Obesity surgery
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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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The Moorehead-Ardelt Quality of Life Questionnaire was originally developed as a disease-specific instrument to measure postoperative outcomes of self-perceived quality of life (QoL) in obese patients. 5 key areas were examined: self-esteem, physical well-being, social relationships, work, and sexuality. Each of these questions offered 5 possible answers, which were given + or - points according to a scoring key. The questionnaire was used independently or incorporated into the Bariatric Analysis and Reporting System (BAROS). The instrument is simple, unbiased, user-friendly and can be completed in <1 minute. It has been found useful, reliable and reproducible in numerous clinical trials in different countries. Further research and feedback from some of its users prompted refinements, now included in the Moorehead-Ardelt Quality of Life Questionnaire II (M-A QoLQII). This study tested the validity of the improved instrument. ⋯ The M-A QoLQII correlates well with other widely used health and well-being indicators such as the SF-36, Beck Depression Inventory II and the Stunkard and Messick Eating Inventory. The study established the validity and reliability of this improved disease-specific instrument for QoL measurement in the obese population.
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Comparative Study
Helium pneumoperitoneum ameliorates hypercarbia and acidosis associated with carbon dioxide insufflation during laparoscopic gastric bypass in pigs.
In the morbidly obese patient undergoing laparoscopic gastric bypass (LGBP), insufflation with carbon dioxide to 20 mmHg for prolonged periods may induce significant hypercarbia and acidosis with attendant sequelae. We hypothesize that the use of helium as an insufflating agent results in less hypercarbia and acidosis. ⋯ Helium pneumoperitoneum in LGBP is associated with less intraoperative hypercarbia and acidosis than is the use of CO2. In addition, pCO2 returns to normal more rapidly postoperatively with the use of helium insufflation. Study of helium insufflation in humans undergoing LGBP is needed to prove its benefits in the clinical setting.
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Anesthetized morbidly obese patients often exhibit impaired pulmonary gas exchanges, mostly because of a reduction in functional residual capacity. At present, several approaches are suggested to ventilate these patients. ⋯ RTP and PEEP can be considered adequate ventilatory settings for morbidly obese patients, without any significant difference with regard to gas exchange improvement. However, the decrease in CO may partially counteract the beneficial effects on oxygenation of these ventilatory settings.
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Case Reports
Gastric perforation in an obese patient with an intragastric balloon, following previous fundoplication.
The Bioenterics Intragastric Balloon (BIB) has been a safe and effective method used in treatment of moderate obesity. Gastric perforation is a rare complication, and its possible sequelae are dangerous. ⋯ According to our experience, fundoplication represents an absolute contraindication to positioning of a BIB.