1
|
Cooiman MI, Aarts EO, Janssen IMC, Hazebroek EJ, Berends FJ. Weight Loss, Remission of Comorbidities, and Quality of Life After Bariatric Surgery in Young Adult Patients. Obes Surg 2020; 29:1851-1857. [PMID: 30790164 DOI: 10.1007/s11695-019-03781-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION One of the current criteria for bariatric surgery is to be of an age between 18 and 65 years. In all the available literature, there is a lack of studies focusing on the results of bariatric surgery in younger patient. This could be of great interest because the weight loss response can be altered by differences in metabolism or compliance rate. In recent years, a high amount of patients between 18 and 25 years of age have undergone bariatric surgery in our center, and it is our aim to evaluate the weight loss results in this youngest patient group. METHODS All preoperative and perioperative data from patients aged 18-25 and 35-55 years (control group) were collected retrospectively. Bariatric procedures took place between 2011 and 2014. Follow-up data were gathered prospectively by collecting (laboratory) measurements and questionnaires. RESULTS In total, 103 young adults (mean age 22.5) were matched to 103 adult control patients (mean age 42.6) on BMI and date of surgery. Of the young adults' group, 75 patients underwent a Roux-en-Y gastric bypass (RYGB) compared with 80 patients in the control group. Three years after RYGB, mean %total body weight loss (%TBWL) was 34 (± 9) and 30.3 (± 9) (p = 0.03), respectively. CONCLUSION Bariatric surgery is effective in young adults, and results after RYGB are even better compared with age groups in which bariatric surgery is most often performed. The high remission rate of comorbidities shows the importance of effective treatment options at a young age and preventing damaging effects in the long term.
Collapse
Affiliation(s)
- M I Cooiman
- Department of Bariatric Surgery, Rijnstate Hospital/Vitalys Clinics, Wagnerlaan, 55, 6815 AD, Arnhem, The Netherlands.
| | - E O Aarts
- Department of Bariatric Surgery, Rijnstate Hospital/Vitalys Clinics, Wagnerlaan, 55, 6815 AD, Arnhem, The Netherlands
| | - I M C Janssen
- Department of Bariatric Surgery, Rijnstate Hospital/Vitalys Clinics, Wagnerlaan, 55, 6815 AD, Arnhem, The Netherlands
| | - E J Hazebroek
- Department of Bariatric Surgery, Rijnstate Hospital/Vitalys Clinics, Wagnerlaan, 55, 6815 AD, Arnhem, The Netherlands
| | - F J Berends
- Department of Bariatric Surgery, Rijnstate Hospital/Vitalys Clinics, Wagnerlaan, 55, 6815 AD, Arnhem, The Netherlands
| |
Collapse
|
2
|
Boerboom AB, Berends FJ, Aarts EO. It Is the Width Not the Size of the Pouch That Matters. Obes Surg 2019; 30:1134-1135. [PMID: 31811622 DOI: 10.1007/s11695-019-04316-2] [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: 10/25/2022]
Affiliation(s)
- A B Boerboom
- Department of Surgery, Rijnstate Hospital, Postal number 1190, 6800TA, Arnhem, Netherlands.
| | - F J Berends
- WeightWorks, The Surgical Weight Loss Clinic, Arnhem, Netherlands
| | - E O Aarts
- WeightWorks, The Surgical Weight Loss Clinic, Arnhem, Netherlands
| |
Collapse
|
3
|
Betzel B, Cooiman MI, Aarts EO, Janssen IMC, Wahab PJ, Groenen MJM, Drenth JPH, Berends FJ. Clinical follow-up on weight loss, glycemic control, and safety aspects of 24 months of duodenal-jejunal bypass liner implantation. Surg Endosc 2019; 34:209-215. [PMID: 30877567 PMCID: PMC6946747 DOI: 10.1007/s00464-019-06752-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/06/2019] [Indexed: 01/30/2023]
Abstract
Background The duodenal-jejunal bypass liner (DJBL) is an endoscopic device designed to induce weight loss and improve glycemic control. The liner is licensed for a maximum implant duration of 12 months. It might be hypothesized that extension of the dwelling time results in added value. The goals of our study were to determine weight change, change in glycemic control, and safety in patients with an intended 24 months of DJBL dwelling time. Methods Patients were initially selected for a 12-month implantation period. When no physical complaints or adverse events (AEs) occurred, motivated patients who responded well were selected for extension of dwelling time to 24 months. Patients underwent a control endoscopy 12 months after implantation and visited the out-patient clinic every 3 months up to explantation. Patients agreed to remove the DJBL when complaints or AEs occurred that could not be treated conservatively. Results Implantation was extended in 44 patients, and 24 (55%) patients completed the full 24 months. Twenty patients required early removal due to AEs. During dwelling time, body weight decreased significantly (15.9 kg; TBWL 14.6%). HbA1c decreased non-significantly (4.9 mmol/mol). The number of insulin users and daily dose of insulin both decreased significantly. At 24 months after removal, glycemic control had worsened, while body weight was still significantly lower compared to baseline. In total, 68% of the patients experienced at least one AE. Two patients developed a hepatic abscess. Conclusions DJBL treatment results in significant weight loss and improves glycemic control during implantation. The largest beneficial effects occur during the first 9–12 months after implantation. Extension of dwelling time to 24 months results only in stabilization of body weight and glycemic control. After explantation, weight improvements are maintained, but glycemic control worsens. As the cumulative risk of AEs increases with time, a maximal dwelling time of 12 months is advisable. Electronic supplementary material The online version of this article (10.1007/s00464-019-06752-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- B Betzel
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, P.O. Box 9101, Code 455, 6500 HB, Nijmegen, The Netherlands.
| | - M I Cooiman
- Vitalys Clinic, Velp, The Netherlands
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - E O Aarts
- Vitalys Clinic, Velp, The Netherlands
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - I M C Janssen
- Vitalys Clinic, Velp, The Netherlands
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - P J Wahab
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - M J M Groenen
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - J P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, P.O. Box 9101, Code 455, 6500 HB, Nijmegen, The Netherlands
| | - F J Berends
- Vitalys Clinic, Velp, The Netherlands
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| |
Collapse
|
4
|
Koehestanie P, Betzel B, Aarts EO, Janssen IMC, Wahab P, Berends FJ. Is reimplantation of the duodenal-jejunal bypass liner feasible? Surg Obes Relat Dis 2015; 11:1099-104. [PMID: 25979208 DOI: 10.1016/j.soard.2015.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/18/2015] [Accepted: 01/20/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND The endoscopic ally implanted DJBL is a 60-cm impermeable fluoropolymer device, which prevents food from making contact with the proximal intestine. It was designed to induce weight loss and treat type 2 diabetes mellitus (T2DM). OBJECTIVES To evaluate the feasibility, safety, and effectiveness of duodenal-jejunal bypass liner (DJBL) reimplantation. SETTING Prospective, observational study was conducted at the department of surgery and gastroenterology of the Rijnstate hospital, Arnhem, the Netherlands, between 2009 and 2011. METHODS Five obese patients with T2DM with body mass index (BMI) = Mass (kg) / height (m(2)), ranging from 30-35 kg/m(2) who completed the follow-up after their first implant and underwent removal of the DJBL after 6 months, were selected for reimplantation after an additional 18 months of follow-up. Weight loss, BMI, and HbA1 c were analyzed before and twelve months after reimplantation. RESULTS In all 5 patients, the DJBL was implanted and explanted without any complications. Also the reimplantation and reexplantation occurred without any complications. Median weight decreased significantly from 105 kg to 95 kg, and BMI decreased from 33 to 29. The glycated hemoglobin (HbA1 c) level decreased from 8.4% to 7.3% by the first implantation but it wasn't significant. CONCLUSIONS Reimplantation of DJBL is feasible, deemed safe, and showed additional weight loss.
Collapse
Affiliation(s)
- P Koehestanie
- Department of Surgery, Rijnstate Hospital, the Netherlands.
| | - B Betzel
- Department of Surgery, Rijnstate Hospital, the Netherlands
| | - E O Aarts
- Department of Surgery, Rijnstate Hospital, the Netherlands
| | - I M C Janssen
- Department of Surgery, Rijnstate Hospital, the Netherlands
| | - P Wahab
- Department of Gastroenterology, Rijnstate Hospital, the Netherlands
| | - F J Berends
- Department of Surgery, Rijnstate Hospital, the Netherlands
| |
Collapse
|
5
|
Dogan K, Betzel B, Homan J, Aarts EO, Ploeger N, de Boer H, Aufenacker TJ, van Laarhoven CJHM, Janssen IMC, Berends FJ. Long-Term Effects of Laparoscopic Roux-en-Y Gastric Bypass on Diabetes Mellitus, Hypertension and Dyslipidaemia in Morbidly Obese Patients. Obes Surg 2014; 24:1835-42. [PMID: 25027982 DOI: 10.1007/s11695-014-1310-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- K Dogan
- Department of Surgery, Rijnstate Hospital, Postal number 1190, P.O. Box 9555, 6800 TA, Arnhem, The Netherlands,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Burgerhart JS, Aarts EO, van de Meeberg PC, Berends FJ, Siersema PD, Smout AJPM. Esophageal motor responses to increasing adjustment of an implanted gastric band. Neurogastroenterol Motil 2013; 25:587-e461. [PMID: 23534401 DOI: 10.1111/nmo.12113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Received: 12/06/2012] [Accepted: 02/14/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND The adjustable gastric band is an effective surgical treatment to induce weight loss in patients with morbid obesity. We aimed to assess the effects of band placement and stepwise adjustment on esophageal motility, using high-resolution manometry (HRM). METHODS Patients underwent esophageal HRM before and 6 weeks after gastric band placement. During postoperative assessment, HRM was combined with intraband pressure measurement at increasing filling volumes. KEY RESULTS In total, 15 patients were studied. Mean DCI (±SD) decreased from 1085.3 ± 1064.1 mmHg s(-1) cm(-1) before to 507 ± 347.2 mmHg s(-1) cm(-1) (P = 0.015) after band placement, mean IBP from 10.7 ± 1.7 mmHg to 7.7 ± 1.6 mmHg (P = 0.01). Stepwise band adjustment from 1 to 8 mL had an immediate and profound effect on swallow-induced esophageal contractions: DCI increased from 766 ± 590.4 to 7231 ± 6298.1 mmHg s(-1) cm(-1) , IBP from 4.3 mmHg to 31.1 ± 17.3 mmHg, and intraband pressure increased from -109.1 ± 60.6 mmHg to 150.2 ± 65 mmHg. During band filling with volumes >5 mL, upward displacement of the LES was observed, indicative of shortening of the esophagus; the distance between the UES and LES decreased from 23.5 ± 1.3 cm at 0 mL to 19.9 ± 2 cm at 8 mL. CONCLUSIONS & INFERENCES Stepwise gastric band adjustment leads to immediate enforcement of esophageal peristalsis associated with an increase in intrabolus pressure and with pronounced esophageal shortening. Subjects who lack these responses to outflow obstruction may be more prone to dysphagia after band placement.
Collapse
Affiliation(s)
- J S Burgerhart
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands. J.S.
| | | | | | | | | | | |
Collapse
|
7
|
de Weijer BA, Aarts E, Janssen IMC, Berends FJ, van de Laar A, Kaasjager K, Ackermans MT, Fliers E, Serlie MJ. Hepatic and peripheral insulin sensitivity do not improve 2 weeks after bariatric surgery. Obesity (Silver Spring) 2013; 21:1143-7. [PMID: 23913729 DOI: 10.1002/oby.20220] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Bariatric surgery has rapid metabolic effects on glucose metabolism before the occurrence of clinically significant weight loss. This suggests an acute effect of the surgery itself, e.g., resulting from bypassing the nutrient flow from the proximal gastrointestinal tract. Rapid effects of Roux-en-Y gastric bypass surgery (RYGB) on glucose metabolism were defined. DESIGN AND METHODS Glucose metabolism and total triglyceride hydrolysis in the basal state and during a hyperinsulinemic euglycemic clamp using stable isotopes 2 weeks were studied before and after RYGB. RESULTS Eighteen pre-menopausal women scheduled for RYGB were included. 2 weeks after RYGB median weight loss was 7.8 kg. Basal insulin and glucose levels decreased after surgery. Endogenous glucose production (EGP) was lower after surgery. In addition, insulin levels were lower during the clamp after surgery, suggesting enhanced clearance. Hepatic and peripheral insulin sensitivity did not change. Free fatty acid (FFA) levels increased after surgery both in the basal state and during the first step of the clamp. Total triglyceride hydrolysis did not change in the basal state and tended to be higher during hyperinsulinemia. CONCLUSIONS Within 2 weeks, RYGB reduces basal EGP as well as insulin and glucose levels without an acute beneficial effect on hepatic or peripheral insulin sensitivity. The latter may be explained by higher rates of lipolysis and exposure to FFA induced by the hypocaloric state.
Collapse
Affiliation(s)
- B A de Weijer
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Aarts EO, Janssen J, Janssen IMC, Berends FJ, Telting D, de Boer H. Preoperative Fasting Plasma C-Peptide Level May Help to Predict Diabetes Outcome After Gastric Bypass Surgery. Obes Surg 2013; 23:867-73. [DOI: 10.1007/s11695-013-0872-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
9
|
Schigt A, Gerdes VEA, Cense HA, Berends FJ, van Dielen FMH, Janssen I, van der Laar A, van Wagensveld BA, Romijn JA, Serlie MJ. Bariatric surgery is an effective treatment for morbid obesity. Neth J Med 2013; 71:4-9. [PMID: 23482295] [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: 06/01/2023]
Abstract
The global obesity epidemic is also affecting the Netherlands, paralleled by a proportional increase in the number of morbidly obese persons. Bariatric surgery has been included as a treatment for morbid obesity in the Dutch Guideline for Obesity (2008). Nonetheless, bariatric surgery is applied in only a limited number of morbidly obese subjects in the Netherlands. Based on the most recent literature and Dutch statistics, this review provides a summary of current knowledge on the impact of obesity on health and health care and highlights the effective role of bariatric surgery in reducing this threat to public health.
Collapse
Affiliation(s)
- A Schigt
- Department of Endocrinology & Metabolism, Academic Medical Center, Amsterdam, the Netherlands
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Aarts EO, van Wageningen B, Janssen IMC, Berends FJ. Prevalence of Anemia and Related Deficiencies in the First Year following Laparoscopic Gastric Bypass for Morbid Obesity. J Obes 2012; 2012:193705. [PMID: 22523660 PMCID: PMC3317129 DOI: 10.1155/2012/193705] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 12/19/2011] [Indexed: 02/08/2023] Open
Abstract
Background. Anemia associated with deficiencies in iron, folic acid, and vitamin B12 are very common after Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) surgery for morbid obesity. This study was conducted to evaluate the prevalence of anemia after LRYGB. Patients and Methods. A total of 377 morbid obese patients were included in our study. All patients underwent a LRYGB. Hematologic parameters were obtained prior to and after surgery on standardized time intervals. Results. Anemia was present in 21 (P = 0.02) patients after surgery. Iron, folic acid, and vitamin B12 deficiencies were diagnosed in 66%, 15%, and 50% of patients, respectively. In 86% of patients, anemia was accompanied by one of these deficiencies. Conclusion. These results show that anemia and deficiencies for iron, folic acid deficiency, and vitamin B12 are very common within the first year after LRYGB. We advise a minimal daily intake of 65 mg of iron in male and 100 mg in female patients, 350 μg of vitamin B12, and 400 μg of folic acid. Patients undergoing LRYGB must be closely monitored for deficiencies pre- and postoperative and supplemented when deficiencies occur.
Collapse
Affiliation(s)
- E. O. Aarts
- Department of Surgery, Rijnstate Hospital, Postal number 1190, P.O. Box 9555, 6800 TA Arnhem, The Netherlands
- Department of Bariatric Surgery, Rijnstate Hospital and Vitalys Clinic, Postal number 1190, P.O. Box 9555, 6800 TA Arnhem, The Netherlands
| | - B. van Wageningen
- Department of Surgery, Rijnstate Hospital, Postal number 1190, P.O. Box 9555, 6800 TA Arnhem, The Netherlands
| | - I. M. C. Janssen
- Department of Surgery, Rijnstate Hospital, Postal number 1190, P.O. Box 9555, 6800 TA Arnhem, The Netherlands
| | - F. J. Berends
- Department of Surgery, Rijnstate Hospital, Postal number 1190, P.O. Box 9555, 6800 TA Arnhem, The Netherlands
| |
Collapse
|
11
|
Abstract
Access-port (AP) complications after laparoscopic adjustable gastric banding (LAGB) are often seen but seldom reported in literature. AP complications requiring additional surgery is reported in 3.6% to 24% of LAGB patients (Susmallian et al. Obes. Surg, 4:128–131, 2003; Peterli et al. Obes. Surg., 12(6):851–856, 2002; Busetto et al. Obes. Surg., 12:83–92, 2002; Mittermair et al. Obes. Surg., 19:446–450, 2009; Holeczy et al. Obes. Surg., 9:453–455, 1999; Bueter et al. Arch. Surg., 393:199–205, 2008; Launay-Savary et al. Obes Surg, 18:1406–1410, 2008; Balsiger et al. J. Gastrointest. Surg., 11:1470–1477, 2007; Szold and Abu-Abeid Surg. Endosc., 16:230–233, 2002). We evaluated the effect of fixing the AP on the pectoral fascia using the Velocity™ Injection Port on complication and re-operation rate. From January 2005 till October 2007, 619 LAGB procedures were performed using the SAGB QuickClose™. All procedures were performed by three dedicated surgeons using the pars flaccida technique. APs were placed on the fascia of the pectoral muscle using an infra-mammary incision. The AP device was fixed on the fascia using the Velocity™ Injection Port and Applier. Data was obtained retrospectively and records of 619 consecutive patients were reviewed for access-port complications. Sixty-eight AP complications were observed. Complications could be divided in four categories. Discomfort was reported in 30 patients, seven needing additional surgery. Infection contributed to 11 patients needing surgical removal of the device. Fourteen Patients with superficial infection were treated conservatively. Nine patients had inaccessible APs. Ultrasound-guided access was required in three patients. The remainder needed surgical relocation of the AP. Leakage of the tube was observed in four patients all of which needed revisional surgery. Our experience shows that fixation of the AP on the left pectoral fascia using the Velocity™ leads to a readily accessible AP with good anaesthetic and aesthetic results. In our series, 68 (11%) complications were recorded, of which 28 (4.5%) needed additional surgery.
Collapse
Affiliation(s)
- Bas van Wageningen
- Department of Surgery, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
| | | | | | | |
Collapse
|
12
|
Aarts EO, Berends FJ, Janssen IMC, Schweitzer DH. Semiquantitative assessment of bowel habits and its relation with calcium metabolism after gastric bypass surgery: a retrospective study. J Obes 2011; 2011:156164. [PMID: 21253537 PMCID: PMC3021851 DOI: 10.1155/2011/156164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 11/02/2010] [Indexed: 11/17/2022] Open
Abstract
Background. Calcium malabsorption after bariatric surgery may be harmful to skeletal health and demands for optimal skeletal management. Methods. 103 Patients were evaluated retrospectively at 12 months after surgery. The evaluation included a questionnaire about stool frequency and consistency and laboratory assessments. Results. 103 Patients, 27 males and 76 females, were included in the study. 83 Patients had an alimentary limb of 100 cm and 20 patients one of 150 cm. At 12 months after surgery, 77.7% reported changes of bowel habits, albumin adjusted calcium levels were normal in all but 2 patients, and PTH levels were increased in 35%. Correlations between semiquantified bowel scores (fecal scores) and data from the laboratory demonstrated increasing PTH values along with more frequent and softer/watery stools (RR 30.5, CI 6.2-149.2, P < .001). There was a trend for higher PTH levels in patients with an alimentary limb of 150 cm. Normal PTH levels were more frequently found in case of calcium and vitamin D3 use (RR 14.3, CI 3.6-56.5, P < .001). Conclusion. This study demonstrates interrelationships between semi-quantified fecal scores, PTH levels, and the compliance of taking calcium/vitamin D3 suppletion. However, prospective randomized studies are necessary to show causal relationships.
Collapse
Affiliation(s)
- E. O. Aarts
- Department of Bariatric Surgery, Rijnstate Hospital, Alysis Zorggroep, P.O. box 9555, 6800 TA Arnhem, The Netherlands
- *E. O. Aarts:
| | - F. J. Berends
- Department of Bariatric Surgery, Rijnstate Hospital, Alysis Zorggroep, P.O. box 9555, 6800 TA Arnhem, The Netherlands
| | - I. M. C. Janssen
- Department of Bariatric Surgery, Rijnstate Hospital, Alysis Zorggroep, P.O. box 9555, 6800 TA Arnhem, The Netherlands
| | - D. H. Schweitzer
- Department of Internal Medicine and Endocrinology, Reinier de Graaf Group of Hospitals, 2625 AD Delft, The Netherlands
| |
Collapse
|
13
|
van Wageningen B, Berends FJ, Van Ramshorst B, Janssen IFM. Revision of failed laparoscopic adjustable gastric banding to Roux-en-Y gastric bypass. Obes Surg 2006; 16:137-41. [PMID: 16469213 DOI: 10.1381/096089206775565212] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The most common bariatric surgical operation in Europe, laparoscopic adjustable gastric banding (LAGB), is reported to have a high incidence of long-term complications. Also, insufficient weight loss is reported. We investigated whether revision to Roux-en-Y gastric bypass (RYGBP) is a safe and effective therapy for failed LAGB and for further weight loss. METHODS From Jan 1999 to May 2004, 613 patients underwent LAGB. Of these, 47 underwent later revisional Roux-en-Y gastric bypass (RYGBP). Using a prospectively collected database, we analyzed these revisions. All procedures were done by two surgeons with extensive experience in bariatric surgery. RESULTS All patients were treated with laparoscopic (n=26) or open (n=21) RYGBP after failed LAGB. Total follow-up after LAGB was 5.5+/-2.0 years. For the RYGBP, mean operating time was 161+/-53 minutes, estimated blood loss was 219+/-329 ml, and hospital stay was 6.7+/-4.5 days. There has been no mortality. Early complications occurred in 17%. There was only one late complication (2%)--a ventral hernia. The mean BMI prior to any form of bariatric surgery was 49.2+/-9.3 kg/m2, and decreased to 45.8+/-8.9 kg/m2 after LAGB and was again reduced to 37.7+/-8.7 kg/m2 after RYGBP within our follow-up period. CONCLUSION Conversion of LAGB to RYGBP is effective to treat complications of LAGB and to further reduce the weight to healthier levels in morbidly obese patients.
Collapse
|
14
|
Van den Broek WT, Makay O, Berends FJ, Yuan JZ, Houdijk APJ, Meijer S, Cuesta MA. Laparoscopically assisted transhiatal resection for malignancies of the distal esophagus. Surg Endosc 2004; 18:812-7. [PMID: 15216864 DOI: 10.1007/s00464-003-9173-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2003] [Accepted: 11/07/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Resection of the esophagus remains the only curative therapy for esophageal cancer. Conventional resections are right-side thoracotomy in combination with laparotomy, gastric tube creation, and the transhiatal approach according to Orringer. This study evaluated laparoscopically assisted transhiatal esophagus resection, which offers perfect visualization of the esophagus during mediastinal dissection without the necessity of a thoracotomy. METHODS In this study, 25 laparoscopically assisted transhiatal esophagus resections were compared with a historical control group consisting of 20 open transhiatal esophagus resections. RESULTS Nine laparoscopically assisted resections (36%) were converted to open procedures. The operating time was longer in the laparoscopically assisted group (300 vs 257 min; p < 0.05), but laparoscopically assisted esophagus resection was associated with less blood loss (600 vs 900 ml; p < 0.05) and shorter intensive care unit stay (1 vs 2 days; p < 0.05). There were no differences in morbidity, mortality, and hospital stay. During a shorter follow-up time for the laparoscopic group (17 vs 54 months), 11 patients (44%) in the laparoscopically assisted group and 10 (50%) patients in the open group had recurrence of the disease. CONCLUSIONS Laparoscopically assisted transhiatal esophagus resection is a safe procedure with important advantages, as compared with the open procedure, such as less blood loss and shorter intensive care unit stay. At this point, the oncologic consequences are not clear.
Collapse
Affiliation(s)
- W T Van den Broek
- Department of Surgery, VU Medisch Centrum, Postbus 7057, Amsterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
15
|
Berends FJ, Schep N, Cuesta MA, Bonjer HJ, Kappers-Klunne MC, Huijgens P, Kazemier G. Hematological long-term results of laparoscopic splenectomy for patients with idiopathic thrombocytopenic purpura: a case control study. Surg Endosc 2004; 18:766-70. [PMID: 14752642 DOI: 10.1007/s00464-003-9140-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2003] [Accepted: 10/02/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Laparoscopic splenectomy (LS) for idiopathic thrombocytopenic purpura (ITP) appears, when compared to open splenectomy (OS), associated with immediate important advantages. However, in a number of patients splenectomy does not lead to an adequate response, or after initial adequate response a relapse occurs after some time. A relapse may be associated to the presence of accessory spleens and splenosis. The purpose of this study was to compare the operative outcome and the hematological results on the long term of a series of LS with a historic series of OS for the treatment of ITP. METHODS A retrospective review was done of 50 consecutive patients who underwent LS for ITP. Patient characteristics, outcome of surgery, and hematological results were compared to a historical group of patients who underwent conventional splenectomy for ITP (n = 31). Response to splenectomy was defined in three groups: complete remission, partial remission, and no response. Grouping was based on hematological data. RESULTS Concerning operative outcome and postoperative complications, there was a significant difference in favor of LS. Moreover, the hematological outcome of both groups showed no differences after a median period of 66 months (OS) and 35 months (LS), respectively. CONCLUSIONS Hematological results after laparoscopic splenectomy for ITP are comparable to those after open splenectomy in both the short and the long term.
Collapse
Affiliation(s)
- F J Berends
- Department of General Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
16
|
Berends FJ, den Hoed PT, Bonjer HJ, Kazemier G, van Riemsdijk I, Weimar W, IJzermans JNM. Technical considerations and pitfalls in laparoscopic live donornephrectomy. Surg Endosc 2002; 16:893-8. [PMID: 12163950 DOI: 10.1007/s004640090078] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2000] [Accepted: 08/16/2001] [Indexed: 01/10/2023]
Abstract
BACKGROUND Recent developments in laparoscopic solid organ surgery suggest a possible reduction in postoperative discomfort and disability for kidney donors. Technical aspects and the influence of surgical experience in laparoscopic donor nephrectomy were evaluated. METHODS The clinical outcome of 57 laparoscopic donor nephrectomies (LapNx) was compared with that for a historic control group of 27 open donor nephrectomies (OpenNx). RESULTS Three conversions to open nephrectomy (5.2%) were necessary. Postoperative complications were minor and comparable in both groups. Patients who underwent laparoscopic surgery demonstrated significantly less postoperative pain and a shorter hospital stay, but operative time and warm ischemia time were significantly longer. Graft survival after LapNx was 100% during a median follow-up period of 13 months. Operative time for LapNx decreased considerably with experience gained and seemed to be less for right nephrectomy. Stenotic ureter-bladder anastomoses occurred after LapNx in four patients during the first half year (7.0%), but this problem seemed to be resolved after modification of the technique. CONCLUSION LapNx is associated with less postoperative discomfort and improved convalescence.
Collapse
Affiliation(s)
- F J Berends
- Department of General Surgery, University Hospital Dijkzigt, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
17
|
Sietses C, von Blomberg ME, Eijsbouts QAJ, Beelen RHJ, Berends FJ, Cuesta MA. The influence of CO2 versus helium insufflation or the abdominal wall lifting technique on the systemic immune response. Surg Endosc 2002; 16:525-8. [PMID: 11928041 DOI: 10.1007/s00464-001-0063-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2000] [Accepted: 07/02/2001] [Indexed: 10/28/2022]
Abstract
BACKGROUND Both laparoscopic and conventional surgery result in activation of the systemic immune response; however, the influence of the laparoscopic approach, using CO2 insufflation, is significantly less. Little is known about the influence of alternative methods for performing laparoscopy, such as helium insufflation and the abdominal wall lifting technique (AWLT), and the systemic immune response. METHODS Thirty-three patients scheduled for elective cholecystectomy were randomly assigned to undergo laparoscopy using either CO2 or helium for abdominal insufflation or laparoscopy using only the AWLT. The postoperative inflammatory response was assessed by measuring the white blood cell count, C-reactive protein (CRP) and interleukin-6 (IL-6). The postoperative immune response was assessed by measuring monocyte HLA-DR expression. RESULTS CRP levels were significantly higher 1 day after helium insufflation when compared with CO2 insufflation; however, no differences were observed 2 days after surgery. The AWLT resulted in significantly higher levels of CRP both 1 and 2 days after surgery when compared with either CO2 or helium insufflation. A small increase in postoperative IL-6 levels was observed in all groups, but no significant differences were seen between the groups. After both helium insufflation and AWLT a significant decrease in HLA-DR expression was observed, in contrast to the CO2 group. CONCLUSION Carbon dioxide used for abdominal insufflation seems to limit the postoperative inflammatory response and to preserve parameters reflecting the immune status. These findings may be of importance in determining the preferred method of laparoscopy in oncologic surgery.
Collapse
Affiliation(s)
- C Sietses
- Department of Surgery, Faculty of Medicine, Academic Hospital Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|
18
|
van der Peet DL, Berends FJ, Klinkenberg-Knol EC, Cuesta MA. Endoscopic treatment of benign esophageal tumors: case report of three patients. Surg Endosc 2001; 15:1489. [PMID: 11965474 DOI: 10.1007/s004640042023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2000] [Accepted: 03/22/2001] [Indexed: 11/25/2022]
Abstract
Benign esophageal tumors are rare. Enucleation of the tumor is considered when the patient reports problems. The traditional approach is to use thoracotomy or laparotomy if the tumor is located in the distal esophagus. The use of minimally invasive techniques permits enucleation with all the concomitant advantages. Our experience with the minimally invasive management of three benign esophageal tumors is described. The methods and results of preoperative studies are reported. The surgical technique is described. Two patients could be managed using thoracoscopy, and one patient required conversion to laparoscopy. All the patients had complete and quick recoveries.
Collapse
Affiliation(s)
- D L van der Peet
- Department of Surgery, University Hospital Vrije Universiteit, 1007 MB, Amsterdam, The Netherlands
| | | | | | | |
Collapse
|
19
|
Abstract
Epiphrenic esophageal diverticula are rare and often asymptomatic. If surgery is mandatory, a thoracotomy is used to resect the diverticulum. The results of a minimal invasive approach and repair in five patients are presented. These patients, who all presented with an epiphrenic diverticulum, were evaluated using barium swallow study, esophagoscopy, and manometry. The diverticula were approached by thoracoscopy in all patients and a description of the surgical technique is given. The diverticula were resected using a right-sided approach in four patients. One patient with a diverticulum in the distal esophagus required conversion to laparoscopy. A myotomy was performed in two patients because of high pressures in the lower esophageal sphincter. The postoperative course was uncomplicated in four patients. One patient with Ehlers-Danlos disease had a complicated course owing to leakage, resulting in two re-operations by means of thoracotomy. There was no mortality. The minimal invasive approach of epiphrenic diverticula is feasible. The long-term results are awaited.
Collapse
Affiliation(s)
- D L van der Peet
- Department of Surgery, Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands
| | | | | | | |
Collapse
|
20
|
Berends FJ, Meijer S, Prevoo W, Bonjer HJ, Cuesta MA. Technical considerations in laparoscopic liver surgery. Surg Endosc 2001; 15:794-8. [PMID: 11443467 DOI: 10.1007/s004640090094] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2000] [Accepted: 12/07/2000] [Indexed: 11/29/2022]
Abstract
BACKGROUND Laparoscopic solid organ surgery has gained growing acceptance, but this does not hold for laparoscopic surgery of the liver. Laparoscopic liver surgery mainly comprizes diagnostic procedures and treatment of liver cysts. However, we believe there is room for a laparoscopic approach to the liver in selected cases, with the benefits that may be expected from laparoscopic solid organ surgery. METHODS Between 1993 and 2000, 10 patients with various lesions of the liver underwent laparoscopic surgery. Indications consisted of cystic disease (n = 2), hemangioma (n = 2), focal nodular hyperplasia (n = 2), liver abcess (n = 1), and liver metastasis (n = 3). Laparoscopic treatment varied from fenestration (n = 3) to wedge resections (n = 5), and formal left lateral hepatectomy (n = 2). RESULTS The mean patient age was 54 years (range, 34-71 years). The mean operative time, including laparoscopic ultrasonography, measured 180 min (range, 80-240 min). Peroperative blood loss ranged from 200 to 450 ml. There was no mortality. In two patients, conversion to laparotomy was necessary. There were no postoperative complications. The mean hospital stay was 6 days (range, 4-11 days). CONCLUSION Laparoscopic treatment should be considered in selected patients with benign and malignant lesions in the left lobe or frontal segments of the liver.
Collapse
Affiliation(s)
- F J Berends
- Department of Surgery, University Hospital of the 'Vrije Universiteit' Amsterdam, De Boelelaan 1117, 1007 MB Amsterdam The Netherlands.
| | | | | | | | | |
Collapse
|
21
|
Bonjer HJ, Sorm V, Berends FJ, Kazemier G, Steyerberg EW, de Herder WW, Bruining HA. Endoscopic retroperitoneal adrenalectomy: lessons learned from 111 consecutive cases. Ann Surg 2000; 232:796-803. [PMID: 11088074 PMCID: PMC1421272 DOI: 10.1097/00000658-200012000-00008] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.8] [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
OBJECTIVE To evaluate the effectiveness of endoscopic retroperitoneal adrenalectomy (ERA). SUMMARY BACKGROUND DATA Minimally invasive adrenalectomy has become the procedure of choice for benign adrenal pathology. Although the adrenal glands are located in the retroperitoneum, most surgeons prefer the transperitoneal laparoscopic approach to adrenal tumors. METHODS Clinical characteristics and outcomes of 111 ERAs from January 1994 to December 1999 were evaluated. RESULTS Ninety-five patients underwent 111 ERAs (79 unilateral, 16 bilateral). Indications were Cushing syndrome (n = 22), Cushing disease (n = 8), ectopic adrenocorticotropic hormone syndrome (n = 6), Conn's adenoma (n = 25), pheochromocytoma (n = 19), incidentaloma (n = 11), and other (n = 4). Tumor size varied from 0.1 to 8 cm. Median age was 50 years. Unilateral ERA required 114 minutes, with median blood loss of 65 mL. Bilateral ERA lasted 214 minutes, with median blood loss of 121 mL. The conversion rate to open surgery was 4.5%. The complication rate was 11%. Median postoperative hospital stay was 2 days for unilateral ERA and 5 days for bilateral ERA. The death rate was 0.9%. At a median follow-up of 14 months, the recurrence rate of disease was 0.9%. CONCLUSION For benign adrenal tumors less than 6 cm, ERA is recommended.
Collapse
Affiliation(s)
- H J Bonjer
- Departments of Surgery and Internal Medicine, University Hospital Dijkzigt, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
22
|
Berends FJ, Cuesta MA, Kazemier G, van Eijck CH, de Herder WW, van Muiswinkel JM, Bruining HA, Bonjer HJ. Laparoscopic detection and resection of insulinomas. Surgery 2000; 128:386-91. [PMID: 10965308 DOI: 10.1067/msy.2000.107413] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.4] [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: 12/12/2022]
Abstract
BACKGROUND Laparoscopic ultrasonography as a diagnostic tool for the localization of islet cell tumors has been described before, but few reports on laparoscopic resection of insulinomas exist. We retrospectively reviewed the results of our experience with laparoscopic detection and the resection of insulinomas to determine its feasibility. METHODS Between February 1996 and February 1999, 10 patients underwent operation for organic hyperinsulinism at our institution. Patient and clinical characteristics were studied retrospectively. Laparoscopic ultrasonography was performed to localize the insulinoma and then laparoscopic resection was performed. RESULTS Eight women and 2 men underwent operation for hyperinsulinism. In 6 patients the insulinoma could be resected laparoscopically, either by enucleation (5 patients) or by resection of the pancreatic tail (1 patient). Four procedures were converted to laparotomy for the proximate location of the insulinoma to the portal vein or pancreatic duct (3 procedures) and failure to identify the insulinoma (1 procedure). The overall success rate of preoperative localization of an insulinoma with the use of various imaging techniques was 60% (6/10 patients). Laparoscopic ultrasonography could identify an insulinoma in 90% of the patients (9/10 patients). The median hospital stay was 7 days. CONCLUSIONS Laparoscopic ultrasonography followed by laparoscopic removal of the insulinoma in patients with clinically manifested hyperinsulinism is a feasible and safe technique with low morbidity and fast postoperative recovery. Preoperative localization studies appear of limited value.
Collapse
Affiliation(s)
- F J Berends
- Department of Surgery, University Hospital Rotterdam Dijkzigt, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Wisselink W, Cuesta MA, Berends FJ, van den Berg FG, Rauwerda JA. Retroperitoneal endoscopic ligation of lumbar and inferior mesenteric arteries as a treatment of persistent endoleak after endoluminal aortic aneurysm repair. J Vasc Surg 2000; 31:1240-4. [PMID: 10842161 DOI: 10.1067/mva.2000.105007] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.7] [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: 11/22/2022]
Abstract
A 74-year-old man receiving long-term anticoagulation therapy for intermittent atrial fibrillation had a type II endoleak after endovascular abdominal aortic aneurysm repair. During an 8-month follow-up, the endoleak persisted, and the aneurysm failed to decrease in diameter. By means of a left flank retroperitoneal endoscopic surgical approach, the aneurysm was dissected free, and the lumbar arteries emanating from the aneurysm, as well as the inferior mesenteric artery, were ligated with titanium clips. A postoperative spiral computed tomography scan depicted one pair of unclipped lumbar arteries just proximal to the aortic bifurcation. After immediate reoperation with the same approach, complete thrombosis of the aneurysm sac was radiographically confirmed.
Collapse
Affiliation(s)
- W Wisselink
- Department of Surgery, Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands
| | | | | | | | | |
Collapse
|
24
|
Bruining HA, Herder WW, Bonjer HJ, Berends FJ. Endoscopic retroperitoneal adrenalectomy. Eur Surg 1999. [DOI: 10.1007/bf02620163] [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]
|
25
|
den Hoed PT, van Wessem KJ, Berends FJ, Kappers-Klunne MC, Kazemier G, Bonjer HJ. [Laparoscopic splenectomy for hematological diseases; results in 28 patients]. Ned Tijdschr Geneeskd 1999; 143:1222-5. [PMID: 10389538] [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] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
OBJECTIVE To evaluate the first results of laparoscopic splenectomy for haematological diseases and the learning curve. DESIGN Retrospective. PATIENTS AND METHODS Data of all patients who underwent a laparoscopic splenectomy in October 1994-July 1998 in the University Hospital Rotterdam, Department of surgery, the Netherlands, were collected from electronic databases. Data on postoperative complications were collected from medical records. Patients with splenomegaly (> 15 cm) were not eligible for the procedure. RESULTS 28 patients were eligible for a laparoscopic splenectomy. The male:female ratio was 1:4. The mean age was 35 years. The indications for surgery were idiopathic thrombocytopenic purpura (ITP; n = 24), Gilbert syndrome (n = 1), spherocytosis (n = 1), thalassaemia (n = 1) and haemolytic anaemia with ITP (n = 1). Conversion to an open procedure was necessary in 5 of 28 laparoscopic splenectomies (18%). The median operating time was 172 minutes. Complications occurred in four patients: pneumonia (n = 2), bleeding (n = 1) and urosepsis (n = 1). The median hospital stay was 5 days (range: 1-18). The first 14 laparoscopic splenectomies differed from the following 14 by a higher conversion rate (p = 0.01), a longer operation time (p = 0.002) and a longer hospital stay (p = 0.004). In 23 out of 25 patients with ITP the thrombocyte count became normal. CONCLUSION Laparoscopic splenectomy is associated with a learning curve, with a high incidence of conversion in the early procedures. It appears to be a safe and effective operation.
Collapse
Affiliation(s)
- P T den Hoed
- Afd. Chirurgie, Academisch Ziekenhuis Rotterdam-Dijkzigt
| | | | | | | | | | | |
Collapse
|
26
|
Ijzermans JN, Berends FJ, van Riemsdijk IC, Weimar W, Bonjer HJ. [Laparoscopic donor nephrectomy for kidney transplants from living family members: good preliminary results]. Ned Tijdschr Geneeskd 1999; 143:942-5. [PMID: 10368710] [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] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVE Evaluation of safety and technical feasibility of laparoscopic live donor nephrectomy. DESIGN Descriptive. METHOD The per- and postoperative results were analysed of 15 patients subjected to laparoscopic live donor nephrectomy in the Erasmus Medical Centre Rotterdam, Dept. of General Surgery, the Netherlands. Both left and right nephrectomy were performed via the transperitoneal route. The kidney was removed via a subumbilical incision. RESULTS Laparoscopic donor nephrectomy was attempted in 15 patients and completed successfully in 14. Conversion to flank incision was resorted to one patient because of a venous bleeding. Median operating time was 290 min (SD: 57). Mean warm ischaemia time was 7 min (range: 4-17), including laparoscopic harvest. All kidneys were functioning well after transplantation. The mean duration of postoperative hospitalization of the donors was 4 days. CONCLUSION Laparoscopic live donor nephrectomy is a safe and technically feasible procedure in a kidney transplant programme involving a living relative.
Collapse
Affiliation(s)
- J N Ijzermans
- Afd. Algemene Heelkunde, Academisch Ziekenhuis Rotterdam-Dijkzigt. Rotterdam.
| | | | | | | | | |
Collapse
|
27
|
Tseng LN, Berends FJ, Wittich P, Bouvy ND, Marquet RL, Kazemier G, Bonjer HJ. Port-site metastases. Impact of local tissue trauma and gas leakage. Surg Endosc 1998; 12:1377-80. [PMID: 9822460 DOI: 10.1007/s004649900862] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.8] [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: 02/03/2023]
Abstract
BACKGROUND Port-site metastases after laparoscopic procedures in patients with digestive malignancies have evoked concern. The pathogenesis of port-site metastases remains unclear. Two experiments in rats were performed to determine the impact of both tissue trauma and leakage of CO2 along trocars (chimney effect) in the development of port-site metastases. METHODS Experiment I: Ten WAG rats had four 5-mm incisions in all abdominal quadrants. The incisions on the right side were crushed to induce tissue trauma. After inserting 5-mm trocars in all incisions, a pneumoperitoneum was created, and CC-531 tumor cells were injected intraperitoneally. CO2 was insufflated for 20 min. Experiment II: Ten WAG rats had 5-mm incisions in the left and right abdominal upper quadrant. A 5-mm trocar was inserted in the incision in the left upper quadrant, and a 2-mm trocar was inserted in the incision in the right upper quadrant. After insufflating the abdomen, CC-531 tumor cells were injected intraperitoneally. Total leakage of CO2 along the trocar in the right quadrant was 10 liters. After 4 weeks, in both experiments, the tumor deposits at the trocar sites were assessed. Statistical analysis was performed by the Wilcoxon matched-pairs test. RESULTS Experiment I: The median weight of tumor deposits at the trocar sites without induced tissue trauma was 22 mg. At the traumatic port sites, median weight of tumor deposits was 316 mg (p = 0.007). Experiment II: The median weight of tumor deposits at the leaking trocar sites was 478 mg and at the control sites 153 mg (p = 0.009). CONCLUSION Tissue trauma at trocar sites and leakage of CO2 along a trocar appear to promote implantation and growth of tumor cells at port sites.
Collapse
Affiliation(s)
- L N Tseng
- Department of General Surgery, University Hospital Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
28
|
Kazemier G, Berends FJ, Bouvy ND, Lange JF, Bonjer HJ. The influence of pneumoperitoneum on the peritoneal implantation of free intraperitoneal cancer cells. Surg Endosc 1997; 11:698-9. [PMID: 9171141 DOI: 10.1007/s004649900428] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- G Kazemier
- Department of Surgery, University Hospital Rotterdam-Dijkzigt, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | | | | | | | | |
Collapse
|
29
|
|
30
|
|
31
|
Berends FJ, Vermeulen MI, Leguit P. [Perforation rate and diagnostic accuracy in acute appendicitis]. Ned Tijdschr Geneeskd 1994; 138:350-4. [PMID: 8121524] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine perforation rate and diagnostic accuracy in acute appendicitis. DESIGN Retrospective study. SETTING Deaconesses' hospital Utrecht. METHOD Data on 235 acute appendectomies performed between 1989 and 1991 were collected: duration of symptoms, doctor or patient delay, pathology, septic complications, and objective data such as body temperature, leukocyte count and sedimentation rate. RESULTS Symptoms lasted on average 1.68 days and in 12.3% of the cases there was doctor delay, while an accurate diagnosis was made in 80%. The perforation rate was 18.3% and tended to be higher in young children and adults over 50. Septic complications ensued in 25% of the perforations. Perforation was associated with symptoms existing for longer than 48 hours. The number of negative appendectomies was 5 times higher in women than in men. The objective data were of limited diagnostic value. According to literature of the last 15 years, the mean value for perforation rate is 17% and for diagnostic accuracy 79%. CONCLUSION In children and elderly appendicectomy should be considered earlier. For sexually mature women additional laparoscopy can be of help in decreasing the number of negative appendectomies. It is recommended not to observe patients too long.
Collapse
Affiliation(s)
- F J Berends
- Diakonessenhuis, afd. Algemene Chirurgie, Utrecht
| | | | | |
Collapse
|