 to December 2015, 40 patients were randomly divided into an observation group who received single-site endoscopic thyroidectomy by the areola approach and a control group who underwent three-port endoscopic thyroidectomy by the areola approach with 20 patients in each group. The feasibility and safety of the operation and postoperative clinical outcomes were compared between these two groups. RESULTS There was no significant difference in operation time, intraoperative blood loss, and hospitalization time (P > .05) between the two groups. The subcutaneous dissection area in the observation group (130 [120-130] cm2) was significantly smaller than that in the control group (180 [170-190] cm2) (P < .01). In addition, there is much less postoperative drainage in the observation group (70 [50-80] mL) than in the control group (80 [60-100] mL) (P = .036). Furthermore, 24-hour postoperative pain score in the observation group (4.0 [3.0-5.5]) was significantly lower compared with that in the control group (5.0 [4.0-7.0]) (P = .047). Moreover, patients in the observation group present with significantly higher 7-day postoperative cosmetic satisfaction scores (9.0 [8.0-9.0]) than those in the control group (7.0 [7.0-8.0]) (P < .001). CONCLUSION Transareola single-site endoscopic thyroidectomy exhibits superior advantages in clinical outcomes such as causing less pain and achieving better cosmetic satisfaction, compared with three-port endoscopic thyroidectomy.
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Affiliation(s)
- Weiwei Liu
- Department of General Surgery, Shanghai Tongren Hospital , Shanghai, China
| | - Ming Zhou
- Department of General Surgery, Shanghai Tongren Hospital , Shanghai, China
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Roslin M, Pearlstein S, Sabrudin S, Brownlee A. Stomach Intestinal Pyloric Sparing Surgery or SIPS. CURRENT SURGERY REPORTS 2016. [DOI: 10.1007/s40137-016-0157-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Beitner M, Luo Y, Kurian M. Procedural changes to decrease complications in laparoscopic gastric bypass. JSLS 2016; 19:e2014.00256. [PMID: 25848188 PMCID: PMC4376221 DOI: 10.4293/jsls.2014.00256] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background and Objectives: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a complex procedure performed in a patient population with significant medical comorbidities. Evaluation and modification of surgical techniques can minimize the complications associated with the lengthy learning curve for this procedure. The purpose of this study was to evaluate a single surgeon's decade-long experience with LRYGB, to determine whether complications decreased with experience and surgical modifications improved perioperative outcomes. Methods: A retrospective review of all procedures performed by a fellowship-trained surgeon (MK) from December 1, 2000, to October 31, 2013, identified patients who underwent LRYGB. We evaluated perioperative outcomes in 1117 patients and examined the impact of modification of surgical techniques on complications. The patients were divided into 4 groups: cases 1–100 (group 1), cases 101–400 (group 2), cases 401–700 (group 3), and cases 701-1117 (group 4). Results: Operating time decreased significantly after the initial 100 cases, from 179.1 minutes for group 1 to 122.1 minutes for group 4. With experience, early complication rates improved from 25.0% to 5.0%, but the rates of early reoperation increased from 1.0% to 2.2% over the 4 case groups. Late complication and reoperation rates increased from 4.0% to 10.5%. However, rates of bleeding, early stricture, internal hernia, and wound infection all decreased after the modification of surgical techniques. Conclusions: Operating time and early complication rates decreased with operative experience, but late complication and early and late reoperation rates increased. However, after modifications of surgical technique, common complications of LRYGB decreased to rates lower than those reported in several gastric bypass case series in the literature. The findings in this study will be helpful to fellow bariatric surgeons who are refining their strategies for reducing morbidity related to LRGYB.
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Affiliation(s)
- Melissa Beitner
- Department of Surgery, New York University Langone Medical Center
| | | | - Marina Kurian
- Department of Surgery, New York University Langone Medical Center
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Ng JY, Cheng AKS, Kim G, Kong LWC, Soe KT, Lomanto D, So JBY, Shabbir A. Is Elective Gastroscopy Prior to Bariatric Surgery in an Asian Cohort Worthwhile? Obes Surg 2016; 26:2156-2160. [DOI: 10.1007/s11695-016-2060-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Sima E, Hedberg J, Ehrenborg A, Sundbom M. Differences in early complications between circular and linear stapled gastrojejunostomy in laparoscopic gastric bypass. Obes Surg 2015; 24:599-603. [PMID: 24323525 DOI: 10.1007/s11695-013-1139-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Laparoscopic gastric bypass (LGBP) is the most common bariatric procedure worldwide. The gastrojejunostomy can be stapled with a circular or linear stapler, each with their own specific advantages. We have evaluated differences in postoperative complications between the two techniques. METHODS We studied operative data and postoperative complications in 560 patients (79.8 % females, median age 42, BMI 42.5) operated with LGBP between 2008 and 2012 at our center. The gastrojejunostomy was initially performed using a circular stapler (CS) in 288 patients and later by linear stapler (LS) in 272. Complications, operative time, and length of stay were retrieved from our database. The risk of developing a port site infection was evaluated with multivariate logistic regression. RESULTS Port site infections were more common with CS than LS, 5.2 and 0.4 %, respectively (p < 0.01). Multivariate analysis demonstrated CS to be an independent risk factor for port site infections (OR 16.3 (2.09-126), p < 0.01), as well as for stomal ulcers (OR 10.1, 1.15-89, p = 0.04). Major postoperative complications remained unchanged (anastomotic leak 1.0 vs. 1.1 %, abscess 0.7 vs. 0.4 %), while operative time and length of stay were found to be shorter using the LS (122 vs. 83 min, p < 0.001 and 4 vs. 3 days, p < 0.001). CONCLUSIONS The linear stapled technique yielded lower incidence of port site infections, probably by avoiding the passage of a contaminated circular stapler through the abdominal wall. No difference in major complications was seen, but operative time was shorter using a linear stapler instead of a circular stapler.
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Affiliation(s)
- E Sima
- Department of Surgical Sciences, Uppsala University, 75185, Uppsala, Sweden,
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Feng Y, Onkendi E, Sarr MG. Chronic gastrointestinal bleeding from an internal hernia after Roux-en-Y gastric bypass causing superior mesenteric venous obstruction with associated intestinal varices. Surg Obes Relat Dis 2015; 11:e29-31. [PMID: 26048515 DOI: 10.1016/j.soard.2015.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 04/21/2015] [Accepted: 04/23/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Yuan Feng
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Edwin Onkendi
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael G Sarr
- Department of Surgery, Mayo Clinic, Rochester, Minnesota.
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Abstract
OBJECTIVE To assess the impact of revisional surgery after laparoscopic adjustable gastric banding (LAGB) on weight loss at 12 and 24 months. BACKGROUND There is no uniform consensus as to the optimal procedure for patients requiring revision after LAGB. Few studies address the issue of weight loss after band salvage procedures, despite this being a critical factor in deciding which reoperative procedure to choose. METHODS A retrospective analysis was conducted of adult patients who underwent LAGB from January 1, 2001 to June 30, 2009 at a single institution. Patients who required revision for pouch-related problems including band slippage, pouch dilation, and hiatal hernia were studied. Demographic data, body mass index (BMI), percentage excess weight loss (% EWL), and operative details were recorded. Weights were recorded at 12 and 24 months after revision. These were compared with initial weight, weight before revision, and weight in patients who did not have a reoperation. RESULTS Of 3876 patients, 390 patients were included in analysis of weight outcomes after revision. The procedure-related mortality was 0%. Early (30-day) complications occurred in 0.5%, late complications (erosion) in 0.5%, and 29 patients (7.4%) required a second revision. For patients undergoing revision, the initial weight was 124.06 ± 21.28 kg and BMI was 44.80 ± 6.12 kg/m. At reoperation, weight was 89.18 ± 20.51 kg, BMI was 32.25 ± 6.50 kg/m and, %EWL was 54.13 ± 21.80%. Twelve months postrevision, weight was 92.24 ± 20.22 kg, BMI was 33.32 ± 6.41 kg/m, and %EWL was 48.81 ± 22.71%. Weight was 92.42 ± 19.91 kg, BMI was 33.53 ± 6.25 kg/m, and %EWL was 47.50 ± 22.91% twenty-four months postrevision. CONCLUSIONS Reoperation for pouch-related problems after LAGB is safe and effective. Weight loss is maintained after reoperation.
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Lim LTCRB, Jones DB. Bariatric surgery. Int Anesthesiol Clin 2013; 51:179-97. [PMID: 23797652 DOI: 10.1097/aia.0b013e31829813f8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- L T C Robert B Lim
- Uniformed Services University of the Health Sciences, Honolulu, Hawaii, USA.
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Wee CC, Hamel MB, Apovian CM, Blackburn GL, Bolcic-Jankovic D, Colten ME, Hess DT, Huskey KW, Marcantonio ER, Schneider BE, Jones DB. Expectations for weight loss and willingness to accept risk among patients seeking weight loss surgery. JAMA Surg 2013; 148:264-71. [PMID: 23553327 DOI: 10.1001/jamasurg.2013.1048] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
IMPORTANCE Weight loss surgery (WLS) has been shown to produce long-term weight loss but is not risk free or universally effective. The weight loss expectations and willingness to undergo perioperative risk among patients seeking WLS remain unknown. OBJECTIVES To examine the expectations and motivations of WLS patients and the mortality risks they are willing to undertake and to explore the demographic characteristics, clinical factors, and patient perceptions associated with high weight loss expectations and willingness to assume high surgical risk. DESIGN We interviewed patients seeking WLS and conducted multivariable analyses to examine the characteristics associated with high weight loss expectations and the acceptance of mortality risks of 10% or higher. SETTING Two WLS centers in Boston. PARTICIPANTS Six hundred fifty-four patients. MAIN OUTCOME MEASURES Disappointment with a sustained weight loss of 20% and willingness to accept a mortality risk of 10% or higher with WLS. RESULTS On average, patients expected to lose as much as 38% of their weight after WLS and expressed disappointment if they did not lose at least 26%. Most patients (84.8%) accepted some risk of dying to undergo WLS, but only 57.5% were willing to undergo a hypothetical treatment that produced a 20% weight loss. The mean acceptable mortality risk to undergo WLS was 6.7%, but the median risk was only 0.1%; 19.5% of all patients were willing to accept a risk of at least 10%. Women were more likely than men to be disappointed with a 20% weight loss but were less likely to accept high mortality risk. After initial adjustment, white patients appeared more likely than African American patients to have high weight loss expectations and to be willing to accept high risk. Patients with lower quality-of-life scores and those who perceived needing to lose more than 10% and 20% of weight to achieve "any" health benefits were more likely to have unrealistic weight loss expectations. Low quality-of-life scores were also associated with willingness to accept high risk. CONCLUSIONS AND RELEVANCE Most patients seeking WLS have high weight loss expectations and believe they need to lose substantial weight to derive any health benefits. Educational efforts may be necessary to align expectations with clinical reality.
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Zurita MV LC, Tabari M, Hong D. Laparoscopic conversion of laparoscopic Roux-en-Y gastric bypass to laparoscopic sleeve gastrectomy for intractable dumping syndrome and excessive weight loss. Surg Obes Relat Dis 2013; 9:e34-7. [DOI: 10.1016/j.soard.2012.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 11/20/2012] [Accepted: 11/21/2012] [Indexed: 11/27/2022]
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Abstract
Enhanced recovery after surgery (ERAS) programs have been shown to minimise morbidity in other types of surgery, but comparatively less data exist investigating ERAS in bariatric surgery. This article reviews the existing literature to identify interventions which may be included in an ERAS program for bariatric surgery. A narrative literature review was conducted. Search terms included 'bariatric surgery', 'weight loss surgery', 'gastric bypass', 'ERAS', 'enhanced recovery', 'enhanced recovery after surgery', 'fast-track surgery', 'perioperative care', 'postoperative care', 'intraoperative care' and 'preoperative care'. Interventions recovered by the database search, as well as interventions garnered from clinical experience in ERAS, were used as individual search terms. A large volume of evidence exists detailing the role of multiple interventions in perioperative care. However, efficacy and safety for a proportion of these interventions for ERAS in bariatric surgery remain unclear. This review concludes that there is potential to implement ERAS programs in bariatric surgery.
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Abstract
Obesity is common among adolescents resulting in substantial comorbidities and reduced life expectancy. Conservative treatments normally fail to ensure significant and sustained weight loss and suitable adolescents should be offered weight loss surgery. Laparoscopic Adjustable Gastric Banding and Roux-en-Y Gastric Bypass are commonly used in adolescents. Complications in RYGB tend to be more severe, but the procedure leads to more immediate results. LAGB complications are often device-related and less severe. Dietary adherence, eating behaviour and unrealistic patient expectations often cause problems. Significant and sustained weight loss of 50-70 per cent of excess weight is achievable, comorbidities and psychological problems improve. Meticulous patient selection and preparation and good post-operative care are vital for successful weight loss surgery. Weight loss surgery is safe, effective and economically viable with nurses playing a vital role at all stages of its application.
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Affiliation(s)
- Michael Pfeil
- School of Nursing Sciences, University of East Anglia, UK.
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