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1.
High Prevalence of Asymptomatic Esophageal Motility Disorders among Morbidly Obese Patients 总被引:4,自引:1,他引:3
Background: Morbid obesity is becoming more prevalent in the industrialized world. Few data exist regarding the resting lower
esophageal sphincter pressure (LESP) and esophageal motility in relationship to body mass index (BMI). Methods: During a 3-year
period, 111 of 152 morbidly obese patients seeking bariatric surgery completed esophageal manometric testing and questionnaire
regarding esophageal symptoms. Manometric parameters included wave amplitude and duration of esophageal contractions, percentage
of peristaltic function, and resting LESP. Questionnaire data included age, sex, medications, prior medical conditions, and
esophageal symptoms. Results: 88 (79%) of the patients were female; 23 (21%) were male. The mean age was 39.8 years (± 9.9),
the mean BMI was 50.7 kg/m2 (± 9.4). There was a lack of correlation between BMI and LESP (r = 0.04). Abnormal manometric
findings were observed in 68/111 (61%) patients: 28 (25%) had only hypotensive lower esophageal sphincter (LESP < 10 mm Hg);
16 (14%) had nutcracker esophagus (amplitude >180 mm Hg), 15 (14%) had nonspecific esophageal motility disorders, 8 (7%) had
diffuse esophageal spasm (DES), and 1 (1%) had achalasia. Patients with DES had a significantly higher BMI than those with
other motility disorders (P < 0.05). Dysphagia was reported in 7 (6%) patients and chest pain in 1 patient. Heartburn and/or
regurgitation (gastroesophageal reflux disease, GERD) was noted in 35 patients (32%), of whom 18 (51%) had a hypotensive resting
LES. 40 of 68 patients (59%) with abnormal motility tracings did not report any esophageal symptoms. Conclusion: Morbid obesity
per se does not imply an abnormality of LESP. In addition, a majority of morbidly obese patients who were considering bariatric
surgery had no esophageal symptoms but were found to have abnormal esophageal manometric patterns. These findings add support
to the suggestion that morbidly obese patients may have abnormal visceral sensation. 相似文献
2.
Outcome Following Bariatric Surgery in Super versus Morbidly Obese Patients: Does Weight Matter? 总被引:4,自引:2,他引:2
Mark Bloomston MD Emmanuel E Zervos MD Mario A Camps MD Sarah E Goode RN Alexander S Rosemurgy MD 《Obesity surgery》1997,7(5):414-419
Background: Numerous investigators have attempted to identify prognostic indicators for successful outcome following bariatric
surgery. The purpose of this study was to determine whether degree of obesity affects outcome in super obese [>225% ideal
body weight (IBW)] versus morbidly obese patients (160-225% IBW) undergoing gastric restrictive/bypass procedures. Methods:
Since 1984, 157 patients underwent either gastric bypass or vertical banded gastroplasty. Super obese (78) and morbidly obese
(79) patients were followed prospectively, documenting outcome and complications. Results: Super obese patients reached maximum
weight loss 3 years following bariatric surgery, exhibiting a decrease in body mass index (BMI) from 61 to 39 kg/m2 and an average loss of 42% excess body weight (EBW). Morbidly obese patients had a decrease in BMI from 44 to 31 kg/m2 and carried 39% EBW at 1 year. After their respective nadirs, each group began to regain the lost weight with the super obese
exhibiting a current BMI of 45 kg/m2 (61% EBW) versus 34 kg/m2 (52% EBW) in the morbidly obese at 72 months cumulative follow-up. Currently, loss of 50% or more of EBW occurred in 53%
of super obese patients versus 72% of morbidly obese (P < 0.01). Twenty-six percent of super obese patients returned to within 50% of ideal body weight (IBW) while 71% of morbidly
obese were able to reach this goal (P < 0.01). Co-morbidities and complications related to surgery were similar in each group. Conclusions: Super obese patients
have a greater absolute weight loss after bariatric surgery than do morbidly obese patients. Using commonly utilized measures
of success based on weight, morbidly obese patients tend to have better outcomes following bariatric surgery. 相似文献
3.
4.
Gastro-esophageal Reflux and Esophageal Motility Disorders in Morbidly Obese Patients 总被引:2,自引:2,他引:0
Background: Morbid obesity has long been considered as a contributing factor to gastro-esophageal reflux, but the literature
contains conflicting data on the subject. The authors studied a large number of morbidly obese candidates for bariatric surgery
with objective means, in order to better define the incidence of gastro-esophageal reflux disease (GERD) and esophageal motility
disorders in this population. Methods: Morbidly obese patients, in whom indication for bariatric surgery was confirmed after
complete evaluation, were included consecutively during a 4-year period. The evaluation included history of reflux symptoms,
upper GI endoscopy, 24-hour pH monitoring, and stationary esophageal manometry. Results: 345 patients were studied, of whom
35.8% reported reflux symptoms. Endoscopy showed a hiatus hernia in 181 patients (52.6%), and reflux esophagitis in 108 (31.4%).
24-hour pH monitoring revealed an elevated De Meester score in 163 patients (51.7%). Manometry was normal in 247 patients
(74.4%), and showed a decreased lower esophageal sphincter pressure in 59 (17.7%). Esophagitis and abnormal pH testing were
more common in patients with symptoms or hiatus hernia, and the incidence of esophagitis was higher with abnormal pH testing.
Esophagitis was associated with increased weight and abdominal obesity. Conclusions: This study confirms the increased prevalence
of GERD in the morbidly obese population. Upper GI endoscopy should be performed routinely during evaluation of morbidly obese
patients for bariatric surgery. When both conditions coexist, effective treatment is probably best provided by Roux-en-Y gastric
bypass, which produces effective weight loss and correction of pathological reflux. 相似文献
5.
《The Journal of arthroplasty》2020,35(7):1766-1775.e3
BackgroundThe cost-effectiveness of bariatric surgery to achieve weight loss prior to total hip arthroplasty (THA), and decrease the complications and costs associated with THA in the morbidly obese, is unknown. This study evaluated the cost-effectiveness of bariatric surgery prior to THA for morbidly obese patients with end-stage hip osteoarthritis (OA).MethodsA state-transition Markov model was constructed to compare the cost-utility of 2 treatment protocols for patients with morbid obesity and end-stage hip OA: (1) immediate THA and (2) bariatric surgery 2 years prior to THA (combined protocol). The analysis was performed from both a payer and a societal perspective using direct and indirect costs over a 40-year time horizon. Utilities, associated costs, and probabilities for health state transitions were derived from the literature. One-way, 2-way and probabilistic sensitivity analyses were performed to validate the robustness of the base case results, using the standard willingness-to-pay threshold of $100,000/quality-adjusted life years.ResultsFrom the societal perspective, the combined protocol was more effective (13.16 vs 12.26) with less cost ($91,717 vs $92,684) and thus was the dominant strategy over immediate THA. These results were stable across broad ranges for independent model variables. Monte Carlo simulation with 100,000 samples demonstrated that bariatric surgery prior to THA was the preferred cost-effective strategy over 95% of the time from both a societal and payer perspective.ConclusionIn the morbidly obese patient with end-stage hip OA, bariatric surgery prior to THA is a cost-effective strategy for improving quality of life and decreasing societal and payer costs.Level of EvidenceII 相似文献
6.
7.
Sanchez H Cabrera A Cabrera K Zerrweck C Mosti M Sierra M Dominguez G Herrera MF 《Obesity surgery》2008,18(12):1539-1543
Background Adjustable gastric banding (AGB) and vertical banded gastroplasty (VBG) have been extensively used to treat morbid obesity.
Patients with insufficient weight loss or complications may require surgical revision. The laparoscopic Roux-en-Y gastric
bypass (LRYGBP) is one of the most common procedures currently used for revision. The aim of the study was to analyze surgical
outcomes of 30 consecutive patients who underwent revision to LRYGBP in a 2-year period.
Methods The prospectively constructed database and the medical records of all patients undergoing revision to LRYGBP were reviewed.
Demographics, surgical details, results, and complications were analyzed.
Results There were 23 women and seven men with a mean age of 41.1 ± 9.7 years (r = 25–61). Mean body mass index (BMI) was 40.0 ± 7.5 kg/m2 (r = 27.2–65.2). Initial operation was AGB in 24, VBG in five, and both in one patient. In ten patients, the band had been removed
before revision, in 13 cases, band removal and LRYGBP were performed in one surgical intervention, and in two patients, it
was performed in a two-step surgery. There were two conversions to open surgery. Five patients presented major surgical complications.
Hospital stay averaged 5.1 days (r = 3–25). Mean percent excess body weight loss at 6 and 12 months was 61.7 ± 27.5 and 81.2 ± 20.5 kg/m2, respectively. Mean percent low body mass index at 6 and 12 months was 22.5 ± 9.1 and 29.1 ± 11.4 kg/m2, respectively.
Conclusions LRYGBP as a revision procedure is feasible in most patients. Surgical complications are more frequent. 相似文献
8.
Madalosso CA Fornari F Callegari-Jacques SM Madalosso CA Gurski RR 《Obesity surgery》2008,18(6):668-674
Background Gastroesophageal reflux disease (GERD) has been increasingly recognized in patients with morbid obesity. A recent global evidence-based
consensus on GERD has been proposed, but its performance in patients with morbid obesity is unknown. The aim of this study
was to assess the performance of the Montreal Consensus in the diagnosis of GERD in morbidly obese patients.
Methods Seventy-five consecutive morbidly obese patients underwent GERD symptoms assessment, upper gastrointestinal endoscopy, and
ambulatory esophageal pH monitoring “off PPI”. The performance of the Montreal Consensus was determined by comparing two diagnostic
algorithms: 1. a gold standard approach in which any GERD symptom and findings from both endoscopy and pH monitoring were
taken into account, and 2. the approach with the Montreal Consensus, in which troublesome GERD symptoms and endoscopic findings
were considered.
Results GERD was found present in 57 patients by applying the gold standard approach. The Montreal Consensus identified 41 of these
patients, whereas the remaining 34 patients were classified as “no GERD”. Of these, 16 (47%) showed reflux esophagitis and/or
abnormal pH-metry. The Montreal Consensus had an accuracy of 78.7%, sensitivity of 72% (95% CI 59–82%), specificity of 100%
(95% CI 82–100%) and negative predictive value of 47% (95% CI 37–57%).
Conclusions In morbidly obese patients, the approach with the Montreal Consensus has high specificity and suboptimal sensitivity in the
diagnosis of GERD. Its intermediate negative predictive value suggests that complementary investigation might be routine in
these patients, particularly in those who do not present with troublesome GERD symptoms.
Madalosso and Fornari contributed equally to the study. 相似文献
9.
Russo V Ammendola E De Crescenzo I Ricciardi D Capuano P Topatino A Docimo L Santangelo L Calabrò R 《Obesity surgery》2007,17(7):857-865
Background Weight-stable obese subjects have an increased risk of arrhythmias and sudden death, even in the absence of cardiac dysfunction,
and the risk of sudden cardiac death (SCD) with increasing weight is seen in both genders. The mechanism of unexplained deaths
in obese patients is still unclear and may be related to ventricular repolarization abnormalities. The aim of this study is
to determine the effect of severe obesity on spatial and transmural ventricular repolarization and to clarify the influence
of bariatric surgery with a consequent substantial weight loss on arrhythmogenic substrate in the morbidly obese population.
Methods For the study, we enrolled 100 severely obese patients; 50 age-matched non-obese healthy subjects were also recruited as controls.
All subjects underwent conventional 12-lead electrocardiography for analysis of spatial and transmural ventricular repolarization
assessed by corrected QT dispersion (QTcd), corrected JT dispersion (JTc-d) and transmural dispersion of repolarization, (TDR).
All subjects underwent bariatric surgery and were resubmitted to electrocardiographic, biochemical and anthropometric examination
12 months postoperatively.
Results Severely obese patients had greater values in QTc-d, JTc-d and TDR than the normal-weight controls. Bariatric surgery reduced
significantly the QTcd value, JTc-d value and TDR value. There was a significant correlation between decrease of heterogeneity
of repolarization indexes (QTd, JTd and TDR) and bariatric surgery-induced weight loss.
Conclusions In severely obese patients, surgicallyinduced weight loss is associated with significant decrease in the heterogeneity of
ventricular repolarization. The reduction of spatial (QTc-d, JTc-d) and transmural dispersion of repolarization (TDR) may
be of clinical significance, by reducing the risk of potentially fatal arrhythmias in morbidly obese subjects. 相似文献
10.
Calcium Metabolism in the Morbidly Obese 总被引:1,自引:0,他引:1
Background: Morbidly obese patients are known to have abnormal calcium metabolism compared with the non-obese, but the clinical
significance of this is unknown. Since surgical treatment of obesity may itself cause hyperparathyroidism, it is important
to understand the preoperative physiology of these patients. Methods: 213 consecutive patients (M 37 : F 176, ages 21-68)
presenting for surgical treatment of morbid obesity between October 2000 and June 2002 were prospectively evaluated. Preoperative
levels of serum calcium corrected for albumin, alkaline phosphatase, parathyroid hormone (PTH), 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin
D were measured. We recorded the prevalence of abnormalities in study parameters and correlated them with PTH levels. Results:
Hyperparathyroidism (PTH >65 pg/ml) was present in 25.0% of subjects. By contrast, abnormalities of serum calcium were rare.
The prevalence of hypocalcemia was 3.5%, and of hypercalcemia was 0.5%. Only 4.3% of patients had increased levels of alkaline
phosphatase. 21.1% of patients had abnormally low levels of 25-hydroxyvitamin D (median 15 ng/ml), and 23.1% had increased
levels of 1,25-dihydroxyvitamin D (median 49 pg/ml). PTH was positively correlated with BMI (r=.30, P=<.001) and 25-dihydroxyvitamin D (r=.27, P=.01), and was negatively correlated with alkaline phosphatase (r=.21, P=.02). There was no correlation between PTH and calcium, 1,25-dihydoxyvitamin D, age, or sex. Conclusions: Parathyroid hormone
levels are increased in the morbidly obese and are positively correlated with BMI. Recognition of preoperative hyperparathyroidism
is important because of the risk of attributing postoperative hyperparathyroidism to the effects of surgery. Further studies
are needed to elucidate the cause of elevated PTH in these patients. 相似文献
11.
Givon-Madhala O Spector R Wasserberg N Beglaibter N Lustigman H Stein M Arar N Rubin M 《Obesity surgery》2007,17(6):722-727
Background Laparoscopic sleeve gastrectomy (LSG) has recently come to be performed as a sole bariatric operation. The postoperative morbidity
and mortality are cause for concern, and possibly are related to non-standardized surgical technique.
Methods The following is the surgical LSG technique used in 25 morbidly obese patients. Five trocars are used. Division of the vascular
supply of the greater gastric curvature is begun at 6–7 cm proximal to the pylorus, proceeding to the angle of His. A 50-Fr
calibrating bougie is positioned against the lesser curvature. The LSG is created using a linear staplercutter device with
one 4.1-mm green load for the antrum, followed by five to seven sequential 3.5-mm blue loads for the remaining gastric corpus
and fundus. The staple-line is inverted by placing a seroserosal continuous absorbable suture over the bougie from the angle
of His .The resected stomach is removed through the 12-mm trocar, and a Jackson-Pratt drain is left along the suture-line.
Results The mean operative time was 120 minutes, and length of hospital stay was 4 ± 2 days.There were no conversions to open procedures.
There were no postoperative complications (no hemorrhage from the staple-line, no anastomotic leakage, no stricture) and no
mortality. In 1 patient, cholecystectomy was also done, and in 4, a gastric band was removed. During a median follow-up of
4 months, BMI decreased from 43 ± 5 kg/m2 to 34 ± 6 kg/m2, and the % excess BMI loss was 49 ± 25%.
Conclusions The proposed surgical technique appears to be a safe and effective procedure for morbid obesity. 相似文献
12.
Pontiroli AE Fossati A Vedani P Fiorilli M Folli F Paganelli M Marchi M Maffei C 《Obesity surgery》2007,17(11):1492-1497
BACKGROUND: With bariatric restrictive procedures a major issue is predictors of clinical outcome; non-surgical (compliance) and psychological factors might play a role in long term-results of bariatric surgery. We evaluated a set of predictors of short-term and long-term clinical outcome including psychiatric and psychological variables, as well as measures of post-surgery compliance. METHODS: 172 consecutive patients undergoing laparoscopic adjustable gastric banding (LAGB) with a minimum of 12 months follow-up, were studied; before surgery they were administered the NIMH Diagnostic Interview Schedule (Version III-R, DIS III-R) and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (Version 2.0, SCID-II). After surgery, patients were scheduled for visits at 2-week intervals for the first 2 months, at monthly intervals up to 1 year and 3-monthly intervals for 2 years; compliance with diet, rules, physical exercise, plus integrated compliance (sum of scores), and percentage of attendance at scheduled visits were recorded. Patients were contacted again at 36 and at 48 months. RESULTS: BMI, compliance, percentage of attendance at scheduled visits (positively), and narcissistic personality (negatively) were all associated with weight loss at 12, 24 (and 36 months). Percentage of attendance was also associated at 48 months. At stepwise regression analysis, BMI and integrated compliance predicted weight loss at 12, 24, and 36 months, while percentage of attendance at scheduled visits predicted weight loss at 48 months. Narcissistic personality predicted weight loss only at 12 months. CONCLUSION: Adherence to scheduled visits and compliance to recommended rules, more than personality disorders, predict success of LAGB, at least during the first 4 years. 相似文献
13.
Anty R Dahman M Iannelli A Gual P Staccini-Myx A Amor IB Luciani N Saint-Paul MC Huet PM Sadoul JL Srai SK Unwin R Gugenheim J Le Marchand-Brustel Y Tran A Bekri S 《Obesity surgery》2008,18(6):709-714
Background Obesity is associated with a chronic and low-grade inflammation which may cause hypoferremia as seen in patients with chronic
inflammatory diseases. The aim of the present study was to investigate the relationship between iron status and markers of
inflammation in morbidly obese women and the effect of bariatric surgery.
Methods Our cohort of patients consisted of 178 morbidly obese females selected for bariatric surgery. Clinical and biochemical data
were recorded before surgery, and histopathological studies were carried out on preoperative liver biopsy samples. Fifty-five
patients have been followed up after bariatric surgery.
Results A high prevalence of iron depletion was present in this cohort, with 53% having a transferrin saturation ratio below 0.20.
Iron depletion was significantly correlated with raised levels of indices of inflammation, C-reactive protein (CRP), orosomucoid
and haptoglobin), and with the white blood cell count. In multivariate analysis, orosomucoid and CRP were independently associated
with iron depletion. Moreover, 6 months after bariatric surgery, inflammation level decreased, which was inversely correlated
with the increase in transferrin saturation.
Conclusions Iron depletion is common in morbidly obese women. Low-grade chronic inflammation associated with obesity could be a modulator
of iron uptake and utilization. Bariatric surgery may reduce chronic inflammation and improve iron status. 相似文献
14.
G. van Hout 《Acta chirurgica Belgica》2013,113(1):40-43
Introduction: Total mesorectal excision (TME) is the accepted standard for rectal cancer treatment. However, there is an increased risk of symptomatic anastomotic leakage associated with TME as TME potentially endangers the blood supply of the remaining rectum. On top of this, many patients will receive neo-adjuvant radio-chemotherapy. A defunctioning stoma helps in avoiding severe complications of anastomotic failure.Material and mehods: We prospectively collected data of all patients with a rectal carcinoma within reach of the palpating finger, operated on in our department between December 2000 and January 2005. There were 70 patients (42 men and 28 women, median age 70 (range 32–95)).Results: In 40 patients (40/70 = 57%) a sphincter-saving procedure was performed. Eleven patients were diagnosed with anastomotic leakage or failure. Seven patients had neo-adjuvant radio-chemotherapy, 4 had no neo-adjuvant therapy. In 4 patients signs of anastomotic leakage were seen on the barium-enema that is routinely performed before closing the defunctioning stoma. Seven patients (7/40 = 17,5%) had clinical signs of anastomotic leakage. Three of them could be treated conservatively with antibiotics and parenteral nutrition. Two of these patients did not have a defunc-tioning stoma. Four patients needed re-intervention and were treated in intensive care for several days. Three of these patients did not have a defunctioning stoma.Conclusion: Neo-adjuvant radio-chemotherapy and TME resection are two factors in the treatment of rectal cancer that might interfere with anastomotic healing in the case of a sphincter-saving procedure. The construction of a defunctioning stoma helps in limiting the complications of anastomotic leakage or failure. 相似文献
15.
Background Laparoscopic adjustable gastric banding (LAGB) is seen as a safe surgical procedure in individuals with morbid obesity, with
satisfactory weight loss and significant postoperative improvement in quality of life (QoL). The present study investigates
the predictive value of various parameters such as age, gender, weight loss, and preoperative psychiatric disorders with regard
to QoL after LAGB.
Methods 300 obesity surgery patients were sent questionnaires to assess a variety of personal parameters. QoL was assessed using the
Ardelt-Moorehead Quality of Life Questionnaire. Questionnaires were completed by 140 (63%) female patients and 36 (45%) male
patients.
Results Average weight loss in both sexes was 14.7 kg/m2; however, not all patients successfully lost weight. No difference was seen in satisfaction with weight loss among the age
groups. Some correlations were seen between the amount of weight loss and QoL scores in females, but not in males. Greater
weight loss showed a statistically significant positive correlation to self-esteem, physical activity, social relationships,
sexuality, and eating pattern. Obese females with no preoperative psychiatric diagnosis had better self-esteem, more physical
activity, and more satisfying social and sexual relationships than those with psychiatric diagnoses at follow-up.
Conclusion A majority of morbidly obese patients show psychological and interpersonal improvement after surgery. However, some obese
patients, particularly those having a preoperative psychiatric or personality disorder, need more individual strategies for
psychosocial intervention than do obese individuals with no psychiatric disorder. 相似文献
16.
Background Obstructive sleep apnea syndrome (OSAS) is present in 44% of patients scheduled for bariatric surgery. Respiratory dysfunction
associated with this syndrome is attributable to chronic obstructive pulmonary disease (COPD) and/or obesity hypoventilation
syndrome (OHS).We studied the long-term effect of bariatric surgery on weight loss, on the respiratory comorbidities associated
with obesity, and on the need for non-invasive positive pressure ventilation.
Methods We followed a sample of patients with respiratory co-morbidity scheduled for open Capella Roux-en-Y gastric bypass (RYGBP)
over 5-years. Patients who were positive for polysomnographic studies and required continous positive airway pressure (CPAP)
before surgery were included. All patients were subjected to the same anesthetic and surgical protocols. At 1 year after surgery,
polysomnographic studies were performed and arterial blood gases and pulmonary function were tested.
Results Of the 209 patients scheduled for bariatric surgery during the study period, 105 had respiratory co-morbidity. Of these, 30
required CPAP-BiPAP treatment before surgery and were included in our study. Surgery took 128 minutes (range 70 to 210 minutes).
Tracheal extubation in the operating theater was possible for 26 patients (86.7%). During the early postoperative period,
7 patients (23.3%) presented respiratory complications. Length of hospitalization was 6.87 days (range 4 to 11 days). At 1
year after RYGBP, patients presented significant weight loss and improvement of hypoxemia (from 73.3 ± 10.6 to 90.5 ± 11.5,
P = 0.000), hypercarbia (from 44.5 ± 5.7 to 40.6 ± 4.9, P = 0.005), and in spirometric (P = 0.004) and polysomnographic results
(P = 0.001). CPAP-BiPAP treatment after weight loss was necessary in only 14% of patients (P = 0.001).
Conclusions Weight loss after RYGBP improved arterial blood gases, respiratory tests and polysomnographic studies. CPAP treatment can
be withdrawn in most patients. 相似文献
17.
Background Morbidly obese individuals may have poor compensatory hyperventilation during exercise. The objective was to examine pulmonary
gas exchange and the compensatory hyperventilatory response during exercise pre- and post-weight reduction surgery in obese
subjects.
Methods Fifteen patients (age = 39 ± 8 years, body mass index = 47 ± 6 kg/m2), with an excess weight of 69 ± 17 kg, were recruited. Pulmonary function at rest was assessed and arterial-blood gases were
sampled at rest and all levels of exercise pre- and 10 ± 3 weeks postsurgery.
Results There was a loss of excess weight 21 ± 6 kg (p < 0.01). Waist and hip circumference decreased by 13 ± 9 and 8 ± 7 cm, respectively (p < 0.01). Prior to surgery, there was no compensatory hyperventilation between rest and peak exercise as arterial PCO2 (PaCO2) remained unchanged (37± 3 mm Hg). However, postsurgery, there was compensatory hyperventilation as PaCO2 decreased to 33 ± 2 mm Hg at peak exercise (p < 0.01), with no change in peak oxygen consumption (VO2peak in L/min). Multiple linear regression revealed that the restored ventilatory response to exercise was most strongly associated
with the reduction in overall fat mass (adjusted r
2 = 0.25; p = 0.03). Total weight loss of 21 kg induces adequate compensatory hyperventilation that begins to show at about 50% of VO2peak, resulting in improved gas exchange at moderate to peak exercise intensities.
Conclusion Improvement in compensatory hyperventilation is most closely related to loss in overall fat mass.
G.S. Zavorsky is the recipient of the 2005 Baxter Corporation Award in Anesthesia from the Canadian Anesthesiologist’s Society.
G.S. Zavorsky is also Research Scholar–Junior 1 from the Quebec Health Research Foundation (Fonds de la Recherche en Santé du Québec). N.V. Christou is a consultant for Ethicon Endo-Surgery and has stock ownership in Weight Loss Surgery. 相似文献
18.
Fischer S Chen E Katterman S Roerhig M Bochierri-Ricciardi L Munoz D Dymek-Valentine M Alverdy J le Grange D 《Obesity surgery》2007,17(6):778-784
Background The impact of presurgical eating patterns on postoperative outcomes is poorly understood. The results of previous studies
are mixed regarding the impact of presurgical binge eating on weight loss after surgery. However, many patients describe other
maladaptive eating patterns prior to surgery, such as eating in response to emotions.The goals of this study were to describe
presurgical emotional eating patterns in morbidly obese individuals, determine whether these individuals were binge eaters,
and assess the effect of this eating behavior on weight loss after surgery.
Methods Prior to surgery, 144 Roux-en-Y gastric bypass (RYGBP) patients completed the Questionnaire of Eating and Weight Patterns
(QEWP) or QEWPRevised (QEWP-R) and the Emotional Eating Scale to assess eating patterns prior to surgery. Their eating behavior,
levels of depression, and weight were assessed after surgery.
Results High emotional eaters tended to have higher levels of depression, binge eating, and eating in response to external cues than
low emotional eaters prior to surgery.However, there appeared to be a distinct group of individuals who were high emotional
eaters but who did not engage in binge eating. At a mean of 8 months after surgery, High Emotional Eaters and Low Emotional
Eaters were indistinguishable on these subscales and there were no differences in weight lost.
Conclusions RYGBP has an equally positive impact on eating behavior and weight loss for both High Emotional Eaters and Low Emotional Eaters.
Further replication is needed with longer follow-up times and larger samples. 相似文献
19.
Background Despite comprehensive preoperative education, patients may forget important information such as potential complications.
Methods Patients who had undergone laparoscopic bariatric surgery were surveyed. All patients were asked to write down as many as
possible of the potential complications. Preoperatively, patients had been given an educational book, two preoperative educational
appointments, a test, and an informed consent discussion and form with clear presentation of complications which may occur.
Results There were 70 patients in this investigation (75% response rate), with 49 laparoscopic gastric bypass patients (bypass), 18
laparoscopic adjustable gastric banding patients (band), and 3 patients who did not indicate their procedure. Patients listed
an average of 5.1 complications. Complications were grouped in 12 categories for each procedure. Percentages reported by patients
(bypass vs band) were: Death 34 (69%) vs 13 (72%), Injury to GI tract/leak 14 (29%) vs 5 (28%), Conversion 1 (2%) vs 0 (0%),
CV/pulmonary issues 11 (22%) vs 4 (22%), Stenosis/ulcer 6 (12%) vs NA, Band erosion/migration NA vs 9 (50%), Malnutrition
24 (49%) vs 4 (22%), GI symptoms 19 (39%) vs 6 (33%), Infection 15 (31%) vs 10 (56%),Weight regain/inadequate loss 5 (10%)
vs 3 (17%), Thromboembolic event 7 (14%) vs 3 (17%), and Hemorrhage 8 (16%) vs 0 (0%).
Conclusions Many patients forget some of the serious complications after laparoscopic bariatric surgery. This may have important medicolegal
consequences especially during malpractice lawsuits. These data underscore the need for continual followup and education in
this patient population.
Presented at the 11th World Congress of the International Federation for the Surgery of Obesity, Sydney, Australia, September
1, 2006. 相似文献
20.
Lutrzykowski M 《Obesity surgery》2008,18(12):1647-1648
Two morbidly obese patients are presented. The first patient is a 38-year-old superobese female with BMI 56.2 in a wheelchair
secondary to multiple sclerosis. The second patient is a 49-year-old female with BMI 47.7 confined to a wheelchair secondary
to spinal cord transection due to a motor vehicle accident. Both patients underwent an open duodenal switch procedure, which
provided significant weight loss and improved quality of life primarily for mobility with a wheelchair, as well as controlling
comorbidities. 相似文献