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Objective:To explore the effects of multi-disciplinary team (MDT) participation for residency training in bariatric and metabolic surgery.Methods:A questionnaire was designed considering patient benefits, doctor benefits, and interviewees' background and recognition of MDT. The questionnaire was used to survey 48 residents who rotated to the department of gastrointestinal surgery and participated in the management of patients undergoing bariatric and metabolic surgery in Peking University Third Hospital from February to October 2023. According to the frequency of MDT participation, the residents were divided into two groups (<5 times and ≥5 times). They were evaluated by five superior surgeons, and the scores of the two groups were compared using the independent samples t test. Results:All the 48 residents completed the questionnaire survey. Only 16 residents (33.33%) had been exposed to the knowledge of bariatric and metabolic surgery, and most of the respondents believed that participating in MDT could improve their professional competence ( n=42, 87.50%) and special English proficiency ( n=30, 62.50%). The group of MDT participation ≥5 times had significantly higher scores of knowledge of internal medicine [(7.42±1.09) vs. (5.16±1.28)], knowledge of anesthesia and critical care medicine [(7.11±0.85) vs. (4.93±0.99)], perioperative management [(7.08±0.67) vs. (4.97±1.21)], laparoscopic skills [(6.43±0.83) vs. (4.99±0.65)], and professional knowledge of general surgery [(6.46±0.86) vs. (5.87±0.51)] compared with the group of MDT participation <5 times (all P<0.05). Conclusions:MDT participation in bariatric and metabolic surgery can help residents quickly understand and master relevant knowledge, which is of great significance for increasing the personnel reserve of bariatric and metabolic surgery.
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Bariatric surgery is the most effective treatment for patients with severe obesity, which can significantly improve the metabolic disorders, especially type 2 diabetes mellitus. Bariatric and metabolic surgery is the latest and fastest-growing branch of surgery, with the types of procedure and other novel treatment modalities are still evolving and in progress. The authors summarize the recent advancement related to novel bariatric and metabolic surgery in the treat-ment of morbid obesity and type 2 diabetes mellitus in recent years through literature search, which can be divided into the following three parts: (1) novel surgical procedures and new guideline of indication. Sleeve gastrectomy and Roux-en-Y gastric bypass are the most performed bariatric surgery. Duodenal switch or the variant of one anastomosis duodenal ileostomy are also accredited procedures but been less performed. One anastomosis gastric bypass is the most recently accredited bariatric surgical procedures with better safety profile and weight loss efficacy than most of the procedures. For other novel procedures, bipartition procedure may be the next accredited proce-dure. A new worldwide guideline is recently launched and the indication for bariatric surgery is lowered BMI 27.5 kg/m 2 for Asian. (2) The effect and mechanism of bariatric surgery. Bariatric surgery can significantly reduce the incidence of cardiovascular disease and mortality in obese patients. The main beneficiary group is patients with diabetes mellitus. Along with the recent basic research and the success of new gut hormone related drugs, the mechanism of bariatric surgery can be mostly attributed to gut hormonal effect, however, gastric volume still play an important role. (3) Novel obesity treatment modalities. Endoscopic obesity treatment has a major progress in the success of endoscopic gastroplasty by endoscopic suturing designs. More noteworthy is the development of new intestinal hormone drug therapy, which can achieve a weight loss of 14% in one year by injec-ting once a week glucagon-like peptide-1 preparation, and then combining two or three intestinal hormone drugs can achieve a weight loss of 24% in one year, which is close to the effectiveness of bariatric surgery. Pharmacologic treatment of obesity is very promising and expected. With the increasing severity of obesity and diabetes mellitus in the world, in addition to the explosive develo-pment of bariatric and metabolic surgery in recent years, many new surgical methods and new treatments, especially new and effective intestinal hormone related therapeutic drugs, have been developed. The success of bariatric and metabolic surgery depends on a multidisciplinary team with rich clinical experience: precise preoperative planning and comprehensive postoperative manage-ment, as well as patient understanding and cooperation, in order to achieve the best results.
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At present, obesity and overweight patients are increasing year by year in the world. Bariatric surgery is the most effective method for treating obesity at present. Due to its high risk, large trauma, irreversible operation, high cost and patient preference, the overall acceptance degree is not high at present. With the development of endoscopic technology and materials and equipment, various surgical methods emerge one after another. They are less invasive, reversible and similar to traditional bariatric surgery in weight loss effect. They are more and more widely used in obesity and metabolism. Depending on the site of the endoscopic intervention: The authors review the advances in endoscopic bariatric surgery for obesity, including the different principles of surgery and the effects of bariatric surgery on different sites.
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The effect of bariatric and metabolic surgery on obesity with type 2 diabetes mellitus has been widely recognized, so the guidelines for the treatment and management of diabetes mellitus are constantly revised. In order to balance the effect and safety of surgery, innovative surgical methods continue to emerge. But for the effect on diabetes mellitus, high-level clinical researches are still needed to provide more evidence. For postoperative remission and the mechanism of bariatric and metabolic surgery to alleviate diabetes, and the application of bariatric and metabolic surgery in the treatment of type 1 diabetes mellitus, new researches have emerged constantly. Based on the clinical practices and domestic and foreign literatures, the authors discuss the application of bariatric and metabolic surgery in the treatment of diabetes mellitus.
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Objective:To investigate the application value of 3D printed model in hemostasis training for laparoscopic sleeve gastrectomy.Methods:The retrospective and descriptive study was conducted. Data were collected from six surgeons who participated in hemostasis training for laparoscopic sleeve gastrectomy using 3D printed model at Zhejiang Provincial People′s Hospital in July 2023. All participants were male, aged (33.5±9.9)years. A 3D printed model simulating bleeding during laparoscopic sleeve gastrectomy was created using hydrogel. Videos were recorded to document the surgeons′ hemostasis techniques and outcomes during laparoscopic sleeve gastrectomy. Two external expert reviewers blindly assessed the training videos using the objective structured assess-ment of technical skills (OSATS) scoring system to evaluate mesentery mobilization, vessel exposure, vessel clipping and bleeding after vessel clipping. Observation indicators: (1) face validity and content validity of the 3D printed model; (2) validity verification of the 3D printed model. Measurement data with normal distribution were represented as Mean± SD. Comparison between groups was conducted using the t test. Results:(1) Face validity and content validity of the 3D printed model. The surgeons′ scores for overall impression, fidelity, texture, appearance, workspace and tactile similarity of the 3D printed model were 4.5±0.6, 4.0±0.6, 3.7±0.5, 4.2±0.8, 3.8±0.8 and 4.2±0.4, respectively. The surgeons′ scores for similarity to real scenarios, operation convenience, learning curve shortening and operation skills improving, patient risk reduction, trainee′s interest enhancing, confidence increasing and recommendation for promotion were 4.0±0.6, 4.2±0.8, 4.3±0.8, 4.3±0.5, 4.3±0.5, 4.0±0.6 and 4.8±0.4, respectively. (2) Validity verification of the 3D printed model. The OSATS scores and operation time to treat bleeding during laparoscopic sleeve gastrectomy for expert surgeons were 18.7±0.6 and (125±12)seconds, respectively, versus 13.7±1.5 and (212±51)seconds for junior doctors, showing significant differences between the two groups ( t=5.30, -2.89, P<0.05). Conclusion:The 3D printed model effectively simulates bleeding scenarios during laparoscopic sleeve gastrectomy and distinguishes between different technical levels of expertise.
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Analysis of the layout and proportion of classic and innovative surgical procedures of bariatric and metabolic surgery throughout the world, the sleeve gastrectomy is beco-ming the most accepted and respected surgical procedure with its increasingly prominent advan-tages, and its operation number has even exceeded the "gold standard" surgery of the roux-en-Y gastric bypass. This trend is even more pronounced in China. With a small number of physicians lacking experience in gastrointestinal surgery and more and more young physicians joining in the field of bariatric and metabolic surgery, operation related complications and the consequences of insufficient perioperative management experience have occurred successively in clinical practice, such as gastrointestinal leakage, bleeding, lumen and anastomotic stenosis, internal hernia and obstruction, venous thromboembolism, etc. Bariatric and metabolic surgery is a branch of gastro-intestinal surgery, and physicians in the field should have the ability to prevent, predict and manage short- and long-term complications after surgery. The authors believe that through the comprehen-sive evaluation of laboratory indexes, patient signs and related examinations, physicians should have the basic qualities of decisively choosing the surgical timing, choosing the right decision-making, and taking effective measures.
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Bariatric surgery is effective on obesity, which can significantly improve the metabolic diseases of obesity patients, especially the type 2 diabetes. However, the surgical proce-dures of bariatric and metabolic surgery are still evolving and in progress. One anastomosis gastric bypass (OAGB) is the latest bariatric surgery recognized by the international bariatric and metabolic surgery community. The authors review the relevant literatures at home and abroad, and introduce the development history, surgical skills, clinical efficacy, status quo and adaptability of OAGB.
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At present, the aging trend of China′s population is intensifying and the number of overweight and obese elderly people is on the rise. The elderly obese is facing the treatment of related metabolic diseases, including cardiovascular disease, hypertension, type 2 diabetes, etc. In addition to life intervention and drug control, bariatric surgery is also one of the effective methods. Bariatric surgery can permanently reduce body mass, improve or alleviate the condition of patients, and prolong life. The authors analyze the indications and contraindications, perioperative manage-ment, surgical methods, surgical safety and effectiveness, and current problems of bariatric surgery for elderly obese patients.
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Objective:To investigate the application value of right minimal invasive three-port technique of laparoscopic sleeve gastrectomy (RMIT-LSG) for the treatment of obesity.Methods:The retrospective and descriptive study was conducted. The clinical data of 66 obesity patients who underwent RMIT-LSG in the Sir Run Run Shaw Hospital of Zhejiang University School of Medicine from January to October 2021 were collected. There were 15 males and 51 females, aged 28.5(range, 16.0?54.0)years. The body mass index (BMI) of the 66 patients was (36.9±4.3)kg/m 2. There were 20 of the 66 patients combined with type 2 diabetes. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted using outpatient examination or the WeChat to detect postoperative recovery of patients including body mass changing, BMI and complications 6 months after operation. The follow-up was up to December 2021. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical situations. All the 66 patients underwent RMIT-LSG successfully, without conversion to laparotomy or changing surgical method. The operation time and the volume of intraoperative blood loss of the 66 patients were (132±22)minutes and (14±8)mL, respectively. (2) Postoperative situations. The time to postoperative initial out-of-bed activities, time to postoperative first flatus, time to postoperative initial water intake, time to postoperative initial liquid food intake and duration of postoperative hospital stay of the 66 patients were (15±6)hours, (1.80±0.60)days, (1.00±0.20)days, (2.00±0.20)days and (3.40±0.60)days, respectively. Of the 66 patients, one case underwent post-operative abdominal hemorrhage at postoperative day 1 and received a second surgery for hemostasis. The patient with postoperative abdominal hemorrhage and other 65 patients recovered well without gastroparesis, gastric fistula, abdominal infection and other complication. (3) Follow-up. All the 66 patients were followed up for 6(range, 1?11)months. All the 66 patients completed the postoperative scar photography at postoperative 1 month, and results of scar photography showed concealed scar with good cosmetic effects. Twenty-seven of the 66 patients were followed up for 6 months after operation, with the weight loss, percentage of weight loss and decrease of BMI were (42±7)kg, 34.8%±2.9%, (14.2±1.9)kg/m 2, respectively. None of the 66 patient had innutrition during the follow-up. Conclusion:The RMIT-LSG is safe and feasible for the treatment of obesity, with a good cosmetic effect of the wound.
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Objective:To investigate the application value of 'N' shaped Trocar placement in Da Vinci robotic bariatric and metabolic surgery.Methods:The retrospective and descriptive study was conducted. The clinical data of 69 patients who underwent Da Vinci robotic bariatric and metabolic surgery in the China-Japan Union Hospital of Jilin University from March to October 2020 were collected. There were 18 males and 51 females, aged from 12 to 67 years, with a median age of 34 years. The surgery was performed with the 'N' shaped Trocar placement by the same team of surgeons. The Da Vinci robotic sleeve gastrectomy, Da Vinci robotic single-anastomosis duodenal-ileal bypass with sleeve gastrectomy or Da Vinci robotic biliopancreatic diversion with duodenal switch was selected according to the patient's condition. Observation indicators: (1) surgical and post-operative conditions; (2) follow-up. Follow-up using the outpatient examination, telephone interview and WeChat to detect the body weight, body mass index, fasting blood glucose, glycosylated hemoglobin, total cholesterol, Trocar-related complications of patients at postoperative 3 months. The follow-up was up to November 2020. Measurement data with normal distribution were represented as Mean± SD, and comparison of general data before and after surgery was analyzed using the paired t test. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers. Results:(1) Surgical and postoperative conditions: of the 69 patients, 34 cases received Da Vinci robotic sleeve gastrectomy, 34 cases received Da Vinci robotic single-anastomosis duodenal-ileal bypass with sleeve gastrectomy, and 1 case received Da Vinci robotic biliopancreatic diversion with duodenal switch. There was no conversion to open surgery or laparoscopic surgery. The operation time of 69 patients was (161±52)minutes, and the volume of intraoperative blood loss was 30 mL(range, 10-100 mL). Two of 69 patients had post-operative complications. One of them with postoperative abdominal hemorrhage was cured after symptomatic treatment and discharged on the 10th day after surgery. The other one patient with postoperative peritoneal effusion was cured and discharged from hospital after puncture drainage and symptomatic treatment. No Trocar-related complication such as Trocar foramen bleeding and Trocar foramen hernia occurred in the 69 patients. The duration of postoperative hospital stay of 69 patients was (6±3)days. (2) Follow-up: 47 of 69 patients were followed up for 3 months. The body mass, body mass index, fasting blood glucose, glycosylated hemoglobin, and total cholesterol were (86±19)kg, (30±5)kg/m 2, (5.2±0.7)mmol/L, 5.3%±0.6%, (4.3±1.3)mmol/L at postoperative 3 months, which had significant differences compared with the preoperative indicators ( t=6.101, 8.261, 2.973, 2.567, 2.098, P<0.05). All the 47 patients had no Trocar-related complications during the follow-up. Conclusion:The 'N' shaped Trocar placement method is safe and feasible in the Da Vinci robotic bariatric and metabolic surgery, with good efficacy.
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Objective:To investigate the clinical efficacy of laparoscopic sleeve gastrec-tomy (LSG) in the treatment of obesity associated nonalcoholic fatty liver disease (NAFLD).Methods:The retrospective and descriptive study was conducted. The clinical data of 40 patients with obesity associated NAFLD who were admitted to Xijing Hospital of Digestive Diseases of Air Force Medical University from January 2018 to June 2019 were collected. There were 19 males and 21 females, aged (27±8)years. Patients underwent LSG after preoperative examinations and evaluations. Observation indicators: (1) surgical and postoperative conditions; (2) follow-up. Follow-up was conducted by telephone interview, WeChat, and outpatient review to detect the liver function, glucose and lipid metabolism-related status as well as the relief of comorbidities of patients at 6 and 12 months after LSG. The follow-up was up to June 2020. Measurement data with normal distribu-tion were represented as Mean± SD. Repeated measurement data were analyzed by the repeated measures ANOVA. Count data were represented as absolute numbers, and chi-square test was used for comparison between groups. Results:(1) Surgical and postoperative conditions: 40 patients underwent LSG successfully, without intraoperative conversion to laparotomy or death. The operation time, volume of intraoperative blood loss, and duration of postoperative hospital stay were (83±12)minutes, (19±7)mL and (3.7±0.7)days. Among the 40 patients, 1 case had fat liquefac-tion after LSG and 2 had abdominal distension within a month, who were improved after symp-tomatic and supportive treatment. (2) Follow-up: 40 patients were followed up at postoperative 6 and 12 months. The body mass of 40 patients was (112±17)kg, (85±16)kg, (73±11)kg before operation, at postoperative 6 and 12 months, respectively. The body mass index was (39.7±4.2)kg/m 2, (30.0±4.5)kg/m 2, (25.9±2.9)kg/m 2 before operation, at postoperative 6 and 12 months, respectively. The alanine aminotransferase was (56.40±39.51)U/L, (30.15±17.93)U/L, (26.45±9.44)U/L before operation, at postoperative 6 and 12 months, respectively. The aspartate amino-transferase was (34.03±19.62)U/L, (28.20±10.27)U/L, (24.90±8.44)U/L before operation, at post-operative 6 and 12 months, respectively. The gamma-glutamyltransferase was (48.68±28.45)U/L, (43.30±18.56)U/L, (32.80±12.09)U/L before operation, at postoperative 6 and 12 months, respectively. The fasting blood-glucose was (6.51±2.38)mmol/L, (5.64±1.51)mmol/L, (4.98±0.91)mmol/L before operation, at postoperative 6 and 12 months, respectively. The triglyceride was (1.81±0.95)mmol/L, (1.48±0.57)mmol/L, (1.17±0.44)mmol/L before operation, at postoperative 6 and 12 months, respectively. The total cholesterol was (4.77±0.98)mmol/L, (4.58±0.75)mmol/L, (4.10±0.68)mmol/L before operation, at postoperative 6 and 12 months, respectively. The low density lipoprotein cholesterin was (2.99±0.81)mmol/L, (2.79±0.54)mmol/L, (2.48±0.40)mmol/L before operation, at postopera-tive 6 and 12 months, respectively. The high density lipoprotein cholesterin increased was (1.08±0.20)mmol/L, (1.15±0.18)mmol/L, (1.45±0.21)mmol/L before operation, at postoperative 6 and 12 months, respectively. Compared with preoperative indicators, there were significant differences in postoperative body mass, body mass index, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase, fasting blood-glucose, triglyceride, total cholesterol and low density lipoprotein cholesterin ( F=472.439, 533.730, 26.791, 11.029, 25.545, 27.994, 27.534, 36.220, 18.596, P<0.05), showing a downward trend. There was a significant difference between preoperative and postoperative high density lipoprotein cholesterin ( F=68.974, P<0.05), showing a upward trend. The excess weight loss of 40 patients at 6 months and 12 months after LSG were 61%±18% and 85%±15%. The preoperative ultrasonography of 40 patients showed no, mild, moderate and severe fatty liver in 0, 2, 15 and 23 cases, respectively. The above indicators were 8, 9, 12, 11 cases at post-operative 6 months, and 23, 11, 6, 0 cases at postoperative 12 months, respectively. There was a significant difference of the grade of NAFLD between patients before and after surgery ( χ2=68.210, P<0.05). Conclusion:LSG has an accurate short-term clinical efficacy for obesity associated NAFLD, which can reduce body mass, improve liver function, alleviat the disorders of glucose and lipid metabolism and the severity of medium-severe fatty liver.
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RESUMEN Objetivo: diseñar y evaluar la comprensión de una Herramienta Gráfica (HG) con recomendaciones de alimentación para personas con obesidad sometidas a Cirugía Bariátrica y Metabólica (CByM), con base en las guías propuestas por la American Society for Metabolic and Bariatric Surgery (ASMBS), American Association of Clinical Endocrinologists (AACE) y The Obesity Society (TOS), así como las recomendaciones del Colegio Mexicano de Cirugía para Obesidad y Enfermedades Metabólicas (CMCOEM) para el uso educativo de la persona profesional en nutriología-paciente. Metodología: se elaboró una HG nombrada "HG de alimentación pos-CByM" considerando las guías nutricionales propuestas por la ASMBS, AACE y TOS en conjunto con las recomendaciones de la CMCOEM. Además de realizar cuatro gráficos representando las fases que componen dicha HG, se incorporó una fase donde se aplicó un cuestionario de autollenado a tres grupos diferentes: 27 estudiantes de medicina, 8 pacientes posquirúrgicos y 16 pacientes prequirúrgicos. Se buscó identificar si el mensaje percibido era claro y conciso. Resultados: >70 % de la población intervenida entiende el mensaje de la HG diseñada, no existe significancia estadística entre los grupos entrevistados (p<0.05). Sin diferencia significativa (p<0.05) entre pacientes pre y posquirúrgicos, en ninguna de las respuestas. Conclusión: la educación en nutrición bariátrica es esencial para que las personas comprendan la transición de las fases posteriores a la intervención, los grupos, consistencia, tolerancia y porción de los alimentos. Esta HG puede ser de utilidad en la consulta nutricional exclusivamente para pacientes que se someterán a este tipo de cirugía o ya están en el proceso de recuperación.
ABSTRACT: Objectives: The purpose of this study is to Design and evaluate a graphic tool (GT) with feeding recommendations for people with obesity after bariatric surgery, based on the guidelines proposed by the American Society for Metabolic and Bariatric Surgery (ASMBS), American Association of Clinical Endocrinologists (AACE) y The Obesity Society (TOS) as well as the recommendations of the Mexican College of Surgery for Obesity and Metabolic Diseases (CMCOEM) for the educational use of the nutritionist-Bariatric patient. Methods: A GT named "Graphic tool for post bariatric surgery feeding" was elaborated based on the nutritional guidelines proposed by the ASMBS, AACE and TOS in conjunction with the recommendations of the CMCOEM. In addition to making four graphs representing each of the phases that conform the GT, a self-administered questionnaire was incorporate, it was carried out in three different groups: 27 medical students, 16 pre surgical patients and 8 postsurgical patients. We sought to identify if the perceived message was clear and brief. Results: More than 70% of the intervened population understood the message of the HG designed, there was no statistical significance among the groups interviewed (p <0.05) without significant difference (p <0.05) between pre and postsurgical patients, in none of the answers. Conclusion: Bariatric nutrition education is essential for the patient to understand the transition of the postsurgical phases, the food groups, the consistency, tolerance and portion of the food. This GT can be useful in the nutritional consultation exclusively for patients who will undergo this type of surgery or are already in the process of recovery.
Subject(s)
Humans , Guideline , Bariatric Surgery , Diet, Healthy , Obesity, Morbid , Activation, Metabolic , MexicoABSTRACT
Nowadays,the incidence of obesity and related metabolic diseases is increasing around the world,which seriously endangers the human health and the quality of life.Obesity has become the most prominent public health issue in the time.With the rapid development of surgical treatment of obesity combined with type 2 diabetes mellitus,bariatric surgery has gradually evolved into a new important branch of upper gastrointestinal surgery or gastrointestinal surgery,that is bariatric and metabolic surgery.To date,bariatric surgery has entered in China since twenty years ago.Following the steps of the rapid development of bariatric and metabolic surgery in the world,bariatric surgery has embarked on a solid and steady journey of development through seizing the opportunity,finding the right direction.On the way forward in the past twenty years,Chinese bariatric and metabolic surgery has not only faced setbacks and confusion,but also gained experience and lessons;it has encountered bottlenecks in its development and provided evidences from China.The number of surgeons in bariatric surgery is still limited compared with a large number of obese people.Therefore,there will be opportunities and challenges coexisting in the future.How to continuously improve the therapeutic effect of surgery,train more professional practitioners,break through the bottleneck,and seek faster development will be an important research topic in metabolic and bariatric surgery with the scientific evidence-based medicine accumulating.
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The new technique of single anastomosis duodenal-ileal bypass with sleeve gastrectomy appeared during recent years,which is a modification of biliopancreatic diversion with duodenal switch.The basic principles of this technique are restricted food intake by a sleeve gastrectomy and decreased absorption by the duodenal-ileal anastomosis.The new technique is relatively simple,with less malnutrition,better weight loss and metabolic disorders remission.The principle,surgical technique,results and possible complications are described,and the technique is also compared with existing weight loss operations in this article.
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Bariatric surgery is an effective method for the treatment of obesity and type 2 diabetes mellitus.Morbidly obese patients usually have metabolic syndromes,as such,surgeons need to choose the reasonable surgical methods for patients according to their individuality and particularity.Hiatal hernia is a very common disease prevalent in obese patients and could induce gastroesophageal reflux,which increases the difficulty of bariatric surgery and proposes higher demands on choice of surgical methods to surgeons.It is important to recognize the presence of the hiatal hernia preoperatively and choose a more effective procedure of bariatric surgery to decrease the incidence of postoperative complications.
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As the incidence of obesity increases globally,treatment strategies of obesity emerge continuously.However,the weight loss effect varies between individuals without explicit explanations.In the recent years,many researchers have revealed regulation mechanisms of central nervous system on eating behavior,proposing that obese individuals exhibit brain functional abnormalities implicated in homeostatic regulation of food intake,central reward and motivation,emotion,memory,and attention system.Therefore,these scholars appeal that treating obesity cannot remain "brainless".The most effective treatment currently available for obesity is bariatric surgery which lead to excess weight loss of 42％-67％ in accompany with changes in brain activity.Functional magnetic resonance imaging showed a decreased activation in the central reward network and increased inhibitory control in the cognitive control system after bariatric surgeries.In this article,the authors introduce the central nervous system regulation of eating and investigate the effects of bariatric surgery on central nervous system.
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Bariatric surgery is an effective treatment for obesity and the related metabolic diseases.At present,although the jejunoileal bypass is widely used in various types of bariatric surgery,the effect of reconstructed anatomy after the jejunoileal bypass on normal physiological function of obese patients has not been clarified.This leaves some controversy about the recommended limb lengths in jejunoileal bypass.At the same time,there is no consensus on the optimal biliary limb length and alimentary limb length in the standard gastric bypass.Lack of accurate measurement of common limb length and total small bowel length inevitably results in unsatisfactory percentage of excess body weight loss caused by short limb length,or malabsorption and malnutrition caused by long limb length.The authors discussed the effects of different length of biliary limb,alimentary limb and common limb on weight loss,and introduced the preliminary application and prospects of the jejunoileal bypass including measurement of total small bowel length in bariatric surgery.
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Objective To investigate the clinical application value of svmmetrical three-hole laparoscopie sleeve gastrectomy (LSG).Methods The retrospective and descriptive study was conducted.The clinical data of 232 patients with obesity who were admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from April 2017 to December 2018 were collected.There were 40 males and 192 females,aged (32±8)years,with a range of 17-63 years.All the 232 patients underwent symmetrical three-hole LSG.Observation indicators:(1) surgical and postoperative conditions;(2) complications;(3) follow-up.Follow-up was conducted by telephone interview and WeChat to collect the patient satisfaction with cosmetic effects of wounds at 3 months after surgery up to March 2019.Measurement data with normal distribution were expressed as Mean±SD.Count data were expressed as absolute numbers or percentages.Results (1) Surgical and postoperative conditions:of the 232 patients,230 underwent symmetrical three-hole LSG successfully,without conversion to open surgery.Two patients had one puncture hole added due to spleen bleeding to help pull the omentum to stop bleeding,and no spleen hemorrhage recurred after improving the surgical procedure.Of the 232 patients,the operation time,volume of intraoperative blood loss,and duration of postoperative hospital stay were (115±7) minutes,(10±5) mL,and (3.0±0.8) days.(2) Complications:of the 232 patients,10 had postoperative complications of fat liquefaction in the umbilical incision,and were cured after repeated dressing changes.All patients had no serious complications such as gastrointestinal bleeding,abdominal bleeding,or gastric fistula.(3) Follow-up:of the 232 patients,230 undergoing successful symmetrical three-hole LSG were followed up for 3 months.Of the 230 patients,3 were dissatisfied with the cosmetic effects of wounds,12 were satisfied,and 215 were very satisfied.The satisfaction rate was 98.70％(227/230).Conclusion Symmetrical three-hole LSG is safe and feasible,with a good cosmetic effects of wounds.
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Objective To explore the application value of laparoscopic gastric plication (LGP) combined with duodeno-jejunal omega switch (DJOS) in modified adjustable gastric banding.Methods The retrospective and descriptive study was conducted.The clinical data of a female 46-year-old patient who had failure to undergo the adjustable gastric banding in the Hospital of Ludwig Maximilian University from December 2016 to December 2018 were collected.LGP and DJOS were performed in two-stages after completion of preoperative examinations.Observation indicators:(1) surgical and postoperative situations;(2) follow-up.Follow-up using outpatient examiantion and telephone interview was performed to collect the information of body mass index (BMI),insulin therapy,and long-term complications until December 2018.Count data were represented as absolute numbers.Results (1) Surgical and postoperative situations:the patient underwent LGP in the first stage and DJOS in the second stage successfully.For the LGP,the operation time,time of intestinal reconstruction,volume of intraoperative blood loss,time to first flatus,time to drainage tube removal,time to resume to normal diet,and duration of postoperative hospital stay were 96 minutes,58 minutes,210 mL,32 hours,48 hours,42 days,and 3 days,respectively.For the DJOS,the above indicators were 148 minutes,117 minutes,260 mL,47 hours,72 hours,21 days,and 7 days,respectively.There was no complication occurred in either LGP or DJOS.(2) Follow-up:the patient was followed up for 24 months after LGP.The BMI of this patient decreased to 45.3 kg/m2 at 6 months after LGP,and decreased to 37.2 kg/m2 at 18 months after DJOS.Insulin therapy was discontinued.There was no long-term complication such as malnutrition,dumping syndrome,or biliary reflux.Conclusion LGP combined with DJOS can enrich treatment methods of obese patient with BMI ＞50 kg/m2,which offers a safer surgical procedure option for patients after gastric binding.
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Cholecystohthiasis is one of the long-term complications after bariatric surgery,of which the exact cause is still unclear.Based on the recent domestic and international literature,the contributing factors for new onset cholecystolithiasis after bariatric surgery and countermeasures are reviewed in this article.