DOCSLIB.ORG

A Bariatric Surgery Primer for Orthopedic Surgeons

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A Bariatric Surgery Primer for Orthopedic Surgeons A Review Paper A Bariatric Surgery Primer for Orthopedic Surgeons Jessica G. Kingsberg, MD, Alan A. Halpern, MD, and Brian C. Hill, MD of the pathophysiology associated with bariatric surgery can Abstract assist orthopedic surgeons in optimizing medical and surgical Increasing numbers of patients who have undergone management of patients’ musculoskeletal issues. bariatric surgery are now presenting to orthopedic sur- geons for elective arthroplasties. In addition, orthope- Bariatric Surgery dic surgeons themselves are referring more patients Surgically induced weight loss works by reducing quantity of for consideration of bariatric surgery in anticipation of food consumed and absorption of calories. Jejunoileal bypass, future elective procedures. Although the full effects one of the first procedures used, significantly decreased the of bariatric surgery on metabolism are not yet known, absorptive area for nutrients, which led to complications such 4 the altered digestion associated with these surgeries as diarrhea, cirrhosis, and nephrolithiasis. This surgery is no poses several issues for orthopedic surgeons. longer performed, and current procedures try to minimize 5 In this article, we address 3 aspects of care of this the risks of malabsorption. class of patient: review of the most commonly per- The 2 types of bariatric surgeries now available in the Unit- formed procedures and their metabolic consequenc- ed States are gastroplasty and gastric bypass, both of which 6 es; suggested preoperative assessment of bariatric are performed laparoscopically. Gastroplasties are purely re- patients for any conditions that should be corrected strictive procedures, which reduce stomach volume. In gastric before surgery; and evaluation of outcomes of elective banding, the most common gastroplasty, a silicone band is procedures performed after bariatric surgery.AJO Aware- placed around the proximal stomach to create a 15-mL pouch ness of the unique characteristics of this group of pa- in the cardia. Sleeve gastrectomy also reduces stomach vol- tients helps minimize the potential for complications of ume, to about 25%, by stapling along the greater curvature. In both procedures, consumed calories are restricted, but the planned orthopedic surgeries. gastrointestinal tract is left in continuity, and essential nutri- ents are properly absorbed.7 However, failure rates are higher, and weight loss more variable, than with gastric bypass pro- n estimated 220,000 bariatric surgeries are per- cedures.8 formed annually in the United States and Canada, Gastric bypass uses both restriction and malabsorption to ADOand 344,221 procedures NOT worldwide.1 Not only are increase weightCOPY loss.7 A gastric pouch (15-30 mL) is created orthopedic surgeons seeing more patients who have had bar- by stapling across the cardia of the stomach. The jejunum is iatric surgery, they are also referring morbidly obese patients then divided, and the distal portion of the divided jejunum to bariatric surgeons before elective procedures.2 Patients with anastomosed to the small proximal stomach pouch. This cre- body mass index (BMI) over 40 kg/m2 are candidates for sur- ates the roux limb where food passes. The duodenum is ex- gical treatment of obesity. Comorbid conditions directly re- cluded, and the proximal portion of the jejunum is attached to lated to obesity, including diabetes, respiratory insufficiency, the roux limb to provide a conduit for biliary and pancreatic and pseudotumor cerebri, decrease the BMI of eligibility to digestive secretions. Weight loss is caused by both reduction 35 kg/m2. Other considerations are failure of nonsurgical in stomach size and malabsorption of calories owing to the weight-loss methods, such as dietary programs for weight diversion of digestive enzymes and the decrease in absorptive reduction, behavioral modification programs, and phar- surface area. Only 28% of ingested fat and 57% of ingested macotherapy. Patients’ psychological stability is extremely protein are absorbed9 (Table 1). important given the rigorous dietary changes required after surgery.3 Although weight-loss surgery can eliminate many Metabolic Consequences of the complications of obesity, bariatric patients even with Nutrient deficiencies are seen more often in the malabsorp- weight loss have increased operative and postoperative risks, tive procedures; however, patients with restrictive procedures likely because of alterations in nutrient absorption. Knowledge may have poor eating habits and are therefore also at risk.10 Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article. www.amjorthopedics.com January 2016 The American Journal of Orthopedics® E1 A Bariatric Surgery Primer for Orthopedic Surgeons In fact, many patients have nutritional deficiencies predating dures because of decreased dietary intake from intolerance. their bariatric surgery, as obesity creates a chronic inflamma- Malabsorptive procedures also decrease pepsinogen secretion tory state that leads to anemia of chronic disease. Schweiger and reduce the intestinal absorption surface. and colleagues11 assessed the nutritional status of bariatric sur- gery candidates and noted a high incidence of iron and folic Considerations for Orthopedic Surgeons acid deficiencies with corresponding anemia. They concluded Wound Healing these deficiencies stemmed from calorie-dense diets high in Much of our knowledge of the effects of bariatric surgery on carbohydrates and fats. Although patients may improve their skin and wound healing has been gleaned from samples ob- diet after surgery with concomitant nutritional counseling, tained from patients during abdominoplasty or other body- deficiencies in iron, calcium, vitamin 12B , folate, and vitamin contouring procedures. These samples have all shown a decrease D are common12 (Table 2). in hydroxyproline, the major constituent of collagen and the Iron deficiency continues after bariatric surgery because main factor in determining the tensile strength of a wound.19 dietary iron must be converted to its absorbable form by hy- D’Ettorre and colleagues20 performed biopsies of abdominal drochloric acid secreted from the stomach. As stomach vol- Table 1. Weight-Loss Surgery Options ume is reduced, there is a cor- responding decrease in acid Restrictive Malabsorptive secretion. The result is that Options Gastric banding Roux-en-Y iron deficiency occurs in both Gastrectomy restrictive and malabsorptive procedures.13 Moreover, with Mechanisms Decreases size of stomach Decreases size of stomach the diversion from the duo- Decreases area of absorption denum and the proximal je- Amount of weight loss expected Unpredictable Predictable junum in bypass surgery, the main areas of absorption are Advantages Easier to reverse More weight loss Decreased risk of metabolic deficiency excluded.10 Patients may re- quire intravenous therapy for Nutrient deficiencies Rare Common iron-deficiency anemia—or AJO oral supplementation com- bined with ascorbic acid to increase stomach acidity. Table 2. Comparison of Gastroplasty and Gastric As calcium is absorbed mainly in the duodenum and the Bypass Procedures jejunum, patients who undergo malabsorptive procedures can Gastroplasty Gastric Bypass absorb only 20% of the amount ingested.14 Restrictive pro- cedures do not have the same effect on calcium absorption; Type Restrictive Malabsorptive however, patients may have reduced dietary lactose intake and Metabolic deficiencies Iron Iron be at risk for deficiency. Vitamin B12 Vitamin B12 DOA study by Ducloux and colleaguesNOT15 found that 96% of COPYProtein Protein bariatric surgery patients had vitamin D deficiency before the Calcium procedure. After malabsorptive procedures, the decrease in Vitamin D bile salts leads to an inability to break down fat-soluble vi- Orthopedic complications Wound healing Wound healing tamins and to uncoordinated mixing of food and bile secre- Osteopenia tions.16 Restrictive procedures do not carry this risk, though many patients still require supplementation because of their underlying deficiency. skin before and after biliopancreatic diversion and noted that The decrease in stomach size causes a decrease in intrinsic tissue proteins, including hydroxyproline, were significantly factor from parietal cells, with subsequent inability to appro- reduced. Histologic examination revealed disorganized dermal priately transport vitamin B12. Exclusion of the duodenum elastic and collagen fibers. In addition, all patients involved in also eliminates the site of absorption; therefore, B12 should the study had wound-healing problems, with delayed healing be replaced orally.11 Megaloblastic anemia is a rarely reported of 25 days, compared with 12 days in nonbariatric patients. 17,18 sequela. Folate deficiency is less common because it can Deficiencies in vitamins B12, D, and E, as well as folate and total take place in the entire intestine after surgery, even though tissue protein, were implicated as causative factors. absorption occurs primarily in the proximal portion of the small intestine.10 Effects on Bone Protein deficiency can result in loss of muscle mass and Malabsorptive procedures decrease bone mineral density subsequent muscle weakness, edema, and anomalies of the (BMD) through their effects on calcium and vitamin D. BMD skin, mucosa, and nails.12 It is seen after both types of proce- is also decreased because these procedures lower levels of E2 The American Journal of Orthopedics® January 2016
Load more

Recommended publications
  • Bariatric Surgery and Kidney-Related Outcomes
    WORLD KIDNEY DAY MINI SYMPOSIUM ON KIDNEY DISEASE AND OBESITY Bariatric Surgery and Kidney-Related Outcomes Alex R. Chang1,2, Morgan E. Grams3,4 and Sankar D. Navaneethan5,6 1Kidney Health Research Institute, Geisinger Health System, Danville, Pennsylvania, USA; 2Department of Epidemiology and Health Services Research, Geisinger Health System, Danville, Pennsylvania, USA; 3Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA; 4Divison of Nephrology, Johns Hopkins Uni- versity, Baltimore, Maryland, USA; 5Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA; and 6Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA The prevalence of severe obesity in both the general and the chronic kidney disease (CKD) populations continues to rise, with more than one-fifth of CKD patients in the United States having a body mass index of $35 kg/m2. Severe obesity has significant renal consequences, including increased risk of end-stage renal disease (ESRD) and nephrolithiasis. Bariatric surgery represents an effective method for achieving sustained weight loss, and evidence from randomized controlled trials suggests that bariatric surgery is also effective in improving blood pressure, reducing hyperglycemia, and even inducing diabetes remis- sion. There is also observational evidence suggesting that bariatric surgery may diminish the long-term risk of kidney function decline and ESRD. Bariatric surgery appears to be relatively safe in patients with CKD, with postoperative complications only slightly higher than in the general bariatric surgery popula- tion. The use of bariatric surgery in patients with CKD might help prevent progression to ESRD or enable selected ESRD patients with severe obesity to become candidates for kidney transplantation.
    [Show full text]
  • About Liver Resection
    ABOUT LIVER RESECTION Surgical removal of part of the liver A guide for patients and relatives This booklet has been written to provide information about the operation called a liver resection. This is a major operation and involves removal of a part of the liver. Information about the benefits and risks will help you make an informed decision about the operation. It is important to remember that each person is different. This booklet cannot replace the professional advice and expertise of a doctor who is familiar with your condition. If you have questions that this booklet does not cover, please discuss them with your surgeon or cancer nurse specialist. page 2 What is the liver? The liver is a large organ which lies on the right side of the upper abdomen, under the rib cage. It has many functions related to body metabolism (chemical processes within the body) and is very important to health. One of its functions is to produce yellow-green fluid called bile. Bile flows down a tube called the bile duct to the intestine, where it mixes with food and helps digestion. The gall bladder is a small sac attached to the side of the bile duct. The gall bladder stores excess bile and pushes it down the bile duct in to the intestine, ready for when it is needed for digestion. The liver has right and left lobes (sections). An artery (hepatic artery) and a vein (portal vein) carry blood to the liver. Blood from the liver flows through the hepatic veins back to the heart.
    [Show full text]
  • Technic VERTICAL GASTROPLASTY WITH
    ABCDDV/802 ABCD Arq Bras Cir Dig Technic 2011;24(3): 242-245 VERTICAL GASTROPLASTY WITH JEJUNOILEAL BYPASS - NEW TECHNICAL PROCEDURE Gastroplastia vertical com desvio jejunoileal - novo procedimento técnico Bruno ZILBERSTEIN, Arthur Sergio da SILVEIRA-FILHO, Juliana Abbud FERREIRA, Marnay Helbo de CARVALHO, Cely BUSSONS, Henrique JOAQUIM, Fernando RAMOS From Gastromed-Instituto Zilberstein, São ABSTRACT - Introduction - Vertical gastroplasty is increasingly used in the surgical Paulo, SP, Brasil. treatment of morbid obesity, being used alone or as part of the duodenal switch surgery or even in intestinal bipartition (Santoro technique). When used alone has only a restrictive character. Method - Is proposed association of jejunoileal bypass to vertical gastroplasty, in order to give a metabolic component to the procedure and eventually empower it to medium and long term. Eight morbidly obese patients were operated after removal of adjustable gastric band or as a primary procedure associated to vertical banded gastroplasty with jejunoileal bypass laterolateral and anastomosis between the jejunum 80 cm from duodenojejunal angle and the ileum at 120 cm from ileocecal valve, by laparoscopy. Results - The patients presented themselves without complications both in trans or in the immediate postoperative period, and also in the months that followed. The evolution BMI showed a significant reduction ranging from 39.57 kg/m2 to 28 kg/m2. No patient reported diarrhea or malabsorptive disorder in HEADINGS - Sleeve gastrectomy. Jejunoileal the period. Conclusion - It can be offered a new therapeutic option, with restraining diversion. Obesity. Surgery. and metabolic aspects, in which there are no consequences as the ones founded in procedures with duodenal diversion or intestinal transit alterations.
    [Show full text]
  • Immunoelectrophoretic Studies on Human Small
    Gut: first published as 10.1136/gut.21.8.662 on 1 August 1980. Downloaded from Gut, 1980, 21, 662-668 Immunoelectrophoretic studies on human small intestinal brush border proteins: cellular alterations in the levels of brush border enzymes after jejunoileal bypass operation H SKOVBJERG, E GUDMAND-H0YER, 0 NOREN, AND H SJOSTROM From the Department ofBiochemistry C, The Panum Institute, Medical-gastroenterological Department C, and Surgical-gastroenterological Department D, Herlev Hospital, University of Copenhagen, Denmark SUMMARY The amounts of lactase (EC 3.2.1.23), sucrase (EC 3.2.1.48), maltase (EC 3.2.1.20), microvillus aminopeptidase (microsomal EC 3.4.11.2), and dipeptidyl peptidase IV (EC 3.4.14. x) in biopsies from proximal jejunum and distal ileum were studied by quantitative crossed immuno- electrophoresis and enzymatic assays in obese patients one and six months after jejunoileal bypass operation and compared with peroperative levels. They were related to DNA and protein content. The protein/DNA ratio fell 28-43 % postoperatively. Except for ileal lactase and sucrase all enzymes showed decreased levels when expressed per mg protein and an even more pronounced decrease when related to DNA. Lactase and sucrase levels in ileum were increased or unchanged. A constant correlation between the amount of immunoreactive enzyme protein and enzymatic activity was shown for all enzymes except maltase. The results suggest that the bypass operation is followed http://gut.bmj.com/ by an increased amount of enterocytes devoid of or low in enzymatic activity and protein content. The amounts of lactase and sucrase in ileum are increased in relation to the other enzymes.
    [Show full text]
  • Hepatic Complications of Bariatric Surgery : the Reverse Side of the Coin
    REVIEW 505 Hepatic complications of bariatric surgery : the reverse side of the coin U. Vespasiani-Gentilucci*1, F. Vorini*1, S. Carotti2, A. De Vincentis1, G. Galati1, P. Gallo1, N. Scopinaro3, A. Picardi1 (1) Internal Medicine and Hepatology Unit ; (2) Laboratory of Microscopic and Ultrastructural Anatomy, CIR ; University Campus Bio-Medico of Rome, Italy; (3) Department of Surgery, Ospedale San Martino, University of Genoa, Italy. Abstract Indeed, several studies demonstrated an association between weight loss and regression of nonalcoholic fatty Background : Even if the jejunoileal bypass has been definitely abandoned due to the high rate of hepatic complications, cases of liver disease (NAFLD) and non-alcoholic steatohepatitis liver injury after the new bariatric procedures are still reported. We (NASH) (5,9-11), and others proved a significant rate of aimed to review the available literature concerning liver damage fibrosis – and even cirrhosis – regression after bariatric associated with the older and newer types of bariatric surgeries. Methods : An extensive literature search of MEDLINE was surgery (12). On the other side, from the middle ’70s, performed using different combinations of the following terms: several reports have focused on the high rate of hepatic “bariatric surgery OR biliopancreatic diversion OR jejunoileal complications following the first widely diffused bariatric bypass OR roux-en-y gastric bypass OR vertical banded gastro- plasty OR laparoscopic adjustable gastric banding” AND “hepatic/ technique, the jejunoileal
    [Show full text]
  • Liver Resections Combined with Closure of Loop Ileostomies: a Retrospective Analysis
    Hindawi Publishing Corporation HPB Surgery Volume 2008, Article ID 501397, 5 pages doi:10.1155/2008/501397 Research Article Liver Resections Combined with Closure of Loop Ileostomies: A Retrospective Analysis Jeffrey T. Lordan, Angela T. Riga, and Nariman D. Karanjia Regional Hepato-Pancreatico-Biliary Unit for Surrey and Sussex, The Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK Correspondence should be addressed to Jeffrey T. Lordan, dr [email protected] Received 6 August 2008; Accepted 30 October 2008 Recommended by Olivier Farges Background. The management of patients with colorectal liver metastases and loop ileostomies remains controversial. This study was performed to assess the outcome of combined liver resection and loop ileostomy closure. Methods. Analysis of prospectively collected perioperative data, including morbidity and mortality, of 283 consecutive hepatectomies for colorectal liver metastases was undertaken. Consecutive liver resections were performed from 1996 to 2006 in one centre by a single surgeon (NDK). Fourteen of these patients had combined liver resection and ileostomy closure. Case-matched analysis was undertaken. Results.Six(2.2%) patients died in the hepatectomy only group and none died in the combined group. There was no difference in operative blood loss between the two groups (0.09). Perioperative morbidity was 36% in the combined group and 23% in the hepatectomy alone group (P = 0.33). Mean hospital stay was 14 days in the combined group and 11 days in the hepatectomy only group (P = 0.046). Case-matched analysis showed a significant increase in hospital stay (P = 0.03) and complications (P = 0.049) in the combined group.
    [Show full text]
  • A History of Bariatric Surgery the Maturation of a Medical Discipline
    A History of Bariatric Surgery The Maturation of a Medical Discipline Adam C. Celio, MD, Walter J. Pories, MD* KEYWORDS Bariatric Obesity Metabolic surgery Intestinal bypass Gastric bypass Gastric sleeve Gastric band Gastric balloon KEY POINTS The history of bariatric surgery, one of the great medical advances of the last century, again documents that science progresses not as a single idea by one person, but rather in small collaborative steps that take decades to accept. Bariatric surgery, now renamed “metabolic surgery,” has, for the first time, provided cure for some of the most deadly diseases, including type 2 diabetes, hypertension, severe obesity, NASH, and hyperlipidemias, among others, that were previously considered incurable and for which there were no effective therapies. With organization, a common database, and certification of centers of excellence, bariat- ric surgery, once one of the most dangerous operations, is now performed throughout the United States with the same safety as a routine cholecystectomy. RECOGNITION Obesity is now a worldwide public health problem, an epidemic, with increasing inci- dence and prevalence, high costs, and associated comorbidities.1 Although the genes from our ancestors were helpful in times of potential famine, now in times of plenty, they have contributed to obesity.1–4 The history of obesity is related to the history of food; the human diet has changed considerably over the last 700,000 years. Our an- cestors at one time were hunter-gatherers, consuming large and small game along with nuts and berries. Their diets were high in protein and their way of life was stren- uous; they were well suited for times of famine.
    [Show full text]
  • Incidence and Risk Factors for Cholelithiasis After Bariatric Surgery
    Obesity Surgery (2019) 29:2110–2114 https://doi.org/10.1007/s11695-019-03760-4 ORIGINAL CONTRIBUTIONS Incidence and Risk Factors for Cholelithiasis After Bariatric Surgery Hernán M. Guzmán1 & Matías Sepúlveda1,2 & Nicolás Rosso 3 & Andrés San Martin2 & Felipe Guzmán4 & Hernán C. Guzmán1,2 Published online: 17 April 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Background Obesity and rapid weight loss after bariatric surgery (BS) are independent risk factors for development of choleli- thiasis (CL), a prevalent disease in the Chilean population. This study aimed to determine the incidence of CL in obese Chilean patients 12 months after BS and identify risk factors for development of gallstones. Methods Retrospective study of patients who underwent BS in 2014. Patients with preoperative negative abdominal ultrasound (US) for CL and follow-up for at least than 12 months were included. Patients underwent US at 6 months and 12 months. We analyzed sex, age, hypertension, dyslipidemia, type 2 diabetes mellitus, body mass index (BMI), surgical procedure, percentage of excess BMI loss (%EBMIL) at 6 months, and BMI at 6 months. Results Of 279 patients who underwent bariatric surgery during 2014, 66 had previous gallbladder disease and 176 met the inclusion criteria (82.6%), while 54.6% were female. The mean age was 37.8 ± 10.5 years and preoperative BMI was 37.5 kg/m2. BMI and %EBMIL at 6 months were 27.8 ± 3.3 kg/m2 and 77.9 ± 33.6%, respectively. At 12 months after BS, CL was found in 65 patients (36.9%). Hypertension turned out to be protective against occurrence of gallstones at 1 year with an OR 0.241.
    [Show full text]
  • 793 H. Chen (Ed.), Illustrative Handbook of General Surgery, DOI
    Index A anesthetization , 763 Abdominoperineal resection incision , 763, 764 (APR) informed consent , 762 anesthesia , 432–433 packing abscess cavity , indications , 430–431 764, 765 patient positioning , 432 potential risks, disclosure post-operative care , 446 of , 762 pre-operative imaging and protective equipment , 762 procedures , 431–432 skin preparation , 763 procedure A C C . See Adrenocortical cancer anococcygeal ligament , (ACC) 441, 442 Achalasia . See Esophageal anterior dissection plane , achalasia 442, 444 Adjustable gastric banding elliptical incision , 441 (AGB) , 237, 244–245 perineal incision , 442, 445 Adrenalectomy robotic , 445–446 indications for , 62 Abscess drainage laparoscopic (see anesthesia , 761–762 (Laparoscopic antibiotic therapy , 759 adrenalectomy) ) complications , 766 open (see (Open indications , 760 adrenalectomy) ) patient positioning , 761 Adrenal incidentaloma , 63 post-procedure Adrenocortical cancer (ACC) instructions , 766 laparoscopic adrenalectomy pre-procedure evaluation , (see (Laparoscopic 760–761 adrenalectomy) ) procedure open adrenalectomy (see abscess cavity, loculations (Open of , 764, 765 adrenalectomy) ) H. Chen (ed.), Illustrative Handbook of General Surgery, 793 DOI 10.1007/978-3-319-24557-7, © Springer International Publishing Switzerland 2016 794 Index A G B . See Adjustable gastric Antirefl ux procedure (ARP) , 194 banding (AGB) Dor fundoplication Aldosterone producing advantages of , 200 adenoma , 71 completion of , 201–202 American College of creation of , 200–201 Radiologists
    [Show full text]
  • Technical Aspects of Orthotopic Liver Transplantation for Hepatocellular Carcinoma
    Technical Aspects of Orthotopic Liver Transplantation for Hepatocellular Carcinoma a a,b, Lung-Yi Lee, MD , David P. Foley, MD * KEYWORDS Liver transplantation Surgery Hepatocellular carcinoma Piggyback technique Portal vein thrombosis KEY POINTS In the majority of cases, patients with cirrhosis and hepatocellular carcinoma (HCC) who undergo liver transplantation are transplanted based on their higher Model for End-Stage Liver Disease (MELD) exception score and not their physiologic MELD score; this usually results in fewer physiologic derangements during liver transplantation. Patients who have previously undergone locoregional therapy or liver resection for HCC can develop significant perihepatic adhesions that increase the complexity of the hepa- tectomy during transplant. Implantation strategy of the inferior vena cava (IVC) during liver transplant may need to be modified based on location of previously treated HCC. Patients who undergo transarterial chemoembolization for pretransplant HCC therapy may have higher rates of hepatic artery thrombosis after liver transplant; therefore, aorto- hepatic bypass grafting with donor iliac artery may be required for arterial in flow to the liver allograft. Patients with portal vein (PV) thrombosis with a bland thrombus and a patent superior mesenteric vein (SMV) can undergo successful liver transplant through either PV throm- bectomy and standard end-to-end PV-PV anastomosis, or the use of SMV-PV bypass graft with donor iliac vein. a Department of Surgery, University of Wisconsin School of Medicine and Public Health, Clinical Sciences Center, H4/766, 600 Highland Avenue, Madison, WI 53792-3284, USA; b Veterans Administration Surgical Services, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA * Corresponding author.
    [Show full text]
  • Colon Adenocarcinoma After Jejunoileal Bypass for Morbid Obesity Lee Morris1,*, Ilimbek Beketaev1, Roberto Barrios2, and Patrick Reardon1
    Journal of Surgical Case Reports, 2017;11, 1–4 doi: 10.1093/jscr/rjx214 Case Report CASE REPORT Colon adenocarcinoma after jejunoileal bypass for morbid obesity Lee Morris1,*, Ilimbek Beketaev1, Roberto Barrios2, and Patrick Reardon1 1Department of Surgery, Houston Methodist, Houston, TX, USA and 2Department of Pathology and Genomic Medicine, Houston Methodist, Houston, TX, USA *Correspondence address: Department of Surgery, Houston Methodist, 6550 Fannin Street, Suite 2435, Houston, TX 77030, USA. Tel: +1-713-790-3140; Fax: +1-713-790-3235; E-mail: [email protected] Abstract Jejunoileal bypass (JIB) was developed as a surgical treatment for morbid obesity in the early 1950s. However, this procedure is now known to be associated with multiple metabolic complications and has subsequently been abandoned as a viable bariatric procedure. Some of these known complications include renal stone formation, liver failure, migratory arthritis, fat- soluble deficiencies, blind-loop syndrome and severe diarrhea. Additionally, there have been animal models suggesting colon dysplasia after JIB. To our knowledge however, in humans, no colon cancers have been attributed to JIB in the litera- ture. Here we report a 63-year-old morbidly obese female who had a JIB surgery in 1973 and subsequently was found to have numerous sessile colonic polyps throughout her colon and adenocarcinoma of the ascending colon without any family his- tory of colonic polyposis syndromes or colon cancer. INTRODUCTION our best knowledge, the first case of a colon adenocarcinoma following JIB surgery in humans. Bariatric surgery has proven to be the most efficacious treat- ment for morbid obesity and resolution of obesity-related comorbidities [1].
    [Show full text]
  • Nutritional Markers Following Duodenal Switch for Morbid Obesity
    Obesity Surgery, 14, pp-pp Nutritional Markers following Duodenal Switch for Morbid Obesity Robert A. Rabkin MD, FACS; John M. Rabkin, MD, FACS; Barbara Metcalf, RN; Myra Lazo, MS, PA-C; Michael Rossi, PA-C; Lee B. Lehman- Becker, BA Pacific Laparoscopy, San Francisco, CA, USA Background: Laparoscopic duodenal switch with gas- Introduction tric reduction (LapDS) is a minimally invasive hybrid operation combining moderate intake restriction with moderate malabsorption for treatment of morbid obe- The duodenal switch (DS) was first performed by sity. In LapDS, both the quantity of food ingested and Hess 19881 and Marceau et al2 in 1990, and a the efficiency of digestion are reduced. laparoscopic approach (LapDS) was first imple- Methods: A cohort of 589 sequential LapDS mented by the author in 1999.3,4 The DS combines patients had laboratory studies drawn annually. Serum markers for calcium, iron and protein metabo- moderate malabsorption with moderate restriction lism and for hepatic function were analyzed using via reduced stomach capacity, yet preserves normal SAS statistical software. stomach functioning. While quality of life is diffi- Results: There were 95 men and 494 women. Mean cult to study, most postoperative patients report that age was 44 years, mean BMI 50 kg/m2 and mean pre- they continue to be able to ingest normally and operative weight 142 kg. Although mean hemoglobin enjoy eating. decreased below reference and mean parathyroid hormone (PTH) increased above reference, similar to The DS and the LapDS are identical in internal abnormal values reported after Roux-en-y gastric anatomy and are fashioned as shown in Figure 1.
    [Show full text]