The Gastric Bypass for Failed Bariatric Surgical Procedures

Background: Revision of failed bariatric surgical procedures is a significant challenge for every bariatric surgeon. Methods: Evaluated are surgical difficulties, management problems and weight loss in patients with distal gastric bypass as a revisionary procedure. Eighty patients were followed up to 3 years; four were lost to follow-up. Mean age was 43; mean prebariatric surgery weight 134 kg; height 1.65 meters; body mass index 40.1; ideal body weight 62.7 kg; excess weight 70.5 kg; per cent excess weight 214%. A 250 cm stomach-to-ileocecal valve segment of small bowel was used, and the biopancreatic secretions were brought into the terminal ileum 100 cm from the ileocecal valve. Mean pouch size was 63 cc; length of hospital stay 5 days; operative blood loss 616 cc; operative time 130 min. Results: Intraoperative complications included three splenic injuries (without splenectomy). Early complications included one deep vein thrombosis, two marginal ulcers, one GI hemorrhage, one wound dehiscence, one pouch outlet obstruction and one pancreatitis. Late complications included: one death from protein malnutrition/ARDS; 21 hypoproteinemia; six protein malnutrition, and of these, three had hyperalimentation; three cholecystitis; 27 anemia; 22 incisional hernia; two staple-line disruption (reoperated); 26 low serum iron; 11 prolonged (> 6 months) diarrhea; three prolonged frequent vomiting; and two unrelated deaths (chronic myelogenous leukemia and amyotrophic lateral sclerosis). Mean excess weight loss was 83% at 12 months; 89% at 24 months; and 94% at 36 months. Conclusion: The distal gastric bypass is fraught with the operative and immediate post-operative complications experienced in any revisionary bariatric surgery. Distal gastric bypass is very effective in producing long-term weight loss. Nutritional problems are common but usually easily corrected. The most serious nutritional complication is protein malnutrition, which must be identified and corrected early. Success of this procedure is dependent upon patient compliance with proper nutrition and supplements, and regular office follow-up with monitoring of laboratory data. Patients who are noncompliant are at significant risk for complications.     

Revisional Surgery for Severe Obesity with Fascia Banded Stoma Roux-en-Y Gastric Bypass

The fascia banded stoma Roux-en-Y gastric bypass (RYGBP) has been effective both as a primary and revision operation for severe obesity or failure of another operation. Since May 1984, 361 primary and 100 revisional fascia banded RYGBP operations have been reported. Weight loss achieved a mean body mass index of 30 for primary and 31 for revision patients at most recent follow-up of 3-6 years (mean 4.3 years) postoperatively. Mean overweight was 28% for primary, and 34% for revision patients. Eighty percent of primary and 79% of revision patients were within 50% of ideal weight. Revision rates for these patients were 0 for primary and 1% for revision patients. Operative mortality was 0 for primary and 1% for revision patients. Since morbidity and mortality, although low, are higher for revision than primary surgery, it is important to use an effective primary operation.     

The Effect of Gastric Bypass on Cholesterol,HDL, and the Risk of Coronary Heart Disease

A review of 150 charts revealed that 36 patients had pre-operative serum cholesterol greater than 200 mg% prior to Roux-Y gastric bypass. The average pre-operative weight was 266 lb (121 kg) and at 1 year post-operative 166 lb (75 kg), or 100 lb (45 kg) lost (77% excess weight loss). We compared the following pre- and post- operative data and found that: (1) cholesterol was decreased by 24% and triglycerides decreased by 40%; (2) post-operative cholesterol/HDL-C ratio of 3.31 put our patients in the half of average risk category for a clinical pathological coronary event according to the SmithKline Beecham Laboratories risk ratio chart. We conclude that Roux-Y gastric bypass and its ability to produce a significant weight loss and markedly affect cholesterol and triglyceride metabolism will also reduce a patient's risk of myocardial infarction.     

Modification of Gastric Banding,Using a Fundal Suture

Many forms of gastric banding have been described and high reoperation rates reported. These can be mainly attributed to excess vomiting associated both with and without stenosis. Reflux oesophagitis and the ‘sump’ effect may be other causes. This paper examines the problems associated with banding leading to revisional surgery and introduces a new technique, ‘fundal supporting suture’, to correct these problems. Preliminary results on 126 bandings without the modification and 22 with the modification are presented.     

Obesity Surgery Poly-parametric Patient Auto-evaluation

A simple auto-evaluation sheet is presented for the proper assessment of the patient's condition after surgery. Stress is put not only on weight loss, but on other important factors as well.     

Gastrostomy and oesophagoplasty with a flap from the greater curvature of the stomach as stages of surgical and combined treatment of cancer of the thoracic oesophagus

Four-hundred fifty-eight patients with cancer of the oesophagus were subjected to revisional laparotomy. Metastases into subphrenic lymph nodes were registered in 24% of the cases with a tumor in the bronchial segment; 42% with tumor in the subbronchial segment; 48% with tumor in the retropericardial segment; 71% with tumors in the sub-, intra-, and supraphrenic segments of the oesophagus. In 345 cases, laparotomy was followed by tube gastrostomy (Beck—Carrel method) with two operative deaths. Fifty-six patients in good condition with a small tumor in the middle part of the oesophagus (≤5 cm) without any abdominal metastases were subjected to primary oesophagoplasty: a 30–32-cm tube was formed out of the greater curvature of the stomach and placed retrosternally; gastrostomy was performed on the level of the thyroid cartilage (without any operative deaths). In two weeks, extirpation of the thoracic part of the oesophagus (with preoperative irradiation) was performed on patients with no abdominal metastases. Then the patients with primary oesophagoplasty were subjected to oesophago-gastrostomy of the neck. From six to 12 months following the combined treatment, the gastrostomy tube of 45 patients was lengthened to 30–32 cm and used for retrosternal oesophagoplasty (six operative deaths). Oesophagoplasty was performed on 14 patients during the extirpation of the oesophagus (six operative deaths).     

神经管发育不良患儿及其核心家庭MTHFR基因A1298C多态性分布的研究

目的　通过对神经管发育不良 (NDTs)患儿及核心家庭MTHFR基因A1 2 98位点多态性分布的研究 ,探讨该基因多态性与NDTs之间的关系。方法　 2 0 0 0年 9月～ 2 0 0 2年 3月 ,40例 3～ 1 5岁NDTs患儿 (男 2 8例 ,女 1 2例 )及其中 2 6个核心家庭进行研究。应用聚合酶链反应 限制性片段长度多态性分析 (PCR RFLP)技术 ,分析MTHFR基因第 1 2 98位核苷酸基因型 (野生型、杂合型、突变纯合型 )的分布情况 ;并对 2 6个核心家庭进行以父母为对照的病例对照研究 ,计算传递失衡指数 (TDT)及基于单体型的单体型相对危险度 (HHRR)。结果　NDTs患儿、核心家庭与正常对照中均未发现纯合突变。基因型构成比采用 χ2 检验 ,NDTs患儿及患儿母亲野生型分别占 1 7.50 % ,1 1 .54 % ,杂合型分别占 82 .50 % ,88.46 % ,与正常对照之间差异无显著性意义 (分别为P >0 .2 5 ;P>0 .90 )。患儿父亲野生型占 30 .77% ,杂合突变型占 69.2 3 % ,低于正常对照 (P <0 .0 5)。等位基因频率比较采用u检验 ,患儿为 41 .2 5 % ,与对照间差异无显著性意义 (P >0 .0 5) ;患儿父母分别为69 .2 3 % ,88.46 % ,均高于正常对照 (P <0 .0 1 )。核心家庭分析结果 :TDT(χ2 ) =0 .36 ,P >0 .0 5 ;HHRR(χ2 ) =0 .369,P >0 .0 5。结论　MTHFR基因第 1 2     

参附注射液在胃癌术前介入化疗中的作用

研究参附注射液在胃癌术前介入化疗中的作用，将87例进展期胃癌患者分成两组。分别检测T细胞亚群、白细胞总数及淋巴细胞数量等。结果：参附组对CD3、CD4，CD4／CD8的提高作用显著高于化疗组，且能保持白细胞及淋巴细胞的数量。提示参附注射液可增强胃癌术前介入化疗的患者的细胞免疫功能。     

Nuclear Pedigree Criteria for the Identification of Individuals Suspected to Be at Risk of an Inherited Predisposition to Gastric Cancer

Gastric cancer is the second most frequently diagnosed malignancy worldwide and therefore represents a significant healthcare burden. Environmental and genetic factors are involved in the development of gastric cancer. To date only one clear genetic predisposition has been identified involving mutations in the E-cadherin gene. The disease phenotype in patients harbouring E-cadherin mutations appears to be specifically related to diffuse gastric cancer. Little is known genetically about the other forms of gastric cancer. Since there is a growing awareness about the necessity of early intervention criteria have been developed that aid the identification of hereditary forms of gastric cancer. The aim of the current study was to identify minimal inclusion criteria so that nuclear pedigree families can be provided with risk assessment and/or genetic testing.The results reveal that inclusion features described herein such as (a) gastric cancer diagnosed before 46 years of age; (b) two gastric cancers among first degree relatives diagnosed over the age of 50 are useful in identifying suspected hereditary gastric cancer patients.     

PCR检测慢性胃炎患儿胃液中幽门螺杆菌DNA

目的检测慢性胃炎儿童胃液中幽门螺杆菌DNA，探讨其在临床诊断中的实用价值。方法应用PCR检测胃液中幽门螺旋菌DNA，应用Warthin-Starry银染色检测胃粘膜组织中的幽门螺旋菌。结果胃炎组与非胃炎组比较，敏感性为75.0％，特异性为96．2％，两组有显著性差异（P＜0．01）。PCR与Warthin－Starry银染色比较，PCR优于Warthin—Starry银染色法。结论PCR检测患儿胃液中的幽门螺旋菌DNA，具有敏感、快速、特异、高效等优点，是基因水平上检测幽门螺旋菌一项新技术，用于慢性胃炎的早期诊断，具有较好的实用价值，值得推广应用。