Obesity surgery
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Laparoscopic sleeve gastrectomy is a relatively new treatment modality implemented in the surgical management for morbid obesity. It has been well documented that obesity is not only associated with an increased risk of malignancies but is also consistent with a higher incidence of surgical complications related to its definitive management. In spite of the weight loss experienced by patients with malignancy due to a catabolic state, bariatric surgery might be considered as a step procedure allowing for a more efficient and suitable surgical approach to treat early stage malignancies, thereby decreasing the procedure-related morbidity and mortality. This study aims to examine the effectiveness of laparoscopic sleeve gastrectomy as a primary weight loss procedure in patients with untreated malignancy facilitating a definitive oncologic surgical approach. ⋯ Laparoscopic sleeve gastrectomy is a safe and reasonable approach to effectively reduce weight in order to allow morbidly obese patients with early stage malignancies to undergo a second oncologic procedure.
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Bariatric procedures excluding the proximal small intestine improve glycemic control in type 2 diabetes within days. To gain insight into the mediators involved, we investigated factors regulating glucose homeostasis in patients with type 2 diabetes treated with the novel endoscopic duodenal-jejunal bypass liner (DJBL). ⋯ The data indicate DJBL to be a promising treatment for obesity and type 2 diabetes, causing rapid improvement of glycemic control paralleled by changes in gut hormones.
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Randomized Controlled Trial
Ultrasound-guided transversus abdominis plane (TAP) block for laparoscopic gastric-bypass surgery: a prospective randomized controlled double-blinded trial.
Despite the laparoscopic approach, patients can suffer moderate to severe pain following bariatric surgery. This randomized controlled double-blinded trial investigated the analgesic efficacy of ultrasound-guided transversus abdominis plane (TAP) blocks for laparoscopic gastric-bypass surgery. ⋯ Bilateral TAP blocks do not provide additional analgesic benefit when added to trocar insertion site local anesthetic infiltration and systemic analgesia for laparoscopic gastric-bypass surgery.
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Rhabdomyolysis (RML) is a rare complication of bariatric surgery. A systematic review was performed to identify risk factors and patient outcomes in morbidly obese patients undergoing bariatric surgery who develop RML. ⋯ Risk factors of developing RML following bariatric surgery include male gender, elevated BMI and prolonged operating time. Patients with a biochemical diagnosis of RML and postoperative myalgia after bariatric surgery are at increased risk of developing acute renal failure and mortality. These patients must be identified and treated promptly.
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Obesity is a worldwide epidemic and surgery is the only proven long-term treatment. The two most commonly performed bariatric procedures are laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB). There are advocates of both procedures but LAGB is associated with potentially high failure rates and may require conversion to an alternative procedure. ⋯ Revisional LRYGB surgery can be carried out safely and efficiently in experienced bariatric units. Good short- and medium-term weight loss can be achieved with no increase in morbidity, mortality or length of hospital stay. This study adds weight to the argument that LRYGB is the revisional procedure of choice following failed LAGB.