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Gastric Bypass Surgeries in New Hampshire, 1996-2007
CDC - Preventing Chronic Disease: Volume 9, 2012: 11_0089 Page 1 of 6 ORIGINAL RESEARCH Gastric Bypass Surgeries in New Hampshire, 1996-2007 Sai S. Cherala, MD, MPH Suggested citation for this article: Cherala SS. Gastric bypass surgeries in New Hampshire, 1996-2007. Prev Chronic Dis 2012;9:110089. DOI: http://dx.doi.org/10.5888/pcd9.110089 . PEER REVIEWED Abstract Introduction Obesity is a national epidemic. Gastric bypass surgery may be the only option that provides significant long-term weight loss for people who are morbidly obese (body mass index [BMI] ≥40 kg/m2 ) or for people who have a BMI of 35 or higher and have an obesity-related comorbidity. The objective of this study was to assess trends in gastric bypass surgery in New Hampshire. Methods Data from 1996 to 2007 from the New Hampshire Inpatient Hospital Discharge data set were analyzed. Records for patients with a gastric bypass surgery code were identified, and data on patients and hospitalizations were collected. A joinpoint regression model was used to analyze trends in surgery rates. Differences between patients and payer types were analyzed by using the Cochran–Mantel–Haenszel χ2 test. Results The annual rate of gastric bypass surgery increased significantly from 3.3 to 22.4 per 100,000 adults between 1996 and 2007. The in-hospital death rate decreased significantly from 11% in 1996 to 1% in 2007. A greater proportion of women (78.1% during the study period) than men had this surgery. The average charge of a surgery decreased significantly from $44,484 in 1996 to $43,907 in 2007; by 2007, total annual charges were $13.9 million. -
Guidelines Before & After Roux-En-Y Gastric Bypass
University of Missouri Health System Missouri Bariatric Services Guidelines Before & After Roux-en-Y Gastric Bypass Table of Contents Topic Page Risks & Benefits of Weight Loss Surgery 3 Guidelines for Your Hospital Stay, Self-Care, & Medications 8 Day of Surgery Expectations 8 What to Expect During Your Hospital Stay 9 Taking Care of Yourself at Home 10 Nutrition Guidelines Before & After Weight Loss Surgery 14 Basic Nutrition Information all Patients Should Know 15 Guidelines for Success after Surgery 34 How to Prepare for Surgery 34 Portions after Weight Loss Surgery 35 Postoperative Dietary Goals 40 Diet Progression 42 Digestive Difficulties after Surgery 49 Understanding Vitamins & Minerals after Surgery 52 Tips for Dining out after Weight Loss Surgery 53 Food Record 55 Frequently Asked Questions 56 Weight Loss Surgery Patient Resources 57 Exercise Guidelines Before & After Weight Loss Surgery 58 Warm Up & Cool Down Stretches 63 Home Strength Training Program 66 Stretch Band Exercises 68 Psychological Considerations after Weight Loss Surgery 71 My Personal Relapse Plan 74 Problem Solving 75 Daily Food Record 76 Guidelines For Preconception & Prenatal Care after Surgery 77 2 | P a g e Risk and Benefits of Weight Loss Surgery All surgery, no matter how minor, carries some risk. Weight loss surgery is major surgery; you are put to sleep with a general anesthetic, carbon dioxide is blown into your abdominal cavity, and we work around the major organs and operate on the stomach and intestines (this area of the body is known as the gastrointestinal tract). National statistics report there is a one to two percent risk of dying after Roux-en-Y gastric bypass. -
The American Society of Colon and Rectal Surgeons' Clinical Practice
CLINICAL PRACTICE GUIDELINES The American Society of Colon and Rectal Surgeons’ Clinical Practice Guideline for the Evaluation and Management of Constipation Ian M. Paquette, M.D. • Madhulika Varma, M.D. • Charles Ternent, M.D. Genevieve Melton-Meaux, M.D. • Janice F. Rafferty, M.D. • Daniel Feingold, M.D. Scott R. Steele, M.D. he American Society of Colon and Rectal Surgeons for functional constipation include at least 2 of the fol- is dedicated to assuring high-quality patient care lowing symptoms during ≥25% of defecations: straining, Tby advancing the science, prevention, and manage- lumpy or hard stools, sensation of incomplete evacuation, ment of disorders and diseases of the colon, rectum, and sensation of anorectal obstruction or blockage, relying on anus. The Clinical Practice Guidelines Committee is com- manual maneuvers to promote defecation, and having less posed of Society members who are chosen because they than 3 unassisted bowel movements per week.7,8 These cri- XXX have demonstrated expertise in the specialty of colon and teria include constipation related to the 3 common sub- rectal surgery. This committee was created to lead inter- types: colonic inertia or slow transit constipation, normal national efforts in defining quality care for conditions re- transit constipation, and pelvic floor or defecation dys- lated to the colon, rectum, and anus. This is accompanied function. However, in reality, many patients demonstrate by developing Clinical Practice Guidelines based on the symptoms attributable to more than 1 constipation sub- best available evidence. These guidelines are inclusive and type and to constipation-predominant IBS, as well. The not prescriptive. -
Small Bowel Obstruction After Laparoscopic Roux-En-Y Gastric Bypass Presenting As Acute Pancreatitis: a Case Report
Netherlands Journal of Critical Care Submitted January 2018; Accepted April 2018 CASE REPORT Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass presenting as acute pancreatitis: a case report N. Henning1, R.K. Linskens2, E.E.M. Schepers-van der Sterren3, B. Speelberg1 Department of 1Intensive Care, 2Gastroenterology and Hepatology, and 3Surgery, Sint Anna Hospital, Geldrop, the Netherlands. Correspondence N. Henning - [email protected] Keywords - Roux-en-Y, gastric bypass, pancreatitis, pancreatic enzymes, small bowel obstruction, biliopancreatic limb obstruction. Abstract Small bowel obstruction is a common and potentially life-threatening bowel obstruction within this complication after laparoscopic Roux-en-Y gastric bypass surgery. population, because misdiagnosis We describe a 30-year-old woman who previously underwent can have disastrous outcomes.[1,3-5,7] gastric bypass surgery. She was admitted to the emergency In this report we describe the department with epigastric pain and elevated serum lipase levels. difficulty of diagnosing small Conservative treatment was started for acute pancreatitis, but she bowel obstruction in post- showed rapid clinical deterioration due to uncontrollable pain and LRYGB patients and why frequent excessive vomiting. An abdominal computed tomography elevated pancreatic enzymes scan revealed small bowel obstruction and surgeons performed can indicate an obstruction in an exploratory laparotomy with adhesiolysis. Our patient quickly these patients. The purpose of improved after surgery and could be discharged home. This case this manuscript is to emphasise report emphasises that in post-bypass patients with elevated Figure 1. Roux-en-Y gastric bypass that in post-bypass patients with pancreatic enzymes, small bowel obstruction should be considered ©Ethicon, Inc. -
OT Resource for K9 Overview of Surgical Procedures
OT Resource for K9 Overview of surgical procedures Prepared by: Hannah Woolley Stage Level 1 2 Gynecology/Oncology Surgeries Lymphadenectomy (lymph node dissection) Surgical removal of lymph nodes Radical: most/all of the lymph nodes in tumour area are removed Regional: some of the lymph nodes in the tumour area are removed Omentectomy Surgical procedure to remove the omentum (thin abdominal tissue that encases the stomach, large intestine and other abdominal organs) Indications for omenectomy: Ovarian cancer Sometimes performed in combination with TAH/BSO Posterior Pelvic Exenteration Surgical removal of rectum, anus, portion of the large intestine, ovaries, fallopian tubes and uterus (partial or total removal of the vagina may also be indicated) Indications for pelvic exenteration Gastrointestinal cancer (bowel, colon, rectal) Gynecological cancer (cervical, vaginal, ovarian, vulvar) Radical Cystectomy Surgical removal of the whole bladder and proximal lymph nodes In men, prostate gland is also removed In women, ovaries and uterus may also be removed Following surgery: Urostomy (directs urine through a stoma on the abdomen) Recto sigmoid pouch/Mainz II pouch (segment of the rectum and sigmoid colon used to provide anal urinary diversion) 3 Radical Vulvectomy Surgical removal of entire vulva (labia, clitoris, vestibule, introitus, urethral meatus, glands/ducts) and surrounding lymph nodes Indication for radical vulvectomy Treatment of vulvar cancer (most common) Sentinel Lymph Node Dissection (SLND) Exploratory procedure where the sentinel lymph node is removed and examined to determine if there is lymph node involvement in patients diagnosed with cancer (commonly breast cancer) Total abdominal hysterectomy/bilateral saplingo-oophorectomy (TAH/BSO) Surgical removal of the uterus (including cervix), both fallopian tubes and ovaries Indications for TAH/BSO: Uterine fibroids: benign growths in the muscle of the uterus Endometriosis: condition where uterine tissue grows on structures outside the uterus (i.e. -
Complications in Bariatric Surgery with Focus on Gastric Bypass
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 1676 Complications in bariatric surgery with focus on gastric bypass BJARNI VIDARSSON ACTA UNIVERSITATIS UPSALIENSIS ISSN 1651-6206 ISBN 978-91-513-0991-0 UPPSALA urn:nbn:se:uu:diva-417549 2020 Dissertation presented at Uppsala University to be publicly examined in H:son Holmdahlsalen, Entrance 100/101, Akademiska Sjukhuset, Uppsala, Friday, 9 October 2020 at 09:00 for the degree of Doctor of Philosophy (Faculty of Medicine). The examination will be conducted in Swedish. Faculty examiner: Associate Professor Jacob Freedman ( Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm). Abstract Vidarsson, B. 2020. Complications in bariatric surgery with focus on gastric bypass. Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 1676. 56 pp. Uppsala: Acta Universitatis Upsaliensis. ISBN 978-91-513-0991-0. Obesity is rising in pandemic proportions. At present, one third of the world’s population has become overweight or obese, and estimates predict 60% in 2030. Thus, the problem is gigantic. Obesity is associated with numerous diseases such as diabetes, high blood pressure, sleep apnea and cancer. Untreated obesity decreases life expectancy by about 10 years. Gastric bypass has been one of the cornerstones of surgical treatment. Since 1994 this is done by laparoscopic technique (LRYGB) In this thesis, we have primarily used data from our national quality register, the Scandinavian Obesity Surgical Registry (SOReg), on patients that have been operated with LRYGB. In the first paper, we evaluated the use of a novel suture for closing the gastrojejunostomy (upper anastomosis). Paper II and III focused on incidence, risk factors, treatment and outcome of anastomotic leaks. -
Clinical Policy: Bariatric Surgery Reference Number: NH
Clinical Policy: Bariatric Surgery Reference Number: NH. CP.MP.37 Coding Implications Effective Date: 06/09 Revision Log Last Review Date: 04/18 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. LAGB devices are currently not FDA approved for adolescents less than 18 years, but an industry- sponsored prospective study is in progress, and numerous retrospective studies of adolescents have been published with favorable results. Policy/Criteria It is the policy of NH Healthy Families that the bariatric surgery procedures LAGB, LSG, and laparoscopic RYGB for adolescents and adults and laparoscopic BPD-DS/BPD-GRDS for adults are medically necessary when meeting the following criteria under section I through III: I. Participating providers that are MBSAQIP (Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program for the American College of Surgeons) accredited have demonstrated a commitment to excellence in ethics, quality and patient care. -
Information for Patients Having a Sigmoid Colectomy
Patient information – Pre-operative Assessment Clinic Information for patients having a sigmoid colectomy This leaflet will explain what will happen when you come to the hospital for your operation. It is important that you understand what to expect and feel able to take an active role in your treatment. Your surgeon will have already discussed your treatment with you and will give advice about what to do when you get home. What is a sigmoid colectomy? This operation involves removing the sigmoid colon, which lies on the left side of your abdominal cavity (tummy). We would then normally join the remaining left colon to the top of the rectum (the ‘storage’ organ of the bowel). The lines on the attached diagram show the piece of bowel being removed. This operation is done with you asleep (general anaesthetic). The operation not only removes the bowel containing the tumour but also removes the draining lymph glands from this part of the bowel. This is sent to the pathologists who will then analyse each bit of the bowel and the lymph glands in detail under the microscope. This operation can often be completed in a ‘keyhole’ manner, which means less trauma to the abdominal muscles, as the biggest wound is the one to remove the bowel from the abdomen. Sometimes, this is not possible, in which case the same operation is done through a bigger incision in the abdominal wall – this is called an ‘open’ operation. It does take longer to recover with an open operation but, if it is necessary, it is the safest thing to do. -
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. -
Mucocele of the Appendix - Appendectomy Or Colectomy?
Original Article Mucocele of the appendix - appendectomy or colectomy? JANDUÍ GOMES DE ABREU FILHO1, ERIVALDO FERNANDES DE LIRA1 1Service of Coloproctology of Hospital de Base do Distrito Federal (HBDF), Secretariat of Health in Distrito Federal - Brasília (DF), Brazil. FILHO JGDA; LIRA EFD. Mucocele of the appendix - appendectomy or colectomy? Rev bras Coloproct, 2011;31(3): 276-284. ABSTRACT: Mucocele of the appendix is a rare disease. It can be triggered by benign or malignant diseases, which cause the obstruc- tion of the appendix and the consequent accumulation of mucus secretion. The preoperative diagnosis is difficult due to non-specific clinical manifestations of the disease. Imaging tests can suggest the diagnosis. The treatment is always surgical and depends on the integrity and size of the appendix base and on the histological type of the original lesion. The prognosis is good in cases of integrity of the appendix. The perforation of the appendix and subsequent extravasation of its contents into the abdominal cavity may lead to pseudomyxoma peritonei, which has very poor prognosis if not treated properly. Keywords: mucocele; appendix; pseudomyxoma peritonei; treatment. INTRODUCTION first one defends the right colectomy as a treatment9, and the second one recommends only appendecto- The mucocele of the appendix was first de- my10. Despite the different adopted conducts, in both scribed in 1842 by Rokitansky1. This disease is reported cases a cystadenoma was diagnosed in the considered as a rare lesion of the appendix, which appendix; the choice was for elective surgery. is found in 0.2 to 0.3% of the appendectomies2. It The objective of this review is to analyze liter- is characterized by the dilation of the organ lumen ature as to mucocele, especially regarding diagnosis with mucus accumulation, being more frequent and treatment, besides discussing follow-up and prog- among individuals aged 50 years or more3,4. -
The Utility of Diagnostic Laparoscopy in Post-Bariatric Surgery Patients with Chronic Abdominal Pain of Unknown Etiology
OBES SURG (2017) 27:1924–1928 DOI 10.1007/s11695-017-2590-0 ORIGINAL CONTRIBUTIONS The Utility of Diagnostic Laparoscopy in Post-Bariatric Surgery Patients with Chronic Abdominal Pain of Unknown Etiology Mohammad Alsulaimy1,2 & Suriya Punchai1,3 & Fouzeyah A. Ali4 & Matthew Kroh1 & Philip R. Schauer1 & Stacy A. Brethauer 1 & Ali Aminian1 Published online: 22 February 2017 # Springer Science+Business Media New York 2017 Abstract Overall, 15 patients (43%) had symptomatic improvement Purpose Chronic abdominal pain after bariatric surgery is as- after laparoscopy; 14 of these patients had positive laparo- sociated with diagnostic and therapeutic challenges. The aim scopic findings requiring intervention (70% of the patients of this study was to evaluate the yield of laparoscopy as a with positive laparoscopy). Conversely, 20 (57%) patients re- diagnostic and therapeutic tool in post-bariatric surgery pa- quired long-term medical treatment for management of chron- tients with chronic abdominal pain who had negative imaging ic abdominal pain. and endoscopic studies. Conclusion Diagnostic laparoscopy, which is a safe proce- Methods A retrospective analysis was performed on post- dure, can detect pathological findings in more than half of bariatric surgery patients who underwent laparoscopy for di- post-bariatric surgery patients with chronic abdominal pain agnosis and treatment of chronic abdominal pain at a single of unknown etiology. About 40% of patients who undergo academic center. Only patients with both negative preopera- diagnostic laparoscopy and 70% of patients with positive find- tive CT scan and upper endoscopy were included. ings on laparoscopy experience significant symptom improve- Results Total of 35 post-bariatric surgery patients met the in- ment. -
Direct Oral Anticoagulants Use in the Setting of Bariatric Surgery and Feeding Tubes Excellence.Acforum.Org
Rapid Resource Direct Oral Anticoagulants Use in the Setting of Bariatric Surgery and Feeding Tubes excellence.acforum.org ACE Rapid Resources are not informed practice guidelines; they are Anticoagulation Forum, Inc.’s best recommendations based on (DOACs) NOTES current knowledge, and no warranty or guaranty is expressed or implied. The content provided is for informational purposes for medical • DOACs are absorbed at various professionals only and is not intended to be used or relied upon by them as specific medical advice, diagnosis, or treatment, the locations throughout the determination of which remains the responsibility of the medical professionals for their patients. gastrointestinal tract. Bariatric Surgery (See Table 1) • Bariatric surgery results in weight FIGURE 1 – Types of Bariatric Surgery loss by reducing stomach volume (which results in a more alkaline pH) A B C D and/or reducing effective intestinal surface area which results in malabsorption. • There is very little evidence regarding safety and efficacy of DOACs in patients with a history of bariatric surgery or requiring DOAC administration via a feeding tube. A. Adjustable gastric banding (AGB): Adjustable silicone band placed around stomach to create a smaller pouch. • This document was compiled utilizing current literature incorporating case B. Roux-en-Y gastric bypass (RYGB): reports, package inserts, and Stomach stapled to form gastric pouch that connects to distal jejunum, excluding the duodenum and proximal jejunum. pharmacokinetic studies as no current C. Gastrectomy (partial or total): randomized controlled trials are Sleeve gastrectomy results in longitudinal resection of 80% of stomach. available. As always, clinical judgment D. Biliopancreatic diversion with duodenal switch (BPD-DS): and a shared decision making Gastric pouch reattached more distally to terminal ileum resulting in considerable reduction in absorptive surface approach should be utilized.