ABSTRACT
BACKGROUND AND OBJECTIVES: Laparoscopic adjustable gastric banding (LAGB) is a commonly performed bariatric procedure. When LAGB fails, restrictive procedures such as gastric bypass have been performed. Laparoscopic sleeve gastrectomy (LSG) has been suggested as an alternative, but it has not yet been fully studied. Evaluated in this report are the experiences of patients who underwent LSG, a restrictive procedure, as a rescue procedure for failed LAGB. METHODS: From June 2002 to June 2007, charts of patients who underwent LAGB were reviewed to find those who had undergone LSG as a rescue procedure. RESULTS: Of 294 patients who underwent LAGB, 10 later underwent LSG. Median excess weight loss (EWL) prior to LSG had been 34%; after LSG, median EWL was 55%. Before LSG was performed, patients had a median 11.5 comorbidities, all of which improved after LSG. No major complications or deaths resulted. CONCLUSION: The results suggest LSG might be a reasonable choice for patients who fail LAGB. A formal study comparing LSG with other rescue procedures should be performed.
Subject(s)
Gastrectomy/methods , Gastroplasty , Body Mass Index , Comorbidity , Device Removal , Endoscopy, Gastrointestinal , Feasibility Studies , Female , Humans , Laparoscopy , Male , Obesity, Morbid/epidemiology , Obesity, Morbid/surgery , Treatment Failure , Weight LossABSTRACT
HYPOTHESIS: Insertion of a Tenckhoff catheter through a small para-median incision results in less catheter dysfunction than in cases where insertion is made through a midline incision. MATERIAL AND METHODS: This is a prospective, longitudinal, comparative, observational study of cause and effect; in other words, it is a study of two cohorts. The study included patients with chronic renal insufficiency aged 16 years and over of either sex who required insertion of a Tenckhoff catheter for peritoneal dialysis treatment. A total of 44 patients were recruited and were divided randomly into two groups: Group A, numbering 23 patients, had their catheter inserted through midline below umbilicus, while Group B numbering 21 patients had their catheter inserted through via para-median approach. The study employed Student t parametric test and chi square trial hypothesis for non-parametric variables. Rejection criterion was p < 0.05. RESULTS: In both groups, cause of chronic renal insufficiency was diabetic nephropathy. After a 30-day follow-up period, the group of patients with catheter inserted through midline incision, i.e., Group A, presented dysfunction in 43.5% of cases. In the group with catheter inserted through para-median incision, i.e., Group B, dysfunction presented in 38% of cases with no other significant statistical difference occurring. Main cause of dysfunction occurring in Group A was catheter migration, whereas in Group B the main cause was dialysis fluid leakage. CONCLUSIONS: This study concluded that there was no significant difference between the two surgical techniques employed for Tenckhoff catheter insertion with regard to incidence of catheter migration, leakage of dialysis solution, catheter obstruction due to adhesions, or post-incisional hernias during the immediate post-surgical period (30 days). Furthermore, no significant difference was found between the two groups with respect to other types of complications such as peritonitis, infection along the subcutaneous catheter pathway, or catheter obstruction due to blood clots.
