DOCSLIB.ORG

Fundoplication in the Management of Hiatal Hernia And

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Fundoplication in the Management of Hiatal Hernia And Surgery for Obesity and Related Diseases 11 (2015) e19–e20 Online case report Modification of Belsey (Mark IV) fundoplication in the management of hiatal hernia and gastroesophageal reflux disease after sleeve gastrectomy: a case report Wei-Tao Liang, MDa,b, Ji-Min Wu, MDa,*, Zhong-Gao Wang, MDa,b aCenter for GERD, The Second Artillery General Hospital of Chinese People’s Liberation Army, Beijing, P.R. China bDepartment of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China Received November 7, 2014; accepted November 23, 2014 Keywords: Laparoscopic sleeve gastrectomy; Belsey Mark IV; Gastroesophageal reflux disease; Hiatal hernia Gastroesophageal reflux disease (GERD) is a condition manometry demonstrated a hypotensive lower esophageal seen commonly in the bariatric surgery population. sphincter (LES, pressure, 4.0 mm Hg) with normal relax- Although some operations, such as Roux-en-Y gastric ation and normal peristalsis of the esophageal body. bypass, are known to be associated with a reduced After the patient was referred to our center for GERD, a incidence of reflux postoperatively, the prevalence of modified laparoscopic Belsey (Mark IV) fundoplication GERD after laparoscopic sleeve gastrectomy (LSG) may with hiatal hernia repair was performed. The patient was be increased by 2.1% 34.9% [1]. In addition, it is still endotracheally intubated in the supine position using 5 controversial for the treatment of medication-refractory laparoscopic ports under general anesthesia. After dissect- GERD after LSG. Here, we report the surgical management ing the gastrohepatic ligament with harmonic scalpel, a of a patient, suffering from acid reflux, heartburn, and widow was created behind the lower esophagus. Then, the vomiting, with a modified laparoscopic Belsey (Mark IV) diaphragmatic crura were dissected carefully, and the distal fundoplication 2 years after a successful LSG operative for esophagus was mobilized about 5 cm while the mediastinal obesity. structures, including pleura, pericardium, vagus nerves and aorta, were identified and preserved. The size of hernia Case presentation defect was measured as approximate 4cm, and then secured with 2 interrupted 2-0 nonabsorbable sutures. A 60-year-old woman with a history of obesity had Because of stapling too close to the angle of His in the undergone LSG at another hospital 4 years ago. The surgery previous LSG, the remnant of gastric fundus could not be provided good control of weight and resulted in a 40-kg utilized for fundoplication. After dissecting the adhesions weight loss. She did well until one year before referral, from the previous operation, one horizontal mattress 2-0 when she began to experience symptoms of acid reflux, nonabsorbable suture was secured between the left wall of heartburn, and vomiting, which severely limited the quality esophagus and the wall of gastric fundus for reconstructing of her life. The hiatal hernia and esophagitis were diagnosed the angle of His. Afterwards, 5 horizontal mattress sutures by esophagogastroduodenoscopy, and esophageal were placed 1.5–2 cm from the esophagogastric junction between stomach and esophagus to create a nearly 2001 * Correspondence: Center for GERD, The Second Artillery General wrap, and the second row of sutures was placed 1–1.5 cm Hospital of Chinese People’s Liberation Army, No. 16 Xinjiekouwai Street, Xicheng District, Beijing 100088. China. Phone: þ86 010- proximally so as to include the diaphragm. A bougie was 62015718. Fax: þ86 010-62015718. not necessary for this anterior and partial fundoplication E-mail: [email protected] surgery if the diaphragmatic hiatus after repairing was not http://dx.doi.org/10.1016/j.soard.2014.11.020 1550-7289/r 2015 American Society for Metabolic and Bariatric Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/). e20 W. -T. Liang et al. / Surgery for Obesity and Related Diseases 11 (2015) e19–e20 smaller than normal. Finally, the ports were removed under are needed to definitely assess the value of a modified direct vision, and the abdomen was desufflated. laparoscopic Belsey (Mark IV) fundoplication in GERD The patient was discharged on the 7th postoperative day patients after LSG. tolerating a liquid diet without reflux or dysphagia. Two year later, she is still well and does not have dysphagia or Conclusion any other symptoms of GERD. A modified laparoscopic Belsey (Mark IV) fundoplica- Discussion tion for medication-refractory GERD appears to be a feasible and efficacious approach. It is a successful treat- Laparoscopic sleeve gastrectomy has become a standard ment option for the GERD patients with good control of bariatric surgical procedure [2]. Although it has an accept- weight after LSG. able complication profile and amount of weight loss, one of the most distressing complications to the patient is reflux Disclosures postoperatively. It is reported that hiatal hernia repair concurrently with LSG could result in a 47.5% decrease The authors have no commercial associations that might in GERD prevalence postoperative at 12 months if one is be a conflict of interest in relation to this article. detected intraoperatively [3]. However, it is controversial for the treatment of patients with medication-refractory Appendix GERD after LSG, especially for these patients with hiatal hernia. Supplementary data Although laparoscopic Nissen fundoplication with hiatal hernia repair is thought to be a gold standard of antireflux Supplementary data cited in this article is available online procedure [4], the remnant of fundus can not be used for at http://dx.doi.org/10.1016/j.hrthm.2014.12.023. fundoplication in these patients after LSG. The transthoracic Belsey (Mark IV) operation has been used for management of hiatal hernia for over 40 years [5]. Based on the basic References technique, a modified Belsey (Mark IV) fundoplication with hiatal hernia repair was performed under laparoscopy in this [1] Laffin M, Chau J, Gill RS, Birch DW, Karmali S. Sleeve gastrectomy patient after LSG. It provides a partial fundoplication on the and gastroesophageal reflux disease. J Obes 2013;2013:741097. anterior of esophagus with using the anterior gastric wall. [2] Gibson SC, Le Page PA, Taylor CJ. Laparoscopic sleeve gastrectomy: Kotak et al. [6] reported that primary hiatal hernia review of 500 cases in single surgeon Australian practice. ANZ J Surg. repairing in GERD patients after LSG was a well- Epub 2013 Dec 5. [3] Daes J, Jimenez ME, Said N, Daza JC, Dennis R. Laparoscopic sleeve tolerated and effective operation. Clapp [7] also reported gastrectomy: symptoms of gastroesophageal reflux can be reduced by that the use of a prosthetic bioabsorbable mesh to repair a changes in surgical technique. Obes Surg 2012;22:1874–9. hiatal hernia could be a more effective operation after LSG. [4] Ielpo B, Martin P, Vazquez R, et al. Long-term results of laparoscopic Comparing with primary hiatal hernia repairing with or Nissen fundoplication with or without short gastric vessels division. – without using mesh, however, fundoplication with hiatal Surg Laparosc Endosc Percutan Tech 2011;21:267 70. [5] Markakis C, Tomos P, Spartalis ED, et al. The Belsey Mark IV: an hernia repair would provide a better and long-term control operation with an enduring role in the management of complicated of reflux in GERD patients after LSG. Although Roux-en-Y hiatal hernia. BMC Surg 2013;24. gastric bypass (RYGB) is a feasible and efficacious treat- [6] Kotak R, Murr M. Recurrent hiatal hernia repair after sleeve gastrectomy. ment option for GERD patients after LSG [8], it is optimal Surg Obes Relat Dis 2013;9:1027–8. [7] Clapp B. Prosthetic bioabsorbable mesh for hiatal hernia repair during for the GERD patient with weight regain after LSG. – fi fi sleeve gastrectomy. JSLS 2013;17:641 4. It is the rst time to perform a modi ed Belsey (Mark IV) [8] Abdemur A, Fendrich I, Rosenthal R. Laparoscopic conversion of operation under laparoscopy in patients after LSG. There- laparoscopic sleeve gastrectomy to gastric bypass for intractable fore, large scale, long-term follow-up and randomized trials gastroesophageal reflux disease. Surg Obes Relat Dis 2012;8:654..
Load more

Recommended publications
  • First Case Report and Surgery in South America
    Laparoscopic re-sleeve gastrectomy for weight regain after modified laparoscopic sleeve gastrectomy: first case report and surgery in South America The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation PIROLLA, Eduardo Henrique, Felipe Piccarone Gonçalves RIBEIRO, and Fernanda Junqueira Cesar PIROLLA. 2016. “Laparoscopic re- sleeve gastrectomy for weight regain after modified laparoscopic sleeve gastrectomy: first case report and surgery in South America.” Arquivos Brasileiros de Cirurgia Digestiva : ABCD 29 (Suppl 1): 135-136. doi:10.1590/0102-6720201600S10033. http:// dx.doi.org/10.1590/0102-6720201600S10033. Published Version doi:10.1590/0102-6720201600S10033 Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:29408237 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#LAA LETTER TO THE EDITOR and was fired on the NG tube while creating the sleeve ABCDDV/1223 (Figure 2). But the most important part was to check, how ABCD Arq Bras Cir Dig Letter to the Editor the NG tube reached the stomach during the stapling? 2016;29(Supl.1):135-136 We have a protocol of inserting a NG tube at the time DOI: /10.1590/0102-6720201600S10033 of induction of anaesthesia to decompress the stomach which is taken out completely after all the ports are inserted and check laparoscopy done. Unfortunately on that day LAPAROSCOPIC RE-SLEEVE the anaesthetist had withdrawn the NG tube partially and kept it hanging in the oesophagus for a probable later GASTRECTOMY FOR WEIGHT use.
    [Show full text]
  • Thoracoscopic Truncal Vagotomy Versus Surgical Revision of the Gastrojejunal Anastomosis for Recalcitrant Marginal Ulcers
    Surgical Endoscopy (2019) 33:607–611 and Other Interventional Techniques https://doi.org/10.1007/s00464-018-6386-7 2018 SAGES ORAL DYNAMIC Thoracoscopic truncal vagotomy versus surgical revision of the gastrojejunal anastomosis for recalcitrant marginal ulcers Alicia Bonanno1 · Brandon Tieu2 · Elizabeth Dewey1 · Farah Husain3 Received: 1 May 2018 / Accepted: 10 August 2018 / Published online: 21 August 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Introduction Marginal ulcer is a common complication following Roux-en-Y gastric bypass with incidence rates between 1 and 16%. Most marginal ulcers resolve with medical management and lifestyle changes, but in the rare case of a non-healing marginal ulcer there are few treatment options. Revision of the gastrojejunal (GJ) anastomosis carries significant morbidity with complication rates ranging from 10 to 50%. Thoracoscopic truncal vagotomy (TTV) may be a safer alternative with decreased operative times. The purpose of this study is to evaluate the safety and effectiveness of TTV in comparison to GJ revision for treatment of recalcitrant marginal ulcers. Methods A retrospective chart review of patients who required surgical intervention for non-healing marginal ulcers was performed from 1 September 2012 to 1 September 2017. All underwent medical therapy along with lifestyle changes prior to intervention and had preoperative EGD that demonstrated a recalcitrant marginal ulcer. Revision of the GJ anastomosis or TTV was performed. Data collected included operative time, ulcer recurrence, morbidity rate, and mortality rate. Results Twenty patients were identified who underwent either GJ revision (n = 13) or TTV (n = 7). There were no 30-day mortalities in either group.
    [Show full text]
  • Laparoscopic Vertical Sleeve Gastrectomy Information
    1441 Constitution Boulevard, Salinas, CA 93906 (831) 783-2556 | www.natividad.com/weight-loss Laparoscopic Vertical Sleeve Gastrectomy Information What is gastric bypass surgery? Vertical sleeve gastrectomy, a type of bariatric surgery (weight loss surgery), is a surgical procedure that alters the process of digestion. Bariatric surgery is the only option today that effectively treats morbid obesity in people for whom more conservative measures such as diet, exercise, and medication have failed. The vertical sleeve gastrectomy involves stapling the stomach to create a small tubular pouch (about the size of a banana) that serves as the “new” stomach, then surgically removing the larger part of the stomach. This is referred to as a restrictive procedure because the size of the stomach is reduced so that the amount of food that can be eaten is “restricted” due to the smaller stomach. There is less risk for nutritional deficiencies with this procedure than with gastric bypass surgery. Vertical Sleeve Gastrectomy (VSG) VSG is a solely restrictive bariatric procedure. This surgery can result in three- quarters of extra weight loss within three years. The procedure involves stapling the stomach to create a small tube that holds less food than the full size stomach. This laparoscopic procedure uses several small incisions and three or more laparoscopes - small thin tubes with video cameras attached - to visualize the inside of the abdomen during the operation. The surgeon performs the surgery while looking at a TV monitor. Persons with a Body Mass Index (BMI) of 55 or more or those who have already had some type of abdominal surgery are usually not considered for this technique.
    [Show full text]
  • Effects of Sleeve Gastrectomy Plus Trunk Vagotomy Compared with Sleeve Gastrectomy on Glucose Metabolism in Diabetic Rats
    Submit a Manuscript: http://www.f6publishing.com World J Gastroenterol 2017 May 14; 23(18): 3269-3278 DOI: 10.3748/wjg.v23.i18.3269 ISSN 1007-9327 (print) ISSN 2219-2840 (online) ORIGINAL ARTICLE Basic Study Effects of sleeve gastrectomy plus trunk vagotomy compared with sleeve gastrectomy on glucose metabolism in diabetic rats Teng Liu, Ming-Wei Zhong, Yi Liu, Xin Huang, Yu-Gang Cheng, Ke-Xin Wang, Shao-Zhuang Liu, San-Yuan Hu Teng Liu, Ming-Wei Zhong, Xin Huang, Yu-Gang Cheng, reviewers. It is distributed in accordance with the Creative Ke-Xin Wang, Shao-Zhuang Liu, San-Yuan Hu, Department Commons Attribution Non Commercial (CC BY-NC 4.0) license, of General Surgery, Qilu Hospital of Shandong University, Jinan which permits others to distribute, remix, adapt, build upon this 250012, Shandong Province, China work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and Yi Liu, Health and Family Planning Commission of Shandong the use is non-commercial. See: http://creativecommons.org/ Provincial Medical Guidance Center, Jinan 250012, Shandong licenses/by-nc/4.0/ Province, China Manuscript source: Unsolicited manuscript Author contributions: Liu T, Liu SZ and Hu SY designed the study and wrote the manuscript; Liu T and Zhong MW instructed Correspondence to: San-Yuan Hu, Professor, Department of on the whole study and prepared the figures; Liu Y and Wang KX General Surgery, Qilu Hospital of Shandong University, No. 107, collected and analyzed the data; Liu T, Huang X and Cheng YG Wenhua Xi Road, Jinan 250012, Shandong Province, performed the operations and performed the observational study; China.
    [Show full text]
  • Laparoscopic Nissen Fundoplication Description
    OhioHealth Mansfield Laparoscopic Nissen Fundoplication Laparoscopic Nissen Fundoplication is a surgical procedure intended to cure Esophagus gastroesophageal reflux disease (GERD). Reflux disease is a disorder of the lower esophageal sphincter (the circular muscle at the base of the esophagus that serves as a barrier between the esophagus and stomach). When the LES malfunctions, acidic stomach contents are able to inappropriately reflux into the esophagus causing undesirable symptoms. The laparoscopic Nissen Esophageal Fundoplication involves wrapping a small portion of the stomach around the sphincter junction between the esophagus and stomach to augment the function of the Tightened LES. The operation effectively cures GERD with recurrence rates ranging from hiatus 5-10 percent over the life of the patient. Patients who experience a recurrence can be treated medically or undergo a redo laparoscopic Nissen Fundoplication. The most common postoperative side effect of a laparoscopic Nissen Fundoplication is gas bloating. A small percentage of patients (10-20 percent) will not be able to belch or vomit after surgery. Some patients may experience temporary difficult swallowing after surgery. Some patients may experience intermittent episodes of “dumping syndrome” due to Vagus nerve irritation or Top of stomach being excessive acid production in the stomach. wrapped around esophagus Patients are typically on a modified diet for a few weeks after surgery to allow time for healing of the surgical repair and recovery of the function of the esophagus and stomach. Top of stomach fully wrapped around esophagus and sutured Nissen fundoplication © OhioHealth Inc. 2018. All rights reserved. Laparoscopic. 05/18..
    [Show full text]
  • Adjustable Gastric Banding
    7 Review Article Page 1 of 7 Adjustable gastric banding Emre Gundogdu, Munevver Moran Department of Surgery, Medical School, Istinye University, Istanbul, Turkey Contributions: (I) Conception and design: All authors; (II) Administrative support: All authors; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Emre Gündoğdu, MD, FEBS. Assistant Professor of Surgery, Department of Surgery, Medical School, Istinye University, Istanbul, Turkey. Email: [email protected]; [email protected]. Abstract: Gastric banding is based on the principle of forming a small volume pouch near the stomach by wrapping the fundus with various synthetic grafts. The main purpose is to limit oral intake. Due to the fact that it is a reversible surgery, ease of application and early results, the adjustable gastric band (AGB) operation has become common practice for the last 20 years. Many studies have shown that the effectiveness of LAGB has comparable results with other procedures in providing weight loss. Early studies have shown that short term complications after LAGB are particularly low when compared to the other complicated procedures. Even compared to RYGB and LSG, short-term results of LAGB have been shown to be significantly superior. However, as long-term results began to emerge, such as failure in weight loss, increased weight regain and long-term complication rates, interest in the procedure disappeared. The rate of revisional operations after LAGB is rapidly increasing today and many surgeons prefer to convert it to another bariatric procedure, such as RYGB or LSG, for revision surgery in patients with band removed after LAGB.
    [Show full text]
  • Assessment of the Correlation Between Gastric Morphology, Gastric Emptying, Post Prandial GLP-1 Response, and Hunger Scores Following Longitudinal Sleeve Gastrectomy
    Assessment of the correlation between gastric morphology, gastric emptying, post prandial GLP-1 response, and hunger scores following longitudinal sleeve gastrectomy Summary: Longitudinal sleeve gastrectomy (LSG) is the most commonly performed bariatric operation. While the physiological mechanism by which LSG causes weight loss is unclear, early investigations indicate LSG causes augmention in the flow of nutrients through the stomach. Our preliminary investigations lead us to believe LSG accelerates gastric emptying, which augments the postprandial secretion of midgut hormones, such as glucagon like peptide-1 (GLP-1), and satiety. We hypothesize the extent to which LSG induces this physiologic effect can be predicted by the morphology of the stomach following resection. We propose to directly test the impact of post surgical gastric morphology on gastric emptying, Glp-1 levels, and hunger/satiety, with the following specific aims: 1) Use dynamic MRI to measure stomach morphology 2) Use dynamic MRI to assess the kinetic rate of gastric emptying, the rate and amplitude of antral contraction, and presence of akinesis/hypokinesis of any segment of the gastric wall 3) Assess levels of Glp-1 in response to a mixed meal challenge 4) Assess hunger in response to a mixed meal challenge using a visual analog scale We propose to study the above before and three months following LSG. Our hope is that the knowledge gained will allow for a) refinement of the technique of LSG to improve weight loss and/or decrease complications, b) development of novel and less invasive interventions that mimic the physiologic effect of LSG, and c) exploration of LSG as a treatment for gastroparesis.
    [Show full text]
  • Clinical Policy: Bariatric Surgery
    Clinical Policy: Bariatric Surgery Reference Number: WA.CP.MP.37 Coding Implications Last Review Date: 06/21 Revision Log Effective Date: 08/01/2021 See Important Reminder at the end of this policy for important regulatory and legal information. Description There are two categories of bariatric surgery: restrictive procedures and malabsorptive procedures. Gastric restrictive procedures include procedures where a small pouch is created in the stomach to restrict the amount of food that can be eaten, resulting in weight loss. The laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) are examples of restrictive procedures. Malabsorptive procedures bypass portions of the stomach and intestines causing incomplete digestion and absorption of food. Duodenal switch is an example of a malabsorptive procedure. Roux-en-y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD-DS), and biliopancreatic diversion with gastric reduction duodenal switch (BPD-GRDS) are examples of restrictive and malabsorptive procedures. Policy/Criteria It is the policy of Coordinated Care of Washington, Inc., in accordance with WAC 182-531-1600, that the only covered bariatric surgery for patients age >= 18 and < 21 years, is laparoscopic sleeve gastrectomy. It is the policy of Coordinated Care of Washington, Inc., in accordance with the Health Care Authority’s Health Technology Assessment, that bariatric surgery is covered only if the service is provided by a facility that is accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). Coordinated Care may authorize up to 34 units of a bariatric case management service as part of the Stage II bariatric surgery approval.
    [Show full text]
  • Nasogastric Tube, Temperature Probe, and Bougie Stapling During Bariatric
    Surgery for Obesity and Related Diseases 8 (2012) 595–601 Original article Nasogastric tube, temperature probe, and bougie stapling during bariatric surgery: a multicenter survey Samir Abu-Gazala, M.D.a,*, Yoel Donchin, M.D.b, Andrei Keidar, M.D.a aDepartment of Surgery, Hadassah, Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel bDepartment of Anesthesia and Intensive Care, Hadassah, Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel Received March 1, 2011; accepted August 17, 2011 Abstract Background: An adverse event in laparoscopic bariatric surgery that has not received much scrutiny involves tube/probe stapling or suturing during gastrectomy or gastroenterostomy. Methods: A retrospective analysis was performed using a questionnaire sent to all bariatric surgeons (n ϭ 43) in Israel. Results: Eight surgeons reported on 17 cases in which intraoperative nasogastric/orogastric tube (n ϭ 8), temperature probe (n ϭ 6), or bougie stapling (n ϭ 3) was identified. Laparoscopic sleeve gastrectomy was performed in 14 patients and laparoscopic gastric bypass in 3 patients. The patient demographics, operative details, and postoperative results are reported. Conclusion: Tube/probe complications can occur during laparoscopic bariatric surgery but are seldom reported. However, they can be associated with significant morbidity. The treatment options are dependent on the situation. More importantly, prevention strategies must include constant communication with the anesthesiologist and removal or relocation of a tube before stapling or suturing. (Surg Obes Relat Dis 2012;8:595–601.) © 2012 American Society for Metabolic and Bariatric Surgery. All rights reserved. Keywords: Nasogastric tube; Bougie; Thermometer probe; Bariatric surgery; Endoscopic stapler The use of bariatric surgery has been increasing at a rapid Laparoscopic sleeve (vertical) gastrectomy (LSG) was rate during the past decade.
    [Show full text]
  • Nissen Fundoplication & Hiatal Hernia Repairs
    Post-Operative Instructions Laparoscopic Nissen Fundoplication (or Hiatal Hernia Repair) Description of the Operation We will be doing a laparoscopic Nissen (or Toupet) fundoplication for you. Any hiatal hernia will also be repaired at the time of surgery. A fundoplication involves wrapping a portion of your stomach around your esophagus. This creates a valve-like mechanism to stop reflux of stomach juices into your esophagus (and to prevent a hiatal hernia from recurring). We’ll close your skin with tiny pieces of tape or transparent glue. Be prepared to spend one night in the hospital, although you might not need to, depending on how you feel after surgery. Your Recovery Vigorous straining (or prolonged vomiting) too soon after surgery can damage your diaphragm muscle before the stitches in it have had a chance to heal. This can cause your stomach to move out of position (a hiatal hernia) and the operation to fail or even require re-operation. Almost everybody experiences constant, dull chest, neck or shoulder discomfort when waking up from surgery. It usually fades within a day or two, sometimes longer. Because your operation will be performed laparoscopically, your discomfort will probably resolve before your diaphragm has finished healing. You should avoid heavy-lifting and any activity that causes you to strain and “get red in the face” for at least a month to let the diaphragm heal. You should be able to return to work or usual activities (except for the heavy-lifting) within a few days to a few weeks, depending on the activities. You may resume showering the day after surgery.
    [Show full text]
  • Sleeve Gastrectomy Rapidly Enhances Islet Function Independently of Body Weight
    Sleeve gastrectomy rapidly enhances islet function independently of body weight Jonathan D. Douros, … , Jonathan Campbell, David D’Alessio JCI Insight. 2019;4(6):e126688. https://doi.org/10.1172/jci.insight.126688. Research Article Endocrinology Metabolism Bariatric surgeries including vertical sleeve gastrectomy (VSG) ameliorate obesity and diabetes. Weight loss and accompanying increases to insulin sensitivity contribute to improved glycemia after surgery; however, studies in humans also suggest weight-independent actions of bariatric procedures to lower blood glucose, possibly by improving insulin secretion. To evaluate this hypothesis, we compared VSG-operated mice with pair-fed, sham-surgical controls (PF-Sham) 2 weeks after surgery. This paradigm yielded similar postoperative body weight and insulin sensitivity between VSG and calorically restricted PF-Sham animals. However, VSG improved glucose tolerance and markedly enhanced insulin secretion during oral nutrient and i.p. glucose challenges compared with controls. Islets from VSG mice displayed a unique transcriptional signature enriched for genes involved in Ca2+ signaling and insulin secretion pathways. This finding suggests that bariatric surgery leads to intrinsic changes within the islet that alter function. Indeed, islets isolated from VSG mice had increased glucose-stimulated insulin secretion and a left-shifted glucose sensitivity curve compared with islets from PF-Sham mice. Isolated islets from VSG animals showed corresponding increases in the pulse duration of glucose-stimulated Ca2+ oscillations. Together, these findings demonstrate a weight-independent improvement in glycemic control following VSG, which is, in part, driven by improved insulin secretion and associated with substantial changes in islet gene expression. These results support a model in which β cells play a key role in the adaptation […] Find the latest version: https://jci.me/126688/pdf RESEARCH ARTICLE Sleeve gastrectomy rapidly enhances islet function independently of body weight Jonathan D.
    [Show full text]
  • Gastroparesis and Dumping Syndrome: Current Concepts and Management
    Journal of Clinical Medicine Review Gastroparesis and Dumping Syndrome: Current Concepts and Management Stephan R. Vavricka 1,2,* and Thomas Greuter 2 1 Center of Gastroenterology and Hepatology, CH-8048 Zurich, Switzerland 2 Department of Gastroenterology and Hepatology, University Hospital Zurich, CH-8091 Zurich, Switzerland * Correspondence: [email protected] Received: 21 June 2019; Accepted: 23 July 2019; Published: 29 July 2019 Abstract: Gastroparesis and dumping syndrome both evolve from a disturbed gastric emptying mechanism. Although gastroparesis results from delayed gastric emptying and dumping syndrome from accelerated emptying of the stomach, the two entities share several similarities among which are an underestimated prevalence, considerable impairment of quality of life, the need for a multidisciplinary team setting, and a step-up treatment approach. In the following review, we will present an overview of the most important clinical aspects of gastroparesis and dumping syndrome including epidemiology, pathophysiology, presentation, and diagnostics. Finally, we highlight promising therapeutic options that might be available in the future. Keywords: gastroparesis; dumping syndrome; pathophysiology; clinical presentation; treatment 1. Introduction Gastroparesis and dumping syndrome both evolve from a disturbed gastric emptying mechanism. While gastroparesis results from significantly delayed gastric emptying, dumping syndrome is a consequence of increased flux of food into the small bowel [1,2]. The two entities share several important similarities: (i) gastroparesis and dumping syndrome are frequent, but also frequently overlooked; (ii) they affect patient’s quality of life considerably due to possibly debilitating symptoms; (iii) patients should be taken care of within a multidisciplinary team setting; and (iv) treatment should follow a step-up approach from dietary modifications and patient education to pharmacological interventions and, finally, surgical procedures and/or enteral feeding.
    [Show full text]