A correlation method for weight loss after gastroplasty

BACKGROUND

Prevalence of morbid obesity is increasing in western countries. As a consequence, bariatric surgery has intensively developed in the last decades. Someone facing the need for comparison between gastric restrictive procedures could find it useful to have a general expression for weight loss after surgery.

METHODS

A first approach of this issue can be made, taking into account two simple hypotheses: linear dependencies of weight variation versus sum of energy transfer, and of loss of energy versus weight. With the additional assumption of a constant energy income (the goal of surgery), one can obtain for the weight loss DeltaP=P(0)-P=(P(0)-B)(1-e(-betat)), where P and P(0) are the weight at time t and t(0), B and beta being adjustable constants.

RESULTS

A preliminary study has shown us that most of our weight loss data could be fitted using such an expression. The model was successfully tested on gastric banding and calibrated vertical banded gastroplasty data, but with greater emphasis on laparoscopic vertical banded gastroplasty.

CONCLUSION

We introduce a simple, exponential growth-like function that can be used for the fit of weight loss data of patients who underwent bariatric surgery in our surgical unit. Such a function could also be of practical interest for the survey of weight loss.

The LM Proring Band and left approach in laparoscopic vertical banded gastroplasty: preliminary results in 44 cases

BACKGROUND

Morbid obesity is one of the most important social and medical issues in Western countries. Many authors have adopted a minimally invasive approach to reproduce current bariatric operations. The aim of this study is to present a personal technique for laparoscopic vertical banded gastroplasty (LVBG) and the preliminary results of 44 patients.

METHODS

Patients fulfilled the indications for bariatric surgery and were followed prospectively. LVBG was performed in patients who refused laparoscopic banding because of port placement and adjustment, or in patients with hiatus hernia, with or without gastroesophageal reflux disease. The technique performed consisted of a laparoscopic Mason modified-MacLean gastroplasty using only 4 ports. The circular stapler was introduced in the left anterior axillary line subcostally using the same working port as the Endo-GIA stapler. A new device, a non-adjustable silicone ring, was placed as the collar around the lower end of the gastric pouch.

RESULTS

The 44 patients underwent a satisfactory LVBG with no conversions to open surgery. Mean operative time was 80 minutes (range 45-180), hospital stay was 4 days, and all 44 operations had an uneventful postoperative course. There were 40 women and 4 men, with mean age 42.5 years (24-59). Preoperative mean weight was 118.7 kg (84.5-184), with mean BMI 44.5 (35.6-60.1). 27 of the 44 patients were selected for analysis of weight loss, selection criteria being a sufficient amount of data (> 2 weight losses separated by at least 2 months). For these 27 patients, mean age 41.9 (26-59), preoperative weight 119.3 kg (95-145) and mean BMI 44.6 (38.3-53.6), weight loss data were fitted with an exponential growth function, using a quasi-Newton fit algorithm. The fitted coefficient was used to calculate % excess weight loss and BMI. Mean weight loss at 1, 3, 6 and 12 months was 9.2 kg (4.4-17.2), 24.5 kg (11.0-35.9), 29 kg (12.6-53.6), and 36.5 kg (12.8-66.5) respectively.

CONCLUSION

LVBG has given good results thus far and may be selected as a restrictive procedure. Weight loss and resolution of comorbidities occurred, and a considerable increase in self-confidence and quality of life were reported.

Laparoscopically assisted subtotal colectomy

A technique for laparoscopic total resection of the colon performed in six patients is reported. The diseased colon was separated from the mesocolon and the greater omentum by electrocoagulation and sharp dissection. The mesenteric vessels were divided using an Endo GIA stapling device (AutoSuture, France). The whole colon was removed after transection of the rectum and extraction through a right minilaparotomy. A primary stapled end-to-side ileorectal anastomosis was performed through the anus under laparoscopic guidance. This technique can be applied to cases involving a variety of benign lesions of the entire bowel or multifocal small malignant colonic neoplasms with a decrease in patient morbidity and shorter inpatient period.

Calcium and vitamin D modulate mouse colon epithelial proliferation and growth characteristics of a human colon tumor cell line

The role of calcium and vitamin D in the prevention of colorectal cancer is only now being investigated at the organismal, cellular, and molecular biologic levels. Recent epidemiologic studies have supported the hypothesis that dietary calcium and vitamin D may be related to a reduced risk for colon cancer. The evidence from laboratory investigations in animals and in cell culture also indicate a possible preventative effect. Addition of calcium and vitamin D to the roster of developmental cancer chemopreventative agents for further research is warranted.