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1.
Background: Gastric banding is one of the simplest surgical procedures for the treatment of morbid obesity. We performed more
than 150 ‘laparotomy’ (open) gastric bandings and more than 50 ‘laparoscopic’ bandings in the last 10 years. Methods: In most
procedures we used non-adjustable bands, but since the beginning of 1995 we have used adjustable silicone banding. Results:
The 5- and 10-year follow-up weight loss results are encouraging. The average long-term weight loss was 35.5 kg. Since 1993,
we performed all the procedures laparoscopically, and the postoperative complications decreased from 18.5% in the ‘laparotomy’
group to 9.5% in the ‘laparoscopic’ group, with the majority being esophagitis and outlet area irritation. Conclusion: Gastric
banding itself and especially the minimally invasive laparoscopic approach is an easy technical procedure. The long-term weight
loss results and the reoperation rate are acceptable for bariatric surgery criteria. 相似文献
2.
Changes in Bone Mineral Density, Body Composition and Adiponectin Levels in Morbidly Obese Patients after Bariatric Surgery 总被引:1,自引:1,他引:0
Carrasco F Ruz M Rojas P Csendes A Rebolledo A Codoceo J Inostroza J Basfi-Fer K Papapietro K Rojas J Pizarro F Olivares M 《Obesity surgery》2009,19(1):41-46
Background Gastric bypass surgery (GBP) is increasingly used as a treatment option in morbid obesity. Little is known about the effects
of this surgery on bone mineral density (BMD) and the underlying mechanisms. To evaluate changes on BMD after GBP and its
relation with changes in body composition and serum adiponectin, a longitudinal study in morbid obese subjects was conducted.
Methods Forty-two women (BMI 45.0 ± 4.3 kg/m2; 37.7 ± 9.6 years) were studied before surgery and 6 and 12 months after GBP. Percentage of body fat (%BF), fat-free mass
(FFM), and BMD were measured by dual-energy X-ray absorptiometry and serum adiponectin levels by RIA.
Results Twelve months after, GBP weight was decreased by 34.4 ± 6.5% and excess weight loss was 68.2 ± 12.8%. Significant reduction
(p < 0.001) in total BMD (−3.0 ± 2.1%), spine BMD (−7.4 ± 6.8%) and hip BMD (−10.5 ± 5.6%) were observed. Adiponectin concentration
increased from 11.4 ± 0.7 mg/L before surgery to 15.7 ± 0.7 and 19.8 ± 1.0 at the sixth and twelfth month after GBP, respectively
(p < 0.001). Thirty-seven percent of the variation in total BMD could be explained by baseline weight, initial BMD, BF reduction,
and adiponectin at the twelfth month (r
2 = 0.373; p < 0.001). Adiponectin at the twelfth month had a significant and positive correlation with the reduction of BMD, unrelated
to baseline and variation in body composition parameters (adjusted correlation coefficient: r = 0.36).
Conclusion GBP induces a significant BMD loss related with changes in body composition, although some metabolic mediators, such as adiponectin
increase, may have an independent action on BMD which deserves further study. 相似文献
3.
Morbidly obese individuals have altered sense of taste and smell. Gastric bypass (GBP) alters taste but olfactory function
has not been evaluated. Changes in these senses may influence dietary preferences following GBP. Our aim was to evaluate the
effect of abdominal operation, specifically GBP, and weight loss on olfactory function. Fifty-five persons undergoing GBP
and cholecystectomy and 40 persons undergoing cholecystectomy (CC) alone were administered the Cross Cultural Smell Identification
Test (CC-SIT) preoperatively and 2 and 6 weeks postoperatively. Patients undergoing GBP underwent further tests at 3, 6, 9,
and 12 months. Body mass index (BMI) was also assessed. Mean BMI was significantly greater preoperatively in the GBP group
(50.6 ± 8.0 vs. 30.6 ± 7.3 kg/m2, p < 0.05). Significantly more GBP patients had abnormal CC-SIT results preoperatively (12.7% vs. 5.0%). There were no significant
differences in percentage of abnormal tests at 2 and 6 weeks within groups but remained lower in CC patients (2 weeks, GBP
6.2% vs. CC 5.7%; 6 weeks, GBP 9.8% vs. CC 3.2%, p < .05). BMI decreased in the GBP group at 12 months (50.6 ± 8.0 preoperatively to 31.9 ± 6.9 p < 0.05). Absolute olfactory dysfunction (AOD) was present at each interval up to 12 months after GBP. Only 22% of patients
with AOD remained obese. GBP does not appear to influence olfactory function. AOD present in morbidly obese persons is not
affected by weight loss. These findings support that olfactory dysfunction may be a contributing factor to the development
of obesity. 相似文献
4.
Surgical treatment of Roux stasis syndrome 总被引:5,自引:0,他引:5
We wondered whether the slow gastric emptying of the Roux stasis syndrome could be improved by performing a corrective ‘uncut’
Roux operation. Five dogs had a standard Roux gastrectomy and placement of serosal electrodes on the proximal jejunum and
Roux limb. After recovery, baseline myoelectrical and gastric emptying data were collected. The animals then underwent a second
operation: take down of the Roux limb, restoration of jejunal continuity, and construction of an ‘uncut’ Roux limb. After
the animals recovered, the tests were repeated. The slow frequency of pacesetter potentials (PPs) in the standard Roux limb
(mean ± standard error of the mean 14 ± 0.4 cpm) was unchanged after the uncut Roux operation (14 ± 0.5 cpm, P>0.05). However,
a greater percentage of PPs propagated aborally in the uncut Roux limb (81% ±4%) than in the standard Roux limb (53% ±7%,
P <0.05). Nonetheless, gastric emptying of a 250 ml 10% dextrose liquid meal was not speeded by the uncut Roux operation (uncut
Roux = 36% ±5% emptied by 20 minutes vs. standard Roux = 35% ±7%; P >0.05). Bile acid concentrations in gastric aspirates were minimal after both operations (0.7 ± 0.2 μmol/L vs. 0.6 ±0.1 (μmol/L;
P >0.05). The conclusion was that more PPs propagated in the aborad direction in the uncut Roux limb than in the standard Roux
limb, but gastric emptying was not speeded by the uncut Roux operation. Both operations were equally effective in preventing
bile reflux into the gastric remnant.
Supported by National Institutes of Health grant DK18278 and the Mayo Foundation.
An abstract of this work was presented at the Annual Meeting of the American Gastroenterological Association, San Diego, Calif.,
May 17, 1995, and published in Gastroenterology 108:A101, 1995. 相似文献
5.
Fobi MA 《Obesity surgery》1993,3(2):161-164
In 1982, a prospective study to evaluate and compare the operations for treatment of morbid obesity, vertical banded gastroplasty
(VBG) and gastric bypass (GBP), was carried out at the Center for Surgical Treatment of Obesity in Los Angeles. The VBG was
performed as described by Dr Mason with a 5.0 cm circumference Marlex band. The GBP was the horizontal GBP with ≤ 50 cc pouch
as described by Mason and modified by Printen and Griffen. One hundred patients had the VBG and 100 had the GBP. At 10 years
follow-up, only 43 of the VBG patients and 46 of the GBP patients can be found. The groups are compared as to the perioperative
complications, late complications and weight loss. VBG compared favorably with GBP for control of morbid obesity. GBP yields
better weight loss and maintenance at all times of follow-up. Both procedures are equal in terms of morbidity and mortality. 相似文献
6.
Background: gastric banding has been performed for morbid obesity, with the last nine patients having a laparoscopic approach.
Materials: forty-five patients who had undergone primary operations for morbid obesity between 1986 and 1993 were selected
for retrospective analysis. All patients had undergone gastric banding. Average pre-operative BMI was 50.9 (kg m−2) and average pre-operative weight was 135.1 kg. Results: the 3-year mean post-operative BMI reached 28.7 and the 3-year mean
post-operative weight loss was 55.7 kg. Blood pressure significantly decreased from the mean 151/96 mmHg to 132/90 mmHg at
1-year follow-up. There were no significant changes noted in the levels of RBC, electrolytes and transaminase. There were
post-operative wound-healing complications in 18.1% of the patients, wound discharge in 8.8% and incisional hernia in 8.8%
of the patients. In 1993 we commenced laparoscopic gastric banding which enabled us to shorten the hospital stay and decrease
post-operative complications. Conclusion: we are achieving the same good weight-loss results with the laparoscopic technique
as after ‘open’ laparotomy gastric banding. 相似文献
7.
Behavior of Type 2 Diabetes Mellitus in Morbid Obese Patients Submitted to Gastric Bypass 总被引:3,自引:0,他引:3
Mottin CC Vontobel Padoin A Schroer CE Barancelli FT Glock L Repetto G 《Obesity surgery》2008,18(2):179-181
Introduction Surgical treatment of obesity has not only resulted in weight loss, but also the control of associated diseases in the postoperative
period. The aim of this study was to determine the post-op response of type 2 diabetes mellitus (DM2) to gastric bypass.
Methods A historical cohort study was performed involving all the diabetic, morbid obese patients who underwent gastric bypass during
the period of May 2000 to October 2006 at the Centro da Obesidade Mórbida. Patient records were reviewed with regard to sex,
age, anthropometric measurements, glycemia, glycosylated hemoglobin, pre-op insulin, and DM2 outcome.
Results A total of 125 diabetic, morbid obese patients were operated; they had a mean age of 42.6 ± 9.7 years and body mass index
of 49 ± 8.3 kg/m2. Of these patients, 63 (50.4%) required medication for control of DM2, and the rest managed only with diet.
Of these 63 patients, 43 (68.2%) achieved control of DM2 and were discharged without the need for antidiabetic medication,
and 20 (31.7%) were discharged still on medication. One month after surgery, seven more patients discontinued medication for
DM2, and 18 months after surgery, 97.6% of the patients showed control of DM2.
Conclusion Gastric bypass is effective in controlling DM2 in morbid obese patients. 相似文献
8.
Reis GM Savassi-Rocha PR Nogueira AM Lima MJ de Carvalho S Arantes V Barros CA Cançado OL 《Obesity surgery》2008,18(4):367-370
Background The effects of vertical banded gastroplasty/Roux-en-Y gastric bypass (Capella) on the esophageal mucosa of patients with histological
esophagitis are poorly understood. To evaluate long-term effects, we investigated the persistence, aggravation or disappearance
of histological esophagitis in patients with morbid obesity and reflux esophagitis (diagnosed by endoscopic biopsy) after
Roux-en-Y gastric bypass.
Methods Twenty-one patients with morbid obesity and esophagitis (histological diagnosis) were submitted to gastric bypass (Fobi-Capella
technique) and underwent upper endoscopy and esophageal biopsy during the late postoperative period.
Results The mean age of the patients was 42.57 ± 7.49 years (30 to 56). Nineteen (90.48%) patients were women, and two (9.52%) were
men. Before surgery, the patients presented a mean weight of 124.26 ± 19.09 kg and a mean body mass index (BMI) of 48.46 ± 6.37 kg/m2. Thirteen (61.90%) patients had endoscopic esophagitis before surgery. The mean weight and BMI were 81.65 ± 13.16 kg and
31.91 ± 4.99 kg/m2, respectively, during the late postoperative period (29.80 ± 8.91 months). The mean percentage of excess weight loss was
68.7 ± 14.6%. Among the 21 patients with a preoperative histological diagnosis of reflux esophagitis, five (23.18%) had the
same diagnosis after surgery, and four (19.04%) continued to present findings of endoscopic esophagitis.
Conclusion Vertical banded gastroplasty/Roux-en-Y gastric bypass (Capella technique) is effective in the treatment of reflux esophagitis.
No association was observed between the percentage of excess weight loss and improvement of esophagitis. 相似文献
9.
Background: There is a familial predisposition to obesity. We wished to document the incidence of obesity (BMI > 40 kg m−2) in the immediate relatives (parents and siblings) of obese patients who were candidates for gastric restrictive surgery.
We determined if a familial predisposition to obesity would influence the surgical results. Methods: The height, weight and
BMI were obtained in 1841 relatives of obese patients and in 1059 relatives of normal weight controls. The results of gastric
surgery after 52.9 ± 23.1 months were obtained in 44 patients with a familial history of obesity and in 34 patients without
a familial history. Results: Patients presenting with a BMI > 40 kg m−2 were 24.541 times more likely to have a first degree relative with morbid or super obesity than individuals in the control
group. Mothers were twice as likely to be severely obese as fathers. A successful result (BMI < 35 kg m−2 or less than 50% excess weight) occurred 52.9 ± 23.1 months in 77% of patients with a family history of obesity and in 73%
of patients without a familial predisposition (p = 0.79). Conclusions: There is a strong familial predisposition to obesity but over one-half of the immediate family members
of obese patients have a BMI < 30 kg m−2. Gastric restrictive surgery induces satiety and produces a successful outcome regardless of familial predisposition. Patients
who undergo surgery have a remarkably stable weight over the year prior to operation, suggesting they are defending a markedly
elevated BMI. 相似文献
10.
Favretti F Cadiere GB Segato G Bruyns G De Marchi F Himpens J Foletto M Lise M 《Obesity surgery》1995,5(4):364-371
Background: Kuzmak's Adjustable Silicone Gastric Banding (ASGB) is the least invasive operation available for morbid obesity,
and it is one of the more effective. Based on the know-how gained from performing more than 250 ‘open’ procedures, we have
developed an original laparoscopic technique, whose main steps are pouch measurement, limited dissection along the lesser
and the greater curvature and the application of the retention sutures. Methods: From September 1993 through October 1994,
30 morbidly obese patients underwent laparoscopic ASGB. Results: Mean operative time was 2 h and the post-operative stay 2-3
days. Only one major perioperative complication (stomach slippage) was observed. The weight loss achieved, reported as a variation
of Body Weight, Body Mass Index, per cent Ideal Body Weight and per cent Excess Weight Loss was similar to that obtained with
the open procedure. Conclusion: This new approach is a major achievement in bariatric surgery, because it combines the minimal
invasiveness of laparoscopy with the reversibility and adjustability of ASGB. 相似文献
11.
Laparoscopic Gastric Bypass,Roux en-Y: Technique and Results in 75 Patients With 3-30 Months Follow-up 总被引:13,自引:0,他引:13
Background: Laparoscopic Roux en-Y Gastric Bypass (RYGB) has been performed in 100 patients, in our series. Methods: The results
of surgery, including 3-30-months follow-up, are described with 100% follow-up, for the first 75 patients. Weight loss, operative
morbidity and relief of co-morbidities have been thoroughly studied in a prospective fashion. Results: Diabetes mellitus was
normalized in 22 of 24 patients and gastroesophageal reflux was relieved in all patients. Length of stay, recovery time and
cosmetic results are superior to the ‘open’ technique, and the operative times are competitive. Conclusion: Laparoscopic RYGB
deserves a place in the operative repertoir of bariatric surgeons. 相似文献
12.
Background: Although jejunoileal bypass (JIB) causes longstanding weight loss, it is no longer recommended as a surgical treatment
of morbid obesity due to adverse effects. Methods: JIB was performed on 87 morbidly obese subjects with a mean age of 35 years.
Complete followup on 95% of the patients included monitoring weight, metabolic parameters and liver biopsies up to 25 years
postoperatively. Results: The mean (± sd) Body Mass Index (BMI) was reduced from 41.5 ± 5.8 kg m−2 preoperative, to 26.7 ± 3.8 kg m−2 at 2 years and 29.7 ± 3.9 kg m−2 at 16 years follow-up. More than 60% loss of initial excess weight was achieved by 88% of the patients at four years and
by 75% at 16 years follow-up. Reversal of the bypass was performed in 3% of the patients and revisions in 8% of the patients.
There was no 30-day hospital mortality but there was one (1%) late bypass-related death. Complications included urinary calculi
in 39% of the patients, electrolyte disturbances in 25% and transient liver failure in 5.5%. Liver biopsies taken more than
13 years postoperatively in 44 patients revealed no cirrhosis. All patients were normoglycemic and normolipemic at follow-up.
Conclusions: The majority of the patients have an acceptable weight reduction, few serious adverse effects but several beneficial
effects after more than 16 years. The JIB deserves a reconsideration as an alternative in obesity surgery. 相似文献
13.
Monteiro MP Ribeiro AH Nunes AF Sousa MM Monteiro JD Aguas AP Cardoso MH 《Obesity surgery》2007,17(12):1599-1607
Background Gastric banding is thought to decrease appetite in addition to the mechanical effects of food restriction, although this has
been difficult to demonstrate in human studies. Our aim was to investigate the changes in orexigenic signals in the obese
Zucker rat after gastric banding.
Methods Obese Zucker rats (fa/fa) were submitted to gastric banding (GBP), sham gastric banding fed ad libitum (sham), or sham operation with food restriction,
pair-fed to the gastric banding group (sham-PF). Lean Zucker rats (fa/+) were used as additional controls. Body weight and food intake were daily recorded for 21 days after surgery when epididymal
fat was weighed and fasting ghrelin and hypothalamic NPY mRNA expression were measured.
Results Gastric banding in obese Zucker rats resulted in a significant decrease of cumulative body weight gain and food intake. Furthermore,
gastric banded rats were leaner than Sham-PF, as expressed by a significantly lower epididymal fat weight. Ghrelin levels
of gastric banded rats were not increased when compared to sham-operated animals fed ad libitum and were significantly lower
than the levels of weight matched sham-PF rats (1116.9 ± 103.3 g GBP vs 963.2 ± 54.3 g sham, 3,079.5 ± 221.6 sham-PF and 2,969.9 ± 150.9 g
lean rats, p < 0.001); hypothalamic NPY mRNA expression was not increased in GBP when compared to sham-operated rats.
Conclusion In obese Zucker rats, GBP prevents the increase in orexigenic signals that occur during caloric deprivation. Our data support
the hypothesis that sustained weight loss observed after gastric banding does not depend solely on food restriction. 相似文献
14.
Busetto L Pisent C Rinaldi D Longhin PL Segato G De Marchi F Foletto M Favretti F Lise M Enzi G 《Obesity surgery》2000,10(6):569-577
Background: A moderate weight loss is known to improve the lipid levels in simple obesity.The extent of weight loss needed
to achieve a clinically meaningful effect on lipid abnormalities in morbid obesity is little understood.We analyzed the effects
of different levels of body weight loss on the lipid levels of morbidly obese patients operated with the LAPBAND? System.
Methods: 225 morbidly obese patients (172 F and 53 M) in which a complete lipid profile has been collected both before and
12-18 months after surgery were studied. The changes of the lipid profile were analyzed according to different levels of percent
weight loss (%WL: <10%, 10-20%, 20-30%, >30%). Results: Mean weight loss was 30.7±15.2 kg, corresponding to a 23.1±9.7% reduction
of body weight. A large variability in the weight loss was observed. A significant difference in the change of the lipid parameters
between the group with <10%WL and the group with 10-20%WL was observed for total-cholesterol (+10.0±17.2% vs-0.7±14.7%; p<0.05),
for the LDL (+18.7±26.3% vs +3.1±22.9%; p<0.05), and for the triglycerides (+7.7±26.3% vs -21.9±25.4%; p<0.05). No further
significant differences were found between the two groups with greater weight loss (20-30%WL and >30%WL) and the group with
10-20%WL, the only exception being the percent change in triglycerides levels, i.e. higher in the group with %WL >30 (-33.6±31.5%
vs -21.9±25.4%; p<0.05). Conclusion: A moderate weight loss of 10-20% of initial body weight produced the maximal effects
on the lipid levels in morbid obesity. 相似文献
15.
Insulin Resistance,Leptin and TNF-α System in Morbidly Obese Women after Gastric Bypass 总被引:1,自引:1,他引:0
Molina A Vendrell J Gutiérrez C Simón I Masdevall C Soler J Gómez JM 《Obesity surgery》2003,13(4):615-621
Obesity is a complex disease associated with insulin resistance. Leptin and the TNF-α system could be involved in the pathogenesis
of obesity and insulin resistance. Gastric bypass (GBP) is a surgical treatment for morbidly obese patients. We conducted
a study after GBP to analyze the pattern of variation of anthropometric and body composition variables, leptin and sTNFR1
and 2. Methods: 29 morbidly obese women were studied, at baseline and throughout 6 months after gastric bypass. Results: At
baseline, the BMI was 49 ± 6 kg/m2 and patients showed a higher fasting insulin resistance index (FIRI), leptin, leptin/fat mass and sTNFR1 and 2 than did controls.
6 months after GBP, BMI was 35±4, and FIRI, leptin and leptin/fat mass decreased significantly in the first months and throughout
the follow-up. sTNFR1 and 2 showed an initial increase, but at 6 months their concentrations were similar to baseline (2.6±0.8
vs 3.1±0.95 ng/ml, P < 0.05; 4.6±1.4 vs 7±2.5 ng/ml, P < 0.05). At baseline, there was no correlation between leptin and BMI and body composition variables but there was a correlation
with fat mass (r=0.42, P=0.004) and sTNFR1 (r=0.58, P=0.001). At 6 months, there was a correlation between leptin and BMI (r=0.53, P=0.004) and sTNFR1 (r=0.46, P=0.013). Conclusions: Morbidly obese women after GBP became less insulin resistant with lower leptin concentrations, but showed
an initial increase of sTNFR1 and 2. This pattern of variation of the leptin TNF-α axis suggests a disregulation of the system
after dramatic weight loss and also that insulin and leptin up-regulate TNF-α production irrespective of insulin resistance
status. 相似文献
16.
T. Diamantis A. Alexandrou E. Pikoulis D. Diamantis J. Griniatsos E. Felekouras E. Papalambros 《Obesity surgery》2010,20(8):1164-1170
Laparoscopic sleeve gastrectomy (LSG) represents a promising alternative option for the surgical treatment of morbid obesity.
Its standard technique includes the longitudinal division of the stomach along a bougie of varying diameter. We report in
this retrospective study our experience with LSG being performed with the use of intra-operative endoscopy instead of the
bougie. Twenty-five consecutive patients (18 women, seven men) with a mean age of 40.2 years and mean body weight of 152.1 kg
were submitted to LSG with intra-operative endoscopy in our hospital. The mean preoperative BMI was 53.5 kg/m2. There were no conversions. Mean operative time was 117.5 min. There was no morbidity or mortality. The mean loss of excess
body weight (EBW) at 3 months post-op was 19 ± 1.8 kg, at 6 months was 28.6 ± 4.5 kg, and at 1 year post-op was 48.9 ± 3.7 kg
(min 11–max 92). In other words the patients had lost 30 ± 5%, 45 ± 7.7%, and 60.8 ± 4.3% of their EBW, respectively. The
mean excess body weight loss at the day of the last visit to our outpatient clinic was 52.3 ± 4.3 kg which corresponded to
66.4 ± 4.3% of the total excess weight. LSG with intra-operative endoscopic guidance is a safe and efficient alternative method
to treat morbid obesity and is a viable option for surgical units familiar with endoscopic techniques. 相似文献
17.
Background Gastric bypass surgery for morbid obesity has dramatically increased in volume over the past decade. Caucasian patients have
been noted previously to lose more weight after bariatric surgery than African-Americans patients. Data regarding predictors
of maintaining weight loss after surgery are minimal. We sought to determine predictors of long-term weight loss after bariatric
surgery.
Methods Retrospective analysis using a multivariate logistic regression model of all patients undergoing Roux-en-Y gastric bypass
surgery at the Medical University of South Carolina from May 1993 to December 2004 for whom 2 years of follow-up data was
available. Our dependent variable was the percentage of weight lost from baseline, dichotomized at ±35%. Our primary independent
variable was race, defined as Caucasian, African-American, or other. Relevant covariates were added to the model to control
for their potential effects on outcome.
Results One hundred eleven patients (17 male/94 female; 85% Caucasian, mean age 44 years (range 18–68 years). In our model, Caucasian
subjects (adjusted odds ratio [OR] = 7.60, 95% confidence intervals [95%CI] = 1.83–31.5) and late post surgical complications
(adjusted OR = 2.67, 95%CI = 1.05–6.80) significantly predicted weight loss at 2 years, after controlling for relevant confounders.
Other covariates did not significantly impact the model.
Conclusion Race and late post surgical complications significantly impacted the percentage of weight loss at 2 years for patients undergoing
Roux-en-Y gastric bypass surgery at our institution. Future research should be directed at determining potential genetic and/or
social reasons for these differences. 相似文献
18.
Guedea ME Arribas del Amo D Solanas JA Marco CA Bernadó AJ Rodrigo MA Diago VA Díez MM 《Obesity surgery》2004,14(6):766-772
Background: Gastric restrictive procedures, currently the most popular surgical operations for morbid obesity, have proved
to be effective in initiating weight loss, but questions regarding their long-term efficacy in weight maintenance have arisen.
Biliopancreatic diversion (BPD) is a mixed and complex technique that has shown good long-term results. There are no series
with long-term follow-up of BPD in Spain. We present >5 year results (average 67.9 ± 15 SD mons, range 48-96), evaluating
weight loss, morbidity and mortality after BPD. Methods: 74 patients who underwent BPD and completed 5 or more years of follow-up
were studied. The results have been analyzed in terms of weight loss (classification of Reinhold), improvement in morbidity,
and improvement in quality of life (BAROS). Results: 78.6% were women. Mean age was 38 ± 11 years (18-61). Mean preoperative
body mass index (BMI) was 54 ± 8 kg/m2. Progression of BMI: 1 year 34 ± 6, 2 years 31 ± 6, 5 years 33 ± 7 and 7 years 31 ± 3 kg/m2 . Excess weight loss at 1 year follow-up was 67%, at 2 years 75%, at 5 years 70% and at 7 years 71%. There were significant
differences between morbidly obese (BMI <50 kg/m2) and super-obese (BMI >50 kg/m2 ), with better results in the morbidly obese group. Conclusion: BPD shows long-term effectiveness in weight loss, co-morbidity
improvement and quality of life. Protein, vitamin and oligoelement deficits may appear in the long-term, so that strict follow-up
and supplementation of deficiencies are necessary. 相似文献
19.
Background Internal hernia is a known complication after gastric bypass, especially when performed laparoscopically. The aim of this
study was to see when internal hernias occur in relation to weight loss and time course after surgery. Furthermore, we wish
to examine the impact of Roux limb positioning ante- versus retrocolic and whether switching to running versus interrupted
closure of the mesenteric defects created at surgery made any difference.
Methods A retrospective chart review was performed of all patients undergoing laparoscopic Roux-en-Y gastric bypass surgery (LRYGB)
who developed symptomatic internal hernia requiring operative intervention between January 1, 2000 and September 15, 2006.
Results Fifty-four internal hernias occurred in 2,572 patients, an incidence of 2.1%. The site of internal hernias varied: 25 (1%),
transverse mesocolon; 22 (0.8%), enteroenterostomy; 7 (0.3%), Peterson’s space. The mean time to intervention for an internal
hernia repair was 413 ± 46 days and average % excess body weight loss (%EBWL) in this period was 59 ± 3.3. Subgroup analysis
demonstrates internal hernia incidence to be 2 in 357 (0.6%) in antecolic Roux versus 52 in 2,215 (2.4%) in retrocolic Roux
limb (odds ratio = 4, P < 0.05). Continuous closure versus interrupted stitching of mesenteric defects does not seem to alter the incidence of internal
hernias.
Conclusion This study demonstrates that the majority of internal hernias occur after a significant (>50%) EBWL. Furthermore, the antecolic
approach is associated with a much reduced incidence of internal hernia. 相似文献
20.
Nocca D Gagner M Abente FC Del Genio GM Ueda K Assalia A Rogula T Bertani D 《Obesity surgery》2005,15(4):523-527
Background: Morbid obesity has become a major global health problem. Surgery remains the only effective treatment for patients
with severe obesity, because diet reduction methods and pharmacologic agents have not resulted in long-term weight reduction.
Gastric bypass (GBP) can provide adequate weight loss, but after some years, dilatation of the gastric pouch and outlet may
lead to weight regain by allowing the patient to increase food intake. Methods: 2 groups of 6 pigs underwent laparoscopic
GBP. In the first group, a non-adjustable silicone band (Proring?-band, IOC, Innovative Obesity Care, Saint Etienne, France)
was positioned 1 cm proximal to the gastrojejunal anastomosis. In the second group, the device used to stabilize the gastric
pouch was an adjustable silicone band (Mid-band?, Medical Innovation Developpement, Villeurbanne, France). Weight loss, complications
and histological reaction were evaluated after 3 months. Results: Mortality rate was 25% (cardiac arrythmia in 2 pigs). Conversion
rate was 25%. The positioning of the band was more difficult with the Mid-band? because of its larger size and the presence
of the catheter. The average weight change in the Proring? group was 15.8 kg (3.5–25.1 kg), and in the Mid-band? group was
12.0 kg (6.2–15.1 kg). Morbidity consisted of one intragastric migration of the Proring? band into the gastrojejunal anastomosis,
and one infection of the port in the Mid-band? group treated by removal of the port and antibiotics. Conclusion: Use of silicone
devices may be safe and effective in the prevention of pouch or outlet dilatation after GBP. 相似文献