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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.
Reproductive effects of obesity in adolescents
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Whitney Wellenstein, Nichole Tyson
Bariatric surgery in adolescents will likely increase as the prevalence and severity of childhood obesity rises. The specific indications and patient criteria for bariatric surgery in adolescents are still being developed. However, it is generally agreed that those with severe obesity (BMI >40) with obesity-related health conditions who have unsuccessfully attempted weight loss with nonsurgical options are good candidates.55 Surgery timing is ideally delayed until mid to late teen years, when skeletal maturity is reached. The risks of bariatric surgery vary depending on which procedure is used. Laparoscopic sleeve gastrectomy and adjustable gastric band are both restrictive procedures. The sleeve gastrectomy carries risks of bleeding, ulcers, gastroesophageal reflux disease, and staple disruption, while the adjustable band can have band slippage and/or erosion.55 The Roux-en-Y gastric bypass surgery is a restrictive and malabsorptive procedure. It is the most effective for weight loss but carries more risks. Short-term risks include anastomotic leak and bowel obstruction, while long-term risks include nutritional deficiencies, dumping syndrome, and complications of the caliber of the bowel anastomosis.55
The Abdomen
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Treatment of injury to the left or right hepatic duct is even more difficult. If only one hepatic duct is injured, a reasonable approach is to ligate it and deal with any infections or atrophy of the lobe rather than to attempt repair. If both ducts are injured, each should be intubated with a small catheter brought through the abdominal wall. Once the patient has recovered sufficiently, delayed repair is performed under elective conditions with a Roux-en-Y hepatojejunostomy.
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].
Hypothyroidism following gastric sleeve surgery resolved by ingesting crushed thyroxine tablets
Published in Baylor University Medical Center Proceedings, 2020
Kristen Fain, Alexsandra P. Rojas, Alan N. Peiris
The difference between gastric bypass and the gastric sleeve is related to the surgical involvement of the stomach. Gastric bypass surgeries such as the Roux-en-Y procedure act by mostly bypassing the stomach, stapling it, and leaving only a small pouch about the size of an egg intact.8 The pouch is then connected to the small intestine, where it can still supply its digestive juices without allowing food to travel through the intact stomach.8 The gastric sleeve also removes a significant portion of the stomach, though less than with gastric bypass. Stomach volume is significantly reduced after bariatric surgery, with fewer parietal cells and subsequently higher pH levels. Ingested material does not pass through the stomach but passes straight through to the small intestine in order to decrease absorption. This has significant implications for levothyroxine absorption (Table 1).1,7–9