ABSTRACT
In small hospitals, where the majority of colectomy surgery is performed in the United States, adopting more individual ERAS components improves outcomes. The accumulation of individual ERAS components influences outcome more than an "ERAS designation" and this can be used by small hospitals to improve outcomes.
Subject(s)
Enhanced Recovery After Surgery , Colectomy , Guideline Adherence , Hospitals, Low-Volume , Humans , Length of Stay , Postoperative ComplicationsABSTRACT
BACKGROUND: Previously, we demonstrated the safety and efficacy of laparoscopic gastric bypass surgery in patients over 65 years of age. The aim of this study is to demonstrate the safety and efficacy of this procedure as a final step for treatment of morbid obesity in the same population. METHODS: A retrospective review of a prospectively collected database was performed. Between 2004 and 2010, a total of 35 patients age 60 and greater were analyzed from a total of 512 sleeve gastrectomy patients. Demographics, preoperative body mass index, complications, and excess weight loss were recorded and compared to bougie size and follow-up in months. Mean age was 66.3 years (range, 60-79 years), mean body mass index was 46.3 kg/m(2) (range, 33.7-77.6 kg/m(2)), and mean excess weight loss was 148.49 lb (range, 72-252 lb). RESULTS: One patient (2.8 %) had an incidental colotomy as a result of trocar insertion, one patient (2.0 %) bled, and one patient (2.8 %) had small-bowel enterotomy. Overall, morbidity was 8.4 % with no mortality. Mean percent excess weight loss results for bougie size 52 were 28, 34, 26, 18, and 27 % at 3, 6, 12, 24 and 48 months, respectively; for bougie size 46 were 31, 57, 64, 62, and 82 % at 3, 6, 12, 24 and 48 months, respectively; and bougie size 38 were 37, 50, 55, and 56 % at 3, 6, 12 and 24 months, respectively. CONCLUSIONS: Laparoscopic sleeve gastrectomy is an effective procedure for morbidly obese patients age 60 and greater that can be performed safely.
Subject(s)
Gastroplasty/adverse effects , Gastroplasty/mortality , Laparoscopy , Obesity, Morbid/surgery , Aged , Body Mass Index , Female , Follow-Up Studies , Humans , Male , Middle Aged , Obesity, Morbid/mortality , Operative Time , Patient Selection , Retrospective Studies , Surveys and Questionnaires , Treatment Outcome , United States/epidemiology , Weight LossABSTRACT
BACKGROUND: Morbid obesity is an epidemic in America. This series evaluates the safety and efficacy in the first 1,001 laparoscopic bariatric operations performed at The Bariatric Institute, Cleveland Clinic Florida. METHODS: A retrospective review was conducted examining all patients undergoing a primary bariatric procedure (either laparoscopic gastric bypass or laparoscopic gastric banding) from July 2000 to December 2003. RESULTS: 2 surgeons performed 1,001 laparoscopic bariatric operations. Average age was 47 (19-75) years, average BMI was 55.6 (35-97) kg/m2, and average ASA class was III. Excess weight loss was 51% at 6 months, 73.4% at 1 year for the gastric bypass group and 54% at 1 year for the laparoscopic banding group. The overall complication rate was 31.8% (12.4% major and 19.4% minor) in the gastric bypass group and 13% in the laparoscopic banding group. There was no postoperative mortality. CONCLUSION: Laparoscopic bariatric surgery is feasible and safe for weight loss. Results obtained have been comparable to those reported for the open approach for weight loss, with a similar major morbidity rate and an improved mortality rate.
Subject(s)
Laparoscopy/methods , Laparoscopy/statistics & numerical data , Obesity, Morbid/epidemiology , Obesity, Morbid/surgery , Adult , Age Distribution , Aged , Bariatrics , Body Mass Index , Female , Florida/epidemiology , Follow-Up Studies , Gastric Bypass/methods , Gastric Bypass/statistics & numerical data , Gastroplasty/methods , Gastroplasty/statistics & numerical data , Hospitals, Community , Humans , Incidence , Male , Middle Aged , Obesity, Morbid/diagnosis , Postoperative Complications/epidemiology , Retrospective Studies , Risk Assessment , Sex Distribution , Weight LossABSTRACT
There is experimental evidence but very few human studies that suggest a role for obesity in the formation and progression of some glomerular lesions. We report the case of a morbidly obese male with hematuria and proteinuria that was subsequently diagnosed with renal failure which required dialysis. Histological findings of the renal biopsy performed during a laparoscopic gastric bypass are presented. His renal failure resolved with the weight loss.
Subject(s)
Acute Kidney Injury/pathology , Gastric Bypass/methods , Glomerulonephritis/diagnosis , Laparoscopy/methods , Obesity, Morbid/surgery , Acute Kidney Injury/complications , Acute Kidney Injury/therapy , Adult , Biopsy, Needle , Body Mass Index , Follow-Up Studies , Glomerulonephritis/complications , Glomerulonephritis/therapy , Humans , Immunohistochemistry , Kidney Function Tests , Male , Obesity, Morbid/complications , Obesity, Morbid/diagnosis , Recovery of Function , Renal Dialysis/methods , Risk Assessment , Severity of Illness Index , Treatment Outcome , Weight LossABSTRACT
Esophageal perforation is a serious complication that requires prompt recognition and treatment. We present the case of a patient with lower esophageal perforation that apparently resulted from orogastric calibration-tube passage during laparoscopic placement of a gastric band. The complication was diagnosed early postoperatively, and was able to be successfully treated by laparoscopy,debanding, drainage, and parenteral nutrition.
