ABSTRACT
The outcomes of bariatric surgery, while often impressive, are not universally satisfactory; they vary from patient to patient and from operation to operation. Between 20-30% of patients experience suboptimal weight loss or substantial weight regain early in their postoperative course. Confronted with this chronic disease, and given that failures are difficult to manage, it is essential to better characterize obesity preoperatively, considering other metrics beyond just the body mass index (BMI), to select the best candidates for surgery and optimize the benefit/risk ratio. Based on the data of the most recent studies on bariatric surgery, our objective is to identify the predictive factors of weight loss as well as the risk factors of failure. Our analysis indicates that the choice of the surgical technique, age, initial BMI, ethnic origin, the presence of eating disorders and metabolic factors all have an impact on weight-loss outcomes after bariatric surgery. Thus, it is of major importance to carefully select patients during a preoperative multidisciplinary discussion in order to optimize weight loss and metabolic outcomes.
Subject(s)
Bariatric Surgery , Obesity, Morbid , Humans , Bariatric Surgery/adverse effects , Obesity/surgery , Body Mass Index , Weight Loss , Obesity, Morbid/surgery , Treatment OutcomeSubject(s)
Biliary Tract Diseases/surgery , Gastric Bypass , Jejunum/surgery , Postoperative Complications/surgery , Abdominal Pain/etiology , Anastomosis, Surgical , Biliary Tract Diseases/diagnosis , Biliary Tract Diseases/etiology , Dilatation, Pathologic/diagnosis , Dilatation, Pathologic/etiology , Dilatation, Pathologic/surgery , Female , Humans , Middle Aged , Postoperative Complications/diagnosis , SyndromeABSTRACT
OBJECTIVE: Abdominal tuberculosis is a rare disease. The clinical and radiological manifestations are non-specific and the diagnosis is difficult. Our objective was to describe the characteristics and treatment of patients presenting with abdominal tuberculosis in a low-incidence country. PATIENTS AND METHODS: We reviewed the clinical, diagnostic, treatment, and outcome features of patients presenting with abdominal tuberculosis diagnosed by bacteriological and/or histological results and managed in five French university hospitals from January 2000 to December 2009. RESULTS: We included 21 patients. The mean diagnostic delay was 13 months. Twelve patients (57%) came from a low-incidence area and only two had a known immunosuppressed condition. Eighteen patients (86%) presented with abdominal symptoms. The main organs involved were the peritoneum (n=14, 66%), the mesenteric lymph nodes (n=13, 62%), and the bowel (n=7, 33%). Sixteen patients (76%) underwent surgery, including two in an emergency setting. Seventeen patients (81%) received six months or more of anti-tuberculosis treatment. Finally, 16 patients (76%) had a positive outcome. CONCLUSION: New diagnostic procedures, and especially molecular biology, may help diagnose unusual clinical presentations of tuberculosis. Invasive procedures are frequently necessary to obtain samples but also for the treatment of digestive involvement.
Subject(s)
Tuberculosis, Gastrointestinal/epidemiology , Tuberculosis, Lymph Node/epidemiology , Adult , Africa/ethnology , Aged , Aged, 80 and over , Antitubercular Agents/therapeutic use , Asia/ethnology , Delayed Diagnosis , Emigrants and Immigrants , Female , France/epidemiology , Humans , Interferon-gamma Release Tests , Male , Middle Aged , Peritonitis, Tuberculous/diagnosis , Peritonitis, Tuberculous/drug therapy , Peritonitis, Tuberculous/epidemiology , Retrospective Studies , Sensitivity and Specificity , Symptom Assessment , Treatment Outcome , Tuberculosis, Gastrointestinal/diagnosis , Tuberculosis, Gastrointestinal/drug therapy , Tuberculosis, Gastrointestinal/surgery , Tuberculosis, Hepatic/diagnosis , Tuberculosis, Hepatic/drug therapy , Tuberculosis, Hepatic/epidemiology , Tuberculosis, Lymph Node/diagnosis , Tuberculosis, Lymph Node/drug therapy , Young AdultABSTRACT
INTRODUCTION: Diffuse esophageal leiomyomatosis is a rare disease. Misdiagnosis is frequent and previous surgeries can complicate surgical management. The only treatment described for severe symptomatic cases is esophagectomy. PRESENTATION OF CASE: We describe a case of diffuse esophageal leiomyomatosis associated with Alport syndrome in a 21 year-old female where endoscopic ultrasonography (EUS) with concomitant fluoroscopy and 3D-gastric computed tomography (3D-GCT) modified surgical management. DISCUSSION: The diagnosis of diffuse esophageal leiomyomatosis is difficult but can be greatly facilitated by extensive endoscopic and radiologic workup. Esophagectomy should only be entertained after complete anatomic mapping of the lesions, especially after previous surgeries. CONCLUSION: EUS and 3D-GCT should strongly be considered as part of routine preoperative workup in these patients.
