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Sample records for bariatric surgery patients

  1. Perioperative Optimization of Patients Undergoing Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    C. E. Owers

    2012-01-01

    Full Text Available Bariatric surgery is fast becoming an efficient and safe method of weight reduction, especially for patients in whom conservative measures have failed. As the obese population of the world increases, so will the number of patients requesting or requiring surgical weight loss methods. Bariatric patients however have numerous co-morbidities that make their operative course more difficult, and therefore is important to have a good understanding of the important issues surrounding their pre, peri and post operative management. This article aims to educate the reader about optimal management of the bariatric surgical patient.

  2. Assessing Sexual Abuse/Attack Histories with Bariatric Surgery Patients

    Science.gov (United States)

    Mahony, David

    2010-01-01

    This study assessed sexual abuse/attack histories in 537 bariatric surgery patients using the PsyBari. The prevalence rates found were lower (15.5%, 19.3% of women, 5.2% of men) than other studies that used bariatric surgery patients but consistent with studies that used nonbariatric obese subjects. Furthermore, bariatric surgery patients who…

  3. Bariatric Surgery in Moderately Obese Patients: A Prospective Study

    OpenAIRE

    M. Cerci; Bellini, M. I.; Russo, F.; Benavoli, D.; Capperucci, M.; Gaspari, A. L.; Gentileschi, P.

    2013-01-01

    Introduction. Moderate obesity (BMI 30–35 kg/m2) affects 25% of the western population. The role of bariatric surgery in this context is currently debated, reserved for patients with comorbidity, as an alternative to conservative medical treatment. We describe our experience in moderately obese patients treated with bariatric surgery. Materials and Methods. Between September 2011 and September 2012, 25 patients with grade I obesity and comorbidities underwent bariatric surgery: preoperative m...

  4. Metabolic Bone Disease in the Bariatric Surgery Patient

    Directory of Open Access Journals (Sweden)

    Susan E. Williams

    2011-01-01

    Full Text Available Bariatric surgery has proven to be a life-saving measure for some, but for others it has precipitated a plethora of metabolic complications ranging from mild to life-threatening, sometimes to the point of requiring surgical revision. Obesity was previously thought to be bone protective, but this is indeed not the case. Morbidly obese individuals are at risk for metabolic bone disease (MBD due to chronic vitamin D deficiency, inadequate calcium intake, sedentary lifestyle, chronic dieting, underlying chronic diseases, and the use of certain medications used to treat those diseases. After bariatric surgery, the risk for bone-related problems is even greater, owing to severely restricted intake, malabsorption, poor compliance with prescribed supplements, and dramatic weight loss. Patients presenting for bariatric surgery should be evaluated for MBD and receive appropriate presurgical interventions. Furthermore, every patient who has undergone bariatric surgery should receive meticulous lifetime monitoring, as the risk for developing MBD remains ever present.

  5. Nutrition Care for Patients with Weight Regain after Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Carlene Johnson Stoklossa

    2013-01-01

    Full Text Available Achieving optimal weight outcomes for patients with obesity is important to the management of their chronic disease. All interventions present risks for weight regain. Bariatric surgery is the most efficacious treatment, producing greater weight losses that are sustained over more time compared to lifestyle interventions. However, approximately 20–30% of patients do not achieve successful weight outcomes, and patients may experience a regain of 20–25% of their lost weight. This paper reviews several factors that influence weight regain after bariatric surgery, including type of surgery, food tolerance, energy requirements, drivers to eat, errors in estimating intake, adherence, food and beverage choices, and patient knowledge. A comprehensive multidisciplinary approach can provide the best care for patients with weight regain. Nutrition care by a registered dietitian is recommended for all bariatric surgery patients. Nutrition diagnoses and interventions are discussed. Regular monitoring of weight status and early intervention may help prevent significant weight regain.

  6. Prevention of venous thromboembolism in patients undergoing bariatric surgery

    OpenAIRE

    Bartlett MA; Mauck KF; Daniels PR

    2015-01-01

    Matthew A Bartlett, Karen F Mauck, Paul R Daniels Division of General Internal Medicine, Mayo Clinic Thrombophilia Center, Department of Medicine, Mayo Clinic, Rochester, MN, USA Abstract: Bariatric surgical procedures are now a common method of obesity treatment with established effectiveness. Venous thromboembolism (VTE) events, which include deep vein thrombosis and pulmonary embolism, are an important source of postoperative morbidity and mortality among bariatric surgery patients. Due t...

  7. A psychiatric perspective view of bariatric surgery patients

    Directory of Open Access Journals (Sweden)

    Isabel Brandão

    2015-10-01

    Full Text Available Abstract Background Bariatric surgery is the only procedure that has significant results in weight loss and improvements in medical comorbidities in morbid obese patients. Severely obese patients are also associated with a higher prevalence of psychiatric disorders and poor quality of life. Objective To evaluate specific areas of psychopathology in individuals undergoing bariatric surgery. Methods A review of the literature was conducted from January 2002 to March 2014 by researching PubMed database using the following query: “morbid AND obesity AND bariatric AND surgery AND (psychiatry OR psychology”. Results Overall improvements in eating behaviors, mood disorders and body image are reported after bariatric surgery, and the mechanism is not enlightened. Risk of suicide and consumption of substances of abuse, especially alcohol, after gastric bypass surgery are problems that clinicians must be aware. Discussion Bariatric patients should be monitored after surgery to identify who did not show the expected benefits postoperatively and the ones who develop psychiatric symptoms after an initial positive response.

  8. Bariatric surgery in elderly patients: a systematic review

    Directory of Open Access Journals (Sweden)

    Giordano S

    2015-10-01

    Full Text Available Salvatore Giordano,1 Mikael Victorzon2,3 1Department of Plastic and General Surgery, Turku University Hospital, Turku, 2Department of Gastrointestinal Surgery, Vaasa Central Hospital, Vaasa, 3University of Turku, Turku, Finland Abstract: Controversy exists regarding the effectiveness and safety of bariatric/metabolic surgery in elderly patients. We performed a systematic review on this issue in patients aged 60 years or older. MEDLINE, Cochrane Library, Embase, Scopus, and Google Scholar were searched until August 2015 for studies on outcomes of bariatric surgery in elderly patients. The results were expressed as pooled proportions (% with 95% confidence intervals. Heterogeneity across the studies was evaluated by the I2 test, and a random-effects model was used. Twenty-six articles encompassing 8,149 patients were pertinent with this issue and included data on bariatric surgery outcomes in elderly population. Fourteen patients died during the 30-day postoperative period, with a pooled mortality of 0.01%. Pooled overall complication rate was 14.7%. At 1-year follow-up, pooled mean excess weight loss was 53.77%, pooled diabetes resolution was 54.5%, and pooled hypertension resolution was 42.5%, while pooled lipid disorder resolution was 41.2%. Outcomes and complication rates of bariatric surgery in patients older than 60 years are comparable to those in a younger population, independent of the type of procedure performed. Patients should not be denied bariatric surgery because of their age alone. Keywords: morbid obesity, bariatric surgery, elderly, gastric bypass, weight loss, laparoscopy

  9. IVF after bariatric surgery

    OpenAIRE

    Doblado, Manuel A.; Lewkowksi, Beth M.; Odem, Randall R.; Jungheim, Emily S.

    2010-01-01

    Little data exist regarding in vitro fertilization in women who have undergone bariatric surgery. Our experience with five patients suggests IVF is a safe and effective fertility treatment for these women although special considerations should be made including the type of bariatric procedure the patient underwent and relating this knowledge to symptoms the patient may experience during their IVF cycle.

  10. Bariatric surgery in elderly patients: a systematic review

    OpenAIRE

    Giordano S; Victorzon M

    2015-01-01

    Salvatore Giordano,1 Mikael Victorzon2,3 1Department of Plastic and General Surgery, Turku University Hospital, Turku, 2Department of Gastrointestinal Surgery, Vaasa Central Hospital, Vaasa, 3University of Turku, Turku, Finland Abstract: Controversy exists regarding the effectiveness and safety of bariatric/metabolic surgery in elderly patients. We performed a systematic review on this issue in patients aged 60 years or older. MEDLINE, Cochrane Library, Embase, Scopus, and Google ...

  11. Bariatric surgery in elderly patients: a systematic review

    OpenAIRE

    Victorzon, Mikael

    2015-01-01

    Salvatore Giordano,1 Mikael Victorzon2,3 1Department of Plastic and General Surgery, Turku University Hospital, Turku, 2Department of Gastrointestinal Surgery, Vaasa Central Hospital, Vaasa, 3University of Turku, Turku, Finland Abstract: Controversy exists regarding the effectiveness and safety of bariatric/metabolic surgery in elderly patients. We performed a systematic review on this issue in patients aged 60 years or older. MEDLINE, Cochrane Library, Embase, Scopus, and...

  12. Nutrition Care for Patients with Weight Regain after Bariatric Surgery

    OpenAIRE

    Carlene Johnson Stoklossa; Suneet Atwal

    2013-01-01

    Achieving optimal weight outcomes for patients with obesity is important to the management of their chronic disease. All interventions present risks for weight regain. Bariatric surgery is the most efficacious treatment, producing greater weight losses that are sustained over more time compared to lifestyle interventions. However, approximately 20–30% of patients do not achieve successful weight outcomes, and patients may experience a regain of 20–25% of their lost weight. This paper reviews ...

  13. Medical management of patients after bariatric surgery: Principles and guidelines

    Institute of Scientific and Technical Information of China (English)

    Abd; Elrazek; Mohammad; Ali; Abd; Elrazek; Abduh; Elsayed; Mohamed; Elbanna; Shymaa; E; Bilasy

    2014-01-01

    Obesity is a major and growing health care concern. Large epidemiologic studies that evaluated the relationship between obesity and mortality, observed that a higher body-mass index(BMI) is associated with increased rate of death from several causes, among them cardiovascular disease; which is particularly true for those with morbid obesity. Being overweight was also associated with decreased survival in several studies. Unfortunately, obese subjects are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior. All obese patients(BMI ≥ 30 kg/m2) should receive counseling on diet, lifestyle, exercise and goals for weight management. Individuals with BMI ≥ 40 kg/m2 and those with BMI > 35 kg/m2 with obesity-related comorbidities; who failed diet, exercise, and drug therapy, should be considered for bariatric surgery. In current review article, we will shed light on important medical principles that each surgeon/gastroenterologist needs to know about bariatric surgical procedure, with special concern to the early post operative period. Additionally, we will explain the common complications that usually follow bariatric surgery and elucidate medical guidelines in their management. For the first 24 h after the bariatric surgery, the postoperative priorities include pain management, leakage, nausea and vomiting, intravenous fluid management, pulmonary hygiene, and ambulation. Patients maintain a low calorie liquid diet for the first few postoperative days that is gradually changed to soft solid food diet within two or three weeks following the bariatric surgery. Later, patients should be monitored for postoperative complications. Hypertension, diabetes, dumping syndrome, gastrointestinal and psychosomatic disorders are among the most important medical conditions discussed in this review.

  14. Imaging of patients treated with bariatric surgery

    International Nuclear Information System (INIS)

    Over the past few years, obesity has become a major clinical and population concern in the majority of developed countries. Obesity leads to significant systemic disorders, such as hypertension, hypercholesterolemia, hypertriglyceridemia and insulin resistance, and also increases the risk of developing cardiovascular diseases (ischemic heart disease, ischemic stroke), metabolic diseases (type 2 diabetes), certain types of cancer, and degenerative bone disorders (osteoarthritis). Health hazards associated with epidemic of obesity and potential benefits of weight loss have spurred interest in new treatment methods. Bariatric surgical procedures constitute a recognized alternative in cases where conservative management of obesity fails. Several bariatric operations can be distinguished: restrictive procedures, such as adjustable gastric band (AGB) and vertical banded gastroplasty (VBG); predominantly malabsorptive procedures, such as biliopancreatic diversion (BPD), and a combination of both methods, such as Roux-en-Y gastric bypass. The adverse consequences of surgical treatment of obesity include i.a.: intestinal anastomotic leakage, impaired intestinal permeability and internal hernia, dilatation of the stomach, gastrointestinal anastomotic stenosis, marginal ulceration, incisional hernia. Basic knowledge of procedures in the surgical treatment of obesity is of vital importance for the radiologist during evaluation of upper gastrointestinal tract in the early and late postoperative period, allowing correct interpretation of acquired images as well as recognition of typical complications

  15. FUNCTIONAL ASSESSMENT OF OLDER OBESE PATIENTS CANDIDATES FOR BARIATRIC SURGERY

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    Denis PAJECKI

    2014-03-01

    Full Text Available Context Obesity in the elderly is associated with exacerbation of functional decline (dependency, that occurs with aging, because of decreased muscle mass and strength, and increased joint dysfunction. Consequently, there is progressive loss of independence, autonomy, chronic pain and impaired quality of life. The weight loss can bring benefits in all these aspects, especially when accompanied by exercises. Elderly patients with morbid obesity may be submitted to surgical treatment, taking into account that the massive weight loss, eventually caused by bariatric surgery, may exacerbate the loss of muscle mass and nutritional complications that may bring harm to the overall health and quality of life of these patients. The functional assessment of elderly patients, candidates for bariatric surgery and the extent to which surgery can bring benefits to the patients, in the field of functionality, has still to be determined. Objective To describe profile functionality in obese elderly referred to a bariatric surgery program. Methods Patients with age ≥60 and BMI ≥35 underwent comprehensive geriatric assessment that evaluates co morbidities, medication use, ability to perform basic activities of daily living and instrumental activities of daily living, and the “Timedupandgo” test to evaluate mobility, whose cut-off point was ≤10 seconds. Statistical analysis was performed in order to see if there is a positive correlation of dependency with BMI and age (over or under 65 years. Results Forty subjects have completed evaluation. The mean age was 64.1 years (60-72 and 75% were women. They had an average weight of 121.1 kg (72.7-204 and a mean BMI of 47.2 kg/m2 (35.8-68.9. 16 patients (40% have shown dependency for activities of daily living, 19 (47,5% for instrumental activities of daily living and 20 patients (50% had a “Timedupandgo” test over 10 seconds. Statistical analysis (t-Student, Mann-Whitney, Binary Logistic Regression has shown

  16. VENOUS INSUFFICIENCY AND THROMBOEMBOLIC DISEASE IN BARIATRIC SURGERY PATIENTS

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    Bonno van BELLEN

    2013-09-01

    Full Text Available Context Morbid obesity is associated with various co-morbidities, including chronic venous insufficiency. Bariatric surgery is the only effective treatment for morbid obesity, but with potential risks and possible complications, including venous thromboembolism. Objective To determine the prevalence of clinical and ultrasonographic signs of chronic venous insufficiency in morbid obese patients in preparation for bariatric surgery and the incidence of post-operative venous thromboembolic disease. Methods Patients on work-up for bariatric surgery of Centro Terapêutico Especializado em Fígado (CETEFI and Pro-Gastro surgical teams of the Hospital Beneficência Portuguesa de São Paulo were included. The analysed data were pre-operative findings for venous insufficiency (CEAP - clinical, etiological, anatomical, physiopathologic - classification and venous ultrassonographic findings, type of surgery (open or laparoscopic, abdominal circumference, body mass index (BMI and post-operative ultrassonography search for venous insufficiency and deep venous thrombosis. Results Between March 2007 and December 2009, 95 patients candidates for bariatric surgery had clinical and duplex scan evaluation of the lower limbs venous system. Of the 95 patients, 53 were submitted to the surgical procedure. There was a predominance of women (77.9%, the average age was 38.5 years, average preoperative weight 124.6 kg and average BMI of 45.5 kg/m2. Regarding obesity, 16.8% were obese, and 83.1% were morbidly obese. In relation to the venous findings, 86.3% of the patients did fit CEAP classification less than 3 and 13.7% greater than or equal to 3. Among the post-operative complications, there were four cases of wound infection. Three patients developed post-operative distal venous thrombosis (7.5%, but no one had clinically manifested pulmonary embolism. Conclusion No relation between BMI, CEAP classification and venous ultrassonographic findings were found. Although

  17. Bariatric Surgery Misconceptions

    Science.gov (United States)

    ... from depression or anxiety and to have lower self-esteem and overall quality of life than someone who ... is a Candidate for Bariatric Surgery? Childhood and Adolescent Obesity Find a Provider Benefits of Bariatric Surgery ...

  18. Endocrine and metabolic aspects of the management of patients undergoing bariatric surgery. Review of clinical recommendations.

    Directory of Open Access Journals (Sweden)

    N V Mazurina

    2012-03-01

    Full Text Available The incidence of morbid obesity increases worldwide. Therefore surgical methods of treatment are widely applied. A lot of patients after bariatric surgery requires lifelong control and therapy. The Endocrine Society offered detailed guideline for the management of boost-bariatric surgery patients. The basic recommendations are reviewed in this article.

  19. American Society for Metabolic and Bariatric Surgery

    Science.gov (United States)

    ... Education CBN CME Policies Meetings of Interest Online Education Directory Search Patient Learning Center Bariatric Surgery FAQs Bariatric Surgery Procedures BMI Calculator Childhood and Adolescent Obesity 100 SW 75th Street, Suite 201, Gainesville, FL, ...

  20. The Night Eating Syndrome (NES) in Bariatric Surgery Patients.

    Science.gov (United States)

    de Zwaan, Martina; Marschollek, Michael; Allison, Kelly C

    2015-11-01

    The night eating syndrome (NES) has been included into the Diagnostic and Statistical Manual of Mental Disorders 5 as an example of an 'other-specified feeding or eating disorder'. The prevalence of NES has found to be higher in obese populations than in the general population and seems to rise with increasing body mass index. Recent studies suggest a prevalence of 2%-20% in bariatric surgery samples. Given that the core feature of this eating disorder may involve a shift in the circadian pattern of eating that disrupts sleep, and not the ingestion of objectively large amounts of food, it is a pattern that can continue after bariatric surgery. Nonetheless, symptoms of NES appear to decrease after weight loss surgery, and there is no evidence that pre-surgery NES negatively impacts weight loss following surgery. Prospective and longitudinal studies of the course of night eating symptoms are warranted using clear criteria and standardized assessment instruments. PMID:26395455

  1. Mental and Physical Impact of Body Contouring Procedures on Post–Bariatric Surgery Patients

    OpenAIRE

    Singh, Devinder; Zahiri, Hamid R.; Janes, Lindsay E; Sabino, Jennifer; Matthews, Jamil A; Bell, Robert L.; Thomson, J. Grant

    2012-01-01

    Objective: The rapid rate of weight loss following bariatric surgery leads to areas of excessive skin that can cause physical ailments and distortion of body image. Dissatisfaction with the excessive skin can lead patients to seek plastic surgery. This study aims to assess the changes in mental and physical quality of life after body contouring procedures in the post–bariatric surgery population. Methods: In this cross-sectional study, the 36-Item Short Form Health Survey was given to 104 pat...

  2. Psychological Assessment of the Patient Undergoing Bariatric Surgery

    OpenAIRE

    Snyder, Allison G.

    2009-01-01

    The purpose of this article is to provide an overview of the critical domains assessed during the psychological evaluation of candidates for bariatric surgery. Although no formal standard exists in the literature, there is growing recognition of the important elements to be addressed and the appropriate means for collecting the necessary data to determine psychological readiness for these procedures. Information regarding the components of the clinical interview and the specific measures used...

  3. Bariatric surgery in hypothalamic obesity

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    Nathan eBingham

    2012-02-01

    Full Text Available Craniopharyngiomas (CP are epithelial neoplasms generally found in the area of the pituitary and hypothalamus. Despite benign histology, these tumors and/or their treatment often result in significant, debilitating disorders of endocrine, neurological, behavioral, and metabolic systems. Severe obesity is observed in a high percentage of patients with CP resulting in significant comorbidities and negatively impacting quality of life. Obesity occurs as a result of hypothalamic damage and disruption of normal homeostatic mechanisms regulating energy balance. Such pathological weight gain, termed hypothalamic obesity (HyOb, is often severe and refractory to therapy.Unfortunately, neither lifestyle intervention nor pharmacotherapy has proven truly effective in the treatment of CP-HyOb. Given the limited choices and poor results of these treatments, several groups have examined bariatric surgery as a treatment alternative for patients with CP-HyOb. While a large body of evidence exists supporting the use of bariatric surgery in the treatment of exogenous obesity and its comorbidities, its role in the treatment of HyOb has yet to be well defined. To date, the existing literature on bariatric surgery in CP-HyOb is largely limited to case reports and series with short term follow-up. Here we review the current reports on the use of bariatric surgery in the treatment of CP-HyOb. We also compare these results to those reported for other populations of HyOb, including Prader-Willi Syndrome and patients with melanocortin signaling defects. While initial reports of bariatric surgery in CP-HyOb are promising, their limited scope makes it difficult to draw any substantial conclusions as to the long term safety and efficacy of bariatric surgery in CP-HyOb. There continues to be a need for more robust, controlled, prospective trials with long term follow-up in order to better define the role of bariatric surgery in the treatment of all types of hypothalamic

  4. Assessing the obese diabetic patient for bariatric surgery: which candidate do I choose?

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    Raffaelli M

    2015-06-01

    Full Text Available Marco Raffaelli,1 Luca Sessa,1 Geltrude Mingrone,2 Rocco Bellantone1 1Division of Endocrine and Metabolic Surgery, 2Division of Obesity Diseases, Università Cattolica del Sacro Cuore, Rome, Italy Abstract: The worldwide prevalence of type 2 diabetes is rising in association with an increasing frequency of overweight and obesity. Bariatric-metabolic procedures are considered as additional therapeutic options, allowing improved diabetes control in most patients. Multiple factors play in concert to achieve the improvements in diabetic remission observed after bariatric-metabolic surgery. Several studies have demonstrated that bariatric-metabolic surgery is an effective treatment for type 2 diabetes when compared with conventional nonsurgical medical treatment. Because the best results are achievable in patients with a relatively short history of diabetes and less advanced controlled disease, the surgical option could be considered early, especially in morbid obese subjects (BMI ≥35 kg/m2 after failure of medical treatment. Patients with extensive weight loss are more likely to achieve type 2 diabetes remission after bariatric surgery. At present, Roux-en-Y gastric bypass seems the surgical procedure of choice because it has fewer risks than biliopancreatic diversion, and it is associated with higher weight loss and metabolic improvements compared with adjustable gastric banding. Recent evidences regarding the effectiveness of sleeve gastrectomy in diabetes remission have to be confirmed by controlled trials with longer follow-up. Keywords: bariatric surgery, metabolic surgery, diabetes, morbid obesity

  5. Bariatric surgery for type 2 diabetes: Weighing the impact for obese patients

    OpenAIRE

    Kashyap, Sangeeta R.; GATMAITAN, PATRICK; Brethauer, Stacy; Schauer, Philip

    2010-01-01

    Obesity is a potent risk factor for the development and progression of type 2 diabetes, and weight loss is a key component of diabetes management. Bariatric surgery results in significant weight loss and remission of diabetes in most patients. After surgery, glycemic control is restored by a combination of enforced caloric restriction, enhanced insulin sensitivity, and increased insulin secretion.

  6. Bariatric Surgery in Youth.

    Science.gov (United States)

    Mirensky, Tamar L

    2016-06-01

    Bariatric surgery provides a clinically effective and cost-effective means of achieving sustained weight reduction and management of associated comorbidities and has been met with increasing enthusiasm for application in obese youth. Following trends seen among obese adults, carefully selected obese youth are now undergoing bariatric surgical procedures with excellent short-term and intermediate-term outcomes. Although long-term data are not yet available, the results thus far hold great promise in the management of this population. PMID:27241972

  7. Interest, views and perceived barriers to bariatric surgery in patients with morbid obesity.

    Science.gov (United States)

    Wharton, S; Serodio, K J; Kuk, J L; Sivapalan, N; Craik, A; Aarts, M-A

    2016-04-01

    The objective of the study was to assess the interest, views and patient-perceived barriers to bariatric surgery among surgery-eligible patients. Surveys were completed at a weight management clinic and local hospital in Ontario, Canada. Patients were ≥18 years of age with a body mass index (BMI) >40 kg m(-2) or BMI > 35 kg m(-2) with ≥1 comorbidity. The sample included 105 participants, 73.3% female, with a mean BMI of 46.6 ± 7.1 kg m(-2) . Only 33.3% of participants were interested in surgery; 50.5% of participants were not interested and 16.2% had mixed feelings. Participants identified risks (69.5%) and side effects (57.1%) as significant surgical barriers. Interested participants were more likely to perceive themselves as obese, were unhappy with their current weight loss method and were less likely to fear surgery (P effectiveness of bariatric surgery, the majority of qualified patients are not interested in surgery mainly due to the perceived risk of surgery in general and satisfaction with current non-surgical weight loss efforts. The self-perception of obesity, as opposed to medical comorbidities, may be a stronger driver of the decision to have bariatric surgery. It is unclear if patients are aware of the effectiveness of bariatric surgery to help improve comorbidities or if bariatric surgery is perceived as being more cosmetic in nature. PMID:26910303

  8. News media reports of patient deaths following 'medical tourism' for cosmetic surgery and bariatric surgery.

    Science.gov (United States)

    Turner, Leigh

    2012-04-01

    Contemporary scholarship examining clinical outcomes in medical travel for cosmetic surgery identifies cases in which patients traveled abroad for medical procedures and subsequently returned home with infections and other surgical complications. Though there are peer-reviewed articles identifying patient deaths in cases where patients traveled abroad for commercial kidney transplantation or stem cell injections, no scholarly publications document deaths of patients who traveled abroad for cosmetic surgery or bariatric surgery. Drawing upon news media reports extending from 1993 to 2011, this article identifies and describes twenty-six reported cases of deaths of individuals who traveled abroad for cosmetic surgery or bariatric surgery. Over half of the reported deaths occurred in two countries. Analysis of these news reports cannot be used to make causal claims about why the patients died. In addition, cases identified in news media accounts do not provide a basis for establishing the relative risk of traveling abroad for care instead of seeking elective cosmetic surgery at domestic health care facilities. Acknowledging these limitations, the case reports suggest the possibility that contemporary peer-reviewed scholarship is underreporting patient mortality in medical travel. The paper makes a strong case for promoting normative analyses and empirical studies of medical travel. In particular, the paper argues that empirically informed ethical analysis of 'medical tourism' will benefit from rigorous studies tracking global flows of medical travelers and the clinical outcomes they experience. The paper contains practical recommendations intended to promote debate concerning how to promote patient safety and quality of care in medical travel. PMID:22420449

  9. Defining the role of bariatric surgery in polycystic ovarian syndrome patients

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    Shaveta M Malik

    2012-01-01

    Full Text Available Polycystic ovarian syndrome (PCOS is the most common endocrine disorder in women. To meet PCOS criteria, women must have a combination of hyperandrogenism, anovulation and ultrasound findings. Almost 10% of all reproductive age women worldwide show signs of PCOS. Although women often seek care for gynecological or body image concerns, many PCOS women are at risk for metabolic syndrome (MS. Many of the metabolic consequences are overlooked and undertreated by physicians because these patients tend to be young, reproductive age women. MS and obesity coexist commonly with PCOS. These young women are predisposed to glucose abnormalities and ultimately diabetes mellitus, dyslipidemia and eventually cardiovascular disease. Bariatric surgery can be an effective means of weight loss in PCOS women. Surgical techniques have become safer and less invasive over time and have been found to be effective in achieving significant weight loss. Surgical options have also increased, giving patients more choices. Bariatric surgery may prevent or reverse metabolic syndrome. Bariatric surgery may also have reproductive benefits in PCOS patients. Although bariatric surgery has historically been performed in older, reproductive aged women, it has recently gained favor in adolescents as well. This is of particular importance due to the prevalence of both PCOS and MS in adolescents. Treatment of PCOS and MS certainly requires a combination of medical therapy, psychological support and lifestyle modifications. These treatments are difficult and often frustrating for patients and physicians. Bariatric surgery can be effective in achieving significant weight loss, restoration of the hypothalamic pituitary axis, reduction of cardiovascular risk and even in improving pregnancy outcomes. Ultimately, bariatric surgery should be considered part of the treatment in PCOS women, especially in those with MS.

  10. Effects of Bariatric Surgery on Facial Features

    OpenAIRE

    Papoian, Vardan; Mardirossian, Vartan; Hess, Donald Thomas; Spiegel, Jeffrey H.

    2015-01-01

    Background Bariatric surgeries performed in the USA has increased twelve-fold in the past two decades. The effects of rapid weight loss on facial features has not been previously studied. We hypothesized that bariatric surgery will mimic the effects of aging thus giving the patient an older and less attractive appearance. Methods Consecutive patients were enrolled from the bariatric surgical clinic at our institution. Pre and post weight loss photographs were taken and used to generate two su...

  11. Quality of Life, Body Image and Sexual Functioning in Bariatric Surgery Patients.

    Science.gov (United States)

    Sarwer, David B; Steffen, Kristine J

    2015-11-01

    This article provides an overview of the literature on quality of life, body image and sexual behaviour in individuals with extreme obesity and who undergo bariatric surgery. Quality of life is a psychosocial construct that includes multiple domains, including health-related quality of life, weight-related quality of life, as well as other psychological constructs such as body image and sexual functioning. A large literature has documented the impairments in quality of life and these other domains in persons with obesity and extreme obesity in particular. These impairments are believed to play an influential role in the decision to undergo bariatric surgery. Individuals who undergo bariatric surgery typically report significant improvements in these and other areas of psychosocial functioning, often before they reach their maximum weight loss. The durability of these changes as patients maintain or regain weight, however, is largely unknown. PMID:26608946

  12. Bariatric surgery as a treatment option in patients with type 2 diabetes mellitus

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    Marianna Spanou

    2013-01-01

    Full Text Available Type 2 diabetes mellitus (T2DM is a leading cause of blindness, non-traumatic amputation and end-stage renal disease as well as a major cardiovascular risk factor. Tight glycemic control reduces the incidence of microvascular complications of T2DM whereas its effects on macrovascular complication are more controversial. However, glycemic targets are achieved by a minority of diabetic patients despite the availability of several antidiabetic agents. In the present commentary, we discuss the findings of two recent randomized studies that compared bariatric surgery with medical treatment in patients with uncontrolled T2DM. Both studies showed that bariatric surgery results in remission of T2DM in the majority of patients. However, both studies were limited to relatively young patients without comorbidities, had relatively short follow-up and did not assess the effects of surgery on T2DM complications. Moreover, the perioperative complications of bariatric surgery and its limited availability in some areas are additional barriers to the wider implementation of this therapeutic approach. On the other hand, the elucidation of the mechanisms underpinning the resolution of T2DM following bariatric surgery might result in the development of novel, more effective pharmacotherapies for this common disease.

  13. Conserved Metabolic Changes in Nondiabetic and Type 2 Diabetic Bariatric Surgery Patients: Global Metabolomic Pilot Study.

    Science.gov (United States)

    Sarosiek, Konrad; Pappan, Kirk L; Gandhi, Ankit V; Saxena, Shivam; Kang, Christopher Y; McMahon, Heather; Chipitsyna, Galina I; Tichansky, David S; Arafat, Hwyda A

    2016-01-01

    The goal of this study was to provide insight into the mechanism by which bariatric surgical procedures led to weight loss and improvement or resolution of diabetes. Global biochemical profiling was used to evaluate changes occurring in nondiabetic and type 2 diabetic (T2D) patients experiencing either less extreme sleeve gastrectomy or a full gastric bypass. We were able to identify changes in metabolism that were affected by standard preoperation liquid weight loss diet as well as by bariatric surgery itself. Preoperation weight-loss diet was associated with a strong lipid metabolism signature largely related to the consumption of adipose reserves for energy production. Glucose usage shift away from glycolytic pyruvate production toward pentose phosphate pathway, via glucose-6-phosphate, appeared to be shared across all patients regardless of T2D status or bariatric surgery procedure. Our results suggested that bariatric surgery might promote antioxidant defense and insulin sensitivity through both increased heme synthesis and HO activity or expression. Changes in histidine and its metabolites following surgery might be an indication of altered gut microbiome ecology or liver function. This initial study provided broad understanding of how metabolism changed globally in morbidly obese nondiabetic and T2D patients following weight-loss surgery. PMID:26881244

  14. Conserved Metabolic Changes in Nondiabetic and Type 2 Diabetic Bariatric Surgery Patients: Global Metabolomic Pilot Study

    Directory of Open Access Journals (Sweden)

    Konrad Sarosiek

    2016-01-01

    Full Text Available The goal of this study was to provide insight into the mechanism by which bariatric surgical procedures led to weight loss and improvement or resolution of diabetes. Global biochemical profiling was used to evaluate changes occurring in nondiabetic and type 2 diabetic (T2D patients experiencing either less extreme sleeve gastrectomy or a full gastric bypass. We were able to identify changes in metabolism that were affected by standard preoperation liquid weight loss diet as well as by bariatric surgery itself. Preoperation weight-loss diet was associated with a strong lipid metabolism signature largely related to the consumption of adipose reserves for energy production. Glucose usage shift away from glycolytic pyruvate production toward pentose phosphate pathway, via glucose-6-phosphate, appeared to be shared across all patients regardless of T2D status or bariatric surgery procedure. Our results suggested that bariatric surgery might promote antioxidant defense and insulin sensitivity through both increased heme synthesis and HO activity or expression. Changes in histidine and its metabolites following surgery might be an indication of altered gut microbiome ecology or liver function. This initial study provided broad understanding of how metabolism changed globally in morbidly obese nondiabetic and T2D patients following weight-loss surgery.

  15. Effective Ventilation Strategies for Obese Patients Undergoing Bariatric Surgery: A Literature Review.

    Science.gov (United States)

    Hu, Xin Yan

    2016-02-01

    Obesity causes major alterations in pulmonary mechanics. Obese patients undergoing bariatric surgery present mechanical ventilation-related challenges that may lead to perioperative complications. Databases were systematically searched for clinical trials of ventilation maneuvers for obese patients and bariatric surgery. Thirteen randomized controlled trials were selected. The quality of the studies was evaluated with the Critical Appraisal Skills Programme tool, and a matrix was developed to present the essential components of the studies. Eight strategies of ventilation maneuvers were identified. Recruitment maneuvers followed by positive end-expiratory pressure (PEEP) consistently demonstrated effectiveness in obese patients undergoing bariatric surgery. Pressure-controlled ventilation and volume-controlled ventilation did not differ significantly in their efficacy. Noninvasive positive pressure ventilation (NIPPV) during induction was effective in preventing atelectasis and increasing the duration of safe apnea. Equal ratio ventilation can be a useful ventilation strategy. Recruitment maneuvers followed by PEEP are effective ventilation strategies for obese patients undergoing bariatric surgery. During induction, NIPPV provides further benefit. Future studies are needed to examine the postoperative effects of recruitment maneuvers with PEEP as well as the efficacy and safety of equal ratio ventilation. PMID:26939387

  16. Iron Deficiency and Bariatric Surgery

    OpenAIRE

    Ignacio Jáuregui-Lobera

    2013-01-01

    It is estimated that the prevalence of anaemia in patients scheduled for bariatric surgery is higher than in the general population and the prevalence of iron deficiencies (with or without anaemia) may be higher as well. After surgery, iron deficiencies and anaemia may occur in a higher percentage of patients, mainly as a consequence of nutrient deficiencies. In addition, perioperative anaemia has been related with increased postoperative morbidity and mortality and poorer quality of life aft...

  17. Psychiatric and Psychosocial Aspects of Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Guzin Mukaddes Sevincer

    2014-02-01

    Full Text Available Bariatric surgery is a treatment modality which is becoming increasingly popular in the last decade in our country and around the world. Patients who treated with a conventional methods are unable to loose sufficient weight and even they regained most of their lost weight easily. The number of patients undergoing bariatric surgery are increasing day by day considering the success of bariatric surgery with regard to lose weight fast and the improvement in co-morbid conditions. Obesity and bariatric surgery are in a reciprocal relationship both with psychiatric disorders and psychosocial variables. Relations are begin with the evaluation of a patients eligibility for surgery in terms of psychiatric and psychosocial issues at a very early stage of the process. Presence of psychopathology, level of knowledge related to the surgical procedure and patients expectations about physical, psychological and social changes that may occur after surgery are the significant parts of the evaluation of bariatric surgery patients. These components should be considered in assessing capacity of patients to comply with medical advice in post-operative stage. In this article the needs for assesment of psychiatric and psychosocial aspects of obese patients who will undergo bariatric surgery is reviewed in the light of current literature . Possible medical, psychiatric and psychosocial complications of bariatric surgery and related issues are reviewed and psycosocial factors that may be predictors of the successful outcome of bariatric surgery are discussed.Discussions around the nature of specific eating disorders seen frequently in bariatric surgery patients, wheter it is a separate entities from well known eating disorders and controversial issues such as presence or absence of psychopathology like suicide as directly consequence of the surgical procedures are summarized. Discussions about performing of psychiatric and psychosocial assesment (i.e by whom, how and

  18. A role for exercise after bariatric surgery?

    Science.gov (United States)

    Coen, Paul M; Goodpaster, Bret H

    2016-01-01

    Obesity predisposes an individual to develop numerous comorbidities, including type 2 diabetes, and represents a major healthcare issue in many countries worldwide. Bariatric surgery can be an effective treatment option, resulting in profound weight loss and improvements in metabolic health; however, not all patients achieve similar weight loss or metabolic improvements. Exercise is an excellent way to improve health, with well-characterized physiological and psychological benefits. In the present paper we review the evidence to determine whether there may be a role for exercise as a complementary adjunct therapy to bariatric surgery. Objectively measured physical activity data indicate that most patients who undergo bariatric surgery do not exercise enough to reap the health benefits of exercise. While there is a dearth of data on the effects of exercise on weight loss and weight loss maintenance after surgery, evidence from studies of caloric restriction and exercise suggest that similar adjunctive benefits may be extended to patients who perform exercise after bariatric surgery. Recent evidence from exercise interventions after bariatric surgery suggests that exercise may provide further improvements in metabolic health compared with surgery-induced weight loss alone. Additional randomized controlled exercise trials are now needed as the next step to more clearly define the potential for exercise to provide additional health benefits after bariatric surgery. This valuable evidence will inform clinical practice regarding much-needed guidelines for exercise after bariatric surgery. PMID:26228356

  19. Pregnancy management following bariatric surgery.

    Science.gov (United States)

    Uzoma, A; Keriakos, R

    2013-02-01

    Bariatric surgery is gaining in popularity, due to globally increasing rates of obesity. In the UK, this has manifested as a 14-fold increase in bariatric surgery between 2004 and 2010, making it necessary to develop strategies to manage women who become pregnant following bariatric surgery. This review paper has explored all the current evidence in the literature and provided a comprehensive management strategy for pregnant women following bariatric surgery. The emphasis is on a multidisciplinary team approach to all aspects of care. Adequate pre-conception and antenatal and postnatal care is essential to good pregnancy outcomes with emphasis on appropriate nutritional supplementation. This is especially important following malabsorptive procedures. There is no evidence to suggest that pregnancy outcome is worse after bariatric surgery, though women who remain obese are prone to obesity-related risks in pregnancy. Neonatal outcome post-bariatric surgery is no different from the general population. PMID:23445128

  20. Guidelines for the follow-up of patients undergoing bariatric surgery.

    Science.gov (United States)

    O'Kane, Mary; Parretti, Helen M; Hughes, Carly A; Sharma, Manisha; Woodcock, Sean; Puplampu, Tamara; Blakemore, Alexandra I; Clare, Kenneth; MacMillan, Iris; Joyce, Jacqueline; Sethi, Su; Barth, Julian H

    2016-06-01

    Bariatric surgery can facilitate weight loss and improvement in medical comorbidities. It has a profound impact on nutrition, and patients need access to follow-up and aftercare. NICE CG189 Obesity emphasized the importance of a minimum of 2 years follow-up in the bariatric surgical service and recommended that following discharge from the surgical service, there should be annual monitoring as part of a shared care model of chronic disease management. NHS England Obesity Clinical Reference Group commissioned a multi-professional subgroup, which included patient representatives, to develop bariatric surgery follow-up guidelines. Terms of reference and scope were agreed upon. The group members took responsibility for different sections of the guidelines depending on their areas of expertise and experience. The quality of the evidence was rated and strength graded. Four different shared care models were proposed, taking into account the variation in access to bariatric surgical services and specialist teams across the country. The common features include annual review, ability for a GP to refer back to specialist centre, submission of follow-up data to the national data base to NBSR. Clinical commissioning groups need to ensure that a shared care model is implemented as patient safety and long-term follow-up are important. PMID:27166136

  1. Bariatric Surgery for Severe Obesity

    Science.gov (United States)

    ... switch, less often. Each type of surgery has advantages and disadvantages. ​ ​​​​ Bariatric Surgery Benefits Bariatric surgery can ... basic and clinical research into many disorders. ​ Additional Reading Active at Any Size! Binge Eating Disorder Dieting ...

  2. The Pharmacokinetics of the CYP3A Substrate Midazolam in Morbidly Obese Patients Before and One Year After Bariatric Surgery

    OpenAIRE

    Brill, Margreke J.; van Rongen, Anne; van Dongen, Eric P.; van Ramshorst, Bert; Hazebroek, Eric J; Darwich, Adam S; Rostami-Hodjegan, Amin; Knibbe, Catherijne A.

    2015-01-01

    Purpose Bariatric surgery is nowadays commonly applied as treatment for morbid obesity (BMI > 40 kg/m2). As information about the effects of this procedure on a drug’s pharmacokinetics is limited, we aimed to evaluate the pharmacokinetics of CYP3A probe substrate midazolam after oral and intravenous administration in a cohort of morbidly obese patients that was studied before and 1 year post bariatric surgery. Methods Twenty morbidly obese patients (aged 26–58 years) undergoing bariatric surg...

  3. Moxifloxacin dosing in post-bariatric surgery patients

    NARCIS (Netherlands)

    Colin, Pieter; Eleveld, Douglas J.; Struys, Michel M. R. F.; T'Jollyn, Huybrecht; Van Bortel, Luc M.; Ruige, Johannes; De Waele, Jan; Van Bocxlaer, Jan; Boussery, Koen

    2014-01-01

    Introduction Given the ever increasing number of obese patients and obesity related bypass surgery, dosing recommendations in the post-bypass population are needed. Using a population pharmacokinetic (PK) analysis and PK-pharmacodynamic (PD) simulations, we investigated whether adequate moxifloxacin

  4. Nursing care in the perioperative period for patients undergoing bariatric surgery

    OpenAIRE

    Maria Beatriz Guimarães Ferreira; Márcia Marques dos Santos Felix; Cristina Maria Galvão

    2014-01-01

    This integrative review aimed to analyze the available evidence in the literature regarding nursing care in the perioperative period for patients who underwent bariatric surgery. The search for primary studies was carried out in the US National Library of Medicine National Institutes of Health, Cumulative Index to Nursing and Allied Health Literature and Latin American and Caribbean Health Sciences Literature databases. The sample was comprised of 11 primary studies, published between January...

  5. Does bariatric surgery improve the patient´s quality of life?

    Directory of Open Access Journals (Sweden)

    Y. Martínez

    2010-12-01

    Full Text Available Objective: The aim of this investigation was to assess the effect of malabsorptive bariatric surgery (BS on the quality of life (QoL, applying the Nottingham Health Profile (NHP and the bariatric analysis and reporting outcome system (BAROS. Design: A prospective cohort study was performed in 100 adult patients (> 18 years undergoing bariatric surgery by malabsorptive technique for one year. Research methods and procedures: Patients were monitored from the beginning of the BS program until a year after the intervention, applying the NHP and the BAROS test. At baseline, the mean weight of the women was 132 ± 22 kg and the Body Mass Index (BMI was 50.7 kg/m². Results: The values obtained from different areas applying the NHP questionnaire showed statistical significant differences (p < 0.001 with respect to baseline values. According to the BAROS test, 48% of patients lost 25-49% of weight excess and 80.8% had resolved major comorbidities at 1 yr. According to the Moorehead-Ardelt QoL score, there were major improvements in employment and self-esteem in 89% and 87% of patients, respectively, and improvements in physical activity, sexual and social relationships. According to the total mean BAROS score, the outcome was considered "very good". Conclusion: NHP and BAROS questionnaires appear to be useful and easily applicable tools to assess the QoL of obese patients.

  6. Inferior vena cava filters and postoperative outcomes in patients undergoing bariatric surgery: a meta-analysis.

    Science.gov (United States)

    Kaw, Roop; Pasupuleti, Vinay; Wayne Overby, D; Deshpande, Abhishek; Coleman, Craig I; Ioannidis, John P A; Hernandez, Adrian V

    2014-01-01

    Background: Pulmonary embolism(PE)accounts for almost 40% of perioperative deaths after bariatric surgery.Placement of prophylactic inferior vena cava(IVC) filter before bariatric surgery to improve outcomes has shown varied results. We performed a meta-analysis to evaluate post- operative outcomes associated with the preoperative placement of IVC filters in these patients. Methods: A systematic review was conducted by three investigators independently in PubMed, EMBASE, the Web of Science and Scopus until February 28,2013.Our search was restricted to studies in adult patients undergoing bariatric surgery with and without IVC filters. Primary outcomes were postoperative deep vein thrombosis(DVT),pulmonary embolism (PE),and postoperative mortality. Meta-analysis used random effects models to account for heterogeneity,and Sidik- Jonkman method to account for scarcity of outcomes and studies. Associations are shown as Relative Risks(RR) and 95% Confidence Intervals(CI). Results: Seven observational studies were identified (n=102,767), with weighted average inci- dences of DVT(0.9%),PE(1.6%),and mortality(1.0%)for a follow-up ranging from 3 weeks to 3 months. Use of IVC filters was associated with an approximately 3-fold higher risk of DVT and death that was nominally significant for the former outcome, but not the latter (RR2.81,95%CI 1.33-5.97, p=0.007; and RR 3.27,95%CI0.78-13.64, p=0.1, respectively);there was no difference in the risk of PE(RR1.02,95%CI0.31-3.77,p=0.9). Moderate to high heterogeneity of effects was noted across studies. Conclusions: Placement of IVC filter before bariatric surgery Is associated with higher risk of postoperative DVT and mortality. A similar risk of PE inpatients with and without IVC filter placement cannot exclude a benefit, given the potential large imbalance in risk at baseline.Ran- domized trials are needed before IVC placement can be recommended. (SurgObesRelatDis 2015;11:268-269.) r 2015 American Society for Metabolic and

  7. [Assessment of bariatric surgery results].

    Science.gov (United States)

    Barros, Lívia Moreira; Frota, Natasha Marques; Moreira, Rosa Aparecida Nogueira; de Araújo, Thiago Moura; Caetano, Joselany Áfio

    2015-03-01

    The objective was to evaluate the results of bariatric surgery in patients in the late postoperative period using the Bariatric Analysis and Reporting Outcome System (BAROS). This cross-sectional study was conducted from November 2011 to June 2012 at a hospital in the state of Ceará, Brazil. Data were collected from 92 patients using the BAROS protocol, which analyzes weight loss, improved comorbidities, complications, reoperations and Quality of Life (QoL). Data were analysed using the chi-squared test, Fischer's exact test and the Mann-Whitney test. There was a reduction in the Body Mass Index (47.2±6.8 kg/m2 in the pre-operatory and 31.3±5.0 kg/m2 after surgery, p<0.001). The comorbidity with the highest resolution was arterial hypertension (p<0.001), and QV improved in 94.6% of patients. The main complications were hair loss, incisional hernia and cholelithiasis. The surgery provided satisfactory weight loss and improvements in the comorbidities associated to a better QL. Use of the BAROS protocol allows nurses to plan interventions and maintain the good results. PMID:26098798

  8. Does bariatric surgery improve the patient´s quality of life? ¿La cirugía bariatrica mejora sensiblemente la calidad de vida del paciente?

    OpenAIRE

    Y. Martínez; M. D. Ruiz-López; Giménez, R.; A. J. Pérez de la Cruz; R. Orduña

    2010-01-01

    Objective: The aim of this investigation was to assess the effect of malabsorptive bariatric surgery (BS) on the quality of life (QoL), applying the Nottingham Health Profile (NHP) and the bariatric analysis and reporting outcome system (BAROS). Design: A prospective cohort study was performed in 100 adult patients (> 18 years) undergoing bariatric surgery by malabsorptive technique for one year. Research methods and procedures: Patients were monitored from the beginning of the BS program unt...

  9. Restoration of Glycemic Control in Patients with Type 2 Diabetes Following Bariatric Surgery is Associated with Reduction in Microparticles

    Science.gov (United States)

    Cheng, V.; Kashyap, S.R.; Schauer, P.R.; Kirwan, J.P.; McCrae, K.R.

    2011-01-01

    Background Microparticles bud from cellular elements during inflammation and are associated with vascular dysfunction related to type 2 diabetes. Although weight loss is known to reduce inflammation, the metabolic effects of bariatric surgery on microparticle concentration and composition are not known. Objectives To determine the effect of bariatric surgery on microparticle concentration and correlate these changes with clinical parameters. Setting Multispecialty group practice Methods We studied 14 obese subjects with type 2 diabetes two weeks before and at one and 12 months following bariatric surgery. Nine of the patients underwent Roux-en-Y gastric bypass and 5 received gastric restrictive surgery. Results One month following surgery, body mass index was reduced by ~10%, glycemic control improved dramatically (P 60% reduction in endothelial, platelet microparticles and CRP levels (P 50% reduction in monocyte microparticles compared to pre-surgery. The reduction in monocyte microparticles one month after surgery was strongly associated with the reduction in hemoglobin A1c (P < 0.05). The reduction in monocyte microparticles 12 months following surgery correlated strongly with the reduction in body mass index (P < 0.05). Conclusion The reduction in microparticles after bariatric surgery in patients with type 2 diabetes reflects an attenuation of inflammation and this mechanism may contribute to normalization of glycemic control. PMID:22093380

  10. Kidney Stone Risk Following Modern Bariatric Surgery

    OpenAIRE

    Gonzalez, Ricardo D.; Canales, Benjamin K.

    2014-01-01

    Over the past 10 years, a variety of reports have linked bariatric surgery to metabolic changes that alter kidney stone risk. Most of these studies were retrospective, lacked appropriate controls, or involved bariatric patients with a variety of inclusion criteria. Despite these limitations, recent clinical and experimental research has contributed to our understanding of the pathophysiology of stone disease in this high-risk population. This review summarizes the urinary chemistry profiles t...

  11. Stone formation and management after bariatric surgery.

    Science.gov (United States)

    Tarplin, Sarah; Ganesan, Vishnu; Monga, Manoj

    2015-05-01

    Obesity is a significant health concern and is associated with an increased risk of nephrolithiasis, particularly in women. The underlying pathophysiology of stone formation in obese patients is thought to be related to insulin resistance, dietary factors, and a lithogenic urinary profile. Uric acid stones and calcium oxalate stones are common in these patients. Use of surgical procedures for obesity (bariatric surgery) has risen over the past two decades. Although such procedures effectively manage obesity-dependent comorbidities, several large, controlled studies have revealed that modern bariatric surgeries increase the risk of nephrolithiasis by approximately twofold. In patients who have undergone bariatric surgery, fat malabsorption leads to hyperabsorption of oxalate, which is exacerbated by an increased permeability of the gut to oxalate. Patients who have undergone bariatric surgery show characteristic 24 h urine parameters including low urine volume, low urinary pH, hypocitraturia, hyperoxaluria and hyperuricosuria. Prevention of stones with dietary limitation of oxalate and sodium and a high intake of fluids is critical, and calcium supplementation with calcium citrate is typically required. Potassium citrate is valuable for treating the common metabolic derangements as it raises urinary pH, enhances the activity of stone inhibitors, reduces the supersaturation of calcium oxalate, and corrects hypokalaemia. Both pyridoxine and probiotics have been shown in small studies to reduce hyperoxaluria, but further study is necessary to clarify their effects on stone morbidity in the bariatric surgery population. PMID:25850790

  12. Timing of food intake is associated with weight loss evolution in severe obese patients after bariatric surgery

    OpenAIRE

    Ruíz-Lozano, T.; Vidal i Cortada, Josep; de Hollanda, A.; Scheer, F.A.J.L.; Garaulet, M.; Izquierdo Pulido, María Luz

    2016-01-01

    Background Recent research has demonstrated a relationship between the timing of food intake and weight loss in humans. However, whether the meal timing can be associated with weight loss in patients treated with bariatric surgery is unknown. Objective To evaluate the role of food-timing in the evolution of weight loss in a sample of 270 patients that underwent bariatric surgery with a follow-up of 6 years. Methods Participants (79% women; age [mean ± SD]: 52 ± 11 years; BMI: 46.5 ± 6.0 kg/m2...

  13. Single-incision laparoscopic bariatric surgery

    Directory of Open Access Journals (Sweden)

    Huang Chih-Kun

    2011-01-01

    Full Text Available Background: Bariatric surgery has been established as the best option of treatment for morbid obesity. In recent years single-incision laparoscopic surgery (SILS has emerged as another modality of carrying out the bariatric procedures. While SILS represents an advance, its application in morbid obesity at present is limited. In this article, we review the technique and results of SILS in bariatric surgery. Methods: The PubMed database was searched and totally 11 series reporting SILS in bariatric surgery were identified and analyzed. The case reports were excluded. Since 2008, 114 morbidly obese patients receiving SILS bariatric surgeries were reported. Results: The procedures performed included SILS gastric banding, sleeve gastrectomy and gastric bypass. No mortality was reported in the literatures. Sixteen patients (14.05% needed an additional incision for a liver retractor, a trocar or for conversion. Only one complication of wound infection was reported in these series. All the surgeons reported that the patients were highly satisfied with the scar. Conclusion: Because of abundant visceral and subcutaneous fat and multiple comorbidities in morbid obesity, it is more challenging for surgeons to perform the procedures with SILS. It is clear that extensive development of new instruments and technical aspects of these procedures as well as randomized studies to compare them with traditional laparoscopy are essential before these procedures can be utilized in day-to-day clinical practice.

  14. [Bariatric surgery in Denmark.

    DEFF Research Database (Denmark)

    Funch-Jensen, P.; Iversen, M.G.; Kehlet, H.

    2008-01-01

    private centres that have entered into an agreement with Danish Regions. Since the operative access and selection of procedures varies between departments we conclude that research should be a firm requirement for all centres, and that research efforts should comprise cooperation concerning the database...... data from the National Patient Registry in the period from 2005 through 2007: annual number of operations, type of operation, laparoscopic versus open procedure. Furthermore, the centres were compared. RESULTS: A total of 2,098 bariatric procedures were performed in the years 2005 to 2007. Apart from a...... departments fulfilled the recommendation from the NBH of a minimum of 100 annual operations. The proportion of banding procedures performed at private clinics was significantly lower than the proportion performed at public hospitals. Significantly more open operations were performed at private clinics, a...

  15. Treatment of Adult Obesity with Bariatric Surgery.

    Science.gov (United States)

    Schroeder, Robin; Harrison, T Daniel; McGraw, Shaniqua L

    2016-01-01

    In 2013, approximately 179,000 bariatric surgery procedures were performed in the United States, including the laparoscopic sleeve gastrectomy (42.1%), Roux-en-Y gastric bypass (34.2%), and laparoscopic adjustable gastric banding (14.0%). Choice of procedure depends on the medical conditions of the patient, patient preference, and expertise of the surgeon. On average, weight loss of 60% to 70% of excess body weight is achieved in the short term, and up to 50% at 10 years. Remission of type 2 diabetes mellitus occurs in 60% to 80% of patients two years after surgery and persists in about 30% of patients 15 years after Roux-en-Y gastric bypass. Other obesity-related comorbidities are greatly reduced, and health-related quality of life improves. The Roux-en-Y procedure carries an increased risk of malabsorption sequelae, which can be minimized with nutritional supplementation and surveillance. Overall, these procedures have a mortality risk of less than 0.5%. Cohort studies show that bariatric surgery reduces all-cause mortality by 30% to 50% at seven to 15 years postsurgery compared with patients with obesity who did not have surgery. Dietary changes, such as consuming protein first at every meal, and regular physical activity are critical for patient success after bariatric surgery. The family physician is well positioned to counsel patients about bariatric surgical options, the risks and benefits of surgery, and to provide long-term support and medical management postsurgery. PMID:26760838

  16. Gastrointestinal changes after bariatric surgery.

    Science.gov (United States)

    Quercia, I; Dutia, R; Kotler, D P; Belsley, S; Laferrère, B

    2014-04-01

    Severe obesity is a preeminent health care problem that impacts overall health and survival. The most effective treatment for severe obesity is bariatric surgery, an intervention that not only maintains long-term weight loss but also is associated with improvement or remission of several comorbidies including type 2 diabetes mellitus. Some weight loss surgeries modify the gastrointestinal anatomy and physiology, including the secretions and actions of gut peptides. This review describes how bariatric surgery alters the patterns of gastrointestinal motility, nutrient digestion and absorption, gut peptide release, bile acids and the gut microflora, and how these changes alter energy homeostasis and glucose metabolism. PMID:24359701

  17. Pregnancy after Bariatric Surgery: A Review

    OpenAIRE

    Eugene Oteng-Ntim; Hezelgrave, N. L.

    2011-01-01

    Maternal obesity is a major cause of obstetric morbidity and mortality. With surgical procedures to facilitate weight loss becoming more widely available and demanded and increasing number of women becoming pregnant after undergoing bariatric surgery, it is important and timely to consider the outcome of pregnancy following bariatric surgery. This paper aims to synthesize the current evidence regarding pregnancy outcomes after bariatric surgery. It concludes that bariatric surgery appears to ...

  18. A Cognitive-Behavioral Mindfulness Group Therapy Intervention for the Treatment of Binge Eating in Bariatric Surgery Patients

    Science.gov (United States)

    Leahey, Tricia M.; Crowther, Janis H.; Irwin, Sharon R.

    2008-01-01

    Binge eating is a negative indicator of post-surgical weight loss and health outcome in bariatric surgery patients (Hsu, Bentancourt, Sullivan, 1996). Cognitive-behavioral techniques and mindfulness-based practices have been shown to successfully treat binge eating (Agras, Telch, Arnow, Eldredge, & Marnell, 1997; Kristeller & Hallett, 1999). This…

  19. Employment and Professional Outcomes in 803 Patients Undergoing Bariatric Surgery in a French Reference Center for Obesity

    Directory of Open Access Journals (Sweden)

    Q Durand-Moreau

    2015-03-01

    Full Text Available Background: Very few studies have been performed on small populations about the links between employment and bariatric surgery.Objective: To determine if rates of employment are increased among patients who have undergone bariatric surgery, to assess their post-operative health consequences (post-prandial weakness, diarrhea, and patients' ability to maintain post-operative advice (ie, 30 minutes of daily physical activity, 6 small meals daily compared to non-employed post-surgical patients.Methods: This cross-sectional study was performed in the Regional Reference Centre for Obesity, which is a partnership between the University Hospital and a clinic in Angers, France during 2012 using a self-administrated questionnaire completed by patients hospitalized for post-operative follow-ups after bariatric surgery. Issues investigated were their professional situation before and after the surgery, compliancy to post-operative advice, and any postoperative side effects.Results: Employment rates were 64.4% before and 64.7% after the surgery (p=0.94. Of these, 30.6% maintained 30 minutes of daily physical activity vs. 41.0% of non-workers (p=0.02. 50.5% of employed patients and 57.3% of non-workers maintained 6 small meals a day after surgery (p=0.09. 8% of working patients reported post-prandial weaknesses and 8% reported diarrhea that caused problems at work.Conclusion: Employment rate remained stable after surgery. Having a job seemed to be an obstacle to managing 30 minutes of daily exercise, especially among women, but not maintaining 6 small meals a day. Therefore, working environment needs to be assessed to improve job quality and retention for patients who have undergone bariatric surgery.

  20. Relevance of Adipose Tissue Stiffness Evaluated by Transient Elastography (AdipoScan™) in Morbidly Obese Patients before Bariatric Surgery

    Science.gov (United States)

    Sasso, Magali; Abdennour, Meriem; Liu, Yuejun; Hazrak, Hecham; Aron-Wisnewsky, Judith; Bouillot, Jean-Luc; Le Naour, Gilles; Bedossa, Pierre; Torjman, Joan; Clément, Karine; Miette, Véronique

    Subcutaneous adipose tissue (scAT) in human obesity undergoes severe alteration such as fibrosis which is related to metabolic alterations and to less efficiency in losing weight after bariatric surgery. There is currently no non-invasive tool to assess fibrosis in scAT. Vibration Controlled Transient Elastography (VCTE) using FibroScan® is widely used to assess liver fibrosis in clinical practice. A novel device named AdipoScan™ which is based on VCTE has been developed by Echosens (Paris) so as to assess scAT. The objective of this study is to show the first AdipoScan clinical results. AdipoScan™ was assessed in vivo on 73 morbidly obese patients candidate for bariatric surgery who were enrolled in the Pitié Salpêtrière hospital. scAT shear wave speed measured by AdipoScan™ is significantly associated with scAT fibrosis, gender, hypertension status, total body fat mass assessed by DXA, hypertension status, glycemic, lipid, hepatic parameters and adiponectin. Results suggest that scAT evaluation before bariatric surgery can be useful in clinical practice since it is related to scAT fibrosis -who plays in role in weight loss resistance after bariatric surgery- and to obesity induced co-morbidities such as diabetes, hypertension liver dysfunction.

  1. Eating Disorders in obese patients seeking bariatric surgery: aspects of mental health before and afterweight-loss treatment

    OpenAIRE

    Dahl, Jens Kornelius

    2014-01-01

    Background: An increasing number of obese patients are seeking surgical weight-loss treatments. Health-care workers need more knowledge about the various characteristics of these patients, and how they should be treated. Prior to bariatric surgery, those with Eating Disorders (EDs) showed impaired psychological functioning in several areas when compared with those without EDs. Some studies have shown that patients with EDs also have less success in the weight loss interventions. The present t...

  2. Cardiac dual-source CT for the preoperative assessment of patients undergoing bariatric surgery

    International Nuclear Information System (INIS)

    Aim: To assess the diagnostic value of coronary dual-source computed tomography (DSCT) as a comprehensive, non-invasive tool in the preoperative cardiac evaluation of patients undergoing bariatric surgery. Materials and methods: Thirty consecutive obese [average body mass index (BMI): 45 ± 7.6, range: 35–59] patients (24 women; six men; median age: 52 ± 15 years) were enrolled in this institutional review board (IRB)-approved, Health Insurance Portability and Accountability Act of 1996 (HIPAA)-compliant prospective study. Calcium scoring (CaS) and electrocardiography (ECG)-gated images of the coronary arteries were obtained with a large body habitus protocol (120 kV; 430 mAs; 100 ml iodinated contrast medium at 7 ml/s injection rate) on a DSCT machine. Qualitative (four-point: 1 = excellent to 4 = not delineable) coronary segmental analysis, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) measurements were performed. The presence and degree of vascular disease (four-grade scale: mild to severe) was correlated with CaS and cardiovascular (CV) risk stratification blood tests. In patients with severe stenosis (>70%), findings were compared with cardiac nuclear medicine imaging (single photon-emission computed tomography; SPECT) imaging. Results: The average HR, enhancement, and quality score were 64 ± 7 beats/min, 288 ± 66 HU and 1.8 ± .5, respectively. Ninety-three percent (417/450) of the coronary segments were rated diagnostic. The SNRs and CNRs were 17 ± 9 and 12 ± 7 for the right coronary artery; 17 ± 8 and 12 ± 7 for the left main coronary artery; 16 ± 9 and 11 ± 7 for the left anterior descending coronary artery; and 15 ± 7 and 10 ± 6 for the left circumflex coronary artery. Ten of the 30 patients (33%) demonstrated coronary artery disease (CAD) of which two (6%) showed three-vessel disease. Four (13%) patients showed severe disease: in three of which the presence of significant stenosis was confirmed by SPECT and by catheter

  3. COMPLICATIONS REQUIRING HOSPITAL MANAGEMENT AFTER BARIATRIC SURGERY

    OpenAIRE

    WRZESINSKI, Aline; CORRÊA, Jéssica Moraes; FERNANDES, Tainiely Müller Barbosa; MONTEIRO, Letícia Fernandes; TREVISOL, Fabiana Schuelter; do NASCIMENTO, Ricardo Reis

    2015-01-01

    Background: The actual gold standard technique for obesity treatment is the Roux-en-Y gastric bypass. However, complications may occur and the surgeon must be prepared for them. Aim: To evaluate retrospectively the complications occurrence and associated factors in patients who underwent bariatric surgery. Methods: In this study, 469 medical charts were considered, from patients and from data collected during outpatient consultations. The variables considered were gender, age, height, pre-ope...

  4. Pregnancy after Bariatric Surgery: A Review

    Directory of Open Access Journals (Sweden)

    N. L. Hezelgrave

    2011-01-01

    Full Text Available Maternal obesity is a major cause of obstetric morbidity and mortality. With surgical procedures to facilitate weight loss becoming more widely available and demanded and increasing number of women becoming pregnant after undergoing bariatric surgery, it is important and timely to consider the outcome of pregnancy following bariatric surgery. This paper aims to synthesize the current evidence regarding pregnancy outcomes after bariatric surgery. It concludes that bariatric surgery appears to have positive effects on fertility and reduces the risk of gestational diabetes and preeclampsia. Moreover, there appears to be a reduced incidence of fetal macrosomia post-bariatric procedure, although there remains uncertainty about the increased rates of small-for-gestational age and intrauterine growth restricted infants, as well as premature rupture of membranes in this group. A number of case reports highlight that pregnancy following bariatric surgery is not without complications and it must be managed as high risk by the multidisciplinary team.

  5. Patient dose during radiological examination in the follow-up of bariatric surgery

    International Nuclear Information System (INIS)

    A patient dose survey was carried out measuring the kerma-area product (KAP) values during radiological evaluation in the follow-up of bariatric surgery. The procedures were performed by three radiologists to adjust laparoscopic gastric bands and to detect postoperative complications after Roux-en-Y gastric bypass procedures to treat morbid obesity. Total fluoroscopy time, exposure factors and the overall contribution of fluoroscopy to the accumulated KAP value were recorded. The median KAP values were used to estimate organ doses and effective dose to a standard patient; the radiation risk associated with the procedures was also evaluated. The doses were smaller for one of the three radiologists, owing to a more appropriate beam collimation and a reduction of the screening time. The KAP values ranged from 1.6 to 7.1 Gy cm2 for the laparoscopic adjustable gastric banding management, and from 3.0 and 8.3 Gy cm2 for the radiological examinations after gastric bypass. As a whole, the effective doses associated to these procedures were between 0.5 and 2.7 mSv. The organs receiving the highest doses were not only breast, stomach, pancreas and liver, but also lungs, owing to of their high radiosensitivity, significantly contributed to the effective dose. (authors)

  6. NONALCOHOLIC FATTY LIVER DISEASE IN SEVERE OBESE PATIENTS, SUBJECTED TO BARIATRIC SURGERY

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    Alexandre LOSEKANN

    2013-12-01

    Full Text Available Context Nonalcoholic fatty liver disease encompasses a spectrum of histopathological changes that range from simple steatosis to nonalcoholic steatohepatitis. Works suggest that iron (Fe deposits in the liver are involved in the physiopathology of nonalcoholic steatohepatitis. Objective The aim of this study was to determine the prevalence of simple steatosis and nonalcoholic steatohepatitis in patients with morbid obesity, subjected to bariatric surgery and to establish a correlation of the anatomopathological findings with the presence of liver fibrosis. Methods A total of 250 liver biopsies were conducted in the transoperation of the surgeries. Results Steatosis was present in 226 (90.4% of the samples, 76 (30.4% being classified as mild; 71 (28.4% as moderate and 79 (31.6% as intense. Nonalcoholic steatohepatitis was diagnosed in 176 (70.4% cases, where 120 (48.4% were mild; 50 (20% were moderate, and 6 (2.4% cases were intense. Fibrosis was referred to in 108 (43.2% biopsies, 95 of which (38% were mild; 2 (0.8% were moderate; 7 (2.8% were intense, and cirrhosis was diagnosed in 4 (1.6% cases. There was a correlation between the degree of steatosis and the level of inflammatory activity (rs = 0.460; P<0.001 and between the degree of this activity and the degree of fibrosis (rs = 0.583; P<0.001. Only 13 (5.2% samples showed Fe deposits. Conclusion There is a high prevalence of nonalcoholic steatohepatitis in these patients and a positive correlation of the degrees of nonalcoholic steatohepatitis with the intensity of fibrosis. The low prevalence of Fe deposits found makes it questionable that the presence of this ion has any participation in the physiopathogeny of nonalcoholic fatty liver disease.

  7. Prevalence of Helicobacter pylori infection in a group of morbidly obese Saudi patients undergoing bariatric surgery: A preliminary report

    Directory of Open Access Journals (Sweden)

    Al-Akwaa Ahmad

    2010-01-01

    Full Text Available Background/Aim: Earlier reports from Saudi Arabia have shown high prevalence of Helicobacter pylori infection. However, recent studies have documented a reduction in the infection prevalence. No prior study has assessed the prevalence in morbidly obese Saudi patients. We aimed to study the prevalence of H. pylori infection in a group morbidly obese Saudi patients referred for endoscopy prior to bariatric surgery. Materials and Methods: We retrospectively reviewed the medical records of all patients who were referred for upper endoscopy prior to bariatric surgery from June 2006 to September 2008. All data were recorded including patient′s demographics, comorbid conditions, endoscopic and histological findings. Results: There were 62 patients included, 20 males and 42 females. The mean age was 34 years (range 18 - 51 with a mean BMI of 55 Kg/m 2 (range 35 -92. H. pylori were present in 53 patients (85.5% with chronic active gastritis. All patients with positive H. pylori had chronic gastritis of variable severity. Intestinal metaplasia was present in 5%. The prevalence of H. pylori infection was similar in patients with and without co-morbid conditions. Main endoscopic findings were gastritis in 67.7%, hiatus hernia in 13%, and gastric erosions in 13%. No patient had duodenal or gastric ulcer. Conclusions: There is a high prevalence of H. pylori infection in morbidly obese Saudi patients undergoing bariatric surgery being referred for upper GI endoscopy. Further prospective studies are needed to evaluate the clinical implication and benefit of eradication treatment of infection in these patients.

  8. The Application of Transcutaneous CO2 Pressure Monitoring in the Anesthesia of Obese Patients Undergoing Laparoscopic Bariatric Surgery

    OpenAIRE

    Liu, Shijiang; Sun, Jie; Chen, Xing; Yu, Yingying; Liu, Xuan; Liu, Cunming

    2014-01-01

    To investigate the correlation and accuracy of transcutaneous carbon dioxide partial pressure (PTCCO2) with regard to arterial carbon dioxide partial pressure (PaCO2) in severe obese patients undergoing laparoscopic bariatric surgery. Twenty-one patients with BMI>35 kg/m2 were enrolled in our study. Their PaCO2, end-tidal carbon dioxide partial pressure (PetCO2), as well as PTCCO2 values were measured at before pneumoperitoneum and 30 min, 60 min, 120 min after pneumoperitoneum respectively. ...

  9. PS1-48: A Patient-centered Electronic Education Tool for Establishing Weight Loss Expectations after Bariatric Surgery

    Science.gov (United States)

    Wood, G. Craig; Benotti, Peter; Gerhard, Glenn; Zaccone, Richard; Zhang, Yushan; Miller, Elaina; Still, Christopher

    2014-01-01

    Background/Aims Bariatric surgery candidates often struggle when deciding between intensive lifestyle therapy, pharmacological therapy, and/or bariatric surgery for achieving their long-term weight loss (WL) goals. Moreover, they often have unrealistic WL expectations prior to surgery. Despite huge individual variation in surgically induced WL, patient education is currently based on average WL results derived from program experience or published literature. Improved patient education tools are needed to provide realistic individual expectations for surgical WL. The purpose of this study was to develop an electronic application for patient education that can aid in surgical decisions, establishing realistic WL goals, and monitoring WL success. Methods Post-operative weight measurements from 2608 Roux-en-Y gastric bypass patients at Geisinger Clinic were collected over an eight year period. While accounting for surgical BMI and age, quantile regression was used to create expected WL curves (10th, 25th, 50th, 75th, and 90th %tile) for the 36 month post-operative period. Results A mobile application (Get-2-Goal) was designed to provide a simple, personalized interface that allows patients to track their WL and compare their WL results to their expected WL curves. Get-2-Goal was made publicly available at no cost on a popular Apps store and is compatible with current smartphone and tablet technology (>1000 downloads to date). Get-2-Goal allows patients to input their personal profile (e.g. age, BMI), review their expected WL, and track their WL post-operatively. Patients have the option of saving a graphic containing their personalized WL curves and e-mailing a tabular form of their WL results to family, friends, and/or care providers. Conclusions Get-2-Goal is a simple tool that may be used by Bariatric Surgery Programs to facilitate electronic patient education. This tool may assist patients in deciding to proceed to WL surgery, and will facilitate early

  10. Effectiveness of a Cognitive Behavioral Therapy for Dysfunctional Eating among Patients Admitted for Bariatric Surgery: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Hege Gade

    2014-01-01

    Full Text Available Objective. To examine whether cognitive behavioral therapy (CBT alleviates dysfunctional eating (DE patterns and symptoms of anxiety and depression in morbidly obese patients planned for bariatric surgery. Design and Methods. A total of 98 (68 females patients with a mean (SD age of 43 (10 years and BMI 43.5 (4.9 kg/m2 were randomly assigned to a CBT-group or a control group receiving usual care (i.e., nutritional support and education. The CBT-group received ten weekly intervention sessions. DE, anxiety, and depression were assessed by the TFEQ R-21 and HADS, respectively. Results. Compared with controls, the CBT-patients showed significantly less DE, affective symptoms, and a larger weight loss at follow-up. The effect sizes were large (DE-cognitive restraint, g=-.92, P≤.001; DE-uncontrolled eating, g=-.90, P≤.001, moderate (HADS-depression, g=-.73, P≤.001; DE-emotional eating, g=-.67, P≤.001; HADS-anxiety, g=-.62, P=.003, and low (BMI, g=-.24, P=.004. Conclusion. This study supports the use of CBT in helping patients preparing for bariatric surgery to reduce DE and to improve mental health. This clinical trial is registered with NCT01403558.

  11. Aortic rupture during reoperative bariatric surgery

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    Sorin Hostiuc

    2015-08-01

    Full Text Available Abstract Morbid obesity has become a very common problem worldwide, causing severe health-related consequences including cardiovascular or metabolic diseases, arthritis, sleep apnea, or an increased risk of cancer. Bariatric surgery was shown to be the only way to achieve sustainable weight loss and to decrease the frequency and severity of metabolic and cardiovascular comorbidities. The purpose of this article is to present a case of bariatric surgery complicated with lesion of the aorta with a lethal outcome.

  12. Methylation and Expression of Immune and Inflammatory Genes in the Offspring of Bariatric Bypass Surgery Patients

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    Frédéric Guénard

    2013-01-01

    Full Text Available Background. Maternal obesity, excess weight gain and overnutrition during pregnancy increase risks of obesity, type 2 diabetes mellitus, and cardiovascular disease in the offspring. Maternal biliopancreatic diversion is an effective treatment for severe obesity and is beneficial for offspring born after maternal surgery (AMS. These offspring exhibit lower severe obesity prevalence and improved cardiometabolic risk factors including inflammatory marker compared to siblings born before maternal surgery (BMS. Objective. To assess relationships between maternal bariatric surgery and the methylation/expression of genes involved in the immune and inflammatory pathways. Methods. A differential gene methylation analysis was conducted in a sibling cohort of 25 BMS and 25 AMS offspring from 20 mothers. Following differential gene expression analysis (23 BMS and 23 AMS, pathway analysis was conducted. Correlations between gene methylation/expression and circulating inflammatory markers were computed. Results. Five immune and inflammatory pathways with significant overrepresentation of both differential gene methylation and expression were identified. In the IL-8 pathway, gene methylation correlated with both gene expression and plasma C-reactive protein levels. Conclusion. These results suggest that improvements in cardiometabolic risk markers in AMS compared to BMS offspring may be mediated through differential methylation of genes involved in immune and inflammatory pathways.

  13. Influence of Bariatric Surgery on Remission of Type 2 Diabetes

    Directory of Open Access Journals (Sweden)

    Paweł Nalepa

    2011-12-01

    Full Text Available The plague of obesity afflicts an increasing group of people. Moreover type 2 diabetes, which is the most serious illness accompanying excessive weight, is becoming more and more common. Traditional methods of obesity treatment, such as diet and physical exercise, fail. This applies especially to people with class III obesity. The only successful way of treating obesity in their case is bariatric surgery. There are three types of bariatric surgery: restrictive procedures (reducing stomach volume, malabsorptive procedures, and mixed procedures, which combine both methods. In spite of the risk connected with the surgery and complications after it, bariatric procedures are advised to patients with class III obesity and class II with an accompanying illness which increases the probability of death. It has been proved that bariatric surgery not only eliminates obesity but also very frequently (in 90�0of cases leads to the remission of type 2 diabetes. Moreover, the remission occurs very fast – it takes place a long time before the patients reduce their weight, even within a few days after surgery. Detailed studies have shown that the remission of diabetes is caused mostly by the change of the gastro-intestinal hormones’ profile, resulting from the surgery. These hormones include GLP-1, GIP, peptide YY, ghrelin and oxyntomodulin. Additionally, the change of the amount of adipose tissue after the surgery influences the level of adipokines, i.e. the hormones of the adipose tissue, among which the most important are leptin, adiponectin and resistin. Thus, bariatric surgery not only changes the shape of the gastrointestinal tract but it also modulates the hormonal activity. Bariatric surgery is considered as therapy not only for the obese but also for diabetic patients.

  14. Techniques, assessment, and effectiveness of bariatric surgery in combating obesity

    Directory of Open Access Journals (Sweden)

    Dimitrios K Papamargaritis

    2010-10-01

    Full Text Available Dimitrios K Papamargaritis, Dimitrios J Pournaras, Carel W Le RouxImperial Weight Centre, Imperial College London, London, UKAbstract: Obesity is an epidemic disease, and its prevalence is predicted to rise in the future. Many health and social comorbidities, such as cardiovascular disease, type 2 diabetes mellitus, cancer, nonalcoholic fatty liver disease, arthritis, infertility, eating disorders, unemployment, and low quality of life, have been associated with obesity. Nowadays, bariatric surgery is the only effective treatment for severe obesity. An increasing body of literature demonstrates significant remission of obesity-related comorbidities and an increase in life expectancy after surgical treatment. Unfortunately, serious complications can appear after surgery, and the careful preoperative assessment of patients is necessary to estimate the indications and contraindications of bariatric surgery. Recent studies report the lower complication and mortality rates when bariatric procedures are performed in high-volume centers. The purpose of this review is to describe the techniques of the currently used surgical procedures and the clinical effectiveness of bariatric surgery. Additionally, the possible complications and mortality rates after bariatric surgery are discussed.Keywords: obesity, surgery, assessment, clinical effectiveness, complications

  15. Preoperative and Postoperative (1st and 3rd Month Metabolic Data of Patients Who Underwent Bariatric Surgery

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    Nilüfer Özdemir Kutbay

    2015-03-01

    Full Text Available Purpose: The growing prevalence of obesity has become a major concern. The efficacy of medical treatment, diet and behavior therapy in morbidly obese patients is limited. Obesity surgery is a treatment option for selected morbidly obese patients. Material and Method: Data of 47 patients (n=39 women, 8 men who underwent bariatric surgery were investigated. Results: Out of 47 patients, 20 underwent Roux-en-Y gastric bypass (RYGB (43% and 27 had sleeve gastrectomy (SG (57%. The mean age of the patients was 37±9.5 (19-59 years. 17% of patients were men and 83% were women. In the analysis of data on weight that could be found for 31 out of 47 patients, we detected preoperative and postoperative (1st and 3rd month mean weight values as 125.4±15.9 kg, 112.7±13.2 kg (p<0.001 and 100.9±17.5 kg (p<0.001, respectively. In addition, the analysis of the data on mean fasting plasma glucose (FPG levels which could be found for 23 out of 47 patients, showed us that preoperative and postoperative (1st and 3rd month FPG levels were 100.9±17.5 mg/dL, 91.6±10.9 mg/dL (p=0.03 and 87.3±2.0 mg/dL, respectively. Only 1 patient had diabetes before the surgery. In the RYGB group, the mean change in weight was 12.4±5.5 kg in the 1st month and 22.2±8.6 kg in the 3rd month (compared to the weights in the preoperative period. Moreover, in the SG group, the mean change in weight was 13.7±4.5 kg in the 1st month and 23.4±5.8 kg in the 3rd month. No statistically significant difference was found between the weight changes in the 1st and the 3rd month as for surgery types. Discussion: After bariatric surgery, significant loss in weight and reduction in FPG occurred in short-term.

  16. Glucose Regulation and Cognitive Function after Bariatric Surgery

    Science.gov (United States)

    Galioto, Rachel; Alosco, Michael L.; Spitznagel, Mary Beth; Strain, Gladys; Devlin, Michael; Cohen, Ronald; Crosby, Ross D.; Mitchell, James E.; Gunstad, John

    2016-01-01

    Introduction Obesity is associated with cognitive impairment and bariatric surgery has been shown to improve cognitive functioning. Rapid improvements in glycemic control are common after bariatric surgery and likely contribute to these cognitive gains. We examined whether improvements in glucose regulation are associated with better cognitive function following bariatric surgery. Method A total of 85 adult bariatric surgery patients underwent computerized cognitive testing and fasting blood draw for glucose, insulin, and glycated hemoglobin (HbA1c) at baseline and 12 month post-operatively. Results Significant improvements in both cognitive function and glycemic control were observed among patients. After controlling for and baseline factors, 12-month homeostatic model assessment of insulin resistance HOMA-IR predicted 12-month digits backward (β = −.253, p < .05), switching of attention- A (β = .156, p < .05), and switching of attention-B (β = −.181, p < .05). Specifically, as HOMA-IR decreased over time, working memory, psychomotor speed, and cognitive flexibility improved. Decreases in HbA1c were not associated with post-operative cognitive improvements. After controlling for baseline cognitive test performance, changes in BMI were also not associated with 12-month cognitive function. Conclusions Small effects of improved glycemic control on improved aspects of attention and executive function were observed following bariatric surgery among severely obese individuals. Future research is needed to identify the underlying mechanisms for the neurocognitive benefits of these procedures. PMID:25875124

  17. Bariatric surgery - effects on obesity and related co-morbidities

    DEFF Research Database (Denmark)

    Svane, Maria Saur; Madsbad, Sten

    2014-01-01

    Laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (SG) are the three most commonly performed bariatric procedures. Obesity responds well to bariatric surgery, with major long-lasting weight loss that is most pronounced...... vitamins and minerals, and anemia. Some patients have dumping after meals, and a few patients will develop postprandial hypoglycemia after RYGB. About 25% of patients require plastic surgery to provide relief from excessive skin tissue.......Laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (SG) are the three most commonly performed bariatric procedures. Obesity responds well to bariatric surgery, with major long-lasting weight loss that is most pronounced...... hormone responses, especially a 10-fold increase in glucagon-like peptide-1 (GLP-1), which improves insulin secretion. After gastric banding, the remission of diabetes depends more on weight loss. Bariatric surgery reduces cardiovascular risk factors including hypertension, lipid disturbances, non...

  18. The application of transcutaneous CO2 pressure monitoring in the anesthesia of obese patients undergoing laparoscopic bariatric surgery.

    Science.gov (United States)

    Liu, Shijiang; Sun, Jie; Chen, Xing; Yu, Yingying; Liu, Xuan; Liu, Cunming

    2014-01-01

    To investigate the correlation and accuracy of transcutaneous carbon dioxide partial pressure (PTCCO2) with regard to arterial carbon dioxide partial pressure (PaCO2) in severe obese patients undergoing laparoscopic bariatric surgery. Twenty-one patients with BMI>35 kg/m(2) were enrolled in our study. Their PaCO2, end-tidal carbon dioxide partial pressure (PetCO2), as well as PTCCO2 values were measured at before pneumoperitoneum and 30 min, 60 min, 120 min after pneumoperitoneum respectively. Then the differences between each pair of values (PetCO2-PaCO2) and. (PTCCO2-PaCO2) were calculated. Bland-Altman method, correlation and regression analysis, as well as exact probability method and two way contingency table were employed for the data analysis. 21 adults (aged 19-54 yr, mean 29, SD 9 yr; weight 86-160 kg, mean 119.3, SD 22.1 kg; BMI 35.3-51.1 kg/m(2), mean 42.1,SD 5.4 kg/m(2)) were finally included in this study. One patient was eliminated due to the use of vaso-excitor material phenylephrine during anesthesia induction. Eighty-four sample sets were obtained. The average PaCO2-PTCCO2 difference was 0.9 ± 1.3 mmHg (mean ± SD). And the average PaCO2-PetCO2 difference was 10.3 ± 2.3 mmHg (mean ± SD). The linear regression equation of PaCO2-PetCO2 is PetCO2 = 11.58+0.57 × PaCO2 (r(2) = 0.64, Ptranscutaneous carbon dioxide monitoring provides a better estimate of PaCO2 than PetCO2 in severe obese patients undergoing laparoscopic bariatric surgery. PMID:24699267

  19. Bariatric surgery: assessing opportunities for value innovation.

    Science.gov (United States)

    Tarantino, David P; Smith, Darlene B

    2005-03-01

    Obesity has been increasing over the past two decades, and the amount of medical and media attention given to bariatric surgery as a promising option for morbidly obese individuals is growing. The growth of bariatric surgery also has been attributed to improved surgical technique, the increase in surgeons trained in laparoscopic procedures, as well increased public awareness with celebrities having successfully undergone surgery. The number of surgeons and hospitals offering bariatric services is increasing. How then does a surgeon or a hospital develop a competitive strategy? The first step is to understand the health-care industry. The key forces are rivalry among present competitors, and the bargaining power of suppliers and buyers. While bariatric surgery currently is in a growth phase, time and competition will force practitioners to compete on the basis of price, unless they find true competitive advantage. Value innovation, is a means of creating new marketing space by looking across the conventionally defined boundaries of business--across substitute industries, across strategic groups, across buyer groups, across complementary product and service offerings, and across the functional-emotional orientation of an industry. One can compete by offering similar services focusing primarily on cost efficiencies as the key to profitability. Alternatively, one can break free from the pack by innovating and focusing on delivering superior value to the customer. As the market for bariatric surgery becomes increasingly overcrowded, profitable growth is not sustainable without developing a clear differential advantage in the market. Value innovation allows you to develop that advantage. PMID:15846452

  20. Cirugía Bariátrica, Cirugía Colorrectal e Internet: ¿Pacientes (desinformados? Bariatric surgery, colorectal surgery and the internet: (Uninformed patients?

    Directory of Open Access Journals (Sweden)

    M. Elisa De Castro Peraza

    2009-12-01

    Full Text Available Introducción: El uso de Internet por los pacientes se incrementa buscando información. Evaluamos una cohorte de pacientes de cirugía bariátrica y otra de colorrectal. Objetivo: Conocer patrones de uso de Internet de pacientes bariátricos y colorrectales. Método: Preguntas a 60 pacientes de bariátrica recogiendo edad, género, nivel académico y patrones de uso de Internet comparados con 61 pacientes de colorrecto. Resultados principales: Los pacientes de bariátrica usan más Internet para informarse, destacando universitarios y mujeres. Los pacientes afirman que la información encontrada les resulta útil para el conocimiento y la toma de decisiones aunque refieran como dudosa y hasta peligrosa alguna información encontrada. Conclusiones: El uso incrementado de Internet favorece a la comunidad quirúrgica permitiendo llegar a más pacientes pero puede ser una fuente de desinformación, creando perspectivas erróneas. Un mejor entendimiento del uso que el paciente hace de Internet y de la información que encuentra permitirá mejorar el cuidado.Introduction: Internet use by patients seeking information increases. We evaluated a cohort of patients for bariatric surgery and another of colorectal. Aim: Knowing patterns of Internet use in colorectal and bariatric patients. Method: 60 questions to gather bariatric patients age, gender, educational level and patterns of Internet use compared with 61 patients of colorectum. Main results: Bariatric patients used the Internet to learn more, leading academics and women. Patients say that they found the information useful for understanding and decision making as suspect and even relate to any dangerous information found. Conclusions: The increased use of the Internet favors the surgical community to reach more patients but can be a source of misinformation, creating prospects wrong. A better understanding of the patient makes use of the Internet and found information that will improve care.

  1. Evaluation of medical and health economic effectiveness of bariatric surgery (obesity surgery versus conservative strategies in adult patients with morbid obesity

    Directory of Open Access Journals (Sweden)

    von der Schulenburg, Johann-Matthias

    2008-07-01

    Full Text Available Background: Obesity with its associated medical, psychological, social, and economic complications is considered a chronic, multifactorial disorder. Given the magnitude of the challenge obesity, there is a clear need for preventive as well as therapeutic measures and strategies on an individual and a public health level. Objectives: The goal of this health technology assessment (HTA-report is to summarise the current literature on bariatric surgery, to evaluate their medical effectiveness/efficacy and cost-effectiveness as well as the ethical, social and legal implications of these procedures in comparison to conventional therapies and compared to each other. Methods: Relevant publications are identified by means of a structured search of databases accessed on 13.11.2006 and an update conducted on 12.11.2007. In addition, a manual search of identified reference lists is conducted. The present report includes German and English literature published since 2001 and targeting adult subjects with morbid obesity (body mass index (BMI >=40 kg/m² or BMI >=35 kg/m² with severe comorbidities. The methodological quality of studies included is assessed according to pre-defined quality criteria by two independent scientists. Results: Among 5910 retrieved publications, 25 medical articles, as well as seven health economic studies meet the inclusion criteria. The medical studies show a superior weight loss following bariatric surgery compared to conventional therapy. Malabsorptive procedures lead to a more profound weight loss than purely restrictive procedures. Weight reduction in general is accompanied by a reduced frequency of comorbidities (mostly diabetes type 2. The evidence is not sufficient to quantify these effects for individual procedures or to assess long-term outcomes. However, recent studies show a profound survival benefit for surgically treated patients up to a period of eleven years. The economic studies illustrate that bariatric surgery is

  2. Bariatric Surgery in Women: A Boon Needs Special Care During Pregnancy.

    Science.gov (United States)

    Kumari, Archana; Nigam, Aruna

    2015-11-01

    Obesity is one of the leading causes of health related disorder and has reached epidemic proportions not only in developed nations but also in developing countries like India. Bariatric surgery has become a popular alternative for obese women planning pregnancy. A multidisciplinary approach involving the obstetrician, the bariatric surgeon and the nutritionist is required to manage pregnancy following bariatric surgery. Early consultation should be done to determine baseline nutritional status and the importance of regular check-ups must be explained. Nutritional supplementation should be tailored to the patient's status and the type of bariatric surgery performed. PMID:26672514

  3. Benefits of Bariatric Surgery and Perioperative Surgical Safety

    Directory of Open Access Journals (Sweden)

    Ji Chung Tham

    2015-11-01

    Full Text Available Obesity is a worldwide problem with numerous associated health problems. The number of patients eligible for surgery outnumber surgical capacity and so patients need to be prioritised based on their obesity- related health burden and comorbidities. Weight loss as a result of bariatric surgery is significant and maintained in the long term. In addition to weight loss, patient health improves in terms of metabolic, macrovascular, and microvascular disease. As a result, quality of life is better, along with psychosocial wellbeing. Bariatric surgery is associated with a relatively low number of complications and appears to result in a reduction in mortality risk due to the resolution of comorbidities. Hence, surgery can now be routinely considered as an adjunct to medical therapy in the management of obesity.

  4. New devices for the bariatric patient.

    Science.gov (United States)

    Debergh, Isabelle; Snauwaert, Christophe; Dillemans, Bruno

    2016-04-01

    Over the past years, the global prevalence of obesity has risen dramatically. This generates enormous costs for the health care system, since obesity is associated with hypertension, diabetes mellitus type 2, coronary heart diseases, stroke, dyslipidemia, psychological problems, and cancer. Bariatric surgery has demonstrated to be the most effective and durable treatment option in the morbidly obese patient. Despite its evidence based efficacy, less than 1% of obese patients will undergo surgery. The role of new, less-invasive devices for the bariatric patient needs to be defined. Are they situated in the gap between lifestyle modification and surgery for the obese patient, in the preoperative work-up of the super-obese patient, in patient groups that are currently excluded for surgery, and/or in the routine treatment of obesity as a chronic disease? This review will focus on emerging technologies for the bariatric patient that are currently in clinical practice or in an advanced development stage, with different modes of action: inducing stretch on the gastric wall (space-occupying or stitching devices), vagal neuromodulation, altering the absorption, or exclusion of the duodenum and proximal jejunum. Exploring the evidence and the indication of different therapeutic approaches and innovations will be an interesting field of research in the near future. PMID:26923812

  5. The application of transcutaneous CO2 pressure monitoring in the anesthesia of obese patients undergoing laparoscopic bariatric surgery.

    Directory of Open Access Journals (Sweden)

    Shijiang Liu

    Full Text Available To investigate the correlation and accuracy of transcutaneous carbon dioxide partial pressure (PTCCO2 with regard to arterial carbon dioxide partial pressure (PaCO2 in severe obese patients undergoing laparoscopic bariatric surgery. Twenty-one patients with BMI>35 kg/m(2 were enrolled in our study. Their PaCO2, end-tidal carbon dioxide partial pressure (PetCO2, as well as PTCCO2 values were measured at before pneumoperitoneum and 30 min, 60 min, 120 min after pneumoperitoneum respectively. Then the differences between each pair of values (PetCO2-PaCO2 and. (PTCCO2-PaCO2 were calculated. Bland-Altman method, correlation and regression analysis, as well as exact probability method and two way contingency table were employed for the data analysis. 21 adults (aged 19-54 yr, mean 29, SD 9 yr; weight 86-160 kg, mean 119.3, SD 22.1 kg; BMI 35.3-51.1 kg/m(2, mean 42.1,SD 5.4 kg/m(2 were finally included in this study. One patient was eliminated due to the use of vaso-excitor material phenylephrine during anesthesia induction. Eighty-four sample sets were obtained. The average PaCO2-PTCCO2 difference was 0.9 ± 1.3 mmHg (mean ± SD. And the average PaCO2-PetCO2 difference was 10.3 ± 2.3 mmHg (mean ± SD. The linear regression equation of PaCO2-PetCO2 is PetCO2 = 11.58+0.57 × PaCO2 (r(2 = 0.64, P<0.01, whereas the one of PaCO2-PTCCO2 is PTCCO2 = 0.60 + 0.97 × PaCO2 (r(2 = 0.89. The LOA (limits of agreement of 95% average PaCO2-PetCO2 difference is 10.3 ± 4.6 mmHg (mean ± 1.96 SD, while the LOA of 95% average PaCO2-PTCCO2 difference is 0.9 ± 2.6 mmHg (mean ± 1.96 SD. In conclusion, transcutaneous carbon dioxide monitoring provides a better estimate of PaCO2 than PetCO2 in severe obese patients undergoing laparoscopic bariatric surgery.

  6. Macrophage activation marker soluble CD163 and non-alcoholic fatty liver disease in morbidly obese patients undergoing bariatric surgery

    DEFF Research Database (Denmark)

    Kazankov, Konstantin; Tordjman, Joan; Møller, Holger Jon; Vilstrup, Hendrik; Poitou, Christine; Bedossa, Pierre; Bouillot, Jean-Luc; Clement, Karine; Grønbaek, Henning

    2015-01-01

    BACKGROUND AND AIMS: Macrophages play an important role in non-alcoholic fatty liver disease (NAFLD). Soluble CD163 (sCD163) is a specific marker of macrophage activation. We aimed to measure sCD163 in morbidly obese patients with varying degrees of NAFLD before and after bariatric surgery (BS...... decreased after BS and was greatly reduced after 12 months, more rapidly so in patients with NAS ≥ 5 (P < 0.001) and non-alcoholic steatohepatitis (NASH) according to the FLIP algorithm (P = 0.03). Immunohistochemistry showed CD163-positive macrophages aligning fat-laden hepatocytes and forming...... microgranulomas in patients with NASH. CD163 mRNA expression did not vary with NAS. CONCLUSION: sCD163 increased in parallel with the severity of NAFLD in morbid obesity, indicating macrophage activation. BS reduced sCD163 even in patients with severe liver injury and fibrosis, suggesting full reversibility of...

  7. Physiologically-based pharmacokinetic modelling and simulation of oral drug bioavailability: Focus on bariatric surgery patients and mechanism-based inhibition of gut wall metabolism

    OpenAIRE

    Darwich, Adam Saed

    2014-01-01

    AbstractTHE UNIVERSITY OF MANCHESTER,Abstract of thesis submitted by Adam S. Darwich, for the degree of PhD and entitled: "Physiologically-based pharmacokinetic modelling and simulation of oral drug bioavailability: Focus on bariatric surgery patients and mechanism-based inhibition of gut wall metabolism"Month and year of submission: November 2013.Understanding the processes that govern pre-systemic drug absorption and elimination is of high importance in pharmaceutical research and developme...

  8. Complications of bariatric surgery: Presentation and emergency management.

    Science.gov (United States)

    Kassir, Radwan; Debs, Tarek; Blanc, Pierre; Gugenheim, Jean; Ben Amor, Imed; Boutet, Claire; Tiffet, Olivier

    2016-03-01

    The epidemic in obesity has led to an increase in number of so called bariatric procedures. Doctors are less comfortable managing an obese patient after bariatric surgery. Peri-operative mortality is less than 1%. The specific feature in the obese patient is that the classical signs of peritoneal irritation are never present as there is no abdominal wall and therefore no guarding or rigidity. Simple post-operative tachycardia in obese patients should be taken seriously as it is a WARNING SIGNAL. The most common complication after surgery is peritonitis due to anastomotic fistula formation. This occurs typically as an early complication within the first 10 days post-operatively and has an incidence of 1-6% after gastric bypass and 3-7% after sleeve gastrectomy. Post-operative malnutrition is extremely rare after restrictive surgery (ring, sleeve gastrectomy) although may occur after malabsorbative surgery (bypass, biliary pancreatic shunt) and is due to the restriction and change in absorption. Prophylactic cholecystectomy is not routinely carried out during the same procedure as the bypass. Superior mesenteric vein thrombosis after bariatric surgery is a diagnosis which should be considered in the presence of any postoperative abdominal pain. Initially a first etiological assessment is performed (measurement of antithrombin III and of protein C and protein S, testing for activated protein C resistance). If the least doubt is present, a medical or surgical consultation should be requested with a specialist practitioner in the management of obese patients as death rates increase with delayed diagnosis. PMID:26808323

  9. Post-operative bariatric surgery complications: Deficiency of nutrients

    Directory of Open Access Journals (Sweden)

    Syed Abdul Majid Mufaqam1, Soni Dhwani Satishkumar2, Patel Palak Arvindkumar2

    2013-08-01

    Full Text Available Since more than half of the population in America falls under the category of obesity, scientists have discovered a surgical technique to reduce the weight of the obese patients. Bariatric surgery or gastric bypass surgery is a procedure that has been successful in reducing the weight for obese people. This technique requires a permanent gastric bypass (Roux-en-Y where part of the stomach and duodenum is removed. Since the size of the stomach is reduced to 20% of its original size along with the removal of duodenum – this may lead to improper absorption of several vitamins and minerals. This review showed that several vitamins and mineral deficiencies are observed in patients, post-operative bariatric surgery. Thiamin, folate, and B12 deficiencies were most commonly observed, and Vitamin A, D, C and B6 deficiencies were also seen in some cases. Iron and calcium deficiencies were also reported by some of the studies.

  10. A Prospective Assessment of Psychosocial Factors Among Bariatric Versus Non-bariatric Surgery Candidates

    OpenAIRE

    Rutledge, Thomas; Adler, Sarah; Friedman, Raquel

    2010-01-01

    Background Psychological factors are considered potential contraindicators to bariatric surgery, but inconsistently predict surgical outcomes. We examined biomedical and psychosocial predictors of future bariatric candidacy in a population of veterans enrolling in a multidisciplinary weight management program. Methods Ninety-five obese veterans meeting bariatric surgery eligibility criteria participating in a weight control intake class from 2007 to 2008 completed the MOVE!23 questionnaire to...

  11. Dietary intake in the postoperative bariatric surgery at a university hospital in Rio de Janeiro

    OpenAIRE

    Louise Crovesy-de-Oliveira; Gigliane Cosendey-Menegati; Eliane Lopes-Rosado

    2014-01-01

    Introduction: bariatric surgery is a treatment for morbid obesity that besides result in high weight loss promotes improvements in laboratory tests and in the pressure reduction. However the surgery can cause bad effects as deficiency some nutrients. This fact become more important evaluates the adequacy of dietary intake of these patients. The objective this study was evaluates the adequacy dietetic of patients after bariatric surgery.Material and methods: we select forty women who underwent...

  12. Obesity and co-morbid psychiatric disorders as contraindications for bariatric surgery?—A case study

    OpenAIRE

    Peterhänsel, C; Wagner, B.; Dietrich, A; A. Kersting

    2014-01-01

    INTRODUCTION: Many patients undergoing bariatric surgery report current or past psychiatric disorders and controversy exists regarding their outcome after bariatric surgery. PRESENTATION OF CASE: We present a case of an obese patient with a borderline personality disorder, a recurrent depressive disorder, post-traumatic stress symptoms and binge eating episodes who underwent bariatric surgery. DISCUSSION: Although the psychiatric disorders remained, the procedure contributed to an impro...

  13. Effects of Bariatric Surgery on Human Small Artery Function

    Science.gov (United States)

    Aghamohammadzadeh, Reza; Greenstein, Adam S.; Yadav, Rahul; Jeziorska, Maria; Hama, Salam; Soltani, Fardad; Pemberton, Phil W.; Ammori, Basil; Malik, Rayaz A.; Soran, Handrean; Heagerty, Anthony M.

    2013-01-01

    Objectives The aim of this study was to investigate the effects of bariatric surgery on small artery function and the mechanisms underlying this. Background In lean healthy humans, perivascular adipose tissue (PVAT) exerts an anticontractile effect on adjacent small arteries, but this is lost in obesity-associated conditions such as the metabolic syndrome and type II diabetes where there is evidence of adipocyte inflammation and increased oxidative stress. Methods Segments of small subcutaneous artery and perivascular fat were harvested from severely obese individuals before (n = 20) and 6 months after bariatric surgery (n = 15). Small artery contractile function was examined in vitro with wire myography, and perivascular adipose tissue (PVAT) morphology was assessed with immunohistochemistry. Results The anticontractile activity of PVAT was lost in obese patients before surgery when compared with healthy volunteers and was restored 6 months after bariatric surgery. In vitro protocols with superoxide dismutase and catalase rescued PVAT anticontractile function in tissue from obese individuals before surgery. The improvement in anticontractile function after surgery was accompanied by improvements in insulin sensitivity, serum glycemic indexes, inflammatory cytokines, adipokine profile, and systolic blood pressure together with increased PVAT adiponectin and nitric oxide bioavailability and reduced macrophage infiltration and inflammation. These changes were observed despite the patients remaining severely obese. Conclusions Bariatric surgery and its attendant improvements in weight, blood pressure, inflammation, and metabolism collectively reverse the obesity-induced alteration to PVAT anticontractile function. This reversal is attributable to reductions in local adipose inflammation and oxidative stress with improved adiponectin and nitric oxide bioavailability. PMID:23665100

  14. Mineral Malnutrition Following Bariatric Surgery12

    OpenAIRE

    Gletsu-Miller, Nana; Wright, Breanne N.

    2013-01-01

    Moderate/severe obesity is on the rise in the United States. Weight management includes bariatric surgery, which is effective and can alleviate morbidity and mortality from obesity-associated diseases. However, many individuals are dealing with nutritional complications. Risk factors include: 1) preoperative malnutrition (e.g., vitamin D, iron); 2) decreased food intake (due to reduced hunger and increased satiety, food intolerances, frequent vomiting); 3) inadequate nutrient supplementation ...

  15. Carbon dioxide monitoring during laparoscopic-assisted bariatric surgery in severely obese patients: transcutaneous versus end-tidal techniques.

    Science.gov (United States)

    Dion, Joanna M; McKee, Chris; Tobias, Joseph D; Herz, Daniel; Sohner, Paul; Teich, Steven; Michalsky, Marc

    2015-02-01

    Various factors including severe obesity or increases in intra-abdominal pressure during laparoscopy can lead to inaccuracies in end-tidal carbon dioxide (PETCO2) monitoring. The current study prospectively compares ET and transcutaneous (TC) CO2 monitoring in severely obese adolescents and young adults during laparoscopic-assisted bariatric surgery. Carbon dioxide was measured with both ET and TC devices during insufflation and laparoscopic bariatric surgery. The differences between each measure (PETCO2 and TC-CO2) and the PaCO2 were compared using a non-paired t test, Fisher's exact test, and a Bland-Altman analysis. The study cohort included 25 adolescents with a mean body mass index of 50.2 kg/m2 undergoing laparoscopic bariatric surgery. There was no difference in the absolute difference between the TC-CO2 and PaCO2 (3.2±3.0 mmHg) and the absolute difference between the PETCO2 and PaCO2 (3.7±2.5 mmHg). The bias and precision were 0.3 and 4.3 mmHg for TC monitoring versus PaCO2 and 3.2 and 3.2 mmHg for ET monitoring versus PaCO2. In the young severely obese population both TC and PETCO2 monitoring can be used to effectively estimate PaCO2. The correlation of PaCO2 to TC-CO2 is good, and similar to the correlation of PaCO2 to PETCO2. In this population, both of these non-invasive measures of PaCO2 can be used to monitor ventilation and minimize arterial blood gas sampling. PMID:24916514

  16. Revisional Bariatric/Metabolic Surgery: What Dictates Its Indications?

    Science.gov (United States)

    Ma, Pearl; Reddy, Subhash; Higa, Kelvin D

    2016-07-01

    Bariatric/metabolic surgery is currently the only effective long-term treatment for morbid obesity- and obesity-related diseases such as diabetes, heart disease, hypertension, obstructive sleep apnea, and dyslipidemia. In addition, bariatric/metabolic surgery has been shown to significantly reduce the incidence of diabetes and cancer and prolong life when compared to non-surgical therapies. However, as obesity is a chronic disease, recidivism of weight and comorbid conditions can occur. In addition, the surgical construct can lead to long-term consequences such as marginal ulceration, bowel obstruction, reflux, and nutritional deficiencies. Despite these drawbacks, prospective randomized controlled studies and long-term longitudinal population-based comparative studies greatly favor surgical intervention as opposed to traditional lifestyle, diet, and exercise programs. Revisional surgery can be quite complex and technically challenging and may offer the patient a wide variety of solutions for treatment of weight recidivism and complications after primary operations. Given the paucity of high quality published data, we have endeavored to provide indications for revisions after bariatric surgery. PMID:27221504

  17. Economic considerations for bariatric surgery and morbid obesity.

    Science.gov (United States)

    Frezza, Eldo E; Wacthell, Mitchell; Ewing, Bradley

    2009-01-01

    The obesity epidemic is also an economic tragedy. This analysis evaluates the economic effects and the potential to improve the well-being of both individual and societal wealth. Econometric techniques should carefully assess the degree to which obesity affects declines in business output, employment, income, and tax revenues at the regional and national levels. Microeconomics assesses lost productivity and associated wages and profit. Macroeconomics assesses trends associated with employment, inflation, interest rates, money supply, and output. To decrease the adverse economic consequences of the obesity epidemic, policy makers must emphasize bariatric surgery as a cost-effective option for qualified patients. Early intervention, education, and tax rebates for obese individuals who undergo bariatric surgery and for medical centers and doctors would likely have positive economic effects on the whole economy in a few years. PMID:21935309

  18. Adherence to vitamin supplementation following adolescent bariatric surgery

    OpenAIRE

    Modi, Avani C.; Zeller, Meg H.; Xanthakos, Stavra A.; Jenkins, Todd M.; Inge, Thomas H.

    2013-01-01

    Adolescents with extreme obesity, who have undergone bariatric surgery, must adhere to many lifestyle and nutritional recommendations, including multivitamin therapy. Little is know about multivitamin adherence following adolescent bariatric surgery. The present study aims to document self-reported and electronically-monitored adherence to multivitamins, determine convergence between self-report and electronic monitoring adherence for multivitamins, and identify barriers to multivitamin adher...

  19. The risk of kidney stones following bariatric surgery: a systematic review and meta-analysis.

    Science.gov (United States)

    Thongprayoon, Charat; Cheungpasitporn, Wisit; Vijayvargiya, Priya; Anthanont, Pimjai; Erickson, Stephen B

    2016-04-01

    Background With rising prevalence of morbid obesity, the number of bariatric surgeries performed each year has been increasing worldwide. The objective of this meta-analysis was to assess the risk of kidney stones following bariatric surgery. Methods A literature search was performed using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from inception through July 2015. Only studies reporting relative risks, odd ratios or hazard ratios (HRs) to compare risk of kidney stones in patients who underwent bariatric surgery versus no surgery were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. Results Four studies (One randomized controlled trial and three cohort studies) with 11,348 patients were included in analysis to assess the risk of kidney stones following bariatric surgery. The pooled RR of kidney stones in patients undergoing bariatric surgery was 1.22 (95% CI, 0.63-2.35). The type of bariatric surgery subgroup analysis demonstrated an increased risk of kidney stones in patients following Roux-en-Y gastric bypass (RYGB) with the pooled RR of 1.73 (95% CI, 1.30-2.30) and a decreased risk of kidney stones in patients following restrictive procedures including laparoscopic banding or sleeve gastrectomy with the pooled RR of 0.37 (95% CI, 0.16-0.85). Conclusions Our meta-analysis demonstrates an association between RYGB and increased risk of kidney stones. Restrictive bariatric surgery, on the other hand, may decrease kidney stone risk. Future study with long-term follow-up data is needed to confirm this potential benefit of restrictive bariatric surgery. PMID:26803902

  20. Detection of non-alcoholic steatohepatitis in patients with morbid obesity before bariatric surgery: preliminary evaluation with acoustic radiation force impulse imaging

    Energy Technology Data Exchange (ETDEWEB)

    Guzman-Aroca, F.; Reus, M.; Dios Berna-Serna, Juan de [Virgen de la Arrixaca University Hospital, Department of of Radiology, El Palmar, Murcia (Spain); Frutos-Bernal, M.D.; Lujan-Mompean, J.A.; Parrilla, P. [Virgen de la Arrixaca University Hospital, Department of Surgery, El Palmar, Murcia (Spain); Bas, A. [Virgen de la Arrixaca University Hospital, Department of Pathology, El Palmar, Murcia (Spain)

    2012-11-15

    To investigate the utility of acoustic radiation force impulse (ARFI) imaging, with the determination of shear wave velocity (SWV), to differentiate non-alcoholic fatty liver disease (NAFLD) from non-alcoholic steatohepatitis (NASH) in patients with morbid obesity before bariatric surgery. Thirty-two patients with morbid obesity were evaluated with ARFI and conventional ultrasound before bariatric surgery. The ARFI and ultrasound results were compared with liver biopsy findings, which is the reference standard. The patients were classed according to their histological findings into three groups: group A, simple steatosis; group B, inflammation; and group C, fibrosis. The median SWV was 1.57 {+-} 0.79 m/s. Hepatic alterations were observed in the histopathological findings for all the patients in the study (100 %), with the results of the laboratory tests proving normal. Differences in SWV were also observed between groups A, B and C: 1.34 {+-} 0.90 m/s, 1.55 {+-} 0.79 m/s and 1.86 {+-} 0.75 m/s (P < 0.001), respectively. The Az for differentiating NAFLD from NASH or fibrosis was 0.899 (optimal cut-off value 1.3 m/s; sensitivity 85 %; specificity 83.3 %). The ARFI technique is a useful diagnostic tool for differentiating NAFLD from NASH in asymptomatic patients with morbid obesity. (orig.)

  1. Detection of non-alcoholic steatohepatitis in patients with morbid obesity before bariatric surgery: preliminary evaluation with acoustic radiation force impulse imaging

    International Nuclear Information System (INIS)

    To investigate the utility of acoustic radiation force impulse (ARFI) imaging, with the determination of shear wave velocity (SWV), to differentiate non-alcoholic fatty liver disease (NAFLD) from non-alcoholic steatohepatitis (NASH) in patients with morbid obesity before bariatric surgery. Thirty-two patients with morbid obesity were evaluated with ARFI and conventional ultrasound before bariatric surgery. The ARFI and ultrasound results were compared with liver biopsy findings, which is the reference standard. The patients were classed according to their histological findings into three groups: group A, simple steatosis; group B, inflammation; and group C, fibrosis. The median SWV was 1.57 ± 0.79 m/s. Hepatic alterations were observed in the histopathological findings for all the patients in the study (100 %), with the results of the laboratory tests proving normal. Differences in SWV were also observed between groups A, B and C: 1.34 ± 0.90 m/s, 1.55 ± 0.79 m/s and 1.86 ± 0.75 m/s (P < 0.001), respectively. The Az for differentiating NAFLD from NASH or fibrosis was 0.899 (optimal cut-off value 1.3 m/s; sensitivity 85 %; specificity 83.3 %). The ARFI technique is a useful diagnostic tool for differentiating NAFLD from NASH in asymptomatic patients with morbid obesity. (orig.)

  2. Economic considerations for bariatric surgery and morbid obesity

    Directory of Open Access Journals (Sweden)

    Eldo E Frezza

    2009-12-01

    Full Text Available Eldo E Frezza, Mitchell Wacthell1, Bradley Ewing21Center for Metabolic Disease and Texas Tech University, Department of Pathology, 2Rawls Business School, Texas Tech University, Lubbock, TX, USAAbstract: The obesity epidemic is also an economic tragedy. This analysis evaluates the economic effects and the potential to improve the well-being of both individual and societal wealth. Econometric techniques should carefully assess the degree to which obesity affects declines in business output, employment, income, and tax revenues at the regional and national levels. Microeconomics assesses lost productivity and associated wages and profit. Macroeconomics assesses trends associated with employment, inflation, interest rates, money supply, and output. To decrease the adverse economic consequences of the obesity epidemic, policy makers must emphasize bariatric surgery as a cost-effective option for qualified patients. Early intervention, education, and tax rebates for obese individuals who undergo bariatric surgery and for medical centers and doctors would likely have positive economic effects on the whole economy in a few years.Keywords: bariatric surgery, morbid obesity, economics

  3. Bariatric surgery and pregnancy: literature review

    Directory of Open Access Journals (Sweden)

    Pedro Ferrand Miranda

    2014-01-01

    Full Text Available Obesity has currently reached epidemic proportions, both in Chile and in the world. This condition is associated to a variety of maternal complications in all stages of the vital cycle and during pregnancy. Medical treatment has not proved successful thus resulting in an increase in bariatric surgery in recent years, even when it is not first line treatment. This literature review aims to report updated results of surgical treatment for obesity before and during pregnancy with respect to fertility, gestational diabetes, pre-eclampsia and pregnancy-induced hypertension. It also looks into the possible effects of surgery on fetal development, and its relation to premature delivery, fetal macrosomy, low birth weight and neural tube defects, as well as effects on maternal and fetal outcomes, mainly in nutrition. Lastly, we suggest some recommendations that arise from this review on the role of contraception, nutrition and time between surgery and pregnancy.

  4. Bariatric surgery and nonalcoholic fatty liver disease: current and potential future treatments

    Directory of Open Access Journals (Sweden)

    Akira eSasaki

    2014-10-01

    Full Text Available Nonalcoholic fatty liver disease (NAFLD and nonalcoholic steatohepatitis (NASH are increasingly common cause of chronic liver disease worldwide. The diagnosis of NASH is challenging as most affected patients are symptom-free and the role of routine screening is not clearly established. Most patients with severe obesity who undergo bariatric surgery have NAFLD, which is associated insulin resistance, type 2 diabetes mellitus (T2DM, hypertension, and obesity-related dyslipidemia. The effective treatment for NAFLD is weight reduction through lifestyle modifications, antiobesity medication, or bariatric surgery. Among these treatments, bariatric surgery is the most reliable method for achieving substantial, sustained weight loss. This procedure is safe when performed by a skilled surgeon, and the benefits include reduced weight, improved quality of life, decreased obesity-related comorbidities, and increased life expectancy. Further research is urgently needed to determine the best use of bariatric surgery with NAFLD patients at high risk of developing liver cirrhosis and its role in modulating complications of NAFLD, such as T2DM and cardiovascular disease. The current evidence suggests that bariatric surgery for patients with severe obesity decreases the grade of steatosis, hepatic inflammation, and fibrosis. However, further long-term studies are required to confirm the true effects before recommending bariatric surgery as a potential treatment for nonalcoholic steatohepatitis.

  5. Metabolic bariatric surgery and type 2 diabetes mellitus: an endocrinologist's perspective

    Institute of Scientific and Technical Information of China (English)

    Sonali Ganguly; Hong Chang Tan; Phong Ching Lee; Kwang Wei Tham

    2015-01-01

    Traditional treatment of T2DM consisting of modification of diet,an exercise regimen,and pharmacotherapy has problems of poor lifestyle modifications and fail tend of treatment over time,now bariatric surgery is recommended for treatment of obese patients with T2DM because its great improvements on weight loss and metabolic.In this article,effects of bariatric surgery on diabetes and diabetes-related complications are reviewed.

  6. Improved Serum Leptin and Ghrelin Following Bariatric Surgery Predict Better Postoperative Cognitive Function

    OpenAIRE

    Alosco, Michael L.; Spitznagel, Mary Beth; Strain, Gladys; Devlin, Michael; Cohen, Ronald; Crosby, Ross D.; Mitchell, James E; Gunstad, John

    2015-01-01

    Background and Purpose Bariatric surgery is associated with improved cognitive function, but the mechanisms underlying these gains remain poorly understood. Disturbed leptin and ghrelin systems are common in obese individuals and are associated with impaired cognitive function in other samples. Bariatric surgery has been shown to improve serum leptin and ghrelin levels, and these changes may underlie postoperative cognitive improvements. Methods Eighty-four patients completed a computerized c...

  7. Bariatric surgery for obesity and metabolic conditions in adults

    OpenAIRE

    Arterburn, David E; Courcoulas, Anita P.

    2014-01-01

    This review summarizes recent evidence related to the safety, efficacy, and metabolic outcomes of bariatric surgery to guide clinical decision making. Several short term randomized controlled trials have demonstrated the effectiveness of bariatric procedures for inducing weight loss and initial remission of type 2 diabetes. Observational studies have linked bariatric procedures with long term improvements in body weight, type 2 diabetes, survival, cardiovascular events, incident cancer, and q...

  8. Liposuction-assisted medial thigh lift in non bariatric surgery patients

    Directory of Open Access Journals (Sweden)

    Abdelmohsen K. Aboueldahab

    2014-03-01

    Results: All patients recovered well in two weeks and showed improvement of thigh contour. Scar downward displacement occurred in one patient. No skin necrosis or seroma was encountered. One patient developed superficial thrombophlebitis and required hospital stay for 5 days and anticoagulant treatment. No labial distortion or separation was encountered.

  9. Defining the Role of Bariatric Surgery in Polycystic Ovarian Syndrome Patients%减重手术在多囊卵巢综合征治疗中的作用

    Institute of Scientific and Technical Information of China (English)

    Shaveta M. Malik; Michael L. Traub; 王恺京; 徐安安

    2013-01-01

    Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women. To meet PCOS criteria, women must have a combination of hyperandrogenism, anovulation and ultrasound findings. Almost 10% of all reproductive age women worldwide show signs of PCOS. Although women often seek care for gynecological or body image concerns, many PCOS women are at risk for metabolic syndrome (MS). Many of the metabolic consequences are overlooked and undertreated by physicians because these patients tend to be young, reproductive age women. MS and obesity coexist commonly with PCOS. These young women are predisposed to glucose abnormalities and ultimately diabetes mellitus, dyslipidemia and eventually cardiovascular disease. Bariatric surgery can be an effective means of weight loss in PCOS women. Surgical techniques have become safer and less invasive over time and have been found to be effective in achieving significant weight loss. Surgical options have also increased, giving patients more choices. Bariatric surgery may prevent or reverse metabolic syndrome. Bariatric surgery may also have reproductive benefits in PCOS patients. Although bariatric surgery has historically been performed in older, reproductive aged women, it has recently gained favor in adolescents as well. This is of particular importance due to the prevalence of both PCOS and MS in adolescents. Treatment of PCOS and MS certainly requires a combination of medical therapy, psychological support and lifestyle modifications. These treatments are difficult and often frustrating for patients and physicians. Bariatric surgery can be effective in achieving significant weight loss, restoration of the hypothalamic pituitary axis, reduction of cardiovascular risk and even in improving pregnancy outcomes. Ultimately, bariatric surgery should be considered part of the treatment in PCOS women, especially in those with MS.

  10. A Prior History of Substance Abuse in Veterans Undergoing Bariatric Surgery

    OpenAIRE

    Maureen Tedesco; William Q. Hua; Lohnberg, Jessica A.; Nina Bellatorre; Dan Eisenberg

    2013-01-01

    Background. The rates of obesity and substance abuse are high among US veterans. Objective. To examine weight loss and substance abuse rates following bariatric surgery in veterans with a history of substance abuse (SA). Methods. A prospective database of consecutive bariatric operations was reviewed. Data for SA patients were compared to patients without a substance abuse history (NA). Behavioral medicine staff followed patients throughout the pre- and postoperative courses. Results. Of 205 ...

  11. Psychological and health comorbidities before and after bariatric surgery: a longitudinal study

    Directory of Open Access Journals (Sweden)

    Susana Sofia Pereira da Silva

    2013-12-01

    Full Text Available INTRODUCTION: Morbid obesity has multiple implications for psychological and physical health. Bariatric surgery has been selected as the treatment of choice for this chronic disease, despite the controversial impact of the surgery on psychosocial health. The objective of this study was to describe candidates for bariatric surgery and analyze changes in weight, psychopathology, personality, and health problems and complaints at 6- and 12- month follow-up assessments. METHODS: Thirty obese patients (20 women and 10 men with a mean age of 39.17±8.81 years were evaluated in different dimensions before surgery and 6 and 12 months after the procedure. RESULTS: Six and 12 months after bariatric surgery, patients reported significant weight loss and a significant reduction in the number of health problems and complaints. The rates of self-reported psychopathology were low before surgery, and there were no statistically significant changes over time. The conscientiousness, extraversion, and agreeableness dimensions increased, but neuroticism and openness remained unchanged. All changes had a medium effect size. CONCLUSIONS: Our results suggest that patients experience significant health improvements and some positive personality changes after bariatric surgery. Even though these findings underscore the role of bariatric surgery as a relevant treatment for morbid obesity, more in-depth longitudinal studies are needed to elucidate the evolution of patients after the procedure.

  12. Bariatric surgery in an obese patient with Albright hereditary osteodystrophy: a case report

    OpenAIRE

    Ferrario, Chiara; Gastaldi, Giacomo; Portmann, Luc; Giusti, Vittorio

    2013-01-01

    Introduction We report for the first time the case of a patient with Albright hereditary osteodystrophy and pseudopseudohypoparathyroidism who underwent a Roux-en-Y gastric bypass. Case presentation A 26-year-old obese Caucasian woman with Albright hereditary osteodystrophy with pseudopseudohypoparathyroidism (heterozygous mutation (L272F) in GNAS1 exon 10 on molecular analysis) was treated with gastric bypass. She had the classical features of Albright hereditary osteodystrophy: short statur...

  13. Defining the role of bariatric surgery in polycystic ovarian syndrome patients

    OpenAIRE

    Malik, Shaveta M; Traub, Michael L

    2012-01-01

    Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women. To meet PCOS criteria, women must have a combination of hyperandrogenism, anovulation and ultrasound findings. Almost 10% of all reproductive age women worldwide show signs of PCOS. Although women often seek care for gynecological or body image concerns, many PCOS women are at risk for metabolic syndrome (MS). Many of the metabolic consequences are overlooked and undertreated by physicians because these patient...

  14. Ethical issues in the psychosocial assessment of bariatric surgery candidates.

    Science.gov (United States)

    Rouleau, Codie R; Rash, Joshua A; Mothersill, Kerry J

    2016-07-01

    Psychosocial evaluation is recommended prior to bariatric surgery. Practice guidelines have been published on assessment methods for bariatric surgery candidates, but they have not emphasized ethical issues with this population. This review outlines ethical and professional considerations for behavioral healthcare providers who conduct pre-surgical assessments of bariatric surgery candidates by merging ethical principles for mental health professionals with current practices in pre-surgical assessments. Issues discussed include the following: (a) establishing and maintaining competence, (b) obtaining informed consent, (c) respecting confidentiality, (d) avoiding bias and discrimination, (e) avoiding and addressing dual roles, (f) selecting and using psychological tests, and (g) acknowledging limitations of psychosocial assessments. PMID:25411197

  15. [Dealing with surgical complications after bariatric gastric bypass surgery].

    Science.gov (United States)

    Schlesinger, Nis Hallundbæk; Naver, Lars

    2013-11-25

    The subject of this article is surgical complications to Roux-en-Y-gastric bypass and how to deal with them. The article addresses doctors, who are on duty in hospitals without bariatric surgery and who often deal with this patient category in the acute situation. Managing complications is challenging due to both the patient's physiognomy and the wide-ranged change in anatomy. The article gives a review of the literature and hands-on-recommendations for treating anastomotic leak, post-operative bleeding, internal herniation, bowel obstruction and biliary complications. PMID:24629437

  16. KIDNEY STONE INCIDENCE AND METABOLIC URINARY CHANGES AFTER MODERN BARIATRIC SURGERY: REVIEW OF CLINICAL STUDIES, EXPERIMENTAL MODELS, AND PREVENTION STRATEGIES

    OpenAIRE

    Canales, Benjamin K.; Hatch, Marguerite

    2014-01-01

    Bariatric surgery has been associated with increased metabolic kidney stone risk and post-operative stone formation. A MEDLINE search, performed for articles published between January 2005 and November 2013, identified 24 pertinent studies containing 683 bariatric patients with 24-hour urine profiles, 6,777 bariatric patients with kidney stone incidence, and 7,089 non-stone forming controls. Of all procedures reviewed, only Roux-en-Y gastric bypass (RYGB) was linked to post-...

  17. Effects of bariatric surgery on the body composition of adults

    Directory of Open Access Journals (Sweden)

    Tiago Wally Hartwig

    2013-09-01

    Full Text Available The most alarming cases are known as morbidly obese. An effective method to change the anthropometric characteristics of this population with excess body weight and high fat mass is bariatric surgery. The objective of this study was to analyze the body composition of morbidly obese patients undergoing bariatric surgery in the city of Pelotas, Southern Brazil. In a prospective cohort study, a group of morbidly obese patients was followed up 30 days before and 30 days after surgery. The sample consisted of 123 patients who underwent vertical banded Roux-en-Y gastroplasty between April 2003 and May 2010. Body composition (fat percentage was determined by bioelectrical impedance analysis. The mean age of the patients was 36.1 ± 8.8 years and mean body weight loss was 14.1 ± 6.0 kg (p<0.001. The mean reduction in body mass index (BMI was 5.2 ± 2.1 kg/m2 (p<0.001. Body fat percentage and fat mass were reduced by 2.8% (p<0.001 and 9.7 ± 4.9 kg (p<0.001, respectively. In addition, there was a reduction of 4.4 ± 3.4 kg (p<0.001 in lean mass. We concluded that the surgical procedure significantly reduced body weight, BMI, fat percentage and fat mass and is an alternative when conventional treatments appear ineffective.

  18. INSTANT REMEDY OR TOTAL SALVATION? MERITS AND DEMERITS OF BARIATRIC SURGERY

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    Randhawa

    2014-12-01

    Full Text Available Bariatric surgery as it is called now is not a new thing. First bariatric surgery was performed in 1954. Later the surgical remedy for bariatric surgery remained dormant till the popularity of laparoscopic surgery. Past decade has seen a tremendous increase in the number of bariatric or metabolic surgical procedures. This trend may continue because of the epidemic of obesity throughout globe and its rising prevalence among children. Advocates of bariatric surgery consider it the most effective and only treatment for morbid obesity and its co morbidities. To simplify; two types of procedures are performed. 1. Restrictive- where the intake of calories are prevented by restricting food intake. 2. The other one is malabsorptive- where food rich in calories is prevented to get absorbed. Operations based on these principles are-Laparoscopic adjustable gastric band and Vertical sleeve resection of stomach; for restrictive surgery and Laparoscopic biliopancreatic diversion with or without duodenal switch; for malabsorptive procedures. Both types have their own merits and demerits, many of which are almost unacceptable. To counter each other’s’ demerits certain combinations of both types are evolved like Roux-en-Y gastric bypass; it combines both restrictive and malabsorptive components. Each operation has its own merits and demerits. Important points for the patient and surgeon alike in the decision to proceed with bariatric operation include – the technical aspects of operation, post-operative complications including long term nutritional problems, Magnitude of initial and later steady weight loss over the period and correction of obesity related comorbidities. Here, the merits and demerits of present day laparoscopic bariatric surgical procedures are reviewed and related controversial aspects related to them are discussed. Right patient selection; right selection of operative procedure for an individual patient and more importantly right

  19. A review of psychological assessment instruments for use in bariatric surgery evaluations.

    Science.gov (United States)

    Marek, Ryan J; Heinberg, Leslie J; Lavery, Megan; Merrell Rish, Julie; Ashton, Kathleen

    2016-09-01

    Bariatric surgery is a viable treatment option for patients with extreme obesity and associated medical comorbidities; however, optimal surgical outcomes are not universal. Surgical societies, such as the American Society for Metabolic and Bariatric Surgery (ASMBS), recommend that patients undergo a presurgical psychological evaluation that includes reviewing patients' medical charts, conducting a comprehensive clinical interview, and employing some form of objective psychometric testing. Despite numerous societies recommending the inclusion of self-report assessments, only about 2/3 of clinics actively use psychological testing-some of which have limited empirical support to justify their use. This review aims to critically evaluate the psychometric properties of self-report measures when used in bariatric surgery settings and provide recommendations to help guide clinicians in selecting instruments to use in bariatric surgery evaluations. Recommended assessment batteries include use of a broadband instrument along with a narrowband eating measure. Suggestions for self-report measures to include in a presurgical psychological evaluation in bariatric surgery settings are also provided. (PsycINFO Database Record PMID:27537008

  20. Bariatric surgery in type 1 diabetes mellitus: long-term experience in two cases

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    Nuria Fuertes-Zamorano

    2013-08-01

    Full Text Available In patients with obesity and type 2 diabetes, recommendations for bariatric surgery are well established. However, no consensus exists regarding its role for the management of patients with type 1 diabetes and morbid obesity. We present the long-term follow-up of two women with type 1 diabetes, morbid obesity and associated comorbidities, who underwent malabsorptive bariatric surgery. More than four years after the procedure, both have a body mass index (BMI within the normal range and HbA1c levels below 7%. Also, they have been able to reduce their insulin requirements in more than 50%, their associated comorbidities have disappeared, and their overall quality of life has significantly improved. We compare our results with other recently published ones, emphasizing potential indications of bariatric surgery for patients with type 1 diabetes.

  1. Over-drainage and persistent shunt-dependency in patients with idiopathic intracranial hypertension treated with shunts and bariatric surgery

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    Jonathan Roth

    2015-01-01

    Conclusions: Patients with IIH that undergo shunt surgery and BS (not concomitantly may suffer from OD symptoms, necessitating multiple shunt revisions, and valve upgrades. Despite BS being a valid primary treatment for some patients with IIH, among shunted patients, BS may not lead to resolution of IIH-related symptoms and patients may remain shunt-dependent.

  2. Enhanced recovery after bariatric surgery – a modern approach

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    Bekkhan Bayalovich Khatsiev

    2014-06-01

    Full Text Available Guidelines for enhanced recovery after surgery (ERAS are widely used and their efficiency was clearly demonstrated by numerous studies. Number of publications on this topic in bariatric surgery is significantly lower compared with other fields of surgery. However, the data accumulated allow to compose recommendations based on studies with high level of evidence. Authors review existing methods of enhanced recovery in their implementation into bariatric surgery. Enhanced recovery methods can be used to optimize all stages of perioperative care and include data on preoperative preparation, maintenance of electrolyte balance, prevention of postoperative nausea and vomiting, sufficient analgesia and safe discharge form hospital. Suggested guidelines for bariatric surgery are implied to be used by a multidisciplinary team.

  3. Association between nutrient adequacy and psychosocial factors with overall rate of weight loss after bariatric surgery.

    Science.gov (United States)

    Vanoh, Divya; Shahar, Suzana; Mahmood, Nik Ritza Kosai Nik

    2015-01-01

    This was a cross-sectional study that investigated the relationship between nutrient intake and psychosocial factors with the overall rate of weight loss after bariatric surgery among patients who had undergone sleeve gastrectomy in University Kebangsaan Malaysia Medical Centre (UKMMC). Forty-three subjects (15 men and 28 women) were recruited for this study. Subjects completed assessment questionnaires including the Binge Eating Scale (BES), Beck Depression Inventory (BECK), Family Support Questionnaires, and the Index of Peer Relation (IPR). Results showed that the median overall rate of weight loss was 4.3±5.5 kg/month, which was lower when compared to the rate of weight loss at three months which was 5.0±5.6 kg/month. Pre-operative weight was the predictor of overall rate of weight loss (peating disorder (BED) and depression were also closely associated with each other after bariatric surgery (peating scale. The mean caloric and protein intake was very low, only 562±310 kcal/day and 29.6±16.1 g/day. The intake of vitamin A, B-1, B-2, B-3, B-12, C, folate, and iron met the Malaysian Recommended Nutrient Intake (RNI). However, the RNI for calcium, zinc, selenium, vitamin D, and vitamin E was not met. In conclusion, although bariatric surgery had many health benefits, several factors hindered weight loss after bariatric surgery. Health care professionals should closely monitor patients after bariatric surgery. PMID:26693745

  4. Bariatric surgery and diabetes remission: Who would have thought it?

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    Awadhesh Kumar Singh

    2015-01-01

    Full Text Available Type 2 diabetes mellitus (T2DM and obesity are increasingly common and major global health problems. The Edmonton obesity staging system clearly pointed towards increased mortality proportionate to the severity of obesity. Obesity itself triggers insulin resistance and thereby poses the risk of T2DM. Both obesity and T2DM have been associated with higher morbidity and mortality and this calls for institution of effective therapies to deal with the rising trend of complications arising out of this dual menace. Although lifestyle changes form the cornerstone of therapy for both the ailments, sustained results from this modalities is far from satisfactory. While Look AHEAD (action for HEAalth in diabetes study showed significant weight loss, reduction in glycated hemoglobin and higher remission rate of T2DM at 1 st year following intensive lifestyle measures; recurrence and relapse rate bounced back in half of subjects at 4 years, thereby indicating that weight loss and glycemic control is difficult to maintain in the long term with lifestyle interventions. Same recurrence phenomenon was also observed with pharmacotherapy with rimonabant, sibutramine and orlistat. Bariatric surgery has been seen to associate with substantial and sustained weight loss in morbidly obese patients. Interestingly, bariatric surgeries also induce higher rates of short and long-term diabetes remission. Although the exact mechanism behinds this diabetes remission are not well understood; improved insulin action, beta-cell function and complex interplay of hormones in the entero-insular axis appears to play a major role. This article reviews the effectiveness of bariatric procedures on remission or improvement in diabetes and put a perspective on its implicated mechanisms.

  5. Prediction of Exercise in Patients across Various Stages of Bariatric Surgery: A Comparison of the Merits of the Theory of Reasoned Action versus the Theory of Planned Behavior

    Science.gov (United States)

    Hunt, Hillary R.; Gross, Alan M.

    2009-01-01

    Obesity is a world-wide health concern approaching epidemic proportions. Successful long-term treatment involves a combination of bariatric surgery, diet, and exercise. Social cognitive models, such as the Theory of Reasoned Action (TRA) and the Theory of Planned Behavior (TPB), are among the most commonly tested theories utilized in the…

  6. Bariatric Surgery and Urinary Stone Disease

    OpenAIRE

    Cevahir Ozer

    2014-01-01

    Obesity is a major public health problem and has been suggested to play a role in the etiology of urinary tract stone disease. Furthermore, the increasingly widespread use of surgery in the treatment of obesity also is related with urinary stone disease. In daily practice, patients to whom obesity surgery has been planned or who have undergone obesity surgery are seen more frequently. This review aims to highlight the urological evaluation and management of this patient group.

  7. Bariatric Surgery and Urinary Stone Disease

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    Cevahir Ozer

    2014-12-01

    Full Text Available Obesity is a major public health problem and has been suggested to play a role in the etiology of urinary tract stone disease. Furthermore, the increasingly widespread use of surgery in the treatment of obesity also is related with urinary stone disease. In daily practice, patients to whom obesity surgery has been planned or who have undergone obesity surgery are seen more frequently. This review aims to highlight the urological evaluation and management of this patient group.

  8. Quality of life of obese patients submitted to bariatric surgery Calidad de vida en pacientes obesos sometidos a cirugía bariátrica

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    N. Barreto Villela

    2004-11-01

    Full Text Available Introduction: The quality of life (QOL of patients with morbid obesity (MO is reduced given the restrictions it imposes. Bariatric surgery is considered an efficient treatment for MO as it leads to marked and progressive weight reduction. Weight loss, appropriate nutritional advice and follow up may induce significant improvement in QOL. Aim: To evaluate the degree of QOL in patients with MO before and after bariatric, surgery (Fobi-Capella reducing gastroplasty. Cases. Material and Methods: 95 morbidly obese(BMI > 40 kg/m² or moderately obese (BNI 35 - 39 kg/m² patients with co-morbidities were seen, followed up and given advice by the Nutrition, Psychology, Endocrinology and Surgery staff at the Federal University of Bahia Hospital. Group I included 66 subjects at the pre-surgical stage and Group II was composed of 29 other patients in a late postsurgical phase. Group II patients were seen at 6, 12 and more months after bariatric surgery. The medical outcomes study Short-Form Health Survey (SF-36 was the instrument used to evaluate QOL in this study. Data were analyzed using the Mann-Whitney non-parametric method and the SPSS program. Results: A statistically significant improvement in QOL was detected in the aspects of general health, functional ability and vitality. A progressive improvement in physical conditioning was particularly observed in the patients who had had bariatric surgery less than 6 months before, between 6 and 12 months and more than 12 months before. Small changes in subjective features were seen. An improvement in social aspects was observed after a post surgical fall. This explains why do not changes appear when pre and post surgical patients are compared. Conclusions: Fobi-Capella bariatric surgery for our patients with MO or with co-morbidities associated moderate obesity resulted in QOL improvement, and gradual but marked improvements in physical condition over time.Introducción: La calidad de vida (QOL de los

  9. Use of alcohol before and after bariatric surgery

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    Ana Carolina Ribeiro de Amorim

    2015-02-01

    Full Text Available OBJECTIVE: to assess alcohol intake in the bariatric surgery pre and postoperative periods. METHODS: Patients were interviewed atSurgery Clinic of the Hospital das Clínicas da Universidade Federal de Pernambuco - HC/UFPE (Brazil from July 2011 to March 2012. We analyzed socioeconomic, anthropometric and clinical variables. We used the Alcohol Use Disorders Identification Test (AUDIT C. RESULTS: One hundred nineteen patients were enrolled (mean age: 41.23+11.30 years, with a predominance of the female gender (83.2%, non-Caucasian race (55%, married individuals or in a stable union (65.5%, with a high school education (40.3%and active in the job market (37%. Weight and body mass index (BMI were 128.77+25.28Kg and 49.09+9.26Kg/m2,respectively in the preoperative period (class II obesity and 87.19+19.16Kg and 33.04+6.21Kg/m2, respectively in the postoperative period (class I obesity (p<0.001. Hypertension was the most frequent disease in the pre (66.6% and postoperative (36.5% periods. The prevalence of alcohol use was 26.6% in the preoperative period, of which 2.2% of high risk, and 35.1% in the postoperative period, of which 1.4% of probable dependence; this difference did not achieve statistical significance (p=0.337. CONCLUSION: The prevalence of abusive alcohol intake and/or probable dependence was low in both the pre and postoperative periods, with little evidence of risky consumption among the patients submitted to bariatric surgery.

  10. Insulinoma After Bariatric Surgery: Diagnostic Dilemma and Therapeutic Approaches.

    Science.gov (United States)

    Mulla, Christopher M; Storino, Alessandra; Yee, Eric U; Lautz, David; Sawnhey, Mandeep S; Moser, A James; Patti, Mary-Elizabeth

    2016-04-01

    Hypoglycemia is increasingly recognized as a complication of bariatric surgery. Typically, hypoglycemia does not appear immediately postoperatively, but rather more than 1 year later, and usually occurs 1-3 h after meals. While rare, insulinoma has been reported after bariatric surgery. Clinical factors which should raise suspicion for insulinoma and the need for comprehensive clinical and biochemical evaluation include hypoglycemia occurring in the fasting state, predating bariatric surgery, and/or worsening immediately postoperatively, and lack of response to conservative therapy. Localization and successful resection of insulinoma can be achieved using novel endoscopic ultrasound and surgical approaches. In summary, hypoglycemia presenting shortly after gastric bypass or with a dominant fasting pattern should be fully evaluated to exclude insulinoma. Additionally, evaluation prior to gastric bypass should include screening for history of hypoglycemia symptoms. PMID:26846121

  11. Mandatory weight loss during the wait for bariatric surgery.

    Science.gov (United States)

    Glenn, Nicole M; Raine, Kim D; Spence, John C

    2015-01-01

    Mandatory presurgical, behavior-induced weight loss, although not standard, is a relatively common practice among bariatric surgical clinics. We explore the patient's experience of this practice using phenomenology. We gathered experiential accounts from 7 individuals waiting to have the procedure at a large publically funded clinic in western Canada. In writing this article, we focused on four phenomenological themes: "just nod your head and carry on"-silencing through the ideal; waiting and weighing-promoting weight consciousness to the weight conscious; paying for surgical approval through weight loss; and presurgical weight loss and questioning the need for weight loss surgery altogether. We contrast the experiential findings with the clinical literature to question the impact and possible (unintended or unexpected) effects the practice might have, particularly on patients' lives. We situate this article within a larger discussion about the possible contribution of experiential knowledge to clinical guidelines, practices, and pedagogies. PMID:25185162

  12. Bariatric surgery complications. Internal hernia: A potentially fatal condition. A case report and literature review

    International Nuclear Information System (INIS)

    In recent years, Obesity (defined as Body Mass Index > 30 kg/m2) has increased its prevalence reaching epidemic levels in countries such as The United States where it has became a national health issue. In Colombia the Obesity prevalence is figured around 14%. Treatment options for Obesity include life style modifications, pharmacologist management and surgical approach (Bariatric Surgery). This article describes a patient with previous bariatric surgery, who presents abdominal pain and melena owed to isquemic process of the alimentary limb caused by an internal hernia which is a potentially lethal condition if it is not highly suspected allowing its early diagnosis and treatment

  13. O impacto emocional da cirurgia bariátrica em pacientes com obesidade mórbida The emotional impact of bariatric surgery in patients with morbid obesity

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    Cristiano Waihrich Leal

    2007-12-01

    Full Text Available A cirurgia bariátrica é um método que tem sido utilizado para o emagrecimento e resgate da saúde. Em muitos casos, porém, o emagrecimento súbito incorre em quadros psiquiátricos, tais como: sintomas depressivos, ansiedade, uso de substâncias, alterações comportamentais e ideação suicida, dentre outras situações, associadas às mudanças emocionais que o paciente vivencia com o novo estado físico e psíquico. O atual estudo teve como objetivo analisar as expectativas, fantasias, resultados, dificuldades e frustrações enfrentadas após o procedimento cirúrgico. Realizou-se um relato de caso das informações colhidas com seis pacientes em acompanhamento num hospital público de Santa Catarina e que desenvolveram sintomas de sofrimento psíquico após a cirurgia bariátrica. Cada paciente participou de duas sessões de entrevistas semi-estruturadas. A pesquisa foi submetida e aprovada pela comissão de ética da Universidade de Joinville. Os resultados obtidos demonstram que as mudanças psicológicas decorrentes da cirurgia foram marcantes. Em determinados casos, as entrevistadas expressaram expectativas além do emagrecimento, como a resolução dos conflitos interpessoais e conjugais, assim como mudanças de traços definidos de suas personalidades. Constatou-se, também, o uso de substâncias (álcool e tabaco associado a comportamentos de risco (envolvimento extraconjugal e direção perigosa. O problema da obesidade ficou evidenciado como parte de uma complexa situação que envolve o estado físico e emocional das pessoas, e sua resolução, por vezes, expõe as dificuldades e as limitações psíquicas dos pacientes.Bariatric surgery has been used for health recovery and weight loss. In many cases, however, abrupt weight loss produces psychiatric symptoms, such as depression, anxiety, use of drugs, behavioral changes and suicidal ideation, among other situations, all related to the emotional changes faced by the patient in

  14. Long-term effects of bariatric surgery on meal disposal and β-cell function in diabetic and nondiabetic patients

    DEFF Research Database (Denmark)

    Camastra, Stefania; Muscelli, Elza; Gastaldelli, Amalia;

    2013-01-01

    patients and 15 obese nondiabetic (ND) subjects before and 1 year after surgery (10 T2D and 11 ND) using the double-tracer technique and modeling of β-cell function. In both groups postsurgery, tracer-derived appearance of oral glucose was biphasic, a rapid increase followed by a sharp drop, a pattern......Gastric bypass surgery leads to marked improvements in glucose tolerance and insulin sensitivity in obese type 2 diabetes (T2D); the impact on glucose fluxes in response to a physiological stimulus, such as a mixed meal test (MTT), has not been determined. We administered an MTT to 12 obese T2D...... that was mirrored by postprandial glucose levels and insulin secretion. In diabetic patients, surgery lowered fasting and postprandial glucose levels, peripheral insulin sensitivity increased in proportion to weight loss (~30%), and β-cell glucose sensitivity doubled but did not normalize (compared with 21...

  15. A Systematic Review and Meta-Analysis of Outcomes for Type 1 Diabetes after Bariatric Surgery

    Science.gov (United States)

    Chow, Alexandra; Switzer, Noah J.; Dang, Jerry; Shi, Xinzhe; de Gara, Christopher; Birch, Daniel W.; Gill, Richdeep S.; Karmali, Shahzeer

    2016-01-01

    Background. The utility of bariatric surgery in type 1 diabetes remains controversial. The aim of the present study is to evaluate glycemic control outcomes in obese patients with type 1 diabetes after bariatric surgery. Methods. A comprehensive search of electronic databases was completed. Inclusion criteria included human adult subjects with BMI ≥35 kg/m2 and a confirmed diagnosis of type 1 diabetes who underwent a bariatric surgical procedure. Results. Thirteen primary studies (86 patients) were included. Subjects had a mean age of 41.16 ± 6.76 years with a mean BMI of 42.50 ± 2.65 kg/m2. There was a marked reduction in BMI postoperatively at 12 months and at study endpoint to 29.55 ± 1.76 kg/m2 (P diabetes leads to significant reductions in BMI and improvements in glycemic control.

  16. Bariatric surgery versus medications in the treatment of type 2 diabetes.

    Science.gov (United States)

    Fanin, A; Benetti, A; Ceriani, V; Pontiroli, A E

    2015-12-01

    Type 2 diabetes mellitus (T2DM) is associated with increased risk of severe comorbidities and mortality; its prevalence is increasing worldwide, linked with the increasing prevalence of obesity. Weight loss prevents the development of T2DM in obese subjects, and can reverse T2DM in morbid obesity. This paper reviews bariatric surgery as a means for prevention and treatment of T2DM and its complications, in comparison with medical treatment, and analyzes the possible mechanisms involved. In morbidly obese patients bariatric surgery results in stable weight loss and long-term reduction in incidence and prevalence of obesity-related comorbidities, especially T2DM. The efficacy of bariatric surgery in improving and normalizing glucose levels has been confirmed by a large number of studies, comparing surgery with medical therapy. When compared to each other, malabsorptive and mixed malabsorptive/restrictive surgery techniques have shown better outcomes than restrictive techniques in terms of T2DM remission. However it is demonstrated that T2DM can reappear in the following years, especially in patients with advanced age, female sex, longer duration of T2DM, poorer glycemic control, use of insulin before surgery and weight regain. Bariatric surgery is superior to conventional medical therapy in inducing significant weight loss and control of T2DM. Weight loss has pleiotropic effects: T2DM can disappear and then re-appear as a result of persistent beta-cells impairment, while other effects last much longer, as reduction of blood pressure and improvement of lipids and of kidney function. This is probably the reason for long-term prevention of cardiovascular events and of mortality in obese and in obese-diabetic patients. The effect of bariatric surgery on diabetic retinopathy is still controversial. PMID:26365477

  17. Change in fracture risk and fracture pattern after bariatric surgery: nested case-control study

    Science.gov (United States)

    Rousseau, Catherine; Jean, Sonia; Gamache, Philippe; Lebel, Stéfane; Mac-Way, Fabrice; Biertho, Laurent; Michou, Laëtitia

    2016-01-01

    Objective To investigate whether bariatric surgery increases the risk of fracture. Design Retrospective nested case-control study. Setting Patients who underwent bariatric surgery in the province of Quebec, Canada, between 2001 and 2014, selected using healthcare administrative databases. Participants 12 676 patients who underwent bariatric surgery, age and sex matched with 38 028 obese and 126 760 non-obese controls. Main outcome measures Incidence and sites of fracture in patients who had undergone bariatric surgery compared with obese and non-obese controls. Fracture risk was also compared before and after surgery (index date) within each group and by type of surgery from 2006 to 2014. Multivariate conditional Poisson regression models were adjusted for fracture history, number of comorbidities, sociomaterial deprivation, and area of residence. Results Before surgery, patients undergoing bariatric surgery (9169 (72.3%) women; mean age 42 (SD 11) years) were more likely to fracture (1326; 10.5%) than were obese (3065; 8.1%) or non-obese (8329; 6.6%) controls. A mean of 4.4 years after surgery, bariatric patients were more susceptible to fracture (514; 4.1%) than were obese (1013; 2.7%) and non-obese (3008; 2.4%) controls. Postoperative adjusted fracture risk was higher in the bariatric group than in the obese (relative risk 1.38, 95% confidence interval 1.23 to 1.55) and non-obese (1.44, 1.29 to 1.59) groups. Before surgery, the risk of distal lower limb fracture was higher, upper limb fracture risk was lower, and risk of clinical spine, hip, femur, or pelvic fractures was similar in the bariatric and obese groups compared with the non-obese group. After surgery, risk of distal lower limb fracture decreased (relative risk 0.66, 0.56 to 0.78), whereas risk of upper limb (1.64, 1.40 to 1.93), clinical spine (1.78, 1.08 to 2.93), pelvic, hip, or femur (2.52, 1.78 to 3.59) fractures increased. The increase in risk of fracture reached significance only for

  18. Nutritional Optic Neuropathy Caused by Copper Deficiency After Bariatric Surgery.

    Science.gov (United States)

    Rapoport, Yuna; Lavin, Patrick J M

    2016-06-01

    A 47-year-old woman developed severe bilateral visual loss 4 years after a Roux-en-Y gastric bypass and 24 years after vertical banded gastroplasty. Her serum copper level was 35 μg/dL (normal, 80-155 μg/dL). She was prescribed elemental copper tablets. Because her methylmalonic acid was slightly elevated, she received vitamin B12 injections as well. Five weeks later, she reported that her vision had improved and, at 10 months, her vision had recovered from 20/400 bilaterally to 20/25 in each eye. This case highlights the importance of checking copper levels in addition to the "more routine" vitamin levels, such as B1, B6, B12, E, and serum folate in patients with suspected nutritional optic neuropathy after bariatric surgery, particularly if it involved a bypass procedure. PMID:26828841

  19. Answers to Clinical Questions in the Primary Care Management of People with Obesity: Bariatric Surgery.

    Science.gov (United States)

    Braverman-Panza, Jill; Horn, Deborah Bade

    2016-07-01

    The role of bariatric surgery in the management of patients with obesity is expanding owing to the amount of data that are accumulating; these data demonstrate significant short- and long-term health benefits, including control or remission of obesity-related complications, as well as acceptable long-term safety. PMID:27565108

  20. Feasibility and analgesic efficacy of the transversus abdominis plane block after single-port laparoscopy in patients having bariatric surgery

    Directory of Open Access Journals (Sweden)

    Wassef M

    2013-11-01

    Full Text Available Michael Wassef, David Y Lee, Jun L Levine, Ronald E Ross, Hamza Guend, Catherine Vandepitte, Admir Hadzic, Julio TeixeiraDepartment of Anesthesiology, St Luke's-Roosevelt Hospital Center, New York, NY, USAPurpose: The transversus abdominis plane (TAP block is a technique increasingly used for analgesia after surgery on the anterior abdominal wall. We undertook this study to determine the feasibility and analgesic efficacy of ultrasound-guided TAP blocks in morbidly obese patients. We describe the dermatomal spread of local anesthetic in TAP blocks administered, and test the hypothesis that TAP blocks decrease visual analog scale (VAS scores.Patients and methods: After ethics committee approval and informed consent, 35 patients with body mass index >35 undergoing single-port sleeve gastrectomy (SPSG were enrolled. All patients received balanced general anesthesia, followed by intravenous patient-controlled analgesia (IV-PCA; hydromorphone postoperatively; all reported VAS >3 upon arrival to the recovery room. From the cohort of 35 patients having single-port laparoscopy (SPL, a sealed envelope method was used to randomly select ten patients to the TAP group and 25 patients to the control group. The ten patients in the TAP group received ultrasound-guided TAP blocks with 30 mL of 0.2% Ropivacaine injected bilaterally. The dermatomal distribution of the sensory block (by pinprick test was recorded. VAS scores for the first 24 hours after surgery and opioid use were compared between the IV-PCA+TAP block and IV-PCA only groups.Results: Sensory block ranged from T5–L1. Mean VAS pain scores decreased from 8 ± 2 to 4 ± 3 (P=0.04 within 30 minutes of TAP block administration. Compared with patients given IV-PCA only, significantly fewer patients who received TAP block had moderate or severe pain (VAS 4–10 after block administration at 6 hours and 12 hours post-surgery. However, cumulative consumption of hydromorphone at 24 hours after SPSG surgery

  1. EFFICACY OF BARIATRIC SURGERY IN OBESE INDIAN WITH TYPE 2 DIABETES MELLITUS

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    Subodh

    2013-01-01

    Full Text Available ABSTRACT: CONTEXT: Individuals with morbid obesity and type 2 diabetes benefit from weight loss, as this allows better glycemic control and modifies the coexisting risk factors for coronary heart disease, namely hypertension, dyslipid emia, insulin resistance, sleep apnea, and other comorbidities that constitute the metabolic s yndrome. AIMS: The purpose of the present study was to investigate whether weight loss after bariatric surgery can correct glycemic control and reduces the need of anti-diabetic treat ment in morbidly obese patients with type 2 diabetes. SETTINGS AND DESIGN: This is a prospective cohort study performed in Sri Aurobindo Medical College & PG Institute, Indore. S ampling done was nonrandom and purposive. METHODS AND MATERIAL: Forty patients with body mass index (BMI > 35 and had known type 2 diabetes were enrolled in study, al l these patient undergone bariatric surgery. Their obesity status in terms of height, weight and BMI, Glycemic status in terms of fasting blood sugar (FBS, postprandial blood sugar (PPBS and glycosylated haemoglobin (HbA1c, and treatment status in terms of oral hypoglycemic a gents and insulin were noted in details preoperatively Statistical analysis used: Quantitative variables w ere tested using Chi square test and p values were calculated between two groups. p val ue of ≤ 0.05 was considered statistically significant. Averages were expressed between groups a s mean ± standard deviation or percentage. RESULTS: Our study shows good control of glycemic status af ter bariatric surgery with mean HbA1c within desired level after 6 months of bariatric surgery. CONCLUSIONS: In conclusion, our study shows that bariatric surgery is an effective option for morbidly obese patients with type 2 diabetes mellitus. Weight loss d ue to surgery is strongly associated with good glycemic control and improved treatment efficac y.

  2. Self-reported problems and wishes for plastic surgery after bariatric surgery

    DEFF Research Database (Denmark)

    Wagenblast, Lene; Laessoe, Line; Printzlau, Andreas

    2014-01-01

    , since some of the patients will experience problems due to excess skin. Foreign studies estimate that ∼30% of all bariatric surgery patients will at some point seek plastic surgical correction of excess skin. The aim of this study is to investigate to what extent the GB patients themselves consider...... plastic surgery for removal of excess skin, and their reasons and motivations for this. The investigation was performed as an anonymous questionnaire handed out to 150 patients at the 1-year standard consultation for GB patients at a private hospital. The questionnaire contained information about...... demographic data, patient habits, earlier or present comorbidity, physical problems, psychological problems, and cosmetic problems due to excess skin. Also, it contained information about what anatomical area bothered the patient the most. One hundred and thirty-eight patients responded to the questionnaire...

  3. Pregnancy after bariatric surgery - a review of benefits and risks

    DEFF Research Database (Denmark)

    Kjær, Mette Karie Mandrup; Nilas, Lisbeth

    2013-01-01

    restriction of food intake and/or malabsorption leading to weight loss, but may induce a risk for malnutrition and pregnancy complications. Method. Systematically conducted review addressing pregnancy after bariatric surgery using the PubMed and Cochrane databases. Main Outcome Measures. Birthweight...

  4. Young adult women's experiences of body image after bariatric surgery

    DEFF Research Database (Denmark)

    Froulund Jensen, Janet; Petersen, Mette H; Larsen, Tine B;

    2014-01-01

    AIM: To understand the lived experience of body image in young women after obesity surgery. BACKGROUND: Quantitative studies have documented that health-related quality of life and body image are improved after bariatric surgery, probably due to significant weight loss. Female obesity surgery...... candidates are likely to be motivated by dissatisfaction regarding physical appearance. However, little is known about the experience of the individual woman, leaving little understanding of the association between bariatric surgery and changes in health-related quality of life and body image. DESIGN...... synthesized into one major theme: on the edge of control, that is describing these women's feelings of being on the edge of balance between control and loss of control. CONCLUSION: Perception of control may be an essential aspect of body image and the key to understanding these young women's feelings...

  5. The effects of bariatric surgeries on type 2 diabetes mellitus

    Science.gov (United States)

    Lerd Ng, Jia; Ortiz, Roberto; Hughes, Tyler; Abou Ghantous, Michel; Bouhali, Othmane; Arredouani, Abdelilah; Allen, Roland

    2012-10-01

    We consider a scientific mystery which is of central importance in treating the most rapidly emerging national and global health threat: type 2 diabetes mellitus. The mystery involves a surprising effect of certain bariatric surgeries, and specifically Roux-en-Y gastric bypass (RYGB), a procedure which bypasses most of the stomach and upper intestine. An unanticipated result is that RYGB is usually found to contribute within only a few days to glucose homeostasis. This means the surgery can immediately cure patients even before they start losing weight. We are investigating this wondrous biochemical response with a quantitative model which includes the most important mechanisms. One of the major contributors is glucagon-like peptide 1 (GLP-1), an incretin whose concentration is found to increase by a large amount right after the RYGB surgical procedure. However, our results, in conjunction with the experimental and medical data, indicate that other substances must also contribute. If these substances can be definitively identified, it may be possible to replace the surgery with pharmaceuticals as the preferred treatment for type 2 diabetes.

  6. Metabolic Hormones in bariatric surgery and reward behaviour

    OpenAIRE

    Emmanuel, J. J.

    2015-01-01

    The World Health Organization (WHO) defines obesity as a condition in which body fat is increased to the extent that health and well-being are impaired. Obesity and type-2 diabetes are two of the leading healthcare challenges facing this generation. Bariatric surgery is the most effective therapeutic option for morbid obesity. A systematic review has concluded that surgery is superior to conventional treatment in reducing weight. However, the review failed to show the superiority of one surgi...

  7. Bariatric surgery decreases carotid intima-media thickness in obese subjects

    Directory of Open Access Journals (Sweden)

    Gonzalo García

    2013-08-01

    Full Text Available Background: Obesity has long been associated with an increased risk of cardiovascular disease (CVD. The aim of this study was to evaluate the impact of substantial weight loss induced by bariatric surgery on carotid intima media thickness (C-IMT (surrogate marker of early atherosclerosis and classic factors of cardiovascular risk (CVRFs. Methods: thirty-one obesity patients were evaluated for bariatric surgery. Twenty-seven were undergone surgery, 14 Roux-en-Y gastric bypass surgery (GBS and 13 sleeve gastrectomy. The four obese patients who did not undergo surgery, were performed the same evaluations. Measurements: Body weight, BMI, blood pressure, total cholesterol, TC levels, LDL-C, HDL-C, TG, fasting plasma glucose and insulin, HOMA IR, and US B-mode C-IMT was measured. Results: After 354 ± 92 days follow up, 27 patients that underwent bariatric surgery evidenced a mean body mass index decrease from 38 to 27 k/m² (p < 0.001, simultaneously was observed improvement in CVRFs, 10 years Framingham risk and a significant reduction of therapeutic requirements. C-IMT diminished from a mean of 0.58 ± 0.14 mm to 0.49 ± 0.09 mm (p = 0.0001. Four patients that did not undergo surgery increased C-IMT from 0.52 ± 0.12 to 0.58 ± 0.13 mm (p = 0.03 with no significant changes in CVRFs. Conclusion: Weight loss, one year after bariatric surgery, GBS and sleeve gastrectomy, decreases C-IMT; improve CVRFs and 10 years Framingham risk.

  8. Post-Bariatric Surgery Satisfaction and Body-Contouring Consideration after Massive Weight Loss

    OpenAIRE

    Saleh M Aldaqal; Ahmad M Makhdoum; Ali M Turki; Awan, Basim A; Osama A Samargandi; Hytham Jamjom

    2013-01-01

    Background: Following a bariatric surgery and massive weight-loss, the outcome is usually sullied by consequences on the body′s contour and redundant skin. Aims: We aimed to record the frequency of contour irregularities and quantify patients′ satisfaction with appearance and anticipations from body contouring surgery. Materials and Methods: The ethical committee at King Abdulaziz University Hospital approved the study, and patients were consented. A cross-sectional study targeting the post-b...

  9. The psychological profile of bariatric patients with and without type 2 diabetes

    DEFF Research Database (Denmark)

    Wimmelmann, Cathrine L; Smith, Evelyn; Lund, Michael T;

    2015-01-01

    BACKGROUND: Some bariatric patients are referred for surgery with a diagnosis of type 2 diabetes while others are referred without co-morbid diabetes, but psychological differences between patients with and without type 2 diabetes undergoing bariatric surgery have not yet been investigated. The...... objective of this study was to present the baseline results of the longitudinal GASMITO-PSYC study, and to evaluate the psychological differences between bariatric patients with and without type 2 diabetes. METHODS: A total of 129 Roux-en- Y gastric bypass patients were recruited from the bariatric clinic...... sex and age. The total study sample differed significantly from Danish test norms reporting higher neuroticism (P = .000), more mental symptoms (P = .000), lower HRQOL (P = .000), and less positive weight-related body image (P = .000). CONCLUSION: Patients with type 2 diabetes had better physical...

  10. Through Thick and Thin: Identifying Barriers to Bariatric Surgery, Weight Loss Maintenance, and Tailoring Obesity Treatment for the Future

    Science.gov (United States)

    Westerveld, Donevan; Yang, Dennis

    2016-01-01

    More than one-third of the adults in the United States are obese. This complex metabolic disorder is associated with multiple comorbidities and increased all-cause mortality. Bariatric surgery has been shown to be more effective than medical therapy and has been associated with weight loss maintenance and decreased mortality. In spite of these well-established benefits, less than 1% of candidates undergo surgery due to multiple factors, such as patient and physician perceptions and attitudes, patient-physician interaction, lack of resources, and cost burden. Furthermore, even in patients who do undergo bariatric surgery and/or alternate weight loss interventions, long-term weight control is associated with high-risk failure and weight regain. In this review, we highlight some of the current barriers to bariatric surgery and long-term weight loss maintenance and underscore the importance of an individualized multidisciplinary longitudinal strategy for the treatment of obesity.

  11. Bile Acids, FXR, and Metabolic Effects of Bariatric Surgery

    Science.gov (United States)

    Noel, Olivier F.; Still, Christopher D.; Argyropoulos, George; Edwards, Michael; Gerhard, Glenn S.

    2016-01-01

    Overweight and obesity represent major risk factors for diabetes and related metabolic diseases. Obesity is associated with a chronic and progressive inflammatory response leading to the development of insulin resistance and type 2 diabetes (T2D) mellitus, although the precise mechanism mediating this inflammatory process remains poorly understood. The most effective intervention for the treatment of obesity, bariatric surgery, leads to glucose normalization and remission of T2D. Recent work in both clinical studies and animal models supports bile acids (BAs) as key mediators of these effects. BAs are involved in lipid and glucose homeostasis primarily via the farnesoid X receptor (FXR) transcription factor. BAs are also involved in regulating genes involved in inflammation, obesity, and lipid metabolism. Here, we review the novel role of BAs in bariatric surgery and the intersection between BAs and immune, obesity, weight loss, and lipid metabolism genes. PMID:27006824

  12. Bariatric Surgery and Non-Alcoholic Fatty Liver Disease: Current and Potential Future Treatments

    OpenAIRE

    Sasaki, Akira; Nitta, Hiroyuki; Otsuka, Koki; Umemura, Akira; Baba, Shigeaki; Obuchi, Toru; WAKABAYASHI, GO

    2014-01-01

    Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are increasingly common cause of chronic liver disease worldwide. The diagnosis of NASH is challenging as most affected patients are symptom-free and the role of routine screening is not clearly established. Most patients with severe obesity who undergo bariatric surgery have NAFLD, which is associated insulin resistance, type 2 diabetes mellitus (T2DM), hypertension, and obesity-related dyslipidemia. The effec...

  13. Utility of Ultrasound, Transaminases, and Visual Inspection to Assess Nonalcoholic Fatty Liver Disease in Bariatric Surgery Patients

    Science.gov (United States)

    Petrick, Anthony; Wood, G. Craig; Still, Christopher D.; Strodel, William E.; Gabrielsen, John; Rolston, David; Chu, Xin; Argyropoulos, George; Ibele, Anna; Gerhard, Glenn S.

    2016-01-01

    Background Nonalcoholic fatty liver disease (NAFLD) is common in adults with extreme obesity and can impact long-term health and survival. Liver biopsy is the only accurate test for diagnosis and staging, but is invasive and costly. Non-invasive testing offers an attractive alternate, but the overall accuracy remains a significant issue. This study was conducted to determine the accuracy and clinical utility of preoperative ultrasound and liver transaminase levels, as well as intra-operative hepatic visual inspection, for assessing presence of NAFLD as confirmed by hepatic histology. Methods Data was collected prospectively from 580 morbidly obese adult patients who underwent Roux-en-Y gastric bypass surgery with intraoperative wedge biopsy between January 2004 and February 2009. Complete data for ultrasound, ALT and AST levels, and documented visual inspection was available for 513 patients. Results The prevalence of NAFLD was 69 % and that of NASH was 32 %. The individual non-invasive clinical assessments demonstrated low sensitivity, specificity, and accuracy for detecting the presence of steatosis, steatohepatitis, or fibrosis. The combination of normal or abnormal results for all tests improved predictive utility. Abnormal tests with all three assessments had a sensitivity of 95–98 % and a specificity of 28–48 % for major histologic findings in NAFLD/NASH. Normal tests with all three assessments had a sensitivity of 12–22 % and a specificity of 89–97 % for major histologic findings in NAFLD/NASH. Conclusions Although individual clinical tests for NAFLD have limited accuracy, the use of combined clinical tests may prove useful. PMID:26003548

  14. Effects of Bariatric Surgery on Human Small Artery Function

    OpenAIRE

    Aghamohammadzadeh, Reza; Greenstein, Adam S.; Yadav, Rahul; Jeziorska, Maria; Hama, Salam; Soltani, Fardad; Pemberton, Phil W.; Ammori, Basil; Malik, Rayaz A; Soran, Handrean; Heagerty, Anthony M

    2013-01-01

    Objectives The aim of this study was to investigate the effects of bariatric surgery on small artery function and the mechanisms underlying this. Background In lean healthy humans, perivascular adipose tissue (PVAT) exerts an anticontractile effect on adjacent small arteries, but this is lost in obesity-associated conditions such as the metabolic syndrome and type II diabetes where there is evidence of adipocyte inflammation and increased oxidative stress. Methods Segments of small subcutaneo...

  15. Anesthesia management in laparoscopic bariatric surgery: Perioperative complications and outcomes in the third year of practice

    Directory of Open Access Journals (Sweden)

    Serkan Karaman

    2014-06-01

    Full Text Available Objective: In this study, we aimed to assess the perioperative and postoperative results of the patients who underwent bariatric surgery. Methods: After obtaining approval, a retrospectively designed observational study was conducted. All adult patients who underwent laparoscopic gastric plication, sleeve gastrectomy, or roux-en-Y anastomosis between January 2011 and May 2013 were included. Results: A total of 104 patients were included in the study period: 49 (47.1% underwent laparoscopic roux-en-Y anastomosis, 44 (42.3% underwent laparoscopic sleeve gastrectomy, and 11 (10.6% underwent laparoscopic gastric plication. The present study showed a mortality rate of 1.9% (n = 2, one after Roux-en-Y anastomosis operation, and the other one after gastric plication. Conclusion: The anesthesia methods and approaches have no association with morbidity and mortality in such procedures of bariatric surgery indicated in the present study. J Clin Exp Invest 2014; 5 (2: 200-205

  16. The bariatric patient: an overview of perioperative care.

    Science.gov (United States)

    Fencl, Jennifer L; Walsh, Angela; Vocke, Dawn

    2015-08-01

    Obesity (ie, a body mass index of ≥30 kg/m(2)) is increasing in the United States. As a result, more overweight individuals are being surgically treated for weight loss, thus making it imperative for perioperative RNs to understand obesity's effects on patients' health, its contribution to significant comorbidities (eg, diabetes, cardiovascular disease, hypertension, sleep apnea, musculoskeletal issues, stroke), the perioperative care requirements (eg, specialized instruments and equipment, positioning and lifting aids), and unique needs of these patients (eg, diet, counseling). It is vital that the perioperative nurse accurately assesses the patient undergoing bariatric surgery to provide safe and appropriate nursing interventions during the perioperative continuum of care. PMID:26227516

  17. Salt taste after bariatric surgery and weight loss in obese persons.

    Science.gov (United States)

    Ekmekcioglu, Cem; Maedge, Julia; Lam, Linda; Blasche, Gerhard; Shakeri-Leidenmühler, Soheila; Kundi, Michael; Ludvik, Bernhard; Langer, Felix B; Prager, Gerhard; Schindler, Karin; Dürrschmid, Klaus

    2016-01-01

    Background. Little is known about the perception of salty taste in obese patients, especially after bariatric surgery. Therefore, the aim of this study was to analyse possible differences in salt detection thresholds and preferences for foods differing in salt content in obese persons before and after bariatric surgery with weight loss compared to non-obese individuals. Methods. Sodium chloride detection thresholds and liking for cream soups with different salt concentrations were studied with established tests. Moreover, a brief salt food questionnaire was assessed to identify the usage and awareness of salt in food. Results. The results showed similar mean sodium chloride detection thresholds between non-obese and obese participants. After bariatric surgery a non-significant increase in the salt detection threshold was observed in the obese patients (mean ± SD: 0.44 ± 0.24 g NaCl/L before OP vs. 0.64 ± 0.47 g NaCl/L after OP, p = 0.069). Cream soup liking between controls and obese patients were not significantly different. However, significant sex specific differences were detected with the tested women not liking the soups (p < 0.001). Results from the food questionnaire were similar between the groups. Conclusion. No differences between non-obese persons and obese patients were shown regarding the salt detection threshold. However, due to highly significant differences in soup liking, sex should be taken into consideration when conducting similar sensory studies. PMID:27330856

  18. Effect of ethnicity on weight loss among adolescents 1 year after bariatric surgery

    Institute of Scientific and Technical Information of China (English)

    Sarah; E; Messiah; Gabriela; Lopez-Mitnik; Deborah; Winegar; Bintu; Sherif; Kristopher; L; Arheart; Kirk; W; Reichard; Marc; P; Michalsky; Steven; E; Lipshultz; Tracie; L; Miller; Alan; S; Livingstone; Nestor; de; la; Cruz-Muoz

    2013-01-01

    AIM:To investigate whether or not bariatric surgeryweight outcomes vary by ethnicity in a large,nationally representative sample of adolescents.METHODS:The Bariatric Outcomes Longitudinal Database was used for analysis and contains data on surgeries performed on adolescents from 2004 to 2010from 423 surgeons at 360 facilities across the United States Adolescents(n=827)between 11 and 19 years old who underwent either gastric bypass or adjustable gastric banding surgery were included in the analysis.Outcome measures included changes in anthropometric measurements[weight(kg)and body mass index]from baseline to 3(n=739),6(n=512),and 12(n=247)mo after surgery.RESULTS:A year after patients underwent either gastric bypass(51%)or adjustable gastric banding(49%)surgery,mean estimated weight loss for all ethnic groups differed by a maximum of only 1.5 kg,being34.3 kg(95%CI:30.0-38.5 kg)for Hispanics,33.8 kg(95%CI:27.3-40.3 kg)for non-Hispanic blacks,and32.8 kg(95%CI:30.9-34.7 kg)for non-Hispanic whites.No overall pairwise group comparisons were significant,indicating that no ethnic group had better weight loss outcomes than did another.CONCLUSION:Bariatric surgery substantially reduces the weight of severely obese adolescents at 1 year post-procedure with little variation by ethnicity and/or gender.These results suggest that bariatric surgery is a safe and reasonable treatment for all severely obese adolescents with the appropriate indications.

  19. Imaging in bariatric surgery: service set-up, post-operative anatomy and complications

    OpenAIRE

    Shah, S.; Shah, V.; Ahmed, A.R; Blunt, D M

    2011-01-01

    Obesity is an increasingly prevalent and costly problem faced by the healthcare system. The role of bariatric surgery in managing obesity has also increased with evidence showing a reduction in long-term morbidity and mortality. There are unique challenges faced by the radiology department in providing an imaging service for this population of patients, from technical and staffing requirements through to the interpretation of challenging post-surgical images. We describe these challenges and ...

  20. Equal ratio ventilation (1:1 improves arterial oxygenation during laparoscopic bariatric surgery: A crossover study

    Directory of Open Access Journals (Sweden)

    Wesam Farid Mousa

    2013-01-01

    Full Text Available Background: Hypoxaemia and high peak airway pressure (Ppeak are common anesthetic problems during laparoscopic bariatric surgery. Several publications have reported the successful improvement in arterial oxygenation using positive end expiratory pressure and alveolar recruitment maneuver, however, high peak airway pressure during laparoscopic bariatric surgery may limit the use of both techniques. This study was designed to determine whether equal I:E (inspiratory-to-expiratory ratio ventilation (1:1 improves arterial oxygenation with parallel decrease in the Ppeak values. Methods: Thirty patients with a body mass index ≥40 kg/m 2 scheduled for laparoscopic bariatric surgery were randomized, after creation of pneumoperitoneum, to receive I:E ratio either 1:1 (group 1, 15 patients or 1:2 (group 2, 15 patients. After a stabilization period of 30 min, patients were crossed over to the other studied I:E ratio. Ppeak, mean airway pressure (Pmean, dynamic compliance (Cdyn, arterial blood gases and hemodynamic data were collected at the end of each stabilization period. Results: Ventilation with I: E ratio of 1:1 significantly increased partial pressure of O 2 in the arterial blood (PaO 2 , Pmean and Cdyn with concomitant significant decrease in Ppeak compared to ventilation with I: E ratio of 1:2. There were no statistical differences between the two groups regarding the mean arterial pressure, heart rate, respiratory rate, end tidal CO 2 or partial pressure of CO 2 in the arterial blood. Conclusion: Equal ratio ventilation (1:1 is an effective technique in increase PaO 2 during laparoscopic bariatric surgery. It increases Pmean and Cdyn while decreasing Ppeak without adverse respiratory or hemodynamic effects.

  1. Características psicológicas de pacientes submetidos a cirurgia bariátrica Psychological characteristics of patients submitted to bariatric surgery

    Directory of Open Access Journals (Sweden)

    Ronis Magdaleno Jr.

    2009-01-01

    terapêutico específico.INTRODUCTION: The great number of patients submitted bariatric surgery who have psychological and psychiatric complications during the postoperative period require a thorough preoperative investigation and a categorization with the purpose of predicting possible complications and personalizing psychological care that might favor patient compliance. Psychodynamic assessment may provide data for such categorization and, thus, suggest effective pre- and postoperative approach strategies. Therefore, the objective of this study was to identify personality structures that may be useful in the postoperative follow-up, as well as additional inclusion and exclusion criteria for the surgical procedure. METHOD: Report of empirical survey conducted during psychotherapy sessions with an open group of patients who underwent bariatric surgery. DISCUSSION: After surgery, patients may experience phases of emotional restructuring, such as an initial phase of feeling triumphant, followed by a phase when there is risk of melancholic behavior and new addictions. We identified three categories of psychological structures: melancholic structure (patients seem to be more likely to develop other postoperative addictive behaviors, mainly eating disorders, since they cannot tolerate the frustration of the loss; dementalized structure (due to the lack of elaborative capacity, patients are unable to reorganize themselves in face of the challenge of keeping their weight under control; and perverse structure (patients comply with the scheduled weight loss; however, their behavior makes the health team experience uncomfortable situations. Establishing psychological categories may be crucial in order to suggest postoperative management strategies, including referral to a psychotherapist with the purpose of providing personalized care, thus increasing specific therapeutic success.

  2. Bariatric Surgery in Women: A Boon Needs Special Care During Pregnancy

    OpenAIRE

    Kumari, Archana; Nigam, Aruna

    2015-01-01

    Obesity is one of the leading causes of health related disorder and has reached epidemic proportions not only in developed nations but also in developing countries like India. Bariatric surgery has become a popular alternative for obese women planning pregnancy. A multidisciplinary approach involving the obstetrician, the bariatric surgeon and the nutritionist is required to manage pregnancy following bariatric surgery. Early consultation should be done to determine baseline nutritional statu...

  3. Endocrine and Nutritional Management After Bariatric Surgery

    Science.gov (United States)

    ... After surgery, you need to follow your doctor’s nutritional recommendations and exercise regularly (150 minutes per week of physical activity is recommended). Participation in a support group could help you stick with new habits. ...

  4. Country of origin and bariatric surgery in Sweden during 2001-2010.

    OpenAIRE

    Memarian, Ensieh; Sundquist, Kristina; Calling, Susanna; Sundquist, Jan; Li, Xinjun

    2015-01-01

    The prevalence of obesity, as well as use of bariatric surgery, has increased worldwide. The aim of the present study was to investigate the potential differences in the use of bariatric surgery among Swedes and immigrants in Sweden and whether the hypothesized differences remain after adjustment for socioeconomic factors.

  5. Chronic Renin-Angiotensin System (RAS) Blockade May Not Induce Hypotension During Anaesthesia for Bariatric Surgery.

    Science.gov (United States)

    Salvetti, Guido; Di Salvo, Claudio; Ceccarini, Giovanni; Abramo, Antonio; Fierabracci, Paola; Magno, Silvia; Piaggi, Paolo; Vitti, Paolo; Santini, Ferruccio

    2016-06-01

    The use of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARB) for the treatment of hypertensive obese patients is steadily increasing. Some studies have reported that the use of these drugs was associated with an increased risk of hypotensive episodes, during general anaesthesia. The number of bariatric procedures is also increasing worldwide, but there is a lack of studies investigating the hypotensive effect of renin-angiotensin system (RAS) blockers in severely obese patients during general anaesthesia for bariatric surgery. The aim of this pilot study was to evaluate hemodynamic changes induced by general anaesthesia in obese patients chronically treated with ACE-I or ARB compared to a control group not treated with antihypertensive therapy. Fourteen obese subjects (mean body mass index (BMI) 47.5 kg/m(2)) treated with ACE-I or ARB and twelve obese (mean BMI 45.7 kg/m2) controls not treated with antihypertensive therapy underwent general anaesthesia to perform laparoscopic bariatric surgery. Systolic blood pressure, diastolic blood pressure, and heart rate were monitored continuously and registered at different time points: T0 before induction, then at 2, 5, 7, 10, 15, 20, 30, 60, 90, 120, and 150 min after induction, and the last time point taken following recovery from anaesthesia. A progressive reduction of both systolic and diastolic blood pressure values was observed without significant differences between the two groups. A similar trend of heart rate values was observed. In conclusion, our pilot study suggests that RAS blockers may be continued during the perioperative period in patients undergoing bariatric surgery, without increasing the risk of hypotensive episodes. PMID:26328531

  6. Acompanhamento psicológico tardio em pacientes submetidos à cirurgia bariátrica Late psychological follow-up on patients submitted to bariatric surgery

    Directory of Open Access Journals (Sweden)

    Simone Dallegrave Marchesini

    2010-06-01

    a prevenção às recaídas possa ser foco terapêutico.BACKGROUND: The human being is not alone; he is always compared to their peers and the environment. Every change corresponds to a social reaction and a response issued in the form of behavior. AIM: To evaluate some of the postoperative psychological conditions and life style in a short and in a long term follow-up. METHOD: A 26 item evaluation questionnaire was sent to post bariatric patients concerning to motivation and compliance to the treatment, behavioral changes, humor alterations, reaching of expectancies among others. RESULTS: The majority of this group of patients felt prepared for surgery during the first office interview, but didn't know the method of treatment that they were about to be submitted to. The majority also had not been treated for their psychological and/or psychiatric conditions and didn't change their life style after the operation. Compliance to nutrition orientation was partial and there were evident emotional manifestations. The weight regain complaint was small compared with the satisfaction of the weight loss. Most of these patients would be submitted again to the operation, and half of them stated the need for support groups. Patients wanted the operation, but didn't realize the need of better preparation and didn't change the behavioral patterns necessary to reach the success in a long term follow-up. They usually abandon the postoperative treatment. CONCLUSION: It can be inferred that the motivations that lead individuals to seek bariatric surgery are predicated on social returns, in the aesthetic standards and the psychological desire for life change. Once implemented the change of life, motivation is over, but does not guarantee the existential satisfaction. It is also possible to infer that the preparation for the care of spouses and family claims a space in training professionals in the area of surgical treatment of obesity, for the prevention of relapses can be therapeutic

  7. An Untargeted Metabolomics Approach to Characterize Short-Term and Long-Term Metabolic Changes after Bariatric Surgery.

    Science.gov (United States)

    Narath, Sophie H; Mautner, Selma I; Svehlikova, Eva; Schultes, Bernd; Pieber, Thomas R; Sinner, Frank M; Gander, Edgar; Libiseller, Gunnar; Schimek, Michael G; Sourij, Harald; Magnes, Christoph

    2016-01-01

    Bariatric surgery is currently one of the most effective treatments for obesity and leads to significant weight reduction, improved cardiovascular risk factors and overall survival in treated patients. To date, most studies focused on short-term effects of bariatric surgery on the metabolic profile and found high variation in the individual responses to surgery. The aim of this study was to identify relevant metabolic changes not only shortly after bariatric surgery (Roux-en-Y gastric bypass) but also up to one year after the intervention by using untargeted metabolomics. 132 serum samples taken from 44 patients before surgery, after hospital discharge (1-3 weeks after surgery) and at a 1-year follow-up during a prospective study (NCT01271062) performed at two study centers (Austria and Switzerland). The samples included 24 patients with type 2 diabetes at baseline, thereof 9 with diabetes remission after one year. The samples were analyzed by using liquid chromatography coupled to high resolution mass spectrometry (LC-HRMS, HILIC-QExactive). Raw data was processed with XCMS and drift-corrected through quantile regression based on quality controls. 177 relevant metabolic features were selected through Random Forests and univariate testing and 36 metabolites were identified. Identified metabolites included trimethylamine-N-oxide, alanine, phenylalanine and indoxyl-sulfate which are known markers for cardiovascular risk. In addition we found a significant decrease in alanine after one year in the group of patients with diabetes remission relative to non-remission. Our analysis highlights the importance of assessing multiple points in time in subjects undergoing bariatric surgery to enable the identification of biomarkers for treatment response, cardiovascular benefit and diabetes remission. Key-findings include different trend pattern over time for various metabolites and demonstrated that short term changes should not necessarily be used to identify important long

  8. Mechanisms of changes in glucose metabolism and bodyweight after bariatric surgery

    DEFF Research Database (Denmark)

    Madsbad, Sten; Dirksen, Carsten; Holst, Jens Juul

    2014-01-01

    Bariatric surgery is the most effective treatment for obesity and also greatly improves glycaemic control, often within days after surgery, independently of weight loss. Laparoscopic adjustable gastric banding (LAGB) was designed as a purely restrictive procedure, whereas vertical sleeve gastrect...

  9. Lithium toxicity after Roux-en-Y bariatric surgery.

    Science.gov (United States)

    Musfeldt, Deanna; Levinson, Andrew; Nykiel, Jennifer; Carino, Gerardo

    2016-01-01

    A 61-year-old woman with medical history significant for morbid obesity, type II diabetes mellitus, nephrogenic diabetes insipidus and bipolar disorder, had been stable on lithium carbonate therapy for several years. She had undergone a Roux-en-Y bypass surgery and, at the time of her surgery, her lithium level was found to be 0.61 mEq/L on a maintenance dose of 600 mg orally twice per day. She was discharged 8 days postoperatively on the same lithium dose, but presented to the emergency department 12 days postoperatively with signs of lithium toxicity. Her lithium level was elevated to 1.51 mEq/L and she was treated for lithium toxicity with supportive care and, ultimately, reduction of her lithium dose. Clinicians should be aware that dramatic and poorly understood changes in drug absorption may occur after bariatric surgery. PMID:26994048

  10. Oral Liquid l-Thyroxine (l-T4) May Be Better Absorbed Compared to l-T4 Tablets Following Bariatric Surgery

    OpenAIRE

    Pirola, Ilenia; Formenti, Anna M.; Gandossi, Elena; Mittempergher, Francesco; Casella, Claudio; Agosti, Barbara; Cappelli, Carlo

    2013-01-01

    Drug malabsorption is a potential concern after bariatric surgery. We present four case reports of hypothyroid patients who were well replaced with thyroxine tablets to euthyroid thyrotropin (TSH) levels prior to Roux-en-Y gastric bypass surgery. These patients developed elevated TSH levels after the surgery, the TSH responded reversibly to switching from treatment with oral tablets to a liquid formulation.

  11. Bariatric Surgery in University Clinic Center Tuzla - Results After 30 Operations

    Science.gov (United States)

    Ahmetasevic, Emir; Pasic, Fuad; Beslin, Miroslav Bekavac; Ilic, Miroslav; Ahmetasevic, Dzenita; Mesic, Mirza

    2016-01-01

    Introduction: Project of Bariatric surgery in University clinic center (UCC) Tuzla has been initiated in 2009 as an idea of professor Dešo Mešić and soon after that Bariatric surgical team led by doctor Fuad Pasic has been created. Material and methods: Practical team education was realized in Croatia in hospital „Sisters of Mercy” under supervision of professor Miroslav-Bekavac Beslin. First bariatric operations in UCC Tuzla has been done in 2011 and it was biliopancreatic diversion (BPD) Scopinaro. Results and discussion: So far there has been done 30 operations and among them there have been used almost all operative modalities - restrictive, malabsorptive and combined (laparoscopic gastric banding-LAPGB, Roux-y mini gastric bypass, open and laparoscopic gastric sleeve resection, and over mentioned Scopinaro’s BPD). Beginning results are very promising according to the fact that almost all operated patients after one year stopped using antihypertensive, antidiabetic and antidepressant therapy, that average year’s weight loss is 35-100 kilograms and total satisfactions of patients after surgeries is obvious. PMID:27147808

  12. EARLY COMPLICATIONS IN BARIATRIC SURGERY: incidence, diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Marco Aurelio SANTO

    2013-03-01

    Full Text Available Context Bariatric surgery has proven to be the most effective method of treating severe obesity. Nevertheless, the acceptance of bariatric surgery is still questioned. The surgical complications observed in the early postoperative period following surgeries performed to treat severe obesity are similar to those associated with other major surgeries of the gastrointestinal tract. However, given the more frequent occurrence of medical comorbidities, these patients require special attention in the early postoperative follow-up. Early diagnosis and appropriate treatment of these complications are directly associated with a greater probability of control. Method The medical records of 538 morbidly obese patients who underwent surgical treatment (Roux-en-Y gastric bypass surgery were reviewed. Ninety-three (17.2% patients were male and 445 (82.8% were female. The ages of the patients ranged from 18 to 70 years (average = 46, and their body mass indices ranged from 34.6 to 77 kg/m2. Results Early complications occurred in 9.6% and were distributed as follows: 2.6% presented bleeding, intestinal obstruction occurred in 1.1%, peritoneal infections occurred in 3.2%, and 2.2% developed abdominal wall infections that required hospitalization. Three (0.5% patients experienced pulmonary thromboembolism. The mortality rate was 0,55%. Conclusion The incidence of early complications was low. The diagnosis of these complications was mostly clinical, based on the presence of signs and symptoms. The value of the clinical signs and early treatment, specially in cases of sepsis, were essential to the favorable surgical outcome. The mortality was mainly related to thromboembolism and advanced age, over 65 years. Contexto A cirurgia bariátrica tem mostrado ser o método mais eficaz de tratamento da obesidade grave. No entanto, sua aceitação como terapia padrão-ouro ainda é questionada. As complicações cirúrgicas observadas no início do período p

  13. Reduction of the risk of rhabdomyolysis after bariatric surgery with lower fluid administration in the perioperative period: a cohort study.

    Science.gov (United States)

    Matłok, Maciej; Major, Piotr; Małczak, Piotr; Wysocki, Michał; Hynnekleiv, Leif; Nowak, Mateusz; Karcz, Konrad; Pędziwiatr, Michał; Budzyński, Andrzej

    2016-04-13

    INTRODUCTION    Obesity is a growing worldwide problem. One of the most effective treatments is a bariatric procedure; however, surgery is associated with the risk of complications, such as staple line leakage, suture line bleeding, and rhabdomyolysis (RML). OBJECTIVES    The objective of our study was to assess the risk of RML after bariatric surgery related to intravenous fluid administration in the perioperative period. PATIENTS AND METHODS    The study involved 194 patients who underwent a bariatric surgery (laparoscopic sleeve gastrectomy or laparoscopic gastric bypass). We studied an association between the development of RML and sex, age, weight, duration of surgery, type of surgery, and the volume of intravenously administered fluids during the perioperative period. RESULTS    The median duration of surgery was 132.5 minutes. The median volume of administered fluids was 3150 ml from the introduction of anesthesia to 24 hours after surgery. Biochemical RML (creatine phosphokinase >1000 U/l) was observed in 30 patients (15.46%). RML with clinical manifestations developed in 6 patients. Multivariate logistic regression revealed an increase in the odds ratio of biochemical RML with an increase of weight on the day of surgery, operative time, and volume of intravenous fluids. A multiple regression model showed that every 500 ml of transfused fluid over the median volume increases creatine phosphokinase concentrations in the first postoperative day by 241.77 U/l over the median level, with the operative time and patient's weight remaining at median values. CONCLUSIONS    We observed an association between the administration of lower fluid volumes and a lower risk of RML. We postulate that decreasing intravenous fluid administration may reduce the risk of RML after bariatric surgery. PMID:27074693

  14. Potential mechanisms mediating improved glycemic control after bariatric/metabolic surgery.

    Science.gov (United States)

    Yamamoto, Hiroshi; Kaida, Sachiko; Yamaguchi, Tsuyoshi; Murata, Satoshi; Tani, Masaji; Tani, Tohru

    2016-03-01

    Conservative medical treatment for morbid obesity generally fails to sustain weight loss. On the other hand, surgical operations, so-called bariatric surgery, have evolved due to their long-term effects. The global increase in the overweight population and the introduction of laparoscopic surgery have resulted in the use of bariatric surgery spreading quickly worldwide in recent years. Recent clinical evidence suggests that bariatric surgery not only reduces body weight, but also improves secondary serious diseases, including type 2 diabetes mellitus, in so-called metabolic surgery. Moreover, several potential mechanisms mediating the improvement in glycemic control after bariatric/metabolic surgery have been proposed based on the animal and human studies. These mechanisms include changes in the levels of gastrointestinal hormones, bacterial flora, bile acids, intestinal gluconeogenesis and gastrointestinal motility as well as adipose tissue and inflammatory mediators after surgery. The mechanisms underlying improved glycemic control are expected to accelerate the promotion of both metabolic and bariatric surgery. This article describes the current status of bariatric surgery worldwide and in Japan, reviews the accumulated data for weight loss and diabetic improvements after surgery and discusses the potential mechanisms mediating improved glycemic control. PMID:25700844

  15. Other aspects of bariatric surgery: liver steatosis, ferritin and cholesterol metabolism

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    A. E. Pontiroli

    2013-01-01

    Full Text Available Bariatric surgery developed in the late 1970 to treat severe hyperlipidemias in overweight individuals, not necessarily obese. Several techniques have been developed, and the concept has come first of a surgery for morbid obesity, then of a cure for diabetes in morbid obesity. There are other aspects of bariatric surgery that deserve attention, beyond BMI and diabetes, such as hypertension, poor life expectancy, increased prevalence of cancer, congestive heart failure, social inadequacy. The aim of this presentation is to review some recent development in clinical research, in the fields of liver steatosis, ferritin metabolism, and cholesterol metabolism. Liver steatosis, also called fatty liver encompasses a graduation of diseases with different clinical relevance and prognosis. NAFLD correlates with atherosclerosis, insulin resistance and diabetes mellitus. There is now evidence that weight loss, obtained through diet or restrictive surgery, reduces the prevalence (and the severity of NAFLD. An other issue is represented by serum ferritin concentrations, that are strongly associated with fibrosis, portal and lobular inflammation in NAFLD patients, especially in the presence of obesity. Body iron contributes to excess oxidative stress already at non iron overload concentrations. Moreover, serum ferritin is an important and independent predictor of the development of diabetes. Weight loss is accompanied by reduction of ferritin, more after restrictive than malabsorptive surgery. Metabolic changes are greater after malabsorptive or mixed surgery than after purely restrictive surgery, and this has been ascribed to a greater weight loss. Studies comparing the two kinds of surgery indicate that, for the same amount of weight loss, decrease of cholesterol is greater with the former than with the latter techniques, and this difference is mainly due to a greater reduction of intestinal absorption of cholesterol. In the choice of surgery for the single

  16. Results of Implementing an Enhanced Recovery After Bariatric Surgery (ERABS) Protocol

    NARCIS (Netherlands)

    G.H.H. Mannaerts (Guido); S. van Mil (Stefanie); P.S. Stepaniak (Pieter); M. Dunkelgrun (Martin); M. de Quelerij (Marcel); S.J.C. Verbrugge (Serge); H. Zengerink (Hans); L.U. Biter (L. Ulas)

    2015-01-01

    textabstractBackground: With the increasing prevalence of morbid obesity and healthcare costs in general, interest is shown in safe, efficient, and cost-effective bariatric care. This study describes an Enhanced Recovery After Bariatric Surgery (ERABS) protocol and the results of implementing such p

  17. Dietary intake in the postoperative bariatric surgery at a university hospital in Rio de Janeiro

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    Louise Crovesy-de-Oliveira

    2014-04-01

    Full Text Available Introduction: bariatric surgery is a treatment for morbid obesity that besides result in high weight loss promotes improvements in laboratory tests and in the pressure reduction. However the surgery can cause bad effects as deficiency some nutrients. This fact become more important evaluates the adequacy of dietary intake of these patients. The objective this study was evaluates the adequacy dietetic of patients after bariatric surgery.Material and methods: we select forty women who underwent Roux-en-Y gastric and carried evaluation anthropometric and dietetic. The dietary evaluate was compared with the daily consumption requirement and food pyramid for these patients.Results: forty women with 43.1 ± 9.96 years, obesity and very high risk for metabolic complications associate with obesity, and with acceptation of supplementation (95% participated this study. The majority of women consumed group’s foods “high-calorie foods, fats and sweets are energy-dense foods” and showed high intake of foods groups “grains and cereals” and “high-fiber, low-calorie foods”. Dietary intake was low-calorie (1342.50 ± 474.06 Kcal, adequate in protein (22.10 ± 6.94%, carbohydrate (50.74 ± 10.96%, lipid (26.14 ± 7.17%, saturated fatty acids (8.69 ± 2.74% and polyunsaturated fatty acids (8.93 ± 3.51% and low-monounsaturated fatty acids (4.13 ± 1.78% and fibers (17.02 ± 10.64 g.Conclusions: nutritional habits of women showed inadequacy, these results reinforce the importance of nutritional accompanying in the late postoperative bariatric surgery.

  18. Binge Eating Disorder and Medical Comorbidities in Bariatric Surgery Candidates

    Science.gov (United States)

    Mitchell, James E.; King, Wendy C.; Pories, Walter; Wolfe, Bruce; Flum, David R.; Spaniolas, Konstatinos; Bessler, Mark; Devlin, Michael; Marcus, Marsha D.; Kalarchian, Melissa; Engel, Scott; Khandelwal, Saurobh; Yanovski, Susan

    2016-01-01

    Objective To determine whether binge eating disorder (BED) status is associated with medical comorbidities in obese adults scheduled for bariatric surgery. Method The study utilized Longitudinal Assessment of Bariatric Surgery-2 data obtained from 6 clinical centers around the United States. This is a well-phenotyped cohort of individuals who were evaluated within 30 days prior to their scheduled surgery using standardized protocols. In the cohort, 350 participants were classified as having BED and 1875 as not having BED (non-BED). Multivariable logistic regression was used to determine whether BED status was independently related to medical comorbidities. As an exploratory analysis, significance was based on nominal P-values (p<.05). Holm-adjusted P-values were also reported. Results After adjusting for age, sex, education and body mass index, BED status was independently associated with 4 of 15 comorbidities (i.e., impaired glucose levels (odds ratio [OR]=1.45 (95%CI: 1.12–1.87), high triglycerides (OR=1.28 (95%CI: 1.002–1.63) and urinary incontinence (OR=1.30 (95%CI: 1.02,1.66) all being more common among the BED sample, and severe walking limitations being less common in the BED sample (OR=0.53 (95%CI: 0.29–0.96)). With further adjustment for psychiatric/emotional health indicators, BED status was independently associated with 3 comorbidities (impaired glucose levels (OR=1.36 (95%CI: 1.04–1.79), cardiovascular disease (OR=0.50 (95%CI: 0.30–0.86) and severe walking limitations (OR=0.38 (95%CI: 0.19–0.77)). However, Holm’s adjusted P-values for all variables were greater than .05. Discussion The results suggest the possibility of a contribution of BED to risk of specific medical comorbidities in severely obese adults. PMID:25778499

  19. Interfaces between bariatric surgery and oral health: a longitudinal survey Interface entre cirurgia bariátrica e saúde bucal: estudo longitudinal

    OpenAIRE

    Juliane Avansini Marsicano; Patrícia Garcia de Moura Grec; Lídia Barbieri Belarmino; Reginaldo Ceneviva; Sílvia Helena de Carvalho Sales Peres

    2011-01-01

    PURPOSE: To evaluate oral changes, such as dental caries, periodontal disease, dental wear and salivary flow in bariatric patients. Fifty four obese patients who underwent bariatric surgery were studied before (n=54), up after 3 months (n=24) and 6 months (n=16). METHODS: Indices for evaluating oral conditions were: DMFT, CPI, DWI and salivary flow. OIDP questionnaire was used to assess the impact of oral health on quality of life. ANOVA and Spearman correlation were used (p0.05), presence of...

  20. Tissue-Specific Effects of Bariatric Surgery Including Mitochondrial Function

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    Simon N. Dankel

    2011-01-01

    Full Text Available A better understanding of the molecular links between obesity and disease is potentially of great benefit for society. In this paper we discuss proposed mechanisms whereby bariatric surgery improves metabolic health, including acute effects on glucose metabolism and long-term effects on metabolic tissues (adipose tissue, skeletal muscle, and liver and mitochondrial function. More short-term randomized controlled trials should be performed that include simultaneous measurement of metabolic parameters in different tissues, such as tissue gene expression, protein profile, and lipid content. By directly comparing different surgical procedures using a wider array of metabolic parameters, one may further unravel the mechanisms of aberrant metabolic regulation in obesity and related disorders.

  1. Remission of Ulcerated Necrobiosis Lipoidica Diabeticorum after Bariatric Surgery

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    Suleyman Bozkurt

    2013-01-01

    Full Text Available A 32-year-old woman with type 2 diabetes mellitus suffering from morbid obesity with BMI 45,14 kg/m2 was operated on. Not only the type 2DM but also one of its complication known as necrobiosis lipoidica diabeticorum remitted postoperatively. Obesity should no longer be regarded simply as a cosmetic problem affecting certain individuals but an epidemic that threatens global well-being. It causes or exacerbates many health problems, and in particular, it is associated with the type 2 diabetes. Necrobiosis lipoidica is a granulomatous skin disease of unknown etiology, associated mainly with diabetes mellitus. We presented in this paper a morbid obese case of necrobiosis lipoidica diabeticorum with dramatic good response to bariatric surgery.

  2. Usefulness of an accelerated transoesophageal stress echocardiography in the preoperative evaluation of high risk severely obese subjects awaiting bariatric surgery

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    Tessier Michel

    2010-07-01

    Full Text Available Abstract Background Severe obesity is associated with an increased risk of coronary artery disease (CAD. Bariatric surgery is an effective procedure for long term weight management as well as reduction of comorbidities. Preoperative evaluation of cardiac operative risk may often be necessary but unfortunately standard imaging techniques are often suboptimal in these subjects. The purpose of this study was to demonstrate the feasibility, safety and utility of transesophageal dobutamine stress echocardiography (TE-DSE using an adapted accelerated dobutamine infusion protocol in severely obese subjects with comorbidities being evaluated for bariatric surgery for assessing the presence of myocardial ischemia. Methods Subjects with severe obesity [body mass index (BMI >40 kg/m2] with known or suspected CAD and being evaluated for bariatric surgery were recruited. Results Twenty subjects (9M/11F, aged 50 ± 8 years (mean ± SD, weighing 141 ± 21 kg and with a BMI of 50 ± 5 kg/m2 were enrolled in the study and underwent a TE-DSE. The accelerated dobutamine infusion protocol used was well tolerated. Eighteen (90% subjects reached their target heart rate with a mean intubation time of 13 ± 4 minutes. Mean dobutamine dose was 31.5 ± 9.9 ug/kg/min while mean atropine dose was 0.5 ± 0.3 mg. TE-DSE was well tolerated by all subjects without complications including no significant arrhythmia, hypotension or reduction in blood arterial saturation. Two subjects had abnormal TE-DSE suggestive of myocardial ischemia. All patients underwent bariatric surgery with no documented cardiovascular complications. Conclusions TE-DSE using an accelerated infusion protocol is a safe and well tolerated imaging technique for the evaluation of suspected myocardial ischemia and cardiac operative risk in severely obese patients awaiting bariatric surgery. Moreover, the absence of myocardial ischemia on TE-DSE correlates well with a low operative risk of cardiac event.

  3. Equal ratio ventilation (1:1) improves arterial oxygenation during laparoscopic bariatric surgery: A crossover study

    OpenAIRE

    Wesam Farid Mousa

    2013-01-01

    Background: Hypoxaemia and high peak airway pressure (Ppeak) are common anesthetic problems during laparoscopic bariatric surgery. Several publications have reported the successful improvement in arterial oxygenation using positive end expiratory pressure and alveolar recruitment maneuver, however, high peak airway pressure during laparoscopic bariatric surgery may limit the use of both techniques. This study was designed to determine whether equal I:E (inspiratory-to-expiratory) ratio ventil...

  4. Bariatric surgery: studies on its consequences with emphasis on thrombotic and bleeding complications

    OpenAIRE

    Brandjes, D.P.M.; Gerdes, V.E.A.; Çelik, F.

    2014-01-01

    Obesity is a steadily growing problem that is associated with several diseases such as diabetes type 2, hypertension and dyslipidemia. For morbidly obese persons who have failed to achieve weight loss after several weight loss interventions, bariatric surgery is at this moment the only long-lasting, effective treatment. Bariatric surgery is not only an effective option to lose weight. It is also associated with significant improvement or remission of diabetes, cardiovascular risk factors and ...

  5. Self-determination and motivation for bariatric surgery: a qualitative study.

    Science.gov (United States)

    Park, Juyeon

    2016-10-01

    This study examined how obese individuals acquire their motivation to undergo weight loss surgery and characterized the motivations within the framework of the self-determination theory (SDT). Participants expecting to have bariatric surgery were recruited and participated in semi-structured interviews. Interview accounts characterized different types of motivation for individuals seeking surgical weight loss treatments on the SDT continuum of relative autonomy. This study demonstrated that the more one's motivation was internally regulated, related to one's personal life and supported for competency, the more personal and hopeful were the anecdotes participants mentioned in accounts, thus the more positive the surgical outcomes were anticipated. Study limitations and future research were discussed as was the need for a systematic scheme to categorize types of motivation within the SDT, a longitudinal approach to measure actual weight loss outcomes based on the patient's pre-surgical motivation, and a further investigation with a larger sample size and balanced gender ratio. Practical implications of the study findings were also discussed as a novel strategy to internalize bariatric patients' motivation, further helping to improve their long-term quality of life post-surgery. PMID:26708344

  6. Imagem corporal, ansiedade e depressão em pacientes obesos submetidos à cirurgia bariátrica Body image, anxiety and depression in obese patients submitted to bariatric surgery

    Directory of Open Access Journals (Sweden)

    Sebastião Sousa Almeida

    2012-04-01

    Full Text Available Pacientes obesos mórbidos têm recorrido à cirurgia bariátrica como um recurso eficaz para perder peso. Entretanto, este procedimento pode causar alterações comportamentais significativas. O objetivo deste trabalho foi investigar os níveis de ansiedade e depressão, assim como as mudanças sofridas na percepção da imagem corporal em pacientes obesos submetidos à cirurgia bariátrica em três momentos: pré-operatório, 6 meses e 12 meses após a cirurgia. Trata-se de um estudo do tipo prospectivo longitudinal, de abordagem quantitativa. No estudo foram aplicados os Inventários de Depressão e Ansiedade de Beck e a Escala Brasileira de Figuras de Silhuetas para Adultos. A cirurgia diminuiu significativamente tanto o índice de massa corporal dos pacientes quanto a insatisfação com a sua imagem corporal. Essa perda de peso e diminuição da insatisfação com a imagem corporal foi acompanhada de redução nos níveis de ansiedade e depressão, o que sugere que estes são fatores importantes no quadro obesidade.Morbidly obese patients often have resorted to bariatric surgery as an effective resource to be used for weight loss. However, this procedure can cause significant behavioral changes. The objective of this study was to investigate levels of anxiety and depression, as well as the changes suffered in the perception of body image in obese patients undergoing bariatric surgery at three different times: preoperatively, 6 months and 12 months after surgery. This is a prospective longitudinal study of a quantitative approach. The study used the Beck Depression Inventory, the Beck Anxiety Inventory and the Brazilian Scale of Figures Silhouettes for Adults. Surgery significantly decreased both the body mass index of patients and dissatisfaction with their body image. This weight loss and decreased body image dissatisfaction was accompanied by reduced levels of anxiety and depression, suggesting that these are important factors in the

  7. Peroral endoscopic reduction of dilated gastrojejunal anastomosis after bariatric surgery: Techniques and efficacy

    Science.gov (United States)

    Changela, Kinesh; Ofori, Emmanuel; Duddempudi, Sushil; Anand, Sury; Singhal, Shashideep

    2016-01-01

    AIM: To investigate the techniques and efficacy of peroral endoscopic reduction of dilated gastrojejunal anastomosis after bariatric surgery. METHODS: An extensive English language literature search was conducted using PubMed, MEDLINE, Medscape and Google to identify peer-reviewed original and review articles using the keywords “bariatric endoscopic suturing”, “overstitch bariatric surgery”, “endoscopic anastomotic reduction”, “bariatric surgery”, “gastric bypass”, “obesity”, “weight loss”. We identified articles describing technical feasibility, safety, efficacy, and adverse outcomes of overstitch endoscopic suturing system for transoral outlet reduction in patients with weight regain following Roux-en-Y gastric bypass (RYGB). All studies that contained material applicable to the topic were considered. Retrieved peer-reviewed original and review articles were reviewed by the authors and the data extracted using a standardized collection tool. Data were analyzed using statistical analysis as percentages of the event. RESULTS: Four original published articles which met our search criteria were pooled. The total number cases were fifty-nine with a mean age of 46.75 years (34-63 years). Eight of the patients included in those studies were males (13.6%) and fifty-one were females (86.4%). The mean time elapsed since the primary bypass surgery was 5.75 years. The average pre-endoscopic procedure body mass index (BMI) was 38.68 (27.5-48.5). Mean body weight regained post-RYGB surgery was 13.4 kg from their post-RYGB nadir. The average pouch length at the initial upper endoscopy was 5.75 cm (2-14 cm). The pre-intervention anastomotic diameter was averaged at 24.85 mm (8-40 mm). Average procedure time was 74 min (50-164 min). Mean post endoscopic intervention anastomotic diameter was 8 mm (3-15 mm). Weight reduction at 3 to 4 mo post revision noted to be an average of 10.1 kg. Average overall post revision BMI was recorded at 37.7. The combined

  8. Use of positive pressure in preoperative and intraoperative of bariatric surgery and its effect on the time of extubation

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    Letícia Baltieri

    2015-04-01

    Full Text Available BACKGROUND AND OBJECTIVE: To investigate the influence of intraoperative and preoperative positive pressure in the time of extubation in patients undergoing bariatric surgery. METHOD: Randomized clinical trial, in which 40 individuals with a body mass index between 40 and 55 kg/m2, age between 25 and 55 years, nonsmokers, underwent bariatric surgery type Roux-en-Y gastric bypass by laparotomy and with normal preoperative pulmonary function were randomized into the following groups: G-pre (n = 10: individuals who received treatment with noninvasive positive pressure before surgery for 1 h; G-intra (n = 10: individuals who received positive end-expiratory pressure of 10 cm H2O throughout the surgical procedure; and G-control (n = 20: not received any preoperative or intraoperative intervention. Following were recorded: time between induction of anesthesia and extubation, between the end of anesthesia and extubation, duration of mechanical ventilation, and time between extubation and discharge from the post-anesthetic recovery. RESULTS: There was no statistical difference between groups. However, when applied to the Cohen coefficient, the use of positive end-expiratory pressure of 10 cm H2O during surgery showed a large effect on the time between the end of anesthesia and extubation. About this same time, the treatment performed preoperatively showed moderate effect. CONCLUSION: The use of positive end-expiratory pressure of 10 cm H2O in the intraoperative and positive pressure preoperatively, influenced the time of extubation of patients undergoing bariatric surgery.

  9. Country of origin and bariatric surgery in Sweden during 2001–2010

    Science.gov (United States)

    Memarian, Ensieh; Sundquist, Kristina; Calling, Susanna; Sundquist, Jan; Li, Xinjun

    2016-01-01

    Background The prevalence of obesity, as well as use of bariatric surgery, has increased worldwide. The aim of the present study was to investigate the potential differences in the use of bariatric surgery among Swedes and immigrants in Sweden and whether the hypothesized differences remain after adjustment for socioeconomic factors. Methods A closed cohort of all individuals aged 20–64 years was followed during 2001–2010. Further analyses were performed in 2 periods separately (2001–2005 and 2006–2010). Age-standardized cumulative incidence rates (CR) of bariatric surgery were compared between Swedes and immigrants considering individual variables. Cox proportional hazards models were used in univariate and multivariate models for males and females. Results A total of 12,791 Swedes and 2060 immigrants underwent bariatric surgery. The lowest rates of bariatric surgery were found in immigrant men. The largest difference in CR between Swedes and immigrants was observed among low-income individuals (3.4 and 2.3 per 1000 individuals, respectively). Adjusted hazard ratios (HRs) were lower for all immigrants compared with Swedes in the second period. The highest HRs were observed among immigrants from Chile and Lebanon and the lowest among immigrants from Bosnia. Except for Nordic countries, immigrants from all other European countries had a lower HR compared with Swedes. Conclusions Men in general and some immigrant groups had a lower HR of bariatric surgery. Moreover, the difference between Swedes and immigrants was more pronounced in individuals with low socioeconomic status (income). It is unclear if underlying barriers to receive bariatric surgery are due to patients’ preferences/lack of knowledge or healthcare structures. Future studies are needed to examine potential causes behind these differences. PMID:25979207

  10. New obesity classification criteria as a tool for bariatric surgery indication.

    Science.gov (United States)

    De Lorenzo, Antonino; Soldati, Laura; Sarlo, Francesca; Calvani, Menotti; Di Lorenzo, Nicola; Di Renzo, Laura

    2016-01-14

    Obesity plays relevant pathophysiological role in the development of health problems, arising as result of complex interaction of genetic, nutritional, and metabolic factors. Due to the role of adipose tissue in lipid and glucose metabolism, and low grade inflammation, it is necessary to classify obesity on the basis of body fat composition and distribution, rather than the simply increase of body weight, and the Body Mass Index. The new term of adiposopathy (''sick fat'') clearly defines the pathogenic role of adipose tissue. Four phenotypes of obese individuals have been described: (1) normal weight obese (NWO); (2) metabolically obese normal weight; (3) metabolically healthy obese; and (4) metabolically unhealthy obese or "at risk" obese. Moreover, sarcopenic obesity has been related to all the phenotypes. The category of normal weight lean, represented by metabolically healthy normal weight has been classified to distinguish from NWO. It is crucial to recommend a bariatric surgery taking into account adiposopathy and sick fat that occurs with the expansion of fat mass, changing the inflammatory and metabolic profile of the patient. Body fat percentage and genetic polymorphism have to be evaluated to personalize the best bariatric surgery intervention. PMID:26811617

  11. Feasibility and Impact of a Combined Supervised Exercise and Nutritional-Behavioral Intervention following Bariatric Surgery: A Pilot Study

    OpenAIRE

    Jassil, Friedrich C.; Sean Manning; Neville Lewis; Siri Steinmo; Helen Kingett; Fiona Lough; Pucci, Andrea B. F.; W.H. Cheung; Nicholas Finer; Judith Walker; Jaqueline Doyle; Batterham, Rachel L.

    2015-01-01

    Background. Lifestyle intervention programs after bariatric surgery have been suggested to maximise health outcomes. This pilot study aimed to investigate the feasibility and impact of an 8-week combined supervised exercise with nutritional-behavioral intervention following Roux-en-Y gastric bypass and sleeve gastrectomy. Methods. Eight female patients (44 ± 8 years old, BMI = 38.5 ± 7.2 kgm−2) completed the program. Before and after intervention, anthropometric measures, six-minute walk test...

  12. Weight Loss After Bariatric Surgery Reverses Insulin-Induced Increases in Brain Glucose Metabolism of the Morbidly Obese

    OpenAIRE

    Tuulari, Jetro J.; Henry K Karlsson; Hirvonen, Jussi; Hannukainen, Jarna C.; Bucci, Marco; Helmiö, Mika; Ovaska, Jari; Soinio, Minna; Salminen, Paulina; Savisto, Nina; Nummenmaa, Lauri; Nuutila, Pirjo

    2013-01-01

    Obesity and insulin resistance are associated with altered brain glucose metabolism. Here, we studied brain glucose metabolism in 22 morbidly obese patients before and 6 months after bariatric surgery. Seven healthy subjects served as control subjects. Brain glucose metabolism was measured twice per imaging session: with and without insulin stimulation (hyperinsulinemic-euglycemic clamp) using [18F]fluorodeoxyglucose scanning. We found that during fasting, brain glucose metabolism was not dif...

  13. Prophylaxis of Venous Thromboembolism with Low Molecular Weight Heparin in Bariatric Surgery: a Prospective, Randomised Pilot Study Evaluating Two Doses of Parnaparin (BAFLUX Study)

    OpenAIRE

    Imberti, Davide; Baldini, Edoardo; Pierfranceschi, Matteo Giorgi; Nicolini, Alberto; Cartelli, Concetto; De Paoli, Marco; Boni, Marcello; Filippucci, Esmeralda; Cariani, Stefano; Bottani, Giorgio

    2013-01-01

    Background The optimal dose of low molecular weight heparin (LMWH) to prevent venous thromboembolism (VTE) after bariatric surgery remains controversial. The aim of this multicentre, open-label, pilot study was to evaluate the efficacy and safety of two different doses of the LMWH parnaparin administered to patients undergoing bariatric surgery. Methods Patients were randomised to receive 4,250 IU/day (group A) or 6,400 IU/day (group B) of parnaparin s.c. for 7–11 days. Bilateral colour Doppl...

  14. Bariatric surgery with Santoro II Technique, metabolic results after 3 months and 1 year

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    Roxana Gayoso N.

    2011-10-01

    Full Text Available INTRODUCTION: Obesity has high prevalence worldwide, 25.1% of chileans suffers from it, with comorbilities associated with cardiovascular risk. The technique of Santoro II (TS as bariatric surgery, has demonstrated to be beneficial in the treatment ofthe obesity and comorbidities. OBJECTIVES: Determine variability of body mass index (BMI and metabolic parameters with TS in Hernán Henríquez Aravena Hospital - Temuco (HHHAand Clínica Alemana Temuco (CAT. HYPOTHESIS: Patientssubmitted to bariatric surgery with TS significantly decrease their body mass index (BMI, and their metabolic parameters. MATERIAL AND METHOD: Cross-sectional study, intentional non-probabilistic sampling, reviewing records of patients operated with TS between 2005 and 2010 in HHHA and CAT. The variables analyzed were BMI, blood sugar, arterial systolic pressure(PAS and diastolic (PAD, and lipidic profile. The data were analyzed using Student’s t-test, X2 and Fisher’s test, when it was correspond. RESULTS: N=26. The 73 % were women, with an average age of 40.16 years (SD 12.07. A normalization of the variables analyzed was observed 3 months after surgery, being statistically significant, with the exception of PAD. One year later the surgery, the difference of these values, with those presurgeries,was higher but the decrease of the PAD was not statisticall ysignificant either. DISCUSSION: In obese patients, the TS is an effective procedure in the metabolic control with results that maintain in a year of follow up. Our results are consistent according to the literature, but further research is needed to supportthat these are independent of the weight loss.

  15. Micronutrient levels and supplement intake in pregnancy after bariatric surgery: a prospective cohort study.

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    Roland Devlieger

    Full Text Available Studies report frequent micronutrient deficiencies after bariatric surgery, but less is known about micronutrient levels of pregnant women after bariatric surgery.To prospectively evaluate micronutrient levels and supplement intake in pregnancy following bariatric surgery.A multicenter prospective cohort study including women with restrictive or malabsorptive types of bariatric surgery. Nutritional deficiencies, together with supplement intake, were screened during pregnancy.The total population included 18 women in the restrictive and 31 in the malabsorptive group. Most micronutrients were depleted and declined significantly during pregnancy. The proportion of women with low vitamin A and B-1 levels increased to respectively 58 and 17% at delivery (P = 0.005 and 0.002. The proportion of women with vitamin D deficiency decreased from 14% at trimester 1 to 6% at delivery (P = 0.030. Mild anemia was found in respectively 22 and 40% of the women at trimester 1 and delivery. In the first trimester, most women took a multivitamin (57.1%. In the second and third trimester, the majority took additional supplements (69.4 and 73.5%. No associations were found between supplement intake and micronutrient deficiencies.Pregnant women with bariatric surgery show frequent low micronutrient levels. Supplementation partially normalizes low levels of micronutrients.

  16. The eating-related behaviours, disorders and expectations of candidates for bariatric surgery.

    Science.gov (United States)

    Opolski, M; Chur-Hansen, A; Wittert, G

    2015-08-01

    It is important that clinicians and researchers understand the possible eating-related difficulties experienced by pre-bariatric surgery candidates, as well as their expectations of how their eating and hunger will change after surgery. This review examines English-language publications related to the eating-related behaviours, disorders and expectations of bariatric candidates. Seventy-five articles related to binge eating disorder, grazing, night eating syndrome, emotional eating, food cravings and addiction, and pre-surgical expectations of post-surgical eating in this population were critically reviewed. A variety of often problematic eating behaviours appear more common in bariatric candidates than in non-obese populations. The literature suggests that 4-45% of candidates may have binge eating disorder, 20-60% may graze, 2-42% may have night eating syndrome, 38-59% may engage in emotional eating and 17-54% may fit criteria for food addiction. Binge eating may also be more prevalent in bariatric candidates than in similarly obese non-surgical individuals. Expectations of surgery are high, with pre-surgical candidates believing their bariatric procedure will virtually guarantee significantly improved eating behaviours. Study replications are needed, and further investigation into prevalence, impacts and candidate characteristics related to disordered eating behaviours, as well as candidates' expectations of eating after surgery, will be important. Further comparisons of bariatric candidates to similarly obese non-bariatric populations will be important to understand eating-related characteristics of candidates beyond those related to their weight. Future research may be improved by the use of validated measures, replicable methodologies, minimization of data collected in circumstances where respondents may been motivated to 'fake good', use of prospective data and consistent definitions of key terminology. PMID:26173752

  17. Weight loss by calorie restriction versus bariatric surgery differentially regulates the HPA axis in male rats

    Science.gov (United States)

    Grayson, Bernadette E.; Hakala-Finch, Andrew P.; Kekulawala, Melani; Laub, Holly; Egan, Ann E.; Ressler, Ilana B.; Woods, Stephen C.; Herman, James P.; Seeley, Randy J.; Benoit, Stephen C.; Ulrich-Lai, Yvonne M.

    2015-01-01

    Behavioral modifications for the treatment of obesity, including caloric restriction, have notoriously low long-term success rates relative to bariatric weight-loss surgery. The reasons for the difference in sustained weight loss are not clear. One possibility is that caloric restriction alone activates the stress-responsive hypothalamo-pituitary-adrenocortical (HPA) axis, undermining the long-term maintenance of weight loss, and that this is abrogated after bariatric surgery. Accordingly, we compared the HPA response to weight loss in 5 groups of male rats: (1) high-fat diet-induced obese (DIO) rats treated with Roux-en-Y gastric bypass surgery (RYGB, n=7), (2) DIO rats treated with vertical sleeve gastrectomy (VSG, n=11), (3) DIO rats given sham surgery and subsequently restricted to the food intake of the VSG/RYGB groups (Pair-fed, n=11), (4) ad libitum-fed DIO rats given sham surgery (Obese, n=11) and (5) ad libitum chow-fed rats given sham surgery (Lean, n=12). Compared to Lean controls, food-restricted rats exhibited elevated morning (nadir) non-stress plasma corticosterone concentrations and increased hypothalamic corticotropin releasing hormone and vasopressin mRNA expression, indicative of basal HPA activation. This was largely prevented when weight loss was achieved by bariatric surgery. DIO increased HPA activation by acute (novel environment) stress and this was diminished by bariatric surgery-, but not pair-feeding-, induced weight loss. These results suggest that the HPA axis is differentially affected by weight loss from caloric restriction versus bariatric surgery, and this may contribute to the differing long-term effectiveness of these two weight-loss approaches. PMID:25238021

  18. Using lifestyle medicine in U.S. health care to treat obesity: too many bariatric surgeries?

    Science.gov (United States)

    Trilk, Jennifer L; Kennedy, Ann Blair

    2015-01-01

    More than one-third of Americans are classified as obese. Many clinicians perform bariatric surgery (BSx) when it is said that lifestyle intervention failed. However, BSx is medically complex, with extremely variable success, certain failures, major complications, and sometimes death. Although many studies declare BSx as more effective for producing weight loss than nonsurgical lifestyle management, these conclusions are flawed when lifestyle management between cohorts are not identical. Lifestyle behavior change is essential to success for both surgical and nonsurgical weight loss, as over 50% of BSx patients regain weight without lifestyle modification. Indeed, programs that include self-reward and reinforcement are extremely effective. It is therefore possible that successful BSx is simply an intrinsic reward for an intensive change in lifestyle behavior. Accounting for the costs and risks associated with BSx, providing state and federal resources for lifestyle behavior change programs could provide a key opportunity for the war against obesity. PMID:25757003

  19. ANTIBIOTIC PROPHYLAXIS IN BARIATRIC SURGERY: a continuous infusion of cefazolin versus ampicillin/sulbactam and ertapenem

    Directory of Open Access Journals (Sweden)

    Álvaro Antônio Bandeira FERRAZ

    2015-06-01

    Full Text Available Background The incidence of surgical site infection in bariatric patients is significant and the current recommendations for antibiotic prophylaxis are sometimes inadequate. Objective The aim of this study was to analyze the effect of three prophylactic antibiotic regimens on the incidence of surgical site infection. Methods A prospective, cross-sectional study was conducted between January 2009 and January 2013 in which 896 Roux-en-Y gastric bypasses were performed to treat obesity. The study compared three groups of patients according to the perioperative antibiotic prophylaxis administered intravenously and beginning at anesthesia induction: Group I consisting of 194 patients treated with two 3-g doses of ampicillin/sulbactam; Group II with 303 patients treated with a single 1-g dose of ertapenem; and Group III with 399 patients treated with a 2-g dose of cefazolin at anesthesia induction followed by a continuous infusion of cefazolin 1g throughout the surgical procedure. The rate of surgical site infection was analyzed, as well as its association with age, sex, preoperative weight, body mass index and comorbidities. Results The rates of surgical site infection were 4.16% in the group treated prophylactically with ampicillin/sulbactam, 1.98% in the ertapenem group and 1.55% in the continuous cefazolin group. Conclusion The prophylactic use of continuous cefazolin in surgeries for morbid obesity shows very promising results. These findings suggest that some prophylactic regimens need to be reconsidered and even substituted by more effective therapies for the prevention of surgical site infections in bariatric patients.

  20. Maintaining weight loss after bariatric surgery: when the spectator role is no longer enough.

    Science.gov (United States)

    Jones, L; Cleator, J; Yorke, J

    2016-08-01

    Bariatric (weight loss) surgery is the gold standard treatment for severe obesity. Concern exists that patients are regaining weight in the longer term. Success and cost-effectiveness of surgery are threatened due to the re-emergence of related conditions such as diabetes. This exploratory qualitative study investigates patients' expectations and experiences of weight regain (WR) 2 years or more after Roux-en-Y gastric bypass (RYGB). Ten participants (two men and eight women) who experienced WR were interviewed between 2 and 6 years following surgery. Findings highlight that participants reacted to initial weight loss as passive spectators and were unprepared for subsequent WR. Their tolerability of WR reduced as the amount of regain increased, suggesting a 'line of tolerance' for WR. WR was influenced by a new vulnerability arising from weight loss over time, and participants struggled to manage their own weight actively as surgical effects waned. They considered self-management skills, and carer and professional support to be limited at the time when WR was most likely to occur. Degrees of tolerability are noted in individuals regaining weight after RYGB. More studies are needed to further understand these problems. Pre- and post-operative support and teaching patients self-management skills may be helpful to minimize WR. PMID:27273813

  1. Psychological predictors of weight loss after bariatric surgery

    DEFF Research Database (Denmark)

    Wimmelmann, Cathrine Lawaetz; Dela, Flemming; Mortensen, Erik Lykke

    2014-01-01

    of surgical weight loss.Methods: We searched PubMed, PsycInfo and Web of Science, for original prospectivestudies with a sample size >30 and at least one year follow-up, using a combina-tion of search terms such as ‘bariatric surgery’, ‘morbid obesity’, ‘psychologicalpredictors’, and ‘weight loss’. Only...

  2. A rare case of small bowel volvulus after jenjunoileal bariatric bypass requiring emergency surgery: a case report

    Directory of Open Access Journals (Sweden)

    Patel Pranav H

    2012-03-01

    Full Text Available Abstract Introduction Bariatric surgery is on the increase throughout the world. Jejunoileal bypass bariatric procedures have fallen out of favor in western surgical centers due to the high rate of associated complications. They are, however, performed routinely in other centers and as a consequence of health tourism, management of complications related to these procedures may still be encountered. Case presentation We describe a rare case of small bowel obstruction in a 45-year-old British Caucasian woman, secondary to a volvulus of the jejunoileal anastomosis following bariatric bypass surgery. The pre-operative diagnosis was confirmed by radiology. We describe a successful surgical technique for this rare complication. Conclusions Bariatric surgery may be complicated by bowel obstruction. Early imaging is vital for diagnosis and effective management. The use of our surgical technique provides a simple and effective approach for the successful management of this bariatric complication.

  3. Bariatric Bypass Surgery to Resolve Complicated Childhood Morbid Obesity: Case Report Study: Erratum.

    Science.gov (United States)

    2016-05-01

    In the article ''Bariatric Bypass Surgery to Resolve Complicated Childhood Morbid Obesity: Case Report Study'', which appeared in Volume 94, Issue 49 of Medicine, Dr. Elrazek's name was incorrectly presented as Abd Elrazek M. Ali Hussein when it should have read Abd Elrazek Abd Elrazek. The article has since been corrected online. PMID:27231816

  4. Could the mechanisms of bariatric surgery hold the key for novel therapies?

    DEFF Research Database (Denmark)

    Tam, C S; Berthoud, H-R; Bueter, M;

    2011-01-01

    in energy metabolism, gut peptides and food preference. The goal of this meeting was to review the latest research to better understand the mechanisms behind the 'magic' of bariatric surgery. Replication of these effects in a non-surgical manner remains one of the ultimate challenges for the...

  5. Emotion processing and regulation in women with morbid obesity who apply for bariatric surgery

    NARCIS (Netherlands)

    Zijlstra, H.; Middendorp, H. van; Devaere, L.; Larsen, J.K.; Ramshorst, B. van; Geenen, M.J.M.

    2012-01-01

    Emotional eating, the tendency to eat when experiencing negative affect, is prevalent in morbid obesity and may indicate that ways to deal with emotions are disturbed. Our aim was to compare emotion processing and regulation between 102 women with morbid obesity who apply for bariatric surgery and 1

  6. Duodenal-jejunal bypass sleeve - a potential alternative to bariatric surgery?

    DEFF Research Database (Denmark)

    Rohde, Ulrich; Gylvin, Silas; Vilmann, Peter;

    2014-01-01

    Overweight and obesity are risk factors for several co-morbidities reducing life expectancy. Conservative treatment of obesity is generally ineffective in the long-term. Bariatric surgery has proven effective, but is associated with potential complications. Duodenal-jejunal bypass sleeve is a novel...

  7. Bariatric surgery: studies on its consequences with emphasis on thrombotic and bleeding complications

    NARCIS (Netherlands)

    F. Çelik

    2014-01-01

    Obesity is a steadily growing problem that is associated with several diseases such as diabetes type 2, hypertension and dyslipidemia. For morbidly obese persons who have failed to achieve weight loss after several weight loss interventions, bariatric surgery is at this moment the only long-lasting,

  8. Evaluation of an In Silico PBPK Post-Bariatric Surgery Model through Simulating Oral Drug Bioavailability of Atorvastatin and Cyclosporine

    OpenAIRE

    Darwich, A S; Pade, D; Rowland-Yeo, K; Jamei, M; A. Åsberg; Christensen, H; Ashcroft, D.M.; Rostami-Hodjegan, A

    2013-01-01

    An increasing prevalence of morbid obesity has led to dramatic increases in the number of bariatric surgeries performed. Altered gastrointestinal physiology following surgery can be associated with modified oral drug bioavailability (F oral). In the absence of clinical data, an indication of changes to F oral via systems pharmacology models would be of value in adjusting dose levels after surgery. A previously developed virtual “post-bariatric surgery” population was evaluated through mimicki...

  9. Experimental Bariatric Surgery in Rats Generates a Cytotoxic Chemical Environment in the Gut Contents.

    Directory of Open Access Journals (Sweden)

    Jia eLi

    2011-09-01

    Full Text Available Bariatric surgery, also known as metabolic surgery, is an effective treatment for morbid obesity which also offers pronounced metabolic effects including the resolution of type 2 diabetes and a decrease in cardiovascular disease and long-term cancer risk. However, the mechanisms of surgical weight loss and the long term consequences of bariatric surgery remain unclear. Bariatric surgery has been demonstrated to alter the composition of both the microbiome and the metabolic phenotype. We observed a marked shift towards Gammaproteobacteria, particularly Enterobacter hormaechei, following Roux-en-Y gastric bypass (RYGB surgery in a rat model compared with sham operated controls. Fecal water from RYGB surgery rats was highly cytotoxic to rodent cells (mouse lymphoma cell line, although In contrast, fecal water from sham operated animals showed no/very low cytotoxicity. This shift in the gross structure of the microbiome correlated with greatly increased cytotoxicity in a regulatory acceptable mouse lymphoma assay. Urinary phenylacetylglycine and indoxyl sulfate and fecal GABA, putrescine, tyramine and uracil were found to be inversely correlated with cell survival rate. This profound co-dependent response of mammalian and microbial metabolism to RYGB surgery and the impact on the cytotoxicity of the gut luminal environment suggests that RYGB exerts local and global metabolic effects which may have an influence on long term cancer risk and cytotoxic load.

  10. Estudo da correlação do IMC e comprimento do intestino delgado em pacientes obesos submetidos à cirurgia bariátrica Correlation study of BMI and small intestine length in obese patients subjected to bariatric surgery

    Directory of Open Access Journals (Sweden)

    Paulo Afonso Nunes Nassif

    2009-09-01

    Full Text Available RACIONAL: Segundo a hipótese do intestino longo, o comprimento do intestino delgado estaria relacionado à obesidade. Existem dados evolutivos, anatômicos e neuroendócrinos em favor desta afirmação. OBJETIVOS: Verificar a medida do comprimento do intestino delgado em pacientes obesos submetidos à cirurgia bariátrica e analisar a correlação entre o seu tamanho e o IMC. MÉTODO: A casuística foi composta de 30 pacientes do Serviço de Obesidade do Hospital Universitário Evangélico de Curitiba, submetidos à cirurgia bariátrica no período de março a junho de 2009, e previamente avaliados, verificando peso, altura e IMC. A técnica cirúrgica foi a de Fobi-Capella. A mensuração do intestino delgado foi realizada desde a flexura duodenojejunal à junção ileocecal, durante o trans-operatório, utilizando uma pinça de manipulação intestinal, a qual foi marcada com a medida de 10 cm. As alças intestinais foram medidas na margem anti-mesentérica, aplicando-se tensão mínima necessária para retificar as mesmas. Os dados foram correlacionados e tabulados estatisticamente, utilizando-se o método de correlação de Pearson. RESULTADOS: A média do comprimento intestinal para o sexo masculino foi de 582,5 cm e para o sexo feminino de 509,1. A partir do cálculo do coeficiente de correlação de Pearson, confirmou-se a ausência de correlação entre IMC e comprimento do intestino delgado. CONCLUSÃO: Obteve-se uma média de tamanho intestinal de 528,7 cm para toda a amostra. O comprimento do intestino delgado não possuiu correspondência com o IMC, não sendo um fator de significância neste estudo.BACKGROUND: According to the hypothesis of long bowel, the length of small intestine is related to obesity. There are evolutionary, anatomics, neuroendocrines evidences in favor of this assertion. AIM: To check the measure of the small intestine length in overweight patients submitted to bariatric surgery and to analyze the correlation

  11. Techniques, assessment, and effectiveness of bariatric surgery in combating obesity

    OpenAIRE

    Dimitrios K Papamargaritis; Dimitrios J Pournaras; le Roux, Carel W.

    2010-01-01

    Dimitrios K Papamargaritis, Dimitrios J Pournaras, Carel W Le RouxImperial Weight Centre, Imperial College London, London, UKAbstract: Obesity is an epidemic disease, and its prevalence is predicted to rise in the future. Many health and social comorbidities, such as cardiovascular disease, type 2 diabetes mellitus, cancer, nonalcoholic fatty liver disease, arthritis, infertility, eating disorders, unemployment, and low quality of life, have been associated with obesity. Nowadays, bariatric s...

  12. Enoxaparin venous thromboembolism prophylaxis in bariatric surgery: A best evidence topic.

    Science.gov (United States)

    Parker, S G; McGlone, E R; Knight, W R; Sufi, P; Khan, O A

    2015-11-01

    A best evidence topic in surgery was written according to a structured protocol. The question addressed was: which is the best regimen of enoxaparin thromboprophylaxis for patients undergoing bariatric surgery? One hundred and twenty-five papers were identified using the reported literature search, of which four represented the best evidence to answer the clinical question. The authors, country and date of publication, patient groups, relevant outcomes and results of these papers were tabulated. All four studies are non-randomized cohort studies examining venous thromboembolism rates and major postoperative bleeding following varying regimens of Enoxaparin thromboprophylaxis. There is no level 1 evidence which significantly favors any particular thromboprophylaxis regimen. There is some evidence that extended duration of treatment of ten days after discharge significantly reduces the incidence of VTE compared to in-hospital treatment only, and that a higher incidence of post-operative bleeding occurs with a regimen that includes a pre-operative dose of Enoxaparin. With regard to dosage, for in-hospital treatment the higher dosage of 40 mg twice daily as opposed to 30 mg seems to significantly reduce the incidence of VTE without significantly affecting bleeding rate. PMID:26394187

  13. General anesthesia type does not influence serum levels of neutrophil gelatinase-associated lipocalin during the perioperative period in video laparoscopic bariatric surgery

    Directory of Open Access Journals (Sweden)

    Adriano Fernandes

    2014-12-01

    Full Text Available OBJECTIVES: Video laparoscopic bariatric surgery is the preferred surgical technique for treating morbid obesity. However, pneumoperitoneum can pose risks to the kidneys by causing a decrease in renal blood flow. Furthermore, as in other surgical procedures, laparoscopic bariatric surgery triggers an acute inflammatory response. Neutrophil gelatinase-associated lipocalin is an early and accurate biomarker of renal injury, as well as of the inflammatory response. Anesthetic drugs could offer some protection for the kidneys and could attenuate the acute inflammatory response from surgical trauma. The objective of this study was to compare the effects of two types of anesthetics, propofol and sevoflurane, on the serum levels of neutrophil gelatinase-associated lipocalin during the perioperative period in laparoscopic bariatric surgery. METHODS: Sixty-four patients scheduled for laparoscopic bariatric surgery were randomized into two anesthesia groups and were administered either total intravenous anesthesia (propofol or inhalation anesthesia (sevoflurane. In the perioperative period, blood samples were collected at three time points (before anesthesia, 6 hours after pneumoperitoneum and 24 hours after pneumoperitoneum and urine output was measured for 24 hours. Acute kidney injuries were evaluated by examining both the clinical and laboratory parameters during the postoperative period. The differences between the groups were compared using non-parametric tests. ReBEC (http://www.ensaiosclinicos.gov.br/rg/recruiting/: RBR-8wt2fy RESULTS: None of the patients developed an acute kidney injury during the study and no significant differences were found between the serum neutrophil gelatinase-associated lipocalin levels of the groups during the perioperative period. CONCLUSION: The choice of anesthetic drug, either propofol or sevoflurane, did not affect the serum levels of neutrophil gelatinase-associated lipocalin during the perioperative period in

  14. Becoming a normal guy: Men making sense of long-term bodily changes following bariatric surgery

    Directory of Open Access Journals (Sweden)

    Karen Synne Groven

    2015-12-01

    Full Text Available Background: To date, research on bodily changes following bariatric surgery has focused predominantly on women, leaving the long-term experience of men relatively unexplored. In this paper, we draw on interviews with men who have undergone an irreversible gastric bypass procedure to explore their bodily changes more than 4 years post-surgery. We apply a phenomenological framework that draws on Leder's perspectives on the “disappearing” and “dys-appearing” body, combined with a gender-sensitive lens that draws on Connell's theory of hegemonic masculinity and Robertson's conceptions of embodied masculinity. Findings: Our principal finding was that the men negotiated their bodily changes following bariatric surgery in profoundly ambivalent ways. Although they enthusiastically praised the surgery for improving their health, self-esteem, and social functioning, they also emphasized their efforts to cope with post-surgical side effects and life-threatening complications. Our analysis elaborates on their efforts to adjust to and come to terms with these changes, focusing on episodes of hypoglycemia, severe pain and internal herniation, and the significance of physical activity and exercise. Conclusions: Our findings point to the need to acknowledge men's ways of making sense of profound and ongoing bodily changes following bariatric surgery and how these negotiations are closely intertwined with masculine ideals of embodiment and social value.

  15. Reconstruction of short bowel syndrome after internal hernia in a pregnant woman with previous bariatric surgery

    OpenAIRE

    Borghede, Märta Kristina; Vinter-Jensen, Lars; Andersen, Jens Christian; Mortensen, Peter Brøndum; Rasmussen, Henrik Højgaard

    2013-01-01

    INTRODUCTION Bariatric surgery is most often performed with the laparoscopic Roux-en-Y gastric bypass. A complication to the laparoscopic Roux-en-Y gastric bypass is internal hernia, which occurs in up to 16% of the patients. Since the laparoscopic Roux-en-Y gastric bypass is performed in women of fertile age, internal hernia may occur during pregnancy. PRESENTATION OF CASE A 22-year old woman with a history of laparoscopic Roux-en-Y gastric bypass suffered from massive internal hernia during...

  16. Study of the patency of different peritoneal drains used prophylactically in bariatric surgery

    Institute of Scientific and Technical Information of China (English)

    Wilson Salgado Júnior; Marcelo Martins Macedo Neto; José Sebastiao dos Santos; Ajith Kumar Sakarankutty; Reginaldo Ceneviva; Orlando de Castro e Silva Jr

    2009-01-01

    AIM: To compare the performance of different types of abdominal drains used in bariatric surgery. METHODS: A vertical banded Roux-en-Y gastric bypass was performed in 33 morbidly obese patients. Drainage of the peritoneal cavity was performed in each case using three different types of drain selected in a randomized manner: a latex tubular drain, a Watterman tubulolaminar drain, and a silicone channeled drain. Drain permeability, contamination of the drained fluid, ease of handling, and patient discomfort were evaluated postoperatively over a period of 7 d. RESULTS: The patients with the silicone channeled drain had larger volumes of drainage compared to patients with tubular and tubulolaminar drains between the third and seventh postoperative days. In addition, a lower incidence of discomfort and of contamination with bacteria of a more pathogenic profile was observed in the patients with the silicone channeled drain.CONCLUSION: The silicone channeled drain was more comfortable and had less chance of occlusion, which is important in the detection of delayed dehiscence.

  17. Can Flaxseed Help Satisfy Appetite in Women Subjected to Bariatric Surgery?

    Directory of Open Access Journals (Sweden)

    Gigliane Cosendey-Menegati

    2014-05-01

    Full Text Available Background: Bariatric surgery is considered the most effective immediate weight loss method for the morbidly obese, despite widely reported weight regain after a few years. Appetite, satiety and satiation control are essential to maintaining a long-term result post-surgery. Dietary fatty acids composition may be implicated in the satiety. As flaxseed is a food high in linolenic acid, we aimed to verify the influence of flaxseed fat on appetite and satiety of women after bariatric surgery.Material and methods: Six women who underwent bariatric surgery at least 2 years before participated in a single-blind crossover trial that compared the effect of two isocaloric meals on satiety, one containing whole golden flaxseed (high in polyunsaturated fatty acids and fiber (G1 and another withdefatted flaxseed (high in fiber (G2, with one week of washout period. This variable was estimated by visual analogue scales in both meals at baseline (T0, immediately after ingestion (T1 and 60, 120, and 180 minutes after the meal (T60, T120 and T180. Fasting anthropometric, body composition, laboratory tests (glucose and lipids and dietary variables, were evaluated while fasting.Results: The volunteers were obese and had excess central adiposity, even after two years of surgery and still showed habitual fibre intake below recommended levels. G1 had reduced hunger after 180 minutes compared to G2 (P=.046. Other parameters related to appetite and satiety did not differ between groups.Conclusions: Less hunger was observed after 180 minutes in whole golden flaxseed meal compared with the defatted flaxseed meal, indicating that the whole golden flaxseed meal, possibly, supports obesity treatment in the long-term after bariatric surgery by controlling appetite and satiety sensations.

  18. The Impact of Bariatric Surgery on Obesity related Metabolic Traits with Specific Emphasis on Glucose, Insulin and Proinsulin

    OpenAIRE

    Johansson, Hans-Erik

    2010-01-01

    Hyperproinsulinemia is associated with type 2 diabetes (T2DM) and obesity and is a predictor for future coronary heart disease. This thesis examines the effect of bariatric surgery on glucometabolic status including insulin and proinsulin responses after meal. Further we explored longitudinally the effects of bariatric surgery on glucose, insulin and proinsulin secretion as well as lipids, liver enzymes and magnesium concentrations. We explored by a standardised meal test the postprandial dyn...

  19. Endoscopic extraction of adjustable gastric bands after intragastric migration as a complication of bariatric surgery: technique and advice

    Science.gov (United States)

    Collado-Pacheco, David; Rábago-Torre, Luis Ramon; Arias-Rivera, Maria; Ortega-Carbonel, Alejandro; Olivares-Valles, Ana; Alonso-Prada, Alicia; Vázquez-Echarri, Jaime; Herrera-Merino, Norberto

    2016-01-01

    Background: Surgery has been the method most widely used to manage the extraction of gastric bands with inclusion as a late complication of bariatric surgery; however, surgical extraction entails morbidity and limits future surgical procedures. The development of endoscopic techniques has provided an important means of improving the treatment of this complication, enabling minimally invasive and safe procedures that have a high success rate. Methods: A retrospective analysis was conducted of patients who had laparoscopic gastric banding complicated by intragastric migration and were treated endoscopically. A technique already described for managing this complication was employed. An MTW Endoskopie Dormia basket for mechanical lithotripsy or a standard 0.0035-in guidewire was placed around the band, and an MTW Endoskopie emergency lithotripter was used to section it, after which the band was extracted with a standard polypectomy snare. Also analyzed were the initial symptoms of patients with this complication, the mean time from surgery to development of the event, the success rate of endoscopic treatment, and complications, Results: A total of 127 patients had undergone gastric banding surgery in our Bariatric Surgery Center; of these, 12 patients (9.4 %) developed a complication such as intragastric migration of the band. Weight gain and pain were the main symptoms in 11 patients (92 %), and the mean time to the development of symptoms was 51.3 months. A single endoscopic treatment was successful in 7 of 9 patients (78 %). Only 1 complication, involving ventilation during anesthesia, occurred; no other adverse events were recorded. Conclusions: The endoscopic extraction of bands with inclusion is feasible and can be performed easily and successfully. The procedure is available in all hospitals and has a low incidence of related complications, so that unnecessary surgical procedures can be avoided.

  20. Ménage-à-trois of bariatric surgery, bile acids and the gutmicrobiome

    Institute of Scientific and Technical Information of China (English)

    Rajendra Raghow

    2015-01-01

    Bariatric surgeries have emerged as highly effectivetreatments for obesity associated type-2 diabetesmellitus. Evidently, the desired therapeutic endpointssuch as rates of weight loss, lower levels of glycatedhemoglobin and remission of diabetes are achievedmore rapidly and last longer following bariatric surgery,as opposed to drug therapies alone. In light of thesefindings, it has been suspected that in addition tocausing weight loss dependent glucose intolerance,bariatric surgery induces other physiological changesthat contribute to the alleviation of diabetes. However,the putative post-surgical neuro-hormonal pathwaysthat underpin the therapeutic benefits of bariatricsurgery remain undefined. In a recent report, Ryan andcolleagues shed new light on the potential mechanismsthat determine the salutary effects of bariatric surgeryin mice. The authors demonstrated that the improvedglucose tolerance and weight loss in mice after verticalsleeve gastrectomy (VSG) surgery were likely to becaused by post-surgical changes in circulating bileacids and farnesoid-X receptor (FXR) signaling, both ofwhich were also mechanistically linked to changes inthe microbial ecology of the gut. The authors arrivedat this conclusion from a comparison of genome-wide,metabolic consequences of VSG surgery in obese wildtype (WT) and FXR knockout mice. Gene expressionin the distal small intestines of WT and FXR knockoutmice revealed that the pathways regulating bile acidcomposition, nutrient metabolism and anti-oxidantdefense were differentially altered by VSG surgeryin WT and FXR-/- mice. Based on these data Ryanet al , hypothesized that bile acid homeostasis andFXR signaling were mechanistically linked to the gutmicrobiota that played a role in modulating post-surgicalchanges in total body mass and glucose tolerance.The authors' data provide a plausible explanation forputative weight loss-independent benefits of bariatricsurgery and its relationship with metabolism of bileacids.

  1. The Alberta population-based prospective evaluation of the quality of life outcomes and economic impact of bariatric surgery (APPLES study: background, design and rationale

    Directory of Open Access Journals (Sweden)

    McCargar Linda

    2010-10-01

    Full Text Available Abstract Background Extreme obesity affects nearly 8% of Canadians, and is debilitating, costly and ultimately lethal. Bariatric surgery is currently the most effective treatment available; is associated with reductions in morbidity/mortality, improvements in quality of life; and appears cost-effective. However, current demand for surgery in Canada outstrips capacity by at least 1000-fold, causing exponential increases in already protracted, multi-year wait-times. The objectives and hypotheses of this study were as follows: 1. To serially assess the clinical, economic and humanistic outcomes in patients wait-listed for bariatric care over a 2-year period. We hypothesize deterioration in these outcomes over time; 2. To determine the clinical effectiveness and changes in quality of life associated with modern bariatric procedures compared with medically treated and wait-listed controls over 2 years. We hypothesize that surgery will markedly reduce weight, decrease the need for unplanned medical care, and increase quality of life; 3. To conduct a 3-year (1 year retrospective and 2 year prospective economic assessment of bariatric surgery compared to medical and wait-listed controls from the societal, public payor, and health-care payor perspectives. We hypothesize that lower indirect, out of pocket and productivity costs will offset increased direct health-care costs resulting in lower total costs for bariatric surgery. Methods/design Population-based prospective cohort study of 500 consecutive, consenting adults, including 150 surgically treated patients, 200 medically treated patients and 150 wait-listed patients. Subjects will be enrolled from the Edmonton Weight Wise Regional Obesity Program (Edmonton, Alberta, Canada, with prospective bi-annual follow-up for 2 years. Mixed methods data collection, linking primary data to provincial administrative databases will be employed. Major outcomes include generic, obesity-specific and preference

  2. Financial costs and patients’ perceptions of medical tourism in bariatric surgery

    Science.gov (United States)

    Kim, David H.; Sheppard, Caroline E.; de Gara, Christopher J.; Karmali, Shahzeer; Birch, Daniel W.

    2016-01-01

    Summary Many Canadians pursue surgical treatment for severe obesity outside of their province or country — so-called “medical tourism.” We have managed many complications related to this evolving phenomenon. The costs associated with this care seem substantial but have not been previously quantified. We surveyed Alberta general surgeons and postoperative medical tourists to estimate costs of treating complications related to medical tourism in bariatric surgery and to understand patients’ motivations for pursuing medical tourism. Our analysis suggests more than $560 000 was spent treating 59 bariatric medical tourists by 25 surgeons between 2012 and 2013. Responses from medical tourists suggest that they believe their surgeries were successful despite some having postoperative complications and lacking support from medical or surgical teams. We believe that the financial cost of treating complications related to medical tourism in Alberta is substantial and impacts existing limited resources. PMID:26574702

  3. BINGE EATING DISORDER AND QUALITY OF LIFE OF CANDIDATES TO BARIATRIC SURGERY

    OpenAIRE

    COSTA, Ana Júlia Rosa Barcelos; PINTO, Sônia Lopes

    2015-01-01

    Background : Obesity decreases the quality of life, which is aggravated by the association of comorbidities, and the binge eating disorder is directly related to body image and predisposes to overweight. Aim: Evaluate association between the presence and the level of binge eating disorder and the quality of life of the obese candidates for bariatric surgery. Methods : Cross-sectional study analyzing anthropometric data (weight and height) and socioeconomics (age, sex, marital status, educatio...

  4. Emotional Eating: A Virtually Untreated Risk Factor for Outcome Following Bariatric Surgery

    OpenAIRE

    Betty E. Chesler

    2012-01-01

    Empirical investigations implicate emotional eating (EE) in dysfunctional eating behavior such as uncontrolled overeating and insufficient weight loss following bariatric surgery. They demonstrate that EE may be a conscious or reflexive behavior motivated by multiple negative emotions and/or feelings of distress about loss-of-control eating. EE, however, has not been targeted in pre- or postoperative interventions or examined as an explanatory construct for failed treatment of dysfunctional e...

  5. Bariatric Surgery vs. Conventional Dieting in the Morbidly Obese.

    Science.gov (United States)

    Greenstein; Rabner; Taler

    1994-02-01

    Weight loss and psychosocial events have been compared between low calorie conventional diet (n = 11) or following obesity surgery (n = 17). Interviews were >/= 9 months following initiation of treatment. After surgery significantly less hunger was experienced (surgery 76% [13/17] vs diet 18% [2/11] p employed (surgery 76% [13/17] vs diet 18% [2/11) p appearance improvements (surgery 94% [15/16] vs diet 50% [5/10] p Physical activity improved (surgery 73% [11/15] vs diet 18% [2/11] p Physical activity increases, and satisfaction with weight loss method is greater, after surgery. Employment is greater (probably self selection) in the post-surgical group. We found that comparing >/= 9 months following surgery or beginning a conventional diet, the morbidly obese have a more positive response to surgery. PMID:10742758

  6. Effects of Bariatric Surgery on Adipokine-Induced Inflammation and Insulin Resistance

    Directory of Open Access Journals (Sweden)

    Zeynep eGoktas

    2013-06-01

    Full Text Available Over a third of the US population is obese and at high risk for developing type 2 diabetes, insulin resistance and other metabolic disorders. Obesity is considered a chronic low grade inflammatory condition that is primarily attributed to expansion and inflammation of adipose tissues. Indeed, adipocytes produce and secrete numerous proinflammatory and anti-inflammatory cytokines known as adipokines. When the balance of these adipokines is shifted towards higher production of proinflammatory factors, local inflammation within adipose tissues and subsequently systemic inflammation occur. These adipokines including leptin, visfatin, resistin, apelin, vaspin, and retinol binding protein-4 can regulate inflammatory responses and contribute to the pathogenesis of diabetes. These effects are mediated by key inflammatory signaling molecules including activated serine kinases such as c-Jun N-terminal kinase (JNK and serine kinases inhibitor κB kinase (IKK and insulin signaling molecules including insulin receptor substrates, protein kinase B (PKB, also known as Akt, and nuclear factor kappa B (NF-kB. Bariatric surgery can decrease body weight and improve insulin resistance in morbidly obese subjects. However, despite reports suggesting reduced inflammation and weight-independent effects of bariatric surgery on glucose metabolism, mechanisms behind such improvements are not yet well understood. This review article focuses on some of these novel adipokines and discusses their changes after bariatric surgery and their relationship to insulin resistance, fat mass, inflammation, and glucose homeostasis.

  7. The Role of Obesity Training in Medical School and Residency on Bariatric Surgery Knowledge in Primary Care Physicians

    Science.gov (United States)

    Stanford, Fatima Cody; Johnson, Erica D.; Claridy, Mechelle D.; Earle, Rebecca L.; Kaplan, Lee M.

    2015-01-01

    Objective. US primary care physicians are inadequately educated on how to provide obesity treatment. We sought to assess physician training in obesity and to characterize the perceptions, beliefs, knowledge, and treatment patterns of primary care physicians. Methods. We administered a cross-sectional web-based survey from July to October 2014 to adult primary care physicians in practices affiliated with the Massachusetts General Hospital (MGH). We evaluated survey respondent demographics, personal health habits, obesity training, knowledge of bariatric surgery care, perceptions, attitudes, and beliefs regarding the etiology of obesity and treatment strategies. Results. Younger primary care physicians (age 20–39) were more likely to have received some obesity training than those aged 40–49 (OR: 0.08, 95% CI: 0.008–0.822) or those 50+ (OR: 0.03, 95% CI: 0.004–0.321). Physicians who were young, had obesity, or received obesity education in medical school or postgraduate training were more likely to answer bariatric surgery knowledge questions correctly. Conclusions. There is a need for educational programs to improve physician knowledge and competency in treating patients with obesity. Obesity is a complex chronic disease, and it is important for clinicians to be equipped with the knowledge of the multiple treatment modalities that may be considered to help their patients achieve a healthy weight. PMID:26339506

  8. The Role of Obesity Training in Medical School and Residency on Bariatric Surgery Knowledge in Primary Care Physicians

    Directory of Open Access Journals (Sweden)

    Fatima Cody Stanford

    2015-01-01

    Full Text Available Objective. US primary care physicians are inadequately educated on how to provide obesity treatment. We sought to assess physician training in obesity and to characterize the perceptions, beliefs, knowledge, and treatment patterns of primary care physicians. Methods. We administered a cross-sectional web-based survey from July to October 2014 to adult primary care physicians in practices affiliated with the Massachusetts General Hospital (MGH. We evaluated survey respondent demographics, personal health habits, obesity training, knowledge of bariatric surgery care, perceptions, attitudes, and beliefs regarding the etiology of obesity and treatment strategies. Results. Younger primary care physicians (age 20–39 were more likely to have received some obesity training than those aged 40–49 (OR: 0.08, 95% CI: 0.008–0.822 or those 50+ (OR: 0.03, 95% CI: 0.004–0.321. Physicians who were young, had obesity, or received obesity education in medical school or postgraduate training were more likely to answer bariatric surgery knowledge questions correctly. Conclusions. There is a need for educational programs to improve physician knowledge and competency in treating patients with obesity. Obesity is a complex chronic disease, and it is important for clinicians to be equipped with the knowledge of the multiple treatment modalities that may be considered to help their patients achieve a healthy weight.

  9. A comparative study to evaluate the effect of intranasal dexmedetomidine versus oral alprazolam as a premedication agent in morbidly obese patients undergoing bariatric surgery

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    Lakshmi Jayaraman

    2013-01-01

    Full Text Available Background: Morbidly obese patients with obstructive sleep apnea are extremely sensitive to sedative premedication. Intranasal dexmedetomidine is painless and quick acting. Intranasal dexmedetomidine can be used for premedication as it produces adequate sedation and also obtund hemodynamic response to laryngoscopy and tracheal intubation. Materials and Methods: Forty morbidly obese patients with BMI > 35 were chosen and divided into two groups. Group DEX received intranasal dexmedetomidine 1 mcg/kg (ideal body weight while other group (AZ received oral alprazolam 0.5 mg. Sedation scale, heart rate and the mean arterial pressure was assessed in both the groups at 0 hour, 45 minutes, during laryngoscopy and tracheal intubation. Results: The demographic profile, baseline heart rate, means arterial pressure, oxygen saturation and sedation scale was comparable between the two groups. The sedation scores, after 45 min, were statistically significant between the two groups i.e., 2.40 ± 1.09 in the AZ group as compared to 3.20 ± 1.79 in DEX group P value 0.034. The heart rate, mean arterial pressure and oxygen saturation were statistically similar between the two groups, after 45 min. The heart rate was significantly lower in the DEX group as compared to the AZ group. There was no statistical difference in the mean arterial pressure between the two groups either during laryngoscopy or tracheal intubation. Conclusion: Intranasal dexmedetomidine is a better premedication agent in morbidly obese patients than oral alprazolam.

  10. Feasibility and Impact of a Combined Supervised Exercise and Nutritional-Behavioral Intervention following Bariatric Surgery: A Pilot Study

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    Friedrich C. Jassil

    2015-01-01

    Full Text Available Background. Lifestyle intervention programs after bariatric surgery have been suggested to maximise health outcomes. This pilot study aimed to investigate the feasibility and impact of an 8-week combined supervised exercise with nutritional-behavioral intervention following Roux-en-Y gastric bypass and sleeve gastrectomy. Methods. Eight female patients (44 ± 8 years old, BMI = 38.5 ± 7.2 kgm−2 completed the program. Before and after intervention, anthropometric measures, six-minute walk test (6MWT, physical activity level, eating behavior, and quality of life (QoL were assessed. Percentage weight loss (%WL outcomes were compared with a historical matched control group. Results. The program significantly improved functional capacity (mean increment in 6MWT was 127 ± 107 meters, p=0.043, increased strenuous intensity exercise (44 ± 49 min/week, p=0.043, increased consumption of fruits and vegetables (p=0.034, reduced consumption of ready meals (p=0.034, and improved “Change in Health” in QoL domain (p=0.039. The intervention group exhibited greater %WL in the 3–12-month postsurgery period compared to historical controls, 12.2 ± 7.5% versus 5.1 ± 5.4%, respectively (p=0.027. Conclusions. Lifestyle intervention program following bariatric surgery is feasible and resulted in several beneficial outcomes. A large randomised control trial is now warranted.

  11. A Gut Feeling to Cure Diabetes: Potential Mechanisms of Diabetes Remission after Bariatric Surgery

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    Young Min Cho

    2014-12-01

    Full Text Available A cure for type 2 diabetes was once a mere dream but has now become a tangible and achievable goal with the unforeseen success of bariatric surgery in the treatment of both obesity and type 2 diabetes. Popular bariatric procedures such as Roux-en-Y gastric bypass and sleeve gastrectomy exhibit high rates of diabetes remission or marked improvement in glycemic control. However, the mechanism of diabetes remission following these procedures is still elusive and appears to be very complex and encompasses multiple anatomical and physiological changes. In this article, calorie restriction, improved β-cell function, improved insulin sensitivity, and alterations in gut physiology, bile acid metabolism, and gut microbiota are reviewed as potential mechanisms of diabetes remission after Roux-en-Y gastric bypass and sleeve gastrectomy.

  12. Neuro-Genetics of Reward Deficiency Syndrome (RDS) as the Root Cause of “Addiction Transfer”: A New Phenomenon Common after Bariatric Surgery

    OpenAIRE

    Blum, Kenneth; Bailey, John; Gonzalez, Anthony M; Oscar-Berman, Marlene; Liu, Yijun; Giordano, John; Braverman, Eric; Gold, Mark

    2011-01-01

    Now after many years of successful bariatric (weight-loss) surgeries directed at the obesity epidemic clinicians are reporting that some patients are replacing compulsive overeating with newly acquired compulsive disorders such as alcoholism, gambling, drugs, and other addictions like compulsive shopping and exercise. This review article explores evidence from psychiatric genetic animal and human studies that link compulsive overeating and other compulsive disorders to explain the phenomenon ...

  13. Retraction Note: Effects of Bariatric Surgery on Incidence of Obesity-Related Cancers: A Meta-Analysis.

    Science.gov (United States)

    Yang, Xiang-Wu; Li, Peng-Zhou; Zhu, Li-Yong; Zhu, Shaihong

    2016-01-01

    In the article entitled, "Effects of Bariatric Surgery on Incidence of Obesity-Related Cancers: A Meta-Analysis" which was published in Medical Science Monitor 2015;21: 1350-1357, sections in the text have been directly copied from a previously published article, entitled, "The Effects of Bariatric Surgery on Colorectal Cancer Risk: Systematic Review and Meta-Analysis", Sorena Afshar, Seamus B. Kelly, Keith Seymour, Jose Lara, Sean Woodcock, John C. Mathers  in Obesity Surgery 2014; 24(10):1793-1799. Thus owing to duplicity of text, the article is being retracted. Reference: 1. Xiang-wu Yang, Peng-zhou Li, Li-yong Zhu, Shaihong Zhu Effects of Bariatric Surgery on Incidence of Obesity-Related Cancers: A Meta-Analysis Medical Science Monitor 2015;21: 1350-1357 DOI: 10.12659/MSM.893553. PMID:27215479

  14. Use of Autologous Platelet Gel in Bariatric Surgery

    OpenAIRE

    Brady, Chad; Vang, See; Christensen, Kevin; Isler, Jack; Vollstedt, Keith; Holt, David

    2006-01-01

    Gastric bypass surgery is a common corrective procedure for obesity that is associated with many risks. Recent studies describing the use of autologous platelet gel (APG) have shown promise in preventing certain operative complications and improved healing processes. These improvements have been credited to the concentrated platelets and growth factors present in APG, as well as the native concentrations of fibrinogen. There are numerous applications for the use of APG in surgery, and the lis...

  15. Cognitive and emotional processes that promote and obstruct a successful outcome after bariatric surgery for morbid obesity

    NARCIS (Netherlands)

    Zijlstra, H.

    2011-01-01

    The studies in this thesis were aimed at examining cognitive and emotional factors that predict or obstruct a successful weight outcome after bariatric surgery (weight loss surgery) for morbid obesity. The thesis includes two studies with a cross-sectional and four studies with a prospective design.

  16. Persistently High Hip Circumference after Bariatric Surgery Is a Major Hurdle to Successful Hip Replacement

    OpenAIRE

    Menachem M. Meller; Courville, Amber B; Sumner, Anne E.

    2014-01-01

    The prevalence of class III obesity (BMI ≥ 40 kg/m2) in black women is 18%. As class III obesity leads to hip joint deterioration, black women frequently present for orthopedic care. Weight loss associated with bariatric surgery should lead to enhanced success of hip replacements. However, we present a case of a black woman who underwent Roux-en-Y gastric bypass with the expectation that weight loss would make her a better surgical candidate for hip replacement. Her gastric bypass was success...

  17. ANTIBIOTIC PROPHYLAXIS IN BARIATRIC SURGERY: a continuous infusion of cefazolin versus ampicillin/sulbactam and ertapenem

    OpenAIRE

    2015-01-01

    Background The incidence of surgical site infection in bariatric patients is significant and the current recommendations for antibiotic prophylaxis are sometimes inadequate. Objective The aim of this study was to analyze the effect of three prophylactic antibiotic regimens on the incidence of surgical site infection. Methods A prospective, cross-sectional study was conducted between January 2009 and January 2013 in which 896 Roux-en-Y gastric bypasses were performed to treat obesity. The stud...

  18. Physical Activity and Physical Function in Individuals Post-bariatric Surgery

    Science.gov (United States)

    Josbeno, Deborah A.; Kalarchian, Melissa; Sparto, Patrick J.; Otto, Amy D.; Jakicic, John M.

    2016-01-01

    Background A better understanding of the physical activity behavior of individuals who undergo bariatric surgery will enable the development of effective post-surgical exercise guidelines and interventions to enhance weight loss outcomes. This study characterized the physical activity profile and physical function of 40 subjects 2–5 years post-bariatric surgery and examined the association between physical activity, physical function, and weight loss after surgery. Methods Moderate-to-vigorous intensity physical activity (MVPA) was assessed with the BodyMedia SenseWear® Pro (SWPro) armband, and physical function (PF) was measured using the physical function subscale of the 36-Item Short Form Health Survey instrument (SF-36PF). Height and weight were measured. Results Percent of excess weight loss (%EWL) was associated with MVPA (r = 0.44, p = 0.01) and PF (r = 0.38, p = 0.02); MVPA was not associated with PF (r = 0.24, p = 0.14). Regression analysis demonstrated that MVPA was associated with %EWL (β = 0.38, t = 2.43, p = 0.02). Subjects who participated in ≥150 min/week of MVPA had a greater %EWL (68.2 ± 19, p = 0.01) than those who participated in interventions. PMID:21153567

  19. To eat or not to eat; is that really the question? An evaluation of problematic eating behaviors and mental health among bariatric surgery candidates.

    Science.gov (United States)

    Miller-Matero, Lisa Renee; Armstrong, Rachel; McCulloch, Katherine; Hyde-Nolan, Maren; Eshelman, Anne; Genaw, Jeffrey

    2014-01-01

    Problematic eating behaviors, such as emotional eating, and food addiction, may affect weight; however, little is known about these eating behaviors, especially among those seeking bariatric surgery. Therefore, the purpose of this study was to estimate the prevalence of problematic eating behaviors and to investigate their relationship with other eating behaviors, body mass index (BMI), and psychiatric symptoms. There were 142 patients who completed a required psychiatric evaluation prior to bariatric surgery. Of these, 16.9 % met criteria for a food addiction and 25.4-40.7 % endorsed emotional eating, depending on type of emotional eating. The number of food addiction symptoms endorsed was related to emotional eating. Both food addiction and emotional eating were related to anxiety and depressive symptoms. However, surprisingly, BMI was not related to a food addiction diagnosis, emotional eating scores, or psychiatric symptoms. Results from this study suggest that problematic eating behaviors are occurring among bariatric surgery candidates. Furthermore, this study may help to address the conflicting research regarding the effects of psychiatric symptoms on weight-loss outcomes. Perhaps it is the problematic eating behaviors (e.g., food addiction and emotional eating) that are associated with psychiatric symptoms that could be influencing outcomes. Future research should evaluate treatments for problematic eating behaviors and whether treatments improve weight-loss success. PMID:24878835

  20. Weight loss by calorie restriction versus bariatric surgery differentially regulates the hypothalamo-pituitary-adrenocortical axis in male rats.

    Science.gov (United States)

    Grayson, Bernadette E; Hakala-Finch, Andrew P; Kekulawala, Melani; Laub, Holly; Egan, Ann E; Ressler, Ilana B; Woods, Stephen C; Herman, James P; Seeley, Randy J; Benoit, Stephen C; Ulrich-Lai, Yvonne M

    2014-12-01

    Behavioral modifications for the treatment of obesity, including caloric restriction, have notoriously low long-term success rates relative to bariatric weight-loss surgery. The reasons for the difference in sustained weight loss are not clear. One possibility is that caloric restriction alone activates the stress-responsive hypothalamo-pituitary-adrenocortical (HPA) axis, undermining the long-term maintenance of weight loss, and that this is abrogated after bariatric surgery. Accordingly, we compared the HPA response to weight loss in five groups of male rats: (1) high-fat diet-induced obese (DIO) rats treated with Roux-en-Y gastric bypass surgery (RYGB, n = 7), (2) DIO rats treated with vertical sleeve gastrectomy (VSG, n = 11), (3) DIO rats given sham surgery and subsequently restricted to the food intake of the VSG/RYGB groups (Pair-fed, n = 11), (4) ad libitum-fed DIO rats given sham surgery (Obese, n = 11) and (5) ad libitum chow-fed rats given sham surgery (Lean, n = 12). Compared with Lean controls, food-restricted rats exhibited elevated morning (nadir) non-stress plasma corticosterone concentration and increased hypothalamic corticotropin-releasing hormone and vasopressin mRNA expression, indicative of basal HPA activation. This was largely prevented when weight loss was achieved by bariatric surgery. DIO increased HPA activation by acute (novel environment) stress and this was diminished by bariatric surgery-, but not pair-feeding-, induced weight loss. These results indicate that the HPA axis is differentially affected by weight loss from caloric restriction versus bariatric surgery, and this may contribute to the differing long-term effectiveness of these two weight-loss approaches. PMID:25238021

  1. Type 2 diabetes, bariatric surgery and the risk of subsequent gestational diabetes

    Science.gov (United States)

    Steven, S; Woodcock, S; Small, P K; Taylor, R

    2011-01-01

    Women with pre-existing abnormal glucose regulation are certain to develop gestational diabetes in pregnancy and pre-gestational type 2 diabetes will become more difficult to control. However, an increasing number of women with type 2 diabetes have had bariatric surgery. In this group, the effect of pregnancy on glucose metabolism is unknown. We report two women with type 2 diabetes who underwent laparoscopic gastric bypass surgery with normalization of plasma glucose levels. During subsequent pregnancy, maternal blood glucose levels remained completely normal throughout. This is remarkable given the predisposition to abnormal glucose tolerance and the ongoing obesity, in the face of the insulin resistance of pregnancy. Women with prior type 2 diabetes reversed by gastric bypass surgery are not at high risk for gestational diabetes.

  2. The ambivalence of losing weight after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Christine Warholm

    2014-01-01

    Full Text Available This study is grounded in a phenomenological lifeworld perspective. It aims at providing rich descriptions of lived experience of the process of losing weight after obesity surgery. Two women participated in in-depth interviews four times each during the first postoperative year. Based on the women's experiences, a meaning structure—the ambivalence of losing weight after obesity surgery—was identified across the women's processes of change. This consisted of five core themes: movement and activity—freedom but new demands and old restraints; eating habits and digestion—the complexity of change; appearance—smaller, but looser; social relations—stability and change; and being oneself—vulnerability and self-assurance. These core themes changed over time in terms of dominance. The experience of ambivalence is discussed according to a phenomenological perspective of the body as lived experience.

  3. Fatal Nonhepatic Hyperammonemia in ICU Setting: A Rare but Serious Complication following Bariatric Surgery

    Science.gov (United States)

    Mehra, Sunil; Patel, Ronakkumar; Frunza-Stefan, Simona; Kaur, Harmanjot

    2016-01-01

    Bariatric surgery is well established in reducing weight and improving the obesity-associated morbidity and mortality. Hyperammonemic encephalopathy following bariatric surgery is rare but highly fatal if not diagnosed in time and managed aggressively. Both macro- and micronutrients deficiencies play a role. A 42-year-old Hispanic female with a history of Roux-en-Y Gastric Bypass Procedure was brought to ED for progressive altered mental status. Physical exam was remarkable for drowsiness with Glasgow Coma Scale 11, ascites, and bilateral pedal edema. Labs showed elevated ammonia, low hemoglobin, low serum prealbumin, albumin, HDL, and positive toxicology. She remained obtunded despite the treatment with Narcan and flumazenil and the serum ammonia level fluctuated despite standard treatment with lactulose and rifaximin. Laboratory investigations helped to elucidate the etiology of the hyperammonemia most likely secondary to unmasking the functional deficiency of the urea cycle enzymes. Hyperammonemia in the context of normal liver function tests becomes diagnostically challenging for physicians. Severe hyperammonemia is highly fatal. Early diagnosis and aggressive treatment can alter the prognosis favorably. PMID:27144037

  4. Fatal Nonhepatic Hyperammonemia in ICU Setting: A Rare but Serious Complication following Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Gyanendra Acharya

    2016-01-01

    Full Text Available Bariatric surgery is well established in reducing weight and improving the obesity-associated morbidity and mortality. Hyperammonemic encephalopathy following bariatric surgery is rare but highly fatal if not diagnosed in time and managed aggressively. Both macro- and micronutrients deficiencies play a role. A 42-year-old Hispanic female with a history of Roux-en-Y Gastric Bypass Procedure was brought to ED for progressive altered mental status. Physical exam was remarkable for drowsiness with Glasgow Coma Scale 11, ascites, and bilateral pedal edema. Labs showed elevated ammonia, low hemoglobin, low serum prealbumin, albumin, HDL, and positive toxicology. She remained obtunded despite the treatment with Narcan and flumazenil and the serum ammonia level fluctuated despite standard treatment with lactulose and rifaximin. Laboratory investigations helped to elucidate the etiology of the hyperammonemia most likely secondary to unmasking the functional deficiency of the urea cycle enzymes. Hyperammonemia in the context of normal liver function tests becomes diagnostically challenging for physicians. Severe hyperammonemia is highly fatal. Early diagnosis and aggressive treatment can alter the prognosis favorably.

  5. Weight loss after bariatric surgery normalizes brain opioid receptors in morbid obesity.

    Science.gov (United States)

    Karlsson, H K; Tuulari, J J; Tuominen, L; Hirvonen, J; Honka, H; Parkkola, R; Helin, S; Salminen, P; Nuutila, P; Nummenmaa, L

    2016-08-01

    Positron emission tomography (PET) studies suggest opioidergic system dysfunction in morbid obesity, while evidence for the role of the dopaminergic system is less consistent. Whether opioid dysfunction represents a state or trait in obesity remains unresolved, but could be assessed in obese subjects undergoing weight loss. Here we measured brain μ-opioid receptor (MOR) and dopamine D2 receptor (D2R) availability in 16 morbidly obese women twice-before and 6 months after bariatric surgery-using PET with [(11)C]carfentanil and [(11)C]raclopride. Data were compared with those from 14 lean control subjects. Receptor-binding potentials (BPND) were compared between the groups and between the pre- and postoperative scans among the obese subjects. Brain MOR availability was initially lower among obese subjects, but weight loss (mean=26.1 kg, s.d.=7.6 kg) reversed this and resulted in ~23% higher MOR availability in the postoperative versus preoperative scan. Changes were observed in areas implicated in reward processing, including ventral striatum, insula, amygdala and thalamus (P'ssystem plays an important role in the pathophysiology of human obesity. Because bariatric surgery and concomitant weight loss recover downregulated MOR availability, lowered MOR availability is associated with an obese phenotype and may mediate excessive energy uptake. Our results highlight that understanding the opioidergic contribution to overeating is critical for developing new treatments for obesity. PMID:26460230

  6. Bariatric surgery in morbidly obese insulin resistant humans normalises insulin signalling but not insulin-stimulated glucose disposal.

    Directory of Open Access Journals (Sweden)

    Mimi Z Chen

    Full Text Available Weight-loss after bariatric surgery improves insulin sensitivity, but the underlying molecular mechanism is not clear. To ascertain the effect of bariatric surgery on insulin signalling, we examined glucose disposal and Akt activation in morbidly obese volunteers before and after Roux-en-Y gastric bypass surgery (RYGB, and compared this to lean volunteers.The hyperinsulinaemic euglycaemic clamp, at five infusion rates, was used to determine glucose disposal rates (GDR in eight morbidly obese (body mass index, BMI=47.3 ± 2.2 kg/m(2 patients, before and after RYGB, and in eight lean volunteers (BMI=20.7 ± 0.7 kg/m2. Biopsies of brachioradialis muscle, taken at fasting and insulin concentrations that induced half-maximal (GDR50 and maximal (GDR100 GDR in each subject, were used to examine the phosphorylation of Akt-Thr308, Akt-473, and pras40, in vivo biomarkers for Akt activity.Pre-operatively, insulin-stimulated GDR was lower in the obese compared to the lean individuals (P<0.001. Weight-loss of 29.9 ± 4 kg after surgery significantly improved GDR50 (P=0.004 but not GDR100 (P=0.3. These subjects still remained significantly more insulin resistant than the lean individuals (p<0.001. Weight loss increased insulin-stimulated skeletal muscle Akt-Thr308 and Akt-Ser473 phosphorylation, P=0.02 and P=0.03 respectively (MANCOVA, and Akt activity towards the substrate PRAS40 (P=0.003, MANCOVA, and in contrast to GDR, were fully normalised after the surgery (obese vs lean, P=0.6, P=0.35, P=0.46, respectively.Our data show that although Akt activity substantially improved after surgery, it did not lead to a full restoration of insulin-stimulated glucose disposal. This suggests that a major defect downstream of, or parallel to, Akt signalling remains after significant weight-loss.

  7. CO - RELATION OF SIX MINUTE WALK TEST WITH PULMONARY FUNCTION TESTS IN OBESE INDIVIDUALS ADMITTED FOR BARIATRIC SURGERY

    Directory of Open Access Journals (Sweden)

    Monti Kumar

    2015-05-01

    Full Text Available AIMS AND OBJECTIVES : To evaluate Pulmonary Function Tests and 6MWT in obese individuals and to correlate 6MWT with FEV1 and MMEF 75 - 25 and establish the individual significance in evaluating bariatric subjects. MATERIAL AND METHOD: Prospective observational study carried out on 50 obese patients r eferred to PFT Lab for pre - operative investigations (admitted for planned Bariatric Surgery after the informed consent in Department of Respiratory Medicine, Sri Aurobindo Medical College and Post Graduate Institute, Indore (MP. Biometric data (age, sex, height and weight, Pulmonary Function Tests (PFT and Six minute walk test (6MWT data was collected. Exclusion criteria for study is those who were not willing, unable to perform PFT/6MWT acceptably, recent cardiac event, patients with osteoarthritis or neuromuscular disorder and patients with known pre - existing respiratory illness. STATISTICAL ANALYSIS : Statistical analysis was performed using Graphpad Quick Calcs: t test calculator software. The data were reported as mean ± standard deviation (SD. The absolute (6MWD in meters was used. The correlation between 6MWD and the patient’s pulmonary function test were evaluated by applying unpaired ‘t’ test. 6MWT shows extremely significant correlation with FEV1and MMEF 75 - 25 . RESULT: There is high correlatio n between 6MWT and PFT in obese individuals. All the patients above normal BMI have ventilatory defect which may be due to restriction imposed by abdominal wall and chemical mediators released by adipocytes. Predicted values are calculated by Udwadia Index . CONCLUSION : 6MWT is a good prognostic tool to study ventilatory mechanism in obese individuals.

  8. Evaluation of an In Silico PBPK Post-Bariatric Surgery Model through Simulating Oral Drug Bioavailability of Atorvastatin and Cyclosporine.

    Science.gov (United States)

    Darwich, A S; Pade, D; Rowland-Yeo, K; Jamei, M; Asberg, A; Christensen, H; Ashcroft, D M; Rostami-Hodjegan, A

    2013-01-01

    An increasing prevalence of morbid obesity has led to dramatic increases in the number of bariatric surgeries performed. Altered gastrointestinal physiology following surgery can be associated with modified oral drug bioavailability (Foral). In the absence of clinical data, an indication of changes to Foral via systems pharmacology models would be of value in adjusting dose levels after surgery. A previously developed virtual "post-bariatric surgery" population was evaluated through mimicking clinical investigations on cyclosporine and atorvastatin after bariatric surgery. Cyclosporine simulations displayed a reduced fraction absorbed through gut wall (fa) and Foral after surgery, consistent with reported observations. Simulated atorvastatin Foral postsurgery was broadly reflective of observed data with indications of counteracting interplay between reduced fa and an increased fraction escaping gut wall metabolism (FG). Inability to fully recover observed atorvastatin exposure after biliopancreatic diversion with duodenal switch highlights the current gap regarding the knowledge of associated biological changes.CPT: Pharmacometrics & Systems Pharmacology (2013) 2, e47; doi:10.1038/psp.2013.23; advance online publication 12 June 2013. PMID:23903405

  9. Bariatric Surgery

    Science.gov (United States)

    ... disorders. ​ Additional Reading Active at Any Size! Binge Eating Disorder Dieting and Gallstones ​ Related Conditions and Diseases Obesity ... Follow Us Contact Us Get Email Updates Twitter Facebook Follow ... Institute of Diabetes and Digestive and Kidney Diseases, Health Information Center, Telephone: 1-800-860-8747 ...

  10. Dissociated incretin response to oral glucose at 1 year after restrictive vs. malabsorptive bariatric surgery

    DEFF Research Database (Denmark)

    Guldstrand, M; Ahrén, B; Näslund, E;

    2009-01-01

    AIM: Compare the response to oral glucose of the two incretin hormones, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) at 1 year after restrictive vs. malabsorptive bariatric surgery. METHODS: Vertical banded gastroplasty (VBG, n = 7) or jejunoileal bypass...... operation, reduction in body weight, actual body weight, fasting glucose or insulin, or the glucose and insulin responses to oral glucose did not differ significantly between the groups. Similarly, fasting GIP and GLP-1 levels did not differ significantly between the groups. In contrast, the GIP and GLP-1...... responses to oral glucose were different between the groups in a dissociated pattern. Thus, AUC(GIP) was significantly higher after VBG than after JIB (53 +/- 8 vs. 26 +/- 6 pmol/l/min, p = 0.003). In contrast, AUC(GLP-1) was significantly higher after JIB than after VBG (49 +/- 5 vs. 20 +/- 3 pmol/l/min, p...

  11. The decision of an obese woman to have bariatric surgery: the social phenomenology

    Directory of Open Access Journals (Sweden)

    Deíse Moura de Oliveira

    2014-12-01

    Full Text Available Objective To understand the process by which an obese woman decides to have bariatric surgery. Method A qualitative survey with a social phenomenology approach, carried out in 2012, with 12 women, using the phenomenological interview. Results A woman bases the decision to have the surgery on: the inappropriateness of her eating habits; a physical appearance that is incompatible with an appearance that is standardized by society; the social prejudice that she has to live with; the limitations imposed by obesity; and her lack of success with previous attempts to lose weight. Outcomes that she hopes for from the decision to have the surgery include: restoring her health; achieving social inclusion; and entering the labor market. Conclusion This study allows one to reflect that prescriptive actions do not give a satisfactory response to a complexity of the subjective questions involved in the decision to have surgery for obesity. For this, what is called for is a program of work based on an interdisciplinary approach, and training that gives value to the bio-psycho-social aspects involved in a decision in favor of surgical treatment.

  12. Nefrolitotomía percutánea en pacientes con cirugía bariátrica: ¿mayor riesgo de complicación? Percutaneous nephrolitotomy in bariatric surgery patients: Is there an increased risk of complications

    Directory of Open Access Journals (Sweden)

    Gastón López-Fontana

    2012-10-01

    Full Text Available Objetivo: Presentar el caso de un paciente con antecedente de cirugía bariátrica y litiasis renal coraliforme, el cual presentó una perforación colónica luego de una nefrolitectomía percutánea. Material y Métodos: Paciente hombre de 38 años de edad con antecedente de bypass gástrico. Fue sometido a una nefrolitectomía percutánea por litiasis renal izquierda coraliforme, complicada de una perforación colónica no reconocida en forma precoz. Resultados: El paciente evolucionó con cuadro séptico y presencia de material fecaloídeo en la zona de la nefrostomía, por lo que requirió colostomía transversa, con resolución de la complicación séptica y resolución de la fístula nefrocólica. Conclusión: Es sabido que la cirugía bariátrica se asocia a litogénesis urinaria y cambios anatómicos de las relaciones de los órganos abdominales. El estudio radiológico y la adecuada estrategia quirúrgica evitará complicaciones graves en la cirugía de la litiasis renal.Introduction: To report a patient with a history of bariatric surgery and staghorn calculi of the left kidney, who had a colonic perforation after percutaneous renal surgery. Material and Methods: A 38 years old male patient, with a history of gastric bypass, underwent a left percutaneous nephrolithotomy due to staghorn renal calculi. In the procedure, the colon was incidentally perforated during the percutaneous access. Results: The patient developed a sepsis and fecal material appeared surrounding the nephrostomy tube. A transverse colostomy was performed, with improvement of the sepsis and a spontaneous resolution of the nephro-colonic fistula. Conclusion: Is known that bariatric surgery is associated with the novo urinary lithiasis. Besides, there are anatomical changes in between intraabdominal viscera. Radiological studies and a adequate surgical strategy are fundamental to avoid severe surgical complications in kidney stone disease.

  13. Providing quality skin and wound care for the bariatric patient: an overview of clinical challenges.

    Science.gov (United States)

    Beitz, Janice M

    2014-01-01

    Obesity, (defined as body mass index [BMI] ≥30), and especially morbid obesity (defined as BMI ≥40), has a profound impact on the health and integrity of the patient's integumentary system and on the caregivers who strive to provide care for larger, heavy patients. The purpose of this overview is to address some common skin and wound care issues faced by bariatric patients in order to inform clinicians, patients, and caregivers and enable them to optimize care. For bariatric patients, extra attention must be paid to skin care, cleanliness, skin fold management, perigenital care, odor management, and effective pressure redistribution. Despite these interventions, the multifactorial challenges presented by morbid obesity increase patient risk for serious skin diseases and wound conditions. Implications for practice include how best to educate patients and caregivers for optimal problem prevention. Future research should target improving bariatric care equipment and decreasing risk indices. PMID:24434162

  14. Application of positive airway pressure in restoring pulmonary function and thoracic mobility in the postoperative period of bariatric surgery: a randomized clinical trial

    OpenAIRE

    Patrícia Brigatto; Carbinatto, Jéssica C.; Costa, Carolina M.; Montebelo, Maria I. L.; Irineu Rasera-Júnior; Pazzianotto-Forti, Eli M.

    2014-01-01

    Objective: To evaluate whether the application of bilevel positive airway pressure in the postoperative period of bariatric surgery might be more effective in restoring lung volume and capacity and thoracic mobility than the separate application of expiratory and inspiratory positive pressure. Method: Sixty morbidly obese adult subjects who were hospitalized for bariatric surgery and met the predefined inclusion criteria were evaluated. The pulmonary function and thoracic mobility were preope...

  15. General anesthesia type does not influence serum levels of neutrophil gelatinase-associated lipocalin during the perioperative period in video laparoscopic bariatric surgery

    OpenAIRE

    Adriano Fernandes; João Ettinger; Fabiano Amaral; Maria José Ramalho; Rodrigo Alves; Norma Sueli Pinheiro Módolo

    2014-01-01

    OBJECTIVES: Video laparoscopic bariatric surgery is the preferred surgical technique for treating morbid obesity. However, pneumoperitoneum can pose risks to the kidneys by causing a decrease in renal blood flow. Furthermore, as in other surgical procedures, laparoscopic bariatric surgery triggers an acute inflammatory response. Neutrophil gelatinase-associated lipocalin is an early and accurate biomarker of renal injury, as well as of the inflammatory response. Anesthetic drugs could offer s...

  16. Effectiveness of cognitive-behavioral therapy in morbidity obese candidates for bariatric surgery with and without binge eating disorder

    Directory of Open Access Journals (Sweden)

    V. Abilés

    2013-10-01

    Full Text Available Aims: To analyze changes in the general and specific psychopathology of morbidly obese bariatric surgery (BS candidates after cognitive behavioral therapy (CBT and assess differences between patients with and without binge eating disorder (BED and between patients with obesity grades III and IV, studying their influence on weight loss. Methods: 110 consecutive morbidly obese BS candidates [77 females; aged 41 ± 9 yrs; body mass index 49.1 ± 9.0 kg/m²] entered a three-month CBT program (12 two-hour sessions before BS. Participants were assessed with general and specific psychopathology tests pre-and post-CBT. Data were analyzed according to the degree of obesity and presence/absence of BED. Results: At baseline, BED patients were more anxious and depressive with lower self-esteem and quality of life versus non-BED patients (p 10% in 61%, with no intergroup differences. Conclusions: CBT is effective to treat psychological comorbidity in BS candidates, regardless of the presence of BED and degree of obesity.

  17. [The psychiatric, psychological and addiction evaluation in bariatric surgery candidates: What should we assess, why and how?].

    Science.gov (United States)

    Brunault, Paul; Gohier, Bénédicte; Ducluzeau, Pierre-Henri; Bourbao-Tournois, Céline; Frammery, Julie; Réveillère, Christian; Ballon, Nicolas

    2016-01-01

    Bariatric surgery is indicated in obese patients with a BMI ≥ 40kg/m(2) or ≥ 35kg/m(2) with serious comorbidities, in second intention in patients who failed to achieve significant weight loss after a well-managed medical, nutritional and psychotherapeutic treatment for 6 to 12 months, and in patients who are aware of the consequences of bariatric surgery and who agree with a long term medical and surgical follow-up. Such a treatment requires a preoperative multidisciplinary assessment and management, which includes a mandatory consultation with a psychiatrist or a psychologist that should be member of the multidisciplinary staff and participate in these staffs. Although one of this consultation's aim is to screen for the few patients who for which surgery is contra-indicated, in most cases, the main aim of this assessment is to screen for and manage psychiatric and psychopathologic disorders that could be temporary contra-indication, because these disorders could lead to poorer postoperative outcome when untreated. By explaining to the patient how these disorders could affect postoperative outcome and which benefits he could retrieve from their management, the patient will increase his motivation for change and he will be more likely to seek professional help for these disorders. In all cases, a systematic examination of the patient's personality and his/her ability to understand the postoperative instructions is essential before surgery because clinicians should check that the patient is able to be adherent to postoperative instructions. In addition to clinical interview, use of self-administered questionnaires before the consultation might help to determine which psychiatric or psychopathologic factors should be more closely screened during the consultation. Psychiatric disorders and addictions are highly prevalent in this population (e.g., mood and anxiety disorders, binge eating disorder, attention deficit hyperactivity disorder, addictions

  18. Pharmacologic and mechanical strategies for preventing venous thromboembolism after bariatric surgery: a systematic review and meta-analysis.

    Science.gov (United States)

    Brotman, Daniel J; Shihab, Hasan M; Prakasa, Kalpana R; Kebede, Sosena; Haut, Elliott R; Sharma, Ritu; Shermock, Kenneth; Chelladurai, Yohalakshmi; Singh, Sonal; Segal, Jodi B

    2013-07-01

    We sought to assess the comparative effectiveness and safety of pharmacologic and mechanical strategies to prevent venous thromboembolism (VTE) in patients undergoing bariatric surgery. We searched (through August 2012) for primary studies that had at least 2 different interventions. Of 30,902 citations, we identified 8 studies of pharmacologic strategies and 5 studies of filter placement. No studies randomized patients to receive different interventions. One study suggested that low-molecular-weight heparin is more efficacious than unfractionated heparin in preventing VTE (0.25% vs 0.68%, P prevent VTE better than inpatient treatment only. There was insufficient evidence supporting the hypothesis that filters reduce the risk of pulmonary embolism, with a point estimate suggesting increased rates with filters (pooled relative risk [RR], 1.21 95% CI, 0.57-2.56). There was low-grade evidence that filters are associated with higher mortality (pooled RR, 4.30 95% CI, 1.60-11.54) and higher deep vein thrombosis rates (2.94 1.35-6.38). There was insufficient evidence to support that augmented subcutaneous enoxaparin doses (>40 mg daily or 30 mg twice daily) are more efficacious than standard dosing, with a trend toward increased bleeding. Of note, for both filters and augmented pharmacologic dosing strategies, patients at highest risk for VTE were more likely to receive more intensive interventions, limiting our ability to attribute outcomes to prophylactic strategies used. PMID:23754086

  19. Incidência da deficiência de vitamina B12 em pacientes submetidos à cirurgia bariátrica pela técnica Fobi-Capella (Y-de-Roux Incidence of vitamin B12 deficiency in patients submitted to Fobi-Capella Roux-en-Y bariatric surgery

    Directory of Open Access Journals (Sweden)

    Iara Ribeiro Carvalho

    2012-03-01

    Full Text Available RACIONAL: Os pacientes submetidos à cirurgia bariátrica podem desenvolver, ao longo do tempo, algumas complicações e a anemia é quadro importante decorrente da ressecção gástrica, levando à deficiência de ferro, ácido fólico ou vitamina B. OBJETIVO: Verificar a incidência da deficiência de vitamina B12 e comparar dados antropométricos e bioquímicos do pré e pós-operatório (seis meses, em pacientes submetidos à cirurgia bariátrica Fobi-Capella (Y de Roux. MÉTODOS: Análise retrospectiva e descritiva de 91 prontuários de pacientes submetidos à operação. Foram coletadas informações pessoais, data do procedimento e valores do pré e pós-operatório (seis meses, redução de peso, co-morbidades, colesterol, triglicérides, glicemia, vitamina B12, hemoglobina e hematócrito. Para análise estatística foi utilizado nível de significância de 5% (pBACKGROUND: Patients undergoing bariatric surgery may develop over time, some complications and anemia is an important one due to gastric resection, leading to iron, folic acid or vitamin B12 deficiency. AIM: To determine the incidence of deficiency of vitamin B12 and other anthropometric and biochemical data comparing the preoperative and postoperative (six months period in patients who underwent bariatric surgery with Fobi-Capella (Roux-en-Y technique. METHODS: Retrospective and descriptive analysis of 91 charts of patients who underwent surgery. It was collected personal information, date of surgery and pre-and postoperative (six months values, weight loss, comorbidities, serum analysis of total cholesterol, triglycerides, glucose, vitamin B12, hemoglobin and hematocrit. For statistical analysis, it was considered significance level of 5% (p<0.05. RESULTS: It was found that there was a reduction in weight of 25,0% compared with the preoperative value and the average BMI was from 41,2±4,9 kg/m² to 30,7±3,9 kg/m². The most common co-morbidities were dyspnea (93,4%, spine

  20. Obesity, bariatric surgery and nutritional implications - doi:10.5020/18061230.2007.p259

    Directory of Open Access Journals (Sweden)

    Michele Novaes Ravelli

    2012-01-01

    Full Text Available Obesity is an important nutritional deviation that is exponentially increasing in Brazil and in the world, becoming a public health problem. The World Health Organization verified in 2005 that 1.6 billion people above 15 years old were overweight and 400 million were obese. Among children, 20 million were overweight. Amongst the different treatments for the obesity the bariatric surgery has been used very often nowadays, for being effective against weight excess and associated co-morbidities, both for the adult and youngster populations. The surgical techniques are divided in restrictive, disabsorptive and mixed procedures. Each technique promotes digestive and absorptive distinct alterations, needing, therefore, an exclusive multidisciplinary educational program, directed both to pre and postsurgery periods, emphasizing the habits of physical activity and the necessity to adhere to the restricted dietary recommendations. The surgeries promote a severe reduction in the consumption, which induces to the ingestion of diets that are hypocaloric and deficient in micronutrients, with consequent nutritional complications.

  1. Bariatric Surgery Restores Cardiac and Sudomotor Autonomic C-Fiber Dysfunction towards Normal in Obese Subjects with Type 2 Diabetes

    Science.gov (United States)

    Lieb, David C.; Wohlgemuth, Stephen D.

    2016-01-01

    Objective The aim was to evaluate the impact of bariatric surgery on cardiac and sudomotor autonomic C-fiber function in obese subjects with and without Type 2 diabetes mellitus (T2DM), using sudorimetry and heart rate variability (HRV) analysis. Method Patients were evaluated at baseline, 4, 12 and 24 weeks after vertical sleeve gastrectomy or Roux-en-Y gastric bypass. All subjects were assessed using SudoscanTM to measure electrochemical skin conductance (ESC) of hands and feet, time and frequency domain analysis of HRV, Neurologic Impairment Scores of lower legs (NIS-LL), quantitative sensory tests (QST) and sural nerve conduction studies. Results Seventy subjects completed up to 24-weeks of follow-up (24 non-T2DM, 29 pre-DM and 17 T2DM). ESC of feet improved significantly towards normal in T2DM subjects (Baseline = 56.71±3.98 vs 12-weeks = 62.69±3.71 vs 24-weeks = 70.13±2.88, p<0.005). HRV improved significantly in T2DM subjects (Baseline sdNN (sample difference of the beat to beat (NN) variability) = 32.53±4.28 vs 12-weeks = 44.94±4.18 vs 24-weeks = 49.71±5.19, p<0,001 and baseline rmsSD (root mean square of the difference of successive R-R intervals) = 23.88±4.67 vs 12-weeks = 38.06±5.39 vs 24-weeks = 43.0±6.25, p<0.0005). Basal heart rate (HR) improved significantly in all groups, as did weight, body mass index (BMI), percent body fat, waist circumference and high-density lipoprotein (HDL). Glycated hemoglobin (HbA1C), insulin and HOMA2-IR (homeostatic model assessment) levels improved significantly in pre-DM and T2DM subjects. On multiple linear regression analysis, feet ESC improvement was independently associated with A1C, insulin and HOMA2-IR levels at baseline, and improvement in A1C at 24 weeks, after adjusting for age, gender and ethnicity. Sudomotor function improvement was not associated with baseline weight, BMI, % body fat or lipid levels. Improvement in basal HR was also independently associated with A1C, insulin and HOMA2-IR levels at

  2. Profilaxia antimicrobiana na cirurgia bariátrica Antibiotic prophylaxis in bariatric surgery

    Directory of Open Access Journals (Sweden)

    Álvaro Antonio Bandeira Ferraz

    2007-04-01

    Full Text Available OBJETIVO: Analisar os resultados da incidência de infecção do sítio cirúrgico com três diferentes esquemas antimicrobianos. MÉTODO: No período de Janeiro de 1999 a Dezembro de 2004 foram realizadas 716 cirurgias para o tratamento da Obesidade mórbida, seguindo a técnica proposta por Fobi/Capella. Foram estudados comparativamente três grupos de pacientes: Grupo I - (185 em que foi realizada a profilaxia antimicrobiana com ampicilina/sulbactam, na dose de 3g em duas doses; Grupo II (280 em que a profilaxia foi com ceftriaxona na dose de 1g (dose única; e Grupo III (251 em que a profilaxia foi com ertapenem, na dose de 1 g (dose única. RESULTADOS: O resultado do presente estudo demonstra taxas de infecção do sítio cirúrgico de 3,78% no grupo de profilaxia com ampicilina-sulbactam, 6,81% no grupo de profilaxia com ceftriaxona e de 1,99% no grupo de ertapenem. Não houve diferença estatisticamente significativa entre o uso da associação ampicilina/sulbactam ou ceftriaxona com relação à incidência de infecção do sítio cirúrgico. No entanto, quando comparados os resultados do Grupo II (Ceftriaxona com o Grupo III (Ertapenem, houve uma diferença estatisticamente sisgnificante. CONCLUSÃO: A utilização do ertapenem, de maneira profilática, no tratamento cirúrgico da obesidade mórbida, determinou taxas de infecção do sítio cirúrgico estatisticamente inferiores ao grupo de ceftriaxona e similar ao de ampicilina-sulbactam.BACKGROUND:To analyze the results of the incidence of wound infection under 3 different antibiotics regiments. METHODS: Between January, 1999 and December, 2004, 716 bariatric surgeries had been performed using the technique proposed by Fobi/Capella. Three groups of patients had been compared, according to the antibiotic prophylaxys regimen: Group I: (n=185 ampicillin/sulbactam, 3g in two doses; Group II (n=280: ceftriaxone, 1g (single dose; and Group III: (n=251 ertapenem, 1 g (single dose. RESULTS

  3. Endoscopy and surgery for obesity

    International Nuclear Information System (INIS)

    Actually bariatric surgery appears to be a secure, feasible and durable option for patients with morbid obesity. Most of the complications that arise from bariatric surgery can be solved with the use of endoscopy avoiding the morbidity and mortality of a surgical intervention. This group of patients has become a challenge for the endoscopist and favours the development of interventional endoscopy

  4. Embarazo posterior a cirugía bariátrica: complicaciones maternas y fetales Maternal and foetal complications in pregnancy following bariatric (weight-loss surgery

    Directory of Open Access Journals (Sweden)

    Jairo Hernández-Pinzón

    2008-09-01

    Full Text Available Objetivo: utilizando herramientas de revisiones sistemáticas, describir los efectos de la obesidad en el embarazo para la madre y el feto, así como describir las complicaciones perinatales, intraparto y posnatales en pacientes a las que se les ha practicado cirugía bariátrica. Metodología: se utilizó la base de datos Pubmed/Medline, los términos de búsqueda fueron: bariatric surgery AND/OR obstetric complications, pregnance, abortion, pregnancy outcomes, adverse pregnancy outcomes. Se hizo énfasis en guías de práctica clínica, se realizó búsqueda en sitios de sinopsis de la literatura médica del Database of Abstracts or Reviews of Effectiveness (DARE. Resultados: se seleccionaron 50 artículos, los cuales fueron sintetizados en la sección de resultados de la revisión. La cirugía bariátrica predispone a la isquemia intestinal y formación de hernias en los embarazos posteriores. También se han descrito deficiencias específicas de micronutrientes. Por otra parte, existen informes contradictorios sobre el efecto en el peso fetal. Conclusiones: el seguimiento de los embarazos después del primer año de la cirugía para pérdida de peso no informa episodios importantes de malnutrición materna o fetal. La evidencia muestra que los resultados del embarazo después de la cirugía bariátrica son favorables, en comparación con los resultados en los obesos no tratados quirúrgicamente, se necesitan más estudios prospectivos diseñados cuidadosamente para evaluar áreas de incertidumbre en este campo.Objective: using systematic review tools for describing the effects of obesity on pregnancy for the mother and the foetus, as well as describing perinatal, intrapartum and postnatal complications in patients who have undergone bariatric (weigh-loss surgery. Methodology: the PUBMED/MEDLINE database was searched using the following search terms: bariatric surgery AND/OR obstetric complications, pregnancy, abortion, pregnancy outcome

  5. Early detection of changes in lung mechanics with oscillometry following bariatric surgery in severe obesity.

    Science.gov (United States)

    Peters, Ubong; Hernandez, Paul; Dechman, Gail; Ellsmere, James; Maksym, Geoffrey

    2016-05-01

    Obesity is associated with respiratory symptoms that are reported to improve with weight loss, but this is poorly reflected in spirometry, and few studies have measured respiratory mechanics with oscillometry. We investigated whether early changes in lung mechanics following weight loss are detectable with oscillometry. Furthermore, we investigated whether the changes in lung mechanics measured in the supine position following weight loss are associated with changes in sleep quality. Nineteen severely obese female subjects (mean body mass index, 47.2 ± 6.6 kg/m(2)) were evaluated using spirometry, oscillometry, plethysmography, and the Pittsburgh Sleep Quality Index before and 5 weeks after bariatric surgery. These tests were conducted in both the upright and the supine position, and pre- and postbronchodilation with 200 μg of salbutamol. Five weeks after surgery, weight loss of 11.5 ± 2.5 kg was not associated with changes in spirometry and plethysmography, with the exception of functional residual capacity. There were also no changes in upright respiratory system resistance (Rrs) or reactance following weight loss. Importantly, however, in the supine position, weight loss caused a substantial reduction in Rrs. In addition, sleep quality improved significantly and was highly correlated with the reduction in supine Rrs. Prior to weight loss, subjects did not respond to the bronchodilator when assessed in the upright position with either spirometry or oscillometry; however, with modest weight loss, bronchodilator responsiveness returned to the normal range. Improvements in lung mechanics occur very early after weight loss, mostly in the supine position, resulting in improved sleep quality. These improvements are detectable with oscillometry but not with spirometry. PMID:27109263

  6. Hipoglicemia por nesidioblastose: uma complicação rara da cirurgia bariátrica? Nesidioblastosis hypoglycemia: is it a rare complication of bariatric surgery?

    Directory of Open Access Journals (Sweden)

    Daniele Gehlen Klaus

    2007-12-01

    mórbidos com diabetes do tipo II, porém em alguns casos raros esse fenômeno benéfico gera malefícios, ou seja, a nesidioblastose, que deve ser corrigida pela ressecção parcial do pâncreas, sob pena de ameaçar a vida desses pacientes.BACKGROUND: Bariatric surgery has shown to be the most effective method in diabetes mellitus (DM type II resolution, reaching up to 80% of cure. However, some studies have shown the development of a hyperinsulinemic hypoglycemia state in certain morbidly obese patients after bariatric surgery, so called nesidioblastosis corresponding to pathological disseminated proliferation of pancreatic beta-cells. The purpose of this study is to review bibliographical data on nesidioblastosis after bariatric surgery, researching scientific articles published since 2000 over the subject. METHODS: A literature review was made over scientific articles published since 2000. Researching data based on PubMed (www.pubmed.gov, crossing the following headings: nesidioblastosis, hyperinsulinism, hypoglycemia and bariatric surgery complications. LITERATURE REVIEW: Fourteen publications related to the subject were reviewed. Among them, Cummings defends alterations in the functional activity of the intestinal tract after bariatric surgery promoting stimulation and excessive growth of pancreatic beta-cells and greater activity of pancreatic hormones, suggesting a possible cause for nesidioblastosis. Corroborating in order to elucidate the cause for this disease, authors suggest that the rapid intestinal transit after gastric bypass surgery elevates the serum level of glucagon-like peptide 1, thereby stimulating hyperinsulinemic hypoglycemia in these patients. Similarly, other authors defend the idea that the weight lost after bariatric surgery decrease intensively insulin-resistance due to hypertrophy and hyperfunctional state of pancreatic beta-cells, which is very common in obesity, promoting the development of nesidioblastosis. CONCLUSION

  7. Função diastólica do ventrículo esquerdo em obesos graves em pré-operatório para cirurgia bariátrica Left ventricular diastolic function in morbidly obese patients in the preoperative for bariatric surgery

    Directory of Open Access Journals (Sweden)

    Irlaneide da Silva Tavares

    2012-04-01

    Full Text Available FUNDAMENTO: Obesidade é uma doença crônica, multifatorial, associada a aumento do risco cardiovascular, especialmente a insuficiência cardíaca diastólica. OBJETIVO: Avaliar a função diastólica do ventrículo esquerdo em obesos graves em pré-operatório para cirurgia bariátrica, relacionando com os fatores de risco cardiovascular e a estrutura cardíaca. MÉTODOS: Trata-se de um estudo transversal, com 132 pacientes candidatos a cirurgia bariátrica, submetidos a avaliação ecocardiográfica transtorácica e dos fatores de risco cardiovascular, sendo: 97 mulheres (73,5%, idade média de 38,5 ± 10,5 anos e IMC de 43,7 ± 7,2 Kg/m². Foram divididos em três grupos: 61 com função diastólica normal, 24 com disfunção diastólica leve e 47 com disfunção diastólica moderada/grave, dos quais 41 com disfunção diastólica moderada (padrão pseudonormal e seis com disfunção diastólica grave (padrão restritivo. RESULTADOS: Hipertensão arterial sistêmica, idade e gênero foram diferentes nos grupos com disfunção diastólica. Os grupos com disfunção tiveram maior diâmetro do átrio esquerdo, do ventrículo esquerdo, volume do átrio esquerdo em quatro e duas câmaras, índice de volume atrial esquerdo e índice de massa do ventrículo esquerdo corrigido para a superfície corpórea e para altura. CONCLUSÃO: A elevada frequência de disfunção diastólica do ventrículo esquerdo na fase pré-clínica em obesos graves justifica a necessidade de uma avaliação ecocardiográfica criteriosa, com o objetivo de identificar indivíduos de maior risco, para que medidas de intervenção precoce sejam adotadas.BACKGROUND: Obesity is a chronic and multifactorial disease, associated with increased cardiovascular risk, especially diastolic heart failure. OBJECTIVE: To evaluate left ventricular diastolic function in morbidly obese patients in the pre-operative for bariatric surgery, correlating it with cardiovascular risk factors and

  8. The research progress on bariatric surgery in the treatment of type 2 diabetes%减肥手术治疗2型糖尿病的研究进展

    Institute of Scientific and Technical Information of China (English)

    张思敏; 纪立农

    2012-01-01

    面对日益严峻的糖尿病发病形势,医务人员应提供更加积极有效的治疗干预措施.除生活方式和药物干预外,减肥手术成为肥胖T2DM患者的选择之一.手术治疗糖尿病的机制和术后肠促胰素的分泌密切相关.本文就手术治疗糖尿病的发展历史、研究机制等方面进行文献综述.%Facing to the increasing global diabetes crisis, health care providers should provide potent therapeutic interventions as more as possible. In addition to behavioural and medical approaches, the bariatric surgery becomes a powerful option to relieve diabetes in obese type 2 diabetic patients. The mechanism of bariatric surgery in the treatment of diabetes is considered to be associated with incretin. This paper is a literature review on the history and mechanism of bariatric surgery.

  9. The Bariatric Patient in the Intensive Care Unit: Pitfalls and Management.

    Science.gov (United States)

    Pompilio, Carlos E; Pelosi, Paolo; Castro, Melina G

    2016-09-01

    The increasing number of bariatric/metabolic operations as important alternatives for the treatment of obesity and type 2 diabetes brought several concerns about the intensive care of patients undergoing those procedures. Intensive Care Unit admission criteria are needed in order to better allocate resources and avoid unnecessary interventions. Furthermore, well-established protocols, helpful in many clinical situations, are not directly applicable to obese patients. Indeed, difficult airway management, mechanical ventilation, fluid therapy protocols, prophylaxis, and treatment of venous thromboembolic events have unique aspects that should be taken into consideration. Finally, new data related to planning nutrition therapy of the critically obese have been highlighted and deserve consideration. In this review, we provide an outline of recent studies related to those important aspects of the care of the bariatric/metabolic patients in critical conditions. PMID:27464648

  10. Bariatric Surgery and Multidisciplinary Treatment for Obesity%减重手术与多学科综合治疗肥胖症

    Institute of Scientific and Technical Information of China (English)

    于健春

    2011-01-01

    减重手术是治疗肥胖症最有效并可明显减重的治疗选择之一.与腹腔镜下可调节胃束带术相比,腹腔镜下Roux-en-Y胃旁路术具有更多的获益及手术风险.减重手术后可出现多种胃肠激素水平的变化,能部分解释减重手术后的体重下降及糖尿病缓解机制.减重手术后的治疗管理应是多学科综合治疗,包括调整饮食结构、增加身体活动量、纠正行为和药物治疗.%Bariatric surgery is one of the most effective treatment options for obesity. Compared with laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery has demonstrated more benefits and surgical risks. Bariatric surgery can result in the decreases in multiple gastrointestinal hormone levels, which can partially explain the mechanisms behind weight loss and resolution of diabetes after bariatric surgery. The management after bariatric surgery should be multidisciplinary and comprehensive, including dietary adjustment, physical exercise, behavioral intervention, and drug therapy.

  11. Aplicação da pressão positiva contínua nas vias aéreas em pacientes em pós-operatório de cirurgia bariátrica Applying continuous positive airways pressure in patients after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Eli Maria Pazzianotto-Forti

    2012-03-01

    Full Text Available O objetivo deste trabalho foi avaliar o efeito da aplicação da pressão positiva contínua nas vias aéreas (CPAP, na frequência respiratória (FR, no volume corrente (VC e no volume minuto (VM, em pacientes em pós-operatório de cirurgia bariátrica. Foram estudadas dez pacientes com média de idade 29,8±8 anos, classificadas como obesas mórbidas [índice de massa corpórea (IMC de 47,5±7,2 kg/m²] que receberam CPAP de 8 a 10 cmH2O, por 30 minutos, uma vez ao dia, durante dois dias consecutivos, no pós-operatório de cirurgia bariátrica. Antes e após a aplicação da CPAP, foram aferidos a FR e o VM por meio do ventilômetro e, de forma indireta, foi calculado o VC. Para verificar a normalidade dos dados foi aplicado o teste de Shapiro-Wilk, e, após, as medidas foram comparadas com o uso do Teste t de Student e de Man-Whitney. As análises foram processadas com o uso do SPSS 7,5 considerando o nível de 5% de significância. Houve um aumento significativo para as seguintes variáveis estudadas no primeiro e no segundo dia de aplicação: FR=20±6 resp/min versus 26±7 resp/min (p=0,009 e FR=22±7 resp/min versus 26±8 resp/min (p=0,007; VM=9,57±2,75 L versus 12,39±4,18 L (p=0,041 e VM=9,71±2,52 L versus 11,18±2,96 L (p=0,037. Os valores do VC=360±157,59 mL versus 440±69,18 mL (p=0,21 e 401±90,46 mL versus 416±78,04 mL (p=0,18 não apresentaram diferença significativa na comparação pré- e pós-aplicação, nos dois dias de terapia. Assim, foi possível concluir que a CPAP pode ser aplicada como recurso auxiliar da fisioterapia respiratória no tratamento de pacientes em período pós-operatório de cirurgia bariátrica, para a manutenção do VC, porém atenção deve ser tomada durante a aplicação, pois pode haver aumento da FR.The objective was to evaluate the effect of continuous positive airway pressure (CPAP in the respiratory rate (RR, tidal volume (TV and minute volume (MV in patients after bariatric surgery. Ten

  12. Post-bariatric abdominoplasty: our experience.

    Science.gov (United States)

    Grignaffini, Eugenio; Grieco, Michele P; Bertozzi, Nicolo'; Gandolfi, Marco; Palli, Dante; Cinieri, Francesco Giovanni; Gardani, Marco; Raposio, Edoardo

    2015-01-01

    The fast increase in obesity has been followed by the growth in the demand for plastic surgery in formerly obese patients. The weight loss is accompanied by new dysfunctions and disorders of the outline of the body that affects the quality of life of the patient. Abdominoplasty is a cosmetic surgery procedure that aims to remove the excess of skin and the redundant fat. The aim of this paper was to analyze our experience in this field and to test how functional abdominoplasty improved quality of life in the operated patients. In our Unit from January 2012 to December 2014, 25 patients (18 women and 7 men, age: 24 - 79 years, mean: 51 years) underwent abdominoplastic surgery. Only at least six months after bariatric surgery the patients were eligible for functional abdominoplasty. Average weight of the patients before surgery was 83.5 kg (range 58 - 163 Kg); averege BMI was 31 (range 24.77 - 57). The average quantity of tissue removed was 1.765 Kg (range 250 g - 11,5 Kg). Minor complications rate was in agreement with the percentages reported in literature. No mortality and major complications have occurred in our series. The majority of patients undergoing post-bariatric abdominoplasty reported an improvement in the quality of life and psychological well-being. In our opinion, however, only a multidisciplinary (surgical, psychological, dietological) approach of the post-bariatric patient allows to maintain long-term aesthetic and functional results. PMID:26694156

  13. Interfaces between bariatric surgery and oral health: a longitudinal survey Interface entre cirurgia bariátrica e saúde bucal: estudo longitudinal

    Directory of Open Access Journals (Sweden)

    Juliane Avansini Marsicano

    2011-01-01

    Full Text Available PURPOSE: To evaluate oral changes, such as dental caries, periodontal disease, dental wear and salivary flow in bariatric patients. Fifty four obese patients who underwent bariatric surgery were studied before (n=54, up after 3 months (n=24 and 6 months (n=16. METHODS: Indices for evaluating oral conditions were: DMFT, CPI, DWI and salivary flow. OIDP questionnaire was used to assess the impact of oral health on quality of life. ANOVA and Spearman correlation were used (p0.05, presence of periodontal pockets in 50%, 58% and 50% of patients (p>0.05, tooth wear in dentin present in 81.5%, 87.5% and 87.5% before, 3 and 6 months after surgical treatment respectively. There were differences between the three periods for prevalence and severity of dental wear (p = 0.012. Salivary flow was 0.8±0.5 ml/min before surgery, 0.9±0.5 ml/min for 3 months and 1.1±0.5m/min for 6 months (p>0.05. The impact of oral health on quality of life decreased with time after bariatric surgery (p= 0.029. CONCLUSION: The lifestyle changes after bariatric surgery and these changes may increase the severity of pre-existing dental problems. However, these alterations in oral health did not influence the quality of life.OBJETIVO: Avaliar alterações bucais, como cárie dentária, doença periodontal, desgaste dentário e fluxo salivar, em pacientes bariátricos. MÉTODOS: Cinquenta e quatro pacientes obesos, submetidos à cirurgia bariátrica, tiveram suas condições bucais avaliadas antes (n=54, aos 3 meses (n=24 e aos 6 meses (n=16 após a cirurgia bariátrica. Os índices para avaliação das condições bucais foram: CPOD, IPC, IDD e o volume de fluxo salivar. O questionário OIDP foi utilizado para verificar o impacto da saúde bucal na qualidade de vida. ANOVA e correlação de Spearman foram utilizados para análise estatística (p0,05, bolsa periodontal foi encontrada em 50%, 58% e 50% dos pacientes (p>0,05 e o desgaste dentário em dentina em 81,5%, 87,5% e 87

  14. Evidence supporting the need for bariatric surgery to address the obesity epidemic in the United States.

    Science.gov (United States)

    Bour, Eric S

    2015-01-01

    Despite aims at prevention, obesity in the United States is now an epidemic. Along with the rise in obesity, the United States has experienced a concomitant rise in obesity-related comorbidities. Furthermore overweight and obesity present a major economic public health challenge. Physicians are likely to recommend weight loss to their overweight patients. Diet, exercise, and behavior modification are often effective during the course of treatment but are subject to recidivism and post-treatment weight gain. Obesity intervention mandates that providers consider the need for surgery in many cases. The three most commonly performed weight loss surgical procedures in the United States include gastric banding, gastric bypass, and sleeve gastrectomy. Patients undergoing surgery lose considerable amounts of excess weight and experience marked improvement in many other obesity-related comorbidities. Surgery is a proven therapy for patients who do not respond to less invasive measures and should be considered mainstream therapy in the treatment of the obesity epidemic. PMID:25757004

  15. Experiencia en cirugía bariátrica en un hospital regional Results of bariatric surgery in a Public Regional Hospital

    Directory of Open Access Journals (Sweden)

    NICOLÁS VELASCO M

    2008-04-01

    Full Text Available Introducción: La obesidad mórbida es una patología de creciente consulta en nuestro medio a la cual los servicios de salud público no están ajenos. En la actualidad la cirugía ha demostrado ser el tratamiento más eficaz a largo plazo. Objetivos: Informar los resultados obtenidos en el tratamiento de obesos mórbidos sometidos a cirugía abierta en un servicio hospitalario público regional. Material y método: Se analiza en forma prospectiva los primeros 100 pacientes sometidos a cirugía bariátrica en el Hospital de Coquimbo entre Septiembre de 1998 y Diciembre de 2005. Se usaron 3 técnicas en forma consecutiva. En todas ellas se efectuó el bypass gástrico empleando anastomosis en Y de Roux con asa larga de 160 cm. Para los análisis estadísticos se emplearon los test de ANOVA y Student. Resultados: El 83% de los operados fueron mujeres. El IMC preoperatorio promedio fue de 46 kg/m², siendo un 29% superobesos (IMC>50. La estadía postoperatoria promedio fue de 7,6 días. Complicaciones postoperatorias precoces hubo en el 5%. No se registró mortalidad operatoria en esta serie. El promedio de reducción de exceso de peso fue de 60% a los 6 meses, 72% al año y 66% a los 3 años. Conclusiones: Los resultados obtenidos en un hospital público regional en relación a la cirugía bariátrica son absolutamente comparables a estudios nacionales e internacionales, tanto en la reducción de peso como en la morbimortalidadBackground: Surgery is the most effective treatment in the long run, for morbid obesity. Aim: To report the results of open bariatric surgery for morbid obesity in a regional public hospital. Material and methods: Prospective study of the first 100 patients aged 14 to 62 years (84% women undergoing bariatric surgery in Coquimbo hospital between September 1998 and December 2005. A Horizontal Gastroplasty without gastric resection was done in 13 patients, a 6/7 Gastrectomy in 58 and a 9/10 Gastrectomy in 29. A gastric bypass

  16. Do Postoperative Psychotherapeutic Interventions and Support Groups Influence Weight Loss Following Bariatric Surgery? A Systematic Review and Meta-analysis of Randomized and Nonrandomized Trials

    DEFF Research Database (Denmark)

    Beck, Nina N.; Johannsen, Maja; Støvring, René K.; Mehlsen, Mimi Yung; Zachariae, Robert

    2012-01-01

    Bariatric surgery is currently considered the most effective treatment of severe obesity, but considerable individual variations in weight loss results have been reported. We therefore conducted a systematic review and meta-analysis of studies investigating the effect of psychotherapeutic interve...

  17. CT findings in Petersen’s hernia as a complication of bariatric surgery with a Roux-en-Y gastric bypass

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    Mauricio Álvares Salum Ximenes

    2008-12-01

    Full Text Available Objectives: To describe tomographic findings in Petersen’s herniaassociated with laparoscopic Roux-en-Y gastric bypass surgery.Methods: Two radiologists, experts in abdominal radiology,independently and retrospectively reviewed four cases of Petersen’shernia confirmed surgically in three patients, between March 2007and July 2008, who had undergone laparoscopic Roux-en-Y gastricbypass surgery with an antecolic anastomosis for treating morbidobesity. The main imaging findings were the presence and locationof abdominal distention, the herniated intestinal loop segment, thepresence of mesenteric vessel rotation and haziness of mesentericfat, the position of the Treitz angle ligament and the course of theileum. Results: In all cases, abdominal distention was located inthe upper abdomen; the herniated jejunal loop was located abovethe gastric level; mesenteric vessel rotation was associated withmesenteric fat haziness; the middle/distal ileum descended from theleft hypochondrium; and the Treiz angle was displaced anteriorly andto the right. Both examiners fully agreed with the analysis of findings.Conclusions: The association of computed tomography findingsdescribed in patients with a history of bariatric surgery is a strongpredictor of Petersen’s hernia.

  18. Enteroendocrine secretion of gut hormones in diabetes, obesity and after bariatric surgery

    DEFF Research Database (Denmark)

    Holst, Jens Juul

    2013-01-01

    indicate that decreased secretion of the hormones is involved in the pathogenesis of obesity and/or diabetes, but impaired secretion generally observed in obesity (and hence also in diabetes) may contribute to the development. Because of these effects receptor agonists for both hormones are currently being...... developed for the treatment of obesity and diabetes.......Gastric bypass surgery is associated with a major weight loss and often causes remission in patients with type 2 diabetes. Surgery is also associated with dramatic increases in the secretion of the gut hormones, glucagon-like peptide-1 (GLP-1) and peptide YY (PYY), both of which regulate appetite...

  19. Striatal dopamine D2/3 receptor availability increases after long-term bariatric surgery-induced weight loss.

    Science.gov (United States)

    van der Zwaal, Esther M; de Weijer, Barbara A; van de Giessen, Elsmarieke M; Janssen, Ignace; Berends, Frits J; van de Laar, Arnold; Ackermans, Mariette T; Fliers, Eric; la Fleur, Susanne E; Booij, Jan; Serlie, Mireille J

    2016-07-01

    In several studies reduced striatal dopamine D2/3 receptor (D2/3R) availability was reported in obese subjects compared to lean controls. Whether this is a reversible phenomenon remained uncertain. We previously determined the short-term effect of Roux-en-Y gastric bypass surgery (RYGB) on striatal D2/3R availability (using [(123)I]IBZM SPECT) in 20 morbidly obese women. Striatal D2/3R availability was lower compared to controls at baseline, and remained unaltered after 6 weeks, despite significant weight loss. To determine whether long-term bariatric surgery-induced weight loss normalizes striatal D2/3R binding, we repeated striatal D2/3R binding measurements at least 2 years after RYGB in 14 subjects of the original cohort. In addition, we assessed long-term changes in body composition, eating behavior and fasting plasma levels of leptin, ghrelin, insulin and glucose. Mean body mass index declined from 46±7kg/m(2) to 32±6kg/m(2), which was accompanied by a significant increase in striatal D2/3R availability (p=0.031). Striatal D2/3R availability remained significantly reduced compared to the age-matched controls (BMI 22±2kg/m(2); p=0.01). Changes in striatal D2/3R availability did not correlate with changes in body weight/fat, insulin sensitivity, ghrelin or leptin levels. Scores on eating behavior questionnaires improved and changes in the General Food Craving Questionnaire-State showed a borderline significant correlation with changes in striatal D2/3R availability. These findings show that striatal D2/3R availability increases after long-term bariatric-surgery induced weight loss, suggesting that reduced D2/3R availability in obesity is a reversible phenomenon. PMID:27184782

  20. Biochemical response and the effects of bariatric surgeries on type 2 diabetes

    Science.gov (United States)

    Allen, Roland; Hughes, Tyler; Lerd Ng, Jia; Ortiz, Roberto; Abou Ghantous, Michel; Bouhali, Othmane; Arredouani, Abdelilah

    2013-03-01

    A general method is introduced for calculating the biochemical response to pharmaceuticals, surgeries, or other medical interventions. This method is then applied in a simple model of the response to Roux-en-Y gastric bypass (RYGB) surgery in obese diabetic patients. We specifically address the amazing fact that glycemia correction is usually achieved immediately after RYGB surgery, long before there is any appreciable weight loss. Many studies indicate that this result is not due merely to caloric restriction, and it is usually attributed to an increase in glucagon-like peptide 1 (GLP-1) levels observed after the surgery. However, our model indicates that this mechanism alone is not sufficient to explain either the largest declines in glucose levels or the measured declines in the homeostatic model assessment insulin resistance (HOMA-IR). The most robust additional mechanism would be production of a factor which opens an insulin-independent pathway for glucose transport into cells, perhaps related to the well-established insulin-independent pathway associated with exercise. Potential candidates include bradykinin, a 9 amino acid peptide. If such a substance were found to exist, it would offer hope for medications which mimic the immediate beneficial effect of RYGB surgery. Supported by Qatar Biomedical Research Institute and Science Program at Texas A&M University at Qatar

  1. Resultados materno-fetales de la gestación tras cirugía bariátrica Maternal and fetal outcomes in pregnancy following bariatric surgery

    Directory of Open Access Journals (Sweden)

    I. González Navarro

    2011-04-01

    Full Text Available Introducción: La obesidad es la enfermedad metabòlica más frecuente en el mundo y conlleva múltiples co-morbilidades, siendo la cirugía bariátrica (CB una opción terapéutica cuando fallan las medidas clásicas. La mitad de los pacientes intervenidos son mujeres en edad fértil y está demostrado que la obesidad se asocia a peores resultados obstétricos y fetales. Dado que el estado nutricional se ve afectado por la CB y es un factor esencial para el adecuado desarrollo del embarazo, el objetivo de nuestro trabajo es valorar los efectos de la CB sobre la gestación en mujeres obesas intervenidas. Material y métodos: Seguimiento de 10 mujeres y 15 gestaciones tras CB durante el periodo 2003-2009. Se realizaron visitas trimestrales en consultas de Nutrición y Obstetricia, con evaluación clínica y de laboratorio en cada una. Resultados: Se evidenció deficiencia de hierro en el 80% de las gestaciones, de vitamina D en el 46,7%, de vitamina A en el 20%, de vitamina E en el 13,3% y de vitamina B12 en el 26,7%. No hubo complicaciones durante la gestación salvo un caso de hiperemesis gravidica. Hubo 9 partos de recién nacidos vivos sin malformaciones de los cuales 3 fueron recién nacidos pequeños para la edad gestacional (RNPEG y uno presentó neumonía por aspiración de meconio. Hubo 3 abortos y un parto prematuro con feto muerto. Conclusiones: En nuestro grupo de estudio hubo menos complicaciones durante la gestación comparado con lo descrito en obesas no operadas y similares a la población general.Background: Obesity is the most frecuent metabolic disease in the World, and is associated with several comorbidities. Bariatric procedures arise as a promising treatment when classical approach is ineffective. Half of the operated patients are reproductive-aged women and there is evidence that obesity is related to worse maternal and fetal outcomes. Because nutritional status is affected by bariatric surgery and is a vital component

  2. Consequências sistêmicas da cirurgia bariátrica e suas repercussões na saúde bucal Systemic consequences of bariatric surgery and its repercussions on oral health

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    Patrícia Garcia Moura-Grec

    2012-09-01

    Full Text Available INTRODUÇÃO: O controle da obesidade mórbida pode ser realizado através da cirurgia bariátrica que leva à restrição e/ou à má-absorção de alimentos. O objetivo dessa revisão foi identificar consequências desse procedimento e suas repercussões na saúde bucal. MÉTODO: Foi realizada busca na Biblioteca Virtual em Saúde, sendo incluídos artigos com relação direta ou indireta entre cirurgia bariátrica e saúde bucal e publicados nos últimos dez anos. RESULTADOS: Verificaram-se algumas complicações decorrentes dessa operação, como regurgitação crônica e deficiências nutricionais, que podem trazer repercussões na cavidade bucal como erosão dentária, perda óssea e cárie dentária. Por outro lado, existem consequências positivas como controle da diabetes, da apnéia e melhora da auto-estima, que tornam os pacientes menos susceptíveis à complicações na cavidade oral, como xerostomia e doença periodontal. CONCLUSÃO: A manutenção da saúde bucal adequada em pacientes submetidos à cirurgia bariátrica contribui para o sucesso após a operação, resguardando os benefícios e minimizando os efeitos colaterais.INTRODUCTION: Morbid obesity control can be done by bariatric surgery that restricts or reduces the amount of food absorption. The objective of this review was to identify the consequences of bariatric surgery and its repercussions on oral health. METHOD: It was used the Virtual Library of Health, which included articles that had any direct or indirect connection between bariatric surgery and oral health, and published in the last ten years. RESULTS: Some complications of the surgery are chronicle reflux and nutritional deficiency, which may bring repercussions on the oral cavity, such as tooth erosion, bone loss and dental caries. On the other hand, there are also positive impacts, such as the decrease of diabetes, apnea and improvement on self-esteem, that makes the patients less vulnerable to complications

  3. Bronchospasm in obese patients undergoing elective laparoscopic surgery under general anesthesia

    OpenAIRE

    Tassoudis, Vassilios; Ieropoulos, Hronis; Karanikolas, Menelaos; Vretzakis, George; Bouzia, Aik; Mantoudis, Elias; Petsiti, Argyro

    2016-01-01

    Background Existing data suggest that obesity correlates with airway hyper-reactivity. However, the incidence of bronchospasm during bariatric surgery in obese patients has not been well studied. Methods This was a prospective observational study comparing 50 obese versus 50 non obese patients undergoing elective laparoscopic surgery over a 2 year period. Bronchospasm was detected clinically by auscultation and was confirmed by measuring peak airway pressure during mechanical ventilation. Blo...

  4. Postoperative intravenously administered iron sucrose versus postoperative orally administered iron to treat post-bariatric abdominoplasty anaemia (ISAPA): the study protocol for a randomised controlled trial

    OpenAIRE

    Montano-Pedroso, Juan Carlos; Garcia, Elvio Bueno; Novo, Neil Ferreira; Veiga, Daniela Francescato; Ferreira, Lydia Masako

    2016-01-01

    Background Anaemia and iron deficiency are common complications following post-bariatric abdominoplasty. Given the low oral absorbability of iron resulting from bariatric surgery, it has been hypothesised that postoperative intravenously administered iron supplementation could be used to treat anaemia and to prevent the development of iron deficiency in these patients. Methods/Design In this multicentre open-label randomised clinical trial, 56 adult women undergoing post-bariatric anchor-line...

  5. The Anatomy of a Weight Recidivism and Revision Bariatric Surgical Clinic

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    C. J. de Gara

    2014-01-01

    Full Text Available Abstract. Weight recidivism in bariatric surgery failure is multifactorial. It ranges from inappropriate patient selection for primary surgery to technical/anatomic issues related to the original surgery. Most bariatric surgeons and centers focus on primary bariatric surgery while weight recidivism and its complications are very much secondary concerns. Methods. We report on our initial experience having established a dedicated weight recidivism and revisional bariatric surgery clinic. A single surgeon, dedicated nursing, dieticians, and psychologist developed care maps, goals of care, nonsurgical candidate rules, and discharge planning strategies. Results. A single year audit (2012 of clinical activity revealed 137 patients, with a mean age 49 ± 10.1 years (6 years older on average than in our primary clinic, 75% of whom were women with BMI 47 ± 11.5. Over three quarters had undergone a vertical band gastroplasty while 15% had had a laparoscopic adjustable gastric band. Only 27% of those attending clinic required further surgery. As for primary surgery, the role of the obesity expert clinical psychologist was a key component to achieving successful revision outcomes. Conclusion. With an exponential rise in obesity and a concomitant major increase in bariatric surgery, an inevitable increase in revisional surgery is becoming a reality. Anticipating this increase in activity, Alberta Health Services, Alberta, Canada, has established a unique and dedicated clinic whose early results are promising.

  6. Initial Weight Loss after Restrictive Bariatric Procedures May Predict Mid-Term Weight Maintenance: Results From a 12-Month Pilot Trial

    OpenAIRE

    Nikolić, Marko; Kruljac, Ivan; Kirigin, Lora; Mirošević, Gorana; Ljubičić, Neven; Nikolić, Borka Pezo; Bekavac-Bešlin, Miroslav; Budimir, Ivan; Vrkljan, Milan

    2015-01-01

    Background: Bariatric procedures are effective options for weight loss (WL) in the morbidly obese. However, some patients fail to lose any weight after bariatric surgery, and mid-term weight maintenance is variable. The aim of this study was to investigate whether initial WL could predict mid-term weight maintenance.

  7. Assistência ao paciente obeso mórbido submetido à cirurgia bariátrica: dificuldades do enfermeiro Asistencia al paciente obeso mórbido sometido a la cirugía bariátrica: dificultades del enfermero Perioperative care for morbid obese patient undergoing bariatric surgery: challenges for nurses

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    Denise Spósito Tanaka

    2009-10-01

    Full Text Available OBJETIVO: Identificar as dificuldades de enfermeiros de centro cirúrgico ao assistir pacientes obesos mórbidos submetidos à cirurgia bariátrica no período transoperatório. MÉTODOS: A amostra constou de 70 enfermeiros com experiência em assistência ao paciente obeso mórbido. Os dados foram coletados durante o 7º Congresso Brasileiro de Enfermeiros de Centro Cirúrgico, Recuperação Anestésica e Centro de Material e Esterilização por meio de um questionário. RESULTADOS: A análise dos resultados apontou como dificuldades aquelas relacionadas ao espaço físico, materiais e equipamentos e à assistência de enfermagem específica ao paciente obeso mórbido. CONCLUSÃO: O conhecimento específico, a especialização e a experiência em Centro Cirúrgico darão o conforto, a segurança física e emocional necessárias a estes pacientes.OBJETIVO: Identificar las dificultades de enfermeros de centro quirúrgico en el cuidado a pacientes obesos mórbidos sometidos a cirugía bariátrica en el período transoperatorio. MÉTODOS: La muestra constó de 70 enfermeros con experiencia en asistencia al paciente obeso mórbido. Los datos fueron recolectados por medio de un cuestionario durante el 7º Congreso Brasileño de Enfermeros de Centro Quirúrgico, Recuperación Anestésica y Centro de Material y Esterilización. RESULTADOS: El análisis de los resultados identificó como dificultades aquellas relacionadas al espacio físico, materiales y equipos y a la asistencia de enfermería específica al paciente obeso mórbido. CONCLUSIÓN: El conocimiento específico, la especialización y la experiencia en Centro Quirúrgico darán el confort, la seguridad física y emocional que necesitan estos pacientes.OBJECTIVE: To identify the challenges for nurses during the perioperative for patients undergoing bariatric surgery. METHODS: The sample consisted of 70 nurses who had experience in providing care for morbid obese patients. Data were collected

  8. Compulsão alimentar antes e após a cirurgia bariátrica Binge eating before and after bariatric surgery

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    Cristiane Evangelista Machado

    2008-12-01

    órias, eram elas ingestão de doces em 12%; ingestão de petiscos em 2% e comer indiscriminadamente tudo que estivesse ao alcance em 64% dos pacientes. Após, 18%, 10% e 22%. CONCLUSÃO: Os pacientes apresentam indícios de compulsão alimentar antes e após a operação. Ela está relacionada a aspectos psicológicos. Os hábitos e preferências alimentares modificam-se após a operação, de modo que os pacientes passam a consumir alimentos de fácil ingestão frente a situações que os faziam comer compulsivamente, não sendo observado trocas de compulsão. O comportamento alimentar inadequado persiste ou é agravado após a operação.BACKGROUND: Obesity is a complex, multifactorial disorder which comprises psychological, social and biological aspects and requires a multidisciplinary approach. It is considered to be a risk factor for binge eating disorder, in that the emotional dynamic of the obese individual would contribute to trigger the compulsive act. AIM: To analyze the signs of binge eating in patients who underwent bariatric surgery, before and two years after the surgery. METHODS: A prospective study was conducted with 50 patients submitted to bariatric surgery by the Fobi-Capella technique. The instruments for psychological evaluation, applied before the surgery and two years after, were Max Pfister's Color Pyramid Test and a semi-structured clinical interview. The test was given before and after the surgery to identify evidence of compulsive behavior. The interview was conducted in the postoperative only. RESULTS: The data showed stability and ability to cope with conflicts in 16% of the patients before and in 10% after the surgery. In terms of control and adaptation, 36% of the patients exhibited strong evidence of an attitude of control and rigidity before the surgery, and 32% postoperatively. Regarding the indicators of impulsivity, agressiveness and irritability, there were strong signs of aggressive and impulsive attitudes in 28% of the patients before

  9. Application of positive airway pressure in restoring pulmonary function and thoracic mobility in the postoperative period of bariatric surgery: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Patrícia Brigatto

    2014-12-01

    Full Text Available Objective: To evaluate whether the application of bilevel positive airway pressure in the postoperative period of bariatric surgery might be more effective in restoring lung volume and capacity and thoracic mobility than the separate application of expiratory and inspiratory positive pressure. Method: Sixty morbidly obese adult subjects who were hospitalized for bariatric surgery and met the predefined inclusion criteria were evaluated. The pulmonary function and thoracic mobility were preoperatively assessed by spirometry and cirtometry and reevaluated on the 1st postoperative day. After preoperative evaluation, the subjects were randomized and allocated into groups: EPAP Group (n=20, IPPB Group (n=20 and BIPAP Group (n=20, then received the corresponding intervention: positive expiratory pressure (EPAP, inspiratory positive pressure breathing (IPPB or bilevel inspiratory positive airway pressure (BIPAP, in 6 sets of 15 breaths or 30 minutes twice a day in the immediate postoperative period and on the 1st postoperative day, in addition to conventional physical therapy. Results: There was a significant postoperative reduction in spirometric variables (p0.05. Thoracic mobility was preserved only in group BIPAP (p>0.05, but no significant difference was found in the comparison among groups (p>0.05. Conclusion: The application of positive pressure does not seem to be effective in restoring lung function after bariatric surgery, but the use of bilevel positive pressure can preserve thoracic mobility, although this technique was not superior to the other techniques.

  10. Changes in Plasma Levels of N-Arachidonoyl Ethanolamine and N-Palmitoylethanolamine following Bariatric Surgery in Morbidly Obese Females with Impaired Glucose Homeostasis

    Directory of Open Access Journals (Sweden)

    Akhila Mallipedhi

    2015-01-01

    Full Text Available Aim. We examined endocannabinoids (ECs in relation to bariatric surgery and the association between plasma ECs and markers of insulin resistance. Methods. A study of 20 participants undergoing bariatric surgery. Fasting and 2-hour plasma glucose, lipids, insulin, and C-peptide were recorded preoperatively and 6 months postoperatively with plasma ECs (AEA, 2-AG and endocannabinoid-related lipids (PEA, OEA. Results. Gender-specific analysis showed differences in AEA, OEA, and PEA preoperatively with reductions in AEA and PEA in females postoperatively. Preoperatively, AEA was correlated with 2-hour glucose (r=0.55, P=0.01, HOMA-IR (r=0.61, P=0.009, and HOMA %S (r=-0.71, P=0.002. OEA was correlated with weight (r=0.49, P=0.03, waist circumference (r=0.52, P=0.02, fasting insulin (r=0.49, P=0.04, and HOMA-IR (r=0.48, P=0.05. PEA was correlated with fasting insulin (r=0.49, P=0.04. 2-AG had a negative correlation with fasting glucose (r=-0.59, P=0.04. Conclusion. Gender differences exist in circulating ECs in obese subjects. Females show changes in AEA and PEA after bariatric surgery. Specific correlations exist between different ECs and markers of obesity and insulin and glucose homeostasis.

  11. Medical management of patients after bariatric surgery: Principles and guidelines

    OpenAIRE

    Elrazek, Abd Elrazek Mohammad Ali Abd; Elbanna, Abduh Elsayed Mohamed; Bilasy, Shymaa E.

    2014-01-01

    Obesity is a major and growing health care concern. Large epidemiologic studies that evaluated the relationship between obesity and mortality, observed that a higher body-mass index (BMI) is associated with increased rate of death from several causes, among them cardiovascular disease; which is particularly true for those with morbid obesity. Being overweight was also associated with decreased survival in several studies. Unfortunately, obese subjects are often exposed to public disapproval b...

  12. Gastrointestinal complications of bariatric Roux-en-Y gastric bypass surgery

    Energy Technology Data Exchange (ETDEWEB)

    Sandrasegaran, Kumaresan; Rajesh, Arumugam; Lall, Chandana; Maglinte, Dean D. [Indiana University Medical Center, UH 0279, Department of Radiology, Indianapolis, IN (United States); Gomez, Gerardo A. [Wishard Memorial Hospital, Department of Surgery, Indianapolis (United States); Lappas, John C. [Wishard Memorial Hospital, Department of Radiology, Indianapolis (United States)

    2005-02-01

    Obesity is rapidly becoming the most important public health issue in USA and Europe. Roux-en-Y gastric bypass is now established as the gold standard for treating intractable morbid or super obesity. We reviewed the imaging findings following this surgery in 234 patients. In this pictorial essay we present the CT and upper gastrointestinal contrast study appearances of the expected postoperative anatomy as well as a range of abdominal complications. The complications are classified into leaks, fistula and obstruction. Postoperative gastric outlet and small bowel obstruction can be caused by anastomotic stenosis, mesocolic tunnel stenosis, adhesions, stomal ulcer, obturation, intussusception and internal or external hernia. Small bowel obstruction may be of a simple, closed loop and/or strangulating type. The radiologist should be able to diagnose the type and possible cause of obstruction. (orig.)

  13. Gastrointestinal complications of bariatric Roux-en-Y gastric bypass surgery

    International Nuclear Information System (INIS)

    Obesity is rapidly becoming the most important public health issue in USA and Europe. Roux-en-Y gastric bypass is now established as the gold standard for treating intractable morbid or super obesity. We reviewed the imaging findings following this surgery in 234 patients. In this pictorial essay we present the CT and upper gastrointestinal contrast study appearances of the expected postoperative anatomy as well as a range of abdominal complications. The complications are classified into leaks, fistula and obstruction. Postoperative gastric outlet and small bowel obstruction can be caused by anastomotic stenosis, mesocolic tunnel stenosis, adhesions, stomal ulcer, obturation, intussusception and internal or external hernia. Small bowel obstruction may be of a simple, closed loop and/or strangulating type. The radiologist should be able to diagnose the type and possible cause of obstruction. (orig.)

  14. Complications following body contouring surgery after massive weight loss

    DEFF Research Database (Denmark)

    Hasanbegovic, Emir; Sørensen, Jens Ahm

    2014-01-01

    Bariatric surgery is a way to achieve lasting weight loss in the obese. Body contouring surgery seeks to alleviate some of the discomfort caused by the excessive loose skin following massive weight loss. Higher complication rates are described in this type of surgery when done post-bariatric. The...... purpose of this article is to compare complication rates of body contouring surgery when performed on patients with weight loss due to bariatric surgery compared to patients who lost weight due to dietary changes and/or exercise....

  15. Anemia pós-cirurgia bariátrica: as causas nem sempre são relacionadas à cirurgia Anemia after bariatric surgery: the causes sometimes are not related to the surgery

    Directory of Open Access Journals (Sweden)

    Giorgio Alfredo Pedroso Baretta

    2008-06-01

    Full Text Available RACIONAL: As anemias ferropriva, perniciosa e megaloblástica são comuns após procedimentos bariátricos como o bypass e as derivações biliopancreáticas. As principais causas devem-se ao desvio duodenal e do jejuno proximal do trânsito alimentar e, em menor grau, às úlceras anastomóticas. Entretanto a dieta pobre em nutrientes, a suplementação vitamínica inadequada, medicamentos, uso de álcool e neoplasias devem ser lembrados. RELATO DOS CASOS: Os autores relatam dois casos de pacientes pós-procedimentos bariátricos com anemia severa sem controle clínico e cuja investigação identificou melanoma metastático em um caso e neoplasia colônica no segundo, ambos tratados cirurgicamente com bons resultados. CONCLUSÃO: Anemias são comuns após procedimentos bariátricos, porém causas atípicas como neoplasias devem ser suspeitadas nos pacientes mais idosos e principalmente naqueles refratários ao controle clínico.BACKGROUND: Iron deficiency anemia, pernicious and megaloblastic are common after gastric bypass and biliopancreatic diversion. The main causes are due to duodenal exclusion and anastomotic ulcers. However, low protein diet, vitaminic supplementation, medicines, alcohol and tumors must be remembered. CASES REPORT: The authors relate two cases of severe anemia after bariatric procedures that were diagnosed as metastatic melanoma in small bowel and a colorectal cancer treated surgically with good results. CONCLUSION: Anemias are common after bariatric surgery, however unusual causes like tumors must be suspected in the elderly and in those patients that clinical treatment didn't have good results.

  16. Weighing the Options: Gastric Sleeve Surgery

    Medline Plus

    Full Text Available ... we need some sort of bariatric program. That’s right. I was asked to be a local HMO, Florida Healthcare Plans, because they wanted their patients taken care of, here, locally. We started going through the process of setting up a real program. Other surgeons had done bariatric surgery before, ...

  17. An unusual cause of hypoglycemia in a middle-aged female after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Ranjan Pathak

    2014-04-01

    Full Text Available Non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS is a disorder characterized by postprandial hypoglycemia and islet cell hypertrophy. It is an uncommon complication of weight-loss surgery. However, with the rising incidence of gastric bypass surgeries, it is important to be able to recognize the clinical picture of NIPHS and not to incorrectly ascribe the symptoms to late dumping syndrome.

  18. Complicações respiratórias pós-operatórias em cirurgia bariátrica: revisão da literatura Postoperative respiratory complications in bariatric surgery: review of literature

    Directory of Open Access Journals (Sweden)

    Priscila Martins Delgado

    2011-12-01

    PubMed, Scielo and Cochrane. The terms searched were complications, pulmonary, postoperative care and bariatric surgery, and the limits, the last ten years, adults, English and Spanish. We found 69 articles, and used 21, showing that the most common respiratory complications in bariatric surgery are pulmonary embolism, atelectasis and pneumonia, being related to age and the presence of hypoventilation. Morbid obesity is associated with respiratory dysfunction, including decreased cardiorespiratory endurance and dyspnea, being the most common changes: the decrease in ventilation and chest wall compliance, and tachypnea and respiratory muscle workload, with high rates of hypoxemia and respiratory fatigue. Our results suggest that pulmonary embolism, atelectasis and pneumonia are the pulmonary complications with the highest incidences in conventional bariatric surgery, and elderly and patients with hypoventilation or syndrome and obstructive sleep apnea have higher risk of developing postoperative pulmonary complications.

  19. Acute axonal polyneuropathy with predominant proximal involvement: an uncommon neurological complication of bariatric surgery Polineuropatia axonal aguda com acometimento proximal predominante: manifestação neurológica incomum de cirurgia bariátrica

    OpenAIRE

    Flavia Costa Nunes Machado; Berenice Cataldo Oliveira Valério; Roberto Naun Franco Morgulis; Karlo Faria Nunes; Sílvia Mazzali-Verst

    2006-01-01

    Bariatric surgery is frequently indicated in the treatment of morbid obesity. Previously unreported complications have been associated to this surgery; among them, neurological complications have gained attention. We report the case of a 25-year-old man submitted to gastric surgery for treatment of morbid obesity who developed, two months after surgery, acute proximal weakness in lower limbs. The electroneuromyography revealed axonal peripheral polyneuropathy with predominant proximal involve...

  20. Changes in uric acid levels following bariatric surgery are not associated with SLC2A9 variants in the Swedish Obese Subjects Study.

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    Mark A Sarzynski

    Full Text Available CONTEXT AND OBJECTIVE: Obesity and SLC2A9 genotype are strong determinants of uric acid levels. However, data on SLC2A9 variants and weight loss induced changes in uric acid levels are missing. We examined whether the changes in uric acid levels two- and ten-years after weight loss induced by bariatric surgery were associated with SLC2A9 single nucleotide polymorphisms (SNPs in the Swedish Obese Subjects study. METHODS: SNPs (N = 14 identified by genome-wide association studies and exonic SNPs in the SLC2A9 gene locus were genotyped. Cross-sectional associations were tested before (N = 1806, two (N = 1664 and ten years (N = 1201 after bariatric surgery. Changes in uric acid were compared between baseline and Year 2 (N = 1660 and years 2 and 10 (N = 1172. A multiple testing corrected threshold of P = 0.007 was used for statistical significance. RESULTS: Overall, 11 of the 14 tested SLC2A9 SNPs were significantly associated with cross-sectional uric acid levels at all three time points, with rs13113918 showing the strongest association at each time point (R(2 = 3.7-5.2%, 3.9×10(-22≤p≤7.7×10(-11. One SNP (rs737267 showed a significant association (R(2 = 0.60%, P = 0.002 with change in uric acid levels from baseline to Year 2, as common allele homozygotes (C/C, N = 957 showed a larger decrease in uric acid (-61.4 µmol/L compared to minor allele carriers (A/X: -51.7 µmol/L, N = 702. No SNPs were associated with changes in uric acid from years 2 to 10. CONCLUSIONS: SNPs in the SLC2A9 locus contribute significantly to uric acid levels in obese individuals, and the associations persist even after considerable weight loss due to bariatric surgery. However, we found little evidence for an interaction between genotype and weight change on the response of uric acid to bariatric surgery over ten years. Thus, the fluctuations in uric acid levels among the surgery group appear to be driven by the weight

  1. Changes in the salivary protein profile of morbidly obese women either previously subjected to bariatric surgery or not.

    Science.gov (United States)

    Lamy, Elsa; Simões, Carla; Rodrigues, Lénia; Costa, Ana Rodrigues; Vitorino, Rui; Amado, Francisco; Antunes, Célia; do Carmo, Isabel

    2015-12-01

    Saliva is a non-invasive source of biomarkers useful in the study of physiological mechanisms. Moreover, this fluid has diverse functions, among which food perception and ingestion, making it particularly suitable for the study of obesity. The aims of this study were to assess changes in salivary proteome among morbidly obese women, with a view to provide information about mechanisms potentially related to the development of obesity, and to evaluate whether these changes persist after weight loss. Mixed saliva samples from morbidly obese women (N = 18) who had been either subjected (group O-BS) or not (group O) to bariatric surgery and women with normal weight (N = 14; group C) were compared for protein profiles, alpha-amylase abundance and enzymatic activity, and carbonic anhydrase (CA) VI abundance. Differences in salivary obese profiles were observed for 23 different spots. Zinc-alpha-2 glycoprotein-containing spots showed higher abundance in group O only, whereas cystatin S-containing spots presented higher abundance in the two groups of obese subjects. Most of the spots identified as salivary amylase were present at lower levels in group O-BS. With regard to the amylase enzymatic activity, increases were observed for group O and decreases for group O-BS. One interesting finding was the high correlation between levels of CA VI and body mass index in group O, which was not observed for groups O-BS or C. The differences between groups, mainly regarding salivary proteins involved in taste sensitivity and metabolism, point to the potential of using saliva in the study of obesity development. PMID:26399515

  2. Embarazo posterior a cirugía bariátrica: complicaciones maternas y fetales Maternal and foetal complications in pregnancy following bariatric (weight-loss) surgery

    OpenAIRE

    Jairo Hernández-Pinzón; Marcos Castillo-Zamora; Victoria E Arango-Galvis

    2008-01-01

    Objetivo: utilizando herramientas de revisiones sistemáticas, describir los efectos de la obesidad en el embarazo para la madre y el feto, así como describir las complicaciones perinatales, intraparto y posnatales en pacientes a las que se les ha practicado cirugía bariátrica. Metodología: se utilizó la base de datos Pubmed/Medline, los términos de búsqueda fueron: bariatric surgery AND/OR obstetric complications, pregnance, abortion, pregnancy outcomes, adverse pregnancy outcomes. Se hizo én...

  3. Papel da cirurgia bariátrica no controle do diabete melito tipo II The role of bariatric surgery on diabetes mellitus type 2 control

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    Daniella Vodola Forcina

    2008-09-01

    Full Text Available RACIONAL: Sabe-se que hoje um dos grandes problemas de saúde pública refere-se a diabete melito com projeção de atingir 366 milhões de pacientes até 2030, entre indivíduos insulino (DM tipo I e não-insulino (DM tipo II dependentes. OBJETIVOS: Avaliar por meio de revisão ampla da literatura os resultados encontrados no controle do DM tipo II com diferentes modalidades de tratamento cirúrgico disponíveis em nosso meio. MÉTODO: A partir de 2004 foram levantados 73 trabalhos, sendo que destes 22 versavam especificamente sobre o tema nas bases de dados LiIacs, Medline, Pubmed cruzando os descritores diabete melito e cirurgia. RESULTADOS: Dentre as operações avaliadas obtiveram resultados satisfatórios em 98,9% a derivação biliopancreática ou duodenal, em 83,7% bypass gástrico, em 71,6% gastroplastia e em 47,9% bandas gástricas. Quanto às complicações, encontram-se descritas as mais diversas, desde as da ferida operatória até casos de insuficiência hepática aguda após cirurgia bariátrica que evoluíram com necessidade de transplante ou mesmo óbito, demonstrando que a decisão pelo tratamento operatório deve ser feita de maneira criteriosa ponderando-se o custo benefício. CONCLUSÃO: As técnicas cirúrgicas bariátricas, exercem melhora do diabete tipo II e as derivações biliopancreática, duodenal switch, Scopinaro e bypass gástrico com Y de Roux são as mais indicadas.INTRODUCTION: One of the today's biggest health problems is diabetes mellitus and is projected to have 366 million patients in 2030, between insulin (DM I and non-insulin dependent (DM II. AIM: To evaluate through a literature review the surgical results in the type II using surgical methods available in bariatric surgery. METHOD: The scientific databases Lilacs, Medline and Pubmed were used to collect papers with the surgical treatment of diabetes and 73 articles were found, being 22 specifically related to the subject. RESULTS: Surgery shows inicial

  4. Advances in weight loss surgery and body contouring after weight loss

    Directory of Open Access Journals (Sweden)

    Charles K Herman

    2010-06-01

    Full Text Available Charles K Herman1,2, Ari S Hoschander3, Nicolas Teleo1, Berish Strauch21Pocono Medical Center/Pocono Health System, East Stroudsburg, PA, 2Albert Einstein College of Medicine, New York, NY; 3Northshore Long Island Jewish Health System, Manhasset, NY, USAAbstract: Surgical treatment for morbid obesity has been increasing over the last few years. Historically, bariatric surgery had been plagued by complications, both technical and metabolic. The criteria to decide if a patient should have bariatric surgery required that the patient’s morbid obesity was contributing to an otherwise imminent demise. Now, with improved techniques, laparoscopic surgery and better understanding of the metabolic consequences of bariatric surgeries, it is presumed that the benefits outweigh the risks of bariatric surgery in increasing numbers of patients. Additionally, the post-bariatric procedures for body contouring have many documented complications. Most of these can be related to the nutritional status of obese patients and the relative immunodeficiency that obese patients possess. After a thorough literature search it appears that bariatric surgery and post-bariatric body contouring are, indeed, safer than previously thought.Keywords: body contouring, gastric bypass, bariatric surgery

  5. Implicaciones nutricionales de la cirugía bariátrica sobre el tracto gastrointestinal Nutritional implications of bariatric surgery on the gastrointestinal tract

    Directory of Open Access Journals (Sweden)

    M. A. Rubio

    2007-05-01

    esencial que la educación nutricional tiene en el aprendizaje de nuevos hábitos alimenticios que contribuyan a mantener esta pérdida de peso a lo largo del tiempo.Anatomical change in the anatomy of the gastrointestinal tract after bariatric surgery leads to modification of dietary patterns that have to be adapted to new physiological conditions, either related with the volume of intakes or the characteristics of the macro- and micronutrients to be administered. Restrictive diet after bariatric surgery (basically gastric bypass and restrictive procedures is done at several steps. The first phase after surgery consists in the administration of clear liquids for 2-3 days, followed by completely low-fat and high-protein content (> 50-60 g/day liquid diet for 2-4 weeks, normally by means of formula-diets. Soft or grinded diet including very soft protein-rich foods, such as egg, low-calories cheese, and lean meats such as chicken, cow, pork, or fish (red meats are not so well tolerated is recommended 2-4 weeks after hospital discharge. Normal diet may be started within 8 weeks from surgery or even later. It is important to incorporate hyperproteic foods with each meal, such egg whites, lean meats, cheese or milk. All these indications should be done under the supervision of an expert nutrition professional to always advise the patients and adapting the diet to some special situations (nausea/vomiting, constipation, diarrhea, dumping syndrome, dehydration, food intolerances, overfeeding, etc.. The most frequent vitamin and mineral deficiencies in the different types of surgeries are reviewed, with a special focus on iron, vitamin B12, calcium, and vitamin D metabolism. It should not be forgotten that the aim of obesity surgery is making the patient loose weight and thus post-surgery diet is designed to achieve that goal although without forgetting the essential role that nutritional education has on the learning of new dietary habits contributing to maintain that weight loss

  6. Hemodynamics and early recovery characteristics of desflurane versus sevoflurane in bariatric surgery

    Directory of Open Access Journals (Sweden)

    Amandeep Kaur

    2013-01-01

    Conclusions: Both desflurane and sevoflurane produce similar hemodynamic changes but the immediate and intermediate recovery was significantly faster after desflurane thus contributing to fast tracking and early discharge of patients.

  7. Cirurgia bariátrica: existe necessidade de internação em unidade de terapia intensiva? Bariatric surgery: is admission to the intensive care unit necessary?

    Directory of Open Access Journals (Sweden)

    Saulo Maia D'Avila Melo

    2009-06-01

    Full Text Available OBJETIVOS: Determinar o local de internação no pós-operatório de cirurgia bariátrica primária e verificar as complicações clínicas-cirúrgicas que justificassem internação em unidade de terapia intensiva, inclusive morte. MÉTODOS: Estudo transversal, prospectivo, aberto, sendo avaliados 120 pacientes submetidos à cirurgia bariátrica primária por vídeolaparoscopia no período de maio de 2007 a abril de 2008 em um hospital terciário. Utilizou-se o índice de Aldrete e Kroulik para liberação da sala de recuperação pós-anestésica e definição do local de encaminhamento no pós-operatório. RESULTADOS: Entre os 120 pacientes, havia 83 mulheres e 37 homens, com média de idade 35,4 ± 10,5 anos (18 a 66 anos, índice de massa corpórea médio 45,6 ± 10,5. O tempo entre admissão hospitalar e inicio da cirurgia foi de 140,7 ± 81,8 minutos, o tempo cirúrgico 105,0 ± 28,6 minutos, o tempo de permanência na sala de recuperação pós-anestésica foi 125,0 ± 38,0 minutos e tempo de internação hospitalar 47,7 ± 12,4 horas, com 100% dos pacientes deambulando em 24 horas. O índice de Aldrete e Kroulik da sala de recuperação pós-anestésica alcançou pontuação de 10 com 120 minutos em todos os pacientes, com sobrevida de 100%. CONCLUSÃO: Com o uso do índice Aldrete e Kroulik na sala de recuperação pós-anestésica de bypass gástrico por videolaparoscopia em cirurgia bariátrica primária, nenhum paciente foi internado em unidade de terapia intensiva e nenhuma complicação maior foi observada.OBJECTIVE: The purpose of this study was to determine the place of stay at postoperative and to verify medical-surgical complications that would justify admission to the intensive care unit, including death. METHODS: Cross-over, prospective, open study that evaluated 120 patients who were submitted to primary bariatric surgery by video laparoscopy from May 2007 to April 2008 in a tertiary hospital. The Aldrete Kroulik index was

  8. The impact of a bariatric rehabilitation service on weight loss and psychological adjustment - study protocol

    Directory of Open Access Journals (Sweden)

    Hollywood Amelia

    2012-04-01

    Full Text Available Abstract Background Bariatric surgery is currently the most effective form of obesity management for those whose BMI is greater than 40 (or 35 with co morbidities. A minority of patients, however, either do not show the desired loss of excess weight or show weight regain by follow up. Research highlights some of the reasons for this variability, most of which centres on the absence of any psychological support with patients describing how although surgery fixes their body, psychological issues relating to dietary control, self esteem, coping and emotional eating remain neglected. The present study aims to evaluate the impact of a health psychology led bariatric rehabilitation service (BRS on patient health outcomes. The bariatric rehabilitation service will provide information, support and mentoring pre and post surgery and will address psychological issues such as dietary control, self esteem, coping and emotional eating. The package reflects the rehabilitation services now common place for patients post heart attack and stroke which have been shown to improve patient health outcomes. Methods/Design The study is a randomised control trial and patients will be allocated to receive either usual care or the bariatric rehabilitation service pre and post bariatric surgery. Follow up measures of weight loss and psychological issues will be taken at baseline (2 weeks preoperatively, 3, 6 and 12 months postoperatively. The contents of the bariatric service and the follow up measures are based on previous pilot work and have been developed further by the research team working closely with two patient support groups (BOSPA & WLSinfo. This study will take place in St Richard's Hospital in Chichester in the UK. Discussion It is predicted that a bariatric rehabilitation service will improve weight loss following surgery and will also facilitate changes in other psychological variables such as quality of life, dietary control, self esteem, coping and

  9. Advances in Weight Loss Surgery: The Fully Robotic Gastric Bypass

    Medline Plus

    Full Text Available ... patients lose the weight through bariatric surgery, those issues that have decreased their lifespan and made their ... of the time, it’s going to be behavioral issues. One of the things that we put the ...

  10. Evaluation of weight loss and metabolic profile of obese patients with type 2 diabetes mellitus (dm2 versus non-dm2 subjects, one and three years after bariatric surgery Avaliação da perda ponderal e perfil metabólico pós-cirurgia bariátrica em pacientes obesos portadores de diabetes mellitus tipo 2 versus não diabéticos

    Directory of Open Access Journals (Sweden)

    Thiago Fraga Napoli

    2010-06-01

    Full Text Available BACKGROUND: There is a debate over results obtained from type 2 diabetes mellitus (DM2 obese patients and non-DM2 patients, in reference to metabolic control and ponderal loss, after bariatric surgery. AIM: To evaluate weight loss and metabolic profile of obese patients with DM2 versus non-DM2 subjects, one and three years after bariatric surgery. METHODS: Data from 38 non-DM2 patients and 44 DM2 patients submitted to Roux-en-Y gastric-bypass were analysed retrospectively. For the pre-operatory, first and third year of post-operatory, were compared: weight, body mass index (BMI, fasting glucose (FG, high density lipoprotein (HDL and triglycerides (TG. RESULTS: Preoperatively, both groups were statistically equivalent in regards to weight, BMI (P = 0.90 and HDL (P = 0.73. This was not the case when TG (P = 0.043 and FG (PRACIONAL: Tem havido debate sobre os resultados obtidos da cirurgia bariátrica nos obesos diabéticos versus não diabéticos, no quesito controle metabólico e perda ponderal. OBJETIVO: Avaliar a perda ponderal e perfil metabólico dos obesos diabéticos e não diabéticos após um e três anos da cirurgia bariátrica. MÉTODO: Análise retrospectiva dos prontuários de 44 diabéticos tipo 2 (DM2 e 38 não-DM2 submetidos à gastroplastia com derivação em Y-de-Roux. Dados como peso, índice de massa corpórea (IMC, glicemia de jejum (GJ, lipoproteína de alta densidade (HDL e triglicérides (TG foram vistos no pré-operatório, primeiro (PO1 e terceiro ano (PO3 após a operação. RESULTADOS: No pré-operatório, ambos os grupos foram estatisticamente equivalentes em peso, IMC (P=0,90 e HDL (P=0.73. Não se verificou o mesmo quando TG (P=0.043 e GJ (P < 0.01 foram analisados. No PO1, ambos DM2 e não-DM2 mostraram redução no peso, IMC e TG, assim como GJ no grupo DM2 (P < 0.05. HDL aumentou (P < 0.05 no PO1 em ambos os grupos. No período seguinte, entre PO1 e PO3, somente TG continuou a cair nos não-DM2 diabéticos (P=0

  11. Pregnancy following bariatric requires special attention

    DEFF Research Database (Denmark)

    Renault, Kristina; Andersen, Lise Lotte Fischer; Kjær, Mette Karie Mandrup;

    2012-01-01

    In the latest years the number of pregnant women having undergone bariatric surgery before pregnancy has increased rapidly. In pregnancy, they seem to have a reduced risk of obesity-related complications but an increased risk of mechanical complications causing small bowel obstruction and...... complications due to malabsorption. This article reviews the effect of bariatric surgery before pregnancy on obstetric and neonatal outcomes and provides, based on the limited available evidence, recommendations for the management of pregnancy in these women....

  12. Aspectos psicossociais em cirurgia bariátrica: a associação entre variáveis emocionais, trabalho, relacionamentos e peso corporal Psychosocial aspects in bariatric surgery: the association among emotional variables, job, relationships and body weight

    Directory of Open Access Journals (Sweden)

    Graziela A Nogueira de Almeida

    2011-09-01

    Full Text Available RACIONAL: Operações bariátricas têm sido consideradas alternativa para o tratamento de obesidade mórbida. Alguns eventos adversos que as pessoas experimentam após o tratamento frequentemente são consequência da falta de conhecimento consistente associada a fatores psicossociais que estão relacionadas ao status pré-operatório dos pacientes. OBJETIVO: Avaliar as variáveis ?psicossociais de 414 candidatos ? cirurgia bari?trica do Hospital de Cl?nicas da Faculdade de Medicina da Universidade de S?o Paulo, Ribeir?o Preto, SP, Brasil. psicossociais de 414 candidatos à cirurgia bariátrica do Hospital de Clínicas da Faculdade de Medicina da Universidade de São Paulo, Ribeirão Preto, SP, Brasil. MÉTODOS: Foram utilizados entrevista semi-estruturada, Inventário de Depressão de Beck (BDI, Inventário de Ansiedade de Beck (BAI e Binge Eating Scale (BES. RESULTADOS: IMC foi maior entre os pacientes que não tinham emprego (p = 0,019, do sexo feminino, os que tinham um parceiro e os pacientes com IMC 50 kg / m² (p 50 kg / m² foram mais propensos a apresentar sintomas de ansiedade.BACKGROUND: Bariatric surgeries have been considered an alternative for treatment of morbid obesity. Some adverse events that people experience after the treatment frequently are the consequence of the lack of consistent knowledge associated with psychosocial factors that are related to the pre-surgery status of the patients. AIM: To evaluate psychosocial variables of 414 candidates for bariatric surgery from Clinical Hospital of Medical School at University of São Paulo, Ribeirão Preto, SP, Brazil. METHODS: Semi-structured interview, Beck Depression Inventory (BDI, Beck Anxiety Inventory (BAI and Binge Eating Scale (BES were used. RESULTS: BMI was higher among patients who had no employment (p = 0.019. Female, patients who had a partner and patients with a BMI 50 kg/m² (p 50 kg / m² were more likely to experience anxiety symptoms.

  13. Pulmonary function and quality of life in patients with morbid obesity six months after bariatric surgery Função pulmonar e qualidade de vida em pacientes obesos mórbidos seis meses após cirurgia bariátrica

    OpenAIRE

    Márcia Arruda Fajardo Xavier; Reginaldo Ceneviva; João Terra Filho; Ajith Kumar Sankarankutty

    2010-01-01

    PURPOSE: To investigate the body weight, pulmonary function and quality of life of twenty patients with morbid obesity six months after the Fobi-Capella operation. METHODS: Patients were evaluated before and six months after surgery. The patients were mainly female (75%), the average age was 40.5 ± 10.27 years; average weight 110.11 kg ± 21.77 and average body mass index (BMI) 39.93 ± 7.13 kg/m² in the postoperative evaluation. Pulmonary function was assessed by spirometry using a Pulmonet/Go...

  14. Bariatric surgery and diabetes

    Directory of Open Access Journals (Sweden)

    Andrew Collier

    2012-01-01

    Full Text Available Obesity is a relatively new and serious world-wide epidemic. Obesity is a stronger predictor in mortality than either poverty or smoking, and obesity is also now more prevalent than malnutrition. The prevalence of obesity continues to increase, ironically, the rate of increase of obesity is highest amongst the morbidly obesity. Obesity is the result of many factors resulting in concert, including poor dietary habits, reduced physical activity and genetic predisposition. With the rapid increase in obesity there has been a pronounced increase in obesity-related metabolic disorders including type 2 diabetes, hyperlipidemia, hypertension and many others. These co-morbidities are responsible for more than 2.5 million deaths, worldwide. The loss of life expectancy due to obesity is profound. In comparison to a normal weight individual Caucasian, a 25-year-old morbidly obese man has a 22% reduction in the expected remaining life span, representing an approximate loss of 12 years of life.

  15. Bariatric Surgery Procedures

    Science.gov (United States)

    ... mechanisms by which obesity induces type 2 diabetes. Advantages Produces significant long-term weight loss (60 to ... band and the roux-en-y gastric bypass. Advantages Restricts the amount of food the stomach can ...

  16. Physical Activity After Surgery for Severe Obesity: The Role of Exercise Cognitions

    NARCIS (Netherlands)

    Wouters , J. Eveline; Larsen, K. Junilla; Zijlstra, Hanna; Ramshorst, van Bert; Geenen, Rinie

    2011-01-01

    Background Physical activity after bariatric surgery is associated with sustained weight loss and improved quality of life. Some bariatric patients engage insufficiently in physical activity. This may be due to exercise cognitions, i.e., specific beliefs about benefits of and barriers to physical ex

  17. Physical activity after surgery for severe obesity: the role of exercise cognitions

    NARCIS (Netherlands)

    Wouters, Eveline; Larsen, Junilla; Zijlstra, Hanna; Ramshorst, Bert van; Geenen, Rinie

    2011-01-01

    Background Physical activity after bariatric surgery is associated with sustained weight loss and improved quality of life. Some bariatric patients engage insufficiently in physical activity. The aim of this study was to examine whether and to what extent both physical activity and exercise cognitio

  18. The Impact of Bariatric Surgery on Pregnancy Outcomes%减肥手术对妊娠结局影响的研究进展

    Institute of Scientific and Technical Information of China (English)

    段力园; 李东浩; 康军聪(综述); 宋光耀(审校)

    2015-01-01

    全球肥胖的发病率在近几十年中持续增长,尽管人们试图采取各种方式进行干预,育龄女性在孕期肥胖者仍占20%,肥胖女性妊娠几乎可以导致所有产科并发症的增加,并且造成胎儿的先天异常和宫内异常生长。由于药物治疗和生活方式改变的局限性,减肥手术已经成为治疗肥胖和减少孕期肥胖相关并发症最有效的方式。对于特定类型的并发症,减肥手术后的怀孕似乎比孕期肥胖更安全。%The prevalence of obesity worldwide has been increasing over the last several decades.Despite attempted intervention,1 in 5 women of reproductive age are obese when they conceive.Obesity during preg-nancy increases the risk of almost every obstetric complication ,and also puts the developing fetus at risk for congenital abnormalities and abnormal intrauterine growth .Due to the limited success of medical therapy and life-style change,bariatric surgery has become increasingly important in managing obesity.Regarding certain complications,pregnancy after bariatric surgery appears to be safer than pregnancy with obesity.

  19. 减肥手术对妊娠结局影响的研究进展%The Impact of Bariatric Surgery on Pregnancy Outcomes

    Institute of Scientific and Technical Information of China (English)

    段力园; 李东浩; 康军聪(综述); 宋光耀(审校)

    2015-01-01

    The prevalence of obesity worldwide has been increasing over the last several decades.Despite attempted intervention,1 in 5 women of reproductive age are obese when they conceive.Obesity during preg-nancy increases the risk of almost every obstetric complication ,and also puts the developing fetus at risk for congenital abnormalities and abnormal intrauterine growth .Due to the limited success of medical therapy and life-style change,bariatric surgery has become increasingly important in managing obesity.Regarding certain complications,pregnancy after bariatric surgery appears to be safer than pregnancy with obesity.%全球肥胖的发病率在近几十年中持续增长,尽管人们试图采取各种方式进行干预,育龄女性在孕期肥胖者仍占20%,肥胖女性妊娠几乎可以导致所有产科并发症的增加,并且造成胎儿的先天异常和宫内异常生长。由于药物治疗和生活方式改变的局限性,减肥手术已经成为治疗肥胖和减少孕期肥胖相关并发症最有效的方式。对于特定类型的并发症,减肥手术后的怀孕似乎比孕期肥胖更安全。

  20. [Bariatric surgery, stomas and other digestive tract reductions: Insufficient data and recommendations to adapt medicines regimens in therapeutic practice].

    Science.gov (United States)

    Bernard, Élodie; Charpiat, Bruno; Mabrut, Jean-Yves; Dode, Xavier; Garcia, Stephan; Le Duff, Michel; Rose, François-Xavier; Ducerf, Christian

    2015-11-01

    Surgery modifying digestive tract may alter drugs pharmacokinetics. To maintain concentrations of active substance in their therapeutic ranges, a dosage adjustment or change of drug may be necessary. This is particularly important when no pharmacological or pharmacodynamic parameter reflecting the medication effectiveness is easily measurable. Our objective was to gather the information and documentary tools that can guide prescription in these patients with rearranged digestive tract. We searched information on the documentary portals of French agencies, on gray literature, on MEDLINE and in the summaries product characteristics. No information was found on the website of French agencies, sparse data were identified in gray literature. Some document are discordant, most are imprecise. One hundred and ten studies or case reports referenced on MEDLINE describe 79 medications pharmacokinetics after gastrointestinal surgery. Four are not available in France. Six literature reviews were found. Four summaries of product characteristics provided information related to drug absorption. No documentary tool adapted to clinical routine exists. This unsatisfactory situation is a barrier to optimal patients care. Information is available. It is however necessary to gather under an ergonomic shape adapted to clinical routine, bringing the surgery type, pharmacokinetic changes induced and what to do about the dose adjustment. PMID:26358672

  1. Effects of a balanced energy and high protein formula diet (Vegestart complet® vs. low-calorie regular diet in morbid obese patients prior to bariatric surgery (laparoscopic single anastomosis gastric bypass: A prospective, double-blind randomized study Efectos de una dieta-formula normocalórica e hiperproteica (Vegestart complet® vs dieta normal baja en calorias en pacientes con obesidad morbida como preparacion a cirugía bariátrica (bypass gástrico laparoscópico de una anastomosis: estudio prospectivo doble ciego aleatorizado

    Directory of Open Access Journals (Sweden)

    M. A. Carbajo

    2010-12-01

    Full Text Available Objective: Bariatric surgery is considered the only therapeutic alternative for morbid obesity and its comorbidities. High risks factors are usually linked with this kind of surgery. In order to reduce it, we consider that losing at least 10% of overweight in Morbid Obese (MO and a minimum of 20% in Super- Obese patients (SO before surgery, may reduce the morbidity of the procedure. The aim of our study is to demonstrate the effectiveness and tolerance of a balanced energy formula diet at the preoperative stage, comparing it against a low calorie regular diet. Method: We studied 120 patients divided into two groups of 60 each, group A was treated 20 days prior to bariatric surgery with a balanced energy formula diet, based on 200Kcal every 6 hours for 12 days and group B was treated with a low calorie regular diet with no carbs or fat. The last eight days prior to surgery both groups took only clear liquids. We studied the evolution of weight loss, the BMI, as well as behavior of co-morbidities as systolic blood pressure, diastolic blood pressure, glucose controls and tolerance at the protocol. Results: The study shows that patients undergoing a balanced energy formula diet improved their comorbidities statistically significant in terms of decrease in weight and BMI loss, blood pressure and glucose, compared to the group that was treated before surgery with a low calorie regular diet. Nevertheless both groups improving the weight loss and co-morbidities with better surgical results and facilities. Conclusion: A correct preparation of the Morbid Obese patients prior of surgery can reduce the operative risks improving the results. Our study show that the preoperative treatment with a balanced energy formula diet as were included in our protocol in patients undergoing bariatric surgery improves statistical better their overall conditions, lowers cardiovascular risk and metabolic diseases that the patients with regular diet alone.Objetivos: La cirug

  2. Prevalence and Predictors of Self-Reported Sexual Abuse in Severely Obese Patients in a Population-Based Bariatric Program

    Directory of Open Access Journals (Sweden)

    Danielle L. Gabert

    2013-01-01

    Full Text Available Background. Sexual abuse may be associated with poorer weight loss outcomes following bariatric treatment. Identifying predictors of abuse would enable focused screening and may increase weight management success. Methods. We analyzed data from 500 consecutively recruited obese subjects from a population-based, regional bariatric program. The prevalence of self-reported sexual abuse was ascertained using a single interview question. Health status was measured using a visual analogue scale (VAS. Multivariable logistic regression was performed to identify sexual abuse predictors. Results. The mean age was 43.7 y (SD 9.6, 441 (88.2% were females, 458 (91.8% were white, and the mean body mass index (BMI was 47.9 kg/m2 (SD 8.1. The self-reported prevalence of past abuse was 21.8% (95% CI 18.4–25.4%. Abused subjects had worse health status (VAS score 53.1 (SD 21.2 versus 58.0 (SD 20.1, P=0.03. BMI was not associated with abuse (P>0.5. Age, sex, BMI, and covariate-adjusted independent predictors of abuse included alcohol addiction (adjusted odds ratio 15.8; 95% CI 4.0–62.8, posttraumatic stress disorder (4.9; 2.5–9.5, borderline personality (3.8; 1.0–13.8, depression (2.4; 1.3–4.3, and lower household income (3.4; 1.6–7.0. Conclusions. Abuse was common amongst obese patients managed in a population-based bariatric program; alcohol addiction, psychiatric comorbidities, and low-income status were highly associated with sexual abuse.

  3. Treating mood disorders in patients with a history of intestinal surgery: a systematic review.

    Science.gov (United States)

    Lloret-Linares, Célia; Bellivier, Frank; Heron, Kyle; Besson, Marie

    2015-05-01

    Bariatric surgery is increasingly being performed, with the intended benefits of significant and durable weight loss. Radical surgical resection can result in short bowel syndrome (SBS), a rare and devastating condition. Psychological distress is common in these patients. Relevant articles were identified by searching Pubmed and EMBASE databases with the following keywords: 'Bariatrics'[Mesh] OR 'Short Bowel Syndrome' AND 'Antidepressive Agents' OR 'Psychotropic Drugs'[Mesh]. One in-vitro study, four clinical studies and six relevant case reports were identified. Most clinical studies on antidepressant focused on the Roux-en-Y gastric bypass (RYGB); these results are somewhat conflicting for a variety of reasons including different methodologies and small sample sizes. One month after RYGB, in patients receiving serotonin or serotonin/noradrenaline reuptake inhibitors, antidepressant levels decrease to 50% of preoperative levels and return to baseline (or greater) by 6 months in almost all patients. Other pharmacokinetic studies have shown that, 1 year after RYGB, duloxetine and sertraline levels are significantly reduced in comparison with the control population. Paradoxically, in patients with SBS and a few years after surgery, high concentration to dose ratios have been reported for citalopram and escitalopram; this may be because of an intestinal adaptation. Surgery of the intestine is likely to modify absorption and first-pass metabolism of drugs; managing the treatment of depression and anxiety in bariatric and SBS patients therefore presents a major challenge. Close clinical follow-up, associated with therapeutic drug monitoring when available, should enable the optimization of treatment response and modulate the risk of adverse events. PMID:25768383

  4. [Ambulatory surgery. Patients and patient education].

    Science.gov (United States)

    Bredland, T; Duesund, R

    1996-02-20

    This article reviews the concept of day surgery and shows how the treatment can be organized pre-, per- and post-operatively. It can be established in a hospital-integrated unit, a unit separate from the hospital, but connected with it, or a satellite ambulatory facility. Because the patient spends only a short time in hospital it is necessary to have structured preparations before admission, for the benefit of both patient and staff. It should be easy to identify patients suitable for day surgery from the waiting lists, and preparations should be directed at treatment by day surgery right from the start. Rules must be worked out for selecting patients, as well as guidelines for information to patients. It is also necessary to plan the operation programme, and to agree how nurses and doctors should take care of the patient during the different steps of treatment. PMID:8658453

  5. Presurgical Weight Is Associated with Pain, Functional Impairment, and Anxiety among Gastric Bypass Surgery Patients

    Directory of Open Access Journals (Sweden)

    Sharlene Wedin

    2012-01-01

    Full Text Available Chronic pain and obesity are significant public health concerns in the United States associated with significant levels of health-care expenses and lost productivity. Previous research suggests that obesity is a risk factor for chronic pain, mainly due to excessive weight placed on the joints. However, the obesity-pain relationship appears to be complex and reciprocal. Little work to date has focused on the relationship between weight and pain among patients undergoing gastric bypass surgery for weight loss. Patients scheduled to undergo bariatric surgery for weight loss at a large southeastern academic medical center ( completed the Brief Pain Inventory (BPI, the Center for Epidemiological Studies 10-item Depression scale (CESD-10, and the Beck Anxiety Inventory (BAI. Higher presurgical weight was associated with higher pain-on-average ratings, higher functional impairment due to pain across the domains of physical activity, mood, walking ability, relationships, and enjoyment of life. Higher presurgical weight was associated with higher BAI scores, but weight was not related to depression. Findings suggest that bariatric surgery candidates report a moderate amount of pain prior to surgery and that presurgical weight is associated with higher pain, increased functional impairment due to pain, and increased anxiety. Anxiety was found to mediate the relationship between increased weight and pain.

  6. Eficacia y complicaciones de la cirugía bariátrica en el tratamiento de la obesidad mórbida Effectiveness and complications of bariatric surgery in the treatment of morbid obesity

    Directory of Open Access Journals (Sweden)

    J. Ocón Bretón

    2005-12-01

    : hipoalbuminemia leve en el 20,3% de los pacientes, hipoprotrombinemia en el 14,9%, descenso de ácido fólico en el 17,8%, déficit de vitamina B12 en el 12,5%, hipocalcemia en el 23,8% e hiperparatiroidismo secundario en el 45,4% de los casos. Todas las complicaciones nutricionales fueron más frecuentes en pacientes sometidos a bypass biliopancreático excepto en el caso del déficit de B12 que ocurrió con más frecuencia en pacientes con bypass gástrico. La complicación digestiva mas frecuentemente observada fue la diarrea/esteatorrea en el 39,1% de los casos. El 64,2% de los enfermos consideraron el resultado de la cirugía como excelente o muy bueno. Conclusión: En pacientes con obesidad mórbida, la cirugía bariátrica es una técnica con la que se consigue una gran mejoría en los parámetros antropométricos, en los factores de riesgo cardiovascular y en la calidad de vida de los pacientes, pero que conlleva asociadas un porcentaje importante de complicaciones nutricionales que deberemos tener en cuenta para poderlas prevenir.Introduction and objectives: Bariatric surgery represents an affective therapeutic alternative for patients with morbid obesity refractory to medical treatment. However, these surgical techniques increase the risk of producing a protein-energy hyponutrition or a selective deficit of some micronutrient. The aim of this work has been to analyze the anthropometrical, nutritional,digestive and cardiovascular risk factors changes and quality of life in patients with morbid obesity submitted to bariatric surgery. Material and methods: Retrospective descriptive study evaluating a group of patients with morbid obesity submitted to bariatric surgery (45 by means of biliopancreatic bypass according to Scopirano’s procedure, and 25 by laparoscopic gastric bypass. Anthropometrics (height, weight, body mass index, cardiovascular risk factors (arterial blood pressure, lipid and glycemic profiles, serum uric acid and nutritional parameters (serum albumin

  7. The alcohol patient and surgery

    DEFF Research Database (Denmark)

    Tønnesen, H

    1999-01-01

    Alcohol abusers have a threefold increased risk of post-operative morbidity after surgery. The most frequent complications are infections, cardiopulmonary insufficiency, and bleeding episodes. Pathogenesis is suppressed immune capacity, subclinical cardiac dysfunction, and haemostatic imbalance....... The economic implications of alcohol abuse in surgical patients are tremendous. Interventional studies are required to reduce future increases in post-operative morbidity....

  8. Cirugía bariátrica laparoscópica: bypass gástrico proximal Laparoscopic bariatric surgery: proximal gastric bypass

    Directory of Open Access Journals (Sweden)

    F. Rotellar

    2005-01-01

    Full Text Available El espectacular aumento en la prevalencia de la obesidad en nuestra sociedad y las importantes complicaciones y comorbilidades que origina ha despertado el interés de científicos y público en esta patología. El tratamiento quirúrgico es en la actualidad el único tratamiento eficaz y duradero para la obesidad mórbida y en muchos casos, mejora sensiblemente e incluso cura definitivamente complicaciones asociadas como es el caso de la diabetes o la hipertensión. De entre las diversas técnicas de cirugía bariátrica, parece imponerse definitvamente el by-pass gástrico (BPG, al ofrecer un excelente balance entre pérdida de peso (70% del exceso y riesgo quirúrgico y calidad de vida posterior. La posiblidad de realizar esta técnica mediante un abordaje laparoscópico ha mejorado su aceptación por parte de médicos y pacientes al tiempo que ha permitido disminuir morbimortalidad, estancia y costes. El BPG proximal se realiza en aquellos pacientes con un IMC The spectacular increase in the prevalence of obesity in our society and the significant complications and comorbidities that it gives rise to have stimulated the interest of scientists and public in this pathology. Surgical treatment is at present the only efficient and lasting treatment for morbid obesity and in many cases it appreciably improves, and even definitively cures, associated complications such as the case of diabetes or hypertension. Amongst the different techniques of bariatric surgery, the gastric bypass (GBP seems to be definitively establishing itself, since it offers an excellent balance between loss of weight (70% of the excess, surgical risk and subsequent quality of life. The possibility of carrying out this technique employing a laparoscopic approach has improved its acceptance by doctors and patients while it has made it possible to reduce morbidity and mortality, length of hospital stay and costs. Proximal GBP is carried on those patients with an BMI <60 Kg

  9. Patient Safety: Guide to Safe Plastic Surgery

    Science.gov (United States)

    ... and Consumer Information > Patient Safety Guide to Safe Plastic Surgery Patient Safety More Resources Choose a surgeon ... Important facts about the safety and risks of plastic surgery Questions to ask my plastic surgeon Choose ...

  10. ProSeal laryngeal mask airway improves oxygenation when used as a conduit prior to laryngoscope guided intubation in bariatric patients

    Directory of Open Access Journals (Sweden)

    Aparna Sinha

    2013-01-01

    Full Text Available Background: The primary objective of this study was to compare the effect of ventilation using the ProSeal TM laryngeal mask airway (PLMA with facemask and oropharyngeal airway (FM, prior to laryngoscopy, on arterial oxygenation in morbidly obese patients undergoing bariatric surgery. Methods: Forty morbidly obese patients were randomly recruited to either PLMA or FM. After pre-oxygenation (FiO 2 1.0 in the ramp position with continuous positive airway pressure of 10 cm H 2 O for 5 min, anaesthesia was induced. Following loss of jaw thrust oropharyngeal airway, the FM and PLMA were inserted. On achieving paralysis, volume control ventilation with PEEP (5 cm H 2 O was initiated. The difficulty in mask ventilation (DMV in FM, number of attempts at PLMA and laryngoscopy were graded (Cormack and Lehane in all patients. Time from onset of laryngoscopy to endotracheal tube confirmation was recorded. Hypoxia was defined as mild (SpO 2 ≤95%, moderate (SpO 2 ≤90% and severe (SpO 2 ≤85%. Results: Significant rise in pO 2 was observed within both groups ( P=0.001, and this was significantly higher in the PLMA ( P=0.0001 when compared between the groups. SpO 2 ≥ 90% ( P=0.018 was seen in 19/20 (95% patients in PLMA and 13/20 (65% in FM at confirmation of tracheal tube. A strong association was found between DMV and Cormack Lehane in the FM group and with number of attempts in the PLMA group. No adverse events were observed. Conclusion: ProSeal TM laryngeal mask airway as conduit prior to laryngoscopy in morbidly obese patients seems effective in increasing oxygen reserves, and can be suggested as a routine airway management technique when managing the airway in the morbidly obese.

  11. Sex, Race, and the Quality of Life Factors Most Important to Patients’ Well-Being Among Those Seeking Bariatric Surgery

    Science.gov (United States)

    Davis, Roger B.; Jones, Dan B.; Apovian, Caroline A.; Chiodi, Sarah; Huskey, Karen W.; Hamel, Mary B.

    2016-01-01

    Background Evidence suggests obesity-related social stigma and impairment in work function may be the two most detrimental quality of life (QOL) factors to overall well-being among patients seeking weight loss surgery (WLS); whether the relative importance of QOL factors varies across patient sex and race/ethnicity is unclear. Methods We interviewed 574 patients seeking WLS at two centers. We measured patient’s health utility (preference-based well-being measure) as determined via standard gamble scenarios assessing patients’ willingness to risk death to achieve weight loss or perfect health. Multivariable models assessed associations between patients’ utility and five weight-related QOL domains stratified by gender and race: social stigma, self-esteem, physical function, public distress (weight stigma), and work life. Results Depending on patients’ sex and race/ethnicity, mean utilities ranged from 0.85 to 0.91, reflecting an average willingness to assume a 9–15 % risk of death to achieve their most desired health/weight state. After adjustment, African Americans (AAs) reported higher utility than Caucasians (+ 0.054, p=0.03), but utilities did not vary significantly by sex. Among Caucasian and AA men, impairment in physical functioning was the most important factor associated with diminished utility; social stigma was also a leading factor for Caucasian men. Among Caucasian women, self-esteem and work function appeared equally important. Social stigma was the leading contributor to utility among AA women; QOL factors did not appear as important among Hispanic patients. Conclusion AAs reported higher utilities than Caucasian patients. Individual QOL domains that drive diminished well-being varied across race/ethnicity and sex. PMID:26630951

  12. The importance of national registries/databases in metabolic surgery: the UK experience.

    Science.gov (United States)

    Hopkins, James; Welbourn, Richard

    2016-07-01

    The United Kingdom (UK) National Bariatric Surgery Registry (NBSR) is a registry of self-reported bariatric surgery from members of the British Obesity and Metabolic Surgery Society. We describe the registry and its usefulness and limitations in improving the knowledge base for metabolic and bariatric surgery, reviewing the main results for the first 5 years of its introduction since 2009. We also review the reports of other national and international bariatric surgery registries and compare the baseline characteristics, including metabolic parameters, of the patients entered into the NBSR. A total of 161 surgeons from 137 UK bariatric surgery units entered 32,212 anonymized patient records. Of these patients, 76% were female, mean weight at preoperative clinic was 135.6 kg, body mass index was 48.8 kg/m(2), and 76.5 % had publicly funded National Health Service treatment. The 3 most common procedures were gastric bypass (55.3%), gastric banding (20.4%), and sleeve gastrectomy (20.2%), although the prevalence of these changed over time and was different between public and private sectors. The 2-year rate for diabetes improvement was 61.5%, but this varied with the duration of diabetes and baseline diabetic therapy. The data were similar to those from other large registries. Establishment of large national registries such as the NBSR has the potential to provide "real-world" information for quality assurance and the effect of metabolic and bariatric surgery on the whole operated population. PMID:27313193

  13. Doença hepática gordurosa não alcoólica e sua relação com a síndrome metabólica no pré-operatório de pacientes submetidos à cirurgia bariátrica Nonalcoholic fatty liver disease and its association with metabolic syndrome in the preoperative period in patients undergoing bariatric surgery

    Directory of Open Access Journals (Sweden)

    Bruna Z. Schild

    2013-04-01

    Full Text Available OBJETIVO: Verificar a relação entre a doença hepática gordurosa não alcoólica (DHGNA e síndrome metabólica (SM no período pré-operatório de pacientes submetidos à cirurgia bariátrica. MÉTODOS: Foram revisados 68 prontuários de pacientes de um centro de tratamento avançado da obesidade da cidade de Caxias do Sul - RS. As variáveis estudadas foram gênero, idade, parâmetros bioquímicos (nível de glicose em jejum, colesterol HDL e triglicerídeos, ultrassonografia abdominal, pressão arterial e antropometria (peso, estatura, circunferência abdominal e Índice de Massa Corporal. O diagnóstico da DHGNA foi obtido pela ultrassonografia abdominal e o da SM através do protocolo descrito pelo National Cholesterol Education Program's Adult Treatment Panel III, atualizado pela American Heart Association; e a National Heart, Lung, and Blood Institute. RESULTADOS: 72,1% (n = 49 da amostra foi composta pelo gênero feminino e a média de idade encontrada na população foi de 37,57 ± 10,29 anos. A média de peso entre eles foi de 123,14 ± 25,40 kg, a altura de 1,67 ± 0,09 m e o valor médio de IMC de 56,24 ± 9,30 kg/m². Apresentaram diagnóstico de DHGNA 60% (n = 27 dos pacientes portadores de SM (p = 0,008, 63,4% (n = 26 dos pacientes portadores de hipertensão arterial (p = 0,013 e 66,7% (n = 18 dos pacientes que apresentaram níveis glicêmicos alterados (p = 0,028. CONCLUSÃO: Os resultados do presente estudo mostraram que o diagnóstico de SM, bem como a presença das desordens associadas a esta (obesidade, hipertensão arterial e elevação nos níveis glicêmicos estão fortemente relacionadas à presença da DHGNA.OBJECTIVE: To investigate the association between nonalcoholic fatty liver disease (NAFLD and metabolic syndrome (MS in the preoperative period in patients undergoing bariatric surgery. METHODS: A total of 68 medical records of patients from a center for advanced treatment of obesity in the city of Caxias do Sul

  14. Physical Activity After Surgery for Severe Obesity: The Role of Exercise Cognitions

    OpenAIRE

    Wouters, Eveline; Larsen, Junilla; Zijlstra, Hanna; van Ramshorst, Bert; Geenen, Rinie

    2011-01-01

    Background Physical activity after bariatric surgery is associated with sustained weight loss and improved quality of life. Some bariatric patients engage insufficiently in physical activity. This may be due to exercise cognitions, i.e., specific beliefs about benefits of and barriers to physical exercise. The aim of this study was to examine whether and to what extent both physical activity and exercise cognitions changed at 1 and 2 years post-surgery and whether exercise cognitions predict ...

  15. Efeitos da cirurgia bariátrica na função do assoalho pélvico Effects of bariatric surgery on pelvic floor function

    Directory of Open Access Journals (Sweden)

    Larissa Araújo de Castro

    2012-12-01

    comorbidity of obesity. Studies demonstrate improvement of incontinency after weight loss. However, the mechanisms are still not clear. AIM: To analyze the effects of bariatric surgery on pelvic floor function in women. METHODS: Thirty women were invited to participate. They were waiting for bariatric surgery. Evaluations were done on pre-operative period and one year after surgery. It comprehended: body mass index, urinary incontinence prevalence, quality of life through the King's Health Questionnaire, quality of pelvic floor muscular contraction through the Oxford Modified Scale and perineometry. RESULTS: Twenty four women were included in the study. The body mass index reduced from 46.96±5.77 kg/m2 at the pre-operatory assessment to 29.97±3.48 kg/m2 one year after surgery. The average excess weight loss was 70.77±13.26%. The prevalence of urinary incontinence reduced from 70.8% to 20.8%. The King's Health Questionnaire showed significant reduction of urinary incontinence impact on quality of life in seven domains. The Oxford Modified Scale showed increased degree of muscular contraction after surgery. Perioneometry showed increased measure of muscular contraction after surgery. The average of the three ordered contractions went from 21.32±12.80 sauers to 28.83±16.17 sauers. The peak of contraction increased from 29±14.49 sauers to 30.92±16.20 sauers. CONCLUSION: Massive weight loss due to bariatric surgery positively affects the function of the pelvic floor and quality of life on morbidly obese women.

  16. Obesity and metabolic surgery in type 1 diabetes mellitus

    OpenAIRE

    Heike Raab; R. A. Weiner; Frenken, M.; K. Rett; Weiner, S

    2013-01-01

    Background: Obesity surgery is an effective method for treating obesity and diabetes mellitus type 2. This type of diabetes can be completely resolved in 78.1% of diabetic patients and can be improved or resolved in 86.6% of diabetic patients. But little is known about bariatric surgery in type 1 diabetes mellitus. Methods: We report of 6 female obese patients with diabetes mellitus type 1 who had bariatric surgery. Two of them underwent Roux-en Y gastric bypass (RNYGB), one of them had sleev...

  17. Correlação entre hipomotilidade da vesícula biliar e desenvolvimento de colecistolitíase após operação bariátrica Correlation of gallbladder hipomotility and gallstone formation after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Ana Lúcia Fürstenberger Lehmann

    2006-10-01

    Full Text Available OBJETIVO: O objetivo deste estudo foi determinar se existe associação entre a hipomotilidade da vesícula biliar em obesos, antes da cirurgia bariátrica e o desenvolvimento da litíase biliar após perda de peso. MÉTODO: No período de setembro de 2002 a janeiro de 2005, utilizando ultra-sonografia em tempo real, com medidas do volume em jejum e 60 minutos após ingestão de dieta, avaliamos a vesícula biliar de noventa e seis pacientes obesos com indicação de cirurgia bariátrica. Estes pacientes foram reavaliados um ano após a cirurgia com ultra-sonografia para detecção de litíase biliar. RESULTADOS: Vinte e sete (28,12% apresentaram hipomotilidade da vesícula, destes, sete (29,62% apresentaram litíase. Dezoito (18,75% da amostra total, desenvolveram litíase biliar no período pós-operatório. CONCLUSÕES: Não foi encontrada diferença estatisticamente significante no desenvolvimento de litíase no grupo de pacientes com hipomotilidade e naqueles com motilidade normal da vesícula biliar.BACKGROUND: This study wants to establish if there is an association between gallbladder hypomotility in obese patients before bariatric surgery and gallstone development after weight loss. METHODS: From September 2002 to January 2005 using realtime ultrasonography we evaluated fasting and postprandial (60th minute gallbladder volumes and ejection fractions in ninety six morbid obese patients prior to bariatric surgery. These patients were followed one year after bariatric surgery with gallbladder ultrasonography to identify cholelithiasis. RESULTS: There were twenty seven (28.12% with gallbladder hypomotility, seven (29.62% of them had cholelithiasis in the postoperative period. Eighteen of ninety six patients (18.75% had developed gallstones. CONCLUSION: There were no statistical differences between cholelithiasis development both in patients with hypomotility and with normal gallbladder motility.

  18. Interdisciplinary preoperative patient education in cardiac surgery.

    OpenAIRE

    De Weert, J.; van Dulmen, S.; Bar, P.; Venus, E.

    2003-01-01

    Patient education in cardiac surgery is complicated by the fact that cardiac surgery patients meet a lot of different health care providers. Little is known about education processes in terms of interdisciplinary tuning. In this study, complete series of consecutive preoperative consultations of 51 cardiac surgery patients with different health care providers (physicians, nurses and health educators) were videotaped. The information exchange between patients and providers was analyzed directl...

  19. Prevalence and Predictors of Self-Reported Sexual Abuse in Severely Obese Patients in a Population-Based Bariatric Program

    OpenAIRE

    Gabert, Danielle L.; Majumdar, Sumit R; Sharma, Arya M; Rueda-Clausen, Christian F; Klarenbach, Scott W.; Birch, Daniel W; Shahzeer Karmali; Linda McCargar; Konrad Fassbender; Padwal, Raj S

    2013-01-01

    Background. Sexual abuse may be associated with poorer weight loss outcomes following bariatric treatment. Identifying predictors of abuse would enable focused screening and may increase weight management success. Methods. We analyzed data from 500 consecutively recruited obese subjects from a population-based, regional bariatric program. The prevalence of self-reported sexual abuse was ascertained using a single interview question. Health status was measured using a visual analogue scale (VA...

  20. Acute axonal polyneuropathy with predominant proximal involvement: an uncommon neurological complication of bariatric surgery Polineuropatia axonal aguda com acometimento proximal predominante: manifestação neurológica incomum de cirurgia bariátrica

    Directory of Open Access Journals (Sweden)

    Flavia Costa Nunes Machado

    2006-09-01

    Full Text Available Bariatric surgery is frequently indicated in the treatment of morbid obesity. Previously unreported complications have been associated to this surgery; among them, neurological complications have gained attention. We report the case of a 25-year-old man submitted to gastric surgery for treatment of morbid obesity who developed, two months after surgery, acute proximal weakness in lower limbs. The electroneuromyography revealed axonal peripheral polyneuropathy with predominant proximal involvement. After treatment with immunoglobulin and vitamin supplementation, rapid clinical and neurophysiologic recovery was observed. We describe the clinical and electroneuromyographic features of this case, stressing the difficulty of initial diagnosis, particularly in the differential diagnosis with Guillain-Barré syndrome. We discuss the importance of nutritional follow-up and the eventual indication of routine vitamin supplementation in these patients.A cirurgia bariátrica é freqüentemente indicada no tratamento da obesidade mórbida. Complicações previamente não relatadas têm sido associadas a essa cirurgia; dentre estas, as complicações neurológicas têm recebido destaque. Relatamos o caso de um homem de 25 anos de idade submetido a cirurgia gástrica para tratamento de obesidade mórbida que desenvolveu, dois meses após a cirurgia, fraqueza de predomínio proximal nos membros inferiores, de instalação aguda. A eletroneuromiografia demonstrou polineuropatia periférica axonal nos membros inferiores, de predomínio proximal. Após tratamento com imunoglobulina e suplementação vitamínica, apresentou rápida melhora clínica e neurofisiológica. Descrevemos as características clínicas e eletroneuromiográficas desse caso, destacando a dificuldade diagnóstica inicial, particularmente com relação ao diagnóstico diferencial com síndrome de Guillain-Barré. Discutimos a importância de acompanhamento nutricional e a eventual indica

  1. Relationships among tonic and episodic aspects of motivation to eat, gut peptides, and weight before and after bariatric surgery

    DEFF Research Database (Denmark)

    Bryant, Eleanor J; King, Neil A; Falkén, Ylva;

    2012-01-01

    BACKGROUND: The interaction between motivation to eat, eating behavior traits, and gut peptides after Roux-en-Y gastric bypass (RYGB) surgery is not fully understood. METHODS: Appetite and hormone responses to a fixed liquid preload were assessed in 12 obese (body mass index 45±1.9 kg/m(2......)) participants immediately before and 3 days, 2 months, and 1 year after RYGB surgery. Subjective appetite and plasma levels of ghrelin, leptin, insulin, and glucagon-like peptide-1 (GLP-1) were measured for a 3-hour postprandial period. Eating behavior traits were also measured using the Three Factor Eating...... subjective appetite ratings and alterations in appetite peptides favoring an anorectic response. Presurgery EE was significantly related to fasting and area under the curve (AUC) ghrelin; UE was associated with AUC desire to eat, and there was a significant association between fasting desire to eat and...

  2. Pulmonary function and quality of life in patients with morbid obesity six months after bariatric surgery Função pulmonar e qualidade de vida em pacientes obesos mórbidos seis meses após cirurgia bariátrica

    Directory of Open Access Journals (Sweden)

    Márcia Arruda Fajardo Xavier

    2010-10-01

    Full Text Available PURPOSE: To investigate the body weight, pulmonary function and quality of life of twenty patients with morbid obesity six months after the Fobi-Capella operation. METHODS: Patients were evaluated before and six months after surgery. The patients were mainly female (75%, the average age was 40.5 ± 10.27 years; average weight 110.11 kg ± 21.77 and average body mass index (BMI 39.93 ± 7.13 kg/m² in the postoperative evaluation. Pulmonary function was assessed by spirometry using a Pulmonet/Godart NV Bilt Vetr Hotland spirometer and quality of life was assessed by applying the Moorehead-Ardelt questionnaire. The pre- and postoperative spirometry values were compared by the paired Student t test and the correlation between weight loss and pulmonary function was determined by linear regression, with the level of significance set at p OBJETIVO: Investigar a evolução do peso corpóreo, da função pulmonar e da qualidade de vida de 20 pacientes obesos mórbidos seis meses após operação de Fobi-Capella. MÉTODOS: Os pacientes foram avaliados antes e seis meses após a cirurgia e o sexo feminino predominou em 75%, com média de idade de 40,5 anos ± 10, 27, média de peso de 110,11 kg ± 21,77 e IMC de 39,93 kg/m² ± 7,13. Para a avaliação da função pulmonar foi realizada espirometria por meio do espirômetro Pulmonet Godart NV Bilt Vetr Holland, e para a qualidade de vida foi aplicado o questionário de Moorehead-Ardelt. As comparações entre os valores espirométricos do pré e do pós-operatório foram realizadas pelo teste t de Student para amostras pareadas, e para a correlação entre a perda de peso e função pulmonar utilizou-se análise de regressão linear simples, adotando-se p < 0,05 para todos os resultados. RESULTADOS: As variáveis espirométricas Freqüência Respiratória (FR, Volume de Reserva Expiratório (VRE e Capacidade Residual Funcional (CRF apresentaram, aos seis meses após a operação, diferen

  3. Lung Cancer Surgery Worthwhile for Older Patients

    Science.gov (United States)

    ... nlm.nih.gov/medlineplus/news/fullstory_158689.html Lung Cancer Surgery Worthwhile for Older Patients Study found those ... 2016 THURSDAY, May 5, 2016 (HealthDay News) -- Older lung cancer patients are surviving longer when they have lung ...

  4. Lung Cancer Surgery Worthwhile for Older Patients

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_158689.html Lung Cancer Surgery Worthwhile for Older Patients Study found ... 2016 THURSDAY, May 5, 2016 (HealthDay News) -- Older lung cancer patients are surviving longer when they have ...

  5. Problemas clínicos pré-anestésicos de pacientes morbidamente obesos submetidos a cirurgias bariátricas: comparação com pacientes não obesos Problemas clínicos pré-anestésicos de pacientes mórbidamente obesos sometidos a cirugías bariátricas: comparación con pacientes no obesos Preanesthetic clinical problems of morbidly obese patients submitted to bariatric surgery: comparison with non-obese patiens

    Directory of Open Access Journals (Sweden)

    Getúlio Rodrigues de Oliveira Filho

    2002-04-01

    átricas, imponiendo nuevos desafíos al anestesiólogo. Este estudio comparó la prevalencia de problemas clínicos entre pacientes mórbidamente obesos sometidos a cirugías bariátricas y no obesos sometidos a otros procedimientos electivos. MÉTODO: Fueron estudiados, retrospectivamente, los registros electrónicos de 2986 pacientes divididos en grupo 1, obesos mórbidos sometidos a cirugías bariátricas y grupo 2, con índice de masa corporal menor que 30, sometidos a otros procedimientos electivos, relacionados al grupo 1 por la edad, sexo y estado físico (ASA. Los problemas pré-anestésicos del grupo 1 fueron pesquisados en el grupo 2 y las prevalencias comparadas. Las razones de chance (RC y respectivos limites de 95% de confianza (LC 95% fueron calculados. RESULTADOS: Los problemas identificados nos grupos 1 y 2 y sus respectivas prevalencias fueron: reflujo gastroesofágico (16,67% y 0,48%, hipertensión arterial sistémica (50% y 3,06%, diabetes mellitus tipo II (6,25% y 0,31%, hipotiroidismo (6,25% y 0,31%, asma bronquica (10,42% y 1,43% y pneumopatia restrictiva (10,42% y 0,03%. Las prevalencias fueron significativamente mas altas en el grupo 1. Fueron también identificados, en el grupo 1, los siguientes problemas que no fueron encontrados en el grupo 2: epilepsia (2,08%, esteatosis hepática (12,5%, colecistopatia calculosa (6,25%, dislipidemia (20,83% e hipopituitarismo (2,08%. CONCLUSIONES: La prevalencia de problemas clínicos es significativamente mas alta en pacientes portadores de obesidad mórbida de que en no obesos de la misma edad, sexo y estado físico.BACKGROUND AND OBJECTIVES: Morbid obesity is associated to clinical problems responsible for decreased life expectancy. Morbidly obese patients are candidates to gastric bypass and pose new challenges to the anesthesiologist. This study compared the prevalence of clinical problems among morbidly obese patients submitted to bariatric surgery to non-obese patients submitted to other elective surgical

  6. Perioperative Education of Patient Undergoing Cardiac Surgery

    OpenAIRE

    Alexandros Zacharis; Aikaterini Kampourelli

    2011-01-01

    In recent years, the number of patients undergoing cardiac surgeries is steadily increasing. In Greece, approximately 10,500 patients per year are admitted to some kind of cardiac operation. Constant evolution of heart surgery techniques calls for adaptation of the perioperative nursing care given. Patient education, as an important part of the perioperative care, is directly related to the reduction of postoperative complications and stress management, thus promoting the patient's overall po...

  7. Bariatric support line: a prospective study of support line activity.

    Science.gov (United States)

    McDougall, Kirsten; Segaran, Ella; Sufi, Pratik; Heath, Dugal I

    2010-03-01

    In this prospective study, we examine the workload of the North London Obesity Surgery Service Bariatric telephone support line (BTSL) and its effects on service provision. Over a 3-month period (June to August 2008), a prospective record was kept of all calls, who they were from, whether the patient was presurgery or postsurgery, the type of procedure planned or undertaken, the nature of the enquiry, and the time taken to answer the query. Seventy-five (72%) calls were related to patients who were postsurgery and 29 (28%) presurgery. Patients scheduled for or having undergone Roux-en-Y gastric bypass accounted for 46 (44%) calls; 24 (23%) were preprocedure and 22 (21%) postprocedure. Patients scheduled for or having undergone gastric banding accounted for 56 (54%) calls; five (0.5%) were preprocedure and 51 (49%) postprocedure. Patients undergoing sleeve gastrectomy accounted for two (<1%) calls. Both calls were postprocedure. The reason for the support line enquiry was psychological support in 15 (14%) patients, questions postsurgery in 26 (25%), general enquiries in 27 (26%), and clinical enquiries in 36 (36%). This study of the BTSL has allowed us to identify areas of need within our bariatric population and improve the service we deliver. The changes we have made should lead to a better use of the team's time, greater patient compliance, and satisfaction as well as reduced complaints and litigation. PMID:19711140

  8. Randomized clinical trial comparing manual suture and different models of mechanical suture in the mimicking of bariatric surgery in swine

    Directory of Open Access Journals (Sweden)

    Fernandes MA

    2014-02-01

    Full Text Available Marcos AP Fernandes,1 Bruno MT Pereira,2 Sandra M Guimarães,1 Aline Paganelli,3 Carlos Manoel CT Pereira,1 Claudio Sergio Batista4 1Institute of Obesity and Advanced Video Laparoscopic Surgery of Petropolis, Rio de Janeiro, Brazil; 2Division of Trauma, University of Campinas, São Paulo, Brazil; 3Laboratório de Patologia Micron Cell Diagnóstico, Rio de Janeiro, Brazil; 4Department of Gynecology and Obstetrics, Faculty of Medicine of Petropolis, Rio de Janeiro, Brazil Context and objective: Variations in the ability of surgeons served as motivation for the development of devices that, overcoming individual differences, allow the techniques to be properly performed, and of which the end result was the best possible. Every technique must be reproduced reliably by the majority of surgeons for their results to be adopted and recognized as effective. The aim of this study was to compare the results, from the point of view of anatomic pathology, of manual sutures versus mechanical sutures using different models of linear mechanical staplers, in the procedure of gastroenteroanastomosis and enteroanastomosis in swine. Methods: Thirty-six healthy, adult, male Sus scrofa domesticus pigs, weighing between 20.7 and 25.5 kg, were used. The swine were randomly divided into four groups of nine pigs, according to the type of suture employed: group A, manual suture with Polysorb® 3-0 wire; group B, 80-shear linear stapler (Covidien® Gia 8038-S; group C, 75-shear linear stapler (Ethicon® Tlc 75; and group D, 75-shear linear stapler (Resource® Yq 75-3. A temporal study was established on the seventh postoperative day for histopathological analysis, and the degree of inflammation, fibrosis, and newly formed vessels, as well as the presence or absence of granulation tissue, foreign body granuloma, and necrosis were all evaluated qualitatively and semiquantitatively. The results were analyzed statistically. Results: Observations during the histopathological

  9. Alopecia en mujeres con obesidad severa y mórbida sometidas a cirugía bariátrica Alopecia in women with severe and morbid obesity who undergo bariatric surgery

    Directory of Open Access Journals (Sweden)

    P. Rojas

    2011-08-01

    Full Text Available Introducción: La cirugía bariátrica produce una reducción de peso significativa, pero se asocia a un mayor riesgo de presentar algunas deficiencias nutricionales. Una complicación frecuente, poco estudiada, que se ha relacionado principalmente con deficiencia de zinc, es la alopecia. Objetivos: comparar el estado nutricional de zinc, hierro, cobre, selenio y proteico-visceral en mujeres con distinto grado de caída del pelo al sexto mes post bypass gástrico o gastrectomía tubular. Métodos: Según el grado de caída de pelo las pacientes fueron divididas en dos grupos: grupo 1 o caída leve (n = 42 y grupo 2 o caída importante del pelo (n = 45. Se evaluó en el preoperatorio y al sexto mes postoperatorio la ingesta de zinc, hierro, cobre y selenio, además de indicadores del estado nutricional de zinc, hierro, cobre y proteico visceral. Resultados: En ambos grupos se produjo una reducción significativa del peso al sexto mes postoperatorio (-38,9 ± 16,4%. Las pacientes del grupo1 presentaron una ingesta significativamente mayor de zinc (20,6 ± 8,1 contra 17,1 ± 7,7 mg/d y de hierro (39,7 ± 35,9 contra 23,8 ± 21,3 mg/d., y un menor compromiso del estado nutricional de zinc y hierro que el grupo 2, pero las pacientes del grupo 2 presentaron un menor compromiso del estado nutricional de cobre. No hubo diferencias en las concentraciones plasmáticas de albúmina. Conclusiones: Las pacientes que presentan una menor caída del pelo hasta el sexto mes postoperatorio tienen una mayor ingesta de zinc y hierro, y un menor compromiso del estado nutricional de ambos minerales.Introduction: Bariatric surgery leads to a significant body weigh reduction although it is associated to a higher risk of presenting some nutritional deficiencies. A common complication, little studied and mainly related to zinc deficiency is alopecia. Objectives: To compare the nutritional status of zinc, iron, copper, selenium and protein-visceral in women with different

  10. Efficacy of a liquid low-energy formula diet in achieving preoperative target weight loss before bariatric surgery

    DEFF Research Database (Denmark)

    Nielsen, Lone Vestergaard; Nielsen, Mette Søndergaard; Schmidt, Julie Berg;

    2016-01-01

    majority of patients (77 %) had reached their target weight, and this was achieved after 5·4 (sem 0·3) weeks. Mean weight loss was 9·3 (sem 0·5) % (P < 0·01) and consisted of 41·6 % fat-free mass (FFM) and 58·4 % fat mass. The weight loss was accompanied by a decrease in systolic and diastolic blood...... TAG (P < 0·05)). Weight, FFM and fat mass continued to decrease from week 7 to 11 (all P < 0·01), whereas no additional improvements was observed in the metabolic parameters. Severely obese patients can safely achieve preoperative target weight on an LCD within 7 weeks as part of preparation for BS....... However, the considerable reduction in FFM in severely obese subjects needs further investigation....

  11. High preoperative depression, phobic anxiety, and binge eating scores and low medium-term weight loss in sleeve gastrectomy obese patients: a preliminary cohort study. : Psychiatric factors and weight loss in obesity surgery

    OpenAIRE

    Brunault, Paul; Jacobi, David; Miknius, Vaïda; Bourbao-Tournois, Céline; Huten, Noël; Gaillard, Philippe; Couet, Charles; Camus, Vincent; Ballon, Nicolas

    2012-01-01

    OBJECTIVE: Although depression, anxiety, and binge eating are prevalent in candidates for bariatric surgery, their impact on weight loss is unknown following sleeve gastrectomy. This study assesses the associations between weight loss and preoperative depression, anxiety, and binge eating scores in patients undergoing sleeve gastrectomy for morbid obesity. METHOD: This cohort study included 34 patients who underwent sleeve gastrectomy for morbid obesity between May 2006 and February 2010 in a...

  12. Treatment of adolescents with morbid obesity with bariatric procedures and anti-obesity pharmacological agents

    Directory of Open Access Journals (Sweden)

    Um SS

    2011-12-01

    Full Text Available Scott S Um1, Wendelin Slusser2, Daniel A DeUgarte11Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; 2Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USAAbstract: Adolescent obesity is a growing health concern that can have immense physical and psychological impact. Treatment of morbidly obese adolescents should include a multidisciplinary team to address medical comorbidities, diet, physical activity, mental health, and behavior modification. Anti-obesity pharmacologic agents have a limited role in the treatment of adolescents because of concerns with side effects, safety, and efficacy. Orlistat (GlaxoSmithKline, Moon Township, PA is the only approved medication for weight-loss in adolescents. However, it is associated with gastrointestinal side effects and its long-term efficacy is unknown. Bariatric surgery is the most effective therapy to treat morbid obesity. However, adolescents must meet rigorous criteria and have appropriate cognitive, psychological, and social clearance before being considered for surgical intervention. Gastric bypass remains the gold standard bariatric operation. The adjustable gastric band is not FDA-approved for use in patients under 18 years of age. Sleeve gastrectomy is a promising procedure for adolescents because it avoids an intestinal bypass and the implantation of a foreign body. Prospective longitudinal assessment of bariatric surgery procedures is required to determine long-term outcomes. In this manuscript, we review the treatment options, efficacy, and impact on quality of life for morbidly obese adolescents.Keywords: bariatric surgery, morbid obesity, weight loss, adolescent

  13. Bariatric Surgery for Severe Obesity

    Science.gov (United States)

    ... Research Training & Career Development Grant programs for students, postdocs, and faculty Research at NIDDK Labs, faculty, and ... diabetes, digestive and liver diseases, kidney diseases, weight control and nutrition, urologic diseases, endocrine and metabolic diseases, ...

  14. The comparison of severity and prevalence of major depressive disorder, general anxiety disorder and eating disorders before and after bariatric surgery

    OpenAIRE

    Matini, Diana; Ghanbari Jolfaei, Atefeh; Pazouki, Abdolreza; Pishgahroudsari, Mohadeseh; Ehtesham, Mehdi

    2014-01-01

    Background: Severe obesity is highly co-morbid with psychiatric disorders and may have effect on the quality of life. This study aimed to compare severity and prevalence rate of depression, anxiety and eating disorders and quality of life in severe obese patients before and 6 months after the gastric bypass surgery. Methods: This was a prospective observational study which conducted at Hazarat Rasool-Akram Hospital in Tehran, 2012. Questionnaires included demographic questions, eating disorde...

  15. Aspirin in patients undergoing noncardiac surgery

    DEFF Research Database (Denmark)

    Devereaux, P J; Mrkobrada, Marko; Sessler, Daniel I;

    2014-01-01

    BACKGROUND: There is substantial variability in the perioperative administration of aspirin in patients undergoing noncardiac surgery, both among patients who are already on an aspirin regimen and among those who are not. METHODS: Using a 2-by-2 factorial trial design, we randomly assigned 10,010...

  16. Anxiety and Postoperative Recovery in Ambulatory Surgery Patients

    OpenAIRE

    Parris, Winston C.V.; Matt, Denise; Jamison, Robert N.; Maxson, Wayne

    1988-01-01

    There has been a growing trend toward one-day ambulatory surgery. Unfortunately, there has been little research evaluating how patients recover at home after one-day surgery. This study examined the relationship between preoperative anxiety and postoperative recovery in ambulatory surgery patients. Fifty women who were scheduled for a laparascopy completed a series of questionnaires on the day before surgery and on each of three days after surgery. One month after surgery, the patients were t...

  17. Effect of Roux-en-Y gastric bypass surgery on ventricular function and cardiac risk factors in obese patients: a systematic review

    Directory of Open Access Journals (Sweden)

    Alireza Abdollahi Moghaddam

    2016-03-01

    Full Text Available Introduction: Weight gain and obesity are two important public health problems, which are associated with many diseases such as cardiovascular disorders. Various policies such as bariatric surgery have been proposed for the treatment of morbid obesity. Methods: PubMed and Scopus were searched thoroughly with the following search terms (roux-en-y gastric bypass surgery AND (ventricular function, OR cardiac risk factors OR heart AND (BMI OR body mass index to find the articles in which the effect of roux-en-Y gastric bypass (RYGB surgery had been evaluated in severely obese patients.Result: Out of 120 articles which were found in PubMed, and 28 records which were found in Scopus, only 18 articles fully met the inclusion criteria. Out of 2740 participants in the included studied, 1706 were patients with body mass index (BMI over 40 kg/m2 who had undergone RYGB surgery, and 1034 were control participants. Results of the studies showed that RYGB surgery could reduce BMI, and cardiac risk factors, and improve diastolic function, systolic and diastolic blood pressures, and aortic function, postoperatively.Discussion: Obesity is associated with increased risk of cardiovascular diseases, impaired cardiac function, and hypertension. It is shown that RYGB surgery reduces the serum level of biochemical markers of cardiac diseases. Cardiac structure, parasympathetic indices of autonomic function, coronary circulatory function, hypertension, epicardial fat thickness, and ventricular performance improve after bariatric surgery.Conclusions: It is concluded that RYGB surgery is an effective strategy to improve ventricular function and cardiac risk factors in morbid obese patients.

  18. Endoscopic Bariatric Therapies.

    Science.gov (United States)

    Goyal, Deepinder; Watson, Rabindra R

    2016-06-01

    Obesity and its associated cardio-metabolic comorbidities have emerged as a global pandemic. The efficacy of various hypo-caloric diets and prescription drugs has been poor with respect to sustained weight loss. Recent advancements in endoscopic technology and techniques have opened a new field of minimally invasive endoscopic treatment options for combatting obesity both as a first line and adjunctive therapy. Presently, two endoscopic space-occupying devices in the form of intragastric balloons have received FDA approval for 6-month implantation in patients within a BMI range of 30-40 kg/m(2). Furthermore, full-thickness suturing has led to the development of primary endoscopic sleeve gastroplasty and Roux-en-Y gastric bypass revision as viable endoscopic alternatives to surgical approaches. These techniques have the potential to reduce adverse events, cost, and recovery times. Looking forward, a variety of promising and novel medical devices and endoscopic platforms that target obesity and diabetes are in various phases of development and investigation. The present review aims to discuss the current and forthcoming endoscopic bariatric therapies with emphasis on relevant procedural technique and review of available evidence. PMID:27098813

  19. Plastic Surgery for Ethnic Patients

    Science.gov (United States)

    ... be more susceptible to adverse scarring due to melanin, a brown pigment, found in the skin. Keloids ... such as laser skin resurfacing, chemical peels, laser hair removal and dermabrasion. Ethnic patients should be cautious ...

  20. General surgery in haemophiliac patients

    OpenAIRE

    Bastounis, E.; Pikoulis, E; Leppaniemi, A.; Alexiou, D.; Tsigris, C; Tsetis, A.

    2000-01-01

    With improvements in medical technology, more and larger surgical procedures are performed in haemophiliac patients, but rarely reported in the surgical literature. A retrospective study from a 10 year period from one referral centre identified a total of 68 operations performed in haemophiliac patients. The levels of the defective factors were carefully monitored preoperatively and postoperatively, and replaced according to a standard formula. Special caution was taken to avoid any postopera...

  1. Relaxation strategies for patients during dermatologic surgery.

    Science.gov (United States)

    Shenefelt, Philip D

    2010-07-01

    Patient stress and anxiety are common preoperatively and during dermatologic procedures and surgeries. Stress and anxiety can occasionally interfere with performance of procedures or surgery and can induce hemodynamic instability, such as elevated blood pressure or syncope, as well as producing considerable discomfort for some patients. Detection of excess stress and anxiety in patients can allow the opportunity for corrective or palliative measures. Slower breathing, biofeedback, progressive muscular relaxation, guided imagery, hypnosis, meditation and music can help calm and rebalance the patient's autonomic nervous system and immune functioning. Handheld miniaturized heart rate variability biofeedback devices are now available. The relaxation response can easily be taught. Guided imagery can be recorded or live. Live rapid induction hypnosis followed by deepening and then self-guided imagery requires no experience on the part of the patient but does require training and experience on the part of a provider. Recorded hypnosis inductions may also be used. Meditation generally requires more prior experience and training, but is useful when the patient already is skilled in it. Live, guided meditation or meditation recordings may be used. Relaxing recorded music from speakers or headphones or live performance music may also be employed to ease discomfort and improve the patient's attitude for dermatologic procedures and surgeries. PMID:20677535

  2. Safety, Effectiveness, and Cost Effectiveness of Metabolic Surgery in the Treatment of Type 2 Diabetes Mellitus

    Directory of Open Access Journals (Sweden)

    Nestor Villamizar

    2011-01-01

    Full Text Available Remission of type 2 diabetes mellitus with metabolic surgery is a field of active investigation and development. The extraordinary results obtained in diabetic patients with BMI > 35 kg/m2 have led investigators to query if similar results could be achieved in patients with BMI < 35 kg/m2. A few studies have been recently conducted to evaluate the safety, effectiveness, and cost effectiveness of bariatric surgery in diabetic patients with BMI BMI < 35 kg/m2. However, stronger evidence would be required before insurance coverage is extended for bariatric surgery to all type 2 diabetic patients, in addition to those with BMI ≥ 35 kg/m2 for whom eligibility is already established. In addition, the hormonal and metabolic mechanisms of diabetes remission after gastrointestinal surgery are yet to be determined. This paper will review the evidence about safety, effectiveness, and cost effectiveness of bariatric surgery in type 2 diabetes mellitus remission and the potential socioeconomic impact of offering bariatric surgery to diabetic patients with BMI BMI < 35 kg/m2.

  3. Weight Loss Surgery (Bariatric Surgery) (For Parents)

    Science.gov (United States)

    ... laparoscopically (using a few small incisions and a camera to guide the doctor's movements instead of opening ... Nemours Foundation, iStock, Getty Images, Corbis, Veer, Science Photo Library, Science Source Images, Shutterstock, and Clipart.com

  4. Efficiency Biliopancreatic bypass surgery in bulimia nervosa

    OpenAIRE

    Yu I Yashkov; D K Bekuzarov; A V Nikol'skiy

    2008-01-01

    A clinical significance in the treatment of bulimia nervosa patients with morbid obesity had already been raised [10, 13], but we did not find publications on the effectiveness of bariatric surgery in these cases. There is also information about the possibility of applying the operation bilio-pancreatic bypass, effective in patients with morbid obesity with uncontrolled eating behavior for the treatment of patients with anorexia BILIM not suffering from morbid obesity. In this article the dat...

  5. Do Patients Fear Undergoing General Anesthesia for Oral Surgery?

    OpenAIRE

    Elmore, Jasmine R.; Priest, James H.; Laskin, Daniel M.

    2014-01-01

    Many patients undergoing major surgery have more fear of the general anesthesia than the procedure. This appears to be reversed with oral surgery. Therefore, patients need to be as well informed about this aspect as the surgical operation.

  6. OPCAB Surgery is cost-effective for elderly patients

    DEFF Research Database (Denmark)

    Holme, Susanne Juel; Jensen Beck, Søren; Houlind, Kim;

    2013-01-01

    To determine the cost-effective operative strategy for coronary artery bypass surgery in patients above 70 years.......To determine the cost-effective operative strategy for coronary artery bypass surgery in patients above 70 years....

  7. Sarcina, a new threat in the bariatric era.

    Science.gov (United States)

    Sopha, Sabrina C; Manejwala, Alif; Boutros, Cherif N

    2015-09-01

    First identified in humans by Goodsir in 1842, Sarcina were already known to cause fatal abomasal bloat in animals. Their pathogenicity in humans has only recently been characterized. Sarcina is not inherently pathogenic but, with a gastric ulcer and delayed gastric emptying, can result in perforation. We present a case report of a 32-year-old woman status post-gastric banding presenting with epigastric pain. Upper endoscopy revealed a gastric ulcer near the band. After deflation, upper gastrointestinal series showed passage of contrast and no perforation. Ulcer biopsy showed gastric contents composed of Sarcina. Proton pump inhibitors and antibiotics were administered. Follow-up endoscopy at an outside institution resulted in perforation. This case report supports a growing body of literature that Sarcina organisms contribute to ulcers and perforation. This is the first report of Sarcina in elective bariatric surgery patients, highlighting the high suspicion needed among pathologists evaluating ulcers in this unique surgical population. PMID:26198746

  8. Post-bariatric abdominoplasty resulting in wound infection and dehiscence—Conservative treatment with medical grade honey: A case report and review of literature

    Science.gov (United States)

    Dina Jarjis, Reem; Thomas Crewe, Bjørn; Henrik Matzen, Steen

    2016-01-01

    Introduction Wound complications in post-bariatric patients undergoing body-contouring surgery after massive weight loss are not uncommon and often, surgical debridement or conservative management is necessary. Honey is one of the most ancient remedies for wound care and it is also considered to possess debriding effects. Current research has demonstrated promising results showing that honey can improve wound granulation and epithelialization, reduce exudate and shorten healing times. Methods This case report has been reported in line with the CARE criteria. Presentation of case A 40 year-old female suffered wound infection and dehiscence after undergoing post-bariatric abdominoplasty. The patient was not interested in surgical revision and split skin grafting. Therefore, conservative wound treatment with topical Manuka honey was instituted resulting in significant clinical improvement and effective healing concurrently with good patient satisfaction. Discussion Surgical wound complications in post-bariatric patients undergoing abdominoplasty are common and often require surgical revision or conservative wound treatment. No previous publication has addressed outpatient treatment of post-bariatric abdominoplasty wound complications with medical grade honey. Conclusion Although more research is needed for definitive conclusions of honey’s efficacy, it is safe and as presented in our case, it may under certain circumstances reduce the need of surgical wound debridement and serve as a remedy for conservative treatment. PMID:26773204

  9. EPILEPSY SURGERY IN PATIENTS WITH TUBEROUS SCLEROSIS

    Directory of Open Access Journals (Sweden)

    Hans Holthausen

    2015-04-01

    Full Text Available With a few exceptions patients with tuberous sclerosis (TS suffering from drug-resistant epilepsies have potentially epileptogenic lesionswithin both hemispheres. Until one decade ago in general such a constellation was an xclusion criteria for considerations with respect to epilepsy surgery. However experience has shown that it is not so rare to find patients in whom over the ears seizures are generated from just one single focus and that these patients can be good candidates for epilepsy surgery. Almost revolutionary was the further evelopment: multi-step procedures in patients with bilateral epileptogenic lesions – with promising results in terms of postoperative seizure outcome. Also, with increasing experience, it becomes more and more possible to differentiate already non-invasively which lesions could be epileptogenic and which are rather not the source of the seizures. The most important achievement of epilepsy surgery in TS however is that in selected cases early surgical intervention is able to prevent severe mental retardations, which are often the main burden for families who have members with this peculiar disease.

  10. Severe Scurvy After Gastric Bypass Surgery and a Poor Postoperative Diet

    OpenAIRE

    Hansen, Esben P.K.; Metzsche, Carsten; Henningsen, Emil; Toft, Palle

    2012-01-01

    After bariatric gastric bypass surgery patients are at risk of developing micronutrient deficiencies. If gastric bypass surgery is followed by a vitamin deficient diet the patients have a risk of developing vitamin-C deficiency. When spontaneous ecchymosis is observed in the skin, in at-risk patients, scurvy must be considered. When treated with large doses of vitamin-C the symptoms of scurvy rapidly improve even if the patient has developed multiple organ dysfunction syndrome. Keywords Scurv...

  11. Comparación de resultados previos y posteriores a la aplicación de un protocolo de actuación en cirugía bariátrica Effect of a multidisciplinar protocol on the clinical results obtained after bariatric surgery

    Directory of Open Access Journals (Sweden)

    B. Cánovas Gaillemin

    2011-02-01

    Full Text Available Introducción: La cirugía bariátrica ha demostrado ser un tratamiento eficaz para la pérdida de peso en pacientes con obesidad severa, recomendándose la aplicación de un protocolo de actuación multidisciplinar. Objetivos: Evaluar la utilidad de la implantación de un protocolo de actuación en cirugía de la obesidad basado en el Documento de consenso español de la SEEDO. Métodos: Estudio restrospectivo comparativo de resultados de pacientes intervenidos previamente (51 pacientes y tras la implantación del protocolo (66 pacientes. Se recogieron datos de: antropometría , comorbilidades pre y postcirugía, complicaciones nutricionales y quirúrgicas postcirugía, test de Calidad de Vida validado, y hábitos alimentarios. Resultados: Los abandonos (17,6% y el alcoholismo (5,8% fueron mayores en pacientes preprotocolo frente postprotocolo (4,5% y 3% respectivamente con diferencias estadísticamente significativas. La mortalidad fue del 2% en los preprotocolo y del 0% en los postprotocolo. Los hábitos alimentarios fueron mejores en los postprotocolo, presentando mayor porcentaje de trastornos de conducta alimentaria los preprotocolo (5,1% aunque sin significación estadística. La mejoría de la calidad de vida fue superior en los postprotocolo en todos los items, pero solo con significación estadística en la actividad sexual (p 0,004. El 70,5% de los pacientes preprotocolo tenían más de una complicación nutricional frente al 32,8% de los postprotocolo (p Introduction: Bariatric surgery has been shown to be an effective therapy for weight loss in patients with severe obesity, and the implementation of a multidisciplinar management protocol is recommended. Objectives: To assess the usefulness of the implementation of a management protocol in obesity surgery based on the Spanish Consensus Document of the SEEDO. Methods: Retrospective comparative study of the outcomes in patients previously operated (51 patients and after the

  12. Nasal surgery in patients with systemic disorders

    Directory of Open Access Journals (Sweden)

    Sachse, Florian

    2010-01-01

    Full Text Available Multisystemic disorders represent a heterogenous group of diseases which can primarily manifest at the nose and paranasal sinuses as limited disease or secondarily as part of systemic involvement. Rhinologists therefore play an important role in the diagnostic but also therapeutic process. Although therapy of multisystemic disorders is primary systemic, additional rhinosurgery may become necessary. The spectrum of procedures consists of sinus surgery, surgery of the orbit and lacrimal duct, septorhinoplasty and closure of nasal septal perforation. Since the prevalence of most systemic diseases is very rare, recommendations are based on the analysis of single case reports and case series with a limited number of patients only. Although data is still limited, experiences published so far have shown that autologous cartilage or bone grafts can be used in nasal reconstruction of deformities caused by tuberculosis, leprosy, Wegener’s granulomatosis, sarcoidosis and relapsing polychondritis. Experiences gained from these diseases support the concept that well-established techniques of septorhinoplasty can be used in systemic diseases as well. However, a state of remission is an essential condition before considering any rhinosurgery in these patients. Even under these circumstances revision surgery has to be expected more frequently compared to the typical collective of patients undergoing septorhinoplasty. In addition, experiences gained from saddle nose reconstruction may in part be of value for the treatment of nasal septal perforations since implantation of cartilage grafts often represents an essential step in multilayer techniques of closure of nasal septal perforations. Aside from the treatment of orbital complications sinus surgery has been proven beneficial in reducing nasal symptoms and increasing quality of life in patients refractory to systemic treatment.

  13. Perioperative Education of Patient Undergoing Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Alexandros Zacharis

    2011-04-01

    Full Text Available In recent years, the number of patients undergoing cardiac surgeries is steadily increasing. In Greece, approximately 10,500 patients per year are admitted to some kind of cardiac operation. Constant evolution of heart surgery techniques calls for adaptation of the perioperative nursing care given. Patient education, as an important part of the perioperative care, is directly related to the reduction of postoperative complications and stress management, thus promoting the patient's overall postoperative well-being. Aim: The aim of this review was to present the most important aspects of the patient's perioperative education and the role that the nurse has to play in it. Methods: Data from selected articles were extracted from Pubmed, Chinahl and Cohrane, as well as from non-electronically published scientific studies ranging from 1998-2010 and 2003-2008 respectively. Results: According to the literature, perioperative patient education can be implemented in various ways, such as through verbal updates, the use of audiovisual means and the provision of informative leaflets. The teaching topics can be divided into those of the preoperative and postoperative phase. Stress management prepares the patients psychologically and also enhances the therapeutic nurse-patient relationship. The teaching of breathing techniques and isometric exercises of the lower limbs, the cessation of smoking, the diet to be followed, as well as the management of medication, aim in the patients' physical preparation, in order to optimize their postoperative course. Conclusion: Perioperative patient education, regardless of how it is implemented, constitutes both an integral part of the nursing care and an independent nursing intervention per se, which strengthens the nurses' autonomy and improves the patient's postoperative course.

  14. Post-bariatric abdominoplasty resulting in wound infection and dehiscence—Conservative treatment with medical grade honey: A case report and review of literature

    OpenAIRE

    Reem Dina Jarjis; Bjørn Thomas Crewe; Steen Henrik Matzen

    2016-01-01

    Introduction: Wound complications in post-bariatric patients undergoing body-contouring surgery after massive weight loss are not uncommon and often, surgical debridement or conservative management is necessary. Honey is one of the most ancient remedies for wound care and it is also considered to possess debriding effects. Current research has demonstrated promising results showing that honey can improve wound granulation and epithelialization, reduce exudate and shorten healing times. Met...

  15. Rabdomiólise por síndrome compartimental glútea após cirurgia bariátrica: relato de caso Rabdomiolisis por síndrome compartimental glúteo después de cirugía bariátrica: relato de caso Rhabdomyolysis secondary to gluteal compartment syndrome after bariatric surgery: case report

    Directory of Open Access Journals (Sweden)

    Márcio Luiz Benevides

    2006-08-01

    a cirugía bariátrica tipo duodenal switch, bajo anestesia general asociada a la anestesia peridural. El procedimiento se dio sin incidencias. El tiempo anestésico quirúrgico fue de 3 horas y 30 minutos. El primer día del postoperatorio el paciente presentó dolor en la región lombosacral y en las nalgas, además de parestesia en los miembros inferiores en la distribución del nervio ciático. Durante el examen, las nalgas presentaban una discreta palidez, tensas, con edemas, dolían cuando eran tocadas y cuando se movían. Fue diagnosticado el síndrome compartimental glúteo que evolucionó con rabdomiolisis e insuficiencia renal aguda. Hubo una recuperación de la función renal y ninguna secuela motora o sensitiva se detectó. CONCLUSIONES: Los pacientes obesos mórbidos sometidos a la cirugía bariátrica pueden presentar síndrome compartimental glúteo. Cuando no se diagnostica y se trata precozmente, puede evolucionar con rabdomiolisis e insuficiencia renal aguda representando una seria amenaza para la vida.BACKGROUND AND OBJECTIVES: Bariatric surgery has become a common procedure and several complications have been reported. The objective of this report is to present a case of gluteal compartment syndrome that evolved to acute renal failure after bariatric surgery and to discuss the diagnosis, and the prophylactic and therapeutic measures. CASE REPORT: A 42 years old male patient, white, with a body mass index (BMI of 43, physical status ASA II, who underwent bariatric surgery of the duodenal switch type, under general anesthesia associated with epidural anesthesia. There were no complications during the procedure. The anesthetic-surgical procedure lasted 3 hours and 30 minutes. On postoperative day one the patient developed lumbosacral and gluteal pain, besides paresthesia in the lower limbs in the distribution of the sciatic nerve. On physical exam, the buttocks were slightly pale, tight, swollen, and painful to palpation and to movement. A diagnosis

  16. Evaluation of obstructive sleep apnea in obese patients scheduled for bariactric surgery

    Directory of Open Access Journals (Sweden)

    José Maurício Lopes Neto

    2013-04-01

    Full Text Available PURPOSE: To evaluate the frequency of obstructive sleep apnea (OSA in obese patients scheduled for bariatric surgery and their identification for risk of OSA by Berlin Questionnaire (BQ and excessive daytime sleepiness by Epworth Sleepiness Scale (ESS. METHODS: Fifty nine patients were evaluated by BQ and ESS. Out of these individuals, 35 performed a full-night sleep study using a type 3 portable monitoring (PM. The questionnaire results were compared for gender and BMI. The presence and severity of OSA was correlated with gender and both questionnaires. RESULTS: 94.75% of the respondents presented high risk for OSA by BQ and 59.65% presented positivity by ESS. Taking into account the AHI> 5 per hour for OSA diagnosis, all of them presented OSA, average AHI of 45.31±26.3 per hour and 68.6% have severe OSA (AHI>30. The male patients had a higher AHI (p<0.05. There was a positive correlation between the positivity in both questionnaires as well as the severity of OSA measured by AHI (p<0.05. CONCLUSION: The frequency and severe obstructive sleep apnea in the studied group is high. The Berlin Questionnaire and Epworth Sleepiness Scale had a positive correlation with the diagnosis of OSA in the group studied.

  17. PULMONARY PHYSIOTHERAPY EFFECT ON PATIENTS UNDERGOING OPEN CARDIAC SURGERY

    OpenAIRE

    Seyed Kazem Shakuri; Yaghoub Salekzamani; Ali Taghizadieh; Hamed Sabbagh-Jadid; Jamal Soleymani; Leyla Sahebi

    2014-01-01

    Backgrounds and Objectives — Respiratory complications after open heart surgeries are common problems which can lead to death if not properly managed. The aim of this study was to evaluate the role of pulmonary rehabilitation before and after surgery for reducing the risk of pulmonary complications after surgery also correlations of the six-minute walk test and respiratory following open heart surgery. Material and Methods — In a randomized clinical trial, 60 patients undergoing heart surgery...

  18. Development of type 2 diabetes mellitus thirty-one years after Billroth II in a patient asking for diabetes surgery

    Directory of Open Access Journals (Sweden)

    M. Garciacaballero

    2014-07-01

    Full Text Available Introduction: Diabetes surgery in obese and slim patients seems to be a superior alternative to the current medical treatment. Gastric bypass is an alternative treatment for diabetes. Nevertheless, there are still doubts whether diabetes can recur if you gain weight or if the effects are maintained over time. Other questions refer to the type of surgery to make the bypass limb length or reservoir size for the resolution of the Diabetes Mellitus. Presentation of case: Male patient 69-year-old came to us in order to perform tailored One Anastomosis Gastric Bypass (BAGUA to treat his type 2 diabetes mellitus and metabolic syndrome. He has a history of peptic ulcer treated with subtotal gastrectomy and Billroth II reconstruction 49 years ago. He currently is not obese and developed diabetes 31 years after surgery. Discussion: Globally there are no reports of patients with normal BMI that after performing gastric bypass developed diabetes mellitus. There are cases where obese diabetic patients after gastric bypass improve or remits the T2DM, but it relapses due to insufficient weight loss or gain it. The patient with gastric bypass Billroth II type, should not developed diabetes. He is normal weight and not had weight gain that could be linked to the development of diabetes. Conclusions: The results generated by bariatric surgery are encouraging, but still do not clarify the precise way how surgery produces rapid improvement of systemic metabolism as in diabetes, but in our patient, the effect was quite different because the gastric bypass had no protective effect against diabetes.

  19. Repercusión nutricional de la cirugía bariátrica según técnica de Scopinaro: análisis de 40 casos Nutritional effect of bariatric surgery with Scopinaro operation: analysis of 40 cases

    Directory of Open Access Journals (Sweden)

    C. Vázquez

    2003-08-01

    Full Text Available Objetivos: Analizar la repercusión de la cirugía bariátrica sobre los valores de antropometría absoluta y relativa, parámetros bioquímicos y niveles vitamínicos tras un año de seguimiento y estudiar la posible influencia del sexo, la longitud del canal común y el grado de esteatorrea en estos pacientes. Material y métodos: Se estudiaron retrospectivamente 40 pacientes (28 mujeres y 12 varones de edad media de 38 ± 12 años (18-62 a los que se les practicó derivación biliopancreática según técnica de Scopinaro dejando 70- 120 cm de canal común y seguidos durante el año posterior a la realización de esta cirugía. Se procedió a control de parámetros antropométricos: índice de masa corporal (IMC, cincunferencia cintura cadera (CC; parámetros bioquímicos: glucosa, ácido úrico, lípidos plasmáticos, proteínas de vida media corta, transaminasas y hemograma; niveles de vitaminas A, E, D, B12, C y ácido fólico y el grado de esteatorrea, que se realizaron antes y un año después de la cirugía. Resultados: Se logró una pérdida de peso del 29,7% ± 2,9 sin diferencia entre ambos sexos. En cuanto a los parámetros bioquímicos se constató una reducción estadísticamente significativa en las cifras de colesterol total, triglicéridos, ácido úrico y transaminasas (p Objectives: To analyze the influence of bariatric surgery over nutritional status in patients with morbid obesity after 1 year of following. To know the influence of specific factors as age, sex and common channel´s length. Design: Retrospective study from 1998-2001. Subject: All patients suffering from morbid obesity that had been operated during this period of time, 40 subjects: 28 women and 12 men with a mean age of 38 ± 12 years old. Were studied. Methods: We analyzed the variations of weight and other anthropometric measures, biochemical parameters and the micronutrient (vitamins A, D, E, B12, folate, C, zinc, Calcium, Magnesium status during 1 year of

  20. Abdômen agudo em gestante tratada de obesidade por cirurgia bariátrica: relato de caso Acute abdomen in pregnant woman treated for bariatric surgery for obesity: case report

    Directory of Open Access Journals (Sweden)

    Belmiro Gonçalves Pereira

    2010-10-01

    Full Text Available A cirurgia bariátrica vem sendo considerada, na atualidade, uma alternativa ao tratamento de obesidade mórbida refratária a tratamentos clínicos convencionais. As cirurgias mais usadas, radicais e invasivas, apresentam resultados melhores e mais rápidos, porém estão mais sujeitas a complicações clínicas e cirúrgicas, como obstruções e suboclusões intestinais. Gestações em mulheres que se submetem a este tipo de cirurgia são cada vez mais frequentes e as complicações relacionadas cada vez mais descritas. Apresentamos o caso clínico de mulher grávida previamente submetida à cirurgia bariátrica que desenvolveu quadro de suboclusão com intussuscepção intestinal. Essa complicação extremamente grave requer muita atenção para seu diagnóstico, utilizando-se exames de imagem e laboratório não empregados usualmente durante a gravidez. A gestação confunde e dificulta sua interpretação, além de o único tratamento de bom resultado ser invasivo, a laparotomia exploradora, ser indesejável no período. A morbidade e mortalidade materna, fetal e perinatal costumam ser elevadas. No caso descrito, o parto ocorreu de forma espontânea nas primeiras horas de internação, antes de o procedimento cirúrgico ser executado. A evolução foi boa e paciente e recém-nascido, embora prematuro, evoluíram bem e tiveram alta em boas condições.Bariatric surgery is currently considered as an alternative for the treatment of morbid obesity refractory to conventional clinical treatments. The surgeries more frequently used, which are radical and invasive, yield better and faster results, but are subject to clinical and surgical complications such as intestinal obstructions and subocclusions. Pregnancies in women submitted to this type of surgery are increasingly frequent, and the related complications have been increasingly reported. We present the case of a pregnant woman previously submitted to bariatric surgery who developed

  1. Ambulatory surgery for the patient with breast cancer: current perspectives

    OpenAIRE

    Tan, Ern Yu; Pek, Chong Han; Tey,Boon Lim, John

    2016-01-01

    Chong Han Pek,1 John Tey,2 Ern Yu Tan1 1Department of General Surgery, 2Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore Abstract: Ambulatory breast cancer surgery is well accepted and is the standard of care at many tertiary centers. Rather than being hospitalized after surgery, patients are discharged on the day of surgery or within 23 hours. Such early discharge does not adversely affect patient outcomes and has the added benefit...

  2. PATIENT PERCEPTION REGARDING PREOPERATIVE INFORMATION TO ANXIETY TOWARDS SURGERY

    OpenAIRE

    Devpriya; Shanti Prakash

    2015-01-01

    OBJECTIVE: Surgeries are seen as stressors that activate preoperative fear. Preparing the patients prior to surgery through preoperative instruction develop crucial to anxiety level. The objective of study is to evaluate the perception of patients regarding anxiety prior to surgery. M ETHODS : A total of 273 patients attending the outpatient department of Hospital were taken in the study. All the patients were aged 20 - 60 years. The anxiety was measured by me...

  3. Indicadores de calidad en cirugía bariátrica: Valoración de la pérdida de peso Quality indicators in bariatric surgery: Weight loss valoration

    Directory of Open Access Journals (Sweden)

    P. Menéndez

    2009-02-01

    /m².The medical management of MO may be effective in the short and intermediate terms, although it usually fails then leading to surgical management. Our goal is to assess Capella's surgical technique by means of quality indicators including weight loss. The present work has been performed with surgical MO patients at the 12 de Octubre University Hospital during 2000-2001, and registering the follow-up checkups for the period 2000-2001/2003-2004. We reviewed the clinical charts of 23 patients. The average Body Mass Index (BMI was 52.24 ± 10.07 kg/m², (range, 41-74.41. When compiling the statistical results, we observed statistically significant post-surgical decreases with no differences whether the PEIMCP outcome was excellent (≥ 65%, fair (= 50-65% or failure (≤ 50% in the following parameters: BMI (p ≤ 0.001; Comorbidities (p ≤ 0.001; Hemoglobinemia (p ≤ 0.005; Glycemia (p ≤ 0.001; Triglyceridemia (p ≤ 0.001; Total cholesterolemia (p ≤ 0.001; Sideraemia (p ≤ 0.001; and serum cianocobalamine (p ≤ 0.001. We could not demonstrate statistically significant changes in the remaining parameters. However, under the presumption that the lack of evidence does not mean the evidence of the absence, that is to say, the results have been obtained from a small sample (N = 23 so that they may not be considered definitely conclusive. Considering the percentage of the loss of Body Mass Index excess as one of the quality indexes in bariatric surgery, we may state that Capella's gastric by-pass is efficient in obese patients with BMI ≤ 50 kg/m², doubtfully effective in patients with BMI 50-60 kg/m², and ineffective in super obese patients with BMI ≥ 60 kg/m².

  4. PATIENT PERCEPTION REGARDING PREOPERATIVE INFORMATION TO ANXIETY TOWARDS SURGERY

    Directory of Open Access Journals (Sweden)

    Devpriya

    2015-06-01

    Full Text Available OBJECTIVE: Surgeries are seen as stressors that activate preoperative fear. Preparing the patients prior to surgery through preoperative instruction develop crucial to anxiety level. The objective of study is to evaluate the perception of patients regarding anxiety prior to surgery. M ETHODS : A total of 273 patients attending the outpatient department of Hospital were taken in the study. All the patients were aged 20 - 60 years. The anxiety was measured by means of different questions like fear of surgery, pain due to surgery, postoperati ve complication, preoperative information of surgery etc. Student’s t - test, one - way ANOVA was performed to obtain the mean values of anxiety using SPSS 16.0 for Windows. RESULTS: It was found that all of the patients received preoperative information about the surgery to be done and most of them obtained information from doctors ( 27.6%, hospital management staff ( 24.3%, and nurses ( 22.5%. Fear of surgery ( 18.6% and pain ( 17.4% are most common factors among study participants. Significant results of anx iety was found with educational level and age ( p=0.000. CONCLUSION: All the patients got information prior to the surgery and main source of information were doctors, hospital management staff and nurses. Mostly patients were anxious of surgery and post - operative pain. Still, health professionals should plan to deliver appropriate information to help patients against this fear.

  5. Patient Selection in Plastic Surgery: Recognizing Body Dysmorphic Disorder

    OpenAIRE

    Cihan Sahin; Onat Yilmaz; Yalcin Bayram; Huseyin Karagoz; Celalettin Sever; Yalcin Kulahci; Alpay Ates

    2013-01-01

    Plastic surgery is a branch of medicine that provides significant improvements to the people with positive changes. But first of all, this branch has a characteristic which requires analysing patients' psychological situation very carefully. Plastic surgeons are often confronted by patients with mental disorders seeking aesthetic surgery. It is imperative for surgeons to recognize possible underlying psychiatric illnesses. Common psychiatric conditions seen in cosmetic surgery patients includ...

  6. Patient Safety in Spine Surgery: Regarding the Wrong-Site Surgery

    OpenAIRE

    Lee, Seung-Hwan; Kim, Ji-Sup; Jeong, Yoo-Chul; Kwak, Dae-Kyung; Chun, Ja-Hae; Lee, Hwan-Mo

    2013-01-01

    Patient safety regarding wrong site surgery has been one of the priority issues in surgical fields including that of spine care. Since the wrong-side surgery in the DM foot patient was reported on a public mass media in 1996, the wrong-site surgery issue has attracted wide public interest as regarding patient safety. Despite the many wrong-site surgery prevention campaigns in spine care such as the operate through your initial program by the Canadian Orthopaedic Association, the sign your sit...

  7. Gastric bypass surgery

    Science.gov (United States)

    ... Morabito A. Long-term prevention of mortality in morbid obesity through bariatric surgery: A systematic review and meta- ... ncbi.nlm.nih.gov/pubmed/21245741 . Richards WO. Morbid obesity. In: Townsend Jr. CM, Beauchamp RD, Evers BM, ...

  8. Quality of life of diabetic patients with medical or surgical treatment

    Directory of Open Access Journals (Sweden)

    S. Weiner

    2013-01-01

    Full Text Available Introduction: In general, most of the studies agree in that the quality of life (QoL of patients with diabetes is worse than that of the general population. Furthermore, these same studies have also described very positive effects on quality of life after bariatric surgery. The aim of this study was to analyze whether the impact on quality of life of diabetic patients after being submitted to bariatric surgery is the one supposed to be. Methods: We prospectively analyzed our data on 524 diabetic patients submitted to bariatric surgery between 2001 and 2005. All the patients filled up three QoL questionnaires before the surgery and at 1, 3, 6, and 12 months after the surgery. The answers were gathered from an annual database. All patients were submitted to adjustable gastric band surgery, Y-Roux gastric bypass, or BPD-Scopinaro. Results: We obtained complete data on 89 patients that were included into the study. One year after the surgery, the QoL had significantly improved independent of disease remission and weight loss. Diabetes got improved in all the cases. The improvement on the quality of life was higher in the patients with total remission of the disease than in those only improving their health status, although it was lower than that of those patients without diabetes before the surgery. Conclusions: After a literature review and with our own prospective data, we may conclude that the benefits obtained by diabetic patients from bariatric surgery are mainly due to improvement of their diabetes, irrespective of their initial BMI and the BMI decrease after the intervention. Further studies are needed to investigate the results of the QoL test in diabetics with low BMI after bariatric surgery and in the long run.

  9. Patients' perceptions of music during surgery.

    Science.gov (United States)

    Stevens, K

    1990-09-01

    Music, as an aesthetic and symbolic medium, has the ability to dispel much of the fear and anxiety associated with facing the unknown alone. As such it is an ideal support for patients undergoing surgery where a non-general anaesthetic is administered. However, it is important to consider whether, from the patient's perspective, the inclusion of music in such a situation is considered to be helpful. A pilot study conducted at an acute hospital involved interviewing 25 patients who, through an attitudinal scale and their interview responses, revealed positive support for the music that they listened to during their operation. Their remarks focused on the ability of the music, as a familiar personal and cultural medium, to ease their anxiety, to act as a distractor and to increase their threshold of pain. From a nursing perspective, such an application of music as therapy to reduce fear and anxiety may be viewed as being highly relevant to the work of the anaesthetic nurse, with regard to a more individualized and holistic approach to patient care. PMID:2229703

  10. Programa de cirugía bariátrica laparoscópica en la Clínica Universidad de Navarra-Complejo Hospitalario de Navarra: resultados a un año Laparoscopic bariatric surgery program in the University Clinic of Navarre - Hospital Complex of Navarre: results after 1-year follow-up

    Directory of Open Access Journals (Sweden)

    V. Valentí Azcárate

    2012-12-01

    use bariatric surgery both to maintain long-term weight loss, and for the resolution of associated comorbidities. This article analyzes the initial results of the implementation of the laparoscopic bariatric surgery program in Navarre, obtained in a group of obese patients with surgical indication and operated on by means of the laparoscopic gastric bypass. Methods. From January 2010 until December 2011, 47 gastric bypasses were performed laparoscopically in the University Clinic of Navarre, all of them from the autonomous community of Navarre and previously and subsequently evaluated in the Hospital Complex of Navarre. The first 19 cases amongst them were selected for this work, as they presented at least one year of follow-up. Results. The percentage of excess weight lost was 65.47%, with a 31.68% reduction of total weight. The figures for glucose, uric acid, arterial tension and lipid metabolism one year after the intervention presented a very significant progressive fall. No significant medical or surgical complications were presented. Conclusions. The laparoscopic gastric bypass is an efficient technique for the long-term treatment of morbid obesity, with a scant number of complications, excellent weight loss and curing or improvement of the associated comorbidities in these patients.

  11. The Avantgarde Carbostent in Patients Scheduled for Undelayable Noncardiac Surgery

    Directory of Open Access Journals (Sweden)

    Carlo Briguori

    2012-01-01

    Full Text Available Background. Treatment of patients who need coronary revascularization before undelayable non-cardiac surgery is challenging. Methods. We assessed the safety and efficacy of percutaneous coronary interventions (PCI using the AvantgardeTM Carbostent (CID, Italy in patients undergoing PCI before undelayable non-cardiac surgery. The Multiplate analyzer point-of-care was used to assess residual platelet reactivity. One major cardiac events (MACE, defined as death, myocardial infarction, and stent thrombosis and major bleeding were assessed. Results. 42 consecutive patients were analyzed. Total stent length ≥25 mm was observed in 16 (37% patients. Multivessel stenting was performed in 11 (31.5% patients. Clopidogrel was interrupted 5 days before surgery in 35 patients, whereas it was stopped the day of the surgery in 7 patients. Surgery was performed after 27±9 (7–42 days from PCI. MACE occurred in one patient (2.4%; 95% confidence interval: 0.01–13%, who had fatal acute myocardial infarction 3 days after abdominal aortic aneurysm surgery and 12 days after stent implantation. No case of major bleeding in the postoperative phase was observed. Conclusions. The present pilot study suggests that, although at least 10–14 days of dual antiplatelet therapy remain mandatory, the AvantgardeTM stent seems to have a role in patients requiring undelayable surgery.

  12. Metabolic response to surgery in the cancer patient

    International Nuclear Information System (INIS)

    The metabolic response to uncomplicated surgery in the patient undergoing primary therapy for malignancy is no different than the response to surgery of similar magnitude for benign disease. Hemodynamic, nutritional-endocrine, and convalescent changes are similar. However, with current aggressive approaches to the management of cancer, the patient often comes to surgery with evidence of major debilitating side effects from his progressive malignancy or from aggressive multimodality therapy. The surgeon must be aware of the consequences of the use of combination therapies on the expected metabolic response to surgery. Awareness of such problems such as the nutritional deficit will allow preventive methods to supercede mtabolic salvage procedures

  13. Evolución de la ingesta y del estado nutricional de zinc, hierro y cobre en mujeres sometidas a cirugía bariátrica hasta el segundo año postoperatorio Evolution of the intake and nutritional status of zinc, iron and copper in women undergoing bariatric surgery until the second year after surgery

    Directory of Open Access Journals (Sweden)

    K. Basfi-fer

    2012-10-01

    Full Text Available Introducción: La cirugía bariátrica permite una reducción significativa de peso y mejoría de comorbilidades asociadas a la obesidad a largo plazo, pero también puede afectar negativamente el estado nutricional de algunos micronutrientes. Objetivos: Evaluar cambios en ingesta e indicadores del estado nutricional de zinc, hierro y cobre en mujeres sometidas a bypass gástrico en Y de Roux (BPG o gastrectomía tubular (GT, hasta el segundo año postoperatorio. Métodos: Se estudió prospectivamente 45 mujeres sometidas a BPG o GT (edad promedio 35,2 ± 8,4 años, IMC promedio 39,8 ± 4,0 kg/m², cada 6 meses se realizaron determinaciones de ingesta e indicadores del estado nutricional de zinc, hierro y cobre, y en forma anual se evaluó la composición corporal. El aporte de minerales a través de los suplementos representaba dos veces la ingesta recomendada para una mujer sana en las pacientes sometidas a GT y tres veces para BPG. Resultados: 20 mujeres se sometieron a GT y 25 a BPG. En ambos grupos se produjo una reducción significativa de peso y del porcentaje de masa grasa, que se mantuvo hasta el segundo año postoperatorio. Las mujeres sometidas a BPG presentaron un mayor compromiso del estado nutricional de zinc, hierro y cobre, que las pacientes sometidas a GT. Conclusiones: El bypass gástrico en Y de Roux produce un compromiso mayor del estado nutricional de zinc, hierro y cobre que la gastrectomía tubular. Se debería evaluar si la administración fraccionada de la suplementación mejoraría la absorción de estos nutrientes.Introduction: Bariatric surgery allows a significant reduction in weight and improvement of comorbidities associated with obesity in the long term, but it can also adversely affect the nutritional status of some micronutrients. Objectives: To evaluate changes in intake and parameters of nutritional status of zinc, iron and copper in patients undergoing Roux-en-Y gastric bypass (GBP or sleeve gastrectomy (SG

  14. Study of Patient Pain Management after Heart Surgery

    Directory of Open Access Journals (Sweden)

    Mohammadreza Sattari

    2013-08-01

    Full Text Available Purpose: To investigate postoperative pain control and analgesic use after heart surgery. Methods: 120 patients undergone heart surgery, randomly entered the study. Each patient was asked to score his pain intensity on visual analog scale (VAS at four different occasions. Results: 120 patients aged 59 year-old; including 81 male were enrolled in the study. 69.2% had coronary artery disease and 16.7% had heart-valve problem. Main types of surgeries were coronary artery bypass surgery (70.5% and valve repairement (23%. Duration of ICU stay was 4.78±2.7 days and duration of intubations was 17.38 ± 36.46 hours. Pre-surgery pain relief was administrated to 42% of the subjects and morphine and promethazine was the main pre-surgery analgesia medication. Post surgery analgesic included morphine (injection, petidine (injection and NSAIDS (oral or rectal. According to VAS, mean pain level, 1 and 4 hours after extubation, and before and one hour after transferring to wards was 5.05±2.5, 4.09±2.0, 3.52±1.8, 2.36±1.89, respectively. Although the level of pain reported was mostly moderate, 80% were reported satisfaction with their post-surgery pain management. Conclusion: A closer pain management control is needed for patients after heart surgery. Introduction of newer pain management techniques, medications and dosages could reduce the pain and suffering.

  15. Endoscopic management of bariatric complications: Areview and update

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    With over a third of Americans being considered obese,bariatric procedures have now become the mostperformed operation be general surgeons in theUnited States. The most common operations are theLaparoscopic Roux-en-Y Gastric Bypass, the LaparoscopicSleeve Gastrectomy, and the LaparoscopicAdjustable Gastric Band. With over 340000 bariatricprocedures preformed worldwide in 2011, the absolutenumber of complications related to these operationsis also increasing. Complications, although few, canbe life threatening. One of the most dreaded acutecomplication is the anastomotic/staple line leak. If leftundiagnosed or untreated they can lead to sepsis, multiorgan failure, and death. Smaller or contained leaks candevelop into fistulas. Although most patients with anacute anastomotic leak return to the operating room,there has been a trend to manage the stable patientwith an endoscopic stent. They offer an advantageby creating a barrier between enteric content and theleak, and will allow the patients to resume enteralfeeding much earlier. Fistulas are a complex andchronic complication with high morbidity and mortality.Postoperative bleeding although rare may also betreated locally with endoscopy. Stenosis is a morefrequent late complication and is best-managed withendoscopic therapy. Stents may not heal every fistula orstenosis, however they may prevent certain patients theneed for additional revisional surgery.

  16. Patient expectations of podiatric surgery in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Wilkinson Antony N

    2011-12-01

    Full Text Available Abstract Background Patient expectations can be difficult to conceptualise and are liable to change with time, health and environmental factors. Patient expectation is known to influence satisfaction, however little is known about the expectations of patients attending for podiatric surgery. This paper will explore the expectations of a large cohort of patients undergoing elective foot surgery. Methods The UK based podiatric audit of surgery and clinical outcome measurement (PASCOM audit system was applied to a consecutive cohort of patients undergoing elective podiatric surgery in Doncaster, South Yorkshire between 2004 and 2010. Data was collected relating to the surgical episode and patient expectations. A patient questionnaire was administered at 6 months post intervention. Results A total of 2910 unique surgical admissions were completed and satisfaction questionnaires were returned by 1869 patients. A total of 1430 patients answered question 1 which relates to patient expectations. Pain relief was the most frequent expectation with 1191 counts (52.3%, while footwear and mobility accounted for 16.6% and 16.4% respectively. Cosmesis counts occurred less commonly; 12.2%. 709 patients (49.6% stated only a single expectation, 599 patients (41.9% stated two expectations, 114 patients (8% stated three expectations and 7 patients (0.5% stated 4 expectations. Pain relief was the dominant expectation accounting for 515 counts (72.6% of patients who provided only one response. Conclusions This paper demonstrates the expectations of a large cohort of podiatric surgery patients. For the most part patients expect pain relief, improved mobility and improved shoe fitting, while a small number of patients also expect a cosmetic improvement. Further research is required to determine the relationship between patient expectation and health related quality of life, and to determine whether podiatric surgery is successful in addressing the expectations of

  17. Evaluation of Female Patients Motivating Factors for Aesthetic Surgery

    OpenAIRE

    Moosavizadeh, Seyed Mehdi; Niazi, Feizollah; Kalantar-Hormozi, Abdoljalil

    2012-01-01

    BACKGROUND Nowadays, plastic surgeries are among the most popular types of surgeries around the world and Iran has one of the highest rankings in this respect regarding its population size. Based on these facts, the present study was conducted in order to evaluate the volunteers’ motivations attitudes and informational sources in Tehran, Iran. METHODS The study was conducted on a cross-sectional basis. All patients who underwent plastic surgeries during years 2005 and 2006 were evaluated and ...

  18. Perioperative Cardiovascular Assessment of Patients Undergoing Noncardiac Surgery

    OpenAIRE

    Freeman, William K.; Gibbons, Raymond J.

    2009-01-01

    Preoperative assessment of the cardiac patient before noncardiac surgery is common in the clinical practice of the medical consultant, anesthesiologist, and surgeon. Currently, most noncardiac surgical procedures are performed for patients of advanced age, and the number of such surgeries is likely to increase with the aging of the population. These same patients have an increased prevalence of cardiovascular disease, especially ischemic heart disease, which is the primary cause of perioperat...

  19. Day surgery; development of a questionnaire for eliciting patients' experiences.

    OpenAIRE

    Black, N.; Sanderson, C

    1993-01-01

    OBJECTIVE--To develop a single, short, acceptable, and validated postal questionnaire for assessing patients' experiences of the process and outcome of day surgery. DESIGN--Interviews and review of existing questionnaires; piloting and field testing of draft questionnaires; consistency and validity checks. SETTING--Four hospitals, in Coventry (two), Swindon, and Milton Keynes. PATIENTS--373 patients undergoing day surgery in 1990. MAIN MEASURES--Postoperative symptoms, complications, health a...

  20. Effect of Massage on Pain Management for Thoracic Surgery Patients

    OpenAIRE

    Dion, Liza; Rodgers, Nancy; Cutshall, Susanne M.; Cordes, Mary Ellen; Bauer, Brent; Cassivi, Stephen D.; Cha, Stephen

    2011-01-01

    Background: Integrative therapies such as massage have gained support as interventions that improve the overall patient experience during hospitalization. Thoracic surgery patients undergo long procedures and commonly have postoperative back, neck, and shoulder pain. Purpose: Given the promising effects of massage therapy for alleviation of pain, we studied the effectiveness and feasibility of massage therapy delivered in the postoperative thoracic surgery setting. Methods: Patients who recei...

  1. Weighing the Options: Gastric Sleeve Surgery

    Medline Plus

    Full Text Available Weighing the Options: Gastric Sleeve Surgery Halifax Health Florida December 7, 2011 I chose to have bariatric surgery because I have struggled with yo-yo dieting for probably 25 years, and ...

  2. Weight-loss surgery and children

    Science.gov (United States)

    ... more likely to have problems such as: Low self-esteem Poor grades in school Depression ... weight-loss surgery should receive care at an adolescent bariatric surgery center. There, a team of experts ...

  3. Bariatric diagnostic CT scanning: A radiotherapy perspective

    International Nuclear Information System (INIS)

    Obesity is increasing in the United Kingdom. Equipment available for this patient group including wheelchairs, beds and hoists is becoming more common in the hospital environment; diagnostic imaging equipment that can accommodate bariatric patients has not increased at the same rate. Subsequently these service-users are often unable to receive “gold-standard” cross-sectional imaging within their patient-pathway. This paper highlights how a diagnostic imaging department has utilised wide-bore CT scanning equipment within the radiotherapy setting to ensure an equitable service for all service users. Through literature review and local experience, a standard operating procedure and scanning service has been developed. Areas explored include technical consideration of scanner design; patient positioning; image artefacts and intravenous contrast administration. Also investigated is patient wellbeing incorporating manual handling, respiration and psycho-social needs. Additionally, demonstration of how interprofessional collaboration by diagnostic and radiotherapy radiographers can ensure the best imaging experience and outcome for this patient group. - Highlights: • Rising obesity in the UK has highlighted a shortage of diagnostic imaging facilities. • Large bore CT scanners are the scanner of choice for radiotherapy planning. • Technical capability, manual handling and psycho-social issues have been explored. • Bariatric diagnostic imaging facilitated by inter-professional collaboration

  4. Associations of physical activity with depressiveness and coping in subjects with high-grade obesity aiming at bariatric surgery: a cross-sectional study

    OpenAIRE

    Elbelt, Ulf; Ahnis, Anne; Riedl, Andrea; Burkert, Silke; Schuetz, Tatjana; Ordemann, Juergen; Strasburger, Christian J.; Klapp, Burghard F.

    2015-01-01

    Background Reduced physical activity is supposed to be associated with depressiveness and more passive coping patterns. For further evaluation of this assumed relation we studied energy expenditure due to physical activity - usually referred to as activity thermogenesis (AT) - together with depressiveness (clinical diagnosis, depression module of the Patient Health Questionnaire), and coping behaviours (Brief COPE Inventory) in 50 patients with high-grade obesity (42 ± 12 years; 9 with II° an...

  5. Severe scurvy after gastric bypass surgery and a poor postoperative diet

    DEFF Research Database (Denmark)

    Hansen, Esben P K; Metzsche, Carsten; Henningsen, Emil;

    2012-01-01

    After bariatric gastric bypass surgery patients are at risk of developing micronutrient deficiencies. If gastric bypass surgery is followed by a vitamin deficient diet the patients have a risk of developing vitamin-C deficiency. When spontaneous ecchymosis is observed in the skin, in at-risk pati......-risk patients, scurvy must be considered. When treated with large doses of vitamin-C the symptoms of scurvy rapidly improve even if the patient has developed multiple organ dysfunction syndrome. KEYWORDS: Scurvy; Gastric bypass surgery; Multiorgan dysfunction....

  6. Clonidine in patients undergoing noncardiac surgery

    DEFF Research Database (Denmark)

    Devereaux, P J; Sessler, Daniel I; Leslie, Kate;

    2014-01-01

    BACKGROUND: Marked activation of the sympathetic nervous system occurs during and after noncardiac surgery. Low-dose clonidine, which blunts central sympathetic outflow, may prevent perioperative myocardial infarction and death without inducing hemodynamic instability. METHODS: We performed a bli...

  7. Portosystemic Shunt Surgery in Patients with Idiopathic Noncirrhotic Portal Hypertension.

    Science.gov (United States)

    Karagul, Servet; Yagci, Mehmet Ali; Tardu, Ali; Ertugrul, Ismail; Kirmizi, Serdar; Sumer, Fatih; Isik, Burak; Kayaalp, Cuneyt; Yilmaz, Sezai

    2016-01-01

    BACKGROUND Idiopathic noncirrhotic portal hypertension (INCPH) is a rare disease characterized by increased portal venous pressure in the absence of cirrhosis and other causes of liver diseases. The aim of the present study was to present our results in using portosystemic shunt surgery in patients with INCPH. MATERIAL AND METHODS Patients who had been referred to our Liver Transplantation Institute for liver transplantation and who had undergone surgery from January 2010 to December 2015 were retrospectively analyzed. Patients with INCPH who had undergone portosystemic shunt procedure were included in the study. Age, sex, symptoms and findings, type of portosystemic shunt, and postoperative complications were assessed. RESULTS A total of 1307 patients underwent liver transplantation from January 2010 to December 2015. Eleven patients with INCPH who did not require liver transplantation were successfully operated on with a portosystemic shunt procedure. The mean follow-up was 30.1±19 months (range 7-69 months). There was no mortality in the perioperative period or during the follow-up. Two patients underwent surgery again due to intra-abdominal hemorrhage; one had bleeding from the surgical site except the portacaval anastomosis and the other had bleeding from the h-graft anastomosis. No patient developed encephalopathy and no patient presented with esophageal variceal bleeding after portosystemic shunt surgery. Shunt thrombosis occurred in 1 patient (9.9%). Only 1 patient developed ascites, which was controlled medically. CONCLUSIONS Portosystemic shunt surgery is a safe and effective procedure for the treatment of patients with INCPH. PMID:27194018

  8. Flu Shot Safe for Surgery Patients in Hospital: Study

    Science.gov (United States)

    ... nih.gov/medlineplus/news/fullstory_157754.html Flu Shot Safe for Surgery Patients in Hospital: Study Findings ... risk for complications if they receive a flu shot in the hospital, a new study suggests. The ...

  9. Patient experiences with interventions to reduce surgery cancellations

    DEFF Research Database (Denmark)

    Hovlid, Einar; von Plessen, Christian; Haug, Kjell;

    2013-01-01

    The cancellation of planned surgery harms patients, increases waiting times and wastes scarce health resources. Previous studies have evaluated interventions to reduce cancellations from medical and management perspectives; these have focused on cost, length of stay, improved efficiency, and...

  10. Ossicular Erosion in Patients Requiring Surgery for Cholesteatoma

    OpenAIRE

    Ghodrat Mohammadi; Masoud Naderpour; Mehrnoosh Mousaviagdas

    2012-01-01

    Introduction: The aim of this study was to evaluate the condition of the ossicular chain in patients requiring surgery for cholesteatoma.  Materials and Methods: In a retrospective analysis, the destruction of the individual and combined bony structures of the ear was described in 166 patients with cholesteatoma who went through surgery in our Otology Center between 2003 and 2009.  Results: Total (55.4%) or partial (30.7%) erosion of the incus was the most common pathology. In...

  11. Update of oral surgery management in orally anticoagulated patients

    OpenAIRE

    Dimova, Cena; Evrosimovska, Biljana; Pandilova, Maja; Kovacevska, Ivona; Zabokova-Bilbilova, Efka

    2013-01-01

    Aim of this study is to review the evidence of different therapy approach, to highlight the areas of major concern and to suggest specific oral surgery treatment for patients on oral anticoagulants. The aim of operative treatment is to minimize the risk of hemorrhage while continuing to protect the patient against thromboembolism formation. The ordinary treatment includes the interruption of anticoagulant therapy for oral surgery interventions to prevent hemorrhage. However, this practice may...

  12. Factors Affecting Patients Undergoing Cosmetic Surgery in Bushehr, Southern Iran

    OpenAIRE

    Salehahmadi, Zeinab; Rafie, Seyyed Reza

    2012-01-01

    BACKGROUND Although, there have been extensive research on the motivations driving patient to undergo cosmetic procedures, there is still a big question mark on the persuasive factors which may lead individuals to undergo cosmetic surgery. The present study evaluated various factors affecting patients undergoing cosmetic surgery in Bushehr, Southern Iran. METHODS From 24th March 2011 to 24th March 2012, eighty-one women and 20 men who wished to be operated in Fatemeh Zahra Hospital in Bushehr...

  13. Reconstructive surgery in immunocompromised patients: evaluation and therapy

    Directory of Open Access Journals (Sweden)

    Dunda, Sebastian E.

    2015-12-01

    Full Text Available Background: An increasing number of patients undergoing reconstructive surgery are immunocompromised due to different reasons and different medical treatments. Some of the used immunosuppressive drugs may affect the process of wound healing and thereby, impair the long-term success of surgical treatment. Therefore, this retrospective analysis aimed at the evaluation of the perioperative treatment and surgical outcome of immunocompromised patients undergoing different reconstructive procedures.Methods: A retrospective review was performed of 8 immunocompromised patients with different primary diseases who needed reconstructive surgery: 2 patients with non-Hodgkin lymphoma, 1 patient with an acute myeloid leukemia, 1 patient with colitis ulcerosa, 1 patient with liver cirrhosis, 1 patient with chronic polyarthritis, and 2 patients with malignant melanoma.Results: In 7 of our 8 presented cases, multiple operations with wound debridements have been necessary to optimize the granulation of the wound bed before reconstructive surgery. 3 out of these 7 patients required further operations due to wound dehiscence or necrosis, with 2 of them as a result of increased immunosuppressive therapy. 5 out of 8 patients needed no further surgical treatment.Conclusions: Both the perioperative drug therapy and the reconstructive surgery concept need to be determined carefully in each individual case of the immunocompromised patients. Thus, the appropriate point in time of operation to achieve the best possible wound healing as well as the complexity of the procedure will require the consideration of a ‘less is more’ strategy in selected cases.

  14. Simultaneous surgery in patients with both cardiac and noncardiac diseases

    Directory of Open Access Journals (Sweden)

    Yang Y

    2016-07-01

    Full Text Available Yang Yang,1 Feng Xiao,1 Jin Wang,1 Bo Song,1 Xi-Hui Li,1 Jian Li,2 Zhi-Song He,3 Huan Zhang,4 Ling Yin5 1Department of Cardiac Surgery, 2Department of Thoracic Surgery, 3Department of Urology Surgery, 4Department of General Surgery, 5Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, People’s Republic of China Background: To investigate the possibility and feasibility of simultaneous cardiac and noncardiac surgery.Methods: From August 2000 to March 2015, 64 patients suffering from cardiac and noncardiac diseases have been treated by simultaneous surgeries.Results: Two patients died after operations in hospital; thus, the hospital mortality rate was 3.1%. One patient with coronary heart disease, acute myocardial infarction, and a recurrence of bladder cancer accepted emergency simultaneous coronary artery bypass grafting (CABG, bladder cystectomy, and ureterostomy. He died of acute cerebral infarction complicated with multiple organ failure on the 153rd day after operation. The other patient with chronic constrictive pericarditis and right lung cancer underwent pericardial stripping and right lung lower lobectomy, which resulted in multiple organ failure, and the patient died on the tenth day postoperatively. The remaining 62 patients recovered and were discharged. The total operative morbidity was 17.2%: postoperative hemorrhage (n, % [1, 1.6%], pulmonary infection and hypoxemia (2, 3.1%, hemorrhage of upper digestive tract (1, 1.6%, incisional infection (3, 4.7%, subphrenic abscess (1, 1.6%, and postoperative acute renal failure and hemofiltration (3, 4.7%. Of the 62 patients discharged, 61 patients were followed up. Eleven patients died with 10 months to 10 years during the follow-up. The mean survival time is 116.2±12.4 months. The cumulative survival rate is 50.8%.Conclusion: Simultaneous surgeries in patients suffering from both cardiac and noncardiac benign or malignant diseases are safe and possible

  15. Recurrent spine surgery patients in hospital administrative database

    Directory of Open Access Journals (Sweden)

    M. Sami Walid

    2012-02-01

    Full Text Available Introduction: Hospital patient databases are typically used by administrative staff to estimate loss-profit ratios and to help with the allocation of hospital resources. These databases can also be very useful in following rehospitalization. This paper studies the recurrence of spine surgery patients in our hospital population based on administrative data analysis. Methods: Hospital data on 4,958 spine surgery patients operated between 2002 and 2009 were retrospectively reviewed. After sorting the cohort per ascending discharge date, the patient official name, consisting of first, middle and last names, was used as the variable determining duplicate cases in the SPSS statistical program, designating the first case in each group as primary. Yearly recurrence rate and change in procedure distribution were studied. In addition, hospital charges and length of stay were compared using the Wilcoxon-Mann-Whitney test. Results: Of 4,958 spine surgery patients 364 (7.3% were categorized as duplicate cases by SPSS. The number of primary cases from which duplicate cases emerged was 327 meaning that some patients had more than two spine surgeries. Among primary patients (N=327 the percentage of excision of intervertebral disk procedures was 33.3% and decreased to 15.1% in recurrent admissions of the same patients (N=364. This decrease was compensated by an increase in lumbar fusion procedures. On the other hand, the rate of cervical fusion remained the same. The difference in hospital charges between primary and duplicate patients was $2,234 for diskectomy, $6,319 for anterior cervical fusion, $8,942 for lumbar fusion – lateral technique, and $12,525 for lumbar fusion – posterior technique. Recurrent patients also stayed longer in hospital, up to 0.9 day in lumbar fusion – posterior technique patients. Conclusion: Spine surgery is associated with an increasing possibility of additional spine surgery with rising invasiveness and cost.

  16. The Psychosocial Improvement after Strabismus Surgery in Iranian Patients

    Directory of Open Access Journals (Sweden)

    Guita Ghiasi

    2013-10-01

    Full Text Available Purpose: To compare the psychosocial status before and after successful strabismus surgery on Iranian strabismic patientsMethods: One hundred twenty-four strabismic patients, older than 15 years were evaluated between 2009 and 2010. They were asked to complete a questionnaire about their psychosocial experiences, before and three months after successful strabismus surgery. Effects of strabismus on self-esteem, self-confidence, and self-assessment of intelligence, employment and interpersonal relationships were compared.Results: Fifty-six percent of patients had problems in adjusting to society, and 71% had developed a mannerism to camouflage their misalignment before surgery. The preoperative scores of self-esteem, self-confidence, and interpersonal relationship were 4.33±2.07, 4.23±2.53 and 6.06±2.33 which changed to 8.33±3.02, 7.29±2.89 and 6.72±3.17 after surgery, respectively (p<0.001 for all of values. More esotropic patients reported to be discriminated against compared to exotropic patients. Postoperatively, 79% of patients reported improvements in their ability to meet new people, and 82% in interpersonal relationships. Scores of self-confidence and self-esteem increased up to three and four units, respectively (p<0.001 for both values.Conclusion: Patients with strabismus have psychosocial problems and successful strabismus surgery improves their psychosocial status.

  17. RISK OF PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY UNDERGOING NONCARDIAC SURGERY

    Institute of Scientific and Technical Information of China (English)

    Tian-ming Xuan; Yong Zeng; Wen-ling Zhu

    2007-01-01

    To determine the risk of noncardiac surgery in patients with hypertrophic cardiomyopathy.Methods We reviewed the medical records of all patients who were diagnosed as hypertrophic cardiomyopathy at Peking Union Medical College Hospital from January 1998 to August 2006 and identified 24 patients who subsequently underwent noncardiac surgery.Results There were no intraoperative cardiac events. Postoperative cardiac events were identified in 3 patients including 1 death due to acute myocardial infarction and 2 episodes of transient hypotension.Conclusions The risk of anesthesia and noncardiac surgery is low in patients with hypertrophic cardiomyopathy.During the perioperative period, beta-blockers and/or calcium channel blockers should be given; vasodilator and inotropic agents should be avoided due to the side effects on hemodynamics.

  18. Evaluation of Patient Radiation Dose during Orthopedic Surgery

    International Nuclear Information System (INIS)

    The number of orthopedic procedures requiring the use of the fluoroscopic guidance has increased over the recent years. Consequently the patient exposed to un avoidable radiation doses. The aim of the current study was to evaluate patient radiation dose during these procedures.37 patients under went dynamic hip screw (DHS) and dynamic cannulated screw (DCS) were evaluated using calibrated Thermolumincent Dosimeters (TLDs), under carm fluoroscopic machines ,in three centers in Khartoum-Sudan. The mean Entrance Skin Dose (ESD) was 7.9 m Gy per procedure. The bone marrow and gonad organ exposed to significant doses. No correlation was found between ESD and Body Mass Index (BMI), or patient weight. Well correlation was found between kilo voltage applied and ESD. Orthopedic surgeries delivered lower radiation dose to patients than cardiac catheterization or hysterosalpingraphy (HSG) procedures. More study should be implemented to follow radiation dose before surgery and after surgery

  19. Prophylactic cerebrovascular reconstructive surgery for occlusive cerebrovascular disease in patients with cardiac surgery

    International Nuclear Information System (INIS)

    We report the outcomes of prophylactic cerebral reconstructive surgery aimed at reducing the incidence of perioperative cerebral infarction in patients with intracranial or extracranial occlusive cerebrovascular disease who were scheduled to undergo cardiac surgery. Before the surgery, carotid artery ultrasonography, magnetic resonance angiography (MRA) of the carotid artery, and magnetic resonance imaging (MRI) and MRA of the brain were performed on 875 patients. The high-risk group was defined as: patients with cervical carotid artery stenosis of at least 90%, those with a reduced cerebral perfusion reserve because of occlusion of the internal carotid or middle cerebral artery, and those with a reduced cerebral perfusion reserve because of major intracranial artery stenosis of at least 75%. According to the degree of cardiac reserve, patients in the high-risk group underwent carotid artery stenting (CAS), carotid endarterectomy (CEA), superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis, or percutaneous transluminal angioplasty (PTA). Of the 875 patients, 29 (3.3%) were classified in the high-risk group, and 16 underwent prophylactic revascularization and cardiac surgery. Prophylactic revascularization included CAS in 7 patients (including stenting of the intracranial internal carotid artery in 1 patient), CEA in 4, STA-MCA in 4 and PTA in 1. Cardiac surgery was performed on 870 of the 875 patients, and perioperative cerebral infarction occurred in 11 (1.3%). It is uncertain whether our treatment strategy significantly reduced the incidence of perioperative cerebral infarction because of the lack of accurate information on the number of patients with this condition before the present study. However, 73% of patients had a score of 1 or 2 on the modified Rankin Scale 1 month after the onset of cerebral infarction, suggesting that our strategy improved the outcome. (author)

  20. Intraocular surgery in a large diabetes patient population

    DEFF Research Database (Denmark)

    Ostri, Christoffer

    population and to report surgical results. The specific objectives are to (1) estimate the incidence of diabetic vitrectomy and analyse risk factors (Study I), (2) report long-term results, prognostic factors and incidence of cataract surgery after diabetic vitrectomy (Study II), (3) report results and...... prognostic factors after cataract surgery in diabetes patients (Study III) and (4) analyse risk factors for diabetic papillopathy with emphasis on metabolic control variability (Study IV). All studies are based on a close-to-complete national surgery register and a large, closely followed diabetic...... 1 year, and the stability is maintained through 10 years of follow-up. The use of silicone oil for endotamponade is a consistent long-term predictor of low vision after surgery. The risk of requiring cataract surgery after diabetic vitrectomy is substantial, and the risk increases if silicone oil is...

  1. Retrograde intrarenal surgery in pediatric patients.

    Science.gov (United States)

    Resorlu, Berkan; Sancak, Eyup Burak; Resorlu, Mustafa; Gulpinar, Murat Tolga; Adam, Gurhan; Akbas, Alpaslan; Ozdemir, Huseyin

    2014-11-01

    Urinary tract stone disease is seen at a level of 1%-2% in childhood (stone disease, particularly in adolescence. A carbohydrate- and salt-heavy diet and a more sedentary lifestyle are implicated in this increase. Although stone disease is rare in childhood, its presence is frequently associated with metabolic or anatomical disorders or infectious conditions, for which reason there is a high possibility of post-therapeutic recurrence. Factors such as a high possibility of recurrence and increasing incidence further enhance the importance of minimally invasive therapeutic options in children, with their expectations of a long life. In children in whom active stone removal is decided on, the way to achieve the highest level of success with the least morbidity is to select the most appropriate treatment modality. Thanks to today's advanced technology, renal stones that were once treated only by surgery can now be treated with minimally invasive techniques, from invasion of the urinary system in an antegrade (percutaneous nephrolithotomy) or retrograde (retrograde intrarenal surgery) manner or shock wave lithotripsy to laparoscopic stone surgery. This compilation study examined studies involving the RIRS procedure, the latest minimally invasive technique, in children and compared the results of those studies with those from other techniques. PMID:25374812

  2. Life saving surgery in polytrauma patients.

    Science.gov (United States)

    Broos, P L; Janzing, H M; Vandermeeren, L A; Klockaerts, K S

    2000-01-01

    Life saving surgery is the surgery which has to be performed during the acute or reanimation period (1 to 3 h) and during the primary or stabilisation period (first day surgery). During the reanimation period lifethreatening conditions are identified and management is begun simultaneously. Many trauma surgeons talk about the first "golden hours" as the time interval starting immediately after the injury when rapid intervention will save lives and a lack of intervention will result in life loss. Most common, these critical conditions are exsanguinating hemorrhage, acute pump failure, obstruction of airways, mechanical failure of ventilation or severe brain damage with tentorial herniation. During this period, the following acts are necessary: surgical access to live support systems (airway, veins), life saving decompression of body cavities, resuscitative thoracotomy, control of exsanguinating external hemorrhage and control of exsanguinating hemorrhage into the body cavities. The primary or stabilisation period starts when vital functions stabilise. This period consists of further diagnostic procedures and treatment of injuries that are not directly life-threatening, but which may become life endangering or severely disabling if not treated promptly. The priorities of the surgical treatment are: brain injuries, eye- and facial injuries, progressive compression of the spinal cord, visceral injuries, musculoskeletal injuries. By improving prehospital care, rapid transport and last but not least immediate life saving surgical treatment preventable deaths can be reduced from 20-30% to 2-9% (5). PMID:11202271

  3. Pulmonary physiotherapy effect on patients undergoing open cardiac surgery

    Directory of Open Access Journals (Sweden)

    Seyed Kazem Shakuri

    2014-09-01

    Full Text Available Backgrounds and Objectives — Respiratory complications after open heart surgeries are common problems which can lead to death if not properly managed. The aim of this study was to evaluate the role of pulmonary rehabilitation before and after surgery for reducing the risk of pulmonary complications after surgery also correlations of the six-minute walk test and respiratory following open heart surgery. Material and Methods — In a randomized clinical trial, 60 patients undergoing heart surgery were divided into two groups randomly (groups A and B. In group A it was performed physiotherapy before and after chest physiotherapy surgery, but on patients in group B were done only chest physiotherapy after surgery. Effects of preoperative pulmonary rehabilitation were compared between two groups, using spirometry and six-minute walk test. Results — Thirty nine of males (65% and 21 females (35% with a mean age of 8.10±9.56 was been analyzed. The mean difference in predicted forced vital capacity (CI95%: 1.3 to 8.7 and predicted peak flow indices (CI95%: 1.9 to 9.4 of spirometery indicator was significant, also evaluation of six-minute walk test showed, mean difference in walking distant (CI95%: 8.8 to 21.0 and mean oxyhemoglobin saturation (CI95%: 0.59 to 1.67 in group A was more than group B. Inverse correlation of heart rate with forced vital capacity showed that patients with more restriction had more heart rate during the walking test. Conclusion — Pulmonary rehabilitation program before surgery is recommended to reduce complications of heart surgery. Further evaluations are necessary in relation to the sensitivity and specificity of six-minute walk test parameters alone in the evaluation of respiratory performance.

  4. Post-Bariatric Buttock Contouring with Autogenous Tissue Augmentation

    OpenAIRE

    Gerut, Zachary E.

    2006-01-01

    There are many established plastic surgical techniques to address effectively the lax, redundant tissue of the post–weight loss patient. Surgeons who are beginning their involvement in treating these patients are discovering that standard techniques are not always applicable to this rapidly growing group of patients and their extraordinary surgical challenges. Unique to the buttocks and the post-bariatric female breast is a tendency for these areas not only to become loose and ptotic but also...

  5. Breast cancer surgery in elderly patients: postoperative complications and survival

    OpenAIRE

    Rocco, Nicola; Rispoli, Corrado; Pagano, Gennaro; Rengo, Giuseppe; Compagna, Rita; Danzi, Michele; Accurso, Antonello; Amato, Bruno

    2013-01-01

    Aims and background Old age is associated with comorbidity and decreased functioning which influences treatment decisions in elderly breast cancer patients. The purpose of this study was to identify risk factors for complications after breast cancer surgery in elderly patients, and to assess mortality in patients with postoperative complications. Methods We retrospectively considered all female patients aged 65 years and older with invasive and in situ breast cancer who were diagnosed and tre...

  6. Towards safer surgery in patients with sickle cell disease

    International Nuclear Information System (INIS)

    Surgery in patients with sickle cell disease (SCD) has been associated with high morbidity and mortality. In recent years, a marked improvement in the safety of surgery and anesthesia in this high-risk group of patients has been witnessed; owing to the improvements in surgical and anesthetic care, greater awareness of pathophysiology of disease, proper perioperative preparation and attention to factors predisposing to vasoocclusive crises. However, this is not paralleled by similar improvement in countries where the disease is not prevalent. Greater population mobility in recent years makes recognition of surgical manifestations of the disease and awareness of perioperative management of sickle cell patients undergoing surgical interventions of paramount importance. This article aims to summarize steps towards safer surgery in patients with SCD. (author)

  7. Upper Alveolar Ridge in Edentulous Patients and Caldwell Luc Surgery

    OpenAIRE

    Ashok Murthy, V.; Mahendra Kumar, R.

    2012-01-01

    The aim of this study is to understand the upper alveolar ridge changes and its impact on Caldwell Luc surgery, in a patient papulation from a Medical College Hospital. We undertook a study to measure the thickness of upper alveolar ridge in edentulous and edentulous patients, to know the difference between the two and its effects on Caldwell Luc surgery. The finding of the study led us to conclude that the upper alveolar ridge is quite thin in edentulous patients and requires care while scra...

  8. Virtual Patients in Undergraduate Surgery Education: A Randomized Controlled Study

    OpenAIRE

    Mohammad Shariati; Masuod Yunesian; Iraj Harirchi; Ahmad Khosravi

    2008-01-01

    Introduction: This study aims to clarify the effects of implementing a series of virtual patients in undergraduate surgery education on various dimensions of skills as applied to clinical problems. Methods: In a randomized controlled trial 48 surgery clerks were assigned to an intervention group who worked on 14 simulated cases of abdominal pain during 7 weeks in a computer lab and a control group without access to software. At the end of the intervention, both groups were tested by a structu...

  9. Early Assessment of Delirium in Elderly Patients after Hip Surgery

    OpenAIRE

    Lee, Hyo Jin; Hwang, Deuk Soo; Wang, Seong Keun; Chee, Ik Seung; Baeg, Sengmi; Kim, Jeong Lan

    2011-01-01

    Objective This study is intended to identify predictive factors of delirium, including risk factors and prodromal symptoms. Methods This study included sixty-five patients aged 65 years or older who had undergone hip surgery. Baseline assessments included age; gender; admission type (acute/elective); reason for surgery (fracture/replacement); C-reactive protein (CRP); Acute Physiology, Age, Chronic Health Evaluation (APACHE III); and the Mini-Mental State Examination (MMSE). The Korean versio...

  10. Demoralization, Patient Activation, and the Outcome of Spine Surgery

    OpenAIRE

    Block, Andrew R

    2016-01-01

    It is now well established that psychosocial factors can adversely impact the outcome of spine surgery. This article discusses in detail one such recently-identified “risk” factor: demoralization. Several studies conducted by the author indicate that demoralization, an emotional construct distinct from depression, is associated with poorer pain reduction, less functional improvement and decreased satisfaction among spine surgery patients. However, there are indications that the adverse impact...

  11. Fluvastatin and perioperative events in patients undergoing vascular surgery

    OpenAIRE

    Schouten, Olaf; Boersma, Eric; Hoeks, Sanne; Benner, Robbert; Urk, Hero; Sambeek, Marc; Verhagen, Hence; Khan, Nisar Ahmed; Dunkelgrun, Martin; Bax, Jeroen; Poldermans, Don

    2009-01-01

    textabstractBACKGROUND: Adverse cardiac events are common after vascular surgery. We hypothesized that perioperative statin therapy would improve postoperative outcomes. METHODS: In this double-blind, placebo-controlled trial, we randomly assigned patients who had not previously been treated with a statin to receive, in addition to a beta-blocker, either 80 mg of extended-release fluvastatin or placebo once daily before undergoing vascular surgery. Lipid, interleukin-6, and C-reactive protein...

  12. Use of antifibrinolytic mouthwash solution in anticoagulated oral surgery patients

    OpenAIRE

    Dimova, Cena; Evrosimovska, Biljana; Papakoca, Kiro; Georgiev, Zlatko; Angelovska, Bistra; Ristoska, Sonja

    2012-01-01

    Introduction:The ordinary treatment of anticoagulated patients includes the interruption of anticoagulant therapy for oral surgery interventions to prevent hemorrhage. However, this practice may logically increase the risk of a potentially life-threatening thromboembolism, so this issue is still controversial. The aim of the study was to evaluate the antifibrinolitic mouthwash solution (tranexamic acid) as a local haemostatic modality after oral surgery interventions. Methods:To realize the a...

  13. Patients' attitude towards residents' participation during gynaecological surgery

    NARCIS (Netherlands)

    Versluis, Marco A. C.; van der Linden, Paul J. Q.

    2010-01-01

    Objective: To evaluate patients' attitude towards participation of residents in training in gynaecological surgery and patients understanding of resident position. Study design: An observational survey study was performed between July and February 2007-2008 in an outpatient clinic of a department of

  14. Orthognathic surgery: is patient information on the Internet valid?

    Science.gov (United States)

    Aldairy, T; Laverick, S; McIntyre, G T

    2012-08-01

    The aims of this study were to evaluate the quality and reliability of UK websites providing information on orthognathic and jaw surgery to patients. An Internet search engine (www.google.com) was used to identify websites containing medical information on 'orthognathic surgery' and 'jaw surgery'. Of over 144,000 links for orthognathic surgery and 700,000 for jaw surgery, the first 100 were examined in detail. After excluding discussion groups, news and video feeds, and removing duplicate sites, only 25 relevant websites remained which were then evaluated using the DISCERN instrument (www.discern.org.uk/discern_instrument.php). Through the 16 questions assessing the reliability and quality of the consumer information which are scored from 1 to 5, a relative index of the quality of the information is produced. The maximum score attainable for an excellent website is 80. Of the 25 websites that were scored, DISCERN indicated the majority of websites fell well below the maximum score. The highest score achieved by one of the websites according to the DISCERN tool was 64 of 80 and the lowest score achieved was 21 of 80. The websites achieving maximum and minimum score were Wikipedia and qualitydentistry.com, respectively. By directing patients to validated websites, clinicians can ensure patients find appropriate information; however, further development of websites relating to orthognathic surgery is required. Internet information should be updated on a regular basis to account for improvements in orthodontic and surgical care. PMID:21459834

  15. Bariatric surgery, adipose tissue and gut microbiota

    OpenAIRE

    Clément, K

    2011-01-01

    Human obesity can be viewed as a set of phenotypes that evolve over time in a sequence of stages that need to be precisely measured. Environmental, behavioral, genetic and biological factors interact to cause obesity. This presentation provides a clinical viewpoint on some biological processes that may explain some of the stages in the development of human obesity, its chronic maintenance and occurrence of complications, with a focus on brain structures, genetics, the profound alterations in ...

  16. Bariatric Surgery and the Endocrine System

    Science.gov (United States)

    ... Cuidadores Hormones and Health Journey Through the Endocrine System Endocrine Glands and Types of Hormones Brainy Hormones What ... Health Hormones and Health Journey Through the Endocrine System Endocrine Glands and Types of Hormones Brainy Hormones What ...

  17. Bariatric surgery, gut morphology and enteroendocrine cells

    DEFF Research Database (Denmark)

    Hansen, Carl Frederik

    40 hormones. In this PhD study, gut morphology and the population of endocrine cells have been examined in three rodent animal models using stereological techniques. First, in a rodent model of type-2 diabetes (T2DM), the Zucker diabetic fatty rat (ZDF), the population of endocrine L-cells and the...

  18. Extensive infectious myelitis post bariatric surgery

    OpenAIRE

    Haddad, Elie; Joukhadar, Carmen; Chehata, Nabil; Nasnas, Roy; Choucair, Jacques

    2015-01-01

    Background Inflammatory myelopathy is an inflammatory neurological disorder of the spinal cord (myelopathy). It occurs in 1 (severe) to 8 (mild) cases/million per year. It is often referred to in the literature as “transverse myelitis” or “acute transverse myelitis”. Myelopathy and by extension myelitis, can present as pyramidal (motor), sensory, and/or autonomic dysfunction to varying degrees. Symptoms typically develop over hours to days and worsen over days to weeks. Sensory symptoms usual...

  19. A comparative analysis of Type 2 diabetes and binge eating disorder in a bariatric sample.

    Science.gov (United States)

    Webb, Jennifer B; Applegate, Katherine L; Grant, John P

    2011-08-01

    An emerging literature has illuminated an important link between Type 2 diabetes mellitus (DM) and binge eating disorder (BED) within obese cohorts. However, prior work has not examined this relationship specifically in a weight loss surgery (WLS) sample or fully explored potential psychosocial factors associated with this co-occurrence. Therefore, the present investigation sought to identify socio-demographic (i.e. age, education, BMI, ethnicity, gender, age of obesity onset) and psychological (i.e. depressive symptoms, hedonic hunger/food locus of control beliefs, severity of binge eating-related cognitions) correlates of the co-occurrence of Type 2 DM and BED among bariatric surgery candidates. An archival sample of 488 patients seeking surgical treatment for clinical obesity completed a standard battery of pre-operative psychosocial measures. The presence of BED was evaluated using a semi-structured clinical interview based on the DSM-IV TR (APA, 2000) and was further corroborated by responses on the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R; Spitzer, Yanovski, & Marcus, 1993). Results indicated that 8.2% of the sample was classified as having both Type 2 DM and BED concurrently. A multivariate logistic regression model revealed that in addition to other psychological (e.g., binge eating-related cognitions, hedonic hunger) and demographic variables (i.e. male gender), African American ethnicity (OR=3.3: 1.41-7.73) was a particularly robust indicator of comorbid status. Findings support and extend previous health disparity research urging greater attention to the needs of traditionally underserved, at-risk populations seeking treatment for obesity complicated by dysregulated eating and metabolism. Additionally, these preliminary results underscore the relevance of considering the potential benefits of providing quality comprehensive pre- and post-operative psychological care among bariatric patients towards optimizing both short- and long

  20. [Robotic surgery for colorectal cancer in elderly patients].

    Science.gov (United States)

    Xu, Pingping; Wei, Ye; Xu, Jianmin

    2016-05-25

    The outstanding advantages of robotic surgery include the stable and three-dimension image and the convenience of surgery manipulation. The disadvantages include the lack of factile feedback, high cost and prolonged surgery time. It was reported that robotic surgery was associated with less trauma stress and faster recovery in elderly patients(≥75 years old) when compared with open surgery. Elderly people have a higher incidence of carcinogenesis and also have more comorbidities and reduced functional reserve. Clinical data of patients over 75 years old treated by robotic surgery in Zhongshan Hospital affiliated to Fudan University from March 2011 to October 2014 were analyzed retrospectively. A total of 24 consecutive patients were included with a median age of 77.8 years old. There were 18 male and 6 female patients. Among them, 14 patients were diagnosed with descending and sigmoid colon cancers while 10 with rectal cancers; 19 had tumor size larger than 5 cm; 16 were diagnosed with ulcerative adenocarcinoma. Fourteen patients were complicated with hypertension, 6 with cardiopulmonary diseases, 4 with diabetes mellitus and 3 with cerebrovascular diseases. Twenty-two patients underwent low anterior resection and 2 abdominoperineal resection. The estimated blood loss was 85 ml; the median operation time was (123.1±45.2) min; the median number of retrieved lymph node was 12.4. Postoperative pathologic results showed that 3 patients were stageI(, 10 stageII(, and 11 stageIII(. Postoperative complication was observed in 3 patients: urinary infection in 1 case, intraperitoneal infection in 1 case and atria fibrillation in 1 case, respectively. Median time to first postoperative flatus was 2.8 days. Our results indicated that robotic surgery is safe and feasible in the elderly patients. The next generation of robotic system may make up for these deficiencies through new technologies. With the advantage of more advanced surgical simulator, robotic surgery will play a

  1. Prevalence of myopic shifts among patients seeking cataract surgery

    Directory of Open Access Journals (Sweden)

    Rafael Iribarren

    2013-06-01

    Full Text Available Modern cataract surgery by phacoemulsification is a widely accepted procedure with a rapid recovery time. The prescription of specific intraocular lens, implanted during surgery, makes it possible to anticipate whether the patient will need reading glasses after the procedure. The present study analyses a sample of cataract surgery patients to show the frequency of myopic shifts related to nuclear opacity, which can result in clear near vision before surgery. A non-selected sample of consecutive patients who underwent elective cataract surgery in a private clinic was studied retrospectively. The myopic shift in refraction was assessed by comparing the old prescription with the spectacle correction at the time of interviewing.The mean age of the 229 subjects studied was 71.5 ± 10.4 years (109, 47.6%, males. A myopic shift in refraction, defined as at least - 0.5 diopters, was present in 37.1% of subjects (95% CI: 30.8%-43.4%. The mean change in refraction in these subjects was -2.52 ± 1.52 diopters. The percentage of subjects who had developed a myopic shift was significantly greater in those who presented greater nuclear opalescence. There were also differences in the mean myopic shift by refractive group, with the emmetropes having the greatest myopic shift. In this study of patients seeking cataract surgery in a clinical setting, more than one third had myopic shifts in refraction. This must be taken into account in order that patients maintain the benefit of clear near vision after surgery.

  2. Obesidad mórbida, enfermedad de hígado graso no alcohólico, síndrome metabólico y cirugía bariátrica Morbid obesity, non-alcoholic fatty liver disease, metabolic syndrome and bariatric surgery

    Directory of Open Access Journals (Sweden)

    V. Silvestre

    2007-10-01

    sus comorbilidades (NAFLD, NASH, hiperinsulinemia, hiperglucemia, dislipemia y componentes del síndrome metabólico.Objectives: The objectives of the present study are: 1 to assess protein changes in patients diagnosed with morbid obesity (MO and non-alcoholic fatty liver disease (NAFLD or steatohepatitis (NASH; 2 to assess the likely reversibility of these entities after bariatric surgery, and 3 to analyze their progression seven years after the gastric bypass. Material and methods: We retrospectively analyzed the data from 190 patients, 150 women (79% and 40 men (21% diagnosed with MO and surgically treated at our Hospital (Capella's gastric bypass. Mean age of the patients was 36.5 years (range: 18.5-54.5. Anthropometric values are gathered: body mass index (BMI, waist circumference (WC and biochemistry: insulin (INS, glucose (GLU, total proteins (TP, albumin (ALB, transferrin (TRF, ferritin (FER, prealbumin (PBA, retinol binding protein (RBP and C reactive protein (CRP. The HOMA index was calculated before the bypass and at the following follow-up periods after bypass: 6, 12, 60 and 84 months. Results: Abdominal ultrasound suggesting NAFLD or NASH was found in 34.7% (n = 66; 52 women and 14 men of MO patients surgically treated. Ninety patients (47.3%; 67 women and 23 men presented risk factors for metabolic syndrome (MS. All patients with possible liver dysfunction had MS. Before the bypass, we found increased levels of: BMI, WC, CRP, GLU, INS and HOMA index and changes in TP, ALB, PBA, RBP, FER and TRF levels. The first set of parameters start to decrease within 6 months after surgical bypass and at the same time the changes in protein levels start to face off and remain stable at 84 months. Conclusions: Weight loss due to bariatric surgery represents an effective method of fighting MO and its associated comorbidities (NAFLD, NASH, hyperinsulinemia, hyperglycemia, dyslipidemia and components of the metabolic syndrome.

  3. Psychological characteristics and associations with weight outcomes two years after gastric bypass surgery

    DEFF Research Database (Denmark)

    Beck, Nina N; Mehlsen, Mimi; Støving, René Klinkby

    2012-01-01

    This study investigated symptoms of eating disorder, depression, and anxiety among Roux-en-Y gastric bypass patients two years after surgery, and the relationship between these characteristics and weight loss. Respondents completed assessment questionnaires including Eating Disorder Inventory-2...... that knowledge of the potential influence of eating disorder symptoms on outcomes after bariatric surgery is needed in order to optimize weight outcomes following surgery....... (EDI-2), Harvard Anxiety and Depression Scale (HADS), and questions related specifically to binge eating. Forty-five patients (8 men, 37 women) out of 65 (67%) responded. Scores were significant higher on impulse regulation, interoceptive awareness, ineffectiveness, maturity fears and interpersonal...

  4. Urological surgery in elderly patients: results and complications

    Directory of Open Access Journals (Sweden)

    Brodak M

    2015-02-01

    Full Text Available Milos Brodak, Jan Tomasek, Jaroslav Pacovsky, Lukas Holub, Petr Husek Department of Urology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic Purpose: Owing to the large aging population, a growing number of elderly patients are undergoing surgical treatment. Surgical procedures in elderly patients are associated with a higher risk of complications. The aim of this study was to evaluate the efficacy and safety of urological surgeries in old patients.Methods: The authors carried out a retrospective study, evaluating results and early postoperative complications in patients aged 75 years and older. The cohort of patients included 221 patients who underwent surgical procedures in the department of urology between January 2011 and December 2012. The average age of patients was 78. The results and complications were categorized based on the type of surgery performed, and the Dindo–Clavien scale.Results: The median follow-up was 18 months. All surgeries for malignant tumors were performed successfully with no residual disease. Totally, 48 (22% complications were recorded. The most serious were as follows: one patient (<0.5% died; and four (<2% patients underwent reoperation. The most common complications involved infection, mainly sepsis and surgical site infections. Other complications included mild respiratory insufficiency, delirium, bleeding, etc.Conclusion: Surgeries in elderly patients were effective and safe. The cornerstone of safety is careful preparation and treatment of comorbidities. Complications occurred mainly as a result of emergency procedures during emergency procedures and in major surgeries such as cystectomy and nephrectomy. The standard use of low molecular-weight heparin caused no incidence of thromboembolic disease. Keywords: urinary tract, aged, postoperative complications, Dindo–Clavien classification

  5. Critical care of obese patients during and after spine surgery.

    Science.gov (United States)

    Elgafy, Hossein; Hamilton, Ryan; Peters, Nicholas; Paull, Daniel; Hassan, Ali

    2016-02-01

    Obesity is one of the most prevalent health problems facing the United States today, with a recent JAMA article published in 2014 estimating the prevalence of one third of all adults in the United States being obese. Also, due to technological advancements, the incidence of spine surgeries is growing. Considering these overall increases in both obesity and the performance of spinal surgeries, it can be inferred that more spinal surgery candidates will be obese. Due to this, certain factors must be taken into consideration when dealing with spine surgeries in the obese. Obesity is closely correlated with additional medical comorbidities, including hypertension, coronary artery disease, congestive heart failure, and diabetes mellitus. The pre-operative evaluation may be more difficult, as a more extensive medical evaluation may be needed. Also, adequate radiographic images can be difficult to obtain due to patient size and equipment limitations. Administering anesthesia becomes more difficult, as does proper patient positioning. Post-operatively, the obese patient is at greater risk for reintubation, difficulty with pain control, wound infection and deep vein thrombosis. However, despite these concerns, appropriate clinical outcomes can still be achieved in the obese spine surgical candidate. Obesity, therefore, is not a contraindication to spine surgery, and appropriate patient selection remains the key to obtaining favorable clinical outcomes. PMID:26855897

  6. Geriatric patient profile in the cardiovascular surgery intensive care unit

    International Nuclear Information System (INIS)

    Objectives: To determine hospitalization durations and mortalities of elderly in the Cardiovascular Surgery Intensive Care Unit. Methods: The retrospective study was conducted in a Cardiovascular Surgery Intensive Care Unit in Turkey and comprised patient records from January 1 to December 31, 2011. Computerized epicrisis reports of 255, who had undergone a cardiac surgery were collected. The patients were grouped according to their ages, Group I aged 65-74 and Group II aged 75 and older. European society for Cardiac Operative Risk Evaluation scores of the two groups were compared using SPSS 17. Results: Overall, there were 80 (31.37%) females and 175 (68.62%) males. There were 138 (54.1%) patients in Group I and 117 (45.9%) in Group II. Regarding their hospitalization reasons, it was determined that 70 (27.5%) patients in Group I and 79 (30.9%) patients in Group II were treated with the diagnosis of coronary artery disease. The average hospitalization duration of patients in the intensive care unit was determined to be 11.57+-10.40 days. Regarding the EuroSCORE score intervals of patients, 132 (51.8%)had 3-5 and 225 (88.2%) patients were transferred to the Cardiovascular Surgery and then all of them were discharged; 5 (4.1%) had a mortal course; and 11 (7.7%) were transferred to the anaesthesia intensive care unit Conclusions: The general mortality rates are very low in the Cardiovascular Surgery Intensive Care Unit and the patients have a good prognosis. (author)

  7. Psychiatric conditions in cosmetic surgery patients.

    Science.gov (United States)

    Ritvo, Eva C; Melnick, Ilan; Marcus, Gina R; Glick, Ira D

    2006-08-01

    Beauty is important. As psychiatrists, we see the interface of beauty with mental health, self-esteem, and mental illness. As physicians who enhance cosmetic appearance, you encounter a broad spectrum of patients ranging from those with a healthy pursuit of enhanced appearance to those whose behavior is extremely maladaptive. This article provides some examples of unhealthy pursuit and how to recognize patients who may be inappropriate for cosmetic procedures. Patients with body dysmorphic disorder and narcissistic and histrionic personality disorders are suffering from psychiatric illnesses that interfere with their judgment and can lead them to make poor choices when considering cosmetic procedures. Clinicians who acquire a basic understanding of these psychiatric conditions can properly screen their patients and enhance their understanding of their patients' goals, both realistic and unrealistic, thus saving them from performing inappropriate procedures that cause frustration to both the clinician and the patient. PMID:17048160

  8. Patient Selection in Plastic Surgery: Recognizing Body Dysmorphic Disorder

    Directory of Open Access Journals (Sweden)

    Cihan Sahin

    2013-04-01

    Full Text Available Plastic surgery is a branch of medicine that provides significant improvements to the people with positive changes. But first of all, this branch has a characteristic which requires analysing patients' psychological situation very carefully. Plastic surgeons are often confronted by patients with mental disorders seeking aesthetic surgery. It is imperative for surgeons to recognize possible underlying psychiatric illnesses. Common psychiatric conditions seen in cosmetic surgery patients include body dysmorphic disorder (BDD, narcissistic personality disorder and histrionic personality disorders. BDD is of particular importance to plastic surgeons. Because outrageous dissatisfaction with one's appearance may conceal psychopathologic traits that are not always easily recognizable, and which, if neglected, may result in serious iatrogenic and medicolegal consequences, we hope that this paper will help plastic surgeons in ultimately preventing patient and surgeon dissatisfaction within the population of patients with psychiatric disorders, and should recognize the diagnostic features of body dysmorphic disorder and screen psychologically unstable patients who may never be satisfied with surgery. [Arch Clin Exp Surg 2013; 2(2.000: 109-115

  9. Challenges of valve surgeries in post-renal transplant patients

    OpenAIRE

    Tanveer Ahmad; Kolkebaile Sadanand Kishore; Nandakumar Neralakere Maheshwarappa; Ashwini Kumar Pasarad

    2015-01-01

    Renal transplantation remains a mainstay of therapy for the end-stage renal disease. Cardiac disease has a high prevalence in this patient population. Cardiovascular disease remains the leading cause of death among kidney transplantation patients. The cardiac disease accounts for 43% of all-cause mortality among dialysis patients and for ≈38% of all-cause mortality after transplantation. In this article, we review the factors and outcomes associated with valve surgeries in renal transplant re...

  10. Sarcopenia and Sarcopenic Obesity in Patients Undergoing Orthopedic Surgery

    OpenAIRE

    Ji, Hyung-Min; Han, Jun; Jin, Dong San; Suh, Hyunseok; Chung, Yoon-Sok; Won, Ye-Yeon

    2016-01-01

    Background The purpose of this retrospective study was to determine the prevalence of sarcopenia and sarcopenic obesity among patients who underwent orthopedic surgery (OS). Methods A total of 222 patients were reviewed immediately after or prior to OS. In the control group, 364 patients from outpatient departments (OPDs) who did not have any OS were enrolled. Whole-body dual-energy X-ray absorptiometry was used to analyze body composition. Skeletal muscle mass was adjusted for height squared...

  11. Plastic Surgery for the Oncological Patient

    OpenAIRE

    Daigeler, Adrien; Harati, Kamran; Kapalschinski, Nicolai; Goertz, Ole; Hirsch, Tobias; Lehnhardt, Marcus; Kolbenschlag, Jonas

    2014-01-01

    The therapy of oncological patients has seen tremendous progress in the last decades. For most entities, it has been possible to improve the survival as well as the quality of life of the affected patients. To supply optimal cancer care, a multidisciplinary approach is vital. Together with oncologists, radiotherapists and other physicians, plastic surgeons can contribute to providing such care in all stages of treatment. From biopsies to the resection of advanced tumors, the coverage of the r...

  12. Patients' need for information prior to colonic surgery.

    Science.gov (United States)

    Sjöstedt, Lisbeth; Hellström, Renee; Stomberg, Margareta Warrén

    2011-01-01

    Perioperative information and communication between patients and health professionals is central to the quality of care and patient involvement for elective colon surgery. Enhanced recovery after surgery (ERAS) means that the care process is accelerated with comprehensive information and additional requirements on an individual. The purpose of this study was to identify nurses' and doctors' experience of patients' need for information before intraoperative care. Nurses (n = 39) with different specialties and professional experience were interviewed in focus groups. Ten anesthesiologists with differing professional experience were interviewed individually. Data were analyzed with qualitative content analysis. The result shows the need to provide information to reduce anxiety, to make the patient feel safe, to explain postoperative pain management, and to provide a comprehensive care pathway. There was no difference between the informants' perception of patients' information needs. All respondents agreed that patients generally have a great need for information. The perioperative information should be repeated at different points in time. The patients' need for information on diagnosis is recurrent. Knowledge, good communication, and attitude from a multiprofessional perspective support the patient's feeling comfortable and involved in the care prior to surgery. PMID:21979401

  13. Recovery of the incretin effect in type 2 diabetic patients after biliopancreatic diversion

    DEFF Research Database (Denmark)

    Novaes, Fernanda S; Vasques, Ana C J; Pareja, José C;

    2015-01-01

    CONTEXT: Bariatric surgery often results in remission of the diabetic state in obese patients. Increased incretin effect seems to play an important role in the glycemic improvements after Roux-en-Y gastric bypass, but the impact of biliopancreatic diversion (BPD) remains unexplored. OBJECTIVE...

  14. Banda gástrica com desvio jejunoileal: nova opção técnica em cirurgia bariátrica Gastric band with jejunoileal by-pass: new option in bariatric surgery

    Directory of Open Access Journals (Sweden)

    Bruno Zilberstein

    2010-06-01

    Full Text Available RACIONAL: Os procedimentos cirúrgicos para tratamento da obesidade morbida têm sido eficientes na resolução desta afecção a curto e longo prazo. Com exceção da banda gástrica ajustável todos estes procedimentos de alguma forma são capazes de induzir a liberação de hormônios intestinais em função do desvio intestinal e desta forma exercerem um efeito metabólico. OBJETIVO: Com a intenção de obter efeitos semelhantes às operações que promovem um desvio intestinal, com as vantagens de baixa morbidade e mortalidade da BGA, foi proposto novo procedimento técnico associando à banda gástrica ajustável a um desvio jejunoileal. MÉTODO: O procedimento cirúrgico totalmente conduzido por videolaparoscopia, consiste na aplicação inicial da banda gástrica e a seguir a realização de anastomose látero-lateral a 80 cm do ângulo duodenojejunal e 120 cm da válvula ileocecal. RESULTADOS: Foram operados 10 pacientes com esta técnica, seis mulheres e quatro homens com IMC médio de 40 kg/m². A perda média de excesso de peso nos seis primeiros meses foi de 51,56%. Em quatro pacientes diabéticos houve normalização dos níveis glicêmicos e suspensão do uso da medicação antidiabética. CONCLUSÃO: Adição de desvio jejunoileal látero-lateral à banda gástrica pode melhorar a perda de peso em pacientes portadores de obesidade mórbida e contribuir para o controle da diabete tipo II.BACKGROUND: Current procedures for surgical treatment of morbid obesity have proved to be efficient in controlling the process in the short and long follow-up. The bariatric surgical procedures, with the exception of the adjustable gastric banding are capable, in one way or another, of inducing hormonal release due to the intestinal by-pass that they may promote and therefore offering a metabolic effect. AIM: With the intention to maintain the same results promoted by gastrojejunal diversion, while maintaining the lower mortality rates of the

  15. Metabolic surgery: gastric bypass and type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Enrique Lanzarini

    2012-08-01

    Full Text Available Currently, type 2 diabetes mellitus and obesity behave as epidemic diseases. Medical treatment has not been able to achieve adequate metabolic control in a sufficient number of patients and is not exempt of complications. Meanwhile, the group of diabetics with severe and morbid obesity that have undergone bariatric surgery have mostly evolved with remission of their diabetes in the medium and long term, so that surgery has become the first choice of treatment. This early post operative remission is not explained by weight loss only, as other mechanisms linked to anatomic and functional changes mediated by surgery are under research. There is a great interest to explore new treatment options for type 2 diabetes including surgery in patients with mild to severe obesity, which has been denominated metabolic surgery.

  16. Review of Postoperative Delirium in Geriatric Patients Undergoing Hip Surgery.

    Science.gov (United States)

    Rizk, Paul; Morris, William; Oladeji, Philip; Huo, Michael

    2016-06-01

    Postoperative delirium is a serious complication following hip surgery in elderly patients that can adversely affect outcomes in both hip fracture and arthroplasty surgery. Recently, the incidence of hip fracture in the Medicare population was estimated at approximately 500 000 patients per year, with the majority treated surgically. The annual volume of total hip arthroplasty is nearly 450 000 patients and is projected to increase over the next 15 to 20 years. Subsequently, the incidence of postoperative delirium will rise. The incidence of postoperative delirium after hip surgery in the elderly patients ranges between 4% and 53%, and it is identified as the most common surgical complication of older patients. The most common risk factors include advanced age, hip fracture surgery (vs elective hip surgery), and preoperative delirium/cognitive impairment. Exact pathophysiology has not been fully defined. It is hypothesized that imbalances in cortical neurotransmitters or inflammatory cytokine pathway mechanisms contribute to delirium. Development of postoperative delirium is associated with longer hospital stay, increased medical complications, and poorer short-term functional outcome. Patients who develop postoperative delirium are also at increased risk for cognitive decline beyond the acute phase. Following acute care, postoperative delirium is associated with the need for a higher level of care, an additional cost. Management of postoperative delirium centers on prevention and early recognition. Medical prophylaxis has been demonstrated to have limited utility. Utilization of delirium detection methods contributed to early recognition. The most effective means of prevention involved a multidisciplinary team focused on adequate hydration, optimization of analgesia, reduction in polypharmacy, aggressive physiotherapy, and early recognition of the delirium symptoms. PMID:27239384

  17. Anestesia em anã acondroplásica obesa mórbida para gastroplastia redutora Anestesia en enana acondroplásica obesa mórbida para gastroplastia reductora Anesthesia for bariatric surgery in an achondroplastic dwarf with morbid obesity

    Directory of Open Access Journals (Sweden)

    Maria Angélica Abrão

    2009-02-01

    í la conducción de la anestesia.BACKGROUND AND OBJECTIVES: Achondroplasia is the most common form among the different types of osteochondrodysplasia that cause dwarfism. Dwarves develop obesity quite frequently, and surgical treatment has shown greater efficacy, both for effective weight loss and long term maintenance. The objective of this report was to present the case of bariatric surgery with Y-en-Roux gastric bypass in an achondroplastic dwarf with morbid obesity. The different difficulties in the anesthetic management of this patient and the way they were dealt with were discussed in order to decrease intraoperative morbidity and mortality. CASE REPORT: This is a 29 years old female dwarf with achondroplasia and morbid obesity since childhood. She was 123 cm tall and weighed 144 kg at the time of admission to the Bariatric Surgery service. With a body mass index (BMI of 95.18 kg.m-2, she had several associated diseases especially of the respiratory system and osteoarticular system. After a long follow-up with diet, exercises, and psychological support, her clinical condition improved and she was referred for surgery: Y-en-Roux gastroplasty using the technique of Capella-Fobi. Intubation of the awake patient under direct laryngoscopy was difficult and a bronchofibroscope had to be used. Surgery was uneventful and the patient was maintained under total intravenous anesthesia with continuous infusion of remifentanil and propofol. She was extubated at the end of the surgery still in the operating room. CONCLUSIONS: The simultaneous comorbidities of achondroplasia and morbid obesity can hinder the anesthetic management, especially regarding the airways. A thorough pre-anesthetic evaluation is necessary to anticipate the conducts and minimize risks, therefore optimizing the evolution of anesthesia.

  18. Hemostatic management of patients undergoing ear-nose-throat surgery

    Directory of Open Access Journals (Sweden)

    Thiele, Thomas

    2015-12-01

    Full Text Available Perioperative hemostatic management is increasingly important in the field of otolaryngology. This review summarizes the key elements of perioperative risk stratification, thromboprophylaxis and therapies for bridging of antithrombotic treatment. It gives practical advice based on the current literature with focus on patients undergoing ENT surgery.

  19. Do Too Many Lung Cancer Patients Miss Out on Surgery?

    Science.gov (United States)

    ... gov/news/fullstory_159488.html Do Too Many Lung Cancer Patients Miss Out on Surgery? Study evaluates treatment outcomes for late-stage disease To use the sharing features on this page, please enable JavaScript. (*this news item will not ...

  20. Fluvastatin and perioperative events in patients undergoing vascular surgery

    NARCIS (Netherlands)

    O. Schouten (Olaf); H. Boersma (Eric); S.E. Hoeks (Sanne); R. Benner (Robbert); H. van Urk (Hero); M.R.H.M. van Sambeek (Marc); H.J.M. Verhagen (Hence); N.A. Khan (Nisar Ahmed); M. Dunkelgrun (Martin); J.J. Bax (Jeroen); D. Poldermans (Don)

    2009-01-01

    textabstractBACKGROUND: Adverse cardiac events are common after vascular surgery. We hypothesized that perioperative statin therapy would improve postoperative outcomes. METHODS: In this double-blind, placebo-controlled trial, we randomly assigned patients who had not previously been treated with a

  1. Determinants of Weight Loss following Laparoscopic Sleeve Gastrectomy: The Role of Psychological Burden, Coping Style, and Motivation to Undergo Surgery

    OpenAIRE

    Andrea Figura; Anne Ahnis; Andreas Stengel; Tobias Hofmann; Ulf Elbelt; Jürgen Ordemann; Matthias Rose

    2015-01-01

    Background. The amount of excess weight loss (%EWL) among obese patients after bariatric surgery varies greatly. However, reliable predictors have not been established yet. The present study evaluated the preoperative psychological burden, coping style, and motivation to lose weight as factors determining postoperative treatment success. Methods. The sample included 64 morbidly obese patients with a preoperative BMI of 51 ± 8 kg/m2 who had undergone laparoscopic sleeve gastrectomy (LSG). Well...

  2. Zinc-deficiency acrodermatitis in a patient with chronic alcoholism and gastric bypass: a case report

    Directory of Open Access Journals (Sweden)

    Dariush Shahsavari

    2014-07-01

    Full Text Available Acquired adult-onset zinc deficiency is occasionally reported in patients with malnutrition states, such as alcoholism, or malabsorptive states, such as post-bariatric surgery. The defining symptoms of hypozincemia include a classic triad of necrolytic dermatitis, diffuse alopecia, and diarrhea. We report a case of zinc deficiency in a 39-year-old man with history of gastric bypass surgery and alcoholism. For this patient, severe hypozincemia confirmed acrodermatitis, and zinc supplementation was met with gradual improvement.

  3. Use of tranexamic acid in anticoagulated oral surgery patients

    OpenAIRE

    Dimova, Cena; Papakoca, Kiro; Kovacevska, Ivona; Kamceva, Gordana

    2010-01-01

    INTRODUCTIONS: The oral surgeons are frequently asked to manage patients who are receiving oral anticoagulants. The goal of treatment is to minimize the risk of hemorrhage while continuing to protect the patient against thromboembolism formation. The ordinary treatment includes the interruption of anticoagulant therapy for oral surgery interventions to prevent hemorrhage. AIM:However, this practice may logically increase the risk of a potentially life-threatening thromboembolism. Thus, thi...

  4. Management of oral surgery procedures in orally anticoagulated patients

    OpenAIRE

    Dimova, Cena

    2010-01-01

    The oral and maxillofacial surgeons are frequently asked to manage patients who are receiving oral anticoagulants. The goal of treatment is to minimize the risk of hemorrhage while continuing to protect the patient against thromboembolism formation. The ordinary treatment includes the interruption of anticoagulant therapy for oral surgery interventions to prevent hemorrhage. However, this practice may logically increase the risk of a potentially life-threatening thromboembolism. Thus, this is...

  5. Management of oral surgery procedures in oral anticoagulated patients

    OpenAIRE

    Dimova, Cena

    2010-01-01

    The oral and maxillofacial surgeons are frequently asked to manage patients who are receiving oral anticoagulants. The goal of treatment is to minimize the risk of hemorrhage while continuing to protect the patient against thromboembolism formation. The ordinary treatment includes the interruption of anticoagulant therapy for oral surgery interventions to prevent hemorrhage. However, this practice may logically increase the risk of a potentially life-threatening thromboembolism. Thus, this is...

  6. Respiratory management of the obese patient undergoing surgery

    OpenAIRE

    Hodgson, Luke E.; Murphy, Patrick B; Hart, Nicholas

    2015-01-01

    As a reflection of the increasing global incidence of obesity, there has been a corresponding rise in the proportion of obese patients undergoing major surgery. This review reports the physiological effect of these changes in body composition on the respiratory system and discusses the clinical approach required to maximize safety and minimize the risk to the patient. The changes in respiratory system compliance and lung volumes, which can adversely affect pulmonary gas exchange, combined wit...

  7. Demoralization, Patient Activation, and the Outcome of Spine Surgery.

    Science.gov (United States)

    Block, Andrew R

    2016-01-01

    It is now well established that psychosocial factors can adversely impact the outcome of spine surgery. This article discusses in detail one such recently-identified "risk" factor: demoralization. Several studies conducted by the author indicate that demoralization, an emotional construct distinct from depression, is associated with poorer pain reduction, less functional improvement and decreased satisfaction among spine surgery patients. However, there are indications that the adverse impact of risk factors such as demoralization can be mitigated by psychosocial "maximizing" factors-characteristics that propel the patient towards positive surgical results. One of these maximizing factors, patient activation, is discussed in depth. The patient activation measure (PAM), an inventory assessing the extent to which patients are active and engaged in their health care, is associated not only with improved spine surgery results, but with better outcomes across a broad range of medical conditions. Other maximizing factors are discussed in this article. The author concludes that the past research focus on psychosocial risk factors has limited the value of presurgical psychological screening, and that future research, as well as clinical assessment, should recognize that the importance of evaluating patients' strengths as well as their vulnerabilities. PMID:27417599

  8. Clinical-epidemiological behaviour of patients after cataract surgery

    OpenAIRE

    Leydi E. Jacomino Hernández; Idalia Triana Casado; Juan C. Medina Perdomo

    2010-01-01

    Background: Cataract is the leading cause of blindness in the world. Its only effective treatment is surgery, with a high rate of efficiency, but it is not always practiced due to several reasons that limit access to health services.Objective: To identify clinical and epidemiological behaviour of patients after cataract surgery. Methods: An observational, descriptive and cross-sectional study conducted in the "José Joaquín Palma" Ophthalmology Center in the town of San Cristóbal, Guatemala. W...

  9. Oral surgery in patients undergoing chemoradiation therapy.

    Science.gov (United States)

    Demian, Nagi M; Shum, Jonathan W; Kessel, Ivan L; Eid, Ahmed

    2014-05-01

    Oral health care in patients undergoing chemotherapy and/or radiation therapy can be complex. Care delivered by a multidisciplinary approach is timely and streamlines the allocation of resources to provide prompt care and to attain favorable outcomes. A hospital dentist, oral and maxillofacial surgeon, and a maxillofacial prosthodontist must be involved early to prevent avoidable oral complications. Prevention and thorough preparation are vital before the start of chemotherapy and radiation therapy. Oral complications must be addressed immediately and, even with the best management, can cause delays and interruption in treatment, with serious consequences for the outcome and prognosis. PMID:24794266

  10. Weighing the Options: Gastric Sleeve Surgery

    Medline Plus

    Full Text Available ... a few health issues. I had been doing research on the different types of bariatric surgery for ... I am going to ask a couple of questions. Joel, you let me know, again, when you ...

  11. Weighing the Options: Gastric Sleeve Surgery

    Medline Plus

    Full Text Available ... experts. To my immediate left is Dr. Harry Black, the patriarch of our Bariatric Surgery Center. And ... I’m going to start with Dr. Harry Black. Dr. Black, as I said before, you’ve ...

  12. Weighing the Options: Gastric Sleeve Surgery

    Medline Plus

    Full Text Available ... is more widely accepted. This is a relatively new procedure for bariatric surgery. It’s only been around ... body. And this, to the left, is a new stomach. Essentially, like I said, about 20% of ...

  13. Weighing the Options: Gastric Sleeve Surgery

    Medline Plus

    Full Text Available ... done bariatric surgery before, but not in the program standpoint, having everyone else on board as a team, as far as the medical doctor, the nutritionist, the exercise specialist, the psychiatrist. And, we put together the ...

  14. Weighing the Options: Gastric Sleeve Surgery

    Medline Plus

    Full Text Available ... going through the process of setting up a real program. Other surgeons had done bariatric surgery before, ... in. If we can look back at me real quick here, I can show you an example ...

  15. Demoralization, Patient Activation, and the Outcome of Spine Surgery

    Directory of Open Access Journals (Sweden)

    Andrew R Block

    2016-01-01

    Full Text Available It is now well established that psychosocial factors can adversely impact the outcome of spine surgery. This article discusses in detail one such recently-identified “risk” factor: demoralization. Several studies conducted by the author indicate that demoralization, an emotional construct distinct from depression, is associated with poorer pain reduction, less functional improvement and decreased satisfaction among spine surgery patients. However, there are indications that the adverse impact of risk factors such as demoralization can be mitigated by psychosocial “maximizing” factors—characteristics that propel the patient towards positive surgical results. One of these maximizing factors, patient activation, is discussed in depth. The patient activation measure (PAM, an inventory assessing the extent to which patients are active and engaged in their health care, is associated not only with improved spine surgery results, but with better outcomes across a broad range of medical conditions. Other maximizing factors are discussed in this article. The author concludes that the past research focus on psychosocial risk factors has limited the value of presurgical psychological screening, and that future research, as well as clinical assessment, should recognize that the importance of evaluating patients’ strengths as well as their vulnerabilities.

  16. Preoperative Preparation and Patient Selection for Cytoreductive Surgery and HIPEC.

    Science.gov (United States)

    Ashvin, Rangole; Nikhilesh, Jain

    2016-06-01

    Peritoneal dissemination is a significant variable affecting long term survival of abdominal cancer patients. A generally accepted clinical point of view is that peritoneal dissemination is tantamount to distant organ metastases. This implies it to be a terminal condition. Current practice dictates that if peritoneal dissemination is observed intraoperatively, the curative therapeutic options are deferred and comprehensive systemic chemotherapy remains the only option with a dismal prognosis. The past few years have generated lot of interest in management of peritoneal carcinomatosis. Prof Paul Sugarbaker has researched, validated and fine-tuned the concept of cytoreductive surgery with peritonectomy procedure (Sugarbaker technique) and perioperative chemotherapy as HIPEC & EPIC. Recognition of a HIPEC centre is based on an infrastructure equipped with basic knowledge of the tumor biology, oncosurgical techniques, technical knowhow for HIPEC administration, intensive care unit etc. There are some aspects which need to be accorded special consideration. Comprehensive therapy of Cytoreduction surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is initiated with exploration and cytoreductive surgery and includes visceral resections and peritonectomy procedure when achieved optimally results in complete, visible resection of all cancer within the abdomen and pelvis. Subsequent to CRS, HIPEC forms an integral part of the surgical procedure. This approach involves conceptual changes in both the route and timing of chemotherapy administration. Patient selection is of utmost importance. The greatest impediment to lasting benefits from intraperitoneal chemotherapy remains an improper patient selection. Currently, there are four important clinical assessments of peritoneal metastasis that need to be used to select patients ie; histopathological type of tumour, radiological distribution of disease, peritoneal cancer index and completeness of cytoreduction

  17. Psychiatric Considerations of the Massive Weight Loss Patient

    OpenAIRE

    Sarwer, David B.; Fabricatore, Anthony N.

    2008-01-01

    As bariatric surgery for extreme obesity continues to grow in popularity, so does interest in post-bariatric surgery body contouring surgery. There is an extensive literature on the psychological characteristics of persons with extreme obesity who undergo bariatric surgery, as well as the psychological changes that typically occur postoperatively. Far less, however, is known about the psychological aspects of body contouring following massive weight loss. In this article, we review the psycho...

  18. 1 in 5 Ovarian Cancer Patients Doesn't Get Life-Extending Surgery

    Science.gov (United States)

    ... medlineplus/news/fullstory_159190.html 1 in 5 Ovarian Cancer Patients Doesn't Get Life-Extending Surgery: ... 3, 2016 (HealthDay News) -- Surgery may significantly extend ovarian cancer patients' lives, but one in five women ...

  19. Long-term postoperative mortality in diabetic patients undergoing major non-cardiac surgery

    DEFF Research Database (Denmark)

    Juul, A B; Wetterslev, J; Kofoed-Enevoldsen, A

    2004-01-01

    a major risk factor for both short-term ( 30 days) patients especially after major cardiac surgery. We examined the long-term postoperative mortality of diabetic patients undergoing major non-cardiac surgery to identify possible perioperative risk factors....

  20. Morbidity of surgery in previously undiagnosed cirrhotic patients

    International Nuclear Information System (INIS)

    Background: Undiagnosed cirrhotic patients are frequently encountered during routine and emergency surgery. These patients have a higher incidence of blood loss and wound infection, resulting in prolonged hospital stay. This study was conducted to highlight the possible complications which result in prolonged hospital stay in these patients. Method: A total of 38 patients were incidentally found to have cirrhosis out of a total of 1560 patients who underwent abdominal operation. Diagnosis was confirmed on per-operative liver biopsy and was suspected preoperatively in patient having abnormal liver function test. Per-operative bleeding, postoperative wound infection and hospital stay was compared in cirrhotic and non-cirrhotic patients. Results: The mean blood loss was 310 ml in cirrhotic patients as compared to 205 ml in non-cirrhotic patients which was statistically significant (p-value 0.008). Post-operative infection rate was 21 percentage in cirrhotic patients compared to non-cirrhotic patients 5 percentage. Significance was tested using Pearson Chi square test (0.042). The Average hospital stay was 10 days in cirrhotic patients and 7.5 days in non-cirrhotic patients respectively which was statistically significant (p-value 0.006). Conclusion: There is statistically significant difference in per-operative bleeding, wound infection and hospital stay in cirrhotic and non-cirrhotic patients. (author)

  1. Prevalencia y determinación de los factores de riesgo asociados con psicopatología en los candidatos a cirugía bariátrica en la Clínica Reina Sofía, Bogotá, Colombia Prevalence and Determination of Risk Factors Associated with Psychopathology in Bariatric Surgery Candidates at Clínica Reina Sofía, Bogotá, Colombia

    Directory of Open Access Journals (Sweden)

    Julio César Reyes Figueroa

    2008-09-01

    Full Text Available Objetivos: Determinar la prevalencia de psicopatología en los candidatos a cirugía bariátrica en la Clínica Reina Sofía, entre octubre y noviembre de 2007, e identificar algunos potenciales factores de riesgo para su aparición. Método: Se realizó un estudio descriptivo con corte transversal comparativo, en el cual participaron 50 candidatos a cirugía bariátrica, a quienes después de firmar el consentimiento informado se les aplicó la Structured Clinical Interview (SCID, para el DSM-IV, y preguntas estructuradas para la exploración sistemática de las variables estudiadas. Resultados: La muestra de 50 pacientes se conformó en un 62% (n=31 por mujeres. La edad promedio de los participantes fue de 45,2 (DE=12,94 y el promedio en el índice de masa corporal (IMC fue de 38,92 Kg/m² (DE=3,53. La prevalencia de psicopatología fue del 38% (n=19, clasificada como trastornos del estado del ánimo: 24% (n=12; trastornos adaptativos: 8% (n=4, y trastornos de ansiedad: 6% (n=3. Al comparar los sujetos de acuerdo con la presencia de psicopatología, se encontró una asociación estadísticamente significativa entre el antecedente de abuso sexual infantil y la presencia de psicopatología (OR=10,71; IC 95%: 1,14-100,52. No hubo relación con variables sociodemográficas, grado de obesidad o problemas psicosociales. Conclusiones: El estudio mostró una asociación estadísticamente significativa entre la presencia de psicopatología y el antecedente de abuso sexual infantil.Objectives: To determine the prevalence of psychopathology among bariatric surgery candidates at the Reina Sofía Clinic during October-November 2007, and to identify some factors associated to psychopathology in this population. Method: This is a descriptive study with a comparative transversal analysis. 50 ba-riatric surgery candidates were considered into study, who accepted to participate in the study and signed written informed consent. These patients were then assessed

  2. MDCT of retractor-related hepatic injury following laparoscopic surgery: Appearances, incidence, and follow-up

    International Nuclear Information System (INIS)

    Aims: To investigate the postoperative computed tomography (CT) features resulting from the use of Nathanson retractors during laparoscopic upper gastro-intestinal surgery. Materials and methods: A 3-year retrospective study of 176 patients who had undergone laparoscopic upper gastro-intestinal surgery for bariatric or malignant disease was performed. Postoperative CT images [divided into early (≤30 days) and late (>30 days)] were assessed by a consultant radiologist and liver abnormalities recorded. Results: The features of a retractor injury were a hypodense lesion, abutting the liver edge, usually triangular or linear in shape. Late postoperative features included focal subcapsular retraction and associated liver atrophy. Sixty-eight percent (52/77) of patients undergoing surgery for malignancy underwent postoperative CT, compared with 11% (11/99) of those undergoing bariatric surgery. Patients with malignancy were more likely to have retraction-related liver abnormalities (14/52, 27%) at postoperative CT than those in the bariatric group (2/11, 18%). Conclusion: Retractor-related liver injuries at MDCT are common following laparoscopic upper gastro-intestinal surgery. Recognition of the characteristic triad of features, a hypodense lesion abutting the liver edge with a triangular or linear shape, should allow confident diagnosis. CT follow-up reveals that over time these lesions may disappear, remain unchanged, or result in a focal subcapsular scar with associated atrophy. - Highlights: • Large numbers of patients undergo post-op CT after upper GI laparoscopic surgery. • Retractor injuries are common in the 30 days after laparoscopic upper GI surgery. • Characteristic features are hypodense, triangular/linear lesions at the liver edge

  3. Attitudes toward cosmetic surgery patients: the role of culture and social contact.

    Science.gov (United States)

    Tam, Kim-Pong; Ng, Henry Kin-Shing; Kim, Young-Hoon; Yeung, Victoria Wai-Lan; Cheung, Francis Yue-Lok

    2012-01-01

    Cosmetic surgery is increasingly popular globally, but how cosmetic surgery patients are socially evaluated is largely unknown. The present research documents attitudes toward these patients in multiple cultures (Hong Kong, Japan, and the United States). Across these cultures, attitudes toward cosmetic surgery patients were predominantly negative: Participants ascribed more negative attributes to cosmetic surgery patients and found cosmetic surgery not acceptable. Also, participants in Hong Kong and Japan were not willing to form social relationships, particularly intimate ones, with these patients. These attitudes were less negative in the United States than in Hong Kong and Japan, partly because social contact, which reduced negativity in attitudes toward cosmetic surgery patients, was more prevalent in the United States. These findings bear important implications for the subjective well-being of cosmetic surgery patients, who very often expect improvement in their social relationships through the surgery. PMID:22822685

  4. Clinical-epidemiological behaviour of patients after cataract surgery

    Directory of Open Access Journals (Sweden)

    Leydi E. Jacomino Hernández

    2010-12-01

    Full Text Available Background: Cataract is the leading cause of blindness in the world. Its only effective treatment is surgery, with a high rate of efficiency, but it is not always practiced due to several reasons that limit access to health services.Objective: To identify clinical and epidemiological behaviour of patients after cataract surgery. Methods: An observational, descriptive and cross-sectional study conducted in the "José Joaquín Palma" Ophthalmology Center in the town of San Cristóbal, Guatemala. We included all patients over 18 years old meeting the inclusion criteria who had had a cataract surgery between July and December 2007. The following variables were analyzed: age, sex, skin color, place of origin, ocular and systemic personal medical history, etiologic type of cataract and intra and immediate postoperative complications. Results: 63.3% of the patients are in the 60 years on age group, with a slight predominance of females (51.89% and most of them come from the rural areas (66.66%. Among personal medical histories myopia was detected (14.17% and among systemic medical histories there were arterial hypertension (25.98% and diabetes mellitus (22.04%. Senile cataract was more frequent (52.75%. The most frequent intraoperative complications were posterior capsule ruptures with or without vitreous loss (29.548% and 3.37% respectively and corneal edema in the immediate postoperative (5.48%. Conclusions: The results of clinical and epidemiological characterization of patients after cataract surgery included in this series do not differ from those of similar studies, except for the personal glaucoma history.

  5. Topical Anesthesia for Cataract Surgery: The Patients' Perspective

    OpenAIRE

    Aytekin Apil; Baki Kartal; Metin Ekinci; Halil Huseyin Cagatay; Sadullah Keles; Erdinc Ceylan; Ozgur Cakici

    2014-01-01

    Purpose. To evaluate the analgesic efficacy of 0.5% propacaine hydrochloride as topical anesthesia during phacoemulsification surgery. Methods. Intraoperative pain intensity was assessed using a 5-category verbal rating scale during each of three surgical stages. Pain scores from each surgical stage and total pain scores were compared for the factors of patient age, gender, cataract laterality, and type. Results. In comparison of cataract type subgroups, the mean total pain scores and mean st...

  6. Laparoscopic surgery for patients with colorectal cancer produces better short‐term outcomes with similar survival outcomes in elderly patients compared to open surgery

    OpenAIRE

    Moon, Soo Yun; Kim, Sohee; Lee, Soo Young; Han, Eon Chul; Kang, Sung‐Bum; Jeong, Seung‐Yong; Park, Kyu Joo; Oh, Jae Hwan; ,

    2016-01-01

    Abstract The number of operations on elderly colorectal cancer (CRC) patients has increased with the aging of the population. The aim of this study was to evaluate surgical outcomes in elderly patients who underwent laparoscopic or open surgery for CRC. We analyzed the data of 280 patients aged 80 or over who underwent surgery for CRC between January 2001 and December 2010. Seventy‐one pairs were selected after propensity score matching for laparoscopic or open surgery. Operative time, return...

  7. Baseline cerebral oximetry values in cardiac and vascular surgery patients: a prospective observational study

    Directory of Open Access Journals (Sweden)

    Matsagas Miltiadis

    2010-05-01

    Full Text Available Abstract Aim This study was conducted to evaluate baseline INVOS values and identify factors influencing preoperative baseline INVOS values in carotid endarterectomy and cardiac surgery patients. Methods This is a prospective observational study on 157 patients (100 cardiac surgery patients, 57 carotid endarterectomy patients. Data were collected on factors potentially related to baseline INVOS values. Data were analyzed with student's t-test, Chi-square, Pearson's correlation or Linear Regression as appropriate. Results 100 cardiac surgery patients and 57 carotid surgery patients enrolled. Compared to cardiac surgery, carotid endarterectomy patients were older (71.05 ± 8.69 vs. 65.72 ± 11.04, P Conclusion Compared to cardiac surgery, carotid endarterectomy patients are older, with higher baseline INVOS values and greater stroke frequency. Diabetes and high cholesterol are associated with lower baseline INVOS values in carotid surgery. Right and left side INVOS values are strongly correlated in both patient groups.

  8. Simultaneous Bilateral Cataract Surgery in General Anesthesia Patients

    Directory of Open Access Journals (Sweden)

    Tien-En Huang

    2007-04-01

    Full Text Available Background: The aim of this study was to evaluate the indications, safety, benefits, disadvantagesand advantages, and the visual outcomes for simultaneous bilateralcataract surgery (SBCS under general anesthesia.Methods: This retrospective case review pertained to a period spanning from June1998 through June 2005 inclusively, and comprised of 27 consecutivepatients (54 eyes that underwent simultaneous bilateral cataract surgeryunder general anesthesia at the Kaohsiung Chang Gung Memorial Hospital,Taiwan. Surgery modalities included phacoemulsification, extracapsularcataract extraction, lens aspiration and intraocular lens implantation.Outcome measures included postoperative best correct visual acuity (BCVAas well as intraoperative and postoperative complication rates. Due to thebipolas distribution of the age, we arbitrarily divided our cases into youngergroup (Group Y, younger than 20 years old and older group (Group O, equalto or older than 20 years old.Results: Thirty-eight of the 54 eyes (60% in the younger group and 76.5% in theolder group, featuring measured preoperative and postoperative BSCVA,achieved improved visual acuity following SBCS. Two eyes (5.9% in theolder group demonstrated poorer visual acuity postoperatively than preoperatively.Seven patients (40% in the younger group and 17.6% in the oldergroup were not able to express VA due to their particular medical conditionssuch as mental disease and young age. Intraoperative and postoperative complicationrates were similar to those cited in previous reports of analogousbut unilateral extracapsular surgery and simultaneous bilateral cataractsurgery. Endophthalmitis did not arise in any of the eyes operated upon andreported on herein, and no examples of bilateral complications that resultedin visual loss occurred in our patients.Conclusion: SBCS could be a good choice when cataract surgery needs to be performedunder general anesthesia. The relative benefits of SBCS under general

  9. Delayed awakening in dystonia patients undergoing deep brain stimulation surgery.

    Science.gov (United States)

    Trombetta, Carlos; Deogaonkar, Anupa; Deogaonkar, Milind; Ebrahim, Zeyd; Rezai, Ali; Machado, Andre; Farag, Ehab

    2010-07-01

    We aimed to identify the incidence, duration and causes of delayed emergence from anesthesia in patients with dystonia undergoing surgery for deep brain stimulation (DBS) placement. A retrospective review of patients with dystonia who underwent DBS placement was conducted and the following characteristics were noted: age, gender, comorbid conditions, American Society of Anesthesiologists classification, anesthetic agents used, amount of initial dose, amount of infusion dose, duration of the infusion and the time needed for emergence. Twenty-four patients underwent 33 DBS procedures for dystonia. Propofol was administered to 21 patients, in 29 of the 33 procedures. Dexmedetomidine was administered to three patients, in four procedures. The average propofol loading dose was 0.7mg/kg, and the infusion rate was 80microg/kg per minute (min), for an average duration of 89min. The average time of emergence was 36min. Only 31% of patients emerged from propofol anesthesia during the expected time frame, 69% of patients had some degree of delayed emergence, and 24% had a significant delay in emergence. Delayed emergence was more common in younger patients due to the higher loading doses these patients received. This study shows a 69% incidence of delayed emergence in dystonia patients undergoing DBS surgery. It also suggests an association between delayed emergence and younger patients who receive higher loading doses. A possible cause of delayed emergence is excessive anesthetic potentiation of the low output pallidal state in dystonia which may depress the pallido-thalamo-cortical circuitry. Delayed emergence could also result from depression of the previously affected ventral pallidal inputs to the septo-hippocampal system that mediates general anesthesia and awareness. Complex neurotransmitter disturbances may also be involved. PMID:20466547

  10. The illness trajectory experienced by patients having spine fusion surgery

    DEFF Research Database (Denmark)

    Damsgaard, Janne Brammer; Bastrup, Lene; Norlyk, Annelise;

    The illness trajectory of spine fusion patients. A feeling of being (in)visible Background Research shows that being a back patient is associated with great personal cost, and that back patients who undergo so-called spine fusion often experience particularly long and uncoordinated trajectories....... The patients describe a feeling of being mistrusted and thrown around in the system. It is the aim of this study to examine how spine fusion patients experience their illness trajectory and hospitalisation. Methods The study is based on qualitative interviews, and the data analysis is inspired by the...... French philosopher Paul Ricoeur’s phenomenological hermeneutic theory of interpretation. Data were collected through observations and semi-structured interviews at an Elective Surgery Centre in a Danish regional hospital. Results The results show that experiences related to prolonged contact with the...

  11. Anaesthesia for the patient with dementia undergoing outpatient surgery

    DEFF Research Database (Denmark)

    Funder, Kamilia S; Steinmetz, Jacob; Rasmussen, Lars S

    2009-01-01

    PURPOSE OF REVIEW: Dementia is common in elderly patients, and anaesthesiologists are increasingly challenged in managing these patients who are especially vulnerable. The aim of this article is to highlight some of the most important perioperative issues relating to demented patients, both...... regarding anaesthesia and other aspects that should be considered to ensure a quick and uncomplicated recovery. RECENT FINDINGS: Demented patients often receive prescribed medication that can interact with various anaesthetic drugs and cause serious side effects. The anaesthesiologist should consider this...... preexisting cognitive impairment and several preventive measurements can be provided. SUMMARY: Outpatient surgery for demented patients causes many concerns in relation to anaesthesia. Extensive drug-related problems may arise and restrictive drug usage is recommended to avoid serious complications....

  12. Malnutrition secondary to non-compliance with vitamin and mineral supplements after gastric bypass surgery: What can we do about it?

    OpenAIRE

    Ahmad, Dina S.; Esmadi, Mohammad; Hammad, Hazem

    2012-01-01

    Summary Background: Nutritional deficiency due to loss of follow up and non-compliance with routine mineral and multivitamin supplements is not uncommonly encountered following bariatric surgery. In this report, and utilizing a case study, we will address issues related to loss of long term medical follow up and the measures that can be taken to prevent it in this patient population. Case Report: The case of a 38-year-old female patient who was recently managed for severe vitamin deficiency a...

  13. Jejunoileal bypass: A surgery of the past and a review of its complications

    OpenAIRE

    Singh, Dushyant; Laya, Alexandra S; Clarkston, Wendell K; Allen, Mark J

    2009-01-01

    Jejunoileal bypass (JIB), popular in the 1960s and 1970s, had remarkable success in achieving weight loss by creating a surgical short bowel syndrome. Our patient had an unusual case of liver disease and provided no history of prior bariatric surgery. Later, it was recognized that he had a JIB in the 1970s, which was also responsible for the gamut of his illnesses. Patients with JIB are often not recognized, as they died of complications, or underwent reversal of their surgery or a liver-kidn...

  14. Subcutaneous Venous Port Implantation in Patients with Bilateral Breast Surgery

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate the long-term follow-up results of subcutaneous venous ports implanted in patients with bilateral mastectomies. We retrospectively reviewed the hospital charts and the electronic database of 17 patients with bilateral mastectomies whom had venous port implantation in our interventional radiology suit. A total of 17 ports were implanted to the paramedian (n = 3) and anterolateral (standard; n = 12) chest wall, on the trapezius muscle (n = 1), and to the antecubital fossa (n = 1). The mean age was 48.29 years (range: 35-60 years). The mean time interval from time of surgery to port implantation was 34 months (range: 1-84 months). The mean follow-up time was 15 months (range: 7-39 months). Follow-up parameters and classification of the complications was defined according to the SIR guidelines. No procedure-related complication occurred. A single case of mild late infection was noted and the infection rate was 0.19/1000 catheter days. Infusion chemotherapy administration was still going on in eight patients. Two patients died during the follow-up and four patients were lost after 6 months. Port removal was performed in three patients at follow-up because of the end of treatment. One trapezius port and one paramedian port weres among the removed ports without any problem. Although we have a limited number of patients, port placement to the anterior chest wall, either paramedian or anterolateral, on the trapezius muscle or to the antecubital fossa depending on the extent of the bilateral breast surgeries that can be performed with low complication rates by a careful patient and anatomical location selection by involving the patients in the decision-making process. We believe that patient education and knowledge of possible complications have high importance in follow-up

  15. Patient with von Willebrand Disease for Gynaecologic Surgery - Perianaesthetic Concerns

    Directory of Open Access Journals (Sweden)

    Rakesh Garg

    2008-01-01

    Patients with vWD do not carry an increased operative risk during elective procedures if appropriate prophylac-tic and corrective therapy is administered. Although the administration of cryoprecipitate and other blood products has traditionally been the cornerstone of treatment for vWD, the recent development of desmopressin(DDAVP for clinical use may provide an effective alternative to replacement therapy with blood products. Further laparaoscopic procedures, taking care during ryle′s tube and foley′s catheter insertion, in such patients are the safer alternative for all kind of gynecologic surgeries.

  16. Optical coherence tomography in patients undergoing cataract surgery

    Directory of Open Access Journals (Sweden)

    Carlos Augusto Moreira Neto

    2015-08-01

    Full Text Available ABSTRACTPurpose:To assess the ability of spectral domain optical coherence tomography (SD-OCT to diagnose macular changes pre- and post-cataract surgery and to identify changes in central foveal thickness (CFT relative to age, sex, and presence of concomitant ophthalmic pathologies, for a period of 6 months post-surgery.Methods:A prospective study of patients evaluated by SD-OCT within 5 h before surgery at 7, 30, 60, 90, and 180 days post-op, with respect to CFT and presence of maculopathy.Results:Ninety-eight eyes of 98 patients were evaluated, with the following mean results: age = 71.4 years, pre-op VA = 0.27 logMAR, and final VA = 0.73 logMAR. There were 21 eyes in patients with diabetes mellitus (DM and 10 eyes with age-related macular degeneration (AMD, three with epiretinal membrane, and four with glaucoma. Sixty eyes had no other ophthalmic-related pathologies (NOO, and had a mean pre-op CFT of 222 μm, which progressively increased up to the 60thday post-op, reaching a mean of 227.2 μm. No pseudophakic cystoid macular edema was observed. The mean CFT was statistically significantly different (p<0.001 between NOO and diabetic patients from 30 days post-op. Four eyes presented with preoperative diagnosis of AMD as measured by ophthalmoscopy. After completion of the OCT, which was performed within 5 h before surgery, six additional patients were found to have AMD. Of the 98 total eyes, 10 were diagnosed with maculopathy only by OCT exam. Binocular indirect ophthalmoscopy (BIO was unable to detect such changes.Conclusion:OCT diagnosed preoperative maculopathies in 21.4% of the patients, and was more effective than BIO (11.2%. OCT showed a progressive increase in CFT in diabetics up to 180 days post-operatively, as well as greater CFT in male patients and patients older than 70 years.

  17. Bone and Soft Tissue Changes after Two-Jaw Surgery in Cleft Patients

    OpenAIRE

    Yun, Yung Sang; Uhm, Ki Il; Kim, Jee Nam; Shin, Dong Hyeok; Choi, Hyun Gon; Kim, Soon Heum; Kim, Cheol Keun; Jo, Dong In

    2015-01-01

    Background Orthognathic surgery is required in 25% to 35% of patients with a cleft lip and palate, for whom functional recovery and aesthetic improvement after surgery are important. The aim of this study was to examine maxillary and mandibular changes, along with concomitant soft tissue changes, in cleft patients who underwent LeFort I osteotomy and sagittal split ramus osteotomy (two-jaw surgery). Methods Twenty-eight cleft patients who underwent two-jaw surgery between August 2008 and Nove...

  18. Prediction of cardiac risk in patients undergoing vascular surgery

    Energy Technology Data Exchange (ETDEWEB)

    Morise, A.P.; McDowell, D.E.; Savrin, R.A.; Goodwin, C.A.; Gabrielle, O.F.; Oliver, F.N.; Nullet, F.R.; Bekheit, S.; Jain, A.C.

    1987-03-01

    In an attempt to determine whether noninvasive cardiac testing could be used to assess cardiac risk in patients undergoing surgery for vascular disease, the authors studied 96 patients. Seventy-seven patients eventually underwent major vascular surgery with 11 (14%) experiencing a significant cardiac complication. Thallium imaging was much more likely to be positive (p less than 0.01) in patients with a cardiac complication; however, there was a significant number of patients with cardiac complications who had a positive history or electrocardiogram for myocardial infarction. When grouped by complication and history of infarction, thallium imaging, if negative, correctly predicted low cardiac risk in the group with a history of infarction. Thallium imaging, however, did not provide a clear separation of risk in those without a history of infarction. Age and coronary angiography, on the other hand, did reveal significant differences within the group without a history of infarction. The resting radionuclide ejection fraction followed a similar pattern to thallium imaging. It is concluded that a positive history of myocardial infarction at any time in the past is the strongest risk predictor in this population and that the predictive value of noninvasive testing is dependent on this factor. Considering these findings, a proposed scheme for assessing risk that will require further validation is presented.

  19. Reasons for not performing keratorefractive surgery in patients seeking refractive surgery in a hospital-based cohort in "Yemen"

    Directory of Open Access Journals (Sweden)

    Bamashmus Mahfouth

    2010-01-01

    Full Text Available Background: To determine and analyze the reasons why keratorefractive surgery, laser in situ keratomileusis (LASIK and photorefractive keratectomy (PRK were not performed in patients who presented for refractive surgery consultation. Materials and Methods: A retrospective observational study was performed between January 2006 and December 2007 in the Yemen Magrabi Hospital. The case records of 2,091 consecutive new patients who presented for refractive surgery were reviewed. Information from the pre-operative ophthalmic examination, such as refractive error, corneal topography and visual acuity, were analyzed. The reasons for not performing LASIK and PRK in the cases that were rejected were recorded and analyzed. Results: In this cohort, 1,660 (79.4% patients were advised to have LASIK or PRK from the 2,091 patients examined. LASIK and PRK were not advised in 431 (21% patients. The most common reasons for not performing the surgery were high myopia >-11.00 Diopters (19%, keratoconus (18%, suboptimal central corneal thickness (15%, cataract (12% and keratoconus suspect (forme fruste keratoconus (10%. Conclusion: Patients who requested keratorefractive surgery have a variety of problems and warrant comprehensive attention to selection criteria on the part of the surgeon. Corneal topographies and pachymetry of refractive surgery candidates need to be read cautiously. High-refractive error, keratoconus and insufficient corneal thickness were found to be the leading reasons for not performing keratorefractive surgery in this study.

  20. Hydrosyringomyelia in an Ankylosing Spondylitis Patient After Stabilization Surgery

    Directory of Open Access Journals (Sweden)

    Deniz Oke Topcu

    2013-08-01

    Full Text Available Ankylosing Spondylitis (AS is a chronic, systemic, and autoimmune inflammatory disease which mainly affects axial skeleton. Despite current approaches in ankylosing spondylitis treatment, the disease frequently causes to thoracolumbar kyphotic deformity due to its progressive course. Many surgical procedures including decompression, stabilization and final fusion could be performed for the treatment of kyphotic deformity. Hydromyelia and syrinx are the terms used to define dilatation in central spinal cord. Some authors reported syringomyelia progression related to spinal operation. In our case; 48-year-old woman, who has been followed for ankylosing spondylitis; spinal cord injury secondary to syringomyelia was detected 7 years after stabilization surgery. Consequently, it should be kept in mind that syringomyelia, which is a rare complication, may develop in patients who underwent stabilization surgery.