DOCSLIB.ORG

Overview of Gastric Bypass Surgery 4 5 Q1 Elroy Patrick Weledji *

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Overview of Gastric Bypass Surgery 4 5 Q1 Elroy Patrick Weledji * ARTICLE IN PRESS International Journal of Surgery Open ■■ (2016) ■■–■■ Contents lists available at ScienceDirect International Journal of Surgery Open journal homepage: www.elsevier.com/locate/ijso 1 Review Article 2 3 Overview of gastric bypass surgery 4 5 Q1 Elroy Patrick Weledji * 6 Department of Surgery, Faculty of Health Sciences, University of Buea, Cameroon 7 8 9 ARTICLE INFO ABSTRACT 10 1211 Article history: Gastric bypass surgery is indicated for several clinical reasons including benign and malignant upper gas- 1413 Received 7 June 2016 trointestinal tract pathologies. Any gastric resection or bypass procedure interferes with gastric emptying 1615 Received in revised form 17 September and the aim of reconstruction is to minimize the disturbance to the upper gastrointestinal physiology. 17 2016 18 Gastric bypass procedures induce early satiety, with or without concomitant impaired absorption of nu- 19 Accepted 19 September 2016 20 trients, and offer the best solution for morbid obesity. The long-term health benefits of gastric bypass 21 Available online 22 surgery for morbid obesity must be found to outweigh the operative risks and side-effects of gastric bypass 23 24 and thus patient selection is fundamental. The aim of the study was to review the indications, compli- 25 Keywords: 2726 Gastric bypass cations, sequelae and outcome of gastric bypass procedures. 2928 Indications © 2016 Published by Elsevier Ltd on behalf of Surgical Associates Ltd. This is an open access article 3130 Complications under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). 32 Sequelae 33 34 1. Introduction 2. Gastrojejunostomy 65 35 66 36 The history of gastric bypass surgery began in 1880 when the By diverting gastric acid away from the duodenum, anastomo- 67 37 Polish surgeon Ludwik Rydygier performed a gastroenterostomy for sis of the stomach to a loop of jejunum was once used to treat 68 38 peptic ulcer disease [1]. In 1885, the Austrian surgeon Theodor duodenal ulcer but carried a high recurrence (50%) rate [12]. Gas- 69 39 Billroth (Fig. 1) performed a first-stage gastrojejunostomy to alle- trojejunostomy was then used as a drainage procedure following 70 40 viate the symptoms of an obstructing large pyloric tumour followed truncal vagotomy for peptic ulcer disease but has fallen into disuse 71 41 by a second-stage resection of the tumour with restoration of gas- since the advent of effective medical treatment to suppress gastric 72 42 troduodenal continuity [1,2]. Most modern forms of gastrectomy with acid output and antral helicobacter pylori invasion [13,14]. Lapa- 73 43 gastrojejunal anastomosis (Billroth II) are modelled on this oper- roscopic gastrojejunostomy (LGJ) has been proposed as the technique 74 44 ation and described for the treatment of peptic ulcer disease in 1911 preferred over open gastrojejunostomy for relieving gastric outlet 75 45 [2–4]. With the success of antral Helicobacter pylori eradication triple obstruction (GOO) due to malignant and benign disease with im- 76 46 therapy for peptic ulcer disease which includes antibiotics and a re- proved outcome and an acceptable complication rate [15]. 77 47 versible chemical vagotomy with H2 receptor antagonist or proton Gastrojejunostomy would also bypass congenital pre-ampullary du- 78 48 pump inhibitor, surgery is now indicated only for the emergency odenal obstruction from a duodenal web/atresia/stenosis and an 79 49 complications of perforation, severe vomiting from pyloric steno- annular pancreas, with no or minimal early or long term compli- 80 50 sis and haemorrhage [5]. It was also well recognized that Billroth cations including malnutrition [16]. Although resection of a primary 81 51 II (partial) gastrectomy is associated with weight loss and several gastric tumour provides better palliation than bypass surgery pro- 82 52 variations of this procedure have been used effectively in the sur- vided the patient’s general health will allow this, patients with 83 53 gical treatment of morbid obesity with benefit lasting for up to 10 unresectable distal gastric tumours may benefit from a high antecolic 84 54 years [4,6–11]. The restriction of volume of ingested food togeth- gastrojejunostomy [17–19]. The control of the rate of delivery of the 85 55 er with altered absorption of nutrients, especially fat contributes gastric contents to the small intestine that allows adequate mixing 86 56 to achieving the weight loss and the malabsorptive procedures alter with bile and pancreatic juices and avoids overwhelming the di- 87 57 the digestive process in different ways [8–11]. The aim of this review gestive and absorptive capacity of the small intestine requires an 88 58 was to evaluate the common gastric bypass procedures with regard intact and innervated pylorus. The importance of attempting to pre- 89 59 to their indications, sequelae and outcome. serve normal gastric emptying in gastric bypass procedures without 90 compromising oncological results is seen with the more physio- 91 60 logical post-operative digestive function of the pylorus – preserving 92 partial pancreaticoduodenectomy for pancreatic head cancer than 93 61 with the partial stomach resection of the classical Kausch–Whipple 94 62 Q2 * Department of Surgery, Faculty of Health Sciences, University of Buea, PO Box 126, 63 Limbe, S. W. Region, Cameroon. procedure [20]. The Whipple’s procedure is also occasionally indi- 95 64 E-mail address: [email protected]. cated in cases of duodenal or pancreatic head trauma. Following a 96 http://dx.doi.org/10.1016/j.ijso.2016.09.004 2405-8572/© 2016 Published by Elsevier Ltd on behalf of Surgical Associates Ltd. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/). Please cite this article in press as: Elroy Patrick Weledji, Overview of gastric bypass surgery, International Journal of Surgery Open (2016), doi: 10.1016/j.ijso.2016.09.004 ARTICLE IN PRESS 2 E.P. Weledji / International Journal of Surgery Open ■■ (2016) ■■–■■ tomy) (Fig. 1) [2–4]. The Polya gastrectomy with retrocolic end-to- 145 side gastrojejunostomy has become a commonly performed 146 modification of the Billroth II procedure [2]. Franz von Hofmeister 147 described a partial gastrectomy with a retrocolic gastrojejunos- 148 tomy involving the greater curvature [2,28]. Reconstruction following 149 partial gastrectomy may be simple or difficult depending partly on 150 the build of the patient and partly on the extent and nature of the 151 disease process. Thus Billroth II gastrectomy is usually used for an 152 emergency perforated large duodenal ulcer not suitable for simple 153 omental patch closure and when a duodenal anastomosis (Billroth 154 1) cannot easily be made [29]. A Billroth I gastrectomy is not a bypass 155 procedure and is suitable for a resistant benign gastric ulcer after 156 excluding malignancy [14,27]. The Billroth II is associated with prob- 157 lems of bile reflux into the gastric remnant and oesophagus, and a 158 higher risk of stomal ulceration. Thus, approximately two-thirds of 159 stomach should be resected to avoid repeated antral exposure to 160 bile [6,14]. For the theoretical benefits of delaying gastric emptying 161 97Q10 Q13 Fig. 1. Diagram of Billroth II gastrectomy. and preventing reflux of duodenal contents into the stomach, a 162 98 Hofmeister ‘valve’ can often be fashioned by reducing the stoma length 163 to around 5 cm through closing part of the opening in the gastric 164 99 retroperitoneal duodenal injury, options for duodenal repair may stump and the rest being used for the actual anastomosis [28]. 165 100 include a pyloric exclusion effected through a gastrostomy. The pyloric 166 101 ring is closed with a continuous suture or stapling which breaks down 3.1. Complications 167 102 after several weeks. The procedure is combined with a gastrojeju- 168 103 nostomy and the addition of octreotide and intravenous acid Billroth II gastrectomy was favoured for many years for its rel- 169 104 suppression may improve duodenal healing and decrease stomach atively low peptic ulcer recurrence rate (less than 5%) [2,4,6]. 170 105 ulceration. Roux-en-Y loop (Roux-en-Y duodenojejunostomy) drain- However, it has a high mortality and complication rate [6,14]. Leakage 171 106 age of the defect from significant tissue loss in the second part of may occur from either the duodenal stump or from the anastomo- 172 107 the duodenum is the procedure of choice in the stable patient [21]. sis. Leakage from the duodenal stump is usually due to afferent loop 173 108 Both the duodenum and the bile duct are triply bypassed with a obstruction. This risk is reduced by the formation of a Roux-en-Y 174 109 gastroenterostomy, and a retrocolic Roux-en-Y hepatico-jejunostomy reconstruction. If there is controlled leak without sepsis or gener- 175 110 for a duodenal obstructive, locally-advanced pancreatic head car- alized peritonitis conservative treatment is indicated with parenteral 176 111 cinoma [22]. However a prophylactic gastrojejunostomy may suffice nutrition. Otherwise exploration is required to drain any sepsis and 177 112 for an obstructive unresectable periampullary carcinoma [23]. to establish drainage of the afferent loop. A useful technique for the 178 113 latter is to insert a T tube into the duodenum and, therefore, es- 179 114 2.1. Complications tablish a controlled fistula, and to decompress the afferent loo 180 115 obstruction [6,30,31]. It is unlikely that direct suture of a leak will 181 116 Early technical complications from a gastrojejunostomy would be feasible. Treatment of a gastrojejunal leak is problematic. More 182 117 include: (a) haemorrhage which is usually from the gastric side of commonly the leak is delayed, occurring 7–14 days postopera- 183 118 the anastomosis and usually only starts when the clamps are re- tively.
Load more

Recommended publications
  • 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.
    [Show full text]
  • 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.
    [Show full text]
  • 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.
    [Show full text]
  • 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.
    [Show full text]
  • 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.
    [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]
  • 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.
    [Show full text]
  • American Society for Metabolic and Bariatric Surgery
    METABOLIC & BARIATRIC SURGERY THE AMERICAN SOCIETY FOR METABOLIC & BARIATRIC SURGERY Overview Metabolic/bariatric surgery is the most effective and long-lasting treatment for severe obesity resulting in significant weight loss and the improvement, prevention or resolution of many related diseases including type 2 diabetes, heart disease, hypertension, sleep apnea and certain cancers.1,2 3,4 Studies show bariatric surgery may reduce a patient’s risk of premature death by 30-50%. Bariatric surgery is as safe or safer than some of the most commonly performed surgeries in America including gallbladder surgery, appendectomy and knee replacement. 5 Effectiveness Safety & Risks Studies show patients typically lose the most weight 1-2 The risks of severe obesity outweigh the risks of years after bariatric surgery and see substantial weight metabolic/bariatric surgery for many patients.11,12 improvements in obesity-related conditions. 6,7 The risk of death associated with bariatric surgery is Patients may lose as much as 60% of excess weight about 0.1% and the overall likelihood of major six months after surgery, and 77% of excess weight complications is about 4%. 14 as early as 12 months after surgery. 8 On average, five years after surgery, patients maintain 50% of their excess weight loss. 9 Economics of Bariatric Surgery Majority of bariatric surgery patients with diabetes, The average cost of bariatric surgery ranges between dyslipidemia, hypertension, and obstructive sleep apnea $17,000 and $26,000.15 experience remission of these obesity-related
    [Show full text]
  • Laparoscopic Adjustable Gastric Band As a Revision Surgery for Failed Vertical Gastric Sleeve Or Roux-En-Y Gastric Bypass
    Lincey Alexida, Xiaohua Qi, Patrick B. Asdell, José M. Martínez Landrón, Samarth B. Patel, Faustino Allongo. Frederick Tiesenga. Laparoscopic Adjustable Gastric Band as a Revision Surgery for Failed Vertical Gastric Sleeve or Roux-en-Y Gastric Bypass. IAIM, 2017; 4(12): 37-42. Original Research Article Laparoscopic Adjustable Gastric Band as a Revision Surgery for Failed Vertical Gastric Sleeve or Roux-en-Y Gastric Bypass Lincey Alexida1*, Xiaohua Qi2, Patrick B. Asdell3, José M. Martínez Landrón4, Samarth B. Patel5, Faustino Allongo6, Frederick Tiesenga7 14th year Medical Student, Saint James School of Medicine, 1480 Renaissance Drive, Suite 300, Park Ridge, IL 60068, USA 23rd year Medical Student, Saint James School of Medicine, 1480 Renaissance Drive, Suite 300, Park Ridge, IL 60068, USA 33rd year Medical Student, Saint James School of Medicine, 1480 Renaissance Drive, Suite 300, Park Ridge, IL 60068, USA 44th year Medical Student, American University of St. Vincent, 17950 Preston Rd #420, Dallas, TX 75252 53rd year medical student, Saint James School of Medicine, 1480 Renaissance Drive, Suite 300, Park Ridge, IL 60068, USA 63rd year medical student, Windsor University School of Medicine, 332 S Austin Blvd #2E, Oak Park Il, 60304 7 Medical Doctor, Department of Surgery, West Suburban Medical Center, 1950 N Harlem Ave, Elmwood Park, IL 60707, USA *Corresponding author email: [email protected] International Archives of Integrated Medicine, Vol. 4, Issue 12, December, 2017. Copy right © 2017, IAIM, All Rights Reserved. Available online at http://iaimjournal.com/ ISSN: 2394-0026 (P) ISSN: 2394-0034 (O) Received on: 02-11-2017 Accepted on: 16-11-2017 Source of support: Nil Conflict of interest: None declared.
    [Show full text]
  • Bariatric Surgery Program Hawai‘I’S First Program with a Director Who Has Walked the Path You’Re On
    Bariatric Surgery Program Hawai‘i’s first program with a director who has walked the path you’re on www.palimomi.org/bariatrics Your role You play a critical role in the long-term success of your surgery. You will need to: • Commit to improving your health. • Discuss your health history with your surgeon. • Discuss any questions or concerns you have and learn all you can about the surgery before making a decision. • Follow all instructions on preparing for your surgery. • Commit to following all instructions described in the bariatric surgery Your bariatric surgerY Handbook guide on nutrition, activity and other care after surgery (given to you by Your Role 3 your surgeon before surgery). Morbid Obesity and its Medical Impact 3 Both the bariatric team and you must Body Mass Index Chart 4 commit to honesty, responsibility and “I talk to them about what Why Consider Major Surgery? 7 cooperation in order to increase your they will be going through so succes ate. Setting Realistic Expectations 8 they don’t feel alone. They call Promotion of Weight Loss With Bariatric Surgery 8 Morbid obesitY me at any time just to talk.” and its Medical iMpact Explore the Benefits and Risks of Gastric Bypass Surgery 9 —Christi Keliipio, R.N., M.S.N., FACHE A clear understanding of morbid obesity Bariatric Surgery Program Director; The Normal Digestive Process 10 is very important, because this is what is former bariatric surgery patient Malabsorptive Procedures 10 used to guide physicians in selection of Restrictive Procedures 11 therapy for people who are overweight.
    [Show full text]
  • Opmaak 1 29/08/12 11:21 Pagina 373
    19-parlak-_Opmaak 1 29/08/12 11:21 Pagina 373 LETTER 373 ERCP in patients with jaboulay pyloroplasty E. Parlak 1, A.Ş. Köksal 1, F.O. Önder 1, S. Dişibeyaz 1, Ö. Tayfur 1, B. Çiçek 1, N. Şaşmaz 1, B. Şahin 1 (1) Türkiye Yüksek İhtisas Hospital, Department of Gastroenterology, Ankara, Turkey. To the Editor, Table 1. — Surgeries altering gastrointestinal and/or bilio- pancreatic anatomy Endoscopic retrograde cholangiopancreatography Upper GI anatomy altered, pancreatico-biliary anatomy preserved (ERCP) is successfuly performed in a substantial percent Billroth I and II gastroenterostomy Simple gastroenterostomy of patients with surgically altered gastrointestinal and/or Side-to-side antroduodenostomy (Jaboulay procedure) bilio-pancreatic anatomy using an appropriate endoscope Roux-en-Y gastrojejunostomy and other instruments (1,2). Billroth II gastroenterostomy, Gastric bypass (for obesity) Roux-en-Y hepaticojejunostomy, Whipple procedure, Both upper GI anatomy and pancreatico-biliary anatomies altered gastrojejunal bypass are the most commonly performed Roux-en-Y hepaticojejunostomy examples (Table 1). Access to the papilla must be Whipple (classical or pylorus preserved) through an afferent loop using a duodenoscope, gastro - scope, colonoscope, pediatric colonoscope or entero - scope (including balloon enteroscope) (1-7). Jaboulay pyloroplasty (JP) is a side-to-side antroduodenostomy anastomosis aimed to relieve gastric outlet obstruction that is infrequently performed currently (Fig. 1) (8). To our knowledge there is no data in the literature regarding the ERCP interventions in patients with JP. Herein we present our ERCP experience in patients with JP. We had 87 patients with surgically altered gastro - intestinal anatomy among 7426 ERCP procedures per - formed in our endoscopy unit within 4 years [10 with Billroth I anastomosis, 50 with Billroth II anastomosis (6 of them had Braun anastomosis), 23 with Roux-en-Y anastomosis and 4 patients (4.5%) with JP.
    [Show full text]
  • Intracorporeal Hemi-Hand-Sewn Technique for Billroth-I
    Ohmura et al. Mini-invasive Surg 2019;3:4 Mini-invasive Surgery DOI: 10.20517/2574-1225.2018.69 Original Article Open Access Intracorporeal hemi-hand-sewn technique for Billroth-I gastroduodenostomy after laparoscopic distal gastrectomy: comparative analysis with laparoscopy-assisted distal gastrectomy Yasushi Ohmura1,2, Hiromitsu Suzuki2,3, Kazutoshi Kotani2,4, Atsushi Teramoto2,3 1Department of Cancer Treatment Support Center, Okayama City Hospital, Okayama 700-8557, Japan. 2Department of Surgery, Okayama City Hospital, Okayama 700-8557, Japan. 3Department of Surgery, Yakage Hospital, Okayama 714-1201, Japan. 4Department of Surgery, Kasaoka Daiichi Hospital, Okayama 714-0043, Japan. Correspondence to: Dr. Yasushi Ohmura, Department of Cancer Treatment Support Center, Okayama City Hospital. 1-20-3 Kitanagase-omotemachi, Kita-ku, Okayama 700-8557, Japan. E-mail: [email protected] How to cite this article: Ohmura Y, Suzuki H, Kotani K, Teramoto A. Intracorporeal hemi-hand-sewn technique for Billroth-I gastroduodenostomy after laparoscopic distal gastrectomy: comparative analysis with laparoscopy-assisted distal gastrectomy. Mini-invasive Surg 2019;3:4. http://dx.doi.org/10.20517/2574-1225.2018.69 Received: 30 Nov 2018 First Decision: 30 Nov 2018 Revised: 30 Jan 2019 Accepted: 1 Feb 2019 Published: 27 Feb 2019 Science Editor: Tetsu Fukunaga Copy Editor: Cai-Hong Wang Production Editor: Huan-Liang Wu Abstract Aim: The purpose of this study was to evaluate the clinical feasibility and efficacy of the intracorporeal hemi-hand-sewn (IC-HHS) technique for Billroth-I gastroduodenostomy in comparison with extracorporeal total hand-sewn (EC-THS) anastomosis. We also examined the size of resected specimens in each procedure.
    [Show full text]