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1.
Background: Laparoscopic adjustable gastric banding (LAGB) influences gastroesophageal reflux. Methods: 26 patients undergoing gastric banding were assessed by a questionnaire for symptom analysis, 24-hour pH monitoring, endoscopy
and barium swallows, preoperatively, at 6 weeks and at 6 months after operation. Results: Gastric banding had minimal effect on heartburn scores, but regurgitation and belching scores increased significantly during
follow-up. Use of acid-reducing drugs decreased significantly at 6 weeks and increased significantly at 6 months. Pathological
reflux was present in 13 of the 26 patients preoperatively. At 6 months pathological reflux was found in only 6 of these 13
patients, but 4 of the 13 patients with preoperative normal reflux patterns had developed pathological reflux. 6 months after
the operation esophagitis had disappeared in 6 patients and was increased in 9 patients. In 9 patients, a pouch was found
at 6 months. Pouch formation was significantly correlated with the presence of pathological reflux, esophagitis and the use
of acid-reducing medication. Preoperative presence of a hiatal hernia did not influence pouch formation or pathological reflux.
Conclusion: LAGB decreases gastroesophageal reflux if there is no pouch formation during follow-up. 相似文献
2.
Background: Surgical treatment is the most effective method for weight reduction in morbid obesity. The most common operations
are gastric banding and gastric bypass. The effect of these interventions on esophageal function and gastroesophageal reflux
symptoms has not been adequately investigated. Methods: Patients undergoing obesity surgery were prospectively included in
an observational study. Before surgery, each of the 53 patients underwent pulmonary function tests, esophageal manometry,
and gastroscopy. Drug medication and esophageal symptoms were recorded. "Non-sweet eater" patients with good compliance underwent
laparoscopic adjustable gastric banding (LAGB). In "sweet-eating" or non-compliant patients, gastric bypass (GBP) was carried
out. Results: Between July 1997 and April 2000, 53 patients (9 males and 44 females) were consecutively operated on. 32 patients
(median BMI 46.4 kg/m2 ±5.4 SD) received LAGB, and 21 patients (BMI 54.0 kg/m2 ±10.7) GBP. Median follow-up was 22 months, and only 3 patients were lost to yearly follow-up. Preoperatively, 6 LAGB patients
had reflux symptoms, which postoperatively resolved in 3 of them, while the other 3 noted no change. Three patients who had
no preoperative reflux symptoms developed them after LAGB. In the GBP group, no patient had esophageal dysmotility or incompetent
esophageal sphincter function pre- or postoperatively. The incidence of postoperative esophageal symptoms was independent
of operative technique (Wilcoxon U-Test: p= 0.75). Conclusion: The present results do not show any effect of gastric reduction
surgery on postoperative esophageal function or gastroesophageal reflux symptoms. 相似文献
3.
Background: Laparoscopic surgery had increased the interest and growth of bariatric surgery. Whether central obesity has any
adverse effect in laparoscopic bariatric surgery is not clear. Methods: 612 morbidly obese patients received laparoscopic
bariatric surgery,in a prospectively controlled clinical trial of the outcome of the bariatric surgery. For comparison, subjects
were dichotomized into either a central obesity group or peripheral obesity group, based on waist/hip ratio (WHR). Various
biochemistry and blood count variables, and perioperative and postoperative results were measured. Results: There were more
female (458) than male patients (154). Male patients had higher BMI, and female patients were younger. 56 of 154 male patients
(36.4%) belonged to the central obesity (WHR >1.0), and 321 of 458 female patients (70.1%) had central obesity (WHR >0.85).
Central obesity was associated with age but not with BMI in males. In females, central obesity was associated with increased
BMI. Central obesity predicted increased hyperglycemia and triglyceride levels in both male and female patients. Male patients
with central obesity had higher WBC counts than the other patients. Although central obesity was associated with more intra-operative
blood loss and prolonged recovery in female patients, there was no increase in complication rate or difference in postoperative
weight loss. Conclusion: Central obesity is associated with a higher degree of hyperglycemia, hyperlipidemia and leukocytosis
in morbidly obese patients who undergo bariatric surgery. Although there is increased technical difficulty in patients with
severe central obesity, laparoscopic bariatric surgery is safe and effective in producing weight loss. 相似文献
4.
Laparoscopic Gastric Bypass after Antireflux Surgery for the Treatment of Gastroesophageal Reflux in Morbidly Obese Patients: Initial Experience 总被引:1,自引:0,他引:1
Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been proven effective against gastroesophageal reflux disease
(GERD) in morbidly obese patients. We present our experience with revision of antireflux procedures to LRYGBP in obese patients
with recurrent GERD, weight gain or a combination of both and discuss the indications and technical considerations involved.
Methods: Between June 2000 and December 2003, 7 morbidly obese patients with a mean BMI of 37.5 kg/m2 underwent revision of an antireflux procedure to LRYGBP by our group. Important steps of the revision include dissection
of the diaphragmatic crura and gastroesophageal fat pad, reduction and repair of hiatal hernia, and complete take-down of
the wrap to avoid stapling over the fundoplication which can create an obstructed, septated pouch. Results: Mean operative
time was 6 hr 12 min and length of stay was 4.8 days. There were 3 major complications postoperatively and no deaths. During
follow-up, 5 patients developed anastomotic strictures and 2 patients were re-explored for gastric remnant herniation and
intestinal obstruction. At a mean follow-up of 24 (3-44) months, mean excess weight loss was 70.7% and 14/20 (70%) co-morbid
conditions were improved or resolved. GERD evaluation with the GERD-HRQL scale showed a significant reduction of GERD scores
postoperatively (P =0.006). Conclusions: Although LRYGBP after antireflux surgery is a technically more difficult procedure with a higher morbidity,
it is feasible and effective for the treatment of recurrent GERD and worsening obesity with the additional advantage of weight
loss and improvement of co-morbidities. 相似文献
5.
Silvestre V Ruano M Domínguez Y Castro R García-Lescun MC Rodríguez A Marco A García-Blanch G 《Obesity surgery》2004,14(9):1227-1232
Background: Morbid obesity (MO) and the pathologies associated with it constitute an important public health problem, accounting
for 7% of the health expenditure in industrialized countries. An important percentage of this expense is attributed to the
different biochemical tests performed in these patients, who suffer from several metabolic derangements. We evaluated the
basic biochemical abnormalities in MO patients and their reversibility by weight loss after gastric bypass, to standardize
the surveillance of the different metabolic abnormalities in obese patients. Methods: By a retrospective analysis on 125 patients
operated in our hospital, we evaluated anthropometric and biochemical data before and 1, 3, 6, 12 and 24 months after gastric
bypass. Results: Preoperatively hyperinsulinemia, hyperglycemia, dyslipidemia and hypertensive disease were present, and began
to improve 1 and 3 months after surgery (although not significantly) and significantly at 6, 12 and 24 months after it. We
also observed deficient protein nutrition and a deficiency of micronutrients both before bypass and during the follow-up.
Conclusion: After gastric bypass, a marked decrease in insulin occurred, with normalization of blood pressure and the biochemical
parameters associated with the metabolic syndrome. We propose a biochemical follow-up protocol for MO patients. 相似文献
6.
Marceau P 《Obesity surgery》2005,15(1):3-10
Convinced that morbid obesity was not due to food excess but rather to a metabolic disorder, we searched in the literature
for data in favor of a metabolic disorder. We have found evidence in support of the thesis that the cause of morbid obesity
is the inability to burn excessive caloric intake normally. It would involve the difficulty to increase heat with the amount
of calories taken, which would be faulty and force fat deposition. This mechanism called dietinduced thermogenesis (DIT) allows the dispersion by heat of excessive calories to obtain energy balance. Results from bariatric surgery and particularly
biliopancreatic diversion (BPD) give further support to this thesis. BPD would improve heat production to a meal (DIT) by
one of these mechanisms: increased insulin sensitivity, change in intestinal hormone secretion, or chronic lipid malabsorption.
Available results show that surgery, to be efficient, must change the physiology and not solely decrease food intake. 相似文献
7.
Salvatore R Maddi PhD S Ross Fox MD Richard H Harvey MA John L Lu BS Deborah M Khoshaba PsyD Michelle Persico BA 《Obesity surgery》2001,11(6):680-685
Background: Although there has been some disagreement, there is growing evidence now that psychopathology is a comorbidity
of morbid obesity among patients seeking bariatric surgery.The aim of this study was to determine whether psychopathology
decreases following this surgery. Methods: Utilizing a national sample, this study focused on pre- and post-surgery scores
on the Minnesota Multiphasic Personality Inventory, Second Edition (MMPI-2). The MMPI-2 was administered first during the
pre-surgery medical examination, and again between 6 months and 1 year following surgery. Results:Validity scale scores on
the pre- and postsurgery MMPI-2s indicated that there was no impediment to interpreting the clinical scale scores of these
tests.There was a pervasive pattern of statistically significant decreases in pre- to post-surgery clinical scale scores.
Further, comparison of MMPI-2 clinical scale scores to available test norms showed that the number of participants showing
signs of mental disorders was unusually high before surgery, and at or below the test norms following surgery. Conclusions:There
is clear evidence in this study that psychopathology declines following bariatric surgery.The unusually high levels of psychopathology
before surgery may be a joint function of the factors producing the morbid obesity, and a reaction to the obesity itself.That
psychopathology declines following surgery to levels expected in the general population indicates that the patients were becoming
more positive about their lives. 相似文献
8.
Regression of Barrett's esophagus may occur after effective anti-reflux surgery. Roux-en-Y gastric bypass (RYGBP) is an effective
operation to treat morbid obesity. In addition, it provides complete relief of gastroesophageal reflux disease (GERD). Regression
of Barrett's has not been reported after RYGBP. We performed a laparoscopic Roux-en-Y gastric bypass on a patient with GERD
and Barrett's esophagus. At 1 year after the RYGBP, an upper endoscopy was performed as routine surveillance for the patient's
Barrett's esophagus; endoscopic and histologic evaluation demonstrated complete regression of the Barrett's esophagus. The
patient lost one-third of her preoperative weight and had resolution of her reflux symptoms. RYGBP limits the amount of acid
reflux and completely diverts bile away from the esophagus. This may lead to the regression of Barrett's esophagus. 相似文献
9.
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
10.
Background: As the number of adolescents with clinically severe obesity has grown, so too have the number of adolescents seeking
bariatric surgery. Methods: The membership of the ASBS was contacted by e-mail with a 14-question survey to ascertain plans
for development of adolescent bariatric surgery (ABS) programs. Results were tabulated and expressed as a percentage of total
respondents. Results: Of the 92 respondents, most (84%) performed >50 adult bariatric procedures per year. Over half (53%)
had performed ABS. Nearly half (45%) had performed <10 ABS cases within the last year, and 70% were planning ABS in the upcoming
year. 42% reported that they have already or were in the process of developing an adolescent bariatric treatment program with
pediatric specialists in their community. The vast majority (84%) of respondents was willing to participate in a multi-center
collection of outcomes data, and 65% reported having dedicated personnel for clinical data collection. Conclusions: There
is increasing interest in developing ABS programs. Despite the perceived need for such services, information is lacking in
the adolescent age group to guide decisions regarding optimal patient selection, choice of operation, and postoperative management.
Rigorous evaluation of the outcomes of this intervention with detailed prospective data collection is needed to support decision-making
regarding use of bariatric surgery for adolescents with morbid obesity. 相似文献
11.
Adolescent obesity has serious immediate and long-term health consequences. There are no effective behavioral or pharmacologic
treatments of extreme obesity among adolescents. Bariatric surgery is the most effective means to achieve durable weight loss,
with amelioration or resolution of most obesity-related co-morbidities. Surgery should be performed when: 1) the risk of operative
complications and of recidivism is lowest; 2) the outcomes of the operation are likely to be the best possible; and 3) there
is little need to consider subsequent bariatric surgery for weight regain and reappearance of co-morbidities. A higher BMI
is an independent risk factor for operative morbidity and mortality, and is associated with less weight loss and greater likelihood
of weight regain. The higher BMI criterion for adolescent bariatric surgery exposes the adolescent to a higher risk for operative
death and complications, and suboptimal outcomes following bariatric surgery. 相似文献
12.
Background: Gastric and mucosal changes were studied when different synthetic materials were used for gastric banding. Methods:
60 Wistar-Albino rats (weight 200-250 g, age 12 weeks) were classiffied into 5 groups. Gastric banding was carried out with
different materials: group 1 - polytetrafluoroethylene (PTFE), group 2 - polythylene (PE), group 3 - polypropylene (PP), group
4 - silicone; and group 5 - controls. Histopathological examination of proximal and distal gastric mucosa and esophagus were
evaluated for foreign body reaction, lymphocytic infiltration, neutrophil infiltration, gastric wall invasion, and gastroesophageal
reflux. Results: PE and PP caused a much more severe foreign body reaction that PTFE and silicone. Lymphocytic infiltration
(chronic inflammation) was not significantly different between PP, PE, and PTFE, and was present in 80% of rats with these
materials (P >0.05); in the silicone group, lymphocytic reaction was minimal. There was no neutrophilic infiltration in the silicone group
(P =0.001), but this sign of acute inflammation was present in the other groups. However, the neutrophilic inflitration showed
no difference between PE, PTFE and PP. PP, PE and PTFE migrated into the gastric wall at similar rates (no significant difference,
P >0.05); in the silicone group, however, intragastric migration was not observed. With regard to gastroesophageal reflux,
no significant difference was found between all the groups (P>0.05). In all groups, no histopathologic change was observed
in the gastric mucosa proximal and distal to the bands. Conclusion: Silicone was the ideal material for banding, because it
had good tissue adaptation and caused no inflammatory response. 相似文献
13.
An association between gastric cancer and obesity has been suggested in large epidemiologic series. We present a 61-year-old
lady with BMI 48.7 kg/m2, who underwent preoperative work-up for Roux-en-Y gastric bypass. Her endoscopy showed a depressed lesion at the incisura
angularis, suggesting early gastric cancer. The biopsy confirmed well/moderately-differentiated adenocarcinoma. The surgical
approach was subtotal gastrectomy leaving only part of the fundus, and was performed on an oncological basis, with lymphatic
D2 dissection. The gastro-enterostomy was 1.5 cm wide, and was constructed closer to the greater curvature over a 12-Fr Fouchet
tube. The reconstruction was in a Roux-en-Y fashion, but the alimentary limb was 150 cm long. Despite the short follow-up,
the way the surgery was conducted presumably maintained both oncologic and bariatric determinations. 相似文献
14.
H Weiss MD B Labeck MD J Klocker MD H Nehoda MD R Mittermair MD F Aigner MD M Gadenstätter MD G Wetscher MD H Schwelberger PhD 《Obesity surgery》2001,11(6):735-739
Background: Patients with gastroesophageal reflux disease (GERD) have alterations of gut neuropeptides, such as neurotensin
(N) and motilin (M), which are resolved following antireflux surgery. Obesity is associated with GERD. Since the adjustable
gastric band prevents gastroesophageal reflux in morbidly obese patients, this study was performed to investigate plasma levels
of N and M before and after adjustable gastric banding (AGB). Methods: 47 morbidly obese patients were operated laparoscopically
using the Swedish AGB. Preand postoperatively basal plasma levels of N and M were investigated. Symptoms such as heartburn,
regurgitation and dysphagia were documented, and esophageal manometry as well as 24-hour pH-monitoring were performed pre-
and postoperatively. 11 non-obese, asymptomatic, age-matched volunteers served as controls. Results: After a median postoperative
follow-up period of 268 days, a significant weight reduction was observed. Preoperatively, 14 patients suffered from reflux
symptoms. An insufficient lower esophageal sphincter (LES) was found in 8 patients, and 2 patients had impaired esophageal
body motility. Pathologic pH-testing was found in 6 patients. Postoperatively, reflux symptoms were present in 4 patients;
LES findings and pH-testing were normalized in all patients. However, there was significant impairment of esophageal peristalsis.
Preoperatively, levels of N were significantly decreased and levels of M increased compared with control subjects. Postoperatively,
there was a significant increase of N and levels of M were normalized. Alterations in gut neuropeptides did not correlate
with reflux symptoms, impaired gastroesophageal motility, age, gender or BMI. Conclusion: Morbid obesity alters gut neuropeparetides,
which are resolved by AGB. This may be caused by reduction of hypercaloric nutrition post-operatively rather than by improvement
of gastroesophageal reflux. 相似文献
15.
de Freitas Carvalho DA Valezi AC de Brito EM de Souza JC Masson AC Matsuo T 《Obesity surgery》2006,16(6):740-744
Background: Rhabdomyolysis is a potential threat after bariatric surgey. The severity ranges from asymptomatic elevations
of serum muscle enzyme levels to life-threatening cases associated with muscle necrosis, compartment syndrome, acute renal
failure and cardiac arrest. Methods: We studied 98 consecutive obese patients who underwent primary uncomplicated bariatric
surgery during a 1-year period. A database was created for all patients (sex, age, BMI, duration of the operation); serum
creatinine phosphokinase (CPK) was systematically measured before surgery and on the first and second postoperative day. Results:
The study sample consisted of 35 males (35.7%) and 63 females (64.3%) with preoperative CPK level 156.6 ± 41.1 U/L (40 to
220), 24 hours postoperatively 1,075.2 ± 596.5 U/L, (85 to 2,790 U/L) and 48 hours postoperatively 967.3 ± 545.3 U/L (79 to
2,630). There was no difference in mean BMI (P=0.1) and mean duration of operation (P=0.5) between males and females. However, a statistically significant difference in mean elevation of CPK between males and
females (P=0.003) was found. The variables sex, age, weight and duration of surgery were analyzed by multivariate logistic regression,
but did not show a statistically significant difference. Conclusion: Rhabdomyolysis is a potentially fatal complication of
surgical procedures in obese patients, and can be minimized with simple measures such as additional padding, aggressive hydration
and urine alkalinization. Diagnosis requires a high level of physician awareness. 相似文献
16.
Heling I Sgan-Cohen HD Itzhaki M Beglaibter N Avrutis O Gimmon Z 《Obesity surgery》2006,16(9):1131-1134
Background: Morbid obesity is a scourge of the 21st century. The effective therapeutic measure is bariatric surgery. The medical
literature has inadequately reported the potential deleterious effects of such surgery on dental health. Acidic levels in
the oral cavity, which are known to be one of the postoperative side-effects of bariatric surgery, directly result in dental
caries and tooth erosion. We investigated the self-assessment of postoperative bariatric patients with regard to their dental
health and associated variables. Methods: 113 patients (25% compliance), who had been operated on in three Jerusalem hospitals,
responded to a mailed questionnaire. Results: Patients' average age was 40±10 years; bariatric surgery had been performed
5±4 years previously. Of the patients, 37% reported eating more sweet foods after surgery, only 20% reported improved oral
hygiene, only 34% reported increased frequency of visits to the dentist, and 37% reported greater dental hypersensitivity
after surgery. Significant associations were found between reported dental hypersensitivity and vomiting (P=0.013), and also dental hypersensitivity and indigestion (P=0.021). Patients from the three hospitals reported different patterns of visits to the dentist. The most common variable
(80% of the subjects) associated with visits to the dentist after surgery was dental hypersensitivity. Conclusion: Medical
teams need to consider potential dental problems after bariatric surgery, and to supply their patients with the appropriate
information and instructions regarding oral hygiene maintenance, healthy dietary patterns and regular dental health monitoring
by a dentist or dental hygienist. 相似文献
17.
Del Castillo Déjardin D Sabench Pereferrer F Hernández González M Blanco Blasco S Abelló Sala M 《Obesity surgery》2004,14(9):1263-1272
Background: We reviewed the experimental surgery, related to bariatric surgery in laboratory animals, to consider new lines
of research. Methods: The literature on experimental surgery for morbid obesity since the mid-20th century was reviewed, focusing
on existing techniques (malabsorptive, restrictive, mixed and experimental) and their associated metabolic component. Results:
In the field of laparoscopy, there is a clear tendency for large laboratory animals such as pigs to be used. These are useful
for developing and perfecting techniques. A second area of animal experimentation concentrates on the relationship between
metabolism and surgery in order to find improvements in the co-morbidities associated with morbid obesity. A third area of
research focuses on manipulating intake via central and vagal control. Conclusion: Further studies are needed to combine traditional
and recently developed techniques of experimental surgery with the mechanisms that determine the physiopathology, metabolism
and regulation of intake of morbidly obese patients. To accurately determine metabolic behavior and avoid drawing conclusions
that are not very significant, these studies should be carried out on obese animals and focus on the co-morbidities associated
with morbid obesity. 相似文献
18.
Antozzi P Soto F Arias F Carrodeguas L Ropos T Zundel N Szomstein S Rosenthal R 《Obesity surgery》2005,15(3):405-407
Background: Gout is associated with increased body weight. We evaluated the prevalence of gout and acute gouty attacks in
the morbidly obese population who underwent bariatric surgery. Methods: The medical records and operative reports of 1,240
patients who underwent bariatric surgery were reviewed retrospectively for weight parameters, BMI, weight loss, medical history
of gout, and onset of acute gouty attacks. Results: Of the 1,240 patients, 5 (0.4%) had been previously diagnosed with gout.
2 of these 5 had acute attacks during the postoperative period, and responded succesfully to intravenous colchicine. Conclusion:
Although rare, gout must be considered a co-morbid illness in obese and morbidly obese patients. Surgeons should be familiar
with the signs and symptoms of attacks in the postoperative period, and be knowledgeable in the management. 相似文献
19.
Background: The role of upper endoscopy (EGD) in obese patients prior to bariatric surgery is controversial. The aim of this
study was to evaluate the diagnostic yield and cost of routine EGD before bariatric surgery. Methods: The medical records
of consecutive obese patients who underwent EGD prior to bariatric surgery between May 2000 and September 2002 were reviewed.
Two experienced endoscopists reviewed all EGD reports, and findings were divided into 4 groups based on predetermined criteria:
group 0 (normal study), group 1 (abnormal findings that neither changed the surgical approach nor postponed surgery), group
2 (abnormal findings that changed the surgical approach or postponed surgery), and group 3 (results that were an absolute
contraindication to surgery). Clinically important findings included lesions in groups 2 and 3. The cost of EGD (US $430.72)
was estimated using the endoscopist fee under Medicare reimbursement. Results: During the 28-month study period, 195 patients
were evaluated by EGD prior to bariatric surgery. One or more lesions were identified in 89.7% of patients, with 61.5% having
a clinically important finding. The prevalence of endoscopic findings using the classification system above was as follows:
group 0 (10.3%), group 1 (28.2%), group 2 (61.5%), and group 3 (0.0%). Overall, the most common lesions identified were hiatal
hernia (40.0%), gastritis (28.7%), esophagitis (9.2%), gastric ulcer (3.6%), Barrett's esophagus (3.1%), and esophageal ulcer
(3.1%). The cost of performing routine endoscopy on all patients prior to bariatric surgery was US $699.92 per clinically
important lesion detected. Conclusions: Routine upper endoscopy before bariatric surgery has a high diagnostic yield and has
a low cost per clinically important lesion detected. 相似文献
20.
Dutta S Morton J Shepard E Peebles R Farrales-Nguyen S Hammer LD Albanese CT 《Obesity surgery》2006,16(6):780-782
Bariatric surgery is increasingly popular as a therapeutic strategy for morbidly obese adolescents. Adolescence represents
a sensitive period of psychosocial development, and children with considerable weight loss may experience greater peer acceptance,
accompanied by both positive and negative influences. Substance abuse exists as one of these negative influences. We present
the case of an adolescent bariatric surgical patient who abused methamphetamines in the postoperative period, with consequent
nutritional instability. A concerted effort must be made in the preoperative assessment of adolescent bariatric patients to
delineate a history of illicit drug use, including abuse of diet pills and stimulants. Excessive postoperative weight loss
or micronutrient supplementation non-compliance should raise a suspicion of stimulant use and appropriate screening tests
should be performed. The consequent appetite suppression may manifest with signs of malnutrition such as bradycardia, hypotension,
and weakness. Inpatient nutritional rehabilitation and psychiatric assessment should be considered. 相似文献