排序方式: 共有1105条查询结果,搜索用时 15 毫秒
81.
Background: Laparoscopic adjustable gastric banding (LAGB) has usually been performed as an inpatient procedure with an average
hospital stay of 2-4 days. The aim of this study was to assess the feasibility of LAGB as an ambulatory procedure in selected
patients. Methods: Potential candidates for ambulatory LAGB were recruited from patients consulting for obesity surgery. The
main inclusion criteria were BMI >35 kg/m2 with co-morbid conditions, living within a reasonable distance from the hospital, and adult company at home. The patients
were admitted at 0700 hours on the day of surgery, underwent laparoscopic placement of a Lap-Band? system and were discharged home that evening. Results: 9 women and 1 man underwent outpatient LAGB. Mean age was 36 (range
18-52) years and mean BMI was 38.4 kg/m2 (range 35.1-43.3). Co-morbidities included functional dyspnea (6), osteoarthritis (4), arterial hypertension (4), type 2
diabetes (2) and dyslipidemia (1). 7 patients had undergone previous abdominal surgery: cesarian section (4), appendectomy
(3), cholecystectomy (1) and hysterectomy (1). All patients had an American Society of Anesthesiologists (ASA) classification
of II. The average operating time was 87 minutes (range 65-115). The mean time lapse between the end of the operation and
discharge from hospital was 9.6 hours. There were no readmissions, and no complications were noticed at 1 month postoperatively.
The patients' satisfaction with the ambulatory LAGB procedure was high. Conclusion: The present study demonstrates that LAGB
for obesity may be performed on an ambulatory basis without complications. 相似文献
82.
Shikora SA 《Obesity surgery》2004,14(4):545-548
The prevalence of obesity is growing worldwide at an alarming rate. Current medical therapies are often ineffective and surgical treatments result in weight loss but have significant risk. Implantable Gastric Stimulation (IGS) offers a novel approach to weight loss. Simply stated, the IGS system electrically stimulates the stomach with a pacemaker-like device. The device is implanted in a brief minimally invasive procedure. Investigation in over 500 patients globally has proven it to be safe and seemly free of long-term sequelae. With refinements in patient selection and device application, the weight loss results have been steadily improving. The IGS may someday become a reliable and safe surgical option for weight loss. 相似文献
83.
Background: Laparoscopic adjustable gastric banding is the least invasive bariatric operation. However, just isolated attempts
to perform this procedure as a Day Case have been published. This study highlights some aspects that might contribute to safe
patient discharge within 23 hours after LAGB. Methods: Prospective evaluation of 20 consecutive patients was carried out.
Patients were indicated for laparoscopic Swedish adjustable gastric banding (SAGB, Obtech, Ethicon Endo-Surgery) in a private
Bariatric center in the first 6 months of 2003. The effect of extensive pre- and immediate postoperative education and psychological
support, and information on postoperative health consequences delivered through a multi-disciplinary bariatric team effort,
was evaluated, regarding the influence of these facilitators in shortening the length of hospital stay. Results: Mean preoperative
BMI of the 20 patients entering the study was 42.3. Mean operating-time was 91 minutes (58-112 min). Time spent on information
and education of each patient was 60 minutes in total during the preoperative period. Average postoperative hospitalization
was 21 hours. There were no intraoperative or early postoperative complications. Excess weight loss was 44% at 12 months after
surgery. Conclusion: SAGB performed on a Day Case basis in selected patients who are subjected to intensive pre- and immediate
postoperative dedicated education appears to be a feasible alternative. 相似文献
84.
Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is an effective operation for morbidly obese patients who have
failed conservative weight loss treatments. It is currently indicated for patients with BMI >40 kg/m2 or >35 with significant co-morbidities. Controversy exists whether there is an upper limit to BMI beyond which this operation
should not be performed. Methods: Between April 1999 and February 2001, 82 patients (19 male, 63 female) underwent LRYGBP.
Average age was 43.6, and average BMI was 56 kg/m2. These patients were divided into those with BMI <60 and those with BMI ≥60 kg/m2. Results:There were 61 patients with BMI <60 and 21 patients with BMI ≥60. The groups were similar in age, gender, distribution
or incidence of co-morbid conditions (diabetes, coronary artery disease, hypertension, sleep apnea, asthma) between the groups.
The BMI ≥60 group had a significantly longer length of stay (6.6 days vs 5.3 days, P <0.05), and only 1 patient (BMI 85) developed an anastomotic leak and died. 2 patients in this group (BMI 62 and 73) developed
small bowel obstruction requiring lysis of adhesions. 1 patient in the BMI <60 group developed a gastrojejunal stricture requiring
balloon dilatation. Conclusion: While patients with a BMI ≥60 are at higher risk for postoperative complications, they are
also at higher risk from continued extreme obesity. In our series, 85% of these patients had an uneventful postoperative course
and began shedding excess weight. BMI ≥60 should not be a contraindication for LRYGBP. 相似文献
85.
Elevated Serum Parathormone after Roux-en-Y Gastric Bypass 总被引:3,自引:3,他引:0
Diniz Mde F Diniz MT Sanches SR Salgado PP Valadão MM Araújo FC Martins DS Rocha AL 《Obesity surgery》2004,14(9):1222-1226
Background: Abnormalities in calcium and vitamin D metabolism are observed early after gastric bypass, whereas clinical or
biochemical evidence of metabolic bone disease might not be detected until many years after the procedure. The aim of the
present study was to evaluate the impact of bariatric surgery on bone metabolism determined on the basis of postoperative
laboratory changes in calcium, phosphorus, magnesium, alkaline phosphatase and parathormone (PTH) levels. Methods: 110 patients
submitted to Roux-en-Y gastric bypass (RYGBP) were followed after surgery, and the following parameters were determined: intact
PTH molecule (PTHi; chemiluminescence), alkaline phosphatase (colorimetric method), ionic calcium (selective electrode), phosphorus
and magnesium (colorimetric method). Results: Elevated serum PTHi levels were observed in 29% of the patients and hypocalcemia
in 0.9% from the 3rd postoperative month and afterwards (3 to 80 months after surgery). Conclusion: There is a need for careful
evaluation of bone metabolism and for routine calcium replacement after RYGBP. 相似文献
86.
Background: Bariatric surgery may be associated with surgical complications. The aim of the study was to identify significant
risk factors for postoperative complications in patients undergoing Roux-en-Y gastric bypass (RYGBP). Methods: The study consisted
of 75 consecutive patients undergoing RYGBP. Full medical examination was performed, and the following parameters were assessed
in the fasting state: plasma glucose, insulin, leptin, serum lipids, liver function tests, and lipoprotein Lp(a). All subjects
had oral 75 g glucose tolerance test before the surgery. All complications occurring within 6 months after the RYGBP were
recorded. The patients were divided into Group 1 - patients in whom complications occurred, and Group 2 - patients with no
complications in the 6-month period. Results: Postoperative complications occurred in 16 patients (wound infection, hernia,
splenic injury, gastro-jejunal obstruction, duodenal ulcer, lower limb deep vein thrombosis). 3 significant risk factors for
postoperative complications within 6 months after gastric bypass were found: 1) fasting plasma glucose ≥ 6.0 mmol/l (OR 11.0;
95% confidence interval (CI) 2.1-77.3), 2) age ≥40 years (OR 5.89, 95% CI 1.35-29.4), and 3) BMI ≥45 kg/m2 (OR 4.1, 95% CI 1.04-17.2). Conclusion: RYGBP is associated with increased risk of developing early postoperative complications
in subjects with even slightly elevated fasting plasma glucose, age ≥40 and BMI ≥45 kg/m2. 相似文献
87.
Background: Postoperative follow-up after bariatric surgery is important. Because of the need for adjustments, follow-up after
gastric banding may have a greater impact on weight loss than after Roux-en-Y gastric bypass.We reviewed all patients at 1
year after these two operations. Methods: During the first year after surgery, laparoscopic adjustable gastric banding (LAGB)
patients were followed every 4 weeks and Roux-en-Y gastric bypass (RYGBP) patients were followed at 3 weeks postoperatively
and then every 3 months.The number of follow-up visits for each patient was calculated, and 50% compliance for follow-up and
weight loss was compared. Results: Between October 2000 and September 2002, 216 LAGB and 139 RYGBP operations were performed.
Of these patients, 186 LAGB patients and 115 RYGBP patients were available for 1-year follow-up. Age and BMI were similar
for each group. Overall excess weight loss (EWL) after LAGB was 44.5%. 130 (70%) returned 6 or less times in the first year
and achieved 42% EWL. 56 patients (30%) returned more than 6 times and had 50% EWL (P=0.005). Overall %EWL after RYGBP was
66.1%. 53 patients (46%) returned 3 or less times in the first year, achieving 66.1% EWL. 62 patients (54%) returned more
than 3 times after surgery and achieved 67.6% EWL (P=NS). Conclusion: Patient follow-up plays a significant role in the amount
of weight lost after LAGB, but not after RYGBP. Patient motivation and surgeon commitment for long-term follow-up is critical
for successful weight loss after LAGB surgery. 相似文献
88.
Villegas L Schneider B Provost D Chang C Scott D Sims T Hill L Hynan L Jones D 《Obesity surgery》2004,14(2):206-211
Background: Routine cholecystectomy is often performed at the time of gastric bypass for morbid obesity. The aim of our study
was to determine the incidence of gallstone formation requiring cholecystectomy following a laparoscopic Roux-en-Y gastric
bypass (LRYGBP). Methods: 289 LRYGBP were performed between November 1999 and May 2002. 60 patients (21%) who had prior cholecystectomy
were excluded. If gallstones were identified by intra-operative ultrasound (IOUS), simultaneous cholecystectomy was performed.
Patients without gallstones were prescribed ursodiol for 6 months and scheduled for follow-up with transabdominal ultrasound.
Results: During LRYGBP, gallstones were detected in 40 patients using IOUS (14%) and simultaneous cholecystectomy was performed.
Of 189 patients with no stones identified by IOUS, 151 patients (80%) had a postoperative ultrasound after 6 months. 39 patients
developed gallstones (22%) and 12 developed sludge (8%), as demonstrated by ultrasound at the time of follow-up. 11 patients
had gallstone-related symptoms and subsequently underwent cholecystectomy (7%). 106 patients (70%) were gallstone-free at
the time of ultrasound follow-up. Ursodiol compliance was found to be significantly lower for patients developing stones than
for gallstone-free patients (38.9% vs 58.3%, z =-2.00, P = 0.045). Conclusions: There is a low incidence of symptomatic gallstones requiring cholecystectomy after LRYGBP. Prophylactic
ursodiol is protective. Routine IOUS and selective cholecystectomy with close patient follow-up is a rational approach in
the era of laparoscopy. 相似文献
89.
Background: The technique of laparoscopic adjustable gastric banding (LAGB), although relatively well standardized, has some
"weak points". Methods: We analysed the experience of 2 German university clinics in order to suggest technical alternatives
that can be helpful in difficult situations. Results: Between April 1997 and May 2002 115 patients in Cologne (87 females,
28 males) with median BMI 49.5 kg/m2 and mean age 39 years (19-54), and 112 patients in Mainz (91 females, 21 males) with median BMI 48 kg/m2 and mean age 35 years (18-57) underwent LAGB, using the Lap-Band?. LAGB was performed through 5 ports (3 10-mm, 1 18-mm, and 1 5-mm in Cologne and 4 10-mm and 1 18-mm port in Mainz). The
pars flaccida technique by means of a fanshaped Endo-Retractor was used in both clinics. Mean duration of follow-up was 3.2
years (SD 1.0) in the Cologne group with complete investigation in all except 4 patients. In the Mainz group, mean duration
of follow-up was 2.7 years (SD 1.0) with complete investigation in all except 9 patients. Conclusions: Some technical aspects
such as induction of pneumoperitoneum, band position, band fixation, band malposition and port-related complications are discussed. 相似文献
90.
Superior Mesenteric Artery Syndrome after Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity 总被引:1,自引:0,他引:1
Goitein D Gagné DJ Papasavas PK Dallal R Quebbemann B Eichinger JK Johnston D Caushaj PF 《Obesity surgery》2004,14(7):1008-1011
Gastrointestinal obstructive complications after laparoscopic Roux-en-Y gastric bypass (LRYGBP) are not uncommon. Their usual
causes are strictures, internal hernias and adhesions. Superior mesenteric artery (SMA) syndrome is a rare disorder caused
by compression of the third portion of the duodenum by the SMA that can occur after rapid weight loss. This has been reported
in patients with scoliosis, burns, immobilization in body casts, and idiopathic weight loss. SMA syndrome following bariatric
surgery has not been reported. We present 3 cases of SMA syndrome after LRYGBP and extensive weight loss. Two patients underwent
laparoscopic duodenojejunostomy and the third patient was treated with intravenous hyperalimentation. All three are symptom
free at 4-18 months follow-up. The diagnosis of SMA syndrome should be considered in bariatric surgery patients with rapid
weight loss who develop atypical, recurrent obstructive symptoms not attributable to other common causes. 相似文献