Orit Kaidar-Person

Laparoscopic Sleeve Gastrectomy as Treatment for Morbid Obesity: Technique and Short-Term Outcome

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) and laparoscopic adjustable gastric banding (LAGB) are the most commonly performed surgical procedures for weight reduction in the United States. Currently, laparoscopic sleeve gastrectomy (LSG) is being explored. The aim of this study was to assess the safety and short-term efficacy of LSG as a treatment option for weight reduction. Methods: Data of all patients who underwent LSG for treatment of morbid obesity between November 2004 and March 2006 and completed the 3- and 6-month follow-up visits at the time of the study, were retrospectively reviewed. Data collected included demographics, operative time, length of stay, postoperative complications, and degree of weight reduction. Results: Of the 62 patients who underwent LSG performed by two surgeons, the data of 30 patients (7 males and 23 females) were further analyzed. Mean preoperative BMI was 41.4 (33-59) kg/m2. Mean operative time was 80 min (range 65-130). Mean hospital stay was 3.2 days (range 2 to 25). Mean weight loss at 3 and 6 months following the procedure was 22.7 kg and 30.5 kg respectively, and mean % excess weight loss (EWL) was 40.7 and 52.8, respectively. Three patients were considered to have mild complications, and one patient had a major complication that necessitated surgical intervention. There was no mortality. Conclusions: In the short-term, LSG is a safe and effective treatment option.

Nutritional Deficiencies in Morbidly Obese Patients: A New Form of Malnutrition?

Even though in the Western world there is almost no limitation to a wide variety of food supply, nutritional deficiencies can be found in both normal-weight population and in the obese population. In this review, we examine the prevalence and manifestations of various mineral deficiencies in obese patients.

Compression anastomosis: history and clinical considerations

BACKGROUND Despite the fact that the concept of compression anastomosis has been investigated for nearly 2 centuries, it has not yet achieved widespread acceptance. The aim of the current report is to review the literature regarding compression anastomoses. DATA SOURCES A multi-database search was conducted using PubMed, Ovid, and the Cochrane Databases (all until June 2007), in addition to electronic links to related articles and references of selected articles. The following terms were used for the search in various combinations: anastomosis, anastomoses, sutureless, compression, nickel-titanium; Nitinol; CAC; CAR; AKA-2, Valtrac biofragmentable anastomotic ring, BAR. Language restrictions were not applied. CONCLUSIONS The various methods of compression anastomosis have been shown to be at least comparable to the standard techniques of suturing and stapling. The measurement of outcomes, including cost, safety, and efficacy of treatment, indicated that compression anastomosis can save time, is cost-effective, and offers an acceptable cost/benefit ratio compared to both stapled and sutured anastomoses. However, compression anastomosis did not gain worldwide popularity.

Hemorrhagic and Thromboembolic Complications after Bariatric Surgery in Patients Receiving Chronic Anticoagulation Therapy

BackgroundPerioperative management of bariatric surgical patients receiving chronic anticoagulation requires an understanding of potential hemorrhagic and thromboembolic risks. The aim of this study is to evaluate hemorrhagic and thromboembolic complications in morbidly obese patients who are on oral anticoagulation treatment and subsequently undergo laparoscopic bariatric surgery.MethodsThe medical records of all laparoscopic Roux-en-Y gastric bypass (LRYGB) patients from June 2001 to March 2006 were retrospectively reviewed. In addition, data of patients who received chronic anticoagulation therapy with Coumadin and underwent laparoscopic Roux-en-Y gastric bypass was analyzed. Clinical parameters included length of hospitalization, hemorrhagic complications, thromboembolic complications, conversion rate, reoperation, and blood transfusion.ResultsDuring the study period, 1,700 consecutive patients underwent bariatric surgery for the treatment of morbid obesity. Of these, 21 patients were treated with chronic oral anticoagulation; 3 of the 21 (14%) had hemorrhagic complications: one patient had intraluminal hemorrhage and two patients had intraabdominal hemorrhage. Two patients required blood transfusion, and one patient underwent surgical reintervention. None of the 21 laparoscopic operations were converted to open procedures. There were no postoperative mortalities, and there were no thromboembolic events in this series.ConclusionsLaparoscopic bariatric surgery can be performed relatively safely in morbidly obese patients who are treated with chronic oral anticoagulation. Even in the presence of bleeding, patients can be successfully treated without the need for reoperation.

Achalasia after vertical banded gastroplasty for morbid obesity: A case report.

Achalasia is an unusual motility disorder that can be seen in conjunction with obesity. The prevalence of achalasia is unknown in obese patients and when present, the clinical characteristics are atypical. We report a case of achalasia that was diagnosed 13 years after a vertical-banded gastroplasty was performed.

Commentary Regarding Flancbaum L, Belsley S, Drake V, Colarusso T, Tayler E. Preoperative Nutritional Status of Patients Undergoing Roux-en-Y Gastric Bypass for Morbid Obesity. J Gastrointest Surg. 2006 10(7):1033–7

Nutritional deficiencies are a known complication following Bariatric procedures, especially after malabsorptive procedures, such as Roux-en-Y gastric bypass and biliopancreatic diversion, but may occur after restrictive procedures, as after any gastrointestinal surgery. Various nutritional deficiencies were described after these procedures. The gravest presentations were described in accordance with thiamine deficiency leading to severe neurological pathology. A study by Flancbaum and coworkers, which was published in 2006, retrospectively analyzed the preoperative values of various nutrients, including thiamine, in patients undergoing bariatric surgery. Twenty-nine percent of the patients had preoperative thiamine deficiency. In their study, the authors stated that they were the first to describe preoperative thiamine deficiency in bariatric patients. However, Flancbaum’s study only confirmed what we have presented at the 22nd Annual Meeting of the American Society for Bariatric Surgery on June 2005, and published in 2005, in which we demonstrated that, out of 303 morbidly obese patients who were scheduled for bariatric surgery, 47 patients (15.5%) presented with low preoperative thiamine levels. In our study, none of the patients had preoperative or postoperative clinical manifestations of thiamine deficiency. In our opinion, the findings of both studies cannot be ignored; in patients with marginal thiamine levels, deficiency may be facilitated by increased demands due to the surgical stress, rapid weight loss, unbalanced diet, and loss of absorptive area after surgery, and may result in neurological and cardiac deterioration. The standard of care should include preoperative thiamine screening and perioperative replacement. Most importantly, prolonged vomiting should be an indication for empiric thiamine treatment, even without biochemical deficiency. We would like to congratulate Flancbaum and coworkers for confirming our initial findings.

The Rationale for Bariatric Surgery

The aim of these guidelines is to systematically review the clinical effectiveness of the various bariatric surgical procedures and support bariatric surgeons and allied physicians in the provision of high-quality care for morbidly obese patients. Obesity is a serious worldwide health problem. It has been shown to predispose to various diseases, particularly cardiovascular disease, diabetes mellitus, sleep apnea, and osteoarthritis. Studies have shown that obesity is an important independent risk factor for morbidity and mortality from coronary disease; consequently, the American Heart Association continues to emphasize the importance of obesity as a major modifi able risk factor in the treatment of coronary artery disease. In the United States, the mortality rate from obesity exceeds 400,000 patients a year, and obesity is considered to be the second cause of preventable death after cigarette smoking. The long-term implications of obesity are detrimental to patients’ health and are costly. It is estimated that the annual cost spent on the treatment of obesity and obesity-related health problems exceeds

Complications of Construction and Closure of Temporary Loop Ileostomy

100 billion. Despite various pharmacological treatments, diets, exercise, and behavioral therapy, most patients regain all lost weight within a period of 2 years. Obesity is a disease in which the natural energy reserve, stored as fat, is increased to a point where it compromises the patient’s state of being. The etiology of obesity is multifactorial, and is related to genotypic and environmental factors. Environmental factors such as social and cultural aspects, in association with genotypic factors, cause the abnormal physiology, metabolism, and behavioral and psychological pathways that result in the obesity phenotype. The defi nition and classifi cation of obesity is primarily based on the body mass index (BMI), calculated as weight divided by the square of height, by means of kilograms per square meter as the unit of measurement. Body mass index provides a reliable indicator of the level of fat in the body for most people (but not athletes), and is used to screen for weight categories that may lead to health problems. For example, Caucasians with a BMI of 30–35 kg/m is considered as class 1 obesity, 35–40 kg/m as class 2, and > 40 kg/m as class 3. Morbid obesity is usually defi ned as a BMI ≥ 40 kg/m or a BMI ≥ 35 kg/m in patients with comorbidities. In addition, in some cases, patients are defi ned as suffering from superand megaobesity, if their BMI > 50 or 70 kg/m, respectively. Alternatively, absolute or relative increase in body weight may be used to defi ne obesity. Morbid obesity is a debilitating disease; it imposes physiological–psychological stress and is often associated with social isolation, depression, and other psychological and somatic comorbidities. These include metabolic complications 1. The Rationale for Bariatric Surgery