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1.
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
2.
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
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.
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
5.
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
6.
Our group has performed the Roux-en-Y gastric bypass (RYGB) in 1450 patients since 1983: 805 patients had primary operations,
and 645 were converted from previous gastroplasty procedures, i.e. horizontal gastroplasty, vertical banded gastroplasty,
and gastrogastrostomy. Within the last 2 years, 38 patients who failed the RYGB were converted to a modified biliopancreatic
diversion (BPD) using a technique that did not require dismantling a major portion of the original gastric exclusion. A 24-month
follow-up has demonstrated a significant and sustained weight loss in all patients. In addition, the modified BPD completely
eliminated the problem of reflux bile gastritis in those patients with a short Roux-en-Y jejunal limb. 相似文献
7.
A case is reported of a patient after long-limb Roux-en-Y gastric bypass who presented with a volvulus of the Roux limb. This is the first report of this complication in the literature. 相似文献
8.
Roux-en-Y Gastric Bypass: An Effective Antireflux Procedure in the Less Than Morbidly Obese 总被引:3,自引:1,他引:2
Background: Since Roux-en-Y gastric bypass (RYGBP) is an excellent antireflux procedure, why is it necessary to do it only
for those who are morbidly obese: why not anyone who has had a longstanding severe weight problem with chronic disabling reflux
esophagitis? Methods: RYGBP was done primarily as an antireflux procedure in 332 patients late from 1987 through October 1996.
Eighty-nine were less than 100 lb (45 kg) overweight. Forty-five were lost to follow-up. All but one had Visick ratings from
2 to 4 preoperatively. Thirty-one were primary RYGBP and 13 were conversions from previous gastroplasties. The diagnosis in
each case was made by esophagogastroscopy with esophageal biopsy with or without the Bernstein test when indicated. Results:
Postoperatively, only one patient was symptomatic. The remaining had Visick ratings of 1. The average preoperative weight
of 192 lb (87 kg) dropped to 145 lb (66 kg) postoperatively, or 67% of excess weight loss at a mean of 56 months. Compared
to the morbidly obese group, there was no significant difference in 1-year postoperative laboratory values. Conclusion: This
study supports the efficacy and safety of RYGBP for reflux esophagitis in the less than morbidly obese patient. Esophagitis
is truly a comorbid condition of severe obesity, and it should be accepted as such. The arbitrary elimination from the consideration
of candidacy for this procedure by those with a body mass index of less than 35 kg/m2 and unproven comorbidity appears unjustified. 相似文献
9.
10.
Background Vertical banded gastroplasty (VBG) is a widely used restrictive procedure in bariatric surgery. However, the re-operation
rate after this operation is high. In the case of VBG failure, a conversion to Rouxen-Y gastric bypass (RYGBP) is an option.
A study was undertaken to evaluate the results of the conversion from VBG to RYGBP.
Methods 101 patients had conversion from VBG to RYGBP. Patients were separated into 3 groups, based on the indication for conversion:
weight regain (group 1), excessive weight loss (group 2) and severe eating difficulties (group 3). Data for the study were
collected by retrospective analysis of prospectively recorded data.
Results Weight regain (group 1) was the reason for conversion in 73.3% of patients. Staple-line disruption was the most important
cause for the weight regain (74.3%). Excessive weight loss (group 2) affected 14% of patients and was caused by outlet stenosis
in 78.6% of patients. The remaining 13% had severe eating difficulties as a result of outlet stenosis (46.1%), pouch dilatation
(30.8%) and pouch diverticula (23.1%). Mean BMI before conversion to RYGBP was 40.5, 22.3 and 29.8 kg/m2 in group 1, 2 and
3, respectively. Minor or major direct postoperative complications were observed in 2.0% to 7.0%. Long-term complications
were more frequent, and consisted mainly of anastomotic stenosis (22.7%) and incisional hernia (16.8%). Follow-up after conversion
was achieved in all patients (100%), with a mean period of 38 ± 29 months. BMI decreased from 40.5 to 30.1 kg/m2, increased
from 22.3 to 25.3 kg/m2. and decreased slightly from 29.8 to 29.0 kg/m2 in group 1, 2 and 3, respectively. All patients in
group 3 noticed an improvement in eating difficulties.
Conclusion Complications after conversion from failed VBG to RYGBP are substantial and need to be considered. However, the conversion
itself is a successful operation in terms of effect on body weight and treating eating difficulties after VBG. 相似文献
11.
Cottam DR Fisher B Atkinson J Link D Volk P Friesen C Link D Grace B Trovar R 《Obesity surgery》2007,17(5):595-600
Background The use of a bupivicaine pain pump has previously been reported to lower costs to hospitals, while providing similar pain
relief to opioid-based patient controlled analgesia (PCA) pumps. However, these benefits have not been investigated in laparoscopic
bariatric surgery.
Methods We prospectively randomized 40 laparoscopic Roux-en-Y gastric bypass (LRYGBP) patients into two groups. The first group received
the ON-Q? bupivicaine pain pump placed subxiphoid and radiating in both directions caudally beneath the lowest rib. The second
group was treated with a meperidine PCA, which was initiated in the PACU and discontinued at 06:00 hrs the following morning.
Both groups had identical surgery, anesthesiologists, anesthesia protocol and postoperative nausea prophylaxis.
Results There were no significant differences between the groups with regard to age, sex, pain scores, nausea scores, gas pain scores,
antiemetic use throughout their stay, or opioid use in the PACU. However, there was a dramatic decrease in opioid use between
the two groups over the time interval from leaving the PACU to 06:00 hrs (meperidine by PCA mean 217 mg vs ON-Q? 129 mg meperidine
equivalents, P = 0.008).
Conclusions The use of a bupivicaine pain pump offers the opportunity to dramatically reduce the use of opioids postoperatively in all
bariatric patients by eliminating PCA. This change could potentially reduce the incidence of respiratory failure from oversedation,
while offering the same levels of pain control. 相似文献
12.
Pajecki D Dalcanalle L Souza de Oliveira CP Zilberstein B Halpern A Garrido AB Cecconello I 《Obesity surgery》2007,17(5):601-607
Background Short-term results (24 to 36 months) after Roux-en-Y gastric bypass (RYGBP) have been extensively described. Little is reported
on the patients operated ≥ 5 years ago. We analyzed the results of weight loss, resolution of co-morbidities and nutritional
complications of patients submitted to the silicone ring RYGBP, at least 5 years before.
Methods 75 morbidly obese patients who underwent silicone ring RYGBP between Oct 1995 and Dec 1999, 18 men and 57 women, were studied.
Demographic data, nutritional status and the presence of co-morbidities (type 2 diabetes, hypertension, sleep apnea, dyslipidemia)
were accessed. Pre- and postoperative BMI were registered, along with excess weight loss (EWL). Nutritional deficiencies were
accessed by laboratory assays.
Results Mean follow-up was 87 months. Initial BMI was 56.7 ± 10 kg/m2. After 2 years, BMI had dropped to 29.3 ± 6.8, and by the last interview BMI was 35.5 ± 10. %EWL after 2 years was 80.2 ± 17.3%,
and at the end was 71.8 ± 21.6%. After 2 years, only 1 of the 75 patients (1.33%) had not achieved an EWL of at least 50%.
At the end, 23 patients (30.6%) could not maintain this EWL. Resolution of diabetes was 76.5%, arterial hypertension 37.3%
and sleep apnea 93.5%. Iron, vitamin B12 and vitamin D were the most common nutritional deficiencies.
Conclusions Long-term follow-up (5 to 9 years) after the RYGBP was associated with satisfactory mantainance of EWL, and resolution or
improvement of the main co-morbidities was observed in the majority of the patients. 相似文献
13.
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
14.
15.
Background The prevalence of gastroesophageal reflux disease (GERD) is increasing in Eastern and Western countries. Obesity is recognized
as a risk factor of gastroesophageal reflux disease. However, little information is available on the prevalence of gastroesophageal
reflux disease in morbidly obese Chinese patients. The aim of this study was to compare the prevalence of GERD in Chinese
patients with morbid obesity and age- and sex-matched controls, and we also assessed the effect of Roux-en-Y gastric bypass
on reflux symptoms and erosive esophagitis.
Methods Between November 2006 and February 2008, 150 morbidly obese Chinese patients underwent laparoscopic Roux-en-Y gastric bypass.
Gastroesophageal reflux disease questionnaires and esophagogastroduodenoscopy results were assessed in all cases before surgery.
The prevalence of reflux symptoms and erosive esophagitis was compared with the prevalence in a database of 300 age- and sex-matched
controls. We also compared baseline and postoperative characteristics at 12 months after operation.
Results Patients with morbid obesity had higher frequencies of reflux symptoms (16% vs. 8%, P = 0.01) and erosive esophagitis (34% vs. 17%, P < 0.01) than those of controls. Twelve months after laparoscopic Roux-en-Y gastric bypass, 26 patients received follow-up
evaluations. In addition to substantial weight loss, the prevalence of reflux symptoms and erosive esophagitis decreased significantly
after operation (19.2% vs. 0%, P = 0.05, and 42.3% vs. 3.8%, P < 0.01, respectively).
Conclusions Gastroesophageal reflux disease is pervasive in Chinese patients with morbid obesity and Roux-en-Y gastric bypass substantially
improves not only the reflux symptoms but also the erosive esophagitis. 相似文献
16.
Distal Gastric Bypass/Duodenal Switch Procedure, Roux-en-Y Gastric Bypass and Biliopancreatic Diversion in a Community Practice 总被引:4,自引:0,他引:4
Background: Hybrid procedures combining purely restrictive and purely malabsorptive components to achieve stable long-term
weight reduction have evolved since the 1970s. In a solo surgical community-based practice over the period 1984-1997, three
different hybrid procedures were utilized as primary operations in patients who had not had prior bariatric surgery. Methods:
Restrospective comparison of 32 patients who underwent biliopancreatic diversion (BPD), 138 patients who underwent distal
gastric bypass Roux-en-Y (RGB) and 105 patients undergoing distal gastric bypass/duodenal switch procedure (DS) with 2-4 year
follow-up in 37 DS patients. Results: Height, initial weight and initial body mass index (BMI) were similar in the three groups.
The DS patients were older. Mean BMI at 2 years fell from 49 to 29 kg/m2 in both DS and RGB. Mean percentage maximum preoperative weight lost was 40% in both the DS and RGB groups. Two-year mean
percentage excess weight lost in DS was 78%, compared to 74% in RGB. There were no operative deaths and no ulcers in the DS
group. Conclusion: DS is an important new option for primary treatment of morbid obesity. It can be performed safely, with
up to 4 year follow-up showing stable weight loss. 相似文献
17.
Raman R Raman B Raman P Rossiter S Curet MJ Mindelzun R Morton JM 《Obesity surgery》2007,17(3):311-316
Background The use of postoperative upper GI series (UGIS) after laparoscopic Roux-en-Y gastric bypass (LRYGBP) varies among bariatric
surgeons. The authors describe the findings and impact of UGIS after LRYGBP.
Methods From July 2003 to January 2006, 487 patients undergoing primary LRYGBP at a single academic institution had a single-contrast
Gastrografin? UGIS performed on the first postoperative day, without complication. Patient and operative demographics were:
mean age 43 years, mean BMI 47 kg/m2, female 84%, and laparoscopic 100%.
Results Of the 487 patients, the UGIS revealed 14 (2.9%) major and 88 (15.2%) minor abnormalities. Among the majorUGIS abnormalities, 6 (1.2%) demonstrated a gastrojejunal anastomotic (GJA) leak, 8 (1.4%)
confirmed complete obstruction at the GJA, and 1 (0.2%) disclosed a communication with the bypassed stomach. For the minor
UGIS abnormalities, 45 (9.2%) displayed significant delay in contrast passage through the GJA, 23 (5.0%) had evidence of dilated
loops of small and/or large bowel, and 6 (1.2%) verified miscellaneous abnormal findings (malrotation, lower esophageal dysmotility,
jejunal clots). Patients with UGIS abnormalities necessitated additional procedures, delayed oral intake and/or longer length
of stay (LOS).
Conclusions UGIS on postoperative day 1 is a useful means of evaluating postoperative LRYGBP anatomy and influenced postoperative care.
Presented at the 11th World Congress of the International Federation for the Surgery of Obesity, Sydney, Australia, August
31, 2006. 相似文献
18.
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
19.
Background Internal hernias have been described after laparoscopic Roux-en-Y gastric bypass (LRYGB) as a major problem. Thus, many routinely
close defects during LRYGB. In our technique, we do not close any defects. We hypothesize that not closing the defects would
not cause a significant internal hernia rate diagnosed during reoperations.
Methods Patients who were reoperated after LRYGB were included in this study. Only patients who had a laparoscopic or open exploration
focused on inspecting for internal hernias are reported here. The LRYGB technique that was utilized included an antecolic,
antegastric gastrojejunostomy, minimal division of the small bowel mesentery, a long jejunojejunostomy performed with three
staple lines, adequate division of the omentum, and placement of the jejunojejunostomy above the colon in the left upper quadrant.
Results There were a total of 387 patients who had LRYGB from 2002 to 2007 utilizing this particular technique. Fifty-four patients
had a reoperation at an average of 24 (Range: 1–60) months postoperatively. The procedures were abdominoplasty, cholecystectomy,
diagnostic laparoscopy, and lysis of adhesions. While two patients had a defect present, no patient had an internal hernia
despite aggressive attempts to diagnose one.
Conclusions Internals hernias are not common after our particular method of LRYGB. Before adopting and advocating routine closure, surgeons
should consider the surgical technique and the true associated incidence of internal hernias. We do not recommend routine
closure of these defects with our technique.
Presented in part at International Federation for the Surgery of Obesity annual meeting; August 2006; Sydney, Australia. 相似文献
20.
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