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1.
Comparative Analysis of Vertical Banded Gastroplasty and Duodenal Switch at Five Years Follow-Up 总被引:2,自引:2,他引:0
Background: Bariatric surgery is the only effective long-term treatment for morbid obesity. We compared long-term results
of the vertical banded gastroplasty (VBG) and biliopancreatic diversion with duodenal switch (DS). Quality of life (QoL),
weight loss (WL), and reoperation were evaluated. Methods: This is a retrospective study of 85 of 129 patients with VBG and
49 of 743 patients with DS, with follow-up >5 years. Mean preoperative BMI of the VBG patients was 48.8 kg/m2 and for the DS patients was 50.3 kg/m2. Results: Percent excess weight loss (%EWL) at 5 years for VBG patients was 56.4% and for DS patients 70.6% (P<0.0001). 8 VBG patients (9.4%) and 1 DS patient (2.0%) required re-operation due to failure of the technique. None of the
VBG patients could eat a normal diet, while 80% of the DS had no restriction in the quality of their intake. Conclusions:
At 60 months follow-up, only the DS patients fullfilled the ASBS requirements of %EWL >50 in over 75% of the patients. 相似文献
2.
Laparoscopic Adjustable Gastric Banding: Early Experience in 400 Consecutive Patients in the USA 总被引:3,自引:3,他引:0
Background: Early experience with 400 consecutive patients who underwent laparoscopic adjustable gastric banding (LAGB) is
reported. Methods: From Nov 2002 to Aug 2004, prospective data were collected on 400 consecutive LAGB patients and evaluated
retrospectively. Results: There were 354 (88.5%) females and 46 males (11.5%), with mean age 43.6 years and mean BMI 46.2
kg/m 2 . For outpatients (freestanding ambulatory surgery center), mean OR time was 55.4 min in 208 patients (52%), compared to mean inpatient OR time of 70.5 min in 192 patients. Inpatients had a higher BMI (48.2 ± 9.3 SD) than outpatients (43.9 ± 5.7 SD) (P<0.0001). Complications occurred in 35 patients (8.8%). These consisted of 9 slipped bands (2.3%) that were surgically repositioned,
6 port problems (1.5%) that were successfully repaired, 17 patients with temporary stoma occlusion (4.3%) that spontaneously
resolved, and 2 bowel perforations (0.5%) that required surgical repair and band removal. One patient died of pneumonia 2
weeks after an uneventful procedure. Average 1-year percent excess weight loss (%EWL) in 138 patients was 48.2%. Patients
who had ≤50 kg initial excess weight (n=37, 27%) had a significantly higher %EWL (55.2%) at 1 year than patients who had >50
kg initial excess weight (P=0.0011). Conclusions: LAGB has been safe and effective thus far for the surgical treatment of morbid obesity, and can be
performed as an outpatient in select patients. 相似文献
3.
Sánchez-Santos R Vilarrasa N Pujol J Moreno P Manuel Francos J Rafecas A Masdevall C 《Obesity surgery》2006,16(4):478-483
Background:The outcome after Roux-en-Y gastric bypass (RYGBP) in morbidly obese (MO) (body mass index [BMI] 40-50) was compared
with super-obese (SO) (BMI >50) and super-super-obese (SSO) (BMI >60) patients. Methods: A prospective study was conducted
in 738 consecutive patients who underwent RYGBP. 483 MO were compared with 184 SO and 70 SSO. Study endpoints included: effect
on co-morbid conditions, postoperative morbidity and mortality, and long-term results. Statistical analysis utilized SPSS
11.0. Results: Percentage of males was significantly greater in the SO groups (16.5% vs 13%, P=0.01). Obesity-related conditions were significantly more frequent in the SO groups: sleep apnea (38% vs 17%, P<0.0005), gallstones (23% vs 14%, P=0.013); diabetes (29% vs 17%, P=0.002). Hospital stay was longer in the SO groups (5.7±6.1 days vs 4.6±2.6 days, P=0.024). Wound infection was more frequent in the SO groups (4.7% vs 1.4%, P=0.019). Postoperative mortality was greater in the SSO and SO groups (1.6% and 1.4%) than MO (0%) (P=0.019). Incisional hernia was more frequent in the SO groups (14.1% vs 8.6%; P=0.041). There was no significant difference in percent of excess weight loss (%EWL) between the three groups. EWL >50% at
5 years was: MO 81.5%, SO 87.5%, SSO 80%. The surgery was effective in treating the co-morbid conditions. Conclusion: RYGBP
achieved significant durable weight loss and effectively treated co-morbid conditions in SO and SSO patients with acceptable
postoperative morbidity and slightly greater mortality than in MO patients. 相似文献
4.
Background: Bariatric surgery in patients >50 years has been controversial. We investigated the safety and efficacy of laparoscopic
Roux-en-Y gastric bypass (LRYGBP) in patients >55 years of age. Methods: Prospective data on 71 patients (54 females and 17
males) undergoing LRYGBP were reviewed. The patients were followed for a mean of 17 months (range 2-35 months). Results: The
mean age was 59 years (range 55-67 years), and the mean preoperative BMI was 50.2 kg/m2 (range 37-65 kg/m2). There were no conversions to open technique. Mean percent of excess weight loss (%EWL) was 20%, 48%, 64% and 67% at 1,
6, 12 and 24 months respectively. 89% of patients had at least a 50% EWL at 1 year postoperatively. There was a significant
decrease in the number of patients requiring medical treatment for co-morbidities associated with morbid obesity: diabetes
mellitus 87%, hypertension 70% and sleep apnea 86%. There was no inpatient mortality. 1 patient died suddenly 2 weeks postoperatively
of possible myocardial infarction or pulmonary embolism. 16 patients developed 22 complications. The median length of hospital
stay was 3 days. Conclusion: LRYGBP is a safe and well-tolerated surgical option for the treatment of morbid obesity in patients
>55 years old. These patients demonstrate a satisfactory weight loss and resolution of co-morbidities. 相似文献
5.
Does Gastric Dilatation Limit the Success of Sleeve Gastrectomy as a Sole Operation for Morbid Obesity? 总被引:6,自引:10,他引:6
Langer FB Bohdjalian A Felberbauer FX Fleischmann E Reza Hoda MA Ludvik B Zacherl J Jakesz R Prager G 《Obesity surgery》2006,16(2):166-171
Background: Sleeve gastrectomy as the sole bariatric operation has been reported for high-risk super-obese patients or as
first-step followed by Roux-en-Y gastric bypass (RYGBP) or duodenal switch (DS) in super-super obese patients. The efficacy
of laparoscopic sleeve gastrectomy (LSG) for morbidly obese patients with a BMI of <50 kg/m2 and the incidence of gastric dilatation following LSG have not yet been investigated. Methods: 23 patients (15 morbidly obese,
8 super-obese) were studied prospectively for weight loss following LSG. The incidence of sleeve dilatation was assessed by
upper GI contrast studies in patients with a follow-up of >12 months. Results: Patients who underwent LSG achieved a mean
excess weight loss (EWL) at 6 and 12 months postoperatively of 46% and 56%, respectively. No significant differences were
observed in %EWL comparing obese and super-obese patients. At a mean follow-up of 20 months, dilatation of the gastric sleeve
was found in 1 patient and weight regain after initial successful weight loss in 3 of the 23 patients. Conclusion: LSG has
been highly effective for weight reduction for morbid obesity even as the sole bariatric operation. Gastric dilatation was
found in only 1 patient in this short-term follow-up. Weight regain following LSG may require conversion to RYGBP or DS. Follow-up
will be necessary to evaluate long-term results. 相似文献
6.
A Genetic "Obesity Risk Index" for Patients With Morbid Obesity 总被引:3,自引:2,他引:1
Background:The influence of genetics on obesity is well established. Adoption studies and twin studies suggest that about
80% of the obesity risk is genetic. We designed a tool to predict outcomes of treatments in patients with sporadic or familial
obesity. Methods:Two factors best correlate with multifactorial genetic risk: 1) familial history and 2) age of onset. 147
morbidly obese adults self- or physician-referred for possible surgery for morbid obesity (age 17-66y, BMI 35-82) were studied.
Six elements were selected to measure the genetic influence on patients' weight: 3 personal weight milestones (weight at age
10, 20 and 30), and 3 family history factors (parents'weight, siblings' weight and second degree relatives' weight. These
6 elements of personal and family history information were collected prospectively on 35 obese patients and a feasible scoring
system devised, with 0 points signifying no genetic component and 100 points suggesting the maximal possible genetic risk
for obesity. Prospective data were then collected on 147 consecutive patients seen in consultation for possible bariatric
surgery,to provide this "obesity risk index" (ORI). Results: The final scoring system for the ORI assigned 50 possible points
for personal weight milestones and 50 possible points for family history factors. At age 10, patients receive 10 or 20 points
for being 2 or 3 SD above the mean BMI for age, respectively. At age 20, 10 or 20 points are received for BMI > 30 or 40,
respectively. At age 30, 5 or 10 points are received for BMI > 35 or 50, respectively. 0 to 28 points are awarded for parental
obesity, with 7 or 14 points for each parent with BMI > 30 or 40, respectively. The mean BMI of all siblings was calculated,
with 6 or 12 points received for mean BMI greater than 30 or 40, respectively.Two points are awarded for each second degree
relative with BMI>35, to a maximum of 10 points. The mean (±SEM) score for our first 114 patients was 32 ± 2 (range 0 to 87).The
median score was 28. 13% of patients had scores <10; conversely, 13% scored points on all 6 elements. Conclusion: An ORI has
been devised to quantify the genetic contribution to an individual's weight. Using this scoring system, we found that about
85% of patients who are candidates for bariatric surgery have elements in their history to suggest a genetic risk for morbid
obesity. About 15% have extremely strong genetic ORIs. 相似文献
7.
Duodenal Switch is a Safe Operation for Patients who have Failed Other Bariatric Operations 总被引:2,自引:0,他引:2
Background: The incidence of morbid obesity and its surgical treatment have been increasing over the last few years. With
this increase, there has been a rise in the number of patients who have had less than desirable outcome after bariatric operations.
We perform the duodenal switch (DS) in patients for whom other weight loss surgical procedures have failed, because of inadequate
weight loss, weight regain or significant complications, such as solid intolerance or dumping syndrome. Method: From November
1999 to March 2004, 46 revisional surgeries were performed at our institution. The data was prospectively collected and reviewed,
based on a number of parameters. Operative details, perioperative morbidity, and results are reported. Results: 46 patients
had their original bariatric surgical operation revised to DS. This resulted in complete resolution of their presenting complaints.
The %EWL was 69% at the time of publication, with a mean lapsed time of 30 months. We had no mortality. Anastomotic leak occurred
in 4 patients, 2 in our first 8 patients. We also noted that the majority of the patients were not aware of all the surgical
procedures available to them at the time of their original operation. Conclusion: In patients in whom gastroplasty, gastric
bypass or both have failed to provide adequate weight loss, or worse have resulted in complications, DS can be performed as
a safe revisional operation. The revision of other failed bariatric operations to DS results in both weight loss and resolution
of the complications. 相似文献
8.
Background: Although bariatric surgery is known to be effective in the short term, the durability of that effect has not been convincingly
demonstrated over the medium term (>3 years) and the long term (>10 years). The authors studied the durability of weight loss
after bariatric surgery based on a systematic review of the published literature. Methods: All reports published up to September, 2005 were included if they were full papers in refereed journals published in English,
of outcomes after Roux-en-Y gastric bypass (RYGBP), and its hybrid procedures of banded bypass (Banded RYGBP) and longlimb
bypass (LL-RYGBP), biliopancreatic diversion with or without duodenal switch (BPD±DS) or laparoscopic adjustable gastric banding
(LAGB). All reports that had at least 100 patients at commencement, and provided ≥3 years of follow-up data were included.
Results: From a total of 1,703 reports extracted, 43 reports fulfilled the entry criteria (18 RYGBP; 18 LAGB; 7 BPD). Pooled data
from all the bariatric operations showed effective and durable weight loss to 10 years. Mean %EWL for standard RYGBP was higher
than for LAGB at years 1 and 2 (67 vs 42; 67 vs 53) but not different at 3, 4, 5, 6 or 7 years (62 vs 55; 58 vs 55; 58 vs
55; 53 vs 50; and 55 vs 51). There was 59 %EWL for LAGB at 8 years, and 52 %EWL for RYGBP at 10 years. Both the BPD±DS and
the Banded RYGBP appeared to show better weight loss than standard RYGBP and LAGB, but with statistically significant differences
present at year 5 alone. The LL-RYGBP was not associated with improved %EWL. Important limitations include lack of data on
loss to follow-up, failure to identify numbers of patients measured at each data point and lack of data beyond 10 years. Conclusions: All current bariatric operations lead to major weight loss in the medium term. BPD and Banded RYGBP appear to be more effective
than both RYGBP and LAGB which are equal in the medium term. 相似文献
9.
10.
Unchanged Hypovitaminosis D and Secondary Hyperparathyroidism in Morbid Obesity after Bariatric Surgery 总被引:6,自引:6,他引:0
Ybarra J Sánchez-Hernández J Gich I De Leiva A Rius X Rodríguez-Espinosa J Pérez A 《Obesity surgery》2005,15(3):330-335
Background: Morbidly obese patients have been reported to present with vitamin D insufficiency and secondary hyperparathyroidism.
We assessed whether bariatric surgery alters the 25-hydroxyvitamin D (calcidiol) and intact parathyroid hormone (iPTH) levels
in patients presenting with morbid obesity. Methods: A cross-sectional survey was conducted on 144 patients of whom 80 had
not undergone bariatric surgery, while 64 had bariatric surgery at a mean of 36 months previously. Calcidiol levels were defined
as being normal (>50 nmol/L), insufficient (2550 nmol/L) and deficient (<25 nmol/L). Mild secondary hyperparathyroidism was
defined as iPTH >7.3 pmol/L with simultaneous normal values for creatinine, calcium and phosphorus. Results: 80% of the patients
presented low vitamin D levels and mild secondary hyperparathyroidism. Previous surgery or the presence of diabetes did not
influence calcidiol levels. Corrected serum calcium, phosphorus, alkaline phosphatase, iPTH and Calcidiol were similar between
subjects with and without surgery. Conclusions: Vitamin D deficient states with secondary hyperparathyroidism in the morbidly
obese precede and are not significantly affected by bariatric surgery. Hypovitaminosis D with secondary hyperparathyroidism
due to low calcidiol bio-availability should be added to the crowded list of sequelae of morbid obesity. While further studies
are warranted, it seems advisable to support vitamin D supplementation in the morbidly obese population. 相似文献
11.
Bariatric Surgery: Asia-Pacific Perspective 总被引:8,自引:0,他引:8
Background: There is a world-wide epidemic of overweight, obesity and morbid obesity. Bariatric surgery today, as the only
effective therapy for morbid obesity, is expanding exponentially to meet the global epidemic of morbid obesity. Bariatric
surgeons in the Asia-Pacific region had founded the Asia-Pacific Bariatric Surgery Group (APBSG) at Seoul, Korea on October
6, 2004. Methods: E-mail requests for information were sent to the national bariatric surgery leaders. These requests were
followed, if necessary, by second e-mail requests and communications seeking clarification. The summary data was also discussed
at the 1st Asia-Pacific Bariatric Consensus Meeting held in Taipei, February 27, 2005. Results: 11 countries or areas in Asia
had started bariatric surgery and responded to the general questions. In 2004, 636 bariatric operations were performed by
61 bariatric surgeons. The earliest data for starting bariatric surgery was in 1974 in Taiwan. Following the development of
gastric partition, Taiwan performed the first case in 1981, Japan in 1982 and Singapore in 1987. In 2004, 11 countries have
started bariatric surgery. The APBSG was founded in 2004. In 2004, 12.1% of operations were open and 87.9% laparoscopic. The
6 most popular operations were: laparoscopic adjustable banding 42.3%; laparoscopic gastric bypass 34.2%; open vertical banded
gastroplasty 7.5%; laparoscopic vertical banded gastroplasty 6.3%; laparoscopic sleeve gastrectomy 6.3%; open gastric bypass
4.2%. Pooling open and laparoscopic procedures, relative percentages were gastric banding 42.3%; gastric bypass 38.4%; vertical
banded gastroplasty 13.8%. The APBSG consensus meeting recommended bariatric surgery in Asian patients with BMI >37 or >32
with diabetes or two other obesity-related co-morbidities. Conclusions: Bariatric surgery is expanding rapidly in Asia to
meet rapidly increasing obesity. The modification of the indications for bariatric surgery in the Asian is proposed. 相似文献
12.
Preoperative Carbohydrate "Addiction" Does Not Predict Weight Loss after Laparoscopic Gastric Bypass
Background: Weight loss after laparoscopic Roux-en-Y gastric bypass (LRYGBP) varies. Dietary habits that exist preoperatively
may continue after surgery and affect weight loss. This study investigated the hypothesis that preoperative carbohydrate addiction
would predict weight loss after laparoscopic gastric bypass. Methods: 104 consecutive patients in our LRYGBP program were
included in the study. A preoperative survey was used to determine level of carbohydrate craving. This survey was scored from
0 to 60. A higher score indicated a higher level of carbohydrate addiction. Percentage of excess weight loss (%EWL) was determined
after at least 1 year postoperatively in all patients. Results: Data were available in 95 (91%) of the patients. There was
no correlation seen between level of carbohydrate addiction and %EWL at 1 year (r=0.02; P=NS). In addition, we looked at patients with successful weight loss (>50% %EWL; n=83) versus those patients who were considered
unsuccessful (<50% EWL; n=12). There was no statistical difference in the level of preoperative carbohydrate craving between
these 2 groups (36±13 vs 33±15; P=NS). Conclusions: Consistently large carbohydrate intake preoperatively does not predict weight loss after LRYGBP. High level
of carbohydrate addiction is not a contraindication to LRYGBP. 相似文献
13.
Calorie Intake and Meal Patterns up to 4 Years after Roux-en-Y Gastric Bypass Surgery 总被引:1,自引:1,他引:0
Background: Roux-en-Y gastric bypass (RYGBP) is the most popular surgical treatment for morbid obesity in the U.S.A., producing
significant and durable weight loss with improvement in co-morbidities. Although a greater number of patients are undergoing
surgical treatment for obesity, little data are available regarding their food intake after surgery. This study was undertaken
to evaluate the caloric amount, nutrient composition and meal patterns of patients 18 months to 4 years after RYGBP. Ethnic
differences in food intake were also investigated. Methods: Questionnaires were mailed to 360 patients who had undergone RYGBP
at least 18 months prior to the onset of the study. Results: Data were available from 69 patients, 52% Caucasian, 25% African-American,
23% Hispanic. 30 months after surgery, the average daily calorie intake was 1733 ± 630 kcal (n=68, range 624-3486 kcal), with
44% of calories from carbohydrates, 22% from protein and 33% from fat. Sugar-sweetened beverages represented 7% of total caloric
intake. Patients consumed 3 meals and 3 snacks per day on average. Food intake from dinner and an evening snack represented
40% of the daily caloric intake. Snacks accounted for 37% of the daily intake. Percent excess weight loss (%EWL) was 58 ±
17% and was not different among ethnic groups. However, Hispanics reported consuming fewer snacks and fewer calories. %EWL
correlated with the total daily caloric intake (r= .446, P <0.001). Follow-up attendance was 54% at 1 year after surgery but fell to 10% at 3 years. Only 77% of patients were taking
vitamin supplements. Conclusion: RYGBP resulted in significant weight loss. Caloric intake was quite variable. Long-term follow-up
remained low, putting patients at risk for metabolic and vitamin deficiencies. The relationship between caloric intake and
long-term weight changes remains to be studied. 相似文献
14.
Background: Duodenal switch (DS) is one of the most effective techniques for the treatment of morbid obesity and its related co-morbidities,
with mortality rates of <1%, but with 9.4% morbidity rates (6.5% due to leaks). We present our experience with 9 patients
operated with a DS, who later underwent total gastrectomy (TG) for complications of the sleeve gastrectomy. Methods: From 1994 to March 2006, 846 patients underwent the DS. 9 patients (1%) underwent TG; 5 were due to gastric leak at the angle
of His, 2 were related to leakage at the doudeno-ileal anastomosis (DIA), 1 was for stenosis of the gastric sleeve, and 1
for a gastroparesis. In 3 cases, the DS was the second bariatric operation. Full restoration of bowel anatomy was attempted
in all patients. Results: TG has been the final solution for gastric complications of the DS in 9 (1%) of our 846 patients. In all cases, bowel anatomy
has been restored, and there was no mortality. Postoperative courses have been difficult and hospital stays have been long
in all patients (mean 4.5 months; range 1-10 months), with several episodes of re-do surgery after the TG. The actual BMI
and %EBMIL are acceptable. Conclusions: TG successfully treated all 9 cases with life-threatening complications and difficult reinterventions after DS, without mortality.
Restoration of bowel anatomy was done in all cases, with good final results. 相似文献
15.
The laparoscopic adjustable gastric band (Lap-Band): a prospective study of medium-term effects on weight,health and quality of life 总被引:10,自引:0,他引:10
O'Brien PE Dixon JB Brown W Schachter LM Chapman L Burn AJ Dixon ME Scheinkestel C Halket C Sutherland LJ Korin A Baquie P 《Obesity surgery》2002,12(5):652-660
Background: Obesity is now one of our major public health problems. Effective and acceptable treatment options are needed.The
Lap-Band? system is placed laparoscopically and allows adjustment of the level of gastric restriction. Methods: A prospective study
of 709 severely obese patients was conducted over a 6-year period at a university-based multidisciplinary referral center.
After extensive preoperative evaluation, patients with a body mass index >35 were treated by LapBand? placement. Close follow-up
with progressive adjustment of gastric restriction continued permanently. Medical co-morbidities were monitored as part of
comprehensive prospective data collection. Results: There have been no deaths perioperatively or during follow-up. Significant
perioperative adverse events occurred in 1.2% only. Reoperation has been needed for prolapse (slippage) in 12.5%, erosion
of the band into the stomach in 2.8% and for tubing breaks in 3.6%. A steady progression of weight loss has occurred through
the duration of the study with 52 ± 19 %EWL at 24 months (n=333), 53±22 %EWL at 36 months (n=264), 52 ± 24 %EWL at 48 months
(n=108), 54 ± 24 %EWL at 60 months (n=30), and 57 ± 15% EWL at 72 months (n=10). Major improvements have occurred in diabetes,
asthma, gastroesophageal reflux, dyslipidemia, sleep apnea and depression. Quality of life as measured by Rand SF-36 shows
highly significant improvement. Conclusions: Placement of the Lap-Band? system provides safe and effective control of severe obesity. The effect on weight loss is durable and is associated with
major improvement in health and quality of life. It has the potential to provide a broadly acceptable option for this common
and serious disease. 相似文献
16.
Ma Y Pagoto SL Olendzki BC Hafner AR Perugini RA Mason R Kelly JJ 《Obesity surgery》2006,16(9):1227-1231
Background: Weight loss after bariatric surgery varies and depends on many factors, such as time elapsed since surgery, baseline
weight, and co-morbidities. Methods: We analyzed weight data from 494 patients who underwent laparoscopic Roux-en-Y gastric
bypass (RYGBP) by one surgeon at an academic institution between June 1999 and December 2004. Linear regression was used to
identify factors in predicting % excess weight loss (%EWL) at 1 year. Results: Mean patient age at time of surgery was 44
± 9.6 (SD), and the majority were female (83.8%). The baseline prevalence of co-morbidities included 24% for diabetes, 42%
for hypertension, and 15% for hypercholesterolemia. Baseline BMI was 51.5 ± 8.5 kg/m2. Mean length of hospital stay was 3.8 ± 4.6 days. Mortality rate was 0.6%. Follow-up weight data were available for 90% of
patients at 6 months after RYGBP, 90% at 1 year, and 51% at 2 years. Mean %EWL at 1 year was 65 ± 15.2%. The success rate
(≥50 %EWL) at 1 year was 85%. Younger age and lower baseline weight predicted greater weight loss. Males lost more weight
than females. Diabetes was associated with a lower %EWL. Depression did not significantly predict %EWL. Conclusion: The study
demonstrated a 65 %EWL and 85% success rate at 1 year in our bariatric surgery program. Our finding that most pre-surgery
co-morbidities and depression did not predict weight loss may have implications for pre-surgery screening. 相似文献
17.
Results of Silastic Ring Vertical Gastroplasty More Than 6 Years after Surgery: Analysis of a Cohort of 214 Patients 总被引:1,自引:0,他引:1
Background: Among the different techniques of surgical treatment for morbid obesity, silastic ring vertical gastroplasty (SRVG)
is an alternative, effective and easily reproducible technique. The aim of this study is to evaluate a cohort of patients
>6 years after SRVG for morbid obesity. Methods: From 1991 to 1996, 273 consecutive patients were eligible for SRVG. The evaluation
criteria included weight loss, evolution of co-morbidities, long-term morbidities, satisfaction of patients and quality of
life. Results: Among these 273 patients, 1 patient died in the postoperative period (0.4%). Postoperative morbidities occured
in 27 patients (10%). The long-term follow-up involved 213 patients (78%). Late postoperative complications consisted of outlet
stoma stenosis (14%), staple-line dehiscence (5.6%) and incisional hernia (8.5%). 23 patients (10%) needed a re-do operation.
Co-morbidities drastically improved. BMI fell from 45.3 to 30.7. Failure of SRVG was statistically associated with male gender
and super-obese patients. 69% of the patients were satisfied, and 73% would recommend this operation. Conclusion: SRVG is
very effective in a selected group of morbidly obese patients. 相似文献
18.
Boru C Silecchia G Pecchia A Iacobellis G Greco F Rizzello M Basso N 《Obesity surgery》2005,15(8):1171-1176
Background: An association between obesity and cancer has been shown in large epidemiological studies. The aim of this study
was to evaluate the prevalence and types of malignancies in an Italian cohort of obese patients referred to a bariatric center.
Methods: A retrospective, observational study was conducted. Between Jan 1996 and Dec 2004, 1,333 obese patients (M=369, F=964)
were seen in the center for minimally invasive treatment of morbid obesity. Morbid obesity were considered as BMI >40 kg/m2 or BMI >35 kg/m2 with at least one co-morbidity. Obese and morbidly obese patients who suffered any form of cancer were reviewed. Results:
43 patients (3.2%) presented various malignancies, with 88.3% in females. The prevalence of cancer in the younger group (21-46
years) was higher than in the older group (47-70 years), 2.1% vs 1.1%. 26 obese patients out of the 43 (60.5%) (age 41±7.9
years, BMI 38.2±9.9) presented hormone-related tumors. The most frequent site of cancer was breast (20.9%), followed closely
by thyroid. Conclusion: This is the first Italian report on prevalence of cancer in a homogeneous obese population attending
an academic bariatric center. The morbidly obese patients appear to have a higher risk of developing cancer, with a higher
prevalence of hormone-related tumors. The predominant gender affected by both obesity and cancer was female. Thus, a preoperative
work-up for cancer screening is indicated in this group of patients. 相似文献
19.
Laparoscopic Biliopancreatic Diversion with Duodenal Switch: Technique and Initial Experience 总被引:3,自引:0,他引:3
Background: The duodenal Switch (DS) is a variant of the biliopancreatic diversion (BPD) for the surgical treatment of morbid
obesity. Materials and Methods: The laparoscopic DS (LapDS) operation is described, and the early surgical outcomes of 16
patients are reported. Results: Postoperative stay was 5 to 8 days. Local wound infection at a trocar site was the most common
local complication. Conclusion: LapDS is an advanced, complex and feasible technique in bariatric surgery. 相似文献
20.
Background: Bariatric surgery in patients with significant co-morbid conditions is associated with increased perioperative
risk. Methods: From 1995-2001, 795 patients were operated upon at our institution for the diagnosis of morbid obesity. Of
these, 671 (84.4%) had the duodenal switch (DS) procedure. Longitudinal gastrectomy (LG) entails a greater curvature linear
gastrectomy creating a gastric tube with a volume of 100 ml along the lesser curvature of the stomach. This procedure was
performed for 21 patients (median age 50.5, median BMI 56). 9 patients were offered LG preoperatively because of their known
high perioperative risks. 12 patients were initially planned for DS, but the procedure was limited to LG alone because of
either unexpected intraoperative findings (n=9) or intraoperative hemodynamic instability (n=3). 5 patients developed complications,
and there were no deaths. Results: 19 out of 21 patients were available for a median follow-up of 17.5 months (6.25-20.25).
Median weight loss and median %EWL at 12 months were 44.5 kg and 45.1%, respectively. Estimated daily dietary volume at 1
year was 35% of preoperative values. Of 10 patients followed for ≥ 1 year, 4 of 10 achieved more than 50% EWL and 8 patients
were taking less or were completely off medications for diabetes, hypertension and congestive heart failure. Weight loss plateaued
at 1 year for the majority of patients. Conclusions: LG is a safe and effective option for high-risk morbidly obese patients.
Weight reduction is accomplished by limitation of caloric intake. LG can be offered to high-risk morbidly obese patients as
an interim procedure to help decrease perioperative risk before DS. 相似文献