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Background: The technique of laparoscopic adjustable gastric banding (LAGB), although relatively well standardized, has some
"weak points". Methods: We analysed the experience of 2 German university clinics in order to suggest technical alternatives
that can be helpful in difficult situations. Results: Between April 1997 and May 2002 115 patients in Cologne (87 females,
28 males) with median BMI 49.5 kg/m2 and mean age 39 years (19-54), and 112 patients in Mainz (91 females, 21 males) with median BMI 48 kg/m2 and mean age 35 years (18-57) underwent LAGB, using the Lap-Band?. LAGB was performed through 5 ports (3 10-mm, 1 18-mm, and 1 5-mm in Cologne and 4 10-mm and 1 18-mm port in Mainz). The
pars flaccida technique by means of a fanshaped Endo-Retractor was used in both clinics. Mean duration of follow-up was 3.2
years (SD 1.0) in the Cologne group with complete investigation in all except 4 patients. In the Mainz group, mean duration
of follow-up was 2.7 years (SD 1.0) with complete investigation in all except 9 patients. Conclusions: Some technical aspects
such as induction of pneumoperitoneum, band position, band fixation, band malposition and port-related complications are discussed. 相似文献
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Associated or rare diseases, such as myasthenia gravis, introduce a challenge to the perioperative management of severely
obese patients undergoing bariatric surgery. We report the surgical management and unique anesthetic approach to a 55-year-old
morbidly obese woman with a complex past medical history that included myasthenia gravis, who underwent laparoscopic gastric
bypass. Her myasthenia was controlled on pyridostigmine and her greatest concern was the potential need for postoperative
mechanical ventilation. While the laparoscopic surgical approach was ideal to reduce pain and the adverse effects on ventilatory
mechanics associated with open upper abdominal surgery, a combined inhalational and intravenous anesthetic without muscle
relaxants resulted in satisfactory surgical conditions, and allowed for immediate postoperative extubation followed by an
uneventful postoperative course. Continued perioperative anticholinesterase administration may have facilitated this successful
outcome. We conclude that a diagnosis of myasthenia gravis does not mandate postoperative mechanical ventilation following
laparoscopic gastric bypass. 相似文献
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Background: Creating the proximal anastomosis in laparoscopic biliopancreatic diversion with duodenal switch (LBPD-DS) and
Roux-en-Y gastric bypass (LRYGBP) is a critical step in ensuring the success of the procedures. The aim of this study was
to assess the safety and efficiency of performing this anastomosis using a flexible, computerized, circular stapling device.
Method: We prospectively monitored the use of a newly FDA-approved stapling device (SurgASSIST, Power Medical Intervention)
for the construction of the proximal anastomosis by a variety of approaches and reviewed the charts of 10 patients. Results:
We successfully constructed 9 out of 10 proximal anastomoses: 2 gastro-jejunostomies and 7 duodeno-ileostomies, without any
signs of leakage. In 2 patients, the stapling technique involved a transpyloric instrumental passage; both were complicated
by the difficulty to pass either the flexible scope or the anvil through the narrow pyloric lumen. In 5 patients, the anvil
was placed directly through a duodenotomy and no technical problems were encountered. The median time for performing the proximal
anastomosis was 19 minutes (range 9-55).There were no postoperative complications in any patients. Conclusions: Stapling using
the SurgASSIST was feasible and safe for performing laparoscopic anastomoses in bariatric bypass procedures. A duodenotomy
for direct placement of the anvil into the postpyloric region seems to be most feasible for duodenoileostomies, while transoral
passage of the anvil can be recommended for gastro-jejunostomies. In its current form, we do not recommend transoral placement
of the flexible shaft of the SurgASSIST device. Further clinical trials need to be performed for comparison with existing
devices. 相似文献
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The Micropouch Gastric Bypass: Technical Considerations in Primary and Revisionary Operations 总被引:2,自引:0,他引:2
Background: Roux-en-Y gastric bypass is an effective procedure for the long-term control of morbid obesity. An eventual revisionary
operation, however, is necessary for some patients (0.8-29%). Redo procedures are required for pouch enlargement, stapleline
dehiscence, or marginal ulceration. In 1994, the micropouch gastric bypass (MBG) was developed to eliminate the need for a
repeat operation. Its design was based on two anatomical principles: 1) The fundus is elastic, aperistaltic, and may significantly
dilate over time; 2) The proximal magenstrasse contains a high concentration of parietal cells, which potentiates the risk
for marginal ulceration or gastroesophageal reflux after vertical pouch restriction. Construction of a micropouch limited
to the gastric cardia avoids using the fundus and proximal lesser curvature, but requires a greater mobilization of the stomach
and its peritoneal attachments. Methods: Between February 1994 and February 2000, 1,120 patients underwent the MGB as a primary
or revisionary operation.The fundus was mobilized completely, including transection of the left phreno-esophageal and gastrophrenic
ligaments. The transected pouch was limited to the gastric cardia with 1 cm of fundus incorporated into the gastrojejunostomy
stoma (GJS). Results: There were 10 anastomotic leaks at the GJS (0.9%). All leaks sealed following surgical drainage or parenteral
nutrition. One patient required re-operation (0.09%) for a dilated pouch and marginal ulceration. An additional patient (0.09%)
developed a gastrogastric fistula secondary to a pharmacobezoar and stomal stenosis. Conclusion: With an appreciation for
the finer anatomy of the proximal stomach and intra-abdominal esophagus, the micropouch can be constructed safely in both
primary and redo procedures. The MGB, now in its seventh year, is durable and has, with rare exception, eliminated pouch enlargement,
staple-line separation, reflux esophagitis, and marginal ulceration. 相似文献
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本文根据野生灵芝对生态环境的要求,采用人工控制光、温、湿、CO_2含量等生态因子,对赤芝进行仿野生栽培获得成功,为广东大面积推广,使灵芝栽培进入商品化生产提供了经验。 相似文献
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双吻合器在低位直肠癌保肛术中的应用 总被引:4,自引:2,他引:2
目的 评估双吻合器在低位直肠癌保肛术中的作用。方法 回顾性分析采用双吻合器在96例低位直肠癌保肛术中应用的临床资料。结果 男63例,女33例,年龄22—84(平均57.7)岁。肿瘤下缘距齿状线的距离为4—7cm。A期24例,B期30例,C期30例,D期l2例。组织学分型:高分化型腺癌47例,中分化型腺癌27例,低分化型腺癌l7例,粘液腺癌5例。无没有手术死亡,术后发生吻合口漏l2例(12.5%),均经治疗后痊愈,吻合口狭窄5例(5.2%);经扩肛处理后治愈。结论 双吻合器在低位直肠癌保肛术中的应用是一种可靠的方法,吻合口漏及狭窄采用保守治疗可获较好的效果。 相似文献