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Message in a Bottle
Published in R. Annie Gough, Injury Illustrated, 2020
It was a typical day, and an attorney appeared in my open doorway. He pulled up a chair and dove into a story about a new client. This client was a woman named Kimberly, she was a wife and new mother. She was morbidly obese. Her weight was likely to take her life sooner than later. She had an elective surgery to lose weight, and her medical record was on its way to my desk. Her deposition had been taken, and it was my turn to prepare the attorney for the deposition of our medical expert. I was given all the key medical records and reports to review. I needed to understand this woman's anatomy before the operation and be sure to fully understand everything that happened during her surgery and in all of her following procedures. I started taking notes, setting up a chronology of key dates in the margin. After much reading, I began researching Vertical Banded Gastroplasty. Laparoscopic gastric banding is a procedure by which the stomach is made smaller to limit the intake of food. This was a surgery I had not witnessed, but the stomach is an anatomical area I do know a good deal about. On my yellow legal pad, I sketched a stomach with its general blood supply and immersed myself into the details of the medical record.
Obesity
Published in Andrew Stevens, James Raftery, Jonathan Mant, Sue Simpson, Health Care Needs Assessment, 2018
John Garrow, Carolyn Summerbell
The HTA 2004 review makes little mention of the efficacy of surgery in the treatment of obesity. In this case also there are problems about entry criteria. By far the largest trial of the effectiveness of surgical treatment is the Swedish Obese Subjects (SOS) trial, that started in 1987.83 It is intended to recruit 2000 matched patient pairs, and to follow them for 10 years. It is not a randomised trial (the patient having surgery is matched (on 18 variables) with a similar patient who is having non-surgical treatment) therefore it is not included in any Cochrane review. So far 1879 patient pairs have been recruited. After 8 years the weight loss in the surgical group was 28±15 kg, and 0.5±8.9 kg among controls. The weight loss in the surgical patients (as percent body weight) was 33±10% after gastric bypass, 23±10% after vertical banded gastroplasty, and 21±12% after gastric banding. The two-year incidence of diabetes in the surgical patients is 32 times less than in the matched controls, and with hypertension it is 2.6 times less than in controls.
Current management of obesity
Published in Nerys Williams, Sudhesh Kumar, Managing Obesity in the Workplace, 2018
The results of the more complex surgery are impressive – data from over 14 000 patients on the International Register of Obesity Surgery show that at 12 months, vertical banded gastroplasty and gastric bypass patients show a mean loss of 53% and 72% excess weight respectively, with an operative mortality of 0.17% and with 93% of patients experiencing no morbidity.11 NICE has produced guidance on the indications for surgery in the UK12 and has further extended its recom mendations for surgery in children (www.nice.org accessed January 2007).
Cardiac remodeling in obesity and after bariatric and metabolic surgery; is there a role for gastro-intestinal hormones?
Published in Expert Review of Cardiovascular Therapy, 2019
Elijah Sanches, Marieke Timmermans, Besir Topal, Alper Celik, Magnus Sundbom, Rui Ribeiro, Chetan Parmar, Surendra Ugale, Monika Proczko, Pieter S. Stepaniak, Juan Pujol Rafols, Kamal Mahawar, Marc P. Buise, Aleksandr Neimark, Rich Severin, Sjaak Pouwels
Bariatric surgery is originally derived from the combination of the ‘old’ Greek words ‘baros’ and ‘iatrike’, which literally mean ‘weight treatment’. The first bariatric procedures were done in the fifties by Arnold Kremen [80], Richard Varco and Henry Buchwald [81,82]. Nowadays the term bariatric surgery is used for all surgical procedures that (can) help in the reduction of excess weight [2]. Historically these procedures were divided into three categories; 1) restrictive procedures 2) malabsorptive procedures and 3) combination procedures (with a restrictive and malabsorptive component) [2,82]. Restrictive surgical procedures are meant to decrease the size of the stomach to reduce hunger or cause earlier satiety with smaller volumes of food [2,82]. Surgical procedures in this category include gastric banding (GB), vertical-banded gastroplasty (VBG) and thirdly the sleeve gastrectomy (SG). In this category, GB and VBG are rarely performed anymore and SG is still a very popular procedure worldwide [83,84]; however, in the recent years, it decreased in numbers worldwide [83,84]. Figure 1(a–c) gives an overview of the surgical anatomy of the RYGB and SG and the production of the most important gastrointestinal hormones.
Cost-effectiveness analysis of bariatric surgery for morbid obesity in Belgium
Published in Journal of Medical Economics, 2018
Oleg Borisenko, Vasily Lukyanov, Isabelle Debergh, Bruno Dillemans
Nevertheless, these results have originated from a decision analytic modeling, which has inherent limitations of being a simplification of the current clinical practice. Several empirical studies, performed mainly in Sweden and the US, failed to demonstrate a cost-saving effect with the use of bariatric surgery. However, they shared similar limitations, including a short time horizon, reporting data for discontinued surgical methods (e.g. vertical banded gastroplasty in the SOS study), and extensive use of the open surgical approach75,76. Due to delays in publication and the natural development of surgical methods, empirical economic evidence may not reflect current safety and efficacy of the bariatric procedures. Decision analytic modeling can complement empirical data and bridge knowledge gaps promptly.
Peroneal neuropathy and bariatric surgery: untying the knot
Published in International Journal of Neuroscience, 2020
Mohamad Y. Fares, Zakia Dimassi, Jawad Fares, Umayya Musharrafieh
Gastric bypass is a restrictive-malabsorptive bariatric procedure that is considered the most commonly used worldwide [27]. This procedure reduces stomach size and bypasses part of the bowel to achieve a markedly lower stomach volume [28]. Several modifications and variations evolved over the years, like reduction in gastric pouch size, complete gastric transection, and application of a Roux-en-Y [29]. Gastric banding is a procedure introduced in the 1980s that constricts the stomach using an inflatable silicon band placed around the top portion of the stomach. This slows and restricts the quantity of food consumed by the patient, hence causing an earlier feeling of satiety. Later modifications saw the introduction of adjustable devices and better techniques that helped increase this procedure’s popularity [30,31]. Gastroplasty is a restrictive procedure first conducted in the 1970s; this procedure later developed into vertical banded gastroplasty (VBG) and became popular in the 1990s [31]. VBG uses a band and staples to reduce stomach size and create a small stomach pouch, thereby decreasing eating consumption. Food can flow into the rest of the gastrointestinal system through a small hole at the bottom of the stomach pouch. Sleeve gastrectomy is a restrictive procedure that was derived from the concept of VBG to be used in high risk patients [32]. This procedure removes a large portion of the stomach along the greater curvature, resulting in a sleeve or tube-like structure [32]. Similar to other procedures, this limits the amount of food taken and illicits hormonal changes that assist in weight loss. A duodenal switch is a less common restrictive-malabsorptive procedure [31,32]. It involves reducing the stomach size by around 80% and bypassing the majority of the intestine by connecting its end portion to the duodenum near the stomach [31,32]. Duodenal switch is considered a very reliable and long lasting BS procedure for weight loss.