共查询到20条相似文献,搜索用时 31 毫秒
1.
Wostrack M Shiban E Harmening K Obermueller T Ringel F Ryang YM Meyer B Stoffel M 《Acta neurochirurgica》2012,154(8):1419-1430
Background
Despite the increased risk of hemorrhage and deteriorating neurological function of once-bled cerebral cavernous malformations (CM), the management of eloquently located CMs remains controversial.Methods
All eloquently located CMs (n?=?45) surgically treated between 03/2006 and 04/2011 in our department were consecutively evaluated. Eloquence was characterized according to Spetzler and Martin's definition. The following locations were approached: brainstem, n?=?16; sensorimotor, n?=?8; visual pathway, n?=?7; cerebellum (deep nuclei and peduncles), n?=?7; basal ganglia, n?=?4, and language, n?=?3. Follow-up data was available for 41 patients (91 %) with a median interval of 14 months. Outcomes were evaluated according to the Glasgow outcome and the modified Rankin scale.Results
Immediately after surgery, 47 % (n?=?21) had a new deficit. At follow-up, 80 % (n?=?36) recovered to at least preoperative status or were better than before surgery, 9 % (n?=?4) exhibited a slight, and 7 % (n?=?3) had a moderate neurological impairment. Only two cases (4 %) with a new permanent severe deficit were observed, both related to dorsal brainstem surgery. The outcome after the surgery of otherwise located brainstem CMs was as beneficial as that for non-brainstem CMs. Patients with initially poor neurological performance fared worse than oligosymptomatic patients.Conclusions
Despite the high postoperative transient morbidity, the majority improved profoundly during follow-ups. Compared with natural history, surgical treatment should be considered for all eloquent symptomatic CMs. Dorsal brainstem location and poor preoperative neurological status are associated with an increased postoperative morbidity.2.
Jianfeng Gong Yao Wei Lili Gu Yi Li Zhen Guo Jing Sun Chao Ding Weiming Zhu Ning Li Jieshou Li 《Journal of gastrointestinal surgery》2016,20(5):976-984
Background
This study was conducted to report the short- and long-term outcomes of surgery for coloduodenal fistula in Crohn’s disease and explore the effect of preoperative optimization on surgical outcome.Methods
This is a retrospective review of 34 patients with coloduodenal fistula complicating Crohn’s disease between Jan 2008 and May 2015. Demographic information, preoperative management, and intraoperative and postoperative outcome data were collected.Results
Primary duodenal repair was carried out in 33 patients (13 with duodenal defect >3 cm), and bypass surgery was performed in one patient with duodenal stenosis. Patients undergoing preoperative optimization (n?=?25) had decreased postoperative major (24.0 vs. 87.5 %, P?=?0.005) and intra-abdominal septic (20.0 vs. 75.0 %, P?=?0.008) complications compared to patients with emergent/semi-emergent surgery (n?=?8). No duodenal stenosis occurred on a median follow-up of 22.5 months. Patients with duodenum-ileocolic anastomosis fistula had longer postoperative stay (14.0 vs. 10.0 days, P?=?0.032) and increased possibility of refistulization of the duodenum on follow-up (30.0 vs. 0 %, P?=?0.031) compared with those with spontaneous duodenum-colonic fistula.Conclusion
Primary duodenal repair can be safely performed in coloduodenal fistula in Crohn’s disease provided there was no duodenal stenosis, even for large duodenal defects. Preoperative optimization is associated with reduced postoperative complications. Patients with duodenum-ileocolic anastomosis fistula are more likely to have duodenum fistula recurrence compared to those with spontaneous duodenum-colonic fistula.3.
Roos E. Pouw Joep J. Gondrie Carine M. Sondermeijer Fiebo J. ten Kate Thomas M. van Gulik Kausilia K. Krishnadath Paul Fockens Bas L. Weusten Jacques J. Bergman 《Journal of gastrointestinal surgery》2008,12(10):1627-1637
Background
Radiofrequency ablation is safe and effective for complete eradication of nondysplastic Barrett esophagus (BE). The aim was to report the combined results of two published and two ongoing studies on radiofrequency ablation of BE with early neoplasia, as presented at SSAT presidential plenary session DDW 2008.Methods
Enrolled patients had BE ≤12 cm with early neoplasia. Visible lesions were endoscopically resected. A balloon-based catheter was used for circumferential ablation and an endoscope-based catheter for focal ablation. Ablation was repeated every 2 months until the entire Barrett epithelium was endoscopically and histologically eradicated.Results
Forty-four patients were included (35 men, median age 68 years, median BE 7 cm). Thirty-one patients first underwent endoscopic resection [early cancer (n?=?16), high-grade dysplasia (n?=?12), low-grade dysplasia (n?=?3)]. Worst histology remaining after resection was high-grade (n?=?32), low-grade (n?=?10), or no (n?=?2) dysplasia. After ablation, complete histological eradication of all dysplasia and intestinal metaplasia was achieved in 43 patients (98%). Complications following ablation were mucosal laceration at resection site (n?=?3) and transient dysphagia (n?=?4). After 21 months of follow-up (interquartile range 10–27), no dysplasia had recurred.Conclusions
Radiofrequency ablation, with or without prior endoscopic resection for visible abnormalities, is effective and safe in eradicating BE and associated neoplasia.4.
Audrey H. Choi Amanda Arrington Ann Falor Rebecca A. Nelson Michael Lew Joseph Chao Byrne Lee Joseph Kim 《Journal of gastrointestinal surgery》2016,20(4):688-692
Introduction
Reports on outcomes after double-staple technique (DST) for total and proximal gastrectomy are limited, originating mostly from Asian centers. Our objective was to examine anastomotic leak and stricture with DST for esophagoenteric anastomosis in gastric cancer patients.Methods
A single institution review was performed for patients who underwent total/proximal gastrectomy with DST between 2006 and 2015. DST was performed using transoral anvil delivery (OrVil?) with end-to-end anastomosis. Clinical characteristics and outcomes, including anastomotic leak and stricture, were recorded.Results
Overall, DST was performed in 60 patients [total gastrectomy (81.7 %, n?=?49/60), proximal gastrectomy (10.0 %, n?=?6/60), and completion gastrectomy (8.3 %, n?=?5/60)]. Neoadjuvant chemotherapy was administered to 21 patients (35.0 %), and 6 patients (10.0 %) received external beam radiation therapy prior to completion gastrectomy. Operative approach was open (51.7 %, n?=?31/60), laparoscopic (43.3 %, n?=?26/60), or robotic (5.0 %, n?=?3/60). Anastomotic leak occurred in 6.7 % (n?=?4/60), while stricture independent of leak was identified in 19.0 % (n?=?11/58) of patients. Complications occurred in 38.3 % (n?=?23/60) of patients, of which 52 % were classified as Clavien-Dindo grades III–V complications.Conclusion
In the largest Western series of DST for esophagoenteric anastomoses in gastric cancer surgery, our experience demonstrates that DST is safe and effective with low rates of leak and stricture.5.
Aurélie?Baillot Warner?M.?Mampuya Isabelle?J.?Dionne Emilie?Comeau Anne?Méziat-Burdin Marie-France?Langlois
Background
Experts recommend physical activity (PA) to optimize bariatric surgery (BS) results. However, evidence on the effect of PA before BS is missing. The aim of this study was to assess the impact of adding a Pre-Surgical Exercise Training (PreSET) to an interdisciplinary lifestyle intervention on physical fitness, quality of life, PA barriers, and anthropometric parameters of subjects awaiting BS.Methods
Thirty candidates for BS (43.2?±?9.2 years, 47.5?±?8.1 kg/m2) have been randomized in two groups: one group following the PreSET (endurance and strength training) and another receiving usual care. Before and after 12 weeks, we assessed physical fitness with a battery of tests (symptom-limited exercise test, 6-min walk test (6MWT), sit-to-stand test, half-squat test, and arm curl test), quality of life with the laval questionnaire, and PA barriers with the physical exercise belief questionnaire.Results
One control group subject abandoned the study. Subjects in the PreSET group participated in 60.0 % of the supervised exercise sessions proposed. Results showed significant improvements in the 6MWT (17.4?±?27.2 vs. ?16.4?±?42.4 m; p?=?0.03), half-squat test (17.1?±?17.9 vs. ?0.9?±?14.5 s; p?=?0.05), arm curl repetitions (4.8?±?2.3 vs. 1.0?±?4.1; p?=?0.01), social interaction score (10.7?±?12.5 vs. ?2.1?±?11.0 %; p?=?0.02), and embarrassment (?15.6?±?10.2 vs. ?3.1?±?17.8 %; p?=?0.02) in completers (n?=?8) compared to the non-completers (n?=?21). No significant difference between groups in BMI and other outcomes studied was observed after the intervention.Conclusions
Adding a PreSET to an individual lifestyle counselling intervention improved physical fitness, social interactions, and embarrassment. Post-surgery data would be interesting to confirm these benefits on the long term.6.
Zubaidah Nor Hanipah Suriya Punchai Arthur McCullough Srinivasan Dasarathy Stacy A. Brethauer Ali Aminian Philip R. Schauer 《Obesity surgery》2018,28(11):3431-3438
Introduction
Studies on bariatric patients with cirrhosis and portal hypertension are limited. The aim of this study was to review our experience in cirrhotic patients with portal hypertension who had bariatric surgery.Method
All cirrhotic patients with portal hypertension who underwent laparoscopic bariatric surgery, from 2007 to 2017, were retrospectively reviewed.Results
Thirteen patients were included; eight (62%) were female. The median age was 54 years (interquartile range, IQR 49–60) and median BMI was 48 kg/m2 (IQR 43–55). Portal hypertension was diagnosed based on endoscopy (n?=?5), imaging studies (n?=?3), intraoperative increased collateral circulation (n?=?2), and endoscopy and imaging studies (n?=?3). The bariatric procedures included sleeve gastrectomy (n?=?10, 77%) and Roux-en-Y gastric bypass (n?=?3, 23%). The median length of hospital stay was 3 days (IQR 2–4). Three 30-day complications occurred including wound infection (n?=?1), intra-abdominal hematoma (n?=?1), and subcutaneous hematoma (n?=?1). No intraoperative or 30-day mortalities. There were 11 patients (85%) at 1-year follow-up and 9 patients (69%) at 2-year follow-up. At 2 years, the median percentage of excess weight loss (EWL) and total weight loss (TWL) were 49 and 25%, respectively. There was significant improvement in diabetes (100%), dyslipidemia (100%), and hypertension (50%) at 2 years after surgery.Conclusion
Bariatric surgery in selected cirrhotic patients with portal hypertension is relatively safe and effective.7.
Daniel Berglind Mikaela Willmer Per Tynelius Ata Ghaderi Erik Näslund Finn Rasmussen 《Obesity surgery》2016,26(7):1463-1470
Background
Roux-en-Y gastric bypass (RYGB) patients report significant pre- to post-surgery increases in physical activity (PA). Conversely, objectively assessed PA does not increase after RYGB. The aim of the study was to compare self-reported and accelerometer-measured changes in moderate-to-vigorous PA (MVPA) and exercise from pre- to post-surgery, in women undergoing RYGB.Methods
Forty-three women with an average pre-surgery body mass index of 39.2 kg/m2 (SD 3.1) were recruited at Swedish hospitals. PA was measured by the Actigraph GT3X+ and by a previously validated short PA questionnaire, at home visits 3 months before and 9 months after surgery, thus limiting seasonal effects.Results
Self-reported time spent in exercise increased with 75 % and time spent in MVPA increased with 51 %, whereas accelerometer-assessed time spent in exercise increased with 0.9 % and time spent in MVPA increased with 2.1 %, from before to after surgery. Correlations comparing accelerometers with the questionnaire were 0.35 (P?=?0.02) for MVPA and 0.13 (P?=?0.4) for exercise before RYGB and 0.52 (P?≤?0.001) for MVPA and 0.12 (P?=?0.4) for exercise after RYGB.Conclusions
Pre- to post-RYGB surgery increases in self-reported PA were not confirmed by accelerometer-measured PA. Thus, health care workers should use objective measures of PA in patients undergoing RYGB, in order to assess whether patients achieve sufficient levels of PA.8.
Erin A Brennand Selphee Tang Colin Birch Magnus Murphy Sue Ross Magali Robert for the Calgary Women’s Pelvic Health Research Group 《International urogynecology journal》2017,28(4):621-628
Introduction and hypothesis
The objective was to evaluate the impact of preoperative body mass index ≥30 on objective and subjective cure rates 5 years after midurethral sling surgery.Methods
Secondary analysis of the 5-year results of a randomized clinical trial evaluating tension-free vaginal tape vs transobturator tape surgery. Women (n?=?176) were classified as obese or non-obese based on preoperative height and weight. Women self-reported symptoms and quality of life, and underwent standardized physical examinations and pad-testing. Categorical data were analyzed using Chi-squared or Fisher’s exact tests, continuous data by Mann–Whitney U test. Primary outcome was objective cure defined as <1 g urine lost on pad-test at 5 years post-surgery. Secondary outcomes were subjective cure of incontinence, urinary urge incontinence symptoms, and quality of life scores.Results
Non-obese women had a higher rate of objective cure, 87.4 % (n?=?83 out of 95) compared with 65.9 % (n?=?29 out of 44) in the obese group (P?=?0.003, risk difference [RD] 21.5 %, 95 % CI 5.9–37.0 %). Subjectively, non-obese women also reported higher rates of cure, 76.7 % (n?=?89 out of 116) compared with 53.6 % (n?=?30 out of 56) of obese women (P?=?0.002, RD 23.2 %, 95 % CI 8.0–38.3 %). Overall rates of urge incontinence symptoms were similar in the two groups, but rates of bothersome symptoms were higher for obese women (58.9 % vs 42.1 %, P?=?0.039, RD 16.8 % 95 % CI 1.1–32.6).Conclusions
Five years after surgery, obese women continued to experience lower rates of cure compared with non-obese women.9.
Purpose
Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease; however, the frequency of recurrence can be reduced if curative surgery following adjuvant chemotherapy is applied. At present, adjuvant chemotherapy is uniformly performed in all patients, as it is unclear which tumor types are controlled best or worst. We investigated patients with recurrence to establish the optimum treatment strategy.Methods
Of 138 patients who underwent curative surgery for PDAC, 85 developed recurrence. Comprehensive clinicopathological factors were investigated for their association with the survival time after recurrence (SAR).Results
The median SAR was 12.6 months. Treatments for recurrence included best supportive care, GEM-based therapy and S-1. The performance status [hazard ratio (HR) 0.12, P?<?0.001], histological invasion of lymph vessels (HR 0.27, P?<?0.001), kind of treatment for recurrence (HR 5.0, P?<?0.001) and initial recurrence site (HR 2.9, P?<?0.001) were independent significant risk factors for the SAR. The initial recurrence sites were the liver (n?=?21, median SAR 8.8 months), lung (n?=?10, 14.9 months), peritoneum (n?=?6, 1.7 months), lymph nodes (n?=?6, 14.7 months), local site (n?=?17, 13.9 months) and multiple sites (n?=?25, 10.1 months). A shorter recurrence-free survival (<?1 year) and higher postoperative CA19-9 level were significantly associated with critical recurrence (peritoneal/liver).Conclusions
Several risk factors for SAR were detected in this study. Further investigations are needed to individualize the adjuvant chemotherapy for each patient with PDAC.10.
Paul R. Burton Geraldine J. Ooi Cheryl Laurie Kalai Shaw Paul E. O’Brien Andrew Smith Peter D. Nottle Wendy A. Brown 《Journal of gastrointestinal surgery》2016,20(10):1683-1691
Background
Oesophageal cancer following bariatric surgery adds significant complexity to an already challenging disease. There is limited data on the diagnosis, presentation and management in these complex cases.Methods
A retrospective cohort study on prospectively collected data over 10 years was conducted. The oesophago-gastric cancer database was searched for patients with prior bariatric surgery. Data were retrieved on bariatric and cancer management.Results
We identified nine patients with oesophageal or gastro-oesophageal junction adenocarcinoma after bariatric surgery. Mean age was 58.3?±?6.9 years, and duration from bariatric surgery was 13.2?±?9.4 years. Weight loss at diagnosis was 30.6?±?23.3 kg (excess weight loss 58.1 %?±?29.6). Modes of presentation were Barrett’s surveillance (n?=?3), reflux symptoms (n?=?4) and incidental (n?=?2). Management was surgical resection (n?=?4), endoscopic mucosal resection (n?=?2) and palliative (n?=?3). Surgical resections were challenging due to adhesions, obesity, luminal dilatation and scarring on the stomach. There were two substantial leaks following gastroplasty.Conclusions
Oesophageal cancer following bariatric surgery is a challenging problem, and surgical resection carries high risk. A high index of suspicion is required and symptoms investigated precipitously. Technical challenges of operating on obese patients and the specific effects of previous bariatric procedures need to be understood, particularly the limitations on reconstructive options.11.
Gautam Sharma Zubaidah Nor Hanipah Ali Aminian Suriya Punchai Emre Bucak Philip R. Schauer Stacy A. Brethauer 《Obesity surgery》2018,28(8):2225-2232
Background
Perioperative management of chronically anti-coagulated patients undergoing bariatric surgery requires a balance of managing hemorrhagic and thromboembolic risks. The aim of this study is to evaluate the incidence of hemorrhagic complications and their management in chronically anticoagulated (CAT) patients undergoing bariatric surgery.Methods
A retrospective review of CAT patients undergoing bariatric surgery at an academic center from 2008 to 2015 was studied.Results
A total of 153 patients on CAT underwent surgery [Roux-en-Y gastric bypass (n?=?79), sleeve gastrectomy (n?=?63), and adjustable gastric banding (n?=?11)] during the study period: 85 patients (55%) were females; median age was 56 years (interquartile range [IQR] 49–64), and median BMI was 49 kg/m2 (IQR 43–56). The most common indications for CAT were venous thromboembolism (n?=?87) and atrial fibrillation (n?=?83). Median duration of procedure and estimated intraoperative blood loss was 150 min (IQR 118–177) and 50 ml (IQR 25–75), respectively. Thirty-day postoperative complications were reported in 33 patients (21.6%) including postoperative bleeding (n?=?19), anastomotic leak (n?=?3), and pulmonary embolism (n?=?1). Nineteen patients (12%) with early postoperative bleeding were further categorized to intra-abdominal (n?=?10), intraluminal (n?=?6), and at the port site or abdominal wall (n?=?3). All-cause readmissions within 30 days of surgery occurred in 19 patients (12%). There was no 30-day mortality.Conclusion
In our experience, patients who require chronic anticoagulation medication are higher than average risk for postoperative complications and all-cause readmission rates. Careful surgical technique and close attention to postoperative anticoagulation protocols are essential to decrease perioperative risk in this high-risk cohort.12.
Jiheum Paek Maria Lee Bo Wook Kim Yongil Kwon 《International urogynecology journal》2016,27(4):593-599
Introduction and hypothesis
The aim of this study was to compare robotic or laparoscopic sacrohysteropexy (RLSH) and open sacrohysteropexy (OSH) as a surgical treatment for pelvic organ prolapse (POP).Methods
Among 111 consecutive patients who had undergone sacrohysteropexy for POP, surgical outcomes and postoperative symptoms were compared between the RLSH (n?=?54; robotic 14 cases and laparoscopic 40 cases) and OSH (n?=?57). groups The medical records of enrolled patients were reviewed retrospectively.Results
Compared with the OSH group, the RLSH group had shorter operating time (120.2 vs 187.5 min, p?<?0.0001), less operative bleeding (median estimated blood loss 50 vs 150 ml; p?<?0.0001; mean hemoglobin drop 1.4 vs 2.0 g/dl; p?<?0.0001), and fewer postoperative symptoms (13 vs 45.6 %; p?<?0.0001). Patients’ overall satisfaction (94.4 vs 91.2 %; p?=?0.717) and required reoperation due to postoperative complications (3.7 vs 1.8 %; p?=?0.611) did not differ between groups.Conclusions
RLSH could be a feasible and safe procedure in patients with POP and should be considered as a surgical option that allows preservation of the uterus. Prospective randomized trials will permit the evaluation of potential benefits of RLSH as a minimally invasive surgical approach.13.
Purpose
To investigate the clinical characteristics of acute type A aortic dissection (ATAAD) occurring during a sporting activity.Methods
The subjects of this study were 615 patients who underwent surgery for ATAAD between 1990 and 2015. The patients were divided into two groups according to whether the ATAAD was associated with a sporting activity (sports group: n?=?25, mean age 62.3 years; non-sports group: n?=?590, mean age 63.7 years). Specific activity was assessed in the sports group, and the characteristics and outcomes were compared between the groups.Results
The sports group accounted for 5% of the patients with daytime onset ATAAD (25/479). The most common sport was golf (n?=?8), followed by swimming (n?=?4), cycling (n?=?4), and weight lifting (n?=?3). The average diameter of the ascending aorta on preoperative computed tomography was 4.8 cm. The dissection characteristics of the sports group included DeBakey type I (n?=?23, 92%) and malperfusion (n?=?9, 36%), which were similar to those of the non-sports group. The 30-day mortality rates were 16% (4/25) for the sports group and 8% (49/590) for the non-sports group (P?=?0.33).Conclusions
The most common sport associated with ATAAD was golf, followed by swimming cycling, and weight lifting. The findings of this study reinforce that sports-related aortic dissection is not a unique clinical condition of young syndromic patients, but can occur in all age groups.14.
Background
The aim of this study was to report a Western experience in the diagnosis and management of choledochal cyst disease.Results
Sixty-seven patients were identified including 15 children and 52 adults; 76.1 % were females. The median age at diagnosis was 3 [inter-quartile range (IQR)?=?6.0–0.7]?years for children, and 46 [IQR?=?55.6–34.3]?years for adults. Forty-eight patients (72 %) were symptomatic. Types of choledochal cyst included: I (n?=?49, 73.1 %), II (n?=?1, 1.5 %), IV (n?=?9, 13.4 %), and V (n?=?8, 12 %). The median diameter of the type I choledochal cyst was 35 [IQR?=?47–25]?mm. All 48 patients underwent excision of cyst with Roux-en-Y hepaticojejunostomy, and eight underwent resection with hepaticoduodenostomy. Six patients underwent liver resection, and five patients underwent orthotopic liver transplantation. Malignancy was concomitant in five adult patients, being identified on preoperative imaging in three cases; and atypia was seen in three additional patients. Early morbidity included Clavien–Dindo classification grades III (n?=?7) and II (n?=?5), while long-term complications consisted of Clavien–Dindo grades V (n?=?5), IV (n?=?2), III (n?=?18), and II (n?=?1).Conclusions
Presentation and management of choledochal cyst is varied. Malignant transformation is often detected incidentally, and so should be the driving source for resection when a choledochal cyst is diagnosed.15.
Max Nyström Evzen Machytka Erik Norén Pier Alberto Testoni Ignace Janssen Jesus Turró Homedes Jorge Carlos Espinos Perez Roman Turro Arau 《Obesity surgery》2018,28(7):1860-1868
Purpose
The objective of this post-market study was to evaluate long-term safety and efficacy of aspiration therapy (AT) in a clinical setting in five European clinics.Materials and Methods
The AspireAssist® System (Aspire Bariatrics, Inc. King of Prussia, PA) is an endoscopic weight loss therapy utilizing a customized percutaneous endoscopic gastrostomy tube and an external device to aspirate approximately 30% of ingested calories after a meal, in conjunction with lifestyle counseling. A total of 201 participants, with body mass index (BMI) of 35.0–70.0 kg/m2, were enrolled in this study from June 2012 to December 2016. Mean baseline BMI was 43.6?±?7.2 kg/m2.Results
Mean percent total weight loss at 1, 2, 3, and 4 years, respectively, was 18.2%?±?9.4% (n/N?=?155/173), 19.8%?±?11.3% (n/N?=?82/114), 21.3%?±?9.6% (n/N?=?24/43), and 19.2%?±?13.1% (n/N?=?12/30), where n is the number of measured participants and N is the number of participants in the absence of withdrawals or lost to follow-up. Clinically significant reductions in glycated hemoglobin (HbA1C), triglycerides, and blood pressure were observed. For participants with diabetes, HbA1C decreased by 1% (P?<?0.0001) from 7.8% at baseline to 6.8% at 1 year. The only serious complications were buried bumpers, experienced by seven participants and resolved by removal/replacement of the A-Tube, and a single case of peritonitis, resolved with a 2-day course of intravenous antibiotics.Conclusion
This study establishes that aspiration therapy is a safe, effective, and durable weight loss therapy in people with classes II and III obesity in a clinical setting.Trial Registration
ISRCTN 4995813216.
Renato Costi Matteo De Pastena Giuseppe Malleo Giovanni Marchegiani Giovanni Butturini Vincenzo Violi Roberto Salvia Claudio Bassi 《Journal of gastrointestinal surgery》2016,20(7):1359-1367
Background
Endoscopic stenting has spread as bridge management before pancreatoduedenectomy (PD) to resolve jaundice, but its role is nowadays challenged as it is reported to increase morbidity. Although bile sampling is increasingly performed, its clinical role is unclear. The objective of the study is to assess bile colonization’s impact on outcome.Methods
Results of pancreatoduodenectomy after endoscopic stenting are analyzed in 61 high-risk patients presenting bacterial bile colonization. The impact of 11 demographic, clinical, infectious, and laboratory parameters and outcome, including pancreatic leakage, morbidity, and mortality, is analyzed.Results
All stented patients present bacterial bile colonization and PD mortality approaches 10 %. The presence of E. coli in the bile is significantly related to poor outcome, including 23.5 % mortality (p?=?0.034), whereas age (≥70 years) and diabetes present borderline results (p?<?0.070 and p?<?0.066, respectively). E. coli (p?=?0.002) and age (p?=?0.017) are also related to grade C pancreatic fistula.Conclusions
In high-risk patients undergoing PD, bile colonization inevitably occurs after endoscopic stenting and is a major risk factor of poor outcome, reaching its maximum in the case of E. coli colonization and elderly patients, where the indication to stent and/or to perform PD should be accurately evaluated. E. coli-targeted antibiotic prophylaxis should be administered.17.
Hinali Zaveri Ramsey M. Dallal Daniel Cottam Amit Surve Susan Kartiko Fernando Bonnani Austin Cottam Samuel Cottam 《Obesity surgery》2016,26(10):2285-2290
Background
Roux-en-Y gastric bypass (RYGB) is one of the best-known and most commonly performed bariatric procedures. However, this procedure carries infrequent but serious long-term complications, which may require revisional procedures. This study reports the indications and outcomes of gastric bypass reversal that have not been described well in the literature.Methods
A multicenter retrospective study of 50 patients who underwent reversal of RYGB conducted between 2006 and 2015 was reviewed to describe the usual indications and outcomes of gastric bypass reversal surgeries.Results
Of 50 patients, 7 (14 %) were males and 43 (86 %) were females. The mean age of the patient population was 40.4?±?11.6 years (range 19–66). Reasons for reversal included anastomotic ulcers (n?=?27), anastomotic complications (n?=?9), malnutrition (n?=?2), and functional disorder (n?=?12). The mean BMI before the reversal was 29?±?9.4 kg/m2 (range 16–60). The mean time between the primary procedure and reversal was 60?±?65.5 months (range 2–300). Fourteen of the reversals were done via laparotomy. Mean hospital stay was 8.4?±?7.3 days (range 3–34 days). There was no peri-operative death 30 days after reversal. Following gastric bypass reversal, 92.6 % (n?=?25) of the patient population had resolution from ulcers, 77.8 % (n?=?7) of the patient population had resolution from anatomic complications, 100 % (n?=?2) of the patient population had resolution from malnutrition, and 66.7 % (n?=?8) of the patient population had resolution from functional disorders.Conclusions
Gastric bypass reversal is a reasonable and safe treatment for complications arising from the GBP surgery. A laparoscopic approach is feasible in select patients.18.
Early Weight Recidivism Following Laparoscopic Sleeve Gastrectomy: A Prospective Observational Study
Mohamed H. A. Fahmy Mohamed D. Sarhan Ayman M. A. Osman Ahmad Badran Amr Ayad Dalia K. Serour Hany A. Balamoun Mohamed E. Salim 《Obesity surgery》2016,26(11):2654-2660
Background
Although weight loss following laparoscopic sleeve gastrectomy (LSG) can be substantial, weight recidivism is still a major concern. The aim of our work is to study early weight recidivism following LSG and to evaluate the role of gastric computed tomography volumetry (GCTV) in the assessment of patients experiencing early weight regain.Methods
One-hundred and one morbidly obese patients undergoing LSG were prospectively studied. Patients were followed up for 2 years. Those who presented with weight recidivism were counseled for dietary habits and assessed for the amount of weight regain. Patients who regained weight were scheduled for GCTV.Results
Twelve patients were excluded from the study. Weight recidivism was reported in 9/89 patients (10.1 %) [weight loss failure (n?=?1), weight regain (n?=?8)] and was almost always first recognized 1½–2 years after LSG. The amount of weight regain showed negative correlations with preoperative body weight and body mass index (r?=??0.643, P?=?0.086 and r?=??0.690, P?=?0.058; respectively) and positive correlations with the distance between the pylorus and the beginning of the staple line (r?=?0.869, P?=?0.005), as well as with the residual gastric volume (RGV) on GCTV 2 years after LSG (r?=?0.786, P?=?0.021).Conclusions
In the small group of patients who regained weight, a longer distance between the pylorus and the beginning of the staple line, as well as a higher RGV on GCTV 2 years after LSG, were both associated with increased weight regain. Gastric computed tomography volumetry with RGV measurement holds promise as a useful research tool after LSG.19.
Jae Uk Chong Sangguen Nam Hee Jung Kim Rami Lee Yunjung Choi Jae Gil Lee Kyung Sik Kim 《Journal of gastrointestinal surgery》2016,20(5):1020-1027
Introduction
Perioperative fluid restriction is advocated to reduce complications after major surgeries. Current methods of monitoring body fluids rely on indirect volume markers that may at times be inadequate. In our study, bioimpedance analysis (BIA) was used to explore fluid dynamics, in terms of intercompartmental shift, of perioperative patients undergoing operation for hepato-pancreato-biliary (HPB) diseases.Methods
A retrospective review was conducted, examining 36 patients surgically treated for HPB diseases between March 2010 and August 2012. Body fluid compartments were estimated via BIA at baseline (1 day prior to surgery), immediately after surgery, and on postoperative day 1, recording fluid balance during and after procedures. Patients were stratified by net fluid status as balanced (≤500 mL) or imbalanced (>550 mL) and outcomes of BIA compared.Results
Mean net fluid balance volumes in balanced (n?=?16) and imbalanced (n?=?20) patient subsets were 231.41?±?155.44 and 1050.18?±?548.77 mL, respectively. Total body water (TBW) (p?=?0.091), extracellular water (ECW) (p?=?0.125), ECW/TBW (p?=?0.740), and intracellular water (ICW) (p?=?0.173) did not fluctuate significantly in fluid-balanced patients. Although TBW (p?=?0.069) in fluid-imbalanced patients did not change significantly (relative to baseline), ECW (p?=?0.001), ECW/TBW (p?=?0.019), and ICW (p?=?0.012) showed significant postoperative increases.Conclusion
The exploration of fluid dynamics using BIA has shown importance of balanced fluid management during perioperative period. Increased ECW/TBW in fluid-imbalanced patients suggests possible causality for the development of ascites or fluid collections during postoperative period in patients undergoing HPB operations.20.