Obesity surgery
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Review
Animal models in bariatric surgery--a review of the surgical techniques and postsurgical physiology.
Bariatric surgery is considered the most effective current treatment for morbid obesity. Since the first publication of an article by Kremen, Linner, and Nelson, many experiments have been performed using animal models. The initial experiments used only malabsorptive procedures like intestinal bypass which have largely been abandoned now. ⋯ We have also reviewed the anatomy and physiology of animal models. We have reviewed the literature and presented it such that it would be a reference to an investigator interested in animal experiments in bariatric surgery. Experimental animal models are further divided into two categories: large mammals that include dogs, cats, rabbits, and pig and small mammals that include rats and mice.
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Type 2 diabetes mellitus being one of the most prevalent diseases in the world has led to a variety of research using animal models. This review focuses on various rat models to study the effect that surgical procedures have on type 2 diabetes mellitus and obesity. Rat models can be classified as Obese Diabetic, Non-Obese Diabetic, Obese Non-Diabetic, and Non-Obese Non-Diabetic. Here, we have discussed the particular characteristics of each rat so that it can provide the appropriate model to study different pathological processes involve in type 2 Diabetes and obesity.
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Restrictive bariatric procedures are frequently considered for patients with morbid obesity, because the weight loss and reduction of comorbidities are good. An impact on gastroesophageal reflux disease (GERD), which is common in this population, may be anticipated. Converse results of GERD symptoms are reported for patients after adjustable gastric banding (AGB), sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGBP). ⋯ Preoperative esophageal manometry is advised for restrictive procedures such as AGB and SG.
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Review
Challenges in pulmonary risk assessment and perioperative management in bariatric surgery patients.
Bariatric surgery has serious associated medical comorbidity and procedure-related risks and is, thus, considered an intermediate-to-high-risk non-cardiac surgery. Altered respiratory mechanics, obstructive sleep apnea (OSA), and less often, pulmonary hypertension and postoperative pulmonary embolism are the major contributors to poor pulmonary outcomes in obese patients. ⋯ Suspected OSA patients requiring intravenous narcotics should be kept in a monitored setting with frequent assessments and naloxone kept at the bedside. Use of reverse Tredelenburg position, preinduction, maintenance of positive end-expiratory pressure, and use of continuous positive airway pressure can help improve oxygenation in the perioperative period.