Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
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Surg Obes Relat Dis · Mar 2006
Comparative StudyComorbidity among the morbidly obese: a comparative study of 2002 U.S. hospital patient discharges.
Increased morbidity is associated with increasing severity of obesity. However, among morbidly obese patients, comorbid prevalence has been reported primarily in the bariatric surgical literature. This study compares demographic characteristics and selected comorbid conditions of morbidly obese patients discharged after surgical obesity procedures and morbidly obese patients discharged after all other hospital procedures. ⋯ Demographic characteristics and comorbid prevalence of morbidly obese patients discharged after obesity surgery are consistent with reports in the bariatric surgical literature. Obesity surgery patients had a higher prevalence of some comorbid conditions. Possible explanations for this include preferential diagnosis, differential diagnostic coding, or increased severity of morbid obesity. Advancing surgical and insurance guidelines for bariatric surgery will require clinical data that accurately describe and quantify the demographic distribution of obesity and the associated burden of disease.
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Surg Obes Relat Dis · Mar 2006
Behavioral assessment of candidates for bariatric surgery: a patient-oriented approach.
This paper discusses the behavioral evaluation of patients who seek bariatric surgery and the psychosocial complications most frequently observed in these individuals. The effects of such complications on surgical outcome are briefly examined, as is the challenge of predicting therapeutic response on the basis of preoperative variables. The paper concludes with a description of the goals and methods of a behavioral assessment used at the University of Pennsylvania. This evaluation includes the use of the Weight and Lifestyle Inventory, a questionnaire that guides our interview with patients.
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Surg Obes Relat Dis · Mar 2006
Frequency and management of internal hernias after laparoscopic antecolic antegastric Roux-en-Y gastric bypass without division of the small bowel mesentery or closure of mesenteric defects: review of 1400 consecutive cases.
It is common practice to close mesenteric defects in abdominal surgery to prevent postoperative herniation and subsequent closed-loop obstruction. The aim of this study was to review our experience with antecolic antegastric laparoscopic Roux-en-Y gastric bypass (AA-LRYGBP) without division of the small bowel mesentery or closure of potential mesenteric defects. ⋯ AA-LRYGBP without division of the small bowel mesentery or closure of mesenteric defects does not result in an increased incidence of internal hernias. The laparoscopic approach for reexploration appears to be an effective and safe option.
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Surg Obes Relat Dis · Nov 2005
Randomized Controlled Trial Comparative StudyEfficacy of ketorolac in lieu of narcotics in the operative management of laparoscopic surgery for morbid obesity.
Prompt recovery of protective airway reflexes, freedom from pain, ability to cooperate with respiratory physical therapy, early ambulation and discharge from the postanesthesia care unit (PACU), coupled with a stable intraoperative environment have been desired goals of anesthesia management of morbidly obese patients. We used ketorolac in lieu of narcotics toward this goal and present our subjective and objective data in this study. ⋯ Perioperative use of intravenous ketorolac up to 24 hours after laparoscopic gastric bypass surgery for morbid obesity helps provide a more stable intraoperative environment, earlier discharge from the PACU, and better outcome in this subset of patients.