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Jedamzik J, Bichler C, Felsenreich DM, Brugger J, Eichelter J, Nixdorf L, Krebs M, Itariu B, Langer FB, Prager G. The male patient with obesity undergoing metabolic and bariatric surgery: changes in testosterone levels correlate with weight loss after one-anastomosis gastric bypass and Roux-en-Y gastric bypass. Surg Obes Relat Dis 2023; 19:699-705. [PMID: 36740523 DOI: 10.1016/j.soard.2022.12.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/10/2022] [Accepted: 12/17/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Male obesity secondary hypogonadism (MOSH) is a common disease among men with obesity and can be associated with metabolic syndrome and a variety of metabolic problems ultimately leading to androgen deficiency. Metabolic and bariatric surgery is a well-established treatment option associated with significant weight loss and reduction in metabolic co-morbidities. OBJECTIVES To evaluate the impact of surgery on plasma levels of sexual hormones and their effect on weight loss comparing 2 surgical methods (one-anastomosis gastric bypass [OAGB] and Roux-en-Y gastric bypass [RYGB]) in male patients with obesity. SETTING University hospital, Austria. METHODS Patients undergoing OAGB and RYGB between 2012 and 2017 were analyzed retrospectively. Follow-up in this study was up to 24 months. Systemic levels of sexual hormones (luteinizing hormone [LH]), follicle stimulating hormone [FSH], total testosterone [TT], sexual hormone binding globin [SHBG], 17 beta-estradiol [17bE], androstenedione [AS]) were retrieved at each visit. A linear mixed model was used to assess the correlation between changes in testosterone levels and percent excess weight loss (%EWL). RESULTS In 30.8% of all patients, MOSH was present preoperatively. A significant increase of TT was observed postoperatively that led to a complete resolution of hypogonadism within the period observed. Bioavailable testosterone (bTT) and FSH levels significantly increased each month of follow-up after surgery (all P < .01). Levels of 17bE did not change significantly after surgery. The overall change of TT, comparing preoperative and 1-year postoperative TT levels (ΔTT), significantly correlated with %EWL. Changes in TT levels were not affected by the choice of surgical method. CONCLUSIONS Serum plasma testosterone levels rise significantly after metabolic and bariatric surgery in male patients. The change of testosterone levels seems to play a role in continued weight loss after surgery. This is true irrespective of the surgical method used.
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Affiliation(s)
- Julia Jedamzik
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Bichler
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniel Moritz Felsenreich
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Jonas Brugger
- Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Section for Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Jakob Eichelter
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Larissa Nixdorf
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Michael Krebs
- Division of Endocrinology, Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | - Bianca Itariu
- Division of Endocrinology, Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | - Felix B Langer
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Gerhard Prager
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
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Krammel M, Eichelter J, Gatterer C, Lobmeyr E, Neymayer M, Grassmann D, Holzer M, Sulzgruber P, Schnaubelt S. Differences in Automated External Defibrillator Types in Out-of-Hospital Cardiac Arrest Treated by Police First Responders. J Cardiovasc Dev Dis 2023; 10:jcdd10050196. [PMID: 37233163 DOI: 10.3390/jcdd10050196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/22/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
Background: Police first responder systems also including automated external defibrillation (AED) has in the past shown considerable impact on favourable outcomes after out-of-hospital cardiac arrest (OHCA). While short hands-off times in chest compressions are known to be beneficial, various AED models use different algorithms, inducing longer or shorter durations of crucial timeframes along basic life support (BLS). Yet, data on details of these differences, and also of their potential impact on clinical outcomes are scarce. Methods: For this retrospective observational study, patients with OHCA of presumed cardiac origin and initially shockable rhythm treated by police first responders in Vienna, Austria, between 01/2013 and 12/2021 were included. Data from the Viennese Cardiac Arrest Registry and AED files were extracted, and exact timeframes were analyzed. Results: There were no significant differences in the 350 eligible cases in demographics, return of spontaneous circulation, 30-day survival, or favourable neurological outcome between the used AED types. However, the Philips HS1 and -FrX AEDs showed immediate rhythm analysis after electrode placement (0 [0-1] s) and almost no shock loading time (0 [0-1] s), as opposed to the LP CR Plus (3 [0-4] and 6 [6-6] s, respectively) and LP 1000 (3 [2-10] and 6 [5-7] s, respectively). On the other hand, the HS1 and -FrX had longer analysis times of 12 [12-16] and 12 [11-18] s than the LP CR Plus (5 [5-6] s) and LP 1000 (6 [5-8] s). The duration from when the AED was turned on until the first defibrillation were 45 [28-61] s (Philips FrX), 59 [28-81] s (LP 1000), 59 [50-97] s (HS1), and 69 [55-85] s (LP CR Plus). Conclusion: In a retrospective analysis of OHCA-cases treated by police first responders, we could not find significant differences in clinical patient outcomes concerning the respective used AED model. However, various differences in time durations (e.g., electrode placement to rhythm analysis, analysis duration, or AED turned on until first defibrillation) along the BLS algorithm were seen. This opens up the question of AED-adaptations and tailored training methods for professional first responders.
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Affiliation(s)
- Mario Krammel
- PULS-Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
- Emergency Medical Service (MA70), 1030 Vienna, Austria
| | - Jakob Eichelter
- PULS-Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
- Department of Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Constantin Gatterer
- PULS-Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | - Elisabeth Lobmeyr
- Department of Internal Medicine I, Medical University of Vienna, 1090 Vienna, Austria
| | - Marco Neymayer
- PULS-Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Patrick Sulzgruber
- PULS-Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | - Sebastian Schnaubelt
- PULS-Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
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Felsenreich DM, Zach ML, Vock N, Jedamzik J, Eichelter J, Mairinger M, Gensthaler L, Nixdorf L, Richwien P, Bichler C, Kristo I, Langer FB, Prager G. Esophageal function and non-acid reflux evaluated by impedance-24 h-pH-metry, high-resolution manometry, and gastroscopy after one-anastomosis gastric bypass-outcomes of a prospective mid-term study. Surg Endosc 2023; 37:3832-3841. [PMID: 36693919 PMCID: PMC10156623 DOI: 10.1007/s00464-022-09857-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/27/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND One-Anastomosis Gastric Bypass (OAGB) is the third most common bariatric operation for patients with obesity worldwide. One concern about OAGB is the presence of acid and non-acid reflux in a mid- and long-term follow-up. The aim of this study was to objectively evaluate reflux and esophagus motility by comparing preoperative and postoperative mid-term outcomes. SETTING Cross-sectional study; University-hospital based. METHODS This study includes primary OAGB patients (preoperative gastroscopy, high-resolution manometry (HRM), and impedance-24 h-pH-metry) operated at Medical University of Vienna before 31st December 2017. After a mean follow-up of 5.1 ± 2.3 years, these examinations were repeated. In addition, history of weight, remission of associated medical problems (AMP), and quality of life (QOL) were evaluated. RESULTS A total of 21 patients were included in this study and went through all examinations. Preoperative weight was 124.4 ± 17.3 kg with a BMI of 44.7 ± 5.6 kg/m2, total weight loss after 5.1 ± 2.3 years was 34.4 ± 8.3%. In addition, remission of AMP and QOL outcomes were very satisfactory in this study. In gastroscopy, anastomositis, esophagitis, Barrett´s esophagus, and bile in the pouch were found in: 38.1%, 28.3%, 9.5%, and 42.9%. Results of HRM of the lower esophageal sphincter pressure were 28.0 ± 15.6 mmHg, which are unchanged compared to preoperative values. Nevertheless, in the impedance-24 h-pH-metry, acid exposure time and DeMeester score decreased significantly to 1.2 ± 1.2% (p = 0.004) and 7.5 ± 8.9 (p = 0.017). Further, the total number of refluxes were equal to preoperative; however, the decreased acid refluxes were replaced by non-acid refluxes. CONCLUSION This study has shown decreased rates of acid reflux and increased non-acid reflux after a mid-term outcome of primary OAGB patients. Gastroscopy showed signs of chronic irritation of the gastrojejunostomy, pouch, and distal esophagus, even in asymptomatic patients. Follow-up gastroscopies in OAGB patients after 5 years may be considered.
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Affiliation(s)
- D M Felsenreich
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - M L Zach
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - N Vock
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - J Jedamzik
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - J Eichelter
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - M Mairinger
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - L Gensthaler
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - L Nixdorf
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - P Richwien
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - C Bichler
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - I Kristo
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - F B Langer
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - G Prager
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.
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Beiglböck H, Mörth E, Reichardt B, Stamm T, Itariu B, Harreiter J, Eichelter J, Prager G, Kautzky-Willer A, Wolf P, Krebs M. The Timing of Pregnancies After Bariatric Surgery has No Impact on Children's Health-a Nationwide Population-based Registry Analysis. Obes Surg 2023; 33:149-155. [PMID: 36344726 PMCID: PMC9834372 DOI: 10.1007/s11695-022-06346-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 10/16/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Bariatric surgery has a favorable effect on fertility in women. However, due to a lack of data regarding children's outcomes, the ideal time for conception following bariatric surgery is unknown. Current guidelines advise avoiding pregnancy during the initial weight loss phase (12-24 months after surgery) as there may be potential risks to offspring. Thus, we aimed to analyze health outcomes in children born to mothers who had undergone bariatric surgery. The surgery-to-delivery interval was studied. MATERIALS AND METHODS A nationwide registry belonging to the Austrian health insurance funds and containing health-related data claims was searched. Data for all women who had bariatric surgery in Austria between 01/2010 and 12/2018 were analyzed. A total of 1057 women gave birth to 1369 children. The offspring's data were analyzed for medical health claims based on International Classification of Diseases (ICD) codes and number of days hospitalized. Three different surgery-to-delivery intervals were assessed: 12, 18, and 24 months. RESULTS Overall, 421 deliveries (31%) were observed in the first 2 years after surgery. Of these, 70 births (5%) occurred within 12 months after surgery. The median time from surgery to delivery was 34 months. Overall, there were no differences noted in frequency of hospitalization and diagnoses leading to hospitalization in the first year of life, regardless of the surgery-to-delivery interval. CONCLUSION Pregnancies in the first 24 months after bariatric surgery were common. Importantly, the surgery-to-delivery interval had no significant impact on the health outcome of the children.
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Affiliation(s)
- Hannes Beiglböck
- grid.22937.3d0000 0000 9259 8492Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Eric Mörth
- grid.7914.b0000 0004 1936 7443Department of Informatics, University of Bergen, 5008 Bergen, Norway ,grid.412008.f0000 0000 9753 1393Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, 5021 Bergen, Norway
| | | | - Tanja Stamm
- grid.22937.3d0000 0000 9259 8492Center for Medical Statistics, Informatics and Intelligent Systems, Institute for Outcomes Research, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria ,grid.491977.5Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Bianca Itariu
- grid.22937.3d0000 0000 9259 8492Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Jürgen Harreiter
- grid.22937.3d0000 0000 9259 8492Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Jakob Eichelter
- grid.22937.3d0000 0000 9259 8492Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Gerhard Prager
- grid.22937.3d0000 0000 9259 8492Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Alexandra Kautzky-Willer
- grid.22937.3d0000 0000 9259 8492Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Peter Wolf
- grid.22937.3d0000 0000 9259 8492Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Michael Krebs
- grid.22937.3d0000 0000 9259 8492Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Nixdorf L, Felsenreich DM, Bichler C, Jedamzik J, Eichelter J, Gensthaler L, Mairinger M, Richwien P, Gachabayov M, Langer FB, Prager G. Surgical Technique for Weight Regain after Roux-en-Y Gastric Bypass: Pouch-resizing and the MiniMIZER® Gastric Ring. Surg Technol Int 2022; 41:sti41/1647. [PMID: 36413791 DOI: 10.52198/22.sti.41.gs1647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Laparoscopic Roux-en-Y Gastric Bypass (RYGB) is a commonly used method in bariatric surgery that leads to sufficient long-term weight loss and consequently to improvement or resolution of obesity-associated diseases. The nadir weight is commonly reached between six months and two years after surgery. Despite this initially good weight loss, weight regain is observed in up to 20% of the patients. Besides intensive dietological evaluation, bariatric re-operation can be an option in these cases. Before the surgical reintervention, an intensive evaluation of the esophagus, pouch, anastomosis, and adjacent small bowel using upper GI-endoscopy and radiological examinations (X-ray and/or 3D-CT volumetry) is mandatory. In patients with a dilated pouch, pouch-resizing with a MiniMIZER® Gastric Ring (Bariatric Solutions GmbH, Stein am Rhein, Switzerland) could be an option to reestablish restriction in the long term. Currently, there is no gold standard for the choice of the weight regain procedure or for the technique used in the procedure itself. This article focuses on the standardized procedure of pouch resizing with implantation of a MiniMIZER® Gastric Ring for the surgical therapy of weight regain due to pouch dilatation and/or dilatation of the gastrojejunostomy and the adjacent small bowel (usually approximately the first 20cm), resulting in a huge neo-stomach after RYGB, as performed at the Medical University of Vienna. Further, indications for revisional surgery for weight regain, mandatory examinations, and recommended conservative therapy options prior to surgery will be described. Next, the fast-track concept and its advantages are explained. Lastly, the surgical procedure, including positioning of the patient, placement of trocars, the intraoperative process, and special advice, is presented. Exact planning of the procedure and postoperative follow-up are indispensable for a further long-term success after weight regain surgery. In conclusion, pouch-resizing and implantation of the MiniMIZER® Gastric Ring represent a practical and effective solution in patients with dilated pouch/anastomosis/adjacent small bowel with weight regain after RYGB, if conservative therapy, including dietitian counseling and new drugs (e.g., Semaglutide), has failed.
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Affiliation(s)
- Larissa Nixdorf
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniel M Felsenreich
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Bichler
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Julia Jedamzik
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Jakob Eichelter
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Lisa Gensthaler
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Magdalena Mairinger
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Paula Richwien
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Mahir Gachabayov
- Section of Colorectal Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Felix B Langer
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Gerhard Prager
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
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Felsenreich DM, Arnoldner MA, Wintersteller L, Mrekva A, Jedamzik J, Eichelter J, Langer FB, Prager G. Intrathoracic pouch migration in one-anastomosis gastric bypass with and without hiatoplasty: A 3-dimensional-computed tomography volumetry study. Surg Obes Relat Dis 2022; 19:492-499. [PMID: 36566133 DOI: 10.1016/j.soard.2022.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 10/14/2022] [Accepted: 11/13/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Currently, 4.8% of bariatric operations worldwide are one-anastomosis gastric bypass (OAGB) procedures. If a hiatal hernia is detected in a preoperative gastroscopy, OAGB can be combined with hiatoplasty. Intrathoracic pouch migration (ITM) is common after bypass procedures because the fundus, a natural abutment, is separated from the pouch. OBJECTIVE The aim of this study was to find out whether OAGB or OAGB combined with hiatoplasty carries a higher risk of ITM and, therefore, also gastroesophageal reflux disease (GERD). SETTING University hospital. METHODS Fifty patients (group 1: 25× primary OAGB; group 2: 25× primary OAGB with hiatoplasty) were included in this study. History of weight, GERD, and quality of life were recorded in patient interviews and pouch volume and ITM were evaluated using 3-dimensional-computed tomography volumetry. RESULTS There were no differences in terms of patient characteristics, history of weight, pouch volume, or quality of life between both groups. ITM was found in group 1 in 60% (n = 15) and group 2 in 76% (n = 19) of all patients (P = .152). The ITM mean length was significantly lower in group 1 with .9 ± 1.1 cm than in group 2 with 1.8 ± 1.2 cm (P = .007). Regarding GERD, there was no difference between both groups; nevertheless, significantly more patients with ITM (38.2%; n = 13) had GERD compared with patients without ITM (6.3%; n = 1). CONCLUSION In primary OAGB, an additional hiatoplasty was not associated with higher rates of ITM or GERD; nevertheless, the length of ITM was higher after hiatoplasty. If ITM occurs, patients have a risk of developing GERD.
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Affiliation(s)
- Daniel M Felsenreich
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Michael A Arnoldner
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Lukas Wintersteller
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Arpad Mrekva
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Julia Jedamzik
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Jakob Eichelter
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Felix B Langer
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Gerhard Prager
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
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7
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Eichelter J, Felsenreich DM, Bichler C, Gensthaler L, Gachabayov M, Richwien P, Nixdorf L, Jedamzik J, Mairinger M, Langer FB, Prager G. Surgical Technique of Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S). Surg Technol Int 2022; 41:sti41/1571. [PMID: 35623034 DOI: 10.52198/22.sti.41.gs1571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Laparoscopic Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) is a bariatric/metabolic procedure that has been gaining popularity in recent years. SADI-S strongly affects the secretion of various gut hormones, adipocytokines and incretins. From a mechanistic point of view, the operation combines malabsorption and restriction, and has been shown to have a long-lasting and significant impact on weight loss and remission of comorbidities. With regard to the technique, first, a Sleeve is created and then the duodenum is tran-sected approximately 3-4cm after the pylorus at the level of the gastroduodenal artery (GDA). Next, 250-300cm of small bowel is measured from the caecum and a hand-sewn duo-deno-ileal anastomosis is performed. The length of the biliopancreatic limb is variable in this procedure. Because of the standardized common limb length in all patients, weight loss is very precise within a low range. Nevertheless, due to the complex hand-sewn anastomosis and the delicacy necessary when handling the duodenum, this procedure should be reserved for experienced bariatric surgeons in specialized centers. This article provides an overview of the standard surgical technique at the Department of Visceral Surgery at the Medical University of Vienna, as well as information about patient selection and pre- and postoperative care.
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Affiliation(s)
- Jakob Eichelter
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniel M Felsenreich
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Bichler
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Lisa Gensthaler
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Mahir Gachabayov
- Section of Colorectal Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Paula Richwien
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Larissa Nixdorf
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Julia Jedamzik
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Magdalena Mairinger
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Felix B Langer
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Gerhard Prager
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
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8
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Gensthaler L, Felsenreich DM, Jedamzik J, Eichelter J, Nixdorf L, Bichler C, Krebs M, Itariu B, Langer FB, Prager G. Trends of Overweight and Obesity in Male Adolescents: Prevalence, Socioeconomic Status, and Impact on Cardiovascular Risk in a Central European Country. Obes Surg 2022; 32:1024-1033. [PMID: 35041124 PMCID: PMC8933384 DOI: 10.1007/s11695-021-05867-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/18/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022]
Abstract
Background Obesity is one of the most important health-related problems of the twenty-first century. Data on its prevalence in Austria remain scarce. Aim of this study was to determine current trends of overweight and obesity, associated comorbidities and socioeconomic status in all 18-year-old male Austrian citizens, and its potential impact on the demand for bariatric surgery in the future. Methods Data from compulsory military conscription examinations in all 18-year-old males from 2003 to 2018 were obtained from the Federal ministry of Defense’s database. Measurements of height, weight, and subsequent body mass index (BMI) calculations in 874, 220 adolescents were subdivided into yearly cohorts. Comorbidities, educational status, and nicotine abuse were evaluated. Results Mean BMI increased from 22.0 ± 3.95 kg/m2 in 2003 to 22.8 ± 4.69 kg/m2 in 2018 (p < 0.001). Overweight and obesity °I–III increased from 15.3%, 4.2%, 1.2%, and 0.4% (2003) to 20.4%, 7.1%, 2.5%, and 0.8% (2018), respectively. Cardiovascular risk, reflected by the waist-to-height ratio, increased significantly over time (p < 0.0001). Additionally, data showed a significant association of nicotine abuse in overweight or obese adolescents (p < 0.0001). Significantly less adolescents with obesity graduated from high school (p < 0.0001). Overall, 25.7% of adolescents with obesity were considered ineligible for military service. Conclusions BMI and cardiovascular risk steadily increased over the last 15 years in Austrian male adolescents. A significant shift from normal weight to overweight was observed, while higher obesity classes doubled over this observational period. This study also revealed a significant association of BMI and lower educational status. Graphical Abstract Trends of overweight and obesity in male adolescents: prevalence, socio-economic status and impact on cardiovascular risk in a central European country
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Affiliation(s)
- Lisa Gensthaler
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Daniel M Felsenreich
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Julia Jedamzik
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jakob Eichelter
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Larissa Nixdorf
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christoph Bichler
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Michael Krebs
- Division of Endocrinology, Department of Internal Medicine, Medical University of Vienna, 1090, Vienna, Austria
| | - Bianca Itariu
- Division of Endocrinology, Department of Internal Medicine, Medical University of Vienna, 1090, Vienna, Austria
| | - Felix B Langer
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gerhard Prager
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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9
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Felsenreich DM, Artemiou E, Wintersteller L, Jedamzik J, Eichelter J, Gensthaler L, Bichler C, Sperker C, Beckerhinn P, Kristo I, Langer FB, Prager G. Fifteen Years after Sleeve Gastrectomy: Gastroscopies, Manometries, and 24-h pH-Metries in a Long-Term Follow-Up: A Multicenter Study. Obes Facts 2022; 15:666-673. [PMID: 35882187 PMCID: PMC9669976 DOI: 10.1159/000526170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/30/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Sleeve gastrectomy (SG) is the most common bariatric operation with over 340,000 procedures per year. There are only few studies presenting follow-up results >10 years in the literature today. The aim of this study was the objective evaluation of long-term outcomes of at least 15 years after SG in non-converted patients. METHODS This study (multicenter cross-sectional; university-hospital based) includes all non-converted patients with primary SG before December 2005 at participating bariatric centers. The following methods were used: gastroscopy, esophageal manometry, 24-h pH-metry, and Gastrointestinal Quality of Life Index (GIQLI). RESULTS After removing converted patients, patients with bariatric procedures before SG, and deceased patients from the cohort, 20 of 53 participants have met the inclusion criteria. Of this group, 55% are suffering from symptomatic gastroesophageal reflux disease (GERD); 45% are without GERD. Esophagitis, hiatal hernias, Barrett's esophagus, and enlarged sleeves were found in 44%, 50%, 13%, and 69% of patients during gastroscopy. Mean lower esophageal sphincter pressure was normal at 20.2 ± 14.1 mm Hg during manometry. Reflux activity in 24 h, number of refluxes, and DeMeester score were increased at 12.9 ± 9.7%, 98.0 ± 80.8, and 55.3 ± 36.3 during 24-h pH-metry. Patients with GERD scored significantly lower in the GIQLI than patients without GERD: 107.6 ± 18.4 versus 127.6 ± 14.4 (p = 0.04). DISCUSSION/CONCLUSION Fifteen years after primary SG, objective testing has shown that GERD, esophagitis, and Barrett's esophagus are major issues for these patients. Surveillance endoscopies at 5-year intervals in all SG patients and 3-year intervals in patients with Barrett's esophagus are recommended.
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Affiliation(s)
- Daniel Moritz Felsenreich
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Evi Artemiou
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Lukas Wintersteller
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Julia Jedamzik
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Jakob Eichelter
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Lisa Gensthaler
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Bichler
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | | | | | - Ivan Kristo
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Felix Benedikt Langer
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Gerhard Prager
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
- *Gerhard Prager,
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10
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Niebuhr H, Aufenberg T, Dag H, Reinpold W, Peiper C, Schardey H, Renter M, Aly M, Eucker D, Köckerling F, Eichelter J. O36 LOD (LOSS-OF-DOMAIN) HERNIA TREATMENT WITH INTRAOPERATIVE FASCIA TRACTION. DOES THIS TECHNIQUE MAKE RELEASE OPERATIONS SUPERFLUOUS? Br J Surg 2021. [DOI: 10.1093/bjs/znab396.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
Measurable and controlled stretching of the fascia for 30 minutes during surgery to achieve primary tension-free abdominal wall closure in LOD hernias. This prospective observational study aimed to clarify the extent to which this traction method can function as an alternative to component separation methods.
Material and Methods
We have already applied this technique in > 50 procedures of LOD hernias. We published the data of first 21 patients treated with intraoperative fascia stretching in seven specialized hernia centers between November 2019 and August 2020. The average patient age was 58 years with a gender ratio of 2.5 males: 1 female. ASA scores were III in 66.7% and II in 33.3%. The body mass index (BMI) averaged 32.5 kg/m2. Thirteen patients were treated with BTA 4 weeks before surgery.
Results
Intraoperatively-measured fascial distance averaged 17.3 cm (range 8.5–44 cm). After application of diagonal-anterior traction >10 kg for an average duration of 32.3 min (range 30–40 min), the fascial distance decreased by 9.8 cm (1–26 cm) to an average 7.5 cm (range 2–19 cm), which is a large effect (r = 0.62). The fascial length increase (average 9.8 cm) after applied traction was highly significant. All hernias were closed under moderate tension after the traction phase. In 19 patients, this closure was reinforced with mesh using a sublay technique.
Conclusions
This method allows primary closure of complex LOD hernias and is potentially less prone to complications than component separation methods.
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Affiliation(s)
- Henning Niebuhr
- Hamburger Hernien Centrum, Hamburg Hernia Center, Hamburg Hernia Center, Hamburg, Germany
| | | | | | | | - Christian Peiper
- Clinic for General, Visceral and Thoracic Surgery, Protestant Hospital, Hamm, Germany
| | - Hans Martin Schardey
- Clinic for General, Visceral, Vascular and Endocrine Surgery, Agatharied Hospital, Hausham, Germany
| | | | - Mohamed Aly
- Clinic for General, Visceral and Thoracic Surgery, Landshut-Achdorf Hospital, Landshut, Germany
| | - Dietmar Eucker
- 8clinic for General, Visceral, Thoracic and Vascular Surgery, Canton Hospital Basel-Land, Liestal, Switzerland, Switzerland
| | - Ferdinand Köckerling
- Clinic for General, Visceral and Vascular Surgery, Vivantes Klinikum Spandau, Berlin, Germany
| | - Jakob Eichelter
- Department of Surgery, Division of General Surgery, Medical University of Vienna, Vienna, Austria, Austria
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11
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Beiglböck H, Mörth E, Reichardt B, Stamm T, Itariu B, Harreiter J, Hufgard-Leitner M, Fellinger P, Eichelter J, Prager G, Kautzky A, Kautzky-Willer A, Wolf P, Krebs M. Sex-Specific Differences in Mortality of Patients with a History of Bariatric Surgery: a Nation-Wide Population-Based Study. Obes Surg 2021; 32:8-17. [PMID: 34751909 PMCID: PMC8752554 DOI: 10.1007/s11695-021-05763-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
Purpose Bariatric surgery reduces mortality in patients with severe obesity and is predominantly performed in women. Therefore, an analysis of sex-specific differences after bariatric surgery in a population-based dataset from Austria was performed. The focus was on deceased patients after bariatric surgery. Materials and Methods The Austrian health insurance funds cover about 98% of the Austrian population. Medical health claims data of all Austrians who underwent bariatric surgery from 01/2010 to 12/2018 were analyzed. In total, 19,901 patients with 107,806 observed years postoperative were eligible for this analysis. Comorbidities based on International Classification of Diseases (ICD)-codes and drug intake documented by Anatomical Therapeutical Chemical (ATC)-codes were analyzed in patients deceased and grouped according to clinically relevant obesity-associated comorbidities: diabetes mellitus (DM), cardiovascular disease (CV), psychiatric disorder (PSY), and malignancy (M). Results In total, 367 deaths were observed (1.8%) within the observation period from 01/2010 to 04/2020. The overall mortality rate was 0.34% per year of observation and significantly higher in men compared to women (0.64 vs. 0.24%; p < 0.001(Chi-squared)). Moreover, the 30-day mortality was 0.19% and sixfold higher in men compared to women (0.48 vs. 0.08%; p < 0.001). CV (82%) and PSY (55%) were the most common comorbidities in deceased patients with no sex-specific differences. Diabetes (38%) was more common in men (43 vs. 33%; p = 0.034), whereas malignant diseases (36%) were more frequent in women (30 vs. 41%; p = 0.025). Conclusion After bariatric surgery, short-term mortality as well as long-term mortality was higher in men compared to women. In deceased patients, diabetes was more common in men, whereas malignant diseases were more common in women. Graphical abstract ![]()
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Affiliation(s)
- Hannes Beiglböck
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Eric Mörth
- Department of Informatics, University of Bergen, 5008, Bergen, Norway.,Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, 5021, Bergen, Norway
| | | | - Tanja Stamm
- Institute for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria.
| | - Bianca Itariu
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Jürgen Harreiter
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Miriam Hufgard-Leitner
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Paul Fellinger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Jakob Eichelter
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gerhard Prager
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Division of Social Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Peter Wolf
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Krebs
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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12
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Jedamzik J, Bichler C, Felsenreich DM, Gensthaler L, Eichelter J, Nixdorf L, Krebs M, Langer FB, Prager G. Conversion from one-anastomosis gastric bypass to Roux-en-Y gastric bypass: when and why-a single-center experience of all consecutive OAGB procedures. Surg Obes Relat Dis 2021; 18:225-232. [PMID: 34794865 DOI: 10.1016/j.soard.2021.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/05/2021] [Accepted: 10/21/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND One-anastomosis gastric bypass (OAGB) is a well-established treatment method in patients with morbid obesity. Its long-term impact on de novo reflux, anastomotic complications, and malnutrition needs further evaluation. Roux-en-Y gastric bypass (RYGB) is a technically feasible procedure in revisional bariatric surgery. This study presents our institutional data on conversion from OAGB to RYGB. OBJECTIVE To determine the reasons for conversion, preoperative endoscopic findings, and feasibility of revisional bariatric surgery after OAGB. SETTING University hospital in Austria METHODS: Retrospective analysis of a prospectively fed database. All patients undergoing OAGB between January 2012 and December 2019 were included. Screening was carried out for all patients needing conversion to RYGB. Percent total weight loss, percent excess weight loss, time to conversion, postoperative complications, and reasons for conversion were assessed. RESULTS Eighty-two of 1,025 patients who underwent OAGB were converted laparoscopically to RYGB. Seven patients were converted early because of anastomotic/gastric tube leakage. Median time to late conversion was 29.1 ± 24.3 months, mean percent excess weight loss was 86.6% ± 33.1% and percent total weight loss was 35.1% ± 13.5%. Forty-two patients were converted because of reflux, 11 because of persistent marginal ulcers, 10 because of anastomotic stenosis, 9 because of malnutrition, and 3 because of weight regain. Seven patients showed Barrett's metaplasia in biopsies at the gastroesophageal junction before conversion. CONCLUSION Laparoscopic conversion from OAGB to RYGB is technically feasible with a moderate rate of postoperative complications. Severe (bile) reflux is a serious long-term complication after OAGB, with 4.1% of patients needing conversion to RYGB. Endoscopy after OAGB in patients showing clinical symptoms of gastroesophageal reflux disease is strongly advised to detect underlying pathologic changes.
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Affiliation(s)
- Julia Jedamzik
- Division of General Surgery, Department of Surgery, Vienna Medical University, Vienna, Austria
| | - Christoph Bichler
- Division of General Surgery, Department of Surgery, Vienna Medical University, Vienna, Austria
| | - Daniel M Felsenreich
- Division of General Surgery, Department of Surgery, Vienna Medical University, Vienna, Austria
| | - Lisa Gensthaler
- Division of General Surgery, Department of Surgery, Vienna Medical University, Vienna, Austria
| | - Jakob Eichelter
- Division of General Surgery, Department of Surgery, Vienna Medical University, Vienna, Austria
| | - Larissa Nixdorf
- Division of General Surgery, Department of Surgery, Vienna Medical University, Vienna, Austria
| | - Michael Krebs
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Vienna Medical University, Vienna, Austria
| | - Felix B Langer
- Division of General Surgery, Department of Surgery, Vienna Medical University, Vienna, Austria
| | - Gerhard Prager
- Division of General Surgery, Department of Surgery, Vienna Medical University, Vienna, Austria.
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13
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Felsenreich DM, Langer FB, Bichler C, Eichelter J, Jedamzik J, Gachabayov M, Mairinger M, Richwien P, Prager G. Surgical Technique of Diverted One-Anastomosis Gastric Bypass. Surg Technol Int 2021; 39:107-112. [PMID: 34699605 DOI: 10.52198/21.sti.39.gs1485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Laparoscopic diverted one-anastomosis gastric bypass (D-OAGB) is a bariatric procedure combining the principles of restriction, malabsorption, and other factors to induce weight loss. It is achieved by creating a narrow, long gastric pouch and bypassing a part of the small bowel (biliopancreatic limb). D-OAGB was first described by Dr. Ribero in 2013 and is technically a variation of the very heterogeneous group of Roux-en-Y gastric bypass operations. There are different technical variants to perform D-OAGB and to organize pre- and postoperative care. The following article is based on the approach to bariatric surgery as taken at the Department of General Surgery at the Medical University of Vienna. This article focuses on patient preparation before bariatric/metabolic surgery with mandatory and optional preoperative examinations to find the surgical procedure best suited for each individual patient and to decrease the patient's risk. The surgical technique of D-OAGB itself, including positioning of the patient and related technical highlights, as well as the specifics of the postoperative course, are described. D-OAGB is an effective procedure for patients with symptomatic gastroesophageal reflux for adequate weight loss and remission of comorbidities with a low risk of malnutrition. For D-OAGB to be successful, important technical steps, such as creating a narrow, long pouch, exact length of the biliopancreatic and alimentary limb, and additional hiatoplasty (if necessary), should be taken. In terms of the postoperative course, regular checkups are vital to ensure desirable outcome in the long-term follow up and early detection of adverse developments.
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Affiliation(s)
- Daniel M Felsenreich
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Felix B Langer
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Bichler
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Jakob Eichelter
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Julia Jedamzik
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Mahir Gachabayov
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Magdalena Mairinger
- Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Paula Richwien
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Gerhard Prager
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
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14
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Felsenreich DM, Artemiou E, Steinlechner K, Vock N, Jedamzik J, Eichelter J, Gensthaler L, Bichler C, Sperker C, Beckerhinn P, Kristo I, Langer FB, Prager G. Fifteen Years After Sleeve Gastrectomy: Weight Loss, Remission of Associated Medical Problems, Quality of Life, and Conversions to Roux-en-Y Gastric Bypass-Long-Term Follow-Up in a Multicenter Study. Obes Surg 2021; 31:3453-3461. [PMID: 34021882 PMCID: PMC8270807 DOI: 10.1007/s11695-021-05475-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 01/07/2023]
Abstract
Purpose Since 2014, sleeve gastrectomy (SG) has been the most frequently performed bariatric-metabolic operation worldwide (2018: 386,096). There are only a few studies reporting a long-term follow-up (up to 11 years) available today. The aim of this study was to evaluate the long-term outcome of SG with a follow-up of at least 15 years regarding weight loss, remission of associated medical problems (AMP), conversions, and quality of life (QOL). Setting Multicenter cross-sectional study; university hospital. Methods This study includes all patients who had SG before 2005 at the participating bariatric centers. History of weight, AMP, conversions, and QOL were evaluated by interview at our bariatric center. Results Fifty-three patients met the inclusion criteria of a minimal follow-up of 15 years. Weight and body mass index at the time of the SG were 136.8kg and 48.7kg/m2. Twenty-six patients (49.1%) were converted to Roux-en-Y gastric bypass (RYGB) for weight regain and gastroesophageal reflux within the follow-up period. Total weight loss after 15 years was 31.5% in the non-converted group and 32.9% in the converted group. Remission rates of AMP and QOL were stable over the follow-up period. Conclusion Fifteen years after SG, a stable postoperative weight was observed at the cost of a high conversion rate. Patients converted to RYGB were able to achieve further weight loss and preserve good remission rates of AMP. SG in patients without the need of a conversion to another bariatric-metabolic procedure may be considered effective. Careful preoperative patient selection is mandatory when performing SG. Graphical abstract ![]()
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Affiliation(s)
- Daniel M Felsenreich
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Evi Artemiou
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Katharina Steinlechner
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Natalie Vock
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Julia Jedamzik
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jakob Eichelter
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Lisa Gensthaler
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christoph Bichler
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | | | | | - Ivan Kristo
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Felix B Langer
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gerhard Prager
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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15
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Niebuhr H, Aufenberg T, Dag H, Reinpold W, Peiper C, Schardey HM, Renter MA, Aly M, Eucker D, Köckerling F, Eichelter J. Intraoperative Fascia Tension as an Alternative to Component Separation. A Prospective Observational Study. Front Surg 2021; 7:616669. [PMID: 33708790 PMCID: PMC7940755 DOI: 10.3389/fsurg.2020.616669] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/14/2020] [Indexed: 11/13/2022] Open
Abstract
Incisional hernias are common late complications of abdominal surgery, with a 1-year post-laparotomy incidence of about 20%. A giant hernia is often preceded by severe peritonitis of various causes. The Fasciotens® Abdomen device is used to stretch the fascia in a measurably controlled manner during surgery to achieve primary tension-free abdominal closure. This prospective observational study aims to clarify the extent to which this traction method can function as an alternative to component separation (CS) methods. Methods: We included data of 21 patients treated with intraoperative fascia stretching in seven specialized hernia centers between November 2019 and August 2020. Results: Intraoperatively-measured fascial distance averaged 17.3 cm (range 8.5-44 cm). After application of diagonal-anterior traction >10 kg for an average duration of 32.3 min (range 30-40 min), the fascial distance decreased by 9.8 cm (1-26 cm) to an average 7.5 cm (range 2-19 cm), which is a large effect (r = 0.62). The fascial length increase (average 9.8 cm) after applied traction was highly significant. All hernias were closed under moderate tension after the traction phase. In 19 patients, this closure was reinforced with mesh using a sublay technique. Conclusion: This method allows primary closure of complex (LOD) hernias and is potentially less prone to complications than component separation (CS) methods.
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Affiliation(s)
| | | | - Halil Dag
- Hanse Hernia Centre, Hamburg, Germany
| | | | - Christian Peiper
- Clinic for General, Visceral and Thoracic Surgery, Protestant Hospital, Hamm, Germany
| | - Hans Martin Schardey
- Clinic for General, Visceral, Vascular and Endocrine Surgery, Agatharied Hospital, Hausham, Germany
| | | | - Mohamed Aly
- Clinic for General, Visceral and Thoracic Surgery, Landshut-Achdorf Hospital, Landshut, Germany
| | - Dietmar Eucker
- Clinic for General, Visceral, Thoracic and Vascular Surgery, Canton Hospital Basel-Land, Liestal, Switzerland
| | - Ferdinand Köckerling
- Clinic for General, Visceral and Vascular Surgery, Vivantes Klinikum Spandau, Berlin, Germany
| | - Jakob Eichelter
- Department of Surgery, Division of General Surgery, Medical University of Vienna, Vienna, Austria
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16
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Felsenreich DM, Bichler C, Langer FB, Gachabayov M, Eichelter J, Gensthaler L, Vock N, Artemiou E, Prager G. Surgical Technique for One-Anastomosis Gastric Bypass. Surg Technol Int 2020; 37:57-61. [PMID: 33180956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
.Laparoscopic One-Anastomosis Gastric Bypass (OAGB) is a bariatric procedure that combines the principles of restriction and malabsorption, which are achieved by creating a long and narrow gastric pouch and bypassing part of the small bowel (duodenum and part of the jejunum). It is currently the third most common bariatric procedure worldwide; more than19,000 operations (4.8%) are performed per year. OAGB is synonymous with "Mini Gastric Bypass" and "Omega Loop Gastric Bypass". There are numerous technical variants for performing OAGB and organizing pre- and postoperative care. This article is based on the approach to bariatric surgery at the Department of General Surgery at Vienna Medical University. We focus on patient preparation before a bariatric/metabolic procedure with mandatory and optional examinations to decrease the patient's risk and find the procedure best suited for each individual patient. Next, the surgical technique itself is described, including positioning of the patient, positioning of the trocars and related tips, tricks, and technical highlights, as well as the specifics of the postoperative course. OAGB is an effective procedure for weight loss and remission of comorbidities with a low risk of malnutrition for patients with good compliance. For OAGB to be successful, important technical steps such as a long and narrow pouch, exact length of the biliopancreatic limb and hiatoplasty, if necessary, should be taken. In terms of post-operative care, regular check-ups are vital to ensure a positive outcome in long-term follow-up and the early detection of adverse developments.
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17
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Bichler C, Jedamzik J, Felsenreich DM, Langer FB, Eilenberg M, Vock N, Steinlechner K, Eichelter J, Gensthaler L, Prager G. Stapling Through a Bougie During Sleeve Gastrectomy in a Superobese Patient-a Video Vignette. Obes Surg 2020; 30:4167-4168. [PMID: 32617922 PMCID: PMC7467964 DOI: 10.1007/s11695-020-04790-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/09/2020] [Accepted: 06/15/2020] [Indexed: 11/27/2022]
Abstract
Purpose Bariatric-metabolic surgery in superobese patients (BMI > 50 kg/m2) is very challenging indeed with little room for error. In many cases, a two-step procedure is required, since more complex primary bariatric procedures can be technically demanding and bearing a relevant risk for the patient. At our institution, laparoscopic sleeve gastrectomy (SG) is the preferred primary procedure, followed by a conversion to either SADI-S or Roux-en-Y gastric bypass (RYGB) after initial weight loss is achieved [1, 2]. This video aims at demonstrating the conversion from primary SG to RYGB due to an adverse event in a 45-year-old superobese female patient (weight, 170 kg; BMI, 73 kg/m2). Methods An intraoperative laparoscopic video has been anonymized and edited to demonstrate the course of the operation on the patient mentioned above. Results The start of the procedure was uneventful. After a successful mobilization of the greater curvature, the stomach was resected with an electronic stapling device guided by a firm 36-french bougie (Rüsch, Germany) towards the angle of His. Due to a limited view, a stapler was placed over the bougie, which resulted in the stomach being subtotally transected, the staples attaching the bougie to the sleeve about 5 cm from the gastroesophageal junction. Salvage surgery after removing the remnants of the bougie was a conversion to RYGB. Conclusion When performing a bariatric-metabolic surgery in superobese patients, an extended skill level is required to provide a solution, should anything go wrong. Therefore, we suggest bariatric-metabolic surgery in superobese patients to be performed solely and specifically at high-volume centres. Electronic supplementary material The online version of this article (10.1007/s11695-020-04790-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christoph Bichler
- Division of General Surgery, Department of Surgery, Vienna Medical University, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Julia Jedamzik
- Division of General Surgery, Department of Surgery, Vienna Medical University, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Daniel M Felsenreich
- Division of General Surgery, Department of Surgery, Vienna Medical University, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Felix B Langer
- Division of General Surgery, Department of Surgery, Vienna Medical University, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Magdalena Eilenberg
- Division of General Surgery, Department of Surgery, Vienna Medical University, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Natalie Vock
- Division of General Surgery, Department of Surgery, Vienna Medical University, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Katharina Steinlechner
- Division of General Surgery, Department of Surgery, Vienna Medical University, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jakob Eichelter
- Division of General Surgery, Department of Surgery, Vienna Medical University, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Lisa Gensthaler
- Division of General Surgery, Department of Surgery, Vienna Medical University, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gerhard Prager
- Division of General Surgery, Department of Surgery, Vienna Medical University, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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18
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Krammel M, Lobmeyr E, Sulzgruber P, Winnisch M, Weidenauer D, Poppe M, Datler P, Zeiner S, Keferboeck M, Eichelter J, Hamp T, Uray T, Schnaubelt S, Nuernberger A. The impact of a high-quality basic life support police-based first responder system on outcome after out-of-hospital cardiac arrest. PLoS One 2020; 15:e0233966. [PMID: 32484818 PMCID: PMC7266310 DOI: 10.1371/journal.pone.0233966] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 05/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Laypersons' efforts to initiate basic life support (BLS) in witnessed Out-of-Hospital Cardiac Arrest (OHCA) remain comparably low within western society. Therefore, in order to shorten no-flow times in cardiac arrest, several police-based first responder systems equipped with automated external defibrillators (Pol-AED) were established in urban areas, which subsequently allow early BLS and AED administration by police officers. However, data on the quality of BLS and AED use in such a system and its impact on patient outcome remain scarce and inconclusive. METHODS A total of 85 Pol-AED cases were randomly assigned to a gender, age and first rhythm matched non-Pol-AED control group (n = 170) in a 1:2 ratio. Data on quality of BLS were extracted via trans-thoracic impedance tracings of used AED devices. RESULTS Comparing Pol-AED cases and the control group, we observed a similar compression rate per minute (p = 0.677) and compression ratio (p = 0.651), mirroring an overall high quality of BLS administered by police officers. Time to the first shock was significantly shorter in Pol-AED cases (6 minutes [IQR: 2-10] vs. 12 minutes [IQR: 8-17]; p<0.001). While Pol-AED was not associated with increased sustained return of spontaneous circulation (p = 0.564), a strong and independent impact on survival until hospital discharge (adj. OR: 1.85 [95%CI: 1.06-3.23; p = 0.030]) and a borderline significance for the association with favorable neurological outcome (adj. OR: 1.58 [95%CI: 0.96-2.89; p = 0.052) were observed. CONCLUSION We were able to demonstrate an early start and a high quality of BLS and AED use in Pol-AED assessed OHCA cases. Moreover, the presence of Pol-AED care was associated with better patient survival and borderline significance for favorable neurological outcome.
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Affiliation(s)
- Mario Krammel
- Department of Anesthesiology, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria.,PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria.,Emergency Medical Service, Vienna, Austria
| | - Elisabeth Lobmeyr
- PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria.,Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Patrick Sulzgruber
- PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria.,Division of Cardiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Markus Winnisch
- PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria.,Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - David Weidenauer
- PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria.,Division of Cardiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Philip Datler
- Department of Anesthesiology, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Sebastian Zeiner
- Department of Anesthesiology, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Markus Keferboeck
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Jakob Eichelter
- PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria.,Emergency Medical Service, Vienna, Austria
| | - Thomas Hamp
- Department of Anesthesiology, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria.,PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - Thomas Uray
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Sebastian Schnaubelt
- PULS-Austrian Cardiac Arrest Awareness Association, Vienna, Austria.,Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
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19
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Krammel M, Schnaubelt S, Weidenauer D, Winnisch M, Steininger M, Eichelter J, Hamp T, van Tulder R, Sulzgruber P. Gender and age-specific aspects of awareness and knowledge in basic life support. PLoS One 2018; 13:e0198918. [PMID: 29894491 PMCID: PMC5997304 DOI: 10.1371/journal.pone.0198918] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 05/29/2018] [Indexed: 11/26/2022] Open
Abstract
Background The ‘chain of survival’—including early call for help, early cardiopulmonary resuscitation (CPR) and early defibrillation—represents the most beneficial approach for favourable patient outcome after out-of-hospital cardiac arrest (OHCA). Despite increasing numbers of publicly accessible automated external defibrillators (AED) and interventions to increase public awareness for basic life support (BLS), the number of their use in real-life emergency situations remains low. Methods In this prospective population-based cross-sectional study, a total of 501 registered inhabitants of Vienna (Austria) were randomly approached via telephone calls between 08/2014 and 09/2014 and invited to answer a standardized questionnaire in order to identify public knowledge and awareness of BLS and AED-use. Results We found that more than 52 percent of participants would presume OHCA correctly and would properly initiate BLS attempts. Of alarming importance, only 33 percent reported that they would be willing to perform CPR and 50 percent would use an AED device. There was a significantly lower willingness to initiate BLS attempts (male: 40% vs. female: 25%; OR: 2.03 [95%CI: 1.39–2.98]; p<0.001) and to use an AED device (male: 58% vs. female: 44%; OR: 1.76 [95%CI: 1.26–2.53]; p = 0.002) in questioned female individuals compared to their male counterparts. Interestingly, we observed a strongly decreasing level of knowledge and willingness for BLS attempts (-14%; OR: 0.72 [95%CI: 0.57–0.92]; p = 0.027) and AED-use (-19%; OR: 0.68 [95%CI: 0.54–0.85]; p = 0.001) with increasing age. Conclusion We found an overall poor knowledge and awareness concerning BLS and the use of AEDs among the Viennese population. Both female and elderly participants reported the lowest willingness to perform BLS and use an AED in case of OHCA. Specially tailored programs to increase awareness and willingness among both the female and elderly community need to be considered for future educational interventions.
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Affiliation(s)
- Mario Krammel
- Department of Anesthesiology, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
- Emergency Medical Service Vienna, Vienna, Austria
- Austrian Cardiac Arrest Awareness Association – PULS, Vienna, Austria
| | - Sebastian Schnaubelt
- Austrian Cardiac Arrest Awareness Association – PULS, Vienna, Austria
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - David Weidenauer
- Austrian Cardiac Arrest Awareness Association – PULS, Vienna, Austria
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Markus Winnisch
- Austrian Cardiac Arrest Awareness Association – PULS, Vienna, Austria
- Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Matthias Steininger
- Austrian Cardiac Arrest Awareness Association – PULS, Vienna, Austria
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Jakob Eichelter
- Department of Anesthesiology, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
- Austrian Cardiac Arrest Awareness Association – PULS, Vienna, Austria
| | - Thomas Hamp
- Emergency Medical Service Vienna, Vienna, Austria
- Austrian Cardiac Arrest Awareness Association – PULS, Vienna, Austria
| | - Raphael van Tulder
- Austrian Cardiac Arrest Awareness Association – PULS, Vienna, Austria
- Department of Internal Medicine I, Division of Cardiology, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Patrick Sulzgruber
- Austrian Cardiac Arrest Awareness Association – PULS, Vienna, Austria
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
- * E-mail:
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20
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Schnaubelt S, Krammel M, van Tulder R, Eichelter J, Gatterer C, Chwojka C, Sulzgruber P. Public access defibrillation is insufficiently available in rural regions - When layperson efforts meet a lack of device distribution. Resuscitation 2018; 126:e4-e5. [PMID: 29501397 DOI: 10.1016/j.resuscitation.2018.02.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 02/24/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Sebastian Schnaubelt
- Department of Emergency Medicine, Medical University of Vienna, Austria; Austrian Cardiac Arrest Awareness Association - PULS, Vienna, Austria
| | - Mario Krammel
- Austrian Cardiac Arrest Awareness Association - PULS, Vienna, Austria; Department of Anesthesiology, General Intensive Care and Pain Management, Medical University of Vienna, Austria; Municipal Ambulance Service of Vienna, Austria
| | - Raphael van Tulder
- Department of Emergency Medicine, Medical University of Vienna, Austria; Austrian Cardiac Arrest Awareness Association - PULS, Vienna, Austria
| | - Jakob Eichelter
- Austrian Cardiac Arrest Awareness Association - PULS, Vienna, Austria
| | | | | | - Patrick Sulzgruber
- Austrian Cardiac Arrest Awareness Association - PULS, Vienna, Austria; Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria.
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