Obesity surgery
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Because of the rearrangement of the gastrointestinal tract, biliopancreatic diversion (BPD) could lead to an increased risk of colorectal cancer caused by possible carcinogenetic action of the unabsorbed food and bile acid on colonic mucosa. ⋯ This study indicates that BPD does not carry any increased risk for colorectal cancer. The complete postoperative restoration of insulin sensibility could exert a valuable protective action.
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Review
Challenges in pulmonary risk assessment and perioperative management in bariatric surgery patients.
Bariatric surgery has serious associated medical comorbidity and procedure-related risks and is, thus, considered an intermediate-to-high-risk non-cardiac surgery. Altered respiratory mechanics, obstructive sleep apnea (OSA), and less often, pulmonary hypertension and postoperative pulmonary embolism are the major contributors to poor pulmonary outcomes in obese patients. ⋯ Suspected OSA patients requiring intravenous narcotics should be kept in a monitored setting with frequent assessments and naloxone kept at the bedside. Use of reverse Tredelenburg position, preinduction, maintenance of positive end-expiratory pressure, and use of continuous positive airway pressure can help improve oxygenation in the perioperative period.
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Randomized Controlled Trial
Pressure-controlled ventilation does not improve gas exchange in morbidly obese patients undergoing abdominal surgery.
Morbid obesity results in marked respiratory pathophysiologic changes that may lead to impaired intraoperative gas exchange. The decelerating inspiratory flow and constant inspiratory airway pressure resulting from pressure-controlled ventilation (PCV) may be more adapted to these changes and improve gas exchanges compared with volume-controlled ventilation (VCV). ⋯ PCV does not improve gas exchange in morbidly obese patients undergoing gastric bypass compared to VCV.
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Male gender has been associated with a higher morbidity and mortality rate after bariatric surgery including laparoscopic and open procedures. This study focused on hand-assisted laparoscopic Roux-en-Y gastric bypass and morbidity and mortality among genders. ⋯ Given their larger size and tendency to accumulate fat in the abdominal compartment that increases the technical difficulty of the procedure, males are historically associated with a higher morbidity and mortality following bariatric surgery. Based on the current study, however, there is no difference in outcome among genders following hand-assisted laparoscopic Roux-en-Y gastric bypass.
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There are limited data on appropriate dosing of low-molecular-weight heparins (LMWHs) for venous thromboembolism (VTE) prophylaxis in bariatric surgery. The primary objective of this preliminary study was to evaluate the preoperative effects of increasing doses of the LMWH parnaparin on coagulation in severely obese patients undergoing bariatric surgery. ⋯ The dose-response data reported in this preliminary study suggest that parnaparin doses of 4250 and 6400 IU may provide effective prophylaxis for VTE in patients undergoing bariatric surgery. However, given the small number of patients, larger, well-controlled trials are required to confirm these findings.