Obesity surgery
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Ghrelin and leptin recently emerged as the most influential neuroendocrine factors in the pathophysiology of obesity. The said peptides act in reciprocity and are responsible for regulation of appetite and energy metabolism. Intragastric balloons acquired worldwide popularity for obesity treatment. However, the roles of ghrelin and leptin in intragastric balloon treatment were still not systematically studied. ⋯ The importance of ghrelin and leptin in treatment-induced changes was reaffirmed. Ghrelin hyper-response in non-morbidly obese subjects characterized greater short-term treatment efficiency and landmarked an inclination to weight regain. The results suggest a potential pattern of individualization between obese patients according to body mass index towards intragastric balloon or bariatric surgery. Further studies are needed in order to get better insights in the pathophysiologic mechanisms of obesity.
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Laparoscopic adjustable gastric banding (LAGB) is a proven method for weight reduction. Less is known about pregnancies in patients after LAGB. ⋯ LAGB is tolerable in pregnancy with rare intrapartum band slips. Weight gain is less in those with higher pre-pregnancy BMI and those who had their bands filled or not adjusted. Babies born to these mothers are as healthy as the general population.
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Considerable controversy exists about the perioperative management of patients at high risk for obstructive sleep apnea (OSA) in free-standing clinics. Eighty-eight percent of an American Society of Anesthesiologists expert panel felt that upper abdominal laparoscopic surgery could not be performed safely on an outpatient basis. We sought to review the incidence of major adverse events after outpatient laparoscopic adjustable gastric banding (LAGB) in a high risk population for OSA at a free-standing facility. ⋯ There were no deaths and no cases of respiratory failure or re-intubation. The 30-day mortality was zero and the 30-day anesthesia related morbidity was less than 0.5%. For patients at high risk for OSA after LAGB, the significance of transient oxygen desaturation and the need to develop monitoring and admission standards remain to be determined.
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Comparative Study
Helicobacter pylori eradication therapy in obese patients undergoing gastric bypass surgery--fourteen days superior to seven days?
The high prevalence of Helicobacter pylori (HP) in our obese population undergoing Roux-en-Y bypass gastric surgery (69.4%) and the concern that it may exacerbate postoperative foregut symptoms and increase gastric cancer risk led us to adopt a policy of HP systematic eradication in this group of patients. Our aim, in obese patients undergoing bypass gastric surgery, was to compare effectivity of 7- and 14-days clarithromycin-based triple therapy as the first-line treatment for HP eradication. ⋯ A 14-days triple therapy is more effective than 7-days triple therapy suggesting this regimen should be the first-line therapy for HP eradication in Portuguese obese patients undergoing bypass gastric surgery.
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Postoperative analgesia following bariatric surgery is complicated by the high prevalence of obstructive sleep apnea which is worsened by systemic opioids. The primary aim of this study is to identify patient factors associated with greater postoperative opioid use in patients undergoing laparoscopic bariatric surgery. ⋯ In patients undergoing laparoscopic bariatric surgery, those who are younger, male, and who have been previously hospitalized for psychiatric disorders use more opioids in the first 48 h postoperatively.