Spectrum and Risk Factors of Complications After Gastric Bypass

Campos, Guilherme M.; Ciovica, Ruxandra; Rogers, Stanley J.; Posselt, Andrew M.; Vittinghoff, Eric; Takata, Mark; Cello, John P.

doi:10.1001/archsurg.142.10.969

Cited by 47 publications

(42 citation statements)

References 55 publications

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“…A total number of 20 articles entered the meta-analysis models (fig. 1) [24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43]. …”

Section: Resultsmentioning

confidence: 99%

Laparoscopic versus Open Obesity Surgery: A Meta-Analysis of Pulmonary Complications

Antoniou¹,

Antoniou²,

Koch³

et al. 2015

Dig Surg

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The clinical effects of laparoscopy in the pulmonary function of obese patients have been poorly investigated in the past. A systematic review was undertaken, with the objective to identify published evidence on pulmonary complications in laparoscopic surgery in the obese. Outcome measures included pulmonary morbidity, pulmonary infection and mortality. The random effects model was used to calculate combined overall effect sizes of pooled data. Data are presented as the odds ratio (OR) with 95% confidence interval (CI). A total of 6 randomized and 14 observational studies were included, which reported data on 185,328 patients. Pulmonary complications occurred in 1.6% of laparoscopic and in 3.6% of open procedures (OR 0.45, 95% CI 0.34-0.60). Pneumonia was reported in 0.5% and in 1.1%, respectively (OR 0.45, 95% CI 0.40-0.51). Available evidence suggests lower pulmonary morbidity for laparoscopic surgery in obese patients; further quality studies are however necessary to consolidate these findings.

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“…A total number of 20 articles entered the meta-analysis models (fig. 1) [24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43]. …”

Section: Resultsmentioning

confidence: 99%

Laparoscopic versus Open Obesity Surgery: A Meta-Analysis of Pulmonary Complications

Antoniou¹,

Antoniou²,

Koch³

et al. 2015

Dig Surg

View full text Add to dashboard Cite

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“…In addition, there are no standardized techniques to account for the different body shapes of the morbidly obese patient. These two factors resulted in increased operative time and complication rate [5][6][7]. We showed that XU distance was predictive of a challenging operation.…”

Section: Discussionmentioning

confidence: 77%

A new and standardized approach for trocar placement in laparoscopic Roux-en-Y gastric bypass

et al. 2008

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Introduction Super-morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) present unique technical challenges. In our experience the ease of the operation and the operative time seem to be more dependent on body habitus than body mass index (BMI). We hypothesized that the distance between the xyphoid process and the umbilicus (the XU distance) correlated with surgical difficulty and described an original modification of trocar placement based on this measurement to improve the ease of the operation. Methods Seven hundred and seventy-four patients underwent LRYGB, and the XU distance was measured in a subset of 38 patients midway through the experience. The need for additional trocars was assessed intraoperatively and the relationship between the XU distance and the need for extra trocars was subsequently analyzed. A standardized approach for trocar placement was implemented in the second half of our series. The operative time was compared between the standardized and nonstandardized groups.Results Fifty percent of the patients required a five-trocar technique. Median XU distance in this group was 21.4 cm (range 17-25 cm). In the remaining 19 patients additional trocars were added; median XU distance was 27.3 cm (range 24-33 cm). From the 774 patients included in the study period, the operative time for the first 322 patients who were completed with a nonstandardized trocar approach was significantly longer than the subsequent 452 cases in which the standardized trocar approach was used (210 versus 173 min, p \ 0.001).Conclusions We define XU distance as the key element in determining the choice of trocar placement. When XU distance is less then 25 cm, the basic approach should be used and if it is greater than 25 cm, the advanced trocar approach is recommended. This standardized technique leads to decreased operative time and improved ease of operation.Keywords Morbid obesity Á Laparoscopic gastric bypass Á Trocar placement Á Surgical treatment of obesity Á Ergonomics in laparoscopy Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a technically demanding procedure with a learning curve of approximately 100 cases [1,2]. Patients with a very high body mass index (BMI) present unique challenges.In our experience ease of the operation, and consequently operative time, seemed to be more dependent on body habitus than BMI alone. Patients with significant central obesity (apple-shaped) were surgically more challenging and had a prolonged operative time compared to pear-shaped patients, independent of their BMI.We noted that the distance between the xiphoid process (X) and the umbilicus (U), which we defined as the XU distance, was significantly greater in patients with marked

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“…Whereas the focus on the development of GJ strictures centers mostly on technical aspects, the underlying mechanism for the development of marginal ulcers has not been clearly defined. Several studies suggest ischemia, increased gastric acid, foreign-body reaction, H. pylori infection, smoking, and NSAID use as contributing factors for the development of this complication [18,23,28,36,[38][39][40]. It is postulated that staples or suture material used to create the GJ leads to an intense inflammatory reaction with mucosal breakdown.…”

Section: Discussionmentioning

confidence: 99%