Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
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Surg Obes Relat Dis · May 2008
Comparative StudyShort-term outcomes for super-super obese (BMI > or =60 kg/m2) patients undergoing weight loss surgery at a high-volume bariatric surgery center: laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and open tubular gastric bypass.
We previously reported significantly longer operating room times and a trend toward increased complications and mortality in the super-super obese (body mass index [BMI] > or =60 kg/m(2)) early in our experience with laparoscopic Roux-en-Y gastric bypass. The goal of this study was to re-examine the short-term outcomes for super-super obese patients undergoing weight loss surgery at our high-volume bariatric surgery center well beyond our learning curve. ⋯ Super-super obese patients required longer total operating room times, a longer hospital length of stay, and were more likely to be discharged to chronic care facilities than were patients with a BMI <60 kg/m(2); however, the in-hospital mortality was similar for both groups.
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Surg Obes Relat Dis · May 2008
Comparative StudyEffect of Center of Excellence requirement by Centers for Medicare and Medicaid Services on practice trends.
To report the effect of the American Society of Bariatric Surgery or American College of Surgeons-designated Centers of Excellence designation in Michigan on our practice trends and patient populations. As of February 2006, weight loss surgery for Medicare beneficiaries are reimbursed when procedures are performed at American Society of Bariatric Surgery or American College of Surgeons-designated Centers of Excellence. ⋯ The Centers for Medicare and Medicaid Services requirements for Centers of Excellence designation resulted in a significant increase in the Medicare case load within our institution. This population tended to be older and more complex, with longer operative times. The changes present new challenges in patient care, including the coordination of care for the multiple co-morbidities of older obese patients with a multispecialty care team.
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Surg Obes Relat Dis · May 2008
Comparative StudyIncidence and management of enteric leaks after gastric bypass for morbid obesity during a 10-year period.
To describe the incidence, etiology, outcomes, and management of enteric leaks in patients who had undergone open or laparoscopic gastric bypass. ⋯ Enteric leak is a significant complication after gastric bypass. Prompt treatment should be based on clinical suspicion, because contrast and cross-sectional imaging studies might not be reliable diagnostic tests. A laparoscopic index procedure might be associated with an earlier diagnosis.
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Surg Obes Relat Dis · May 2008
Comparative StudyPreoperative weight gain does not predict failure of weight loss or co-morbidity resolution of laparoscopic Roux-en-Y gastric bypass for morbid obesity.
Success with preoperative weight loss (PWL) is often mandated by the bariatric team to assess patient compliance and has been suggested to correlate with improved postoperative weight loss outcomes. ⋯ The results of our study have shown that weight loss before laparoscopic Roux-en-Y gastric bypass is not mandatory and might deter patients from considering weight loss surgery. Laparoscopic Roux-en-Y gastric bypass can be performed safely with equivalent co-morbidity resolution and %EWL regardless of PWG or PWL.
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Surg Obes Relat Dis · Mar 2008
Emergency room visits after laparoscopic Roux-en-Y gastric bypass for morbid obesity.
Patients can be symptomatic after laparoscopic Roux-en-Y gastric bypass because of either surgical complications or physiologic changes and adjustment to the new anatomy. The aim of this study was to evaluate the factors that could influence the rate of postoperative emergency room admissions (ERAs) and the clinical implication of these visits for patients who have undergone laparoscopic Roux-en-Y gastric bypass. ⋯ Our results suggest that the rate of potential ERAs should not be disregarded. A prolonged operative time and early postoperative complications were significant predictors for late ERAs. Abdominal pain with or without vomiting was the most common presenting symptom. Most patients can be treated conservatively.