ABSTRACT
PURPOSE: The objective of this study was to analyze the mid-term outcomes of sleeve gastrectomy in a cohort of obese patients. METHODS: We analyzed the outcomes of 159 adult patients who had laparoscopic sleeve gastrectomy between January 2011 and January 2015 in our center. Data collected included patient demographics, presence of comorbid diseases, preoperative body mass index, percent excess weight loss, resolution of comorbid diseases, morbidity and in-hospital mortality. RESULTS: We achieved a 24th month percent excess weight loss of 75.1 ± 10.5. Remission of diabetes mellitus, hypertension, hyperlipidemia and obstructive sleep apnea syndrome after sleeve gastrectomy was as high as 84, 63.9, 75.8 and 93 %, respectively, in different studies. Our results in diabetes mellitus, hypertension and hyperlipidemia are comparable with other data on the improvement of comorbidites after sleeve gastrectomy. We found less improvement in obstructive sleep apnea syndrome in our cohort when compared to other reports. CONCLUSIONS: Sleeve gastrectomy is an efficient, durable technique for the treatment of obesity and associated comorbidities in all body mass index subgroups of obese population. For better outcomes, strategies for proper education and certification are needed.
Subject(s)
Diabetes Mellitus, Type 2/surgery , Gastrectomy/methods , Laparoscopy/methods , Obesity/surgery , Adult , Body Mass Index , Diabetes Mellitus, Type 2/complications , Female , Humans , Male , Middle Aged , Obesity/complications , Retrospective Studies , Treatment Outcome , Turkey , Young AdultABSTRACT
BACKGROUND: The aim of this study is to stage pancreatic injury and to assess the appropriate surgical approach. Trauma leading to pancreatic injury, factors responsible for the mortality and complication rates are evaluated and compared with the literature. METHODS: Records of 20 patients with pancreatic injuries treated at the Emergency Surgical Unit of Research Hospital between January 1997 to October 2001 were retrospectively evaluated. RESULTS: In this series 20 per cent of the mortality occurred within the first 48 hours. The factor responsible for the mortality in these patients was major bleeding; related to major vascular, hepatic, splenic, renal or thoracic injuries. Late mortality was seen in 3 patients (15 per cent) due to sepsis, respiratory insufficiency or ARDS. ln the literature mortality rate is between 5 to 30 per cent and morbidity rate is 30 to 64 per cent. In this series, these percentages were 35 per cent and 43 per cent respectively. CONCLUSION: The surgical therapy should be tailored up to the presence of ductal injury and the extent and anatomical localization of the injured segment. In principle the control of bleeding and contamination, and application of the appropriate surgical treatment can lower the morbidity and mortality. Key words: Abdominal trauma, pancreatic injury, pancreatic drainage
Subject(s)
Hemorrhage/mortality , Pancreas/injuries , Pancreas/surgery , Wounds and Injuries/mortality , Wounds and Injuries/surgery , Adolescent , Adult , Emergency Treatment , Female , Hemorrhage/complications , Humans , Male , Medical Records , Respiratory Distress Syndrome/complications , Respiratory Distress Syndrome/mortality , Retrospective Studies , Sepsis/complications , Sepsis/mortality , Treatment Outcome , Turkey/epidemiology , Wounds and Injuries/complicationsABSTRACT
PURPOSE: The main disadvantage of gaseous laparoscopic surgery is the need for CO(2) insufflation and the elevation of intra-abdominal pressure. Gasless laparoscopic surgery is an alternative to gaseous laparoscopic surgery, which avoids the hazardous effects of pneumoperitoneum. This study was conducted to investigate the hemodynamic effects of pneumoperitoneum and to compare gasless and gaseous laparoscopic cholecystectomy on a hemodynamic basis. METHODS: The gasless laparoscopic procedure uses an electromechanical retractor system to lift the abdominal wall. We performed 20 gaseous and 11 gasless laparoscopic cholecystectomies in a collective total of 31 patients with symptomatic gallstones. The mean arterial pressure, heart rate, end diastolic index, systemic vascular resistance index, cardiac index (CI), ejection fraction (EF), and stroke index (SI) values were monitored noninvasively by thoracic electrical bioimpedance. RESULTS: In the gaseous group, statistically significant changes were detected in CI, EF, and SI values after insufflation as compared to the values before pneumoperitoneum. In the gasless group, only minimal changes were detected in the SI values, which were not significant. CONCLUSION: Gasless laparoscopy has little effect on the hemodynamic parameters of patients and provides an alternative to the gaseous technique in selected cases.
