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 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The epidemic of obesity in the United States has triggered an exponential increase in the number of bariatric procedures performed. This has led to an elevated awareness of the complications of bariatric surgery. Several recent studies have suggested that the mortality rate from bariatric surgery is substantially higher than previously stated, particularly in the elderly and disabled population. As more complications from bariatric surgery occur, general surgeons, primary care doctors and emergency room personnel may be increasingly called upon to diagnose and treat them. This review describes the most commonly seen complications of bariatric surgery including anastomotic leak, thromboembolism, stricture formation, internal hernia, ulcer formation, cholelithiasis, hemorrhage, nutritional and metabolic derangements. Additionally, complications specific to the adjustable gastric band are addressed. The etiology, diagnosis and management of these complications is discussed. The long-term viability of bariatric surgery as a treatment for severe obesity will depend upon the prevention and appropriate treatment of bariatric complications.
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PMID:Complications of bariatric surgery. 1687 Nov 44

Obesity surgery is becoming one of the most common general surgery procedures done in the United States. Internal hernias are a known and increasingly more common occurrence after laparoscopic roux-en-Y gastric bypass (LRYGB). Increased clinical awareness of this complication will lead to decreased surgical morbidity and mortality. We retrospectively reviewed our database of 529 patients who had undergone LRYGB from 2000 to 2005 and identified those presenting with intestinal obstruction from an internal hernia. The type of internal hernia (jejunojejunostomy, transverse mesocolon, roux limb mesentery [Peterson's hernia]), length of time from presentation to operative intervention, and length of stay were obtained for all patients. Of 529 laparoscopic retrocolic retrogastric LRYGBs, 13 internal hernias (2.5%) were identified in 13 different patients. Eight of the hernias were at the mesenteric defect created by the jejunojejunostomy (62%), 3 originated from the transverse mesocolon defect (23%), and 2 were a Peterson's hernia (15%). The median time from initial operation to repair was 150 days. The average time from presentation to operative repair was 29.2 hours (range, 5-67.5 hours). The median length of stay was 3 days (range, 1.5-45 days). Eleven hernias were repaired laparoscopically (85%). There were no mortalities associated with obstruction from the internal hernia. Intestinal obstruction from an internal hernia after LRYGB is becoming increasingly more common. General awareness of this condition and high clinical suspicion allow for prompt surgical intervention with decreased morbidity and mortality.
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PMID:Internal hernia: postoperative complication of roux-en-Y gastric bypass surgery. 1687 78

Bariatric surgery has evolved considerably since the introduction of jejunoileal bypass in the 1950s. With modifications of early procedures, implementation of new techniques, and establishment of minimally invasive approaches, operative intervention has become the mainstay in the treatment of extreme (class III) obesity. The laparoscopic adjustable gastric band technique is the most common purely restrictive procedure. Advantages of the laparoscopic adjustable gastric band include reduced perioperative morbidity and mortality compared to other bariatric procedures, but this procedure has been associated with substantial intermediate and long-term complications. Although vertical banded gastroplasty was associated with decreased perioperative morbidity and acceptable early weight loss, results from long-term follow-up have been discouraging. Roux-en-Y gastric bypass (RYGB) is the most common bariatric procedure performed in the United States because of its effectiveness in long-term weight loss and low rates of serious complications. Modifications of RYGB to induce malabsorption have led to greater weight loss but increased risks of metabolic and nutritional sequelae. Duodenal switch is a malabsorptive procedure associated with excellent weight loss and resolution of weight-related comorbidities, but concerns regarding potential metabolic and nutritional sequelae have limited its widespread use. Laparoscopic approaches to bariatric procedures have reduced wound-related complications and improved patient recovery. However, the incidence of anastomotic leak and internal hernia is higher after laparoscopic RYGB compared to the open approach. Each of the currently available bariatric procedures has both advantages and disadvantages that must be considered in determining which operation should be selected for an individual patient.
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PMID:Surgical approaches to obesity. 1703 75

Obesity continues to plague much of the western world. With the novel approach of laparoscopic sleeve gastrectomy (LSG), there are exciting results being reported in weight loss. One key problem in this patient population is hernia occurrences, particularly at the largest site where the specimen was retrieved. Using an interdisciplinary research design, a new technological breakthrough was proposed. A morcellator was introduced through the existing 15 millimeter (mm) incision to retrieve the resected portion of the stomach. This technology utilized widely by the obstetricians and gynecologists has been proven to retrieve specimens through smaller incisions fostering less pain, greater mobility, earlier discharge from hospitals--ultimately greater patient care. When applied to general bariatric surgery this technology is human centered, is exceedingly affordable, practical yet very forward looking. The morcellator's role in bariatric surgery is drawn from interdisciplinary communication regarding human technology, however the use of this innovative device has the potential to revolutionize the removal of resected specimens. The application of the morcellator in this regards has never been utilized to our knowledge.
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PMID:The utilization of a morcellator during laparoscopic sleeve gastrectomy. 1714 66

Necrotizing fasciitis is an acute surgical condition that demands prompt and multi-faceted treatment. Early recognition, aggressive surgical debridement, and targeted antibiotic therapy significantly affect the overall course of treatment and survival. The author reports here the case of a woman with necrotizing fasciitis of the abdominal wall and the course and methods of treatment. Two comorbidity factors (extreme obesity, diabetes) and the late diagnosis of necrotizing fasciitis, the latter masked by celullitis and phlegmona of the abdominal wall, resulted in overdue adequate surgical treatment. The combination of these factors contributed to medical treatment failure and, consequently, a lethal outcome.
Hernia 2007 Jun
PMID:Necrotizing fasciitis of the abdominal wall with lethal outcome: a case report. 1718 May 43

The authors examined risk factors for incident inguinal hernia among US adults (5,316 men and 8,136 women) participating in the First National Health and Nutrition Examination Survey (1971-1975) who were followed through 1992-1993 for a hospital (International Classification of Diseases, Ninth Revision, Clinical Modification, code 550) or physician diagnosis of inguinal hernia. Ninety-six percent of the baseline cohort was recontacted, with a median follow-up of 18.2 years (range, 0.02-22.1 years). Because the cumulative incidence of inguinal hernia was higher among men (13.9%) than among women (2.1%), more detailed analyses were conducted in men. Among men in multivariate analysis, a higher incidence (p < 0.05) of inguinal hernia was associated with an age of 40-59 years (hazard ratio (HR) = 2.2, 95% confidence interval (CI): 1.7, 2.8), an age of 60-74 years (HR = 2.8, 95% CI: 2.2, 3.6), and hiatal hernia (HR = 1.8, 95% CI: 1.2, 2.7), while Black race (HR = 0.58, 95% CI: 0.42, 0.79), being overweight (HR = 0.79, 95% CI: 0.66, 0.95), and obesity (HR = 0.51, 95% CI: 0.36, 0.71) were associated with a lower incidence. Among women, older age, rural residence, greater height, chronic cough, and umbilical hernia were associated with inguinal hernia. In the United States, inguinal hernias are common among men, especially with aging. The lower risk among heavier men was unexpected and bears further study.
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PMID:Risk factors for inguinal hernia among adults in the US population. 1737 52

Despite the advantages offered by laparoscopy in bariatric surgery, the incidence of a new complication that was uncommon in the previous era of open surgery--internal hernias--has increased. Most publications in the literature dealing with internal hernia describe the incidence and form of presentation of this entity but few explain how these complications can be prevented. In this review article we describe a technique to close mesenteric defects in retrocolic Roux-en-Y laparoscopic gastric bypass with permanent, continuous running suture (ethibond). We also review the literature in MEDLINE (www.ncbi.nlm.nih.gov/entrez/ using the key words: obesity, laparoscopy, gastric bypass, internal hernia, Petersen hernia) and references from articles of interest to determine the real incidence of this complication. Our technique has proven to be safe, reliable and reproducible and has greatly diminished the incidence of internal hernias. However, our data need to be analyzed in the future to determine whether the technique described eliminates this complication. The optimal results achieved with complete closure of all mesenteric defects have also been observed by other authors.
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PMID:[Mesenteric closure in laparoscopic gastric bypass: surgical technique and literature review]. 1778 39

Cystic renal lymphangiectasia (CRL) is a rare malformation of lymphatics that can present in childhood and adulthood. Symptoms and radiologic features are relatively well defined, but clinical evolution and prognosis remain unclear. We treated a boy with CRL who developed chronic renal insufficiency. The first manifestation was abdominal swelling associated with an umbilical hernia noted incidentally at 1.6 years. Computed tomography with intravenous contrast administration demonstrated perirenal cysts with fluid collection, suggesting CRL. Intractable ascites resisted pharmacologic treatments such as diuretics. After approximately 7 years, the ascites resolved spontaneously, but the perirenal cysts persisted. At 11 years, proteinuria was noted. A renal biopsy specimen showed interstitial abnormalities consistent with CRL, glomeruli showed a focal segmental mesangial increase. Proteinuria persisted despite administration of an angiotensin-converting enzyme inhibitor, increasing as obesity and hypertension worsened. Renal function gradually declined in the ensuing years. Polycythemia coexisted with a normal serum erythropoietin concentration. A follow-up renal biopsy specimen disclosed glomerular enlargement together with focal segmental mesangial expansion, suggesting obesity-related glomerulopathy. Our observation suggest that under some specific circumstances like our patient CRL may exacerbate. Management of complicating obesity and hypertension are likely to be important for maintaining normal renal function, especially in the diffuse bilateral type of CRL present in our patient.
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PMID:Chronic renal insufficiency in a boy with cystic renal lymphangiectasia: morphological findings and long-term follow-up. 1818 26

Achalasia and gastroesophageal reflux disease (GERD) represent diverse physiologic disorders both of which result from lower esophageal sphincter (LES) dysfunction. Fortunately, both diseases are benign and amenable to surgically corrective therapies. Achalasia is characterized by destruction of the smooth muscle ganglion cells of the myenteric plexus (Auerbach) resulting in motor dysfunction, incomplete LES relaxation, and progressive esophageal dilation. GERD is frequently characterized by hypotonia or shortening of the LES. Local anatomical derangements such as a hiatal hernia (eg, sliding type I hernia) can predispose to GERD. Other predisposing factors for GERD include obesity, smoking, alcohol, and pregnancy. Transient LES relaxation is the most significant factor in the development of GERD. Transient LES relaxations last from 10 to 45 seconds and are not related to swallowing. The diagnostic workup of achalasia and GERD may include barium esophagram, upper gastrointestinal endoscopy, pH monitoring, and esophageal manometry. The different medical treatment options for achalasia comprise pharmacologic treatment, botulinum toxin, and balloon dilation. Surgical interventions include Heller myotomy, which is usually combined with a partial fundoplication. GERD is managed by treating the predisposing factors, using medications (ie, anatacids or proton pump inhibitors) and surgery (ie, fundoplication). Recently, endoluminal therapy has been employed in the treatment of GERD with promising short-term results.
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PMID:Recent advances in the surgical treatment of achalasia and gastroesophageal reflux disease. 1836 81

Morgagni hernia is a disease in which the abdominal contents herniate into the thoracic cavity through a congenital parasternal defect of the diaphragm resulting from an increased intra-abdominal pressure. Obesity, pregnancy, and a history of trauma are considered predisposing factors of Morgagni hernia. However, there is slight evidence that trauma has been the factor. Moreover, Morgagni hernia related to an operation has been rarely reported. We report a case of a female patient, whose mediastinal tumor had been removed 6 months prior to her being diagnosed with postoperative Morgagni hernia. There was a satisfactory result after the repair by an upper abdominal incision.
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PMID:A Morgagni diaphragmatic hernia found after removal of mediastinal tumor. 1857 97


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