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Query: UMLS:C0019209 (hepatomegaly)
 5,798 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Endoscopic gastrostomy is one procedure that is recommended for feeding or for gastric drainage, when the permanence of the feeding tube is required for a long time. This has arisen as a better alternative than surgical gastrostomy, because of its simplicity, efficiency, lower costs, and scarce morbidity-mortality. The most commonly recommended technique consists of gastric punction by percutaneous route and traction of the feeding tube from the mouth with the aid of an endoscopy. The indications are the necessity of feeding patients in a critical state who have gastric disorders and in whom prolonged gastric suction is required. It is contraindicated in morbid obesity, tension ascites, distension of intestinal loops, gastric carcinoma, pyloric obstruction, liver cirrhosis, previous gastric resective surgery, very voluminous hepatomegaly, and in patients who have had previous high abdominal surgery and who are suspected of having many loop adherences. The procedure may not be carried out when there exists the impossibility of passing the endoscope to the stomach. Complications occur is nearly 5% of the patients, and consist of wound infection due to the dragging of the oropharynx, periostomal leaks, peritonitis, gastrocolic fistulas, and pneumonia by aspiration. Mortality occurs in some 2%.
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PMID:[Endoscopic gastrostomy]. 1006 25

Mortality has been reported to complicate gastric bypass, with common causes of death attributable to anastomotic leaks, sepsis, hemorrhage, and bowel obstruction. We evaluated autopsy reports from 10 patients having undergone gastric bypass. Medical records were reviewed to identify comorbidities. Data of interest included preoperative electrocardiogram (EKG) abnormalities, cause of death, body weight, anastamosis appearance, heart weight, extent of coronary artery disease, ventricular size, liver weight, and gall bladder status. A total of 7 men and 3 women were autopsied. Average age was 40 years (range, 30-49 years), and mean body mass index at autopsy was 60.3 kg/m(2) (range, 33.2-80.9 kg/m(2)). Evidence of anastomotic leaks was present in 7 cases, resulting in 4 deaths. Death was attributed to pulmonary embolism in one case. There were 5 cardiac-related deaths, all attributed to arrhythmias. Microscopic evidence of coronary artery disease was observed in 6. Cardiomegaly was seen in all patients, left ventricular hypertrophy in 8, right ventricular hypertrophy in 3, and hepatomegaly in all 10. Nine patients were status post cholecystectomy. Of the 8 preoperative EKG available, abnormalities were identified in 5. After gastric bypass, death was attributed to cardiac-related causes, pulmonary embolism, and operative complications. A significant proportion of cardiac-related deaths occured in the absence of atherosclerosis. Most patients had preoperative EKG abnormalities. As a high incidence of cardiomegaly was observed, operative stress associated with the procedure may increase the risk of arrhythmia in morbid obesity. Consequently, in morbidly obese patients, a detailed preoperative cardiovascular evaluation is warranted to reduce postoperative mortality.
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PMID:Postmortem findings in morbidly obese individuals dying after gastric bypass procedures. 1723 34

Surgical treatment of morbid obesity continues to increase in popularity. The evolution of laparoscopic techniques has in part fueled that popularity. A common obstacle in achieving exposure of the angle of His during a laparoscopic Roux-en-Y gastric bypass is a massively enlarged liver. Exposure of the angle of His is key to successfully creating the gastric pouch and completing the gastrojejunostomy. Several well-described techniques exist to achieve this exposure but suffer from potential draw backs such as bleeding and the need to insert additional trocars. We describe a technique that allows safe, excellent exposure of the gastroesophageal junction during laparoscopic Roux-en-Y gastric bypass.
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PMID:Ante-hepatic gastrojejunostomy. 1842 92