共查询到20条相似文献，搜索用时 31 毫秒
1.
Erik Schadde Boris Guiu Rebecca Deal Jennifer Kalil Bulent Arslan Jordan Tasse Pim B. Olthof Jan Heil Andreas A. Schnitzbauer Shriram Jakate Stefan Breitenstein Martin Schläpfer Beatrice Beck Schimmer Martin Hertl 《Surgery》2019,165(3):525-533
Background
Liver hypertrophy induced by partial portal vein occlusion (PVL) is accelerated by adding simultaneous parenchymal transection (“ALPPS procedure”). This preclinical experimental study in pigs tests the hypothesis that simultaneous ligation of portal and hepatic veins of the liver also accelerates regeneration by abrogation of porto-portal collaterals without need for operative transection.Methods
A pig model of portal vein occlusion was compared with the novel model of simultaneous portal and hepatic vein occlusion, where major hepatic veins draining the portal vein–deprived lobe were identified with intraoperative ultrasonography and ligated using pledgeted transparenchymal sutures. Kinetic growth was compared, and the portal vein system was then studied after 7 days using epoxy casts of the portal circulation. Portal vein flow and portal pressure were measured, and Ki-67 staining was used to evaluate the proliferative response.Results
Pigs were randomly assigned to portal vein occlusion (n?=?8) or simultaneous portal and hepatic vein occlusion (n?=?6). Simultaneous portal and hepatic vein occlusion was well tolerated and led to mild cytolysis, with no necrosis in the outflow vein–deprived liver sectors. The portal vein–supplied sector increased by 90 ± 22% (mean ± standard deviation) after simultaneous portal and hepatic vein occlusion compared with 29 ± 18% after PVL (P < .001). Collaterals to the deportalized liver developed after 7 days in both procedures but were markedly reduced in simultaneous portal and hepatic vein occlusion. Ki-67 staining at 7 days was comparable.Conclusion
This study in pigs found that simultaneous portal and hepatic vein occlusion led to rapid hypertrophy without necrosis of the deportalized liver. The findings suggest that the use of simultaneous portal and hepatic vein occlusion accelerates liver hypertrophy for extended liver resections and should be evaluated further. 相似文献2.
Joohyun Kim Michael A Zimmerman Stacee M Lerret John P Scott Stylianos Voulgarelis Roger A Fons Bernadette E Vitola Grzegorz W Telega George M Hoffman Richard J Berens Johnny C Hong 《Surgery》2019,165(2):323-328
Introduction
Biliary complications after pediatric orthotopic liver transplantation remain causes of significant patient morbidity. Staged operative approach in complex hepatobiliary surgery has improved postoperative outcomes but has not been evaluated in pediatric orthotopic liver transplantation. We sought to analyze the outcomes of staged biliary reconstruction after orthotopic liver transplantation in high acuity patients.Methods
A retrospective analysis of 43 pediatric orthotopic liver transplantations at our center (January 2013 through December 2017). Median follow-up was 25 months. Variables were compared for group I: 1-stage orthotopic liver transplantation with biliary anastomosis (n?=?6) versus group II: staged biliary reconstruction orthotopic liver transplantation (n?=?37).Results
Comparing groups I and II, median age (7.3 vs 4.8 years), weight (27 vs 19 kg), proportion of urgent orthotopic liver transplantation (50% vs 65%), partial graft orthotopic liver transplantation (33% vs 35%), and intraoperative red blood cell transfusion volume (11 vs 21 mL/kg) were comparable. Roux-en-Y hepaticojejunostomy was performed in 67% (group I) and 49% (group II). There was no biliary complication in both groups. For groups I and II, 3-year survival rates for graft (100% vs 92%, P?=?.477) and patient (100% vs 97%, P?=?.679) were comparable.Conclusion
Our study showed excellent outcomes with staged biliary reconstruction orthotopic liver transplantation in high acuity pediatric transplant recipients. This is the first report showing clinical applicability of staged biliary reconstruction orthotopic liver transplantation in children. 相似文献3.
Saurav Chakravartty Gillian Vivian Nicola Mullholland Hizbullah Shaikh John McGrath Paul S. Sidhu Ounali Jaffer Ameet G. Patel 《Surgery for obesity and related diseases》2019,15(1):117-125
Background
In bariatric surgery, preoperative very low-calorie diets (VLCD) may better meet the technical demands of surgery by shrinking the liver. However, diets may affect tissue healing and influence bowel anastomosis in an as-yet-undefined manner.Objective
This randomized controlled trial aimed to examine the effect on collagen deposition in wounds in patients on a 4-week VLCD before laparoscopic gastric bypass.Setting
University hospital.Methods
The trial was undertaken in patients undergoing laparoscopic Roux-en-Y gastric bypass, with a control group (n?=?10) on normal diet and an intervention group (n?=?10) on VLCD (800 kcal) for 4 weeks. The primary outcome measured was expression of collagen I and III in skin wounds, with biopsies taken before and after the diet and 7 days postoperatively as a surrogate of anastomotic healing. Secondary outcome measures included liver volume and fibrosis score, body composition, operating time, blood loss, hospital stay, and complications.Results
Patients in both groups were similar in age, sex, body mass index (53.4 versus 52.8 kg/m2), co-morbidities, liver volume, and body composition. Expression of mature collagen type I was significantly decreased in diet patients compared with controls after 4 weeks of diet and 7 days after surgery. This was significant decrease in liver volume (23% versus 2%, P?=?.03) but no difference in operating times (129 versus 139 min, P?=?.16), blood loss, length of stay, or incidence of complications.Conclusions
Preoperative diets shrink liver volume and decrease expression of mature collagen in wounds after surgery. Whether the latter has a detrimental effect on clinical outcomes requires further evaluation. 相似文献4.
Séverine Ledoux Ouidad Sami Daniela Calabrese Maud Le Gall Martin Flamant Muriel Coupaye 《Surgery for obesity and related diseases》2019,15(2):220-226
Background
Numerous studies have shown that Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) differently affect metabolic disorders associated with obesity. While bariatric surgery has been shown to improve nonalcoholic fatty liver disease, very few studies have compared liver parameters after both procedures.Objectives
To compare the evolution of liver parameters after SG and RYGB and their relationships with improvement of metabolic disorders.Methods
Metabolic parameters and abdominal ultrasonography were recorded before and 1 year after bariatric surgery in all patients who underwent SG or RYGB between 2004 and 2016 in our institution.Setting
University hospital, Colombes, France.Results
Five hundred thirty-three patients (15% men, age 43 ± 11 yr) were analyzed, including 326 who underwent RYGB and 207 who underwent SG. Before surgery, body mass index (44.7 ± 5.7 versus 44.4 ± 7.4 kg/m²) and metabolic parameters were not significantly different. One year after surgery, RYGB induced greater weight loss (31.9 ± 7.7 versus 28.6 ± 8.3 %, P < .001). Metabolic parameters improved in both groups, but fasting insulin, low-density lipoprotein cholesterol, C-reactive protein, and ferritin were lower after RYGB (P < .001). In contrast, transaminases were higher after RYGB compared with SG (alanine aminotransferase: 31.6 ± 18.7 versus 22.6 ± 7.7 IU/L; P < .001). The persistence of alanine aminotransferase >34 IU/L (27% versus 7% of patients, P < .001) was independent of the persistence of steatosis on ultrasonography (39% versus 37% of patients) 1 year after RYGB and SG, respectively.Conclusion
Despite a greater improvement of metabolic disorders, RYGB has less beneficial effect on liver parameters compared with SG. Further studies are required to define the mechanisms explaining these differences between both procedures. 相似文献5.
Masayuki Okuno Claire Goumard Scott Kopetz Eduardo A. Vega Katharina Joechle Takashi Mizuno Ching-Wei D. Tzeng Yun Shin Chun Jeffrey E. Lee Jean-Nicolas Vauthey Thomas A. Aloia Claudius Conrad 《Surgery》2019,165(2):329-336
Background
The survival impact of specific body composition changes during preoperative chemotherapy in patients with colorectal liver metastases undergoing curative-intent surgery remains unclear. This study aimed to determine the impact of changes in body weight and muscle mass during preoperative chemotherapy on survival after hepatectomy in patients with colorectal liver metastases.Methods
Consecutive patients with colorectal liver metastases undergoing preoperative chemotherapy and curative hepatectomy during 2009–2013 were retrospectively analyzed. Recurrence-free and overall survival were examined according to body compositions, including muscle mass, as measured by skeletal muscle index (area of muscle [cm2]/square of height [m2]), and body weight before and after preoperative chemotherapy.Results
The median follow-up duration in overall 169 patients was 47 months. Skeletal muscle index and body weight changed significantly during chemotherapy (skeletal muscle index: –0.52 cm2/m2, P?=?.03; body weight: +1.1 kg, P?=?.002). Patients with major muscle mass loss (≥7%) had significantly shorter median RFS than patients with no or minor muscle mass loss (<7%) (9.6 months vs 15.9 months; P?=?.02). Although major muscle mass loss was associated with poor outcome, skeletal muscle index before or after preoperative chemotherapy was not associated with recurrence-free or overall survival. On multivariate analysis, major muscle mass loss was independently associated with poorer recurrence-free survival (hazard ratio, 1.76; P?=?.045).Conclusion
Major loss of muscle mass but not body weight loss during preoperative chemotherapy is significantly associated with poor recurrence-free survival after hepatectomy in patients with colorectal liver metastases. The mechanisms mediating this association may inform future trials on maintaining muscle mass with dedicated nutrition and exercise programs to improve outcomes. 相似文献6.
Timothy H. Mungroop Bart F. Geerts Denise P. Veelo Timothy M. Pawlik Aurélie Bonnet Mickaël Lesurtel Koen M. Reyntjens Takehiro Noji Chao Liu Eduard Jonas Christopher L. Wu Eduardo de Santibañes Mohammed Abu Hilal Markus W. Hollmann Marc G. Besselink Thomas M. van Gulik 《Surgery》2019,165(2):337-344
Background
Fluid and pain management during liver surgery (eg, low central venous pressure) is a classic topic of controversy between anesthesiologists and surgeons. Little is known about practices worldwide. The aim of this study was to assess perioperative practices in liver surgery among and between surgeons and anesthesiologists worldwide that could guide the design of future international studies.Methods
An online questionnaire was sent to 22 societies, including 4 international hepatopancreatobiliary societies, the American Society of Anesthesiologists, and 17 other (inter-)national societies.Results
A total of 913 participants (495 surgeons and 418 anesthesiologists) from 66 countries were surveyed. A large heterogeneity in fluid management practices was identified, with 66% using low central venous pressure, 22% goal-directed fluid therapy, and 6% normovolemia. In addition, large heterogeneity was found regarding pain management practices, with 49% using epidural analgesia, 25% patient-controlled analgesia with opioids, and 12% regional techniques. Most participants assume that there is a relation between perioperative pain management and morbidity and mortality (78% of surgeons vs 89% of anesthesiologists; P < .001). Both surgeons and anesthesiologists have the highest expectations for minimally invasive surgery and enhanced recovery pathways for improving outcomes in liver surgery. No clear differences between continents were found.Conclusion
Worldwide there is a large heterogeneity in fluid and pain management practices in liver surgery. This survey identified several areas of interest for future international studies aiming to improve outcomes in liver surgery. 相似文献7.
Cheng Huang Xiao-Dong Zhu Guo-Ming Shi Ying-Hao Shen Guang-Yu Ding Jia-Bin Cai Jian Zhou Jia Fan Hui-Chuan Sun 《Surgery》2019,165(3):534-540
Background
Although prophylactic glucocorticoids have been used before liver resection to minimize liver dysfunction, it is unknown whether treatment with glucocorticoids will accelerates recovery from hyperbilirubinemia after liver resection.Methods
In this open-label, randomized, controlled trial, patients with hyperbilirubinemia (>2.5?×?and ≤5?×?the upper limit of normal) within 7 days after hepatic resection were assigned randomly to the dexamethasone or control groups. For the dexamethasone group, 10 mg, 10 mg, and 5 mg dexamethasone were administered intravenously on days 0, 1, and 2, respectively, after randomization. For the control group, patients received standard treatment only. The primary outcome was time to recovery from hyperbilirubinemia defined as the period from the day of randomization to the day when serum bilirubin decreased to ≤1.5 times that of the upper limit of normal. Secondary outcomes were the prevalence of postoperative complications, postoperative hospital stay, and hospital expense.Results
Between March 2016 and December 2017, 76 participants were enrolled (38 in each group). Median time to recovery from hyperbilirubinemia was less in the dexamethasone group than in the control group (2 vs 4 days, P < .001). Serum bilirubin levels were less in the dexamethasone group on days 1–3 after randomization (P < .05). The prevalence of infection, posthepatectomy liver failure, postoperative hospital stay, and hospital expense were not different between the groups.Conclusion
Dexamethasone accelerated recovery from hyperbilirubinemia and decreased serum bilirubin levels without causing more side effects in patients after hepatectomy. 相似文献8.
Han Zhang Jun Han Hao Xing Zhen-Li Li Myron E. Schwartz Ya-Hao Zhou Ting-Hao Chen Hong Wang Wei-Min Gu Wan Yee Lau Han Wu Meng-Chao Wu Feng Shen Tian Yang 《Surgery》2019,165(3):516-524
Background
There is a striking sex difference in the incidence of hepatocellular carcinoma, with a strong predominance for men; however, the impact of sex on the incidence of recurrence after curative resection of hepatocellular carcinoma remains controversial. This study aimed to assess sex differences in the risks of recurrence and mortality for patients treated with curative resection of hepatocellular carcinoma.Methods
We retrospectively reviewed data from 1,435 hepatocellular carcinoma patients treated with curative resection (1,228 men and 207 women) between 2004 and 2014 at 5 institutions in China. Patients’ baseline characteristics, operative variables, and rates of early recurrence (≤2 years after resection), late recurrence (>2 years after resection), and cancer-specific mortality were evaluated and compared. To clarify the true oncologic impact of sex, multivariable competing-risks regression analyses were performed to identify predictors associated with early and late recurrence, as well as cancer-specific mortality.Results
The early recurrence rates between men and women were similar (43.3% vs 42.0%, P?=?.728), but the late recurrence and rates of cancer-specific mortality in men were greater compared with women (17.2% vs 11.2%, P?=?.044; and 42.8% vs 34.3%, P?=?.022, respectively). Multivariable competing-risks regression analyses revealed no sex difference in early recurrence; however, men had greater late recurrence rate (hazard ratio, 1.752; 95% confidence interval, 1.145–2.682; P?=?.010) and rate of cancer-specific mortality (hazard ratio, 1.307; 95% confidence interval, 1.015–1.683; P?=?.038).Conclusion
There was no difference in early recurrence rate (≤2 years after resection between men and women, but men had significantly greater late recurrence (>2 years) and rates of cancer-specific mortality after hepatocellular carcinoma resection than women. 相似文献9.
Brian N. Arnold Daniel C. Thomas Vikrant Bhatnagar Justin D. Blasberg Zuoheng Wang Daniel J. Boffa Frank C. Detterbeck Anthony W. Kim 《Surgery》2019,165(2):450-454
Background
Robot-assisted thoracoscopic lobectomy has been shown to be a safe approach to pulmonary lobectomy. This study sought to define, mathematically, the learning curve for RATS lobectomy.Methods
Patients undergoing robot-assisted thoracoscopic lobectomy at a single institution from 2010 through 2016 were considered. Covariates included patient demographics, comorbidities, operating time, length of stay, estimated blood loss, and postoperative complications. A cumulative sum analysis of operating time was performed to define the learning curve.Results
A total of 101 patients were included. Three distinct phases of the learning curve were identified: cases 1–22, cases 23–63, and cases 64–101. There was a statistically significant difference in operating time and estimated blood loss between phases 1 and 2 (P < .05, P?=?.016, respectively) and between phases 1 and 3 (P < .05, P?=?.006, respectively). There was no statistically significant difference in comorbidities, chest tube duration, length of stay, postoperative complications, or conversion rate across the learning curve.Conclusion
Based on operating time, the learning curve for robot-assisted thoracoscopic lobectomy is 22 cases, with mastery achieved after 63 cases. No differences in length of stay, chest tube duration, conversion rate, or complication rate were observed in the learning curve. Other factors not measured in this study may play a role in the learning process and warrant further study. 相似文献10.
Nicholas J. Goel Prateek Agarwal Arka N. Mallela Kalil G. Abdullah Zarina S. Ali Ali K. Ozturk Neil R. Malhotra James M. Schuster H. Isaac Chen 《The spine journal》2019,19(3):448-460
BACKGROUND AND CONTEXT
The impact of underlying liver disease on surgical outcomes has been recognized in a wide variety of surgical disciplines. However, less empiric data are available about the importance of liver disease in spinal surgery.PURPOSE
To measure the independent impact of underlying liver disease on 30-day outcomes following surgery for the degenerative cervical spine.STUDY DESIGN
Retrospective comparative study.PATIENT SAMPLE
A cohort of 21,207 patients undergoing elective surgery for degenerative disease of the cervical spine from the American College of Surgeons National Surgical Quality Improvement Program.OUTCOME MEASURES
Outcome measures included mortality, hospital length of stay, and postoperative complications within 30 days of surgery.METHODS
The NSQIP dataset was queried for patients undergoing surgery for degenerative disease of the cervical spine from 2006 to 2015. Assessment of underlying liver disease was based on aspartate aminotransferase-to-platelet ratio index and Model of End-Stage Liver Disease-Sodium scores, computed from preoperative laboratory data. The effect of liver disease on outcomes was assessed by bivariate and multivariate analyses, in comparison with 16 other preoperative and operative factors.RESULTS
Liver disease could be assessed in 21,207 patients based on preoperative laboratory values. Mild liver disease was identified in 2.2% of patients, and advanced liver disease was identified in 1.6% of patients. The 30-day mortality rates were 1.7% and 5.1% in mild and advanced liver diseases, respectively, compared with 0.6% in patients with healthy livers. The 30-day complication rates were 11.8% and 31.5% in these patients, respectively, compared with 8.8% in patients with healthy livers. In multivariate analysis, the presence of any liver disease (mild or advanced) was independently associated with an increased risk of mortality (OR=2.00, 95% CI=1.12–3.55, p=.019), morbidity (OR=1.35, 95% CI=1.07–1.70, p=.012), and length of hospital stay longer than 7 days (OR=1.73, 95% CI=1.40–2.13, p<.001), when compared with 18 other preoperative and operative factors. Liver disease was also independently associated with perioperative respiratory failure (OR=1.80, 95% CI=1.21–2.68, p=.004), bleeding requiring transfusion (OR=1.43, 95% CI=1.01–2.02, p=.044), wound disruption (OR=2.82, 95% CI=1.04–7.66, p=.042), and unplanned reoperation (OR=1.49, 95% CI=1.05–2.11, p=.025).Conclusions
Liver disease independently predicts poor perioperative outcome following surgery for degenerative disease of the cervical spine. Based on these findings, careful consideration of a patient's underlying liver function before surgery may prove valuable in surgical decision-making, preoperative patient counseling, and postoperative patient care. 相似文献11.
Tone Nygaard Flølo Grethe S. Tell Ronette L. Kolotkin Anny Aasprang Tone M. Norekvål Villy Våge John R. Andersen 《Surgery for obesity and related diseases》2019,15(2):161-167
Background
A person's confidence to control eating, eating self-efficacy (ESE), has been identified as a target for long-term weight management in nonsurgical weight loss interventions, but has to a limited extent been studied after bariatric surgery.Objective
We investigated the association between ESE, weight loss, and obesity-specific quality of life (QOL) after sleeve gastrectomy (SG).Setting
A single-center longitudinal study.Methods
Data from adult patients were collected before SG, and at mean 16 months (±standard deviation 4 mo) and 55 (±4) months postoperatively. ESE was measured by the Weight Efficacy Lifestyle Questionnaire Short-Form. Multiple regression analyses were performed with excess body mass index loss (%EBMIL) and obesity-specific QOL as dependent variables. Age, sex, and other preoperative values were covariates in all models.Results
Of 114 preoperative patients, 91 (80%) and 84 (74%) were available for follow-up 16 and 55 months after SG, respectively. Mean %EBMIL from baseline to 16 and 55 months was 76% (95% confidence interval: 71.9, 79.6) and 67% (95% confidence interval: 61.9, 72.2), respectively. Preoperative ESE scores improved significantly at both 16 and 55 months (P?=?.002) but did not predict postoperative %EBMIL or QOL at 55 months (β?=??.08, P?=?.485). Greater change in ESE from 0 to 16 months predicted higher %EBMIL (β?=?.34, P?=?.013) at 55 months, and improvements in ESE from 0 to 55 months were significantly associated with higher %EBMIL (β?=?.46, P?=?.001) and obesity-specific QOL (β?=?.50, P < .001) 55 months after SG.Conclusion
Significant improvements in ESE were seen at 16 months, and remained high at 55 months after SG in this cohort. Patients who improved their ESE the most also experienced the highest weight loss and obesity-specific QOL 5 years postoperatively. Future research should address whether enhancement of ESE corresponds to sustained improvements in eating behavior after bariatric surgery. 相似文献12.
Tammy Ju Lisbi Rivas Suzanne Arnott Samantha Olafson Ashlyn Whitlock Andrew Sparks Ivy N. Haskins Paul P. Lin Khashayar Vaziri 《Surgery for obesity and related diseases》2019,15(2):261-268
Background
Bariatric surgery is an effective and durable treatment for obesity. However, the number of patients that progress to bariatric surgery after initial evaluation remains low.Objectives
The purpose of this study was to identify factors influencing a qualified patient's successful progression to surgery in a U.S. metropolitan area.Setting
Academic, university hospital.Methods
A single-institution retrospective chart review was performed from 2003 to 2016. Patient demographics and follow-up data were compared between those who did and did not progress to surgery. A follow-up telephone survey was performed for patients who failed to progress. Univariate analyses were performed and statistically significant variables of interest were analyzed using a multivariable logistic regression model.Results
A total of 1102 patients were identified as eligible bariatric surgery candidates. Four hundred ninety-eight (45%) patients progressed to surgery and 604 (55%) did not. Multivariable analysis showed that patients who did not progress were more likely male (odds ratio [OR] 2.2 confidence interval [CI]: 1.2–4.2, P < .05), smokers (OR 2.4 CI: 1.1–5.4, P < .05), attended more nutrition appointments (OR 2.1 CI: 1.5–2.8, P < .0001), attended less total preoperative appointments (OR .41 CI: .31–.55, P < .0001), and resided in-state compared with out of state (OR .39 CI: .22–.68, P < .05). The top 3 patient self-reported factors influencing nonprogression were fear of complication, financial hardship, and insurance coverage.Conclusions
Multiple patient factors and the self-reported factors of fear of complication and financial hardship influenced progression to bariatric surgery in a U.S. metropolitan population. Bariatric surgeons and centers should consider and address these factors when assessing patients. 相似文献13.
Jaime Ruiz-Tovar Alejandro Garcia Carlos Ferrigni Juan Gonzalez Camilo Castellon Manuel Duran 《Surgery for obesity and related diseases》2019,15(2):228-235
Background
The essence of enhanced recovery after surgery (ERAS) program is the multimodal approach, and many authors have demonstrated safety and feasibility in fast-track bariatric surgery.Objectives
The aim of this study was to evaluate the postoperative pain after the implementation of an ERAS protocol in Roux-en-Y gastric bypass and to compare it with the application of a standard care protocol.Setting
University Hospital Rey Juan Carlos, Madrid, Spain.Methods
A prospective randomized clinical trial of all the patients undergoing Roux-en-Y gastric bypass was performed. Patients were randomized into the following 2 groups: those patients after an ERAS program and those patients after a standard care protocol. Postoperative pain, nausea or vomiting, morbidity, mortality, hospital stay, and analytic acute phase reactants 24 hours after surgery were evaluated.Results
One hundred eighty patients were included in the study, 90 in each group. Postoperative pain (16 versus 37 mm; P < .001), nausea or vomiting (8.9% versus 2.2%; P?=?.0498), and hospital stay (1.7 versus 2.8 d; P < .001) were significantly lower in the ERAS group. There were no significant differences in complications, mortality, and readmission rates. White blood cell count, serum fibrinogen, and C reactive protein levels were significantly lower in the ERAS group 24 hours after surgery.Conclusion
The implementation of an ERAS protocol was associated with lower postoperative pain, reduced incidence of postoperative nausea or vomiting, lower levels of acute phase reactants, and earlier hospital discharge. Complications, reinterventions, mortality, and readmission rates were similar to that obtained after a standard care protocol. 相似文献14.
Kevin T. Lynch J. Hunter Mehaffey Robert B. Hawkins Taryn E. Hassinger Peter T. Hallowell Jennifer L. Kirby 《Surgery for obesity and related diseases》2019,15(2):279-285
Background
Obesity is associated with an increased risk of atrial fibrillation (AF). Bariatric surgery results insubstantial long-term weight loss and the amelioration of several chronic comorbidities. We hypothesized that weightreduction with bariatric surgery would reduce the long-term incidence of AF.Objectives
To assess the association between bariatric surgery and AF prevention.Setting
University Hospital, United States.Methods
All patients who underwent bariatric surgery at a single institution from 1985–2015 (n?=?3,572) were propensity score matched 1:1 to a control population of obese patients with outpatient appointments (n?=?45,750) in our clinical data repository. Patients with a prior diagnosis of AF were excluded. Demographics, relevant comorbidities, and insurance status were collected and a chart review was performed for all patients with AF. Paired univariate analyses were used to compare the two groups.Results
After propensity score matching, 5,044 total patients were included (2,522 surgical, 2,522 non-surgical). There were no differences in preoperative body mass index (BMI) (47.1 vs 47.7 kg/m2, P?=?0.76) or medical comorbidities between groups. The incidence of AF was lower among surgical patients (0.8% vs 2.9%, P?=?0.0001). In patients ultimately diagnosed with AF, time from enrollment to development of AF did not differ between groups; however, surgical patients with AF experienced a significantly higher reduction in excess BMI compared to non-surgical patients with AF (57.9% vs ?3.8%, P<0.001).Conclusion
The incidence of AF was lower among patients who underwent bariatric surgery compared to their medically managed counterparts. Weight reduction with bariatric surgery may reduce the long-term incidence of AF. 相似文献15.
David Gutierrez Blanco David Romero Funes Giulio Giambartolomei Emanuele Lo Menzo Samuel Szomstein Raul J. Rosenthal 《Surgery for obesity and related diseases》2019,15(1):14-20
Background
There is a paucity of studies comparing risk reduction of the atherosclerotic cardiovascular disease (ASCVD) and Framingham-body mass index (BMI) Coronary Heart risk score after a laparoscopic Roux-en-Y gastric bypass (RYGB), and few studies have assessed the efficacy of laparoscopic sleeve gastrectomy (SG) in reducing cardiovascular risk.Objective
Our goal in this study was to compare the impact of SG and RYGB on cardiovascular risk reduction.Setting
U.S. university hospital.Methods
We retrospectively reviewed the records of all SG or RYGB cases at our institution between 2010 and 2015. Patients who met the criteria for calculating the ASCVD 10-year and Framingham-BMI score were included in the study. Propensity score matching was used to match SG and RYGB on demographic characteristics and co-morbidities.Results
Of the 1330 bariatric patients reviewed in the study period, 219 (19.3%) patients met the criteria for risk score calculation. SG was the most prevalent surgery in 72.6% (N?=?159) of cases compared with RYGB in 27.4% (N?=?60) of cases. At 12-month follow-up, ASCVD 10-year score had an absolute risk reduction of 3.9 ± 6.5% in SG patients and 2.9 ± 5.8% in RYGB patients (P?=?.3). Framingham-BMI score absolute risk reduction was 11.0 ± 12.0% in SG and 9.0 ± 11.0% in RYGB patients (P?=?.4), and the decrease in estimated heart age was 12.1 ± 15.6 years in SG versus 9.2 ± 9.6 years in RYGB (P?=?.1). The percentage of estimated BMI loss at 1 year was 68.1 ± 23.3% in SG versus 74.2 ± 24.8% in RYGB (P?=?.1).Conclusion
Our results suggest that SG and RYGB are equally effective in improving cardiovascular risk and decreasing the estimated vascular/heart age at 12-month follow-up. 相似文献16.
Brian H.H. Lang Carlos K.H. Wong Estella P.M. Ma Yu-Cho Woo Keith Wan-Hang Chiu 《Surgery》2019,165(1):85-91
Background
High-intensity focused ultrasound is a promising, nonoperative treatment for benign thyroid nodules. Our study aimed to compare treatment outcomes of single-session high-intensity focused ultrasound ablation with open lobectomy after propensity score matching.Methods
After propensity matching, we compared treatment-related morbidity, treatment time, duration of hospitalization, improvement in symptom score, cost, and acoustic parameters of consecutive patients who underwent high-intensity focused ultrasound ablation or lobectomy. All eligible patients completed the computerized, multidimensional voice program and Voice Handicap Index questionnaire before, and 3 and 6 months after treatment.Results
The matched cohort comprised 154 patients (77 in each group). Although treatment-related morbidity was comparable between the two groups (P?=?.368), treatment time (P <.001), duration of hospitalization (P <.001), and medical cost (P <.001) were less in the high-intensity focused ultrasound group. After high-intensity focused ultrasound ablation, the 6-month nodule shrinkage (mean ± SD) was 64% ± 26% and the 6-month symptom improvement score was comparable with lobectomy (P?=?.283). At 6 months, none of the acoustic parameters were changed from the baseline in both groups (P >.05), and the Voice Handicap Index questionnaire did not differ between the two groups (P >.05).Conclusion
Despite having similar treatment-related morbidity and voice outcomes, there were possibly some advantages with high-intensity focused ultrasound during open lobectomy, including the avoidance of a neck scar, shorter treatment time and duration of hospitalization, and lower medical cost. 相似文献17.
Pia Henfridsson Anna Laurenius Ola Wallengren Eva Gronowitz Jovanna Dahlgren Carl-Erik Flodmark Claude Marcus Torsten Olbers Lars Ellegård 《Surgery for obesity and related diseases》2019,15(1):51-58
Background
Information is scarce on long-term changes in energy intake (EI), dietary energy density (DED), and body composition in adolescents undergoing laparoscopic Roux-en-Y gastric bypass (RYGB).Objectives
To investigate long-term changes in EI, DED, and body composition in adolescents after LRYGB.Setting
University hospitals, multicenter study, Sweden.Methods
Eighty-five adolescents (67% girls; mean ± standard deviation, age 16.0 ± 1.2 yr, body mass index 45.5 ± 6.1 kg/m2) were assessed preoperatively (baseline) and 1, 2, and 5 years after LRYGB with diet history interviews and dual-energy x-ray absorptiometry. Matched obese adolescent controls receiving nonsurgical treatment were assessed only at 5 years.Results
Weight decreased 31%, 33%, and 28% at 1, 2, and 5 years after LRYGB (P < .001) while controls gained 13% over 5 years (P < .001). Dietary assessments were completed in 98%, 93%, 87%, and 75% at baseline and 1, 2, and 5 years, respectively, and in 65% of controls. Baseline EI (2558 kcal/d), decreased by 34%, 22%, and 10% after 1, 2, and 5 years (P < .05). DED decreased at 1 year (P?=?.03). Macronutrient distribution was not different from controls at 5 years, but EI and DED were 31% and 14% lower (P < .015). Fat, fat-free, and muscle mass decreased through 5 years after LRYGB (P < .001). Boys preserved muscle mass more than girls (P < .01). Adequate protein intake was associated with preservation of muscle mass (P?=?.003).Conclusions
In adolescents undergoing LRYGB EI remained 10% lower 5 years after surgery. Decreased EI and DED, rather than macronutrient distribution, are important factors in weight loss after surgery. Higher protein intake may facilitate preservation of muscle mass. 相似文献18.
Allison N. Martin Jean Claude Byiringiro Robin T. Petroze Menelas Nkeshimana Fidele Byiringiro James F. Calland 《Surgery》2019,165(2):444-449
Background
There is conflicting evidence regarding the impact of human immunodeficiency virus serostatus on trauma outcomes in low-resource settings. This study sought to evaluate the impact of human immunodeficiency virus serostatus on mortality outcomes for Rwandan patients presenting after trauma.Methods
This retrospective review of the University of Rwanda trauma registry captured all adult trauma patients with known human immunodeficiency virus status presenting between March 2011 and July 2015. Confirmed human immunodeficiency virus-positive cases were matched 1:2 with known human immunodeficiency virus-negative controls using a modified Kampala Trauma Score, sex, and district of residence or primary hospital. All-cause mortality was compared using multivariable logistic regression.Results
In total, 11,280 patients were recorded prospectively in the registry (169 human immunodeficiency virus positive; 334 human immunodeficiency virus negative matches). There was no difference in delay of hospital presentation or time until operation (P?=?.50 and P?=?.57, respectively). Less than 30% of all patients underwent operation during admission (n?=?133), and the rate of operative intervention was independent of human immunodeficiency virus serostatus (P?=?.946). There was no association between development of any complication and human immunodeficiency virus status (P?=?.837). The overall mortality rate was 8.9% and 3.3% for human immunodeficiency virus-positive and human immunodeficiency virus-negative patients, respectively (P?=?.010). Human immunodeficiency virus positivity was associated with increased 30-day mortality when controlling for potential confounders (P?=?.016; odds ratio 3.60, 95% confidence interval: 1.27–10.2, C statistic 0.88).Conclusion
Both human immunodeficiency virus and trauma pose substantial public health threats in sub-Saharan Africa. Known human immunodeficiency virus seropositivity in Rwandan trauma patients is associated with early mortality. Further investigation regarding testing, treatment, and outcomes in human immunodeficiency virus-positive trauma patients is warranted and provides an opportunity for leveraging human immunodeficiency virus global health efforts in trauma outcomes assessment. 相似文献19.
Mustapha El Lakis Andreas Giannakou Pavel J. Nockel Douglas Wiseman Sudheer Kumar Gara Dhaval Patel Zahraa Abdul Sater Yevgeniya Y. Kushchayeva Joanna Klubo-Gwiezdzinska Naris Nilubol Maria J. Merino Electron Kebebew 《Surgery》2019,165(1):50-57
Background
There are conflicting reports on whether familial nonmedullary thyroid cancer is more aggressive than sporadic nonmedullary thyroid cancer. Our aim was to determine if the clinical and pathologic characteristics of familial nonmedullary thyroid cancer are different than nonmedullary thyroid cancer.Methods
We compared patients with familial nonmedullary thyroid cancer to a cohort of 53,571 nonmedullary thyroid cancer patients from the Surveillance, Epidemiology, and End Results database.Results
A total of 78 patients with familial nonmedullary thyroid cancer from 31 kindreds presented at a younger age (P?=?.04) and had a greater rate of T1 disease (P?=?.019), lymph node metastasis (P?=?.002), and the classic variant of papillary thyroid cancer on histology (P < .001) compared with the Surveillance, Epidemiology, and End Results cohort. Patients with ≥3 affected family members presented at a younger age (P?=?.04), had a lesser female-to-male ratio (P?=?.04), and had a greater rate of lymph node metastasis (P?=?.009). Compared with the Surveillance, Epidemiology, and End Results cohort, we found a higher prevalence of lymph node metastasis in familial nonmedullary thyroid cancer index cases (P?=?.003) but not in those diagnosed by screening ultrasonography (P?=?.58).Conclusion
Patients with familial nonmedullary thyroid cancer present at a younger age and have a greater rate of lymph node metastasis. The treatment for familial nonmedullary thyroid cancer should be more aggressive in patients who present clinically and in those who have ≥3 first-degree relatives affected. 相似文献20.
Jeung Hui Pyo Hyuk Lee Yang Won Min Byung-Hoon Min Jun Haeng Lee Kyoung-Mee Kim Heejin Yoo Kyunga Kim Yoon-Ho Choi Jae J. Kim Sung Kim 《Surgery》2019,165(4):802-807