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1.
Andrews G 《Obesity surgery》1996,6(5):426-429
Background: A psychological profile of the average bariatric patient demonstrates psychopathology that may contribute to patient
noncompliance with post-surgical treatment guidelines. Methods and results: Patient psychopathology is analysed with regard
to noncompliance and its contribution to poor surgical outcome. The interpersonal process approach is reviewed as a psychotherapeutic
framework that provides interventions to patient psychopathology. Conclusions: Treatment of patient psychopathology with the
interpersonal process approach encourages postsurgical compliance and helps patients succeed. 相似文献
2.
Background: Surgery is increasingly used for weight loss in morbidly obese patients. The authors evaluated the safety and
efficacy of bariatric surgery in patients older than 50 years. Methods: Prospective data on 62 consecutive patients (Male
= 13, Female = 49) undergoing bariatric procedures between 1985-1994 were reviewed. Mean followup was 30 ± 2 months (3-48
months). All data are mean ± sem. Results: Age was 57 ± 1 year (range 50-71 years). Patients had a mean preoperative weight
of 125 ± 4 kg (275 ± 9 lb) and 119 ± 6% excess body weight. A total of 68 procedures were performed: vertical banded gastroplasty
(VBG = 23), Roux-en-Y gastric bypass (RYGB = 43), and biliopancreatic diversion (BPD = 2). Six patients were converted to
RYGB (5) and BPD (1) after failed VBG. Hospital mortality was nil. Complications were wound infection (5), pulmonary (4),
gastric leak (2), abscess (1) and others (4). Mean weight loss at 3 years was 55 ± 7 and 33 ± 6% of percent excess body weight
for RYGB and VBG, respectively. Postoperative use of medications for arthritis, diabetes mellitus and asthma was reduced by
23%, 62% and 100%, respectively. Satisfaction with the outcome of treatment and weight loss was reported by 81% of patients.
Six patients that were converted from jejunoileal bypass (metabolic complications) to VBG gained weight. Conclusions: Bariatric
surgery is safe and well tolerated in morbidly obese patients older than 50 years. Weight loss parallels that of younger populations
and is greater in patients treated with RYGB in this subgroup. Age should not be a contraindication to bariatric surgery provided
the patient has obesity-related medical morbidity. Control of obesity-related co-morbid conditions is improved by weight loss. 相似文献
3.
A Decade of Change in Obesity Surgery 总被引:4,自引:0,他引:4
Edward E Mason MD PhD Shenghui Tang MS Kathleen E Renquist BS Dwight T Barnes Joseph J Cullen MD Cornelius Doherty MD James W Maher MD 《Obesity surgery》1997,7(3):189-197
Background: The International (formerly National) Bariatric Surgery Registry began collecting data in January 1986. The aim
of this study was to examine changes in the practice of surgical treatment of severe obesity that occurred during the decade
of 1986 through 1995, as observed in the IBSR data. Methods: All data submitted to the IBSR during the decade were transferred
to the IBM mainframe computer for analysis. Characteristics of operative type populations were compared over time using analysis
of variance (ANOVA) for age, body mass index (BMI), operative weight and Chi-square (χ2) test for gender. Results: There has been a steady increase over the decade in mean patient weight. The operations used have
changed from predominantly ‘simple’ operations to more frequent use of ‘complex’ operations. Within the categories of ‘simple’
and ‘complex’, an increase in the variety of operations occurred. As a group, patients with ‘simple’ operations have been
heavier, more often male and public pay patients than those who have undergone ‘complex’ operations. One year weight loss
was greater for Roux-en-Y gastric bypass (RGB) than vertical banded gastroplasty (VBG), but follow-up rates were too low to
study the relative merits of the operations used. The reported incidence of operative mortality and serious complications
(leak with peritonitis, abscess and pulmonary embolism) remained low. Conclusions: These observations and their implications
can be summarized in three statements which relate to action for improved patient care in the beginning of the new century:
(1) increasing weight of candidates for surgical treatment during this decade indicates the need for earlier use of operative
treatment before irreversible complications of obesity can develop; (2) low risk of obesity surgery, decreasing postoperative
hospital stay, and early weight control support the continued and increased use of surgical treatment; (3) continued widespread
use of both ‘simple’ and ‘complex’ operations with increased modifications of standard RGB and VBG procedures emphasizes the
need for standardized long-term data and analyses regarding both weight control and postoperative side-effects. 相似文献
4.
Background: Bariatric surgery has been classified as high risk by the medical malpractice industry, but it is unclear what
data support this classification. When a small group of physicians is separated from their peers and asked to support their
malpractice claims, their premiums will often rise unfairly in relation to the outcome of the claims. This report outlines
the results of a survey sent to the members of the American Society for Bariatric Surgery (ASBS) asking for information on
malpractice claims. Methods: Surveys were mailed to the 285 ASBS members requesting which bariatric operations were performed,
how many procedures were completed each year, details of any suits filed against the member including final outcome, and information
on whether the members also performed gastric surgery for ulcer disease. Results: Surveys were returned by 165 members (58%)
from surgeons in 33 states and Washington, D.C. Malpractice claims had been made after 107 bariatric procedures and three
ulcer procedures with the risk of a suit being filed for a bariatric procedure being approximately 1.6/1,000 cases. The average
monetary award was $88,667. Of the suits that resulted in a jury trial, 14% agreed with the plaintiff. Over half the cases
that had been resolved were either dropped or dismissed before trial. Conclusions: The incidence of suit being brought against
ASBS members performing bariatric procedures is low. Once filed, most cases do not reach a jury trial. Settlements are usually
under $100,000. These data suggest that this group of bariatric surgeons do not represent a disproportionately large risk
pool for medical malpractice insurance companies. 相似文献
5.
6.
Background: The relative risks and effectiveness of primary and revision operations done to produce weight loss are of interest
both from a patient care and an economic perspective. The possibility that patients requiring revision surgery comprise a
treatment resistant subgroup who are more likely to have post-operative complications is a valid concern. Methods: The records
of all patients having bariatric procedures since January of 1970 were evaluated for weight loss and complications. Results:
Most revisions were from jejunoileal bypass or a gastric restrictive procedure. Early complications were significantly more
common following revision surgery (19%) than after primary procedures (6%), although late and combined early and late complication
rates were similar. Operative mortality was lower following primary procedures (2/382) than revisions (1/75). Cholecystectomy
was a common sequela following primary procedures but did not occur after revision procedures. Regardless of surgical category,
weight loss after revision was equivalent to weight loss after primary procedures. Conclusions: Weight loss following revisional
bariatric surgery is equivalent to weight loss following a primary operation of the same type. Although mortality and early
complications are more common after revisional bariatric surgery, the frequency of late complications is not different. In
all groups wound infections and hernias were relatively common complications and cholecystectomies are rare after revisional
bariatric operations. 相似文献
7.
Background: The pharmacokinetic variables of drug clearance and volume of distribution are usually corrected for body weight
or surface area. Only recently have the relationships which exist between body size, physiologic function and pharmacokinetic
variables been evaluated in the obese population. These effects are not widely known, and data on this and the effects of
bariatric surgical procedures are scantily documented in the surgical literature. Methods: Literature review. Results: Drugs
with a low or moderate affinity for adipose tissue have a moderate increase in the volume of distribution (Vd), and this correlates
with the increase in lean body mass (LBM). Highly lipophilic drugs, with some exceptions, show the expected increase in Vd
and prolongation of elimination half-life, indicating a marked distribution into adipose tissue. Drug absorption, in general,
is slowed by delayed gastric emptying and is normal when gastric emptying is normal or increased. Most drug absorption occurs
in the small intestine where duration of drug/mucosal contact is the most important factor. Conclusions: Drugs whose distribution
is restricted to LBM should utilize a loading dose based on ideal body weight (IBW). For those drugs which distribute freely
into adipose tissue, the loading dose should be based on total body weight (TBW). Adjustment of the maintenance dose depends
on clearance rates. In a few cases dosage adjustment depends on pharmacodynamic data, since drug clearance does not conform
to these recommendations, for reasons which remain to be defined. Following bariatric surgery, in the absence of delayed gastric
emptying or uncontrolled diarrhea, drug absorption rates are usually comparable to the non-operated patient. 相似文献
8.
One to 5 years after gastric restrictive surgery and subsequent weight loss, 79 bariatric surgery patients were compared with
a similar group of 54 non-operated patients. The operated group had a significantly higher proportion of employment, more
working hours, and a higher income. They were also more active in different physical and social activities and had a better
sexual life. They required less medical care, had fewer days of sick leave or sick pension, and gave a much higher score in
assessment of their general health. The results indicate that obesity surgery is highly cost-effective. 相似文献
9.
10.
11.
Background: Predicting successful outcomes after bariatric surgical procedures has been difficult, and the establishment of
specific selection criteria has been a subject of ongoing research. In an effort to choose the most appropriate surgical procedure
for each patient, we have established a specific set of selection criteria for each procedure based on degree of obesity,
preoperative dietary habits, eating behavior, and various metabolic features. Methods: From June 1994 to December 1998, 90
bariatric surgical procedures were performed at the authors' institution by a single surgeon (F.K.) based on specific selection
criteria. Vertical banded gastroplasty (VBG) was performed in 35 patients, standard Roux-en-Y gastric bypass (RYGB) in 38
patients, and distal RYGB in 17 patients. All patients were monitored postoperatively 1, 3, 6, and 12 months and once per
year thereafter, with an additional visit at 18 months in distal RYGB patients. Results: Early postoperative morbidity (<30
days) did not differ significantly between the three groups and averaged 9% of total patients. Long-term postoperative morbidity
(>30 days) included 9 incisional hernias (2 in the VBG group, 5 after RYGB, and 2 in the distal RYGB group). There were 6
cases of staple-line disruption, 4 after VBG and 2 after standard RYGB, 1 of which resulted in stomal ulcer. Early postoperative
mortality was 0%, and long-term mortality was 1.1%, which was due to pulmonary embolism in 1 standard RYGB patient on the
65th postoperative day. Average percentage of excess weight loss (%EWL) was 62% the first year, 61% the second year, and 50%
the third year in VBG patients, and 63.6%, 65%, and 63.3%, respectively, in standard RYGB patients. In distal RYGB patients,
where the patient number was significantly smaller, the %EWL at 1 and 2 years, respectively, was 51% and 53%. The most significant
metabolic/nutritional complication was the appearance of hypoproteinemia (hypoalbuminemia) in 1 distal RYGB patient 20 months
after surgery, which was corrected by total parenteral nutrition and subsequent increase in dietary protein intake. Significant
improvement or resolution of pre-existing comorbid conditions was observed in all patient groups. The postoperative quality
of eating, as evaluated by variety of food intake and frequency of vomiting, was significantly better in RYGB patients. Conclusions:
These results show that selection of the bariatric surgical procedure to be performed in each patient based on specific criteria
leads to acceptable weight loss, improvement in preexisting comorbid conditions, and a high degree of patient satisfaction
in most patients. On the basis of our own observations as well as those of others, our selection criteria have become more
strict over time and our selection of VBG as the operation of choice increasingly infrequent. 相似文献
12.
Esophageal Anatomy and Function in Laparoscopic Gastric Restrictive Bariatric Surgery: Implications for Patient Selection 总被引:4,自引:2,他引:2
Background: The purpose of this study was to assess factors of clinical importance in morbidly obese patients having a laparoscopically
adjustable gastric band (LAP-BAND?) implanted in order to achieve weight loss. Methods: Preoperative evaluation of hiatus
hernia and esophageal (dys)motility were compared with the need for reoperation. Results are presented for the first 50 consecutive
patients entered. Results: Nine of the first 50 patients required reoperation (18%). Five (10%) were for LAP-BAND slippage
on the stomach. Of these five, reoperation was required in four of 12 (33%) with hiatus hernia (P = 0.0093); three of nine (33%) with a motility disorder (P = 0.025); and three of six (50%) with both hiatus hernia and a motility disorder (P = 0.0076). Conclusions: We identify two factors, hiatus hernia and esophageal dysmotility, which are associated, both independently
as well as in combination, with reoperation for LAP-BAND? slippage. Both patients and their physicians should consider these
data when considering the LAP-BAND? as possible therapy for morbid obesity. 相似文献
13.
J. Fatima M.D. S. G. Houghton M.D. C. W. Iqbal M.D. G. B. Thompson M.D. F. L. Que M.D. M. L. Kendrick M.D. J. L. Mai M.D. B.S. R.N. M. L. Collazo-Clavel M.D. M. G. Sarr M.D. 《Journal of gastrointestinal surgery》2006,10(10):1392-1396
The safety and efficacy of bariatric surgery in adolescents and especially in Medicare population have been challenged. Our
aim was to determine short-term (30-day) and long-term outcomes of bariatric surgery in patients ⩾60 years and ⩽18 years old.
Query of our 20-year bariatric surgery database identified 155 patients ⩾60 years and 12 patients ⩽18 years. We determined
morbidity and mortality rates and sent a questionnaire to all surviving patients; 127 of 139 survivors ⩾60 years and all 12
adolescents returned the questionnaire (92%) at a mean of 5 years (range 1–19 years). For patients ⩾60 years, 30-day mortality
was 0.7%, serious morbidity delaying discharge was 14%, and 5-year mortality was 5%. At a mean of 5 years, body mass index
(BMI in kg/m2) decreased from a mean (±SEM) of 46±1 to 33±1 with a 51% resolution of weight-related comorbidities and an 89% subjective
overall satisfaction rate. In patients ⩽18 years, all with serious comorbidities, there were no deaths and no serious complications.
BMI decreased from 55 (range 39–74) to 36 (range 27–53) at 4 years (range 1–8 years). Resolution of weight-related comorbidities
was 82%, and satisfaction with outcome was 83%. Thirty-day hospital mortality (<1%) and 5-year mortality (5%) were much lower
than reported previously in the senior population, with acceptable morbidity and importantly, with satisfactory outcomes.
Bariatric surgery is safe and effective at high volume centers for patients with morbid obesity at both extremes of age.
Presented at the Forty-Seventh Annual Meeting of The Society for Surgery of the Alimentary Tract, Los Angeles, May 20–25,
2005. 相似文献
14.
Cowan GS 《Obesity surgery》1992,2(2):169-176
Scientific evidence is pointing more and more strongly to the fact that serious, or morbid, obesity is not a moral issue.
Serious obesity is a consequence of a genetically-related, powerful biophysiological drive to consume more calories than are
burned. This concept must eventually become incorporated into lay and medical paradigms of obesity. It will result in an increased
understanding and sympathy for the suffering of the seriously obese and, as a consequence, stronger support for definitive
treatment of serious obesity such as bariatric surgery. Reoperative bariatric surgery principles, currently limited by individual
exposure and experience, will develop and evolve. Laparoscopic bariatric surgery may, in time, be developed and prove itself
to be of value. Bariatric surgeons should also find it useful to enhance their teams' skills for nutritional, behavioral and
psychological management, as well as broaden their operative base into other, related surgical areas such as partial ileal
bypass procedures for hyperlipidemia management. As fields mature, organizational maturation is a natural and necessary accompaniment.
An International Federation for Bariatric Surgery, or similar entity, will be founded to constructively unite national bariatric
surgery and related organizations together. The international bariatric surgery journal, Obesity Surgery, will become more and more accepted as the truly professional and essential vehicle of communication concerning bariatric
surgery that it has been since its first issue. Medical management simulating the effects of surgery will be employed successfully;
it may arise out of the current genetic work. It may ultimately, in the next 25 years or so, replace the surgical treatment
of serious obesity. 相似文献
15.
Sixteen morbidly obese patients (12 females, four males) underwent the Scopinaro operation according to Gazet. Profound weight
loss occurred, along with marked improvements in eating patterns, mood and psychosocial functioning which were reported retrospectively
1 year and repeated 2 years after surgery. Continued binge eating, comfort eating and ‘eating sensibly/making up in private’
were associated with reduced weight loss, suggesting that a therapeutic cognitive behavioural programme to correct eating
problems in association with the Scopinario operation may increase weight loss. Some physical symptoms were related to increased
(burping) or decreased (hunger, thirst) intake of food, but the patterns of preoperative symptoms did not predict postoperative
physical symptoms or weight loss. Subjects were divided into two subgroups with (n = 8) or without (n = 8) a history of self-damaging and addictive behaviours. The aberrant behaviour subgroup had more disturbed eating patterns
preoperatively (higher BITE severity scores) but similar BITE scores postoperatively. Mean BMIs were similar before and after
surgery. This suggested that patients with these aberrant behaviours should not be denied surgery. Half of the female patients
reported early sexual abuse, and were lighter than the non-abused group. This merits further investigation. 相似文献
16.
Rhabdomyolysis after Laparoscopic Bariatric Surgery 总被引:4,自引:4,他引:0
Background: Postoperative rhabdomyolysis is an uncommon event. The aim of this study was to determine the incidence of rhabdomyolysis
following laparoscopic obesity surgery. Methods: Rhabdomyolysis was studied prospectively. Over a 6-month period, 66 consecutive
patients underwent bariatric surgery (gastric banding (n=50) and gastric bypass (n=16)). All patients underwent laparoscopic
procedures. A range of blood tests, including serum creatine phosphokinase (CPK) level and serum creatinine, were systematically
performed before surgery, and on the first and third day postoperatively. Rhabdomyolysis was defined as a postoperative CPK
level >1,050 IU/L. Results: Serum CPK was noted to increase significantly postoperatively to >1,050 units in 3 patients (6%)
in the adjustable banding group and 12 patients (75%) in the gastric bypass group (P <0.01). In the bypass group, 4 patients (25%) had a serum CPK level >10,000 IU/L, but there were none in the gastric banding
group. All patients with CPK level >10,000 IU/L had BMI >60 kg/m2. No patients experienced acute renal failure. Conclusion: Rhabdomyolysis occurred in 22.7 % of 66 consecutive patients undergoing
laparoscopic bariatric surgery. Risk factors were identified: massive obesity and long duration of the operation. Early diagnosis
may have significant impact on outcome by preventing or reducing the severity of complications from rhabdomyolysis. CPK level
should be performed systematically after obesity surgery. 相似文献
17.
Vertical Banded Gastroplasty at More than 5 Years 总被引:1,自引:0,他引:1
Aniceto Baltasar MD FACS Rafael Bou MD Francisco Arlandis MD Rosa Martínez MD Carlos Serra MD Marcelo Bengochea MD Javier Miró MD 《Obesity surgery》1998,8(1):29-34
Background: Optimal evaluation of the results of surgery for morbid obesity requires a long-term follow-up for at least 5
years. Methods: One hundred patients were operated by vertical banded gastroplasty (VBG) and revised with a follow-up of no
less than 5 years. Sixty patients were morbidly obese with a body mass index (BMI) of between 40 and 50 kg/m2, and 40 were superobese with a BMI of >50 kg/m2. Follow-up included 93 patients (93%). Results: Initial surgical mortality was nil. Twenty-five patients required surgery
for complications related to the technique (25%) and one patient died due to pulmonary embolism after a re-stapling operation.
The percentage excess weight loss was 54.3%, and the BMI was 33 kg/m2 for the 84 patients followed to 5 years post VBG. Only 40 out of 92 patients (43.5%), obtained the weight loss benefit due
to the operation. None of them is able to eat a regular diet, and the quality of food intake has been severely affected in
some of them. Conclusions: VBG is, in our experience, a safe and technically simple operation, but the long-term results are
questionable. The reoperation rate was high, and weight loss and quality of life are superior with other operations. 相似文献
18.
The Gastric Bypass for Failed Bariatric Surgical Procedures 总被引:1,自引:0,他引:1
Background: Revision of failed bariatric surgical procedures is a significant challenge for every bariatric surgeon. Methods:
Evaluated are surgical difficulties, management problems and weight loss in patients with distal gastric bypass as a revisionary
procedure. Eighty patients were followed up to 3 years; four were lost to follow-up. Mean age was 43; mean prebariatric surgery
weight 134 kg; height 1.65 meters; body mass index 40.1; ideal body weight 62.7 kg; excess weight 70.5 kg; per cent excess
weight 214%. A 250 cm stomach-to-ileocecal valve segment of small bowel was used, and the biopancreatic secretions were brought
into the terminal ileum 100 cm from the ileocecal valve. Mean pouch size was 63 cc; length of hospital stay 5 days; operative
blood loss 616 cc; operative time 130 min. Results: Intraoperative complications included three splenic injuries (without
splenectomy). Early complications included one deep vein thrombosis, two marginal ulcers, one GI hemorrhage, one wound dehiscence,
one pouch outlet obstruction and one pancreatitis. Late complications included: one death from protein malnutrition/ARDS;
21 hypoproteinemia; six protein malnutrition, and of these, three had hyperalimentation; three cholecystitis; 27 anemia; 22
incisional hernia; two staple-line disruption (reoperated); 26 low serum iron; 11 prolonged (> 6 months) diarrhea; three prolonged
frequent vomiting; and two unrelated deaths (chronic myelogenous leukemia and amyotrophic lateral sclerosis). Mean excess
weight loss was 83% at 12 months; 89% at 24 months; and 94% at 36 months. Conclusion: The distal gastric bypass is fraught
with the operative and immediate post-operative complications experienced in any revisionary bariatric surgery. Distal gastric
bypass is very effective in producing long-term weight loss. Nutritional problems are common but usually easily corrected.
The most serious nutritional complication is protein malnutrition, which must be identified and corrected early. Success of
this procedure is dependent upon patient compliance with proper nutrition and supplements, and regular office follow-up with
monitoring of laboratory data. Patients who are noncompliant are at significant risk for complications. 相似文献
19.
A Sérgio Silva MD Helena Cardoso MD Carlos Nogueira MD Jorge Santos MD Hernâni Vilaça MD 《Obesity surgery》1999,9(2):194-197
Background: The goal of surgery for morbid obesity is to achieve a good and durable loss of weight and improve health. Previous
studies have demonstrated a significant weight loss for the Swedish adjustable gastric band (SAGB). Patients and Methods:
Between November 1996 and April 1998, 18 morbidly obese patients underwent SAGB laparoscopically. Their mean age at surgery
was 35 years. The mean preoperative weight was 128 kg (range 89-163), and the mean body mass index was 50.4 ± 9. Comorbidity
was present in 13 patients. Results: One gastric perforation occurred, and in one patient it was not possible to create the
pneumoperitoneum. Regarding late morbidity, one intragastric migration and one slippage of the band occurred. There was no
mortality. Conclusion: The low morbidity, the good results with weight loss, and the improvement in comorbidity lead the authors
to believe that Swedish adjustable gastric banding for the treatment of morbidly obese patients is a successful means of losing
weight and improving general health. 相似文献
20.
Background Despite the initial success of primary gastric restrictive operations, many patients require revision for weight regain, mechanical
complications or intolerance to restriction. The mini-gastric bypass (MGB) for revision of failed primary restrictive procedures
was evaluated.
Methods 33 patients undergoing revisional surgery to a MGB for a failed silastic ring vertical banded gastroplasty (VBG) or a gastric
banding (GB) from June 2005 to September 2006, were reviewed at an academic institution. The patients had had a minilaparotomy.
Revision of the VBGs was further compared with revision of the GBs.
Results The MGB was completed in all except 2 patients who required Roux-en-Y gastric bypass (RYGBP) because of gastric tube damage.
Mean age was 41 years (range 20–64), preoperative BMI was 39.5 kg/m2 (range 28–58), and 20 (65%) were women. The revision was performed after an average of 36.3 months (range 12–84), and was
more time-consuming in patients with prior VBG than GB (184 vs 155 min, P = 0.007). Postoperative complications occurred in 2 (6.4%) with prior VBG, and length of hospital stay was 4.65 days (range
3–17).Mean BMI at 6 months was 30.6 (range 24.8–50.0, P < 0.001) compared with the preoperative BMI. Reflux disease was cured, and all patients noted major improvement in the eating
dimension.
Conclusion Open MGB through a previous mini-incision is a safe and effective operation for revision of failed gastric restrictive operations.
The revision procedure was technically more difficult in patients with prior VBG and hazardous in patients with prior redo
VBG. 相似文献