Perioperative risks and safety of surgery for severe obesity

Mason, Edward E.; Renquist, Kathleen E; Jiang, Donald Dah-Shyong

doi:10.1093/ajcn/55.2.573s

Cited by 117 publications

(52 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…MASON et al (23) , in 1992, studied the peri-operative surgical risks for severe obesity and found median age, weight and BMI in the male population to be serious factors (P<0.01). After logistic regression analysis, they found the greater risk of complications to be among the aged with greater BMI and of masculine gender (P<0.01).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of risk factors in superobese patients submitted to conventional Fobi-Capella surgery

Martins-Filho

Câmara-Neto

Ferraz³

et al. 2008

Arq. Gastroenterol.

View full text Add to dashboard Cite

-Background -Obesity is one of the world's greatest health problems. The Roux-en-Y gastric bypass is the gold standard treatment for severe obesity. Surgery in obese patients has an acceptable level of morbidity and mortality. The superobese patient, a subcategory of severe obese patients with a high surgical risk has not yet been analyzed as a group. Methods -A retrospective and prospective cohort study was conducted enrolling 135 patients submitted to Roux-en-Y gastric bypass for treatment of severe obesity at the "Hospital das Clínicas", Federal University of Pernambuco, Recife, PE, Brazil, between November 1997 and September 2003. The independent variables were possible risk factors of adverse outcomes: age, gender, weight, body mass index, diabetes, hypertension, hypercholesterolemia, sleep apnea, cardiopathy/coronariopathy, pneumopathy or any other co-morbidity. The dependent variables were major complications, minor complications and death. Results -Diabetes (RR = 1.6 and CI = 1.02-2.40) and sleep apnea (RR = 1.8 and CI = 1.18-2.64) were associated to minor complications. Cardiopathy/coronariopathy were associated with major complications (RR = 5.42 and CI = 1.22-2.40) and death (RR = 16.25 and CI = 3.00-87.95). BMI ≥55 kg/m 2 was associated with minor complications (RR = 1.58 and CI = 1.04-2.40), major complications (RR = 3.17 and CI = 1.03-9.80) and death (P = 0.007). After logistic regression, the body mass index ≥55 kg/m 2 remained as a strong risk factor of death (OR = 3.6 and CI = 1.05-12.32). Conclusions -The body mass index ≥55 kg/m 2 was the main risk factor for severe complications and death. Other risk factors affecting the outcome were diabetes, obstructive sleep apnea and cardiopathy/coronariopathy.

show abstract

Section: Discussionmentioning

confidence: 99%

Evaluation of risk factors in superobese patients submitted to conventional Fobi-Capella surgery

Martins-Filho

Câmara-Neto

Ferraz³

et al. 2008

Arq. Gastroenterol.

View full text Add to dashboard Cite

show abstract

“…With a protocol consisting of early ambulation, compression stockings, intermittent compression stockings, and enoxaparin, a low rate of postoperative venous thromboembolism was described (74). In patients at especially high risk for venous thromboembolism (e.g., patients: older than 65 years, BMIO50, a previous venous thromboembolism, venous insufficiency, sleep apnea), placement of a vena cava filter as well as a prolonged course of oral anticoagulants should be seriously considered (75)(76)(77)(78).…”

Section: Postoperative Complications and Difficultiesmentioning

confidence: 99%

“…Anastomotic leaks are another cause of morbidity and mortality occurring in w0.5-3% (52,63,71,75,(79)(80)(81)(82)(83)(84). Leaks are difficult to diagnose, a heart rate above 120 beats/min and respiratory distress/failure are the most common manifestations of anastomotic leak (68,70,85).…”

Section: Postoperative Complications and Difficultiesmentioning

confidence: 99%

Surgical treatment of obesity

Bult¹,

Dalen²,

Müller³

2008

European Journal of Endocrinology

229

140

View full text Add to dashboard Cite

More than half of the European population are overweight (body mass index (BMI) O25 and !30 kg/m 2 ) and up to 30% are obese (BMIR30 kg/m 2 ). Being overweight and obesity are becoming endemic, particularly because of increasing nourishment and a decrease in physical exercise. Insulin resistance, type 2 diabetes, dyslipidemia, hypertension, cholelithiasis, certain forms of cancer, steatosis hepatis, gastroesophageal reflux, obstructive sleep apnea, degenerative joint disease, gout, lower back pain, and polycystic ovary syndrome are all associated with overweight and obesity. The endemic extent of overweight and obesity with its associated comorbidities has led to the development of therapies aimed at weight loss. The long-term effects of diet, exercise, and medical therapy on weight are relatively poor. With respect to durable weight reduction, bariatric surgery is the most effective long-term treatment for obesity with the greatest chances for amelioration and even resolution of obesity-associated complications. Recent evidence shows that bariatric surgery for severe obesity is associated with decreased overall mortality. However, serious complications can occur and therefore a careful selection of patients is of utmost importance. Bariatric surgery should at least be considered for all patients with a BMI of more than 40 kg/m 2 and for those with a BMI of more than 35 kg/m 2 with concomitant obesity-related conditions after failure of conventional treatment. The importance of weight loss and results of conventional treatment will be discussed first. Currently used operative treatments for obesity and their effectiveness and complications are described. Proposed criteria for bariatric surgery are given. Also, some attention is devoted to more basic insights that bariatric surgery has provided. Finally we deal with unsolved questions and future directions for research. European Journal of Endocrinology 158 135-145

show abstract

“…Mason y cols 15 , encontraron que la edad, mayor IMC y género masculino se asociaban con más complicaciones; igualmente Livingston y cols 16 , reportan una mortalidad 3 veces mayor en pacientes mayores de 55 años, comparándolos con los de menor edad, por falta de reserva en la recuperación de las complicaciones. Por otro lado Schwartz y cols 17 , describen mayor incidencia de filtraciones, hasta 20%, en reoperados por fallas técnicas o inadecuada baja de peso.…”

Section: Discussionunclassified

Filtraciones en bypass gástrico resectivo por laparotomía en obesidad mórbida

Burgos

María²

2012

Rev Chil Cir

View full text Add to dashboard Cite

Anastomotic leaks after roux-en Y gastric bypass for morbid obesityBackground: Obesity is a severe disease whose prevalence continues to increase. Resective gastric bypass is one of the surgical procedures used in our center in patients with obesity, but like other techniques is not without complications, and the leak is one of the most serious. The use of drains and leak test with methylene blue during surgery, such as barium x-ray were performed in all patients as part of a protocol. Clinical signs, development, testing and treatment were recorded. Results: 36 patients (4%) developed leaks. Of the 900 patients died 3 (0.33%). Fever and tachycardia were the predominant symptoms. The diagnosis was made by imaging studies in 19 cases (52.7%). The leaks were mostly between 5 th and 9 th postoperative day. The most frequent location of the leak was at the gastrojejunal anastomosis (58.3%). Treatment was medical in 24 patients (66.7%), requiring re-operation only in 12 cases. The average time of closure of the leak was 35.5 days and the patients were hospitalized a total of 33.7 days on average. Conclusions: In the series studied after resective gastric bypass the leak is presented in 4% of patients. Fever and tachycardia are useful signs to suspect a leak. The early detection of leaks is determinant to reach the best evolution of the patient and success in the treatment.Key words: Leak, complications, morbid obesity, gastric bypass, morbidity. ResumenIntroducción: La obesidad es una enfermedad severa cuya prevalencia continúa en incremento. El bypass gástrico resectivo, es una intervención quirúrgica realizada en nuestro centro, para obesidad; al igual que otras técnicas no está exenta de complicaciones, siendo la filtración una de las más graves. Objetivos: Determinar mediante estudio prospectivo la incidencia, presentación clínica, evolución y tratamiento de pacientes obesos con filtraciones después de bypass gástrico resectivo vía abierta. Material y Método: Desde agosto de 1999 a diciembre de 2009, 900 obesos mórbidos fueron sometidos a bypass gástrico resectivo en Y de Roux vía abierta en el Hospital Clínico de la Universidad de Chile. Se realizó a los pacientes por protocolo, prueba con azul de metileno intraoperatoria y control radiológico con bario postoperatorio. Fue registrada la evolución, exámenes y tratamiento realizado. Resultados: 36 pacientes (4%) desarrollaron filtraciones. De 900Rev.

show abstract

Perioperative risks and safety of surgery for severe obesity

Cited by 117 publications

References 5 publications

Evaluation of risk factors in superobese patients submitted to conventional Fobi-Capella surgery

Evaluation of risk factors in superobese patients submitted to conventional Fobi-Capella surgery

Surgical treatment of obesity

Filtraciones en bypass gástrico resectivo por laparotomía en obesidad mórbida

Contact Info

Product

Resources

About