Manga gástrica laparoscópica versus banda gástrica ajustable para el tratamiento de la obesidad severa en pacientes de alto riesgo
Laparoscopic sleeve gastrectomy versus laparoscopic adjustable gastric banding for the treatment severe obesity in high risk patients.
Varela JE.
Department of Surgery, Washington University, St. Louis, MO, USA.varelae@wustl.edu
JSLS. 2011 Oct-Dec;15(4):486-91.
Abstract
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has emerged as an alternative restrictive bariatric procedure to the most popular laparoscopic adjustable gastric banding (LAGB). We analyze and compare the clinical and weight loss outcomes of LSG versus LAGB for the treatment of severe obesity in high-risk patients. METHODS: Forty severely obese veterans (20/group) received either LSG or LAGB and were followed prospectively for 2 years. Outcome measures included operating room (OR) time, estimated blood loss (EBL), length of hospital stay (LOS), morbidity, mortality, reoperations, readmission rates, and weight loss over time. RESULTS: The cohort primarily comprised high-risk and older male veterans. Patient's baseline demographics were similar between groups. LSG was associated with prolonged OR time (116±31 vs. 94±28min), higher EBL (34±28 vs. 17±19mL), and LOS (2±.9 vs. 1±.4days) when compared with LAGB. Minor morbidity and readmissions were similar between groups, while no major morbidity, reoperations, or mortality occurred. Total weight and BMI decreased significantly after surgery in both groups (LSG: 302±52 to 237lbs and 45±5 to 36±5kg/m(2) vs. LAGB: 280±36 to 231±29lbs and 43±5 to 36±5kg/m(2), respectively). Total weight loss was superior in the LSG vs. LAGB group at 2 years (TWL=65±24 vs. 49±28 lbs (P=.03); %EWL=51±20 vs. 46±23%; %EBMI loss=48±22 vs. 45±23%, and %BWL=21±8 vs. 17±9%, respectively). CONCLUSION: In severely obese and high-risk patients, laparoscopic sleeve gastrectomy provides superior total weight loss at 2 years.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340957/pdf/jls486.pdf
Gastrectomía en manga laparoscópica viable para la cirugía de revisión bariátrica
Laparoscopic sleeve gastrectomy feasible for bariatric revision surgery.
Berende CA, de Zoete JP, Smulders JF, Nienhuijs SW.
Catharina Hospital, Eindhoven, the Netherlands. niels.berende@cze.nl
Obes Surg. 2012 Feb;22(2):330-4.
Abstract
Bariatric revision surgery is associated with several complications that can be attributed to decreased quality of tissue and complexity of the surgery. A laparoscopic sleeve gastrectomy is a simple technique with potential advantages. Therefore, the results of this procedure were evaluated as a revisional option. Fifty-one patients underwent laparoscopic sleeve gastrectomy (LSG). Indications for the LSG were insufficient weight loss (34 patients, group 1) or vomiting (17 patients, group 2) following a laparoscopic adjustable gastric banding (LAGB) or vertical banded gastroplasty (VBG). Patient and procedure characteristics as well as outcome were collected prospectively. From October 2006 to June 2010, 51 patients with a failed prior bariatic procedure (VBG or LAGB) were converted to (L)SG. The conversion rate was zero. The median procedure time was 99 min (range 54-221) and hospital stay was 3 days (range 2-38). There was no mortality after 30 days. Complications included bleeding (six) and leakage of the staple line (seven). Mean follow-up was 13.8 (2-46) months. LSG as revision surgery for insufficient weight loss resulted in extra weight loss of 52.7%, and the overall extra weight loss was 49.3%. When LSG was performed because of vomiting, 82% was able to eat solid food at follow-up. Of the 65 pre-existent co-morbidities, 21 were resolved and 18 improved. LSG as a revision procedure is feasible. An additional weight loss and further resolution of co-morbidity seem achievable, however, at the cost of a high number of complications. Therefore, revision bariatric surgery should be limited to expert tertiary bariatric centers
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266499/pdf/11695
_2011_Article_501.pdf
Manejo perioperatorio de los pacientes de cirugía bariátrica: enfermedad ósea metabólica
Perioperative management of bariatric surgery patients: focus on metabolic bone disease.
Williams SE, Cooper K, Richmond B, Schauer P.
Center for Nutrition and Metabolic Medicine, Greene Memorial Hospital Advanced Medical Group, Xenia, OH 45385, USA.swilliams@greenehealth.org
Cleve Clin J Med. 2008 May;75(5):333-4, 336, 338 passim.
Abstract
Chronic vitamin D deficiency, inadequate calcium intake, and secondary hyperparathyroidism are common in obese individuals, placing them at risk for low bone mass and metabolic bone disease. After bariatric surgery, they are at even higher risk, owing to malabsorption and decreased oral intake. Meticulous preoperative screening, judicious use of vitamin and mineral supplements, addressing modifiable risk factors, and monitoring the absorption of key nutrients postoperatively are essential in preventing metabolic bone disease in bariatric surgery patients.
http://www.ccjm.org/content/75/5/333.full.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Laparoscopic sleeve gastrectomy versus laparoscopic adjustable gastric banding for the treatment severe obesity in high risk patients.
Varela JE.
Department of Surgery, Washington University, St. Louis, MO, USA.varelae@wustl.edu
JSLS. 2011 Oct-Dec;15(4):486-91.
Abstract
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has emerged as an alternative restrictive bariatric procedure to the most popular laparoscopic adjustable gastric banding (LAGB). We analyze and compare the clinical and weight loss outcomes of LSG versus LAGB for the treatment of severe obesity in high-risk patients. METHODS: Forty severely obese veterans (20/group) received either LSG or LAGB and were followed prospectively for 2 years. Outcome measures included operating room (OR) time, estimated blood loss (EBL), length of hospital stay (LOS), morbidity, mortality, reoperations, readmission rates, and weight loss over time. RESULTS: The cohort primarily comprised high-risk and older male veterans. Patient's baseline demographics were similar between groups. LSG was associated with prolonged OR time (116±31 vs. 94±28min), higher EBL (34±28 vs. 17±19mL), and LOS (2±.9 vs. 1±.4days) when compared with LAGB. Minor morbidity and readmissions were similar between groups, while no major morbidity, reoperations, or mortality occurred. Total weight and BMI decreased significantly after surgery in both groups (LSG: 302±52 to 237lbs and 45±5 to 36±5kg/m(2) vs. LAGB: 280±36 to 231±29lbs and 43±5 to 36±5kg/m(2), respectively). Total weight loss was superior in the LSG vs. LAGB group at 2 years (TWL=65±24 vs. 49±28 lbs (P=.03); %EWL=51±20 vs. 46±23%; %EBMI loss=48±22 vs. 45±23%, and %BWL=21±8 vs. 17±9%, respectively). CONCLUSION: In severely obese and high-risk patients, laparoscopic sleeve gastrectomy provides superior total weight loss at 2 years.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340957/pdf/jls486.pdf
Gastrectomía en manga laparoscópica viable para la cirugía de revisión bariátrica
Laparoscopic sleeve gastrectomy feasible for bariatric revision surgery.
Berende CA, de Zoete JP, Smulders JF, Nienhuijs SW.
Catharina Hospital, Eindhoven, the Netherlands. niels.berende@cze.nl
Obes Surg. 2012 Feb;22(2):330-4.
Abstract
Bariatric revision surgery is associated with several complications that can be attributed to decreased quality of tissue and complexity of the surgery. A laparoscopic sleeve gastrectomy is a simple technique with potential advantages. Therefore, the results of this procedure were evaluated as a revisional option. Fifty-one patients underwent laparoscopic sleeve gastrectomy (LSG). Indications for the LSG were insufficient weight loss (34 patients, group 1) or vomiting (17 patients, group 2) following a laparoscopic adjustable gastric banding (LAGB) or vertical banded gastroplasty (VBG). Patient and procedure characteristics as well as outcome were collected prospectively. From October 2006 to June 2010, 51 patients with a failed prior bariatic procedure (VBG or LAGB) were converted to (L)SG. The conversion rate was zero. The median procedure time was 99 min (range 54-221) and hospital stay was 3 days (range 2-38). There was no mortality after 30 days. Complications included bleeding (six) and leakage of the staple line (seven). Mean follow-up was 13.8 (2-46) months. LSG as revision surgery for insufficient weight loss resulted in extra weight loss of 52.7%, and the overall extra weight loss was 49.3%. When LSG was performed because of vomiting, 82% was able to eat solid food at follow-up. Of the 65 pre-existent co-morbidities, 21 were resolved and 18 improved. LSG as a revision procedure is feasible. An additional weight loss and further resolution of co-morbidity seem achievable, however, at the cost of a high number of complications. Therefore, revision bariatric surgery should be limited to expert tertiary bariatric centers
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266499/pdf/11695
_2011_Article_501.pdf
Manejo perioperatorio de los pacientes de cirugía bariátrica: enfermedad ósea metabólica
Perioperative management of bariatric surgery patients: focus on metabolic bone disease.
Williams SE, Cooper K, Richmond B, Schauer P.
Center for Nutrition and Metabolic Medicine, Greene Memorial Hospital Advanced Medical Group, Xenia, OH 45385, USA.swilliams@greenehealth.org
Cleve Clin J Med. 2008 May;75(5):333-4, 336, 338 passim.
Abstract
Chronic vitamin D deficiency, inadequate calcium intake, and secondary hyperparathyroidism are common in obese individuals, placing them at risk for low bone mass and metabolic bone disease. After bariatric surgery, they are at even higher risk, owing to malabsorption and decreased oral intake. Meticulous preoperative screening, judicious use of vitamin and mineral supplements, addressing modifiable risk factors, and monitoring the absorption of key nutrients postoperatively are essential in preventing metabolic bone disease in bariatric surgery patients.
http://www.ccjm.org/content/75/5/333.full.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
