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Affiliation(s)
- Scott Um
- Department of Surgery University of California–Los Angeles Los Angeles, California
| | - Alaa Koleilat
- Department of Surgery University of California–Los Angeles Los Angeles, California
| | - Erik Dutson
- Department of Surgery University of California–Los Angeles Los Angeles, California
| | - Amir Mehran
- Department of Surgery University of California–Los Angeles Los Angeles, California
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Shayestehfar M, Seif-Barghi T, Zarei S, Mehran A. Acupuncture Anxiolytic Effects on Physiological and Psychological Assessments for a Clinical Trial. Scientifica (Cairo) 2016; 2016:4016952. [PMID: 27127679 PMCID: PMC4834398 DOI: 10.1155/2016/4016952] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/21/2016] [Indexed: 06/05/2023]
Abstract
In a randomized controlled trial we examined the effect of acupuncture on anxiety of the adolescent football players prior to the competition using psychological and physiological markers. A total of 45 athletes were equally allocated to either acupuncture group, sham group, or wait-list control group. Thereafter, all participants were asked to complete an anxiety questionnaire before and after the intervention. Their heart rate and skin conductance were also examined before and after the intervention. The results of ANOVA on posttest scores showed that acupuncture had a significant effect on cognitive anxiety (p = 0.001) and somatic anxiety (p < 0.001) but not on self-confidence (p > 0.05). Furthermore, the results showed that acupuncture significantly decreased the skin conductance in acupuncture group compared to sham group (p = 0.006) and wait-list control group (p < 0.001). In conclusion, the results suggested that acupuncture has the capacity to decrease cognitive anxiety and somatic anxiety prior to competition in adolescent athletes, while this was accompanied by significant physiological changes. This trial is registered with IRCT138904074264N1 (IRCT is a Primary Registry in the WHO Registry Network).
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Affiliation(s)
- Monir Shayestehfar
- Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Tohid Seif-Barghi
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Zarei
- Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Mehran
- Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Ghiyasvandian SH, Jalali niya F, Fadaei Dehcheshme M, Mehran A, Saatchi K. Effect of Acupressure on Bowel Elimination in Patients with Skeletal Traction. ACTA ACUST UNITED AC 2015. [DOI: 10.29252/ijn.28.96.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Maleki B, Rahimikian F, Salehi T, Mehran A. The impact of instructing management skill to managers on the obstetrician's efficiency. J Med Life 2015; 8:174-179. [PMID: 28316727 PMCID: PMC5319276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
UNLABELLED The importance of efficiency and improvement of health service for resolving people's health requirement and meeting their expectation is increasing. In addition, it considers as a priority for making decision and manager's activity in health officials. Manager's control on the management principle and the proper use of their management skill and creating a sense of trust and commitment are the tools that were providing a good condition for working and catching the organization's goals. In this quasi-experimental study, before beginning the research, the non-teaching hospitals that are affiliated to the Kurdistan's medical science university were randomly divided into 2 groups. Three hospitals from 3 cities considered as a control group, and three hospitals from 3 cities considered as an intervention group.80 person of hospital's obstetrician staff classified in these 2 group by quota method and the hospital's nurses and obstetrician's manager of case-control involved by census method. The research's tool was Hersi and Gold Smith's standard efficiency questionnaire, which was filled out at the beginning of the study by the obstetricians of both groups and then it gave to the hospital's nurses and obstetrician's managers of the case group's instructing management skills for 16 hours. The efficiency's questionnaire was filled out, compared, and evaluated again by the obstetricians of both groups, 12 weeks after intervention. The data analyzed by the independent T-test, variance analysis, paired T-test, and SPSS 22. The findings showed that the average of the obstetrician's efficiency mainly developed in the intervention team after the instruction of management skills to the managers (P < 0.001). CONCLUSION The instruction of the management skill to the nurses and obstetrician's managers caused the efficiency's promotion. Therefore, the instruction of the management skills has suggested as a method of increasing efficiency in hospitals.
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Affiliation(s)
- B Maleki
- Department of Midwifery, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - F Rahimikian
- Faculty of Nursing and Midwifery Care Research Center, School of Nursing and Midwifery,
Tehran University of Medical Sciences, Tehran, Iran
| | - T Salehi
- Department of Internal Surgery, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - A Mehran
- Faculty of Biostatistics Department, School of Nursing and Midwifery,
Tehran University of Medical Sciences, Tehran, Iran
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Um S, Koleilat A, Dutson E, Mehran A. Laparoscopic vertical sleeve gastrectomy for the treatment of pseudotumor cerebri. Am Surg 2013; 79:E61-E62. [PMID: 23336633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Scott Um
- Department of Surgery, University of California-Los Angeles, Los Angeles, CA, USA.
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Abstract
BACKGROUND Body piercing has become increasingly popular throughout the world and may cause unanticipated complications during surgery. METHODS We describe the case of a 35-y-old woman with hepatocellular carcinoma who underwent a diagnostic laparoscopy for metastatic disease evaluation. RESULTS An early intestinal injury occurred upon abdominal entry and introduction of pneumoperitoneum. The injury was secondary to a single adhesion between the abdominal wall and small bowel caused by a previous umbilical piercing. CONCLUSIONS Umbilical piercing can lead to unanticipated intraoperative complications even if it is removed prior to surgery. Surgeons performing laparoscopy should be aware of potential pitfalls associated with these art forms.
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Affiliation(s)
- Mi Hee Park
- Section for Minimally Invasive and Bariatric Surgery, Department of Surgery, University of California, Los Angeles, USA
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Chan T, Conovaloff C, Mehran A. Hetastarch use in bariatric surgery: word of caution. Am Surg 2012; 78:E278-E279. [PMID: 22546105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Tony Chan
- Section for Minimally Invasive and Bariatric Surgery, University of California Los Angeles, Department of Surgery, Los Angeles, California 90095-6904, USA
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Zelones J, Biswas O, Mehran A. Laparoscopic sleeve gastrectomy after simultaneous pancreas-kidney transplant. Am Surg 2012; 78:613-614. [PMID: 22546137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Justin Zelones
- Department of Surgery, University of California Los Angeles, Los Angeles, California 90095-6904, USA
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Chan T, Conovaloff C, Mehran A. Hetastarch Use in Bariatric Surgery: Word of Caution. Am Surg 2012. [DOI: 10.1177/000313481207800514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Tony Chan
- Section for Minimally Invasive and Bariatric Surgery University of California Los Angeles Department of Surgery Los Angeles, California
| | - Cheryl Conovaloff
- Section for Minimally Invasive and Bariatric Surgery University of California Los Angeles Department of Surgery Los Angeles, California
| | - Amir Mehran
- Section for Minimally Invasive and Bariatric Surgery University of California Los Angeles Department of Surgery Los Angeles, California
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Chan T, Conovaloff C, Mehran A. Hetastarch use in bariatric surgery: word of caution. Am Surg 2012; 78:E278-E279. [PMID: 22691328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Tony Chan
- Section for Minimally Invasive and Bariatric Surgery, University of California Los Angeles, Department of Surgery, Los Angeles, California, USA
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Affiliation(s)
- Justin Zelones
- Department of Surgery University of California Los Angeles Los Angeles, California
| | - Olivia Biswas
- Department of Surgery University of California Los Angeles Los Angeles, California
| | - Amir Mehran
- Department of Surgery University of California Los Angeles Los Angeles, California
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Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A, Ko CY, Gibbons MM. Patient behaviors associated with weight regain after laparoscopic gastric bypass. Obes Res Clin Pract 2011; 5:e169-266. [DOI: 10.1016/j.orcp.2011.03.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 02/21/2011] [Accepted: 03/10/2011] [Indexed: 02/05/2023]
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Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A, Ko CY, Shekelle PG, Gibbons MM. Is social support associated with greater weight loss after bariatric surgery?: a systematic review. Obes Rev 2011; 12:142-8. [PMID: 20158617 DOI: 10.1111/j.1467-789x.2010.00720.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Social support may be associated with increased weight loss after bariatric surgery. The objective of this article is to determine impact of post-operative support groups and other forms of social support on weight loss after bariatric surgery. MEDLINE search (1988-2009) was completed using MeSH terms including bariatric procedures and a spectrum of patient factors with potential relationship to weight loss outcomes. Of the 934 screened studies, 10 reported on social support and weight loss outcomes. Five studies reported on support groups and five studies reported on other forms of social support (such as perceived family support or number of confidants) and degree of post-operative weight loss (total n = 735 patients). All studies found a positive association between post-operative support groups and weight loss. One study found a positive association between marital status (being single) and weight loss, while three studies found a non-significant positive trend and one study was inconclusive. Support group attendance after bariatric surgery is associated with greater post-operative weight loss. Further research is necessary to determine the impact of other forms of social support. These factors should be addressed in prospective studies of weight loss following bariatric surgery, as they may represent ways to improve post-operative outcomes.
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Affiliation(s)
- M Livhits
- Department of Surgery, David Geffen School of Medicine at UCLA, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
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Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A, Ko CY, Gibbons MM. Behavioral Factors Associated with Successful Weight Loss after Gastric Bypass. Am Surg 2010. [DOI: 10.1177/000313481007601027] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients undergoing bariatric surgery lose substantial weight (≥50% excess weight loss [EWL]), but an estimated 20 per cent fail to achieve this goal. Our objective was to identify behavioral predictors of weight loss after laparoscopic Roux-en-Y gastric bypass. We retrospectively surveyed 148 patients using validated instruments for factors predictive of weight loss. Success was defined as ≥50 per cent EWL and failure as <50 per cent EWL. Mean follow-up after laparoscopic Roux-en-Y gastric bypass was 40.1 ± 15.3 months, with 52.7 per cent of patients achieving successful weight loss. After controlling for age, gender, and preoperative body mass index, predictors of successful weight loss included surgeon follow-up (odds ratio [OR] 8.2, P < 0.01), attendance of postoperative support groups (OR 3.7, P = 0.02), physical activity (OR 3.5, P < 0.01), single or divorced marital status (OR 3.2, P = 0.03), self-esteem (OR 0.3, P = 0.02), and binge eating (OR 0.9, P < 0.01). These factors should be addressed in prospective studies of weight loss after bariatric surgery, as they may identify patients at risk for weight loss failure who may benefit from early tailored interventions.
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Affiliation(s)
- Masha Livhits
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
- Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Cheryl Mercado
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Irina Yermilov
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
- Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Janak A. Parikh
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
- Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Erik Dutson
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Amir Mehran
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Clifford Y. Ko
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
- Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Melinda Maggard Gibbons
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
- Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, California
- Department of Surgery, Olive View-University of California, Los Angeles, Sylmar, California
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Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A, Ko CY, Gibbons MM. Behavioral factors associated with successful weight loss after gastric bypass. Am Surg 2010; 76:1139-1142. [PMID: 21105629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Patients undergoing bariatric surgery lose substantial weight (> or = 50% excess weight loss [EWL]), but an estimated 20 per cent fail to achieve this goal. Our objective was to identify behavioral predictors of weight loss after laparoscopic Roux-en-Y gastric bypass. We retrospectively surveyed 148 patients using validated instruments for factors predictive of weight loss. Success was defined as > or =50 per cent EWL and failure as <50 per cent EWL. Mean follow-up after laparoscopic Roux-en-Y gastric bypass was 40.1 +/- 15.3 months, with 52.7 per cent of patients achieving successful weight loss. After controlling for age, gender, and preoperative body mass index, predictors of successful weight loss included surgeon follow-up (odds ratio [OR] 8.2, P < 0.01), attendance of postoperative support groups (OR 3.7, P = 0.02), physical activity (OR 3.5, P < 0.01), single or divorced marital status (OR 3.2, P = 0.03), self-esteem (OR 0.3, P = 0.02), and binge eating (OR 0.9, P < 0.01). These factors should be addressed in prospective studies of weight loss after bariatric surgery, as they may identify patients at risk for weight loss failure who may benefit from early tailored interventions.
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Affiliation(s)
- Masha Livhits
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, 10833 LeConte Avenue, 72 215 CHS, Los Angeles, CA 90095, USA.
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Racu C, Squire BT, Asgari S, Dardashti S, Dutson EP, Mehran A, Kealey CP. P-89: Laparoscopic sleeve gastrectomy vs laparoscopic roux-en-Y gastric bypass: A prospective 1 year follow-up study. Surg Obes Relat Dis 2010. [DOI: 10.1016/j.soard.2010.03.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A, Ko CY, Gibbons MM. Exercise following bariatric surgery: systematic review. Obes Surg 2010; 20:657-65. [PMID: 20180039 PMCID: PMC2850994 DOI: 10.1007/s11695-010-0096-0] [Citation(s) in RCA: 148] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 01/28/2010] [Indexed: 02/05/2023]
Abstract
The contribution of physical activity on the degree of weight loss following bariatric surgery is unclear. To determine impact of exercise on postoperative weight loss. Medline search (1988–2009) was completed using MeSH terms including bariatric procedures and a spectrum of patient factors with potential relationship to weight loss outcomes. Of the 934 screened articles, 14 reported on exercise and weight loss outcomes. The most commonly used instruments to measure activity level were the Baecke Physical Activity Questionnaire, the International Physical Activity Questionnaire, and a variety of self-made questionnaires. The definition of an active patient varied but generally required a minimum of 30 min of exercise at least 3 days per week. Thirteen articles reported on exercise and degree of postoperative weight loss (n = 4,108 patients). Eleven articles found a positive association of exercise on postoperative weight loss, and two did not. Meta-analysis of three studies revealed a significant increase in 1-year postoperative weight loss (mean difference = 4.2% total body mass index (BMI) loss, 95% confidence interval (CI; 0.26–8.11)) for patients who exercise postoperatively. Exercise following bariatric surgery appears to be associated with a greater weight loss of over 4% of BMI. While a causal relationship cannot be established with observational data, this finding supports the continued efforts to encourage and support patients’ involvement in post-surgery exercise. Further research is necessary to determine the recommended activity guidelines for this patient population.
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Affiliation(s)
- Masha Livhits
- Department of Surgery, David Geffen School of Medicine at UCLA, 10833 LeConte Ave, 72-215 CHS, Los Angeles, CA 90095, USA.
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Mehran A. Response to Letter to the Editor from Jan-Uwe Schreiber, MD and Thomas Fuchs-Buder, MD, PhD; Succinylcholine: the Dilemma with the Evidence. Obes Surg 2010. [PMCID: PMC2803262 DOI: 10.1007/s11695-009-9993-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Abstract
Laparoscopic sleeve gastrectomy (LSG) as a single-stage restrictive bariatric procedure is becoming increasingly popular, especially in patients who are high risk and/or superobese. Between November 21, 2006, and September 30, 2008, 42 patients underwent LSG at our institution. Average age was 47 ± 11 years, average body mass index was 54 ± 10 kg/m2, and 62 per cent were female. Preoperative indications for LSG included contraindication to laparoscopic Roux-en-Y gastric bypass (n = 11), severe coronary artery disease and/or congestive heart failure (n = 3), significant liver disease (n = 3), and patient preference (n = 4). Intraoperative indications for LSG included a foreshortened mesentery with inability to create a gastrojejunostomy (n = 13), extensive adhesions (n = 5), and intraoperative findings concerning for cirrhosis (n = 3). Twelve complications occurred in six patients: laparoscopic to open conversion (n = 1), reoperation (n = 3), nosocomial pneumonia (n = 1), wound infection (n = 1), bleeding (n = 1), pulmonary embolus (n = 1), readmission (n = 3), and superior splenic pole infarction. There was one death resulting from pulmonary embolism that occurred 2 weeks postoperatively. Preliminary excess body weight loss at 3, 6, 9, and 12 months was 29, 32 t, 38, and 30 per cent, respectively, and many patients had improvement or resolution of obesity-related comorbidities. Early review of our experience demonstrates that LSG may be an effective single-stage bariatric procedure. Additional follow up will be necessary to better define its long-term safety and efficacy.
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Affiliation(s)
- Catherine E. Lewis
- From the Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Andrew Dhanasopon
- From the Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Erik P. Dutson
- From the Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Amir Mehran
- From the Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California
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Lewis CE, Dhanasopon A, Dutson EP, Mehran A. Early experience with laparoscopic sleeve gastrectomy as a single-stage bariatric procedure. Am Surg 2009; 75:945-949. [PMID: 19886141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Laparoscopic sleeve gastrectomy (LSG) as a single-stage restrictive bariatric procedure is becoming increasingly popular, especially in patients who are high risk and/or superobese. Between November 21, 2006, and September 30, 2008, 42 patients underwent LSG at our institution. Average age was 47 +/- 11 years, average body mass index was 54 +/- 10 kg/m2, and 62 per cent were female. Preoperative indications for LSG included contraindication to laparoscopic Roux-en-Y gastric bypass (n = 11), severe coronary artery disease and/or congestive heart failure (n = 3), significant liver disease (n = 3), and patient preference (n = 4). Intraoperative indications for LSG included a foreshortened mesentery with inability to create a gastrojejunostomy (n = 13), extensive adhesions (n = 5), and intraoperative findings concerning for cirrhosis (n = 3). Twelve complications occurred in six patients: laparoscopic to open conversion (n = 1), reoperation (n = 3), nosocomial pneumonia (n = 1), wound infection (n = 1), bleeding (n = 1), pulmonary embolus (n = 1), readmission (n = 3), and superior splenic pole infarction. There was one death resulting from pulmonary embolism that occurred 2 weeks postoperatively. Preliminary excess body weight loss at 3, 6, 9, and 12 months was 29, 32 t, 38, and 30 per cent, respectively, and many patients had improvement or resolution of obesity-related comorbidities. Early review of our experience demonstrates that LSG may be an effective single-stage bariatric procedure. Additional follow up will be necessary to better define its long-term safety and efficacy.
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Affiliation(s)
- Catherine E Lewis
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California 90095-6904, USA
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Dhanasopon AP, Lewis CE, Folek JM, Dutson EP, Mehran A. Splenic infarct as complication of sleeve gastrectomy. Surg Obes Relat Dis 2009; 5:626-9. [DOI: 10.1016/j.soard.2009.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Accepted: 03/18/2009] [Indexed: 12/19/2022]
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Jensen C, Tejirian T, Lewis C, Yadegar J, Dutson E, Mehran A. Postoperative CPAP and BiPAP use can be safely omitted after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2008; 4:512-4. [PMID: 18656832 DOI: 10.1016/j.soard.2008.05.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Revised: 05/07/2008] [Accepted: 05/13/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is prevalent in the morbidly obese population. The need for routine preoperative testing for OSA has been debated in bariatric surgery publications. Most investigators have advocated the use of continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP) in the postoperative setting; however, others have reported pouch perforations or other gastrointestinal complications as a result of their use. From a review of our experience, we present an algorithm for the safe postoperative treatment of patients with OSA without the use of CPAP or BiPAP. METHODS From January 2003 to December 2007, 1095 laparoscopic Roux-en-Y gastric bypasses were performed at our institution. Preoperative testing for OSA was not routinely performed. A prospective database was maintained. The data included patient demographics, co-morbidities (including OSA and CPAP/BiPAP use), perioperative events, complications, and follow-up information. Patients with known OSA were not given CPAP/BiPAP after surgery. They were observed in a monitored setting during their inpatient stay, ensuring continuous oxygen saturation of >92%. All patients used patient-controlled analgesia, were trained in the use of incentive spirometry, and ambulated within a few hours of surgery. The outcomes were compared between the OSA patients using preoperative CPAP/BiPAP versus those with OSA without preoperative CPAP/BiPAP versus patients with no history of OSA. RESULTS A total of 811 patients were included in the study group with no known history of OSA. Of the 284 patients with a confirmed diagnosis of OSA, 144 were CPAP/BiPAP dependent. Statistically significant differences were present in age distribution and gender, with men having greater CPAP/BiPAP dependency. No significant differences were found in body mass index, length of stay, pulmonary complications, or deaths. One pulmonary complication occurred in the OSA, CPAP/BiPAP-dependent group, three in the OSA, non-CPAP group, and six in the no-known OSA group. No anastomotic leaks or deaths occurred in the series. CONCLUSION Postoperative CPAP/BiPAP can be safely omitted in laparoscopic Roux-en-Y gastric bypass patients with known OSA, provided they are observed in a monitored setting and their pulmonary status is optimized by aggressive incentive spirometry and early ambulation.
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Affiliation(s)
- Candice Jensen
- Section of Minimally Invasive and Bariatric Surgery, University of California-Los Angeles, David Geffen School of Medicine, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
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Tejirian T, Jensen C, Lewis C, Dutson E, Mehran A. Laparoscopic Gastric Bypass at a Large Academic Medical Center: Lessons Learned from the First 1000 Cases. Am Surg 2008. [DOI: 10.1177/000313480807401017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bariatric surgery is an effective and durable treatment for morbid obesity in properly selected patients. Surgical outcomes and patient management methods should routinely be reviewed to improve patient care and maintain long-term effectiveness of the bariatric operation. Over a 5-year period, 1096 laparoscopic Roux-en-Y gastric bypass operations were performed at our institution. A comprehensive prospective database was maintained, which included data for comorbidities, operative techniques, perioperative management, complications, and follow up. Many practice patterns such as the omission of routine preoperative sleep apnea testing and biliary ultrasounds remained constant and were validated by the outcomes measured. Several changes, however, were implemented based on outcomes analyses, including antecolic placement of the roux limb, a pars flaccida approach to the creation of the gastric pouch, longer alimentary limbs in superobese patients, and a selective approach to postoperative upper gastrointestinal imaging. Postoperative weight regain and inability to maintain long-term follow up in a significant per cent of patients were two identified and ongoing problems. Maintenance of a bariatric patient database is essential with its routine review resulting in changes to practice patterns and operative techniques. An effective method for long-term patient follow up remains elusive and may contribute to postoperative weight regain in some patients.
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Affiliation(s)
- Talar Tejirian
- Department of Surgery UCLA Medical Center, Los Angeles, California
| | - Candice Jensen
- Department of Surgery UCLA Medical Center, Los Angeles, California
| | - Catherine Lewis
- Department of Surgery UCLA Medical Center, Los Angeles, California
| | - Erik Dutson
- Department of Surgery UCLA Medical Center, Los Angeles, California
| | - Amir Mehran
- Department of Surgery UCLA Medical Center, Los Angeles, California
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Tejirian T, Jensen C, Lewis C, Dutson E, Mehran A. Laparoscopic gastric bypass at a large academic medical center: lessons learned from the first 1000 cases. Am Surg 2008; 74:962-966. [PMID: 18942623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Bariatric surgery is an effective and durable treatment for morbid obesity in properly selected patients. Surgical outcomes and patient management methods should routinely be reviewed to improve patient care and maintain long-term effectiveness of the bariatric operation. Over a 5-year period, 1096 laparoscopic Roux-en-Y gastric bypass operations were performed at our institution. A comprehensive prospective database was maintained, which included data for comorbidities, operative techniques, perioperative management, complications, and follow up. Many practice patterns such as the omission of routine preoperative sleep apnea testing and biliary ultrasounds remained constant and were validated by the outcomes measured. Several changes, however, were implemented based on outcomes analyses, including antecolic placement of the roux limb, a pars flaccida approach to the creation of the gastric pouch, longer alimentary limbs in superobese patients, and a selective approach to postoperative upper gastrointestinal imaging. Postoperative weight regain and inability to maintain long-term follow up in a significant per cent of patients were two identified and ongoing problems. Maintenance of a bariatric patient database is essential with its routine review resulting in changes to practice patterns and operative techniques. An effective method for long-term patient follow up remains elusive and may contribute to postoperative weight regain in some patients.
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Affiliation(s)
- Talar Tejirian
- Department of Surgery, UCLA Medical Center, Los Angeles, California 90095-6904, USA
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Basa NR, Dutson E, Lewis C, Derezin M, Han S, Mehran A. Laparoscopic transgastric removal of eroded adjustable band: a novel approach. Surg Obes Relat Dis 2008; 4:194-7. [PMID: 18359458 DOI: 10.1016/j.soard.2007.12.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Revised: 12/05/2007] [Accepted: 12/26/2007] [Indexed: 12/17/2022]
Abstract
Gastric erosion is a well-known complication of laparoscopic adjustable gastric band (LAGB) placement for morbid obesity. We describe a novel approach for the removal of an eroded band through a laparoscopic gastrotomy with subsequent intraluminal division and removal of the band. A 67-year-old woman with a body mass index of 35.5 kg/m2 was seen 1 year after LAGB placement performed outside the United States. She had developed dysphagia and regurgitation of undigested food a few months after the procedure. The LAGB had been adjusted twice by her primary surgeons and was completely deflated once her symptoms began. The patient failed to improve and was subsequently referred to our institution where an upper endoscopy revealed intragastric band erosion. The patient was taken to the operating room for LAGB removal; however, standard laparoscopic and endoscopic attempts at band retrieval were unsuccessful. We then attempted a novel laparoscopic technique. An anterior gastrotomy was created, distal to the area of erosion, to facilitate easy intraluminal band division and removal. The gastrotomy was repaired, and a leak test was performed. A postoperative Gastrografin upper gastrointestinal series showed no extravasation. The patient began a diet, was discharged, and was seen in follow-up with complete resolution of her symptoms. The results of this case have shown that laparoscopic transgastric removal of an eroded gastric band is safe and feasible when standard endoscopic and laparoscopic techniques fail.
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Affiliation(s)
- Nicole R Basa
- Section of Minimally Invasive and Bariatric Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
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27
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Jensen CM, Tejirian T, Lewis C, Mehran A, Dutson E. P78: Early jejunojejunostomy obstructions following laparoscopic gastric bypass: Case series and treatment algorithm. Surg Obes Relat Dis 2008. [DOI: 10.1016/j.soard.2008.03.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hwa Han S, Gracia C, Mehran A, Basa N, Hines J, Suleman L, Vira D, Dutson E. Improved Outcomes Using a Systematic and Evidence-Based Approach to the Laparoscopic Roux-En-Y Gastric Bypass in a Single Academic Institution. Am Surg 2007. [DOI: 10.1177/000313480707301004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
No standardized approach exists for laparoscopic Roux-en-Y gastric bypass (LRYGB). At a newly instituted bariatric surgery program, four experienced laparoscopic surgeons used the systematic and evidence-based approach consisting of multidisciplinary preoperative evaluation, screening, and education; standardized operative technique; inpatient clinical pathway; and close postoperative follow-up. The outcomes were subsequently analyzed to determine if this approach improved the morbidity and mortality. From January 2003 to June 2006, 835 consecutive LRYGBs were performed. The patient population was 85 per cent women with a mean body mass index (BMI) of 50.4 kg/m2 (range 33–96 kg/m2). The mean age was 44 (range 15–67). Sixty-two per cent of the patients had previous abdominal or pelvic operations. The conversion rate to open surgery was 0.2 per cent. The average length of hospital stay was 2.6 days (range 2–13 days). There were no anastomotic leaks or deaths. The 30-day readmission and re-operation rates were 3.2 per cent and 1.8 per cent, respectively. The incidence of anastomotic stricture, marginal ulcer, bleeding, pulmonary embolism, and internal hernia was 0.8 per cent, 3.5 per cent, 4.2 per cent, 0.1 per cent, and 0.4 per cent, respectively. A systematic and evidence-based approach to the LRYGB by experienced laparoscopic surgeons resulted in a lower incidence of complications when compared with the published results from other comparable institutions.
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Affiliation(s)
- Soo Hwa Han
- University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Carlos Gracia
- University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Amir Mehran
- University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Nicole Basa
- University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Joe Hines
- University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Lubna Suleman
- University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Darshni Vira
- University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Erik Dutson
- University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, California
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Han SH, Gracia C, Mehran A, Basa N, Hines J, Suleman L, Vira D, Dutson E. Improved outcomes using a systematic and evidence-based approach to the laparoscopic Roux-en-Y gastric bypass in a single academic institution. Am Surg 2007; 73:955-958. [PMID: 17983055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
No standardized approach exists for laparoscopic Roux-en-Y gastric bypass (LRYGB). At a newly instituted bariatric surgery program, four experienced laparoscopic surgeons used the systematic and evidence-based approach consisting of multidisciplinary preoperative evaluation, screening, and education; standardized operative technique; inpatient clinical pathway; and close postoperative follow-up. The outcomes were subsequently analyzed to determine if this approach improved the morbidity and mortality. From January 2003 to June 2006, 835 consecutive LRYGBs were performed. The patient population was 85 per cent women with a mean body mass index (BMI) of 50.4 kg/m2 (range 33-96 kg/m2). The mean age was 44 (range 15-67). Sixty-two per cent of the patients had previous abdominal or pelvic operations. The conversion rate to open surgery was 0.2 per cent. The average length of hospital stay was 2.6 days (range 2-13 days). There were no anastomotic leaks or deaths. The 30-day readmission and re-operation rates were 3.2 per cent and 1.8 per cent, respectively. The incidence of anastomotic stricture, marginal ulcer, bleeding, pulmonary embolism, and internal hernia was 0.8 per cent, 3.5 per cent, 4.2 per cent, 0.1 per cent, and 0.4 per cent, respectively. A systematic and evidence-based approach to the LRYGB by experienced laparoscopic surgeons resulted in a lower incidence of complications when compared with the published results from other comparable institutions.
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Affiliation(s)
- Soo Hwa Han
- University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
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Han SH, Basa N, Suleman L, Vira D, Dutson E, Gracia C, Mehran A. P12. Surg Obes Relat Dis 2007. [DOI: 10.1016/j.soard.2007.03.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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32
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Basa NR, Han S, Dutson E, Derezin M, Mehran A. V6. Surg Obes Relat Dis 2007. [DOI: 10.1016/j.soard.2007.03.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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33
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Bertucci W, White S, Yadegar J, Patel K, Han SH, Blocker O, Frickel D, Kadell B, Mehran A, Gracia C, Dutson E. Routine Postoperative Upper Gastroesophageal Imaging is Unnecessary after Laparoscopic Roux-en-Y Gastric Bypass. Am Surg 2006. [DOI: 10.1177/000313480607201004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Routine early postoperative upper gastroesophageal imaging (UGI) is often used in laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures to confirm anastomotic patency and to exclude leaks. The aim of our study was to assess the usefulness of this practice. From January 2003 to November 2004, 322 LRYGB cases were performed using linear staplers for the gastrojejunostomy and jejuno-jejunostomy anastomoses. As part of our protocol, all patients received a Gastrograffin® (Mallinkrodt, Inc., St Louis, Missouri) UGI on postoperative Day 1. The same radiological techniques were used and the same radiological team reviewed all films. Abnormal films were identified. In addition, patient demographics, time to discharge, and complications were collected and analyzed in a prospective database. There were no anastomotic leaks or obstructions. However, 42 of 322 (13%) studies demonstrated delayed gastric emptying. There were no statistically significant differences between patients with normal and delayed UGI studies. Routine UGI studies did not contribute significantly to patient care, and its routine use was subsequently abandoned.
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Affiliation(s)
- William Bertucci
- From the Section for Minimally Invasive and Bariatric Surgery, UCLA Department of Surgery, Los Angeles, California
| | - Stephen White
- From the Section for Minimally Invasive and Bariatric Surgery, UCLA Department of Surgery, Los Angeles, California
| | - John Yadegar
- From the Section for Minimally Invasive and Bariatric Surgery, UCLA Department of Surgery, Los Angeles, California
| | - Kaushal Patel
- From the Section for Minimally Invasive and Bariatric Surgery, UCLA Department of Surgery, Los Angeles, California
| | - Soo Hwa Han
- From the Section for Minimally Invasive and Bariatric Surgery, UCLA Department of Surgery, Los Angeles, California
| | - Oliver Blocker
- From the Section for Minimally Invasive and Bariatric Surgery, UCLA Department of Surgery, Los Angeles, California
| | - Deborah Frickel
- From the Section for Minimally Invasive and Bariatric Surgery, UCLA Department of Surgery, Los Angeles, California
| | - Barbara Kadell
- From the Section for Minimally Invasive and Bariatric Surgery, UCLA Department of Surgery, Los Angeles, California
| | - Amir Mehran
- From the Section for Minimally Invasive and Bariatric Surgery, UCLA Department of Surgery, Los Angeles, California
| | - Carlos Gracia
- From the Section for Minimally Invasive and Bariatric Surgery, UCLA Department of Surgery, Los Angeles, California
| | - Erik Dutson
- From the Section for Minimally Invasive and Bariatric Surgery, UCLA Department of Surgery, Los Angeles, California
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Bertucci W, White S, Yadegar J, Patel K, Han SH, Blocker O, Frickel D, Kadell B, Mehran A, Gracia C, Dutson E. Routine postoperative upper gastroesophageal imaging is unnecessary after laparoscopic Roux-en-Y gastric bypass. Am Surg 2006; 72:862-4. [PMID: 17058722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Routine early postoperative upper gastroesophageal imaging (UGI) is often used in laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures to confirm anastomotic patency and to exclude leaks. The aim of our study was to assess the usefulness of this practice. From January 2003 to November 2004, 322 LRYGB cases were performed using linear staplers for the gastrojejunostomy and jejuno-jejunostomy anastomoses. As part of our protocol, all patients received a Gastrograffin (Mallinkrodt, Inc., St Louis, Missouri) UGI on postoperative Day 1. The same radiological techniques were used and the same radiological team reviewed all films. Abnormal films were identified. In addition, patient demographics, time to discharge, and complications were collected and analyzed in a prospective database. There were no anastomotic leaks or obstructions. However, 42 of 322 (13%) studies demonstrated delayed gastric emptying. There were no statistically significant differences between patients with normal and delayed UGI studies. Routine UGI studies did not contribute significantly to patient care, and its routine use was subsequently abandoned.
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Affiliation(s)
- William Bertucci
- Section for Minimally Invasive and Bariatric Surgery, UCLA Department of Surgery, Los Angeles, California, USA
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Patel KR, White S, Tejirian T, Han SH, Russell D, Vira D, Liao L, Patel KB, Gracia C, Haigh P, Dutson E, Mehran A. Gallbladder Management during Laparoscopic Roux-en-Y Gastric Bypass Surgery: Routine Preoperative Screening for Gallstones and Postoperative Prophylactic Medical Treatment are Not Necessary. Am Surg 2006. [DOI: 10.1177/000313480607201003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the bariatric surgery literature, the optimum approach to the gallbladder is controversial. Recommendations range from concomitant cholecystectomy to selective screening and postoperative medical prophylaxis. At our institution, we have taken a highly selective approach where patients are not routinely screened for gallstones, nor are they medically treated postoperatively with bile salts. We have reviewed our experience with this approach. From January 2003 to January 2005, 407 laparoscopic Roux en Y gastric bypasses were performed at UCLA and postoperative outcomes were collected into a prospective database. Exclusion criteria included previous cholecystectomy, a follow-up period less than 6 months, or incomplete records. One hundred ninety-nine patients were included in the study. With a mean follow up period of 17.8 months, 12 (6%) patients required cholecystectomy for gallstone-induced pathology. Laparoscopic removal was performed in 11 (92%) patients. Indications for surgery included acute cholecystitis in five (2.5%) patients, gallstone pancreatitis in two (1%) patients, and biliary colic alone in another five (2.5%) patients. The incidence of symptomatic gallstones requiring cholecystectomy after laparoscopic Roux en Y gastric bypass is low. These results are similar to those from institutions where routine preoperative screening and prophylactic postoperative medical therapy is used. Routine preoperative screening or medical prophylaxis may not be necessary.
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Affiliation(s)
- Kevin R. Patel
- Section of Minimally Invasive and Bariatric Surgery, UCLA School of Medicine, Los Angeles, California and the
| | - S.C. White
- Section of Minimally Invasive and Bariatric Surgery, UCLA School of Medicine, Los Angeles, California and the
| | - Talar Tejirian
- Department of General Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Soo H. Han
- Section of Minimally Invasive and Bariatric Surgery, UCLA School of Medicine, Los Angeles, California and the
| | - Doug Russell
- Section of Minimally Invasive and Bariatric Surgery, UCLA School of Medicine, Los Angeles, California and the
| | - Darshai Vira
- Section of Minimally Invasive and Bariatric Surgery, UCLA School of Medicine, Los Angeles, California and the
| | - Lingchen Liao
- Section of Minimally Invasive and Bariatric Surgery, UCLA School of Medicine, Los Angeles, California and the
| | - Karina B. Patel
- Section of Minimally Invasive and Bariatric Surgery, UCLA School of Medicine, Los Angeles, California and the
| | - Carlos Gracia
- Section of Minimally Invasive and Bariatric Surgery, UCLA School of Medicine, Los Angeles, California and the
| | - Phillip Haigh
- Department of General Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Erik Dutson
- Section of Minimally Invasive and Bariatric Surgery, UCLA School of Medicine, Los Angeles, California and the
| | - Amir Mehran
- Section of Minimally Invasive and Bariatric Surgery, UCLA School of Medicine, Los Angeles, California and the
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Patel KR, White SC, Tejirian T, Han SH, Russell D, Vira D, Liao L, Patel KB, Gracia C, Haigh P, Dutson E, Mehran A. Gallbladder management during laparoscopic Roux-en-Y gastric bypass surgery: routine preoperative screening for gallstones and postoperative prophylactic medical treatment are not necessary. Am Surg 2006; 72:857-61. [PMID: 17058721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
In the bariatric surgery literature, the optimum approach to the gallbladder is controversial. Recommendations range from concomitant cholecystectomy to selective screening and postoperative medical prophylaxis. At our institution, we have taken a highly selective approach where patients are not routinely screened for gallstones, nor are they medically treated postoperatively with bile salts. We have reviewed our experience with this approach. From January 2003 to January 2005, 407 laparoscopic Roux en Y gastric bypasses were performed at UCLA and postoperative outcomes were collected into a prospective database. Exclusion criteria included previous cholecystectomy, a follow-up period less than 6 months, or incomplete records. One hundred ninety-nine patients were included in the study. With a mean follow up period of 17.8 months, 12 (6%) patients required cholecystectomy for gallstone-induced pathology. Laparoscopic removal was performed in 11 (92%) patients. Indications for surgery included acute cholecystitis in five (2.5%) patients, gallstone pancreatitis in two (1%) patients, and biliary colic alone in another five (2.5%) patients. The incidence of symptomatic gallstones requiring cholecystectomy after laparoscopic Roux en Y gastric bypass is low. These results are similar to those from institutions where routine preoperative screening and prophylactic postoperative medical therapy is used. Routine preoperative screening or medical prophylaxis may not be necessary.
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Affiliation(s)
- Kevin R Patel
- Section of Minimally Invasive and Bariatric Surgery, UCLA School of Medicine, Los Angeles, California, USA
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Han SH, White S, Patel K, Dutson E, Gracia C, Mehran A. Acute gastric remnant dilation after laparoscopic Roux-en-Y gastric bypass operation in long-standing type I diabetic patient: Case report and literature review. Surg Obes Relat Dis 2006; 2:664-6. [PMID: 16979957 DOI: 10.1016/j.soard.2006.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Revised: 07/09/2006] [Accepted: 08/05/2006] [Indexed: 11/20/2022]
Affiliation(s)
- Soo Hwa Han
- Section of Minimally Invasive and Bariatric Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California 90095-6904, USA
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Nelson LG, Mehran A, Szomstein S, Zundel N, Rosenthal RR. Prevention and management of access port site hernia associated with the laparoscopic adjustable gastric band. Surg Laparosc Endosc Percutan Tech 2005; 15:174-6. [PMID: 15956906 DOI: 10.1097/01.sle.0000166970.38972.2c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Access port site hernia is a rare complication associated with the laparoscopic adjustable gastric band (LAGB). Specifically, this unique problem occurs when a fascial defect allows herniation adjacent to the Silastic tubing connects the LAGB to the access port. A 48-year-old woman who had previously undergone placement of LAGB presented with a bulge lateral to the access port; physical examination revealed a hernia near the access port. At laparoscopy, a large portion of omentum was herniated lateral to the Silastic tubing at the port site. This was laparoscopically repaired by first reducing the omentum and then placing a surgical mesh underlay to cover the defect; the patient recovered uneventfully. Access port site hernia is a rare complication with only a single case report published in the literature. We present a case of access port site hernia that was laparoscopically repaired. In addition, we have identified several important technical aspects that may contribute to the development of access port site hernias.
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Affiliation(s)
- Lana G Nelson
- Bariatric Institute, Cleveland Clinic Florida, Weston, FL 33331, USA
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Bertucci W, Yadegar J, Takahashi A, Alzahrani A, Frickel D, Tobin K, Kapur K, Namdari B, Dutson E, Gracia C, Mehran A. Antecolic Laparoscopic Roux-en-Y Gastric Bypass is not Associated with Higher Complication Rates. Am Surg 2005. [DOI: 10.1177/000313480507100908] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Since its introduction in 1994, laparoscopic Roux- en-Y gastric bypass (LRYGB) has rapidly gained popularity for the treatment of morbid obesity. Historically, the operation is performed in a retrocolic fashion; however antecolic LRYGB has been advocated as a safe alternative. We reviewed our experience with both techniques. From January 2003 to November 2004, the new UCLA Laparoscopic Bariatric Surgery Program performed 341 LRYGBs. In March 2004, our program transitioned from a retrocolic to an antecolic approach for all gastric bypass procedures. Institutional review board approval was obtained, and the data for all patients was collected into a prospective database. The patient characteristics for the two groups were similar. The significant differences between the two groups were average body mass index and the percentage of patients with diabetes and sleep apnea. The complication profiles for the two groups were also similar. There were significant differences between the two groups in the reoperation rate, antecolic 2.0 per cent versus retrocolic 7.8 per cent, and length of stay, antecolic 2.57 versus retrocolic 2.89 days. There were no anastomotic leaks or deaths in either group. Antecolic LRYGB is safe and may be associated with fewer complications. Only long-term weight loss results and complication rates will provide a definitive answer.
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Affiliation(s)
| | - John Yadegar
- From UCLA Medical Center, Los Angeles, California
| | | | | | | | | | - Karan Kapur
- From UCLA Medical Center, Los Angeles, California
| | | | - Erik Dutson
- From UCLA Medical Center, Los Angeles, California
| | | | - Amir Mehran
- From UCLA Medical Center, Los Angeles, California
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Bertucci W, Yadegar J, Takahashi A, Alzahrani A, Frickel D, Tobin K, Kapur K, Namdari B, Dutson E, Gracia C, Mehran A. Antecolic laparoscopic Roux-en-Y gastric bypass is not associated with higher complication rates. Am Surg 2005; 71:735-7. [PMID: 16468508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Since its introduction in 1994, laparoscopic Roux-en-Y gastric bypass (LRYGB) has rapidly gained popularity for the treatment of morbid obesity. Historically, the operation is performed in a retrocolic fashion; however antecolic LRYGB has been advocated as a safe alternative. We reviewed our experience with both techniques. From January 2003 to November 2004, the new UCLA Laparoscopic Bariatric Surgery Program performed 341 LRYGBs. In March 2004, our program transitioned from a retrocolic to an antecolic approach for all gastric bypass procedures. Institutional review board approval was obtained, and the data for all patients was collected into a prospective database. The patient characteristics for the two groups were similar. The significant differences between the two groups were average body mass index and the percentage of patients with diabetes and sleep apnea. The complication profiles for the two groups were also similar. There were significant differences between the two groups in the reoperation rate, antecolic 2.0 per cent versus retrocolic 7.8 per cent, and length of stay, antecolic 2.57 versus retrocolic 2.89 days. There were no anastomotic leaks or deaths in either group. Antecolic LRYGB is safe and may be associated with fewer complications. Only long-term weight loss results and complication rates will provide a definitive answer.
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Mehran A, Bertucci W, Yadegar J, Takahashi A, Alzahrani A, Drasin T, Namdari B, Frickel D, Valencia S, Dutson E, Gracia C. Multidisciplinary approach and minimally invasive surgery reduce morbidity and mortality in bariatric surgery. Surg Obes Relat Dis 2005. [DOI: 10.1016/j.soard.2005.03.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mehran A, Podkameni D, Rosenthal R, Szomstein S. Gastric perforation secondary to ingestion of a sharp foreign body. JSLS 2005; 9:91-3. [PMID: 15791979 PMCID: PMC3015552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Foreign body ingestions are commonly seen by pediatricians and emergency room personnel. The majority of foreign bodies transit through the gastrointestinal system without any complications. Perforations are uncommon and usually involve peritonitis. We present a case of gastric perforation secondary to ingestion of a sharp metallic pin. Our patient did not demonstrate any of the classic findings described in the literature. His complaints, physical examination, and radiological findings all pointed to acalculous cholecystitis or biliary dyskinesia as the source of pain. Laparoscopy, however, provided the definitive diagnosis. Gastroduodenal perforation secondary to foreign body ingestion should be included in the differential diagnosis of these atypical cases of abdominal pain, especially if such history can be elicited from the patient.
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Affiliation(s)
- Amir Mehran
- Division of Minimally Invasive & Bariatric Surgery, Cleveland Clinic Florida, Weston, Florida 33331, USA
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Mehran A, Ukleja A, Szomstein S, Rosenthal R. Laparoscopic partial gastrectomy for the treatment of gastropleural fistula. JSLS 2005; 9:213-5. [PMID: 15984713 PMCID: PMC3015586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Gastropleural fistulas (GPF) are uncommon and can occur as a consequence of prior pulmonary surgery, trauma, or malignancy. Conservative management usually fails, requiring gastrectomy and even thoracotomy in these often debilitated patients. We present a patient with GPF confirmed by upper endoscopy and radiographic contrast examination, who underwent a laparoscopic partial gastrectomy and closure of the fistula. To our knowledge, this is the first such report in the English language literature. Laparoscopic treatment of GPF may be associated with less early morbidity and should be considered as the initial procedure of choice.
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Affiliation(s)
- Amir Mehran
- Division of Minimally Invasive & Bariatric Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331, USA
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Affiliation(s)
- A Mehran
- Division of Minimally Invasive & Bariatric Surgery, Department of Surgery, Cleveland Clinic Florida, Weston, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA.
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Abstract
BACKGROUND Intra-operative pneumothorax (PTX) is an infrequent complication of laparoscopic surgery. Most cases are attributed to CO(2) diffusion across congenital diaphragmatic defects and resolve spontaneously. We report a case of PTX during a laparoscopic Roux-en-Y gastric bypass (LRYGBP). When applied to this specific patient population, the current literature recommendations for the management of intra-operative PTX are questioned. MATERIAL AND METHODS A retrospective chart review of 400 consecutive LRYGBP procedures performed over a 30-month period revealed 1 case of PTX (0.025%). RESULTS A bulging left diaphragm, hypotension, bradycardia, decreased pO(2), and elevated EtCO(2) and airway pressures, were noted early in the case. She initially responded to conservative management but required multiple subsequent hospital admissions for pulmonary complications. CONCLUSIONS Pneumoperitoneum-induced PTX during laparoscopic bariatric surgery is a rare complication. Its treatment must be based on the potential underlying cause, with consideration of these patients' often delicate pulmonary status. In stable patients, where the PTX is attributed to diaphragmatic or hiatal dissection, expectant treatment is appropriate. In all other situations, however, we believe that tube thoracostomy is indicated. An algorithm for treatment of PTX in laparoscopic bariatric surgery is proposed. It follows the dictum of maintaining extreme vigilance and a low threshold for aggressive intervention in this group of patients.
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Affiliation(s)
- Amir Mehran
- Division of General and Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, FL 33331, USA
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Mehran A, Liberman M, Rosenthal R, Szomstein S. Ruptured appendicitis after laparoscopic Roux-enY gastric bypass: pitfalls in diagnosing a surgical Abdomen in the morbidly obese. Obes Surg 2004; 13:938-40. [PMID: 14738686 DOI: 10.1381/096089203322618812] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A recent gastric bypass can mask the symptoms of an acute abdomen. Physical examination is generally unreliable and subtle clinical symptoms or signs should alert clinicians to a significant postoperative problem. In morbidly obese patients, the presence of overt peritoneal findings is usually ominous, leading to sepsis, organ failure and death. We report a case of ruptured appendicitis following a laparoscopic Roux-en-Y gastric bypass. The patient developed tachycardia, fever, and leukocytosis in the absence of abdominal pain or positive upper GI contrast studies. Eventually, a CT scan revealed a large pelvic abscess and inflammation. A subsequent exploratory laparotomy confirmed a perforated appendicitis with pelvic peritonitis. Her recovery was rapid and uneventful. This case highlights the pitfalls in promptly diagnosing an unrelated acute surgical abdomen postoperatively in the morbidly obese patient. The need for extreme vigilance and a low threshold for aggressive intervention in the period after bariatric surgery is emphasized.
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Affiliation(s)
- Amir Mehran
- Division of Minimally Invasive and Bariatric Surgery, Cleveland Clinic Florida, Weston, FL, USA
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Abstract
Esophageal perforation is a serious complication that requires prompt recognition and treatment. We present the case of a patient with lower esophageal perforation that apparently resulted from orogastric calibration-tube passage during laparoscopic placement of a gastric band. The complication was diagnosed early postoperatively, and was able to be successfully treated by laparoscopy,debanding, drainage, and parenteral nutrition.
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Affiliation(s)
- Flavia C Soto
- The Bariatric Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
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Mehran A, Jaffe P, Efron J, Vernava A, Liberman MA. Colonoscopy. Surg Endosc 2004. [DOI: 10.1007/s00464-004-0057-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Affiliation(s)
- Ronnie R Pimentel
- Department of Gastroenterology, Section Minimally Invasive Surgery, The Bariatric Institute, USA
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Szomstein S, Avital S, Brasesco O, Mehran A, Cabral JM, Rosenthal R. Laparoscopic Gastric Bypass in Patients on Thyroid Replacement Therapy for Subnormal Thyroid Function – Prevalence and Short-Term Outcome. Obes Surg 2004; 14:95-7. [PMID: 14980041 DOI: 10.1381/096089204772787365] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hypothyroidism is associated with increased body weight. Weight gain may occur despite normal levels of serum thyroid stimulating hormone (TSH) and thyroxine (T4) achieved by replacement therapy. We evaluated the prevalence of patients on thyroid replacement for subnormal thyroid function who were operated on for morbid obesity and monitored their postoperative weight loss pattern. METHODS Data was identified from a prospectively accrued database of patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGBP) or laparoscopic adjustable gastric banding (LAGB) for morbid obesity from February 2000 to November 2001. All patients with subnormal thyroid function, diagnosed by past thyroid function tests and treated by an endocrinologist, who were on thyroid replacement therapy, were identified; 5 of these were matched for age, gender, preoperative body mass index (BMI) and surgical procedure (LRYGBP) to 5 non-hypothyroid patients. Weight loss at 3 and 9 months after surgery was compared between the 2 groups. RESULTS 192 patients underwent LRYGBP (n=155) or LAGB (n=37). Of the 21 patients (10.9%) on thyroid replacement identified, 14 were primary, 4 were postablative, and 3 were post-surgical; 17 underwent LRYGBP. All patients had normal preoperative serum levels of TSH and T4. Comparison of the 2 matched groups of patients revealed no difference in weight loss at 3 and 9 months after surgery (P=1.0). CONCLUSIONS The prevalence of euthyroid patients on thyroid replacement for subnormal thyroid function who undergo surgical intervention for morbid obesity is high. Short-term weight loss in these patients is comparable to normal thyroid patients. Longer follow-up may be necessary to demonstrate the weight loss pattern in this group.
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Affiliation(s)
- Samuel Szomstein
- The Bariatric Institute, Cleveland Clinic Florida, Weston, FL 33331, USA.
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