Obesity surgery
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Utility of divided omentum for preventing complications associated with laparoscopic gastric bypass.
Laparoscopic Roux-en-Y gastric bypass has emerged as a standard surgical treatment for morbid obesity. However, prevention of postoperative complications associated with bariatric surgery is an important consideration. ⋯ Our procedure using a divided omentum during bariatric surgery is feasible and safe for obtaining better outcomes without artificial materials. Although the long-term outcome of this technique is still unclear, we believe that it will contribute to decreasing the particular complications related to laparoscopic Roux-en-Y gastric bypass for morbid obesity.
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Obstructive sleep apnea is a common condition in patients undergoing bariatric surgery. The aim of this study was to determine the clinical outcome of a cohort of morbidly obese patients with documented sleep apnea who underwent laparoscopic Roux-en-Y gastric bypass (LRYGBP). ⋯ Weight loss associated with LRYGBP significantly improves the symptoms of sleep apnea and is effective in discontinuation in the clinical use of CPAP therapy. Improvement of obstructive sleep apnea symptoms occur as early as 1 month postoperatively.
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The potential advantages of regional anesthesia include minimal airway intervention, less cardiopulmonary depression, excellent postoperative analgesia, less postoperative nausea and vomiting, and shorter recovery room and hospital stays. These concerns are particularly important for the obese surgical patient. This review discusses the application of regional anesthetic techniques in obesity. Further clinical studies are needed to fill the knowledge gap about regional anesthesia and outcome in obese and morbidly obese patients.
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Recent studies suggest that weight loss operations may actually increase the costs to society due to increased hospital readmission rates. The purpose of this study was to determine the 30-day readmission rates following bariatric operations at a high volume bariatric surgery program. ⋯ This study found an overall 30-day readmission rate of 6.5% following bariatric operations at a high volume bariatric surgery program. This study supports the concept of bariatric surgery Centers of Excellence and accreditation of Bariatric Surgery Programs based on hospital volume of bariatric operations.
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Case Reports
Appetite suppression and weight loss incidental to spinal cord stimulation for pain relief.
Spinal cord stimulation (SCS) uses electrical stimulation of the dorsal columns of the spinal cord to prevent the perception of intractable neuropathic pain signals, but its mechanisms and consequences of use are poorly understood. Two overweight female patients who were implanted with SCS systems (Precision; Advanced Bionics/Boston Scientific, Valencia, CA) reported better than 50% relief of their chronic back and leg pain. ⋯ Both patients were thus able to reduce food intake at mealtimes and had lost about 9 kg in the first 4 months of SCS use, despite denying changes in exercise habits. The mechanism by which SCS can reduce the desire for food is unknown, but this and similar neuromodulation techniques may hold promise for weight loss in patients who fail other treatments or are not healthy enough for surgery.