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1.
Background
The aim of this study was to determine the efficacy of routine upper gastrointestinal imaging following the three forms of laparoscopic bariatric surgery completed at our institution (laparoscopic Roux en Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LS), and laparoscopic adjustable gastric banding (LAGB)).Methods
Radiograph reports were reviewed from the period of January 2005 to July 2010. During that time, 129 patients underwent LRYGB, 209 underwent LS, and 12 patients underwent LAGB. Of those patients, 120 LRYGB patients, 188 LS patients, and 11 LAGB patients underwent upper gastrointestinal studies on postoperative days (POD) 1 or 2.Results
Of the 319 total patients who underwent UGI, no contrast leaks were found. One LRYGB patient was found to have stenosis of the jejunojejunal anastomosis and was taken to the operating room for revision. A total of ten patients went on to develop leaks: four LRYGB patients, six LS patients, and zero LAGB patients.Conclusions
The results of our study show that a positive UGI study for stricture has a specificity of 100?%. In terms of leak, which offers a much higher risk of significant morbidity and mortality, UGI was unable to find any on postoperative days 1 or 2. Based on the results of this study, our institution has stopped completing routine UGI on POD 1 following bariatric surgery. 相似文献2.
M. Timucin Aydin Orhan Aras Bora Karip Kemal Memisoglu 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2015,19(3)
Background and Objectives:
Laparoscopic sleeve gastrectomy is a technically simple and popular bariatric operation with acceptable results. However, leaks can occur in long staple lines, for which various reinforcement methods are used. We compared nonreinforced stapling in laparoscopic sleeve gastrectomy with 3 staple line reinforcement methods: suturing, absorbable buttressing material, and fibrin glue.Methods:
From March 1 until September 30, 2014, 118 patients with body mass index >40 kg/m2 underwent sleeve gastrectomy and were enrolled in 4 groups, depending on the type of reinforcement used. The resected stomach specimens were treated with the same methods of reinforcement as used in the surgeries in the corresponding patients and then insufflated until a burst occurred. The burst pressures of the resected stomach specimens and adverse postoperative events were recorded.Results:
Five postoperative leaks occurred in the reinforcement groups (fibrin glue, 2; absorbable buttresses, 2; sutures, 1); no leaks were evident in the no-reinforcement group. Suturing afforded the highest burst pressure and took the longest to perform of the methods. There was no correlation between the leaks and burst pressures. All of the leaks occurred in the proximal fundus in the resected stomach specimens and in the affected patients.Discussion:
Although most surgeons use additional reinforcement on long staple lines in sleeve gastrectomy, there is no consensus about its necessity. We did not show any benefit of such reinforcement methods over proper stapling technique alone.Conclusion:
Laparoscopic sleeve gastrectomy without staple line reinforcement is safe and avoids additional costs for reinforcement materials. 相似文献3.
Monica Sethi Melissa Magrath Eduardo Somoza Manish Parikh John Saunders Aku Ude-Welcome Bradley Schwack Marina Kurian George Fielding Christine Ren-Fielding 《Surgical endoscopy》2016,30(6):2266-2275
Background
Leak after laparoscopic sleeve gastrectomy (LSG) often presents after hospital discharge, making timely diagnosis difficult. This study evaluates the utility of radiological upper gastrointestinal (UGI) series and clinical indicators in detecting leak after LSG.Methods
A retrospective case-controlled study of 1762 patients who underwent LSG from 2006 to 2014 was performed. All patients with radiographically confirmed leaks were included. Controls consisted of patients who underwent LSG without leak, selected using a 10:1 case-match. Data included baseline patient characteristics, surgical characteristics, and UGI series results. Clinical indicators including vital signs, SIRS criteria, and pain score were compared between patients who developed leak and controls.Results
Of 1762 LSG operations, 20 (1.1 %) patients developed leaks and were compared with 200 case-matched controls. Three patients developed leak during their index admission [mean = 1.3 days, range (1, 2)], while the majority (n = 17) were discharged and developed symptoms at a mean of 17.1 days [range (4, 63)] postoperatively. Patients diagnosed with leak were similar to controls in baseline and surgical characteristics. Contrast extravasation on routine postoperative UGI identified two patients with early leaks, but was negative in the remainder (89 %). Patients with both early and delayed leaks demonstrated significant clinical abnormalities at the time of leak presentation, prior to confirmatory radiographic study. In multiple regression analysis, independent clinical factors associated with leak included fever [OR 16.6, 95 % CI (4.04, 68.10), p < 0.0001], SIRS criteria [OR 7.0, 95 % CI (1.47, 33.26), p = 0.014], and pain score ≥9 [OR 19.1, 95 % CI (1.38, 263.87), p = 0.028].Conclusions
Contrast extravasation on routine postoperative radiological UGI series may detect early leaks after LSG, but the vast majority of leaks demonstrate normal results and present 2–3 weeks after discharge. Therefore, clinical indicators (specifically fever, SIRS criteria, and pain score) are the most useful factors to raise concern for leaks prior to confirmatory radiographic study and may be used as criteria to selectively obtain UGI studies after LSG.4.
Uzma Rahman Salvatore Docimo Aurora D. Pryor Andrew Bates Nabeel R. Obeid Konstantinos Spaniolas 《Surgery for obesity and related diseases》2018,14(4):517-520
Background
Although multiple studies demonstrate that routine postoperative contrast studies have a low yield in diagnosing patients with early gastrointestinal (GI) leak after bariatric surgery, the practice pattern is unknown. Additionally, routine imaging may hinder procedural pathways that lead to accelerated postoperative discharge.Objectives
To report on the nationwide use of routine upper GI studies (UGI) and evaluate the effect on hospital resource utilization.Setting
Nationwide analysis of accredited centers.Methods
The Metabolic and Bariatric Surgery Accreditation Quality and Improvement Program public use file for 2015 was used to identify patients who underwent routine UGI after nonrevisional Roux-en-Y gastric bypass or sleeve gastrectomy. Multivariable logistic regression models were developed to identify risk factors for early hospital discharge.Results
Bariatric surgery was performed on 130,686 patients. Routine UGI was performed in 30.9% of Roux-en-Y gastric bypass and 43% of sleeve gastrectomy patients (P<.0001). Patients undergoing routine UGI were less likely to be discharged by postoperative day 1 (odds ratio .7, 95%; confidence interval .69–0.72). There was no difference in postoperative leak rate between the routine UGI versus nonroutine UGI group (.7% versus .8%, P = .208). Among patients who developed a GI leak, there was no significant difference in the rate of reoperation, readmission, and reintervention between the 2 groups. The time interval between index operation and any further management for the leak was longer in the routine UGI group.Conclusions
Routine UGI evaluation after bariatric surgery remains a common practice in accredited centers. This practice is associated with prolonged hospital length of stay, with no effect on the diagnosis of leak rate. 相似文献5.
Amihai Rottenstreich Ram Elazary Jonathan B. Yuval Galia Spectre Geffen Kleinstern Yosef Kalish 《Surgery for obesity and related diseases》2018,14(1):1-7
Background
Bariatric surgery is associated with increased thromboembolic risk, which may extend well beyond hospital stay. The hemostatic mechanisms implicated in this risk are not well established.Objectives
We aimed to determine the dynamics of hemostatic changes and procoagulant potential among patients undergoing laparoscopic sleeve gastrectomy, during both the early and late postoperative periods.Setting
A university hospital.Methods
Patients who underwent laparoscopic sleeve gastrectomy were recruited consecutively to this study. Blood samples were taken preoperatively, before discharge (postoperative day [POD] 3), and at the first follow-up visit (POD10). All samples were tested for complete blood count, C-reactive protein, von Willebrand factor, factor VIII, fibrinogen, and thrombin generation.Results
The median preoperative body mass index of the 26 participants was 41.3 (38.7–43.3) kg/m2. Compared with preoperative evaluation, fibrinogen, von Willebrand factor antigen and activity, and factor VIII levels were significantly higher at POD3 and POD10 (P<.0001 for all comparisons). Peak thrombin levels and endogenous thrombin potential (ETP) were higher at POD3 (P = .005 for both comparisons) and POD10 (P = .0009 and<.0001) compared with baseline. ETP and peak thrombin, as well as fibrinogen, von Willebrand factor, and factor VIII levels, were comparable between POD3 and POD10. Multivariate analysis showed that the only predictor of postoperative ETP was the preoperative ETP level (β = .55, P = .007).Conclusions
As determined by thrombin generation, laparoscopic sleeve gastrectomy was associated with hypercoagulability, which persisted during POD10. This finding suggests a possible benefit of extended thromboprophylaxis. Nevertheless, our results should be interpreted with caution due to the lack of a control group. 相似文献6.
Nasser Malekpour Alamdari Mahmood Bakhtiyari Barmak Gholizadeh Catrine Shariati 《Journal of gastrointestinal surgery》2018,22(3):396-401
Background
The indications for sleeve gastrectomy as a primary procedure for the surgical treatment of morbid obesity have increased worldwide. Pain is the most common complaint for patients on the first day after laparoscopic sleeve gastrectomy. There are various methods for decreasing pain after laparoscopic sleeve gastrectomy such as the use of intraperitoneal bupivacaine hydrochloride. This clinical trial was an attempt to discover the effects of intraperitoneal bupivacaine hydrochloride on alleviating postoperative pain after laparoscopic sleeve gastrectomy.Methods
In general, 120 patients meeting the inclusion criteria were enrolled. Patients were randomly allocated into two interventions and control groups using a balanced block randomization technique. One group received intraperitoneal bupivacaine hydrochloride (30 cm3), and the other group served as the control one and did not receive bupivacaine hydrochloride. Diclofenac suppository and paracetamol injection were administered to both groups for postoperative pain management.Results
The mean subjective postoperative pain score was significantly decreased in patients who received intraperitoneal bupivacaine hydrochloride within the first 24 h after the surgery; thus, the instillation of bupivacaine hydrochloride was beneficial in managing postoperative pain.Conclusions
The intraoperative peritoneal irrigation of bupivacaine hydrochloride (30 cm3, 0.25%) in sleeve gastrectomy patients was safe and effective in reducing postoperative pain, nausea, and vomiting (IRCT2016120329181N4).7.
Leyre Lorente José Manuel Ramón Pablo Vidal Alberto Goday Alejandra Parri Enrique Lanzarini Manuel Pera Luis Grande 《Cirugía espa?ola》2014
Introduction
Morbimortality after bariatric surgery varies according to patient characteristics and associated comorbidities. The aim of this study was to evaluate the usefulness of the Obesity sugery mortality risk score scale (OS-MRS) to predict the risk of postoperative complications after bariatric surgery.Methods
A retrospective study was performed of a prospective series of patients undergoing bariatric surgery in which the OS-MRS scale was applied preoperatively. Postoperative complications were classified as proposed by Dindo-Clavien. We analyzed the relationship between the categories of OS-MRS scale: A) low risk, B) intermediate risk, and C) high risk and the presence of complications.Results
Between May 2008 and June 2012, 198 patients were included (85 [42.9%] after gastric bypass and 113 [57.1%] after sleeve gastrectomy). Using the OS-MRS scale, 124 patients were classified as class A (62.6%), 70 as class B (35.4%) and 4 as class C (2%). The overall morbidity rate was 12.6% (25 patients). A significant association between OS-MRS scale and rate of complications (7.3, 20 and 50%, respectively, P=.004) was demonstrated. The gastric bypass was associated with a higher complication rate than sleeve gastrectomy (P=.007). In multivariate analysis, OS-MRS scale and surgical technique were the only significant predictive factors.Conclusions
The OS-MRS scale is a useful tool to predict the risk of complications and can be used as a guide when choosing the type of bariatric surgery. 相似文献8.
Background
The appearance and incidence of gastroesophageal reflux after sleeve gastrectomy is not yet resolved, and there is an important controversy in the literature. No publications regarding the appearance of Barrett’s esophagus after sleeve gastrectomy are present in the current literature.Purpose
The purpose of this paper was to report the incidence of Barrett’s esophagus in patients submitted to sleeve.Material and Methods
Two hundred thirty-one patients are included in this study who were submitted to sleeve gastrectomy for morbid obesity. None had Barrett’s esophagus. Postoperative upper endoscopy control was routinely performed 1 month after surgery and 1 year after the operation, all completed the follow-up in the first year, 188 in the second year, 123 in the third year, 108 in the fifth year, and 66 patients over 5 years after surgery.Results
Among 231 patients operated on and followed clinically, reflux symptoms were detected in 57 (23.2 %). Erosive esophagitis was found in 38 patients (15.5 %), and histological examination confirmed Barrett’s esophagus in 3/231 cases (1.2 %) with presence of intestinal metaplasia.Conclusion
Bariatric surgeons should be aware of the association of gastroesophageal reflux (GER) disease and obesity. Appropriate bariatric surgery should be indicated in order to prevent the occurrence of esophagitis and Barrett’s esophagus.9.
Alan A. Saber Nami Azar Mahmoud Dekal Tamer N. Abdelbaki 《American journal of surgery》2015,209(6):999-1006
Background
Several postoperative gastrointestinal complications are attributed to ischemia. We herein evaluate the gastric wall perfusion using computed tomography (CT) scan perfusion index on trial to address the etiology of ischemic complication after sleeve gastrectomy.Methods
A retrospective study of 205 patients undergoing CT scan of the abdomen to evaluate the pattern of gastric vascular perfusion was performed. The perfusion index of the gastric mucosa was measured at 5 gastric points using CT perfusion scanning.Results
Gastric perfusion at the angle of His (AOH) (53.51 ± 14.38) was statistically significantly lower (P < .001) than that at the other gastric points studied: fundus, greater curvature, lesser curvature, incisura angularis, and mid gastric points (76.16 ± 15.21, 73.27 ± 16.55, 76.12 ± 16.12, and 75.24 ± 14.9, respectively). Gastric perfusion was significantly lower at all the gastric points (and especially so at the AOH) among obese patients (33 cases) compared with nonobese patients (18 cases). Gastric perfusion at all the points studied showed a decrease as the body mass index increases. Hypertensive patients had a better gastric perfusion compared with nonhypertensive patients.Conclusions
Gastric wall perfusion is statistically significantly decreased at the AOH and gastric fundus compared with perfusion at other gastric points. Gastric perfusion at all the gastric points studied decreased with the increase in body mass index. Gastric leakage in obese patients following sleeve gastrectomy could be attributed to a decrease in the blood supply at AOH. 相似文献10.
Monica Sethi Jonathan Zagzag Karan Patel Melissa Magrath Eduardo Somoza Manish S. Parikh John K. Saunders Aku Ude-Welcome Bradley F. Schwack Marina S. Kurian George A. Fielding Christine J. Ren-Fielding 《Surgical endoscopy》2016,30(3):883-891
Background
Staple line leak is a serious complication of sleeve gastrectomy. Intraoperative methylene blue and air leak tests are routinely used to evaluate for leak; however, the utility of these tests is controversial. We hypothesize that the practice of routine intraoperative leak testing is unnecessary during sleeve gastrectomy.Methods
A retrospective cohort study was designed using a prospectively collected database of seven bariatric surgeons from two institutions. All patients who underwent sleeve gastrectomy from March 2012 to November 2014 were included. The performance of intraoperative leak testing and the type of test (air or methylene blue) were based on surgeon preference. Data obtained included BMI, demographics, comorbidity, presence of intraoperative leak test, result of test, and type of test. The primary outcome was leak rate between the leak test (LT) and no leak test (NLT) groups. SAS version 9.4 was used for univariate and multivariate analyses.Results
A total of 1550 sleeve gastrectomies were included; most were laparoscopic (99.8 %), except for one converted and two open cases. Routine intraoperative leak tests were performed in 1329 (85.7 %) cases, while 221 (14.3 %) did not have LTs. Of the 1329 cases with LTs, there were no positive intraoperative results. Fifteen (1 %) patients developed leaks, with no difference in leak rate between the LT and NLT groups (1 vs. 1 %, p = 0.999). After adjusting for baseline differences between the groups with a propensity analysis, the observed lack of association between leak and intraoperative leak test remained. In this cohort, leaks presented at a mean of 17.3 days postoperatively (range 1–67 days). Two patients with staple line leaks underwent repeat intraoperative leak testing at leak presentation, and the tests remained negative.Conclusion
Intraoperative leak testing has no correlation with leak due to laparoscopic sleeve gastrectomy and is not predictive of the later development of staple line leak.11.
Mousa Khoursheed Ibtisam Al-Bader Ali Mouzannar Aqeel Ashraf Yousef Bahzad Abdulla Al-Haddad Ali Sayed Abe Fingerhut 《Obesity surgery》2016,26(12):2944-2951
Background
Sleeve gastrectomy is being performed increasingly, mainly due to its low morbidity and mortality, but complications do occur. The aim of this study was to evaluate bleeding and leakage rates of primary and revisional sleeve gastrectomy in a personal series of 664 consecutive patients.Methods
Medical charts of all patients undergoing a primary or revisional sleeve gastrectomy between August 2008 and December 2014 were reviewed retrospectively. Subgroup analysis compared bleeding in patients after reduced port versus multiport technique and primary versus revisional sleeve gastrectomy.Results
A total of 664 sleeve gastrectomies (489 women and 175 men) were performed. Mean age and body mass index were 36.03?±?11.4 years and 42.9?±?8.3 kg/m2, respectively. Mean operative time was 58.5?±?20.0 min, with a 0.15 % conversion rate. Mean hospital stay was 2.1?±?0.3 days. The overall 30-day complication rate was 7.5 %. Thirteen patients sustained postoperative bleeding (2 %), three of whom required reoperation (0.5 %). Staple line leakage and mortality were both nil in this series. No difference in postoperative complications was found between the subgroups.Conclusions
In this single-surgeon, single-center experience, sleeve gastrectomy was a safe and effective bariatric procedure with a low complication rate. Staple line reinforcement by oversewing was associated with low bleeding complications and no leakage. The majority of patients with postoperative bleeding could be managed conservatively. In our experience, reduced port technique and revisional sleeve gastrectomy had similar complication rates compared to multiport and primary sleeve gastrectomy.12.
Marcos Bruna Verónica Gumbau Marcos Guaita Enrique Canelles Claudia Mulas Carla Basés Isabel Celma José Puche Goitzane Marcaida Miguel Oviedo Antonio Vázquez 《Cirugía espa?ola》2014
Introduction
Different hormones and peptides involved in lipid and carbohydrate metabolism have been studied in relation to morbid obesity and its variation after bariatric surgery. The aim of this study is toevaluate variations in different molecules related to glico-lipidic metabolism during the first year after sleeve gastrectomy in morbidly obese patients.Material and methods
Prospective study in patients undergoing sleeve gastrectomy between November 2009 and January 2011. We analyzed changes in different clinical, anthropometric and analytic parameters related with glico-lipidic metabolism in all patients in the preoperative period, first postoperative day, fifth day, one month, 6 months and one year after surgery. Statistical analysis was performed using SPSS 20.0.Results
We included 20 patients, 60% were women with a median of age of 45 years. Median of body mass index (IMC) was 48,5 kg/m2 and 70% had obstructive sleep apnea syndrome (SAOS), 65% arterial hypertension (HTA), 45% dyslipidemia and 40% diabetes mellitus. One year after surgery, the percentage of excess of BMI loss was 72% and the rate of cure or improvement of dyslipidemia was 100%, diabetes 87,5%, HTA 84,6% and SAOS 57,1%. At this time, glycemia levels decreased significantly (P<.001), and levels of IGF-1 and HDL-cholesterol increased significantly. Levels of adiponectine increased and leptine (P=.003), insulin (P=.004) and triglycerides (P=.016) decreased significantly one year after the surgery. ACTH levels (that decreased during first 6 months after surgery), glycosilated hemoglobin, total cholesterol and LDL-cholesterol had no changes one year after surgery.Conclusions
Sleeve gastrectomy is a surgical technique with good results of weight loss and cure of comorbidities. This procedure induces significant modifications in blood levels of glico-lipidic metabolism related peptides and hormones, such as glucose, IGF-1, insulin, leptin, triglycerides and HDL-cholesterol. 相似文献13.
Vikrom K. Dhar Dennis J. Hanseman Brad M. Watkins Ian M. Paquette Shimul A. Shah Jonathan R. Thompson 《Surgery》2018,163(3):571-577
Background
The impact of operative technique on outcomes in laparoscopic sleeve gastrectomy has been explored previously; however, the relative importance of patient characteristics remains unknown. Our aim was to characterize national variability in operative technique for laparoscopic sleeve gastrectomy and determine whether patient-specific factors are more critical to predicting outcomes.Methods
We queried the database of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program for laparoscopic sleeve gastrostomies performed in 2015 (n?=?88,845). Logistic regression models were used to determine predictors of postoperative outcomes.Results
In 2015, >460 variations of laparoscopic sleeve gastrectomy were performed based on combinations of bougie size, distance from the pylorus, use of staple line reinforcement, and oversewing of the staple line. Despite such substantial variability, technique variants were not predictive of outcomes, including perioperative morbidity, leak, or bleeding (all P ≥ .05). Instead, preoperative patient characteristics were found to be more predictive of these outcomes after laparoscopic sleeve gastrectomy. Only history of gastroesophageal disease (odds ratio 1.44, 95% confidence interval 1.08–1.91, P < .01) was associated with leak.Conclusion
Considerable variability exists in technique among surgeons nationally, but patient characteristics are more predictive of adverse outcomes after laparoscopic sleeve gastrectomy. Bundled payments and reimbursement policies should account for patient-specific factors in addition to current accreditation and volume thresholds when deciding risk-adjustment strategies. 相似文献14.
Objective
This study evaluated the safety and efficacy of Stilamin (Somatostatin) in the treatment of lymphatic leaks after living-related renal transplanatation.Methods
Twenty-four patients with lymphatic leaks after kidney transplantation were recruited. All patients were treated with Stilamin and the drainage recorded.Results
The incidence of lymphatic leaks after kidney transplantation was 3.5% usually occurring in 3–9 days after operation. Stilamin decreased the drainage dramatically and shortened the time of wound healing. In most cases, lymphatic fluid outflow was reduced by 50% after 1 day of stilamin treatment. No major adverse reactions were found except temporary hyperglycemia.Conclusions
Stilamin administration is a safe and effective treatment for lymphorrhea after kidney transplanation. 相似文献15.
Sara E. Martin del Campo Dean J. Mikami Bradley J. Needleman Sabrena F. Noria 《Surgery for obesity and related diseases》2018,14(4):453-461
Background
Laparoscopic sleeve gastrectomy (SG) has risen in prevalence as a standalone surgical option for treating obesity over the last 15 years. One of the most worrisome complications is development of a leak at the gastrectomy staple line.Objective
The objective of this report is to describe our single-institution experience in managing SG staple-line leaks with fully covered endoscopic stents.Setting
Academic medical center, United States.Methods
Data for all patients who underwent endoscopic stent placement for an SG leak between 2010 and 2016 at a single academic institution were retrospectively reviewed. Patient medical history, perioperative information, stent placement details, outcomes, and subsequent interventions were recorded.Results
Twenty-four patients with SG staple-line leaks treated with fully covered endoscopic stents were identified. Leaks were identified at a median of 31.5 days postoperatively (range, 1–1615 d). The majority of patients underwent other treatment(s) for their leak before stent placement at our institution. Stents remained in place for an average of 28.8 ± 16.8 days. Migration occurred in 22% of all stent placements. Three patients were lost to follow-up, and 14 of the remaining 21 patients (66.7%) healed after stent placement. Five patients (23.8%) ultimately required operative revision with partial gastrectomy and Roux-en-Y esophagojejunostomy for management of persistent leaks.Conclusion
Endoscopic management using fully covered stents for staple-line leaks after SG is effective in the majority of patients. However, algorithms are needed for the management of chronic staple-line leaks, which are less likely to heal with stent placement. 相似文献16.
Mark Ellebæk Niels QvistClaus Fristrup M.D. Ph.D. Michael B. Mortensen M.D. Ph.D. D.M.Sc. 《American journal of surgery》2014
Background
Anastomotic leakage (AL) after gastroesophageal resection for cancer is a serious complication. The aim was to evaluate mediastinal microdialysis in the detection of AL before clinical symptoms.Methods
Sixty patients were included. Samples were collected every 4 hours in the 1st 8 postoperative days and analyzed for several metabolites.Results
Forty-four patients had an uncomplicated postoperative recovery, 7 developed anastomotic-related complications, and 5 developed major nonanastomotic-related complications. Six patients were excluded (early catheter malfunction and reoperation). Logistic regression model on several metabolites demonstrated a 100% sensitivity, specificity, and positive and negative predictive values regarding the diagnosis of anastomotic complications within postoperative day 7. However, as independent markers, none of the measured metabolites were able to predict AL.Conclusion
The diagnosis of anastomotic-related complications before clinical symptoms seemed possible by mediastinal microdialysis, but the diagnosis should be based on an interpretation of several metabolic events. 相似文献17.
Gwen L. Bonner Andrew J. Nagy Daniel C. Jupiter Joaquin A. Rodriguez Richard E. Symmonds Jr. Robert O. Carpenter 《American journal of surgery》2014,208(6):897-902
Background
Bariatric surgery reduces the prevalence of diabetes and improves lipid profiles. Low-density lipoprotein particle (LDL-P) is a more accurate predictor of cardiovascular events than high-density lipoprotein (HDL) and LDL cholesterol. The effects of bariatric procedures on LDL-P have not been previously reported.Methods
Two hundred thirty patients undergoing bariatric surgery, including gastric bypass, sleeve gastrectomy, and laparoscopic adjustable gastric band placement at a single institution were included. HDL, LDL, hemoglobin A1c, and LDL-P were measured preoperatively and at 3, 6, and 12 months postoperatively. Weight was recorded at baseline and after 1 year.Results
There was a decrease in serum LDL-P levels, averaging 472.58 (P < .0001) over 1 year. HDL levels increased. Hemoglobin A1c and LDL levels declined. On average, patients lost 58% of excess weight.Conclusion
LDL-P significantly decreased after bariatric surgery in relation to weight loss. It may be inferred that bariatric surgery decreases the risk of cardiovascular events. 相似文献18.
Attila CSENDES J. Andrea MU?OZ Ch. Ana María BURGOS L. 《Brazilian archives of digestive surgery》2014,27(4):234-236
Background
The complete blood count (CBC) and C-reactive protein (CRP) are useful inflammatory parameters for ruling out acute postoperative inflammatory complications.Aim
To determine their changes in gastric cancer patients submitted to total gastrectomy.Methods
This is a prospective study, with 36 patients with gastric cancer who were submitted to elective total gastrectomy. On the first, third and fifth postoperative day (POD), blood count and CRP changes were assessed. Patients with postoperative complications were excluded.Results
Twenty-one (58%) were men and 15 (42%) women. The mean age was 65 years. The leukocytes peaked on the 1st POD with a mean of 13,826 u/mm³, and decreased to 8,266 u/mm³ by the 5th POD. The bacilliforms peaked on the 1st POD with a maximum value of 1.48%. CRP reached its maximum level on the 3rd POD with a mean of 144.64 mg/l±44.84. Preoperative hematocrit (HCT) was 35% and 33.67% by the 5th POD. Hemoglobin, showed similar values.Conclusions
Leukocytes increased during the 1st POD but reached normal values by the 5th POD. CRP peaked on the 3rd POD but did not reach normal values by the 5th POD. 相似文献19.
Joel R. Brockmeyer Brandon T. Grover Kara J. Kallies Shanu N. Kothari 《American journal of surgery》2015,210(6):1010-1017
Background
Biliary disease requiring intervention can be complicated in the postbariatric surgery patient.Methods
A retrospective review was completed to identify patients who underwent laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy from September 2001 to September 2014, and those who underwent biliary intervention were identified.Results
A total of 1527 patients underwent bariatric surgery during the study period. Of the 1,112 patients without prior cholecystectomy, 91 (8%) had biliary symptoms requiring intervention. Ninety patients underwent cholecystectomy, with 86 successfully completed laparoscopically. Six patients required laparoscopy-assisted percutaneous transgastric endoscopic retrograde cholangiopancreatography along with cholecystectomy to clear gallstones from the common bile duct. Three patients who had undergone cholecystectomy before bariatric surgery developed primary common bile duct stones.Conclusions
Surgery for biliary disease after bariatric surgery can be completed successfully with minimal complications, and percutaneous transgastric endoscopic retrograde cholangiopancreatography has a high success rate of access to and clearance of the biliary tree. 相似文献20.