Effect of Roux-en Y gastric bypass on bone metabolism in patients with morbid obesity: Mansoura experiences.

BACKGROUND: Roux-en-Y gastric bypass (RYGBP) has been found to be the most efficient way to lose weight and maintain the weight loss in morbid obesity. However, with the formation of a new stomach and the modification of intestinal anatomy, there are significant changes on bone metabolism. The objectives of this study were to evaluate effects of weight loss on bone metabolism after Roux-en Y gastric bypass in patients with morbid obesity. METHODS: Our study included 70 patients with morbid obesity; RYGB was done for all patients. Daily postoperative oral supplementation with 1,000 mg of calcium and 800 IU of vitamin D was done for each patient. Body weight (BW), body mass index (BMI), total body fat, total lean tissue mass, bone mineral content (BMC), bone mineral density (BMD), total bone area (TBA; using dual energy X-ray absorptiometry), serum calcium, parathyroid hormone (PTH), 25-OH vitamin D, 24-h urinary calcium, and bone-specific alkaline phosphatase (BSAP) were assessed preoperatively and 1 year after surgery. RESULTS: In our study, females comprised 70% of cases. The mean age was 35+/-8.8 years. One year after RYGB, BW decreased significantly from 132.8+/-26.5 to 90.3+/-17.3 kg (p=0.001). BMI decreased significantly from 48+/-7.3 to 32.6+/-4.1 kg/m(2) (p=0.001). BMC decreased significantly from 2,968.6+/-71.4 to 2,700.8+/-45.4 g (p=0.001). BMD decreased significantly from 1.026+/-0.03 to 1.22+/-0.015 g/cm(2) (p=0.001). TBA decreased significantly from 2,356.2+/-35.4 to 2,216.3+/-43.5 cm(2) (p=0.001). Serum calcium, 24-h urinary calcium, and BSAP were not significantly decreased while 25-OH vitamin D and PTH were not significantly increased after surgery. CONCLUSIONS: From this study, it is shown that RYGBP operation gives very good results as regards reduction of body weight in morbidly obese patients. Postoperative supplementation with calcium and vitamin D partially corrects osteoporosis. Thus, these patients need periodic follow-up for BMD, PTH, calcium, serum vitamin D, and markers of bone resorption and formation specially postmenopausal female.

Thyroid surgery: use of the LigaSure Vessel Sealing System versus conventional knot tying.

BACKGROUND: The aim of this work is to compare the use of conventional knot tying vs. LigaSuretrade mark Vessel Sealing System (Valley Lab, Boulder, CO) in patients undergoing thyroid surgery. We hypothesized that use of the LigaSure would reduce operating time while resulting in a similar rate of complications. METHODS: This study was conducted in Endocrine Surgery Unit, Mansoura University Hospital on patients who underwent thyroid surgery from January 1, 2006 to December 31, 2006. One hundred and ten patients were operated upon by the same team of surgeons using conventional knot tying in 55 and the LigaSure in 55 patients for hemostasis. The medical records of the patients enrolled were reviewed and compared regarding age, sex, histopathological diagnosis, type of operation performed (lobectomy vs. subtotal thyroidectomy vs. total thyroidectomy), operating time, estimated intraoperative blood loss, postoperative complications, length of incision, hospital stay and cost, postoperative pain and outcome evaluation. RESULTS: The two groups had similar demographics, thyroid pathology, types of operations and complication rates. The LigaSure group had lower operating times, lower intraoperative blood loss, less postoperative pain and early pain-free return to normal activity and return to work. CONCLUSION: The LigaSure Vessel Sealing System was as safe as conventional knot tying for thyroidectomy, with the benefit of reduced operating time, postoperative pain severity and early pain-free return to normal activity and return to work.