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1.
Background: The bariatric patient exists in dynamic relationship with family members and friends who have considerable influence
upon the patient and his or her surgical outcome. When family members and friends behave as intimate saboteurs, they attempt
to hamper, hurt, or subvert the bariatric patient's goal of achieving and maintaining a healthy body weight. Successful or
not, intimate saboteurs provide significant treatment challenges for the patient and the treatment team. Methods and Patients:
Patient profiles provide examples of intimate sabotage. The psychological construct of Family Systems Theory is used as a
plausible explanation for the sabotage of friends and family. Conclusions: Multidisciplinary professionals treating the bariatric
patient must be aware of the critical influence of intimate saboteurs and the tactics they use to sabotage. Treatment guidelines
recommended by Family Systems Theory are presented as strategies to mitigate the influence of intimate saboteurs. 相似文献
2.
3.
Outcome Following Bariatric Surgery in Super versus Morbidly Obese Patients: Does Weight Matter? 总被引:4,自引:2,他引:2
Mark Bloomston MD Emmanuel E Zervos MD Mario A Camps MD Sarah E Goode RN Alexander S Rosemurgy MD 《Obesity surgery》1997,7(5):414-419
Background: Numerous investigators have attempted to identify prognostic indicators for successful outcome following bariatric
surgery. The purpose of this study was to determine whether degree of obesity affects outcome in super obese [>225% ideal
body weight (IBW)] versus morbidly obese patients (160-225% IBW) undergoing gastric restrictive/bypass procedures. Methods:
Since 1984, 157 patients underwent either gastric bypass or vertical banded gastroplasty. Super obese (78) and morbidly obese
(79) patients were followed prospectively, documenting outcome and complications. Results: Super obese patients reached maximum
weight loss 3 years following bariatric surgery, exhibiting a decrease in body mass index (BMI) from 61 to 39 kg/m2 and an average loss of 42% excess body weight (EBW). Morbidly obese patients had a decrease in BMI from 44 to 31 kg/m2 and carried 39% EBW at 1 year. After their respective nadirs, each group began to regain the lost weight with the super obese
exhibiting a current BMI of 45 kg/m2 (61% EBW) versus 34 kg/m2 (52% EBW) in the morbidly obese at 72 months cumulative follow-up. Currently, loss of 50% or more of EBW occurred in 53%
of super obese patients versus 72% of morbidly obese (P < 0.01). Twenty-six percent of super obese patients returned to within 50% of ideal body weight (IBW) while 71% of morbidly
obese were able to reach this goal (P < 0.01). Co-morbidities and complications related to surgery were similar in each group. Conclusions: Super obese patients
have a greater absolute weight loss after bariatric surgery than do morbidly obese patients. Using commonly utilized measures
of success based on weight, morbidly obese patients tend to have better outcomes following bariatric surgery. 相似文献
4.
Milutin Bulajic Salvatore Francesco Vadal di Prampero Ivo Boškoski Guido Costamagna 《World journal of gastrointestinal surgery》2021,13(12):1584-1596
Weight regain following primary bariatric surgery occurs in a significant proportion of patients and is attributed to epidemiological, anatomical and metabolic factors. Surgical revision of these patients has significant risks and limited benefits. Endoscopic revisions that reduce gastric pouch size and diameter of the gastrojejunal anastomosis may offer an effective, safe, less invasive and even reproducible treatment. We herein discuss the indication, selection and feasibility of different endoscopic techniques that could be used in the management of weight regain following primary bariatric surgery. Future research could optimize a personalized approach not only in the endoscopic management but also in combination with other therapeutic modalities for weight regain after bariatric surgery. 相似文献
5.
Case reports are presented on three patients treated for morbid obesity by vertical gastroplasty. Prior to surgery the patients
had diabetes which required insulin, up to 200 units per day, or oral hypoglycaemics for its control. Six months after surgery
the diabetes had been resolved in all three patients, and they were no longer dependent on medication. Subjective reports
from the patients suggests that their quality of life improved significantly. 相似文献
6.
A prospective study of biochemical changes after vertical banded gastroplasty for morbid obesity, in 94 patients (10 males
and 84 females, ages ranging from 18 to 59 years) has been carried out. Liver function tests and electrolyte estimations were
performed preoperatively, during hospitalisation for surgery, at 6 weeks and at 6 months postoperatively, and demonstrated
no significant changes in liver function in these patients 6 months after surgery. The study concludes that there is no increase
in the risk of liver damage or electrolyte disturbance after vertical gastroplasty, but that there may be subtle hepatic changes
present as gall bladder disease developed in 18 patients postoperation (19%). 相似文献
7.
Aidonopoulos AP Papavramidis ST Zaraboukas TG Habib HW Pothoulakis IG 《Obesity surgery》1994,4(1):8-12
Morbidly obese patients constitute a high risk group for the development of gallbladder disease. In our series 70 consecutive
patients underwent vertical gastroplasty in an effort to manage morbid obesity. The mean age was 37 years (range 20-60), and
the mean excess body weight was 92 kg (range 52-265). Six patients (8.5%) had undergone cholecystectomy before bariatric surgery
because of symptomatic cholelithiasis. The remaining 64 patients underwent cholecystectomy at the time of vertical gastroplasty.
Ninety-seven percent of the removed gallbladders had gross or histologic abnormalities, including cholelithiasis 18.5% (13
patients), and cholesterolosis 31% (22 patients). Histologically, chronic cholecystitis was present in all patients with cholelithiasis
and cholesterolosis. Chronic cholecystitis alone was found in 27 patients (38.5%) and only two patients (3%) had normal findings.
The mean excess body weight of the patients with cholesterolosis (96 kg) was not significantly greater than that of patients
with cholelithiasis (89 kg) or chronic cholecystitis (88 kg). Our findings suggest that cholecystectomy should be performed
in all morbidly obese patients concomitant with vertical gastroplasty. 相似文献
8.
Background: Vitamin B12 deficiency after gastric surgery for obesity is due to a failure of separation of vitamin B12 from protein foodstuffs and to a failure of absorption of crystalline vitamin B12 in the presence of intrinsic factor. The purpose of this study was to determine which of four oral doses of crystalline vitamin
B12 was most effective in treating vitamin B12 deficiency in 102 patients. Methods and Results: At time of entry into the study, the patients had a serum vitamin B12 < 100 pmol L −1, were 29.9 ± 21.7 months post-op, were 37 ± 8 years old and had a body mass index of 30 ± 6 kg m−2. Eight (8%) had had a vertical banded gastroplasty and 94 (92%) a gastric bypass. For the first 3 months all patients received
350 μg per day of crystalline vitamin B12 and all increased their serum vitamin B12 levels to over 100 pmol L−1. The patients were then assigned to receive for a further 3 month period one of four oral doses of crystalline vitamin B12-100 μg, 250 μg, 350 μg and 600 μg. Serum vitamin B12 levels were greater than 150 pmol L−1 after 6 months in 83.3% of patients who received 100 μg; 92.3% of patients who received 250 μg; 94.7% after 350 μg and 95.2%
after 600 μg (p%0.525). Conclusion: At least 350 μg per day is the appropriate oral dose of crystalline vitamin B12 after gastric surgery for obesity to correct low serum vitamin B12 levels in 95% of patients. 相似文献
9.
Background: This study explored eating habits, nutrient intake, and blood vitamin and mineral levels to determine whether
severely obese subjects (BMI 40-50 kg m−2) post-vertical banded gastroplasty (VBG) or gastric bypass Roux-en-Y (GBR) are at risk of developing compounded under-nutrition.
Methods: A dietary follow-up of 36 VBG and 19 GBR was maintained for 18 months via 7-day food intake diaries and 24-h recalls.
Food intake was analysed for energy and nutrient composition and for its relative amount to recommended dietary allowances
(RDA). Results: Weight loss was greatest during the first 6 months, continued at a slower rate for the next 6 months, nearly
ceasing thereafter. The results following GBR were not substantially different from those following VBG 18 months postoperatively.
The median weight loss at 1 year postoperatively was 48, 46, 48 and 36 kg; expressed as residual excess body weight: 0.2,
16, 13 and 22% for GBR Men, Women, VBG Men, Women, respectively. According to the classification proposed by Reinhold, all
subjects achieved excellent treatment outcomes 18 months postoperatively. Despite the relatively low reported energy intake
(20-50% below RDA), no correlation was found between rate of weight loss and energy intake at 6 months postoperatively. The
intake of most vitamins and minerals was below 50% of RDA during the 18 months follow-up. The increase in energy intake did
not improve the level of the nonenergy-contributing nutrients. Compliance to multivitamin and mineral supplement intake deteriorated
with time. Conclusion: The low to within-normal range of blood vitamin and mineral levels 12 months postoperatively suggests
the slow development of subclinical nutritional deficiency which could jeopardize the subjects' long-term health status. 相似文献
10.