共查询到20条相似文献，搜索用时 31 毫秒
1.
Marc Schiesser Josef Guber Stefan Wildi Ivo Guber Markus Weber Markus K. Muller 《Obesity surgery》2011,21(8):1238-1242
Background
In up to 4% of laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures, anastomotic leaks occur. Early detection of gastrointestinal leakage is important for successful treatment. Consequently, many centers advocate routine postoperative upper gastrointestinal (UGI) series. The aim of this study was to determine the utility of this practice after LRYGB. 相似文献2.
Bendewald FP Choi JN Blythe LS Selzer DJ Ditslear JH Mattar SG 《Obesity surgery》2011,21(11):1671-1675
Background
There is no consensus on the ideal gastrojejunostomy anastomosis (GJA) technique in laparoscopic Roux-en-Y gastric bypass (LRYGB). We reviewed our experience with three GJA techniques (hand-sewn (HSA), linear-stapled (LSA), and 25-mm circular-stapled (CSA)) to determine which anastomosis technique is associated with the lowest early (60-day) anastomotic complication rates. 相似文献3.
Anna R. Ibele Frank P. Bendewald Samer G. Mattar Daniel T. McKenna 《Obesity surgery》2014,24(7):1052-1056
Background
Anastomotic leak at the gastrojejunostomy is a life-threatening complication of laparoscopic Roux-en-Y gastric bypass (LRYGB). Fibrin sealants have been used as topical adjuncts to reduce leaks at the gastrojejunostomy. Our clinical observations suggest that an unintended consequence may be the promotion of anastomotic stricture. We hypothesized that the use of fibrin sealant at the gastrojejunostomy in patients undergoing LRYGB decreases the incidence of anastomotic leak but increases the incidence of clinically significant stricture.Methods
Following institutional review board approval, medical records of patients undergoing LRYGB by two surgeons at a single institution over a 5-year period were retrospectively reviewed. Preoperative demographics and postoperative complication rates including incidence of gastrojejunostomy leak and endoscopically diagnosed stricture requiring dilation within 1 year of surgery were recorded.Results
Four hundred twenty-five patients had fibrin sealant routinely applied to their gastrojejunostomy site and 104 did not. Four leaks occurred in the sealant group and two leaks occurred in the control group (p?=?0.2). Of patients who received sealant, 1.6 % needed postoperative blood transfusion compared to those 1.6 % of patient who did not receive sealant (p?=?0.05). There was a significantly increased rate of strictures requiring dilation in the sealant group (11.3 % compared to 4.8 % stricture rate in patients who did not receive sealant, p?=?0.04).Conclusions
In our experience, the use of fibrin sealant at linear stapled gastrojejunostomy site during LRYGB increases the incidence of clinically significant postoperative stricture and does not reduce the incidence of anastomotic leak. 相似文献4.
Background
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a potentially complicated surgery with significant hospitalisation, especially during the learning curve. There are inadequate data on fast-track LRYGB in relation to learning curve. This study highlights the outcomes of a fast-track LRYGB service. 相似文献5.
Jad Khoraki Guilherme S. Mazzini Amar S. Shah Paul A.R. Del Prado Luke G. Wolfe Guilherme M. Campos 《Surgery for obesity and related diseases》2018,14(8):1118-1125
Background
Early small bowel obstruction (ESBO; within 30 d of surgery) after laparoscopic gastric bypass (LRYGB) is reported in .5% to 5.2% of primary cases, but it is associated with significant morbidity, and the treatment is not standardized.Objectives
To review prevalence, causes, management, and outcomes of patients treated for ESBO after LRYGB.Setting
Tertiary academic medical center.Methods
Retrospective review to identify consecutive patients who underwent primary LRYGB and those who developed ESBO from January 2000 through June 2017. Data included demographic characteristics, co-morbidities, LRYGB technical details, and ESBO clinical presentation, location, causes, treatment, and outcomes.Results
One thousand seven hundred seventeen patients (84.2% females) had LRYGB. Mean age and body mass index was 42.4 ± 11.1 years and 48.2 ± 7.3 kg/m2, respectively. Twenty-nine patients (1.7%) had ESBO. All patients presented with symptoms, most commonly nausea and vomiting (n?=?17), on average 4.1 ± 5.9 days postoperatively; most required reoperation (n?=?23, 79.3%) and 5 required >1 reoperation. Location of the obstruction and treatment used were the following: (1) jejuno-jejunostomy (n?=?17, 58.6%; narrowing or clot), treated with reoperation in 11; and (2) other than at the jejuno-jejunostomy (n?=?12, 41.4%; trocar site, incisional or internal hernia, adhesions, mesenteric ischemia), treated with reoperation in all. All ESBO patients had additional complications, 6 (20.1%) developed an anastomotic leak, and 2 (6.9%) died.Conclusion
ESBO infrequently occurs after LRYGB; many causes are technique related and possibly preventable. However, it is associated with significant morbidity and mortality. A high index of clinical suspicion, rapid and appropriate imaging, and prompt operative intervention are recommended. 相似文献6.
Background
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is suggested as the gold standard of the surgical techniques for morbid obesity treatment. The aim of this study was to evaluate the weight loss and biomarker parameter changes over a 1-year period following LRYGB in Iranian morbidly obese patients. 相似文献7.
Background
Outcomes for patients who undergo laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery have improved, but a subset of patients who significantly utilize more resources exists. We identified preoperative variables that increase resource utilization in patients who undergo LRYGB. 相似文献8.
Background
Laparoscopic Roux-en-Y gastric bypass (LRYGB) can dramatically ameliorate type 2 diabetes mellitus (T2DM) in morbidly obese patients. However, there is little evidence supporting the effectiveness of LRYGB in low body mass index (BMI) patients. The study was designed to evaluate the safety and results of LRYGB for achieving T2DM remission in patients with BMI in the range of 25–35 kg/m2. 相似文献9.
Rena Moon Andre Teixeira Sheila Varnadore Kelly Potenza Muhammad A. Jawad 《Obesity surgery》2013,23(6):788-793
Background
In the literature, staple line leak rate is reported to be 1–6 %, and hemorrhage rate is 2–5 % in laparoscopic Roux-en-Y gastric bypass (LRYGB). Various buttress materials are available in an attempt to reduce perioperative complications. The aims of our study are to evaluate the effect of using absorbable hemostat (SNK) as buttress material and compare its usage with bovine pericardial strips (PSD).Methods
Between January 2006 to May 2007 and from October 2007 to December 2009, a total of 1,074 patients underwent LRYGB at our institution. Of these 1,074 patients, PSD was used in 443 (41.2 %) patients, and SNK was used in 631 (58.8 %) patients. A retrospective review of a prospectively collected database was performed for all LRYGB patients, noting the outcomes and complications of the procedure.Results
Five (1.1 %) patients required transfusion of packed red blood cells (PRBC) during early postoperative period (postoperative 1–3 days) in the PSD group, while two (0.3 %) patients required transfusion in the SNK group. SNK patients received significantly lower mean units of PRBC (1.0 unit) when compared to that of PSD patients (5.0 units). One (0.2 %) anastomotic leak was found in the PSD group on postoperative day (POD) 10. One (0.2 %) patient in the SNK group also showed an anastomotic leak on POD 2. Additionally, the cost of SNK per procedure was significantly less than that of PSD.Conclusions
The use of absorbable hemostat as buttress material may be effective in reducing acute postoperative bleeding in LRYGB at a significantly lower cost. 相似文献10.
Arturo Rodríguez Maureen Mosti Mauricio Sierra Rocío Pérez-Johnson Salvador Flores Guillermo Dominguez Hugo Sánchez Artemio Zarco Karen Romay Miguel F. Herrera 《Obesity surgery》2010,20(10):1380-1384
Background
Small bowel obstruction (SBO) after laparoscopic Roux-en-Y gastric bypass (LRYGB) may be related to the surgical technique used. The frequency and characteristics of postoperative SBO were studied in two cohorts of patients after LRYGB. 相似文献11.
Van Nieuwenhove Y Ceelen W Van Renterghem K Van de Putte D Henckens T Pattyn P 《Obesity surgery》2011,21(4):501-505
Background
Morbidity after converting failed laparoscopic adjustable gastric banding (LAGB) to laparoscopic Roux-en-Y gastric bypass (LRYGB) is three- to fivefold higher than after primary LRYGB. Allowing a time interval between band removal and actual gastric bypass might reduce local inflammation and reduce morbidity. 相似文献12.
Waleed Al-Khyatt Charles A. Bull Sherif Awad Javed Ahmed 《World journal of surgery》2016,40(8):1918-1924
Background
Laparoscopic Roux en-Y gastric bypass (LRYGB) achieves sustained long-term weight loss and reduced mortality in morbidly obese patients. It is routinely performed using an ante- or retrocolic approach with the jejuno-jejunostomy constructed in the infracolic compartment. We have modified the standard technique of performing LRYGB by constructing both anastomoses in the supracolic compartment. This study describes the outcomes of consecutive primary LRYGB performed using this novel retrocolic–supracolic approach.Methods
Data were prospectively collected on consecutive primary LRYGB performed in a tertiary-referral Bariatric Centre in the United Kingdom from September 2009 to March 2013. Data included demographics, operative outcomes (duration of surgery, postoperative anastomotic leak/bleeding/reoperations), development of strictures, length of stay, excess weight loss (EWL) and resolution of diabetes mellitus.Results
Hand-sewn LRYGB was successfully performed using the retrocolic–supracolic approach in 300 of 307 (98 %) consecutive patients (72 % female). Median (IQR) age, weight and baseline body mass index were 49 (41–56) years, 146 (134–163) kg and 52.9 (48.8–57.2) kg/m2, respectively. There were 4 (1.3 %) anastomotic leaks and 8 (2.6 %) postoperative bleeds. The 30-day reoperation rate was 1.6 %. Median (IQR) hospital stay was 2 (2–2) days. Postoperative dysphagia requiring endoscopic balloon dilatation occurred in 19 (6.3 %) patients. Mean ± SD 12-month EWL was 69.9 ± 19.0 %. Within the follow-up period, 81 % of patients with type II diabetes mellitus achieved remission and 19 % reduced dosage of diabetes medication.Conclusions
LRYGB performed using the retrocolic–supracolic approach was safe, feasible, technically advantageous and resulted in clinical outcomes akin to the standard infracolic approach.13.
Background
Obesity surgery is the most effective treatment for morbid obesity and the fastest growing area in surgery. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the gold standard procedure in many countries. Optimization of the treatment process is important in order to keep the morbidity rate down and cost of treatment as low as possible. 相似文献14.
Michał R. Janik Rami R. Mustafa Tomasz G. Rogula Adel Alhaj Saleh Mujjahid Abbas Leena Khaitan 《Surgery for obesity and related diseases》2018,14(9):1276-1282
Background
An increase in the prevalence of obesity and longer life expectancy has resulted in an increased number of candidates over the age of 60 who are pursuing a bariatric procedure.Objective
The aim of this study was to assess the safety of laparoscopic Roux-Y gastric bypass (LRYGB) compared to laparoscopic sleeve gastrectomy (LSG) in patients aged 60 years or older.Setting
University Hospital, United StatesMethods
Preoperative characteristics and 30-day outcomes from the MBSAQIP 2015 were selected for all patients aged 60 years or older who underwent a LSG or LRYGB. LRYGB cases were closely matched (1:1) with LSG patients by age (±1 year), BMI (±1 kg/m2), gender, preoperative steroid or immunosuppressant use, preoperative functional health status and comorbidities including: diabetes, gastroesophageal reflux disease, hypertension, hyperlipidemia, venous stasis, sleep apnea and history of severe chronic obstructive pulmonary disease.Results
A 3371 matched pairs were included in the study. The mean operative time in LRYGB was significantly longer in comparison to LSG patients (122 vs 84 min., P<0.001). Patients after LRYGB had a significantly increased anastomotic leakage rate (1.01% vs 0.47 %, p = 0.011), 30-day readmission rate (6.08% vs 3.74%, p < 0.001) and 30-day reoperation rate (2.49% vs 0.89%, p < 0.001) The length of hospital stay was longer in LRYGB. Mortality and bleed rate was comparable.Conclusions
LRYGB and LSG in patients aged 60 years or older are relatively safe in the short term with an acceptable complication rate and low mortality. However, LRYGB is more challenging and is associated with significantly increased rates of leakage events, 30-day reoperation, 30-day readmission, longer operative time and longer hospital stay. 相似文献15.
Dimitrios J. Pournaras Sadaf Jafferbhoy Daniel R. Titcomb Samer Humadi Janet R. Edmond David Mahon Richard Welbourn 《Obesity surgery》2010,20(3):290-294
Background
Bariatric surgery is expanding and the increasing workload needs to be undertaken safely in new surgical centres with no previous bariatric experience. The laparoscopic Roux-en-Y gastric bypass (LRYGB) has a steep learning curve with documented high risk. We present the results for the first 300 cases of LRYGB in a new centre. 相似文献16.
Jonathan D. Zellmer Michelle A. Mathiason Kara J. Kallies Shanu N. Kothari 《American journal of surgery》2014,208(6):903-910
Background
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the current “gold standard” bariatric procedure in the United States. Laparoscopic sleeve gastrectomy (LSG) has recently become a commonly performed procedure for many reasons, including patients' perception that LSG has less complexity and invasiveness, and lower risk. Our objective was to review the literature and compare the leak rates, morbidity, and mortality for LRYGB versus LSG.Methods
Publications from 2002 to 2012 with n greater than or equal to 25 and postoperative leak rate reported were included. Statistical analysis included chi-square according to patient number.Results
Twenty-eight (10,906 patients) LRYGB and 33 (4,816 patients) LSG articles were evaluated. Leak rates after LRYGB versus LSG were 1.9% (n = 206) versus 2.3% (n = 110), respectively (P = .077). Mortality rates were .4% (27/7,117) for LRYGB and .2% (7/3,594) for LSG (P = .110). Timing from surgery to leak ranged from 1 to 12 days for LRYGB versus 1 to 35 days for LSG.Conclusions
Leak and mortality rates after LRYGB and LSG were comparable. The appropriate procedure should be tailored based on patient factors, comorbidities, patient and surgeon comfort level, surgeon experience, and institutional outcomes. 相似文献17.
Low Anastomotic Stricture Rate After Roux-en-Y Gastric Bypass Using a 21-mm Circular Stapling Device
Background
Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been established as a safe and effective procedure for morbid obesity management. Amongst some of the postoperative complications are gastrojejunal (GJ) anastomotic strictures, with an incidence of 3 to 27?% in some series. This study evaluates the incidence of GJ strictures using a 21-mm circular stapling device and its response to treatment with endoscopic balloon dilation.Methods
A retrospective chart review was conducted of patients who underwent LRYGB between January 2007 and September 2010. We used our previously published technique of retrocolic, retrogastric Roux-en-Y bypass, using a 21-mm circular stapler to construct the gastrojejunostomy. Postoperatively, patients with persistent food intolerance underwent an endoscopy. Those found to have a GJ stricture (defined as inability to pass the endoscope beyond he anastomotic site) underwent pneumatic dilation with a 12-mm balloon.Results
A total of 338 patients underwent LRYGB. Median follow-up was 57.6?weeks (8?C137). Twenty-two patients underwent an endoscopy due to food intolerance. Sixteen patients (4.7?%, 16/338) were identified with GJ stricture and received at least one endoscopic dilation. The other six patients had a normal endoscopic evaluation. GJ strictures presented at an average of 35?days (13 to 90?days) postoperatively. Four patients underwent two endoscopic interventions, and one underwent three endoscopic interventions.Conclusions
We hereby demonstrate that the construction of GJ anastomosis with a 21-mm circular stapler is associated with a low stricture rate using our standardized technique. Strictures are amenable to balloon dilatation with subsequent long-term resolution of symptoms. 相似文献18.
Muffazal A. Lakdawala Aparna Bhasker Dheeraj Mulchandani Sunita Goel Sneha Jain 《Obesity surgery》2010,20(1):1-6
Background
Laparoscopic sleeve gastrectomy (LSG) is gaining popularity as a procedure for the treatment of morbid obesity. Its indications and long-term results are currently under evaluation. Initially started as a first-stage procedure for superobese patients, it is now emerging as a standalone procedure in Asia and other parts of the world. Early results suggest that, at the end of 1 year, weight loss and resolution of comorbidities with LSG is comparable to laparoscopic Roux-en-Y gastric bypass (LRYGB). Whether LSG alone can replace LRYGB as a standard bariatric procedure is questionable. The aim of this study is to compare the results, resolution of comorbidities, and complications between LSG and LRYGB. 相似文献19.
Xiao Du Xiang-hui Fu Lei Shi Jian-kun Hu Zong-guang Zhou Zhong Cheng 《Obesity surgery》2018,28(3):702-711
Background
Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been proven to be effective on treating type 2 diabetes mellitus (T2DM) in severely obese patients, but whether LRYGB surgery should be performed in obese class I patients is controversial.Materials and Methods
A retrospective study of 3-year bariatric and metabolic outcomes in different obese class T2DM patients who underwent LRYGB was conducted to compare the effectiveness of LRYGB in obese class I patients with that in obese class II/III patients in a Chinese T2DM population.Results
Totally, 58 patients with class I obesity and 45 patients with class II/III obesity were enrolled in this study. Major complications included two cases of incomplete intestinal obstructions and one anastomotic leak. The remission rates of T2DM were 70.6% in obese class I group and 77.8% in obese class II/III group at 1 year after surgery and 55.6 versus 64.3% at 3 years (all P > 0.05). Logistic regression analysis showed that higher waist circumference, lower fasting plasma glucose, and higher FCP at 2 h of OGTT were independently associated with diabetes remission at 1 year after surgery. At 1 year and thereafter, the percentage of excess weight loss was significantly greater in obese class II/III patients. At 3 years, body mass index was not significantly different between the two groups, and the obese class I patients had high recurrence rates of hypertension and hyperuricemia.Conclusions
LRYGB surgery is feasible, safe, and effective in Chinese obese class I patients with T2DM.20.
Rudolf A. Weiner Islam A. El-Sayes Sophia Theodoridou Sylvia R. Weiner Oliver Scheffel 《Obesity surgery》2013,23(12):2004-2012