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1.
Background Despite the initial success of primary gastric restrictive operations, many patients require revision for weight regain, mechanical
complications or intolerance to restriction. The mini-gastric bypass (MGB) for revision of failed primary restrictive procedures
was evaluated.
Methods 33 patients undergoing revisional surgery to a MGB for a failed silastic ring vertical banded gastroplasty (VBG) or a gastric
banding (GB) from June 2005 to September 2006, were reviewed at an academic institution. The patients had had a minilaparotomy.
Revision of the VBGs was further compared with revision of the GBs.
Results The MGB was completed in all except 2 patients who required Roux-en-Y gastric bypass (RYGBP) because of gastric tube damage.
Mean age was 41 years (range 20–64), preoperative BMI was 39.5 kg/m2 (range 28–58), and 20 (65%) were women. The revision was performed after an average of 36.3 months (range 12–84), and was
more time-consuming in patients with prior VBG than GB (184 vs 155 min, P = 0.007). Postoperative complications occurred in 2 (6.4%) with prior VBG, and length of hospital stay was 4.65 days (range
3–17).Mean BMI at 6 months was 30.6 (range 24.8–50.0, P < 0.001) compared with the preoperative BMI. Reflux disease was cured, and all patients noted major improvement in the eating
dimension.
Conclusion Open MGB through a previous mini-incision is a safe and effective operation for revision of failed gastric restrictive operations.
The revision procedure was technically more difficult in patients with prior VBG and hazardous in patients with prior redo
VBG. 相似文献
2.
Open vs Laparoscopic Roux-en-Y Gastric Bypass: Comparison of Operative Morbidity and Mortality 总被引:3,自引:1,他引:2
Background: Open Roux-en-Y gastric bypass (RYGBP) has proven to be an effective method for weight control for the morbidly
obese patient. With technologic and surgical skill advancement in the application of laparoscopic surgery, laparoscopic RYGBP
has also been found to be of value in surgical control of obesity. Risk/benefit ratios in comparison of the 2 methods are
undergoing definition by experience. Methods: 779 patients who underwent RYGBP between March 1, 2000 and June 30, 2002 were
evaluated retrospectively. 328 patients underwent laparoscopic RYGBP (Group A) and 451 underwent open RYGBP (Group B). All
charts and hospital records of these patients were reviewed. Questionnaires were mailed to all patients who had undergone
RYGBP. Follow-up was 5-29 months. Results: 89 patients in Group A and 162 patients in Group B experienced significant morbidity.
There were no surgical deaths in Group A and one surgical death in Group B.Weight loss profiles were the same. Significant
differences in morbidity were noted with respect to gastrojejunal stenosis (Group A = 11.6%, Group B = 4.7%, P=.0012), occurrence of ventral incisonal hernia (A=0%, B=10%, P<.00013), and wound problems (abdominal wall hematoma A=1.5%%, B=0%, P=.013; wound infection A=1.2%, B=6.2%, P=.00037). Gastrojejunal perforation was not significantly different (A=1.5%, B=0.89%, P=.50), as was true of small bowel obstruction (A=2.7%, B=3.3%, P=.68). Conclusions: Each operative approach has associated problems.Wound care problems and ventral hernias are more common
in Group B (open) and anas tomotic stenoses are more common in Group A (laparoscopic). Anastomotic leaks and small bowel obstruction
are troublesome but not statistically different in occurrence. 相似文献
3.
Dallal RM Mattar SG Lord JL Watson AR Cottam DR Eid GM Hamad G Rabinovitz M Schauer PR 《Obesity surgery》2004,14(1):47-53
Background: The safety and efficacy of bariatric surgery in patients with cirrhosis has not been well studied. Methods: A
retrospective review was conducted of patients with cirrhosis who underwent weight-loss surgery at a single institution. Results:
Out of a total of 2,119 patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGBP), 30 patients (1.4%) with cirrhosis
were identified.When compared with the entire cohort, patients with cirrhosis were significantly more prone to be heavier
(BMI 53 vs 48), older in years (age 50 vs 45), more likely to be male (RR=1.3), and have a higher incidence of diabetes (70%
vs 21%) and hypertension (67% vs 21%), P<0.05. The diagnosis of cirrhosis was made intra-operatively in 90% of patients. There were no perioperative deaths, conversions
to laparotomy, or liver-related complications. Early complications occurred in 9 patients and included anastomotic leak (1),
acute tubular necrosis (4), prolonged intubation (2), ileus (1), and blood transfusion (2). Mean length of hospital stay was
4 days (2-18). There was one late unrelated death and one patient with prolonged nausea and protein malnutrition. The average
follow-up time was 16 months (1-48). For patients >12 months postoperatively (n=15), the average percent excess weight loss
was 63±15%. Conclusion: Laparoscopic RYGBP in the cirrhotic patient has an acceptable complication rate and achieves satisfactory
early weight loss. Patients tend to be heavier, older, male and more likely to have diabetes and hypertension. Long-term studies
are necessary to examine how weight loss impacts established cirrhosis. 相似文献
4.
5.
Intestinal malrotation is a congenital anomaly occurring in one of 500 live births. It typically presents during the first
months of life, but in rare instances, it can persist undetected into adulthood when it is identified during a radiographic
or surgical procedure. We present a case of intestinal malrotation discovered at the time of laparoscopic Roux-en-Y gastric
bypass (LRYGBP), detail the technical aspects needed to be incorporated to complete the operation, followed by a literature
review of this rare clinical scenario. Incomplete malrotation is not a contraindication to performing a LRYGBP for morbid
obesity. 相似文献
6.
Background: Intra-operative pneumothorax (PTX) is an infrequent complication of laparoscopic surgery. Most cases are attributed
to CO2 diffusion across congenital diaphragmatic defects and resolve spontaneously. We report a case of PTX during a laparoscopic
Roux-en-Y gastric bypass (LRYGBP). When applied to this specific patient population, the current literature recommendations
for the management of intra-operative PTX are questioned. Material and Methods: A retrospective chart review of 400 consecutive
LRYGBP procedures performed over a 30-month period revealed 1 case of PTX (0.025%). Results: A bulging left diaphragm, hypotension,
bradycardia, decreased pO2, and elevated EtCO2 and airway pressures, were noted early in the case. She initially responded to conservative management but required multiple
subsequent hospital admissions for pulmonary complications. Conclusions: Pneumoperitoneum-induced PTX during laparoscopic
bariatric surgery is a rare complication. Its treatment must be based on the potential underlying cause, with consideration
of these patients' often delicate pulmonary status. In stable patients, where the PTX is attributed to diaphragmatic or hiatal
dissection, expectant treatment is appropriate. In all other situations, however, we believe that tube thoracostomy is indicated.
An algorithm for treatment of PTX in laparoscopic bariatric surgery is proposed. It follows the dictum of maintaining extreme
vigilance and a low threshold for aggressive intervention in this group of patients. 相似文献
7.
Rhabdomyolysis after Laparoscopic Bariatric Surgery 总被引:4,自引:4,他引:0
Background: Postoperative rhabdomyolysis is an uncommon event. The aim of this study was to determine the incidence of rhabdomyolysis
following laparoscopic obesity surgery. Methods: Rhabdomyolysis was studied prospectively. Over a 6-month period, 66 consecutive
patients underwent bariatric surgery (gastric banding (n=50) and gastric bypass (n=16)). All patients underwent laparoscopic
procedures. A range of blood tests, including serum creatine phosphokinase (CPK) level and serum creatinine, were systematically
performed before surgery, and on the first and third day postoperatively. Rhabdomyolysis was defined as a postoperative CPK
level >1,050 IU/L. Results: Serum CPK was noted to increase significantly postoperatively to >1,050 units in 3 patients (6%)
in the adjustable banding group and 12 patients (75%) in the gastric bypass group (P <0.01). In the bypass group, 4 patients (25%) had a serum CPK level >10,000 IU/L, but there were none in the gastric banding
group. All patients with CPK level >10,000 IU/L had BMI >60 kg/m2. No patients experienced acute renal failure. Conclusion: Rhabdomyolysis occurred in 22.7 % of 66 consecutive patients undergoing
laparoscopic bariatric surgery. Risk factors were identified: massive obesity and long duration of the operation. Early diagnosis
may have significant impact on outcome by preventing or reducing the severity of complications from rhabdomyolysis. CPK level
should be performed systematically after obesity surgery. 相似文献
8.
Intussusception: An Uncommon Cause of Postoperative Small Bowel Obstruction after Gastric Bypass 总被引:1,自引:0,他引:1
Intussusception of the jejuno-jejunal anastomosis is a rare complication of the Roux-en-Y gastric bypass (RYGBP).There are
only 3 previous cases reported in the surgical literature. We describe 2 adults who developed jejuno-jejunal intussusception
requiring emergent laparotomy several months after RYGBP. Both patients underwent exploratory laparotomy after the diagnosis
was made with abdominal CT scan. Each patient had an uneventful postoperative course after bowel resection and revision of
the enteroenterostomy. Small bowel obstruction due to intussusception may occur many months after RYGBP and may present with
non-specific symptoms such as crampy abdominal pain, nausea, and vomiting. The diagnosis of this rare entity is typically
made via abdominal CT scan. Treatment mandates urgent abdominal exploration with reduction. 相似文献
9.
Abu-Hilal M Vanden Bossche M Bailey IS Harb A Sutherland R Sansome AJ Byrne JP 《Obesity surgery》2007,17(6):742-746
Background Laparoscopic Roux-en-Y gastric bypass (LRYGBP) can be technically challenging. It is imperative that patient morbidity and
mortality are minimized while teams are on the learning curve for this procedure.
Methods This retrospective study evaluated the peri-operative risk of LRYGBP utilizing a two-consultant surgeon approach in a newly
established bariatric service. 100 consecutive patients undergoing LRYGBP were included. Two consultants participated in each
procedure.
Results Median operative duration was 113 minutes (range 80–240) and fell with increasing experience [127 minutes (range 90–240) in
cases 1–50 and 105 minutes (range 80–210) in cases 51–100; P = 0.009]. Multivariate analysis found operation time correlated only with number of procedures performed (P < 0.001). There were no conversions to laparotomy. Intra-operatively, 2 patients had hand-assisted completion of the jejuno-jejunostomy,
and 2 underwent laparoscopic revision of the reconstruction. Postoperative complications were observed in 8 patients on the
operative admission. Median stay was 4 days (range 3–7). 4 patients required readmission. There was no mortality. Percentage
of excess BMI loss was 47%, 53% and 70% at 3, 6 and 12 months respectively.
Conclusion A learning curve for LRYGBP is evidenced in this series by reduction in operative time with increasing experience. Complication
rates in line with large published series can be achieved by adopting a two-surgeon approach, which we propose as a safe method
to adopt in the development of new bariatric services. 相似文献
10.
Background The concern about internal hernias has prompted recommendations for routine closure of defects during laparoscopic Roux-en-Y
gastric bypass (LRYGBP). Our belief is that not all techniques require closure of defects. We hypothesize that nonclosure
of defects with our particular technique would not cause a significant clinically evident internal hernia rate.
Methods All patients who were operated on between December 2002 and June 2005 were included in this study. The technique that was
utilized included an antecolic antegastric gastrojejunostomy (GJ), division of the greater omentum, a long jejunojejunostomy
(JJ) performed with three staple-lines, a short (<4 cm) division of the small bowel mesentery, and placement of the JJ above
the colon in the left upper quadrant. Clinical records were reviewed for reoperations.
Results here was a total of 300 patients, and no incidence of internal hernia. In the first 100 patients, there was 97% follow-up
for 1 year or more. Four patients underwent reoperations for unexplained abdominal pain. Intraoperative findings included
an adhesive band from the JJ to the colon (1), an adhesive band from the JJ to the anterior abdominal wall (1), an adhesive
band 3 cm from the GJ to the anterior abdominal wall (1), and adhesions of the jejunum to the anterior abdominal wall (1).
No patient had an internal hernia.
Conclusions Internal hernias are not common after this particular method of LRYGBP. Before adopting routine closure of potential spaces,
surgeons should consider their technique, follow-up, and incidence of internal hernias. Routine closure of these defects is
not always necessary. 相似文献
11.
Gawdat K 《Obesity surgery》1999,9(5):456-458
Background: Gastric restrictive procedures such as vertical banded gastroplasty (VBG), Roux-en-Y gastric bypass (RYGB) and
gastric banding have become the standard in morbid obesity surgery. Surgeons have started to perform these procedures through
the laparoscope to give the patient the advantages of smaller incisions, less postoperative pain, shorter hospital stay, and
earlier return to work. These laparoscopic procedures have not gained popularity in Egypt because they are more expensive
and require longer operating times than open surgery. Instead, we have refined our open surgery technique into a method that
gives most of the laparoscopic advantages and yet retains all of the open surgery advantages, i.e., performance of the open
procedure through a 7- to 8-cm incision. Methods: From September 1997 to July 1999, 25 morbidly obese patients underwent gastric
restrictive procedures through mini-incisions with a follow-up period of ≤22 months. Twenty-one patients underwent VBG, and
4 patients underwent RYGB. Ninety-two percent of these patients were female, with a mean age of 28.8 years, a mean weight
of 117 kg, and a mean body mass index of 45.7 kg/m2. Results: The operative time was a mean of 56 minutes for the gastroplasty group and a mean of 116 minutes for the bypass
group. The mean hospital stay was 3.3 days. Patients returned to normal activity within 15.6 days. Wound infections developed
in 3 patients (12%) and incisional hernias in 2 (8%). The total expense of the procedure was one- third to one-half that of
the laparoscopic procedure. Conclusion: If cost prevents the wide use of laparoscopic procedures for morbid obesity, performing
open procedures through a miniincision is an alternative approach. 相似文献
12.
J C Cagigas MD PhD E Martino MD PhD C F Escalante MD PhD A Ingelmo MD PhD R Estefanía MD J M Gutierrez MD M Gomez Fleitas MD PhD 《Obesity surgery》1999,9(2):166-170
Background: Laparoscopic gastric bypass and vertical banded gastroplasty are two procedures used in the treatment of morbid
obesity. The authors describe alternative techniques of laparoscopic distal gastric bypass as a modification of the Scopinaro
procedure, which were used experimentally in a porcine model. Methods: Five pigs were used. The laparoscopic procedure was
performed with the pigs under general anesthesia after pneumoperitoneum had been achieved. Five or six trocars were used.
One port was converted from 12 to 33 mm, and all the other ports were 10-11 mm. The initial surgical technique was similar
to that used by others for laparoscopic gastrectomy, except that atraumatic ultracision was used for all the dissection. The
stomach was stapled with a linear cutter stapler (Endopath, 31 mm) to create a 50-ml pouch. The ileum was divided with a linear
cutter-stapler (Endopath, 31 mm) or ultracision cautery. A long length of ileum was positioned between the stomach pouch and
the jejunoileostomy. Only 50-70 cm of terminal ileum was preserved as a common channel. In three animals, the circular stapler
(ILS, 21 mm) was used to produce an end-to-side anastomosis. In one animal, two purse-string sutures were handsewn in the
ileum and jejunum stumps, and in another two animals, two endoloops were used for the anvil. In two animals, the linear stapler
was used to form a side-to-side pouch stomach-ileum and jejunoileostomy anastomosis. In other animals, the two types of anastomosis
have been combined. All animals were killed after surgery so that the anastomoses could be evaluated for size and integrity.
Results: In all animals, with the circular and linear stapler, both 21 and 13-15 mm anastomoses were intact. Conclusion: Distal
gastric bypass is feasible laparoscopically, with intact anastomoses. 相似文献
13.
14.
Background Shift work is an increasingly common employment structure in the United States and has been associated with increased rates
of obesity and the metabolic syndrome. Shift work can necessitate altered patterns of sleep, eating, and activity over traditional
work schedules. We investigated the effects of shift work on postoperative weight loss in bariatric surgery patients.
Methods A retrospective chart review of 389 patients undergoing laparoscopic Roux-en-Y gastric bypass was conducted. Shift workers
were identified as patients with at least 2 years of employment primarily outside the hours of 8:00 am to 5:00 pm preoperatively
and without return to a traditional schedule in the period up to 1 year postoperatively. Trends in excess body weight loss
were categorized and compared between the shift workers and the nonshift workers in the cohort. Student’s t-test was used
for statistical analysis.
Results 8 shift workers were identified in the cohort. They had an average age of 45.9 years and preoperative BMI of 54.6, as compared
to an age of 43.6 and BMI of 47.0 for the non-shift-workers in the cohort. 75% were female, compared to 83% for the non-shift-workers.
Average postoperative excess weight loss for the shift workers was significantly lower than in the non-shift-workers: 29.9%
vs 43.8% (P < .01) at 3 months, 46.4% vs 61.3% (P < .01) at 6 months, and 56.5% vs 76.8% (P < .01) at 12 months.
Conclusions The postoperative period in bariatric surgery requires significant adjustments in patients’ lives. The potential for altered
sleep physiology, reduced quantity of sleep, altered hormonal balance, increased tendency to disordered eating, and poorer
quality of food intake, are all possible etiologies for substandard weight loss outcomes in shift workers undergoing bariatric
surgery. Additional care should be taken in preoperative counseling and postoperative management of these patients. 相似文献
15.
Background: The complications of the gastric pouch in gastric bypass surgery are well known. Since the first report of this
surgery 30 years ago, new technical aspects that make it safer and more effective have been implemented. Methods: As a modification
of gastric bypass, the authors have performed 305 vertical banded gastroplasty-gastric bypass procedures. Two groups of patients
underwent the procedure: Group I (n = 206) without a limb of jejunum interposed between the gastric pouch and the excluded
stomach, and Group II (n = 99) with a limb of jejunum interposed between the pouch and the stomach. The results regarding
excess weight loss and complications of the gastric pouch during the first year after surgery were compared. Results: Age,
sex, initial weight, body mass index, and percentage of ideal weight were similar in both groups. Excess weight loss was also
similar. The complications in Group I were 1 leak, 3 left subphrenic abscesses, 2 erosive gastritis with bleeding, 1 stenosis
of the gastrojejunostomy, 1 perforated ulcer, and 4 marginal ulcers with bleeding. Two patients in Group II developed bleeding
from the staple-line. Conclusions: These preliminary data suggest that complications of the gastric pouch can be reduced by
interposing a limb of jejunum between the pouch and the excluded stomach. This is an early experience; long-term results are
pending. 相似文献
16.
A rare cause of intestinal obstruction after laparoscopic Roux-en-Y gastric bypass (RYGBP) is reported. A 42-year-old woman
developed nausea, vomiting and dilated loops of small bowel upon commencing oral intake the day after RYGBP surgery. A CT
scan demonstrated a loop of bowel twisting around the abdominal drainage catheter. After removal of the catheter, the patient’s
symptoms immediately resolved and her subsequent course was uneventful. We suggest avoidance of drainage catheters after uncomplicated
laparoscopic RYGBP. 相似文献
17.
Fisher BL 《Obesity surgery》2004,14(1):67-72
Background: Laparoscopy is believed to reduce recovery time and patient discomfort following bariatric surgical operations.
This study tests that hypothesis. Methods: 60 randomly selected bariatric surgery patients, consisting of 20 open Roux-en-Y
gastric bypass (RYGBP), 19 lap RYGBP, and 21 laparoscopic adjustable banding, were studied. Outcome measures including hospital
length of stay (LOS), days to return to normal activity, days to surgical recovery, and pain medication usage were defined
by the patients' subjective responses to a retrospective questionnaire. Overall differences among the three surgeries were
first determined using the Kruskal-Wallis test, and then individual comparisons were made between each of the three pairs
of operations using a Wilcoxon rank-sum test when a significant difference existed. Results: Patients reported an average
LOS of 3.45 days following open RYGBP, 2.47 days following lap RYGBP, and 1.33 days following Lap-Band? surgery. There was
little difference in return to normal activity, with open RYGBP patients reporting a 17.55 day delay in return to normal activity,
and lap RYGBP reporting an 18.16 day delay. In contrast, Lap-Band? patients responded that the delay was only 7.24 days. Days
to recovery were reported to be 29.05 for open RYGBP patients, 21.68 for lap RYGBP patients and 15.81 for Lap-Band? patients.
Hospital days (P=0.0002), days to normal activity (P=0.0115), and days to recovery (P<0.0001) differed significantly among the surgery types. Lap and open RYGBP did not differ significantly regarding days to
resumption of normal activities. Open RYGBP and banding differed significantly regarding days to recovery (P <0.001). Conclusions: Lap-Band? patients returned to normal activity levels earlier than gastric bypass patient's irrespective
of approach. Lap-Band? patients also reported recovering from surgery significantly sooner than open RYGBP patients. Perceived
differences in recovery time between open and laparoscopic RYGBP patients did not affect their time to resumption of normal
activity. 相似文献
18.
Baierlein SA Wistop A Looser C Peters T Riehle HM von Flüe M Peterli R 《Obesity surgery》2007,17(8):1123-1126
A 33-year-old, morbidity obese woman underwent a laparoscopic Roux-en-Y gastric bypass in November 2004. She presented 18
months later with a history of recurrent pain in the upper region of the abdomen and severe vomiting. Radiologic and endoscopic
evaluations revealed wall thickening in the transverse colon and a solid tumor near the liver. Therefore, a sonography-guided
biopsy of the tumor was performed. Cytopathological examination revealed actinomycosis. Thus, therapy with penicillin was
started, after which the parameters associated with the infection decreased. The symptoms persisted, however, and the decision
was made to operate on the patient to resect the abdominal masses. Nearly 90% of the masses could be removed. Histological
analysis showed a fibro-productive inflammation with an actinomycotic etiology. Antibiotic therapy with penicillin was continued
for 6 months. Actinomycosis must be considered in the differential diagnosis of patients with abdominal mass, wall thickening
of the intestine, and other such symptoms, including abdominal pain following bariatric surgery, even many years after the
intervention. 相似文献
19.
Pablo G Zorrilla MD Ricardo J Salinas MD Ana Maria Salinas-Martinez MD MPH Dr PH 《Obesity surgery》1997,7(4):322-325
Background: Different surgical alternatives for the treatment of severe obesity have been described. The two most common surgical
procedures are the Vertical Banded Gastroplasty (VBG) and the Rouxen-Y Gastric Bypass (GBP). Methods: This work describes
the results seen during the first 12 months after a surgical technique named Vertical Banded Gastroplasty-Gastric Bypass on
221 Mexican patients with severe obesity operated on between March 1993 and August 1996. Results: 73.3% of the patients were
female with an average age of 33.4 years with a standard deviation (SD) of 10 years. The initial mean overweight was 62.2
kg (SD = 26.5 kg). The percentage of ideal weight was 202.3% (SD = 39.4%). The initial body mass index (BMI) was 44.9 kg/m2 (SD = 9.1). The average of excess weight loss in a year was 81.2% (SD = 15.6%) and the BMI was lowered to 26.7 kg/m2 (SD = 5.9). An interesting finding was that the greater the initial overweight, the lesser the resulting weight loss (r = 0.57, P < 0.001). Conclusions: The procedure was fairly easy to perform. The results were excellent in terms of weight loss and postoperative
complications. It is an early experience and the long-term results are still inconclusive; regular check-ups should indicate
the procedure's long-term effectiveness. 相似文献
20.
Laparoscopic Gastric Bypass in Patients on Thyroid Replacement Therapy for Subnormal Thyroid Function – Prevalence and Short-Term Outcome 总被引:1,自引:1,他引:0
Background: Hypothyroidism is associated with increased body weight. Weight gain may occur despite normal levels of serum
thyroid stimulating hormone (TSH) and thyroxine (T4) achieved by replacement therapy. We evaluated the prevalence of patients
on thyroid replacement for subnormal thyroid function who were operated on for morbid obesity and monitored their postoperative
weight loss pattern. Methods: Data was identified from a prospectively accrued database of patients undergoing laparoscopic
Roux-en-Y gastric bypass (LRYGBP) or laparoscopic adjustable gastric banding (LAGB) for morbid obesity from February 2000
to November 2001. All patients with subnormal thyroid function, diagnosed by past thyroid function tests and treated by an
endocrinologist, who were on thyroid replacement therapy, were identified; 5 of these were matched for age, gender, preoperative
body mass index (BMI) and surgical procedure (LRYGBP) to 5 non-hypothyroid patients. Weight loss at 3 and 9 months after surgery
was compared between the 2 groups. Results: 192 patients underwent LRYGBP (n=155) or LAGB (n=37). Of the 21 patients (10.9%)
on thyroid replacement identified, 14 were primary, 4 were postablative, and 3 were post-surgical; 17 underwent LRYGBP. All
patients had normal preoperative serum levels of TSH and T4. Comparison of the 2 matched groups of patients revealed no difference
in weight loss at 3 and 9 months after surgery (P=1.0). Conclusions: The prevalence of euthyroid patients on thyroid replacement for subnormal thyroid function who undergo
surgical intervention for morbid obesity is high. Short-term weight loss in these patients is comparable to normal thyroid
patients. Longer follow-up may be necessary to demonstrate the weight loss pattern in this group. 相似文献