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1.
Gastrointestinal Hemorrhage after Laparoscopic Gastric Bypass 总被引:1,自引:0,他引:1
Gastrointestinal hemorrhage is a potential perioperative complication after Roux-en-Y gastric bypass. The surgeon performing
laparoscopic gastric bypass should understand the need for early recognition and management of this complication, as it can
be life-threatening. This paper discusses the incidence and clinical presentation of gastrointestinal hemorrhage, mechanisms
for hemorrhage, management options, and possible methods of prevention. 相似文献
2.
Laparoscopic Adjustable Gastric Banding: Weight Loss,Co-morbidities,Medication Usage and Quality of Life at One Year 总被引:4,自引:4,他引:0
Background: The objective of this study was to determine the weight loss, changes in co-morbidities, medication usage and
general health status at 1 year after laparoscopic adjustable gastric banding (LAGB). Methods: Prospective data were obtained
from all subjects undergoing LAGB. These measurements included a medical history and review of systems, medications, height
and weight and the SF-36 general health survey. Patients were seen for band adjustments as needed throughout the year. At
the 1-year follow-up visit, patients were weighed and interviewed about the status of their health conditions and their current
medications, and the SF-36 was repeated. Results: Between November 2002 and November 2003, 195 patients had LAGB. The majority
of subjects were female (82.8%), married (65.1%), and white (94.9%). Complications occurred in 18 subjects (9.2%). These included
3 slipped bands (1.5%), 4 port problems (2.1%), 8 patients with temporary stoma occlusion (4.1%), 1 explantation (0.5%), and
1 mortality (0.5%). Mean BMI decreased from 45.8 kg/m2 (± 7.7) to 32.3 kg/m2 (± 7.0). Mean percent excess body weight lost was 45.7% (± 17.1) during the first year. Major improvements occurred in arthritis,
asthma, depression, diabetes, gastro-esophageal reflux disease, hyperlipidemia, hypertension, joint and back pain, sleep apnea
and stress incontinence. Medication usage declined remarkably. Quality of life (QoL) by the SF-36 showed highly significant
improvements. Conclusions: At 1 year after LAGB, patients had experienced significant weight loss, resolution of comorbidities,
decreases in medication usage, and improvements in QoL. 相似文献
3.
Background: This study is a trial to compare the effects and outcomes of three different bariatric procedures performed in
two centers. Standard Roux-en-Y gastric bypass was performed by Dr. Norman Samuels in Fort Lauderdale (Florida); vertical
banded gastroplasty and laparoscopic adjustable silicone gastric banding were done in Hallein (Salzburg) by Dr. Emanuel Hell
and Dr. Karl Miller. Methods: In a prospective comparative study 30 matched patients from each group were followed to assess
post-operative improvement in health status and quality of life, to compare the three different techniques. The Bariatric
Analysis and Reporting Outcome System (BAROS) as described by Oria and Moorehead has been used for evaluation. Results:The
observation time was at least 3 years (3 to 8 years) in each individual case. A significant increase in quality of life and
health status in 75% of the surgically-treated patients was observed when compared with a non-operated control group of morbidly
obese patients. Conclusions: By utilizing BAROS it has been found possible to compare the results of different procedures
done by different surgeons with different techniques, utilizing patients from different cultures and with different languages.
The results of this comparative study favor the standard gastric bypass for the treatment of morbid obesity.This operation
is superior to purely gastric restrictive procedures in weight loss and improvement of quality of life. 相似文献
4.
Background: While Roux-en-Y gastric bypass (RYGBP) appears to be the most effective procedure for weight loss in morbidly
obese patients, objective outcome data regarding quality of life (QoL) and psychosocial status following surgery are lacking.
Methods: The present study examined the effects of RYGBP in 32 morbidly obese subjects on a variety of outcome measures including
QoL and psychosocial functioning. Assessments were conducted before surgery, 1 to 3 weeks post-surgery, and at 6- month follow-up.
Results: In addition to weight loss, results show significant improvements in health-related QoL, depression, and self-esteem,
as well as a significant reduction in eating pathology following surgery. Results also show that neither the presence of binge-eating
disorder nor clinical depression predicted poorer outcome post-surgery. Conclusion: RYGBP results in a dramatic reduction
in weight, and marked improvements in health-related QoL, depression, self-esteem, and eating pathology, including binge-eating
in the short term. These findings need to be replicated in a larger cohort of patients and followed for a longer time before
we can reach more definitive conclusions regarding the psychosocial outcome in RYGBP. 相似文献
5.
Binge Eating,Quality of Life and Physical Activity Improve after Roux-en-Y Gastric Bypass for Morbid Obesity 总被引:3,自引:3,他引:0
Background: Severe obesity has been associated with disordered eating, impaired quality of life (QoL), and decreased physical activity.This
study examines changes in these variables 6 months after Roux-en-Y gastric bypass (RYGBP). Methods: 40 morbidly obese patients were evaluated at baseline and at 6 months after RYGBP on the following measures: Binge Eating
Scale, Three Factor Eating Questionnaire, Impact of Weight on Quality of Life-Lite (IWQoL-Lite), and the Baseline Questionnaire
of Activity. Results: 6 months after RYGBP, weight loss averaged 26.7%, and scores on measures of disordered eating, weight-related QoL, and physical
activity showed statistically significant improvement from baseline. At the time of follow-up, 100% of participants achieved
a score on the Binge Eating Scale that indicated no binge eating problems, and weight-related QoL scores approached those
obtained by a reference sample of community volunteers. There were also improvements in the level of self-reported physical
activity and television watching behavior. Conclusions: RYGBP resulted in significant improvements in disordered eating, weight-related QoL, and physical activity in addition to
weight loss. 相似文献
6.
Background: Early gastrointestinal (GI) hemorrhage after open gastric bypass has been infrequently reported. The aim of this
study was to examine the incidence of early GI hemorrhage after laparoscopic Roux-en-Y gastric bypass (LRYGBP), its presentation,
and possible treatment options. Methods: A retrospective review of 5 patients who developed early postoperative GI hemorrhage
after LRYGBP was performed.The charts were reviewed for demographics, clinical presentation, diagnostic evaluation, and treatment.
All patients underwent a transected LRYGBP with creation of the gastrojejunostomy anastomosis with a circular stapler and
the jejunojejunostomy anastomosis with a linear stapler. Results: Of the 155 patients in our database who underwent LRYGBP,
5 (3.2%) developed early clinical GI hemorrhage. There were 2 males with an average age of 40 years. Clinical presentations
of GI hemorrhage were hematemesis (2 patients), bright red blood per rectum (1 patient), melena (1 patient), and hypotension
(1 patient). A diagnostic study (nuclear scintigraphy) was performed in only 1 of 5 patients. 3 of 5 patients were managed
nonoperatively; 2 patients required fluid and blood resuscitation, and the other patient was managed without blood transfusion.
The onset of hemorrhage in these 3 patients occurred 24 hours postoperatively or later. 2 of 5 patients required operative
intervention for control of hemorrhage. The onset of hemorrhage or hypotension in these 2 patients occurred within 12 hours
after surgery. The sites of hemorrhage were at the gastric remnant staple-lines in 1 patient and at the gastrojejunostomy
and gastric remnant staple-lines in the other patient. Conclusion: Early GI hemorrhage is a potential complication after transected
LRYGBP. Early reoperative intervention should be performed for patients with hemodynamic instability and patients with early
onset of hemorrhage after surgery. 相似文献
7.
Pinto D Carrodeguas L Soto F Lascano C Cho M Szomstein S Rosenthal R 《Obesity surgery》2006,16(3):365-368
Gastric bezoar is an uncommon complication following Roux-en-Y gastric bypass (RYGBP). We report two cases of bezoar formation
that occurred following laparoscopic RYGBPs. In both cases, the patients presented with abdominal pain, nausea, and "frothy"
vomiting. The patients were successfully treated by endoscopic fragmentation and removal of the bezoar. 相似文献
8.
Health-Related Quality of Life in Patients Seeking Gastric Bypass Surgery vs Non-Treatment-Seeking Controls 总被引:3,自引:3,他引:0
Background: Previous research has found that health-related quality of life (HRQOL) differs among obese individuals depending
on treatment-seeking status, with greater impairments found in obese individuals seeking treatments of greatest intensity.
The goals of this study were to determine: 1) if there are differences in obesity-specific HRQOL between seekers of gastric
bypass surgery and non-treatment-seeking controls; and, 2) if the presence and number of co-morbid conditions impacts on HRQOL.
Methods: Participants were 339 surgical cases (mean age 42.9, mean BMI 47.7, 85.5% women) and 87 controls (mean age 48.8,
mean BMI 43.5, 71.3% women). Obesity-specific HRQOL was assessed using the Impact of Weight on Quality of Life-Lite (IWQOL-Lite).
Subjects were given a detailed medical history to determine the presence of co-morbid conditions. Results: After controlling
for BMI, age, and gender, obesity-specific HRQOL was significantly more impaired (P<.001) in the surgery-seeking group than in the control group on all 5 scales and total score of the IWQOL-Lite. For total
score, physical function and sexual life, there was increasing impairment with increasing number of co-morbid conditions.
Treatment-seeking status, BMI, gender, and the presence of depression accounted for most of the variance in IWQOL-Lite total
score. Conclusions: Persons seeking gastric bypass expe rience poorer HRQOL than non-treatment-seeking individuals after controlling
for BMI, age, and gender. The presence of co-morbid conditions contributes to some aspects of HRQOL impairment. 相似文献
9.
A 44-year-old woman was admitted from the emergency department with severe acute upper abominal pain. The patient had undergone
a laparoscopic Roux-en-Y gastric bypass (RYGBP) operation 16 months previously. CT scan showed intraabdominal free air. At
emergency laparoscopic reoperation, a perforated ulcer at the gastrojejunostomy was found. This late complication of RYGBP
can be a rapidly progressing life-threatening situation, and requires prompt treatment. Closure and omental patch were successful
laparoscopically. 相似文献
10.
Anastomotic Leaks after Laparoscopic Gastric Bypass 总被引:1,自引:0,他引:1
The gastrojejunostomy may be the most technically challenging step when performing laparoscopic Roux-en-Y gastric bypass.
Patients who develop anastomotic leaks have increased morbidity and mortality rates. Difficulty in diagnosis is related to
nonspecific systemic symptoms and limitations in most radiological studies. Our aim is to evaluate the incidence, etiology,
diagnosis, management, and prevention of anastomotic leaks occurring in patients undergoing laparoscopic Roux-en-Y gastric
bypass. 相似文献
11.
Revision of Failed Laparoscopic Adjustable Gastric Banding to Roux-en-Y Gastric Bypass 总被引:3,自引:3,他引:0
Background: The most common bariatric surgical operation in Europe, laparoscopic adjustable gastric banding (LAGB), is reported
to have a high incidence of long-term complications. Also, insufficient weight loss is reported. We investigated whether revision
to Roux-en-Y gastric bypass (RYGBP) is a safe and effective therapy for failed LAGB and for further weight loss. Methods:
From Jan 1999 to May 2004, 613 patients underwent LAGB. Of these, 47 underwent later revisional Roux-en-Y gastric bypass (RYGBP).
Using a prospectively collected database, we analyzed these revisions. All procedures were done by two surgeons with extensive
experience in bariatric surgery. Results: All patients were treated with laparoscopic (n=26) or open (n=21) RYGBP after failed
LAGB. Total follow-up after LAGB was 5.5±2.0 years. For the RYGBP, mean operating time was 161±53 minutes, estimated blood
loss was 219±329 ml, and hospital stay was 6.7±4.5 days. There has been no mortality. Early complications occurred in 17%.
There was only one late complication (2%) – a ventral hernia. The mean BMI prior to any form of bariatric surgery was 49.2±9.3
kg/m2, and decreased to 45.8±8.9 kg/m2 after LAGB and was again reduced to 37.7±8.7 kg/m2 after RYGBP within our follow-up period. Conclusion: Conversion of LAGB to RYGBP is effective to treat complications of LAGB
and to further reduce the weight to healthier levels in morbidly obese patients. 相似文献
12.
Background: Bariatric surgery has the potential for serious complications. A case is presented of unilateral lower extremity
compartment syndrome after a laparoscopic Roux-en-Y gastric bypass performed in the modified lithotomy position. Case report:
A 38-year-old female (weight 134.5 kg, BMI 49.6) underwent a laparoscopic Roux-en-Y gastric bypass (operating time 375 min).
Postoperatively, she complained of bilateral lower extremity pain that gradually subsided over the course of the day. However,
on the 1st postoperative day she developed numbness on the dorsum of the foot and compartment syndrome was diagnosed (anterior
compartment pressure 71 mmHg). She underwent emergency fasciotomy,which resulted in a reduction of the pain and numbness on
the dorsum of the foot. The next day she ambulated without difficulty and was discharged home on the 5th postoperative day.
12 days after her operation, delayed primary closure of the fasciotomy wound was done with the assistance of a novel device
(Proxiderm) that applies constant tension to the wound edges. Subsequent recovery was uneventful, and at 4- month follow-up
the patient had a weight loss of 28 kg without any right leg motor or sensory deficits. Conclusion: Bariatric surgeons should
be aware of compartment syndrome as a rare but serious complication. Prevention, early recognition, and prompt fasciotomy
are crucial for a favorable outcome. 相似文献
13.
Gastrointestinal Quality of Life Following Laparoscopic Adjustable Gastric Banding in Asia 总被引:5,自引:5,他引:0
Background: Laparoscopic adjustable gastric banding (LAGB) is a safe and effective treatment for morbid obesity. Previous
studies in Western countries disclosed a significant improvement in co-morbidities and health-related quality of life. Data
from Asia and regarding the specific GI quality of life following LAGB are lacking. Methods: From May 2002 to May 2005, 107
consecutive patients – 48 men and 59 women, with mean age 31.4 years (range 17-57 years) with morbid obesity (mean weight
115.8 kg, range 81-174 kg; mean BMI 41.3 kg/m2, range 32.0-59.8 kg/m2) underwent LAGB in a prospective trial. All bands were placed via the pars flaccida technique. Quality of life was measured
by the Gastrointestinal Quality of Life Index (GIQLI), a 36item questionnaire before LAGB, and at 3, 6, 12 and 24 months after
surgery. Results: All procedures were performed laparoscopically with no conversions. There was neither intra-operative complications
nor major postoperative complications. Minor complications occurred in 3 patients (2.8%); all were transient stoma obstruction.
At follow-up, only one band (0.94%) was removed at 3 months postoperatively because of the patient's intolerance. No gastric
slippage occurred. 4 patients (3.7%) had tubing problems and required revision surgery for port adjustment. Mean BMI decreased
from 41.3 to 33.1 after 2 years. Percent excess BMI loss averaged 48.1% at 2 years (range 6.7-139.2). All co-morbidities were
eliminated significantly. 80% of patients were satisfied with the results at 2 years. However, the GIQLI score remained similar
before and after surgery. Preoperative score was 110.8+15 points. The score became 116.2+13, 114.7+13, 108.5+14 and 107.2+17
at 3, 6, 12 and 24 months. The patients had improvement in 3 domains of general health (social, physical and emotional functions),
but decrease in the domain of symptoms. Conclusion: Although LAGB was successful in weight loss and resolution of co-morbidities
in morbidly obese patients, the GIQLI did not improve. This feature will be the major disadvantage of LAGB. 相似文献
14.
Higa-Sansone G Szomstein S Soto F Brasecsco O Cohen C Rosenthal RJ 《Obesity surgery》2004,14(8):1132-1134
Background: Psoriasis is a chronic skin disease characterized by epithelial hyperplasia and an accelerated rate of epithelial
turnover affecting approximately 1-3% of the population. Exogenous and endogenous factors including morbid obesity can increase
the morbidity of psoriasis. Case Report: A 55-year-old male, who weighed 131 kg with BMI 41 kg/m2, underwent laparoscopic Roux-en-Y gastric bypass (LRYGBP). He had a 15-year duration of severe psoriasis and was being medically
treated. At 12 months after LRYGBP, he had lost 39 kg (68% EWL), and had complete resolution of the psoriasis and had discontinued
all preoperative medications related to the disease. At 2 years after LRYGBP, psoriasis has not recurred. Conclusion: Weight
loss after LRYGBP should be considered as a strategy in the treatment of severe psoriasis in morbidly obese patients. 相似文献
15.
Quality of life (QoL) is an important measure of outcome after bariatric surgery. Impairment in QoL has been well documented
in morbidly obese patients before undergoing bariatric surgery and has been shown to improve significantly within 3 months
after the operative intervention. Improvement in QoL should be recognized as one of the benefits of bariatric surgery that
can be quantified. 相似文献
16.
Prospective Randomized Comparison of Linear Staplers during Laparoscopic Roux-en-Y Gastric Bypass 总被引:3,自引:0,他引:3
Background: The development of laparoscopic linear staplers has enabled minimally invasive approaches to bariatric surgery,
but there have been no comparison studies of the two current 6-row devices. We report our experience with a prospective randomized
comparison of 6-row linear staplers during laparoscopic Roux-en-Y gastric bypass (LRYGBP). Methods: From January to March
2003, 100 patients were randomly assigned to undergo LRYGBP with either an Endo-GIA Universal 6-row stapler (USSC) or the
ETS-Flex 6-row stapler (Ethicon). Mean preoperative BMI was 49±8 for 50 Endo-GIA patients, and 49±7 for 50 ETS-Flex patients.
Parameters measured included quantity of cartridges, handles, hemoclips, estimated blood loss, misfires, OR time, postoperative
leaks and bleeds, and cost. Results: Mean follow-up was 135 days (range 90- 180). The ETS-Flex group experienced significantly
more misfires (28% vs 2%, P <.001), hemoclips applied (30±9 vs 21±7, P <.001), estimated blood loss (132±56 vs 100±32 ml, P <.001) and OR time (66±19 vs 58±13 mins, P <.02) compared with the Endo-GIA group respectively.There was one postoperative leak associated with the ETS-Flex group and
two postoperative bleeds with the Endo-GIA group, which were not a significant differences.The Endo-GIA group averaged $319
more per case for staple cost. Conclusion: While the ETS-Flex stapler was less expensive, it was associated with more technical
failures requiring surgeon intervention to reduce potential patient morbidity, compared with the Endo-GIA. 相似文献
17.
Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is associated with a significant learning curve. We hypothesize
that differences in surgeon and assistant training backgrounds may significantly impact outcomes during the learning curve.
Methods: Retrospective analysis was performed on patients undergoing LRYGBP at an academic medical center between January
1998 and August 2003. Operations were performed by surgeons with different training backgrounds: without formal laparoscopic
fellowship (S1, n=95); immediately following laparoscopic fellowship (S2, n=100); and with extensive laparoscopic experience
post fellowship (S3, n=88). First assistants were attendings, fellows, or residents. The variables analyzed included demographics,
operative times, estimated blood loss (EBL), rate of conversion, length of stay (LOS), ICU stay, re-operation/re-admission
rate, and complications. Results were analyzed by ANOVA and Fisher's exact test. Results: There were significant differences
among surgeons of different training backgrounds in EBL, LOS, rate of ICU admission, and intraoperative and late complications
rates. Among assistants of different training levels, there were significant differences in operative time, EBL, intraoperative
complication rates and re-admission rates. Conclusions: Differences in training background of the surgeons resulted in significant
differences in outcome, including EBL, LOS, ICU admission and intraoperative and late complication rates. Lower assistant
training levels significantly impacted efficiency through lengthened operative times and increased EBL, as well as increased
intraoperative complication rates and re-admission rates. Our results suggested that participating in a laparoscopic fellowship
and operating with a more experienced assistant may improve outcomes during the learning curve. 相似文献
18.
Clements RH Gonzalez QH Foster A Richards WO McDowell J Bondora A Laws HL 《Obesity surgery》2003,13(4):610-614
Background: Currently there are few reports comparing gastrointestinal (GI) symptoms in the morbidly obese versus control
subjects or the effect of laparoscopic Roux-en-Y gastric bypass (LRYGBP) on such symptoms. Methods: A previously validated,
19-point GI symptom questionnaire was administered prospectively to each patient undergoing LRYGBP, and the questionnaire
was re-administered 6 months postoperatively. Six symptom clusters (abdominal pain, irritable bowel [IBS], reflux, gastroesophageal
reflux disease [GERD], sleep disturbances, and dysphagia) were compared in the following manner using Students t-test: 1)
Control vs. Preop, 2) Control vs Postop, and 3) Preop vs Postop. Results are expressed as mean ± standard deviation, significance
P=0.05. Results: 43 patients (40 female and 3 male, age 37.3 ± 8.6, BMI 47.8 ± 4.9) completed the questionnaire preoperatively,
and 36 patients (34 female, 2 male, BMI 31.6 ± 5.3) completed the questionnaire 6 months postoperatively, for a response-rate
of 84%. Abdominal pain, IBS, reflux, GERD and sleep disturbance symptoms were significantly worse in preop versus controls.
Dysphagia was not different. Postop vs preop scores revealed abdominal pain, IBS, GERD, reflux, and sleep disturbance symptoms
to be improved significantly. Dysphagia was not significantly different. Only dysphagia was worse when comparing postoperative
to controls. No other symptom cluster was significantly different in controls vs postoperative. Conclusions: Morbidly obese
patients experience more intense GI symptoms than control subjects, and many of these symptoms return to control levels 6
months after LRYGBP. Dysphagia is equivalent to control subjects preoperatively but increases significantly after LRYGBP.
This data suggests another quality-of-life improvement (relief of GI symptoms) for morbidly obese patients. Further follow-up
is needed to document the long-term reduction of GI symptoms. 相似文献
19.
Liver transplantation has become a life-saving procedure for patients with end-stage liver disease. Since obesity is rampant
in our society, it is not surprising that patients with a liver transplant suffer from obesity as well. In addition, Roux-en-Y
gastric bypass (RYGBP) is a life-saving procedure for patients suffering from morbid obesity. However, a liver transplant
is an extensive and invasive abdominal procedure. Further operations after orthotopic liver transplantation may be challenging.
With increasing surgeon experience and technical advancements in laparoscopic equipment, previous abdominal surgery is no
longer a contraindication to utilize the laparoscopic approach for RYGBP. In fact, herein, we describe the first laparoscopic
RYGBP after orthotopic liver transplantation in the world literature. 相似文献
20.
Small Bowel Obstruction and Internal Hernias after Laparoscopic Roux-en-Y Gastric Bypass 总被引:10,自引:7,他引:3
Background: Small bowel obstruction (SBO) is a recognized complication of open bariatric surgery; however, the incidence after
laparoscopic procedures is not clearly established. This paper reviews our experience with small bowel obstruction after laparoscopic
Roux-en-Y gastric bypass. Methods: Between 1995 and 2001, 711 (246 antecolic, 465 retrocolic) patients underwent a laparoscopic
proximal divided Roux-en-Y gastric bypass via the linear endostapler technique. 13 patients (1.8%) developed SBO requiring
surgical intervention.There were 11 females and 2 males, ages 29-60 (mean 38), with mean weight 126 kg (range 105-188), and
mean BMI 50 (range 41-59). 7 obstructive patients (55%) had undergone previous open abdominal surgery. Median time to obstruction
was 21 days (range 5-1095). Mean follow-up of all patients is 43 months (range 3-79). Results: Etiology of obstruction was
internal hernia - 6, adhesive bands - 5 (only 2 were related to prior open surgery), mesocolon window scarring - 1, and incarcerated
ventral hernia - 1. The incidence of SBO was 4.5% (11/246) in the retrocolic group, and 0.43% (2/465) in the antecolic group,
which was highly significant (P=.006). 1 adhesive patient required an open bowel resection for ischemia. There was 1 death. Conclusion: SBO occurred with
an overall incidence of 1.8% in a large series of laparoscopic gastric bypass patients, and was associated with a high morbidity.
A significant decrease in occurrence was found after adoption of antecolic placement of the Roux limb. 相似文献