Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
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Surg Obes Relat Dis · Jan 2009
Feasibility and technique of laparoscopic conversion of adjustable gastric banding to sleeve gastrectomy.
To evaluate the feasibility, safety, and short-term efficacy of the conversion of laparoscopic adjustable gastric banding (LAGB) to laparoscopic sleeve gastrectomy (LSG) because of inadequate weight loss. ⋯ The results of this study support the safety of LSG in the case of an inadequate %EWL after LAGB. However, the degree of weight loss and co-morbidity resolution is of concern.
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Surg Obes Relat Dis · Jan 2009
Randomized Controlled Trial Comparative StudyPreinductive use of clonidine and ketamine improves recovery and reduces postoperative pain after bariatric surgery.
In obese patients, concomitant use of clonidine and ketamine might be suitable to reduce the doses and minimize the undesired side effects of anesthetic and analgesic drugs. In this study, we evaluated the perioperative effects of administration of clonidine and ketamine in morbidly obese patients undergoing weight loss surgery at a university hospital in Rome, Italy. ⋯ The preoperative administration of low doses of ketamine and clonidine at induction appears to provide early extubation and diminished postoperative analgesic requirements in morbidly obese patients undergoing open bariatric surgery.
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Surg Obes Relat Dis · Jan 2009
Effect of laparoscopic Roux-en-Y gastric bypass surgery on hemoglobin A1c levels in diabetic patients: a matched-cohort analysis.
Elevated hemoglobin A1c (HbA1c) values are known to increase the risk of diabetic retinopathy, nephropathy, and peripheral neuropathy. The current guidelines recommend maintaining HbA1c values at <7%. We assessed the effect of laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) on HbA1c values in diabetic patients compared with a conventionally treated cohort. ⋯ The patients who underwent LRYGB had a significant and sustained improvement in the HbA1c value compared with the conventionally treated obese patients with type 2 diabetes mellitus.
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Surg Obes Relat Dis · Nov 2008
Use of critical care resources after laparoscopic gastric bypass: effect on respiratory complications.
Before 2005, all subjects undergoing laparoscopic gastric bypass with a body mass index >50 kg/m(2), age >40 years, and documented obstructive sleep apnea (OSA) were admitted to the intensive care unit (ICU) in our institution. Starting in January 2005, only patients with a body mass index >60 kg/m(2) and severe OSA were admitted. This study assessed the incidence of respiratory complications in patients undergoing laparoscopic gastric bypass before and after implementation of the new ICU admission criteria. ⋯ Limiting ICU admission after laparoscopic gastric bypass to patients with a body mass index >60 kg/m(2) and severe OSA did not increase the overall incidence of postoperative respiratory complications or hospital stay.
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Surg Obes Relat Dis · Nov 2008
Limitations of a standardized weight-based nomogram for heparin dosing in patients with morbid obesity.
Confusion exists when dosing heparin using a weight-based nomogram in the obese population. At 2 affiliated community teaching hospitals, we compared the activated partial thromboplastin time (aPTT) values in morbidly obese and nonmorbidly obese patients using a standardized nomogram and determined factors associated with achieving a supratherapeutic aPTT value. ⋯ Heparin dosing with a weight-based nomogram will yield greater aPTT values in morbidly obese patients. Consideration of BMI and age can help identify those patients at risk of supratherapeutic aPTTs. Alternative strategies, such as a dose cap should be considered in patients with morbid obesity.