When performed for ITP, laparoscopic splenectomy resulted in shorter operations, minimal blood loss, earlier discharge, no conversions, and excellent remission rates, as compared with other hematologic indications. Despite larger spleens, more blood loss, and longer operations in patients with hematologic malignancies, morbidity and length of hospital stay still were similar to those associated with benign indications for laparoscopic splenectomy. In conclusion, laparoscopic splenectomy is safe and efficacious for a multitude of benign and malignant hematologic indications, and our data compares favorably to those for open series.
The DJBS achieves noninvasive duodenal exclusion and short term weight loss efficacy. Longer term randomized controlled sham trials for weight loss and treatment of T2DM are underway.
At present, bariatric surgery is the only treatment that can achieve meaningful and sustainable weight loss for the millions of morbidly obese individuals. The current popular operative procedures (the Roux-en-y gastric bypass, laparoscopic adjustable gastric band, and the biliopancreatic diversion with or without duodenal switch) are all relatively safe and effective. However, all of these procedures, to variable degrees, alter the anatomy and physiology of the gastrointestinal tract. This fact, along with postoperative dietary changes, makes these patients vulnerable to a multitude of potential complications. As more and more patients undergo these procedures, an increasing number of clinicians will be asked to care for them. It is therefore imperative that all clinicians have a general understanding of the operative procedures and the potential problems these patients may develop. This article will describe these operative procedures and will discuss the more common consequences.
MICHAEL TARNOFF. Best practice guidelines in pediatric/adolescent weight loss surgery. Obes Res. 2005; 13:274 -282. Objective: To establish evidence-based guidelines for best practices in pediatric/adolescent weight loss surgery (WLS).
Research Methods and Procedures:We carried out a systematic search of English-language literature in MEDLINE on WLS performed on children and adolescents. Key words were used to narrow the field for a selective review of abstracts. Data were extracted, and evidence categories were assigned according to a grading system based on established evidence-based models. Eight pertinent case series, published between 1980 and 2004, were identified and reviewed. These data were supplemented with expert opinions and literature on WLS in adults. Results: Recommendations focused on patient safety, reduction of medical errors, systems improvements, credentialing, and future research. We developed evidence-based criteria for eligibility, assessment, treatment, and follow-up; recommended surgical procedures based on the best available evidence; and established minimum guideline requirements for data collection. Discussion: Lack of adequate data and gaps in knowledge were cited as important reasons for caution. Physiological status, comprehensive screening of patients and their families, and required education and counseling were identified as key factors in assessing eligibility for surgery. Data collection and peer review were also identified as important issues in the delivery of best practice care.
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