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1.
Fuks D Dumont F Berna P Verhaeghe P Sinna R Sabbagh C Demuynck F Yzet T Delcenserie R Bartoli E Regimbeau JM 《Obesity surgery》2009,19(2):261-264
Laparoscopic sleeve gastrectomy (LSG) is a new restrictive bariatric procedure increasingly indicated in the treatment of
morbid obesity. Postoperative complications are mainly represented by gastric fistula with an occurrence rate of 0% to 5.1%
in the literature. This complication is difficult to manage and requires multiple radiological, endoscopic, and surgical procedures.
We report herein the case of a 23-year-old woman who underwent LSG for morbid obesity. This patient was reoperated for peritonitis
due to a gastric fistula located on the top of the staple line. Five months later, she complained of a cough with fever and
expectoration. A methylene blue test and a computed tomography scan diagnosed a postoperative bronchogastric fistula. After
failure of aggressive conservative management, radical surgery was performed with total gastrectomy, reconstruction of the
diaphragm using the extended latissimus dorsi flap, and a pulmonary lobectomy. This case report highlights the possible issue
of the complex management of gastric fistula after LSG. 相似文献
2.
Jagat Pal Singh Om Tantia Tamonas Chaudhuri Shashi Khanna Prateek H. Patil 《Obesity surgery》2014,24(10):1656-1661
Background
Laparoscopic sleeve gastrectomy (LSG) was initially performed as the first stage of biliopancreatic diversion with duodenal switch for the treatment of super-obese or high-risk obese patients but is now most commonly performed as a standalone operation. The aim of this prospective study was to investigate outcomes after LSG according to resected stomach volume.Methods
Between May 2011 and April 2013, LSG was performed in 102 consecutive patients undergoing bariatric surgery. Two patients were excluded, and data from the remaining 100 patients were analyzed in this study. Patients were divided into three groups according to the following resected stomach volume: 700–1,200 mL (group A, n?=?21), 1,200–1,700 mL (group B, n?=?62), and >1,700 mL (group C, n?=?17). Mean values were compared among the groups by analysis of variance.Results
The mean percentage excess body weight loss (%EBWL) at 3, 6, 12, and 24 months after surgery was 37.68?±?10.97, 50.97?±?13.59, 62.35?±?11.31, and 67.59?±?9.02 %, respectively. There were no significant differences in mean %EBWL among the three groups. Resected stomach volume was greater in patients with higher preoperative body mass index and was positively associated with resected stomach weight.Conclusions
Mean %EBWL after LSG was not significantly different among three groups of patients divided according to resected stomach volume. Resected stomach volume was significantly greater in patients with higher preoperative body mass index. 相似文献3.
Asaad Salama Tamer Saafan Walid El Ansari Mohsen Karam Moataz Bashah 《Obesity surgery》2018,28(1):52-60
Background
Controversy exists as to whether routine preoperative esophagogastroduodenoscopy (p-OGD) in bariatric surgery should be routinely undertaken or undertaken selectively based on patients’ symptoms. As very few studies have focused on the role of p-OGD prior to the increasingly common laparoscopic sleeve gastrectomy (LSG), we assessed the role/impact of p-OGD in LSG patients.Methods
Retrospective review of records of all LSG patients operated upon at Hamad General Hospital, Qatar (2011–2014, n = 1555). All patients were screened by p-OGD. Patient characteristics were analyzed, and p-OGD findings were categorized into four groups employing Sharaf et al.’s classification (Obes Surg 14:1367–1372, 23). We assessed the impact of p-OGD findings on any change in surgical management or lack thereof.Results
p-OGD findings indicated that 89.5% of our patients had normal or mild findings and were asymptomatic (groups 0 and 1, not necessitating any change in surgical management), and no patients had gastric cancer or varices (group 3). A total of 10.5% of our sample were categorized as group 2 patients who, according to Sharaf et al. (Obes Surg 14:1367–1372, 23), might have their surgical approach changed. All patients diagnosed preoperatively with hiatal hernia (HH) had LSG with crural repair and their symptoms resolved postoperatively.Conclusion
Due to effectiveness and best utilization of resources, routine p-OGD screening in patients scheduled for LSG may require further justification for asymptomatic patients especially in regions with low upper GI cancers. p-OGD findings had low impact on the management of asymptomatic patients. Crural repair plus LSG was effective for hiatal hernia.4.
Background
This is a prospective pilot study done to evaluate the feasibility and to assess the outcomes and complication rates of the single-incision sleeve gastrectomy versus the conventional five-port laparoscopic sleeve gastrectomy. 相似文献5.
Monica Sethi Karan Patel Jonathan Zagzag Manish Parikh John Saunders Aku Ude-Welcome Eduardo Somoza Bradley Schwack Marina Kurian George Fielding Christine Ren-Fielding 《Journal of gastrointestinal surgery》2016,20(2):244-252
Background
Thirty-day readmission post-bariatric surgery is used as a metric for surgical quality and patient care. We sought to examine factors driving 30-day readmissions after laparoscopic sleeve gastrectomy (LSG).Methods
We reviewed 1257 LSG performed between March 2012 and June 2014. Readmitted and nonreadmitted patients were compared in their demographics, medical histories, and index hospitalizations. Multivariable regression was used to identify risk factors for readmission.Results
Forty-five (3.6 %) patients required 30-day readmissions. Forty-seven percent were readmitted with malaise (emesis, dehydration, abdominal pain) and 42 % with technical complications (leak, bleed, mesenteric vein thrombosis). Factors independently associated with 30-day readmission include index admission length of stay (LOS) ≥3 days (OR 2.54, CI?=?[1.19, 5.40]), intraoperative drain placement (OR 3.11, CI?=?[1.58, 6.13]), postoperative complications (OR 8.21, CI?=?[2.33, 28.97]), and pain at discharge (OR?8.49, CI?=?[2.37, 30.44]). Patients requiring 30-day readmissions were 72 times more likely to have additional readmissions by 6 months (OR?72.4, CI?=?[15.8, 330.5]).Conclusions
The 30-day readmission rate after LSG is 3.6 %, with near equal contributions from malaise and technical complications. LOS, postoperative complications, drain placement, and pain score can aid in identifying patients at increased risk for 30-day readmissions. Patients should be educated on postoperative hydration and pain management, so readmissions can be limited to technical complications requiring acute inpatient management.6.
Pequignot A Fuks D Verhaeghe P Dhahri A Brehant O Bartoli E Delcenserie R Yzet T Regimbeau JM 《Obesity surgery》2012,22(5):712-720
Laparoscopic sleeve gastrectomy (LSG) has a specific morbidity profile in which gastric leak (GL) is the main complication.
With a view to defining a standardized protocol for GL management, the present retrospective study sought to describe the
clinical patterns of post-LSG GL and treatment of the latter in our university medical center. From July 2004 to December
2010, 25 patients were included. GL was described in terms of clinical presentation, time to onset, and location in the staple
line. Treatment of GL with pharmacologic, radiologic, endoscopic, and/or surgical procedures was always validated by a multidisciplinary
care team. “Treatment success” was defined as the absence of contrast agent leakage on CT and endoscopy after removal of covered
metallic stent or pigtail drains. Systemic inflammation and peritonitis were the main signs for early-onset GL (56%), whereas
pulmonary symptoms and intra-abdominal abscesses revealed delayed-onset GL (44%). Surgery was always performed for early-onset
GL. In the total study population, the median number of endoscopic procedures was five (range, 1–11) per patient, of covered
SEMS was three (range, 1–8), and of pigtail drains was three (range, 1–4). Nine (36%) patients presented endoscopic-related
complications. Four (16%) patients with treatment failure underwent radical surgery. The mortality rate was 4% (n=1). The management of post-LSG GL is challenging. Surgery was always performed for early-onset GL, whereas treatment of delayed-onset
GL was based on endoscopy. Pigtail drains required fewer procedures per patient, were better tolerated, and had lower morbidity–mortality
than covered SEMS. 相似文献
7.
Piotr K. Kowalewski Robert Olszewski Maciej S. Walędziak Michał R. Janik Andrzej Kwiatkowski Natalia Gałązka-Świderek Krzysztof Cichoń Jakub Brągoszewski Krzysztof Paśnik 《Obesity surgery》2018,28(1):130-134
Introduction
Sleeve gastrectomy (LSG) is one of the most popular bariatric procedures. We present our long-term results regarding weight loss, comorbidities, and gastric reflux disease.Material and Methods
We identified patients who underwent LSG in our institution between 2006 and 2009. We revised the data, and the patients with outdated contact details were tracked with the national health insurance database and social media (facebook). Each of the identified patients was asked to complete an online or telephone survey covering, among others, their weight and comorbidities. On that basis, we calculated the percent total weight loss (%TWL) and percent excess weight loss (%EWL), along with changes in body mass index (ΔBMI). Satisfactory weight loss was set at >50% EWL (for BMI = 25 kg/m2). We evaluated type 2 diabetes (T2DM) and arterial hypertension (AHT) based on the pharmacological therapy. GERD presence was evaluated by the typical symptoms and/or proton pump inhibitor (PPI) therapy.Results
One hundred twenty-seven patients underwent LSG between 2006 and 2009. One hundred twenty patients were qualified for this study. Follow-up data was available for 100 participants (47 female, 53 male). Median follow-up period reached 8.0 years (from 7.1 to 10.7). Median BMI upon qualification for LSG was 51.6 kg/m2. Sixteen percent of patients required revisional surgery over the years (RS group), mainly because of insufficient weight loss (14 Roux-Y gastric bypass—LRYGB; one mini gastric bypass, one gastric banding). For the LSG (LSG group n = 84), the mean %EWL was 51.1% (±22.3), median %TWL was 23.5% (IQR 17.7–33.3%), and median ΔBMI was 12.1 kg/m2 (IQR 8.2–17.2). Fifty percent (n = 42) of patients achieved the satisfactory %EWL of 50%. For RS group, the mean %EWL was 57.8% (±18.2%) and median %TWL reached 33% (IQR 27.7–37.9%). Sixty-two percent (n = 10) achieved the satisfactory weight loss. Fifty-nine percent of patients reported improvement in AHT therapy, 58% in T2DM. After LSG, 60% (n = 60) of patients reported recurring GERD symptoms and 44% were treated with proton pomp inhibitors (PPI). In 93% of these cases, GERD has developed de novo.Conclusions
Isolated LSG provides fairly good effects in a long-term follow-up with mean %EWL at 51.1%. Sixteen percent of patients require additional surgery due to insufficient weight loss. More than half of the subjects observe improvement in AHT and T2DM. Over half of the patients complain of GERD symptoms, which in most of the cases is a de novo complaint.8.
Baumann T Kuesters S Grueneberger J Marjanovic G Zimmermann L Schaefer AO Hopt UT Langer M Karcz WK 《Obesity surgery》2011,21(1):95-101
Background
Laparoscopic sleeve gastrectomy (LSG) is generally considered a restrictive procedure. However, studies with nuclear medicine techniques have demonstrated that gastric motility changes occur following LSG. These motility changes could represent complementary mechanisms of weight loss. Therefore, we analyzed the stomach motility before and after LSG by means of dynamic MRI. 相似文献9.
Fabio Pomerri Mirto Foletto Giorgia Allegro Paolo Bernante Luca Prevedello Pier Carlo Muzzio 《Obesity surgery》2011,21(7):858-863
Background
Laparoscopic sleeve gastrectomy (LSG) is now considered an effective bariatric procedure (American Society for Metabolic and Bariatric Surgery statement). We attempted to assess the size of the gastric fundus remaining after LSG and gastric voiding rate (fast/slow) by radiological upper gastrointestinal series (UGS) with a water-soluble contrast medium (CM). The findings were compared with weight loss data.Methods
Seventy-four obese patients underwent LSG. Radiological UGS were used to measure the remaining fundus size in 28 of 74 patients 24?C72 h after the procedure, with the aid of Matlab software and a library image processing toolbox (MathWorks®). Sleeve voiding was measured in 57 of 74 patients, based on the patients?? radiological reports.Results
The mean volume of the remaining fundus was 17.56 ml (range 1.00?C77.03 ml). The mean percent excess BMI loss (%EBL) was 39.5%, 53.7%, and 60.8%, respectively, 3, 6, and 12 months after LSG. Sleeve voiding was fast in 49 of 57 patients (85.96%) and slow in eight (14.03%).Conclusions
No correlation was found between the estimated volume of the remaining gastric fundus and weight loss (%EBL) after LSG. Patients showing a rapid gastroduodenal transit of the CM achieved a better weight loss than patients with a slow voiding rate. 相似文献10.
Background Although the efficacy of laparoscopic sleeve gastrectomy (LSG) for morbidly obese patients with a BMI of < 50 kg/m2, the incidence of weight gain by change of eating behaviors, and gastric dilatation following LSG have not been investigated
thus far, LSG is becoming more common as a single-stage operation for the treatment morbid obesity.
Methods This is a prospective study of the initial 120 patients who underwent isolated LSG. Initially, the LSG was performed without
a calibration tube and resulted in high sleeve volumes (group 1: n = 25). In group 2 (n = 32), a calibration tube of 44 Fr
and in group 3 (n = 63) a calibration tube of 32 Fr were used. The study group consists of 101 patients with high BMI who
were scheduled for a two-step LBPD-DS, but rejected the second step after 1 year. Study endpoints include estimated sleeve
volume, volume of removed stomach, operative time, complication rates, length of hospital stay, changes in co-morbidity, percentage
of excess BMI loss (%EBL) and changes in BMI (kg/m2).
Results All 3 groups were comparable regarding age, gender, and co-morbidities. There was no hospital mortality, but there was one
case of late mortality (0.8%). 2 early leaks (1.7%) were seen. % excess BMI loss was significantly higher for patients who
underwent LSG with tube calibrations. LSG with large sleeve volume showed a slight weight gain during 5 years of observation.
A total of 16 patients (13.3%) underwent a second stage procedure within a period of 5 years (2 redo-sleeves, 7 LBPD-DS, 3
LRYGBP).
Conclusion Early weight loss results were not different between the groups, but after 2 years the more restrictive LSG (groups 2, 3)
results were significantly better than in patients without calibration. A removed gastric volume of < 500 cc seems to be a
predictor of failure in treatment or early weight regain. A statistically significant improved health status and quality of
life were registered for all groups. The general introduction of LSG as a one-stage restrictive procedure in the bariatric
field can be considered only if the procedure is standardized and long-term results are available. 相似文献
11.
12.
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is currently gaining ground as a new option for the treatment of morbid obesity. The main advantages of this procedure are less postoperative food restrictions, no vomiting, and absence of late complications due to the lack of foreign implants. The aim of this study is to present our experience with this new bariatric technique. METHODS: Ninety three obese patients (65 females and 28 males) who underwent LSG between September 2005 and September 2007 were studied in terms of postoperative complications and weight loss. RESULTS: Mean age was 38.37 +/- 10.81 years (range 19-69) and mean preoperative weight and body mass index (BMI) were 139.12 +/- 24.03 kg (range 100-210) and 46.86 +/- 6.48 kg/m(2) (range 37-66), respectively. Mean follow-up was 12.51 +/- 4.15 months (range 3-24). There were no mortalities, but there were four major and four minor postoperative complications. The mean postoperative excess weight loss (EWL) was 58.32 +/- 16.54%, while mean BMI dropped to 32.98 +/- 6.54 kg/m(2). Mean EWL 3, 6, 12, and 24 months after the operation was 31%, 53%, 67%, and 72%, respectively. Superobese patients (BMI > 50 kg/m(2)) lost less weight. CONCLUSION: In the short term, LSG is a safe and highly effective bariatric operation more suitable for intermediate morbidly obese patients with BMI between 40 and 50 kg/m(2). 相似文献
13.
Ahmad NZ 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2011,15(1):65-69
Background and Objectives:
Liver function tests (LFTs) include alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), and bilirubin. The role of routine testing before and after laparoscopic cholecystectomy was evaluated in this study.Patients and Methods:
A total of 355 patients were retrospectively analyzed by examining the LFTs the day before, the day after, and 3 weeks after the surgery. The Wilcoxon signed-rank test and Student t test were performed to determine statistical significance.Results:
Alterations in the serum AST, ALT, and GGT were seen on the first postoperative day. Minor changes were seen in bilirubin and ALP. An overall disturbance in the LFTs was seen in more than two-thirds of the cases. Repeat LFTs performed after 3 weeks on follow-up were found to be within normal limits.Conclusion:
Mild-to-moderate elevation in preoperative LFTs may not be associated with any deleterious effect, and, in the absence of clinical indications, routine preoperative or postoperative liver function testing is unnecessary. 相似文献14.
Laparoscopic Vertical Sleeve Gastrectomy for Morbid Obesity. The Future Procedure of Choice? 总被引:5,自引:0,他引:5
Frezza EE 《Surgery today》2007,37(4):275-281
I report the general experience of performing sleeve gastrectomy defined as “a partial gastrectomy that results in removal
of most of the stomach,” as a first-stage procedure for morbidly and super-obese people. I also explore its potential as a
single procedure evaluating its advantages and disadvantages. This procedure is designed to reduce the size of the stomach
and its distention, whereby the patient feels full sooner and their appetite is decreased. Some posit-increased satiety results
from the decreased ghrelin, secreted by the fundus, which is resected during this procedure. The advantages of sleeve gastrectomy
are as follows: the stomach is reduced without loss of function, pyloric preservation prevents dumping, it requires only 1
day in the hospital, it provides an effective first-stage procedure for super-obese patients, it is useful in patients with
disorders such as anemia or Crohn's disease, which preclude intestinal bypass, it can be performed laparoscopically, even
in patients who weigh over 500 lbs, no band adjustment is required, it does not result in malabsorption, and it provides a
good educational teaching base for doctors lacking experience in the treatment of gastric ulcers. The disadvantages include
the risk of stapling complications and its irreversibility. 相似文献
15.
Aliaa Al-Mutawa Salman Al-Sabah Alfred Kojo Anderson Mohammad Al-Mutawa 《Obesity surgery》2018,28(6):1473-1483
Introduction
Obesity is considered a public health problem and has led to advancements in bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) had become the most performed procedure worldwide; however, its consequences on nutritional status in the short and long term are of concern.Methods
A retrospective analysis of medical records and bariatric database of patients who underwent LSG from October 2008–September 2015 at Al-Amiri Hospital, Kuwait, was performed. Data regarding nutritional status along with demographic data were collected over a 5-year follow-up period.Results
One thousand seven hundred ninety-three patients comprising of 74% females and 26% males were included. The greatest % total body weight loss (%TBWL) was at 18 months post-LSG (33%), corresponding to a % excess weight loss (%EWL) of 73.8%. With regard to nutritional status, vitamin B1 showed a significant drop at 3–5 years post-op in comparison to pre-op value, but stayed within the normal range throughout the study. Red blood cells count, hemoglobin, and hematocrit also showed a significant drop starting from 6 months post-op until the fifth year of follow-up. On the other hand, vitamins B6 and B12 showed a significant increase at 6 months post-op and decreased afterwards, but did not reach pre-op values. Vitamin D also showed a significant increase throughout the study period from deficient value at the pre-op time, but remained insufficient. Albumin, transferrin, folate, ferritin, iron, and vitamin B2 showed no significant changes at 5 years post-LSG compared to pre-op values.Conclusion
Little is known about the nutritional status and optimal nutritional care plan post-LSG, especially in the longer term. Nutritional deficiencies were prevalent prior and post-LSG. Some of the nutritional parameters improved and even reached the abnormal high level post-LSG. These observations highlight the importance of pre- and post-operative nutritional assessment and tailored supplementation to ensure optimal nutritional status.16.
Aleksey A. Novikov Cheguevara Afaneh Monica Saumoy Viviana Parra Alpana Shukla Gregory F. Dakin Alfons Pomp Enad Dawod Shawn Shah Louis J. Aronne Reem Z. Sharaiha 《Journal of gastrointestinal surgery》2018,22(2):267-273
Background
Endoscopic sleeve gastroplasty (ESG) is a novel endobariatric procedure. Initial studies demonstrated an association of ESG with weight loss and improvement of obesity-related comorbidities. Our aim was to compare ESG to laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB).Methods
We included 278 obese (BMI > 30) patients who underwent ESG (n = 91), LSG (n = 120), or LAGB (n = 67) at our tertiary care academic center. Primary outcome was percent total body weight loss (%TBWL) at 3, 6, 9, and 12 months. Secondary outcome measures included adverse events (AE), length of stay (LOS), and readmission rate.Results
At 12-month follow-up, LSG achieved the greatest %TBWL compared to LAGB and ESG (29.28 vs 13.30 vs 17.57%, respectively; p < 0.001). However, ESG had a significantly lower rate of morbidity when compared to LSG or LAGB (p = 0.01). The LOS was significantly less for ESG compared to LSG or LAGB (0.34 ± 0.73 vs 3.09 ± 1.47 vs 1.66 ± 3.07 days, respectively; p < 0.01). Readmission rates were not significantly different between the groups (p = 0.72).Conclusion
Although LSG is the most effective option for weight loss, ESG is a safe and feasible endobariatric option associated with low morbidity and short LOS in select patients.17.
Ido Mizrahi Abbas Alkurd Muhammad Ghanem Diaa Zugayar Haggi Mazeh Ahmed Eid Nahum Beglaibter Ronit Grinbaum 《Obesity surgery》2014,24(6):855-860
Background
Morbidity and mortality following laparoscopic sleeve gastrectomy (LSG) occur at acceptable rates, but its safety and efficacy in the elderly are unknown.Methods
A retrospective review was performed of all patients aged >60 years who underwent LSG from 2008 to 2012. These patients were 1:2 matched, by gender and body mass index (BMI) to young patients, 18?<?age?<?50. Data analyzed included demographics, preoperative and postoperative BMI, postoperative complications, and improvement or resolution of obesity-related comorbidities.Results
Fifty-two morbid obese patients older than 60 years underwent LSG (mean age, 62.9?±?0.3 years). These were matched to 104 young patients, age 18–50 years (mean age, 35.7?±?0.8 years). Groups did not differ in male gender (44 vs. 43 %, p?=?0.9), preoperative BMI (42.6?±?0.7 vs. 42.6?±?0.6, p?=?0.97), and length of follow-up (17?±?2 vs. 22?±?1.4 months, p?=?0.06). Obesity-related comorbidities were significantly higher in the older group (96 vs. 65 %, p?<?0.001). Excess weight loss (EWL) was higher in the younger group (75?±?2.4 vs. 62?±?3 %, p?=?0.001). Older patients had a significantly higher rate of a concurrent hiatal hernia repair (23 vs. 1.9 %, p?<?0.001). Overall postoperative minor complication rate was higher in the older group (25 vs. 4.8 %, p?<?0.001). This included atrial fibrillation (9.5 %), urinary tract infection (7 %), trocar site hernia (4 %), dysphagia, surgical site infection, bleeding, bowel obstruction, colitis, and nutritional deficiency (2 %, each). No perioperative mortality occurred. Comorbidity resolution or improvement was comparable between groups (88 vs. 80 %, p?=?0.13).Conclusions
LSG is safe and very efficient in patients aged >60, despite higher rates of perioperative comorbidities. 相似文献18.
Villegas L Schneider B Provost D Chang C Scott D Sims T Hill L Hynan L Jones D 《Obesity surgery》2004,14(1):60-66
Background: Routine cholecystectomy is often performed at the time of gastric bypass for morbid obesity.The aim of this study
was to determine the incidence of gallstone formation requiring cholecystectomy following a laparoscopic Roux-en-Y gastric
bypass (LRYGBP). Methods: 289 LRYGBP were performed between November 1999 and May 2002. 60 patients (21%) who had prior cholecystectomy
were excluded. If gallstones were identified by intra-operative ultrasound (IOUS), simultaneous cholecystectomy was performed.
Patients without gallstones were prescribed ursodiol for 6 months and scheduled for follow-up with transabdominal ultrasound.
Results: During LRYGBP, gallstones were detected in 40 patients using IOUS (14%) and simultaneous cholecystectomy was performed.
Of 189 patients with no stones identified by IOUS, 151 patients (80%) had a postoperative ultrasound after 6 months. 33 patients
developed gallstones (22%) and 12 developed sludge (8%) as demonstrated by ultrasound at the time of follow-up. 11 patients
had gallstone-related symptoms and subsequently underwent cholecystectomy (7%). 106 patients (70%) were gallstone-free at
the time of ultrasound follow-up. Ursodiol compliance was found to be significantly lower for patients who developed stones
than for gallstone-free patients (38.9% vs 58.3%, z =-2.00, P = 0.045). Conclusions: There is a low incidence of symptomatic gallstones requiring cholecystectomy after LRYGBP. Prophylactic
ursodiol is protective. Routine IOUS and selective cholecystectomy with close patient follow-up is a rational approach in
the era of laparoscopy. 相似文献
19.
Villegas L Schneider B Provost D Chang C Scott D Sims T Hill L Hynan L Jones D 《Obesity surgery》2004,14(2):206-211
Background: Routine cholecystectomy is often performed at the time of gastric bypass for morbid obesity. The aim of our study
was to determine the incidence of gallstone formation requiring cholecystectomy following a laparoscopic Roux-en-Y gastric
bypass (LRYGBP). Methods: 289 LRYGBP were performed between November 1999 and May 2002. 60 patients (21%) who had prior cholecystectomy
were excluded. If gallstones were identified by intra-operative ultrasound (IOUS), simultaneous cholecystectomy was performed.
Patients without gallstones were prescribed ursodiol for 6 months and scheduled for follow-up with transabdominal ultrasound.
Results: During LRYGBP, gallstones were detected in 40 patients using IOUS (14%) and simultaneous cholecystectomy was performed.
Of 189 patients with no stones identified by IOUS, 151 patients (80%) had a postoperative ultrasound after 6 months. 39 patients
developed gallstones (22%) and 12 developed sludge (8%), as demonstrated by ultrasound at the time of follow-up. 11 patients
had gallstone-related symptoms and subsequently underwent cholecystectomy (7%). 106 patients (70%) were gallstone-free at
the time of ultrasound follow-up. Ursodiol compliance was found to be significantly lower for patients developing stones than
for gallstone-free patients (38.9% vs 58.3%, z =-2.00, P = 0.045). Conclusions: There is a low incidence of symptomatic gallstones requiring cholecystectomy after LRYGBP. Prophylactic
ursodiol is protective. Routine IOUS and selective cholecystectomy with close patient follow-up is a rational approach in
the era of laparoscopy. 相似文献
20.
Jose Luis Leyba Salvador Navarrete Llopis Salvador Navarrete Aulestia 《Obesity surgery》2014,24(12):2094-2098