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1.
Escalona A Devaud N Boza C Pérez G Fernández J Ibáñez L Guzmán S 《Surgical endoscopy》2007,21(5):765-768
Background Roux-en-Y gastric bypass (RYGBP) is currently one of the most frequently performed procedures for the surgical treatment of
morbid obesity. The success of this procedure’s restrictive component requires a small gastrojejunostomy (GJ), which occasionally
results in stenosis. The treatment of choice for this complication is balloon dilation. This study aimed to evaluate the feasibility
and safety of ambulatory management for stenosis of the GJ using endoscopically guided Savary–Gilliard dilators.
Methods Between January 1998 and October 2003, 769 patients underwent RYGBP. The mean age of these patients was 38 ± 12 years, and
their mean body mass index (BMI) was 43 ± 6 kg/m2. Of these 769 patients, 520 (68%) underwent open surgery and 249 (32%) underwent laparoscopic RYGBP. Patients suspected of
GJ stenosis were referred for upper gastrointestinal endoscopy. Those who presented with stenosis were managed endoscopically
with Savary–Gilliard dilators.
Results Stenosis at the GJ was confirmed in 53 patients (6.9%). A total of 71 dilations were performed for these patients, resulting
in a mean of 1.3 dilations per patient. One dilation was needed for 41 patients (75.5%), two dilations for 9 patients (16.9%),
three dilations for 3 patients (5.7%), and four dilations 1 patient (1.9%). The patients subjected to open RYGBP required
a mean of 1.57 dilations, and those who had laparoscopic RYGBP required mean of 1.08 dilations. The mean time for the first
dilation was 51 ± 28 days after surgery (range, 20–178 days). All the dilations were performed in ambulatory settings. One
patient (1.9%) was admitted after GJ dilation for pain. He was discharged without symptoms after 2 days with no need for invasive
procedures.
Conclusions The management and treatment of GJ stenosis after RYGBP can be effectively accomplished in ambulatory settings using endoscopically
guided Savary–Gilliard dilators, with good and safe results.
Presented at the 9th World Congress of Endoscopic Surgery, Cancún, México, February 2004 相似文献
2.
Alfalah H Philippe B Ghazal F Jany T Arnalsteen L Romon M Pattou F 《Obesity surgery》2006,16(2):147-150
Background: Laparoscopic bariatric operations can be technically challenging in massively obese patients. The potential of
the intragastric balloon for preoperative weight reduction was evaluated in candidates for laparoscopic Roux-en-Y gastric
bypass (LRYGBP) with super obesity. Methods: From January 2004 to March 2005, 10 patients with super obesity who were potential
candidates for LRYGBP were included in a prospective observational study. An intragastric balloon was placed endoscopically
under general anesthesia. Patients were then followed by a multidisciplinary team until removal of the balloon after 6 months.
Weight, BMI, and percent excess weight lost (%EWL) were monitored after 1, 3 and 6 months. Results: The 10 patients were all
female with mean ± SD age of 33±11 years (range 17-51). Initial weight was 175±25 kg (range 135-223) and initial BMI was 64±7
kg/m2 (range 59-78). After completion of 1, 3 and 6 months, weight, BMI, and %EWL reached respectively: 166±27 kg*, 165±27 kg*,
and 169±26 kg*; 61.1±7.6 kg/m2*, 60.8±8.4 kg/m2*, and 61±8.2 kg/m2*; 9±5%, 10±7%, 7±6%. (*=P<0.01 vs preop). Conclusion: In potential candidates for LRYGBP with super obesity, preoperative placement of an intragastric
balloon can reduce the excess weight by 10% within 3 months. Extending this period failed to improve these results further. 相似文献
3.
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
4.
Background: We tested the hypothesis that the amount of weight lost after Roux-en-Y gastric bypass (RYGBP) correlates with
plasma ghrelin levels. Methods: 36 morbidly obese patients were studied 3 years after RYGBP (6 men, 30 women) with mean initial
BMI 51 kg/m2 and 8 healthy controls (2 men, 6 women) with mean BMI 25 kg/m2. Subjects consumed a light breakfast, and the first blood sample was drawn at 1200 hrs immediately before lunch and the second
sample at 1400 hrs. Satiety was assessed using a Visual Analog Scale (VAS). Patients were stratified as success (current BMI
<35) or failures (current BMI ≥35). Results: Plasma ghrelin levels were significantly lower in patients after RYGBP (269 ±
66 pcg/ml) compared with lean controls (616 ± 112 pcg/ml, P<0.001). Ghrelin levels pre or post meals were not different between patients who had a successful weight loss (preoperative
BMI 47, current BMI 29, 72% EWL) or those who achieved a less then ideal weight loss (preoperative BMI 48, current BMI 41,
29% EWL). There was no correlation between any of the VAS scores and plasma ghrelin. There was a strong inverse correlation
between pre-prandial ghrelin levels and the preoperative or current BMI. Conclusion: Failure to lose weight after RYGBP does
not correlate with pre- or post-prandial ghrelin plasma levels. Ghrelin levels were inversely proportional to BMI and did
not correlate with satiety. These data do not support a role for higher plasma ghrelin levels for inadequate weight loss after
RYGBP. 相似文献
5.
Ballantyne GH Svahn J Capella RF Capella JF Schmidt HJ Wasielewski A Davies RJ 《Obesity surgery》2004,14(8):1042-1050
Background: The number of weight reduction operations performed for type II and type III obesity is rapidly escalating. Risk
of surgery has been infrequently stratified for patient subgroups. The purpose of this study was to identify patient characteristics
that increased the odds of a prolonged hospital length of stay (LOS) following open or laparoscopic Roux-en-Y gastric bypass
(RYGBP). Methods: The hospital records of 311 patients who underwent RYGBP in a 6-month period were retrospectively reviewed.
Patient characteristics including the presence of significant obesity-related medical conditions were recorded. Analysis was
based on intent to treat. Univariate and step-wise logistic regression analysis was used to identify the odds ratio (OR) and adjusted odds ratio (AOR) for predictors of an increased hospital LOS. Results: Datasets for 311 patients were complete. 159 patients underwent
open vertical banded gastroplasty-Roux-en-Y gastric bypass (VBG-RYGBP) and 152 laparoscopic RYGBP (LRYGBP). 78% of patients
were female. Median age was 40 years (range 18-68). Median BMI was 49 kg/m2 (range 35-82). 17% of patients had sleep apnea, 18% asthma, 19% type 2 diabetes, 13% hypercholesterolemia and 44% hypertension.
Median length of surgery for open VBG-RYGBP (64 minutes) was significantly faster than for LRYGBP (105 minutes). Median length
of stay was significantly shorter for LRYGBP (2 days) than open VBG-RYGBP (3 days). Univariate logistic regression analysis
identified 6 predictors of increased LOS: open surgery (0.4 OR); increasing BMI (60 kg/m2 0.38 OR; BMI 70 kg/m2 0.53 OR); increasing length of surgery (120 min 0.33 OR; 180 min 0.48 OR); sleep apnea (2.25 OR); asthma (3.73 OR); and hypercholesterolemia
(3.73 OR). Subset analysis identified patients with the greatest odds for a prolonged hospital stay: women with asthma (2.47
AOR) or coronary artery disease (8.65 AOR); men with sleep apnea (5.54 OR) or the metabolic syndrome (6.67 – 10.20 OR); and
patients undergoing a laparoscopic operation with sleep apnea (11.53 AOR) or coronary artery disease (12.15 AOR). Conclusions:
Open surgery, BMI, length of surgery, sleep apnea, asthma and hypercholesterolemia all increased the odds of a prolonged LOS.
Patients with the greatest odds of long LOS were women with asthma or coronary disease, men with sleep apnea or the metabolic
syndrome, and patients undergoing laparoscopic surgery with sleep apnea or coronary artery disease. Patients at high-risk
for prolonged hospital stay can be identified before undergoing RYGBP. Surgeons may wish to avoid high-risk patients early
in their bariatric surgery experience. 相似文献
6.
Ledoux S Msika S Moussa F Larger E Boudou P Salomon L Roy C Clerici C 《Obesity surgery》2006,16(8):1041-1049
Background: Roux-en-Y gastric bypass (RYGBP) is more efficient than adjustable gastric banding (AGB) in weight loss and relieving co-morbidities,
but nutritional complications of each surgical procedure have been poorly evaluated. Methods: A cross-sectional study was performed to compare nutritional parameters in 201 consecutive obese patients, who had been treated
either by conventional behavioral and dietary therapy (CT, n=110) or by bariatric surgery, including 51 AGB and 40 RYGBP.
Results: BMI was similar after AGB (36.6 ± 5.3 kg/m2) and RYGBP (35.4 ± 6.3 kg/m2), but patients in the RYGBP group had lost more weight and had less metabolic disturbances than those in the AGB group. On
the other hand, the prevalence of nutritional deficits was significantly higher in the RYGBP group than in the 2 other groups
(P <0.01), whereas the AGB group did not differ from CT. Particularly, the RYGBP group presented an unexpected high frequency
of deficiencies in fat-soluble vitamins. Moreover, vitamin B12, hemoglobin, plasma prealbumin and creatinine concentrations were low in the RYGBP group. Conclusion: RYGBP is more efficient than AGB in correcting obesity, but this operation is associated with a higher frequency of nutritional
deficits that should be carefully monitored. 相似文献
7.
Silecchia G Boru CE Mouiel J Rossi M Anselmino M Tacchino RM Foco M Gaspari AL Gentileschi P Morino M Toppino M Basso N 《Obesity surgery》2006,16(2):125-131
Background: Gastro-jejunal anastomotic leak and internal hernia can be life-threatening complications of laparoscopic Roux-en-Y
gastric bypass (LRYGBP), ranging from 0.1-4.3% and from 0.8-4.5% respectively. The safety and efficacy of a fibrin glue (Tissucol?) was assessed when placed around the anastomoses and over the mesenteric openings for prevention of anastomotic leaks and
internal hernias after LRYGBP. Methods: A prospective, randomized, multicenter, clinical trial commenced in January 2004.
Patients with BMI 40-59 kg/m2, aged 21-60 years, undergoing LRYGBP, were randomized into: 1) study group (fibrin glue applied on the gastro-jejunal and
jejuno-jejunal anastomoses and the mesenteric openings); 2) control group (no fibrin glue, but suture of the mesenteric openings).
322 patients, 161 for each arm, will be enrolled for an estimated period of 24 months. Sex, age, operative time, time to postoperative
oral diet and hospital stay, early and late complications rates are evaluated. An interim evaluation was conducted after 15
months. Results: To April 2005, 204 patients were randomized: 111 in the control group (mean age 39.0±11.6 years, BMI 46.4±8.2)
and 93 in the fibrin glue group (mean age 42.9±11.7 years, BMI 46.9±6.4). There was no mortality or conversion in both groups;
no differences in operative time and postoperative hospital stay were recorded. Time to postoperative oral diet was shorter
for the fibrin glue group (P=0.0044). Neither leaks nor internal hernias have occurred in the fibrin glue group. The incidence of leaks (2 cases, 1.8%)
and the overall reoperation rate were higher in the control group (P=0.0165). Conclusion: The preliminary results suggest that Tissucol? application has no adverse effects, is not time-consuming, and may be effective in preventing leaks and internal hernias
in morbidly obese patients undergoing LRYGBP. 相似文献
8.
Lessons Learned from the First 100 Cases in a New Minimally Invasive Bariatric Surgery Program 总被引:7,自引:4,他引:3
Background:Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is a technically demanding procedure with a steep learning curve.
Experienced laparoscopic surgeons and bariatric surgeons can learn from the outcomes and complications of their initial experience
in LRYGBP.n Methods: Between August of 2002 and July of 2003, we performed our first 100 LRYGBPs. Our surgical technique involves
the ante-colic, ante-gastric placement of the Roux-limb. A 21-mm circular stapler is used to create the gastrojejunostomy.
The stapler anvil is placed transgastrically.n Results:The mean preoperative BMI was 49.7 kg/m2 (range 37-70). 12% of patients were male. Early complications (14%) included 3 leaks, 4 bleeding episodes and 2 gastrogastric
fistulas. There was 1 peri-operative mortality and 1 conversion to laparotomy. Late complications (17%) included stenosis
of the gastrojejunostomy which occurred in 14 patients. Leaks occurred more commonly in males (16% vs 1%, P<0.05). Elevated BMI was also found to be a risk factor for leak (BMI 58.7 leak vs 49.3 no leak, P<0.05). Stenosis was often associated with other complications such as leak or marginal ulcer. Stenosis responded well to
endoscopic dilation. Co-morbid medical conditions responded to weight loss in all patients, regardless of initial BMI. Mean
excess weight loss was 69% at 1 year, but varied according to preoperative BMI. Conclusions: Careful recording of patient
outcomes and complications is important, particularly in a new minimally invasive bariatric surgery program. Review and analysis
of specific complications may help to minimize the occurrence of similar subsequent complications. 相似文献
9.
Increased Serum Amyloid A Concentrations in Morbid Obesity Decrease after Gastric Bypass 总被引:2,自引:2,他引:0
Gómez-Ambrosi J Salvador J Rotellar F Silva C Catalán V Rodríguez A Jesús Gil M Frühbeck G 《Obesity surgery》2006,16(3):262-269
Background: Obesity is considered a state of low-grade chronic inflammation, which may favor the development of cardiovascular
diseases. Serum amyloid A (SAA) is an acute phase protein synthesized in response to infection, inflammation, injury, and stress. The aim of the present
study was to compare the circulating concentrations of SAA and the mRNA expression in omental adipose tissue between lean
and obese individuals and to analyze the effect of weight loss after gastric bypass. Methods: 16 lean volunteers (BMI 20.5
± 0.6 kg/m2) and 24 obese patients (BMI 47.0 ± 1.2 kg/m2) were included in the study. Serum concentrations of SAA were measured by ELISA. In addition, the concentrations of SAA in
18 morbidly obese patients (7 male/11 female; BMI 44.6 ± 1.9 kg/m2) were measured before and after weight loss following Roux-en-Y gastric bypass (RYGBP). SAA expression in omental adipose
tissue was quantified by RT-PCR in biopsies from obese patients undergoing RYGBP and from age-matched lean individuals subjected
to Nissen fundoplication. Results: Obese patients exhibited significantly increased circulating SAA concentrations (6.6 ±
0.5 vs 39.3 ± 9.1 μg/ml; P<0.01) compared to lean subjects. A significant positive correlation was found between logSAA and body fat (r=0.631, P<0.0001). Obese patients showed significantly increased (P<0.05) mRNA expression of SAA in omental adipose tissue compared to lean subjects. Weight loss significantly decreased SAA
concentrations after RYGBP (final BMI 28.5 ± 0.9 kg/m2, P<0.0001 vs initial) from 47.5 ± 14.5 to 15.7 ± 2.9 μg/ml (P<0.05). Conclusion: It can be concluded that serum SAA and mRNA expression of SAA in omental adipose tissue are increased
in obese patients contributing to the obesity-associated cardiovascular disease risk. Moreover, weight loss reduces SAA concentrations,
which may contribute to the beneficial effects accompanying weight reduction. 相似文献
10.
Álvaro Ferraz Josemberg Campos Victor Dib Lyz B. Silva Patrícia S. de Paula Amador Gordejuela Felippe Rolim Luciana Siqueira Manoel Galvão Neto 《Obesity surgery》2013,23(7):959-964
Background
Roux-en-Y gastric bypass (RYGBP) controls obesity and comorbidities. However, there is no consensus on ring placement due to its complications. Surgical ring removal has been the standard approach, despite its inherent morbidity risks. Endoscopic dilation with achalasia balloon is a novel and minimally invasive option. We aimed to evaluate safety and efficacy of aggressive dilation as an outpatient procedure to treat food intolerance after banded RYGBP without stenosis; we also analyzed long-term weight regain.Methods
This prospective study included 63 patients presenting with more than four vomiting episodes per week. Therapeutic endoscopy with a 30-mm balloon (Rigiflex®) was performed with radioscopic guidance in the first 16 patients (25.4 %). Four dilation sessions were performed in 12 patients (19 %), three in 14 (22.2 %), two in 24 (38 %), and one in 13 (20.6 %).Results
Complete symptom improvement was achieved in 59 patients (93.6 %), partial improvement in 2 (3.2 %), and failure in 2, leading to ring removal by laparotomy. Complications rate was 9.5 %, including three cases of bleeding, two intragastric ring erosions, and one pneumoperitoneum; all treated clinically with no need for reintervention. Mean preoperative body mass index (BMI) was 42.4 kg/m2 and postoperative (before endoscopic treatment) BMI was 25.3 kg/m2. At a mean follow-up of 46.1 months after endoscopic intervention, mean BMI was 27.8 kg/m2.Conclusions
Aggressive endoscopic dilation for food intolerance is a safe and minimally invasive method that promotes symptom improvement. It avoided reoperation in 96.8 % of patients and led to a low rate of weight regain. 相似文献11.
Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is an effective operation for morbidly obese patients who have
failed conservative weight loss treatments. It is currently indicated for patients with BMI >40 kg/m2 or >35 with significant co-morbidities. Controversy exists whether there is an upper limit to BMI beyond which this operation
should not be performed. Methods: Between April 1999 and February 2001, 82 patients (19 male, 63 female) underwent LRYGBP.
Average age was 43.6, and average BMI was 56 kg/m2. These patients were divided into those with BMI <60 and those with BMI ≥60 kg/m2. Results:There were 61 patients with BMI <60 and 21 patients with BMI ≥60. The groups were similar in age, gender, distribution
or incidence of co-morbid conditions (diabetes, coronary artery disease, hypertension, sleep apnea, asthma) between the groups.
The BMI ≥60 group had a significantly longer length of stay (6.6 days vs 5.3 days, P <0.05), and only 1 patient (BMI 85) developed an anastomotic leak and died. 2 patients in this group (BMI 62 and 73) developed
small bowel obstruction requiring lysis of adhesions. 1 patient in the BMI <60 group developed a gastrojejunal stricture requiring
balloon dilatation. Conclusion: While patients with a BMI ≥60 are at higher risk for postoperative complications, they are
also at higher risk from continued extreme obesity. In our series, 85% of these patients had an uneventful postoperative course
and began shedding excess weight. BMI ≥60 should not be a contraindication for LRYGBP. 相似文献
12.
Background The aim of this study was to evaluate the changes of micronutrients in patients with morbid obesity after laparoscopic Roux-en-Y
gastric bypass surgery (LRYGBP).
Methods We retrospectively reviewed 121 patients diagnosed with morbid obesity who undertook LRYGBP and evaluated the serum iron (Fe),
calcium (Ca), zinc (Zn), selenium (Se), vitamin A (VitA), 25-hydroxy vitamin D3 (VitD), vitamin B12 (VitB12), and parathormone (PTH) measured at 6, 12, and 24 months after LRYGBP.
Results During a follow-up period of 69 months (June 1999 to February 2005), a cohort of 121 patients, 40 men and 81 women, underwent
LRYGBP, a mean age of 46 years (range 22–67). The mean body mass index (BMI) before LRYGBP was 47.00 ± 7.15 kg/m2 (range 30.65–76.60 kg/m2). After 6 months of the surgery, the mean BMI was 33.79 ± 6.06 kg/m2 (range 21.70–52.76 kg/m2). The mean BMI decreased (P < 0.001) 6 months after the surgery. Within the following 2 years, the serum Fe, Ca, Zn, Se, VitA, VitD, and VitB12 had normalized. The serum Zn, Se, and VitA of some patients decreased but were nearly normal. In contrast, serum PTH remained
continuously at a higher level than normal.
Conclusions This study confirms that LRYGBP is a reliable and safe weight loss method for the patients suffering from morbid obesity.
After surgery, serum Ca, Zn, and Se metabolisms and PTH levels are altered in these patients. Therefore, multi-vitamin and
mineral supplementation are strongly recommended in all patients after LRYGBP. 相似文献
13.
Silecchia G Boru CE Mouiel J Rossi M Anselmino M Morino M Toppino M Gaspari A Gentileschi P Tacchino R Basso N 《Surgical endoscopy》2008,22(11):2492-2497
Background
Published interim results have shown that fibrin sealant (Tissucol®/Tisseel® Baxter AG, Vienna, Austria) may be effective in preventing anastomotic leaks and internal hernias following laparoscopic Roux-en-Y gastric bypass (LRYGBP). We report the final results of a multicenter, randomized clinical trial evaluating the use of fibrin sealant in LRYGBP.Methods
Between January 2004 and December 2005, 340 patients aged 21–65 years with a body mass index (BMI) of 40–59 kg/m2 undergoing LRYGBP were randomized (1:1) to two treatment groups: fibrin sealant group (applied to gastrojejunal and jejunojejunal anastomoses and over mesenteric openings), and control group (no fibrin sealant; suture of the mesenteric openings). Operative time, early and late complications, reinterventions, time to oral diet initiation, and length of stay were assessed.Results
Overall, 320 patients were included into the study: 160 in the control group and 160 in the fibrin sealant group. All patients completed follow-up assessments at 6 and 12 months, and 60.9% completed assessments at 24 months. There were no significant differences between groups with respect to demographics, operative time, oral diet initiation, hospital stay, and BMI reduction at 6, 12, and 24 months. The incidence of anastomotic leak was numerically, but not significantly, greater in the control group. The overall reintervention rate for specific early complications (<30 days) was significantly higher in the control group (p = 0.016). No deaths or conversions to open laparotomy occurred.Conclusion
The use of fibrin sealant in laparoscopic RYGBP may be beneficial in reducing the reintervention rate for major perioperative (<30 days) complications. Larger studies are needed. 相似文献14.
Background:The Roux-en-Y gastric bypass (RYGBP) is one of the ideal operations for morbid obesity.The minimal invasive laparoscopic
technique has been performed to shorten the operative time and to reduce the complications of the open surgery. Methods: From
Jan 1999 through Jan 2001, laparoscopic RYGBP (LRYGBP) was attempted in 90 patients. Median age was 30, with median preoperative
BMI 47. The preoperative nutritional habits and comorbidities were recorded. LRYGBP was done by three different techniques
in three equal groups. In the first group, the gastrojejunostomy was constructed by passing the EEA anvil transorally, using
a pull-wire technique. In the second group, the gastrojejunostomy was fashioned with a totally hand-sewn technique. In the
third group, the gastrojejunostomy was performed with an endo-cutter cartridge and the anastomotic incision was closed with
an endo TA30 stapler. Results: The results were nearly identical in the three groups. Average excess weight loss at 1 year
was 70%. The mean operating time was 120 min in the first group, 100 min in the second group and 75 min in the third group.
Esophageal injury was the most common problem in the first group. Incidence of gastrojejunostomy stenosis was higher in the
second group (36.6%). Incidence of internal herniation was higher in the second (17%) and first (13.6%) groups than in the
third group (3.3%). Conclusion: Whichever technique is used to construct the gastrojejunostomy, LRYGBP is a safe, effective
and technically feasible operation for morbidly obese patients. We recommend the technique of constructing the gastrojejunostomy
with an endocutter cartridge and closing the anastomotic incision with an endo TA stapler, as it saved time and reduced the
incidence of the essential complications in gastric bypass surgery. 相似文献
15.
Helling TS 《Obesity surgery》2005,15(4):482-485
Background: Roux-en-Y gastric bypass (RYGBP) has been found to be a safe and effective operation for the morbidly obese whether
performed open or laparoscopically. Weight loss has been substantial and sustained. Less is known about those at the extremes
of obesity, with BMI ≥70 kg/m2 with regard to safety and efficacy. This study is a retrospective review of a cohort of such patients, to examine operative
experience and response to surgical treatment. Methods: A cohort of 34 patients who underwent open RYGBP at one institution
was retrospectively reviewed. All operations were performed by a single surgeon. Operative outcome was examined, including
early mortality, morbidity, need for intensive (ICU) care and hospital length of stay (LOS). Percent of excess weight lost
(EWL) and percent reduction of BMI after at least 1 year of follow-up were determined. Late mortality was assessed. Results:
There were 22 females and 12 males with mean age 42.0 + 8.1 years and mean BMI 78.3 + 8.5 kg/m2. Obstructive sleep apnea (OSA) was found in 19/34 (58%) and hypoventilation syndrome of obesity (HSO) in 11/34 (32%). There
was 1 early death (3 months) from renal failure. 7 patients (21%) developed complications, 3 major (pulmonary embolus, wound
dehiscence) and 4 minor (wound infection). 16 patients (47%) required ICU, and 12 (35%) required extended mechanical ventilation.
Hospital LOS was 10.3 ± 10.4 days for all patients. There were 4 late deaths (12%) from 7 to 36 months after RYGBP. Mean percent
EWL was 61 ± 17 and mean percent reduction in BMI was 44 ± 11. For those followed at least 36 months, weight loss was sustained
in 12/14 patients. Conclusions: RYGBP can be performed safely, even at the extremes of weight. While technically challenging,
there were no instances of intra-abdominal sepsis. Postoperative complications were few. Need for ICU and hospital LOS is
greater, reflecting the incidence of pre-existing pulmonary problems. Weight loss is significant and appears to be sustained
in most patients. Late deaths have been noted and deserve careful scrutiny. 相似文献
16.
Laparoscopic Bariatric Surgery in Super-obese Patients (BMI>50) is Safe and Effective: A Review of 332 Patients 总被引:2,自引:2,他引:0
Background: Bariatric surgery in super-obese patients (BMI >50 kg/m2) can be challenging because of difficulties in exposure of visceral fat, retracting the fatty liver, and strong torque applied
to instruments, as well as existing co-morbidities. Methods: A retrospective review of super-obese patients who underwent
laparoscopic adjustable gastric banding (LAGB n=192), Roux-en-Y gastric bypass (RYGBP n=97), and biliopancreatic diversion
with/without duodenal switch (BPD n= 43), was performed. 30day peri-operative morbidity and mortality were evaluated to determine
relative safety of the 3 operations. Results: From October 2000 through June 2004, 331 super-obese patients underwent laparoscopic
bariatric surgery, with mean BMI 55.3 kg/m2. Patients were aged 42 years (13-72), and 75% were female. When categorized by opertaion (LAGB, RYGBP, BPD), the mean age,
BMI and gender were comparable. 6 patients were converted to open (1.8%). LAGB had a 0.5%, RYGBP 2.1% and BPD 7.0% conversion
rate (P=0.02, all groups). Median operative time was 60 min for LAGB, 130 min for RYGBP and 255 min for BPD (P<0.001, all groups). Median length of stay was 24 hours for LAGB, 72 hours for RYGBP, and 96 hours for BPD (P <0.001). Mean %EWL for the LAGB was 35.3±12.6, 45.8±19.4, and 49.5±18.6 with follow-up of 87%, 76% and 72% at 1, 2 and 3
years, respectively. Mean %EWL for the RYGBP was 57.7±15.4, 54.7±21.2, and 56.8±21.1 with follow-up of 76%, 33% and 54% at
1, 2 and 3 years, respectively. Mean %EWL for the BPD was 60.6±15.9, 69.4±13.0 and 77.4±11.9 with follow-up of 79%, 43% and
47% at 1, 2 and 3 years, respectively. The difference in %EWL was significant at all time intervals between the LAGB and BPD
(P<0.004). However, there was no significant difference in %EWL between LAGB and RYGBP at 2 and 3 years. Overall perioperative
morbidity occurred in 27 patients (8.1%). LAGB had 4.7% morbidity rate, RYGBP 11.3%, and BPD 16.3% (P=0.02, all groups). There were no deaths. Conclusion: Laparoscopic bariatric surgery is safe in super-obese patients. LAGB,
the least invasive procedure, resulted in the lowest operative times, the lowest conversion rate, the shortest hospital stay
and the lowest morbidity in this high-risk cohort of patients. Rates of all parameters studied increased with increasing procedural
complexity. However, the difference in %EWL between RYGBP and LAGB at 2 and 3 years was not statistically significant. 相似文献
17.
Bowel Obstruction after Laparoscopic Roux-en-Y Gastric Bypass 总被引:5,自引:5,他引:0
Background: Bowel obstruction has been frequently reported after laparoscopic Roux-en-Y gastric bypass (LRYGBP). The aim of
this study was to review our experience with bowel obstruction following LRYGBP, specifically examining its etiology and management
and to strategize maneuvers to minimize this complication. Methods: We retrospectively reviewed the charts of 9 patients who
developed postoperative bowel obstruction after LRYGBP. Each chart was reviewed for demographics, timing of bowel obstruction
from the primary operation, etiology of obstruction, and management. Results: 9 of our initial 225 patients (4%) who underwent
LRYGBP developed postoperative bowel obstruction. The mean age was 46 ± 12 years, with mean BMI 47 ± 9 kg/m2. 6 patients developed early bowel obstruction, and 3 patients developed late bowel obstruction. The mean time interval for
development of early bowel obstruction was 16 ±16 days. The causes for early bowel obstruction included narrowing of the jejunojenunostomy
anastomosis (n=3), angulation of the Roux limb (n=2), and obstruction of the Roux limb at the level of the transverse mesocolon
(n=1). The mean time interval for development of late bowel obstruction was 7.4 ± 0.5 months. The causes for late bowel obstruction
included internal herniation (n=2) and adhesions (n=1). 6 of 9 bowel obstructions (66%) were considered technically related
to the learning curve of the laparoscopic approach. Eight of the 9 patients required operative intervention, and 6 of the
8 reoperations were managed laparoscopically. Management included laparoscopic bypass of the jejunojejunostomy obstruction
site (n=5), open reduction of internal hernia (n=2), and laparoscopic lysis of adhesion (n=1). Conclusions: Bowel obstruction
is a frequent complication after LRYGBP, particularly during the learn ing curve of the laparoscopic approach. Specific measures
should be instituted to minimize bowel obstruction after LRYGBP as most of these complications are considered technically
preventable. 相似文献
18.
Background Roux-en-Y gastric bypass (RYGBP) is presently one of the most popular surgical procedures for obesity. One of the possible
long-term problems is weight regain, usually after a period of successful weight loss. Weight regain after RYGBP can be due
to new eating habits, like sweet-eating or grazing, or volume eating because of impaired restriction. This paper reports our
experience in patients who presented weight regain after laparoscopic RYGBP, because of new appearance of volume eating or
hyperphagia, treated by the laparoscopic placement of a non-adjustable silicone ring around the gastric pouch.
Methods From July 2004 to November 2007, six patients affected by weight regain due to hyperphagic behavior, benefited from revision
of RYGBP consisting of the placement of a non-adjustable silicone ring loosely encircling the stomach part. Mean weight and
body mass index (BMI) at the time of RYGBP were 105.0 kg ± 12.3 and 36.3 ± 3.0 kg/m2, respectively, and all patients suffered from obesity-related co-morbidities. After a mean time from RYGBP of 26.0 ± 14.2 months,
patients presented a weight regain of 4.7 ± 3.4 kg compared with their minimal weight, with a final mean weight, BMI, and
percentage of excess weight loss (%EWL) at the time of the silicone ring of 86.0 ± 13.1 kg, 29.5 ± 3.9 kg/m2, and 47.0 ± 24.7%, respectively. Preoperative evaluation for each patient included history and physical examination, nutritional
and psychiatric evaluation, laboratory tests, and barium swallow check. Outcome measures included evaluation of the Roux-en-Y
construction, operative time, postoperative morbidity and mortality, and weight loss in terms of absolute weight loss, BMI,
and %EWL.
Results Any modification of the digestive circuit was evidenced. Mean operative time was 82.5 ± 18.3 min. No operative mortality and
no conversion to open surgery were achieved. No postoperative complications were achieved. Mean hospital stay was 2.6 ± 1.5 days.
After a mean follow-up of 14.0 ± 9.2 months, the six patients presented a mean weight loss of 9.1 ± 2.4 kg, with a final mean
weight, BMI, and %EWL of 76.8 ± 13.7 kg, 26.4 ± 4.2 kg/m2, and 70.4 ± 30.4%, respectively. Difference in term of %EWL before and after revision (23.4 ± 5.7) is statistically significant
(p < 0.05). There have been no erosions or slippage of the ring during this follow-up.
Conclusion One of the possible causes of weight regain after RYGBP is the new eating behavior of the patient, one of which is hyperphagia.
Treatment of this condition can be the placement of a non-adjustable silicone ring loosely fitted around the gastric pouch
which contributes to improved weight loss.
This paper was presented at the XIII World Congress of International Federation for the Surgery of Obesity and metabolic disorders,
Buenos Aires, Argentina, September 24–27, 2008. 相似文献
19.
The Decrease in Plasma Ghrelin Concentrations following Bariatric Surgery Depends on the Functional Integrity of the Fundus 总被引:7,自引:3,他引:4
Frühbeck G Diez-Caballero A Gil MJ Montero I Gómez-Ambrosi J Salvador J Cienfuegos JA 《Obesity surgery》2004,14(5):606-612
Background: Gastric bypass surgery, which involves the production of a reduced stomach pouch,has been shown to markedly suppress
circulating ghrelin concentrations. Since bypassing the ghrelin-producing cell population may be relevant to the disruption
of fundic-derived factors participating in food intake signaling, the effect of weight loss induced by either adjustable gastric
banding (AGB), Roux-en-Y gastric bypass (RYGBP) or biliopancreatic diversion (BPD) was studied. Methods: 16 matched obese
patients [35.0 + 2.4 years; initial body weight 124.8 ± 5.7 kg; body mass index (BMI) 47.1 ± 2.2 kg/m2] in whom similar weight loss had been achieved by either AGB (n=7), RYGBP (n=6) or BPD (n=3) were studied. Blood was obtained
for biochemical and hormonal analyses. Body composition was assessed by air-displacement-plethysmography. Results: Comparable
weight loss (AGB: 26.1 ± 5.1 kg; RYGBP: 32.1 ± 5.0; BPD: 31.7 ± 6.1; P=NS) and decrease in percentage body fat (AGB: 10.0 ± 1.5%; RYGBP: 14.2 ± 2.8; BPD: 10.3 ± 1.0; P=NS) induced by bariatric surgery exerted significantly different (P=0.004) effects on plasma ghrelin concentrations, depending on the surgical procedure applied (AGB: 480 ± 78 pg/ml; RYGBP:
117 ± 34; BPD: 406 ± 86). Without significant differences in BMI, body fat, glucose, triglycerides, cholesterol, insulin and
leptin levels, patients who had undergone the RYGBP exhibited statistically significant diminished circulating fasting plasma
ghrelin concentrations compared with the other two bariatric techniques which conserve direct contact of the fundus with ingested
food (P=0.003 vs AGB and P=0.020 vs BPD). Conclusion: Fasting circulating ghrelin concentrations in patients undergoing diverse bariatric operations
depend on the degree of dysfunctionality of the fundus. 相似文献
20.
Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been shown to be safe and effective. There is little data on
the outcomes in massively super-obese patients, with a body mass index (BMI) &ge60 kg/m2(super-super-obese). The goal of this study was to determine the safety and effectiveness of LRYGBP in these patients, and
compare these results to patients with a BMI <60. Methods: 213 consecutive patients undergoing LRYGBP by a single surgeon
at a university hospital were included in the study. The patients were divided into 2 groups: BMI <60 kg/m2(n=167) and BMI ≥60 kg/m2 (n=46). The 2 groups were compared with regard to perioperative complications, and postoperative weight loss. Results: Both
groups had statistically similar complication rates. There were major complications in 8 patients (5%) in the lower BMI group
and in 3 patients (7%) in the higher BMI group. There were minor complications in 9 patients (5%) in the lower BMI group and
in 4 patients (9%) in the higher BMI group. Mean percent excess weight loss (%EWL) was 64% at 1 year in the BMI <60 group
and 53% in the BMI ≥60 group. Conclusion: LRYGBP can be performed safely and effectively in super-super-obese patients (BMI
≥60). Although these patients have less %EWL than lighter patients, they still end up with a good result. Therefore, LRYGBP
should be considered a good surgical option even for patients with a BMI ≥60. 相似文献