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941.
Background: The complications of the gastric pouch in gastric bypass surgery are well known. Since the first report of this
surgery 30 years ago, new technical aspects that make it safer and more effective have been implemented. Methods: As a modification
of gastric bypass, the authors have performed 305 vertical banded gastroplasty-gastric bypass procedures. Two groups of patients
underwent the procedure: Group I (n = 206) without a limb of jejunum interposed between the gastric pouch and the excluded
stomach, and Group II (n = 99) with a limb of jejunum interposed between the pouch and the stomach. The results regarding
excess weight loss and complications of the gastric pouch during the first year after surgery were compared. Results: Age,
sex, initial weight, body mass index, and percentage of ideal weight were similar in both groups. Excess weight loss was also
similar. The complications in Group I were 1 leak, 3 left subphrenic abscesses, 2 erosive gastritis with bleeding, 1 stenosis
of the gastrojejunostomy, 1 perforated ulcer, and 4 marginal ulcers with bleeding. Two patients in Group II developed bleeding
from the staple-line. Conclusions: These preliminary data suggest that complications of the gastric pouch can be reduced by
interposing a limb of jejunum between the pouch and the excluded stomach. This is an early experience; long-term results are
pending. 相似文献
942.
Background: Morbid obesity contributes to many health risks, including physical, emotional, and social problems. Various surgical
treatments for morbid obesity have developed and have so far met with good results. This study compares vertical banded gastroplasty
(VBG) with gastric bypass (GBP) and the patients' satisfaction with either procedure. Methods: Between April 1993 and July
1997, 63 bariatric surgical procedures were performed at Eisenhower Army Medical Center. Of those, complete follow-up was
obtained for 29 patients. The parameters evaluated included age, preoperative and postoperative weights, body mass index (BMI),
type of surgery, complications, and the patient's level of satisfaction. Results: The study group consisted of 27 women and
2 men. The average preoperative weight was 135 kg, and the average preoperative BMI was 48.3 kg/m2. There were 17 VBGs and 12 GBPs performed. The average total weight loss was 45.1 kg. The average postoperative BMI was 33.2
kg/m2. There were no statistically significant differences in weight loss between VBG and GBP. Four of 17 patients had complications
after VBG, and three of 12 patients had complications after GBP. After VBG, 94.1% of patients were satisfied, and after GBP,
100% were satisfied. Twenty-seven of 28 patients stated that they would have the surgery again. Conclusion: There were no
statistically significant differences in weight loss or complications after VBG or GBP. Patient satisfaction was high after
both procedures. Therefore, bariatric surgery is important in the treatment of appropriately selected, morbidly obese patients. 相似文献
943.
Success Habits of Long-Term Gastric Bypass Patients 总被引:1,自引:1,他引:0
Background: By identifying common habits of the most successful long-term gastric bypass patients, one is able to establish
more specific guidelines for new patients to follow. The first postoperative year is a critical time that must be dedicated
to changing old behavior and forming new, lifelong habits. Methods: 100 gastric bypass patients from 1979 to 1995 participated
in a comprehensive survey. Surveys were completed in person, by phone, or in writing. Participants were asked to answer questions
regarding their eating, drinking, sleeping, exercise, and personal habits. Results: The survey revealed that specific habits
are common in gastric bypass patients who have maintained their weight loss for many years. Conclusion: Identifying and defining
the common habits of patients who are successful with long-term weight loss enabled specific guidelines to be established
for new patients to implement during the initial weight loss phase, which will contribute to life-long success. 相似文献
944.
Background: Predicting successful outcomes after bariatric surgical procedures has been difficult, and the establishment of
specific selection criteria has been a subject of ongoing research. In an effort to choose the most appropriate surgical procedure
for each patient, we have established a specific set of selection criteria for each procedure based on degree of obesity,
preoperative dietary habits, eating behavior, and various metabolic features. Methods: From June 1994 to December 1998, 90
bariatric surgical procedures were performed at the authors' institution by a single surgeon (F.K.) based on specific selection
criteria. Vertical banded gastroplasty (VBG) was performed in 35 patients, standard Roux-en-Y gastric bypass (RYGB) in 38
patients, and distal RYGB in 17 patients. All patients were monitored postoperatively 1, 3, 6, and 12 months and once per
year thereafter, with an additional visit at 18 months in distal RYGB patients. Results: Early postoperative morbidity (<30
days) did not differ significantly between the three groups and averaged 9% of total patients. Long-term postoperative morbidity
(>30 days) included 9 incisional hernias (2 in the VBG group, 5 after RYGB, and 2 in the distal RYGB group). There were 6
cases of staple-line disruption, 4 after VBG and 2 after standard RYGB, 1 of which resulted in stomal ulcer. Early postoperative
mortality was 0%, and long-term mortality was 1.1%, which was due to pulmonary embolism in 1 standard RYGB patient on the
65th postoperative day. Average percentage of excess weight loss (%EWL) was 62% the first year, 61% the second year, and 50%
the third year in VBG patients, and 63.6%, 65%, and 63.3%, respectively, in standard RYGB patients. In distal RYGB patients,
where the patient number was significantly smaller, the %EWL at 1 and 2 years, respectively, was 51% and 53%. The most significant
metabolic/nutritional complication was the appearance of hypoproteinemia (hypoalbuminemia) in 1 distal RYGB patient 20 months
after surgery, which was corrected by total parenteral nutrition and subsequent increase in dietary protein intake. Significant
improvement or resolution of pre-existing comorbid conditions was observed in all patient groups. The postoperative quality
of eating, as evaluated by variety of food intake and frequency of vomiting, was significantly better in RYGB patients. Conclusions:
These results show that selection of the bariatric surgical procedure to be performed in each patient based on specific criteria
leads to acceptable weight loss, improvement in preexisting comorbid conditions, and a high degree of patient satisfaction
in most patients. On the basis of our own observations as well as those of others, our selection criteria have become more
strict over time and our selection of VBG as the operation of choice increasingly infrequent. 相似文献
945.
Background: The Swedish adjustable gastric band (SAGB) has been in use since 1985. The aim of this study was to analyze short
and long-term complications linked to the SAGB. Materials and Methods: Between August 1990 and December 1996, we operated
on a series of 326 patients (78 men and 248 women) at the Huddinge University Hospital and the Norra ?lvsborg County Hospital.
The mean age of patients at surgery was 40 years (range 19-62). The mean preoperative weight was 125 kg (range 81-181). The
mean excess weight was 80%. Results: The mean time of follow-up was 28 months (range 6-76). Complications requiring reoperation
included two (0.6%) band dislocations, six (1.8%) band leakages, and 16 (4.6%) band migrations-erosions. The most common reason
for abdominal reoperation, band migration, was attributed to overfilling of the band system. In the patients in whom migration
occurred, the bands had been filled with a mean volume of 12.6 ml fluid. In the remaining patients, the mean volume was 8.7
ml. The most common complication not requiring reoperation was reflux disease (4.7%). In cases with a small pouch, this complication
did not seem to be a serious problem. The mean excess weight loss in the 296 patients without complications was 68%. Conclusion:
The overall long-term complication rate following SAGB is reasonable. With improved operating technique and closer follow-up,
it should be possible to reduce the complication rate further. Reoperation because of band migration appears to be related
to overfilling of the system and should therefore be avoidable in most cases. 相似文献
946.
Quality-of-Life Outcome After Laparoscopic Adjustable Gastric Banding for Morbid Obesity 总被引:3,自引:0,他引:3
Background: The definition of success and failure of a bariatric procedure should include weight loss as well as improvement
of comorbidity and quality-of-life (QoL) assessment. QoL measures changes in physical, functional, mental, and social health
in order to evaluate benefits of new programs and interventions. Material and Methods: From April 1995 until March 1999, 287
patients underwent laparoscopic adjustable silicone gastric banding (LASGB) at Northwest Hospital Frankfurt a.M. (Germany).
In this study, 100 of 287 patients (preoperative mean BMI 48.3 kg/m2; mean age 35.2 years) with a follow-up >18 month were evaluated. All patients underwent anonymous questionnaire (26 questions
with a maximum score of 60) about different aspects of QoL outcome after LSAGB. Results: In this study, 4 of 100 patients
refused to give an answer to the QoL questions. Therefore 96 patients were evaluated. The QoL auto-evaluation of the patients
shows that QoL generally improved after surgery in 92%. Using the scoring system, 44% of patients have excellent, 52% good,
and only 4% bad results. The 4 patients who refused had to be classified as failure. General acceptance of LSAGB is wide,
but gastrointestinal side effects are recognizable in more than 78% of operated patients. Successful weight loss is followed
by an improvement of comorbidities. Conclusions: Safe, effective bariatric procedures increase the quality of life in morbidly
obese patients markedly. Bariatric surgeons are committed to support and help their patients until they reach a new quality
of life after obesity surgery. 相似文献
947.
Eriksson S 《Obesity surgery》1999,9(5):499-501
Background: Breast reduction surgery is common in females; however, in males it is mainly due to gynecomastia. After weight
reduction following obesity surgery, it is a problem in women, but also in some men. Method: One patient is described in whom
the weight reduction declined from BMI 52 to BMI 36 after vertical banded gastroplasty, giving the patient ptotic breasts.
Results: The patient underwent reduction mammaplasty with lateral single-based cutaneous flaps, and a total of 1,000 g was
removed. Conclusion: Reduction mammoplasty can be performed in males with the methods used today, after successful weight
loss following obesity surgery. 相似文献
948.
Komaki H Sugai K Sasaki M Hashimoto T Arai N Takada E Maehara T Shimizu H 《Epilepsia》1999,40(3):365-369
We report a surgically treated case of early infantile epileptic encephalopathy (EIEE) with suppression-bursts associated with focal cortical dysplasia. Tonic-clonic seizures followed by a series of spasms occurred about a hundred times a day at a few days of age. Interictal electroencephalogram (EEG) revealed a suppression-burst pattern that was predominant in the left hemisphere. Magnetic resonance imaging (MRI) suggested focal cortical dysplasia in the left prefrontal area. Combination therapies with antiepileptic treatments showed only partial efficacy. The patient underwent lesionectomy at age 4 months, after which he gradually showed psychomotor development and a decrease of spasms to 0-2 series daily. In cases of EIEE with focal cortical dysplasia, surgical treatment may have beneficial effects on both psychomotor development and seizure control. 相似文献
949.
We present an unusual case of a patient who was diagnosed with temporal lobe epilepsy and whose seizures were reduced markedly after excision of an angiographically occult arteriovenous malformation (AVM) located in the left medial parietal lobe. A 38-year-old man had complex partial seizures characterized by motionless staring with oroalimentary and behavioral automatisms since the age of 15 years. Magnetic resonance imaging (MRI) demonstrated a small lesion extending from the left posterior cingulate gyrus to the precuneus. There was no MRI evidence of mesial temporal sclerosis. Intracranial EEG recordings showed ictal onset from the left medial parietal lobe propagating to the medial temporal lobes. Clinical signs appeared when these discharges reached the temporal lobes. After excision of the lesion (which was histologically confirmed as an AVM), together with the marginal cortex, seizures were reduced significantly. Careful diagnostic evaluation of lesions such as the this one may reveal an epileptogenic lesion (zone) far from the region where scalp ictal discharges seem to arise. In our case, we hypothesize that false localization was due to propagation of ictal discharges from the parietal focus through the limbic system. 相似文献
950.
内窥镜辅助下显微神经血管减压术治疗
特发性偏侧面肌痉挛 总被引:2,自引:0,他引:2
张开文 《中国神经精神疾病杂志》1999,(3)
目的为进一步提高神经血管减压术治疗特发性偏侧面肌痉挛的疗效。方法经乙状窦后小骨窗开颅加用内窥镜辅助显微血管减压术治疗特发性偏侧面肌痉挛35例。结果术后34例症状消失,1例症状减轻,35例随访6个月至3年半,术后面肌抽搐消失者33例,1例症状减轻,1例1年后复发。结论内窥镜可弥补手术显微镜的不足之处,减少组织损伤和判断错误,提高治疗效果。 相似文献