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1.
Open vs Laparoscopic Roux-en-Y Gastric Bypass: Comparison of Operative Morbidity and Mortality 总被引:3,自引:1,他引:2
Background: Open Roux-en-Y gastric bypass (RYGBP) has proven to be an effective method for weight control for the morbidly
obese patient. With technologic and surgical skill advancement in the application of laparoscopic surgery, laparoscopic RYGBP
has also been found to be of value in surgical control of obesity. Risk/benefit ratios in comparison of the 2 methods are
undergoing definition by experience. Methods: 779 patients who underwent RYGBP between March 1, 2000 and June 30, 2002 were
evaluated retrospectively. 328 patients underwent laparoscopic RYGBP (Group A) and 451 underwent open RYGBP (Group B). All
charts and hospital records of these patients were reviewed. Questionnaires were mailed to all patients who had undergone
RYGBP. Follow-up was 5-29 months. Results: 89 patients in Group A and 162 patients in Group B experienced significant morbidity.
There were no surgical deaths in Group A and one surgical death in Group B.Weight loss profiles were the same. Significant
differences in morbidity were noted with respect to gastrojejunal stenosis (Group A = 11.6%, Group B = 4.7%, P=.0012), occurrence of ventral incisonal hernia (A=0%, B=10%, P<.00013), and wound problems (abdominal wall hematoma A=1.5%%, B=0%, P=.013; wound infection A=1.2%, B=6.2%, P=.00037). Gastrojejunal perforation was not significantly different (A=1.5%, B=0.89%, P=.50), as was true of small bowel obstruction (A=2.7%, B=3.3%, P=.68). Conclusions: Each operative approach has associated problems.Wound care problems and ventral hernias are more common
in Group B (open) and anas tomotic stenoses are more common in Group A (laparoscopic). Anastomotic leaks and small bowel obstruction
are troublesome but not statistically different in occurrence. 相似文献
2.
3.
Ninh T Nguyen MD Hung S Ho MD FACS Levi S Palmer BS Bruce M Wolfe MD FACS 《Obesity surgery》1999,9(4):403-406
Laparoscopic gastric bypass has been recently introduced as an alternative method to conventional open gastric bypass. This
procedure has been generally limited to patients with a BMI <60 kg/m2 due to the possible technical limitations of the laparoscopic instruments. In this article, we present a patient with super/super
obesity (61 kg/m2) who underwent Rouxen-Y gastric bypass using the laparoscopic approach. 相似文献
4.
Background: 3855 patients undergoing Roux-en-Y gastric bypass for morbid obesity between 1988 and 1994 are presented. Methods:
All patients were sent a standard questionnaire reflecting current weight, intervening complications and general health status
and 1039 patients responded. Information gleaned from review of these questionnaires and a review of individual charts provided
the data for this study. Results: Average weight loss at 1 year was 46 kg and at 5 years was 34.5 kg. Operative mortality
was 0.18%. Surgical morbidity rate was 3.4%. Average length of stay for patients hospitalized in 1994 was 3.6 days. The average
operating time during that same year was 78 min, and the average hospital charges were $7250. Conclusions: Roux-en-Y gastric
bypass can be performed with relative safety and acceptable morbidity. There is a demonstrable weight loss benefit which is
maintained in the majority of patients over a period greater than 5 years. The expense and consumption of provider services
are modest, and this procedure remains an excellent alternative for weight control among morbidly obese individuals. 相似文献
5.
BACKGROUND: Patients undergoing laparoscopic Roux-en-Y bariatric surgery undergo screening esophagoduodenoscopy (EGD) during preoperative evaluation. The hypothesis is to examine the utility of this examination. The purpose of this study was to evaluate the prevalence of clinically significant upper gastrointestinal (UGI) tract findings at screening EGD in patients undergoing laparoscopic Roux-en-Y bariatric surgery. A secondary aim was to determine whether preprocedure symptoms could predict findings at EGD. METHODS: We evaluated records of patients undergoing EGD prior to bariatric surgery between 2000 and 2005 at the Stanford University Medical Center. Clinical, endoscopic, and pathological data were analyzed. The prevalence of endoscopic findings of clinical significance was determined. RESULTS: Two hundred seventy two complete patient records were identified and included in the study. Of these, 237 (87%) were female and 197 (72%) were Caucasian. The mean age was 43 +/- 9.68 years and mean body mass index was 48 +/- 7.95 kg/m(2). Of the 272 patients, 33 (12%) had EGD findings of clinical significance including erosive esophagitis (3.7%), Barrett's esophagus (3.7%), gastric ulcers (2.9%), erosive gastritis (1.8%), duodenal ulcers (0.7%), and gastric carcinoid (0.3%). No patients had malignancy. Of these 33 patients, 22 (67%) had UGI symptoms. CONCLUSIONS: Significant findings at screening EGD were found in 12% of patients. While EGD may be low-yield, the findings could be useful in guiding clinical decision making. 相似文献
6.
Gallstone disease, common after Roux-en-Y gastricbypass (RYGBP), may be complicated by biliary ductobstruction and gallstone
pancreatitis. Althoughendoscopic retrograde cholangiopancreatographyplays an important role in management of biliary ductobstruction,
the altered anatomy of patients who havehad a RYGBP makes this procedure technically difficult.With the increased number of
patients undergoingRYGBP for morbid obesity, bariatric surgeonsmay benefit from an alternative laparoscopic techniquefor accessing
the biliary tree. We describe alaparoscopic technique of accessing the biliary treethrough the bypassed stomach. 相似文献
7.
Laparoscopic Gastric Bypass,Roux-en-Y: Preliminary Report of Five Cases 总被引:23,自引:9,他引:14
The technique of laparoscopic gastric bypass, Roux-en-Y, has been developed, and performed in five patients. The detailed
technique and instrumentation is described. Early case results show comparable weight loss, and reduced morbidity and disability.
Laparoscopic gastric bypass is a feasible alternative to the open operative procedure. 相似文献
8.
Torres JC 《Obesity surgery》1993,3(2):191-195
Gastric bypass with jejunal interposition is a version of the distal Roux-en-Y. Ninety cm of the jejunum is interposed between
the gastric stoma and the ileum. This new procedure initially was used in super-obese patients mainly to facilitate the gastric
anastomosis. 相似文献
9.
10.
In order to evaluate the short- and long-term complications of obesity surgery, a review was done on 452 cases of morbidly
obese patients who met the basic guidelines for obesity surgery and were operated upon; gastric bypass was performed in all
of them. There were seven major complications: one myocardial infarction, two pulmonary embolisms, two gastric fistulas, one
sepsis from bowel infection and one acute thrombocytopenia purpura. Five of the patients died. It is important to note, in
those patients with abdominal complications, the absence of classical signs and symptoms of peritonitis, and the need to act
immediately in order to solve the post-operative problem. As in other series, minor complications were also present: subcutaneous
infection in 18 cases, hernia in four, peptic syndrome in three, mild anemia in 28 and hypovitaminosis A and B in 58; all
received medical treatment without problem. It is concluded that obesity surgery, like all major surgery in high-risk patients,
may have complications, and therefore it is necessary to recognize them in order to prevent them, and if they emerge, diagnose
and treat properly. 相似文献
11.
Anastomotic Leak following Antecolic versus Retrocolic Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity 总被引:1,自引:0,他引:1
Background Laparoscopic Roux-en-Y gastric bypass(LRYGBP) is the most commonly performed operation for the treatment of morbid obesity
in the United States. Previous reports suggest that postoperative complications may be influenced by Roux limb orientation
(antecolic versus retrocolic), although thisremains controversial. The aim of this study was toanalyze our experience with
anastomotic leaks following LRYGBP with an antecolic- versus retrocolicrouted Roux limb.
Methods During the 2-year period of June 2003 to June 2005, 353 patients underwent a LRYGBP. 135 were antecolic and 218 retrocolic.
All cases were performedby one of three bariatric surgeons. The decisionto perform antecolic versus retrocolic LRYGBP was
left to the surgeon’s preference. The primary outcome measure was anastomotic leak.
Results Mean follow-up was 28 weeks. There wereno perioperative deaths. Overall complication rate was 16.9%. 17 gastrojejunal leaks
(4.8%) were identified, consisting of 12 intraoperative leaks (3.4%) and 5 postoperative leaks (1.4%). Postoperative gastrojejunal
leak rate was higher in the antecolic group (P = 0.04).
Conclusion Mortality and complication rates were consistent with reported benchmarks on the efficacy and safety of LRYGBP. Our review
suggests that anastomotic leak may be more common after antecolic than after retrocolic LRYGBP for morbid obesity. A prospective
randomized study is needed to determine whether antecolically-routed Roux limb is an independent predictor for anastomotic
leak following LRYGBP. 相似文献
12.
Background: Intra-operative pneumothorax (PTX) is an infrequent complication of laparoscopic surgery. Most cases are attributed
to CO2 diffusion across congenital diaphragmatic defects and resolve spontaneously. We report a case of PTX during a laparoscopic
Roux-en-Y gastric bypass (LRYGBP). When applied to this specific patient population, the current literature recommendations
for the management of intra-operative PTX are questioned. Material and Methods: A retrospective chart review of 400 consecutive
LRYGBP procedures performed over a 30-month period revealed 1 case of PTX (0.025%). Results: A bulging left diaphragm, hypotension,
bradycardia, decreased pO2, and elevated EtCO2 and airway pressures, were noted early in the case. She initially responded to conservative management but required multiple
subsequent hospital admissions for pulmonary complications. Conclusions: Pneumoperitoneum-induced PTX during laparoscopic
bariatric surgery is a rare complication. Its treatment must be based on the potential underlying cause, with consideration
of these patients' often delicate pulmonary status. In stable patients, where the PTX is attributed to diaphragmatic or hiatal
dissection, expectant treatment is appropriate. In all other situations, however, we believe that tube thoracostomy is indicated.
An algorithm for treatment of PTX in laparoscopic bariatric surgery is proposed. It follows the dictum of maintaining extreme
vigilance and a low threshold for aggressive intervention in this group of patients. 相似文献
13.
Laparoscopic Roux-en-Y gastric bypass is the most common bariatric surgical procedure in the USA in women of reproductive
age. A pregnant patient presented with nonspecific upper abdominal pain and nausea, suggesting an internal hernia. At surgery,
an intussusception was identified and reduced without complications. Obstetricians should be familiar with late serious complications
of bariatric surgery. 相似文献
14.
Pires LV Martins LM Geloneze B Tambascia MA Hadad do Monte SJ do Nascimento Nogueira N Santos de Sousa G Marreiro DN 《Obesity surgery》2007,17(5):617-621
Background Researchers have found that zinc nutritional status in obese and diabetic subjects is altered: low zinc concentrations in
plasma and erythrocytes, with high urinary zinc excretion, were observed. This study evaluated the effect of Roux-en-Y gastric
bypass (RYGBP) on plasma, erythrocyte and urinary zinc concentration.
Methods 22 morbidly obese patients were studied before and 6 months after RYGBP. Fasting blood sample and 24-hour urine were collected
in the pre- and postoperative phases. A software analyzed the diet information from 3-day food records after RYGBP. Zinc nutritional
status was evaluated by determination of the concentration of this mineral in plasma and erythrocytes, and the urinary excretion
of zinc / 24 hours by atomic absorption spectrophotometry.
Results The diets consumed by the patients had adequate average concentrations of zinc. Zinc concentration in plasma, erythrocytes
and urine were within the values of normality before RYGBP, with mean values of 93.25 ± 19.34 μg/dL, 43.85 ± 7.76 μg Zn/gHb
and 583.05 ± 359.30 μg Zn/24 hours, respectively. At 6 months after RYGBP, there was a change in these parameters to 69.82 ± 10.95 μg/dL,
51.80 ± 6.92 μg Zn/gHb, 535.29 ± 216.40 μg Zn/24 hours in the concentration of plasma, erythrocyte and urinary zinc.
Conclusion These results suggest that RYGBP promoted, besides change in body composition, an alteration in the zinc plasma and erythrocytes
concentrations which in the medium and long term, could cause problems for these patients. 相似文献
15.
Background The concern about internal hernias has prompted recommendations for routine closure of defects during laparoscopic Roux-en-Y
gastric bypass (LRYGBP). Our belief is that not all techniques require closure of defects. We hypothesize that nonclosure
of defects with our particular technique would not cause a significant clinically evident internal hernia rate.
Methods All patients who were operated on between December 2002 and June 2005 were included in this study. The technique that was
utilized included an antecolic antegastric gastrojejunostomy (GJ), division of the greater omentum, a long jejunojejunostomy
(JJ) performed with three staple-lines, a short (<4 cm) division of the small bowel mesentery, and placement of the JJ above
the colon in the left upper quadrant. Clinical records were reviewed for reoperations.
Results here was a total of 300 patients, and no incidence of internal hernia. In the first 100 patients, there was 97% follow-up
for 1 year or more. Four patients underwent reoperations for unexplained abdominal pain. Intraoperative findings included
an adhesive band from the JJ to the colon (1), an adhesive band from the JJ to the anterior abdominal wall (1), an adhesive
band 3 cm from the GJ to the anterior abdominal wall (1), and adhesions of the jejunum to the anterior abdominal wall (1).
No patient had an internal hernia.
Conclusions Internal hernias are not common after this particular method of LRYGBP. Before adopting routine closure of potential spaces,
surgeons should consider their technique, follow-up, and incidence of internal hernias. Routine closure of these defects is
not always necessary. 相似文献
16.
J C Cagigas MD PhD E Martino MD PhD C F Escalante MD PhD A Ingelmo MD PhD R Estefanía MD J M Gutierrez MD M Gomez Fleitas MD PhD 《Obesity surgery》1999,9(2):166-170
Background: Laparoscopic gastric bypass and vertical banded gastroplasty are two procedures used in the treatment of morbid
obesity. The authors describe alternative techniques of laparoscopic distal gastric bypass as a modification of the Scopinaro
procedure, which were used experimentally in a porcine model. Methods: Five pigs were used. The laparoscopic procedure was
performed with the pigs under general anesthesia after pneumoperitoneum had been achieved. Five or six trocars were used.
One port was converted from 12 to 33 mm, and all the other ports were 10-11 mm. The initial surgical technique was similar
to that used by others for laparoscopic gastrectomy, except that atraumatic ultracision was used for all the dissection. The
stomach was stapled with a linear cutter stapler (Endopath, 31 mm) to create a 50-ml pouch. The ileum was divided with a linear
cutter-stapler (Endopath, 31 mm) or ultracision cautery. A long length of ileum was positioned between the stomach pouch and
the jejunoileostomy. Only 50-70 cm of terminal ileum was preserved as a common channel. In three animals, the circular stapler
(ILS, 21 mm) was used to produce an end-to-side anastomosis. In one animal, two purse-string sutures were handsewn in the
ileum and jejunum stumps, and in another two animals, two endoloops were used for the anvil. In two animals, the linear stapler
was used to form a side-to-side pouch stomach-ileum and jejunoileostomy anastomosis. In other animals, the two types of anastomosis
have been combined. All animals were killed after surgery so that the anastomoses could be evaluated for size and integrity.
Results: In all animals, with the circular and linear stapler, both 21 and 13-15 mm anastomoses were intact. Conclusion: Distal
gastric bypass is feasible laparoscopically, with intact anastomoses. 相似文献
17.
Debra S Mason RN BA CNOR RNFA James A Sapala MD FACS Michael H Wood MD FACS M Andrew Sapala MD FACS 《Obesity surgery》1998,8(4):453-460
Background: Hypothermia during and after major abdominal surgery decreases host defenses, increases the incidence of coagulopathy
and may alter blood pressure, cardiac contractility and myocardial stability. Methods: We designed a prospective randomized
study to compare the benefits of a forced air warming system with warm blanket treatments in minimizing the effects of hypothermia
on 64 morbidly obese patients undergoing Roux-en-Y gastric bypass. Results: Patients in the forced air warming group (n = 32) had significantly higher perioperative body core temperature, lower central venous pressure and blood pressure readings,
lower incidence of shivering, less blood loss intraoperatively and achieved a higher post anesthesia Aldrete Score than those
patients in the warmed blanket group (n = 32). Conclusion: The forced air warming system is safe, cost effective and beneficial in minimizing the undesirable consequences
of hypothermia in morbidly obese patients undergoing Roux-en-Y gastric bypass. 相似文献
18.
Changes in Diabetic Management After Roux-en-Y Gastric Bypass 总被引:3,自引:0,他引:3
Background: Control of hyperglycemia in diabetes mellitus through diet, exercise, oral hypoglycemics and insulin has underlined
the medical treatment for that disease. Morbidly obese diabetics can be more successfully rendered euglycemic if their excess
body weight is reduced and their diets are carefully controlled. Methods: Roux-en-Y Gastric Bypass has been used as a weight
control measure for 205 morbidly obese diabetics over an 8-year period, 1988-1995. Early follow-up has been possible in all
patients up to 3 months, and late follow-up has been achieved by phone contact and office visits in 133 patients. Results:
Operative mortality occurred in 1/205 patients (0.49%). Major operative morbidity occurred in 14/205 (6.8%). While 46/133
(35%) patients were on insulin preoperatively, only 11/133 (8%) have remained on insulin and 9/11 at lower doses. 64/133 (48%)
were on oral hypoglycemics, but only 8/133 (6%) continue their use. 23/133 (17%) were on diet alone or no treatment before
surgery, and 91/133 (68%) claimed diet alone or no treatment after surgery. The long-term mean % Excess Body Weight Loss is
55%. Conclusions: Morbidly obese diabetics undergoing Roux-en-Y Gastric Bypass can experience markedly diminished need for
insulin and oral hypoglycemics to control hyperglycemia. 相似文献
19.
20.
Eric J Keyser MD Najma A Ahmed MD PhD Brian D Mott MD Jean Tchervenkov MD FRCS 《Obesity surgery》1998,8(4):475-479
A healthy 45-year-old woman with a previous Rouxen-Y gastric bypass presented with the signs, symptoms and blood analysis
results consistent with acute pancreatitis. She was initially treated nonoperatively and subsequently went into circulatory
shock. Computerized tomographic scan and exploratory laparotomy revealed a volvulus of the afferent jejunal limb with secondary
obstruction, necrosis, and perforation of the bypassed stomach. 相似文献