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Obesity and Lipid Disorders
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Christine San Giovanni, Janet Carter, Elise Rodriguez
Roux-en-Y gastric bypass surgery is the gold standard for surgical management of severe obesity (Figure 25.1). This is done by laparoscopic surgery. During the procedure, there is creation of a small proximal gastric pouch to the jejunum of the small intestine. Thus, the remaining stomach and proximal small bowel are excluded from enteral content. On the other hand, the vertical sleeve gastrectomy is currently the most common bariatric operation in the USA and results in removal of 80% of the stomach, which produces a gastric sleeve of approximately 60–100 mL (Figure 25.2). The pylorus and distal antrum remain and gastric filling and emptying are preserved. This results in post-prandial satiety while avoiding dumping syndrome.
Upper gastrointestinal emergencies
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
In a Roux-en-Y gastric bypass the stomach is divided proximally to form a small pouch which is connected directly to the jejunum. A Y loop is formed from remaining stomach and duodenum, with anastomosis to the distal jejunum (see Figure 8.1).
Surgical management of diabetes
Published in Janet Titchener, Diabetes Management, 2020
Roux-en-Y gastric bypass This is the most frequently performed bariatric surgery. As illustrated in Figure 6.1, RYGB begins with the surgical formation of a small stomach pouch. The small intestine is then cut about 75 cm below the stomach. The distal cut end of the small intestine is pulled up and connected to the small stomach pouch (forming one arm of the ‘Y’) so that ingested food bypasses most of the stomach and part of the small intestine, reducing nutrient absorption. The proximal cut end of the small intestine is then connected to the distal segment of the small intestine (forming the second arm of the ‘Y’) so that gastric juices, bile and pancreatic exocrine products can enter the duodenum.
Current and emerging gluconeogenesis inhibitors for the treatment of Type 2 diabetes
Published in Expert Opinion on Pharmacotherapy, 2021
The most direct approach to improve lipid metabolism is by promoting loss of adipose tissue through weight loss. Bariatric surgery has been the most effective weight loss treatment. The Roux en Y gastric bypass procedure has been the most successful long-term procedure resulting in an approximate 30% reduction in the initial body weight after four years [142]. Reduction in gluconeogenesis following a bariatric procedure is rapid, not strictly related to progressive loss of adipose tissue, with reduced expression of key gluconeogenic enzymes [143–146]. The rapid reduction in hepatic gluconeogenesis is accompanied by an increase in intestinal gluconeogenesis [6,145,146]. Bariatric surgery results in a significant post-operative increase in gut peptides, notably GLP-1, which stimulates insulin secretion and reduces post-prandial glucagon levels, further suppressing gluconeogenesis [147].
Vague abdominal pain after Roux-en-Y gastric bypass: not always an internal herniation: case report and literature review
Published in Acta Chirurgica Belgica, 2020
T. Allaeys, V. Dhooghe, S. Nicolay, G. Hubens
Bariatric surgery has gained more and more popularity in the management of the obese population. Roux-en-Y gastric bypass is one of the most frequently carried out procedures in bariatric surgery. It has been proven to be successful in the management of obesity, not only leading to weight loss on the long-term but also influencing its well-known related diseases. Its success is based on both restrictive and malabsorptive mechanisms. Since it has gained popularity, abdominal pain after gastric bypass is a frequent reason for encounter at the emergency department. In the literature, legible lists of complications have been described. A distinction often made is the difference in early and late complications. The most severe complications seen in the early postoperative course is an anastomotic leakage and an intra or extra luminal haemorrhage, besides other less specific complications such as wound infection, pulmonary embolism and ileus or obstruction [1–5]. The purpose of this case report, however, is to focus on the long-term complications. Approximately 15–30% of patients seek help for their complaints within the first 3 years, of which abdominal pain is the main reason for consulting their surgeon [6,7]. Reviews have been published describing late complications, the one more extensive than the other [1–5,7].
Using clonidine in the treatment of tizanidine abuse and withdrawal: a case report of a patient with somatoform pain disorder
Published in Journal of Substance Use, 2020
Anna Kitta, Andreas Wippel, Paula Richwien, Gerhard Prager, Feroniki Adamidis, Eva Katharina Masel, Daniel König, Michael Ossege, Peter Berger
History: In 2003, the patient first started to experience symptoms of heartburn and reflux. In 2011, due to morbid obesity (BMI 42.2) and several unsuccessful weight loss attempts, indication for a gastric bypass was provided. As the patient had experienced problems with reflux before, it was decided to perform the Roux-en-Y gastric bypass. The procedure was carried out without any complications and the postoperative course was satisfactory. One year later, she experienced abdominal pain, was diagnosed with endometriosis and underwent surgery for hydrosalpinx and endometrial cysts and got an adnexectomy. Since 2016, several in patient hospital stays and visits at the emergency unit followed, always due to abdominal pain and nausea. Multiple CT-scans and X-rays were performed, due to the above-mentioned symptoms. In all, proper abdominal situs without any signs of passage obstacle or anastomotic stenosis was observed.