Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
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Surg Obes Relat Dis · Apr 2019
Randomized Controlled TrialA randomized control trial using intraoperative dexmedetomidine during Roux-en-Y gastric bypass surgery to reduce postoperative pain and narcotic use.
Dexmedetomidine (DMET), a selective a2-adrenergic agonist, is an opioid-sparing adjuvant sedative that avoids respiratory depression and has been shown to be beneficial in bariatric surgery patients. Although benefit has been shown, prior studies have not evaluated the pain control effects of a single intraoperative bolus. ⋯ A single bolus of DMET (1 mg/kg delivered over 10 min) administered at the time of surgical closure did not reduce immediate PACU usage of opioids but significantly reduced reported pain scores and caused a significant decrease in the number of attempts made by patients; this is a trend of decreased attempts over time (P = .04) in the DMET group. The trend of the mean total medication used over time indicates that there is neither an increasing nor decreasing trend for the DMET group, but there is an increasing trend in the total used over time for the placebo group. There was no statistically or clinically significant bradycardia, hypotension, hypoxia, respiratory depression intraoperative duration, or PACU stay. Reduced single bolus dosing of DMET required for analgesia in bariatric surgery patients is optimal from physiologic, level of care, and cost perspectives.
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Surg Obes Relat Dis · Apr 2019
The impact of socioeconomic factors on the early postoperative complication rate after laparoscopic gastric bypass surgery: A register-based cohort study.
Socioeconomic factors may influence the outcome of certain surgical procedures, but it is not known whether such factors influence the risk for postoperative complication after bariatric surgery. ⋯ Socioeconomic factors influence the risk for early postoperative complication after laparoscopic gastric bypass surgery. The impact is not enough to exclude patients from surgery, but they must be taken into account in preoperative risk assessment.
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Surg Obes Relat Dis · Mar 2019
Comparative Study Observational StudyTen-year outcomes after Roux-en-Y gastric bypass and sleeve gastrectomy: an observational nonrandomized cohort study.
Sleeve gastrectomy (SG) has replaced Roux-en-Y gastric bypass (RYGB) as the most commonly performed bariatric surgery procedure. Data on the long-term (up to 10 yr) outcomes after SG is scarce. No previous study has compared the long-term outcomes between RYGB and SG. ⋯ This study suggested comparable effectiveness between SG and RYGB on weight loss.
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Surg Obes Relat Dis · Mar 2019
The influence of staple height on postoperative complication rates after laparoscopic gastric bypass surgery using linear staplers.
The use of circular staplers with a low staple height is associated with a lower risk for complication when used to construct the gastroenterostomy in laparoscopic gastric bypass surgery. The influence of staple height on outcome when using linear staplers has not been studied. ⋯ The use of low staple height for construction of the gastric pouch and gastroenterostomy in laparoscopic gastric bypass surgery was associated with lower complication rates.
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Surg Obes Relat Dis · Feb 2019
Randomized Controlled TrialImpact of implementation of an enhanced recovery after surgery (ERAS) program in laparoscopic Roux-en-Y gastric bypass: a prospective randomized clinical trial.
The essence of enhanced recovery after surgery (ERAS) program is the multimodal approach, and many authors have demonstrated safety and feasibility in fast-track bariatric surgery. ⋯ The implementation of an ERAS protocol was associated with lower postoperative pain, reduced incidence of postoperative nausea or vomiting, lower levels of acute phase reactants, and earlier hospital discharge. Complications, reinterventions, mortality, and readmission rates were similar to that obtained after a standard care protocol.