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Addison P. Comment on: Patient perspectives on the usefulness of the MBSAQIP Bariatric Surgical Risk/Benefit Calculator: a randomized controlled trial. Surg Obes Relat Dis 2023; 19:610-611. [PMID: 36774325 DOI: 10.1016/j.soard.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/01/2023] [Indexed: 01/09/2023]
Affiliation(s)
- Poppy Addison
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, New York
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Giannopoulos S, Athanasiadis DI, Hernandez E, Baumgartner TC, Pokala B, Banerjee A, Choi JN, Stefanidis D. Patient perspectives on the usefulness of the MBSAQIP Bariatric Surgical Risk/Benefit Calculator: a randomized controlled trial. Surg Obes Relat Dis 2022; 19:604-610. [PMID: 36635191 DOI: 10.1016/j.soard.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 11/08/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Bariatric Surgical Risk/Benefit Calculator uses procedure-specific prediction models to generate individualized surgical risk/outcome estimates. This tool helps guide informed consent and operative selection. We hypothesized that calculator use would influence patient procedure choice. OBJECTIVE To assess patient perspectives on the bariatric surgical calculator. SETTING A randomized controlled trial at an MBSAQIP-accredited center. METHODS During the preoperative bariatric surgical office consultation, patients were randomized into 2 groups: the control group received conventional surgeon-led counseling, whereas surgeons used the risk/benefit calculator to guide decision making for the calculator group. Surveys were completed by patients following consultations to evaluate satisfaction and perceived impact of the risk/benefit calculator on operative selection. RESULTS Between 2020 and 2022, 61 patients were randomized to the calculator group and 68 patients to the control group. The percentage of patients whose procedure of choice changed following consultation was similar in the calculator versus control group (44.3% versus 41.2%; P = .723). However, calculator group patients were less likely to perceive surgeon counseling as very important for their decision making (43.3% versus 76.5%; P < .001). Eighty-five percent of calculator group patients rated the calculator as useful or very useful, and only 1.7% found it not very important. The reasons patients changed procedure choice were similar between the groups (P = .091); the most common cause was to improve their anticipated outcome (48.7% versus 54.8%). CONCLUSIONS While the risk/benefit calculator was perceived as a helpful tool by most patients, its use did not influence their procedure choice. However, the patient-reported usefulness and importance of the calculator during surgeon counseling suggest that the information provided has weight in patient decision making.
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Affiliation(s)
| | | | - Edward Hernandez
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Bhavani Pokala
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Bariatric Surgery Program, Indiana University Health North Hospital, Carmel, India
| | - Ambar Banerjee
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Bariatric Surgery Program, Indiana University Health North Hospital, Carmel, India
| | - Jennifer N Choi
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Bariatric Surgery Program, Indiana University Health North Hospital, Carmel, India
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Bariatric Surgery Program, Indiana University Health North Hospital, Carmel, India.
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Güven B, Akyolcu N. Effects of Nurse-Led Education on Quality of Life and Weight Loss in Patients Undergoing Bariatric Surgery. Bariatr Surg Pract Patient Care 2020. [DOI: 10.1089/bari.2019.0025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Betül Güven
- School of Nursing, Koç University, İstanbul, Turkey
| | - Neriman Akyolcu
- Faculty of Health Science, Istinye University, İstanbul, Turkey
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Roh SY, Park YH, Lee WK, Kim SM. Patient preferences regarding bariatric/metabolic procedures: a survey of Korean obese candidates for surgery. Ann Surg Treat Res 2020; 98:82-88. [PMID: 32051816 PMCID: PMC7002879 DOI: 10.4174/astr.2020.98.2.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose The objective of this study was to survey potential candidates for bariatric/metabolic surgery for procedure preferences. Methods Questions asked were divided into 5 categories: (1) demographic and anthropometric data, comorbidities, and favored surgery; (2) awareness of safety, effectiveness, and complications of each type of surgery; (3) discordances in opinion between self-selected and medically recommended procedures; and (4, 5) reasons for/against particular surgery. Results From 1 October to 15 November 2018, 104 respondents adequately responded and were included in the analysis. The number (%) of female respondents was 79 (76.0%). The number (%) of respondents by decade was 17 (16.3%) in their 20s, 65 (62.5%) in their 30s, 19 (18.3%) in their 40s, and 3 (2.9%) in their 60s, respectively. Mean body mass index was 37.1 ± 6.3 kg/m2. Comorbidities were type 2 diabetes in 34 (32.7%) and hypertension in 35 (33.7%). The most favored procedure was sleeve gastrectomy (SG) in 78 (75.0%), adjustable gastric band (AGB) surgery in 12 (11.5%), Roux-en-Y gastric bypass (RYGB) in 6 (5.8%), and gastric plication (GP) in 8 (7.7%). Major reasons for choosing procedures were; “adjustable” for AGB, “stomach sparing” for GP, “excellent weight loss” for SG, and “comorbidity resolution” in RYGB. Conclusion Candidates for bariatric/metabolic surgery favored SG followed by AGB, GP, and RYGB, and their choices were compatible with current evidence-based clinical practice.
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Affiliation(s)
- Su Yeon Roh
- Department of Exercise Rehabilitation and Welfare, Gachon University, Incheon, Korea
| | - Yeon Ho Park
- Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Woon Ki Lee
- Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Seong Min Kim
- Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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Kallies KJ, Ramirez LD, Grover BT, Kothari SN. Roux-en-Y gastric bypass versus sleeve gastrectomy: what factors influence patient preference? Surg Obes Relat Dis 2018; 14:1843-1849. [PMID: 30290991 DOI: 10.1016/j.soard.2018.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 06/25/2018] [Accepted: 08/22/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most commonly performed bariatric procedures. RYGB involves altered gastrointestinal anatomy and 2 anastomoses, while SG involves gastric resection. When potential patients view images of the procedures, they may perceive RYGB to involve significant risk compared with SG, in which no significant gastrointestinal alterations are depicted. OBJECTIVE To evaluate preferences for RYGB versus SG. SETTING Survey of U.S. adults. METHODS An electronic survey was distributed to 1000 U.S. adults. Respondents selected either RYGB or SG based on (1) procedural pictures alone, (2) only data on risks and benefits of each procedure, (3) pictures with corresponding risk/benefit profile, and (4) pictures with mismatched information. RESULTS Overall, 999 individuals met inclusion criteria; 66 (7%) had undergone bariatric surgery and were excluded. Mean age and body mass index of respondents was 44.8 ± 14.6 years (n = 922) and 28.7 ± 8.0 kg/m2 (n = 915). A higher proportion of patients preferred RYGB to SG when images only were provided (54% versus 46%), when information only was provided (63% versus 37%), and when correct information with the procedure image was provided (57% versus 43%). When presented with mismatched information and images, 56% preferred RYGB information + SG image versus SG information + RYGB image (44%). CONCLUSIONS Based on this survey, providing evidence-based risks and benefits of a procedure resulted in the majority of respondents choosing RYGB over SG. When procedure images were provided alone, preference for RYGB and SG were similar. There are likely other factors contributing to increasing SG volume aside from patient preference.
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Affiliation(s)
- Kara J Kallies
- Department of Medical Research, Gundersen Medical Foundation, La Crosse, Wisconsin
| | - Luis D Ramirez
- Department of Medical Research, Gundersen Medical Foundation, La Crosse, Wisconsin
| | - Brandon T Grover
- Department of General Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Shanu N Kothari
- Department of General Surgery, Gundersen Health System, La Crosse, Wisconsin.
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6
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Groller KD, Teel C, Stegenga KH, El Chaar M. Patient perspectives about bariatric surgery unveil experiences, education, satisfaction, and recommendations for improvement. Surg Obes Relat Dis 2018; 14:785-796. [PMID: 29703505 DOI: 10.1016/j.soard.2018.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 01/10/2018] [Accepted: 02/10/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Following bariatric surgery, up to 35% of patients struggle with strict regimens and experience weight recidivism within 2 years [1-5]. Accredited weight management centers (WMC) must provide educational programs and support patients in lifestyle changes before and after surgery. Educational programs, however, may not be evidence-based or patient-centered and may vary in curriculum, approach, and educator type [6]. OBJECTIVE To obtain patient descriptions about the weight loss surgery (WLS) experience, including education, satisfaction, and recommendations for improvement. SETTING Participants were recruited from a university hospital-based WMC in Pennsylvania. METHODS This qualitative descriptive study used purposive sampling and inductive content analysis. RESULTS A NEW ME-VERSION 2.0, encompassed themes from semistructured interviews with 11 participants (36% male). Theme 1: Programming and Tools, explained how individuals undergoing WLS found support through educational programming. Theme 2: Updates and Upgrades, identified issues surrounding quality of life and challenges before and after surgery. Theme 3: Lessons Learned and Future Considerations, identified satisfaction levels and recommendations for improving the WLS experience. Participants reported positive experiences, acknowledging educational programs and extensive WMC resources, yet also offered recommendations for improving educational programming. CONCLUSION Patient narratives provided evidence about the WLS experience. Achievement of weight goals, adherence to rules, and improved health status contributed to perceptions of WLS success. Participants encouraged educators to identify expected outcomes of educational programming, monitor holistic transformations, foster peer support, and use technology in WMC programming. Results also validated the need for the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program's education requirement (standard 5.1). Future educational research could help develop best practices in WLS patient education and assess associations between education and clinical outcomes.
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Affiliation(s)
- Karen D Groller
- Moravian College, Helen S. Breidegam School of Nursing, Bethlehem, Pennsylvania.
| | - Cynthia Teel
- University of Kansas School of Nursing, Kansas City, Kansas
| | | | - Maher El Chaar
- Medical School of Temple University, St. Luke's University Hospital and Health Network, Allentown, Pennsylvania
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7
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Opozda M, Wittert G, Chur-Hansen A. Patients’ reasons for and against undergoing Roux-en-Y gastric bypass, adjustable gastric banding, and vertical sleeve gastrectomy. Surg Obes Relat Dis 2017; 13:1887-1896. [DOI: 10.1016/j.soard.2017.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
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Applegate KL. Comment on: Patients' reasons for and against undergoing Roux-en-Y gastric bypass, adjustable gastric banding, and vertical sleeve gastrectomy. Surg Obes Relat Dis 2017; 13:1896-1898. [PMID: 28917615 DOI: 10.1016/j.soard.2017.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 08/17/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Katherine L Applegate
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
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Groller KD. Systematic review of patient education practices in weight loss surgery. Surg Obes Relat Dis 2017; 13:1072-1085. [PMID: 28216118 DOI: 10.1016/j.soard.2017.01.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 01/03/2017] [Accepted: 01/03/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Education plays a key role in adherence to lifestyle modifications after weight loss surgery (WLS). Education given before and after surgery may decrease weight recidivism rates and improve outcomes. OBJECTIVE The purpose of this systematic review was to analyze educational practices in bariatric centers. METHODS The Cumulative Index to Nursing and Allied Health and PubMed databases were searched in May 2016 for English-language, peer-reviewed studies about WLS patient education practices from 1999 to 2016. Publications were: (1) rated with the Advancing Research and Clinical Practice through Close Collaboration levels of evidence hierarchy (see Melnyk's pryamid [http://guides.lib.umich.edu/c.php?g=282802&p=1888246]) and (2) analyzed according to surgical phase, curriculum, program delivery, and educator. RESULTS Twenty-four publications met the study criteria. Evidence ratings for preoperative (n = 16) and postoperative studies (n = 8) were levels I to III (n = 5) and IV to VII (n = 17). Two publications were not ratable. Preoperative and postoperative education programs varied in curriculum, teaching methods, and educator. Topics varied in depth. Commonalities were surgical procedure, nutrition, activity, and psychosocial behaviors. Preoperative education was mostly provided in small groups, whereas individual sessions were used postoperatively. Lecture and discussion provided by myriad of healthcare experts from multiple disciplines were typical in both phases. Written or web-based aides supported learning needs in both phases. CONCLUSION WLS patient education varied by curriculum and dose and commonly used passive learning methods (e.g., traditional lecture style instruction with minimal engagement from learners). Results shared can inform future bariatric education programs and accreditation standard development (e.g., Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program patient education standards). Additional study is needed, but existing evidence can guide improvements in high-quality, cost-effective, and patient-centered educational programs.
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Affiliation(s)
- Karen D Groller
- Department of Nursing and Public Health, Moravian College, Bethlehem, Pennsylvania.
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10
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Weinstein AL, Marascalchi BJ, Spiegel MA, Saunders JK, Fagerlin A, Parikh M. Patient preferences and bariatric surgery procedure selection; the need for shared decision-making. Obes Surg 2015; 24:1933-9. [PMID: 24788395 DOI: 10.1007/s11695-014-1270-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bariatric surgery is the most effective treatment for patients suffering from obesity-related comorbidities. There is little data regarding how patients choose one particular bariatric procedure over another. This study aimed to better define the relationship between preferences of patients considering bariatric surgery and the procedure patients undergo. METHODS A bilingual questionnaire was administered to all prospective patients seen between March 1 and August 31, 2012. The questionnaire assessed basic knowledge of bariatric surgery (based on the information seminar) as well as patient preferences of the various outcomes and complications for sleeve gastrectomy, gastric bypass, and gastric banding. RESULTS One hundred seventy-two patients completed the questionnaire. Fifty-eight percent of patients chose "maximum weight loss" as the most important outcome, and 65 % chose "leak" as the most concerning complication. Subgroup analysis of patients with diabetes revealed that 58 % chose "curing diabetes" as the most important outcome. Nineteen percent of patients were either not sure which procedure they wanted or changed their decision after consultation with the surgeon. CONCLUSIONS The decision to choose one bariatric procedure over another is complex and is based on factors beyond absolute patient preferences. Although maximum weight loss is a commonly reported preference for patients seeking bariatric surgery, patients with diabetes are more focused on diabetes remission. Most patients have already decided which procedure to undergo prior to surgeon consultation. Patients may benefit from shared decision making, which integrates patient values and preferences along with current medical evidence to assist in the complex bariatric surgery selection process.
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Affiliation(s)
- Andrew L Weinstein
- Department of Surgery, New York University Langone Medical Center, Bellevue Hospital Center, 550 First Avenue, NBV 15 South 7, New York, NY, 10016, USA,
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Madan AK, Martinez JM, Menzo EL, Khan KA, Tichansky DS. Omental Reinforcement for Intraoperative Leak Repairs during Laparoscopic Roux-en-Y Gastric Bypass. Am Surg 2009. [DOI: 10.1177/000313480907500917] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Leaks from the gastrojejunostomy after laparoscopic Roux-en-Y gastric bypass (LRYGB) have the potential for significant morbidity and mortality. When intraoperative leaks are discovered, we choose to perform omental reinforcement around the gastrojejunostomy and pouch after suture repair of the leaks. This study examined the hypothesis that omental reinforcement would be useful after intraoperative leaks during LRYGB. Omental reinforcement was performed on gastrojejunostomies, in which leaks were seen, created using a circular stapler during LRYGB. Data were reviewed retrospectively on these patients. There were a total of 387 patients with 32 (8.26%) patients who had a staple line dehiscence or evidence of gastric pouch or gastrojejunostomy leak intraoperatively Leaks/dehiscences were repaired with sutures and then reinforced with omentum. None of these patient developed anastomotic leak postoperatively. Of the other 365 patients, there were four (1.1%) leaks from the gastrojejunostomy and/or gastric pouch. Omental reinforcement may be useful in decreasing the incidence of postoperative leaks when an intraoperative leak is encountered during LRYGB. However, omental reinforcement does not completely prevent a postoperative leak. Consideration of reinforcement with omentum may be given for patients in whom an intraoperative leak is noted.
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Affiliation(s)
- Atul K. Madan
- Division of Laparoendoscopic and Bariatric Surgery, University of Miami, Miami, Florida
| | - Jose M. Martinez
- Division of Laparoendoscopic and Bariatric Surgery, University of Miami, Miami, Florida
| | - Emanuele Lo Menzo
- Division of Laparoendoscopic and Bariatric Surgery, University of Miami, Miami, Florida
| | - Khurram A. Khan
- Colorado Springs Health Partners, PC, Colorado Springs, Colorado
| | - David S. Tichansky
- Division of Minimally Invasive and Bariatric Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
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Antonoff MB, Erickson AE, Hess DJ, Acton RD, Saltzman DA. When patients choose: comparison of Nuss, Ravitch, and Leonard procedures for primary repair of pectus excavatum. J Pediatr Surg 2009; 44:1113-8; discussion 118-9. [PMID: 19524726 DOI: 10.1016/j.jpedsurg.2009.02.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Accepted: 02/17/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE Pectus excavatum is a common chest wall deformity, and several procedures have been developed for its correction. We allow patients to choose among Leonard, Nuss, and Ravitch procedures. This study aimed to determine which procedure most patients select and the resultant outcomes. METHODS Charts were reviewed of all pectus excavatum repairs performed for 4 years by a practice covering a university-based children's hospital. Procedure choice, operative time, length of stay, analgesia, fees, and complications were recorded. RESULTS The Ravitch procedure was chosen by 60.9% of our patients, Leonard procedure by 23.9%, and Nuss procedure by 15.2%. Operative times were not significantly different among the groups. The mean length of stay was 2.2 days (Ravitch), 1.5 days (Leonard), and 3.9 days (Nuss) (P < .005). Epidural analgesia/patient-controlled analgesia pump requirements were 50% (Ravitch), 5% (Leonard), and 100% (Nuss). The mean charges were $27,414 (Ravitch), $18,094 (Leonard), and $43,749 (Nuss) (P < .05). The overall complication rate was 16.3%. The complications among each group were as follows: Ravitch, 14.3%; Leonard, 9.1%; and Nuss, 35.7%. CONCLUSIONS We allow patients to choose among Leonard, Ravitch, and Nuss procedures for repair of pectus excavatum. Most select the Ravitch procedure. Length of stay, fees, analgesic needs, and complication rate were highest among patients in the Nuss group; all of these variables were lowest in the Leonard group.
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Affiliation(s)
- Mara B Antonoff
- Department of Surgery, Division of Pediatric Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
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13
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Alaedeen D, Madan AK, Ro CY, Khan KA, Martinez JM, Tichansky DS. Intraoperative Endoscopy and Leaks after Laparoscopic Roux-en-Y Gastric Bypass. Am Surg 2009. [DOI: 10.1177/000313480907500606] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Postoperative leaks after laparoscopic Roux-en-Y gastric bypass (LRYGB) are a source of morbidity and mortality. Any intervention that would decrease leak rates after LRYGB would be useful. This investigation tested the hypothesis that postoperative leak rates are lower after LRYGB with the routine use of intraoperative endoscopy (EN). Consecutive patients who underwent LRYGB were included. Intraoperative leak testing with air and methylene blue through an orogastric tube (OG) was used in the first 200 patients. Intraoperative endoscopy was used after the first 200 patients. There were 400 patients in this study. Preoperative demographics did not differ between groups. The intraoperative leak rate of the EN group was double the OG group (8 vs 4%; P = not significant), although the difference was not statistically significant. The OG group had a postoperative leak rate of 4 per cent with a mortality rate of 1 per cent. The EN group had a postoperative leak rate of 0.5 per cent with a mortality rate of 0 per cent. The difference in leak rates was statistically significant ( P < 0.04). Despite the issues of learning curve, EN demonstrates more intraoperative leaks than OG, indicating EN may be a more sensitive test than OG. Routine use of EN is associated with less postoperative leaks after LRYGB.
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Affiliation(s)
- Diya Alaedeen
- Division of Laparoendoscopic and Bariatric Surgery, University of Miami, Miami, Florida
- Colorado Springs Health Partners, Colorado Springs, Colorado
| | - Atul K. Madan
- Division of Laparoendoscopic and Bariatric Surgery, University of Miami, Miami, Florida
- Colorado Springs Health Partners, Colorado Springs, Colorado
| | - Charles Y. Ro
- Division of Laparoendoscopic and Bariatric Surgery, University of Miami, Miami, Florida
- Colorado Springs Health Partners, Colorado Springs, Colorado
| | - Khurram A. Khan
- Colorado Springs Health Partners, Colorado Springs, Colorado
| | - Jose M. Martinez
- Division of Laparoendoscopic and Bariatric Surgery, University of Miami, Miami, Florida
- Colorado Springs Health Partners, Colorado Springs, Colorado
| | - David S. Tichansky
- Division of Minimally Invasive and Bariatric Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
- Colorado Springs Health Partners, Colorado Springs, Colorado
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14
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Teixeira J, McGill K, Binenbaum S, Forrester G. Laparoscopic single-site surgery for placement of an adjustable gastric band: initial experience. Surg Endosc 2009; 23:1409-14. [PMID: 19288157 DOI: 10.1007/s00464-009-0411-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 01/19/2009] [Accepted: 02/11/2009] [Indexed: 01/20/2023]
Abstract
BACKGROUND Laparoendoscopic single-site (LESS) surgery for cholecystectomy and appendectomy are described in the literature. The benefits of these procedures compared with traditional laparoscopic approaches have yet to be determined. To date, no series of LESS surgeries for placement of an adjustable gastric band has been published or documented. This study aimed to determine the safety and feasibility of LESS surgery for placement of an adjustable gastric band. METHODS From December 2007 to June 2008, LESS surgery to place an adjustable gastric band via a transumbilical incision was performed for 10 patients with institutional review board approval. Essentially, multiple ports were placed through a single incision in the umbilicus to allow for liver retraction, visualization, and working instruments. All critical steps using a standard pars flaccida technique were performed without alteration. RESULTS For this study, 10 patients (9 women and 1 man) were carefully selected. These patients ranged in age from 32 to 61 years (mean, 47 years) and had a mean body mass index (BMI) of 42 kg/m2 (range, 35-45 kg/m2). The patients were selected for absence of both hepatomegaly and central obesity. Superobese patients were not considered for inclusion in the study. The mean operative time was 1 h and 10 min (range, 53 min to 1 h and 48 min). All the patients were discharged home within 23 h of admission, and no perioperative complications were noted. In addition, no wound-related complications occurred. Notably, only 2 of the 10 patients required the use of narcotic analgesia after discharge from the recovery room. There were no intra- or postoperative complications. CONCLUSIONS In our experience, LESS surgery for adjustable gastric banding shows this technique to be both feasible and safe for selected patients. Although technical limitations exist that will be improved upon, further studies are needed to compare LESS surgery for placement of an adjustable gastric band with traditional laparoscopic techniques.
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Affiliation(s)
- J Teixeira
- Department of Surgery, St. Luke's-Roosevelt Hospital Center, New York, NY, USA.
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15
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Psychosocial evaluation for bariatric surgery: the Boston interview and opportunities for intervention. Obes Surg 2008; 19:369-77. [PMID: 18795379 DOI: 10.1007/s11695-008-9676-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 08/28/2008] [Indexed: 01/14/2023]
Abstract
The process of psychosocial evaluation for weight loss surgery (WLS) is one that goes beyond serving the function of information-gathering (Bauchowitz et al. in Surg Obes Relat Dis 3:554-558, 2007; Friedman et al. in Surg Obes Relat Dis 3:376-382, 2007; Lanyon and Maxwell in Obes Surg 17:321-328, 2007; Sogg and Mori in Obes Surg 14:370-380, 2004; Sogg and Mori in Surg Obes Relat Dis 4:455-463, 2008). This process offers myriad opportunities for delivering significant and powerful interventions that can enhance the patient's success in the WLS process. A discussion of the unique opportunities for psychosocial intervention afforded by the pre-surgical evaluation process is presented, using The Boston Interview for Bariatric Surgery (Sogg and Mori in Surg Obes Relat Dis 4:455-463, 2008) as the organizing framework.
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Madan AK, Tichansky DS, Taddeucci RJ. Postoperative laparoscopic bariatric surgery patients do not remember potential complications. Obes Surg 2007; 17:885-8. [PMID: 17894146 DOI: 10.1007/s11695-007-9164-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Despite comprehensive preoperative education, patients may forget important information such as potential complications. METHODS Patients who had undergone laparoscopic bariatric surgery were surveyed. All patients were asked to write down as many as possible of the potential complications. Preoperatively, patients had been given an educational book, two preoperative educational appointments, a test, and an informed consent discussion and form with clear presentation of complications which may occur. RESULTS There were 70 patients in this investigation (75% response rate), with 49 laparoscopic gastric bypass patients (bypass), 18 laparoscopic adjustable gastric banding patients (band), and 3 patients who did not indicate their procedure. Patients listed an average of 5.1 complications. Complications were grouped in 12 categories for each procedure. Percentages reported by patients (bypass vs band) were: Death 34 (69%) vs. 13 (72%), Injury to GI tract/leak 14 (29%) vs. 5 (28%), Conversion 1 (2%) vs 0 (0%), CV/pulmonary issues 11 (22%) vs. 4 (22%), Stenosis/ulcer 6 (12%) vs NA, Band erosion/migration NA vs 9 (50%), Malnutrition 24 (49%) vs, 4 (22%), GI symptoms 19 (39%) vs. 6 (33%), Infection 15 (31%) vs. 10 (56%), Weight regain/inadequate loss 5 (10%) vs. 3 (17%), Thromboembolic event 7 (14%) vs. 3 (17%), and Hemorrhage 8 (16%) vs. 0 (0%). CONCLUSIONS Many patients forget some of the serious complications after laparoscopic bariatric surgery. This may have important medicolegal consequences especially during malpractice lawsuits. These data underscore the need for continual follow-up and education in this patient population.
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Affiliation(s)
- Atul K Madan
- Minimally Invasive Surgery Section, Department of Surgery, University of Tennessee Health Science Center, Memphis 38163, USA.
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