Obesity surgery
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Anastomotic leaks and bleeding are the two most feared major complications in patients undergoing laparoscopic gastric bypass (LRYGB). This study was designed to evaluate if there is a clinical correlation between abnormal vital signs and postoperative leaks and bleeding. After IRB approval and adherence to HIPAA guidelines, a retrospective review of medical records was performed on 518 patients who underwent LRYGB between October 2002 and October 2006. ⋯ Tachycardia less than 120 bpm that has occurred in a cyclical pattern strongly pointed toward postoperative bleeding. Anastomotic leaks and bleeding are the two most feared major complications in patients undergoing LRYGB. This study was designed to evaluate if there is a clinical correlation between abnormal vital signs and postoperative leaks and bleeding.
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Comparative Study
Perioperative outcomes of laparoscopic adjustable gastric banding in mildly obese (BMI < 35 kg/m2) compared to severely obese.
Laparoscopic adjustable gastric banding (LAGB) has become a standard restrictive procedure in the USA for the treatment of severe obesity (body mass index, BMI > 35 kg/m(2)). Mildly obese individuals (BMI < 35 kg/m(2)) are also at increased risk from obesity-related conditions. Recently, an FDA panel supported its use in this subgroup. ⋯ In mildly obese, LAGB is as safe as in the severely obese with no perioperative morbidity. The perioperative outcomes and hospital resource utilization are comparable between BMI groups. Lower BMI is associated with lower operative times and blood loss.
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Obesity may cause adverse effects on the respiratory system. The main purpose of this study was to investigate how various measures of obesity are related to arterial blood gases and pulmonary function. ⋯ Both central and overall obesity were associated with unfavorable blood gases and low ERV.
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The patient population that is evaluated for bariatric surgery is characterized by a very high body mass index (BMI). Since obesity is the most important risk factor for obstructive sleep apnea (OSA), sleep disordered breathing is highly prevalent in this population. If undiagnosed before bariatric surgery, untreated OSA can lead to perioperative and postoperative complications. Debate exists whether all patients that are considered for bariatric surgery should undergo polysomnography (PSG) evaluation and screening for OSA as opposed to only those patients with clinical history or examination concerning sleep disordered breathing. We examined the prevalence and severity of OSA in all patients that were considered for bariatric surgery. We hypothesized that, by utilizing preoperative questionnaires (regarding sleepiness and OSA respiratory symptoms) in combination with menopausal status and BMI data, we would be able to predict which subjects did not have sleep apnea without the use of polysomnography. In addition, we hypothesized that we would be able to predict which subjects had severe OSA (apnea-hypopnea index (AHI) > 30). ⋯ The prevalence of OSA in all patients considered for bariatric surgery was greater than 77%, irrespective of OSA symptoms, gender, menopausal status, age, or BMI. The prediction model that we developed for the presence of OSA (AHI ≥ 5 events per hour) has excellent discriminative ability (evidenced by an AUC value of 0.8). However, the negative prediction values for the presence of OSA were too low to be clinically useful due to the high prevalence of OSA in this high-risk group. We demonstrated that, by utilizing even the most stringent possible cutoff values for the prediction model, OSA cannot be predicted with enough certainty. Therefore, we advocate routine PSG testing for all patients that are considered for bariatric surgery.
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Laparoscopic sleeve gastrectomy (LSG) has evolved as a primary weight loss surgery. This study provides changes in lipid profiles in obese patients 1 year after LSG. ⋯ One year after LSG, significant weight loss and improvements in HDL and TG levels, TC/HDL and TG/HDL ratios were observed. TC and LDL levels were unchanged.