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Jérôme Dargent 《Obesity surgery》2009,19(9):1243-1249
Background The redo issue is a growing and debated issue in bariatric surgery. From the experience of failed vertical banded gastroplasty
(VBG), we suggest that adjustable gastric band is a relevant method in many cases.
Methods Ninety-eight patients have been operated on in a 13-year period (07/1995–07/2008). The cause of VBG failure has been staple
disruption in 58% of cases and an outlet enlargement in 37% of cases. In the meantime, two gastric bypasses have been performed.
Mean body mass index has been 38 (28–48) and was less than 35 in 37% of the cases.
Results Postoperative complications occurred in seven cases, and the band had to be removed in five cases. Mean excess weight loss
has been 52% at 8 years, yet 22% of the patients have been lost for follow-up. Slippage occurred in two patients and erosion
in one. A final removal of the band has been necessary in two patients.
Conclusions VBG failures are highly common in the long run. Lap banding represents an interesting option for redo in a majority of cases,
providing good long-term results and demonstrating that “restriction over restriction” can be a relevant strategy. The initial
response to VBG has been a key information: if it has been successful in terms of weight loss and food tolerance, then lap
banding was a valuable option. VBG has represented an interesting model because it has historical value and could be a procedure
for the future if performed through endoscopic channels. 相似文献
4.
目的:获得抗解脲脲原体外膜多条带蛋白(MB蛋白)的多克隆抗体,制备能够用于解脲脲原体检测的上转换发光免疫层析试纸条。方法:以体外表达的解脲脲原体外膜MB蛋白N端保守性序列为抗原,免疫小鼠制备抗MB蛋白的抗体,ELISA检测免疫动物血清抗MB抗体滴度,并以小鼠抗体标记上转换发光体颗粒(UCP颗粒),制备能够检测解脲脲原体的上转换发光免疫层析试纸条。结果:解脲脲原体多条带蛋白免疫动物血清抗MB的IgG抗体滴度均超过1∶25600,以此抗体为基础建立的解脲脲原体上转换发光免疫层析试纸条能够识别1~200μg/L的解脲脲原体MB抗原。结论:初步制备的上转换发光免疫层析试纸条能够检测解脲脲原体。 相似文献
5.
Stoma Adjustable Silicone Gastric Banding versus Vertical Banded Gastroplasty for the Treatment of Morbid Obesity 总被引:1,自引:0,他引:1
Background: Among gastric restrictive operations, the procedure of choice is still controversial. The aim of this study is
to compare the results of two different gastric restrictive procedures: vertical banded gastroplasty (VBG) and stoma adjustable
silicone gastric banding (ASGB). Methods: Between 1991 and 1996, 51 patients were treated surgically for morbid obesity: 27
underwent VBG and 24 underwent ASGB. Preoperative body weight (BW), body mass index (BMI) and percentage of ideal body weight
(% IBW) were (mean ± SD): 145.7 ± 45.3 kg; 53.9 ± 15.9 kg/m2; 249.1 ± 73.5% respectively in the VBG group. Corresponding figures for the ASBG group were 132.5 ± 22.7 kg; 46.9 ± 7.8 kg/m2 and 207.2 ± 35.0%. Results: In the VBG group, the median follow-up period was 26 months (range: 7-47). Eighteen months after
the operation BW, BMI, % IBW and percentage of excess weight loss (% EWL) were 85.5 ± 26.8 kg, 31.9 ± 9.8 kg/m2, 145.4 ± 43.9% and 74 ± 1% respectively. Complications included incisional hernia (n = 1), and bowel obstruction (n = 1).
One patient died of acute myocardial infarction on the third postoperative day. In the ASGB group, median follow-up time was
19.7 months (range: 18-26). At 18 months postoperation BW, BMI, % IBW and % EWL values were 86.6 ± 20.6 kg 30.6 ± 6.6 kg/m2
140.6 ± 29.3% and 64 ± 1% respectively. Gastric wall erosion occurred in two patients and the bands had to be removed. These
patients underwent VBG 6 months later. Complications encountered in this group were incisional hernia (n = 1), outlet stenosis
and reflux esophagitis (n = 1), reservoir leakage (n = 1) and gastrointestinal bleeding (n = 1). Two patients died of pulmonary
embolism and acute gastrointestinal bleeding. Conclusions: Weight reduction was not statistically significant between the
two groups. ASGB was easier to perform and less invasive than VBG. 相似文献
6.
Masazumi Masuda Kazuto Yamazaki Jin Kanzaki Yasuhiro Hosoda 《Anatomical record (Hoboken, N.J. : 2007)》1994,240(4):481-491
Background: It is known that melanocytes exist in almost all parts of the inner ear, such as the cochlear duct, stria vascularis, Reissner's membrane, modiolus, vestibular organs in the region surrounding the cristae and maculae, semicircular canals, and pars rugosa of the endolymphatic sac. But there have been few studies using human materials, because of the difficulty of obtaining materials. We attempted to investigate the detailed ultrastructure of melanocytes in the vestibular organs of human inner ear. Methods: Eight surgical specimens obtained from patients with vestibular schwannoma were studied by light microscopy and electron microscopy. Results: Melanocytes were found in the subepithelial layer of the dark cell area. Melanocytes had round or spindle-shaped nuclei and clear cytoplasm with brown pigment granules. Besides melanocytes, there were melanophages, fibroblasts, and small blood vessels. Through electron microscopy we found melanocytes with round-shaped melanosomes in various stages of pigmentation, well-developed Golgi apparatus and endoplasmic reticulum in the cytoplasm, and many cytoplasmic processes. Gap junctions were occasionally found between the cytoplasmic processes. And there were pinocytotic vesicles just under the limiting membrane of melanocytes, and intermediate filaments were abundant in the cytoplasm. Isolated cilia of melanocytes, annulate lamellae, and fusiform banded structures in the connective tissue area around melanocytes were found. Conclusions: Melanocytes in human vestibular organs actively synthesize melanosomes. Frequent findings of isoalted cilia and fusiform banded structures and the incidental existence of annulate lamellae may be an indicator of this metabolically activated state of melanocytes. Moreover, monitoring environmental changes by isolated cilia, melanocytes in the human inner ear could act not only as one cell but also as a group to achieve their physiological functions by means of information transmission through gap junctions. © 1994 Wiley-Liss, Inc. 相似文献
7.
Staple-line Disruption Following Vertical Banded Gastroplasty 总被引:2,自引:1,他引:1
John Melissas MD Manousos Christodoulakis MD George Schoretsanitis MD George Harocopos MD Eelco de Bree MD John Gramatikakis MD Dimitris Tsiftsis MD 《Obesity surgery》1998,8(1):15-20
Background: The purpose of this study was to determine the frequency with which staple-line disruption occurs following vertical
banded gastroplasty (VBG) in morbidly obese patients, to investigate the effect of this complication on weight loss, and to
identify any clinical symptoms that might be associated with staple-line disruption. Methods: From April of 1992 to June of
1994, 60 patients with morbid obesity underwent VBG. Double-contrast radiographic examination of the upper gastrointestinal
tract was performed on all patients at 6, 12, 24, and 36 months postoperation to assess the integrity of the staple line.
At these same times, the weight of each patient was measured, so that the patients found to have staple-line disruption could
be compared to those without disruption in terms of weight loss. Results: Over the duration of the study, staple-line disruption
was found in 12 patients (20%). All of these patients demonstrated satisfactory weight loss. Between the group of patients
with staple-line disruption versus the group without disruption, weight loss did not differ significantly at any time up to
3 years postoperation. In addition, in the patients with staple-line disruption, no clear symptomatology that might be associated
with this complication was discovered. Conclusions: Our results lead to the conclusion that small disruptions in the staple
line lack clinical importance and do not significantly affect weight loss for at least the first 3 postoperative years. Furthermore,
staple-line disruption does not seem to be associated with any specific clinical symptoms. Follow-up of all patients via barium
meal is the correct approach for discovering the exact incidence of this complication. 相似文献
8.
Changes in Esophageal Function after Vertical Banded Gastroplasty as Demonstrated by Esophageal Scintigraphy 总被引:1,自引:0,他引:1
Keith Seymour MB FRCS Alison Mackie PhD Elizabeth McCauley MSc John G Stephen MB MChir FRCS 《Obesity surgery》1998,8(4):429-433
Background: The effects of surgery for morbid obesity on the function of the upper gastrointestinal (GI) tract are of interest
to bariatric surgeons. This study was undertaken to determine any changes in esophageal function, following vertical banded
gastroplasty (VBG) in morbidly obese patients, as detected by esophageal scintigraphy. Methods: Ten consecutive morbidly obese
patients (six female and four male) underwent preoperative esophageal scintigraphy and upper GI endoscopy. These investigations
were repeated 12 months after VBG to coincide with expected appreciable weight reduction. The results were tabulated together
with body mass indices, crude weights and percentage excess weight lost. Results: Before VBG one patient gave a history of
mild heartburn, one had mild dyspepsia and the remaining eight patients had no GI symptoms. No patient had a hiatus hernia
or endoscopic evidence of reflux esophagitis. Preoperatively all patients had abnormal scintiscans. The abnormalities were
esophageal retention (all) and intraesophageal reflux (five out of 10 patients). Gastroesophageal reflux was not identified
in any patient. Postoperatively scintiscans were normal or improved in six out of 10 patients and unchanged in four out of
10 patients. In three patients the scans were normal and three showed overall improvement in esophageal function, although
in one of these latter patients gastroesophageal reflux was observed. Conclusions: In this series of morbidly obese patients,
esophageal function as assessed by scintigraphy was abnormal. Following VBG it improved in six out of 10 patients and was
unchanged in four out of 10. However, in one patient, who had shown an overall improvement in esophageal function, gastroesophageal
reflux was demonstrated when it had not been seen preoperatively. This was asymptomatic. Thus, adverse changes in esophageal
function after VBG were uncommon. 相似文献
9.
Mathus-Vliegen EM 《Best Practice & Research: Clinical Gastroenterology》2008,22(5):839-864
Morbid obesity is a chronic disease of excess fat storage, characterised by premature death and obesity-associated co-morbidities. The results of the current non-surgical treatment to treat obesity are disappointing, but surgical approaches may achieve a durable and longstanding weight loss with resolution and improvement of co-morbidities. Gastrointestinal complaints and digestive complications may, however, increase and may require an actively involved gastroenterologist. 相似文献
10.
Trenkner SW 《Abdominal imaging》2009,34(3):335-344
Surgery for morbid obesity has become commonplace in the United States. Any radiologist who reads abdominal films, body CT,
or does gastrointestinal fluoroscopy should be familiar with the surgical procedures and their imaging. Included in this update
will be discussions of the vertical banded gastroplasty, Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding,
and biliopancreatic diversion with duodenal switch. 相似文献