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Background
Before bariatric surgery, we demonstrate a 96% rate of vitamin D deficiency in morbidly obese French patients: should supplement intake be routinely prescribed? We conducted a prospective observational study to demonstrate the prevalence of vitamin D deficiency in morbidly obese patients awaiting bariatric surgery.Methods
Clinical and biological data were collected on 50 successive patients.Results
Data showed vitamin D deficiency in 96% (25-OH vitamin D = 31 ± 13 nmol/l), with a cut-point of 50 nmol/l. Secondary hyperparathyroidism was found in 44% of patients with hypovitaminosis D (parathyroid hormone (PTH), 59?±?24 pg/ml). Impaired PTH level concerned 89% of this group, considering the cut-point at 30 pg/ml. No significant correlation appeared between vitamin D and calcium or phosphate levels.Conclusions
Before surgery, we demonstrated a higher incidence of vitamin D deficiency in morbidly obese French patients as compared to the general population. The incidence was also higher than previous American studies. Screening for hypovitaminosis D may routinely be considered in morbid obesity. Long-term observation is, however, needed to assess the advantages and potential side effects of systematic vitamin D supplements.3.
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Michal Mekel MD Hayim Gilshtein MD Katya Chapchay MD Bishara Bishara MD Michael M. Krausz MD Herbert R. Freund MD Yoram Kluger MD Ahmed Eid MD Haggi Mazeh MD 《Annals of surgical oncology》2014,21(4):1369-1373
Background
Single adenoma is the cause of 80 % of primary hyperparathyroidism (PHPT) resulting in wide acceptance of minimally invasive parathyroidectomy (MIP). The incidence of PHPT increases with age. Little information is available regarding the prevalence of multiglandular disease (MGD) in older patients.Methods
The records of 537 patients that underwent parathyroid surgery between January 2005 and October 2012 at two endocrine surgery referral centers were retrospectively reviewed. Comparison was performed between patients younger than 65 and older than 65 years of age. Clinical variables included preoperative laboratories and imaging, extent of neck exploration, number of glands excised, and intraoperative parathyroid hormone levels during surgery.Results
There were 374 (70 %) patients in the younger age group (YG) and 163 (30 %) patients in the older age group (OG). The mean age was 50 ± 0.5 and 71 ± 0.4 years, respectively. There was no difference between the groups in terms of gender or laboratory results. MGD was significantly more common in the OG (24 % vs. 12 %; p = 0.001) and similarly MIP was less commonly completed in the OG (49 % vs. 68 %; p < 0.001). Cure rates were comparable between the OG and YG (93 % vs. 95 %; p = 0.27). In the OG, patients with MGD had significantly smaller glands as compared to patients with single adenomas in this group (331 ± 67 vs. 920 ± 97 mg; p = 0.006, respectively).Conclusions
MGD in PHPT was found to be more prevalent in older patients. Planning a bilateral neck exploration should be considered in older patients, especially when a relatively small gland is suggested by imaging or encountered during surgery. 相似文献8.
Bogoevski D Bockhorn M Koenig A Reeh M von Loga K Sauter G Rösch T Izbicki JR 《World journal of surgery》2011,35(6):1311-1320
Background
We have compared the oncologic effectiveness of limited resection (LR) techniques such as transhiatal (TH) or limited resection of the esophagogastric junction with intestinal interposition (LREGJ) in the treatment of early esophageal carcinoma with that of the extended resection such as the classical thoracoabdominal (TA) en bloc esophagectomy. 相似文献9.
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Kasama K Tagaya N Kanahira E Umezawa A Kurosaki T Oshiro T Ishikawa M Negishi Y Kurokawa Y Suzuki N Kakihara Y Taketsuka S Horie K Nakazato T Kikkawa E Kabasawa S Fukuda Y Sonoda K 《Obesity surgery》2008,18(11):1473-1478
Background Obesity is steadily increasing in Asia due to factors such as a lack of exercise, adoption of a more Western diet, changing
lifestyles, environments, or stresses. Even in Japan, this tendency is notable, and metabolic syndrome has become widely recognized.
However, bariatric surgery is still uncommon in Japan. There are no adequate data regarding the experience and outcome of
bariatric surgery in Asia. Here, we report on the current status of morbid obesity and the outcomes of bariatric surgery by
a single surgeon in Japan.
Methods Between February 2002 and January 2008, we have performed laparoscopic bariatric surgery for morbid obesity in 178 cases.
They consisted of laparoscopic Roux-en-Y gastric bypass (LRYGBP) in 105 cases, laparoscopic sleeve gastrectomy (LSG) in 26
cases, laparoscopic sleeve gastrectomy with duodenal jejunal bypass (LSG/DJB) in 14 cases, laparoscopic adjustable gastric
banding (LAGB) in 13 cases, and laparoscopic biliopancreatic diversion with duodenal switch in one case under the same protocol
of follow up. The first author of this paper performed all procedures.
Results One hundred and thirty-eight patients with a follow-up of over 3 months after surgery were enrolled. LRYGBP accounted for
72% of all bariatric procedures. The reduction of weight and body mass index (BMI) in LRYGBP and LSG showed similar results.
These outcomes were superior to those of LAGB. Percentage of excess BMI loss (%EBMIL) of LRYGBP showed greater reductions
at follow-ups 6, 9, 12, and 18 months after surgery compared to that of LRYGBP and LAGB. All procedures resulted in over 50%
of %EBMIL after 18 months of follow-up. There was no postoperative mortality within 30 days after surgery. Preoperative comorbidity
including diabetes mellitus, hypertension, and hyperlipidemia were resolved or improved after surgery in most patients.
Conclusion In bariatric surgery, LRYGBP is the most effective treatment for morbid obesity, while LAGB has a low risk of postoperative
complications. LSG is also a safe procedure for supermorbidly obese patients. We expect that bariatric surgery will be a common
procedure for patients with morbid obesity in Japan. 相似文献
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Mühlmann G Klaus A Kirchmayr W Wykypiel H Unger A Höller E Nehoda H Aigner F Weiss HG 《Obesity surgery》2003,13(6):848-854
Background: Laparoscopic silicone adjustable gastric banding (SAGB) has gained popularity for the surgical treatment of morbid
obesity. The implantable gastric stimulator (IGS?) system represents a novel surgical alternative. We aimed to assess the
feasibility of robotic-assisted laparoscopic bariatric operations and to critically elucidate the technical and financial
advantages and patient outcome. Methods: Robotic-assisted laparoscopic bariatric procedures were performed on 10 consecutive
patients using the daVinci? robot system (4 SAGB, 4 IGS?, 2 SAGB revisions). 10 conventional laparoscopic-operated patients
(4 SAGB, 4 IGS?, 2 SAGB revisions) during the learning curve served as controls. Equipment, operative technique and procedural
time were evaluated. A cost analysis was calculated. Results: The personnel equipment, numbers of trocars and operation technique
were comparable in both groups. The mean operative time was 137 min (range 110-175) and 97 min (60-140) in robotic-assisted
and conventional laparoscopy, respectively (P =0.04). Establishment of the pneumoperitoneum and placement of trocars and robotic arms took a mean of 30 min (15-45) in
the robotic-assisted group, compared with 5 min in the control group (P <0.001). In 1 patient, intraoperative gastric injury was suspected and led to band removal in the robotic-assisted group.
There was no postoperative complication. Average procedural costs were significantly higher in the robotic-assisted group.
Conclusion: Primary and revisional robotic-assisted bariatric surgery is technically simple, with the benefit of precise instrument
handling. However, it is still expensive, the set-up of the system is time-consuming, and a limited variety of instruments
are available presently. 相似文献
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Formal economic evaluations of obesity surgery have not been reported in the medical literature to date. In this article,
we briefly review the most important types of health economic evaluations, namely cost-effectiveness analysis, cost-utility
analysis, and cost-benefit analysis. Bariatric surgery has the potential to substantially impact quality of life, morbidity,
and mortality costs in patients with morbid obesity. Health economic studies that include these effects are needed. 相似文献
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Background: A previous study reported an association between obesity and increased tenderness. However, the effect of weight
reduction on tenderness is not known. The aim of the study was to assess tenderness thresholds before and after bariatric
surgery. Methods: 42 obese women were evaluated for tenderness before and 6 months after bariatric surgery. A count of 18
tender points at 9 symmetrical sites was performed by thumb palpation. 13 point sites (9 tender point sites and 4 control
sites) were further studied using a dolorimeter. Results: The obese subjects displayed increased tenderness before surgery
and its level did not change 6 months later. The mean tender point count before surgery was 8.8±3.9 and after surgery was
8.3±4.3 (P=0.500). The mean tenderness thresholds at nine tender points were 4.0±1.1 and 3.8±1.1, respectively (P=0.247). Conclusion: Nonarticular tenderness in obese women remained high after weight reduction. These findings are relevant
to physicians taking care of obese patients. Further studies are needed to elucidate the relationship between weight reduction
and pain thresholds. 相似文献
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Amer H. Zureikat Jason A. Breaux Jennifer L. Steel Steven J. Hughes 《Journal of gastrointestinal surgery》2011,15(7):1151-1157