George Kerlakian

Changes in Ghrelin Levels Following Bariatric Surgery: Review of the Literature

Obesity is a severe health issue that is a global epidemic. Bariatric surgery is an accepted, popular, and effective therapy for weight loss. Ghrelin, a peptide secreted primarily by the fundus cells of the stomach, has been found to impact body weight by its influence on appetite. Although numerous studies have investigated serum ghrelin levels following bariatric surgery, there is no solid agreement yet as to the direction or magnitude of its change, or even its impact on weight loss. Some studies have found an increase in ghrelin, some have found a decrease, and others have found no change in ghrelin following bariatric surgery. The purpose of this review was to establish the impact of ghrelin changes following bariatric surgery.

Early complications and outcomes of the current technique of transperitoneal laparoscopic herniorrhaphy and a comparison to the traditional open approach

We conducted a prospective study to evaluate early complications and complaints of 60 patients who underwent laparoscopic transperitoneal hernia repair at our institution. Average follow-up was 9 months. Patients graded levels and duration of postoperative pain subjectively. Nine patients (15%) had complications of anterior/medial thigh numbness, 4 (6.7%) scrotal swelling, 4 (6.7%) scrotal ecchymosis, 3 (5%) hematoma, 2 (3.3%) prolonged sensation of tightness/pressure, 1 (1.7%) seroma, 1 (1.7%) urinary retention, and 1 (1.7%) pain with intercourse. Twenty-six (43%) had no postoperative complaints. Overall, 57 (95%) stated they were satisfied with their repair and would recommend the laparoscopic technique. Fifty-five patients (92%) returned to basic activities of daily living in less than 2 weeks. Thirty-five (73%) of the 48 patients who were employed returned to work within 3 weeks. In comparison, only 7 (29%) of 24 patients in an open hernia repair group resumed normal activity during the first 2 postoperative weeks, and only 3 (14%) of the 21 employed patients in this group returned to work at 3 weeks. The laparoscopic and traditional open herniorrhaphy methods were compared in terms of operating room time and cost. The average unilateral laparoscopic repair (n = 51) cost

Factors Influencing Primary Care Physicians’ Referral for Bariatric Surgery.

3,094 and lasted 81 minutes. Bilateral laparoscopy procedures (n = 9) averaged

Perineal and perirectal sarcomas

3,774 and 110 minutes. Unilateral traditional hernia repairs (n = 24) had an average cost of

Outcome of hand-assisted laparoscopic gastric bypass in super obese patients

1,990 and duration of 69 minutes. In follow-up ranging from 2 to 28 months, there has been only 1 recurrence to report in the laparoscopic group (1.7%). All patients continue to be followed to determine long-term recurrence risks.

Gender differences in early outcomes following hand-assisted laparoscopic Roux-en-Y gastric bypass surgery : gender differences in bariatric surgery.

Background and Objectives: Bariatric surgery has been shown to be an effective weight loss treatment for the morbidly obese, but some primary care physicians remain hesitant about postoperative treatment and management of patients who have undergone the surgery and recommend it to their obese patients infrequently. The purpose of this study was to evaluate perceptions of primary care physicians of the role of bariatric surgery in the management of obese patients and to identify possible barriers to treatment. Methods: A survey of PCPs within our institution was conducted to determine attitudes, knowledge, and practices regarding the treatment of morbidly obese patients, with a specific focus on identifying factors that influence referral patterns for bariatric surgery. Results: Among 161 eligible PCPs, 57 (35.4%) responded. Most respondents (59%) reported that at least 1 in 4 of their patients had a BMI ≥35 kg/m2. Although 39% thought that diet and exercise were an effective means of sustained weight loss, only 12% were satisfied with prescribing nonsurgical interventions. Sixty-three percent agreed that bariatric surgery is generally effective in the long term. All respondents were aware of the commonly established benefits, including improvement of diabetes, hypertension, and hyperlipidemia. In addition, 65% were familiar with the indications for bariatric surgery, and 70% felt comfortable discussing it with patients as a treatment option. Fewer than half of the respondents felt confident in providing postoperative management. Cost was a perceived limitation, with 53% reporting that most of their patients could not afford bariatric surgery. Conclusions: The general attitude of PCPs toward bariatric surgery is supportive. Physicians are largely aware of the indications and benefits; however, far fewer are comfortable in management of patients after surgery. A lack of supplemental information and concerns regarding the cost of surgery can impede treatment and referrals.

Superior Vena Cava Thrombosis after In Vitro Fertilization: Case Report and Review of the Literature

PURPOSE: Perineal sarcomas are rare tumors that are typically of an extensive nature by the time of diagnosis. In this article, two case reports are followed by a brief review of different types of sarcomas that may occur in the perineal and perirectal region. STUDY PATIENTS: This study consists of two cases that are representative of the many types of perineal/perirectal sarcomas. PRINCIPLE CONCLUSIONS: Perineal and perirectal sarcomas are generally of poor prognosis mainly because of delayed diagnosis. Computed tomography and magnetic resonance imaging can be extremely useful to help assess these tumors. It is well known that the most important criterion for diagnosing leiomyosarcomas appears to be the presence of mitotic activity. Anorectal stromal tumors having five or more mitoses per 50 high powered fields are considered to be malignant. The mainstay of treatment is surgical excision with wide margins. Currently, chemotherapeutic and radiotherapy trials are under way.

Perineal and perirectal sarcomas: report of two cases.

BACKGROUND The optimal surgical treatment for super obese patients (body mass index [BMI] >or=50 kg/m2) has been a challenge and debate for most bariatric surgeons. To compare the outcomes of hand-assisted laparoscopic Roux-en-Y gastric bypass (HALGB) in super obese patients (BMI >or=50 kg/m2) to morbidly obese patients (BMI <50 kg/m2). METHODS A total of 295 patients who underwent HALGB from October 2003 to December 2005 were studied. These patients included 177 with a BMI of <or=49 kg/m2 (morbidly obese) and 118 with a BMI of >or=50 kg/m2 (super-obese). The patient demographics, complications, and outcomes were examined. Additionally, the 12-month postoperative outcomes included the percentage of excess weight loss and improvement of co-morbidities. RESULTS The patient age and gender were similar between the 2 groups. The super-obese patients had significantly more co-morbidities and required a greater number of medications. A significant difference was found in 3 early postoperative complications, with super-obese patients experiencing more wound infections (P = .039), nausea/vomiting (P = .003), and pulmonary failure (P = .010). Logistic regression analysis found, after controlling for significant risk factors, that the difference in the incidence of nausea/vomiting was still significant (odds ratio 14.33, 95% confidence interval 1.73-118.60, P = .01). Morbidly obese patients had a significantly greater percentage of excess weight loss at 12 months postoperatively compared with the super-obese patients (80% versus 55%, respectively, P <.001). CONCLUSION HALGB is a safe and effective procedure in the super obese but with less favorable outcomes compared with those for morbidly obese patients regarding the percentage of excess weight loss.