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1.
Ashish C. Sinha Preet Mohinder Singh Noel W. Williams Edward Andrew Ochroch Basavana G. Goudra 《Obesity surgery》2014,24(2):225-231
Background
Postoperative nausea and vomiting is a major cause of patient dissatisfaction towards surgery. For bariatric surgery, increased vomiting/retching is detrimental to surgical anastomosis. The present study evaluated the efficacy of aprepitant (neurokinin-1 inhibitor) as a prophylactic antiemetic in morbidly obese patients for laparoscopic bariatric surgery.Methods
After institutional review board approval, 125 morbidly obese patients were recruited into this double-blind placebo-controlled trial. On random division, the patients received a tablet of aprepitant (80 mg) in group A, or a similar-appearing placebo in group P, an hour prior to surgery. All patients received intravenous ondansetron (4 mg) intraoperatively. Postoperatively, the patients were evaluated for nausea and vomiting by a blinded evaluator at 30 min, 1, 2, 6, 24, 48, and 72 h.Results
Both groups were evenly distributed for age, body mass index, type, and length of surgery. Cumulative incidence of vomiting at 72 h was significantly lower in group A (3 %) compared to group P (15 %; p?=?0.021). Odds ratio for vomiting in group P compared to group A was 5.47 times. On Kaplan–Meier plot, time to first vomiting was also significantly delayed in group A (p?=?0.019). A higher number of patients showed complete absence of nausea or vomiting in group A compared to group P (42.18 vs. 36.67 %). On the other hand, nausea scores were unaffected by aprepitant, and no significant difference between groups was found at any of the measured time points.Conclusions
In morbidly obese patients undergoing laparoscopic bariatric surgery, addition of aprepitant to ondansetron can significantly delay vomiting episodes simultaneously lowering the incidence of postoperative vomiting. 相似文献2.
Lascano CA Soto F Carrodeguas L Szomstein S Rosenthal RJ Wexner SD 《Obesity surgery》2006,16(6):783-786
Ulcerative colitis and obesity share a systemic chronic inflammatory response manifested by increased inflammatory markers.
There are data suggesting a benefit in both diseases after inflammatory markers are decreased. We present a 39-year-old morbidly
obese male with a history of ulcerative colitis who manifested significant symptomatic improvement after an 86.8% excess weight
loss following gastric bypass surgery. We believe that this result may have been due to a reduction of inflammatory markers
secondary to considerable weight loss. Although to our knowledge there are no publications showing a direct relationship between
symptomatic improvement of ulcerative colitis and weight loss in the obese patient, we believe that weight loss surgery could
become a promising tool in the treatment of ulcerative colitis when associated with morbid obesity. 相似文献
3.
Choon-Pin Lim Oliver M. Fisher Dan Falkenback Damien Boyd Christopher S. Hayward Anne Keogh Katherine Samaras Peter MacDonald Reginald V. Lord 《Obesity surgery》2016,26(3):486-493
Background
In patients with advanced heart failure, morbid obesity is a relative contraindication to heart transplantation due to higher morbidity and mortality in these patients.Methods
We performed a retrospective analysis of consecutive morbidly obese patients with advanced heart failure who underwent bariatric surgery for durable weight loss in order to meet eligibility criteria for cardiac transplantation.Results
Seven patients (4 M/3 F, age range 31–56 years) with left ventricular ejection fraction (LVEF) ≤25 % underwent laparoscopic bariatric surgery. Median preoperative body mass index (BMI) was 42.8 kg/m2 (range 37.5–50.8). There were no major perioperative complications in six of seven patients. Median length of hospital stay was 5 days. There was no mortality recorded during complete patient follow-up. At a median follow-up of 406 days, median BMI reduction was 12.9 kg/m2 (p?=?0.017). Postoperative LVEF improved to a median of 30 % (interquartile range (IQR) 25–53 %; p?=?0.039). Two patients underwent successful cardiac transplantation. Two patients reported symptomatic improvement with little change in LV function and now successfully meet listing criteria. Three patients showed marked improvement of their LVEF and functional status, thus removing the requirement for transplantation.Conclusions
Bariatric surgery can achieve successful weight loss in morbidly obese patients with advanced cardiac failure, enabling successful heart transplantation. In some patients, cardiac transplantation can be avoided through surgical weight loss.4.
Zubaidah Nor Hanipah Suriya Punchai Linden A. Karas Samuel Szomstein Rahul J. Rosenthal Stacy A. Brethauer Ali Aminian Philip R. Schauer 《Obesity surgery》2018,28(6):1498-1503
Background
Bariatric surgery has been shown to be safe and effective in patients aged 60–75 years; however, outcomes in patients aged 75 or older are undocumented.Methods
Patients aged 75 years and older who underwent bariatric procedures in two academic centers between 2006 and 2015 were studied.Results
A total of 19 patients aged 75 years and above were identified. Eleven (58%) were male, the median age was 76 years old (range 75–81), and the median preoperative body mass index (BMI) was 41.4 kg/m2 (range 35.8–57.5). All of the bariatric procedures were primary procedures and performed laparoscopically: sleeve gastrectomy (SG) (n?=?11, 58%), adjustable gastric band (AGB) (n?=?4, 21%), Roux-en-Y gastric bypass (RYGB) (n?=?2, 11%), banded gastric plication (n?=?1, 5%), and gastric plication (n?=?1, 5%). The median operative time was 120 min (range 75–240), and the median length of stay was 2 days (range 1–7). Three patients (16%) developed postoperative atrial fibrillation which completely resolved at discharge. At 1 year, the median percentage of total weight loss (%TWL) was 18.4% (range 7.4–22.0). The 1-year %TWL varied among the bariatric procedures performed: SG (21%), RYGB (22%), AGB (7%), and gastric plication (8%). There were no 30-day readmissions, reoperations, or mortalities.Conclusion
Our experience suggests that bariatric surgery in selected patients aged 75 years and older would be safe and effective despite being higher risk. Age alone should not be the limiting factor for selecting patients for bariatric surgery.5.
Daniel A. de Luis David Pacheco Olatz Izaola Maria Concepcion Terroba Luis Cuellar Tomas Martin 《Journal of gastrointestinal surgery》2011,15(12):2178-2181
Background
Zinc and copper are two essential trace elements. However, few studies have been conducted specifically to investigate these deficiencies in patients who underwent bariatric surgery. The aim of our work was to describe the influence of biliopancreatic diversion (BPD) on serum copper and zinc levels during 4 years.Methods
We have analyzed a consecutive series of 65 patients who have been followed-up for 4 years after undergoing open BPD.Results
The final (4 years) initial excess weight percent loss was 63.5%. A significant improvement of BMI, weight, waist circumference, and fat mass was detected. The preoperative average zinc (42.2?±?53.2 ??g/dl) and copper (61.3?±?58.6 ??g/dl) levels are under the lower limit of the normal values. These data show a deficient micronutrient status in morbidly obese patients, 73.8% of patients had low basal zinc values and 67.8% low basal copper values. Values of both micronutrients at different times (6 months, 1, 2, 3, and 4 years) were lower than basal value.Conclusion
BPD is an effective method of sustainable weight loss. Otherwise, a high prevalence of zinc and copper basal deficiencies in morbidly obese seeking bariatric surgery was detected. These deficiencies of copper and zinc increased during the 4 years of follow-up after BDP. 相似文献6.
Carneiro JR da Silveira VG Vasconcelos AC de Souza LL Xerez D da Cruz GG Quaresma JC Macedo RG de Oliveira JE 《Obesity surgery》2007,17(2):255-257
A young woman with achondroplasia and morbid obesity (two disabling conditions) is presented. She underwent open Roux-en-Y
gastric bypass (RYGBP). We emphasize preoperative preparation by a multidisciplinary team and the use of the 6-minute walk
test to follow and assess mobility and quality of life. 相似文献
7.
Improvement of Physical Functioning of Morbidly Obese Patients Who Have Undergone a Lap-Band® Operation: One-Year Study 总被引:3,自引:3,他引:0
Background: The Netherlands has a population of 20,000 morbidly obese patients, an average of 350 of whom per year undergo
a stomach reduction operation involving the surgical placement of a Lap-Band?. The quality of life (QOL) of a sample of female
patients who underwent this operation was studied in a 1-year postoperative study. Methods: The Medical Outcome Study Short
Form-36 (MOS SF-36) was used to assess 1-year postoperative quality of life among a sample of 39 female patients aged 19-53
years. QOL was measured at most 20 h preoperatively and 1 year postoperatively using a randomized pretest/posttest design.
Statistical data, after transformation, were analyzed with SPSS Version 7.5 for Windows 95. Results: The response rate of
92.9% of patients polled was good, in contrast to earlier findings with this measuring instrument. Mean body mass index (BMI)
declined from 40.86 kg/m2 preoperatively to 33.14 kg/m2 1 year postoperatively. QOL improved on all scores in the MOS SF-36. Internal consistency of the scales used was high. Conclusions:
The response rate to the MOS SF-36 questionnaire was high. The surgical placement of a Lap-Band? resulted in a significant
improvement of QOL (1 year postoperatively) on all scores used. The internal consistency of the scales used was high. 相似文献
8.
Background
Morbidly obese patients are at risk of hypoxemia at the time of induction of anesthesia. The aim of this study was to assess the possible increase in the safe apnea time with the use of ProSeal laryngeal mask airway (PLMA) as a conduit prior to laryngoscope-guided intubation in morbidly obese patients undergoing surgery under general anesthesia.Methods
Hundred patients with BMI greater than 35 kg/m2, undergoing surgery under general anesthesia, were randomly divided to receive either PLMA or facemask with oropharyngeal airway (FM) as the airway device. Following preoxygenation with 100 % oxygen with continuous positive airway pressure of 10 cm H2O, in ramp position for 5 min the patients were made apneic. From start of apnea to the time to reach SpO2 to 92 % was recorded as safe apnea time. Ventilation was initiated and time to reach SpO2 of 100 % was recorded as recovery time.Results
The mean safe apnea time was 205 (96–320)?s in FM vs. 337 (176–456) s in PLMA (P?=?0.0000). The mean recovery period was 49 (36–68)?s in FM vs. 42(30–56)?s in PLMA groups (P?=?0.0000). Arterial blood gas analysis showed significant difference in pO2 between the two groups.Conclusion
The use of ProSeal laryngeal mask airway prior to laryngoscope-guided intubation is beneficial in increasing safe apnea period and achieving faster recovery from hypoxemia in morbidly obese patients. 相似文献9.
Joerg Zehetner Steven R. DeMeester Shahin Ayazi Jesse L. Costales Florian Augustin Arzu Oezcelik John C. Lipham Helen J. Sohn Jeffrey A. Hagen Tom R. DeMeester 《Journal of gastrointestinal surgery》2010,14(10):1483-1491
Background
Factors associated with the risk of progression of Barrett’s esophagus remain unclear, and the impact of therapy on this risk remains uncertain. The aim of this study was to assess patients followed long-term after anti-reflux surgery for Barrett’s esophagus. 相似文献10.
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12.
Even though in the Western world there is almost no limitation to a wide variety of food supply, nutritional deficiencies can be found in both normal-weight population and in the obese population. In this review, we examine the prevalence and manifestations of various mineral deficiencies in obese patients. 相似文献
13.
BACKGROUND: It is estimated that 25% of Americans older than 60 years are obese. Male gender and advanced age are indicators of increased risk for bariatric surgery. Good results have been shown in patients older than 50, but nearly all published studies include a large majority of females, and few include patients >60 years old. In this study, we examined the results of males over 60 years old. METHODS: We reviewed a prospective database of 107 consecutive patients who underwent bariatric surgery between April 2002 and June 2007 at the Palo Alto VA. Of these, 60 patients were males older than 50 and available for follow-up 12 months postoperatively. There were 47 males 50-59 years old (group I) and 13 males older than 60 years (group II). Data were analyzed using Student's t test. RESULTS: Mean preoperative body mass index was similar in both groups (49.4 vs. 47.5 kg/m(2); p = 0.468). Length of hospital stay was similar (3.2 vs. 3.5 days; p = 0.678), but early morbidity was higher in group II patients (30.8% vs. 8.5%; p = 0.037). Morbidity included urinary tract infection, cardiac arrhythmias, and early bowel obstruction. Excess weight loss after 1 year was not significantly different (63.6% vs. 60.6%; p = 0.565). Diabetes resolution or improvement was seen in 87% of group I patients and 90% of group II patients. CONCLUSION: Despite a higher early morbidity rate, obese males >/=60 years old perform as well as male patients 50-59 years old with respect to excess weight loss, mortality, length of stay, and improvement of diabetes, at 1 year postoperatively. 相似文献
14.
Sofia Manousou Lena M. S. Carlsson Robert Eggertsen Lena Hulthén Peter Jacobson Kerstin Landin-Wilhelmsen Penelope Trimpou Per-Arne Svensson Helena Filipsson Nyström 《Obesity surgery》2018,28(2):349-357
Context
Bariatric surgery can lead to nutrient deficiencies. Gastric by-pass (GBP) entails restriction and malabsorption, whereas, vertical banded gastroplasty (VBG) is only restrictive.Objective
The objective of this study is to study whether GBP-patients develop iodine deficiency from malabsorption, and if GBP- and VBG-patients develop lower 24-h urinary iodine excretion (24-UIE) than obese non-operated controls (OB-controls) due to lower iodine intake.Design
The Swedish Obese Subjects (SOS) study is a prospective, non-randomized study of 4047 obese patients included 1987–2001, who chose bariatric surgery or non-surgical treatment. SOS-groups were compared at baseline, after 2 and 10 years and with population-based subsamples (MONICA-controls).Patients
One hundred eighty-eight GBP-patients were matched with 188 VBG-patients and 188 OB-controls and with three subgroups from 412 MONICA-controls.Main Outcome Measurements
Primary outcome was 24-UIE. Secondary outcomes were iodine intake, iodine supplementation, TSH, FT4, and thyroid morbidity.Results
At baseline, median 24-UIE was higher in GBP-patients, VBG-patients and OB-controls than in MONICA-controls (214, 201, 203 and 137 μg/day, p < 0.001). At 10 years, 24-UIE in GBP-patients (161 μg/day) and VBG-patients (149 μg/day) was lower compared with baseline (p < 0.01) and OB-controls (189 μg/day, p < 0.01), but similar to 24-UIE in MONICA-controls (137 μg/day). The 10-year-dietary iodine intake was similar in GPB-patients and OB-controls, but higher in VBG-patients. Iodine supplementation was taken by 0–9% in SOS-groups.Conclusion
After surgery, GBP- and VBG-patients did not suffer from iodine deficiency, but both groups had lower iodine status than OB-controls. Dietary supplements recommended after bariatric surgery do not need to include iodine, in iodine sufficient countries.Trial Registration
clinicaltrials.gov: NCT0147945215.
Anastasia Zotou Athina Siampalioti Panagiota Tagari Leonidas Paridis Fotis Kalfarentzos Kriton S. Filos 《Obesity surgery》2014,24(12):2099-2108
Background
Insufficient data exist regarding postoperative thoracic epidural analgesia for morbidly obese patients undergoing open bariatric surgery. This study evaluated the effectiveness of morphine loading in a postoperative thoracic epidural analgesic regimen of patient-controlled epidural analgesia (PCEA) with levobupivacaine combined with continuously administered epidural morphine in this patient group.Methods
In this prospective randomized controlled trial, 48 superobese patients (body mass index of ≥50 kg/m2) undergoing open bariatric surgery were randomly allocated to three groups of 16 patients each. Postoperatively, all groups received a continuous epidural morphine infusion of 0.2 mg/h with 0.1 % levobupivacaine via PCEA. Group A did not receive intraoperative epidural morphine loading, while groups B and C received an intraoperative 1- and 2-mg morphine bolus, respectively. Levobupivacaine consumption via PCEA (primary outcome), pain scores at rest and on cough, the time to return of bowel function and ambulation, and arterial blood gas levels (secondary outcomes) were recorded.Results
The increase in perioperative morphine administration (groups B and C) led to a significantly prolonged return to normal bowel function and delayed ambulation (P?0.05 to 0.01, respectively), without an improvement in postoperative analgesia or a reduction in local anesthetic consumption. Although the prevalence of obstructive sleep apnea (OSA) was high in all groups, no respiratory depression was observed.Conclusions
Thoracic PCEA with 0.1 % levobupivacaine combined with continuous epidural morphine administration of 0.2 mg/h without morphine loading is an effective postoperative analgesic regimen that provides adequate pain control, early ambulation, and early return of bowel function in superobese patients, particularly those with OSA. 相似文献16.
Javier Crespo Pedro Fernández-Gil Manuel Hernández-Guerra Amalia Cayón Marta Mayorga Agustín Domínguez-Diez José Carlos Fernández-Escalante Fernando Pons-Romero 《Obesity surgery》2001,11(3):254-257
Background: Non-alcoholic steatohepatitis (NASH) is a clinicopathological entity characterized by the presence of steatosis
and lobular and/or portal inflammation with or without fibrosis. Patients with non-alcoholic fatty liver and fibrosis on liver
biopsy have increased liver-related deaths. Methods: 181 wedge liver biopsies, taken at the time of bariatric surgery from
patients with a mean body mass index (BMI) of 47, were studied. In all cases, the liver biopsy was performed without knowledge
of the patient's clinical and biochemical data, which were then examined with univariate and multivariate analysis. Results:
Diagnosis of NASH was established in 105 patients (91%); 74 patients (70%) showed mild steatosis, 20 (19%) had moderate inflammation
and fibrosis, and 11 (10%) had steatosis with severe fibrosis. None of the liver biopsies showed cirrhosis. Age was the only
independent predictor of moderate and severe fibrosis (p=0.001). Conclusions: Since only age was a predictor of moderate or
severe fibrosis, and no clinical or biochemical abnormalities detected slowly progressive hepatic fibrosis, liver biopsy is
the only means of detecting progression to more advanced liver disease in a NASH patient. 相似文献
17.
18.
Background
Although morbid obesity rates in patients ≥65 years of age are increasing, few centers have reported weight loss surgery outcomes in elderly patients, resulting in a paucity of literature on perioperative mortality and morbidity. 相似文献19.
Hyun Jin Song Jin Won Kwon Yong Jin Kim Sung-Hee Oh Yoonseok Heo Sang-Moon Han 《Obesity surgery》2013,23(12):2058-2067
Background
In South Korea, the number of severely obese patients has increased. An economic study comparing bariatric surgery with nonsurgical interventions has not been published for Asia.Objectives
This study was conducted to evaluate the cost effectiveness of bariatric surgery as compared to nonsurgical interventions for severe obese Korean people.Methods
We used the Markov model to compare the lifetime expected costs and quality-adjusted life years (QALYs) between bariatric surgery and nonsurgical interventions from Korean Healthcare system perspectives. Our target cohort consisted of severe obese people defined as having a body mass index of 30–<40 kg/m2 in South Korea. The starting age of the cohort was 30 years old, and the cycle length was 1 year. Nonsurgical interventions included a physician visit, exercise, diet, and pharmacotherapy. A discount of 5 % was applied in cost and QALY. The incremental cost-effectiveness ratio (ICER) of bariatric surgery compared to nonsurgery interventions was calculated.Results
The cost-utility analysis study indicated that bariatric surgery had US$1,522 incremental costs and 0.86 incremental QALYs as compared to nonsurgical interventions. Through the base case analysis, ICER was US$1,771/QALY. The sensitivity analyses were performed using a variety of assumptions, and the robustness of the study results was also demonstrated.Conclusion
The study indicated that bariatric surgery was a cost-effective alternative to nonsurgical interventions over a lifetime, providing substantial lifetime benefits for severely obese Korean people. 相似文献20.
Mathieu D’Hondt Gregory Sergeant Bert Deylgat Dirk Devriendt Frank Van Rooy Franky Vansteenkiste 《Journal of gastrointestinal surgery》2011,15(9):1532-1536