Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
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Surg Obes Relat Dis · Nov 2013
Overcoming the learning curve of laparoscopic Roux-en-Y gastric bypass: a 12-year experience.
Surgical treatment of morbid obesity with laparoscopic Roux-en-Y gastric bypass (LRYGB) is technically challenging and involves high-risk patients. In this study, the short-term outcome of LRYGB in a large population of patients has been evaluated, and morbimortality before and after overcoming the learning curve has been assessed. The objective of this study was to establish the learning curve for laparoscopic Roux-en-Y gastric bypass. ⋯ Operating time and risks of adverse outcome were significantly reduced after a long learning curve of 500 consecutive procedures. The number of surgeries performed and the standardization of the laparoscopic technique used were the main factors contributing to the low rates of postoperative complications, mortality, and conversion.
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Surg Obes Relat Dis · Nov 2013
Comparative StudyIs selection bias toward super obese patients in the rationing of metabolic surgery justified?--A pilot study from the United Kingdom.
Recent evidence suggests that National Health Service (NHS) rationing of bariatric surgery is biased toward super-obese patients without scientific basis. The aim of this study was to compare health, quality of life, and employment outcomes in morbidly obese (MO) versus super-obese (SO) patients after laparoscopic Roux-en-Y gastric bypass (LRYGB) to provide a basis for rationing. ⋯ These results suggest that MO patients appear to benefit more than SO patients from LRYGB and yet seem to be disadvantaged in some NHS Trusts in the United Kingdom for access to bariatric surgery. This study provides a baseline framework for further research to generate evidence for more scientific rationing of bariatric surgery.
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Morbidly obese patients commonly have gastroesophageal reflux (GERD) and associated hiatal hernias. As such, some surgeons routinely perform a concomitant hiatal hernia repair during bariatric surgery. However, the intraoperative inspection for a hiatal hernia based on laparoscopic visualization can be misleading. The aim of this study was to assess the prevalence of hiatal hernias in morbidly obese patients based on preoperative upper gastrointestinal (GI) contrast study. ⋯ Based on upper GI contrast study, we identified the presence of a hiatal hernia in nearly 40% of morbidly obese patients. The results from this study suggest that surgeons should evaluate the morbidly obese patient for the presence of hiatal hernias and perform concomitant repair at the time of the bariatric procedure, particularly in patients undergoing gastric banding and sleeve gastrectomy, while less so in the gastric bypass patient.
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Surg Obes Relat Dis · Nov 2013
Observational StudyManagement of iron deficiency and anemia after Roux-en-Y gastric bypass surgery: an observational study.
Iron deficiency (ID) is common after Roux-en-Y gastric bypass surgery (RYGB). Optimal iron management in this population is unclear. The objective of this study was to assess our management of RYGB patients with ID and anemia. ⋯ Iron management was inadequate. Hematologic values often were deficient for sustained periods. Initially, few patients received intravenous iron after oral iron failure, many received no iron supplementation, and there was high use of blood transfusions. Subsequently, administration of intravenous iron was beneficial.