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21.
Background: Hybrid, combined or mixed bariatric surgery is the combination of a degree of ‘malabsorption’ (as achieved by the intestinal bypass) with a ‘rrestriction’
(as achieved by gastric bypass or gastroplasty), thereby simultaneously reducing the absorption of fats in the small bowel
and decreasing the intake of food. Methods: A modification of the bilio-pancreatic diversion (BPD) with a duodenal switch
procedure, vertical lineal gastrectomy and preservation of the pylorus, has been used in 23 patients. The antropyloric pump
and 4 cm of the duodenum are left intact to preserve physiologic gastric emptying and to prevent anastomotic ulcer. The use
of staplers and continuous running sutures reduces surgical risks and operative time. Results: One patient, converted from
a vertical gastroplasty, had an intrathoracic esophageal perforation and died of multisystemic organ failure, a mortality
rate of 4.5%. One patient had a partial dehiscence of the laparotomy wound. Three patients developed subcutaneous seromas.
Mean weight losses during the first 4 months were 13, 11, 6 and 5 kg, with a loss of 70% of excess weight in patients approaching
1 year. No patient needs treatment for diarrhea. No serious secondary side-effects have been detected. Conclusion: This operation
appears to result in very satisfactory weight loss, improved quality of life, and a low incidence of complications. 相似文献
22.
23.
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
24.
Background: The authors studied the results of silicone ring vertical gastroplasty (SRVG) in patients aged 50 years and older.
Methods: The early and late postoperative results in 28 patients aged 50 years or older undergoing SRVG were reviewed retrospectively.
The results were compared to those of 370 patients younger than 50 years operated during the same period. Results: There was
no postoperative mortality among patients aged 50 years and older. There was a significantly higher incidence of pulmonary
embolus and wound infection among patients aged 50 years and older (p < 0.05). The weight loss did not differ significantly between the two studied age groups. Conclusion: SRVG may be performed
on patients aged 50 years or older with acceptable complication rate and favourable postoperative results. 相似文献
25.
Mason EE 《Obesity surgery》1996,6(3):218-223
BACKGROUND: Have surgeons in North America accepted operations for the treatment of severe obesity? This question was posed by organizers of the Ninth International Symposium on Obesity Surgery that met in Stockholm in September, 1995. Study design: In order to obtain opinions which might help to answer the question posed, a 1-page questionnaire was sent to 151 chairmen of academic departments of surgery in North America in December 1994 asking about the acceptance and use of surgical operations for the treatment of severe obesity. RESULTS: Answers, received from 112 or 74%, indicated that operative treatment should be used (74%), was effective (77%) and safe (71 %). However, only 65% of departments provided such operations. Operative treatment for obesity was available outside the department in 53%. The operations most frequently used were Roux-en-Y gastric bypass (RGB) and vertical banded gastroplasty (VBG). A single operation was offered by 44 departments and a choice of two or more operations in 30 departments. RGB and VBG were equally in use. Gastric banding was used as an alternative to VBG in six departments. Other operations were in use in six departments either alone (three) or as alternatives to RGB and VBG (three). CONCLUSIONS: It appears that surgical treatment of obesity is accepted and available in the majority of academic departments of surgery. 相似文献
26.
The success of vertical gastroplasty may be jeopardized by gastric leakage or ulceration due to failure of the technique.
Reports of band erosion and staple-line leakage have led us to seek technical improvements to reduce technical failures. We
describe a modification to the technique of band placement and a manoeuvre to aid the placement of staples when the TA90 staple
gun is used. 相似文献
27.
Downie JR 《Obesity surgery》1992,2(1):75-78
This paper is based on observations on a personal series of patients who presented with severe ulcerating esophagitis, unresponsive
to medical treatment following a vertical stapled gastroplasty. With one exception this was a late complication in an effective
weight loss procedure. The therapeutic modalities chosen to treat this problem depended on patient choice, as well as personal
experience with treating earlier cases. Unfortunately, I could find little guidance in the literature or from my colleagues
on how to treat this problem. Conversion to a Roux-Y gastric bypass seemed the most satisfactory solution to the problem,
relieving the symptoms and maintaining the weight loss. 相似文献
28.
Erosion of Marlex Mesh Collar after Vertical Banded Gastroplasty 总被引:1,自引:0,他引:1
Marlex mesh, as opposed to silastic ring, when used as a collar in the bariatric procedure of vertical banded gastroplasty,
has been reported rarely to erode into the gastric lumen. We report two cases of such an erosion, of which one ended as a
complete internalization of the collar into the stomach. In one of the patients we observed a wider than expected portion
of tissue that had been encircled by the collar, which might have caused a local inflammatory reaction leading to the later
erosion. 相似文献
29.
Class IV obesity (body mass index > 40) is associated with an increased risk of a variety of health problems, many of them
potentially life-threatening or life-shortening. Vertical banded gastroplasty (VBG) is currently the most frequently performed
surgical procedure used to restrict food intake and assist with weight loss. After massive weight loss, however, redundant
abdominal and breast tissue can result in physiological and psychological problems related to an unusual body habitus. Patients
complain of difficulties with daily activities, choice of clothing, social acceptance, etc. Body contouring has proven to
be an important part of the rehabilitation of the morbidly obese patient, and we have therefore reviewed the records of 55
patients who experienced massive weight loss following VBG and then underwent abdominoplasty with or without mammoplasty/mastopexy,
in order to assess the parameters which will be seen more frequently in the future by plastic surgeons as bariatric surgery
becomes more widely accepted and performed. 相似文献
30.
In our Institute we have performed 124 vertical banded gastroplasties. Patients with a follow-up beyond 3 months were studied
with a barium meal, in order to evaluate the efficiency of surgery and the eventual complications. Seventy-nine patients have
had one or more X-ray investigations at various times after surgery (for a total of 136 studies). The first 20 patients were
routinely studied at 1, 2 and 3 years after the operation; the next 32 patients were studied for features such as vomiting,
poor weight loss or low food intake; the last 27 patients were studied with an early overlook beginning 3 months after surgery.
We noted gastroesophageal reflux in eight (10.1%) cases, outlet dilatation in four (5%) cases, outlet substenosis (diameter
6-8 mm) in 13 (16.4%) cases, outlet stenosis (diameter ≤5 mm) in four (5%) cases, peanut-type deformation in three (3.7%)
cases, and staple-line disruption in 17 (21.5%) cases. The staple-line disruption was correlated in the first part of the
series with a reinforcement of such a suture, while the last 27 patients, with vertical stapling carried out with a 4-row
stapler without reinforcement, did not present any disruption. The radiographic examination gives information about weight
loss and side effects. 相似文献