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1.
Bent Johnny Nergaard Björn Geir Leifsson Jan Hedenbro Hjörtur Gislason 《Obesity surgery》2014,24(10):1595-1602
Background
Several studies indicate that increasing the alimentary limb length in gastric bypass surgery produces only a minor improvement of excess BMI loss. Few studies have addressed the efficacy of increasing the length of the pancreatico-biliary limb.Methods
Here, we present a prospective randomized study of 187 consecutive laparoscopic Roux-Y gastric bypass operations operated over 2 years (2004–2005) in Iceland. The patients were operated with a gastric bypass with either a 2-m biliopancreatic (BP)-limb and a 60-cm alimentary (A)-limb (n?=?93) or with a 150-cm A-limb and a 60-cm BP-limb (n?=?94).Results
Preoperative median BMI was 44.1 (38–70), median age 35.5 (17–74) years, and 85 % of the patients were female. Follow-up rate after 5 years was 85 %. Eighteen months following surgery, the weight loss was significantly higher in the BP-limb group (p?0.001), and this difference remained 7 years after surgery. Weight regain occurred in both groups, and 7 years after surgery, excess BMI loss (EBMIL) was 78.4 % in the BP-limb group compared to 67.1 % in the A-limb group (p?0.001). Most patients (78 %) needed supplementation adjustment (iron, vitamin D and calcium) during the study period, significantly more often in the BP-limb group compared to the A-limb group (p?0.001). Patients in the BP-limb group had more frequent stools than patients in the A-limb group; otherwise, gastro-intestinal symptoms rating scoring were comparable. Complication rate was similar.Conclusions
Gastric bypass with a 2-m BP-limb gives better weight loss than gastric bypass with a 60-cm BP-limb and a 150-cm A-limb. Metabolic follow-up is of utmost importance, as most patients needed repeated adjustments of their supplementation. 相似文献2.
Background
Gastric bypass is the “gold standard” procedure of bariatric surgery. However, 20.4–34.9 % of these patients may fail to achieve or maintain the weight loss on long-term follow-up and may require additional procedures. StomaphyX? has been promoted for weight reduction in such patients.Objectives
To study whether endoluminal reduction of gastric pouch and stoma using StomaphyX? results in sustained weight loss in patients who regain weight after gastric bypass.Methods
Retrospective chart review was performed on 59 postgastric bypass patients who underwent revision of gastric pouch using StomaphyX? from 2007 to 2008. Postprocedure weight at 1 week, 1 month, and 6 months follow-up as well as weight at the time of the review was recorded for each patient.Results
Average weight loss and excess body weight loss (EBWL) were 2.6 ± 2.3 kg and 7.3 ± 7.1 % (n = 42) at 1 week, 3.7 ± 2.9 kg and 11.6 ± 12.1 % (n = 31) at 1 month, and 3.8 ± 4.5 kg and 11.5 ± 17.9 % (n = 10) at 6 months respectively. At the time of review, the average follow-up was 41 months, average weight loss was 1.7 ± 9.7 kg, and EBWL was 4.3 ± 29.8 % (n = 53). Endoscopy in 12 patients at average 18 months follow-up showed no sustained reduction in pouch and stoma size.Conclusions
StomaphyX? results in weight loss that is not sustained on long-term follow-up. Pouch and stoma tend to regain their preprocedure size on follow-up. StomaphyX? cannot be recommended as a weight loss strategy in postgastric bypass patients who regain weight. 相似文献3.
Background
Twenty percent of gastric restrictive operations require revision. Conversion to Proximal Roux-en-Y gastric bypass (PRNYGBP) is associated with weight regain. Forty-one percent of these fail to achieve a body mass index (BMI)?<?35. Few report follow-up (F/U) or quality of life (QOL) beyond 5 years. We report the long-term effectiveness of MRNYGBP as a revision.Methods
Retrospective chart review of patients (1993?C2005) with a failed gastric restrictive operation (S1) at least a year out from revision (S2) to a MRNYGBP: small lesser curve 22?±?10 (11?C55) cm3 pouch, long biliopancreatic limb, 150 cm alimentary limb, 141?±?24 (102?C190) cm common channel. Staple-line disruptions were excluded.Results
Thirty-eight (37 F, 1 M) patients aged 46?±?8 (17?C56) years underwent conversion to a MRYGBP 8?±?5 (2?C23) years after: gastroplasty 25, adjustable gastric band 13 for weight regain (79%), gastroesophageal reflux disease (GERD; 29%), and band problems (24%). S1 provided only 24?±?25% excess weight loss (EWL; 5.9?±?6.3 BMI drop) and caused GERD in 32% of patients (p?=?0.0124). There were no deaths or leaks. BMI dropped from 41.4?±?7.8 to 27.3?±?5.6 (down 20.5?±?8.3 from S1), 80.1?±?23.3% EWL (n?=?32) at year 1 (p?<?0.0001). This was maintained for 10 years. BMI was 28?±?4 (21.5?C31.9), 75.6?±?21.1% EWL (57.3?C109.6) (n?=?5) at 10 years. Super obese patients had better 9.95% EWL after S2 (p?=?0.0359). QOL (5?=?excellent): 4.5?±?0.5 (3?C5). F/U: 5.1?±?3.3 (1?C13) years with 83.3% F/U 10-year rate. Labs at 3 years (n?=?10): Alb 3.8?±?0.4, Prot 6.8?±?0.6, Iron 47.6?±?33.3, VitD 15.1?±?7.43, PTH 54.5?±?27.2, B12 620.1?±?676.5, Hct 34?±?4.3.Conclusions
Revision MRNYGBP provides excellent durable long-term weight loss after failed gastric restrictive operations. Non-compliant patients are at a higher risk for malnutrition, anemia, and osteoporosis. 相似文献4.
Deylgat B D'Hondt M Pottel H Vansteenkiste F Van Rooy F Devriendt D 《Surgical endoscopy》2012,26(7):1997-2002
Background
Roux-en-Y gastric bypass (RYGB) is considered the “gold standard” revision procedure. The purpose of this study was to compare the surgical outcome of primary laparoscopic RYGB (pLRYGB) to revisional open or laparoscopic Roux-en-Y gastric bypass surgery (rRYGB).Methods
A retrospective analysis of all patients who underwent pLRYGB or rRYGB from January 2003 to December 2009 has been performed. Demographics, indications for revision, and complications have been reviewed. The rRYGB and pLRYGB patients have been compared.Results
Seventy-two patients underwent rRYGB, and 652 patients underwent pLRYGB. Mean follow-up was 35 and 45?months, respectively. Fifty-six rRYGB procedures were performed laparoscopically. The primary operations had consisted of laparoscopic gastric banding (n?=?28), laparoscopic vertical banded gastroplasty (n?=?19), laparoscopic sleeve gastrectomy (n?=?6), laparoscopic RYGB (n?=?3), and biliopancreatic diversion with duodenal switch (n?=?16). Indications included weight regain (n?=?29), malabsorption (n?=?16), gastrogastric fistula (n?=?5), band-associated problems (n?=?3), and refractory stomal ulceration (n?=?1). There was no significant difference in early or late postoperative complications when comparing rRYGB to pLRYGBP patients (11.1% vs. 5.52%, P?=?0.069 and 19.4% vs. 24.2%, P?=?0.465 respectively). Five rRYGB patients (7.04%) required reintervention (3 internal hernias, 1 ventral hernia, 1 laparoscopic exploration) compared with 101 pLRYGB patients (15.71%; P?=?0.051). None of the patients died. Mean hospital stay was not significantly longer in the rRYGB group (5.38 vs. 4.95?days, P?=?0.058).Conclusions
In our series, hospital stay, morbidity, and mortality of rRYGB were not significantly higher compared with pLRYGB. Furthermore, we believe that this type of revisional bariatric surgery should be performed in high-volume bariatric centers. 相似文献5.
F. B. Langer G. Prager M. Poglitsch R. Kefurt S. Shakeri-Leidenmühler B. Ludvik K. Schindler A. Bohdjalian 《Obesity surgery》2013,23(6):776-781
Background
Weight regain (WR) occurs in some patients after laparoscopic Roux-en-Y gastric bypass (LRYGBP). Loss of restriction due to dilation of the gastrojejunostomy (GJS) or the gastric pouch might be the main cause for WR. With different techniques available for the establishment of the GJS, the surgical technique might influence long-term success.Methods
We present a 5-year follow-up for weight loss and WR of a matched-pair study comparing circular stapled (CSA) to linear stapled (LSA) GJS in a series of 150 patients who underwent primary antecolic antegastric LRYGBP. Complete 5-year follow-up was obtained for 79 % of the patients.Results
Excess BMI loss (EBL) at 3 months was better with the CSA (p?=?0.02) and comparable thereafter. The 5-year %EBL was 67.3?±?23.2 vs. 73.3?±?24.3 % (CSA vs. LSA, p?=?0.19) WR of?>?10 kg from nadir was found in 24 patients (16 %) with higher incidence in CSA than in LSA patients (20 % vs. 12 %). The %WR was comparable for both groups, 16?±?13 vs. 15?±?19 % (CSA vs. LSA, p?=?0.345). Eleven patients underwent surgical re-intervention for WR by placement of a non-adjustable band (n?=?2), adjustable band (n?=?7) and conversion to distal gastric bypass (n?=?2).Conclusions
CSA and LSA lead to comparable weight loss in this 5-year follow-up. More patients in the CSA group had WR. Weight regain of more than 10 kg was found in one out of seven patients within 5 years postoperatively. 相似文献6.
Hideharu Shimizu Shohrat Annaberdyev Isaac Motamarry Matthew Kroh Philip R. Schauer Stacy A. Brethauer 《Obesity surgery》2013,23(11):1766-1773
Background
There are growing numbers of patients who require revisional bariatric surgery due to the undesirable results of their primary procedures. The aim of this study was to review our experience with bariatric patients undergoing revisional surgery.Methods
We conducted a retrospective analysis to review the indications for revisional bariatric procedures and assess their postoperative outcomes.Results
From 04/04 to 01/11, 2,918 patients underwent bariatric surgery at our institution. A total of 154 patients (5.3 %) of these cases were coded as revisional procedures. The mean age at revision was 49.1?±?11.3 and the mean BMI was 44.0?±?13.7 kg/m2. Revisional surgery was performed laparoscopically in 121 patients (78.6 %). Laparoscopic revisions had less blood loss, shorter length of hospital stay, and fewer complications compared to open revisions. Two groups (A and B) were defined by the indication for revision: patients with unsuccessful weight loss (group A, n?=?106) and patients with complications of their primary procedures (group B, n?=?48). In group A, 74.5 % of the patients were revised to a bypass procedure and 25.5 % to a restrictive procedure. Mean excess weight loss was 53.7?±?29.3 % after revision of primary restrictive procedures and 37.6?±?35.1 % after revision of bypass procedures at >1-year follow-up (p?<?0.05). In group B, the complications prompting revision were effectively treated by revisional surgery.Conclusions
Revisional bariatric surgery effectively treated the undesirable results from primary bariatric surgery. Laparoscopic revisional surgery can be performed after both failed open and laparoscopic bariatric procedures without a prohibitive complication rate. Carefully selected patients undergoing revision for weight regain have satisfactory additional weight loss. 相似文献7.
Paul Del Prado Pavlos K. Papasavas Darren S. Tishler Andrea M. Stone Janet S. Ng Sean B. Orenstein 《Obesity surgery》2014,24(4):584-587
Background
Past medical or family history of autoimmune diseases and patient chronic steroid use are label contraindications for laparoscopic placement of adjustable gastric band (LAGB). We reviewed our experience with placement of LAGB in patients with autoimmune disease or chronic steroid use.Methods
This was a retrospective review of our prospective bariatric database. All patients who underwent LAGB and had a diagnosis of autoimmune disease or chronic steroid use with at least 1-year follow-up data were included in the study. Data on demographics, weight loss, and complications were collected.Results
Sixteen patients with autoimmune diseases or chronic steroid use underwent LAGB. Diseases included were lupus (n?=?6), sarcoidosis (n?=?4), renal transplant (n?=?2), rheumatoid arthritis (n?=?1), ulcerative colitis (n?=?1), Grave's disease (n?=?1), and celiac disease (n?=?1). No patients developed infectious complications. One patient required port replacement due to malfunction, and one patient underwent a conversion to gastric bypass due to failure of weight loss. The average preoperative body mass index was 46.8 kg/m2 with an average weight of 292.0 lbs. Average excess weight loss was 39.8 % (range, 7.4 to 95.5 %) at a median follow-up of 54 months.Conclusions
Our review indicates that LAGB in patients with autoimmune diseases or chronic steroid use is safe, with no infectious complications and only one explant. Some of these autoimmune conditions may improve following significant weight loss, but larger studies are required to further substantiate these findings. 相似文献8.
Alexander Kokkinos Kleopatra Alexiadou Christos Liaskos Georgia Argyrakopoulou Ioanna Balla Nicholas Tentolouris Ioannis Moyssakis Nicholas Katsilambros Irene Vafiadis Andreas Alexandrou Theodoros Diamantis 《Obesity surgery》2013,23(1):31-38
Background
Morbidly obese patients display cardiac abnormalities which are partially reversed after weight loss. The aim of the present study was to assess the potential difference in cardiovascular disease indices between patients who underwent either gastric bypass surgery or sleeve gastrectomy.Methods
Thirty-seven morbidly obese patients who underwent either Roux-en-Y gastric bypass (RYGB) (n?=?14) or SG (n?=?23) were examined before, 3 and 6 months after surgery. Indices of cardiac autonomic nervous system activity were evaluated, namely baroreflex sensitivity (BRS) and heart rate variability (HRV). A complete echocardiographic study was performed in a subgroup of 17 patients (RYGB 8, SG 9) preoperatively and 6 months after surgery, evaluating epicardial fat thickness, aortic distensibility, left ventricular (LV) Tei index, left atrium diameter, ejection fraction, and LV mass.Results
All subjects experienced significant (p?<?0.001) and similar weight loss independently of the type of operation. BRS and HRV indices improved significantly and to the same degree after surgery in both groups. In the echocardiographic study, all parameters improved significantly at 6 months in comparison with the baseline values. In addition, the RYGB group displayed significantly greater reduction in epicardial fat thickness (p?=?0.007) and also tended to have a better LV performance as expressed by the lower values of the Tei index (p?=?0.06) compared to the SG group 6 months after surgery.Conclusions
Both RYGB and SG exert comparable effects on weight loss and improvement of cardiovascular parameters. RYGB displays a more beneficial influence on epicardial fat thickness and left ventricular performance than SG. 相似文献9.
Zubaidah Nor Hanipah Suriya Punchai Stacy A. Brethauer Philip R. Schauer Ali Aminian 《Obesity surgery》2018,28(8):2247-2251
Introduction
While bariatric surgery leads to significant prevention and improvement of type 2 diabetes, patients may rarely develop diabetes after bariatric surgery. The aim of this study was to determine the incidence and the characteristic of new-onset diabetes after bariatric surgery over a 17-year period at our institution.Methods
Non-diabetic patients who underwent bariatric surgery at a single academic center (1997–2013) and had a postoperative glycated hemoglobin (HbA1c) ≥?6.5%, fasting blood glucose (FBG) ≥?126 mg/dl, or positive glucose tolerance test were identified and studied.Results
Out of 2263 non-diabetic patients at the time of bariatric surgery, 11 patients had new-onset diabetes in the median follow-up time of 9 years (interquartile range [IQR], 4–12). Bariatric procedures performed were Roux-en-Y gastric bypass (n?=?7), adjustable gastric banding (n?=?3), and sleeve gastrectomy (n?=?1). The median interval between surgery and diagnosis of diabetes was 6 years (IQR, 2–9). At the last follow-up, the median HbA1c and FBG values were 6.3% (IQR, 6.1–6.5) and 95 mg/dl (IQR, 85–122), respectively. Possible etiologic factors leading to diabetes were weight regain to baseline (n?=?6, 55%), steroid-induced after renal transplantation (n?=?1), pancreatic insufficiency after pancreatitis (n?=?1), and unknown (n?=?3).Conclusion
De novo diabetes after bariatric surgery is rare with an incidence of 0.4% based on our cohort. Weight regain was common (>?50%) in patients who developed new-onset diabetes suggesting recurrent severe obesity as a potential etiologic factor. All patients had good glycemic control (HbA1c ≤?7%) in the long-term postoperative follow-up.10.
Maryam Alfa Wali Hutan Ashrafian Kerry L. Schofield Leanne Harling Abdullah Alkandari Ara Darzi Thanos Athansiou Evangelos Efthimiou 《Obesity surgery》2014,24(12):2126-2132
Background
Social deprivation is associated with a greater morbidity and shorter life expectancy. This study evaluates differences in weight loss following bariatric surgery and deprivation, based on UK deprivation measures in a London bariatric centre.Methods
All patients undergoing bariatric surgery between 2002 and 2012 were retrospectively identified. Demographic details, type of surgery and percentage excess weight loss data were collected. UK Index of Multiple Deprivation (IMD, 2010) and IMD domain of the Health Deprivation and Disability (HDD) scores were used to assess deprivation (where 1 is the most deprived in rank order and 32,482 is the least deprived). Two-way between-subjects analysis of variance (ANOVA) was performed to examine the effect of IMD score, deprivation, procedure type and gender on percentage excess weight loss.Results
Data were included from 983 patients (178 male, 805 female) involving 3,663 patient episodes. Treatments comprised laparoscopic gastric bands (n?=?533), gastric bypass (n?=?362) and gastric balloons (n?=?88). The average percentage excess weight loss across all procedures was 38 % over a follow-up period (3 months–9 years). There was no correlation between weight loss and IMD/HDD rank scores. Gastric bypass was significantly more effective at achieving weight loss than the other two procedures at 3-, 6- and 9-month and 1-year follow-up.Conclusions
Social deprivation does not influence weight loss after bariatric surgery, suggesting that all socioeconomic groups may equally benefit from surgical intervention. Social deprivation should not therefore negatively influence the decision for surgical intervention in these patients. 相似文献11.
Juul J. W. Tegels M. F. G. de Maat K. W. E. Hulsewé A. G. M. Hoofwijk J. H. M. B. Stoot 《Journal of gastrointestinal surgery》2014,18(3):439-446
Objectives
This study seeks to evaluate assessment of geriatric frailty and nutritional status in predicting postoperative mortality in gastric cancer surgery.Methods
Preoperatively, patients operated for gastric adenocarcinoma underwent assessment of Groningen Frailty Indicator (GFI) and Short Nutritional Assessment Questionnaire (SNAQ). We studied retrospectively whether these scores were associated with in-hospital mortality.Results
From 2005 to September 2012 180 patients underwent surgery with an overall mortality of 8.3 %. Patients with a GFI?≥?3 (n?=?30, 24 %) had a mortality rate of 23.3 % versus 5.2 % in the lower GFI group (OR 4.0, 95%CI 1.1–14.1, P?=?0.03). For patients who underwent surgery with curative intent (n?=?125), this was 27.3 % for patients with GFI?≥?3 (n?=?22, 18 %) versus 5.7 % with GFI?<?3 (OR 4.6, 95 % CI 1.0–20.9, P?=?0.05). SNAQ?≥?1 (n?=?98, 61 %) was associated with a mortality rate of 13.3 % versus 3.2 % in patients with SNAQ?=?0 (OR 5.1, 95 % CI 1.1–23.8, P?=?0.04). Given odds ratios are corrected in multivariate analyses for age, neoadjuvant chemotherapy, type of surgery, tumor stage and ASA classification.Conclusions
This study shows a significant relationship between gastric cancer surgical mortality and geriatric frailty as well as nutritional status using a simple questionnaire. This may have implications in preoperative decision making in selecting patients who optimally benefit from surgery. 相似文献12.
Jacqueline Odom Kerstyn C. Zalesin Tamika L. Washington Wendy W. Miller Basil Hakmeh Danielle L. Zaremba Mohamed Altattan Mamtha Balasubramaniam Deborah S. Gibbs Kevin R. Krause David L. Chengelis Barry A. Franklin Peter A. McCullough 《Obesity surgery》2010,20(3):349-356
Background
After bariatric surgery, a lifelong threat of weight regain remains. Behavior influences are believed to play a modulating role in this problem. Accordingly, we sought to identify these predictors in patients with extreme obesity after Roux-en-Y gastric bypass (RYGB).Methods
In a large tertiary hospital with an established bariatric program, including a multidisciplinary outpatient center specializing in bariatric medicine, with two bariatric surgeons, we mailed a survey to 1,117 patients after RYGB. Of these, 203 (24.8%) were completed, returned, and suitable for analysis. Respondents were excluded if they were less than 1 year after RYGB. Baseline demographic history, preoperative Beck Depression Inventory (BDI), and Brief Symptom Inventory-18 scores were abstracted from the subjects’ medical records; pre- and postoperative well-being scores were compared.Results
Of the study population, mean age was 50.6?±?9.8 years, 147 (85%) were female, and 42 (18%) were male. Preoperative weight was 134.1?±?23.6 kg (295?±?52 lb) and 170.0?±?29.1 kg (374.0?±?64.0 lb) for females and males, respectively, p?<?0.0001. The mean follow-up after bariatric surgery was 28.1?±?18.9 months. Overall, the mean pre- versus postoperative well-being scores improved from 3.7 to 4.2, on a five-point Likert scale, p?=?0.001. A total of 160 of the 203 respondents (79%) reported some weight regain from the nadir. Of those who reported weight regain, 30 (15%) experienced significant regain defined as an increase of ≥15% from the nadir. Independent predictors of significant weight regain were increased food urges (odds ratios (OR)?=?5.10, 95% CI 1.83–14.29, p?=?0.002), severely decreased postoperative well-being (OR?=?21.5, 95% CI 2.50–183.10, p?<?0.0001), and concerns over alcohol or drug use (OR?=?12.74, 95% CI 1.73–93.80, p?=?0.01). Higher BDI scores were associated with lesser risk of significant weight regain (OR?=?0.94 for each unit increase, 95% CI 0.91– 0.98, p?=?0.001). Subjects who engaged in self-monitoring were less likely to regain any weight following bariatric surgery (OR?=?0.54, 95% CI 0.30–0.98, p?=?0.01). Although the frequency of postoperative follow-up visits was inversely related to weight regain, this variable was not statistically significant in the multivariate model.Conclusions
Predictors of significant postoperative weight regain after bariatric surgery include indicators of baseline increased food urges, decreased well-being, and concerns over addictive behaviors. Postoperative self-monitoring behaviors are strongly associated with freedom from regain. These data suggest that weight regain can be anticipated, in part, during the preoperative evaluation and potentially reduced with self-monitoring strategies after RYGB. 相似文献13.
Dean Mikami Bradley Needleman Vimal Narula Janice Durant W. Scott Melvin 《Surgical endoscopy》2010,24(1):223-228
Introduction
Weight gain after gastric bypass can occur in up to 10% of patients 5 years following and in about 20% of patients 10 years following surgery. The nadir weight is usually reached within the first 2 years after bypass surgery. However, weight may slowly be regained for numerous reasons. This phenomenon has been studied extensively, but there is often no one reason this occurs. Once psychological and dietary reasons have been investigated, revisional surgery may be the only alternative for treatment. Revisional gastric bypass surgery is associated with a much higher morbidity and mortality when compared with a primary gastric bypass procedure.Patients and methods
Thirty-nine patients underwent endoluminal gastric pouch reduction with the StomaphyXTM device after informed consent. The StomaphyXTM device is a sterile, single-use device for use in endoluminal transoral tissue approximation and ligation in the gastrointestinal (GI) tract.Results
Average age was 47.8 (29–64) years, and 36/39 (92.3%) patients were female. Average body mass index (BMI) and weight prior to the StomaphyXTM procedure were 39.8 (22.7–63.2) kg/m2 and 108.0 kg (65.90–172.2 kg). The average preprocedure excess body weight was 51.1 kg. Weight loss at 2 weeks (n = 39) was 3.8 kg (7.4% excess body weight loss, EBWL), at 1 month (n = 34) was 5.4 kg (10.6% EBWL), at 2 months (n = 26) was 6.7 kg (13.1% EBWL), at 3 months (n = 15) was 6.7 kg (13.1% EBWL), at 6 months (n = 14) was 8.7 kg (17.0% EBWL), and at 1 year (n = 6) was 10.0 kg (19.5% EBWL). No major complications were observed. The minor complications that were seen included a sore throat lasting less than 48 h in 34/39 patients (87.1%) and epigastric pain that lasted for a few days in 30/39 patients (76.9%). Three patients with chronic diarrhea had their symptoms resolved after the procedure. Eight patients with gastroesophageal reflux disease reported improvement in their symptoms post procedure.Conclusions
Endoluminal revision of gastric bypass patients with weight gain using the StomaphyXTM procedure may offer an alternative to open or laparoscopic revisional bariatric surgery. 相似文献14.
Maud Robert Arnaud Pasquer Philippe Espalieu Martine Laville Christian Gouillat Emmanuel Disse 《Obesity surgery》2014,24(10):1662-1669
Background
Obesity prevalence increases in elderly population. Bariatric surgery has been underused in patients over 60 because of fears of complications and lower weight loss. We postulated worse outcomes in the elderly in comparison to young and middle-aged population 1 year after gastric bypass.Methods
We retrospectively analyzed gastric bypass outcomes in young (<40 years), middle-aged (40 to 55 years), and elderly (>60 years) patients between 2007 and 2013. Each subject over 60 (n?=?24) was matched with one subject of both the other groups according to gender, preoperative body mass index (BMI), surgical procedure, and history of previous bariatric surgery (n?=?72).Results
Older subjects demonstrated higher prevalence of preoperative metabolic comorbidities (70 vs 30 % in the <40-year-old group, p?0.0001). Mean duration of the surgical procedure, mean length of stay, and early and late complication rates were similar between age groups. A trend towards fewer early complications and less-severe complications in the younger groups was noted. One-year weight loss results were similar between young, middle-aged, and elderly patients (percentage of excess BMI loss (EBL%), 74.4?±?3.5; 78.9?±?4.5, and 73.7?±?4.5 respectively, p?=?0.69). Age was not predictive of weight loss failure 1 year after surgery. Remission and improvement rates of comorbidities were similar between age groups 6 months after surgery.Conclusions
Our study confirms weight loss efficacy of gastric bypass in the elderly with acceptable risks. Further studies evaluating the benefit-risk balance of bariatric surgery in the elderly population will be required so as to confirm the relevance of increasing age limit. 相似文献15.
Bruno Dillemans Nasser Sakran Sebastiaan Van Cauwenberge Thibault Sablon Barbara Defoort Els Van Dessel Faki Akin Nathalie Moreels Sebastiaan Lambert Jan Mulier Ravindra Date Michel Vandelanotte Tom Feryn Luc Proot 《Obesity surgery》2009,19(10):1355-1364
Background
Various techniques of laparoscopic Roux-en-Y gastric bypass have been described. We completely standardized this procedure to minimize its sometimes substantial morbidity and mortality. This study describes our experience with the standardized fully stapled laparoscopic Roux-en-Y gastric bypass (FS-LRYGB) and its influence on the 30-day morbidity and mortality.Methods
We retrospectively analyzed 2,645 patients who underwent FS-LRYGB from May 2004 to August 2008. Operative time, hospital stay and readmission, re-operation, and 30-day morbidity/mortality rates were then calculated. The 30-day follow-up data were complete for 2,606 patients (98.5%).Results
There were 539 male and 2,067 female patients. Mean age was 39.2 years (range 14–73), mean BMI 41.44 kg/m2 (range, 23–75.5). The mean hospital stay was 3.35 days (range 2–71). Mean total operative time was 63 min (range 35–150). One patient died of pneumonia within 30 days of surgery (0.04%). One hundred and fifty one (5.8%) patients had postoperative complications as follows: gastrointestinal hemorrhage (n?=?89, 3.42%), intestinal obstruction (n?=?9, 0.35%), anastomotic leak (n?=?5, 0.19%) and others (n?=?47, 1.80%). In 66 patients, the bleeding resolved without any surgical re-intervention. One hemorrhage resulted in hypovolemic shock with subsequent renal and hepatic failure.Conclusion
The systematic approach and the full standardization of the FS-LRYGB procedure contribute highly to the very low mortality and the low morbidity rates in our institution. Gastrointestinal bleeding appears to be the commonest complication, but is self-limiting in the majority of cases. Our approach also significantly reduces operative time and turns the technically demanding laparoscopic Roux-en-Y gastric bypass procedure into an easy reproducible operation, effective for training. 相似文献16.
Allison M. Barrett Kim T. Vu Kulmeet K. Sandhu Edward H. Phillips Scott A. Cunneen Miguel A. Burch 《Journal of gastrointestinal surgery》2014,18(10):1737-1743
Introduction
The laparoscopic adjustable gastric band (LAGB) can be revised to sleeve gastrectomy (LSG) for various reasons. Data are limited on the safety and efficacy of single-stage removal of LAGB and creation of LSG.Methods
A retrospective review of cases was performed from 2010 to 2013. From the primary LSG group, a control group was matched in a 2:1 ratio.Results
Thirty-two patients underwent single-stage revision from LAGB to LSG, with a control group of 64. The most common indication for revision was insufficient weight loss (62.5 %). Operative time for revision and control groups was 134 and 92 min, respectively (p?0.0001). Hospital stay was 3.22 and 2.59 days, respectively (p?=?0.02). Overall, the 30-day complication rate for revision and control patients was 14.71 and 6.25 %, respectively (p?=?0.20). There were no leaks, one stricture (3.13 %) in the revision group, and one reoperation for bleeding in the control group (1.56 %). For patients with BMI >30 at surgery, change in BMI at 12 months for revision and control was 8.77 and 11.58, respectively (p?=?0.02).Conclusion
Single-stage revision can be performed safely, with minimal increases in hospital stay and 30-day complications. Weight loss is greater in those who undergo primary LSG compared to those who undergo LSG as revision. 相似文献17.
Owaid M. Almalki Wei-Jei Lee Jung-Chien Chen Kong-Han Ser Yi-Chih Lee Shu-Chun Chen 《Obesity surgery》2018,28(4):970-975
Background
Ten to 50% of patients who received restrictive bariatric operations may require reoperation for unsatisfactory weight loss or weight regain. Failed restrictive procedures are usually managed with conversion to another bariatric procedure with a favor of conversion to laparoscopic gastric bypass. Our aim is to evaluate two different bypass techniques, laparoscopic RY gastric bypass (RYGB) versus single-anastomosis (mini-) gastric bypass (SAGB) as a revision option (R-RYGB and R-SAGB) for failed restrictive bariatric operations.Material and Methods
From May 2001 to December 2015, a total of 116 patients with failed restrictive bariatric operations underwent laparoscopic revisional bypass surgery (81 R-SAGB and 35 R-RYGB). Among them, 81 were failed after vertical banded gastroplasty (VBG) and 35 were after adjustable gastric band (AGB). The demographic data, surgical parameters, and outcomes were studied.Results
The average age at revision surgery was 35.7 years (range 22–56), and the average body mass index (BMI) before reoperation was 37.2 kg/m2 (29.0–51.8). Revision surgery was performed after 58.8 months from the primary surgery on average (14–180 months). The main reasons for the revisions were weight regain (50.9%), inadequate weight loss (31%), and intolerance (18.1%). All of the procedures were completed laparoscopically as one-stage procedure. R-RYGB had significantly longer operative times than R-SAGB. Major complication occurred in 12 (10%) patients without significant difference between R-SAGB group and R-RYGB group. At 1 year follow-up, weight loss was better in R-SAGB than R-RYGB (76.8 vs. 32.9% EWL; p = 0.001). At 5 year follow-up, a significantly lower hemoglobin level was found in R-SAGB group (p = 0.03).Conclusion
Both SAGB and RYGB are acceptable options for revising a restrictive type of bariatric procedures with equal safety profile. R-SAGB was shown to be a simpler procedure with better weight reduction than R-RYGB but anemia is a considerable complication at long-term follow-up.18.
Seyfried F Lannoo M Gsell W Tremoleda JL Bueter M Olbers T Jurowich C Germer CT le Roux CW 《Obesity surgery》2012,22(7):1117-1125
Background
A reproducible Roux-en-Y gastric bypass (RYGB) model in mice is needed to study the physiological alterations after surgery.Methods
Male C57BL6 mice weighing 29.0?±?0.8?g underwent either RYGB (n?=?14) or sham operations (n?=?6). RYGB surgery consisted of a small gastric pouch (~2?% of the initial stomach size), a biliopancreatic and alimentary limb of 10?cm each and a common channel of 15?cm. Animals had free access to standard chow in the postoperative period. Body mass and food intake were recorded for 60?days. Bomb calorimetry was used for faecal analysis. Anatomical rearrangement was assessed using planar X-ray fluoroscopy and computed tomography (CT) after oral Gastrografin? injection.Results
RYGB surgery led to a sustained reduction in body weight compared to sham-operated mice (postoperative week 1: sham 27.8?±?0.7?g vs. RYGB 26.5?±?1.0?g, p?=?0.008; postoperative week 8: sham 30.7?±?0.8?g vs. RYGB 28.4?±?1.1?g, p?=?0.003). RYGB mice ate less compared to shams (sham 4.6?±?0.2?g/day vs. RYGB 4.3?±?0.4?g/day, p?0.001). There were no differences in faecal mass (p?=?0.13) and faecal energy content (p?=?0.44) between RYGB and shams. CT scan demonstrated the expected anatomical rearrangement without leakage or stenosis. Fluoroscopy revealed rapid pouch emptying.Conclusions
RYGB with a small gastric pouch is technically feasible in mice. With this model in place, genetically manipulated mouse models could be used to study the physiological mechanisms involved with metabolic changes after gastric bypass. 相似文献19.
David A. Froehling Paul R. Daniels Karen F. Mauck Maria L. Collazo-Clavell Aneel A. Ashrani Michael G. Sarr Tanya M. Petterson Kent R. Bailey John A. Heit 《Obesity surgery》2013,23(11):1874-1879
Background
The incidence of venous thromboembolism (VTE) after bariatric surgery is uncertain.Methods
Using the resources of the Rochester Epidemiology Project and the Mayo Bariatric Surgery Registry, we identified all residents of Olmsted County, Minnesota, with incident VTE after undergoing bariatric surgery from 1987 through 2005. Using the dates of bariatric surgery and VTE events, we determined the cumulative incidence of VTE after bariatric surgery by using the Kaplan–Meier estimator. Cox proportional hazards modeling was used to assess patient age, sex, weight, and body mass index as potential predictors of VTE after bariatric surgery.Results
We identified 396 residents who underwent 402 bariatric operations. The most common operation was an open Roux-en-Y gastric bypass (n?=?228). Eight patients had VTE that developed within 6 months (7 within 1 month) after surgery; five events occurred after hospital discharge but within 1 month after bariatric surgery. The cumulative incidence of VTE at 7, 30, 90, and 180 days was 0.3, 1.9, 2.1, and 2.1 %, respectively (180-day 95 % confidence interval (CI), 0.7–3.6 %). Patient age was a predictor of postoperative VTE (hazard ratio, 1.89 per 10-year increase in age; 95 % CI, 1.01–3.55; P?=?0.05).Conclusions
In our population-based study, bariatric surgery had a high risk of VTE, especially for older patients. Because most VTE events occurred after hospital discharge, a randomized controlled trial of extended outpatient thromboprophylaxis is warranted in patients undergoing open Roux-en-Y gastric bypass for medically complicated obesity. 相似文献20.
Elemer Mohos Zoltán Jánó Doris Richter Elizabeth Schmaldienst Gábor Sándor Petra Mohos Miroslav Horzov Gábor Tornai Manfred Prager 《Obesity surgery》2014,24(12):2048-2054