Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
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Surg Obes Relat Dis · Jul 2013
Comparative StudyWeight loss is more sustained after biliopancreatic diversion with duodenal switch than Roux-en-Y gastric bypass in superobese patients.
Although biliopancreatic diversion with duodenal switch (BPD-DS) is not the most performed procedure, Roux-en-Y gastric bypass (RYGB) is challenged by weight regain and insufficient weight loss, especially in patients with a body mass index >50 kg/m(2). The aim of our retrospective study was to compare the weight loss after 2 types of primary bariatric surgery. A total of 83 BPD-DS and 97 RYGB procedures were performed from March 2002 to October 2009 for an initial mean body mass index of 55 kg/m(2). ⋯ After 12 months postoperatively, the number of patients regaining 10% of the weight lost during the first postoperative year was significantly greater after RYGB than after BPD-DS.
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A small, but significant, number of patients undergoing bariatric surgery refuse blood transfusion for religious or other personal reasons. Jehovah's Witnesses number more than 1 million members in the United States alone. The reported rates of hemorrhage vary from .5% to 4% after bariatric surgery, with transfusion required in one half of these cases. Pharmacologic prophylaxis against venous thromboembolism could further increase the perioperative bleeding risk. Our objective was to report the perioperative outcomes of bariatric surgery who refuse blood transfusion at a bariatric center of excellence, private practice in the United States. ⋯ Bariatric surgery can be performed in patients who refuse blood transfusion with acceptable postoperative morbidity. Larger studies are necessary to confirm the safety of this approach and to examine the effect of pharmacologic thromboprophylaxis in this patient group.
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Surg Obes Relat Dis · May 2013
Predictors of a difficult intubation in the bariatric patient: does preoperative body mass index matter?
The incidence of difficult intubations in morbidly obese patients has been reported to be 12-20%; however, no well-established predictors of a difficult intubation exist for this patient population. Our objective was to evaluate the factors associated with a difficult intubation in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass at an integrated multispecialty health system with a 325-bed community teaching hospital serving 19 counties. ⋯ An increased Mallampati class, abnormal thyromental distance, restricted jaw mobility, and a history of difficult intubations were independent predictors of a difficult intubation. An increasing body mass index did not predict for a difficult intubation.
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Surg Obes Relat Dis · Mar 2013
Changes in gut hormone profile and glucose homeostasis after laparoscopic sleeve gastrectomy.
Changes in glucagon-like peptide-1 (GLP-1) and peptide YY (PYY) levels after bariatric surgery have been proposed as a mechanism for long-term maintenance of weight loss and improvement in glucose homeostasis postoperatively. The objective of the present study was to assess the changes in GLP-1, PYY, insulin, and glucose levels after laparoscopic sleeve gastrectomy (SG). ⋯ Postprandial total GLP-1 and total PYY levels increased significantly at 6 weeks post-SG and remained elevated for at least 1 year. These findings may indicate their involvement in better glucose homeostasis and weight loss maintenance after SG.