Obesity surgery
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Randomized Controlled Trial
Boussignac CPAP in the postoperative period in morbidly obese patients.
In the postoperative period hypoventilation and hypoxia with hypercarbia may occur in morbidly obese patients due to the residual influence of general anesthesia drugs, postoperative atelectasis and postoperative pain. Non-Invasive Ventilation (NIV) is a method of improvement of respiratory efficiency in patients not requiring mechanical ventilation. The aim of the study was to compare NIV (Boussignac) CPAP and traditional oxygen delivery via nasal catheter in the postoperative acute care unit (PACU) in morbidly obese patients after open Roux-en-Y gastric bypass (RYGBP). ⋯ Boussignac CPAP improved blood oxygenation compared to passive oxygenation with a nasal catheter but had no influence on CO2 elimination in non-CO2 retaining morbidly obese patients.
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Case Reports
Vertical gastric resection (sleeve gastrectomy) in a morbidly obese patient with past jejunoileal bypass.
Jejunoileal bypass (JIB) is a purely malabsorptive operation, which has been abandoned in the USA and Western Europe due to occasional serious complications. We are still seeing past JIB patients who have become obese again over the years, but are not suffering side-effects of the previous JIB, and are complaining of typical co-morbidities of the obesity. ⋯ The patient has been followed for another 4 years with regular laboratory tests, monitoring of weight loss, bone densitometry and possible complications. Selected morbidly obese patients who have undergone past JIB, can be safely treated by a restrictive procedure, sleeve gastrectomy, to accomplish successful weight loss without increasing the risk of possible serious complications.
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The bariatric surgery community is complaining about the multiple barriers that hamper the growth of procedures that have been found to be the only effective treatment for morbid obesity. The French situation demonstrates that the number of procedures has stabilized after a period of rapid growth, despite the facts that the needs are not satisfied and that there are less important barriers to surgery than in most countries. This new "French paradox" is understandable if one accepts the reluctance of the public audience and an insufficient level of evidence for a systematic referral to bariatric surgery. Less invasive procedures should make it possible to re-unify the physicians who deal with obesity, as well as the implementation of comparatives and randomized clinical studies.
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Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by successive episodes of cessation or decrease in respiratory airflow, in which obesity is an important risk factor. The prevalence of the disease in morbidly obese patients is approximately 70%. ⋯ Bariatric surgery has emerged as the treatment for morbid obesity and various associated co-morbidities. This article reviews the principal studies that evaluate the modifications in obstructive sleep apnea after bariatric surgery, showing that surgery is an effective treatment for the management of OSAHS in morbidly obese patients.