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Lower Glycemic Fluctuations Early After Bariatric Surgery Partially Explained by Caloric Restriction
S. Yip M. Signal G. Smith G. Beban M. Booth R. Babor J. G. Chase R. Murphy 《Obesity surgery》2014,24(1):62-70
Background
We assessed the acute impact of laparoscopic Roux-en-Y gastric bypass (GBP) or sleeve gastrectomy (SG) compared to caloric-matched control group without surgery on glucose excursion in obese patients with type 2 diabetes, and examined if this was mediated by changes in insulin resistance, early insulin response or glucagon-like peptide (GLP)-1 levels.Methods
Six-day subcutaneous continuous glucose monitoring (CGM) recordings were obtained from patients beginning 3 days before GBP (n?=?11), SG (n?=?10) or fasting in control group (n?=?10). GLP-1, insulin and glucose were measured during 75 g oral glucose tolerance testing at the start and end of each CGM.Results
Post-operative hyperglycaemia occurred after both surgeries in the first 6 h, with a more rapid decline in glycaemia after GBP (p?<?0.001). Beyond 24 h post-operatively, continuous overlapping of net glycaemia action reduced from baseline after GBP (median [interquartile range]) 1.6 [1.2–2.4] to 1.0 [0.7–1.3] and after SG 1.4 [0.9–1.8] to 0.7 [0.7–1.0]; p?<?0.05), similar to controls (2.2 [1.7–2.5] to 1.3 [0.8–2.8] p?<?0.05). Higher log GLP-1 increment post-oral glucose occurred after GBP (mean ± SE, 0.80?±?0.12 vs. 0.37?±?0.09, p?<?0.05), but not after SG or control intervention. Among subgroup with baseline hyperglycaemia, a reduction in HOMA-IR followed GBP. Reduction in time and level of peak glucose and 2-h glucose occurred after both surgeries but not in controls.Conclusions
GBP and SG have a similar acute impact on reducing glycaemia to caloric restriction; however, with a superior impact on glucose tolerance. 相似文献3.
Liying Zhao Yanan Wang Hao Liu Hao Chen Haijun Deng Jiang Yu Qi Xue Guoxin Li 《Journal of gastrointestinal surgery》2014,18(5):1003-1009
Background
The role of laparoscopic surgery for advanced transverse colon cancer (TCC) remains controversial, especially in terms of long-term oncologic outcomes.Methods
This retrospective cohort study enrolled 157 consecutive patients who underwent curable resections for advanced TCC between January 2002 and June 2011 (laparoscopic-assisted colectomy (LAC), n?=?74; open colectomy (OC), n?=?83). Short-term outcomes and oncologic long-term outcomes were compared between the two groups.Results
Compared to the OC group, patients in the LAC group had less blood loss (LAC vs. OC, 79.6?±?70.3 vs. 158.4?±?89.3 ml, p?<?0.001), faster return of bowel function (2.6?±?0.7 vs. 3.8?±?0.8 days, p?<?0.001), and shorter postoperative hospital stay (10.3?±?3.7 vs. 12.6?±?6.0 days, p?=?0.007). Conversions were required in four (5.4 %) patients. Rates of short-term complication, mortality, and long-term complication were comparable between the two groups. The median follow-up time was 54 (26–106) months in the LAC group and 58 (29–113) months in the OC group (p?=?0.407). There were no statistical differences in the rates of 5-year overall survival (73.6 vs. 71.1 %, p?=?0.397) and 5-year disease-free survival (70.5 vs. 66.7 %, p?=?0.501) between the two groups.Conclusions
Laparoscopic surgery for advanced TCC yield short-term benefits while achieving equivalent long-term oncologic outcomes. 相似文献4.
Beatriz Gras-Miralles Jenny Rosario Haya José Manuel Ramon Moros Albert Goday Arnó Sandra Torra Alsina Lucas Ilzarbe Sánchez Jordi Muñoz Galitó Inés-Ana Ibáñez Zafón M. Carmen Alonso Romera Alejandra Parri Bonet Felip Bory Ros Montserrat Andreu Garcia Sílvia Delgado-Aros 《Obesity surgery》2014,24(12):2138-2144
5.
Julián Varas Ricardo Mejía Arnoldo Riquelme Felipe Maluenda Erwin Buckel José Salinas Jorge Martínez Rajesh Aggarwal Nicolás Jarufe Camilo Boza 《Surgical endoscopy》2012,26(12):3486-3494
Background
Simulation may provide a solution to acquire advanced laparoscopic skills, thereby completing the curriculum of residency programs in general surgery. This study was designed to present an advanced simulation-training program and to assess the transfer of skills to a live porcine model.Methods
First-year residents were assessed in a 14-session advanced laparoscopic training program followed by performing a jejunojejunostomy in a live porcine model. Previous and after training assessments at the bench model were compared to a single performance of six expert laparoscopic surgeons. Results obtained by trainees at the porcine model assessment were compared to those of 11 general surgeons without any laparoscopic lab-simulation training and 6 expert laparoscopic surgeons. In all assessments, global and specific OSATS scores, operative time, and covered path length of hands were registered.Results
Twenty-five residents improved significantly their global and specific OSATS score median at the bench model [7 (range, 6?C11) vs. 23 (range, 21?C24); p?<?0.05 and 7 (range, 4?C8) vs. 18 (range, 18?C19); p?<?0.05, respectively] and obtained significantly better scores on the porcine model compared with general surgeons with no lab-simulation training [21 (range, 20.5?C21) vs. 8 (range, 12?C14); p?<?0.05]. The results were comparable to those achieved by expert certificated bariatric surgeons. Total path lengths registered for trainees were more efficient post-training and significantly lower compared with general surgeons on the porcine model [7 (range, 6?C11) vs. 23 (range, 21?C24); p?<?0.05] with no statistical difference compared with experts.Conclusions
Trainees significantly improved their advanced laparoscopic skills to a level compared with expert surgeons. More importantly, these acquired skills were transferred to a more complex live model. 相似文献6.
Casagrande DS Repetto G Mottin CC Shah J Pietrobon R Worni M Schaan BD 《Obesity surgery》2012,22(8):1287-1292
Background
Roux-en-Y gastric bypass (RYGB) surgery is the gold standard surgical treatment for obesity. However, unintended nutritional deficiencies following this surgery are common, including changes in bone metabolism. We assessed changes in bone mineral density (BMD), nutritional compounds, and bone resorption markers before and 1?year following RYGB surgery.Methods
Our study included 22 female patients with class II/III obesity. A clinical questionnaire, a 24-h recall, blood and urine samples, and dual-energy X-ray absorptiometry were provided.Results
Mean age was 37.2?±?9.6?years; 86?% were Caucasian and 77.2?% were premenopausal. Mean preoperative body mass index was 44.4?±?5.0 and 27.5?±?4.5?kg/m2 at 1-year follow-up (p?0.001). 25-OH-vitamin D-levels were similar in both periods [11.7 (9.7?C18.0) vs. 15.7 (10.2?C2.7) pg/dL, p?=?0.327]. Serum N-telopeptide (16.3?±?3.4 vs. 38.2?±?7.0 nM BCE, p?0.001) and parathyroid hormone (45.4?±?16.7 vs. 62.7?±?28.9?pg/mL, p?=?0.026) increased after RYGB surgery, reflecting bone resorption. BMD decreased after RYGB surgery in the lumbar spine (1.13?±?0.11 vs. 1.04?±?0.09?g/cm2, p?=?0.001), femoral neck (1.03?±?0.15 vs. 0.94?±?0.16?g/cm2, p?=?0.001), and total femur (1.07?±?0.11 vs. 0.97?±?0.15?g/cm2, p?=?0.003).Conclusions
Decreased BMD in the lumbar spine, femoral neck, and total femur is detectable in women 1?year after RYGB surgery. Calcium malabsorption, caused by vitamin D deficiency and increased bone resorption, is partially responsible for these outcomes and should be targeted in future clinical trials. 相似文献7.
Constantinos Nastos Konstantinos Kalimeris Nikolaos Papoutsidakis George Defterevos Agathi Pafiti Helen Kalogeropoulou Loukia Zerva Tzortzis Nomikos Georgia Kostopanagiotou Vasillios Smyrniotis Nikolaos Arkadopoulos 《Journal of gastrointestinal surgery》2011,15(5):809-817
Background
This study aims to evaluate whether injury of gut mucosa in a porcine model of post-hepatectomy liver dysfunction can be prevented using antioxidant treatment with desferrioxamine.Methods
Post-hepatectomy liver failure was induced in pigs combining major (70%) liver resection and ischemia/reperfusion injury. An ischemic period of 150 minutes, was followed by reperfusion for 24 h. Animals were randomly divided into a control group (n?=?6) and a desferrioxamine group (DFX, n?=?6). DFX animals were treated with continuous IV infusion of desferrioxamine 100 mg/kg. Intestinal mucosal injury (IMI), bacterial and endotoxin translocation (BT) were evaluated in all animals. Intestinal mucosa was also evaluated for oxidative markers.Results
DFX animals had significantly lower IMI score (3.3?±?1.2 vs. 1.8?±?0.9, p?<?0.05), decreased BT in the portal circulation at 0 and 12 h of reperfusion (p?=?0.007 and p?=?0.008, respectively), decreased portal endotoxin levels at 6 (p?=?0.006) and 24 h (p?=?0.004), decreased systemic endotoxin levels (p?=?0.01) at 24 h compared to controls. Also, 24 h post-reperfusion mucosal malondialdehyde and protein carbonyls were decreased in DFX animals compared to controls (4.1?±?1.2 vs. 2.5?±?1.2, p?=?0.05 and 0.5?±?0.1 vs. 0.4?±?0.1, p?=?0.04 respectively).Conclusion
Desferrioxamine seems to attenuate mucosal injury from post-hepatectomy liver dysfunction possibly through blockage of iron-catalyzed oxidative reactions. 相似文献8.
Sangoh Lee Andrew R. Davies Sameer Bahal Daniel M. Cocker Gianluca Bonanomi Jeremy Thompson Evangelos Efthimiou 《Obesity surgery》2014,24(9):1425-1429
Background
Different gastrojejunal anastomotic (GJA) techniques have been described in laparoscopic Roux-en-Y gastric bypass (LRYGB). There is conflicting data on whether one technique is superior to the other. We aimed to compare hand-sewn (HSA), circular-stapled (CSA) and linear-stapled (LSA) anastomotic techniques in terms of stricture rates and their impact on subsequent weight loss.Methods
A prospectively collected database was used to identify patients undergoing LRYGB surgery between March 2005 and May 2012. Anastomotic technique (HSA, CSA, LSA) was performed according to individual surgeon preference. The database recorded patient demographics, relevant comorbidities and the type of GJA performed. Serial weight measurements and percentage excess weight loss (%EWL) were available at defined follow-up intervals.Results
Included in the data were 426 patients, divided between HSA (n?=?174, 40.8 %), CSA (n?=?110, 25.8 %) and LSA (n?=?142, 33.3 %). There was no significant difference in the stricture rates (HSA n?=?17, 9.72 %; CSA n?=?9, 8.18 %; LSA n?=?8, 5.63 %; p?=?0.4006). Weight loss was similar between the three techniques (HSA, CSA and LSA) at 3 months (40.6 %?±?16.2 % vs 35.92 %?±?21.42 % vs 48.21 %?±?14.79 %; p?=?0.0821), 6 months (61.48 %?±?23.94 % vs 58.16 %?±?27.31 % vs 60.18 %?±?22.26 %; p?=?0.2296), 12 months (72.94 %?±?19.93 % vs 69.72?±?21.42 % vs 66.05 %?±?17.75 %; p?=?0.0617) and 24 months (73.29 %?±?22.31 % vs 68.75 %?±?24.71 % vs 69.40 %?±?23.10 %; p?=?0.7242), respectively. The stricture group lost significantly greater weight (%EWL) within the first 3 months compared to the non-stricture group (45.39 %?±?16.82 % vs 39.22 %?±?21.93 %; p?=?0.0340); however, this difference had resolved at 6 months (61.29 %?±?18.50 % vs 59.79 %?±?23.03 %; p?=?0.8802) and 12 months (71.59 %?±?18.67 % vs 68.69 %?±?22.19 %; p?=?0.5970).Conclusions
There was no significant difference in the rate of strictures between the three techniques, although the linear technique appears to have the lowest requirement for post-operative dilatation. The re-intervention rate will, in part, be dictated by the threshold for endoscopy, which will vary between units. Weight loss was similar between the three anastomotic techniques. Surgeons should use techniques that they are most familiar with, as stricture and weight loss rates are not significantly different. 相似文献9.
Vilma Dzenkeviciūte Zaneta Petrulioniene Virginijus Sapoka Sigita Aidietiene Lina Abaraviciute 《Obesity surgery》2014,24(11):1961-1968
Background
Herein, we investigate the anthropometric, biochemical and left ventricle (LV) geometry changes following the laparoscopic adjustable gastric banding (LAGB) operation in morbidly obese individuals.Methods
Eighty-three morbidly obese participants (mean age, 46.1?±?11.5 years; 30.1 % men), scheduled for elective LAGB were examined before and 12 months after the surgery. LV geometry and diastolic function were investigated by 2-dimensional echocardiography, whereas laboratory tests assessed the glycaemic, serum lipid and inflammatory marker profiles.Results
Twelve months after the operation, body mass index (BMI) decreased from 46.9?±?7.2 kg/m2 to 40.1?±?8.2 kg/m2 (p?0.05), which was associated with the significant improvements in glycaemic control, inflammatory state, LV end-diastolic diameter (53.6?±?4.6 mm vs. 52.9?±?4.1 mm, p?0.05), LV mass (223.6?±?61.3 vs. 215.4?±?52.7 g, p?0.05) and LV mass index (53.9?±?14.1 g/m2.7 vs. 52.0?±?12.3 g/m2.7, p?0.05). However, no overall improvements in LV geometry or the prevalence of LV hypertrophy subtypes were recorded 12 months after the LAGB. The reduction in LV end-diastolic diameter (ß?=?0.56, p?=?0.0001) and BMI (ß?=?0.26, p?=?0.015) were both associated with diminished LV mass. Additionally, a statistically significant correlation between LV mass and changes in BMI (R?=?0.29, p?=?0.007), waist circumference (R?=?0.32, p?=?0.004), LV end-diastolic diameter (R?=?0.63, p?=?0.0001) and E-wave deceleration time (R?=??0.24, p?=?0.03) were observed within our study population.Conclusions
LV mass decreases 12 months after LAGB surgery, but no improvements in LV geometry and function occur. The regression of LV mass is better predicted by weight loss than by reduction in blood pressure or changes in metabolic parameters. 相似文献10.
Paul Robert Burton Kenneth Yap Wendy A. Brown Cheryl Laurie Matthew O’Donnell Geoff Hebbard Victor Kalff Paul E. O’Brien 《Obesity surgery》2010,20(12):1690-1697
Background
The laparoscopic adjustable gastric band (LAGB) has previously been classified as a restrictive procedure; physically limiting meal size. Recently, the key mechanism has been hypothesized to be the induction of satiety without restriction. Effects can be controlled by modifying LAGB volume, possibly as a result of effects on gastric emptying or transit through the LAGB.Methods
Successful LAGB patients underwent paired, double blinded, esophageal transit and gastric emptying scintigraphic studies; with the LAGB at optimal volume and near empty. A new technique allowed assessment of emptying and transit through the infra- and supraband compartments.Results
Fourteen of 17 patients completed both scans (six males; mean age, 48.9?±?11.3 years, % excess weight loss 69.0?±?15.2). At optimal volume a delay in transit of semi-solids into the infraband compartment was observed in ten patients vs. three when the LAGB was empty, (p?=?0.01). The median retention of a meal in the supraband compartment immediately after cessation of intake was: empty 2.8% (2.3–7.9) vs. optimal 3.6% (1.7–4.5), (p?=?0.57). Overall gastric emptying half time (minutes) was normal at both volumes: optimal 64.2?±?29.8 vs. empty 95.2?±?64.1, (p?=?0.14). LAGB volume did not affect satiety before the scan: optimal 4.3?±?1.9 vs. empty 4.0?±?2.2, (p?=?0.49), or 90 min later: optimal 6.1?±?1.9 vs. empty 5.9?±?1.4, (p?=?0.68).Conclusions
The optimally adjusted LAGB briefly delays semi-solid transit into the infraband stomach without physically restricting meal size. The supraband compartment is usually empty of an ingested meal 1–2 min after intake ceases and overall gastric emptying is not affected. 相似文献11.
Tomasz Rogula Christopher Daigle Monica Dua Hideharu Shimizu Jonathan Davis Olga Lavryk Ali Aminian Philip Schauer 《Obesity surgery》2014,24(7):1102-1108
Background
The application of single-incision laparoscopic surgery (SILS) in bariatric patients has been limited to less complex procedures. We evaluated the short-term outcomes of SILS sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), compared to a group of well-established minimally invasive techniques.Methods
Twenty-eight morbidly obese patients who underwent SILS SG (n?=?14) and RYGB (n?=?14) were compared to a matched control group composed of 28 cases of conventional laparoscopic surgery (CLS). A single vertical 2.5–3-cm intra-umbilical incision, three-ports placed trans-fascially, and a liver suspension technique were used to perform SILS.Results
Both groups were comparable in terms of age (p?=?0.96), gender (p?=?1.0), type of procedure (p?=?1.0), and number of comorbidities (p?=?0.63). Two (7 %) SILS patients required placement of one additional port, and no conversions to CLS or open surgery were needed. The estimated blood loss (p?=?0.48), operative time (p?=?0.33), length of hospital stay (p?=?0.79), overall 90-day perioperative complication rate (p?=?1.0), and short-term weight loss (p?=?0.53) were comparable between the two groups. In terms of pain control, the frequency of patient-controlled analgesia use in both groups was similar. However, the pain score (assessed by visual analog scale) was significantly less for SILS patients on postoperative days 1 (5.0?±?2.1 vs. 6.5?±?1.8; p?=?0.007) and 2 (4.0?±?2.0 vs. 5.1?±?2.4; p?=?0.49). Cosmetic satisfaction with the scar was high in the SILS group. No patients required reoperation or readmission during the 90 days after surgery.Conclusion
SILS is feasible in carefully selected bariatric patients and results in short-term outcomes comparable to those observed after CLS. Improved pain and cosmesis are potential benefits of SILS. 相似文献12.
Ido Mizrahi Abbas Alkurd Muhammad Ghanem Diaa Zugayar Haggi Mazeh Ahmed Eid Nahum Beglaibter Ronit Grinbaum 《Obesity surgery》2014,24(6):855-860
Background
Morbidity and mortality following laparoscopic sleeve gastrectomy (LSG) occur at acceptable rates, but its safety and efficacy in the elderly are unknown.Methods
A retrospective review was performed of all patients aged >60 years who underwent LSG from 2008 to 2012. These patients were 1:2 matched, by gender and body mass index (BMI) to young patients, 18?<?age?<?50. Data analyzed included demographics, preoperative and postoperative BMI, postoperative complications, and improvement or resolution of obesity-related comorbidities.Results
Fifty-two morbid obese patients older than 60 years underwent LSG (mean age, 62.9?±?0.3 years). These were matched to 104 young patients, age 18–50 years (mean age, 35.7?±?0.8 years). Groups did not differ in male gender (44 vs. 43 %, p?=?0.9), preoperative BMI (42.6?±?0.7 vs. 42.6?±?0.6, p?=?0.97), and length of follow-up (17?±?2 vs. 22?±?1.4 months, p?=?0.06). Obesity-related comorbidities were significantly higher in the older group (96 vs. 65 %, p?<?0.001). Excess weight loss (EWL) was higher in the younger group (75?±?2.4 vs. 62?±?3 %, p?=?0.001). Older patients had a significantly higher rate of a concurrent hiatal hernia repair (23 vs. 1.9 %, p?<?0.001). Overall postoperative minor complication rate was higher in the older group (25 vs. 4.8 %, p?<?0.001). This included atrial fibrillation (9.5 %), urinary tract infection (7 %), trocar site hernia (4 %), dysphagia, surgical site infection, bleeding, bowel obstruction, colitis, and nutritional deficiency (2 %, each). No perioperative mortality occurred. Comorbidity resolution or improvement was comparable between groups (88 vs. 80 %, p?=?0.13).Conclusions
LSG is safe and very efficient in patients aged >60, despite higher rates of perioperative comorbidities. 相似文献13.
Kolozsvari NO Kaneva P Brace C Chartrand G Vaillancourt M Cao J Banaszek D Demyttenaere S Vassiliou MC Fried GM Feldman LS 《Surgical endoscopy》2011,25(7):2063-2070
Background
Little evidence exists to guide educators in the best way to implement simulation within surgical skills curricula. This study investigated whether practicing a basic Fundamentals of Laparoscopic Surgery (FLS) simulator task [peg transfer (PT)] facilitates learning a more complex skill [intracorporeal suturing (ICS)] and compared the effect of PT training to mastery with training to the passing level on PT retention and on learning ICS.Methods
For this study, 98 surgically na?ve subjects were randomized to one of three PT training groups: control, standard training, and overtraining. All the participants then trained in ICS. The learning curves for ICS were analyzed by estimating the learning plateau and rate using nonlinear regression. Skill retention was assessed by retesting participants 1?month after training. The groups were compared using analysis of variance (ANOVA). Effectiveness of skill transfer was calculated using the transfer effectiveness ratio (TER). Data are presented as mean?±?standard deviation (p?0.05).Results
The study was completed by 77 participants (28 control, 26 standard, and 23 overtrained subjects). The ICS learning plateau rose with increasing PT training (452?±?10 vs. 459?±?10 vs. 467?±?10; p?0.01). Increased PT training was associated with a trend toward higher initial ICS scores (128?±?107 vs. 127?±?110 vs. 183?±?106; p?=?0.13) and faster learning rates (15?±?4 vs. 14?±?4 vs. 13?±?4 trials; p?=?0.10). At retention, there were no differences in PT scores (p?=?0.5). The PT training took 20?±?10?min for standard training and 39?±?20?min for overtraining (p?0.01). Overtrained participants saved 11?±?5?min in ICS training compared with the control subjects (p?=?0.04). However, TER was 0.165 for the overtraining group and 0.160 for the standard training group, suggesting that PT overtraining took longer than the time saved on ICS training.Conclusion
For surgically na?ve subjects, part-task training with PT alone was associated with slight improvements in the learning curve for ICS. However, overtraining with PT did not improve skill retention, and peg training alone was not an efficient strategy for learning ICS. 相似文献14.
Solomon D Shariff AH Silasi DA Duffy AJ Bell RL Roberts KE 《Surgical endoscopy》2012,26(10):2823-2827
Objective
This report describes the first prospective cohort study comparing transvaginal cholecystectomies (TVC) with single incision laparoscopic cholecystectomies (SILC) and four-port laparoscopic cholecystectomies (4PLC).Methods
Between May 2009 and August 2010, 14 patients underwent a TVC. These patients were compared with patients who underwent SILC (22 patients) or 4PLC (11 patients) in a concurrent, randomized, controlled trial. Demographic data, operative time, numerical pain scales, complications, and return to work were recorded.Results
Mean age (TVC: 33.5?±?3.0?year; SILC: 38.4?±?3.3?year; 4PLC: 35.5?±?4.1?year; p?=?0.58) and mean BMI (TVC: 28.8?±?1.5?kg/m2; SILC: 31.8?±?1?kg/m2; 4PLC: 31.4?±?2.2?kg/m2; p?=?0.35) were not statistically significant. However, mean operative time (TVC: 67?±?3.9?min; SILC: 48.9?±?2.6?min; 4PLC: 42.3?±?3.9?min; p?0.001) was significantly longer for TVC. Numerical pain scales showed significantly lower pain scores on POD 1 and 3 for TVC compared with SILC and 4PLC (TVC: 4.1?±?0.5 and 2.9?±?0.7; SILC: 6.1?±?0.5 and 5.3?±?0.5; 4PLC: 5.7?±?0.4 and 4.7?±?0.3; p?=?0.02) with equilibration of pain scores by days 14 and 30. Return to work (TVC: 6.4?±?1.5?days; SILC: 13.1?±?1.3?days; 4PLC: 14.1?±?1.4?days; p?0.001) also was significantly faster for patients in the TVC group. One conversion in the TVC group to a 4PLC was necessary due to adhesions within the pelvis. One dislodged IUD was seen and immediately replaced in the TVC group. One hernia was observed in the SILC group.Conclusions
Transvaginal cholecystectomy is a safe and well-tolerated procedure with statistically significantly less pain at 1 and 3?days after surgery, with a faster return to work but longer operative times compared with single incision and four-port laparoscopic cholecystectomy. 相似文献15.
Ortega E Morínigo R Flores L Moize V Rios M Lacy AM Vidal J 《Surgical endoscopy》2012,26(6):1744-1750
Background
Bariatric surgery (BS) is widely accepted for the treatment of patients with morbid obesity (MO). We aimed to determine presurgical predictors of and surgical technique-related differences in excess weight loss (EWL) 1?year after BS.Methods
This retrospective study included 407 subjects (F/M 3:1, median age?=?44?years) who underwent laparoscopic Roux-en-Y gastric bypass (RYGB, n?=?307) or sleeve gastrectomy (SG, n?=?100) at our University Hospital and were evaluated 1?year after surgery.Results
Baseline median (min–max) body mass index (BMI) was 47?kg/m2 (range?=?36–71). BMI was higher in the SG than in the RYGB group (53 vs. 46?kg/m2, p?0.0001). Simple correlation analysis showed negative associations between EWL and age, BMI, waist circumference (WC), fasting glucose, HbA1c, triglycerides (TG), blood pressure, and total cholesterol (all p?0.01). EWL (mean?±?SD) did not differ by gender (p?=?0.2), was lower in diabetic than in nondiabetic subjects (71?±?17% vs. 79?±?17%, p?0.0001), and higher in the RYGB vs. SG group (76?±?18% vs. 68?±?15%, p?0.0001). However, SG vs. RYGB differences in EWL disappeared (p?=?0.4) after taking into account baseline BMI. Multiple regression and logistic analysis showed that younger individuals with lower BMI but higher WC, and lower HbA1c and TG, had higher EWL and a higher rate of successful (EWL?≥?60%) weight loss.Conclusions
Our data indicate that some of the characteristics that would have subjects referred early for BS were associated with higher weight loss. Therefore, the timing of laparoscopic BS might be an important factor for MO individuals in which medical weight loss intervention has failed. 相似文献16.
Background
Hyperparathyroidism is much more common in women and therefore may represent different diseases in men and women. In order to understand the role of gender in hyperparathyroidism, we reviewed our experience.Methods
We analyzed a prospective database of 1309 consecutive patients with primary hyperparathyroidism who underwent parathyroidectomy at our institution between March 2001 and August 2010.Results
The female-to-male ratio was 3.3:1, and female patients were older at presentation (60?±?0 vs. 57?±?1?years, p?0.005). Male patients were more commonly asymptomatic at presentation (25?% vs. 18?%, p?=?0.005) and the most common symptom for men was kidney stones (23?% vs. 13?%, p?0.0001). For patients with bone density scans, osteoporosis was more common in women (34?% vs. 17?%, p?0.0001). Men had a slightly higher preoperative serum calcium level (11.1?±?0 vs. 11.0?±?0?mg/dl, p?=?0.03), higher parathyroid hormone level (140?±?7 vs. 124?±?4?pg/ml, p?=?0.04), higher urinary calcium level (376?±?10 vs. 314?±?5?mg/24?h, p?0.005), and lower vitamin D level (28?±?1 vs. 32?±?0?ng/ml, p?0.005). Men were more likely to have abnormally elevated creatinine values (15?% vs. 9?%, p?=?0.004). The operative approach as well as the number of glands involved and their location did not significantly differ between the groups. The mean gland weight for a single adenomas was higher in male patients (1123?±?128 vs. 636?±?32?mg, p?=?0.001). No significant difference was identified in the immediate and remote postoperative course.Conclusions
Hyperparathyroidism appears to present differently depending on gender. Male patients more often present without symptoms, present with vitamin D deficiency, and have larger parathyroid glands. Importantly, surgical outcomes were equivalent between men and women. 相似文献17.
Hadar Spivak Moshe Rubin Eran Sadot Esther Pollak Anya Feygin David Goitein 《Obesity surgery》2014,24(7):1090-1093
Background
The optimal size of bougie in laparoscopic sleeve gastrectomy (LSG) remains controversial. The aim of this study was to evaluate the first-year outcome of LSG using two different sizes of bougies.Methods
This study used a single institute retrospective case-control study of two groups of patients. Group A (N?=?66) underwent LSG using 42-Fr and group B (N?=?54) using 32-Fr bougies. A medication score was applied to assess the change in comorbid conditions.Results
Groups A and B's age (39.5?±?12 vs. 43.6?±?12.3 years), weight (119?±?17 vs. 120?±?20), and BMI (42.8?±?3.8 vs. 43.6?±?6.9 kg/m2), respectively, were comparable (p?=?NS). Comorbid conditions were type 2 diabetes (T2DM) in 19 (29 %) vs. 23 (43 %) patients, hypertension in 22 (33 %) vs. 18 (33 %) patients, and gastroesophageal reflux (GERD) in 28 (42 %) vs. 10 (19 %) patients, respectively. At 1 year, group A vs. B BMI was (29.4?±?5 vs. 30?±?5 kg/m2) and excess weight loss was 67 vs. 65 %, respectively (p?=?NS). Postoperatively, T2DM (79 vs. 83 %), hypertension (82 vs. 61 %), and GERD (82 vs. 60 %) (p?=?NS), respectively, in groups A vs. B did not require previous medications anymore. Complications were comparable.Conclusions
Our data suggest that using a 42-Fr or 32-Fr bougie does not influence LSG first-year weight loss or resolution of comorbid conditions. Long-term data is needed to conclude this issue. 相似文献18.
Background
Patients undergoing abdominal surgery for Crohn??s disease are predisposed to recurrence requiring reoperation. The effectiveness of laparoscopic versus open resection in patients with previous intestinal resection for Crohn??s through midline laparotomy is controversial.Methods
Patients with previous open resection for intestinal Crohn??s disease undergoing elective laparoscopic surgery for recurrent bowel disease from 1997 to 2011 were case-matched with open counterparts based on age (±5?years), gender, body mass index (±2?kg/m2), American Society of Anesthesiologists (ASA) score, surgical procedure, and year of surgery (±3?years). Groups were compared using Chi-square or Fisher exact tests for categorical and the Wilcoxon rank-sum test for quantitative data.Results
26 patients undergoing laparoscopic ileocolectomy (n?=?14), proctocolectomy (n?=?5), small bowel resection (n?=?4), abdominoperineal resection (n?=?1), extended right colectomy (n?=?1), and strictureplasty (n?=?1) were well matched to 26 patients undergoing open surgery. The number of previous operations, disease phenotypes, steroid use, and comorbidities were comparable in the two groups. There were no deaths, and three patients (12?%) required conversion because of adhesions. Laparoscopic and open groups had statistically similar operating times (169 versus 158?min, p?=?0.94), estimated blood loss (222 versus 427?ml, p?=?0.32), overall morbidity (39 versus 69?%, p?=?0.051), reoperation rates (8 versus 0?%, p?=?0.5), postoperative return of bowel function (3.5?±?1.4 versus 3.9?±?1.7?days, p?=?0.3), mean length of hospital stay (6.4?±?6.2 versus 6.9?±?3.5?days, p?=?0.12), and readmission rates (8 versus 12?%, p?=?0.64). Wound infection rate was decreased after laparoscopic surgery (0 versus 27?%, p?=?0.01).Conclusions
Surgery for recurrent Crohn??s disease in patients with previous primary resection through laparotomy can be frequently and safely completed laparoscopically. Wound infection rates are reduced, but the recovery advantages of a minimally invasive approach are not maintained when compared with open surgery. The decision to operate laparoscopically should therefore be carefully calibrated. 相似文献19.
Background
Morbidly obese (MO) patients are at increased risk for postoperative anesthesia-related complications. We evaluated the role of sugammadex versus neostigmine in the quality of recovery from profound rocuronium-induced neuromuscular blockade (NMB) in patients with morbid obesity.Methods
We studied 40 female MO patients who received desflurane and remifentanil anesthesia for laparoscopic removal of adjustable gastric banding. NMB was achieved with rocuronium. At the end of the surgical procedure, complete reversal of NMB was obtained with sugammadex (SUG group, n?=?20) or neostigmine plus atropine (NEO group, n?=?20) in the presence of profound NMB.Results
No difference in surgical time or anesthetic drugs was found between the groups. Anesthesia time was significantly greater in the NEO group than in the SUG group (95?±?21 vs. 47.9?±?6.4 min, p?<?0.0001), which was mainly due to a longer time to reach a train-of-four ratio (TOFR)?≥?0.9 in the NEO group (48.6?±?18 vs. 3.1?±?1.3 min, p?<?0.0001) during reversal of profound NMB. Upon admission to the postanesthesia care unit, level of SpO2 (p?=?0.018), TOFR (p?<?0.0001), ability to swallow (p?=?0.0027), and ability to get into bed independently (p?=?0.022) were better in the SUG group than in the NEO group. Patients in the SUG group were discharged to the surgical ward earlier than patients in the NEO group were (p?=?0.013).Conclusions
Sugammadex allowed a safer and faster recovery from profound rocuronium-induced NMB than neostigmine did in patients with MO. Sugammadex may play an important role in fast-track bariatric anesthesia 相似文献20.
Edward L. Jones Thomas N. Robinson Jennifer R. McHenry Christina L. Dunn Paul N. Montero Henry R. Govekar Greg V. Stiegmann 《Surgical endoscopy》2012,26(11):3053-3057