Laparoscopic bariatric surgery: a five-year review.

OBJECTIVE: To review our results of laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, and laparoscopic gastric bypass for the treatment of morbid obesity. DESIGN: Prospective cohort study. SETTING: Bariatric Surgery Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong. PATIENTS: All patients consisted of those referred to our Combined Obesity Clinic (to provide multidisciplinary weight management for severely obese patients) during the period July 2002 to December 2007. For patients who received bariatric surgeries as treatment of morbid obesity, peri-operative data, postoperative weight change, and co-morbidity improvements were collected and prospectively reviewed. RESULTS: During the study period, 531 patients attended our Clinic for treatment of obesity. Their mean (standard deviation) body weight was 96 (22) kg, mean body mass index was 36 (6) kg/m(2), mean age was 40 (10) years, and 64% were female. Of these patients, 94 (18%) underwent bariatric surgery, which included: laparoscopic adjustable gastric banding (n=57), laparoscopic sleeve gastrectomy (n=30), and laparoscopic gastric bypass (n=7). Adverse events occurred in 11 (12%) of these 94 patients, but there was no operative mortality. At 2 years, the mean percentage weight loss for patients having laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, and laparoscopic gastric bypass were 34%, 51% and 61%, respectively. After operative treatment, obesity-related co-morbidities including metabolic syndrome, type 2 diabetes, hypertension, and sleep apnoea had also improved significantly. CONCLUSION: Through a multidisciplinary weight management programme and various bariatric procedures, favourable results can be achieved in Chinese patients with severe obesity.

Measurement of lumbar spine loads and motions during rotational mobilization.

OBJECTIVES: To measure the loads acting at the lumbar spine and the resulting motions during rotational mobilization. METHODS: Twenty healthy subjects were subjected to right rotational mobilization of different grades. The magnitude and frequency of mobilization loads were decided by an experienced manipulative therapist to be appropriate for each mobilization grade. Subjects were positioned on a specially constructed plinth capable of measuring forces and moments about 3 axes. The 3-dimensional movements of the lumbar spine were captured by an electromagnetic tracking device. RESULTS: In the starting positions, the lumbar spines were found to be flexed, axially rotated to the right, and laterally bent to the left. As the mobilization grade increased, the spine was axially rotated further into the range. Rotational mobilization was found to induce oscillatory moments and movements of the spine in all 3 anatomical planes. The twisting moment and movement were generally accompanied by lateral bending moment and movement in the opposite direction. The mean amplitudes of the moment and movement oscillations were small and found to be largest for grade III mobilization. CONCLUSION: The mechanical effects of rotational mobilization are not restricted to axial rotation of the spine as the name may have suggested. Rotational mobilization may be able to restore lost movements of the lumbar spine in any of the 3 planes. The method developed in this study showed good reliability and may be considered to assess treatment outcome and changes in spinal stiffness after therapy.

Bending stiffness of the lumbar spine subjected to posteroanterior manipulative force.

This study measured the bending stiffness of the spine when it is subjected to posteroanterior mobilization force. The lumbar spine was modeled as an initially curved beam column supported over the rib cage and the pelvis. Posteroanterior mobilization was assumed to be three-point bending of the beam. The mobilization force was measured by the mounting of a force plate onto the manipulation couch, where electromagnetic sensors measured the change in spinal curvature. The bending stiffness of the spine was derived from the force and curvature data. The technique developed in this study provided highly repeatable data. The theoretical analysis suggests that the pelvic rotation produced by mobilization may be used clinically to indicate the magnitude of the mobilization force. Future research may employ the present method to determine how back pain may affect the bending stiffness of the spine. The bending stiffness values reported in this study will be valuable to future modeling work.