Obesity surgery
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Randomized Controlled Trial Comparative Study Clinical Trial
Use of anti-emetics after intragastric balloon placement: experience with three different drug treatments.
Tropisetron treatment was compared with alizapride treatment. The secondary aim was to assess whether droperidol supplement would still improve the therapeutic outcome of tropisetron. ⋯ To decrease the incidence of vomiting in patients undergoing intragastric balloon placement, tropisetron proved to be the most effective antiemetic. A supplement of droperidol gave no better results but impaired postoperative mood and wellbeing. Alizapride was least effective.
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Surgical management of the supersuper obese patient (BMI >60 kg/m2) has been a challenging problem associated with higher morbidity, mortality, and long-term weight loss failure. Current limited experience exists with a two-stage biliopancreatic diversion and duodenal switch in the supersuper obese patient, and we now present our early experience with a two-stage gastric bypass for these patients. ⋯ Laparoscopic sleeve gastrectomy with second-stage Roux-en-Y gastric bypass are feasible and effective procedures based on short-term results. This two-stage approach is a reasonable alternative for surgical treatment of the high-risk supersuper obese patient.
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We examined our database of 600 consecutive laparoscopic Roux-en-Y gastric bypasses (LRYGBP) to determine predictors of prolonged operations, conversion to open operations and postoperative complications. ⋯ Larger patients as measured by waist measurement, weight, and BMI but not previous surgery prolonged LRYGBP. Conversion to open surgery was more frequently necessary in patients with larger abdomens, central obesity, and type II diabetes. Complications did not correlate with any preoperative parameter measured.
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The effects of morbid obesity, pneumoperitoneum (PP) and body position on cardiac function during laparoscopy were studied. ⋯ Anesthetized obese patients undergoing laparoscopy have higher LVESWS before pneumoperitoneum (due to increased end-systolic left ventricular dimensions) and during pneumoperitoneum (due to more pronounced increases in blood pressure). Since LVESWS is a determinant of myocardial oxygen demand, more aggressive control of blood pressure (ventricular afterload) in MO patients may be warranted to optimize the myocardial oxygen requirements.
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Obesity is a well known risk factor for obstructive sleep apnea (OSA). Medical therapy is not effective for morbid obesity. Bariatric surgery is therefore a reasonable option for weight reduction for patients with clinically severe obesity. Unrecognized OSA, especially in those patients receiving abdominal surgery, has influenced perioperative morbidity and morality. The incidence of OSA for patients being evaluated for bariatric surgery has not been previously defined. ⋯ This population of clinically severe obese patients being evaluated for bariatric surgery had an 88% incidence of an OSRBD, 71% with OSA. Appropriate therapy with CPAP perioperatively would theoretically prevent hypoxic complications associated with OSRBD. Providers should have a low threshold for ordering a PSG as part of the preoperative evaluation for bariatric surgery. Empiric CPAP at 10 cm H2O should be considered for those patients who cannot complete a PSG before surgery.