RESUMEN
Health education provided by a group of professionals from different disciplines, so-called “team medical care”, is considered essential for the treatment of diabetes. When each specialized professional educates diabetic patients on how to manage their condition, patient-centered medical care is realized, and it becomes possible to provide appropriate support to individual patients. The treatment of obesity is somewhat similar to that of diabetes. Diet therapy and exercise are the basic therapies, and diabetes in many obese patients can simply be improved by weight loss. Metabolic syndrome has been reported to be associated with visceral fat-type obesity. In order to prevent the development of atherosclerotic occlusive diseases due to weight loss, individual counseling after each medical checkup is provided by public health nurses or registered dietitians. Behavior modification is necessary to improve lifestyle. Helpful education and advice by various professionals help patients to modify their behavior, and thus patient-centered medical care can be achieved. Recently, for the treatment of diabetes, new oral hypoglycemic agents and insulin preparations as well as incretin preparations have become available, indicating that diabetes treatment strategies are increasing. This has allowed better glycemic control in diabetes than was possible before. Nonetheless, diet therapy and exercise remain the basic treatment methods, and they should not be made light of.
RESUMEN
Morbid obesity is synonymous with “clinically severe obesity” and correlates with a body mass index (BMI) of 40kg/m<SUP>2</SUP>, being associated with real severe physical problems inducing to highly mortality rates. While obesity, of itself, is a risk factor, most mortality and morbidity is associated with the co-morbid conditions, including hypertension, hypertrophic cardiomyopathy, hyperlipidemia, diabetes, cholelithiasis, sleep apnea syndrome, hypoventilation, degenerative arthritis and psychosocial impairments. And, most obvious is an increased mortality and morbidity rates directly related to weight increase. Therefore, it must be emphasized that morbidly obese patients should be treated positively and urgently in USA and European countries, where have had the common social problem of obesity. With the obvious failure of conservative medical treatments of producing permanent weight reduction in patients with morbid obesity, which successfully achieved initial weight loss but failed to maintain it, operative approaches have to be adopted occasionally and become popular in Western countries.<BR>Although the population of morbidly obese patients in Japanese people is muchsmaller than in Western people, the hazardous due to obesity is recognized more serious among Japanese people. Furthermore, the rate of obesity as well as morbid obesity among a people in our country is increasing apparently not only in urban but also in rural district. The most important strategy against the problem of morbid obesity is the precausion. But, we have to recognize even in Japan that surgical treatment is medically necessary because it is the only proven method of achieving long term weight control enough to treat the severe complications for the morbidly obese patients. Bariatric surgery involves reducing the size of the gastric reservoir, with or without a degree of associated malabsorption.
RESUMEN
The patient was a 63-years-old female with early gastric cancer in her upper stomach. Widely spreading on the mucous membrane, the cancer was too big to remove by endoscopical mucosal resection, although she wanted minimal invasive treatment. Therefore, we adopted total gastrectomy with hand-assisted laparoscopic surgery (HALS) after obtaining “informed consent” from her. Five small skin-incisions were necessary to perform it-one 7cm' for hand-port and four 1.2cm' for trocars.<BR>The dissection was started from greater omentum and proceeded counterclockwise to remove primary lymphnodes. The abdominal esophagus and the duodenum were devided with a single or double application of Endo GIA stapler (linear stapler). All these steps were accomplished safely and securely with the effective support of the left hand of the operator. After extraction of the whole stomach through the 7cm-incision, Roux-en Y reconstruction was performed laparoscopically (esophago-jejunostomy) followed by hand sewing through the 7cm-incision (jejuno-jejunostomy). The anvil of 21mm circular stapler (EEA) was inserted orally in order to anastomose the esophagus to the jejunum. The patient had acceptable results intra-operatively as well as postoperatively by HALS total gastrectomy, which had been considered to be very hard to perform up to present time.
RESUMEN
Based upon the 8 years' experience in vertical banded gastroplasty (VBG) for the treatment of morbid obesity in our department, we analysed the clinical results after operation. As a result, the weight-reducing effect and safety of VBG were found favourvable, but some of complications developed in a few, causing serious conditions. Therefore, a modification of VBG was tried in order to utilize the characteristics of VBG and to lessen the factors of complications development as much as possible. Its essential points are to utilize the His-angle by making an oblique staple line instead of a vertical one, and to block the stomach with GIA90 and EEA28 and embed the staple line by suturing the serous membrane. Because the stomach is formed into a K-shape, it has been named k-gastroplasty. Its operative mode is discussed.