Initial experience and result of a Swedish adjustable gastric banding by laparoscopic approach in Thai cohorts.

BACKGROUND: Morbid obesity is a growing problem in Thailand. Several surgical procedures are available for weight reduction. The laparoscopic gastric banding has been shown to be an effective weight loss with a low post or perioperative complication. OBJECTIVE: The aim of this report was to evaluate the early preliminary outcome of the laparoscopic Swedish adjustable gastric banding operation in Thai cohort patients. MATERIAL AND METHOD: From November 2003 until March 2005, ten patients with a median age of 31 (range, 18-61) underwent laparoscopic Swedish adjustable gastric banding for morbid obesity at Ramathibodi Hospital. Demography, clinical course and outcome including excess weight loss and peri-operative complications were reviewed and studied. Descriptive statistics were used for data summary. RESULTS: There were 3 men and 7 women with a median preoperative body weight of 142.5 kg (range, 98-164 kg), and median body mass index (BMI) of 49.2 kg/m2 (range, 40.3-62.4 kg/m2). The operations were successful in 9 out of 10 patients with median operative time of 195 minutes (range, 125-275 minutes). One patient with a BMI of 62.4 had a failed operation due to poor operative exposure from a very large left lobe of the liver. None of the remaining patients required conversion to the opened technique. The mean hospital stay was 4 days with no perioperative mortality. There was no major post operative complication except one minor wound infection. The excess weight loss was within the range of 33.5% to 62.1% during the short-term follow-up (range, 1-15 months) CONCLUSION: The presented early preliminary result of the laparoscopic Swedish adjustable gastric banding showed a good technical success with a significant short-term weight loss. The authors believe this minimally invasive operation is appropriate for morbidly obese Thai patient. However a longer follow-up study is needed.

Hypovitaminosis D in long-stay hospitalized patients in Songklanagarind Hospital.

The major source of vitamin D is endogenous synthesis under sunlight exposure, thus, vitamin D deficiency is uncommon in healthy people living in a tropical area where sunshine is plentiful. However, long-stay hospitalized patients who do not get direct sunlight may become vitamin D deficient. The authors studied the prevalence of vitamin D deficiency in patients without other risk factors for vitamin D deficiency who had been admitted to Songklanagarind Hospital for longer than 27 days. The second objective was to identify predictive factors for vitamin D deficiency. Considered variables were clinical character, basic laboratory results, and intact parathyroid hormone level (iPTH). Among 60 patients studied, there were 12 patients who were vitamin D deficient and only one had a level lower than 8 ng/ml. Despite vitamin D deficiency, average serum calcium was normal. Patients in the vitamin D deficient group had lower serum corrected calcium and higher iPTH level than patients in the vitamin D sufficient group. No other clinical or laboratory data could predict a vitamin D deficiency state. In summary, the present tropical area study showed that 20 per cent of long-stay hospitalized patients who had a mild degree of vitamin D deficiency and 1.7 per cent had severe vitamin D deficit. Vitamin D supplementation is unnecessary in this group of patients.