Cesarean delivery technique: evidence or tradition? A review of the evidence-based cesarean delivery.

Cesarean delivery is the most common surgical procedure performed in the United States, yet the techniques used during this procedure often vary significantly among providers. The purpose of this review was to evaluate and outline current evidence behind the cesarean delivery technique. A search of the PubMed database was conducted using the terms cesarean section and cesarean delivery and the technique of interest, for example, cesarean section prophylactic antibiotics. Few aspects of the cesarean delivery were found to have high-quality consistent evidence to support use of a particular technique. Because many aspects of the procedure are based on limited or no data, more studies on specific cesarean delivery techniques are clearly needed. Providers should be aware of which components of the cesarean delivery are evidence-based versus not when performing this procedure.

Halo effect for bariatric surgery: collateral weight loss in patients' family members.

CONTEXT: Bariatric surgery is an effective treatment for morbid obesity, which is increasingly recognized as a familial disease. Healthy behavior transmission may be enhanced by family relationships. OBJECTIVE: To determine changes in weight and healthy behavior in patients who underwent Roux-en-Y gastric bypass surgery and their family members. DESIGN: Prospective, longitudinal, and multidimensional health assessment before and 1 year after index Roux-en-Y gastric bypass surgery. SETTING: An academic bariatric center of excellence, from January 1, 2007, through December 31, 2009. PARTICIPANTS: Eighty-five participants (35 patients, 35 adult family members, and 15 children <18 years old). INTERVENTION: Roux-en-Y gastric bypass surgery and associated dietary and lifestyle counseling. MAIN OUTCOME MEASURES: Weight and expected body mass index (calculated as weight in kilograms divided by height in meters squared). Secondary outcomes were waist circumference, quality of life (36-Item Short Form or Pediatric Quality of Life Inventory), healthy behaviors, eating behaviors, and activity levels. RESULTS: Participants were grouped by relationship to patient for analysis with paired 2-sample t tests. Before the operation, 60% of adult family members and 73% of children of patients undergoing Roux-en-Y gastric bypass surgery were obese. At 12 months after the operation, significant weight loss was observed in obese adult family members (from 234 to 226 lb; P = .01). There was a trend for obese children to have a lower body mass index than expected for their growth curve (31.2 expected vs 29.6 observed; P = .07). Family members increased their daily activity levels (adults, from 8 to 17 metabolic equivalent task-hours, P = .005; and children, from 13 to 22, P = .04). Adult family members also had improved eating habits with less uncontrollable eating (from 35 to 28; P = .01), emotional eating (from 36 to 28; P = .04), and alcohol consumption (from 11 drinks per month to 1 drink per month; P = .009). CONCLUSION: Gastric bypass surgery may render an additional benefit of weight loss and improved healthy behavior for bariatric patients' family members.

Probiotics improve outcomes after Roux-en-Y gastric bypass surgery: a prospective randomized trial.

INTRODUCTION: Roux-en-Y gastric bypass (RNYGB) surgery offers an effective and enduring treatment for morbid obesity. Gastric bypass may alter gastrointestinal (GI) flora possibly resulting in bacterial overgrowth and dysmotility. Our hypothesis was that daily use of probiotics would improve GI outcomes after RNYGB. METHODS: Forty-four patients undergoing RNYGB were randomized to either a probiotic or control group; 2.4 billion colonies of Lactobacillus were administered daily postoperatively to the probiotic group. The outcomes of H(2) levels indicative of bacterial overgrowth, GI-related quality of life (GIQoL), serologies, and weight loss were measured preoperatively and at 3 and 6 months postoperatively. Categorical variables were analyzed by chi(2) test and continuous variables were analyzed by t test with a p < 0.05 for significance. RESULTS: At 6 months, a statistically significant reduction in bacterial overgrowth was achieved in the probiotic group with a preoperative to postoperative change of sum H(2) part per million (probiotics = -32.13, controls = 0.80). Surprisingly, the probiotic group attained significantly greater percent excess weight loss than that of control group at 6 weeks (controls = 25.5%, probiotic = 29.9%) and 3 months (38.55%, 47.68%). This trend also continued but was not significant at 6 months (60.78%, 67.15%). The probiotic group had significantly higher postoperative vitamin B12 levels than the control group. Both probiotic and control groups significantly improved their GIQoL. CONCLUSION: In this novel study, probiotic administration improves bacterial overgrowth, vitamin B12 availability, and weight loss after RNYGB. These data may provide further evidence that altering the GI microbiota can influence weight loss.

Does gastric bypass alter alcohol metabolism?

BACKGROUND: Morbid obesity is the leading public health crisis in the United States, with bariatric surgery as the only effective and enduring treatment for this disease. a concern has been raised, that, postoperatively, alcohol metabolism might be altered in gastric bypass patients. We hypothesized that alcohol metabolism in the postoperative gastric bypass patient would be altered. METHODS: Of 36 subjects, 17 control and 19 postgastric bypass subjects each consumed 5 oz of red wine. They underwent an alcohol breath analysis every 5 minutes. The outcomes recorded included symptoms, initial peak alcohol breath level, and the time for alcohol breath levels to normalize. RESULTS: The gastric bypass group was on average 10 years older and had a greater weight and body mass index than the control group. The average time after gastric bypass was 2 years, with an average body mass index loss of 18 kg/m(2) (51 kg/m(2) before versus 33 kg/m(2) after). The gastric bypass patients had a peak alcohol breath level of 0.08% and the controls had a level of 0.05%. The gastric bypass group needed, on average, 108 minutes to reach an alcohol breath level of 0; the control group reached this level after an average of 72 minutes. Both groups showed a similar postingestion symptom profile. CONCLUSION: In this study, alcohol metabolism was significantly different between the postgastric bypass and control subjects. Although the gastric bypass patients' had a greater peak alcohol level and a longer time for the alcohol level to reach 0 than the controls, the gastric bypass group did not experience more symptoms than the control group. These findings provide caution regarding alcohol use by gastric bypass patients.