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81.
Changes in Esophageal Function after Vertical Banded Gastroplasty as Demonstrated by Esophageal Scintigraphy 总被引:1,自引:0,他引:1
Keith Seymour MB FRCS Alison Mackie PhD Elizabeth McCauley MSc John G Stephen MB MChir FRCS 《Obesity surgery》1998,8(4):429-433
Background: The effects of surgery for morbid obesity on the function of the upper gastrointestinal (GI) tract are of interest
to bariatric surgeons. This study was undertaken to determine any changes in esophageal function, following vertical banded
gastroplasty (VBG) in morbidly obese patients, as detected by esophageal scintigraphy. Methods: Ten consecutive morbidly obese
patients (six female and four male) underwent preoperative esophageal scintigraphy and upper GI endoscopy. These investigations
were repeated 12 months after VBG to coincide with expected appreciable weight reduction. The results were tabulated together
with body mass indices, crude weights and percentage excess weight lost. Results: Before VBG one patient gave a history of
mild heartburn, one had mild dyspepsia and the remaining eight patients had no GI symptoms. No patient had a hiatus hernia
or endoscopic evidence of reflux esophagitis. Preoperatively all patients had abnormal scintiscans. The abnormalities were
esophageal retention (all) and intraesophageal reflux (five out of 10 patients). Gastroesophageal reflux was not identified
in any patient. Postoperatively scintiscans were normal or improved in six out of 10 patients and unchanged in four out of
10 patients. In three patients the scans were normal and three showed overall improvement in esophageal function, although
in one of these latter patients gastroesophageal reflux was observed. Conclusions: In this series of morbidly obese patients,
esophageal function as assessed by scintigraphy was abnormal. Following VBG it improved in six out of 10 patients and was
unchanged in four out of 10. However, in one patient, who had shown an overall improvement in esophageal function, gastroesophageal
reflux was demonstrated when it had not been seen preoperatively. This was asymptomatic. Thus, adverse changes in esophageal
function after VBG were uncommon. 相似文献
82.
HANNU SOMER LEA BERGSTR
M PERTTI MUSTAJOKI LIISA ROVAMO 《Journal of internal medicine》1985,217(5):575-576
ABSTRACT. SomerH, BergstrÖm L, Mustajoki P, Rovamo L. (Department of Neurology, Third Department of Internal Medicine and Children's Hospital, University of Helsinki, Helsinki, Finland.) Morbid obesity, gastric plication and a severe neurological deficit. A 39-year-old man had protracted vomiting after gastric plication for morbid obesity. Within three months he lost 53 kg in weight and developed neuromuscular weakness, especially in the lower extremities. Clinical and laboratory studies suggested both radicular and peripheral neuropathy. One year later the condition was only marginally improved: he took only few steps unsupported. The apparent etiology is malnutrition but the primary cause remained unknown. 相似文献
83.
Vijay Langer Amitabh Singh Al S. Aly Albert E. Cram 《Indian Journal of Plastic Surgery》2011,44(1):14-20
Obesity is a global disease with epidemic proportions. Bariatric surgery or modified lifestyles go a long way in mitigating the vast weight gain. Patients following these interventions usually undergo massive weight loss. This results in redundant tissues in various parts of the body. Loose skin causes increased morbidity and psychological trauma. This demands various body contouring procedures that are usually excisional. These procedures are complex and part of a painstaking process that needs a committed patient and an industrious plastic surgeon. As complications in these patients can be quite frequent, both the patient and the surgeon need to be aware and willing to deal with them. 相似文献
84.
Pontiroli AE Fossati A Vedani P Fiorilli M Folli F Paganelli M Marchi M Maffei C 《Obesity surgery》2007,17(11):1492-1497
BACKGROUND: With bariatric restrictive procedures a major issue is predictors of clinical outcome; non-surgical (compliance) and psychological factors might play a role in long term-results of bariatric surgery. We evaluated a set of predictors of short-term and long-term clinical outcome including psychiatric and psychological variables, as well as measures of post-surgery compliance. METHODS: 172 consecutive patients undergoing laparoscopic adjustable gastric banding (LAGB) with a minimum of 12 months follow-up, were studied; before surgery they were administered the NIMH Diagnostic Interview Schedule (Version III-R, DIS III-R) and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (Version 2.0, SCID-II). After surgery, patients were scheduled for visits at 2-week intervals for the first 2 months, at monthly intervals up to 1 year and 3-monthly intervals for 2 years; compliance with diet, rules, physical exercise, plus integrated compliance (sum of scores), and percentage of attendance at scheduled visits were recorded. Patients were contacted again at 36 and at 48 months. RESULTS: BMI, compliance, percentage of attendance at scheduled visits (positively), and narcissistic personality (negatively) were all associated with weight loss at 12, 24 (and 36 months). Percentage of attendance was also associated at 48 months. At stepwise regression analysis, BMI and integrated compliance predicted weight loss at 12, 24, and 36 months, while percentage of attendance at scheduled visits predicted weight loss at 48 months. Narcissistic personality predicted weight loss only at 12 months. CONCLUSION: Adherence to scheduled visits and compliance to recommended rules, more than personality disorders, predict success of LAGB, at least during the first 4 years. 相似文献
85.
Cardoso-Júnior A Coelho LG Savassi-Rocha PR Vignolo MC Abrantes MM de Almeida AM Dias EE Vieira Júnior G de Castro MM Lemos YV 《Obesity surgery》2007,17(2):236-241
Background It has been suggested that obesity is associated with an altered rate of gastric emptying. The objective of the present study
was to determine whether the rates of solid and semi-solid gastric emptying differ between morbidly obese patients and lean
subjects.
Methods The Gastric-emptying time (GET) of solid and semi-solid meals were compared between lean healthy subjects and morbidly obese
patients enrolled in two previously published studies. GET of solid and semi-solid meals was measured using the 13C-octanoic acid breath test and 13C-acetic acid breath test, respectively, in 24 lean and 14 morbidly obese individuals of both sexes. Student t-test was used to compare the mean data between the lean and morbidly obese groups. The influence of sex, gender, BMI and
morbid obesity on the GET of solid meals was verified by linear regression analysis.
Results Mean t(1/2) values of solid GET (± standard deviation) were 203.6 ± 76.0 min and 143.5 ± 19.1 min for lean and obese subjects,
respectively (P = 0.0010). Mean t(lag) values of solid GET were 127.3 ± 42.7 min and 98.4 ± 13.0 min for lean and obese subjects, respectively
(P = 0.0044). No significant difference in semi-solid GET was observed between the lean and morbidly obese groups.
Conclusion The present study demonstrated a significantly enhanced gastric emptying of the solid meal test in morbidly obese patients
when compared to lean subjects. This finding is compatible with the hypothesis that rapid gastric emptying in morbidly obese
subjects increases caloric intake due to a more rapid loss of satiety. 相似文献
86.
Bonatti H Brandacher G Hoeller E Stelzmueller I Mark W Margreiter R Weiss H 《Obesity surgery》2007,17(1):100-103
Combined kidney-pancreas transplantation is the treatment of choice for end-stage diabetic nephropathy. Weight gain post-transplant
increases the risk for post-transplant complications and death due to cardiovascular events. Gastric pacemakers have been
used for therapy of diabetic gastropathy and for the treatment of moderate morbid obesity. We report a patient who experienced
significant weight gain following successful kidney-pancreas transplantation and was thereafter successfully treated for diabetic
gastroparesis and morbid obesity by use of a laparoscopically implanted gastric pacemaker. 相似文献
87.
Botella-Carretero JI Alvarez-Blasco F Martinez-García MA Luque-Ramírez M San Millán JL Escobar-Morreale HF 《Obesity surgery》2007,17(9):1199-1208
Background We have evaluated the impact of the reproductive status of morbidly obese women, and of the time elapsed since surgery, on
the response of the proinflammatory serum cardiovascular risk marker interleukin-18 (IL-18) to the sustained and marked weight
loss achieved after bariatric surgery.
Methods Serum IL-18 levels were measured in 33 morbidly obese women before bariatric surgery and after losing at least 15% of the
initial weight, irrespective of the time needed to achieve this goal (5 to 33 months).
Results Patients lost 30.7 ± 7.8% of the initial weight, with a concomitant reduction of serum IL-18 concentrations (P < 0.001). A stepwise multiple regression analysis showed that the percentual decrease in serum IL-18 levels was determined
by the interaction between the time elapsed since surgery and the percentual reduction of waist circumference (R2 = 0.333, F = 15.500, β = 0.577, P < 0.001), but not by the individual effects of the time elapsed since surgery, percentual body weight loss, percentual reduction
of waist circumference, menopausal status or type of surgical procedure, or by the interaction between the time elapsed since
surgery with the percentual body weight loss or with menopausal status.
Conclusion Serum IL-18 levels decrease after bariatric surgery in a time-dependent manner, in relation to the reduction in waist circumference.
The fact that the amelioration of the obesity-associated inflammatory process requires time and not only weight loss, might
contribute to explain early non-surgical cardiovascular complications of bariatric surgery. 相似文献
88.
When behavioral or anatomic issues are not present, revisional surgery should be approached with a goal of treating malnutrition
or enhancing excess weight loss. Unfortunately, no randomized controlled trials currently exist to help the practicing bariatric
surgeon choose which revisional procedure to perform. A review of the available literature was undertaken and compared with
our standard practices to see if any guidelines could be devised. At our institution, patients who have failed jejunal-ileal
bypass are reversed in the setting of malnutrition and converted to a sleeve gastrectomy (SG) followed by duodenal switch
(DS) as a second stage procedure in the setting of inadequate weight loss. After failed vertical banded gastroplasty (VBG),
patients are converted to a Roux-en-Y gastric bypass (RYGBP). After failed adjustable gastric band (AGB) placement, we perform
RYGBP. In the super-obese, we leave the band in place or convert to a DS with band removal. In patients with failed RYGBP,
we convert our patients to DS, but placement of an AGB may be an acceptable option. 相似文献
89.
López Deogracias M Domínguez-Diez A Palomar-Fontanet R González-Noriega M Rodrigo E Fernández-Fresnedo G Zubimendi JA Olmedo F Gómez-Fleitas M Arias M Fernández-Escalante C 《Obesity surgery》2007,17(4):553-555
Surgery is usually the only solution to modify the evolution of morbid obesity and resolve the associated co-morbidities.
There is very little written regarding malabsorptive surgery and transplantation. A 48-yearold male with hypertension, hyperuricemia
and obesity underwent renal transplantation in 1994 for renal amyloidosis. He was maintained on oral immunosuppressive cyclosporine.
The patient developed uncontrollable hypertension, hyperlipemia, hyperglycemia and increasing weight to a BMI of 44. Thus,
in December 2004, he underwent biliopancreatic diversion (BPD). After 18 months follow-up, he has lost 85% of his excess weight,
and his hypertension, hyperglycemia and hyperlipemia are markedly improved. Renal function was not modified, nor were the
levels of cyclosporine. He has had no complications derived from the BPD, and has a better quality of life. 相似文献
90.
Guerdjikova AI West-Smith L McElroy SL Sonnanstine T Stanford K Keck PE 《Obesity surgery》2007,17(8):1091-1096
Background The purpose of this study was to characterize emotional eating and its alternatives in obese patients undergoing bariatric
surgery.
Methods The medical charts of 178 consecutive patients who had laparoscopic Roux-en-Y gastric bypass provided by a multidisciplinary
bariatric program were reviewed. Data from patients who had emotional eating, reported strategies to overcome their urges
to emotionally eat, and had their 6 months follow-up after surgery (N = 50) were further analyzed in terms of weight history,
medical co-morbidity prior to surgery, weight loss after surgery, and lifetime psychiatric status.
Results 38.7% of the 178 bariatric surgery patients reported emotional eating. Patients reported using three main types of behaviors
(oral, sedentary and physical activity) to overcome urges to eat emotionally. Most patients (42%) experiencing emotional eating
chose sedentary behaviors to overcome urges to eat in response to emotion. The three groups did not differ in any of the examined
variables.
Conclusions While patients using different coping mechanisms to overcome urges to eat emotionally did not differ before and 6 months after
surgery, further research is needed to examine the frequency and long-term effects of emotional eating in bariatric surgery
patients.
This research project was performed as part of Dr. Guerdjikova’s MSW internship with Tristate Surgical Weight Loss Center. 相似文献