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

Abdominal wound dehiscence is a surgical complication with a high morbidity rate but which is associated with predictable and preventable factors. During a 10 year period (1966 to 1975) at the New York Lying-In Hospital, 70 cases were found on the obstetric-gynecologic service, and these cases were analyzed to see why dehiscence remains a problem. Those factors contributing to dehiscence include obesity, pre-existing pulmonary and cardiovascular problems, vertical incisions, the triad of ileus, vomiting, and coughing, and, to a lesser extent, hypoproteinemia, fluid and electrolyte imbalance, and wound infection. The incidence of abdominal wound dehiscence would be much lower if high-risk patients were identified, adequate pulmonary toilet was used, ileus was promptly treated with abdominal decompression, and strict attention was paid to electrolyte and protein balance in the pre- and post-operative period. The management of abdominal wound dehiscence is also discussed.
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PMID:Abdominal wound dehiscence. 87 48

Percutaneous endoscopic gastrostomy (PEG) has become a commonly performed procedure to provide nutritional support to chronically ill patients. Following a PEG-related death, we retrospectively reviewed our complication rate with that of the published values. In the past 48 months at Madigan Army Medical Center and Eisenhower Army Medical Center, 147 PEGs have been performed. We have had 20 minor complications and 5 major complications, with 2 reported deaths directly related to the procedure. Minor complications included 14 cases of localized cellulitis and 5 cases of prolonged ileus. The major complications included two cases of necrotizing fasciitis (both fatal), two cases of tube extubation within 24 hours, both resulting in surgical gastrostomy, and one bowel obstruction requiring laparotomy. Both patients who developed necrotizing fasciitis had several predisposing factors including diabetes, malnutrition, obesity, and long-term hospitalization. In conclusion, we believe PEG is an extremely valuable procedure which should be utilized with caution in the immunocompromised or morbidly obese patient.
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PMID:Complications of percutaneous endoscopic gastrostomy. 152 71

Records of 11 patients undergoing biliary reconstruction after laparoscopic cholecystectomy are reviewed. Ductal injuries resulted from failure to define the anatomy of Calot's triangle. Risk factors include scarring, acute cholecystitis, and obesity. Presenting findings included anorexia, ileus, failure to thrive, pain, ascites, and jaundice. All patients required hepaticojejunostomies, which were multiple and above the hepatic bifurcation in four patients. Given the extensive nature of these injuries and the frequent need for intrahepatic anastomosis and early stenosis of repairs by referring physicians, we recommend reconstruction be undertaken by an experienced hepatobiliary surgeon. To avoid injuries, a greater appreciation of risk factors and anatomic distortion and variance and strict adherence to principles of dissection and identification of anatomic structures are suggested. The use of cholangiography and a low threshold for conversion to the open procedure are advised.
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PMID:Laparoscopic bile duct injuries. Risk factors, recognition, and repair. 153 9

The records of 123 patients with Stage I cervical cancer who underwent radical hysterectomy with pelvic lymphadenectomy and para-aortic node sampling from 1981 to 1988 were reviewed to assess the risks of surgery associated with increasing weight and age. Fifty-four patients were obese (20% or more over ideal body weight) and fourteen were elderly (age 65 or older). Previous abdominal/pelvic surgery and operative time were significantly increased in the obese patients (P less than 0.05). Increased weight was associated with increased blood loss (P = 0.06). Medical illnesses, transfusion rates, postoperative stay, intraoperative and postoperative complications (including wound infection and separation), long-term complications, and 5-year survival rates were not significantly different in obese and nonobese women. Diabetes mellitus, hypertension, any medical illness, intraoperative complications (29% vs 3%), and postoperative ileus were significantly higher (P less than 0.05) in elderly patients. However, operative time, blood loss, transfusion rates, postoperative stay, postoperative complications (exclusive of ileus), long-term complications (13-21%), and 5-year survival rates (77-99%) were not significantly different when analyzed by age. We found no significant increase in morbidity of radical hysterectomy for Stage I cervical cancer in the obese patient and minimally increased morbidity in the elderly patient with no increase in long-term complications or decrease in survival. Obesity should not represent a contraindication to radical surgery in appropriately selected patients with cervical cancer.
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PMID:Radical hysterectomy for cervical cancer: morbidity and survival in relation to weight and age. 161 10

A gastric balloon was endoscopically implanted in seven over-weight (36-58%) patients to achieve weight reduction on an out-patient basis. During the period of observation four patients spontaneously passed the balloon transanally, one after brief intestinal obstruction with abdominal cramps and vomiting, another with the development of ileus, which responded to eight days of conservative treatment. The occurrence of such not insignificant side effects suggests that at present the use of endoscopic implantation of gastric balloons is not a reasonable way of treating obesity.
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PMID:[Endoscopic implantation of a gastric balloon--a method of weight reduction with few complications?]. 338 57

CT-Sonogram as an independent examination should be used in defined cases of ileus combined with pregnancy, obesity, great abdominal tumours (e.g. large hernias). Less x-ray exposure and absence of faulty x-ray films are the arguments in favour of this method.
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PMID:[Digital CT scanogram versus conventional general image in the diagnosis of ileus--a prospective study]. 343 70

During a 14-month period we used a left-flank, retroperitoneal, retrorenal approach in 23 high-risk patients with abdominal aortic aneurysm (AAA). Fourteen patients underwent suprarenal/celiac cross clamp for juxtarenal/suprarenal AAA and/or associated occlusive disease. Other indications for this approach included diminished cardiac and/or pulmonary reserve, previous extensive abdominal surgery, obesity, and inflammatory AAA. There was only one death (4%) in this high-risk group and minimal operative morbidity. The flexibility afforded by this approach for high aortic exposure allowed expeditious proximal anastomoses with minimal postoperative renal dysfunction. Pulmonary complications, ileus, and pain were reduced and patient mobilization was rapid despite the complex nature of the operative procedures. We believe that this approach offers significant advantages for all cases of AAA but particularly for anatomically complex lesions and medically high-risk patients.
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PMID:Retroperitoneal approach to high-risk abdominal aortic aneurysms. 395 89

We present our experience concerning surgical treatment of great upper and/or lower abdominal incisional hernias, by the technique using a mesh placed in the rectus sheath. Durind 5 years, we operated 42 cases. The features of our trial were: average age--56 years; female prevalence--40 cases (95%); great obesity rate (15 observations--35%). The early postoperative morbidity was represented by (number of cases): thrombophlebitis (2), prolonged postoperative ileus (3), seromas (7), prolongs hemorrhagic drainage (3), hematomas (2). We recorded no death. The late postoperative morbidity (number of observations) recorded granulomas (3) and recurrency (2). We obtained good and very good results in 37 cases (88%).
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PMID:[Surgical treatment of great median upper and/or lower abdominal incisional hernias with mesh placed in the rectus sheath(behind the muscle)]. 1487 May 45

Gallstone disease remains one of the most common medical problems leading to surgical intervention. Every year, approximately 500,000 cholecystectomies are performed in the US. Cholelithiasis affects approximately 10% of the adult population in the United States. It has been well demonstrated that the presence of gallstones increases with age. An estimated 20% of adults over 40 years of age and 30% of those over age 70 have biliary calculi. During the reproductive years, the female-to-male ratio is about 4:1, with the sex discrepancy narrowing in the older population to near equality. The risk factors predisposing to gallstone formation include obesity, diabetes mellitus, estrogen and pregnancy, hemolytic diseases, and cirrhosis. A study of the natural history of cholelithiasis demonstrates that approximately 35% of patients initially diagnosed with having, but not treated for, gallstones later developed complications or recurrent symptoms leading to cholecystectomy. During the last two decades, the general principles of gallstone management have not notably changed. However, methods of treatment have been dramatically altered. Today, laparoscopic cholecystectomy, laparoscopic common bile duct exploration, and endoscopic retrograde management of common bile duct (CBD) stones play important roles in the treatment of gallstones. These technological advances in the management of biliary tract disease are not infrequently accomplished by a multidisciplinary team of physicians, including surgeons trained in laparoscopic techniques, interventional gastroenterologists, and interventional radiologists. With the evolution of laparoscopic cholecystectomy, there has been a global reeducation and retraining program of surgeons. However, the treatment of choice for gallstones remains cholecystectomy. In recognition of the revolutionary advances in the treatment of cholelithiasis, it is the purpose of this collective review to describe recent information on the following topics: types of gallstones, asymptomatic gallstones, symptomatic gallstones, chronic cholecystitis, acute cholecystitis, and other complications of gallstones. Gross and compositional analysis of gallstones allows them to be classified as cholesterol, mixed, and pigment gallstones. When asymptomatic gallstones are detected during the evaluation of a patient, a prophylactic cholecystectomy is normally not indicated because of several factors. Only about 30% of patients with asymptomatic cholelithiasis will warrant surgery during their lifetime, suggesting that cholelithiasis can be a relatively benign condition in some people. However, there are certain factors that predict a more serious course in patients with asymptomatic gallstones and warrant a prophylactic cholecystectomy when they are present. These factors include patients with large (>2.5 cm) gallstones, patients with congenital hemolytic anemia or nonfunctioning gallbladders, or during bariatric surgery or colectomy. Epigastric and right upper quadrant pain occurring 30-60 minutes after meals is frequently associated with gallstone disease. The diagnosis of chronic cholecystitis is made by the presence of biliary colic with evidence of gallstones on an imaging study. Ultrasonography is the diagnostic test of choice, being 90-95% sensitive. The surgical literature suggests that 3-10% of patients undergoing cholecystectomy will have CBD stones. Intraoperative laparoscopic ultrasonography has recently replaced cholangiography as the method of choice for detecting CBD stones. Ultrasonography and radionuclide cholescintigraphy (HIDA scan) are useful in establishing a diagnosis of acute cholecystitis. Laparoscopic cholecystectomy should also be used in the treatment of acute cholecystitis. Laparoscopic cholecystectomy is more likely to be successful when performed within 3 days of the onset of symptoms. It is important to remember that gallstones can lead to a variety of other complications including choledocholithiasis, gallstone ileus, and acute gallstone pancreatitis.
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PMID:Cholelithiasis and cholecystitis. 1602 43

Living donor liver transplantation evolved in response to donor shortage. Current guidelines recommend potential living donors (LD) have a body mass index (BMI) <30. With the current obesity epidemic, locating nonobese LD is difficult. From September 1999 to August 2003, 68 LD with normal liver function test (LFTs) and without significant comorbidities underwent donor hepatectomy at our center. Post-operative complications were collected, including wound infection, pneumonia, hernia, fever, ileus, biliary leak, biliary stricture, thrombosis, bleeding, hepatic dysfunction, thrombocytopenia, deep venous thrombosis, pulmonary embolism, difficult to control pain, depression and anxiety. Complication rates for LD with BMI >30 (n = 16) and BMI <30 (n = 52) were compared. The incidence of wound infection increased with BMI, 4% for nonobese and 25% for obese LD (p = 0.024). There were no statistically significant differences for all other complications. No LD died. Recipient survival was 100% with obese LD and 80% with nonobese LD (p = 0.1). Select donors with a BMI >30 may undergo donor hepatectomy with acceptable morbidity and excellent recipient results. Updating current guidelines to include select LD with BMI >30 has the potential to safely increase the donor pool.
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PMID:Select utilization of obese donors in living donor liver transplantation: implications for the donor pool. 1630 13


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