1,721,075 research outputs found
Feasibility of laparoscopic sleeve gastrectomy as a revision procedure of prior laparoscopic gastric banding
No full textBackground: Laparoscopic sleeve gastrectomy (LSG), initially described by Gagner’s group as the first stage of the laparoscopic duodenal switch in super-obese patients, is now gaining wide diffusion among bariatric surgeons as a new restrictive operation.
Methods: From January 2005 to January 2006, 8 obese patients with BMI 37-74 kg/m2 underwent LSG for conversion from a prior complicated or failed laparoscopic adjustable gastric banding (LAGB). Three patients had severe symptomatic esophageal dilation, while 5 patients had unsuccessful weight loss with poor “band compliance”. After de-banding, LSG was calibrated upon a 34-Fr gastric bougie, and blue and green linear staplers were used. The staple- line was buttressed by placing a sero-serosal running suture in all but one patient, and methylene blue dye was used to test for leaks. All the patients underwent upper GI series with water-soluble contrast medium 2 days after the surgery.
Results: The average operating-time for LSG was 90 minutes (range 60-120 min). The average hospital stay was 4 days (range 3-7). There were no perioperative complications, no conversion, and no mortality. No intraoperative or postoperative blood transfusions were required.
Conclusions: LSG proved to be feasible and safe after LAGB. Longer follow-up and larger series are needed to assess weight loss results
LA REGISTRAZIONE DELLE PROCEDURE OPERATIVE DI CANTIERE COME GUIDA PER UNA CURA CONSAPEVOLE DEL PATRIMONIO ARCHITETTONICO ED EDILIZIO: UNA PROPOSTA DI METODO (II PARTE)
No full textProgettare l'involucro edilizio: risultati delle prime esperienze condotte presso il Politecnico di Torino
No full textAnesthesiology in Obesity: Pre-op Assessment, OR Strategy, and Tips and Tricks for a Successful “Go Through”The Globesity Challenge to General Surgery
No full textThe incidence and prevalence of obesity continues to increase globally. Bariatric surgery is an attractive treatment option for obesity. So, anesthesiologists are going to care for an increasing number of obese patients for the foreseeable future. Anesthesiologists should take into consideration the specific problems associated with obesity (i.e. metabolic syndrome, obstructive sleep apnea, pulmonary and cardiovascular disease, deep venous thrombosis) that may complicate anesthesiological management and concur to optimize them before surgery. All patients seeking bariatric surgery should have a comprehensive preoperative evaluation with emphasis on upper airways, and pertinent laboratory and diagnostic testing. The major topics about the perioperative anesthesiological management of obese patient undergoing bariatric surgery are thus discussed highlighting a proper strategy for the better outcom
Creation of pneumoperitoneum using a bladed optical trocar in morbidly obese patients: Technique and results
No full textBackground: It is advised by the manufacturer that the bladed optical trocar is to be applied only after CO2 insufflation. However, after a long experience with bladed optical trocars after CO2 insufflation in bariatric patients, we found that it is possible to enter the abdomen with this trocar prior to insufflation. This investigation was performed to test the hypothesis that this bladed technique under direct visualization before abdominal insufflation is a safe and effective method for initial trocar placement for laparoscopic bariatric procedures. Methods: Data on a series of 200 consecutive laparoscopic bariatric procedures with bladed optical access trocar were reviewed. The entry time for the optical trocar was measured in 70 patients. All the operative reports were reviewed for the following data: (1) successful initial trocar placement, (2) vascular injury during initial trocar placement, and (3) hollow viscus injury accessing the peritoneal cavity with bladed trocar. The trocar placement time was defined as the time to place the trocar into the peritoneal cavity after skin incision and was recorded in the last 70 cases. Results: There was no evidence of any vascular injury during initial trocar placement. There was no evidence of hollow viscus or organ injury during initial trocar placement. The insertion of the initial trocar was successful in all the patients. The average trocar insertion time was 20 s (range 10-50), and BMI did not affect the time of insertion. Conclusions: We think that our technique of entering the abdominal cavity via a bladed optical trocar without prior abdominal insufflation can be performed safely in morbidly obese patients. More studies and larger series are needed to validate this method. © 2008 Springer Science + Business Media, LLC
Conoscere il costruito per programmare la manutenzione e governare la gestione. Studio dei dati informativi di interventi edilizi presso le sedi del Politecnico di Torino
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Perioperative care of the obese patient
Full text linkBackground: Obesity has become an increasing problem worldwide during the past few decades. Hence, surgeons and anaesthetists will care for an increasing number of obese patients in the foreseeable future, and should be prepared to provide optimal management for these individuals. This review provides an update of recent evidence regarding perioperative strategies for obese patients. Methods: A search for papers on the perioperative care of obese patients (English language only) was performed in July 2019 using the PubMed, Scopus, Web of Science and Cochrane Library electronic databases. The review focused on the results of RCTs, although observational studies, meta-analyses, reviews, guidelines and other reports discussing the perioperative care of obese patients were also considered. When data from obese patients were not available, relevant data from non-obese populations were used. Results and conclusion: Obese patients require comprehensive preoperative evaluation. Experienced medical teams, appropriate equipment and monitoring, careful anaesthetic management, and an adequate perioperative ventilation strategy may improve postoperative outcomes. Additional perioperative precautions are necessary in patients with severe morbid obesity, metabolic syndrome, untreated or severe obstructive sleep apnoea syndrome, or obesity hypoventilation syndrome; patients receiving home ventilatory support or postoperative opioid therapy; and obese patients undergoing open operations, long procedures or revisional surgery
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