Obesity surgery
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Laparoscopic Roux Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the most commonly performed bariatric procedures. Improvement in techniques and perioperative management of patients have resulted in shorter hospital stay and reduced overall costs. Many post-operative protocols aspire to post-operative day 1 discharge with studies showing reduction in length of stay without increasing complications. In this study, we investigate the factors predictive of early discharge at our high-volume bariatric centre. ⋯ Early discharge, on post-operative day 1 appears to be safe and is not associated with a greater risk of readmission. Sleeve gastrectomy and a BMI > 50 are associated with an increased risk of failure to achieve day 1 discharge.
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Utilization of the robotic platform has become more common in bariatric applications. We aim to show that robotic revisional bariatric surgery (RRBS) can be safely performed in a complex patient population with perioperative outcomes equivalent to laparoscopic revisional bariatric surgery (LRBS). ⋯ RRBS is associated with a shorter length of stay than LRBS in complex procedures and has at least an equivalent safety profile. Long-term follow-up data is needed.
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Many respectable guidelines recommend lifelong vitamin B12 injections for Roux-en-Y gastric bypass (RYGB) patients in the absence of lack of consensus on the efficacy of oral route of prophylaxis and the appropriate doses needed for this purpose. The purpose of this review was to examine the published English language scientific literature in accordance with PRISMA principles to find out if orally given vitamin B12 is adequate for prophylactic purposes in RYGB patients and the appropriate dosages needed for this purpose if it is. ⋯ The review finds that oral supplementation doses of ≤ 15 μg vitamin B12 daily are inadequate for prophylaxis of vitamin B12 deficiency in adult RYGB patients but doses of 1000 μg vitamin B12 daily might be adequate. Future studies need to examine this and even higher oral doses for vitamin B12 supplementation for patients undergoing RYGB.
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Randomized Controlled Trial Multicenter Study Comparative Study
Glycemic Control after Sleeve Gastrectomy and Roux-En-Y Gastric Bypass in Obese Subjects with Type 2 Diabetes Mellitus.
Roux-en-Y gastric bypass (LRYGB) has weight-independent effects on glycemia in obese type 2 diabetic patients, whereas sleeve gastrectomy (LSG) is less well characterized. This study aims to compare early weight-independent and later weight-dependent glycemic effects of LRYGB and LSG. ⋯ LRYGB and LSG show very similar effects on glycemic control, despite lower GLP-1 levels and inferior BMI decrease after LSG.
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Comparative Study
Comparative Effectiveness of Laparoscopic Sleeve Gastrectomy on Morbidly Obese, Super-Obese, and Super-Super Obese Patients for the Treatment of Morbid Obesity.
The management of super-super obese patients is challenging for bariatric surgeons. Laparoscopic sleeve gastrectomy (LSG) is feasible as two-stage treatment for high-risk patients. However, its efficacy as a stand-alone procedure in super-super obese (SSO) patients is controversial. The study objective was to demonstrate the safety and efficacy of LSG in super-obese (SO) and SSO patients. ⋯ Although %EWL was lower in the SSO group, LSG was a feasible and safe stand-alone bariatric surgical procedure for the resolution of comorbidities in MO, SO, and SSO patients.