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Upper GI Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Nicola C Tanner, Chris Collins
How does a sleeve gastrectomy work?The body and fundus of the stomach are excised vertically using a linear stapler to create a narrow gastric tube along the lesser curve with a capacity of approximately 150–200 mL. A linear stapling device begins division 3–6 cm proximal to the pylorus and moves upwards just lateral to the Angle of His.The average loss of excess body weight at 5 years with an LSG is 53%.6
Surgical management of diabetes
Published in Janet Titchener, Diabetes Management, 2020
Sleeve gastrectomy With a sleeve gastrectomy (Figure 6.3), the outer part of the stomach is surgically removed so that it becomes a long narrow tube or ‘sleeve’. The reduced gastric volume limits the amount of food that can be consumed at any one time. Unlike gastric banding, the stomach volume cannot be adjusted at a later date.
Childhood Obesity
Published in James M. Rippe, Lifestyle Medicine, 2019
Jaime M. Moore, Matthew Allen Haemer
The Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study is a large, multicenter, prospective observational study of adolescents who underwent either sleeve gastrectomy or Roux-en-Y gastric bypass surgery betwee n 2007 and 2012. Three years after surgery, mean weight had decreased by 27% for gastric bypass patients and 26% for sleeve gastrectomy patients. Further, the majority of participants experienced remission of type 2 diabetes, elevated blood pressure, dyslipidemia, and abnormal kidney function.31 Risks include the possible need for additional abdominal surgeries and micronutrient deficiencies. The 2018 American Society for Metabolic and Bariatric Surgery pediatric metabolic and bariatric surgery guidelines recommend that adolescents with class II obesity (BMI ≥ 35 kg/m2 or ≥ 120% of the 95th percentile, whichever is lower) with co-morbidities including obstructive sleep apnea (apnea hypopnea index >5), type 2 diabetes, idiopathic intracranial hypertension, NASH, Blount disease, SCFE, GERD, or hypertension, or class III obesity (BMI ≥ 40 kg/m2 or ≥ 140% of the 95th percentile, whichever is lower) should be considered for metabolic and bariatric surgery.89,90,91 The adolescent must undergo a comprehensive psychologic evaluation pre- and post-operatively. Females must agree to avoid pregnancy for at least one year postoperatively, and placement of a long-acting reversible contraception device is preferable before or at the time of surgery.
Sleeve gastrectomy in patients with severe obesity restores circadian rhythms and their relationship with sleep pattern
Published in Chronobiology International, 2021
Cristina Barnadas Solé, María Fernanda Zerón Rugerio, Javier Foncillas Corvinos, Antoni Díez-Noguera, Trinitat Cambras, Maria Izquierdo-Pulido
As expected, 9 months after sleeve gastrectomy BMI decreased significantly, together with a reduction of glucose levels and an important decrease of energy intake. Furthermore, triglyceride and leptin levels decreased after surgery, variables that have been associated with the manifestation of circadian rhythms. For instance, elevated triglycerides have been described to be associated with lower amplitude and lower stability of the skin temperature rhythm in humans, and may be considered as a primary metabolic predictor of circadian disruption (Harfmann et al. 2017). On the other hand, the hormone leptin is strongly associated with glucose and lipid metabolism and with energy balance (Serin and Nilufer 2019), and hyperleptinemia, leading to leptin resistance, has been linked to the pathophysiology of obesity-related disorders (Shea et al. 2005). Leptin pattern disruption has been related with alterations of meal and sleep timing (St-Onge et al. 2019), and short sleep duration with reduction in leptin and increase in appetite and body weight (Dashti et al. 2015; Taheri et al. 2004). Thus, the recovery of the normal values in triglycerides and leptin levels, as observed before (Mazahreh et al. 2019), due to the surgery could also contribute to the regularity of the circadian rhythms observed at following 9 months after surgery.
How viable is pre-surgery weight reduction for the reduction of periprosthetic joint infection risk after total joint arthroplasty?
Published in Expert Review of Medical Devices, 2020
Michael Yayac, Rajesh Aggarwal, Javad Parvizi
For some patients, especially those with a BMI of 40 or greater, bariatric surgery may be the only feasible option to achieve and sustain substantial weight loss. In recent years, there have been three commonly performed procedures, including laparoscopic Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy, and laparoscopic gastric banding [7]. While still performed, laparoscopic gastric banding has fallen out of favor as a surgical option due to inferior outcomes and complications secondary to band slippage, erosions, and viscous penetrations, necessitating removal [8]. RYGB is considered the gold-standard procedure, having demonstrated superior results through several studies with long-term follow-up [9]. However, sleeve gastrectomy has recently become the preferred procedure for many bariatric surgeons due to its relative technical ease and lower risk of complications [7,8]. Evidence regarding the long-term outcomes of sleeve gastrectomy is limited, but two recent RCTs comparing sleeve gastrectomy to RYGB found no clinically significant differences between the procedures at a 5-year follow-up [7,10]. Unlike lifestyle modification or weight loss medications, bariatric surgery can result in rapid weight loss, which may be substantial enough to impact the risk of PJI. Patients undergoing either RYGB or sleeve gastrectomy have achieved BMI reductions of 11.5 to 13.1 points within 1 year, losing greater than 70% of their excess weight, and the success of these of procedures has been linked to numerous health benefits including improved glucose tolerance, blood pressure control, and blood lipid levels [7,9,10].
The negative effects of obesity on heart, especially the electrophysiology of the heart
Published in Artificial Cells, Nanomedicine, and Biotechnology, 2020
Haishan Chen, Xin Wang, Chongxiang Xiong, Hequn Zou
The health risks that obesity brings to human beings are far-reaching, so it is necessary to take active measures to lose weight. According to the surgical procedure, bariatric surgery can be divided into gastric bypass (Roux-en-Y gastric bypass; duodenal transposition; biliary-pancreatic shunt and Roux-en-Y gastric bypass), adjustable gastric banding, sleeve gastrectomy, and vertical occlusion gastroplasty. In the early days, most bariatric surgeries was vertical occlusion gastroplasty. However, in the United States, this procedure was associated with a number of complications, which have essentially been halted. Gastric bypass has resulted in more effective weight loss but is associated with more complications. Adjustable gastric banding is associated with lower mortality and comorbidities, while there is a higher rate of re-operation than gastric bypass and less weight loss. Sleeve gastrectomy, which is increasingly popular, reduces body weight more than adjustable gastric banding and is comparable to gastric bypass surgery [94].