RESUMO
BACKGROUND: Prevalence of obesity is increasing steadily. It exposes the patient to numerous complications and represents a serious public health issue. Various treatments were tried. Surgery is actually a credible alternative. Many techniques can be made by laparoscopic approach. AIM: To evaluate early and late results of laparoscopic treatment of morbid obesity by two techniques: gastric banding adjustable and gastric by-pass. METHODS: From May 2001 to July 2007, 27 patients were laparoscopically operated on for severe obesity in our department. Twenty four patients were treated with a gastric banding and 3 patients with gastric bypass. The primary endpoint was: excessive weight loss (EWL), BMI variations and patients' satisfaction. The secondary endpoints were mortality, morbidity and conversion. RESULTS: The mean age was 36 years. There were 4 males and 23 females. The mean preoperative weight was 122.4 kg (range: 87-152) and the mean body mass index (BMI) was 42,5 kg/m2 (range 36.5-52 kg/m2). The mean operating time was 129 minutes (range: 50-300). The mean hospital stay was 4.76 days (range: 3-8). There were no postoperative deaths. Early complication was present in 3 patients. Late complications were present in one patient. No conversion to laparotomy was necessary. BMI decreased from 42.9 to 31 kg/m2 and EWL reached 43%; CONCLUSION: The results of our experience are encouraging with an acceptable complication rate and no death. Laparoscopic treatment can be done with good results.
Assuntos
Derivação Gástrica , Gastroplastia , Laparoscopia , Obesidade Mórbida/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: The fundoplication to treat gastroesophageal reflux disease have proven themselves in open surgery and are being validated by laparoscopy. BUT: The purpose of this retrospective study was to evaluate the results in the short and medium term treatment of gastroesophageal reflux by laparoscopy in a series of 51 patients and compare our results with those of literature. METHODS: We report the results of a retrospective study of 51 consecutive patients operated by laparoscopy for gastro-esophageal reflux during the period January 2000 to December 2004. The indication for surgery was the drug resistance (persistence of symptoms of reflux on treatment), drug addiction, persistent esophagitis after a well conducted medical treatment and endobrachy-esophagus. All our patients had a total or partial fundoplication. Our outcome measures were mortality, morbidity, specifically, the conversion rate and functional outcome in the short and medium term. RESULTS: These 24 men and 27 women of average age 38 years (range: 17-71 ans). All patients were approached first by laparoscopy. All our patients had a fundoplication: 44 total, including 10 with section of short vessels (Nissen) and 34 without section of short vessels (Nissen-Rossetti). The other 7 patients had a partial posterior fundoplication of 180 degrees. We used the conversion in four patients (7.8%). Mortality was nil. The specific complications were observed in 2 patients (4%), a case of gastroparesis positive trends in gastric aspiration. A case of aphagie requiring reoperation for postoperative J2 to convert a valve type Nissen-Rossetti valve type Toupet. The non-specific complications were dominated by pneumonia in 4 patients (7.8%). In the medium term, gas bloat syndrome was present in 7.8% of cases. Dysphagia, present in (77%) cases, was transient in 40 patients (62%) and persistent in 15 patients including 2 requiring dilation sessions. One patient experienced a recurrence of reflux confirmed by pH monitoring. CONCLUSION: the laparoscopic approach is being validated in the surgical treatment of gastroesophageal reflux. In our series of 51 patients, the results were satisfactory and comparable to those of the literature.