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Sleeve Gastrectomy (sleeve + gastrectomy)
Kinds of Sleeve Gastrectomy Selected AbstractsBT02 LAPAROSCOPIC SLEEVE GASTRECTOMY AS A SINGLE-STAGE BARIATRIC PROCEDUREANZ JOURNAL OF SURGERY, Issue 2009T. Sammour Purpose: , Laparoscopic sleeve gastrectomy is increasingly being recognised as a stand-alone procedure in bariatric surgery, with long term follow-up data now emerging. We present our early experience patients with a mean BMI in the super-obese range. Methodology: , Retrospective review of laparoscopic sleeve gastrectomies performed by two surgeons at Middlemore Hospital, between March 2007 and July 2008. Results: , One hundred and one patients were identified, with a mean age of 42.7 years (95% CI 40.9,44.5). Maori and Pacific Islanders made up 31% of the patient subset. Patients had a mean BMI of 50.2 kg/m2 (95% CI 48.8,51.7), and 45 patients were super-obese. They had a median hospital stay of 2 days (1,7 days), and a mean follow-up of 6.0 months. Mean excess BMI loss (excluding patients with a major complication) was 46% (95% CI 43.3,48.7). 64% of diabetics and 37% of hypertensives showed in an improvement in medication requirement. There was a major complication rate of 8%, including 3 staple line leaks (one of which required laparotomy), 2 staple line bleeds (one requiring laparotomy), 1 infected haematoma, and 1 critical stricture. There were no deaths. Conclusion: , Laparoscopic sleeve gastrectomy has achieved satisfactory weight-loss results with an acceptable complication rate in the short to medium term. [source] Bariatric surgery vs. advanced practice medical management in the treatment of type 2 diabetes mellitus: rationale and design of the Surgical Therapy And Medications Potentially Eradicate Diabetes Efficiently trial (STAMPEDE)DIABETES OBESITY & METABOLISM, Issue 5 2010Sangeeta R. Kashyap Obesity and Type 2 diabetes mellitus (T2DM) are closely interrelated, and are two of the most common chronic, debilitating diseases worldwide. Surgical approaches to weight loss (bariatric surgery) result in marked improvement of T2DM, however randomized trials directly comparing the efficacy of surgical and medical approaches are lacking. The Surgical Therapy and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial was designed to evaluate the efficacy of two bariatric surgery procedures involving gastric restriction only (laparascopic sleeve gastrectomy) and gastric bypass (Roux-en-Y) to advanced medical therapy in patients with T2DM with modest obesity with BMI of 27,42 kg/m2. This single site, prospective, randomized controlled trial will enroll 150 subjects who will be followed. The primary end point will be the rate of biochemical resolution of T2DM at 1 year as measured by HbA1c < 6%. The safety and adverse event rates will also be compared between the three arms of the study. [source] Endoscopic fibrin sealing of gastrocutaneous fistulas after sleeve gastrectomy and biliopancreatic diversion with duodenal switchJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2008Theodossis S Papavramidis Abstract Background and Aim:, Gastrocutaneous fistulas (GCF) are uncommon complications accounting for 0.5,3.9% of gastric operations. When their management is not effective, the mortality rate is high. This study reports the conservative treatment of GCF in morbidly obese patients who underwent biliopancreatic diversion with duodenal switch. Methods:, Ninety-six morbidly obese patients were treated in our department with biliopancreatic diversion with duodenal switch (Marceau technique) and, in six of them, a high-output GCF developed. A general protocol was applied to all patients presenting a GCF. Everyone was treated by total parenteral nutrition (TPN) and somatostatin for at least 7 days after the appearance of the leak. If the leak continued, then fibrin glue was used as a tissue adhesive. Endoscopic application of the sealant was accomplished under direct vision via a double-lumen catheter passed through a forward-viewing gastroscope. Results:, All patients were treated successfully with conservative treatment (either solely with TPN and somatostatin, or with endoscopic fibrin sealing sessions). No evidence of fistula was observed at gastroscopy 3 and 24 months after therapy. Conclusion:, The conservative treatment of GCF following biliopancreatic diversion with duodenal switch is highly effective. All patients should enter a protocol that includes TPN and somatostatin. When the GCF persist, endoscopic sealing glue should be considered before operation because it is simple, safe, effective and, in some cases, life-saving. Therefore, conservative treatment should be employed as a therapeutic option in GCF developing after bariatric surgery. [source] Perspective on biomaterials used in the surgical treatment of morbid obesityOBESITY REVIEWS, Issue 3 2009J. A. Henry Summary Morbid obesity is defined as having a body mass index greater than or equal to 40.0 kg m,2, or 37.0 kg m,2 with comorbidities. Bariatric surgery remains the most effective treatment for morbid obesity. Bariatric procedures such as sleeve gastrectomy, vertical banded gastroplasty and adjustable gastric banding all generate excess body-weight loss typically over 3,5 years. The biomaterials used during these procedures, namely silicone, polypropylene, expanded polytetrafluoroethylene and titanium, are all non-degradable biomaterials. Hence, their presence in vivo exceeds the functional requirement of an implant to treat morbid obesity. Accordingly, research into non-invasive and reversible surgical procedures has increased, particularly in light of the dramatic increase in paediatric obesity. Tissue engineering is an alternative approach to treat morbid obesity, as it incorporates both engineering and biological principles into the design and development of an implant to surgically treat morbid obesity. It is hypothesized that a biodegradable polymer to treat morbid obesity could be developed to effectively promote excess weight loss. The aim of this review is to discuss morbid obesity with regards to its aetiology, prevalence and current modalities of treatment. Specifically, the shortcomings of the biomaterials currently used to surgically treat morbid obesity shall be reviewed, and alternative biomaterials shall be proposed. [source] BT02 LAPAROSCOPIC SLEEVE GASTRECTOMY AS A SINGLE-STAGE BARIATRIC PROCEDUREANZ JOURNAL OF SURGERY, Issue 2009T. Sammour Purpose: , Laparoscopic sleeve gastrectomy is increasingly being recognised as a stand-alone procedure in bariatric surgery, with long term follow-up data now emerging. We present our early experience patients with a mean BMI in the super-obese range. Methodology: , Retrospective review of laparoscopic sleeve gastrectomies performed by two surgeons at Middlemore Hospital, between March 2007 and July 2008. Results: , One hundred and one patients were identified, with a mean age of 42.7 years (95% CI 40.9,44.5). Maori and Pacific Islanders made up 31% of the patient subset. Patients had a mean BMI of 50.2 kg/m2 (95% CI 48.8,51.7), and 45 patients were super-obese. They had a median hospital stay of 2 days (1,7 days), and a mean follow-up of 6.0 months. Mean excess BMI loss (excluding patients with a major complication) was 46% (95% CI 43.3,48.7). 64% of diabetics and 37% of hypertensives showed in an improvement in medication requirement. There was a major complication rate of 8%, including 3 staple line leaks (one of which required laparotomy), 2 staple line bleeds (one requiring laparotomy), 1 infected haematoma, and 1 critical stricture. There were no deaths. Conclusion: , Laparoscopic sleeve gastrectomy has achieved satisfactory weight-loss results with an acceptable complication rate in the short to medium term. [source] Initial experience in laparoscopic sleeve gastrectomy for Japanese morbid obesityASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 3 2009M Ohta Abstract Introduction: We evaluated the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) in Japanese patients with morbid obesity. Materials and Methods: Between June 2006 and March 2009, seven morbidly obese Japanese patients (four women, three men; mean age 36±12 years; mean body mass index (BMI) 51±3 kg/m2) underwent LSG at our institute. The inclusion criteria were morbid obesity (BMI>35 kg/m2), the presence of obesity-related disorders, and failure to lose weight while using other medical therapies for at least 6 months. The criteria also included contraindications for laparoscopic adjustable gastric banding or super-obesity (BMI>50 kg/m2). LSG was carried out using endoscopic linear staplers from the greater curvature of the antrum 6,7 cm proximal to the pyloric ring to the angle of His alongside a 32-Fr endoscope or a 45-Fr overtube of the endoscope. Results: In all of the patients, LSG was successfully performed without open conversion. There were no serious postoperative complications and there was no mortality. The mean weight loss and percent excess weight loss after LSG were 33±8 kg and 47±16% at 6 months, and then 44±16 kg and 63±30% at 12 months. Due to the weight loss, the resolution and improvement rates of comorbidities in the five patients followed up for >3 months were 100% and 100% in type 2 diabetes, 67% and 100% in hypertension, 60% and 100% in dyslipidemia, and 100% and 100% in metabolic syndrome. Discussion: Although further long-term studies are necessary with regard to weight maintenance, LSG is a feasible and safe treatment for Japanese patients with morbid obesity. [source] Laparoscopic obesity surgery in an Asian Institute: A 10-year prospective study with review of literatureASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 2 2009Wei-Jei Lee Abstract Objective: Obesity surgery is the most effective treatment for morbid obesity and leads to dramatic improvement in related co-morbidities. The aim of this study was to present the long-term results of a prospective trial studying the efficacy of laparoscopic obesity surgery in a group of oriental patients. Method: From April 1998 to March 2009, 2385 patients who underwent obesity surgery in a single bariatric center in Asia were recruited. Various procedures have been adopted so far, including laparoscopic vertical banded gastric partition in 652 patients (27.3%), laparoscopic gastric bypass (LGB) in 1228 patients (51.5%), laparoscopic adjustable gastric banding in 226 patients (9.5%), laparoscopic sleeve gastrectomy in 128 patients (5.4%), gastric balloon in 68 patients (2.8%) and laparoscopic revision surgery in 83 patients (3.5%). We evaluated the clinical data and effect of obesity surgery on different procedures. Results: Overall, the major complication rate and mortality were 1.5% and 0.12%. There was an increase of surgical risk in laparoscopic sleeve gastrectomy and laparoscopic revision surgery patients. The mean total weight loss for the population was 28.1%, 33.9%, 21.3% 18.7% and 17.4% at 1, 3, 5, 7 and 9 years after surgery, respectively. LGB had a better weight loss (30.1%) than that of the restrictive-type procedures (20.9%) at 5 years after surgery. After surgery, most of the obesity-associated co-morbidities were resolved or improved in these patients. Conclusion: Laparoscopic obesity surgery resulted in significant and sustained weight loss in morbidly obese Asian patients with resolution of associated co-morbidities. LGB had a better result in weight reduction than other restrictive procedures. [source] Hormonal control of diabetes type 2 after surgery: Clinical and experimental evaluationASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 1 2009EE Frezza Abstract Diabetes mellitus (DM) type 2 now afflicts over 170 million people worldwide, a number expected to surpass 220 million by 2010. DM and its associated complications is a significant burden to public health care funding. In 2007, $US174 billion was spent in the United States, according to the American Diabetic Society. The morbidly obese have high serum leptin and insulin levels and low ghrelin levels, which have been associated with altered satiety. Exercise, medical therapy and dieting usually do not result in long-term weight loss or euglycemia. Bariatric surgery yields euglycemia for many patients, but its mechanism has yet to be fully elucidated. Our preliminary studies showed resolution of DM after both gastric bypass (GBP) and sleeve gastrectomy (SG), more so than after gastric banding. GBP significantly reduces ghrelin levels in the morbidly obese, perhaps as a result of exhausting ghrelin production in the stomach. A reduction in serum ghrelin levels would be expected after SG, which extirpates the ghrelin-producing cells by removing the fundus. This question has not, to our knowledge, been fully explored with regard to the relationship between ghrelin and other hormones. [source] | ||||||||||