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World Journal of Clinical Cases 2015年第6期3卷 504-509页

作者： Suleyman Cetinkunar Hasan Erdem Recep Aktimur Selim Sozen Clinic of General Surgery Adana Numune Training and Research Hospital Clinic of General Surgery Samsun Training and Research Hospital Department of General Surgery Faculty of Medicine Nam?k Kemal University

Obesity and diabetes is a co-pandemic and amajor health concern that is expanding. It has many psychosocial and economic consequences due to morbidity and mortality of this disease combination. The pathophysiology of obesity and related diabetes is complex and multifactorial. One arm of this disease process is the genetic susceptibility. Other arm is dependent on the intricate neuro-humoral factors that converge in the central nerve system. Gut hormones and the adipose tissue derived factors plays an important role in this delicate network. bariatric surgery provides the only durable option for treatment of obesity and furthermore it provides a remission in the concomitant diseases that accompany obesity. This review provides a brief insight to all these mechanisms and tries to deduce the possible reasons of remission of type 2 diabetes after bariatric surgery.

关键词： Type 2 diabetes Morbid obesity bariatric surgery

Assessment of Endometrial Carcinoma Markers and Hormone Receptors Profile before and after bariatric Surgery: A Clinico-Pathological-Immunohistochemical Study

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Open Journal of Obstetrics and Gynecology 2019年第7期9卷 1019-1031页

作者： Walid Mohamed Elnagar Samah Said Elbasateeny Mai Mohamed Abdelwahab Mahmoud Abdou Yassin Taha Abdelwahab Baiomy Maha Abdelhamid Fathy Amin Dalia Abdallah El-Shafei Department of Obstetrics and Gynecology Faculty of Medicine Zagazig University Zagazig Egypt Department of Pathology Faculty of Medicine (Rabigh Branch) King Abdul Aziz University Jeddah KSA Department of Pathology Faculty of Medicine Zagazig University Zagazig Egypt Department of General Surgery Faculty of Medicine Zagazig University Zagazig Egypt Department of Physiology Faculty of Medicine Zagazig University Zagazig Egypt Department of Community Environmental & Occupational Medicine Faculty of Medicine Zagazig University Zagazig Egypt

Background: Obesity is a major risk factor for endometrial carcinoma, and we aim to assess markers of carcinogenesis including PTEN and Ki-67 and hormone receptors profile including ER, PR and AR before and after bariatric surgery to find out its effects in reducing endometrial carcinoma risk in morbid obese females. Patients and methods: The study included 80 females with morbid obesity (BMI > 40 Kg/m2) who underwent bariatric surgery. All were sampled by Pipelle biopsy at baseline and 12 months after operation and examined histopathologically and immunohistochemically for Ki-67, PTEN, ER, PR and AR. Results: Sixty two out of 80 (62/80) females showed no pathological abnormalities;4 had polyps;7 had simple endometrial hyperplasia;4 had atypical endometrial hyperplasia and 3 had endometrial carcinoma. In total, 34 females underwent gastric bypass operation (42.5%) and 46 underwent a sleeve gastrectomy operation (57.5%). There was a statistically significant difference between baseline weight and BMI before and after surgery (p < 0.001). Of the 7 women with simple hyperplasia, resolution occurred in 5 within 7 months of surgery. Three of 4 females with atypical hyperplasia (AH) showed resolution after 9 months. Mean Ki-67 score was lower at 12 months (p < 0.001) after surgery. 43/77 (55.8%) baseline biopsies were glandular PTEN null, including 9/15 of the women with baseline endometrial abnormalities, of whom 5/15 regained glandular PTEN expression as their endometrial abnormalities resolved. There was a significant reduction in ER score after surgery (p < 0.001). PR H-scores were not significantly different post-operatively (p = 0.193). AR H-scores were higher significantly in pre-operative biopsies than post-operative ones (p < 0.001). Conclusion: Females with morbid obesity have a higher risk of harboring endometrial abnormalities even if asymptomatic. However, the endometrial pathology and the high ER and PR expression can be normalized within one year without medical treatment, signifying the role of bariatri

关键词： bariatric Surgery Obesity Endometrial Cancer Hormone Receptors

Obesity: Body Relief Surgeries before bariatric Surgery for Risk Reduction

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Modern Plastic Surgery 2020年第3期10卷 31-37页

作者： José Humberto Cardoso Resende Ana Letícia Pinto Guimarã es Brunna Abreu Perillo Ana Carolina Melo Maluf Laura Ribeiro da Costa Rafaella Cristina Gomes Bernardes Arthur Camargo Pires Thalles Gonç alves Souza Menezes Murilo Calil Alves Emídio Silva Falcã o Brasileiro UNIFAN Work Coordinator Aparecida de Goi&#226 nia Brazil UNIFAN Medicine Academics Aparecida de Goi&#226 nia Brazil UNIFAN Research Coordinator Aparecida de Goi&#226 nia Brazil

Depending on the treatment and weight of the breasts or abdomen, they may exceed volumes considered giant and morbidly obese. In these cases, and when the patient’s BMI is high above 40 kg/m2, the weight of the breasts or abdomen produces what we consider suffocation when the patient is placed in horizontal position on surgical tables, decreasing his respiratory capacity and increasing the difficulty in treating respiratory or embolic risks. An 8-kg breast on the patient’s chest prevents normal breathing. An abdomen with a volume of 30 kg causes difficulties in all senses, making the physiological expansion of the lungs impossible and even preventing surgical assistance to patients. These patients are almost always customers who sleep in the sitting position to breathe better. The gigantic extirpation of the surgical parts facilitates a better respiratory expansion reducing by a large percentage the risk of death, what we call body relief. This relief does not free the patient from bariatric surgery for a possible weight loss, which is vital for the proper functioning of the organs and decreasing arterial hypertension and diabetes.

关键词： Obesity Disease Surgery bariatric Risk Hypertension and Diabetes

Results of Sleeve Gastrectomy in Germany—Data on Nationwide Survey on Quality Assurance in bariatric Surgery in Germany

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Surgical Science 2012年第4期3卷 169-176页

作者： Christine Stroh Rudolf Weiner Thomas Horbach Kaja Ludwig Miriam Dressler Stefanie Wolff Hans Lippert Martin Büsing Uwe Schmidt Thomas Manger Department of General Abdominal and Pediatric Surgery Municipal Hospital Gera Germany Department of General Abdominal and Vascular Surgery University Hospital Magdeburg Magdeburg Germany Friedrich Alexander University Erlangen-Nürnberg Erlangen Germany Hospital Knappschaft Recklinghausen Recklinghausen Germany Hospital Rostock Südstadt Rostock Germany Hospital Sachsenhausen Frankfurt am Main Frankfurt Main Germany Muncipial Hospitals Dresden Neustadt Dresden Germany StatConsult Magdeburg Magdeburg Germany

Background: Since January 1st of 2005, the situation of bariatric surgery is being analyzed in Germany. The data is registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University Magdeburg. Methods: The data is registered through an online database which includes all information for primary and revision bariatric procedures as well as yearly follow-up. Participation in the quality assurance study is optional. All certificated centers have to participate at the survey. Results: From January 2006 to December 2009, 1478 sleeve gastrectomies (SG) were performed at 45 hospitals. The number of procedures has increased from 126 in 2007 to 933 in 2009. The main complication is leakage of the staple-line. Initial leakage rate was 7% in 2007. Leakage rate dropped down to 2.3% in 2008 and 2.5% in 2009. Mean age of patients was 43.1 years and mean BMI was 52.83 kg/m2. Age and BMI were significantly higher in patients with SG than in all other patients undergoing bariatric surgery. Conclusion: SG is a common and hype bariatric procedure in Germany, but postoperative complication rate is high. Data on the long-term effect of SG on weight loss and amelioration of comorbidities need to be evaluated. More detailed analyzes are necessary to establish the position of SG in the bariatric surgery. Further studies should also include examinations on long-term complications and redo-procedure after SG.

关键词： bariatric Surgery Sleeve Gastrectomy German Multicenter Trial Leakage Complications

Does Obstructive Sleep Apnea (OSA) Increase the Risk of Post-Operative Respiratory Complications after bariatric Surgery?

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Open Journal of Anesthesiology 2018年第10期8卷 255-266页

作者： Ayman A. Elrashidy Mohamed Elsherif Wahiba Elhag Reda Sobhi Abdel-Rahman S. Abdelaziem Surgery Department Hamad Medical Corporation Doha Qatar Anesthesia Department Faculty of Medicine Tanta University Tanta Egypt bariatric and Metabolic Surgery Department Hamad Medical Corporation Doha Qatar Surgery Department Faculty of Medicine Tanta University Tanta Egypt

Background: OSA affects up to quarter of general population. It is associated with morbid obesity with a higher morbidity and mortality rates. STOP Bang questionnaire is a validated method for OSA screening. OSA patients are at high risk of developing airway obstruction, cardiac events, congestive heart failure, stroke and desaturation post operatively. The aim of this study is to evaluate adverse respiratory events in patients undergoing bariatric surgery in relation to risk of OSA using Stop Bang questionnaire. Methods: This prospective double cohort study was conducted in Tanta University Hospital from Marchto August 2017. During the preoperative assessment, STOP-BANG questionnaire was performed. After extubation, patients were transferred to PACU unit. Respiratory complications were assessed thereafter. Based on STOP-BANG score, patients were divided into two groups, high risk of OSA with STOP-BANG > 3 (Group I) and low risk of OSA with STOP-BANG Results: 104 patients were included in this study. Group I had more comorbidities in the form of CAD (15% versus 2%, P 0.001). Higher number of respiratory complications was noted in high-risk group (31 patients, 59%) compared to (24 patients, 46%) in group II yet, it was not significant. Conclusion: Obese patients with STOP-BANG score > 3 undergoing bariatric surgery are associated with hypertension, dyslipidemia, CAD, and renal insufficiency. High-risk OSA obese patients are at higher risk of developing respiratory compilations like inability to breathe deeply and hypoxia in postoperatively.

关键词： Obstructive Sleep Apnea (OSA) Respiratory Complications Morbid Obesity bariatric Surgery STOP-BANG Score

Effectiveness of the Service Mapping Method in Re-designing the bariatric Surgery Clinical Pathway of a Public Hospital

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Journal of Pharmacy and Pharmacology 2017年第8期5卷 536-553页

作者： Loreggian Lara Sartor Mafia Elisa Strohmenger Laura Rovati Marco Pietro Lucca The Department of Medicine of St Paul Hospital Milan University Milan 20142 Italy The Department of Economics Management and Quantitative Methods Milan University Milan 20122 Italy The Department of Biomedical Surgical and Dental Sciences of St Paul Hospital Milan University Milan 20142 Italy The Department of Surgery of St Paul Hospital Milan University Milan 20142 Italy

Background： Nowadays obesity is the world＇s common disease. bariatric surgery is the only therapy that providessignificant cost savings within Public Health Service, but the lack of diagnostic paths universally accepted causes enormous waste ofresources and disruptions. Service Mapping is the ideal methodology to describe work＇s organization and to plan a new service model.Methods： The Service Mapping has been used to represent the actual state of the bariatric surgery service and starting from the criticalaspects found, we have developed a desirable state of the service. Results： Experience-based design has given centrality to thebeneficiary, making the bariatric service sensitive to patient＇s needs and expectations. The micro-organization of work has improvedprofessionals＇ integration, avoiding the creation of new operational entities or additional costs. The service has been simplified both forclinicians and hospital managers. The strategic repositioning of the dietician and general practitioner＇s recognition within the bariatricpath allowed us to achieve better clinical outcomes. Conclusions： Service Mapping has highlighted clinicians＇ difficulties in providingthe service, emphasizing the importance of the beneficiary. The iconic representation is a powerful explicit framework, fundamental formanagement purposes, to understand the role of every subject involved in the service, to rationalize work＇s organization, and integratehealthcare activities.

关键词： Service mapping, bariatric surgery, obesity, public health costs, national health service, management.

Predictors of Gallstone Formation in Morbidly Obese Patients after bariatric Surgery: A Retrospective Observational Study

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Surgical Science 2014年第1期5卷 1-5页

作者： Mohammad H. Abo-Ryia Hamdy S. Abd-Allah Osama H. El-Khadrawy Gamal I. Moussa Department of Surgery Gastrointestinal Surgery Unit Tanta University Hospital Tanta Egypt

Background: Obesity alone and rapid weight loss induced by bariatric surgery are recognized risk factors for the development of cholelithiasis. This study aimed to identify the predictive factors for gallstone formation after bariatric surgery. Patient and methods: The files of all morbidly obese patients underwent bariatric surgery in our unit during the period from March 2003 till October 2010 were reviewed and analyzed. All patients underwent routine preoperative ultrasonography and selective concomitant cholecystectomy was done in all patients with ultrasonographic-confirmed cholelithiasis. After excluding cases with prior and concomitant cholecystectomies, patients were divided into two groups;those who developed gallstones and those who did not and the two groups were compared. Results: Of the 143 reviewed files 135 were eligible to be included in the study. The incidence of cholelithiasis before surgery was 25.9% (35 cases). 19 cases (19%) of the 100 cases free at surgery developed gallstone at a mean of 13.2 months. Comparing the two groups, no significant difference was revealed regarding gender, age, preoperative BMI or type of the operation. But the percent of excess weight loss was significantly higher in the group that formed gallstones. Conclusion: Gender, age, preoperative BMI and type of the operation were not predictive of gallstones formation after bariatric surgery. The percent of excess weight loss was the only predictive postoperative factor.

关键词： Obesity Gallstone bariatric Surgery

Obesity Management-bariatric Surgery vs Lifestyle Modification

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Open Journal of Endocrine and Metabolic Diseases 2013年第1期3卷 69-74页

作者： Poondy G. R. Raman Subodh Banzal MGM Medical College Indore India Shri Aurobindo Institute of Medical Sciences Indore India

Role of bariatric surgery for obesity is briefly outlined. Selection criteria, contraindications, evaluations of patients before surgery, types of bariatric surgery with their merits and demerits are discussed. Result... 详细信息

关键词： Types of bariatric Surgery Selection Criteria Contraindication Merits and Demerits Lifestyle Modification

Obesity and obstructive sleep apnea, bariatric surgery and follow-up post treatment

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Health 2013年第8期5卷 40-46页

作者： Won Hee Seo Christian Guilleminault Department of Pediatrics Korea University Ansan Hospital Korea University College of Medicine Seoul Korea Stanford University Sleep Medicine Division Redwood City USA

bariatric surgery is a valid treatment alternative for obese patients with obstructive sleep apnea (OSA), but subjects who are overweight or obese represent a poor model to investigate the role of OSA treatment on cardiovascular variables, calling into question the attribution of cardiovascular and metabolic problems associated with OSA with excess weight. Seventeen patients with significant obesity who demonstrated OSA with a high apnea-hypopnea index (AHI) were treated with bariatric surgery alone after refusal of nasal continuous positive airway pressure (CPAP) treatment. At approximately 3 years post-surgery, subjects demonstrated a significant drop in blood pressure measured at rest, improvement in sleepiness and fatigue visual analogue scales, but continued to complain of daytime sleepiness. Polysomnography in these subjects demonstrated relative improvement in AHI, but patients continued to have a significant number of respiratory events and episodes of flow limitation.? Subsequent treatment with a dental device led to further improvement in nocturnal respiration, but did not reduce AHI to a normal range on repeat polysomnography. In this study we demonstrate that bariatric surgery alone and in conjunction with a dental device may significantly reduce AHI but does not eliminate daytime fatigue and sleepiness. Systematic long term follow-up examining the persistence of sleep related abnormalities should be performed particularly if daytime fatigue or sleepiness is still present in patients with OSA after treatment with bariatric surgery alone.

关键词： Obstructive Sleep Apnea Obesity bariatric Surgery Blood Pressure Flow Limitation

Situs Inversus during bariatric Surgery: A Retrospective Analyze

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Surgical Science 2015年第10期6卷 454-458页

作者： Augusto Tinoco Amanda Bussad Renam Tinoco Luciana El-Kadre Department of Surgery Sao Jose do Avaí Hospital Rio de Janeiro Brazil

Background: We were reporting three cases of Situs Inversus in morbidly obese patients that were submitted a laparoscopic gastric bypass (LGBP). The condition itself was not a serious hazard to normal, healthy patients but, may cause difficulties in the diagnosis and management of abdominal pathology. The incidence of surgical disease did not seem to be different as in the general population, but its presentation, diagnosis and the operative procedure were. This was particularly true for laparoscopic surgery. Methods: From January 1999 to June 2015, 3047 morbidly obese patients underwent. Three patients with Situs Inverse (SI), two of the three with Situs Inversus Totalis (SIT), and one with Situs Inversus Parcialis (SIP) were submitted to a laparoscopic Roux-en-Y gastric bypass with no major difficulties. The mean age was 45 years (39 - 49), BMI 37.7 kg/m2, two of the above patients were female. Results: The LGBP was completed successfully in two of the three patients with SI. The mean duration of surgery was a 167 minutes, ranging from 110 - 210 minutes. The hospital stay was 5 days (3 - 8). Conclusions: The benefits of surgery were evident, even in the patients with SI;as there was no need for ICU admission and patients had an early hospital discharge. Morbidly obese patients with SI might be submitted to LGBP. This procedure was feasible and safe when the diagnosis was pre-operatively confirmed, and the surgical team made proper adjustments.

关键词： Gastric Bypass Laparoscopy Morbid Obesity Situs Inversus bariatric Surgery