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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Gastric bypass as a 90 per cent gastric exclusion operation was used in 393 patients with massive obesity to limit food intake. Stomal ulcer has occurred in 1.8 per cent of such patients or one ulcer per 140 man years of observation. The studies of indwelling fundic pH and of gastric acid secretion from the excluded stomach indicate that acid secretion is reduced after gastric bypass but that the acid, unbuffered by food in the excluded stomach, results in a lowered gastrin secretion after a meal. Thus, gastric bypass in inhibitory to acid secretion in most morbidly obese patients who do not have known acid peptic disease.
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PMID:Effect of gastric bypass on gastric secretion. 125 57

Fiberoptic endoscopy is an important diagnostic modality for evaluating the patient with upper gastrointestinal tract symptoms following gastric restrictive operations. The specific indications for endoscopy after obesity surgery include stoma evaluation in patients who fail to lose adequate weight; stomal stenosis; esophagitis; surveillance of the excluded pouch; and suspicion of a marginal ulcer after gastric bypass.
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PMID:The use of endoscopy after gastric partitioning for morbid obesity. 331 8

Severe obesity is associated with a number of co-morbidities. Medical weight reduction programs have not been proven to have long-term efficacy for these severely obese patients. Surgically induced weight loss has been found to completely reverse or markedly ameliorate obesity-related problems. Gastric bypass has been found to provide significantly more weight loss than a purely restrictive procedure such as a vertical banded gastroplasty or adjustable silicone gastric banding. Gastric bypass may be associated with micronutrient deficiencies such as iron, vitamin B(12), and calcium. These patients require life-long supplementation. Laparoscopic gastric bypass has been shown to be feasible and safe and equivalent to the weight loss seen following open gastric bypass. The mortality in most series of gastric bypass surgery, whether open or laparoscopic, is <1%. Problems of stomal stenosis and marginal ulcer can almost always be treated medically with endoscopic dilatation or acid suppression therapy, respectively.
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PMID:Gastric bypass surgery for severe obesity. 1215 50

Obesity is a serious health problem in the United States today, and surgical treatment is recognized as long-term effective therapy. Minimally invasive techniques are becoming the "gold standard" approach to the treatment of disease, and robotic surgery has the potential to advance the use and development of minimally invasive procedures. In this article, we report our experience using robotically assisted technology to perform bariatric surgery. From mid 2002 to early 2004, 110 robotically assisted Roux-en-Y gastric bypass and 32 robotically assisted gastric banding procedures were performed at our institution. The mean preoperative body mass index was 46 for the patients receiving Roux-en-Y gastric bypass and 49 for the patients receiving gastric banding. The mean length of stay was 2.1 days and 1 day for patients in the 2 respective groups. There were 3 strictures in the Roux-en-Y group and 1 marginal ulcer in the gastric banding group; no leaks were observed in any patients in either group. There was 1 conversion to a laparoscopic procedure in the Roux-en-Y gastric bypass group. We conclude that robotically assisted bariatric surgery will allow more surgeons to offer patients the same safety and successful outcomes currently available through open techniques but without the significant morbidities of large surgical wounds.
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PMID:Robotically assisted bariatric surgery. 1547 50

Leaks are the most frequent early postoperative complication in the two most popular bariatric procedures, Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy. Multimodal therapy based on self-expandable stent insertion 'to cover' the defect is the most widely documented technique to date with a reported success rate >80%. Additional experimental techniques 'to close' the defect or 'to drain' the paradigestive cavity have been reported with encouraging results. The role of endoscopy in early postoperative bleeding is limited to management of bleeds arising from fresh sutures and the diagnosis of chronic sources of bleeding such as marginal ulcer after RYGB. Post-RYGB stricture is a more delayed complication than leaks and the role of endoscopic dilation as a first-line treatment in this indication is well documented. Ring and band placement are outdated procedures for obesity treatment, but might still be an indication for endoscopic removal, a technique which does not compromise further surgery, if needed.
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PMID:Major complications of bariatric surgery: endoscopy as first-line treatment. 2634 62

Archaic surgical procedures such as the jejunoileal bypass, vertical banded gastroplasty and duodenal switch have contributed to the current best practice of Roux-en-Y gastric bypass (RYGB) procedure for the treatment of obesity and its consequences. Despite this, RYGB has been blighted with late occurring adverse events such as severe malnutrition, marginal ulcer and reactive hypoglycemia. Despite this, RYGB has given us an opportunity to examine the effect of surgery on gut hormones and the impact on metabolic syndrome which in turn has allowed us to carry out a lower impact but equally, if not more effective, procedure - the vertical sleeve gastrectomy (VSG). We examine the benefits of sleeve gastrectomy from the less challenging technical aspect to the effect on obesity and its metabolic syndrome long-term and have concluded that sleeve gastrectomy is possibly the next current best practice.
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PMID:The future of the Roux-en-Y gastric bypass. 2702 14

Bariatric and metabolic surgery has become the clinical hot topic of the treatment of metabolic syndromes including obesity and diabetes mellitus, but how to choose the appropriate surgical procedure remains the difficult problem in clinical practice. Clinical guidelines of American Society for Metabolic and Bariatric Surgery(ASMBS)(version 2013) introduced the procedures of bariatric and metabolic surgery mainly including biliopancreatic diversion with duodenal switch(BPD-DS), laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy(LSG). To choose the appropriate bariatric and metabolic procedure, the surgeons should firstly understand the indications and the contraindications of each procedure. Procedure choice should also consider personal condition (body mass index, comorbidities and severity of diabetes), family and socioeconomic status (postoperative follow-up attendance, understanding of potential surgical risk of gastrectomy and patient's will), family and disease history (patients with high risk of gastric cancer should avoid LRYGB; patients with gastroesophageal reflux disease should avoid LSG) and associated personal factors of surgeons. With the practice of bariatric and metabolic surgery, the defects, especially long-term complications, of different procedures were found. For example, LRYGB resulted in higher incidence of postoperative anemia and marginal ulcer, high risk of gastric cancer as well as the requirement of vitamin supplementation and regular follow-up. Though LSG has lower surgical risk, its efficacy of diabetes mellitus remission and long-term weight loss are inferior to the LRYGB. These results pose challenges to the surgeons to balance the benefits and risks of the bariatric procedures. A lot of factors can affect the choice of bariatric and metabolic procedure. Surgeons should choose the procedure according to patient's condition with the consideration of the choice of patients. The bariatric and metabolic surgery not only manages the diabetes mellitus and weight loss, but also results in the reconstruction of gastrointestinal tract and side effect. Postoperative surgical complications and nutritional deficiency should also be considered. Thereby, individualized bariatric procedure with the full consideration of each related factors is the ultimate objective of bariatric and metabolic surgery.
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PMID:[Choice of bariatric and metabolic surgical procedures]. 2844 May 18

Surgical operation in treating obesity and type 2 diabetes is popularizing rapidly in China. Correct prevention and recognition of perioperation-related operative complications is the premise of ensuring surgical safety. Familiar complications of the operation include deep venous thrombosis, pulmonary artery embolism, anastomotic bleeding, anastomotic fistula and marginal ulcer. The prevention of deep venous thrombosis is better than treatment. The concrete measures contain physical prophylaxis (graduated compression stocking and intermittent pneumatic compression leg sleeves) and drug prophylaxis (unfractionated heparin and low molecular heparin), and the treatment is mainly thrombolysis or operative thrombectomy. The treatment of pulmonary artery embolism includes remittance of pulmonary arterial hypertension, anticoagulation, thrombolysis, operative thrombectomy, interventional therapy and extracorporeal membrane oxygenation (ECMO). Hemorrhage is a rarely occurred but relatively serious complication after bariatric surgery. The primary cause of anastomotic bleeding after laparoscopic gastric bypass is incomplete hemostasis or weak laparoscopic repair. The common bleeding site in laparoscopic sleeve gastrectomy is gastric stump and close to partes pylorica, and the bleeding may be induced by malformation and weak repair technique. Patients with hemodynamic instability caused by active bleeding or excessive bleeding should timely received surgical treatment. Anastomotic fistula in gastric bypass can be divided into gastrointestinal anastomotic fistula and jejunum-jejunum anastomotic fistula. The treatment of postoperative anastomotic fistula should vary with each individual, and conservative treatment or operative treatment should be adopted. Anastomotic stenosis is mainly related to the operative techniques. Stenosis after sleeve gastrectomy often occurs in gastric angle, and the treatment methods include balloon dilatation and stent implantation, and surgical treatment should be performed when necessary. Marginal ulcer after gastric bypass is a kind of peptic ulcer occurring close to small intestine mucosa in the junction point of stomach and jejunum. Ulcer will also occur in the vestige stomach after laparoscopic sleeve gastrectomy, and the occurrence site locates mostly in the gastric antrum incisal margin. Preoperative anti-HP (helicobacter pylorus) therapy and postoperative continuous administration of proton pump inhibitor (PPI) for six months is the main means to prevent and treat marginal ulcer. For patients on whom conservative treatment is invalid, endoscopic repair or surgical repair should be considered. Different surgical procedures will generate different related operative complications. Fully understanding and effectively dealing with the complications of various surgical procedures through multidisciplinary cooperation is a guarantee for successful operation.
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PMID:[Prevention, diagnosis and treatment of perioperative complications of bariatric and metabolic surgery]. 2844 May 19