ABSTRACT
Objective:To investigate the application value of right minimal invasive three-port technique of laparoscopic sleeve gastrectomy (RMIT-LSG) for the treatment of obesity.Methods:The retrospective and descriptive study was conducted. The clinical data of 66 obesity patients who underwent RMIT-LSG in the Sir Run Run Shaw Hospital of Zhejiang University School of Medicine from January to October 2021 were collected. There were 15 males and 51 females, aged 28.5(range, 16.0?54.0)years. The body mass index (BMI) of the 66 patients was (36.9±4.3)kg/m 2. There were 20 of the 66 patients combined with type 2 diabetes. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted using outpatient examination or the WeChat to detect postoperative recovery of patients including body mass changing, BMI and complications 6 months after operation. The follow-up was up to December 2021. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical situations. All the 66 patients underwent RMIT-LSG successfully, without conversion to laparotomy or changing surgical method. The operation time and the volume of intraoperative blood loss of the 66 patients were (132±22)minutes and (14±8)mL, respectively. (2) Postoperative situations. The time to postoperative initial out-of-bed activities, time to postoperative first flatus, time to postoperative initial water intake, time to postoperative initial liquid food intake and duration of postoperative hospital stay of the 66 patients were (15±6)hours, (1.80±0.60)days, (1.00±0.20)days, (2.00±0.20)days and (3.40±0.60)days, respectively. Of the 66 patients, one case underwent post-operative abdominal hemorrhage at postoperative day 1 and received a second surgery for hemostasis. The patient with postoperative abdominal hemorrhage and other 65 patients recovered well without gastroparesis, gastric fistula, abdominal infection and other complication. (3) Follow-up. All the 66 patients were followed up for 6(range, 1?11)months. All the 66 patients completed the postoperative scar photography at postoperative 1 month, and results of scar photography showed concealed scar with good cosmetic effects. Twenty-seven of the 66 patients were followed up for 6 months after operation, with the weight loss, percentage of weight loss and decrease of BMI were (42±7)kg, 34.8%±2.9%, (14.2±1.9)kg/m 2, respectively. None of the 66 patient had innutrition during the follow-up. Conclusion:The RMIT-LSG is safe and feasible for the treatment of obesity, with a good cosmetic effect of the wound.
ABSTRACT
At present, the aging trend of China′s population is intensifying and the number of overweight and obese elderly people is on the rise. The elderly obese is facing the treatment of related metabolic diseases, including cardiovascular disease, hypertension, type 2 diabetes, etc. In addition to life intervention and drug control, bariatric surgery is also one of the effective methods. Bariatric surgery can permanently reduce body mass, improve or alleviate the condition of patients, and prolong life. The authors analyze the indications and contraindications, perioperative manage-ment, surgical methods, surgical safety and effectiveness, and current problems of bariatric surgery for elderly obese patients.
ABSTRACT
Bariatric surgery is effective on obesity, which can significantly improve the metabolic diseases of obesity patients, especially the type 2 diabetes. However, the surgical proce-dures of bariatric and metabolic surgery are still evolving and in progress. One anastomosis gastric bypass (OAGB) is the latest bariatric surgery recognized by the international bariatric and metabolic surgery community. The authors review the relevant literatures at home and abroad, and introduce the development history, surgical skills, clinical efficacy, status quo and adaptability of OAGB.
ABSTRACT
Analysis of the layout and proportion of classic and innovative surgical procedures of bariatric and metabolic surgery throughout the world, the sleeve gastrectomy is beco-ming the most accepted and respected surgical procedure with its increasingly prominent advan-tages, and its operation number has even exceeded the "gold standard" surgery of the roux-en-Y gastric bypass. This trend is even more pronounced in China. With a small number of physicians lacking experience in gastrointestinal surgery and more and more young physicians joining in the field of bariatric and metabolic surgery, operation related complications and the consequences of insufficient perioperative management experience have occurred successively in clinical practice, such as gastrointestinal leakage, bleeding, lumen and anastomotic stenosis, internal hernia and obstruction, venous thromboembolism, etc. Bariatric and metabolic surgery is a branch of gastro-intestinal surgery, and physicians in the field should have the ability to prevent, predict and manage short- and long-term complications after surgery. The authors believe that through the comprehen-sive evaluation of laboratory indexes, patient signs and related examinations, physicians should have the basic qualities of decisively choosing the surgical timing, choosing the right decision-making, and taking effective measures.
ABSTRACT
Objective:To investigate the clinical efficacy of laparoscopic sleeve gastrec-tomy (LSG) in the treatment of obesity associated nonalcoholic fatty liver disease (NAFLD).Methods:The retrospective and descriptive study was conducted. The clinical data of 40 patients with obesity associated NAFLD who were admitted to Xijing Hospital of Digestive Diseases of Air Force Medical University from January 2018 to June 2019 were collected. There were 19 males and 21 females, aged (27±8)years. Patients underwent LSG after preoperative examinations and evaluations. Observation indicators: (1) surgical and postoperative conditions; (2) follow-up. Follow-up was conducted by telephone interview, WeChat, and outpatient review to detect the liver function, glucose and lipid metabolism-related status as well as the relief of comorbidities of patients at 6 and 12 months after LSG. The follow-up was up to June 2020. Measurement data with normal distribu-tion were represented as Mean± SD. Repeated measurement data were analyzed by the repeated measures ANOVA. Count data were represented as absolute numbers, and chi-square test was used for comparison between groups. Results:(1) Surgical and postoperative conditions: 40 patients underwent LSG successfully, without intraoperative conversion to laparotomy or death. The operation time, volume of intraoperative blood loss, and duration of postoperative hospital stay were (83±12)minutes, (19±7)mL and (3.7±0.7)days. Among the 40 patients, 1 case had fat liquefac-tion after LSG and 2 had abdominal distension within a month, who were improved after symp-tomatic and supportive treatment. (2) Follow-up: 40 patients were followed up at postoperative 6 and 12 months. The body mass of 40 patients was (112±17)kg, (85±16)kg, (73±11)kg before operation, at postoperative 6 and 12 months, respectively. The body mass index was (39.7±4.2)kg/m 2, (30.0±4.5)kg/m 2, (25.9±2.9)kg/m 2 before operation, at postoperative 6 and 12 months, respectively. The alanine aminotransferase was (56.40±39.51)U/L, (30.15±17.93)U/L, (26.45±9.44)U/L before operation, at postoperative 6 and 12 months, respectively. The aspartate amino-transferase was (34.03±19.62)U/L, (28.20±10.27)U/L, (24.90±8.44)U/L before operation, at post-operative 6 and 12 months, respectively. The gamma-glutamyltransferase was (48.68±28.45)U/L, (43.30±18.56)U/L, (32.80±12.09)U/L before operation, at postoperative 6 and 12 months, respectively. The fasting blood-glucose was (6.51±2.38)mmol/L, (5.64±1.51)mmol/L, (4.98±0.91)mmol/L before operation, at postoperative 6 and 12 months, respectively. The triglyceride was (1.81±0.95)mmol/L, (1.48±0.57)mmol/L, (1.17±0.44)mmol/L before operation, at postoperative 6 and 12 months, respectively. The total cholesterol was (4.77±0.98)mmol/L, (4.58±0.75)mmol/L, (4.10±0.68)mmol/L before operation, at postoperative 6 and 12 months, respectively. The low density lipoprotein cholesterin was (2.99±0.81)mmol/L, (2.79±0.54)mmol/L, (2.48±0.40)mmol/L before operation, at postopera-tive 6 and 12 months, respectively. The high density lipoprotein cholesterin increased was (1.08±0.20)mmol/L, (1.15±0.18)mmol/L, (1.45±0.21)mmol/L before operation, at postoperative 6 and 12 months, respectively. Compared with preoperative indicators, there were significant differences in postoperative body mass, body mass index, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase, fasting blood-glucose, triglyceride, total cholesterol and low density lipoprotein cholesterin ( F=472.439, 533.730, 26.791, 11.029, 25.545, 27.994, 27.534, 36.220, 18.596, P<0.05), showing a downward trend. There was a significant difference between preoperative and postoperative high density lipoprotein cholesterin ( F=68.974, P<0.05), showing a upward trend. The excess weight loss of 40 patients at 6 months and 12 months after LSG were 61%±18% and 85%±15%. The preoperative ultrasonography of 40 patients showed no, mild, moderate and severe fatty liver in 0, 2, 15 and 23 cases, respectively. The above indicators were 8, 9, 12, 11 cases at post-operative 6 months, and 23, 11, 6, 0 cases at postoperative 12 months, respectively. There was a significant difference of the grade of NAFLD between patients before and after surgery ( χ2=68.210, P<0.05). Conclusion:LSG has an accurate short-term clinical efficacy for obesity associated NAFLD, which can reduce body mass, improve liver function, alleviat the disorders of glucose and lipid metabolism and the severity of medium-severe fatty liver.
ABSTRACT
Objective:To investigate the application value of 'N' shaped Trocar placement in Da Vinci robotic bariatric and metabolic surgery.Methods:The retrospective and descriptive study was conducted. The clinical data of 69 patients who underwent Da Vinci robotic bariatric and metabolic surgery in the China-Japan Union Hospital of Jilin University from March to October 2020 were collected. There were 18 males and 51 females, aged from 12 to 67 years, with a median age of 34 years. The surgery was performed with the 'N' shaped Trocar placement by the same team of surgeons. The Da Vinci robotic sleeve gastrectomy, Da Vinci robotic single-anastomosis duodenal-ileal bypass with sleeve gastrectomy or Da Vinci robotic biliopancreatic diversion with duodenal switch was selected according to the patient's condition. Observation indicators: (1) surgical and post-operative conditions; (2) follow-up. Follow-up using the outpatient examination, telephone interview and WeChat to detect the body weight, body mass index, fasting blood glucose, glycosylated hemoglobin, total cholesterol, Trocar-related complications of patients at postoperative 3 months. The follow-up was up to November 2020. Measurement data with normal distribution were represented as Mean± SD, and comparison of general data before and after surgery was analyzed using the paired t test. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers. Results:(1) Surgical and postoperative conditions: of the 69 patients, 34 cases received Da Vinci robotic sleeve gastrectomy, 34 cases received Da Vinci robotic single-anastomosis duodenal-ileal bypass with sleeve gastrectomy, and 1 case received Da Vinci robotic biliopancreatic diversion with duodenal switch. There was no conversion to open surgery or laparoscopic surgery. The operation time of 69 patients was (161±52)minutes, and the volume of intraoperative blood loss was 30 mL(range, 10-100 mL). Two of 69 patients had post-operative complications. One of them with postoperative abdominal hemorrhage was cured after symptomatic treatment and discharged on the 10th day after surgery. The other one patient with postoperative peritoneal effusion was cured and discharged from hospital after puncture drainage and symptomatic treatment. No Trocar-related complication such as Trocar foramen bleeding and Trocar foramen hernia occurred in the 69 patients. The duration of postoperative hospital stay of 69 patients was (6±3)days. (2) Follow-up: 47 of 69 patients were followed up for 3 months. The body mass, body mass index, fasting blood glucose, glycosylated hemoglobin, and total cholesterol were (86±19)kg, (30±5)kg/m 2, (5.2±0.7)mmol/L, 5.3%±0.6%, (4.3±1.3)mmol/L at postoperative 3 months, which had significant differences compared with the preoperative indicators ( t=6.101, 8.261, 2.973, 2.567, 2.098, P<0.05). All the 47 patients had no Trocar-related complications during the follow-up. Conclusion:The 'N' shaped Trocar placement method is safe and feasible in the Da Vinci robotic bariatric and metabolic surgery, with good efficacy.
ABSTRACT
RESUMEN Objetivo: diseñar y evaluar la comprensión de una Herramienta Gráfica (HG) con recomendaciones de alimentación para personas con obesidad sometidas a Cirugía Bariátrica y Metabólica (CByM), con base en las guías propuestas por la American Society for Metabolic and Bariatric Surgery (ASMBS), American Association of Clinical Endocrinologists (AACE) y The Obesity Society (TOS), así como las recomendaciones del Colegio Mexicano de Cirugía para Obesidad y Enfermedades Metabólicas (CMCOEM) para el uso educativo de la persona profesional en nutriología-paciente. Metodología: se elaboró una HG nombrada "HG de alimentación pos-CByM" considerando las guías nutricionales propuestas por la ASMBS, AACE y TOS en conjunto con las recomendaciones de la CMCOEM. Además de realizar cuatro gráficos representando las fases que componen dicha HG, se incorporó una fase donde se aplicó un cuestionario de autollenado a tres grupos diferentes: 27 estudiantes de medicina, 8 pacientes posquirúrgicos y 16 pacientes prequirúrgicos. Se buscó identificar si el mensaje percibido era claro y conciso. Resultados: >70 % de la población intervenida entiende el mensaje de la HG diseñada, no existe significancia estadística entre los grupos entrevistados (p<0.05). Sin diferencia significativa (p<0.05) entre pacientes pre y posquirúrgicos, en ninguna de las respuestas. Conclusión: la educación en nutrición bariátrica es esencial para que las personas comprendan la transición de las fases posteriores a la intervención, los grupos, consistencia, tolerancia y porción de los alimentos. Esta HG puede ser de utilidad en la consulta nutricional exclusivamente para pacientes que se someterán a este tipo de cirugía o ya están en el proceso de recuperación.
ABSTRACT: Objectives: The purpose of this study is to Design and evaluate a graphic tool (GT) with feeding recommendations for people with obesity after bariatric surgery, based on the guidelines proposed by the American Society for Metabolic and Bariatric Surgery (ASMBS), American Association of Clinical Endocrinologists (AACE) y The Obesity Society (TOS) as well as the recommendations of the Mexican College of Surgery for Obesity and Metabolic Diseases (CMCOEM) for the educational use of the nutritionist-Bariatric patient. Methods: A GT named "Graphic tool for post bariatric surgery feeding" was elaborated based on the nutritional guidelines proposed by the ASMBS, AACE and TOS in conjunction with the recommendations of the CMCOEM. In addition to making four graphs representing each of the phases that conform the GT, a self-administered questionnaire was incorporate, it was carried out in three different groups: 27 medical students, 16 pre surgical patients and 8 postsurgical patients. We sought to identify if the perceived message was clear and brief. Results: More than 70% of the intervened population understood the message of the HG designed, there was no statistical significance among the groups interviewed (p <0.05) without significant difference (p <0.05) between pre and postsurgical patients, in none of the answers. Conclusion: Bariatric nutrition education is essential for the patient to understand the transition of the postsurgical phases, the food groups, the consistency, tolerance and portion of the food. This GT can be useful in the nutritional consultation exclusively for patients who will undergo this type of surgery or are already in the process of recovery.
Subject(s)
Humans , Guideline , Bariatric Surgery , Diet, Healthy , Obesity, Morbid , Activation, Metabolic , MexicoABSTRACT
OBJECTIVE: To summarize the experience of bariatric and metabolic surgery in a single center from 2009 to2017 and explore the methods of the specialty construction of bariatric and metabolic surgery. METHODS: The clinical data of 1139 cases of bariatric and metabolic procedures performed from October 2009 to December 2017 in Department of Bariatric and Metabolic Surgery,the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively. RESULTS: The case numbers increased annually after the foundation of bariatric and metabolic surgery with the annual growth rate of 40.1%. Bleeding and leakage were the main postoperative complications. Among them,there was one case of postoperative death,6 cases of re-operations within the 30-day after discharge,and 21 cases of 30-day postoperative readmission. The learning curve analysis indicated that learning time was 23 cases for laparoscopic gastric bypass and 25 cases for sleeve gastrectomy. The rates of 1-year excessive weight loss were 83.0% for gastric bypass,72.4% for sleeve gastrectomy,and 82.3% for sleeve gastrectomy plus jejunal bypass. The rates of 1,3 and 5-year follow-up were around 95.0%,67.0% and 52.0%. CONCLUSION: The foundation of bariatric and metabolic specialty is the key reason for the massive increase of surgical cases. The learning curve of laparoscopic bariatric and metabolic surgery can be shortened though systemic specialty training. The collaboration of multi-disciplinary team and the perioperative process management are the key points for the construction of an excellent center.
ABSTRACT
OBJECTIVE: To explore the cause and treatment of bariatric and metabolic surgery reoperation. METHODS: A retrospective analysis was conducted on the clinical data of 54 patients underwent reoperative metabolic and bariatric surgery in Department of Bariatric and Metabolic Surgery,the First Affiliated Hospital of Jinan University from November 2000 to December 2018, and the reasons and surgical techniques of reoperation were analyzed. RESULTS: Causes of reoperation included inadequate weight loss/weight regain in 22 cases(40.7%),adhesive intestinal obstruction in 5 cases(9.3%),mesenteric hernia in 5 cases(9.3%),gastroesophageal reflux in 4 cases(7.4%),anastomotic leakage4 cases(7.4%),anastomotic ulcer bleeding in 3 cases(5.6%),anastomotic stenosis in 3 cases(5.6%),postoperative intraabdominal bleeding in 3 cases(5.6%),recurrent diabetes in 2 cases(3.7%),severe dumping syndrome in 2 cases(3.7%),anastomotic error in 1 case(1.9%). Reoperation methods mainly included Roux-en-Y gastric bypass in 30 cases(55.6%),sleeve gastrostomy in 10 cases(18.5%),hernia repair in 5 cases(9.3%),exploratory laparotomy hemostasis in 4 cases(7.4%),gastroscopic balloon dilatation in 2 cases(3.7%),restoration surgery in 1 case(1.9%),revisional banded gastric bypass with GaBP ring in 1 case(1.9%), hiatal hernia repair in 1 case(1.9%). A total of 54 patients underwent reoperation with a follow-up period of 1 to 102 months. Among them, 42 patients were followed up,and 12 patients were lost to follow-up(follow-up rate of 77.8%). Among the 42 patients who were followed up, 41 of them achieved good results after surgery, and the symptoms and signs were relieved to various degrees. CONCLUSION: The most common cause of reoperative metabolic and bariatric surgery is inadequate weight loss/weight regain.The choice of reoperation method depends on the primary surgical procedure, the cause of failure, and the intraoperative condition.
ABSTRACT
OBJECTIVE: To learn the latest developments of Shanghai's bariatric & metabolic surgery and the differences with east Asian countries according to the transverse and vertical comparison. METHODS: Through data reporting mechanism of the Shanghai Quality Control Center of General Surgery,the bariatric & metabolic surgery data were regularly collected and summarized. RESULTS: The number of hospitals developed from 11 in 2012 to 14 in 2018,and the overall surgery cases showed a progressive growth. In 2017, nineteen hospitals and 798 surgical cases had reached the highest level while decreased in 2018. The study showed that mean surgical time decreased to 112±14.8 min with no severe complication. The proportion of patients with type 2 diabetes pre-surgery decreased from 53.4% in 2014 to 30.9%in 2018. The proportion of sleeve gastrectomy(SG) increased from 68.4% in 2014 to 94.1% in 2018, which had become the most commonly bariatric surgical procedure. CONCLUSION: The amount of Shanghai metabolic and bariatric surgery increases year by year from 2012 to 2018, while increased little in 2017-2018,patients tend to be younger,mainly with obesity. The SG has become the main procedure performed in Shanghai.
ABSTRACT
In recent years,bariatric surgery has developed rapidly in China,and its surgical procedures are constantly being innovated. But the postoperative complications do not reduce. Each new kind of surgery brings new problems,and each new bariatric center established brings new test. Some long-term complications are emerging with the extension of time for bariatric postoperative follow-up in China. Metabolic surgeon should pay more attention to the prevention of postoperative complications. Only by analyzing and solving the developing problems can make postoperative complications be effectively prevented.
ABSTRACT
Gastroesophageal reflux disease(GERD) is pronouncedly increased among obese population due to the incompetence of anti-reflux barrier resulting from adiposity.While lifestyle changes, medications and anti-reflux surgery have limited effects, bariatric surgery is the best treatment for GERD in patients with obesity. Roux-en-Y gastric bypass is an ideal procedure and sleeve gastrectomy can also be accepted as an option despite its controversy over GERD.Besides, some combination surgeries have emerged to be worth attempts. In case of the postoperative reflux, causes for that should be found and treated. Revisional surgery can be performed when it is necessary.
ABSTRACT
Bariatric and metabolic surgery has gained its rapid development recently. However,their perioperative management remains special due to the complex nature of obesity and type 2 diabetes mellitus. Special attention regarding the perioperative management of bariatric and metabolic surgery includes preoperative diagnosis and differential diagnosis, management of obesity related preoperative comorbidities, preoperative and postoperative management. Preoperative weight loss could decrease the surgical difficulty and surgical related compilations.Perioperative management of obstructive sleep apnea syndrome is relatively complicated. Meanwhile,measures regarding the deep venous thromboembolism prophylaxis are different in eastern and western countries.
ABSTRACT
After nearly 70 years development,bariatric and metabolic surgery has become one of the most innovation and technical challenges sub-specialty in general surgery.Jejunoileal bypass, Roux-en-Y gastric bypass,vertical banded gastroplasty,biliopancreatic diversion and duodenal switch, adjustable gastric banding and sleeve gastrectomy have ever dominated during the development of bariatric and metabolic surgery. In addition, new procedures such as minigastric bypass,are also being developed. Improvement in minimally invasive surgery, cognition of gastrointestinal and metabolic physiological mechanisms, and multidisciplinary treatment promote the development of bariatric and metabolic surgery.
ABSTRACT
Bariatric and metabolic surgery in China has went through 20 years,which is a tortuous but fruitful experience.However, it is undeniable that there are still many shortcomings in Chinese bariatric and metabolic surgery,mainly including the different views of endocrinologists and bariatric surgeons on the medium and long-term efficacies of operations, the insufficient understandings and low recognitions of the patients for bariatric surgery,the inaccurate mastery of surgical indications by some bariatric surgery teams,the inappropriate choices of surgical methods,uneven surgical techniques,untimely managements of postoperative complications,and nonstandard postoperative follow-ups.Under the positive guidance of the industry association, the implementation of standardization of data collection, reporting system and industry training, the advocacy of standardizedmanagement of multi-center prospective research, and the increase of media publicity will surely break the bottleneck of the bariatric surgery in China and usher in a new starting point of rapid development.
ABSTRACT
Cholecystolithiasis is one of the long-term complications after bariatric surgery, of which the exact cause is still unclear. Based on the recent domestic and international literature, the contributing factors for new onset cholecystolithiasis after bariatric surgery and countermeasures are reviewed in this article.
ABSTRACT
Objective@#To explore the application value of laparoscopic gastric plication (LGP) combined with duodeno-jejunal omega switch (DJOS) in modified adjustable gastric banding.@*Methods@#The retrospective and descriptive study was conducted. The clinical data of a female 46-year-old patient who had failure to undergo the adjustable gastric banding in the Hospital of Ludwig Maximilian University from December 2016 to December 2018 were collected. LGP and DJOS were performed in two-stages after completion of preoperative examinations. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Follow-up using outpatient examiantion and telephone interview was performed to collect the information of body mass index (BMI), insulin therapy, and long-term complications until December 2018. Count data were represented as absolute numbers.@*Results@#(1) Surgical and postoperative situations: the patient underwent LGP in the first stage and DJOS in the second stage successfully. For the LGP, the operation time, time of intestinal reconstruction, volume of intraoperative blood loss, time to first flatus, time to drainage tube removal, time to resume to normal diet, and duration of postoperative hospital stay were 96 minutes, 58 minutes, 210 mL, 32 hours, 48 hours, 42 days, and 3 days, respectively. For the DJOS, the above indicators were 148 minutes, 117 minutes, 260 mL, 47 hours, 72 hours, 21 days, and 7 days, respectively. There was no complication occurred in either LGP or DJOS. (2) Follow-up: the patient was followed up for 24 months after LGP. The BMI of this patient decreased to 45.3 kg/m2 at 6 months after LGP, and decreased to 37.2 kg/m2 at 18 months after DJOS. Insulin therapy was discontinued. There was no long-term complication such as malnutrition, dumping syndrome, or biliary reflux.@*Conclusion@#LGP combined with DJOS can enrich treatment methods of obese patient with BMI >50 kg/m2, which offers a safer surgical procedure option for patients after gastric binding.
ABSTRACT
Objective@#To investigate the clinical application value of symmetrical three-hole laparoscopic sleeve gastrectomy (LSG).@*Methods@#The retrospective and descriptive study was conducted. The clinical data of 232 patients with obesity who were admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from April 2017 to December 2018 were collected. There were 40 males and 192 females, aged (32±8)years, with a range of 17-63 years. All the 232 patients underwent symmetrical three-hole LSG. Observation indicators: (1) surgical and postoperative conditions; (2) complications; (3) follow-up. Follow-up was conducted by telephone interview and WeChat to collect the patient satisfaction with cosmetic effects of wounds at 3 months after surgery up to March 2019. Measurement data with normal distribution were expressed as Mean±SD. Count data were expressed as absolute numbers or percentages.@*Results@#(1) Surgical and postoperative conditions: of the 232 patients, 230 underwent symmetrical three-hole LSG successfully, without conversion to open surgery. Two patients had one puncture hole added due to spleen bleeding to help pull the omentum to stop bleeding, and no spleen hemorrhage recurred after improving the surgical procedure. Of the 232 patients, the operation time, volume of intraoperative blood loss, and duration of postoperative hospital stay were (115±7)minutes, (10±5)mL, and (3.0±0.8)days. (2) Complications: of the 232 patients, 10 had postoperative complications of fat liquefaction in the umbilical incision, and were cured after repeated dressing changes. All patients had no serious complications such as gastrointestinal bleeding, abdominal bleeding, or gastric fistula. (3) Follow-up: of the 232 patients, 230 undergoing successful symmetrical three-hole LSG were followed up for 3 months. Of the 230 patients, 3 were dissatisfied with the cosmetic effects of wounds, 12 were satisfied, and 215 were very satisfied. The satisfaction rate was 98.70%(227/230).@*Conclusion@#Symmetrical three-hole LSG is safe and feasible, with a good cosmetic effects of wounds.
ABSTRACT
Bariatric surgery is an effective treatment for obesity and the related metabolic diseases. At present, although the jejunoileal bypass is widely used in various types of bariatric surgery, the effect of reconstructed anatomy after the jejunoileal bypass on normal physiological function of obese patients has not been clarified. This leaves some controversy about the recommended limb lengths in jejunoileal bypass. At the same time, there is no consensus on the optimal biliary limb length and alimentary limb length in the standard gastric bypass. Lack of accurate measurement of common limb length and total small bowel length inevitably results in unsatisfactory percentage of excess body weight loss caused by short limb length, or malabsorption and malnutrition caused by long limb length. The authors discussed the effects of different length of biliary limb, alimentary limb and common limb on weight loss, and introduced the preliminary application and prospects of the jejunoileal bypass including measurement of total small bowel length in bariatric surgery.
ABSTRACT
As the incidence of obesity increases globally, treatment strategies of obesity emerge continuously. However, the weight loss effect varies between individuals without explicit explanations. In the recent years, many researchers have revealed regulation mechanisms of central nervous system on eating behavior, proposing that obese individuals exhibit brain functional abnormalities implicated in homeostatic regulation of food intake, central reward and motivation, emotion, memory, and attention system. Therefore, these scholars appeal that treating obesity cannot remain "brainless" . The most effective treatment currently available for obesity is bariatric surgery which lead to excess weight loss of 42%-67% in accompany with changes in brain activity. Functional magnetic resonance imaging showed a decreased activation in the central reward network and increased inhibitory control in the cognitive control system after bariatric surgeries. In this article, the authors introduce the central nervous system regulation of eating and investigate the effects of bariatric surgery on central nervous system.