Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
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Surg Obes Relat Dis · Dec 2016
Revision of primary sleeve gastrectomy to Roux-en-Y gastric bypass: indications and outcomes from a high-volume center.
Laparoscopic sleeve gastrectomy (SG) has become an accepted primary bariatric operation. Like other bariatric operations, inadequate weight loss and complications have been reported. ⋯ Revision of SG to RYGB is a potentially effective means of treating SG complications, particularly reflux. Reflux was the most common indication for revision and was often associated with a hiatal hernia. Further studies will be necessary to evaluate the long-term maintenance of additional weight loss after revision of SG to RYGB.
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Surg Obes Relat Dis · Nov 2016
Randomized Controlled Trial Comparative StudyA randomized trial comparing reflux symptoms in sleeve gastrectomy patients with or without hiatal hernia repair.
The effect of laparoscopic sleeve gastrectomy (SG) on reflux symptoms is unclear. Many surgeons offer SG only to patients with minor or no reflux symptoms, fearing that patients with severe reflux symptoms will experience worsening of their condition after SG. Many also advocate crural repair at the time of SG to prevent de novo or worsening reflux symptoms. These decisions are made without suitable data to form such conclusions. ⋯ These data suggest that a crural repair at the time of SG does not significantly reduce reflux symptoms compared with SG alone. Preoperative patients with significant reflux symptoms experienced a more significant improvement in symptoms after surgery compared with those who did not report significant reflux symptoms before surgery. The high incidence of reflux after SG observed in the current literature may be a result of a specific patient subpopulation who undergoes SG because of surgeon bias rather than an inherent property of SG itself or the presence of a hiatal hernia.
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Surg Obes Relat Dis · Nov 2016
Impact of care coaching on hospital length of stay, readmission rates, postdischarge phone calls, and patient satisfaction after bariatric surgery.
Bariatric surgery is well established as an effective means of treating obesity; however, 30-day readmission rates remain high. The Bariatric Care Coaching Program was developed in response to a perceived need for better communication with patients upon discharge from hospital and prior to being seen at their first postoperative visit. The lack of communication was apparent from the number of patient phone calls to clinic and readmissions to hospital. ⋯ The Bariatric Care Coaching Program is an important new adjunct in the care of our bariatric inpatients. It has had the greatest impact on postoperative nausea/vomiting, LOS for sleeve gastrectomy, and patient satisfaction. Further studies are needed to evaluate how to use this program to reduce readmission rates and phone calls to the clinic.
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Surg Obes Relat Dis · Sep 2016
Predicting incisional hernia after bariatric surgery: a risk stratification model based upon 2161 operations.
Incisional hernia (IH) is a persistent cause of morbidity and diminished quality of life and a substantial source of healthcare resource utilization. The literature suggests prophylactic mesh augmentation reduces IH risk in bariatric surgery, but no predictive models are available. ⋯ Bariatric surgery conferred an IH risk of 2.4%. IH was associated with additional readmissions and complications and substantially greater costs and resource utilization. This risk stratification tool identifies candidates for prophylactic mesh augmentation, which may optimize outcomes while mitigating costs.