Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
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Surg Obes Relat Dis · Sep 2012
Management of gastrointestinal leaks after surgery for clinically severe obesity.
Gastrointestinal leaks after bariatric surgery are the primary cause of serious morbidity and mortality nationwide. Enteric leaks can differ in severity, presentation, and management, depending on the type of bariatric surgery performed. Our objective was to describe the clinical presentation and treatment outcomes in patients who developed postoperative leaks at a university hospital bariatric referral center. ⋯ In our experience, most leaks resulting from antiobesity surgery were successfully managed using nonoperative methods. Rapid management of gastrointestinal leaks using computed tomography-guided drainage and/or intraluminal stent placement could be the treatment of choice in selected patients.
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Surg Obes Relat Dis · Sep 2012
Multicenter StudyPre- to postoperative changes in physical activity: report from the longitudinal assessment of bariatric surgery-2 (LABS-2).
Numerous studies have reported that bariatric surgery patients report more physical activity (PA) after surgery than before; however, the quality of the PA assessment has been questionable. ⋯ The majority of adults increase their PA level after bariatric surgery. However, most remain insufficiently active, and some become less active. Increasing PA, addressing pain, and treating asthma before surgery might have a positive effect on postoperative PA.
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Surg Obes Relat Dis · Sep 2012
Multicenter StudyPredictors of pulmonary complications after bariatric surgery.
Postoperative pneumonia (PP) and respiratory failure (PRF) are known to be the most common nonwound complications after bariatric surgery. Our objective was to identify their current prevalence after bariatric surgery and to study the preoperative factors associated with them using data from the American College of Surgeons' National Surgical Quality Improvement Program. ⋯ Although PP and PRF are infrequent, they account for one fifth of the postoperative morbidity and are associated with significantly increased 30-day mortality. They can be predicted by various risk factors, emphasizing the importance of patient optimization and careful selection before bariatric surgery.
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Surg Obes Relat Dis · Sep 2012
Multicenter StudyNasogastric tube, temperature probe, and bougie stapling during bariatric surgery: a multicenter survey.
An adverse event in laparoscopic bariatric surgery that has not received much scrutiny involves tube/probe stapling or suturing during gastrectomy or gastroenterostomy. ⋯ Tube/probe complications can occur during laparoscopic bariatric surgery but are seldom reported. However, they can be associated with significant morbidity. The treatment options are dependent on the situation. More importantly, prevention strategies must include constant communication with the anesthesiologist and removal or relocation of a tube before stapling or suturing.
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Surg Obes Relat Dis · Sep 2012
Type 2 diabetes after gastric bypass: remission in five models using HbA1c, fasting blood glucose, and medication status.
The remission rates of type 2 diabetes mellitus (T2DM) after Roux-en-Y gastric bypass (RYGB) vary according to the glycosylated hemoglobin A1c (HbA1c), fasting blood glucose (FG), and medication status. Our objectives were to describe remission using the American Diabetes Association standards for defining normoglycemia and to identify the factors related to the preoperative severity of T2DM that predict remission to normoglycemia, independent of weight loss, after RYGB. The setting was an urban not-for-profit community hospital. ⋯ Remission, defined at a threshold less than what would be expected to result in microvascular damage, was achieved in 43.2% of diabetic patients by 14 months after RYGB. A more recent diagnosis of T2DM and the absence of preoperative insulin therapy were significant predictors, regardless of how remission was defined, independent of the percentage of excess weight loss.